| National Provider Identifier [NPI]: | 1770574253 |
| Last Name Of The Provider | FULLINGIM |
| First Name Of The Provider | DEAN |
| Middle Initial Of The Provider | R |
| Credentials Of The Provider | DO |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 744 W 9TH ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | TULSA |
| Zip Code Of The Provider | 741279020 |
| State Code Of The Provider | OK |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 250 |
| Number Of Services | 5741 |
| Number Of Medicare Beneficiaries | 3912 |
| Total Submitted Charge Amount | 578378.46 |
| Total Medicare Allowed Amount | 163135.04 |
| Total Medicare Payment Amount | 122345.8 |
| Total Medicare Standardized Payment Amount | 132603.68 |
| 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 | 250 |
| Number Of Medical Services | 5741 |
| Number Of Medicare Beneficiaries With Medical Services | 3912 |
| Total Medical Submitted Charge Amount | 578378.46 |
| Total Medical Medicare Allowed Amount | 163135.04 |
| Total Medical Medicare Payment Amount | 122345.8 |
| Total Medical Medicare Standardized Payment Amount | 132603.68 |
| Average Age Of Beneficiaries | 69 |
| Number Of Beneficiaries Age Less65 | 1051 |
| Number Of Beneficiaries Age 65 to 74 | 1494 |
| Number Of Beneficiaries Age 75 to 84 | 963 |
| Number Of Beneficiaries Age Greater 84 | 404 |
| Number Of Female Beneficiaries | 2546 |
| Number Of Male Beneficiaries | 1366 |
| Number Of Non Hispanic White Beneficiaries | 2727 |
| Number Of Black or African American Beneficiaries | 254 |
| Number Of AsianPacific Islander Beneficiaries | 15 |
| Number Of Hispanic Beneficiaries | 51 |
| Number Of American Indian Alaska Native Beneficiaries | 845 |
| Number Of Beneficiaries With Race Not Else where Classified | 20 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2493 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1419 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 15 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 31 |
| Percent Of With Chronic Kidney Disease | 32 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 31 |
| Percent Of With Depression | 36 |
| Percent Of With Diabetes | 40 |
| Percent Of With Hyperlipidemia | 55 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 46 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 49 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.5764 |