| National Provider Identifier [NPI]: | 1518156181 |
| Last Name Of The Provider | LY |
| First Name Of The Provider | NICK |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | DO |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2864 WOODRUFF ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | FORT BRAGG |
| Zip Code Of The Provider | 28320 |
| State Code Of The Provider | NC |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 18 |
| Number Of Services | 624 |
| Number Of Medicare Beneficiaries | 453 |
| Total Submitted Charge Amount | 560708 |
| Total Medicare Allowed Amount | 65510.28 |
| Total Medicare Payment Amount | 50663.88 |
| Total Medicare Standardized Payment Amount | 52209.09 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 0 |
| Number Of Drug Services | 0 |
| Number Of Medicare Beneficiaries With Drug Services | 0 |
| Total Drug Submitted ChargeAmount | 0 |
| Total Drug Medicare AllowedAmount | 0 |
| Total Drug Medicare PaymentAmount | 0 |
| Total Drug Medicare Standardized Payment Amount | 0 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 18 |
| Number Of Medical Services | 624 |
| Number Of Medicare Beneficiaries With Medical Services | 453 |
| Total Medical Submitted Charge Amount | 560708 |
| Total Medical Medicare Allowed Amount | 65510.28 |
| Total Medical Medicare Payment Amount | 50663.88 |
| Total Medical Medicare Standardized Payment Amount | 52209.09 |
| Average Age Of Beneficiaries | 68 |
| Number Of Beneficiaries Age Less65 | 155 |
| Number Of Beneficiaries Age 65 to 74 | 130 |
| Number Of Beneficiaries Age 75 to 84 | 113 |
| Number Of Beneficiaries Age Greater 84 | 55 |
| Number Of Female Beneficiaries | 262 |
| Number Of Male Beneficiaries | 191 |
| Number Of Non Hispanic White Beneficiaries | 291 |
| Number Of Black or African American Beneficiaries | 144 |
| 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 | 213 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 240 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 25 |
| Percent Of With Asthma | 13 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 37 |
| Percent Of With Chronic Kidney Disease | 40 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 35 |
| Percent Of With Depression | 37 |
| Percent Of With Diabetes | 48 |
| Percent Of With Hyperlipidemia | 63 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 54 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 51 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 13 |
| Percent Of With Stroke | 13 |
| Average HCC Risk Score Of Beneficiaries | 1.908 |