Covered Entity Details

DSH160058BP UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER (Active) - information as of 5/6/2025 12:02:20 AM

Main Details

Name

UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER

Subdivision Name

UNIVERSITY OF IOWA HEALTH CARE - IRL ORTHOPAEDIC SPORTS MED

Type

Disproportionate Share Hospital

Rural

340B ID

DSH160058BP

Medicare Provider Number

160058

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

1/12/2024

Participating Start Date

4/1/2024

Participating Approval Date

2/12/2024

Last Recertification Date

8/19/2024

Contacts

Authorizing Official

University of Iowa Health Care
Michael Brownlee, Chief Pharmacy Officer
(319) 384-9371

Primary Contact

University of Iowa Health Care
Becky Marie Triplett, Manager, 340B and Compliance
(319) 384-5583

Addresses

Street Address

105 East 9th Street
Coralville, IA 52241-2209

Billing Address

University of Iowa Accounts Payable
202 PCO
Iowa City, IA 52242

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
No records to display.

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
Yes

State	Medicaid Number	NPI Number
IA	0260927,0501847,0600585,0713967	1093790578,1114905387,1174845101,1194035436,1265433676,1265523062,1275048217,1275534620,1285635235,1306304027,1326589482,1346386513,1376544320,1386809457,1437295607,1477554814,1508858127,1548248321,1629054846,1629219498,1639157415,1730180761,1811246473,1811984636,1841346970,1881679371,1972588465,1982799045,1578639126,1114732559,1932904927
IL	426004813001,426004813002,426004813007,426004813401	1093790578,1114905387,1174845101,1194035436,1265433676,1265523062,1275048217,1275534620,1285635235,1306304027,1326589482,1346386513,1376544320,1386809457,1437295607,1477554814,1508858127,1548248321,1629054846,1629219498,1639157415,1730180761,1811246473,1811984636,1841346970,1881679371,1972588465,1982799045,1578639126,1114732559,1932904927
AK	1005657	1376544320,1508858127,1811246473,1306304027,1730180761,1285635235,1265433676,1275534620,1477554814,1811984636,1114905387,1548248321,1093790578,1629054846,1639157415,1972588465,1881679371,1841346970,1437295607,1346386513,1194035436,1386809457,1629219498,1326589482,1275048217,1174845101,1982799045,1265523062,1578639126,1114732559,1932904927
AL	UNI0058N	1376544320,1508858127,1811246473,1306304027,1730180761,1285635235,1265433676,1275534620,1477554814,1811984636,1114905387,1548248321,1093790578,1629054846,1639157415,1972588465,1881679371,1841346970,1437295607,1346386513,1194035436,1386809457,1629219498,1326589482,1275048217,1174845101,1982799045,1265523062,1578639126,1114732559,1932904927
AR	108932105	1376544320,1508858127,1811246473,1306304027,1730180761,1285635235,1265433676,1275534620,1477554814,1811984636,1114905387,1548248321,1093790578,1629054846,1639157415,1972588465,1881679371,1841346970,1437295607,1346386513,1194035436,1386809457,1629219498,1326589482,1275048217,1174845101,1982799045,1265523062,1578639126,1114732559,1932904927
AZ	022773	1376544320,1508858127,1811246473,1306304027,1730180761,1285635235,1265433676,1275534620,1477554814,1811984636,1114905387,1548248321,1093790578,1629054846,1639157415,1972588465,1881679371,1841346970,1437295607,1346386513,1194035436,1386809457,1629219498,1326589482,1275048217,1174845101,1982799045,1265523062,1578639126,1114732559,1932904927
CA	10056587,800249545,800249546	1376544320,1508858127,1811246473,1306304027,1730180761,1285635235,1265433676,1275534620,1477554814,1811984636,1114905387,1548248321,1093790578,1629054846,1639157415,1972588465,1881679371,1841346970,1437295607,1346386513,1194035436,1386809457,1629219498,1326589482,1275048217,1174845101,1982799045,1265523062,1578639126,1114732559,1932904927
CO	1376544320,95004032	1376544320,1508858127,1811246473,1306304027,1730180761,1285635235,1265433676,1275534620,1477554814,1811984636,1114905387,1548248321,1093790578,1629054846,1639157415,1972588465,1881679371,1841346970,1437295607,1346386513,1194035436,1386809457,1629219498,1326589482,1275048217,1174845101,1982799045,1265523062,1578639126,1114732559,1932904927
CT	003101590,003031614	1376544320,1508858127,1811246473,1306304027,1730180761,1285635235,1265433676,1275534620,1477554814,1811984636,1114905387,1548248321,1093790578,1629054846,1639157415,1972588465,1881679371,1841346970,1437295607,1346386513,1194035436,1386809457,1629219498,1326589482,1275048217,1174845101,1982799045,1265523062,1578639126,1114732559,1932904927
DE	000571306	1376544320,1508858127,1811246473,1306304027,1730180761,1285635235,1265433676,1275534620,1477554814,1811984636,1114905387,1548248321,1093790578,1629054846,1639157415,1972588465,1881679371,1841346970,1437295607,1346386513,1194035436,1386809457,1629219498,1326589482,1275048217,1174845101,1982799045,1265523062,1578639126,1114732559,1932904927
FL	109271900	1376544320,1508858127,1811246473,1306304027,1730180761,1285635235,1265433676,1275534620,1477554814,1811984636,1114905387,1548248321,1093790578,1629054846,1639157415,1972588465,1881679371,1841346970,1437295607,1346386513,1194035436,1386809457,1629219498,1326589482,1275048217,1174845101,1982799045,1265523062,1578639126,1114732559,1932904927
GA	00354615Y	1376544320,1508858127,1811246473,1306304027,1730180761,1285635235,1265433676,1275534620,1477554814,1811984636,1114905387,1548248321,1093790578,1629054846,1639157415,1972588465,1881679371,1841346970,1437295607,1346386513,1194035436,1386809457,1629219498,1326589482,1275048217,1174845101,1982799045,1265523062,1578639126,1114732559,1932904927
HI	53564303	1376544320,1508858127,1811246473,1306304027,1730180761,1285635235,1265433676,1275534620,1477554814,1811984636,1114905387,1548248321,1093790578,1629054846,1639157415,1972588465,1881679371,1841346970,1437295607,1346386513,1194035436,1386809457,1629219498,1326589482,1275048217,1174845101,1982799045,1265523062,1578639126,1114732559,1932904927
ID	000336300	1376544320,1508858127,1811246473,1306304027,1730180761,1285635235,1265433676,1275534620,1477554814,1811984636,1114905387,1548248321,1093790578,1629054846,1639157415,1972588465,1881679371,1841346970,1437295607,1346386513,1194035436,1386809457,1629219498,1326589482,1275048217,1174845101,1982799045,1265523062,1578639126,1114732559,1932904927
IN	300063132	1376544320,1508858127,1811246473,1306304027,1730180761,1285635235,1265433676,1275534620,1477554814,1811984636,1114905387,1548248321,1093790578,1629054846,1639157415,1972588465,1881679371,1841346970,1437295607,1346386513,1194035436,1386809457,1629219498,1326589482,1275048217,1174845101,1982799045,1265523062,1578639126,1114732559,1932904927
KS	100245160A,30003896540001,30003896540003	1376544320,1508858127,1811246473,1306304027,1730180761,1285635235,1265433676,1275534620,1477554814,1811984636,1114905387,1548248321,1093790578,1629054846,1639157415,1972588465,1881679371,1841346970,1437295607,1346386513,1194035436,1386809457,1629219498,1326589482,1275048217,1174845101,1982799045,1265523062,1578639126,1114732559,1932904927
KY	01350222	1376544320,1508858127,1811246473,1306304027,1730180761,1285635235,1265433676,1275534620,1477554814,1811984636,1114905387,1548248321,1093790578,1629054846,1639157415,1972588465,1881679371,1841346970,1437295607,1346386513,1194035436,1386809457,1629219498,1326589482,1275048217,1174845101,1982799045,1265523062,1578639126,1114732559,1932904927
LA	1741345	1376544320,1508858127,1811246473,1306304027,1730180761,1285635235,1265433676,1275534620,1477554814,1811984636,1114905387,1548248321,1093790578,1629054846,1639157415,1972588465,1881679371,1841346970,1437295607,1346386513,1194035436,1386809457,1629219498,1326589482,1275048217,1174845101,1982799045,1265523062,1578639126,1114732559,1932904927
MA	110010615F	1376544320,1508858127,1811246473,1306304027,1730180761,1285635235,1265433676,1275534620,1477554814,1811984636,1114905387,1548248321,1093790578,1629054846,1639157415,1972588465,1881679371,1841346970,1437295607,1346386513,1194035436,1386809457,1629219498,1326589482,1275048217,1174845101,1982799045,1265523062,1578639126,1114732559,1932904927
MD	398765500	1376544320,1508858127,1811246473,1306304027,1730180761,1285635235,1265433676,1275534620,1477554814,1811984636,1114905387,1548248321,1093790578,1629054846,1639157415,1972588465,1881679371,1841346970,1437295607,1346386513,1194035436,1386809457,1629219498,1326589482,1275048217,1174845101,1982799045,1265523062,1578639126,1114732559,1932904927
ME	174800000	1376544320,1508858127,1811246473,1306304027,1730180761,1285635235,1265433676,1275534620,1477554814,1811984636,1114905387,1548248321,1093790578,1629054846,1639157415,1972588465,1881679371,1841346970,1437295607,1346386513,1194035436,1386809457,1629219498,1326589482,1275048217,1174845101,1982799045,1265523062,1578639126,1114732559,1932904927
MI	404608162,304608153	1376544320,1508858127,1811246473,1306304027,1730180761,1285635235,1265433676,1275534620,1477554814,1811984636,1114905387,1548248321,1093790578,1629054846,1639157415,1972588465,1881679371,1841346970,1437295607,1346386513,1194035436,1386809457,1629219498,1326589482,1275048217,1174845101,1982799045,1265523062,1578639126,1114732559,1932904927
MN	128847400,49207,1765544320	1376544320,1508858127,1811246473,1306304027,1730180761,1285635235,1265433676,1275534620,1477554814,1811984636,1114905387,1548248321,1093790578,1629054846,1639157415,1972588465,1881679371,1841346970,1437295607,1346386513,1194035436,1386809457,1629219498,1326589482,1275048217,1174845101,1982799045,1265523062,1578639126,1114732559,1932904927
MO	1376544320	1376544320,1508858127,1811246473,1306304027,1730180761,1285635235,1265433676,1275534620,1477554814,1811984636,1114905387,1548248321,1093790578,1629054846,1639157415,1972588465,1881679371,1841346970,1437295607,1346386513,1194035436,1386809457,1629219498,1326589482,1275048217,1174845101,1982799045,1265523062,1578639126,1114732559,1932904927
MS	02857378	1376544320,1508858127,1811246473,1306304027,1730180761,1285635235,1265433676,1275534620,1477554814,1811984636,1114905387,1548248321,1093790578,1629054846,1639157415,1972588465,1881679371,1841346970,1437295607,1346386513,1194035436,1386809457,1629219498,1326589482,1275048217,1174845101,1982799045,1265523062,1578639126,1114732559,1932904927
MT	0416936	1376544320,1508858127,1811246473,1306304027,1730180761,1285635235,1265433676,1275534620,1477554814,1811984636,1114905387,1548248321,1093790578,1629054846,1639157415,1972588465,1881679371,1841346970,1437295607,1346386513,1194035436,1386809457,1629219498,1326589482,1275048217,1174845101,1982799045,1265523062,1578639126,1114732559,1932904927
NC	1376544320	1376544320,1508858127,1811246473,1306304027,1730180761,1285635235,1265433676,1275534620,1477554814,1811984636,1114905387,1548248321,1093790578,1629054846,1639157415,1972588465,1881679371,1841346970,1437295607,1346386513,1194035436,1386809457,1629219498,1326589482,1275048217,1174845101,1982799045,1265523062,1578639126,1114732559,1932904927
ND	02227	1376544320,1508858127,1811246473,1306304027,1730180761,1285635235,1265433676,1275534620,1477554814,1811984636,1114905387,1548248321,1093790578,1629054846,1639157415,1972588465,1881679371,1841346970,1437295607,1346386513,1194035436,1386809457,1629219498,1326589482,1275048217,1174845101,1982799045,1265523062,1578639126,1114732559,1932904927
NE	426004813-00	1376544320,1508858127,1811246473,1306304027,1730180761,1285635235,1265433676,1275534620,1477554814,1811984636,1114905387,1548248321,1093790578,1629054846,1639157415,1972588465,1881679371,1841346970,1437295607,1346386513,1194035436,1386809457,1629219498,1326589482,1275048217,1174845101,1982799045,1265523062,1578639126,1114732559,1932904927
NJ	4110102	1376544320,1508858127,1811246473,1306304027,1730180761,1285635235,1265433676,1275534620,1477554814,1811984636,1114905387,1548248321,1093790578,1629054846,1639157415,1972588465,1881679371,1841346970,1437295607,1346386513,1194035436,1386809457,1629219498,1326589482,1275048217,1174845101,1982799045,1265523062,1578639126,1114732559,1932904927
NM	A0009	1376544320,1508858127,1811246473,1306304027,1730180761,1285635235,1265433676,1275534620,1477554814,1811984636,1114905387,1548248321,1093790578,1629054846,1639157415,1972588465,1881679371,1841346970,1437295607,1346386513,1194035436,1386809457,1629219498,1326589482,1275048217,1174845101,1982799045,1265523062,1578639126,1114732559,1932904927
NV	100512868,100514320,1188874	1376544320,1508858127,1811246473,1306304027,1730180761,1285635235,1265433676,1275534620,1477554814,1811984636,1114905387,1548248321,1093790578,1629054846,1639157415,1972588465,1881679371,1841346970,1437295607,1346386513,1194035436,1386809457,1629219498,1326589482,1275048217,1174845101,1982799045,1265523062,1578639126,1114732559,1932904927
NY	01706927	1376544320,1508858127,1811246473,1306304027,1730180761,1285635235,1265433676,1275534620,1477554814,1811984636,1114905387,1548248321,1093790578,1629054846,1639157415,1972588465,1881679371,1841346970,1437295607,1346386513,1194035436,1386809457,1629219498,1326589482,1275048217,1174845101,1982799045,1265523062,1578639126,1114732559,1932904927
OH	0333384	1376544320,1508858127,1811246473,1306304027,1730180761,1285635235,1265433676,1275534620,1477554814,1811984636,1114905387,1548248321,1093790578,1629054846,1639157415,1972588465,1881679371,1841346970,1437295607,1346386513,1194035436,1386809457,1629219498,1326589482,1275048217,1174845101,1982799045,1265523062,1578639126,1114732559,1932904927
OK	100693080A	1376544320,1508858127,1811246473,1306304027,1730180761,1285635235,1265433676,1275534620,1477554814,1811984636,1114905387,1548248321,1093790578,1629054846,1639157415,1972588465,1881679371,1841346970,1437295607,1346386513,1194035436,1386809457,1629219498,1326589482,1275048217,1174845101,1982799045,1265523062,1578639126,1114732559,1932904927
OR	500625209	1376544320,1508858127,1811246473,1306304027,1730180761,1285635235,1265433676,1275534620,1477554814,1811984636,1114905387,1548248321,1093790578,1629054846,1639157415,1972588465,1881679371,1841346970,1437295607,1346386513,1194035436,1386809457,1629219498,1326589482,1275048217,1174845101,1982799045,1265523062,1578639126,1114732559,1932904927
SC	11509A,187283	1376544320,1508858127,1811246473,1306304027,1730180761,1285635235,1265433676,1275534620,1477554814,1811984636,1114905387,1548248321,1093790578,1629054846,1639157415,1972588465,1881679371,1841346970,1437295607,1346386513,1194035436,1386809457,1629219498,1326589482,1275048217,1174845101,1982799045,1265523062,1578639126,1114732559,1932904927
TN	0160058	1376544320,1508858127,1811246473,1306304027,1730180761,1285635235,1265433676,1275534620,1477554814,1811984636,1114905387,1548248321,1093790578,1629054846,1639157415,1972588465,1881679371,1841346970,1437295607,1346386513,1194035436,1386809457,1629219498,1326589482,1275048217,1174845101,1982799045,1265523062,1578639126,1114732559,1932904927
TX	072004701,072004702	1376544320,1508858127,1811246473,1306304027,1730180761,1285635235,1265433676,1275534620,1477554814,1811984636,1114905387,1548248321,1093790578,1629054846,1639157415,1972588465,1881679371,1841346970,1437295607,1346386513,1194035436,1386809457,1629219498,1326589482,1275048217,1174845101,1982799045,1265523062,1578639126,1114732559,1932904927
UT	426004813012	1376544320,1508858127,1811246473,1306304027,1730180761,1285635235,1265433676,1275534620,1477554814,1811984636,1114905387,1548248321,1093790578,1629054846,1639157415,1972588465,1881679371,1841346970,1437295607,1346386513,1194035436,1386809457,1629219498,1326589482,1275048217,1174845101,1982799045,1265523062,1578639126,1114732559,1932904927
VA	98-1114-1	1376544320,1508858127,1811246473,1306304027,1730180761,1285635235,1265433676,1275534620,1477554814,1811984636,1114905387,1548248321,1093790578,1629054846,1639157415,1972588465,1881679371,1841346970,1437295607,1346386513,1194035436,1386809457,1629219498,1326589482,1275048217,1174845101,1982799045,1265523062,1578639126,1114732559,1932904927
VT	0160058	1376544320,1508858127,1811246473,1306304027,1730180761,1285635235,1265433676,1275534620,1477554814,1811984636,1114905387,1548248321,1093790578,1629054846,1639157415,1972588465,1881679371,1841346970,1437295607,1346386513,1194035436,1386809457,1629219498,1326589482,1275048217,1174845101,1982799045,1265523062,1578639126,1114732559,1932904927
WA	2203156	1376544320,1508858127,1811246473,1306304027,1730180761,1285635235,1265433676,1275534620,1477554814,1811984636,1114905387,1548248321,1093790578,1629054846,1639157415,1972588465,1881679371,1841346970,1437295607,1346386513,1194035436,1386809457,1629219498,1326589482,1275048217,1174845101,1982799045,1265523062,1578639126,1114732559,1932904927
WI	11020900,1376544320	1376544320,1508858127,1811246473,1306304027,1730180761,1285635235,1265433676,1275534620,1477554814,1811984636,1114905387,1548248321,1093790578,1629054846,1639157415,1972588465,1881679371,1841346970,1437295607,1346386513,1194035436,1386809457,1629219498,1326589482,1275048217,1174845101,1982799045,1265523062,1578639126,1114732559,1932904927
WV	0173719000	1376544320,1508858127,1811246473,1306304027,1730180761,1285635235,1265433676,1275534620,1477554814,1811984636,1114905387,1548248321,1093790578,1629054846,1639157415,1972588465,1881679371,1841346970,1437295607,1346386513,1194035436,1386809457,1629219498,1326589482,1275048217,1174845101,1982799045,1265523062,1578639126,1114732559,1932904927
WY	1095790-00	1376544320,1508858127,1811246473,1306304027,1730180761,1285635235,1265433676,1275534620,1477554814,1811984636,1114905387,1548248321,1093790578,1629054846,1639157415,1972588465,1881679371,1841346970,1437295607,1346386513,1194035436,1386809457,1629219498,1326589482,1275048217,1174845101,1982799045,1265523062,1578639126,1114732559,1932904927
PR		1376544320,1508858127,1811246473,1306304027,1730180761,1285635235,1265433676,1275534620,1477554814,1811984636,1114905387,1548248321,1093790578,1629054846,1639157415,1972588465,1881679371,1841346970,1437295607,1346386513,1194035436,1386809457,1629219498,1326589482,1275048217,1174845101,1982799045,1265523062,1578639126,1114732559,1932904927
RI		1376544320,1508858127,1811246473,1306304027,1730180761,1285635235,1265433676,1275534620,1477554814,1811984636,1114905387,1548248321,1093790578,1629054846,1639157415,1972588465,1881679371,1841346970,1437295607,1346386513,1194035436,1386809457,1629219498,1326589482,1275048217,1174845101,1982799045,1265523062,1578639126,1114732559,1932904927
DC		1376544320,1508858127,1811246473,1306304027,1730180761,1285635235,1265433676,1275534620,1477554814,1811984636,1114905387,1548248321,1093790578,1629054846,1639157415,1972588465,1881679371,1841346970,1437295607,1346386513,1194035436,1386809457,1629219498,1326589482,1275048217,1174845101,1982799045,1265523062,1578639126,1114732559,1932904927

