Covered Entity Details

DSH160058N UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER (Active) - information as of 5/13/2025 1:28:40 AM

Main Details

Name

UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER

Subdivision Name

Dermatology

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH160058N

Medicare Provider Number

160058

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

10/12/2012

Participating Start Date

1/1/2013

Participating Approval Date

10/31/2012

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 E 9th ST
Coralville, IA 52241

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
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
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
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
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
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
CA	10056587,800249546,800249545	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
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
IL	426004813001,426004813007,426004813401,426004813002	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
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
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
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
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
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
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
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
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
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
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	187283,11509A	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
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
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
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
IA	0713967,0600585,0260927,0501847	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
CO	95004032,1376544320	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
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
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
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
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
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
DC		1306304027,1376544320,1508858127,1811246473,1730180761,1285635235,1265433676,1275534620,1477554814,1811984636,1114905387,1548248321,1093790578,1629054846,1639157415,1972588465,1881679371,1841346970,1437295607,1346386513,1194035436,1386809457,1629219498,1326589482,1275048217,1174845101,1982799045,1265523062,1578639126,1114732559,1932904927
PR		1306304027,1376544320,1508858127,1811246473,1730180761,1285635235,1265433676,1275534620,1477554814,1811984636,1114905387,1548248321,1093790578,1629054846,1639157415,1972588465,1881679371,1841346970,1437295607,1346386513,1194035436,1386809457,1629219498,1326589482,1275048217,1174845101,1982799045,1265523062,1578639126,1114732559,1932904927
RI		1306304027,1376544320,1508858127,1811246473,1730180761,1285635235,1265433676,1275534620,1477554814,1811984636,1114905387,1548248321,1093790578,1629054846,1639157415,1972588465,1881679371,1841346970,1437295607,1346386513,1194035436,1386809457,1629219498,1326589482,1275048217,1174845101,1982799045,1265523062,1578639126,1114732559,1932904927

