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 |
Amount |
Payer |
Pmt/Adj |
Session |
Account |
---|---|---|---|---|---|---|---|
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