| National Provider Identifier [NPI]: | 1932169893 |
| Last Name Of The Provider | FULLER |
| First Name Of The Provider | RONALD |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | M.S. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1970 E 53RD ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | DAVENPORT |
| Zip Code Of The Provider | 528072710 |
| State Code Of The Provider | IA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 200 |
| Number Of Services | 6576 |
| Number Of Medicare Beneficiaries | 4129 |
| Total Submitted Charge Amount | 1268526.55 |
| Total Medicare Allowed Amount | 239789.87 |
| Total Medicare Payment Amount | 179751.63 |
| Total Medicare Standardized Payment Amount | 193070.88 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 1 |
| Number Of Drug Services | 362 |
| Number Of Medicare Beneficiaries With Drug Services | 50 |
| Total Drug Submitted ChargeAmount | 2599.1 |
| Total Drug Medicare AllowedAmount | 713.7 |
| Total Drug Medicare PaymentAmount | 556.89 |
| Total Drug Medicare Standardized Payment Amount | 556.89 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 199 |
| Number Of Medical Services | 6214 |
| Number Of Medicare Beneficiaries With Medical Services | 4129 |
| Total Medical Submitted Charge Amount | 1265927.45 |
| Total Medical Medicare Allowed Amount | 239076.17 |
| Total Medical Medicare Payment Amount | 179194.74 |
| Total Medical Medicare Standardized Payment Amount | 192513.99 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 641 |
| Number Of Beneficiaries Age 65 to 74 | 1580 |
| Number Of Beneficiaries Age 75 to 84 | 1237 |
| Number Of Beneficiaries Age Greater 84 | 671 |
| Number Of Female Beneficiaries | 2436 |
| Number Of Male Beneficiaries | 1693 |
| Number Of Non Hispanic White Beneficiaries | 3782 |
| Number Of Black or African American Beneficiaries | 199 |
| Number Of AsianPacific Islander Beneficiaries | 22 |
| Number Of Hispanic Beneficiaries | 90 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 36 |
| Number Of Beneficiaries With Medicare Only Entitlement | 3335 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 794 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 25 |
| Percent Of With Chronic Kidney Disease | 30 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 26 |
| Percent Of With Depression | 25 |
| Percent Of With Diabetes | 32 |
| Percent Of With Hyperlipidemia | 57 |
| Percent Of With Hypertension | 72 |
| Percent Of With Ischemic Heart Disease | 43 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 40 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 1.443 |