| National Provider Identifier [NPI]: | 1932177482 |
| Last Name Of The Provider | FULLER |
| First Name Of The Provider | ROBERT |
| Middle Initial Of The Provider | P |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 800 OAK RIDGE TPKE |
| Street Address 2 Of The Provider | SUITE A300 |
| City Of The Provider | OAK RIDGE |
| Zip Code Of The Provider | 378306957 |
| State Code Of The Provider | TN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Dermatology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 106 |
| Number Of Services | 16795 |
| Number Of Medicare Beneficiaries | 2036 |
| Total Submitted Charge Amount | 1279575 |
| Total Medicare Allowed Amount | 788745.99 |
| Total Medicare Payment Amount | 566615.5 |
| Total Medicare Standardized Payment Amount | 616242.63 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 142 |
| Number Of Medicare Beneficiaries With Drug Services | 57 |
| Total Drug Submitted ChargeAmount | 3970 |
| Total Drug Medicare AllowedAmount | 2813.48 |
| Total Drug Medicare PaymentAmount | 1980.87 |
| Total Drug Medicare Standardized Payment Amount | 1980.87 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 104 |
| Number Of Medical Services | 16653 |
| Number Of Medicare Beneficiaries With Medical Services | 2036 |
| Total Medical Submitted Charge Amount | 1275605 |
| Total Medical Medicare Allowed Amount | 785932.51 |
| Total Medical Medicare Payment Amount | 564634.63 |
| Total Medical Medicare Standardized Payment Amount | 614261.76 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | 92 |
| Number Of Beneficiaries Age 65 to 74 | 815 |
| Number Of Beneficiaries Age 75 to 84 | 788 |
| Number Of Beneficiaries Age Greater 84 | 341 |
| Number Of Female Beneficiaries | 874 |
| Number Of Male Beneficiaries | 1162 |
| Number Of Non Hispanic White Beneficiaries | 1998 |
| Number Of Black or African American Beneficiaries | |
| 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 | 24 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1914 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 122 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 13 |
| Percent Of With Chronic Kidney Disease | 16 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 12 |
| Percent Of With Depression | 13 |
| Percent Of With Diabetes | 25 |
| Percent Of With Hyperlipidemia | 52 |
| Percent Of With Hypertension | 63 |
| Percent Of With Ischemic Heart Disease | 31 |
| Percent Of With Osteoporosis | 5 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 34 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 0.9788 |