HOSPITAL NAME ADDRESS PHONE NUMBER............ 999999999 0111 99-999999910/01/201011/01/2010 LAS VEGAS NV89119 05/05/1955F6 10/01/201019341403 1110/01/2010 01 11300080 2000 110ROOM-BOARD PVT 1130.00 20 2260000 250PHARMACY 328 357100 270MED-SURG SUPPLIES 15 29250 300LABORATORY 26 300260 320DX X-RAY 3 71850 420PHYSICAL THERAPY 46 279900 430OCCUPATION THERAPY 70 422300 440SPEECH PATHOL 53 352775 730EKG/ECG 1 11550 00100201/01/2011MEDICARE FEDERAL BLUE CROSS YY YY 9999999999 000000000 1818 9V5789 99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y25000 Y2859 Y86600 496 Y70703 Y V5789 9999999999 OB99999 LASTNAME FIRSTNAME 1021 HOSPITAL NAME ADDRESS PHONE NUMBER............ 999999999 0111 99-999999910/01/201011/01/2010 LAS VEGAS NV89119 05/05/1955F1 10/01/201019342103 0510/01/2010 01 11300080 2000 120ROOM-BOARD SEMI 1130.00 20 2260000 250PHARMACY 444 288000 270MED-SURG SUPPLIES 11 293700 300LABORATORY 9 43605 420PHYSICAL THERAPY 85 523475 430OCCUPATION THERAPY 85 513425 440SPEECH PATHOL 27 180700 001 4102905 00100101/01/2011BLUE CROSS BLUE SHIELD Y Y 9999999999 000000000 18 9V5789 99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y V5789 9999999999 OB99999 LASTNAME FIRSTNAME 21 HOSPITAL NAME ADDRESS PHONE NUMBER............ 999999999 0111 99-999999910/01/201011/01/2010 LAS VEGAS NV89119 05/05/1955M2 10/01/201017341703 0510/01/2010 01 11300080 1300 120ROOM-BOARD SEMI 1130.00 13 1469000 250PHARMACY 552 840400 300LABORATORY 9 73750 320DX X-RAY 2 59450 420PHYSICAL THERAPY 33 207500 430OCCUPATION THERAPY 42 263600 440SPEECH PATHOL 15 96325 001 3010025 00100101/01/2011BLUE CROSS BLUE SHIELD Y Y 9999999999 000000000 18 9V5789 99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y29590 Y7993 Y V5789 9999999999 OB99999 LASTNAME FIRSTNAME 21 HOSPITAL NAME ADDRESS PHONE NUMBER............ 999999999 0111 99-999999910/01/201011/01/2010 LAS VEGAS NV89119 05/05/1955F6 10/01/201016341803 1110/01/2010 01 11300080 1400 110ROOM-BOARD PVT 1130.00 14 1582000 250PHARMACY 357 263000 270MED-SURG SUPPLIES 7 13650 300LABORATORY 25 191465 420PHYSICAL THERAPY 64 373250 430OCCUPATION THERAPY 72 413400 001 2836765 00100101/01/2011MEDICARE AARP HEALTHCARE OPTIONS YY YY 9999999999 000000000 1818 9V5789 99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 YV553 V5861 V5789 9999999999 OB99999 LASTNAME FIRSTNAME 1019 HOSPITAL NAME ADDRESS PHONE NUMBER............ 999999999 0111 99-999999910/01/201011/01/2010 LAS VEGAS NV89119 05/05/1955M6 10/01/201021341206 1110/01/2010 01 11300080 700 110ROOM-BOARD PVT 1130.00 7 791000 250PHARMACY 27 31000 300LABORATORY 3 18390 420PHYSICAL THERAPY 31 194275 430OCCUPATION THERAPY 29 183875 440SPEECH PATHOL 8 56450 001 1274990 00100101/01/2011MEDICARE NEVADA MEDICAID YY YY 9999999999 000000000 1818 9V5789 99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y V5789 9999999999 OB99999 LASTNAME FIRSTNAME 1017 HOSPITAL NAME ADDRESS PHONE NUMBER............ 999999999 0111 99-999999910/01/201011/01/2010 LAS VEGAS NV89119 05/05/1955M2 10/01/201022341706 0510/01/2010 01 11300080 1400 110ROOM-BOARD PVT 1130.00 14 1582000 250PHARMACY 279 447400 300LABORATORY 5 25400 420PHYSICAL THERAPY 55 335150 430OCCUPATION THERAPY 52 292000 440SPEECH PATHOL 7 49950 001 2731900 00100101/01/2011MEDICARE TRICARE FOR LIFE YY YY 9999999999 000000000 1818 9V5789 99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y V5789 9999999999 OB99999 LASTNAME FIRSTNAME 1019 HOSPITAL NAME ADDRESS PHONE NUMBER............ 999999999 0111 99-999999910/01/201011/01/2010 LAS VEGAS NV89119 05/05/1955F1 10/01/201018340970 0510/01/2010 01 11300080 3500 120ROOM-BOARD SEMI 1130.00 35 3955000 250PHARMACY 229 130500 300LABORATORY 15 102320 320DX X-RAY 1 24100 420PHYSICAL THERAPY 108 670650 430OCCUPATION THERAPY 135 815900 440SPEECH PATHOL 122 763325 001 6461795 00100101/01/2011TRIPLE A AUTO INS LOOMIS SHEET METAL WORKERS HEA YYYYYY 9999999999 000000000 181919 9V5789 99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y V5789 9999999999 OB99999 LASTNAME FIRSTNAME 192121 HOSPITAL NAME ADDRESS PHONE NUMBER............ 999999999 0111 99-999999910/01/201011/01/2010 LAS VEGAS NV89119 05/05/1955M1 10/01/201018341001 1110/01/2010 01 11300080 700 120ROOM-BOARD SEMI 1130.00 7 791000 250PHARMACY 178 122100 300LABORATORY 2 16365 420PHYSICAL THERAPY 26 166150 430OCCUPATION THERAPY 16 109050 001 1204665 00100101/01/2011THE LOOMIS CO Y Y 9999999999 000000000 18 9V5789 99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y V5789 9999999999 OB99999 LASTNAME FIRSTNAME 21 HOSPITAL NAME ADDRESS PHONE NUMBER............ 999999999 0111 99-999999910/01/201011/01/2010 LAS VEGAS NV89119 05/05/1955F2 10/01/201018341206 1110/01/2010 01 11300080 800 120ROOM-BOARD SEMI 1130.00 8 904000 250PHARMACY 134 92600 270MED-SURG SUPPLIES 7 116900 300LABORATORY 14 67655 420PHYSICAL THERAPY 45 281725 430OCCUPATION THERAPY 25 149125 001 1612005 00100101/01/2011CULINARY HEALTH FUND Y Y 9999999999 000000000 01 9V5789 99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y V5789 9999999999 OB99999 LASTNAME FIRSTNAME 21 HOSPITAL NAME ADDRESS PHONE NUMBER............ 