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Radiol 621399

DAFTAR PENDISTRIBUSIAN JASA PENGIRIMAN JKN (RADIOLOGI) JANUARI 2016


NO. NAMA GOL. / PAJAK NILAI PAJAK DITERIMA TANDA TANGAN
1 dr. Taufiq Sp.PD IV/ 15% 16794.57 2519.185 14275.38 1
2 dr. Luthfi Sp.PD III/ 5% 16794.57 839.7284 15954.84 2
3 dr. Irene Sp.PD 2.5% 16794.57 419.8642 16374.7 3
4 dr. Iskandar Sp.B IV/ 15% 16794.57 2519.185 14275.38 4
5 dr. Dini Sp.B III/ 5% 16794.57 839.7284 15954.84 5
6 dr. Irman Sp.A III/ 5% 16794.57 839.7284 15954.84 6
7 dr. Ineu Sp.A III/ 5% 16794.57 839.7284 15954.84 7
8 dr. Tatan Sp.A III/ 5% 16794.57 839.7284 15954.84 8
9 dr. Hervan Sp.OG III/ 5% 16794.57 839.7284 15954.84 9
10 dr. Bogie Sp.OG III/ 5% 16794.57 839.7284 15954.84 10
11 dr. Deni Sp.OG III/ 5% 16794.57 839.7284 15954.84 11
12 dr. Nunung Sp. OG III/ 5% 16794.57 839.7284 15954.84 12
13 dr. Binto Sp.M III/ 5% 16794.57 839.7284 15954.84 13
14 dr. Widi Sp.M III/ 5% 16794.57 839.7284 15954.84 14
15 dr. Edy Sp.THT IV/ 15% 16794.57 2519.185 14275.38 15
16 dr. Aris Sp. An III/ 5% 16794.57 839.7284 15954.84 16
17 dr. Widyatmiko Sp.OT III/ 5% 16794.57 839.7284 15954.84 17
18 dr. R. Haryo Sp. BS III/ 5% 16794.57 839.7284 15954.84 18
19 dr. Juhaeriyah IV/ 15% 16794.57 2519.185 14275.38 19
20 dr. Nurzaman III/ 5% 16794.57 839.7284 15954.84 20
21 dr. Hari Mukt III/ 5% 16794.57 839.7284 15954.84 21
22 dr. Amaludin III/ 5% 16794.57 839.7284 15954.84 22
23 dr. Aji Prasetyo III/ 5% 16794.57 839.7284 15954.84 23
24 dr. Dyan Fakhry III/ 5% 16794.57 839.7284 15954.84 24
25 dr. Sedayu III/ 5% 16794.57 839.7284 15954.84 25
26 dr. Eva R III/ 5% 16794.57 839.7284 15954.84 26
27 dr. Aulia III/ 5% 16794.57 839.7284 15954.84 27
28 dr. Riany III/ 5% 16794.57 839.7284 15954.84 28
29 dr.Rendy III/ 5% 16794.57 839.7284 15954.84 29
30 dr. Trisy III/ 5% 16794.57 839.7284 15954.84 30
31 dr.Gisda 2.5% 16794.57 419.8642 16374.7 31
32 dr. Denok 2.5% 16794.57 419.8642 16374.7 32
33 dr. Novy 2.5% 16794.57 419.8642 16374.7 33
34 dr. Dian R. 2.5% 16794.57 419.8642 16374.7 34
35 dr. Ivan 2.5% 16794.57 419.8642 16374.7 35
36 dr. Nihayatul 2.5% 16794.57 419.8642 16374.7 36
37 drg. Yuyum III/ 5% 16794.57 839.7284 15954.84 37
621399 34848.73 586550.3
USG 1232616

DAFTAR PENDISTRIBUSIAN JASA PENGIRIMAN JKN (USG) JANUARI 2016


NO. NAMA GOL./ PAJAK NILAI PAJAK DITERIMA TANDA TANGAN
1 dr. Taufiq Sp.PD IV/ 15% 33313.95 4997.092 28316.85 1
2 dr. Luthfi Sp.PD III/ 5% 33313.95 1665.697 31648.25 2
3 dr. Irene Sp.PD 2.5% 33313.95 832.8486 32481.1 3
4 dr. Iskandar Sp.B IV/ 15% 33313.95 4997.092 28316.85 4
5 dr. Dini Sp.B III/ 5% 33313.95 1665.697 31648.25 5
6 dr. Irman Sp.A III/ 5% 33313.95 1665.697 31648.25 6
7 dr. Ineu Sp.A III/ 5% 33313.95 1665.697 31648.25 7
8 dr. Tatan Sp.A III/ 5% 33313.95 1665.697 31648.25 8
9 dr. Hervan Sp.OG III/ 5% 33313.95 1665.697 31648.25 9
10 dr. Bogie Sp.OG III/ 5% 33313.95 1665.697 31648.25 10
11 dr. Deni Sp.OG III/ 5% 33313.95 1665.697 31648.25 11
12 dr. Nunung Sp. OG III/ 5% 33313.95 1665.697 31648.25 12
13 dr. Binto Sp.M III/ 5% 33313.95 1665.697 31648.25 13
14 dr. Widi Sp.M III/ 5% 33313.95 1665.697 31648.25 14
15 dr. Edy Sp.THT IV/ 15% 33313.95 4997.092 28316.85 15
16 dr. Aris Sp.An III/ 5% 33313.95 1665.697 31648.25 16
17 dr. Widyatmiko Sp.OT III/ 5% 33313.95 1665.697 31648.25 17
18 dr. R. Haryo Sp. BS III/ 5% 33313.95 1665.697 31648.25 18
19 dr. Juhaeriyah IV/ 15% 33313.95 1665.697 31648.25 19
20 dr. Nurzaman III/ 5% 33313.95 1665.697 31648.25 20
21 dr. Hari Mukt III/ 5% 33313.95 1665.697 31648.25 21
22 dr. Amaludin III/ 5% 33313.95 1665.697 31648.25 22
23 dr. Aji Prasetyo III/ 5% 33313.95 1665.697 31648.25 23
24 dr. Dyan Fakhry III/ 5% 33313.95 1665.697 31648.25 24
25 dr. Sedayu III/ 5% 33313.95 1665.697 31648.25 25
26 dr. Eva R III/ 5% 33313.95 1665.697 31648.25 26
27 dr. Aulia III/ 5% 33313.95 1665.697 31648.25 27
28 dr. Riany III/ 5% 33313.95 1665.697 31648.25 28
29 dr.Rendy III/ 5% 33313.95 1665.697 31648.25 29
30 dr. Trisy III/ 5% 33313.95 1665.697 31648.25 30
31 dr.Gisda 2.5% 33313.95 832.8486 32481.1 31
32 dr. Denok 2.5% 33313.95 832.8486 32481.1 32
33 dr. Novy 2.5% 33313.95 832.8486 32481.1 33
34 dr. Dian R. 2.5% 33313.95 832.8486 32481.1 34
35 dr. Ivan 2.5% 33313.95 832.8486 32481.1 35
36 dr. Nihayatul 2.5% 33313.95 832.8486 32481.1 36
37 drg. Yuyum III/ 5% 33313.95 1665.697 31648.25 37
1232616 65795.04 1166821
EKG Jan 1097778

DAFTAR PENDISTRIBUSIAN JASA PENGIRIMAN JKN (EKG) JANUARI 2016


NO. NAMA GOL./ PAJAK NILAI PAJAK DITERIMA TANDA TANGAN
1 dr. Taufiq Sp.PD IV/ 15% 91481.5 13722.23 77759.28 1
2 dr. Luthfi Sp.PD III/ 5% 91481.5 4574.075 86907.43 2
3 dr. Irene Sp.PD 2.5% 91481.5 2287.038 89194.46 3
4 dr. Juhaeriyah IV/ 15% 45740.75 6861.113 38879.64 4
5 dr. Nurzaman III/ 5% 45740.75 2287.038 43453.71 5
6 dr. Hari Mukt III/ 5% 45740.75 2287.038 43453.71 6
7 dr. Amaludin III/ 5% 45740.75 2287.038 43453.71 7
8 dr. Aji Prasetyo III/ 5% 45740.75 2287.038 43453.71 8
9 dr. Dyan Fakhry III/ 5% 45740.75 2287.038 43453.71 9
10 dr. Sedayu III/ 5% 45740.75 2287.038 43453.71 10
11 dr. Eva R III/ 5% 45740.75 2287.038 43453.71 11
12 dr. Aulia III/ 5% 45740.75 2287.038 43453.71 12
13 dr. Riany III/ 5% 45740.75 2287.038 43453.71 13
14 dr.Rendy III/ 5% 45740.75 2287.038 43453.71 14
15 dr. Trisy III/ 5% 45740.75 2287.038 43453.71 15
16 dr.Gisda 2.5% 45740.75 1143.519 44597.23 16
17 dr. Denok 2.5% 45740.75 1143.519 44597.23 17
18 dr. Novy 2.5% 45740.75 1143.519 44597.23 18
19 dr. Dian R. 2.5% 45740.75 1143.519 44597.23 19
20 dr. Ivan 2.5% 45740.75 1143.519 44597.23 20
21 dr. Nihayatul 2.5% 45740.75 1143.519 44597.23 21
1097778 59462.98 1038315

Lab Jan 3982843

DAFTAR PENDISTRIBUSIAN JASA PENGIRIMAN JKN (LABORATORIUM) JANUARI 2016


NO. NAMA GOL./ PAJAK NILAI PAJAK DITERIMA TANDA TANGAN
1 dr. Taufiq Sp.PD IV/ 15% 168764.5 25314.68 143449.9 1
2 dr. Luthfi Sp.PD III/ 5% 168764.5 8438.227 160326.3 2
3 dr. Irene Sp.PD 2.5% 168764.5 4219.113 164545.4 3
4 dr. Iskandar Sp.B IV/ 15% 67505.81 10125.87 57379.94 4
5 dr. Dini Sp.B III/ 5% 67505.81 3375.291 64130.52 5
6 dr. Irman Sp.A III/ 5% 67505.81 3375.291 64130.52 6
7 dr. Ineu Sp.A III/ 5% 67505.81 3375.291 64130.52 7
8 dr. Tatan Sp.A III/ 5% 67505.81 3375.291 64130.52 8
9 dr. Hervan Sp.OG III/ 5% 67505.81 3375.291 64130.52 9
10 dr. Bogie Sp.OG III/ 5% 67505.81 3375.291 64130.52 10
11 dr. Deni Sp.OG III/ 5% 67505.81 3375.291 64130.52 11
12 dr. Nunung Sp. OG III/ 5% 67505.81 3375.291 64130.52 12
13 dr. Binto Sp.M III/ 5% 67505.81 3375.291 64130.52 13
14 dr. Widi Sp.M III/ 5% 67505.81 3375.291 64130.52 14
15 dr. Edy Sp.THT IV/ 15% 67505.81 10125.87 57379.94 15
16 dr. Aris Sp.An III/ 5% 67505.81 3375.291 64130.52 16
17 dr. Widyatmiko Sp.OT III/ 5% 67505.81 3375.291 64130.52 17
18 dr. R. Haryo Sp. BS III/ 5% 67505.81 3375.291 64130.52 18
19 dr. Juhaeriyah IV/ 15% 135011.6 20251.74 114759.9 19
20 dr. Nurzaman III/ 5% 135011.6 6750.581 128261 20
21 dr. Hari Mukt III/ 5% 135011.6 6750.581 128261 21
22 dr. Amaludin III/ 5% 135011.6 6750.581 128261 22
23 dr. Aji Prasetyo III/ 5% 135011.6 6750.581 128261 23
24 dr. Dyan Fakhry III/ 5% 135011.6 6750.581 128261 24
25 dr. Sedayu III/ 5% 135011.6 6750.581 128261 25
26 dr. Eva R III/ 5% 135011.6 6750.581 128261 26
27 dr. Aulia III/ 5% 135011.6 6750.581 128261 27
28 dr. Riany III/ 5% 135011.6 6750.581 128261 28
29 dr.Rendy III/ 5% 135011.6 6750.581 128261 29
30 dr. Trisy III/ 5% 135011.6 6750.581 128261 30
31 dr.Gisda 2.5% 135011.6 3375.291 131636.3 31
32 dr. Denok 2.5% 135011.6 3375.291 131636.3 32
33 dr. Novy 2.5% 135011.6 3375.291 131636.3 33
34 dr. Dian R. 2.5% 135011.6 3375.291 131636.3 34
35 dr. Ivan 2.5% 135011.6 3375.291 131636.3 35
36 dr. Nihayatul 2.5% 135011.6 3375.291 131636.3 36
37 drg. Yuyum III/ 5% 33752.91 1687.645 32065.26 37
3982843 218550.1 3764293
radiologi 635216

DAFTAR PENDISTRIBUSIAN JASA PENGIRIMAN JKN (RADIOLOGI) FEBRUARI 2016 DAFTA


NO. NAMA GOL./ PAJAK NILAI PAJAK DITERIMA TANDA TANGAN NO.
1 dr. Taufiq Sp.PD IV/ 15% 17168 2575.2 14592.8 1 1
2 dr. Luthfi Sp.PD III/ 5% 17168 858.4 16309.6 2 2
3 dr. Irene Sp.PD 2.5% 17168 429.2 16738.8 3 3
4 dr. Iskandar Sp.B IV/ 15% 17168 2575.2 14592.8 4 4
5 dr. Dini Sp.B III/ 5% 17168 858.4 16309.6 5 5
6 dr. Irman Sp.A III/ 5% 17168 858.4 16309.6 6 6
7 dr. Ineu Sp.A III/ 5% 17168 858.4 16309.6 7 7
8 dr. Tatan Sp.A III/ 5% 17168 858.4 16309.6 8 8
9 dr. Hervan Sp.OG III/ 5% 17168 858.4 16309.6 9 9
10 dr. Bogie Sp.OG III/ 5% 17168 858.4 16309.6 10 10
11 dr. Deni Sp.OG III/ 5% 17168 858.4 16309.6 11 11
12 dr. Nunung Sp. OG III/ 5% 17168 858.4 16309.6 12 12
13 dr. Binto Sp.M III/ 5% 17168 858.4 16309.6 13 13
14 dr. Widi Sp.M III/ 5% 17168 858.4 16309.6 14 14
15 dr. Edy Sp.THT IV/ 15% 17168 2575.2 14592.8 15 15
16 dr. Aris Sp.An III/ 5% 17168 858.4 16309.6 16 16
17 dr. Widyatmiko Sp.OT III/ 5% 17168 858.4 16309.6 17 17
18 dr. R. Haryo Sp. BS III/ 5% 17168 858.4 16309.6 18 18
19 dr. Juhaeriyah IV/ 15% 17168 858.4 16309.6 19 19
20 dr. Nurzaman III/ 5% 17168 858.4 16309.6 20 20
21 dr. Hari Mukt III/ 5% 17168 858.4 16309.6 21 21
22 dr. Amaludin III/ 5% 17168 858.4 16309.6 22 22
23 dr. Aji Prasetyo III/ 5% 17168 858.4 16309.6 23 23
24 dr. Dyan Fakhry III/ 5% 17168 858.4 16309.6 24 24
25 dr. Sedayu III/ 5% 17168 858.4 16309.6 25 25
26 dr. Eva R III/ 5% 17168 858.4 16309.6 26 26
27 dr. Aulia III/ 5% 17168 858.4 16309.6 27 27
28 dr. Riany III/ 5% 17168 858.4 16309.6 28 28
29 dr.Rendy III/ 5% 17168 858.4 16309.6 29 29
30 dr. Trisy III/ 5% 17168 858.4 16309.6 30 30
31 dr.Gisda 2.5% 17168 429.2 16738.8 31 31
32 dr. Denok 2.5% 17168 429.2 16738.8 32 32
33 dr. Novy 2.5% 17168 429.2 16738.8 33 33
34 dr. Dian R. 2.5% 17168 429.2 16738.8 34 34
35 dr. Ivan 2.5% 17168 429.2 16738.8 35 35
36 dr. Nihayatul 2.5% 17168 429.2 16738.8 36 36
37 drg. Yuyum III/ 5% 17168 858.4 16309.6 37 37
635216 33906.8 601309.2 38
USG Feb 1181313

DAFTAR PENDISTRIBUSIAN JASA PENGIRIMAN JKN (USG) FEBRUARI 2016 DA


NO. NAMA GOL./ PAJAK NILAI PAJAK DITERIMA TANDA TANGAN NO.
1 dr. Taufiq Sp.PD IV/ 15% 31927.38 4789.107 27138.27 1 1
2 dr. Luthfi Sp.PD III/ 5% 31927.38 1596.369 30331.01 2 2
3 dr. Irene Sp.PD 2.5% 31927.38 798.1845 31129.19 3 3
4 dr. Iskandar Sp.B IV/ 15% 31927.38 4789.107 27138.27 4 4
5 dr. Dini Sp.B III/ 5% 31927.38 1596.369 30331.01 5 5
6 dr. Irman Sp.A III/ 5% 31927.38 1596.369 30331.01 6 6
7 dr. Ineu Sp.A III/ 5% 31927.38 1596.369 30331.01 7 7
8 dr. Tatan Sp.A III/ 5% 31927.38 1596.369 30331.01 8 8
9 dr. Hervan Sp.OG III/ 5% 31927.38 1596.369 30331.01 9 9
10 dr. Bogie Sp.OG III/ 5% 31927.38 1596.369 30331.01 10 10
11 dr. Deni Sp.OG III/ 5% 31927.38 1596.369 30331.01 11 11
12 dr. Nunung Sp. OG III/ 5% 31927.38 1596.369 30331.01 12 12
13 dr. Binto Sp.M III/ 5% 31927.38 1596.369 30331.01 13 13
14 dr. Widi Sp.M III/ 5% 31927.38 1596.369 30331.01 14 14
15 dr. Edy Sp.THT IV/ 15% 31927.38 4789.107 27138.27 15 15
16 dr. Aris Sp.An III/ 5% 31927.38 1596.369 30331.01 16 16
17 dr. Widyatmiko Sp.OT III/ 5% 31927.38 1596.369 30331.01 17 17
18 dr. R. Haryo Sp. BS III/ 5% 31927.38 1596.369 30331.01 18 18
19 dr. Juhaeriyah IV/ 15% 31927.38 1596.369 30331.01 19 19
20 dr. Nurzaman III/ 5% 31927.38 1596.369 30331.01 20 20
21 dr. Hari Mukt III/ 5% 31927.38 1596.369 30331.01 21 21
22 dr. Amaludin III/ 5% 31927.38 1596.369 30331.01 22 22
23 dr. Aji Prasetyo III/ 5% 31927.38 1596.369 30331.01 23 23
24 dr. Dyan Fakhry III/ 5% 31927.38 1596.369 30331.01 24 24
25 dr. Sedayu III/ 5% 31927.38 1596.369 30331.01 25 25
26 dr. Eva R III/ 5% 31927.38 1596.369 30331.01 26 26
27 dr. Aulia III/ 5% 31927.38 1596.369 30331.01 27 27
28 dr. Riany III/ 5% 31927.38 1596.369 30331.01 28 28
29 dr.Rendy III/ 5% 31927.38 1596.369 30331.01 29 29
30 dr. Trisy III/ 5% 31927.38 1596.369 30331.01 30 30
31 dr.Gisda 2.5% 31927.38 798.1845 31129.19 31 31
32 dr. Denok 2.5% 31927.38 798.1845 31129.19 32 32
33 dr. Novy 2.5% 31927.38 798.1845 31129.19 33 33
34 dr. Dian R. 2.5% 31927.38 798.1845 31129.19 34 34
35 dr. Ivan 2.5% 31927.38 798.1845 31129.19 35 35
36 dr. Nihayatul 2.5% 31927.38 798.1845 31129.19 36 36
37 drg. Yuyum III/ 5% 31927.38 1596.369 30331.01 37 37
1181313 63056.57 1118256 38
EKG Feb 1306454

DAFTAR PENDISTRIBUSIAN JASA PENGIRIMAN JKN (EKG) FEBRUARI 2016 DA


NO. NAMA GOL./ PAJAK NILAI PAJAK DITERIMA TANDA TANGAN NO.
1 dr. Taufiq Sp.PD IV/ 15% 108871.2 16330.68 92540.49 1 1
2 dr. Luthfi Sp.PD III/ 5% 108871.2 5443.558 103427.6 2 2
3 dr. Irene Sp.PD 2.5% 108871.2 2721.779 106149.4 3 3
4 dr. Juhaeriyah IV/ 15% 54435.58 8165.338 46270.25 4 4
5 dr. Nurzaman III/ 5% 54435.58 2721.779 51713.8 5 5
6 dr. Hari Mukt III/ 5% 54435.58 2721.779 51713.8 6 6
7 dr. Amaludin III/ 5% 54435.58 2721.779 51713.8 7 7
8 dr. Aji Prasetyo III/ 5% 54435.58 2721.779 51713.8 8 8
9 dr. Dyan Fakhry III/ 5% 54435.58 2721.779 51713.8 9 9
10 dr. Sedayu III/ 5% 54435.58 2721.779 51713.8 10 10
11 dr. Eva R III/ 5% 54435.58 2721.779 51713.8 11 11
12 dr. Aulia III/ 5% 54435.58 2721.779 51713.8 12 12
13 dr. Riany III/ 5% 54435.58 2721.779 51713.8 13 13
14 dr.Rendy III/ 5% 54435.58 2721.779 51713.8 14 14
15 dr. Trisy III/ 5% 54435.58 2721.779 51713.8 15 15
16 dr.Gisda 2.5% 54435.58 1360.89 53074.69 16 16
17 dr. Denok 2.5% 54435.58 1360.89 53074.69 17 17
18 dr. Novy 2.5% 54435.58 1360.89 53074.69 18 18
19 dr. Dian R. 2.5% 54435.58 1360.89 53074.69 19 19
20 dr. Ivan 2.5% 54435.58 1360.89 53074.69 20 20
21 dr. Nihayatul 2.5% 54435.58 1360.89 53074.69 21 21
1306454 70766.26 1235688

Lab Feb 4487732

DAFTAR PENDISTRIBUSIAN JASA PENGIRIMAN JKN (LABORATORIUM) FEBRUARI 2016 DAFTAR


NO. NAMA GOL./ PAJAK NILAI PAJAK DITERIMA TANDA TANGAN NO.
1 dr. Taufiq Sp.PD IV/ 15% 190158.1 28523.72 161634.4 1 1
2 dr. Luthfi Sp.PD III/ 5% 190158.1 9507.907 180650.2 2 2
3 dr. Irene Sp.PD 2.5% 190158.1 4753.953 185404.2 3 3
4 dr. Iskandar Sp.B IV/ 15% 76063.25 11409.49 64653.77 4 4
5 dr. Dini Sp.B III/ 5% 76063.25 3803.163 72260.09 5 5
6 dr. Irman Sp.A III/ 5% 76063.25 3803.163 72260.09 6 6
7 dr. Ineu Sp.A III/ 5% 76063.25 3803.163 72260.09 7 7
8 dr. Tatan Sp.A III/ 5% 76063.25 3803.163 72260.09 8 8
9 dr. Hervan Sp.OG III/ 5% 76063.25 3803.163 72260.09 9 9
10 dr. Bogie Sp.OG III/ 5% 76063.25 3803.163 72260.09 10 10
11 dr. Deni Sp.OG III/ 5% 76063.25 3803.163 72260.09 11 11
12 dr. Nunung Sp. OG III/ 5% 76063.25 3803.163 72260.09 12 12
13 dr. Binto Sp.M III/ 5% 76063.25 3803.163 72260.09 13 13
14 dr. Widi Sp.M III/ 5% 76063.25 3803.163 72260.09 14 14
15 dr. Edy Sp.THT IV/ 15% 76063.25 11409.49 64653.77 15 15
16 dr. Aris Sp.An III/ 5% 76063.25 3803.163 72260.09 16 16
17 dr. Widyatmiko Sp.OT III/ 5% 76063.25 3803.163 72260.09 17 17
18 dr. R. Haryo Sp. BS III/ 5% 76063.25 3803.163 72260.09 18 18
19 dr. Juhaeriyah IV/ 15% 152126.5 22818.98 129307.5 19 19
20 dr. Nurzaman III/ 5% 152126.5 7606.325 144520.2 20 20
21 dr. Hari Mukt III/ 5% 152126.5 7606.325 144520.2 21 21
22 dr. Amaludin III/ 5% 152126.5 7606.325 144520.2 22 22
23 dr. Aji Prasetyo III/ 5% 152126.5 7606.325 144520.2 23 23
24 dr. Dyan Fakhry III/ 5% 152126.5 7606.325 144520.2 24 24
25 dr. Sedayu III/ 5% 152126.5 7606.325 144520.2 25 25
26 dr. Eva R III/ 5% 152126.5 7606.325 144520.2 26 26
27 dr. Aulia III/ 5% 152126.5 7606.325 144520.2 27 27
28 dr. Riany III/ 5% 152126.5 7606.325 144520.2 28 28
29 dr.Rendy III/ 5% 152126.5 7606.325 144520.2 29 29
30 dr. Trisy III/ 5% 152126.5 7606.325 144520.2 30 30
31 dr.Gisda 2.5% 152126.5 3803.163 148323.3 31 31
32 dr. Denok 2.5% 152126.5 3803.163 148323.3 32 32
33 dr. Novy 2.5% 152126.5 3803.163 148323.3 33 33
34 dr. Dian R. 2.5% 152126.5 3803.163 148323.3 34 34
35 dr. Ivan 2.5% 152126.5 3803.163 148323.3 35 35
36 dr. Nihayatul 2.5% 152126.5 3803.163 148323.3 36 36
37 drg. Yuyum III/ 5% 38031.63 1901.581 36130.05 37 37
4487732 246254.8 4241477 38
Radiologi 778100

