| National Provider Identifier [NPI]: | 1255537304 |
| Last Name Of The Provider | FULLINGIM |
| First Name Of The Provider | JEREMY |
| Middle Initial Of The Provider | S |
| Credentials Of The Provider | D.O. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 4500 S GARNETT RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | TULSA |
| Zip Code Of The Provider | 741465229 |
| 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 | 218 |
| Number Of Services | 7160 |
| Number Of Medicare Beneficiaries | 4625 |
| Total Submitted Charge Amount | 734330.13 |
| Total Medicare Allowed Amount | 180462.18 |
| Total Medicare Payment Amount | 136560.15 |
| Total Medicare Standardized Payment Amount | 144748.25 |
| 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 | 218 |
| Number Of Medical Services | 7160 |
| Number Of Medicare Beneficiaries With Medical Services | 4625 |
| Total Medical Submitted Charge Amount | 734330.13 |
| Total Medical Medicare Allowed Amount | 180462.18 |
| Total Medical Medicare Payment Amount | 136560.15 |
| Total Medical Medicare Standardized Payment Amount | 144748.25 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 1152 |
| Number Of Beneficiaries Age 65 to 74 | 1788 |
| Number Of Beneficiaries Age 75 to 84 | 1177 |
| Number Of Beneficiaries Age Greater 84 | 508 |
| Number Of Female Beneficiaries | 2988 |
| Number Of Male Beneficiaries | 1637 |
| Number Of Non Hispanic White Beneficiaries | 3176 |
| Number Of Black or African American Beneficiaries | 198 |
| Number Of AsianPacific Islander Beneficiaries | 15 |
| Number Of Hispanic Beneficiaries | 66 |
| Number Of American Indian Alaska Native Beneficiaries | 1151 |
| Number Of Beneficiaries With Race Not Else where Classified | 19 |
| Number Of Beneficiaries With Medicare Only Entitlement | 3026 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1599 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 17 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 34 |
| Percent Of With Chronic Kidney Disease | 34 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 32 |
| Percent Of With Depression | 36 |
| Percent Of With Diabetes | 41 |
| Percent Of With Hyperlipidemia | 55 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 48 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 49 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.5833 |