ATTACHMENT F - Sample Claims.xlsx
XLSX spreadsheet 120 KB Posted
- Solicitation number
- 36C10G22R0015
About this file
This solicitation seeks pricing services for Medicare claims processed through the Department of Veterans Affairs Community Care program. The VA Office of Community Care requires resources to price healthcare claim data using Medicare payment methodologies to validate payments made to outside providers. Claims requiring Medicare pricing are identified by VA for internal audit purposes. Offerors should have experience with Medicare pricing methodologies and be able to process large volumes of medical claims. The period of performance is one base year with four one-year options. Proposals are due by April 29, 2022.
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Other files
| File | Type | Posted |
|---|---|---|
| 36C10G22R0015 0002.docx | DOCX document | |
| 36C10G22R0015 0001.docx | DOCX document | |
| ATTACHMENT C - QUESTIONS SPREADSHEET_ ANSWERS.xlsx | XLSX spreadsheet | |
| ATTACHMENT E -QASP.pdf | ||
| 36C10G22R0015 0001.docx | DOCX document | |
| 36C10G22R0015.docx | DOCX document | |
| ATTACHMENT B - PAST PERFORMANCE QUESTIONNAIRE.docx | DOCX document | |
| ATTACHMENT A - PRICING SPREADSHEET.xls | XLS spreadsheet | |
| ATTACHMENT D - PWS.pdf | ||
| ATTACHMENT C - QUESTIONS SPREADSHEET.xlsx | XLSX spreadsheet |
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Text version
Claims Facility
| Claim Number | Patient_DOB | Patient_Gender | Type_of_Bill | Billing_Provider | Billing_Provider_Address | Billing_Provider_Zip_Code | Billing_Provider_NPI | Billing_Provider_Taxonomy | Service_Facility_Name | Service_Facility_Address | Service_Facility_Zip_Code | Service_Facility_NPI | Attending_Provider_Name | Attending_Provider_NPI | Operating_Provider_Name | Operating_Provider_NPI | Admission_Date | Service_Date_From | Service_Date_To | Patient_Discharge_Status | Admission_Source | Condition_Codes | Occurrence_Span_Codes_Dates | Value_Codes | Claim_DRG | ICD10_Diagnosis_Codes_POA_Indicators | ICD10_Procedure_Codes | Total_Amount_Billed | Invoice_Line | Service_Date | Revenue_Code | HCPCS | Modifiers | NDC | Units | Line_Item_Billed_Amount | ESRD Onset Date | Covered Days | Subsection (d) Hospital Stay |
| 1 | 12/28/44 | M | 851 | BANNER PAYSON MEDICAL CENTER | PO BOX 29693, PHOENIX, AZ | 85038-9693 | 1063923340 | NULL | BANNER PAYSON MEDICAL CENTER | 807 SOUTH PONDEROSA STREET, PAYSON, AZ | 85541-5542 | 1063923340 | MARMER, MICHAEL | 1720156284 | MARMER, MICHAEL | 1720156284 | NULL | 8/9/19 | 8/9/19 | 1 | 1 | 9 | NULL | NULL | NULL | C678:,R310:,I10:,E119:,I2510:,E7800:,K2270:,K449:,N40:,F329:,Z79899:,Z7982:,Z7902:,Z7984:,Z8546: | NULL | $26,743.10 | 1 | 8/9/19 | 250 | NULL | NULL | NULL | 2 | $206.40 | NULL | ||
| 12/28/44 | M | 851 | BANNER PAYSON MEDICAL CENTER | PO BOX 29693, PHOENIX, AZ | 85038-9693 | 1063923340 | NULL | BANNER PAYSON MEDICAL CENTER | 807 SOUTH PONDEROSA STREET, PAYSON, AZ | 85541-5542 | 1063923340 | MARMER, MICHAEL | 1720156284 | MARMER, MICHAEL | 1720156284 | NULL | 8/9/19 | 8/9/19 | 1 | 1 | 9 | NULL | NULL | NULL | C678:,R310:,I10:,E119:,I2510:,E7800:,K2270:,K449:,N40:,F329:,Z79899:,Z7982:,Z7902:,Z7984:,Z8546: | NULL | $26,743.10 | 2 | 8/9/19 | 250 | J0330 | NULL | NULL | 10 | $81.00 | NULL | |||
| 12/28/44 | M | 851 | BANNER PAYSON MEDICAL CENTER | PO BOX 29693, PHOENIX, AZ | 85038-9693 | 1063923340 | NULL | BANNER PAYSON MEDICAL CENTER | 807 SOUTH PONDEROSA STREET, PAYSON, AZ | 85541-5542 | 1063923340 | MARMER, MICHAEL | 1720156284 | MARMER, MICHAEL | 1720156284 | NULL | 8/9/19 | 8/9/19 | 1 | 1 | 9 | NULL | NULL | NULL | C678:,R310:,I10:,E119:,I2510:,E7800:,K2270:,K449:,N40:,F329:,Z79899:,Z7982:,Z7902:,Z7984:,Z8546: | NULL | $26,743.10 | 3 | 8/9/19 | 250 | J1170 | NULL | NULL | 1 | $11.50 | NULL | |||
| 12/28/44 | M | 851 | BANNER PAYSON MEDICAL CENTER | PO BOX 29693, PHOENIX, AZ | 85038-9693 | 1063923340 | NULL | BANNER PAYSON MEDICAL CENTER | 807 SOUTH PONDEROSA STREET, PAYSON, AZ | 85541-5542 | 1063923340 | MARMER, MICHAEL | 1720156284 | MARMER, MICHAEL | 1720156284 | NULL | 8/9/19 | 8/9/19 | 1 | 1 | 9 | NULL | NULL | NULL | C678:,R310:,I10:,E119:,I2510:,E7800:,K2270:,K449:,N40:,F329:,Z79899:,Z7982:,Z7902:,Z7984:,Z8546: | NULL | $26,743.10 | 4 | 8/9/19 | 271 | NULL | NULL | NULL | 2 | $264.00 | NULL | |||
| 12/28/44 | M | 851 | BANNER PAYSON MEDICAL CENTER | PO BOX 29693, PHOENIX, AZ | 85038-9693 | 1063923340 | NULL | BANNER PAYSON MEDICAL CENTER | 807 SOUTH PONDEROSA STREET, PAYSON, AZ | 85541-5542 | 1063923340 | MARMER, MICHAEL | 1720156284 | MARMER, MICHAEL | 1720156284 | NULL | 8/9/19 | 8/9/19 | 1 | 1 | 9 | NULL | NULL | NULL | C678:,R310:,I10:,E119:,I2510:,E7800:,K2270:,K449:,N40:,F329:,Z79899:,Z7982:,Z7902:,Z7984:,Z8546: | NULL | $26,743.10 | 5 | 8/9/19 | 272 | NULL | NULL | NULL | 3 | $1,206.00 | NULL | |||
| 12/28/44 | M | 851 | BANNER PAYSON MEDICAL CENTER | PO BOX 29693, PHOENIX, AZ | 85038-9693 | 1063923340 | NULL | BANNER PAYSON MEDICAL CENTER | 807 SOUTH PONDEROSA STREET, PAYSON, AZ | 85541-5542 | 1063923340 | MARMER, MICHAEL | 1720156284 | MARMER, MICHAEL | 1720156284 | NULL | 8/9/19 | 8/9/19 | 1 | 1 | 9 | NULL | NULL | NULL | C678:,R310:,I10:,E119:,I2510:,E7800:,K2270:,K449:,N40:,F329:,Z79899:,Z7982:,Z7902:,Z7984:,Z8546: | NULL | $26,743.10 | 6 | 8/9/19 | 301 | 82947 | NULL | NULL | 1 | $55.00 | NULL | |||
| 12/28/44 | M | 851 | BANNER PAYSON MEDICAL CENTER | PO BOX 29693, PHOENIX, AZ | 85038-9693 | 1063923340 | NULL | BANNER PAYSON MEDICAL CENTER | 807 SOUTH PONDEROSA STREET, PAYSON, AZ | 85541-5542 | 1063923340 | MARMER, MICHAEL | 1720156284 | MARMER, MICHAEL | 1720156284 | NULL | 8/9/19 | 8/9/19 | 1 | 1 | 9 | NULL | NULL | NULL | C678:,R310:,I10:,E119:,I2510:,E7800:,K2270:,K449:,N40:,F329:,Z79899:,Z7982:,Z7902:,Z7984:,Z8546: | NULL | $26,743.10 | 7 | 8/9/19 | 312 | 88307 | NULL | NULL | 1 | $103.00 | NULL | |||
| 12/28/44 | M | 851 | BANNER PAYSON MEDICAL CENTER | PO BOX 29693, PHOENIX, AZ | 85038-9693 | 1063923340 | NULL | BANNER PAYSON MEDICAL CENTER | 807 SOUTH PONDEROSA STREET, PAYSON, AZ | 85541-5542 | 1063923340 | MARMER, MICHAEL | 1720156284 | MARMER, MICHAEL | 1720156284 | NULL | 8/9/19 | 8/9/19 | 1 | 1 | 9 | NULL | NULL | NULL | C678:,R310:,I10:,E119:,I2510:,E7800:,K2270:,K449:,N40:,F329:,Z79899:,Z7982:,Z7902:,Z7984:,Z8546: | NULL | $26,743.10 | 8 | 8/9/19 | 360 | 52240 | NULL | NULL | 1 | $12,522.00 | NULL | |||
| 12/28/44 | M | 851 | BANNER PAYSON MEDICAL CENTER | PO BOX 29693, PHOENIX, AZ | 85038-9693 | 1063923340 | NULL | BANNER PAYSON MEDICAL CENTER | 807 SOUTH PONDEROSA STREET, PAYSON, AZ | 85541-5542 | 1063923340 | MARMER, MICHAEL | 1720156284 | MARMER, MICHAEL | 1720156284 | NULL | 8/9/19 | 8/9/19 | 1 | 1 | 9 | NULL | NULL | NULL | C678:,R310:,I10:,E119:,I2510:,E7800:,K2270:,K449:,N40:,F329:,Z79899:,Z7982:,Z7902:,Z7984:,Z8546: | NULL | $26,743.10 | 9 | 8/9/19 | 370 | NULL | NULL | NULL | 5 | $6,857.00 | NULL | |||
| 12/28/44 | M | 851 | BANNER PAYSON MEDICAL CENTER | PO BOX 29693, PHOENIX, AZ | 85038-9693 | 1063923340 | NULL | BANNER PAYSON MEDICAL CENTER | 807 SOUTH PONDEROSA STREET, PAYSON, AZ | 85541-5542 | 1063923340 | MARMER, MICHAEL | 1720156284 | MARMER, MICHAEL | 1720156284 | NULL | 8/9/19 | 8/9/19 | 1 | 1 | 9 | NULL | NULL | NULL | C678:,R310:,I10:,E119:,I2510:,E7800:,K2270:,K449:,N40:,F329:,Z79899:,Z7982:,Z7902:,Z7984:,Z8546: | NULL | $26,743.10 | 10 | 8/9/19 | 636 | C9399 | NULL | NULL | 1 | $223.20 | NULL | |||