999999999 0111 99-999999910/01/201011/01/2010 LAS VEGAS NV89119 05/05/1955M2 10/01/201022341406 1110/01/2010 01 11300080 500 120ROOM-BOARD SEMI 1130.00 5 565000 250PHARMACY 97 124000 300LABORATORY 4 29290 420PHYSICAL THERAPY 15 95400 430OCCUPATION THERAPY 33 201375 440SPEECH PATHOL 2 12600 001 1027665 00100101/01/2011CIGNA CIGNA YY YY 9999999999 000000000 1801 9V5789 99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y V5789 9999999999 OB99999 LASTNAME FIRSTNAME 2121 HOSPITAL NAME ADDRESS PHONE NUMBER............ 999999999 0111 99-999999910/01/201011/01/2010 LAS VEGAS NV89119 05/05/1955F2 10/01/201016341401 1110/01/2010 01 11300080 1100 120ROOM-BOARD SEMI 1130.00 11 1243000 250PHARMACY 179 140500 300LABORATORY 3 18490 420PHYSICAL THERAPY 17 107450 430OCCUPATION THERAPY 31 187400 440SPEECH PATHOL 20 132550 001 1829390 00100101/01/2011CIGNA CULINARY HEALTH FUND YY YY 9999999999 000000000 1801 9V5789 99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y V5789 9999999999 OB99999 LASTNAME FIRSTNAME 2121 HOSPITAL NAME ADDRESS PHONE NUMBER............ 999999999 0111 99-999999910/01/201011/01/2010 LAS VEGAS NV89119 05/05/1955M2 10/01/201017341206 1110/01/2010 01 11300080 1200 120ROOM-BOARD SEMI 1130.00 12 1356000 250PHARMACY 330 296500 270MED-SURG SUPPLIES 10 167000 300LABORATORY 7 48975 420PHYSICAL THERAPY 41 256800 430OCCUPATION THERAPY 44 273100 440SPEECH PATHOL 20 128825 001 2527200 00100101/01/2011CULINARY HEALTH FUND SENIOR DIMENSIONS YY YY 9999999999 000000000 1818 9V5789 99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y V5789 9999999999 OB99999 LASTNAME FIRSTNAME 2121 HOSPITAL NAME ADDRESS PHONE NUMBER............ 999999999 0111 99-999999910/01/201011/01/2010 LAS VEGAS NV89119 05/05/1955F2 10/01/201018340307 1110/01/2010 01 11300080 300 120ROOM-BOARD SEMI 1130.00 3 339000 250PHARMACY 37 20100 300LABORATORY 4 24890 420PHYSICAL THERAPY 8 56050 430OCCUPATION THERAPY 4 31400 001 471440 00100101/01/2011ZENITH ADMIN Y Y 9999999999 000000000 18 9V5789 99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y V5789 9999999999 OB99999 LASTNAME FIRSTNAME 21 HOSPITAL NAME ADDRESS PHONE NUMBER............ 999999999 0111 99-999999910/01/201011/01/2010 LAS VEGAS NV89119 05/05/1955F2 10/01/201014341006 1110/01/2010 01 11300080 700 120ROOM-BOARD SEMI 1130.00 7 791000 250PHARMACY 69 48094 300LABORATORY 3 18490 420PHYSICAL THERAPY 22 139850 430OCCUPATION THERAPY 24 149450 001 1146884 00100101/01/2011LOOMIS Y Y 9999999999 000000000 18 9V5789 99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y V5789 9999999999 OB99999 LASTNAME FIRSTNAME 21 HOSPITAL NAME ADDRESS PHONE NUMBER............ 999999999 0111 99-999999910/01/201011/01/2010 LAS VEGAS NV89119 05/05/1955F6 10/01/201018341503 0510/01/2010 01 11300080 2200 120ROOM-BOARD SEMI 1130.00 22 2486000 250PHARMACY 440 417000 270MED-SURG SUPPLIES 15 29250 300LABORATORY 7 86375 420PHYSICAL THERAPY 88 537500 430OCCUPATION THERAPY 102 652325 001 4208450 00100101/01/2011BC NON-CON MEDICARE PFF Y Y 9999999999 000000000 18 9V5789 99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y V5789 9999999999 OB99999 LASTNAME FIRSTNAME 22 HOSPITAL NAME ADDRESS PHONE NUMBER............ 999999999 0111 99-999999910/01/201011/01/2010 LAS VEGAS NV89119 05/05/1955F1 10/01/201018341206 1110/01/2010 01 11300080 600 120ROOM-BOARD SEMI 1130.00 6 678000 250PHARMACY 135 339100 300LABORATORY 6 170615 420PHYSICAL THERAPY 23 148625 430OCCUPATION THERAPY 18 115275 001 1451615 00100101/01/2011BCBS MEDICARE Y Y 9999999999 000000000 18 9V5789 99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y V5789 9999999999 OB99999 LASTNAME FIRSTNAME 27 HOSPITAL NAME ADDRESS PHONE NUMBER............ 999999999 0111 99-999999910/01/201011/01/2010 LAS VEGAS NV89119 05/05/1955F2 10/01/201016341706 0510/01/2010 01 11300080 1700 110ROOM-BOARD PVT 1130.00 17 1921000 250PHARMACY 409 549100 300LABORATORY 15 91965 320DX X-RAY 3 95600 420PHYSICAL THERAPY 77 443375 430OCCUPATION THERAPY 70 392325 440SPEECH PATHOL 15 93600 001 3586965 00100101/01/2011MEDICARE TRICARE FOR LIFE YY YY 9999999999 000000000 1818 9V5789 99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y V5789 9999999999 OB99999 LASTNAME FIRSTNAME 1019 HOSPITAL NAME ADDRESS PHONE NUMBER............ 999999999 0111 99-999999910/01/201011/01/2010 LAS VEGAS NV89119 05/05/1955F6 10/01/201011341306 1110/01/2010 01 11300080 800 110ROOM-BOARD PVT 1130.00 8 904000 250PHARMACY 161 226500 300LABORATORY 9 58155 320DX X-RAY 2 46500 420PHYSICAL THERAPY 24 141975 430OCCUPATION THERAPY 33 188425 440SPEECH PATHOL 13 88550 001 1654105 00100101/01/2011MEDICARE Y Y 9999999999 000000000 18 9V5789 99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y V5789 9999999999 OB99999 LASTNAME FIRSTNAME 10 HOSPITAL NAME ADDRESS PHONE NUMBER............ 999999999 0111 99-999999910/01/201011/01/2010 LAS VEGAS NV89119 05/05/1955F6 10/01/201019341703 1110/01/2010 01 11300080 1500 110ROOM-BOARD PVT 1130.00 15 1695000 250PHARMACY 383 484500 300LABORATORY 43 253415 320DX X-RAY 1 23950 420PHYSICAL THERAPY 31 195175 430OCCUPATION THERAPY 49 305925 440SPEECH PATHOL 11 73525 001 3031490 00100101/01/2011MEDICARE ZENITH ADMIN YY YY 9999999999 000000000 1818 9V5789 99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y V5789 9999999999 OB99999 LASTNAME FIRSTNAME 1021 HOSPITAL NAME ADDRESS PHONE NUMBER............ 