| National Provider Identifier [NPI]: | 1760478259 |
| Last Name Of The Provider | WELLBORN |
| First Name Of The Provider | COLVIN |
| Middle Initial Of The Provider | C |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1715 N GEORGE MASON DR |
| Street Address 2 Of The Provider | #504 |
| City Of The Provider | ARLINGTON |
| Zip Code Of The Provider | 222053609 |
| State Code Of The Provider | VA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Orthopedic Surgery |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 87 |
| Number Of Services | 3186 |
| Number Of Medicare Beneficiaries | 410 |
| Total Submitted Charge Amount | 1229866 |
| Total Medicare Allowed Amount | 304554.34 |
| Total Medicare Payment Amount | 230522.86 |
| Total Medicare Standardized Payment Amount | 207707.81 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 1426 |
| Number Of Medicare Beneficiaries With Drug Services | 132 |
| Total Drug Submitted ChargeAmount | 47952 |
| Total Drug Medicare AllowedAmount | 16693.84 |
| Total Drug Medicare PaymentAmount | 13077.07 |
| Total Drug Medicare Standardized Payment Amount | 13077.07 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 83 |
| Number Of Medical Services | 1760 |
| Number Of Medicare Beneficiaries With Medical Services | 410 |
| Total Medical Submitted Charge Amount | 1181914 |
| Total Medical Medicare Allowed Amount | 287860.5 |
| Total Medical Medicare Payment Amount | 217445.79 |
| Total Medical Medicare Standardized Payment Amount | 194630.74 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 21 |
| Number Of Beneficiaries Age 65 to 74 | 203 |
| Number Of Beneficiaries Age 75 to 84 | 125 |
| Number Of Beneficiaries Age Greater 84 | 61 |
| Number Of Female Beneficiaries | 263 |
| Number Of Male Beneficiaries | 147 |
| Number Of Non Hispanic White Beneficiaries | 333 |
| Number Of Black or African American Beneficiaries | 33 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 23 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 373 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 37 |
| Percent Of With Atrial Fibrillation | 9 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 10 |
| Percent Of With Chronic Kidney Disease | 13 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 9 |
| Percent Of With Depression | 19 |
| Percent Of With Diabetes | 20 |
| Percent Of With Hyperlipidemia | 55 |
| Percent Of With Hypertension | 63 |
| Percent Of With Ischemic Heart Disease | 26 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 75 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.9732 |