| National Provider Identifier [NPI]: | 1730144882 |
| Last Name Of The Provider | SIEGEL |
| First Name Of The Provider | LORI |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2101 WAUKEGAN RD |
| Street Address 2 Of The Provider | SUITE 110 |
| City Of The Provider | BANNOCKBURN |
| Zip Code Of The Provider | 600151836 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Rheumatology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 75 |
| Number Of Services | 17038 |
| Number Of Medicare Beneficiaries | 632 |
| Total Submitted Charge Amount | 606759 |
| Total Medicare Allowed Amount | 296245.17 |
| Total Medicare Payment Amount | 227216.65 |
| Total Medicare Standardized Payment Amount | 219013.76 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 11 |
| Number Of Drug Services | 14899 |
| Number Of Medicare Beneficiaries With Drug Services | 124 |
| Total Drug Submitted ChargeAmount | 148475 |
| Total Drug Medicare AllowedAmount | 118716.45 |
| Total Drug Medicare PaymentAmount | 92928.77 |
| Total Drug Medicare Standardized Payment Amount | 92928.77 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 64 |
| Number Of Medical Services | 2139 |
| Number Of Medicare Beneficiaries With Medical Services | 632 |
| Total Medical Submitted Charge Amount | 458284 |
| Total Medical Medicare Allowed Amount | 177528.72 |
| Total Medical Medicare Payment Amount | 134287.88 |
| Total Medical Medicare Standardized Payment Amount | 126084.99 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 80 |
| Number Of Beneficiaries Age 65 to 74 | 260 |
| Number Of Beneficiaries Age 75 to 84 | 215 |
| Number Of Beneficiaries Age Greater 84 | 77 |
| Number Of Female Beneficiaries | 530 |
| Number Of Male Beneficiaries | 102 |
| Number Of Non Hispanic White Beneficiaries | 588 |
| Number Of Black or African American Beneficiaries | 13 |
| 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 | 16 |
| Number Of Beneficiaries With Medicare Only Entitlement | 600 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 32 |
| Percent Of With Atrial Fibrillation | 8 |
| Percent Of With Alzheimers Disease or Dementia | 5 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 8 |
| Percent Of With Chronic Kidney Disease | 12 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 8 |
| Percent Of With Depression | 19 |
| Percent Of With Diabetes | 16 |
| Percent Of With Hyperlipidemia | 52 |
| Percent Of With Hypertension | 52 |
| Percent Of With Ischemic Heart Disease | 16 |
| Percent Of With Osteoporosis | 28 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 59 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.0116 |