999999999 0111 99-999999910/01/201011/01/2010 LAS VEGAS NV89119 05/05/1955F5 10/01/201016341803 1110/01/2010 01 11300080 2000 110ROOM-BOARD PVT 1130.00 20 2260000 250PHARMACY 429 599700 300LABORATORY 43 278755 320DX X-RAY 1 23950 420PHYSICAL THERAPY 83 481625 430OCCUPATION THERAPY 64 362900 440SPEECH PATHOL 26 166275 001 4173205 00100101/01/2011MEDICARE BLUE CROSS BLUE SHIELD YY YY 9999999999 000000000 1818 9V5789 99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y2768 Y V5789 9999999999 OB99999 LASTNAME FIRSTNAME 1021 HOSPITAL NAME ADDRESS PHONE NUMBER............ 999999999 0111 99-999999910/01/201011/01/2010 LAS VEGAS NV89119 05/05/1955M5 10/01/201016341703 1110/01/2010 01 11300080 1100 110ROOM-BOARD PVT 1130.00 11 1243000 250PHARMACY 375 242400 300LABORATORY 14 90455 320DX X-RAY 2 135050 420PHYSICAL THERAPY 52 316525 430OCCUPATION THERAPY 32 191925 440SPEECH PATHOL 4 31400 001 2250755 00100101/01/2011MEDICARE Y Y 9999999999 000000000 18 9V5789 99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y V5789 3893 10/01/2010 9999999999 OB99999 LASTNAME FIRSTNAME 1528059672 0B10806 PONNAIYA PAUL 10 HOSPITAL NAME ADDRESS PHONE NUMBER............ 999999999 0111 99-999999910/01/201011/01/2010 LAS VEGAS NV89119 05/05/1955F6 10/01/201018341703 1110/01/2010 01 11300080 700 110ROOM-BOARD PVT 1130.00 7 791000 250PHARMACY 108 164900 270MED-SURG SUPPLIES 4 106800 300LABORATORY 7 35540 320DX X-RAY 1 23950 420PHYSICAL THERAPY 17 111550 430OCCUPATION THERAPY 25 156050 440SPEECH PATHOL 16 102725 001 1492515 00100101/01/2011MEDICARE TRICARE FOR LIFE YY YY 9999999999 000000000 1818 9V5789 99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 YV1588 V5789 9999999999 OB99999 LASTNAME FIRSTNAME 1019 HOSPITAL NAME ADDRESS PHONE NUMBER............ 999999999 0111 99-999999910/01/201011/01/2010 LAS VEGAS NV89119 05/05/1955F2 10/01/201023341503 1110/01/2010 01 11300080 1500 110ROOM-BOARD PVT 1130.00 15 1695000 250PHARMACY 386 404068 300LABORATORY 6 38350 320DX X-RAY 3 98550 420PHYSICAL THERAPY 63 369950 430OCCUPATION THERAPY 83 466050 001 3071968 00100101/01/2011MEDICARE ZENITH ADMIN YY YY 9999999999 000000000 1801 9V5789 99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 YV1254 V5789 9999999999 OB99999 LASTNAME FIRSTNAME 1021 HOSPITAL NAME ADDRESS PHONE NUMBER............ 999999999 0111 99-999999910/01/201011/01/2010 LAS VEGAS NV89119 05/05/1955F2 10/01/201009341006 1110/01/2010 01 11300080 2400 110ROOM-BOARD PVT 1130.00 24 2712000 250PHARMACY 510 578900 300LABORATORY 5 41615 320DX X-RAY 1 24100 420PHYSICAL THERAPY 56 329325 430OCCUPATION THERAPY 65 376675 440SPEECH PATHOL 40 241825 001 4304440 00100101/01/2011MEDICARE TRICARE FOR LIFE YY YY 9999999999 000000000 1818 9V5789 99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y V5789 9999999999 OB99999 LASTNAME FIRSTNAME 1019 HOSPITAL NAME ADDRESS PHONE NUMBER............ 999999999 0111 99-999999910/01/201011/01/2010 LAS VEGAS NV89119 05/05/1955M1 10/01/201016341406 0510/01/2010 01 11300080 1100 110ROOM-BOARD PVT 1130.00 11 1243000 250PHARMACY 240 597000 300LABORATORY 49 262640 320DX X-RAY 3 111100 420PHYSICAL THERAPY 58 354775 430OCCUPATION THERAPY 47 288200 001 2856715 00100101/01/2011MEDICARE Y Y 9999999999 000000000 18 9V5789 99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y V5789 9999999999 OB99999 LASTNAME FIRSTNAME 10 HOSPITAL NAME ADDRESS PHONE NUMBER............ 999999999 0111 99-999999910/01/201011/01/2010 LAS VEGAS NV89119 05/05/1955F6 10/01/201018341603 1110/01/2010 01 11300080 1600 110ROOM-BOARD PVT 1130.00 16 1808000 250PHARMACY 358 442500 300LABORATORY 8 54390 420PHYSICAL THERAPY 73 447125 430OCCUPATION THERAPY 74 460850 001 3212865 00100101/01/2011MEDICARE MISC IP MEDICAID YY YY 9999999999 000000000 1818 9V5789 99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y V5789 9999999999 OB99999 LASTNAME FIRSTNAME 1017 HOSPITAL NAME ADDRESS PHONE NUMBER............ 999999999 0111 99-999999910/01/201011/01/2010 LAS VEGAS NV89119 05/05/1955M2 10/01/201020341401 1110/01/2010 01 11300080 400 110ROOM-BOARD PVT 1130.00 4 452000 250PHARMACY 60 86000 270MED-SURG SUPPLIES 3 50100 300LABORATORY 3 18390 420PHYSICAL THERAPY 21 134925 430OCCUPATION THERAPY 11 73725 001 815140 00100101/01/2011MEDICARE UNITED HEALTHCARE YY YY 9999999999 000000000 1818 9V5789 99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y V5789 9999999999 OB99999 LASTNAME FIRSTNAME 1021 HOSPITAL NAME ADDRESS PHONE NUMBER............ 999999999 0111 99-999999910/01/201011/01/2010 LAS VEGAS NV89119 05/05/1955F2 10/01/201017342302 1110/01/2010 01 11300080 100 110ROOM-BOARD PVT 1130.00 1 113000 250PHARMACY 5 17500 300LABORATORY 2 16365 420PHYSICAL THERAPY 7 47650 430OCCUPATION THERAPY 9 63325 001 257840 00100101/01/2011MEDICARE NEVADA MEDICAID YY YY 9999999999 000000000 1818 9V5789 99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y V5789 9999999999 OB99999 LASTNAME FIRSTNAME 1019 HOSPITAL NAME ADDRESS PHONE NUMBER............ 999999999 0111 99-999999910/01/201011/01/2010 LAS VEGAS NV89119 05/05/1955F2 10/01/201018341406 1110/01/2010 01 11300080 600 110ROOM-BOARD PVT 1130.00 6 678000 250PHARMACY 121 87500 300LABORATORY 14 105420 420PHYSICAL THERAPY 12 72300 430OCCUPATION THERAPY 10 61350 001 1004570 00100101/01/2011MEDICARE NEVADA MEDICAID YY YY 9999999999 000000000 1818 9V5789 99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y7993 YV1588 V5789 9999999999 OB99999 LASTNAME FIRSTNAME 1019 HOSPITAL NAME ADDRESS PHONE NUMBER............ 