DAFTAR PENDISTRIBUSIAN JASA PENGIRIMAN JKN (RADIOLOGI) MARET 2016 DAFTAR P


NAMA GOL./ PAJAK NILAI PAJAK DITERIMA TANDA TANGAN NO.
dr. Taufiq Sp.PD IV/ 15% 20476.32 3071.447 17404.87 1 1
dr. Luthfi Sp.PD III/ 5% 20476.32 1023.816 19452.5 2 2
dr. Irene Sp.PD 2.5% 20476.32 511.9079 19964.41 3 3
dr. Iskandar Sp.B IV/ 15% 20476.32 3071.447 17404.87 4 4
dr. Dini Sp.B III/ 5% 20476.32 1023.816 19452.5 5 5
dr. Irman Sp.A III/ 5% 20476.32 1023.816 19452.5 6 6
dr. Ineu Sp.A III/ 5% 20476.32 1023.816 19452.5 7 7
dr. Tatan Sp.A III/ 5% 20476.32 1023.816 19452.5 8 8
dr. Hervan Sp.OG III/ 5% 20476.32 1023.816 19452.5 9 9
dr. Bogie Sp.OG III/ 5% 20476.32 1023.816 19452.5 10 10
dr. Deni Sp.OG III/ 5% 20476.32 1023.816 19452.5 11 11
dr. Nunung Sp. OG III/ 5% 20476.32 1023.816 19452.5 12 12
dr. Binto Sp.M III/ 5% 20476.32 1023.816 19452.5 13 13
dr. Widi Sp.M III/ 5% 20476.32 1023.816 19452.5 14 14
dr. Edy Sp.THT IV/ 15% 20476.32 3071.447 17404.87 15 15
dr. Ismi Sp. THT III/ 5% 20476.32 1023.816 19452.5 16 16
dr. Aris Sp.An III/ 5% 20476.32 1023.816 19452.5 17 17
dr. Widyatmiko Sp.OT III/ 5% 20476.32 1023.816 19452.5 18 18
dr. R. Haryo Sp. BS III/ 5% 20476.32 1023.816 19452.5 19 19
dr. Juhaeriyah IV/ 15% 20476.32 1023.816 19452.5 20 20
dr. Nurzaman III/ 5% 20476.32 1023.816 19452.5 21 21
dr. Hari Mukt III/ 5% 20476.32 1023.816 19452.5 22 22
dr. Amaludin III/ 5% 20476.32 1023.816 19452.5 23 23
dr. Aji Prasetyo III/ 5% 20476.32 1023.816 19452.5 24 24
dr. Dyan Fakhry III/ 5% 20476.32 1023.816 19452.5 25 25
dr. Sedayu III/ 5% 20476.32 1023.816 19452.5 26 26
dr. Eva R III/ 5% 20476.32 1023.816 19452.5 27 27
dr. Aulia III/ 5% 20476.32 1023.816 19452.5 28 28
dr. Riany III/ 5% 20476.32 1023.816 19452.5 29 29
dr.Rendy III/ 5% 20476.32 1023.816 19452.5 30 30
dr. Trisy III/ 5% 20476.32 1023.816 19452.5 31 31
dr.Gisda 2.5% 20476.32 511.9079 19964.41 32 32
dr. Denok 2.5% 20476.32 511.9079 19964.41 33 33
dr. Novy 2.5% 20476.32 511.9079 19964.41 34 34
dr. Dian R. 2.5% 20476.32 511.9079 19964.41 35 35
dr. Ivan 2.5% 20476.32 511.9079 19964.41 36 36
dr. Nihayatul 2.5% 20476.32 511.9079 19964.41 37 37
drg. Yuyum III/ 5% 20476.32 1023.816 19452.5 38 38
778100 41464.54 736635.5
USG Maret 1746018

DAFTAR PENDISTRIBUSIAN JASA PENGIRIMAN JKN (USG) MARET 2016 DAFTA


NAMA GOL./ PAJAK NILAI PAJAK DITERIMA TANDA TANGAN NO.
dr. Taufiq Sp.PD IV/ 15% 45947.84 6892.176 39055.67 1 1
dr. Luthfi Sp.PD III/ 5% 45947.84 2297.392 43650.45 2 2
dr. Irene Sp.PD 2.5% 45947.84 1148.696 44799.15 3 3
dr. Iskandar Sp.B IV/ 15% 45947.84 6892.176 39055.67 4 4
dr. Dini Sp.B III/ 5% 45947.84 2297.392 43650.45 5 5
dr. Irman Sp.A III/ 5% 45947.84 2297.392 43650.45 6 6
dr. Ineu Sp.A III/ 5% 45947.84 2297.392 43650.45 7 7
dr. Tatan Sp.A III/ 5% 45947.84 2297.392 43650.45 8 8
dr. Hervan Sp.OG III/ 5% 45947.84 2297.392 43650.45 9 9
dr. Bogie Sp.OG III/ 5% 45947.84 2297.392 43650.45 10 10
dr. Deni Sp.OG III/ 5% 45947.84 2297.392 43650.45 11 11
dr. Nunung Sp. OG III/ 5% 45947.84 2297.392 43650.45 12 12
dr. Binto Sp.M III/ 5% 45947.84 2297.392 43650.45 13 13
dr. Widi Sp.M III/ 5% 45947.84 2297.392 43650.45 14 14
dr. Edy Sp.THT IV/ 15% 45947.84 6892.176 39055.67 15 15
dr. Ismi Sp. THT III/ 5% 45947.84 2297.392 43650.45 16 16
dr. Aris Sp.An III/ 5% 45947.84 2297.392 43650.45 17 17
dr. Widyatmiko Sp.OT III/ 5% 45947.84 2297.392 43650.45 18 18
dr. R. Haryo Sp. BS III/ 5% 45947.84 2297.392 43650.45 19 19
dr. Juhaeriyah IV/ 15% 45947.84 2297.392 43650.45 20 20
dr. Nurzaman III/ 5% 45947.84 2297.392 43650.45 21 21
dr. Hari Mukt III/ 5% 45947.84 2297.392 43650.45 22 22
dr. Amaludin III/ 5% 45947.84 2297.392 43650.45 23 23
dr. Aji Prasetyo III/ 5% 45947.84 2297.392 43650.45 24 24
dr. Dyan Fakhry III/ 5% 45947.84 2297.392 43650.45 25 25
dr. Sedayu III/ 5% 45947.84 2297.392 43650.45 26 26
dr. Eva R III/ 5% 45947.84 2297.392 43650.45 27 27
dr. Aulia III/ 5% 45947.84 2297.392 43650.45 28 28
dr. Riany III/ 5% 45947.84 2297.392 43650.45 29 29
dr.Rendy III/ 5% 45947.84 2297.392 43650.45 30 30
dr. Trisy III/ 5% 45947.84 2297.392 43650.45 31 31
dr.Gisda 2.5% 45947.84 1148.696 44799.15 32 32
dr. Denok 2.5% 45947.84 1148.696 44799.15 33 33
dr. Novy 2.5% 45947.84 1148.696 44799.15 34 34
dr. Dian R. 2.5% 45947.84 1148.696 44799.15 35 35
dr. Ivan 2.5% 45947.84 1148.696 44799.15 36 36
dr. Nihayatul 2.5% 45947.84 1148.696 44799.15 37 37
drg. Yuyum III/ 5% 45947.84 2297.392 43650.45 38 38
1746018 93044.38 1652974

EKG Maret 1340170

DAFTAR PENDISTRIBUSIAN JASA PENGIRIMAN JKN (EKG) MARET 2016 DAFTA


NAMA GOL./ PAJAK NILAI PAJAK DITERIMA TANDA TANGAN NO.
dr. Taufiq Sp.PD IV/ 15% 111680.8 16752.13 94928.71 1 1
dr. Luthfi Sp.PD III/ 5% 111680.8 5584.042 106096.8 2 2
dr. Irene Sp.PD 2.5% 111680.8 2792.021 108888.8 3 3
dr. Juhaeriyah IV/ 15% 55840.42 8376.063 47464.35 4 4
dr. Nurzaman III/ 5% 55840.42 2792.021 53048.4 5 5
dr. Hari Mukt III/ 5% 55840.42 2792.021 53048.4 6 6
dr. Amaludin III/ 5% 55840.42 2792.021 53048.4 7 7
dr. Aji Prasetyo III/ 5% 55840.42 2792.021 53048.4 8 8
dr. Dyan Fakhry III/ 5% 55840.42 2792.021 53048.4 9 9
dr. Sedayu III/ 5% 55840.42 2792.021 53048.4 10 10
dr. Eva R III/ 5% 55840.42 2792.021 53048.4 11 11
dr. Aulia III/ 5% 55840.42 2792.021 53048.4 12 12
dr. Riany III/ 5% 55840.42 2792.021 53048.4 13 13
dr.Rendy III/ 5% 55840.42 2792.021 53048.4 14 14
dr. Trisy III/ 5% 55840.42 2792.021 53048.4 15 15
dr.Gisda 2.5% 55840.42 1396.01 54444.41 16 16
dr. Denok 2.5% 55840.42 1396.01 54444.41 17 17
dr. Novy 2.5% 55840.42 1396.01 54444.41 18 18
dr. Dian R. 2.5% 55840.42 1396.01 54444.41 19 19
dr. Ivan 2.5% 55840.42 1396.01 54444.41 20 20
dr. Nihayatul 2.5% 55840.42 1396.01 54444.41 21 21
1340170 72592.54 1267577

Lab Maret 4886220

DAFTAR PENDISTRIBUSIAN JASA PENGIRIMAN JKN (LABORATORIUM) MARET 2016 DAFTAR PEN
NAMA GOL./ PAJAK NILAI PAJAK DITERIMA TANDA TANGAN NO.
dr. Taufiq Sp.PD IV/ 15% 203592.5 30538.88 173053.6 1 1
dr. Luthfi Sp.PD III/ 5% 203592.5 10179.63 193412.9 2 2
dr. Irene Sp.PD 2.5% 203592.5 5089.813 198502.7 3 3
dr. Iskandar Sp.B IV/ 15% 81437 12215.55 69221.45 4 4
dr. Dini Sp.B III/ 5% 81437 4071.85 77365.15 5 5
dr. Irman Sp.A III/ 5% 81437 4071.85 77365.15 6 6
dr. Ineu Sp.A III/ 5% 81437 4071.85 77365.15 7 7
dr. Tatan Sp.A III/ 5% 81437 4071.85 77365.15 8 8
dr. Hervan Sp.OG III/ 5% 81437 4071.85 77365.15 9 9
dr. Bogie Sp.OG III/ 5% 81437 4071.85 77365.15 10 10
dr. Deni Sp.OG III/ 5% 81437 4071.85 77365.15 11 11
dr. Nunung Sp. OG III/ 5% 81437 4071.85 77365.15 12 12
dr. Binto Sp.M III/ 5% 81437 4071.85 77365.15 13 13
dr. Widi Sp.M III/ 5% 81437 4071.85 77365.15 14 14
dr. Edy Sp.THT IV/ 15% 81437 12215.55 69221.45 15 15
dr. Ismi Sp. THT III/ 5% 81437 4071.85 77365.15 16 16
dr. Aris Sp.An III/ 5% 81437 4071.85 77365.15 17 17
dr. Widyatmiko Sp.OT III/ 5% 81437 4071.85 77365.15 18 18
dr. R. Haryo Sp. BS III/ 5% 81437 4071.85 77365.15 19 19
dr. Juhaeriyah IV/ 15% 162874 24431.1 138442.9 20 20
dr. Nurzaman III/ 5% 162874 8143.7 154730.3 21 21
dr. Hari Mukt III/ 5% 162874 8143.7 154730.3 22 22
dr. Amaludin III/ 5% 162874 8143.7 154730.3 23 23
dr. Aji Prasetyo III/ 5% 162874 8143.7 154730.3 24 24
dr. Dyan Fakhry III/ 5% 162874 8143.7 154730.3 25 25
dr. Sedayu III/ 5% 162874 8143.7 154730.3 26 26
dr. Eva R III/ 5% 162874 8143.7 154730.3 27 27
dr. Aulia III/ 5% 162874 8143.7 154730.3 28 28
dr. Riany III/ 5% 162874 8143.7 154730.3 29 29
dr.Rendy III/ 5% 162874 8143.7 154730.3 30 30
dr. Trisy III/ 5% 162874 8143.7 154730.3 31 31
dr.Gisda 2.5% 162874 4071.85 158802.2 32 32
dr. Denok 2.5% 162874 4071.85 158802.2 33 33
dr. Novy 2.5% 162874 4071.85 158802.2 34 34
dr. Dian R. 2.5% 162874 4071.85 158802.2 35 35
dr. Ivan 2.5% 162874 4071.85 158802.2 36 36
dr. Nihayatul 2.5% 162874 4071.85 158802.2 37 37
drg. Yuyum III/ 5% 40718.5 2035.925 38682.58 38 38
4886220 267724.1 4618496
Radiologi 662378

DAFTAR PENDISTRIBUSIAN JASA PENGIRIMAN JKN (RADIOLOGI) APRIL 2016 DAFTAR PEN
NAMA GOL./ PAJAK NILAI PAJAK DITERIMA TANDA TANGAN NO.
dr. Taufiq Sp.PD IV/ 15% 17431 2614.65 14816.35 1 1
dr. Luthfi Sp.PD III/ 5% 17431 871.55 16559.45 2 2
dr. Irene Sp.PD 2.5% 17431 435.775 16995.23 3 3
dr. Iskandar Sp.B IV/ 15% 17431 2614.65 14816.35 4 4
dr. Dini Sp.B III/ 5% 17431 871.55 16559.45 5 5
dr. Irman Sp.A III/ 5% 17431 871.55 16559.45 6 6
dr. Ineu Sp.A III/ 5% 17431 871.55 16559.45 7 7
dr. Tatan Sp.A III/ 5% 17431 871.55 16559.45 8 8
dr. Hervan Sp.OG III/ 5% 17431 871.55 16559.45 9 9
dr. Bogie Sp.OG III/ 5% 17431 871.55 16559.45 10 10
dr. Deni Sp.OG III/ 5% 17431 871.55 16559.45 11 11
dr. Nunung Sp. OG III/ 5% 17431 871.55 16559.45 12 12
dr. Binto Sp.M III/ 5% 17431 871.55 16559.45 13 13
dr. Widi Sp.M III/ 5% 17431 871.55 16559.45 14 14
dr. Edy Sp.THT IV/ 15% 17431 2614.65 14816.35 15 15
dr. Ismi Sp. THT III/ 5% 17431 871.55 16559.45 16 16
dr. Aris Sp.An III/ 5% 17431 871.55 16559.45 17 17
dr. Widyatmiko Sp.OT III/ 5% 17431 871.55 16559.45 18 18
dr. R. Haryo Sp. BS III/ 5% 17431 871.55 16559.45 19 19
dr. Juhaeriyah IV/ 15% 17431 871.55 16559.45 20 20
dr. Nurzaman III/ 5% 17431 871.55 16559.45 21 21
dr. Hari Mukt III/ 5% 17431 871.55 16559.45 22 22
dr. Amaludin III/ 5% 17431 871.55 16559.45 23 23
dr. Aji Prasetyo III/ 5% 17431 871.55 16559.45 24 24
dr. Dyan Fakhry III/ 5% 17431 871.55 16559.45 25 25
dr. Sedayu III/ 5% 17431 871.55 16559.45 26 26
dr. Eva R III/ 5% 17431 871.55 16559.45 27 27
dr. Aulia III/ 5% 17431 871.55 16559.45 28 28
dr. Riany III/ 5% 17431 871.55 16559.45 29 29
dr.Rendy III/ 5% 17431 871.55 16559.45 30 30
dr. Trisy III/ 5% 17431 871.55 16559.45 31 31
dr.Gisda 2.5% 17431 435.775 16995.23 32 32
dr. Denok 2.5% 17431 435.775 16995.23 33 33
dr. Novy 2.5% 17431 435.775 16995.23 34 34
dr. Dian R. 2.5% 17431 435.775 16995.23 35 35
dr. Ivan 2.5% 17431 435.775 16995.23 36 36
dr. Nihayatul 2.5% 17431 435.775 16995.23 37 37
drg. Yuyum III/ 5% 17431 871.55 16559.45 38 38
662378 35297.78 627080.2 39
40
USG April 1602237

DAFTAR PENDISTRIBUSIAN JASA PENGIRIMAN JKN (USG) APRIL 2016 DAFTAR


NAMA GOL./ PAJAK NILAI PAJAK DITERIMA TANDA TANGAN NO.
dr. Taufiq Sp.PD IV/ 15% 42164.13 6324.62 35839.51 1 1
dr. Luthfi Sp.PD III/ 5% 42164.13 2108.207 40055.93 2 2
dr. Irene Sp.PD 2.5% 42164.13 1054.103 41110.03 3 3
dr. Iskandar Sp.B IV/ 15% 42164.13 6324.62 35839.51 4 4
dr. Dini Sp.B III/ 5% 42164.13 2108.207 40055.93 5 5
dr. Irman Sp.A III/ 5% 42164.13 2108.207 40055.93 6 6
dr. Ineu Sp.A III/ 5% 42164.13 2108.207 40055.93 7 7
dr. Tatan Sp.A III/ 5% 42164.13 2108.207 40055.93 8 8
dr. Hervan Sp.OG III/ 5% 42164.13 2108.207 40055.93 9 9
dr. Bogie Sp.OG III/ 5% 42164.13 2108.207 40055.93 10 10
dr. Deni Sp.OG III/ 5% 42164.13 2108.207 40055.93 11 11
dr. Nunung Sp. OG III/ 5% 42164.13 2108.207 40055.93 12 12
dr. Binto Sp.M III/ 5% 42164.13 2108.207 40055.93 13 13
dr. Widi Sp.M III/ 5% 42164.13 2108.207 40055.93 14 14
dr. Edy Sp.THT IV/ 15% 42164.13 6324.62 35839.51 15 15
dr. Ismi Sp. THT III/ 5% 42164.13 2108.207 40055.93 16 16
dr. Aris Sp.An III/ 5% 42164.13 2108.207 40055.93 17 17
dr. Widyatmiko Sp.OT III/ 5% 42164.13 2108.207 40055.93 18 18
dr. R. Haryo Sp. BS III/ 5% 42164.13 2108.207 40055.93 19 19
dr. Juhaeriyah IV/ 15% 42164.13 2108.207 40055.93 20 20
dr. Nurzaman III/ 5% 42164.13 2108.207 40055.93 21 21
dr. Hari Mukt III/ 5% 42164.13 2108.207 40055.93 22 22
dr. Amaludin III/ 5% 42164.13 2108.207 40055.93 23 23
dr. Aji Prasetyo III/ 5% 42164.13 2108.207 40055.93 24 24
dr. Dyan Fakhry III/ 5% 42164.13 2108.207 40055.93 25 25
dr. Sedayu III/ 5% 42164.13 2108.207 40055.93 26 26
dr. Eva R III/ 5% 42164.13 2108.207 40055.93 27 27
dr. Aulia III/ 5% 42164.13 2108.207 40055.93 28 28
dr. Riany III/ 5% 42164.13 2108.207 40055.93 29 29
dr.Rendy III/ 5% 42164.13 2108.207 40055.93 30 30
dr. Trisy III/ 5% 42164.13 2108.207 40055.93 31 31
dr.Gisda 2.5% 42164.13 1054.103 41110.03 32 32
dr. Denok 2.5% 42164.13 1054.103 41110.03 33 33
dr. Novy 2.5% 42164.13 1054.103 41110.03 34 34
dr. Dian R. 2.5% 42164.13 1054.103 41110.03 35 35
dr. Ivan 2.5% 42164.13 1054.103 41110.03 36 36
dr. Nihayatul 2.5% 42164.13 1054.103 41110.03 37 37
drg. Yuyum III/ 5% 42164.13 2108.207 40055.93 38 38
1602237 85382.37 1516855 39
40

EKG April 1255052

DAFTAR PENDISTRIBUSIAN JASA PENGIRIMAN JKN (EKG) APRIL 2016 DAFTAR


NAMA GOL./ PAJAK NILAI PAJAK DITERIMA TANDA TANGAN NO.
dr. Taufiq Sp.PD IV/ 15% 104587.7 15688.15 88899.52 1 1
dr. Luthfi Sp.PD III/ 5% 104587.7 5229.383 99358.28 2 2
dr. Irene Sp.PD 2.5% 104587.7 2614.692 101973 3 3
dr. Juhaeriyah IV/ 15% 52293.83 7844.075 44449.76 4 4
dr. Nurzaman III/ 5% 52293.83 2614.692 49679.14 5 5
dr. Hari Mukt III/ 5% 52293.83 2614.692 49679.14 6 6
dr. Amaludin III/ 5% 52293.83 2614.692 49679.14 7 7
dr. Aji Prasetyo III/ 5% 52293.83 2614.692 49679.14 8 8
dr. Dyan Fakhry III/ 5% 52293.83 2614.692 49679.14 9 9
dr. Sedayu III/ 5% 52293.83 2614.692 49679.14 10 10
dr. Eva R III/ 5% 52293.83 2614.692 49679.14 11 11
dr. Aulia III/ 5% 52293.83 2614.692 49679.14 12 12
dr. Riany III/ 5% 52293.83 2614.692 49679.14 13 13
dr.Rendy III/ 5% 52293.83 2614.692 49679.14 14 14
dr. Trisy III/ 5% 52293.83 2614.692 49679.14 15 15
dr.Gisda 2.5% 52293.83 1307.346 50986.49 16 16
dr. Denok 2.5% 52293.83 1307.346 50986.49 17 17
dr. Novy 2.5% 52293.83 1307.346 50986.49 18 18
dr. Dian R. 2.5% 52293.83 1307.346 50986.49 19 19
dr. Ivan 2.5% 52293.83 1307.346 50986.49 20 20
dr. Nihayatul 2.5% 52293.83 1307.346 50986.49 21 21
1255052 67981.98 1187070 22
23