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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
DSH160058CU	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	UNIVERSITY OF IOWA HEALTH CARE - FIRST AVE FAMILY MEDICINE	269 N. 1ST AVE	IOWA CITY	IA	Approved
DSH160058CV	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	UNIVERSITY OF IOWA HEALTH CARE - JEFFERSON STREET MED PULMONARY	540 E. JEFFERSON ST.	IOWA CITY	IA	Approved
DSH160058CW	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	UNIVERSITY OF IOWA HEALTH CARE - JEFFERSON STREET GI/HEPATOLOGY	540 E. JEFFERSON ST.	IOWA CITY	IA	Approved
DSH160058CX	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	UNIVERSITY OF IOWA HEALTH CARE - JEFFERSON STREET MED INFECTIOUS DISEASE	540 E. JEFFERSON ST.	IOWA CITY	IA	Approved
DSH160058CY	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	UNIVERSITY OF IOWA HEALTH CARE - TIPTON FAMILY MEDICINE	56 CEDAR ST	TIPTON	IA	Approved
DSH160058CZ	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	UNIVERSITY OF IOWA HEALTH CARE - IRL Diabetes Center Clinical Nutrition	105 East 9th Street	Coralville	IA	Approved
DSH160058D	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	Outreach Dialysis - North Liberty	5 Lions Drive	North Liberty	IA	Active
DSH160058DA	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	UNIVERSITY OF IOWA HEALTH CARE - HEARTLAND DRIVE OBG OBSTETRICS/GYNECOLOGY	2769 HEARTLAND DR	Coralville	IA	Approved
DSH160058DB	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	UNIVERSITY OF IOWA HEALTH CARE - OAKDALE PSY PSYCHIATRY	2055 OAKDALE RD	Coralville	IA	Approved
DSH160058DC	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	UNIVERSITY OF IOWA HEALTH CARE - HEARTLAND DRIVE GENERAL INTERNAL MEDICINE	2769 HEARTLAND DR	Coralville	IA	Approved
DSH160058DD	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	UNIVERSITY OF IOWA HEALTH CARE - WEST LIBERTY FAMILY MEDICINE	1401 CREES ST	WEST LIBERTY	IA	Approved
DSH160058DE	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	UNIVERSITY OF IOWA HEALTH CARE - OAKDALE FAMILY MEDICINE	2055 OAKDALE RD	Coralville	IA	Approved
DSH160058DF	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	UNIVERSITY OF IOWA HEALTH CARE - NORTHGATE DRIVE UROLOGY	2943 NORTHGATE DR	IOWA CITY	IA	Approved
DSH160058DG	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	UNIVERSITY OF IOWA HEALTH CARE - WEST BRANCH FAMILY MEDICINE	206 COOKSON DR	WEST BRANCH	IA	Approved
DSH160058DH	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	UNIVERSITY OF IOWA HEALTH CARE - MUSCATINE CEDARWOOD DRIVE FAMILY MEDICINE	2104 CEDARWOOD DR	MUSCATINE	IA	Approved
DSH160058DJ	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	UNIVERSITY OF IOWA HEALTH CARE - WILLIAMSBURG FAMILY MEDICINE	819 S HIGHLAND ST	WILLIAMSBURG	IA	Approved
DSH160058DK	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	UNIVERSITY OF IOWA HEALTH CARE - JEFFERSON STREET SRG ACUTE CARE	540 E. JEFFERSON ST.	IOWA CITY	IA	Approved
DSH160058DL	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	UNIVERSITY OF IOWA HEALTH CARE - HEARTLAND DRIVE GENERAL PEDIATRICS	2769 HEARTLAND DR	Coralville	IA	Approved
DSH160058DM	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	UNIVERSITY OF IOWA HEALTH CARE - JEFFERSON STREET MED CARDIOLOGY	540 E. JEFFERSON ST.	IOWA CITY	IA	Approved
DSH160058DN	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	UNIVERSITY OF IOWA HEALTH CARE - SOLON FAMILY MEDICINE	510 WEST MAIN STREET	SOLON	IA	Approved
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	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 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	8/30/2023 10:49:43 AM	8/19/2024 2:40:34 PM	8/19/2024 2:40 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
Medicaid Billing	NPI: Number	Insert	Group Change Request		1578639126	3/3/2024 8:45 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AK	3/3/2024 8:45 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1578639126	3/3/2024 8:45 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AL	3/3/2024 8:45 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1578639126	3/3/2024 8:45 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AR	3/3/2024 8:45 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1578639126	3/3/2024 8:45 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AZ	3/3/2024 8:45 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1578639126	3/3/2024 8:45 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CA	3/3/2024 8:45 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1578639126	3/3/2024 8:45 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CO	3/3/2024 8:45 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1578639126	3/3/2024 8:45 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CT	3/3/2024 8:45 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1578639126	3/3/2024 8:45 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		DC	3/3/2024 8:45 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1578639126	3/3/2024 8:45 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		DE	3/3/2024 8:45 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1578639126	3/3/2024 8:45 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		FL	3/3/2024 8:45 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1578639126	3/3/2024 8:45 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		GA	3/3/2024 8:45 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1578639126	3/3/2024 8:45 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		HI	3/3/2024 8:45 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1578639126	3/3/2024 8:45 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ID	3/3/2024 8:45 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1578639126	3/3/2024 8:45 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		IL	3/3/2024 8:45 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1578639126	3/3/2024 8:45 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		IN	3/3/2024 8:45 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1578639126	3/3/2024 8:45 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		KS	3/3/2024 8:45 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1578639126	3/3/2024 8:45 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		KY	3/3/2024 8:45 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1578639126	3/3/2024 8:45 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		LA	3/3/2024 8:45 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1578639126	3/3/2024 8:45 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MA	3/3/2024 8:45 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1578639126	3/3/2024 8:45 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MD	3/3/2024 8:45 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1578639126	3/3/2024 8:45 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ME	3/3/2024 8:45 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1578639126	3/3/2024 8:45 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MI	3/3/2024 8:45 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1578639126	3/3/2024 8:45 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MN	3/3/2024 8:45 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1578639126	3/3/2024 8:45 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MO	3/3/2024 8:45 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1578639126	3/3/2024 8:45 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MS	3/3/2024 8:45 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1578639126	3/3/2024 8:45 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MT	3/3/2024 8:45 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1578639126	3/3/2024 8:45 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NC	3/3/2024 8:45 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1578639126	3/3/2024 8:45 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ND	3/3/2024 8:45 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1578639126	3/3/2024 8:45 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NE	3/3/2024 8:45 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1578639126	3/3/2024 8:45 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NJ	3/3/2024 8:45 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1578639126	3/3/2024 8:45 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NM	3/3/2024 8:45 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1578639126	3/3/2024 8:45 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NV	3/3/2024 8:45 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1578639126	3/3/2024 8:45 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NY	3/3/2024 8:45 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1578639126	3/3/2024 8:45 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OH	3/3/2024 8:45 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1578639126	3/3/2024 8:45 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OK	3/3/2024 8:45 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1578639126	3/3/2024 8:45 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OR	3/3/2024 8:45 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1578639126	3/3/2024 8:45 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		PA	3/3/2024 8:45 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1578639126	3/3/2024 8:45 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		PR	3/3/2024 8:45 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1578639126	3/3/2024 8:45 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		RI	3/3/2024 8:45 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1578639126	3/3/2024 8:45 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		SC	3/3/2024 8:45 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1578639126	3/3/2024 8:45 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		TN	3/3/2024 8:45 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1578639126	3/3/2024 8:45 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		TX	3/3/2024 8:45 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1578639126	3/3/2024 8:45 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		UT	3/3/2024 8:45 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1578639126	3/3/2024 8:45 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		VA	3/3/2024 8:45 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1578639126	3/3/2024 8:45 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		VT	3/3/2024 8:45 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1578639126	3/3/2024 8:45 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WA	3/3/2024 8:45 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1578639126	3/3/2024 8:45 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WI	3/3/2024 8:45 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1578639126	3/3/2024 8:45 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WV	3/3/2024 8:45 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1578639126	3/3/2024 8:45 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WY	3/3/2024 8:45 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1578639126	1/2/2024 10:08 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		IA	1/2/2024 10:08 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1982799045	12/7/2023 2:45 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		DC	12/7/2023 2:45 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265523062	12/7/2023 2:45 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		DC	12/7/2023 2:45 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1982799045	12/6/2023 10:35 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		AL	12/6/2023 10:35 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265523062	12/6/2023 10:35 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		AL	12/6/2023 10:35 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1982799045	12/6/2023 10:35 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		AK	12/6/2023 10:35 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265523062	12/6/2023 10:35 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		AK	12/6/2023 10:35 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1982799045	12/6/2023 10:35 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		AZ	12/6/2023 10:35 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265523062	12/6/2023 10:35 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		AZ	12/6/2023 10:35 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1982799045	12/6/2023 10:35 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		AR	12/6/2023 10:35 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265523062	12/6/2023 10:35 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		AR	12/6/2023 10:35 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1982799045	12/6/2023 10:35 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		CA	12/6/2023 10:35 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265523062	12/6/2023 10:35 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		CA	12/6/2023 10:35 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1982799045	12/6/2023 10:35 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		CO	12/6/2023 10:35 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265523062	12/6/2023 10:35 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		CO	12/6/2023 10:35 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1982799045	12/6/2023 10:35 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		CT	12/6/2023 10:35 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265523062	12/6/2023 10:35 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		CT	12/6/2023 10:35 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1982799045	12/6/2023 10:35 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		DE	12/6/2023 10:35 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265523062	12/6/2023 10:35 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		DE	12/6/2023 10:35 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1982799045	12/6/2023 10:35 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		FL	12/6/2023 10:35 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265523062	12/6/2023 10:35 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		FL	12/6/2023 10:35 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1982799045	12/6/2023 10:35 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		GA	12/6/2023 10:35 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265523062	12/6/2023 10:35 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		GA	12/6/2023 10:35 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1982799045	12/6/2023 10:35 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		HI	12/6/2023 10:35 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265523062	12/6/2023 10:35 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		HI	12/6/2023 10:35 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1982799045	12/6/2023 10:35 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		ID	12/6/2023 10:35 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265523062	12/6/2023 10:35 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		ID	12/6/2023 10:35 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1982799045	12/6/2023 10:35 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		IL	12/6/2023 10:35 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265523062	12/6/2023 10:35 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		IL	12/6/2023 10:35 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1982799045	12/6/2023 10:35 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		IN	12/6/2023 10:35 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265523062	12/6/2023 10:35 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		IN	12/6/2023 10:35 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1982799045	12/6/2023 10:35 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		IA	12/6/2023 10:35 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265523062	12/6/2023 10:35 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		IA	12/6/2023 10:35 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1982799045	12/6/2023 10:35 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		KS	12/6/2023 10:35 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265523062	12/6/2023 10:35 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		KS	12/6/2023 10:35 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1982799045	12/6/2023 10:35 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		KY	12/6/2023 10:35 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265523062	12/6/2023 10:35 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		KY	12/6/2023 10:35 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1982799045	12/6/2023 10:35 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		LA	12/6/2023 10:35 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265523062	12/6/2023 10:35 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		LA	12/6/2023 10:35 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1982799045	12/6/2023 10:35 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		ME	12/6/2023 10:35 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265523062	12/6/2023 10:35 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		ME	12/6/2023 10:35 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1982799045	12/6/2023 10:35 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		MD	12/6/2023 10:35 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265523062	12/6/2023 10:35 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		MD	12/6/2023 10:35 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1982799045	12/6/2023 10:35 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		MA	12/6/2023 10:35 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265523062	12/6/2023 10:35 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		MA	12/6/2023 10:35 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1982799045	12/6/2023 10:35 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		MI	12/6/2023 10:35 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265523062	12/6/2023 10:35 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		MI	12/6/2023 10:35 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1982799045	12/6/2023 10:35 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		MN	12/6/2023 10:35 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265523062	12/6/2023 10:35 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		MN	12/6/2023 10:35 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1982799045	12/6/2023 10:35 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		MS	12/6/2023 10:35 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265523062	12/6/2023 10:35 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		MS	12/6/2023 10:35 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1982799045	12/6/2023 10:35 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		MO	12/6/2023 10:35 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265523062	12/6/2023 10:35 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		MO	12/6/2023 10:35 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1982799045	12/6/2023 10:35 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		MT	12/6/2023 10:35 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265523062	12/6/2023 10:35 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		MT	12/6/2023 10:35 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1982799045	12/6/2023 10:35 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		NE	12/6/2023 10:35 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265523062	12/6/2023 10:35 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		NE	12/6/2023 10:35 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1982799045	12/6/2023 10:35 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		NV	12/6/2023 10:35 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265523062	12/6/2023 10:35 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		NV	12/6/2023 10:35 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1982799045	12/6/2023 10:35 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		NJ	12/6/2023 10:35 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265523062	12/6/2023 10:35 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		NJ	12/6/2023 10:35 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1982799045	12/6/2023 10:35 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		NM	12/6/2023 10:35 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265523062	12/6/2023 10:35 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		NM	12/6/2023 10:35 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1982799045	12/6/2023 10:35 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		NY	12/6/2023 10:35 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265523062	12/6/2023 10:35 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		NY	12/6/2023 10:35 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1982799045	12/6/2023 10:35 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		NC	12/6/2023 10:35 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265523062	12/6/2023 10:35 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		NC	12/6/2023 10:35 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1982799045	12/6/2023 10:35 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		ND	12/6/2023 10:35 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265523062	12/6/2023 10:35 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		ND	12/6/2023 10:35 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1982799045	12/6/2023 10:35 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		OH	12/6/2023 10:35 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265523062	12/6/2023 10:35 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		OH	12/6/2023 10:35 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1982799045	12/6/2023 10:35 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		OK	12/6/2023 10:35 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265523062	12/6/2023 10:35 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		OK	12/6/2023 10:35 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1982799045	12/6/2023 10:35 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		OR	12/6/2023 10:35 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265523062	12/6/2023 10:35 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		OR	12/6/2023 10:35 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1982799045	12/6/2023 10:35 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		PA	12/6/2023 10:35 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265523062	12/6/2023 10:35 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		PA	12/6/2023 10:35 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1982799045	12/6/2023 10:35 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		PR	12/6/2023 10:35 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265523062	12/6/2023 10:35 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		PR	12/6/2023 10:35 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1982799045	12/6/2023 10:35 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		RI	12/6/2023 10:35 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265523062	12/6/2023 10:35 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		RI	12/6/2023 10:35 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1982799045	12/6/2023 10:35 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		SC	12/6/2023 10:35 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265523062	12/6/2023 10:35 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		SC	12/6/2023 10:35 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1982799045	12/6/2023 10:35 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		TN	12/6/2023 10:35 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265523062	12/6/2023 10:35 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		TN	12/6/2023 10:35 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1982799045	12/6/2023 10:35 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		TX	12/6/2023 10:35 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265523062	12/6/2023 10:35 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		TX	12/6/2023 10:35 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1982799045	12/6/2023 10:35 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		UT	12/6/2023 10:35 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265523062	12/6/2023 10:35 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		UT	12/6/2023 10:35 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1982799045	12/6/2023 10:35 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		VT	12/6/2023 10:35 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265523062	12/6/2023 10:35 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		VT	12/6/2023 10:35 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1982799045	12/6/2023 10:35 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		VA	12/6/2023 10:35 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265523062	12/6/2023 10:35 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		VA	12/6/2023 10:35 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1982799045	12/6/2023 10:35 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		WA	12/6/2023 10:35 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265523062	12/6/2023 10:35 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		WA	12/6/2023 10:35 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1982799045	12/6/2023 10:35 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		WV	12/6/2023 10:35 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265523062	12/6/2023 10:35 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		WV	12/6/2023 10:35 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1982799045	12/6/2023 10:35 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		WI	12/6/2023 10:35 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265523062	12/6/2023 10:35 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		WI	12/6/2023 10:35 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1982799045	12/6/2023 10:35 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		WY	12/6/2023 10:35 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265523062	12/6/2023 10:35 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		WY	12/6/2023 10:35 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1174845101 (NH)		9/7/2023 5:10 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1174845101 (SD)		9/7/2023 5:10 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	. (IA)		8/30/2023 10:49 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1265523062 (IA)		8/30/2023 10:49 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1982799045 (IA)		8/30/2023 10:49 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1265523062 (AL)		8/30/2023 10:49 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1982799045 (AL)		8/30/2023 10:49 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1982799045 (AK)		8/30/2023 10:49 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1265523062 (AK)		8/30/2023 10:49 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1265523062 (AZ)		8/30/2023 10:49 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1982799045 (AZ)		8/30/2023 10:49 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1265523062 (AR)		8/30/2023 10:49 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1982799045 (AR)		8/30/2023 10:49 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1265523062 (CA)		8/30/2023 10:49 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1982799045 (CA)		8/30/2023 10:49 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1265523062 (CO)		8/30/2023 10:49 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1982799045 (CO)		8/30/2023 10:49 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1265523062 (CT)		8/30/2023 10:49 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1982799045 (CT)		8/30/2023 10:49 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1265523062 (DC)		8/30/2023 10:49 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1982799045 (DC)		8/30/2023 10:49 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1982799045 (DE)		8/30/2023 10:49 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1265523062 (DE)		8/30/2023 10:49 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1265523062 (FL)		8/30/2023 10:49 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1982799045 (FL)		8/30/2023 10:49 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1982799045 (GA)		8/30/2023 10:49 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1265523062 (GA)		8/30/2023 10:49 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1265523062 (HI)		8/30/2023 10:49 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1982799045 (HI)		8/30/2023 10:49 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1982799045 (ID)		8/30/2023 10:49 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1265523062 (ID)		8/30/2023 10:49 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1265523062 (IL)		8/30/2023 10:49 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1982799045 (IL)		8/30/2023 10:49 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1265523062 (IN)		8/30/2023 10:49 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1982799045 (IN)		8/30/2023 10:49 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1265523062 (KS)		8/30/2023 10:49 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1982799045 (KS)		8/30/2023 10:49 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1982799045 (KY)		8/30/2023 10:49 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1265523062 (KY)		8/30/2023 10:49 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1265523062 (LA)		8/30/2023 10:49 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1982799045 (LA)		8/30/2023 10:49 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1982799045 (MA)		8/30/2023 10:49 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1265523062 (MA)		8/30/2023 10:49 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1265523062 (MD)		8/30/2023 10:49 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1982799045 (MD)		8/30/2023 10:49 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1982799045 (ME)		8/30/2023 10:49 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1265523062 (ME)		8/30/2023 10:49 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1265523062 (MI)		8/30/2023 10:49 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1982799045 (MI)		8/30/2023 10:49 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1982799045 (MN)		8/30/2023 10:49 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1265523062 (MN)		8/30/2023 10:49 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1265523062 (MO)		8/30/2023 10:49 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1982799045 (MO)		8/30/2023 10:49 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1982799045 (MS)		8/30/2023 10:49 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1265523062 (MS)		8/30/2023 10:49 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1265523062 (MT)		8/30/2023 10:49 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1982799045 (MT)		8/30/2023 10:49 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1982799045 (NC)		8/30/2023 10:49 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1265523062 (NC)		8/30/2023 10:49 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1265523062 (ND)		8/30/2023 10:49 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1982799045 (ND)		8/30/2023 10:49 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1265523062 (NE)		8/30/2023 10:49 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1982799045 (NE)		8/30/2023 10:49 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1982799045 (NJ)		8/30/2023 10:49 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1265523062 (NJ)		8/30/2023 10:49 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1265523062 (NM)		8/30/2023 10:49 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1982799045 (NM)		8/30/2023 10:49 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1982799045 (NV)		8/30/2023 10:49 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1265523062 (NV)		8/30/2023 10:49 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1265523062 (NY)		8/30/2023 10:49 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1982799045 (NY)		8/30/2023 10:49 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1265523062 (OH)		8/30/2023 10:49 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1982799045 (OH)		8/30/2023 10:49 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1982799045 (OK)		8/30/2023 10:49 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1265523062 (OK)		8/30/2023 10:49 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1265523062 (OR)		8/30/2023 10:49 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1982799045 (OR)		8/30/2023 10:49 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1982799045 (PA)		8/30/2023 10:49 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1265523062 (PA)		8/30/2023 10:49 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1265523062 (PR)		8/30/2023 10:49 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1982799045 (PR)		8/30/2023 10:49 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1982799045 (RI)		8/30/2023 10:49 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1265523062 (RI)		8/30/2023 10:49 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1265523062 (SC)		8/30/2023 10:49 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1982799045 (SC)		8/30/2023 10:49 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1982799045 (TN)		8/30/2023 10:49 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1265523062 (TN)		8/30/2023 10:49 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1265523062 (TX)		8/30/2023 10:49 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1982799045 (TX)		8/30/2023 10:49 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1265523062 (UT)		8/30/2023 10:49 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1982799045 (UT)		8/30/2023 10:49 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1982799045 (VA)		8/30/2023 10:49 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1265523062 (VA)		8/30/2023 10:49 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1265523062 (VT)		8/30/2023 10:49 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1982799045 (VT)		8/30/2023 10:49 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1982799045 (WA)		8/30/2023 10:49 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1265523062 (WA)		8/30/2023 10:49 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1265523062 (WI)		8/30/2023 10:49 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1982799045 (WI)		8/30/2023 10:49 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1265523062 (WV)		8/30/2023 10:49 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1982799045 (WV)		8/30/2023 10:49 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1982799045 (WY)		8/30/2023 10:49 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1265523062 (WY)		8/30/2023 10:49 AM
Details	Last Recertification Date	Update	Recertification	9/6/2022 6:38:17 PM	8/30/2023 10:49:43 AM	8/30/2023 10:49 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Group Change Request		False	8/6/2023 9:56 PM
Medicaid Billing	Medicaid: Number	Insert	Group Change Request		.	8/6/2023 9:56 PM
