| National Provider Identifier [NPI]: | 1861488348 |
| Last Name Of The Provider | PORTER |
| First Name Of The Provider | REVEL |
| Middle Initial Of The Provider | D |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 300 CARSON ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | JONESBORO |
| Zip Code Of The Provider | 724013104 |
| State Code Of The Provider | AR |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 149 |
| Number Of Services | 16619 |
| Number Of Medicare Beneficiaries | 2076 |
| Total Submitted Charge Amount | 896812 |
| Total Medicare Allowed Amount | 394316.82 |
| Total Medicare Payment Amount | 296673.46 |
| Total Medicare Standardized Payment Amount | 322459.01 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 10 |
| Number Of Drug Services | 427 |
| Number Of Medicare Beneficiaries With Drug Services | 350 |
| Total Drug Submitted ChargeAmount | 9748 |
| Total Drug Medicare AllowedAmount | 7660.62 |
| Total Drug Medicare PaymentAmount | 7298.22 |
| Total Drug Medicare Standardized Payment Amount | 7298.22 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 139 |
| Number Of Medical Services | 16192 |
| Number Of Medicare Beneficiaries With Medical Services | 2076 |
| Total Medical Submitted Charge Amount | 887064 |
| Total Medical Medicare Allowed Amount | 386656.2 |
| Total Medical Medicare Payment Amount | 289375.24 |
| Total Medical Medicare Standardized Payment Amount | 315160.79 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 454 |
| Number Of Beneficiaries Age 65 to 74 | 703 |
| Number Of Beneficiaries Age 75 to 84 | 605 |
| Number Of Beneficiaries Age Greater 84 | 314 |
| Number Of Female Beneficiaries | 1216 |
| Number Of Male Beneficiaries | 860 |
| Number Of Non Hispanic White Beneficiaries | 1911 |
| Number Of Black or African American Beneficiaries | 137 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 15 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 1373 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 703 |
| Percent Of With Atrial Fibrillation | 17 |
| Percent Of With Alzheimers Disease or Dementia | 24 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 31 |
| Percent Of With Chronic Kidney Disease | 32 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 31 |
| Percent Of With Depression | 30 |
| Percent Of With Diabetes | 43 |
| Percent Of With Hyperlipidemia | 63 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 52 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 37 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 10 |
| Average HCC Risk Score Of Beneficiaries | 1.6418 |