| National Provider Identifier [NPI]: | 1093730749 |
| Last Name Of The Provider | FULLER |
| First Name Of The Provider | SAMUEL |
| Middle Initial Of The Provider | E |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2008 CARIBOU DR |
| Street Address 2 Of The Provider | |
| City Of The Provider | FORT COLLINS |
| Zip Code Of The Provider | 80525 |
| State Code Of The Provider | CO |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 175 |
| Number Of Services | 5522 |
| Number Of Medicare Beneficiaries | 4033 |
| Total Submitted Charge Amount | 503098 |
| Total Medicare Allowed Amount | 132454.48 |
| Total Medicare Payment Amount | 93994.66 |
| Total Medicare Standardized Payment Amount | 95685.88 |
| 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 | 175 |
| Number Of Medical Services | 5522 |
| Number Of Medicare Beneficiaries With Medical Services | 4033 |
| Total Medical Submitted Charge Amount | 503098 |
| Total Medical Medicare Allowed Amount | 132454.48 |
| Total Medical Medicare Payment Amount | 93994.66 |
| Total Medical Medicare Standardized Payment Amount | 95685.88 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 611 |
| Number Of Beneficiaries Age 65 to 74 | 1498 |
| Number Of Beneficiaries Age 75 to 84 | 1140 |
| Number Of Beneficiaries Age Greater 84 | 784 |
| Number Of Female Beneficiaries | 2304 |
| Number Of Male Beneficiaries | 1729 |
| Number Of Non Hispanic White Beneficiaries | 3629 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 25 |
| Number Of Hispanic Beneficiaries | 305 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 50 |
| Number Of Beneficiaries With Medicare Only Entitlement | 3162 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 871 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 13 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 25 |
| Percent Of With Chronic Kidney Disease | 27 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 22 |
| Percent Of With Depression | 30 |
| Percent Of With Diabetes | 27 |
| Percent Of With Hyperlipidemia | 45 |
| Percent Of With Hypertension | 66 |
| Percent Of With Ischemic Heart Disease | 38 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 51 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.4271 |