| National Provider Identifier [NPI]: | 1114098555 |
| Last Name Of The Provider | SANTIAGO |
| First Name Of The Provider | SANDRA |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | MOUNT KISCO MEDICAL GROUP |
| Street Address 2 Of The Provider | 90 SOUTH BEDFORD ROAD |
| City Of The Provider | MOUNT KISCO |
| Zip Code Of The Provider | 105493412 |
| State Code Of The Provider | NY |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 95 |
| Number Of Services | 6498 |
| Number Of Medicare Beneficiaries | 1409 |
| Total Submitted Charge Amount | 264640.31 |
| Total Medicare Allowed Amount | 228592.15 |
| Total Medicare Payment Amount | 174733.13 |
| Total Medicare Standardized Payment Amount | 152396.29 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 4345 |
| Number Of Medicare Beneficiaries With Drug Services | 48 |
| Total Drug Submitted ChargeAmount | 1052.95 |
| Total Drug Medicare AllowedAmount | 1044.37 |
| Total Drug Medicare PaymentAmount | 818.82 |
| Total Drug Medicare Standardized Payment Amount | 818.82 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 93 |
| Number Of Medical Services | 2153 |
| Number Of Medicare Beneficiaries With Medical Services | 1409 |
| Total Medical Submitted Charge Amount | 263587.36 |
| Total Medical Medicare Allowed Amount | 227547.78 |
| Total Medical Medicare Payment Amount | 173914.31 |
| Total Medical Medicare Standardized Payment Amount | 151577.47 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 122 |
| Number Of Beneficiaries Age 65 to 74 | 687 |
| Number Of Beneficiaries Age 75 to 84 | 428 |
| Number Of Beneficiaries Age Greater 84 | 172 |
| Number Of Female Beneficiaries | 951 |
| Number Of Male Beneficiaries | 458 |
| Number Of Non Hispanic White Beneficiaries | 1294 |
| Number Of Black or African American Beneficiaries | 20 |
| Number Of AsianPacific Islander Beneficiaries | 13 |
| Number Of Hispanic Beneficiaries | 45 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 37 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1310 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 99 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 5 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 9 |
| Percent Of With Chronic Kidney Disease | 13 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 10 |
| Percent Of With Depression | 16 |
| Percent Of With Diabetes | 21 |
| Percent Of With Hyperlipidemia | 50 |
| Percent Of With Hypertension | 57 |
| Percent Of With Ischemic Heart Disease | 26 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 46 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 1 |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 0.9839 |