| National Provider Identifier [NPI]: | 1861489130 |
| Last Name Of The Provider | PORTNER |
| First Name Of The Provider | WILLIAM |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 181 MAIN ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | NORWAY |
| Zip Code Of The Provider | 042685648 |
| State Code Of The Provider | ME |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 136 |
| Number Of Services | 5158 |
| Number Of Medicare Beneficiaries | 2253 |
| Total Submitted Charge Amount | 427314 |
| Total Medicare Allowed Amount | 127631.06 |
| Total Medicare Payment Amount | 96347 |
| Total Medicare Standardized Payment Amount | 101524.05 |
| 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 | 136 |
| Number Of Medical Services | 5158 |
| Number Of Medicare Beneficiaries With Medical Services | 2253 |
| Total Medical Submitted Charge Amount | 427314 |
| Total Medical Medicare Allowed Amount | 127631.06 |
| Total Medical Medicare Payment Amount | 96347 |
| Total Medical Medicare Standardized Payment Amount | 101524.05 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 508 |
| Number Of Beneficiaries Age 65 to 74 | 782 |
| Number Of Beneficiaries Age 75 to 84 | 669 |
| Number Of Beneficiaries Age Greater 84 | 294 |
| Number Of Female Beneficiaries | 1496 |
| Number Of Male Beneficiaries | 757 |
| Number Of Non Hispanic White Beneficiaries | 2203 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 37 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1134 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1119 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 13 |
| Percent Of With Chronic Kidney Disease | 18 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 19 |
| Percent Of With Depression | 28 |
| Percent Of With Diabetes | 27 |
| Percent Of With Hyperlipidemia | 49 |
| Percent Of With Hypertension | 62 |
| Percent Of With Ischemic Heart Disease | 24 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 35 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.0942 |