| National Provider Identifier [NPI]: | 1346231065 |
| Last Name Of The Provider | SIDDIQ |
| First Name Of The Provider | FARJAAD |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 234 DR MICHAEL DEBAKEY DR |
| Street Address 2 Of The Provider | |
| City Of The Provider | LAKE CHARLES |
| Zip Code Of The Provider | 706015960 |
| State Code Of The Provider | LA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Urology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 102 |
| Number Of Services | 13605.5 |
| Number Of Medicare Beneficiaries | 1486 |
| Total Submitted Charge Amount | 1632477.47 |
| Total Medicare Allowed Amount | 609897.55 |
| Total Medicare Payment Amount | 464166.42 |
| Total Medicare Standardized Payment Amount | 494399.2 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 9 |
| Number Of Drug Services | 1148.5 |
| Number Of Medicare Beneficiaries With Drug Services | 122 |
| Total Drug Submitted ChargeAmount | 270809.62 |
| Total Drug Medicare AllowedAmount | 96976.97 |
| Total Drug Medicare PaymentAmount | 75418.74 |
| Total Drug Medicare Standardized Payment Amount | 75418.74 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 93 |
| Number Of Medical Services | 12457 |
| Number Of Medicare Beneficiaries With Medical Services | 1484 |
| Total Medical Submitted Charge Amount | 1361667.85 |
| Total Medical Medicare Allowed Amount | 512920.58 |
| Total Medical Medicare Payment Amount | 388747.68 |
| Total Medical Medicare Standardized Payment Amount | 418980.46 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 138 |
| Number Of Beneficiaries Age 65 to 74 | 713 |
| Number Of Beneficiaries Age 75 to 84 | 478 |
| Number Of Beneficiaries Age Greater 84 | 157 |
| Number Of Female Beneficiaries | 301 |
| Number Of Male Beneficiaries | 1185 |
| Number Of Non Hispanic White Beneficiaries | 1201 |
| Number Of Black or African American Beneficiaries | 247 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 19 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 1330 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 156 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 21 |
| Percent Of With Heart Failure | 18 |
| Percent Of With Chronic Kidney Disease | 26 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 15 |
| Percent Of With Depression | 12 |
| Percent Of With Diabetes | 33 |
| Percent Of With Hyperlipidemia | 61 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 41 |
| Percent Of With Osteoporosis | 3 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 33 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.1244 |