| National Provider Identifier [NPI]: | 1447216999 |
| Last Name Of The Provider | LEBOURDAIS |
| First Name Of The Provider | JILL |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | PA |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 4905 BERL DR |
| Street Address 2 Of The Provider | |
| City Of The Provider | SAGINAW |
| Zip Code Of The Provider | 486042801 |
| State Code Of The Provider | MI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 26 |
| Number Of Services | 9774 |
| Number Of Medicare Beneficiaries | 514 |
| Total Submitted Charge Amount | 177708.8 |
| Total Medicare Allowed Amount | 133749.99 |
| Total Medicare Payment Amount | 101293.02 |
| Total Medicare Standardized Payment Amount | 115497.73 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 8282 |
| Number Of Medicare Beneficiaries With Drug Services | 33 |
| Total Drug Submitted ChargeAmount | 54534.77 |
| Total Drug Medicare AllowedAmount | 54331.12 |
| Total Drug Medicare PaymentAmount | 42595.72 |
| Total Drug Medicare Standardized Payment Amount | 42595.72 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 21 |
| Number Of Medical Services | 1492 |
| Number Of Medicare Beneficiaries With Medical Services | 514 |
| Total Medical Submitted Charge Amount | 123174.03 |
| Total Medical Medicare Allowed Amount | 79418.87 |
| Total Medical Medicare Payment Amount | 58697.3 |
| Total Medical Medicare Standardized Payment Amount | 72902.01 |
| Average Age Of Beneficiaries | 58 |
| Number Of Beneficiaries Age Less65 | 320 |
| Number Of Beneficiaries Age 65 to 74 | 100 |
| Number Of Beneficiaries Age 75 to 84 | 59 |
| Number Of Beneficiaries Age Greater 84 | 35 |
| Number Of Female Beneficiaries | 290 |
| Number Of Male Beneficiaries | 224 |
| Number Of Non Hispanic White Beneficiaries | 370 |
| Number Of Black or African American Beneficiaries | 113 |
| 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 | 145 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 369 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 24 |
| Percent Of With Asthma | 20 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 31 |
| Percent Of With Chronic Kidney Disease | 33 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 36 |
| Percent Of With Depression | 67 |
| Percent Of With Diabetes | 39 |
| Percent Of With Hyperlipidemia | 50 |
| Percent Of With Hypertension | 69 |
| Percent Of With Ischemic Heart Disease | 43 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 44 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 54 |
| Percent Of With Stroke | 10 |
| Average HCC Risk Score Of Beneficiaries | 1.9703 |