| National Provider Identifier [NPI]: | 1174532469 |
| Last Name Of The Provider | WELLS |
| First Name Of The Provider | JOHN |
| 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 | 7301 ROGERS AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | FORT SMITH |
| Zip Code Of The Provider | 729034100 |
| State Code Of The Provider | AR |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Hematology/Oncology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 65 |
| Number Of Services | 31532 |
| Number Of Medicare Beneficiaries | 44 |
| Total Submitted Charge Amount | 869686.3 |
| Total Medicare Allowed Amount | 326195.07 |
| Total Medicare Payment Amount | 255624.39 |
| Total Medicare Standardized Payment Amount | 255130.64 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 33 |
| Number Of Drug Services | 29621 |
| Number Of Medicare Beneficiaries With Drug Services | 19 |
| Total Drug Submitted ChargeAmount | 584935.3 |
| Total Drug Medicare AllowedAmount | 239801.87 |
| Total Drug Medicare PaymentAmount | 188011.48 |
| Total Drug Medicare Standardized Payment Amount | 188011.48 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 32 |
| Number Of Medical Services | 1911 |
| Number Of Medicare Beneficiaries With Medical Services | 44 |
| Total Medical Submitted Charge Amount | 284751 |
| Total Medical Medicare Allowed Amount | 86393.2 |
| Total Medical Medicare Payment Amount | 67612.91 |
| Total Medical Medicare Standardized Payment Amount | 67119.16 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 14 |
| Number Of Beneficiaries Age 75 to 84 | 17 |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 15 |
| Number Of Male Beneficiaries | 29 |
| 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 | |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | 50 |
| Percent Of With Heart Failure | 27 |
| Percent Of With Chronic Kidney Disease | 43 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 30 |
| Percent Of With Depression | |
| Percent Of With Diabetes | 32 |
| Percent Of With Hyperlipidemia | 57 |
| Percent Of With Hypertension | 73 |
| Percent Of With Ischemic Heart Disease | 55 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 25 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.662 |