| National Provider Identifier [NPI]: | 1598832677 |
| Last Name Of The Provider | PORTER |
| First Name Of The Provider | GARY |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | OD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 7340 WEST COLLEGE DRIVE |
| Street Address 2 Of The Provider | SECOND FLOOR |
| City Of The Provider | PALOS HEIGHTS |
| Zip Code Of The Provider | 60463 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Optometry |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 13 |
| Number Of Services | 2320 |
| Number Of Medicare Beneficiaries | 1397 |
| Total Submitted Charge Amount | 268904 |
| Total Medicare Allowed Amount | 252242.2 |
| Total Medicare Payment Amount | 176529.91 |
| Total Medicare Standardized Payment Amount | 166747.28 |
| 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 | 13 |
| Number Of Medical Services | 2320 |
| Number Of Medicare Beneficiaries With Medical Services | 1397 |
| Total Medical Submitted Charge Amount | 268904 |
| Total Medical Medicare Allowed Amount | 252242.2 |
| Total Medical Medicare Payment Amount | 176529.91 |
| Total Medical Medicare Standardized Payment Amount | 166747.28 |
| Average Age Of Beneficiaries | 78 |
| Number Of Beneficiaries Age Less65 | 15 |
| Number Of Beneficiaries Age 65 to 74 | 439 |
| Number Of Beneficiaries Age 75 to 84 | 638 |
| Number Of Beneficiaries Age Greater 84 | 305 |
| Number Of Female Beneficiaries | 890 |
| Number Of Male Beneficiaries | 507 |
| Number Of Non Hispanic White Beneficiaries | 1353 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 23 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 1374 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 23 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 16 |
| Percent Of With Chronic Kidney Disease | 19 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 13 |
| Percent Of With Depression | 11 |
| Percent Of With Diabetes | 26 |
| Percent Of With Hyperlipidemia | 65 |
| Percent Of With Hypertension | 73 |
| Percent Of With Ischemic Heart Disease | 37 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 41 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 1 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.1162 |