| National Provider Identifier [NPI]: | 1396783551 |
| Last Name Of The Provider | SICKLES |
| First Name Of The Provider | EDWARD |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1600 DIVISADERO ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | SAN FRANCISCO |
| Zip Code Of The Provider | 941153010 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 4 |
| Number Of Services | 685 |
| Number Of Medicare Beneficiaries | 665 |
| Total Submitted Charge Amount | 127559 |
| Total Medicare Allowed Amount | 27614.86 |
| Total Medicare Payment Amount | 25951.36 |
| Total Medicare Standardized Payment Amount | 23007.2 |
| 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 | 4 |
| Number Of Medical Services | 685 |
| Number Of Medicare Beneficiaries With Medical Services | 665 |
| Total Medical Submitted Charge Amount | 127559 |
| Total Medical Medicare Allowed Amount | 27614.86 |
| Total Medical Medicare Payment Amount | 25951.36 |
| Total Medical Medicare Standardized Payment Amount | 23007.2 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 73 |
| Number Of Beneficiaries Age 65 to 74 | 383 |
| Number Of Beneficiaries Age 75 to 84 | 184 |
| Number Of Beneficiaries Age Greater 84 | 25 |
| Number Of Female Beneficiaries | 665 |
| Number Of Male Beneficiaries | 0 |
| Number Of Non Hispanic White Beneficiaries | 478 |
| Number Of Black or African American Beneficiaries | 47 |
| Number Of AsianPacific Islander Beneficiaries | 87 |
| Number Of Hispanic Beneficiaries | 26 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 27 |
| Number Of Beneficiaries With Medicare Only Entitlement | 376 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 289 |
| Percent Of With Atrial Fibrillation | 5 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 6 |
| Percent Of With Chronic Kidney Disease | 9 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 5 |
| Percent Of With Depression | 23 |
| Percent Of With Diabetes | 27 |
| Percent Of With Hyperlipidemia | 46 |
| Percent Of With Hypertension | 56 |
| Percent Of With Ischemic Heart Disease | 15 |
| Percent Of With Osteoporosis | 14 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 33 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 2 |
| Average HCC Risk Score Of Beneficiaries | 0.9108 |