Check Register Detail
By Group Code Report Date: 12/30/2003
By Plan Report Period: 11-01-2003 to 11-30-2003 Paid
By Location
Check # Check Incurred Dates Received Claim Ben Emp Enr SSN Claimant Dep Payee BWH Check Reg Chk
Date Date Type Lastname Amt Typ Typ
Group: 99999
Plan: 99999A
Location: 0000
Benefit Type: %
0 00205737 2/3/2004 09/08/2003-09/08/2003 10/16/2003 3048069801 % DOE 123456789 JON e JUDY WOOD MD $0.00 ($389.09) j e
0 00208974 2/24/2004 09/25/2003-09/25/2003 10/31/2003 3049450401 % DOE 123456789 JON e JERRY MCCALL MD $0.00 ($91.42) j e
0 00213900 2/12/2004 07/20/2003-07/31/2003 11/21/2003 3040470303 % DOE 123456789 JON e TNPHA HOSPICE CARE TEAM $0.00 ($705.60) j e
0 00214758 2/24/2004 09/04/2003-09/05/2003 12/3/2003 3051892801 % DOE 123456789 JON 4 ODESSA REG HOSP $0.00 ($1,492.46) j e
0 00218529 2/12/2004 11/21/2003-11/21/2003 12/18/2003 3053431401 % DOE 123456789 JON e HEALTHSOUTH HOLDINGS INC $0.00 ($26.83) j e
0 00225618 2/2/2004 12/02/2003-12/02/2003 1/22/2004 4002927201 % DOE 123456789 JON e ROBERT K BECK MD $0.00 $4.55 c a
0 00225620 2/2/2004 12/08/2003-12/08/2003 1/22/2004 4002927501 % DOE 123456789 JON e PRAGUE MUNICIPAL HOSPITAL $0.00 $105.21 c a
0 00225653 2/2/2004 12/23/2003-12/23/2003 1/26/2004 4002972901 % DOE 123456789 JON e DAVID L WILLIAMS MD $0.00 $68.60 c a
0 00225654 2/2/2004 12/15/2003-12/15/2003 1/26/2004 4002973501 % DOE 123456789 JON 1 MED SELECT $0.00 $60.20 c a
0 00225681 2/2/2004 12/09/2003-12/09/2003 1/22/2004 4002991301 % DOE 123456789 JON s JANE WILKINS CST RN $0.00 $156.00 c a
0 00225692 2/2/2004 12/10/2003-12/10/2003 1/22/2004 4002995101 % DOE 123456789 JON e QUALITY ASSURED SERV $0.00 $1,064.28 c a
0 00225843 2/3/2004 10/03/2003-10/03/2003 1/30/2004 4003051201 % DOE 123456789 JON e ALDO A BATTISTE MD $0.00 $84.49 c a
0 00225844 2/3/2004 02/05/2003-02/21/2003 1/28/2004 4003053301 % DOE 123456789 JON 3 EVA L BLANEY AA IV $0.00 $124.95 c a
0 00225845 2/3/2004 01/07/2004-01/07/2004 1/30/2004 4003053501 % DOE 123456789 JON 2 FEUERBORN & MCCRORY LLC $0.00 $75.74 c a
0 00225849 2/3/2004 12/26/2003-12/26/2003 1/30/2004 4003055501 % DOE 123456789 JON s EMAD HANNA MD $0.00 $378.00 c a
0 00225856 2/3/2004 01/02/2004-01/02/2004 1/30/2004 4003063001 % DOE 123456789 JON s MARK VIETTI MD $0.00 $18.77 c a
0 00225857 2/3/2004 01/02/2004-01/02/2004 1/30/2004 4003063501 % DOE 123456789 JON s MARK VIETTI MD $0.00 $54.97 c a
0 00225898 2/3/2004 01/03/2004-01/03/2004 1/28/2004 4003096601 % DOE 123456789 JON s JOSHUA WILLIFOORD PA $0.00 $728.53 c a
0 00225899 2/3/2004 01/06/2004-01/06/2004 1/28/2004 4003100501 % DOE 123456789 JON s WHITE ROCK OBSTETRICS & G $0.00 $12.60 c a
0 00225900 2/3/2004 01/06/2004-01/06/2004 1/28/2004 4003101301 % DOE 123456789 JON s WHITE ROCK OBSTETRICS & G $0.00 $71.51 c a
0 00225901 2/3/2004 01/09/2004-01/09/2004 1/28/2004 4003102501 % DOE 123456789 JON s WHITE ROCK OBSTETRICS & G $0.00 $1,860.60 c a
0 00225902 2/3/2004 10/04/2003-10/14/2003 1/28/2004 4003103801 % DOE 123456789 JON 1 MARTHA AGUILAR MD $0.00 $223.44 c a
0 00225916 2/3/2004 01/14/2004-01/14/2004 1/29/2004 4003123901 % DOE 123456789 JON s RD MEDICAL $0.00 $33.60 c a
0 00226039 2/4/2004 12/24/2003-12/24/2003 1/28/2004 4003180401 % DOE 123456789 JON e THE SURGERY CENTER $0.00 $840.00 c a
0 00226050 2/4/2004 12/19/2003-12/19/2003 2/2/2004 4003195101 % DOE 123456789 JON e PAULA LEWIS DO PLLC $0.00 $199.85 c a
0 00226051 2/4/2004 11/21/2003-11/21/2003 2/2/2004 4003195901 % DOE 123456789 JON e PAULA LEWIS DO PLLC $0.00 $428.40 c a
