| National Provider Identifier [NPI]: | 1194853952 |
| Last Name Of The Provider | DELPORT |
| First Name Of The Provider | ANTON |
| Middle Initial Of The Provider | G |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 4755 OGLETOWN-STANTON |
| Street Address 2 Of The Provider | ROADROOM 2A00-CHRISTIANA HOSPITAL |
| City Of The Provider | NEWARK |
| Zip Code Of The Provider | 197180001 |
| State Code Of The Provider | DE |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Interventional Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 62 |
| Number Of Services | 3935 |
| Number Of Medicare Beneficiaries | 870 |
| Total Submitted Charge Amount | 2518815.16 |
| Total Medicare Allowed Amount | 405185.89 |
| Total Medicare Payment Amount | 310609.53 |
| Total Medicare Standardized Payment Amount | 306250.84 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 1194 |
| Number Of Medicare Beneficiaries With Drug Services | 179 |
| Total Drug Submitted ChargeAmount | 68757.16 |
| Total Drug Medicare AllowedAmount | 17056.43 |
| Total Drug Medicare PaymentAmount | 13366.86 |
| Total Drug Medicare Standardized Payment Amount | 13366.86 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 59 |
| Number Of Medical Services | 2741 |
| Number Of Medicare Beneficiaries With Medical Services | 870 |
| Total Medical Submitted Charge Amount | 2450058 |
| Total Medical Medicare Allowed Amount | 388129.46 |
| Total Medical Medicare Payment Amount | 297242.67 |
| Total Medical Medicare Standardized Payment Amount | 292883.98 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 81 |
| Number Of Beneficiaries Age 65 to 74 | 440 |
| Number Of Beneficiaries Age 75 to 84 | 271 |
| Number Of Beneficiaries Age Greater 84 | 78 |
| Number Of Female Beneficiaries | 561 |
| Number Of Male Beneficiaries | 309 |
| Number Of Non Hispanic White Beneficiaries | 758 |
| Number Of Black or African American Beneficiaries | 68 |
| 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 | 22 |
| Number Of Beneficiaries With Medicare Only Entitlement | 804 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 66 |
| Percent Of With Atrial Fibrillation | 9 |
| Percent Of With Alzheimers Disease or Dementia | 5 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 11 |
| Percent Of With Chronic Kidney Disease | 16 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 10 |
| Percent Of With Depression | 27 |
| Percent Of With Diabetes | 30 |
| Percent Of With Hyperlipidemia | 67 |
| Percent Of With Hypertension | 69 |
| Percent Of With Ischemic Heart Disease | 35 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 75 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.0159 |