| National Provider Identifier [NPI]: | 1194914465 |
| Last Name Of The Provider | BLITSTEIN |
| First Name Of The Provider | MARISA |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 701 N 1ST ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | SPRINGFIELD |
| Zip Code Of The Provider | 627810001 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 162 |
| Number Of Services | 3956 |
| Number Of Medicare Beneficiaries | 2427 |
| Total Submitted Charge Amount | 810518 |
| Total Medicare Allowed Amount | 136120.62 |
| Total Medicare Payment Amount | 104599.5 |
| Total Medicare Standardized Payment Amount | 106898.79 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 1 |
| Number Of Drug Services | 363 |
| Number Of Medicare Beneficiaries With Drug Services | 21 |
| Total Drug Submitted ChargeAmount | 3267 |
| Total Drug Medicare AllowedAmount | 713.2 |
| Total Drug Medicare PaymentAmount | 559.18 |
| Total Drug Medicare Standardized Payment Amount | 559.18 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 161 |
| Number Of Medical Services | 3593 |
| Number Of Medicare Beneficiaries With Medical Services | 2427 |
| Total Medical Submitted Charge Amount | 807251 |
| Total Medical Medicare Allowed Amount | 135407.42 |
| Total Medical Medicare Payment Amount | 104040.32 |
| Total Medical Medicare Standardized Payment Amount | 106339.61 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 519 |
| Number Of Beneficiaries Age 65 to 74 | 809 |
| Number Of Beneficiaries Age 75 to 84 | 706 |
| Number Of Beneficiaries Age Greater 84 | 393 |
| Number Of Female Beneficiaries | 1369 |
| Number Of Male Beneficiaries | 1058 |
| Number Of Non Hispanic White Beneficiaries | 2235 |
| Number Of Black or African American Beneficiaries | 140 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 15 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 24 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1741 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 686 |
| Percent Of With Atrial Fibrillation | 18 |
| Percent Of With Alzheimers Disease or Dementia | 17 |
| Percent Of With Asthma | 14 |
| Percent Of With Cancer | 17 |
| Percent Of With Heart Failure | 33 |
| Percent Of With Chronic Kidney Disease | 34 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 31 |
| Percent Of With Depression | 35 |
| Percent Of With Diabetes | 37 |
| Percent Of With Hyperlipidemia | 62 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 50 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 43 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 9 |
| Percent Of With Stroke | 12 |
| Average HCC Risk Score Of Beneficiaries | 1.6803 |