| National Provider Identifier [NPI]: | 1639104813 |
| Last Name Of The Provider | WELLS |
| First Name Of The Provider | TERRY |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1015 ELLIS AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | LUFKIN |
| Zip Code Of The Provider | 759043397 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 36 |
| Number Of Services | 1356 |
| Number Of Medicare Beneficiaries | 297 |
| Total Submitted Charge Amount | 127610.57 |
| Total Medicare Allowed Amount | 75795.63 |
| Total Medicare Payment Amount | 50219.54 |
| Total Medicare Standardized Payment Amount | 54502.69 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 179 |
| Number Of Medicare Beneficiaries With Drug Services | 139 |
| Total Drug Submitted ChargeAmount | 7490 |
| Total Drug Medicare AllowedAmount | 3391.97 |
| Total Drug Medicare PaymentAmount | 3281.48 |
| Total Drug Medicare Standardized Payment Amount | 3281.48 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 32 |
| Number Of Medical Services | 1177 |
| Number Of Medicare Beneficiaries With Medical Services | 295 |
| Total Medical Submitted Charge Amount | 120120.57 |
| Total Medical Medicare Allowed Amount | 72403.66 |
| Total Medical Medicare Payment Amount | 46938.06 |
| Total Medical Medicare Standardized Payment Amount | 51221.21 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 40 |
| Number Of Beneficiaries Age 65 to 74 | 125 |
| Number Of Beneficiaries Age 75 to 84 | 98 |
| Number Of Beneficiaries Age Greater 84 | 34 |
| Number Of Female Beneficiaries | 209 |
| Number Of Male Beneficiaries | 88 |
| Number Of Non Hispanic White Beneficiaries | 257 |
| 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 | 255 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 42 |
| Percent Of With Atrial Fibrillation | 8 |
| Percent Of With Alzheimers Disease or Dementia | 12 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 19 |
| Percent Of With Chronic Kidney Disease | 24 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 14 |
| Percent Of With Depression | 26 |
| Percent Of With Diabetes | 35 |
| Percent Of With Hyperlipidemia | 54 |
| Percent Of With Hypertension | 68 |
| Percent Of With Ischemic Heart Disease | 26 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 46 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.1495 |