| National Provider Identifier [NPI]: | 1386792455 |
| Last Name Of The Provider | PORTMORE |
| First Name Of The Provider | AMY |
| Middle Initial Of The Provider | C |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 805 VETERANS BLVD |
| Street Address 2 Of The Provider | |
| City Of The Provider | REDWOOD CITY |
| Zip Code Of The Provider | 940631734 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 33 |
| Number Of Services | 459 |
| Number Of Medicare Beneficiaries | 199 |
| Total Submitted Charge Amount | 102280 |
| Total Medicare Allowed Amount | 47025.86 |
| Total Medicare Payment Amount | 36332.83 |
| Total Medicare Standardized Payment Amount | 31325.72 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 9 |
| Number Of Drug Services | 57 |
| Number Of Medicare Beneficiaries With Drug Services | 42 |
| Total Drug Submitted ChargeAmount | 2110 |
| Total Drug Medicare AllowedAmount | 1887.07 |
| Total Drug Medicare PaymentAmount | 1847.77 |
| Total Drug Medicare Standardized Payment Amount | 1847.77 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 24 |
| Number Of Medical Services | 402 |
| Number Of Medicare Beneficiaries With Medical Services | 199 |
| Total Medical Submitted Charge Amount | 100170 |
| Total Medical Medicare Allowed Amount | 45138.79 |
| Total Medical Medicare Payment Amount | 34485.06 |
| Total Medical Medicare Standardized Payment Amount | 29477.95 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 104 |
| Number Of Beneficiaries Age 75 to 84 | 54 |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 140 |
| Number Of Male Beneficiaries | 59 |
| Number Of Non Hispanic White Beneficiaries | 165 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 14 |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 9 |
| Percent Of With Chronic Kidney Disease | 12 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 8 |
| Percent Of With Depression | 17 |
| Percent Of With Diabetes | 15 |
| Percent Of With Hyperlipidemia | 55 |
| Percent Of With Hypertension | 58 |
| Percent Of With Ischemic Heart Disease | 17 |
| Percent Of With Osteoporosis | 14 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 38 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.7834 |