| National Provider Identifier [NPI]: | 1780617811 |
| Last Name Of The Provider | WELLS |
| First Name Of The Provider | BECKY |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | PAC |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 6052 W STATE ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | BOISE |
| Zip Code Of The Provider | 837032739 |
| State Code Of The Provider | ID |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 57 |
| Number Of Services | 866 |
| Number Of Medicare Beneficiaries | 377 |
| Total Submitted Charge Amount | 62395.11 |
| Total Medicare Allowed Amount | 31307.9 |
| Total Medicare Payment Amount | 21992.17 |
| Total Medicare Standardized Payment Amount | 27451.67 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 8 |
| Number Of Drug Services | 115 |
| Number Of Medicare Beneficiaries With Drug Services | 88 |
| Total Drug Submitted ChargeAmount | 3340 |
| Total Drug Medicare AllowedAmount | 3135.56 |
| Total Drug Medicare PaymentAmount | 3057.18 |
| Total Drug Medicare Standardized Payment Amount | 3057.18 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 49 |
| Number Of Medical Services | 751 |
| Number Of Medicare Beneficiaries With Medical Services | 377 |
| Total Medical Submitted Charge Amount | 59055.11 |
| Total Medical Medicare Allowed Amount | 28172.34 |
| Total Medical Medicare Payment Amount | 18934.99 |
| Total Medical Medicare Standardized Payment Amount | 24394.49 |
| Average Age Of Beneficiaries | 69 |
| Number Of Beneficiaries Age Less65 | 70 |
| Number Of Beneficiaries Age 65 to 74 | 173 |
| Number Of Beneficiaries Age 75 to 84 | 100 |
| Number Of Beneficiaries Age Greater 84 | 34 |
| Number Of Female Beneficiaries | 231 |
| Number Of Male Beneficiaries | 146 |
| Number Of Non Hispanic White Beneficiaries | 364 |
| 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 | 308 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 69 |
| Percent Of With Atrial Fibrillation | 6 |
| Percent Of With Alzheimers Disease or Dementia | 4 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 7 |
| Percent Of With Heart Failure | 5 |
| Percent Of With Chronic Kidney Disease | 14 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 10 |
| Percent Of With Depression | 23 |
| Percent Of With Diabetes | 16 |
| Percent Of With Hyperlipidemia | 37 |
| Percent Of With Hypertension | 48 |
| Percent Of With Ischemic Heart Disease | 15 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 32 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.853 |