| A | B | C | D | E | F | G | H | |||
| Estimated | Estimated | Estimated | ||||||||
| Estimated | Payable | Recoverable | Amount Eligible | Estimated | First Interim | |||||
| Submitted | Percent | Amount | Two-Thirds | Amount | for Distribution | Distribution | Distribution | |||
| Type | POC # | Provider Name | POC Amount | Allowable | (Col A x B) | of Col C | To Date | (Col D - E) | at 35% | w/ De Minimus |
| Ancillary | APP0009535 | YOLANDA ABICH, D.D.S. | $1,280.00 | 29.5% | $377.30 | $251.53 | $0.00 | $251.53 | $88.04 | $0.00 |
| Ancillary | APP0009616 | ABLE DENTAL CENTER | $7,231.25 | 85.4% | $6,172.50 | $4,115.00 | $0.00 | $4,115.00 | $1,440.25 | $1,440.25 |
| Ancillary | APP0049356 | ABLE MEDICAL TRANSPORTATION | $768.50 | 39.8% | $306.00 | $204.00 | $0.00 | $204.00 | $71.40 | $0.00 |
| Ancillary | APP0010752 | ACCESS AMBULANCE | $571.84 | 51.4% | $294.00 | $196.00 | $0.00 | $196.00 | $68.60 | $0.00 |
| Ancillary | APP0001558 | ADVANTAGE PHYSICAL THERAPY | $3,155.75 | 0.0% | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Ancillary | APP0009531 | ALL CITY DENTAL SERVICES | $8,241.58 | 98.5% | $8,120.65 | $5,413.77 | $679.60 | $4,734.17 | $1,656.96 | $1,656.96 |
| Ancillary | APP0010480 | ALLIED HEALTH CARE | $6,844.70 | 9.1% | $622.50 | $415.00 | $75.00 | $340.00 | $119.00 | $0.00 |
| Ancillary | APP0005454 | ANTONIO ALOSCO, D.P.M. | $420.00 | 92.9% | $390.00 | $260.00 | $0.00 | $260.00 | $91.00 | $0.00 |
| Ancillary | APP0010560 | ALWAYS CARING MED. TRANSPORT | $780.00 | 21.5% | $168.00 | $112.00 | $0.00 | $112.00 | $39.20 | $0.00 |
| Ancillary | APP0010501 | AMY COOPER GROSSBERG, P.C. | $6,167.40 | 57.6% | $3,555.10 | $2,370.07 | $0.00 | $2,370.07 | $829.52 | $829.52 |
| Ancillary | APP0049234 | ANESTHESIA BILLING CONSULTANTS | $135.00 | 0.0% | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Ancillary | APP0049338 | DONALD ANTONELLI, D.C. | $2,135.00 | 39.3% | $838.40 | $558.93 | $0.00 | $558.93 | $195.63 | $0.00 |
| Ancillary | APP0008247 | AT HOME MEDICAL INC. | $7,854.35 | 11.8% | $926.53 | $617.69 | $0.00 | $617.69 | $216.19 | $0.00 |
| Ancillary | APP0010663 | ATLANTIC CITY MED. CTR.\HOSPICE | $0.00 | 0.0% | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Ancillary | APP0010471 | B.J.ROTH & SONS, INC. | $1,430.42 | 48.1% | $688.00 | $458.67 | $41.04 | $417.63 | $146.17 | $0.00 |
| Ancillary | APP0049232 | ROBERT T. BADO, DC | $1,055.00 | 39.5% | $416.80 | $277.87 | $0.00 | $277.87 | $97.25 | $0.00 |
| Ancillary | APP0009530 | BRUCES BAINES, D.D.S. | $28,639.00 | 22.1% | $6,335.65 | $4,223.77 | $713.95 | $3,509.82 | $1,228.44 | $1,228.44 |
| Ancillary | APP0009740 | ABRAHAM BANKER, D.M.D. | $11,178.10 | 81.7% | $9,133.00 | $6,088.67 | $509.85 | $5,578.82 | $1,952.59 | $1,952.59 |
| Ancillary | APP0009791 | ANDREA BARRETT, D.D.S. | $1,222.00 | 0.0% | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Ancillary | APP0009590 | KENNETH BARTON D.D.S. | $1,625.00 | 17.6% | $286.00 | $190.67 | $1,201.00 | ($1,010.33) | $0.00 | $0.00 |
| Ancillary | APP0010528 | BASIC HOME CARE | $45,452.72 | 98.1% | $44,588.97 | $29,725.98 | $9,929.94 | $19,796.04 | $6,928.61 | $6,928.61 |
