National Provider Identifier [NPI]: |
1093967838 |
Last Name Of The Provider |
SIDDIQI |
First Name Of The Provider |
ASMAT |
Middle Initial Of The Provider |
Q |
Credentials Of The Provider |
|
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
2201 S CLEAR CREEK RD |
Street Address 2 Of The Provider |
|
City Of The Provider |
KILLEEN |
Zip Code Of The Provider |
765494110 |
State Code Of The Provider |
TX |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Internal Medicine |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
17 |
Number Of Services |
1541 |
Number Of Medicare Beneficiaries |
525 |
Total Submitted Charge Amount |
167635.44 |
Total Medicare Allowed Amount |
159472.16 |
Total Medicare Payment Amount |
122286.16 |
Total Medicare Standardized Payment Amount |
128522.84 |
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 |
17 |
Number Of Medical Services |
1541 |
Number Of Medicare Beneficiaries With Medical Services |
525 |
Total Medical Submitted Charge Amount |
167635.44 |
Total Medical Medicare Allowed Amount |
159472.16 |
Total Medical Medicare Payment Amount |
122286.16 |
Total Medical Medicare Standardized Payment Amount |
128522.84 |
Average Age Of Beneficiaries |
70 |
Number Of Beneficiaries Age Less65 |
161 |
Number Of Beneficiaries Age 65 to 74 |
155 |
Number Of Beneficiaries Age 75 to 84 |
119 |
Number Of Beneficiaries Age Greater 84 |
90 |
Number Of Female Beneficiaries |
288 |
Number Of Male Beneficiaries |
237 |
Number Of Non Hispanic White Beneficiaries |
505 |
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 |
234 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
291 |
Percent Of With Atrial Fibrillation |
24 |
Percent Of With Alzheimers Disease or Dementia |
23 |
Percent Of With Asthma |
11 |
Percent Of With Cancer |
17 |
Percent Of With Heart Failure |
50 |
Percent Of With Chronic Kidney Disease |
45 |
Percent Of With Chronic Obstructive Pulmonary Disease |
55 |
Percent Of With Depression |
46 |
Percent Of With Diabetes |
47 |
Percent Of With Hyperlipidemia |
58 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
66 |
Percent Of With Osteoporosis |
9 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
48 |
Percent Of With Schizophrenia Other PsychoticDisorders |
14 |
Percent Of With Stroke |
12 |
Average HCC Risk Score Of Beneficiaries |
2.1013 |