INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
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('272937959', 'W12012811', 'W12012811', 'UT01', 'Mountain View Family Eyecare', 'Tory', 'J', 'Goode', 'OD', 'Optometry', '', '', NULL, 'B', 'PO Box 571', 'Heber City', 'Wasatch', 'UT', '84032', '4356571555', '4356571556', 'PO Box 571', 'Heber City', 'Wasatch', 'UT', '84032', '4356571555', '4356571556', 'WUTALBERT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-11-10', '2011-11-10', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1154569796', 0, 'N', 0, '2014-04-23', NULL, NULL, 0, 0, NULL, NULL),
('870482436', 'W12012812', 'W12012812', 'UT01', 'Mountain West Eyecare', 'Alan', 'B', 'Gummow', 'OD', 'Optometry', '', '', NULL, 'O', '2727 W 3500 S', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8019686772', '8019686771', '2727 W 3500 S', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8019686772', '8019686771', 'WUTALBERT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-11-10', '2013-02-28', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1558550913', 0, 'N', 0, '2014-04-23', NULL, NULL, 0, 0, NULL, NULL),
('830335735', 'W12012813', 'W12012813', 'WY01', 'Physical Therapy of Star Valley', 'Daniel ', 'D', 'Jeske', 'PT', 'Physical Therapy', '', '', NULL, 'O', '124 Petersen Pkwy Ste 1', 'Thayne', 'Lincoln', 'WY', '83127', '3078837878', '3078837877', '124 Petersen Pkwy Ste 1', 'Thayne', 'Lincoln', 'WY', '83127', '3078837878', '3078837877', 'WYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-08-01', NULL, 0, 0, 0, 'Star Valley Medical Center', '', '', '', 'HCFA|UB|', '1801816897', 0, 'N', 0, '2014-05-13', NULL, NULL, 42.944, -111.008, NULL, NULL),
('830335735', 'W12012814', 'W12012814', 'WY01', 'Physical Therapy of Star Valley', 'Daniel ', 'D', 'Jeske', 'PT', 'Physical Therapy', '', '', NULL, 'B', '161 Lafayette St', 'Winona', 'Winona', 'MN', '55987', '3078837878', '3078837877', '161 Lafayette St', 'Winona', 'Winona', 'MN', '55987', '3078837878', '3078837877', 'WYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-08-01', NULL, 0, 0, 0, 'Star Valley Medical Center', '', '', '', 'HCFA|UB|', '1801816897', 0, 'N', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('830335735', 'W12012815', 'W12012815', 'WYT1', 'Physical Therapy of Star Valley', 'Daniel ', 'D', 'Jeske', 'PT', 'Physical Therapy', '', '', NULL, 'O', '124 Petersen Pkwy Ste 1', 'Thayne', 'Lincoln', 'WY', '83127', '3078837878', '3078837877', '124 Petersen Pkwy Ste 1', 'Thayne', 'Lincoln', 'WY', '83127', '3078837878', '3078837877', 'WYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-08-01', NULL, 0, 0, 0, 'Star Valley Medical Center', '', '', '', 'HCFA|UB|', '1801816897', 0, 'N', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('830335735', 'W12012816', 'W12012816', 'WYT1', 'Physical Therapy of Star Valley', 'Daniel ', 'D', 'Jeske', 'PT', 'Physical Therapy', '', '', NULL, 'B', '161 Lafayette St', 'Winona', 'Winona', 'MN', '55987', '3078837878', '3078837877', '161 Lafayette St', 'Winona', 'Winona', 'MN', '55987', '3078837878', '3078837877', 'WYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-08-01', NULL, 0, 0, 0, 'Star Valley Medical Center', '', '', '', 'HCFA|UB|', '1801816897', 0, 'N', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('830335735', 'W12012817', 'W12012817', 'WY01', 'Physical Therapy of Star Valley', 'David', 'M', 'Johnson', 'PT', 'Physical Therapy', '', '', NULL, 'O', '124 Petersen Pkwy Ste 1', 'Thayne', 'Lincoln', 'WY', '83127', '3078837878', '3078837877', '124 Petersen Pkwy Ste 1', 'Thayne', 'Lincoln', 'WY', '83127', '3078837878', '3078837877', 'WYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1851314785', 0, 'N', 0, '2014-05-13', NULL, NULL, 42.944, -111.008, NULL, NULL),
