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			T. P. A.. I,vC.		
	DATE: D9/18/92	GAI	LY CM~.CK ~r;,ISTE ~ 8Y	GROUP	PAGE: 9
			ftcIIlAY SEPTEM6Ek 18. 192		
			REGI~TFk •iUMBE~ti 223		
~iECK	CHECK				CHECK
1MnGR	DATc CLAI~h N!J SOC	SEC	vU FMPLUYE~ CLAIMANT	PAY TO	AMGUNT
:ars=cn=-wa=csenres~c~.-sa=~-=-:.cx=	~::se='==.-_.. ;..r_.,._,_-..=,.craa:z__='axxc a: aaxeav	axaa_tazaesmarcr~3nrasnss~a	aaeazaotasmse:aaazesea
G: 7PX-0024 Gk~UP: TrX-OG24	~C`rtn	COUriTY __		
	Cni:CK 6RUUf: 02k	KEri:~	COUadTY		
1857	09/16/9%		MANUAL OTHEfi	YUID	.00
185e	Q9/16/9Z LIiV~ UP			#~ V O I D C A E C K ##	.00
1$Sv	09/1'019:,		VOUCHER PAYNEriT	VASCULAR SURtiICAL ASSOC	84.92
1660	09/18/92		YUUCHER PAYrttiT	a~d;:STNESIA ASSOCIATES	4E. 44
					133.36
.l .. ,..
T. P. A., INC.
DATE 09/#8/92 PROVIDER VOUCHER LISTING PRGE 1
tPV003)
fOR PROVIDER: 74-196765# VASCULAR SURGICAL RSSOC
FOR GROUP: 1PR-0024 1{ERR COUNTP
SEQUENCE N0: 1
PATIENT CLAIM INCURRED COVERED iOTAI
CLAIMANT DEP. N0. N0. FROM TD CHARGE PAID
R PIEPER E 101431 9300002301 Ob/26/92 Ob/26l92 200.04 84.92
GROUP TOTAL: 200.00 84.92
PROVIDER TOTAL: 200.40 89.92
T. P. A., anti.
DATE 09/18/92 PROVIDER UOUGNER LISTING PAGE 1
(PV043}
TOR PROVIDER: 74-2018188 ANE5TiiESIA ASSOGIATES
FOR GROUP: TPR-0024 KERR COUNTM
SFQUENGE NO: 2
PATIENT CLAItt INCURRED COVERED TOTAL
CLAitlANT DFP. N0. NO. FROIi TO GNAR6E PAID
W LEE E 003923 9300033501 04/27/92 04121/92 40{!.00 48.99
GROUP TOTAL: 400.00 48.44
PROVIDER TOTAL: 400.00 48.4a