ORDER No. 20288 APPROVAL TO PAY INDIGENT HEALTH CARE BILLS TO VARIOUS PROVIDERS On this the 10th day Commissioner Morgan, C.ommissioner's Morgan, Commissioner Holekamp Indigent Health Care 512, 149.04 to various vote of 3-0-1. of June 1991, upon motion made by seconded by Commissioner Oehler, with Oehler and Lackey voting "AYE", and "ABSTAINING" said motion to pay gills in the amounts of 5929.34 and providers was approved by a majority „~ i ~ ' O _ i--. ,- ~~ ^ ~, ` 1 r~ .1 i ~ 4; (' ' \ G] !~ ..___ - ._-.-. ._ `J~ 1 T.P.A. r- D A T E: 0 5/ 10 / 91 U' A I L Y C H E C X p c G I S TER b y u P G U P ~ ref^aY '!.AY 1D~ 1)41 P P G E: 4 rEGI~~:, rUNL~- 123 CHICK CnEC!: r!unnEk ---------- DATE CLaI~+ NG S^C SEC ----- -°= ======= ~y0 Er~l]YEE CL~[ ia,fT ~aY T~) CHECK Ayf.UNT - - --~-=='a-. ~=- -=cr..ooo. .'O'"°-'-'"O p=°c -..c cc o.°°'O'-" "=""'°O°-°°°°°"_==-°'O.O• ••"'°'-O==s oer.e--=- .. fur~J: THX-u~24 SECUP: TP>,-7024 Kc~4 C9~"TY 1311 OS/lu/91 ~a'IUAL OTyER YD1~ 00 1312 05110/~1 L!',c GP =* Y O [ D CHECK ** . I3I3 OS/IJ!';1__~-_ _ - ----------~--- _ _ ~;F'iu~L OT4ER - __ VGI~J .....----- ----- .00 00 1514 J5/1G/91 LIVE UP ** Y O i D CHECK*r . GO 1315 US/10/91 VOUGiEk PAYi+EI,T SOUTHUEST TEXAS PATHOLOGY . 99 156 131G OS/lU/~1 V~UCHE7 PAY°EHT- -NALC-MD: HICHAEL- . _ 23 00 -- - - - '- --- 1317 Ji/10!91 Yot,CHEC pAyHE>,T ANESTHESIA ASSOCIATES . 1@1 G0 1310 V5l1G/71 V~IOCNER PAY:~E>,T PARTLY PRACTICE ASSOCIATE . 25 75 1319 u5/lu/~~1- ------ --------.---- - --- _ Yr,UC'ILR ^,+,ryc~~T y E 3 PHARMACY ;08Q - . 263 25 '?~hC Y~ 1 JaC. ECKEPD COR . 15 5 1.;21 ~.ii:/>1 v~.uC ir.~: aAYYEi~I SHAV Y0. HIL7011 ~ , 99 211 1522 US/IC/;1 -__._..-------------__.- -._-- --...------._-__-, - V~,i;C't° P1,Y°S;+T U~CLDGY-ASSOC KE3pYILLE . 41.70 ...__~- -- 929.34 ~ ~ r T. P. E, lHC. F. 45/14/91 PROUIDFR UOUCHFR tISTIH6 PAGE 1 74-2183183 SOUTHAEST TE%AS PATHOt06V :-0424 KERR COUl31Y PATIEHi CIRIM I1lCURREA COUEREA TOiAt CLAI1fAHT DEP. H0. tti). fR4lt TO CHARGE PAID ~EFIY F 90480693 9444362841 01/14/91 41/13191 284.16 1bb.99 GfiOUP TOTAL: 284.1b 1bb.99 PROVIDER 101AL~ 2$Q.Tb tbb.99 T. P. IMC. 1TF 45/14/91 PROUIDIR VOUCHER IISTIN6 PAGE 1 19-2185835 {CALL AD, lIICKAEL 