Lab April 5288053

DAFTAR PENDISTRIBUSIAN JASA PENGIRIMAN JKN (LABORATORIUM) APRIL 2016 DAFTAR PENDI
NAMA GOL./ PAJAK NILAI PAJAK DITERIMA TANDA TANGAN NO.
dr. Taufiq Sp.PD IV/ 15% 220335.5 33050.33 187285.2 1 1
dr. Luthfi Sp.PD III/ 5% 220335.5 11016.78 209318.8 2 2
dr. Irene Sp.PD 2.5% 220335.5 5508.389 214827.2 3 3
dr. Iskandar Sp.B IV/ 15% 88134.22 13220.13 74914.08 4 4
dr. Dini Sp.B III/ 5% 88134.22 4406.711 83727.51 5 5
dr. Irman Sp.A III/ 5% 88134.22 4406.711 83727.51 6 6
dr. Ineu Sp.A III/ 5% 88134.22 4406.711 83727.51 7 7
dr. Tatan Sp.A III/ 5% 88134.22 4406.711 83727.51 8 8
dr. Hervan Sp.OG III/ 5% 88134.22 4406.711 83727.51 9 9
dr. Bogie Sp.OG III/ 5% 88134.22 4406.711 83727.51 10 10
dr. Deni Sp.OG III/ 5% 88134.22 4406.711 83727.51 11 11
dr. Nunung Sp. OG III/ 5% 88134.22 4406.711 83727.51 12 12
dr. Binto Sp.M III/ 5% 88134.22 4406.711 83727.51 13 13
dr. Widi Sp.M III/ 5% 88134.22 4406.711 83727.51 14 14
dr. Edy Sp.THT IV/ 15% 88134.22 13220.13 74914.08 15 15
dr. Ismi Sp. THT III/ 5% 88134.22 4406.711 83727.51 16 16
dr. Aris Sp.An III/ 5% 88134.22 4406.711 83727.51 17 17
dr. Widyatmiko Sp.OT III/ 5% 88134.22 4406.711 83727.51 18 18
dr. R. Haryo Sp. BS III/ 5% 88134.22 4406.711 83727.51 19 19
dr. Juhaeriyah IV/ 15% 176268.4 26440.27 149828.2 20 20
dr. Nurzaman III/ 5% 176268.4 8813.422 167455 21 21
dr. Hari Mukt III/ 5% 176268.4 8813.422 167455 22 22
dr. Amaludin III/ 5% 176268.4 8813.422 167455 23 23
dr. Aji Prasetyo III/ 5% 176268.4 8813.422 167455 24 24
dr. Dyan Fakhry III/ 5% 176268.4 8813.422 167455 25 25
dr. Sedayu III/ 5% 176268.4 8813.422 167455 26 26
dr. Eva R III/ 5% 176268.4 8813.422 167455 27 27
dr. Aulia III/ 5% 176268.4 8813.422 167455 28 28
dr. Riany III/ 5% 176268.4 8813.422 167455 29 29
dr.Rendy III/ 5% 176268.4 8813.422 167455 30 30
dr. Trisy III/ 5% 176268.4 8813.422 167455 31 31
dr.Gisda 2.5% 176268.4 4406.711 171861.7 32 32
dr. Denok 2.5% 176268.4 4406.711 171861.7 33 33
dr. Novy 2.5% 176268.4 4406.711 171861.7 34 34
dr. Dian R. 2.5% 176268.4 4406.711 171861.7 35 35
dr. Ivan 2.5% 176268.4 4406.711 171861.7 36 36
dr. Nihayatul 2.5% 176268.4 4406.711 171861.7 37 37
drg. Yuyum III/ 5% 44067.11 2203.355 41863.75 38 38
5288053 289741.2 4998312 39
40
Radiologi 879636

DAFTAR PENDISTRIBUSIAN JASA PENGIRIMAN JKN (RADIOLOGI) MEI 2016 DAFTAR PEN
NAMA GOL./ PAJAK NILAI PAJAK DITERIMA TANDA TANGAN NO.
dr. Taufiq Sp.PD IV/ 15% 21990.9 3298.635 18692.27 1 1
dr. Luthfi Sp.PD III/ 5% 21990.9 1099.545 20891.36 2 2
dr. Irene Sp.PD 2.5% 21990.9 549.7725 21441.13 3 3
dr. Fariz Sp. PD III/ 5% 21990.9 1099.545 20891.36 4 4
dr. Iskandar Sp.B IV/ 15% 21990.9 3298.635 18692.27 5 5
dr. Dini Sp.B III/ 5% 21990.9 1099.545 20891.36 6 6
dr. Irman Sp.A III/ 5% 21990.9 1099.545 20891.36 7 7
dr. Ineu Sp.A III/ 5% 21990.9 1099.545 20891.36 8 8
dr. Tatan Sp.A III/ 5% 21990.9 1099.545 20891.36 9 9
dr. Hervan Sp.OG III/ 5% 21990.9 1099.545 20891.36 10 10
dr. Bogie Sp.OG III/ 5% 21990.9 1099.545 20891.36 11 11
dr. Deni Sp.OG III/ 5% 21990.9 1099.545 20891.36 12 12
dr. Nunung Sp. OG III/ 5% 21990.9 1099.545 20891.36 13 13
dr. Binto Sp.M III/ 5% 21990.9 1099.545 20891.36 14 14
dr. Widi Sp.M III/ 5% 21990.9 1099.545 20891.36 15 15
dr. Edy Sp.THT IV/ 15% 21990.9 3298.635 18692.27 16 16
dr. Ismi Sp. THT III/ 5% 21990.9 1099.545 20891.36 17 17
dr. Aris Sp.An III/ 5% 21990.9 1099.545 20891.36 18 18
dr. Widyatmiko Sp.OT III/ 5% 21990.9 1099.545 20891.36 19 19
dr. R. Haryo Sp. BS III/ 5% 21990.9 1099.545 20891.36 20 20
dr. Juhaeriyah IV/ 15% 21990.9 1099.545 20891.36 21 21
dr. Nurzaman III/ 5% 21990.9 1099.545 20891.36 22 22
dr. Hari Mukt III/ 5% 21990.9 1099.545 20891.36 23 23
dr. Amaludin III/ 5% 21990.9 1099.545 20891.36 24 24
dr. Aji Prasetyo III/ 5% 21990.9 1099.545 20891.36 25 25
dr. Dyan Fakhry III/ 5% 21990.9 1099.545 20891.36 26 26
dr. Sedayu III/ 5% 21990.9 1099.545 20891.36 27 27
dr. Eva R III/ 5% 21990.9 1099.545 20891.36 28 28
dr. Aulia III/ 5% 21990.9 1099.545 20891.36 29 29
dr. Riany III/ 5% 21990.9 1099.545 20891.36 30 30
dr.Rendy III/ 5% 21990.9 1099.545 20891.36 31 31
dr. Trisy III/ 5% 21990.9 1099.545 20891.36 32 32
dr.Gisda 2.5% 21990.9 549.7725 21441.13 33 33
dr. Denok 2.5% 21990.9 549.7725 21441.13 34 34
dr. Novy 2.5% 21990.9 549.7725 21441.13 35 35
dr. Dian R. 2.5% 21990.9 549.7725 21441.13 36 36
dr. Ivan 2.5% 21990.9 549.7725 21441.13 37 37
dr. Nihayatul 2.5% 21990.9 549.7725 21441.13 38 38
dr. Heni Diana 2.5% 21990.9 549.7725 21441.13 39 39
drg. Yuyum III/ 5% 21990.9 1099.545 20891.36 40 40
879636 46180.89 833455.1

USG Mei 1435185

DAFTAR PENDISTRIBUSIAN JASA PENGIRIMAN JKN (USG) MEI 2016 DAFTAR P


NAMA GOL./ PAJAK NILAI PAJAK DITERIMA TANDA TANGAN NO.
dr. Taufiq Sp.PD IV/ 15% 35879.63 5381.944 30497.68 1 1
dr. Luthfi Sp.PD III/ 5% 35879.63 1793.981 34085.64 2 2
dr. Irene Sp.PD 2.5% 35879.63 896.9906 34982.63 3 3
dr. Fariz Sp. PD III/ 5% 35879.63 1793.981 34085.64 4 4
dr. Iskandar Sp.B IV/ 15% 35879.63 5381.944 30497.68 5 5
dr. Dini Sp.B III/ 5% 35879.63 1793.981 34085.64 6 6
dr. Irman Sp.A III/ 5% 35879.63 1793.981 34085.64 7 7
dr. Ineu Sp.A III/ 5% 35879.63 1793.981 34085.64 8 8
dr. Tatan Sp.A III/ 5% 35879.63 1793.981 34085.64 9 9
dr. Hervan Sp.OG III/ 5% 35879.63 1793.981 34085.64 10 10
dr. Bogie Sp.OG III/ 5% 35879.63 1793.981 34085.64 11 11
dr. Deni Sp.OG III/ 5% 35879.63 1793.981 34085.64 12 12
dr. Nunung Sp. OG III/ 5% 35879.63 1793.981 34085.64 13 13
dr. Binto Sp.M III/ 5% 35879.63 1793.981 34085.64 14 14
dr. Widi Sp.M III/ 5% 35879.63 1793.981 34085.64 15 15
dr. Edy Sp.THT IV/ 15% 35879.63 5381.944 30497.68 16 16
dr. Ismi Sp. THT III/ 5% 35879.63 1793.981 34085.64 17 17
dr. Aris Sp.An III/ 5% 35879.63 1793.981 34085.64 18 18
dr. Widyatmiko Sp.OT III/ 5% 35879.63 1793.981 34085.64 19 19
dr. R. Haryo Sp. BS III/ 5% 35879.63 1793.981 34085.64 20 20
dr. Juhaeriyah IV/ 15% 35879.63 1793.981 34085.64 21 21
dr. Nurzaman III/ 5% 35879.63 1793.981 34085.64 22 22
dr. Hari Mukt III/ 5% 35879.63 1793.981 34085.64 23 23
dr. Amaludin III/ 5% 35879.63 1793.981 34085.64 24 24
dr. Aji Prasetyo III/ 5% 35879.63 1793.981 34085.64 25 25
dr. Dyan Fakhry III/ 5% 35879.63 1793.981 34085.64 26 26
dr. Sedayu III/ 5% 35879.63 1793.981 34085.64 27 27
dr. Eva R III/ 5% 35879.63 1793.981 34085.64 28 28
dr. Aulia III/ 5% 35879.63 1793.981 34085.64 29 29
dr. Riany III/ 5% 35879.63 1793.981 34085.64 30 30
dr.Rendy III/ 5% 35879.63 1793.981 34085.64 31 31
dr. Trisy III/ 5% 35879.63 1793.981 34085.64 32 32
dr.Gisda 2.5% 35879.63 896.9906 34982.63 33 33
dr. Denok 2.5% 35879.63 896.9906 34982.63 34 34
dr. Novy 2.5% 35879.63 896.9906 34982.63 35 35
dr. Dian R. 2.5% 35879.63 896.9906 34982.63 36 36
dr. Ivan 2.5% 35879.63 896.9906 34982.63 37 37
dr. Nihayatul 2.5% 35879.63 896.9906 34982.63 38 38
dr. Heni Diana 2.5% 35879.63 896.9906 34982.63 39 39
drg. Yuyum III/ 5% 35879.63 1793.981 34085.64 40 40
1435185 75347.21 1359838

EKG Mei 1562771

DAFTAR PENDISTRIBUSIAN JASA PENGIRIMAN JKN (EKG) MEI 2016 DAFTAR P


NAMA GOL./ PAJAK NILAI PAJAK DITERIMA TANDA TANGAN NO.
dr. Taufiq Sp.PD IV/ 15% 115760.8 17364.12 98396.69 1 1
dr. Luthfi Sp.PD III/ 5% 115760.8 5788.041 109972.8 2 2
dr. Irene Sp.PD 2.5% 115760.8 2894.02 112866.8 3 3
dr. Fariz Sp. PD III/ 5% 115760.8 5788.041 109972.8 4 4
dr. Juhaeriyah IV/ 15% 57880.41 8682.061 49198.35 5 5
dr. Nurzaman III/ 5% 57880.41 2894.02 54986.39 6 6
dr. Hari Mukt III/ 5% 57880.41 2894.02 54986.39 7 7
dr. Amaludin III/ 5% 57880.41 2894.02 54986.39 8 8
dr. Aji Prasetyo III/ 5% 57880.41 2894.02 54986.39 9 9
dr. Dyan Fakhry III/ 5% 57880.41 2894.02 54986.39 10 10
dr. Sedayu III/ 5% 57880.41 2894.02 54986.39 11 11
dr. Eva R III/ 5% 57880.41 2894.02 54986.39 12 12
dr. Aulia III/ 5% 57880.41 2894.02 54986.39 13 13
dr. Riany III/ 5% 57880.41 2894.02 54986.39 14 14
dr.Rendy III/ 5% 57880.41 2894.02 54986.39 15 15
dr. Trisy III/ 5% 57880.41 2894.02 54986.39 16 16
dr.Gisda 2.5% 57880.41 1447.01 56433.4 17 17
dr. Denok 2.5% 57880.41 1447.01 56433.4 18 18
dr. Novy 2.5% 57880.41 1447.01 56433.4 19 19
dr. Dian R. 2.5% 57880.41 1447.01 56433.4 20 20
dr. Ivan 2.5% 57880.41 1447.01 56433.4 21 21
dr. Nihayatul 2.5% 57880.41 1447.01 56433.4 22 22
dr. Heni Diana 2.5% 57880.41 1447.01 56433.4 23 23
1562771 82479.58 1480291

Lab Mei 5278486

DAFTAR PENDISTRIBUSIAN JASA PENGIRIMAN JKN (LABORATORIUM) MEI 2016 DAFTAR PENDIS
NAMA GOL./ PAJAK NILAI PAJAK DITERIMA TANDA TANGAN NO.
dr. Taufiq Sp.PD IV/ 15% 204592.5 30688.87 173903.6 1 1
dr. Luthfi Sp.PD III/ 5% 204592.5 10229.62 194362.9 2 2
dr. Irene Sp.PD 2.5% 204592.5 5114.812 199477.7 3 3
dr. Fariz Sp. PD III/ 5% 204592.5 10229.62 194362.9 4 4
dr. Iskandar Sp.B IV/ 15% 81836.99 12275.55 69561.44 5 5
dr. Dini Sp.B III/ 5% 81836.99 4091.85 77745.14 6 6
dr. Irman Sp.A III/ 5% 81836.99 4091.85 77745.14 7 7
dr. Ineu Sp.A III/ 5% 81836.99 4091.85 77745.14 8 8
dr. Tatan Sp.A III/ 5% 81836.99 4091.85 77745.14 9 9
dr. Hervan Sp.OG III/ 5% 81836.99 4091.85 77745.14 10 10
dr. Bogie Sp.OG III/ 5% 81836.99 4091.85 77745.14 11 11
dr. Deni Sp.OG III/ 5% 81836.99 4091.85 77745.14 12 12
dr. Nunung Sp. OG III/ 5% 81836.99 4091.85 77745.14 13 13
dr. Binto Sp.M III/ 5% 81836.99 4091.85 77745.14 14 14
dr. Widi Sp.M III/ 5% 81836.99 4091.85 77745.14 15 15
dr. Edy Sp.THT IV/ 15% 81836.99 12275.55 69561.44 16 16
dr. Ismi Sp. THT III/ 5% 81836.99 4091.85 77745.14 17 17
dr. Aris Sp.An III/ 5% 81836.99 4091.85 77745.14 18 18
dr. Widyatmiko Sp.OT III/ 5% 81836.99 4091.85 77745.14 19 19
dr. R. Haryo Sp. BS III/ 5% 81836.99 4091.85 77745.14 20 20
dr. Juhaeriyah IV/ 15% 163674 24551.1 139122.9 21 21
dr. Nurzaman III/ 5% 163674 8183.699 155490.3 22 22
dr. Hari Mukt III/ 5% 163674 8183.699 155490.3 23 23
dr. Amaludin III/ 5% 163674 8183.699 155490.3 24 24
dr. Aji Prasetyo III/ 5% 163674 8183.699 155490.3 25 25
dr. Dyan Fakhry III/ 5% 163674 8183.699 155490.3 26 26
dr. Sedayu III/ 5% 163674 8183.699 155490.3 27 27
dr. Eva R III/ 5% 163674 8183.699 155490.3 28 28
dr. Aulia III/ 5% 163674 8183.699 155490.3 29 29
dr. Riany III/ 5% 163674 8183.699 155490.3 30 30
dr.Rendy III/ 5% 163674 8183.699 155490.3 31 31
dr. Trisy III/ 5% 163674 8183.699 155490.3 32 32
dr.Gisda 2.5% 163674 4091.85 159582.1 33 33
dr. Denok 2.5% 163674 4091.85 159582.1 34 34
dr. Novy 2.5% 163674 4091.85 159582.1 35 35
dr. Dian R. 2.5% 163674 4091.85 159582.1 36 36
dr. Ivan 2.5% 163674 4091.85 159582.1 37 37
dr. Nihayatul 2.5% 163674 4091.85 159582.1 38 38
dr. Heni Diana 2.5% 163674 4091.85 159582.1 39 39
drg. Yuyum III/ 5% 40918.5 2045.925 38872.57 40 40
5278486 283360.6 4995125
Radiologi 681895

DAFTAR PENDISTRIBUSIAN JASA PENGIRIMAN JKN (RADIOLOGI) JUNI 2016 DAFTAR PEN
NAMA GOL./ PAJAK NILAI PAJAK DITERIMA TANDA TANGAN NO.
dr. Taufiq Sp.PD IV/ 15% 17047.38 2557.106 14490.27 1 1
dr. Luthfi Sp.PD III/ 5% 17047.38 852.3688 16195.01 2 2
dr. Irene Sp.PD 2.5% 17047.38 426.1844 16621.19 3 3
dr. Fariz Sp. PD III/ 5% 17047.38 852.3688 16195.01 4 4
dr. Iskandar Sp.B IV/ 15% 17047.38 2557.106 14490.27 5 5
dr. Dini Sp.B III/ 5% 17047.38 852.3688 16195.01 6 6
dr. Irman Sp.A III/ 5% 17047.38 852.3688 16195.01 7 7
dr. Ineu Sp.A III/ 5% 17047.38 852.3688 16195.01 8 8
dr. Tatan Sp.A III/ 5% 17047.38 852.3688 16195.01 9 9
dr. Hervan Sp.OG III/ 5% 17047.38 852.3688 16195.01 10 10
dr. Bogie Sp.OG III/ 5% 17047.38 852.3688 16195.01 11 11
dr. Deni Sp.OG III/ 5% 17047.38 852.3688 16195.01 12 12
dr. Nunung Sp. OG III/ 5% 17047.38 852.3688 16195.01 13 13
dr. Binto Sp.M III/ 5% 17047.38 852.3688 16195.01 14 14
dr. Widi Sp.M III/ 5% 17047.38 852.3688 16195.01 15 15
dr. Edy Sp.THT IV/ 15% 17047.38 2557.106 14490.27 16 16
dr. Ismi Sp. THT III/ 5% 17047.38 852.3688 16195.01 17 17
dr. Aris Sp.An III/ 5% 17047.38 852.3688 16195.01 18 18
dr. Widyatmiko Sp.OT III/ 5% 17047.38 852.3688 16195.01 19 19
dr. R. Haryo Sp. BS III/ 5% 17047.38 852.3688 16195.01 20 20
dr. Juhaeriyah IV/ 15% 17047.38 852.3688 16195.01 21 21
dr. Nurzaman III/ 5% 17047.38 852.3688 16195.01 22 22
dr. Hari Mukt III/ 5% 17047.38 852.3688 16195.01 23 23
dr. Amaludin III/ 5% 17047.38 852.3688 16195.01 24 24
dr. Aji Prasetyo III/ 5% 17047.38 852.3688 16195.01 25 25
dr. Dyan Fakhry III/ 5% 17047.38 852.3688 16195.01 26 26
dr. Sedayu III/ 5% 17047.38 852.3688 16195.01 27 27
dr. Eva R III/ 5% 17047.38 852.3688 16195.01 28 28
dr. Aulia III/ 5% 17047.38 852.3688 16195.01 29 29
dr. Riany III/ 5% 17047.38 852.3688 16195.01 30 30
dr.Rendy III/ 5% 17047.38 852.3688 16195.01 31 31
dr. Trisy III/ 5% 17047.38 852.3688 16195.01 32 32
dr.Gisda 2.5% 17047.38 426.1844 16621.19 33 33
dr. Denok 2.5% 17047.38 426.1844 16621.19 34 34
dr. Novy 2.5% 17047.38 426.1844 16621.19 35 35
dr. Dian R. 2.5% 17047.38 426.1844 16621.19 36 36
dr. Ivan 2.5% 17047.38 426.1844 16621.19 37 37
dr. Nihayatul 2.5% 17047.38 426.1844 16621.19 38 38
dr. Heni Diana 2.5% 17047.38 426.1844 16621.19 39 39
drg. Yuyum III/ 5% 17047.38 852.3688 16195.01 40 40
681895 35799.49 646095.5

USG juni 1343483

DAFTAR PENDISTRIBUSIAN JASA PENGIRIMAN JKN (USG) JUNI 2016 DAFTAR


NAMA GOL./ PAJAK NILAI PAJAK DITERIMA TANDA TANGAN NO.
dr. Taufiq Sp.PD IV/ 15% 33587.08 5038.061 28549.01 1 1
dr. Luthfi Sp.PD III/ 5% 33587.08 1679.354 31907.72 2 2
dr. Irene Sp.PD 2.5% 33587.08 839.6769 32747.4 3 3
dr. Fariz Sp. PD III/ 5% 33587.08 1679.354 31907.72 4 4
dr. Iskandar Sp.B IV/ 15% 33587.08 5038.061 28549.01 5 5
dr. Dini Sp.B III/ 5% 33587.08 1679.354 31907.72 6 6
dr. Irman Sp.A III/ 5% 33587.08 1679.354 31907.72 7 7
dr. Ineu Sp.A III/ 5% 33587.08 1679.354 31907.72 8 8
dr. Tatan Sp.A III/ 5% 33587.08 1679.354 31907.72 9 9
dr. Hervan Sp.OG III/ 5% 33587.08 1679.354 31907.72 10 10
dr. Bogie Sp.OG III/ 5% 33587.08 1679.354 31907.72 11 11
dr. Deni Sp.OG III/ 5% 33587.08 1679.354 31907.72 12 12
dr. Nunung Sp. OG III/ 5% 33587.08 1679.354 31907.72 13 13
dr. Binto Sp.M III/ 5% 33587.08 1679.354 31907.72 14 14
dr. Widi Sp.M III/ 5% 33587.08 1679.354 31907.72 15 15
dr. Edy Sp.THT IV/ 15% 33587.08 5038.061 28549.01 16 16
dr. Ismi Sp. THT III/ 5% 33587.08 1679.354 31907.72 17 17
dr. Aris Sp.An III/ 5% 33587.08 1679.354 31907.72 18 18
dr. Widyatmiko Sp.OT III/ 5% 33587.08 1679.354 31907.72 19 19
dr. R. Haryo Sp. BS III/ 5% 33587.08 1679.354 31907.72 20 20
dr. Juhaeriyah IV/ 15% 33587.08 1679.354 31907.72 21 21
dr. Nurzaman III/ 5% 33587.08 1679.354 31907.72 22 22
dr. Hari Mukt III/ 5% 33587.08 1679.354 31907.72 23 23
dr. Amaludin III/ 5% 33587.08 1679.354 31907.72 24 24
dr. Aji Prasetyo III/ 5% 33587.08 1679.354 31907.72 25 25
dr. Dyan Fakhry III/ 5% 33587.08 1679.354 31907.72 26 26
dr. Sedayu III/ 5% 33587.08 1679.354 31907.72 27 27
dr. Eva R III/ 5% 33587.08 1679.354 31907.72 28 28
dr. Aulia III/ 5% 33587.08 1679.354 31907.72 29 29
dr. Riany III/ 5% 33587.08 1679.354 31907.72 30 30
dr.Rendy III/ 5% 33587.08 1679.354 31907.72 31 31
dr. Trisy III/ 5% 33587.08 1679.354 31907.72 32 32
dr.Gisda 2.5% 33587.08 839.6769 32747.4 33 33
dr. Denok 2.5% 33587.08 839.6769 32747.4 34 34
dr. Novy 2.5% 33587.08 839.6769 32747.4 35 35
dr. Dian R. 2.5% 33587.08 839.6769 32747.4 36 36
dr. Ivan 2.5% 33587.08 839.6769 32747.4 37 37
dr. Nihayatul 2.5% 33587.08 839.6769 32747.4 38 38
dr. Heni Diana 2.5% 33587.08 839.6769 32747.4 39 39
drg. Yuyum III/ 5% 33587.08 1679.354 31907.72 40 40
1343483 70532.86 1272950