Medicaid Billing	Medicaid: State	Insert	Group Change Request		IA	8/6/2023 9:56 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1174845101	5/31/2023 10:50 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		AL	5/31/2023 10:50 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1174845101	5/31/2023 10:50 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		AK	5/31/2023 10:50 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1174845101	5/31/2023 10:50 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		AZ	5/31/2023 10:50 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1174845101	5/31/2023 10:50 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		AR	5/31/2023 10:50 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1174845101	5/31/2023 10:50 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		CA	5/31/2023 10:50 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1174845101	5/31/2023 10:50 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		CO	5/31/2023 10:50 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1174845101	5/31/2023 10:50 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		CT	5/31/2023 10:50 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1174845101	5/31/2023 10:50 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		DE	5/31/2023 10:50 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1174845101	5/31/2023 10:50 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		DC	5/31/2023 10:50 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1174845101	5/31/2023 10:50 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		FL	5/31/2023 10:50 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1174845101	5/31/2023 10:50 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		GA	5/31/2023 10:50 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1174845101	5/31/2023 10:50 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		HI	5/31/2023 10:50 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1174845101	5/31/2023 10:50 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		ID	5/31/2023 10:50 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1174845101	5/31/2023 10:50 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		IL	5/31/2023 10:50 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1174845101	5/31/2023 10:50 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		IN	5/31/2023 10:50 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1174845101	5/31/2023 10:50 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		KS	5/31/2023 10:50 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1174845101	5/31/2023 10:50 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		KY	5/31/2023 10:50 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1174845101	5/31/2023 10:50 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		LA	5/31/2023 10:50 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1174845101	5/31/2023 10:50 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		ME	5/31/2023 10:50 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1174845101	5/31/2023 10:50 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		MD	5/31/2023 10:50 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1174845101	5/31/2023 10:50 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		MA	5/31/2023 10:50 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1174845101	5/31/2023 10:50 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		MI	5/31/2023 10:50 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1174845101	5/31/2023 10:50 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		MN	5/31/2023 10:50 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1174845101	5/31/2023 10:50 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		MS	5/31/2023 10:50 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1174845101	5/31/2023 10:50 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		MO	5/31/2023 10:50 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1174845101	5/31/2023 10:50 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		MT	5/31/2023 10:50 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1174845101	5/31/2023 10:50 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		NE	5/31/2023 10:50 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1174845101	5/31/2023 10:50 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		NV	5/31/2023 10:50 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1174845101	5/31/2023 10:50 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		NH	5/31/2023 10:50 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1174845101	5/31/2023 10:50 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		NJ	5/31/2023 10:50 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1174845101	5/31/2023 10:50 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		NM	5/31/2023 10:50 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1174845101	5/31/2023 10:50 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		NY	5/31/2023 10:50 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1174845101	5/31/2023 10:50 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		NC	5/31/2023 10:50 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1174845101	5/31/2023 10:50 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		ND	5/31/2023 10:50 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1174845101	5/31/2023 10:50 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		OH	5/31/2023 10:50 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1174845101	5/31/2023 10:50 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		OK	5/31/2023 10:50 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1174845101	5/31/2023 10:50 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		OR	5/31/2023 10:50 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1174845101	5/31/2023 10:50 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		PA	5/31/2023 10:50 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1174845101	5/31/2023 10:50 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		PR	5/31/2023 10:50 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1174845101	5/31/2023 10:50 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		RI	5/31/2023 10:50 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1174845101	5/31/2023 10:50 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		SC	5/31/2023 10:50 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1174845101	5/31/2023 10:50 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		SD	5/31/2023 10:50 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1174845101	5/31/2023 10:50 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		TN	5/31/2023 10:50 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1174845101	5/31/2023 10:50 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		TX	5/31/2023 10:50 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1174845101	5/31/2023 10:50 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		UT	5/31/2023 10:50 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1174845101	5/31/2023 10:50 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		VT	5/31/2023 10:50 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1174845101	5/31/2023 10:50 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		VA	5/31/2023 10:50 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1174845101	5/31/2023 10:50 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		WA	5/31/2023 10:50 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1174845101	5/31/2023 10:50 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		WV	5/31/2023 10:50 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1174845101	5/31/2023 10:50 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		WI	5/31/2023 10:50 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1174845101	5/31/2023 10:50 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		WY	5/31/2023 10:50 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1174845101	5/30/2023 11:44 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		IA	5/30/2023 11:44 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Group Change Request		False	2/3/2023 12:05 PM
Medicaid Billing	Medicaid: Number	Insert	Group Change Request		30003896540001	2/3/2023 12:05 PM
Medicaid Billing	Medicaid: State	Insert	Group Change Request		KS	2/3/2023 12:05 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Group Change Request		False	2/3/2023 12:05 PM
Medicaid Billing	Medicaid: Number	Insert	Group Change Request		30003896540003	2/3/2023 12:05 PM
Medicaid Billing	Medicaid: State	Insert	Group Change Request		KS	2/3/2023 12:05 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265523062	9/12/2022 5:24 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AL	9/12/2022 5:24 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1982799045	9/12/2022 5:24 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AL	9/12/2022 5:24 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1982799045	9/12/2022 5:24 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AK	9/12/2022 5:24 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265523062	9/12/2022 5:24 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AK	9/12/2022 5:24 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265523062	9/12/2022 5:24 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AZ	9/12/2022 5:24 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1982799045	9/12/2022 5:24 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AZ	9/12/2022 5:24 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265523062	9/12/2022 5:24 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AR	9/12/2022 5:24 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1982799045	9/12/2022 5:24 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AR	9/12/2022 5:24 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265523062	9/12/2022 5:24 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CA	9/12/2022 5:24 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1982799045	9/12/2022 5:24 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CA	9/12/2022 5:24 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265523062	9/12/2022 5:24 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CO	9/12/2022 5:24 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1982799045	9/12/2022 5:24 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CO	9/12/2022 5:24 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265523062	9/12/2022 5:24 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CT	9/12/2022 5:24 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1982799045	9/12/2022 5:24 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CT	9/12/2022 5:24 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265523062	9/12/2022 5:24 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		DC	9/12/2022 5:24 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1982799045	9/12/2022 5:24 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		DC	9/12/2022 5:24 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1982799045	9/12/2022 5:24 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		DE	9/12/2022 5:24 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265523062	9/12/2022 5:24 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		DE	9/12/2022 5:24 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265523062	9/12/2022 5:24 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		FL	9/12/2022 5:24 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1982799045	9/12/2022 5:24 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		FL	9/12/2022 5:24 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1982799045	9/12/2022 5:24 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		GA	9/12/2022 5:24 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265523062	9/12/2022 5:24 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		GA	9/12/2022 5:24 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265523062	9/12/2022 5:24 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		HI	9/12/2022 5:24 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1982799045	9/12/2022 5:24 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		HI	9/12/2022 5:24 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1982799045	9/12/2022 5:24 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ID	9/12/2022 5:24 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265523062	9/12/2022 5:24 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ID	9/12/2022 5:24 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265523062	9/12/2022 5:24 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		IL	9/12/2022 5:24 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1982799045	9/12/2022 5:24 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		IL	9/12/2022 5:24 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265523062	9/12/2022 5:24 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		IN	9/12/2022 5:24 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1982799045	9/12/2022 5:24 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		IN	9/12/2022 5:24 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265523062	9/12/2022 5:24 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		KS	9/12/2022 5:24 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1982799045	9/12/2022 5:24 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		KS	9/12/2022 5:24 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1982799045	9/12/2022 5:24 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		KY	9/12/2022 5:24 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265523062	9/12/2022 5:24 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		KY	9/12/2022 5:24 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265523062	9/12/2022 5:24 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		LA	9/12/2022 5:24 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1982799045	9/12/2022 5:24 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		LA	9/12/2022 5:24 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1982799045	9/12/2022 5:24 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MA	9/12/2022 5:24 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265523062	9/12/2022 5:24 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MA	9/12/2022 5:24 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265523062	9/12/2022 5:24 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MD	9/12/2022 5:24 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1982799045	9/12/2022 5:24 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MD	9/12/2022 5:24 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1982799045	9/12/2022 5:24 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ME	9/12/2022 5:24 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265523062	9/12/2022 5:24 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ME	9/12/2022 5:24 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265523062	9/12/2022 5:24 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MI	9/12/2022 5:24 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1982799045	9/12/2022 5:24 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MI	9/12/2022 5:24 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1982799045	9/12/2022 5:24 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MN	9/12/2022 5:24 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265523062	9/12/2022 5:24 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MN	9/12/2022 5:24 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265523062	9/12/2022 5:24 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MO	9/12/2022 5:24 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1982799045	9/12/2022 5:24 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MO	9/12/2022 5:24 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1982799045	9/12/2022 5:24 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MS	9/12/2022 5:24 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265523062	9/12/2022 5:24 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MS	9/12/2022 5:24 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265523062	9/12/2022 5:24 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MT	9/12/2022 5:24 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1982799045	9/12/2022 5:24 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MT	9/12/2022 5:24 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1982799045	9/12/2022 5:24 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NC	9/12/2022 5:24 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265523062	9/12/2022 5:24 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NC	9/12/2022 5:24 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265523062	9/12/2022 5:24 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ND	9/12/2022 5:24 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1982799045	9/12/2022 5:24 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ND	9/12/2022 5:24 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265523062	9/12/2022 5:24 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NE	9/12/2022 5:24 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1982799045	9/12/2022 5:24 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NE	9/12/2022 5:24 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1982799045	9/12/2022 5:24 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NJ	9/12/2022 5:24 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265523062	9/12/2022 5:24 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NJ	9/12/2022 5:24 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265523062	9/12/2022 5:24 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NM	9/12/2022 5:24 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1982799045	9/12/2022 5:24 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NM	9/12/2022 5:24 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1982799045	9/12/2022 5:24 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NV	9/12/2022 5:24 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265523062	9/12/2022 5:24 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NV	9/12/2022 5:24 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265523062	9/12/2022 5:24 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NY	9/12/2022 5:24 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1982799045	9/12/2022 5:24 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NY	9/12/2022 5:24 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265523062	9/12/2022 5:24 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OH	9/12/2022 5:24 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1982799045	9/12/2022 5:24 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OH	9/12/2022 5:24 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1982799045	9/12/2022 5:24 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OK	9/12/2022 5:24 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265523062	9/12/2022 5:24 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OK	9/12/2022 5:24 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265523062	9/12/2022 5:24 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OR	9/12/2022 5:24 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1982799045	9/12/2022 5:24 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OR	9/12/2022 5:24 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1982799045	9/12/2022 5:24 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		PA	9/12/2022 5:24 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265523062	9/12/2022 5:24 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		PA	9/12/2022 5:24 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265523062	9/12/2022 5:24 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		PR	9/12/2022 5:24 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1982799045	9/12/2022 5:24 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		PR	9/12/2022 5:24 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1982799045	9/12/2022 5:24 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		RI	9/12/2022 5:24 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265523062	9/12/2022 5:24 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		RI	9/12/2022 5:24 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265523062	9/12/2022 5:24 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		SC	9/12/2022 5:24 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1982799045	9/12/2022 5:24 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		SC	9/12/2022 5:24 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1982799045	9/12/2022 5:24 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		TN	9/12/2022 5:24 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265523062	9/12/2022 5:24 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		TN	9/12/2022 5:24 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265523062	9/12/2022 5:24 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		TX	9/12/2022 5:24 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1982799045	9/12/2022 5:24 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		TX	9/12/2022 5:24 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265523062	9/12/2022 5:24 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		UT	9/12/2022 5:24 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1982799045	9/12/2022 5:24 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		UT	9/12/2022 5:24 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1982799045	9/12/2022 5:24 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		VA	9/12/2022 5:24 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265523062	9/12/2022 5:24 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		VA	9/12/2022 5:24 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265523062	9/12/2022 5:24 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		VT	9/12/2022 5:24 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1982799045	9/12/2022 5:24 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		VT	9/12/2022 5:24 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1982799045	9/12/2022 5:24 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WA	9/12/2022 5:24 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265523062	9/12/2022 5:24 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WA	9/12/2022 5:24 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265523062	9/12/2022 5:24 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WI	9/12/2022 5:24 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1982799045	9/12/2022 5:24 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WI	9/12/2022 5:24 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265523062	9/12/2022 5:24 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WV	9/12/2022 5:24 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1982799045	9/12/2022 5:24 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WV	9/12/2022 5:24 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1982799045	9/12/2022 5:24 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WY	9/12/2022 5:24 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265523062	9/12/2022 5:24 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WY	9/12/2022 5:24 PM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	300038550 (IN)		9/8/2022 11:26 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Group Change Request		False	9/8/2022 11:26 AM
Medicaid Billing	Medicaid: Number	Insert	Group Change Request		300063132	9/8/2022 11:26 AM
Medicaid Billing	Medicaid: State	Insert	Group Change Request		IN	9/8/2022 11:26 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265523062	9/8/2022 11:26 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		IA	9/8/2022 11:26 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1982799045	9/8/2022 11:26 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		IA	9/8/2022 11:26 AM
Details	Last Recertification Date	Update	Recertification	9/3/2021 1:12:35 PM	9/6/2022 6:38:17 PM	9/6/2022 6:38 PM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	1008875 (WA)		3/8/2022 2:21 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1114323599 (AL)		3/8/2022 2:21 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1114323599 (AK)		3/8/2022 2:21 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1114323599 (AZ)		3/8/2022 2:21 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1114323599 (AR)		3/8/2022 2:21 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1114323599 (CA)		3/8/2022 2:21 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1114323599 (CO)		3/8/2022 2:21 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1114323599 (CT)		3/8/2022 2:21 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1114323599 (DE)		3/8/2022 2:21 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1114323599 (DC)		3/8/2022 2:21 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1114323599 (FL)		3/8/2022 2:21 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1114323599 (GA)		3/8/2022 2:21 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1114323599 (HI)		3/8/2022 2:21 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Group Change Request		False	3/6/2022 11:19 PM
Medicaid Billing	Medicaid: Number	Insert	Group Change Request		2203156	3/6/2022 11:19 PM
Medicaid Billing	Medicaid: State	Insert	Group Change Request		WA	3/6/2022 11:19 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1114323599 (IA)		3/6/2022 11:19 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1114323599 (ID)		3/6/2022 11:19 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1114323599 (IL)		3/6/2022 11:19 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1114323599 (IN)		3/6/2022 11:19 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1114323599 (KS)		3/6/2022 11:19 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1114323599 (KY)		3/6/2022 11:19 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1114323599 (LA)		3/6/2022 11:19 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1114323599 (ME)		3/6/2022 11:19 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1114323599 (MD)		3/6/2022 11:19 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1114323599 (MA)		3/6/2022 11:19 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1114323599 (MI)		3/6/2022 11:19 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1114323599 (MN)		3/6/2022 11:19 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1114323599 (MS)		3/6/2022 11:19 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1114323599 (MO)		3/6/2022 11:19 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1114323599 (MT)		3/6/2022 11:19 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1114323599 (NE)		3/6/2022 11:19 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1114323599 (NV)		3/6/2022 11:19 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1114323599 (NJ)		3/6/2022 11:19 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1114323599 (NM)		3/6/2022 11:19 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1114323599 (NY)		3/6/2022 11:19 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1114323599 (NC)		3/6/2022 11:19 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1114323599 (ND)		3/6/2022 11:19 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1114323599 (OH)		3/6/2022 11:19 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1114323599 (OK)		3/6/2022 11:19 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1114323599 (OR)		3/6/2022 11:19 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1114323599 (PA)		3/6/2022 11:19 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1114323599 (PR)		3/6/2022 11:19 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1114323599 (RI)		3/6/2022 11:19 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1114323599 (SC)		3/6/2022 11:19 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1114323599 (TN)		3/6/2022 11:19 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1114323599 (TX)		3/6/2022 11:19 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1114323599 (UT)		3/6/2022 11:19 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1114323599 (VT)		3/6/2022 11:19 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1114323599 (VA)		3/6/2022 11:19 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1114323599 (WA)		3/6/2022 11:19 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1114323599 (WV)		3/6/2022 11:19 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1114323599 (WI)		3/6/2022 11:19 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1114323599 (WY)		3/6/2022 11:19 PM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	5522600 (SD)		12/15/2021 5:03 PM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	0122600 (SD)		12/15/2021 5:03 PM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	1376544320 (SD)		12/15/2021 5:03 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1376544320 (SD)		12/15/2021 5:03 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1508858127 (SD)		12/15/2021 5:03 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1811246473 (SD)		12/15/2021 5:03 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1306304027 (SD)		12/15/2021 5:03 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1306304027 (NH)		12/15/2021 5:03 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1376544320 (NH)		12/15/2021 5:03 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1508858127 (NH)		12/15/2021 5:03 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1811246473 (NH)		12/15/2021 5:03 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1710988761 (IA)		12/15/2021 5:03 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1710988761 (AL)		12/15/2021 5:03 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1710988761 (AK)		12/15/2021 5:03 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1710988761 (AZ)		12/15/2021 5:03 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1710988761 (AR)		12/15/2021 5:03 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1710988761 (CA)		12/15/2021 5:03 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1710988761 (CO)		12/15/2021 5:03 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1710988761 (CT)		12/15/2021 5:03 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1710988761 (DE)		12/15/2021 5:03 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1710988761 (DC)		12/15/2021 5:03 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1710988761 (FL)		12/15/2021 5:03 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1710988761 (GA)		12/15/2021 5:03 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1710988761 (HI)		12/15/2021 5:03 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1710988761 (ID)		12/15/2021 5:03 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1710988761 (IL)		12/15/2021 5:03 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1710988761 (IN)		12/15/2021 5:03 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1710988761 (KS)		12/15/2021 5:03 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1710988761 (KY)		12/15/2021 5:03 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1710988761 (LA)		12/15/2021 5:03 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1710988761 (ME)		12/15/2021 5:03 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1710988761 (MD)		12/15/2021 5:03 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1710988761 (MA)		12/15/2021 5:03 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1710988761 (MI)		12/15/2021 5:03 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1710988761 (MN)		12/15/2021 5:03 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1710988761 (MS)		12/15/2021 5:03 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1710988761 (MO)		12/15/2021 5:03 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1710988761 (MT)		12/15/2021 5:03 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1710988761 (NE)		12/15/2021 5:03 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1710988761 (NV)		12/15/2021 5:03 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1710988761 (NH)		12/15/2021 5:03 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1730180761 (NH)		12/15/2021 5:03 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1285635235 (NH)		12/15/2021 5:03 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1265433676 (NH)		12/15/2021 5:03 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1275534620 (NH)		12/15/2021 5:03 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1477554814 (NH)		12/15/2021 5:03 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1811984636 (NH)		12/15/2021 5:03 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1114905387 (NH)		12/15/2021 5:03 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1548248321 (NH)		12/15/2021 5:03 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1093790578 (NH)		12/15/2021 5:03 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1629054846 (NH)		12/15/2021 5:03 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1639157415 (NH)		12/15/2021 5:03 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1972588465 (NH)		12/15/2021 5:03 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1881679371 (NH)		12/15/2021 5:03 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1841346970 (NH)		12/15/2021 5:03 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1437295607 (NH)		12/15/2021 5:03 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1346386513 (NH)		12/15/2021 5:03 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1194035436 (NH)		12/15/2021 5:03 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1386809457 (NH)		12/15/2021 5:03 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1629219498 (NH)		12/15/2021 5:03 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1114323599 (NH)		12/15/2021 5:03 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1326589482 (NH)		12/15/2021 5:03 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1275048217 (NH)		12/15/2021 5:03 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1710988761 (NJ)		12/15/2021 5:03 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1710988761 (NM)		12/15/2021 5:03 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1710988761 (NY)		12/15/2021 5:03 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1710988761 (NC)		12/15/2021 5:03 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1710988761 (ND)		12/15/2021 5:03 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1710988761 (OH)		12/15/2021 5:03 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1710988761 (OK)		12/15/2021 5:03 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1710988761 (OR)		12/15/2021 5:03 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1710988761 (PA)		12/15/2021 5:03 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1710988761 (PR)		12/15/2021 5:03 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1710988761 (RI)		12/15/2021 5:03 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1710988761 (SC)		12/15/2021 5:03 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1710988761 (SD)		12/15/2021 5:03 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1730180761 (SD)		12/15/2021 5:03 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1285635235 (SD)		12/15/2021 5:03 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1265433676 (SD)		12/15/2021 5:03 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1275534620 (SD)		12/15/2021 5:03 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1477554814 (SD)		12/15/2021 5:03 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1811984636 (SD)		12/15/2021 5:03 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1114905387 (SD)		12/15/2021 5:03 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1548248321 (SD)		12/15/2021 5:03 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1093790578 (SD)		12/15/2021 5:03 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1629054846 (SD)		12/15/2021 5:03 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1639157415 (SD)		12/15/2021 5:03 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1972588465 (SD)		12/15/2021 5:03 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1881679371 (SD)		12/15/2021 5:03 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1841346970 (SD)		12/15/2021 5:03 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1437295607 (SD)		12/15/2021 5:03 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1346386513 (SD)		12/15/2021 5:03 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1194035436 (SD)		12/15/2021 5:03 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1386809457 (SD)		12/15/2021 5:03 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1629219498 (SD)		12/15/2021 5:03 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1114323599 (SD)		12/15/2021 5:03 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1326589482 (SD)		12/15/2021 5:03 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1275048217 (SD)		12/15/2021 5:03 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1710988761 (TN)		12/15/2021 5:03 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1710988761 (TX)		12/15/2021 5:03 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1710988761 (UT)		12/15/2021 5:03 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1710988761 (VT)		12/15/2021 5:03 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1710988761 (VA)		12/15/2021 5:03 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1710988761 (WA)		12/15/2021 5:03 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1710988761 (WV)		12/15/2021 5:03 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1710988761 (WI)		12/15/2021 5:03 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1710988761 (WY)		12/15/2021 5:03 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1861430373 (IA)		11/19/2021 6:11 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1861430373 (AL)		11/19/2021 6:11 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1861430373 (AK)		11/19/2021 6:11 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1861430373 (AZ)		11/19/2021 6:11 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1861430373 (AR)		11/19/2021 6:11 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1861430373 (CA)		11/19/2021 6:11 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1861430373 (CO)		11/19/2021 6:11 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1861430373 (CT)		11/19/2021 6:11 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1861430373 (DE)		11/19/2021 6:11 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1861430373 (DC)		11/19/2021 6:11 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1861430373 (FL)		11/19/2021 6:11 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1861430373 (GA)		11/19/2021 6:11 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1861430373 (HI)		11/19/2021 6:11 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1861430373 (ID)		11/19/2021 6:11 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1861430373 (IL)		11/19/2021 6:11 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1861430373 (IN)		11/19/2021 6:11 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1861430373 (KS)		11/19/2021 6:11 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1861430373 (KY)		11/19/2021 6:11 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1861430373 (LA)		11/19/2021 6:11 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1861430373 (ME)		11/19/2021 6:11 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1861430373 (MD)		11/19/2021 6:11 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1861430373 (MA)		11/19/2021 6:11 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1861430373 (MI)		11/19/2021 6:11 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1861430373 (MN)		11/19/2021 6:11 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1861430373 (MS)		11/19/2021 6:11 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1861430373 (MO)		11/19/2021 6:11 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1861430373 (MT)		11/19/2021 6:11 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1861430373 (NE)		11/19/2021 6:11 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1861430373 (NV)		11/19/2021 6:11 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1861430373 (NH)		11/19/2021 6:11 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1861430373 (NJ)		11/19/2021 6:11 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1861430373 (NM)		11/19/2021 6:11 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1861430373 (NY)		11/19/2021 6:11 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1861430373 (NC)		11/19/2021 6:11 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1861430373 (ND)		11/19/2021 6:11 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1861430373 (OH)		11/19/2021 6:11 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1861430373 (OK)		11/19/2021 6:11 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1861430373 (OR)		11/19/2021 6:11 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1861430373 (PA)		11/19/2021 6:11 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1861430373 (PR)		11/19/2021 6:11 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1861430373 (RI)		11/19/2021 6:11 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1861430373 (SC)		11/19/2021 6:11 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1861430373 (SD)		11/19/2021 6:11 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1861430373 (TN)		11/19/2021 6:11 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1861430373 (TX)		11/19/2021 6:11 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1861430373 (UT)		11/19/2021 6:11 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1861430373 (VT)		11/19/2021 6:11 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1861430373 (VA)		11/19/2021 6:11 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1861430373 (WA)		11/19/2021 6:11 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1861430373 (WV)		11/19/2021 6:11 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1861430373 (WI)		11/19/2021 6:11 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1861430373 (WY)		10/31/2021 11:56 AM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	94005675 (CO)		9/22/2021 3:01 PM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	092113100 (FL)		9/22/2021 3:01 PM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	100035480A (IN)		9/22/2021 3:01 PM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	7201516 (MA)		9/22/2021 3:01 PM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	0008423270001 (PA)		9/10/2021 6:05 PM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	1011295 (WA)		9/10/2021 6:05 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Group Change Request		False	9/10/2021 6:05 PM
