| National Provider Identifier [NPI]: | 1649238148 |
| Last Name Of The Provider | SIDHOM |
| First Name Of The Provider | OSAMA |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1135 S SUNSET AVE STE 405 |
| Street Address 2 Of The Provider | |
| City Of The Provider | WEST CORINA |
| Zip Code Of The Provider | 91790 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Gastroenterology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 36 |
| Number Of Services | 3491 |
| Number Of Medicare Beneficiaries | 993 |
| Total Submitted Charge Amount | 958340 |
| Total Medicare Allowed Amount | 391944.47 |
| Total Medicare Payment Amount | 305165.02 |
| Total Medicare Standardized Payment Amount | 287419.46 |
| 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 | 36 |
| Number Of Medical Services | 3491 |
| Number Of Medicare Beneficiaries With Medical Services | 993 |
| Total Medical Submitted Charge Amount | 958340 |
| Total Medical Medicare Allowed Amount | 391944.47 |
| Total Medical Medicare Payment Amount | 305165.02 |
| Total Medical Medicare Standardized Payment Amount | 287419.46 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 166 |
| Number Of Beneficiaries Age 65 to 74 | 277 |
| Number Of Beneficiaries Age 75 to 84 | 335 |
| Number Of Beneficiaries Age Greater 84 | 215 |
| Number Of Female Beneficiaries | 603 |
| Number Of Male Beneficiaries | 390 |
| Number Of Non Hispanic White Beneficiaries | 377 |
| Number Of Black or African American Beneficiaries | 55 |
| Number Of AsianPacific Islander Beneficiaries | 129 |
| Number Of Hispanic Beneficiaries | 405 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 303 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 690 |
| Percent Of With Atrial Fibrillation | 17 |
| Percent Of With Alzheimers Disease or Dementia | 44 |
| Percent Of With Asthma | 13 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 53 |
| Percent Of With Chronic Kidney Disease | 60 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 42 |
| Percent Of With Depression | 38 |
| Percent Of With Diabetes | 59 |
| Percent Of With Hyperlipidemia | 57 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 61 |
| Percent Of With Osteoporosis | 16 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 49 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 20 |
| Percent Of With Stroke | 21 |
| Average HCC Risk Score Of Beneficiaries | 3.3477 |