| 12/28/44 | M | 851 | BANNER PAYSON MEDICAL CENTER | PO BOX 29693, PHOENIX, AZ | 85038-9693 | 1063923340 | NULL | BANNER PAYSON MEDICAL CENTER | 807 SOUTH PONDEROSA STREET, PAYSON, AZ | 85541-5542 | 1063923340 | MARMER, MICHAEL | 1720156284 | MARMER, MICHAEL | 1720156284 | NULL | 8/9/19 | 8/9/19 | 1 | 1 | 9 | NULL | NULL | NULL | C678:,R310:,I10:,E119:,I2510:,E7800:,K2270:,K449:,N40:,F329:,Z79899:,Z7982:,Z7902:,Z7984:,Z8546: | NULL | $26,743.10 | 11 | 8/9/19 | 710 | NULL | NULL | NULL | 183 | $5,214.00 | NULL | |||
| 2 | 5/7/46 | M | 721 | Tennessee Valley Dialysis Center | PO Box 785691, Philadelphia, PA | 19178-5691 | 1902851033 | NULL | Tennessee Valley Dialysis Center | 107 Woodlawn Dr, Johnson City, TN | 37604-6287 | 1902851033 | Tran, Martin | 1851395891 | NULL | NULL | NULL | 4/1/21 | 4/29/21 | 01: Discharged to home or self care (routine discharge) | Physician Referral | 71 | NULL | 48:7.30,49:21.90,68:56200.00,A8:136.00,A9:172.72,D5:1.28 | NULL | N186:,D509:,E611:,R110:,D631:,Z992:,N2581 | NULL | $101,764.42 | 1 | 4/1/21 | 250 | NULL | NULL | NULL | 1 | $72.88 | 10/5/19 | ||
| 5/7/46 | M | 721 | Tennessee Valley Dialysis Center | PO Box 785691, Philadelphia, PA | 19178-5691 | 1902851033 | NULL | Tennessee Valley Dialysis Center | 107 Woodlawn Dr, Johnson City, TN | 37604-6287 | 1902851033 | Tran, Martin | 1851395891 | NULL | NULL | NULL | 4/1/21 | 4/29/21 | 01: Discharged to home or self care (routine discharge) | Physician Referral | 71 | NULL | 48:7.30,49:21.90,68:56200.00,A8:136.00,A9:172.72,D5:1.28 | NULL | N186:,D509:,E611:,R110:,D631:,Z992:,N2581 | NULL | $101,764.42 | 2 | 4/3/21 | 250 | NULL | NULL | NULL | 1 | $72.88 | 10/5/19 | |||
| 5/7/46 | M | 721 | Tennessee Valley Dialysis Center | PO Box 785691, Philadelphia, PA | 19178-5691 | 1902851033 | NULL | Tennessee Valley Dialysis Center | 107 Woodlawn Dr, Johnson City, TN | 37604-6287 | 1902851033 | Tran, Martin | 1851395891 | NULL | NULL | NULL | 4/1/21 | 4/29/21 | 01: Discharged to home or self care (routine discharge) | Physician Referral | 71 | NULL | 48:7.30,49:21.90,68:56200.00,A8:136.00,A9:172.72,D5:1.28 | NULL | N186:,D509:,E611:,R110:,D631:,Z992:,N2581 | NULL | $101,764.42 | 3 | 4/6/21 | 250 | NULL | NULL | NULL | 1 | $72.88 | 10/5/19 | |||
| 5/7/46 | M | 721 | Tennessee Valley Dialysis Center | PO Box 785691, Philadelphia, PA | 19178-5691 | 1902851033 | NULL | Tennessee Valley Dialysis Center | 107 Woodlawn Dr, Johnson City, TN | 37604-6287 | 1902851033 | Tran, Martin | 1851395891 | NULL | NULL | NULL | 4/1/21 | 4/29/21 | 01: Discharged to home or self care (routine discharge) | Physician Referral | 71 | NULL | 48:7.30,49:21.90,68:56200.00,A8:136.00,A9:172.72,D5:1.28 | NULL | N186:,D509:,E611:,R110:,D631:,Z992:,N2581 | NULL | $101,764.42 | 4 | 4/8/21 | 250 | NULL | NULL | NULL | 1 | $72.88 | 10/5/19 | |||
| 5/7/46 | M | 721 | Tennessee Valley Dialysis Center | PO Box 785691, Philadelphia, PA | 19178-5691 | 1902851033 | NULL | Tennessee Valley Dialysis Center | 107 Woodlawn Dr, Johnson City, TN | 37604-6287 | 1902851033 | Tran, Martin | 1851395891 | NULL | NULL | NULL | 4/1/21 | 4/29/21 | 01: Discharged to home or self care (routine discharge) | Physician Referral | 71 | NULL | 48:7.30,49:21.90,68:56200.00,A8:136.00,A9:172.72,D5:1.28 | NULL | N186:,D509:,E611:,R110:,D631:,Z992:,N2581 | NULL | $101,764.42 | 5 | 4/10/21 | 250 | NULL | NULL | NULL | 1 | $72.88 | 10/5/19 | |||
| 5/7/46 | M | 721 | Tennessee Valley Dialysis Center | PO Box 785691, Philadelphia, PA | 19178-5691 | 1902851033 | NULL | Tennessee Valley Dialysis Center | 107 Woodlawn Dr, Johnson City, TN | 37604-6287 | 1902851033 | Tran, Martin | 1851395891 | NULL | NULL | NULL | 4/1/21 | 4/29/21 | 01: Discharged to home or self care (routine discharge) | Physician Referral | 71 | NULL | 48:7.30,49:21.90,68:56200.00,A8:136.00,A9:172.72,D5:1.28 | NULL | N186:,D509:,E611:,R110:,D631:,Z992:,N2581 | NULL | $101,764.42 | 6 | 4/13/21 | 250 | NULL | NULL | NULL | 1 | $72.88 | 10/5/19 | |||
| 5/7/46 | M | 721 | Tennessee Valley Dialysis Center | PO Box 785691, Philadelphia, PA | 19178-5691 | 1902851033 | NULL | Tennessee Valley Dialysis Center | 107 Woodlawn Dr, Johnson City, TN | 37604-6287 | 1902851033 | Tran, Martin | 1851395891 | NULL | NULL | NULL | 4/1/21 | 4/29/21 | 01: Discharged to home or self care (routine discharge) | Physician Referral | 71 | NULL | 48:7.30,49:21.90,68:56200.00,A8:136.00,A9:172.72,D5:1.28 | NULL | N186:,D509:,E611:,R110:,D631:,Z992:,N2581 | NULL | $101,764.42 | 7 | 4/15/21 | 250 | NULL | NULL | NULL | 1 | $72.88 | 10/5/19 | |||
| 5/7/46 | M | 721 | Tennessee Valley Dialysis Center | PO Box 785691, Philadelphia, PA | 19178-5691 | 1902851033 | NULL | Tennessee Valley Dialysis Center | 107 Woodlawn Dr, Johnson City, TN | 37604-6287 | 1902851033 | Tran, Martin | 1851395891 | NULL | NULL | NULL | 4/1/21 | 4/29/21 | 01: Discharged to home or self care (routine discharge) | Physician Referral | 71 | NULL | 48:7.30,49:21.90,68:56200.00,A8:136.00,A9:172.72,D5:1.28 | NULL | N186:,D509:,E611:,R110:,D631:,Z992:,N2581 | NULL | $101,764.42 | 8 | 4/17/21 | 250 | NULL | NULL | NULL | 1 | $72.88 | 10/5/19 | |||
| 5/7/46 | M | 721 | Tennessee Valley Dialysis Center | PO Box 785691, Philadelphia, PA | 19178-5691 | 1902851033 | NULL | Tennessee Valley Dialysis Center | 107 Woodlawn Dr, Johnson City, TN | 37604-6287 | 1902851033 | Tran, Martin | 1851395891 | NULL | NULL | NULL | 4/1/21 | 4/29/21 | 01: Discharged to home or self care (routine discharge) | Physician Referral | 71 | NULL | 48:7.30,49:21.90,68:56200.00,A8:136.00,A9:172.72,D5:1.28 | NULL | N186:,D509:,E611:,R110:,D631:,Z992:,N2581 | NULL | $101,764.42 | 9 | 4/20/21 | 250 | NULL | NULL | NULL | 1 | $72.88 | 10/5/19 | |||
| 5/7/46 | M | 721 | Tennessee Valley Dialysis Center | PO Box 785691, Philadelphia, PA | 19178-5691 | 1902851033 | NULL | Tennessee Valley Dialysis Center | 107 Woodlawn Dr, Johnson City, TN | 37604-6287 | 1902851033 | Tran, Martin | 1851395891 | NULL | NULL | NULL | 4/1/21 | 4/29/21 | 01: Discharged to home or self care (routine discharge) | Physician Referral | 71 | NULL | 48:7.30,49:21.90,68:56200.00,A8:136.00,A9:172.72,D5:1.28 | NULL | N186:,D509:,E611:,R110:,D631:,Z992:,N2581 | NULL | $101,764.42 | 10 | 4/22/21 | 250 | NULL | NULL | NULL | 1 | $72.88 | 10/5/19 | |||
| 5/7/46 | M | 721 | Tennessee Valley Dialysis Center | PO Box 785691, Philadelphia, PA | 19178-5691 | 1902851033 | NULL | Tennessee Valley Dialysis Center | 107 Woodlawn Dr, Johnson City, TN | 37604-6287 | 1902851033 | Tran, Martin | 1851395891 | NULL | NULL | NULL | 4/1/21 | 4/29/21 | 01: Discharged to home or self care (routine discharge) | Physician Referral | 71 | NULL | 48:7.30,49:21.90,68:56200.00,A8:136.00,A9:172.72,D5:1.28 | NULL | N186:,D509:,E611:,R110:,D631:,Z992:,N2581 | NULL | $101,764.42 | 11 | 4/24/21 | 250 | NULL | NULL | NULL | 1 | $72.88 | 10/5/19 | |||
| 5/7/46 | M | 721 | Tennessee Valley Dialysis Center | PO Box 785691, Philadelphia, PA | 19178-5691 | 1902851033 | NULL | Tennessee Valley Dialysis Center | 107 Woodlawn Dr, Johnson City, TN | 37604-6287 | 1902851033 | Tran, Martin | 1851395891 | NULL | NULL | NULL | 4/1/21 | 4/29/21 | 01: Discharged to home or self care (routine discharge) | Physician Referral | 71 | NULL | 48:7.30,49:21.90,68:56200.00,A8:136.00,A9:172.72,D5:1.28 | NULL | N186:,D509:,E611:,R110:,D631:,Z992:,N2581 | NULL | $101,764.42 | 12 | 4/27/21 | 250 | NULL | NULL | NULL | 2 | $61.08 | 10/5/19 | |||
