| National Provider Identifier [NPI]: | 1720041957 |
| Last Name Of The Provider | WELLS |
| First Name Of The Provider | DAVID |
| Middle Initial Of The Provider | I |
| Credentials Of The Provider | DPM |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 4101 TULLY RD |
| Street Address 2 Of The Provider | SUITE 102 |
| City Of The Provider | MODESTO |
| Zip Code Of The Provider | 953568980 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Podiatry |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 64 |
| Number Of Services | 2415 |
| Number Of Medicare Beneficiaries | 557 |
| Total Submitted Charge Amount | 215410 |
| Total Medicare Allowed Amount | 188852.89 |
| Total Medicare Payment Amount | 139078.96 |
| Total Medicare Standardized Payment Amount | 135785.79 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 270 |
| Number Of Medicare Beneficiaries With Drug Services | 42 |
| Total Drug Submitted ChargeAmount | 9300 |
| Total Drug Medicare AllowedAmount | 7678.88 |
| Total Drug Medicare PaymentAmount | 6020.24 |
| Total Drug Medicare Standardized Payment Amount | 6020.24 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 62 |
| Number Of Medical Services | 2145 |
| Number Of Medicare Beneficiaries With Medical Services | 557 |
| Total Medical Submitted Charge Amount | 206110 |
| Total Medical Medicare Allowed Amount | 181174.01 |
| Total Medical Medicare Payment Amount | 133058.72 |
| Total Medical Medicare Standardized Payment Amount | 129765.55 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 72 |
| Number Of Beneficiaries Age 65 to 74 | 211 |
| Number Of Beneficiaries Age 75 to 84 | 168 |
| Number Of Beneficiaries Age Greater 84 | 106 |
| Number Of Female Beneficiaries | 316 |
| Number Of Male Beneficiaries | 241 |
| Number Of Non Hispanic White Beneficiaries | 463 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 70 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 11 |
| Number Of Beneficiaries With Medicare Only Entitlement | 437 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 120 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 12 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 25 |
| Percent Of With Chronic Kidney Disease | 34 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 15 |
| Percent Of With Depression | 18 |
| Percent Of With Diabetes | 42 |
| Percent Of With Hyperlipidemia | 51 |
| Percent Of With Hypertension | 70 |
| Percent Of With Ischemic Heart Disease | 36 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 44 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.5261 |