| National Provider Identifier [NPI]: | 1053392720 |
| Last Name Of The Provider | SIEGEL |
| First Name Of The Provider | TIMOTHY |
| Middle Initial Of The Provider | S |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1485 CHESTER BLVD |
| Street Address 2 Of The Provider | |
| City Of The Provider | RICHMOND |
| Zip Code Of The Provider | 473741919 |
| State Code Of The Provider | IN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Urology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 117 |
| Number Of Services | 4772 |
| Number Of Medicare Beneficiaries | 942 |
| Total Submitted Charge Amount | 1246749.67 |
| Total Medicare Allowed Amount | 330464.09 |
| Total Medicare Payment Amount | 246467.43 |
| Total Medicare Standardized Payment Amount | 258057.23 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 7 |
| Number Of Drug Services | 2109 |
| Number Of Medicare Beneficiaries With Drug Services | 62 |
| Total Drug Submitted ChargeAmount | 175331 |
| Total Drug Medicare AllowedAmount | 89003.6 |
| Total Drug Medicare PaymentAmount | 68375.48 |
| Total Drug Medicare Standardized Payment Amount | 68375.48 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 110 |
| Number Of Medical Services | 2663 |
| Number Of Medicare Beneficiaries With Medical Services | 942 |
| Total Medical Submitted Charge Amount | 1071418.67 |
| Total Medical Medicare Allowed Amount | 241460.49 |
| Total Medical Medicare Payment Amount | 178091.95 |
| Total Medical Medicare Standardized Payment Amount | 189681.75 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 107 |
| Number Of Beneficiaries Age 65 to 74 | 332 |
| Number Of Beneficiaries Age 75 to 84 | 337 |
| Number Of Beneficiaries Age Greater 84 | 166 |
| Number Of Female Beneficiaries | 242 |
| Number Of Male Beneficiaries | 700 |
| Number Of Non Hispanic White Beneficiaries | 898 |
| Number Of Black or African American Beneficiaries | 26 |
| 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 | 785 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 157 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 12 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 22 |
| Percent Of With Heart Failure | 23 |
| Percent Of With Chronic Kidney Disease | 40 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 17 |
| Percent Of With Depression | 21 |
| Percent Of With Diabetes | 37 |
| Percent Of With Hyperlipidemia | 61 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 52 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 41 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.413 |