('830335735', 'W12012820', 'W12012820', 'WY01', 'Physical Therapy of Star Valley', 'David', 'M', 'Johnson', 'PT', 'Physical Therapy', '', '', NULL, 'B', '161 Lafayette St', 'Winona', 'Winona', 'MN', '55987', '3078837878', '3078837877', '161 Lafayette St', 'Winona', 'Winona', 'MN', '55987', '3078837878', '3078837877', 'WYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1851314785', 0, 'N', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('830335735', 'W12012819', 'W12012819', 'WYT1', 'Physical Therapy of Star Valley', 'David', 'M', 'Johnson', 'PT', 'Physical Therapy', '', '', NULL, 'O', '124 Petersen Pkwy Ste 1', 'Thayne', 'Lincoln', 'WY', '83127', '3078837878', '3078837877', '124 Petersen Pkwy Ste 1', 'Thayne', 'Lincoln', 'WY', '83127', '3078837878', '3078837877', 'WYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1851314785', 0, 'N', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('830335735', 'W12012818', 'W12012818', 'WYT1', 'Physical Therapy of Star Valley', 'David', 'M', 'Johnson', 'PT', 'Physical Therapy', '', '', NULL, 'B', '161 Lafayette St', 'Winona', 'Winona', 'MN', '55987', '3078837878', '3078837877', '161 Lafayette St', 'Winona', 'Winona', 'MN', '55987', '3078837878', '3078837877', 'WYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1851314785', 0, 'N', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('223510467', 'W12012825', 'W12012825', 'ID02', 'Medical Diagnostic Laboratories', '', '', 'Medical Diagnostic Laboratories', 'Group', 'Laboratory', '', '', NULL, 'O', '2439 Kuser Rd', 'Trenton', 'Mercer', 'NJ', '08690', '8772690090', '6095701050', '2439 Kuser Rd', 'Trenton', 'Mercer', 'NJ', '08690', '8772690090', '6095701050', 'WULABCORP5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-10-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1750373908', 0, 'N', 0, '2011-11-15', NULL, NULL, 0, 0, NULL, NULL),
('223510467', 'W12012823', 'W12012823', 'TX01', 'Medical Diagnostic Laboratories', '', '', 'Medical Diagnostic Laboratories', 'Group', 'Laboratory', '', '', NULL, 'O', '2439 Kuser Rd', 'Trenton', 'Mercer', 'NJ', '08690', '8772690090', '6095701050', '2439 Kuser Rd', 'Trenton', 'Mercer', 'NJ', '08690', '8772690090', '6095701050', 'WULABCORP5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1750373908', 0, 'N', 0, '2011-11-15', NULL, NULL, 0, 0, NULL, NULL),
('223510467', 'W12012822', 'W12012822', 'UT01', 'Medical Diagnostic Laboratories', '', '', 'Medical Diagnostic Laboratories', 'Group', 'Laboratory', '', '', NULL, 'O', '2439 Kuser Rd', 'Trenton', 'Mercer', 'NJ', '08690', '8772690090', '6095701050', '2439 Kuser Rd', 'Trenton', 'Mercer', 'NJ', '08690', '8772690090', '6095701050', 'WULABCORP5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1750373908', 0, 'N', 0, '2011-11-15', NULL, NULL, 0, 0, NULL, NULL),
('223510467', 'W12012824', 'W12012824', 'WY01', 'Medical Diagnostic Laboratories', '', '', 'Medical Diagnostic Laboratories', 'Group', 'Laboratory', '', '', NULL, 'O', '2439 Kuser Rd', 'Trenton', 'Mercer', 'NJ', '08690', '8772690090', '6095701050', '2439 Kuser Rd', 'Trenton', 'Mercer', 'NJ', '08690', '8772690090', '6095701050', 'WULABCORP5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1750373908', 0, 'N', 0, '2011-11-15', NULL, NULL, 0, 0, NULL, NULL),
('800705979', 'W12012826', 'W12012826', 'UT01', '', 'David', 'J', 'Myers', 'MD', 'Dermatology', '', '', NULL, 'O', '1385 E 750 N', 'Orem', 'Utah', 'UT', '84097', '8012245200', '8012242667', '1385 E 750 N', 'Orem', 'Utah', 'UT', '84097', '8012245200', '8012242667', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-11-10', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1255425252', 0, 'N', 0, '2012-05-24', NULL, NULL, 40.3113, -111.664, NULL, NULL),
('273541098', 'W12012827', 'W12012827', 'UTMH1', '', 'D.', 'K', 'Openshaw', 'LCSW LMFT', 'Mental Health', 'Counseling', 'Social Worker', NULL, 'O', '295 W Schiess Ct', 'Garland', 'Box Elder', 'UT', '84312', '4357537332', '4357977220', '295 W Schiess Ct', 'Garland', 'Box Elder', 'UT', '84312', '4357537332', '4357977220', 'UTPHD', '', '', '0.00', '35.00', '0.00', 3, '2011-09-15', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1528132503', 0, 'N', 0, '2014-04-17', NULL, NULL, 0, 0, NULL, NULL),
