| National Provider Identifier [NPI]: | 1548214380 |
| Last Name Of The Provider | FULLER |
| First Name Of The Provider | CLINTON |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 9601 LILE DR |
| Street Address 2 Of The Provider | SUITE 1100 |
| City Of The Provider | LITTLE ROCK |
| Zip Code Of The Provider | 722056321 |
| State Code Of The Provider | AR |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Interventional Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 211 |
| Number Of Services | 2688 |
| Number Of Medicare Beneficiaries | 1515 |
| Total Submitted Charge Amount | 853288.5 |
| Total Medicare Allowed Amount | 208878.91 |
| Total Medicare Payment Amount | 160479.78 |
| Total Medicare Standardized Payment Amount | 174343.42 |
| 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 | 211 |
| Number Of Medical Services | 2688 |
| Number Of Medicare Beneficiaries With Medical Services | 1515 |
| Total Medical Submitted Charge Amount | 853288.5 |
| Total Medical Medicare Allowed Amount | 208878.91 |
| Total Medical Medicare Payment Amount | 160479.78 |
| Total Medical Medicare Standardized Payment Amount | 174343.42 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 318 |
| Number Of Beneficiaries Age 65 to 74 | 561 |
| Number Of Beneficiaries Age 75 to 84 | 467 |
| Number Of Beneficiaries Age Greater 84 | 169 |
| Number Of Female Beneficiaries | 814 |
| Number Of Male Beneficiaries | 701 |
| Number Of Non Hispanic White Beneficiaries | 1230 |
| Number Of Black or African American Beneficiaries | 264 |
| 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 | 1149 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 366 |
| Percent Of With Atrial Fibrillation | 19 |
| Percent Of With Alzheimers Disease or Dementia | 17 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 19 |
| Percent Of With Heart Failure | 36 |
| Percent Of With Chronic Kidney Disease | 44 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 27 |
| Percent Of With Depression | 29 |
| Percent Of With Diabetes | 40 |
| Percent Of With Hyperlipidemia | 59 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 57 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 36 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 12 |
| Percent Of With Stroke | 16 |
| Average HCC Risk Score Of Beneficiaries | 2.1738 |