'R-4U24 KFkR COil11T41 . PATIENT CIAIfI INCURRED COUEREO tOTn! CLAIIIAt{T DEP. K0. i{O. FRO1! TO CNAR6E PAID KFLLFR F 94442193?4 U1131/91 44!1$191 26.46 ?3.00 GROUP TOTRL: 2b.04 23.00 PROVIDER TOTAI: 26.4D 23.00 T. P. R.. ANC. E~05/10/91 PROVIDER VOUCHER LISTI~f6 PR6E 1 ' 74-2878288 ANESTHESIA ASSOCIATES •8429 KERB CO~ft1TY ' PATIENT CLARE INCURREI} COVERED TOTRI CLAIttAHT DEP. N0. NO. TR0i4 TO CHAR&E PAID ss-.saze::zxtssso=-.sse:saeoeat==--osa~aea=__s..cceocc~;=eo.as .a.ezn.._=e-:=.e=~:_ 8L6REN E 4000336586 01/15/91 81/15/91 528.06 181.00 6R4UP TOTAL: 520.OD 181.OD PROVIDER tOTRI: 528.86 181.84 ~, . ... r. T. P. INC. r.. T~ 05/10!41 PROVIDER VOUCHER LISTING PAGE 1 74-1417555 FANILSI PRACTICE ASSOCIA[E X-bbf4 i~RR Cbi}ifTY PATIENT CLAIA INCURRED COVERED TOTAL CLAIffAHT DEP. N0. k0. FROit TO CHARSE PAID PFEBIES , E 2477$ 9000321306 43125191 03/25/41 75.04 25.15 SROUP TOiAL~ 1S.OD 25.15 PROVIDER TOTAL: 75.0D 25.75 is ~ n f 7~ ~ T. P. ,.., IMC. TE 05/10/41 PROVIDER 1l000NE R LISTING PAGE 1 74-0537i 15f N E B PNARMACY #089 • x-aa2a lCERR cou~r~ PATIENT CLAIM INCURRED COVERED TOTAL CLAiMAHT DEP. M0. N0. FROt4 TO CNAR£E PAID BIAS E 9000300610 02/19191 03/01/91 14.09 14.04 BURROA E b21478b 9000220709 03/04/91 03/04141 22.43 22.43 MHRRIS E 9404~b2747 42/1Sl91 02/15191 1b.31 16.3! MAU6NAN E 944147 9440324101 42111191 02/21!91 4).59 41.54 MARSCNALL E 91003 900033720b 02/24/41 02/21/91 1$.23 18.?3 QRTIZ f $84438 9444718549 42/13191 42113191 24.98 24.48 VANGE E 62125140 9000361905 03/05191 03/05/91 8.96 8.9b UANCF E $900ti5 9000361906 0?112/91 03/05191 43.58 43.58 11ATS4M E 9444302511 OT12?191 43/01/91 Zt.tl 21.17 . YARBOROU6H E 8744b7 9000229832 42/1?191 42!20!91 46.01 4b. 01 &ROUP IOTAt: 2b3.25 263.25 PROVIDER ?4TAl: 263.25 263.25 ~~ i~$ ' ~ ~;`~ ~ i, ,, 1. P.... , iHG. ATE 05/10/91 PROVIDER VOUCHER LISTING PAGE 1 59-1370018E JNCK ECHFRD COR PX-0024 t(EftR COIIHTY PAIIEHT GLAIR iHCURRFD COVFRFD T01RL CLAItlRHT DEP. H0. N0. FRO11 i0 CHARGE PAID DRISCOLL E 008206 ~ X00022051$ Oi110/91 OJlO1/91 15.58 15.58 6ROEIF TOTAI: 15.56 15.58 PROVIDER TOTAL 15.58 t5.58 T. P. INC. ;1T.E OS/10/9t PROUIDFR UOUCNfR LISTING PAGE 1 14-2397281 SNA{t tlD, HILTON D ?X-4024 f(ERR COUN14 PATIENT CLAIA INCURRED COUEREO TOTAL CLAIlfANT DEP. N0. H0. FROlI TO CNAR6E PAID ------------------------------------------------------------------------------------ DUNCnN f 172730 9080374703 x2118191 02124141 225.OD 211.99 GROUP TOTAL: 225.04 211.99 PRfNIDfR TOTAL: 225.OD 211.99 ,~ ,, ;',' t, „ ~ ~. ~ i [, P.. INC. AiE 05/10/91 PROVIDER VOUCHER IISTIN6 PA6f 1 14-i698i37 UROLOSY ASSOC KERRVILLE PX-0024 XFRR COURTY PATIENT CLAIM INCURRED COVERED TOTRL CLAIAA~IT DEF. N0. N0. FROiJ 10 CNARGE PRID - --- -- - - - - --- -- - - -- - - --- KFLLER E 13189 900022!012 01/08191 01/08/9! ~ 54.00 41.78 GROUP T0TA1: 54.08 4i .78 PROVIDER T0TA1: 54.4D 41.18 3 ` ~l ,e ~~ ~ {.' ,~.Y i ~ JJ ` T.P.A. ---- I1 DATE:05/24/91 DAILY CHECK REG ST r'~~i [ ER BY GROUP PAGE: 7 .1~ FRIDAY MAY 20. 1991 , ~ REGISTER NUn6ER 127 n , ~ CHECK ~. ,. K . ..... .:. .... .... , ,.., . _ . _ _ .. v:_.- .. ... _. ' ~ ",' , ~~ ~ _' CHECK ~ ~_;: NUMBER DATE CLAIM NO $OC SEC NO EMPIDYEE CLAIMANT PAY TO AM CUNT ~ zaazeazeaz eezzz ez.zeosz::zz::axez s ae.o.s -zz-----:-_--az:zzzssz:z:zes .saz-s-eels-azs:a-aa-c:z----zeczazaaezazczzseaszez oaseessoa~ -~-~~ / r FUND: iPX-0024 GF.OUP: TPX-CD24 , KEAR COUNTY ~ ~~ ' t~ 1323 05/24/91 NANUAI OTdER VOID 00 1324 05/24/91 LINE UP ro V 0 I 0 C HECK ## . 00 ~+ _ 1325 05~2~91 MANUAL OTNEn VOID - -" . -- ----- p0 ---__.- --~"-' ~ 1326 05/24/91 LINE UP #: Y 0 I D C NECK ## .00 ~1 _ _ 1327 1328 .05/i4/91 05!24/51 VOUCHER PAYMENT - _ HILL _COUNTRY RADIOLOGY - _ ~ 711.04 ~- ----_ - _ ~, 1329 05/24/91 VOUCHER PAYMENT ~ SPECK ND. FRED 3L 27 ~ YDUC9ER PAYMENT FELL MD. RAHCALL 847 42 130 05/24/91 ---_--- -` ~ VUUCHER PAYNEnT ,-- JRS 6ACON 8 RCTH . 67.47 1331 05/i4/91 -^ - ---~---'---'-Yi~UCHEn PAY4EIT ANESTHESIA ASSDCIATES 325.80 `~` 1332 U>/20/91 vUUCHEk PAYNE~;T nOLCGMB r,D, JOHV 16 D.UU - 1333 US/i4/91 ---~---- YCUCH_k PAYMENT NA U' MD, THG".a5 I4C.09 1334 JSl24/91 - ~------'- `------_ - _ ~ -- vUiiCH:R PAYMEr~T KlnrrAN ND, THOMAS 28.47 1335 05/24/91 VOUCH~~ PAYMENI ALA9C PHYSICIANS SEPVICE Sb2.97 1336 - 05/24/91 vOUCNEF PAYMENT S[D PETERSON BEN HOSPlTAI 6,605.40 1337 05724791 `" -- - _-_V;;UC4=a PAYMFNT N E-8 PHA3rACY b089 873.19- _.._ 