| National Provider Identifier [NPI]: | 1083783609 |
| Last Name Of The Provider | FULTON |
| First Name Of The Provider | JENNIFER |
| Middle Initial Of The Provider | C |
| Credentials Of The Provider | |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 800 PRUDENTIAL DR |
| Street Address 2 Of The Provider | |
| City Of The Provider | JACKSONVILLE |
| Zip Code Of The Provider | 322078202 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Pulmonary Disease |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 45 |
| Number Of Services | 3590 |
| Number Of Medicare Beneficiaries | 1127 |
| Total Submitted Charge Amount | 913367 |
| Total Medicare Allowed Amount | 383102.47 |
| Total Medicare Payment Amount | 290354.07 |
| Total Medicare Standardized Payment Amount | 291138.68 |
| Drug Suppress Indicator | * |
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| Number Of Medicare Beneficiaries With Drug Services | |
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| Medical SuppressIndicator | # |
| Number Of HCPCS Associated With MedicalServices | |
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| Number Of Medicare Beneficiaries With Medical Services | |
| Total Medical Submitted Charge Amount | |
| Total Medical Medicare Allowed Amount | |
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| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 180 |
| Number Of Beneficiaries Age 65 to 74 | 466 |
| Number Of Beneficiaries Age 75 to 84 | 343 |
| Number Of Beneficiaries Age Greater 84 | 138 |
| Number Of Female Beneficiaries | 663 |
| Number Of Male Beneficiaries | 464 |
| Number Of Non Hispanic White Beneficiaries | 906 |
| Number Of Black or African American Beneficiaries | 174 |
| Number Of AsianPacific Islander Beneficiaries | 12 |
| Number Of Hispanic Beneficiaries | 20 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 15 |
| Number Of Beneficiaries With Medicare Only Entitlement | 887 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 240 |
| Percent Of With Atrial Fibrillation | 27 |
| Percent Of With Alzheimers Disease or Dementia | 20 |
| Percent Of With Asthma | 24 |
| Percent Of With Cancer | 20 |
| Percent Of With Heart Failure | 50 |
| Percent Of With Chronic Kidney Disease | 51 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 53 |
| Percent Of With Depression | 36 |
| Percent Of With Diabetes | 49 |
| Percent Of With Hyperlipidemia | 74 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 64 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 48 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | 15 |
| Average HCC Risk Score Of Beneficiaries | 2.2664 |