0 00226059 2/4/2004 10/21/2003-10/21/2003 2/2/2004 4003198601 % DOE 123456789 JON 1 JERRY W DODSON MD $0.00 $26.50 c a
0 00226388 2/5/2004 01/14/2004-01/14/2004 1/30/2004 4003333601 % DOE 123456789 JON 2 BURNS MD/DIANNA M $0.00 $188.08 c a
0 00226452 2/5/2004 12/01/2003-12/15/2003 1/28/2004 4003371601 % DOE 123456789 JON e HOME HEALTH SERV OF NEVAD $0.00 $989.25 c a
0 00226463 2/6/2004 12/12/2003-12/12/2003 2/3/2004 4001666302 % DOE 123456789 JON 2 FEUERBORN & MCCRORY LLC $0.00 $63.00 c a
0 00226571 2/6/2004 12/12/2003-12/12/2003 1/28/2004 4003419001 % DOE 123456789 JON s JOLLY MD/ANN $0.00 $35.00 c a
0 00226573 2/6/2004 10/21/2003-10/21/2003 1/28/2004 4003419801 % DOE 123456789 JON s MARK W HAGER MD $0.00 $1,595.75 c a
0 00226579 2/6/2004 12/18/2003-12/18/2003 1/28/2004 4003424001 % DOE 123456789 JON e TRAVIS CONKLIN OPAC $0.00 $717.50 c a
0 00226618 2/6/2004 12/16/2003-12/31/2003 1/29/2004 4003448701 % DOE 123456789 JON e HOME HEALTH SERV OF NEVAD $0.00 $1,049.89 c a
0 00227224 2/10/2004 10/22/2003-10/22/2003 2/2/2004 4003702401 % DOE 123456789 JON s KATHRYN FERRY MD $0.00 $16.59 c a
0 00227225 2/10/2004 01/07/2004-01/07/2004 2/2/2004 4003702701 % DOE 123456789 JON e REYNALDO RODRIGUEZ $0.00 $833.00 c a
0 00227249 2/10/2004 11/10/2003-11/10/2003 2/4/2004 4003715501 % DOE 123456789 JON e JOHN RAMSEY MD $0.00 $48.57 c a
0 00227250 2/10/2004 12/05/2003-12/05/2003 2/4/2004 4003716601 % DOE 123456789 JON e JOHN RAMSEY MD $0.00 $69.38 c a
0 00227368 2/10/2004 12/03/2003-12/03/2003 2/4/2004 4003762201 % DOE 123456789 JON 1 LAKE GRANBURY MEDICAL CEN $0.00 $210.46 c a
0 00227369 2/10/2004 12/03/2003-12/03/2003 2/4/2004 4003762701 % DOE 123456789 JON 3 LAKE GRANBURY MEDICAL CEN $0.00 $58.51 c a
0 00227422 2/10/2004 08/05/2003-08/05/2003 2/5/2004 4003779201 % DOE 123456789 JON s PRIYA PHILIP MD $0.00 $34.02 c a
0 00227423 2/10/2004 08/05/2003-08/05/2003 2/5/2004 4003779501 % DOE 123456789 JON s PRIYA PHILIP MD $0.00 $23.80 c a
0 00227424 2/10/2004 08/05/2003-08/05/2003 2/5/2004 4003779701 % DOE 123456789 JON s PRIYA PHILIP MD $0.00 $91.35 c a
0 00227835 2/12/2004 12/15/2003-12/19/2003 2/11/2004 4002409402 % DOE 123456789 JON 1 ANDREW R UTSINGER PT $0.00 $47.29 c a
0 00227836 2/12/2004 12/22/2003-12/29/2003 2/11/2004 4002456202 % DOE 123456789 JON 1 ANDREW R UTSINGER PT $0.00 $141.21 c a
0 00227840 2/12/2004 01/02/2004-01/09/2004 2/11/2004 4003048602 % DOE 123456789 JON 1 ANDREW R UTSINGER PT $0.00 $157.43 c a
0 00227985 2/12/2004 12/30/2003-01/29/2004 2/4/2004 4004028701 % DOE 123456789 JON s RS MEDICAL $0.00 $72.10 c a
0 00228141 2/13/2004 01/08/2004-01/09/2004 2/9/2004 4004097701 % DOE 123456789 JON e HOMER MD/KEVIN S $0.00 $48.40 c a
0 00228142 2/13/2004 01/09/2004-01/12/2004 2/9/2004 4004097901 % DOE 123456789 JON e HOMER MD/KEVIN S $0.00 $40.50 c a
0 00228367 2/16/2004 01/05/2004-01/05/2004 2/4/2004 4004234001 % DOE 123456789 JON s ST JOSEPH EMS $0.00 $206.40 c a
0 00228619 2/16/2004 01/12/2004-01/12/2004 2/11/2004 4004352701 % DOE 123456789 JON s SOUTHWEST CARDIAC ASSOCIA $0.00 $14.00 c a
0 00228820 2/17/2004 01/16/2004-01/16/2004 2/5/2004 4004386401 % DOE 123456789 JON s ROBERT MIDDENDORF $0.00 $28.35 c a
0 00228944 2/17/2004 01/16/2004-01/16/2004 2/10/2004 4004441401 % DOE 123456789 JON 1 JANITA M ARDIS MD $0.00 $25.00 c a
0 00228971 2/18/2004 09/26/2003-09/26/2003 2/18/2004 3049449302 % DOE 123456789 JON e PAGE C JORDAN MD $0.00 $141.72 c a
0 00228972 2/18/2004 10/31/2003-10/31/2003 2/18/2004 3051870502 % DOE 123456789 JON e BENJAMIN A LAMPERT $0.00 $168.43 c a
0 00228974 2/18/2004 12/02/2003-12/02/2003 2/18/2004 4001690402 % DOE 123456789 JON e ST JOHNS REG HEALTH CTR $0.00 $539.49 c a
