Exhibit_E_-_Institution_Outpatient_Paid_Claims.xlsx
XLSX spreadsheet 8 MB Posted
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- Solicitation number
- 4115RC
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- Florida
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| CLAIM_TYPE_DE | BILLING_PVDR_NPI_ID | BILLING_PVDR_TAX_ID | BILLING_PVDR_NM | BILLING_PVDR_ADDR_STREET_NM | BILLING_PVDR_ADDR_CITY_NM | BILLING_PVDR_ADDR_STATE_CD | BILLING_PVDR_ADDR_ZIP_CD | BILLING_PVDR_PAR_STATUS_IND | RENDERING_PVDR_NPI_ID | RENDERING_PVDR_TAX_ID | RENDERING_PVDR_BCBSFL_ID | RENDERING_PVDR_NM | RENDERING_PVDR_ADDR_STREET_NM | RENDERING_PVDR_ADDR_CITY_NM | RENDERING_PVDR_ADDR_STATE_CD | RENDERING_PVDR_ADDR_ZIP_CD | RENDERING_PVDR_TYPE_CD | RENDERING_PVDR_TYPE_DE | RENDERING_PVDR_SPECIALTY_CD | RENDERING_PVDR_SPECIALTY_DE | LOB_DE | GROUP_NB | LOCATION_OF_SERVICE_CD | DRG_CD | ADMITTING_DIAGNOSIS_CD | HEADER_DIAGNOSIS_1_CD | HEADER_DIAGNOSIS_1_DE | HEADER_DIAGNOSIS_1_PRINC_TYPE_DE | HEADER_DIAGNOSIS_1_CHAPTER_DE | HEADER_DIAGNOSIS_2_CD | HEADER_DIAGNOSIS_3_CD | HEADER_DIAGNOSIS_4_CD | HEADER_DIAGNOSIS_5_CD | LINE_DIAGNOSIS_1_CD | PROCEDURE_CD_TYPE_DE | PROCEDURE_CD | MODIFIER_1_CD | MODIFIER_2_CD | REVENUE_CD | UNIT_CT | PATIENT_DISCHARGE_STATUS_CD | BILL_TYPE_CD | LINE_SERVICE_BEG_DT | LINE_SERVICE_END_DT | RECEIVED_DT | POST_DT | LINE_BILLED_AMT | Proposer Reimbursements | Proposer Participating Network |
| INSTITUTIONAL - OUTPATIENT | 1760847792 | 472831130 | OCALA FL ORTHOPAEDIC ASC LLC | PO BOX 305250 | NASHVILLE | TN | 37230 | YES | 1063497428 | 472831130 | N8Q | ORTHOPAEDIC SURGERY CENTER OF OCALA | 1600 SE 17TH ST | OCALA | FL | 04 | AMBULATORY SURGERY CENTER | FAC | INSTITUTIONAL FACILITIES | GROUP BLUE OPTIONS | 16153 | 24 | 554 | M1712 | M1712 | UNILATERAL PRIMARY OSTEOARTHRITIS, LEFT KNEE | OSTEOARTHRITIS OF KNEE | DISEASES OF THE MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE | M25562 | M1712 | CPT | 27447 | LT | 490 | 1 | 01 | 831 | 4/19/24 | 4/19/24 | 4/30/24 | 5/1/24 | 43,000.00 | |||||||
| INSTITUTIONAL - OUTPATIENT | 1760847792 | 472831130 | OCALA FL ORTHOPAEDIC ASC LLC | PO BOX 305250 | NASHVILLE | TN | 37230 | YES | 1063497428 | 472831130 | N8Q | ORTHOPAEDIC SURGERY CENTER OF OCALA | 1600 SE 17TH ST | OCALA | FL | 04 | AMBULATORY SURGERY CENTER | FAC | INSTITUTIONAL FACILITIES | GROUP BLUE OPTIONS | 16153 | 24 | 554 | M1712 | M1712 | UNILATERAL PRIMARY OSTEOARTHRITIS, LEFT KNEE | OSTEOARTHRITIS OF KNEE | DISEASES OF THE MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE | M25562 | M1712 | CPT | 64447 | 59 | LT | 490 | 1 | 01 | 831 | 4/19/24 | 4/19/24 | 4/30/24 | 5/1/24 | 2,963.00 | ||||||
| INSTITUTIONAL - OUTPATIENT | 1689646937 | 621650750 | ENDOSCOPY CENTER OF OCALA | 1901 SE 18TH AVE | OCALA | FL | 34471 | YES | 1558724237 | 621650750 | 62Z | THE OCALA ENDOSCOPY ASC | 1160 SE 18TH PL | OCALA | FL | 04 | AMBULATORY SURGERY CENTER | FAC | INSTITUTIONAL FACILITIES | GROUP BLUE OPTIONS | 16153 | 24 | 951 | Z1211 | Z1211 | ENCOUNTER FOR SCREENING FOR MALIGNANT NEOPLASM OF COLON | ENCOUNTER FOR SCREENING FOR MALIGNANT NEOPLASMS | FACTORS INFLUENCING HEALTH STATUS AND CONTACT WITH HEALTH SERVICES | Z800 | K635 | K219 | K317 | Z1211 | CPT | 45385 | 33 | 490 | 1 | 01 | 831 | 4/22/24 | 4/22/24 | 4/23/24 | 4/24/24 | 2,732.00 | ||||
| INSTITUTIONAL - OUTPATIENT | 1689646937 | 621650750 | ENDOSCOPY CENTER OF OCALA | 1901 SE 18TH AVE | OCALA | FL | 34471 | YES | 1558724237 | 621650750 | 62Z | THE OCALA ENDOSCOPY ASC | 1160 SE 18TH PL | OCALA | FL | 04 | AMBULATORY SURGERY CENTER | FAC | INSTITUTIONAL FACILITIES | GROUP BLUE OPTIONS | 16153 | 24 | 951 | Z1211 | Z1211 | ENCOUNTER FOR SCREENING FOR MALIGNANT NEOPLASM OF COLON | ENCOUNTER FOR SCREENING FOR MALIGNANT NEOPLASMS | FACTORS INFLUENCING HEALTH STATUS AND CONTACT WITH HEALTH SERVICES | Z800 | K635 | K219 | K317 | Z1211 | CPT | 43239 | 490 | 1 | 01 | 831 | 4/22/24 | 4/22/24 | 4/23/24 | 4/24/24 | 2,732.00 | |||||
| INSTITUTIONAL - OUTPATIENT | 1740772268 | 824372339 | FLORIDA HOSPITAL OCALA, INC. | PO BOX 947696 | ATLANTA | GA | 30394 | YES | 1578927687 | 824372339 | 80G | ADVENTHEALTH OCALA | 1500 SW 1ST AVE | OCALA | FL | 02 | ACUTE CARE HOSPITAL | FAC | INSTITUTIONAL FACILITIES | GROUP BLUE OPTIONS | 16153 | 23 | 641 | E860 | E860 | DEHYDRATION | VOLUME DEPLETION | ENDOCRINE, NUTRITIONAL AND METABOLIC DISEASES | I10 | R112 | R1011 | E6601 | E860 | REVENUE | 250 | 250 | 4 | 01 | 131 | 6/1/24 | 6/1/24 | 6/7/24 | 6/10/24 | 574.57 | |||||
| INSTITUTIONAL - OUTPATIENT | 1740772268 | 824372339 | FLORIDA HOSPITAL OCALA, INC. | PO BOX 947696 | ATLANTA | GA | 30394 | YES | 1578927687 | 824372339 | 80G | ADVENTHEALTH OCALA | 1500 SW 1ST AVE | OCALA | FL | 02 | ACUTE CARE HOSPITAL | FAC | INSTITUTIONAL FACILITIES | GROUP BLUE OPTIONS | 16153 | 23 | 641 | E860 | E860 | DEHYDRATION | VOLUME DEPLETION | ENDOCRINE, NUTRITIONAL AND METABOLIC DISEASES | I10 | R112 | R1011 | E6601 | E860 | CPT | 84484 | 91 | 301 | 2 | 01 | 131 | 6/1/24 | 6/1/24 | 6/7/24 | 6/10/24 | 1,145.06 | ||||
| INSTITUTIONAL - OUTPATIENT | 1740772268 | 824372339 | FLORIDA HOSPITAL OCALA, INC. | PO BOX 947696 | ATLANTA | GA | 30394 | YES | 1578927687 | 824372339 | 80G | ADVENTHEALTH OCALA | 1500 SW 1ST AVE | OCALA | FL | 02 | ACUTE CARE HOSPITAL | FAC | INSTITUTIONAL FACILITIES | GROUP BLUE OPTIONS | 16153 | 23 | 641 | E860 | E860 | DEHYDRATION | VOLUME DEPLETION | ENDOCRINE, NUTRITIONAL AND METABOLIC DISEASES | I10 | R112 | R1011 | E6601 | E860 | CPT | 84703 | 301 | 1 | 01 | 131 | 6/1/24 | 6/1/24 | 6/7/24 | 6/10/24 | 1,075.99 | |||||
| INSTITUTIONAL - OUTPATIENT | 1740772268 | 824372339 | FLORIDA HOSPITAL OCALA, INC. | PO BOX 947696 | ATLANTA | GA | 30394 | YES | 1578927687 | 824372339 | 80G | ADVENTHEALTH OCALA | 1500 SW 1ST AVE | OCALA | FL | 02 | ACUTE CARE HOSPITAL | FAC | INSTITUTIONAL FACILITIES | GROUP BLUE OPTIONS | 16153 | 23 | 641 | E860 | E860 | DEHYDRATION | VOLUME DEPLETION | ENDOCRINE, NUTRITIONAL AND METABOLIC DISEASES | I10 | R112 | R1011 | E6601 | E860 | CPT | 84703 | 91 | 301 | 1 | 01 | 131 | 6/1/24 | 6/1/24 | 6/7/24 | 6/10/24 | 1,075.99 | ||||
| INSTITUTIONAL - OUTPATIENT | 1740772268 | 824372339 | FLORIDA HOSPITAL OCALA, INC. | PO BOX 947696 | ATLANTA | GA | 30394 | YES | 1578927687 | 824372339 | 80G | ADVENTHEALTH OCALA | 1500 SW 1ST AVE | OCALA | FL | 02 | ACUTE CARE HOSPITAL | FAC | INSTITUTIONAL FACILITIES | GROUP BLUE OPTIONS | 16153 | 23 | 641 | E860 | E860 | DEHYDRATION | VOLUME DEPLETION | ENDOCRINE, NUTRITIONAL AND METABOLIC DISEASES | I10 | R112 | R1011 | E6601 | E860 | CPT | 80048 | 301 | 1 | 01 | 131 | 6/2/24 | 6/2/24 | 6/7/24 | 6/10/24 | 863.66 | |||||
| INSTITUTIONAL - OUTPATIENT | 1740772268 | 824372339 | FLORIDA HOSPITAL OCALA, INC. | PO BOX 947696 | ATLANTA | GA | 30394 | YES | 1578927687 | 824372339 | 80G | ADVENTHEALTH OCALA | 1500 SW 1ST AVE | OCALA | FL | 02 | ACUTE CARE HOSPITAL | FAC | INSTITUTIONAL FACILITIES | GROUP BLUE OPTIONS | 16153 | 23 | 641 | E860 | E860 | DEHYDRATION | VOLUME DEPLETION | ENDOCRINE, NUTRITIONAL AND METABOLIC DISEASES | I10 | R112 | R1011 | E6601 | E860 | CPT | 84484 | 301 | 1 | 01 | 131 | 6/1/24 | 6/1/24 | 6/7/24 | 6/10/24 | 572.53 | |||||
| INSTITUTIONAL - OUTPATIENT | 1740772268 | 824372339 | FLORIDA HOSPITAL OCALA, INC. | PO BOX 947696 | ATLANTA | GA | 30394 | YES | 1578927687 | 824372339 | 80G | ADVENTHEALTH OCALA | 1500 SW 1ST AVE | OCALA | FL | 02 | ACUTE CARE HOSPITAL | FAC | INSTITUTIONAL FACILITIES | GROUP BLUE OPTIONS | 16153 | 23 | 641 | E860 | E860 | DEHYDRATION | VOLUME DEPLETION | ENDOCRINE, NUTRITIONAL AND METABOLIC DISEASES | I10 | R112 | R1011 | E6601 | E860 | CPT | 83690 | 301 | 1 | 01 | 131 | 6/1/24 | 6/1/24 | 6/7/24 | 6/10/24 | 396.39 | |||||
