| Center | Group Name | Plan | LOB | Member ID | Medicare ID | Medicaid ID | Member Name | DOB | Age | Sex | Address | City | ST | Zip | County | Phone | MOS | Mbsp | PCP Name | Age Group | Act-Term | Cur Roster | Stat |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Camillus Health Concern | SIMPLY | MCAID | 732192703 | 9628204581 | Puertas, Lunamarina A | Dec. 6, 2021 | 3 | F | 1310 NW 29TH TER | MIAMI | FL | 331426628 | MIAMI-DADE | 7863660195 | 2025-03 | 1 | Jennings, Chandra M. | PEDIATRIC | A | 2025-06 | None | ||
| Camillus Health Concern | SIMPLY | MCAID | 732492524 | 9506854211 | Garcia, Raiza | Oct. 3, 1986 | 38 | F | 2922 NW 17TH ST | MIAMI | FL | 331251129 | MIAMI-DADE | 2025-03 | 1 | Sahar, Christoph A. | ADULT | A | 2025-06 | None | |||
| Camillus Health Concern | SIMPLY | MCAID | 732654707 | 3184088103 | Mangham, Kanisha N | June 5, 1989 | 35 | F | GENERAL DELIVERY | MIAMI | FL | 331019999 | MIAMI-DADE | 2025-03 | 1 | Sahar, Christoph A. | ADULT | A | 2025-06 | None | |||
| Camillus Health Concern | SIMPLY | MCAID | 732707652 | 3430712025 | Showell, Roberta A | April 5, 1966 | 58 | F | 789 NW 13TH AVE APT 302 | MIAMI | FL | 331253705 | MIAMI-DADE | 7866338682 | 2025-03 | 1 | Gottert, Nicholas C. | ADULT | A | 2025-06 | None | ||
| Camillus Health Concern | SIMPLY | MCAID | 732922455 | 9536261049 | Collazo, Claudia | Oct. 1, 1992 | 32 | F | 1441 NW 19TH ST APT 103 | MIAMI | FL | 331251501 | MIAMI-DADE | 3054928346 | 2025-03 | 1 | Garcia, Roberto F. | ADULT | A | 2025-06 | None | ||
| Camillus Health Concern | SIMPLY | MCAID | 732928497 | 9636963240 | Gonzalez Perez, Lisbelsis M | Oct. 1, 1998 | 26 | F | 7240 W 4TH AVE APT 108 | HIALEAH | FL | 330145080 | MIAMI-DADE | 7866840646 | 2025-03 | 1 | Sahar, Christoph A. | ADULT | A | 2025-06 | None | ||
| Camillus Health Concern | SIMPLY | MCAID | 733739702 | 9560618512 | Ortiz, Iris J | May 24, 1967 | 57 | F | 1827 NW 6TH ST | MIAMI | FL | 331254507 | MIAMI-DADE | 3056802946 | 2025-03 | 1 | Jennings, Chandra M. | ADULT | A | 2025-06 | None | ||
| Camillus Health Concern | SIMPLY | MCAID | 733739766 | 8917901891 | Toledo, Osvaldo A | Oct. 4, 1973 | 51 | M | 1001 E 10 STREET APT 19 | HIALEAH | FL | 33010 | MIAMI-DADE | 7863051494 | 2025-03 | 1 | Garcia, Roberto F. | ADULT | T | None | None | ||
| Camillus Health Concern | SIMPLY | MCAID | 733900109 | 7776583251 | Daniels, Keshanna D | Oct. 7, 1999 | 25 | F | GENERAL DELIVERY | MIAMI | FL | 331019999 | MIAMI-DADE | 9548839224 | 2025-03 | 1 | Sahar, Christoph A. | ADULT | A | 2025-06 | None | ||
| Camillus Health Concern | SIMPLY | MCAID | 733971575 | 7541606472 | Planes, Melissa | March 27, 1984 | 41 | F | 571 SW 9TH ST APT 301 | MIAMI | FL | 331303479 | MIAMI-DADE | 2025-03 | 1 | Gottert, Nicholas C. | ADULT | A | 2025-06 | ENROLLED |