999999999 0111 99-999999910/01/201011/01/2010 LAS VEGAS NV89119 05/05/1955F6 10/01/201019341302 1110/01/2010 01 11300080 1500 110ROOM-BOARD PVT 1130.00 15 1695000 250PHARMACY 328 990480 300LABORATORY 15 99475 320DX X-RAY 1 50500 420PHYSICAL THERAPY 61 352525 430OCCUPATION THERAPY 73 421900 001 3609880 00100101/01/2011MEDICARE UMR YY YY 9999999999 000000000 1818 9V5789 99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y2724 YV1083 V5789 9999999999 OB99999 LASTNAME FIRSTNAME 1021 HOSPITAL NAME ADDRESS PHONE NUMBER............ 999999999 0111 99-999999910/01/201011/01/2010 LAS VEGAS NV89119 05/05/1955M1 10/01/201018341102 1110/01/2010 01 11300080 900 110ROOM-BOARD PVT 1130.00 9 1017000 250PHARMACY 126 175500 270MED-SURG SUPPLIES 8 213600 300LABORATORY 4 24890 320DX X-RAY 2 49150 420PHYSICAL THERAPY 28 156150 430OCCUPATION THERAPY 33 198125 001 1834415 00100101/01/2011MEDICARE TRICARE FOR LIFE YY YY 9999999999 000000000 1818 9V5789 99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y V5789 9999999999 OB99999 LASTNAME FIRSTNAME 1019 HOSPITAL NAME ADDRESS PHONE NUMBER............ 999999999 0111 99-999999910/01/201011/01/2010 LAS VEGAS NV89119 05/05/1955F6 10/01/201010342102 1110/01/2010 01 11300080 700 110ROOM-BOARD PVT 1130.00 7 791000 250PHARMACY 271 457212 300LABORATORY 5 34855 320DX X-RAY 3 83250 420PHYSICAL THERAPY 28 163800 430OCCUPATION THERAPY 46 262900 001 1793017 00100101/01/2011MEDICARE INSURANCE SERVICE CENTE YY YY 9999999999 000000000 1818 9V5789 99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y V5789 9999999999 OB99999 LASTNAME FIRSTNAME 1019 HOSPITAL NAME ADDRESS PHONE NUMBER............ 999999999 0111 99-999999910/01/201011/01/2010 LAS VEGAS NV89119 05/05/1955F2 10/01/201022341703 1110/01/2010 01 11300080 2300 110ROOM-BOARD PVT 1130.00 23 2599000 250PHARMACY 559 573000 300LABORATORY 14 90875 320DX X-RAY 3 111975 420PHYSICAL THERAPY 102 606950 430OCCUPATION THERAPY 91 536100 001 4517900 00100101/01/2011MEDICARE NEVADA MEDICAID YY YY 9999999999 000000000 1818 9V5789 99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y7812 Y V5789 9999999999 OB99999 LASTNAME FIRSTNAME 1017 HOSPITAL NAME ADDRESS PHONE NUMBER............ 999999999 0111 99-999999910/01/201011/01/2010 LAS VEGAS NV89119 05/05/1955F6 10/01/201019341401 0510/01/2010 01 11300080 1700 110ROOM-BOARD PVT 1130.00 17 1921000 250PHARMACY 346 555400 270MED-SURG SUPPLIES 12 320400 300LABORATORY 14 107685 420PHYSICAL THERAPY 65 390200 430OCCUPATION THERAPY 55 315025 440SPEECH PATHOL 18 115625 001 3725335 00100101/01/2011MEDICARE AARP HEALTHCARE OPTIONS YY YY 9999999999 000000000 1818 9V5789 99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y71590 Y43310 YV1588 Y V5789 9999999999 OB99999 LASTNAME FIRSTNAME 1019 HOSPITAL NAME ADDRESS PHONE NUMBER............ 999999999 0111 99-999999910/01/201011/01/2010 LAS VEGAS NV89119 05/05/1955M2 10/01/201016341006 1110/01/2010 01 11300080 700 110ROOM-BOARD PVT 1130.00 7 791000 250PHARMACY 136 169500 300LABORATORY 5 33240 420PHYSICAL THERAPY 19 122150 430OCCUPATION THERAPY 28 170950 001 1286840 00100101/01/2011MEDICARE NEVADA MEDICAID YY YY 9999999999 000000000 1818 9V5789 99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y V5789 9999999999 OB99999 LASTNAME FIRSTNAME 1017 HOSPITAL NAME ADDRESS PHONE NUMBER............ 999999999 0111 99-999999910/01/201011/01/2010 LAS VEGAS NV89119 05/05/1955F6 10/01/201018342202 0510/01/2010 01 11300080 600 110ROOM-BOARD PVT 1130.00 6 678000 250PHARMACY 102 111500 300LABORATORY 5 35890 320DX X-RAY 1 23950 420PHYSICAL THERAPY 20 129900 430OCCUPATION THERAPY 19 126525 440SPEECH PATHOL 12 79900 001 1185665 00100101/01/2011MEDICARE COUNTRY LIFE INSURANCE YY YY 9999999999 000000000 1818 9V5789 99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y V5789 9999999999 OB99999 LASTNAME FIRSTNAME 1019 HOSPITAL NAME ADDRESS PHONE NUMBER............ 999999999 0111 99-999999910/01/201011/01/2010 LAS VEGAS NV89119 05/05/1955F2 10/01/201020341006 1110/01/2010 01 11300080 900 110ROOM-BOARD PVT 1130.00 9 1017000 250PHARMACY 221 131500 300LABORATORY 5 25990 420PHYSICAL THERAPY 43 254825 430OCCUPATION THERAPY 26 153275 440SPEECH PATHOL 15 101700 001 1684290 00100101/01/2011MEDICARE CIGNA YY YY 9999999999 000000000 1818 9V5789 99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y7993 Y V5789 9999999999 OB99999 LASTNAME FIRSTNAME 1021 HOSPITAL NAME ADDRESS PHONE NUMBER............ 999999999 0111 99-999999910/01/201011/01/2010 LAS VEGAS NV89119 05/05/1955M2 10/01/201021341206 1110/01/2010 01 11300080 1200 110ROOM-BOARD PVT 1130.00 12 1356000 250PHARMACY 250 249100 300LABORATORY 17 72840 420PHYSICAL THERAPY 66 405625 430OCCUPATION THERAPY 59 364750 001 2448315 00100101/01/2011MEDICARE CIGNA TRICARE FOR LIFE YYYYYY 9999999999 000000000 181818 9V5789 99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y56400 Y49390 Y28860 YV5861 V5865 V5789 9999999999 OB99999 LASTNAME FIRSTNAME 102119 HOSPITAL NAME ADDRESS PHONE NUMBER............ 