| INSTITUTIONAL - OUTPATIENT | 1740772268 | 824372339 | FLORIDA HOSPITAL OCALA, INC. | PO BOX 947696 | ATLANTA | GA | 30394 | YES | 1578927687 | 824372339 | 80G | ADVENTHEALTH OCALA | 1500 SW 1ST AVE | OCALA | FL | 02 | ACUTE CARE HOSPITAL | FAC | INSTITUTIONAL FACILITIES | GROUP BLUE OPTIONS | 16153 | 23 | 641 | E860 | E860 | DEHYDRATION | VOLUME DEPLETION | ENDOCRINE, NUTRITIONAL AND METABOLIC DISEASES | I10 | R112 | R1011 | E6601 | E860 | CPT | 85027 | 305 | 1 | 01 | 131 | 6/2/24 | 6/2/24 | 6/7/24 | 6/10/24 | 458.84 | |||||
| INSTITUTIONAL - OUTPATIENT | 1740772268 | 824372339 | FLORIDA HOSPITAL OCALA, INC. | PO BOX 947696 | ATLANTA | GA | 30394 | YES | 1578927687 | 824372339 | 80G | ADVENTHEALTH OCALA | 1500 SW 1ST AVE | OCALA | FL | 02 | ACUTE CARE HOSPITAL | FAC | INSTITUTIONAL FACILITIES | GROUP BLUE OPTIONS | 16153 | 23 | 641 | E860 | E860 | DEHYDRATION | VOLUME DEPLETION | ENDOCRINE, NUTRITIONAL AND METABOLIC DISEASES | I10 | R112 | R1011 | E6601 | E860 | CPT | 85025 | 305 | 1 | 01 | 131 | 6/1/24 | 6/1/24 | 6/7/24 | 6/10/24 | 325.10 | |||||
| INSTITUTIONAL - OUTPATIENT | 1740772268 | 824372339 | FLORIDA HOSPITAL OCALA, INC. | PO BOX 947696 | ATLANTA | GA | 30394 | YES | 1578927687 | 824372339 | 80G | ADVENTHEALTH OCALA | 1500 SW 1ST AVE | OCALA | FL | 02 | ACUTE CARE HOSPITAL | FAC | INSTITUTIONAL FACILITIES | GROUP BLUE OPTIONS | 16153 | 23 | 641 | E860 | E860 | DEHYDRATION | VOLUME DEPLETION | ENDOCRINE, NUTRITIONAL AND METABOLIC DISEASES | I10 | R112 | R1011 | E6601 | E860 | CPT | 85379 | 305 | 1 | 01 | 131 | 6/1/24 | 6/1/24 | 6/7/24 | 6/10/24 | 25.99 | |||||
| INSTITUTIONAL - OUTPATIENT | 1740772268 | 824372339 | FLORIDA HOSPITAL OCALA, INC. | PO BOX 947696 | ATLANTA | GA | 30394 | YES | 1578927687 | 824372339 | 80G | ADVENTHEALTH OCALA | 1500 SW 1ST AVE | OCALA | FL | 02 | ACUTE CARE HOSPITAL | FAC | INSTITUTIONAL FACILITIES | GROUP BLUE OPTIONS | 16153 | 23 | 641 | E860 | E860 | DEHYDRATION | VOLUME DEPLETION | ENDOCRINE, NUTRITIONAL AND METABOLIC DISEASES | I10 | R112 | R1011 | E6601 | E860 | CPT | 81003 | 307 | 1 | 01 | 131 | 6/1/24 | 6/1/24 | 6/7/24 | 6/10/24 | 228.52 | |||||
| INSTITUTIONAL - OUTPATIENT | 1740772268 | 824372339 | FLORIDA HOSPITAL OCALA, INC. | PO BOX 947696 | ATLANTA | GA | 30394 | YES | 1578927687 | 824372339 | 80G | ADVENTHEALTH OCALA | 1500 SW 1ST AVE | OCALA | FL | 02 | ACUTE CARE HOSPITAL | FAC | INSTITUTIONAL FACILITIES | GROUP BLUE OPTIONS | 16153 | 23 | 641 | E860 | E860 | DEHYDRATION | VOLUME DEPLETION | ENDOCRINE, NUTRITIONAL AND METABOLIC DISEASES | I10 | R112 | R1011 | E6601 | E860 | HCPCS | Q9967 | 255 | 100 | 01 | 131 | 6/1/24 | 6/1/24 | 6/7/24 | 6/10/24 | 0.01 | |||||
| INSTITUTIONAL - OUTPATIENT | 1740772268 | 824372339 | FLORIDA HOSPITAL OCALA, INC. | PO BOX 947696 | ATLANTA | GA | 30394 | YES | 1578927687 | 824372339 | 80G | ADVENTHEALTH OCALA | 1500 SW 1ST AVE | OCALA | FL | 02 | ACUTE CARE HOSPITAL | FAC | INSTITUTIONAL FACILITIES | GROUP BLUE OPTIONS | 16153 | 23 | 641 | E860 | E860 | DEHYDRATION | VOLUME DEPLETION | ENDOCRINE, NUTRITIONAL AND METABOLIC DISEASES | I10 | R112 | R1011 | E6601 | E860 | CPT | 71045 | 324 | 1 | 01 | 131 | 6/1/24 | 6/1/24 | 6/7/24 | 6/10/24 | 416.00 | |||||
| INSTITUTIONAL - OUTPATIENT | 1740772268 | 824372339 | FLORIDA HOSPITAL OCALA, INC. | PO BOX 947696 | ATLANTA | GA | 30394 | YES | 1578927687 | 824372339 | 80G | ADVENTHEALTH OCALA | 1500 SW 1ST AVE | OCALA | FL | 02 | ACUTE CARE HOSPITAL | FAC | INSTITUTIONAL FACILITIES | GROUP BLUE OPTIONS | 16153 | 23 | 641 | E860 | E860 | DEHYDRATION | VOLUME DEPLETION | ENDOCRINE, NUTRITIONAL AND METABOLIC DISEASES | I10 | R112 | R1011 | E6601 | E860 | CPT | 74177 | 352 | 1 | 01 | 131 | 6/1/24 | 6/1/24 | 6/7/24 | 6/10/24 | 4,182.55 | |||||
| INSTITUTIONAL - OUTPATIENT | 1740772268 | 824372339 | FLORIDA HOSPITAL OCALA, INC. | PO BOX 947696 | ATLANTA | GA | 30394 | YES | 1578927687 | 824372339 | 80G | ADVENTHEALTH OCALA | 1500 SW 1ST AVE | OCALA | FL | 02 | ACUTE CARE HOSPITAL | FAC | INSTITUTIONAL FACILITIES | GROUP BLUE OPTIONS | 16153 | 23 | 641 | E860 | E860 | DEHYDRATION | VOLUME DEPLETION | ENDOCRINE, NUTRITIONAL AND METABOLIC DISEASES | I10 | R112 | R1011 | E6601 | E860 | CPT | 99285 | 25 | 450 | 1 | 01 | 131 | 6/1/24 | 6/1/24 | 6/7/24 | 6/10/24 | 2,638.40 | ||||
| INSTITUTIONAL - OUTPATIENT | 1740772268 | 824372339 | FLORIDA HOSPITAL OCALA, INC. | PO BOX 947696 | ATLANTA | GA | 30394 | YES | 1578927687 | 824372339 | 80G | ADVENTHEALTH OCALA | 1500 SW 1ST AVE | OCALA | FL | 02 | ACUTE CARE HOSPITAL | FAC | INSTITUTIONAL FACILITIES | GROUP BLUE OPTIONS | 16153 | 23 | 641 | E860 | E860 | DEHYDRATION | VOLUME DEPLETION | ENDOCRINE, NUTRITIONAL AND METABOLIC DISEASES | I10 | R112 | R1011 | E6601 | E860 | HCPCS | J2405 | 636 | 4 | 01 | 131 | 6/1/24 | 6/1/24 | 6/7/24 | 6/10/24 | 67.95 | |||||
| INSTITUTIONAL - OUTPATIENT | 1740772268 | 824372339 | FLORIDA HOSPITAL OCALA, INC. | PO BOX 947696 | ATLANTA | GA | 30394 | YES | 1578927687 | 824372339 | 80G | ADVENTHEALTH OCALA | 1500 SW 1ST AVE | OCALA | FL | 02 | ACUTE CARE HOSPITAL | FAC | INSTITUTIONAL FACILITIES | GROUP BLUE OPTIONS | 16153 | 23 | 641 | E860 | E860 | DEHYDRATION | VOLUME DEPLETION | ENDOCRINE, NUTRITIONAL AND METABOLIC DISEASES | I10 | R112 | R1011 | E6601 | E860 | CPT | 93005 | 730 | 1 | 01 | 131 | 6/1/24 | 6/1/24 | 6/7/24 | 6/10/24 | 300.48 | |||||
| INSTITUTIONAL - OUTPATIENT | 1740772268 | 824372339 | FLORIDA HOSPITAL OCALA, INC. | PO BOX 947696 | ATLANTA | GA | 30394 | YES | 1578927687 | 824372339 | 80G | ADVENTHEALTH OCALA | 1500 SW 1ST AVE | OCALA | FL | 02 | ACUTE CARE HOSPITAL | FAC | INSTITUTIONAL FACILITIES | GROUP BLUE OPTIONS | 16153 | 23 | 641 | E860 | E860 | DEHYDRATION | VOLUME DEPLETION | ENDOCRINE, NUTRITIONAL AND METABOLIC DISEASES | I10 | R112 | R1011 | E6601 | E860 | HCPCS | G0378 | 762 | 13 | 01 | 131 | 6/1/24 | 6/1/24 | 6/7/24 | 6/10/24 | 1,861.28 | |||||
| INSTITUTIONAL - OUTPATIENT | 1740772268 | 824372339 | FLORIDA HOSPITAL OCALA, INC. | PO BOX 947696 | ATLANTA | GA | 30394 | YES | 1578927687 | 824372339 | 80G | ADVENTHEALTH OCALA | 1500 SW 1ST AVE | OCALA | FL | 02 | ACUTE CARE HOSPITAL | FAC | INSTITUTIONAL FACILITIES | GROUP BLUE OPTIONS | 16153 | 23 | 641 | E860 | E860 | DEHYDRATION | VOLUME DEPLETION | ENDOCRINE, NUTRITIONAL AND METABOLIC DISEASES | I10 | R112 | R1011 | E6601 | E860 | REVENUE | 259 | 259 | 1 | 01 | 131 | 6/2/24 | 6/2/24 | 6/7/24 | 6/10/24 | 25.32 | |||||
| INSTITUTIONAL - OUTPATIENT | 1740772268 | 824372339 | FLORIDA HOSPITAL OCALA, INC. | PO BOX 947696 | ATLANTA | GA | 30394 | YES | 1578927687 | 824372339 | 80G | ADVENTHEALTH OCALA | 1500 SW 1ST AVE | OCALA | FL | 02 | ACUTE CARE HOSPITAL | FAC | INSTITUTIONAL FACILITIES | GROUP BLUE OPTIONS | 16153 | 23 | 641 | E860 | E860 | DEHYDRATION | VOLUME DEPLETION | ENDOCRINE, NUTRITIONAL AND METABOLIC DISEASES | I10 | R112 | R1011 | E6601 | E860 | HCPCS | J8499 | 259 | 1 | 01 | 131 | 6/2/24 | 6/2/24 | 6/7/24 | 6/10/24 | 17.06 | |||||
