Ins Carriers with a value in the ledger field

select Ledger, * from InsuranceCarriers where len(isnull(ledger,''))>0

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Ledger	InsuranceCarriersId	Inactive	Name	ListName	Address1	City	State	Zip	Phone1	Phone1Type	Phone2	Phone2Type	InsuranceGroupId	CollectionsGroupMId	CarrierTypeMId	FinancialClassMId	AllocationSetId	FilingMethodMId	FilingType	TransactionColumnSetId	Ledger1	RequiresAuth	ReferenceCarrier	AcceptAssignmentMId	DotId	Keyword	Created	CreatedBy	LastModified	LastModifiedBy	ICD10SERVICEDATE	InsSOP_db_Updated_Date	AUC
C	1	False	SELF PAY	SELF PAY									7	1701	91	1743	2	0	0	3	C			233	1	SELF PAY SELF PAY	2/22/2010 10:05:52 AM	cammy	5/12/2025 3:45:19 PM	gaia-wendy	10/1/2014 12:00:00 AM	5/12/2025 3:45:19 PM	False
C	3	False	MEDICARE A&B	MEDICARE A&B	PO BOX 2711	Jacksonville	FL	32211	8776028816	IVR	8886644112	CUSTOMER SERVICE	1	1701	1799	1738	2	1682	2	3	C	0	False	233	3	PO BOX 2711 MEDICARE A&B MEDICARE A&B JACKSONVILLE FL 32211	8/23/2022 3:28:21 PM	gaia-bruce	8/27/2025 4:57:06 PM	gaia-sandy	10/1/2015 12:00:00 AM	8/27/2025 4:57:06 PM	False
C	17	False	PENDING INSURANCE	PENDING INSURANCE									7	1701	80	1743	2	0	0	2	C			233	17	PENDING INSURANCE PENDING INSURANCE	3/5/2025 9:08:14 AM	gaia-nina	4/28/2025 8:31:20 AM	gaia-cary	10/1/2015 12:00:00 AM	4/28/2025 8:31:21 AM

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Ledger	InsuranceCarriersId	Inactive	Name	ListName	Address1	City	State	Zip	Phone1	InsuranceGroupId	CollectionsGroupMId	CarrierTypeMId	FinancialClassMId	AllocationSetId	FilingMethodMId	FilingType	TransactionColumnSetId	IncludeClaimOfficeNo	Ledger1	RequiresAuth	ReferenceCarrier	AcceptAssignmentMId	DotId	Keyword	Created	CreatedBy	LastModified	LastModifiedBy	ICD10SERVICEDATE	InsSOP_db_Updated_Date	AUC
C	1	False	SELF PAY	SELF PAY	PO BOX 12345	JACKSONVILLE	FL	32231		7	1701	91	1743	2	0	0	3	0	C			233	1	PO BOX 12345 SELF PAY SELF PAY JACKSONVILLE FL 32231	2/22/2010 10:05:52 AM	cammy	4/2/2025 1:46:42 PM	gaia-cary	10/1/2014 12:00:00 AM	4/2/2025 1:46:42 PM	False
C	3	False	MEDICARE A&B	MEDICARE A&B	PO BOX 2711	Jacksonville	FL	32211	8776028816	1	1701	1799	1738	2	1682	2	3	0	C	0	False	233	3	PO BOX 2711 MEDICARE A&B MEDICARE A&B JACKSONVILLE FL 32211	8/23/2022 3:28:21 PM	gaia-bruce	5/13/2026 11:18:36 AM	gaia-melisha	10/1/2015 12:00:00 AM	5/13/2026 11:18:36 AM	False
C	9	True	LEON HEALTH MCD	LEON HEALTH MCD - DO NOT USE	PO BOX 61265	PHOENIX	AZ	85082	8333735366	4	1702	83	1740	2	1682	2	2		C			233	9	PO BOX 61265 LEON HEALTH MCD - DO NOT USE LEON HEALTH MCD PHOENIX AZ 85082	12/21/2022 3:43:58 PM	gaia-michael	10/28/2024 11:25:13 AM	gaia-cary	10/1/2015 12:00:00 AM	10/28/2024 11:25:12 AM	False
C T	1029	False	MEDICARE PART A ONLY	MEDICARE PART A ONLY	PO BOX 2711	Jacksonville	FL	32211	8776028816	1	1701	1799	1738	2	1682	2	3		C T			233	1029	PO BOX 2711 MEDICARE PART A ONLY MEDICARE PART A ONLY JACKSONVILLE FL 32211	12/23/2022 8:49:07 AM	gaia-michael	4/30/2026 10:19:21 AM	gaia-melisha	10/1/2015 12:00:00 AM	4/30/2026 10:19:21 AM	False
C	1030	False	PENDING	PENDING	DO NOT BILL	LITTLETON	CO	80120		7	1701	91	1743	2	0	0	2	0	C	0	False	233	1030	DO NOT BILL PENDING PENDING LITTLETON CO 80120	12/23/2022 1:16:56 PM	gaia-amanda	4/28/2025 8:36:36 AM	gaia-cary	10/1/2015 12:00:00 AM	4/28/2025 8:36:36 AM	False
C	2047	False	COMMUNITY CARE PLAN MCD MMA	COMMUNITY CARE PLAN MCD MMA	PO Box 841309	PEMBROKE PINES	FL	33084	8668994828	4	1702	83	1740	2	1682	2	2	0	C			233	2047	PO BOX 841309 COMMUNITY CARE PLAN MCD MMA COMMUNITY CARE PLAN MCD MMA PEMBROKE PINES FL 33084	11/10/2023 11:51:32 AM	gaia-amanda	7/16/2025 1:24:50 PM	gaia-brenda	10/1/2015 12:00:00 AM	7/16/2025 1:24:50 PM	False
AF	2057	False	VA COMMUNITY CARE	VA COMMUNITY CARE	PO BOX 202117	FLORENCE	SC	29502	8889016613	6	1704	95	1742	2	1682	2	3	0	AF			233	2057	PO BOX 202117 VA COMMUNITY CARE VA COMMUNITY CARE FLORENCE SC 29502	11/14/2023 4:40:08 PM	gaia-amanda	5/7/2026 9:32:31 AM	gaia-wendy	10/1/2015 12:00:00 AM	5/7/2026 9:32:31 AM	False

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Ledger	InsuranceCarriersId	Inactive	Name	ListName	Address1	City	State	Zip	Phone1	Phone1Type	Phone2	Phone2Type	InsuranceGroupId	CollectionsGroupMId	CarrierTypeMId	FinancialClassMId	AllocationSetId	FilingMethodMId	FilingType	TransactionColumnSetId	PolicyTypeMId	IncludeClaimOfficeNo	Ledger1	Notes	RequiresAuth	ReferenceCarrier	AcceptAssignmentMId	DotId	PreAuthorizationFormType	Keyword	Created	CreatedBy	LastModified	LastModifiedBy	ICD10SERVICEDATE	InsSourceOfPaymentsID	InsSOP_db_Updated_Date	AUC
C	1	False	SELF PAY	SELF PAY									7	1701	91	1743	2	0	0	3		0	C				233	1		SELF PAY SELF PAY	2/22/2010 10:05:52 AM	cammy	8/23/2022 3:34:04 PM	gaia-bruce	10/1/2014 12:00:00 AM		8/23/2022 3:34:04 PM	False
CFP	3	False	Novitas Solutions Part A Medicare	Novitas Solutions Part A Medicare	PO Box 3113	Mechanicsburg	PA	17055-1828	8552528782	Work			1	1701	1799	1738	2	1682	2	3		0	CFP		0	False	233	3		PO BOX 3113 NOVITAS SOLUTIONS PART A MEDICARE NOVITAS SOLUTIONS PART A MEDICARE MECHANICSBURG PA 17055-1828	8/23/2022 3:28:21 PM	gaia-bruce	4/30/2026 2:36:23 PM	gwoods	10/1/2015 12:00:00 AM	1	4/30/2026 1:36:22 PM	False
CFP	4	False	MEDICAID	MEDICAID	PO Box 200555	Austin	TX	78720-0555					3	1702	83	1739	2	1682	2	2			CFP				233	4		PO BOX 200555 MEDICAID MEDICAID AUSTIN TX 78720-0555	8/23/2022 3:29:22 PM	gaia-bruce	4/30/2026 2:35:49 PM	gwoods	10/1/2015 12:00:00 AM		4/30/2026 1:35:49 PM	False
CFP	6	False	AARP	AARP	PO Box 740819	Atlanta	GA	30374-0819	8002277789	Work	2679332086	Fax	8	1703	104	1744	2	1682	2	2	116		CFP	Fax Number is to send Secondary Claims			233	1743	D	PO BOX 740819 AARP AARP ATLANTA GA 30374-0819	2/28/2025 12:40:07 PM	gwoods	4/30/2026 2:34:58 PM	gwoods	10/1/2015 12:00:00 AM		4/30/2026 1:34:58 PM
CFP	7	False	Aetna	Aetna	PO Box 981106	El Paso	TX	79998-9998	8006240756	Work			5	1703	104	1744	2	1682	2	2			CFP				233	99	D	PO BOX 981106 AETNA AETNA EL PASO TX 79998-9998	2/28/2025 12:46:27 PM	gwoods	5/18/2026 10:50:04 AM	gwoods	10/1/2015 12:00:00 AM		5/18/2026 9:50:04 AM
CFP	8	False	Mutual of Omaha	Mutual of Omaha	3300 Mutual of Omaha Plaza	Omaha	NE	68175	8005465906	Work			5	1703	104	1744	2	1682	2	2			CFP				233	1766	D	3300 MUTUAL OF OMAHA PLAZA MUTUAL OF OMAHA MUTUAL OF OMAHA OMAHA NE 68175	2/28/2025 2:01:12 PM	gwoods	4/30/2026 2:36:04 PM	gwoods	10/1/2015 12:00:00 AM		4/30/2026 1:36:04 PM
CFP	9	False	Superior Star Plus	Superior Star Plus	PO Box 3003	Farmington	MO	63640-3803	8668961844	Work			3	1702	83	1739	2	1682	2	2			CFP				233	1769	D	PO BOX 3003 SUPERIOR STAR PLUS SUPERIOR STAR PLUS FARMINGTON MO 63640-3803	2/28/2025 2:12:25 PM	gwoods	4/30/2026 2:36:38 PM	gwoods	10/1/2015 12:00:00 AM		4/30/2026 1:36:38 PM
CFP	10	False	BCBS of Texas	BCBS of Texas	PO Box 655488	Dallas	TX	75265-9998	8004424607	Work			5	1703	84	1744	2	1682	2	2	116	0	CFP			False	233	1750	D	PO BOX 655488 BCBS OF TEXAS BCBS OF TEXAS DALLAS TX 75265-9998	2/28/2025 2:21:40 PM	gwoods	5/18/2026 10:49:18 AM	gwoods	10/1/2015 12:00:00 AM		5/18/2026 9:49:18 AM
CFP	11	False	Humana	Humana	PO Box 14601	Lexington	KY	40512-4601	8667771569	Work			5	1703	104	1744	2	1682	2	2		0	CFP			False	233	1745		PO BOX 14601 HUMANA HUMANA LEXINGTON KY 40512-4601	2/28/2025 2:24:35 PM	gwoods	4/30/2026 2:35:39 PM	gwoods	10/1/2015 12:00:00 AM		4/30/2026 1:35:39 PM
CFP	12	False	United Healthcare	United Healthcare	PO Box 30557	Salt Lake City	UT	84130-0557	8778423210	Work			5	1703	104	1744	2	1682	2	2		0	CFP			False	233	1764	D	PO BOX 30557 UNITED HEALTHCARE UNITED HEALTHCARE SALT LAKE CITY UT 84130-0557	2/28/2025 2:31:43 PM	gwoods	5/18/2026 12:43:51 PM	gwoods	10/1/2015 12:00:00 AM		5/18/2026 11:43:51 AM
CFP	13	False	WellMed	WellMed	PO Box 30508	Salt Lake City	UT	84130-0508	8005507691	Work			5	1703	104	1744	2	1682	2	2			CFP				233	1760	D	PO BOX 30508 WELLMED WELLMED SALT LAKE CITY UT 84130-0508	2/28/2025 2:34:08 PM	gwoods	5/21/2026 11:37:26 AM	gaia-wendy	10/1/2015 12:00:00 AM		5/21/2026 11:37:26 AM
CFP	14	False	TriCare for Life	TriCare for Life	PO Box 7890	Madison	WI	53797	8063559703	Work			5	1703	104	1744	2	1682	2	2		0	CFP				233	TDFIC		PO BOX 7890 TRICARE FOR LIFE TRICARE FOR LIFE MADISON WI 53797	3/20/2025 8:57:44 AM	jrobledo	6/24/2026 1:55:48 PM	gwoods	10/1/2015 12:00:00 AM		6/24/2026 12:55:48 PM
CFP	15	False	Wellpoint	Wellpoint	PO Box 61010	Virgina Beach	VA	23466-1010	8337312162	Work			5	1703	104	1744	2	1682	2	2		0	CFP				233	WLPNT		PO BOX 61010 WELLPOINT WELLPOINT VIRGINA BEACH VA 23466-1010	3/20/2025 2:23:02 PM	jrobledo	6/24/2026 1:56:12 PM	gwoods	10/1/2015 12:00:00 AM		6/24/2026 12:56:12 PM
CFP	16	False	Medicare Secondary Payer	Medicare Secondary Payer	PO Box 3108	Mechanicsburg	PA	17055	8552528782	work			1	1703	1799	1738	2	1682	2	3		0	CFP			False	233	16		PO BOX 3108 MEDICARE SECONDARY PAYER MEDICARE SECONDARY PAYER MECHANICSBURG PA 17055	4/1/2025 8:34:15 AM	gwoods	4/30/2026 2:35:57 PM	gwoods	10/1/2015 12:00:00 AM	1	4/30/2026 1:35:57 PM
CFP	17	False	WebTPA	WebTPA	PO Box 99906	Grapevine	TX	76099	8773052432	Work			5	1703	104	1744	2	1682	2	2		0	CFP			False	233	GEC903841		PO BOX 99906 WEBTPA WEBTPA GRAPEVINE TX 76099	6/28/2025 9:52:25 AM	jrobledo	6/24/2026 1:55:58 PM	gwoods	10/1/2015 12:00:00 AM		6/24/2026 12:55:58 PM
CFP	19	False	Prosperity Medicare Supplement	Prosperity Medicare Supplement	PO Box 10854	Clearwater	TX	33757	8552283276	Work			9	1703	104	1744	2	1682	2	2			CFP				233	19		PO BOX 10854 PROSPERITY MEDICARE SUPPLEMENT PROSPERITY MEDICARE SUPPLEMENT CLEARWATER TX 33757	7/24/2025 2:50:18 PM	jrobledo	6/24/2026 1:55:33 PM	gwoods	10/1/2015 12:00:00 AM		6/24/2026 12:55:33 PM
CFP	20	False	Ambetter from Superior HealthPlan	Ambetter from Superior HealthPlan	PO Box 5010	Farmington	MO	63460-5010	8776871196	Work			3	1702	83	1739	2	1682	2	2		0	CFP		0		233	20		PO BOX 5010 AMBETTER FROM SUPERIOR HEALTHPLAN AMBETTER FROM SUPERIOR HEALTHPLAN FARMINGTON MO 63460-5010	9/11/2025 12:01:55 PM	jrobledo	6/24/2026 1:54:57 PM	gwoods	10/1/2015 12:00:00 AM		6/24/2026 12:54:57 PM
CFP	21	False	Baylor Scott & White Health Plan	Baylor Scott & White Health Plan	PO Box 211342	Eagan	MN	55121-1342	8446335325	Work			5	1703	104	1744	2	1682	2	2		0	CFP				233	21	D	PO BOX 211342 BAYLOR SCOTT & WHITE HEALTH PLAN BAYLOR SCOTT & WHITE HEALTH PLAN EAGAN MN 55121-1342	9/15/2025 1:53:53 PM	jrobledo	4/30/2026 2:35:21 PM	gwoods	10/1/2015 12:00:00 AM		4/30/2026 1:35:21 PM
CFP	22	False	WellCare Dual	WellCare Dual	P.O. Box 31372	Tampa	FL	33631-3372	8555380454	Work			2	1701	103	1741	2	1682	2	3		0	CFP			False	233	22		P.O. BOX 31372 WELLCARE DUAL WELLCARE DUAL TAMPA FL 33631-3372	3/5/2026 12:39:40 PM	jrobledo	4/30/2026 2:37:06 PM	gwoods	10/1/2015 12:00:00 AM		4/30/2026 1:37:06 PM

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Ledger	InsuranceCarriersId	Inactive	Name	ListName	Address1	City	State	Zip	Country	Contact	Phone1	Phone1Type	Phone2	Phone2Type	InsuranceGroupId	CollectionsGroupMId	CarrierTypeMId	FinancialClassMId	AllocationSetId	FilingMethodMId	FilingType	TransactionColumnSetId	IncludeClaimOfficeNo	Ledger1	RequiresAuth	AcceptAssignmentMId	DotId	Keyword	Created	CreatedBy	LastModified	LastModifiedBy	ICD10SERVICEDATE	InsSOP_db_Updated_Date	AUC
C	3	False	MEDICARE TX	MEDICARE TX	PO BOX 660155	DALLAS	TX	75266	USA		8552528782	Work			1	1701	1799	1738	2	1682	2	3		C		233	3	PO BOX 660155 MEDICARE TX MEDICARE TX DALLAS TX 75266	5/24/2019 2:49:24 PM	PADAI	9/19/2025 12:21:07 PM	gaia-cary	10/1/2015 12:00:00 AM	9/19/2025 12:21:07 PM	False
C	4	False	AETNA MCR	AETNA MCR	PO BOX 981106	EL PASO	TX	79998	USA	MOBILE IS AUTH DEPT	8886323862	Work	8665030857	Mobile	2	1701	2397	1741	2	1682	2	2	0	C	-1	233	4	PO BOX 981106 AETNA MCR AETNA MCR EL PASO TX 79998	5/28/2019 8:42:13 AM	padai	5/16/2023 2:15:09 PM	PADAI	10/1/2015 12:00:00 AM	5/16/2023 1:15:10 PM	False
C	16	False	AETNA COMM	AETNA COMM	PO BOX 981106	EL PASO	TX	79998-1106	USA		8886323862				3	1701	104	1744	2	1682	2	2	0	C	-1	233	16	PO BOX 981106 AETNA COMM AETNA COMM EL PASO TX 79998-1106	5/30/2019 8:58:24 AM	padai	5/16/2023 2:18:15 PM	PADAI	10/1/2015 12:00:00 AM	5/16/2023 1:18:15 PM	False

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Ledger	InsuranceCarriersId	Inactive	Name	ListName	Address1	City	State	Zip	Phone1	Phone2	InsuranceGroupId	CollectionsGroupMId	CarrierTypeMId	FinancialClassMId	AllocationSetId	FilingMethodMId	FilingType	TransactionColumnSetId	Ledger1	RequiresAuth	ReferenceCarrier	AcceptAssignmentMId	DotId	Keyword	Created	CreatedBy	LastModified	LastModifiedBy	ICD10SERVICEDATE	InsSOP_db_Updated_Date	AUC
C	1	False	SELF PAY	SELF PAY							7	1701	91	1743	2	0	0	2	C			233	1	SELF PAY SELF PAY	2/22/2010 10:05:52 AM	cammy	2/5/2026 1:37:31 PM	gaia-cary	10/1/2014 12:00:00 AM	2/5/2026 1:37:31 PM	False
C	3	False	MEDICARE A&B	MEDICARE A&B	PO BOX 2711	Jacksonville	FL	32110	8776028816	8886644112	1	1701	1799	1738	2	1682	2	3	C	0	False	233	3	PO BOX 2711 MEDICARE A&B MEDICARE A&B JACKSONVILLE FL 32110	8/23/2022 3:28:21 PM	gaia-bruce	5/13/2026 11:19:44 AM	gaia-melisha	10/1/2015 12:00:00 AM	5/13/2026 11:19:44 AM	False
C	1009	False	PENDING	PENDING	DO NOT BILL	LITTLETON	CO	80120			7	1701	80	1743	2	0	0	2	C	0	False	233	1009	DO NOT BILL PENDING PENDING LITTLETON CO 80120	8/30/2023 8:11:02 AM	gaia-amanda	4/28/2025 8:32:41 AM	gaia-cary	10/1/2015 12:00:00 AM	4/28/2025 8:32:41 AM	False
C	1010	False	WELLCARE MCR	WELLCARE MCR	PO BOX 31372	TAMPA	FL	33631	8555380454		2	1701	1799	1741	2	1682	2	3	C		False	233	1010	PO BOX 31372 WELLCARE MCR WELLCARE MCR TAMPA FL 33631	8/30/2023 8:58:58 AM	gaia-amanda	1/31/2024 12:42:26 PM	gaia-brenda	10/1/2015 12:00:00 AM	1/31/2024 12:42:29 PM	False
C	1018	False	Humana MCR	Humana MCR	Po Box 14601	Lexington	KY	40512	8004574708		2	1701	1799	1741	2	1682	2	3	C	0		233	12345	PO BOX 14601 HUMANA MCR HUMANA MCR LEXINGTON KY 40512	5/2/2024 8:37:41 AM	gaia-nina	5/2/2024 8:37:41 AM	gaia-nina	10/1/2015 12:00:00 AM	5/2/2024 8:37:41 AM	False
C T	1030	False	Medicare Part A ONLY	Medicare Part A ONLY	PO BOX 2711	Jacksonville	FL	32110	8776028816		1	1701	1799	1738	2	1682	2	3	C T		False	233	22589	PO BOX 2711 MEDICARE PART A ONLY MEDICARE PART A ONLY JACKSONVILLE FL 32110	7/15/2025 8:44:35 AM	gaia-nina	4/30/2026 10:20:17 AM	gaia-melisha	10/1/2015 12:00:00 AM	4/30/2026 10:20:17 AM
AF	1031	False	VA	VA	PO BOX 202117	Florence	SC	29502	8889016613		6	1704	95	1742	2	1682	2	2	AF		False	233	05987	PO BOX 202117 VA VA FLORENCE SC 29502	7/30/2025 12:04:11 PM	gaia-nina	7/9/2026 1:28:03 PM	gaia-wendy	10/1/2015 12:00:00 AM	7/9/2026 1:28:03 PM

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Ledger	InsuranceCarriersId	Inactive	Name	ListName	Address1	City	State	Zip	Phone1	InsuranceGroupId	CollectionsGroupMId	CarrierTypeMId	FinancialClassMId	AllocationSetId	FilingMethodMId	FilingType	TransactionColumnSetId	IncludeClaimOfficeNo	Ledger1	RequiresAuth	ReferenceCarrier	AcceptAssignmentMId	DotId	Keyword	Created	CreatedBy	LastModified	LastModifiedBy	ICD10SERVICEDATE	InsSOP_db_Updated_Date	AUC
C	1	False	SELF PAY	SELF PAY	PO BOX 12345	JACKSONVILLE	FL	32231		7	1701	91	1743	2	0	0	3	0	C			233	1	PO BOX 12345 SELF PAY SELF PAY JACKSONVILLE FL 32231	2/22/2010 10:05:52 AM	cammy	5/15/2025 3:12:59 PM	gaia-wendy	10/1/2014 12:00:00 AM	5/15/2025 3:12:59 PM	False
C	3	False	MEDICARE A&B	MEDICARE A&B	PO BOX 2711	JACKSONVILLE	FL	32211	8776028816	1	1701	1799	1738	2	1682	2	3	0	C	0	False	233	3	PO BOX 2711 MEDICARE A&B MEDICARE A&B JACKSONVILLE FL 32211	8/23/2022 3:28:21 PM	gaia-bruce	5/13/2026 11:06:52 AM	gaia-melisha	10/1/2015 12:00:00 AM	5/13/2026 11:06:52 AM	False
C	23	False	PENDING INSURANCE	PENDING INSURANCE	DO NOT BILL	MIAMI	FL	33173		7	1701	91	1743	2	0	0	2	0	C	0	False	233	23	DO NOT BILL PENDING INSURANCE PENDING INSURANCE MIAMI FL 33173	8/31/2022 7:39:47 AM	gaia-michael	4/28/2025 8:33:49 AM	gaia-cary	10/1/2015 12:00:00 AM	4/28/2025 8:33:49 AM	False
C T	47	False	MEDICARE PART A ONLY	MEDICARE PART A ONLY	PO BOX 2711	JACKSONVILLE	FL	32211	8776028816	1	1701	1799	1738	2	1682	2	3		C T			233	47	PO BOX 2711 MEDICARE PART A ONLY MEDICARE PART A ONLY JACKSONVILLE FL 32211	11/3/2022 10:47:28 AM	gaia-amanda	4/30/2026 9:59:20 AM	gaia-melisha	10/1/2015 12:00:00 AM	4/30/2026 9:59:20 AM	False

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Ledger	InsuranceCarriersId	Inactive	Name	ListName	Address1	City	State	Zip	Phone1	InsuranceGroupId	CollectionsGroupMId	CarrierTypeMId	FinancialClassMId	AllocationSetId	FilingMethodMId	FilingType	TransactionColumnSetId	Ledger1	Notes	RequiresAuth	ReferenceCarrier	AcceptAssignmentMId	DotId	Keyword	Created	CreatedBy	LastModified	LastModifiedBy	ICD10SERVICEDATE	InsSOP_db_Updated_Date	AUC
C	1	False	SELF PAY	SELF PAY						7	1701	91	1743	2	0	0	3	C				233	1	SELF PAY SELF PAY	2/22/2010 10:05:52 AM	cammy	7/9/2025 10:35:26 AM	gaia-wendy	10/1/2014 12:00:00 AM	7/9/2025 10:35:26 AM	False
C	3	False	MEDICARE A&B	MEDICARE A&B	PO BOX 2711	Jacksonville	FL	32211	8776028816	1	1701	1799	1738	2	1682	2	3	C		0	False	233	3	PO BOX 2711 MEDICARE A&B MEDICARE A&B JACKSONVILLE FL 32211	8/23/2022 3:28:21 PM	gaia-bruce	5/13/2026 11:07:46 AM	gaia-melisha	10/1/2015 12:00:00 AM	5/13/2026 11:07:46 AM	False
C	8	False	UHC MCR	UHC MCR	PO BOX 31350	Salt Lake City	UT	84131	8778423210	2	1701	1799	1741	2	1682	2	3	C				233	13	PO BOX 31350 UHC MCR UHC MCR SALT LAKE CITY UT 84131	5/3/2024 11:29:30 AM	gaia-nina	5/27/2025 3:11:34 PM	gaia-Tricia	10/1/2015 12:00:00 AM	5/27/2025 3:11:34 PM	False
C	13	False	PENDING INSURANCE	PENDING INSURANCE						7	1701	80	1743	2	0	0	2	C		0		233	18	PENDING INSURANCE PENDING INSURANCE	5/3/2024 3:11:22 PM	gaia-nina	4/28/2025 8:35:15 AM	gaia-cary	10/1/2015 12:00:00 AM	4/28/2025 8:35:15 AM	False
C	14	False	UHC CM	UHC CM	PO BOX 740800	Atlanta	GA	30374	8778423210	5	1703	104	1744	2	1682	2	2	C		0		233	19	PO BOX 740800 UHC CM UHC CM ATLANTA GA 30374	5/3/2024 3:17:59 PM	gaia-nina	5/27/2025 3:09:20 PM	gaia-Tricia	10/1/2015 12:00:00 AM	5/27/2025 3:09:20 PM	False
C	15	False	WELLCARE MCR	WELLCARE MCR	PO BOX 31372	Tampa	FL	33631	8555380454	2	1701	1799	1741	2	1682	2	3	C				233	20	PO BOX 31372 WELLCARE MCR WELLCARE MCR TAMPA FL 33631	5/3/2024 3:28:41 PM	gaia-nina	5/3/2024 3:37:19 PM	gaia-nina	10/1/2015 12:00:00 AM	5/3/2024 3:37:19 PM	False
C	16	False	WELLMED MCR	WELLMED MCR	PO BOX 30508	Salt Lake City	UT	84130	8778423210	2	1701	1799	1741	2	1682	2	3	C				233	23	PO BOX 30508 WELLMED MCR WELLMED MCR SALT LAKE CITY UT 84130	5/14/2024 7:31:13 AM	gaia-nina	3/27/2025 11:11:35 AM	gaia-nina	10/1/2015 12:00:00 AM	3/27/2025 11:11:35 AM	False
C	20	False	Anthem of Michigan	Anthem of Michigan	PO Box 1798	Jacksonville	FL	32231	8006762583	2	1701	1799	1741	2	1682	2	3	C	Per Anthem agent MagyRef# I-37829003 submit claims to Local BCBS			233	145	PO BOX 1798 ANTHEM OF MICHIGAN ANTHEM OF MICHIGAN JACKSONVILLE FL 32231	6/7/2024 1:46:08 PM	gaia-nina	6/7/2024 1:46:08 PM	gaia-nina	10/1/2015 12:00:00 AM	6/7/2024 1:46:08 PM	False
F	24	False	Gold Kidney MCR	Gold Kidney MCR	PO Box 285	Portsmouth	NH	03802	8442946535	2	1701	1799	1741	2	1682	2	3	F				233	A6865	PO BOX 285 GOLD KIDNEY MCR GOLD KIDNEY MCR PORTSMOUTH NH 03802	1/24/2025 1:13:29 PM	gaia-nina	6/3/2026 3:53:38 PM	gaia-wendy	10/1/2015 12:00:00 AM	6/3/2026 3:53:38 PM	False

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Ledger	InsuranceCarriersId	Inactive	Name	ListName	Address1	City	State	Zip	Phone1	InsuranceGroupId	CollectionsGroupMId	CarrierTypeMId	FinancialClassMId	AllocationSetId	FilingMethodMId	FilingType	TransactionColumnSetId	IncludeClaimOfficeNo	Ledger1	RequiresAuth	ReferenceCarrier	AcceptAssignmentMId	DotId	Keyword	Created	CreatedBy	LastModified	LastModifiedBy	ICD10SERVICEDATE	InsSOP_db_Updated_Date	AUC
C	1	False	SELF PAY	SELF PAY	PO BOX 12345	JACKSONVILLE	FL	32231		7	1701	91	1743	2	0	0	3	0	C			233	1	PO BOX 12345 SELF PAY SELF PAY JACKSONVILLE FL 32231	2/22/2010 10:05:52 AM	cammy	4/2/2025 1:46:42 PM	gaia-cary	10/1/2014 12:00:00 AM	4/2/2025 1:46:42 PM	False
C	3	False	MEDICARE A&B	MEDICARE A&B	PO BOX 2711	Jacksonville	FL	32211	8776028816	1	1701	1799	1738	2	1682	2	3	0	C	0	False	233	3	PO BOX 2711 MEDICARE A&B MEDICARE A&B JACKSONVILLE FL 32211	8/23/2022 3:28:21 PM	gaia-bruce	5/13/2026 11:08:37 AM	gaia-melisha	10/1/2015 12:00:00 AM	5/13/2026 11:08:37 AM	False
C	9	True	LEON HEALTH MCD	LEON HEALTH MCD - DO NOT USE	PO BOX 61265	PHOENIX	AZ	85082	8333735366	4	1702	83	1740	2	1682	2	2		C			233	9	PO BOX 61265 LEON HEALTH MCD - DO NOT USE LEON HEALTH MCD PHOENIX AZ 85082	12/21/2022 3:43:58 PM	gaia-michael	10/28/2024 11:25:13 AM	gaia-cary	10/1/2015 12:00:00 AM	10/28/2024 11:25:12 AM	False
C T	1029	False	MEDICARE PART A ONLY	MEDICARE PART A ONLY	PO BOX 2711	Jacksonville	FL	32211	8776028816	1	1701	1799	1738	2	1682	2	3		C T			233	1029	PO BOX 2711 MEDICARE PART A ONLY MEDICARE PART A ONLY JACKSONVILLE FL 32211	12/23/2022 8:49:07 AM	gaia-michael	4/30/2026 10:01:19 AM	gaia-melisha	10/1/2015 12:00:00 AM	4/30/2026 10:01:19 AM	False
C	1030	False	PENDING	PENDING	DO NOT BILL	LITTLETON	CO	80120		7	1701	91	1743	2	0	0	2	0	C	0	False	233	1030	DO NOT BILL PENDING PENDING LITTLETON CO 80120	12/23/2022 1:16:56 PM	gaia-amanda	11/3/2025 10:43:08 AM	gaia-cary	10/1/2015 12:00:00 AM	11/3/2025 10:43:08 AM	False
C	2047	False	COMMUNITY CARE PLAN MCD MMA	COMMUNITY CARE PLAN MCD MMA	PO Box 841309	PEMBROKE PINES	FL	33084	8668994828	4	1702	83	1740	2	1682	2	2	0	C			233	2047	PO BOX 841309 COMMUNITY CARE PLAN MCD MMA COMMUNITY CARE PLAN MCD MMA PEMBROKE PINES FL 33084	11/10/2023 11:51:32 AM	gaia-amanda	4/24/2026 3:43:55 PM	gaia-wendy	10/1/2015 12:00:00 AM	4/24/2026 3:43:55 PM	False

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Ledger	InsuranceCarriersId	Inactive	Name	ListName	Address1	Address2	City	State	Zip	Country	Phone1	Phone1Type	InsuranceGroupId	CollectionsGroupMId	CarrierTypeMId	FinancialClassMId	AllocationSetId	FilingMethodMId	FilingType	TransactionColumnSetId	IncludeClaimOfficeNo	Ledger1	RequiresAuth	ReferenceCarrier	AcceptAssignmentMId	DotId	Keyword	Created	CreatedBy	LastModified	LastModifiedBy	ICD10SERVICEDATE	InsSOP_db_Updated_Date	AUC
C	1	False	SELF PAY	SELF PAY	DO NOT BILL		NOWHERE	NL	12345	USA			7	1701	91	1743	2	0	0	3	0	C			233	1	DO NOT BILL SELF PAY SELF PAY NOWHERE NL 12345	2/22/2010 10:05:52 AM	cammy	6/17/2026 11:37:16 AM	gaia-jennifer	10/1/2014 12:00:00 AM	6/17/2026 9:37:16 AM	False
CF	3	False	MEDICARE A&B	MEDICARE A&B	PO BOX 2006		MECHANICSBURG	PA	17055				1	1701	1799	1738	2	1682	2	3	0	CF	0	False	233	3	PO BOX 2006 MEDICARE A&B MEDICARE A&B MECHANICSBURG PA 17055	8/23/2022 3:28:21 PM	gaia-bruce	6/17/2026 11:39:16 AM	gaia-jennifer	10/1/2015 12:00:00 AM	6/17/2026 9:39:16 AM	False
C	5	False	NO SECONDARY	NO SECONDARY	DO NOT BILL		Dialyis	DL	14674				7	1701	91	1743	2	0	0	1		C			233	5	DO NOT BILL NO SECONDARY NO SECONDARY DIALYIS DL 14674	8/23/2022 3:35:22 PM	gaia-bruce	6/17/2026 11:37:29 AM	gaia-jennifer	10/1/2015 12:00:00 AM	6/17/2026 9:37:29 AM	False
CF	6	False	SOLIS MCR	SOLIS MCR	Solis Health Plans Attn: Claims	PO Box 211486	Eagan	MN	55121		8336159259	Work	2	1701	1799	1741	2	1682	2	3	0	CF			233	SOLIS	SOLIS HEALTH PLANS ATTN: CLAIMS PO BOX 211486 SOLIS MCR SOLIS MCR EAGAN MN 55121	12/3/2025 8:24:28 AM	gaia-Lydia	6/17/2026 11:40:03 AM	gaia-jennifer	10/1/2015 12:00:00 AM	6/17/2026 9:40:03 AM
CF	10	False	UHC PCP MCR HMO POS	UHC PCP MCR HMO POS	PO Box 30448		Salt Lake City	UT	84130-0448		8667259334		2	1701	1799	1741	2	1682	2	3	0	CF	0	False	233	65088	PO BOX 30448 UHC PCP MCR HMO POS UHC PCP MCR HMO POS SALT LAKE CITY UT 84130-0448	4/3/2026 10:30:35 AM	gaia-Lydia	5/20/2026 12:14:25 PM	gaia-jennifer	10/1/2015 12:00:00 AM	5/20/2026 10:14:25 AM
CF	12	False	AETNA MCR	AETNA MCR	PO BOX 981106		El Paso	TX	79998-1106		8006240756		1	1701	1799	1741	2	1682	2	3	0	CF	0		233	60054	PO BOX 981106 AETNA MCR AETNA MCR EL PASO TX 79998-1106	4/6/2026 9:49:41 AM	gaia-melisha	6/17/2026 11:39:55 AM	gaia-jennifer	10/1/2015 12:00:00 AM	6/17/2026 9:39:55 AM
CF	15	False	HUMANA MCR	HUMANA MCR	PO Box 14601		Lexington	KY	40512-4601		8004574708		2	1701	1799	1741	2	1682	2	3	0	CF			233	61101	PO BOX 14601 HUMANA MCR HUMANA MCR LEXINGTON KY 40512-4601	4/23/2026 3:57:01 PM	gaia-Lydia	6/17/2026 11:39:50 AM	gaia-jennifer	10/1/2015 12:00:00 AM	6/17/2026 9:39:50 AM
CF	16	False	UHC PCP MCR HMO	UHC PCP MCR HMO	PO Box 30448		Salt Lake City	UT	84130-0448		8667259334		2	1701	1799	1741	2	1682	2	3	0	CF			233	650883	PO BOX 30448 UHC PCP MCR HMO UHC PCP MCR HMO SALT LAKE CITY UT 84130-0448	4/24/2026 7:31:45 AM	gaia-Lydia	6/17/2026 11:39:07 AM	gaia-jennifer	10/1/2015 12:00:00 AM	6/17/2026 9:39:07 AM
CF	17	False	UHC PCN MCR HMO	UHC PCN MCR HMO	P.O. Box 30448		Salt Lake City	UT	84130-0448		8003485548		2	1701	1799	1741	2	1682	2	3	0	CF			233	78857	P.O. BOX 30448 UHC PCN MCR HMO UHC PCN MCR HMO SALT LAKE CITY UT 84130-0448	5/25/2026 7:39:24 AM	gaia-Lydia	6/17/2026 11:39:11 AM	gaia-jennifer	10/1/2015 12:00:00 AM	6/17/2026 9:39:11 AM

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Ledger	InsuranceCarriersId	MasterInsuranceCarriersId	Inactive	Name	ListName	Address1	Address2	City	State	Zip	Country	Contact	Phone1	Phone1Type	Phone2	Phone2Type	Phone3	Phone3Type	InsuranceGroupId	CollectionsGroupMId	CarrierTypeMId	FinancialClassMId	AllocationSetId	FilingMethodMId	FilingType	TransactionColumnSetId	PolicyTypeMId	CopayAmt	Deductible	GroupId	GroupName	MediGapId	OrgId	IncludeClaimOfficeNo	LocationId	PPOId	ECSClearinghouseId	ECSPayorId	ECSClaimOfficeNumber	ECSNEIC	UseRenderingProviderId	RequiresPIN	ECSMaximumNumberOfProcedures	ELIMIKDestination	ELIClearinghouseId	ELIPayorId	ELIMessageType	ElectronicFilingStatus	SupplementalFiling	Ledger1	Notes	AlertNotes	RequiresAuth	ReferenceCarrier	PayerIdNumberCodeMId	OtherPayerIdNumber	SubscriberIDMask	AcceptAssignmentMId	DotId	PartnerInsuranceCarriersId	PreAuthorizationFormType	PreAuthorizationFormFile	Keyword	OrderNotes	Created	CreatedBy	LastModified	LastModifiedBy	CountrySubdiv	ICD10SERVICEDATE	InsSourceOfPaymentsID	InsSOP_db_Updated_Date	AUC
C	1		False	SELF PAY	SELF PAY														7	1701	91	1743	2	0	0	3		0	0					0																C								233	1				SELF PAY SELF PAY		2/22/2010 10:05:52 AM	cammy	8/23/2022 3:34:04 PM	gaia-bruce		10/1/2014 12:00:00 AM		8/23/2022 3:34:04 PM	False
C	3		False	MEDICARE A&B	MEDICARE A&B														1	1701	1799	1738	2	1682	2	3		0	0					0																C			0	False				233	3				MEDICARE A&B MEDICARE A&B		8/23/2022 3:28:21 PM	gaia-bruce	8/23/2022 3:28:21 PM	gaia-bruce		10/1/2015 12:00:00 AM		8/23/2022 3:28:21 PM	False

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Ledger	InsuranceCarriersId	MasterInsuranceCarriersId	Inactive	Name	ListName	Address1	Address2	City	State	Zip	Country	Contact	Phone1	Phone1Type	Phone2	Phone2Type	Phone3	Phone3Type	InsuranceGroupId	CollectionsGroupMId	CarrierTypeMId	FinancialClassMId	AllocationSetId	FilingMethodMId	FilingType	TransactionColumnSetId	PolicyTypeMId	CopayAmt	Deductible	GroupId	GroupName	MediGapId	OrgId	IncludeClaimOfficeNo	LocationId	PPOId	ECSClearinghouseId	ECSPayorId	ECSClaimOfficeNumber	ECSNEIC	UseRenderingProviderId	RequiresPIN	ECSMaximumNumberOfProcedures	ELIMIKDestination	ELIClearinghouseId	ELIPayorId	ELIMessageType	ElectronicFilingStatus	SupplementalFiling	Ledger1	Notes	AlertNotes	RequiresAuth	ReferenceCarrier	PayerIdNumberCodeMId	OtherPayerIdNumber	SubscriberIDMask	AcceptAssignmentMId	DotId	PartnerInsuranceCarriersId	PreAuthorizationFormType	PreAuthorizationFormFile	Keyword	OrderNotes	Created	CreatedBy	LastModified	LastModifiedBy	CountrySubdiv	ICD10SERVICEDATE	InsSourceOfPaymentsID	InsSOP_db_Updated_Date	AUC

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Ledger	InsuranceCarriersId	Inactive	Name	ListName	Address1	Address2	City	State	Zip	Phone1	InsuranceGroupId	CollectionsGroupMId	CarrierTypeMId	FinancialClassMId	AllocationSetId	FilingMethodMId	FilingType	TransactionColumnSetId	IncludeClaimOfficeNo	Ledger1	AlertNotes	RequiresAuth	ReferenceCarrier	AcceptAssignmentMId	DotId	Keyword	Created	CreatedBy	LastModified	LastModifiedBy	ICD10SERVICEDATE	InsSOP_db_Updated_Date	AUC
C	3	False	MEDICARE PART A&B	MEDICARE PART A&B	PO BOX 6770		FARGO	ND	58108	8556099960	1	1701	1799	1738	2	1682	2	3	0	C		0	False	233	GER00022I_MCR	PO BOX 6770 MEDICARE PART A&B MEDICARE PART A&B FARGO ND 58108	6/15/2022 3:12:47 PM	gaia-michael	5/13/2026 11:05:59 AM	gaia-michellem	10/1/2015 12:00:00 AM	5/13/2026 11:05:59 AM	False
C	5	False	CAREMORE HEALTH MCR	CAREMORE HEALTH MCR	PO BOX 157		ARTESIA	CA	90702	8882911358	1	1701	1799	1741	2	1682	2	3		C				233	GEC91506I_MCR	PO BOX 157 CAREMORE HEALTH MCR CAREMORE HEALTH MCR ARTESIA CA 90702	6/15/2022 3:37:22 PM	gaia-michael	5/4/2026 9:06:20 AM	gaia-michellem	10/1/2015 12:00:00 AM	5/4/2026 9:06:22 AM	False
C	6	False	Anthem BCBS MCR	Anthem BCBS MCR	PO BOX 60007		LOS ANGELES	CA	90060	8338488730	1	1701	1799	1741	2	1682	2	3		C				233	GEB90261I_MCR	PO BOX 60007 ANTHEM BCBS MCR ANTHEM BCBS MCR LOS ANGELES CA 90060	6/15/2022 3:42:30 PM	gaia-michael	3/18/2026 8:27:17 AM	gaia-wendy	10/1/2015 12:00:00 AM	3/18/2026 8:27:17 AM	False
C	1003	False	PENDING INSURANCE	PENDING INSURANCE	DO NOT BILL		GLENDALE	CA	91204		1002	1701	80	1743	2	0	0	2	0	C		0	False	233	1003	DO NOT BILL PENDING INSURANCE PENDING INSURANCE GLENDALE CA 91204	6/16/2022 9:31:36 AM	gaia-michael	4/28/2025 8:37:59 AM	gaia-cary	10/1/2015 12:00:00 AM	4/28/2025 8:37:59 AM	False
C	1009	False	MEDICARE PART A ONLY	MEDICARE PART A ONLY	PO BOX 6770		FARGO	ND	58108	8556099960	1	1701	1799	1738	2	1682	2	3		C				233	GER00022I_MCR A	PO BOX 6770 MEDICARE PART A ONLY MEDICARE PART A ONLY FARGO ND 58108	10/24/2022 9:04:37 AM	gaia-michael	5/13/2026 11:05:54 AM	gaia-michellem	10/1/2015 12:00:00 AM	5/13/2026 11:05:54 AM	False
C	1010	False	SELF PAY	SELF PAY	DO NOT BILL		VAN NUYS	CA	91405		1002	1701	91	1743	2	0	0	2	0	C		0	False	233	1010	DO NOT BILL SELF PAY SELF PAY VAN NUYS CA 91405	11/3/2022 11:42:27 AM	gaia-amanda	6/23/2025 9:23:58 AM	gaia-jennifer	10/1/2015 12:00:00 AM	6/23/2025 7:23:58 AM	False
C	1011	False	SCAN HEALTH OPTUM MCR	SCAN HEALTH OPTUM MCR	PO BOX 6099		TORRANCE	CA	90504	8777787226	1	1701	1799	1741	2	1682	2	3	0	C		0	False	233	GEC91633I_MCR	PO BOX 6099 SCAN HEALTH OPTUM MCR SCAN HEALTH OPTUM MCR TORRANCE CA 90504	12/26/2022 9:09:37 AM	gaia-amanda	4/15/2025 8:01:22 AM	gaia-jennifer	10/1/2015 12:00:00 AM	4/15/2025 6:01:22 AM	False
C	3013	False	WELLCARE MCR	WELLCARE MCR	PO Box 31372		Tampa	FL	33631	8555380454	1	1701	1799	1741	2	1682	2	3	0	C			False	233	GEC91594I_MCR	PO BOX 31372 WELLCARE MCR WELLCARE MCR TAMPA FL 33631	7/28/2023 2:01:43 PM	gaia-michael	4/15/2025 8:02:46 AM	gaia-jennifer	10/1/2015 12:00:00 AM	4/15/2025 6:02:46 AM	False
CF	3014	False	PROSPECT HEALTH SOURCE MCR	PROSPECT HEALTH SOURCE MCR	600 City Parkway West	Ste 800	Orange	CA	92868	7147965900	1	1701	1799	1741	2	1682	2	3	0	CF			False	233	GEC90122I_MCR	600 CITY PARKWAY WEST STE 800 PROSPECT HEALTH SOURCE MCR PROSPECT HEALTH SOURCE MCR ORANGE CA 92868	9/30/2023 11:29:01 AM	gaia-amanda	5/5/2026 9:28:22 AM	gaia-wendy	10/1/2015 12:00:00 AM	5/5/2026 9:28:22 AM	False
C	3019	False	UHC OPTUM HEALTH MCR	UHC OPTUM HEALTH MCR	PO BOX 6099		TORRANCE	CA	90504	3109651100	1	1701	1799	1741	2	1682	2	3	0	C				233	GEC94350I_MCR_1	PO BOX 6099 UHC OPTUM HEALTH MCR UHC OPTUM HEALTH MCR TORRANCE CA 90504	11/8/2023 10:36:13 AM	gaia-amanda	4/15/2025 9:05:08 AM	gaia-jennifer	10/1/2015 12:00:00 AM	4/15/2025 7:05:08 AM	False
C	3020	False	UHC MCR	UHC MCR	PO BOX 30555		SALT LAKE CITY	UT	84130	8778423210	1	1701	1799	1741	2	1682	2	3	0	C	Facility TAX ID# not registered with UHC- Paper Claim			233	GEC90096I_MCR	PO BOX 30555 UHC MCR UHC MCR SALT LAKE CITY UT 84130	12/4/2023 9:06:49 AM	gaia-nina	4/23/2026 3:40:49 PM	gaia-wendy	10/1/2015 12:00:00 AM	4/23/2026 3:40:49 PM	False
C	4025	False	LA CARE MCR	LA CARE MCR	PO Box 811580		LOS ANGELES	CA	90081	8665222736	1	1701	1799	1741	2	1682	2	3	0	C		0		233	GEC91518I_MCR	PO BOX 811580 LA CARE MCR LA CARE MCR LOS ANGELES CA 90081	8/30/2024 2:14:37 PM	gaia-briana	1/7/2026 10:01:57 AM	gaia-Tricia	10/1/2015 12:00:00 AM	1/7/2026 10:01:57 AM	False
C	4031	False	AETNA MCR	AETNA MCR	Po Box 91106		EL PASO	TX	79998	8886323862	1	1701	1799	1741	2	1682	2	3	0	C				233	GEC90057I_MCR	PO BOX 91106 AETNA MCR AETNA MCR EL PASO TX 79998	2/25/2025 1:00:21 PM	gaia-nina	4/15/2025 7:56:16 AM	gaia-jennifer	10/1/2015 12:00:00 AM	4/15/2025 5:56:16 AM	False
C	4054	False	MEDICARE PART B ONLY	MEDICARE PART B ONLY	PO BOX 6770		FARGO	ND	58108	8779088431	1	1701	82	1738	2	1682	2	3	0	C				233	GER00022I_MCR B	PO BOX 6770 MEDICARE PART B ONLY MEDICARE PART B ONLY FARGO ND 58108	3/31/2026 3:52:22 PM	gaia-Tamika	5/13/2026 11:06:03 AM	gaia-michellem	10/1/2015 12:00:00 AM	5/13/2026 11:06:03 AM

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Ledger	InsuranceCarriersId	Inactive	Name	ListName	Address1	City	State	Zip	Country	Phone1	Phone1Type	Phone2	Phone2Type	InsuranceGroupId	CollectionsGroupMId	CarrierTypeMId	FinancialClassMId	AllocationSetId	FilingMethodMId	FilingType	TransactionColumnSetId	IncludeClaimOfficeNo	Ledger1	RequiresAuth	ReferenceCarrier	AcceptAssignmentMId	DotId	Keyword	Created	CreatedBy	LastModified	LastModifiedBy	ICD10SERVICEDATE	InsSOP_db_Updated_Date	AUC
C	1	False	MEDICARE PART A & B CARL T CURTIS	MEDICARE PART A & B CARL T CURTIS	P O BOX 24563	OMAHA	NE	68124-4563		8552528782				1	1701	1799	1738	2	1682	2	3	0	C			233	1	P O BOX 24563 MEDICARE PART A & B CARL T CURTIS MEDICARE PART A & B CARL T CURTIS OMAHA NE 68124-4563	2/22/2010 10:05:52 AM	cammy	5/13/2026 11:08:13 AM	gaia-michellem	10/1/2014 12:00:00 AM	5/13/2026 11:08:13 AM	False
C	7	False	PENDING INSURANCE	PENDING INSURANCE	DO NOT BILL	NOWHERE	NL	12345	USA					3	1701	80	1743	2	0	0	2		C			233	7	DO NOT BILL PENDING INSURANCE PENDING INSURANCE NOWHERE NL 12345	4/17/2019 8:07:25 AM	superuser	4/28/2025 8:39:53 AM	gaia-cary	10/1/2015 12:00:00 AM	4/28/2025 8:39:53 AM	False
C	11	False	UHC MCR	UHC MCR	PO BOX 31353	SALT LAKE CITY	UT	84131-0353		8889808117		8778423210		5	1701	1799	1741	2	1682	2	3		C			233	11	PO BOX 31353 UHC MCR UHC MCR SALT LAKE CITY UT 84131-0353	4/17/2019 8:20:15 AM	superuser	3/3/2023 3:47:13 PM	gaia-vicki	10/1/2015 12:00:00 AM	3/3/2023 3:47:13 PM	False
C	20	False	UHC AARP MCR	UHC AARP MCR	PO Box 31362	SALT LAKE CITY	UT	84131-0362		8778423210	Clinic	8665617518	Fax	5	1701	1799	1741	2	1682	2	3	0	C	0	False	233	20	PO BOX 31362 UHC AARP MCR UHC AARP MCR SALT LAKE CITY UT 84131-0362	6/29/2021 3:54:10 PM	gaia-veronica	3/28/2025 8:55:56 AM	gaia-nina	10/1/2015 12:00:00 AM	3/28/2025 8:55:56 AM	False
C	21	False	UHC MEDICARE ADV	UHC MEDICARE ADV	PO Box 5240	KINGSTON	NY	12425-5240		8778423210	Clinic	8666043267		5	1701	1799	1741	2	1682	2	3	0	C	0	False	233	21	PO BOX 5240 UHC MEDICARE ADV UHC MEDICARE ADV KINGSTON NY 12425-5240	7/14/2021 7:13:24 AM	gaia-veronica	6/18/2024 9:36:28 AM	gaia-nina	10/1/2015 12:00:00 AM	6/18/2024 9:36:28 AM	False
C	23	False	MEDICARE PART A ONLY CARL T CURTIS	MEDICARE PART A ONLY CARL T CURTIS	PO BOX 24563	OMAHA	NE	68124-4563		8665183285				1	1701	1799	1738	2	1682	2	3		C			233	23	PO BOX 24563 MEDICARE PART A ONLY CARL T CURTIS MEDICARE PART A ONLY CARL T CURTIS OMAHA NE 68124-4563	7/29/2021 12:06:37 PM	gaia-jennifer	5/13/2026 11:08:19 AM	gaia-michellem	10/1/2015 12:00:00 AM	5/13/2026 11:08:19 AM	False
C	25	False	MEDICARE PART A&B WALT HILL	MEDICARE PART A&B WALT HILL	PO BOX 24563	OMAHA	NE	68124		8552528782	IVR			1	1701	1799	1738	2	1682	2	3	0	C	0	False	233	25	PO BOX 24563 MEDICARE PART A&B WALT HILL MEDICARE PART A&B WALT HILL OMAHA NE 68124	9/20/2022 10:37:46 AM	gaia-michael	5/13/2026 11:08:27 AM	gaia-michellem	10/1/2015 12:00:00 AM	5/13/2026 11:08:27 AM	False
C	26	False	MEDICARE PART A ONLY WALT HILL	MEDICARE PART A ONLY WALT HILL	PO BOX 24563	OMAHA	NE	68124-4563		8665183285				1	1701	1799	1738	2	1682	2	3		C			233	26	PO BOX 24563 MEDICARE PART A ONLY WALT HILL MEDICARE PART A ONLY WALT HILL OMAHA NE 68124-4563	9/20/2022 10:39:30 AM	gaia-michael	5/13/2026 11:08:23 AM	gaia-michellem	10/1/2015 12:00:00 AM	5/13/2026 11:08:23 AM	False
C	27	False	HUMANA MCR	HUMANA MCR	PO BOX 14601	LEXINGTON	KY	40512		8004574708				5	1701	1799	1741	2	1682	2	3	0	C	0	False	233	27	PO BOX 14601 HUMANA MCR HUMANA MCR LEXINGTON KY 40512	4/19/2023 7:30:58 AM	gaia-amanda	5/22/2024 10:43:50 AM	gaia-Tricia	10/1/2015 12:00:00 AM	5/22/2024 10:43:50 AM	False
C	35	False	Alohacare MCD	Alohacare MCD	1357 KAPIOLANI BLVD SUITE G-101	Honolulu	HI	96814		8089731650				2	1703	83	1739	2	1682	2	2	0	C			233	ALOHA	1357 KAPIOLANI BLVD SUITE G-101 ALOHACARE MCD ALOHACARE MCD HONOLULU HI 96814	8/2/2024 1:46:51 PM	gaia-nina	6/17/2025 3:16:23 PM	gaia-nina	10/1/2015 12:00:00 AM	6/17/2025 3:16:23 PM	False

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Ledger	InsuranceCarriersId	Inactive	Name	ListName	Address1	City	State	Zip	Phone1	Phone2	InsuranceGroupId	CollectionsGroupMId	CarrierTypeMId	FinancialClassMId	AllocationSetId	FilingMethodMId	FilingType	TransactionColumnSetId	Ledger1	RequiresAuth	ReferenceCarrier	AcceptAssignmentMId	DotId	Keyword	Created	CreatedBy	LastModified	LastModifiedBy	ICD10SERVICEDATE	InsSOP_db_Updated_Date	AUC
C	1	False	SELF PAY	SELF PAY							7		91	1743	2	0	0	1	C			233	1	SELF PAY SELF PAY	2/22/2010 10:05:52 AM	cammy	3/27/2025 12:48:51 PM	gaia-nina	10/1/2014 12:00:00 AM	3/27/2025 12:48:51 PM	False
C	3	False	MEDICARE A&B	MEDICARE A&B	PO BOX 2711	Jacksonville	FL	32231	8776028816	8886644112	1	1701	1799	1738	2	1682	2	3	C	0	False	233	3	PO BOX 2711 MEDICARE A&B MEDICARE A&B JACKSONVILLE FL 32231	8/23/2022 3:28:21 PM	gaia-bruce	5/13/2026 11:22:26 AM	gaia-melisha	10/1/2015 12:00:00 AM	5/13/2026 11:22:27 AM	False
C	11	False	PENDING INSURANCE	PENDING INSURANCE	DO NOT BILL	LITTLETON	CO	80120			7	1701	80	1743	2	0	0	2	C	0	False	233	11	DO NOT BILL PENDING INSURANCE PENDING INSURANCE LITTLETON CO 80120	10/18/2023 3:58:44 PM	gaia-amanda	4/28/2025 8:41:29 AM	gaia-cary	10/1/2015 12:00:00 AM	4/28/2025 8:41:29 AM	False
C	18	False	CAREPLUS MCR	CAREPLUS MCR	PO BOX 14697	LEXINGTON	KY	40512	8663137587		2	1701	1799	1741	2	1682	2	3	C			233	18	PO BOX 14697 CAREPLUS MCR CAREPLUS MCR LEXINGTON KY 40512	10/19/2023 10:20:19 AM	gaia-amanda	10/19/2023 10:20:19 AM	gaia-amanda	10/1/2015 12:00:00 AM	10/19/2023 10:20:19 AM	False
C T	31	False	Medicare Part A ONLY	Medicare Part A ONLY	PO BOX 2711	Jacksonville	FL	32110	8776028816		1	1701	1799	1738	2	1682	2	3	C T		False	233	456456	PO BOX 2711 MEDICARE PART A ONLY MEDICARE PART A ONLY JACKSONVILLE FL 32110	10/18/2024 10:01:50 AM	gaia-nina	4/30/2026 10:25:19 AM	gaia-melisha	10/1/2015 12:00:00 AM	4/30/2026 10:25:19 AM

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Ledger	InsuranceCarriersId	Inactive	Name	ListName	Address1	City	State	Zip	Phone1	InsuranceGroupId	CollectionsGroupMId	CarrierTypeMId	FinancialClassMId	AllocationSetId	FilingMethodMId	FilingType	TransactionColumnSetId	Ledger1	RequiresAuth	ReferenceCarrier	AcceptAssignmentMId	DotId	Keyword	Created	CreatedBy	LastModified	LastModifiedBy	ICD10SERVICEDATE	InsSOP_db_Updated_Date	AUC
C	1	False	SELF PAY	SELF PAY						7		91	1743	2	0	0	1	C			233	1	SELF PAY SELF PAY	2/22/2010 10:05:52 AM	cammy	3/27/2025 2:05:24 PM	gaia-nina	10/1/2014 12:00:00 AM	3/27/2025 2:05:24 PM	False
C	3	False	MEDICARE A&B	MEDICARE A&B	PO BOX 2711	Jacksonville	FL	32111	8776028816	1	1701	1799	1738	2	1682	2	3	C	0	False	233	3	PO BOX 2711 MEDICARE A&B MEDICARE A&B JACKSONVILLE FL 32111	8/23/2022 3:28:21 PM	gaia-bruce	5/13/2026 11:09:29 AM	gaia-melisha	10/1/2015 12:00:00 AM	5/13/2026 11:09:29 AM	False
C	7	False	Simply Healthcare MCR	Simply Healthcare MCR	PO Box 61010	Virginia Beach	VA	23466	8775770115	2	1701	1799	1741	2	1682	2	3	C	0	False	233	7	PO BOX 61010 SIMPLY HEALTHCARE MCR SIMPLY HEALTHCARE MCR VIRGINIA BEACH VA 23466	12/12/2022 3:14:31 PM	gaia-amanda	5/10/2024 1:15:57 PM	gaia-Tricia	10/1/2015 12:00:00 AM	5/10/2024 1:15:57 PM	False
C	2006	False	PENDING INSURANCE	PENDING INSURANCE	DO NOT BILL	HIALEAH	FL	33016		7	1701	80	1743	2	0	0	2	C	0	False	233	2006	DO NOT BILL PENDING INSURANCE PENDING INSURANCE HIALEAH FL 33016	3/3/2023 12:29:33 PM	gaia-michael	4/28/2025 8:42:58 AM	gaia-cary	10/1/2015 12:00:00 AM	4/28/2025 8:42:58 AM	False
C	2009	False	OSCAR CM	OSCAR CM	PO BOX 62146	PHOENIX	AZ	85072	8556722755	5	1703	104	1744	2	1681	2	2	C	0	False	233	2009	PO BOX 62146 OSCAR CM OSCAR CM PHOENIX AZ 85072	10/4/2023 11:27:36 AM	gaia-amanda	10/4/2023 11:28:30 AM	gaia-amanda	10/1/2015 12:00:00 AM	10/4/2023 11:28:30 AM	False
C	2010	False	HEALTHSUN MCR	HEALTHSUN MCR	PO BOX 211154	EAGAN	MN	55121	8779997776	2	1701	1799	1741	2	1682	2	3	C			233	2010	PO BOX 211154 HEALTHSUN MCR HEALTHSUN MCR EAGAN MN 55121	11/2/2023 7:40:53 AM	gaia-amanda	11/2/2023 7:41:51 AM	gaia-amanda	10/1/2015 12:00:00 AM	11/2/2023 7:41:51 AM	False