1338 05/24/91 Y~'UCH~n PAYMENT SEYEhAVCE 8 ASSOC Mh5601 o4. C9 1339 05/24/91 - 9000HEk PAYMENT L~uiS n0, CHARLES E 23.24 134D OS/i4f91 -'-- --'--`-'---'---- VOUCHER PAYMENT HDr,BS MC, PAUL W 4E.48 - 1341 05/24/91 YCUCHER PAYMENT ALLEN NC, uILL1AM N 107.31 1342 - -- 05/24/91 - VCUCN_R PAYMENT DFLA6EY nD, R GORDON 23.24 1343 05/24 /S 1 -~-- -------YGUCH[R PaY`EKT -JAGS ECKERC "COR - ------ -'-"517.81 -- --"- - -.__. _.. 1344 05/24/91 vUUCNER PAYMEtIT SHAG NC. MILTON D 2C. 00 1345 "' 05/24/91 --- VOUCHER PAYMENT HIII CO NUCLEAR IMAGING 162.43 1346 OS114/9T `--'--'-- ------------------ -----` VCUCH..7 P.4YF'ENT HTLL CO DI AG~NAGING `--" ' 23 e. 00 ' - 1347 05/24/91 VOUCNEF P;,YMc!iT 541TN D0, STGpHEN L 25.83 1344 J/i4/91 ' -- Y('UCa_k P.1YMEieT kELIS tC, JA9E5 D 23.20 1345 :i>/26/~1 __ -- - _ VCUC'1ER PAYMENT i,OVCE M.D. T R 19 C. 4d 1356 05/241,1 V;;uCN=k PAYMENT VEH'IOR ND,. C.L.. . _ 54.77 -.,_--_ 12,149.04 ~~ ~ G, _.. ~~ .- i 4.' ' bl i. P. A., IHC. DATE 45/24/91 Pfi4UIDER dOUGNER LISTI~kG PAGE 1 74-1733761 HItt COUNTRY RADID1069 TPis-u0z4 KkKR CGUritY PATIENT GLAIli INGilRfiEO C021ERED IOIAL CLAItlANT DFA. N0. N0. TRDi1 TO CHARGE PAIII a_..e=_ez.xa__;ss,.e.a~=aa=;x..-.~:n aax-e._--c-c-,~a~-c.=ssae==_:=xcz..~_=__.a-- ._anea S D(lCK~iUZiN E 047659 9DDD-s73bD3 D31251~i1 44/29/91 134.75 88.?8 S 6ARCIA F !29447 9000321405 04/24/91 04/24/91 13.00 13.00 J FIfILt ! lUL9tlL Y{1tiUS74LDt U9%b~tY1 u4%iz19i [3.DU 2-s.00 D HASTEN E 1299T4 4000374842 04/29/91 04/29/9f 464.00 453.76 J t(EFSF F 102137 4D00374142 63/20/91 04/07/91 14.00 14.DD r i-RiI1 E u$~74i yvu02i$5i0 0-siz519i 031f5i91 i7.Ga 11.00 A PEEBLES E 1269$b 9000321301 D8/14/9D 03J2819i 14.04 14.00 L RDBINSON E b62b1 9004229b1f 04/22/91 04123/91 88.00 $8.00 6RDUP TOTAL 767.75 711.04 FfiD~lIOER TOTAL: 767.75 71i.D4 ~i ,~R 1c T. P. A., IMC. DATE 65/24/91 ~ PROVIDER VOUCHER LT.STIN6 FACE 1 14-2174129 &PFCK ND, FRFD TP8-0024 KERB COUNT4 PATIENT CLAIl1 i~lCURRFD COVERED TOTAL CIAINANT DEP. N0. H0. FROt! TO CHArGE PAID B FRANKLIN E 9000342501 11/07/90 05/01/91 35.00 32.23 GROUP TOTAL: 35.OD 32.?1 PROUIUfR TOTAL: 35.OD 32.27 r' T. P. A., INC. DATE 45/24/91 PRUUIDFR U4UCHFR tISTIN6 PAGE l 