Medicaid Billing	Medicaid: Number	Insert	Group Change Request		1376544320	9/10/2021 6:05 PM
Medicaid Billing	Medicaid: State	Insert	Group Change Request		CO	9/10/2021 6:05 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Group Change Request		False	9/10/2021 6:05 PM
Medicaid Billing	Medicaid: Number	Insert	Group Change Request		109271900	9/10/2021 6:05 PM
Medicaid Billing	Medicaid: State	Insert	Group Change Request		FL	9/10/2021 6:05 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Group Change Request		False	9/10/2021 6:05 PM
Medicaid Billing	Medicaid: Number	Insert	Group Change Request		300038550	9/10/2021 6:05 PM
Medicaid Billing	Medicaid: State	Insert	Group Change Request		IN	9/10/2021 6:05 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Group Change Request		False	9/10/2021 6:05 PM
Medicaid Billing	Medicaid: Number	Insert	Group Change Request		110010615F	9/10/2021 6:05 PM
Medicaid Billing	Medicaid: State	Insert	Group Change Request		MA	9/10/2021 6:05 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Group Change Request		False	9/10/2021 6:05 PM
Medicaid Billing	Medicaid: Number	Insert	Group Change Request		49207	9/10/2021 6:05 PM
Medicaid Billing	Medicaid: State	Insert	Group Change Request		MN	9/10/2021 6:05 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Group Change Request		False	9/10/2021 6:05 PM
Medicaid Billing	Medicaid: Number	Insert	Group Change Request		1765544320	9/10/2021 6:05 PM
Medicaid Billing	Medicaid: State	Insert	Group Change Request		MN	9/10/2021 6:05 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Group Change Request		False	9/10/2021 6:05 PM
Medicaid Billing	Medicaid: Number	Insert	Group Change Request		1376544320	9/10/2021 6:05 PM
Medicaid Billing	Medicaid: State	Insert	Group Change Request		SD	9/10/2021 6:05 PM
Details	Last Recertification Date	Update	Recertification	9/4/2020 1:50:46 PM	9/3/2021 1:12:35 PM	9/3/2021 1:12 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1710988761	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AL	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1730180761	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AL	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1285635235	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AL	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265433676	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AL	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275534620	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AL	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1477554814	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AL	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811984636	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AL	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114905387	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AL	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1548248321	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AL	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1093790578	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AL	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629054846	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AL	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1639157415	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AL	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1972588465	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AL	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1881679371	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AL	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1841346970	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AL	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1437295607	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AL	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1346386513	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AL	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1194035436	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AL	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1386809457	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AL	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629219498	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AL	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114323599	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AL	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1326589482	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AL	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275048217	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AL	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1861430373	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AL	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1710988761	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AK	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1730180761	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AK	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1285635235	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AK	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265433676	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AK	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275534620	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AK	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1477554814	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AK	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811984636	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AK	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114905387	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AK	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1548248321	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AK	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1093790578	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AK	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629054846	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AK	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1639157415	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AK	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1972588465	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AK	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1881679371	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AK	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1841346970	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AK	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1437295607	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AK	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1346386513	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AK	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1194035436	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AK	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1386809457	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AK	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629219498	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AK	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114323599	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AK	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1326589482	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AK	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275048217	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AK	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1861430373	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AK	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1710988761	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AZ	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1730180761	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AZ	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1285635235	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AZ	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265433676	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AZ	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275534620	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AZ	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1477554814	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AZ	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811984636	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AZ	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114905387	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AZ	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1548248321	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AZ	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1093790578	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AZ	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629054846	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AZ	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1639157415	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AZ	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1972588465	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AZ	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1881679371	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AZ	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1841346970	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AZ	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1437295607	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AZ	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1346386513	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AZ	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1194035436	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AZ	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1386809457	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AZ	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629219498	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AZ	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114323599	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AZ	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1326589482	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AZ	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275048217	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AZ	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1861430373	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AZ	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1710988761	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AR	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1730180761	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AR	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1285635235	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AR	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265433676	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AR	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275534620	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AR	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1477554814	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AR	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811984636	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AR	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114905387	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AR	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1548248321	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AR	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1093790578	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AR	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629054846	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AR	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1639157415	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AR	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1972588465	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AR	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1881679371	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AR	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1841346970	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AR	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1437295607	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AR	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1346386513	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AR	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1194035436	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AR	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1386809457	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AR	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629219498	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AR	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114323599	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AR	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1326589482	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AR	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275048217	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AR	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1861430373	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		AR	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1710988761	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1730180761	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1285635235	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265433676	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275534620	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1477554814	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811984636	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114905387	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1548248321	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1093790578	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629054846	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1639157415	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1972588465	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1881679371	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1841346970	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1437295607	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1346386513	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1194035436	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1386809457	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629219498	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114323599	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1326589482	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275048217	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1861430373	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1710988761	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CO	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1730180761	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CO	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1285635235	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CO	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265433676	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CO	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275534620	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CO	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1477554814	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CO	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811984636	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CO	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114905387	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CO	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1548248321	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CO	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1093790578	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CO	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629054846	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CO	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1639157415	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CO	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1972588465	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CO	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1881679371	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CO	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1841346970	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CO	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1437295607	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CO	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1346386513	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CO	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1194035436	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CO	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1386809457	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CO	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629219498	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CO	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114323599	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CO	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1326589482	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CO	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275048217	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CO	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1861430373	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CO	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1710988761	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CT	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1730180761	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CT	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1285635235	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CT	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265433676	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CT	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275534620	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CT	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1477554814	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CT	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811984636	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CT	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114905387	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CT	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1548248321	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CT	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1093790578	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CT	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629054846	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CT	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1639157415	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CT	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1972588465	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CT	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1881679371	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CT	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1841346970	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CT	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1437295607	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CT	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1346386513	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CT	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1194035436	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CT	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1386809457	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CT	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629219498	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CT	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114323599	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CT	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1326589482	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CT	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275048217	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CT	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1861430373	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CT	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1710988761	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		DE	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1730180761	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		DE	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1285635235	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		DE	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265433676	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		DE	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275534620	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		DE	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1477554814	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		DE	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811984636	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		DE	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114905387	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		DE	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1548248321	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		DE	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1093790578	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		DE	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629054846	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		DE	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1639157415	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		DE	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1972588465	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		DE	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1881679371	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		DE	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1841346970	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		DE	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1437295607	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		DE	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1346386513	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		DE	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1194035436	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		DE	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1386809457	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		DE	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629219498	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		DE	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114323599	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		DE	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1326589482	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		DE	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275048217	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		DE	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1861430373	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		DE	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1710988761	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		DC	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1730180761	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		DC	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1285635235	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		DC	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265433676	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		DC	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275534620	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		DC	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1477554814	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		DC	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811984636	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		DC	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114905387	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		DC	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1548248321	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		DC	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1093790578	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		DC	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629054846	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		DC	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1639157415	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		DC	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1972588465	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		DC	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1881679371	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		DC	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1841346970	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		DC	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1437295607	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		DC	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1346386513	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		DC	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1194035436	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		DC	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1386809457	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		DC	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629219498	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		DC	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114323599	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		DC	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1326589482	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		DC	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275048217	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		DC	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1861430373	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		DC	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1710988761	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		FL	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1730180761	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		FL	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1285635235	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		FL	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265433676	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		FL	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275534620	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		FL	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1477554814	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		FL	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811984636	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		FL	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114905387	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		FL	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1548248321	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		FL	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1093790578	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		FL	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629054846	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		FL	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1639157415	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		FL	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1972588465	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		FL	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1881679371	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		FL	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1841346970	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		FL	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1437295607	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		FL	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1346386513	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		FL	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1194035436	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		FL	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1386809457	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		FL	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629219498	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		FL	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114323599	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		FL	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1326589482	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		FL	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275048217	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		FL	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1861430373	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		FL	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1710988761	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		GA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1730180761	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		GA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1285635235	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		GA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265433676	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		GA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275534620	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		GA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1477554814	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		GA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811984636	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		GA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114905387	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		GA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1548248321	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		GA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1093790578	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		GA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629054846	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		GA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1639157415	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		GA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1972588465	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		GA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1881679371	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		GA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1841346970	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		GA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1437295607	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		GA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1346386513	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		GA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1194035436	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		GA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1386809457	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		GA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629219498	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		GA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114323599	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		GA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1326589482	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		GA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275048217	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		GA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1861430373	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		GA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1710988761	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		HI	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1730180761	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		HI	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1285635235	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		HI	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265433676	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		HI	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275534620	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		HI	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1477554814	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		HI	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811984636	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		HI	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114905387	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		HI	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1548248321	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		HI	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1093790578	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		HI	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629054846	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		HI	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1639157415	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		HI	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1972588465	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		HI	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1881679371	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		HI	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1841346970	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		HI	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1437295607	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		HI	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1346386513	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		HI	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1194035436	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		HI	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1386809457	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		HI	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629219498	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		HI	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114323599	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		HI	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1326589482	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		HI	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275048217	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		HI	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1861430373	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		HI	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1710988761	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ID	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1730180761	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ID	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1285635235	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ID	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265433676	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ID	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275534620	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ID	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1477554814	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ID	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811984636	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ID	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114905387	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ID	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1548248321	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ID	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1093790578	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ID	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629054846	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ID	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1639157415	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ID	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1972588465	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ID	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1881679371	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ID	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1841346970	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ID	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1437295607	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ID	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1346386513	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ID	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1194035436	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ID	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1386809457	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ID	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629219498	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ID	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114323599	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ID	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1326589482	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ID	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275048217	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ID	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1861430373	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ID	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1710988761	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		IL	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1730180761	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		IL	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1285635235	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		IL	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265433676	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		IL	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275534620	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		IL	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1477554814	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		IL	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811984636	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		IL	