Glen Neal Lilly II, PA-C
Individual provider Active NPI Physician Assistant · Hollywood, MD
NPI 1275935934 · NPPES record last updated Aug 19, 2026
Key facts
- NPI
- 1275935934
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- C0009583 (MD)
- Practice address
- 24035 Three Notch Road
Hollywood, MD 20636-4871 - Phone
- (301) 373-7100
- Fax
- (301) 373-6100
- NPI assigned
- Sep 24, 2014
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 7
Hospital & facility affiliations 2
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2014
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Medstar Medical Group - Southern Maryland LLC
Practice addresses (Care Compare)
10 Saint Patricks Dr
Waldorf, MD 20603-4527
Phone (301) 373-7900
24035 Three Notch Rd
Hollywood, MD 20636-4871
Hospital & facility affiliations
- Medstar Health Home Care
- Medstar Saint Mary'S Hospital
Merit-based Incentive Payment System (MIPS)
- Final score
- 81.41 of 100
- Quality
- 61.45
- Promoting interoperability
- 96
- Improvement activities
- 40
- Cost
- 79.91
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (3 enrollments) in SC, MD, DC
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150325002616 | SC | Practitioner - Physician Assistant | 6002133303 | Reassigns benefits to 1 organization |
| I20240913000830 | MD | Practitioner - Physician Assistant | 6002133303 | Reassigns benefits to 1 organization |
| I20260514000844 | DC | Practitioner - Physician Assistant | 6002133303 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| C0009583 | MD | MD | Physician Assistant |
| TL2189 | SC | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Georgetown Physician Associates, LLC | Current |
Accepting new patients | |
| Georgetown Physician Associates LLC | Current |
Accepting new patients | |
| Medstar Medical Group - Southern Maryland LLC | Current | Accepting new patients | |
| Medstar Southern Maryland Physicians, LLC | Past | Accepting new patients | |
| Frederick Health Hospital Inc | Past | Accepting new patients |
Locations
24035 Three Notch Rd
Hollywood, MD 20636
Phone (301) 373-2588
10 Saint Patricks Dr
Waldorf, MD 20603
Phone (301) 705-7870
2347 S Highway 17
Murrells Inlet, SC 29576
Phone (843) 357-2443
4301 Dick Pond Rd
Myrtle Beach, SC 29588
Phone (843) 652-8100
12117 Ocean Hwy
Pawleys Island, SC 29585
Phone (843) 237-8231
Interoperability endpoints
- glen.lillypac.p2@direct.msmg.nextgenshare.com
- glilly73707@direct.musc.edu
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | TL2189 | SC | |
| Physician Assistant | 363A00000X | C0009583 | MD | Yes |
Addresses
Primary practice location
24035 Three Notch Road
Hollywood, MD 20636-4871
Mailing address
24035 Three Notch Rd
Hollywood, MD 20636-4871
Phone (301) 373-7100
Other practice location 1
10 St. Patrick's Drive
Waldorf, MD 20603-4572
Phone (301) 705-7870
Other practice location 2
4301 Dick Pond Rd
Myrtle Beach, SC 29588-6807
Phone (843) 652-8100
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 216982700 | Medicaid | MD | |
| 2189 | Other | SC | MEDICAL LICENSE |
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | glen.lilly@thg.eclinicaldirectplus.com |
Other providers in Hollywood, MD
- Carol Kieber
- Chase Matthew Klasmeyer
- Bryan John Lebude
- Richard John Lee
- Lissette Libby
- Mark Constantine Cristobal Manguerra
- Carol Marcy
- Crystal Martirano
- Jenna M Mattingly
- Kathleen McClanahan
All providers in Hollywood, MD · Physician Assistant in Maryland
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 19, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.