| National Provider Identifier [NPI]: | 1588632111 |
| Last Name Of The Provider | KIDWAI |
| First Name Of The Provider | ARIF |
| Middle Initial Of The Provider | S |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 400 HEALTH PARK BLVD |
| Street Address 2 Of The Provider | ATTN: RADIOLOGY DEPARTMENT |
| City Of The Provider | SAINT AUGUSTINE |
| Zip Code Of The Provider | 320865784 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 192 |
| Number Of Services | 7110 |
| Number Of Medicare Beneficiaries | 3922 |
| Total Submitted Charge Amount | 704983 |
| Total Medicare Allowed Amount | 228270.63 |
| Total Medicare Payment Amount | 174683.22 |
| Total Medicare Standardized Payment Amount | 175579.71 |
| 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 | 192 |
| Number Of Medical Services | 7110 |
| Number Of Medicare Beneficiaries With Medical Services | 3922 |
| Total Medical Submitted Charge Amount | 704983 |
| Total Medical Medicare Allowed Amount | 228270.63 |
| Total Medical Medicare Payment Amount | 174683.22 |
| Total Medical Medicare Standardized Payment Amount | 175579.71 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 533 |
| Number Of Beneficiaries Age 65 to 74 | 1523 |
| Number Of Beneficiaries Age 75 to 84 | 1215 |
| Number Of Beneficiaries Age Greater 84 | 651 |
| Number Of Female Beneficiaries | 2436 |
| Number Of Male Beneficiaries | 1486 |
| Number Of Non Hispanic White Beneficiaries | 3479 |
| Number Of Black or African American Beneficiaries | 302 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 83 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 32 |
| Number Of Beneficiaries With Medicare Only Entitlement | 3141 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 781 |
| Percent Of With Atrial Fibrillation | 18 |
| Percent Of With Alzheimers Disease or Dementia | 18 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 26 |
| Percent Of With Chronic Kidney Disease | 34 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 31 |
| Percent Of With Depression | 26 |
| Percent Of With Diabetes | 33 |
| Percent Of With Hyperlipidemia | 70 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 55 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 52 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 11 |
| Average HCC Risk Score Of Beneficiaries | 1.5619 |