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114905387	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		IL	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1548248321	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		IL	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1093790578	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		IL	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629054846	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		IL	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1639157415	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		IL	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1972588465	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		IL	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1881679371	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		IL	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1841346970	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		IL	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1437295607	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		IL	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1346386513	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		IL	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1194035436	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		IL	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1386809457	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		IL	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629219498	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		IL	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114323599	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		IL	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1326589482	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		IL	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275048217	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		IL	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1861430373	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		IL	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1710988761	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		IN	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1730180761	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		IN	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1285635235	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		IN	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265433676	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		IN	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275534620	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		IN	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1477554814	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		IN	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811984636	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		IN	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114905387	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		IN	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1548248321	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		IN	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1093790578	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		IN	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629054846	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		IN	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1639157415	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		IN	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1972588465	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		IN	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1881679371	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		IN	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1841346970	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		IN	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1437295607	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		IN	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1346386513	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		IN	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1194035436	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		IN	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1386809457	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		IN	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629219498	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		IN	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114323599	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		IN	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1326589482	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		IN	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275048217	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		IN	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1861430373	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		IN	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1710988761	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		KS	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1730180761	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		KS	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1285635235	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		KS	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265433676	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		KS	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275534620	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		KS	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1477554814	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		KS	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811984636	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		KS	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114905387	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		KS	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1548248321	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		KS	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1093790578	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		KS	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629054846	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		KS	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1639157415	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		KS	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1972588465	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		KS	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1881679371	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		KS	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1841346970	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		KS	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1437295607	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		KS	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1346386513	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		KS	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1194035436	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		KS	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1386809457	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		KS	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629219498	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		KS	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114323599	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		KS	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1326589482	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		KS	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275048217	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		KS	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1861430373	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		KS	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1710988761	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		KY	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1730180761	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		KY	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1285635235	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		KY	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265433676	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		KY	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275534620	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		KY	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1477554814	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		KY	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811984636	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		KY	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114905387	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		KY	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1548248321	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		KY	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1093790578	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		KY	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629054846	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		KY	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1639157415	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		KY	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1972588465	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		KY	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1881679371	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		KY	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1841346970	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		KY	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1437295607	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		KY	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1346386513	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		KY	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1194035436	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		KY	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1386809457	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		KY	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629219498	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		KY	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114323599	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		KY	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1326589482	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		KY	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275048217	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		KY	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1861430373	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		KY	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1710988761	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		LA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1730180761	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		LA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1285635235	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		LA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265433676	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		LA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275534620	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		LA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1477554814	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		LA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811984636	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		LA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114905387	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		LA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1548248321	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		LA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1093790578	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		LA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629054846	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		LA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1639157415	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		LA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1972588465	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		LA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1881679371	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		LA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1841346970	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		LA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1437295607	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		LA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1346386513	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		LA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1194035436	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		LA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1386809457	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		LA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629219498	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		LA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114323599	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		LA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1326589482	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		LA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275048217	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		LA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1861430373	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		LA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1710988761	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ME	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1730180761	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ME	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1285635235	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ME	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265433676	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ME	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275534620	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ME	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1477554814	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ME	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811984636	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ME	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114905387	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ME	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1548248321	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ME	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1093790578	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ME	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629054846	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ME	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1639157415	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ME	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1972588465	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ME	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1881679371	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ME	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1841346970	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ME	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1437295607	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ME	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1346386513	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ME	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1194035436	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ME	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1386809457	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ME	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629219498	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ME	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114323599	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ME	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1326589482	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ME	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275048217	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ME	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1861430373	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ME	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1710988761	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MD	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1730180761	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MD	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1285635235	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MD	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265433676	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MD	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275534620	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MD	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1477554814	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MD	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811984636	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MD	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114905387	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MD	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1548248321	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MD	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1093790578	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MD	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629054846	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MD	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1639157415	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MD	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1972588465	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MD	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1881679371	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MD	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1841346970	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MD	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1437295607	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MD	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1346386513	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MD	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1194035436	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MD	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1386809457	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MD	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629219498	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MD	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114323599	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MD	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1326589482	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MD	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275048217	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MD	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1861430373	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MD	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1710988761	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1730180761	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1285635235	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265433676	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275534620	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1477554814	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811984636	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114905387	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1548248321	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1093790578	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629054846	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1639157415	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1972588465	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1881679371	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1841346970	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1437295607	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1346386513	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1194035436	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1386809457	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629219498	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114323599	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1326589482	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275048217	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1861430373	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1710988761	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MI	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1730180761	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MI	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1285635235	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MI	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265433676	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MI	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275534620	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MI	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1477554814	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MI	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811984636	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MI	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114905387	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MI	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1548248321	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MI	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1093790578	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MI	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629054846	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MI	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1639157415	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MI	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1972588465	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MI	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1881679371	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MI	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1841346970	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MI	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1437295607	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MI	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1346386513	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MI	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1194035436	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MI	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1386809457	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MI	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629219498	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MI	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114323599	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MI	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1326589482	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MI	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275048217	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MI	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1861430373	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MI	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1710988761	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MN	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1730180761	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MN	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1285635235	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MN	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265433676	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MN	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275534620	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MN	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1477554814	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MN	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811984636	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MN	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114905387	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MN	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1548248321	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MN	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1093790578	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MN	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629054846	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MN	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1639157415	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MN	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1972588465	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MN	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1881679371	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MN	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1841346970	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MN	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1437295607	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MN	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1346386513	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MN	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1194035436	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MN	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1386809457	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MN	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629219498	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MN	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114323599	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MN	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1326589482	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MN	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275048217	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MN	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1861430373	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MN	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1710988761	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MS	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1730180761	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MS	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1285635235	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MS	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265433676	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MS	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275534620	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MS	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1477554814	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MS	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811984636	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MS	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114905387	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MS	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1548248321	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MS	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1093790578	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MS	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629054846	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MS	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1639157415	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MS	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1972588465	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MS	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1881679371	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MS	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1841346970	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MS	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1437295607	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MS	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1346386513	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MS	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1194035436	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MS	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1386809457	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MS	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629219498	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MS	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114323599	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MS	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1326589482	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MS	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275048217	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MS	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1861430373	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MS	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1710988761	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MO	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1730180761	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MO	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1285635235	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MO	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265433676	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MO	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275534620	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MO	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1477554814	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MO	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811984636	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MO	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114905387	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MO	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1548248321	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MO	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1093790578	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MO	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629054846	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MO	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1639157415	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MO	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1972588465	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MO	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1881679371	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MO	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1841346970	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MO	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1437295607	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MO	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1346386513	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MO	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1194035436	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MO	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1386809457	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MO	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629219498	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MO	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114323599	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MO	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1326589482	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MO	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275048217	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MO	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1861430373	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MO	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1710988761	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MT	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1730180761	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MT	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1285635235	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MT	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265433676	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MT	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275534620	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MT	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1477554814	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MT	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811984636	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MT	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114905387	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MT	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1548248321	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MT	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1093790578	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MT	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629054846	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MT	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1639157415	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MT	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1972588465	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MT	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1881679371	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MT	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1841346970	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MT	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1437295607	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MT	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1346386513	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MT	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1194035436	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MT	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1386809457	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MT	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629219498	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MT	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114323599	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MT	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1326589482	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MT	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275048217	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MT	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1861430373	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MT	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1710988761	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NE	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1730180761	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NE	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1285635235	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NE	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265433676	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NE	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275534620	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NE	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1477554814	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NE	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811984636	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NE	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114905387	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NE	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1548248321	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NE	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1093790578	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NE	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629054846	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NE	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1639157415	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NE	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1972588465	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NE	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1881679371	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NE	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1841346970	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NE	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1437295607	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NE	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1346386513	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NE	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1194035436	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NE	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1386809457	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NE	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629219498	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NE	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114323599	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NE	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1326589482	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NE	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275048217	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NE	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1861430373	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NE	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1710988761	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NV	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1730180761	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NV	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1285635235	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NV	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265433676	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NV	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275534620	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NV	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1477554814	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NV	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811984636	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NV	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114905387	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NV	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1548248321	