| 5/7/46 | M | 721 | Tennessee Valley Dialysis Center | PO Box 785691, Philadelphia, PA | 19178-5691 | 1902851033 | NULL | Tennessee Valley Dialysis Center | 107 Woodlawn Dr, Johnson City, TN | 37604-6287 | 1902851033 | Tran, Martin | 1851395891 | NULL | NULL | NULL | 4/1/21 | 4/29/21 | 01: Discharged to home or self care (routine discharge) | Physician Referral | 71 | NULL | 48:7.30,49:21.90,68:56200.00,A8:136.00,A9:172.72,D5:1.28 | NULL | N186:,D509:,E611:,R110:,D631:,Z992:,N2581 | NULL | $101,764.42 | 13 | 4/29/21 | 250 | NULL | NULL | NULL | 1 | $72.88 | 10/5/19 | |||
| 5/7/46 | M | 721 | Tennessee Valley Dialysis Center | PO Box 785691, Philadelphia, PA | 19178-5691 | 1902851033 | NULL | Tennessee Valley Dialysis Center | 107 Woodlawn Dr, Johnson City, TN | 37604-6287 | 1902851033 | Tran, Martin | 1851395891 | NULL | NULL | NULL | 4/1/21 | 4/29/21 | 01: Discharged to home or self care (routine discharge) | Physician Referral | 71 | NULL | 48:7.30,49:21.90,68:56200.00,A8:136.00,A9:172.72,D5:1.28 | NULL | N186:,D509:,E611:,R110:,D631:,Z992:,N2581 | NULL | $101,764.42 | 14 | 4/1/21 | 270 | A4657 | NULL | NULL | 22 | $2,559.70 | 10/5/19 | |||
| 5/7/46 | M | 721 | Tennessee Valley Dialysis Center | PO Box 785691, Philadelphia, PA | 19178-5691 | 1902851033 | NULL | Tennessee Valley Dialysis Center | 107 Woodlawn Dr, Johnson City, TN | 37604-6287 | 1902851033 | Tran, Martin | 1851395891 | NULL | NULL | NULL | 4/1/21 | 4/29/21 | 01: Discharged to home or self care (routine discharge) | Physician Referral | 71 | NULL | 48:7.30,49:21.90,68:56200.00,A8:136.00,A9:172.72,D5:1.28 | NULL | N186:,D509:,E611:,R110:,D631:,Z992:,N2581 | NULL | $101,764.42 | 15 | 4/22/21 | 301 | 82306 | NULL | NULL | 1 | $526.18 | 10/5/19 | |||
| 5/7/46 | M | 721 | Tennessee Valley Dialysis Center | PO Box 785691, Philadelphia, PA | 19178-5691 | 1902851033 | NULL | Tennessee Valley Dialysis Center | 107 Woodlawn Dr, Johnson City, TN | 37604-6287 | 1902851033 | Tran, Martin | 1851395891 | NULL | NULL | NULL | 4/1/21 | 4/29/21 | 01: Discharged to home or self care (routine discharge) | Physician Referral | 71 | NULL | 48:7.30,49:21.90,68:56200.00,A8:136.00,A9:172.72,D5:1.28 | NULL | N186:,D509:,E611:,R110:,D631:,Z992:,N2581 | NULL | $101,764.42 | 16 | 4/22/21 | 301 | 82728 | NULL | NULL | 1 | $242.12 | 10/5/19 | |||
| 5/7/46 | M | 721 | Tennessee Valley Dialysis Center | PO Box 785691, Philadelphia, PA | 19178-5691 | 1902851033 | NULL | Tennessee Valley Dialysis Center | 107 Woodlawn Dr, Johnson City, TN | 37604-6287 | 1902851033 | Tran, Martin | 1851395891 | NULL | NULL | NULL | 4/1/21 | 4/29/21 | 01: Discharged to home or self care (routine discharge) | Physician Referral | 71 | NULL | 48:7.30,49:21.90,68:56200.00,A8:136.00,A9:172.72,D5:1.28 | NULL | N186:,D509:,E611:,R110:,D631:,Z992:,N2581 | NULL | $101,764.42 | 17 | 4/22/21 | 301 | 83540 | NULL | NULL | 1 | $115.16 | 10/5/19 | |||
| 5/7/46 | M | 721 | Tennessee Valley Dialysis Center | PO Box 785691, Philadelphia, PA | 19178-5691 | 1902851033 | NULL | Tennessee Valley Dialysis Center | 107 Woodlawn Dr, Johnson City, TN | 37604-6287 | 1902851033 | Tran, Martin | 1851395891 | NULL | NULL | NULL | 4/1/21 | 4/29/21 | 01: Discharged to home or self care (routine discharge) | Physician Referral | 71 | NULL | 48:7.30,49:21.90,68:56200.00,A8:136.00,A9:172.72,D5:1.28 | NULL | N186:,D509:,E611:,R110:,D631:,Z992:,N2581 | NULL | $101,764.42 | 18 | 4/15/21 | 301 | 83970 | NULL | NULL | 1 | $733.68 | 10/5/19 | |||
| 5/7/46 | M | 721 | Tennessee Valley Dialysis Center | PO Box 785691, Philadelphia, PA | 19178-5691 | 1902851033 | NULL | Tennessee Valley Dialysis Center | 107 Woodlawn Dr, Johnson City, TN | 37604-6287 | 1902851033 | Tran, Martin | 1851395891 | NULL | NULL | NULL | 4/1/21 | 4/29/21 | 01: Discharged to home or self care (routine discharge) | Physician Referral | 71 | NULL | 48:7.30,49:21.90,68:56200.00,A8:136.00,A9:172.72,D5:1.28 | NULL | N186:,D509:,E611:,R110:,D631:,Z992:,N2581 | NULL | $101,764.42 | 19 | 4/22/22 | 301 | 84466 | NULL | NULL | 1 | $226.98 | 10/5/19 | |||
| 5/7/46 | M | 721 | Tennessee Valley Dialysis Center | PO Box 785691, Philadelphia, PA | 19178-5691 | 1902851033 | NULL | Tennessee Valley Dialysis Center | 107 Woodlawn Dr, Johnson City, TN | 37604-6287 | 1902851033 | Tran, Martin | 1851395891 | NULL | NULL | NULL | 4/1/21 | 4/29/21 | 01: Discharged to home or self care (routine discharge) | Physician Referral | 71 | NULL | 48:7.30,49:21.90,68:56200.00,A8:136.00,A9:172.72,D5:1.28 | NULL | N186:,D509:,E611:,R110:,D631:,Z992:,N2581 | NULL | $101,764.42 | 20 | 4/22/21 | 305 | 85041 | NULL | NULL | 1 | $53.49 | 10/5/19 | |||
| 5/7/46 | M | 721 | Tennessee Valley Dialysis Center | PO Box 785691, Philadelphia, PA | 19178-5691 | 1902851033 | NULL | Tennessee Valley Dialysis Center | 107 Woodlawn Dr, Johnson City, TN | 37604-6287 | 1902851033 | Tran, Martin | 1851395891 | NULL | NULL | NULL | 4/1/21 | 4/29/21 | 01: Discharged to home or self care (routine discharge) | Physician Referral | 71 | NULL | 48:7.30,49:21.90,68:56200.00,A8:136.00,A9:172.72,D5:1.28 | NULL | N186:,D509:,E611:,R110:,D631:,Z992:,N2581 | NULL | $101,764.42 | 21 | 4/22/21 | 305 | 85048 | NULL | NULL | 1 | $45.17 | 10/5/19 | |||
| 5/7/46 | M | 721 | Tennessee Valley Dialysis Center | PO Box 785691, Philadelphia, PA | 19178-5691 | 1902851033 | NULL | Tennessee Valley Dialysis Center | 107 Woodlawn Dr, Johnson City, TN | 37604-6287 | 1902851033 | Tran, Martin | 1851395891 | NULL | NULL | NULL | 4/1/21 | 4/29/21 | 01: Discharged to home or self care (routine discharge) | Physician Referral | 71 | NULL | 48:7.30,49:21.90,68:56200.00,A8:136.00,A9:172.72,D5:1.28 | NULL | N186:,D509:,E611:,R110:,D631:,Z992:,N2581 | NULL | $101,764.42 | 22 | 4/6/21 | 635 | Q4081 | JB | NULL | 127 | $4,038.60 | 10/5/19 | |||
| 5/7/46 | M | 721 | Tennessee Valley Dialysis Center | PO Box 785691, Philadelphia, PA | 19178-5691 | 1902851033 | NULL | Tennessee Valley Dialysis Center | 107 Woodlawn Dr, Johnson City, TN | 37604-6287 | 1902851033 | Tran, Martin | 1851395891 | NULL | NULL | NULL | 4/1/21 | 4/29/21 | 01: Discharged to home or self care (routine discharge) | Physician Referral | 71 | NULL | 48:7.30,49:21.90,68:56200.00,A8:136.00,A9:172.72,D5:1.28 | NULL | N186:,D509:,E611:,R110:,D631:,Z992:,N2581 | NULL | $101,764.42 | 23 | 4/13/21 | 635 | Q4081 | JB | NULL | 127 | $4,038.60 | 10/5/19 | |||
| 5/7/46 | M | 721 | Tennessee Valley Dialysis Center | PO Box 785691, Philadelphia, PA | 19178-5691 | 1902851033 | NULL | Tennessee Valley Dialysis Center | 107 Woodlawn Dr, Johnson City, TN | 37604-6287 | 1902851033 | Tran, Martin | 1851395891 | NULL | NULL | NULL | 4/1/21 | 4/29/21 | 01: Discharged to home or self care (routine discharge) | Physician Referral | 71 | NULL | 48:7.30,49:21.90,68:56200.00,A8:136.00,A9:172.72,D5:1.28 | NULL | N186:,D509:,E611:,R110:,D631:,Z992:,N2581 | NULL | $101,764.42 | 24 | 4/20/21 | 635 | Q4081 | JB | NULL | 127 | $4,038.60 | 10/5/19 | |||
| 5/7/46 | M | 721 | Tennessee Valley Dialysis Center | PO Box 785691, Philadelphia, PA | 19178-5691 | 1902851033 | NULL | Tennessee Valley Dialysis Center | 107 Woodlawn Dr, Johnson City, TN | 37604-6287 | 1902851033 | Tran, Martin | 1851395891 | NULL | NULL | NULL | 4/1/21 | 4/29/21 | 01: Discharged to home or self care (routine discharge) | Physician Referral | 71 | NULL | 48:7.30,49:21.90,68:56200.00,A8:136.00,A9:172.72,D5:1.28 | NULL | N186:,D509:,E611:,R110:,D631:,Z992:,N2581 | NULL | $101,764.42 | 25 | 4/27/21 | 635 | Q4081 | JB | NULL | 181 | $5,755.80 | 10/5/19 | |||
