| National Provider Identifier [NPI]: | 1013963826 |
| Last Name Of The Provider | FULLER |
| First Name Of The Provider | R |
| Middle Initial Of The Provider | W |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2602 BUFORD RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | RICHMOND |
| Zip Code Of The Provider | 232353422 |
| State Code Of The Provider | VA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 207 |
| Number Of Services | 10735 |
| Number Of Medicare Beneficiaries | 6105 |
| Total Submitted Charge Amount | 844721.16 |
| Total Medicare Allowed Amount | 260378.06 |
| Total Medicare Payment Amount | 202864.88 |
| Total Medicare Standardized Payment Amount | 208383.67 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 1 |
| Number Of Drug Services | 1450 |
| Number Of Medicare Beneficiaries With Drug Services | 14 |
| Total Drug Submitted ChargeAmount | 1827 |
| Total Drug Medicare AllowedAmount | 248.46 |
| Total Drug Medicare PaymentAmount | 194.76 |
| Total Drug Medicare Standardized Payment Amount | 194.76 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 206 |
| Number Of Medical Services | 9285 |
| Number Of Medicare Beneficiaries With Medical Services | 6105 |
| Total Medical Submitted Charge Amount | 842894.16 |
| Total Medical Medicare Allowed Amount | 260129.6 |
| Total Medical Medicare Payment Amount | 202670.12 |
| Total Medical Medicare Standardized Payment Amount | 208188.91 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 1092 |
| Number Of Beneficiaries Age 65 to 74 | 2229 |
| Number Of Beneficiaries Age 75 to 84 | 1784 |
| Number Of Beneficiaries Age Greater 84 | 1000 |
| Number Of Female Beneficiaries | 3903 |
| Number Of Male Beneficiaries | 2202 |
| Number Of Non Hispanic White Beneficiaries | 4366 |
| Number Of Black or African American Beneficiaries | 1575 |
| Number Of AsianPacific Islander Beneficiaries | 54 |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 53 |
| Number Of Beneficiaries With Medicare Only Entitlement | 4608 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1497 |
| Percent Of With Atrial Fibrillation | 20 |
| Percent Of With Alzheimers Disease or Dementia | 19 |
| Percent Of With Asthma | 13 |
| Percent Of With Cancer | 18 |
| Percent Of With Heart Failure | 35 |
| Percent Of With Chronic Kidney Disease | 42 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 30 |
| Percent Of With Depression | 32 |
| Percent Of With Diabetes | 43 |
| Percent Of With Hyperlipidemia | 65 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 47 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 44 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 9 |
| Percent Of With Stroke | 12 |
| Average HCC Risk Score Of Beneficiaries | 1.8422 |