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Ledger	InsuranceCarriersId	Inactive	Name	ListName	Address1	City	State	Zip	Phone1	Phone1Type	Phone2	InsuranceGroupId	CollectionsGroupMId	CarrierTypeMId	FinancialClassMId	AllocationSetId	FilingMethodMId	FilingType	TransactionColumnSetId	IncludeClaimOfficeNo	Ledger1	RequiresAuth	ReferenceCarrier	AcceptAssignmentMId	DotId	Keyword	Created	CreatedBy	LastModified	LastModifiedBy	ICD10SERVICEDATE	InsSOP_db_Updated_Date	AUC
C	1	False	MEDICARE PART A & B	MEDICARE PART A & B	PO Box 6773	FARGO	ND	58108	8556099960			1	1701	1799	1738	2	1682	2	2	0	C			233	1	PO BOX 6773 MEDICARE PART A & B MEDICARE PART A & B FARGO ND 58108	2/22/2010 10:05:52 AM	cammy	5/13/2026 11:10:17 AM	gaia-melisha	10/1/2014 12:00:00 AM	5/13/2026 11:10:17 AM	False
C	6	False	CHARITY	CHARITY								4		91	1743	2	0	0	2		C			233	6	CHARITY CHARITY	9/18/2020 10:32:34 AM	gaia-jennifer	3/27/2025 3:46:12 PM	gaia-nina	10/1/2015 12:00:00 AM	3/27/2025 3:46:12 PM	False
C	7	False	SLIDING FEE SCHEDULE	SLIDING FEE SCHEUDLE		Dialyis	DL	14674				4	1701	91	1743	2	0	0	3	0	C			233	7	SLIDING FEE SCHEUDLE SLIDING FEE SCHEDULE DIALYIS DL 14674	9/18/2020 10:33:43 AM	gaia-jennifer	3/16/2026 7:56:03 AM	gaia-sandy	10/1/2015 12:00:00 AM	3/16/2026 7:56:03 AM	False
C	8	False	SELF PAY	SELF PAY								4	1701	91	1743	2	0	0	3	0	C	0	False	233	8	SELF PAY SELF PAY	9/18/2020 2:09:33 PM	gaia-michael	3/10/2026 3:10:11 PM	gaia-michellem	10/1/2015 12:00:00 AM	3/10/2026 3:10:11 PM	False
C T	9	False	MEDICARE PART A ONLY	MEDICARE PART A ONLY	PO BOX 6773	FARGO	ND	58108	8556099960			1	1701	1799	1738	2	1682	2	2	0	C T		False	233	9	PO BOX 6773 MEDICARE PART A ONLY MEDICARE PART A ONLY FARGO ND 58108	9/22/2020 12:06:34 PM	gaia-michael	4/30/2026 10:04:14 AM	gaia-melisha	10/1/2015 12:00:00 AM	4/30/2026 10:04:14 AM	False
C	10	False	TAKECARE INSURANCE COMPANY	TAKECARE GUAM - GUAM TRANSFER TO PT	PO BOX 6578	TAMUNING	GU	96913	6716473526			3	1703	104	1744	2	1682	2	2	0	C			233	10	PO BOX 6578 TAKECARE GUAM - GUAM TRANSFER TO PT TAKECARE INSURANCE COMPANY TAMUNING GU 96913	11/6/2020 12:26:29 PM	gaia-michael	3/27/2025 3:50:13 PM	gaia-nina	10/1/2015 12:00:00 AM	3/27/2025 3:50:13 PM	False
C	13	False	CALVO'S SELECTCARE	CALVO'S SELECTCARE - GUAM TRANSFER TO PT	PO BOX FJ	HAGATNA	GU	96932	6714779808		6714774141	4	1701	91	1743	2	1682	1	3	0	C		False	233	13	PO BOX FJ CALVO'S SELECTCARE - GUAM TRANSFER TO PT CALVO'S SELECTCARE HAGATNA GU 96932	11/6/2020 1:54:41 PM	gaia-michael	3/19/2026 6:58:53 AM	gaia-sandy	10/1/2015 12:00:00 AM	3/19/2026 6:58:53 AM	False
C	16	False	PENDING INSURANCE	PENDING INSURANCE	DO NOT BILL							4	1701	80	1743	2	0	0	2	0	C	0	False	233	16	DO NOT BILL PENDING INSURANCE PENDING INSURANCE	3/8/2021 10:19:48 AM	gaia-michael	4/28/2025 8:45:55 AM	gaia-cary	10/1/2015 12:00:00 AM	4/28/2025 8:45:55 AM	False
c	17	False	UHC MCR	UHC MCR	PO BOX 31365	SALT LAKE CITY	UT	84131	8778423210			5	1701	1799	1741	2	1682	2	3	0	c	0	False	233	17	PO BOX 31365 UHC MCR UHC MCR SALT LAKE CITY UT 84131	3/8/2021 10:39:02 AM	gaia-michael	5/1/2023 11:43:44 AM	gaia-vicki	10/1/2015 12:00:00 AM	5/1/2023 11:43:44 AM	False
A	18	False	VA COMMUNITY CARE NETWORK	VA COMMUNITY CARE NETWORK	PO Box 108851	FLORENCE	SC	29502	8778817618	Clinic		3	1704	95	1742	2	1682	2	2	0	A	0	False	233	18	PO BOX 108851 VA COMMUNITY CARE NETWORK VA COMMUNITY CARE NETWORK FLORENCE SC 29502	6/22/2021 10:47:31 AM	gaia-veronica	5/8/2026 9:22:10 AM	gaia-Lydia	10/1/2015 12:00:00 AM	5/8/2026 9:22:10 AM	False
C	20	False	HMSA MCR	HMSA MCR	PO BOX 860	HONOLULU	HI	96808	8007904672			5	1701	1799	1741	2	1682	2	3	0	C	0	False	233	20	PO BOX 860 HMSA MCR HMSA MCR HONOLULU HI 96808	4/28/2022 3:31:26 PM	gaia-michael	5/1/2023 11:41:53 AM	gaia-vicki	10/1/2015 12:00:00 AM	5/1/2023 11:41:53 AM	False
C	24	False	Medicaid Oregon	Medicaid Oregon - TRANSFER TO PATIENT	Po Box 3550	Portland	OR	97208	8887889821			2	1702	83	1739	2	1682	2	2	0	C			233	12356	PO BOX 3550 MEDICAID OREGON - TRANSFER TO PATIENT MEDICAID OREGON PORTLAND OR 97208	5/24/2024 1:36:03 PM	gaia-racheal	12/10/2024 1:08:28 PM	gaia-jennifer	10/1/2015 12:00:00 AM	12/10/2024 11:08:28 AM	False

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Ledger	InsuranceCarriersId	MasterInsuranceCarriersId	Inactive	Name	ListName	Address1	Address2	City	State	Zip	Country	Contact	Phone1	Phone1Type	Phone2	Phone2Type	Phone3	Phone3Type	InsuranceGroupId	CollectionsGroupMId	CarrierTypeMId	FinancialClassMId	AllocationSetId	FilingMethodMId	FilingType	TransactionColumnSetId	PolicyTypeMId	CopayAmt	Deductible	GroupId	GroupName	MediGapId	OrgId	IncludeClaimOfficeNo	LocationId	PPOId	ECSClearinghouseId	ECSPayorId	ECSClaimOfficeNumber	ECSNEIC	UseRenderingProviderId	RequiresPIN	ECSMaximumNumberOfProcedures	ELIMIKDestination	ELIClearinghouseId	ELIPayorId	ELIMessageType	ElectronicFilingStatus	SupplementalFiling	Ledger1	Notes	AlertNotes	RequiresAuth	ReferenceCarrier	PayerIdNumberCodeMId	OtherPayerIdNumber	SubscriberIDMask	AcceptAssignmentMId	DotId	PartnerInsuranceCarriersId	PreAuthorizationFormType	PreAuthorizationFormFile	Keyword	OrderNotes	Created	CreatedBy	LastModified	LastModifiedBy	CountrySubdiv	ICD10SERVICEDATE	InsSourceOfPaymentsID	InsSOP_db_Updated_Date	AUC

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Ledger	InsuranceCarriersId	MasterInsuranceCarriersId	Inactive	Name	ListName	Address1	Address2	City	State	Zip	Country	Contact	Phone1	Phone1Type	Phone2	Phone2Type	Phone3	Phone3Type	InsuranceGroupId	CollectionsGroupMId	CarrierTypeMId	FinancialClassMId	AllocationSetId	FilingMethodMId	FilingType	TransactionColumnSetId	PolicyTypeMId	CopayAmt	Deductible	GroupId	GroupName	MediGapId	OrgId	IncludeClaimOfficeNo	LocationId	PPOId	ECSClearinghouseId	ECSPayorId	ECSClaimOfficeNumber	ECSNEIC	UseRenderingProviderId	RequiresPIN	ECSMaximumNumberOfProcedures	ELIMIKDestination	ELIClearinghouseId	ELIPayorId	ELIMessageType	ElectronicFilingStatus	SupplementalFiling	Ledger1	Notes	AlertNotes	RequiresAuth	ReferenceCarrier	PayerIdNumberCodeMId	OtherPayerIdNumber	SubscriberIDMask	AcceptAssignmentMId	DotId	PartnerInsuranceCarriersId	PreAuthorizationFormType	PreAuthorizationFormFile	Keyword	OrderNotes	Created	CreatedBy	LastModified	LastModifiedBy	CountrySubdiv	ICD10SERVICEDATE	InsSourceOfPaymentsID	InsSOP_db_Updated_Date	AUC
C	62		False	TRINITY HEALTH PACE	TRINITY HEALTH PACE	Claims Adjudication - MS-E3E	20555 Victor Parkway	Livonia	MI	48152			2677878300						2	1701	2397	1738	2	1682	1	3		0	0					0																C			0	False				233	TRI				CLAIMS ADJUDICATION - MS-E3E 20555 VICTOR PARKWAY TRINITY HEALTH PACE TRINITY HEALTH PACE LIVONIA MI 48152		8/3/2021 1:59:45 PM	deers-linda	10/26/2021 8:12:35 AM	deers-linda		10/1/2015 12:00:00 AM		10/26/2021 6:12:35 AM	False

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Ledger	InsuranceCarriersId	MasterInsuranceCarriersId	Inactive	Name	ListName	Address1	Address2	City	State	Zip	Country	Contact	Phone1	Phone1Type	Phone2	Phone2Type	Phone3	Phone3Type	InsuranceGroupId	CollectionsGroupMId	CarrierTypeMId	FinancialClassMId	AllocationSetId	FilingMethodMId	FilingType	TransactionColumnSetId	PolicyTypeMId	CopayAmt	Deductible	GroupId	GroupName	MediGapId	OrgId	IncludeClaimOfficeNo	LocationId	PPOId	ECSClearinghouseId	ECSPayorId	ECSClaimOfficeNumber	ECSNEIC	UseRenderingProviderId	RequiresPIN	ECSMaximumNumberOfProcedures	ELIMIKDestination	ELIClearinghouseId	ELIPayorId	ELIMessageType	ElectronicFilingStatus	SupplementalFiling	Ledger1	Notes	AlertNotes	RequiresAuth	ReferenceCarrier	PayerIdNumberCodeMId	OtherPayerIdNumber	SubscriberIDMask	AcceptAssignmentMId	DotId	PartnerInsuranceCarriersId	PreAuthorizationFormType	PreAuthorizationFormFile	Keyword	OrderNotes	Created	CreatedBy	LastModified	LastModifiedBy	CountrySubdiv	ICD10SERVICEDATE	InsSourceOfPaymentsID	InsSOP_db_Updated_Date	AUC
C	3		False	MEDICARE A&B	MEDICARE A&B	PO Box 3398		Mechanicsburg	PA	17055-1843			8772358073						1	1701	1799	1738	2	1682	2	3		0	0					0																C			0	False				233	61002				PO BOX 3398 MEDICARE A&B MEDICARE A&B MECHANICSBURG PA 17055-1843		8/23/2022 3:28:21 PM	gaia-bruce	5/13/2026 11:15:15 AM	gaia-michellem		10/1/2015 12:00:00 AM		5/13/2026 11:15:15 AM	False
C	6		False	Pending Insurance	Pending Insurance		DO NOT BILL	LITTLETON	CO	80121									2	1701	91	1743	2	0	0	2		0	0					0																C								233	6				DO NOT BILL PENDING INSURANCE PENDING INSURANCE LITTLETON CO 80121		11/3/2025 3:21:36 PM	gaia-melisha	11/5/2025 11:23:29 AM	gaia-cary		10/1/2015 12:00:00 AM		11/5/2025 11:23:29 AM

