| National Provider Identifier [NPI]: | 1932121191 |
| Last Name Of The Provider | PORT |
| First Name Of The Provider | DOUGLAS |
| Middle Initial Of The Provider | R |
| Credentials Of The Provider | D.O. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 111 E WISCONSIN AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | MILWAUKEE |
| Zip Code Of The Provider | 532024815 |
| State Code Of The Provider | WI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 117 |
| Number Of Services | 2627 |
| Number Of Medicare Beneficiaries | 1711 |
| Total Submitted Charge Amount | 462375 |
| Total Medicare Allowed Amount | 74319.62 |
| Total Medicare Payment Amount | 60785.53 |
| Total Medicare Standardized Payment Amount | 62990.57 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 0 |
| Number Of Drug Services | 0 |
| Number Of Medicare Beneficiaries With Drug Services | 0 |
| Total Drug Submitted ChargeAmount | 0 |
| Total Drug Medicare AllowedAmount | 0 |
| Total Drug Medicare PaymentAmount | 0 |
| Total Drug Medicare Standardized Payment Amount | 0 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 117 |
| Number Of Medical Services | 2627 |
| Number Of Medicare Beneficiaries With Medical Services | 1711 |
| Total Medical Submitted Charge Amount | 462375 |
| Total Medical Medicare Allowed Amount | 74319.62 |
| Total Medical Medicare Payment Amount | 60785.53 |
| Total Medical Medicare Standardized Payment Amount | 62990.57 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 363 |
| Number Of Beneficiaries Age 65 to 74 | 621 |
| Number Of Beneficiaries Age 75 to 84 | 487 |
| Number Of Beneficiaries Age Greater 84 | 240 |
| Number Of Female Beneficiaries | 1201 |
| Number Of Male Beneficiaries | 510 |
| Number Of Non Hispanic White Beneficiaries | 1526 |
| Number Of Black or African American Beneficiaries | 98 |
| Number Of AsianPacific Islander Beneficiaries | 16 |
| Number Of Hispanic Beneficiaries | 58 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 1259 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 452 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 11 |
| Percent Of With Asthma | 13 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 22 |
| Percent Of With Chronic Kidney Disease | 24 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 21 |
| Percent Of With Depression | 28 |
| Percent Of With Diabetes | 31 |
| Percent Of With Hyperlipidemia | 57 |
| Percent Of With Hypertension | 65 |
| Percent Of With Ischemic Heart Disease | 33 |
| Percent Of With Osteoporosis | 15 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 46 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.3018 |