| National Provider Identifier [NPI]: | 1700889003 |
| Last Name Of The Provider | LISKO |
| First Name Of The Provider | BRADLEY |
| 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 | 110 POLARIS PKWY |
| Street Address 2 Of The Provider | STE 250 |
| City Of The Provider | WESTERVILLE |
| Zip Code Of The Provider | 430828074 |
| State Code Of The Provider | OH |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 40 |
| Number Of Services | 969 |
| Number Of Medicare Beneficiaries | 121 |
| Total Submitted Charge Amount | 51794 |
| Total Medicare Allowed Amount | 40199.51 |
| Total Medicare Payment Amount | 30459.41 |
| Total Medicare Standardized Payment Amount | 31845.11 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 7 |
| Number Of Drug Services | 79 |
| Number Of Medicare Beneficiaries With Drug Services | 70 |
| Total Drug Submitted ChargeAmount | 3015 |
| Total Drug Medicare AllowedAmount | 2232.92 |
| Total Drug Medicare PaymentAmount | 2156.18 |
| Total Drug Medicare Standardized Payment Amount | 2156.18 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 33 |
| Number Of Medical Services | 890 |
| Number Of Medicare Beneficiaries With Medical Services | 120 |
| Total Medical Submitted Charge Amount | 48779 |
| Total Medical Medicare Allowed Amount | 37966.59 |
| Total Medical Medicare Payment Amount | 28303.23 |
| Total Medical Medicare Standardized Payment Amount | 29688.93 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 71 |
| Number Of Beneficiaries Age 75 to 84 | 27 |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 62 |
| Number Of Male Beneficiaries | 59 |
| Number Of Non Hispanic White Beneficiaries | 109 |
| Number Of Black or African American Beneficiaries | |
| 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 | |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | |
| Percent Of With Chronic Kidney Disease | 14 |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | 11 |
| Percent Of With Diabetes | 27 |
| Percent Of With Hyperlipidemia | 45 |
| Percent Of With Hypertension | 60 |
| Percent Of With Ischemic Heart Disease | 23 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 28 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.9152 |