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Ledger	InsuranceCarriersId	Inactive	Name	ListName	Address1	Address2	City	State	Zip	Country	Contact	Phone1	Phone1Type	Phone2	Phone2Type	InsuranceGroupId	CollectionsGroupMId	CarrierTypeMId	FinancialClassMId	AllocationSetId	FilingMethodMId	FilingType	TransactionColumnSetId	PolicyTypeMId	IncludeClaimOfficeNo	Ledger1	RequiresAuth	ReferenceCarrier	AcceptAssignmentMId	DotId	Keyword	Created	CreatedBy	LastModified	LastModifiedBy	ICD10SERVICEDATE	InsSOP_db_Updated_Date	AUC
EDF	3	False	AETNA B H MMAI	AETNA B H MMAI	PO BOX 66545		PHOENIX	AZ	85082-2198			866 212 2851				12	1701	3644	73558	2	1682	2	3	116	0	EDF	0		233	26337	PO BOX 66545 AETNA B H MMAI AETNA B H MMAI PHOENIX AZ 85082-2198	1/2/2019 9:55:36 AM	gaia-jennifer	4/23/2026 3:14:26 PM	lmurphy	10/1/2015 12:00:00 AM	4/23/2026 2:14:26 PM	False
ED	7	False	ADVANTRA SAVINGS MCR	ADVANTRA SAVINGS MCR	PO Box 7087		LONDON	KY	40742							2	1701	3644	1741	2	1682	2	3	116		ED	0		233	25133_1	PO BOX 7087 ADVANTRA SAVINGS MCR ADVANTRA SAVINGS MCR LONDON KY 40742	1/10/2019 7:57:01 AM	cpaulino	3/28/2025 10:27:29 AM	cpaulino	10/1/2015 12:00:00 AM	3/28/2025 9:27:29 AM	False
CEDF	8	False	ADVOCATE HEALTH SYSTEM MCR REP	ADVOCATE HEALTH SYSTEM MCR REP	PO BOX 0838		MOUNT PROSPECT	IL	60056							2	1701	3644	1741	2	1682	2	3	116		CEDF	0		233	36320	PO BOX 0838 ADVOCATE HEALTH SYSTEM MCR REP ADVOCATE HEALTH SYSTEM MCR REP MOUNT PROSPECT IL 60056	1/10/2019 8:20:39 AM	cpaulino	4/23/2026 3:13:10 PM	lmurphy	10/1/2015 12:00:00 AM	4/23/2026 2:13:10 PM	False
EDF	9	False	ADVOCATE PHYSICIAN PARTNERS MCR REPL	ADVOCATE PHYSICIAN PARTNERS MCR REPL	PO BOX 0455		MOUNT PROSPECT	IL	60056							2	1701	3644	1741	2	1682	2	3	116	0	EDF	0		233	65093_1	PO BOX 0455 ADVOCATE PHYSICIAN PARTNERS MCR REPL ADVOCATE PHYSICIAN PARTNERS MCR REPL MOUNT PROSPECT IL 60056	1/10/2019 8:24:29 AM	cpaulino	4/23/2026 3:13:28 PM	lmurphy	10/1/2015 12:00:00 AM	4/23/2026 2:13:28 PM	False
DF	11	False	ADVOCATE SOUTH SUB MCR REP	ADVOCATE SOUTH SUB MCR REP	PO BOX 0869		MOUNT PROSPECT	IL	60056							2	1701	3644	1741	2	1682	2	3	116	0	DF			233	65093_2	PO BOX 0869 ADVOCATE SOUTH SUB MCR REP ADVOCATE SOUTH SUB MCR REP MOUNT PROSPECT IL 60056	1/10/2019 8:57:41 AM	cpaulino	4/23/2026 3:13:42 PM	lmurphy	10/1/2015 12:00:00 AM	4/23/2026 2:13:42 PM	False
ED	14	False	AETNA MCR REPL	AETNA MCR REPL	PO BOX 14020		LEXINGTON	KY	40512							2	1703	3644	1741	2	1682	2	3	116	0	ED			233	60054_1	PO BOX 14020 AETNA MCR REPL AETNA MCR REPL LEXINGTON KY 40512	1/10/2019 9:06:12 AM	cpaulino	3/28/2025 10:27:56 AM	cpaulino	10/1/2015 12:00:00 AM	3/28/2025 9:27:56 AM	False
ED	16	False	AETNA TX MCR REPL	AETNA TX MCR REPL	PO BOX 981106		EL PASO	TX	79998							2	1703	3644	1741	2	1682	2	3	116	0	ED			233	60054_3	PO BOX 981106 AETNA TX MCR REPL AETNA TX MCR REPL EL PASO TX 79998	1/10/2019 9:13:52 AM	cpaulino	3/28/2025 10:29:24 AM	cpaulino	10/1/2015 12:00:00 AM	3/28/2025 9:29:24 AM	False
D	18	False	AMBETTER HMO MCD	AMBETTER HMO MCD	PO BOX 5010		FARMINGTON	MO	36340			855 745 5507				8	1703	3643	1742	2	1682	2	3	116	0	D			233	68069-3	PO BOX 5010 AMBETTER HMO MCD AMBETTER HMO MCD FARMINGTON MO 36340	1/11/2019 9:25:44 AM	cpaulino	3/28/2025 10:19:52 AM	cpaulino	10/1/2015 12:00:00 AM	3/28/2025 9:19:52 AM	False
DF	30	False	BCBS IL MCR ADVANTAGE	BCBS IL MCR ADVANTAGE	PO BOX 3686		SCRANTON	PA	18505			877 774 8592		8556749192	Fax	2	1701	3644	1741	2	1682	2	3	116	0	DF			233	66006	PO BOX 3686 BCBS IL MCR ADVANTAGE BCBS IL MCR ADVANTAGE SCRANTON PA 18505	1/11/2019 10:05:37 AM	cpaulino	4/23/2026 3:17:51 PM	lmurphy	10/1/2015 12:00:00 AM	4/23/2026 2:17:51 PM	False
ED	33	False	BCBS OF TN MCR REP	BCBS OF TN MCR REP	1 CAMERON HILLS CIRCLE	STE 0002	CHATTANOOGA	TN	37402							2	1701	2398	1741	2	1682	2	3	116	0	ED			233	00390_2	1 CAMERON HILLS CIRCLE STE 0002 BCBS OF TN MCR REP BCBS OF TN MCR REP CHATTANOOGA TN 37402	1/11/2019 10:15:50 AM	cpaulino	3/28/2025 10:30:09 AM	cpaulino	10/1/2015 12:00:00 AM	3/28/2025 9:30:09 AM	False
ED	34	False	BCBS OF TN MMAI	BCBS OF TN MMAI	1 CAMERON HILLS CIRCLE	STE 0002	CHATTANOOGA	TN	37402							12	1701	2398	73558	2	1682	2	3	116	0	ED			233	00390_5	1 CAMERON HILLS CIRCLE STE 0002 BCBS OF TN MMAI BCBS OF TN MMAI CHATTANOOGA TN 37402	1/11/2019 10:18:27 AM	cpaulino	3/28/2025 10:23:29 AM	cpaulino	10/1/2015 12:00:00 AM	3/28/2025 9:23:29 AM	False
ED	41	False	BLUE CROSS COMM MMAI	BLUE CROSS COMM MMAI	PO BOX 4168		SCRANTON	PA	18505							12	1701	3644	73558	2	1682	2	3	116		ED	0		233	MCDIL_2	PO BOX 4168 BLUE CROSS COMM MMAI BLUE CROSS COMM MMAI SCRANTON PA 18505	1/11/2019 10:59:54 AM	cpaulino	3/28/2025 10:24:36 AM	cpaulino	10/1/2015 12:00:00 AM	3/28/2025 9:24:36 AM	False
TD	42	False	BLUE CROSS COMM MCD	BLUE CROSS COMM MCD	PO BOX 650712		DALLAS	TX	75265-0712			877 727 7702				8	1702	3643	1742	2	1682	2	3	116	0	TD			233	60012	PO BOX 650712 BLUE CROSS COMM MCD BLUE CROSS COMM MCD DALLAS TX 75265-0712	1/11/2019 11:04:44 AM	cpaulino	6/15/2026 11:09:24 AM	lmurphy	10/1/2015 12:00:00 AM	6/15/2026 10:09:24 AM	False
D	43	False	BUCKEYE COMMUNITY HEALTH MCD	BUCKEYE COMMUNITY HEALTH MCD	PO BOX 6200		FARMINGTON	MO	63640							8	1703	3643	1742	2	1682	2	3	116	0	D			233	0004202	PO BOX 6200 BUCKEYE COMMUNITY HEALTH MCD BUCKEYE COMMUNITY HEALTH MCD FARMINGTON MO 63640	1/11/2019 11:06:21 AM	cpaulino	3/28/2025 10:23:00 AM	cpaulino	10/1/2015 12:00:00 AM	3/28/2025 9:23:00 AM	False
D	45	False	CAPITAL BLUE CROSS MCR REP	CAPITAL BLUE CROSS MCR REP	PO BOX 211457		EAGAN	MN	55121							2	1701	3644	1741	2	1682	2	3	116	0	D			233	12B61_2	PO BOX 211457 CAPITAL BLUE CROSS MCR REP CAPITAL BLUE CROSS MCR REP EAGAN MN 55121	1/11/2019 12:06:29 PM	cpaulino	3/28/2025 10:30:15 AM	cpaulino	10/1/2015 12:00:00 AM	3/28/2025 9:30:15 AM	False
ED	46	False	CAPITAL BLUE CROSS MMAI	CAPITAL BLUE CROSS MMAI	PO BOX 211457		EAGAN	MN	55121							12	1701	3644	73558	2	1682	2	3	116	0	ED			233	12B61_3	PO BOX 211457 CAPITAL BLUE CROSS MMAI CAPITAL BLUE CROSS MMAI EAGAN MN 55121	1/11/2019 12:07:51 PM	cpaulino	3/28/2025 10:24:13 AM	cpaulino	10/1/2015 12:00:00 AM	3/28/2025 9:24:13 AM	False
ED	47	False	CAREPLUS MCR REPL	CAREPLUS MCR REPL	PO BOX 14697		LEXINGTON	KY	40512							2	1701	3644	1741	2	1682	2	3	116	0	ED			233	95092	PO BOX 14697 CAREPLUS MCR REPL CAREPLUS MCR REPL LEXINGTON KY 40512	1/11/2019 12:09:21 PM	cpaulino	3/28/2025 10:30:12 AM	cpaulino	10/1/2015 12:00:00 AM	3/28/2025 9:30:12 AM	False
D	48	False	CARESOURCE OH MCD	CARESOURCE OH MCD	PO BOX 8730		DAYTON	OH	45401			800 488 0134	Home			8	1702	3643	1742	2	1682	2	3	116	0	D			233	31114	PO BOX 8730 CARESOURCE OH MCD CARESOURCE OH MCD DAYTON OH 45401	1/11/2019 12:11:09 PM	cpaulino	3/28/2025 10:22:22 AM	cpaulino	10/1/2015 12:00:00 AM	3/28/2025 9:22:22 AM	False
E	50	False	CHAMPVA-HAC	CHAMPVA-HAC	PO BOX 65024		DENVER	CO	80206							3	1704	95	3642	2	1682	2	3	116	0	E			233	8414	PO BOX 65024 CHAMPVA-HAC CHAMPVA-HAC DENVER CO 80206	1/11/2019 12:30:04 PM	cpaulino	5/30/2023 9:16:21 AM	CPAULINO	10/1/2015 12:00:00 AM	5/30/2023 8:16:21 AM	False
ED	54	False	CIGNA HEALTHSPRING MCR REP	CIGNA HEALTHSPRING MCR REP	PO BOX 981706		EL PASO	TX	79998			800 230 6138				2	1701	3644	1741	2	1682	2	3	116	0	ED			233	52192	PO BOX 981706 CIGNA HEALTHSPRING MCR REP CIGNA HEALTHSPRING MCR REP EL PASO TX 79998	1/11/2019 12:42:25 PM	cpaulino	3/28/2025 10:29:58 AM	cpaulino	10/1/2015 12:00:00 AM	3/28/2025 9:29:58 AM	False
TD	57	False	COUNTY CARE	COUNTY CARE	PO BOX 211592		EAGAN	MN	55121							8	1702	3643	1742	2	1682	2	3	116	0	TD			233	06541	PO BOX 211592 COUNTY CARE COUNTY CARE EAGAN MN 55121	1/11/2019 1:05:58 PM	cpaulino	2/4/2026 9:57:06 AM	lmurphy	10/1/2015 12:00:00 AM	2/4/2026 8:57:06 AM	False
ED	58	False	COVENTRY MCR REP	COVENTRY MCR REP	PO BOX 7109		LONDON	KY	40742			800 431 1211				2	1701	3644	1741	2	1682	2	3	116	0	ED			233	25133	PO BOX 7109 COVENTRY MCR REP COVENTRY MCR REP LONDON KY 40742	1/11/2019 2:11:29 PM	cpaulino	3/28/2025 10:27:43 AM	cpaulino	10/1/2015 12:00:00 AM	3/28/2025 9:27:43 AM	False
D	61	False	MEDICAID OF FL	MEDICAID OF FL	PO BOX 7072		TALLAHASSEE	FL	32314							9	1702	83	1739	2	1682	2	3	116	0	D			233	12K34	PO BOX 7072 MEDICAID OF FL MEDICAID OF FL TALLAHASSEE FL 32314	1/11/2019 2:19:38 PM	cpaulino	3/29/2025 1:29:27 PM	cpaulino	10/1/2015 12:00:00 AM	3/29/2025 12:29:27 PM	False
CE	62	False	MEDICARE OF FL	MEDICARE OF FL	PO BOX 2711		JACKSONVILOLE	FL	32231			888 664 4112		8776028816		1	1701	1799	1738	2	1682	2	3	120	0	CE			233	09101	PO BOX 2711 MEDICARE OF FL MEDICARE OF FL JACKSONVILOLE FL 32231	1/11/2019 2:30:47 PM	cpaulino	9/25/2025 10:24:57 AM	lmurphy	10/1/2015 12:00:00 AM	9/25/2025 9:24:57 AM	False
ED	63	False	HIGHMARK FREEDOM BLUE MCR ADV OF PA	HIGHMARK FREEDOM BLUE MCR ADV OF PA	PO BOX 151348		TAMPA	FL	32684							2	1701	3644	1741	2	1682	2	3	116	0	ED			233	15460_1	PO BOX 151348 HIGHMARK FREEDOM BLUE MCR ADV OF PA HIGHMARK FREEDOM BLUE MCR ADV OF PA TAMPA FL 32684	1/11/2019 2:35:02 PM	cpaulino	3/28/2025 10:28:28 AM	cpaulino	10/1/2015 12:00:00 AM	3/28/2025 9:28:28 AM	False
EDP	64	False	FREEDOM HEALTH OF FL	FREEDOM HEALTH OF FL	PO BOX 151348		TAMPA	FL	32684			800 448 6262				2	1701	3644	1741	2	1682	2	3	116	0	EDP			233	41212	PO BOX 151348 FREEDOM HEALTH OF FL FREEDOM HEALTH OF FL TAMPA FL 32684	1/11/2019 2:36:53 PM	cpaulino	5/23/2025 3:18:08 PM	cpaulino	10/1/2015 12:00:00 AM	5/23/2025 2:18:08 PM	False
D	65	False	HIGHMARK WHOLECARE	HIGHMARK WHOLECARE GATEWAY MCD	PO BOX 830249		BURMINGHAM	AL	35283							8	1702	3643	1742	2	1682	2	3	116	0	D			233	25169	PO BOX 830249 HIGHMARK WHOLECARE GATEWAY MCD HIGHMARK WHOLECARE BURMINGHAM AL 35283	1/11/2019 2:39:56 PM	cpaulino	3/28/2025 10:21:57 AM	cpaulino	10/1/2015 12:00:00 AM	3/28/2025 9:21:57 AM	False
D	69	False	HARMONY MEDICAID	HARMONY MEDICAID	PO BOX 31372		TAMPA	FL	33631							8	1702	3643	1742	2	1682	2	3	116	0	D			233	14163	PO BOX 31372 HARMONY MEDICAID HARMONY MEDICAID TAMPA FL 33631	1/11/2019 2:52:45 PM	cpaulino	3/28/2025 10:22:08 AM	cpaulino	10/1/2015 12:00:00 AM	3/28/2025 9:22:08 AM	False
ED	74	False	HUMANA EMPLOYERS HEALTH MCR REP	HUMANA EMPLOYERS HEALTH MCR REP	PO BOX 14601		LEXINGTON	KY	40512			800 457 4708				2	1701	3644	1741	2	1682	2	3	116	0	ED			233	1101	PO BOX 14601 HUMANA EMPLOYERS HEALTH MCR REP HUMANA EMPLOYERS HEALTH MCR REP LEXINGTON KY 40512	1/11/2019 3:05:48 PM	cpaulino	3/28/2025 10:30:21 AM	cpaulino	10/1/2015 12:00:00 AM	3/28/2025 9:30:21 AM	False
ED	76	False	HUMANA MCR REPL	HUMANA MCR REPL	PO BOX 14601		LEXINGTON	KY	40512			800 542 2070				2	1701	3644	1741	2	1682	2	3	116	0	ED			233	61101_2	PO BOX 14601 HUMANA MCR REPL HUMANA MCR REPL LEXINGTON KY 40512	1/11/2019 3:29:02 PM	cpaulino	3/28/2025 10:31:12 AM	cpaulino	10/1/2015 12:00:00 AM	3/28/2025 9:31:12 AM	False
ED	77	False	HUMANA MMAI	HUMANA MMAI	PO BOX 14601		LEXINGTON	KY	40512			800 542 2070				12	1701	3644	73558	2	1682	2	3	116	0	ED			233	61101_3	PO BOX 14601 HUMANA MMAI HUMANA MMAI LEXINGTON KY 40512	1/11/2019 3:31:17 PM	cpaulino	3/28/2025 10:24:25 AM	cpaulino	10/1/2015 12:00:00 AM	3/28/2025 9:24:25 AM	False
ED	78	False	HUMANA TRICARE SELECT	HUMANA TRICARE SELECT	PO BOX 202146		FLORENCE	SC	29502							2	1701	86	1741	2	1682	2	3	116	0	ED			233	99727	PO BOX 202146 HUMANA TRICARE SELECT HUMANA TRICARE SELECT FLORENCE SC 29502	1/11/2019 3:33:49 PM	cpaulino	3/28/2025 10:31:20 AM	cpaulino	10/1/2015 12:00:00 AM	3/28/2025 9:31:20 AM	False
CE	79	False	MEDICARE OF IL	MEDICARE OF IL	PO BOX 20013		NASHVILLE	TN	37202-0009			877 702 0900				1	1701	1799	1738	2	1682	2	3	120	-1	CE			233	06101	PO BOX 20013 MEDICARE OF IL MEDICARE OF IL NASHVILLE TN 37202-0009	1/11/2019 3:39:58 PM	cpaulino	4/19/2023 12:24:21 PM	CPAULINO	10/1/2015 12:00:00 AM	4/19/2023 11:24:21 AM	False
D	80	False	ILLINICARE MCD	ILLINICARE MCD	PO BOX 4020		FARMINGTON	MO	36340			866 329 4701				8	1702	3643	1742	2	1682	2	3	116	0	D			233	8069	PO BOX 4020 ILLINICARE MCD ILLINICARE MCD FARMINGTON MO 36340	1/11/2019 4:52:10 PM	cpaulino	3/28/2025 10:22:54 AM	cpaulino	10/1/2015 12:00:00 AM	3/28/2025 9:22:54 AM	False
ED	81	False	ILLINICARE MCR REPL	ILLINICARE MCR REPL	PO BOX 4020		FARMINGTON	MO	63640			866 329 4701				2	1701	3644	1741	2	1682	2	3	116	0	ED		False	233	8069_2	PO BOX 4020 ILLINICARE MCR REPL ILLINICARE MCR REPL FARMINGTON MO 63640	1/14/2019 8:01:40 AM	cpaulino	3/28/2025 10:31:00 AM	cpaulino	10/1/2015 12:00:00 AM	3/28/2025 9:31:00 AM	False
ED	82	False	ILLINICARE MMAI	ILLINICARE MMAI	PO BOX 4020		FARMINGTON	MO	36340			866 329 4701				12	1701	3644	73558	2	1682	2	3	117	0	ED			233	8069_3	PO BOX 4020 ILLINICARE MMAI ILLINICARE MMAI FARMINGTON MO 36340	1/14/2019 8:03:02 AM	cpaulino	3/28/2025 10:24:22 AM	cpaulino	10/1/2015 12:00:00 AM	3/28/2025 9:24:22 AM	False
TD	84	False	ILLINOIS MEDICAID	ILLINOIS MEDICAID	PO BOX 19133		SPRINGFIELD	IL	62794							9	1702	83	1739	2	1682	2	3	116	0	TD			233	IL621	PO BOX 19133 ILLINOIS MEDICAID ILLINOIS MEDICAID SPRINGFIELD IL 62794	1/14/2019 8:24:26 AM	cpaulino	4/7/2025 2:49:01 PM	lmurphy	10/1/2015 12:00:00 AM	4/7/2025 1:49:01 PM	False
D	86	False	BCBS OF INDIANA (ANTHEM) MEDICAID	BCBS OF INDIANA (ANTHEM) MEDICAID	PO BOX 61010		VIRGINIA BEACH	VA	23466							8	1702	3643	1742	2	1682	2	3	116	0	D			233	00130	PO BOX 61010 BCBS OF INDIANA (ANTHEM) MEDICAID BCBS OF INDIANA (ANTHEM) MEDICAID VIRGINIA BEACH VA 23466	1/14/2019 8:41:19 AM	cpaulino	3/28/2025 10:20:26 AM	cpaulino	10/1/2015 12:00:00 AM	3/28/2025 9:20:26 AM	False
TD	87	False	MEDICAID OF IN	MEDICAID OF IN	PO BOX 7269		INDIANAPOLIS	IN	46209							9	1702	83	1739	2	1682	2	3	116	0	TD			233	ICHP	PO BOX 7269 MEDICAID OF IN MEDICAID OF IN INDIANAPOLIS IN 46209	1/14/2019 8:43:27 AM	cpaulino	3/29/2025 1:29:40 PM	cpaulino	10/1/2015 12:00:00 AM	3/29/2025 12:29:40 PM	False
CE	88	False	MEDICARE OF IN	MEDICARE OF IN	PO BOX 8602		MADISON	WI	53708			800 633 4227		8662347331	Work	1	1701	1799	1738	2	1682	2	3	120	0	CE			233	08101	PO BOX 8602 MEDICARE OF IN MEDICARE OF IN MADISON WI 53708	1/14/2019 8:55:32 AM	cpaulino	6/28/2023 3:24:09 PM	lmurphy	10/1/2015 12:00:00 AM	6/28/2023 2:24:09 PM	False
CE	89	False	MEDICARE OF KANSAS	MEDICARE OF KANSAS	PO BOX 14260		MADISON	WI	53708			8665183285				1	1701	1799	1738	2	1682	2	3	120	0	CE			233	05201	PO BOX 14260 MEDICARE OF KANSAS MEDICARE OF KANSAS MADISON WI 53708	1/14/2019 8:59:40 AM	cpaulino	4/19/2023 12:24:44 PM	CPAULINO	10/1/2015 12:00:00 AM	4/19/2023 11:24:44 AM	False
D	91	False	MANAGED HEALTH SERVICES OF IN MCD	MANAGED HEALTH SERVICES OF IN MCD	PO BOX 3002		FARMINGTON	MO	36340							8	1702	3643	1742	2	1682	2	3	116	0	D			233	68069_2	PO BOX 3002 MANAGED HEALTH SERVICES OF IN MCD MANAGED HEALTH SERVICES OF IN MCD FARMINGTON MO 36340	1/14/2019 9:03:47 AM	cpaulino	3/28/2025 10:21:04 AM	cpaulino	10/1/2015 12:00:00 AM	3/28/2025 9:21:04 AM	False
D	93	False	MEDICAID OF TN (TENNCARE)	MEDICAID OF TN (TENNCARE)	PO BOX 460		NASHVILLE	TN	37202							9	1702	83	1739	2	1682	2	3	116	0	D			233	00390	PO BOX 460 MEDICAID OF TN (TENNCARE) MEDICAID OF TN (TENNCARE) NASHVILLE TN 37202	1/14/2019 9:07:12 AM	cpaulino	3/29/2025 1:30:03 PM	cpaulino	10/1/2015 12:00:00 AM	3/29/2025 12:30:03 PM	False
TD	95	True	MERIDIAN HEALTH PLAN PRIOR TO 7.1.21	MERIDIAN HEALTH PLAN PRIOR TO 7.1.21	1 CAMPJUS MARTIN	STE 710	DETROIT	MI	48226			313 324 3700				8	1702	3643	1742	2	1682	2	3	116	0	TD			233	83253	1 CAMPJUS MARTIN STE 710 MERIDIAN HEALTH PLAN PRIOR TO 7.1.21 MERIDIAN HEALTH PLAN PRIOR TO 7.1.21 DETROIT MI 48226	1/14/2019 9:10:40 AM	cpaulino	5/12/2026 11:54:59 AM	cpaulino	10/1/2015 12:00:00 AM	5/12/2026 10:54:59 AM	False
ED	96	False	MERIDIAN MCR REPL	MERIDIAN MCR REPL	1 CAMPUS MARTIN	STE 710	DETROIT	MI	48226			313 324 3700				2	1701	3644	1741	2	1682	2	3	116	0	ED			233	83253_1	1 CAMPUS MARTIN STE 710 MERIDIAN MCR REPL MERIDIAN MCR REPL DETROIT MI 48226	1/14/2019 9:15:50 AM	cpaulino	3/28/2025 10:30:24 AM	cpaulino	10/1/2015 12:00:00 AM	3/28/2025 9:30:24 AM	False
CE	97	False	MEDICARE OF MI	MEDICARE OF MI	PO BOX 8987		MADISON	WI	57308			8662347331				1	1701	1799	1738	2	1682	2	3	120	0	CE			233	08201	PO BOX 8987 MEDICARE OF MI MEDICARE OF MI MADISON WI 57308	1/14/2019 9:17:31 AM	cpaulino	4/11/2024 1:04:52 PM	CPAULINO	10/1/2015 12:00:00 AM	4/11/2024 12:04:52 PM	False
D	98	False	MEDICAID OF MI	MEDICAID OF MI	PO BOX 30238		LANSING	MI	48909					8002922550		9	1702	83	1739	2	1682	2	3	116	0	D			233	D00111	PO BOX 30238 MEDICAID OF MI MEDICAID OF MI LANSING MI 48909	1/14/2019 9:18:49 AM	cpaulino	3/29/2025 1:30:13 PM	cpaulino	10/1/2015 12:00:00 AM	3/29/2025 12:30:13 PM	False
ED	101	False	MOLINA MCR REPL	MOLINA MCR REPL OF IL	PO BOX 540		LONG BEACH	CA	90801							2	1701	3644	1741	2	1682	2	3	116	0	ED			233	20934_3	PO BOX 540 MOLINA MCR REPL OF IL MOLINA MCR REPL LONG BEACH CA 90801	1/14/2019 9:27:43 AM	cpaulino	3/28/2025 10:30:27 AM	cpaulino	10/1/2015 12:00:00 AM	3/28/2025 9:30:27 AM	False
ED	102	False	MOLINA MMAI	MOLINA MMAI OF IL	PO BOX 540		LONG BEACH	CA	90801							12	1701	3644	73558	2	1682	2	3	116	0	ED			233	20934_2	PO BOX 540 MOLINA MMAI OF IL MOLINA MMAI LONG BEACH CA 90801	1/14/2019 9:29:06 AM	cpaulino	3/28/2025 10:23:48 AM	cpaulino	10/1/2015 12:00:00 AM	3/28/2025 9:23:48 AM	False
TD	103	False	MOLINA MEDICAID	MOLINA MEDICAID OF IL	PO BOX 22812		LONG BEACH	CA	90801							8	1702	3643	1742	2	1682	2	3	116	0	TD			233	20934	PO BOX 22812 MOLINA MEDICAID OF IL MOLINA MEDICAID LONG BEACH CA 90801	1/14/2019 9:30:32 AM	cpaulino	3/28/2025 10:21:35 AM	cpaulino	10/1/2015 12:00:00 AM	3/28/2025 9:21:35 AM	False
D	106	False	NEXT LEVEL HEALTH PARTNERS	NEXT LEVEL HEALTH PARTNERS	PO BOX 830700		BURMINGHAM	AL	35283			844 807 9734				8	1702	3643	1742	2	1682	2	3	116	0	D			233	69821	PO BOX 830700 NEXT LEVEL HEALTH PARTNERS NEXT LEVEL HEALTH PARTNERS BURMINGHAM AL 35283	1/14/2019 9:37:13 AM	cpaulino	3/28/2025 10:21:09 AM	cpaulino	10/1/2015 12:00:00 AM	3/28/2025 9:21:09 AM	False
CE	108	False	MEDICARE OF OH	MEDICARE OF OH	PO BOX		NASHVILLE	TN	37202			8665906703				1	1701	1799	1738	2	1682	2	3	120	0	CE			233	12M24	PO BOX MEDICARE OF OH MEDICARE OF OH NASHVILLE TN 37202	1/14/2019 9:41:49 AM	cpaulino	4/19/2023 12:25:16 PM	CPAULINO	10/1/2015 12:00:00 AM	4/19/2023 11:25:16 AM	False
ED	110	False	BCBS ANTHEM OF OH MCR REPL	BCBS ANTHEM OF OH MCR REPL	PO BOX 105187		ATLANTA	GA	30348			866 797 8894				2	1701	3644	1741	2	1682	2	3	116	0	ED			233	00032_2	PO BOX 105187 BCBS ANTHEM OF OH MCR REPL BCBS ANTHEM OF OH MCR REPL ATLANTA GA 30348	1/14/2019 9:51:00 AM	cpaulino	3/28/2025 10:28:56 AM	cpaulino	10/1/2015 12:00:00 AM	3/28/2025 9:28:56 AM	False
D	112	False	MEDICAID OF PA	MEDICAID OF PA	PO BOX 8194		HARRISBURG	PA	17105			800 692 7462				9	1702	83	1739	2	1681	2	3	116	0	D			233	236003113	PO BOX 8194 MEDICAID OF PA MEDICAID OF PA HARRISBURG PA 17105	1/14/2019 9:57:12 AM	cpaulino	3/29/2025 1:29:55 PM	cpaulino	10/1/2015 12:00:00 AM	3/29/2025 12:29:55 PM	False
CE	113	False	MEDICARE OF PA	MEDICARE OF PA	PO BOX 3418		MECHANICSBURG	PA	17055-1840			8772358073				1	1701	1799	1738	2	1682	2	3	120	0	CE			233	12501	PO BOX 3418 MEDICARE OF PA MEDICARE OF PA MECHANICSBURG PA 17055-1840	1/14/2019 10:01:36 AM	cpaulino	5/7/2024 8:33:20 AM	cpaulino	10/1/2015 12:00:00 AM	5/7/2024 7:33:20 AM	False
D	116	False	STAYWELL MCD	STAYWELL MCD	PO BOX 31372		TAMPA	FL	33631			866 334 7927				8	1702	3643	1742	2	1682	2	3	116	0	D			233	14163_2	PO BOX 31372 STAYWELL MCD STAYWELL MCD TAMPA FL 33631	1/14/2019 10:06:17 AM	cpaulino	3/28/2025 10:19:48 AM	cpaulino	10/1/2015 12:00:00 AM	3/28/2025 9:19:48 AM	False
EDP	117	False	SUMMACARE HEALTH PLAN MCR REP	SUMMACARE HEALTH PLAN MCR REP	PO BOX 3620		AKRON	OH	44309							2	1701	3644	1741	2	1682	2	3	116	0	EDP			233	95202	PO BOX 3620 SUMMACARE HEALTH PLAN MCR REP SUMMACARE HEALTH PLAN MCR REP AKRON OH 44309	1/14/2019 10:07:44 AM	cpaulino	5/23/2025 3:20:55 PM	cpaulino	10/1/2015 12:00:00 AM	5/23/2025 2:20:55 PM	False
D	118	False	SUNSHINE STATE HEALTH PLAN	SUNSHINE STATE HEALTH PLAN	PO BOX 3070		FARMINGTON	MO	63640			866 796 0530				8	1702	3643	1742	2	1682	2	3	116	0	D			233	68069_3	PO BOX 3070 SUNSHINE STATE HEALTH PLAN SUNSHINE STATE HEALTH PLAN FARMINGTON MO 63640	1/14/2019 10:09:19 AM	cpaulino	3/28/2025 10:33:30 AM	cpaulino	10/1/2015 12:00:00 AM	3/28/2025 9:33:30 AM	False
D	119	False	BCBS MEDICAID OF TN	BCBS MEDICAID OF TN	1 CAMERON HILL CIRCLE		CHATTANOOGA	TN	37402							9	1702	3643	1739	2	1682	2	3	116	0	D			233	00390_3	1 CAMERON HILL CIRCLE BCBS MEDICAID OF TN BCBS MEDICAID OF TN CHATTANOOGA TN 37402	1/14/2019 10:10:53 AM	cpaulino	3/29/2025 1:29:05 PM	cpaulino	10/1/2015 12:00:00 AM	3/29/2025 12:29:05 PM	False
CE	120	False	MEDICARE OF TN	MEDICARE OF TN	PO BOX 6169		INDIANAPOLIS	IN	46206							1	1701	1799	1738	2	1682	2	3	120	0	CE			233	10311	PO BOX 6169 MEDICARE OF TN MEDICARE OF TN INDIANAPOLIS IN 46206	1/14/2019 10:15:57 AM	cpaulino	4/19/2023 12:25:42 PM	CPAULINO	10/1/2015 12:00:00 AM	4/19/2023 11:25:42 AM	False
E	121	False	TRICARE FOR LIFE	TRICARE FOR LIFE	PO BOX 7890		MADISON	WI	53707							2	1701	3644	1741	2	1682	2	3	116	0	E			233	99727_1	PO BOX 7890 TRICARE FOR LIFE TRICARE FOR LIFE MADISON WI 53707	1/14/2019 10:18:01 AM	cpaulino	10/16/2025 11:40:07 AM	lmurphy	10/1/2015 12:00:00 AM	10/16/2025 10:40:07 AM	False
EF	122	False	VA FEE BASIS PROGRAM	VA FEE BASIS PROGRAM	PO BOX 290196		TAMPA	FL	33687			813 903 4275				2	1704	3644	1741	2	1682	2	3	116	0	EF			233	12115_2	PO BOX 290196 VA FEE BASIS PROGRAM VA FEE BASIS PROGRAM TAMPA FL 33687	1/14/2019 10:21:56 AM	cpaulino	4/23/2026 3:09:04 PM	lmurphy	10/1/2015 12:00:00 AM	4/23/2026 2:09:04 PM	False
EF	123	False	VA OF COLUMBUS OH	VA OF COLUMBUS OH	420 NORTH JAMES RD		COLUMBUS	OH	43219							2	1701	3644	1741	2	1682	1	3	116	0	EF			233	4632	420 NORTH JAMES RD VA OF COLUMBUS OH VA OF COLUMBUS OH COLUMBUS OH 43219	1/14/2019 10:23:13 AM	cpaulino	4/23/2026 3:09:22 PM	lmurphy	10/1/2015 12:00:00 AM	4/23/2026 2:09:22 PM	False
D	130	False	UHC COMMUNITY MEDICAID	UHC COMMUNITY MEDICAID	PO BOX 8207		KINGSTON	NY	12402							8	1702	3643	1742	2	1682	2	3	116	0	D			233	87726_13	PO BOX 8207 UHC COMMUNITY MEDICAID UHC COMMUNITY MEDICAID KINGSTON NY 12402	1/14/2019 10:37:28 AM	cpaulino	3/28/2025 10:22:29 AM	cpaulino	10/1/2015 12:00:00 AM	3/28/2025 9:22:29 AM	False
EDP	131	False	UHC DUAL MMAI	UHC DUAL MMAI	PO BOX 31350		SALT LAKE CITY	UT	84131			877 842 3210				12	1701	3644	73558	2	1682	2	3	116	0	EDP			233	87726_12	PO BOX 31350 UHC DUAL MMAI UHC DUAL MMAI SALT LAKE CITY UT 84131	1/14/2019 10:38:52 AM	cpaulino	5/23/2025 3:21:38 PM	cpaulino	10/1/2015 12:00:00 AM	5/23/2025 2:21:38 PM	False
EDP	132	False	UHC MCR ADVANTAGE	UHC MCR ADVANTAGE	PO BOX 3134		SALT LAKE CITY	UT	84131			877 842 3210				2	1701	3644	1741	2	1682	2	3	116	0	EDP			233	87726_2	PO BOX 3134 UHC MCR ADVANTAGE UHC MCR ADVANTAGE SALT LAKE CITY UT 84131	1/14/2019 10:40:17 AM	cpaulino	5/23/2025 3:21:28 PM	cpaulino	10/1/2015 12:00:00 AM	5/23/2025 2:21:28 PM	False
EDP	133	False	UHC MMAI	UHC MMAI	PO BOX 31353		SALT LAKE CITY	UT	84131			877 842 3210				12	1701	3644	73558	2	1682	2	3	116	0	EDP			233	87726_10	PO BOX 31353 UHC MMAI UHC MMAI SALT LAKE CITY UT 84131	1/14/2019 10:42:27 AM	cpaulino	5/23/2025 3:21:46 PM	cpaulino	10/1/2015 12:00:00 AM	5/23/2025 2:21:46 PM	False
D	134	False	UHC MEDICAID OF TN	UHC MEDICAID OF TN	PO BOX 5220		KINGSTON	NY	12402			877 842 3210				8	1702	3643	1742	2	1682	2	3	116	0	D			233	95378	PO BOX 5220 UHC MEDICAID OF TN UHC MEDICAID OF TN KINGSTON NY 12402	1/14/2019 10:43:52 AM	cpaulino	3/28/2025 10:21:41 AM	cpaulino	10/1/2015 12:00:00 AM	3/28/2025 9:21:41 AM	False
EDP	136	False	OPTIMUM MCR HMO OF FL	OPTIMUM MCR HMO OF FL	PO BOX 151258		TAMPA	FL	33684							2	1701	3644	1741	2	1682	2	3	116	0	EDP			233	20133	PO BOX 151258 OPTIMUM MCR HMO OF FL OPTIMUM MCR HMO OF FL TAMPA FL 33684	1/14/2019 10:47:42 AM	cpaulino	5/23/2025 3:20:31 PM	cpaulino	10/1/2015 12:00:00 AM	5/23/2025 2:20:31 PM	False
D	141	False	US MARSHALL SERVICE PRISONER MEDICAL BILLING	US MARSHALL SERVICE PRISONER MEDICAL BILLING	219 S DEARBORN ST	RM2444	CHICAGO	IL	60604			312 353 7457				8	1702	3643	1742	2	1682	1	3	116	0	D			233	4614	219 S DEARBORN ST RM2444 US MARSHALL SERVICE PRISONER MEDICAL BILLING US MARSHALL SERVICE PRISONER MEDICAL BILLING CHICAGO IL 60604	1/14/2019 11:00:21 AM	cpaulino	3/28/2025 10:21:01 AM	cpaulino	10/1/2015 12:00:00 AM	3/28/2025 9:21:01 AM	False
E	142	False	MEDICARE ACUTE OF IL	MEDICARE ACUTE OF IL	PO BOX 20013		NASHVILLE	TN	37202			877 702 0900				1	1701	1799	1738	2	1682	2	3	120	0	E			233	06101_1	PO BOX 20013 MEDICARE ACUTE OF IL MEDICARE ACUTE OF IL NASHVILLE TN 37202	1/15/2019 12:18:24 PM	cpaulino	4/25/2023 9:10:32 AM	CPAULINO	10/1/2015 12:00:00 AM	4/25/2023 8:10:32 AM	False
E	143	False	MEDICARE ACUTE OF FL	MEDICARE ACUTE OF FL	PO BOX 2711		JACKSONVILOLE	FL	32231			888 664 4112				1	1701	1799	1738	2	1682	2	3	120	0	E	0		233	09101_1	PO BOX 2711 MEDICARE ACUTE OF FL MEDICARE ACUTE OF FL JACKSONVILOLE FL 32231	1/15/2019 12:25:02 PM	cpaulino	9/25/2025 10:26:00 AM	lmurphy	10/1/2015 12:00:00 AM	9/25/2025 9:26:00 AM	False
E	144	False	MEDICARE ACUTE OF IN	MEDICARE ACUTE OF IN	PO BOX 8602		MADISON	WI	53708			800 633 4227				1	1701	1799	1738	2	1682	2	3	120	0	E	0		233	08101_1	PO BOX 8602 MEDICARE ACUTE OF IN MEDICARE ACUTE OF IN MADISON WI 53708	1/15/2019 12:27:52 PM	cpaulino	4/25/2023 9:12:02 AM	CPAULINO	10/1/2015 12:00:00 AM	4/25/2023 8:12:02 AM	False
E	145	False	MEDICARE ACUTE OF KANSAS	MEDICARE ACUTE OF KANSAS	PO BOX 14260		MADISON	WI	53708							1	1701	1799	1738	2	1682	2	3	120	0	E			233	05201_1	PO BOX 14260 MEDICARE ACUTE OF KANSAS MEDICARE ACUTE OF KANSAS MADISON WI 53708	1/15/2019 12:45:01 PM	cpaulino	4/25/2023 9:11:29 AM	CPAULINO	10/1/2015 12:00:00 AM	4/25/2023 8:11:29 AM	False
E	146	False	MEDICARE ACUTE OF MI	MEDICARE ACUTE OF MI	PO BOX 8987		MADISON	WI	57308							1	1701	1799	1738	2	1682	2	3	120	0	E			233	08201_1	PO BOX 8987 MEDICARE ACUTE OF MI MEDICARE ACUTE OF MI MADISON WI 57308	1/15/2019 12:46:22 PM	cpaulino	4/11/2024 1:05:01 PM	CPAULINO	10/1/2015 12:00:00 AM	4/11/2024 12:05:01 PM	False
E	147	False	MEDICARE ACUTE OF OH	MEDICARE ACUTE OF OH	PO BOX		NASHVILLE	TN	37202							1	1701	1799	1738	2	1682	2	3	120	0	E			233	12M24_1	PO BOX MEDICARE ACUTE OF OH MEDICARE ACUTE OF OH NASHVILLE TN 37202	1/15/2019 12:47:56 PM	cpaulino	4/25/2023 9:11:50 AM	CPAULINO	10/1/2015 12:00:00 AM	4/25/2023 8:11:50 AM	False
E	148	False	MEDICARE ACUTE OF PA	MEDICARE ACUTE OF PA	PO BOX 3418		MECHANICSBURG	PA	17055							1	1701	1799	1738	2	1682	2	3	120	0	E			233	12501_1	PO BOX 3418 MEDICARE ACUTE OF PA MEDICARE ACUTE OF PA MECHANICSBURG PA 17055	1/15/2019 12:49:21 PM	cpaulino	4/11/2024 1:04:03 PM	CPAULINO	10/1/2015 12:00:00 AM	4/11/2024 12:04:03 PM	False
E	149	False	MEDICARE ACUTE OF TN	MEDICARE ACUTE OF TN	PO BOX 6169		INDIANAPOLIS	IN	46206							1	1701	1799	1738	2	1682	2	3	120	0	E	0		233	10301_1	PO BOX 6169 MEDICARE ACUTE OF TN MEDICARE ACUTE OF TN INDIANAPOLIS IN 46206	1/15/2019 12:59:53 PM	cpaulino	4/25/2023 9:11:16 AM	CPAULINO	10/1/2015 12:00:00 AM	4/25/2023 8:11:16 AM	False
EDP	150	False	PRIORITY HEALTH MCR HMO/POS	PRIORITY HEALTH MCR HMO/POS	PO BOX 232		GRAND RAPIDS	MI	49501			800 942 4765	Work			2	1701	3644	1741	2	1682	2	3	116	0	EDP	0		233	38217	PO BOX 232 PRIORITY HEALTH MCR HMO/POS PRIORITY HEALTH MCR HMO/POS GRAND RAPIDS MI 49501	1/31/2019 8:33:37 AM	cpaulino	5/23/2025 3:20:43 PM	cpaulino	10/1/2015 12:00:00 AM	5/23/2025 2:20:43 PM	False
EDP	152	False	BCBS OF FL MCR REPL	BCBS OF FL MCR REPL	PO BOX 1798		JACKSONVILOLE	FL	32231							2	1703	3644	1741	2	1682	2	3		0	EDP			233	00590_1	PO BOX 1798 BCBS OF FL MCR REPL BCBS OF FL MCR REPL JACKSONVILOLE FL 32231	2/28/2019 2:26:33 PM	cpaulino	5/23/2025 3:18:53 PM	cpaulino	10/1/2015 12:00:00 AM	5/23/2025 2:18:53 PM	False
D	153	False	ANTHEM BCBS MCD OF WI	ANTHEM BCBS MCD OF WI	PO BOX 61010		VIRGINIA BEACH	VA	23466							8	1702	3643	1742	2	1682	2	3		0	D	0		233	26375	PO BOX 61010 ANTHEM BCBS MCD OF WI ANTHEM BCBS MCD OF WI VIRGINIA BEACH VA 23466	2/28/2019 3:56:01 PM	cpaulino	3/28/2025 10:22:25 AM	cpaulino	10/1/2015 12:00:00 AM	3/28/2025 9:22:25 AM	False
ED	154	False	MERIDIAN MMAI	MERIDIAN MMAI	1 CAMPUS MARTIN		DETROIT	MI	48226							12	1701	3644	73558	2	1682	2	3	116	0	ED			233	13189_2	1 CAMPUS MARTIN MERIDIAN MMAI MERIDIAN MMAI DETROIT MI 48226	3/5/2019 1:14:53 PM	cpaulino	3/28/2025 10:23:33 AM	cpaulino	10/1/2015 12:00:00 AM	3/28/2025 9:23:33 AM	False
D	155	False	MEDICAID OF OH	MEDICAID OF OH	PO BOX 1461		COLUMBUS	OH	43216							9	1702	83	1739	2	1682	2	3		0	D	0	False	233	15201	PO BOX 1461 MEDICAID OF OH MEDICAID OF OH COLUMBUS OH 43216	3/12/2019 8:19:56 AM	cpaulino	3/29/2025 1:30:33 PM	cpaulino	10/1/2015 12:00:00 AM	3/29/2025 12:30:33 PM	False
F	159	False	ADVOCATE PHYSICIAN PARTNERS COMMERCIAL	ADVOCATE PHYSICIAN PARTNERS COMMERCIAL	PO BOX 0455		MOUNT PROSPECT	IL	60056			8472986000	Work			3	1703	104	30939	2	1682	2	3			F			233	65093_4	PO BOX 0455 ADVOCATE PHYSICIAN PARTNERS COMMERCIAL ADVOCATE PHYSICIAN PARTNERS COMMERCIAL MOUNT PROSPECT IL 60056	3/14/2019 3:17:02 PM	cpaulino	4/23/2026 3:13:22 PM	lmurphy	10/1/2015 12:00:00 AM	4/23/2026 2:13:22 PM	False
ED	160	False	ANTHEM BCBS GA MCR REP	ANTHEM BCBS GA MCR REP	PO BOX 105187		ATLANTA	GA	30348							2	1701	3644	1741	2	1682	2	3			ED			233	00101_2	PO BOX 105187 ANTHEM BCBS GA MCR REP ANTHEM BCBS GA MCR REP ATLANTA GA 30348	3/25/2019 9:11:24 AM	cpaulino	6/11/2025 1:29:20 PM	cpaulino	10/1/2015 12:00:00 AM	6/11/2025 12:29:20 PM	False
D	161	False	BCBS OF TN MCD	BCBS OF TN MCD	1 CAMERON HILLS CR		CHATTANOOGA	TN	37402							8	1702	3643	1742	2	1682	2	3			D			233	00390_4	1 CAMERON HILLS CR BCBS OF TN MCD BCBS OF TN MCD CHATTANOOGA TN 37402	3/25/2019 10:27:24 AM	cpaulino	3/28/2025 10:21:12 AM	cpaulino	10/1/2015 12:00:00 AM	3/28/2025 9:21:12 AM	False
ED	162	False	WELLPOINT/AMERIGROUP MCR REPL	WELLPOINT/AMERIGROUP MCR REPL	PO BOX 61010		VIRGINIA BEACH	VA	23466							2	1702	3644	1741	2	1682	2	3		0	ED		False	233	26375_1	PO BOX 61010 WELLPOINT/AMERIGROUP MCR REPL WELLPOINT/AMERIGROUP MCR REPL VIRGINIA BEACH VA 23466	3/27/2019 3:28:18 PM	cpaulino	3/28/2025 10:26:07 AM	cpaulino	10/1/2015 12:00:00 AM	3/28/2025 9:26:07 AM	False
D	165	False	ANTHEM HOOSIER CARE CONNECT MCD	ANTHEM HOOSIER CARE CONNECT MCD	PO BOX 61010		VIRGINIA BEACH	VA	23466							8	1702	3643	1742	2	1682	2	3			D			233	00130_1	PO BOX 61010 ANTHEM HOOSIER CARE CONNECT MCD ANTHEM HOOSIER CARE CONNECT MCD VIRGINIA BEACH VA 23466	4/10/2019 10:08:31 AM	cpaulino	3/28/2025 10:22:39 AM	cpaulino	10/1/2015 12:00:00 AM	3/28/2025 9:22:39 AM	False
ED	166	False	CHRISTIAN BROTHERS SERVICES RELIGIOUS MEDICAL TRUST	CHRISTIAN BROTHERS SERVICES RELIGIOUS MEDICAL TRUST	1205 WINDHAM PKWY		ROMEOVILLE	IL	60446							2	1701	3643	1741	2	1682	2	3		0	ED			233	38308	1205 WINDHAM PKWY CHRISTIAN BROTHERS SERVICES RELIGIOUS MEDICAL TRUST CHRISTIAN BROTHERS SERVICES RELIGIOUS MEDICAL TRUST ROMEOVILLE IL 60446	4/22/2019 10:41:30 AM	cpaulino	3/28/2025 10:29:43 AM	cpaulino	10/1/2015 12:00:00 AM	3/28/2025 9:29:43 AM	False
ED	176	False	DUPAGE MEDICAL GROUP	DUPAGE MEDICAL GROUP MCR REP	PO BOX 7051		DOWNERS GROVE	IL	60515							2	1701	3644	1741	2	1682	1	3		0	ED		False	233	66727	PO BOX 7051 DUPAGE MEDICAL GROUP MCR REP DUPAGE MEDICAL GROUP DOWNERS GROVE IL 60515	6/10/2019 2:38:06 PM	cpaulino	5/2/2025 3:07:52 PM	CPAULINO	10/1/2015 12:00:00 AM	5/2/2025 2:07:52 PM	False
ED	177	False	AARP MCR REP	AARP MCR REP	PO BOX 740800		atlanta	GA	30374							2	1701	3644	1741	2	1682	2	3			ED			233	87726	PO BOX 740800 AARP MCR REP AARP MCR REP ATLANTA GA 30374	6/12/2019 2:35:53 PM	cpaulino	3/28/2025 10:28:48 AM	cpaulino	10/1/2015 12:00:00 AM	3/28/2025 9:28:48 AM	False
EDP	178	False	WELLCARE MCR REP	WELLCARE MCR REP	PO Box 31372		TAMPA	FL	33631-3224			855 538 0454				2	1701	3644	1741	2	1682	2	3		0	EDP		False	233	14163-1	PO BOX 31372 WELLCARE MCR REP WELLCARE MCR REP TAMPA FL 33631-3224	6/13/2019 7:37:30 AM	lmurphy	5/23/2025 3:22:24 PM	cpaulino	10/1/2015 12:00:00 AM	5/23/2025 2:22:24 PM	False
ED	179	False	MEDICAL MUTUAL MCR REP	MEDICAL MUTUAL MCR REP	PO BOX 981543		EL PASO	TX	79998							2	1701	3644	1741	2	1682	2	3		0	ED			233	60054_4	PO BOX 981543 MEDICAL MUTUAL MCR REP MEDICAL MUTUAL MCR REP EL PASO TX 79998	6/13/2019 2:41:25 PM	cpaulino	3/28/2025 10:30:41 AM	cpaulino	10/1/2015 12:00:00 AM	3/28/2025 9:30:41 AM	False
D	182	False	AMERIHEALTH CARITAS PENNSYLVANIA	AMERIHEALTH CARITAS PENNSYLVANIA	PO BOX 7118		LONDON	KY	40742-7110							8	1702	3643	1742	2	1682	2	3	118	0	D			233	22248	PO BOX 7118 AMERIHEALTH CARITAS PENNSYLVANIA AMERIHEALTH CARITAS PENNSYLVANIA LONDON KY 40742-7110	6/21/2019 12:06:57 PM	cpaulino	3/28/2025 10:20:04 AM	cpaulino	10/1/2015 12:00:00 AM	3/28/2025 9:20:04 AM	False
D	185	False	AETNA BETTER HEALTH OF PA	AETNA BETTER HEALTH OF PA	PO BOX 62198		PHOENIX	AZ	85082							8	1702	3643	1742	2	1682	2	3		0	D			233	23228	PO BOX 62198 AETNA BETTER HEALTH OF PA AETNA BETTER HEALTH OF PA PHOENIX AZ 85082	7/12/2019 2:26:01 PM	lmurphy	3/28/2025 10:20:38 AM	cpaulino	10/1/2015 12:00:00 AM	3/28/2025 9:20:38 AM	False
D	186	False	PARAMOUNT MEDICAID HMO	PARAMOUNT MEDICAID HMO	PO BOX 497		TOLEDO	OH	43697			800 891 2520				8	1702	3643	1742	2	1682	2	3			D			233	SX158	PO BOX 497 PARAMOUNT MEDICAID HMO PARAMOUNT MEDICAID HMO TOLEDO OH 43697	7/16/2019 7:02:50 AM	lmurphy	3/28/2025 10:20:17 AM	cpaulino	10/1/2015 12:00:00 AM	3/28/2025 9:20:17 AM	False
ED	188	False	JENCARE MCR REP	JENCARE MCR REP	PO BOX 7970		WESTCHESTER	IL	60154							2	1701	3644	1741	2	1682	2	3		0	ED		False	233	66006_1	PO BOX 7970 JENCARE MCR REP JENCARE MCR REP WESTCHESTER IL 60154	7/16/2019 1:28:21 PM	lmurphy	3/28/2025 10:31:32 AM	cpaulino	10/1/2015 12:00:00 AM	3/28/2025 9:31:32 AM	False
ED	189	False	BCBS MED ADV OF MI	BCBS MED HMO ADV OF MI	PO BOX 32593		DETROIT	MI	48232							2	1701	438374	1741	2	1682	2	3		0	ED			233	00210-1	PO BOX 32593 BCBS MED HMO ADV OF MI BCBS MED ADV OF MI DETROIT MI 48232	7/23/2019 12:21:54 PM	lmurphy	9/17/2025 10:32:08 AM	cpaulino	10/1/2015 12:00:00 AM	9/17/2025 9:32:08 AM	False
F	191	False	ADVOCATE SOUTH SUB COMM	ADVOCATE SOUTH SUB COMM	PO BOX 0869		MOUNT PROSPECT	IL	60056			8472986000	Work			3	1703	25823	30939	2	1682	2	3			F			233	65093_5	PO BOX 0869 ADVOCATE SOUTH SUB COMM ADVOCATE SOUTH SUB COMM MOUNT PROSPECT IL 60056	8/8/2019 8:52:07 AM	cpaulino	4/23/2026 3:13:38 PM	lmurphy	10/1/2015 12:00:00 AM	4/23/2026 2:13:38 PM	False
EDP	193	False	HIGHMARK WHOLECARE	HIGHMARK WHOLECARE GATEWAY MCR	PO Box 830430		BIRMINGHAM	AL	35283			800 685 5209	Work			2	1701	3644	1741	2	1682	2	3	116	0	EDP	0	False	233	60550	PO BOX 830430 HIGHMARK WHOLECARE GATEWAY MCR HIGHMARK WHOLECARE BIRMINGHAM AL 35283	8/29/2019 7:19:37 AM	ajurgenson	5/23/2025 3:19:11 PM	cpaulino	10/1/2015 12:00:00 AM	5/23/2025 2:19:11 PM	False
D	194	False	HEALTHY INDIANA MEDICAID HMO	HEALTHY INDIANA MEDICAID HMO	PO BOX 1575		FLINT	MI	48501							8	1702	3643	1742	2	1682	2	3		0	D	0	False	233	3135M	PO BOX 1575 HEALTHY INDIANA MEDICAID HMO HEALTHY INDIANA MEDICAID HMO FLINT MI 48501	9/10/2019 7:42:24 AM	ajurgenson	3/28/2025 10:21:44 AM	cpaulino	10/1/2015 12:00:00 AM	3/28/2025 9:21:44 AM	False
ED	196	False	MCS MEDICARE ADVANTAGE	MCS MEDICARE ADVANTAGE	PO BOX 191720		SAN JUAN	PR	00919			866 627 8183	Work			2	1701	3644	1741	2	1682	1	3	116	0	ED	0	False	233	0000	PO BOX 191720 MCS MEDICARE ADVANTAGE MCS MEDICARE ADVANTAGE SAN JUAN PR 00919	9/11/2019 9:53:21 AM	ajurgenson	3/28/2025 10:30:36 AM	cpaulino	10/1/2015 12:00:00 AM	3/28/2025 9:30:36 AM	False
D	197	False	HOOSIER CARE CONNECT MCD	HOOSIER CARE CONNECT MCD	PO BOX 3002		FARMINGTON	MO	63640							8	1702	3643	1742	2	1682	2	3		0	D		False	233	68069_4	PO BOX 3002 HOOSIER CARE CONNECT MCD HOOSIER CARE CONNECT MCD FARMINGTON MO 63640	9/11/2019 10:21:52 AM	cpaulino	3/28/2025 10:23:03 AM	cpaulino	10/1/2015 12:00:00 AM	3/28/2025 9:23:03 AM	False
EDP	199	False	ANTHEM BCBS IN MCR REP	ANTHEM BCBS IN MCR REP	PO BOX 105187		ATLANTA	GA	30348							2	1701	3644	1741	2	1682	2	3			EDP			233	00130_3	PO BOX 105187 ANTHEM BCBS IN MCR REP ANTHEM BCBS IN MCR REP ATLANTA GA 30348	9/13/2019 2:27:00 PM	cpaulino	5/23/2025 3:16:30 PM	cpaulino	10/1/2015 12:00:00 AM	5/23/2025 2:16:30 PM	False
ED	200	False	COMMUNITY BLUE PA MCR ADV PPO	COMMUNITY BLUE PA MCR ADV PPO	PO BOX 890062		CAMP HILL	PA	17089-0062							2	1701	3644	1741	2	1682	2	3		0	ED		False	233	15460_4	PO BOX 890062 COMMUNITY BLUE PA MCR ADV PPO COMMUNITY BLUE PA MCR ADV PPO CAMP HILL PA 17089-0062	9/16/2019 9:52:03 AM	cpaulino	3/28/2025 10:28:09 AM	cpaulino	10/1/2015 12:00:00 AM	3/28/2025 9:28:09 AM	False
C	201	False	MEDICAL ASSOCIATES HEALTH PLAN/HEALTH CHOICES	MEDICAL ASSOCIATES HEALTH PLAN/HEALTH CHOICES	PO Box 211094		EAGAN	MN	55121							3	1703	104	30939	2	1682	2	3	117	0	C		False	233	MAHC1	PO BOX 211094 MEDICAL ASSOCIATES HEALTH PLAN/HEALTH CHOICES MEDICAL ASSOCIATES HEALTH PLAN/HEALTH CHOICES EAGAN MN 55121	9/30/2019 9:38:35 AM	lmurphy	9/30/2019 9:38:35 AM	lmurphy	10/1/2015 12:00:00 AM	9/30/2019 9:38:34 AM	False
D	207	False	MDWISE MEDICAID	MDWISE MEDICAID	PO BOX 1575		FLINT	MI	48501							8	1702	3643	1742	2	1682	2	3	116	0	D		False	233	3135M_2	PO BOX 1575 MDWISE MEDICAID MDWISE MEDICAID FLINT MI 48501	12/5/2019 11:46:20 AM	cpaulino	3/28/2025 10:21:15 AM	cpaulino	10/1/2015 12:00:00 AM	3/28/2025 9:21:15 AM	False
ED	208	False	CCAI MEDICARE HMO	CCAI MEDICARE HMO	PO BOX 3417		SCRANTON	PA	18505-0417							2	1701	3644	1741	2	1682	2	3		0	ED		False	233	66012	PO BOX 3417 CCAI MEDICARE HMO CCAI MEDICARE HMO SCRANTON PA 18505-0417	12/9/2019 8:09:32 AM	lmurphy	3/28/2025 10:29:46 AM	cpaulino	10/1/2015 12:00:00 AM	3/28/2025 9:29:46 AM	False
CE	211	False	MEDICARE OF GA	MEDICARE OF GA	PO BOX 12847		BIRMINGHAM	AL	35202	USA						1	1701	1799	1738	2	1682	2	3	120	0	CE			233	12M05	PO BOX 12847 MEDICARE OF GA MEDICARE OF GA BIRMINGHAM AL 35202	12/16/2019 9:26:15 AM	lmurphy	4/19/2023 12:24:09 PM	CPAULINO	10/1/2015 12:00:00 AM	4/19/2023 11:24:09 AM	False
T	213	False	MEDICAID OF GA	MEDICAID OF GA	PO BOX 105201		TUCKER	GA	30085	USA		8007664456				9	1703	83	1739	2	1682	2	3			T			233	77034	PO BOX 105201 MEDICAID OF GA MEDICAID OF GA TUCKER GA 30085	12/16/2019 9:31:29 AM	lmurphy	3/28/2025 10:16:55 AM	cpaulino	10/1/2015 12:00:00 AM	3/28/2025 9:16:55 AM	False
F	217	False	ADVOCATE HEALTH SYSTEM COMMERCIAL	ADVOCATE HEALTH SYSTEM COMMERCIAL	PO BOX 0838		MOUNT PROSPECT	IL	60056			8472986000	Work			3	1703	25823	30939	2	1682	2	3		0	F	0	False	233	36320_2	PO BOX 0838 ADVOCATE HEALTH SYSTEM COMMERCIAL ADVOCATE HEALTH SYSTEM COMMERCIAL MOUNT PROSPECT IL 60056	1/14/2020 8:43:20 AM	cpaulino	4/23/2026 3:13:05 PM	lmurphy	10/1/2015 12:00:00 AM	4/23/2026 2:13:05 PM	False
EF	222	False	VA FULTON	VA FULTON	1700 S LINCOLN AVE		LEBANON	PA	17042							2	1701	3644	1741	2	1682	1	3		0	EF			233	N/A	1700 S LINCOLN AVE VA FULTON VA FULTON LEBANON PA 17042	2/10/2020 10:20:59 AM	cpaulino	4/23/2026 3:09:09 PM	lmurphy	10/1/2015 12:00:00 AM	4/23/2026 2:09:09 PM	False
D	225	False	HUMANA MCD	HUMANA MCD	PO BOX 14359		LEXINGTON	KY	40512							8	1702	3643	1742	2	1682	2	3			D			233	61101_5	PO BOX 14359 HUMANA MCD HUMANA MCD LEXINGTON KY 40512	2/13/2020 2:28:35 PM	cpaulino	3/28/2025 10:22:32 AM	cpaulino	10/1/2015 12:00:00 AM	3/28/2025 9:22:32 AM	False
D	227	False	UPMC MCD REP	UPMC MCD REP	PO BOX 106042		PITTSBURG	PA	15230							8	1702	3643	1742	2	1682	2	3	116	0	D		False	233	23281_1	PO BOX 106042 UPMC MCD REP UPMC MCD REP PITTSBURG PA 15230	2/18/2020 1:34:01 PM	cpaulino	3/28/2025 10:21:47 AM	cpaulino	10/1/2015 12:00:00 AM	3/28/2025 9:21:47 AM	False
D	228	False	PA HEALTH AND WELLNESS MCD	PA HEALTH AND WELLNESS MCD	PO BOX 5070		FARMINGTON	MO	63640							8	1702	3643	1742	2	1681	2	3	116	0	D		False	233	68069_6	PO BOX 5070 PA HEALTH AND WELLNESS MCD PA HEALTH AND WELLNESS MCD FARMINGTON MO 63640	2/18/2020 1:38:32 PM	cpaulino	3/28/2025 10:19:45 AM	cpaulino	10/1/2015 12:00:00 AM	3/28/2025 9:19:45 AM	False
ED	229	False	OAK STREET HEALTH MCR REP	OAK STREET HEALTH MCR REP	PO BOX 7970		WESCHESTER	IL	60154							2	1701	3644	1741	2	1682	2	3		0	ED			233	OAKST	PO BOX 7970 OAK STREET HEALTH MCR REP OAK STREET HEALTH MCR REP WESCHESTER IL 60154	3/4/2020 2:04:01 PM	cpaulino	3/28/2025 10:25:35 AM	cpaulino	10/1/2015 12:00:00 AM	3/28/2025 9:25:35 AM	False
EDP	230	False	ULTIMATE HEALTH PLANS MCR REP	ULTIMATE HEALTH PLANS MCR REP	PO BOX 3418		SCRANTON	PA	18505							2	1701	3644	1741	2	1682	2	3	116	0	EDP		False	233	77022	PO BOX 3418 ULTIMATE HEALTH PLANS MCR REP ULTIMATE HEALTH PLANS MCR REP SCRANTON PA 18505	3/11/2020 2:11:40 PM	lmurphy	5/23/2025 3:21:06 PM	cpaulino	10/1/2015 12:00:00 AM	5/23/2025 2:21:06 PM	False
TD	232	False	MOLINA MCD OF OH	MOLINA MCD OF OH	PO BOX 22712		LONG BEACH	CA	90801							8	1702	3643	1742	2	1682	2	3			TD			233	73160	PO BOX 22712 MOLINA MCD OF OH MOLINA MCD OF OH LONG BEACH CA 90801	3/23/2020 12:08:44 PM	cpaulino	3/28/2025 10:21:50 AM	cpaulino	10/1/2015 12:00:00 AM	3/28/2025 9:21:50 AM	False
D	233	False	UHC MO HEALTHNET MEDICAID HMO	UHC MO HEALTHNET MEDICAID HMO	PO BOX 5240		KINGSTON	NY	12402							8	1702	3643	1742	2	1682	2	3		0	D			233	86050	PO BOX 5240 UHC MO HEALTHNET MEDICAID HMO UHC MO HEALTHNET MEDICAID HMO KINGSTON NY 12402	3/23/2020 1:57:26 PM	lmurphy	3/28/2025 10:19:20 AM	cpaulino	10/1/2015 12:00:00 AM	3/28/2025 9:19:20 AM	False
ED	234	False	EVERENCE MEDICARE SUPPLEMENT	EVERENCE MEDICARE SUPPLEMENT	PO BOX 483		GOSHEN	IN	46527							2	1701	3644	1741	2	1682	2	3	116	0	ED		False	233	35605	PO BOX 483 EVERENCE MEDICARE SUPPLEMENT EVERENCE MEDICARE SUPPLEMENT GOSHEN IN 46527	3/26/2020 9:23:03 AM	lmurphy	3/28/2025 10:28:45 AM	cpaulino	10/1/2015 12:00:00 AM	3/28/2025 9:28:45 AM	False
D	237	False	WELLPOINT/AMERIGROUP MEDICAID	WELLPOINT/AMERIGROUP MEDICAID	PO BOX 61010		VIRGINIA BEACH	VA	23466							8	1702	3643	1742	2	1682	2	3	116	0	D		False	233	27514	PO BOX 61010 WELLPOINT/AMERIGROUP MEDICAID WELLPOINT/AMERIGROUP MEDICAID VIRGINIA BEACH VA 23466	5/4/2020 11:36:08 AM	lmurphy	3/28/2025 10:20:35 AM	cpaulino	10/1/2015 12:00:00 AM	3/28/2025 9:20:35 AM	False
EDF	239	False	VA MEMPHIS MEDICAL CENTER	VA MEMPHIS MEDICAL CENTER	1030 JEFFERSON AVE		MEMPHIS	TN	38104							2	1701	3644	1741	2	1682	1	3	116	0	EDF	0		233	239	1030 JEFFERSON AVE VA MEMPHIS MEDICAL CENTER VA MEMPHIS MEDICAL CENTER MEMPHIS TN 38104	5/8/2020 7:12:02 AM	lmurphy	4/23/2026 3:09:15 PM	lmurphy	10/1/2015 12:00:00 AM	4/23/2026 2:09:15 PM	False
ED	240	False	BCBS ANTHEM MEDIBLUE DUAL ADVANTAGE HMO	BCBS ANTHEM MEDIBLUE DUAL ADVANTAGE HMO	PO BOX 105187		ATLANTA	GA	30348							12	1701	3644	73558	2	1682	2	3		0	ED			233	26375_2	PO BOX 105187 BCBS ANTHEM MEDIBLUE DUAL ADVANTAGE HMO BCBS ANTHEM MEDIBLUE DUAL ADVANTAGE HMO ATLANTA GA 30348	5/12/2020 9:27:02 AM	lmurphy	3/28/2025 10:23:10 AM	cpaulino	10/1/2015 12:00:00 AM	3/28/2025 9:23:10 AM	False
ED	242	False	UNIFIED PHYSICIANS NETWORK	UNIFIED PHYSICIANS NETWORK	3525 OLD ORCHARD	STE 340	SKOKIE	IL	60077							2	1701	3644	1741	2	1682	2	3		0	ED			233	34628	3525 OLD ORCHARD STE 340 UNIFIED PHYSICIANS NETWORK UNIFIED PHYSICIANS NETWORK SKOKIE IL 60077	5/26/2020 9:28:43 AM	cpaulino	3/28/2025 10:26:04 AM	cpaulino	10/1/2015 12:00:00 AM	3/28/2025 9:26:04 AM	False
D	246	False	AMERIHEALTH CARITAS PA COMMUNITY HEALTHCHOICES	AMERIHEALTH CARITAS PA COMMUNITY HEALTHCHOICES	PO BOX 7110		LONDON	KY	40742							8	1702	3643	1742	2	1682	2	3		0	D		False	233	77062	PO BOX 7110 AMERIHEALTH CARITAS PA COMMUNITY HEALTHCHOICES AMERIHEALTH CARITAS PA COMMUNITY HEALTHCHOICES LONDON KY 40742	6/23/2020 8:40:50 AM	cpaulino	3/28/2025 10:22:44 AM	cpaulino	10/1/2015 12:00:00 AM	3/28/2025 9:22:44 AM	False
ED	248	False	KAISER PERMANENTE MEDICARE ADVANTAGE HMO	KAISER PERMANENTE MEDICARE ADVANTAGE HMO	PO BOX 370010		DENVER	CO	80237							2	1701	3644	1741	2	1682	2	3		0	ED			233	21313	PO BOX 370010 KAISER PERMANENTE MEDICARE ADVANTAGE HMO KAISER PERMANENTE MEDICARE ADVANTAGE HMO DENVER CO 80237	7/1/2020 3:02:51 PM	lmurphy	3/28/2025 10:31:26 AM	cpaulino	10/1/2015 12:00:00 AM	3/28/2025 9:31:26 AM	False
D	249	False	UHC MEDICAID HMO OF KS	UHC MEDICAID HMO OF KS	PO BOX 31364		SALT LAKE CITY	UT	84131							8	1702	3643	1742	2	1682	2	3		0	D			233	96385	PO BOX 31364 UHC MEDICAID HMO OF KS UHC MEDICAID HMO OF KS SALT LAKE CITY UT 84131	7/1/2020 3:09:04 PM	lmurphy	3/28/2025 10:22:19 AM	cpaulino	10/1/2015 12:00:00 AM	3/28/2025 9:22:19 AM	False
ED	252	False	CARESOURCE DUAL MCR HMO	CARESOURCE DUAL MCR HMO	PO BOX 8730		DAYTON	OH	45401							12	1701	3644	73558	2	1682	2	3		0	ED			233	31114_1	PO BOX 8730 CARESOURCE DUAL MCR HMO CARESOURCE DUAL MCR HMO DAYTON OH 45401	7/23/2020 9:30:28 AM	lmurphy	3/28/2025 10:23:45 AM	cpaulino	10/1/2015 12:00:00 AM	3/28/2025 9:23:45 AM	False
EF	253	False	VA	VA	PO BOX 202117		FLORENCE	SC	29506							2	1704	95	1741	2	1682	2	3		0	EF		False	233	VACCN	PO BOX 202117 VA VA FLORENCE SC 29506	7/24/2020 1:50:51 PM	lmurphy	7/2/2026 8:03:10 AM	lmurphy	10/1/2015 12:00:00 AM	7/2/2026 7:03:10 AM	False
ED	255	False	STAYWELL FL MMA	STAYWELL FL MMA	PO BOX 31372		TAMPA	FL	33631							12	1701	3644	73558	2	1682	2	3		0	ED		False	233	14163_1	PO BOX 31372 STAYWELL FL MMA STAYWELL FL MMA TAMPA FL 33631	7/29/2020 3:03:01 PM	lmurphy	3/28/2025 10:24:42 AM	cpaulino	10/1/2015 12:00:00 AM	3/28/2025 9:24:42 AM	False
ED	261	False	HUMANA MILITARY TRICARE EAST	HUMANA MILITARY TRICARE EAST	PO BOX 7981		MADISON	WI	53707							2	1701	3644	1741	2	1682	1	3		0	ED			233	261	PO BOX 7981 HUMANA MILITARY TRICARE EAST HUMANA MILITARY TRICARE EAST MADISON WI 53707	10/9/2020 10:01:34 AM	lmurphy	3/28/2025 10:31:17 AM	cpaulino	10/1/2015 12:00:00 AM	3/28/2025 9:31:17 AM	False
DP	262	False	WELLCARE MEDICAID HMO	WELLCARE MEDICAID HMO	PO BOX 31224		TAMPA	FL	33631							8	1702	3643	1742	2	1682	2	3		0	DP			233	14163_3	PO BOX 31224 WELLCARE MEDICAID HMO WELLCARE MEDICAID HMO TAMPA FL 33631	10/9/2020 1:07:23 PM	LMURPHY	5/23/2025 3:22:27 PM	cpaulino	10/1/2015 12:00:00 AM	5/23/2025 2:22:27 PM	False
D	264	False	PRIORITY HEALTH MCD REP	PRIORITY HEALTH MCD REP	PO BOX 232		GRAND RAPIDS	MI	49501							8	1702	3643	1742	2	1682	2	3			D			233	38217_2	PO BOX 232 PRIORITY HEALTH MCD REP PRIORITY HEALTH MCD REP GRAND RAPIDS MI 49501	10/14/2020 1:07:46 PM	lmurphy	3/28/2025 10:20:23 AM	cpaulino	10/1/2015 12:00:00 AM	3/28/2025 9:20:23 AM	False
ED	266	False	AMERIHEALTH CARITAS VIP MEDICARE HMO	AMERIHEALTH CARITAS VIP MEDICARE HMO	PO BOX 7143		LONDON	KY	40742							2	1701	3644	1741	2	1682	2	3		0	ED			233	77062_1	PO BOX 7143 AMERIHEALTH CARITAS VIP MEDICARE HMO AMERIHEALTH CARITAS VIP MEDICARE HMO LONDON KY 40742	10/27/2020 4:44:48 PM	lmurphy	3/28/2025 10:29:30 AM	cpaulino	10/1/2015 12:00:00 AM	3/28/2025 9:29:30 AM	False
DT	273	False	AETNA BETTER HEALTH MCD RISK	AETNA BETTER HEALTH MCD RISK	PO BOX 982970		EL PASO	TX	79998							8	1702	3643	1742	2	1682	2	3		0	DT	0	False	233	68024	PO BOX 982970 AETNA BETTER HEALTH MCD RISK AETNA BETTER HEALTH MCD RISK EL PASO TX 79998	12/2/2020 4:14:15 PM	lmurphy	3/19/2026 12:11:11 PM	lmurphy	10/1/2015 12:00:00 AM	3/19/2026 11:11:11 AM	False
ED	274	False	SPRITRUST LUTHERN LIFE MEDICARE REPLACEMENT	SPRITRUST LUTHERN LIFE MEDICARE REPLACEMENT	PO BOX 30760		TAMPA	FL	33630							2	1701	3644	1741	2	1682	2	3		0	ED	0	False	233	27034	PO BOX 30760 SPRITRUST LUTHERN LIFE MEDICARE REPLACEMENT SPRITRUST LUTHERN LIFE MEDICARE REPLACEMENT TAMPA FL 33630	12/8/2020 2:20:30 PM	lmurphy	3/28/2025 10:27:14 AM	cpaulino	10/1/2015 12:00:00 AM	3/28/2025 9:27:14 AM	False
D	275	False	PEACH STATE HEALTH PLAN MCD	PEACH STATE HEALTH PLAN MCD	PO BOX 3030		FARMINGTON	MO	68990							8	1702	3643	1742	2	1682	2	3		0	D		False	233	68069_5	PO BOX 3030 PEACH STATE HEALTH PLAN MCD PEACH STATE HEALTH PLAN MCD FARMINGTON MO 68990	12/14/2020 3:12:14 PM	lmurphy	3/28/2025 10:21:19 AM	cpaulino	10/1/2015 12:00:00 AM	3/28/2025 9:21:19 AM	False
ED	278	False	GEISINGER MEDICARE ADVANTAGE HMO	GEISINGER MEDICARE ADVANTAGE HMO	PO BOX 853910		RICHARDSON	TX	75085							2	1701	3644	1741	2	1682	2	3		0	ED	0	False	233	75273	PO BOX 853910 GEISINGER MEDICARE ADVANTAGE HMO GEISINGER MEDICARE ADVANTAGE HMO RICHARDSON TX 75085	1/18/2021 1:01:43 PM	lmurphy	3/28/2025 10:28:50 AM	cpaulino	10/1/2015 12:00:00 AM	3/28/2025 9:28:50 AM	False
TD	281	False	MOLINA MEDICAID MICHIGAN	MOLINA MEDICAID MICHIGAN	PO BOX 22668		LONG BEACH	CA	90801							8	1702	3643	1742	2	1682	2	3		0	TD	0	False	233	38334	PO BOX 22668 MOLINA MEDICAID MICHIGAN MOLINA MEDICAID MICHIGAN LONG BEACH CA 90801	2/3/2021 4:44:43 PM	lmurphy	3/28/2025 10:21:38 AM	cpaulino	10/1/2015 12:00:00 AM	3/28/2025 9:21:38 AM	False
ED	283	False	CLOVER HEALTH MCR REP	CLOVER HEALTH MCR REP	PO BOX 981704		EL PASO	TX	79998							2	1701	3644	1741	2	1682	2	3		0	ED	0	False	233	13285	PO BOX 981704 CLOVER HEALTH MCR REP CLOVER HEALTH MCR REP EL PASO TX 79998	2/24/2021 8:21:45 AM	lmurphy	3/28/2025 10:27:59 AM	cpaulino	10/1/2015 12:00:00 AM	3/28/2025 9:27:59 AM	False
E	284	False	TRICARE EAST HMO-POS	TRICARE EAST HMO-POS	PO BOX 7981		MADISON	WI	53707							2	1701	3644	1741	2	1682	2	3		0	E	0	False	233	68299_1	PO BOX 7981 TRICARE EAST HMO-POS TRICARE EAST HMO-POS MADISON WI 53707	2/25/2021 11:11:07 AM	lmurphy	5/30/2023 9:04:26 AM	CPAULINO	10/1/2015 12:00:00 AM	5/30/2023 8:04:26 AM	False
ED	285	False	CIGNA HEALTHSPRING MCR TRUE CHOICE PPO	CIGNA HEALTHSPRING MCR TRUE CHOICE PPO	PO BOX 981706		EL PASO	TX	79998							2	1701	3644	1741	2	1682	2	3		0	ED			233	52192_2	PO BOX 981706 CIGNA HEALTHSPRING MCR TRUE CHOICE PPO CIGNA HEALTHSPRING MCR TRUE CHOICE PPO EL PASO TX 79998	2/25/2021 3:11:32 PM	lmurphy	3/27/2026 9:56:42 AM	cpaulino	10/1/2015 12:00:00 AM	3/27/2026 8:56:42 AM	False
ED	286	False	VIBRA HEALTH MCR ADV PPO PLAN	VIBRA HEALTH MCR ADV PPO PLAN	PO BOX 2119		EAGAN	MN	55121							2	1701	3644	1741	2	1682	2	3		0	ED	0	False	233	15976	PO BOX 2119 VIBRA HEALTH MCR ADV PPO PLAN VIBRA HEALTH MCR ADV PPO PLAN EAGAN MN 55121	2/25/2021 3:37:08 PM	lmurphy	3/28/2025 10:27:03 AM	cpaulino	10/1/2015 12:00:00 AM	3/28/2025 9:27:03 AM	False
EDP	288	False	UPMC MEDICARE HMO	UPMC MEDICARE HMO	PO BOX 2997		PITTSBURG	PA	15230							2	1701	3644	1741	2	1682	2	3		0	EDP		False	233	23281_2	PO BOX 2997 UPMC MEDICARE HMO UPMC MEDICARE HMO PITTSBURG PA 15230	3/1/2021 8:41:10 AM	lmurphy	5/23/2025 3:22:05 PM	cpaulino	10/1/2015 12:00:00 AM	5/23/2025 2:22:05 PM	False
EDP	289	False	UHC DUAL COMPLETE MEDICARE HMO-SNP	UHC DUAL COMPLETE MEDICARE HMO-SNP	PO BOX 5240		KINGSTON	NY	12402							2	1701	3644	1741	2	1682	2	3		0	EDP	0	False	233	86050_1	PO BOX 5240 UHC DUAL COMPLETE MEDICARE HMO-SNP UHC DUAL COMPLETE MEDICARE HMO-SNP KINGSTON NY 12402	3/1/2021 4:38:14 PM	lmurphy	5/23/2025 3:21:31 PM	cpaulino	10/1/2015 12:00:00 AM	5/23/2025 2:21:31 PM	False
D	292	False	BCBS MO MEDICAID HMO	BCBS MO MEDICAID HMO	PO BOX 61010		VIRGINIA BEACH	VA	23466							8	1702	3643	1742	2	1682	2	3		0	D	0	False	233	00541	PO BOX 61010 BCBS MO MEDICAID HMO BCBS MO MEDICAID HMO VIRGINIA BEACH VA 23466	3/4/2021 2:30:43 PM	lmurphy	3/28/2025 10:20:07 AM	cpaulino	10/1/2015 12:00:00 AM	3/28/2025 9:20:07 AM	False
DF	293	False	DMG	DMG MCR REP	PO BOX 3358		Glen Ellyn	IL	60138							2	1701	2398	1741	2	1682	2	3		0	DF	0	False	233	DMG01	PO BOX 3358 DMG MCR REP DMG GLEN ELLYN IL 60138	3/16/2021 11:02:22 AM	lmurphy	4/23/2026 3:11:20 PM	lmurphy	10/1/2015 12:00:00 AM	4/23/2026 2:11:20 PM	False
D	295	False	ARIZONA MEDICAID	ARIZONA MEDICAID	PO BOX 9010		FARMINGTON	MO	63640							9	1702	83	1739	2	1682	1	3		0	D	0	False	233	AZMCD	PO BOX 9010 ARIZONA MEDICAID ARIZONA MEDICAID FARMINGTON MO 63640	3/18/2021 12:15:14 PM	lmurphy	3/29/2025 1:29:12 PM	cpaulino	10/1/2015 12:00:00 AM	3/29/2025 12:29:12 PM	False
D	298	False	CARESOURCE GA MCD	CARESOURCE GA MCD	PO BOX 0803		DAYTON	OH	45401							8	1702	3643	1742	2	1682	2	3		0	D			233	GACS1_1 Insta	PO BOX 0803 CARESOURCE GA MCD CARESOURCE GA MCD DAYTON OH 45401	3/29/2021 1:55:27 PM	lmurphy	3/28/2025 10:19:55 AM	cpaulino	10/1/2015 12:00:00 AM	3/28/2025 9:19:55 AM	False
E	303	False	MEDICARE ACUTE OF GA	MEDICARE ACUTE OF GA	PO BOX 12847		BIRMINGHAM	AL	35202	USA						1	1701	1799	1738	2	1682	2	3	120		E			233	12M05_1	PO BOX 12847 MEDICARE ACUTE OF GA MEDICARE ACUTE OF GA BIRMINGHAM AL 35202	4/30/2021 10:45:13 AM	cpaulino	4/25/2023 9:10:53 AM	CPAULINO	10/1/2015 12:00:00 AM	4/25/2023 8:10:53 AM	False
ED	305	False	MOLINA MEDICARE COMPLETE HMO SNP	MOLINA MEDICARE COMPLETE MI HMO SNP	PO BOX 22811		LONG BEACH	CA	90801							2	1701	3644	1741	2	1682	2	3		0	ED	0	False	233	38334_1	PO BOX 22811 MOLINA MEDICARE COMPLETE MI HMO SNP MOLINA MEDICARE COMPLETE HMO SNP LONG BEACH CA 90801	5/10/2021 3:17:46 PM	lmurphy	3/6/2026 10:53:00 AM	cpaulino	10/1/2015 12:00:00 AM	3/6/2026 9:53:00 AM	False
ED	307	False	UCARE CONNECT	UCARE CONNECT	PO BOX 70		MINNEAPOLIS	MN	55440							2	1701	3644	1741	2	1682	2	3		0	ED	0	False	233	52629	PO BOX 70 UCARE CONNECT UCARE CONNECT MINNEAPOLIS MN 55440	5/26/2021 1:39:35 PM	lmurphy	3/28/2025 10:25:38 AM	cpaulino	10/1/2015 12:00:00 AM	3/28/2025 9:25:38 AM	False
ED	308	False	GA HEALTH MED ADV HMO	GA HEALTH MED ADV HMO	PO BOX 93780		LUBOCK	TX	79493							2	1701	3644	1741	2	1682	2	3		0	ED	0	False	233	31140	PO BOX 93780 GA HEALTH MED ADV HMO GA HEALTH MED ADV HMO LUBOCK TX 79493	5/27/2021 1:47:45 PM	lmurphy	3/28/2025 10:28:38 AM	cpaulino	10/1/2015 12:00:00 AM	3/28/2025 9:28:38 AM	False
EDP	309	False	ANTHEM IN MEDIBLUE DUAL ADV	ANTHEM IN MEDIBLUE DUAL ADV	PO BOX 61010		VIRGINIA BEACH	VA	23466							12	1701	3644	73558	2	1682	2	3		0	EDP	0	False	233	26375_3	PO BOX 61010 ANTHEM IN MEDIBLUE DUAL ADV ANTHEM IN MEDIBLUE DUAL ADV VIRGINIA BEACH VA 23466	6/3/2021 4:00:25 PM	lmurphy	5/23/2025 3:16:36 PM	cpaulino	10/1/2015 12:00:00 AM	5/23/2025 2:16:36 PM	False
EDP	311	False	ZING HEALTH HMO	ZING HEALTH MCR REP HMO	PO BOX 240599		APPLE VALLEY	MN	55124							2	1701	3644	1741	2	1682	2	3		0	EDP		False	233	83248	PO BOX 240599 ZING HEALTH MCR REP HMO ZING HEALTH HMO APPLE VALLEY MN 55124	6/7/2021 1:02:45 PM	lmurphy	3/19/2026 12:03:11 PM	lmurphy	10/1/2015 12:00:00 AM	3/19/2026 11:03:11 AM	False
ED	316	False	ALLWELL PEACH STATE MCR HMO	ALLWELL PEACH STATE MCR HMO	PO BOX 3060		FARMINGTON	MO	63640							2	1701	3644	1741	2	1682	2	3		0	ED	0	False	233	68069_7	PO BOX 3060 ALLWELL PEACH STATE MCR HMO ALLWELL PEACH STATE MCR HMO FARMINGTON MO 63640	6/11/2021 8:14:51 AM	CPAULINO	3/28/2025 10:29:18 AM	cpaulino	10/1/2015 12:00:00 AM	3/28/2025 9:29:18 AM	False
EDP	317	False	UHC MEDICARE DUAL COMPLETE	UHC MEDICARE DUAL COMPLETE	PO BOX 740800		KINGSTON	NY	12402							2	1701	3644	1741	2	1682	2	3			EDP			233	95378_2	PO BOX 740800 UHC MEDICARE DUAL COMPLETE UHC MEDICARE DUAL COMPLETE KINGSTON NY 12402	6/14/2021 1:11:11 PM	CPAULINO	5/23/2025 3:21:35 PM	cpaulino	10/1/2015 12:00:00 AM	5/23/2025 2:21:35 PM	False
ED	318	False	PROVIDERS PARTNERS HEALTH PLAN MCR HMO OF ILLINOIS	PROVIDERS PARTNERS HEALTH PLAN MCR HMO OF ILLINOIS	PO BOX 94290		LUBOCK	TX	79493							2	1701	3644	1741	2	1682	2	3		0	ED	0	False	233	31401	PO BOX 94290 PROVIDERS PARTNERS HEALTH PLAN MCR HMO OF ILLINOIS PROVIDERS PARTNERS HEALTH PLAN MCR HMO OF ILLINOIS LUBOCK TX 79493	6/22/2021 11:44:25 AM	lmurphy	3/28/2025 10:26:28 AM	cpaulino	10/1/2015 12:00:00 AM	3/28/2025 9:26:28 AM	False
TD	321	False	MERIDIAN MCD EFF. 7/1/2021	MERIDIAN MCD	PO BOX 4020		FARMINGTON	MO	63640			8666063700				8	1702	3643	1742	2	1682	2	3		0	TD	0	False	233	MHPIL	PO BOX 4020 MERIDIAN MCD MERIDIAN MCD EFF. 7/1/2021 FARMINGTON MO 63640	7/15/2021 10:28:25 AM	lmurphy	5/12/2026 11:55:10 AM	cpaulino	10/1/2015 12:00:00 AM	5/12/2026 10:55:10 AM	False
ED	325	False	COMMUNICARE MCR ADV HMO	COMMUNICARE MCR ADV HMO	PO BOX 94238		LUBOCK	TX	79493							2	1701	3644	1741	2	1682	1	3		0	ED	0	False	233	34525	PO BOX 94238 COMMUNICARE MCR ADV HMO COMMUNICARE MCR ADV HMO LUBOCK TX 79493	7/29/2021 1:47:51 PM	lmurphy	3/28/2025 10:27:50 AM	cpaulino	10/1/2015 12:00:00 AM	3/28/2025 9:27:50 AM	False
ED	327	False	PROVIDER PARTNERS HEALTH PLAN OF IL	PROVIDER PARTNERS HEALTH PLAN OF IL	901 ELKRIDGE LANDING ROAD		LINTHICUM HEIGHTS	MD	21090		CUSTCARE@HEALTHAXIS.COM					2	1701	3644	1741	2	1682	2	3			ED			233	31401_1	901 ELKRIDGE LANDING ROAD PROVIDER PARTNERS HEALTH PLAN OF IL PROVIDER PARTNERS HEALTH PLAN OF IL LINTHICUM HEIGHTS MD 21090	8/5/2021 10:50:50 AM	acarroll	3/28/2025 10:26:26 AM	cpaulino	10/1/2015 12:00:00 AM	3/28/2025 9:26:26 AM	False
ED	331	False	NORTHWESTERN MEDICINE MCR REP	NORTHWESTERN MEDICINE MCR REP	PO BOX 8150		WESTCHESTER	IL	60154							2	1701	3644	1741	2	1682	2	3		0	ED	0	False	233	NWEST	PO BOX 8150 NORTHWESTERN MEDICINE MCR REP NORTHWESTERN MEDICINE MCR REP WESTCHESTER IL 60154	9/8/2021 10:46:42 AM	lmurphy	3/28/2025 10:30:48 AM	cpaulino	10/1/2015 12:00:00 AM	3/28/2025 9:30:48 AM	False
ED	338	False	COMMUNITY CARE ALLIANCE OF IL	COMMUNITY CARE ALLIANCE OF IL	PO BOX 491		PARK RIDGE	IL	60068							2	1701	3644	1741	2	1682	2	3		0	ED	0	False	233	85468	PO BOX 491 COMMUNITY CARE ALLIANCE OF IL COMMUNITY CARE ALLIANCE OF IL PARK RIDGE IL 60068	10/14/2021 1:40:04 PM	lmurphy	3/28/2025 10:27:46 AM	cpaulino	10/1/2015 12:00:00 AM	3/28/2025 9:27:46 AM	False
D	341	False	VERMONT MEDICAID	VERMONT MEDICAID	PO BOX 999		WILLISTON	VT	05495							9	1702	83	1739	2	1682	1	3		0	D	0	False	233	341	PO BOX 999 VERMONT MEDICAID VERMONT MEDICAID WILLISTON VT 05495	10/21/2021 11:35:59 AM	lmurphy	3/29/2025 1:29:21 PM	cpaulino	10/1/2015 12:00:00 AM	3/29/2025 12:29:21 PM	False
ED	342	False	MVP GOLD MOHAWK VALLEY MCR REP PPO	MVP GOLD MOHAWK VALLEY MCR REP PPO	PO BOX 2207		SCHENECTADY	NY	12301							2	1701	3644	1741	2	1682	2	3		0	ED	0	False	233	14165	PO BOX 2207 MVP GOLD MOHAWK VALLEY MCR REP PPO MVP GOLD MOHAWK VALLEY MCR REP PPO SCHENECTADY NY 12301	11/8/2021 4:03:22 PM	lmurphy	3/28/2025 10:30:54 AM	cpaulino	10/1/2015 12:00:00 AM	3/28/2025 9:30:54 AM	False
ED	343	False	KAISER PERNAMENTE SOUTH MCR REP	KAISER PERNAMENTE SOUTH MCR REP	PO BOX 70004		DOWNEY	CA	90242							2	1701	3644	1741	2	1682	2	3		0	ED	0	False	233	94134	PO BOX 70004 KAISER PERNAMENTE SOUTH MCR REP KAISER PERNAMENTE SOUTH MCR REP DOWNEY CA 90242	11/19/2021 2:26:43 PM	lmurphy	3/28/2025 10:30:56 AM	cpaulino	10/1/2015 12:00:00 AM	3/28/2025 9:30:56 AM	False
ED	344	False	AMERIGROUP MMAI HMO OF TX	AMERIGROUP MMAI HMO OF TX	PO BOX 8668		VIRGINIA BEACH	VA	26375							12	1701	3644	73558	2	1682	2	3		0	ED	0	False	233	26375_4	PO BOX 8668 AMERIGROUP MMAI HMO OF TX AMERIGROUP MMAI HMO OF TX VIRGINIA BEACH VA 26375	11/22/2021 8:38:39 AM	lmurphy	3/28/2025 10:24:06 AM	cpaulino	10/1/2015 12:00:00 AM	3/28/2025 9:24:06 AM	False
EDP	347	False	ULTIMATE MCR ADV HMO	ULTIMATE MCR ADV HMO	PO BOX 3146		SCRANTON	PA	18505							2	1701	3644	1741	2	1682	2	3		0	EDP	0	False	233	77022_1	PO BOX 3146 ULTIMATE MCR ADV HMO ULTIMATE MCR ADV HMO SCRANTON PA 18505	12/17/2021 9:35:10 AM	lmurphy	5/23/2025 3:21:09 PM	cpaulino	10/1/2015 12:00:00 AM	5/23/2025 2:21:09 PM	False
EDF	350	False	DEVOTED HEALTH PLAN MCR REP HMO	DEVOTED HEALTH PLAN MCR REP HMO	PO BOX 211524		EAGAN	MN	55121			8777623515	Work			2	1701	3644	1741	2	1682	2	3		0	EDF	0	False	233	DEVOT	PO BOX 211524 DEVOTED HEALTH PLAN MCR REP HMO DEVOTED HEALTH PLAN MCR REP HMO EAGAN MN 55121	1/11/2022 11:11:47 AM	lmurphy	4/23/2026 3:11:02 PM	lmurphy	10/1/2015 12:00:00 AM	4/23/2026 2:11:02 PM	False
ED	351	False	PEAK PACE SOLUTIONS	PEAK PACE SOLUTIONS MCR REP	PO BOX 21631		EAGAN	MN	55121			7202043361		8663864447		2	1701	3644	1741	2	1682	2	3		0	ED	0	False	233	U7034	PO BOX 21631 PEAK PACE SOLUTIONS MCR REP PEAK PACE SOLUTIONS EAGAN MN 55121	1/18/2022 1:03:24 PM	CPAULINO	3/28/2025 10:26:11 AM	cpaulino	10/1/2015 12:00:00 AM	3/28/2025 9:26:11 AM	False
ED	352	False	MORECARE MCR REP	MORECARE MCR REP	PO BOX 21325		EAGAN	MN	55121							2	1701	3644	1741	2	1682	2	3		0	ED	0	False	233	65465	PO BOX 21325 MORECARE MCR REP MORECARE MCR REP EAGAN MN 55121	1/31/2022 3:03:21 PM	cpaulino	3/28/2025 10:30:51 AM	cpaulino	10/1/2015 12:00:00 AM	3/28/2025 9:30:51 AM	False
ED	354	False	MO ANTHEM MEDIBLUE DUAL ADV HMO SNP	MO ANTHEM MEDIBLUE DUAL ADV HMO SNP	PO BOX 105187		ATLANTA	GA	30348							12	1701	3644	73558	2	1682	2	3		0	ED	0	False	233	00241	PO BOX 105187 MO ANTHEM MEDIBLUE DUAL ADV HMO SNP MO ANTHEM MEDIBLUE DUAL ADV HMO SNP ATLANTA GA 30348	2/1/2022 4:01:50 PM	lmurphy	3/28/2025 10:23:42 AM	cpaulino	10/1/2015 12:00:00 AM	3/28/2025 9:23:42 AM	False
ED	355	False	CLEAR SPRING HEALTH MCR REP HMO	CLEAR SPRING HEALTH MCR REP HMO	PO BOX 981731		EL PASO	TX	79998							2	1701	3644	1741	2	1682	2	3		0	ED	0	False	233	85468_1	PO BOX 981731 CLEAR SPRING HEALTH MCR REP HMO CLEAR SPRING HEALTH MCR REP HMO EL PASO TX 79998	2/24/2022 12:36:54 PM	lmurphy	3/28/2025 10:29:52 AM	cpaulino	10/1/2015 12:00:00 AM	3/28/2025 9:29:52 AM	False
ED	356	False	HEALTH ALLIANCE MCR HMO	HEALTH ALLIANCE MCR HMO	PO BOX 6003		URBANA	IL	61803							2	1701	3644	1741	2	1682	2	3		0	ED	0	False	233	77950_1	PO BOX 6003 HEALTH ALLIANCE MCR HMO HEALTH ALLIANCE MCR HMO URBANA IL 61803	2/28/2022 4:41:19 PM	lmurphy	3/28/2025 10:28:34 AM	cpaulino	10/1/2015 12:00:00 AM	3/28/2025 9:28:34 AM	False
D	1357	False	MI UHC HEALTHY MICHIGAN MCD	MI UHC HEALTHY MICHIGAN MCD	PO BOX 30991		SALT LAKE CITY	UT	84130							8	1702	3643	1742	2	1682	2	3		0	D	0	False	233	87726_9	PO BOX 30991 MI UHC HEALTHY MICHIGAN MCD MI UHC HEALTHY MICHIGAN MCD SALT LAKE CITY UT 84130	3/7/2022 1:13:48 PM	cpaulino	3/28/2025 10:20:20 AM	cpaulino	10/1/2015 12:00:00 AM	3/28/2025 9:20:20 AM	False
ED	1359	False	ASCENSION COMPLETE MCR HMO	ASCENSION COMPLETE MCR HMO	PO BOX 8050		FARMINGTON	MO	63640							2	1701	3644	1741	2	1682	2	3		0	ED	0	False	233	68069_8	PO BOX 8050 ASCENSION COMPLETE MCR HMO ASCENSION COMPLETE MCR HMO FARMINGTON MO 63640	4/1/2022 8:23:27 AM	cpaulino	3/28/2025 10:28:59 AM	cpaulino	10/1/2015 12:00:00 AM	3/28/2025 9:28:59 AM	False
ED	1360	False	MERIDIAN COMPLETE MMAI	MERIDIAN COMPLETE MMAI	PO BOX 3060		FARMINGTON	MO	63640							12	1701	3644	73558	2	1682	2	3		0	ED	0	False	233	MHPIL_1	PO BOX 3060 MERIDIAN COMPLETE MMAI MERIDIAN COMPLETE MMAI FARMINGTON MO 63640	4/1/2022 10:17:29 AM	lmurphy	3/28/2025 10:23:36 AM	cpaulino	10/1/2015 12:00:00 AM	3/28/2025 9:23:36 AM	False
ED	1362	False	BUCKEYE MCR WELLCARE DUAL ACCESS HMO	BUCKEYE MCR WELLCARE DUAL ACCESS HMO	PO BOC 3060		FARMINGTON	MO	63640							2	1701	3644	1741	2	1682	2	3		0	ED	0	False	233	68069_9	PO BOC 3060 BUCKEYE MCR WELLCARE DUAL ACCESS HMO BUCKEYE MCR WELLCARE DUAL ACCESS HMO FARMINGTON MO 63640	4/8/2022 11:16:12 AM	lmurphy	3/28/2025 10:30:18 AM	cpaulino	10/1/2015 12:00:00 AM	3/28/2025 9:30:18 AM	False
ED	1365	False	MERIDIAN COMPLETE MCR REP	MERIDIAN COMPLETE MCR REP	PO BOX 3060		FARMINGTON	MO	63640							2	1701	3644	1741	2	1682	2	3			ED			233	MHPIL_4	PO BOX 3060 MERIDIAN COMPLETE MCR REP MERIDIAN COMPLETE MCR REP FARMINGTON MO 63640	4/15/2022 2:34:07 PM	CPAULINO	3/28/2025 10:30:30 AM	cpaulino	10/1/2015 12:00:00 AM	3/28/2025 9:30:30 AM	False
EDP	1367	False	WELLCARE MMAI	WELLCARE MMAI SNP	PO BOX 31372		TAMPA	FL	33631							12	1701	3644	73558	2	1682	2	3			EDP			233	14163_4	PO BOX 31372 WELLCARE MMAI SNP WELLCARE MMAI TAMPA FL 33631	4/28/2022 9:01:14 AM	CPAULINO	6/18/2025 8:25:12 AM	cpaulino	10/1/2015 12:00:00 AM	6/18/2025 7:25:12 AM	False
EDP	1368	False	WELLCARE DUAL SNP P	WELLCARE DUAL SNP PA ALLWELL	PO BOX 3060		FARMINGTON	MO	63640							12	1701	3644	73558	2	1682	2	3			EDP			233	68069_10	PO BOX 3060 WELLCARE DUAL SNP PA ALLWELL WELLCARE DUAL SNP P FARMINGTON MO 63640	5/27/2022 2:56:13 PM	CPAULINO	5/23/2025 3:22:21 PM	cpaulino	10/1/2015 12:00:00 AM	5/23/2025 2:22:21 PM	False
E	1369	False	U OF C	U OF C	PO BOX 3358		Glen Ellyn	IL	60138							2	1701	3644	1741	2	1682	1	3		0	E	0	False	233	1369	PO BOX 3358 U OF C U OF C GLEN ELLYN IL 60138	6/7/2022 12:33:47 PM	lmurphy	5/1/2023 2:31:35 PM	CPAULINO	10/1/2015 12:00:00 AM	5/1/2023 1:31:35 PM	False
ED	1372	False	CIGNA HEALTHSPRING DUAL MCR HMO SNP	CIGNA HEALTHSPRING DUAL MCR HMO SNP	PO BOX 981706		EL PASO	TX	79998							12	1701	3644	73558	2	1682	2	3		0	ED	0	False	233	52192_3	PO BOX 981706 CIGNA HEALTHSPRING DUAL MCR HMO SNP CIGNA HEALTHSPRING DUAL MCR HMO SNP EL PASO TX 79998	6/16/2022 3:50:06 PM	lmurphy	3/27/2026 9:57:05 AM	cpaulino	10/1/2015 12:00:00 AM	3/27/2026 8:57:05 AM	False
ED	1373	False	LONGEVITY HEALTH PLAN MCR REP HMO	LONGEVITY HEALTH PLAN MCR REP HMO	PO BOX 16170		LUBBOCK	TX	79490							2	1701	3644	1741	2	1682	1	3		0	ED	0	False	233	L1L01	PO BOX 16170 LONGEVITY HEALTH PLAN MCR REP HMO LONGEVITY HEALTH PLAN MCR REP HMO LUBBOCK TX 79490	6/22/2022 12:24:48 PM	lmurphy	3/28/2025 10:30:33 AM	cpaulino	10/1/2015 12:00:00 AM	3/28/2025 9:30:33 AM	False
ED	1374	False	OMNI MEDICARE REP	OMNI MEDICARE REP	PO BOX 981694		EL PASO	TX	79998							2	1701	3644	1741	2	1682	2	3		0	ED		False	233	68037	PO BOX 981694 OMNI MEDICARE REP OMNI MEDICARE REP EL PASO TX 79998	7/13/2022 8:21:23 AM	lmurphy	3/28/2025 10:25:47 AM	cpaulino	10/1/2015 12:00:00 AM	3/28/2025 9:25:47 AM	False
EDP	1375	False	ANTHEM BCBS MMAI	ANTHEM BCBS MMAI	PO BOX 105187		ATLANTA	GA	30348							12	1701	3644	73558	2	1682	2	3		0	EDP	0	False	233	00101_4	PO BOX 105187 ANTHEM BCBS MMAI ANTHEM BCBS MMAI ATLANTA GA 30348	7/14/2022 12:39:40 PM	lmurphy	5/23/2025 3:17:27 PM	cpaulino	10/1/2015 12:00:00 AM	5/23/2025 2:17:27 PM	False
ED	1376	False	WELLPOINT/AMERIGROUP MCR DUAL HMO-SNP	WELLPOINT/AMERIGROUP MCR DUAL HMO-SNP	PO BOX 61010		VIRGINIA BEACH	VA	23466							12	1701	3644	73558	2	1682	2	3		0	ED		False	233	26375_5	PO BOX 61010 WELLPOINT/AMERIGROUP MCR DUAL HMO-SNP WELLPOINT/AMERIGROUP MCR DUAL HMO-SNP VIRGINIA BEACH VA 23466	7/26/2022 2:40:50 PM	lmurphy	3/28/2025 10:24:16 AM	cpaulino	10/1/2015 12:00:00 AM	3/28/2025 9:24:16 AM	False
ED	1378	False	SIMPLY HEALTH MCR ADV HMO	SIMPLY HEALTH MCR ADV HMO	PO BOX 61010		VIRGINIA BEACH	VA	23466							2	1701	3644	1741	2	1682	2	3		0	ED	0	False	233	SMPLY	PO BOX 61010 SIMPLY HEALTH MCR ADV HMO SIMPLY HEALTH MCR ADV HMO VIRGINIA BEACH VA 23466	8/1/2022 8:03:55 AM	lmurphy	3/28/2025 10:26:01 AM	cpaulino	10/1/2015 12:00:00 AM	3/28/2025 9:26:01 AM	False
ED	1379	False	ALLWELL SUPERIOR HEALTH MCR ADV DUAL	ALLWELL SUPERIOR HEALTH MCR ADV DUAL	PO BOX 3003		FARMINGTON	MO	63640							12	1701	3644	73558	2	1682	2	3		0	ED	0	False	233	68069_11	PO BOX 3003 ALLWELL SUPERIOR HEALTH MCR ADV DUAL ALLWELL SUPERIOR HEALTH MCR ADV DUAL FARMINGTON MO 63640	8/9/2022 3:18:30 PM	lmurphy	3/28/2025 10:24:39 AM	cpaulino	10/1/2015 12:00:00 AM	3/28/2025 9:24:39 AM	False
D	1381	False	CORECIVIC	CORECIVIC	PO BOX 21488		EAGAN	MN	55121							8	1702	3643	1742	2	1682	2	3		0	D	0	False	233	55962	PO BOX 21488 CORECIVIC CORECIVIC EAGAN MN 55121	8/22/2022 1:15:12 PM	lmurphy	3/28/2025 10:22:36 AM	cpaulino	10/1/2015 12:00:00 AM	3/28/2025 9:22:36 AM	False
ED	1384	False	UMWA (UNITED MINE WORKERS OF AMERICA)	UMWA (UNITED MINE WORKERS OF AMERICA)	PO BOX 99002		LUBBOCK	TX	79490							2	1701	3644	1741	2	1682	2	3		0	ED	0	False	233	52180	PO BOX 99002 UMWA (UNITED MINE WORKERS OF AMERICA) UMWA (UNITED MINE WORKERS OF AMERICA) LUBBOCK TX 79490	9/8/2022 2:29:46 PM	lmurphy	3/28/2025 10:27:07 AM	cpaulino	10/1/2015 12:00:00 AM	3/28/2025 9:27:07 AM	False
D	1385	False	AETNA BETTER HEALTH MI MCD REP	AETNA BETTER HEALTH MI MCD REP	PO BOX 66215		PHOENIX	AZ	85082							8	1702	3643	1742	2	1682	2	3		0	D		False	233	128MI	PO BOX 66215 AETNA BETTER HEALTH MI MCD REP AETNA BETTER HEALTH MI MCD REP PHOENIX AZ 85082	9/21/2022 9:43:10 AM	lmurphy	3/25/2026 9:31:47 AM	lmurphy	10/1/2015 12:00:00 AM	3/25/2026 8:31:47 AM	False
D	1386	False	GEISINGER MEDICAID	GEISINGER MCD REP	PO BOX 853910		RICHARDSON	TX	75085							8	1702	3643	1742	2	1682	2	3			D			233	72573	PO BOX 853910 GEISINGER MCD REP GEISINGER MEDICAID RICHARDSON TX 75085	9/23/2022 1:37:29 PM	cpaulino	3/28/2025 10:20:10 AM	cpaulino	10/1/2015 12:00:00 AM	3/28/2025 9:20:10 AM	False
EDF	1387	False	AETNA BETTER HEALTH MMAI OF MI	AETNA BETTER HEALTH MMAI OF MI	PO BOX 982963		EL PASO	TX	79998							12	1701	3644	73558	2	1682	2	3		0	EDF	0	False	233	128MI_1	PO BOX 982963 AETNA BETTER HEALTH MMAI OF MI AETNA BETTER HEALTH MMAI OF MI EL PASO TX 79998	9/28/2022 1:00:10 PM	lmurphy	4/23/2026 3:16:26 PM	lmurphy	10/1/2015 12:00:00 AM	4/23/2026 2:16:26 PM	False
EDP	1389	False	HEALTH ALLIANCE MCR HMO OF MI	HEALTH ALLIANCE MCR HMO OF MI	PO BOX 21063		EAGAN	MN	55121							2	1701	3644	1741	2	1682	2	3		0	EDP	0	False	233	38224	PO BOX 21063 HEALTH ALLIANCE MCR HMO OF MI HEALTH ALLIANCE MCR HMO OF MI EAGAN MN 55121	10/11/2022 2:56:59 PM	CPAULINO	5/23/2025 3:19:57 PM	cpaulino	10/1/2015 12:00:00 AM	5/23/2025 2:19:57 PM	False
TD	1391	False	MERIDIAN MI MCD	MERIDIAN MI MCD	PO BOX 8080		FARMINGTON	MO	63640							8	1702	3643	1742	2	1682	2	3		0	TD			233	MHPMI	PO BOX 8080 MERIDIAN MI MCD MERIDIAN MI MCD FARMINGTON MO 63640	10/12/2022 2:39:12 PM	lmurphy	3/28/2025 10:19:42 AM	cpaulino	10/1/2015 12:00:00 AM	3/28/2025 9:19:42 AM	False
ED	1392	False	MERIDIAN MCR DUAL COMPLETE OF MI	MERIDIAN MCR DUAL COMPLETE OF MI	PO BOX 3060		FARMINGTON	MO	63640							12	1701	3644	73558	2	1682	2	3			ED			233	MHPMI_2	PO BOX 3060 MERIDIAN MCR DUAL COMPLETE OF MI MERIDIAN MCR DUAL COMPLETE OF MI FARMINGTON MO 63640	10/24/2022 11:38:20 AM	CPAULINO	3/28/2025 10:23:39 AM	cpaulino	10/1/2015 12:00:00 AM	3/28/2025 9:23:39 AM	False
D	1393	False	UHC MEDICAID OF MI	UHC MEDICAID OF MI	PO BOX 30991		SALT LAKE CITY	UT	84130							8	1702	3643	1742	2	1682	2	3		0	D	0	False	233	95467	PO BOX 30991 UHC MEDICAID OF MI UHC MEDICAID OF MI SALT LAKE CITY UT 84130	10/24/2022 1:04:20 PM	CPAULINO	3/28/2025 10:22:00 AM	cpaulino	10/1/2015 12:00:00 AM	3/28/2025 9:22:00 AM	False
D	1395	False	HEALTH PARTNERS MEDICAID OF PA	HEALTH PARTNERS MEDICAID OF PA	PO BOX 981744		EL PASO	TX	79998							8	1702	3643	1742	2	1682	2	3		0	D	0	False	233	80142	PO BOX 981744 HEALTH PARTNERS MEDICAID OF PA HEALTH PARTNERS MEDICAID OF PA EL PASO TX 79998	11/2/2022 4:56:54 PM	lmurphy	3/28/2025 10:22:16 AM	cpaulino	10/1/2015 12:00:00 AM	3/28/2025 9:22:16 AM	False
ED	1396	False	AETNA MMAI OF MI	AETNA MMAI OF MI	PO BOX 981106		EL PASO	TX	79998							12	1701	3644	73558	2	1682	2	3		0	ED	0	False	233	60054_2	PO BOX 981106 AETNA MMAI OF MI AETNA MMAI OF MI EL PASO TX 79998	11/14/2022 9:15:00 AM	lmurphy	3/28/2025 10:25:06 AM	cpaulino	10/1/2015 12:00:00 AM	3/28/2025 9:25:06 AM	False
D	1397	False	HMP MEDICAID OF MI	HMP MEDICAID OF MI	PO BOX 2578		DETROIT	MI	48202							8	1702	3643	1742	2	1682	2	3		0	D	0	False	233	38224_3	PO BOX 2578 HMP MEDICAID OF MI HMP MEDICAID OF MI DETROIT MI 48202	11/21/2022 3:29:52 PM	lmurphy	3/28/2025 10:22:57 AM	cpaulino	10/1/2015 12:00:00 AM	3/28/2025 9:22:57 AM	False
ED	1398	False	COMMUNITY PACE MCR HMO	COMMUNITY PACE MCR HMO	PO BOX 21631		EAGAN	MN	55121							2	1701	3644	1741	2	1682	2	3		0	ED	0	False	233	27034_2	PO BOX 21631 COMMUNITY PACE MCR HMO COMMUNITY PACE MCR HMO EAGAN MN 55121	11/23/2022 11:36:53 AM	cpaulino	3/28/2025 10:27:26 AM	cpaulino	10/1/2015 12:00:00 AM	3/28/2025 9:27:26 AM	False
ED	1400	False	WELLMED MCR PPO	WELLMED MCR PPO	PO BOX 30508		SALT LAKE CITY	UT	84130							2	1701	3644	1741	2	1682	2	3		0	ED	0	False	233	WELM2	PO BOX 30508 WELLMED MCR PPO WELLMED MCR PPO SALT LAKE CITY UT 84130	12/7/2022 8:02:49 AM	lmurphy	3/28/2025 10:26:52 AM	cpaulino	10/1/2015 12:00:00 AM	3/28/2025 9:26:52 AM	False
ED	1401	False	HEALTH ALLIANCE PLAN MMAI	HEALTH ALLIANCE PLAN MMAI	PO BOX 21063		EAGAN	MN	55121							12	1701	3644	73558	2	1682	2	3		0	ED		False	233	38224_4	PO BOX 21063 HEALTH ALLIANCE PLAN MMAI HEALTH ALLIANCE PLAN MMAI EAGAN MN 55121	12/14/2022 1:22:17 PM	lmurphy	3/28/2025 10:24:10 AM	cpaulino	10/1/2015 12:00:00 AM	3/28/2025 9:24:10 AM	False
EDP	1403	False	OPTIMUM HEALTHCARE MMAI	OPTIMUM HEALTHCARE MMAI	PO BOX 151258		TAMPA	FL	33684							12	1701	3644	73558	2	1682	2	3			EDP	0	False	233	20133_1	PO BOX 151258 OPTIMUM HEALTHCARE MMAI OPTIMUM HEALTHCARE MMAI TAMPA FL 33684	12/27/2022 2:16:04 PM	lmurphy	5/23/2025 3:20:35 PM	cpaulino	10/1/2015 12:00:00 AM	5/23/2025 2:20:35 PM	False
ED	1406	False	BCBS MMAI OF OH	BCBS MMAI OF OH	PO BOX 10507		ATLANTA	GA	30348							12	1701	3644	73558	2	1682	2	3		0	ED	0	False	233	00332_1	PO BOX 10507 BCBS MMAI OF OH BCBS MMAI OF OH ATLANTA GA 30348	1/23/2023 2:26:20 PM	lmurphy	3/28/2025 10:23:16 AM	cpaulino	10/1/2015 12:00:00 AM	3/28/2025 9:23:16 AM	False
EDF	1408	False	ADVOCATE PHYSICIAN PARTNERS MMAI	ADVOCATE PHYSICIAN PARTNERS MMAI	PO BOX 0569		MOUNT PROSPECT	IL	60056							12	1701	3644	73558	2	1682	2	3			EDF			233	65093_6	PO BOX 0569 ADVOCATE PHYSICIAN PARTNERS MMAI ADVOCATE PHYSICIAN PARTNERS MMAI MOUNT PROSPECT IL 60056	1/30/2023 8:38:14 AM	CPAULINO	4/23/2026 3:13:33 PM	lmurphy	10/1/2015 12:00:00 AM	4/23/2026 2:13:33 PM	False
D	1417	False	BLUE CROSS COMPLETE OF MI MCD	BLUE CROSS COMPLETE OF MI MCD	PO BOX 7355		LONDON	KY	40742							8	1702	438374	1742	2	1682	2	3		0	D	0	False	233	32002	PO BOX 7355 BLUE CROSS COMPLETE OF MI MCD BLUE CROSS COMPLETE OF MI MCD LONDON KY 40742	3/2/2023 3:02:05 PM	CPAULINO	8/28/2025 2:54:49 PM	cpaulino	10/1/2015 12:00:00 AM	8/28/2025 1:54:49 PM	False
D	1418	False	UHC COMMUNITY MCD OH	UHC COMMUNITY MCD OH	PO BOX 8207		KINGSTON	NY	12402							8	1702	3643	1742	2	1682	2	3		0	D	0	False	233	88337	PO BOX 8207 UHC COMMUNITY MCD OH UHC COMMUNITY MCD OH KINGSTON NY 12402	3/3/2023 12:49:12 PM	CPAULINO	3/28/2025 10:22:05 AM	cpaulino	10/1/2015 12:00:00 AM	3/28/2025 9:22:05 AM	False
ED	1420	False	AETNA MEDICARE DUAL PPO-SNP	AETNA MEDICARE DUAL PPO-SNP	PO BOX 98116		EL PASO	TX	79998							12	1701	3644	73558	2	1682	2	3			ED			233	60054_7	PO BOX 98116 AETNA MEDICARE DUAL PPO-SNP AETNA MEDICARE DUAL PPO-SNP EL PASO TX 79998	3/13/2023 1:25:22 PM	CPAULINO	12/15/2025 9:23:57 AM	lmurphy	10/1/2015 12:00:00 AM	12/15/2025 8:23:57 AM	False
EDP	1421	False	UHC OPTUM AARP MCR ADV HMO	UHC OPTUM AARP MCR ADV HMO	PO BOX 30539		SALT LAKE CITY	UT	84130							2	1701	3644	1741	2	1682	2	3		0	EDP		False	233	LIFE1	PO BOX 30539 UHC OPTUM AARP MCR ADV HMO UHC OPTUM AARP MCR ADV HMO SALT LAKE CITY UT 84130	3/14/2023 9:15:45 AM	lmurphy	10/10/2025 11:43:05 AM	aszalai	10/1/2015 12:00:00 AM	10/10/2025 9:43:05 AM	False
D	1424	False	HAP EMPOWERED MCD	HAP EMPOWERED MCD	PO BOX 2578		DETROIT	MI	48202							8	1702	3643	1742	2	1682	2	3		0	D			233	38224_5	PO BOX 2578 HAP EMPOWERED MCD HAP EMPOWERED MCD DETROIT MI 48202	3/27/2023 2:28:13 PM	CPAULINO	3/28/2025 10:22:02 AM	cpaulino	10/1/2015 12:00:00 AM	3/28/2025 9:22:02 AM	False
EDP	1426	False	UPMC HEALTHCARE MMAI	UPMC HEALTHCARE MMAI	PO BOX 2997		PITTSBURG	PA	15230							12	1701	3644	73558	2	1682	2	3		0	EDP		False	233	23281_3	PO BOX 2997 UPMC HEALTHCARE MMAI UPMC HEALTHCARE MMAI PITTSBURG PA 15230	4/12/2023 2:19:20 PM	lmurphy	5/23/2025 3:22:01 PM	cpaulino	10/1/2015 12:00:00 AM	5/23/2025 2:22:01 PM	False
ED	1427	False	INDEPENDENT CARE HEALTH PLAN	INDEPENDENT CARE HEALTH PLAN	PO BOX 660346		DALLAS	TX	75266							2	1701	3644	1741	2	1682	2	3		0	ED			233	11695	PO BOX 660346 INDEPENDENT CARE HEALTH PLAN INDEPENDENT CARE HEALTH PLAN DALLAS TX 75266	4/25/2023 2:34:51 PM	CPAULINO	3/28/2025 10:31:03 AM	cpaulino	10/1/2015 12:00:00 AM	3/28/2025 9:31:03 AM	False
D	1429	False	SIMPLY MEDICAID	SIMPLY MEDICAID	PO BOX 61010		VIRGINIA BEACH	VA	23466							8	1702	3643	1742	2	1682	2	3		0	D		False	233	SMPLY_1	PO BOX 61010 SIMPLY MEDICAID SIMPLY MEDICAID VIRGINIA BEACH VA 23466	4/27/2023 1:27:44 PM	lmurphy	3/28/2025 10:20:32 AM	cpaulino	10/1/2015 12:00:00 AM	3/28/2025 9:20:32 AM	False
ED	1430	False	SIGNATURE ADVANTAGE MCR HMO	SIGNATURE ADVANTAGE MCR HMO	PO BOX 93720		LUBOCK	TX	79493							2	1701	3644	1741	2	1682	2	3		0	ED		False	233	SA001	PO BOX 93720 SIGNATURE ADVANTAGE MCR HMO SIGNATURE ADVANTAGE MCR HMO LUBOCK TX 79493	5/11/2023 1:16:12 PM	CPAULINO	3/28/2025 10:26:34 AM	cpaulino	10/1/2015 12:00:00 AM	3/28/2025 9:26:34 AM	False
ED	1431	False	ALLWELL WELLCARE MEDICARE PPO	ALLWELL WELLCARE MEDICARE PPO	PO BOX 3060 FARMINGTON		FARMINGTON	MO	63640							2	1701	3644	1741	2	1682	2	3			ED			233	68069_12	PO BOX 3060 FARMINGTON ALLWELL WELLCARE MEDICARE PPO ALLWELL WELLCARE MEDICARE PPO FARMINGTON MO 63640	5/23/2023 12:05:17 PM	CPAULINO	3/28/2025 10:29:34 AM	cpaulino	10/1/2015 12:00:00 AM	3/28/2025 9:29:34 AM	False
DP	1433	False	ZING HEALTH MCR DUAL HMO	ZING HEALTH MCR DUAL HMO	PO BOX 240599		APPLE VALLEY	MN	55124							12	1701	3644	73558	2	1682	2	3		0	DP			233	83248_1	PO BOX 240599 ZING HEALTH MCR DUAL HMO ZING HEALTH MCR DUAL HMO APPLE VALLEY MN 55124	6/20/2023 2:54:53 PM	lmurphy	3/19/2026 12:03:03 PM	lmurphy	10/1/2015 12:00:00 AM	3/19/2026 11:03:03 AM	False
ECD	1434	False	CAREPLUS DUAL HMO	CAREPLUS DUAL HMO	PO BOX 14697		LEXINGTON	KY	40512							12	1701	3644	73558	2	1682	2	3			ECD			233	95092_2	PO BOX 14697 CAREPLUS DUAL HMO CAREPLUS DUAL HMO LEXINGTON KY 40512	6/27/2023 10:01:09 AM	CPAULINO	3/28/2025 10:23:52 AM	cpaulino	10/1/2015 12:00:00 AM	3/28/2025 9:23:52 AM	False
D	1436	False	SONDER MCR ADV	SONDER MCR ADV	PO BOX 3325		SPRING HILL	FL	34611							2	1701	3644	1741	2	1682	2	3		0	D			233	A0339	PO BOX 3325 SONDER MCR ADV SONDER MCR ADV SPRING HILL FL 34611	7/7/2023 2:44:05 PM	lmurphy	3/28/2025 10:26:19 AM	cpaulino	10/1/2015 12:00:00 AM	3/28/2025 9:26:19 AM	False
D	1438	False	MOLINA MICHIGAN MMAI	MOLINA MICHIGAN MMAI	PO BOX 22668		LONG BEACH	CA	90981							12	1701	3644	73558	2	1682	2	3		0	D		False	233	38334_2	PO BOX 22668 MOLINA MICHIGAN MMAI MOLINA MICHIGAN MMAI LONG BEACH CA 90981	7/18/2023 12:54:39 PM	lmurphy	3/28/2025 10:23:56 AM	cpaulino	10/1/2015 12:00:00 AM	3/28/2025 9:23:56 AM	False
D	1443	False	AMERIHEALTH CARITAS VIP MMAI	AMERIHEALTH CARITAS VIP MMAI	PO BOX 7074		LONDON	KY	40742							2	1701	3644	1741	2	1682	2	3		0	D		False	233	77013	PO BOX 7074 AMERIHEALTH CARITAS VIP MMAI AMERIHEALTH CARITAS VIP MMAI LONDON KY 40742	8/17/2023 11:49:58 AM	cpaulino	3/4/2026 9:36:26 AM	cpaulino	10/1/2015 12:00:00 AM	3/4/2026 8:36:26 AM	False
ED	1447	False	BCBS OF MI MCR ADV	BCBS MED PPO ADV OF MI	PO BOX 32593		DETROIT	MI	48232							2	1701	1799	1741	2	1682	2	3			ED			233	12M85	PO BOX 32593 BCBS MED PPO ADV OF MI BCBS OF MI MCR ADV DETROIT MI 48232	9/25/2023 11:39:41 AM	cpaulino	9/17/2025 10:32:37 AM	cpaulino	10/1/2015 12:00:00 AM	9/17/2025 9:32:37 AM	False
D	1449	False	WELLPOINT/AMERIGROUP MCD	WELLPOINT/AMERIGROUP MCD	PO BOX 61010		VIRGINIA BEACH	VA	23466							8	1702	3643	1742	2	1682	2	3		0	D			233	26375_7	PO BOX 61010 WELLPOINT/AMERIGROUP MCD WELLPOINT/AMERIGROUP MCD VIRGINIA BEACH VA 23466	10/18/2023 12:45:22 PM	lmurphy	3/28/2025 10:19:23 AM	cpaulino	10/1/2015 12:00:00 AM	3/28/2025 9:19:23 AM	False
DP	1450	False	UHC DUAL OF COMPLETE SNP	UHC DUAL COMPLETE SNP OF MI	PO BOX 30991		SALT LAKE CITY	UT	84130							12	1701	3644	73558	2	1682	2	3		0	DP			233	95467_2	PO BOX 30991 UHC DUAL COMPLETE SNP OF MI UHC DUAL OF COMPLETE SNP SALT LAKE CITY UT 84130	10/23/2023 12:34:29 PM	CPAULINO	5/23/2025 3:21:42 PM	cpaulino	10/1/2015 12:00:00 AM	5/23/2025 2:21:42 PM	False
D	1451	False	CARESOURCE MEDICAID OF MICHIGAN	CARESOURCE MCD OF MICHIGAN	PO BOX 1186		DAYTON	OH	45401							8	1702	3643	1742	2	1682	2	3		0	D			233	MIMCDCS1	PO BOX 1186 CARESOURCE MCD OF MICHIGAN CARESOURCE MEDICAID OF MICHIGAN DAYTON OH 45401	11/8/2023 11:38:13 AM	CPAULINO	3/28/2025 10:22:12 AM	cpaulino	10/1/2015 12:00:00 AM	3/28/2025 9:22:12 AM	False
D	1456	False	HIGHMARK COMMUNITY BLUE MCR HMO	HIGHMARK COMMUNITY BLUE MCR HMO	PO BOX 890062		CAMP HILL	PA	17089							2	1701	3644	1741	2	1682	2	3		0	D			233	54771C_2	PO BOX 890062 HIGHMARK COMMUNITY BLUE MCR HMO HIGHMARK COMMUNITY BLUE MCR HMO CAMP HILL PA 17089	3/18/2024 9:06:16 AM	lmurphy	3/28/2025 10:28:31 AM	cpaulino	10/1/2015 12:00:00 AM	3/28/2025 9:28:31 AM	False
D	1457	False	MEDICAL MUTUAL MCR HMO	MEDICAL MUTUAL MCR HMO	PO BOX 6018		CLEVELAND	OH	44101							2	1701	3644	1741	2	1682	2	3		0	D			233	29076_1	PO BOX 6018 MEDICAL MUTUAL MCR HMO MEDICAL MUTUAL MCR HMO CLEVELAND OH 44101	4/23/2024 11:58:41 AM	lmurphy	3/28/2025 10:30:44 AM	cpaulino	10/1/2015 12:00:00 AM	3/28/2025 9:30:44 AM	False
D	1461	False	BLUE CARE NETWORK OF MICHIGAN MCR REP	BLUE CARE NETWORK OF MICHIGAN MCR REP	BOX 68710		GRAND RAPIDS	MI	49516-8710							2	1701	438374	1741	2	1682	2	3		0	D			233	00210_1	BOX 68710 BLUE CARE NETWORK OF MICHIGAN MCR REP BLUE CARE NETWORK OF MICHIGAN MCR REP GRAND RAPIDS MI 49516-8710	5/30/2024 2:34:25 PM	cpaulino	3/28/2025 10:30:07 AM	cpaulino	10/1/2015 12:00:00 AM	3/28/2025 9:30:07 AM	False
D	1462	False	SONDER MEDICARE DUAL HMO	SONDER MCR DUAL HMO	PO BOX 3325		SPRING HILL	FL	34611							12	1701	3644	73558	2	1682	2	3		0	D	0	False	233	A0339_2	PO BOX 3325 SONDER MCR DUAL HMO SONDER MEDICARE DUAL HMO SPRING HILL FL 34611	7/10/2024 9:21:39 AM	cpaulino	3/28/2025 10:24:45 AM	cpaulino	10/1/2015 12:00:00 AM	3/28/2025 9:24:45 AM	False
D	1463	False	MOLINA HEALTHCARE OF ILLINOIS MMAI	MOLINA HEALTHCARE OF ILLINOIS MMAI	PO BOX 540		LONG BEACH	CA	90801	USA		4408353511				12	1701	3644	73558	2	1682	2	3	116	0	D	0	False	233	20934_4	PO BOX 540 MOLINA HEALTHCARE OF ILLINOIS MMAI MOLINA HEALTHCARE OF ILLINOIS MMAI LONG BEACH CA 90801	7/22/2024 9:51:18 AM	acarroll	6/18/2025 10:04:14 AM	lmurphy	10/1/2015 12:00:00 AM	6/18/2025 9:04:14 AM	False
D	1465	False	GEISINGER INDEMNITY INS CO	GEISINGER INDEMNITY INS CO	100 N ACADEMY AVE STE 32-51		DANVILLE	PA	17822	USA						2	1701	3644	1741	2	1682	2	3		0	D	0	False	233	INSTAMED	100 N ACADEMY AVE STE 32-51 GEISINGER INDEMNITY INS CO GEISINGER INDEMNITY INS CO DANVILLE PA 17822	7/23/2024 2:40:06 PM	acarroll	3/28/2025 10:28:53 AM	cpaulino	10/1/2015 12:00:00 AM	3/28/2025 9:28:53 AM	False
D	1466	True	BLUE CROSS BLUE SHIELD OF MI MCR REP	BLUE CROSS BLUE SHIELD OF MI MCR REP	P.O. BOX 553912		DETROIT	MI	48255	USA						2	1701	3644	1741	2	1682	2	3		0	D	0	False	233	BCBSM	P.O. BOX 553912 BLUE CROSS BLUE SHIELD OF MI MCR REP BLUE CROSS BLUE SHIELD OF MI MCR REP DETROIT MI 48255	7/23/2024 3:09:13 PM	acarroll	12/3/2025 10:58:47 AM	cpaulino	10/1/2015 12:00:00 AM	12/3/2025 9:58:47 AM	False
D	1467	False	ANTHEM HEALTH PLANS OF NH	ANTHEM HEALTH PLANS OF NH	3075 VANDERCAR WAY		CINCINNATI	OH	45209	USA						2	1701	3644	1741	2	0	2	3		0	D	0	False	233	00770	3075 VANDERCAR WAY ANTHEM HEALTH PLANS OF NH ANTHEM HEALTH PLANS OF NH CINCINNATI OH 45209	7/23/2024 4:12:00 PM	acarroll	3/28/2025 10:28:19 AM	cpaulino	10/1/2015 12:00:00 AM	3/28/2025 9:28:19 AM	False
D	1468	False	VSHP TENNCARE SELECT	VSHP TENNCARE SELECT	ONE CAMERON HILL CIRCLE		CHATTANOOGA	TN	37402	USA						2	1701	2398	1741	2	1682	2	3		0	D	0	False	233	00390_6	ONE CAMERON HILL CIRCLE VSHP TENNCARE SELECT VSHP TENNCARE SELECT CHATTANOOGA TN 37402	7/26/2024 11:44:10 AM	acarroll	3/28/2025 10:28:22 AM	cpaulino	10/1/2015 12:00:00 AM	3/28/2025 9:28:22 AM	False
D	1469	False	PEACH STATE HEALTHPLAN	PEACH STATE HEALTHPLAN	3200 HIGHLANDS PARKWAY SE-SUITE 300		SMYRNA	GA	30082	USA						8	1702	3643	1742	2	1682	2	3		0	D	0	False	233	CNC00003	3200 HIGHLANDS PARKWAY SE-SUITE 300 PEACH STATE HEALTHPLAN PEACH STATE HEALTHPLAN SMYRNA GA 30082	7/29/2024 11:23:46 AM	acarroll	3/28/2025 10:20:58 AM	cpaulino	10/1/2015 12:00:00 AM	3/28/2025 9:20:58 AM	False
D	1472	False	FLORIDA COMMUNITY CARE	FLORIDA COMMUNITY CARE	PO BOX 211322		EAGAN	MN	55121							8	1702	3643	1742	2	1682	2	3		0	D			233	FLCCR	PO BOX 211322 FLORIDA COMMUNITY CARE FLORIDA COMMUNITY CARE EAGAN MN 55121	10/15/2024 10:10:59 AM	lmurphy	3/28/2025 10:21:28 AM	cpaulino	10/1/2015 12:00:00 AM	3/28/2025 9:21:28 AM	False
D	1473	False	MCLAREN MEDICIAD	MCLAREN MCD REP	PO BOX 1511		FLINT	MI	48501			8883270671				8	1702	3643	1742	2	1682	2	3			D			233	3833C_1	PO BOX 1511 MCLAREN MCD REP MCLAREN MEDICIAD FLINT MI 48501	11/11/2024 2:39:25 PM	cpaulino	3/28/2025 10:21:32 AM	cpaulino	10/1/2015 12:00:00 AM	3/28/2025 9:21:32 AM
D	1474	False	ALIGN SENIOR CARE	ALIGN SENIOR CARE MCR REP	PO BOX 40		GLEN BURNIE	MD	21060			8558550336				2	1701	3644	1741	2	1682	2	3			D			233	ASMI1	PO BOX 40 ALIGN SENIOR CARE MCR REP ALIGN SENIOR CARE GLEN BURNIE MD 21060	11/12/2024 1:32:28 PM	cpaulino	3/28/2025 10:29:21 AM	cpaulino	10/1/2015 12:00:00 AM	3/28/2025 9:29:21 AM
D	1477	False	AMERIHEALTH CARITAS OH MCD	AMERIHEALTH CARITAS OH MCD	PO BOX 7126		LONDON	KY	40742							8	1702	3643	1742	2	1682	2	3		0	D	0		233	35374	PO BOX 7126 AMERIHEALTH CARITAS OH MCD AMERIHEALTH CARITAS OH MCD LONDON KY 40742	11/25/2024 2:21:17 PM	cpaulino	3/28/2025 10:21:53 AM	cpaulino	10/1/2015 12:00:00 AM	3/28/2025 9:21:53 AM
D	1478	False	CCA HEALTH	CCA HEALTH MCR	PO BOX 21063		EAGAN	MN	55121							2	1701	3644	1741	2	1682	2	3		0	D	0		233	RHP01	PO BOX 21063 CCA HEALTH MCR CCA HEALTH EAGAN MN 55121	11/26/2024 3:25:50 PM	cpaulino	3/28/2025 10:30:01 AM	cpaulino	10/1/2015 12:00:00 AM	3/28/2025 9:30:01 AM
D	1482	False	INNERMARK MCR TPA	INNERMARK MCR TPA	PO BOX 21002		EAGAN	MN	55121							2	1701	3644	1741	2	1682	2	3		0	D	0		233	98481	PO BOX 21002 INNERMARK MCR TPA INNERMARK MCR TPA EAGAN MN 55121	1/27/2025 2:41:33 PM	cpaulino	3/28/2025 10:31:07 AM	cpaulino	10/1/2015 12:00:00 AM	3/28/2025 9:31:07 AM
D	1483	False	KAISER PERMANENTE NORTH MCR REP	KAISER PERMANENTE NORTH MCR REP	PO BOX 8002		PLEASANTON	CA	94588							2	1701	3644	1741	2	1682	2	3			D	0		233	94135	PO BOX 8002 KAISER PERMANENTE NORTH MCR REP KAISER PERMANENTE NORTH MCR REP PLEASANTON CA 94588	1/30/2025 1:28:29 PM	cpaulino	3/28/2025 10:31:23 AM	cpaulino	10/1/2015 12:00:00 AM	3/28/2025 9:31:23 AM
D	1484	False	AMERIHEALTH CARITAS MCR DUAL VIP CARE HMO	AMERIHEALTH CARITAS MCR DUAL VIP CARE HMO	PO BOX 7143		LONDON	KY	40742							12	1703	3644	73558	2	1682	2	3		0	D		False	233	77062_3	PO BOX 7143 AMERIHEALTH CARITAS MCR DUAL VIP CARE HMO AMERIHEALTH CARITAS MCR DUAL VIP CARE HMO LONDON KY 40742	1/31/2025 12:12:03 PM	cpaulino	3/28/2025 10:25:12 AM	cpaulino	10/1/2015 12:00:00 AM	3/28/2025 9:25:12 AM
D	1485	False	HIGHMARK WHOLECARE MCR DIAMOND DUAL HMO	HIGHMARK WHOLECARE MCR DIAMOND DUAL HMO	PO BOX 221164		EAGAN	MN	55121							12	1701	3644	73558	2	1682	2	3		0	D		False	233	60550_2	PO BOX 221164 HIGHMARK WHOLECARE MCR DIAMOND DUAL HMO HIGHMARK WHOLECARE MCR DIAMOND DUAL HMO EAGAN MN 55121	2/28/2025 3:57:41 PM	cpaulino	3/28/2025 10:24:32 AM	cpaulino	10/1/2015 12:00:00 AM	3/28/2025 9:24:33 AM
D	1487	False	CIGNA HEALTHSPRING MCR HMO	CIGNA HEALTHSPRING MCR HMO	PO BOX 981706		EL PASO	TX	79998							2	1701	3644	1741	2	1682	2	3		0	D	0		233	52192_4	PO BOX 981706 CIGNA HEALTHSPRING MCR HMO CIGNA HEALTHSPRING MCR HMO EL PASO TX 79998	3/17/2025 1:43:59 PM	cpaulino	3/27/2026 9:57:29 AM	cpaulino	10/1/2015 12:00:00 AM	3/27/2026 8:57:29 AM
D	1488	False	JEFFERSON HEALTH PLAN FLEX MCR PPO	JEFFERSON HEALTH PLAN FLEX MCR PPO	PO BOX 21921		EAGAN	MN	55121							2	1701	3644	1741	2	1682	2	3			D			233	RP099	PO BOX 21921 JEFFERSON HEALTH PLAN FLEX MCR PPO JEFFERSON HEALTH PLAN FLEX MCR PPO EAGAN MN 55121	3/27/2025 11:09:32 AM	cpaulino	3/28/2025 10:31:29 AM	cpaulino	10/1/2015 12:00:00 AM	3/28/2025 9:31:29 AM
EDP	1530	False	ANTHEM BCBS MCR DUAL OF IN	ANTHEM BCBS MCR DUAL OF IN	PO BOX 105187		ATLANTA	GA	30348							12	1701	3643	73558	2	1682	2	3			EDP			233	00130_5	PO BOX 105187 ANTHEM BCBS MCR DUAL OF IN ANTHEM BCBS MCR DUAL OF IN ATLANTA GA 30348	7/18/2025 12:16:28 PM	cpaulino	12/10/2025 10:06:37 AM	cpaulino	10/1/2015 12:00:00 AM	12/10/2025 9:06:37 AM
ED	1543	False	HUMANA	HUMANA CAREPLUS MCR FL	PO BOX 14601		LEXINGTON	KY	40512							2	1701	3644	1741	2	1682	2	3		0	ED		False	233	61101_6	PO BOX 14601 HUMANA CAREPLUS MCR FL HUMANA LEXINGTON KY 40512	5/12/2026 10:51:16 AM	cpaulino	6/2/2026 12:19:17 PM	lmurphy	10/1/2015 12:00:00 AM	6/2/2026 11:19:17 AM
ED	1545	False	AMERICAN HEALTH MCR OF FL	AMERICAN HEALTH MCR OF FL	PO BOX 31039		TAMPA	FL	33631							2	1701	3644	1741	2	1682	2	3		0	ED	0		233	31150	PO BOX 31039 AMERICAN HEALTH MCR OF FL AMERICAN HEALTH MCR OF FL TAMPA FL 33631	7/6/2026 2:06:20 PM	cpaulino	7/6/2026 2:07:18 PM	cpaulino	10/1/2015 12:00:00 AM	7/6/2026 1:07:18 PM

