| National Provider Identifier [NPI]: | 1861529174 |
| Last Name Of The Provider | PORVIN |
| First Name Of The Provider | BRIAN |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | DO |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3638 E SOUTHERN AVE |
| Street Address 2 Of The Provider | STE C 108 |
| City Of The Provider | MESA |
| Zip Code Of The Provider | 852062563 |
| State Code Of The Provider | AZ |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Pulmonary Disease |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 36 |
| Number Of Services | 2738 |
| Number Of Medicare Beneficiaries | 571 |
| Total Submitted Charge Amount | 356465 |
| Total Medicare Allowed Amount | 282588.35 |
| Total Medicare Payment Amount | 213853.42 |
| Total Medicare Standardized Payment Amount | 219719.33 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 549 |
| Number Of Medicare Beneficiaries With Drug Services | 232 |
| Total Drug Submitted ChargeAmount | 10430 |
| Total Drug Medicare AllowedAmount | 8269.4 |
| Total Drug Medicare PaymentAmount | 6510.42 |
| Total Drug Medicare Standardized Payment Amount | 6510.42 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 32 |
| Number Of Medical Services | 2189 |
| Number Of Medicare Beneficiaries With Medical Services | 571 |
| Total Medical Submitted Charge Amount | 346035 |
| Total Medical Medicare Allowed Amount | 274318.95 |
| Total Medical Medicare Payment Amount | 207343 |
| Total Medical Medicare Standardized Payment Amount | 213208.91 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 75 |
| Number Of Beneficiaries Age 65 to 74 | 308 |
| Number Of Beneficiaries Age 75 to 84 | 149 |
| Number Of Beneficiaries Age Greater 84 | 39 |
| Number Of Female Beneficiaries | 295 |
| Number Of Male Beneficiaries | 276 |
| Number Of Non Hispanic White Beneficiaries | 505 |
| Number Of Black or African American Beneficiaries | 16 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 29 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 479 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 92 |
| Percent Of With Atrial Fibrillation | 19 |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | 20 |
| Percent Of With Cancer | 20 |
| Percent Of With Heart Failure | 31 |
| Percent Of With Chronic Kidney Disease | 40 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 57 |
| Percent Of With Depression | 26 |
| Percent Of With Diabetes | 34 |
| Percent Of With Hyperlipidemia | 59 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 50 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 43 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.8615 |