| National Provider Identifier [NPI]: | 1235167545 |
| Last Name Of The Provider | FULLER |
| First Name Of The Provider | ANGELA |
| Middle Initial Of The Provider | B |
| Credentials Of The Provider | RN, PA-C |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2710 SAINT FRANCIS DR |
| Street Address 2 Of The Provider | SUITE 210 |
| City Of The Provider | WATERLOO |
| Zip Code Of The Provider | 507025619 |
| State Code Of The Provider | IA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 10 |
| Number Of Services | 323 |
| Number Of Medicare Beneficiaries | 170 |
| Total Submitted Charge Amount | 34437.54 |
| Total Medicare Allowed Amount | 14748.42 |
| Total Medicare Payment Amount | 9817.37 |
| Total Medicare Standardized Payment Amount | 12798.07 |
| 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 | 10 |
| Number Of Medical Services | 323 |
| Number Of Medicare Beneficiaries With Medical Services | 170 |
| Total Medical Submitted Charge Amount | 34437.54 |
| Total Medical Medicare Allowed Amount | 14748.42 |
| Total Medical Medicare Payment Amount | 9817.37 |
| Total Medical Medicare Standardized Payment Amount | 12798.07 |
| Average Age Of Beneficiaries | 66 |
| Number Of Beneficiaries Age Less65 | 55 |
| Number Of Beneficiaries Age 65 to 74 | 63 |
| Number Of Beneficiaries Age 75 to 84 | 29 |
| Number Of Beneficiaries Age Greater 84 | 23 |
| Number Of Female Beneficiaries | 130 |
| Number Of Male Beneficiaries | 40 |
| Number Of Non Hispanic White Beneficiaries | 144 |
| Number Of Black or African American Beneficiaries | |
| 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 | 109 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 61 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 12 |
| Percent Of With Chronic Kidney Disease | 9 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 12 |
| Percent Of With Depression | 29 |
| Percent Of With Diabetes | 24 |
| Percent Of With Hyperlipidemia | 34 |
| Percent Of With Hypertension | 43 |
| Percent Of With Ischemic Heart Disease | 25 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 38 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.9176 |