Download as Spreadsheet

Ledger	InsuranceCarriersId	Inactive	Name	ListName	Address1	Address2	City	State	Zip	Phone1	Phone1Type	InsuranceGroupId	CollectionsGroupMId	CarrierTypeMId	FinancialClassMId	AllocationSetId	FilingMethodMId	FilingType	TransactionColumnSetId	IncludeClaimOfficeNo	Ledger1	Notes	RequiresAuth	ReferenceCarrier	AcceptAssignmentMId	DotId	Keyword	Created	CreatedBy	LastModified	LastModifiedBy	ICD10SERVICEDATE	InsSOP_db_Updated_Date	AUC
C	1	False	MEDICARE A & B	MEDICARE A & B	Po box 2711		Jacksonsville	FL	32211	8776028816		1	1701	1799	1738	2	1682	2	3	0	C				233	1	PO BOX 2711 MEDICARE A & B MEDICARE A & B JACKSONSVILLE FL 32211	2/22/2010 10:05:52 AM	cammy	5/13/2026 11:11:23 AM	gaia-melisha	10/1/2015 12:00:00 AM	5/13/2026 11:11:23 AM	False
C	4	False	Self Pay	Self Pay								9	1701	91	1743	2	0	0	3	0	C		0	False	233	4	SELF PAY SELF PAY	8/31/2015 3:04:10 PM	gaia-brenda	9/2/2025 1:16:56 PM	gaia-cary	10/1/2015 12:00:00 AM	9/2/2025 1:16:56 PM	False
C	6	False	Pending Insurance	Pending Insurance								9	1701	80	1743	2	0	0	2	0	C		0	False	233	6	PENDING INSURANCE PENDING INSURANCE	11/2/2015 3:24:43 PM	gaia-brenda	4/28/2025 8:47:07 AM	gaia-cary	10/1/2015 12:00:00 AM	4/28/2025 8:47:07 AM	False
C	9	False	MEDICARE ACUTE	MEDICARE ACUTE	PO BOX 2711		Jacksonsville	FL	32211			1	1701	1799	1738	2	1682	2	3	0	C		0	False	233	9	PO BOX 2711 MEDICARE ACUTE MEDICARE ACUTE JACKSONSVILLE FL 32211	1/31/2017 10:45:03 AM	GAIA-JENNIFER	11/20/2024 7:14:52 AM	gaia-jennifer	10/1/2015 12:00:00 AM	11/20/2024 5:14:52 AM	False
C	12	False	Simply MCR	Simply MCR	PO Box 61010		Virginia Beach	VA	23466	8005144561		7	1701	1799	1741	2	1682	2	3	0	C		0	False	233	12	PO BOX 61010 SIMPLY MCR SIMPLY MCR VIRGINIA BEACH VA 23466	7/6/2017 8:19:26 AM	gaia-renee	9/23/2024 3:44:28 PM	gaia-Tricia	10/1/2015 12:00:00 AM	9/23/2024 3:44:28 PM	False
C	18	False	UHC MCR	UHC MCR	P O BOX 31362		Salt Lake City	UT	84131-0362	8778423210		7	1701	1799	1741	2	1682	2	3	0	C		0	False	233	18	P O BOX 31362 UHC MCR UHC MCR SALT LAKE CITY UT 84131-0362	7/27/2018 11:22:09 AM	gaia-renee	5/1/2023 11:58:37 AM	gaia-vicki	10/1/2015 12:00:00 AM	5/1/2023 11:58:37 AM	False
C	21	False	UHC PCP MCR HMO-POS	UHC PCP MCR HMO-POS	PO Box 30448		Salt Lake City	UT	84130	8778423210		7	1701	1799	1741	2	1682	2	2	0	C			False	233	21	PO BOX 30448 UHC PCP MCR HMO-POS UHC PCP MCR HMO-POS SALT LAKE CITY UT 84130	11/13/2018 2:45:02 PM	gaia-michael	4/15/2026 12:42:18 PM	gaia-Lydia	10/1/2015 12:00:00 AM	4/15/2026 12:42:18 PM	False
C	24	False	Doctors Healthcare MCR	Doctors Healthcare MCR	2020 Ponce De Leon Blvd	PH 1	Coral Gables	FL	33134	3054229300		7	1701	1799	1741	2	1682	2	3	0	C				233	24	2020 PONCE DE LEON BLVD PH 1 DOCTORS HEALTHCARE MCR DOCTORS HEALTHCARE MCR CORAL GABLES FL 33134	1/27/2020 10:44:45 AM	gaia-michael	5/1/2023 11:50:58 AM	gaia-vicki	10/1/2015 12:00:00 AM	5/1/2023 11:50:58 AM	False
C	27	False	Molina MCR	Molina MCR	PO BOX 22811		Long Beach	CA	90801	8553224076	Home	7	1701	1799	1741	2	1682	2	3	0	C		0	False	233	66	PO BOX 22811 MOLINA MCR MOLINA MCR LONG BEACH CA 90801	6/3/2020 7:36:45 AM	gaia-mwhite	11/20/2024 7:09:35 AM	gaia-jennifer	10/1/2015 12:00:00 AM	11/20/2024 5:09:35 AM	False
C	33	True	UHC DUAL MCR/MCD	UHC DUAL MCR/MCD	PO BOX 31362		Salt Lake City	UT	84131	8778423210		7	1701	1799	1741	2	1682	2	3	0	C	DO NOT USE DUAL PROFILES			233	33	PO BOX 31362 UHC DUAL MCR/MCD UHC DUAL MCR/MCD SALT LAKE CITY UT 84131	2/2/2021 7:52:22 AM	gaia-michael	6/16/2025 1:08:27 PM	gaia-nina	10/1/2015 12:00:00 AM	6/16/2025 1:08:27 PM	False
C	34	True	MEDICA DUAL MCR/MCD	MEDICA DUAL MCR/MCD	PO BOX 30448		Salt Lake City	UT	84130	8003485548		7	1701	1799	1741	2	1682	2	3	0	C	DO NOT USE DUAL PROFILES	0	False	233	34	PO BOX 30448 MEDICA DUAL MCR/MCD MEDICA DUAL MCR/MCD SALT LAKE CITY UT 84130	3/3/2021 7:22:01 AM	gaia-michael	6/16/2025 1:07:57 PM	gaia-nina	10/1/2015 12:00:00 AM	6/16/2025 1:07:57 PM	False
C	42	True	Preferred Care Partners Dual MCR/MCD	Preferred Care Partners Dual MCR/MCD	PO Box 30448		Salt Lake City	UT	84130	8662317220		7	1701	1799	1741	2	1682	2	3	0	C	DO NOT USE DUAL PROFILES	0	False	233	42	PO BOX 30448 PREFERRED CARE PARTNERS DUAL MCR/MCD PREFERRED CARE PARTNERS DUAL MCR/MCD SALT LAKE CITY UT 84130	1/31/2022 11:28:59 AM	gaia-amanda	6/16/2025 1:08:12 PM	gaia-nina	10/1/2015 12:00:00 AM	6/16/2025 1:08:12 PM	False
C	44	False	Bright Health MCR	Bright Health MCR	PO Box 211502		Eagan	MN	55121	8442024463		7	1701	1799	1741	2	1682	2	3	0	C		0	False	233	44	PO BOX 211502 BRIGHT HEALTH MCR BRIGHT HEALTH MCR EAGAN MN 55121	2/7/2022 1:55:24 PM	gaia-michael	5/1/2023 11:48:55 AM	gaia-vicki	10/1/2015 12:00:00 AM	5/1/2023 11:48:55 AM	False
C T	1045	False	MEDICARE PART A ONLY	MEDICARE PART A ONLY	PO BOX 2711		Jacksonsville	FL	32211			1	1701	1799	1738	2	1682	2	3		C T				233	1045	PO BOX 2711 MEDICARE PART A ONLY MEDICARE PART A ONLY JACKSONSVILLE FL 32211	5/2/2022 8:33:27 AM	gaia-michael	4/30/2026 10:05:26 AM	gaia-melisha	10/1/2015 12:00:00 AM	4/30/2026 10:05:26 AM	False
C	1046	False	WELLCARE MCR	WELLCARE MCR	PO BOX 31372		Tampa	FL	33631	8555380454		7	1701	1799	1741	2	1682	2	2	0	C		0	False	233	1046	PO BOX 31372 WELLCARE MCR WELLCARE MCR TAMPA FL 33631	6/13/2022 10:48:30 AM	gaia-michael	4/15/2026 2:03:25 PM	gaia-Lydia	10/1/2015 12:00:00 AM	4/15/2026 2:03:25 PM	False

Download as Spreadsheet

Ledger	InsuranceCarriersId	MasterInsuranceCarriersId	Inactive	Name	ListName	Address1	Address2	City	State	Zip	Country	Contact	Phone1	Phone1Type	Phone2	Phone2Type	Phone3	Phone3Type	InsuranceGroupId	CollectionsGroupMId	CarrierTypeMId	FinancialClassMId	AllocationSetId	FilingMethodMId	FilingType	TransactionColumnSetId	PolicyTypeMId	CopayAmt	Deductible	GroupId	GroupName	MediGapId	OrgId	IncludeClaimOfficeNo	LocationId	PPOId	ECSClearinghouseId	ECSPayorId	ECSClaimOfficeNumber	ECSNEIC	UseRenderingProviderId	RequiresPIN	ECSMaximumNumberOfProcedures	ELIMIKDestination	ELIClearinghouseId	ELIPayorId	ELIMessageType	ElectronicFilingStatus	SupplementalFiling	Ledger1	Notes	AlertNotes	RequiresAuth	ReferenceCarrier	PayerIdNumberCodeMId	OtherPayerIdNumber	SubscriberIDMask	AcceptAssignmentMId	DotId	PartnerInsuranceCarriersId	PreAuthorizationFormType	PreAuthorizationFormFile	Keyword	OrderNotes	Created	CreatedBy	LastModified	LastModifiedBy	CountrySubdiv	ICD10SERVICEDATE	InsSourceOfPaymentsID	InsSOP_db_Updated_Date	AUC
C	1		False	SELF PAY	SELF PAY														7	1701	91	1743	2	0	0	3		0	0					0																C								233	1				SELF PAY SELF PAY		2/22/2010 10:05:52 AM	cammy	8/23/2022 3:34:04 PM	gaia-bruce		10/1/2014 12:00:00 AM		8/23/2022 3:34:04 PM	False
C	3		False	MEDICARE A&B	MEDICARE A&B	PO BOX 2711		Jacksonville	FL	32211			8776028816						1	1701	1799	1738	2	1682	2	2		0	0					0																C			0	False				233	3				PO BOX 2711 MEDICARE A&B MEDICARE A&B JACKSONVILLE FL 32211		8/23/2022 3:28:21 PM	gaia-bruce	5/13/2026 11:24:49 AM	gaia-melisha		10/1/2015 12:00:00 AM		5/13/2026 11:24:49 AM	False

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Ledger	InsuranceCarriersId	Inactive	Name	ListName	Address1	City	State	Zip	Phone1	InsuranceGroupId	CollectionsGroupMId	CarrierTypeMId	FinancialClassMId	AllocationSetId	FilingMethodMId	FilingType	TransactionColumnSetId	IncludeClaimOfficeNo	Ledger1	RequiresAuth	ReferenceCarrier	AcceptAssignmentMId	DotId	Keyword	Created	CreatedBy	LastModified	LastModifiedBy	ICD10SERVICEDATE	InsSOP_db_Updated_Date	AUC
C	1	False	MEDICARE PART A & B	MEDICARE PART A & B	PO Box 2711	JACKSONVILLE	FL	32211	8776028816	1	1701	1799	1738	2	1682	2	3	0	C			233	1	PO BOX 2711 MEDICARE PART A & B MEDICARE PART A & B JACKSONVILLE FL 32211	2/22/2010 10:05:52 AM	cammy	5/1/2023 12:37:08 PM	gaia-cary	10/1/2015 12:00:00 AM	5/1/2023 12:37:08 PM	False
C	13	False	Pending	Pending						1	1701	91	1743	2	0	0	3	0	C	0	False	233	13	PENDING PENDING	6/2/2016 1:31:08 PM	gaia-renee	9/26/2018 7:46:47 AM	gaia-jennifer	10/1/2015 12:00:00 AM		False
C	22	False	PREFERRED CARE PARTNERS MCR DUAL	PREFERRED CARE PARNTERS MCR DUAL	Po Box 30448	Salt Lake City	UT	84130	8667259334	6	1701	1799	1741	2	1682	2	3	0	C	0		233	22	PO BOX 30448 PREFERRED CARE PARNTERS MCR DUAL PREFERRED CARE PARTNERS MCR DUAL SALT LAKE CITY UT 84130	1/3/2017 2:20:06 PM	gaia-brenda	5/1/2023 12:39:17 PM	gaia-cary	10/1/2015 12:00:00 AM	5/1/2023 12:39:17 PM	False
C	23	False	MEDICARE ACUTE	MEDICARE ACUTE	PO BOX 2711	JACKSONVILLE	FL	32211		1	1701	1799	1746	2	1682	2	3	0	C	0	False	233	23	PO BOX 2711 MEDICARE ACUTE MEDICARE ACUTE JACKSONVILLE FL 32211	1/31/2017 11:07:14 AM	GAIA-JENNIFER	5/1/2023 12:36:48 PM	gaia-cary	10/1/2015 12:00:00 AM	5/1/2023 12:36:48 PM	False
C	24	False	Elderplan MCR HMO	Elderplan MCR HMO	Po Box 73111	Newnan	GA	30271	8003533765	6	1701	1799	1741	2	1682	2	3	0	C	0	False	233	24	PO BOX 73111 ELDERPLAN MCR HMO ELDERPLAN MCR HMO NEWNAN GA 30271	2/2/2017 12:53:45 PM	gaia-brenda	5/1/2023 12:33:05 PM	gaia-cary	10/1/2015 12:00:00 AM	5/1/2023 12:33:05 PM	False
C	38	False	WellCare MCR	WellCare MCR	P O BOX 31372	Tampa	FL	33631-3372	8555380454	6	1701	1799	1741	2	1682	2	3	0	C	0	False	233	38	P O BOX 31372 WELLCARE MCR WELLCARE MCR TAMPA FL 33631-3372	8/20/2018 12:04:34 PM	gaia-renee	5/1/2023 12:42:53 PM	gaia-cary	10/1/2015 12:00:00 AM	5/1/2023 12:42:53 PM	False
c	50	False	BRIGHT HEALTH CM	BRIGHT HEALTH CM	PO BOX 16275	READING	PA	19612	8662397191	4	1701	104	1744	2	1682	2	2	0	c	0	False	233	50	PO BOX 16275 BRIGHT HEALTH CM BRIGHT HEALTH CM READING PA 19612	2/12/2021 10:12:45 AM	gaia-michael	5/1/2023 12:29:38 PM	gaia-cary	10/1/2015 12:00:00 AM	5/1/2023 12:29:38 PM	False
C	53	False	MEDICARE PART A ONLY	MEDICARE PART A ONLY	PO BOX 2711	JACKSONVILLE	FL	32211		1	1701	1799	1738	2	1682	2	3		C			233	53	PO BOX 2711 MEDICARE PART A ONLY MEDICARE PART A ONLY JACKSONVILLE FL 32211	5/2/2022 12:14:04 PM	gaia-michael	5/1/2023 12:37:36 PM	gaia-cary	10/1/2015 12:00:00 AM	5/1/2023 12:37:36 PM	False
C	55	False	Healthsun MCR	Healthsun MCR	PO Box 211154	Eagan	MN	55121	3052349292	6	1701	1799	1741	2	1682	2	3	0	C	0	False	233	55	PO BOX 211154 HEALTHSUN MCR HEALTHSUN MCR EAGAN MN 55121	12/12/2022 10:47:02 AM	gaia-michael	5/1/2023 12:33:56 PM	gaia-cary	10/1/2015 12:00:00 AM	5/1/2023 12:33:56 PM	False

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Ledger	InsuranceCarriersId	Inactive	Name	ListName	Address1	Address2	City	State	Zip	Phone1	Phone2	InsuranceGroupId	CollectionsGroupMId	CarrierTypeMId	FinancialClassMId	AllocationSetId	FilingMethodMId	FilingType	TransactionColumnSetId	IncludeClaimOfficeNo	Ledger1	ReferenceCarrier	AcceptAssignmentMId	DotId	PreAuthorizationFormType	Keyword	Created	CreatedBy	LastModified	LastModifiedBy	ICD10SERVICEDATE	InsSOP_db_Updated_Date	AUC
C	1	False	MEDICARE PART A&B	MEDICARE PART A&B	PO Box 6475		Indianapolis	IN	46306	8773094290	8777020990	1	1701	1799	1738	2	1682	2	3	0	C		233	1		PO BOX 6475 MEDICARE PART A&B MEDICARE PART A&B INDIANAPOLIS IN 46306	2/22/2010 10:05:52 AM	cammy	6/10/2020 8:42:10 AM	gaia-jennifer	1/1/2018 12:00:00 AM	6/10/2020 8:42:09 AM	False
C	17	False	OSCAR HEALTH	OSCAR HEALTH	PO Box 52146		Phoenix	AZ	85072	8556722755		4	1703	105	1744	2	1682	2	2	0	C	False	233	17		PO BOX 52146 OSCAR HEALTH OSCAR HEALTH PHOENIX AZ 85072	2/11/2022 4:52:48 PM	ksyed	3/31/2022 11:48:00 AM	gaia-andrea	10/1/2015 12:00:00 AM	3/31/2022 11:48:00 AM	False
C	19	False	AARP Medicare Advantage Plan	AARP Medicare Advantage Plan	United Healthcare Insurance Plan	PO BOX 31362	Salt Lake	UT	84131			1	1701	80	1738	2	1682	2	3		C		233	9	D	UNITED HEALTHCARE INSURANCE PLAN PO BOX 31362 AARP MEDICARE ADVANTAGE PLAN AARP MEDICARE ADVANTAGE PLAN SALT LAKE UT 84131	1/9/2023 5:06:29 PM	ksyed	1/9/2023 5:17:35 PM	ksyed	10/1/2015 12:00:00 AM	1/9/2023 4:17:35 PM	False

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Ledger	InsuranceCarriersId	Inactive	Name	ListName	Address1	City	State	Zip	Phone1	Phone2	InsuranceGroupId	CollectionsGroupMId	CarrierTypeMId	FinancialClassMId	AllocationSetId	FilingMethodMId	FilingType	TransactionColumnSetId	IncludeClaimOfficeNo	Ledger1	RequiresAuth	ReferenceCarrier	AcceptAssignmentMId	DotId	Keyword	Created	CreatedBy	LastModified	LastModifiedBy	ICD10SERVICEDATE	InsSOP_db_Updated_Date	AUC
C	1	False	MEDICARE PART A & B	MEDICARE PART A & B	PO BOX 2711	Jacksonville	FL	32231	8776028816	8886644112	1	1701	1799	1738	2	1682	2	3	0	C			233	1	PO BOX 2711 MEDICARE PART A & B MEDICARE PART A & B JACKSONVILLE FL 32231	2/22/2010 10:05:52 AM	cammy	5/13/2026 11:26:52 AM	gaia-melisha	10/1/2015 12:00:00 AM	5/13/2026 11:26:52 AM	False
C	14	False	PENDING INSURANCE	PENDING INSURANCE	DO NOT BILL	LIGHT HOUSE POINT	FL	33064			6	1701	80	1743	2	0	0	2		C			233	14	DO NOT BILL PENDING INSURANCE PENDING INSURANCE LIGHT HOUSE POINT FL 33064	12/19/2019 10:31:56 AM	gaia-jennifer	4/28/2025 8:50:02 AM	gaia-cary	10/1/2015 12:00:00 AM	4/28/2025 8:50:02 AM	False
C	23	False	MEDICARE PART ACUTE	MEDICARE PART ACUTE	PO BOX 2711	Jacksonville	FL	32231			1	1701	1799	1738	2	1682	2	3		C			233	23	PO BOX 2711 MEDICARE PART ACUTE MEDICARE PART ACUTE JACKSONVILLE FL 32231	3/1/2021 10:58:38 AM	gaia-jennifer	5/1/2023 2:23:58 PM	gaia-vicki	10/1/2015 12:00:00 AM	5/1/2023 2:23:58 PM	False
C	39	False	SUNSHINE HEALTH MCR	SUNSHINE HEALTH MCR	PO BOX 3070	Farmington	MI	63640	8444778313		1	1701	82	1738	2	1682	1	3	0	C	0	False	233	39	PO BOX 3070 SUNSHINE HEALTH MCR SUNSHINE HEALTH MCR FARMINGTON MI 63640	2/15/2022 2:30:26 PM	gaia-amanda	5/1/2023 2:27:01 PM	gaia-vicki	10/1/2015 12:00:00 AM	5/1/2023 2:27:01 PM	False
C	42	False	Wellcare MCR	Wellcare MCR	PO BOX 31372	Tampa	FL	33631	8555380454		3	1701	1799	1741	2	1682	2	3	0	C			233	42	PO BOX 31372 WELLCARE MCR WELLCARE MCR TAMPA FL 33631	3/11/2022 1:57:48 PM	gaia-amanda	1/16/2025 4:14:20 PM	gaia-brenda	10/1/2015 12:00:00 AM	1/16/2025 4:14:20 PM	False

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Ledger	InsuranceCarriersId	Inactive	Name	ListName	Address1	City	State	Zip	Phone1	InsuranceGroupId	CollectionsGroupMId	CarrierTypeMId	FinancialClassMId	AllocationSetId	FilingMethodMId	FilingType	TransactionColumnSetId	IncludeClaimOfficeNo	Ledger1	RequiresAuth	ReferenceCarrier	AcceptAssignmentMId	DotId	Keyword	Created	CreatedBy	LastModified	LastModifiedBy	ICD10SERVICEDATE	InsSOP_db_Updated_Date	AUC
C	1	False	MEDICARE PART A & B	MEDICARE PART A & B	PO Box 2711	JACKSONVILLE	FL	32211	8776028816	1	1701	1799	1738	2	1682	2	3	0	C			233	1	PO BOX 2711 MEDICARE PART A & B MEDICARE PART A & B JACKSONVILLE FL 32211	2/22/2010 10:05:52 AM	cammy	5/13/2026 11:25:48 AM	gaia-melisha	10/1/2015 12:00:00 AM	5/13/2026 11:25:48 AM	False
C	13	False	Pending	Pending						5	1701	80	1743	2	0	0	2	0	C	0	False	233	13	PENDING PENDING	6/2/2016 1:31:08 PM	gaia-renee	4/28/2025 8:48:34 AM	gaia-cary	10/1/2015 12:00:00 AM	4/28/2025 8:48:34 AM	False
C	22	False	UHC PCP MCR HMO-POS	UHC PCP MCR HMO-POS	Po Box 30448	Salt Lake City	UT	84130	8667259334	6	1701	1799	1741	2	1682	2	2	0	C	0		233	65088	PO BOX 30448 UHC PCP MCR HMO-POS UHC PCP MCR HMO-POS SALT LAKE CITY UT 84130	1/3/2017 2:20:06 PM	gaia-brenda	4/16/2026 7:47:43 AM	gaia-Lydia	10/1/2015 12:00:00 AM	4/16/2026 7:47:44 AM	False
C	23	False	MEDICARE ACUTE	MEDICARE ACUTE	PO BOX 2711	JACKSONVILLE	FL	32211		1	1701	1799	1746	2	1682	2	3	0	C	0	False	233	23	PO BOX 2711 MEDICARE ACUTE MEDICARE ACUTE JACKSONVILLE FL 32211	1/31/2017 11:07:14 AM	GAIA-JENNIFER	5/1/2023 12:36:48 PM	gaia-cary	10/1/2015 12:00:00 AM	5/1/2023 12:36:48 PM	False
C	24	False	Elderplan MCR HMO	Elderplan MCR HMO	Po Box 73111	Newnan	GA	30271	8003533765	6	1701	1799	1741	2	1682	2	3	0	C	0	False	233	24	PO BOX 73111 ELDERPLAN MCR HMO ELDERPLAN MCR HMO NEWNAN GA 30271	2/2/2017 12:53:45 PM	gaia-brenda	5/1/2023 12:33:05 PM	gaia-cary	10/1/2015 12:00:00 AM	5/1/2023 12:33:05 PM	False
C	38	False	WellCare MCR	WellCare MCR	P O BOX 31372	Tampa	FL	33631-3372	8555380454	6	1701	1799	1741	2	1682	2	3	0	C	0	False	233	38	P O BOX 31372 WELLCARE MCR WELLCARE MCR TAMPA FL 33631-3372	8/20/2018 12:04:34 PM	gaia-renee	5/1/2023 12:42:53 PM	gaia-cary	10/1/2015 12:00:00 AM	5/1/2023 12:42:53 PM	False
C	50	False	BRIGHT HEALTH CM	BRIGHT HEALTH CM	PO BOX 16275	READING	PA	19612	8662397191	4	1703	104	1744	2	1682	2	2	0	C	0	False	233	50	PO BOX 16275 BRIGHT HEALTH CM BRIGHT HEALTH CM READING PA 19612	2/12/2021 10:12:45 AM	gaia-michael	3/28/2025 7:54:23 AM	gaia-nina	10/1/2015 12:00:00 AM	3/28/2025 7:54:23 AM	False
C T	53	False	MEDICARE PART A ONLY	MEDICARE PART A ONLY	PO BOX 2711	JACKSONVILLE	FL	32211		1	1701	1799	1738	2	1682	2	3		C T			233	53	PO BOX 2711 MEDICARE PART A ONLY MEDICARE PART A ONLY JACKSONVILLE FL 32211	5/2/2022 12:14:04 PM	gaia-michael	4/30/2026 10:29:14 AM	gaia-melisha	10/1/2015 12:00:00 AM	4/30/2026 10:29:14 AM	False
C	55	False	Healthsun MCR	Healthsun MCR	PO Box 211154	Eagan	MN	55121	3052349292	6	1701	1799	1741	2	1682	2	3	0	C	0	False	233	55	PO BOX 211154 HEALTHSUN MCR HEALTHSUN MCR EAGAN MN 55121	12/12/2022 10:47:02 AM	gaia-michael	5/1/2023 12:33:56 PM	gaia-cary	10/1/2015 12:00:00 AM	5/1/2023 12:33:56 PM	False

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Ledger	InsuranceCarriersId	MasterInsuranceCarriersId	Inactive	Name	ListName	Address1	Address2	City	State	Zip	Country	Contact	Phone1	Phone1Type	Phone2	Phone2Type	Phone3	Phone3Type	InsuranceGroupId	CollectionsGroupMId	CarrierTypeMId	FinancialClassMId	AllocationSetId	FilingMethodMId	FilingType	TransactionColumnSetId	PolicyTypeMId	CopayAmt	Deductible	GroupId	GroupName	MediGapId	OrgId	IncludeClaimOfficeNo	LocationId	PPOId	ECSClearinghouseId	ECSPayorId	ECSClaimOfficeNumber	ECSNEIC	UseRenderingProviderId	RequiresPIN	ECSMaximumNumberOfProcedures	ELIMIKDestination	ELIClearinghouseId	ELIPayorId	ELIMessageType	ElectronicFilingStatus	SupplementalFiling	Ledger1	Notes	AlertNotes	RequiresAuth	ReferenceCarrier	PayerIdNumberCodeMId	OtherPayerIdNumber	SubscriberIDMask	AcceptAssignmentMId	DotId	PartnerInsuranceCarriersId	PreAuthorizationFormType	PreAuthorizationFormFile	Keyword	OrderNotes	Created	CreatedBy	LastModified	LastModifiedBy	CountrySubdiv	ICD10SERVICEDATE	InsSourceOfPaymentsID	InsSOP_db_Updated_Date	AUC
C	1		False	MEDICARE PART A & B	MEDICARE PART A & B	PO BOX 660155		DALLAS	TX	75266			8552528782						1	1701	1799	1738	2	1682	2	3		0	0					0																C								233	1				PO BOX 660155 MEDICARE PART A & B MEDICARE PART A & B DALLAS TX 75266		2/22/2010 10:05:52 AM	cammy	6/28/2024 7:09:49 AM	gaia-Tricia		10/1/2014 12:00:00 AM		6/28/2024 7:09:49 AM	False

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Ledger	InsuranceCarriersId	MasterInsuranceCarriersId	Inactive	Name	ListName	Address1	Address2	City	State	Zip	Country	Contact	Phone1	Phone1Type	Phone2	Phone2Type	Phone3	Phone3Type	InsuranceGroupId	CollectionsGroupMId	CarrierTypeMId	FinancialClassMId	AllocationSetId	FilingMethodMId	FilingType	TransactionColumnSetId	PolicyTypeMId	CopayAmt	Deductible	GroupId	GroupName	MediGapId	OrgId	IncludeClaimOfficeNo	LocationId	PPOId	ECSClearinghouseId	ECSPayorId	ECSClaimOfficeNumber	ECSNEIC	UseRenderingProviderId	RequiresPIN	ECSMaximumNumberOfProcedures	ELIMIKDestination	ELIClearinghouseId	ELIPayorId	ELIMessageType	ElectronicFilingStatus	SupplementalFiling	Ledger1	Notes	AlertNotes	RequiresAuth	ReferenceCarrier	PayerIdNumberCodeMId	OtherPayerIdNumber	SubscriberIDMask	AcceptAssignmentMId	DotId	PartnerInsuranceCarriersId	PreAuthorizationFormType	PreAuthorizationFormFile	Keyword	OrderNotes	Created	CreatedBy	LastModified	LastModifiedBy	CountrySubdiv	ICD10SERVICEDATE	InsSourceOfPaymentsID	InsSOP_db_Updated_Date	AUC
C	1		False	SELF PAY	SELF PAY														7	1701	91	1743	2	0	0	3		0	0					0																C								233	1				SELF PAY SELF PAY		2/22/2010 10:05:52 AM	cammy	8/23/2022 3:34:04 PM	gaia-bruce		10/1/2014 12:00:00 AM		8/23/2022 3:34:04 PM	False
C	3		False	MEDICARE A&B	MEDICARE A&B														1	1701	1799	1738	2	1682	2	3		0	0					0																C			0	False				233	3				MEDICARE A&B MEDICARE A&B		8/23/2022 3:28:21 PM	gaia-bruce	5/13/2026 11:27:41 AM	gaia-melisha		10/1/2015 12:00:00 AM		5/13/2026 11:27:41 AM	False