0 00228980 2/18/2004 01/07/2004-01/07/2004 2/18/2004 4003714302 % DOE 123456789 JON e OZARK MAGNETIC IMAGING IN $0.00 $656.88 c a
0 00229362 2/19/2004 12/31/2003-12/31/2003 2/17/2004 4004692501 % DOE 123456789 JON s MILLER MD/JOHN K $0.00 $25.20 c a
0 00229409 2/20/2004 01/06/2004-01/07/2004 2/9/2004 4004097601 % DOE 123456789 JON e HOMER MD/KEVIN S $0.00 $26.60 c a
0 00229421 2/20/2004 01/06/2004-01/06/2004 2/11/2004 4004351901 % DOE 123456789 JON s ODESSA REG HOSP $0.00 $524.92 c a
0 00229502 2/20/2004 01/14/2004-01/14/2004 2/17/2004 4004718501 % DOE 123456789 JON s PRIYA PHILIP MD $0.00 $37.80 c a
0 00230023 2/24/2004 12/19/2003-12/31/2003 2/17/2004 4004987001 % DOE 123456789 JON s JOLLY MD/ANN $0.00 $263.25 c a
0 00230270 2/25/2004 12/15/2003-01/14/2004 2/16/2004 4005081601 % DOE 123456789 JON e RS MEDICAL $0.00 $37.80 c a
0 00230271 2/25/2004 01/26/2004-01/26/2004 2/18/2004 4005081901 % DOE 123456789 JON e DANIEL WILLIAMS MD $0.00 $43.93 c a
0 00230300 2/25/2004 01/19/2004-01/19/2004 2/18/2004 4005105601 % DOE 123456789 JON 3 RHONDA WARD PT $0.00 $16.84 c a
0 00230326 2/25/2004 12/08/2003-12/08/2003 2/17/2004 4005121301 % DOE 123456789 JON s PAMELA HWANG MD $0.00 $23.70 c a
0 00230355 2/25/2004 01/16/2004-01/16/2004 2/18/2004 4005141201 % DOE 123456789 JON s MARC T DICKER PHD RPA $0.00 $63.75 c a
0 00230391 2/25/2004 01/30/2004-01/30/2004 2/19/2004 4005181601 % DOE 123456789 JON s RS MEDICAL $0.00 $33.60 c a
0 00230413 2/26/2004 12/03/2003-12/07/2003 2/9/2004 3052002601 % DOE 123456789 JON s LAKE GRANBURY MEDICAL CEN $0.00 $26,626.82 c a
0 00230802 2/27/2004 01/26/2004-01/26/2004 2/20/2004 4005355601 % DOE 123456789 JON s JOHN M BOUTTE PHD $0.00 $84.38 c a
0 00230803 2/27/2004 01/28/2004-01/28/2004 2/20/2004 4005355801 % DOE 123456789 JON s RS MEDICAL $0.00 $51.60 c a
0 00230897 2/27/2004 11/14/2003-12/13/2003 2/20/2004 4005428401 % DOE 123456789 JON s RS MEDICAL $0.00 $62.10 c a
nochk0025722 2/6/2004 09/24/2003-09/24/2003 10/15/2003 3048038701 % DOE 123456789 JON 2 MICHAEL J FRANK MD $0.00 $0.00 j e
nochk0026374 2/19/2004 10/02/2003-10/02/2003 10/28/2003 3049099401 % DOE 123456789 JON 2 MARIA R GUAJARDO MD $0.00 $0.00 j e
nochk0026904 2/12/2004 09/29/2003-09/29/2003 11/4/2003 3049948801 % DOE 123456789 JON e EMCARE HTN EMERGENCY PHYS $0.00 $0.00 j e
nochk0027578 2/12/2004 09/05/2003-09/05/2003 11/11/2003 3050828701 % DOE 123456789 JON e ARNOLD O&P INC $0.00 $0.00 j e
nochk0028252 2/6/2004 11/04/2003-11/04/2003 11/24/2003 3051768201 % DOE 123456789 JON s Y. ALYSSA KIM MD $0.00 $0.00 j e
nochk0029246 2/19/2004 11/20/2003-11/20/2003 12/16/2003 3053149901 % DOE 123456789 JON 2 MARIA R GUAJARDO MD $0.00 $0.00 j e
nochk0029779 2/12/2004 11/26/2003-11/26/2003 12/23/2003 4000547501 % DOE 123456789 JON 2 MARIA R GUAJARDO MD $0.00 $0.00 j e
nochk0031347 2/2/2004 01/02/2004-01/02/2004 1/21/2004 4002480101 % DOE 123456789 JON s STEFANI WYLIE PT $0.00 $0.00 z a
nochk0031348 2/2/2004 01/05/2004-01/05/2004 1/22/2004 4002583601 % DOE 123456789 JON s STEFANI WYLIE PT $0.00 $0.00 z a
nochk0031398 2/2/2004 12/16/2003-12/16/2003 1/28/2004 4002991701 % DOE 123456789 JON e RAY A INNIS MD $0.00 $0.00 z a
nochk0031399 2/2/2004 01/06/2004-01/06/2004 1/28/2004 4002993801 % DOE 123456789 JON s RALPH F COX MD $0.00 $0.00 z a
nochk0031405 2/2/2004 12/03/2003-12/03/2003 1/28/2004 4002997501 % DOE 123456789 JON s ROBERT KAUFFMAN MD $0.00 $0.00 z a
nochk0031438 2/3/2004 01/02/2004-01/02/2004 1/26/2004 4003048101 % DOE 123456789 JON s BEATRIZ TAMAYO MD $0.00 $0.00 z a
