| National Provider Identifier [NPI]: | 1578545349 |
| Last Name Of The Provider | SIESHOLTZ |
| First Name Of The Provider | THOMAS |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 915 LAWN AVENUE |
| Street Address 2 Of The Provider | SUITE 202 |
| City Of The Provider | SELLERSVILLE |
| Zip Code Of The Provider | 189601560 |
| State Code Of The Provider | PA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Hematology/Oncology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 102 |
| Number Of Services | 111844 |
| Number Of Medicare Beneficiaries | 678 |
| Total Submitted Charge Amount | 3833594 |
| Total Medicare Allowed Amount | 1919313.61 |
| Total Medicare Payment Amount | 1500621.21 |
| Total Medicare Standardized Payment Amount | 1481059.91 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 59 |
| Number Of Drug Services | 105773 |
| Number Of Medicare Beneficiaries With Drug Services | 240 |
| Total Drug Submitted ChargeAmount | 3174475 |
| Total Drug Medicare AllowedAmount | 1631917.04 |
| Total Drug Medicare PaymentAmount | 1277980.74 |
| Total Drug Medicare Standardized Payment Amount | 1277980.74 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 43 |
| Number Of Medical Services | 6071 |
| Number Of Medicare Beneficiaries With Medical Services | 678 |
| Total Medical Submitted Charge Amount | 659119 |
| Total Medical Medicare Allowed Amount | 287396.57 |
| Total Medical Medicare Payment Amount | 222640.47 |
| Total Medical Medicare Standardized Payment Amount | 203079.17 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 72 |
| Number Of Beneficiaries Age 65 to 74 | 262 |
| Number Of Beneficiaries Age 75 to 84 | 224 |
| Number Of Beneficiaries Age Greater 84 | 120 |
| Number Of Female Beneficiaries | 371 |
| Number Of Male Beneficiaries | 307 |
| Number Of Non Hispanic White Beneficiaries | 654 |
| Number Of Black or African American Beneficiaries | |
| 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 | |
| Number Of Beneficiaries With Medicare Only Entitlement | 600 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 78 |
| Percent Of With Atrial Fibrillation | 24 |
| Percent Of With Alzheimers Disease or Dementia | 18 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 42 |
| Percent Of With Heart Failure | 33 |
| Percent Of With Chronic Kidney Disease | 43 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 21 |
| Percent Of With Depression | 24 |
| Percent Of With Diabetes | 33 |
| Percent Of With Hyperlipidemia | 62 |
| Percent Of With Hypertension | 74 |
| Percent Of With Ischemic Heart Disease | 46 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 33 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 9 |
| Average HCC Risk Score Of Beneficiaries | 2.0788 |