74-2297591 BELL HD, RANDALL TPX-0474 KIRR CUllNTY PATIENT CLAIM INCURRED CUUERED TOTAL CLAIMANT DFP. NU. NU. FRUH TU CHARGE FAIR R SFELV E 9144194 9D44367809 D1/14191 U1 /14/91 975.4D x47.47 GROUP TOTALS 975.QD 841.42 PROUIDFR TOTAL 975.OD 847.42 T. P. A., IHC. DATE 05/24/91 ~ PROVIDER V01lCHER LISTIH6 PAGE i 14-1b98911 DRS BACON ~ ROTN TPR-0024 KERB COUHT1f PATIEKT CIAIit IHCURREB COVEfiEO TGTAI ~ ~ ' CIAIMAHT DEP. H0. H0. FROM i0 CHA~,GE PAI6 soesac__c-.a--osssz=sar_resa-oe_oaassso_-c.aoooc~r_e_xssoaeeaao»^-..==-a_s_r_e_..aaa T BARTTS E 4899 9000219409 03f20/9i 03/2b/9f 39.OD 39.00 J KEESE E 44G1 9000's741G2 03!20!91 04/47/91 30.OG 28.41 bR0lJP 10TAL: b9.OD b7.47 PROVIDER TOTAL: 64.00 67.47 :i i ;.:: T. P. A., INC. DATE 05/24/91 PfiOUIDER UOUCNkR LISTLNG PAGE t 74-247$788 ANESTNESIH ASSUCIATFS TPS-4024 NERR C4UNT4 PATIENT CtAIn INCURRED COUERkO TOTA! _ CLAIMANT DEP. N0. N0. FROA TO CHARGE PAID ' ~ tACKER E 9000373704 01/30!91 62/04/91 1130.OQ 325.80 GROUP TOTAL: 1130.OD 'si5.80 PfiDUIDER TOTAt~ 1130.C0 32S.E0 T. P. A., INC. DATE G5/24/91 PROUIDFR UOUCHFR LISTiN6 pA6E 1 14-2221752 HOLCOnB qD, JOHN TPR-4024 KERR COUNTY PATIENT CLAIn INCURRED C4VERFD T4TAl CLAIdAN1 DFP. N0. NU. ERGN TO CHARGE FAIR ' R $FEL4 F 91GGi9A 9GaG3628G8 G1/12/91 G1113/91 ibG.GD 1bG.GG GROUP iOTfll: 1ba.00 ~ba as PROVIDER TOTRt: 160.04 16a.0a ' T. P. A., Inc. QATE 05!24/91 PROVIDER UOUCNER LISTING PASS 1 74-245bi71 NAU ttD, THQtlAS TPR-4024 KERR CDUHTV AATIEhT ClAIB IHGURRED CUUERfD TOTAL CLAIflAHT DEP. NO. n0. FRUtI TO C1lARL'•E PAIO J JEFFfRS E 9000219511 0416il91 04!0219! 75.08 40.61 M MAU6NAt! E 9000J2010$ {i~tl01/91 04!08/9i i85.OD 94.48 GROUP TOTAL: 2b0.00 140.09 PROVIDER TOTAL- ?60.OD 140.09 ' f s T. P. A., INC. DATE 05/24/91 PRQUIDER VOUCHER LISTIHb ~ PAbE 1 ' 74-2445241 K.IHG?IAH ilD, 1Hpi1AS iP8-0024 KERR COUHT4 PATIENT cLhIfl INCURRED cuUFkID TOTAL CIAIffANT 6EP. NO. 1l0. iROff 'f0 CHARbC PAID ~ ' S DUCK{IORTN E 3070 9000373b03 03125191 04129/91 45.40 28.41 6RgUP TgTAI: 45.49 ?8.4J PROVIDER TOTAL: 45.44 28.47 T. P. A., IHC. DATE 05/24!91 PROUIDFR VOUCHER LISTING PAGE 1 74-24523 67 ALAMO PH YSICIANS SERVICE TP}t-0uz4 HERB COUHTY PATiEHi CLAIt1 INCURRED COVERED TOTAL CLAIftA!