| National Provider Identifier [NPI]: | 1487886776 |
| Last Name Of The Provider | WELLS |
| First Name Of The Provider | ELIZABETH |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | NP |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1040 MAIN ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | DANVILLE |
| Zip Code Of The Provider | 245411816 |
| State Code Of The Provider | VA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 72 |
| Number Of Services | 5530 |
| Number Of Medicare Beneficiaries | 795 |
| Total Submitted Charge Amount | 409184 |
| Total Medicare Allowed Amount | 168625.16 |
| Total Medicare Payment Amount | 130916.29 |
| Total Medicare Standardized Payment Amount | 151498.35 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 9 |
| Number Of Drug Services | 71 |
| Number Of Medicare Beneficiaries With Drug Services | 17 |
| Total Drug Submitted ChargeAmount | 740 |
| Total Drug Medicare AllowedAmount | 154.29 |
| Total Drug Medicare PaymentAmount | 130.34 |
| Total Drug Medicare Standardized Payment Amount | 130.34 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 63 |
| Number Of Medical Services | 5459 |
| Number Of Medicare Beneficiaries With Medical Services | 795 |
| Total Medical Submitted Charge Amount | 408444 |
| Total Medical Medicare Allowed Amount | 168470.87 |
| Total Medical Medicare Payment Amount | 130785.95 |
| Total Medical Medicare Standardized Payment Amount | 151368.01 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 87 |
| Number Of Beneficiaries Age 65 to 74 | 316 |
| Number Of Beneficiaries Age 75 to 84 | 284 |
| Number Of Beneficiaries Age Greater 84 | 108 |
| Number Of Female Beneficiaries | 244 |
| Number Of Male Beneficiaries | 551 |
| Number Of Non Hispanic White Beneficiaries | 580 |
| 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 | 631 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 164 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 11 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 19 |
| Percent Of With Heart Failure | 18 |
| Percent Of With Chronic Kidney Disease | 28 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 17 |
| Percent Of With Depression | 16 |
| Percent Of With Diabetes | 40 |
| Percent Of With Hyperlipidemia | 70 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 45 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 33 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.3303 |