Financial Report | Jeremy Johns

Payer: All Payers

Provider: Susan C. Bronson, Ph.D.

Session Date Range: July 1, 2009 - Aug 1, 2009

Date

Charges

Account
Activity

Amount

Payer

Pmt/Adj
Amount

Session
Balance

Account
Balance

Balance carried forward: $100.00
07/03/09 $120.00 90806       $120.00 $220.00
07/03/09   Billed Ins #1 $120.00     $120.00 $220.00
07/23/09   Payment   Ins #1 $50.00 $70.00 $170.00
07/23/09   Ins #1 Adjustment     $20.00 $50.00 $150.00
07/24/09   Billed Ins #2 $50.00     $50.00 $150.00
08/03/09   Payment   Ins #2 $20.00 $30.00 $130.00
08/10/09   Billed Client $30.00     $30.00 $130.00
08/23/09   Payment   Client $20.00 $10.00 $110.00
08/23/09   Client Adjustment     $10.00 $0.00 $100.00
 
07/10/09 $120.00 90806       $120.00 $220.00
07/10/09   Billed Ins #1 $120.00     $120.00 $220.00
08/20/09   Payment   Ins #1 $50.00 $70.00 $120.00
08/20/09   Ins #1 Adjustment     $20.00 $50.00 $100.00
08/21/09   Billed Ins #2 $50.00     $50.00 $100.00
09/01/09   Payment   Ins #2 $20.00 $30.00 $60.00
09/01/09   Billed Client $30.00     $30.00 $60.00
09/13/09   Payment   Client $20.00 $10.00 $60.00
 
07/14/09   Unallocated Pmt   Client $50.00 $0.00 $60.00
 
07/17/09 $120.00 90806       $120.00 $180.00
07/17/09   Billed Ins #1 $120.00     $120.00 $180.00
 
Total due on account: $100.00
 

Report Information:

Report Date: November 14, 2009

Date Range: July 1, 2009 - Aug 1, 2009

Client: Jeremy Johns

Description: Amounts billed to Jeremy Johns for services rendered by Susan C. Litton, Ph.D. Includes amount billed and outstanding balances for the selected date range.

Provider Information:

Susan C. Bronson, Ph.D. | Tax ID: 440-52-8896 | NPI: 1802293511

2944 Woodfield Rd, Decatur, GA 30033

770-441-6361