| National Provider Identifier [NPI]: | 1316917321 |
| Last Name Of The Provider | SULLIVAN |
| First Name Of The Provider | JOHN |
| Middle Initial Of The Provider | E |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1611 NW 12TH AVE |
| Street Address 2 Of The Provider | JACKSON MEMORIAL HOSPITAL |
| City Of The Provider | MIAMI |
| Zip Code Of The Provider | 33136 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Emergency Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 85 |
| Number Of Services | 1952 |
| Number Of Medicare Beneficiaries | 1162 |
| Total Submitted Charge Amount | 705297 |
| Total Medicare Allowed Amount | 198497.7 |
| Total Medicare Payment Amount | 149138.67 |
| Total Medicare Standardized Payment Amount | 141397.24 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 12 |
| Number Of Drug Services | 89 |
| Number Of Medicare Beneficiaries With Drug Services | 60 |
| Total Drug Submitted ChargeAmount | 5350 |
| Total Drug Medicare AllowedAmount | 915.14 |
| Total Drug Medicare PaymentAmount | 803.69 |
| Total Drug Medicare Standardized Payment Amount | 803.69 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 73 |
| Number Of Medical Services | 1863 |
| Number Of Medicare Beneficiaries With Medical Services | 1162 |
| Total Medical Submitted Charge Amount | 699947 |
| Total Medical Medicare Allowed Amount | 197582.56 |
| Total Medical Medicare Payment Amount | 148334.98 |
| Total Medical Medicare Standardized Payment Amount | 140593.55 |
| Average Age Of Beneficiaries | 79 |
| Number Of Beneficiaries Age Less65 | 49 |
| Number Of Beneficiaries Age 65 to 74 | 302 |
| Number Of Beneficiaries Age 75 to 84 | 400 |
| Number Of Beneficiaries Age Greater 84 | 411 |
| Number Of Female Beneficiaries | 697 |
| Number Of Male Beneficiaries | 465 |
| Number Of Non Hispanic White Beneficiaries | 1109 |
| Number Of Black or African American Beneficiaries | 14 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 20 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 1079 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 83 |
| Percent Of With Atrial Fibrillation | 25 |
| Percent Of With Alzheimers Disease or Dementia | 22 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 17 |
| Percent Of With Heart Failure | 31 |
| Percent Of With Chronic Kidney Disease | 32 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 20 |
| Percent Of With Depression | 30 |
| Percent Of With Diabetes | 33 |
| Percent Of With Hyperlipidemia | 75 |
| Percent Of With Hypertension | 74 |
| Percent Of With Ischemic Heart Disease | 61 |
| Percent Of With Osteoporosis | 19 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 53 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 11 |
| Average HCC Risk Score Of Beneficiaries | 1.7479 |