| National Provider Identifier [NPI]: | 1922084649 |
| Last Name Of The Provider | LIEGEL |
| First Name Of The Provider | LESLIE |
| Middle Initial Of The Provider | P |
| Credentials Of The Provider | PA |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 34 SCHROEDER CT. |
| Street Address 2 Of The Provider | STE 100 |
| City Of The Provider | MADISON |
| Zip Code Of The Provider | 53711 |
| State Code Of The Provider | WI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 20 |
| Number Of Services | 3728 |
| Number Of Medicare Beneficiaries | 337 |
| Total Submitted Charge Amount | 372153.44 |
| Total Medicare Allowed Amount | 121714.19 |
| Total Medicare Payment Amount | 104844.48 |
| Total Medicare Standardized Payment Amount | 97912.39 |
| 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 | 20 |
| Number Of Medical Services | 3728 |
| Number Of Medicare Beneficiaries With Medical Services | 337 |
| Total Medical Submitted Charge Amount | 372153.44 |
| Total Medical Medicare Allowed Amount | 121714.19 |
| Total Medical Medicare Payment Amount | 104844.48 |
| Total Medical Medicare Standardized Payment Amount | 97912.39 |
| Average Age Of Beneficiaries | 65 |
| Number Of Beneficiaries Age Less65 | 145 |
| Number Of Beneficiaries Age 65 to 74 | 95 |
| Number Of Beneficiaries Age 75 to 84 | 70 |
| Number Of Beneficiaries Age Greater 84 | 27 |
| Number Of Female Beneficiaries | 223 |
| Number Of Male Beneficiaries | 114 |
| Number Of Non Hispanic White Beneficiaries | 307 |
| Number Of Black or African American Beneficiaries | 12 |
| 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 | 220 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 117 |
| Percent Of With Atrial Fibrillation | 9 |
| Percent Of With Alzheimers Disease or Dementia | 6 |
| Percent Of With Asthma | 13 |
| Percent Of With Cancer | 6 |
| Percent Of With Heart Failure | 15 |
| Percent Of With Chronic Kidney Disease | 19 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 15 |
| Percent Of With Depression | 45 |
| Percent Of With Diabetes | 33 |
| Percent Of With Hyperlipidemia | 46 |
| Percent Of With Hypertension | 57 |
| Percent Of With Ischemic Heart Disease | 25 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 75 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.2657 |