| National Provider Identifier [NPI]: | 1770512006 |
| Last Name Of The Provider | SIEGEL |
| First Name Of The Provider | JACK |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 5716 CLEVELAND ST |
| Street Address 2 Of The Provider | SUITE 200 |
| City Of The Provider | VIRGINIA BEACH |
| Zip Code Of The Provider | 234621784 |
| State Code Of The Provider | VA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Orthopedic Surgery |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 59 |
| Number Of Services | 10535 |
| Number Of Medicare Beneficiaries | 1072 |
| Total Submitted Charge Amount | 2257521.58 |
| Total Medicare Allowed Amount | 557673.81 |
| Total Medicare Payment Amount | 416984.87 |
| Total Medicare Standardized Payment Amount | 429669.59 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 5204 |
| Number Of Medicare Beneficiaries With Drug Services | 422 |
| Total Drug Submitted ChargeAmount | 18607.5 |
| Total Drug Medicare AllowedAmount | 11860.48 |
| Total Drug Medicare PaymentAmount | 8568.65 |
| Total Drug Medicare Standardized Payment Amount | 8568.65 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 57 |
| Number Of Medical Services | 5331 |
| Number Of Medicare Beneficiaries With Medical Services | 1072 |
| Total Medical Submitted Charge Amount | 2238914.08 |
| Total Medical Medicare Allowed Amount | 545813.33 |
| Total Medical Medicare Payment Amount | 408416.22 |
| Total Medical Medicare Standardized Payment Amount | 421100.94 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 48 |
| Number Of Beneficiaries Age 65 to 74 | 475 |
| Number Of Beneficiaries Age 75 to 84 | 426 |
| Number Of Beneficiaries Age Greater 84 | 123 |
| Number Of Female Beneficiaries | 652 |
| Number Of Male Beneficiaries | 420 |
| Number Of Non Hispanic White Beneficiaries | 911 |
| Number Of Black or African American Beneficiaries | 113 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 21 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 1035 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 37 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 6 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 11 |
| Percent Of With Chronic Kidney Disease | 19 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 12 |
| Percent Of With Depression | 21 |
| Percent Of With Diabetes | 25 |
| Percent Of With Hyperlipidemia | 73 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 28 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 75 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.0661 |