| National Provider Identifier [NPI]: | 1154399483 |
| Last Name Of The Provider | SIDOR |
| First Name Of The Provider | TIM |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 6900 PEARL ROAD |
| Street Address 2 Of The Provider | 2ND FLOOR |
| City Of The Provider | MIDDLEBURG HEIGHTS |
| Zip Code Of The Provider | 441303639 |
| State Code Of The Provider | OH |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Urology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 118 |
| Number Of Services | 13509 |
| Number Of Medicare Beneficiaries | 1315 |
| Total Submitted Charge Amount | 1452360.44 |
| Total Medicare Allowed Amount | 625860.78 |
| Total Medicare Payment Amount | 473557.89 |
| Total Medicare Standardized Payment Amount | 484901.74 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 11 |
| Number Of Drug Services | 8315 |
| Number Of Medicare Beneficiaries With Drug Services | 86 |
| Total Drug Submitted ChargeAmount | 433541.4 |
| Total Drug Medicare AllowedAmount | 309549.54 |
| Total Drug Medicare PaymentAmount | 241349.1 |
| Total Drug Medicare Standardized Payment Amount | 241349.1 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 107 |
| Number Of Medical Services | 5194 |
| Number Of Medicare Beneficiaries With Medical Services | 1315 |
| Total Medical Submitted Charge Amount | 1018819.04 |
| Total Medical Medicare Allowed Amount | 316311.24 |
| Total Medical Medicare Payment Amount | 232208.79 |
| Total Medical Medicare Standardized Payment Amount | 243552.64 |
| Average Age Of Beneficiaries | 77 |
| Number Of Beneficiaries Age Less65 | 53 |
| Number Of Beneficiaries Age 65 to 74 | 445 |
| Number Of Beneficiaries Age 75 to 84 | 540 |
| Number Of Beneficiaries Age Greater 84 | 277 |
| Number Of Female Beneficiaries | 272 |
| Number Of Male Beneficiaries | 1043 |
| Number Of Non Hispanic White Beneficiaries | 1251 |
| Number Of Black or African American Beneficiaries | 17 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 19 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 15 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1223 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 92 |
| Percent Of With Atrial Fibrillation | 16 |
| Percent Of With Alzheimers Disease or Dementia | 13 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 25 |
| Percent Of With Heart Failure | 21 |
| Percent Of With Chronic Kidney Disease | 31 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 16 |
| Percent Of With Depression | 16 |
| Percent Of With Diabetes | 32 |
| Percent Of With Hyperlipidemia | 63 |
| Percent Of With Hypertension | 74 |
| Percent Of With Ischemic Heart Disease | 47 |
| Percent Of With Osteoporosis | 4 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 46 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.3971 |