nochk0031439 2/3/2004 01/02/2004-01/09/2004 1/30/2004 4003048601 % DOE 123456789 JON 1 ANDREW R UTSINGER PT $0.00 $0.00 z a
nochk0031440 2/3/2004 01/11/2004-01/11/2004 1/30/2004 4003050801 % DOE 123456789 JON s P GABOS $0.00 $0.00 z a
nochk0031442 2/3/2004 12/17/2003-12/17/2003 1/30/2004 4003054401 % DOE 123456789 JON s JAMES JONES $0.00 $0.00 z a
nochk0031443 2/3/2004 07/02/2003-07/02/2003 1/30/2004 4003056001 % DOE 123456789 JON s JAMES DREES $0.00 $0.00 z a
nochk0031444 2/3/2004 07/02/2003-07/02/2003 1/30/2004 4003056401 % DOE 123456789 JON s JAMES DREES $0.00 $0.00 z a
nochk0031446 2/3/2004 01/03/2004-01/04/2004 1/30/2004 4003058501 % DOE 123456789 JON s HARRIS MD/RICHARD L $0.00 $0.00 z a
nochk0031447 2/3/2004 01/06/2004-01/06/2004 1/30/2004 4003064201 % DOE 123456789 JON s ALAN R GAVECK DPM $0.00 $0.00 z a
nochk0031448 2/3/2004 01/06/2004-01/06/2004 1/30/2004 4003065101 % DOE 123456789 JON 1 ALAN R GAVECK DPM $0.00 $0.00 z a
nochk0031449 2/3/2004 01/08/2004-01/08/2004 1/30/2004 4003066001 % DOE 123456789 JON s BRAY, WILLIAM P., DC $0.00 $0.00 z a
nochk0031467 2/3/2004 01/11/2004-01/11/2004 1/28/2004 4003105001 % DOE 123456789 JON 2 NORTHWEST MEDICAL GROUP $0.00 $0.00 z a
nochk0031601 2/5/2004 06/10/2003-06/10/2003 1/30/2004 4003332701 % DOE 123456789 JON e FAJTORA MD/TIMOTHY C $0.00 $0.00 z a
nochk0031602 2/5/2004 10/28/2003-10/28/2003 1/30/2004 4003334501 % DOE 123456789 JON e RICHARD BARTLETT $0.00 $0.00 z a
nochk0031625 2/5/2004 12/27/2003-12/29/2003 1/28/2004 4003366801 % DOE 123456789 JON s SHAILESH DHADUK MD $0.00 $0.00 z a
nochk0031626 2/5/2004 12/30/2003-12/30/2003 1/28/2004 4003367101 % DOE 123456789 JON s SHAILESH DHADUK MD $0.00 $0.00 z a
nochk0031627 2/5/2004 12/31/2003-12/31/2003 1/28/2004 4003367301 % DOE 123456789 JON s SHAILESH DHADUK MD $0.00 $0.00 z a
nochk0031628 2/5/2004 01/01/2004-01/02/2004 1/28/2004 4003367901 % DOE 123456789 JON s SHAILESH DHADUK MD $0.00 $0.00 z a
nochk0031631 2/5/2004 10/17/2003-10/17/2003 1/28/2004 4003372401 % DOE 123456789 JON s ST MARYS HOSPITAL $0.00 $0.00 z a
nochk0031687 2/6/2004 08/21/2003-08/21/2003 1/28/2004 4003424601 % DOE 123456789 JON s JOSEPH VIERNOW DC $0.00 $0.00 z a
nochk0031689 2/6/2004 01/07/2003-01/24/2003 1/28/2004 4003427401 % DOE 123456789 JON 3 EVA L BLANEY AA IV $0.00 $0.00 z a
nochk0031793 2/9/2004 10/20/2003-10/21/2003 2/2/2004 4003640501 % DOE 123456789 JON s JOHN L SMART $0.00 $0.00 z a
nochk0031854 2/10/2004 01/09/2004-01/09/2004 2/4/2004 4003709101 % DOE 123456789 JON s CHARLES R JAYNES MD $0.00 $0.00 z a
nochk0031855 2/10/2004 01/08/2004-01/08/2004 2/4/2004 4003709701 % DOE 123456789 JON s JOHN T FOWLER MD $0.00 $0.00 z a
nochk0031862 2/10/2004 01/07/2004-01/07/2004 2/4/2004 4003714301 % DOE 123456789 JON e OZARK MAGNETIC IMAGING IN $0.00 $0.00 z a
nochk0031863 2/10/2004 01/12/2004-01/12/2004 2/4/2004 4003716401 % DOE 123456789 JON e JOHN RAMSEY MD $0.00 $0.00 z a
nochk0031899 2/10/2004 12/29/2003-01/05/2004 2/5/2004 4003779101 % DOE 123456789 JON s BRAZOS LUNG ASSOCIATION L $0.00 $0.00 z a
nochk0032013 2/12/2004 12/10/2003-12/12/2003 2/11/2004 4001610302 % DOE 123456789 JON 1 ANDREW R UTSINGER PT $0.00 $0.00 z a
nochk0032054 2/12/2004 01/11/2004-01/11/2004 2/5/2004 4003989701 % DOE 123456789 JON 2 CHRIST HOSPITAL $0.00 $0.00 z a
nochk0032077 2/12/2004 01/06/2004-01/06/2004 2/4/2004 4004018601 % DOE 123456789 JON s ERROL K DRAPER $0.00 $0.00 z a
nochk0032078 2/12/2004 01/09/2004-01/09/2004 2/4/2004 4004018801 % DOE 123456789 JON s ERROL K DRAPER $0.00 $0.00 z a