| 5/7/46 | M | 721 | Tennessee Valley Dialysis Center | PO Box 785691, Philadelphia, PA | 19178-5691 | 1902851033 | NULL | Tennessee Valley Dialysis Center | 107 Woodlawn Dr, Johnson City, TN | 37604-6287 | 1902851033 | Tran, Martin | 1851395891 | NULL | NULL | NULL | 4/1/21 | 4/29/21 | 01: Discharged to home or self care (routine discharge) | Physician Referral | 71 | NULL | 48:7.30,49:21.90,68:56200.00,A8:136.00,A9:172.72,D5:1.28 | NULL | N186:,D509:,E611:,R110:,D631:,Z992:,N2581 | NULL | $101,764.42 | 26 | 4/1/21 | 636 | J1270 | NULL | NULL | 2 | $514.20 | 10/5/19 | |||
| 5/7/46 | M | 721 | Tennessee Valley Dialysis Center | PO Box 785691, Philadelphia, PA | 19178-5691 | 1902851033 | NULL | Tennessee Valley Dialysis Center | 107 Woodlawn Dr, Johnson City, TN | 37604-6287 | 1902851033 | Tran, Martin | 1851395891 | NULL | NULL | NULL | 4/1/21 | 4/29/21 | 01: Discharged to home or self care (routine discharge) | Physician Referral | 71 | NULL | 48:7.30,49:21.90,68:56200.00,A8:136.00,A9:172.72,D5:1.28 | NULL | N186:,D509:,E611:,R110:,D631:,Z992:,N2581 | NULL | $101,764.42 | 27 | 4/3/21 | 636 | J1270 | NULL | NULL | 2 | $514.20 | 10/5/19 | |||
| 5/7/46 | M | 721 | Tennessee Valley Dialysis Center | PO Box 785691, Philadelphia, PA | 19178-5691 | 1902851033 | NULL | Tennessee Valley Dialysis Center | 107 Woodlawn Dr, Johnson City, TN | 37604-6287 | 1902851033 | Tran, Martin | 1851395891 | NULL | NULL | NULL | 4/1/21 | 4/29/21 | 01: Discharged to home or self care (routine discharge) | Physician Referral | 71 | NULL | 48:7.30,49:21.90,68:56200.00,A8:136.00,A9:172.72,D5:1.28 | NULL | N186:,D509:,E611:,R110:,D631:,Z992:,N2581 | NULL | $101,764.42 | 28 | 4/6/21 | 636 | J1270 | NULL | NULL | 2 | $514.20 | 10/5/19 | |||
| 5/7/46 | M | 721 | Tennessee Valley Dialysis Center | PO Box 785691, Philadelphia, PA | 19178-5691 | 1902851033 | NULL | Tennessee Valley Dialysis Center | 107 Woodlawn Dr, Johnson City, TN | 37604-6287 | 1902851033 | Tran, Martin | 1851395891 | NULL | NULL | NULL | 4/1/21 | 4/29/21 | 01: Discharged to home or self care (routine discharge) | Physician Referral | 71 | NULL | 48:7.30,49:21.90,68:56200.00,A8:136.00,A9:172.72,D5:1.28 | NULL | N186:,D509:,E611:,R110:,D631:,Z992:,N2581 | NULL | $101,764.42 | 29 | 4/8/21 | 636 | J1270 | NULL | NULL | 2 | $514.20 | 10/5/19 | |||
| 5/7/46 | M | 721 | Tennessee Valley Dialysis Center | PO Box 785691, Philadelphia, PA | 19178-5691 | 1902851033 | NULL | Tennessee Valley Dialysis Center | 107 Woodlawn Dr, Johnson City, TN | 37604-6287 | 1902851033 | Tran, Martin | 1851395891 | NULL | NULL | NULL | 4/1/21 | 4/29/21 | 01: Discharged to home or self care (routine discharge) | Physician Referral | 71 | NULL | 48:7.30,49:21.90,68:56200.00,A8:136.00,A9:172.72,D5:1.28 | NULL | N186:,D509:,E611:,R110:,D631:,Z992:,N2581 | NULL | $101,764.42 | 30 | 4/10/21 | 636 | J1270 | NULL | NULL | 2 | $514.20 | 10/5/19 | |||
| 5/7/46 | M | 721 | Tennessee Valley Dialysis Center | PO Box 785691, Philadelphia, PA | 19178-5691 | 1902851033 | NULL | Tennessee Valley Dialysis Center | 107 Woodlawn Dr, Johnson City, TN | 37604-6287 | 1902851033 | Tran, Martin | 1851395891 | NULL | NULL | NULL | 4/1/21 | 4/29/21 | 01: Discharged to home or self care (routine discharge) | Physician Referral | 71 | NULL | 48:7.30,49:21.90,68:56200.00,A8:136.00,A9:172.72,D5:1.28 | NULL | N186:,D509:,E611:,R110:,D631:,Z992:,N2581 | NULL | $101,764.42 | 31 | 4/13/21 | 636 | J1270 | NULL | NULL | 2 | $514.20 | 10/5/19 | |||
| 5/7/46 | M | 721 | Tennessee Valley Dialysis Center | PO Box 785691, Philadelphia, PA | 19178-5691 | 1902851033 | NULL | Tennessee Valley Dialysis Center | 107 Woodlawn Dr, Johnson City, TN | 37604-6287 | 1902851033 | Tran, Martin | 1851395891 | NULL | NULL | NULL | 4/1/21 | 4/29/21 | 01: Discharged to home or self care (routine discharge) | Physician Referral | 71 | NULL | 48:7.30,49:21.90,68:56200.00,A8:136.00,A9:172.72,D5:1.28 | NULL | N186:,D509:,E611:,R110:,D631:,Z992:,N2581 | NULL | $101,764.42 | 32 | 4/15/21 | 636 | J1270 | NULL | NULL | 2 | $514.20 | 10/5/19 | |||
| 5/7/46 | M | 721 | Tennessee Valley Dialysis Center | PO Box 785691, Philadelphia, PA | 19178-5691 | 1902851033 | NULL | Tennessee Valley Dialysis Center | 107 Woodlawn Dr, Johnson City, TN | 37604-6287 | 1902851033 | Tran, Martin | 1851395891 | NULL | NULL | NULL | 4/1/21 | 4/29/21 | 01: Discharged to home or self care (routine discharge) | Physician Referral | 71 | NULL | 48:7.30,49:21.90,68:56200.00,A8:136.00,A9:172.72,D5:1.28 | NULL | N186:,D509:,E611:,R110:,D631:,Z992:,N2581 | NULL | $101,764.42 | 33 | 4/17/21 | 636 | J1270 | NULL | NULL | 2 | $514.20 | 10/5/19 | |||
| 5/7/46 | M | 721 | Tennessee Valley Dialysis Center | PO Box 785691, Philadelphia, PA | 19178-5691 | 1902851033 | NULL | Tennessee Valley Dialysis Center | 107 Woodlawn Dr, Johnson City, TN | 37604-6287 | 1902851033 | Tran, Martin | 1851395891 | NULL | NULL | NULL | 4/1/21 | 4/29/21 | 01: Discharged to home or self care (routine discharge) | Physician Referral | 71 | NULL | 48:7.30,49:21.90,68:56200.00,A8:136.00,A9:172.72,D5:1.28 | NULL | N186:,D509:,E611:,R110:,D631:,Z992:,N2581 | NULL | $101,764.42 | 34 | 4/20/21 | 636 | J1270 | NULL | NULL | 2 | $514.20 | 10/5/19 | |||
| 5/7/46 | M | 721 | Tennessee Valley Dialysis Center | PO Box 785691, Philadelphia, PA | 19178-5691 | 1902851033 | NULL | Tennessee Valley Dialysis Center | 107 Woodlawn Dr, Johnson City, TN | 37604-6287 | 1902851033 | Tran, Martin | 1851395891 | NULL | NULL | NULL | 4/1/21 | 4/29/21 | 01: Discharged to home or self care (routine discharge) | Physician Referral | 71 | NULL | 48:7.30,49:21.90,68:56200.00,A8:136.00,A9:172.72,D5:1.28 | NULL | N186:,D509:,E611:,R110:,D631:,Z992:,N2581 | NULL | $101,764.42 | 35 | 4/22/21 | 636 | J1270 | NULL | NULL | 2 | $514.20 | 10/5/19 | |||
| 5/7/46 | M | 721 | Tennessee Valley Dialysis Center | PO Box 785691, Philadelphia, PA | 19178-5691 | 1902851033 | NULL | Tennessee Valley Dialysis Center | 107 Woodlawn Dr, Johnson City, TN | 37604-6287 | 1902851033 | Tran, Martin | 1851395891 | NULL | NULL | NULL | 4/1/21 | 4/29/21 | 01: Discharged to home or self care (routine discharge) | Physician Referral | 71 | NULL | 48:7.30,49:21.90,68:56200.00,A8:136.00,A9:172.72,D5:1.28 | NULL | N186:,D509:,E611:,R110:,D631:,Z992:,N2581 | NULL | $101,764.42 | 36 | 4/24/21 | 636 | J1270 | NULL | NULL | 2 | $514.20 | 10/5/19 | |||
| 5/7/46 | M | 721 | Tennessee Valley Dialysis Center | PO Box 785691, Philadelphia, PA | 19178-5691 | 1902851033 | NULL | Tennessee Valley Dialysis Center | 107 Woodlawn Dr, Johnson City, TN | 37604-6287 | 1902851033 | Tran, Martin | 1851395891 | NULL | NULL | NULL | 4/1/21 | 4/29/21 | 01: Discharged to home or self care (routine discharge) | Physician Referral | 71 | NULL | 48:7.30,49:21.90,68:56200.00,A8:136.00,A9:172.72,D5:1.28 | NULL | N186:,D509:,E611:,R110:,D631:,Z992:,N2581 | NULL | $101,764.42 | 37 | 4/27/21 | 636 | J1270 | NULL | NULL | 2 | $514.20 | 10/5/19 | |||