Shipping Addresses

Same as Street Address

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Carve-In Effective Date	Termination Date	Last Updated On
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Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
DSH160058A	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	Outreach Dialysis - Grinnell	803 Broad Street	Grinnell	IA	Active
DSH160058AA	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	STATE UNIVERSITY OF IOWA - IRL EAST - PEDIATRIC SPECIALTY CLINIC	920 E 2ND AVE	CORALVILLE	IA	Active
DSH160058AB	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	UNIVERSITY OF IOWA HEALTH CARE - IRL - OCCUPATIONAL THERAPY	105 E 9TH ST	CORALVILLE	IA	Active
DSH160058AC	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	UNIVERSITY OF IOWA HEALTH CARE - IRL - CARDIOLOGY Vascular Surg	105 E 9TH ST	CORALVILLE	IA	Active
DSH160058AD	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	UNIVERSITY OF IOWA HEALTH CARE- IRL EAST - NEUROLOGY CLINIC	920 E 2ND AVE	CORALVILLE	IA	Active
DSH160058AE	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	UNIVERSITY OF IOWA HEALTH CARE - IRL RADIOLOGY DIAGNOSTIC	105 E 9TH ST	CORALVILLE	IA	Active
DSH160058AF	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	UNIVERSITY OF IOWA HEALTH CARE- IRL EAST - DIABETES CENTER CLINIC	920 E 2ND AVE	CORALVILLE	IA	ToBeTerminated
DSH160058AG	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	UNIVERSITY OF IOWA HOSPITALS & CLIN - IRL EAST - DERMATOLOGY CLINIC	920 E 2ND AVE	CORALVILLE	IA	Active
DSH160058AH	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	UNIVERSITY OF IOWA HEALTH CARE - IRL - CARDIAC REHABILITATION	105 E 9TH ST	CORALVILLE	IA	Active
DSH160058AJ	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	UNIVERSITY OF IOWA HEALTH CARE - NORTH DODGE - REI CLINIC	1360 N DODGE ST	IOWA CITY	IA	Active
DSH160058AK	Child	DSH	UNIVERSITY OF IOWA HOSPITALS & CLINICS	UNIVERSITY OF IOWA HOSPITALS & CLIN - IRL - PHYSICAL THERAPY	105 E 9TH ST	CORALVILLE	IA	Terminated
DSH160058AL	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	UNIVERSITY OF IOWA HEALTH CARE- IRL EAST - RADIOLOGY DIAGNOSTIC	920 E 2ND AVE	CORALVILLE	IA	ToBeTerminated
DSH160058AM	Child	DSH	UNIVERSITY OF IOWA HOSPITALS & CLINICS	UNIVERSITY OF IOWA HOSPITALS & CLIN - IRL EAST - SURGERY CLINIC	920 E 2ND AVE	CORALVILLE	IA	Terminated
DSH160058AN	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	STATE UNIVERSITY OF IOWA - IRL - Anticoagulation Clinic	105 E 9TH ST	CORALVILLE	IA	Active
DSH160058AP	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	University of Iowa HEALTH CARE - IRL East - Anesthesia Pain Clinic	920 East 2nd Avenue	Coralville	IA	Active
DSH160058AQ	Child	DSH	UNIVERSITY OF IOWA HOSPITALS & CLINICS	UNIVERSITY OF IOWA HOSPITALS & CLIN - IRL EAST - OCCUPATIONAL THERAPY	920 E 2ND AVE	CORALVILLE	IA	Terminated
DSH160058AR	Child	DSH	UNIVERSITY OF IOWA HOSPITALS & CLINICS	UNIVERSITY OF IOWA HOSPITALS & CLIN - IRL EAST - RESPIRATORY THERAPY	920 E 2ND AVE	CORALVILLE	IA	Terminated
DSH160058AS	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	UNIVERSITY OF IOWA HEALTH CARE - IRL - GASTROENEROLOGY BREATH TESTING	105 E 9TH ST	CORALVILLE	IA	Active
DSH160058AT	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	UNIVERSITY OF IOWA HEALTH CARE - IRL - DIGESTIVE DISEASE CENTER	105 E 9TH ST	CORALVILLE	IA	ToBeTerminated
DSH160058AU	Child	DSH	UNIVERSITY OF IOWA HOSPITALS & CLINICS	UNIVERSITY OF IOWA HOSPITALS & CLIN - IRL EAST - PHYSICAL THERAPY	920 E 2ND AVE	CORALVILLE	IA	Terminated
DSH160058AV	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	STATE UNIVERSITY OF IOWA - NORTH DODGE RADIOLOGY - DIAGNOSTIC	1360 N DODGE ST	IOWA CITY	IA	Active
DSH160058AW	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	STATE UNIVERSITY OF IOWA - NORTH DODGE REI ULTRASOUND	1360 N DODGE ST	IOWA CITY	IA	Active
DSH160058AX	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	UNIVERSITY OF IOWA HEALTH CARE - NORTH DODGE OB/GYN ULTRASOUND	1360 N DODGE ST	IOWA CITY	IA	Active
DSH160058AY	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	UNIVERSITY OF IOWA HEALTH CARE - IRL - PROC ANESTHESIA	105 East 9th Street	Coralville	IA	Active
DSH160058AZ	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	UNIVERSITY OF IOWA HEALTH CARE - IRL EAST ANEMIA CLINIC	920 East 2nd Avenue	Coralville	IA	Active
DSH160058B	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	Outreach Dialysis - Washington	414 East Polk Street	Washington	IA	Active
DSH160058BA	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	UNIVERSITY OF IOWA HEALTH CARE - IRL PULM FUNCTION TESTING - IM	105 East 9th Street	Coralville	IA	Active
DSH160058BB	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	UNIVERSITY OF IOWA HEALTH CARE - PEDIATRIC ASSOC NORTH DODGE	1360 NORTH DODGE STREET	IOWA CITY	IA	Active
DSH160058BC	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	UNIVERSITY OF IOWA HEALTH CARE - PEDIATRIC ASSOC HOLIDAY ROAD	2593 Holiday Road	Coralville	IA	Active
DSH160058BD	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	UNIVERSITY OF IOWA HEALTH CARE - IRL - PROC GI MED	105 East 9th Street	Coralville	IA	Active
DSH160058BE	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	UNIVERSITY OF IOWA HEALTH CARE - IRL WOMENS WELLNESS	105 East 9th Street	Coralville	IA	Active
DSH160058BF	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	UNIVERSITY OF IOWA HELATH CARE - IRL SURGICAL ONCOLOGY	105 East 9th Street	Coralville	IA	Active
DSH160058BG	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	UNIVERSITY OF IOWA HEALTH CARE - FOOD NUTR SPORTS MED CLINIC	UI SPORTS MEDICINE	IOWA CITY	IA	Terminated
DSH160058BH	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	UNIVERSITY OF IOWA HEALTH CARE - IRL PODIATRY	105 East 9th Street	Coralville	IA	Active
DSH160058BJ	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	MEDICAL CENTER NORTH LIBERTY - ORTHOPEDICS	701 W FOREVERGREEN ROAD	NORTH LIBERTY	IA	Active
DSH160058BK	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	UNIVERSITY OF IOWA HEALTH CARE - AMBUL CARE- ORTHO TOTAL JOINT	200 HAWKINS DRIVE	IOWA CITY	IA	ToBeTerminated
DSH160058BL	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	MEDICAL CENTER NORTH LIBERTY - ORTHOPEDICS WORK INJURY RECOVERY	701 W FOREVERGREEN ROAD	NORTH LIBERTY	IA	Active
DSH160058BM	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	UNIVERSITY OF IOWA HEALTH CARE - IRL - PROC ORTHOPEDICS	105 East 9th Street	Coralville	IA	Active
DSH160058BN	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	UNIVERSITY OF IOWA HEALTH CARE - AMBUL CARE FCC FAMILY MEDICINE	200 HAWKINS DRIVE	IOWA CITY	IA	Active
DSH160058BP	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	UNIVERSITY OF IOWA HEALTH CARE - IRL ORTHOPAEDIC SPORTS MED	105 East 9th Street	Coralville	IA	Active
DSH160058BQ	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	UNIVERSITY OF IOWA HEALTH CARE - AMBUL CARE SPINE TREATMENT CTR	200 HAWKINS DRIVE	IOWA CITY	IA	ToBeTerminated
DSH160058BR	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	UNIVERSITY OF IOWA HEALTH CARE - IRL PEDIATRIC SPECIALTY CLINIC	105 East 9th Street	Coralville	IA	Active
DSH160058BS	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	STATE UNIVERSITY OF IOWA - IRL ORTHOPAEDIC PHY MED-REHAB	105 E 9TH ST	CORALVILLE	IA	Active
DSH160058BT	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	UNIVERSITY OF IOWA HEALTH CARE - CDD AUDIOLOGY	100 HAWKINS DRIVE	IOWA CITY	IA	Active
DSH160058BU	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	UNIVERSITY OF IOWA HEALTH CARE - CDD SPEECH AND LANGUAGE	100 HAWKINS DRIVE	IOWA CITY	IA	Active
DSH160058BV	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	UNIVERSITY OF IOWA HEALTH CARE - NORTH DODGE OBG IVF PROCEDURES	1360 NORTH DODGE STREET	IOWA CITY	IA	Active
DSH160058BW	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	UNIVERSITY OF IOWA HEALTH CARE - CDD SOCIAL SERVICES	100 HAWKINS DRIVE	IOWA CITY	IA	Active
DSH160058BX	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	UNIVERSITY OF IOWA HEALTH CARE - CDD BIO BEHAVIOR SERVICES	100 HAWKINS DRIVE	IOWA CITY	IA	Active
DSH160058BY	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	UNIVERSITY OF IOWA HEALTH CARE - CDD PSYCHOLOGY	100 HAWKINS DRIVE	IOWA CITY	IA	Active
DSH160058BZ	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	UNIVERSITY OF IOWA HEALTH CARE - CDD PHYSICAL THERAPY	100 HAWKINS DRIVE	IOWA CITY	IA	Active
DSH160058C	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	Outreach Dialysis - Muscatine	3465 Mulberry Avenue	Muscatine	IA	Active
DSH160058CA	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	UNIVERSITY OF IOWA HEALTH CARE - CDD OCCUPATIONAL THERAPY	100 HAWKINS DRIVE	IOWA CITY	IA	Active
DSH160058CB	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	UNIVERSITY OF IOWA HEALTH CARE - CDD NUTRITION	100 HAWKINS DRIVE	IOWA CITY	IA	Active
DSH160058CC	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	UNIVERSITY OF IOWA HEALTH CARE - CDD EDUCATION	100 HAWKINS DRIVE	IOWA CITY	IA	Active
DSH160058CD	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	UNIVERSITY OF IOWA HEALTH CARE - CDD Clinics Outpatient Srvcs	100 HAWKINS DRIVE	IOWA CITY	IA	Active
DSH160058CE	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	UNIVERSITY OF IOWA HEALTH CARE - IRL MED RENAL/HYPERTENSION	105 East 9th Street	Coralville	IA	Active
DSH160058CF	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	UNIVERSITY OF IOWA HEALTH CARE - IRL MED PULMONARY	105 East 9th Street	Coralville	IA	Active
DSH160058CG	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	UNIVERSITY OF IOWA HEALTH CARE - IRL ANE PAIN MANAGEMENT PROCEDURE UNIT	105 East 9th Street	Coralville	IA	Active
DSH160058CH	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	UNIVERSITY OF IOWA HEALTH CARE - IRL GI SRG PROCEDURE UNIT	105 East 9th Street	Coralville	IA	Active
DSH160058CJ	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	UNIVERSITY OF IOWA HEALTH CARE - IRL INFUSION SUITE	105 East 9th Street	Coralville	IA	Active
DSH160058CK	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	UNIVERSITY OF IOWA HEALTH CARE - IRL WHC GYNECOLOGY PROCEDURE UNIT	105 East 9th Street	Coralville	IA	Active
DSH160058CL	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	UNIVERSITY OF IOWA HEALTH CARE - IRL EYE PROCEDURE UNIT	105 East 9th Street	Coralville	IA	Active
DSH160058CM	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	UNIVERSITY OF IOWA HEALTH CARE - IRL PROC PHYSIATRY	105 East 9th Street	Coralville	IA	Active
DSH160058CN	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	UNIVERSITY OF IOWA HEALTH CARE - IRL UROLOGY PROCEDURE UNIT	105 East 9th Street	Coralville	IA	Active
DSH160058CP	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	UNIVERSITY OF IOWA HEALTH CARE - IRL HVC HEART AND VASCULAR PROCEDURE UNIT	105 East 9th Street	Coralville	IA	Active
DSH160058CQ	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	UNIVERSITY OF IOWA HEALTH CARE - IRL EAST NEU SLEEP - IRL EAST NEU SLEEP	920 East 2nd Avenue	Coralville	IA	Active
DSH160058CR	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	UNIVERSITY OF IOWA HEALTH CARE - IRL EAST PRESURGICAL EVALUATION CLINIC - IRL EAST PRESURGICAL EVALUATION CLINIC	920 East 2nd Avenue	Coralville	IA	Active
DSH160058CS	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	UNIVERSITY OF IOWA HEALTH CARE - RADIATION ONCOLOGY QUAD CITIES - RADIATION ONCOLOGY QUAD CITIES	1351 Kimberly Road	Bettendorf	IA	Active
DSH160058CT	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	UNIVERSITY OF IOWA HEALTH CARE - NEU HEADACHE NORTH DODGE - NEU HEADACHE NORTH DODGE	1360 NORTH DODGE STREET	IOWA CITY	IA	Active
DSH160058D	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	Outreach Dialysis - North Liberty	5 Lions Drive	North Liberty	IA	Active
DSH160058E	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	Sports Medicine Clinic	2701 Prairie Meadow Drive	Iowa City	IA	Active
DSH160058F	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	Pediatrics	105 E 9th ST	Coralville	IA	Active
DSH160058G	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	Internal Medicine	105 E 9th ST	Coralville	IA	Active
DSH160058H	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	Otolaryngology	105 E 9th ST	Coralville	IA	Active
DSH160058J	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	Ophthalmology	105 E 9th ST	Coralville	IA	Active
DSH160058K	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	IRL East - GASTROENTEROLOGY CLINIC	920 E 2nd Avenue	Coralville	IA	Active
DSH160058L	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	OB-GYN	105 E 9th ST	Coralville	IA	Active
DSH160058M	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	Cardiology	105 E 9th ST	Coralville	IA	Active
DSH160058N	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	Dermatology	105 E 9th ST	Coralville	IA	Active
DSH160058P	Child	DSH	UNIVERSITY OF IOWA HOSPITALS & CLINICS	Surgery	105 E 9th Street	Coralville	IA	Terminated
DSH160058Q	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	Urology	105 E 9th ST	Coralville	IA	Active
DSH160058R	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	IRL Diabetes Management Clinic	105 E 9TH ST	CORALVILLE	IA	Active
DSH160058S	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	Orthopedics	105 E 9TH ST	CORALVILLE	IA	Active
DSH160058T	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	UNIVERSITY OF IOWA HEALTH CARE - IRL - Procedure Suites	105 E 9TH ST	CORALVILLE	IA	Active
DSH160058U	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	UNIVERSITY OF IOWA HEALTH CARE - IRL East Family Practice Clinic	920 East 2nd Ave	Coralville	IA	Active
DSH160058V	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	STATE UNIVERSITY OF IOWA - QUAD CITIES - CANCER CENTER	1351 KIMBERLY RD STE 100	BETTENDORF	IA	Active
DSH160058W	Child	DSH	UNIVERSITY OF IOWA HOSPITALS & CLINICS	STATE UNIVERSITY OF IOWA - IRL - Family Care Clinic	105 E 9TH ST	CORALVILLE	IA	Terminated
DSH160058X	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	STATE UNIVERSITY OF IOWA - IRL - Psychiatric Clinic	105 E 9TH ST	CORALVILLE	IA	Active
DSH160058Y	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	STATE UNIVERSITY OF IOWA - NORTH DODGE - OB/GYN CLINIC	1360 N DODGE ST	IOWA CITY	IA	Active
DSH160058Z	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	STATE UNIVERSITY OF IOWA - IRL - Anesthesia Pain Clinic	105 E 9TH ST	CORALVILLE	IA	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114732559	3/10/2025 4:52 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AK	3/10/2025 4:52 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1932904927	3/10/2025 4:52 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AK	3/10/2025 4:52 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114732559	3/10/2025 4:52 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AL	3/10/2025 4:52 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1932904927	3/10/2025 4:52 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AL	3/10/2025 4:52 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114732559	3/10/2025 4:52 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AZ	3/10/2025 4:52 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1932904927	3/10/2025 4:52 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AZ	3/10/2025 4:52 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114732559	3/10/2025 4:52 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AR	3/10/2025 4:52 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1932904927	3/10/2025 4:52 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AR	3/10/2025 4:52 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114732559	3/10/2025 4:52 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CA	3/10/2025 4:52 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1932904927	3/10/2025 4:52 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CA	3/10/2025 4:52 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114732559	3/10/2025 4:52 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CO	3/10/2025 4:52 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1932904927	3/10/2025 4:52 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CO	3/10/2025 4:52 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114732559	3/10/2025 4:52 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CT	3/10/2025 4:52 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1932904927	3/10/2025 4:52 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CT	3/10/2025 4:52 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114732559	3/10/2025 4:52 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		DC	3/10/2025 4:52 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1932904927	3/10/2025 4:52 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		DC	3/10/2025 4:52 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114732559	3/10/2025 4:52 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		DE	3/10/2025 4:52 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1932904927	3/10/2025 4:52 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		DE	3/10/2025 4:52 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114732559	3/10/2025 4:52 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		FL	3/10/2025 4:52 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1932904927	3/10/2025 4:52 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		FL	3/10/2025 4:52 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114732559	3/10/2025 4:52 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		GA	3/10/2025 4:52 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1932904927	3/10/2025 4:52 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		GA	3/10/2025 4:52 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114732559	3/10/2025 4:52 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		HI	3/10/2025 4:52 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1932904927	3/10/2025 4:52 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		HI	3/10/2025 4:52 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114732559	3/10/2025 4:52 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		IA	3/10/2025 4:52 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1932904927	3/10/2025 4:52 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		IA	3/10/2025 4:52 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114732559	3/10/2025 4:52 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ID	3/10/2025 4:52 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1932904927	3/10/2025 4:52 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ID	3/10/2025 4:52 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114732559	3/10/2025 4:52 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		IL	3/10/2025 4:52 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1932904927	3/10/2025 4:52 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		IL	3/10/2025 4:52 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114732559	3/10/2025 4:52 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		IN	3/10/2025 4:52 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1932904927	3/10/2025 4:52 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		IN	3/10/2025 4:52 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114732559	3/10/2025 4:52 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		KS	3/10/2025 4:52 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1932904927	3/10/2025 4:52 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		KS	3/10/2025 4:52 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114732559	3/10/2025 4:52 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		KY	3/10/2025 4:52 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1932904927	3/10/2025 4:52 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		KY	3/10/2025 4:52 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114732559	3/10/2025 4:52 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		LA	3/10/2025 4:52 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1932904927	3/10/2025 4:52 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		LA	3/10/2025 4:52 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114732559	3/10/2025 4:52 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MA	3/10/2025 4:52 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1932904927	3/10/2025 4:52 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MA	3/10/2025 4:52 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114732559	3/10/2025 4:52 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MD	3/10/2025 4:52 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1932904927	3/10/2025 4:52 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MD	3/10/2025 4:52 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114732559	3/10/2025 4:52 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ME	3/10/2025 4:52 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1932904927	3/10/2025 4:52 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ME	3/10/2025 4:52 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114732559	3/10/2025 4:52 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MI	3/10/2025 4:52 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1932904927	3/10/2025 4:52 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MI	3/10/2025 4:52 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114732559	3/10/2025 4:52 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MN	3/10/2025 4:52 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1932904927	3/10/2025 4:52 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MN	3/10/2025 4:52 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114732559	3/10/2025 4:52 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MO	3/10/2025 4:52 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1932904927	3/10/2025 4:52 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MO	3/10/2025 4:52 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114732559	3/10/2025 4:52 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MS	3/10/2025 4:52 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1932904927	3/10/2025 4:52 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MS	3/10/2025 4:52 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114732559	3/10/2025 4:52 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MT	3/10/2025 4:52 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1932904927	3/10/2025 4:52 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MT	3/10/2025 4:52 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114732559	3/10/2025 4:52 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NC	3/10/2025 4:52 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1932904927	3/10/2025 4:52 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NC	3/10/2025 4:52 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114732559	3/10/2025 4:52 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ND	3/10/2025 4:52 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1932904927	3/10/2025 4:52 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ND	3/10/2025 4:52 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114732559	3/10/2025 4:52 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NE	3/10/2025 4:52 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1932904927	3/10/2025 4:52 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NE	3/10/2025 4:52 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114732559	3/10/2025 4:52 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NJ	3/10/2025 4:52 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1932904927	3/10/2025 4:52 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NJ	3/10/2025 4:52 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114732559	3/10/2025 4:52 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NM	3/10/2025 4:52 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1932904927	3/10/2025 4:52 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NM	3/10/2025 4:52 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114732559	3/10/2025 4:52 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NV	3/10/2025 4:52 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1932904927	3/10/2025 4:52 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NV	3/10/2025 4:52 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114732559	3/10/2025 4:52 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NY	3/10/2025 4:52 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1932904927	3/10/2025 4:52 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NY	3/10/2025 4:52 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114732559	3/10/2025 4:52 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OH	3/10/2025 4:52 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1932904927	3/10/2025 4:52 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OH	3/10/2025 4:52 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114732559	3/10/2025 4:52 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OK	3/10/2025 4:52 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1932904927	3/10/2025 4:52 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OK	3/10/2025 4:52 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114732559	3/10/2025 4:52 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OR	3/10/2025 4:52 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1932904927	3/10/2025 4:52 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OR	3/10/2025 4:52 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114732559	3/10/2025 4:52 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		PR	3/10/2025 4:52 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1932904927	3/10/2025 4:52 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		PR	3/10/2025 4:52 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114732559	3/10/2025 4:52 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		RI	3/10/2025 4:52 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1932904927	3/10/2025 4:52 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		RI	3/10/2025 4:52 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114732559	3/10/2025 4:52 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		SC	3/10/2025 4:52 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1932904927	3/10/2025 4:52 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		SC	3/10/2025 4:52 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114732559	3/10/2025 4:52 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		TN	3/10/2025 4:52 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1932904927	3/10/2025 4:52 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		TN	3/10/2025 4:52 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114732559	3/10/2025 4:52 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		TX	3/10/2025 4:52 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1932904927	3/10/2025 4:52 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		TX	3/10/2025 4:52 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114732559	3/10/2025 4:52 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		UT	3/10/2025 4:52 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1932904927	3/10/2025 4:52 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		UT	3/10/2025 4:52 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114732559	3/10/2025 4:52 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		VA	3/10/2025 4:52 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1932904927	3/10/2025 4:52 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		VA	3/10/2025 4:52 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114732559	3/10/2025 4:52 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		VT	3/10/2025 4:52 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1932904927	3/10/2025 4:52 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		VT	3/10/2025 4:52 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114732559	3/10/2025 4:52 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WA	3/10/2025 4:52 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1932904927	3/10/2025 4:52 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WA	3/10/2025 4:52 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114732559	3/10/2025 4:52 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WI	3/10/2025 4:52 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1932904927	3/10/2025 4:52 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WI	3/10/2025 4:52 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114732559	3/10/2025 4:52 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WV	3/10/2025 4:52 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1932904927	3/10/2025 4:52 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WV	3/10/2025 4:52 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114732559	3/10/2025 4:52 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WY	3/10/2025 4:52 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1932904927	3/10/2025 4:52 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WY	3/10/2025 4:52 PM
Contacts	Authorizing Official	Update	Profile Change Request	Brownlee, Michael Chief Pharmacy Officer University of Iowa Hospitals & Clinics 3193849371	Brownlee, Michael Chief Pharmacy Officer University of Iowa Health Care 3193849371	11/22/2024 9:44 AM
Contacts	Signed By	Update	Profile Change Request	Brownlee, Michael Chief Pharmacy Officer University of Iowa Hospitals & Clinics 3193849371	Brownlee, Michael Chief Pharmacy Officer University of Iowa Health Care 3193849371	11/22/2024 9:44 AM
Contacts	Primary Contact	Update	Profile Change Request	Triplett, Becky Marie Manager, 340B and Compliance University of Iowa Hospitals and Clinics 3193845583	Triplett, Becky Marie Manager, 340B and Compliance University of Iowa Health Care 3193845583	11/20/2024 12:11 PM
Details	Entity Subname	Update	Change Request	UNIVERSITY OF IOWA HOSPITALS & CLINICS - IRL ORTHOPAEDIC SPORTS MED	UNIVERSITY OF IOWA HEALTH CARE - IRL ORTHOPAEDIC SPORTS MED	11/8/2024 9:28 AM
Details	Entity Name	Update	Recertification	UNIVERSITY OF IOWA HOSPITALS & CLINICS	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	8/23/2024 7:21 AM
Details	Last Recertification Date	Update	Recertification		8/19/2024 2:39:03 PM	8/19/2024 2:39 PM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	0008423270002 (PA)		5/6/2024 6:16 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1376544320 (PA)		5/6/2024 6:16 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1508858127 (PA)		5/6/2024 6:16 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1811246473 (PA)		5/6/2024 6:16 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1306304027 (PA)		5/6/2024 6:16 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1730180761 (PA)		5/6/2024 6:16 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1285635235 (PA)		5/6/2024 6:16 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1265433676 (PA)		5/6/2024 6:16 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1275534620 (PA)		5/6/2024 6:16 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1477554814 (PA)		5/6/2024 6:16 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1811984636 (PA)		5/6/2024 6:16 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1114905387 (PA)		5/6/2024 6:16 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1548248321 (PA)		5/6/2024 6:16 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1093790578 (PA)		5/6/2024 6:16 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1629054846 (PA)		5/6/2024 6:16 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1639157415 (PA)		5/6/2024 6:16 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1972588465 (PA)		5/6/2024 6:16 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1881679371 (PA)		5/6/2024 6:16 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1841346970 (PA)		5/6/2024 6:16 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1437295607 (PA)		5/6/2024 6:16 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1346386513 (PA)		5/6/2024 6:16 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1194035436 (PA)		5/6/2024 6:16 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1386809457 (PA)		5/6/2024 6:16 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1629219498 (PA)		5/6/2024 6:16 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1326589482 (PA)		5/6/2024 6:16 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1275048217 (PA)		5/6/2024 6:16 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1174845101 (PA)		5/6/2024 6:16 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1982799045 (PA)		5/6/2024 6:16 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1265523062 (PA)		5/6/2024 6:16 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1578639126 (PA)		5/6/2024 6:16 PM
