| National Provider Identifier [NPI]: | 1003858275 |
| Last Name Of The Provider | SIDDIQUI |
| First Name Of The Provider | MOHAMMAD |
| Middle Initial Of The Provider | T |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1101 N CENTRAL AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | KISSIMMEE |
| Zip Code Of The Provider | 347414405 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nephrology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 38 |
| Number Of Services | 6284 |
| Number Of Medicare Beneficiaries | 602 |
| Total Submitted Charge Amount | 925488 |
| Total Medicare Allowed Amount | 310945.91 |
| Total Medicare Payment Amount | 238235.36 |
| Total Medicare Standardized Payment Amount | 238464.22 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 3481 |
| Number Of Medicare Beneficiaries With Drug Services | 40 |
| Total Drug Submitted ChargeAmount | 26521 |
| Total Drug Medicare AllowedAmount | 15246.6 |
| Total Drug Medicare PaymentAmount | 11951.02 |
| Total Drug Medicare Standardized Payment Amount | 11951.02 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 35 |
| Number Of Medical Services | 2803 |
| Number Of Medicare Beneficiaries With Medical Services | 602 |
| Total Medical Submitted Charge Amount | 898967 |
| Total Medical Medicare Allowed Amount | 295699.31 |
| Total Medical Medicare Payment Amount | 226284.34 |
| Total Medical Medicare Standardized Payment Amount | 226513.2 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 167 |
| Number Of Beneficiaries Age 65 to 74 | 191 |
| Number Of Beneficiaries Age 75 to 84 | 168 |
| Number Of Beneficiaries Age Greater 84 | 76 |
| Number Of Female Beneficiaries | 285 |
| Number Of Male Beneficiaries | 317 |
| Number Of Non Hispanic White Beneficiaries | 268 |
| Number Of Black or African American Beneficiaries | 110 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 206 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 355 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 247 |
| Percent Of With Atrial Fibrillation | 20 |
| Percent Of With Alzheimers Disease or Dementia | 20 |
| Percent Of With Asthma | 12 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 59 |
| Percent Of With Chronic Kidney Disease | 75 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 31 |
| Percent Of With Depression | 31 |
| Percent Of With Diabetes | 74 |
| Percent Of With Hyperlipidemia | 75 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 73 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 38 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 16 |
| Average HCC Risk Score Of Beneficiaries | 4.8684 |