| National Provider Identifier [NPI]: | 1205826526 |
| Last Name Of The Provider | ILIA |
| First Name Of The Provider | HANNA |
| Middle Initial Of The Provider | C |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 207 W LOCUST ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | LAFAYETTE |
| Zip Code Of The Provider | 370831710 |
| State Code Of The Provider | TN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 149 |
| Number Of Services | 4620 |
| Number Of Medicare Beneficiaries | 741 |
| Total Submitted Charge Amount | 667104.76 |
| Total Medicare Allowed Amount | 269089.45 |
| Total Medicare Payment Amount | 198080.89 |
| Total Medicare Standardized Payment Amount | 213767.39 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 20 |
| Number Of Drug Services | 848 |
| Number Of Medicare Beneficiaries With Drug Services | 225 |
| Total Drug Submitted ChargeAmount | 23049 |
| Total Drug Medicare AllowedAmount | 2723.94 |
| Total Drug Medicare PaymentAmount | 2364.61 |
| Total Drug Medicare Standardized Payment Amount | 2364.61 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 129 |
| Number Of Medical Services | 3772 |
| Number Of Medicare Beneficiaries With Medical Services | 741 |
| Total Medical Submitted Charge Amount | 644055.76 |
| Total Medical Medicare Allowed Amount | 266365.51 |
| Total Medical Medicare Payment Amount | 195716.28 |
| Total Medical Medicare Standardized Payment Amount | 211402.78 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 143 |
| Number Of Beneficiaries Age 65 to 74 | 292 |
| Number Of Beneficiaries Age 75 to 84 | 176 |
| Number Of Beneficiaries Age Greater 84 | 130 |
| Number Of Female Beneficiaries | 441 |
| Number Of Male Beneficiaries | 300 |
| Number Of Non Hispanic White Beneficiaries | 729 |
| 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 | 463 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 278 |
| Percent Of With Atrial Fibrillation | 9 |
| Percent Of With Alzheimers Disease or Dementia | 23 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 24 |
| Percent Of With Chronic Kidney Disease | 29 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 27 |
| Percent Of With Depression | 32 |
| Percent Of With Diabetes | 35 |
| Percent Of With Hyperlipidemia | 54 |
| Percent Of With Hypertension | 72 |
| Percent Of With Ischemic Heart Disease | 44 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 35 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 9 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.3003 |