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{"form_type":"ub04","billing_provider":{"name":"SARAHSIDE REGIONAL MEDICAL CENTER","address_line":"50804 ROGERS PRAIRIE SUITE 645","city":"JACOBSBURGH","state":"CA","zip":"20818","phone":"(998) 013-0624"},"pay_to":{"name":null,"address_line":null,"city":null,"state":null,"zip":null,"phone":null},"patient_control_no":"B... | phone_photo | 000005 | |
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{"form_type":"ub04","billing_provider":{"name":"DONALDBURY GENERAL HOSPITAL","address_line":"63667 MILLER ISLE APT. 721","city":"PATTERSONLAND","state":"NM","zip":"50856","phone":"(091) 793-0805"},"pay_to":{"name":"SAUNDERS BILLING SERVICES","address_line":"6314 STACY TUNNEL SUITE 558","city":"NORTH MARGARET","state":"... | phone_photo | 000040 | |
{"form_type":"ub04","billing_provider":{"name":"GREEN HOME CARE LLC","address_line":"3668 ANDERSON CANYON","city":"WEST WALTERBOROUGH","state":"ND","zip":"03707","phone":"(154) 151-5085"},"pay_to":{"name":"WEST CALEB HEALTH BILLING","address_line":"5979 WILSON FORDS APT. 885","city":"WILSONFURT","state":"ME","zip":"764... | phone_photo | 000044 | |
{"form_type":"ub04","billing_provider":{"name":"GREENBERG GENERAL HOSPITAL","address_line":"2149 SHELBY VILLAGES SUITE 514","city":"PORT JENNIFER","state":"NC","zip":"26107","phone":"(828) 949-9707"},"pay_to":{"name":null,"address_line":null,"city":null,"state":null,"zip":null,"phone":null},"patient_control_no":"Z86948... | phone_photo | 000050 | |
{"form_type":"ub04","billing_provider":{"name":"NATASHAVIEW REGIONAL MEDICAL CENTER","address_line":"23224 SMITH LIGHT","city":"EAST CHRISTOPHERMOUTH","state":"FL","zip":"50735","phone":"(811) 446-3100"},"pay_to":{"name":null,"address_line":null,"city":null,"state":null,"zip":null,"phone":null},"patient_control_no":"A5... | phone_photo | 000056 | |
{"form_type":"ub04","billing_provider":{"name":"DAVISSHIRE HOME HEALTH SERVICES","address_line":"8775 SHANNON PORTS","city":"NEW JILLIANLAND","state":"WA","zip":"18445","phone":"(895) 485-8379"},"pay_to":{"name":null,"address_line":null,"city":null,"state":null,"zip":null,"phone":null},"patient_control_no":"W77357330",... | phone_photo | 000066 | |
{"form_type":"ub04","billing_provider":{"name":"NV ORTHOPEDIC HOSPITAL","address_line":"0865 AMANDA EXTENSIONS APT. 750","city":"VILLASIDE","state":"MO","zip":"82267","phone":"(270) 768-6205"},"pay_to":{"name":null,"address_line":null,"city":null,"state":null,"zip":null,"phone":null},"patient_control_no":"X728613283","... | phone_photo | 000075 | |
{"form_type":"ub04","billing_provider":{"name":"REESE HOME CARE LLC","address_line":"80334 DAVID SHOALS APT. 627","city":"SIMONLAND","state":"SC","zip":"72482","phone":"(499) 090-6771"},"pay_to":{"name":"HERNANDEZ BILLING SERVICES","address_line":"19474 JANICE RIDGES APT. 585","city":"ROGERSVIEW","state":"CO","zip":"50... | phone_photo | 000083 | |
{"form_type":"ub04","billing_provider":{"name":"ST MAXWELL HOSPITAL","address_line":"5607 HINTON TUNNEL SUITE 356","city":"WEST DAVID","state":"WI","zip":"12542","phone":"(241) 097-0654"},"pay_to":{"name":null,"address_line":null,"city":null,"state":null,"zip":null,"phone":null},"patient_control_no":"O207955039","medic... | phone_photo | 000091 | |
{"form_type":"ub04","billing_provider":{"name":"NEW AUDREYVILLE ORTHOPEDIC ASC","address_line":"68576 CINDY FALL","city":"WEST SARAH","state":"UT","zip":"22237","phone":"(775) 669-9217"},"pay_to":{"name":null,"address_line":null,"city":null,"state":null,"zip":null,"phone":null},"patient_control_no":"L1726235","medical_... | phone_photo | 000094 | |
