| National Provider Identifier [NPI]: | 1427030865 |
| Last Name Of The Provider | WELLS |
| First Name Of The Provider | SEAN |
| Middle Initial Of The Provider | D |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1 MEDICAL VILLAGE DR |
| Street Address 2 Of The Provider | |
| City Of The Provider | EDGEWOOD |
| Zip Code Of The Provider | 410173403 |
| State Code Of The Provider | KY |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 161 |
| Number Of Services | 3395 |
| Number Of Medicare Beneficiaries | 2023 |
| Total Submitted Charge Amount | 529349 |
| Total Medicare Allowed Amount | 142313.79 |
| Total Medicare Payment Amount | 106372.4 |
| Total Medicare Standardized Payment Amount | 115093.29 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 527 |
| Number Of Medicare Beneficiaries With Drug Services | 55 |
| Total Drug Submitted ChargeAmount | 5231 |
| Total Drug Medicare AllowedAmount | 1386.01 |
| Total Drug Medicare PaymentAmount | 1068.11 |
| Total Drug Medicare Standardized Payment Amount | 1068.11 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 157 |
| Number Of Medical Services | 2868 |
| Number Of Medicare Beneficiaries With Medical Services | 2022 |
| Total Medical Submitted Charge Amount | 524118 |
| Total Medical Medicare Allowed Amount | 140927.78 |
| Total Medical Medicare Payment Amount | 105304.29 |
| Total Medical Medicare Standardized Payment Amount | 114025.18 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 549 |
| Number Of Beneficiaries Age 65 to 74 | 588 |
| Number Of Beneficiaries Age 75 to 84 | 544 |
| Number Of Beneficiaries Age Greater 84 | 342 |
| Number Of Female Beneficiaries | 1188 |
| Number Of Male Beneficiaries | 835 |
| Number Of Non Hispanic White Beneficiaries | 1927 |
| Number Of Black or African American Beneficiaries | 53 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 17 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 1396 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 627 |
| Percent Of With Atrial Fibrillation | 17 |
| Percent Of With Alzheimers Disease or Dementia | 20 |
| Percent Of With Asthma | 15 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 36 |
| Percent Of With Chronic Kidney Disease | 42 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 34 |
| Percent Of With Depression | 46 |
| Percent Of With Diabetes | 39 |
| Percent Of With Hyperlipidemia | 68 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 50 |
| Percent Of With Osteoporosis | 15 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 59 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 13 |
| Percent Of With Stroke | 13 |
| Average HCC Risk Score Of Beneficiaries | 1.8205 |