| INSTITUTIONAL - OUTPATIENT | 1740772268 | 824372339 | FLORIDA HOSPITAL OCALA, INC. | PO BOX 947696 | ATLANTA | GA | 30394 | YES | 1578927687 | 824372339 | 80G | ADVENTHEALTH OCALA | 1500 SW 1ST AVE | OCALA | FL | 02 | ACUTE CARE HOSPITAL | FAC | INSTITUTIONAL FACILITIES | GROUP BLUE OPTIONS | 16153 | 23 | 641 | E860 | E860 | DEHYDRATION | VOLUME DEPLETION | ENDOCRINE, NUTRITIONAL AND METABOLIC DISEASES | I10 | R112 | R1011 | E6601 | E860 | HCPCS | J8499 | 259 | 1 | 01 | 131 | 6/2/24 | 6/2/24 | 6/7/24 | 6/10/24 | 11.36 | |||||
| INSTITUTIONAL - OUTPATIENT | 1740772268 | 824372339 | FLORIDA HOSPITAL OCALA, INC. | PO BOX 947696 | ATLANTA | GA | 30394 | YES | 1578927687 | 824372339 | 80G | ADVENTHEALTH OCALA | 1500 SW 1ST AVE | OCALA | FL | 02 | ACUTE CARE HOSPITAL | FAC | INSTITUTIONAL FACILITIES | GROUP BLUE OPTIONS | 16153 | 23 | 641 | E860 | E860 | DEHYDRATION | VOLUME DEPLETION | ENDOCRINE, NUTRITIONAL AND METABOLIC DISEASES | I10 | R112 | R1011 | E6601 | E860 | CPT | 96374 | XU | 260 | 1 | 01 | 131 | 6/1/24 | 6/1/24 | 6/7/24 | 6/10/24 | 380.53 | ||||
| INSTITUTIONAL - OUTPATIENT | 1740772268 | 824372339 | FLORIDA HOSPITAL OCALA, INC. | PO BOX 947696 | ATLANTA | GA | 30394 | YES | 1578927687 | 824372339 | 80G | ADVENTHEALTH OCALA | 1500 SW 1ST AVE | OCALA | FL | 02 | ACUTE CARE HOSPITAL | FAC | INSTITUTIONAL FACILITIES | GROUP BLUE OPTIONS | 16153 | 23 | 641 | E860 | E860 | DEHYDRATION | VOLUME DEPLETION | ENDOCRINE, NUTRITIONAL AND METABOLIC DISEASES | I10 | R112 | R1011 | E6601 | E860 | CPT | 96361 | 260 | 2 | 01 | 131 | 6/1/24 | 6/1/24 | 6/7/24 | 6/10/24 | 378.76 | |||||
| INSTITUTIONAL - OUTPATIENT | 1740772268 | 824372339 | FLORIDA HOSPITAL OCALA, INC. | PO BOX 947696 | ATLANTA | GA | 30394 | YES | 1578927687 | 824372339 | 80G | ADVENTHEALTH OCALA | 1500 SW 1ST AVE | OCALA | FL | 02 | ACUTE CARE HOSPITAL | FAC | INSTITUTIONAL FACILITIES | GROUP BLUE OPTIONS | 16153 | 23 | 641 | E860 | E860 | DEHYDRATION | VOLUME DEPLETION | ENDOCRINE, NUTRITIONAL AND METABOLIC DISEASES | I10 | R112 | R1011 | E6601 | E860 | CPT | 87637 | 300 | 1 | 01 | 131 | 6/1/24 | 6/1/24 | 6/7/24 | 6/10/24 | 2,830.50 | |||||
| INSTITUTIONAL - OUTPATIENT | 1740772268 | 824372339 | FLORIDA HOSPITAL OCALA, INC. | PO BOX 947696 | ATLANTA | GA | 30394 | YES | 1578927687 | 824372339 | 80G | ADVENTHEALTH OCALA | 1500 SW 1ST AVE | OCALA | FL | 02 | ACUTE CARE HOSPITAL | FAC | INSTITUTIONAL FACILITIES | GROUP BLUE OPTIONS | 16153 | 23 | 641 | E860 | E860 | DEHYDRATION | VOLUME DEPLETION | ENDOCRINE, NUTRITIONAL AND METABOLIC DISEASES | I10 | R112 | R1011 | E6601 | E860 | CPT | 80053 | 301 | 1 | 01 | 131 | 6/1/24 | 6/1/24 | 6/7/24 | 6/10/24 | 1,230.33 | |||||
| INSTITUTIONAL - OUTPATIENT | 1841237930 | 591479652 | MARION COMMUNITY HOSPITAL INC | P.O. BOX 406549 | ATLANTA | GA | 30384 | YES | 1245230127 | 591479652 | 339 | HCA FLORIDA OCALA HOSPITAL | 1431 SW 1ST AVE | OCALA | FL | 02 | ACUTE CARE HOSPITAL | FAC | INSTITUTIONAL FACILITIES | GROUP BLUE OPTIONS | 16153 | 22 | 760 | D259 | D259 | LEIOMYOMA OF UTERUS, UNSPECIFIED | LEIOMYOMA OF UTERUS | NEOPLASMS | N920 | N939 | I10 | K219 | D259 | REVENUE | 250 | 250 | 2 | 01 | 131 | 11/5/24 | 11/5/24 | 11/8/24 | 11/11/24 | 9.30 | |||||
| INSTITUTIONAL - OUTPATIENT | 1841237930 | 591479652 | MARION COMMUNITY HOSPITAL INC | P.O. BOX 406549 | ATLANTA | GA | 30384 | YES | 1245230127 | 591479652 | 339 | HCA FLORIDA OCALA HOSPITAL | 1431 SW 1ST AVE | OCALA | FL | 02 | ACUTE CARE HOSPITAL | FAC | INSTITUTIONAL FACILITIES | GROUP BLUE OPTIONS | 16153 | 22 | 760 | D259 | D259 | LEIOMYOMA OF UTERUS, UNSPECIFIED | LEIOMYOMA OF UTERUS | NEOPLASMS | N920 | N939 | I10 | K219 | D259 | HCPCS | J0330 | 636 | 7 | 01 | 131 | 11/5/24 | 11/5/24 | 11/8/24 | 11/11/24 | 80.50 | |||||
| INSTITUTIONAL - OUTPATIENT | 1841237930 | 591479652 | MARION COMMUNITY HOSPITAL INC | P.O. BOX 406549 | ATLANTA | GA | 30384 | YES | 1245230127 | 591479652 | 339 | HCA FLORIDA OCALA HOSPITAL | 1431 SW 1ST AVE | OCALA | FL | 02 | ACUTE CARE HOSPITAL | FAC | INSTITUTIONAL FACILITIES | GROUP BLUE OPTIONS | 16153 | 22 | 760 | D259 | D259 | LEIOMYOMA OF UTERUS, UNSPECIFIED | LEIOMYOMA OF UTERUS | NEOPLASMS | N920 | N939 | I10 | K219 | D259 | HCPCS | J2405 | 636 | 4 | 01 | 131 | 11/5/24 | 11/5/24 | 11/8/24 | 11/11/24 | 24.00 | |||||
| INSTITUTIONAL - OUTPATIENT | 1841237930 | 591479652 | MARION COMMUNITY HOSPITAL INC | P.O. BOX 406549 | ATLANTA | GA | 30384 | YES | 1245230127 | 591479652 | 339 | HCA FLORIDA OCALA HOSPITAL | 1431 SW 1ST AVE | OCALA | FL | 02 | ACUTE CARE HOSPITAL | FAC | INSTITUTIONAL FACILITIES | GROUP BLUE OPTIONS | 16153 | 22 | 760 | D259 | D259 | LEIOMYOMA OF UTERUS, UNSPECIFIED | LEIOMYOMA OF UTERUS | NEOPLASMS | N920 | N939 | I10 | K219 | D259 | HCPCS | J1100 | 636 | 4 | 01 | 131 | 11/5/24 | 11/5/24 | 11/8/24 | 11/11/24 | 17.00 | |||||
| INSTITUTIONAL - OUTPATIENT | 1841237930 | 591479652 | MARION COMMUNITY HOSPITAL INC | P.O. BOX 406549 | ATLANTA | GA | 30384 | YES | 1245230127 | 591479652 | 339 | HCA FLORIDA OCALA HOSPITAL | 1431 SW 1ST AVE | OCALA | FL | 02 | ACUTE CARE HOSPITAL | FAC | INSTITUTIONAL FACILITIES | GROUP BLUE OPTIONS | 16153 | 22 | 760 | D259 | D259 | LEIOMYOMA OF UTERUS, UNSPECIFIED | LEIOMYOMA OF UTERUS | NEOPLASMS | N920 | N939 | I10 | K219 | D259 | HCPCS | J2704 | 636 | 20 | 01 | 131 | 11/5/24 | 11/5/24 | 11/8/24 | 11/11/24 | 14.40 | |||||
| INSTITUTIONAL - OUTPATIENT | 1841237930 | 591479652 | MARION COMMUNITY HOSPITAL INC | P.O. BOX 406549 | ATLANTA | GA | 30384 | YES | 1245230127 | 591479652 | 339 | HCA FLORIDA OCALA HOSPITAL | 1431 SW 1ST AVE | OCALA | FL | 02 | ACUTE CARE HOSPITAL | FAC | INSTITUTIONAL FACILITIES | GROUP BLUE OPTIONS | 16153 | 22 | 760 | D259 | D259 | LEIOMYOMA OF UTERUS, UNSPECIFIED | LEIOMYOMA OF UTERUS | NEOPLASMS | N920 | N939 | I10 | K219 | D259 | HCPCS | S0028 | 636 | 1 | 01 | 131 | 11/5/24 | 11/5/24 | 11/8/24 | 11/11/24 | 14.00 | |||||
| INSTITUTIONAL - OUTPATIENT | 1841237930 | 591479652 | MARION COMMUNITY HOSPITAL INC | P.O. BOX 406549 | ATLANTA | GA | 30384 | YES | 1245230127 | 591479652 | 339 | HCA FLORIDA OCALA HOSPITAL | 1431 SW 1ST AVE | OCALA | FL | 02 | ACUTE CARE HOSPITAL | FAC | INSTITUTIONAL FACILITIES | GROUP BLUE OPTIONS | 16153 | 22 | 760 | D259 | D259 | LEIOMYOMA OF UTERUS, UNSPECIFIED | LEIOMYOMA OF UTERUS | NEOPLASMS | N920 | N939 | I10 | K219 | D259 | HCPCS | J0690 | 636 | 4 | 01 | 131 | 11/5/24 | 11/5/24 | 11/8/24 | 11/11/24 | 12.00 | |||||
| INSTITUTIONAL - OUTPATIENT | 1841237930 | 591479652 | MARION COMMUNITY HOSPITAL INC | P.O. BOX 406549 | ATLANTA | GA | 30384 | YES | 1245230127 | 591479652 | 339 | HCA FLORIDA OCALA HOSPITAL | 1431 SW 1ST AVE | OCALA | FL | 02 | ACUTE CARE HOSPITAL | FAC | INSTITUTIONAL FACILITIES | GROUP BLUE OPTIONS | 16153 | 22 | 760 | D259 | D259 | LEIOMYOMA OF UTERUS, UNSPECIFIED | LEIOMYOMA OF UTERUS | NEOPLASMS | N920 | N939 | I10 | K219 | D259 | HCPCS | J3010 | 636 | 1 | 01 | 131 | 11/5/24 | 11/5/24 | 11/8/24 | 11/11/24 | 9.00 | |||||
| INSTITUTIONAL - OUTPATIENT | 1841237930 | 591479652 | MARION COMMUNITY HOSPITAL INC | P.O. BOX 406549 | ATLANTA | GA | 30384 | YES | 1245230127 | 591479652 | 339 | HCA FLORIDA OCALA HOSPITAL | 1431 SW 1ST AVE | OCALA | FL | 02 | ACUTE CARE HOSPITAL | FAC | INSTITUTIONAL FACILITIES | GROUP BLUE OPTIONS | 16153 | 22 | 760 | D259 | D259 | LEIOMYOMA OF UTERUS, UNSPECIFIED | LEIOMYOMA OF UTERUS | NEOPLASMS | N920 | N939 | I10 | K219 | D259 | HCPCS | J2250 | 636 | 2 | 01 | 131 | 11/5/24 | 11/5/24 | 11/8/24 | 11/11/24 | 3.90 | |||||