EKG Juni 1076165

DAFTAR PENDISTRIBUSIAN JASA PENGIRIMAN JKN (EKG) JUNI 2016 DAFTAR


NAMA GOL./ PAJAK NILAI PAJAK DITERIMA TANDA TANGAN NO.
dr. Taufiq Sp.PD IV/ 15% 79715.93 11957.39 67758.54 1 1
dr. Luthfi Sp.PD III/ 5% 79715.93 3985.796 75730.13 2 2
dr. Irene Sp.PD 2.5% 79715.93 1992.898 77723.03 3 3
dr. Fariz Sp. PD III/ 5% 79715.93 3985.796 75730.13 4 4
dr. Juhaeriyah IV/ 15% 39857.96 5978.694 33879.27 5 5
dr. Nurzaman III/ 5% 39857.96 1992.898 37865.06 6 6
dr. Hari Mukt III/ 5% 39857.96 1992.898 37865.06 7 7
dr. Amaludin III/ 5% 39857.96 1992.898 37865.06 8 8
dr. Aji Prasetyo III/ 5% 39857.96 1992.898 37865.06 9 9
dr. Dyan Fakhry III/ 5% 39857.96 1992.898 37865.06 10 10
dr. Sedayu III/ 5% 39857.96 1992.898 37865.06 11 11
dr. Eva R III/ 5% 39857.96 1992.898 37865.06 12 12
dr. Aulia III/ 5% 39857.96 1992.898 37865.06 13 13
dr. Riany III/ 5% 39857.96 1992.898 37865.06 14 14
dr.Rendy III/ 5% 39857.96 1992.898 37865.06 15 15
dr. Trisy III/ 5% 39857.96 1992.898 37865.06 16 16
dr.Gisda 2.5% 39857.96 996.4491 38861.51 17 17
dr. Denok 2.5% 39857.96 996.4491 38861.51 18 18
dr. Novy 2.5% 39857.96 996.4491 38861.51 19 19
dr. Dian R. 2.5% 39857.96 996.4491 38861.51 20 20
dr. Ivan 2.5% 39857.96 996.4491 38861.51 21 21
dr. Nihayatul 2.5% 39857.96 996.4491 38861.51 22 22
dr. Heni Diana 2.5% 39857.96 996.4491 38861.51 23 23
1076165 56797.6 1019367

Lab Jun 5021535

DAFTAR PENDISTRIBUSIAN JASA PENGIRIMAN JKN (LABORATORIUM) JUNI 2016 DAFTAR PENDI
NAMA GOL./ PAJAK NILAI PAJAK DITERIMA TANDA TANGAN NO.
dr. Taufiq Sp.PD IV/ 15% 194633.1 29194.97 165438.2 1 1
dr. Luthfi Sp.PD III/ 5% 194633.1 9731.657 184901.5 2 2
dr. Irene Sp.PD 2.5% 194633.1 4865.828 189767.3 3 3
dr. Fariz Sp. PD III/ 5% 194633.1 9731.657 184901.5 4 4
dr. Iskandar Sp.B IV/ 15% 77853.26 11677.99 66175.27 5 5
dr. Dini Sp.B III/ 5% 77853.26 3892.663 73960.59 6 6
dr. Irman Sp.A III/ 5% 77853.26 3892.663 73960.59 7 7
dr. Ineu Sp.A III/ 5% 77853.26 3892.663 73960.59 8 8
dr. Tatan Sp.A III/ 5% 77853.26 3892.663 73960.59 9 9
dr. Hervan Sp.OG III/ 5% 77853.26 3892.663 73960.59 10 10
dr. Bogie Sp.OG III/ 5% 77853.26 3892.663 73960.59 11 11
dr. Deni Sp.OG III/ 5% 77853.26 3892.663 73960.59 12 12
dr. Nunung Sp. OG III/ 5% 77853.26 3892.663 73960.59 13 13
dr. Binto Sp.M III/ 5% 77853.26 3892.663 73960.59 14 14
dr. Widi Sp.M III/ 5% 77853.26 3892.663 73960.59 15 15
dr. Edy Sp.THT IV/ 15% 77853.26 11677.99 66175.27 16 16
dr. Ismi Sp. THT III/ 5% 77853.26 3892.663 73960.59 17 17
dr. Aris Sp.An III/ 5% 77853.26 3892.663 73960.59 18 18
dr. Widyatmiko Sp.OT III/ 5% 77853.26 3892.663 73960.59 19 19
dr. R. Haryo Sp. BS III/ 5% 77853.26 3892.663 73960.59 20 20
dr. Juhaeriyah IV/ 15% 155706.5 23355.98 132350.5 21 21
dr. Nurzaman III/ 5% 155706.5 7785.326 147921.2 22 22
dr. Hari Mukt III/ 5% 155706.5 7785.326 147921.2 23 23
dr. Amaludin III/ 5% 155706.5 7785.326 147921.2 24 24
dr. Aji Prasetyo III/ 5% 155706.5 7785.326 147921.2 25 25
dr. Dyan Fakhry III/ 5% 155706.5 7785.326 147921.2 26 26
dr. Sedayu III/ 5% 155706.5 7785.326 147921.2 27 27
dr. Eva R III/ 5% 155706.5 7785.326 147921.2 28 28
dr. Aulia III/ 5% 155706.5 7785.326 147921.2 29 29
dr. Riany III/ 5% 155706.5 7785.326 147921.2 30 30
dr.Rendy III/ 5% 155706.5 7785.326 147921.2 31 31
dr. Trisy III/ 5% 155706.5 7785.326 147921.2 32 32
dr.Gisda 2.5% 155706.5 3892.663 151813.8 33 33
dr. Denok 2.5% 155706.5 3892.663 151813.8 34 34
dr. Novy 2.5% 155706.5 3892.663 151813.8 35 35
dr. Dian R. 2.5% 155706.5 3892.663 151813.8 36 36
dr. Ivan 2.5% 155706.5 3892.663 151813.8 37 37
dr. Nihayatul 2.5% 155706.5 3892.663 151813.8 38 38
dr. Heni Diana 2.5% 155706.5 3892.663 151813.8 39 39
drg. Yuyum III/ 5% 38926.63 1946.331 36980.3 40 40
5021535 269566.9 4751968
Radiologi 852929

DAFTAR PENDISTRIBUSIAN JASA PENGIRIMAN JKN (RADIOLOGI) JULI 2016 DAFTAR PENDI
NAMA GOL./ PAJAK NILAI PAJAK DITERIMA TANDA TANGAN NO.
dr. Taufiq Sp.PD IV/ 15% 21323.23 3198.484 18124.74 1 1
dr. Luthfi Sp.PD III/ 5% 21323.23 1066.161 20257.06 2 2
dr. Irene Sp.PD 2.5% 21323.23 533.0806 20790.14 3 3
dr. Fariz Sp. PD III/ 5% 21323.23 1066.161 20257.06 4 4
dr. Iskandar Sp.B IV/ 15% 21323.23 3198.484 18124.74 5 5
dr. Dini Sp.B III/ 5% 21323.23 1066.161 20257.06 6 6
dr. Irman Sp.A III/ 5% 21323.23 1066.161 20257.06 7 7
dr. Ineu Sp.A III/ 5% 21323.23 1066.161 20257.06 8 8
dr. Tatan Sp.A III/ 5% 21323.23 1066.161 20257.06 9 9
dr. Hervan Sp.OG III/ 5% 21323.23 1066.161 20257.06 10 10
dr. Bogie Sp.OG III/ 5% 21323.23 1066.161 20257.06 11 11
dr. Deni Sp.OG III/ 5% 21323.23 1066.161 20257.06 12 12
dr. Nunung Sp. OG III/ 5% 21323.23 1066.161 20257.06 13 13
dr. Binto Sp.M III/ 5% 21323.23 1066.161 20257.06 14 14
dr. Widi Sp.M III/ 5% 21323.23 1066.161 20257.06 15 15
dr. Edy Sp.THT IV/ 15% 21323.23 3198.484 18124.74 16 16
dr. Ismi Sp. THT III/ 5% 21323.23 1066.161 20257.06 17 17
dr. Aris Sp.An III/ 5% 21323.23 1066.161 20257.06 18 18
dr. Widyatmiko Sp.OT III/ 5% 21323.23 1066.161 20257.06 19 19
dr. R. Haryo Sp. BS III/ 5% 21323.23 1066.161 20257.06 20 20
dr. Juhaeriyah IV/ 15% 21323.23 1066.161 20257.06 21 21
dr. Nurzaman III/ 5% 21323.23 1066.161 20257.06 22 22
dr. Hari Mukt III/ 5% 21323.23 1066.161 20257.06 23 23
dr. Amaludin III/ 5% 21323.23 1066.161 20257.06 24 24
dr. Aji Prasetyo III/ 5% 21323.23 1066.161 20257.06 25 25
dr. Dyan Fakhry III/ 5% 21323.23 1066.161 20257.06 26 26
dr. Sedayu III/ 5% 21323.23 1066.161 20257.06 27 27
dr. Eva R III/ 5% 21323.23 1066.161 20257.06 28 28
dr. Aulia III/ 5% 21323.23 1066.161 20257.06 29 29
dr. Riany III/ 5% 21323.23 1066.161 20257.06 30 30
dr.Rendy III/ 5% 21323.23 1066.161 20257.06 31 31
dr. Trisy III/ 5% 21323.23 1066.161 20257.06 32 32
dr.Gisda 2.5% 21323.23 533.0806 20790.14 33 33
dr. Denok 2.5% 21323.23 533.0806 20790.14 34 34
dr. Novy 2.5% 21323.23 533.0806 20790.14 35 35
dr. Dian R. 2.5% 21323.23 533.0806 20790.14 36 36
dr. Ivan 2.5% 21323.23 533.0806 20790.14 37 37
dr. Nihayatul 2.5% 21323.23 533.0806 20790.14 38 38
dr. Heni Diana 2.5% 21323.23 533.0806 20790.14 39 39
drg. Yuyum III/ 5% 21323.23 1066.161 20257.06 40 40
852929 44778.77 808150.2

USG Juli 1111561

DAFTAR PENDISTRIBUSIAN JASA PENGIRIMAN JKN (USG) JULI 2016 DAFTAR PEN
NAMA GOL./ PAJAK NILAI PAJAK DITERIMA TANDA TANGAN NO.
dr. Taufiq Sp.PD IV/ 15% 27789.03 4168.354 23620.67 1 1
dr. Luthfi Sp.PD III/ 5% 27789.03 1389.451 26399.57 2 2
dr. Irene Sp.PD 2.5% 27789.03 694.7256 27094.3 3 3
dr. Fariz Sp. PD III/ 5% 27789.03 1389.451 26399.57 4 4
dr. Iskandar Sp.B IV/ 15% 27789.03 4168.354 23620.67 5 5
dr. Dini Sp.B III/ 5% 27789.03 1389.451 26399.57 6 6
dr. Irman Sp.A III/ 5% 27789.03 1389.451 26399.57 7 7
dr. Ineu Sp.A III/ 5% 27789.03 1389.451 26399.57 8 8
dr. Tatan Sp.A III/ 5% 27789.03 1389.451 26399.57 9 9
dr. Hervan Sp.OG III/ 5% 27789.03 1389.451 26399.57 10 10
dr. Bogie Sp.OG III/ 5% 27789.03 1389.451 26399.57 11 11
dr. Deni Sp.OG III/ 5% 27789.03 1389.451 26399.57 12 12
dr. Nunung Sp. OG III/ 5% 27789.03 1389.451 26399.57 13 13
dr. Binto Sp.M III/ 5% 27789.03 1389.451 26399.57 14 14
dr. Widi Sp.M III/ 5% 27789.03 1389.451 26399.57 15 15
dr. Edy Sp.THT IV/ 15% 27789.03 4168.354 23620.67 16 16
dr. Ismi Sp. THT III/ 5% 27789.03 1389.451 26399.57 17 17
dr. Aris Sp.An III/ 5% 27789.03 1389.451 26399.57 18 18
dr. Widyatmiko Sp.OT III/ 5% 27789.03 1389.451 26399.57 19 19
dr. R. Haryo Sp. BS III/ 5% 27789.03 1389.451 26399.57 20 20
dr. Juhaeriyah IV/ 15% 27789.03 1389.451 26399.57 21 21
dr. Nurzaman III/ 5% 27789.03 1389.451 26399.57 22 22
dr. Hari Mukt III/ 5% 27789.03 1389.451 26399.57 23 23
dr. Amaludin III/ 5% 27789.03 1389.451 26399.57 24 24
dr. Aji Prasetyo III/ 5% 27789.03 1389.451 26399.57 25 25
dr. Dyan Fakhry III/ 5% 27789.03 1389.451 26399.57 26 26
dr. Sedayu III/ 5% 27789.03 1389.451 26399.57 27 27
dr. Eva R III/ 5% 27789.03 1389.451 26399.57 28 28
dr. Aulia III/ 5% 27789.03 1389.451 26399.57 29 29
dr. Riany III/ 5% 27789.03 1389.451 26399.57 30 30
dr.Rendy III/ 5% 27789.03 1389.451 26399.57 31 31
dr. Trisy III/ 5% 27789.03 1389.451 26399.57 32 32
dr.Gisda 2.5% 27789.03 694.7256 27094.3 33 33
dr. Denok 2.5% 27789.03 694.7256 27094.3 34 34
dr. Novy 2.5% 27789.03 694.7256 27094.3 35 35
dr. Dian R. 2.5% 27789.03 694.7256 27094.3 36 36
dr. Ivan 2.5% 27789.03 694.7256 27094.3 37 37
dr. Nihayatul 2.5% 27789.03 694.7256 27094.3 38 38
dr. Heni Diana 2.5% 27789.03 694.7256 27094.3 39 39
drg. Yuyum III/ 5% 27789.03 1389.451 26399.57 40 40
1111561 58356.95 1053204

EKG Juli 1058696

DAFTAR PENDISTRIBUSIAN JASA PENGIRIMAN JKN (EKG) JULI 2016 DAFTAR PE


NAMA GOL./ PAJAK NILAI PAJAK DITERIMA TANDA TANGAN NO.
dr. Taufiq Sp.PD IV/ 15% 78421.93 11763.29 66658.64 1 1
dr. Luthfi Sp.PD III/ 5% 78421.93 3921.096 74500.83 2 2
dr. Irene Sp.PD 2.5% 78421.93 1960.548 76461.38 3 3
dr. Fariz Sp. PD III/ 5% 78421.93 3921.096 74500.83 4 4
dr. Juhaeriyah IV/ 15% 39210.96 5881.644 33329.32 5 5
dr. Nurzaman III/ 5% 39210.96 1960.548 37250.41 6 6
dr. Hari Mukt III/ 5% 39210.96 1960.548 37250.41 7 7
dr. Amaludin III/ 5% 39210.96 1960.548 37250.41 8 8
dr. Aji Prasetyo III/ 5% 39210.96 1960.548 37250.41 9 9
dr. Dyan Fakhry III/ 5% 39210.96 1960.548 37250.41 10 10
dr. Sedayu III/ 5% 39210.96 1960.548 37250.41 11 11
dr. Eva R III/ 5% 39210.96 1960.548 37250.41 12 12
dr. Aulia III/ 5% 39210.96 1960.548 37250.41 13 13
dr. Riany III/ 5% 39210.96 1960.548 37250.41 14 14
dr.Rendy III/ 5% 39210.96 1960.548 37250.41 15 15
dr. Trisy III/ 5% 39210.96 1960.548 37250.41 16 16
dr.Gisda 2.5% 39210.96 980.2741 38230.69 17 17
dr. Denok 2.5% 39210.96 980.2741 38230.69 18 18
dr. Novy 2.5% 39210.96 980.2741 38230.69 19 19
dr. Dian R. 2.5% 39210.96 980.2741 38230.69 20 20
dr. Ivan 2.5% 39210.96 980.2741 38230.69 21 21
dr. Nihayatul 2.5% 39210.96 980.2741 38230.69 22 22
dr. Heni Diana 2.5% 39210.96 980.2741 38230.69 23 23
1058696 55875.62 1002820

Lab Jul 4469952

DAFTAR PENDISTRIBUSIAN JASA PENGIRIMAN JKN (LABORATORIUM) JULI 2016 DAFTAR PENDISTR
NAMA GOL./ PAJAK NILAI PAJAK DITERIMA TANDA TANGAN NO.
dr. Taufiq Sp.PD IV/ 15% 173254 25988.09 147265.9 1 1
dr. Luthfi Sp.PD III/ 5% 173254 8662.698 164591.3 2 2
dr. Irene Sp.PD 2.5% 173254 4331.349 168922.6 3 3
dr. Fariz Sp. PD III/ 5% 173254 8662.698 164591.3 4 4
dr. Iskandar Sp.B IV/ 15% 69301.58 10395.24 58906.34 5 5
dr. Dini Sp.B III/ 5% 69301.58 3465.079 65836.5 6 6
dr. Irman Sp.A III/ 5% 69301.58 3465.079 65836.5 7 7
dr. Ineu Sp.A III/ 5% 69301.58 3465.079 65836.5 8 8
dr. Tatan Sp.A III/ 5% 69301.58 3465.079 65836.5 9 9
dr. Hervan Sp.OG III/ 5% 69301.58 3465.079 65836.5 10 10
dr. Bogie Sp.OG III/ 5% 69301.58 3465.079 65836.5 11 11
dr. Deni Sp.OG III/ 5% 69301.58 3465.079 65836.5 12 12
dr. Nunung Sp. OG III/ 5% 69301.58 3465.079 65836.5 13 13
dr. Binto Sp.M III/ 5% 69301.58 3465.079 65836.5 14 14
dr. Widi Sp.M III/ 5% 69301.58 3465.079 65836.5 15 15
dr. Edy Sp.THT IV/ 15% 69301.58 10395.24 58906.34 16 16
dr. Ismi Sp. THT III/ 5% 69301.58 3465.079 65836.5 17 17
dr. Aris Sp.An III/ 5% 69301.58 3465.079 65836.5 18 18
dr. Widyatmiko Sp.OT III/ 5% 69301.58 3465.079 65836.5 19 19
dr. R. Haryo Sp. BS III/ 5% 69301.58 3465.079 65836.5 20 20
dr. Juhaeriyah IV/ 15% 138603.2 20790.47 117812.7 21 21
dr. Nurzaman III/ 5% 138603.2 6930.158 131673 22 22
dr. Hari Mukt III/ 5% 138603.2 6930.158 131673 23 23
dr. Amaludin III/ 5% 138603.2 6930.158 131673 24 24
dr. Aji Prasetyo III/ 5% 138603.2 6930.158 131673 25 25
dr. Dyan Fakhry III/ 5% 138603.2 6930.158 131673 26 26
dr. Sedayu III/ 5% 138603.2 6930.158 131673 27 27
dr. Eva R III/ 5% 138603.2 6930.158 131673 28 28
dr. Aulia III/ 5% 138603.2 6930.158 131673 29 29
dr. Riany III/ 5% 138603.2 6930.158 131673 30 30
dr.Rendy III/ 5% 138603.2 6930.158 131673 31 31
dr. Trisy III/ 5% 138603.2 6930.158 131673 32 32
dr.Gisda 2.5% 138603.2 3465.079 135138.1 33 33
dr. Denok 2.5% 138603.2 3465.079 135138.1 34 34
dr. Novy 2.5% 138603.2 3465.079 135138.1 35 35
dr. Dian R. 2.5% 138603.2 3465.079 135138.1 36 36
dr. Ivan 2.5% 138603.2 3465.079 135138.1 37 37
dr. Nihayatul 2.5% 138603.2 3465.079 135138.1 38 38
dr. Heni Diana 2.5% 138603.2 3465.079 135138.1 39 39
drg. Yuyum III/ 5% 34650.79 1732.54 32918.25 40 40
4469952 239956.7 4229995
Radiologi Agust 701566

DAFTAR PENDISTRIBUSIAN JASA PENGIRIMAN JKN (RADIOLOGI) AGUSTUS 2016 DAFTAR PENDIST
NAMA GOL./ PAJAK NILAI PAJAK DITERIMA TANDA TANGAN NO.
dr. Taufiq Sp.PD IV/ 15% 17539.15 2630.873 14908.28 1 1
dr. Luthfi Sp.PD III/ 5% 17539.15 876.9575 16662.19 2 2
dr. Irene Sp.PD 2.5% 17539.15 438.4788 17100.67 3 3
dr. Fariz Sp. PD III/ 5% 17539.15 876.9575 16662.19 4 4
dr. Iskandar Sp.B IV/ 15% 17539.15 2630.873 14908.28 5 5
dr. Dini Sp.B III/ 5% 17539.15 876.9575 16662.19 6 6
dr. Irman Sp.A III/ 5% 17539.15 876.9575 16662.19 7 7
dr. Ineu Sp.A III/ 5% 17539.15 876.9575 16662.19 8 8
dr. Tatan Sp.A III/ 5% 17539.15 876.9575 16662.19 9 9
dr. Hervan Sp.OG III/ 5% 17539.15 876.9575 16662.19 10 10
dr. Bogie Sp.OG III/ 5% 17539.15 876.9575 16662.19 11 11
dr. Deni Sp.OG III/ 5% 17539.15 876.9575 16662.19 12 12
dr. Nunung Sp. OG III/ 5% 17539.15 876.9575 16662.19 13 13
dr. Binto Sp.M III/ 5% 17539.15 876.9575 16662.19 14 14
dr. Widi Sp.M III/ 5% 17539.15 876.9575 16662.19 15 15
dr. Edy Sp.THT IV/ 15% 17539.15 2630.873 14908.28 16 16
dr. Ismi Sp. THT III/ 5% 17539.15 876.9575 16662.19 17 17
dr. Aris Sp.An III/ 5% 17539.15 876.9575 16662.19 18 18
dr. Widyatmiko Sp.OT III/ 5% 17539.15 876.9575 16662.19 19 19
dr. R. Haryo Sp. BS III/ 5% 17539.15 876.9575 16662.19 20 20
dr. Juhaeriyah IV/ 15% 17539.15 876.9575 16662.19 21 21
dr. Nurzaman III/ 5% 17539.15 876.9575 16662.19 22 22
dr. Hari Mukt III/ 5% 17539.15 876.9575 16662.19 23 23
dr. Amaludin III/ 5% 17539.15 876.9575 16662.19 24 24
dr. Aji Prasetyo III/ 5% 17539.15 876.9575 16662.19 25 25
dr. Dyan Fakhry III/ 5% 17539.15 876.9575 16662.19 26 26
dr. Sedayu III/ 5% 17539.15 876.9575 16662.19 27 27
dr. Eva R III/ 5% 17539.15 876.9575 16662.19 28 28
dr. Aulia III/ 5% 17539.15 876.9575 16662.19 29 29
dr. Riany III/ 5% 17539.15 876.9575 16662.19 30 30
dr.Rendy III/ 5% 17539.15 876.9575 16662.19 31 31
dr. Trisy III/ 5% 17539.15 876.9575 16662.19 32 32
dr.Gisda 2.5% 17539.15 438.4788 17100.67 33 33
dr. Denok 2.5% 17539.15 438.4788 17100.67 34 34
dr. Novy 2.5% 17539.15 438.4788 17100.67 35 35
dr. Dian R. 2.5% 17539.15 438.4788 17100.67 36 36
dr. Ivan 2.5% 17539.15 438.4788 17100.67 37 37
dr. Nihayatul 2.5% 17539.15 438.4788 17100.67 38 38
dr. Heni Diana 2.5% 17539.15 438.4788 17100.67 39 39
drg. Yuyum III/ 5% 17539.15 876.9575 16662.19 40 40
701566 36832.22 664733.8

USG Agust 1622524

DAFTAR PENDISTRIBUSIAN JASA PENGIRIMAN JKN (USG) AGUSTUS 2016 DAFTAR PEN
NAMA GOL./ PAJAK NILAI PAJAK DITERIMA TANDA TANGAN NO.
dr. Taufiq Sp.PD IV/ 15% 40563.1 6084.465 34478.64 1 1
dr. Luthfi Sp.PD III/ 5% 40563.1 2028.155 38534.95 2 2
dr. Irene Sp.PD 2.5% 40563.1 1014.078 39549.02 3 3
dr. Fariz Sp. PD III/ 5% 40563.1 2028.155 38534.95 4 4
dr. Iskandar Sp.B IV/ 15% 40563.1 6084.465 34478.64 5 5
dr. Dini Sp.B III/ 5% 40563.1 2028.155 38534.95 6 6
dr. Irman Sp.A III/ 5% 40563.1 2028.155 38534.95 7 7
dr. Ineu Sp.A III/ 5% 40563.1 2028.155 38534.95 8 8
dr. Tatan Sp.A III/ 5% 40563.1 2028.155 38534.95 9 9
dr. Hervan Sp.OG III/ 5% 40563.1 2028.155 38534.95 10 10
dr. Bogie Sp.OG III/ 5% 40563.1 2028.155 38534.95 11 11
dr. Deni Sp.OG III/ 5% 40563.1 2028.155 38534.95 12 12
dr. Nunung Sp. OG III/ 5% 40563.1 2028.155 38534.95 13 13
dr. Binto Sp.M III/ 5% 40563.1 2028.155 38534.95 14 14
dr. Widi Sp.M III/ 5% 40563.1 2028.155 38534.95 15 15
dr. Edy Sp.THT IV/ 15% 40563.1 6084.465 34478.64 16 16
dr. Ismi Sp. THT III/ 5% 40563.1 2028.155 38534.95 17 17
dr. Aris Sp.An III/ 5% 40563.1 2028.155 38534.95 18 18
dr. Widyatmiko Sp.OT III/ 5% 40563.1 2028.155 38534.95 19 19
dr. R. Haryo Sp. BS III/ 5% 40563.1 2028.155 38534.95 20 20
dr. Juhaeriyah IV/ 15% 40563.1 2028.155 38534.95 21 21
dr. Nurzaman III/ 5% 40563.1 2028.155 38534.95 22 22
dr. Hari Mukt III/ 5% 40563.1 2028.155 38534.95 23 23
dr. Amaludin III/ 5% 40563.1 2028.155 38534.95 24 24
dr. Aji Prasetyo III/ 5% 40563.1 2028.155 38534.95 25 25
dr. Dyan Fakhry III/ 5% 40563.1 2028.155 38534.95 26 26
dr. Sedayu III/ 5% 40563.1 2028.155 38534.95 27 27
dr. Eva R III/ 5% 40563.1 2028.155 38534.95 28 28
dr. Aulia III/ 5% 40563.1 2028.155 38534.95 29 29
dr. Riany III/ 5% 40563.1 2028.155 38534.95 30 30
dr.Rendy III/ 5% 40563.1 2028.155 38534.95 31 31
dr. Trisy III/ 5% 40563.1 2028.155 38534.95 32 32
dr.Gisda 2.5% 40563.1 1014.078 39549.02 33 33
dr. Denok 2.5% 40563.1 1014.078 39549.02 34 34
dr. Novy 2.5% 40563.1 1014.078 39549.02 35 35
dr. Dian R. 2.5% 40563.1 1014.078 39549.02 36 36
dr. Ivan 2.5% 40563.1 1014.078 39549.02 37 37
dr. Nihayatul 2.5% 40563.1 1014.078 39549.02 38 38
dr. Heni Diana 2.5% 40563.1 1014.078 39549.02 39 39
drg. Yuyum III/ 5% 40563.1 2028.155 38534.95 40 40
1622524 85182.51 1537341