('273541098', 'W12012828', 'W12012828', 'UTMH1', '', 'D.', 'K', 'Openshaw', 'LCSW LMFT', 'Mental Health', 'Counseling', 'Social Worker', NULL, 'B', 'PO Box 504', 'Logan', 'Cache', 'UT', '84323', '4357537332', '4357977220', 'PO Box 504', 'Logan', 'Cache', 'UT', '84323', '4357537332', '4357977220', 'UTPHD', '', '', '0.00', '35.00', '0.00', 3, '2011-09-15', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1528132503', 0, 'N', 0, '2014-04-17', NULL, NULL, 0, 0, NULL, NULL),
('519298290', 'W12012829', 'W12012829', 'ID01', 'Ada Orthopaedics', 'Katherine', 'R', 'Reed', 'NP', 'Orthopedic Surgery', 'Family Practice', '', NULL, 'O', '6500 W Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083770777', '2083771070', '6500 W Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083770777', '2083771070', 'IDORTHO2', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2011-11-10', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1588807838', 0, 'N', 0, '2014-03-27', NULL, NULL, 43.612, -116.262, NULL, NULL),
('870570172', 'W12012830', 'W12012830', 'UT01', 'Bear River Medical Arts', 'Alysha', '', 'Stokes', 'NP', 'Family Practice', '', '', NULL, 'O', '300 W 1400 S', 'Garland', 'Box Elder', 'UT', '84312', '4352572469', '4352572434', '300 W 1400 S', 'Garland', 'Box Elder', 'UT', '84312', '4352572469', '4352572434', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-11-10', NULL, 0, 0, 0, 'Bear River Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1992090104', 0, 'N', 0, '2011-11-14', NULL, NULL, 41.7264, -112.158, NULL, NULL),
('830335735', 'W12012832', 'W12012832', 'WY01', 'Physical Therapy of Star Valley', 'Jimmy', '', 'Wheeler', 'PT', 'Physical Therapy', '', '', NULL, 'O', '124 Petersen Pkwy Ste 1', 'Thayne', 'Lincoln', 'WY', '83127', '3078837878', '3078837877', '124 Petersen Pkwy Ste 1', 'Thayne', 'Lincoln', 'WY', '83127', '3078837878', '3078837877', 'WYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1982634879', 0, 'N', 0, '2014-05-01', NULL, NULL, 42.944, -111.008, NULL, NULL),
('830335735', 'W12012835', 'W12012835', 'WY01', 'Physical Therapy of Star Valley', 'Jimmy', '', 'Wheeler', 'PT', 'Physical Therapy', '', '', NULL, 'B', '161 Lafayette St', 'Winona', 'Winona', 'MN', '55987', '3078837878', '3078837877', '161 Lafayette St', 'Winona', 'Winona', 'MN', '55987', '3078837878', '3078837877', 'WYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1982634879', 0, 'N', 0, '2014-05-01', NULL, NULL, 0, 0, NULL, NULL),
('830335735', 'W12012834', 'W12012834', 'WYT1', 'Physical Therapy of Star Valley', 'Jimmy', '', 'Wheeler', 'PT', 'Physical Therapy', '', '', NULL, 'O', '124 Petersen Pkwy Ste 1', 'Thayne', 'Lincoln', 'WY', '83127', '3078837878', '3078837877', '124 Petersen Pkwy Ste 1', 'Thayne', 'Lincoln', 'WY', '83127', '3078837878', '3078837877', 'WYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1982634879', 0, 'N', 0, '2014-05-01', NULL, NULL, 0, 0, NULL, NULL),
('830335735', 'W12012833', 'W12012833', 'WYT1', 'Physical Therapy of Star Valley', 'Jimmy', '', 'Wheeler', 'PT', 'Physical Therapy', '', '', NULL, 'B', '161 Lafayette St', 'Winona', 'Winona', 'MN', '55987', '3078837878', '3078837877', '161 Lafayette St', 'Winona', 'Winona', 'MN', '55987', '3078837878', '3078837877', 'WYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1982634879', 0, 'N', 0, '2014-05-01', NULL, NULL, 0, 0, NULL, NULL),
('830250612', 'W12012837', 'W12012837', 'WY01', 'Central Wyoming Urological Associates', 'James', '', 'Haden', 'MD', 'Urology', '', '', NULL, 'O', '1416 E A St Ste 101', 'Casper', 'Natrona', 'WY', '82601', '3075778600', '3075778605', '1416 E A St Ste 101', 'Casper', 'Natrona', 'WY', '82601', '3075778600', '3075778605', '', '', '', '0.00', '10.00', '0.00', 3, '2011-11-10', NULL, 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1578679809', 0, 'N', 0, '2014-04-17', NULL, NULL, 42.8514, -106.307, NULL, NULL),
