| National Provider Identifier [NPI]: | 1043241078 |
| Last Name Of The Provider | SIU |
| First Name Of The Provider | VIRGILIO |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | PAC |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2354 E BONANZA RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | LAS VEGAS |
| Zip Code Of The Provider | 891013451 |
| State Code Of The Provider | NV |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 45 |
| Number Of Services | 565 |
| Number Of Medicare Beneficiaries | 265 |
| Total Submitted Charge Amount | 40295.61 |
| Total Medicare Allowed Amount | 27358.84 |
| Total Medicare Payment Amount | 20594.75 |
| Total Medicare Standardized Payment Amount | 24497.08 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 8 |
| Number Of Drug Services | 80 |
| Number Of Medicare Beneficiaries With Drug Services | 75 |
| Total Drug Submitted ChargeAmount | 3363.34 |
| Total Drug Medicare AllowedAmount | 2491.36 |
| Total Drug Medicare PaymentAmount | 2437.92 |
| Total Drug Medicare Standardized Payment Amount | 2437.92 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 37 |
| Number Of Medical Services | 485 |
| Number Of Medicare Beneficiaries With Medical Services | 264 |
| Total Medical Submitted Charge Amount | 36932.27 |
| Total Medical Medicare Allowed Amount | 24867.48 |
| Total Medical Medicare Payment Amount | 18156.83 |
| Total Medical Medicare Standardized Payment Amount | 22059.16 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 47 |
| Number Of Beneficiaries Age 65 to 74 | 125 |
| Number Of Beneficiaries Age 75 to 84 | 65 |
| Number Of Beneficiaries Age Greater 84 | 28 |
| Number Of Female Beneficiaries | 161 |
| Number Of Male Beneficiaries | 104 |
| Number Of Non Hispanic White Beneficiaries | 150 |
| Number Of Black or African American Beneficiaries | 18 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 86 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 188 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 77 |
| Percent Of With Atrial Fibrillation | 8 |
| Percent Of With Alzheimers Disease or Dementia | 6 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 4 |
| Percent Of With Heart Failure | 9 |
| Percent Of With Chronic Kidney Disease | 13 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 12 |
| Percent Of With Depression | 16 |
| Percent Of With Diabetes | 32 |
| Percent Of With Hyperlipidemia | 56 |
| Percent Of With Hypertension | 63 |
| Percent Of With Ischemic Heart Disease | 27 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 33 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.9611 |