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NV	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1093790578	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NV	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629054846	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NV	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1639157415	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NV	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1972588465	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NV	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1881679371	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NV	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1841346970	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NV	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1437295607	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NV	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1346386513	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NV	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1194035436	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NV	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1386809457	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NV	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629219498	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NV	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114323599	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NV	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1326589482	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NV	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275048217	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NV	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1861430373	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NV	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1710988761	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NH	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1730180761	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NH	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1285635235	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NH	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265433676	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NH	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275534620	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NH	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1477554814	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NH	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811984636	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NH	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114905387	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NH	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1548248321	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NH	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1093790578	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NH	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629054846	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NH	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1639157415	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NH	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1972588465	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NH	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1881679371	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NH	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1841346970	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NH	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1437295607	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NH	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1346386513	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NH	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1194035436	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NH	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1386809457	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NH	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629219498	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NH	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114323599	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NH	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1326589482	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NH	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275048217	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NH	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1861430373	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NH	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1710988761	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NJ	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1730180761	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NJ	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1285635235	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NJ	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265433676	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NJ	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275534620	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NJ	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1477554814	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NJ	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811984636	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NJ	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114905387	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NJ	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1548248321	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NJ	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1093790578	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NJ	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629054846	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NJ	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1639157415	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NJ	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1972588465	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NJ	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1881679371	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NJ	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1841346970	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NJ	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1437295607	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NJ	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1346386513	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NJ	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1194035436	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NJ	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1386809457	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NJ	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629219498	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NJ	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114323599	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NJ	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1326589482	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NJ	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275048217	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NJ	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1861430373	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NJ	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1710988761	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NM	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1730180761	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NM	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1285635235	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NM	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265433676	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NM	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275534620	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NM	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1477554814	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NM	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811984636	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NM	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114905387	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NM	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1548248321	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NM	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1093790578	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NM	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629054846	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NM	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1639157415	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NM	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1972588465	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NM	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1881679371	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NM	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1841346970	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NM	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1437295607	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NM	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1346386513	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NM	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1194035436	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NM	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1386809457	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NM	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629219498	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NM	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114323599	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NM	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1326589482	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NM	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275048217	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NM	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1861430373	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NM	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1710988761	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NY	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1730180761	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NY	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1285635235	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NY	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265433676	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NY	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275534620	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NY	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1477554814	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NY	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811984636	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NY	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114905387	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NY	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1548248321	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NY	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1093790578	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NY	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629054846	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NY	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1639157415	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NY	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1972588465	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NY	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1881679371	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NY	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1841346970	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NY	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1437295607	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NY	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1346386513	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NY	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1194035436	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NY	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1386809457	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NY	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629219498	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NY	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114323599	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NY	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1326589482	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NY	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275048217	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NY	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1861430373	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NY	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1710988761	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NC	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1730180761	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NC	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1285635235	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NC	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265433676	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NC	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275534620	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NC	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1477554814	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NC	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811984636	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NC	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114905387	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NC	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1548248321	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NC	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1093790578	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NC	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629054846	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NC	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1639157415	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NC	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1972588465	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NC	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1881679371	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NC	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1841346970	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NC	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1437295607	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NC	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1346386513	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NC	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1194035436	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NC	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1386809457	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NC	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629219498	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NC	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114323599	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NC	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1326589482	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NC	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275048217	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NC	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1861430373	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NC	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1710988761	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ND	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1730180761	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ND	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1285635235	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ND	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265433676	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ND	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275534620	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ND	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1477554814	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ND	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811984636	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ND	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114905387	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ND	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1548248321	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ND	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1093790578	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ND	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629054846	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ND	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1639157415	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ND	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1972588465	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ND	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1881679371	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ND	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1841346970	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ND	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1437295607	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ND	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1346386513	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ND	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1194035436	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ND	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1386809457	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ND	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629219498	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ND	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114323599	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ND	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1326589482	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ND	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275048217	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ND	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1861430373	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ND	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1710988761	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OH	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1730180761	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OH	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1285635235	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OH	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265433676	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OH	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275534620	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OH	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1477554814	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OH	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811984636	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OH	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114905387	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OH	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1548248321	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OH	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1093790578	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OH	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629054846	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OH	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1639157415	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OH	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1972588465	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OH	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1881679371	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OH	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1841346970	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OH	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1437295607	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OH	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1346386513	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OH	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1194035436	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OH	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1386809457	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OH	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629219498	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OH	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114323599	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OH	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1326589482	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OH	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275048217	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OH	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1861430373	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OH	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1710988761	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OK	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1730180761	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OK	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1285635235	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OK	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265433676	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OK	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275534620	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OK	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1477554814	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OK	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811984636	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OK	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114905387	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OK	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1548248321	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OK	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1093790578	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OK	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629054846	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OK	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1639157415	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OK	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1972588465	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OK	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1881679371	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OK	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1841346970	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OK	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1437295607	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OK	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1346386513	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OK	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1194035436	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OK	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1386809457	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OK	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629219498	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OK	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114323599	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OK	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1326589482	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OK	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275048217	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OK	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1861430373	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OK	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1710988761	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OR	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1730180761	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OR	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1285635235	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OR	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265433676	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OR	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275534620	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OR	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1477554814	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OR	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811984636	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OR	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114905387	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OR	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1548248321	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OR	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1093790578	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OR	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629054846	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OR	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1639157415	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OR	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1972588465	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OR	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1881679371	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OR	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1841346970	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OR	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1437295607	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OR	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1346386513	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OR	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1194035436	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OR	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1386809457	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OR	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629219498	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OR	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114323599	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OR	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1326589482	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OR	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275048217	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OR	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1861430373	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OR	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1710988761	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		PA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1730180761	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		PA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1285635235	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		PA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265433676	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		PA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275534620	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		PA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1477554814	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		PA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811984636	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		PA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114905387	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		PA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1548248321	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		PA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1093790578	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		PA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629054846	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		PA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1639157415	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		PA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1972588465	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		PA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1881679371	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		PA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1841346970	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		PA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1437295607	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		PA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1346386513	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		PA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1194035436	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		PA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1386809457	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		PA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629219498	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		PA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114323599	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		PA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1326589482	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		PA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275048217	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		PA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1861430373	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		PA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1710988761	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		PR	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1730180761	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		PR	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1285635235	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		PR	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265433676	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		PR	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275534620	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		PR	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1477554814	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		PR	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811984636	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		PR	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114905387	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		PR	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1548248321	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		PR	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1093790578	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		PR	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629054846	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		PR	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1639157415	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		PR	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1972588465	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		PR	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1881679371	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		PR	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1841346970	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		PR	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1437295607	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		PR	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1346386513	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		PR	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1194035436	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		PR	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1386809457	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		PR	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629219498	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		PR	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114323599	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		PR	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1326589482	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		PR	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275048217	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		PR	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1861430373	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		PR	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1710988761	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		RI	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1730180761	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		RI	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1285635235	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		RI	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265433676	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		RI	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275534620	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		RI	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1477554814	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		RI	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811984636	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		RI	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114905387	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		RI	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1548248321	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		RI	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1093790578	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		RI	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629054846	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		RI	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1639157415	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		RI	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1972588465	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		RI	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1881679371	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		RI	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1841346970	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		RI	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1437295607	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		RI	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1346386513	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		RI	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1194035436	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		RI	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1386809457	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		RI	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629219498	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		RI	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114323599	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		RI	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1326589482	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		RI	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275048217	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		RI	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1861430373	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		RI	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1710988761	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		SC	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1730180761	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		SC	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1285635235	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		SC	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265433676	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		SC	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275534620	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		SC	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1477554814	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		SC	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811984636	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		SC	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114905387	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		SC	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1548248321	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		SC	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1093790578	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		SC	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629054846	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		SC	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1639157415	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		SC	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1972588465	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		SC	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1881679371	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		SC	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1841346970	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		SC	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1437295607	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		SC	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1346386513	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		SC	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1194035436	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		SC	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1386809457	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		SC	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629219498	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		SC	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114323599	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		SC	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1326589482	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		SC	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275048217	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		SC	