| INSTITUTIONAL - OUTPATIENT | 1841237930 | 591479652 | MARION COMMUNITY HOSPITAL INC | P.O. BOX 406549 | ATLANTA | GA | 30384 | YES | 1245230127 | 591479652 | 339 | HCA FLORIDA OCALA HOSPITAL | 1431 SW 1ST AVE | OCALA | FL | 02 | ACUTE CARE HOSPITAL | FAC | INSTITUTIONAL FACILITIES | GROUP BLUE OPTIONS | 16153 | 22 | 760 | D259 | D259 | LEIOMYOMA OF UTERUS, UNSPECIFIED | LEIOMYOMA OF UTERUS | NEOPLASMS | N920 | N939 | I10 | K219 | D259 | REVENUE | 710 | 710 | 125 | 01 | 131 | 11/5/24 | 11/5/24 | 11/8/24 | 11/11/24 | 14,791.20 | |||||
| INSTITUTIONAL - OUTPATIENT | 1841237930 | 591479652 | MARION COMMUNITY HOSPITAL INC | P.O. BOX 406549 | ATLANTA | GA | 30384 | YES | 1245230127 | 591479652 | 339 | HCA FLORIDA OCALA HOSPITAL | 1431 SW 1ST AVE | OCALA | FL | 02 | ACUTE CARE HOSPITAL | FAC | INSTITUTIONAL FACILITIES | GROUP BLUE OPTIONS | 16153 | 22 | 760 | D259 | D259 | LEIOMYOMA OF UTERUS, UNSPECIFIED | LEIOMYOMA OF UTERUS | NEOPLASMS | N920 | N939 | I10 | K219 | D259 | CPT | 93005 | 730 | 1 | 01 | 131 | 10/31/24 | 10/31/24 | 11/8/24 | 11/11/24 | 202.95 | |||||
| INSTITUTIONAL - OUTPATIENT | 1841237930 | 591479652 | MARION COMMUNITY HOSPITAL INC | P.O. BOX 406549 | ATLANTA | GA | 30384 | YES | 1245230127 | 591479652 | 339 | HCA FLORIDA OCALA HOSPITAL | 1431 SW 1ST AVE | OCALA | FL | 02 | ACUTE CARE HOSPITAL | FAC | INSTITUTIONAL FACILITIES | GROUP BLUE OPTIONS | 16153 | 22 | 760 | D259 | D259 | LEIOMYOMA OF UTERUS, UNSPECIFIED | LEIOMYOMA OF UTERUS | NEOPLASMS | N920 | N939 | I10 | K219 | D259 | REVENUE | 272 | 272 | 3 | 01 | 131 | 11/5/24 | 11/5/24 | 11/8/24 | 11/11/24 | 53,225.00 | |||||
| INSTITUTIONAL - OUTPATIENT | 1841237930 | 591479652 | MARION COMMUNITY HOSPITAL INC | P.O. BOX 406549 | ATLANTA | GA | 30384 | YES | 1245230127 | 591479652 | 339 | HCA FLORIDA OCALA HOSPITAL | 1431 SW 1ST AVE | OCALA | FL | 02 | ACUTE CARE HOSPITAL | FAC | INSTITUTIONAL FACILITIES | GROUP BLUE OPTIONS | 16153 | 22 | 760 | D259 | D259 | LEIOMYOMA OF UTERUS, UNSPECIFIED | LEIOMYOMA OF UTERUS | NEOPLASMS | N920 | N939 | I10 | K219 | D259 | CPT | 85027 | 305 | 1 | 01 | 131 | 10/31/24 | 10/31/24 | 11/8/24 | 11/11/24 | 868.95 | |||||
| INSTITUTIONAL - OUTPATIENT | 1841237930 | 591479652 | MARION COMMUNITY HOSPITAL INC | P.O. BOX 406549 | ATLANTA | GA | 30384 | YES | 1245230127 | 591479652 | 339 | HCA FLORIDA OCALA HOSPITAL | 1431 SW 1ST AVE | OCALA | FL | 02 | ACUTE CARE HOSPITAL | FAC | INSTITUTIONAL FACILITIES | GROUP BLUE OPTIONS | 16153 | 22 | 760 | D259 | D259 | LEIOMYOMA OF UTERUS, UNSPECIFIED | LEIOMYOMA OF UTERUS | NEOPLASMS | N920 | N939 | I10 | K219 | D259 | CPT | 81025 | 307 | 1 | 01 | 131 | 11/5/24 | 11/5/24 | 11/8/24 | 11/11/24 | 612.35 | |||||
| INSTITUTIONAL - OUTPATIENT | 1841237930 | 591479652 | MARION COMMUNITY HOSPITAL INC | P.O. BOX 406549 | ATLANTA | GA | 30384 | YES | 1245230127 | 591479652 | 339 | HCA FLORIDA OCALA HOSPITAL | 1431 SW 1ST AVE | OCALA | FL | 02 | ACUTE CARE HOSPITAL | FAC | INSTITUTIONAL FACILITIES | GROUP BLUE OPTIONS | 16153 | 22 | 760 | D259 | D259 | LEIOMYOMA OF UTERUS, UNSPECIFIED | LEIOMYOMA OF UTERUS | NEOPLASMS | N920 | N939 | I10 | K219 | D259 | CPT | 88305 | 310 | 1 | 01 | 131 | 11/5/24 | 11/5/24 | 11/8/24 | 11/11/24 | 2,931.05 | |||||
| INSTITUTIONAL - OUTPATIENT | 1841237930 | 591479652 | MARION COMMUNITY HOSPITAL INC | P.O. BOX 406549 | ATLANTA | GA | 30384 | YES | 1245230127 | 591479652 | 339 | HCA FLORIDA OCALA HOSPITAL | 1431 SW 1ST AVE | OCALA | FL | 02 | ACUTE CARE HOSPITAL | FAC | INSTITUTIONAL FACILITIES | GROUP BLUE OPTIONS | 16153 | 22 | 760 | D259 | D259 | LEIOMYOMA OF UTERUS, UNSPECIFIED | LEIOMYOMA OF UTERUS | NEOPLASMS | N920 | N939 | I10 | K219 | D259 | CPT | 58563 | 360 | 1 | 01 | 131 | 11/5/24 | 11/5/24 | 11/8/24 | 11/11/24 | 21,449.08 | |||||
| INSTITUTIONAL - OUTPATIENT | 1841237930 | 591479652 | MARION COMMUNITY HOSPITAL INC | P.O. BOX 406549 | ATLANTA | GA | 30384 | YES | 1245230127 | 591479652 | 339 | HCA FLORIDA OCALA HOSPITAL | 1431 SW 1ST AVE | OCALA | FL | 02 | ACUTE CARE HOSPITAL | FAC | INSTITUTIONAL FACILITIES | GROUP BLUE OPTIONS | 16153 | 22 | 760 | D259 | D259 | LEIOMYOMA OF UTERUS, UNSPECIFIED | LEIOMYOMA OF UTERUS | NEOPLASMS | N920 | N939 | I10 | K219 | D259 | CPT | 58580 | 360 | 1 | 01 | 131 | 11/5/24 | 11/5/24 | 11/8/24 | 11/11/24 | 21,449.07 | |||||
| INSTITUTIONAL - OUTPATIENT | 1841237930 | 591479652 | MARION COMMUNITY HOSPITAL INC | P.O. BOX 406549 | ATLANTA | GA | 30384 | YES | 1245230127 | 591479652 | 339 | HCA FLORIDA OCALA HOSPITAL | 1431 SW 1ST AVE | OCALA | FL | 02 | ACUTE CARE HOSPITAL | FAC | INSTITUTIONAL FACILITIES | GROUP BLUE OPTIONS | 16153 | 22 | 760 | D259 | D259 | LEIOMYOMA OF UTERUS, UNSPECIFIED | LEIOMYOMA OF UTERUS | NEOPLASMS | N920 | N939 | I10 | K219 | D259 | REVENUE | 370 | 370 | 1 | 01 | 131 | 11/5/24 | 11/5/24 | 11/8/24 | 11/11/24 | 21,579.00 | |||||
| INSTITUTIONAL - OUTPATIENT | 1841237930 | 591479652 | MARION COMMUNITY HOSPITAL INC | P.O. BOX 406549 | ATLANTA | GA | 30384 | YES | 1245230127 | 591479652 | 339 | HCA FLORIDA OCALA HOSPITAL | 1431 SW 1ST AVE | OCALA | FL | 02 | ACUTE CARE HOSPITAL | FAC | INSTITUTIONAL FACILITIES | GROUP BLUE OPTIONS | 16153 | 22 | 760 | D259 | D259 | LEIOMYOMA OF UTERUS, UNSPECIFIED | LEIOMYOMA OF UTERUS | NEOPLASMS | N920 | N939 | I10 | K219 | D259 | HCPCS | J7120 | 636 | 1 | 01 | 131 | 11/5/24 | 11/5/24 | 11/8/24 | 11/11/24 | 581.00 | |||||
| INSTITUTIONAL - OUTPATIENT | 1699874248 | 591943502 | SHANDS TEACHING HOSPITAL AND CLINICS INC | PO BOX 100005 | ATLANTA | GA | 30384 | YES | 1134474240 | 591943502 | 125 | SHANDS AND UNIVERSITY OF FLORIDA HEALTH | 1600 SW ARCHER RD | GAINESVILLE | FL | 02 | ACUTE CARE HOSPITAL | FAC | INSTITUTIONAL FACILITIES | GROUP BLUE OPTIONS | 16153 | 22 | 951 | Z3A29 | Z3A29 | 29 WEEKS GESTATION OF PREGNANCY | WEEKS OF GESTATION | FACTORS INFLUENCING HEALTH STATUS AND CONTACT WITH HEALTH SERVICES | Z3A29 | CPT | 86780 | 302 | 1 | 01 | 131 | 3/1/24 | 3/1/24 | 3/6/24 | 3/7/24 | 82.00 | |||||||||
| INSTITUTIONAL - OUTPATIENT | 1699874248 | 591943502 | SHANDS TEACHING HOSPITAL AND CLINICS INC | PO BOX 100005 | ATLANTA | GA | 30384 | YES | 1134474240 | 591943502 | 125 | SHANDS AND UNIVERSITY OF FLORIDA HEALTH | 1600 SW ARCHER RD | GAINESVILLE | FL | 02 | ACUTE CARE HOSPITAL | FAC | INSTITUTIONAL FACILITIES | GROUP BLUE OPTIONS | 16153 | 22 | 951 | Z3A29 | Z3A29 | 29 WEEKS GESTATION OF PREGNANCY | WEEKS OF GESTATION | FACTORS INFLUENCING HEALTH STATUS AND CONTACT WITH HEALTH SERVICES | Z3A29 | CPT | 85025 | 305 | 1 | 01 | 131 | 3/1/24 | 3/1/24 | 3/6/24 | 3/7/24 | 53.00 | |||||||||
| INSTITUTIONAL - OUTPATIENT | 1699874248 | 591943502 | SHANDS TEACHING HOSPITAL AND CLINICS INC | PO BOX 100005 | ATLANTA | GA | 30384 | YES | 1134474240 | 591943502 | 125 | SHANDS AND UNIVERSITY OF FLORIDA HEALTH | 1600 SW ARCHER RD | GAINESVILLE | FL | 02 | ACUTE CARE HOSPITAL | FAC | INSTITUTIONAL FACILITIES | GROUP BLUE OPTIONS | 16153 | 22 | 951 | Z3A29 | Z3A29 | 29 WEEKS GESTATION OF PREGNANCY | WEEKS OF GESTATION | FACTORS INFLUENCING HEALTH STATUS AND CONTACT WITH HEALTH SERVICES | Z3A29 | CPT | 87340 | 306 | 1 | 01 | 131 | 3/1/24 | 3/1/24 | 3/6/24 | 3/7/24 | 70.00 | |||||||||
| INSTITUTIONAL - OUTPATIENT | 1699874248 | 591943502 | SHANDS TEACHING HOSPITAL AND CLINICS INC | PO BOX 100005 | ATLANTA | GA | 30384 | YES | 1134474240 | 591943502 | 125 | SHANDS AND UNIVERSITY OF FLORIDA HEALTH | 1600 SW ARCHER RD | GAINESVILLE | FL | 02 | ACUTE CARE HOSPITAL | FAC | INSTITUTIONAL FACILITIES | GROUP BLUE OPTIONS | 16153 | 22 | 951 | Z3A29 | Z3A29 | 29 WEEKS GESTATION OF PREGNANCY | WEEKS OF GESTATION | FACTORS INFLUENCING HEALTH STATUS AND CONTACT WITH HEALTH SERVICES | Z3A29 | CPT | 87389 | 306 | 1 | 01 | 131 | 3/1/24 | 3/1/24 | 3/6/24 | 3/7/24 | 131.00 | |||||||||
