| National Provider Identifier [NPI]: | 1265487508 |
| Last Name Of The Provider | PORTLAND |
| First Name Of The Provider | GREGORY |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2401 RAVINE WAY |
| Street Address 2 Of The Provider | SUITE 200 |
| City Of The Provider | GLENVIEW |
| Zip Code Of The Provider | 600257645 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Sports Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 79 |
| Number Of Services | 8170 |
| Number Of Medicare Beneficiaries | 662 |
| Total Submitted Charge Amount | 785754 |
| Total Medicare Allowed Amount | 280670.07 |
| Total Medicare Payment Amount | 209575.68 |
| Total Medicare Standardized Payment Amount | 196803.98 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 5725 |
| Number Of Medicare Beneficiaries With Drug Services | 294 |
| Total Drug Submitted ChargeAmount | 68163 |
| Total Drug Medicare AllowedAmount | 45589.65 |
| Total Drug Medicare PaymentAmount | 35585.38 |
| Total Drug Medicare Standardized Payment Amount | 35585.38 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 75 |
| Number Of Medical Services | 2445 |
| Number Of Medicare Beneficiaries With Medical Services | 662 |
| Total Medical Submitted Charge Amount | 717591 |
| Total Medical Medicare Allowed Amount | 235080.42 |
| Total Medical Medicare Payment Amount | 173990.3 |
| Total Medical Medicare Standardized Payment Amount | 161218.6 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 25 |
| Number Of Beneficiaries Age 65 to 74 | 316 |
| Number Of Beneficiaries Age 75 to 84 | 227 |
| Number Of Beneficiaries Age Greater 84 | 94 |
| Number Of Female Beneficiaries | 408 |
| Number Of Male Beneficiaries | 254 |
| Number Of Non Hispanic White Beneficiaries | 616 |
| Number Of Black or African American Beneficiaries | 12 |
| 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 | 17 |
| Number Of Beneficiaries With Medicare Only Entitlement | 632 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 30 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 5 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 11 |
| Percent Of With Chronic Kidney Disease | 10 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 6 |
| Percent Of With Depression | 15 |
| Percent Of With Diabetes | 16 |
| Percent Of With Hyperlipidemia | 51 |
| Percent Of With Hypertension | 47 |
| Percent Of With Ischemic Heart Disease | 23 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 66 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 0.8955 |