EKG Agust 10766771

DAFTAR PENDISTRIBUSIAN JASA PENGIRIMAN JKN (EKG) AGUSTUS 2016 DAFTAR PEN
NAMA GOL./ PAJAK NILAI PAJAK DITERIMA TANDA TANGAN NO.
dr. Taufiq Sp.PD IV/ 15% 797538.6 119630.8 677907.8 1 1
dr. Luthfi Sp.PD III/ 5% 797538.6 39876.93 757661.7 2 2
dr. Irene Sp.PD 2.5% 797538.6 19938.46 777600.1 3 3
dr. Fariz Sp. PD III/ 5% 797538.6 39876.93 757661.7 4 4
dr. Juhaeriyah IV/ 15% 398769.3 59815.39 338953.9 5 5
dr. Nurzaman III/ 5% 398769.3 19938.46 378830.8 6 6
dr. Hari Mukt III/ 5% 398769.3 19938.46 378830.8 7 7
dr. Amaludin III/ 5% 398769.3 19938.46 378830.8 8 8
dr. Aji Prasetyo III/ 5% 398769.3 19938.46 378830.8 9 9
dr. Dyan Fakhry III/ 5% 398769.3 19938.46 378830.8 10 10
dr. Sedayu III/ 5% 398769.3 19938.46 378830.8 11 11
dr. Eva R III/ 5% 398769.3 19938.46 378830.8 12 12
dr. Aulia III/ 5% 398769.3 19938.46 378830.8 13 13
dr. Riany III/ 5% 398769.3 19938.46 378830.8 14 14
dr.Rendy III/ 5% 398769.3 19938.46 378830.8 15 15
dr. Trisy III/ 5% 398769.3 19938.46 378830.8 16 16
dr.Gisda 2.5% 398769.3 9969.232 388800.1 17 17
dr. Denok 2.5% 398769.3 9969.232 388800.1 18 18
dr. Novy 2.5% 398769.3 9969.232 388800.1 19 19
dr. Dian R. 2.5% 398769.3 9969.232 388800.1 20 20
dr. Ivan 2.5% 398769.3 9969.232 388800.1 21 21
dr. Nihayatul 2.5% 398769.3 9969.232 388800.1 22 22
dr. Heni Diana 2.5% 398769.3 9969.232 388800.1 23 23
10766771 568246.2 10198525

Lab Agust 5103099

DAFTAR PENDISTRIBUSIAN JASA PENGIRIMAN JKN (LABORATORIUM) AGUSTUS 2016 DAFTAR PENDISTRI
NAMA GOL./ PAJAK NILAI PAJAK DITERIMA TANDA TANGAN NO.
dr. Taufiq Sp.PD IV/ 15% 197794.5 29669.18 168125.4 1 1
dr. Luthfi Sp.PD III/ 5% 197794.5 9889.727 187904.8 2 2
dr. Irene Sp.PD 2.5% 197794.5 4944.863 192849.7 3 3
dr. Fariz Sp. PD III/ 5% 197794.5 9889.727 187904.8 4 4
dr. Iskandar Sp.B IV/ 15% 79117.81 11867.67 67250.14 5 5
dr. Dini Sp.B III/ 5% 79117.81 3955.891 75161.92 6 6
dr. Irman Sp.A III/ 5% 79117.81 3955.891 75161.92 7 7
dr. Ineu Sp.A III/ 5% 79117.81 3955.891 75161.92 8 8
dr. Tatan Sp.A III/ 5% 79117.81 3955.891 75161.92 9 9
dr. Hervan Sp.OG III/ 5% 79117.81 3955.891 75161.92 10 10
dr. Bogie Sp.OG III/ 5% 79117.81 3955.891 75161.92 11 11
dr. Deni Sp.OG III/ 5% 79117.81 3955.891 75161.92 12 12
dr. Nunung Sp. OG III/ 5% 79117.81 3955.891 75161.92 13 13
dr. Binto Sp.M III/ 5% 79117.81 3955.891 75161.92 14 14
dr. Widi Sp.M III/ 5% 79117.81 3955.891 75161.92 15 15
dr. Edy Sp.THT IV/ 15% 79117.81 11867.67 67250.14 16 16
dr. Ismi Sp. THT III/ 5% 79117.81 3955.891 75161.92 17 17
dr. Aris Sp.An III/ 5% 79117.81 3955.891 75161.92 18 18
dr. Widyatmiko Sp.OT III/ 5% 79117.81 3955.891 75161.92 19 19
dr. R. Haryo Sp. BS III/ 5% 79117.81 3955.891 75161.92 20 20
dr. Juhaeriyah IV/ 15% 158235.6 23735.34 134500.3 21 21
dr. Nurzaman III/ 5% 158235.6 7911.781 150323.8 22 22
dr. Hari Mukt III/ 5% 158235.6 7911.781 150323.8 23 23
dr. Amaludin III/ 5% 158235.6 7911.781 150323.8 24 24
dr. Aji Prasetyo III/ 5% 158235.6 7911.781 150323.8 25 25
dr. Dyan Fakhry III/ 5% 158235.6 7911.781 150323.8 26 26
dr. Sedayu III/ 5% 158235.6 7911.781 150323.8 27 27
dr. Eva R III/ 5% 158235.6 7911.781 150323.8 28 28
dr. Aulia III/ 5% 158235.6 7911.781 150323.8 29 29
dr. Riany III/ 5% 158235.6 7911.781 150323.8 30 30
dr.Rendy III/ 5% 158235.6 7911.781 150323.8 31 31
dr. Trisy III/ 5% 158235.6 7911.781 150323.8 32 32
dr.Gisda 2.5% 158235.6 3955.891 154279.7 33 33
dr. Denok 2.5% 158235.6 3955.891 154279.7 34 34
dr. Novy 2.5% 158235.6 3955.891 154279.7 35 35
dr. Dian R. 2.5% 158235.6 3955.891 154279.7 36 36
dr. Ivan 2.5% 158235.6 3955.891 154279.7 37 37
dr. Nihayatul 2.5% 158235.6 3955.891 154279.7 38 38
dr. Heni Diana 2.5% 158235.6 3955.891 154279.7 39 39
drg. Yuyum III/ 5% 39558.91 1977.945 37580.96 40 40
5103099 273945.4 4829154
Radiologi Sept 967500

DAFTAR PENDISTRIBUSIAN JASA PENGIRIMAN JKN (RADIOLOGI) SEPTEMBER 2016 DAFTAR PEND
NAMA GOL./ PAJAK NILAI PAJAK DITERIMA TANDA TANGAN NO.
dr. Taufiq Sp.PD IV/ 15% 24187.5 3628.125 20559.38 1 1
dr. Luthfi Sp.PD III/ 5% 24187.5 1209.375 22978.13 2 2
dr. Irene Sp.PD 2.5% 24187.5 604.6875 23582.81 3 3
dr. Fariz Sp. PD III/ 5% 24187.5 1209.375 22978.13 4 4
dr. Iskandar Sp.B IV/ 15% 24187.5 3628.125 20559.38 5 5
dr. Dini Sp.B III/ 5% 24187.5 1209.375 22978.13 6 6
dr. Irman Sp.A III/ 5% 24187.5 1209.375 22978.13 7 7
dr. Ineu Sp.A III/ 5% 24187.5 1209.375 22978.13 8 8
dr. Tatan Sp.A III/ 5% 24187.5 1209.375 22978.13 9 9
dr. Hervan Sp.OG III/ 5% 24187.5 1209.375 22978.13 10 10
dr. Bogie Sp.OG III/ 5% 24187.5 1209.375 22978.13 11 11
dr. Deni Sp.OG III/ 5% 24187.5 1209.375 22978.13 12 12
dr. Nunung Sp. OG III/ 5% 24187.5 1209.375 22978.13 13 13
dr. Binto Sp.M III/ 5% 24187.5 1209.375 22978.13 14 14
dr. Widi Sp.M III/ 5% 24187.5 1209.375 22978.13 15 15
dr. Edy Sp.THT IV/ 15% 24187.5 3628.125 20559.38 16 16
dr. Ismi Sp. THT III/ 5% 24187.5 1209.375 22978.13 17 17
dr. Aris Sp.An III/ 5% 24187.5 1209.375 22978.13 18 18
dr. Widyatmiko Sp.OT III/ 5% 24187.5 1209.375 22978.13 19 19
dr. R. Haryo Sp. BS III/ 5% 24187.5 1209.375 22978.13 20 20
dr. Juhaeriyah IV/ 15% 24187.5 1209.375 22978.13 21 21
dr. Nurzaman III/ 5% 24187.5 1209.375 22978.13 22 22
dr. Hari Mukt III/ 5% 24187.5 1209.375 22978.13 23 23
dr. Amaludin III/ 5% 24187.5 1209.375 22978.13 24 24
dr. Aji Prasetyo III/ 5% 24187.5 1209.375 22978.13 25 25
dr. Dyan Fakhry III/ 5% 24187.5 1209.375 22978.13 26 26
dr. Sedayu III/ 5% 24187.5 1209.375 22978.13 27 27
dr. Eva R III/ 5% 24187.5 1209.375 22978.13 28 28
dr. Aulia III/ 5% 24187.5 1209.375 22978.13 29 29
dr. Riany III/ 5% 24187.5 1209.375 22978.13 30 30
dr.Rendy III/ 5% 24187.5 1209.375 22978.13 31 31
dr. Trisy III/ 5% 24187.5 1209.375 22978.13 32 32
dr.Gisda 2.5% 24187.5 604.6875 23582.81 33 33
dr. Denok 2.5% 24187.5 604.6875 23582.81 34 34
dr. Novy 2.5% 24187.5 604.6875 23582.81 35 35
dr. Dian R. 2.5% 24187.5 604.6875 23582.81 36 36
dr. Ivan 2.5% 24187.5 604.6875 23582.81 37 37
dr. Nihayatul 2.5% 24187.5 604.6875 23582.81 38 38
dr. Heni Diana 2.5% 24187.5 604.6875 23582.81 39 39
drg. Yuyum III/ 5% 24187.5 1209.375 22978.13 40 40
967500 50793.75 916706.3

USG Sept 1646123

DAFTAR PENDISTRIBUSIAN JASA PENGIRIMAN JKN (USG) SEPTEMBER 2016 DAFTAR P


NAMA GOL./ PAJAK NILAI PAJAK DITERIMA TANDA TANGAN NO.
dr. Taufiq Sp.PD IV/ 15% 41153.08 6172.961 34980.11 1 1
dr. Luthfi Sp.PD III/ 5% 41153.08 2057.654 39095.42 2 2
dr. Irene Sp.PD 2.5% 41153.08 1028.827 40124.25 3 3
dr. Fariz Sp. PD III/ 5% 41153.08 2057.654 39095.42 4 4
dr. Iskandar Sp.B IV/ 15% 41153.08 6172.961 34980.11 5 5
dr. Dini Sp.B III/ 5% 41153.08 2057.654 39095.42 6 6
dr. Irman Sp.A III/ 5% 41153.08 2057.654 39095.42 7 7
dr. Ineu Sp.A III/ 5% 41153.08 2057.654 39095.42 8 8
dr. Tatan Sp.A III/ 5% 41153.08 2057.654 39095.42 9 9
dr. Hervan Sp.OG III/ 5% 41153.08 2057.654 39095.42 10 10
dr. Bogie Sp.OG III/ 5% 41153.08 2057.654 39095.42 11 11
dr. Deni Sp.OG III/ 5% 41153.08 2057.654 39095.42 12 12
dr. Nunung Sp. OG III/ 5% 41153.08 2057.654 39095.42 13 13
dr. Binto Sp.M III/ 5% 41153.08 2057.654 39095.42 14 14
dr. Widi Sp.M III/ 5% 41153.08 2057.654 39095.42 15 15
dr. Edy Sp.THT IV/ 15% 41153.08 6172.961 34980.11 16 16
dr. Ismi Sp. THT III/ 5% 41153.08 2057.654 39095.42 17 17
dr. Aris Sp.An III/ 5% 41153.08 2057.654 39095.42 18 18
dr. Widyatmiko Sp.OT III/ 5% 41153.08 2057.654 39095.42 19 19
dr. R. Haryo Sp. BS III/ 5% 41153.08 2057.654 39095.42 20 20
dr. Juhaeriyah IV/ 15% 41153.08 2057.654 39095.42 21 21
dr. Nurzaman III/ 5% 41153.08 2057.654 39095.42 22 22
dr. Hari Mukt III/ 5% 41153.08 2057.654 39095.42 23 23
dr. Amaludin III/ 5% 41153.08 2057.654 39095.42 24 24
dr. Aji Prasetyo III/ 5% 41153.08 2057.654 39095.42 25 25
dr. Dyan Fakhry III/ 5% 41153.08 2057.654 39095.42 26 26
dr. Sedayu III/ 5% 41153.08 2057.654 39095.42 27 27
dr. Eva R III/ 5% 41153.08 2057.654 39095.42 28 28
dr. Aulia III/ 5% 41153.08 2057.654 39095.42 29 29
dr. Riany III/ 5% 41153.08 2057.654 39095.42 30 30
dr.Rendy III/ 5% 41153.08 2057.654 39095.42 31 31
dr. Trisy III/ 5% 41153.08 2057.654 39095.42 32 32
dr.Gisda 2.5% 41153.08 1028.827 40124.25 33 33
dr. Denok 2.5% 41153.08 1028.827 40124.25 34 34
dr. Novy 2.5% 41153.08 1028.827 40124.25 35 35
dr. Dian R. 2.5% 41153.08 1028.827 40124.25 36 36
dr. Ivan 2.5% 41153.08 1028.827 40124.25 37 37
dr. Nihayatul 2.5% 41153.08 1028.827 40124.25 38 38
dr. Heni Diana 2.5% 41153.08 1028.827 40124.25 39 39
drg. Yuyum III/ 5% 41153.08 2057.654 39095.42 40 40
1646123 86421.46 1559702

EKG Sept 940609

DAFTAR PENDISTRIBUSIAN JASA PENGIRIMAN JKN (EKG) SEPTEMBER 2016 DAFTAR P


NAMA GOL./ PAJAK NILAI PAJAK DITERIMA TANDA TANGAN NO.
dr. Taufiq Sp.PD IV/ 15% 69674.74 10451.21 59223.53 1 1
dr. Luthfi Sp.PD III/ 5% 69674.74 3483.737 66191 2 2
dr. Irene Sp.PD 2.5% 69674.74 1741.869 67932.87 3 3
dr. Fariz Sp. PD III/ 5% 69674.74 3483.737 66191 4 4
dr. Juhaeriyah IV/ 15% 34837.37 5225.606 29611.76 5 5
dr. Nurzaman III/ 5% 34837.37 1741.869 33095.5 6 6
dr. Hari Mukt III/ 5% 34837.37 1741.869 33095.5 7 7
dr. Amaludin III/ 5% 34837.37 1741.869 33095.5 8 8
dr. Aji Prasetyo III/ 5% 34837.37 1741.869 33095.5 9 9
dr. Dyan Fakhry III/ 5% 34837.37 1741.869 33095.5 10 10
dr. Sedayu III/ 5% 34837.37 1741.869 33095.5 11 11
dr. Eva R III/ 5% 34837.37 1741.869 33095.5 12 12
dr. Aulia III/ 5% 34837.37 1741.869 33095.5 13 13
dr. Riany III/ 5% 34837.37 1741.869 33095.5 14 14
dr.Rendy III/ 5% 34837.37 1741.869 33095.5 15 15
dr. Trisy III/ 5% 34837.37 1741.869 33095.5 16 16
dr.Gisda 2.5% 34837.37 870.9343 33966.44 17 17
dr. Denok 2.5% 34837.37 870.9343 33966.44 18 18
dr. Novy 2.5% 34837.37 870.9343 33966.44 19 19
dr. Dian R. 2.5% 34837.37 870.9343 33966.44 20 20
dr. Ivan 2.5% 34837.37 870.9343 33966.44 21 21
dr. Nihayatul 2.5% 34837.37 870.9343 33966.44 22 22
dr. Heni Diana 2.5% 34837.37 870.9343 33966.44 23 23
940609 49643.25 890965.7

Lab Sept 4573175

DAFTAR PENDISTRIBUSIAN JASA PENGIRIMAN JKN (LABORATORIUM) SEPTEMBER 2016 DAFTAR PENDIS
NAMA GOL./ PAJAK NILAI PAJAK DITERIMA TANDA TANGAN NO.
dr. Taufiq Sp.PD IV/ 15% 177254.8 26588.23 150666.6 1 1
dr. Luthfi Sp.PD III/ 5% 177254.8 8862.742 168392.1 2 2
dr. Irene Sp.PD 2.5% 177254.8 4431.371 172823.5 3 3
dr. Fariz Sp. PD III/ 5% 177254.8 8862.742 168392.1 4 4
dr. Iskandar Sp.B IV/ 15% 70901.94 10635.29 60266.65 5 5
dr. Dini Sp.B III/ 5% 70901.94 3545.097 67356.84 6 6
dr. Irman Sp.A III/ 5% 70901.94 3545.097 67356.84 7 7
dr. Ineu Sp.A III/ 5% 70901.94 3545.097 67356.84 8 8
dr. Tatan Sp.A III/ 5% 70901.94 3545.097 67356.84 9 9
dr. Hervan Sp.OG III/ 5% 70901.94 3545.097 67356.84 10 10
dr. Bogie Sp.OG III/ 5% 70901.94 3545.097 67356.84 11 11
dr. Deni Sp.OG III/ 5% 70901.94 3545.097 67356.84 12 12
dr. Nunung Sp. OG III/ 5% 70901.94 3545.097 67356.84 13 13
dr. Binto Sp.M III/ 5% 70901.94 3545.097 67356.84 14 14
dr. Widi Sp.M III/ 5% 70901.94 3545.097 67356.84 15 15
dr. Edy Sp.THT IV/ 15% 70901.94 10635.29 60266.65 16 16
dr. Ismi Sp. THT III/ 5% 70901.94 3545.097 67356.84 17 17
dr. Aris Sp.An III/ 5% 70901.94 3545.097 67356.84 18 18
dr. Widyatmiko Sp.OT III/ 5% 70901.94 3545.097 67356.84 19 19
dr. R. Haryo Sp. BS III/ 5% 70901.94 3545.097 67356.84 20 20
dr. Juhaeriyah IV/ 15% 141803.9 21270.58 120533.3 21 21
dr. Nurzaman III/ 5% 141803.9 7090.194 134713.7 22 22
dr. Hari Mukt III/ 5% 141803.9 7090.194 134713.7 23 23
dr. Amaludin III/ 5% 141803.9 7090.194 134713.7 24 24
dr. Aji Prasetyo III/ 5% 141803.9 7090.194 134713.7 25 25
dr. Dyan Fakhry III/ 5% 141803.9 7090.194 134713.7 26 26
dr. Sedayu III/ 5% 141803.9 7090.194 134713.7 27 27
dr. Eva R III/ 5% 141803.9 7090.194 134713.7 28 28
dr. Aulia III/ 5% 141803.9 7090.194 134713.7 29 29
dr. Riany III/ 5% 141803.9 7090.194 134713.7 30 30
dr.Rendy III/ 5% 141803.9 7090.194 134713.7 31 31
dr. Trisy III/ 5% 141803.9 7090.194 134713.7 32 32
dr.Gisda 2.5% 141803.9 3545.097 138258.8 33 33
dr. Denok 2.5% 141803.9 3545.097 138258.8 34 34
dr. Novy 2.5% 141803.9 3545.097 138258.8 35 35
dr. Dian R. 2.5% 141803.9 3545.097 138258.8 36 36
dr. Ivan 2.5% 141803.9 3545.097 138258.8 37 37
dr. Nihayatul 2.5% 141803.9 3545.097 138258.8 38 38
dr. Heni Diana 2.5% 141803.9 3545.097 138258.8 39 39
drg. Yuyum III/ 5% 35450.97 1772.548 33678.42 40 40
4573175 245498 4327677
Radiologi Okt 1598901

DAFTAR PENDISTRIBUSIAN JASA PENGIRIMAN JKN (RADIOLOGI) OKTOBER 2016 DAFTAR PEND
NAMA GOL./ PAJAK NILAI PAJAK DITERIMA TANDA TANGAN NO.
dr. Taufiq Sp.PD IV/ 15% 39972.53 5995.879 33976.65 1 1
dr. Luthfi Sp.PD III/ 5% 39972.53 1998.626 37973.9 2 2
dr. Irene Sp.PD 2.5% 39972.53 999.3131 38973.21 3 3
dr. Fariz Sp. PD III/ 5% 39972.53 1998.626 37973.9 4 4
dr. Iskandar Sp.B IV/ 15% 39972.53 5995.879 33976.65 5 5
dr. Dini Sp.B III/ 5% 39972.53 1998.626 37973.9 6 6
dr. Irman Sp.A III/ 5% 39972.53 1998.626 37973.9 7 7
dr. Ineu Sp.A III/ 5% 39972.53 1998.626 37973.9 8 8
dr. Tatan Sp.A III/ 5% 39972.53 1998.626 37973.9 9 9
dr. Hervan Sp.OG III/ 5% 39972.53 1998.626 37973.9 10 10
dr. Bogie Sp.OG III/ 5% 39972.53 1998.626 37973.9 11 11
dr. Deni Sp.OG III/ 5% 39972.53 1998.626 37973.9 12 12
dr. Nunung Sp. OG III/ 5% 39972.53 1998.626 37973.9 13 13
dr. Binto Sp.M III/ 5% 39972.53 1998.626 37973.9 14 14
dr. Widi Sp.M III/ 5% 39972.53 1998.626 37973.9 15 15
dr. Edy Sp.THT IV/ 15% 39972.53 5995.879 33976.65 16 16
dr. Ismi Sp. THT III/ 5% 39972.53 1998.626 37973.9 17 17
dr. Aris Sp.An III/ 5% 39972.53 1998.626 37973.9 18 18
dr. Widyatmiko Sp.OT III/ 5% 39972.53 1998.626 37973.9 19 19
dr. R. Haryo Sp. BS III/ 5% 39972.53 1998.626 37973.9 20 20
dr. Juhaeriyah IV/ 15% 39972.53 1998.626 37973.9 21 21
dr. Nurzaman III/ 5% 39972.53 1998.626 37973.9 22 22
dr. Hari Mukt III/ 5% 39972.53 1998.626 37973.9 23 23
dr. Amaludin III/ 5% 39972.53 1998.626 37973.9 24 24
dr. Aji Prasetyo III/ 5% 39972.53 1998.626 37973.9 25 25
dr. Dyan Fakhry III/ 5% 39972.53 1998.626 37973.9 26 26
dr. Sedayu III/ 5% 39972.53 1998.626 37973.9 27 27
dr. Eva R III/ 5% 39972.53 1998.626 37973.9 28 28
dr. Aulia III/ 5% 39972.53 1998.626 37973.9 29 29
dr. Riany III/ 5% 39972.53 1998.626 37973.9 30 30
dr.Rendy III/ 5% 39972.53 1998.626 37973.9 31 31
dr. Trisy III/ 5% 39972.53 1998.626 37973.9 32 32
dr.Gisda 2.5% 39972.53 999.3131 38973.21 33 33
dr. Denok 2.5% 39972.53 999.3131 38973.21 34 34
dr. Novy 2.5% 39972.53 999.3131 38973.21 35 35
dr. Dian R. 2.5% 39972.53 999.3131 38973.21 36 36
dr. Ivan 2.5% 39972.53 999.3131 38973.21 37 37
dr. Nihayatul 2.5% 39972.53 999.3131 38973.21 38 38
dr. Heni Diana 2.5% 39972.53 999.3131 38973.21 39 39
drg. Yuyum III/ 5% 39972.53 1998.626 37973.9 40 40
1598901 83942.3 1514959

