| National Provider Identifier [NPI]: | 1104098961 |
| Last Name Of The Provider | PORTER |
| First Name Of The Provider | JUSTIN |
| Middle Initial Of The Provider | R |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3601 NW 138TH ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | OKLAHOMA CITY |
| Zip Code Of The Provider | 731342513 |
| State Code Of The Provider | OK |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Pain Management |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 61 |
| Number Of Services | 5860 |
| Number Of Medicare Beneficiaries | 601 |
| Total Submitted Charge Amount | 1058620.1 |
| Total Medicare Allowed Amount | 552177.74 |
| Total Medicare Payment Amount | 419064.25 |
| Total Medicare Standardized Payment Amount | 394205.18 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 7 |
| Number Of Drug Services | 1523 |
| Number Of Medicare Beneficiaries With Drug Services | 398 |
| Total Drug Submitted ChargeAmount | 15432.1 |
| Total Drug Medicare AllowedAmount | 6296.06 |
| Total Drug Medicare PaymentAmount | 4831.96 |
| Total Drug Medicare Standardized Payment Amount | 4831.96 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 54 |
| Number Of Medical Services | 4337 |
| Number Of Medicare Beneficiaries With Medical Services | 601 |
| Total Medical Submitted Charge Amount | 1043188 |
| Total Medical Medicare Allowed Amount | 545881.68 |
| Total Medical Medicare Payment Amount | 414232.29 |
| Total Medical Medicare Standardized Payment Amount | 389373.22 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 138 |
| Number Of Beneficiaries Age 65 to 74 | 251 |
| Number Of Beneficiaries Age 75 to 84 | 171 |
| Number Of Beneficiaries Age Greater 84 | 41 |
| Number Of Female Beneficiaries | 367 |
| Number Of Male Beneficiaries | 234 |
| Number Of Non Hispanic White Beneficiaries | 540 |
| Number Of Black or African American Beneficiaries | 26 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 19 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 492 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 109 |
| Percent Of With Atrial Fibrillation | 7 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 7 |
| Percent Of With Heart Failure | 19 |
| Percent Of With Chronic Kidney Disease | 18 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 16 |
| Percent Of With Depression | 30 |
| Percent Of With Diabetes | 31 |
| Percent Of With Hyperlipidemia | 51 |
| Percent Of With Hypertension | 71 |
| Percent Of With Ischemic Heart Disease | 40 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 75 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.1099 |