| National Provider Identifier [NPI]: | 1831359744 |
| Last Name Of The Provider | WELLS |
| First Name Of The Provider | JOHN |
| Middle Initial Of The Provider | S |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 250 W 300 N |
| Street Address 2 Of The Provider | |
| City Of The Provider | ROOSEVELT |
| Zip Code Of The Provider | 840662336 |
| State Code Of The Provider | UT |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 51 |
| Number Of Services | 1030 |
| Number Of Medicare Beneficiaries | 223 |
| Total Submitted Charge Amount | 85827.25 |
| Total Medicare Allowed Amount | 59770.35 |
| Total Medicare Payment Amount | 39734.54 |
| Total Medicare Standardized Payment Amount | 41704.06 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 11 |
| Number Of Drug Services | 127 |
| Number Of Medicare Beneficiaries With Drug Services | 62 |
| Total Drug Submitted ChargeAmount | 3469 |
| Total Drug Medicare AllowedAmount | 1825.17 |
| Total Drug Medicare PaymentAmount | 1610.5 |
| Total Drug Medicare Standardized Payment Amount | 1610.5 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 40 |
| Number Of Medical Services | 903 |
| Number Of Medicare Beneficiaries With Medical Services | 222 |
| Total Medical Submitted Charge Amount | 82358.25 |
| Total Medical Medicare Allowed Amount | 57945.18 |
| Total Medical Medicare Payment Amount | 38124.04 |
| Total Medical Medicare Standardized Payment Amount | 40093.56 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 35 |
| Number Of Beneficiaries Age 65 to 74 | 90 |
| Number Of Beneficiaries Age 75 to 84 | 67 |
| Number Of Beneficiaries Age Greater 84 | 31 |
| Number Of Female Beneficiaries | 124 |
| Number Of Male Beneficiaries | 99 |
| Number Of Non Hispanic White Beneficiaries | 205 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 0 |
| 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 | 181 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 42 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 13 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 18 |
| Percent Of With Chronic Kidney Disease | 16 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 10 |
| Percent Of With Depression | 13 |
| Percent Of With Diabetes | 33 |
| Percent Of With Hyperlipidemia | 21 |
| Percent Of With Hypertension | 53 |
| Percent Of With Ischemic Heart Disease | 20 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 20 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.0157 |