('830250612', 'W12012838', 'W12012838', 'WYT2', 'Central Wyoming Urological Associates', 'James', '', 'Haden', 'MD', 'Urology', '', '', NULL, 'O', '1416 E A St Ste 101', 'Casper', 'Natrona', 'WY', '82601', '3075778600', '3075778605', '1416 E A St Ste 101', 'Casper', 'Natrona', 'WY', '82601', '3075778600', '3075778605', '', '', '', '0.00', '10.00', '0.00', 3, '2011-11-10', NULL, 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1578679809', 0, 'N', 0, '2014-04-17', NULL, NULL, 0, 0, NULL, NULL),
('830250612', 'W12012839', 'W12012839', 'Sinclair', 'Central Wyoming Urological Associates', 'James', '', 'Haden', 'MD', 'Urology', '', '', NULL, 'O', '1416 E A St Ste 101', 'Casper', 'Natrona', 'WY', '82601', '3075778600', '3075778605', '1416 E A St Ste 101', 'Casper', 'Natrona', 'WY', '82601', '3075778600', '3075778605', '', '', '', '0.00', '10.00', '0.00', 3, '2011-11-10', NULL, 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1578679809', 0, 'N', 0, '2014-04-17', NULL, NULL, 0, 0, NULL, NULL),
('830250612', 'W12012840', 'W12012840', 'WY01', 'Central Wyoming Urological Associates', 'J Paul', '', 'Jones', 'MD', 'Urology', '', '', NULL, 'O', '1416 E A St Ste 101', 'Casper', 'Natrona', 'WY', '82601', '3075778600', '3075778605', '1416 E A St Ste 101', 'Casper', 'Natrona', 'WY', '82601', '3075778600', '3075778605', '', '', '', '0.00', '10.00', '0.00', 3, '2011-11-10', NULL, 0, 0, 0, 'Wyoming Medical Center ', NULL, NULL, NULL, 'HCFA|UB|', '1275592024', 0, 'N', 0, '2013-06-28', NULL, NULL, 42.8514, -106.307, NULL, NULL),
('830250612', 'W12012841', 'W12012841', 'WYT2', 'Central Wyoming Urological Associates', 'J Paul', '', 'Jones', 'MD', 'Urology', '', '', NULL, 'O', '1416 E A St Ste 101', 'Casper', 'Natrona', 'WY', '82601', '3075778600', '3075778605', '1416 E A St Ste 101', 'Casper', 'Natrona', 'WY', '82601', '3075778600', '3075778605', '', '', '', '0.00', '10.00', '0.00', 3, '2011-11-10', NULL, 0, 0, 1, 'Wyoming Medical Center ', NULL, NULL, NULL, 'HCFA|UB|', '1275592024', 0, 'N', 0, '2013-06-28', NULL, NULL, 0, 0, NULL, NULL),
('830250612', 'W12012844', 'W12012844', 'WY01', 'Central Wyoming Urological Associates', 'Todd ', '', 'Hansen', 'MD', 'Urology', '', '', NULL, 'O', '1416 E A St Ste 101', 'Casper', 'Natrona', 'WY', '82601', '3075778600', '3075778605', '1416 E A St Ste 101', 'Casper', 'Natrona', 'WY', '82601', '3075778600', '3075778605', '', '', '', '0.00', '10.00', '0.00', 3, '2011-08-01', NULL, 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1245293455', 0, 'N', 0, '2014-04-17', NULL, NULL, 42.8514, -106.307, NULL, NULL),
('830250612', 'W12012843', 'W12012843', 'WYT2', 'Central Wyoming Urological Associates', 'Todd ', '', 'Hansen', 'MD', 'Urology', '', '', NULL, 'O', '1416 E A St Ste 101', 'Casper', 'Natrona', 'WY', '82601', '3075778600', '3075778605', '1416 E A St Ste 101', 'Casper', 'Natrona', 'WY', '82601', '3075778600', '3075778605', '', '', '', '0.00', '10.00', '0.00', 3, '2011-08-01', NULL, 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1245293455', 0, 'N', 0, '2014-04-17', NULL, NULL, 0, 0, NULL, NULL),
('452325442', 'W12012845', 'W12012845', 'UT01', 'Utah Oculoplasty Consultants', 'Matheson', 'A', 'Harris', 'MD', 'Ophthalmology', '', '', NULL, 'O', '4400 S 700 E Ste 130', 'Murray', 'Salt Lake', 'UT', '84107', '8012644420', '8012660604', '4400 S 700 E Ste 130', 'Murray', 'Salt Lake', 'UT', '84107', '8012644420', '8012660604', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-10-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1912110230', 0, 'N', 0, '2011-10-07', NULL, NULL, 40.6758, -111.871, NULL, NULL),
('200545016', 'W12012846', 'W12012846', 'WY01', 'Chiropractic Wellness Ctr', 'Kirsten', 'K', 'Maycock', 'DC', 'Chiropractic', '', '', NULL, 'O', '404 S Douglas Hwy', 'Gillette', 'Campbell', 'WY', '82716', '3076824000', '3076860768', '404 S Douglas Hwy', 'Gillette', 'Campbell', 'WY', '82716', '3076824000', '3076860768', '', '', '5004', '0.00', '100.00', '0.00', 3, '2011-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1801977400', 0, 'N', 0, '2014-04-24', NULL, NULL, 44.2912, -105.494, NULL, NULL),
