| National Provider Identifier [NPI]: | 1861442931 |
| Last Name Of The Provider | SIEWERT |
| First Name Of The Provider | STEVEN |
| Middle Initial Of The Provider | P |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 251 E COTTAGE GROVE RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | COTTAGE GROVE |
| Zip Code Of The Provider | 535279619 |
| State Code Of The Provider | WI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 82 |
| Number Of Services | 1247 |
| Number Of Medicare Beneficiaries | 162 |
| Total Submitted Charge Amount | 118711 |
| Total Medicare Allowed Amount | 40945.48 |
| Total Medicare Payment Amount | 30084.02 |
| Total Medicare Standardized Payment Amount | 31067.08 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 8 |
| Number Of Drug Services | 95 |
| Number Of Medicare Beneficiaries With Drug Services | 59 |
| Total Drug Submitted ChargeAmount | 2663 |
| Total Drug Medicare AllowedAmount | 2363.97 |
| Total Drug Medicare PaymentAmount | 2249.92 |
| Total Drug Medicare Standardized Payment Amount | 2249.92 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 74 |
| Number Of Medical Services | 1152 |
| Number Of Medicare Beneficiaries With Medical Services | 160 |
| Total Medical Submitted Charge Amount | 116048 |
| Total Medical Medicare Allowed Amount | 38581.51 |
| Total Medical Medicare Payment Amount | 27834.1 |
| Total Medical Medicare Standardized Payment Amount | 28817.16 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 22 |
| Number Of Beneficiaries Age 65 to 74 | 79 |
| Number Of Beneficiaries Age 75 to 84 | 34 |
| Number Of Beneficiaries Age Greater 84 | 27 |
| Number Of Female Beneficiaries | 86 |
| Number Of Male Beneficiaries | 76 |
| Number Of Non Hispanic White Beneficiaries | |
| Number Of Black or African American Beneficiaries | |
| 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 | |
| Number Of Beneficiaries With Medicare Only Entitlement | 140 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 22 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 14 |
| Percent Of With Chronic Kidney Disease | 15 |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | 23 |
| Percent Of With Diabetes | 30 |
| Percent Of With Hyperlipidemia | 55 |
| Percent Of With Hypertension | 57 |
| Percent Of With Ischemic Heart Disease | 28 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 25 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.8705 |