999999999 0111 99-999999910/01/201011/01/2010 LAS VEGAS NV89119 05/05/1955F6 10/01/201011341206 1110/01/2010 01 11300080 1100 110ROOM-BOARD PVT 1130.00 11 1243000 250PHARMACY 165 320000 300LABORATORY 4 24890 320DX X-RAY 1 23950 420PHYSICAL THERAPY 40 231275 430OCCUPATION THERAPY 45 258950 001 2102065 00100101/01/2011MEDICARE BLUE CROSS BLUE SHIELD YY YY 9999999999 000000000 1818 9V5789 99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y V5789 9999999999 OB99999 LASTNAME FIRSTNAME 1021 HOSPITAL NAME ADDRESS PHONE NUMBER............ 999999999 0111 99-999999910/01/201011/01/2010 LAS VEGAS NV89119 05/05/1955M2 10/01/201018341303 0510/01/2010 01 11300080 1700 110ROOM-BOARD PVT 1130.00 17 1921000 250PHARMACY 119 265800 300LABORATORY 7 50860 320DX X-RAY 4 111225 420PHYSICAL THERAPY 59 338025 430OCCUPATION THERAPY 75 444100 001 3131010 00100101/01/2011MEDICARE Y Y 9999999999 000000000 18 9V5789 99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y4019 Y V5789 9999999999 OB99999 LASTNAME FIRSTNAME 10 HOSPITAL NAME ADDRESS PHONE NUMBER............ 999999999 0111 99-999999910/01/201011/01/2010 LAS VEGAS NV89119 05/05/1955M2 10/01/201018341802 1110/01/2010 01 11300080 500 110ROOM-BOARD PVT 1130.00 5 565000 250PHARMACY 160 361034 300LABORATORY 4 34690 420PHYSICAL THERAPY 28 174550 430OCCUPATION THERAPY 15 98850 001 1234124 00100101/01/2011MEDICARE Y Y 9999999999 000000000 18 9V5789 99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y7993 Y V5789 3893 10/01/2010 9999999999 OB99999 LASTNAME FIRSTNAME 1528059672 0B10806 PONNAIYA PAUL 10 HOSPITAL NAME ADDRESS PHONE NUMBER............ 999999999 0111 99-999999910/01/201011/01/2010 LAS VEGAS NV89119 05/05/1955M2 10/01/201021341106 1110/01/2010 01 11300080 1200 110ROOM-BOARD PVT 1130.00 12 1356000 250PHARMACY 416 704698 300LABORATORY 5 35500 420PHYSICAL THERAPY 51 301200 430OCCUPATION THERAPY 42 251300 001 2648698 00100101/01/2011MEDICARE Y Y 9999999999 000000000 18 9V5789 99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y V5789 9999999999 OB99999 LASTNAME FIRSTNAME 10 HOSPITAL NAME ADDRESS PHONE NUMBER............ 999999999 0111 99-999999910/01/201011/01/2010 LAS VEGAS NV89119 05/05/1955M1 10/01/201012341906 1110/01/2010 01 11300080 1300 110ROOM-BOARD PVT 1130.00 13 1469000 250PHARMACY 234 291500 300LABORATORY 32 170210 420PHYSICAL THERAPY 54 316200 430OCCUPATION THERAPY 61 343650 001 2590560 00100101/01/2011MEDICARE Y Y 9999999999 000000000 18 9V5789 99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y V5789 9999999999 OB99999 LASTNAME FIRSTNAME 10 HOSPITAL NAME ADDRESS PHONE NUMBER............ 999999999 0111 99-999999910/01/201011/01/2010 LAS VEGAS NV89119 05/05/1955M5 10/01/201014341003 1110/01/2010 01 11300080 1300 110ROOM-BOARD PVT 1130.00 13 1469000 250PHARMACY 380 261500 300LABORATORY 25 112270 320DX X-RAY 1 23950 420PHYSICAL THERAPY 70 413875 430OCCUPATION THERAPY 49 279600 001 2560195 00100101/01/2011MEDICARE Y Y 9999999999 000000000 18 9V5789 99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y78830 Y2724 Y1122 Y V5789 9999999999 OB99999 LASTNAME FIRSTNAME 10 HOSPITAL NAME ADDRESS PHONE NUMBER............ 999999999 0111 99-999999910/01/201011/01/2010 LAS VEGAS NV89119 05/05/1955F6 10/01/201018341907 1110/01/2010 01 11300080 100 110ROOM-BOARD PVT 1130.00 1 113000 250PHARMACY 23 25500 300LABORATORY 3 18490 420PHYSICAL THERAPY 4 31400 430OCCUPATION THERAPY 4 31400 001 219790 00100101/01/2011MEDICARE Y Y 9999999999 000000000 18 9V5789 99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y V5789 9999999999 OB99999 LASTNAME FIRSTNAME 10 HOSPITAL NAME ADDRESS PHONE NUMBER............ 999999999 0111 99-999999910/01/201011/01/2010 LAS VEGAS NV89119 05/05/1955M2 10/01/201018341903 1110/01/2010 01 11300080 2700 110ROOM-BOARD PVT 1130.00 27 3051000 250PHARMACY 498 507500 300LABORATORY 44 197550 320DX X-RAY 1 23950 420PHYSICAL THERAPY 109 668425 430OCCUPATION THERAPY 74 471725 440SPEECH PATHOL 28 179125 001 5099275 00100101/01/2011MEDICARE AARP YY YY 9999999999 000000000 1818 9V5789 99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y V5789 9999999999 OB99999 LASTNAME FIRSTNAME 1019 HOSPITAL NAME ADDRESS PHONE NUMBER............ 999999999 0111 99-999999910/01/201011/01/2010 LAS VEGAS NV89119 05/05/1955F5 10/01/201015341206 1110/01/2010 01 11300080 1200 110ROOM-BOARD PVT 1130.00 12 1356000 250PHARMACY 238 296000 300LABORATORY 6 36320 320DX X-RAY 1 35350 420PHYSICAL THERAPY 45 276350 430OCCUPATION THERAPY 55 332300 001 2332320 00100101/01/2011MEDICARE AARP YY YY 9999999999 000000000 1818 9V5789 99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y3899 YV1582 V5789 9999999999 OB99999 LASTNAME FIRSTNAME 1019 HOSPITAL NAME ADDRESS PHONE NUMBER............ 999999999 0111 99-999999910/01/201011/01/2010 LAS VEGAS NV89119 05/05/1955F1 10/01/201016341606 1110/01/2010 01 11300080 500 110ROOM-BOARD PVT 1130.00 5 565000 250PHARMACY 99 99000 300LABORATORY 8 48925 320DX X-RAY 4 108300 420PHYSICAL THERAPY 26 158225 430OCCUPATION THERAPY 24 142225 001 1121675 00100101/01/2011MEDICARE AARP-HEALTHCARE OPTIONS YY YY 9999999999 000000000 1818 9V5789 99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y V5789 9999999999 OB99999 LASTNAME FIRSTNAME 1019 HOSPITAL NAME ADDRESS PHONE NUMBER............ 