('200545016', 'W12012847', 'W12012847', 'WYT1', 'Chiropractic Wellness Ctr', 'Kirsten', 'K', 'Maycock', 'DC', 'Chiropractic', '', '', NULL, 'O', '404 S Douglas Hwy', 'Gillette', 'Campbell', 'WY', '82716', '3076824000', '3076860768', '404 S Douglas Hwy', 'Gillette', 'Campbell', 'WY', '82716', '3076824000', '3076860768', '', '', '5004', '0.00', '100.00', '0.00', 3, '2011-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1801977400', 0, 'N', 0, '2014-04-24', NULL, NULL, 0, 0, NULL, NULL),
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('830250612', 'W12012852', 'W12012852', 'WY01', 'Central Wyoming Urological Associates', 'Mary', 'E', 'Williams', 'NP', 'Urology', '', '', NULL, 'O', '1416 E A St Ste 701', 'Casper', 'Natrona', 'WY', '82601', '3075778600', '3075778605', '1416 E A St Ste 701', 'Casper', 'Natrona', 'WY', '82601', '3075778600', '3075778605', '', '', '', '0.00', '10.00', '0.00', 3, '2011-11-10', NULL, 0, 0, 0, 'Wyoming Medical Center ', NULL, NULL, NULL, 'HCFA|UB|', '1972803013', 0, 'N', 0, '2011-11-14', NULL, NULL, 42.8514, -106.307, NULL, NULL),
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('800239738', 'W12012863', 'W12012863', 'UT01', 'Jordan Family Health', 'David', 'E', 'Curtis', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', 'PO Box 405483', 'Atlanta', 'Fulton', 'GA', '30384', '8015691999', '8015692001', 'PO Box 405483', 'Atlanta', 'Fulton', 'GA', '30384', '8015691999', '8015692001', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-08-01', '2011-12-31', 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1730222720', 0, 'N', 0, '2012-06-25', NULL, NULL, 0, 0, NULL, NULL),
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('820299231', 'W12012890', 'W12012890', 'ID02', 'Saltzer Medical Group-Hearing & Balance', 'Ryan', 'S', 'Owsley', 'MD', 'Dermatology', '', '', NULL, 'O', '210 W Georgia Ave Ste 100', 'Nampa', 'Canyon', 'ID', '83686', '2084633000', '2084633044', '210 W Georgia Ave Ste 100', 'Nampa', 'Canyon', 'ID', '83686', '2084633000', '2084633044', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-04-21', '2012-01-30', 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', 'Saint Alphonsus Regional Medical Center', '', '', 'HCFA|UB|', '1659361681', 0, 'N', 0, '2014-03-26', NULL, NULL, 43.5564, -116.575, NULL, NULL),
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('820299231', 'W12013144', 'W12013144', 'ID02', 'Saltzer Medical Group', 'David', 'H', 'Clements', 'PA-C', 'Family Practice', '', '', NULL, 'O', '215 E Hawaii Ave', 'Nampa', 'Canyon', 'ID', '83686', '2084633000', '2084633044', '215 E Hawaii Ave', 'Nampa', 'Canyon', 'ID', '83686', '2084633000', '2084633044', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-04-21', '2012-11-11', 0, 0, 1, 'Saint Alphonsus Regional Medical Center', 'Saint Alphonsus Medical Center Nampa', '', '', 'HCFA|UB|', '1114917168', 0, 'N', 0, '2013-08-21', NULL, NULL, 0, 0, NULL, NULL);
INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
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('820299231', 'W12013143', 'W12013143', 'ID02', 'Saltzer Medical Group Rehab', 'David', 'H', 'Clements', 'PA-C', 'Family Practice', '', '', NULL, 'O', '290 W Georgia Ave', 'Nampa', 'Canyon', 'ID', '83686', '2084633000', '2084633044', '290 W Georgia Ave', 'Nampa', 'Canyon', 'ID', '83686', '2084633000', '2084633044', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-04-21', '2012-11-11', 0, 0, 1, 'Saint Alphonsus Regional Medical Center', 'Saint Alphonsus Medical Center Nampa', '', '', 'HCFA|UB|', '1114917168', 0, 'N', 0, '2013-08-21', NULL, NULL, 0, 0, NULL, NULL),
('820299231', 'W12013139', 'W12013139', 'ID02', 'Saltzer Medical Group-Portico', 'David', 'H', 'Clements', 'PA-C', 'Family Practice', '', '', NULL, 'O', '3277 E Louise Dr Ste 200', 'Meridian', 'Ada', 'ID', '83642', '2084633000', '2084633044', '3277 E Louise Dr Ste 200', 'Meridian', 'Ada', 'ID', '83642', '2084633000', '2084633044', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-04-21', '2012-11-11', 0, 0, 1, 'Saint Alphonsus Regional Medical Center', 'Saint Alphonsus Medical Center Nampa', '', '', 'HCFA|UB|', '1114917168', 0, 'N', 0, '2013-08-21', NULL, NULL, 0, 0, NULL, NULL),
