| National Provider Identifier [NPI]: | 1174545362 |
| Last Name Of The Provider | PORTER |
| First Name Of The Provider | RUSSELL |
| Middle Initial Of The Provider | T |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1448 FLORIDA AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | MODESTO |
| Zip Code Of The Provider | 953504424 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 51 |
| Number Of Services | 1420 |
| Number Of Medicare Beneficiaries | 253 |
| Total Submitted Charge Amount | 139722 |
| Total Medicare Allowed Amount | 91289.35 |
| Total Medicare Payment Amount | 65449.52 |
| Total Medicare Standardized Payment Amount | 63297.87 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 12 |
| Number Of Drug Services | 264 |
| Number Of Medicare Beneficiaries With Drug Services | 70 |
| Total Drug Submitted ChargeAmount | 6832 |
| Total Drug Medicare AllowedAmount | 1962.13 |
| Total Drug Medicare PaymentAmount | 1817.68 |
| Total Drug Medicare Standardized Payment Amount | 1817.68 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 39 |
| Number Of Medical Services | 1156 |
| Number Of Medicare Beneficiaries With Medical Services | 253 |
| Total Medical Submitted Charge Amount | 132890 |
| Total Medical Medicare Allowed Amount | 89327.22 |
| Total Medical Medicare Payment Amount | 63631.84 |
| Total Medical Medicare Standardized Payment Amount | 61480.19 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 26 |
| Number Of Beneficiaries Age 65 to 74 | 118 |
| Number Of Beneficiaries Age 75 to 84 | 67 |
| Number Of Beneficiaries Age Greater 84 | 42 |
| Number Of Female Beneficiaries | 133 |
| Number Of Male Beneficiaries | 120 |
| Number Of Non Hispanic White Beneficiaries | 204 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 30 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 199 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 54 |
| Percent Of With Atrial Fibrillation | 17 |
| Percent Of With Alzheimers Disease or Dementia | 11 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 27 |
| Percent Of With Chronic Kidney Disease | 30 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 16 |
| Percent Of With Depression | 13 |
| Percent Of With Diabetes | 34 |
| Percent Of With Hyperlipidemia | 40 |
| Percent Of With Hypertension | 58 |
| Percent Of With Ischemic Heart Disease | 34 |
| Percent Of With Osteoporosis | 5 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 44 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.248 |