| National Provider Identifier [NPI]: | 1265439228 |
| Last Name Of The Provider | WELLS |
| First Name Of The Provider | RALPH |
| Middle Initial Of The Provider | P |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1860 CHADWICK DR |
| Street Address 2 Of The Provider | SUITE B |
| City Of The Provider | JACKSON |
| Zip Code Of The Provider | 392043463 |
| State Code Of The Provider | MS |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 192 |
| Number Of Services | 4671 |
| Number Of Medicare Beneficiaries | 2487 |
| Total Submitted Charge Amount | 844610 |
| Total Medicare Allowed Amount | 145751.98 |
| Total Medicare Payment Amount | 112779.6 |
| Total Medicare Standardized Payment Amount | 120193.02 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 0 |
| Number Of Drug Services | 0 |
| Number Of Medicare Beneficiaries With Drug Services | 0 |
| Total Drug Submitted ChargeAmount | 0 |
| Total Drug Medicare AllowedAmount | 0 |
| Total Drug Medicare PaymentAmount | 0 |
| Total Drug Medicare Standardized Payment Amount | 0 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 192 |
| Number Of Medical Services | 4671 |
| Number Of Medicare Beneficiaries With Medical Services | 2487 |
| Total Medical Submitted Charge Amount | 844610 |
| Total Medical Medicare Allowed Amount | 145751.98 |
| Total Medical Medicare Payment Amount | 112779.6 |
| Total Medical Medicare Standardized Payment Amount | 120193.02 |
| Average Age Of Beneficiaries | 68 |
| Number Of Beneficiaries Age Less65 | 816 |
| Number Of Beneficiaries Age 65 to 74 | 800 |
| Number Of Beneficiaries Age 75 to 84 | 552 |
| Number Of Beneficiaries Age Greater 84 | 319 |
| Number Of Female Beneficiaries | 1575 |
| Number Of Male Beneficiaries | 912 |
| Number Of Non Hispanic White Beneficiaries | 1250 |
| Number Of Black or African American Beneficiaries | 1203 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 12 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 1131 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1356 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 23 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 36 |
| Percent Of With Chronic Kidney Disease | 34 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 27 |
| Percent Of With Depression | 34 |
| Percent Of With Diabetes | 46 |
| Percent Of With Hyperlipidemia | 48 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 39 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 48 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 13 |
| Percent Of With Stroke | 10 |
| Average HCC Risk Score Of Beneficiaries | 1.929 |