| National Provider Identifier [NPI]: | 1174752927 |
| Last Name Of The Provider | PORT |
| First Name Of The Provider | ABBIE |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | PA-C |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 400 S BLAIRSFERRY XING |
| Street Address 2 Of The Provider | SUITE A |
| City Of The Provider | HIAWATHA |
| Zip Code Of The Provider | 522337988 |
| State Code Of The Provider | IA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 27 |
| Number Of Services | 481 |
| Number Of Medicare Beneficiaries | 120 |
| Total Submitted Charge Amount | 45965 |
| Total Medicare Allowed Amount | 22318.57 |
| Total Medicare Payment Amount | 15662.15 |
| Total Medicare Standardized Payment Amount | 20471 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 8 |
| Number Of Drug Services | 174 |
| Number Of Medicare Beneficiaries With Drug Services | 24 |
| Total Drug Submitted ChargeAmount | 1003 |
| Total Drug Medicare AllowedAmount | 642.57 |
| Total Drug Medicare PaymentAmount | 621.18 |
| Total Drug Medicare Standardized Payment Amount | 621.18 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 19 |
| Number Of Medical Services | 307 |
| Number Of Medicare Beneficiaries With Medical Services | 120 |
| Total Medical Submitted Charge Amount | 44962 |
| Total Medical Medicare Allowed Amount | 21676 |
| Total Medical Medicare Payment Amount | 15040.97 |
| Total Medical Medicare Standardized Payment Amount | 19849.82 |
| Average Age Of Beneficiaries | 63 |
| Number Of Beneficiaries Age Less65 | 40 |
| Number Of Beneficiaries Age 65 to 74 | 55 |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 102 |
| Number Of Male Beneficiaries | 18 |
| Number Of Non Hispanic White Beneficiaries | |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 82 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 38 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | |
| Percent Of With Chronic Kidney Disease | 9 |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | 25 |
| Percent Of With Diabetes | 23 |
| Percent Of With Hyperlipidemia | 37 |
| Percent Of With Hypertension | 37 |
| Percent Of With Ischemic Heart Disease | 11 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 23 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.7003 |