| National Provider Identifier [NPI]: | 1639192206 |
| Last Name Of The Provider | SISTRUN |
| First Name Of The Provider | NIKKI |
| Middle Initial Of The Provider | T |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 559 W GERMANTOWN PIKE |
| Street Address 2 Of The Provider | |
| City Of The Provider | EAST NORRITON |
| Zip Code Of The Provider | 194034250 |
| State Code Of The Provider | PA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 128 |
| Number Of Services | 3753 |
| Number Of Medicare Beneficiaries | 2358 |
| Total Submitted Charge Amount | 395170 |
| Total Medicare Allowed Amount | 107314.83 |
| Total Medicare Payment Amount | 78312.72 |
| Total Medicare Standardized Payment Amount | 75150.18 |
| 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 | 128 |
| Number Of Medical Services | 3753 |
| Number Of Medicare Beneficiaries With Medical Services | 2358 |
| Total Medical Submitted Charge Amount | 395170 |
| Total Medical Medicare Allowed Amount | 107314.83 |
| Total Medical Medicare Payment Amount | 78312.72 |
| Total Medical Medicare Standardized Payment Amount | 75150.18 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 370 |
| Number Of Beneficiaries Age 65 to 74 | 916 |
| Number Of Beneficiaries Age 75 to 84 | 618 |
| Number Of Beneficiaries Age Greater 84 | 454 |
| Number Of Female Beneficiaries | 1356 |
| Number Of Male Beneficiaries | 1002 |
| Number Of Non Hispanic White Beneficiaries | 1896 |
| Number Of Black or African American Beneficiaries | 339 |
| Number Of AsianPacific Islander Beneficiaries | 44 |
| Number Of Hispanic Beneficiaries | 44 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 35 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1894 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 464 |
| Percent Of With Atrial Fibrillation | 19 |
| Percent Of With Alzheimers Disease or Dementia | 15 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 17 |
| Percent Of With Heart Failure | 32 |
| Percent Of With Chronic Kidney Disease | 34 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 23 |
| Percent Of With Depression | 28 |
| Percent Of With Diabetes | 37 |
| Percent Of With Hyperlipidemia | 68 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 56 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 47 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 9 |
| Average HCC Risk Score Of Beneficiaries | 1.657 |