| National Provider Identifier [NPI]: | 1457788697 |
| Last Name Of The Provider | FULLER |
| First Name Of The Provider | THOMAS |
| Middle Initial Of The Provider | S |
| Credentials Of The Provider | AA-C |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 650 WOOD VALLEY TRCE |
| Street Address 2 Of The Provider | |
| City Of The Provider | ROSWELL |
| Zip Code Of The Provider | 300762672 |
| State Code Of The Provider | GA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Anesthesiologist Assistants |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 31 |
| Number Of Services | 79 |
| Number Of Medicare Beneficiaries | 75 |
| Total Submitted Charge Amount | 65340.36 |
| Total Medicare Allowed Amount | 10995.02 |
| Total Medicare Payment Amount | 8584.73 |
| Total Medicare Standardized Payment Amount | 8602.26 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 0 |
| Number Of Drug Services | 0 |
| Number Of Medicare Beneficiaries With Drug Services | 0 |
| Total Drug Submitted ChargeAmount | 0 |
| Total Drug Medicare AllowedAmount | 0 |
| Total Drug Medicare PaymentAmount | 0 |
| Total Drug Medicare Standardized Payment Amount | 0 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 31 |
| Number Of Medical Services | 79 |
| Number Of Medicare Beneficiaries With Medical Services | 75 |
| Total Medical Submitted Charge Amount | 65340.36 |
| Total Medical Medicare Allowed Amount | 10995.02 |
| Total Medical Medicare Payment Amount | 8584.73 |
| Total Medical Medicare Standardized Payment Amount | 8602.26 |
| Average Age Of Beneficiaries | 64 |
| Number Of Beneficiaries Age Less65 | 31 |
| Number Of Beneficiaries Age 65 to 74 | 26 |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 40 |
| Number Of Male Beneficiaries | 35 |
| Number Of Non Hispanic White Beneficiaries | |
| Number Of Black or African American Beneficiaries | 52 |
| 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 | 34 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 41 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | 24 |
| Percent Of With Asthma | 24 |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 33 |
| Percent Of With Chronic Kidney Disease | 49 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 23 |
| Percent Of With Depression | 35 |
| Percent Of With Diabetes | 47 |
| Percent Of With Hyperlipidemia | 53 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 36 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 35 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 20 |
| Average HCC Risk Score Of Beneficiaries | 2.8158 |