| National Provider Identifier [NPI]: | 1144228255 |
| Last Name Of The Provider | SIDES |
| First Name Of The Provider | DOUGLAS |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 688 KINOOLE ST |
| Street Address 2 Of The Provider | SUITE 103 |
| City Of The Provider | HILO |
| Zip Code Of The Provider | 967203877 |
| State Code Of The Provider | HI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 178 |
| Number Of Services | 5544 |
| Number Of Medicare Beneficiaries | 1431 |
| Total Submitted Charge Amount | 786011 |
| Total Medicare Allowed Amount | 164862.02 |
| Total Medicare Payment Amount | 120789.57 |
| Total Medicare Standardized Payment Amount | 113372.21 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 2617 |
| Number Of Medicare Beneficiaries With Drug Services | 43 |
| Total Drug Submitted ChargeAmount | 8691 |
| Total Drug Medicare AllowedAmount | 739.16 |
| Total Drug Medicare PaymentAmount | 579.38 |
| Total Drug Medicare Standardized Payment Amount | 579.38 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 176 |
| Number Of Medical Services | 2927 |
| Number Of Medicare Beneficiaries With Medical Services | 1431 |
| Total Medical Submitted Charge Amount | 777320 |
| Total Medical Medicare Allowed Amount | 164122.86 |
| Total Medical Medicare Payment Amount | 120210.19 |
| Total Medical Medicare Standardized Payment Amount | 112792.83 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 221 |
| Number Of Beneficiaries Age 65 to 74 | 636 |
| Number Of Beneficiaries Age 75 to 84 | 366 |
| Number Of Beneficiaries Age Greater 84 | 208 |
| Number Of Female Beneficiaries | 811 |
| Number Of Male Beneficiaries | 620 |
| Number Of Non Hispanic White Beneficiaries | 799 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 407 |
| Number Of Hispanic Beneficiaries | 88 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 126 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1112 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 319 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 14 |
| Percent Of With Asthma | 12 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 25 |
| Percent Of With Chronic Kidney Disease | 28 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 17 |
| Percent Of With Depression | 19 |
| Percent Of With Diabetes | 29 |
| Percent Of With Hyperlipidemia | 55 |
| Percent Of With Hypertension | 66 |
| Percent Of With Ischemic Heart Disease | 36 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 32 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.3351 |