| National Provider Identifier [NPI]: | 1922177237 |
| Last Name Of The Provider | FULLER |
| First Name Of The Provider | ELIZABETH |
| Middle Initial Of The Provider | W |
| Credentials Of The Provider | |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 850 5TH AVE E |
| Street Address 2 Of The Provider | |
| City Of The Provider | TUSCALOOSA |
| Zip Code Of The Provider | 354017419 |
| State Code Of The Provider | AL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 54 |
| Number Of Services | 443 |
| Number Of Medicare Beneficiaries | 173 |
| Total Submitted Charge Amount | 21418 |
| Total Medicare Allowed Amount | 14902.61 |
| Total Medicare Payment Amount | 9282.07 |
| Total Medicare Standardized Payment Amount | 12259.84 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 8 |
| Number Of Drug Services | 89 |
| Number Of Medicare Beneficiaries With Drug Services | 25 |
| Total Drug Submitted ChargeAmount | 587 |
| Total Drug Medicare AllowedAmount | 143.91 |
| Total Drug Medicare PaymentAmount | 130 |
| Total Drug Medicare Standardized Payment Amount | 130 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 46 |
| Number Of Medical Services | 354 |
| Number Of Medicare Beneficiaries With Medical Services | 173 |
| Total Medical Submitted Charge Amount | 20831 |
| Total Medical Medicare Allowed Amount | 14758.7 |
| Total Medical Medicare Payment Amount | 9152.07 |
| Total Medical Medicare Standardized Payment Amount | 12129.84 |
| Average Age Of Beneficiaries | 65 |
| Number Of Beneficiaries Age Less65 | 68 |
| Number Of Beneficiaries Age 65 to 74 | 59 |
| Number Of Beneficiaries Age 75 to 84 | 28 |
| Number Of Beneficiaries Age Greater 84 | 18 |
| Number Of Female Beneficiaries | 104 |
| Number Of Male Beneficiaries | 69 |
| Number Of Non Hispanic White Beneficiaries | 105 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 109 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 64 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 10 |
| Percent Of With Chronic Kidney Disease | 12 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 15 |
| Percent Of With Depression | 22 |
| Percent Of With Diabetes | 34 |
| Percent Of With Hyperlipidemia | 39 |
| Percent Of With Hypertension | 73 |
| Percent Of With Ischemic Heart Disease | 17 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 38 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.1446 |