| National Provider Identifier [NPI]: | 1265459010 |
| Last Name Of The Provider | GULLE |
| First Name Of The Provider | SHANNON |
| Middle Initial Of The Provider | S |
| Credentials Of The Provider | PA |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 210 E DERENNE AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | SAVANNAH |
| Zip Code Of The Provider | 314056736 |
| State Code Of The Provider | GA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 45 |
| Number Of Services | 3541 |
| Number Of Medicare Beneficiaries | 574 |
| Total Submitted Charge Amount | 598066.4 |
| Total Medicare Allowed Amount | 107366.99 |
| Total Medicare Payment Amount | 81665.41 |
| Total Medicare Standardized Payment Amount | 90397.21 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 2390 |
| Number Of Medicare Beneficiaries With Drug Services | 167 |
| Total Drug Submitted ChargeAmount | 20833 |
| Total Drug Medicare AllowedAmount | 8052.02 |
| Total Drug Medicare PaymentAmount | 6182.61 |
| Total Drug Medicare Standardized Payment Amount | 6182.61 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 40 |
| Number Of Medical Services | 1151 |
| Number Of Medicare Beneficiaries With Medical Services | 574 |
| Total Medical Submitted Charge Amount | 577233.4 |
| Total Medical Medicare Allowed Amount | 99314.97 |
| Total Medical Medicare Payment Amount | 75482.8 |
| Total Medical Medicare Standardized Payment Amount | 84214.6 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 22 |
| Number Of Beneficiaries Age 65 to 74 | 313 |
| Number Of Beneficiaries Age 75 to 84 | 196 |
| Number Of Beneficiaries Age Greater 84 | 43 |
| Number Of Female Beneficiaries | 354 |
| Number Of Male Beneficiaries | 220 |
| Number Of Non Hispanic White Beneficiaries | 520 |
| Number Of Black or African American Beneficiaries | 39 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 547 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 27 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 5 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 11 |
| Percent Of With Chronic Kidney Disease | 15 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 10 |
| Percent Of With Depression | 16 |
| Percent Of With Diabetes | 21 |
| Percent Of With Hyperlipidemia | 72 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 25 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 75 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 0.9416 |