nochk0032079 2/12/2004 12/05/2003-12/05/2003 2/4/2004 4004019301 % DOE 123456789 JON 3 EVA L BLANEY AA IV $0.00 $0.00 z a
nochk0032149 2/13/2004 07/30/2003-07/30/2003 2/4/2004 4004108201 % DOE 123456789 JON e LAURA WRIGHT PT $0.00 $0.00 z a
nochk0032150 2/13/2004 08/18/2003-08/18/2003 2/4/2004 4004109401 % DOE 123456789 JON e LAURA WRIGHT PT $0.00 $0.00 z a
nochk0032154 2/13/2004 09/27/2002-09/27/2002 2/9/2004 4004118701 % DOE 123456789 JON 1 LLANO MEMORIAL HOSP EMERG $0.00 $0.00 z a
nochk0032258 2/16/2004 10/11/2003-10/11/2003 2/11/2004 4004352401 % DOE 123456789 JON 2 THOMAS PETERS MD $0.00 $0.00 z a
nochk0032259 2/16/2004 10/11/2003-10/11/2003 2/11/2004 4004352501 % DOE 123456789 JON 1 THOMAS PETERS MD $0.00 $0.00 z a
nochk0032355 2/17/2004 12/31/2003-12/31/2003 2/10/2004 4004441001 % DOE 123456789 JON 2 MID AMERICA RADIOLOGY $0.00 $0.00 z a
nochk0032356 2/17/2004 01/13/2004-01/13/2004 2/10/2004 4004441101 % DOE 123456789 JON e JAMES DARROW $0.00 $0.00 z a
nochk0032357 2/17/2004 01/19/2004-01/19/2004 2/10/2004 4004441201 % DOE 123456789 JON e HAROLD MILLER $0.00 $0.00 z a
nochk0032358 2/17/2004 01/08/2004-01/08/2004 2/10/2004 4004441301 % DOE 123456789 JON 3 BRADLEY CHASTANT $0.00 $0.00 z a
nochk0032359 2/17/2004 10/30/2003-10/30/2003 2/10/2004 4004441501 % DOE 123456789 JON s JOHN L SEIFERT MD $0.00 $0.00 z a
nochk0032360 2/17/2004 01/16/2004-01/16/2004 2/10/2004 4004441701 % DOE 123456789 JON e GARY ROBERTS $0.00 $0.00 z a
nochk0032367 2/18/2004 01/08/2004-01/08/2004 2/18/2004 4003066002 % DOE 123456789 JON s BRAY, WILLIAM P., DC $0.00 $0.00 z a
nochk0032405 2/18/2004 12/28/2003-12/28/2003 2/13/2004 4004517601 % DOE 123456789 JON e KYLE GROOM DO $0.00 $0.00 z a
nochk0032408 2/18/2004 01/08/2004-01/09/2004 2/10/2004 4004527201 % DOE 123456789 JON e J BARRANCO PT $0.00 $0.00 z a
nochk0032415 2/18/2004 10/17/2003-10/17/2003 2/12/2004 4004536801 % DOE 123456789 JON e WILLIAM J STROHMAN MD $0.00 $0.00 z a
nochk0032516 2/19/2004 01/08/2004-01/08/2004 2/17/2004 4004691101 % DOE 123456789 JON e JOHN R OWEN MD $0.00 $0.00 z a
nochk0032582 2/20/2004 10/22/2003-10/22/2003 2/17/2004 4004716801 % DOE 123456789 JON s KAY MORRIS MD $0.00 $0.00 z a
nochk0032583 2/20/2004 01/20/2004-01/20/2004 2/17/2004 4004717601 % DOE 123456789 JON e HALL DC/NORMAN J $0.00 $0.00 z a
nochk0032584 2/20/2004 02/28/2003-02/28/2003 2/17/2004 4004719301 % DOE 123456789 JON s TRI LE DPM $0.00 $0.00 z a
nochk0032789 2/25/2004 12/05/2003-12/05/2003 2/18/2004 4005096901 % DOE 123456789 JON s CARLTON PITTARD MD $0.00 $0.00 z a
nochk0032790 2/25/2004 01/21/2004-01/21/2004 2/18/2004 4005098001 % DOE 123456789 JON 3 RHONDA WARD PT $0.00 $0.00 z a
nochk0032796 2/25/2004 01/06/2004-01/06/2004 2/17/2004 4005120601 % DOE 123456789 JON e CENLA HEART SPECIALISTS $0.00 $0.00 z a
nochk0032824 2/25/2004 01/13/2004-01/13/2004 2/19/2004 4005179901 % DOE 123456789 JON 3 JEFFREY D SCHUSTER $0.00 $0.00 z a
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nochk0032835 2/26/2004 01/12/2004-01/12/2004 2/4/2004 4003708101 % DOE 123456789 JON s STEFANI WYLIE PT $0.00 $0.00 z a
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nochk0032885 2/26/2004 01/05/2004-01/05/2004 2/18/2004 4005288901 % DOE 123456789 JON e BENJAMIN A LAMPERT $0.00 $0.00 z a
nochk0032897 2/26/2004 01/26/2004-01/26/2004 2/20/2004 4005317201 % DOE 123456789 JON 3 RHONDA WARD PT $0.00 $0.00 z a
nopay0004367 2/24/2004 09/04/2003-09/05/2003 2/24/2004 3051892802 % DOE 123456789 JON 4 ODESSA REG HOSP $0.00 $1,492.46 n a
Total Ben Type: % $0.00 $41,641.49
Benefit Type: D
