NPIMap

Individual provider Active NPI

Elyssa Blissenbach, MD PA

  • Internal Medicine Physician
  • Jacksonville, FL
National Provider Identifier
1881601714
Registry record updated Oct 15, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
ME0069426 Issued in FL
Practice address
2065 Herschel St
Jacksonville, FL 32204-3817
Phone
(904) 387-4050
Fax
(904) 387-4860
NPI assigned
Aug 2, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 15, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X ME0069426 FL Primary

Addresses

Primary practice location

2065 Herschel St
Jacksonville, FL 32204-3817

Mailing address

2065 Herschel St
Jacksonville, FL 32204-3817
Phone (904) 387-4050

Other identifiers 1

IdentifierTypeStateIssuer
252461900MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070726000288 FL Practitioner - Internal Medicine 1759482318 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1993
Medicare assignment
May accept Medicare assignment
Telehealth
Offers telehealth services
Group practices
N E Florida Internal Medicine PAGroup PAC ID 6406947167, 2 clinicians

Practice addresses (Care Compare)

2065 Herschel St
Jacksonville, FL 32204-3817
Phone (904) 387-4050

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as individual

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine, Physician Assistant

State licenses

LicenseStateTypeSpecialty
ME0069426FLMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
N E Florida Internal Medicine PA Internal Medicine CurrentSince Feb 23, 2007 Accepting new patients
St Vincents Electrocardiography, Inc Past Accepting new patients

Locations

2065 Herschel St
Jacksonville, FL 32204
Phone (904) 387-3933

Interoperability endpoints

  • Direct secure messaging: elyssa.blissenbach@nefim.eclinicaldirectplus.com

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 12

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1154476800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1224028800000",
    "number": "1881601714",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2065 HERSCHEL ST",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322043817",
            "telephone_number": "904-387-4050",
            "fax_number": "904-387-4860"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2065 HERSCHEL ST",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322043817",
            "telephone_number": "904-387-4050",
            "fax_number": "904-387-4860"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLISSENBACH",
        "first_name": "ELYSSA",
        "credential": "MD PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-02",
        "last_updated": "2008-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "ME0069426",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "252461900",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

Verify at the official NPI Registry.