| National Provider Identifier [NPI]: | 1114994738 |
| Last Name Of The Provider | FULLMER |
| First Name Of The Provider | DANIEL |
| Middle Initial Of The Provider | R |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 19020 33RD AVE W |
| Street Address 2 Of The Provider | SUITE 210 |
| City Of The Provider | LYNNWOOD |
| Zip Code Of The Provider | 980364746 |
| State Code Of The Provider | WA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 132 |
| Number Of Services | 4587 |
| Number Of Medicare Beneficiaries | 2940 |
| Total Submitted Charge Amount | 575900.76 |
| Total Medicare Allowed Amount | 117372.75 |
| Total Medicare Payment Amount | 92558.55 |
| Total Medicare Standardized Payment Amount | 95448.05 |
| 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 | 132 |
| Number Of Medical Services | 4587 |
| Number Of Medicare Beneficiaries With Medical Services | 2940 |
| Total Medical Submitted Charge Amount | 575900.76 |
| Total Medical Medicare Allowed Amount | 117372.75 |
| Total Medical Medicare Payment Amount | 92558.55 |
| Total Medical Medicare Standardized Payment Amount | 95448.05 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 423 |
| Number Of Beneficiaries Age 65 to 74 | 1166 |
| Number Of Beneficiaries Age 75 to 84 | 899 |
| Number Of Beneficiaries Age Greater 84 | 452 |
| Number Of Female Beneficiaries | 1956 |
| Number Of Male Beneficiaries | 984 |
| Number Of Non Hispanic White Beneficiaries | 2743 |
| Number Of Black or African American Beneficiaries | 28 |
| Number Of AsianPacific Islander Beneficiaries | 44 |
| Number Of Hispanic Beneficiaries | 55 |
| Number Of American Indian Alaska Native Beneficiaries | 33 |
| Number Of Beneficiaries With Race Not Else where Classified | 37 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2376 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 564 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 11 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 21 |
| Percent Of With Chronic Kidney Disease | 32 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 20 |
| Percent Of With Depression | 26 |
| Percent Of With Diabetes | 29 |
| Percent Of With Hyperlipidemia | 50 |
| Percent Of With Hypertension | 65 |
| Percent Of With Ischemic Heart Disease | 29 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 45 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.3991 |