| National Provider Identifier [NPI]: | 1881601714 |
| Last Name Of The Provider | BLISSENBACH |
| First Name Of The Provider | ELYSSA |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MD PA |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2065 HERSCHEL ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | JACKSONVILLE |
| Zip Code Of The Provider | 322043817 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 88 |
| Number Of Services | 12125 |
| Number Of Medicare Beneficiaries | 598 |
| Total Submitted Charge Amount | 1227786 |
| Total Medicare Allowed Amount | 830484.39 |
| Total Medicare Payment Amount | 639453.08 |
| Total Medicare Standardized Payment Amount | 647941.01 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 10 |
| Number Of Drug Services | 1608 |
| Number Of Medicare Beneficiaries With Drug Services | 388 |
| Total Drug Submitted ChargeAmount | 28865 |
| Total Drug Medicare AllowedAmount | 11163.69 |
| Total Drug Medicare PaymentAmount | 10374.4 |
| Total Drug Medicare Standardized Payment Amount | 10374.4 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 78 |
| Number Of Medical Services | 10517 |
| Number Of Medicare Beneficiaries With Medical Services | 598 |
| Total Medical Submitted Charge Amount | 1198921 |
| Total Medical Medicare Allowed Amount | 819320.7 |
| Total Medical Medicare Payment Amount | 629078.68 |
| Total Medical Medicare Standardized Payment Amount | 637566.61 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 47 |
| Number Of Beneficiaries Age 65 to 74 | 231 |
| Number Of Beneficiaries Age 75 to 84 | 207 |
| Number Of Beneficiaries Age Greater 84 | 113 |
| Number Of Female Beneficiaries | 449 |
| Number Of Male Beneficiaries | 149 |
| Number Of Non Hispanic White Beneficiaries | 539 |
| Number Of Black or African American Beneficiaries | 44 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 559 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 39 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 15 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 20 |
| Percent Of With Chronic Kidney Disease | 17 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 14 |
| Percent Of With Depression | 24 |
| Percent Of With Diabetes | 43 |
| Percent Of With Hyperlipidemia | 75 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 31 |
| Percent Of With Osteoporosis | 15 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 39 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.0924 |