{T DFP. N0. H0. FRQlt TO CHAFCF PAID T BARTTS F 170060 9000219409 03/20/91 03J2b/9t $2.(.D 50.70 B FRAHKLIH E 164156 9000392501 11101!90 05/01/9f 12b.OD 57.91 F suiirz t i7vYaS 9000s744u2 04/09191 84109/91 5s.t~0 37.43 J HALE E 170811 9000374202 114105/91 84/12/91 82.00 50.70 E JOY F 136056 9000393201 071'[4/89 071?4/89 45.00 3).43 J 4{EESE E 170903 9000374102 03/20/91 04107/91 135.OQ 50.70 D hORENO E 169965 9000374003 03/18!91 03/21/91 10b,00 74.85 T HISiON E ib9bb7 9000373907 03/12/91 03/12/91 173.0D 57.41 E ORTI2 E 170279 9000218510 03/25/91 03/25/9i 53.00 37.43 M PEEBLES F l102b7 9000321307 08!14!90 03/28/91 668.00 333.04 F PFHA F 171023 9004393401 44!10/91 04/10/91 53.04 37.43 c riisiFJuvsKY -t 161741 9o0u2i9iu5 Oyii1193 09/11/90 q£.i?d 31.43 6ROU° TOTfl1: 1629.OD Sb2.97 PROVIDER TOTAL: 1624.04 $62.97 ,. f r ~~ Ob'5494 SZ~Zt4L18101 83~IA0;ld Ob~S099 SZ'Zl9L 18101 dntJa9 S1'$41 SL'89l lb/£Z/b0 16/ZZ/bD 1196ZZ004b Ob1b0 3 ~NOSNI908 1 5Z'lS Sl'lS 1610!160 161011b0 tOh£6f006b OZtfO 3 8N3d 3 SS'90! SS"9bt 1b/8Z/FO ObIbl/80 LO£ll£0006 Zl6Sb9 3 SllQiid A 00'9!0£ 00'0006 161AZ/f0 lb/lllf0 fObfLf004b lS9SEt 3 HQXIH 1 S8"lfl S$'lfl 16/82160 16/82/60 L4Z1ff0006 SbfSb 3 1i8H9Sy8H ~ 4S'ibl aS'lbl 16/84/k0 16/10/b4 801OZF4D06 6£46b9 3 N8H9A8H W Sl'LbOI 40'DDII 16162/b4 lb/bt/b0 Z08bLf0006 9bff1 3 H3i18H Q S8"lbl S8'lbl lb/Z1/64 1b/S0/b0 ZOZb1f0006 Zll 3 318H f OS'l4l 0S'l1l lbl+~0!1+4 lb/bQ!64 Z466L£0006 4SaL64 3 Z3ung j 00'Lll 04'1ll lb/bZ/k4 161bl/bD SObl7£0006 8£260 3 dIab89 S 00"9l 04'9! 16/84lb0 1b184/60 $OfLff0806 1f08$9 3 N801i 9 OS'klL QS'bll l6!bZ/64 Ib/SZIfO f09fLf4006 ObbZO 3 H1SQh?!0(iL~ S OS'8S 4S'8S tblbZ/60 thlLi/b0 b000ZZOD06 fb4f4 3 SSIia4 Q 40"fZ 00'fZ 16/22/64 l6/ZZIbD b091ZZ04Db 166£0 3 a31a8:1 9 028d i~•HdHO ~ Ol 1f0a3 'OH 'OH 'd30 1H8lII819 18101 Q3H3f100 4iaatla!!I NI810 ik3I18d h1Hfl4~ aa3N 6240-Xd! 1@lidSQH 0311 N4SJ313d QIS OZ8ISSZ-bL 1 398d 9HIISII y3HOn0A y30If-O~d 16/bZ/S0 318Q 'OHI "N 'd '1 t. 1'. A., INC. DATE 05!24!91 . PROVIDER UpUCHER LISTIt16 PAGE 1 14-0537115E !! E B PHARtfACY #489 TPIt-4424 RIRR COUNTY PATIENT CLAIH INCURRED COVEREf1 iOTAI CLAIflA14T DEP. 110. 