Details	State	Update		Approved	Active	4/1/2024 12:01 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1376544320 (NH)		3/5/2024 11:02 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1508858127 (NH)		3/5/2024 11:02 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1811246473 (NH)		3/5/2024 11:02 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1306304027 (NH)		3/5/2024 11:02 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1730180761 (NH)		3/5/2024 11:02 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1285635235 (NH)		3/5/2024 11:02 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1265433676 (NH)		3/5/2024 11:02 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1275534620 (NH)		3/5/2024 11:02 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1477554814 (NH)		3/5/2024 11:02 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1811984636 (NH)		3/5/2024 11:02 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1114905387 (NH)		3/5/2024 11:02 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1548248321 (NH)		3/5/2024 11:02 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1093790578 (NH)		3/5/2024 11:02 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1629054846 (NH)		3/5/2024 11:02 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1639157415 (NH)		3/5/2024 11:02 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1972588465 (NH)		3/5/2024 11:02 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1881679371 (NH)		3/5/2024 11:02 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1841346970 (NH)		3/5/2024 11:02 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1437295607 (NH)		3/5/2024 11:02 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1346386513 (NH)		3/5/2024 11:02 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1194035436 (NH)		3/5/2024 11:02 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1386809457 (NH)		3/5/2024 11:02 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1629219498 (NH)		3/5/2024 11:02 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1326589482 (NH)		3/5/2024 11:02 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1275048217 (NH)		3/5/2024 11:02 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1174845101 (NH)		3/5/2024 11:02 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1982799045 (NH)		3/5/2024 11:02 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1265523062 (NH)		3/5/2024 11:02 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1578639126 (NH)		3/5/2024 11:02 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1376544320 (SD)		3/5/2024 11:02 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1508858127 (SD)		3/5/2024 11:02 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1811246473 (SD)		3/5/2024 11:02 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1306304027 (SD)		3/5/2024 11:02 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1730180761 (SD)		3/5/2024 11:02 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1285635235 (SD)		3/5/2024 11:02 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1265433676 (SD)		3/5/2024 11:02 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1275534620 (SD)		3/5/2024 11:02 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1477554814 (SD)		3/5/2024 11:02 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1811984636 (SD)		3/5/2024 11:02 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1114905387 (SD)		3/5/2024 11:02 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1548248321 (SD)		3/5/2024 11:02 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1093790578 (SD)		3/5/2024 11:02 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1629054846 (SD)		3/5/2024 11:02 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1639157415 (SD)		3/5/2024 11:02 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1972588465 (SD)		3/5/2024 11:02 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1881679371 (SD)		3/5/2024 11:02 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1841346970 (SD)		3/5/2024 11:02 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1437295607 (SD)		3/5/2024 11:02 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1346386513 (SD)		3/5/2024 11:02 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1194035436 (SD)		3/5/2024 11:02 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1386809457 (SD)		3/5/2024 11:02 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1629219498 (SD)		3/5/2024 11:02 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1326589482 (SD)		3/5/2024 11:02 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1275048217 (SD)		3/5/2024 11:02 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1174845101 (SD)		3/5/2024 11:02 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1982799045 (SD)		3/5/2024 11:02 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1265523062 (SD)		3/5/2024 11:02 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1578639126 (SD)		3/5/2024 11:02 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1376544320	3/5/2024 11:02 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		LA	3/5/2024 11:02 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1508858127	3/5/2024 11:02 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		LA	3/5/2024 11:02 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811246473	3/5/2024 11:02 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		LA	3/5/2024 11:02 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1306304027	3/5/2024 11:02 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		LA	3/5/2024 11:02 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1730180761	3/5/2024 11:02 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		LA	3/5/2024 11:02 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1285635235	3/5/2024 11:02 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		LA	3/5/2024 11:02 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265433676	3/5/2024 11:02 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		LA	3/5/2024 11:02 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275534620	3/5/2024 11:02 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		LA	3/5/2024 11:02 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1477554814	3/5/2024 11:02 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		LA	3/5/2024 11:02 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811984636	3/5/2024 11:02 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		LA	3/5/2024 11:02 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114905387	3/5/2024 11:02 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		LA	3/5/2024 11:02 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1548248321	3/5/2024 11:02 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		LA	3/5/2024 11:02 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1093790578	3/5/2024 11:02 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		LA	3/5/2024 11:02 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629054846	3/5/2024 11:02 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		LA	3/5/2024 11:02 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1639157415	3/5/2024 11:02 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		LA	3/5/2024 11:02 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1972588465	3/5/2024 11:02 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		LA	3/5/2024 11:02 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1881679371	3/5/2024 11:02 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		LA	3/5/2024 11:02 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1841346970	3/5/2024 11:02 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		LA	3/5/2024 11:02 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1437295607	3/5/2024 11:02 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		LA	3/5/2024 11:02 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1346386513	3/5/2024 11:02 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		LA	3/5/2024 11:02 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1194035436	3/5/2024 11:02 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		LA	3/5/2024 11:02 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1386809457	3/5/2024 11:02 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		LA	3/5/2024 11:02 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629219498	3/5/2024 11:02 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		LA	3/5/2024 11:02 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1326589482	3/5/2024 11:02 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		LA	3/5/2024 11:02 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275048217	3/5/2024 11:02 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		LA	3/5/2024 11:02 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1174845101	3/5/2024 11:02 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		LA	3/5/2024 11:02 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1982799045	3/5/2024 11:02 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		LA	3/5/2024 11:02 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265523062	3/5/2024 11:02 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		LA	3/5/2024 11:02 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1578639126	3/5/2024 11:02 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		LA	3/5/2024 11:02 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1376544320	3/5/2024 11:02 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		MA	3/5/2024 11:02 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1508858127	3/5/2024 11:02 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		MA	3/5/2024 11:02 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811246473	3/5/2024 11:02 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		MA	3/5/2024 11:02 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1306304027	3/5/2024 11:02 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		MA	3/5/2024 11:02 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1730180761	3/5/2024 11:02 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		MA	3/5/2024 11:02 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1285635235	3/5/2024 11:02 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		MA	3/5/2024 11:02 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265433676	3/5/2024 11:02 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		MA	3/5/2024 11:02 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275534620	3/5/2024 11:02 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		MA	3/5/2024 11:02 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1477554814	3/5/2024 11:02 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		MA	3/5/2024 11:02 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811984636	3/5/2024 11:02 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		MA	3/5/2024 11:02 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114905387	3/5/2024 11:02 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		MA	3/5/2024 11:02 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1548248321	3/5/2024 11:02 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		MA	3/5/2024 11:02 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1093790578	3/5/2024 11:02 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		MA	3/5/2024 11:02 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629054846	3/5/2024 11:02 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		MA	3/5/2024 11:02 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1639157415	3/5/2024 11:02 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		MA	3/5/2024 11:02 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1972588465	3/5/2024 11:02 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		MA	3/5/2024 11:02 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1881679371	3/5/2024 11:02 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		MA	3/5/2024 11:02 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1841346970	3/5/2024 11:02 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		MA	3/5/2024 11:02 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1437295607	3/5/2024 11:02 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		MA	3/5/2024 11:02 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1346386513	3/5/2024 11:02 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		MA	3/5/2024 11:02 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1194035436	3/5/2024 11:02 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		MA	3/5/2024 11:02 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1386809457	3/5/2024 11:02 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		MA	3/5/2024 11:02 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629219498	3/5/2024 11:02 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		MA	3/5/2024 11:02 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1326589482	3/5/2024 11:02 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		MA	3/5/2024 11:02 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275048217	3/5/2024 11:02 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		MA	3/5/2024 11:02 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1174845101	3/5/2024 11:02 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		MA	3/5/2024 11:02 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1982799045	3/5/2024 11:02 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		MA	3/5/2024 11:02 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265523062	3/5/2024 11:02 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		MA	3/5/2024 11:02 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1578639126	3/5/2024 11:02 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		MA	3/5/2024 11:02 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1376544320	3/5/2024 11:02 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		NV	3/5/2024 11:02 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1508858127	3/5/2024 11:02 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		NV	3/5/2024 11:02 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811246473	3/5/2024 11:02 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		NV	3/5/2024 11:02 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1306304027	3/5/2024 11:02 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		NV	3/5/2024 11:02 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1730180761	3/5/2024 11:02 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		NV	3/5/2024 11:02 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1285635235	3/5/2024 11:02 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		NV	3/5/2024 11:02 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265433676	3/5/2024 11:02 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		NV	3/5/2024 11:02 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275534620	3/5/2024 11:02 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		NV	3/5/2024 11:02 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1477554814	3/5/2024 11:02 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		NV	3/5/2024 11:02 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811984636	3/5/2024 11:02 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		NV	3/5/2024 11:02 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114905387	3/5/2024 11:02 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		NV	3/5/2024 11:02 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1548248321	3/5/2024 11:02 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		NV	3/5/2024 11:02 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1093790578	3/5/2024 11:02 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		NV	3/5/2024 11:02 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629054846	3/5/2024 11:02 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		NV	3/5/2024 11:02 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1639157415	3/5/2024 11:02 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		NV	3/5/2024 11:02 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1972588465	3/5/2024 11:02 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		NV	3/5/2024 11:02 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1881679371	3/5/2024 11:02 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		NV	3/5/2024 11:02 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1841346970	3/5/2024 11:02 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		NV	3/5/2024 11:02 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1437295607	3/5/2024 11:02 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		NV	3/5/2024 11:02 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1346386513	3/5/2024 11:02 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		NV	3/5/2024 11:02 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1194035436	3/5/2024 11:02 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		NV	3/5/2024 11:02 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1386809457	3/5/2024 11:02 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		NV	3/5/2024 11:02 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629219498	3/5/2024 11:02 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		NV	3/5/2024 11:02 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1326589482	3/5/2024 11:02 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		NV	3/5/2024 11:02 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275048217	3/5/2024 11:02 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		NV	3/5/2024 11:02 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1174845101	3/5/2024 11:02 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		NV	3/5/2024 11:02 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1982799045	3/5/2024 11:02 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		NV	3/5/2024 11:02 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265523062	3/5/2024 11:02 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		NV	3/5/2024 11:02 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1578639126	3/5/2024 11:02 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		NV	3/5/2024 11:02 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Group Change Request		False	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: Number	Insert	Group Change Request		1005657	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: State	Insert	Group Change Request		AK	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Group Change Request		False	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: Number	Insert	Group Change Request		UNI0058N	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: State	Insert	Group Change Request		AL	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Group Change Request		False	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: Number	Insert	Group Change Request		108932105	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: State	Insert	Group Change Request		AR	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Group Change Request		False	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: Number	Insert	Group Change Request		022773	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: State	Insert	Group Change Request		AZ	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Group Change Request		False	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: Number	Insert	Group Change Request		10056587	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: State	Insert	Group Change Request		CA	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Group Change Request		False	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: Number	Insert	Group Change Request		800249545	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: State	Insert	Group Change Request		CA	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Group Change Request		False	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: Number	Insert	Group Change Request		800249546	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: State	Insert	Group Change Request		CA	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Group Change Request		False	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: Number	Insert	Group Change Request		1376544320	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: State	Insert	Group Change Request		CO	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Group Change Request		False	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: Number	Insert	Group Change Request		95004032	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: State	Insert	Group Change Request		CO	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Group Change Request		False	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: Number	Insert	Group Change Request		003101590	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: State	Insert	Group Change Request		CT	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Group Change Request		False	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: Number	Insert	Group Change Request		003031614	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: State	Insert	Group Change Request		CT	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Group Change Request		False	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: Number	Insert	Group Change Request		000571306	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: State	Insert	Group Change Request		DE	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Group Change Request		False	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: Number	Insert	Group Change Request		109271900	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: State	Insert	Group Change Request		FL	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Group Change Request		False	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: Number	Insert	Group Change Request		00354615Y	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: State	Insert	Group Change Request		GA	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Group Change Request		False	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: Number	Insert	Group Change Request		53564303	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: State	Insert	Group Change Request		HI	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Group Change Request		False	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: Number	Insert	Group Change Request		000336300	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: State	Insert	Group Change Request		ID	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Group Change Request		False	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: Number	Insert	Group Change Request		300063132	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: State	Insert	Group Change Request		IN	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Group Change Request		False	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: Number	Insert	Group Change Request		100245160A	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: State	Insert	Group Change Request		KS	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Group Change Request		False	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: Number	Insert	Group Change Request		30003896540001	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: State	Insert	Group Change Request		KS	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Group Change Request		False	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: Number	Insert	Group Change Request		30003896540003	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: State	Insert	Group Change Request		KS	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Group Change Request		False	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: Number	Insert	Group Change Request		01350222	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: State	Insert	Group Change Request		KY	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Group Change Request		False	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: Number	Insert	Group Change Request		1741345	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: State	Insert	Group Change Request		LA	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Group Change Request		False	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: Number	Insert	Group Change Request		110010615F	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: State	Insert	Group Change Request		MA	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Group Change Request		False	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: Number	Insert	Group Change Request		398765500	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: State	Insert	Group Change Request		MD	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Group Change Request		False	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: Number	Insert	Group Change Request		174800000	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: State	Insert	Group Change Request		ME	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Group Change Request		False	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: Number	Insert	Group Change Request		404608162	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: State	Insert	Group Change Request		MI	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Group Change Request		False	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: Number	Insert	Group Change Request		304608153	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: State	Insert	Group Change Request		MI	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Group Change Request		False	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: Number	Insert	Group Change Request		128847400	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: State	Insert	Group Change Request		MN	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Group Change Request		False	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: Number	Insert	Group Change Request		49207	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: State	Insert	Group Change Request		MN	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Group Change Request		False	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: Number	Insert	Group Change Request		1765544320	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: State	Insert	Group Change Request		MN	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Group Change Request		False	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: Number	Insert	Group Change Request		1376544320	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: State	Insert	Group Change Request		MO	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Group Change Request		False	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: Number	Insert	Group Change Request		02857378	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: State	Insert	Group Change Request		MS	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Group Change Request		False	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: Number	Insert	Group Change Request		0416936	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: State	Insert	Group Change Request		MT	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Group Change Request		False	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: Number	Insert	Group Change Request		1376544320	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: State	Insert	Group Change Request		NC	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Group Change Request		False	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: Number	Insert	Group Change Request		02227	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: State	Insert	Group Change Request		ND	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Group Change Request		False	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: Number	Insert	Group Change Request		426004813-00	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: State	Insert	Group Change Request		NE	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Group Change Request		False	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: Number	Insert	Group Change Request		4110102	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: State	Insert	Group Change Request		NJ	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Group Change Request		False	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: Number	Insert	Group Change Request		A0009	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: State	Insert	Group Change Request		NM	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Group Change Request		False	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: Number	Insert	Group Change Request		100512868	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: State	Insert	Group Change Request		NV	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Group Change Request		False	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: Number	Insert	Group Change Request		100514320	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: State	Insert	Group Change Request		NV	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Group Change Request		False	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: Number	Insert	Group Change Request		1188874	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: State	Insert	Group Change Request		NV	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Group Change Request		False	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: Number	Insert	Group Change Request		01706927	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: State	Insert	Group Change Request		NY	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Group Change Request		False	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: Number	Insert	Group Change Request		0333384	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: State	Insert	Group Change Request		OH	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Group Change Request		False	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: Number	Insert	Group Change Request		100693080A	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: State	Insert	Group Change Request		OK	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Group Change Request		False	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: Number	Insert	Group Change Request		500625209	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: State	Insert	Group Change Request		OR	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Group Change Request		False	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: Number	Insert	Group Change Request		0008423270002	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: State	Insert	Group Change Request		PA	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Group Change Request		False	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: Number	Insert	Group Change Request		11509A	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: State	Insert	Group Change Request		SC	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Group Change Request		False	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: Number	Insert	Group Change Request		187283	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: State	Insert	Group Change Request		SC	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Group Change Request		False	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: Number	Insert	Group Change Request		0160058	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: State	Insert	Group Change Request		TN	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Group Change Request		False	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: Number	Insert	Group Change Request		072004701	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: State	Insert	Group Change Request		TX	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Group Change Request		False	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: Number	Insert	Group Change Request		072004702	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: State	Insert	Group Change Request		TX	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Group Change Request		False	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: Number	Insert	Group Change Request		426004813012	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: State	Insert	Group Change Request		UT	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Group Change Request		False	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: Number	Insert	Group Change Request		98-1114-1	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: State	Insert	Group Change Request		VA	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Group Change Request		False	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: Number	Insert	Group Change Request		0160058	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: State	Insert	Group Change Request		VT	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Group Change Request		False	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: Number	Insert	Group Change Request		2203156	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: State	Insert	Group Change Request		WA	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Group Change Request		False	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: Number	Insert	Group Change Request		11020900	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: State	Insert	Group Change Request		WI	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Group Change Request		False	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: Number	Insert	Group Change Request		1376544320	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: State	Insert	Group Change Request		WI	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Group Change Request		False	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: Number	Insert	Group Change Request		0173719000	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: State	Insert	Group Change Request		WV	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Group Change Request		False	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: Number	Insert	Group Change Request		1095790-00	3/3/2024 8:42 PM
