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  • Req - 16207733

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    Dorian Flores
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    This document is a demand statement from Kent Diagnostic Radiology addressed to Corey Nowell. It details two medical procedures, an MRI of the cervical spine and an MRI of the lumbar spine, performed in March and April 2023. The statement shows insurance payments made and balances still owed for each procedure. The total balance due upon receipt is $00.

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    REQ- 16207733

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    This document is a demand statement from Kent Diagnostic Radiology addressed to Corey Nowell. It details two medical procedures, an MRI of the cervical spine and an MRI of the lumbar spine, performed in March and April 2023. The statement shows insurance payments made and balances still owed for each procedure. The total balance due upon receipt is $00.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    28 views1 page

    Req - 16207733

    Uploaded by

    Dorian Flores
    This document is a demand statement from Kent Diagnostic Radiology addressed to Corey Nowell. It details two medical procedures, an MRI of the cervical spine and an MRI of the lumbar spine, performed in March and April 2023. The statement shows insurance payments made and balances still owed for each procedure. The total balance due upon receipt is $00.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 1

    Group Management Print Job Viewer Page 1 of 1

    Practice KDR, Job #3704: Run by AHR45 on 10/02/2023. Close


    Job Title: DEMAND STMTS (D5)

    KENT DIAGNOSTIC RADIOLOGY PAGE 1 1(305) 710-7803 CNOWELL1226@GMAIL.COM

    PO BOX 4238
    PORTSMOUTH NH 03802-4238 10/02/23 .00 KDR300131121 12/26/1985
    SERVICES PERFORMED AT: EDEN HILL MEDICAL CENTER (305) 710-7803

    COREY
    KENT DIAGNOSTIC RADIOLOGY
    NOWELL
    PO BOX 4238
    247 HORSE TRAIL LANE PORTSMOUTH NH 03802-4238
    FELTON
    DE
    19943

    COREY

    NOWELL

    03/24/22 72141 MRI C-SPINE W/O CONTRAST KYL EHM 219.00 1117138
    04/06/22 CONTRACTED INS PAYMENT 73.14-

    04/06/22 CONTRACTED INS ADJUSTMENT 145.86-


    AMOUNT DUE THIS CHARGE

    03/24/22 72148 MRI L-SPINE W/O CONTRAST KYL EHM 219.00 1806216
    06/02/23 CONTRACTED INS PAYMENT 73.14-
    AMOUNT DUE THIS CHARGE

    KDR300131121

    KENT DIAGNOSTIC RADIOLOGY

    BALANCE DUE UPON RECEIPT PO BOX 4238


    PORTSMOUTH NH 03802-4238
    1(888) 333-8131
    00 FAX 1(610) 956-0024

    http://gpms/gpmsweb/cgi-bin/wwwspoolview.cgi?job=3704&practice=kdr 10/2/2023

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