| INSTITUTIONAL - OUTPATIENT | 1699874248 | 591943502 | SHANDS TEACHING HOSPITAL AND CLINICS INC | PO BOX 100005 | ATLANTA | GA | 30384 | YES | 1134474240 | 591943502 | 125 | SHANDS AND UNIVERSITY OF FLORIDA HEALTH | 1600 SW ARCHER RD | GAINESVILLE | FL | 02 | ACUTE CARE HOSPITAL | FAC | INSTITUTIONAL FACILITIES | GROUP BLUE OPTIONS | 16153 | 22 | 951 | Z3A33 | Z3A33 | 33 WEEKS GESTATION OF PREGNANCY | WEEKS OF GESTATION | FACTORS INFLUENCING HEALTH STATUS AND CONTACT WITH HEALTH SERVICES | Z3A33 | CPT | 80053 | 301 | 1 | 01 | 131 | 3/15/24 | 3/15/24 | 3/20/24 | 3/21/24 | 72.00 | |||||||||
| INSTITUTIONAL - OUTPATIENT | 1699874248 | 591943502 | SHANDS TEACHING HOSPITAL AND CLINICS INC | PO BOX 100005 | ATLANTA | GA | 30384 | YES | 1134474240 | 591943502 | 125 | SHANDS AND UNIVERSITY OF FLORIDA HEALTH | 1600 SW ARCHER RD | GAINESVILLE | FL | 02 | ACUTE CARE HOSPITAL | FAC | INSTITUTIONAL FACILITIES | GROUP BLUE OPTIONS | 16153 | 22 | 951 | Z3A33 | Z3A33 | 33 WEEKS GESTATION OF PREGNANCY | WEEKS OF GESTATION | FACTORS INFLUENCING HEALTH STATUS AND CONTACT WITH HEALTH SERVICES | Z3A33 | CPT | 82239 | 301 | 1 | 01 | 131 | 3/15/24 | 3/15/24 | 3/20/24 | 3/21/24 | 29.00 | |||||||||
| INSTITUTIONAL - OUTPATIENT | 1699874248 | 591943502 | SHANDS TEACHING HOSPITAL AND CLINICS INC | PO BOX 100005 | ATLANTA | GA | 30384 | YES | 1376623603 | 591943502 | 125 | SHANDS AND UNIVERSITY OF FLORIDA HEALTH | 1600 SW ARCHER RD | GAINESVILLE | FL | 02 | ACUTE CARE HOSPITAL | FAC | INSTITUTIONAL FACILITIES | GROUP BLUE OPTIONS | 16153 | 22 | 443 | K7689 | K7689 | OTHER SPECIFIED DISEASES OF LIVER | OTHER DISEASES OF LIVER | DISEASES OF THE DIGESTIVE SYSTEM | Z3A35 | K7689 | CPT | 82239 | 301 | 1 | 01 | 131 | 4/1/24 | 4/1/24 | 4/8/24 | 4/9/24 | 29.00 | ||||||||
| INSTITUTIONAL - OUTPATIENT | 1699874248 | 591943502 | SHANDS TEACHING HOSPITAL AND CLINICS INC | PO BOX 100005 | ATLANTA | GA | 30384 | YES | 1376623603 | 591943502 | 125 | SHANDS AND UNIVERSITY OF FLORIDA HEALTH | 1600 SW ARCHER RD | GAINESVILLE | FL | 02 | ACUTE CARE HOSPITAL | FAC | INSTITUTIONAL FACILITIES | GROUP BLUE OPTIONS | 16153 | 22 | 443 | K7689 | K7689 | OTHER SPECIFIED DISEASES OF LIVER | OTHER DISEASES OF LIVER | DISEASES OF THE DIGESTIVE SYSTEM | Z3A35 | K7689 | CPT | 87081 | 306 | 1 | 01 | 131 | 4/1/24 | 4/1/24 | 4/8/24 | 4/9/24 | 45.00 | ||||||||
| INSTITUTIONAL - OUTPATIENT | 1740772268 | 824372339 | FLORIDA HOSPITAL OCALA, INC. | PO BOX 947696 | ATLANTA | GA | 30394 | YES | 1952405607 | 824372339 | 80G | ADVENTHEALTH OCALA | 1500 SW 1ST AVE | OCALA | FL | 02 | ACUTE CARE HOSPITAL | FAC | INSTITUTIONAL FACILITIES | GROUP BLUE OPTIONS | 16153 | 22 | 607 | R221 | R221 | LOCALIZED SWELLING, MASS AND LUMP, NECK | LOCALIZED SWELLING, MASS AND LUMP OF SKIN AND SUBCUTANEOUS TISSUE | SYMPTOMS, SIGNS AND ABNORMAL CLINICAL AND LABORATORY FINDINGS, NOT ELSEWHERE CLASSIFIED | R221 | CPT | 36415 | 300 | 1 | 01 | 131 | 6/28/24 | 6/28/24 | 7/2/24 | 7/3/24 | 33.50 | |||||||||
| INSTITUTIONAL - OUTPATIENT | 1740772268 | 824372339 | FLORIDA HOSPITAL OCALA, INC. | PO BOX 947696 | ATLANTA | GA | 30394 | YES | 1952405607 | 824372339 | 80G | ADVENTHEALTH OCALA | 1500 SW 1ST AVE | OCALA | FL | 02 | ACUTE CARE HOSPITAL | FAC | INSTITUTIONAL FACILITIES | GROUP BLUE OPTIONS | 16153 | 22 | 607 | R221 | R221 | LOCALIZED SWELLING, MASS AND LUMP, NECK | LOCALIZED SWELLING, MASS AND LUMP OF SKIN AND SUBCUTANEOUS TISSUE | SYMPTOMS, SIGNS AND ABNORMAL CLINICAL AND LABORATORY FINDINGS, NOT ELSEWHERE CLASSIFIED | R221 | CPT | 80048 | 301 | 1 | 01 | 131 | 6/28/24 | 6/28/24 | 7/2/24 | 7/3/24 | 863.66 | |||||||||
| INSTITUTIONAL - OUTPATIENT | 1740772268 | 824372339 | FLORIDA HOSPITAL OCALA, INC. | PO BOX 947696 | ATLANTA | GA | 30394 | YES | 1952405607 | 824372339 | 80G | ADVENTHEALTH OCALA | 1500 SW 1ST AVE | OCALA | FL | 02 | ACUTE CARE HOSPITAL | FAC | INSTITUTIONAL FACILITIES | GROUP BLUE OPTIONS | 16153 | 22 | 607 | R221 | R221 | LOCALIZED SWELLING, MASS AND LUMP, NECK | LOCALIZED SWELLING, MASS AND LUMP OF SKIN AND SUBCUTANEOUS TISSUE | SYMPTOMS, SIGNS AND ABNORMAL CLINICAL AND LABORATORY FINDINGS, NOT ELSEWHERE CLASSIFIED | R221 | CPT | 85025 | 305 | 1 | 01 | 131 | 6/28/24 | 6/28/24 | 7/2/24 | 7/3/24 | 325.10 | |||||||||
| INSTITUTIONAL - OUTPATIENT | 1740772268 | 824372339 | FLORIDA HOSPITAL OCALA, INC. | PO BOX 947696 | ATLANTA | GA | 30394 | YES | 1952405607 | 824372339 | 80G | ADVENTHEALTH OCALA | 1500 SW 1ST AVE | OCALA | FL | 02 | ACUTE CARE HOSPITAL | FAC | INSTITUTIONAL FACILITIES | GROUP BLUE OPTIONS | 16153 | 22 | 607 | R221 | R221 | LOCALIZED SWELLING, MASS AND LUMP, NECK | LOCALIZED SWELLING, MASS AND LUMP OF SKIN AND SUBCUTANEOUS TISSUE | SYMPTOMS, SIGNS AND ABNORMAL CLINICAL AND LABORATORY FINDINGS, NOT ELSEWHERE CLASSIFIED | R221 | CPT | 93005 | 730 | 1 | 01 | 131 | 6/28/24 | 6/28/24 | 7/2/24 | 7/3/24 | 300.48 | |||||||||
| INSTITUTIONAL - OUTPATIENT | 1740772268 | 824372339 | FLORIDA HOSPITAL OCALA, INC. | PO BOX 947696 | ATLANTA | GA | 30394 | YES | 1649212879 | 824372339 | 80G | ADVENTHEALTH OCALA | 1500 SW 1ST AVE | OCALA | FL | 02 | ACUTE CARE HOSPITAL | FAC | INSTITUTIONAL FACILITIES | GROUP BLUE OPTIONS | 16153 | 22 | 607 | L720 | L720 | EPIDERMAL CYST | FOLLICULAR CYSTS OF SKIN AND SUBCUTANEOUS TISSUE | DISEASES OF THE SKIN AND SUBCUTANEOUS TISSUE | E669 | E1165 | E785 | Z888 | L720 | REVENUE | 250 | 250 | 1 | 01 | 131 | 7/3/24 | 7/3/24 | 7/10/24 | 7/11/24 | 233.95 | |||||
| INSTITUTIONAL - OUTPATIENT | 1740772268 | 824372339 | FLORIDA HOSPITAL OCALA, INC. | PO BOX 947696 | ATLANTA | GA | 30394 | YES | 1649212879 | 824372339 | 80G | ADVENTHEALTH OCALA | 1500 SW 1ST AVE | OCALA | FL | 02 | ACUTE CARE HOSPITAL | FAC | INSTITUTIONAL FACILITIES | GROUP BLUE OPTIONS | 16153 | 22 | 607 | L720 | L720 | EPIDERMAL CYST | FOLLICULAR CYSTS OF SKIN AND SUBCUTANEOUS TISSUE | DISEASES OF THE SKIN AND SUBCUTANEOUS TISSUE | E669 | E1165 | E785 | Z888 | L720 | HCPCS | J0690 | 636 | 4 | 01 | 131 | 7/3/24 | 7/3/24 | 7/10/24 | 7/11/24 | 251.30 | |||||
| INSTITUTIONAL - OUTPATIENT | 1740772268 | 824372339 | FLORIDA HOSPITAL OCALA, INC. | PO BOX 947696 | ATLANTA | GA | 30394 | YES | 1649212879 | 824372339 | 80G | ADVENTHEALTH OCALA | 1500 SW 1ST AVE | OCALA | FL | 02 | ACUTE CARE HOSPITAL | FAC | INSTITUTIONAL FACILITIES | GROUP BLUE OPTIONS | 16153 | 22 | 607 | L720 | L720 | EPIDERMAL CYST | FOLLICULAR CYSTS OF SKIN AND SUBCUTANEOUS TISSUE | DISEASES OF THE SKIN AND SUBCUTANEOUS TISSUE | E669 | E1165 | E785 | Z888 | L720 | HCPCS | J0134 | 636 | 100 | 01 | 131 | 7/3/24 | 7/3/24 | 7/10/24 | 7/11/24 | 223.07 | |||||
| INSTITUTIONAL - OUTPATIENT | 1740772268 | 824372339 | FLORIDA HOSPITAL OCALA, INC. | PO BOX 947696 | ATLANTA | GA | 30394 | YES | 1649212879 | 824372339 | 80G | ADVENTHEALTH OCALA | 1500 SW 1ST AVE | OCALA | FL | 02 | ACUTE CARE HOSPITAL | FAC | INSTITUTIONAL FACILITIES | GROUP BLUE OPTIONS | 16153 | 22 | 607 | L720 | L720 | EPIDERMAL CYST | FOLLICULAR CYSTS OF SKIN AND SUBCUTANEOUS TISSUE | DISEASES OF THE SKIN AND SUBCUTANEOUS TISSUE | E669 | E1165 | E785 | Z888 | L720 | HCPCS | J2704 | 636 | 20 | 01 | 131 | 7/3/24 | 7/3/24 | 7/10/24 | 7/11/24 | 173.12 | |||||