Medicaid Billing	Medicaid: State	Insert	Group Change Request		WY	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1376544320	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AK	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1508858127	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AK	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811246473	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AK	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1306304027	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AK	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1730180761	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AK	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1285635235	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AK	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265433676	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AK	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275534620	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AK	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1477554814	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AK	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811984636	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AK	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114905387	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AK	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1548248321	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AK	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1093790578	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AK	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629054846	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AK	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1639157415	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AK	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1972588465	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AK	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1881679371	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AK	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1841346970	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AK	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1437295607	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AK	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1346386513	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AK	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1194035436	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AK	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1386809457	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AK	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629219498	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AK	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1326589482	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AK	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275048217	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AK	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1174845101	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AK	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1982799045	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AK	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265523062	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AK	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1578639126	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AK	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1376544320	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AL	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1508858127	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AL	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811246473	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AL	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1306304027	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AL	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1730180761	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AL	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1285635235	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AL	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265433676	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AL	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275534620	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AL	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1477554814	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AL	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811984636	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AL	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114905387	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AL	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1548248321	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AL	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1093790578	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AL	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629054846	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AL	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1639157415	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AL	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1972588465	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AL	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1881679371	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AL	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1841346970	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AL	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1437295607	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AL	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1346386513	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AL	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1194035436	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AL	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1386809457	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AL	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629219498	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AL	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1326589482	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AL	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275048217	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AL	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1174845101	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AL	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1982799045	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AL	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265523062	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AL	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1578639126	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AL	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1376544320	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AR	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1508858127	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AR	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811246473	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AR	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1306304027	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AR	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1730180761	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AR	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1285635235	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AR	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265433676	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AR	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275534620	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AR	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1477554814	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AR	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811984636	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AR	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114905387	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AR	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1548248321	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AR	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1093790578	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AR	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629054846	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AR	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1639157415	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AR	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1972588465	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AR	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1881679371	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AR	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1841346970	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AR	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1437295607	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AR	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1346386513	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AR	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1194035436	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AR	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1386809457	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AR	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629219498	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AR	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1326589482	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AR	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275048217	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AR	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1174845101	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AR	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1982799045	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AR	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265523062	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AR	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1578639126	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AR	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1376544320	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AZ	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1508858127	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AZ	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811246473	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AZ	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1306304027	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AZ	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1730180761	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AZ	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1285635235	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AZ	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265433676	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AZ	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275534620	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AZ	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1477554814	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AZ	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811984636	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AZ	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114905387	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AZ	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1548248321	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AZ	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1093790578	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AZ	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629054846	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AZ	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1639157415	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AZ	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1972588465	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AZ	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1881679371	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AZ	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1841346970	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AZ	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1437295607	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AZ	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1346386513	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AZ	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1194035436	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AZ	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1386809457	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AZ	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629219498	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AZ	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1326589482	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AZ	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275048217	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AZ	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1174845101	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AZ	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1982799045	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AZ	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265523062	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AZ	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1578639126	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AZ	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1376544320	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CA	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1508858127	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CA	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811246473	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CA	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1306304027	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CA	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1730180761	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CA	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1285635235	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CA	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265433676	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CA	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275534620	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CA	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1477554814	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CA	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811984636	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CA	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114905387	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CA	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1548248321	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CA	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1093790578	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CA	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629054846	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CA	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1639157415	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CA	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1972588465	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CA	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1881679371	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CA	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1841346970	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CA	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1437295607	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CA	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1346386513	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CA	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1194035436	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CA	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1386809457	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CA	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629219498	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CA	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1326589482	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CA	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275048217	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CA	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1174845101	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CA	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1982799045	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CA	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265523062	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CA	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1578639126	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CA	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1376544320	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CO	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1508858127	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CO	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811246473	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CO	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1306304027	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CO	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1730180761	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CO	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1285635235	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CO	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265433676	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CO	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275534620	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CO	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1477554814	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CO	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811984636	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CO	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114905387	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CO	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1548248321	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CO	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1093790578	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CO	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629054846	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CO	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1639157415	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CO	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1972588465	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CO	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1881679371	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CO	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1841346970	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CO	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1437295607	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CO	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1346386513	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CO	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1194035436	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CO	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1386809457	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CO	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629219498	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CO	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1326589482	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CO	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275048217	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CO	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1174845101	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CO	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1982799045	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CO	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265523062	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CO	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1578639126	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CO	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1376544320	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CT	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1508858127	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CT	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811246473	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CT	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1306304027	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CT	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1730180761	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CT	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1285635235	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CT	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265433676	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CT	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275534620	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CT	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1477554814	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CT	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811984636	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CT	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114905387	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CT	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1548248321	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CT	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1093790578	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CT	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629054846	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CT	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1639157415	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CT	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1972588465	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CT	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1881679371	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CT	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1841346970	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CT	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1437295607	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CT	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1346386513	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CT	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1194035436	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CT	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1386809457	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CT	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629219498	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CT	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1326589482	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CT	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275048217	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CT	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1174845101	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CT	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1982799045	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CT	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265523062	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CT	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1578639126	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CT	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1376544320	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		DE	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1508858127	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		DE	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811246473	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		DE	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1306304027	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		DE	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1730180761	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		DE	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1285635235	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		DE	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265433676	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		DE	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275534620	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		DE	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1477554814	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		DE	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811984636	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		DE	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114905387	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		DE	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1548248321	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		DE	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1093790578	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		DE	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629054846	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		DE	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1639157415	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		DE	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1972588465	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		DE	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1881679371	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		DE	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1841346970	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		DE	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1437295607	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		DE	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1346386513	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		DE	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1194035436	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		DE	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1386809457	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		DE	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629219498	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		DE	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1326589482	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		DE	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275048217	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		DE	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1174845101	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		DE	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1982799045	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		DE	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265523062	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		DE	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1578639126	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		DE	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1376544320	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		FL	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1508858127	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		FL	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811246473	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		FL	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1306304027	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		FL	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1730180761	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		FL	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1285635235	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		FL	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265433676	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		FL	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275534620	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		FL	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1477554814	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		FL	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811984636	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		FL	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114905387	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		FL	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1548248321	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		FL	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1093790578	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		FL	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629054846	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		FL	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1639157415	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		FL	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1972588465	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		FL	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1881679371	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		FL	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1841346970	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		FL	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1437295607	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		FL	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1346386513	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		FL	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1194035436	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		FL	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1386809457	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		FL	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629219498	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		FL	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1326589482	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		FL	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275048217	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		FL	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1174845101	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		FL	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1982799045	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		FL	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265523062	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		FL	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1578639126	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		FL	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1376544320	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		GA	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1508858127	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		GA	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811246473	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		GA	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1306304027	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		GA	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1730180761	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		GA	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1285635235	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		GA	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265433676	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		GA	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275534620	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		GA	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1477554814	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		GA	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811984636	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		GA	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114905387	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		GA	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1548248321	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		GA	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1093790578	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		GA	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629054846	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		GA	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1639157415	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		GA	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1972588465	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		GA	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1881679371	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		GA	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1841346970	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		GA	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1437295607	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		GA	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1346386513	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		GA	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1194035436	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		GA	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1386809457	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		GA	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629219498	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		GA	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1326589482	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		GA	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275048217	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		GA	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1174845101	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		GA	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1982799045	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		GA	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265523062	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		GA	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1578639126	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		GA	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1376544320	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		HI	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1508858127	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		HI	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811246473	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		HI	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1306304027	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		HI	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1730180761	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		HI	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1285635235	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		HI	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265433676	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		HI	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275534620	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		HI	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1477554814	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		HI	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811984636	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		HI	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114905387	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		HI	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1548248321	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		HI	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1093790578	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		HI	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629054846	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		HI	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1639157415	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		HI	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1972588465	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		HI	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1881679371	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		HI	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1841346970	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		HI	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1437295607	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		HI	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1346386513	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		HI	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1194035436	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		HI	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1386809457	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		HI	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629219498	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		HI	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1326589482	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		HI	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275048217	