999999999 0111 99-999999910/01/201011/01/2010 LAS VEGAS NV89119 05/05/1955M2 10/01/201019341306 1110/01/2010 01 11300080 700 110ROOM-BOARD PVT 1130.00 7 791000 250PHARMACY 263 244700 300LABORATORY 15 76725 420PHYSICAL THERAPY 35 203425 430OCCUPATION THERAPY 34 200050 001 1515900 00100101/01/2011MEDICARE SOUTHWEST ADMINISTRATOR YY YY 9999999999 000000000 1818 9V5789 99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y V5789 9999999999 OB99999 LASTNAME FIRSTNAME 1019 HOSPITAL NAME ADDRESS PHONE NUMBER............ 999999999 0111 99-999999910/01/201011/01/2010 LAS VEGAS NV89119 05/05/1955F6 10/01/201017341106 1110/01/2010 01 11300080 600 110ROOM-BOARD PVT 1130.00 6 678000 250PHARMACY 73 103500 270MED-SURG SUPPLIES 5 83500 300LABORATORY 4 24890 420PHYSICAL THERAPY 37 228425 430OCCUPATION THERAPY 27 160075 001 1278390 00100101/01/2011MEDICARE BCBS FED EMPLOYEE YY YY 9999999999 000000000 1818 9V5789 99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y V5789 9999999999 OB99999 LASTNAME FIRSTNAME 1021 HOSPITAL NAME ADDRESS PHONE NUMBER............ 999999999 0111 99-999999910/01/201011/01/2010 LAS VEGAS NV89119 05/05/1955M6 10/01/201016341406 1110/01/2010 01 11300080 700 110ROOM-BOARD PVT 1130.00 7 791000 250PHARMACY 143 85000 300LABORATORY 18 99475 420PHYSICAL THERAPY 23 146700 430OCCUPATION THERAPY 24 154100 001 1276275 00100101/01/2011MEDICARE BLUE CROSS BLUE SHIELD YY YY 9999999999 000000000 1818 9V5789 99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y V5789 9999999999 OB99999 LASTNAME FIRSTNAME 1021 HOSPITAL NAME ADDRESS PHONE NUMBER............ 999999999 0111 99-999999910/01/201011/01/2010 LAS VEGAS NV89119 05/05/1955F2 10/01/201016341106 1110/01/2010 01 11300080 1100 110ROOM-BOARD PVT 1130.00 11 1243000 250PHARMACY 204 209500 300LABORATORY 3 18390 420PHYSICAL THERAPY 44 256750 430OCCUPATION THERAPY 58 330050 001 2057690 00100101/01/2011MEDICARE Y Y 9999999999 000000000 18 9V5789 99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y V5789 9999999999 OB99999 LASTNAME FIRSTNAME 10 HOSPITAL NAME ADDRESS PHONE NUMBER............ 999999999 0111 99-999999910/01/201011/01/2010 LAS VEGAS NV89119 05/05/1955F6 10/01/201020341102 1110/01/2010 01 11300080 700 110ROOM-BOARD PVT 1130.00 7 791000 250PHARMACY 235 652000 300LABORATORY 24 232445 320DX X-RAY 3 159000 420PHYSICAL THERAPY 11 73850 430OCCUPATION THERAPY 14 90250 440SPEECH PATHOL 19 136325 001 2134870 00100101/01/2011MEDICARE NEVADA MEDICAID YY YY 9999999999 000000000 1818 9V5789 99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y53081 Y3899 YV1254 V1588 51881 N V5789 3893 10/11/2010 9999999999 OB99999 LASTNAME FIRSTNAME 1528059672 0B10806 PONNAIYA PAUL 1017 HOSPITAL NAME ADDRESS PHONE NUMBER............ 999999999 0111 99-999999910/01/201011/01/2010 LAS VEGAS NV89119 05/05/1955F5 10/01/201018341106 0510/01/2010 01 11300080 900 110ROOM-BOARD PVT 1130.00 9 1017000 250PHARMACY 341 268600 300LABORATORY 7 50560 420PHYSICAL THERAPY 34 214350 430OCCUPATION THERAPY 31 198450 001 1748960 00100101/01/2011MEDICARE MEDICAID YY YY 9999999999 000000000 1818 9V5789 99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y V5789 9999999999 OB99999 LASTNAME FIRSTNAME 1019 HOSPITAL NAME ADDRESS PHONE NUMBER............ 999999999 0111 99-999999910/01/201011/01/2010 LAS VEGAS NV89119 05/05/1955M2 10/01/201021341803 1110/01/2010 01 11300080 2100 110ROOM-BOARD PVT 1130.00 21 2373000 220SPECIAL CHARGES 1 861200 250PHARMACY 528 1348500 300LABORATORY 13 158780 320DX X-RAY 1 111100 420PHYSICAL THERAPY 50 301100 430OCCUPATION THERAPY 71 424950 440SPEECH PATHOL 29 179950 001 5758580 00100101/01/2011MEDICARE AARP HEALTHCARE OPTIONS YY YY 9999999999 000000000 1818 9V5789 99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y V5789 3893 09/24/2010 9999999999 OB99999 LASTNAME FIRSTNAME 1019 HOSPITAL NAME ADDRESS PHONE NUMBER............ 999999999 0111 99-999999910/01/201011/01/2010 LAS VEGAS NV89119 05/05/1955F2 10/01/201017341206 1110/01/2010 01 11300080 1000 110ROOM-BOARD PVT 1130.00 10 1130000 250PHARMACY 336 290000 300LABORATORY 18 82265 320DX X-RAY 1 23950 420PHYSICAL THERAPY 41 245050 430OCCUPATION THERAPY 58 325525 001 2096790 00100101/01/2011MEDICARE BLUE CROSS BLUE SHIELD YY YY 9999999999 000000000 1818 9V5789 99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y49390 Y311 Y V5789 9999999999 OB99999 LASTNAME FIRSTNAME 1021 HOSPITAL NAME ADDRESS PHONE NUMBER............ 999999999 0111 99-999999910/01/201011/01/2010 LAS VEGAS NV89119 05/05/1955M2 10/01/201018341101 0510/01/2010 01 11300080 600 110ROOM-BOARD PVT 1130.00 6 678000 250PHARMACY 36 23500 300LABORATORY 6 39640 420PHYSICAL THERAPY 28 171450 430OCCUPATION THERAPY 23 136025 001 1048615 00100101/01/2011MEDICARE BEECH STREET YY YY 9999999999 000000000 1818 9V5789 99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y V5789 9999999999 OB99999 LASTNAME FIRSTNAME 1021 HOSPITAL NAME ADDRESS PHONE NUMBER............ 999999999 0111 99-999999910/01/201011/01/2010 LAS VEGAS NV89119 05/05/1955F6 10/01/201012341706 1110/01/2010 01 11300080 1400 110ROOM-BOARD PVT 1130.00 14 1582000 250PHARMACY 280 180000 300LABORATORY 29 135985 420PHYSICAL THERAPY 62 360650 430OCCUPATION THERAPY 64 378875 001 2637510 00100101/01/2011MEDICARE COVENTRY HEALTHCARE YY YY 9999999999 000000000 1818 9V5789 99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y V5789 9999999999 OB99999 LASTNAME FIRSTNAME 1021 HOSPITAL NAME ADDRESS PHONE NUMBER............ 