| INSTITUTIONAL - OUTPATIENT | 1740772268 | 824372339 | FLORIDA HOSPITAL OCALA, INC. | PO BOX 947696 | ATLANTA | GA | 30394 | YES | 1649212879 | 824372339 | 80G | ADVENTHEALTH OCALA | 1500 SW 1ST AVE | OCALA | FL | 02 | ACUTE CARE HOSPITAL | FAC | INSTITUTIONAL FACILITIES | GROUP BLUE OPTIONS | 16153 | 22 | 607 | L720 | L720 | EPIDERMAL CYST | FOLLICULAR CYSTS OF SKIN AND SUBCUTANEOUS TISSUE | DISEASES OF THE SKIN AND SUBCUTANEOUS TISSUE | E669 | E1165 | E785 | Z888 | L720 | HCPCS | J7120 | 636 | 1 | 01 | 131 | 7/3/24 | 7/3/24 | 7/10/24 | 7/11/24 | 170.06 | |||||
| INSTITUTIONAL - OUTPATIENT | 1740772268 | 824372339 | FLORIDA HOSPITAL OCALA, INC. | PO BOX 947696 | ATLANTA | GA | 30394 | YES | 1649212879 | 824372339 | 80G | ADVENTHEALTH OCALA | 1500 SW 1ST AVE | OCALA | FL | 02 | ACUTE CARE HOSPITAL | FAC | INSTITUTIONAL FACILITIES | GROUP BLUE OPTIONS | 16153 | 22 | 607 | L720 | L720 | EPIDERMAL CYST | FOLLICULAR CYSTS OF SKIN AND SUBCUTANEOUS TISSUE | DISEASES OF THE SKIN AND SUBCUTANEOUS TISSUE | E669 | E1165 | E785 | Z888 | L720 | HCPCS | J3010 | 636 | 1 | 01 | 131 | 7/3/24 | 7/3/24 | 7/10/24 | 7/11/24 | 153.87 | |||||
| INSTITUTIONAL - OUTPATIENT | 1740772268 | 824372339 | FLORIDA HOSPITAL OCALA, INC. | PO BOX 947696 | ATLANTA | GA | 30394 | YES | 1649212879 | 824372339 | 80G | ADVENTHEALTH OCALA | 1500 SW 1ST AVE | OCALA | FL | 02 | ACUTE CARE HOSPITAL | FAC | INSTITUTIONAL FACILITIES | GROUP BLUE OPTIONS | 16153 | 22 | 607 | L720 | L720 | EPIDERMAL CYST | FOLLICULAR CYSTS OF SKIN AND SUBCUTANEOUS TISSUE | DISEASES OF THE SKIN AND SUBCUTANEOUS TISSUE | E669 | E1165 | E785 | Z888 | L720 | HCPCS | J1100 | 636 | 4 | 01 | 131 | 7/3/24 | 7/3/24 | 7/10/24 | 7/11/24 | 96.64 | |||||
| INSTITUTIONAL - OUTPATIENT | 1740772268 | 824372339 | FLORIDA HOSPITAL OCALA, INC. | PO BOX 947696 | ATLANTA | GA | 30394 | YES | 1649212879 | 824372339 | 80G | ADVENTHEALTH OCALA | 1500 SW 1ST AVE | OCALA | FL | 02 | ACUTE CARE HOSPITAL | FAC | INSTITUTIONAL FACILITIES | GROUP BLUE OPTIONS | 16153 | 22 | 607 | L720 | L720 | EPIDERMAL CYST | FOLLICULAR CYSTS OF SKIN AND SUBCUTANEOUS TISSUE | DISEASES OF THE SKIN AND SUBCUTANEOUS TISSUE | E669 | E1165 | E785 | Z888 | L720 | HCPCS | J2250 | 636 | 2 | 01 | 131 | 7/3/24 | 7/3/24 | 7/10/24 | 7/11/24 | 76.46 | |||||
| INSTITUTIONAL - OUTPATIENT | 1740772268 | 824372339 | FLORIDA HOSPITAL OCALA, INC. | PO BOX 947696 | ATLANTA | GA | 30394 | YES | 1649212879 | 824372339 | 80G | ADVENTHEALTH OCALA | 1500 SW 1ST AVE | OCALA | FL | 02 | ACUTE CARE HOSPITAL | FAC | INSTITUTIONAL FACILITIES | GROUP BLUE OPTIONS | 16153 | 22 | 607 | L720 | L720 | EPIDERMAL CYST | FOLLICULAR CYSTS OF SKIN AND SUBCUTANEOUS TISSUE | DISEASES OF THE SKIN AND SUBCUTANEOUS TISSUE | E669 | E1165 | E785 | Z888 | L720 | HCPCS | J2405 | 636 | 4 | 01 | 131 | 7/3/24 | 7/3/24 | 7/10/24 | 7/11/24 | 67.95 | |||||
| INSTITUTIONAL - OUTPATIENT | 1740772268 | 824372339 | FLORIDA HOSPITAL OCALA, INC. | PO BOX 947696 | ATLANTA | GA | 30394 | YES | 1649212879 | 824372339 | 80G | ADVENTHEALTH OCALA | 1500 SW 1ST AVE | OCALA | FL | 02 | ACUTE CARE HOSPITAL | FAC | INSTITUTIONAL FACILITIES | GROUP BLUE OPTIONS | 16153 | 22 | 607 | L720 | L720 | EPIDERMAL CYST | FOLLICULAR CYSTS OF SKIN AND SUBCUTANEOUS TISSUE | DISEASES OF THE SKIN AND SUBCUTANEOUS TISSUE | E669 | E1165 | E785 | Z888 | L720 | REVENUE | 710 | 710 | 3 | 01 | 131 | 7/3/24 | 7/3/24 | 7/10/24 | 7/11/24 | 11,644.54 | |||||
| INSTITUTIONAL - OUTPATIENT | 1740772268 | 824372339 | FLORIDA HOSPITAL OCALA, INC. | PO BOX 947696 | ATLANTA | GA | 30394 | YES | 1649212879 | 824372339 | 80G | ADVENTHEALTH OCALA | 1500 SW 1ST AVE | OCALA | FL | 02 | ACUTE CARE HOSPITAL | FAC | INSTITUTIONAL FACILITIES | GROUP BLUE OPTIONS | 16153 | 22 | 607 | L720 | L720 | EPIDERMAL CYST | FOLLICULAR CYSTS OF SKIN AND SUBCUTANEOUS TISSUE | DISEASES OF THE SKIN AND SUBCUTANEOUS TISSUE | E669 | E1165 | E785 | Z888 | L720 | REVENUE | 250 | 250 | 1 | 01 | 131 | 7/3/24 | 7/3/24 | 7/10/24 | 7/11/24 | 63.12 | |||||
| INSTITUTIONAL - OUTPATIENT | 1740772268 | 824372339 | FLORIDA HOSPITAL OCALA, INC. | PO BOX 947696 | ATLANTA | GA | 30394 | YES | 1649212879 | 824372339 | 80G | ADVENTHEALTH OCALA | 1500 SW 1ST AVE | OCALA | FL | 02 | ACUTE CARE HOSPITAL | FAC | INSTITUTIONAL FACILITIES | GROUP BLUE OPTIONS | 16153 | 22 | 607 | L720 | L720 | EPIDERMAL CYST | FOLLICULAR CYSTS OF SKIN AND SUBCUTANEOUS TISSUE | DISEASES OF THE SKIN AND SUBCUTANEOUS TISSUE | E669 | E1165 | E785 | Z888 | L720 | CPT | 82947 | 301 | 1 | 01 | 131 | 7/3/24 | 7/3/24 | 7/10/24 | 7/11/24 | 85.17 | |||||
| INSTITUTIONAL - OUTPATIENT | 1740772268 | 824372339 | FLORIDA HOSPITAL OCALA, INC. | PO BOX 947696 | ATLANTA | GA | 30394 | YES | 1649212879 | 824372339 | 80G | ADVENTHEALTH OCALA | 1500 SW 1ST AVE | OCALA | FL | 02 | ACUTE CARE HOSPITAL | FAC | INSTITUTIONAL FACILITIES | GROUP BLUE OPTIONS | 16153 | 22 | 607 | L720 | L720 | EPIDERMAL CYST | FOLLICULAR CYSTS OF SKIN AND SUBCUTANEOUS TISSUE | DISEASES OF THE SKIN AND SUBCUTANEOUS TISSUE | E669 | E1165 | E785 | Z888 | L720 | CPT | 82947 | 91 | 301 | 1 | 01 | 131 | 7/3/24 | 7/3/24 | 7/10/24 | 7/11/24 | 85.17 | ||||
| INSTITUTIONAL - OUTPATIENT | 1740772268 | 824372339 | FLORIDA HOSPITAL OCALA, INC. | PO BOX 947696 | ATLANTA | GA | 30394 | YES | 1649212879 | 824372339 | 80G | ADVENTHEALTH OCALA | 1500 SW 1ST AVE | OCALA | FL | 02 | ACUTE CARE HOSPITAL | FAC | INSTITUTIONAL FACILITIES | GROUP BLUE OPTIONS | 16153 | 22 | 607 | L720 | L720 | EPIDERMAL CYST | FOLLICULAR CYSTS OF SKIN AND SUBCUTANEOUS TISSUE | DISEASES OF THE SKIN AND SUBCUTANEOUS TISSUE | E669 | E1165 | E785 | Z888 | L720 | CPT | 88305 | 312 | 1 | 01 | 131 | 7/3/24 | 7/3/24 | 7/10/24 | 7/11/24 | 1,275.10 | |||||
| INSTITUTIONAL - OUTPATIENT | 1740772268 | 824372339 | FLORIDA HOSPITAL OCALA, INC. | PO BOX 947696 | ATLANTA | GA | 30394 | YES | 1649212879 | 824372339 | 80G | ADVENTHEALTH OCALA | 1500 SW 1ST AVE | OCALA | FL | 02 | ACUTE CARE HOSPITAL | FAC | INSTITUTIONAL FACILITIES | GROUP BLUE OPTIONS | 16153 | 22 | 607 | L720 | L720 | EPIDERMAL CYST | FOLLICULAR CYSTS OF SKIN AND SUBCUTANEOUS TISSUE | DISEASES OF THE SKIN AND SUBCUTANEOUS TISSUE | E669 | E1165 | E785 | Z888 | L720 | CPT | 11426 | 360 | 1 | 01 | 131 | 7/3/24 | 7/3/24 | 7/10/24 | 7/11/24 | 34,355.75 | |||||
| INSTITUTIONAL - OUTPATIENT | 1740772268 | 824372339 | FLORIDA HOSPITAL OCALA, INC. | PO BOX 947696 | ATLANTA | GA | 30394 | YES | 1649212879 | 824372339 | 80G | ADVENTHEALTH OCALA | 1500 SW 1ST AVE | OCALA | FL | 02 | ACUTE CARE HOSPITAL | FAC | INSTITUTIONAL FACILITIES | GROUP BLUE OPTIONS | 16153 | 22 | 607 | L720 | L720 | EPIDERMAL CYST | FOLLICULAR CYSTS OF SKIN AND SUBCUTANEOUS TISSUE | DISEASES OF THE SKIN AND SUBCUTANEOUS TISSUE | E669 | E1165 | E785 | Z888 | L720 | REVENUE | 370 | 370 | 46 | 01 | 131 | 7/3/24 | 7/3/24 | 7/10/24 | 7/11/24 | 14,143.57 | |||||
| INSTITUTIONAL - OUTPATIENT | 1740772268 | 824372339 | FLORIDA HOSPITAL OCALA, INC. | PO BOX 947696 | ATLANTA | GA | 30394 | YES | 1649212879 | 824372339 | 80G | ADVENTHEALTH OCALA | 1500 SW 1ST AVE | OCALA | FL | 02 | ACUTE CARE HOSPITAL | FAC | INSTITUTIONAL FACILITIES | GROUP BLUE OPTIONS | 16153 | 22 | 607 | L720 | L720 | EPIDERMAL CYST | FOLLICULAR CYSTS OF SKIN AND SUBCUTANEOUS TISSUE | DISEASES OF THE SKIN AND SUBCUTANEOUS TISSUE | E669 | E1165 | E785 | Z888 | L720 | HCPCS | J7120 | 636 | 1 | 01 | 131 | 7/3/24 | 7/3/24 | 7/10/24 | 7/11/24 | 285.43 | |||||
| INSTITUTIONAL - OUTPATIENT | 1740772268 | 824372339 | FLORIDA HOSPITAL OCALA, INC. | PO BOX 947696 | ATLANTA | GA | 30394 | YES | 1649212879 | 824372339 | 80G | ADVENTHEALTH OCALA | 1500 SW 1ST AVE | OCALA | FL | 02 | ACUTE CARE HOSPITAL | FAC | INSTITUTIONAL FACILITIES | GROUP BLUE OPTIONS | 16153 | 22 | 607 | L720 | L720 | EPIDERMAL CYST | FOLLICULAR CYSTS OF SKIN AND SUBCUTANEOUS TISSUE | DISEASES OF THE SKIN AND SUBCUTANEOUS TISSUE | E669 | E1165 | E785 | Z888 | L720 | HCPCS | J0665 | 636 | 100 | 01 | 131 | 7/3/24 | 7/3/24 | 7/10/24 | 7/11/24 | 283.98 | |||||
