| National Provider Identifier [NPI]: | 1568523199 |
| Last Name Of The Provider | HANISH |
| First Name Of The Provider | SIDNEY |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1A VILLAGE SQUARE SHOP CTR |
| Street Address 2 Of The Provider | |
| City Of The Provider | HAZELWOOD |
| Zip Code Of The Provider | 630421817 |
| State Code Of The Provider | MO |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Ophthalmology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 27 |
| Number Of Services | 5888 |
| Number Of Medicare Beneficiaries | 2795 |
| Total Submitted Charge Amount | 1396473 |
| Total Medicare Allowed Amount | 666297.87 |
| Total Medicare Payment Amount | 475191.66 |
| Total Medicare Standardized Payment Amount | 484349.93 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 0 |
| Number Of Drug Services | 0 |
| Number Of Medicare Beneficiaries With Drug Services | 0 |
| Total Drug Submitted ChargeAmount | 0 |
| Total Drug Medicare AllowedAmount | 0 |
| Total Drug Medicare PaymentAmount | 0 |
| Total Drug Medicare Standardized Payment Amount | 0 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 27 |
| Number Of Medical Services | 5888 |
| Number Of Medicare Beneficiaries With Medical Services | 2795 |
| Total Medical Submitted Charge Amount | 1396473 |
| Total Medical Medicare Allowed Amount | 666297.87 |
| Total Medical Medicare Payment Amount | 475191.66 |
| Total Medical Medicare Standardized Payment Amount | 484349.93 |
| Average Age Of Beneficiaries | 78 |
| Number Of Beneficiaries Age Less65 | 80 |
| Number Of Beneficiaries Age 65 to 74 | 889 |
| Number Of Beneficiaries Age 75 to 84 | 1137 |
| Number Of Beneficiaries Age Greater 84 | 689 |
| Number Of Female Beneficiaries | 1730 |
| Number Of Male Beneficiaries | 1065 |
| Number Of Non Hispanic White Beneficiaries | 2730 |
| Number Of Black or African American Beneficiaries | 40 |
| 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 | 14 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2674 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 121 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 4 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 17 |
| Percent Of With Chronic Kidney Disease | 18 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 12 |
| Percent Of With Depression | 15 |
| Percent Of With Diabetes | 33 |
| Percent Of With Hyperlipidemia | 62 |
| Percent Of With Hypertension | 74 |
| Percent Of With Ischemic Heart Disease | 38 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 39 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.0535 |