| National Provider Identifier [NPI]: | 1629001680 |
| Last Name Of The Provider | SIDDIQUI |
| First Name Of The Provider | SHAZIA |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 770 PARK EAST BLVD |
| Street Address 2 Of The Provider | SUITE B |
| City Of The Provider | LAFAYETTE |
| Zip Code Of The Provider | 47905 |
| State Code Of The Provider | IN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Anesthesiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 53 |
| Number Of Services | 7425 |
| Number Of Medicare Beneficiaries | 496 |
| Total Submitted Charge Amount | 1090089.3 |
| Total Medicare Allowed Amount | 548642.58 |
| Total Medicare Payment Amount | 436379.95 |
| Total Medicare Standardized Payment Amount | 415608.72 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 1284 |
| Number Of Medicare Beneficiaries With Drug Services | 200 |
| Total Drug Submitted ChargeAmount | 14323.8 |
| Total Drug Medicare AllowedAmount | 3898.57 |
| Total Drug Medicare PaymentAmount | 3030.27 |
| Total Drug Medicare Standardized Payment Amount | 3030.27 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 47 |
| Number Of Medical Services | 6141 |
| Number Of Medicare Beneficiaries With Medical Services | 496 |
| Total Medical Submitted Charge Amount | 1075765.5 |
| Total Medical Medicare Allowed Amount | 544744.01 |
| Total Medical Medicare Payment Amount | 433349.68 |
| Total Medical Medicare Standardized Payment Amount | 412578.45 |
| Average Age Of Beneficiaries | 57 |
| Number Of Beneficiaries Age Less65 | 351 |
| Number Of Beneficiaries Age 65 to 74 | 99 |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 311 |
| Number Of Male Beneficiaries | 185 |
| Number Of Non Hispanic White Beneficiaries | 464 |
| Number Of Black or African American Beneficiaries | 18 |
| 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 | 159 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 337 |
| Percent Of With Atrial Fibrillation | 4 |
| Percent Of With Alzheimers Disease or Dementia | 4 |
| Percent Of With Asthma | 17 |
| Percent Of With Cancer | 5 |
| Percent Of With Heart Failure | 16 |
| Percent Of With Chronic Kidney Disease | 16 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 31 |
| Percent Of With Depression | 58 |
| Percent Of With Diabetes | 33 |
| Percent Of With Hyperlipidemia | 41 |
| Percent Of With Hypertension | 58 |
| Percent Of With Ischemic Heart Disease | 31 |
| Percent Of With Osteoporosis | 4 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 75 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 1.4549 |