| National Provider Identifier [NPI]: | 1629173554 |
| Last Name Of The Provider | SAID |
| First Name Of The Provider | MOWAFFAQ |
| Middle Initial Of The Provider | R |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1019 N MAIN ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | SIKESTON |
| Zip Code Of The Provider | 638015043 |
| State Code Of The Provider | MO |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nephrology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 38 |
| Number Of Services | 11159 |
| Number Of Medicare Beneficiaries | 3012 |
| Total Submitted Charge Amount | 1363587 |
| Total Medicare Allowed Amount | 550559.15 |
| Total Medicare Payment Amount | 413370.8 |
| Total Medicare Standardized Payment Amount | 434922.97 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 2662 |
| Number Of Medicare Beneficiaries With Drug Services | 13 |
| Total Drug Submitted ChargeAmount | 42623.5 |
| Total Drug Medicare AllowedAmount | 9874.56 |
| Total Drug Medicare PaymentAmount | 7186.62 |
| Total Drug Medicare Standardized Payment Amount | 7186.62 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 36 |
| Number Of Medical Services | 8497 |
| Number Of Medicare Beneficiaries With Medical Services | 3012 |
| Total Medical Submitted Charge Amount | 1320963.5 |
| Total Medical Medicare Allowed Amount | 540684.59 |
| Total Medical Medicare Payment Amount | 406184.18 |
| Total Medical Medicare Standardized Payment Amount | 427736.35 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 816 |
| Number Of Beneficiaries Age 65 to 74 | 935 |
| Number Of Beneficiaries Age 75 to 84 | 771 |
| Number Of Beneficiaries Age Greater 84 | 490 |
| Number Of Female Beneficiaries | 1735 |
| Number Of Male Beneficiaries | 1277 |
| Number Of Non Hispanic White Beneficiaries | 2572 |
| Number Of Black or African American Beneficiaries | 415 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 13 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 1525 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1487 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 24 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 34 |
| Percent Of With Chronic Kidney Disease | 42 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 37 |
| Percent Of With Depression | 36 |
| Percent Of With Diabetes | 46 |
| Percent Of With Hyperlipidemia | 62 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 48 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 50 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 13 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.8035 |