('820299231', 'W12013141', 'W12013141', 'ID02', 'Saltzer Medical Group North', 'David', 'H', 'Clements', 'PA-C', 'Family Practice', '', '', NULL, 'O', '4400 E Flamingo Ave', 'Nampa', 'Canyon', 'ID', '83687', '2084633000', '2084633044', '4400 E Flamingo Ave', 'Nampa', 'Canyon', 'ID', '83687', '2084633000', '2084633044', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-04-21', '2012-11-11', 0, 0, 1, 'Saint Alphonsus Regional Medical Center', 'Saint Alphonsus Medical Center Nampa', '', '', 'HCFA|UB|', '1114917168', 0, 'N', 0, '2013-08-21', NULL, NULL, 43.5976, -116.517, NULL, NULL),
('820299231', 'W12013142', 'W12013142', 'ID02', 'Saltzer Medical Group-Sleep', 'David', 'H', 'Clements', 'PA-C', 'Family Practice', '', '', NULL, 'O', '7272 W Potomac Dr', 'Boise', 'Ada', 'ID', '83704', '2084633000', '2084633044', '7272 W Potomac Dr', 'Boise', 'Ada', 'ID', '83704', '2084633000', '2084633044', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-04-21', '2012-11-11', 0, 0, 1, 'Saint Alphonsus Regional Medical Center', 'Saint Alphonsus Medical Center Nampa', '', '', 'HCFA|UB|', '1114917168', 0, 'N', 0, '2013-08-21', NULL, NULL, 0, 0, NULL, NULL),
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('820476912', 'W12013155', 'W12013155', 'ID02', 'Two Rivers Medical Clinic', 'Kent', '', 'Hamilton', 'PAC', 'Physician Assistant', '', '', NULL, 'O', '683 E 3rd St', 'Weiser', 'Washington', 'ID', '83672', '2085490211', '2085490104', '683 E 3rd St', 'Weiser', 'Washington', 'ID', '83672', '2085490211', '2085490104', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-04-21', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1821183617', 0, 'N', 0, '2012-02-02', NULL, NULL, 0, 0, NULL, NULL),
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('820299231', 'W12013157', 'W12013157', 'ID02', 'Saltzer Medical Group North', 'Rachel', 'M', 'King', 'PAC', 'Physician Assistant', '', '', NULL, 'O', '4400 E Flamingo Ave', 'Nampa', 'Canyon', 'ID', '83687', '2084633000', '2084633044', '4400 E Flamingo Ave', 'Nampa', 'Canyon', 'ID', '83687', '2084633000', '2084633044', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-04-21', '2012-12-31', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1205826245', 0, 'N', 0, '2013-02-21', NULL, NULL, 43.5976, -116.517, NULL, NULL),
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('270655418', 'W12013245', 'W12013245', 'UTMH1', 'Davis Mental Health', 'Jaclyn', 'K', 'Knapp', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'M', '2367 N 2350 E', 'Layton', 'Davis', 'UT', '84040', '8016435225', '8018232344', '2367 N 2350 E', 'Layton', 'Davis', 'UT', '84040', '8016435225', '8018232344', 'UTMA', '', '', '0.00', '35.00', '0.00', 3, '2011-11-10', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1508152885', 0, 'N', 0, '2014-05-08', NULL, NULL, 0, 0, NULL, NULL),
('270655418', 'W12013246', 'W12013246', 'UTMH1', 'Davis Mental Health', 'Jaclyn', 'K', 'Knapp', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'B', 'PO Box 1071', 'Layton', 'Davis', 'UT', '84040', '8016435225', '8018232344', 'PO Box 1071', 'Layton', 'Davis', 'UT', '84040', '8016435225', '8018232344', 'UTMA', '', '', '0.00', '35.00', '0.00', 3, '2011-11-10', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1508152885', 0, 'N', 0, '2014-05-08', NULL, NULL, 0, 0, NULL, NULL);
INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
('270283404', 'W12013247', 'W12013247', 'UTMH1', '', 'Ryan', 'L', 'Leybas', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '1174 E Graystone Way Ste 6', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8012772129', '8016495651', '1174 E Graystone Way Ste 6', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8012772129', '8016495651', 'UTMA', '', '', '0.00', '35.00', '0.00', 3, '2011-11-10', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1679741623', 0, 'N', 0, '2014-04-24', NULL, NULL, 0, 0, NULL, NULL),
