| National Provider Identifier [NPI]: | 1669451639 |
| Last Name Of The Provider | SIEGEL |
| First Name Of The Provider | MARC |
| Middle Initial Of The Provider | F |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1000 WATERMAN WAY |
| Street Address 2 Of The Provider | ATTN: RADIOLOGY DEPT |
| City Of The Provider | TAVARES |
| Zip Code Of The Provider | 327785266 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 191 |
| Number Of Services | 7250 |
| Number Of Medicare Beneficiaries | 4166 |
| Total Submitted Charge Amount | 876786 |
| Total Medicare Allowed Amount | 240859.8 |
| Total Medicare Payment Amount | 183675.82 |
| Total Medicare Standardized Payment Amount | 183328.93 |
| 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 | 191 |
| Number Of Medical Services | 7250 |
| Number Of Medicare Beneficiaries With Medical Services | 4166 |
| Total Medical Submitted Charge Amount | 876786 |
| Total Medical Medicare Allowed Amount | 240859.8 |
| Total Medical Medicare Payment Amount | 183675.82 |
| Total Medical Medicare Standardized Payment Amount | 183328.93 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 487 |
| Number Of Beneficiaries Age 65 to 74 | 1455 |
| Number Of Beneficiaries Age 75 to 84 | 1440 |
| Number Of Beneficiaries Age Greater 84 | 784 |
| Number Of Female Beneficiaries | 2511 |
| Number Of Male Beneficiaries | 1655 |
| Number Of Non Hispanic White Beneficiaries | 3791 |
| Number Of Black or African American Beneficiaries | 213 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 108 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 28 |
| Number Of Beneficiaries With Medicare Only Entitlement | 3419 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 747 |
| Percent Of With Atrial Fibrillation | 22 |
| Percent Of With Alzheimers Disease or Dementia | 20 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 19 |
| Percent Of With Heart Failure | 28 |
| Percent Of With Chronic Kidney Disease | 31 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 33 |
| Percent Of With Depression | 29 |
| Percent Of With Diabetes | 40 |
| Percent Of With Hyperlipidemia | 75 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 58 |
| Percent Of With Osteoporosis | 14 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 54 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 14 |
| Average HCC Risk Score Of Beneficiaries | 1.6294 |