| National Provider Identifier [NPI]: | 1114033396 |
| Last Name Of The Provider | PORT |
| First Name Of The Provider | JASON |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3640 MAIN ST |
| Street Address 2 Of The Provider | SUITE 101 |
| City Of The Provider | SPRINGFIELD |
| Zip Code Of The Provider | 011071145 |
| State Code Of The Provider | MA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 103 |
| Number Of Services | 11740 |
| Number Of Medicare Beneficiaries | 1205 |
| Total Submitted Charge Amount | 2009618.75 |
| Total Medicare Allowed Amount | 302121.6 |
| Total Medicare Payment Amount | 235146.36 |
| Total Medicare Standardized Payment Amount | 226704.27 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 10255 |
| Number Of Medicare Beneficiaries With Drug Services | 197 |
| Total Drug Submitted ChargeAmount | 43920 |
| Total Drug Medicare AllowedAmount | 4797.74 |
| Total Drug Medicare PaymentAmount | 3761.46 |
| Total Drug Medicare Standardized Payment Amount | 3761.46 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 101 |
| Number Of Medical Services | 1485 |
| Number Of Medicare Beneficiaries With Medical Services | 1205 |
| Total Medical Submitted Charge Amount | 1965698.75 |
| Total Medical Medicare Allowed Amount | 297323.86 |
| Total Medical Medicare Payment Amount | 231384.9 |
| Total Medical Medicare Standardized Payment Amount | 222942.81 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 261 |
| Number Of Beneficiaries Age 65 to 74 | 476 |
| Number Of Beneficiaries Age 75 to 84 | 321 |
| Number Of Beneficiaries Age Greater 84 | 147 |
| Number Of Female Beneficiaries | 686 |
| Number Of Male Beneficiaries | 519 |
| Number Of Non Hispanic White Beneficiaries | 1025 |
| Number Of Black or African American Beneficiaries | 65 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 91 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 876 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 329 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 12 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 12 |
| Percent Of With Chronic Kidney Disease | 23 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 14 |
| Percent Of With Depression | 28 |
| Percent Of With Diabetes | 25 |
| Percent Of With Hyperlipidemia | 51 |
| Percent Of With Hypertension | 64 |
| Percent Of With Ischemic Heart Disease | 26 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 52 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.0914 |