{"form_type":"ub04","billing_provider":{"name":"JACQUELINETON GENERAL HOSPITAL","address_line":"928 JUSTIN PRAIRIE APT. 673","city":"PORT MIGUEL","state":"VI","zip":"78952","phone":"(258) 501-7493"},"pay_to":{"name":null,"address_line":null,"city":null,"state":null,"zip":null,"phone":null},"patient_control_no":"U456932... | phone_photo | 000095 | |
{"form_type":"ub04","billing_provider":{"name":"EAST JONATHANHAVEN GENERAL HOSPITAL","address_line":"9545 SAMUEL PARKS","city":"SOUTH GINAVILLE","state":"FM","zip":"23986","phone":"(984) 394-6791"},"pay_to":{"name":null,"address_line":null,"city":null,"state":null,"zip":null,"phone":null},"patient_control_no":"B712008"... | phone_photo | 000109 | |
{"form_type":"ub04","billing_provider":{"name":"GRAY HOME CARE LLC","address_line":"250 STOKES COURSE","city":"DAVIDSIDE","state":"AR","zip":"45663","phone":"(533) 578-1783"},"pay_to":{"name":null,"address_line":null,"city":null,"state":null,"zip":null,"phone":null},"patient_control_no":"S07280265","medical_record_no":... | phone_photo | 000110 | |
{"form_type":"ub04","billing_provider":{"name":"HARRINGTONHAVEN GENERAL HOSPITAL","address_line":"821 BURNS TURNPIKE APT. 999","city":"JOHNSONFORT","state":"TX","zip":"40319","phone":"(501) 062-5879"},"pay_to":{"name":null,"address_line":null,"city":null,"state":null,"zip":null,"phone":null},"patient_control_no":"E7380... | phone_photo | 000113 | |
{"form_type":"ub04","billing_provider":{"name":"GONZALES AMBULATORY SURGERY LLC","address_line":"9723 ORR LOOP APT. 110","city":"ZACHARYBOROUGH","state":"IA","zip":"04097","phone":"(016) 386-7847"},"pay_to":{"name":null,"address_line":null,"city":null,"state":null,"zip":null,"phone":null},"patient_control_no":"S047141"... | phone_photo | 000123 | |
{"form_type":"ub04","billing_provider":{"name":"LAKE CARL GENERAL HOSPITAL","address_line":"3643 CURTIS ESTATES","city":"NEW ERNESTBURGH","state":"MO","zip":"32145","phone":"(815) 456-5696"},"pay_to":{"name":null,"address_line":null,"city":null,"state":null,"zip":null,"phone":null},"patient_control_no":"D134681","medic... | phone_photo | 000125 | |
{"form_type":"ub04","billing_provider":{"name":"UNIVERSITY HOSPITAL OF MN","address_line":"108 WATSON INLET","city":"DENISETON","state":"MH","zip":"81369","phone":"(485) 912-7293"},"pay_to":{"name":null,"address_line":null,"city":null,"state":null,"zip":null,"phone":null},"patient_control_no":"O59592004","medical_recor... | phone_photo | 000136 | |
{"form_type":"ub04","billing_provider":{"name":"CO ORTHOPEDIC HOSPITAL","address_line":"792 JAMIE FORD","city":"FRANKLAND","state":"OK","zip":"01182","phone":"(070) 557-4581"},"pay_to":{"name":null,"address_line":null,"city":null,"state":null,"zip":null,"phone":null},"patient_control_no":"S7609045","medical_record_no":... | phone_photo | 000147 | |
{"form_type":"ub04","billing_provider":{"name":"ST HENDERSON HOSPITAL","address_line":"007 JAMES CIRCLE","city":"WEST DAMON","state":"NE","zip":"49193","phone":"(136) 465-7326"},"pay_to":{"name":null,"address_line":null,"city":null,"state":null,"zip":null,"phone":null},"patient_control_no":"N4868243","medical_record_no... | phone_photo | 000159 | |
