Physician Compare National (NPI:1033120993)

HEALTHCARE PROVIDER: LILLY S BONTRAGER MD

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1033120993
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	8022042639
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20200707003271
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	BONTRAGER
	Individual professional last name
Provider First Name	LILLY
	Individual professional first name
Provider Gender	F
	The provider's gender if the provider is a person.
Provider Credential Text	MD
	The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	2000
	Individual professional's medical school graduation year
Primary Specialty	FAMILY MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	MERCY HEALTH PHYSICIANS LIMA, LLC
	Legal name of the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Group Practice PAC ID	3375607351
	Unique Group Practice ID assigned by PECOS to the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Number of Group Practice members	193
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	1800 E 5TH ST
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 1
	Group Practice or individual's line 2 address
City	DELPHOS
	Group Practice or individual's city
State	OH
	Group Practice or individual's state
Zip Code	458339180
	Group Practice or individual's zip code (9 digits when available)
Phone Number	4196922662
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	150146
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	PARKVIEW NOBLE HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	360066
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	ST RITA'S MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	150021
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	PARKVIEW REGIONAL MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 3
Professional Accepts Medicare Assignment	Y