| 5/7/46 | M | 721 | Tennessee Valley Dialysis Center | PO Box 785691, Philadelphia, PA | 19178-5691 | 1902851033 | NULL | Tennessee Valley Dialysis Center | 107 Woodlawn Dr, Johnson City, TN | 37604-6287 | 1902851033 | Tran, Martin | 1851395891 | NULL | NULL | NULL | 4/1/21 | 4/29/21 | 01: Discharged to home or self care (routine discharge) | Physician Referral | 71 | NULL | 48:7.30,49:21.90,68:56200.00,A8:136.00,A9:172.72,D5:1.28 | NULL | N186:,D509:,E611:,R110:,D631:,Z992:,N2581 | NULL | $101,764.42 | 38 | 4/29/21 | 636 | J1270 | NULL | NULL | 3 | $771.30 | 10/5/19 | |||
| 5/7/46 | M | 721 | Tennessee Valley Dialysis Center | PO Box 785691, Philadelphia, PA | 19178-5691 | 1902851033 | NULL | Tennessee Valley Dialysis Center | 107 Woodlawn Dr, Johnson City, TN | 37604-6287 | 1902851033 | Tran, Martin | 1851395891 | NULL | NULL | NULL | 4/1/21 | 4/29/21 | 01: Discharged to home or self care (routine discharge) | Physician Referral | 71 | NULL | 48:7.30,49:21.90,68:56200.00,A8:136.00,A9:172.72,D5:1.28 | NULL | N186:,D509:,E611:,R110:,D631:,Z992:,N2581 | NULL | $101,764.42 | 39 | 4/6/21 | 636 | J1756 | NULL | NULL | 100 | $1,580.00 | 10/5/19 | |||
| 5/7/46 | M | 721 | Tennessee Valley Dialysis Center | PO Box 785691, Philadelphia, PA | 19178-5691 | 1902851033 | NULL | Tennessee Valley Dialysis Center | 107 Woodlawn Dr, Johnson City, TN | 37604-6287 | 1902851033 | Tran, Martin | 1851395891 | NULL | NULL | NULL | 4/1/21 | 4/29/21 | 01: Discharged to home or self care (routine discharge) | Physician Referral | 71 | NULL | 48:7.30,49:21.90,68:56200.00,A8:136.00,A9:172.72,D5:1.28 | NULL | N186:,D509:,E611:,R110:,D631:,Z992:,N2581 | NULL | $101,764.42 | 40 | 4/13/21 | 636 | J1756 | NULL | NULL | 100 | $1,580.00 | 10/5/19 | |||
| 5/7/46 | M | 721 | Tennessee Valley Dialysis Center | PO Box 785691, Philadelphia, PA | 19178-5691 | 1902851033 | NULL | Tennessee Valley Dialysis Center | 107 Woodlawn Dr, Johnson City, TN | 37604-6287 | 1902851033 | Tran, Martin | 1851395891 | NULL | NULL | NULL | 4/1/21 | 4/29/21 | 01: Discharged to home or self care (routine discharge) | Physician Referral | 71 | NULL | 48:7.30,49:21.90,68:56200.00,A8:136.00,A9:172.72,D5:1.28 | NULL | N186:,D509:,E611:,R110:,D631:,Z992:,N2581 | NULL | $101,764.42 | 41 | 4/20/21 | 636 | J1756 | NULL | NULL | 100 | $1,580.00 | 10/5/19 | |||
| 5/7/46 | M | 721 | Tennessee Valley Dialysis Center | PO Box 785691, Philadelphia, PA | 19178-5691 | 1902851033 | NULL | Tennessee Valley Dialysis Center | 107 Woodlawn Dr, Johnson City, TN | 37604-6287 | 1902851033 | Tran, Martin | 1851395891 | NULL | NULL | NULL | 4/1/21 | 4/29/21 | 01: Discharged to home or self care (routine discharge) | Physician Referral | 71 | NULL | 48:7.30,49:21.90,68:56200.00,A8:136.00,A9:172.72,D5:1.28 | NULL | N186:,D509:,E611:,R110:,D631:,Z992:,N2581 | NULL | $101,764.42 | 42 | 4/27/21 | 636 | J1756 | NULL | NULL | 50 | $790.00 | 10/5/19 | |||
| 5/7/46 | M | 721 | Tennessee Valley Dialysis Center | PO Box 785691, Philadelphia, PA | 19178-5691 | 1902851033 | NULL | Tennessee Valley Dialysis Center | 107 Woodlawn Dr, Johnson City, TN | 37604-6287 | 1902851033 | Tran, Martin | 1851395891 | NULL | NULL | NULL | 4/1/21 | 4/29/21 | 01: Discharged to home or self care (routine discharge) | Physician Referral | 71 | NULL | 48:7.30,49:21.90,68:56200.00,A8:136.00,A9:172.72,D5:1.28 | NULL | N186:,D509:,E611:,R110:,D631:,Z992:,N2581 | NULL | $101,764.42 | 43 | 4/8/21 | 636 | J2405 | NULL | NULL | 4 | $1,893.00 | 10/5/19 | |||
| 5/7/46 | M | 721 | Tennessee Valley Dialysis Center | PO Box 785691, Philadelphia, PA | 19178-5691 | 1902851033 | NULL | Tennessee Valley Dialysis Center | 107 Woodlawn Dr, Johnson City, TN | 37604-6287 | 1902851033 | Tran, Martin | 1851395891 | NULL | NULL | NULL | 4/1/21 | 4/29/21 | 01: Discharged to home or self care (routine discharge) | Physician Referral | 71 | NULL | 48:7.30,49:21.90,68:56200.00,A8:136.00,A9:172.72,D5:1.28 | NULL | N186:,D509:,E611:,R110:,D631:,Z992:,N2581 | NULL | $101,764.42 | 44 | 4/1/21 | 821 | 90999 | G3,V7 | NULL | 1 | $4,930.00 | 10/5/19 | |||
| 5/7/46 | M | 721 | Tennessee Valley Dialysis Center | PO Box 785691, Philadelphia, PA | 19178-5691 | 1902851033 | NULL | Tennessee Valley Dialysis Center | 107 Woodlawn Dr, Johnson City, TN | 37604-6287 | 1902851033 | Tran, Martin | 1851395891 | NULL | NULL | NULL | 4/1/21 | 4/29/21 | 01: Discharged to home or self care (routine discharge) | Physician Referral | 71 | NULL | 48:7.30,49:21.90,68:56200.00,A8:136.00,A9:172.72,D5:1.28 | NULL | N186:,D509:,E611:,R110:,D631:,Z992:,N2581 | NULL | $101,764.42 | 45 | 4/3/21 | 821 | 90999 | G3,V7 | NULL | 1 | $4,930.00 | 10/5/19 | |||
| 5/7/46 | M | 721 | Tennessee Valley Dialysis Center | PO Box 785691, Philadelphia, PA | 19178-5691 | 1902851033 | NULL | Tennessee Valley Dialysis Center | 107 Woodlawn Dr, Johnson City, TN | 37604-6287 | 1902851033 | Tran, Martin | 1851395891 | NULL | NULL | NULL | 4/1/21 | 4/29/21 | 01: Discharged to home or self care (routine discharge) | Physician Referral | 71 | NULL | 48:7.30,49:21.90,68:56200.00,A8:136.00,A9:172.72,D5:1.28 | NULL | N186:,D509:,E611:,R110:,D631:,Z992:,N2581 | NULL | $101,764.42 | 46 | 4/6/21 | 821 | 90999 | G3,V7 | NULL | 1 | $4,930.00 | 10/5/19 | |||
| 5/7/46 | M | 721 | Tennessee Valley Dialysis Center | PO Box 785691, Philadelphia, PA | 19178-5691 | 1902851033 | NULL | Tennessee Valley Dialysis Center | 107 Woodlawn Dr, Johnson City, TN | 37604-6287 | 1902851033 | Tran, Martin | 1851395891 | NULL | NULL | NULL | 4/1/21 | 4/29/21 | 01: Discharged to home or self care (routine discharge) | Physician Referral | 71 | NULL | 48:7.30,49:21.90,68:56200.00,A8:136.00,A9:172.72,D5:1.28 | NULL | N186:,D509:,E611:,R110:,D631:,Z992:,N2581 | NULL | $101,764.42 | 47 | 4/8/21 | 821 | 90999 | G3,V7 | NULL | 1 | $4,930.00 | 10/5/19 | |||
| 5/7/46 | M | 721 | Tennessee Valley Dialysis Center | PO Box 785691, Philadelphia, PA | 19178-5691 | 1902851033 | NULL | Tennessee Valley Dialysis Center | 107 Woodlawn Dr, Johnson City, TN | 37604-6287 | 1902851033 | Tran, Martin | 1851395891 | NULL | NULL | NULL | 4/1/21 | 4/29/21 | 01: Discharged to home or self care (routine discharge) | Physician Referral | 71 | NULL | 48:7.30,49:21.90,68:56200.00,A8:136.00,A9:172.72,D5:1.28 | NULL | N186:,D509:,E611:,R110:,D631:,Z992:,N2581 | NULL | $101,764.42 | 48 | 4/10/21 | 821 | 90999 | G3,V7 | NULL | 1 | $4,930.00 | 10/5/19 | |||
| 5/7/46 | M | 721 | Tennessee Valley Dialysis Center | PO Box 785691, Philadelphia, PA | 19178-5691 | 1902851033 | NULL | Tennessee Valley Dialysis Center | 107 Woodlawn Dr, Johnson City, TN | 37604-6287 | 1902851033 | Tran, Martin | 1851395891 | NULL | NULL | NULL | 4/1/21 | 4/29/21 | 01: Discharged to home or self care (routine discharge) | Physician Referral | 71 | NULL | 48:7.30,49:21.90,68:56200.00,A8:136.00,A9:172.72,D5:1.28 | NULL | N186:,D509:,E611:,R110:,D631:,Z992:,N2581 | NULL | $101,764.42 | 49 | 4/13/21 | 821 | 90999 | G3,V7 | NULL | 1 | $4,930.00 | 10/5/19 | |||
| 5/7/46 | M | 721 | Tennessee Valley Dialysis Center | PO Box 785691, Philadelphia, PA | 19178-5691 | 1902851033 | NULL | Tennessee Valley Dialysis Center | 107 Woodlawn Dr, Johnson City, TN | 37604-6287 | 1902851033 | Tran, Martin | 1851395891 | NULL | NULL | NULL | 4/1/21 | 4/29/21 | 01: Discharged to home or self care (routine discharge) | Physician Referral | 71 | NULL | 48:7.30,49:21.90,68:56200.00,A8:136.00,A9:172.72,D5:1.28 | NULL | N186:,D509:,E611:,R110:,D631:,Z992:,N2581 | NULL | $101,764.42 | 50 | 4/15/21 | 821 | 90999 | G3,V7 | NULL | 1 | $4,930.00 | 10/5/19 | |||