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Ledger	InsuranceCarriersId	Inactive	Name	ListName	Address1	City	State	Zip	Phone1	Phone1Type	Phone2	Phone2Type	InsuranceGroupId	CollectionsGroupMId	CarrierTypeMId	FinancialClassMId	AllocationSetId	FilingMethodMId	FilingType	TransactionColumnSetId	IncludeClaimOfficeNo	Ledger1	Notes	RequiresAuth	ReferenceCarrier	PayerIdNumberCodeMId	OtherPayerIdNumber	AcceptAssignmentMId	DotId	Keyword	Created	CreatedBy	LastModified	LastModifiedBy	ICD10SERVICEDATE	InsSOP_db_Updated_Date	AUC
C	3	False	MEDICARE PART A	MEDICARE PART A	PO Box 335	Mechanicsburg	PA	17055-1840	8772358073		8772358051		1	1701	1799	1738	2	1682	2	3	0	C		0	False			233	3	PO BOX 335 MEDICARE PART A MEDICARE PART A MECHANICSBURG PA 17055-1840	6/6/2018 1:56:09 PM	gaia-jennifer	2/23/2023 4:04:23 PM	caloa	10/1/2015 12:00:00 AM	2/23/2023 2:04:23 PM	False
C	29	False	CAROLINAS ANSON SECONDARY	CAROLINAS ANSON SECONDARY	500 Morven Road	Wadesboro	NC	28170	7046945131				5	1703	104	1744	2	1682	1	2	0	C	Fax #704-694-3900	0	False			233	29	500 MORVEN ROAD CAROLINAS ANSON SECONDARY CAROLINAS ANSON SECONDARY WADESBORO NC 28170	11/14/2018 6:32:04 AM	caloa	11/16/2023 3:14:11 PM	caloa	10/1/2015 12:00:00 AM	11/16/2023 1:14:12 PM	False
C	43	False	AMERICAN CONTINENTAL SECONDARY	AMERICAN CONTINENTAL SECONDARY	PO BOX 14770	Lexingtion	KY	40512	8002644000				5	1703	104	1744	2	1682	1	2	0	C		0		145	GEC92528I	233	43	PO BOX 14770 AMERICAN CONTINENTAL SECONDARY AMERICAN CONTINENTAL SECONDARY LEXINGTION KY 40512	3/15/2019 7:49:07 AM	caloa	7/19/2019 8:32:09 AM	caloa	10/1/2015 12:00:00 AM	7/19/2019 8:32:09 AM	False
C	46	False	UNITED HEALTHCARE COMMUNITY PLAN	UNITED HEALTHCARE COMMUNITY PLAN	PO Box 31375	Salt Lake city	UT	84131					4	1702	81	56190	2	1682	2	2	0	C						233	46	PO BOX 31375 UNITED HEALTHCARE COMMUNITY PLAN UNITED HEALTHCARE COMMUNITY PLAN SALT LAKE CITY UT 84131	4/11/2019 12:22:26 PM	caloa	7/12/2019 2:21:08 PM	caloa	10/1/2015 12:00:00 AM	7/12/2019 2:21:08 PM	False
C	62	False	USAA Insurance	USAA Insurance	529 Main Street	Highland Falls	NY	10928	2105318722	Work			5	1703	86	1744	2	1682	1	2	0	C		0	False	145		233	62	529 MAIN STREET USAA INSURANCE USAA INSURANCE HIGHLAND FALLS NY 10928	10/27/2020 2:21:06 PM	caloa	10/27/2020 2:21:06 PM	caloa	10/1/2015 12:00:00 AM	10/27/2020 12:21:06 PM	False
C	68	False	PA MEDICARE PART A	PA MEDICARE PART A	PO Box 335	Mechanicsburg	PA	17055					1	1701	1799	1738	2	1682	2	3	0	C		0	False			233	68	PO BOX 335 PA MEDICARE PART A PA MEDICARE PART A MECHANICSBURG PA 17055	5/18/2021 7:14:19 AM	caloa	4/11/2024 6:58:09 AM	caloa	10/1/2015 12:00:00 AM	4/11/2024 4:58:09 AM	False
C	73	False	Local 99	Local 99	406 S Eldorado Rd	Bloomington	IL	61704	3094345640				5	1703	80	1744	2	0	2	2	0	C		0				233	73	406 S ELDORADO RD LOCAL 99 LOCAL 99 BLOOMINGTON IL 61704	8/30/2021 9:44:57 AM	kistnerj	8/30/2021 9:46:42 AM	kistnerj	10/1/2015 12:00:00 AM	8/30/2021 7:46:42 AM	False
C	74	False	HUMANA MEDICARE ADVANTAGE	HUMANA MEDICARE ADVANTAGE	PO Box 14601	Lexingtion	KY	40512					2	1703	2463	1741	2	1682	2	3	0	C						233	74	PO BOX 14601 HUMANA MEDICARE ADVANTAGE HUMANA MEDICARE ADVANTAGE LEXINGTION KY 40512	10/8/2021 12:27:44 PM	caloa	11/1/2021 3:19:32 PM	caloa	10/1/2015 12:00:00 AM	11/1/2021 1:19:32 PM	False
C	75	False	WELLCARE ADVANTAGE NY	WELLCARE ADVANTAGE NY	PO Box 52846	Philadelphia	PA	19115	8444586739	Home	8772771808	Fax	2	1701	2463	1741	2	1682	2	3	0	C		0	False			233	75	PO BOX 52846 WELLCARE ADVANTAGE NY WELLCARE ADVANTAGE NY PHILADELPHIA PA 19115	10/18/2021 4:10:22 PM	caloa	3/1/2024 12:13:08 PM	caloa	10/1/2015 12:00:00 AM	3/1/2024 10:13:08 AM	False
C	76	False	VA LOCAL	VA LOCAL	VA Medical Center	Perry Point	MD	21902	4106422411	Work			6	1704	95	1742	2	0	2	3		C		-1				233	76	VA MEDICAL CENTER VA LOCAL VA LOCAL PERRY POINT MD 21902	12/2/2021 1:59:56 PM	caloa	12/2/2021 1:59:56 PM	caloa	10/1/2015 12:00:00 AM	12/2/2021 11:59:56 AM	False
C	77	False	KAISER MID-ATLANTIC MCO	KAISER MID-ATLANTIC MCO	3495 Piedmont Road NE	Atlanta	GA	30305					4	1703	81	56190	2	1682	2	2	0	C			False			233	77	3495 PIEDMONT ROAD NE KAISER MID-ATLANTIC MCO KAISER MID-ATLANTIC MCO ATLANTA GA 30305	12/8/2021 9:42:05 AM	caloa	2/10/2022 3:50:51 PM	caloa	10/1/2015 12:00:00 AM	2/10/2022 1:50:51 PM	False
C	80	False	AMERIGROUP MCO	AMERIGROUP MCO	PO BOX 61010	Viriginia Beach	VA	23466	8668054589	Work			4	1703	2463	56190	2	1682	2	2	0	C						233	80	PO BOX 61010 AMERIGROUP MCO AMERIGROUP MCO VIRIGINIA BEACH VA 23466	2/17/2022 8:31:27 AM	caloa	11/1/2023 9:01:19 AM	caloa	10/1/2015 12:00:00 AM	11/1/2023 7:01:19 AM	False
C	85	False	NORTHWEST HOSPITAL	NORTHWEST HOSPITAL	5401 OLD COURT ROAD	Randallstown	MD	21133					5	1703		1744	2	0	1	2	0	C			False			233	85	5401 OLD COURT ROAD NORTHWEST HOSPITAL NORTHWEST HOSPITAL RANDALLSTOWN MD 21133	9/1/2023 10:46:49 AM	caloa	9/1/2023 12:48:58 PM	caloa	10/1/2015 12:00:00 AM	9/1/2023 10:48:58 AM	False

Download as Spreadsheet

Ledger	InsuranceCarriersId	Inactive	Name	ListName	Address1	Address2	City	State	Zip	Phone1	Phone2	InsuranceGroupId	CollectionsGroupMId	CarrierTypeMId	FinancialClassMId	AllocationSetId	FilingMethodMId	FilingType	TransactionColumnSetId	IncludeClaimOfficeNo	Ledger1	Notes	RequiresAuth	ReferenceCarrier	AcceptAssignmentMId	DotId	Keyword	Created	CreatedBy	LastModified	LastModifiedBy	ICD10SERVICEDATE	InsSOP_db_Updated_Date	AUC
C	1	False	MEDICARE PART A & B	MEDICARE PART A & B	P O BOX 5533		MARION	IL	62959	8665183285		1	1701	1799	1738	2	1682	2	3	0	C				233	1	P O BOX 5533 MEDICARE PART A & B MEDICARE PART A & B MARION IL 62959	2/22/2010 10:05:52 AM	cammy	6/27/2024 4:19:35 PM	gaia-sandy	10/1/2014 12:00:00 AM	6/27/2024 4:19:35 PM	False
C	6	False	AETNA MCR	AETNA MCR	PO BOX 981106		EL PASO	TX	79998	8886323862		5	1701	1799	1741	2	1682	2	3	0	C				233	6	PO BOX 981106 AETNA MCR AETNA MCR EL PASO TX 79998	1/5/2019 8:31:08 AM	gaia-jennifer	5/1/2023 10:21:42 AM	gaia-vicki	10/1/2015 12:00:00 AM	5/1/2023 10:21:42 AM	False
C	7	False	AETNA BETTER HEALTH MCR	AETNA BETTER HEALTH MCR	PO BOX 66215		PHOENIX	AZ	85082	8663163784		5	1701	1799	1741	2	1682	2	3	0	C				233	7	PO BOX 66215 AETNA BETTER HEALTH MCR AETNA BETTER HEALTH MCR PHOENIX AZ 85082	1/5/2019 8:32:42 AM	gaia-jennifer	5/1/2023 10:21:16 AM	gaia-vicki	10/1/2015 12:00:00 AM	5/1/2023 10:21:16 AM	False
C	9	False	AMERIHEALTH MICHIGAN MCR	AMERIHEALTH MICHIGAN MCR	P O BOX 853914		RICHARDSON	TX	75085	8886670318		5	1701	1799	1741	2	1682	2	3	0	C	contract is for 85%of medicare rate			233	9	P O BOX 853914 AMERIHEALTH MICHIGAN MCR AMERIHEALTH MICHIGAN MCR RICHARDSON TX 75085	1/5/2019 8:33:38 AM	gaia-jennifer	5/1/2023 10:22:21 AM	gaia-vicki	10/1/2015 12:00:00 AM	5/1/2023 10:22:21 AM	False
C	14	False	HARBOR HEALTH MCR	HARBOR HEALTH MCR	PO BOX 830850		Birmingham	AL	35283	8444272671		5	1701	1799	1741	2	1682	2	3	0	C				233	14	PO BOX 830850 HARBOR HEALTH MCR HARBOR HEALTH MCR BIRMINGHAM AL 35283	1/5/2019 8:40:27 AM	gaia-jennifer	5/1/2023 10:25:07 AM	gaia-vicki	10/1/2015 12:00:00 AM	5/1/2023 10:25:07 AM	False
C	20	False	MCLAREN HEALTH PLAN MCR	MCLAREN HEALTH PLAN MCR	PO BOX 1511		FLINT	MI	48501	8883270671		5	1701	1799	1741	2	1682	2	3	0	C				233	20	PO BOX 1511 MCLAREN HEALTH PLAN MCR MCLAREN HEALTH PLAN MCR FLINT MI 48501	1/5/2019 8:42:39 AM	gaia-jennifer	5/1/2023 10:28:01 AM	gaia-vicki	10/1/2015 12:00:00 AM	5/1/2023 10:28:01 AM	False
C	25	False	MERITAIN HEALTH MCR	MERITAIN HEALTH MCR	P O BOX 853921		RICHARDSON	TX	75085	8002421199		5	1701	1799	1741	2	1682	2	3	0	C				233	25	P O BOX 853921 MERITAIN HEALTH MCR MERITAIN HEALTH MCR RICHARDSON TX 75085	1/5/2019 8:46:11 AM	gaia-jennifer	5/1/2023 10:29:51 AM	gaia-vicki	10/1/2015 12:00:00 AM	5/1/2023 10:29:51 AM	False
C	27	False	MOLINA HEALTHCARE MCR	MOLINA HEALTHCARE MCR	P O BOX 22668		LONG BEACH	CA	90801	8888987969		5	1701	1799	1741	2	1682	2	3	0	C				233	27	P O BOX 22668 MOLINA HEALTHCARE MCR MOLINA HEALTHCARE MCR LONG BEACH CA 90801	1/5/2019 8:46:54 AM	gaia-jennifer	9/6/2023 3:03:27 PM	gaia-amanda	10/1/2015 12:00:00 AM	9/6/2023 3:03:27 PM	False
C	30	False	PACE SOUTHEAST MI MCR	PACE SOUTHEAST MI MCR	7700 EQUITABLE DRIVE STE 103		ED PRAIRIE	MN	55344	3135436320	2485569111	5	1701	1799	1741	2	1682	2	3	0	C				233	30	7700 EQUITABLE DRIVE STE 103 PACE SOUTHEAST MI MCR PACE SOUTHEAST MI MCR ED PRAIRIE MN 55344	1/5/2019 8:49:31 AM	gaia-jennifer	5/1/2023 10:31:25 AM	gaia-vicki	10/1/2015 12:00:00 AM	5/1/2023 10:31:26 AM	False
C	32	False	TOTAL HEALTHCARE MCR	TOTAL HEALTHCARE MCR	3956 MT ELLIOTT		DETROIT	MI	48207	8008262862		5	1701	1799	1741	2	1682	2	3	0	C	call Donetta 313-293-6426 to have claims reprocessed for underpayment			233	32	3956 MT ELLIOTT TOTAL HEALTHCARE MCR TOTAL HEALTHCARE MCR DETROIT MI 48207	1/5/2019 8:55:35 AM	gaia-jennifer	5/1/2023 10:32:39 AM	gaia-vicki	10/1/2015 12:00:00 AM	5/1/2023 10:32:39 AM	False
C	35	False	UHC MCR	UHC MCR	PO BOX 30555		SALT LAKE CITY	UT	84130	8778423210		5	1701	1799	1741	2	1682	2	3	0	C				233	35	PO BOX 30555 UHC MCR UHC MCR SALT LAKE CITY UT 84130	1/5/2019 8:59:00 AM	gaia-jennifer	5/1/2023 10:33:34 AM	gaia-vicki	10/1/2015 12:00:00 AM	5/1/2023 10:33:34 AM	False
C	41	False	MEDICARE PART A ACUTE	MEDICARE PART A ACUTE	PO BOX 5533		MARION	IL	62959			1	1701	1799	1746	2	1682	2	3	0	C		0		233	41	PO BOX 5533 MEDICARE PART A ACUTE MEDICARE PART A ACUTE MARION IL 62959	1/5/2019 11:05:43 AM	gaia-jennifer	4/24/2024 9:00:05 AM	gaia-cary	10/1/2014 12:00:00 AM	4/24/2024 9:00:05 AM	False
C	45	False	HAP MIDWEST HEALTH MCR	HAP MIDWEST HEALTH MCR	PO BOX 2578		DETROIT	MI	48202-0578	8667664661		5	1701	1799	1741	2	1682	2	3	0	C				233	45	PO BOX 2578 HAP MIDWEST HEALTH MCR HAP MIDWEST HEALTH MCR DETROIT MI 48202-0578	1/11/2019 1:24:55 PM	gaia-jennifer	6/13/2024 8:46:29 AM	gaia-nina	10/1/2015 12:00:00 AM	6/13/2024 8:46:29 AM	False
C	49	False	MERIDIAN HEALTH MCD	MERIDIAN HEALTH MCD	777 Woodward	Ste. 700	DETROIT	MI	48226	8002038206		2	1703	83	1739	2	1682	2	2	0	C	• Meridian is contracted to pay 80% of Medicaid rate per agreement	0		233	49	777 WOODWARD STE. 700 MERIDIAN HEALTH MCD MERIDIAN HEALTH MCD DETROIT MI 48226	1/14/2019 2:01:50 PM	gaia-brenda	4/29/2024 2:47:37 PM	GAIA-LIO	10/1/2015 12:00:00 AM	4/29/2024 2:47:37 PM	False
C	56	True	BCBS of MI MCR	BCBS of MI MCR	PO BOX 310166		Detroit	MI	48231	8663091719		5	1701	2398	1741	2	1682	2	3	0	C		0	False	233	56	PO BOX 310166 BCBS OF MI MCR BCBS OF MI MCR DETROIT MI 48231	6/10/2019 11:34:06 AM	gaia-brenda	8/1/2019 7:18:14 AM	gaia-brenda	10/1/2015 12:00:00 AM	8/1/2019 7:18:14 AM	False
C	58	False	PRIORITY HEALTH MCR	PRIORITY HEALTH MCR	PO BOX 232		GRAND RAPIDS	MI	49501	8009424765		5	1701	1799	1741	2	1682	2	3	0	C			False	233	58	PO BOX 232 PRIORITY HEALTH MCR PRIORITY HEALTH MCR GRAND RAPIDS MI 49501	1/6/2020 8:24:49 AM	gaia-michael	6/21/2024 8:09:58 AM	gaia-nina	10/1/2015 12:00:00 AM	6/21/2024 8:09:58 AM	False
C	59	False	WELLCARE MCR	WELLCARE MCR	PO BOX 31372		TAMPA	FL	33631	8009977522		5	1701	1799	1741	2	1682	2	3	0	C			False	233	59	PO BOX 31372 WELLCARE MCR WELLCARE MCR TAMPA FL 33631	1/21/2020 7:36:21 AM	gaia-michael	9/6/2024 8:49:56 AM	gaia-nina	10/1/2015 12:00:00 AM	9/6/2024 8:49:56 AM	False
C	61	False	MICHIGAN COMPLETE HEALTH MCR	MICHIGAN COMPLETE HEALTH MCR	PO BOX 3060		FARMINGTON	MO	63640	8442397387		5	1701	1799	1741	2	1682	2	3		C				233	61	PO BOX 3060 MICHIGAN COMPLETE HEALTH MCR MICHIGAN COMPLETE HEALTH MCR FARMINGTON MO 63640	10/22/2020 12:03:53 PM	gaia-michael	5/1/2023 10:30:16 AM	gaia-vicki	10/1/2015 12:00:00 AM	5/1/2023 10:30:16 AM	False
C	64	False	ZING HEALTH MCR	ZING HEALTH MCR	PO Box 981718		EL PASO	TX	79918	8669464458	8449464458	5	1701	1799	1741	2	1682	2	3	0	C		0	False	233	64	PO BOX 981718 ZING HEALTH MCR ZING HEALTH MCR EL PASO TX 79918	5/4/2021 10:53:21 AM	gaia-veronica	5/1/2023 10:34:25 AM	gaia-vicki	10/1/2015 12:00:00 AM	5/1/2023 10:34:25 AM	False
C	69	False	ALIGN SENIOR CARE MCR	ALIGN SENIOR CARE MCR	PO BOX 21593		EAGAN	MN	55121	8558550336		5	1701	1799	1741	2	1682	2	3	0	C		0	False	233	69	PO BOX 21593 ALIGN SENIOR CARE MCR ALIGN SENIOR CARE MCR EAGAN MN 55121	3/4/2022 8:20:35 AM	gaia-michael	5/1/2023 10:21:56 AM	gaia-vicki	10/1/2015 12:00:00 AM	5/1/2023 10:21:56 AM	False
C	70	False	MEDICARE PART A ONLY	MEDICARE PART A ONLY	PO BOX 5533		MARION	IL	62959			1	1701	1799	1738	2	1682	2	3		C				233	70	PO BOX 5533 MEDICARE PART A ONLY MEDICARE PART A ONLY MARION IL 62959	5/2/2022 9:33:07 AM	gaia-michael	6/27/2024 4:20:06 PM	gaia-sandy	10/1/2015 12:00:00 AM	6/27/2024 4:20:06 PM	False
C	74	False	COMMONWEALTH CARE ALLIANCE MCR	COMMONWEALTH CARE ALLIANCE MCR	PO BOX 21063		EAGAN	MN	55121	8559595855		5	1701	1799	1741	2	1682	2	3	0	C		0	False	233	74	PO BOX 21063 COMMONWEALTH CARE ALLIANCE MCR COMMONWEALTH CARE ALLIANCE MCR EAGAN MN 55121	9/14/2023 9:09:37 AM	gaia-amanda	7/9/2024 4:08:46 PM	gaia-brenda	10/1/2015 12:00:00 AM	7/9/2024 4:08:46 PM	False
C	76	False	Wellcare by Allwell MCR	Wellcare by Allwell MCR	7700 Forsyth Boulevard		Clayton	MO	63105	8009777522		5	1701	1799	1741	2	1682	2	3	0	C		0		233	65	7700 FORSYTH BOULEVARD WELLCARE BY ALLWELL MCR WELLCARE BY ALLWELL MCR CLAYTON MO 63105	5/31/2024 2:00:15 PM	gaia-nina	2/17/2025 5:01:26 PM	gaia-brenda	10/1/2015 12:00:00 AM	2/17/2025 5:01:26 PM	False
C	77	False	Wellpoint Amerigroup MCR	Wellpoint Amerigroup MCR	Po Box 61010		Viginia Beach	VA	23466	8668054589		5	1701	1799	1741	2	1682	2	3	0	C				233	159	PO BOX 61010 WELLPOINT AMERIGROUP MCR WELLPOINT AMERIGROUP MCR VIGINIA BEACH VA 23466	6/13/2024 10:33:47 AM	gaia-nina	6/28/2024 1:07:39 PM	gaia-Tricia	10/1/2015 12:00:00 AM	6/28/2024 1:07:39 PM	False

Download as Spreadsheet

Ledger	InsuranceCarriersId	Inactive	Name	ListName	Address1	City	State	Zip	Country	Phone1	Phone2	InsuranceGroupId	CollectionsGroupMId	CarrierTypeMId	FinancialClassMId	AllocationSetId	FilingMethodMId	FilingType	TransactionColumnSetId	IncludeClaimOfficeNo	Ledger1	Notes	RequiresAuth	ReferenceCarrier	AcceptAssignmentMId	DotId	Keyword	Created	CreatedBy	LastModified	LastModifiedBy	ICD10SERVICEDATE	InsSOP_db_Updated_Date	AUC
C	1	False	MEDICARE PART A & B	MEDICARE PART A & B	PO BOX 6773	FARGO	ND	58108		8556099960		1	1701	1799	1738	2	1682	2	3	0	C	NORIDIAN JE PART A			233	1	PO BOX 6773 MEDICARE PART A & B MEDICARE PART A & B FARGO ND 58108	2/22/2010 10:05:52 AM	cammy	2/26/2025 8:28:35 AM	gaia-jennifer	10/1/2014 12:00:00 AM	2/26/2025 6:28:35 AM	False
C	4	False	UHC MCR	UHC MCR	PO BOX 740800	ATLANTA	GA	30374		8664141959		3	1701	1799	1741	2	1682	2	3		C				233	4	PO BOX 740800 UHC MCR UHC MCR ATLANTA GA 30374	7/17/2020 9:06:00 AM	gaia-jennifer	8/13/2024 9:00:54 AM	gaia-Tricia	10/1/2015 12:00:00 AM	8/13/2024 9:00:54 AM	False
C	5	False	PENDING INSURANCE	PENDING INSURANCE	none	NOWHERE	NL	12345	USA			4	1701	80	1743	2	0	0	2	0	C			False	233	5	NONE PENDING INSURANCE PENDING INSURANCE NOWHERE NL 12345	7/20/2020 8:23:54 AM	gaia-michael	4/28/2025 8:51:18 AM	gaia-cary	10/1/2015 12:00:00 AM	4/28/2025 8:51:18 AM	False
C	7	False	HUMANA MCR	HUMANA MCR	PO BOX 14601	LEXINGTON	KY	40512		8004574708		3	1701	1799	1741	2	1682	1	3	0	C		0	False	233	7	PO BOX 14601 HUMANA MCR HUMANA MCR LEXINGTON KY 40512	4/27/2021 3:39:29 PM	gaia-michael	4/29/2025 7:27:18 AM	gaia-cary	10/1/2015 12:00:00 AM	4/29/2025 7:27:18 AM	False
C	9	False	WELLCARE MCR OHANA HEALTH	WELLCARE MCR OHANA HEALTH	PO BOX 31370	TAMPA	FL	33631		8663193554		3	1701	1799	1741	2	1682	2	3	0	C		0	False	233	9	PO BOX 31370 WELLCARE MCR OHANA HEALTH WELLCARE MCR OHANA HEALTH TAMPA FL 33631	6/28/2021 8:33:55 AM	gaia-michael	8/2/2023 5:19:20 PM	gaia-brenda	10/1/2015 12:00:00 AM	8/2/2023 5:19:19 PM	False
C	11	False	BCBS ANTHEM MCR	BCBS ANTHEM MCR	PO BOX 60007	Los Angeles	CA	90060		8776762583		3	1701	1799	1741	2	1682	2	3	0	C				233	11	PO BOX 60007 BCBS ANTHEM MCR BCBS ANTHEM MCR LOS ANGELES CA 90060	1/14/2022 3:22:21 PM	gaia-amanda	3/28/2025 8:48:57 AM	gaia-nina	10/1/2015 12:00:00 AM	3/28/2025 8:48:57 AM	False
C	12	False	AETNA MCR	AETNA MCR	PO BOX 14079	LEXINGTON	KY	40512		8006240756		3	1701	1799	1741	2	1682	2	3	0	C		0	False	233	12	PO BOX 14079 AETNA MCR AETNA MCR LEXINGTON KY 40512	2/18/2022 8:28:12 AM	gaia-michael	8/2/2023 3:51:21 PM	gaia-bruce	10/1/2015 12:00:00 AM	8/2/2023 3:51:21 PM	False
C	14	False	MEDICARE PART A ONLY	MEDICARE PART A ONLY	PO BOX 6773	FARGO	ND	58108				1	1701	1799	1738	2	1682	2	3	0	C		0	False	233	14	PO BOX 6773 MEDICARE PART A ONLY MEDICARE PART A ONLY FARGO ND 58108	3/23/2022 9:56:45 AM	gaia-jennifer	6/27/2024 4:22:27 PM	gaia-sandy	10/1/2015 12:00:00 AM	6/27/2024 4:22:27 PM	False
C	15	False	Health Generations Utah MCR	Health Generations Utah MCR	PO BOX 3745	Scranton	PA	18505		8444578943		3	1701	1799	1741	2	1682	2	3	0	C		0	False	233	15	PO BOX 3745 HEALTH GENERATIONS UTAH MCR HEALTH GENERATIONS UTAH MCR SCRANTON PA 18505	3/23/2022 2:01:15 PM	gaia-amanda	3/28/2025 8:48:11 AM	gaia-nina	10/1/2015 12:00:00 AM	3/28/2025 8:48:11 AM	False
C	16	False	Scan Health MCR	Village Health MCR	PO BOX 22698	Long Beach	CA	90801		8777787226		3	1701	1799	1741	2	1682	2	3	0	C		0	False	233	16	PO BOX 22698 VILLAGE HEALTH MCR SCAN HEALTH MCR LONG BEACH CA 90801	3/23/2022 2:44:00 PM	gaia-amanda	3/28/2025 8:52:17 AM	gaia-nina	10/1/2015 12:00:00 AM	3/28/2025 8:52:17 AM	False
C	1016	False	SELF PAY	SELF PAY	DO NOT BILL	Hope	AS	90089				4	1701	91	1743	2	0	0	2	0	C		0	False	233	1016	DO NOT BILL SELF PAY SELF PAY HOPE AS 90089	6/16/2022 1:46:37 PM	gaia-michael	5/7/2025 12:32:21 PM	gaia-cary	10/1/2015 12:00:00 AM	5/7/2025 12:32:21 PM	False
C	1017	False	Kaiser MCR of HI	Kaiser MCR of HI	PO BOX 378021	DENVER	CO	80023-7		8009665955		3	1701	1799	1741	2	1682	2	3	0	C		0	False	233	1017	PO BOX 378021 KAISER MCR OF HI KAISER MCR OF HI DENVER CO 80023-7	6/17/2022 7:22:52 AM	gaia-amanda	3/28/2025 8:49:37 AM	gaia-nina	10/1/2015 12:00:00 AM	3/28/2025 8:49:37 AM	False
C	2018	False	AMERIGROUP MCR	AMERIGROUP MCR	PO BOX 61010	VIRGINIA BEACH	VA	23466		8336812639		3	1701	1799	1741	2	1682	2	3	0	C		0	False	233	2018	PO BOX 61010 AMERIGROUP MCR AMERIGROUP MCR VIRGINIA BEACH VA 23466	8/16/2022 10:12:04 AM	gaia-michael	5/31/2023 10:56:29 AM	gaia-cary	10/1/2015 12:00:00 AM	5/31/2023 10:56:29 AM	False
C	2019	False	WELLMED MCR	WELLMED MCR	PO BOX 30508	SALT LAKE CITY	UT	84130-0508		8778423210	8777574440	3	1701	1799	1741	2	1682	2	3	0	C		0	False	233	2019	PO BOX 30508 WELLMED MCR WELLMED MCR SALT LAKE CITY UT 84130-0508	12/2/2022 12:55:55 PM	gaia-amanda	5/31/2023 11:04:04 AM	gaia-cary	10/1/2015 12:00:00 AM	5/31/2023 11:04:04 AM	False
C	2023	False	WELLCARE MCD OHANA HEALTH	WELLCARE MCD OHANA HEALTH	PO BOX 31370	TAMPA	FL	33631		8663193554		6	1702	83	1740	2	1682	2	2		C				233	2023	PO BOX 31370 WELLCARE MCD OHANA HEALTH WELLCARE MCD OHANA HEALTH TAMPA FL 33631	12/26/2022 11:25:28 AM	gaia-amanda	3/28/2025 3:15:25 PM	gaia-cary	10/1/2015 12:00:00 AM	3/28/2025 3:15:25 PM	False
C	3023	False	BCBS of UTAH - Regence	BCBS of UTAH - Regence	Do not send paper claim	PAGO PAGO	AS	96799		8002629712	8772765906	2	1703	104	1744	2	1682	2	2	0	C		0	False	233	3023	DO NOT SEND PAPER CLAIM BCBS OF UTAH - REGENCE BCBS OF UTAH - REGENCE PAGO PAGO AS 96799	1/6/2023 3:12:39 PM	gaia-amanda	5/31/2023 10:57:20 AM	gaia-cary	10/1/2015 12:00:00 AM	5/31/2023 10:57:20 AM	False
C	5027	False	BCBS HMSA MCR	BCBS HMSA MCR	PO BOX 860	Honolulu	HI	96808		8007904672		3	1701	1799	1741	2	1682	2	3	0	C	6/11/2025 Test Run failed payer ID#. per Atherna Portal payer id is EDI#GEB90261I Do not use BCBS Akamai payer ID iGEC909481I (this one failed)			233	5027	PO BOX 860 BCBS HMSA MCR BCBS HMSA MCR HONOLULU HI 96808	11/6/2023 8:17:15 AM	gaia-amanda	8/12/2025 3:33:02 PM	gaia-melisha	10/1/2015 12:00:00 AM	8/12/2025 3:33:02 PM	False
C	5029	False	CIGNA HEALTHCARE OF AZ MCR	CIGNA HEALTHCARE OF AZ MCR	PO BOX 981706	EL PASO	TX	79998		8006683813		3	1701	1799	1741	2	1682	2	3	0	C		0		233	62308 63092	PO BOX 981706 CIGNA HEALTHCARE OF AZ MCR CIGNA HEALTHCARE OF AZ MCR EL PASO TX 79998	6/14/2024 10:09:00 AM	gaia-nina	6/10/2025 4:41:32 PM	gaia-brenda	10/1/2015 12:00:00 AM	6/10/2025 4:41:32 PM	False
C	5030	False	Medicaid of NV	Medicaid of NV	P.O. Box 30042	Reno	NV	89520		8776383472		5	1702	83	1739	2	1682	2	2	0	C				233	157	P.O. BOX 30042 MEDICAID OF NV MEDICAID OF NV RENO NV 89520	6/14/2024 10:41:06 AM	gaia-nina	6/14/2024 10:41:06 AM	gaia-nina	10/1/2015 12:00:00 AM	6/14/2024 10:41:06 AM	False

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Ledger	InsuranceCarriersId	MasterInsuranceCarriersId	Inactive	Name	ListName	Address1	Address2	City	State	Zip	Country	Contact	Phone1	Phone1Type	Phone2	Phone2Type	Phone3	Phone3Type	InsuranceGroupId	CollectionsGroupMId	CarrierTypeMId	FinancialClassMId	AllocationSetId	FilingMethodMId	FilingType	TransactionColumnSetId	PolicyTypeMId	CopayAmt	Deductible	GroupId	GroupName	MediGapId	OrgId	IncludeClaimOfficeNo	LocationId	PPOId	ECSClearinghouseId	ECSPayorId	ECSClaimOfficeNumber	ECSNEIC	UseRenderingProviderId	RequiresPIN	ECSMaximumNumberOfProcedures	ELIMIKDestination	ELIClearinghouseId	ELIPayorId	ELIMessageType	ElectronicFilingStatus	SupplementalFiling	Ledger1	Notes	AlertNotes	RequiresAuth	ReferenceCarrier	PayerIdNumberCodeMId	OtherPayerIdNumber	SubscriberIDMask	AcceptAssignmentMId	DotId	PartnerInsuranceCarriersId	PreAuthorizationFormType	PreAuthorizationFormFile	Keyword	OrderNotes	Created	CreatedBy	LastModified	LastModifiedBy	CountrySubdiv	ICD10SERVICEDATE	InsSourceOfPaymentsID	InsSOP_db_Updated_Date	AUC
C	1		False	SELF PAY	SELF PAY	915 S.LARDEO STREET	SUITE 100	SAN ANTONIO	TX	78204-3211	USA								7	1701	91	1743	2	1682	1	3		0	0					0																C								233	1				915 S.LARDEO STREET SUITE 100 SELF PAY SELF PAY SAN ANTONIO TX 78204-3211		2/22/2010 10:05:52 AM	cammy	6/5/2025 12:11:12 PM	padai		10/1/2014 12:00:00 AM		6/5/2025 11:11:12 AM	False
C	3		False	MEDICARE	MEDICARE	PO BOX 660155		DALLAS	TX	75266	USA		8552528782	Work					1	1701	1799	1738	2	1682	2	3		0	0					0																C			0	False				233	3				PO BOX 660155 MEDICARE MEDICARE DALLAS TX 75266		8/23/2022 3:28:21 PM	gaia-bruce	10/31/2025 3:48:18 PM	ids-agray		10/1/2015 12:00:00 AM		10/31/2025 2:48:18 PM	False

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Ledger	InsuranceCarriersId	Inactive	Name	ListName	Address1	Address2	City	State	Zip	Phone1	Phone1Type	InsuranceGroupId	CollectionsGroupMId	CarrierTypeMId	FinancialClassMId	AllocationSetId	FilingMethodMId	FilingType	TransactionColumnSetId	IncludeClaimOfficeNo	Ledger1	RequiresAuth	ReferenceCarrier	AcceptAssignmentMId	DotId	Keyword	Created	CreatedBy	LastModified	LastModifiedBy	ICD10SERVICEDATE	InsSOP_db_Updated_Date	AUC
C	1	False	MEDICARE A&B	MEDICARE A&B	PO BOX 2711		Jacksonville	FL	32211	8776028816		1	1701	1799	1738	2	1682	2	3	0	C			233	1	PO BOX 2711 MEDICARE A&B MEDICARE A&B JACKSONVILLE FL 32211	2/22/2010 10:05:52 AM	cammy	5/13/2026 11:28:50 AM	gaia-melisha	10/1/2014 12:00:00 AM	5/13/2026 11:28:51 AM	False
C	8	False	PENDING INSURANCE	PENDING INSURANCE	DO NOT BILL							6	1701	80	1743	2	0	0	2	0	C		False	233	8	DO NOT BILL PENDING INSURANCE PENDING INSURANCE	9/7/2020 2:16:44 PM	gaia-michael	4/28/2025 8:53:53 AM	gaia-cary	10/1/2015 12:00:00 AM	4/28/2025 8:53:53 AM	False
C	10	False	MMM MCR	MMM MCR	PO BOX 260430		MIAMI	FL	33126	8442129858		2	1701	1799	1741	2	1682	2	3	0	C	0	False	233	10	PO BOX 260430 MMM MCR MMM MCR MIAMI FL 33126	10/1/2020 9:23:22 AM	gaia-michael	6/16/2025 1:26:38 PM	gaia-nina	10/1/2015 12:00:00 AM	6/16/2025 1:26:38 PM	False
C	13	False	WELLCARE MCR	WELLCARE MCR	PO BOX 31224		TAMPA	FL	33631	8663347927		2	1701	1799	1741	2	1682	2	3	0	C	0	False	233	13	PO BOX 31224 WELLCARE MCR WELLCARE MCR TAMPA FL 33631	12/28/2020 10:37:32 AM	gaia-michael	5/31/2023 11:09:21 AM	gaia-renee2	10/1/2015 12:00:00 AM	5/31/2023 11:09:21 AM	False
C	19	False	DOCTORS HEALTHCARE PLANS MCR	DOCTORS HEALTHCARE PLANS MCR	PO Box 132,	1825 Ponce de Leon Blvd	Coral Gables	FL	33134	3054229300	Clinic	2	1701	1799	1741	2	1682	2	3	0	C	0	False	233	19	PO BOX 132, 1825 PONCE DE LEON BLVD DOCTORS HEALTHCARE PLANS MCR DOCTORS HEALTHCARE PLANS MCR CORAL GABLES FL 33134	6/17/2021 1:26:59 PM	gaia-veronica	3/28/2025 9:07:08 AM	gaia-nina	10/1/2015 12:00:00 AM	3/28/2025 9:07:08 AM	False
C	27	False	UHC MCR	UHC MCR	PO BOX 740800		ATLANTA	GA	30374	8778423210		2	1701	1799	1741	2	1682	2	3	0	C		False	233	27	PO BOX 740800 UHC MCR UHC MCR ATLANTA GA 30374	1/5/2022 9:40:28 AM	gaia-amanda	3/28/2025 9:20:16 AM	gaia-nina	10/1/2015 12:00:00 AM	3/28/2025 9:20:16 AM	False
C	28	False	SELF PAY	SELF PAY								6	1701	91	1743	2	0	0	3	0	C	0	False	233	28	SELF PAY SELF PAY	1/24/2022 10:55:55 AM	gaia-amanda	5/14/2025 7:56:54 AM	gaia-michellem	10/1/2015 12:00:00 AM	5/14/2025 7:56:55 AM	False
C	30	False	Leon Medicare Advantage	Leon MCR	PO BOX 659006		MIAMI	FL	33126	3056315343		2	1701	1799	1741	2	1682	2	3	0	C	0	False	233	30	PO BOX 659006 LEON MCR LEON MEDICARE ADVANTAGE MIAMI FL 33126	3/3/2022 1:19:12 PM	gaia-amanda	5/31/2023 11:04:35 AM	gaia-renee2	10/1/2015 12:00:00 AM	5/31/2023 11:04:35 AM	False
C	1030	False	UHC PCP MCR HMO-POS	UHC PCP MCR HMO-POS	PO BOX 30448		SALT LAKE CITY	UT	84130	8667259334	H	2	1701	1799	1741	2	1682	2	2	0	C	0	False	233	1030	PO BOX 30448 UHC PCP MCR HMO-POS UHC PCP MCR HMO-POS SALT LAKE CITY UT 84130	4/1/2022 10:14:46 AM	gaia-michael	4/17/2026 3:54:27 PM	gaia-Lydia	10/1/2015 12:00:00 AM	4/17/2026 3:54:27 PM	False
C T	1031	False	MEDICARE PART A ONLY	MEDICARE PART A ONLY	PO BOX 2711		Jacksonville	FL	32211			1	1701	1799	1738	2	1682	2	3		C T			233	1031	PO BOX 2711 MEDICARE PART A ONLY MEDICARE PART A ONLY JACKSONVILLE FL 32211	5/2/2022 2:50:32 PM	gaia-michael	4/30/2026 10:34:11 AM	gaia-melisha	10/1/2015 12:00:00 AM	4/30/2026 10:34:11 AM	False

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Ledger	InsuranceCarriersId	Inactive	Name	ListName	Address1	City	State	Zip	Phone1	InsuranceGroupId	CollectionsGroupMId	CarrierTypeMId	FinancialClassMId	AllocationSetId	FilingMethodMId	FilingType	TransactionColumnSetId	Ledger1	RequiresAuth	ReferenceCarrier	AcceptAssignmentMId	DotId	Keyword	Created	CreatedBy	LastModified	LastModifiedBy	ICD10SERVICEDATE	InsSOP_db_Updated_Date	AUC
C	1	False	SELF PAY	SELF PAY						7	1701	91	1743	2	0	0	3	C			233	1	SELF PAY SELF PAY	2/22/2010 10:05:52 AM	cammy	8/23/2022 3:34:04 PM	gaia-bruce	10/1/2014 12:00:00 AM	8/23/2022 3:34:04 PM	False
C	3	False	MEDICARE A&B	MEDICARE A&B	PO BOX 2711	Jacksonville	FL	32211	8776028816	1	1701	1799	1738	2	1682	2	3	C	0	False	233	3	PO BOX 2711 MEDICARE A&B MEDICARE A&B JACKSONVILLE FL 32211	8/23/2022 3:28:21 PM	gaia-bruce	5/13/2026 11:33:35 AM	gaia-gery	10/1/2015 12:00:00 AM	5/13/2026 11:33:36 AM	False
C	10	False	Pending Insurance	Pending Insurance	DO NOT BILL	Littleton	CO	80120		7	1701	91	1743	2	0	0	2	C			233	10	DO NOT BILL PENDING INSURANCE PENDING INSURANCE LITTLETON CO 80120	8/21/2025 1:06:31 PM	gaia-melisha	11/3/2025 10:40:08 AM	gaia-cary	10/1/2015 12:00:00 AM	11/3/2025 10:40:08 AM

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Ledger	InsuranceCarriersId	Inactive	Name	ListName	Address1	City	State	Zip	Phone1	Phone1Type	Phone2	InsuranceGroupId	CollectionsGroupMId	CarrierTypeMId	FinancialClassMId	AllocationSetId	FilingMethodMId	FilingType	TransactionColumnSetId	IncludeClaimOfficeNo	Ledger1	RequiresAuth	ReferenceCarrier	AcceptAssignmentMId	DotId	Keyword	Created	CreatedBy	LastModified	LastModifiedBy	ICD10SERVICEDATE	InsSOP_db_Updated_Date	AUC
CE	4	False	MEDICARE FLORIDA	MEDICARE FLORIDA	PO BOX 2711	JACKSONVILLE	FL	32231	8776028816		8886644112	10	1701	1799	1738	2	1682	2	3	0	CE	0	False	233	4	PO BOX 2711 MEDICARE FLORIDA MEDICARE FLORIDA JACKSONVILLE FL 32231	11/20/2017 10:26:21 AM	iacosta	4/27/2026 8:57:40 AM	gaia-jen	10/1/2014 12:00:00 AM	4/27/2026 6:57:40 AM	False
C	16	False	BCBS FL MCR	BCBS FL MCR	PO BOX 1798	JACKSONVILLE	FL	32231-0014	8007272227			9	1701	1799	1741	2	1682	2	3	0	C	0	False	233	16	PO BOX 1798 BCBS FL MCR BCBS FL MCR JACKSONVILLE FL 32231-0014	11/21/2017 1:09:30 PM	vhernandez	9/4/2025 5:52:24 AM	admin	10/1/2014 12:00:00 AM	9/4/2025 3:52:24 AM	False
CF	40	False	UHC PREFERRED CARE PARTNERS HMO MCR	UHC PREFERRED CARE PARTNERS HMO MCR	PO BOX 30448	SALT LAKE CITY	UT	84130	8009950480			9	1701	1799	1741	2	1682	2	3	0	CF	0	False	233	40	PO BOX 30448 UHC PREFERRED CARE PARTNERS HMO MCR UHC PREFERRED CARE PARTNERS HMO MCR SALT LAKE CITY UT 84130	11/22/2017 1:42:10 PM	vhernandez	6/23/2026 9:55:32 AM	ADMIN	10/1/2014 12:00:00 AM	6/23/2026 7:55:33 AM	False
C	58	True	MMM OF FLORIDA MCR	MMM OF FLORIDA MCR	PO BOX 241658	APPLE VALLEY	MN	55124-1658	8887227559			9	1701	1799	1741	2	1682	2	3	0	C		False	233	58	PO BOX 241658 MMM OF FLORIDA MCR MMM OF FLORIDA MCR APPLE VALLEY MN 55124-1658	7/17/2019 8:46:27 AM	vhernandez	2/1/2025 1:17:44 PM	admin	10/1/2015 12:00:00 AM	2/1/2025 11:17:44 AM	False
C	72	False	WELLCARE OF FLORIDA MCR	WELLCARE OF FLORIDA MCR	PO BOX 31372	TAMPA	FL	33631-3372	8888889355	Work		9	1701	1799	1741	2	1682	2	3	0	C	0	False	233	72	PO BOX 31372 WELLCARE OF FLORIDA MCR WELLCARE OF FLORIDA MCR TAMPA FL 33631-3372	8/1/2022 11:40:52 AM	Vhernandez	9/4/2025 5:57:07 AM	admin	10/1/2015 12:00:00 AM	9/4/2025 3:57:07 AM	False
CE	73	False	MEDICARE GEORGIA	MEDICARE GEORGIA	PO BOX 100105	COLUMBIA	SC	29202	8775677271	Work		10	1701	1799	1738	2	1682	2	3		CE			233	73	PO BOX 100105 MEDICARE GEORGIA MEDICARE GEORGIA COLUMBIA SC 29202	10/20/2022 12:10:42 PM	Vhernandez	9/26/2024 7:52:14 AM	kidney-jj	10/1/2015 12:00:00 AM	9/26/2024 5:52:15 AM	False
C	75	False	BCBS GA ANTHEM MCR	BCBS GA ANTHEM MCR	PO BOX 105370	ATLANTA	GA	30348-5370	8006762583	Work		9	1701	84	1741	2	1682	2	3		C			233	79	PO BOX 105370 BCBS GA ANTHEM MCR BCBS GA ANTHEM MCR ATLANTA GA 30348-5370	1/31/2023 11:59:07 AM	Vhernandez	9/4/2025 5:52:35 AM	admin	10/1/2015 12:00:00 AM	9/4/2025 3:52:35 AM	False
C	76	False	WELLCARE OF GEORGIA MCR	WELLCARE OF GEORGIA MCR	PO BOX 31372	TAMPA	FL	33631-3372	8662311821	WORK		9	1701	1799	1741	2	1682	2	3		C			233	76	PO BOX 31372 WELLCARE OF GEORGIA MCR WELLCARE OF GEORGIA MCR TAMPA FL 33631-3372	2/26/2023 1:26:17 PM	Vhernandez	9/4/2025 5:57:22 AM	admin	10/1/2015 12:00:00 AM	9/4/2025 3:57:22 AM	False
C	77	False	AMBETTER PEACH STATE CM	AMBETTER PEACH STATE CM	PO BOX 5010	FARMINGTON	MO	63640	8776871180			8	1703	104	1744	2	1682	2	3		C			233	77	PO BOX 5010 AMBETTER PEACH STATE CM AMBETTER PEACH STATE CM FARMINGTON MO 63640	3/20/2023 3:26:18 PM	Vhernandez	9/8/2025 10:12:25 AM	smatos	10/1/2015 12:00:00 AM	9/8/2025 8:12:25 AM	False
C	84	False	SOLIS HEALTH PLANS MCR	SOLIS HEALTH PLANS MCR	9052 NW 36TH ST SUITE 400	MIAMI	FL	33178	8444476547	Work		9	1701	1799	1741	2	1682	2	3	0	C			233	86	9052 NW 36TH ST SUITE 400 SOLIS HEALTH PLANS MCR SOLIS HEALTH PLANS MCR MIAMI FL 33178	2/2/2024 6:49:34 AM	Mrodriguez	2/17/2026 11:20:05 AM	admin	10/1/2015 12:00:00 AM	2/17/2026 9:20:05 AM	False
CE	85	False	NOVITAS SOLUTIONS	MEDICARE TEXAS	PO BOX 3108	MECHANICSBURG	PA	17055-1824	8006334227		8779088431	10	1701	1799	1738	2	1682	2	3	0	CE	0	False	233	87	PO BOX 3108 MEDICARE TEXAS NOVITAS SOLUTIONS MECHANICSBURG PA 17055-1824	4/17/2024 10:52:52 AM	ldelira	9/4/2025 5:55:28 AM	admin	10/1/2015 12:00:00 AM	9/4/2025 3:55:28 AM	False
C	88	False	BCBSTX MCR	BCBSTX MCR	PO BOX 3686	SCRANTON	PA	18505				9	1701	1799	1741	2	1682	2	3	0	C	0	False	233	90	PO BOX 3686 BCBSTX MCR BCBSTX MCR SCRANTON PA 18505	6/17/2024 11:39:23 AM	ldelira	9/4/2025 5:52:47 AM	admin	10/1/2015 12:00:00 AM	9/4/2025 3:52:47 AM	False
c	91	False	PENDING INSURANCE	PENDING INSURANCE								9	1701	1799	1738	2	1682	2	3	0	c			233	93	PENDING INSURANCE PENDING INSURANCE	9/4/2024 7:30:12 AM	gaia-jennifer	9/20/2024 7:49:36 AM	gaia-jennifer	10/1/2015 12:00:00 AM	9/20/2024 5:49:36 AM	False
C	93	False	GOLD KIDNEY HEALTH PLAN MCR	GOLD KIDNEY HEALTH PLAN MCR	P O BOX 285	PORTSMOUTH	NH	03802	8442946535			9	1701	1799	1741	2	1682	2	3	0	C		False	233	95	P O BOX 285 GOLD KIDNEY HEALTH PLAN MCR GOLD KIDNEY HEALTH PLAN MCR PORTSMOUTH NH 03802	10/8/2024 11:12:35 AM	smatos	9/4/2025 5:53:58 AM	admin	10/1/2015 12:00:00 AM	9/4/2025 3:53:58 AM
C	94	False	SONDER HEALTH MCR	SONDER HEALTH MCR	PO BOX 3325	SPRINGHILL	FL	34611	8885251730			9	1701	2397	1741	2	1682	2	3	0	C	0		233	96	PO BOX 3325 SONDER HEALTH MCR SONDER HEALTH MCR SPRINGHILL FL 34611	10/11/2024 1:18:41 PM	ldelira	9/4/2025 5:56:13 AM	admin	10/1/2015 12:00:00 AM	9/4/2025 3:56:13 AM
C	96	False	COMMUNITY HEALTH CHOICE TX CM	COMMUNITY HEALTH CHOICE TX CM	PO BOX 981839	EL PASO	TX	79998-1839				8	1703	104	1744	2	0	2	3	0	C		False	233	201	PO BOX 981839 COMMUNITY HEALTH CHOICE TX CM COMMUNITY HEALTH CHOICE TX CM EL PASO TX 79998-1839	10/30/2024 9:34:05 AM	ldelira	9/8/2025 10:13:10 AM	smatos	10/1/2015 12:00:00 AM	9/8/2025 8:13:10 AM
C	98	False	CIGNA MCR	CIGNA MCR	PO BOX 981706	EL PASO	TX	79998	8002306138			9	1701	1799	1741	2	1682	2	3	0	C		False	233	98	PO BOX 981706 CIGNA MCR CIGNA MCR EL PASO TX 79998	12/11/2024 8:51:54 AM	ldelira	9/4/2025 5:53:09 AM	admin	10/1/2015 12:00:00 AM	9/4/2025 3:53:09 AM
C	101	False	HAP SENIOR PLUS MCR	HAP SENIOR PLUS MCR	1414 E Mapple Rd	Troy	MI	48083	8009263436			9	1701	1799	1741	2	1682	2	3	0	C		False	233	101	1414 E MAPPLE RD HAP SENIOR PLUS MCR HAP SENIOR PLUS MCR TROY MI 48083	2/20/2025 6:36:01 AM	smatos	9/4/2025 5:54:11 AM	admin	10/1/2015 12:00:00 AM	9/4/2025 3:54:11 AM
CF	114	False	UHC PREFERRED CARE PARTNERS POS MCR	UHC PREFERRED CARE PARTNERS POS MCR	PO BOX 30448	SALT LAKE CITY	UT	84130				9	1701	1799	1741	2	1682	2	3	0	CF		False	233	114	PO BOX 30448 UHC PREFERRED CARE PARTNERS POS MCR UHC PREFERRED CARE PARTNERS POS MCR SALT LAKE CITY UT 84130	3/31/2026 10:46:37 AM	admin	6/23/2026 9:55:27 AM	ADMIN	10/1/2015 12:00:00 AM	6/23/2026 7:55:27 AM
C	116	False	HUMANA GOLD MCR	HUMANA GOLD MCR	PO BOX 14601	LEXINGTON	KY	40512	8004574708	Work		9	1701	1799	1741	2	1682	2	3	0	C	0		233	116	PO BOX 14601 HUMANA GOLD MCR HUMANA GOLD MCR LEXINGTON KY 40512	5/21/2026 12:34:17 PM	ldelira	6/8/2026 10:03:02 AM	admin	10/1/2015 12:00:00 AM	6/8/2026 9:03:02 AM

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Ledger	InsuranceCarriersId	MasterInsuranceCarriersId	Inactive	Name	ListName	Address1	Address2	City	State	Zip	Country	Contact	Phone1	Phone1Type	Phone2	Phone2Type	Phone3	Phone3Type	InsuranceGroupId	CollectionsGroupMId	CarrierTypeMId	FinancialClassMId	AllocationSetId	FilingMethodMId	FilingType	TransactionColumnSetId	PolicyTypeMId	CopayAmt	Deductible	GroupId	GroupName	MediGapId	OrgId	IncludeClaimOfficeNo	LocationId	PPOId	ECSClearinghouseId	ECSPayorId	ECSClaimOfficeNumber	ECSNEIC	UseRenderingProviderId	RequiresPIN	ECSMaximumNumberOfProcedures	ELIMIKDestination	ELIClearinghouseId	ELIPayorId	ELIMessageType	ElectronicFilingStatus	SupplementalFiling	Ledger1	Notes	AlertNotes	RequiresAuth	ReferenceCarrier	PayerIdNumberCodeMId	OtherPayerIdNumber	SubscriberIDMask	AcceptAssignmentMId	DotId	PartnerInsuranceCarriersId	PreAuthorizationFormType	PreAuthorizationFormFile	Keyword	OrderNotes	Created	CreatedBy	LastModified	LastModifiedBy	CountrySubdiv	ICD10SERVICEDATE	InsSourceOfPaymentsID	InsSOP_db_Updated_Date	AUC
C	73		False	Medicare Part A	Medicare Part A	PO Box 2711		Jacksonville	FL	32231			8776028816						1	1701	1799	1738	6	1682	2	5		0	0																					C								233	73				PO BOX 2711 MEDICARE PART A MEDICARE PART A JACKSONVILLE FL 32231		2/15/2021 11:46:40 AM	gaia-jennifer	10/12/2025 12:22:36 AM	ipirela		10/1/2015 12:00:00 AM		10/11/2025 10:22:36 PM	False
C	74		False	MMM FL	MMM FL	PO BOX 260370		Miami	FL	33126	USA		8887730404						22	1701	1799	1741	6	1682	2	5		0	0					0																C			0	False				233	74				PO BOX 260370 MMM FL MMM FL MIAMI FL 33126		2/23/2021 11:14:02 AM	laura	5/26/2023 10:45:47 AM	ipirela		10/1/2015 12:00:00 AM		5/26/2023 8:45:47 AM	False

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A network-related or instance-specific error occurred while establishing a connection to SQL Server. The server was not found or was not accessible. Verify that the instance name is correct and that SQL Server is configured to allow remote connections. (provider: SQL Network Interfaces, error: 26 - Error Locating Server/Instance Specified)

Ledger	InsuranceCarriersId	Inactive	Name	ListName	Address1	City	State	Zip	Phone1	Phone1Type	Phone2	InsuranceGroupId	CollectionsGroupMId	CarrierTypeMId	FinancialClassMId	AllocationSetId	FilingMethodMId	FilingType	TransactionColumnSetId	IncludeClaimOfficeNo	Ledger1	RequiresAuth	ReferenceCarrier	AcceptAssignmentMId	DotId	Keyword	Created	CreatedBy	LastModified	LastModifiedBy	ICD10SERVICEDATE	InsSOP_db_Updated_Date	AUC
C	3	False	MEDICARE PART A & B	MEDICARE PART A & B	PO Box 2711	Jacksonville	FL	32211	8776028816		8886644112	4	1701	1799	1738	2	1682	2	3	0	C	0	False	233	3	PO BOX 2711 MEDICARE PART A & B MEDICARE PART A & B JACKSONVILLE FL 32211	7/1/2015 7:33:49 AM	gaia-jennifer	5/13/2026 10:20:36 AM	GAIA-JENNIFER	10/1/2015 12:00:00 AM	5/13/2026 8:20:36 AM	False
C	6	False	COVENTRY MCR	COVENTRY MCR	Po Box 7808	London	KY	40742	8008473995			1	1701	1799	1741	2	1682	2	3	0	C	0	False	233	6	PO BOX 7808 COVENTRY MCR COVENTRY MCR LONDON KY 40742	7/1/2015 10:01:48 AM	gaia-jennifer	5/1/2023 12:52:35 PM	gaia-cary	10/1/2015 12:00:00 AM	5/1/2023 12:52:35 PM	False
CT	12	False	UHC PCN MCR HMO POS	UHC PCN MCR HMO POS	PO Box 56-6616	Miami	FL	33256	8003485548			1	1701	1799	1741	2	1682	2	3	0	CT			233	12	PO BOX 56-6616 UHC PCN MCR HMO POS UHC PCN MCR HMO POS MIAMI FL 33256	7/1/2015 10:06:55 AM	gaia-jennifer	5/18/2026 8:23:13 AM	gaia-jennifer	10/1/2015 12:00:00 AM	5/18/2026 6:23:13 AM	False
C	24	False	PENDING INSURANCE	PENDING INSURANCE								5	1701	91	1743	2	0	0	3	0	C	0	False	233	24	PENDING INSURANCE PENDING INSURANCE	7/2/2015 10:43:23 AM	gaia-jennifer	4/8/2025 10:15:50 AM	gaia-melisha	10/1/2015 12:00:00 AM	4/8/2025 10:15:50 AM	False
C	25	False	Self Pay	Self Pay								5	1701	91	1743	2	0	0	2	0	C	0	False	233	25	SELF PAY SELF PAY	12/3/2015 9:15:52 AM	gaia-brenda	4/10/2026 7:24:57 AM	gaia-melisha	10/1/2015 12:00:00 AM	4/10/2026 7:24:57 AM	False
C	32	False	MEDICARE ACUTE	MEDICARE ACUTE	PO BOX 2711	Jacksonville	FL	32211				4	1701	1799	1746	2	1682	2	3	0	C	0	False	233	32	PO BOX 2711 MEDICARE ACUTE MEDICARE ACUTE JACKSONVILLE FL 32211	1/31/2017 3:33:34 PM	gaia-jennifer	3/28/2025 9:48:05 AM	gaia-nina	10/1/2015 12:00:00 AM	3/28/2025 9:48:05 AM	False
C	52	False	BCBS MCR	BCBS MCR	PO BOX 1798	Jacksonville	FL	32231	8007272227			1	1701	1799	1741	2	1682	2	3	0	C			233	52 AVAILITY ERA	PO BOX 1798 BCBS MCR BCBS MCR JACKSONVILLE FL 32231	9/5/2019 7:12:12 AM	gaia-michael	6/18/2025 11:53:36 AM	gaia-jennifer	10/1/2015 12:00:00 AM	6/18/2025 9:53:36 AM	False
CT	64	False	UHC PCP MCR HMO	UHC PCP MCR HMO	PO BOX 30448	SALT LAKE CITY	UT	84130	8667259334	Work		1	1701	1799	1741	2	1682	2	3	0	CT	0	False	233	64	PO BOX 30448 UHC PCP MCR HMO UHC PCP MCR HMO SALT LAKE CITY UT 84130	9/10/2020 2:47:57 PM	gaia-mwhite	5/18/2026 8:23:27 AM	gaia-jennifer	10/1/2015 12:00:00 AM	5/18/2026 6:23:27 AM	False
C	67	False	WELLCARE MCR	WELLCARE MCR	PO BOX 31372	Tampa	FL	33631	8555380454			1	1701	1799	1741	2	1682	2	3	0	C			233	67	PO BOX 31372 WELLCARE MCR WELLCARE MCR TAMPA FL 33631	12/22/2020 1:32:52 PM	gaia-michael	6/18/2025 11:53:15 AM	gaia-jennifer	10/1/2015 12:00:00 AM	6/18/2025 9:53:15 AM	False
C	80	False	MEDICARE PART A ONLY	MEDICARE PART A ONLY	PO BOX 2711	Jacksonville	FL	32211	8776028816			4	1701	1799	1738	2	1682	2	3		C			233	80	PO BOX 2711 MEDICARE PART A ONLY MEDICARE PART A ONLY JACKSONVILLE FL 32211	4/29/2022 5:52:29 AM	gaia-jennifer	5/13/2026 10:21:01 AM	GAIA-JENNIFER	10/1/2015 12:00:00 AM	5/13/2026 8:21:01 AM	False
C	1088	False	DOCTORS HEALTH PLAN MCR	DOCTORS HEALTH PLAN MCR	PO BOX 132	MIami	FL	33134	3054229300			1	1701	1799	1741	2	1682	2	3		C			233	90	PO BOX 132 DOCTORS HEALTH PLAN MCR DOCTORS HEALTH PLAN MCR MIAMI FL 33134	8/17/2022 7:01:54 AM	gaia-amanda	6/18/2025 11:52:51 AM	gaia-jennifer	10/1/2015 12:00:00 AM	6/18/2025 9:52:51 AM	False
C	1092	False	DEVOTED MCR	DEVOTED MCR	PO BOX 211524	Eagan	MN	55121	8003386833			1	1701	1799	1741	2	1682	2	3	0	C	0	False	233	1092	PO BOX 211524 DEVOTED MCR DEVOTED MCR EAGAN MN 55121	10/11/2022 8:22:01 AM	gaia-michael	6/18/2025 11:52:47 AM	gaia-jennifer	10/1/2015 12:00:00 AM	6/18/2025 9:52:47 AM	False
C	1097	False	FLORIDA PACE MCR	FLORIDA PACE MCR	5200 NE 2ND AVE	Miami	FL	33137	3057518626			1	1701	1799	1741	2	1682	2	3	0	C	0	False	233	1097	5200 NE 2ND AVE FLORIDA PACE MCR FLORIDA PACE MCR MIAMI FL 33137	1/13/2023 3:34:25 PM	gaia-michael	6/18/2025 11:53:31 AM	gaia-jennifer	10/1/2015 12:00:00 AM	6/18/2025 9:53:31 AM	False
C	1098	False	SOLIS HEALTH MCR	SOLIS HEALTH MCR	PO BOX 211486	Eagan	MN	55121	8336159259			1	1701	1799	1741	2	1682	2	3	0	C			233	1098	PO BOX 211486 SOLIS HEALTH MCR SOLIS HEALTH MCR EAGAN MN 55121	7/31/2023 1:21:30 PM	gaia-michael	6/18/2025 11:53:18 AM	gaia-jennifer	10/1/2015 12:00:00 AM	6/18/2025 9:53:18 AM	False
C	1101	False	ALIGN SENIOR CARE MCR	ALIGN SENIOR CARE MCR	PO BOX 4440	GLEN ALLEN	VA	23058-5850	8558550336		8447888935	1	1701	1799	1741	2	1682	2	3	0	C			233	1101	PO BOX 4440 ALIGN SENIOR CARE MCR ALIGN SENIOR CARE MCR GLEN ALLEN VA 23058-5850	10/4/2023 2:53:13 PM	gaia-amanda	10/4/2023 2:54:12 PM	gaia-amanda	10/1/2015 12:00:00 AM	10/4/2023 2:54:12 PM	False
C	1102	False	WELLMED MCR	WELLMED MCR	PO BOX 30508	SALT LAKE CITY	UT	84130	8005007691			1	1701	1799	1741	2	1682	2	3	0	C			233	1102	PO BOX 30508 WELLMED MCR WELLMED MCR SALT LAKE CITY UT 84130	12/5/2023 11:03:10 AM	gaia-amanda	12/5/2023 11:03:10 AM	gaia-amanda	10/1/2015 12:00:00 AM	12/5/2023 11:03:13 AM	False
C	1108	False	VA COMMUNITY CARE	VA COMMUNITY CARE	PO BOX 202117	Florence	SC	29502	8778817618			7	1704	86	1742	2	1682	2	2	0	C			233	145789658	PO BOX 202117 VA COMMUNITY CARE VA COMMUNITY CARE FLORENCE SC 29502	6/7/2024 2:18:18 PM	gaia-racheal	8/11/2025 8:21:25 AM	gaia-melisha	10/1/2015 12:00:00 AM	8/11/2025 8:21:25 AM	False
C	1111	False	CIGNA HEALTHSPINGS MCR	CIGNA HEALTHSPINGS MCR	Po Box 981706	El Paso	TX	7998	8009971654			1	1701	1799	1741	2	1682	2	3	0	C	0		233	35241987	PO BOX 981706 CIGNA HEALTHSPINGS MCR CIGNA HEALTHSPINGS MCR EL PASO TX 7998	9/4/2024 1:28:49 PM	gaia-nina	3/4/2026 7:48:39 AM	gaia-jennifer	10/1/2015 12:00:00 AM	3/4/2026 5:48:39 AM	False
C	1123	False	Gold Kidney MCR	Gold Kidney MCR	PO Box 285	Portsmouth	NH	03802	9175455439			1	1701	1799	1741	2	1682	2	3	0	C			233	8795268	PO BOX 285 GOLD KIDNEY MCR GOLD KIDNEY MCR PORTSMOUTH NH 03802	4/25/2025 10:55:19 AM	gaia-nina	6/18/2025 11:53:25 AM	gaia-jennifer	10/1/2015 12:00:00 AM	6/18/2025 9:53:25 AM
C	1140	False	PCN MCR HMO	PCN MCR HMO	PO BOX 30448	SALT LAKE CITY	UT	84130-0448	8003485548			4	1701	1799	1738	2	1682	2	2	0	C	0		233	78857	PO BOX 30448 PCN MCR HMO PCN MCR HMO SALT LAKE CITY UT 84130-0448	4/8/2026 2:46:15 PM	gaia-melisha	4/8/2026 2:46:15 PM	gaia-melisha	10/1/2015 12:00:00 AM	4/8/2026 2:46:15 PM
CT	1143	False	UHC PCN MCR HMO	UHC PCN MCR HMO	PO BOX 56-6616	Miami	FL	33256	8003485548			4	1701	1799	1738	2	1682	2	2	0	CT			233	788577	PO BOX 56-6616 UHC PCN MCR HMO UHC PCN MCR HMO MIAMI FL 33256	4/30/2026 12:19:56 PM	gaia-melisha	5/18/2026 8:23:08 AM	gaia-jennifer	10/1/2015 12:00:00 AM	5/18/2026 6:23:09 AM

