| National Provider Identifier [NPI]: | 1730125527 |
| Last Name Of The Provider | FULLER |
| First Name Of The Provider | KEITH |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | D.O. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2214 GATEWAY DR |
| Street Address 2 Of The Provider | SUITE C |
| City Of The Provider | OPELIKA |
| Zip Code Of The Provider | 368011500 |
| State Code Of The Provider | AL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 76 |
| Number Of Services | 8484 |
| Number Of Medicare Beneficiaries | 889 |
| Total Submitted Charge Amount | 367804.35 |
| Total Medicare Allowed Amount | 315180.18 |
| Total Medicare Payment Amount | 233331.66 |
| Total Medicare Standardized Payment Amount | 248795.3 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 12 |
| Number Of Drug Services | 631 |
| Number Of Medicare Beneficiaries With Drug Services | 194 |
| Total Drug Submitted ChargeAmount | 6270.15 |
| Total Drug Medicare AllowedAmount | 2113.98 |
| Total Drug Medicare PaymentAmount | 1871.42 |
| Total Drug Medicare Standardized Payment Amount | 1871.42 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 64 |
| Number Of Medical Services | 7853 |
| Number Of Medicare Beneficiaries With Medical Services | 888 |
| Total Medical Submitted Charge Amount | 361534.2 |
| Total Medical Medicare Allowed Amount | 313066.2 |
| Total Medical Medicare Payment Amount | 231460.24 |
| Total Medical Medicare Standardized Payment Amount | 246923.88 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 151 |
| Number Of Beneficiaries Age 65 to 74 | 321 |
| Number Of Beneficiaries Age 75 to 84 | 251 |
| Number Of Beneficiaries Age Greater 84 | 166 |
| Number Of Female Beneficiaries | 562 |
| Number Of Male Beneficiaries | 327 |
| Number Of Non Hispanic White Beneficiaries | 661 |
| Number Of Black or African American Beneficiaries | 217 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 599 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 290 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 26 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 26 |
| Percent Of With Chronic Kidney Disease | 26 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 16 |
| Percent Of With Depression | 19 |
| Percent Of With Diabetes | 46 |
| Percent Of With Hyperlipidemia | 51 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 46 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 44 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.4556 |