{"form_type":"ub04","billing_provider":{"name":"ST ALLISON HOSPITAL","address_line":"6972 MICHELLE ROADS","city":"WEST SABRINA","state":"MH","zip":"93088","phone":"(158) 320-1923"},"pay_to":{"name":null,"address_line":null,"city":null,"state":null,"zip":null,"phone":null},"patient_control_no":"D759155277","medical_reco... | phone_photo | 000161 | |
{"form_type":"ub04","billing_provider":{"name":"SOUTH STACEY ORTHOPEDIC ASC","address_line":"14966 REGINA TERRACE SUITE 085","city":"BRIANAFURT","state":"WI","zip":"27296","phone":"(733) 696-0960"},"pay_to":{"name":null,"address_line":null,"city":null,"state":null,"zip":null,"phone":null},"patient_control_no":"A6676938... | phone_photo | 000162 | |
{"form_type":"ub04","billing_provider":{"name":"WEST JOHNSIDE GENERAL HOSPITAL","address_line":"84852 HAMILTON FLATS SUITE 249","city":"PORT ZACHARY","state":"FL","zip":"58445","phone":"(609) 913-7762"},"pay_to":{"name":"HILL BILLING SERVICES","address_line":"742 GREEN SPUR","city":"TUCKERHAVEN","state":"FL","zip":"488... | phone_photo | 000163 | |
{"form_type":"ub04","billing_provider":{"name":"NJ ORTHOPEDIC HOSPITAL","address_line":"80906 ASHLEY ISLANDS","city":"SOUTH TRACY","state":"MA","zip":"03435","phone":"(464) 202-6179"},"pay_to":{"name":null,"address_line":null,"city":null,"state":null,"zip":null,"phone":null},"patient_control_no":"J029504","medical_reco... | phone_photo | 000168 | |
{"form_type":"ub04","billing_provider":{"name":"PORT STEPHANIESHIRE GENERAL HOSPITAL","address_line":"93305 KRAMER STRAVENUE","city":"RIOSPORT","state":"PW","zip":"88375","phone":"(649) 114-0001"},"pay_to":{"name":"ROBERTOFURT HEALTH BILLING","address_line":"849 KELLY MANORS","city":"EAST TIM","state":"KS","zip":"20957... | phone_photo | 000181 | |
{"form_type":"ub04","billing_provider":{"name":"NJ VISITING NURSES","address_line":"906 NICOLE CANYON APT. 887","city":"SOUTH ASHLEYFORT","state":"TX","zip":"81041","phone":"(901) 577-4884"},"pay_to":{"name":"WASHINGTON REVENUE CYCLE LLC","address_line":"57101 ELIZABETH WELL SUITE 653","city":"NEW BRIAN","state":"DE","... | phone_photo | 000184 | |
{"form_type":"ub04","billing_provider":{"name":"TN VISITING NURSES","address_line":"2363 AMANDA FIELD","city":"ALLENFURT","state":"NM","zip":"81997","phone":"(023) 130-8788"},"pay_to":{"name":null,"address_line":null,"city":null,"state":null,"zip":null,"phone":null},"patient_control_no":"Z556614","medical_record_no":"9... | phone_photo | 000186 | |
{"form_type":"ub04","billing_provider":{"name":"ST WILLIS HOSPITAL","address_line":"297 SMITH TUNNEL SUITE 928","city":"PORT BEVERLY","state":"PR","zip":"81994","phone":"(137) 298-3521"},"pay_to":{"name":"FORBES BILLING SERVICES","address_line":"305 EMILY RUE APT. 261","city":"MATTHEWPORT","state":"DC","zip":"23391","p... | phone_photo | 000190 | |
{"form_type":"ub04","billing_provider":{"name":"PORT LINDSAYMOUTH REGIONAL MEDICAL CENTER","address_line":"137 ANGELICA STATION SUITE 176","city":"DEREKBERG","state":"WI","zip":"13540","phone":"(211) 061-0113"},"pay_to":{"name":null,"address_line":null,"city":null,"state":null,"zip":null,"phone":null},"patient_control_... | phone_photo | 000194 | |
{"form_type":"ub04","billing_provider":{"name":"BROOKSPORT HOME HEALTH","address_line":"7472 DEANNA GATEWAY","city":"WEST JULIA","state":"VA","zip":"21172","phone":"(932) 302-1371"},"pay_to":{"name":null,"address_line":null,"city":null,"state":null,"zip":null,"phone":null},"patient_control_no":"S476143198","medical_rec... | phone_photo | 000195 | |