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Ledger	InsuranceCarriersId	Inactive	Name	ListName	Address1	City	State	Zip	Phone1	InsuranceGroupId	CollectionsGroupMId	CarrierTypeMId	FinancialClassMId	AllocationSetId	FilingMethodMId	FilingType	TransactionColumnSetId	IncludeClaimOfficeNo	Ledger1	RequiresAuth	ReferenceCarrier	AcceptAssignmentMId	DotId	Keyword	Created	CreatedBy	LastModified	LastModifiedBy	ICD10SERVICEDATE	InsSOP_db_Updated_Date	AUC
C	1	False	SELF PAY	SELF PAY						7	1701	91	1743	2	0	0	3	0	C			233	1	SELF PAY SELF PAY	2/22/2010 10:05:52 AM	cammy	3/31/2025 10:26:14 AM	gaia-cary	10/1/2014 12:00:00 AM	3/31/2025 10:26:14 AM	False
C	3	False	MEDICARE A&B	MEDICARE A&B	PO BOX 2711	JACKSONVILLE	FL	32211	8776028816	1	1701	1799	1738	2	1682	2	3	0	C	0	False	233	3	PO BOX 2711 MEDICARE A&B MEDICARE A&B JACKSONVILLE FL 32211	8/23/2022 3:28:21 PM	gaia-bruce	5/13/2026 11:31:08 AM	gaia-melisha	10/1/2015 12:00:00 AM	5/13/2026 11:31:08 AM	False
C	1013	False	CAREPLUS MCR	CAREPLUS MCR	PO BOX 14697	LEXINGTON	KY	40512	8663137587	2	1701	1799	1741	2	1682	2	3	0	C	0	False	233	1013	PO BOX 14697 CAREPLUS MCR CAREPLUS MCR LEXINGTON KY 40512	1/9/2023 4:41:08 PM	gaia-amanda	5/31/2023 11:11:45 AM	gaia-cary	10/1/2015 12:00:00 AM	5/31/2023 11:11:45 AM	False
C	4018	False	MOLINA MCR	MOLINA MCR	PO BOX 22812	LONG BEACH	CA	90801	8553224076	2	1701	1799	1741	2	1682	2	3	0	C		False	233	4018	PO BOX 22812 MOLINA MCR MOLINA MCR LONG BEACH CA 90801	5/3/2023 8:31:35 AM	gaia-amanda	7/3/2023 11:10:42 AM	gaia-amanda	10/1/2015 12:00:00 AM	7/3/2023 11:10:42 AM	False
C	4020	False	PENDING INSURANCE	PENDING INSURANCE	DO NOT BILL	MIAMI	FL	33312		7	1701	80	1743	2	0	0	2	0	C			233	4020	DO NOT BILL PENDING INSURANCE PENDING INSURANCE MIAMI FL 33312	5/17/2023 2:57:08 PM	gaia-michael	4/28/2025 8:55:56 AM	gaia-cary	10/1/2015 12:00:00 AM	4/28/2025 8:55:56 AM	False
C	4024	False	CIGNA MCR	CIGNA MCR	PO BOX 188004	CHATTANOOGA	TN	37422		2	1701	1799	1741	2	1682	2	3		C			233	4024	PO BOX 188004 CIGNA MCR CIGNA MCR CHATTANOOGA TN 37422	8/25/2023 10:40:36 AM	gaia-amanda	8/25/2023 10:40:36 AM	gaia-amanda	10/1/2015 12:00:00 AM	8/25/2023 10:40:36 AM	False

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Ledger	InsuranceCarriersId	MasterInsuranceCarriersId	Inactive	Name	ListName	Address1	Address2	City	State	Zip	Country	Contact	Phone1	Phone1Type	Phone2	Phone2Type	Phone3	Phone3Type	InsuranceGroupId	CollectionsGroupMId	CarrierTypeMId	FinancialClassMId	AllocationSetId	FilingMethodMId	FilingType	TransactionColumnSetId	PolicyTypeMId	CopayAmt	Deductible	GroupId	GroupName	MediGapId	OrgId	IncludeClaimOfficeNo	LocationId	PPOId	ECSClearinghouseId	ECSPayorId	ECSClaimOfficeNumber	ECSNEIC	UseRenderingProviderId	RequiresPIN	ECSMaximumNumberOfProcedures	ELIMIKDestination	ELIClearinghouseId	ELIPayorId	ELIMessageType	ElectronicFilingStatus	SupplementalFiling	Ledger1	Notes	AlertNotes	RequiresAuth	ReferenceCarrier	PayerIdNumberCodeMId	OtherPayerIdNumber	SubscriberIDMask	AcceptAssignmentMId	DotId	PartnerInsuranceCarriersId	PreAuthorizationFormType	PreAuthorizationFormFile	Keyword	OrderNotes	Created	CreatedBy	LastModified	LastModifiedBy	CountrySubdiv	ICD10SERVICEDATE	InsSourceOfPaymentsID	InsSOP_db_Updated_Date	AUC
C	1		False	SELF PAY	SELF PAY	1237 SOUTHRIDGE COURT 203		HURST	TX	76053	USA								7	1701	91	1743	2	1682	1	2		0	0					0																C								233	1				1237 SOUTHRIDGE COURT 203 SELF PAY SELF PAY HURST TX 76053		2/22/2010 10:05:52 AM	cammy	10/24/2022 6:30:34 PM	padai		10/1/2014 12:00:00 AM		10/24/2022 5:30:34 PM	False
C	3		False	MEDICARE TX	MEDICARE TX	PO BOX 660155		DALLAS	TX	75266	USA		8552528782						1	1701	1799	1738	2	1682	2	3		0	0					0																C			0	False				233	3				PO BOX 660155 MEDICARE TX MEDICARE TX DALLAS TX 75266		8/23/2022 3:28:21 PM	gaia-bruce	12/21/2022 1:27:27 PM	padai		10/1/2015 12:00:00 AM		12/21/2022 12:27:27 PM	False

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Ledger	InsuranceCarriersId	Inactive	Name	ListName	Address1	Address2	City	State	Zip	Contact	Phone1	Phone1Type	Phone2	Phone2Type	InsuranceGroupId	CollectionsGroupMId	CarrierTypeMId	FinancialClassMId	AllocationSetId	FilingMethodMId	FilingType	TransactionColumnSetId	PolicyTypeMId	IncludeClaimOfficeNo	Ledger1	Notes	RequiresAuth	ReferenceCarrier	AcceptAssignmentMId	DotId	PreAuthorizationFormType	Keyword	Created	CreatedBy	LastModified	LastModifiedBy	ICD10SERVICEDATE	InsSOP_db_Updated_Date	AUC
C	1	False	MEDICARE	MEDICARE	NEBRASKA GHA WPS	PO BOX 8999	MADIISON	WI	53708-8999		8778696503	Work			1	1701	1799	1738	2	1682	2	3		0	C				233	1		NEBRASKA GHA WPS PO BOX 8999 MEDICARE MEDICARE MADIISON WI 53708-8999	2/22/2010 10:05:52 AM	cammy	12/17/2025 5:03:50 PM	gaia-jennifer	10/1/2015 12:00:00 AM	12/17/2025 3:03:50 PM	False
C	3	False	DEPARTMENT OF VETERANS AFFAIR	DEPARTMENT OF VETERANS AFFAIR	NWHCS ATTN 136F	4101 WOOLWORTH AVENUE	OMAHA	NE	68105		8778817618		4064412619		4	1701	80	1742	2	1682	2	2		0	C	Tammy 406-441-2619; Candice 406-441-2639; 866-372-1141 X 1 800-733-8387 416-995-5400	-1	False	233	3		NWHCS ATTN 136F 4101 WOOLWORTH AVENUE DEPARTMENT OF VETERANS AFFAIR DEPARTMENT OF VETERANS AFFAIR OMAHA NE 68105	7/13/2017 10:56:02 AM	ksysel	12/15/2025 5:13:32 PM	HStubbendeck	10/1/2015 12:00:00 AM	12/15/2025 4:13:31 PM	False
C	5	False	COVENTRY MEDICARE ADVANTAGE	COVENTRY MEDICARE ADVANTAGE	ATTN CLAIMS DEPARTMENT	P O BOX 7152	LONDON	KY	40742		8669014692	Work			5	1701	1799	1741	2	1682	2	2		0	C	AUTH PHONE # 800-471-0240	0	False	233	5		ATTN CLAIMS DEPARTMENT P O BOX 7152 COVENTRY MEDICARE ADVANTAGE COVENTRY MEDICARE ADVANTAGE LONDON KY 40742	7/13/2017 12:35:56 PM	grai	12/15/2025 5:13:18 PM	HStubbendeck	10/1/2015 12:00:00 AM	12/15/2025 4:13:17 PM	False
C	15	False	HIGHMARK FREEDOM BLUE PPO	HIGHMARK FREEDOM BLUE PPO	CLAIMS DEPARTMENT	PO BOX 3248	OMAHA	NE	68180		8665886967		8882583428		5	1701	84	1741	2	1682	2	2		0	C	(402) 390-1800 - TIMELY FILING 365 FROM DOS GRIEVANCE:P O BOX 535047, PITTSBURGH, PA 15253. fax # 717-635-4209	0	False	233	15		CLAIMS DEPARTMENT PO BOX 3248 HIGHMARK FREEDOM BLUE PPO HIGHMARK FREEDOM BLUE PPO OMAHA NE 68180	8/4/2017 4:46:07 PM	GRai	12/15/2025 5:14:29 PM	HStubbendeck	10/1/2014 12:00:00 AM	12/15/2025 4:14:28 PM	False
C	16	False	HUMANA GOLD PLUS	HUMANA GOLD PLUS	HUMANA CORRESPONDENCE	PO BOX 14601	LEXINGTON	KY	40512		8775115000	Work	8885562128	Fax	5	1701	104	1741	2	1682	2	2		0	C	CLAM STATUS 800-457-4708; 866-396-8810 800-866-0581		False	233	16		HUMANA CORRESPONDENCE PO BOX 14601 HUMANA GOLD PLUS HUMANA GOLD PLUS LEXINGTON KY 40512	8/4/2017 4:55:11 PM	GRai	1/21/2026 1:31:49 PM	gaia-jennifer	10/1/2014 12:00:00 AM	1/21/2026 11:31:49 AM	False
C	17	False	NEBRASKA TOTAL CARE	NEBRASKA TOTAL CARE	CLAIMS DEPARTMENT	P O BOX 5060	FARMINGTON	MO	63640	Deb Koopmans	8443852192		4029959910	Mobile	6	1701	80	1739	2	1682	2	2		0	C	180 DAYS FROM DOS TO FILE; 90 DAYS FROM DENIALS	0	False	233	17		CLAIMS DEPARTMENT P O BOX 5060 NEBRASKA TOTAL CARE NEBRASKA TOTAL CARE FARMINGTON MO 63640	8/4/2017 5:04:40 PM	GRai	12/15/2025 5:19:20 PM	HStubbendeck	10/1/2014 12:00:00 AM	12/15/2025 4:19:18 PM	False
C	94	False	BCBS MEDICARE ADVANTAGE	BCBS MEDICARE ADVANTAGE	CLAIMS DEPARTMENT	P O BOX 3248	OMAHA	NE	68180		8885052022	Work	8884889850		5	1701	84	1741	2	1682	2	2		0	C				233	95		CLAIMS DEPARTMENT P O BOX 3248 BCBS MEDICARE ADVANTAGE BCBS MEDICARE ADVANTAGE OMAHA NE 68180	2/6/2021 12:05:52 PM	grai	12/15/2025 5:09:44 PM	HStubbendeck	10/1/2015 12:00:00 AM	12/15/2025 4:09:43 PM	False
C	97	False	VA CCN OPTUM	VA CCN OPTUM	CLAIMS DEPARTMENT	P O BOX 202117	FLORENCE	SC	29502						4	1701	80	1742	2	1682	2	2			C	TF IS 180 FROM DOS	-1		233	98		CLAIMS DEPARTMENT P O BOX 202117 VA CCN OPTUM VA CCN OPTUM FLORENCE SC 29502	5/25/2021 3:42:22 PM	grai	12/15/2025 5:23:42 PM	HStubbendeck	10/1/2015 12:00:00 AM	12/15/2025 4:23:41 PM	False
C	1107	False	WELLCARE ASSIST OPEN MCR	WELLCARE ASSIST OPEN MCR	PO BOX 3060		FARMINGTON	MO	63640		8335420693	Work			5	1701	1799	1741	2	1682	2	2		0	C		0	False	233	1107		PO BOX 3060 WELLCARE ASSIST OPEN MCR WELLCARE ASSIST OPEN MCR FARMINGTON MO 63640	9/28/2022 4:25:41 PM	HStubbendeck	1/7/2026 10:44:00 AM	HStubbendeck	10/1/2015 12:00:00 AM	1/7/2026 9:44:00 AM	False
C	1111	False	MERITAIN HEALTH	MERITAIN HEALTH	PO BOX 953921		RICHARDSON	TX	75085	WWW.CCBYQH.COM	8556512066	Work	8663742452	Fax	2	1703	104	1744	2	1682	2	2		0	C		0	False	233	1111		PO BOX 953921 MERITAIN HEALTH MERITAIN HEALTH RICHARDSON TX 75085	2/27/2023 3:21:30 PM	HStubbendeck	12/17/2025 4:27:44 PM	HStubbendeck	10/1/2015 12:00:00 AM	12/17/2025 3:27:44 PM	False
C	1114	False	AMBETTER	AMBETTER	CLAIMS DEPARTMENT	PO BOX 5010	FARMINGTON	MO	63640		8338900329	Work			5	1701	93	1741	2	1682	2	2		0	C		0	False	233	1114	D	CLAIMS DEPARTMENT PO BOX 5010 AMBETTER AMBETTER FARMINGTON MO 63640	6/14/2023 9:51:19 AM	HStubbendeck	12/15/2025 5:27:53 PM	HStubbendeck	10/1/2015 12:00:00 AM	12/15/2025 4:27:52 PM	False
C	1115	False	HUMANA INSURANCE CO	HUMANA INSURANCE CO	1100 EMPLOYERS BLVD		DEPERE	WI	54115		8004486262	Work			5	1701	104	1741	2	1682	2	2		0	C			False	233	1115		1100 EMPLOYERS BLVD HUMANA INSURANCE CO HUMANA INSURANCE CO DEPERE WI 54115	6/20/2023 12:47:05 PM	HStubbendeck	4/21/2026 12:58:43 PM	gaia-jennifer	10/1/2015 12:00:00 AM	4/21/2026 10:58:43 AM	False
C	1124	False	WELLCARE DUAL ACCESS MCR	WELLCARE DUAL ACCESS MCR	PO BOX 3060		FARMINGTON	MO	63640		8447966811				5	1701	1799	1741	2	1682	2	2	116	0	C				233	1200		PO BOX 3060 WELLCARE DUAL ACCESS MCR WELLCARE DUAL ACCESS MCR FARMINGTON MO 63640	2/7/2025 2:11:28 PM	HStubbendeck	3/20/2026 1:41:20 PM	HStubbendeck	10/1/2015 12:00:00 AM	3/20/2026 12:41:20 PM	False
C	1127	False	WELLCARE GIVEBACK MCR	WELLCARE GIVEBACK MCR	PO BOX 3060		FARMINGTON	MO	63640		8009777522	Work			5	1701	1799	1741	2	1682	2	2		0	C			False	233	1127		PO BOX 3060 WELLCARE GIVEBACK MCR WELLCARE GIVEBACK MCR FARMINGTON MO 63640	5/22/2025 9:36:55 AM	HStubbendeck	12/15/2025 5:24:23 PM	HStubbendeck	10/1/2015 12:00:00 AM	12/15/2025 4:24:22 PM

Download as Spreadsheet

Ledger	InsuranceCarriersId	Inactive	Name	ListName	Address1	City	State	Zip	Phone1	Phone1Type	Phone2	InsuranceGroupId	CollectionsGroupMId	CarrierTypeMId	FinancialClassMId	AllocationSetId	FilingMethodMId	FilingType	TransactionColumnSetId	IncludeClaimOfficeNo	Ledger1	Notes	RequiresAuth	ReferenceCarrier	AcceptAssignmentMId	DotId	Keyword	Created	CreatedBy	LastModified	LastModifiedBy	ICD10SERVICEDATE	InsSOP_db_Updated_Date	AUC
C	1	False	MEDICARE PART A & B	MEDICARE PART A & B	PO Box 660155	Dallas	TX	75266	8552528782			1	1701	1799	1738	2	1682	2	2	0	C				233	04412	PO BOX 660155 MEDICARE PART A & B MEDICARE PART A & B DALLAS TX 75266	2/22/2010 10:05:52 AM	cammy	5/13/2026 11:32:56 AM	gaia-melisha	10/1/2015 12:00:00 AM	5/13/2026 11:32:56 AM	False
C	5	False	PENDING INSURANCE	PENDING INSURANCE	123456	HOUSTON	TX	77054				5	1701	80	1743	2	0	0	2	0	C			False	233	5	123456 PENDING INSURANCE PENDING INSURANCE HOUSTON TX 77054	7/22/2019 2:17:26 PM	gaia-michael	4/28/2025 8:57:07 AM	gaia-cary	10/1/2015 12:00:00 AM	4/28/2025 8:57:07 AM	False
C	6	False	NO SECONDARY	NO SECONDARY	DO NOT BILL	Dialyis	DL	14674				5		91	1743	2	0	0	1	0	C				233	6	DO NOT BILL NO SECONDARY NO SECONDARY DIALYIS DL 14674	7/22/2019 2:41:43 PM	gaia-michael	3/28/2025 12:58:41 PM	gaia-nina	10/1/2015 12:00:00 AM	3/28/2025 12:58:41 PM	False
c	20	False	HUMANA MCR	HUMANA MCR	PO BOX 14601	LEXINGTON	KY	45012	8004574708			4	1701	1799	1741	2	1682	2	3	0	c			False	233	20	PO BOX 14601 HUMANA MCR HUMANA MCR LEXINGTON KY 45012	7/3/2020 1:46:15 PM	mwhite	8/2/2023 10:28:43 AM	gaia-sandy	10/1/2015 12:00:00 AM	8/2/2023 10:28:43 AM	False
C	21	False	UHC MCR	UHC MCR	PO BOX 31362	Salt Lake City	UT	84131	8778423210	h		4	1701	1799	1741	2	1682	2	2	0	C				233	87726	PO BOX 31362 UHC MCR UHC MCR SALT LAKE CITY UT 84131	7/14/2020 1:51:36 PM	mwhite	3/20/2026 11:11:00 AM	gaia-Lydia	10/1/2015 12:00:00 AM	3/20/2026 11:11:00 AM	False
C	23	False	AMBETTER SUPERIOR HEALTH CM	AMBETTER SUPERIOR HEALTH CM	PO BOX 5010	FARMINGTON	MO	63640	8776871196	Home		2	1703	104	1744	2	1682	2	2	0	C		0	False	233	23	PO BOX 5010 AMBETTER SUPERIOR HEALTH CM AMBETTER SUPERIOR HEALTH CM FARMINGTON MO 63640	9/14/2020 1:54:53 PM	mwhite	3/28/2025 12:46:16 PM	gaia-nina	10/1/2015 12:00:00 AM	3/28/2025 12:46:16 PM	False
c	27	False	Cigna MCR	Cigna MCR	PO BOX 2888	Houston	TX	77252	8002306138			4	1701	1799	1741	2	1682	2	3	0	c		0	False	233	27	PO BOX 2888 CIGNA MCR CIGNA MCR HOUSTON TX 77252	1/4/2021 8:12:42 AM	gaia-michael	8/31/2023 11:44:21 AM	gaia-sandy	10/1/2015 12:00:00 AM	8/31/2023 11:44:21 AM	False
c	28	False	AMERIGROUP WELLPOINT MCR	Amerigroup Wellpoint MCR	PO BOX 61010	VIRGINIA BEACH	VA	23466	8668054589		8668054589	4	1701	1799	1741	2	1682	2	3	0	c		0	False	233	28	PO BOX 61010 AMERIGROUP WELLPOINT MCR AMERIGROUP WELLPOINT MCR VIRGINIA BEACH VA 23466	1/22/2021 8:26:55 AM	gaia-michael	7/2/2025 1:20:13 PM	gaia-brenda	10/1/2015 12:00:00 AM	7/2/2025 1:20:13 PM	False
C	29	False	SELF PAY	SELF PAY	DO NOT BILL							5	1701	91	1743	2	0	0	1	0	C		0	False	233	29	DO NOT BILL SELF PAY SELF PAY	2/8/2021 12:45:50 PM	gaia-michael	7/2/2025 2:05:45 PM	gaia-cary	10/1/2015 12:00:00 AM	7/2/2025 2:05:45 PM	False
c	30	False	DEVOTED HEALTH MCR	DEVOTED HEALTH MCR	PO BOX 211524	EAGAN	MN	55121	8003386833			4	1701	1799	1741	2	1682	2	3	0	c	not contracted		False	233	30	PO BOX 211524 DEVOTED HEALTH MCR DEVOTED HEALTH MCR EAGAN MN 55121	3/19/2021 1:40:30 PM	gaia-michael	5/18/2024 8:11:17 AM	gaia-brenda	10/1/2015 12:00:00 AM	5/18/2024 8:11:17 AM	False
c	32	True	UHC MCR DUAL	UHC MCR DUAL- ADD UHC MCD AS SECONDARY	PO BOX 5270	Kingston	NY	12402	8778423210			4	1701	1799	1741	2	1682	2	3		c	DO NOT USE DUAL PROFILE			233	32	PO BOX 5270 UHC MCR DUAL- ADD UHC MCD AS SECONDARY UHC MCR DUAL KINGSTON NY 12402	5/20/2021 11:16:53 AM	gaia-veronica	6/16/2025 1:36:32 PM	gaia-nina	10/1/2015 12:00:00 AM	6/16/2025 1:36:32 PM	False
C T	33	False	MEDICARE PART A ONLY	MEDICARE PART A ONLY	PO Box 660155	Dallas	TX	75266				1	1701	1799	1738	2	1682	2	2		C T				233	100	PO BOX 660155 MEDICARE PART A ONLY MEDICARE PART A ONLY DALLAS TX 75266	6/18/2021 9:08:22 AM	gaia-veronica	4/30/2026 10:41:46 AM	gaia-melisha	10/1/2015 12:00:00 AM	4/30/2026 10:41:46 AM	False
C	34	False	AETNA MCR	AETNA MCR	PO Box 14770	Lexington	KY	40512	8886246290			4	1701	1799	1741	2	1682	2	3	0	C		0	False	233	34	PO BOX 14770 AETNA MCR AETNA MCR LEXINGTON KY 40512	8/2/2021 9:53:20 AM	gaia-veronica	5/1/2023 2:28:08 PM	gaia-cary	10/1/2015 12:00:00 AM	5/1/2023 2:28:08 PM	False
C	36	False	WELLMED MCR	WELLMED MCR	PO BOX 30508	Salt Lake City	UT	84130	8005507691			4	1701	1799	1741	2	1682	2	2	0	C				233	WELM2	PO BOX 30508 WELLMED MCR WELLMED MCR SALT LAKE CITY UT 84130	1/17/2022 10:42:37 AM	gaia-michael	3/20/2026 11:10:06 AM	gaia-Lydia	10/1/2015 12:00:00 AM	3/20/2026 11:10:06 AM	False
C	1042	False	PROMINENCE HEALTH MCR	PROMINENCE HEALTH MCR	PO BOX 981748	EL PASO	TX	79998	8665002741		7757709311	4	1701	1799	1741	2	1682	2	3	0	C		0	False	233	1042	PO BOX 981748 PROMINENCE HEALTH MCR PROMINENCE HEALTH MCR EL PASO TX 79998	8/2/2022 8:27:39 AM	gaia-amanda	5/1/2023 4:39:32 PM	gaia-vicki	10/1/2015 12:00:00 AM	5/1/2023 4:39:32 PM	False
A	1043	False	VA - TRIWEST	VA - TRIWEST	PO BOX 108851	FLORENCE	SC	29502-8851	8772268749			1	1704	95	1742	2	1682	2	3		A				233	1043	PO BOX 108851 VA - TRIWEST VA - TRIWEST FLORENCE SC 29502-8851	8/11/2022 3:36:36 PM	gaia-amanda	5/7/2026 2:13:45 PM	gaia-wendy	10/1/2015 12:00:00 AM	5/7/2026 2:13:45 PM	False
C	1050	False	CIGNA HEALTH SPRING MCR	CIGNA HEALTH SPRING MCR	PO BOX 981706	EL PASO	TX	79998	8006683813			4	1701	1799	1741	2	1682	2	3	0	C		0		233	1050	PO BOX 981706 CIGNA HEALTH SPRING MCR CIGNA HEALTH SPRING MCR EL PASO TX 79998	12/29/2023 11:56:32 AM	gaia-amanda	5/18/2026 4:01:16 PM	gaia-wendy	10/1/2015 12:00:00 AM	5/18/2026 4:01:16 PM	False
C	1053	False	Health Smart CM	Health Smart CM	PO BOX 507	ARNOLD	MD	21012	8882166533			2	1703	104	1744	2	1682	2	2	0	C		0		233	123456	PO BOX 507 HEALTH SMART CM HEALTH SMART CM ARNOLD MD 21012	9/13/2024 8:26:04 AM	gaia-briana	11/4/2024 8:06:05 AM	gaia-briana	10/1/2015 12:00:00 AM	11/4/2024 8:06:05 AM	False

Download as Spreadsheet

Ledger	InsuranceCarriersId	Inactive	Name	ListName	Address1	City	State	Zip	Contact	Phone1	Phone1Type	Phone2	InsuranceGroupId	CollectionsGroupMId	CarrierTypeMId	FinancialClassMId	AllocationSetId	FilingMethodMId	FilingType	TransactionColumnSetId	IncludeClaimOfficeNo	Ledger1	Notes	RequiresAuth	ReferenceCarrier	AcceptAssignmentMId	DotId	Keyword	Created	CreatedBy	LastModified	LastModifiedBy	ICD10SERVICEDATE	InsSOP_db_Updated_Date	AUC
C T	1	False	MEDICARE PART A & B	MEDICARE PART A & B	PO BOX 2711	Jacksonville	FL	32231		8776028816		8886644112	1	1701	1799	1738	2	1682	2	3	0	C T				233	1	PO BOX 2711 MEDICARE PART A & B MEDICARE PART A & B JACKSONVILLE FL 32231	2/22/2010 10:05:52 AM	cammy	4/30/2026 10:45:11 AM	gaia-melisha	10/1/2015 12:00:00 AM	4/30/2026 10:45:11 AM	False
C	11	False	PENDING INSURANCE	PENDING INSURANCE									9	1701	80	1743	2	0	0	2	0	C		0	False	233	11	PENDING INSURANCE PENDING INSURANCE	9/1/2016 3:34:13 PM	gaia-renee	4/28/2025 8:59:46 AM	gaia-cary	10/1/2015 12:00:00 AM	4/28/2025 8:59:46 AM	False
C	14	False	MEDICARE ACUTE	MEDICARE ACUTE	PO Box 2711	Jacksonville	FL	32211					1	1701	1799	1738	2	1682	2	3	0	C		0	False	233	14	PO BOX 2711 MEDICARE ACUTE MEDICARE ACUTE JACKSONVILLE FL 32211	1/31/2017 3:42:08 PM	gaia-jennifer	3/28/2025 1:18:45 PM	gaia-nina	10/1/2015 12:00:00 AM	3/28/2025 1:18:45 PM	False
C	19	False	WELLCARE MCR	WELLCARE MCR	P O Box 31372	Tampa	FL	33631-3372		8555380454			6	1701	1799	1741	2	1682	2	3	0	C		0	False	233	19	P O BOX 31372 WELLCARE MCR WELLCARE MCR TAMPA FL 33631-3372	6/1/2017 7:51:22 AM	gaia-renee	5/1/2023 5:15:54 PM	gaia-vicki	10/1/2015 12:00:00 AM	5/1/2023 5:15:54 PM	False
C	33	True	LEON MEDICAL MCR	LEON MEDICAL MCR	PO Box 659006	Miami	FL	33126	3035595366	3056315343		3056442150	1	1701	1799	1741	2	1682	2	3	0	C			False	233	33	PO BOX 659006 LEON MEDICAL MCR LEON MEDICAL MCR MIAMI FL 33126	11/20/2018 9:25:59 AM	gaia-michael	2/1/2021 1:53:09 PM	gaia-jennifer	10/1/2015 12:00:00 AM	2/1/2021 1:53:09 PM	False
C	35	False	MEDICA MCR	MEDICA MCR	PO Box 56-6616	Miami	FL	33256		8004079069			1	1701	1799	1741	2	1682	2	3	0	C				233	35	PO BOX 56-6616 MEDICA MCR MEDICA MCR MIAMI FL 33256	6/4/2019 9:18:28 AM	gaia-michael	5/1/2023 5:11:06 PM	gaia-vicki	10/1/2015 12:00:00 AM	5/1/2023 5:11:06 PM	False
C	36	False	ALLWELL MCR	ALLWELL MCR	PO Box 3060	Farmington	MO	63640		8442932636			1	1701	1799	1741	2	1682	2	2	0	C		0	False	233	36	PO BOX 3060 ALLWELL MCR ALLWELL MCR FARMINGTON MO 63640	7/8/2019 9:19:08 AM	gaia-michael	3/18/2026 10:16:46 AM	gaia-Lydia	10/1/2015 12:00:00 AM	3/18/2026 10:16:46 AM	False
C	44	True	MEDICA DUAL MCR/MCD	MEDICA DUAL MCR/MCD	Po Box 303448	Salt Lake City	UT	84130		8004079069			1	1701	1799	1741	2	1682	2	3	0	C	DO NOT USE DUAL PROFILE			233	44	PO BOX 303448 MEDICA DUAL MCR/MCD MEDICA DUAL MCR/MCD SALT LAKE CITY UT 84130	3/6/2020 3:20:10 PM	gaia-mwhite	6/16/2025 1:41:04 PM	gaia-nina	10/1/2015 12:00:00 AM	6/16/2025 1:41:04 PM	False
C	49	False	UHC MCR	UHC MCR	PO BOX 5240	KINGSTON	NY	12402		8778423210	Work		6	1701	1799	1741	2	1682	2	3	0	C			False	233	49	PO BOX 5240 UHC MCR UHC MCR KINGSTON NY 12402	10/26/2020 11:53:24 AM	gaia-mwhite	5/20/2024 10:46:44 AM	gaia-Tricia	10/1/2015 12:00:00 AM	5/20/2024 10:46:44 AM	False
C	50	False	SOLIS HEALTH MCR	SOLIS HEALTH MCR	PO BOX 211486	Eagan	MN	55121		8336159259			6	1701	1799	1741	2	1682	2	3	0	C			False	233	52	PO BOX 211486 SOLIS HEALTH MCR SOLIS HEALTH MCR EAGAN MN 55121	1/19/2021 8:34:30 AM	gaia-michael	5/23/2024 9:30:33 AM	gaia-nina	10/1/2015 12:00:00 AM	5/23/2024 9:30:33 AM	False
C	51	False	UHC PCP MCR HMO	UHC PCP MCR HMO	PO BOx 30448	Salt Lake City	UT	84130		8778423210			6	1701	1799	1741	2	1682	2	2	0	C		0	False	233	65088	PO BOX 30448 UHC PCP MCR HMO UHC PCP MCR HMO SALT LAKE CITY UT 84130	1/19/2021 9:42:10 AM	gaia-michael	4/10/2026 8:09:11 AM	gaia-Lydia	10/1/2015 12:00:00 AM	4/10/2026 8:09:11 AM	False
C	55	False	BCBS MCR	BCBS MCR	PO BOX 1798	Jacksonville	FL	32231		8007272227			6	1701	1799	1741	2	1682	2	3	0	C			False	233	57	PO BOX 1798 BCBS MCR BCBS MCR JACKSONVILLE FL 32231	7/1/2021 12:49:05 PM	gaia-jason	5/20/2024 11:28:58 AM	gaia-Tricia	10/1/2015 12:00:00 AM	5/20/2024 11:28:58 AM	False
C	57	True	UHC DUAL COMPLETE MCR	UHC DUAL COMPLETE MCR	PO Box 31350	Salt Lake CIty	UT	84131		8778423210	Clinic		6	1701	1799	1741	2	1682	2	3	0	C	DO NOT USE DUAL PROFILE	0	False	233	59	PO BOX 31350 UHC DUAL COMPLETE MCR UHC DUAL COMPLETE MCR SALT LAKE CITY UT 84131	8/2/2021 3:23:57 PM	gaia-veronica	6/16/2025 1:41:23 PM	gaia-nina	10/1/2015 12:00:00 AM	6/16/2025 1:41:23 PM	False
C T	62	False	MEDICARE PART A ONLY	MEDICARE PART A ONLY	PO BOX 2711	Jacksonville	FL	32211		8776028816			1	1701	1799	1738	2	1682	2	3		C T				233	64	PO BOX 2711 MEDICARE PART A ONLY MEDICARE PART A ONLY JACKSONVILLE FL 32211	5/2/2022 2:09:46 PM	gaia-amanda	4/30/2026 10:45:18 AM	gaia-melisha	10/1/2015 12:00:00 AM	4/30/2026 10:45:18 AM	False
C	64	False	Devoted Health MCR	Devoted Health MCR	PO BOX 211524	Eagan	MN	55121		8003886833			6	1701	1799	1741	2	1682	2	3	0	C		0	False	233	66	PO BOX 211524 DEVOTED HEALTH MCR DEVOTED HEALTH MCR EAGAN MN 55121	7/18/2022 1:33:13 PM	gaia-amanda	3/28/2025 1:14:59 PM	gaia-nina	10/1/2015 12:00:00 AM	3/28/2025 1:14:59 PM	False
C	66	False	FREEDOM HEALTH MCR	FREEDOM HEALTH MCR	PO BOX 151348	TAMPA	FL	33684		8004012740			6	1701	1799	1741	2	1682	2	3	0	C			False	233	68	PO BOX 151348 FREEDOM HEALTH MCR FREEDOM HEALTH MCR TAMPA FL 33684	4/12/2023 2:48:08 PM	gaia-amanda	5/1/2023 5:09:47 PM	gaia-vicki	10/1/2015 12:00:00 AM	5/1/2023 5:09:47 PM	False
C	67	False	LEON HEALTH MCR	LEON HEALTH MCR	PO BOX 61265	Phoenix	AZ	85082		8333735366			6	1701	1799	1741	2	1682	2	3	0	C			False	233	69	PO BOX 61265 LEON HEALTH MCR LEON HEALTH MCR PHOENIX AZ 85082	7/19/2023 9:50:52 AM	gaia-amanda	7/19/2023 9:50:52 AM	gaia-amanda	10/1/2015 12:00:00 AM	7/19/2023 9:50:52 AM	False
C	70	False	UMR	UMR	PO BOX 30541	Salt Lake City	UT	84130		8777720567			5	1703	104	1744	2	1682	2	2	0	C				233	72	PO BOX 30541 UMR UMR SALT LAKE CITY UT 84130	11/3/2023 10:33:46 AM	gaia-amanda	3/28/2025 1:26:34 PM	gaia-nina	10/1/2015 12:00:00 AM	3/28/2025 1:26:34 PM	False
C	72	False	AMERIHEALTH CARITAS MCD MMA	AMERIHEALTH CARITAS MCD MMA	PO BOX 7367	London	KY	40742		8553559800			8	1702	83	311318	2	1682	2	2	0	C		0		233	97	PO BOX 7367 AMERIHEALTH CARITAS MCD MMA AMERIHEALTH CARITAS MCD MMA LONDON KY 40742	1/5/2024 8:04:32 AM	gaia-nina	1/5/2024 8:04:32 AM	gaia-nina	10/1/2015 12:00:00 AM	1/5/2024 8:04:34 AM	False
C	79	False	Triple-S Advantage MCR	Triple-S Advantage MCR	PO Box 11320	San Juan	PR	00922		8558867474			6	1701	1799	1741	2	1682	2	3	0	C				233	78419	PO BOX 11320 TRIPLE-S ADVANTAGE MCR TRIPLE-S ADVANTAGE MCR SAN JUAN PR 00922	7/12/2024 10:16:50 AM	gaia-nina	1/21/2025 9:31:55 AM	gaia-michellem	10/1/2015 12:00:00 AM	1/21/2025 9:31:55 AM	False
C	80	False	Amerihealth Caritas Next CM	Amerihealth Caritas Next CM	PO Box 7425	London	KY	40742		8553559800			5	1703	104	1744	2	1682	2	2	0	C				233	789521	PO BOX 7425 AMERIHEALTH CARITAS NEXT CM AMERIHEALTH CARITAS NEXT CM LONDON KY 40742	7/12/2024 10:40:16 AM	gaia-nina	7/12/2024 10:40:16 AM	gaia-nina	10/1/2015 12:00:00 AM	7/12/2024 10:40:16 AM	False

Download as Spreadsheet

Ledger	InsuranceCarriersId	Inactive	Name	ListName	Address1	City	State	Zip	Phone1	InsuranceGroupId	CollectionsGroupMId	CarrierTypeMId	FinancialClassMId	AllocationSetId	FilingMethodMId	FilingType	TransactionColumnSetId	IncludeClaimOfficeNo	Ledger1	RequiresAuth	ReferenceCarrier	AcceptAssignmentMId	DotId	Keyword	Created	CreatedBy	LastModified	LastModifiedBy	ICD10SERVICEDATE	InsSOP_db_Updated_Date	AUC
C	1	False	SELF PAY	SELF PAY						7		91	1743	2	0	0	1	0	C			233	1	SELF PAY SELF PAY	2/22/2010 10:05:52 AM	cammy	3/28/2025 1:55:27 PM	gaia-nina	10/1/2014 12:00:00 AM	3/28/2025 1:55:27 PM	False
C T	3	False	MEDICARE A&B	MEDICARE A&B	PO Box 3114	Mechanicsburg	PA	17055	8552528782	1	1701	1799	1738	2	1682	2	3	0	C T	0	False	233	3	PO BOX 3114 MEDICARE A&B MEDICARE A&B MECHANICSBURG PA 17055	8/23/2022 3:28:21 PM	gaia-bruce	4/30/2026 10:43:13 AM	gaia-melisha	10/1/2015 12:00:00 AM	4/30/2026 10:43:13 AM	False
C	8	False	PENDING INSURANCE	PENDING INSURANCE	DO NOT BILL	Oklahoma City	OK	73111		7	1701	80	1743	2	0	0	2	0	C		False	233	8	DO NOT BILL PENDING INSURANCE PENDING INSURANCE OKLAHOMA CITY OK 73111	6/26/2023 2:46:15 PM	gaia-michael	4/28/2025 8:58:24 AM	gaia-cary	10/1/2015 12:00:00 AM	4/28/2025 8:58:24 AM	False
C	9	False	UHC MCR	UHC MCR	PO BOX 5270	KINGSTON	NY	12402	8443687150	2	1701	1799	1741	2	1682	2	3	0	C		False	233	9	PO BOX 5270 UHC MCR UHC MCR KINGSTON NY 12402	6/26/2023 2:56:11 PM	gaia-michael	9/17/2024 10:10:14 AM	gaia-Tricia	10/1/2015 12:00:00 AM	9/17/2024 10:10:14 AM	False
C	15	False	TRICARE EAST HUMANA MILITARY	TRICARE EAST HUMANA MILITARY	PO BOX 7891	MADISON	WI	53707	8004445445	5	1703	104	1744	2	1682	2	2		C			233	15	PO BOX 7891 TRICARE EAST HUMANA MILITARY TRICARE EAST HUMANA MILITARY MADISON WI 53707	8/10/2023 12:38:56 PM	gaia-amanda	8/10/2023 12:38:56 PM	gaia-amanda	10/1/2015 12:00:00 AM	8/10/2023 12:38:56 PM	False
C	19	False	Global Health MCR	Global Health MCR	PO Box 2328	Oklahoma City	OK	73101	8442805555	2	1701	1799	1741	2	1682	2	3	0	C	0		233	5498	PO BOX 2328 GLOBAL HEALTH MCR GLOBAL HEALTH MCR OKLAHOMA CITY OK 73101	9/20/2024 1:10:58 PM	gaia-nina	9/20/2024 1:11:29 PM	gaia-nina	10/1/2015 12:00:00 AM	9/20/2024 1:11:29 PM	False

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Ledger	InsuranceCarriersId	Inactive	Name	ListName	Address1	City	State	Zip	Phone1	Phone1Type	InsuranceGroupId	CollectionsGroupMId	CarrierTypeMId	FinancialClassMId	AllocationSetId	FilingMethodMId	FilingType	TransactionColumnSetId	PolicyTypeMId	Ledger1	RequiresAuth	ReferenceCarrier	AcceptAssignmentMId	DotId	Keyword	Created	CreatedBy	LastModified	LastModifiedBy	ICD10SERVICEDATE	InsSOP_db_Updated_Date	AUC
C	1	False	MEDICARE PART A	MEDICARE PART A	PO BOX 100305	COLUMBIA	SC	29203			1	1701	1799	1738	2	1682	2	3		C			233	1	PO BOX 100305 MEDICARE PART A MEDICARE PART A COLUMBIA SC 29203	2/22/2010 10:05:52 AM	cammy	8/10/2023 8:13:51 AM	gaia-bruce	10/1/2014 12:00:00 AM	8/10/2023 8:13:51 AM	False
C	5	False	BCBS OF GA MCR	BCBS OF GA MCR	PO BOX 105370	ATLANTA	GA	30348	8553227062		2	1701	1799	1741	2	1682	2	3		C	-1	False	233	5	PO BOX 105370 BCBS OF GA MCR BCBS OF GA MCR ATLANTA GA 30348	7/27/2018 9:04:27 AM	gaia-jennifer	8/18/2023 3:05:24 PM	vopris	10/1/2014 12:00:00 AM	8/18/2023 1:05:24 PM	False
C	9	False	HUMANA MCR	HUMANA MCR	PO BOX 14601	LEXINGTON	KY	40512	8004574708		2	1701	1799	1741	2	1682	2	3		C	-1	False	233	9	PO BOX 14601 HUMANA MCR HUMANA MCR LEXINGTON KY 40512	7/27/2018 9:08:33 AM	gaia-jennifer	8/11/2023 10:26:14 AM	vopris	10/1/2014 12:00:00 AM	8/11/2023 8:26:14 AM	False
C	10	False	UNITED HEALTHCARE MCR	UNITED HEALTHCARE MCR	PO BOX 748000	ATLANTA	GA	30472	8778423210		2	1701	1799	1741	2	1682	2	3		C		False	233	10	PO BOX 748000 UNITED HEALTHCARE MCR UNITED HEALTHCARE MCR ATLANTA GA 30472	7/27/2018 11:06:06 AM	gaia-jennifer	8/10/2023 4:38:43 PM	izabela	10/1/2014 12:00:00 AM	8/10/2023 2:38:43 PM	False
C	12	False	AETNA MCR	AETNA MCR	PO BOX 981106	EL PASO	TX	79988	8886323862		2	1701	2397	1741	2	1682	2	3		C	-1	False	233	12	PO BOX 981106 AETNA MCR AETNA MCR EL PASO TX 79988	7/27/2018 11:30:53 AM	gaia-jennifer	8/9/2023 2:19:24 PM	izabela	10/1/2014 12:00:00 AM	8/9/2023 12:19:24 PM	False
C	14	False	CIGNA HEALTHSPRING	CIGNA HEALTHSPRING	PO BOX 981804	EL PASO	TX	79998	8002306138		2	1701	2397	1741	2	1682	2	3		C	-1	False	233	14	PO BOX 981804 CIGNA HEALTHSPRING CIGNA HEALTHSPRING EL PASO TX 79998	8/1/2018 9:45:17 AM	Izabela	4/15/2023 4:10:38 PM	kikashah	10/1/2014 12:00:00 AM	4/15/2023 2:10:38 PM	False
C	28	False	PRUITT HEALTH PREMIER	PRUITT HEALTH PREMIER	PO BOX 908	ADDISON	TX	75001-0908	8442243659		2	1701	2397	1741	2	1682	2	3		C	-1	False	233	28	PO BOX 908 PRUITT HEALTH PREMIER PRUITT HEALTH PREMIER ADDISON TX 75001-0908	8/7/2018 12:40:39 PM	alina	8/10/2023 4:36:22 PM	izabela	10/1/2014 12:00:00 AM	8/10/2023 2:36:22 PM	False
C	31	False	PENDING INSURANCE	PENDING INSURANCE	11111	NEW YORK	NY	10108			7	1701	80	1743	2	0	2	3		C	0	False	233	31	11111 PENDING INSURANCE PENDING INSURANCE NEW YORK NY 10108	10/3/2018 9:15:09 AM	alina	10/3/2018 9:15:09 AM	alina	10/1/2014 12:00:00 AM		False
C	34	False	WELLCARE	WELLCARE	PO BOX 31372	TAMPA	FL	33631			2	1701	1799	1741	2	1682	2	3	116	C	-1	False	233	34	PO BOX 31372 WELLCARE WELLCARE TAMPA FL 33631	2/5/2019 10:40:36 AM	snelson	8/10/2023 4:42:12 PM	izabela	10/1/2015 12:00:00 AM	8/10/2023 2:42:12 PM	False
C	36	False	Ambetter by PeachState	Ambetter by PeachState	Po Box 5010	Farmington	MO	63640-1180	8776871180		1	1701	1799	1738	3	1682	2	3		C	-1	False	233	36	PO BOX 5010 AMBETTER BY PEACHSTATE AMBETTER BY PEACHSTATE FARMINGTON MO 63640-1180	5/8/2019 2:25:18 PM	izabela	11/8/2023 4:30:10 PM	izabela	10/1/2015 12:00:00 AM	11/8/2023 2:30:10 PM	False
C	48	False	Clover Health Investments	Clover Health Investments	P.O.Box 981704	EL PASO	TX	79998	8887781478	Work	2	1701	1799	1741	2	1682	2	3		C	0	False	233	48	P.O.BOX 981704 CLOVER HEALTH INVESTMENTS CLOVER HEALTH INVESTMENTS EL PASO TX 79998	10/31/2022 4:47:43 PM	vopris	8/18/2023 3:05:57 PM	vopris	10/1/2015 12:00:00 AM	8/18/2023 1:05:57 PM	False

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Ledger	InsuranceCarriersId	Inactive	Name	ListName	Address1	City	State	Zip	Phone1	Phone2	InsuranceGroupId	CollectionsGroupMId	CarrierTypeMId	FinancialClassMId	AllocationSetId	FilingMethodMId	FilingType	TransactionColumnSetId	IncludeClaimOfficeNo	Ledger1	RequiresAuth	ReferenceCarrier	AcceptAssignmentMId	DotId	Keyword	Created	CreatedBy	LastModified	LastModifiedBy	ICD10SERVICEDATE	InsSOP_db_Updated_Date	AUC
C	1	False	SELF PAY	SELF PAY							7	1701	91	1743	2	0	0	3	0	C			233	1	SELF PAY SELF PAY	2/22/2010 10:05:52 AM	cammy	8/23/2022 3:34:04 PM	gaia-bruce	10/1/2014 12:00:00 AM	8/23/2022 3:34:04 PM	False
C	3	False	MEDICARE A&B	MEDICARE A&B	PO Box 2711	Jacksonville	FL	32211	8776028816	8886644112	1	1701	1799	1738	2	1682	2	2	0	C	0	False	233	3	PO BOX 2711 MEDICARE A&B MEDICARE A&B JACKSONVILLE FL 32211	8/23/2022 3:28:21 PM	gaia-bruce	5/13/2026 11:34:31 AM	gaia-melisha	10/1/2015 12:00:00 AM	5/13/2026 11:34:31 AM	False
C	11	False	Doctors Health MCR	Doctors Health MCR	PO Box 1321825 Ponce De Leon	Coral Gables	FL	33134	3054229300		2	1701	80	1741	2	0	2	3		C			233	72	PO BOX 1321825 PONCE DE LEON DOCTORS HEALTH MCR DOCTORS HEALTH MCR CORAL GABLES FL 33134	11/26/2025 10:51:43 AM	gaia-Tricia	12/4/2025 1:20:47 PM	gaia-cary	10/1/2015 12:00:00 AM	12/4/2025 1:20:47 PM

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Ledger	InsuranceCarriersId	Inactive	Name	ListName	Address1	City	State	Zip	Phone1	Phone2	InsuranceGroupId	CollectionsGroupMId	CarrierTypeMId	FinancialClassMId	AllocationSetId	FilingMethodMId	FilingType	TransactionColumnSetId	IncludeClaimOfficeNo	Ledger1	Notes	RequiresAuth	ReferenceCarrier	AcceptAssignmentMId	DotId	PreAuthorizationFormType	Keyword	Created	CreatedBy	LastModified	LastModifiedBy	ICD10SERVICEDATE	InsSOP_db_Updated_Date	AUC
C T	1	False	MEDICARE PART A & B	MEDICARE PART A & B	PO BOX 2711	JACKSONVILLE	FL	32211	8776028816	8886644112	1	1701	1799	1738	2	1682	2	3	0	C T				233	1		PO BOX 2711 MEDICARE PART A & B MEDICARE PART A & B JACKSONVILLE FL 32211	2/22/2010 10:05:52 AM	cammy	4/30/2026 10:08:46 AM	gaia-melisha	10/1/2015 12:00:00 AM	4/30/2026 10:08:46 AM	False
C	7	False	Aetna MCR	Aetna MCR	Po Box 981106	El Paso	TX	79998	8006240756		8	1701	1799	1741	2	1682	2	3	0	C		0	False	233	8	D	PO BOX 981106 AETNA MCR AETNA MCR EL PASO TX 79998	4/7/2015 9:32:36 AM	gaia-jennifer	5/1/2023 4:15:22 PM	gaia-vicki	10/1/2015 12:00:00 AM	5/1/2023 4:15:22 PM	False
C	15	False	Coventry of Florida MCR	Coventry of Florida MCR	Po Box 7403	London	KY	40742	8008473995		8	1701	1799	1741	2	1682	2	3	0	C		0	False	233	16	D	PO BOX 7403 COVENTRY OF FLORIDA MCR COVENTRY OF FLORIDA MCR LONDON KY 40742	4/7/2015 10:01:13 AM	gaia-jennifer	5/1/2023 4:19:10 PM	gaia-vicki	10/1/2015 12:00:00 AM	5/1/2023 4:19:10 PM	False
C	18	False	Humana MCR	Humana MCR	PO Box 14603	Lexington	KY	40512-4601	8004486262		8	1701	1799	1741	2	1682	2	3	0	C		0	False	233	19	D	PO BOX 14603 HUMANA MCR HUMANA MCR LEXINGTON KY 40512-4601	4/7/2015 10:33:42 AM	gaia-jennifer	6/13/2023 10:32:42 AM	gaia-Tricia	10/1/2015 12:00:00 AM	6/13/2023 10:32:42 AM	False
C	20	False	Magellon Complete Care of Florida MCR	Magellon Complete Care of Florida MCR	Po Box 2097	Maryland Heigh	MO	63043	8003278613		8	1701	1799	1741	2	1682	2	3	0	C	No Par			233	21	D	PO BOX 2097 MAGELLON COMPLETE CARE OF FLORIDA MCR MAGELLON COMPLETE CARE OF FLORIDA MCR MARYLAND HEIGH MO 63043	4/7/2015 10:39:52 AM	gaia-jennifer	5/1/2023 4:22:43 PM	gaia-vicki	10/1/2015 12:00:00 AM	5/1/2023 4:22:43 PM	False
C	22	False	PCN / Medica MCR	PCN / Medica MCR	Po Box 566616	Miami	FL	33256	8003485548		8	1701	1799	1741	2	1682	2	3	0	C		0	False	233	23	D	PO BOX 566616 PCN / MEDICA MCR PCN / MEDICA MCR MIAMI FL 33256	4/7/2015 10:55:56 AM	gaia-jennifer	6/26/2023 10:07:49 AM	gaia-amanda	10/1/2015 12:00:00 AM	6/26/2023 10:07:49 AM	False
C	31	False	Self Pay	Self Pay							10	1701	91	1743	2	1682	1	1	0	C				233	32	D	SELF PAY SELF PAY	4/7/2015 11:28:56 AM	gaia-jennifer	12/16/2019 11:05:29 AM	gaia-jennifer	10/1/2015 12:00:00 AM	12/16/2019 11:05:28 AM	False
C	42	False	Wellcare MCR	Wellcare MCR	Po Box 31372	Tampa	FL	33631	8663347927		8	1701	1799	1741	2	1682	2	3	0	C		0	False	233	42		PO BOX 31372 WELLCARE MCR WELLCARE MCR TAMPA FL 33631	4/10/2015 2:09:14 PM	gaia-brenda	5/1/2023 4:34:35 PM	gaia-vicki	10/1/2015 12:00:00 AM	5/1/2023 4:34:35 PM	False
C	49	True	Freedom Health	Freedom Health	Po Box 151348	Tampa	FL	33684	8004012740		1	1701	1799	1738	2	1682	2	3	0	C		0	False	233	55		PO BOX 151348 FREEDOM HEALTH FREEDOM HEALTH TAMPA FL 33684	7/29/2015 1:31:57 PM	gaia-leticia	12/16/2019 7:51:48 AM	gaia-jennifer	10/1/2015 12:00:00 AM	12/16/2019 7:51:47 AM	False
C	58	False	UHC MCR	UHC MCR	P O Box 31362	Salt Lake City	UT	84131-0362	8778423210		8	1701	1799	1741	2	1682	2	3	0	C		0	False	233	62		P O BOX 31362 UHC MCR UHC MCR SALT LAKE CITY UT 84131-0362	12/21/2016 7:28:01 AM	gaia-renee	5/2/2023 5:13:08 PM	gaia-vicki	10/1/2015 12:00:00 AM	5/2/2023 5:13:08 PM	False
C	60	False	Medicare Acute	Medicare Acute	PO Box 2711	JACKSONVILLE	FL	32211			1	1701	1799	1738	2	1682	2	3	0	C		0	False	233	64		PO BOX 2711 MEDICARE ACUTE MEDICARE ACUTE JACKSONVILLE FL 32211	1/31/2017 3:51:50 PM	GAIA-JENNIFER	9/17/2022 11:59:55 AM	gaia-amanda	10/1/2015 12:00:00 AM	9/17/2022 11:59:55 AM	False
C	61	False	BCBS of FL MCR	BCBS of FL MCR	PO Box 1798	Jacksonville	FL	32231	8007272227		8	1701	1799	1741	2	1682	2	3	0	C		0	False	233	65		PO BOX 1798 BCBS OF FL MCR BCBS OF FL MCR JACKSONVILLE FL 32231	2/28/2017 8:17:41 AM	gaia-jennifer	5/1/2023 4:16:57 PM	gaia-vicki	10/1/2015 12:00:00 AM	5/1/2023 4:16:57 PM	False
C	66	False	Care Improvement Plus MCR	Care Improvement Plus MCR	Po Box 30436	Salt Lake City	UT	84130-0436	8778423210		8	1701	1799	1741	2	1682	2	3	0	C		0	False	233	70		PO BOX 30436 CARE IMPROVEMENT PLUS MCR CARE IMPROVEMENT PLUS MCR SALT LAKE CITY UT 84130-0436	7/10/2017 1:29:22 PM	gaia-brenda	5/1/2023 4:17:50 PM	gaia-vicki	10/1/2015 12:00:00 AM	5/1/2023 4:17:50 PM	False
C	77	False	Leon Medical Center MCR	Leon Medical Center MCR	PO Box 669441	Miami Springs	FL	33166	3055595366		8	1701	1799	1741	2	1682	2	3	0	C		0	False	233	80		PO BOX 669441 LEON MEDICAL CENTER MCR LEON MEDICAL CENTER MCR MIAMI SPRINGS FL 33166	3/25/2019 10:33:59 AM	gaia-michael	5/1/2023 4:22:15 PM	gaia-vicki	10/1/2015 12:00:00 AM	5/1/2023 4:22:15 PM	False
C	79	False	Freedom Health MCR	Freedom Health MCR	PO BOX 151348	Tampa	FL	33684	8004012740		8	1701	1799	1741	2	1682	2	3	0	C			False	233	82		PO BOX 151348 FREEDOM HEALTH MCR FREEDOM HEALTH MCR TAMPA FL 33684	2/3/2020 11:50:21 AM	gaia-michael	5/1/2023 4:20:12 PM	gaia-vicki	10/1/2015 12:00:00 AM	5/1/2023 4:20:12 PM	False
C	80	False	Medica Dual MCR/MCD	Medica Dual MCR/MCD	PO Box 30448	Salt Lake City	UT	84130	8003485548		8	1701	1799	1741	2	1682	2	3	0	C			False	233	83		PO BOX 30448 MEDICA DUAL MCR/MCD MEDICA DUAL MCR/MCD SALT LAKE CITY UT 84130	2/4/2020 10:44:49 AM	gaia-michael	5/1/2023 4:23:06 PM	gaia-vicki	10/1/2015 12:00:00 AM	5/1/2023 4:23:06 PM	False
C	81	False	Humana Dual MCR/MCD	Humana Dual MCR/MCD	PO Box 14601	Lexington	KY	40512	8004486262		8	1701	1799	1741	2	1682	2	3		C				233	84		PO BOX 14601 HUMANA DUAL MCR/MCD HUMANA DUAL MCR/MCD LEXINGTON KY 40512	2/4/2020 10:46:12 AM	gaia-michael	6/13/2023 10:29:32 AM	gaia-Tricia	10/1/2015 12:00:00 AM	6/13/2023 10:29:32 AM	False
C	82	False	Simply Dual MCR/MCD	Simply Dual MCR/MCD	PO Box 61010	Virginia Beach	VA	23466	8008876888		8	1701	1799	1741	2	1682	2	3	0	C				233	85		PO BOX 61010 SIMPLY DUAL MCR/MCD SIMPLY DUAL MCR/MCD VIRGINIA BEACH VA 23466	2/4/2020 10:47:57 AM	gaia-michael	5/1/2023 4:31:55 PM	gaia-vicki	10/1/2015 12:00:00 AM	5/1/2023 4:31:55 PM	False
C	84	False	Wellcare Dual MCR/MCD	Wellcare Dual MCR/MCD	PO Box 31224	Tampa	FL	33631	8666378041		8	1701	1799	1741	2	1682	2	3	0	C			False	233	87		PO BOX 31224 WELLCARE DUAL MCR/MCD WELLCARE DUAL MCR/MCD TAMPA FL 33631	7/13/2020 8:15:58 AM	gaia-michael	5/1/2023 4:34:24 PM	gaia-vicki	10/1/2015 12:00:00 AM	5/1/2023 4:34:24 PM	False
C	86	False	AETNA DUAL MCR/MCD	AETNA DUAL MCR/MCD	PO BOX 981106	El Paso	TX	79998	8006240756		8	1701	1799	1741	2	1682	2	3		C				233	89		PO BOX 981106 AETNA DUAL MCR/MCD AETNA DUAL MCR/MCD EL PASO TX 79998	12/7/2020 1:00:01 PM	gaia-michael	5/1/2023 4:15:10 PM	gaia-vicki	10/1/2015 12:00:00 AM	5/1/2023 4:15:10 PM	False
C	87	False	PCP MCR HMO	PCP MCR HMO	PO BOX 30448	Salt Lake City	UT	84130	8667259334		8	1701	1799	1741	2	1682	2	3	0	C		0	False	233	90		PO BOX 30448 PCP MCR HMO PCP MCR HMO SALT LAKE CITY UT 84130	1/4/2021 8:56:23 AM	gaia-michael	5/1/2023 4:30:02 PM	gaia-vicki	10/1/2015 12:00:00 AM	5/1/2023 4:30:02 PM	False
C	89	False	PCP DUAL MCR/MCD	PCP DUAL MCR/MCD	PO BOX 30448	Salt Lake City	UT	84130	8667259334		8	1701	1799	1741	2	1682	2	3		C				233	92		PO BOX 30448 PCP DUAL MCR/MCD PCP DUAL MCR/MCD SALT LAKE CITY UT 84130	6/1/2021 10:01:18 AM	gaia-michael	5/1/2023 4:29:35 PM	gaia-vicki	10/1/2015 12:00:00 AM	5/1/2023 4:29:35 PM	False
C	90	False	UHC DUAL MCR/MCD	UHC DUAL MCR/MCD	PO BOX 31362	Salt Lake City	UT	84131	8778423210		8	1701	1799	1741	2	1682	2	3		C				233	93		PO BOX 31362 UHC DUAL MCR/MCD UHC DUAL MCR/MCD SALT LAKE CITY UT 84131	6/1/2021 10:11:21 AM	gaia-michael	5/1/2023 4:33:12 PM	gaia-vicki	10/1/2015 12:00:00 AM	5/1/2023 4:33:12 PM	False
C T	93	False	MEDICARE PART A ONLY	MEDICARE PART A ONLY	PO BOX 2711	JACKSONVILLE	FL	32211	8776028816		1	1701	1799	1738	2	1682	2	3		C T				233	96		PO BOX 2711 MEDICARE PART A ONLY MEDICARE PART A ONLY JACKSONVILLE FL 32211	5/2/2022 1:43:35 PM	gaia-amanda	4/30/2026 10:08:52 AM	gaia-melisha	10/1/2015 12:00:00 AM	4/30/2026 10:08:52 AM	False
C	95	False	PHP MCR	PHP MCR	PO BOX 472377	AURORA	CO	80047	8332676768		8	1701	1799	1741	2	1682	2	3	0	C		0	False	233	98		PO BOX 472377 PHP MCR PHP MCR AURORA CO 80047	7/11/2022 1:31:05 PM	gaia-amanda	5/1/2023 4:30:13 PM	gaia-vicki	10/1/2015 12:00:00 AM	5/1/2023 4:30:13 PM	False
C	98	False	Devoted MCR	Devoted MCR	PO Box 211524	Eagan	MN	55121	8003386833		8	1701	1799	1741	2	1682	2	3	0	C			False	233	101		PO BOX 211524 DEVOTED MCR DEVOTED MCR EAGAN MN 55121	12/13/2022 8:19:35 AM	gaia-michael	5/1/2023 4:19:44 PM	gaia-vicki	10/1/2015 12:00:00 AM	5/1/2023 4:19:44 PM	False

