| National Provider Identifier [NPI]: | 1992717185 |
| Last Name Of The Provider | WELLS |
| First Name Of The Provider | JAMES |
| Middle Initial Of The Provider | H |
| Credentials Of The Provider | D.O. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 9459 HOLY CROSS LN |
| Street Address 2 Of The Provider | |
| City Of The Provider | BREESE |
| Zip Code Of The Provider | 622303510 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 43 |
| Number Of Services | 2120 |
| Number Of Medicare Beneficiaries | 251 |
| Total Submitted Charge Amount | 182652.14 |
| Total Medicare Allowed Amount | 151078.69 |
| Total Medicare Payment Amount | 103408.81 |
| Total Medicare Standardized Payment Amount | 105331.81 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 1 |
| Number Of Drug Services | 138 |
| Number Of Medicare Beneficiaries With Drug Services | 14 |
| Total Drug Submitted ChargeAmount | 1380 |
| Total Drug Medicare AllowedAmount | 288.89 |
| Total Drug Medicare PaymentAmount | 219.45 |
| Total Drug Medicare Standardized Payment Amount | 219.45 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 42 |
| Number Of Medical Services | 1982 |
| Number Of Medicare Beneficiaries With Medical Services | 251 |
| Total Medical Submitted Charge Amount | 181272.14 |
| Total Medical Medicare Allowed Amount | 150789.8 |
| Total Medical Medicare Payment Amount | 103189.36 |
| Total Medical Medicare Standardized Payment Amount | 105112.36 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | 11 |
| Number Of Beneficiaries Age 65 to 74 | 105 |
| Number Of Beneficiaries Age 75 to 84 | 99 |
| Number Of Beneficiaries Age Greater 84 | 36 |
| Number Of Female Beneficiaries | 131 |
| Number Of Male Beneficiaries | 120 |
| Number Of Non Hispanic White Beneficiaries | |
| Number Of Black or African American Beneficiaries | |
| 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 | |
| Number Of Beneficiaries With Medicare Only Entitlement | 233 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 18 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 4 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 12 |
| Percent Of With Chronic Kidney Disease | 16 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 11 |
| Percent Of With Depression | 10 |
| Percent Of With Diabetes | 28 |
| Percent Of With Hyperlipidemia | 73 |
| Percent Of With Hypertension | 73 |
| Percent Of With Ischemic Heart Disease | 35 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 31 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.9119 |