| National Provider Identifier [NPI]: | 1497790547 |
| Last Name Of The Provider | LILLEGARD |
| First Name Of The Provider | WADE |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 400 E 3RD ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | DULUTH |
| Zip Code Of The Provider | 558051951 |
| State Code Of The Provider | MN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Sports Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 35 |
| Number Of Services | 2301 |
| Number Of Medicare Beneficiaries | 410 |
| Total Submitted Charge Amount | 150153 |
| Total Medicare Allowed Amount | 87168.96 |
| Total Medicare Payment Amount | 61958.82 |
| Total Medicare Standardized Payment Amount | 58269.13 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 604 |
| Number Of Medicare Beneficiaries With Drug Services | 51 |
| Total Drug Submitted ChargeAmount | 6221 |
| Total Drug Medicare AllowedAmount | 2512.51 |
| Total Drug Medicare PaymentAmount | 1957.8 |
| Total Drug Medicare Standardized Payment Amount | 1957.8 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 31 |
| Number Of Medical Services | 1697 |
| Number Of Medicare Beneficiaries With Medical Services | 410 |
| Total Medical Submitted Charge Amount | 143932 |
| Total Medical Medicare Allowed Amount | 84656.45 |
| Total Medical Medicare Payment Amount | 60001.02 |
| Total Medical Medicare Standardized Payment Amount | 56311.33 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 83 |
| Number Of Beneficiaries Age 65 to 74 | 162 |
| Number Of Beneficiaries Age 75 to 84 | 110 |
| Number Of Beneficiaries Age Greater 84 | 55 |
| Number Of Female Beneficiaries | 268 |
| Number Of Male Beneficiaries | 142 |
| Number Of Non Hispanic White Beneficiaries | 393 |
| Number Of Black or African American Beneficiaries | 0 |
| 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 | 318 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 92 |
| Percent Of With Atrial Fibrillation | 8 |
| Percent Of With Alzheimers Disease or Dementia | 4 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 7 |
| Percent Of With Heart Failure | 13 |
| Percent Of With Chronic Kidney Disease | 21 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 9 |
| Percent Of With Depression | 24 |
| Percent Of With Diabetes | 27 |
| Percent Of With Hyperlipidemia | 43 |
| Percent Of With Hypertension | 57 |
| Percent Of With Ischemic Heart Disease | 23 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 69 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.0107 |