📄 Extracted Text (168 words)
Life Steps Ob/Gyn Healthcare For Women,
LLP October 18, 2016
60 EAST END AVENUE
New York, NY, 10028
Phone 212-860-4800 Account ID: 14159
Chart ID: 14159
Coverage Insurance Policy ID
)lagnosis:
SERVICES
Date Claim-Line Provider X Ref CPT Units Mod Description Charges Payments Adjusts Balance
10/18/16 63450-1 Dr. Karen KIRSCH &WC 99213 1 Subseo visit lid 250.00 0.00
Paid
10/18/16 Paid On. 10/18116 Patient Payment - Cr 250.00
10/18/16 81159.2 Dr. Karen KIRSCH A 90636 1 125.00 0.00
Paid
10/18/16 Paid On 10/18/16 Patient Payment - Cr 125.00
10/18/16 63459.3 Dr. Karen KIRSCH A 90471 1 75.00 0.00
Patd
10/18/16 Paid On 10/18/16 Patent Payment - Cr 75.00
Balance : 0.00
RECEIPT
Received *** $450.00 en Dollars Thank You I 0
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EFTA00317139
ℹ️ Document Details
SHA-256
c2b8943c98bd7230c03956960458545f841d1e81fafa8fec948fdc2b0e45db66
Bates Number
EFTA00317139
Dataset
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document
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1
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