| Ancillary | APP0009608 | MICHAEL BATARSEH, D.D.S. | $975.00 | 0.0% | $0.00 | $0.00 | $110.00 | ($110.00) | $0.00 | $0.00 |
| Ancillary | APP0006495 | SIMON BECKER, D.P.M. | $420.00 | 160.2% | $673.00 | $448.67 | $0.00 | $448.67 | $157.03 | $0.00 |
| Ancillary | APP0049392 | BELLEVILLE DENTAL CENTER, PC | $6,245.00 | 15.6% | $976.05 | $650.70 | $0.00 | $650.70 | $227.75 | $0.00 |
| Ancillary | APP0009523 | MORTON BERENBAUM, D.D.S. | $3,958.85 | 81.8% | $3,239.65 | $2,159.77 | $4,176.95 | ($2,017.18) | $0.00 | $0.00 |
| Ancillary | APP0009541 | STANLEY BERG, D.D.S. | $11,100.00 | 51.9% | $5,761.70 | $3,841.13 | $2,023.30 | $1,817.83 | $636.24 | $636.24 |
| Ancillary | APP0010408 | STUART BERGER, O.D. | $315.00 | 2.2% | $7.00 | $4.67 | $119.40 | ($114.73) | $0.00 | $0.00 |
| Ancillary | APP0007372 | BEST CARE MEDICAL SUPPLY | $221.76 | 34.7% | $77.00 | $51.33 | $0.00 | $51.33 | $17.97 | $0.00 |
| Ancillary | APP0009200 | BEST INSTITUTE INC. | $120.00 | 50.7% | $60.83 | $40.55 | $0.00 | $40.55 | $14.19 | $0.00 |
| Ancillary | APP0010620 | BIO-LABS USA INC. | $71,341.00 | 15.5% | $11,076.80 | $7,384.53 | $6.80 | $7,377.73 | $2,582.21 | $2,582.21 |
| Ancillary | APP0005862 | BMA OF JERSEY CITY | $2,085.79 | 62.7% | $1,308.61 | $872.41 | $0.00 | $872.41 | $305.34 | $0.00 |
| Ancillary | APP0009641 | EDWARD BOEHM, D.M.D. | $141,362.00 | 15.6% | $22,071.20 | $14,714.13 | $3,008.05 | $11,706.08 | $4,097.13 | $4,097.13 |
| Ancillary | APP0007578 | PHILIP BOOS, D.C. | $620.00 | 51.1% | $316.68 | $211.12 | $0.00 | $211.12 | $73.89 | $0.00 |
| Ancillary | APP0008094 | STEPHEN BORBERLY, D.P.M. | $6,107.00 | 8.4% | $513.00 | $342.00 | $333.00 | $9.00 | $3.15 | $0.00 |
| Ancillary | APP0009734 | POURANG BRAL, D.D.S. | $14,800.00 | 16.8% | $2,491.35 | $1,660.90 | $50.60 | $1,610.30 | $563.61 | $563.61 |
| Ancillary | APP0008345 | RICHARD BRAVER, D.P.M. | $6,410.00 | 3.2% | $206.00 | $137.33 | $0.00 | $137.33 | $48.07 | $0.00 |
| Ancillary | APP0010366 | BROOKDALE CLINICAL LABORATORY | $277,728.41 | 9.9% | $27,421.96 | $18,281.31 | $802.40 | $17,478.91 | $6,117.62 | $6,117.62 |
| Ancillary | APP0008836 | BURGESS ORTHOTICS | $711.00 | 0.0% | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Ancillary | APP0010365 | CAL LAB, P.A. | $4,598.50 | 18.2% | $835.00 | $556.67 | $122.80 | $433.87 | $151.85 | $0.00 |
| Ancillary | APP0009645 | OLIVER CAMPBELL, D.D.S. | $7,309.50 | 83.7% | $6,117.90 | $4,078.60 | $4,911.90 | ($833.30) | $0.00 | $0.00 |
| Ancillary | APP0009794 | JOHN J. CARCHMAN, D.D.S. | $569.50 | 117.4% | $668.50 | $445.67 | $0.00 | $445.67 | $155.98 | $0.00 |
| Ancillary | APP0010374 | CAREMARK INC. | $920.80 | 99.9% | $920.00 | $613.33 | $1,890.00 | ($1,276.67) | $0.00 | $0.00 |
| Ancillary | APP0010735 | CAREMARK THERAPEUTIC SERVICES | $5,352.96 | 100.0% | $5,352.96 | $3,568.64 | $0.00 | $3,568.64 | $1,249.02 | $1,249.02 |
| Ancillary | APP0010339 | CARLASCIO ORTHOPEDICS | $5,668.14 | 26.6% | $1,507.00 | $1,004.67 | $2,289.50 | ($1,284.83) | $0.00 | $0.00 |
