| National Provider Identifier [NPI]: | 1255373999 |
| Last Name Of The Provider | PORTER |
| First Name Of The Provider | DAVID |
| Middle Initial Of The Provider | W |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 7253 AMBASSADOR RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | BALTIMORE |
| Zip Code Of The Provider | 212442710 |
| State Code Of The Provider | MD |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 167 |
| Number Of Services | 26987 |
| Number Of Medicare Beneficiaries | 4408 |
| Total Submitted Charge Amount | 1901577.09 |
| Total Medicare Allowed Amount | 533034.5 |
| Total Medicare Payment Amount | 398521.51 |
| Total Medicare Standardized Payment Amount | 380912.92 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 20582 |
| Number Of Medicare Beneficiaries With Drug Services | 304 |
| Total Drug Submitted ChargeAmount | 9975.21 |
| Total Drug Medicare AllowedAmount | 7276.74 |
| Total Drug Medicare PaymentAmount | 5250.54 |
| Total Drug Medicare Standardized Payment Amount | 5250.54 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 164 |
| Number Of Medical Services | 6405 |
| Number Of Medicare Beneficiaries With Medical Services | 4408 |
| Total Medical Submitted Charge Amount | 1891601.88 |
| Total Medical Medicare Allowed Amount | 525757.76 |
| Total Medical Medicare Payment Amount | 393270.97 |
| Total Medical Medicare Standardized Payment Amount | 375662.38 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 689 |
| Number Of Beneficiaries Age 65 to 74 | 1751 |
| Number Of Beneficiaries Age 75 to 84 | 1337 |
| Number Of Beneficiaries Age Greater 84 | 631 |
| Number Of Female Beneficiaries | 2776 |
| Number Of Male Beneficiaries | 1632 |
| Number Of Non Hispanic White Beneficiaries | 3524 |
| Number Of Black or African American Beneficiaries | 673 |
| Number Of AsianPacific Islander Beneficiaries | 104 |
| Number Of Hispanic Beneficiaries | 61 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 3650 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 758 |
| Percent Of With Atrial Fibrillation | 16 |
| Percent Of With Alzheimers Disease or Dementia | 15 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 16 |
| Percent Of With Heart Failure | 26 |
| Percent Of With Chronic Kidney Disease | 34 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 26 |
| Percent Of With Depression | 30 |
| Percent Of With Diabetes | 37 |
| Percent Of With Hyperlipidemia | 67 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 42 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 49 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 12 |
| Average HCC Risk Score Of Beneficiaries | 1.5948 |