| National Provider Identifier [NPI]: | 1386627206 |
| Last Name Of The Provider | WELLNITZ |
| First Name Of The Provider | CLINTON |
| Middle Initial Of The Provider | V |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 13400 E SHEA BLVD |
| Street Address 2 Of The Provider | |
| City Of The Provider | SCOTTSDALE |
| Zip Code Of The Provider | 852595404 |
| State Code Of The Provider | AZ |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 86 |
| Number Of Services | 62845 |
| Number Of Medicare Beneficiaries | 2422 |
| Total Submitted Charge Amount | 471016.73 |
| Total Medicare Allowed Amount | 296417.29 |
| Total Medicare Payment Amount | 221431.89 |
| Total Medicare Standardized Payment Amount | 248004.75 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 58135 |
| Number Of Medicare Beneficiaries With Drug Services | 414 |
| Total Drug Submitted ChargeAmount | 14020.56 |
| Total Drug Medicare AllowedAmount | 11964.23 |
| Total Drug Medicare PaymentAmount | 8120.48 |
| Total Drug Medicare Standardized Payment Amount | 8120.48 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 80 |
| Number Of Medical Services | 4710 |
| Number Of Medicare Beneficiaries With Medical Services | 2406 |
| Total Medical Submitted Charge Amount | 456996.17 |
| Total Medical Medicare Allowed Amount | 284453.06 |
| Total Medical Medicare Payment Amount | 213311.41 |
| Total Medical Medicare Standardized Payment Amount | 239884.27 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 213 |
| Number Of Beneficiaries Age 65 to 74 | 979 |
| Number Of Beneficiaries Age 75 to 84 | 854 |
| Number Of Beneficiaries Age Greater 84 | 376 |
| Number Of Female Beneficiaries | 1065 |
| Number Of Male Beneficiaries | 1357 |
| Number Of Non Hispanic White Beneficiaries | 2197 |
| Number Of Black or African American Beneficiaries | 50 |
| Number Of AsianPacific Islander Beneficiaries | 21 |
| Number Of Hispanic Beneficiaries | 96 |
| Number Of American Indian Alaska Native Beneficiaries | 25 |
| Number Of Beneficiaries With Race Not Else where Classified | 33 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2303 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 119 |
| Percent Of With Atrial Fibrillation | 19 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 27 |
| Percent Of With Heart Failure | 25 |
| Percent Of With Chronic Kidney Disease | 40 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 17 |
| Percent Of With Depression | 23 |
| Percent Of With Diabetes | 26 |
| Percent Of With Hyperlipidemia | 57 |
| Percent Of With Hypertension | 68 |
| Percent Of With Ischemic Heart Disease | 44 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 42 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.8505 |