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nochk0032992 2/27/2004 12/30/2003-12/30/2003 2/24/2004 4005455701 D DOE 123456789 JANE 1 KAREN ROBERTSON DDS $0.00 $0.00 z a
nopay0004346 2/6/2004 08/08/2003-08/08/2003 2/6/2004 4001713303 D DOE 123456789 JANE s ELIOT YEO DDS $0.00 $85.00 n a
Total Ben Type: D $0.00 $82,991.86
Benefit Type: FM
0 00228609 2/16/2004 01/16/2004-01/18/2004 2/11/2004 4004350201 FM DOE 123456789 JON e MUHAMMAD J MOTIWALA MD $0.00 $179.22 c a
0 00228610 2/16/2004 01/15/2004-01/15/2004 2/11/2004 4004350301 FM DOE 123456789 JON e MUHAMMAD J MOTIWALA MD $0.00 $52.84 c a
0 00229068 2/18/2004 01/23/2004-01/23/2004 2/13/2004 4004509301 FM DOE 123456789 JON 1 MARYRITA K MALLET MD $0.00 $39.16 c a
0 00229078 2/18/2004 01/20/2004-01/20/2004 2/13/2004 4004514301 FM DOE 123456789 JON s BRAZOS LUNG ASSOCIATION L $0.00 $45.84 c a
0 00229121 2/18/2004 11/19/2003-11/19/2003 2/12/2004 4004536401 FM DOE 123456789 JON e THOMAS COSTELLO MD $0.00 $86.32 c a
0 00229294 2/19/2004 01/21/2004-01/22/2004 2/16/2004 4004657301 FM DOE 123456789 JON e MUHAMMAD J MOTIWALA MD $0.00 $105.68 c a
0 00229353 2/19/2004 01/09/2004-02/08/2004 2/16/2004 4004685601 FM DOE 123456789 JON s P A BURKE $0.00 $200.99 c a
0 00229354 2/19/2004 12/09/2003-01/08/2004 2/16/2004 4004685901 FM DOE 123456789 JON s P A BURKE $0.00 $334.99 c a
0 00229394 2/20/2004 10/29/2003-10/31/2003 1/5/2004 4001604301 FM DOE 123456789 JON e THE FAMILY $0.00 $3,405.75 c a
0 00229483 2/20/2004 01/16/2004-01/16/2004 2/11/2004 4004703201 FM DOE 123456789 JON s DAVID S KARDATZKE $0.00 $51.57 c a
0 00229484 2/20/2004 01/20/2004-01/20/2004 2/11/2004 4004703301 FM DOE 123456789 JON e CHARLES M REPA DDS $0.00 $30.80 c a
0 00229491 2/20/2004 01/23/2004-01/23/2004 2/16/2004 4004711301 FM DOE 123456789 JON e MUHAMMAD J MOTIWALA MD $0.00 $52.84 c a
0 00229492 2/20/2004 12/31/2003-12/31/2003 2/16/2004 4004711401 FM DOE 123456789 JON e JOZEF VERHAERT DC $0.00 $48.18 c a
0 00229493 2/20/2004 01/07/2004-01/07/2004 2/16/2004 4004711501 FM DOE 123456789 JON 2 ONNA J EARLE $0.00 $405.21 c a
0 00230030 2/24/2004 01/01/2004-01/02/2004 2/17/2004 4004995701 FM DOE 123456789 JON 3 VIA CHRISTI REG MED CT $0.00 $1,967.98 c a
0 00230077 2/24/2004 01/15/2004-01/15/2004 2/18/2004 4005020201 FM DOE 123456789 JON e YUNPYO SOHN $0.00 $8.27 c a
0 00230116 2/24/2004 01/23/2004-01/23/2004 2/18/2004 4005032001 FM DOE 123456789 JON s ROBERT STEVENSON MD $0.00 $129.07 c a
0 00230120 2/24/2004 01/16/2004-01/16/2004 2/18/2004 4005032801 FM DOE 123456789 JON e ANANT MAUSKAR MD PA $0.00 $2.80 c a
0 00230121 2/24/2004 01/12/2004-01/12/2004 2/18/2004 4005033201 FM DOE 123456789 JON e ANANT MAUSKAR MD PA $0.00 $17.51 c a
0 00230123 2/24/2004 01/09/2004-01/09/2004 2/18/2004 4005033701 FM DOE 123456789 JON e ANANT MAUSKAR MD PA $0.00 $319.38 c a
0 00230176 2/24/2004 01/09/2004-01/09/2004 2/20/2004 4005062601 FM DOE 123456789 JON 3 RICK G WRIGHT DO $0.00 $42.57 c a
0 00230330 2/25/2004 02/04/2004-02/04/2004 2/19/2004 4005122801 FM DOE 123456789 JON 1 JANITA M ARDIS MD $0.00 $32.09 c a
0 00230389 2/25/2004 01/26/2004-01/26/2004 2/19/2004 4005177501 FM DOE 123456789 JON s F PAREDES $0.00 $1.78 c a
0 00230415 2/26/2004 11/01/2003-11/07/2003 1/5/2004 4001604701 FM DOE 123456789 JON e THE FAMILY $0.00 $7,946.75 c a
0 00230416 2/26/2004 12/01/2003-12/05/2003 1/5/2004 4001607001 FM DOE 123456789 JON e THE FAMILY $0.00 $2,731.25 c a
0 00230582 2/26/2004 02/03/2004-02/03/2004 2/20/2004 4005293201 FM DOE 123456789 JON e MUHAMMAD J MOTIWALA MD $0.00 $73.54 c a
nochk0032397 2/18/2004 01/09/2004-01/09/2004 2/12/2004 4004478601 FM DOE 123456789 JON 1 MATTHEW J BUECHE MD $0.00 $0.00 z a
