| National Provider Identifier [NPI]: | 1679588750 |
| Last Name Of The Provider | LILLE |
| First Name Of The Provider | KEVIN |
| Middle Initial Of The Provider | D |
| Credentials Of The Provider | PAC |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 21298 OLEAN BLVD |
| Street Address 2 Of The Provider | FAWCETT MEMORIAL HOSPITAL |
| City Of The Provider | PORT CHARLOTTE |
| Zip Code Of The Provider | 33952 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 20 |
| Number Of Services | 969 |
| Number Of Medicare Beneficiaries | 799 |
| Total Submitted Charge Amount | 1098492 |
| Total Medicare Allowed Amount | 105197.47 |
| Total Medicare Payment Amount | 80209.12 |
| Total Medicare Standardized Payment Amount | 93085.82 |
| 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 | 20 |
| Number Of Medical Services | 969 |
| Number Of Medicare Beneficiaries With Medical Services | 799 |
| Total Medical Submitted Charge Amount | 1098492 |
| Total Medical Medicare Allowed Amount | 105197.47 |
| Total Medical Medicare Payment Amount | 80209.12 |
| Total Medical Medicare Standardized Payment Amount | 93085.82 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 148 |
| Number Of Beneficiaries Age 65 to 74 | 237 |
| Number Of Beneficiaries Age 75 to 84 | 224 |
| Number Of Beneficiaries Age Greater 84 | 190 |
| Number Of Female Beneficiaries | 445 |
| Number Of Male Beneficiaries | 354 |
| Number Of Non Hispanic White Beneficiaries | 728 |
| Number Of Black or African American Beneficiaries | 32 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 27 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 598 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 201 |
| Percent Of With Atrial Fibrillation | 19 |
| Percent Of With Alzheimers Disease or Dementia | 26 |
| Percent Of With Asthma | 12 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 30 |
| Percent Of With Chronic Kidney Disease | 38 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 33 |
| Percent Of With Depression | 37 |
| Percent Of With Diabetes | 38 |
| Percent Of With Hyperlipidemia | 69 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 60 |
| Percent Of With Osteoporosis | 17 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 52 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 10 |
| Percent Of With Stroke | 10 |
| Average HCC Risk Score Of Beneficiaries | 1.8076 |