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1861430373	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		SC	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1710988761	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		SD	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1730180761	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		SD	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1285635235	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		SD	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265433676	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		SD	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275534620	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		SD	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1477554814	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		SD	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811984636	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		SD	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114905387	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		SD	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1548248321	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		SD	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1093790578	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		SD	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629054846	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		SD	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1639157415	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		SD	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1972588465	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		SD	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1881679371	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		SD	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1841346970	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		SD	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1437295607	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		SD	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1346386513	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		SD	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1194035436	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		SD	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1386809457	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		SD	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629219498	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		SD	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114323599	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		SD	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1326589482	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		SD	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275048217	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		SD	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1861430373	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		SD	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1710988761	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		TN	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1730180761	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		TN	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1285635235	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		TN	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265433676	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		TN	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275534620	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		TN	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1477554814	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		TN	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811984636	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		TN	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114905387	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		TN	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1548248321	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		TN	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1093790578	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		TN	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629054846	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		TN	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1639157415	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		TN	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1972588465	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		TN	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1881679371	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		TN	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1841346970	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		TN	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1437295607	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		TN	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1346386513	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		TN	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1194035436	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		TN	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1386809457	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		TN	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629219498	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		TN	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114323599	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		TN	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1326589482	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		TN	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275048217	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		TN	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1861430373	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		TN	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1710988761	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		TX	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1730180761	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		TX	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1285635235	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		TX	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265433676	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		TX	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275534620	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		TX	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1477554814	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		TX	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811984636	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		TX	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114905387	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		TX	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1548248321	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		TX	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1093790578	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		TX	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629054846	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		TX	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1639157415	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		TX	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1972588465	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		TX	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1881679371	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		TX	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1841346970	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		TX	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1437295607	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		TX	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1346386513	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		TX	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1194035436	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		TX	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1386809457	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		TX	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629219498	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		TX	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114323599	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		TX	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1326589482	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		TX	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275048217	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		TX	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1861430373	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		TX	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1710988761	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		UT	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1730180761	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		UT	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1285635235	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		UT	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265433676	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		UT	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275534620	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		UT	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1477554814	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		UT	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811984636	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		UT	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114905387	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		UT	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1548248321	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		UT	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1093790578	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		UT	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629054846	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		UT	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1639157415	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		UT	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1972588465	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		UT	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1881679371	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		UT	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1841346970	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		UT	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1437295607	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		UT	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1346386513	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		UT	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1194035436	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		UT	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1386809457	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		UT	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629219498	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		UT	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114323599	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		UT	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1326589482	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		UT	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275048217	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		UT	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1861430373	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		UT	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1710988761	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		VT	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1730180761	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		VT	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1285635235	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		VT	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265433676	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		VT	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275534620	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		VT	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1477554814	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		VT	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811984636	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		VT	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114905387	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		VT	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1548248321	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		VT	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1093790578	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		VT	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629054846	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		VT	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1639157415	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		VT	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1972588465	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		VT	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1881679371	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		VT	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1841346970	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		VT	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1437295607	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		VT	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1346386513	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		VT	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1194035436	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		VT	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1386809457	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		VT	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629219498	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		VT	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114323599	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		VT	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1326589482	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		VT	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275048217	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		VT	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1861430373	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		VT	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1710988761	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		VA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1730180761	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		VA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1285635235	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		VA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265433676	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		VA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275534620	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		VA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1477554814	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		VA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811984636	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		VA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114905387	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		VA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1548248321	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		VA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1093790578	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		VA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629054846	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		VA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1639157415	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		VA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1972588465	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		VA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1881679371	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		VA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1841346970	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		VA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1437295607	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		VA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1346386513	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		VA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1194035436	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		VA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1386809457	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		VA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629219498	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		VA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114323599	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		VA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1326589482	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		VA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275048217	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		VA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1861430373	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		VA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1710988761	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1730180761	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1285635235	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265433676	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275534620	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1477554814	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811984636	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114905387	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1548248321	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1093790578	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629054846	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1639157415	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1972588465	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1881679371	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1841346970	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1437295607	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1346386513	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1194035436	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1386809457	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629219498	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114323599	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1326589482	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275048217	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1861430373	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WA	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1710988761	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WV	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1730180761	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WV	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1285635235	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WV	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265433676	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WV	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275534620	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WV	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1477554814	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WV	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811984636	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WV	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114905387	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WV	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1548248321	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WV	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1093790578	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WV	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629054846	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WV	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1639157415	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WV	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1972588465	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WV	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1881679371	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WV	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1841346970	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WV	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1437295607	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WV	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1346386513	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WV	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1194035436	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WV	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1386809457	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WV	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629219498	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WV	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114323599	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WV	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1326589482	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WV	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275048217	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WV	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1861430373	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WV	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1710988761	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WI	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1730180761	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WI	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1285635235	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WI	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265433676	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WI	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275534620	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WI	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1477554814	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WI	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811984636	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WI	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114905387	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WI	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1548248321	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WI	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1093790578	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WI	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629054846	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WI	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1639157415	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WI	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1972588465	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WI	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1881679371	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WI	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1841346970	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WI	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1437295607	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WI	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1346386513	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WI	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1194035436	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WI	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1386809457	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WI	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629219498	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WI	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114323599	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WI	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1326589482	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WI	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275048217	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WI	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1861430373	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WI	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1710988761	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WY	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1730180761	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WY	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1285635235	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WY	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265433676	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WY	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275534620	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WY	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1477554814	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WY	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811984636	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WY	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114905387	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WY	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1548248321	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WY	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1093790578	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WY	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629054846	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WY	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1639157415	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WY	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1972588465	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WY	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1881679371	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WY	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1841346970	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WY	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1437295607	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WY	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1346386513	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WY	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1194035436	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WY	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1386809457	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WY	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629219498	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WY	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114323599	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WY	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1326589482	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WY	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275048217	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WY	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1861430373	8/15/2021 5:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WY	8/15/2021 5:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1710988761	8/14/2021 11:47 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		IA	8/14/2021 11:47 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1730180761	8/14/2021 11:47 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		IA	8/14/2021 11:47 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1285635235	8/14/2021 11:47 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		IA	8/14/2021 11:47 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1265433676	8/14/2021 11:47 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		IA	8/14/2021 11:47 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275534620	8/14/2021 11:47 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		IA	8/14/2021 11:47 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1477554814	8/14/2021 11:47 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		IA	8/14/2021 11:47 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1811984636	8/14/2021 11:47 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		IA	8/14/2021 11:47 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114905387	8/14/2021 11:47 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		IA	8/14/2021 11:47 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1548248321	8/14/2021 11:47 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		IA	8/14/2021 11:47 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1093790578	8/14/2021 11:47 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		IA	8/14/2021 11:47 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629054846	8/14/2021 11:47 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		IA	8/14/2021 11:47 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1639157415	8/14/2021 11:47 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		IA	8/14/2021 11:47 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1972588465	8/14/2021 11:47 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		IA	8/14/2021 11:47 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1881679371	8/14/2021 11:47 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		IA	8/14/2021 11:47 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1841346970	8/14/2021 11:47 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		IA	8/14/2021 11:47 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1437295607	8/14/2021 11:47 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		IA	8/14/2021 11:47 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1346386513	8/14/2021 11:47 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		IA	8/14/2021 11:47 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1194035436	8/14/2021 11:47 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		IA	8/14/2021 11:47 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1386809457	8/14/2021 11:47 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		IA	8/14/2021 11:47 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1629219498	8/14/2021 11:47 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		IA	8/14/2021 11:47 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114323599	8/14/2021 11:47 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		IA	8/14/2021 11:47 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1326589482	8/14/2021 11:47 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		IA	8/14/2021 11:47 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1275048217	8/14/2021 11:47 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		IA	8/14/2021 11:47 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1861430373	8/14/2021 11:47 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		IA	8/14/2021 11:47 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	1600058 (NC)		6/4/2021 10:37 AM
Medicaid Billing	Medicaid: Number	Delete	Change Request	3012697 (WA)		6/4/2021 10:37 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	6/4/2021 10:37 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		800249546	6/4/2021 10:37 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		CA	6/4/2021 10:37 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	6/4/2021 10:37 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		800249545	6/4/2021 10:37 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		CA	6/4/2021 10:37 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	6/4/2021 10:37 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		95004032	6/4/2021 10:37 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		CO	6/4/2021 10:37 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	6/4/2021 10:37 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		003031614	6/4/2021 10:37 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		CT	6/4/2021 10:37 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	6/4/2021 10:37 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		0600585	6/4/2021 10:37 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		IA	6/4/2021 10:37 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	6/4/2021 10:37 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		426004813002	6/4/2021 10:37 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		IL	6/4/2021 10:37 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	6/4/2021 10:37 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		304608153	6/4/2021 10:37 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		MI	6/4/2021 10:37 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	6/4/2021 10:37 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		11509A	6/4/2021 10:37 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		SC	6/4/2021 10:37 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	6/4/2021 10:37 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		0122600	6/4/2021 10:37 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		SD	6/4/2021 10:37 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	6/4/2021 10:37 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		072004702	6/4/2021 10:37 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		TX	6/4/2021 10:37 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	6/4/2021 10:37 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1008875	6/4/2021 10:37 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		WA	6/4/2021 10:37 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	6/4/2021 10:37 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1011295	6/4/2021 10:37 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		WA	6/4/2021 10:37 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	6/4/2021 10:37 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1376544320	6/4/2021 10:37 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		NC	6/4/2021 10:37 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	6/4/2021 10:37 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1188874	6/4/2021 10:37 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		NV	6/4/2021 10:37 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1306304027	6/4/2021 10:37 AM
Medicaid Billing	NPI: State	Insert	Change Request		DC	6/4/2021 10:37 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1376544320	6/4/2021 10:37 AM
Medicaid Billing	NPI: State	Insert	Change Request		DC	6/4/2021 10:37 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1508858127	6/4/2021 10:37 AM
Medicaid Billing	NPI: State	Insert	Change Request		DC	6/4/2021 10:37 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1811246473	6/4/2021 10:37 AM
Medicaid Billing	NPI: State	Insert	Change Request		DC	6/4/2021 10:37 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1306304027	6/4/2021 10:37 AM
Medicaid Billing	NPI: State	Insert	Change Request		NH	6/4/2021 10:37 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1376544320	6/4/2021 10:37 AM
Medicaid Billing	NPI: State	Insert	Change Request		NH	6/4/2021 10:37 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1508858127	6/4/2021 10:37 AM
Medicaid Billing	NPI: State	Insert	Change Request		NH	6/4/2021 10:37 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1811246473	6/4/2021 10:37 AM
Medicaid Billing	NPI: State	Insert	Change Request		NH	6/4/2021 10:37 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1306304027	6/4/2021 10:37 AM
Medicaid Billing	NPI: State	Insert	Change Request		PR	6/4/2021 10:37 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1376544320	6/4/2021 10:37 AM
Medicaid Billing	NPI: State	Insert	Change Request		PR	6/4/2021 10:37 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1508858127	6/4/2021 10:37 AM
Medicaid Billing	NPI: State	Insert	Change Request		PR	6/4/2021 10:37 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1811246473	6/4/2021 10:37 AM
Medicaid Billing	NPI: State	Insert	Change Request		PR	6/4/2021 10:37 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1306304027	6/4/2021 10:37 AM
Medicaid Billing	NPI: State	Insert	Change Request		RI	6/4/2021 10:37 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1376544320	6/4/2021 10:37 AM
Medicaid Billing	NPI: State	Insert	Change Request		RI	6/4/2021 10:37 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1508858127	6/4/2021 10:37 AM
Medicaid Billing	NPI: State	Insert	Change Request		RI	6/4/2021 10:37 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1811246473	6/4/2021 10:37 AM
Medicaid Billing	NPI: State	Insert	Change Request		RI	6/4/2021 10:37 AM
