| National Provider Identifier [NPI]: | 1477546745 |
| Last Name Of The Provider | WELLE |
| First Name Of The Provider | GREGORY |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1133 COLLEGE AVE |
| Street Address 2 Of The Provider | E-120 |
| City Of The Provider | MANHATTAN |
| Zip Code Of The Provider | 665022770 |
| State Code Of The Provider | KS |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 234 |
| Number Of Services | 6476 |
| Number Of Medicare Beneficiaries | 3507 |
| Total Submitted Charge Amount | 573027 |
| Total Medicare Allowed Amount | 216377.84 |
| Total Medicare Payment Amount | 169759.83 |
| Total Medicare Standardized Payment Amount | 179633.81 |
| 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 | 234 |
| Number Of Medical Services | 6476 |
| Number Of Medicare Beneficiaries With Medical Services | 3507 |
| Total Medical Submitted Charge Amount | 573027 |
| Total Medical Medicare Allowed Amount | 216377.84 |
| Total Medical Medicare Payment Amount | 169759.83 |
| Total Medical Medicare Standardized Payment Amount | 179633.81 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 457 |
| Number Of Beneficiaries Age 65 to 74 | 1316 |
| Number Of Beneficiaries Age 75 to 84 | 1082 |
| Number Of Beneficiaries Age Greater 84 | 652 |
| Number Of Female Beneficiaries | 2236 |
| Number Of Male Beneficiaries | 1271 |
| Number Of Non Hispanic White Beneficiaries | 3316 |
| Number Of Black or African American Beneficiaries | 87 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 49 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 33 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2906 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 601 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 14 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 21 |
| Percent Of With Chronic Kidney Disease | 21 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 20 |
| Percent Of With Depression | 24 |
| Percent Of With Diabetes | 29 |
| Percent Of With Hyperlipidemia | 46 |
| Percent Of With Hypertension | 66 |
| Percent Of With Ischemic Heart Disease | 33 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 41 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.2414 |