| National Provider Identifier [NPI]: | 1730267071 |
| Last Name Of The Provider | FUQUA |
| First Name Of The Provider | CHARLES |
| Middle Initial Of The Provider | S |
| Credentials Of The Provider | REGISTERED PHYSICAL |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 6560 GREENBACK LANE |
| Street Address 2 Of The Provider | # 100 |
| City Of The Provider | CITRUS HEIGHTS |
| Zip Code Of The Provider | 95621 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physical Therapist |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 8 |
| Number Of Services | 4757 |
| Number Of Medicare Beneficiaries | 192 |
| Total Submitted Charge Amount | 194268 |
| Total Medicare Allowed Amount | 117505.22 |
| Total Medicare Payment Amount | 88537.28 |
| Total Medicare Standardized Payment Amount | 56783.19 |
| 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 | 8 |
| Number Of Medical Services | 4757 |
| Number Of Medicare Beneficiaries With Medical Services | 192 |
| Total Medical Submitted Charge Amount | 194268 |
| Total Medical Medicare Allowed Amount | 117505.22 |
| Total Medical Medicare Payment Amount | 88537.28 |
| Total Medical Medicare Standardized Payment Amount | 56783.19 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 35 |
| Number Of Beneficiaries Age 65 to 74 | 79 |
| Number Of Beneficiaries Age 75 to 84 | 58 |
| Number Of Beneficiaries Age Greater 84 | 20 |
| Number Of Female Beneficiaries | 125 |
| Number Of Male Beneficiaries | 67 |
| Number Of Non Hispanic White Beneficiaries | 153 |
| Number Of Black or African American Beneficiaries | 13 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 11 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 146 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 46 |
| Percent Of With Atrial Fibrillation | 8 |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 7 |
| Percent Of With Heart Failure | 11 |
| Percent Of With Chronic Kidney Disease | 18 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 11 |
| Percent Of With Depression | 19 |
| Percent Of With Diabetes | 34 |
| Percent Of With Hyperlipidemia | 62 |
| Percent Of With Hypertension | 63 |
| Percent Of With Ischemic Heart Disease | 32 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 54 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.9933 |