Medicaid Billing	Medicaid: Number	Delete	Change Request	0600585 (IA)		3/14/2021 10:57 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	12-88774 (NV)		3/14/2021 10:57 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	3/14/2021 10:57 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		100512868	3/14/2021 10:57 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		NV	3/14/2021 10:57 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	3/14/2021 10:57 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		100514320	3/14/2021 10:57 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		NV	3/14/2021 10:57 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1376544320	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		ID	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1508858127	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		ID	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1811246473	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		ID	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1306304027	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		ID	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1376544320	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		DE	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1508858127	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		DE	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1811246473	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		DE	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1306304027	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		DE	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1376544320	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		PA	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1508858127	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		PA	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1811246473	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		PA	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1306304027	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		PA	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1376544320	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		CT	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1508858127	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		CT	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1811246473	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		CT	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1306304027	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		CT	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1376544320	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		GA	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1508858127	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		GA	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1811246473	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		GA	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1306304027	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		GA	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1376544320	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		KY	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1508858127	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		KY	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1811246473	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		KY	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1306304027	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		KY	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1376544320	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		TN	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1508858127	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		TN	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1811246473	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		TN	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1306304027	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		TN	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1376544320	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		VT	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1508858127	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		VT	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1811246473	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		VT	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1306304027	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		VT	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1376544320	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		NY	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1508858127	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		NY	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1811246473	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		NY	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1306304027	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		NY	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1376544320	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		WV	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1508858127	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		WV	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1811246473	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		WV	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1306304027	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		WV	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1376544320	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		ND	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1508858127	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		ND	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1811246473	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		ND	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1306304027	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		ND	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1376544320	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		AZ	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1508858127	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		AZ	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1811246473	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		AZ	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1306304027	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		AZ	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1376544320	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		IA	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1508858127	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		IA	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1811246473	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		IA	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1306304027	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		IA	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1376544320	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		MS	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1508858127	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		MS	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1811246473	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		MS	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1306304027	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		MS	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1376544320	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		OH	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1508858127	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		OH	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1811246473	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		OH	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1306304027	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		OH	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1376544320	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		MT	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1508858127	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		MT	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1811246473	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		MT	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1306304027	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		MT	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1376544320	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		TX	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1508858127	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		TX	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1811246473	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		TX	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1306304027	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		TX	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1376544320	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		FL	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1508858127	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		FL	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1811246473	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		FL	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1306304027	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		FL	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1376544320	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		IN	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1508858127	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		IN	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1811246473	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		IN	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1306304027	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		IN	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1376544320	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		KS	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1508858127	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		KS	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1811246473	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		KS	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1306304027	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		KS	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1376544320	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		AK	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1508858127	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		AK	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1811246473	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		AK	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1306304027	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		AK	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1376544320	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		CA	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1508858127	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		CA	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1811246473	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		CA	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1306304027	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		CA	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1376544320	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		OK	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1508858127	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		OK	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1811246473	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		OK	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1306304027	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		OK	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1376544320	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		AR	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1508858127	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		AR	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1811246473	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		AR	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1306304027	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		AR	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1376544320	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		WY	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1508858127	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		WY	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1811246473	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		WY	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1306304027	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		WY	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1376544320	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		WI	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1508858127	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		WI	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1811246473	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		WI	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1306304027	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		WI	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1376544320	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		MN	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1508858127	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		MN	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1811246473	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		MN	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1306304027	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		MN	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1376544320	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		NV	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1508858127	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		NV	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1811246473	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		NV	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1306304027	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		NV	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1376544320	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		MO	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1508858127	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		MO	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1811246473	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		MO	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1306304027	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		MO	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1376544320	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		NC	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1508858127	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		NC	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1811246473	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		NC	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1306304027	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		NC	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1376544320	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		LA	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1508858127	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		LA	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1811246473	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		LA	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1306304027	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		LA	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1376544320	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		ME	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1508858127	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		ME	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1811246473	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		ME	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1306304027	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		ME	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1376544320	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		SC	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1508858127	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		SC	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1811246473	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		SC	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1306304027	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		SC	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1376544320	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		WA	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1508858127	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		WA	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1811246473	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		WA	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1306304027	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		WA	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1376544320	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		MD	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1508858127	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		MD	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1811246473	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		MD	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1306304027	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		MD	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1376544320	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		MI	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1508858127	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		MI	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1811246473	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		MI	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1306304027	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		MI	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1376544320	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		NJ	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1508858127	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		NJ	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1811246473	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		NJ	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1306304027	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		NJ	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1376544320	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		NE	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1508858127	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		NE	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1811246473	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		NE	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1306304027	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		NE	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1376544320	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		IL	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1508858127	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		IL	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1811246473	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		IL	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1306304027	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		IL	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1376544320	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		UT	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1508858127	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		UT	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1811246473	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		UT	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1306304027	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		UT	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1376544320	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		OR	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1508858127	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		OR	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1811246473	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		OR	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1306304027	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		OR	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1376544320	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		HI	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1508858127	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		HI	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1811246473	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		HI	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1306304027	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		HI	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1376544320	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		SD	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1508858127	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		SD	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1811246473	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		SD	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1306304027	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		SD	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1376544320	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		MA	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1508858127	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		MA	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1811246473	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		MA	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1306304027	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		MA	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1376544320	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		CO	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1508858127	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		CO	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1811246473	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		CO	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1306304027	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		CO	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1376544320	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		VA	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1508858127	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		VA	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1811246473	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		VA	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1306304027	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		VA	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1376544320	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		NM	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1508858127	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		NM	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1811246473	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		NM	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1306304027	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		NM	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1376544320	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		AL	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1508858127	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		AL	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1811246473	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		AL	2/5/2021 11:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1306304027	2/5/2021 11:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		AL	2/5/2021 11:34 AM
Contacts	Primary Contact	Update	Change Request	Smith, Trisha Director, Business & Support University of Iowa Hospitals & Clinics 3193562577	Triplett, Becky Marie Manager, 340B and Compliance University of Iowa Hospitals and Clinics 3193845583	1/19/2021 8:17 AM
Medicaid Billing	Medicaid: Number	Delete	Change Request	713967 (IA)		10/15/2020 9:57 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	10/15/2020 9:57 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		0713967	10/15/2020 9:57 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		IA	10/15/2020 9:57 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1306304027 ( )		9/4/2020 1:50 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1508858127 ( )		9/4/2020 1:50 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1811246473 ( )		9/4/2020 1:50 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1376544320 ( )		9/4/2020 1:50 PM
Details	Last Recertification Date	Update	Recertification	9/10/2019 4:26:52 PM	9/4/2020 1:50:46 PM	9/4/2020 1:50 PM
Medicaid Billing	Medicaid: Number	Update	Change Request	UNI00058N	UNI0058N	7/30/2020 9:10 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	7/30/2020 9:10 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		713967	7/30/2020 9:10 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		IA	7/30/2020 9:10 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	7/30/2020 9:10 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1376544320	7/30/2020 9:10 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		WI	7/30/2020 9:10 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/1/2020 10:01 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		11020900	5/1/2020 10:01 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		WI	5/1/2020 10:01 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/1/2020 10:01 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		UNI00058N	5/1/2020 10:01 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		AL	5/1/2020 10:01 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/1/2020 10:01 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1005657	5/1/2020 10:01 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		AK	5/1/2020 10:01 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/1/2020 10:01 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		022773	5/1/2020 10:01 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		AZ	5/1/2020 10:01 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/1/2020 10:01 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		108932105	5/1/2020 10:01 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		AR	5/1/2020 10:01 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/1/2020 10:01 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		10056587	5/1/2020 10:01 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		CA	5/1/2020 10:01 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/1/2020 10:01 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		94005675	5/1/2020 10:01 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		CO	5/1/2020 10:01 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/1/2020 10:01 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		003101590	5/1/2020 10:01 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		CT	5/1/2020 10:01 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/1/2020 10:01 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		000571306	5/1/2020 10:01 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		DE	5/1/2020 10:01 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/1/2020 10:01 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		092113100	5/1/2020 10:01 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		FL	5/1/2020 10:01 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/1/2020 10:01 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		00354615Y	5/1/2020 10:01 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		GA	5/1/2020 10:01 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/1/2020 10:01 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		53564303	5/1/2020 10:01 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		HI	5/1/2020 10:01 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/1/2020 10:01 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		000336300	5/1/2020 10:01 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		ID	5/1/2020 10:01 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/1/2020 10:01 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		426004813001	5/1/2020 10:01 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		IL	5/1/2020 10:01 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/1/2020 10:01 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		426004813007	5/1/2020 10:01 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		IL	5/1/2020 10:01 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/1/2020 10:01 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		426004813401	5/1/2020 10:01 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		IL	5/1/2020 10:01 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/1/2020 10:01 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		100035480A	5/1/2020 10:01 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		IN	5/1/2020 10:01 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/1/2020 10:01 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		100245160A	5/1/2020 10:01 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		KS	5/1/2020 10:01 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/1/2020 10:01 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		01350222	5/1/2020 10:01 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		KY	5/1/2020 10:01 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/1/2020 10:01 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1741345	5/1/2020 10:01 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		LA	5/1/2020 10:01 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/1/2020 10:01 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		174800000	5/1/2020 10:01 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		ME	5/1/2020 10:01 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/1/2020 10:01 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		398765500	5/1/2020 10:01 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		MD	5/1/2020 10:01 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/1/2020 10:01 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		7201516	5/1/2020 10:01 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		MA	5/1/2020 10:01 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/1/2020 10:01 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		404608162	5/1/2020 10:01 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		MI	5/1/2020 10:01 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/1/2020 10:01 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		128847400	5/1/2020 10:01 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		MN	5/1/2020 10:01 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/1/2020 10:01 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		02857378	5/1/2020 10:01 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		MS	5/1/2020 10:01 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/1/2020 10:01 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1376544320	5/1/2020 10:01 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		MO	5/1/2020 10:01 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/1/2020 10:01 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		0416936	5/1/2020 10:01 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		MT	5/1/2020 10:01 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/1/2020 10:01 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		426004813-00	5/1/2020 10:01 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		NE	5/1/2020 10:01 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/1/2020 10:01 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		12-88774	5/1/2020 10:01 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		NV	5/1/2020 10:01 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/1/2020 10:01 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		4110102	5/1/2020 10:01 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		NJ	5/1/2020 10:01 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/1/2020 10:01 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		A0009	5/1/2020 10:01 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		NM	5/1/2020 10:01 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/1/2020 10:01 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		01706927	5/1/2020 10:01 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		NY	5/1/2020 10:01 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/1/2020 10:01 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1600058	5/1/2020 10:01 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		NC	5/1/2020 10:01 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/1/2020 10:01 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		02227	5/1/2020 10:01 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		ND	5/1/2020 10:01 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/1/2020 10:01 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		0333384	5/1/2020 10:01 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		OH	5/1/2020 10:01 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/1/2020 10:01 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		100693080A	5/1/2020 10:01 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		OK	5/1/2020 10:01 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/1/2020 10:01 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		500625209	5/1/2020 10:01 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		OR	5/1/2020 10:01 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/1/2020 10:01 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		0008423270001	5/1/2020 10:01 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		PA	5/1/2020 10:01 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/1/2020 10:01 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		0008423270002	5/1/2020 10:01 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		PA	5/1/2020 10:01 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/1/2020 10:01 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		187283	5/1/2020 10:01 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		SC	5/1/2020 10:01 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/1/2020 10:01 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		5522600	5/1/2020 10:01 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		SD	5/1/2020 10:01 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/1/2020 10:01 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		0160058	5/1/2020 10:01 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		TN	5/1/2020 10:01 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/1/2020 10:01 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		072004701	5/1/2020 10:01 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		TX	5/1/2020 10:01 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/1/2020 10:01 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		426004813012	5/1/2020 10:01 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		UT	5/1/2020 10:01 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/1/2020 10:01 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		0160058	5/1/2020 10:01 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		VT	5/1/2020 10:01 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/1/2020 10:01 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		98-1114-1	5/1/2020 10:01 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		VA	5/1/2020 10:01 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/1/2020 10:01 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		3012697	5/1/2020 10:01 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		WA	5/1/2020 10:01 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/1/2020 10:01 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		0173719000	5/1/2020 10:01 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		WV	5/1/2020 10:01 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/1/2020 10:01 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1095790-00	5/1/2020 10:01 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		WY	5/1/2020 10:01 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1306304027	9/10/2019 4:26 PM
Details	Last Recertification Date	Update	Recertification	9/6/2018 4:52:14 PM	9/10/2019 4:26:52 PM	9/10/2019 4:26 PM
Addresses	Main Address	Update	Change Request	105 E 9th Street Coralville, IA 52241	105 E 9th ST Coralville, IA 52241	1/25/2019 8:36 AM
Details	Last Recertification Date	Update	Recertification	11/28/2017 12:38:18 PM	9/6/2018 4:52:14 PM	9/6/2018 4:52 PM
Contacts	Authorizing Official	Update	Change Request	Singh, Saradeep COO University of Iowa Hospitals and Clinics 3193537202	Brownlee, Michael Chief Pharmacy Officer University of Iowa Hospitals & Clinics 3193849371	5/14/2018 6:55 AM
Details	Last Recertification Date	Update	Recertification	9/1/2016 12:00:00 AM	11/28/2017 12:38:18 PM	11/28/2017 12:38 PM
Contacts	Signed By	Update	Recertification	Kates, Ken Associate Vice President 3193563155	Kates, Ken Associate Vice President University of Iowa Hospitals & Clinics 3193563155	11/28/2017 8:40 AM
Contacts	Authorizing Official	Update		Singh, Saradeep COO 3193537202	Singh, Saradeep COO University of Iowa Hospitals and Clinics 3193537202	10/20/2017 2:19 PM
Contacts	Primary Contact	Update		Smith, Trisha Director, Business & Support 3193562577	Smith, Trisha Director, Business & Support University of Iowa Hospitals & Clinics 3193562577	10/14/2017 6:02 PM
Contacts	Authorizing Official	Insert			Singh, Saradeep COO 3193537202	7/17/2017 3:05 PM
Contacts	Primary Contact	Insert			Smith, Trisha Director, Business & Support 3193562577	5/17/2017 9:42 AM
Addresses	Main Address	Insert			105 E 9th Street Coralville, IA 52241	2/21/2017 5:25 PM
Addresses	Billing Address	Insert			University of Iowa Accounts Payable 202 PCO Iowa City, IA 52242	2/21/2017 5:25 PM
Contacts	Signed By	Insert			Kates, Ken Associate Vice President 3193563155	2/21/2017 5:25 PM
Details	Last Recertification Date	Update		8/24/2015 12:00:00 AM	9/1/2016 12:00:00 AM	9/1/2016 11:49 AM
Medicaid Billing	Medicaid: Is Primary	Insert			False	10/21/2015 4:50 PM
Medicaid Billing	Medicaid: Number	Insert			0260927	10/21/2015 4:50 PM
Medicaid Billing	Medicaid: State	Insert			IA	10/21/2015 4:50 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	10/21/2015 4:50 PM
Medicaid Billing	Medicaid: Number	Insert			0501847	10/21/2015 4:50 PM
Medicaid Billing	Medicaid: State	Insert			IA	10/21/2015 4:50 PM
Medicaid Billing	NPI: Number	Insert			1508858127	10/21/2015 4:50 PM
Medicaid Billing	NPI: Number	Insert			1811246473	10/21/2015 4:50 PM
Details	Last Recertification Date	Update		8/21/2014 12:00:00 AM	8/24/2015 12:00:00 AM	8/24/2015 11:48 AM
Details	Last Recertification Date	Update		9/10/2013 11:58:32 AM	8/21/2014 12:00:00 AM	8/21/2014 3:07 PM
Details	Last Recertification Date	Update			9/10/2013 11:58:32 AM	9/10/2013 11:58 AM
Details	340B ID	Update		IS-AP-DSH160058N	DSH160058N	10/31/2012 1:28 PM
Dates	Participating Approval Date	Update			10/31/2012 12:00:00 AM	10/31/2012 1:28 PM
Details	State	Update		Pending	Active	10/31/2012 1:28 PM
Dates	Start Date	Update			1/1/2013 12:00:00 AM	10/31/2012 1:28 PM
Details	340B ID	Update		AP101212I	IS-AP-DSH160058N	10/31/2012 12:47 PM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG	AP101212I	10/12/2012 5:45 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	10/12/2012 9:27 AM
Medicaid Billing	Medicaid: Number	Insert			0600585	10/12/2012 9:27 AM
Medicaid Billing	Medicaid: State	Insert			IA	10/12/2012 9:27 AM
Medicaid Billing	NPI: Number	Insert			1376544320	10/12/2012 9:27 AM
Details	Last Recertification Date	Insert				10/12/2012 9:27 AM
Details	Grant Number	Insert				10/12/2012 9:27 AM
Details	340B ID	Insert			OUTPATIENT_ONLINE_REG	10/12/2012 9:27 AM
Details	Is Authorizing Official EHB Data	Insert				10/12/2012 9:27 AM
Dates	Last Date That 340B Drugs Purchased	Insert				10/12/2012 9:27 AM
Details	Medicare Provider Number	Insert			160058	10/12/2012 9:27 AM
Details	Entity Name	Insert			UNIVERSITY OF IOWA HOSPITALS & CLINICS	10/12/2012 9:27 AM
Details	Program Code	Insert			DSH	10/12/2012 9:27 AM
Details	Entity Subname	Insert			Dermatology	10/12/2012 9:27 AM
Dates	Participating Approval Date	Insert				10/12/2012 9:27 AM
Details	State	Insert			Pending	10/12/2012 9:27 AM
Dates	Registration Date	Insert			10/12/2012 12:00:00 AM	10/12/2012 9:27 AM
Dates	Signed By Date	Insert			10/12/2012 12:00:00 AM	10/12/2012 9:27 AM
Dates	Start Date	Insert				10/12/2012 9:27 AM
Terminations	Termination Comments	Insert				10/12/2012 9:27 AM
Terminations	Termination Date	Insert				10/12/2012 9:27 AM
Terminations	Termination Effective Date	Insert				10/12/2012 9:27 AM
Terminations	Termination Reason	Insert				10/12/2012 9:27 AM