| 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 | 730875680 | Mendez, Yessica | March 4, 1989 | 36 | 111 E FLAGLER ST APT 202 | MIAMI | FL | 331311107 | MIAMI-DADE | 2025-06 | 1 | Sahar, Christoph A. | ADULT | A | 2025-06 | None | |||||
| Camillus Health Concern | SIMPLY | MCAID | 731566839 | Lancaster, Nickiya | Nov. 6, 1995 | 28 | 6020 NW 13TH AVE APT 16 | MIAMI | FL | 331428218 | MIAMI-DADE | 2025-06 | 1 | Sahar, Christoph A. | ADULT | A | 2025-06 | None | |||||
| Camillus Health Concern | SIMPLY | MCAID | 731727872 | Lao Bazan, Ramon | Aug. 31, 1951 | 72 | 820 NW 28TH ST APT W4 | MIAMI | FL | 331274046 | MIAMI-DADE | 7867637991 | 2025-06 | 1 | Brito, Carlos A. | ADULT | A | 2025-06 | None | ||||
| Camillus Health Concern | SIMPLY | MCAID | 732066272 | Navarrete Vazqu, Jose | Feb. 22, 1954 | 71 | HOMELESS | MIAMI | FL | 33142 | MIAMI-DADE | 7863991513 | 2025-06 | 1 | Garcia, Roberto F. | ADULT | A | 2025-06 | None | ||||
| Camillus Health Concern | SIMPLY | MCAID | 732192703 | Puertas, Lunamarina | Dec. 6, 2021 | 2 | 1310 NW 29TH TER | MIAMI | FL | 331426628 | MIAMI-DADE | 7863660195 | 2025-06 | 1 | Jennings, Chandra M. | PEDIATRIC | A | 2025-06 | None | ||||
| Camillus Health Concern | SIMPLY | MCAID | 732492524 | Garcia, Raiza | Oct. 3, 1986 | 37 | 2922 NW 17TH ST | MIAMI | FL | 331251129 | MIAMI-DADE | 2025-06 | 1 | Sahar, Christoph A. | ADULT | A | 2025-06 | None | |||||
| Camillus Health Concern | SIMPLY | MCAID | 732654707 | Mangham, Kanisha | June 5, 1989 | 36 | GENERAL DELIVERY | MIAMI | FL | 331019999 | MIAMI-DADE | 2025-06 | 1 | Sahar, Christoph A. | ADULT | A | 2025-06 | None | |||||
| Camillus Health Concern | SIMPLY | MCAID | 732707652 | Showell, Roberta | April 5, 1966 | 59 | 789 NW 13TH AVE APT 302 | MIAMI | FL | 331253705 | MIAMI-DADE | 7866338682 | 2025-06 | 1 | Gottert, Nicholas C. | ADULT | A | 2025-06 | None | ||||
| Camillus Health Concern | SIMPLY | MCAID | 732922455 | Collazo, Claudia | Oct. 1, 1992 | 31 | 1441 NW 19TH ST APT 103 | MIAMI | FL | 331251501 | MIAMI-DADE | 3054928346 | 2025-06 | 1 | Garcia, Roberto F. | ADULT | A | 2025-06 | None | ||||
| Camillus Health Concern | SIMPLY | MCAID | 732928497 | Gonzalez, Lisbelsis | Oct. 1, 1998 | 25 | 7240 W 4TH AVE APT 108 | HIALEAH | FL | 330145080 | MIAMI-DADE | 7866840646 | 2025-06 | 1 | Sahar, Christoph A. | ADULT | A | 2025-06 | None |
