| National Provider Identifier [NPI]: | 1699705293 |
| Last Name Of The Provider | SIDDIQUI |
| First Name Of The Provider | JAWED |
| Middle Initial Of The Provider | H |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 11115 NEW HALLS FERRY RD |
| Street Address 2 Of The Provider | SUITES 301-302 |
| City Of The Provider | FLORISSANT |
| Zip Code Of The Provider | 630337613 |
| State Code Of The Provider | MO |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 36 |
| Number Of Services | 4513 |
| Number Of Medicare Beneficiaries | 546 |
| Total Submitted Charge Amount | 1283164.79 |
| Total Medicare Allowed Amount | 502375.8 |
| Total Medicare Payment Amount | 373340.98 |
| Total Medicare Standardized Payment Amount | 394266.56 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 1 |
| Number Of Drug Services | 15 |
| Number Of Medicare Beneficiaries With Drug Services | 15 |
| Total Drug Submitted ChargeAmount | 195 |
| Total Drug Medicare AllowedAmount | 180.6 |
| Total Drug Medicare PaymentAmount | 177 |
| Total Drug Medicare Standardized Payment Amount | 177 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 35 |
| Number Of Medical Services | 4498 |
| Number Of Medicare Beneficiaries With Medical Services | 546 |
| Total Medical Submitted Charge Amount | 1282969.79 |
| Total Medical Medicare Allowed Amount | 502195.2 |
| Total Medical Medicare Payment Amount | 373163.98 |
| Total Medical Medicare Standardized Payment Amount | 394089.56 |
| Average Age Of Beneficiaries | 61 |
| Number Of Beneficiaries Age Less65 | 309 |
| Number Of Beneficiaries Age 65 to 74 | 146 |
| Number Of Beneficiaries Age 75 to 84 | 63 |
| Number Of Beneficiaries Age Greater 84 | 28 |
| Number Of Female Beneficiaries | 300 |
| Number Of Male Beneficiaries | 246 |
| Number Of Non Hispanic White Beneficiaries | 175 |
| Number Of Black or African American Beneficiaries | 350 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 185 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 361 |
| Percent Of With Atrial Fibrillation | 2 |
| Percent Of With Alzheimers Disease or Dementia | 11 |
| Percent Of With Asthma | 14 |
| Percent Of With Cancer | 6 |
| Percent Of With Heart Failure | 46 |
| Percent Of With Chronic Kidney Disease | 21 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 21 |
| Percent Of With Depression | 39 |
| Percent Of With Diabetes | 62 |
| Percent Of With Hyperlipidemia | 41 |
| Percent Of With Hypertension | 71 |
| Percent Of With Ischemic Heart Disease | 44 |
| Percent Of With Osteoporosis | 2 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 68 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 10 |
| Percent Of With Stroke | 10 |
| Average HCC Risk Score Of Beneficiaries | 1.6545 |