| National Provider Identifier [NPI]: | 1497938690 |
| Last Name Of The Provider | FULLENWIDER |
| First Name Of The Provider | JOHN |
| Middle Initial Of The Provider | P |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2301 S LAMAR BLVD |
| Street Address 2 Of The Provider | |
| City Of The Provider | OXFORD |
| Zip Code Of The Provider | 386555373 |
| State Code Of The Provider | MS |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Pathology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 30 |
| Number Of Services | 15070 |
| Number Of Medicare Beneficiaries | 5392 |
| Total Submitted Charge Amount | 1535571.89 |
| Total Medicare Allowed Amount | 656888.18 |
| Total Medicare Payment Amount | 510356.77 |
| Total Medicare Standardized Payment Amount | 419632.83 |
| 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 | 30 |
| Number Of Medical Services | 15070 |
| Number Of Medicare Beneficiaries With Medical Services | 5392 |
| Total Medical Submitted Charge Amount | 1535571.89 |
| Total Medical Medicare Allowed Amount | 656888.18 |
| Total Medical Medicare Payment Amount | 510356.77 |
| Total Medical Medicare Standardized Payment Amount | 419632.83 |
| Average Age Of Beneficiaries | 69 |
| Number Of Beneficiaries Age Less65 | 1382 |
| Number Of Beneficiaries Age 65 to 74 | 2315 |
| Number Of Beneficiaries Age 75 to 84 | 1328 |
| Number Of Beneficiaries Age Greater 84 | 367 |
| Number Of Female Beneficiaries | 3052 |
| Number Of Male Beneficiaries | 2340 |
| Number Of Non Hispanic White Beneficiaries | 3783 |
| Number Of Black or African American Beneficiaries | 1555 |
| Number Of AsianPacific Islander Beneficiaries | 13 |
| Number Of Hispanic Beneficiaries | 20 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 21 |
| Number Of Beneficiaries With Medicare Only Entitlement | 3620 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1772 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 16 |
| Percent Of With Heart Failure | 22 |
| Percent Of With Chronic Kidney Disease | 27 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 18 |
| Percent Of With Depression | 18 |
| Percent Of With Diabetes | 36 |
| Percent Of With Hyperlipidemia | 54 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 35 |
| Percent Of With Osteoporosis | 5 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 42 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.3194 |