| National Provider Identifier [NPI]: | 1215908124 |
| Last Name Of The Provider | GILLETTE |
| First Name Of The Provider | LISA |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 733 W CLAIREMONT AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | EAU CLAIRE |
| Zip Code Of The Provider | 547016101 |
| State Code Of The Provider | WI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 24 |
| Number Of Services | 520 |
| Number Of Medicare Beneficiaries | 226 |
| Total Submitted Charge Amount | 71517.69 |
| Total Medicare Allowed Amount | 34371.27 |
| Total Medicare Payment Amount | 23278.84 |
| Total Medicare Standardized Payment Amount | 24914.46 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 65 |
| Number Of Medicare Beneficiaries With Drug Services | 60 |
| Total Drug Submitted ChargeAmount | 3025.69 |
| Total Drug Medicare AllowedAmount | 2608.01 |
| Total Drug Medicare PaymentAmount | 2538.09 |
| Total Drug Medicare Standardized Payment Amount | 2538.09 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 20 |
| Number Of Medical Services | 455 |
| Number Of Medicare Beneficiaries With Medical Services | 226 |
| Total Medical Submitted Charge Amount | 68492 |
| Total Medical Medicare Allowed Amount | 31763.26 |
| Total Medical Medicare Payment Amount | 20740.75 |
| Total Medical Medicare Standardized Payment Amount | 22376.37 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 35 |
| Number Of Beneficiaries Age 65 to 74 | 118 |
| Number Of Beneficiaries Age 75 to 84 | 49 |
| Number Of Beneficiaries Age Greater 84 | 24 |
| Number Of Female Beneficiaries | 171 |
| Number Of Male Beneficiaries | 55 |
| Number Of Non Hispanic White Beneficiaries | |
| Number Of Black or African American Beneficiaries | |
| 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 | 194 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 32 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | 5 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 9 |
| Percent Of With Chronic Kidney Disease | 14 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 8 |
| Percent Of With Depression | 21 |
| Percent Of With Diabetes | 22 |
| Percent Of With Hyperlipidemia | 35 |
| Percent Of With Hypertension | 41 |
| Percent Of With Ischemic Heart Disease | 19 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 45 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.8786 |