('270283404', 'W12013248', 'W12013248', 'UTMH1', '', 'Ryan', 'L', 'Leybas', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '535 W 2600 S Ste B', 'Bountiful', 'Davis', 'UT', '84010', '8012772129', '8016495651', '535 W 2600 S Ste B', 'Bountiful', 'Davis', 'UT', '84010', '8012772129', '8016495651', 'UTMA', '', '', '0.00', '35.00', '0.00', 3, '2011-11-10', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1679741623', 0, 'N', 0, '2014-04-24', NULL, NULL, 0, 0, NULL, NULL),
('870414618', 'W12013252', 'W12013252', 'UT01', 'Foot and Ankle Institute', 'Ryan', 'T', 'Peterson', 'DPM', 'Podiatry', '', '', NULL, 'O', '1811 W Royal Hunt Dr', 'Cedar City', 'Iron', 'UT', '84720', '4355862225', '4358671909', '1811 W Royal Hunt Dr', 'Cedar City', 'Iron', 'UT', '84720', '4355862225', '4358671909', 'WURURAL10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-11-10', NULL, 0, 0, 0, 'Dixie Regional Medical Center', 'Valley View Medical Center', NULL, NULL, 'HCFA|UB|', '1245486307', 0, 'N', 0, '2011-11-11', NULL, NULL, 37.658, -113.086, NULL, NULL),
('870414618', 'W12013250', 'W12013250', 'UT01', 'Foot and Ankle Institute', 'Ryan', 'T', 'Peterson', 'DPM', 'Podiatry', '', '', NULL, 'O', '340 Falconridge Pkwy Ste 300 A', 'Mesquite', 'Clark', 'NV', '89027', '7023467678', '7023461623', '340 Falconridge Pkwy Ste 300 A', 'Mesquite', 'Clark', 'NV', '89027', '7023467678', '7023461623', 'WURURAL10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-11-10', NULL, 0, 0, 0, 'Dixie Regional Medical Center', 'Valley View Medical Center', NULL, NULL, 'HCFA|UB|', '1245486307', 0, 'N', 0, '2011-11-11', NULL, NULL, 36.8077, -114.113, NULL, NULL),
('870414618', 'W12013249', 'W12013249', 'UT01', 'Foot and Ankle Institute', 'Ryan', 'T', 'Peterson', 'DPM', 'Podiatry', '', '', NULL, 'O', '52 S 850 W Ste 101', 'Hurricane', 'Washington', 'UT', '84737', '4356354609', '4356355708', '52 S 850 W Ste 101', 'Hurricane', 'Washington', 'UT', '84737', '4356354609', '4356355708', 'WURURAL10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-11-10', NULL, 0, 0, 0, 'Dixie Regional Medical Center', 'Valley View Medical Center', NULL, NULL, 'HCFA|UB|', '1245486307', 0, 'N', 0, '2011-11-11', NULL, NULL, 37.1756, -113.305, NULL, NULL),
('870414618', 'W12013251', 'W12013251', 'UT01', 'Foot And Ankle Institute', 'Ryan', 'T', 'Peterson', 'DPM', 'Podiatry', '', '', NULL, 'B', '754 S Main St Ste 3', 'St George', 'Washington', 'UT', '84770', '4356282671', NULL, '754 S Main St Ste 3', 'St George', 'Washington', 'UT', '84770', '4356282671', '          ', 'WURURAL10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-11-10', NULL, 0, 0, 0, 'Dixie Regional Medical Center', 'Valley View Medical Center', NULL, NULL, 'HCFA|UB|', '1245486307', 0, 'N', 0, '2011-11-11', NULL, NULL, 0, 0, NULL, NULL),
('202500191', 'W12013253', 'W12013253', 'UTMH1', 'Draper Psychological Services', 'Suzanne', 'F', 'Plowman', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '668 E 12225 S Ste 202', 'Draper', 'Salt Lake', 'UT', '84020', '8016193569', '8015767540', '668 E 12225 S Ste 202', 'Draper', 'Salt Lake', 'UT', '84020', '8016193569', '8015767540', 'UTPHD', '', '', '0.00', '35.00', '0.00', 3, '2011-11-10', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1720258726', 0, 'N', 0, '2014-05-01', NULL, NULL, 0, 0, NULL, NULL),
('870179340', 'W12013257', 'W12013257', 'UT01', 'Standard Optical', 'Arthur', '', 'Holloway', 'OD', 'Optometry', '', '', NULL, 'B', '1901 W Pkwy Blvd', 'Salt Lake City', 'Salt Lake', 'UT', '841119', '8015061111', '8015062021', '1901 W Pkwy Blvd', 'Salt Lake City', 'Salt Lake', 'UT', '841119', '8015061111', '8015062021', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-11-10', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1992787923', 0, 'N', 0, '2013-07-25', NULL, NULL, 0, 0, NULL, NULL),
