| National Provider Identifier [NPI]: | 1710087119 |
| Last Name Of The Provider | SULLIVAN |
| First Name Of The Provider | MICHAEL |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 400 FAIRVIEW |
| Street Address 2 Of The Provider | SUITE 19 |
| City Of The Provider | PONCA CITY |
| Zip Code Of The Provider | 74602 |
| State Code Of The Provider | OK |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 30 |
| Number Of Services | 3236 |
| Number Of Medicare Beneficiaries | 579 |
| Total Submitted Charge Amount | 153003.91 |
| Total Medicare Allowed Amount | 148853.37 |
| Total Medicare Payment Amount | 105945.63 |
| Total Medicare Standardized Payment Amount | 118186.83 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 133 |
| Number Of Medicare Beneficiaries With Drug Services | 128 |
| Total Drug Submitted ChargeAmount | 4439.16 |
| Total Drug Medicare AllowedAmount | 2018.14 |
| Total Drug Medicare PaymentAmount | 1969.73 |
| Total Drug Medicare Standardized Payment Amount | 1969.73 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 27 |
| Number Of Medical Services | 3103 |
| Number Of Medicare Beneficiaries With Medical Services | 579 |
| Total Medical Submitted Charge Amount | 148564.75 |
| Total Medical Medicare Allowed Amount | 146835.23 |
| Total Medical Medicare Payment Amount | 103975.9 |
| Total Medical Medicare Standardized Payment Amount | 116217.1 |
| Average Age Of Beneficiaries | 78 |
| Number Of Beneficiaries Age Less65 | 23 |
| Number Of Beneficiaries Age 65 to 74 | 181 |
| Number Of Beneficiaries Age 75 to 84 | 219 |
| Number Of Beneficiaries Age Greater 84 | 156 |
| Number Of Female Beneficiaries | 304 |
| Number Of Male Beneficiaries | 275 |
| Number Of Non Hispanic White Beneficiaries | 543 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 17 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 527 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 52 |
| Percent Of With Atrial Fibrillation | 16 |
| Percent Of With Alzheimers Disease or Dementia | 14 |
| Percent Of With Asthma | 4 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 18 |
| Percent Of With Chronic Kidney Disease | 14 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 10 |
| Percent Of With Depression | 16 |
| Percent Of With Diabetes | 26 |
| Percent Of With Hyperlipidemia | 32 |
| Percent Of With Hypertension | 67 |
| Percent Of With Ischemic Heart Disease | 32 |
| Percent Of With Osteoporosis | 2 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 34 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 0.9967 |