USG Okt 1265317

DAFTAR PENDISTRIBUSIAN JASA PENGIRIMAN JKN (USG) OKTOBER 2016 DAFTAR PE


NAMA GOL./ PAJAK NILAI PAJAK DITERIMA TANDA TANGAN NO.
dr. Taufiq Sp.PD IV/ 15% 31632.93 4744.939 26887.99 1 1
dr. Luthfi Sp.PD III/ 5% 31632.93 1581.646 30051.28 2 2
dr. Irene Sp.PD 2.5% 31632.93 790.8231 30842.1 3 3
dr. Fariz Sp. PD III/ 5% 31632.93 1581.646 30051.28 4 4
dr. Iskandar Sp.B IV/ 15% 31632.93 4744.939 26887.99 5 5
dr. Dini Sp.B III/ 5% 31632.93 1581.646 30051.28 6 6
dr. Irman Sp.A III/ 5% 31632.93 1581.646 30051.28 7 7
dr. Ineu Sp.A III/ 5% 31632.93 1581.646 30051.28 8 8
dr. Tatan Sp.A III/ 5% 31632.93 1581.646 30051.28 9 9
dr. Hervan Sp.OG III/ 5% 31632.93 1581.646 30051.28 10 10
dr. Bogie Sp.OG III/ 5% 31632.93 1581.646 30051.28 11 11
dr. Deni Sp.OG III/ 5% 31632.93 1581.646 30051.28 12 12
dr. Nunung Sp. OG III/ 5% 31632.93 1581.646 30051.28 13 13
dr. Binto Sp.M III/ 5% 31632.93 1581.646 30051.28 14 14
dr. Widi Sp.M III/ 5% 31632.93 1581.646 30051.28 15 15
dr. Edy Sp.THT IV/ 15% 31632.93 4744.939 26887.99 16 16
dr. Ismi Sp. THT III/ 5% 31632.93 1581.646 30051.28 17 17
dr. Aris Sp.An III/ 5% 31632.93 1581.646 30051.28 18 18
dr. Widyatmiko Sp.OT III/ 5% 31632.93 1581.646 30051.28 19 19
dr. R. Haryo Sp. BS III/ 5% 31632.93 1581.646 30051.28 20 20
dr. Juhaeriyah IV/ 15% 31632.93 1581.646 30051.28 21 21
dr. Nurzaman III/ 5% 31632.93 1581.646 30051.28 22 22
dr. Hari Mukt III/ 5% 31632.93 1581.646 30051.28 23 23
dr. Amaludin III/ 5% 31632.93 1581.646 30051.28 24 24
dr. Aji Prasetyo III/ 5% 31632.93 1581.646 30051.28 25 25
dr. Dyan Fakhry III/ 5% 31632.93 1581.646 30051.28 26 26
dr. Sedayu III/ 5% 31632.93 1581.646 30051.28 27 27
dr. Eva R III/ 5% 31632.93 1581.646 30051.28 28 28
dr. Aulia III/ 5% 31632.93 1581.646 30051.28 29 29
dr. Riany III/ 5% 31632.93 1581.646 30051.28 30 30
dr.Rendy III/ 5% 31632.93 1581.646 30051.28 31 31
dr. Trisy III/ 5% 31632.93 1581.646 30051.28 32 32
dr.Gisda 2.5% 31632.93 790.8231 30842.1 33 33
dr. Denok 2.5% 31632.93 790.8231 30842.1 34 34
dr. Novy 2.5% 31632.93 790.8231 30842.1 35 35
dr. Dian R. 2.5% 31632.93 790.8231 30842.1 36 36
dr. Ivan 2.5% 31632.93 790.8231 30842.1 37 37
dr. Nihayatul 2.5% 31632.93 790.8231 30842.1 38 38
dr. Heni Diana 2.5% 31632.93 790.8231 30842.1 39 39
drg. Yuyum III/ 5% 31632.93 1581.646 30051.28 40 40
1265317 66429.14 1198888

EKG Okt 964342

DAFTAR PENDISTRIBUSIAN JASA PENGIRIMAN JKN (EKG) OKTOBER 2016 DAFTAR PE


NAMA GOL./ PAJAK NILAI PAJAK DITERIMA TANDA TANGAN NO.
dr. Taufiq Sp.PD IV/ 15% 71432.74 10714.91 60717.83 1 1
dr. Luthfi Sp.PD III/ 5% 71432.74 3571.637 67861.1 2 2
dr. Irene Sp.PD 2.5% 71432.74 1785.819 69646.92 3 3
dr. Fariz Sp. PD III/ 5% 71432.74 3571.637 67861.1 4 4
dr. Juhaeriyah IV/ 15% 35716.37 5357.456 30358.91 5 5
dr. Nurzaman III/ 5% 35716.37 1785.819 33930.55 6 6
dr. Hari Mukt III/ 5% 35716.37 1785.819 33930.55 7 7
dr. Amaludin III/ 5% 35716.37 1785.819 33930.55 8 8
dr. Aji Prasetyo III/ 5% 35716.37 1785.819 33930.55 9 9
dr. Dyan Fakhry III/ 5% 35716.37 1785.819 33930.55 10 10
dr. Sedayu III/ 5% 35716.37 1785.819 33930.55 11 11
dr. Eva R III/ 5% 35716.37 1785.819 33930.55 12 12
dr. Aulia III/ 5% 35716.37 1785.819 33930.55 13 13
dr. Riany III/ 5% 35716.37 1785.819 33930.55 14 14
dr.Rendy III/ 5% 35716.37 1785.819 33930.55 15 15
dr. Trisy III/ 5% 35716.37 1785.819 33930.55 16 16
dr.Gisda 2.5% 35716.37 892.9093 34823.46 17 17
dr. Denok 2.5% 35716.37 892.9093 34823.46 18 18
dr. Novy 2.5% 35716.37 892.9093 34823.46 19 19
dr. Dian R. 2.5% 35716.37 892.9093 34823.46 20 20
dr. Ivan 2.5% 35716.37 892.9093 34823.46 21 21
dr. Nihayatul 2.5% 35716.37 892.9093 34823.46 22 22
dr. Heni Diana 2.5% 35716.37 892.9093 34823.46 23 23
964342 50895.83 913446.2

lab Okt 4980166

DAFTAR PENDISTRIBUSIAN JASA PENGIRIMAN JKN (LABORATORIUM) OKTOBER 2016 DAFTAR PENDIST
NAMA GOL./ PAJAK NILAI PAJAK DITERIMA TANDA TANGAN NO.
dr. Taufiq Sp.PD IV/ 15% 193029.7 28954.45 164075.2 1 1
dr. Luthfi Sp.PD III/ 5% 193029.7 9651.484 183378.2 2 2
dr. Irene Sp.PD 2.5% 193029.7 4825.742 188203.9 3 3
dr. Fariz Sp. PD III/ 5% 193029.7 9651.484 183378.2 4 4
dr. Iskandar Sp.B IV/ 15% 77211.88 11581.78 65630.09 5 5
dr. Dini Sp.B III/ 5% 77211.88 3860.594 73351.28 6 6
dr. Irman Sp.A III/ 5% 77211.88 3860.594 73351.28 7 7
dr. Ineu Sp.A III/ 5% 77211.88 3860.594 73351.28 8 8
dr. Tatan Sp.A III/ 5% 77211.88 3860.594 73351.28 9 9
dr. Hervan Sp.OG III/ 5% 77211.88 3860.594 73351.28 10 10
dr. Bogie Sp.OG III/ 5% 77211.88 3860.594 73351.28 11 11
dr. Deni Sp.OG III/ 5% 77211.88 3860.594 73351.28 12 12
dr. Nunung Sp. OG III/ 5% 77211.88 3860.594 73351.28 13 13
dr. Binto Sp.M III/ 5% 77211.88 3860.594 73351.28 14 14
dr. Widi Sp.M III/ 5% 77211.88 3860.594 73351.28 15 15
dr. Edy Sp.THT IV/ 15% 77211.88 11581.78 65630.09 16 16
dr. Ismi Sp. THT III/ 5% 77211.88 3860.594 73351.28 17 17
dr. Aris Sp.An III/ 5% 77211.88 3860.594 73351.28 18 18
dr. Widyatmiko Sp.OT III/ 5% 77211.88 3860.594 73351.28 19 19
dr. R. Haryo Sp. BS III/ 5% 77211.88 3860.594 73351.28 20 20
dr. Juhaeriyah IV/ 15% 154423.8 23163.56 131260.2 21 21
dr. Nurzaman III/ 5% 154423.8 7721.188 146702.6 22 22
dr. Hari Mukt III/ 5% 154423.8 7721.188 146702.6 23 23
dr. Amaludin III/ 5% 154423.8 7721.188 146702.6 24 24
dr. Aji Prasetyo III/ 5% 154423.8 7721.188 146702.6 25 25
dr. Dyan Fakhry III/ 5% 154423.8 7721.188 146702.6 26 26
dr. Sedayu III/ 5% 154423.8 7721.188 146702.6 27 27
dr. Eva R III/ 5% 154423.8 7721.188 146702.6 28 28
dr. Aulia III/ 5% 154423.8 7721.188 146702.6 29 29
dr. Riany III/ 5% 154423.8 7721.188 146702.6 30 30
dr.Rendy III/ 5% 154423.8 7721.188 146702.6 31 31
dr. Trisy III/ 5% 154423.8 7721.188 146702.6 32 32
dr.Gisda 2.5% 154423.8 3860.594 150563.2 33 33
dr. Denok 2.5% 154423.8 3860.594 150563.2 34 34
dr. Novy 2.5% 154423.8 3860.594 150563.2 35 35
dr. Dian R. 2.5% 154423.8 3860.594 150563.2 36 36
dr. Ivan 2.5% 154423.8 3860.594 150563.2 37 37
dr. Nihayatul 2.5% 154423.8 3860.594 150563.2 38 38
dr. Heni Diana 2.5% 154423.8 3860.594 150563.2 39 39
drg. Yuyum III/ 5% 38605.94 1930.297 36675.64 40 40
4980166 267346.1 4712820
Radiologi Nop 1052620

DAFTAR PENDISTRIBUSIAN JASA PENGIRIMAN JKN (RADIOLOGI) NOVEMBER 2016 DAFTAR P


NAMA GOL./ PAJAK NILAI PAJAK DITERIMA TANDA TANGAN NO.
dr. Taufiq Sp.PD IV/ 15% 26315.5 3947.325 22368.18 1 1
dr. Luthfi Sp.PD III/ 5% 26315.5 1315.775 24999.73 2 2
dr. Irene Sp.PD 2.5% 26315.5 657.8875 25657.61 3 3
dr. Fariz Sp. PD III/ 5% 26315.5 1315.775 24999.73 4 4
dr. Iskandar Sp.B IV/ 15% 26315.5 3947.325 22368.18 5 5
dr. Dini Sp.B III/ 5% 26315.5 1315.775 24999.73 6 6
dr. Irman Sp.A III/ 5% 26315.5 1315.775 24999.73 7 7
dr. Ineu Sp.A III/ 5% 26315.5 1315.775 24999.73 8 8
dr. Tatan Sp.A III/ 5% 26315.5 1315.775 24999.73 9 9
dr. Hervan Sp.OG III/ 5% 26315.5 1315.775 24999.73 10 10
dr. Bogie Sp.OG III/ 5% 26315.5 1315.775 24999.73 11 11
dr. Deni Sp.OG III/ 5% 26315.5 1315.775 24999.73 12 12
dr. Nunung Sp. OG III/ 5% 26315.5 1315.775 24999.73 13 13
dr. Binto Sp.M III/ 5% 26315.5 1315.775 24999.73 14 14
dr. Widi Sp.M III/ 5% 26315.5 1315.775 24999.73 15 15
dr. Edy Sp.THT IV/ 15% 26315.5 3947.325 22368.18 16 16
dr. Ismi Sp. THT III/ 5% 26315.5 1315.775 24999.73 17 17
dr. Aris Sp.An III/ 5% 26315.5 1315.775 24999.73 18 18
dr. Widyatmiko Sp.OT III/ 5% 26315.5 1315.775 24999.73 19 19
dr. R. Haryo Sp. BS III/ 5% 26315.5 1315.775 24999.73 20 20
dr. Juhaeriyah IV/ 15% 26315.5 1315.775 24999.73 21 21
dr. Nurzaman III/ 5% 26315.5 1315.775 24999.73 22 22
dr. Hari Mukt III/ 5% 26315.5 1315.775 24999.73 23 23
dr. Amaludin III/ 5% 26315.5 1315.775 24999.73 24 24
dr. Aji Prasetyo III/ 5% 26315.5 1315.775 24999.73 25 25
dr. Dyan Fakhry III/ 5% 26315.5 1315.775 24999.73 26 26
dr. Sedayu III/ 5% 26315.5 1315.775 24999.73 27 27
dr. Eva R III/ 5% 26315.5 1315.775 24999.73 28 28
dr. Aulia III/ 5% 26315.5 1315.775 24999.73 29 29
dr. Riany III/ 5% 26315.5 1315.775 24999.73 30 30
dr.Rendy III/ 5% 26315.5 1315.775 24999.73 31 31
dr. Trisy III/ 5% 26315.5 1315.775 24999.73 32 32
dr.Gisda 2.5% 26315.5 657.8875 25657.61 33 33
dr. Denok 2.5% 26315.5 657.8875 25657.61 34 34
dr. Novy 2.5% 26315.5 657.8875 25657.61 35 35
dr. Dian R. 2.5% 26315.5 657.8875 25657.61 36 36
dr. Ivan 2.5% 26315.5 657.8875 25657.61 37 37
dr. Nihayatul 2.5% 26315.5 657.8875 25657.61 38 38
dr. Heni Diana 2.5% 26315.5 657.8875 25657.61 39 39
drg. Yuyum III/ 5% 26315.5 1315.775 24999.73 40 40
1052620 55262.55 997357.5

USG Nop 1836704

DAFTAR PENDISTRIBUSIAN JASA PENGIRIMAN JKN (USG) NOVEMBER 2016


NAMA GOL./ PAJAK NILAI PAJAK DITERIMA TANDA TANGAN
dr. Taufiq Sp.PD IV/ 15% 45917.6 6887.64 39029.96 1
dr. Luthfi Sp.PD III/ 5% 45917.6 2295.88 43621.72 2
dr. Irene Sp.PD 2.5% 45917.6 1147.94 44769.66 3
dr. Fariz Sp. PD III/ 5% 45917.6 2295.88 43621.72 4
dr. Iskandar Sp.B IV/ 15% 45917.6 6887.64 39029.96 5
dr. Dini Sp.B III/ 5% 45917.6 2295.88 43621.72 6
dr. Irman Sp.A III/ 5% 45917.6 2295.88 43621.72 7
dr. Ineu Sp.A III/ 5% 45917.6 2295.88 43621.72 8
dr. Tatan Sp.A III/ 5% 45917.6 2295.88 43621.72 9
dr. Hervan Sp.OG III/ 5% 45917.6 2295.88 43621.72 10
dr. Bogie Sp.OG III/ 5% 45917.6 2295.88 43621.72 11
dr. Deni Sp.OG III/ 5% 45917.6 2295.88 43621.72 12
dr. Nunung Sp. OG III/ 5% 45917.6 2295.88 43621.72 13
dr. Binto Sp.M III/ 5% 45917.6 2295.88 43621.72 14
dr. Widi Sp.M III/ 5% 45917.6 2295.88 43621.72 15
dr. Edy Sp.THT IV/ 15% 45917.6 6887.64 39029.96 16
dr. Ismi Sp. THT III/ 5% 45917.6 2295.88 43621.72 17
dr. Aris Sp.An III/ 5% 45917.6 2295.88 43621.72 18
dr. Widyatmiko Sp.OT III/ 5% 45917.6 2295.88 43621.72 19
dr. R. Haryo Sp. BS III/ 5% 45917.6 2295.88 43621.72 20
dr. Juhaeriyah IV/ 15% 45917.6 2295.88 43621.72 21
dr. Nurzaman III/ 5% 45917.6 2295.88 43621.72 22
dr. Hari Mukt III/ 5% 45917.6 2295.88 43621.72 23
dr. Amaludin III/ 5% 45917.6 2295.88 43621.72 24
dr. Aji Prasetyo III/ 5% 45917.6 2295.88 43621.72 25
dr. Dyan Fakhry III/ 5% 45917.6 2295.88 43621.72 26
dr. Sedayu III/ 5% 45917.6 2295.88 43621.72 27
dr. Eva R III/ 5% 45917.6 2295.88 43621.72 28
dr. Aulia III/ 5% 45917.6 2295.88 43621.72 29
dr. Riany III/ 5% 45917.6 2295.88 43621.72 30
dr.Rendy III/ 5% 45917.6 2295.88 43621.72 31
dr. Trisy III/ 5% 45917.6 2295.88 43621.72 32
dr.Gisda 2.5% 45917.6 1147.94 44769.66 33
dr. Denok 2.5% 45917.6 1147.94 44769.66 34
dr. Novy 2.5% 45917.6 1147.94 44769.66 35
dr. Dian R. 2.5% 45917.6 1147.94 44769.66 36
dr. Ivan 2.5% 45917.6 1147.94 44769.66 37
dr. Nihayatul 2.5% 45917.6 1147.94 44769.66 38
dr. Heni Diana 2.5% 45917.6 1147.94 44769.66 39
drg. Yuyum III/ 5% 45917.6 2295.88 43621.72 40
1836704 96426.96 1740277

EKG Nop 886820

DAFTAR PENDISTRIBUSIAN JASA PENGIRIMAN JKN (EKG) NOVEMBER 2016 DAFTAR PE


NAMA GOL./ PAJAK NILAI PAJAK DITERIMA TANDA TANGAN NO.
dr. Taufiq Sp.PD IV/ 15% 65690.37 9853.556 55836.81 1 1
dr. Luthfi Sp.PD III/ 5% 65690.37 3284.519 62405.85 2 2
dr. Irene Sp.PD 2.5% 65690.37 1642.259 64048.11 3 3
dr. Fariz Sp. PD III/ 5% 65690.37 3284.519 62405.85 4 4
dr. Juhaeriyah IV/ 15% 32845.19 4926.778 27918.41 5 5
dr. Nurzaman III/ 5% 32845.19 1642.259 31202.93 6 6
dr. Hari Mukt III/ 5% 32845.19 1642.259 31202.93 7 7
dr. Amaludin III/ 5% 32845.19 1642.259 31202.93 8 8
dr. Aji Prasetyo III/ 5% 32845.19 1642.259 31202.93 9 9
dr. Dyan Fakhry III/ 5% 32845.19 1642.259 31202.93 10 10
dr. Sedayu III/ 5% 32845.19 1642.259 31202.93 11 11
dr. Eva R III/ 5% 32845.19 1642.259 31202.93 12 12
dr. Aulia III/ 5% 32845.19 1642.259 31202.93 13 13
dr. Riany III/ 5% 32845.19 1642.259 31202.93 14 14
dr.Rendy III/ 5% 32845.19 1642.259 31202.93 15 15
dr. Trisy III/ 5% 32845.19 1642.259 31202.93 16 16
dr.Gisda 2.5% 32845.19 821.1296 32024.06 17 17
dr. Denok 2.5% 32845.19 821.1296 32024.06 18 18
dr. Novy 2.5% 32845.19 821.1296 32024.06 19 19
dr. Dian R. 2.5% 32845.19 821.1296 32024.06 20 20
dr. Ivan 2.5% 32845.19 821.1296 32024.06 21 21
dr. Nihayatul 2.5% 32845.19 821.1296 32024.06 22 22
dr. Heni Diana 2.5% 32845.19 821.1296 32024.06 23 23
886820 46804.39 840015.6

lab Nop 4454765

DAFTAR PENDISTRIBUSIAN JASA PENGIRIMAN JKN (LABORATORIUM) NOVEMBER 2016 DAFTAR PENDISTR
NAMA GOL./ PAJAK NILAI PAJAK DITERIMA TANDA TANGAN NO.
dr. Taufiq Sp.PD IV/ 15% 172665.3 25899.8 146765.5 1 1
dr. Luthfi Sp.PD III/ 5% 172665.3 8633.266 164032 2 2
dr. Irene Sp.PD 2.5% 172665.3 4316.633 168348.7 3 3
dr. Fariz Sp. PD III/ 5% 172665.3 8633.266 164032 4 4
dr. Iskandar Sp.B IV/ 15% 69066.12 10359.92 58706.21 5 5
dr. Dini Sp.B III/ 5% 69066.12 3453.306 65612.82 6 6
dr. Irman Sp.A III/ 5% 69066.12 3453.306 65612.82 7 7
dr. Ineu Sp.A III/ 5% 69066.12 3453.306 65612.82 8 8
dr. Tatan Sp.A III/ 5% 69066.12 3453.306 65612.82 9 9
dr. Hervan Sp.OG III/ 5% 69066.12 3453.306 65612.82 10 10
dr. Bogie Sp.OG III/ 5% 69066.12 3453.306 65612.82 11 11
dr. Deni Sp.OG III/ 5% 69066.12 3453.306 65612.82 12 12
dr. Nunung Sp. OG III/ 5% 69066.12 3453.306 65612.82 13 13
dr. Binto Sp.M III/ 5% 69066.12 3453.306 65612.82 14 14
dr. Widi Sp.M III/ 5% 69066.12 3453.306 65612.82 15 15
dr. Edy Sp.THT IV/ 15% 69066.12 10359.92 58706.21 16 16
dr. Ismi Sp. THT III/ 5% 69066.12 3453.306 65612.82 17 17
dr. Aris Sp.An III/ 5% 69066.12 3453.306 65612.82 18 18
dr. Widyatmiko Sp.OT III/ 5% 69066.12 3453.306 65612.82 19 19
dr. R. Haryo Sp. BS III/ 5% 69066.12 3453.306 65612.82 20 20
dr. Juhaeriyah IV/ 15% 138132.2 20719.84 117412.4 21 21
dr. Nurzaman III/ 5% 138132.2 6906.612 131225.6 22 22
dr. Hari Mukt III/ 5% 138132.2 6906.612 131225.6 23 23
dr. Amaludin III/ 5% 138132.2 6906.612 131225.6 24 24
dr. Aji Prasetyo III/ 5% 138132.2 6906.612 131225.6 25 25
dr. Dyan Fakhry III/ 5% 138132.2 6906.612 131225.6 26 26
dr. Sedayu III/ 5% 138132.2 6906.612 131225.6 27 27
dr. Eva R III/ 5% 138132.2 6906.612 131225.6 28 28
dr. Aulia III/ 5% 138132.2 6906.612 131225.6 29 29
dr. Riany III/ 5% 138132.2 6906.612 131225.6 30 30
dr.Rendy III/ 5% 138132.2 6906.612 131225.6 31 31
dr. Trisy III/ 5% 138132.2 6906.612 131225.6 32 32
dr.Gisda 2.5% 138132.2 3453.306 134678.9 33 33
dr. Denok 2.5% 138132.2 3453.306 134678.9 34 34
dr. Novy 2.5% 138132.2 3453.306 134678.9 35 35
dr. Dian R. 2.5% 138132.2 3453.306 134678.9 36 36
dr. Ivan 2.5% 138132.2 3453.306 134678.9 37 37
dr. Nihayatul 2.5% 138132.2 3453.306 134678.9 38 38
dr. Heni Diana 2.5% 138132.2 3453.306 134678.9 39 39
drg. Yuyum III/ 5% 34533.06 1726.653 32806.41 40 40
4454765 239141.5 4215624
Jamkesda 47416