110. FRO11 TO G1IARGE PAID T $IAS E 9D4142 9440304611 03/22/91 03129791 91.b8 84.41 J BQL6RE1{ E 8741488 9000336b10 03114/91 03/30/91 55.86 55.8b A IsilRxuli -t 8740ub 90442247i0 v3/2i191 03121/91 .49 .49 K BURTON E 9000229509 02/12/91 02/12/91 127.04 121.04 L DElEON E 894101 9400337505 03/12/91 43/19/91 40.19 40.49 E DREHER E 9000337403 02/2b/9i 02/2b/91 b.3a 6.38 D FRICsOl{ E 9140b 9000314502 44!41/91 44101!41 80.61 80.61 6 FLORA E 910004 9004337349 03/12/91 03/12/91 69.51 b9.51 J f(EESE E $70045 9004314103 03/27/91 03/27/91 35.05 35.05 Y LAC1{EY E 914021 9040373145 43120!41 03/20/91 11.82 11.82 h tlAUSHAH E 440107 9044324149 43/27/91 43127!91 3.8) 3,87 C iiARSCHAII E 91403 9400337208 43/2b/9i 03/2b/91 5.7i 5.71 D fI0REN0 E 91404b 4000314004 03128/91 03/28/91 5.25 5.25 T NIXOH E 91002$ 9400313904 43/20/91 03/20/91 4b.2D 4b.2D E ORTIi E 884438 940021851! 031?5/31 03/25/91 52.59 52.59 A PFEUFFER E 940082 9460232417 02/18/91 02/1$191 65.28 85.28 A PFEUFFER E 900082 904423241$ 03!18191 03/18/91 85.28 85.28 R PIEPER E 910022 9404396041 03/11/91 03/11/91 9.49 9.49 S DANCE F D3t$91 90003b1907 03!18/91 03/18/91 15.13 9.84 J AATSOH E 904096 9004302513 ~ 03/2b191 03/26!91 17.55 17.55 8 ARIGHT E 410415 9000362904 03/19/91 04/02/91 44.47 40.41 6ROs1P 101AL: 885.75 ~i73.19 PROVIDER 1D1AL: 885.75 873.19 T. P. A., INC. , DATE 05/24/91 PROVIDER VOUCHER LISTING Pb6F i 74-1648679D SEVERANCE >< ASSOC 1ib56D1 TFi~-uoi4 riEH~ CuUriT9 PATIENT CLAIfl INCURRED COVERED TOTAL CLAIt1AiiT DFP. N0. N0. TRO~i TO CHARGE PAID D NORFNO E 21496D 90DDs14003 G3/10/41 0/21/41 i[5.OD 64.09 GROj1P TDTAL~ ]25.OD b4.09 PROVIDER TOTAL: 125.OD b9.04 T. P. A., INC. DATE 05/24/91 PROVIDER VOUCHER IISTIH6 PAGE 1 74-219b500 LEAiS MD, LHARLFS E TPR-0024 KERR COUHi4 PATIENT CLAIfl IkCURRED COVERED TOTAL CLAIMANT DEP. k0. HO. FROM t0 CHARGE PAtO '. ==-=°==--__xcssem°cx~_c-e---c-cn_-_-"-~_°`=Q-6---=0~===_=--^-=- ==-=----========--sa B ARIGHT E 26821 904032903 04!02!91 04/02/91 27.G0 23.24 GROUP i07AL: 27.OD 23.24 PROVIDER TOTAL: 21.OD 23.24 T. P. A., I1iC. DATE 05/24!91 PROVIDER UOUCNER LFSTIN6 PAGE 1 73-1254444 NGBBS MD, PAUL U TPR-0024 KfRR COUNT4 PATIENT CLAIfl INCURRED Ci~UERED TOTAL CLAIMANT DEP. k0. N0. FROM