| INSTITUTIONAL - OUTPATIENT | 1699874248 | 591943502 | SHANDS TEACHING HOSPITAL AND CLINICS INC | PO BOX 100005 | ATLANTA | GA | 30384 | YES | 1447783436 | 591943502 | 125 | SHANDS AND UNIVERSITY OF FLORIDA HEALTH | 1600 SW ARCHER RD | GAINESVILLE | FL | 02 | ACUTE CARE HOSPITAL | FAC | INSTITUTIONAL FACILITIES | GROUP BLUE OPTIONS | 16153 | 23 | 563 | S93401A | S93401A | SPRAIN OF UNSPECIFIED LIGAMENT OF RIGHT ANKLE, INITIAL ENCOUNTER | DISLOCATION AND SPRAIN OF JOINTS AND LIGAMENTS AT ANKLE, FOOT AND TOE LEVEL | INJURY, POISONING AND CERTAIN OTHER CONSEQUENCES OF EXTERNAL CAUSES | F840 | Z881 | Z880 | S93401A | CPT | 73590 | RT | 320 | 1 | 01 | 131 | 10/18/24 | 10/18/24 | 10/23/24 | 10/24/24 | 280.00 | |||||
| INSTITUTIONAL - OUTPATIENT | 1699874248 | 591943502 | SHANDS TEACHING HOSPITAL AND CLINICS INC | PO BOX 100005 | ATLANTA | GA | 30384 | YES | 1447783436 | 591943502 | 125 | SHANDS AND UNIVERSITY OF FLORIDA HEALTH | 1600 SW ARCHER RD | GAINESVILLE | FL | 02 | ACUTE CARE HOSPITAL | FAC | INSTITUTIONAL FACILITIES | GROUP BLUE OPTIONS | 16153 | 23 | 563 | S93401A | S93401A | SPRAIN OF UNSPECIFIED LIGAMENT OF RIGHT ANKLE, INITIAL ENCOUNTER | DISLOCATION AND SPRAIN OF JOINTS AND LIGAMENTS AT ANKLE, FOOT AND TOE LEVEL | INJURY, POISONING AND CERTAIN OTHER CONSEQUENCES OF EXTERNAL CAUSES | F840 | Z881 | Z880 | S93401A | CPT | 73610 | RT | 320 | 1 | 01 | 131 | 10/18/24 | 10/18/24 | 10/23/24 | 10/24/24 | 280.00 | |||||
| INSTITUTIONAL - OUTPATIENT | 1699874248 | 591943502 | SHANDS TEACHING HOSPITAL AND CLINICS INC | PO BOX 100005 | ATLANTA | GA | 30384 | YES | 1447783436 | 591943502 | 125 | SHANDS AND UNIVERSITY OF FLORIDA HEALTH | 1600 SW ARCHER RD | GAINESVILLE | FL | 02 | ACUTE CARE HOSPITAL | FAC | INSTITUTIONAL FACILITIES | GROUP BLUE OPTIONS | 16153 | 23 | 563 | S93401A | S93401A | SPRAIN OF UNSPECIFIED LIGAMENT OF RIGHT ANKLE, INITIAL ENCOUNTER | DISLOCATION AND SPRAIN OF JOINTS AND LIGAMENTS AT ANKLE, FOOT AND TOE LEVEL | INJURY, POISONING AND CERTAIN OTHER CONSEQUENCES OF EXTERNAL CAUSES | F840 | Z881 | Z880 | S93401A | CPT | 99283 | 25 | 450 | 1 | 01 | 131 | 10/18/24 | 10/18/24 | 10/23/24 | 10/24/24 | 2,930.00 | |||||
| INSTITUTIONAL - OUTPATIENT | 1740772268 | 824372339 | FLORIDA HOSPITAL OCALA, INC. | PO BOX 947696 | ATLANTA | GA | 30394 | YES | 1063468221 | 824372339 | 80G | ADVENTHEALTH OCALA | 1500 SW 1ST AVE | OCALA | FL | 02 | ACUTE CARE HOSPITAL | FAC | INSTITUTIONAL FACILITIES | GROUP BLUE OPTIONS | 16153 | 23 | 313 | R079 | R079 | CHEST PAIN, UNSPECIFIED | PAIN IN THROAT AND CHEST | SYMPTOMS, SIGNS AND ABNORMAL CLINICAL AND LABORATORY FINDINGS, NOT ELSEWHERE CLASSIFIED | Z9189 | R002 | I499 | I4710 | R079 | REVENUE | 259 | 259 | 4 | 01 | 131 | 11/13/24 | 11/13/24 | 11/20/24 | 11/21/24 | 34.82 | |||||
| INSTITUTIONAL - OUTPATIENT | 1740772268 | 824372339 | FLORIDA HOSPITAL OCALA, INC. | PO BOX 947696 | ATLANTA | GA | 30394 | YES | 1063468221 | 824372339 | 80G | ADVENTHEALTH OCALA | 1500 SW 1ST AVE | OCALA | FL | 02 | ACUTE CARE HOSPITAL | FAC | INSTITUTIONAL FACILITIES | GROUP BLUE OPTIONS | 16153 | 23 | 313 | R079 | R079 | CHEST PAIN, UNSPECIFIED | PAIN IN THROAT AND CHEST | SYMPTOMS, SIGNS AND ABNORMAL CLINICAL AND LABORATORY FINDINGS, NOT ELSEWHERE CLASSIFIED | Z9189 | R002 | I499 | I4710 | R079 | CPT | 80053 | 301 | 1 | 01 | 131 | 11/13/24 | 11/13/24 | 11/20/24 | 11/21/24 | 1,230.33 | |||||
| INSTITUTIONAL - OUTPATIENT | 1740772268 | 824372339 | FLORIDA HOSPITAL OCALA, INC. | PO BOX 947696 | ATLANTA | GA | 30394 | YES | 1063468221 | 824372339 | 80G | ADVENTHEALTH OCALA | 1500 SW 1ST AVE | OCALA | FL | 02 | ACUTE CARE HOSPITAL | FAC | INSTITUTIONAL FACILITIES | GROUP BLUE OPTIONS | 16153 | 23 | 313 | R079 | R079 | CHEST PAIN, UNSPECIFIED | PAIN IN THROAT AND CHEST | SYMPTOMS, SIGNS AND ABNORMAL CLINICAL AND LABORATORY FINDINGS, NOT ELSEWHERE CLASSIFIED | Z9189 | R002 | I499 | I4710 | R079 | CPT | 84484 | 301 | 1 | 01 | 131 | 11/13/24 | 11/13/24 | 11/20/24 | 11/21/24 | 572.53 | |||||
| INSTITUTIONAL - OUTPATIENT | 1740772268 | 824372339 | FLORIDA HOSPITAL OCALA, INC. | PO BOX 947696 | ATLANTA | GA | 30394 | YES | 1063468221 | 824372339 | 80G | ADVENTHEALTH OCALA | 1500 SW 1ST AVE | OCALA | FL | 02 | ACUTE CARE HOSPITAL | FAC | INSTITUTIONAL FACILITIES | GROUP BLUE OPTIONS | 16153 | 23 | 313 | R079 | R079 | CHEST PAIN, UNSPECIFIED | PAIN IN THROAT AND CHEST | SYMPTOMS, SIGNS AND ABNORMAL CLINICAL AND LABORATORY FINDINGS, NOT ELSEWHERE CLASSIFIED | Z9189 | R002 | I499 | I4710 | R079 | CPT | 84484 | 91 | 301 | 1 | 01 | 131 | 11/13/24 | 11/13/24 | 11/20/24 | 11/21/24 | 572.53 | ||||
| INSTITUTIONAL - OUTPATIENT | 1740772268 | 824372339 | FLORIDA HOSPITAL OCALA, INC. | PO BOX 947696 | ATLANTA | GA | 30394 | YES | 1063468221 | 824372339 | 80G | ADVENTHEALTH OCALA | 1500 SW 1ST AVE | OCALA | FL | 02 | ACUTE CARE HOSPITAL | FAC | INSTITUTIONAL FACILITIES | GROUP BLUE OPTIONS | 16153 | 23 | 313 | R079 | R079 | CHEST PAIN, UNSPECIFIED | PAIN IN THROAT AND CHEST | SYMPTOMS, SIGNS AND ABNORMAL CLINICAL AND LABORATORY FINDINGS, NOT ELSEWHERE CLASSIFIED | Z9189 | R002 | I499 | I4710 | R079 | CPT | 85025 | 305 | 1 | 01 | 131 | 11/13/24 | 11/13/24 | 11/20/24 | 11/21/24 | 325.10 | |||||
| INSTITUTIONAL - OUTPATIENT | 1740772268 | 824372339 | FLORIDA HOSPITAL OCALA, INC. | PO BOX 947696 | ATLANTA | GA | 30394 | YES | 1063468221 | 824372339 | 80G | ADVENTHEALTH OCALA | 1500 SW 1ST AVE | OCALA | FL | 02 | ACUTE CARE HOSPITAL | FAC | INSTITUTIONAL FACILITIES | GROUP BLUE OPTIONS | 16153 | 23 | 313 | R079 | R079 | CHEST PAIN, UNSPECIFIED | PAIN IN THROAT AND CHEST | SYMPTOMS, SIGNS AND ABNORMAL CLINICAL AND LABORATORY FINDINGS, NOT ELSEWHERE CLASSIFIED | Z9189 | R002 | I499 | I4710 | R079 | CPT | 71045 | 324 | 1 | 01 | 131 | 11/13/24 | 11/13/24 | 11/20/24 | 11/21/24 | 416.00 | |||||
| INSTITUTIONAL - OUTPATIENT | 1740772268 | 824372339 | FLORIDA HOSPITAL OCALA, INC. | PO BOX 947696 | ATLANTA | GA | 30394 | YES | 1063468221 | 824372339 | 80G | ADVENTHEALTH OCALA | 1500 SW 1ST AVE | OCALA | FL | 02 | ACUTE CARE HOSPITAL | FAC | INSTITUTIONAL FACILITIES | GROUP BLUE OPTIONS | 16153 | 23 | 313 | R079 | R079 | CHEST PAIN, UNSPECIFIED | PAIN IN THROAT AND CHEST | SYMPTOMS, SIGNS AND ABNORMAL CLINICAL AND LABORATORY FINDINGS, NOT ELSEWHERE CLASSIFIED | Z9189 | R002 | I499 | I4710 | R079 | CPT | 99285 | 25 | 450 | 1 | 01 | 131 | 11/13/24 | 11/13/24 | 11/20/24 | 11/21/24 | 2,638.40 | ||||
| INSTITUTIONAL - OUTPATIENT | 1740772268 | 824372339 | FLORIDA HOSPITAL OCALA, INC. | PO BOX 947696 | ATLANTA | GA | 30394 | YES | 1063468221 | 824372339 | 80G | ADVENTHEALTH OCALA | 1500 SW 1ST AVE | OCALA | FL | 02 | ACUTE CARE HOSPITAL | FAC | INSTITUTIONAL FACILITIES | GROUP BLUE OPTIONS | 16153 | 23 | 313 | R079 | R079 | CHEST PAIN, UNSPECIFIED | PAIN IN THROAT AND CHEST | SYMPTOMS, SIGNS AND ABNORMAL CLINICAL AND LABORATORY FINDINGS, NOT ELSEWHERE CLASSIFIED | Z9189 | R002 | I499 | I4710 | R079 | CPT | 93005 | 730 | 1 | 01 | 131 | 11/13/24 | 11/13/24 | 11/20/24 | 11/21/24 | 300.48 | |||||