DAFTAR PENDISTRIBUSIAN JASA PENGIRIMAN JAMKESDA (RADIOLOGI)


NAMA GOL./ PAJAK NILAI PAJAK DITERIMA TANDA TANGAN NO.
dr. Taufiq Sp.PD IV/ 15% 1185.4 177.81 1007.59 1 1
dr. Luthfi Sp.PD III/ 5% 1185.4 59.27 1126.13 2 2
dr. Irene Sp.PD 2.5% 1185.4 29.635 1155.765 3 3
dr. Fariz Sp. PD III/ 5% 1185.4 59.27 1126.13 4 4
dr. Iskandar Sp.B IV/ 15% 1185.4 177.81 1007.59 5 5
dr. Dini Sp.B III/ 5% 1185.4 59.27 1126.13 6 6
dr. Irman Sp.A III/ 5% 1185.4 59.27 1126.13 7 7
dr. Ineu Sp.A III/ 5% 1185.4 59.27 1126.13 8 8
dr. Tatan Sp.A III/ 5% 1185.4 59.27 1126.13 9 9
dr. Hervan Sp.OG III/ 5% 1185.4 59.27 1126.13 10 10
dr. Bogie Sp.OG III/ 5% 1185.4 59.27 1126.13 11 11
dr. Deni Sp.OG III/ 5% 1185.4 59.27 1126.13 12 12
dr. Nunung Sp. OG III/ 5% 1185.4 59.27 1126.13 13 13
dr. Binto Sp.M III/ 5% 1185.4 59.27 1126.13 14 14
dr. Widi Sp.M III/ 5% 1185.4 59.27 1126.13 15 15
dr. Edy Sp.THT IV/ 15% 1185.4 177.81 1007.59 16 16
dr. Ismi Sp. THT III/ 5% 1185.4 59.27 1126.13 17 17
dr. Aris Sp.An III/ 5% 1185.4 59.27 1126.13 18 18
dr. Widyatmiko Sp.OT III/ 5% 1185.4 59.27 1126.13 19 19
dr. R. Haryo Sp. BS III/ 5% 1185.4 59.27 1126.13 20 20
dr. Juhaeriyah IV/ 15% 1185.4 59.27 1126.13 21 21
dr. Nurzaman III/ 5% 1185.4 59.27 1126.13 22 22
dr. Hari Mukt III/ 5% 1185.4 59.27 1126.13 23 23
dr. Amaludin III/ 5% 1185.4 59.27 1126.13 24 24
dr. Aji Prasetyo III/ 5% 1185.4 59.27 1126.13 25 25
dr. Dyan Fakhry III/ 5% 1185.4 59.27 1126.13 26 26
dr. Sedayu III/ 5% 1185.4 59.27 1126.13 27 27
dr. Eva R III/ 5% 1185.4 59.27 1126.13 28 28
dr. Aulia III/ 5% 1185.4 59.27 1126.13 29 29
dr. Riany III/ 5% 1185.4 59.27 1126.13 30 30
dr.Rendy III/ 5% 1185.4 59.27 1126.13 31 31
dr. Trisy III/ 5% 1185.4 59.27 1126.13 32 32
dr.Gisda 2.5% 1185.4 29.635 1155.765 33 33
dr. Denok 2.5% 1185.4 29.635 1155.765 34 34
dr. Novy 2.5% 1185.4 29.635 1155.765 35 35
dr. Dian R. 2.5% 1185.4 29.635 1155.765 36 36
dr. Ivan 2.5% 1185.4 29.635 1155.765 37 37
dr. Nihayatul 2.5% 1185.4 29.635 1155.765 38 38
dr. Heni Diana 2.5% 1185.4 29.635 1155.765 39 39
drg. Yuyum III/ 5% 1185.4 59.27 1126.13 40 40
47416 2489.34 44926.66

NO.
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40

EKG JAMKESDA 7769

DAFTAR PENDISTRIBUSIAN JASA PENGIRIMAN JKN (EKG) JAMKESDA 2016


NAMA GOL./ PAJAK NILAI PAJAK DITERIMA TANDA TANGAN NO.
dr. Taufiq Sp.PD IV/ 15% 575.4815 86.32222 489.1593 1 1
dr. Luthfi Sp.PD III/ 5% 575.4815 28.77407 546.7074 2 2
dr. Irene Sp.PD 2.5% 575.4815 14.38704 561.0944 3 3
dr. Fariz Sp. PD III/ 5% 575.4815 28.77407 546.7074 4 4
dr. Juhaeriyah IV/ 15% 287.7407 43.16111 244.5796 5 5
dr. Nurzaman III/ 5% 287.7407 14.38704 273.3537 6 6
dr. Hari Mukt III/ 5% 287.7407 14.38704 273.3537 7 7
dr. Amaludin III/ 5% 287.7407 14.38704 273.3537 8 8
dr. Aji Prasetyo III/ 5% 287.7407 14.38704 273.3537 9 9
dr. Dyan Fakhry III/ 5% 287.7407 14.38704 273.3537 10 10
dr. Sedayu III/ 5% 287.7407 14.38704 273.3537 11 11
dr. Eva R III/ 5% 287.7407 14.38704 273.3537 12 12
dr. Aulia III/ 5% 287.7407 14.38704 273.3537 13 13
dr. Riany III/ 5% 287.7407 14.38704 273.3537 14 14
dr.Rendy III/ 5% 287.7407 14.38704 273.3537 15 15
dr. Trisy III/ 5% 287.7407 14.38704 273.3537 16 16
dr.Gisda 2.5% 287.7407 7.193519 280.5472 17 17
dr. Denok 2.5% 287.7407 7.193519 280.5472 18 18
dr. Novy 2.5% 287.7407 7.193519 280.5472 19 19
dr. Dian R. 2.5% 287.7407 7.193519 280.5472 20 20
dr. Ivan 2.5% 287.7407 7.193519 280.5472 21 21
dr. Nihayatul 2.5% 287.7407 7.193519 280.5472 22 22
dr. Heni Diana 2.5% 287.7407 7.193519 280.5472 23 23
7769 410.0306 7358.969

Lab Jamkesda 1063490

DAFTAR PENDISTRIBUSIAN JASA PENGIRIMAN JKN (LABORATORIUM) NOVEMBER 2016


NAMA GOL./ PAJAK NILAI PAJAK DITERIMA TANDA TANGAN NO.
dr. Taufiq Sp.PD IV/ 15% 41220.54 6183.081 35037.46 1 1
dr. Luthfi Sp.PD III/ 5% 41220.54 2061.027 39159.52 2 2
dr. Irene Sp.PD 2.5% 41220.54 1030.514 40190.03 3 3
dr. Fariz Sp. PD III/ 5% 41220.54 2061.027 39159.52 4 4
dr. Iskandar Sp.B IV/ 15% 16488.22 2473.233 14014.98 5 5
dr. Dini Sp.B III/ 5% 16488.22 824.4109 15663.81 6 6
dr. Irman Sp.A III/ 5% 16488.22 824.4109 15663.81 7 7
dr. Ineu Sp.A III/ 5% 16488.22 824.4109 15663.81 8 8
dr. Tatan Sp.A III/ 5% 16488.22 824.4109 15663.81 9 9
dr. Hervan Sp.OG III/ 5% 16488.22 824.4109 15663.81 10 10
dr. Bogie Sp.OG III/ 5% 16488.22 824.4109 15663.81 11 11
dr. Deni Sp.OG III/ 5% 16488.22 824.4109 15663.81 12 12
dr. Nunung Sp. OG III/ 5% 16488.22 824.4109 15663.81 13 13
dr. Binto Sp.M III/ 5% 16488.22 824.4109 15663.81 14 14
dr. Widi Sp.M III/ 5% 16488.22 824.4109 15663.81 15 15
dr. Edy Sp.THT IV/ 15% 16488.22 2473.233 14014.98 16 16
dr. Ismi Sp. THT III/ 5% 16488.22 824.4109 15663.81 17 17
dr. Aris Sp.An III/ 5% 16488.22 824.4109 15663.81 18 18
dr. Widyatmiko Sp.OT III/ 5% 16488.22 824.4109 15663.81 19 19
dr. R. Haryo Sp. BS III/ 5% 16488.22 824.4109 15663.81 20 20
dr. Juhaeriyah IV/ 15% 32976.43 4946.465 28029.97 21 21
dr. Nurzaman III/ 5% 32976.43 1648.822 31327.61 22 22
dr. Hari Mukt III/ 5% 32976.43 1648.822 31327.61 23 23
dr. Amaludin III/ 5% 32976.43 1648.822 31327.61 24 24
dr. Aji Prasetyo III/ 5% 32976.43 1648.822 31327.61 25 25
dr. Dyan Fakhry III/ 5% 32976.43 1648.822 31327.61 26 26
dr. Sedayu III/ 5% 32976.43 1648.822 31327.61 27 27
dr. Eva R III/ 5% 32976.43 1648.822 31327.61 28 28
dr. Aulia III/ 5% 32976.43 1648.822 31327.61 29 29
dr. Riany III/ 5% 32976.43 1648.822 31327.61 30 30
dr.Rendy III/ 5% 32976.43 1648.822 31327.61 31 31
dr. Trisy III/ 5% 32976.43 1648.822 31327.61 32 32
dr.Gisda 2.5% 32976.43 824.4109 32152.02 33 33
dr. Denok 2.5% 32976.43 824.4109 32152.02 34 34
dr. Novy 2.5% 32976.43 824.4109 32152.02 35 35
dr. Dian R. 2.5% 32976.43 824.4109 32152.02 36 36
dr. Ivan 2.5% 32976.43 824.4109 32152.02 37 37
dr. Nihayatul 2.5% 32976.43 824.4109 32152.02 38 38
dr. Heni Diana 2.5% 32976.43 824.4109 32152.02 39 39
drg. Yuyum III/ 5% 8244.109 412.2054 7831.903 40 40
1063490 57090.45 1006400
DAFTAR JUMLAH PENDISTRIBUSIAN PENDAPATAN RADIOLOGI
NAMA JANUARI FEBRUARI MARET APRIL MEI JUNI JULI AGUSTUS
dr. Taufiq Sp.PD 15613.88 20376.41 19039.28 22460.8 23389.88 22706.9 22535.63 24306.18
dr. Luthfi Sp.PD 17450.81 22773.63 21279.2 25103.25 26141.63 25378.3 25186.88 27165.73
dr. Irene Sp.PD 17910.04 23372.94 21839.18 25763.86 26829.56 26046.15 25849.69 27880.16
dr. Fariz Sp. PD - - - - 26141.63 25378.3 25186.88 27165.73
dr. Iskandar Sp.B 15613.88 20376.41 19039.28 22460.8 23389.88 22706.9 22535.63 24306.18
dr. Dini Sp.B 17450.81 22773.63 21279.2 25103.25 26141.63 25378.3 25186.88 27165.73
dr. Irman Sp.A 17450.81 22773.63 21279.2 25103.25 26141.63 25378.3 25186.88 27165.73
dr. Ineu Sp.A 17450.81 22773.63 21279.2 25103.25 26141.63 25378.3 25186.88 27165.73
dr. Tatan Sp.A 17450.81 22773.63 21279.2 25103.25 26141.63 25378.3 25186.88 27165.73
dr. Hervan Sp.OG 17450.81 22773.63 21279.2 25103.25 26141.63 25378.3 25186.88 27165.73
dr. Bogie Sp.OG 17450.81 22773.63 21279.2 25103.25 26141.63 25378.3 25186.88 27165.73
dr. Deni Sp.OG 17450.81 22773.63 21279.2 25103.25 26141.63 25378.3 25186.88 27165.73
dr. Nunung Sp. OG 17450.81 22773.63 21279.2 25103.25 26141.63 25378.3 25186.88 27165.73
dr. Binto Sp.M 17450.81 22773.63 21279.2 25103.25 26141.63 25378.3 25186.88 27165.73
dr. Widi Sp.M 17450.81 22773.63 21279.2 25103.25 26141.63 25378.3 25186.88 27165.73
dr. Edy Sp.THT 15613.88 20376.41 19039.28 22460.8 23389.88 22706.9 22535.63 24306.18
dr. Ismi Sp. THT - - 21279.2 25103.25 26141.63 25378.3 25186.88 27165.73
dr. Aris Sp.An 17450.81 22773.63 21279.2 25103.25 26141.63 25378.3 25186.88 27165.73
dr. Widyatmiko Sp.OT 17450.81 22773.63 21279.2 25103.25 26141.63 25378.3 25186.88 27165.73
dr. R. Haryo Sp. BS 17450.81 22773.63 21279.2 25103.25 26141.63 25378.3 25186.88 27165.73
dr. Juhaeriyah 15613.88 20376.41 19039.28 22460.8 23389.88 22706.9 22535.63 24306.18
dr. Nurzaman 17450.81 22773.63 21279.2 25103.25 26141.63 25378.3 25186.88 27165.73
dr. Hari Mukt 17450.81 22773.63 21279.2 25103.25 26141.63 25378.3 25186.88 27165.73
dr. Amaludin 17450.81 22773.63 21279.2 25103.25 26141.63 25378.3 25186.88 27165.73
dr. Aji Prasetyo 17450.81 22773.63 21279.2 25103.25 26141.63 25378.3 25186.88 27165.73
dr. Dyan Fakhry 17450.81 22773.63 21279.2 25103.25 26141.63 25378.3 25186.88 27165.73
dr. Sedayu 17450.81 22773.63 21279.2 25103.25 26141.63 25378.3 25186.88 27165.73
dr. Eva R 17450.81 22773.63 21279.2 25103.25 26141.63 25378.3 25186.88 27165.73
dr. Aulia 17450.81 22773.63 21279.2 25103.25 26141.63 25378.3 25186.88 27165.73
dr. Riany 17450.81 22773.63 21279.2 25103.25 26141.63 25378.3 25186.88 27165.73
dr.Rendy 17450.81 22773.63 21279.2 25103.25 26141.63 25378.3 25186.88 27165.73
dr. Trisy 17450.81 22773.63 21279.2 25103.25 26141.63 25378.3 25186.88 27165.73
dr.Gisda 17910.04 23372.94 21839.18 25763.86 26829.56 26046.15 25849.69 27880.16
dr. Denok 17910.04 23372.94 21839.18 25763.86 26829.56 26046.15 25849.69 27880.16
dr. Novy 17910.04 23372.94 21839.18 25763.86 26829.56 26046.15 25849.69 27880.16
dr. Dian R. 17910.04 23372.94 21839.18 25763.86 26829.56 26046.15 25849.69 27880.16
dr. Ivan 17910.04 23372.94 21839.18 25763.86 26829.56 26046.15 25849.69 27880.16
dr. Nihayatul 17910.04 23372.94 21839.18 25763.86 26829.56 26046.15 25849.69 27880.16
dr. Heni Diana - - - - 26829.56 26046.15 25849.69 27880.16
drg. Yuyum 17450.81 22773.63 21279.2 25103.25 26141.63 25378.3 25186.88 27165.73
641546.9 837230.6 803569.8 947978 1040162 1009789 1002173 1080906

DAFTAR JUMLAH PENDISTRIBUSIAN PENDAPATAN USG


NAMA JANUARI FEBRUARI MARET APRIL MEI JUNI JULI AGUSTUS
dr. Taufiq Sp.PD 28316.85 27138.27 39055.67 35839.51 30497.68 28549.01 23620.67 34478.64
dr. Luthfi Sp.PD 31648.25 30331.01 43650.45 40055.93 34085.64 31907.72 26399.57 38534.95
dr. Irene Sp.PD 32481.1 31129.19 44799.15 41110.03 34982.63 32747.4 27094.3 39549.02
dr. Fariz Sp. PD - - - - 34085.64 31907.72 26399.57 38534.95
dr. Iskandar Sp.B 28316.85 27138.27 39055.67 35839.51 30497.68 28549.01 23620.67 34478.64
dr. Dini Sp.B 31648.25 30331.01 43650.45 40055.93 34085.64 31907.72 26399.57 38534.95
dr. Irman Sp.A 31648.25 30331.01 43650.45 40055.93 34085.64 31907.72 26399.57 38534.95
dr. Ineu Sp.A 31648.25 30331.01 43650.45 40055.93 34085.64 31907.72 26399.57 38534.95
dr. Tatan Sp.A 31648.25 30331.01 43650.45 40055.93 34085.64 31907.72 26399.57 38534.95
dr. Hervan Sp.OG 31648.25 30331.01 43650.45 40055.93 34085.64 31907.72 26399.57 38534.95
dr. Bogie Sp.OG 31648.25 30331.01 43650.45 40055.93 34085.64 31907.72 26399.57 38534.95
dr. Deni Sp.OG 31648.25 30331.01 43650.45 40055.93 34085.64 31907.72 26399.57 38534.95
dr. Nunung Sp. OG 31648.25 30331.01 43650.45 40055.93 34085.64 31907.72 26399.57 38534.95
dr. Binto Sp.M 31648.25 30331.01 43650.45 40055.93 34085.64 31907.72 26399.57 38534.95
dr. Widi Sp.M 31648.25 30331.01 43650.45 40055.93 34085.64 31907.72 26399.57 38534.95
dr. Edy Sp.THT 28316.85 27138.27 39055.67 35839.51 30497.68 28549.01 23620.67 34478.64
dr. Ismi Sp. THT - - 43650.45 40055.93 34085.64 31907.72 26399.57 38534.95
dr. Aris Sp.An 31648.25 30331.01 43650.45 40055.93 34085.64 31907.72 26399.57 38534.95
dr. Widyatmiko Sp.OT 31648.25 30331.01 43650.45 40055.93 34085.64 31907.72 26399.57 38534.95
dr. R. Haryo Sp. BS 31648.25 30331.01 43650.45 40055.93 34085.64 31907.72 26399.57 38534.95
dr. Juhaeriyah 28316.85 27138.27 39055.67 35839.51 30497.68 28549.01 23620.67 34478.64
dr. Nurzaman 31648.25 30331.01 43650.45 40055.93 34085.64 31907.72 26399.57 38534.95
dr. Hari Mukt 31648.25 30331.01 43650.45 40055.93 34085.64 31907.72 26399.57 38534.95
dr. Amaludin 31648.25 30331.01 43650.45 40055.93 34085.64 31907.72 26399.57 38534.95
dr. Aji Prasetyo 31648.25 30331.01 43650.45 40055.93 34085.64 31907.72 26399.57 38534.95
dr. Dyan Fakhry 31648.25 30331.01 43650.45 40055.93 34085.64 31907.72 26399.57 38534.95
dr. Sedayu 31648.25 30331.01 43650.45 40055.93 34085.64 31907.72 26399.57 38534.95
dr. Eva R 31648.25 30331.01 43650.45 40055.93 34085.64 31907.72 26399.57 38534.95
dr. Aulia 31648.25 30331.01 43650.45 40055.93 34085.64 31907.72 26399.57 38534.95
dr. Riany 31648.25 30331.01 43650.45 40055.93 34085.64 31907.72 26399.57 38534.95
dr.Rendy 31648.25 30331.01 43650.45 40055.93 34085.64 31907.72 26399.57 38534.95
dr. Trisy 31648.25 30331.01 43650.45 40055.93 34085.64 31907.72 26399.57 38534.95
dr.Gisda 32481.1 31129.19 44799.15 41110.03 34982.63 32747.4 27094.3 39549.02
dr. Denok 32481.1 31129.19 44799.15 41110.03 34982.63 32747.4 27094.3 39549.02
dr. Novy 32481.1 31129.19 44799.15 41110.03 34982.63 32747.4 27094.3 39549.02
dr. Dian R. 32481.1 31129.19 44799.15 41110.03 34982.63 32747.4 27094.3 39549.02
dr. Ivan 32481.1 31129.19 44799.15 41110.03 34982.63 32747.4 27094.3 39549.02
dr. Nihayatul 32481.1 31129.19 44799.15 41110.03 34982.63 32747.4 27094.3 39549.02
dr. Heni Diana - - - - 34982.63 32747.4 27094.3 39549.02
drg. Yuyum 31648.25 30331.01 43650.45 40055.93 34085.64 31907.72 26399.57 38534.95
1163490 1115064 1648379 1512638 1356250 1269591 1050425 1533285

DAFTAR JUMLAH PENDISTRIBUSIAN PENDAPATAN EKG


NAMA JANUARI FEBRUARI MARET APRIL MEI JUNI JULI AGUSTUS
dr. Taufiq Sp.PD 77759.28 92540.49 94928.71 88899.52 98396.69 67758.54 66658.64 677907.8
dr. Luthfi Sp.PD 86907.43 103427.6 106096.8 99358.28 109972.8 75730.13 74500.83 757661.7
dr. Irene Sp.PD 89194.46 106149.4 108888.8 101973 112866.8 77723.03 76461.38 777600.1
dr. Fariz Sp. PD - - - - 109972.8 75730.13 74500.83 757661.7
dr. Juhaeriyah 38879.64 46270.25 47464.35 44449.76 49198.35 33879.27 33329.32 338953.9
dr. Nurzaman 43453.71 51713.8 53048.4 49679.14 54986.39 37865.06 37250.41 378830.8
dr. Hari Mukt 43453.71 51713.8 53048.4 49679.14 54986.39 37865.06 37250.41 378830.8
dr. Amaludin 43453.71 51713.8 53048.4 49679.14 54986.39 37865.06 37250.41 378830.8
dr. Aji Prasetyo 43453.71 51713.8 53048.4 49679.14 54986.39 37865.06 37250.41 378830.8
dr. Dyan Fakhry 43453.71 51713.8 53048.4 49679.14 54986.39 37865.06 37250.41 378830.8
dr. Sedayu 43453.71 51713.8 53048.4 49679.14 54986.39 37865.06 37250.41 378830.8
dr. Eva R 43453.71 51713.8 53048.4 49679.14 54986.39 37865.06 37250.41 378830.8
dr. Aulia 43453.71 51713.8 53048.4 49679.14 54986.39 37865.06 37250.41 378830.8
dr. Riany 43453.71 51713.8 53048.4 49679.14 54986.39 37865.06 37250.41 378830.8
dr.Rendy 43453.71 51713.8 53048.4 49679.14 54986.39 37865.06 37250.41 378830.8
dr. Trisy 43453.71 51713.8 53048.4 49679.14 54986.39 37865.06 37250.41 378830.8
dr.Gisda 44597.25 53074.69 54444.41 50986.49 56433.4 38861.51 38230.69 388800.1
dr. Denok 44597.25 53074.69 54444.41 50986.49 56433.4 38861.51 38230.69 388800.1
dr. Novy 44597.25 53074.69 54444.41 50986.49 56433.4 38861.51 38230.69 388800.1
dr. Dian R. 44597.25 53074.69 54444.41 50986.49 56433.4 38861.51 38230.69 388800.1
dr. Ivan 44597.25 53074.69 54444.41 50986.49 56433.4 38861.51 38230.69 388800.1
dr. Nihayatul 44597.25 53074.69 54444.41 50986.49 56433.4 38861.51 38230.69 388800.1
dr. Heni Diana - - - - 56433.4 38861.51 38230.69 388800.1
1038315 1235688 1267578 1187070 1480292 1019367 1002820 10198525

