| National Provider Identifier [NPI]: | 1316971070 |
| Last Name Of The Provider | LISSE |
| First Name Of The Provider | BRIAN |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | HOLY FAMILY HOSPITAL ED |
| Street Address 2 Of The Provider | 70 EAST STREET |
| City Of The Provider | METHUEN |
| Zip Code Of The Provider | 01844 |
| State Code Of The Provider | MA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Emergency Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 28 |
| Number Of Services | 956 |
| Number Of Medicare Beneficiaries | 574 |
| Total Submitted Charge Amount | 334214 |
| Total Medicare Allowed Amount | 96547.95 |
| Total Medicare Payment Amount | 73365.73 |
| Total Medicare Standardized Payment Amount | 71933.9 |
| 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 | 28 |
| Number Of Medical Services | 956 |
| Number Of Medicare Beneficiaries With Medical Services | 574 |
| Total Medical Submitted Charge Amount | 334214 |
| Total Medical Medicare Allowed Amount | 96547.95 |
| Total Medical Medicare Payment Amount | 73365.73 |
| Total Medical Medicare Standardized Payment Amount | 71933.9 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 155 |
| Number Of Beneficiaries Age 65 to 74 | 143 |
| Number Of Beneficiaries Age 75 to 84 | 150 |
| Number Of Beneficiaries Age Greater 84 | 126 |
| Number Of Female Beneficiaries | 335 |
| Number Of Male Beneficiaries | 239 |
| Number Of Non Hispanic White Beneficiaries | 533 |
| Number Of Black or African American Beneficiaries | 14 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 11 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 379 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 195 |
| Percent Of With Atrial Fibrillation | 22 |
| Percent Of With Alzheimers Disease or Dementia | 22 |
| Percent Of With Asthma | 18 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 35 |
| Percent Of With Chronic Kidney Disease | 31 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 24 |
| Percent Of With Depression | 42 |
| Percent Of With Diabetes | 38 |
| Percent Of With Hyperlipidemia | 60 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 57 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 43 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 17 |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 1.5703 |