| 5/7/46 | M | 721 | Tennessee Valley Dialysis Center | PO Box 785691, Philadelphia, PA | 19178-5691 | 1902851033 | NULL | Tennessee Valley Dialysis Center | 107 Woodlawn Dr, Johnson City, TN | 37604-6287 | 1902851033 | Tran, Martin | 1851395891 | NULL | NULL | NULL | 4/1/21 | 4/29/21 | 01: Discharged to home or self care (routine discharge) | Physician Referral | 71 | NULL | 48:7.30,49:21.90,68:56200.00,A8:136.00,A9:172.72,D5:1.28 | NULL | N186:,D509:,E611:,R110:,D631:,Z992:,N2581 | NULL | $101,764.42 | 51 | 4/17/21 | 821 | 90999 | G3,V7 | NULL | 1 | $4,930.00 | 10/5/19 | |||
| 5/7/46 | M | 721 | Tennessee Valley Dialysis Center | PO Box 785691, Philadelphia, PA | 19178-5691 | 1902851033 | NULL | Tennessee Valley Dialysis Center | 107 Woodlawn Dr, Johnson City, TN | 37604-6287 | 1902851033 | Tran, Martin | 1851395891 | NULL | NULL | NULL | 4/1/21 | 4/29/21 | 01: Discharged to home or self care (routine discharge) | Physician Referral | 71 | NULL | 48:7.30,49:21.90,68:56200.00,A8:136.00,A9:172.72,D5:1.28 | NULL | N186:,D509:,E611:,R110:,D631:,Z992:,N2581 | NULL | $101,764.42 | 52 | 4/20/21 | 821 | 90999 | G3,V7 | NULL | 1 | $4,930.00 | 10/5/19 | |||
| 5/7/46 | M | 721 | Tennessee Valley Dialysis Center | PO Box 785691, Philadelphia, PA | 19178-5691 | 1902851033 | NULL | Tennessee Valley Dialysis Center | 107 Woodlawn Dr, Johnson City, TN | 37604-6287 | 1902851033 | Tran, Martin | 1851395891 | NULL | NULL | NULL | 4/1/21 | 4/29/21 | 01: Discharged to home or self care (routine discharge) | Physician Referral | 71 | NULL | 48:7.30,49:21.90,68:56200.00,A8:136.00,A9:172.72,D5:1.28 | NULL | N186:,D509:,E611:,R110:,D631:,Z992:,N2581 | NULL | $101,764.42 | 53 | 4/22/21 | 821 | 90999 | G3,V7 | NULL | 1 | $4,930.00 | 10/5/19 | |||
| 5/7/46 | M | 721 | Tennessee Valley Dialysis Center | PO Box 785691, Philadelphia, PA | 19178-5691 | 1902851033 | NULL | Tennessee Valley Dialysis Center | 107 Woodlawn Dr, Johnson City, TN | 37604-6287 | 1902851033 | Tran, Martin | 1851395891 | NULL | NULL | NULL | 4/1/21 | 4/29/21 | 01: Discharged to home or self care (routine discharge) | Physician Referral | 71 | NULL | 48:7.30,49:21.90,68:56200.00,A8:136.00,A9:172.72,D5:1.28 | NULL | N186:,D509:,E611:,R110:,D631:,Z992:,N2581 | NULL | $101,764.42 | 54 | 4/24/21 | 821 | 90999 | G3,V7 | NULL | 1 | $4,930.00 | 10/5/19 | |||
| 5/7/46 | M | 721 | Tennessee Valley Dialysis Center | PO Box 785691, Philadelphia, PA | 19178-5691 | 1902851033 | NULL | Tennessee Valley Dialysis Center | 107 Woodlawn Dr, Johnson City, TN | 37604-6287 | 1902851033 | Tran, Martin | 1851395891 | NULL | NULL | NULL | 4/1/21 | 4/29/21 | 01: Discharged to home or self care (routine discharge) | Physician Referral | 71 | NULL | 48:7.30,49:21.90,68:56200.00,A8:136.00,A9:172.72,D5:1.28 | NULL | N186:,D509:,E611:,R110:,D631:,Z992:,N2581 | NULL | $101,764.42 | 55 | 4/27/21 | 821 | 90999 | G3,V7 | NULL | 1 | $4,930.00 | 10/5/19 | |||
| 5/7/46 | M | 721 | Tennessee Valley Dialysis Center | PO Box 785691, Philadelphia, PA | 19178-5691 | 1902851033 | NULL | Tennessee Valley Dialysis Center | 107 Woodlawn Dr, Johnson City, TN | 37604-6287 | 1902851033 | Tran, Martin | 1851395891 | NULL | NULL | NULL | 4/1/21 | 4/29/21 | 01: Discharged to home or self care (routine discharge) | Physician Referral | 71 | NULL | 48:7.30,49:21.90,68:56200.00,A8:136.00,A9:172.72,D5:1.28 | NULL | N186:,D509:,E611:,R110:,D631:,Z992:,N2581 | NULL | $101,764.42 | 56 | 4/29/21 | 821 | 90999 | G3,V7 | NULL | 1 | $4,930.00 | 10/5/19 | |||
| 3 | 1/15/58 | F | 111 | ST VINCENTS EAST | PO BOX 934547, GA | 31193-0000 | 1376841841 | NULL | ST VINCENTS EAST | 50 MEDICAL PARK EAST DR, BIRMINGHAM, AL | 35235-3401 | 1376841841 | STANLEY, CHRISTOPHER | 1689865461 | NULL | NULL | NULL | 4/16/19 | 5/1/19 | 1 | 6 | NULL | NULL | 01:850.00,80:15.00 | 885 | F200:Y | NULL | $58,197.10 | 1 | 4/16/19 | 124 | NULL | NULL | NULL | 15 | $55,380.00 | NULL | ||
| 1/15/58 | F | 111 | ST VINCENTS EAST | PO BOX 934547, GA | 31193-0000 | 1376841841 | NULL | ST VINCENTS EAST | 50 MEDICAL PARK EAST DR, BIRMINGHAM, AL | 35235-3401 | 1376841841 | STANLEY, CHRISTOPHER | 1689865461 | NULL | NULL | NULL | 4/16/19 | 5/1/19 | 1 | 6 | NULL | NULL | 01:850.00,80:15.00 | 885 | F200:Y | NULL | $58,197.10 | 2 | 4/16/19 | 250 | NULL | NULL | NULL | 150 | $1,124.10 | NULL | |||
| 1/15/58 | F | 111 | ST VINCENTS EAST | PO BOX 934547, GA | 31193-0000 | 1376841841 | NULL | ST VINCENTS EAST | 50 MEDICAL PARK EAST DR, BIRMINGHAM, AL | 35235-3401 | 1376841841 | STANLEY, CHRISTOPHER | 1689865461 | NULL | NULL | NULL | 4/16/19 | 5/1/19 | 1 | 6 | NULL | NULL | 01:850.00,80:15.00 | 885 | F200:Y | NULL | $58,197.10 | 3 | 4/16/19 | 301 | NULL | NULL | NULL | 6 | $1,137.00 | NULL | |||
| 1/15/58 | F | 111 | ST VINCENTS EAST | PO BOX 934547, GA | 31193-0000 | 1376841841 | NULL | ST VINCENTS EAST | 50 MEDICAL PARK EAST DR, BIRMINGHAM, AL | 35235-3401 | 1376841841 | STANLEY, CHRISTOPHER | 1689865461 | NULL | NULL | NULL | 4/16/19 | 5/1/19 | 1 | 6 | NULL | NULL | 01:850.00,80:15.00 | 885 | F200:Y | NULL | $58,197.10 | 4 | 4/16/19 | 305 | NULL | NULL | NULL | 1 | $88.00 | NULL | |||
| 1/15/58 | F | 111 | ST VINCENTS EAST | PO BOX 934547, GA | 31193-0000 | 1376841841 | NULL | ST VINCENTS EAST | 50 MEDICAL PARK EAST DR, BIRMINGHAM, AL | 35235-3401 | 1376841841 | STANLEY, CHRISTOPHER | 1689865461 | NULL | NULL | NULL | 4/16/19 | 5/1/19 | 1 | 6 | NULL | NULL | 01:850.00,80:15.00 | 885 | F200:Y | NULL | $58,197.10 | 5 | 4/16/19 | 307 | NULL | NULL | NULL | 1 | $61.00 | NULL | |||
| 1/15/58 | F | 111 | ST VINCENTS EAST | PO BOX 934547, GA | 31193-0000 | 1376841841 | NULL | ST VINCENTS EAST | 50 MEDICAL PARK EAST DR, BIRMINGHAM, AL | 35235-3401 | 1376841841 | STANLEY, CHRISTOPHER | 1689865461 | NULL | NULL | NULL | 4/16/19 | 5/1/19 | 1 | 6 | NULL | NULL | 01:850.00,80:15.00 | 885 | F200:Y | NULL | $58,197.10 | 6 | 4/16/19 | 730 | NULL | NULL | NULL | 1 | $407.00 | NULL | |||
| 4 | 8/5/63 | M | 721 | Thornton Dialysis Center | PO Box 780284, Philadelphia, PA | 19178-0284 | 1386012268 | NULL | Thornton Dialysis Center | 8800 Fox Dr, Thornton, CO | 80260-6880 | 1386012268 | Newsome, Britt | 1306873476 | NULL | NULL | NULL | 4/2/21 | 4/19/21 | 01: Discharged to home or self care (routine discharge) | Physician Referral | 71 | NULL | 48:8.80,49:26.40,68:27500.00,A8:84.10,A9:170.18,D5:1.41 | NULL | N186:,D631:,D509:,N2581:,Z992 | NULL | $51,519.26 | 1 | 4/2/21 | 250 | NULL | NULL | NULL | 1 | $30.54 | 5/25/18 | ||
| 8/5/63 | M | 721 | Thornton Dialysis Center | PO Box 780284, Philadelphia, PA | 19178-0284 | 1386012268 | NULL | Thornton Dialysis Center | 8800 Fox Dr, Thornton, CO | 80260-6880 | 1386012268 | Newsome, Britt | 1306873476 | NULL | NULL | NULL | 4/2/21 | 4/19/21 | 01: Discharged to home or self care (routine discharge) | Physician Referral | 71 | NULL | 48:8.80,49:26.40,68:27500.00,A8:84.10,A9:170.18,D5:1.41 | NULL | N186:,D631:,D509:,N2581:,Z992 | NULL | $51,519.26 | 2 | 4/5/21 | 250 | NULL | NULL | NULL | 1 | $30.54 | 5/25/18 | |||
| 8/5/63 | M | 721 | Thornton Dialysis Center | PO Box 780284, Philadelphia, PA | 19178-0284 | 1386012268 | NULL | Thornton Dialysis Center | 8800 Fox Dr, Thornton, CO | 80260-6880 | 1386012268 | Newsome, Britt | 1306873476 | NULL | NULL | NULL | 4/2/21 | 4/19/21 | 01: Discharged to home or self care (routine discharge) | Physician Referral | 71 | NULL | 48:8.80,49:26.40,68:27500.00,A8:84.10,A9:170.18,D5:1.41 | NULL | N186:,D631:,D509:,N2581:,Z992 | NULL | $51,519.26 | 3 | 4/7/21 | 250 | NULL | NULL | NULL | 1 | $30.54 | 5/25/18 | |||
