| National Provider Identifier [NPI]: | 1942306600 |
| Last Name Of The Provider | PORTNOY |
| First Name Of The Provider | JANE |
| Middle Initial Of The Provider | Z |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 51 N 39TH ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | PHILADELPHIA |
| Zip Code Of The Provider | 19104 |
| State Code Of The Provider | PA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Ophthalmology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 24 |
| Number Of Services | 1032 |
| Number Of Medicare Beneficiaries | 620 |
| Total Submitted Charge Amount | 209957 |
| Total Medicare Allowed Amount | 94526.54 |
| Total Medicare Payment Amount | 66467.07 |
| Total Medicare Standardized Payment Amount | 62687.92 |
| 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 | 24 |
| Number Of Medical Services | 1032 |
| Number Of Medicare Beneficiaries With Medical Services | 620 |
| Total Medical Submitted Charge Amount | 209957 |
| Total Medical Medicare Allowed Amount | 94526.54 |
| Total Medical Medicare Payment Amount | 66467.07 |
| Total Medical Medicare Standardized Payment Amount | 62687.92 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 67 |
| Number Of Beneficiaries Age 65 to 74 | 308 |
| Number Of Beneficiaries Age 75 to 84 | 179 |
| Number Of Beneficiaries Age Greater 84 | 66 |
| Number Of Female Beneficiaries | 377 |
| Number Of Male Beneficiaries | 243 |
| Number Of Non Hispanic White Beneficiaries | 462 |
| Number Of Black or African American Beneficiaries | 112 |
| 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 | 26 |
| Number Of Beneficiaries With Medicare Only Entitlement | 537 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 83 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 5 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 11 |
| Percent Of With Chronic Kidney Disease | 18 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 8 |
| Percent Of With Depression | 16 |
| Percent Of With Diabetes | 31 |
| Percent Of With Hyperlipidemia | 61 |
| Percent Of With Hypertension | 62 |
| Percent Of With Ischemic Heart Disease | 27 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 40 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 1.0637 |