Download as Spreadsheet

Ledger	InsuranceCarriersId	Inactive	Name	ListName	Address1	City	State	Zip	Phone1	Phone2	InsuranceGroupId	CollectionsGroupMId	CarrierTypeMId	FinancialClassMId	AllocationSetId	FilingMethodMId	FilingType	TransactionColumnSetId	Ledger1	RequiresAuth	ReferenceCarrier	AcceptAssignmentMId	DotId	Keyword	Created	CreatedBy	LastModified	LastModifiedBy	ICD10SERVICEDATE	InsSOP_db_Updated_Date	AUC
C	1	False	SELF PAY	SELF PAY							7	1701	91	1743	2	0	0	3	C			233	1	SELF PAY SELF PAY	2/22/2010 10:05:52 AM	cammy	8/23/2022 3:34:04 PM	gaia-bruce	10/1/2014 12:00:00 AM	8/23/2022 3:34:04 PM	False
C	3	False	MEDICARE A&B	MEDICARE A&B	P.O. Box 2006	Mechanicsburg	PA	17055-0733	8776028816	8886644112	1	1701	1799	1738	2	1682	2	3	C	0	False	233	3	P.O. BOX 2006 MEDICARE A&B MEDICARE A&B MECHANICSBURG PA 17055-0733	8/23/2022 3:28:21 PM	gaia-bruce	5/13/2026 11:35:22 AM	gaia-melisha	10/1/2015 12:00:00 AM	5/13/2026 11:35:22 AM	False
C	6	False	PENDING INSURANCE	PENDING INSURANCE	DO NOT BILL						7	1701	80	1743	2	0	0	2	C			233	6	DO NOT BILL PENDING INSURANCE PENDING INSURANCE	11/26/2025 1:46:09 PM	gaia-Tricia	6/4/2026 10:46:30 AM	gaia-wendy	10/1/2015 12:00:00 AM	6/4/2026 10:46:30 AM

Download as Spreadsheet

Ledger	InsuranceCarriersId	Inactive	Name	ListName	Address1	Address2	City	State	Zip	Phone1	Phone1Type	Phone2	Phone2Type	InsuranceGroupId	CollectionsGroupMId	CarrierTypeMId	FinancialClassMId	AllocationSetId	FilingMethodMId	FilingType	TransactionColumnSetId	IncludeClaimOfficeNo	Ledger1	Notes	RequiresAuth	ReferenceCarrier	AcceptAssignmentMId	DotId	Keyword	Created	CreatedBy	LastModified	LastModifiedBy	ICD10SERVICEDATE	InsSOP_db_Updated_Date	AUC
C	1	False	Medicare Part A Only	Medicare Part A Only	PO Box 2711		Jacksonville	FL	32211	8776028816		8886644112		1	1701	1799	1738	2	1682	2	3	0	C				233	1	PO BOX 2711 MEDICARE PART A ONLY MEDICARE PART A ONLY JACKSONVILLE FL 32211	2/22/2010 10:05:52 AM	cammy	3/28/2025 2:14:37 PM	gaia-nina	10/1/2015 12:00:00 AM	3/28/2025 2:14:37 PM	False
C	5	False	Pending Insurance	Pending Insurance										9	1701	80	1743	2	0	0	2	0	C		0	False	233	5	PENDING INSURANCE PENDING INSURANCE	7/12/2016 9:47:45 AM	gaia-michelle	4/28/2025 9:00:59 AM	gaia-cary	1/1/2015 12:00:00 AM	4/28/2025 9:00:59 AM	False
C	7	False	Molina MCR	Molina MCR	P O Box 22812		Long Beach	CA	90801	8553224076				7	1701	1799	1741	2	1682	2	3	0	C		0	False	233	45	P O BOX 22812 MOLINA MCR MOLINA MCR LONG BEACH CA 90801	7/29/2016 9:10:51 AM	gaia-renee	3/28/2025 2:15:27 PM	gaia-nina	10/1/2014 12:00:00 AM	3/28/2025 2:15:27 PM	False
C	18	False	Medicare Acute	Medicare Acute	PO BOX 2711		Jacksonville	FL	32211	8776028816				1	1701	1799	1746	2	1682	2	3	0	C		0	False	233	18	PO BOX 2711 MEDICARE ACUTE MEDICARE ACUTE JACKSONVILLE FL 32211	2/1/2017 9:14:46 AM	GAIA-JENNIFER	3/28/2025 2:14:29 PM	gaia-nina	10/1/2015 12:00:00 AM	3/28/2025 2:14:29 PM	False
C	19	False	Coventry /Aetna Medicare Advantage	Coventry /Aetna Medicare Advantage	PO BOX 7403		London	KY	40742	8008473995				7	1701	1799	1741	2	1682	2	3	0	C		0	False	233	19	PO BOX 7403 COVENTRY /AETNA MEDICARE ADVANTAGE COVENTRY /AETNA MEDICARE ADVANTAGE LONDON KY 40742	3/23/2017 11:35:24 AM	gaia-michelle	5/1/2023 4:50:37 PM	gaia-vicki	10/1/2016 12:00:00 AM	5/1/2023 4:50:37 PM	False
6	25	False	UHC MCD MMA	UHC MCD MMA	PO Box 31350		Salt Lake City	UT	84131	8778423210				8	1703	83	325113	2	1682	2	3	0	6		0	False	233	25	PO BOX 31350 UHC MCD MMA UHC MCD MMA SALT LAKE CITY UT 84131	7/31/2017 10:35:30 AM	gaia-michael	7/7/2026 11:27:56 AM	gaia-gery	10/1/2015 12:00:00 AM	7/7/2026 11:27:56 AM	False
C	27	False	Simply Healthcare MCR	Simply Healthcare MCR	PO Box 61010		Virginia Beach	VA	23466	8002131133				7	1701	1799	1741	2	1682	2	3	0	C		0	False	233	27	PO BOX 61010 SIMPLY HEALTHCARE MCR SIMPLY HEALTHCARE MCR VIRGINIA BEACH VA 23466	11/2/2017 1:17:44 PM	gaia-michael	5/1/2023 4:59:01 PM	gaia-vicki	10/1/2015 12:00:00 AM	5/1/2023 4:59:01 PM	False
C	40	False	Leon Medical Center MCR	Leon Medical Center MCR	PO Box 659006		Miami	FL	33126	3056315343		3056442150		7	1701	1799	1741	2	1682	2	3	0	C			False	233	40	PO BOX 659006 LEON MEDICAL CENTER MCR LEON MEDICAL CENTER MCR MIAMI FL 33126	9/2/2019 8:53:32 AM	gaia-michael	5/1/2023 4:55:36 PM	gaia-vicki	10/1/2015 12:00:00 AM	5/1/2023 4:55:36 PM	False
C	41	False	Aetna MCR	Aetna MCR	PO BOX 981106		El Paso	TX	79998	8006240756				7	1701	1799	1741	2	1682	2	2	0	C		0	False	233	41	PO BOX 981106 AETNA MCR AETNA MCR EL PASO TX 79998	1/7/2020 8:06:37 AM	gaia-michael	3/16/2026 2:08:19 PM	gaia-Lydia	10/1/2015 12:00:00 AM	3/16/2026 2:08:19 PM	False
C	45	True	Simply Dual MCR/MCD	Simply Dual MCR/MCD	PO BOX 61010		Virginia Beach	VA	23466	8005144561				7	1701	1799	1741	2	1682	2	3		C	DO NOT USE DUAL PROFILE			233	47	PO BOX 61010 SIMPLY DUAL MCR/MCD SIMPLY DUAL MCR/MCD VIRGINIA BEACH VA 23466	2/6/2020 1:08:54 PM	gaia-michael	6/16/2025 1:44:34 PM	gaia-nina	10/1/2015 12:00:00 AM	6/16/2025 1:44:34 PM	False
C	46	False	Medica MCR	Medica MCR	Po Box 56-6616		Miami	FL	33256	8003485548				7	1701	1799	1741	2	1682	2	3	0	C			False	233	48	PO BOX 56-6616 MEDICA MCR MEDICA MCR MIAMI FL 33256	2/24/2020 11:22:46 AM	gaia-michael	6/16/2025 1:44:14 PM	gaia-nina	10/1/2015 12:00:00 AM	6/16/2025 1:44:14 PM	False
C	49	True	Aetna Dual MCR MCD	Aetna Dual MCR MCD	Po Box 981106		El Paso	TX	79998	8006240756				7	1701	1799	1741	2	1682	2	3	0	C	DO NOT USE DUAL PROFILE			233	49	PO BOX 981106 AETNA DUAL MCR MCD AETNA DUAL MCR MCD EL PASO TX 79998	4/7/2020 8:37:54 AM	gaia-mwhite	6/16/2025 1:43:17 PM	gaia-nina	10/1/2015 12:00:00 AM	6/16/2025 1:43:17 PM	False
C	51	False	BCBS of FL MCR	BCBS of FL MCR	Po Bpx 1798		Jacksonville	FL	32231	8007272227				7	1701	1799	1741	2	1682	2	3		C				233	52	PO BPX 1798 BCBS OF FL MCR BCBS OF FL MCR JACKSONVILLE FL 32231	7/8/2020 7:50:34 AM	gaia-mwhite	5/1/2023 4:47:17 PM	gaia-vicki	10/1/2015 12:00:00 AM	5/1/2023 4:47:17 PM	False
C	53	True	HEALTHSUN DUAL MCR/MCD	HEALTHSUN DUAL MCR/MCD	PO BOX 211154		Eagan	MI	55121	3052349292				7	1701	1799	1741	2	1682	2	3	0	C	DO NOT USE DUAL PROFILE		False	233	54	PO BOX 211154 HEALTHSUN DUAL MCR/MCD HEALTHSUN DUAL MCR/MCD EAGAN MI 55121	3/4/2021 7:10:54 AM	gaia-michael	6/16/2025 1:43:43 PM	gaia-nina	10/1/2015 12:00:00 AM	6/16/2025 1:43:43 PM	False
C	54	False	PCP MCR	PCP MCR	PO Box 30448		Salt Lake City	UT	84130	8667259334				7	1701	1799	1741	2	1682	2	2	0	C		0	False	233	65088	PO BOX 30448 PCP MCR PCP MCR SALT LAKE CITY UT 84130	5/31/2021 10:42:26 AM	gaia-michael	3/16/2026 12:19:51 PM	gaia-Lydia	10/1/2015 12:00:00 AM	3/16/2026 12:19:51 PM	False
C	55	False	Healthsun MCR	Healthsun MCR	PO BOx 211154		Eagan	MI	55121	3052349292				7	1701	1799	1741	2	1682	2	2		C				233	56	PO BOX 211154 HEALTHSUN MCR HEALTHSUN MCR EAGAN MI 55121	8/4/2021 2:08:05 PM	gaia-michael	3/16/2026 2:12:29 PM	gaia-Lydia	10/1/2015 12:00:00 AM	3/16/2026 2:12:29 PM	False
C6	58	False	UHC MCR	UHC MCR	PO BOX 31362		Salt Lake City	UT	84131	8778423210				7	1701	1799	1738	2	1682	2	3	0	C6		0	False	233	59	PO BOX 31362 UHC MCR UHC MCR SALT LAKE CITY UT 84131	5/18/2022 9:19:14 AM	gaia-amanda	7/7/2026 11:28:11 AM	gaia-gery	10/1/2015 12:00:00 AM	7/7/2026 11:28:11 AM	False
C	59	False	WELLCARE MCR	WELLCARE MCR	PO BOX 31372		Tampa	FL	33631	8555380454				7	1701	1799	1741	2	1682	2	2	0	C		0	False	233	60	PO BOX 31372 WELLCARE MCR WELLCARE MCR TAMPA FL 33631	6/6/2022 8:33:55 AM	gaia-michael	3/16/2026 2:10:32 PM	gaia-Lydia	10/1/2015 12:00:00 AM	3/16/2026 2:10:32 PM	False
C	60	False	MEDICARE PART A&B	MEDICARE PART A&B	PO BOX 2711		Jacksonville	FL	32211	8776028816	IVR	8886644112	CUSTOMER SERVICE	1	1701	1799	1738	2	1682	2	2		C				233	61	PO BOX 2711 MEDICARE PART A&B MEDICARE PART A&B JACKSONVILLE FL 32211	7/2/2022 10:05:31 AM	gaia-amanda	5/13/2026 11:36:28 AM	gaia-melisha	10/1/2015 12:00:00 AM	5/13/2026 11:36:28 AM	False
C	1060	False	BRIGHT HEALTH MCR	BRIGHT HEALTH MCR	PO BOX 211502		Eagan	MI	55121	8449264522		8449900375		7	1701	1799	1741	2	1682	2	3	0	C		0	False	233	1060	PO BOX 211502 BRIGHT HEALTH MCR BRIGHT HEALTH MCR EAGAN MI 55121	9/13/2022 7:50:27 AM	gaia-amanda	3/28/2025 2:07:05 PM	gaia-nina	10/1/2015 12:00:00 AM	3/28/2025 2:07:05 PM	False
C	1061	False	LEON HEALTH MCR	LEON HEALTH MCR	PO BOX 61265		PHOENIX	AZ	85082	8333735366				7	1701	1799	1741	2	1682	2	3	0	C		0	False	233	1061	PO BOX 61265 LEON HEALTH MCR LEON HEALTH MCR PHOENIX AZ 85082	10/4/2022 2:06:09 PM	gaia-amanda	4/18/2025 7:25:22 AM	gaia-Tricia	10/1/2015 12:00:00 AM	4/18/2025 7:25:22 AM	False
C	1064	False	LEON HEALTH MCD MMA	LEON HEALTH MCD MMA	PO BOX 61265		PHOENIX	AZ	85082	8333735366				8	1703	83	325113	2	1682	2	3		C				233	1064	PO BOX 61265 LEON HEALTH MCD MMA LEON HEALTH MCD MMA PHOENIX AZ 85082	4/10/2023 10:00:28 AM	gaia-amanda	6/17/2025 3:32:29 PM	gaia-nina	10/1/2015 12:00:00 AM	6/17/2025 3:32:29 PM	False
C	1066	False	DOCTORS HEALTH PLAN MCR	DOCTORS HEALTH PLAN MCR	BOX 132	1825 PONCE DE LEON BLVD	CORAL GABLES	FL	33134	3054229300				7	1701	1799	1741	2	1682	2	3	0	C				233	1066	BOX 132 1825 PONCE DE LEON BLVD DOCTORS HEALTH PLAN MCR DOCTORS HEALTH PLAN MCR CORAL GABLES FL 33134	10/3/2023 1:12:38 PM	gaia-amanda	10/3/2023 1:12:38 PM	gaia-amanda	10/1/2015 12:00:00 AM	10/3/2023 1:12:38 PM	False
C	1069	False	Devoted MCR	Devoted MCR	PO Box 211524		Eagan	MI	55121	8003386833				7	1701	1799	1741	2	1682	2	3	0	C		0		233	12345	PO BOX 211524 DEVOTED MCR DEVOTED MCR EAGAN MI 55121	5/22/2024 2:23:20 PM	gaia-racheal	5/22/2024 2:23:20 PM	gaia-racheal	10/1/2015 12:00:00 AM	5/22/2024 2:23:20 PM	False
6	1072	False	UHC Silver C - CM	UHC Silver C - CM	P.O. Box 5290		Kingston	NY	12402	8884784760				4	1703	104	1744	2	1682	2	2	0	6				233	546897	P.O. BOX 5290 UHC SILVER C - CM UHC SILVER C - CM KINGSTON NY 12402	9/9/2024 1:35:39 PM	gaia-nina	6/2/2026 12:08:19 PM	gaia-wendy	10/1/2015 12:00:00 AM	6/2/2026 12:08:19 PM	False
F	1075	False	Gold Kidney MCR	Gold Kidney MCR	PO Box 285		Portsmouth	NH	03802	8442946535				7	1701	1799	1741	2	1682	2	2	0	F		0		233	A6865	PO BOX 285 GOLD KIDNEY MCR GOLD KIDNEY MCR PORTSMOUTH NH 03802	1/16/2025 2:36:43 PM	gaia-nina	6/2/2026 12:02:14 PM	gaia-wendy	10/1/2015 12:00:00 AM	6/2/2026 12:02:14 PM	False
6	1083	False	UMR	UMR	P.O. Box 30541		Salt Lake City	UT	84130-0541	8772331800				4	1703	104	1744	2	1682	2	2	0	6				233	39026	P.O. BOX 30541 UMR UMR SALT LAKE CITY UT 84130-0541	1/22/2026 7:51:06 AM	gaia-Lydia	7/7/2026 11:28:27 AM	gaia-gery	10/1/2015 12:00:00 AM	7/7/2026 11:28:27 AM
6	1085	False	UHC PCP MCR HMO-POS	UHC PCP MCR HMO-POS	P.O. Box 30448		Salt Lake City	UT	84130-0448	8667259334				7	1701	1799	1741	2	1682	2	2	0	6				233	650881	P.O. BOX 30448 UHC PCP MCR HMO-POS UHC PCP MCR HMO-POS SALT LAKE CITY UT 84130-0448	3/31/2026 1:48:24 PM	gaia-Lydia	7/7/2026 11:27:50 AM	gaia-gery	10/1/2015 12:00:00 AM	7/7/2026 11:27:50 AM
6	1086	False	UHC PCP MCR HMO	UHC PCP MCR HMO	P.O. Box 30448		Salt Lake City	UT	84130-0448	8667259334				7	1701	1799	1741	2	1682	2	2	0	6				233	650882	P.O. BOX 30448 UHC PCP MCR HMO UHC PCP MCR HMO SALT LAKE CITY UT 84130-0448	4/10/2026 3:24:33 PM	gaia-Lydia	7/7/2026 11:28:17 AM	gaia-gery	10/1/2015 12:00:00 AM	7/7/2026 11:28:17 AM

Download as Spreadsheet

Ledger	InsuranceCarriersId	Inactive	Name	ListName	Address1	Address2	City	State	Zip	Contact	Phone1	Phone1Type	Phone2	InsuranceGroupId	CollectionsGroupMId	CarrierTypeMId	FinancialClassMId	AllocationSetId	FilingMethodMId	FilingType	TransactionColumnSetId	Ledger1	Notes	RequiresAuth	ReferenceCarrier	AcceptAssignmentMId	DotId	PreAuthorizationFormType	Keyword	Created	CreatedBy	LastModified	LastModifiedBy	ICD10SERVICEDATE	InsSOP_db_Updated_Date	AUC
C	1	False	FIRST COAST MEDICARE PART A	1 FIRST COAST MEDICARE PART A	PO BOX 2711		JACKSONVILLE	FL	32231		8776028816		8886644112	1	1701	1799	1738	2	1682	2	3	C				233	1		PO BOX 2711 1 FIRST COAST MEDICARE PART A FIRST COAST MEDICARE PART A JACKSONVILLE FL 32231	2/22/2010 10:05:52 AM	cammy	7/18/2019 3:49:40 PM	PDA-Paul	10/1/2015 12:00:00 AM	7/18/2019 3:49:40 PM	False
C	13	False	NGS MEDICARE PART A	1 NGS MCR VA	PO BOX 100238		COLUMBIA	SC	29202		8556960705	Work		1	1701	1799	1738	2	1682	2	3	C	888-379-9132 DDE			233	256		PO BOX 100238 1 NGS MCR VA NGS MEDICARE PART A COLUMBIA SC 29202	1/11/2016 11:11:31 AM	PDA-Linda	5/21/2019 10:21:50 AM	PDA-Julie	10/1/2015 12:00:00 AM	5/21/2019 10:21:50 AM	False
C	23	False	NON-VA MEDICAL CARE	VA MIAMI NON-VA MEDICAL CARE	ATTN:CLAIMS DEPARTMENT (136E)	1201 NW 16 STREET	MIAMI	FL	33125		3055757000	Work		5	1701	95	1742	2	1682	2	2	C		-1		233	1416		ATTN:CLAIMS DEPARTMENT (136E) 1201 NW 16 STREET VA MIAMI NON-VA MEDICAL CARE NON-VA MEDICAL CARE MIAMI FL 33125	1/11/2016 12:40:11 PM	PDA-Linda	5/29/2019 4:49:02 PM	PDA-Leah	10/1/2015 12:00:00 AM	5/29/2019 4:49:02 PM	False
C	24	False	JAMES A HALEY VA HOSPITAL	VA TAMPA JAMES A HALEY VA HOSPITAL	ATTN:NON VA CARE	PO BOX 290196	TAMPA	FL	33687		8669728201	Work		5	1701	95	1742	2	1682	2	2	C		-1	False	233	24		ATTN:NON VA CARE PO BOX 290196 VA TAMPA JAMES A HALEY VA HOSPITAL JAMES A HALEY VA HOSPITAL TAMPA FL 33687	1/11/2016 12:43:39 PM	PDA-Linda	4/9/2020 10:16:15 AM	PDA-Julie	10/1/2015 12:00:00 AM	4/9/2020 10:16:15 AM	False
C	30	False	SIMPLY HEALTHCARE PLANS MCR	SIMPLY HEALTHCARE MCR	ATTN:CLAIMS DEPT	PO BOX 21535	EAGAN	MN	55121	(844) 405-4297 Claims	8779150551	Work		4	1701	104	1741	2	1682	2	2	C		-1	False	233	1784		ATTN:CLAIMS DEPT PO BOX 21535 SIMPLY HEALTHCARE MCR SIMPLY HEALTHCARE PLANS MCR EAGAN MN 55121	1/11/2016 1:14:37 PM	PDA-Linda	9/19/2019 11:52:16 AM	Pda-Linda	10/1/2015 12:00:00 AM	9/19/2019 11:52:15 AM	False
C	55	False	CAHABA PART A	1 CAHABA MCR GA	PO Box 830139		BIRMINGHAM	AL	35202		8775677271			1	1701	1799	1738	2	1682	2	3	C		0	False	233	55		PO BOX 830139 1 CAHABA MCR GA CAHABA PART A BIRMINGHAM AL 35202	3/15/2016 11:02:47 AM	pda-rreid	7/19/2019 3:14:00 PM	Pda-Linda	10/1/2015 12:00:00 AM	7/19/2019 3:14:00 PM	False
C	119	False	AETNA US HEALTHCARE	AETNA US HEALTHCARE	PO BOX 14079		Lexington	KY	40512		8886323862	Work		4	1701	104	1741	2	1682	2	2	C		0	False	233	119		PO BOX 14079 AETNA US HEALTHCARE AETNA US HEALTHCARE LEXINGTON KY 40512	6/12/2017 3:17:51 PM	pda-rreid	10/3/2019 4:25:30 PM	Pda-Linda	10/1/2014 12:00:00 AM	10/3/2019 4:25:30 PM	False
C	155	False	OPTUMCARE/ MCR	OPTUMCARE/ MCR	PO BOX 46770		LAS VEGAS	NV	89114-6770		8778013507	Work		1	1703	103	1738	2	1682	2	3	C		0	False	233	155	D	PO BOX 46770 OPTUMCARE/ MCR OPTUMCARE/ MCR LAS VEGAS NV 89114-6770	3/22/2018 1:57:37 PM	pda-linda	5/29/2019 3:28:46 PM	PDA-Leah	10/1/2015 12:00:00 AM	5/29/2019 3:28:46 PM	False
C	167	False	VA ADMINISTRATION	VA ADMINISTRATION	1601 SW ARCHER RD		GAINSVILLE	FL	32608		8884933260	Work		5	1701	95	1742	2	1682	1	2	C		0	False	233	167	D	1601 SW ARCHER RD VA ADMINISTRATION VA ADMINISTRATION GAINSVILLE FL 32608	9/18/2018 10:52:10 AM	pda-linda	5/29/2019 4:47:33 PM	PDA-Leah	10/1/2015 12:00:00 AM	5/29/2019 4:47:33 PM	False

Download as Spreadsheet

Ledger	InsuranceCarriersId	Inactive	Name	ListName	Address1	City	State	Zip	Country	Contact	Phone1	Phone2	InsuranceGroupId	CollectionsGroupMId	CarrierTypeMId	FinancialClassMId	AllocationSetId	FilingMethodMId	FilingType	TransactionColumnSetId	Ledger1	Notes	AlertNotes	RequiresAuth	ReferenceCarrier	AcceptAssignmentMId	DotId	Keyword	Created	CreatedBy	LastModified	LastModifiedBy	ICD10SERVICEDATE	InsSOP_db_Updated_Date	AUC
C	1	False	MEDICARE TX	MEDICARE TX	PO BOX 660155	DALLAS	TX	75266			8552528782		8	1701	1799	1738	2	1682	2	3	C					233	1	PO BOX 660155 MEDICARE TX MEDICARE TX DALLAS TX 75266	2/22/2010 10:05:52 AM	cammy	6/5/2025 9:26:56 AM	padai	10/1/2015 12:00:00 AM	6/5/2025 8:26:56 AM	False
C	6	False	AMERIVANTAGE MCR	AMERIVANTAGE MCR	PO BOX 61010	VIRGINIA BEACH	VA	23466-1010	USA		8668054589	8006004441	8	1701	2397	1741	2	1682	2	5	C			-1	False	233	6	PO BOX 61010 AMERIVANTAGE MCR AMERIVANTAGE MCR VIRGINIA BEACH VA 23466-1010	2/8/2017 11:33:21 AM	padai	7/9/2024 12:39:24 PM	padai	10/1/2015 12:00:00 AM	7/9/2024 11:39:24 AM	False
C	11	False	AMERIVANTAGE MMP	AMERIVANTAGE MMP	PO BOX 61010	VIRGINIA BEACH	VA	23466-1010	USA		8558781785	8668054589	8	1701	2397	1741	2	1682	2	5	C			-1	False	233	11	PO BOX 61010 AMERIVANTAGE MMP AMERIVANTAGE MMP VIRGINIA BEACH VA 23466-1010	2/8/2017 12:12:18 PM	padai	10/13/2017 8:47:40 AM	mwatkins	10/1/2015 12:00:00 AM		False
C	12	False	MEDICAID OF TX	MEDICAID OF TX	PO BOX 200555	AUSTIN	TX	78720-0555	USA		8009259126		8	1702	83	1739	2	1682	2	4	C			0	False	233	12	PO BOX 200555 MEDICAID OF TX MEDICAID OF TX AUSTIN TX 78720-0555	2/8/2017 12:16:15 PM	padai	5/28/2019 8:29:38 AM	ggarmenta	10/1/2015 12:00:00 AM	5/28/2019 8:29:39 AM	False
C	17	False	MOLINA MMP	MOLINA MMP	PO BOX 22719	LONG BEACH	CA	90801-5719	USA	FAX 866-420-3639	8668568699	8664090039	8	1701	2397	1741	2	1682	2	5	C			-1	False	233	17	PO BOX 22719 MOLINA MMP MOLINA MMP LONG BEACH CA 90801-5719	2/10/2017 11:05:09 AM	PADAI	5/2/2017 2:20:46 PM	gaia-jennifer	10/1/2015 12:00:00 AM		False
C	19	False	UHC MMP	UHC MMP	PO BOX 31352	SALT LAKE CITY	UT	84131-0352	USA		8888879003	8772859093	8	1701	2397	1741	2	1682	2	5	C			-1	False	233	19	PO BOX 31352 UHC MMP UHC MMP SALT LAKE CITY UT 84131-0352	2/10/2017 11:09:31 AM	PADAI	3/28/2019 12:16:29 PM	ahall	10/1/2015 12:00:00 AM	3/28/2019 12:16:29 PM	False
C	32	False	MOLINA MCR	MOLINA MCR	PO BOX 22719	LONG BEACH	CA	90801	USA		8664496849		3	1701	2397	1741	2	1682	2	4	C			-1	False	233	32	PO BOX 22719 MOLINA MCR MOLINA MCR LONG BEACH CA 90801	3/16/2017 1:05:09 PM	padai	8/4/2025 6:25:02 PM	padai	10/1/2015 12:00:00 AM	8/4/2025 5:25:02 PM	False
C	33	False	WELLMED MCR	WELLMED MCR	PO BOX 400066	SAN ANTONIO	TX	78229	USA		8005507691		8	1701	2397	1741	2	1682	2	5	C			-1		233	33	PO BOX 400066 WELLMED MCR WELLMED MCR SAN ANTONIO TX 78229	3/16/2017 1:08:17 PM	padai	5/13/2025 4:48:42 PM	padai	10/1/2015 12:00:00 AM	5/13/2025 3:48:42 PM	False
C	42	False	EVERCARE	EVERCARE	PO BOX 31352	SALT LAKE CITY	UT	84131	USA		8888879003	8778423210	8	1701	80	1741	2	1682	2	5	C			-1	False	233	42	PO BOX 31352 EVERCARE EVERCARE SALT LAKE CITY UT 84131	3/22/2017 7:27:31 PM	padai	3/28/2019 11:12:02 AM	ahall	10/1/2015 12:00:00 AM	3/28/2019 11:12:02 AM	False
C	44	False	SUPERIOR MCR	SUPERIOR MCR	PO BOX 3060	FARMINGTON	MO	63640	USA		8668084589		8	1701	2397	1741	2	1682	2	5	C			-1	False	233	44	PO BOX 3060 SUPERIOR MCR SUPERIOR MCR FARMINGTON MO 63640	3/22/2017 7:38:08 PM	padai	5/13/2025 4:38:53 PM	padai	10/1/2015 12:00:00 AM	5/13/2025 3:38:53 PM	False
C	45	False	SELECT CARE/TX PLUS MCR	SELECT CARE/TX PLUS MCR	PO BOX 17900	AUSTIN	TX	78760	USA				8	1701	2397	1741	2	1682	2	5	C	Letter was sent from Insurance stating the old address PO Box 741107, Houston TX 77274 has now changed to PO Box 17900, Austin, Tx 78760-7900. I changed on 1-25-18. PA	Address changed on 1-28-18. PA	-1	False	233	45	PO BOX 17900 SELECT CARE/TX PLUS MCR SELECT CARE/TX PLUS MCR AUSTIN TX 78760	3/22/2017 7:40:52 PM	padai	6/22/2018 11:32:24 AM	gaia-jennifer	10/1/2015 12:00:00 AM		False
C	46	False	TX HEALTH SPRING MCR	TX HEALTH SPRING MCR	PO BOX 981706	EL PASO	TX	79998	USA		8002306138		8	1701	2397	1741	2	1682	2	5	C			-1	False	233	46	PO BOX 981706 TX HEALTH SPRING MCR TX HEALTH SPRING MCR EL PASO TX 79998	3/22/2017 7:43:07 PM	padai	5/16/2023 2:57:55 PM	padai	10/1/2015 12:00:00 AM	5/16/2023 1:57:55 PM	False
C	47	False	WELLCARE MCR	WELLCARE MCR	PO BOX 31372	TAMPA	FL	33631-3372	USA		8555380454		8	1701	2397	1741	2	1682	2	5	C			-1	False	233	47	PO BOX 31372 WELLCARE MCR WELLCARE MCR TAMPA FL 33631-3372	3/22/2017 7:50:44 PM	padai	5/29/2025 12:46:11 PM	padai	10/1/2015 12:00:00 AM	5/29/2025 11:46:11 AM	False
C	56	False	PEOPLE'S HEALTH MCR	PEOPLE'S HEALTH MCR	PO BOX 7890	METAIRIE	LA	70010	USA		8773465703		8	1701	2397	1741	2	1682	2	5	C			-1	False	233	56	PO BOX 7890 PEOPLE'S HEALTH MCR PEOPLE'S HEALTH MCR METAIRIE LA 70010	3/27/2017 1:22:07 PM	padai	11/30/2017 9:04:19 AM	mwatkins	10/1/2015 12:00:00 AM		False
C	57	False	MEDICARE OF LA	MEDICARE OF LA	PO BOX 660155	DALLAS	TX	75266	USA		8552528782		8	1701	1799	1738	2	1682	2	3	C			0	False	233	57	PO BOX 660155 MEDICARE OF LA MEDICARE OF LA DALLAS TX 75266	3/27/2017 2:05:58 PM	padai	5/10/2017 2:52:48 PM	padai	10/1/2015 12:00:00 AM		False
C	83	False	MEDICARE OF GA (ST TAMMANY)	MEDICARE OF GA (ST TAMMANY)	PO BOX 6168	INDIANAPOLIS	IN	46206	USA		8552528782		8	1701	1799	1738	2	1682	2	3	C			0	False	233	83	PO BOX 6168 MEDICARE OF GA (ST TAMMANY) MEDICARE OF GA (ST TAMMANY) INDIANAPOLIS IN 46206	5/10/2017 1:19:51 PM	padai	3/28/2019 9:22:30 AM	agray	10/1/2015 12:00:00 AM	3/28/2019 9:22:30 AM	False
C	84	False	SUPERIOR MMP	SUPERIOR MMP	PO BOX 3060	FARMINGTON	MO	63640	USA		8668084589		8	1701	2397	1741	2	1682	2	5	C			-1	False	233	84	PO BOX 3060 SUPERIOR MMP SUPERIOR MMP FARMINGTON MO 63640	5/11/2017 4:09:51 PM	padai	11/30/2017 9:16:29 AM	mwatkins	10/1/2015 12:00:00 AM		False
C	86	False	PROSPECT HEALTH	PROSPECT HEALTH	PO BOX 11466	SANTA ANNA	CA	92711	USA		8555152408		8	1701	2397	1741	2	1682	2	5	C			-1	False	233	86	PO BOX 11466 PROSPECT HEALTH PROSPECT HEALTH SANTA ANNA CA 92711	5/22/2017 9:57:24 AM	padai	9/29/2021 1:42:20 PM	padai	10/1/2015 12:00:00 AM	9/29/2021 12:42:20 PM	False
C	100	False	MEDICARE OK	MEDICARE OK	PO BOX 660155	DALLAS	TX	75201	USA		8552528782		8	1701	1799	1738	2	1682	2	3	C				False	233	100	PO BOX 660155 MEDICARE OK MEDICARE OK DALLAS TX 75201	8/2/2017 1:17:48 PM	padai	1/31/2018 1:39:48 PM	padai	10/1/2015 12:00:00 AM		False
C	128	False	COMMUNITY HEALTH CHOICE MCD	COMMUNITY HEALTH CHOICE MCD	P.O. BOX 301404	HOUSTON	TX	77230	USA		8555315386		8	1702	80	1740	2	1682	2	4	C					233	128	P.O. BOX 301404 COMMUNITY HEALTH CHOICE MCD COMMUNITY HEALTH CHOICE MCD HOUSTON TX 77230	5/15/2019 9:43:32 AM	tshipley	10/4/2024 2:05:08 PM	padai	10/1/2015 12:00:00 AM	10/4/2024 1:05:08 PM	False
C	133	False	PROMINENCE HEALTH PLAN OF TEXAS	PROMINENCE HEALTH PLAN OF TEXAS	P O BOX 981748	EL PASO	TX	79998	USA		8559695882		3	1701	2397	1741	2	1682	2	3	C				False	233	133	P O BOX 981748 PROMINENCE HEALTH PLAN OF TEXAS PROMINENCE HEALTH PLAN OF TEXAS EL PASO TX 79998	3/23/2021 10:19:27 AM	tshipley	9/8/2021 9:51:12 AM	padai	10/1/2015 12:00:00 AM	9/8/2021 8:51:12 AM	False
C	135	False	MASTERS MATES AND PILOTS	MASTERS MATES AND PILOTS	700 MARITIME BLVD SUITE A	LINTHICUM	MD	21090	USA		4108508500		1	1703	104	1744		1682	1	4	C			0	False	233	135	700 MARITIME BLVD SUITE A MASTERS MATES AND PILOTS MASTERS MATES AND PILOTS LINTHICUM MD 21090	6/14/2021 12:58:27 PM	tshipley	8/19/2021 1:55:14 PM	padai	10/1/2015 12:00:00 AM	8/19/2021 12:55:14 PM	False
C	136	False	EMBLEM HEALTH CARE	EMBLEM HEALTH CARE	PO BOX 3000	NEW YORK	NY	10116	USA		8006242414		1	1703	104	1744	2	1682	2	4	C			0	False	233	136	PO BOX 3000 EMBLEM HEALTH CARE EMBLEM HEALTH CARE NEW YORK NY 10116	7/1/2021 7:12:30 AM	tshipley	7/1/2021 7:28:46 AM	tshipley	10/1/2015 12:00:00 AM	7/1/2021 6:28:46 AM	False

Download as Spreadsheet

Ledger	InsuranceCarriersId	Inactive	Name	ListName	Address1	Address2	City	State	Zip	Phone1	Phone1Type	Phone2	InsuranceGroupId	CollectionsGroupMId	CarrierTypeMId	FinancialClassMId	AllocationSetId	FilingMethodMId	FilingType	TransactionColumnSetId	IncludeClaimOfficeNo	Ledger1	Notes	RequiresAuth	ReferenceCarrier	AcceptAssignmentMId	DotId	Keyword	Created	CreatedBy	LastModified	LastModifiedBy	ICD10SERVICEDATE	InsSOP_db_Updated_Date	AUC
C	3	False	Medicare Part A & B	Medicare Part A & B	PO Box 2711		Jacksonville	FL	32211	8776028816		8886644112	1	1701	1799	1738	2	1682	2	3	0	C	Provider ID 682536	0	False	233	3	PO BOX 2711 MEDICARE PART A & B MEDICARE PART A & B JACKSONVILLE FL 32211	8/13/2013 10:00:02 AM	gaia-jennifer	5/13/2026 3:47:39 PM	gaia-michellem	10/1/2015 12:00:00 AM	5/13/2026 3:47:39 PM	False
C	12	False	HUMANA MCR	HUMANA MCR	PO BOX 14601		Lexington	KY	40512	8004574708			1	1701	1799	1738	2	1682	2	3	0	C		0	False	233	12	PO BOX 14601 HUMANA MCR HUMANA MCR LEXINGTON KY 40512	9/9/2014 8:50:54 AM	gaia-jennifer	2/27/2026 8:46:35 AM	gaia-Tamika	10/1/2015 12:00:00 AM	2/27/2026 8:46:35 AM	False
C	18	False	UHC	UHC	Po Box 5290		Kingston	NY	12402	8778423210			1	1701	104	1738	2	1682	2	3	0	C	do not use	0	False	233	18	PO BOX 5290 UHC UHC KINGSTON NY 12402	1/15/2015 8:12:16 AM	gaia-brenda	3/31/2025 7:27:55 AM	gaia-nina	10/1/2015 12:00:00 AM	3/31/2025 7:27:55 AM	False
C	20	False	Care Plus MCR	Care Plus MCR	Po Box 14697		Lexington	KY	40512	8662205448			5	1701	1799	1741	2	1682	2	3	0	C		0	False	233	028	PO BOX 14697 CARE PLUS MCR CARE PLUS MCR LEXINGTON KY 40512	5/11/2015 10:57:48 AM	gaia-leticia	3/28/2025 2:39:43 PM	gaia-nina	10/1/2015 12:00:00 AM	3/28/2025 2:39:43 PM	False
C	22	False	Pending Insurance	Pending Insurance									6	1701	80	1743	2	0	0	2	0	C		0	False	233	034	PENDING INSURANCE PENDING INSURANCE	5/28/2015 11:49:38 AM	gaia-leticia	4/28/2025 9:02:30 AM	gaia-cary	10/1/2015 12:00:00 AM	4/28/2025 9:02:30 AM	False
C	26	False	Coventry MCR	Coventry MCR	Po Box 7807		London	KY	40742	8008473995			1	1701	1799	1738	2	1682	2	3	0	C		0	False	233	26	PO BOX 7807 COVENTRY MCR COVENTRY MCR LONDON KY 40742	8/20/2015 11:33:27 AM	gaia-brenda	3/6/2023 2:21:33 PM	gaia-vicki	10/1/2015 12:00:00 AM	3/6/2023 2:21:33 PM	False
C	27	False	Preferred Healthcare Partners/Welmed	Preferred Healthcare Partners/Welmed	Po Box 400066		San Antonio	TX	78229	8005507691			1	1701	1799	1738	2	1682	2	3	0	C		0	False	233	27	PO BOX 400066 PREFERRED HEALTHCARE PARTNERS/WELMED PREFERRED HEALTHCARE PARTNERS/WELMED SAN ANTONIO TX 78229	10/5/2015 2:08:57 PM	gaia-jennifer	3/6/2023 2:47:03 PM	gaia-vicki	10/1/2015 12:00:00 AM	3/6/2023 2:47:03 PM	False
C	29	False	Avmed MCR	Avmed MCR	Po Box 569000		Miami	FL	33256	8008165465			5	1701	1799	1741	2	1682	2	3	0	C		0	False	233	29	PO BOX 569000 AVMED MCR AVMED MCR MIAMI FL 33256	11/24/2015 11:22:27 AM	gaia-brenda	3/6/2023 2:17:17 PM	gaia-vicki	10/1/2015 12:00:00 AM	3/6/2023 2:17:17 PM	False
C	31	False	Medicare Acute	Medicare Acute	PO Box 2711		Jacksonville	FL	32211	8776028816			1	1701	1799	1746	2	1682	2	3	0	C		0	False	233	31	PO BOX 2711 MEDICARE ACUTE MEDICARE ACUTE JACKSONVILLE FL 32211	2/1/2017 10:15:41 AM	GAIA-JENNIFER	9/17/2022 12:11:01 PM	gaia-amanda	10/1/2015 12:00:00 AM	9/17/2022 12:11:01 PM	False
C	39	False	Arch Care Advantage MCR	Arch Care Advantage MCR	PO Box 211775		Eagan	MN	55121	8003733177			1	1701	1799	1741	2	1682	2	3	0	C		0	False	233	39	PO BOX 211775 ARCH CARE ADVANTAGE MCR ARCH CARE ADVANTAGE MCR EAGAN MN 55121	11/30/2018 7:50:33 AM	gaia-michael	3/6/2023 2:16:47 PM	gaia-vicki	10/1/2015 12:00:00 AM	3/6/2023 2:16:47 PM	False
C	43	False	HUMANA MCR OF PR	HUMANA MCR OF PR	PO BOX 191920		SAN JUAN	PR	00919	8004574708			5	1701	1799	1741	2	1682	1	3	0	C				233	43	PO BOX 191920 HUMANA MCR OF PR HUMANA MCR OF PR SAN JUAN PR 00919	7/30/2019 11:16:40 AM	gaia-michael	9/17/2022 12:10:50 PM	gaia-amanda	10/1/2015 12:00:00 AM	9/17/2022 12:10:50 PM	False
C	45	True	Aetna Dual MCR MCD	Aetna Dual MCR MCD	Po Box 981106		EL PASO	TX	79998	8335706671			5	1701	1799	1741	2	1682	2	3	0	C	DO NOT USE DUAL PROFILE		False	233	45	PO BOX 981106 AETNA DUAL MCR MCD AETNA DUAL MCR MCD EL PASO TX 79998	4/7/2020 12:20:00 PM	gaia-white	6/16/2025 1:45:53 PM	gaia-nina	10/1/2015 12:00:00 AM	6/16/2025 1:45:53 PM	False
C	50	True	UHC DUAL MCR/ MCD	UHC DUAL MCR/ MCD	PO BOX 31350		Salt Lake City	UT	84131	8778423210			1	1701	1799	1738	2	1682	2	3	0	C	DO NOT USE DUAL PROFILE		False	233	50	PO BOX 31350 UHC DUAL MCR/ MCD UHC DUAL MCR/ MCD SALT LAKE CITY UT 84131	8/10/2020 11:45:09 AM	gaia-white	6/16/2025 1:46:21 PM	gaia-nina	10/1/2015 12:00:00 AM	6/16/2025 1:46:21 PM	False
C	57	False	Bright Health CM	Bright Health CM	PO Box 16275		Reading	PA	19612	8662397191			3	1703	104	1744	2	1682	2	2	0	C		0	False	233	57	PO BOX 16275 BRIGHT HEALTH CM BRIGHT HEALTH CM READING PA 19612	9/2/2021 1:55:28 PM	gaia-michael	3/28/2025 2:37:40 PM	gaia-nina	10/1/2015 12:00:00 AM	3/28/2025 2:37:40 PM	False
C	60	True	Wellcare Dual MCR/MCD	Wellcare Dual MCR/MCD	PO BOX 31372		Tampa	FL	33631	8444778313			1	1701	1799	1738	2	1682	2	3	0	C	DO NOT USE DUAL PROFILE	0	False	233	60	PO BOX 31372 WELLCARE DUAL MCR/MCD WELLCARE DUAL MCR/MCD TAMPA FL 33631	1/12/2022 11:30:23 AM	gaia-amanda	6/16/2025 1:46:34 PM	gaia-nina	10/1/2015 12:00:00 AM	6/16/2025 1:46:34 PM	False
C	61	False	Sunshine State MCR	Sunshine State MCR	PO BOX 3070		Farmington	MO	63640	8444778313			5	1701	1799	1741	2	1682	2	3	0	C			False	233	61	PO BOX 3070 SUNSHINE STATE MCR SUNSHINE STATE MCR FARMINGTON MO 63640	2/10/2022 10:19:04 AM	gaia-amanda	3/6/2023 2:48:59 PM	gaia-vicki	10/1/2015 12:00:00 AM	3/6/2023 2:48:59 PM	False
C	1066	False	PCP MCR	PCP MCR	PO Box 30448		Salt Lake City	UT	84130	8667259334			5	1701	1799	1741	2	1682	2	3	0	C		0	False	233	1066	PO BOX 30448 PCP MCR PCP MCR SALT LAKE CITY UT 84130	9/16/2022 2:56:41 PM	gaia-michael	5/28/2024 3:19:03 PM	gaia-Tricia	10/1/2015 12:00:00 AM	5/28/2024 3:19:03 PM	False
C	1067	False	MEDICARE PART A ONLY	MEDICARE PART A ONLY	PO BOX 2711		Jacksonville	FL	32211	8776028816			1	1701	1799	1738	2	1682	2	3		C				233	1067	PO BOX 2711 MEDICARE PART A ONLY MEDICARE PART A ONLY JACKSONVILLE FL 32211	9/17/2022 12:14:06 PM	gaia-amanda	5/13/2026 3:47:34 PM	gaia-michellem	10/1/2015 12:00:00 AM	5/13/2026 3:47:34 PM	False
C	2071	False	USIS / CITY OF MIAMI	USIS / CITY OF MIAMI	PO BOX 616648	ATTN: CLAIMS ADJUSTER	ORLANDO	FL	32861-6648	8004449098	6230		3	1703	89	1744	2	1682	1	2		C				233	2071	PO BOX 616648 ATTN: CLAIMS ADJUSTER USIS / CITY OF MIAMI USIS / CITY OF MIAMI ORLANDO FL 32861-6648	5/2/2023 3:27:30 PM	gaia-amanda	1/5/2024 11:42:21 AM	gaia-nina	10/1/2015 12:00:00 AM	1/5/2024 11:42:30 AM	False
C	2072	False	CIGNA MEDICARE	CIGNA MEDICARE	PO BOX 188004		Chattanooga	TN	37422	8002222798			5	1701	1799	1741	2	1682	2	3	0	C		0		233	2072	PO BOX 188004 CIGNA MEDICARE CIGNA MEDICARE CHATTANOOGA TN 37422	10/27/2023 8:40:30 AM	gaia-amanda	10/30/2023 9:25:16 AM	gaia-cary	10/1/2015 12:00:00 AM	10/30/2023 9:25:16 AM	False
C	2073	False	AMBETTER SUNSHINE CM	AMBETTER SUNSHINE CM	PO BOX 5010		Farmington	MO	63640	8776871169			3	1703	104	1744	2	1682	2	2	0	C				233	2073	PO BOX 5010 AMBETTER SUNSHINE CM AMBETTER SUNSHINE CM FARMINGTON MO 63640	12/7/2023 9:05:06 AM	gaia-amanda	12/7/2023 9:05:06 AM	gaia-amanda	10/1/2015 12:00:00 AM	12/7/2023 9:05:06 AM	False

Download as Spreadsheet

Ledger	InsuranceCarriersId	Inactive	Name	ListName	Address1	City	State	Zip	Phone1	InsuranceGroupId	CollectionsGroupMId	CarrierTypeMId	FinancialClassMId	AllocationSetId	FilingMethodMId	FilingType	TransactionColumnSetId	IncludeClaimOfficeNo	Ledger1	RequiresAuth	ReferenceCarrier	AcceptAssignmentMId	DotId	Keyword	Created	CreatedBy	LastModified	LastModifiedBy	ICD10SERVICEDATE	InsSOP_db_Updated_Date	AUC
C	1	False	MEDICARE PART A & B	MEDICARE PART A & B	PO BOX 6773	FARGO	ND	58108	8556099960	1	1701	1799	1738	2	1682	2	3	0	C			233	1	PO BOX 6773 MEDICARE PART A & B MEDICARE PART A & B FARGO ND 58108	2/22/2010 10:05:52 AM	cammy	5/13/2026 11:37:27 AM	gaia-melisha	10/1/2014 12:00:00 AM	5/13/2026 11:37:27 AM	False
C	5	False	PENDING INSURANCE	PENDING INSURANCE						8	1701	80	1743	2	0	0	2	0	C	0	False	233	5	PENDING INSURANCE PENDING INSURANCE	7/28/2021 3:48:36 PM	gaia-veronica	4/28/2025 9:05:09 AM	gaia-cary	10/1/2015 12:00:00 AM	4/28/2025 9:05:10 AM	False
C	7	False	MEDICARE PART A ONLY	MEDICARE PART A ONLY	PO BOX 6773	FARGO	ND	58108	8556099960	1	1701	1799	1738	2	1682	2	3		C			233	7	PO BOX 6773 MEDICARE PART A ONLY MEDICARE PART A ONLY FARGO ND 58108	4/19/2022 9:21:13 AM	gaia-michael	3/31/2025 7:32:01 AM	gaia-nina	10/1/2015 12:00:00 AM	3/31/2025 7:32:01 AM	False

Download as Spreadsheet

Ledger	InsuranceCarriersId	Inactive	Name	ListName	Address1	City	State	Zip	Phone1	InsuranceGroupId	CollectionsGroupMId	CarrierTypeMId	FinancialClassMId	AllocationSetId	FilingMethodMId	FilingType	TransactionColumnSetId	Ledger1	RequiresAuth	ReferenceCarrier	AcceptAssignmentMId	DotId	Keyword	Created	CreatedBy	LastModified	LastModifiedBy	ICD10SERVICEDATE	InsSOP_db_Updated_Date	AUC
C	1	False	SELF PAY	SELF PAY						7		91	1743	2	0	0	1	C			233	1	SELF PAY SELF PAY	2/22/2010 10:05:52 AM	cammy	3/31/2025 7:35:23 AM	gaia-nina	10/1/2014 12:00:00 AM	3/31/2025 7:35:23 AM	False
C T	3	False	Medicare A&B Indian Health and Veteran Affairs	Medicare A&B Indian Health and Veteran Affairs	P O BOX 24563	Omaha	NE	68124	8552528782	1	1701	1799	1738	2	1682	2	3	C T	0	False	233	3	P O BOX 24563 MEDICARE A&B INDIAN HEALTH AND VETERAN AFFAIRS MEDICARE A&B INDIAN HEALTH AND VETERAN AFFAIRS OMAHA NE 68124	8/23/2022 3:28:21 PM	gaia-bruce	4/30/2026 10:10:44 AM	gaia-melisha	10/1/2015 12:00:00 AM	4/30/2026 10:10:44 AM	False
C	6	False	PENDING INSURANCE	PENDING INSURANCE						7	1701	80	1743	2	0	0	2	C			233	00000000	PENDING INSURANCE PENDING INSURANCE	2/12/2025 12:36:59 PM	gaia-nina	4/28/2025 9:06:19 AM	gaia-cary	10/1/2015 12:00:00 AM	4/28/2025 9:06:19 AM

Download as Spreadsheet

Ledger	InsuranceCarriersId	Inactive	Name	ListName	Address1	City	State	Zip	Phone1	InsuranceGroupId	CollectionsGroupMId	CarrierTypeMId	FinancialClassMId	AllocationSetId	FilingMethodMId	FilingType	TransactionColumnSetId	Ledger1	RequiresAuth	ReferenceCarrier	AcceptAssignmentMId	DotId	Keyword	Created	CreatedBy	LastModified	LastModifiedBy	ICD10SERVICEDATE	InsSOP_db_Updated_Date	AUC
C T	4	False	MEDICARE PART A & B	MEDICARE PART A & B	PO Box 2711	Jacksonville	FL	32111	8776028816	2	1701	1799	1738	2	1682	2	3	C T			233	4	PO BOX 2711 MEDICARE PART A & B MEDICARE PART A & B JACKSONVILLE FL 32111	7/19/2022 9:18:20 AM	gaia-jennifer	4/30/2026 10:12:12 AM	gaia-melisha	10/1/2015 12:00:00 AM	4/30/2026 10:12:12 AM	False
C	6	False	OSCAR CM	OSCAR CM	PO Box 52146	PHOENIX	AZ	85072	8556722755	1	1703	104	1744	2	1682	2	2	C	0	False	233	6	PO BOX 52146 OSCAR CM OSCAR CM PHOENIX AZ 85072	3/23/2023 7:01:03 AM	gaia-amanda	3/23/2023 7:01:03 AM	gaia-amanda	10/1/2015 12:00:00 AM	3/23/2023 7:01:03 AM	False
C	1006	False	PENDING INSURANCE	PENDING INSURANCE						5	1701	80	1743	2	0	0	2	C			233	1006	PENDING INSURANCE PENDING INSURANCE	3/8/2024 3:02:26 PM	GAIA-LIO	4/28/2025 9:07:32 AM	gaia-cary	10/1/2015 12:00:00 AM	4/28/2025 9:07:32 AM	False
C	1008	False	DEVOTED HEALTH MCR	DEVOTED HEALTH MCR	PO BOX 211524	EAGAN	MN	55121	8003386833	3	1701	1799	1741	2	1682	2	3	C			233	83	PO BOX 211524 DEVOTED HEALTH MCR DEVOTED HEALTH MCR EAGAN MN 55121	4/18/2024 2:40:52 PM	gaia-lio	4/18/2024 2:40:52 PM	gaia-lio	10/1/2015 12:00:00 AM	4/18/2024 2:40:52 PM	False

