| National Provider Identifier [NPI]: | 1386662757 |
| Last Name Of The Provider | SIDDIQUI |
| First Name Of The Provider | SHAHID |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 14090 H.G. TRUMAN RD |
| Street Address 2 Of The Provider | STE. 2100 |
| City Of The Provider | SOLOMONS |
| Zip Code Of The Provider | 20688 |
| State Code Of The Provider | MD |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 61 |
| Number Of Services | 3414 |
| Number Of Medicare Beneficiaries | 412 |
| Total Submitted Charge Amount | 291448.79 |
| Total Medicare Allowed Amount | 163366.51 |
| Total Medicare Payment Amount | 127968.36 |
| Total Medicare Standardized Payment Amount | 128115.15 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 109 |
| Number Of Medicare Beneficiaries With Drug Services | 85 |
| Total Drug Submitted ChargeAmount | 3955 |
| Total Drug Medicare AllowedAmount | 2325.37 |
| Total Drug Medicare PaymentAmount | 2260.21 |
| Total Drug Medicare Standardized Payment Amount | 2260.21 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 56 |
| Number Of Medical Services | 3305 |
| Number Of Medicare Beneficiaries With Medical Services | 412 |
| Total Medical Submitted Charge Amount | 287493.79 |
| Total Medical Medicare Allowed Amount | 161041.14 |
| Total Medical Medicare Payment Amount | 125708.15 |
| Total Medical Medicare Standardized Payment Amount | 125854.94 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 86 |
| Number Of Beneficiaries Age 65 to 74 | 157 |
| Number Of Beneficiaries Age 75 to 84 | 116 |
| Number Of Beneficiaries Age Greater 84 | 53 |
| Number Of Female Beneficiaries | 205 |
| Number Of Male Beneficiaries | 207 |
| Number Of Non Hispanic White Beneficiaries | 289 |
| Number Of Black or African American Beneficiaries | 106 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 285 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 127 |
| Percent Of With Atrial Fibrillation | 18 |
| Percent Of With Alzheimers Disease or Dementia | 16 |
| Percent Of With Asthma | 17 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 36 |
| Percent Of With Chronic Kidney Disease | 35 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 28 |
| Percent Of With Depression | 25 |
| Percent Of With Diabetes | 50 |
| Percent Of With Hyperlipidemia | 75 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 55 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 40 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 11 |
| Average HCC Risk Score Of Beneficiaries | 1.7945 |