| INSTITUTIONAL - OUTPATIENT | 1740772268 | 824372339 | FLORIDA HOSPITAL OCALA, INC. | PO BOX 947696 | ATLANTA | GA | 30394 | YES | 1760800403 | 824372339 | 80G | ADVENTHEALTH OCALA | 1500 SW 1ST AVE | OCALA | FL | 02 | ACUTE CARE HOSPITAL | FAC | INSTITUTIONAL FACILITIES | GROUP BLUE OPTIONS | 16153 | 22 | 951 | Z1211 | Z1211 | ENCOUNTER FOR SCREENING FOR MALIGNANT NEOPLASM OF COLON | ENCOUNTER FOR SCREENING FOR MALIGNANT NEOPLASMS | FACTORS INFLUENCING HEALTH STATUS AND CONTACT WITH HEALTH SERVICES | D122 | D123 | K640 | E119 | Z1211 | CPT | 82947 | 301 | 1 | 01 | 131 | 12/9/24 | 12/9/24 | 12/15/24 | 12/16/24 | 85.17 | |||||
| INSTITUTIONAL - OUTPATIENT | 1740772268 | 824372339 | FLORIDA HOSPITAL OCALA, INC. | PO BOX 947696 | ATLANTA | GA | 30394 | YES | 1760800403 | 824372339 | 80G | ADVENTHEALTH OCALA | 1500 SW 1ST AVE | OCALA | FL | 02 | ACUTE CARE HOSPITAL | FAC | INSTITUTIONAL FACILITIES | GROUP BLUE OPTIONS | 16153 | 22 | 951 | Z1211 | Z1211 | ENCOUNTER FOR SCREENING FOR MALIGNANT NEOPLASM OF COLON | ENCOUNTER FOR SCREENING FOR MALIGNANT NEOPLASMS | FACTORS INFLUENCING HEALTH STATUS AND CONTACT WITH HEALTH SERVICES | D122 | D123 | K640 | E119 | Z1211 | CPT | 88305 | 312 | 1 | 01 | 131 | 12/9/24 | 12/9/24 | 12/15/24 | 12/16/24 | 1,275.10 | |||||
| INSTITUTIONAL - OUTPATIENT | 1740772268 | 824372339 | FLORIDA HOSPITAL OCALA, INC. | PO BOX 947696 | ATLANTA | GA | 30394 | YES | 1760800403 | 824372339 | 80G | ADVENTHEALTH OCALA | 1500 SW 1ST AVE | OCALA | FL | 02 | ACUTE CARE HOSPITAL | FAC | INSTITUTIONAL FACILITIES | GROUP BLUE OPTIONS | 16153 | 22 | 951 | Z1211 | Z1211 | ENCOUNTER FOR SCREENING FOR MALIGNANT NEOPLASM OF COLON | ENCOUNTER FOR SCREENING FOR MALIGNANT NEOPLASMS | FACTORS INFLUENCING HEALTH STATUS AND CONTACT WITH HEALTH SERVICES | D122 | D123 | K640 | E119 | Z1211 | CPT | 88305 | XU | 312 | 1 | 01 | 131 | 12/9/24 | 12/9/24 | 12/15/24 | 12/16/24 | 1,275.10 | ||||
| INSTITUTIONAL - OUTPATIENT | 1740772268 | 824372339 | FLORIDA HOSPITAL OCALA, INC. | PO BOX 947696 | ATLANTA | GA | 30394 | YES | 1760800403 | 824372339 | 80G | ADVENTHEALTH OCALA | 1500 SW 1ST AVE | OCALA | FL | 02 | ACUTE CARE HOSPITAL | FAC | INSTITUTIONAL FACILITIES | GROUP BLUE OPTIONS | 16153 | 22 | 951 | Z1211 | Z1211 | ENCOUNTER FOR SCREENING FOR MALIGNANT NEOPLASM OF COLON | ENCOUNTER FOR SCREENING FOR MALIGNANT NEOPLASMS | FACTORS INFLUENCING HEALTH STATUS AND CONTACT WITH HEALTH SERVICES | D122 | D123 | K640 | E119 | Z1211 | REVENUE | 370 | 370 | 20 | 01 | 131 | 12/9/24 | 12/9/24 | 12/15/24 | 12/16/24 | 10,066.65 | |||||
| INSTITUTIONAL - OUTPATIENT | 1740772268 | 824372339 | FLORIDA HOSPITAL OCALA, INC. | PO BOX 947696 | ATLANTA | GA | 30394 | YES | 1760800403 | 824372339 | 80G | ADVENTHEALTH OCALA | 1500 SW 1ST AVE | OCALA | FL | 02 | ACUTE CARE HOSPITAL | FAC | INSTITUTIONAL FACILITIES | GROUP BLUE OPTIONS | 16153 | 22 | 951 | Z1211 | Z1211 | ENCOUNTER FOR SCREENING FOR MALIGNANT NEOPLASM OF COLON | ENCOUNTER FOR SCREENING FOR MALIGNANT NEOPLASMS | FACTORS INFLUENCING HEALTH STATUS AND CONTACT WITH HEALTH SERVICES | D122 | D123 | K640 | E119 | Z1211 | HCPCS | J2704 | 636 | 60 | 01 | 131 | 12/9/24 | 12/9/24 | 12/15/24 | 12/16/24 | 313.35 | |||||
| INSTITUTIONAL - OUTPATIENT | 1740772268 | 824372339 | FLORIDA HOSPITAL OCALA, INC. | PO BOX 947696 | ATLANTA | GA | 30394 | YES | 1760800403 | 824372339 | 80G | ADVENTHEALTH OCALA | 1500 SW 1ST AVE | OCALA | FL | 02 | ACUTE CARE HOSPITAL | FAC | INSTITUTIONAL FACILITIES | GROUP BLUE OPTIONS | 16153 | 22 | 951 | Z1211 | Z1211 | ENCOUNTER FOR SCREENING FOR MALIGNANT NEOPLASM OF COLON | ENCOUNTER FOR SCREENING FOR MALIGNANT NEOPLASMS | FACTORS INFLUENCING HEALTH STATUS AND CONTACT WITH HEALTH SERVICES | D122 | D123 | K640 | E119 | Z1211 | REVENUE | 710 | 710 | 1 | 01 | 131 | 12/9/24 | 12/9/24 | 12/15/24 | 12/16/24 | 3,877.93 | |||||
| INSTITUTIONAL - OUTPATIENT | 1740772268 | 824372339 | FLORIDA HOSPITAL OCALA, INC. | PO BOX 947696 | ATLANTA | GA | 30394 | YES | 1760800403 | 824372339 | 80G | ADVENTHEALTH OCALA | 1500 SW 1ST AVE | OCALA | FL | 02 | ACUTE CARE HOSPITAL | FAC | INSTITUTIONAL FACILITIES | GROUP BLUE OPTIONS | 16153 | 22 | 951 | Z1211 | Z1211 | ENCOUNTER FOR SCREENING FOR MALIGNANT NEOPLASM OF COLON | ENCOUNTER FOR SCREENING FOR MALIGNANT NEOPLASMS | FACTORS INFLUENCING HEALTH STATUS AND CONTACT WITH HEALTH SERVICES | D122 | D123 | K640 | E119 | Z1211 | CPT | 45385 | 33 | 750 | 1 | 01 | 131 | 12/9/24 | 12/9/24 | 12/15/24 | 12/16/24 | 6,516.70 | ||||
| INSTITUTIONAL - OUTPATIENT | 1699874248 | 591943502 | SHANDS TEACHING HOSPITAL AND CLINICS INC | PO BOX 100005 | ATLANTA | GA | 30384 | YES | 1649760463 | 591943502 | 125 | SHANDS AND UNIVERSITY OF FLORIDA HEALTH | 1600 SW ARCHER RD | GAINESVILLE | FL | 02 | ACUTE CARE HOSPITAL | FAC | INSTITUTIONAL FACILITIES | GROUP BLUE OPTIONS | 16153 | 23 | 203 | J40 | J40 | BRONCHITIS, NOT SPECIFIED AS ACUTE OR CHRONIC | BRONCHITIS, NOT SPECIFIED AS ACUTE OR CHRONIC | DISEASES OF THE RESPIRATORY SYSTEM | Z880 | Z885 | Z886 | J40 | REVENUE | 250 | 250 | 1 | 01 | 131 | 12/19/24 | 12/19/24 | 12/30/24 | 12/31/24 | 4.29 | ||||||
| INSTITUTIONAL - OUTPATIENT | 1699874248 | 591943502 | SHANDS TEACHING HOSPITAL AND CLINICS INC | PO BOX 100005 | ATLANTA | GA | 30384 | YES | 1649760463 | 591943502 | 125 | SHANDS AND UNIVERSITY OF FLORIDA HEALTH | 1600 SW ARCHER RD | GAINESVILLE | FL | 02 | ACUTE CARE HOSPITAL | FAC | INSTITUTIONAL FACILITIES | GROUP BLUE OPTIONS | 16153 | 23 | 203 | J40 | J40 | BRONCHITIS, NOT SPECIFIED AS ACUTE OR CHRONIC | BRONCHITIS, NOT SPECIFIED AS ACUTE OR CHRONIC | DISEASES OF THE RESPIRATORY SYSTEM | Z880 | Z885 | Z886 | J40 | CPT | 0241U | 306 | 1 | 01 | 131 | 12/19/24 | 12/19/24 | 12/30/24 | 12/31/24 | 1,122.00 | ||||||
| INSTITUTIONAL - OUTPATIENT | 1699874248 | 591943502 | SHANDS TEACHING HOSPITAL AND CLINICS INC | PO BOX 100005 | ATLANTA | GA | 30384 | YES | 1649760463 | 591943502 | 125 | SHANDS AND UNIVERSITY OF FLORIDA HEALTH | 1600 SW ARCHER RD | GAINESVILLE | FL | 02 | ACUTE CARE HOSPITAL | FAC | INSTITUTIONAL FACILITIES | GROUP BLUE OPTIONS | 16153 | 23 | 203 | J40 | J40 | BRONCHITIS, NOT SPECIFIED AS ACUTE OR CHRONIC | BRONCHITIS, NOT SPECIFIED AS ACUTE OR CHRONIC | DISEASES OF THE RESPIRATORY SYSTEM | Z880 | Z885 | Z886 | J40 | CPT | 87651 | 306 | 1 | 01 | 131 | 12/19/24 | 12/19/24 | 12/30/24 | 12/31/24 | 160.00 | ||||||
| INSTITUTIONAL - OUTPATIENT | 1699874248 | 591943502 | SHANDS TEACHING HOSPITAL AND CLINICS INC | PO BOX 100005 | ATLANTA | GA | 30384 | YES | 1649760463 | 591943502 | 125 | SHANDS AND UNIVERSITY OF FLORIDA HEALTH | 1600 SW ARCHER RD | GAINESVILLE | FL | 02 | ACUTE CARE HOSPITAL | FAC | INSTITUTIONAL FACILITIES | GROUP BLUE OPTIONS | 16153 | 23 | 203 | J40 | J40 | BRONCHITIS, NOT SPECIFIED AS ACUTE OR CHRONIC | BRONCHITIS, NOT SPECIFIED AS ACUTE OR CHRONIC | DISEASES OF THE RESPIRATORY SYSTEM | Z880 | Z885 | Z886 | J40 | CPT | 71046 | 324 | 1 | 01 | 131 | 12/19/24 | 12/19/24 | 12/30/24 | 12/31/24 | 280.00 | ||||||
| INSTITUTIONAL - OUTPATIENT | 1699874248 | 591943502 | SHANDS TEACHING HOSPITAL AND CLINICS INC | PO BOX 100005 | ATLANTA | GA | 30384 | YES | 1649760463 | 591943502 | 125 | SHANDS AND UNIVERSITY OF FLORIDA HEALTH | 1600 SW ARCHER RD | GAINESVILLE | FL | 02 | ACUTE CARE HOSPITAL | FAC | INSTITUTIONAL FACILITIES | GROUP BLUE OPTIONS | 16153 | 23 | 203 | J40 | J40 | BRONCHITIS, NOT SPECIFIED AS ACUTE OR CHRONIC | BRONCHITIS, NOT SPECIFIED AS ACUTE OR CHRONIC | DISEASES OF THE RESPIRATORY SYSTEM | Z880 | Z885 | Z886 | J40 | CPT | 99283 | 25 | 450 | 1 | 01 | 131 | 12/19/24 | 12/19/24 | 12/30/24 | 12/31/24 | 2,930.00 |
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