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		HI	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1174845101	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		HI	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1982799045	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		HI	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265523062	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		HI	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1578639126	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		HI	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1376544320	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ID	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1508858127	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ID	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811246473	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ID	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1306304027	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ID	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1730180761	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ID	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1285635235	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ID	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265433676	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ID	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275534620	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ID	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1477554814	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ID	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811984636	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ID	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114905387	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ID	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1548248321	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ID	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1093790578	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ID	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629054846	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ID	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1639157415	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ID	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1972588465	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ID	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1881679371	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ID	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1841346970	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ID	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1437295607	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ID	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1346386513	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ID	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1194035436	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ID	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1386809457	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ID	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629219498	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ID	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1326589482	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ID	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275048217	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ID	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1174845101	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ID	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1982799045	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ID	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265523062	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ID	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1578639126	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ID	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1376544320	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		IN	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1508858127	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		IN	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811246473	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		IN	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1306304027	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		IN	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1730180761	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		IN	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1285635235	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		IN	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265433676	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		IN	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275534620	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		IN	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1477554814	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		IN	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811984636	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		IN	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114905387	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		IN	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1548248321	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		IN	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1093790578	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		IN	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629054846	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		IN	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1639157415	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		IN	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1972588465	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		IN	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1881679371	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		IN	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1841346970	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		IN	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1437295607	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		IN	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1346386513	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		IN	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1194035436	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		IN	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1386809457	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		IN	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629219498	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		IN	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1326589482	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		IN	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275048217	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		IN	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1174845101	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		IN	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1982799045	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		IN	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265523062	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		IN	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1578639126	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		IN	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1376544320	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		KS	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1508858127	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		KS	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811246473	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		KS	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1306304027	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		KS	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1730180761	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		KS	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1285635235	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		KS	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265433676	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		KS	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275534620	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		KS	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1477554814	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		KS	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811984636	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		KS	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114905387	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		KS	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1548248321	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		KS	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1093790578	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		KS	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629054846	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		KS	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1639157415	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		KS	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1972588465	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		KS	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1881679371	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		KS	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1841346970	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		KS	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1437295607	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		KS	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1346386513	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		KS	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1194035436	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		KS	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1386809457	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		KS	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629219498	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		KS	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1326589482	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		KS	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275048217	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		KS	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1174845101	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		KS	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1982799045	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		KS	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265523062	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		KS	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1578639126	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		KS	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1376544320	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		KY	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1508858127	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		KY	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811246473	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		KY	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1306304027	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		KY	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1730180761	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		KY	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1285635235	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		KY	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265433676	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		KY	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275534620	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		KY	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1477554814	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		KY	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811984636	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		KY	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114905387	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		KY	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1548248321	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		KY	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1093790578	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		KY	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629054846	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		KY	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1639157415	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		KY	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1972588465	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		KY	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1881679371	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		KY	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1841346970	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		KY	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1437295607	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		KY	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1346386513	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		KY	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1194035436	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		KY	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1386809457	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		KY	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629219498	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		KY	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1326589482	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		KY	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275048217	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		KY	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1174845101	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		KY	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1982799045	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		KY	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265523062	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		KY	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1578639126	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		KY	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1376544320	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MD	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1508858127	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MD	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811246473	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MD	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1306304027	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MD	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1730180761	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MD	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1285635235	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MD	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265433676	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MD	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275534620	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MD	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1477554814	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MD	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811984636	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MD	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114905387	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MD	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1548248321	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MD	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1093790578	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MD	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629054846	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MD	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1639157415	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MD	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1972588465	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MD	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1881679371	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MD	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1841346970	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MD	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1437295607	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MD	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1346386513	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MD	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1194035436	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MD	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1386809457	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MD	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629219498	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MD	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1326589482	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MD	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275048217	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MD	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1174845101	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MD	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1982799045	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MD	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265523062	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MD	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1578639126	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MD	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1376544320	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MS	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1508858127	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MS	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811246473	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MS	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1306304027	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MS	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1730180761	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MS	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1285635235	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MS	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265433676	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MS	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275534620	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MS	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1477554814	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MS	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811984636	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MS	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114905387	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MS	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1548248321	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MS	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1093790578	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MS	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629054846	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MS	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1639157415	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MS	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1972588465	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MS	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1881679371	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MS	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1841346970	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MS	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1437295607	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MS	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1346386513	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MS	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1194035436	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MS	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1386809457	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MS	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629219498	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MS	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1326589482	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MS	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275048217	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MS	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1174845101	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MS	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1982799045	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MS	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265523062	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MS	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1578639126	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MS	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1376544320	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MT	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1508858127	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MT	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811246473	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MT	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1306304027	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MT	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1730180761	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MT	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1285635235	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MT	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265433676	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MT	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275534620	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MT	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1477554814	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MT	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811984636	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MT	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114905387	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MT	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1548248321	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MT	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1093790578	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MT	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629054846	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MT	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1639157415	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MT	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1972588465	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MT	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1881679371	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MT	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1841346970	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MT	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1437295607	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MT	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1346386513	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MT	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1194035436	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MT	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1386809457	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MT	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629219498	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MT	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1326589482	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MT	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275048217	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MT	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1174845101	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MT	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1982799045	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MT	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265523062	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MT	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1578639126	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MT	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1376544320	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MO	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1508858127	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MO	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811246473	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MO	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1306304027	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MO	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1730180761	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MO	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1285635235	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MO	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265433676	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MO	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275534620	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MO	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1477554814	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MO	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811984636	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MO	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114905387	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MO	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1548248321	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MO	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1093790578	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MO	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629054846	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MO	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1639157415	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MO	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1972588465	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MO	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1881679371	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MO	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1841346970	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MO	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1437295607	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MO	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1346386513	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MO	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1194035436	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MO	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1386809457	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MO	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629219498	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MO	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1326589482	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MO	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275048217	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MO	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1174845101	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MO	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1982799045	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MO	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265523062	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MO	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1578639126	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MO	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1376544320	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MI	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1508858127	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MI	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811246473	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MI	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1306304027	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MI	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1730180761	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MI	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1285635235	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MI	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265433676	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MI	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275534620	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MI	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1477554814	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MI	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811984636	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MI	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114905387	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MI	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1548248321	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MI	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1093790578	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MI	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629054846	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MI	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1639157415	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MI	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1972588465	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MI	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1881679371	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MI	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1841346970	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MI	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1437295607	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MI	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1346386513	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MI	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1194035436	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MI	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1386809457	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MI	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629219498	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MI	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1326589482	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MI	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275048217	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MI	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1174845101	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MI	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1982799045	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MI	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265523062	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MI	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1578639126	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MI	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1376544320	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ME	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1508858127	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ME	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811246473	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ME	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1306304027	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ME	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1730180761	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ME	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1285635235	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ME	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265433676	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ME	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275534620	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ME	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1477554814	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ME	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811984636	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ME	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114905387	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ME	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1548248321	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ME	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1093790578	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ME	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629054846	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ME	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1639157415	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ME	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1972588465	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ME	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1881679371	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ME	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1841346970	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ME	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1437295607	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ME	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1346386513	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ME	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1194035436	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ME	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1386809457	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ME	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629219498	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ME	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1326589482	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ME	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275048217	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ME	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1174845101	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ME	