| National Provider Identifier [NPI]: | 1245204007 |
| Last Name Of The Provider | SISLOW |
| First Name Of The Provider | JOHN |
| Middle Initial Of The Provider | G |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 55 W TIETAN ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | WALLA WALLA |
| Zip Code Of The Provider | 993624445 |
| State Code Of The Provider | WA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Urology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 124 |
| Number Of Services | 5552 |
| Number Of Medicare Beneficiaries | 844 |
| Total Submitted Charge Amount | 1083861.2 |
| Total Medicare Allowed Amount | 358301.7 |
| Total Medicare Payment Amount | 269861.12 |
| Total Medicare Standardized Payment Amount | 273552.7 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 10 |
| Number Of Drug Services | 1639 |
| Number Of Medicare Beneficiaries With Drug Services | 44 |
| Total Drug Submitted ChargeAmount | 84997.2 |
| Total Drug Medicare AllowedAmount | 60270.41 |
| Total Drug Medicare PaymentAmount | 46920.16 |
| Total Drug Medicare Standardized Payment Amount | 46920.16 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 114 |
| Number Of Medical Services | 3913 |
| Number Of Medicare Beneficiaries With Medical Services | 844 |
| Total Medical Submitted Charge Amount | 998864 |
| Total Medical Medicare Allowed Amount | 298031.29 |
| Total Medical Medicare Payment Amount | 222940.96 |
| Total Medical Medicare Standardized Payment Amount | 226632.54 |
| Average Age Of Beneficiaries | 77 |
| Number Of Beneficiaries Age Less65 | 27 |
| Number Of Beneficiaries Age 65 to 74 | 329 |
| Number Of Beneficiaries Age 75 to 84 | 312 |
| Number Of Beneficiaries Age Greater 84 | 176 |
| Number Of Female Beneficiaries | 125 |
| Number Of Male Beneficiaries | 719 |
| Number Of Non Hispanic White Beneficiaries | 790 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 23 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 18 |
| Number Of Beneficiaries With Medicare Only Entitlement | 786 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 58 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 31 |
| Percent Of With Heart Failure | 16 |
| Percent Of With Chronic Kidney Disease | 23 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 12 |
| Percent Of With Depression | 13 |
| Percent Of With Diabetes | 26 |
| Percent Of With Hyperlipidemia | 50 |
| Percent Of With Hypertension | 53 |
| Percent Of With Ischemic Heart Disease | 35 |
| Percent Of With Osteoporosis | 5 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 31 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.0945 |