| National Provider Identifier [NPI]: | 1104872837 |
| Last Name Of The Provider | SIDDEN |
| First Name Of The Provider | CHRISTOPHER |
| 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 | 13737 NOEL RD STE 1600 |
| Street Address 2 Of The Provider | ATTN RAYS |
| City Of The Provider | DALLAS |
| Zip Code Of The Provider | 752401374 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 104 |
| Number Of Services | 2168 |
| Number Of Medicare Beneficiaries | 1742 |
| Total Submitted Charge Amount | 416202.01 |
| Total Medicare Allowed Amount | 66263.9 |
| Total Medicare Payment Amount | 50494.14 |
| Total Medicare Standardized Payment Amount | 52572.11 |
| 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 | 104 |
| Number Of Medical Services | 2168 |
| Number Of Medicare Beneficiaries With Medical Services | 1742 |
| Total Medical Submitted Charge Amount | 416202.01 |
| Total Medical Medicare Allowed Amount | 66263.9 |
| Total Medical Medicare Payment Amount | 50494.14 |
| Total Medical Medicare Standardized Payment Amount | 52572.11 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 451 |
| Number Of Beneficiaries Age 65 to 74 | 506 |
| Number Of Beneficiaries Age 75 to 84 | 454 |
| Number Of Beneficiaries Age Greater 84 | 331 |
| Number Of Female Beneficiaries | 1047 |
| Number Of Male Beneficiaries | 695 |
| Number Of Non Hispanic White Beneficiaries | 910 |
| Number Of Black or African American Beneficiaries | 540 |
| Number Of AsianPacific Islander Beneficiaries | 60 |
| Number Of Hispanic Beneficiaries | 209 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 990 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 752 |
| Percent Of With Atrial Fibrillation | 22 |
| Percent Of With Alzheimers Disease or Dementia | 30 |
| Percent Of With Asthma | 15 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 49 |
| Percent Of With Chronic Kidney Disease | 51 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 36 |
| Percent Of With Depression | 38 |
| Percent Of With Diabetes | 51 |
| Percent Of With Hyperlipidemia | 67 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 61 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 53 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 14 |
| Percent Of With Stroke | 18 |
| Average HCC Risk Score Of Beneficiaries | 2.5022 |