| National Provider Identifier [NPI]: | 1184623639 |
| Last Name Of The Provider | FULLER |
| First Name Of The Provider | DWAIN |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | M.D. . |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 9600 N. CENTRAL EXPRESSWAY |
| Street Address 2 Of The Provider | SUITE 100 |
| City Of The Provider | DALLAS |
| Zip Code Of The Provider | 752315078 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Ophthalmology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 32 |
| Number Of Services | 15036 |
| Number Of Medicare Beneficiaries | 1578 |
| Total Submitted Charge Amount | 5320546.27 |
| Total Medicare Allowed Amount | 2128785.42 |
| Total Medicare Payment Amount | 1619003.04 |
| Total Medicare Standardized Payment Amount | 1631540.96 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 5975 |
| Number Of Medicare Beneficiaries With Drug Services | 513 |
| Total Drug Submitted ChargeAmount | 2742102.27 |
| Total Drug Medicare AllowedAmount | 1285526.69 |
| Total Drug Medicare PaymentAmount | 1003336.24 |
| Total Drug Medicare Standardized Payment Amount | 1003336.24 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 26 |
| Number Of Medical Services | 9061 |
| Number Of Medicare Beneficiaries With Medical Services | 1578 |
| Total Medical Submitted Charge Amount | 2578444 |
| Total Medical Medicare Allowed Amount | 843258.73 |
| Total Medical Medicare Payment Amount | 615666.8 |
| Total Medical Medicare Standardized Payment Amount | 628204.72 |
| Average Age Of Beneficiaries | 77 |
| Number Of Beneficiaries Age Less65 | 75 |
| Number Of Beneficiaries Age 65 to 74 | 535 |
| Number Of Beneficiaries Age 75 to 84 | 569 |
| Number Of Beneficiaries Age Greater 84 | 399 |
| Number Of Female Beneficiaries | 924 |
| Number Of Male Beneficiaries | 654 |
| Number Of Non Hispanic White Beneficiaries | 1413 |
| Number Of Black or African American Beneficiaries | 57 |
| Number Of AsianPacific Islander Beneficiaries | 20 |
| Number Of Hispanic Beneficiaries | 68 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 1454 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 124 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 13 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 20 |
| Percent Of With Chronic Kidney Disease | 22 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 14 |
| Percent Of With Depression | 18 |
| Percent Of With Diabetes | 35 |
| Percent Of With Hyperlipidemia | 57 |
| Percent Of With Hypertension | 70 |
| Percent Of With Ischemic Heart Disease | 37 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 40 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.3921 |