999999999 0111 99-999999910/01/201011/01/2010 LAS VEGAS NV89119 05/05/1955F6 10/01/201016341103 0510/01/2010 01 11300080 1400 110ROOM-BOARD PVT 1130.00 14 1582000 250PHARMACY 289 395950 300LABORATORY 7 44805 420PHYSICAL THERAPY 50 310750 430OCCUPATION THERAPY 48 300200 001 2633705 00100101/01/2011MEDICARE AMERICAN REPUBLIC INSUR YY YY 9999999999 000000000 1818 9V5789 99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y V5789 9999999999 OB99999 LASTNAME FIRSTNAME 1019 HOSPITAL NAME ADDRESS PHONE NUMBER............ 999999999 0111 99-999999910/01/201011/01/2010 LAS VEGAS NV89119 05/05/1955F1 10/01/201016341306 1110/01/2010 01 11300080 800 110ROOM-BOARD PVT 1130.00 8 904000 250PHARMACY 132 230600 300LABORATORY 4 24890 420PHYSICAL THERAPY 28 167450 430OCCUPATION THERAPY 31 181925 001 1508865 00100101/01/2011MEDICARE AARP HEALTHCARE OPTIONS YY YY 9999999999 000000000 1818 9V5789 99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y V5789 9999999999 OB99999 LASTNAME FIRSTNAME 1019 HOSPITAL NAME ADDRESS PHONE NUMBER............ 999999999 0111 99-999999910/01/201011/01/2010 LAS VEGAS AZ89119 05/05/1955M1 10/01/201019341301 1110/01/2010 01 11300080 1300 110ROOM-BOARD PVT 1130.00 13 1469000 250PHARMACY 159 81500 300LABORATORY 11 53310 420PHYSICAL THERAPY 47 273375 430OCCUPATION THERAPY 61 350450 001 2227635 00100101/01/2011MEDICARE MUTUAL OF OMAHA YY YY 9999999999 000000000 1818 9V5789 99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y V5789 9999999999 OB99999 LASTNAME FIRSTNAME 1019 HOSPITAL NAME ADDRESS PHONE NUMBER............ 999999999 0111 99-999999910/01/201011/01/2010 LAS VEGAS NV89119 05/05/1955M2 10/01/201019341006 1110/01/2010 01 11300080 1400 110ROOM-BOARD PVT 1130.00 14 1582000 250PHARMACY 123 331400 300LABORATORY 4 24490 420PHYSICAL THERAPY 65 380100 430OCCUPATION THERAPY 80 451375 440SPEECH PATHOL 4 31400 001 2800765 00100101/01/2011MEDICARE TRICARE FOR LIFE YY YY 9999999999 000000000 1818 9V5789 99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y V5789 9999999999 OB99999 LASTNAME FIRSTNAME 1019 HOSPITAL NAME ADDRESS PHONE NUMBER............ 999999999 0111 99-999999910/01/201011/01/2010 LAS VEGAS NV89119 05/05/1955F5 10/01/201018341607 1110/01/2010 01 11300080 400 110ROOM-BOARD PVT 1130.00 4 452000 250PHARMACY 84 138500 300LABORATORY 6 30015 320DX X-RAY 1 35350 420PHYSICAL THERAPY 4 31400 430OCCUPATION THERAPY 8 59150 00100201/01/2011MEDICARE NEVADA MEDICAID YY YY 9999999999 000000000 1818 9V5789 99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y2875 YV462 496 Y30000 Y2449 Y V5789 9999999999 OB99999 LASTNAME FIRSTNAME 1019 REHAB HOSP OF DESERT CANY 999999999 99-999999910/01/201011/01/2010 LAS VEGAS 89119 05/05/1955 10/01 10/01 001 746415 002 01/01 9999999999 2761 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y 9999999999 OB99999 LASTNAME FIRSTNAME HOSPITAL NAME ADDRESS PHONE NUMBER............ 999999999 0111 99-999999910/01/201011/01/2010 LAS VEGAS NV89119 05/05/1955M2 10/01/201018341406 1110/01/2010 01 11300080 1300 110ROOM-BOARD PVT 1130.00 13 1469000 250PHARMACY 138 190000 300LABORATORY 18 133040 420PHYSICAL THERAPY 67 393600 430OCCUPATION THERAPY 47 265975 440SPEECH PATHOL 10 73575 001 2525190 00100101/01/2011MEDICARE Y Y 9999999999 000000000 18 9V5789 99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 YV1003 V1582 V5789 9999999999 OB99999 LASTNAME FIRSTNAME 10 HOSPITAL NAME ADDRESS PHONE NUMBER............ 999999999 0111 99-999999910/01/201011/01/2010 LAS VEGAS NV89119 05/05/1955M2 10/01/201018341603 1110/01/2010 01 11300080 1100 110ROOM-BOARD PVT 1130.00 11 1243000 250PHARMACY 240 293700 270MED-SURG SUPPLIES 9 150300 300LABORATORY 10 67040 320DX X-RAY 3 94650 420PHYSICAL THERAPY 55 338875 430OCCUPATION THERAPY 47 281625 001 2469190 00100101/01/2011MEDICARE BLUE CROSS BLUE SHIELD YY YY 9999999999 000000000 1818 9V5789 99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y V5789 9999999999 OB99999 LASTNAME FIRSTNAME 1021 HOSPITAL NAME ADDRESS PHONE NUMBER............ 999999999 0111 99-999999910/01/201011/01/2010 LAS VEGAS NV89119 05/05/1955M2 10/01/201017341001 1110/01/2010 01 11300080 1100 110ROOM-BOARD PVT 1130.00 11 1243000 250PHARMACY 249 315500 300LABORATORY 14 79370 420PHYSICAL THERAPY 54 314725 430OCCUPATION THERAPY 54 316650 001 2269245 00100101/01/2011MEDICARE ANTHEM BC OF NEVADA YY YY 9999999999 000000000 1818 9V5789 99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 YV1254 V5789 9999999999 OB99999 LASTNAME FIRSTNAME 1021 HOSPITAL NAME ADDRESS PHONE NUMBER............ 999999999 0111 99-999999910/01/201011/01/2010 LAS VEGAS NV89119 05/05/1955F6 10/01/201017341306 1110/01/2010 01 11300080 1800 110ROOM-BOARD PVT 1130.00 18 2034000 250PHARMACY 590 612000 270MED-SURG SUPPLIES 17 283900 300LABORATORY 9 59145 420PHYSICAL THERAPY 108 660050 430OCCUPATION THERAPY 73 444300 001 4093395 00100101/01/2011MEDICARE TRICARE FOR LIFE YY YY 9999999999 000000000 1818 9V5789 99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y V5789 9999999999 OB99999 LASTNAME FIRSTNAME 1019 HOSPITAL NAME ADDRESS PHONE NUMBER............ 