| National Provider Identifier [NPI]: | 1609948256 |
| Last Name Of The Provider | SIEGEL |
| First Name Of The Provider | SHARON |
| Middle Initial Of The Provider | G |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 22 BRAMHALL ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | PORTLAND |
| Zip Code Of The Provider | 041023134 |
| State Code Of The Provider | ME |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 116 |
| Number Of Services | 6586 |
| Number Of Medicare Beneficiaries | 4201 |
| Total Submitted Charge Amount | 814849 |
| Total Medicare Allowed Amount | 151358.47 |
| Total Medicare Payment Amount | 114940.53 |
| Total Medicare Standardized Payment Amount | 118975.96 |
| 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 | 116 |
| Number Of Medical Services | 6586 |
| Number Of Medicare Beneficiaries With Medical Services | 4201 |
| Total Medical Submitted Charge Amount | 814849 |
| Total Medical Medicare Allowed Amount | 151358.47 |
| Total Medical Medicare Payment Amount | 114940.53 |
| Total Medical Medicare Standardized Payment Amount | 118975.96 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 860 |
| Number Of Beneficiaries Age 65 to 74 | 1339 |
| Number Of Beneficiaries Age 75 to 84 | 1231 |
| Number Of Beneficiaries Age Greater 84 | 771 |
| Number Of Female Beneficiaries | 2389 |
| Number Of Male Beneficiaries | 1812 |
| Number Of Non Hispanic White Beneficiaries | 4030 |
| Number Of Black or African American Beneficiaries | 35 |
| Number Of AsianPacific Islander Beneficiaries | 49 |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 58 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2545 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1656 |
| Percent Of With Atrial Fibrillation | 22 |
| Percent Of With Alzheimers Disease or Dementia | 15 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 34 |
| Percent Of With Chronic Kidney Disease | 38 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 28 |
| Percent Of With Depression | 40 |
| Percent Of With Diabetes | 34 |
| Percent Of With Hyperlipidemia | 60 |
| Percent Of With Hypertension | 73 |
| Percent Of With Ischemic Heart Disease | 41 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 38 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 9 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.7273 |