<xdwc:BulkDWC020SI xmlns:xdwc="http://tdi.texas.gov/DWCForms" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xsi:schemaLocation="http://tdi.texas.gov/DWCForms EmployerFormsSchema.xsd">
    <formData>
        <Name>Agua Dulce ISD</Name>
        <EffectiveDates>
            <StartDate>2024-02-28</StartDate>
            <EndDate>2024-02-29</EndDate>
        </EffectiveDates>
        <Address>
            <Line1>5151 Flynn Pkwy Ste 301</Line1>
            <Line2></Line2>
            <City>Corpus Christi</City>
            <State>TX</State>
            <Zip>78330</Zip>
        </Address>
        <FEIN>746000003</FEIN>
        <POC>
            <Name>Lynn Cummings</Name>
            <Phone>
                <AreaCode>972</AreaCode>
                <Number>8899300</Number>
                <Extension></Extension>
            </Phone>
            <EMail>lcummings@crf.cc</EMail>
        </POC>
        <PoolGroupFlag>N</PoolGroupFlag>
        <ClaimAdminiContactInfo>
            <ClaimAdjustment>
                <BusinessName>Agua Dulce ISD</BusinessName>
                <EffectiveDate>2009-11-02</EffectiveDate>
                <Address>
                    <Line1>5151 Flynn Pkwy Ste 301</Line1>
                    <Line2></Line2>
                    <City>Corpus Christi</City>
                    <State>TX</State>
                    <Zip>78411</Zip>
                </Address>
                <Phone>
                    <CountryCode>1</CountryCode>
                    <AreaCode>671</AreaCode>
                    <Number>7493946</Number>
                    <Extension></Extension>
                </Phone>
                <Fax>
                    <CountryCode>1</CountryCode>
                    <AreaCode>561</AreaCode>
                    <Number>8524035</Number>
                    <Extension>111</Extension>
                </Fax>
                <EMail>lcummings@crf.cc</EMail>
                <Comments>Comments field</Comments>
            </ClaimAdjustment>
            <CoverageVerification>
                <BusinessName>Agua Dulce ISD</BusinessName>
                <EffectiveDate>2015-05-27</EffectiveDate>
                <Address>
                    <Line1>5151 Flynn Pkwy Ste 301</Line1>
                    <Line2></Line2>
                    <City>Corpus Christi</City>
                    <State>TX</State>
                    <Zip>78411</Zip>
                </Address>
                <Phone>
                    <CountryCode>1</CountryCode>
                    <AreaCode>205</AreaCode>
                    <Number>7944625</Number>
                </Phone>
                <Fax>
                    <CountryCode>1</CountryCode>
                    <AreaCode>561</AreaCode>
                    <Number>8524035</Number>
                </Fax>
                <EMail>lcummings@crf.cc</EMail>
                <Comments>Comments field</Comments>
            </CoverageVerification>
            <MedicalBilling>
                <BusinessName>Agua Dulce ISD</BusinessName>
                <EffectiveDate>2018-12-16</EffectiveDate>
                <Address>
                    <Line1>5151 Flynn Pkwy Ste 301</Line1>
                    <Line2></Line2>
                    <City>Corpus Christi</City>
                    <State>TX</State>
                    <Zip>78411</Zip>
                </Address>
                <Phone>
                    <CountryCode>1</CountryCode>
                    <AreaCode>303</AreaCode>
                    <Number>7815124</Number>
                </Phone>
                <Fax>
                    <CountryCode>1</CountryCode>
                    <AreaCode>561</AreaCode>
                    <Number>8524035</Number>
                </Fax>
                <EMail>lcummings@crf.cc</EMail>
                <Comments>Comments field</Comments>
            </MedicalBilling>
            <PharmacyBilling>
                <BusinessName>Agua Dulce ISD</BusinessName>
                <EffectiveDate>1981-04-06</EffectiveDate>
                <Address>
                    <Line1>5151 Flynn Pkwy Ste 301</Line1>
                    <Line2></Line2>
                    <City>Corpus Christi</City>
                    <State>TX</State>
                    <Zip>78411</Zip>
                </Address>
                <Phone>
                    <CountryCode>1</CountryCode>
                    <AreaCode>561</AreaCode>
                    <Number>8524035</Number>
                </Phone>
                <Fax>
                    <CountryCode>1</CountryCode>
                    <AreaCode>561</AreaCode>
                    <Number>8524035</Number>
                </Fax>
                <EMail>lcummings@crf.cc</EMail>
                <Comments>Comments field</Comments>
            </PharmacyBilling>
            <Preauthorization>
                <BusinessName>Agua Dulce ISD</BusinessName>
                <EffectiveDate>1977-02-26</EffectiveDate>
                <Address>
                    <Line1>5151 Flynn Pkwy Ste 301</Line1>
                    <Line2></Line2>
                    <City>Corpus Christi</City>
                    <State>TX</State>
                    <Zip>78411</Zip>
                </Address>
                <Phone>
                    <CountryCode>1</CountryCode>
                    <AreaCode>220</AreaCode>
                    <Number>9212983</Number>
                </Phone>
                <Fax>
                    <CountryCode>1</CountryCode>
                    <AreaCode>561</AreaCode>
                    <Number>8524035</Number>
                </Fax>
                <EMail>lcummings@crf.cc</EMail>
                <Comments>Comments field</Comments>
            </Preauthorization>
            <WCorHCNorMBP>
                <BusinessName>Agua Dulce ISD</BusinessName>
                <EffectiveDate>2009-06-18</EffectiveDate>
                <Address>
                    <Line1>5151 Flynn Pkwy Ste 301</Line1>
                    <Line2></Line2>
                    <City>Corpus Christi</City>
                    <State>TX</State>
                    <Zip>78411</Zip>
                </Address>
                <Phone>
                    <CountryCode>1</CountryCode>
                    <AreaCode>976</AreaCode>
                    <Number>0603504</Number>
                </Phone>
                <Fax>
                    <CountryCode>1</CountryCode>
                    <AreaCode>561</AreaCode>
                    <Number>8524035</Number>
                </Fax>
                <EMail>lcummings@crf.cc</EMail>
                <Comments>Comments field</Comments>
            </WCorHCNorMBP>
        </ClaimAdminiContactInfo>
    </formData>
</xdwc:BulkDWC020SI>