DAFTAR JUMLAH PENDISTRIBUSIAN PENDAPATAN LABORATORIUM


NAMA JANUARI FEBRUARI MARET APRIL MEI JUNI JULI AGUSTUS
dr. Taufiq Sp.PD 143449.9 161634.4 173053.6 187285.2 173903.6 165438.2 147265.9 168125.4
dr. Luthfi Sp.PD 160326.3 180650.2 193412.9 209318.8 194362.9 184901.5 164591.3 187904.8
dr. Irene Sp.PD 164545.4 185404.2 198502.7 214827.2 199477.7 189767.3 168922.6 192849.7
dr. Fariz Sp. PD - - - - 194362.9 184901.5 164591.3 187904.8
dr. Iskandar Sp.B 573779.9 64653.77 69221.45 74914.08 69561.44 66175.27 58906.34 67250.14
dr. Dini Sp.B 64130.52 72260.09 77365.15 83727.51 77745.14 73960.59 65836.5 75161.92
dr. Irman Sp.A 64130.52 72260.09 77365.15 83727.51 77745.14 73960.59 65836.5 75161.92
dr. Ineu Sp.A 64130.52 72260.09 77365.15 83727.51 77745.14 73960.59 65836.5 75161.92
dr. Tatan Sp.A 64130.52 72260.09 77365.15 83727.51 77745.14 73960.59 65836.5 75161.92
dr. Hervan Sp.OG 64130.52 72260.09 77365.15 83727.51 77745.14 73960.59 65836.5 75161.92
dr. Bogie Sp.OG 64130.52 72260.09 77365.15 83727.51 77745.14 73960.59 65836.5 75161.92
dr. Deni Sp.OG 64130.52 72260.09 77365.15 83727.51 77745.14 73960.59 65836.5 75161.92
dr. Nunung Sp. OG 64130.52 72260.09 77365.15 83727.51 77745.14 73960.59 65836.5 75161.92
dr. Binto Sp.M 64130.52 72260.09 77365.15 83727.51 77745.14 73960.59 65836.5 75161.92
dr. Widi Sp.M 64130.52 72260.09 77365.15 83727.51 77745.14 73960.59 65836.5 75161.92
dr. Edy Sp.THT 573779.9 64653.77 69221.45 74914.08 69561.44 66175.27 58906.34 67250.14
dr. Ismi Sp. THT - - - 83727.51 77745.14 73960.59 65836.5 75161.92
dr. Aris Sp.An 64130.52 72260.09 77365.15 83727.51 77745.14 73960.59 65836.5 75161.92
dr. Widyatmiko Sp.OT 64130.52 72260.09 77365.15 83727.51 77745.14 73960.59 65836.5 75161.92
dr. R. Haryo Sp. BS 64130.52 72260.09 77365.15 83727.51 77745.14 73960.59 65836.5 75161.92
dr. Juhaeriyah 114759.9 129307.5 138442.9 149828.2 139122.9 132950.5 117812.7 134500.3
dr. Nurzaman 128261 144520.2 154730.3 167455 155490.3 147921.2 131673 150323.8
dr. Hari Mukt 128261 144520.2 154730.3 167455 155490.3 147921.2 131673 150323.8
dr. Amaludin 128261 144520.2 154730.3 167455 155490.3 147921.2 131673 150323.8
dr. Aji Prasetyo 128261 144520.2 154730.3 167455 155490.3 147921.2 131673 150323.8
dr. Dyan Fakhry 128261 144520.2 154730.3 167455 155490.3 147921.2 131673 150323.8
dr. Sedayu 128261 144520.2 154730.3 167455 155490.3 147921.2 131673 150323.8
dr. Eva R 128261 144520.2 154730.3 167455 155490.3 147921.2 131673 150323.8
dr. Aulia 128261 144520.2 154730.3 167455 155490.3 147921.2 131673 150323.8
dr. Riany 128261 144520.2 154730.3 167455 155490.3 147921.2 131673 150323.8
dr.Rendy 128261 144520.2 154730.3 167455 155490.3 147921.2 131673 150323.8
dr. Trisy 128261 144520.2 154730.3 167455 155490.3 147921.2 131673 150323.8
dr.Gisda 131636.3 148323.3 158802.2 171861.7 159582.1 151813.8 135138.1 154279.7
dr. Denok 131636.3 148323.3 158802.2 171861.7 159582.1 151813.8 135138.1 154279.7
dr. Novy 131636.3 148323.3 158802.2 171861.7 159582.1 151813.8 135138.1 154279.7
dr. Dian R. 131636.3 148323.3 158802.2 171861.7 159582.1 151813.8 135138.1 154279.7
dr. Ivan 131636.3 148323.3 158802.2 171861.7 159582.1 151813.8 135138.1 154279.7
dr. Nihayatul 131636.3 148323.3 158802.2 171861.7 159582.1 151813.8 135138.1 154279.7
dr. Heni Diana - - - - 159582.1 151813.8 135138.1 154279.7
drg. Yuyum 32065.26 36130.05 38682.58 41863.75 38872.57 36980.3 32918.25 37580.96
4797092 4241477 4541131 4998312 4995125 4752568 4229995 4829153
NDAPATAN RADIOLOGI DAFTAR JUM
SEPT OKTOBER NOV JAKESDA TOTAL TANDA TANGAN NO.
20559.38 33976.65 22368.18 1007.59 248340.8 1 1
22978.13 37973.9 24999.73 1126.13 277557.3 2 2
23582.81 38973.21 25657.61 1155.765 284861 3 3
22978.13 37973.9 24999.73 1126.13 190950.4 4 4
20559.38 33976.65 22368.18 1007.59 248340.8 5 5
22978.13 37973.9 24999.73 1126.13 277557.3 6 6
22978.13 37973.9 24999.73 1126.13 277557.3 7 7
22978.13 37973.9 24999.73 1126.13 277557.3 8 8
22978.13 37973.9 24999.73 1126.13 277557.3 9 9
22978.13 37973.9 24999.73 1126.13 277557.3 10 10
22978.13 37973.9 24999.73 1126.13 277557.3 11 11
22978.13 37973.9 24999.73 1126.13 277557.3 12 12
22978.13 37973.9 24999.73 1126.13 277557.3 13 13
22978.13 37973.9 24999.73 1126.13 277557.3 14 14
22978.13 37973.9 24999.73 1126.13 277557.3 15 15
20559.38 33976.65 22368.18 1007.59 248340.8 16 16
22978.13 37973.9 24999.73 1126.13 237332.9 17 17
22978.13 37973.9 24999.73 1126.13 277557.3 18 18
22978.13 37973.9 24999.73 1126.13 277557.3 19 19
22978.13 37973.9 24999.73 1126.13 277557.3 20 20
20559.38 33976.65 22368.18 1007.59 248340.8 21 21
22978.13 37973.9 24999.73 1126.13 277557.3 22 22
22978.13 37973.9 24999.73 1126.13 277557.3 23 23
22978.13 37973.9 24999.73 1126.13 277557.3 24 24
22978.13 37973.9 24999.73 1126.13 277557.3 25 25
22978.13 37973.9 24999.73 1126.13 277557.3 26 26
22978.13 37973.9 24999.73 1126.13 277557.3 27 27
22978.13 37973.9 24999.73 1126.13 277557.3 28 28
22978.13 37973.9 24999.73 1126.13 277557.3 29 29
22978.13 37973.9 24999.73 1126.13 277557.3 30 30
22978.13 37973.9 24999.73 1126.13 277557.3 31 31
22978.13 37973.9 24999.73 1126.13 277557.3 32 32
23582.81 38973.21 25657.61 1155.765 284861 33 33
23582.81 38973.21 25657.61 1155.765 284861 34 34
23582.81 38973.21 25657.61 1155.765 284861 35 35
23582.81 38973.21 25657.61 1155.765 284861 36 36
23582.81 38973.21 25657.61 1155.765 284861 37 37
23582.81 38973.21 25657.61 1155.765 284861 38 38
23582.81 38973.21 25657.61 1155.765 195975 39 39
22978.13 37973.9 24999.73 1126.13 277557.3 40 40
914287.6 1510961 994726 44808.12 10828138

APATAN USG
SEPT OKTOBER NOV TOTAL TANDA TANGAN
34980.11 26887.99 39029.96 348394.4 1
39095.42 30051.28 43621.72 389381.9 2
40124.25 30842.1 44769.66 399628.8 3
39095.42 30051.28 43621.72 243696.3 4
34980.11 26887.99 39029.96 348394.4 5
39095.42 30051.28 43621.72 389381.9 6
39095.42 30051.28 43621.72 389381.9 7
39095.42 30051.28 43621.72 389381.9 8
39095.42 30051.28 43621.72 389381.9 9
39095.42 30051.28 43621.72 389381.9 10
39095.42 30051.28 43621.72 389381.9 11
39095.42 30051.28 43621.72 389381.9 12
39095.42 30051.28 43621.72 389381.9 13
39095.42 30051.28 43621.72 389381.9 14
39095.42 30051.28 43621.72 389381.9 15
34980.11 26887.99 39029.96 348394.4 16
39095.42 30051.28 43621.72 327402.7 17
39095.42 30051.28 43621.72 389381.9 18
39095.42 30051.28 43621.72 389381.9 19
39095.42 30051.28 43621.72 389381.9 20
34980.11 26887.99 39029.96 348394.4 21
39095.42 30051.28 43621.72 389381.9 22
39095.42 30051.28 43621.72 389381.9 23
39095.42 30051.28 43621.72 389381.9 24
39095.42 30051.28 43621.72 389381.9 25
39095.42 30051.28 43621.72 389381.9 26
39095.42 30051.28 43621.72 389381.9 27
39095.42 30051.28 43621.72 389381.9 28
39095.42 30051.28 43621.72 389381.9 29
39095.42 30051.28 43621.72 389381.9 30
39095.42 30051.28 43621.72 389381.9 31
39095.42 30051.28 43621.72 389381.9 32
40124.25 30842.1 44769.66 399628.8 33
40124.25 30842.1 44769.66 399628.8 34
40124.25 30842.1 44769.66 399628.8 35
40124.25 30842.1 44769.66 399628.8 36
40124.25 30842.1 44769.66 399628.8 37
40124.25 30842.1 44769.66 399628.8 38
40124.25 30842.1 44769.66 250109.4 39
39095.42 30051.28 43621.72 389381.9 40
1555586 1195725 1735685 15136118

PENDAPATAN EKG
SEPT OKTOBER NOV JAKESDA TOTAL TANDA TANGAN
59223.53 60717.83 55836.81 489.15 1441117 1
66191 67861.1 62405.85 546.7 1610660 2
67932.87 69646.92 64048.11 561.09 1653046 3
66191 67861.1 62405.85 546.7 1214870 4
29611.76 30358.91 27918.41 244.57 720558.5 5
33095.5 33930.55 31202.93 273.35 805330 6
33095.5 33930.55 31202.93 273.35 805330 7
33095.5 33930.55 31202.93 273.35 805330 8
33095.5 33930.55 31202.93 273.35 805330 9
33095.5 33930.55 31202.93 273.35 805330 10
33095.5 33930.55 31202.93 273.35 805330 11
33095.5 33930.55 31202.93 273.35 805330 12
33095.5 33930.55 31202.93 273.35 805330 13
33095.5 33930.55 31202.93 273.35 805330 14
33095.5 33930.55 31202.93 273.35 805330 15
33095.5 33930.55 31202.93 273.35 805330 16
33966.44 34823.46 32024.06 280.54 826523 17
33966.44 34823.46 32024.06 280.54 826523 18
33966.44 34823.46 32024.06 280.54 826523 19
33966.44 34823.46 32024.06 280.54 826523 20
33966.44 34823.46 32024.06 280.54 826523 21
33966.44 34823.46 32024.06 280.54 826523 22
33966.44 34823.46 32024.06 280.54 623420.2 23
890965.7 913446.1 840015.7 7358.84 21081441

APATAN LABORATORIUM
SEPT OKTOBER NOV JAKESDA TOTAL TANDA TANGAN
150666.6 164075.2 146765.5 35037.46 1673251 1
168392.1 183378.2 164032 39159.52 1870104 2
172823.5 188203.9 168348.7 40190.03 1919318 3
168392.1 183378.2 164032 39159.52 1286722 4
60266.65 65630.09 58706.21 14014.48 669299.9 5
67356.84 73351.28 65612.82 15663.81 748041.7 6
67356.84 73351.28 65612.82 15663.81 748041.7 7
67356.84 73351.28 65612.82 15663.81 748041.7 8
67356.84 73351.28 65612.82 15663.81 748041.7 9
67356.84 73351.28 65612.82 15663.81 748041.7 10
67356.84 73351.28 65612.82 15663.81 748041.7 11
67356.84 73351.28 65612.82 15663.81 748041.7 12
67356.84 73351.28 65612.82 15663.81 748041.7 13
67356.84 73351.28 65612.82 15663.81 748041.7 14
67356.84 73351.28 65612.82 15663.81 748041.7 15
60266.65 73351.28 58706.21 14014.48 677021.1 16
67356.84 73351.28 65612.82 15663.81 598416.4 17
67356.84 73351.28 65612.82 15663.81 748041.7 18
67356.84 73351.28 65612.82 15663.81 748041.7 19
67356.84 73351.28 65612.82 15663.81 748041.7 20
120533.3 131260.2 117412.4 28029.97 1339201 21
134713.7 146702.6 131225.6 31327.61 1496083 22
134713.7 146702.6 131225.6 31327.61 1496083 23
134713.7 146702.6 131225.6 31327.61 1496083 24
134713.7 146702.6 131225.6 31327.61 1496083 25
134713.7 146702.6 131225.6 31327.61 1496083 26
134713.7 146702.6 131225.6 31327.61 1496083 27
134713.7 146702.6 131225.6 31327.61 1496083 28
134713.7 146702.6 131225.6 31327.61 1496083 29
134713.7 146702.6 131225.6 31327.61 1496083 30
134713.7 146702.6 131225.6 31327.61 1496083 31
134713.7 146702.6 131225.6 31327.61 1496083 32
138258.8 150563.2 134678.9 32152.02 1535454 33
138258.8 150563.2 134678.9 32152.02 1535454 34
138258.8 150563.2 134678.9 32152.02 1535454 35
138258.8 150563.2 134678.9 32152.02 1535454 36
138258.8 150563.2 134678.9 32152.02 1535454 37
138258.8 150563.2 134678.9 32152.02 1535454 38
138258.8 150563.2 134678.9 32152.02 1056467 39
33678.42 36675.64 32806.41 7831.903 374020.8 40
4327677 4720542 4215623 1006399 46858002
DAFTAR JUMLAH PENDISTRIBUSIAN PENDAPATAN JKN
NAMA RADIOLOGI USG EKG LAB TOTAL TANDA TANGAN
dr. Taufiq Sp.PD 248340.8 348394.4 1441117 1673251 3711103.2 1
dr. Luthfi Sp.PD 277557.3 389381.9 1610660 1870104 4147703.2 2
dr. Irene Sp.PD 284861 399628.8 1653046 1919318 4256853.8 3
dr. Fariz Sp. PD 190950.4 243696.3 1214870 1286722 2936238.7 4
dr. Iskandar Sp.B 248340.8 348394.4 - 669299.2 1266034.4 5
dr. Dini Sp.B 277557.3 389381.9 - 748041.7 1414980.9 6
dr. Irman Sp.A 277557.3 389381.9 - 748041.7 1414980.9 7
dr. Ineu Sp.A 277557.3 389381.9 - 748041.7 1414980.9 8
dr. Tatan Sp.A 277557.3 389381.9 - 748041.7 1414980.9 9
dr. Hervan Sp.OG 277557.3 389381.9 - 748041.7 1414980.9 10
dr. Bogie Sp.OG 277557.3 389381.9 - 748041.7 1414980.9 11
dr. Deni Sp.OG 277557.3 389381.9 - 748041.7 1414980.9 12
dr. Nunung Sp. OG 277557.3 389381.9 - 748041.7 1414980.9 13
dr. Binto Sp.M 277557.3 389381.9 - 748041.7 1414980.9 14
dr. Widi Sp.M 277557.3 389381.9 - 748041.7 1414980.9 15
dr. Edy Sp.THT 248340.8 348394.4 - 677021.1 1273756.3 16
dr. Ismi Sp. THT 237332.9 327402.7 - 598416.4 1163152 17
dr. Aris Sp.An 277557.3 389381.9 - 748041.7 1414980.9 18
dr. Widyatmiko Sp.OT 277557.3 389381.9 - 748041.7 1414980.9 19
dr. R. Haryo Sp. BS 277557.3 389381.9 - 748041.7 1414980.9 20
dr. Juhaeriyah 248340.8 348394.4 720558.5 1339201 2656494.7 21
dr. Nurzaman 277557.3 389381.9 805330 1496083 2968352.2 22
dr. Hari Mukt 277557.3 389381.9 805330 1496083 2968352.2 23
dr. Amaludin 277557.3 389381.9 805330 1496083 2968352.2 24
dr. Aji Prasetyo 277557.3 389381.9 805330 1496083 2968352.2 25
dr. Dyan Fakhry 277557.3 389381.9 805330 1496083 2968352.2 26
dr. Sedayu 277557.3 389381.9 805330 1496083 2968352.2 27
dr. Eva R 277557.3 389381.9 805330 1496083 2968352.2 28
dr. Aulia 277557.3 389381.9 805330 1496083 2968352.2 29
dr. Riany 277557.3 389381.9 805330 1496083 2968352.2 30
dr.Rendy 277557.3 389381.9 805330 1496083 2968352.2 31
dr. Trisy 277557.3 389381.9 805330 1496083 2968352.2 32
dr.Gisda 284861 399628.8 826523 1535454 3046466.8 33
dr. Denok 284861 399628.8 826523 1535454 3046466.8 34
dr. Novy 284861 399628.8 826523 1535454 3046466.8 35
dr. Dian R. 284861 399628.8 826523 1535454 3046466.8 36
dr. Ivan 284861 399628.8 826523 1535454 3046466.8 37
dr. Nihayatul 284861 399628.8 826523 1535454 3046466.8 38
dr. Heni Diana 195975 250109.4 623420.2 1056467 2125971.6 39
drg. Yuyum 277557.3 389381.9 - 374020.8 1040960 40
10828138.3 15136117 21081440 46858000 93903695
DAFTAR JUMLAH PEN
NO. NAMA JANUARI FEBRUARI MARET APRIL
1 dr. Taufiq Sp.PD 22460.8
2 dr. Luthfi 17450.81 22773.63 21279.2 25103.25
3 dr. Irene S 17910.04 23372.94 21839.18 25763.86
4 dr. Fariz Sp- - - -
5 dr. Iskanda 15613.88 20376.41 19039.28 22460.8
6 dr. Dini Sp 17450.81 22773.63 21279.2 25103.25
7 dr. Irman S 17450.81 22773.63 21279.2 25103.25
8 dr. Ineu Sp 17450.81 22773.63 21279.2 25103.25
9 dr. Tatan 17450.81 22773.63 21279.2 25103.25
10 dr. Hervan 17450.81 22773.63 21279.2 25103.25
11 dr. Bogie 17450.81 22773.63 21279.2 25103.25
12 dr. Deni S 17450.81 22773.63 21279.2 25103.25
13 dr. Nunung 17450.81 22773.63 21279.2 25103.25
14 dr. Binto S 17450.81 22773.63 21279.2 25103.25
15 dr. Widi S 17450.81 22773.63 21279.2 25103.25
16 dr. Edy Sp. 15613.88 20376.41 19039.28 22460.8
17 dr. Ismi Sp - - 21279.2 25103.25
18 dr. Aris Sp 17450.81 22773.63 21279.2 25103.25
19 dr. Widyat 17450.81 22773.63 21279.2 25103.25
20 dr. R. Hary 17450.81 22773.63 21279.2 25103.25
21 dr. Juhaeri 15613.88 20376.41 19039.28 22460.8
22 dr. Nurzam 17450.81 22773.63 21279.2 25103.25
23 dr. Hari Mu17450.81 22773.63 21279.2 25103.25
24 dr. Amalud 17450.81 22773.63 21279.2 25103.25
25 dr. Aji Pra 17450.81 22773.63 21279.2 25103.25
26 dr. Dyan F 17450.81 22773.63 21279.2 25103.25
27 dr. Sedayu 17450.81 22773.63 21279.2 25103.25
28 dr. Eva R 17450.81 22773.63 21279.2 25103.25
29 dr. Aulia 17450.81 22773.63 21279.2 25103.25
30 dr. Riany 17450.81 22773.63 21279.2 25103.25
31 dr.Rendy 17450.81 22773.63 21279.2 25103.25
32 dr. Trisy 17450.81 22773.63 21279.2 25103.25
33 dr.Gisda 17910.04 23372.94 21839.18 25763.86
34 dr. Denok 17910.04 23372.94 21839.18 25763.86
35 dr. Novy 17910.04 23372.94 21839.18 25763.86
36 dr. Dian R. 17910.04 23372.94 21839.18 25763.86
37 dr. Ivan 17910.04 23372.94 21839.18 25763.86
38 dr. Nihayat 17910.04 23372.94 21839.18 25763.86
39 dr. Heni Di- - - -
40 drg. Yuyum17450.81 22773.63 21279.2 25103.25
625933 816854.2 784530.5 947978
DAFTAR JUMLAH PENDISTRIBUSIAN PENDAPATAN USG
MEI JUNI JULI AGUSTUS SEPT OKTOBER NOV JAKESDA TOTAL TANDA TANGAN
23389.88 22706.9 22535.63 24306.18 20559.38 33976.65 22368.18 1007.59 193311.2 1
26141.63 25378.3 25186.88 27165.73 22978.13 37973.9 24999.73 1126.13 277557.3
26829.56 26046.15 25849.69 27880.16 23582.81 38973.21 25657.61 1155.765 284861 3
26141.63 25378.3 25186.88 27165.73 22978.13 37973.9 24999.73 1126.13 190950.4
23389.88 22706.9 22535.63 24306.18 20559.38 33976.65 22368.18 1007.59 248340.8 5
26141.63 25378.3 25186.88 27165.73 22978.13 37973.9 24999.73 1126.13 277557.3
26141.63 25378.3 25186.88 27165.73 22978.13 37973.9 24999.73 1126.13 277557.3 7
26141.63 25378.3 25186.88 27165.73 22978.13 37973.9 24999.73 1126.13 277557.3
26141.63 25378.3 25186.88 27165.73 22978.13 37973.9 24999.73 1126.13 277557.3 9
26141.63 25378.3 25186.88 27165.73 22978.13 37973.9 24999.73 1126.13 277557.3
26141.63 25378.3 25186.88 27165.73 22978.13 37973.9 24999.73 1126.13 277557.3 11
26141.63 25378.3 25186.88 27165.73 22978.13 37973.9 24999.73 1126.13 277557.3
26141.63 25378.3 25186.88 27165.73 22978.13 37973.9 24999.73 1126.13 277557.3 13
26141.63 25378.3 25186.88 27165.73 22978.13 37973.9 24999.73 1126.13 277557.3
26141.63 25378.3 25186.88 27165.73 22978.13 37973.9 24999.73 1126.13 277557.3 15
23389.88 22706.9 22535.63 24306.18 20559.38 33976.65 22368.18 1007.59 248340.8
26141.63 25378.3 25186.88 27165.73 22978.13 37973.9 24999.73 1126.13 237332.9 17
26141.63 25378.3 25186.88 27165.73 22978.13 37973.9 24999.73 1126.13 277557.3
26141.63 25378.3 25186.88 27165.73 22978.13 37973.9 24999.73 1126.13 277557.3 19
26141.63 25378.3 25186.88 27165.73 22978.13 37973.9 24999.73 1126.13 277557.3
23389.88 22706.9 22535.63 24306.18 20559.38 33976.65 22368.18 1007.59 248340.8 21
26141.63 25378.3 25186.88 27165.73 22978.13 37973.9 24999.73 1126.13 277557.3
26141.63 25378.3 25186.88 27165.73 22978.13 37973.9 24999.73 1126.13 277557.3 23
26141.63 25378.3 25186.88 27165.73 22978.13 37973.9 24999.73 1126.13 277557.3
26141.63 25378.3 25186.88 27165.73 22978.13 37973.9 24999.73 1126.13 277557.3 25
26141.63 25378.3 25186.88 27165.73 22978.13 37973.9 24999.73 1126.13 277557.3
26141.63 25378.3 25186.88 27165.73 22978.13 37973.9 24999.73 1126.13 277557.3 27
26141.63 25378.3 25186.88 27165.73 22978.13 37973.9 24999.73 1126.13 277557.3
26141.63 25378.3 25186.88 27165.73 22978.13 37973.9 24999.73 1126.13 277557.3 29
26141.63 25378.3 25186.88 27165.73 22978.13 37973.9 24999.73 1126.13 277557.3
26141.63 25378.3 25186.88 27165.73 22978.13 37973.9 24999.73 1126.13 277557.3 31
26141.63 25378.3 25186.88 27165.73 22978.13 37973.9 24999.73 1126.13 277557.3
26829.56 26046.15 25849.69 27880.16 23582.81 38973.21 25657.61 1155.765 284861 33
26829.56 26046.15 25849.69 27880.16 23582.81 38973.21 25657.61 1155.765 284861
26829.56 26046.15 25849.69 27880.16 23582.81 38973.21 25657.61 1155.765 284861 35
26829.56 26046.15 25849.69 27880.16 23582.81 38973.21 25657.61 1155.765 284861
26829.56 26046.15 25849.69 27880.16 23582.81 38973.21 25657.61 1155.765 284861 37
26829.56 26046.15 25849.69 27880.16 23582.81 38973.21 25657.61 1155.765 284861
26829.56 26046.15 25849.69 27880.16 23582.81 38973.21 25657.61 1155.765 195975 39
26141.63 25378.3 25186.88 27165.73 22978.13 37973.9 24999.73 1126.13 277557.3
1040162 1009789 1002173 1080906 914287.6 1510961 994726 44808.12 10773109
TANDA TANGAN

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