| National Provider Identifier [NPI]: | 1194767780 |
| Last Name Of The Provider | SIDDIQUI |
| First Name Of The Provider | RINA |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2113 RUBY RED BLVD |
| Street Address 2 Of The Provider | |
| City Of The Provider | CLERMONT |
| Zip Code Of The Provider | 347146115 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Pathology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 26 |
| Number Of Services | 1103 |
| Number Of Medicare Beneficiaries | 584 |
| Total Submitted Charge Amount | 220711 |
| Total Medicare Allowed Amount | 40365.63 |
| Total Medicare Payment Amount | 29867.35 |
| Total Medicare Standardized Payment Amount | 22900.32 |
| 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 | 26 |
| Number Of Medical Services | 1103 |
| Number Of Medicare Beneficiaries With Medical Services | 584 |
| Total Medical Submitted Charge Amount | 220711 |
| Total Medical Medicare Allowed Amount | 40365.63 |
| Total Medical Medicare Payment Amount | 29867.35 |
| Total Medical Medicare Standardized Payment Amount | 22900.32 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 50 |
| Number Of Beneficiaries Age 65 to 74 | 223 |
| Number Of Beneficiaries Age 75 to 84 | 219 |
| Number Of Beneficiaries Age Greater 84 | 92 |
| Number Of Female Beneficiaries | 327 |
| Number Of Male Beneficiaries | 257 |
| Number Of Non Hispanic White Beneficiaries | 530 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 12 |
| Number Of Hispanic Beneficiaries | 23 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 458 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 126 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 22 |
| Percent Of With Heart Failure | 20 |
| Percent Of With Chronic Kidney Disease | 30 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 20 |
| Percent Of With Depression | 25 |
| Percent Of With Diabetes | 28 |
| Percent Of With Hyperlipidemia | 66 |
| Percent Of With Hypertension | 73 |
| Percent Of With Ischemic Heart Disease | 39 |
| Percent Of With Osteoporosis | 13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 42 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.5827 |