Luminary Health
Luminary Health Partners, PLLC
2200 Riverside Parkway, Suite 310, Austin, TX 78701
(512) 555-0142 · billing@luminaryhealth.com
Northgate Clinic · Dr. Samuel Ortiz, DO
Invoice
HP-1201
- Issued
- 08-28-2026
- Payment
- Card
Billed to
James Turner
DOB 11-02-1978
77 Harbor View Ln, Oakland, CA 94610
(510) 555-0143 · james.turner@example.com
Rendering provider
Dr. Samuel Ortiz, DO
Northgate Clinic
| Description | Enc. | Qty | Unit price | Amount |
|---|---|---|---|---|
Physical Therapy Session Service· HP-1020 · CPT 97110 | 2 | 2 | $110.00 | $220.00 |
Continuous Glucose Sensor Product· HP-3010 · CPT A4239 Sig: 30-day trial | 1 | 1 | $89.00 | $89.00 |
- Subtotal
- $309.00
- Total due
- $309.00
- Paid by Card
- $309.00
Linked encounters
08-15-2026 · Annual Wellness Evaluation
Procedure · Dr. Alicia Chen, MD · Riverside Clinic · Self-pay · note-8822
Assessment
Healthy adult, routine preventive care.
Plan
Baseline lipid panel. Vitamin D repletion. Annual return.
08-28-2026 · Headache Consult
Telehealth · Dr. Alicia Chen, MD · Riverside Clinic · Insured (Zing Health) · note-8790
Assessment
Tension-type headache, likely posture and strain related.
Plan
Start magnesium glycinate nightly. Ergonomic and hydration guidance. Physical therapy referral for cervical mobility.
Follow-up
Follow-up scheduled with the treating provider.