| 8/5/63 | M | 721 | Thornton Dialysis Center | PO Box 780284, Philadelphia, PA | 19178-0284 | 1386012268 | NULL | Thornton Dialysis Center | 8800 Fox Dr, Thornton, CO | 80260-6880 | 1386012268 | Newsome, Britt | 1306873476 | NULL | NULL | NULL | 4/2/21 | 4/19/21 | 01: Discharged to home or self care (routine discharge) | Physician Referral | 71 | NULL | 48:8.80,49:26.40,68:27500.00,A8:84.10,A9:170.18,D5:1.41 | NULL | N186:,D631:,D509:,N2581:,Z992 | NULL | $51,519.26 | 4 | 4/9/21 | 250 | NULL | NULL | NULL | 1 | $30.54 | 5/25/18 | |||
| 8/5/63 | M | 721 | Thornton Dialysis Center | PO Box 780284, Philadelphia, PA | 19178-0284 | 1386012268 | NULL | Thornton Dialysis Center | 8800 Fox Dr, Thornton, CO | 80260-6880 | 1386012268 | Newsome, Britt | 1306873476 | NULL | NULL | NULL | 4/2/21 | 4/19/21 | 01: Discharged to home or self care (routine discharge) | Physician Referral | 71 | NULL | 48:8.80,49:26.40,68:27500.00,A8:84.10,A9:170.18,D5:1.41 | NULL | N186:,D631:,D509:,N2581:,Z992 | NULL | $51,519.26 | 5 | 4/12/21 | 250 | NULL | NULL | NULL | 1 | $30.54 | 5/25/18 | |||
| 8/5/63 | M | 721 | Thornton Dialysis Center | PO Box 780284, Philadelphia, PA | 19178-0284 | 1386012268 | NULL | Thornton Dialysis Center | 8800 Fox Dr, Thornton, CO | 80260-6880 | 1386012268 | Newsome, Britt | 1306873476 | NULL | NULL | NULL | 4/2/21 | 4/19/21 | 01: Discharged to home or self care (routine discharge) | Physician Referral | 71 | NULL | 48:8.80,49:26.40,68:27500.00,A8:84.10,A9:170.18,D5:1.41 | NULL | N186:,D631:,D509:,N2581:,Z992 | NULL | $51,519.26 | 6 | 4/14/21 | 250 | NULL | NULL | NULL | 1 | $30.54 | 5/25/18 | |||
| 8/5/63 | M | 721 | Thornton Dialysis Center | PO Box 780284, Philadelphia, PA | 19178-0284 | 1386012268 | NULL | Thornton Dialysis Center | 8800 Fox Dr, Thornton, CO | 80260-6880 | 1386012268 | Newsome, Britt | 1306873476 | NULL | NULL | NULL | 4/2/21 | 4/19/21 | 01: Discharged to home or self care (routine discharge) | Physician Referral | 71 | NULL | 48:8.80,49:26.40,68:27500.00,A8:84.10,A9:170.18,D5:1.41 | NULL | N186:,D631:,D509:,N2581:,Z992 | NULL | $51,519.26 | 7 | 4/19/21 | 250 | NULL | NULL | NULL | 1 | $30.54 | 5/25/18 | |||
| 8/5/63 | M | 721 | Thornton Dialysis Center | PO Box 780284, Philadelphia, PA | 19178-0284 | 1386012268 | NULL | Thornton Dialysis Center | 8800 Fox Dr, Thornton, CO | 80260-6880 | 1386012268 | Newsome, Britt | 1306873476 | NULL | NULL | NULL | 4/2/21 | 4/19/21 | 01: Discharged to home or self care (routine discharge) | Physician Referral | 71 | NULL | 48:8.80,49:26.40,68:27500.00,A8:84.10,A9:170.18,D5:1.41 | NULL | N186:,D631:,D509:,N2581:,Z992 | NULL | $51,519.26 | 8 | 4/2/21 | 270 | A4657 | NULL | NULL | 16 | $1,861.60 | 5/25/18 | |||
| 8/5/63 | M | 721 | Thornton Dialysis Center | PO Box 780284, Philadelphia, PA | 19178-0284 | 1386012268 | NULL | Thornton Dialysis Center | 8800 Fox Dr, Thornton, CO | 80260-6880 | 1386012268 | Newsome, Britt | 1306873476 | NULL | NULL | NULL | 4/2/21 | 4/19/21 | 01: Discharged to home or self care (routine discharge) | Physician Referral | 71 | NULL | 48:8.80,49:26.40,68:27500.00,A8:84.10,A9:170.18,D5:1.41 | NULL | N186:,D631:,D509:,N2581:,Z992 | NULL | $51,519.26 | 9 | 4/12/21 | 301 | 83970 | NULL | NULL | 1 | $733.68 | 5/25/18 | |||
| 8/5/63 | M | 721 | Thornton Dialysis Center | PO Box 780284, Philadelphia, PA | 19178-0284 | 1386012268 | NULL | Thornton Dialysis Center | 8800 Fox Dr, Thornton, CO | 80260-6880 | 1386012268 | Newsome, Britt | 1306873476 | NULL | NULL | NULL | 4/2/21 | 4/19/21 | 01: Discharged to home or self care (routine discharge) | Physician Referral | 71 | NULL | 48:8.80,49:26.40,68:27500.00,A8:84.10,A9:170.18,D5:1.41 | NULL | N186:,D631:,D509:,N2581:,Z992 | NULL | $51,519.26 | 10 | 4/2/21 | 634 | Q4081 | JA | NULL | 38 | $1,208.40 | 5/25/18 | |||
| 8/5/63 | M | 721 | Thornton Dialysis Center | PO Box 780284, Philadelphia, PA | 19178-0284 | 1386012268 | NULL | Thornton Dialysis Center | 8800 Fox Dr, Thornton, CO | 80260-6880 | 1386012268 | Newsome, Britt | 1306873476 | NULL | NULL | NULL | 4/2/21 | 4/19/21 | 01: Discharged to home or self care (routine discharge) | Physician Referral | 71 | NULL | 48:8.80,49:26.40,68:27500.00,A8:84.10,A9:170.18,D5:1.41 | NULL | N186:,D631:,D509:,N2581:,Z992 | NULL | $51,519.26 | 11 | 4/5/21 | 634 | Q4081 | JA | NULL | 38 | $1,208.40 | 5/25/18 | |||
| 8/5/63 | M | 721 | Thornton Dialysis Center | PO Box 780284, Philadelphia, PA | 19178-0284 | 1386012268 | NULL | Thornton Dialysis Center | 8800 Fox Dr, Thornton, CO | 80260-6880 | 1386012268 | Newsome, Britt | 1306873476 | NULL | NULL | NULL | 4/2/21 | 4/19/21 | 01: Discharged to home or self care (routine discharge) | Physician Referral | 71 | NULL | 48:8.80,49:26.40,68:27500.00,A8:84.10,A9:170.18,D5:1.41 | NULL | N186:,D631:,D509:,N2581:,Z992 | NULL | $51,519.26 | 12 | 4/7/21 | 634 | Q4081 | JA | NULL | 38 | $1,208.40 | 5/25/18 | |||
| 8/5/63 | M | 721 | Thornton Dialysis Center | PO Box 780284, Philadelphia, PA | 19178-0284 | 1386012268 | NULL | Thornton Dialysis Center | 8800 Fox Dr, Thornton, CO | 80260-6880 | 1386012268 | Newsome, Britt | 1306873476 | NULL | NULL | NULL | 4/2/21 | 4/19/21 | 01: Discharged to home or self care (routine discharge) | Physician Referral | 71 | NULL | 48:8.80,49:26.40,68:27500.00,A8:84.10,A9:170.18,D5:1.41 | NULL | N186:,D631:,D509:,N2581:,Z992 | NULL | $51,519.26 | 13 | 4/9/21 | 634 | Q4081 | JA | NULL | 38 | $1,208.40 | 5/25/18 | |||
| 8/5/63 | M | 721 | Thornton Dialysis Center | PO Box 780284, Philadelphia, PA | 19178-0284 | 1386012268 | NULL | Thornton Dialysis Center | 8800 Fox Dr, Thornton, CO | 80260-6880 | 1386012268 | Newsome, Britt | 1306873476 | NULL | NULL | NULL | 4/2/21 | 4/19/21 | 01: Discharged to home or self care (routine discharge) | Physician Referral | 71 | NULL | 48:8.80,49:26.40,68:27500.00,A8:84.10,A9:170.18,D5:1.41 | NULL | N186:,D631:,D509:,N2581:,Z992 | NULL | $51,519.26 | 14 | 4/12/21 | 634 | Q4081 | JA | NULL | 38 | $1,208.40 | 5/25/18 | |||
| 8/5/63 | M | 721 | Thornton Dialysis Center | PO Box 780284, Philadelphia, PA | 19178-0284 | 1386012268 | NULL | Thornton Dialysis Center | 8800 Fox Dr, Thornton, CO | 80260-6880 | 1386012268 | Newsome, Britt | 1306873476 | NULL | NULL | NULL | 4/2/21 | 4/19/21 | 01: Discharged to home or self care (routine discharge) | Physician Referral | 71 | NULL | 48:8.80,49:26.40,68:27500.00,A8:84.10,A9:170.18,D5:1.41 | NULL | N186:,D631:,D509:,N2581:,Z992 | NULL | $51,519.26 | 15 | 4/14/21 | 634 | Q4081 | JA | NULL | 38 | $1,208.40 | 5/25/18 | |||
| 8/5/63 | M | 721 | Thornton Dialysis Center | PO Box 780284, Philadelphia, PA | 19178-0284 | 1386012268 | NULL | Thornton Dialysis Center | 8800 Fox Dr, Thornton, CO | 80260-6880 | 1386012268 | Newsome, Britt | 1306873476 | NULL | NULL | NULL | 4/2/21 | 4/19/21 | 01: Discharged to home or self care (routine discharge) | Physician Referral | 71 | NULL | 48:8.80,49:26.40,68:27500.00,A8:84.10,A9:170.18,D5:1.41 | NULL | N186:,D631:,D509:,N2581:,Z992 | NULL | $51,519.26 | 16 | 4/19/21 | 634 | Q4081 | JA | NULL | 47 | $1,494.60 | 5/25/18 | |||
| 8/5/63 | M | 721 | Thornton Dialysis Center | PO Box 780284, Philadelphia, PA | 19178-0284 | 1386012268 | NULL | Thornton Dialysis Center | 8800 Fox Dr, Thornton, CO | 80260-6880 | 1386012268 | Newsome, Britt | 1306873476 | NULL | NULL | NULL | 4/2/21 | 4/19/21 | 01: Discharged to home or self care (routine discharge) | Physician Referral | 71 | NULL | 48:8.80,49:26.40,68:27500.00,A8:84.10,A9:170.18,D5:1.41 | NULL | N186:,D631:,D509:,N2581:,Z992 | NULL | $51,519.26 | 17 | 4/2/21 | 636 | J1270 | NULL | NULL | 2 | $514.20 | 5/25/18 | |||
