| National Provider Identifier [NPI]: | 1578547287 |
| Last Name Of The Provider | SIEGELBAUM |
| First Name Of The Provider | MARC |
| Middle Initial Of The Provider | H |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 7505 OSLER DR |
| Street Address 2 Of The Provider | STE 506 |
| City Of The Provider | TOWSON |
| Zip Code Of The Provider | 212047736 |
| State Code Of The Provider | MD |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Urology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 103 |
| Number Of Services | 5147 |
| Number Of Medicare Beneficiaries | 793 |
| Total Submitted Charge Amount | 846668 |
| Total Medicare Allowed Amount | 410740.63 |
| Total Medicare Payment Amount | 308599.06 |
| Total Medicare Standardized Payment Amount | 296206.62 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 7 |
| Number Of Drug Services | 1391 |
| Number Of Medicare Beneficiaries With Drug Services | 29 |
| Total Drug Submitted ChargeAmount | 124413 |
| Total Drug Medicare AllowedAmount | 63173.77 |
| Total Drug Medicare PaymentAmount | 49425.31 |
| Total Drug Medicare Standardized Payment Amount | 49425.31 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 96 |
| Number Of Medical Services | 3756 |
| Number Of Medicare Beneficiaries With Medical Services | 793 |
| Total Medical Submitted Charge Amount | 722255 |
| Total Medical Medicare Allowed Amount | 347566.86 |
| Total Medical Medicare Payment Amount | 259173.75 |
| Total Medical Medicare Standardized Payment Amount | 246781.31 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 31 |
| Number Of Beneficiaries Age 65 to 74 | 347 |
| Number Of Beneficiaries Age 75 to 84 | 300 |
| Number Of Beneficiaries Age Greater 84 | 115 |
| Number Of Female Beneficiaries | 140 |
| Number Of Male Beneficiaries | 653 |
| Number Of Non Hispanic White Beneficiaries | 669 |
| Number Of Black or African American Beneficiaries | 85 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 20 |
| Number Of Beneficiaries With Medicare Only Entitlement | 770 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 23 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 27 |
| Percent Of With Heart Failure | 15 |
| Percent Of With Chronic Kidney Disease | 32 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 12 |
| Percent Of With Depression | 15 |
| Percent Of With Diabetes | 32 |
| Percent Of With Hyperlipidemia | 68 |
| Percent Of With Hypertension | 74 |
| Percent Of With Ischemic Heart Disease | 44 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 33 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.2012 |