Contact_FullName1:
Contact_FullName:
Contact_Title:
Contact_Organization:
Contact_StreetAddress:
Contact_Address2:
Contact_City:
Contact_State:
Contact_ZipCode:
Contact_Country:
Contact_WorkPhone:
Contact_FAX:
Contact_Email:
Contact_URL:
Cost: Submit Form
Date: 14 December, 2006
Time: 01:47 PM

Contact_FullName1: dave
Contact_FullName: test
Contact_Title:
Contact_Organization:
Contact_StreetAddress:
Contact_Address2:
Contact_City: 5000
Contact_State: 69
Contact_ZipCode: 10,000
Contact_Country: 600.00
Contact_WorkPhone: 100.00
Contact_FAX: no
Contact_Email: yes
Contact_URL: yes
Cost: Submit Form
Date: 14 December, 2006
Time: 01:49 PM

Contact_FullName1: dave
Contact_FullName: Tester
Contact_Title:
Contact_Organization:
Contact_StreetAddress:
Contact_Address2: dbrandenburg@woh.rr.com
Contact_City: wwwwwwwwwwwwwwww
Contact_State: 777777777777777777777
Contact_ZipCode: 999999999999
Contact_Country: 2222222222222222222.00
Contact_WorkPhone: 300.00
Contact_FAX: yes
Contact_Email: yes
Contact_URL: yes
Cost: Submit Form
Date: 14 December, 2006
Time: 02:27 PM

Contact_FullName1: test
Contact_FullName: test
Contact_Title: test
Contact_Organization: test
Contact_StreetAddress: test
Contact_Address2: test
Contact_City: 900
Contact_State: 200
Contact_ZipCode: 12
Contact_Country: 12
Contact_WorkPhone: 24.00
Contact_FAX: yes
Contact_Email: no
Contact_URL: no
Cost: Submit Form
Date: 14 December, 2006
Time: 02:37 PM

Physicians_Name: Dave
Practice_Name: Fix- it
Specialty: Whatever
Practice_Phone: 223-223-4455
Practice_Address: 30 last st
City_State: Kettering, OH
Zip_Code: 45429
Email_Address: daveb@accu-bil.com
How_many_active_patients_do_you_have: 6000
How_many_patients_do_you_seen_per_day: 100
Average_number_of_claims_per_month: 20,000
Average_billed_amount_per_claim: 600.00
What_is_the_average_hourly_wage_per_employee: 300.00
Do_you_file_claims_electronically: no
Do_you_experience_a_great_number_of_rejections: yes
Do_you_currently_have_a_backlog_of_claims: yes
Cost: Submit Form
Date: 14 December, 2006
Time: 03:56 PM

Physicians_Name: test
Practice_Name: test
Specialty: test
Practice_Phone: test
Practice_Address: test
City_State: test
Zip_Code: test
Email_Address: test
How_many_active_patients_do_you_have: test
How_many_patients_do_you_seen_per_day: test
Average_number_of_claims_per_month: test
Average_billed_amount_per_claim: test
What_is_the_average_hourly_wage_per_employee: test
Do_you_file_claims_electronically: test
Do_you_experience_a_great_number_of_rejections: test
Do_you_currently_have_a_backlog_of_claims: test
Cost: Submit Form
Date: 26 December, 2006
Time: 04:51 PM

Physicians_Name: Dr. Ronald Miller
Practice_Name: same
Specialty: Internal Medicine
Practice_Phone: 419-353-4565
Practice_Address: 960 W. Wooster Suite 205
City_State: Bowling Green, OH
Zip_Code: 43402
Email_Address: amybeth3@verizon.net
How_many_active_patients_do_you_have: 300
How_many_patients_do_you_seen_per_day: 20
Average_number_of_claims_per_month: 400
Average_billed_amount_per_claim: 80-100
What_is_the_average_hourly_wage_per_employee: 12
Do_you_file_claims_electronically: yes
Do_you_experience_a_great_number_of_rejections: not sure
Do_you_currently_have_a_backlog_of_claims: not sure
Cost: Submit Form
Date: 31 January, 2007
Time: 08:05 PM

Physicians_Name: Regina Hillsman
Practice_Name: Active Orthopedic Therapy
Specialty: Orthopedics
Practice_Phone: (203) 729-2344
Practice_Address: 1183 New Haven Road
City_State: Naugatuck
Zip_Code: 06770
Email_Address: dsav1919@yahoo.com
How_many_active_patients_do_you_have:
How_many_patients_do_you_seen_per_day:
Average_number_of_claims_per_month:
Average_billed_amount_per_claim:
What_is_the_average_hourly_wage_per_employee:
Do_you_file_claims_electronically:
Do_you_experience_a_great_number_of_rejections:
Do_you_currently_have_a_backlog_of_claims:
Cost: Submit Form
Date: 21 June, 2007
Time: 11:40 AM