| 8/5/63 | M | 721 | Thornton Dialysis Center | PO Box 780284, Philadelphia, PA | 19178-0284 | 1386012268 | NULL | Thornton Dialysis Center | 8800 Fox Dr, Thornton, CO | 80260-6880 | 1386012268 | Newsome, Britt | 1306873476 | NULL | NULL | NULL | 4/2/21 | 4/19/21 | 01: Discharged to home or self care (routine discharge) | Physician Referral | 71 | NULL | 48:8.80,49:26.40,68:27500.00,A8:84.10,A9:170.18,D5:1.41 | NULL | N186:,D631:,D509:,N2581:,Z992 | NULL | $51,519.26 | 18 | 4/5/21 | 636 | J1270 | NULL | NULL | 2 | $514.20 | 5/25/18 | |||
| 8/5/63 | M | 721 | Thornton Dialysis Center | PO Box 780284, Philadelphia, PA | 19178-0284 | 1386012268 | NULL | Thornton Dialysis Center | 8800 Fox Dr, Thornton, CO | 80260-6880 | 1386012268 | Newsome, Britt | 1306873476 | NULL | NULL | NULL | 4/2/21 | 4/19/21 | 01: Discharged to home or self care (routine discharge) | Physician Referral | 71 | NULL | 48:8.80,49:26.40,68:27500.00,A8:84.10,A9:170.18,D5:1.41 | NULL | N186:,D631:,D509:,N2581:,Z992 | NULL | $51,519.26 | 19 | 4/7/21 | 636 | J1270 | NULL | NULL | 2 | $514.20 | 5/25/18 | |||
| 8/5/63 | M | 721 | Thornton Dialysis Center | PO Box 780284, Philadelphia, PA | 19178-0284 | 1386012268 | NULL | Thornton Dialysis Center | 8800 Fox Dr, Thornton, CO | 80260-6880 | 1386012268 | Newsome, Britt | 1306873476 | NULL | NULL | NULL | 4/2/21 | 4/19/21 | 01: Discharged to home or self care (routine discharge) | Physician Referral | 71 | NULL | 48:8.80,49:26.40,68:27500.00,A8:84.10,A9:170.18,D5:1.41 | NULL | N186:,D631:,D509:,N2581:,Z992 | NULL | $51,519.26 | 20 | 4/9/21 | 636 | J1270 | NULL | NULL | 2 | $514.20 | 5/25/18 | |||
| 8/5/63 | M | 721 | Thornton Dialysis Center | PO Box 780284, Philadelphia, PA | 19178-0284 | 1386012268 | NULL | Thornton Dialysis Center | 8800 Fox Dr, Thornton, CO | 80260-6880 | 1386012268 | Newsome, Britt | 1306873476 | NULL | NULL | NULL | 4/2/21 | 4/19/21 | 01: Discharged to home or self care (routine discharge) | Physician Referral | 71 | NULL | 48:8.80,49:26.40,68:27500.00,A8:84.10,A9:170.18,D5:1.41 | NULL | N186:,D631:,D509:,N2581:,Z992 | NULL | $51,519.26 | 21 | 4/12/21 | 636 | J1270 | NULL | NULL | 2 | $514.20 | 5/25/18 | |||
| 8/5/63 | M | 721 | Thornton Dialysis Center | PO Box 780284, Philadelphia, PA | 19178-0284 | 1386012268 | NULL | Thornton Dialysis Center | 8800 Fox Dr, Thornton, CO | 80260-6880 | 1386012268 | Newsome, Britt | 1306873476 | NULL | NULL | NULL | 4/2/21 | 4/19/21 | 01: Discharged to home or self care (routine discharge) | Physician Referral | 71 | NULL | 48:8.80,49:26.40,68:27500.00,A8:84.10,A9:170.18,D5:1.41 | NULL | N186:,D631:,D509:,N2581:,Z992 | NULL | $51,519.26 | 22 | 4/14/21 | 636 | J1270 | NULL | NULL | 2 | $514.20 | 5/25/18 | |||
| 8/5/63 | M | 721 | Thornton Dialysis Center | PO Box 780284, Philadelphia, PA | 19178-0284 | 1386012268 | NULL | Thornton Dialysis Center | 8800 Fox Dr, Thornton, CO | 80260-6880 | 1386012268 | Newsome, Britt | 1306873476 | NULL | NULL | NULL | 4/2/21 | 4/19/21 | 01: Discharged to home or self care (routine discharge) | Physician Referral | 71 | NULL | 48:8.80,49:26.40,68:27500.00,A8:84.10,A9:170.18,D5:1.41 | NULL | N186:,D631:,D509:,N2581:,Z992 | NULL | $51,519.26 | 23 | 4/5/21 | 636 | J1756 | NULL | NULL | 50 | $790.00 | 5/25/18 | |||
| 8/5/63 | M | 721 | Thornton Dialysis Center | PO Box 780284, Philadelphia, PA | 19178-0284 | 1386012268 | NULL | Thornton Dialysis Center | 8800 Fox Dr, Thornton, CO | 80260-6880 | 1386012268 | Newsome, Britt | 1306873476 | NULL | NULL | NULL | 4/2/21 | 4/19/21 | 01: Discharged to home or self care (routine discharge) | Physician Referral | 71 | NULL | 48:8.80,49:26.40,68:27500.00,A8:84.10,A9:170.18,D5:1.41 | NULL | N186:,D631:,D509:,N2581:,Z992 | NULL | $51,519.26 | 24 | 4/12/21 | 636 | J1756 | NULL | NULL | 50 | $790.00 | 5/25/18 | |||
| 8/5/63 | M | 721 | Thornton Dialysis Center | PO Box 780284, Philadelphia, PA | 19178-0284 | 1386012268 | NULL | Thornton Dialysis Center | 8800 Fox Dr, Thornton, CO | 80260-6880 | 1386012268 | Newsome, Britt | 1306873476 | NULL | NULL | NULL | 4/2/21 | 4/19/21 | 01: Discharged to home or self care (routine discharge) | Physician Referral | 71 | NULL | 48:8.80,49:26.40,68:27500.00,A8:84.10,A9:170.18,D5:1.41 | NULL | N186:,D631:,D509:,N2581:,Z992 | NULL | $51,519.26 | 25 | 4/19/21 | 636 | J1756 | NULL | NULL | 50 | $790.00 | 5/25/18 | |||
| 8/5/63 | M | 721 | Thornton Dialysis Center | PO Box 780284, Philadelphia, PA | 19178-0284 | 1386012268 | NULL | Thornton Dialysis Center | 8800 Fox Dr, Thornton, CO | 80260-6880 | 1386012268 | Newsome, Britt | 1306873476 | NULL | NULL | NULL | 4/2/21 | 4/19/21 | 01: Discharged to home or self care (routine discharge) | Physician Referral | 71 | NULL | 48:8.80,49:26.40,68:27500.00,A8:84.10,A9:170.18,D5:1.41 | NULL | N186:,D631:,D509:,N2581:,Z992 | NULL | $51,519.26 | 26 | 4/2/21 | 821 | 90999 | G4,V7 | NULL | 1 | $4,930.00 | 5/25/18 | |||
| 8/5/63 | M | 721 | Thornton Dialysis Center | PO Box 780284, Philadelphia, PA | 19178-0284 | 1386012268 | NULL | Thornton Dialysis Center | 8800 Fox Dr, Thornton, CO | 80260-6880 | 1386012268 | Newsome, Britt | 1306873476 | NULL | NULL | NULL | 4/2/21 | 4/19/21 | 01: Discharged to home or self care (routine discharge) | Physician Referral | 71 | NULL | 48:8.80,49:26.40,68:27500.00,A8:84.10,A9:170.18,D5:1.41 | NULL | N186:,D631:,D509:,N2581:,Z992 | NULL | $51,519.26 | 27 | 4/5/21 | 821 | 90999 | G4,V7 | NULL | 1 | $4,930.00 | 5/25/18 | |||
| 8/5/63 | M | 721 | Thornton Dialysis Center | PO Box 780284, Philadelphia, PA | 19178-0284 | 1386012268 | NULL | Thornton Dialysis Center | 8800 Fox Dr, Thornton, CO | 80260-6880 | 1386012268 | Newsome, Britt | 1306873476 | NULL | NULL | NULL | 4/2/21 | 4/19/21 | 01: Discharged to home or self care (routine discharge) | Physician Referral | 71 | NULL | 48:8.80,49:26.40,68:27500.00,A8:84.10,A9:170.18,D5:1.41 | NULL | N186:,D631:,D509:,N2581:,Z992 | NULL | $51,519.26 | 28 | 4/7/21 | 821 | 90999 | G4,V7 | NULL | 1 | $4,930.00 | 5/25/18 | |||
| 8/5/63 | M | 721 | Thornton Dialysis Center | PO Box 780284, Philadelphia, PA | 19178-0284 | 1386012268 | NULL | Thornton Dialysis Center | 8800 Fox Dr, Thornton, CO | 80260-6880 | 1386012268 | Newsome, Britt | 1306873476 | NULL | NULL | NULL | 4/2/21 | 4/19/21 | 01: Discharged to home or self care (routine discharge) | Physician Referral | 71 | NULL | 48:8.80,49:26.40,68:27500.00,A8:84.10,A9:170.18,D5:1.41 | NULL | N186:,D631:,D509:,N2581:,Z992 | NULL | $51,519.26 | 29 | 4/9/21 | 821 | 90999 | G4,V7 | NULL | 1 | $4,930.00 | 5/25/18 | |||
| 8/5/63 | M | 721 | Thornton Dialysis Center | PO Box 780284, Philadelphia, PA | 19178-0284 | 1386012268 | NULL | Thornton Dialysis Center | 8800 Fox Dr, Thornton, CO | 80260-6880 | 1386012268 | Newsome, Britt | 1306873476 | NULL | NULL | NULL | 4/2/21 | 4/19/21 | 01: Discharged to home or self care (routine discharge) | Physician Referral | 71 | NULL | 48:8.80,49:26.40,68:27500.00,A8:84.10,A9:170.18,D5:1.41 | NULL | N186:,D631:,D509:,N2581:,Z992 | NULL | $51,519.26 | 30 | 4/12/21 | 821 | 90999 | G4,V7 | NULL | 1 | $4,930.00 | 5/25/18 |
This is the start of the file's text. The full file is on GovTribe.
File details come from the government source that posted it. Updated .