| National Provider Identifier [NPI]: | 1841252145 |
| Last Name Of The Provider | LILLY |
| First Name Of The Provider | SCOTT |
| Middle Initial Of The Provider | G |
| Credentials Of The Provider | DDS, MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 350 S 40TH ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | MUSKOGEE |
| Zip Code Of The Provider | 744014915 |
| State Code Of The Provider | OK |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Hematology/Oncology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 163 |
| Number Of Services | 10710 |
| Number Of Medicare Beneficiaries | 310 |
| Total Submitted Charge Amount | 1028299.95 |
| Total Medicare Allowed Amount | 442795.91 |
| Total Medicare Payment Amount | 329691.82 |
| Total Medicare Standardized Payment Amount | 356990.47 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 27 |
| Number Of Drug Services | 4160 |
| Number Of Medicare Beneficiaries With Drug Services | 171 |
| Total Drug Submitted ChargeAmount | 130865.95 |
| Total Drug Medicare AllowedAmount | 15534.33 |
| Total Drug Medicare PaymentAmount | 12279.99 |
| Total Drug Medicare Standardized Payment Amount | 12279.99 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 136 |
| Number Of Medical Services | 6550 |
| Number Of Medicare Beneficiaries With Medical Services | 310 |
| Total Medical Submitted Charge Amount | 897434 |
| Total Medical Medicare Allowed Amount | 427261.58 |
| Total Medical Medicare Payment Amount | 317411.83 |
| Total Medical Medicare Standardized Payment Amount | 344710.48 |
| Average Age Of Beneficiaries | 62 |
| Number Of Beneficiaries Age Less65 | 172 |
| Number Of Beneficiaries Age 65 to 74 | 77 |
| Number Of Beneficiaries Age 75 to 84 | 42 |
| Number Of Beneficiaries Age Greater 84 | 19 |
| Number Of Female Beneficiaries | 206 |
| Number Of Male Beneficiaries | 104 |
| Number Of Non Hispanic White Beneficiaries | 210 |
| Number Of Black or African American Beneficiaries | 51 |
| 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 | 142 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 168 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | 13 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 24 |
| Percent Of With Chronic Kidney Disease | 28 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 43 |
| Percent Of With Depression | 53 |
| Percent Of With Diabetes | 38 |
| Percent Of With Hyperlipidemia | 48 |
| Percent Of With Hypertension | 72 |
| Percent Of With Ischemic Heart Disease | 44 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 58 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.7386 |