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1982799045	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ME	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265523062	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ME	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1578639126	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ME	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1376544320	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MN	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1508858127	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MN	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811246473	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MN	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1306304027	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MN	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1730180761	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MN	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1285635235	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MN	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265433676	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MN	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275534620	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MN	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1477554814	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MN	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811984636	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MN	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114905387	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MN	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1548248321	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MN	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1093790578	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MN	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629054846	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MN	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1639157415	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MN	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1972588465	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MN	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1881679371	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MN	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1841346970	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MN	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1437295607	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MN	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1346386513	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MN	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1194035436	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MN	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1386809457	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MN	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629219498	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MN	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1326589482	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MN	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275048217	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MN	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1174845101	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MN	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1982799045	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MN	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265523062	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MN	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1578639126	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MN	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1376544320	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NE	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1508858127	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NE	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811246473	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NE	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1306304027	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NE	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1730180761	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NE	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1285635235	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NE	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265433676	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NE	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275534620	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NE	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1477554814	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NE	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811984636	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NE	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114905387	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NE	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1548248321	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NE	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1093790578	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NE	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629054846	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NE	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1639157415	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NE	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1972588465	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NE	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1881679371	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NE	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1841346970	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NE	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1437295607	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NE	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1346386513	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NE	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1194035436	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NE	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1386809457	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NE	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629219498	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NE	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1326589482	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NE	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275048217	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NE	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1174845101	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NE	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1982799045	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NE	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265523062	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NE	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1578639126	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NE	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1376544320	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ND	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1508858127	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ND	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811246473	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ND	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1306304027	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ND	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1730180761	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ND	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1285635235	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ND	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265433676	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ND	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275534620	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ND	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1477554814	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ND	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811984636	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ND	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114905387	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ND	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1548248321	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ND	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1093790578	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ND	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629054846	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ND	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1639157415	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ND	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1972588465	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ND	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1881679371	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ND	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1841346970	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ND	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1437295607	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ND	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1346386513	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ND	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1194035436	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ND	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1386809457	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ND	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629219498	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ND	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1326589482	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ND	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275048217	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ND	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1174845101	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ND	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1982799045	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ND	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265523062	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ND	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1578639126	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ND	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1376544320	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NM	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1508858127	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NM	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811246473	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NM	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1306304027	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NM	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1730180761	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NM	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1285635235	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NM	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265433676	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NM	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275534620	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NM	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1477554814	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NM	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811984636	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NM	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114905387	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NM	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1548248321	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NM	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1093790578	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NM	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629054846	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NM	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1639157415	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NM	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1972588465	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NM	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1881679371	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NM	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1841346970	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NM	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1437295607	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NM	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1346386513	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NM	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1194035436	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NM	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1386809457	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NM	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629219498	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NM	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1326589482	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NM	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275048217	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NM	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1174845101	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NM	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1982799045	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NM	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265523062	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NM	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1578639126	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NM	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1376544320	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NH	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1508858127	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NH	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811246473	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NH	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1306304027	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NH	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1730180761	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NH	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1285635235	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NH	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265433676	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NH	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275534620	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NH	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1477554814	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NH	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811984636	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NH	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114905387	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NH	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1548248321	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NH	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1093790578	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NH	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629054846	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NH	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1639157415	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NH	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1972588465	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NH	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1881679371	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NH	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1841346970	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NH	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1437295607	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NH	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1346386513	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NH	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1194035436	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NH	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1386809457	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NH	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629219498	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NH	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1326589482	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NH	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275048217	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NH	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1174845101	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NH	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1982799045	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NH	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265523062	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NH	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1578639126	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NH	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1376544320	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NJ	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1508858127	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NJ	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811246473	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NJ	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1306304027	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NJ	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1730180761	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NJ	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1285635235	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NJ	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265433676	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NJ	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275534620	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NJ	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1477554814	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NJ	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811984636	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NJ	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114905387	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NJ	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1548248321	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NJ	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1093790578	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NJ	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629054846	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NJ	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1639157415	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NJ	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1972588465	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NJ	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1881679371	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NJ	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1841346970	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NJ	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1437295607	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NJ	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1346386513	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NJ	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1194035436	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NJ	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1386809457	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NJ	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629219498	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NJ	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1326589482	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NJ	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275048217	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NJ	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1174845101	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NJ	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1982799045	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NJ	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265523062	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NJ	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1578639126	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NJ	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1376544320	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NY	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1508858127	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NY	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811246473	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NY	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1306304027	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NY	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1730180761	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NY	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1285635235	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NY	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265433676	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NY	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275534620	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NY	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1477554814	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NY	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811984636	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NY	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114905387	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NY	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1548248321	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NY	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1093790578	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NY	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629054846	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NY	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1639157415	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NY	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1972588465	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NY	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1881679371	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NY	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1841346970	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NY	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1437295607	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NY	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1346386513	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NY	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1194035436	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NY	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1386809457	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NY	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629219498	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NY	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1326589482	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NY	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275048217	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NY	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1174845101	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NY	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1982799045	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NY	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265523062	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NY	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1578639126	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NY	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1376544320	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OH	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1508858127	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OH	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811246473	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OH	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1306304027	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OH	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1730180761	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OH	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1285635235	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OH	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265433676	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OH	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275534620	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OH	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1477554814	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OH	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811984636	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OH	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114905387	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OH	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1548248321	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OH	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1093790578	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OH	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629054846	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OH	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1639157415	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OH	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1972588465	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OH	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1881679371	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OH	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1841346970	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OH	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1437295607	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OH	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1346386513	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OH	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1194035436	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OH	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1386809457	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OH	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629219498	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OH	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1326589482	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OH	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275048217	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OH	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1174845101	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OH	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1982799045	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OH	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265523062	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OH	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1578639126	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OH	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1376544320	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NC	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1508858127	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NC	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811246473	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NC	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1306304027	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NC	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1730180761	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NC	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1285635235	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NC	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265433676	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NC	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275534620	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NC	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1477554814	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NC	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811984636	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NC	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114905387	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NC	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1548248321	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NC	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1093790578	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NC	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629054846	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NC	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1639157415	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NC	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1972588465	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NC	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1881679371	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NC	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1841346970	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NC	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1437295607	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NC	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1346386513	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NC	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1194035436	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NC	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1386809457	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NC	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629219498	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NC	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1326589482	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NC	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275048217	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NC	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1174845101	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NC	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1982799045	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NC	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265523062	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NC	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1578639126	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NC	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1376544320	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OK	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1508858127	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OK	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811246473	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OK	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1306304027	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OK	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1730180761	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OK	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1285635235	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OK	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265433676	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OK	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275534620	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OK	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1477554814	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OK	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811984636	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OK	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114905387	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OK	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1548248321	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OK	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1093790578	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OK	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629054846	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OK	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1639157415	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OK	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1972588465	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OK	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1881679371	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OK	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1841346970	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OK	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1437295607	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OK	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1346386513	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OK	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1194035436	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OK	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1386809457	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OK	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629219498	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OK	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1326589482	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OK	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275048217	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OK	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1174845101	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OK	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1982799045	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OK	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265523062	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OK	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1578639126	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OK	