| Ancillary | APP0049514 | CASTLE CHIROPRACTIC CENTER | $1,603.48 | 47.4% | $760.65 | $507.10 | $0.00 | $507.10 | $177.48 | $0.00 |
| Ancillary | APP0008725 | THOMAS CATARELLA, D.C. | $175.00 | 0.0% | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Ancillary | APP0010274 | JOHN CERUTTI, D.C. | $1,165.00 | 38.8% | $451.60 | $301.07 | $0.00 | $301.07 | $105.37 | $0.00 |
| Ancillary | APP0009642 | ALLEN CHENG, D.M.D. | $4,785.38 | 91.2% | $4,362.50 | $2,908.33 | $0.00 | $2,908.33 | $1,017.92 | $1,017.92 |
| Ancillary | APP0009546 | FAINA CHERKEZ D.D.S. | $12,704.60 | 62.8% | $7,982.65 | $5,321.77 | $3,741.00 | $1,580.77 | $553.27 | $553.27 |
| Ancillary | APP0009269 | WAYNE CHIEPPA, D.P.M. | $360.00 | 37.5% | $135.00 | $90.00 | $0.00 | $90.00 | $31.50 | $0.00 |
| Ancillary | APP0009547 | ANTOINE CHIHA D.D.S. | $7,953.00 | 88.4% | $7,032.60 | $4,688.40 | $476.30 | $4,212.10 | $1,474.23 | $1,474.23 |
| Ancillary | APP0049362 | CHIRO-REHAB SPINE CENTER | $350.00 | 0.0% | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Ancillary | APP0009208 | CHIROPRACTIC CENTER OF WESTFIELD | $175.00 | 42.9% | $75.00 | $50.00 | $0.00 | $50.00 | $17.50 | $0.00 |
| Ancillary | APP0008599 | CHRIST HOSPITAL DENTAL | $7,455.00 | 22.2% | $1,654.45 | $1,102.97 | $923.75 | $179.22 | $62.73 | $0.00 |
| Ancillary | APP0010363 | CHRIST HOSPITAL HOME HEALTH | $9,340.00 | 75.8% | $7,078.30 | $4,718.87 | $226.00 | $4,492.87 | $1,572.50 | $1,572.50 |
| Ancillary | APP0008932 | JOSEPH CILEA, D.C. | $4,560.00 | 42.7% | $1,948.40 | $1,298.93 | $0.00 | $1,298.93 | $454.63 | $0.00 |
| Ancillary | APP0008953 | CITY DENTAL | $47,841.75 | 59.0% | $28,215.39 | $18,810.26 | $17,123.65 | $1,686.61 | $590.31 | $590.31 |
| Ancillary | APP0010714 | CITY ELIZABETH AMBULANCE SV BUREAU | $0.00 | 0.0% | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Ancillary | APP0010614 | CITY OF ELIZABETH - EMS CITY HALL | $21,255.24 | 23.9% | $5,073.00 | $3,382.00 | $0.00 | $3,382.00 | $1,183.70 | $1,183.70 |
| Ancillary | APP0009591 | PETER CLEMENTE, D.M.D. | $360.00 | 8.6% | $30.80 | $20.53 | $0.00 | $20.53 | $7.19 | $0.00 |
| Ancillary | APP0010699 | CLIFTON EYE CARE | $15,385.00 | 16.4% | $2,529.00 | $1,686.00 | $365.00 | $1,321.00 | $462.35 | $0.00 |
| Ancillary | APP0009620 | CLINTON HILL DENTAL ASSOC. | $1,565.00 | 7.5% | $117.50 | $78.33 | $0.00 | $78.33 | $27.42 | $0.00 |
| Ancillary | APP0010303 | MARTIN COHEN, D.C. | $175.00 | 0.0% | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Ancillary | APP0009750 | COLOR PLAZA DENTAL CENTER | $443.00 | 92.1% | $407.90 | $271.93 | $196.10 | $75.83 | $26.54 | $0.00 |
| Ancillary | APP0000600 | COMMUNITY MEDICAL CENTER | $21,529.00 | 90.9% | $19,568.76 | $13,045.84 | $44.00 | $13,001.84 | $4,550.64 | $4,550.64 |
| Ancillary | APP0007524 | COMPASSIONATE CARE HOSPICE | $0.00 | 0.0% | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Ancillary | APP0010711 | COMPASSIONATE CARE HOSPICE | $15,400.00 | 11.7% | $1,800.00 | $1,200.00 | $0.00 | $1,200.00 | $420.00 | $0.00 |
| Ancillary | APP0009509 | COMPLETE DENTAL CARE, DMD P.C. | $20,420.00 | 11.3% | $2,307.95 | $1,538.63 | $675.95 | $862.68 | $301.94 | $0.00 |
