| National Provider Identifier [NPI]: | 1801848668 |
| Last Name Of The Provider | FULK |
| First Name Of The Provider | CHARLES |
| Middle Initial Of The Provider | S |
| Credentials Of The Provider | |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 400 E ECONOMY ROAD |
| Street Address 2 Of The Provider | SUITE 8 |
| City Of The Provider | MORRISTOWN |
| Zip Code Of The Provider | 378143388 |
| State Code Of The Provider | TN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Dermatology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 90 |
| Number Of Services | 9160 |
| Number Of Medicare Beneficiaries | 1745 |
| Total Submitted Charge Amount | 671010.12 |
| Total Medicare Allowed Amount | 603400.53 |
| Total Medicare Payment Amount | 450701.7 |
| Total Medicare Standardized Payment Amount | 423795.52 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 1 |
| Number Of Drug Services | 12 |
| Number Of Medicare Beneficiaries With Drug Services | 12 |
| Total Drug Submitted ChargeAmount | 2759.7 |
| Total Drug Medicare AllowedAmount | 2739.3 |
| Total Drug Medicare PaymentAmount | 2080.71 |
| Total Drug Medicare Standardized Payment Amount | 2080.71 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 89 |
| Number Of Medical Services | 9148 |
| Number Of Medicare Beneficiaries With Medical Services | 1745 |
| Total Medical Submitted Charge Amount | 668250.42 |
| Total Medical Medicare Allowed Amount | 600661.23 |
| Total Medical Medicare Payment Amount | 448620.99 |
| Total Medical Medicare Standardized Payment Amount | 421714.81 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 124 |
| Number Of Beneficiaries Age 65 to 74 | 724 |
| Number Of Beneficiaries Age 75 to 84 | 648 |
| Number Of Beneficiaries Age Greater 84 | 249 |
| Number Of Female Beneficiaries | 869 |
| Number Of Male Beneficiaries | 876 |
| Number Of Non Hispanic White Beneficiaries | 1721 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 1537 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 208 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 11 |
| Percent Of With Asthma | 4 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 14 |
| Percent Of With Chronic Kidney Disease | 20 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 16 |
| Percent Of With Depression | 15 |
| Percent Of With Diabetes | 29 |
| Percent Of With Hyperlipidemia | 57 |
| Percent Of With Hypertension | 71 |
| Percent Of With Ischemic Heart Disease | 34 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 39 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 1.0453 |