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1376544320	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OR	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1508858127	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OR	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811246473	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OR	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1306304027	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OR	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1730180761	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OR	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1285635235	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OR	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265433676	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OR	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275534620	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OR	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1477554814	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OR	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811984636	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OR	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114905387	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OR	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1548248321	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OR	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1093790578	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OR	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629054846	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OR	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1639157415	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OR	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1972588465	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OR	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1881679371	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OR	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1841346970	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OR	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1437295607	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OR	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1346386513	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OR	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1194035436	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OR	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1386809457	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OR	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629219498	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OR	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1326589482	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OR	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275048217	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OR	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1174845101	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OR	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1982799045	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OR	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265523062	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OR	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1578639126	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OR	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1376544320	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		PA	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1508858127	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		PA	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811246473	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		PA	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1306304027	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		PA	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1730180761	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		PA	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1285635235	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		PA	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265433676	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		PA	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275534620	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		PA	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1477554814	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		PA	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811984636	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		PA	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114905387	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		PA	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1548248321	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		PA	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1093790578	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		PA	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629054846	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		PA	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1639157415	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		PA	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1972588465	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		PA	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1881679371	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		PA	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1841346970	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		PA	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1437295607	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		PA	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1346386513	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		PA	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1194035436	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		PA	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1386809457	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		PA	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629219498	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		PA	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1326589482	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		PA	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275048217	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		PA	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1174845101	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		PA	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1982799045	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		PA	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265523062	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		PA	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1578639126	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		PA	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1376544320	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		PR	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1508858127	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		PR	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811246473	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		PR	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1306304027	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		PR	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1730180761	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		PR	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1285635235	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		PR	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265433676	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		PR	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275534620	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		PR	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1477554814	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		PR	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811984636	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		PR	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114905387	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		PR	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1548248321	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		PR	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1093790578	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		PR	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629054846	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		PR	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1639157415	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		PR	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1972588465	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		PR	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1881679371	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		PR	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1841346970	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		PR	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1437295607	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		PR	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1346386513	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		PR	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1194035436	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		PR	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1386809457	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		PR	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629219498	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		PR	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1326589482	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		PR	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275048217	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		PR	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1174845101	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		PR	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1982799045	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		PR	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265523062	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		PR	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1578639126	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		PR	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1376544320	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		RI	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1508858127	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		RI	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811246473	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		RI	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1306304027	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		RI	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1730180761	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		RI	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1285635235	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		RI	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265433676	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		RI	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275534620	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		RI	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1477554814	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		RI	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811984636	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		RI	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114905387	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		RI	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1548248321	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		RI	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1093790578	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		RI	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629054846	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		RI	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1639157415	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		RI	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1972588465	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		RI	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1881679371	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		RI	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1841346970	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		RI	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1437295607	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		RI	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1346386513	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		RI	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1194035436	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		RI	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1386809457	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		RI	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629219498	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		RI	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1326589482	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		RI	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275048217	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		RI	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1174845101	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		RI	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1982799045	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		RI	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265523062	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		RI	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1578639126	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		RI	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1376544320	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		SC	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1508858127	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		SC	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811246473	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		SC	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1306304027	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		SC	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1730180761	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		SC	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1285635235	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		SC	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265433676	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		SC	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275534620	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		SC	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1477554814	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		SC	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811984636	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		SC	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114905387	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		SC	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1548248321	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		SC	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1093790578	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		SC	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629054846	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		SC	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1639157415	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		SC	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1972588465	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		SC	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1881679371	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		SC	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1841346970	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		SC	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1437295607	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		SC	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1346386513	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		SC	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1194035436	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		SC	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1386809457	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		SC	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629219498	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		SC	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1326589482	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		SC	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275048217	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		SC	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1174845101	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		SC	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1982799045	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		SC	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265523062	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		SC	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1578639126	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		SC	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1376544320	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		SD	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1508858127	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		SD	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811246473	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		SD	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1306304027	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		SD	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1730180761	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		SD	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1285635235	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		SD	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265433676	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		SD	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275534620	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		SD	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1477554814	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		SD	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811984636	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		SD	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114905387	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		SD	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1548248321	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		SD	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1093790578	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		SD	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629054846	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		SD	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1639157415	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		SD	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1972588465	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		SD	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1881679371	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		SD	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1841346970	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		SD	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1437295607	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		SD	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1346386513	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		SD	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1194035436	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		SD	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1386809457	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		SD	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629219498	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		SD	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1326589482	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		SD	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275048217	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		SD	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1174845101	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		SD	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1982799045	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		SD	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265523062	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		SD	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1578639126	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		SD	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1376544320	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		TN	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1508858127	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		TN	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811246473	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		TN	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1306304027	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		TN	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1730180761	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		TN	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1285635235	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		TN	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265433676	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		TN	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275534620	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		TN	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1477554814	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		TN	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811984636	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		TN	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114905387	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		TN	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1548248321	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		TN	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1093790578	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		TN	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629054846	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		TN	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1639157415	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		TN	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1972588465	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		TN	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1881679371	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		TN	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1841346970	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		TN	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1437295607	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		TN	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1346386513	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		TN	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1194035436	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		TN	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1386809457	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		TN	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629219498	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		TN	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1326589482	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		TN	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275048217	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		TN	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1174845101	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		TN	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1982799045	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		TN	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265523062	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		TN	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1578639126	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		TN	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1376544320	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		TX	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1508858127	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		TX	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811246473	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		TX	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1306304027	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		TX	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1730180761	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		TX	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1285635235	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		TX	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265433676	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		TX	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275534620	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		TX	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1477554814	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		TX	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811984636	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		TX	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114905387	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		TX	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1548248321	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		TX	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1093790578	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		TX	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629054846	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		TX	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1639157415	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		TX	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1972588465	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		TX	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1881679371	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		TX	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1841346970	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		TX	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1437295607	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		TX	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1346386513	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		TX	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1194035436	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		TX	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1386809457	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		TX	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629219498	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		TX	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1326589482	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		TX	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275048217	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		TX	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1174845101	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		TX	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1982799045	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		TX	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265523062	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		TX	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1578639126	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		TX	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1376544320	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		UT	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1508858127	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		UT	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811246473	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		UT	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1306304027	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		UT	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1730180761	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		UT	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1285635235	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		UT	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265433676	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		UT	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275534620	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		UT	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1477554814	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		UT	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811984636	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		UT	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114905387	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		UT	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1548248321	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		UT	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1093790578	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		UT	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629054846	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		UT	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1639157415	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		UT	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1972588465	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		UT	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1881679371	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		UT	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1841346970	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		UT	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1437295607	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		UT	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1346386513	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		UT	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1194035436	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		UT	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1386809457	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		UT	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629219498	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		UT	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1326589482	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		UT	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275048217	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		UT	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1174845101	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		UT	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1982799045	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		UT	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265523062	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		UT	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1578639126	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		UT	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1376544320	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		VT	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1508858127	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		VT	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811246473	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		VT	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1306304027	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		VT	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1730180761	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		VT	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1285635235	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		VT	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265433676	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		VT	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275534620	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		VT	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1477554814	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		VT	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811984636	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		VT	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114905387	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		VT	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1548248321	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		VT	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1093790578	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		VT	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629054846	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		VT	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1639157415	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		VT	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1972588465	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		VT	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1881679371	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		VT	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1841346970	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		VT	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1437295607	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		VT	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1346386513	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		VT	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1194035436	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		VT	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1386809457	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		VT	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629219498	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		VT	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1326589482	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		VT	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275048217	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		VT	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1174845101	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		VT	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1982799045	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		VT	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265523062	