| National Provider Identifier [NPI]: | 1396701850 |
| Last Name Of The Provider | FUKUDA |
| First Name Of The Provider | WILLIAM |
| 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 | 400 NEWPORT CENTER DR |
| Street Address 2 Of The Provider | SUITE 608 |
| City Of The Provider | NEWPORT BEACH |
| Zip Code Of The Provider | 926607601 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 90 |
| Number Of Services | 11082 |
| Number Of Medicare Beneficiaries | 722 |
| Total Submitted Charge Amount | 797944 |
| Total Medicare Allowed Amount | 382396.5 |
| Total Medicare Payment Amount | 299629.97 |
| Total Medicare Standardized Payment Amount | 280307.9 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 8 |
| Number Of Drug Services | 626 |
| Number Of Medicare Beneficiaries With Drug Services | 247 |
| Total Drug Submitted ChargeAmount | 26465 |
| Total Drug Medicare AllowedAmount | 9068.33 |
| Total Drug Medicare PaymentAmount | 8452.72 |
| Total Drug Medicare Standardized Payment Amount | 8452.72 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 82 |
| Number Of Medical Services | 10456 |
| Number Of Medicare Beneficiaries With Medical Services | 722 |
| Total Medical Submitted Charge Amount | 771479 |
| Total Medical Medicare Allowed Amount | 373328.17 |
| Total Medical Medicare Payment Amount | 291177.25 |
| Total Medical Medicare Standardized Payment Amount | 271855.18 |
| Average Age Of Beneficiaries | 77 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 318 |
| Number Of Beneficiaries Age 75 to 84 | 262 |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 329 |
| Number Of Male Beneficiaries | 393 |
| Number Of Non Hispanic White Beneficiaries | 635 |
| Number Of Black or African American Beneficiaries | 0 |
| Number Of AsianPacific Islander Beneficiaries | 58 |
| Number Of Hispanic Beneficiaries | 15 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 14 |
| Number Of Beneficiaries With Medicare Only Entitlement | |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 9 |
| Percent Of With Chronic Kidney Disease | 11 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 6 |
| Percent Of With Depression | 8 |
| Percent Of With Diabetes | 16 |
| Percent Of With Hyperlipidemia | 66 |
| Percent Of With Hypertension | 64 |
| Percent Of With Ischemic Heart Disease | 27 |
| Percent Of With Osteoporosis | 5 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 35 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 0.9576 |