| National Provider Identifier [NPI]: | 1598765471 |
| Last Name Of The Provider | PORT |
| First Name Of The Provider | STEVEN |
| Middle Initial Of The Provider | C |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2801 W KINNICKINNIC RIVER PKWY |
| Street Address 2 Of The Provider | #840 |
| City Of The Provider | MILWAUKEE |
| Zip Code Of The Provider | 532153669 |
| State Code Of The Provider | WI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Cardiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 79 |
| Number Of Services | 51640 |
| Number Of Medicare Beneficiaries | 1927 |
| Total Submitted Charge Amount | 7669322.38 |
| Total Medicare Allowed Amount | 1105073.49 |
| Total Medicare Payment Amount | 844324 |
| Total Medicare Standardized Payment Amount | 879323.59 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 47114 |
| Number Of Medicare Beneficiaries With Drug Services | 550 |
| Total Drug Submitted ChargeAmount | 157052 |
| Total Drug Medicare AllowedAmount | 38635.2 |
| Total Drug Medicare PaymentAmount | 29672.73 |
| Total Drug Medicare Standardized Payment Amount | 29672.73 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 73 |
| Number Of Medical Services | 4526 |
| Number Of Medicare Beneficiaries With Medical Services | 1927 |
| Total Medical Submitted Charge Amount | 7512270.38 |
| Total Medical Medicare Allowed Amount | 1066438.29 |
| Total Medical Medicare Payment Amount | 814651.27 |
| Total Medical Medicare Standardized Payment Amount | 849650.86 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 197 |
| Number Of Beneficiaries Age 65 to 74 | 694 |
| Number Of Beneficiaries Age 75 to 84 | 720 |
| Number Of Beneficiaries Age Greater 84 | 316 |
| Number Of Female Beneficiaries | 872 |
| Number Of Male Beneficiaries | 1055 |
| Number Of Non Hispanic White Beneficiaries | 1695 |
| Number Of Black or African American Beneficiaries | 86 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 88 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 30 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1646 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 281 |
| Percent Of With Atrial Fibrillation | 28 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 34 |
| Percent Of With Chronic Kidney Disease | 40 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 22 |
| Percent Of With Depression | 23 |
| Percent Of With Diabetes | 38 |
| Percent Of With Hyperlipidemia | 75 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 75 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 46 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 1.6197 |