{"form_type":"ub04","billing_provider":{"name":"HUYNHTON HOME HEALTH","address_line":"5600 PAUL BYPASS","city":"EAST MICHAEL","state":"OK","zip":"37672","phone":"(040) 216-6459"},"pay_to":{"name":null,"address_line":null,"city":null,"state":null,"zip":null,"phone":null},"patient_control_no":"U82955456","medical_record_... | phone_photo | 000199 | |
{"form_type":"ub04","billing_provider":{"name":"DAVIS MEMORIAL HOSPITAL","address_line":"28753 ROGERS FIELDS APT. 947","city":"PORT ANGELA","state":"PW","zip":"54131","phone":"(900) 130-6072"},"pay_to":{"name":null,"address_line":null,"city":null,"state":null,"zip":null,"phone":null},"patient_control_no":"Z740456619","... | phone_photo | 000200 | |
{"form_type":"ub04","billing_provider":{"name":"EAST TYLER REGIONAL MEDICAL CENTER","address_line":"899 WHITEHEAD SPRINGS APT. 002","city":"DUNLAPTON","state":"CA","zip":"66388","phone":"(833) 678-4833"},"pay_to":{"name":null,"address_line":null,"city":null,"state":null,"zip":null,"phone":null},"patient_control_no":"L5... | phone_photo | 000206 | |
{"form_type":"ub04","billing_provider":{"name":"MD VISITING NURSES","address_line":"6961 COLLIN FLAT","city":"ALISONTOWN","state":"VT","zip":"72591","phone":"(090) 407-8295"},"pay_to":{"name":null,"address_line":null,"city":null,"state":null,"zip":null,"phone":null},"patient_control_no":"G4868241","medical_record_no":"... | phone_photo | 000208 | |
{"form_type":"ub04","billing_provider":{"name":"RI VISITING NURSES","address_line":"3769 RILEY ROUTE","city":"LAKE CINDY","state":"LA","zip":"23356","phone":"(802) 076-4629"},"pay_to":{"name":"MORALES BILLING SERVICES","address_line":"8056 JACOB STATION","city":"NEW DANIELBURY","state":"DE","zip":"68238","phone":"(027)... | phone_photo | 000209 | |
{"form_type":"ub04","billing_provider":{"name":"RICHARDFORT GENERAL HOSPITAL","address_line":"032 JOSEPH PRAIRIE APT. 836","city":"PORT MARTHATOWN","state":"MI","zip":"13063","phone":"(168) 633-3594"},"pay_to":{"name":null,"address_line":null,"city":null,"state":null,"zip":null,"phone":null},"patient_control_no":"T4170... | phone_photo | 000210 | |
{"form_type":"ub04","billing_provider":{"name":"AZ VISITING NURSES","address_line":"76742 SMITH TUNNEL","city":"NORTH BRIAN","state":"NJ","zip":"59973","phone":"(301) 639-5649"},"pay_to":{"name":"JONES REVENUE CYCLE LLC","address_line":"313 MELISSA SUMMIT SUITE 343","city":"GLENNBERG","state":"PR","zip":"84857","phone"... | phone_photo | 000214 | |
{"form_type":"ub04","billing_provider":{"name":"SOUTH BRIANBERG GENERAL HOSPITAL","address_line":"5364 HEATHER LOOP APT. 721","city":"JUANSTAD","state":"TX","zip":"81620","phone":"(862) 467-1530"},"pay_to":{"name":null,"address_line":null,"city":null,"state":null,"zip":null,"phone":null},"patient_control_no":"X43962221... | phone_photo | 000220 | |
{"form_type":"ub04","billing_provider":{"name":"TIMOTHYSHIRE HOME HEALTH SERVICES","address_line":"172 DAVIS MOUNTAINS","city":"LAKE HEATHER","state":"MN","zip":"79211","phone":"(577) 630-2131"},"pay_to":{"name":null,"address_line":null,"city":null,"state":null,"zip":null,"phone":null},"patient_control_no":"G159257532"... | phone_photo | 000223 | |
{"form_type":"ub04","billing_provider":{"name":"GILBERTSHIRE HOME HEALTH SERVICES","address_line":"23086 SANTOS SHOALS SUITE 472","city":"WEST CARLOSSHIRE","state":"VA","zip":"28007","phone":"(670) 012-5708"},"pay_to":{"name":"MAYPORT HEALTH BILLING","address_line":"59827 ROBERT STRAVENUE SUITE 687","city":"LAKE DAWN",... | phone_photo | 000224 |
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