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		VT	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1578639126	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		VT	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1376544320	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		VA	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1508858127	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		VA	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811246473	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		VA	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1306304027	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		VA	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1730180761	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		VA	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1285635235	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		VA	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265433676	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		VA	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275534620	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		VA	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1477554814	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		VA	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811984636	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		VA	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114905387	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		VA	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1548248321	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		VA	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1093790578	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		VA	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629054846	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		VA	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1639157415	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		VA	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1972588465	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		VA	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1881679371	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		VA	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1841346970	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		VA	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1437295607	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		VA	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1346386513	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		VA	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1194035436	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		VA	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1386809457	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		VA	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629219498	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		VA	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1326589482	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		VA	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275048217	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		VA	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1174845101	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		VA	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1982799045	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		VA	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265523062	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		VA	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1578639126	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		VA	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1376544320	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WA	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1508858127	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WA	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811246473	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WA	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1306304027	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WA	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1730180761	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WA	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1285635235	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WA	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265433676	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WA	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275534620	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WA	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1477554814	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WA	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811984636	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WA	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114905387	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WA	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1548248321	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WA	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1093790578	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WA	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629054846	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WA	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1639157415	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WA	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1972588465	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WA	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1881679371	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WA	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1841346970	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WA	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1437295607	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WA	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1346386513	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WA	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1194035436	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WA	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1386809457	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WA	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629219498	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WA	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1326589482	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WA	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275048217	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WA	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1174845101	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WA	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1982799045	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WA	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265523062	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WA	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1578639126	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WA	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1376544320	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WV	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1508858127	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WV	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811246473	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WV	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1306304027	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WV	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1730180761	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WV	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1285635235	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WV	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265433676	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WV	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275534620	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WV	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1477554814	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WV	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811984636	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WV	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114905387	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WV	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1548248321	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WV	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1093790578	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WV	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629054846	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WV	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1639157415	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WV	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1972588465	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WV	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1881679371	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WV	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1841346970	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WV	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1437295607	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WV	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1346386513	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WV	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1194035436	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WV	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1386809457	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WV	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629219498	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WV	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1326589482	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WV	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275048217	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WV	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1174845101	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WV	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1982799045	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WV	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265523062	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WV	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1578639126	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WV	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1376544320	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WI	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1508858127	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WI	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811246473	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WI	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1306304027	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WI	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1730180761	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WI	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1285635235	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WI	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265433676	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WI	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275534620	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WI	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1477554814	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WI	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811984636	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WI	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114905387	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WI	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1548248321	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WI	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1093790578	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WI	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629054846	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WI	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1639157415	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WI	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1972588465	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WI	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1881679371	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WI	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1841346970	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WI	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1437295607	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WI	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1346386513	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WI	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1194035436	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WI	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1386809457	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WI	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629219498	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WI	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1326589482	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WI	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275048217	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WI	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1174845101	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WI	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1982799045	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WI	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265523062	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WI	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1578639126	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WI	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1376544320	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WY	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1508858127	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WY	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811246473	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WY	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1306304027	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WY	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1730180761	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WY	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1285635235	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WY	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265433676	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WY	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275534620	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WY	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1477554814	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WY	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811984636	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WY	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114905387	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WY	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1548248321	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WY	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1093790578	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WY	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629054846	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WY	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1639157415	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WY	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1972588465	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WY	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1881679371	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WY	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1841346970	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WY	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1437295607	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WY	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1346386513	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WY	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1194035436	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WY	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1386809457	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WY	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629219498	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WY	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1326589482	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WY	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275048217	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WY	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1174845101	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WY	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1982799045	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WY	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265523062	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WY	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1578639126	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WY	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1376544320	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		DC	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1508858127	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		DC	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811246473	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		DC	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1306304027	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		DC	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1730180761	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		DC	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1285635235	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		DC	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265433676	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		DC	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275534620	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		DC	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1477554814	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		DC	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811984636	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		DC	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114905387	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		DC	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1548248321	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		DC	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1093790578	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		DC	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629054846	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		DC	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1639157415	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		DC	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1972588465	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		DC	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1881679371	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		DC	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1841346970	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		DC	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1437295607	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		DC	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1346386513	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		DC	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1194035436	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		DC	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1386809457	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		DC	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629219498	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		DC	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1326589482	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		DC	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275048217	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		DC	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1174845101	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		DC	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1982799045	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		DC	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265523062	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		DC	3/3/2024 8:42 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1578639126	3/3/2024 8:42 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		DC	3/3/2024 8:42 PM
Contacts	Signed By	Insert	New Registration		Brownlee, Michael Chief Pharmacy Officer University of Iowa Hospitals & Clinics 3193849371	2/12/2024 6:38 AM
Details	340B ID	Update	New Registration		DSH160058BP	2/12/2024 6:38 AM
Details	Entity Name	Update	New Registration	UNIVERSITY OF IOWA HOSP & CLINICS	UNIVERSITY OF IOWA HOSPITALS & CLINICS	2/12/2024 6:38 AM
Details	Entity Subname	Update	New Registration	UNIVERSITY OF IOWA HOSPITALS & CLINICS	UNIVERSITY OF IOWA HOSPITALS & CLINICS - IRL ORTHOPAEDIC SPORTS MED	2/12/2024 6:38 AM
Dates	Participating Approval Date	Update	New Registration		2/12/2024 6:38:17 AM	2/12/2024 6:38 AM
Details	State	Update	New Registration	Pending	Approved	2/12/2024 6:38 AM
Dates	Signed By Date	Update	New Registration		2/5/2024 8:56:17 PM	2/12/2024 6:38 AM
Dates	Start Date	Update	New Registration		4/1/2024 12:00:00 AM	2/12/2024 6:38 AM
Addresses	Main Address	Insert	New Registration		105 East 9th Street Coralville, IA 52241-2209	1/12/2024 11:35 PM
Addresses	Billing Address	Insert	New Registration		University of Iowa Accounts Payable 202 PCO Iowa City, IA 52242	1/12/2024 11:35 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	1/12/2024 11:35 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		0260927	1/12/2024 11:35 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		IA	1/12/2024 11:35 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	1/12/2024 11:35 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		0501847	1/12/2024 11:35 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		IA	1/12/2024 11:35 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	1/12/2024 11:35 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		0600585	1/12/2024 11:35 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		IA	1/12/2024 11:35 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	1/12/2024 11:35 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		0713967	1/12/2024 11:35 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		IA	1/12/2024 11:35 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	1/12/2024 11:35 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		426004813001	1/12/2024 11:35 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		IL	1/12/2024 11:35 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	1/12/2024 11:35 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		426004813002	1/12/2024 11:35 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		IL	1/12/2024 11:35 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	1/12/2024 11:35 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		426004813007	1/12/2024 11:35 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		IL	1/12/2024 11:35 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	1/12/2024 11:35 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		426004813401	1/12/2024 11:35 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		IL	1/12/2024 11:35 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1093790578	1/12/2024 11:35 PM
Medicaid Billing	NPI: State	Insert	New Registration		IA	1/12/2024 11:35 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1114905387	1/12/2024 11:35 PM
Medicaid Billing	NPI: State	Insert	New Registration		IA	1/12/2024 11:35 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1174845101	1/12/2024 11:35 PM
Medicaid Billing	NPI: State	Insert	New Registration		IA	1/12/2024 11:35 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1194035436	1/12/2024 11:35 PM
Medicaid Billing	NPI: State	Insert	New Registration		IA	1/12/2024 11:35 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1265433676	1/12/2024 11:35 PM
Medicaid Billing	NPI: State	Insert	New Registration		IA	1/12/2024 11:35 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1265523062	1/12/2024 11:35 PM
Medicaid Billing	NPI: State	Insert	New Registration		IA	1/12/2024 11:35 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1275048217	1/12/2024 11:35 PM
Medicaid Billing	NPI: State	Insert	New Registration		IA	1/12/2024 11:35 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1275534620	1/12/2024 11:35 PM
Medicaid Billing	NPI: State	Insert	New Registration		IA	1/12/2024 11:35 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1285635235	1/12/2024 11:35 PM
Medicaid Billing	NPI: State	Insert	New Registration		IA	1/12/2024 11:35 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1306304027	1/12/2024 11:35 PM
Medicaid Billing	NPI: State	Insert	New Registration		IA	1/12/2024 11:35 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1326589482	1/12/2024 11:35 PM
Medicaid Billing	NPI: State	Insert	New Registration		IA	1/12/2024 11:35 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1346386513	1/12/2024 11:35 PM
Medicaid Billing	NPI: State	Insert	New Registration		IA	1/12/2024 11:35 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1376544320	1/12/2024 11:35 PM
Medicaid Billing	NPI: State	Insert	New Registration		IA	1/12/2024 11:35 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1386809457	1/12/2024 11:35 PM
Medicaid Billing	NPI: State	Insert	New Registration		IA	1/12/2024 11:35 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1437295607	1/12/2024 11:35 PM
Medicaid Billing	NPI: State	Insert	New Registration		IA	1/12/2024 11:35 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1477554814	1/12/2024 11:35 PM
Medicaid Billing	NPI: State	Insert	New Registration		IA	1/12/2024 11:35 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1508858127	1/12/2024 11:35 PM
Medicaid Billing	NPI: State	Insert	New Registration		IA	1/12/2024 11:35 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1548248321	1/12/2024 11:35 PM
Medicaid Billing	NPI: State	Insert	New Registration		IA	1/12/2024 11:35 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1629054846	1/12/2024 11:35 PM
Medicaid Billing	NPI: State	Insert	New Registration		IA	1/12/2024 11:35 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1629219498	1/12/2024 11:35 PM
Medicaid Billing	NPI: State	Insert	New Registration		IA	1/12/2024 11:35 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1639157415	1/12/2024 11:35 PM
Medicaid Billing	NPI: State	Insert	New Registration		IA	1/12/2024 11:35 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1730180761	1/12/2024 11:35 PM
Medicaid Billing	NPI: State	Insert	New Registration		IA	1/12/2024 11:35 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1811246473	1/12/2024 11:35 PM
Medicaid Billing	NPI: State	Insert	New Registration		IA	1/12/2024 11:35 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1811984636	1/12/2024 11:35 PM
Medicaid Billing	NPI: State	Insert	New Registration		IA	1/12/2024 11:35 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1841346970	1/12/2024 11:35 PM
Medicaid Billing	NPI: State	Insert	New Registration		IA	1/12/2024 11:35 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1881679371	1/12/2024 11:35 PM
Medicaid Billing	NPI: State	Insert	New Registration		IA	1/12/2024 11:35 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1972588465	1/12/2024 11:35 PM
Medicaid Billing	NPI: State	Insert	New Registration		IA	1/12/2024 11:35 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1982799045	1/12/2024 11:35 PM
Medicaid Billing	NPI: State	Insert	New Registration		IA	1/12/2024 11:35 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1578639126	1/12/2024 11:35 PM
Medicaid Billing	NPI: State	Insert	New Registration		IA	1/12/2024 11:35 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1093790578	1/12/2024 11:35 PM
Medicaid Billing	NPI: State	Insert	New Registration		IL	1/12/2024 11:35 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1114905387	1/12/2024 11:35 PM
Medicaid Billing	NPI: State	Insert	New Registration		IL	1/12/2024 11:35 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1174845101	1/12/2024 11:35 PM
Medicaid Billing	NPI: State	Insert	New Registration		IL	1/12/2024 11:35 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1194035436	1/12/2024 11:35 PM
Medicaid Billing	NPI: State	Insert	New Registration		IL	1/12/2024 11:35 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1265433676	1/12/2024 11:35 PM
Medicaid Billing	NPI: State	Insert	New Registration		IL	1/12/2024 11:35 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1265523062	1/12/2024 11:35 PM
Medicaid Billing	NPI: State	Insert	New Registration		IL	1/12/2024 11:35 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1275048217	1/12/2024 11:35 PM
Medicaid Billing	NPI: State	Insert	New Registration		IL	1/12/2024 11:35 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1275534620	1/12/2024 11:35 PM
Medicaid Billing	NPI: State	Insert	New Registration		IL	1/12/2024 11:35 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1285635235	1/12/2024 11:35 PM
Medicaid Billing	NPI: State	Insert	New Registration		IL	1/12/2024 11:35 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1306304027	1/12/2024 11:35 PM
Medicaid Billing	NPI: State	Insert	New Registration		IL	1/12/2024 11:35 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1326589482	1/12/2024 11:35 PM
Medicaid Billing	NPI: State	Insert	New Registration		IL	1/12/2024 11:35 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1346386513	1/12/2024 11:35 PM
Medicaid Billing	NPI: State	Insert	New Registration		IL	1/12/2024 11:35 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1376544320	1/12/2024 11:35 PM
Medicaid Billing	NPI: State	Insert	New Registration		IL	1/12/2024 11:35 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1386809457	1/12/2024 11:35 PM
Medicaid Billing	NPI: State	Insert	New Registration		IL	1/12/2024 11:35 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1437295607	1/12/2024 11:35 PM
Medicaid Billing	NPI: State	Insert	New Registration		IL	1/12/2024 11:35 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1477554814	1/12/2024 11:35 PM
Medicaid Billing	NPI: State	Insert	New Registration		IL	1/12/2024 11:35 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1508858127	1/12/2024 11:35 PM
Medicaid Billing	NPI: State	Insert	New Registration		IL	1/12/2024 11:35 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1548248321	1/12/2024 11:35 PM
Medicaid Billing	NPI: State	Insert	New Registration		IL	1/12/2024 11:35 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1629054846	1/12/2024 11:35 PM
Medicaid Billing	NPI: State	Insert	New Registration		IL	1/12/2024 11:35 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1629219498	1/12/2024 11:35 PM
Medicaid Billing	NPI: State	Insert	New Registration		IL	1/12/2024 11:35 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1639157415	1/12/2024 11:35 PM
Medicaid Billing	NPI: State	Insert	New Registration		IL	1/12/2024 11:35 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1730180761	1/12/2024 11:35 PM
Medicaid Billing	NPI: State	Insert	New Registration		IL	1/12/2024 11:35 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1811246473	1/12/2024 11:35 PM
Medicaid Billing	NPI: State	Insert	New Registration		IL	1/12/2024 11:35 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1811984636	1/12/2024 11:35 PM
Medicaid Billing	NPI: State	Insert	New Registration		IL	1/12/2024 11:35 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1841346970	1/12/2024 11:35 PM
Medicaid Billing	NPI: State	Insert	New Registration		IL	1/12/2024 11:35 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1881679371	1/12/2024 11:35 PM
Medicaid Billing	NPI: State	Insert	New Registration		IL	1/12/2024 11:35 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1972588465	1/12/2024 11:35 PM
Medicaid Billing	NPI: State	Insert	New Registration		IL	1/12/2024 11:35 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1982799045	1/12/2024 11:35 PM
Medicaid Billing	NPI: State	Insert	New Registration		IL	1/12/2024 11:35 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1578639126	1/12/2024 11:35 PM
Medicaid Billing	NPI: State	Insert	New Registration		IL	1/12/2024 11:35 PM
Contacts	Primary Contact	Insert	New Registration		Triplett, Becky Marie Manager, 340B and Compliance University of Iowa Hospitals and Clinics 3193845583	1/12/2024 11:35 PM
Contacts	Authorizing Official	Insert	New Registration		Brownlee, Michael Chief Pharmacy Officer University of Iowa Hospitals & Clinics 3193849371	1/12/2024 11:35 PM
Details	Assistance Received From Date	Insert	New Registration			1/12/2024 11:35 PM
Details	Assistance Received To Date	Insert	New Registration			1/12/2024 11:35 PM
Details	Last Recertification Date	Insert	New Registration			1/12/2024 11:35 PM
Details	Grant Number	Insert	New Registration			1/12/2024 11:35 PM
Details	340B ID	Insert	New Registration			1/12/2024 11:35 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			1/12/2024 11:35 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			1/12/2024 11:35 PM
Details	Medicare Provider Number	Insert	New Registration		160058	1/12/2024 11:35 PM
Details	Entity Name	Insert	New Registration		UNIVERSITY OF IOWA HOSP & CLINICS	1/12/2024 11:35 PM
Details	NOFO Number	Insert	New Registration			1/12/2024 11:35 PM
Details	Program Code	Insert	New Registration		DSH	1/12/2024 11:35 PM
Details	Entity Subname	Insert	New Registration		UNIVERSITY OF IOWA HOSPITALS & CLINICS	1/12/2024 11:35 PM
Dates	Participating Approval Date	Insert	New Registration			1/12/2024 11:35 PM
Details	State	Insert	New Registration		Pending	1/12/2024 11:35 PM
Dates	Registration Date	Insert	New Registration		1/12/2024 11:35:08 PM	1/12/2024 11:35 PM
Dates	Signed By Date	Insert	New Registration			1/12/2024 11:35 PM
Dates	Start Date	Insert	New Registration			1/12/2024 11:35 PM
Terminations	Termination Comments	Insert	New Registration			1/12/2024 11:35 PM
Terminations	Termination Date	Insert	New Registration			1/12/2024 11:35 PM
Terminations	Termination Effective Date	Insert	New Registration			1/12/2024 11:35 PM
Terminations	Termination Reason	Insert	New Registration			1/12/2024 11:35 PM