999999999 0111 99-999999910/01/201011/01/2010 LAS VEGAS NV89119 05/05/1955F2 10/01/201021341006 1110/01/2010 01 11300080 700 110ROOM-BOARD PVT 1130.00 7 791000 250PHARMACY 162 200700 300LABORATORY 5 28850 420PHYSICAL THERAPY 32 198925 430OCCUPATION THERAPY 32 184100 001 1403575 00100101/01/2011MEDICARE AARP YY YY 9999999999 000000000 1818 9V5789 99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y V5789 9999999999 OB99999 LASTNAME FIRSTNAME 1019 HOSPITAL NAME ADDRESS PHONE NUMBER............ 999999999 0111 99-999999910/01/201011/01/2010 LAS VEGAS NV89119 05/05/1955F5 10/01/201016340901 1110/01/2010 01 11300080 900 110ROOM-BOARD PVT 1130.00 9 1017000 250PHARMACY 147 106900 300LABORATORY 4 24890 420PHYSICAL THERAPY 42 251350 430OCCUPATION THERAPY 26 157750 001 1557890 00100101/01/2011MEDICARE Y Y 9999999999 000000000 18 9V5789 99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y V5789 9999999999 OB99999 LASTNAME FIRSTNAME 10 HOSPITAL NAME ADDRESS PHONE NUMBER............ 999999999 0111 99-999999910/01/201011/01/2010 LAS VEGAS NV89119 05/05/1955M2 10/01/201015342103 1110/01/2010 01 11300080 1800 110ROOM-BOARD PVT 1130.00 18 2034000 250PHARMACY 373 562500 300LABORATORY 24 126335 320DX X-RAY 2 47900 420PHYSICAL THERAPY 74 456175 430OCCUPATION THERAPY 57 351750 440SPEECH PATHOL 17 116925 001 3695585 00100101/01/2011MEDICARE UMR YY YY 9999999999 000000000 1818 9V5789 99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 YV1253 V113 V1582 V5789 9999999999 OB99999 LASTNAME FIRSTNAME 1021 HOSPITAL NAME ADDRESS PHONE NUMBER............ 999999999 0111 99-999999910/01/201011/01/2010 LAS VEGAS NV89119 05/05/1955M2 10/01/201014341201 1110/01/2010 01 11300080 800 110ROOM-BOARD PVT 1130.00 8 904000 250PHARMACY 146 118200 300LABORATORY 2 16365 320DX X-RAY 1 24425 420PHYSICAL THERAPY 53 323925 430OCCUPATION THERAPY 30 193500 001 1580415 00100101/01/2011MEDICARE UMR ST OF NEVADA YY YY 9999999999 000000000 1818 9V5789 99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y V5789 9999999999 OB99999 LASTNAME FIRSTNAME 1021 HOSPITAL NAME ADDRESS PHONE NUMBER............ 999999999 0111 99-999999910/01/201011/01/2010 LAS VEGAS NV89119 05/05/1955F2 10/01/201017340906 0510/01/2010 01 11300080 1000 110ROOM-BOARD PVT 1130.00 10 1130000 250PHARMACY 161 256500 300LABORATORY 14 64555 320DX X-RAY 1 24100 420PHYSICAL THERAPY 35 201425 430OCCUPATION THERAPY 58 340125 001 2016705 00100101/01/2011MEDICARE UMR YY YY 9999999999 000000000 1818 9V5789 99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y V5789 9999999999 OB99999 LASTNAME FIRSTNAME 1021 HOSPITAL NAME ADDRESS PHONE NUMBER............ 999999999 0111 99-999999910/01/201011/01/2010 LAS VEGAS NV89119 05/05/1955F6 10/01/201022341906 1110/01/2010 01 11300080 2400 120ROOM-BOARD SEMI 1130.00 24 2712000 250PHARMACY 747 693900 270MED-SURG SUPPLIES 21 40950 300LABORATORY 26 199060 320DX X-RAY 2 59300 420PHYSICAL THERAPY 156 931250 430OCCUPATION THERAPY 110 653975 440SPEECH PATHOL 10 67300 001 5357735 00100101/01/2011SENIOR DIMENSIONS Y Y 9999999999 000000000 18 9V5789 99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y V5789 9999999999 OB99999 LASTNAME FIRSTNAME 21 HOSPITAL NAME ADDRESS PHONE NUMBER............ 999999999 0111 99-999999910/01/201011/01/2010 LAS VEGAS NV89119 05/05/1955F2 10/01/201017341401 1110/01/2010 01 11300080 800 120ROOM-BOARD SEMI 1130.00 8 904000 250PHARMACY 122 162589 300LABORATORY 4 32730 420PHYSICAL THERAPY 25 160675 430OCCUPATION THERAPY 29 184200 001 1444194 00100101/01/2011CIGNA Y Y 9999999999 000000000 18 9V5789 99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y V5789 9999999999 OB99999 LASTNAME FIRSTNAME 21 HOSPITAL NAME ADDRESS PHONE NUMBER............ 999999999 0111 99-999999910/01/201011/01/2010 LAS VEGAS NV89119 05/05/1955M2 10/01/201011341106 0510/01/2010 01 11300080 300 120ROOM-BOARD SEMI 1130.00 3 339000 250PHARMACY 61 56000 300LABORATORY 4 24890 420PHYSICAL THERAPY 15 100600 430OCCUPATION THERAPY 4 31400 001 551890 00100101/01/2011BLUE CROSS BLUE SHIELD Y Y 9999999999 000000000 18 9V5789 99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y V5789 9999999999 OB99999 LASTNAME FIRSTNAME 21 HOSPITAL NAME ADDRESS PHONE NUMBER............ 999999999 0111 99-999999910/01/201011/01/2010 LAS VEGAS NV89119 05/05/1955F1 10/01/201011341401 1110/01/2010 01 11300080 1100 110ROOM-BOARD PVT 1130.00 11 1243000 250PHARMACY 94 190500 300LABORATORY 2 16365 420PHYSICAL THERAPY 46 268450 430OCCUPATION THERAPY 61 346925 001 2065240 00100101/01/2011MEDICARE Y Y 9999999999 000000000 18 9V5789 99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y V5789 9999999999 OB99999 LASTNAME FIRSTNAME 10 HOSPITAL NAME ADDRESS PHONE NUMBER............ 999999999 0111 99-999999910/01/201011/01/2010 LAS VEGAS NV89119 05/05/1955F5 10/01/201020341001 1110/01/2010 01 11300080 500 120ROOM-BOARD SEMI 1130.00 5 565000 250PHARMACY 124 103800 300LABORATORY 4 24890 420PHYSICAL THERAPY 11 71575 430OCCUPATION THERAPY 31 186150 001 951415 00100101/01/2011BENEFIT CONCEPTS Y Y 9999999999 000000000 18 9V5789 99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y99999 Y V5789 9999999999 OB99999 LASTNAME FIRSTNAME 21