| National Provider Identifier [NPI]: | 1609823558 |
| Last Name Of The Provider | SIDDIQI |
| First Name Of The Provider | NOAMAN |
| Middle Initial Of The Provider | W |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 12303 DEPAUL DR |
| Street Address 2 Of The Provider | DEPAUL HEALTH CENTER |
| City Of The Provider | BRIDGETON |
| Zip Code Of The Provider | 63044 |
| State Code Of The Provider | MO |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 242 |
| Number Of Services | 5769 |
| Number Of Medicare Beneficiaries | 3356 |
| Total Submitted Charge Amount | 898987.67 |
| Total Medicare Allowed Amount | 226866.56 |
| Total Medicare Payment Amount | 174570.4 |
| Total Medicare Standardized Payment Amount | 180018.4 |
| 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 | 242 |
| Number Of Medical Services | 5769 |
| Number Of Medicare Beneficiaries With Medical Services | 3356 |
| Total Medical Submitted Charge Amount | 898987.67 |
| Total Medical Medicare Allowed Amount | 226866.56 |
| Total Medical Medicare Payment Amount | 174570.4 |
| Total Medical Medicare Standardized Payment Amount | 180018.4 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 866 |
| Number Of Beneficiaries Age 65 to 74 | 1114 |
| Number Of Beneficiaries Age 75 to 84 | 841 |
| Number Of Beneficiaries Age Greater 84 | 535 |
| Number Of Female Beneficiaries | 2094 |
| Number Of Male Beneficiaries | 1262 |
| Number Of Non Hispanic White Beneficiaries | 2387 |
| Number Of Black or African American Beneficiaries | 906 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 22 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 21 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2374 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 982 |
| Percent Of With Atrial Fibrillation | 16 |
| Percent Of With Alzheimers Disease or Dementia | 20 |
| Percent Of With Asthma | 15 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 34 |
| Percent Of With Chronic Kidney Disease | 42 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 30 |
| Percent Of With Depression | 39 |
| Percent Of With Diabetes | 43 |
| Percent Of With Hyperlipidemia | 61 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 47 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 53 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 10 |
| Percent Of With Stroke | 15 |
| Average HCC Risk Score Of Beneficiaries | 2.0529 |