nochk0032402 2/18/2004 11/23/2003-11/23/2003 2/13/2004 4004513701 FM DOE 123456789 JON e DANIEL A MACKAY MD $0.00 $0.00 z a
nochk0032403 2/18/2004 01/16/2004-01/16/2004 2/13/2004 4004516101 FM DOE 123456789 JON 1 M N ALMOUIE MD $0.00 $0.00 z a
nochk0032404 2/18/2004 01/19/2004-01/19/2004 2/13/2004 4004516801 FM DOE 123456789 JON e CRAIG BARTON RPT $0.00 $0.00 z a
nochk0032413 2/18/2004 01/23/2004-01/23/2004 2/12/2004 4004535501 FM DOE 123456789 JON s FEUERBORN & MCCRORY LLC $0.00 $0.00 z a
nochk0032414 2/18/2004 01/23/2004-01/23/2004 2/12/2004 4004536001 FM DOE 123456789 JON s BILLY M EDEN MD $0.00 $0.00 z a
nochk0032444 2/19/2004 01/11/2004-01/11/2004 2/11/2004 4004574701 FM DOE 123456789 JON s KARIN ANDERSON MD $0.00 $0.00 z a
nochk0032447 2/19/2004 09/15/2003-09/15/2003 2/12/2004 4004579301 FM DOE 123456789 JON s RED RIVER VALLEY RADIOLOG $0.00 $0.00 z a
nochk0032481 2/19/2004 06/03/2003-06/03/2003 2/16/2004 4004656401 FM DOE 123456789 JON s BLAKEMAN DO/SCOT T $0.00 $0.00 z a
nochk0032482 2/19/2004 01/08/2004-01/08/2004 2/16/2004 4004657901 FM DOE 123456789 JON e JOZEF VERHAERT DC $0.00 $0.00 z a
nochk0032483 2/19/2004 08/05/2003-08/05/2003 2/16/2004 4004658301 FM DOE 123456789 JON e RANDALL W WILDS DC $0.00 $0.00 z a
nochk0032484 2/19/2004 08/04/2003-08/04/2003 2/16/2004 4004659201 FM DOE 123456789 JON e RANDALL W WILDS DC $0.00 $0.00 z a
nochk0032764 2/24/2004 02/06/2004-02/06/2004 2/20/2004 4005062501 FM DOE 123456789 JON e INTERNAL MED ASC OF SANTA $0.00 $0.00 z a
nochk0032797 2/25/2004 10/05/2003-10/05/2003 2/19/2004 4005121201 FM DOE 123456789 JON e MICHAEL T MOORE MD $0.00 $0.00 z a
nochk0032800 2/25/2004 01/26/2004-01/26/2004 2/19/2004 4005122401 FM DOE 123456789 JON s IL BALKCOM IV MD $0.00 $0.00 z a
nochk0032802 2/25/2004 02/02/2004-02/02/2004 2/19/2004 4005123001 FM DOE 123456789 JON s FEUERBORN & MCCRORY LLC $0.00 $0.00 z a
nochk0032803 2/25/2004 01/25/2004-01/25/2004 2/19/2004 4005123201 FM DOE 123456789 JON e ROBERT GONZALES MD $0.00 $0.00 z a
nochk0032804 2/25/2004 02/02/2004-02/02/2004 2/19/2004 4005123301 FM DOE 123456789 JON e JOHN P SHEA $0.00 $0.00 z a
nochk0032806 2/25/2004 01/26/2004-01/26/2004 2/19/2004 4005123801 FM DOE 123456789 JON 1 JILL WAGGONER $0.00 $0.00 z a
nochk0032821 2/25/2004 01/23/2004-01/29/2004 2/19/2004 4005177001 FM DOE 123456789 JON s BRAY, WILLIAM P., DC $0.00 $0.00 z a
nochk0032822 2/25/2004 01/29/2004-01/29/2004 2/19/2004 4005177201 FM DOE 123456789 JON e BRADLEY CORBIN $0.00 $0.00 z a
nochk0032935 2/27/2004 10/05/2003-10/05/2003 2/26/2004 4005121202 FM DOE 123456789 JON e MICHAEL T MOORE MD $0.00 $0.00 z a
nochk0032957 2/27/2004 01/16/2004-01/16/2004 2/20/2004 4005354501 FM DOE 123456789 JON e DAVID DOLEZAL $0.00 $0.00 z a
Total Ben Type: FM $0.00 $18,312.38
Benefit Type: M
0 00127182 2/3/2004 08/28/2002-08/28/2002 9/18/2002 2086762101 M DOE 123456789 JANE s BELINDA BROADYSYMES $0.00 ($53.05) j e
0 00135999 2/20/2004 09/14/2002-09/14/2002 11/7/2002 2092561302 M DOE 123456789 JANE 2 JAMES GREGORY $0.00 ($17.58) r g
0 00139564 2/24/2004 10/17/2002-10/17/2002 11/18/2002 2104859801 M DOE 123456789 JANE e CARY HERNANDEZ MD $0.00 ($9.10) j e
0 00151193 2/20/2004 12/03/2002-12/06/2002 1/10/2003 3004353401 M DOE 123456789 JANE s MCALLEN MEDICAL CRT ACUTE $0.00 ($713.52) r h
0 00154942 2/20/2004 12/19/2002-12/19/2002 1/27/2003 3009066801 M DOE 123456789 JANE s MCALLEN MEDICAL CRT ACUTE $0.00 ($612.04) r h
0 00166043 2/9/2004 03/10/2003-03/10/2003 3/17/2003 3021365501 M DOE 123456789 JANE s GIBBS MD/MARK E $0.00 ($106.18) r g
