| National Provider Identifier [NPI]: | 1063599009 |
| Last Name Of The Provider | SULLIVAN |
| First Name Of The Provider | THERESA |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | RN, CNS |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1515 HOLCOMBE BLVD |
| Street Address 2 Of The Provider | |
| City Of The Provider | HOUSTON |
| Zip Code Of The Provider | 770304009 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Certified Clinical Nurse Specialist |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 5 |
| Number Of Services | 745 |
| Number Of Medicare Beneficiaries | 405 |
| Total Submitted Charge Amount | 368177 |
| Total Medicare Allowed Amount | 30932.45 |
| Total Medicare Payment Amount | 23635.5 |
| Total Medicare Standardized Payment Amount | 27548.86 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 0 |
| Number Of Drug Services | 0 |
| Number Of Medicare Beneficiaries With Drug Services | 0 |
| Total Drug Submitted ChargeAmount | 0 |
| Total Drug Medicare AllowedAmount | 0 |
| Total Drug Medicare PaymentAmount | 0 |
| Total Drug Medicare Standardized Payment Amount | 0 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 5 |
| Number Of Medical Services | 745 |
| Number Of Medicare Beneficiaries With Medical Services | 405 |
| Total Medical Submitted Charge Amount | 368177 |
| Total Medical Medicare Allowed Amount | 30932.45 |
| Total Medical Medicare Payment Amount | 23635.5 |
| Total Medical Medicare Standardized Payment Amount | 27548.86 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 51 |
| Number Of Beneficiaries Age 65 to 74 | 214 |
| Number Of Beneficiaries Age 75 to 84 | 124 |
| Number Of Beneficiaries Age Greater 84 | 16 |
| Number Of Female Beneficiaries | 153 |
| Number Of Male Beneficiaries | 252 |
| Number Of Non Hispanic White Beneficiaries | 327 |
| Number Of Black or African American Beneficiaries | 30 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 31 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 367 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 38 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 6 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 18 |
| Percent Of With Heart Failure | 24 |
| Percent Of With Chronic Kidney Disease | 41 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 13 |
| Percent Of With Depression | 25 |
| Percent Of With Diabetes | 28 |
| Percent Of With Hyperlipidemia | 55 |
| Percent Of With Hypertension | 71 |
| Percent Of With Ischemic Heart Disease | 42 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 40 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 2.9577 |