| National Provider Identifier [NPI]: | 1164422408 |
| Last Name Of The Provider | FULLER |
| First Name Of The Provider | ALEN |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1725 E 19TH ST |
| Street Address 2 Of The Provider | SUITE 100 |
| City Of The Provider | TULSA |
| Zip Code Of The Provider | 741045437 |
| State Code Of The Provider | OK |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Otolaryngology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 11 |
| Number Of Services | 1984 |
| Number Of Medicare Beneficiaries | 347 |
| Total Submitted Charge Amount | 52633.05 |
| Total Medicare Allowed Amount | 51150.21 |
| Total Medicare Payment Amount | 32641.83 |
| Total Medicare Standardized Payment Amount | 37178.02 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 731 |
| Number Of Medicare Beneficiaries With Drug Services | 97 |
| Total Drug Submitted ChargeAmount | 372.98 |
| Total Drug Medicare AllowedAmount | 272.7 |
| Total Drug Medicare PaymentAmount | 190.49 |
| Total Drug Medicare Standardized Payment Amount | 190.49 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 9 |
| Number Of Medical Services | 1253 |
| Number Of Medicare Beneficiaries With Medical Services | 347 |
| Total Medical Submitted Charge Amount | 52260.07 |
| Total Medical Medicare Allowed Amount | 50877.51 |
| Total Medical Medicare Payment Amount | 32451.34 |
| Total Medical Medicare Standardized Payment Amount | 36987.53 |
| Average Age Of Beneficiaries | 77 |
| Number Of Beneficiaries Age Less65 | 11 |
| Number Of Beneficiaries Age 65 to 74 | 131 |
| Number Of Beneficiaries Age 75 to 84 | 126 |
| Number Of Beneficiaries Age Greater 84 | 79 |
| Number Of Female Beneficiaries | 194 |
| Number Of Male Beneficiaries | 153 |
| Number Of Non Hispanic White Beneficiaries | 328 |
| 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 | |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | |
| Percent Of With Atrial Fibrillation | 9 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 9 |
| Percent Of With Chronic Kidney Disease | 12 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 7 |
| Percent Of With Depression | 14 |
| Percent Of With Diabetes | 16 |
| Percent Of With Hyperlipidemia | 42 |
| Percent Of With Hypertension | 55 |
| Percent Of With Ischemic Heart Disease | 25 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 42 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.851 |