| National Provider Identifier [NPI]: | 1316016827 |
| Last Name Of The Provider | PORTER |
| First Name Of The Provider | DAVID |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | DO |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 401 SW WATER ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | PEORIA |
| Zip Code Of The Provider | 616021571 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 193 |
| Number Of Services | 6032 |
| Number Of Medicare Beneficiaries | 3939 |
| Total Submitted Charge Amount | 966839 |
| Total Medicare Allowed Amount | 161475.62 |
| Total Medicare Payment Amount | 120123.35 |
| Total Medicare Standardized Payment Amount | 122301.09 |
| 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 | 193 |
| Number Of Medical Services | 6032 |
| Number Of Medicare Beneficiaries With Medical Services | 3939 |
| Total Medical Submitted Charge Amount | 966839 |
| Total Medical Medicare Allowed Amount | 161475.62 |
| Total Medical Medicare Payment Amount | 120123.35 |
| Total Medical Medicare Standardized Payment Amount | 122301.09 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 636 |
| Number Of Beneficiaries Age 65 to 74 | 1434 |
| Number Of Beneficiaries Age 75 to 84 | 1258 |
| Number Of Beneficiaries Age Greater 84 | 611 |
| Number Of Female Beneficiaries | 2328 |
| Number Of Male Beneficiaries | 1611 |
| Number Of Non Hispanic White Beneficiaries | 3677 |
| Number Of Black or African American Beneficiaries | 157 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 51 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 40 |
| Number Of Beneficiaries With Medicare Only Entitlement | 3038 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 901 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 12 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 26 |
| Percent Of With Chronic Kidney Disease | 32 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 28 |
| Percent Of With Depression | 25 |
| Percent Of With Diabetes | 32 |
| Percent Of With Hyperlipidemia | 61 |
| Percent Of With Hypertension | 73 |
| Percent Of With Ischemic Heart Disease | 38 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 44 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.4124 |