| National Provider Identifier [NPI]: | 1619918042 |
| Last Name Of The Provider | BRULTE |
| First Name Of The Provider | SUZANNE |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 14011 BEACH BLVD |
| Street Address 2 Of The Provider | UNIT 120 |
| City Of The Provider | JACKSONVILLE |
| Zip Code Of The Provider | 322501694 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nephrology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 79 |
| Number Of Services | 1437 |
| Number Of Medicare Beneficiaries | 407 |
| Total Submitted Charge Amount | 215526.18 |
| Total Medicare Allowed Amount | 129061.8 |
| Total Medicare Payment Amount | 101472.18 |
| Total Medicare Standardized Payment Amount | 100802.99 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 7 |
| Number Of Drug Services | 36 |
| Number Of Medicare Beneficiaries With Drug Services | 22 |
| Total Drug Submitted ChargeAmount | 984 |
| Total Drug Medicare AllowedAmount | 485.63 |
| Total Drug Medicare PaymentAmount | 471 |
| Total Drug Medicare Standardized Payment Amount | 471 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 72 |
| Number Of Medical Services | 1401 |
| Number Of Medicare Beneficiaries With Medical Services | 407 |
| Total Medical Submitted Charge Amount | 214542.18 |
| Total Medical Medicare Allowed Amount | 128576.17 |
| Total Medical Medicare Payment Amount | 101001.18 |
| Total Medical Medicare Standardized Payment Amount | 100331.99 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 67 |
| Number Of Beneficiaries Age 65 to 74 | 121 |
| Number Of Beneficiaries Age 75 to 84 | 113 |
| Number Of Beneficiaries Age Greater 84 | 106 |
| Number Of Female Beneficiaries | 256 |
| Number Of Male Beneficiaries | 151 |
| Number Of Non Hispanic White Beneficiaries | 350 |
| Number Of Black or African American Beneficiaries | 36 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 333 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 74 |
| Percent Of With Atrial Fibrillation | 24 |
| Percent Of With Alzheimers Disease or Dementia | 26 |
| Percent Of With Asthma | 12 |
| Percent Of With Cancer | 17 |
| Percent Of With Heart Failure | 41 |
| Percent Of With Chronic Kidney Disease | 50 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 37 |
| Percent Of With Depression | 35 |
| Percent Of With Diabetes | 47 |
| Percent Of With Hyperlipidemia | 72 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 56 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 52 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 12 |
| Percent Of With Stroke | 18 |
| Average HCC Risk Score Of Beneficiaries | 2.0555 |