| Ancillary | APP0010409 | ALLAN R. COOPER, O.D. | $9,858.40 | 57.4% | $5,656.10 | $3,770.73 | $7,799.10 | ($4,028.37) | $0.00 | $0.00 |
| Ancillary | APP0049368 | CORAM ALTERNATE SITE SERVICES | $2,075.20 | 86.2% | $1,789.40 | $1,192.93 | $0.00 | $1,192.93 | $417.53 | $0.00 |
| Ancillary | APP0049491 | CORAM PRESCRIPTION SERVICES | $3,304.53 | 58.6% | $1,935.53 | $1,290.35 | $0.00 | $1,290.35 | $451.62 | $0.00 |
| Ancillary | APP0008145 | CORNELL SURGICAL COMPANY | $467.75 | 82.2% | $384.57 | $256.38 | $0.00 | $256.38 | $89.73 | $0.00 |
| Ancillary | APP0010538 | CREATIVE MEDICAL | $6,358.00 | 88.9% | $5,653.00 | $3,768.67 | $0.00 | $3,768.67 | $1,319.03 | $1,319.03 |
| Ancillary | APP0009592 | WARREN DAVIS D.D.S. | $4,250.80 | 41.4% | $1,760.90 | $1,173.93 | $1,227.60 | ($53.67) | $0.00 | $0.00 |
| Ancillary | APP0009384 | MATTHEW DE LUCA | $163.97 | 0.0% | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Ancillary | APP0005571 | TESTA DEBENEDICTIS, D.P.M. | $885.00 | 36.2% | $320.25 | $213.50 | $2,169.16 | ($1,955.66) | $0.00 | $0.00 |
| Ancillary | APP0009738 | JOHN DEFRANCO, D.D.S. | $5,254.30 | 64.8% | $3,406.55 | $2,271.03 | $319.50 | $1,951.53 | $683.04 | $683.04 |
| Ancillary | APP0006792 | ANGELO DEL PRIORE, D.P.M. | $271.22 | 24.0% | $65.00 | $43.33 | $0.00 | $43.33 | $15.17 | $0.00 |
| Ancillary | APP0004522 | DENTAL HEALTH ASSOC. OF NEWARK | $2,691.10 | 37.8% | $1,016.40 | $677.60 | $0.00 | $677.60 | $237.16 | $0.00 |
| Ancillary | APP0004881 | DENTAL HEALTH ASSOCIATES | $22,915.00 | 55.7% | $12,752.45 | $8,501.63 | $62,423.55 | ($53,921.92) | $0.00 | $0.00 |
| Ancillary | APP0007982 | DENTAL HEALTH ASSOCIATES | $22,815.15 | 78.6% | $17,943.65 | $11,962.43 | $1,718.20 | $10,244.23 | $3,585.48 | $3,585.48 |
| Ancillary | APP0009643 | DENTAL PLAZA, P.A. | $22,025.90 | 98.8% | $21,772.00 | $14,514.67 | $0.00 | $14,514.67 | $5,080.13 | $5,080.13 |
| Ancillary | APP0009515 | MICHAEL DICKMAN, D.D.S | $4,562.05 | 71.8% | $3,274.70 | $2,183.13 | $127.70 | $2,055.43 | $719.40 | $719.40 |
| Ancillary | APP0007793 | PHILIP DIPASQUALE, D.C. | $1,000.00 | 33.8% | $338.40 | $225.60 | $0.00 | $225.60 | $78.96 | $0.00 |
| Ancillary | APP0010734 | ALICIA DORMAN, O.D. | $160.00 | 0.0% | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Ancillary | APP0009597 | ROBERT DORSKY D.M.D. | $1,639.50 | 70.1% | $1,150.10 | $766.73 | $0.00 | $766.73 | $268.36 | $0.00 |
| Ancillary | APP0009976 | DRUG EMPORIUM #0001 | $0.00 | 0.0% | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Ancillary | APP0008928 | EDISON FOOT AND ANKLE CARE PC | $1,661.89 | 44.2% | $735.00 | $490.00 | $0.00 | $490.00 | $171.50 | $0.00 |
| Ancillary | APP0009605 | JAMIL EL-SAMNA, D.D.S. | $7,299.80 | 82.6% | $6,031.70 | $4,021.13 | $1,286.45 | $2,734.68 | $957.14 | $957.14 |
| Ancillary | APP0049428 | ENGLEWOOD KNEE & SPORTS MED. | $270.00 | 0.0% | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Ancillary | APP0004899 | ERIC B. CHANDLER HEALTH CENTER | $17,520.25 | 57.8% | $10,128.65 | $6,752.43 | $712.80 | $6,039.63 |