0 00167152 2/9/2004 03/14/2003-03/14/2003 3/20/2003 3022428101 M DOE 123456789 JANE s MCLEROY MD/ROBERT R $0.00 ($37.75) r g
0 00169259 2/9/2004 03/26/2003-03/26/2003 4/1/2003 3024718701 M DOE 123456789 JANE s MCLEROY MD/ROBERT R $0.00 ($37.75) r g
0 00173948 2/9/2004 04/08/2003-04/08/2003 4/28/2003 3029260101 M DOE 123456789 JANE s DAVID T LARSEN MD $0.00 ($164.05) r g
0 00180538 2/25/2004 01/16/2003-01/16/2003 6/2/2003 3035088001 M DOE 123456789 JANE 2 BAIR MD/STUART A $0.00 ($37.50) j e
0 00180540 2/25/2004 01/29/2003-01/29/2003 6/2/2003 3035089101 M DOE 123456789 JANE 2 BAIR MD/STUART A $0.00 ($37.50) j e
0 00180541 2/25/2004 02/10/2003-02/10/2003 6/2/2003 3035089301 M DOE 123456789 JANE 2 BAIR MD/STUART A $0.00 ($37.50) j e
0 00180542 2/25/2004 04/18/2003-04/18/2003 6/2/2003 3035089901 M DOE 123456789 JANE 2 BAIR MD/STUART A $0.00 ($30.00) j e
0 00186655 2/20/2004 06/17/2003-06/17/2003 6/30/2003 3039506301 M DOE 123456789 JANE s THOMAS NEUSCHATZ MD $0.00 ($28.48) r g
0 00192218 2/12/2004 07/18/2003-07/18/2003 8/5/2003 3041930701 M DOE 123456789 JANE e MICHAEL PARISH MD $0.00 ($464.84) j e
0 00192327 2/9/2004 04/08/2003-04/08/2003 8/11/2003 3026368502 M DOE 123456789 JANE s ROBERT MENDONSA $0.00 ($146.42) r g
0 00192328 2/9/2004 04/22/2003-04/22/2003 8/11/2003 3030128802 M DOE 123456789 JANE s SURGERY CENTER OF LEWISVI $0.00 ($711.90) r g
0 00192329 2/9/2004 04/08/2003-04/08/2003 8/11/2003 3032954502 M DOE 123456789 JANE s IMAGING SPECIALISTS $0.00 ($2,790.00) r g
0 00192330 2/9/2004 04/25/2003-04/30/2003 8/11/2003 3033011202 M DOE 123456789 JANE s GAINESVILLE MEMORIAL HOSP $0.00 ($353.77) r g
0 00192331 2/9/2004 04/22/2003-04/22/2003 8/11/2003 3033049402 M DOE 123456789 JANE s ALAN W CARRUTH MD PA $0.00 ($288.00) r g
0 00192334 2/9/2004 05/05/2003-05/07/2003 8/11/2003 3039647602 M DOE 123456789 JANE s GAINESVILLE MEMORIAL HOSP $0.00 ($172.80) r g
0 00192527 2/9/2004 04/17/2003-04/17/2003 8/11/2003 3029261002 M DOE 123456789 JANE s ROBERT MENDONSA $0.00 ($103.22) r g
0 00192530 2/9/2004 04/22/2003-04/22/2003 8/11/2003 3031303502 M DOE 123456789 JANE s ROBERT MENDONSA $0.00 ($1,786.76) r g
0 00195071 2/23/2004 10/01/2001-10/02/2001 8/26/2003 1104179903 M DOE 123456789 JANE e NORTH HILLS HOSPITAL $0.00 ($521.30) r h
0 00196150 2/24/2004 08/11/2003-08/11/2003 8/27/2003 3043639101 M DOE 123456789 JANE e PHYSICIANS EMERGENCY CARE $0.00 ($193.50) j e
0 00196193 2/19/2004 07/09/2003-07/11/2003 9/3/2003 3042825802 M DOE 123456789 JANE s CURTIS WITT MS PT $0.00 ($80.00) j e
0 00196699 2/3/2004 08/18/2003-08/18/2003 8/29/2003 3043875301 M DOE 123456789 JANE e INSIGHT DIAGNOSTIC CENTER $0.00 ($70.00) j e
0 00197003 2/3/2004 08/26/2003-08/26/2003 9/2/2003 3043961601 M DOE 123456789 JANE s RENAISSANCE PHY MIDWEST C $0.00 ($46.68) j e
0 00203334 2/12/2004 09/25/2003-09/26/2003 10/6/2003 3046748301 M DOE 123456789 JANE s HARRIS METHODIST HEB HOSP $0.00 ($520.75) j e
0 00208989 2/24/2004 10/28/2003-10/28/2003 10/31/2003 3049453001 M DOE 123456789 JANE s RYAN KLEMENT LPT $0.00 ($51.00) j e
0 00209329 2/6/2004 07/17/2003-07/17/2003 10/31/2003 3049555101 M DOE 123456789 JANE e MATTHEW WAY $0.00 ($259.00) j e
0 00211570 2/9/2004 11/06/2003-11/06/2003 11/12/2003 3050647301 M DOE 123456789 JANE s CLINICAL PATHOLOGY LABS $0.00 ($12.60) r g
0 00211582 2/4/2004 10/24/2003-10/24/2003 11/10/2003 3050656601 M DOE 123456789 JANE 1 CAROLYN CARTWRIGHT $0.00 ($513.00) j e
0 00211610 2/9/2004 11/05/2003-11/05/2003 11/12/2003 3050671101 M DOE 123456789 JANE s ROBERT MCLEROY $0.00 ($37.75)