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Ledger	InsuranceCarriersId	Inactive	Name	ListName	Address1	Address2	City	State	Zip	Phone1	Phone2	InsuranceGroupId	CollectionsGroupMId	CarrierTypeMId	FinancialClassMId	AllocationSetId	FilingMethodMId	FilingType	TransactionColumnSetId	IncludeClaimOfficeNo	Ledger1	Notes	RequiresAuth	ReferenceCarrier	AcceptAssignmentMId	DotId	Keyword	Created	CreatedBy	LastModified	LastModifiedBy	ICD10SERVICEDATE	InsSOP_db_Updated_Date	AUC
C	4	False	Medicare IL Part A & B	Medicare IL Part A & B	Po Box 1111		Chicago	IL	60686	8773094290	8777020990	2	1701	1799	1738	2	1682	2	3	0	C		0	False	233	4	PO BOX 1111 MEDICARE IL PART A & B MEDICARE IL PART A & B CHICAGO IL 60686	9/28/2017 9:12:57 AM	gaia-brenda	5/13/2026 11:13:25 AM	gaia-melisha	10/2/2015 12:00:00 AM	5/13/2026 11:13:25 AM	False
C	5	False	Pending Insurance	Pending Insurance	Po Box		Chicago	IL	60647			8	1701	80	1743	2	0	0	2	0	C		0	False	233	5	PO BOX PENDING INSURANCE PENDING INSURANCE CHICAGO IL 60647	9/28/2017 9:31:08 AM	gaia-brenda	4/28/2025 9:09:19 AM	gaia-cary	10/1/2015 12:00:00 AM	4/28/2025 9:09:19 AM	False
DT	9	False	Illinois Medicaid Full, QMB	Illinois Medicaid Full, QMB	PO Box 19109		Springfield	IL	62794	8777825565		4	1703	83	1739	2	1682	2	2	0	DT		0	False	233	9	PO BOX 19109 ILLINOIS MEDICAID FULL, QMB ILLINOIS MEDICAID FULL, QMB SPRINGFIELD IL 62794	2/5/2018 9:39:13 AM	gaia-jennifer	5/7/2026 2:35:28 PM	gaia-wendy	10/1/2015 12:00:00 AM	5/7/2026 2:35:28 PM	False
C	11	False	UHC MCR Advantage	UHC MCR Advantage	P O BOX 31362		Salt Lake City	UT	84131-0362	8778423210		3	1701	1799	1741	2	1682	2	3	0	C		0	False	233	11	P O BOX 31362 UHC MCR ADVANTAGE UHC MCR ADVANTAGE SALT LAKE CITY UT 84131-0362	3/27/2018 3:11:13 PM	gaia-renee	5/31/2023 11:25:47 AM	gaia-cary	10/1/2015 12:00:00 AM	5/31/2023 11:25:47 AM	False
C	20	False	Humana MCR	Humana MCR	PO BOX 14601		Lexington	KY	40512	8004574708		3	1701	1799	1741	2	1682	2	3	0	C		0	False	233	20	PO BOX 14601 HUMANA MCR HUMANA MCR LEXINGTON KY 40512	3/1/2019 3:40:09 PM	gaia-brenda	6/10/2024 7:13:34 AM	gaia-racheal	10/1/2015 12:00:00 AM	6/10/2024 7:13:34 AM	False
C	21	False	Illinicare MCR	Illinicare MCR	PO Box 4020		Farmington	MO	63640	8553234578		3	1701	1799	1741	2	1682	2	3	0	C	as of 06/26/20 call meridian for claims	0	False	233	21	PO BOX 4020 ILLINICARE MCR ILLINICARE MCR FARMINGTON MO 63640	5/16/2019 9:22:16 AM	gaia-michael	3/31/2025 7:48:46 AM	gaia-nina	10/1/2015 12:00:00 AM	3/31/2025 7:48:46 AM	False
C	22	False	Wellcare MCR/Harmony Health MCR	Wellcare MCR/Harmony Health MCR	PO BOX 31372		Tampa	FL	33631	8555380454		3	1701	1799	1741	2	1682	2	3	0	C		0	False	233	22	PO BOX 31372 WELLCARE MCR/HARMONY HEALTH MCR WELLCARE MCR/HARMONY HEALTH MCR TAMPA FL 33631	6/13/2019 8:04:38 AM	gaia-brenda	3/14/2025 12:10:10 PM	gaia-nina	10/1/2014 12:00:00 AM	3/14/2025 12:10:10 PM	False
C	24	False	Meridian MCR	Meridian MCR	1 Campus Martius	Suite 720	Detroit	MI	48226	8553234578		3	1701	1799	1741	2	1682	2	3	0	C			False	233	24	1 CAMPUS MARTIUS SUITE 720 MERIDIAN MCR MERIDIAN MCR DETROIT MI 48226	7/10/2020 8:24:37 AM	gaia-michael	3/31/2025 7:50:31 AM	gaia-nina	10/1/2015 12:00:00 AM	3/31/2025 7:50:31 AM	False
CFA	27	False	AETNA BETTER HEALTH MCR	AETNA BETTER HEALTH MCR	PO BOX 982974		El Paso	TX	79998	8666002139		3	1701	1799	1741	2	1682	2	3	0	CFA		0	False	233	27	PO BOX 982974 AETNA BETTER HEALTH MCR AETNA BETTER HEALTH MCR EL PASO TX 79998	1/26/2021 2:27:17 PM	gaia-michael	5/7/2026 2:33:19 PM	gaia-wendy	10/1/2015 12:00:00 AM	5/7/2026 2:33:19 PM	False
C	28	False	Meridian Total Care MCR	Meridian Total Care MCR	PO Box 3060		Farmington	MO	63640	8553234578		3	1701	1799	1741	2	1682	2	3	0	C		0	False	233	28	PO BOX 3060 MERIDIAN TOTAL CARE MCR MERIDIAN TOTAL CARE MCR FARMINGTON MO 63640	10/15/2021 9:28:06 AM	gaia-michael	5/31/2023 11:24:12 AM	gaia-cary	10/1/2015 12:00:00 AM	5/31/2023 11:24:12 AM	False
C	31	False	Cigna Healthspring MCR	Cigna Healthspring MCR	PO Box 981706		El Paso	TX	79998	8006683813		3	1701	1799	1741	2	1682	2	3	0	C		-1	False	233	31	PO BOX 981706 CIGNA HEALTHSPRING MCR CIGNA HEALTHSPRING MCR EL PASO TX 79998	3/24/2022 8:19:34 AM	gaia-amanda	5/31/2023 11:20:20 AM	gaia-cary	10/1/2015 12:00:00 AM	5/31/2023 11:20:20 AM	False
C T	33	False	Medicare IL Part A Only	Medicare IL Part A Only	PO BOX 1111		Chicago	IL	60686			2	1701	1799	1738	2	1682	2	3		C T				233	33	PO BOX 1111 MEDICARE IL PART A ONLY MEDICARE IL PART A ONLY CHICAGO IL 60686	9/17/2022 12:21:54 PM	gaia-amanda	4/30/2026 10:13:38 AM	gaia-melisha	10/1/2015 12:00:00 AM	4/30/2026 10:13:38 AM	False
C	1035	False	CLEAR SPRING HEALTH MCR	CLEAR SPRING HEALTH MCR	PO BOX 981731		El Paso	TX	79998	8339881607	7542085880	3	1701	1799	1741	2	1682	2	2	0	C		0	False	233	1035	PO BOX 981731 CLEAR SPRING HEALTH MCR CLEAR SPRING HEALTH MCR EL PASO TX 79998	3/9/2023 8:05:18 AM	gaia-amanda	5/7/2026 8:54:31 AM	gaia-Lydia	10/1/2015 12:00:00 AM	5/7/2026 8:54:32 AM	False
C T	1038	False	Medicare Part B Only	Medicare Part B Only	Po Box 1111		Chicago	IL	60686	8773094290		2	1701	1799	1738	2	1682	2	3	0	C T	TPL 910 for Medicaid Secondary Billing	-1	False	233	4564654	PO BOX 1111 MEDICARE PART B ONLY MEDICARE PART B ONLY CHICAGO IL 60686	12/11/2024 1:07:59 PM	gaia-nina	4/30/2026 10:13:44 AM	gaia-melisha	10/1/2015 12:00:00 AM	4/30/2026 10:13:44 AM

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Ledger	InsuranceCarriersId	Inactive	Name	ListName	Address1	City	State	Zip	Phone1	InsuranceGroupId	CollectionsGroupMId	CarrierTypeMId	FinancialClassMId	AllocationSetId	FilingMethodMId	FilingType	TransactionColumnSetId	PolicyTypeMId	IncludeClaimOfficeNo	Ledger1	RequiresAuth	ReferenceCarrier	AcceptAssignmentMId	DotId	Keyword	Created	CreatedBy	LastModified	LastModifiedBy	ICD10SERVICEDATE	InsSOP_db_Updated_Date	AUC
C	4	False	MEDICARE A&B	MEDICARE A&B	PO BOX 660155	DALLAS	TX	75266	8552528782	2	1701	1799	1738	2	1682	2	3			C			233	4	PO BOX 660155 MEDICARE A&B MEDICARE A&B DALLAS TX 75266	6/15/2022 10:15:07 AM	gaia-michael	5/13/2026 11:14:24 AM	gaia-melisha	10/1/2015 12:00:00 AM	5/13/2026 11:14:24 AM	False
C	5	False	MEDICARE PART A ONLY	MEDICARE PART A ONLY	PO BOX 660155	DALLAS	TX	75266		2	1701	1799	1738	2	1682	2	3			C			233	5	PO BOX 660155 MEDICARE PART A ONLY MEDICARE PART A ONLY DALLAS TX 75266	6/15/2022 10:16:08 AM	gaia-michael	10/23/2023 2:14:39 PM	gaia-sandy	10/1/2015 12:00:00 AM	10/23/2023 2:14:39 PM	False
C	6	False	AETNA MCR	AETNA MCR	PO BOX 14770	LEXINGTON	KY	40512	8335706670	2	1701	1799	1741	2	1682	2	3			C			233	6	PO BOX 14770 AETNA MCR AETNA MCR LEXINGTON KY 40512	6/15/2022 10:17:35 AM	gaia-michael	3/5/2025 1:26:40 PM	gaia-michellem	10/1/2015 12:00:00 AM	3/5/2025 1:26:40 PM	False
C	11	False	PENDING INSURANCE	PENDING INSURANCE	DO NOT BILL	HOUSTON	TX	77054		3	1701	80	1743	2	0	0	2	116		C			233	11	DO NOT BILL PENDING INSURANCE PENDING INSURANCE HOUSTON TX 77054	6/15/2022 10:30:54 AM	gaia-michael	4/28/2025 9:11:38 AM	gaia-cary	10/1/2015 12:00:00 AM	4/28/2025 9:11:38 AM	False
C	12	False	UHC MCR - WELL MED	UHC MCR - WELL MED	PO BOX 845833	DALLAS	TX	75284-5833	8005507691	2	1701	1799	1741	2	1682	2	3		0	C	0	False	233	12	PO BOX 845833 UHC MCR - WELL MED UHC MCR - WELL MED DALLAS TX 75284-5833	7/14/2022 11:08:53 AM	gaia-amanda	3/25/2026 1:26:17 PM	gaia-gery	10/1/2015 12:00:00 AM	3/25/2026 1:26:17 PM	False
C	16	False	UHC MCR	UHC MCR	PO BOX 30995	SALT LAKE CITY	UT	84130	8778423210	2	1701	1799	1741	2	1682	2	3			C			233	16	PO BOX 30995 UHC MCR UHC MCR SALT LAKE CITY UT 84130	9/16/2022 2:12:40 PM	gaia-michael	5/26/2025 10:55:14 AM	gaia-Tricia	10/1/2015 12:00:00 AM	5/26/2025 10:55:14 AM	False
C	20	False	HUMANA MCR	HUMANA MCR	PO BOX 14601	LEXINGTON	KY	45012	8004574708	2	1701	1799	1741	2	1682	2	3		0	C	0	False	233	20	PO BOX 14601 HUMANA MCR HUMANA MCR LEXINGTON KY 45012	3/27/2023 10:10:45 AM	gaia-amanda	3/27/2023 10:10:45 AM	gaia-amanda	10/1/2015 12:00:00 AM	3/27/2023 10:10:45 AM	False
C	25	False	WELLCARE MCR	WELLCARE MCR	PO BOX 31372	TAMPA	FL	33631	8334449088	2	1701	1799	1738	2	1682	2	3		0	C	0	False	233	25	PO BOX 31372 WELLCARE MCR WELLCARE MCR TAMPA FL 33631	6/26/2023 8:56:59 AM	gaia-amanda	6/26/2023 8:56:59 AM	gaia-amanda	10/1/2015 12:00:00 AM	6/26/2023 8:56:59 AM	False
C	1028	False	AMERIGROUP WELLPOINT MCR	AMERIGROUP WELLPOINT MCR	PO BOX 61010	VIRGINIA BEACH	VA	23466	8444696823	2	1701	1799	1741	2	1682	2	3		0	C			233	1028	PO BOX 61010 AMERIGROUP WELLPOINT MCR AMERIGROUP WELLPOINT MCR VIRGINIA BEACH VA 23466	12/19/2023 2:48:40 PM	gaia-amanda	12/19/2023 2:48:40 PM	gaia-amanda	10/1/2015 12:00:00 AM	12/19/2023 2:48:43 PM	False
C	1029	False	CIGNA HEALTH SPRING	CIGNA HEALTH SPRING	PO BOX 981706	EL PASO	TX	79998	8002306138	2	1701	1799	1741	2	1682	2	3		0	C	0		233	1029	PO BOX 981706 CIGNA HEALTH SPRING CIGNA HEALTH SPRING EL PASO TX 79998	12/29/2023 11:59:31 AM	gaia-amanda	2/20/2026 1:06:54 PM	gaia-gery	10/1/2015 12:00:00 AM	2/20/2026 1:06:54 PM	False
F	1033	False	Van Lang IPA-Wellpoint	Van Lang IPA-Wellpoint	Po Box 211406	EAGAN	MN	55121	8883190777	2	1701	1799	1741	2	1682	2	3		0	F	0		233	5197	PO BOX 211406 VAN LANG IPA-WELLPOINT VAN LANG IPA-WELLPOINT EAGAN MN 55121	5/23/2024 7:58:02 AM	gaia-nina	5/8/2026 11:37:25 AM	gaia-wendy	10/1/2015 12:00:00 AM	5/8/2026 11:37:25 AM	False

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Ledger	InsuranceCarriersId	Inactive	Name	ListName	Address1	Address2	City	State	Zip	Contact	Phone1	Phone2	InsuranceGroupId	CollectionsGroupMId	CarrierTypeMId	FinancialClassMId	AllocationSetId	FilingMethodMId	FilingType	TransactionColumnSetId	IncludeClaimOfficeNo	Ledger1	Notes	AlertNotes	RequiresAuth	ReferenceCarrier	AcceptAssignmentMId	DotId	Keyword	Created	CreatedBy	LastModified	LastModifiedBy	ICD10SERVICEDATE	InsSOP_db_Updated_Date	AUC
c	3	False	MEDICARE PART A & B	MEDICARE PART A & B	PO BOX 2711		JACKSONVILLE	FL	32211		8776028816	8886644112	9	1701	1799	1738	2	1682	2	3	0	c	PROVIDER ID 682521		0	False	233	3	PO BOX 2711 MEDICARE PART A & B MEDICARE PART A & B JACKSONVILLE FL 32211	2/22/2013 9:40:18 AM	gaia-jennifer	5/13/2026 10:37:39 AM	gaia-jennifer	10/1/2015 12:00:00 AM	5/13/2026 8:37:39 AM	False
F	22	False	UHC PCN / Medica MCR	UHC PCN/ Medica MCR	PO Box 56-6616		Miami	FL	33256		8003485548		8	1701	1799	1741	2	1682	2	3	0	F			0	False	233	78857 MCR	PO BOX 56-6616 UHC PCN/ MEDICA MCR UHC PCN / MEDICA MCR MIAMI FL 33256	3/17/2014 11:03:51 AM	gaia-cassie	5/5/2026 11:20:09 AM	gaia-wendy	10/1/2015 12:00:00 AM	5/5/2026 11:20:09 AM	False
C	34	False	DEPARTMENT OF VA	Department of VA	1201 NW 16th ST	ATTN: 136E	Miami	FL	33125	EXT 17130	3055757000		11	1704	95	1742	2	1682	1	2	0	C			0	False	233	34	1201 NW 16TH ST ATTN: 136E DEPARTMENT OF VA DEPARTMENT OF VA MIAMI FL 33125	1/30/2015 8:57:56 AM	gaia-michelle	3/31/2025 8:11:37 AM	gaia-nina	10/2/2015 12:00:00 AM	3/31/2025 8:11:37 AM	False
C	38	False	Pending Insurance	Pending Insurance	DO NOT BILL		LITTLETON	CO	80120				6	1701	80	1743	2	0	0	2	0	C			0	False	233	38	DO NOT BILL PENDING INSURANCE PENDING INSURANCE LITTLETON CO 80120	5/28/2015 1:19:20 PM	gaia-leticia	4/28/2025 9:10:25 AM	gaia-cary	10/1/2015 12:00:00 AM	4/28/2025 9:10:25 AM	False
C	48	False	BCBS of Florida MCR	BCBS of Florida MCR	PO Box 896		Jacksonville	FL	32232		8007272227		8	1701	1799	1741	2	1682	2	3	0	C			0	False	233	48	PO BOX 896 BCBS OF FLORIDA MCR BCBS OF FLORIDA MCR JACKSONVILLE FL 32232	10/27/2016 1:08:25 PM	gaia-jennifer	8/26/2024 1:34:13 PM	gaia-jennifer	10/1/2015 12:00:00 AM	8/26/2024 11:34:12 AM	False
C	51	False	MEDICARE PART A ACUTE	MEDICARE PART A ACUTE	PO BOX 2711		JACKSONVILLE	FL	32211				9	1701	1799	1738	2	1682	2	3	0	C			0	False	233	51	PO BOX 2711 MEDICARE PART A ACUTE MEDICARE PART A ACUTE JACKSONVILLE FL 32211	2/1/2017 9:02:25 AM	GAIA-JENNIFER	5/13/2026 10:37:46 AM	gaia-jennifer	10/1/2015 12:00:00 AM	5/13/2026 8:37:46 AM	False
C	59	False	UHC Preferred Care Partners MCR	UHC Preferred Care Partners MCR	P O BOX 30448		Salt Lake City	UT	84130		8667259334		8	1701	1799	1741	2	1682	2	3	0	C		MCO PLAN	0	False	233	59	P O BOX 30448 UHC PREFERRED CARE PARTNERS MCR UHC PREFERRED CARE PARTNERS MCR SALT LAKE CITY UT 84130	9/1/2017 2:35:26 PM	gaia-renee	3/2/2026 7:29:00 AM	gaia-jennifer	10/1/2016 12:00:00 AM	3/2/2026 5:29:00 AM	False
c	64	False	Wellcare MCR	Wellcare MCR	PO Box 31372		TAMPA	FL	33631-3372		8555380454		8	1701	1799	1741	2	1682	2	3	0	c			0		233	64	PO BOX 31372 WELLCARE MCR WELLCARE MCR TAMPA FL 33631-3372	10/29/2018 3:52:46 PM	gaia-michelle	10/13/2023 10:16:55 AM	GAIA-JENNIFER	10/1/2015 12:00:00 AM	10/13/2023 10:16:55 AM	False
C	71	False	Optimum MCR	Optimum MCR	PO Box 151258		Tampa	FL	33684		8884012740		8	1701	1799	1741	2	1682	2	3	0	C					233	71	PO BOX 151258 OPTIMUM MCR OPTIMUM MCR TAMPA FL 33684	1/22/2020 7:38:15 AM	gaia-michael	3/3/2023 2:15:24 PM	gaia-vicki	10/1/2015 12:00:00 AM	3/3/2023 2:15:24 PM	False
C	72	False	Doctor Health MCR	Doctor Health MCR	PO Box 1321825 Ponce De Leon		CORAL GABLES	FL	33134		3054229300		8	1701	1799	1741	2	1682	2	3	0	C				False	233	837 1	PO BOX 1321825 PONCE DE LEON DOCTOR HEALTH MCR DOCTOR HEALTH MCR CORAL GABLES FL 33134	2/3/2020 8:46:25 AM	gaia-michael	3/9/2026 10:18:02 AM	gaia-Tamika	10/1/2015 12:00:00 AM	3/9/2026 10:18:02 AM	False
C	82	True	LEON MEDICAL CENTERS HEALTH PLAN MCR	INACTIVE LEON MEDICAL CENTERS HEALTH PLAN MCR	PO Box 659006		Miami	FL	33126		3056315343		8	1701	1799	1741	2	1682	2	3	0	C			-1		233	37316	PO BOX 659006 INACTIVE LEON MEDICAL CENTERS HEALTH PLAN MCR LEON MEDICAL CENTERS HEALTH PLAN MCR MIAMI FL 33126	5/4/2021 12:25:34 PM	gaia-michael	7/7/2026 10:05:37 AM	GAIA-JENNIFER	10/1/2015 12:00:00 AM	7/7/2026 8:05:37 AM	False
C	83	False	DEVOTED HEALTH MCR	DEVOTED HEALTH MCR	PO BOX 211524		EAGAN	MN	55121		8003386833		8	1701	1799	1741	2	1682	2	3	0	C			0	False	233	83	PO BOX 211524 DEVOTED HEALTH MCR DEVOTED HEALTH MCR EAGAN MN 55121	5/24/2021 2:20:56 PM	gaia-michael	9/6/2023 2:13:29 PM	gaia-amanda	10/1/2015 12:00:00 AM	9/6/2023 2:13:29 PM	False
C	85	True	CAREPLUS DUAL MCR/MCD	INACTIVE CAREPLUS DUAL MCR/MCD	PO BOX 14697		Lexington	KY	40512		8663137587		8	1703	1799	1741	2	1682	2	3	-1	C	DO NO TUSE DUAL PROFILE				233	85	PO BOX 14697 INACTIVE CAREPLUS DUAL MCR/MCD CAREPLUS DUAL MCR/MCD LEXINGTON KY 40512	6/15/2021 7:39:28 AM	gaia-michael	7/7/2026 10:05:00 AM	GAIA-JENNIFER	10/1/2015 12:00:00 AM	7/7/2026 8:05:00 AM	False
C	86	True	UHC Preferred Care Partners Dual MCR/MCD	INACTIVE UHC Preferred Care Partners Dual MCR/MCD	PO Box 30448		Salt Lake City	UT	84130		8667259334		8	1701	1799	1741	2	1682	2	3		C	DO NOT USE DUAL PROFILE				233	86	PO BOX 30448 INACTIVE UHC PREFERRED CARE PARTNERS DUAL MCR/MCD UHC PREFERRED CARE PARTNERS DUAL MCR/MCD SALT LAKE CITY UT 84130	7/6/2021 12:13:24 PM	gaia-michael	7/7/2026 10:06:49 AM	GAIA-JENNIFER	10/1/2015 12:00:00 AM	7/7/2026 8:06:49 AM	False
C	90	False	MMM OF FLORIDA MCR	MMM OF FLORIDA MCR	5775 Blue Lagoon Drive, Suite 450		Miami	FL	33126				8	1701	1799	1741	2	1682	2	3	-1	C					233	90	5775 BLUE LAGOON DRIVE, SUITE 450 MMM OF FLORIDA MCR MMM OF FLORIDA MCR MIAMI FL 33126	3/4/2022 11:55:56 AM	gaia-andrea	3/3/2023 2:12:01 PM	gaia-vicki	10/1/2015 12:00:00 AM	3/3/2023 2:12:00 PM	False
C	95	False	MEDICARE PART A ONLY	MEDICARE PART A ONLY	PO BOX 2711		JACKSONVILLE	FL	32211		8776028816		9	1701	1799	1738	2	1682	2	3	0	C					233	95	PO BOX 2711 MEDICARE PART A ONLY MEDICARE PART A ONLY JACKSONVILLE FL 32211	8/10/2022 10:20:31 AM	gaia-amanda	5/13/2026 10:37:53 AM	gaia-jennifer	10/1/2015 12:00:00 AM	5/13/2026 8:37:53 AM	False
C	97	False	AMERIHEALTH CARITAS MCD MMA	AMERIHEALTH CARITAS MCD MMA	PO BOX 7367		London	KY	40742		8553559800		7	1703	83	1739	2	1682	2	2	0	C			0	False	233	97	PO BOX 7367 AMERIHEALTH CARITAS MCD MMA AMERIHEALTH CARITAS MCD MMA LONDON KY 40742	8/29/2022 1:29:34 PM	gaia-amanda	6/17/2025 3:31:07 PM	gaia-melisha	10/1/2015 12:00:00 AM	6/17/2025 3:31:07 PM	False
CA	105	False	LEON HEALTH MCR	LEON HEALTH MCR	PO BOX 61265		Phoenix	AZ	85082		3057182842		8	1701	1799	1741	2	1682	2	3	0	CA					233	105	PO BOX 61265 LEON HEALTH MCR LEON HEALTH MCR PHOENIX AZ 85082	11/21/2022 8:31:56 AM	gaia-amanda	5/5/2026 11:18:01 AM	gaia-wendy	10/1/2015 12:00:00 AM	5/5/2026 11:18:01 AM	False
A	106	False	LEON HEALTH MCD MMA	LEON HEALTH MCD MMA	PO BOX 61265		Phoenix	AZ	85082		8333735366		7	1703	83	1739	2	1682	2	2		A					233	106	PO BOX 61265 LEON HEALTH MCD MMA LEON HEALTH MCD MMA PHOENIX AZ 85082	11/21/2022 8:33:32 AM	gaia-amanda	5/5/2026 11:18:09 AM	gaia-wendy	10/1/2015 12:00:00 AM	5/5/2026 11:18:09 AM	False
C	108	False	FREEDOM HEALTH MCR	FREEDOM HEALTH MCR	PO BOX 151348		Tampa	FL	33684		8004012740		8	1701	1799	1741	2	1682	2	3	0	C				False	233	108	PO BOX 151348 FREEDOM HEALTH MCR FREEDOM HEALTH MCR TAMPA FL 33684	1/23/2023 10:53:50 AM	gaia-amanda	11/1/2024 6:47:51 AM	gaia-jennifer	10/1/2015 12:00:00 AM	11/1/2024 4:47:51 AM	False
C	117	False	NY Hotel Benefit Fund	NY Hotel Benefit Fund	305 W 44th St		New York	NY	10036		2125866400		8	1701	1799	1741	2	0	1	3	0	C					233	117	305 W 44TH ST NY HOTEL BENEFIT FUND NY HOTEL BENEFIT FUND NEW YORK NY 10036	10/16/2023 3:10:52 PM	gaia-amanda	10/16/2023 3:11:26 PM	gaia-amanda	10/1/2015 12:00:00 AM	10/16/2023 3:11:25 PM	False
C	118	False	LONGEVITY MCR	LONGEVITY MCR	PO Box 23428		Tampa	FL	33623		8557992666		8	1701	1799	1741	2	1682	2	3	0	C			0		233	118	PO BOX 23428 LONGEVITY MCR LONGEVITY MCR TAMPA FL 33623	10/25/2023 8:10:15 AM	gaia-amanda	1/14/2026 3:45:59 PM	gaia-tamika	10/1/2015 12:00:00 AM	1/14/2026 3:45:59 PM	False
C A	122	False	VA Community Care Network Regions 1-3	VA Community Care Network Regions 1-3	P.O. Box 202117		Florence	SC	29502		8889016613		11	1704	95	1742	2	1682	2	2	0	C A					233	VACCN	P.O. BOX 202117 VA COMMUNITY CARE NETWORK REGIONS 1-3 VA COMMUNITY CARE NETWORK REGIONS 1-3 FLORENCE SC 29502	6/5/2024 11:13:05 AM	gaia-nina	4/28/2026 9:52:16 AM	gaia-Tamika	10/1/2015 12:00:00 AM	4/28/2026 9:52:16 AM	False
C	125	False	Cigna Healthspring MCR	Cigna Healthspring MCR	Po Box 981706		El Paso	TX	79998		8006683813		8	1701	1799	1741	2	1682	2	3	0	C					233	196387	PO BOX 981706 CIGNA HEALTHSPRING MCR CIGNA HEALTHSPRING MCR EL PASO TX 79998	7/8/2024 9:37:52 AM	gaia-nina	7/8/2024 9:39:39 AM	gaia-nina	10/1/2015 12:00:00 AM	7/8/2024 9:39:39 AM	False

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Ledger	InsuranceCarriersId	Inactive	Name	ListName	Address1	City	State	Zip	Country	Phone1	Phone1Type	InsuranceGroupId	CollectionsGroupMId	CarrierTypeMId	FinancialClassMId	AllocationSetId	FilingMethodMId	FilingType	TransactionColumnSetId	Ledger1	RequiresAuth	ReferenceCarrier	AcceptAssignmentMId	DotId	Keyword	Created	CreatedBy	LastModified	LastModifiedBy	ICD10SERVICEDATE	InsSOP_db_Updated_Date	AUC
C	1	False	SELF PAY	SELF PAY								7	1701	91	1743	2	0	0	3	C			233	1	SELF PAY SELF PAY	2/22/2010 10:05:52 AM	cammy	1/8/2026 11:25:18 AM	gaia-wendy	10/1/2014 12:00:00 AM	1/8/2026 11:25:18 AM	False
C	3	False	MEDICARE A & B	MEDICARE A & B	PO BOX 660155	DALLAS	TX	75266	USA	8552528782	Work	1	1701	1799	1738	2	1682	2	3	C	0	False	233	3	PO BOX 660155 MEDICARE A & B MEDICARE A & B DALLAS TX 75266	8/23/2022 3:28:21 PM	gaia-bruce	6/8/2026 7:42:57 AM	gaia-jennifer	10/1/2015 12:00:00 AM	6/8/2026 6:42:57 AM	False
C	26	False	PENDING INSURANCE	PENDING INSURANCE								7	1701	80	1743	2	0	0	3	C		False	233	003	PENDING INSURANCE PENDING INSURANCE	6/24/2025 3:05:59 PM	gaia-nina	8/21/2025 9:33:31 AM	gaia-cary	10/1/2015 12:00:00 AM	8/21/2025 9:33:31 AM

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Ledger	InsuranceCarriersId	Inactive	Name	ListName	Address1	Address2	City	State	Zip	Phone1	Phone2	InsuranceGroupId	CollectionsGroupMId	CarrierTypeMId	FinancialClassMId	AllocationSetId	FilingMethodMId	FilingType	TransactionColumnSetId	IncludeClaimOfficeNo	Ledger1	RequiresAuth	ReferenceCarrier	AcceptAssignmentMId	DotId	Keyword	Created	CreatedBy	LastModified	LastModifiedBy	ICD10SERVICEDATE	InsSOP_db_Updated_Date	AUC
C	1	False	MEDICARE PART A & B	MEDICARE PART A & B	PO BOX 6770		Fargo	ND	58108	8556099960		1	1701	1799	1738	2	1682	2	2	0	C			233	1	PO BOX 6770 MEDICARE PART A & B MEDICARE PART A & B FARGO ND 58108	2/22/2010 10:05:52 AM	cammy	5/13/2026 11:38:37 AM	gaia-melisha	10/1/2015 12:00:00 AM	5/13/2026 11:38:37 AM	False
C	7	False	MEDICARE ACUTE	MEDICARE ACUTE	PO Box 6770		Fargo	ND	58108	8556099960		1	1701	1799	1738	2	1682	2	3		C			233	7	PO BOX 6770 MEDICARE ACUTE MEDICARE ACUTE FARGO ND 58108	4/28/2021 10:35:42 AM	gaia-jennifer	3/31/2025 8:34:42 AM	gaia-nina	10/1/2015 12:00:00 AM	3/31/2025 8:34:42 AM	False
C	9	False	PENDING INSURANCE	PENDING INSURANCE								7	1701	80	1743	2	0	0	2		C			233	9	PENDING INSURANCE PENDING INSURANCE	4/28/2021 10:39:12 AM	gaia-jennifer	4/28/2025 9:12:51 AM	gaia-cary	10/1/2015 12:00:00 AM	4/28/2025 9:12:51 AM	False
C T	10	False	MEDICARE PART A ONLY	MEDICARE PART A ONLY	PO Box 6770		Fargo	ND	58108	8556099960		1	1701	1799	1738	2	1682	2	3	0	C T			233	10	PO BOX 6770 MEDICARE PART A ONLY MEDICARE PART A ONLY FARGO ND 58108	4/28/2021 10:42:52 AM	gaia-jennifer	4/30/2026 10:52:54 AM	gaia-melisha	10/1/2015 12:00:00 AM	4/30/2026 10:52:54 AM	False
A	15	False	VA ADMINISTRATION	VA ADMINISTRATION	PO BOX 30780		TAMPA	FL	33630	5628268000		6	1704	95	1742	2	1682	2	2	0	A		False	233	15	PO BOX 30780 VA ADMINISTRATION VA ADMINISTRATION TAMPA FL 33630	8/9/2021 12:53:13 PM	gaia-michael	5/8/2026 8:03:20 AM	gaia-Lydia	10/1/2015 12:00:00 AM	5/8/2026 8:03:20 AM	False
C	18	False	SCAN HEALTH MCR	SCAN HEALTH MCR	PO BOX 22698		LONG BEACH	CA	90801	8005593500		2	1701	1799	1741	2	1682	2	3	0	C	0	False	233	18	PO BOX 22698 SCAN HEALTH MCR SCAN HEALTH MCR LONG BEACH CA 90801	9/2/2021 1:48:07 PM	gaia-michael	5/31/2023 11:35:14 AM	gaia-cary	10/1/2015 12:00:00 AM	5/31/2023 11:35:14 AM	False
C	19	False	HEALTH NET MCR	HEALTHNET MCR	PO BOX 3060		FARMINGTON	MO	63640	8889264988		2	1701	1799	1741	2	1682	2	3	0	C	0	False	233	68069	PO BOX 3060 HEALTHNET MCR HEALTH NET MCR FARMINGTON MO 63640	9/2/2021 3:38:28 PM	gaia-michael	2/24/2026 2:49:31 PM	gaia-Lydia	10/1/2015 12:00:00 AM	2/24/2026 2:49:31 PM	False
C	21	False	KAISER MCR OF SOUTHERN CA	KAISER MCR OF SOUTHERN CA	PO BOX 7004		DOWNEY	CA	90242	8003903510		2	1701	1799	1741	2	1682	2	3	0	C			233	21	PO BOX 7004 KAISER MCR OF SOUTHERN CA KAISER MCR OF SOUTHERN CA DOWNEY CA 90242	10/4/2021 7:28:42 AM	gaia-michael	3/25/2026 11:37:10 AM	gaia-wendy	10/1/2015 12:00:00 AM	3/25/2026 11:37:10 AM	False
C	1024	False	AETNA MCR ADVANTAGE	AETNA MCR ADVANTAGE	PO BOX 981106		El Paso	TX	79998-1106	8006240758	8886323862	2	1701	1799	1741	2	1682	2	3	0	C	0	False	233	1024	PO BOX 981106 AETNA MCR ADVANTAGE AETNA MCR ADVANTAGE EL PASO TX 79998-1106	6/13/2022 8:27:58 AM	gaia-amanda	3/31/2025 8:30:49 AM	gaia-nina	10/1/2015 12:00:00 AM	3/31/2025 8:30:49 AM	False
C	1026	False	UHC MCR NEVADA	UHC MCR NEVADA	PO BOX 95638		LAS VEGAS	NV	89193	8778423210		2	1701	1799	1741	2	1682	2	3	0	C	0	False	233	1026	PO BOX 95638 UHC MCR NEVADA UHC MCR NEVADA LAS VEGAS NV 89193	9/19/2022 8:37:26 AM	gaia-amanda	5/31/2023 11:35:34 AM	gaia-cary	10/1/2015 12:00:00 AM	5/31/2023 11:35:34 AM	False
C	2032	False	HUMANA MCR	HUMANA MCR	PO BOX 14601		Lexington	KY	40512	8004574708		2	1701	1799	1741	2	1682	2	3		C			233	2032	PO BOX 14601 HUMANA MCR HUMANA MCR LEXINGTON KY 40512	4/10/2023 8:42:41 AM	gaia-amanda	4/10/2023 8:42:41 AM	gaia-amanda	10/1/2015 12:00:00 AM	4/10/2023 8:42:41 AM	False
A	2045	False	Triwest VA Community Care	Triwest VA Community Care	Triwest VA Community Care	P.O. 108851	Florence	SC	29502-8851	8778817618		6	1704	95	1742	2	1682	2	2	0	A			233	TWVACCN	TRIWEST VA COMMUNITY CARE P.O. 108851 TRIWEST VA COMMUNITY CARE TRIWEST VA COMMUNITY CARE FLORENCE SC 29502-8851	5/8/2026 8:09:55 AM	gaia-Lydia	5/8/2026 8:09:55 AM	gaia-Lydia	10/1/2015 12:00:00 AM	5/8/2026 8:09:56 AM

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Ledger	InsuranceCarriersId	Inactive	Name	ListName	Address1	City	State	Zip	Phone1	Phone2	InsuranceGroupId	CollectionsGroupMId	CarrierTypeMId	FinancialClassMId	AllocationSetId	FilingMethodMId	FilingType	TransactionColumnSetId	IncludeClaimOfficeNo	Ledger1	RequiresAuth	ReferenceCarrier	AcceptAssignmentMId	DotId	Keyword	Created	CreatedBy	LastModified	LastModifiedBy	ICD10SERVICEDATE	InsSOP_db_Updated_Date	AUC
C	3	False	MEDICARE A & B INDIANA WPS	MEDICARE A & B INDIANA WPS	PO BOX 8805	MARION	IL	62959	8665183285		1	1701	1799	1738	2	1682	2	3	0	C	0	False	233	3	PO BOX 8805 MEDICARE A & B INDIANA WPS MEDICARE A & B INDIANA WPS MARION IL 62959	3/22/2021 8:25:55 AM	superuser	5/13/2026 11:16:24 AM	gaia-melisha	10/1/2015 12:00:00 AM	5/13/2026 11:16:24 AM	False
C	7	False	PENDING INSURANCE	PENDING INSURANCE	DO NOT BILL						4	1701	80	1743	2	0	0	2		C			233	7	DO NOT BILL PENDING INSURANCE PENDING INSURANCE	3/22/2021 8:33:37 AM	superuser	4/28/2025 9:14:18 AM	gaia-cary	10/1/2015 12:00:00 AM	4/28/2025 9:14:18 AM	False
C T	9	False	MEDICARE ACUTE	MEDICARE ACUTE							1	1701	1799	1738	2	1682	2	3		C T			233	9	MEDICARE ACUTE MEDICARE ACUTE	4/5/2021 8:30:41 AM	gaia-jennifer	4/30/2026 10:17:17 AM	gaia-melisha	10/1/2015 12:00:00 AM	4/30/2026 10:17:17 AM	False
C T	1017	False	MEDICARE PART A ONLY INDIANA	MEDICARE PART A ONLY INDIANA	PO BOX 8805	MARION	IL	62959	8662347331	8775677201	1	1701	1799	1738	2	1682	2	3		C T			233	1017	PO BOX 8805 MEDICARE PART A ONLY INDIANA MEDICARE PART A ONLY INDIANA MARION IL 62959	5/2/2022 8:03:49 AM	gaia-amanda	4/30/2026 10:17:24 AM	gaia-melisha	10/1/2015 12:00:00 AM	4/30/2026 10:17:24 AM	False
C	4033	False	MEDICARE A & B KENTUCKY CGS	MEDICARE A & B KENTUCKY CGS	PO BOX 20010	NASHVILLE	TN	37202	8662896501	8665906703	1	1701	1799	1738	2	1682	2	3	0	C			233	4033	PO BOX 20010 MEDICARE A & B KENTUCKY CGS MEDICARE A & B KENTUCKY CGS NASHVILLE TN 37202	10/7/2024 9:12:33 AM	gaia-jennifer	6/16/2026 9:57:10 AM	gaia-sandy	10/1/2015 12:00:00 AM	6/16/2026 9:57:10 AM	False
C	4035	False	MEDICARE A & B OHIO CGS	MEDICARE A & B OHIO CGS	PO Box 20211	NASHVILLE	TN	37202	8665906703		1	1701	1799	1738	2	1682	2	3	0	C		False	233	15201	PO BOX 20211 MEDICARE A & B OHIO CGS MEDICARE A & B OHIO CGS NASHVILLE TN 37202	12/2/2024 10:23:04 AM	gaia-nina	5/13/2026 11:16:37 AM	gaia-melisha	10/1/2015 12:00:00 AM	5/13/2026 11:16:37 AM
C	4051	False	SELF PAY	SELF PAY							4	1701	91	1743	2	0	0	3	0	C			233	0123456789	SELF PAY SELF PAY	3/3/2025 3:24:16 PM	gaia-nina	4/1/2025 7:21:54 AM	gaia-cary	10/1/2015 12:00:00 AM	4/1/2025 7:21:54 AM

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Ledger	InsuranceCarriersId	Inactive	Name	ListName	Address1	City	State	Zip	Phone1	Phone1Type	Phone2	Phone2Type	InsuranceGroupId	CollectionsGroupMId	CarrierTypeMId	FinancialClassMId	AllocationSetId	FilingMethodMId	FilingType	TransactionColumnSetId	IncludeClaimOfficeNo	Ledger1	Notes	RequiresAuth	ReferenceCarrier	AcceptAssignmentMId	DotId	PartnerInsuranceCarriersId	Keyword	Created	CreatedBy	LastModified	LastModifiedBy	ICD10SERVICEDATE	InsSOP_db_Updated_Date	AUC
C	1	False	MEDICARE PART A	MEDICARE PART A	PO BOX 2711	Jacksonville	FL	32211	8776028816				1	1701	1799	1738	2	1682	2	3	0	C				233	1		PO BOX 2711 MEDICARE PART A MEDICARE PART A JACKSONVILLE FL 32211	2/22/2010 10:05:52 AM	cammy	5/13/2026 11:25:15 AM	gaia-michellem	10/1/2015 12:00:00 AM	5/13/2026 11:25:15 AM	False
C	7	False	SELF PAY	SELF PAY									4	1701	91	1743	2	0	0	2	0	C		0	False	233	7		SELF PAY SELF PAY	3/4/2016 8:52:18 AM	gaia-jennifer	5/5/2025 3:27:55 PM	gaia-cary	10/1/2015 12:00:00 AM	5/5/2025 3:27:55 PM	False
C	8	False	PENDING INSURANCE	PENDING INSURANCE									4	1701	80	1743	2	0	0	2	0	C		0	False	233	8		PENDING INSURANCE PENDING INSURANCE	3/4/2016 8:52:55 AM	gaia-jennifer	4/28/2025 9:16:03 AM	gaia-cary	10/1/2015 12:00:00 AM	4/28/2025 9:16:03 AM	False
C	9	False	Humana MCR	Humana MCR	PO BOX 14601	Lexington	KY	40512	8004486262				1	1701	1799	1741	2	1682	2	3	0	C		0	False	233	61101		PO BOX 14601 HUMANA MCR HUMANA MCR LEXINGTON KY 40512	3/7/2016 6:54:09 AM	gaia-brenda	2/6/2026 3:36:38 PM	gaia-Lydia	10/1/2015 12:00:00 AM	2/6/2026 3:36:38 PM	False
C	15	False	UHC MCR	UHC MCR	P O Box 5230	Kingston	NY	12402	8778423210				1	1701	1799	1741	2	1682	2	2	0	C		0	False	233	15		P O BOX 5230 UHC MCR UHC MCR KINGSTON NY 12402	1/12/2017 2:28:00 PM	gaia-renee	4/7/2026 3:30:01 PM	gaia-Lydia	10/1/2015 12:00:00 AM	4/7/2026 3:30:01 PM	False
C	16	False	MEDICARE ACUTE	MEDICARE ACUTE	PO BOX 2711	Jacksonville	FL	32211	8776028816		8886644112		1	1701	1799	1746	2	1682	2	3	0	C		0		233	16		PO BOX 2711 MEDICARE ACUTE MEDICARE ACUTE JACKSONVILLE FL 32211	2/1/2017 10:19:54 AM	gaia-jennifer	5/31/2023 2:14:34 PM	gaia-renee2	10/1/2015 12:00:00 AM	5/31/2023 2:14:33 PM	False
C	17	False	CarePlus MCR Advantage HMO	CarePlus MCR Advantage HMO	P O Box 14697	Lexington	KY	40512	8662205448				1	1701	1799	1741	2	1682	2	3	0	C		-1	False	233	17		P O BOX 14697 CAREPLUS MCR ADVANTAGE HMO CAREPLUS MCR ADVANTAGE HMO LEXINGTON KY 40512	2/9/2017 9:45:01 AM	gaia-renee	5/31/2023 2:07:30 PM	gaia-renee2	10/1/2015 12:00:00 AM	5/31/2023 2:07:30 PM	False
C	18	False	AARP Member Advantages/UHC	AARP Member Advantages/UHC	P O BOX 740819	Atlanta	GA	30374-0819	8005235800				1	1701	1799	1738	2	1682	2	3	0	C		0	False	233	18		P O BOX 740819 AARP MEMBER ADVANTAGES/UHC AARP MEMBER ADVANTAGES/UHC ATLANTA GA 30374-0819	2/21/2017 9:34:35 AM	gaia-renee	3/16/2026 11:54:16 AM	gaia-michellem	10/1/2015 12:00:00 AM	3/16/2026 11:54:16 AM	False
C	24	False	Molina Marketplace MCR	Molina Marketplace MCR	P O Box 22812	Long Beach	CA	90801	8555421973				1	1701	1799	1741	2	1682	2	3	0	C		0	False	233	24		P O BOX 22812 MOLINA MARKETPLACE MCR MOLINA MARKETPLACE MCR LONG BEACH CA 90801	10/3/2017 2:46:34 PM	gaia-renee	3/31/2025 9:04:58 AM	gaia-nina	10/1/2015 12:00:00 AM	3/31/2025 9:04:58 AM	False
C	27	False	MCR HPHC Insurance (Harvard Pilgrim Health Care)	MCR HPHC Insurance (Harvard Pilgrim Health Care)	93 Worcester Street	Wellesley	MA	02481	8007084414		8886090692		1	1701	1799	1738	2	1682	1	3	0	C	MCR enhance	0	False	233	27	1	93 WORCESTER STREET MCR HPHC INSURANCE (HARVARD PILGRIM HEALTH CARE) MCR HPHC INSURANCE (HARVARD PILGRIM HEALTH CARE) WELLESLEY MA 02481	1/30/2018 11:56:08 AM	gaia-renee	9/17/2022 12:50:54 PM	gaia-amanda	10/1/2015 12:00:00 AM	9/17/2022 12:50:55 PM	False
C	32	False	Independant Health Benefits Corp	Independant Health Benefits Corp	Po Box 9066	Buffalo	NY	14231	8007365771				1	1701	1799	1738	2	1682	2	3	0	C		0	False	233	32		PO BOX 9066 INDEPENDANT HEALTH BENEFITS CORP INDEPENDANT HEALTH BENEFITS CORP BUFFALO NY 14231	3/12/2018 8:08:26 AM	gaia-brenda	5/31/2023 2:12:13 PM	gaia-renee2	10/1/2015 12:00:00 AM	5/31/2023 2:12:13 PM	False
C	33	False	Aetna MCR Advantage	Aetna MCR Advantage	P O BOX 14079	Lexington	KY	40512-4079	8006240756				1	1701	1799	1741	2	1682	2	3	0	C		0	False	233	33		P O BOX 14079 AETNA MCR ADVANTAGE AETNA MCR ADVANTAGE LEXINGTON KY 40512-4079	3/26/2018 1:18:05 PM	gaia-renee	5/31/2023 2:05:21 PM	gaia-renee2	10/1/2015 12:00:00 AM	5/31/2023 2:05:21 PM	False
C	38	False	Harvard Pilgram Health Care (HPHC)	Harvard Pilgram Health Care (HPHC)	P. O. BOX 699183	Quincy	MA	02269	8007084414				1	1701	1799	1738	2	1682	2	3	0	C	Payer ID#04271			233	38		P. O. BOX 699183 HARVARD PILGRAM HEALTH CARE (HPHC) HARVARD PILGRAM HEALTH CARE (HPHC) QUINCY MA 02269	4/10/2018 11:19:07 AM	gaia-renee	5/31/2023 2:10:47 PM	gaia-renee2	10/1/2015 12:00:00 AM	5/31/2023 2:10:46 PM	False
C	41	False	Emblem Health MCR HMO	Emblem Health MCR HMO	P O BOX 2803	New York	NY	10116	8006242414				1	1701	1799	1738	2	1682	2	3	0	C		0	False	233	41		P O BOX 2803 EMBLEM HEALTH MCR HMO EMBLEM HEALTH MCR HMO NEW YORK NY 10116	5/1/2018 7:13:31 AM	gaia-renee	5/31/2023 2:08:49 PM	gaia-renee2	10/1/2015 12:00:00 AM	5/31/2023 2:08:49 PM	False
C	56	False	UHC PCP MCR HMO	UHC PCP MCR HMO	PO Box 30448	Salt Lake City	UT	84130	8667259334				1	1701	1799	1741	2	1682	2	2	0	C		0	False	233	56		PO BOX 30448 UHC PCP MCR HMO UHC PCP MCR HMO SALT LAKE CITY UT 84130	5/20/2019 8:27:12 AM	gaia-michael	4/16/2026 3:05:14 PM	gaia-Lydia	10/1/2015 12:00:00 AM	4/16/2026 3:05:14 PM	False
C	66	False	WELLCARE MCR HMO	WELLCARE MCR HMO	PO BOX 31372	TAMPA	FL	33631	8002780656				1	1701	1799	1741	2	1682	2	3	0	C		0	False	233	66		PO BOX 31372 WELLCARE MCR HMO WELLCARE MCR HMO TAMPA FL 33631	4/8/2021 10:41:03 AM	gaia-michael	5/31/2023 2:20:01 PM	gaia-renee2	10/1/2015 12:00:00 AM	5/31/2023 2:20:01 PM	False
C	67	False	SUNSHINE / WELLCARE MCR	SUNSHINE / WELLCARE MCR	PO BOX 31372	TAMPA	FL	33631	8002780656				1	1701	1799	1741	2	1682	2	3		C				233	67		PO BOX 31372 SUNSHINE / WELLCARE MCR SUNSHINE / WELLCARE MCR TAMPA FL 33631	6/17/2021 1:29:10 PM	gaia-michael	3/31/2025 9:07:13 AM	gaia-nina	10/1/2015 12:00:00 AM	3/31/2025 9:07:13 AM	False
C	69	False	Captial District Physician Health Plan	CDPHP MCR	PO BOX 66602	Albany	NY	12206	8009267526				1	1701	1799	1738	2	1682	2	3	0	C		0	False	233	69		PO BOX 66602 CDPHP MCR CAPTIAL DISTRICT PHYSICIAN HEALTH PLAN ALBANY NY 12206	2/14/2022 12:42:23 PM	gaia-amanda	5/31/2023 2:07:42 PM	gaia-renee2	10/1/2015 12:00:00 AM	5/31/2023 2:07:42 PM	False
C	70	False	MEDICARE PART A&B	MEDICARE PART A&B	PO BOX 2711	Jacksonville	FL	32211	8776028816	IVR	8886644112	REP	1	1701	1799	1738	2	1682	2	3		C				233	70		PO BOX 2711 MEDICARE PART A&B MEDICARE PART A&B JACKSONVILLE FL 32211	5/2/2022 8:26:47 AM	gaia-amanda	5/13/2026 11:25:19 AM	gaia-michellem	10/1/2015 12:00:00 AM	5/13/2026 11:25:19 AM	False
C	75	False	UHC AARP MCR	UHC AARP MCR	PO BOX 31362	Salt Lake City	UT	84131-0362	8778423120				1	1701	1799	1741	2	1682	2	3	0	C		0	False	233	75		PO BOX 31362 UHC AARP MCR UHC AARP MCR SALT LAKE CITY UT 84131-0362	12/19/2022 8:59:10 AM	gaia-amanda	5/31/2023 2:18:17 PM	gaia-renee2	10/1/2015 12:00:00 AM	5/31/2023 2:18:17 PM	False
C	77	False	HEALTH NET MCR SUPPLEMENT	HEALTH NET MCR SUPPLEMENT	PO BOX 9040	Farmington	MO	63640					5	1703	104	1744	2	1682	2	2	0	C			False	233	77		PO BOX 9040 HEALTH NET MCR SUPPLEMENT HEALTH NET MCR SUPPLEMENT FARMINGTON MO 63640	3/13/2023 7:30:23 AM	gaia-amanda	5/31/2023 2:11:08 PM	gaia-renee2	10/1/2015 12:00:00 AM	5/31/2023 2:11:07 PM	False
C	1082	False	SANUS HEALTH CORP - UHC - CM	SANUS HEALTH CORP - UHC - CM	Po Box 30526	Salt Lake City	UT	84130	3055729756				5	1703	104	1744	2	1682	2	2	0	C	09/09/2024 Per Email from Facility confirmed Sanus is with UHC: updated EDI and Claims Address based on info received	0		233	1082		PO BOX 30526 SANUS HEALTH CORP - UHC - CM SANUS HEALTH CORP - UHC - CM SALT LAKE CITY UT 84130	12/19/2023 7:12:30 AM	gaia-amanda	9/9/2024 9:01:12 AM	gaia-nina	10/1/2015 12:00:00 AM	9/9/2024 9:01:12 AM	False
C	1086	False	Healthsun MCR	Healthsun MCR	PO Box 211154	Eagan	MN	55121	8779997776				1	1701	1799	1741	2	1682	2	3	0	C				233	7123		PO BOX 211154 HEALTHSUN MCR HEALTHSUN MCR EAGAN MN 55121	5/30/2024 8:14:03 AM	gaia-nina	5/30/2024 8:18:20 AM	gaia-nina	10/1/2015 12:00:00 AM	5/30/2024 8:18:20 AM	False

Download as Spreadsheet

Ledger	InsuranceCarriersId	Inactive	Name	ListName	Address1	City	State	Zip	Phone1	InsuranceGroupId	CollectionsGroupMId	CarrierTypeMId	FinancialClassMId	AllocationSetId	FilingMethodMId	FilingType	TransactionColumnSetId	PolicyTypeMId	Ledger1	AlertNotes	RequiresAuth	ReferenceCarrier	AcceptAssignmentMId	DotId	Keyword	Created	CreatedBy	LastModified	LastModifiedBy	ICD10SERVICEDATE	InsSOP_db_Updated_Date	AUC
C	1	False	SELF PAY	SELF PAY						7	1701	91	1743	2	0	0	3		C				233	1	SELF PAY SELF PAY	2/22/2010 10:05:52 AM	cammy	7/10/2025 12:04:56 PM	gaia-wendy	10/1/2014 12:00:00 AM	7/10/2025 12:04:56 PM	False
C	3	False	MEDICARE A&B	MEDICARE A&B	PO Box 660155	Dallas	TX	75266	8552528782	1	1701	1799	1738	2	1682	2	3	116	C		0	False	233	3	PO BOX 660155 MEDICARE A&B MEDICARE A&B DALLAS TX 75266	8/23/2022 3:28:21 PM	gaia-bruce	5/13/2026 11:31:31 AM	gaia-michellem	10/1/2015 12:00:00 AM	5/13/2026 11:31:31 AM	False
C	6	False	HUMANA MCR	HUMANA MCR	PO BOX 14601	LEXINGTON	KY	40512	8004574708	2	1701	1799	1741	2	1682	2	3		C				233	6	PO BOX 14601 HUMANA MCR HUMANA MCR LEXINGTON KY 40512	12/7/2023 9:40:25 AM	gaia-lio	3/6/2024 11:38:44 AM	gaia-Tricia	10/1/2015 12:00:00 AM	3/6/2024 11:38:44 AM	False
C	10	False	PENDING INSURANCE	PENDING INSURANCE	DO NOT BILL	LITTTLETON	CO	80120		7	1701	80	1743	2	0	0	2		C		0		233	10	DO NOT BILL PENDING INSURANCE PENDING INSURANCE LITTTLETON CO 80120	12/8/2023 9:49:47 AM	gaia-amanda	4/28/2025 9:17:16 AM	gaia-cary	10/1/2015 12:00:00 AM	4/28/2025 9:17:16 AM	False
C	11	False	BCBSTX MCR	BCBSTX MCR	PO Box 3686	SCRANTON	PA	18505	8777748592	2	1701	1799	1741	2	1682	2	3		C				233	11	PO BOX 3686 BCBSTX MCR BCBSTX MCR SCRANTON PA 18505	12/8/2023 11:30:03 AM	gaia-amanda	5/13/2026 11:56:12 AM	gaia-michellem	10/1/2015 12:00:00 AM	5/13/2026 11:56:12 AM	False
C	12	False	SUPERIOR HEALTH MCR	SUPERIOR HEALTH MCR	PO BOX 3060	FARMINGTON	MO	63640	8773915921	2	1701	1799	1741	2	1682	2	3		C		0		233	12	PO BOX 3060 SUPERIOR HEALTH MCR SUPERIOR HEALTH MCR FARMINGTON MO 63640	12/8/2023 11:58:36 AM	gaia-amanda	12/8/2023 12:02:08 PM	gaia-amanda	10/1/2015 12:00:00 AM	12/8/2023 12:02:04 PM	False
C	40	False	Charity	Charity						7	1701	91	1743	2	0	0	2		C	No Statement. Facility Responsiblity			233	123	CHARITY CHARITY	5/7/2026 3:37:56 PM	gaia-Lydia	5/7/2026 3:37:56 PM	gaia-Lydia	10/1/2015 12:00:00 AM	5/7/2026 3:37:56 PM

Download as Spreadsheet

Ins Carriers with a value in the ledger field

AdvancedRCF Dialysis (a693012b-99cd-4a3c-b4dc-08dc54bb5f48) Table1: 3 Rows

Americare Dialysis EMR (f74d6529-601d-4e1e-6754-08dba26a1012) Table1: 7 Rows

Angelo Kidney Center (36941535-e64f-403c-0dc8-08dd3c98ba6f) Table1: 19 Rows

aQua (1862fb48-6054-4ad4-8145-08d8776b3a0f) Table1: 3 Rows

ARC Bonita Springs (b41a0c5f-0af0-4869-f777-08db19d9c0c8) Table1: 7 Rows

ARC Kendall (afa2ad5c-8cef-4880-9d20-08da85e019eb) Table1: 4 Rows

ARC Labelle (d20c9b68-1664-438a-0d29-08dc121992fa) Table1: 9 Rows

ARC Perrine (273801e4-7d22-437e-a14b-08d876a5b044) Table1: 6 Rows

Best Care Dialysis (27176e7a-558e-4c25-adc5-08ddbd8ff65c) Table1: 9 Rows

Blank athenaPractice DB - DO NOT USE (0aa758e0-0702-40db-a7e4-08db2a406987) Table1: 2 Rows

Branson Dialysis EMR (f33bacc1-b307-464e-6f2f-08d8b0c770ca) Table1: 0 Rows

Care Dialysis Center (8640602f-3bf7-4950-d149-08d998b2f1b6) Table1: 14 Rows

CarlTCurtis (66b31fe9-5d9a-4068-4550-08d87e7bf81e) Table1: 10 Rows

Coastal Dialysis Center (074076c6-f15d-42c0-d4b0-08db951c9a67) Table1: 5 Rows

Comfort Care Dialysis (ec18e579-4f7d-4202-e7f8-08da7a42619d) Table1: 6 Rows

Commonwealth Healthcare (2a33d3ab-2225-45e8-3156-08d8789a8ade) Table1: 12 Rows

Crown Dialysis (c18c20e6-eec6-418e-2231-08d8858de233) Table1: 0 Rows

Deer's Head (58756bc7-9cd0-41d3-cf53-08d8a29f497e) Table1: 1 Rows

Deer's Head 3rd party (ff4f330f-a1b8-4b33-814d-08de15669f96) Table1: 2 Rows

Dialysis Care Centers (DCC) (5312bd25-bda3-4a83-222f-08d8858de233) Table1: 250 Rows

DonateEMR (f6285762-dafb-4494-77e1-08d86f27ae90) Table1: 15 Rows

Dr. Dialysis (1b7027e6-b9d1-42a0-4476-08dd45ffa43e) Table1: 2 Rows

EMR_Sales_DEMO (373364dd-e16d-47d2-c038-08d84de4713f) Table1: 9 Rows

Excel EHR (2ef58f5b-2d86-42c0-3155-08d8789a8ade) Table1: 3 Rows

First Class EHR (933b8f4d-ecef-4944-94cf-08d872a3124b) Table1: 5 Rows

FirstPreventionEMR (c2b7280a-6e82-4812-ba78-08d8705e1c26) Table1: 9 Rows

Freedom Dialysis (30c2ff40-79cd-412a-104a-08d940bc5adf) Table1: 1 Rows

Fusion Dialysis (abec871f-f968-4168-f74c-08ddeee30e2f) Table1: 2 Rows

Future Care EHR (9d0ab8d1-a403-48fc-c7a7-08d883e8bbea) Table1: 13 Rows

Great Lakes (GLD) (ae3acf20-301a-439c-3154-08d8789a8ade) Table1: 24 Rows

Hope Dialysis Center (85c1caab-876f-421d-94d0-08d872a3124b) Table1: 19 Rows

IDS (60011796-ca44-4873-c537-08dd6ba343bd) Table1: 2 Rows

Integra (cd068fce-6a8d-4eb3-2232-08d8858de233) Table1: 10 Rows

Kendall Kidney (3983a5de-668a-4380-d035-08dda9235498) Table1: 3 Rows

Kidney Spa (659e2bd7-0094-4a20-3df8-08d89c50c9d1) Table1: 20 Rows

Kidney Treatment Center of South Florida (KTCSF) (a47967d5-65c8-40fc-2234-08d8858de233) Table1: 2 Rows

KRT (eaf75ef8-0da3-4b29-77e2-08d86f27ae90)

Lakes Dialysis (f622a83e-1ab3-4c9f-73ad-08d88a75657b) Table1: 21 Rows

LeJeune (29be149f-c91b-41d9-3e33-08d9fc91faf1) Table1: 6 Rows

Lifeline Renal Care (d2902741-ea2f-4ec8-7075-08daad3534fa) Table1: 2 Rows

Lincoln (DCL) (0439ec08-3196-4cc9-efd6-08d83fda1c24) Table1: 14 Rows

Luxury (Five Star) (c30a3605-1fa0-4728-dbee-08d86feefd9e) Table1: 18 Rows

Maple Avenue Kidney Center (301d5606-8914-4a5a-25f3-08d8b35f16aa)

Martin Luther King Dialysis (88eb5376-86ec-4af3-dbef-08d86feefd9e) Table1: 21 Rows

Midtown Dialysis (52c6be77-f6ae-43ac-ec57-08db30964195) Table1: 6 Rows

NephronEHR (1d2091b0-4b33-40f2-f3cb-08d85a5a85c1) Table1: 11 Rows

New Life (db86d042-1574-4750-921b-08dcb87bdf88) Table1: 3 Rows

NewStart (dd454507-24d3-4169-dbed-08d86feefd9e) Table1: 26 Rows

Nueva Vida (ad6f0232-6b67-41a5-7433-08ddc608c717) Table1: 3 Rows

Nulife Dialysis (ba77b60b-7950-4b75-dbf0-08d86feefd9e) Table1: 29 Rows

PDA (5d5c99cc-85e4-403d-5ba3-08dcf90bf65b) Table1: 9 Rows

PPG Health (72e94f8a-3c94-4895-6f11-08d86640f9ff) Table1: 23 Rows

Professional (Gaia Hosted) (8f4eb36d-cf6c-487f-34a3-08db66939a80) Table1: 21 Rows

Saipan Renal Care (4958275d-c868-4723-d7b5-08d8e1165e60) Table1: 3 Rows

Santee Dialysis Center (62aa7bba-39ad-41ae-c253-08dbc508d3f6) Table1: 3 Rows

SDA Dialysis (cc20b80a-dfbe-42b2-65b7-08d984f98bf6) Table1: 4 Rows

Shifa Dialysis (52109bbc-d2f7-488b-dbf1-08d86feefd9e) Table1: 14 Rows

South Belt (791f5d6f-d752-4bd0-1a75-08d8ece3b5e5) Table1: 11 Rows

South Florida Dialysis Center (dfcd4f31-b435-4cb8-dbf2-08d86feefd9e) Table1: 24 Rows

Sugarland PD (formerly KSpa) (26b1a0e5-5f2e-48a1-c538-08dd6ba343bd) Table1: 3 Rows

Toiyabe (3a094585-cd64-44a3-9692-08d8d8392eb3) Table1: 12 Rows

Trilogy Healthcare (6efcc6bd-c990-48a1-69be-08d8a0685a5b) Table1: 7 Rows

United Dialysis EMR (87bc6345-8ce1-4ee9-73ae-08d88a75657b) Table1: 23 Rows

Universal Dialysis (200dbcec-b77d-49c1-decc-08db86d8ad06) Table1: 7 Rows

Villa Park (afc6b949-a74e-44e7-2238-08d8858de233)