TO CNARtiE PAID J JEFFERS E 18041 9000219511 04!41/91 04/02/91 23.30 23.24 R KELLFR E 17948 40t?d119327 d4/01/91 44/41/91 23.34 23.?4 GROUP iOTAI~ 4h.69 46.48 PROVIDER TOTAL: 46.69 4b.48 T. P. A., INC. DATE 85/24/41 PROVIDER UDUCNER LISTING PAGE i ~~ 74-204b814 ALLFN MD, AILLIAfl h TP8-0024 KERR COUNi4 PATIENT CLAIB INCUkkFD CGUERFD IGTAL CLAInANT DEP. H0. N0. FROH TO CHARFE PAID 3 BOL6REN E 900033bb09 04/01/91 04122/91 27.49 23.24 L itOBIHSON F 9000229611 b412T1y1 04/23/91 100.30 84.07 GfiOUP TOTAL: 127.79 107.3# PROVIDER TOTAL: 127.79 107.31 T. P. A., IkC. DATE 05/24/91 PROVIDER VOUCHER LISTIII~ PAGE 1 74-1738310 DELANEY nD, R GORDUN TPK-0029 KERB COUNTY FAIIEHI ClHIfi It{CORKED CUVFRED TOTA1 CLAIafANT DEP. N0. HD. FROM i0 CNAR6E PAID J BOIGREk E 10507b 900433bb04 09/01/41 04/22/41 30.G0 23.24 GROUP iOTAI: 30.U0 23.29 PROVIDER TOTAL: 30.Oa 23.29 T. P. A., IHC. ' DATE 05/24/91 PROVIDER VODCH[R LiSTIR6 PAGE 1 59-1374418E JACK FCKERD COR TPK-4424 KERR COUHT4 PATIEHT CLAIH TkC11RRED COUEfiFD TOTAL CLAInAHT DEP. H0. H0. FROH TO CHARGE PRID R CRIDER E 9444114 9044396141 41f06l9i 43/Qb/9i 14.bb 14.bb D DRFISS E 9400224014 43/43/91 43/43/91 ilb.b4 17b.64 J JEFFERS E $94126 9006219512 03/04/91 43!44191 17.34 7].34 C J4HNSOH E 4128ti1 9004232946 43/45/41 43/45/91 34.49 34.49 R KELLER E 413bbb 9644219321 41/20/91 02124/41 iSS.19 155.19 R xtLLtR E 0191)4 944u2193i3 b311ziy1 43112/91 fY.19 19.19 E KELLER E 4i 4499 9044221413 43i4b/9t 43/15/91 31.43 31.43 5 AFLTV E 419714 9446361804 43111!91 43/11/91 8.2T 8.21 GR0~1? TOTAl~ 5i7.D1 517.81 PROVIDER TOTAL: 511.81 517.81 T. P. A., INC. DATE 45/24/91 PRUUIDIR VOUCHER tiSTING PAEF 1 74-23972$1 SNAR !!t!, HILTON D TPB-4424 KERB CUUNTY PATIENT CLAIM IHGURRfD COVfI;AID D FRANKLIN E 9444392541 i1J41/9D 45/41J91 341.49 194.48 GROUP TOTAL: 301.49 190.48 PRDVIDFR TOTAL: 301.00 194.98 T. P.. A., It1C. QATE 05/24/91 PROUIDfR UQUCHF.R LISTI{~& F'kCf i 457-b2-7045 UFRtiUR till, C. L . 1PX-0624 KERR COUNTY PiiTIF#iT CLdIit I't{CUI~I;ED t:UUFREif i(iIf!t CLAItlRNT DEP. k0. t10. TR011 TO CNARb[ PRIG S DUCKi16RTH E 041091 9000373604 02/26191 03/28/91 69.Of} 51.71 GROUP TOTAL 69.OD `•4.77 PftOUTAER TOTflL: b9.00 54.17