('870179340', 'W12013258', 'W12013258', 'UT01', 'Standard Optical', '', '', 'Standard Optical', 'GROUP', 'Optometry', '', '', NULL, 'O', '1438 E Main St Ste 4', 'Lehi', 'Utah', 'UT', '84043', '8017537999', NULL, '1438 E Main St Ste 4', 'Lehi', 'Utah', 'UT', '84043', '8017537999', '          ', 'WUTALBERT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000008882', 0, 'N', 0, '2013-12-16', NULL, NULL, 40.3884, -111.828, NULL, NULL),
('870179340', 'W12013259', 'W12013259', 'UT01', 'Standard Optical', '', '', 'Standard Optical', 'GROUP', 'Optometry', '', '', NULL, 'O', '4878 S Highland Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012728861', '8012728867', '4878 S Highland Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012728861', '8012728867', 'WUTALBERT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000008882', 0, 'N', 0, '2013-12-16', NULL, NULL, 40.6633, -111.838, NULL, NULL),
('870179340', 'W12013260', 'W12013260', 'UT01', 'Standard Optical', '', '', 'Standard Optical', 'GROUP', 'Optometry', '', '', NULL, 'O', '5289 S State St', 'Murray', 'Salt Lake', 'UT', '84107', '8015061111', '8015062021', '5289 S State St', 'Murray', 'Salt Lake', 'UT', '84107', '8015061111', '8015062021', 'WUTALBERT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000008882', 0, 'N', 0, '2013-12-16', NULL, NULL, 40.6563, -111.888, NULL, NULL),
('611539244', 'W12013261', 'W12013261', 'UT01', 'Eye Center of Ephraim ', 'Jacob', 'M', 'Robison', 'OD', 'Optometry', '', '', NULL, 'O', '43 E 450 N', 'Ephraim', 'Sanpete', 'UT', '84627', '4352835555', '4352838642', '43 E 450 N', 'Ephraim', 'Sanpete', 'UT', '84627', '4352835555', '4352838642', 'WUTALBERT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-11-10', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1780970582', 0, 'N', 0, '2014-04-24', NULL, NULL, 39.3545, -111.588, NULL, NULL),
('205934739', 'W12013262', 'W12013262', 'ID02', 'Family Medicine Health Center', 'Aaron', 'S', 'Anderson', 'MD', 'Family Practice', '', '', NULL, 'O', '777 N Raymond St', 'Boise', 'Ada', 'ID', '83704', '2085142500', '2083752217', '777 N Raymond St', 'Boise', 'Ada', 'ID', '83704', '2085142500', '2083752217', 'IDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2011-08-15', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1730317348', 0, 'N', 0, '2014-06-05', NULL, NULL, 0, 0, NULL, NULL),
('942938348', 'W12013264', 'W12013264', 'UTMH1', 'Valley Mental Health  Inc', 'JULIE', '', 'HENDERSON', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'B', '5965 S 900 E Ste 430', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012637100', NULL, '5965 S 900 E Ste 430', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012637100', '          ', 'UTVMHMA', '', '', '0.00', '35.00', '0.00', 6, '2011-08-15', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1306825104', 0, 'N', 0, '2013-07-09', NULL, NULL, 0, 0, NULL, NULL),
('953372911', 'W12013266', 'W12013266', 'ID02', 'Table Rock Dialysis', '', '', 'Table Rock Dialysis', 'Group', 'Dialysis Center', '', '', NULL, 'O', '5610 Gage St Ste B', 'Boise', 'Ada', 'ID', '83706', '2086588111', NULL, '5610 Gage St Ste B', 'Boise', 'Ada', 'ID', '83706', '2086588111', '          ', '', '', '', '0.00', '15.00', '0.00', 3, '2011-06-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1871545418', 0, 'N', 0, '2011-08-09', NULL, NULL, 0, 0, NULL, NULL),
('953372911', 'W12013270', 'W12013270', 'ID02', 'Treasure Valley Dialysis Center', '', '', 'Treasure Valley Dialysis Center', 'Group', 'Dialysis Center', '', '', NULL, 'O', '3525 E Louise St Ste 155', 'Meridian', 'Ada', 'ID', '83642', '2086393000', NULL, '3525 E Louise St Ste 155', 'Meridian', 'Ada', 'ID', '83642', '2086393000', '          ', '', '', '', '0.00', '15.00', '0.00', 3, '2011-06-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1720032535', 0, 'N', 0, '2011-08-09', NULL, NULL, 0, 0, NULL, NULL),
('953372911', 'W12013271', 'W12013271', 'ID02', 'Treasure Valley Dialysis Center', '', '', 'Treasure Valley Dialysis Center', 'Group', 'Dialysis Center', '', '', NULL, 'B', 'PO Box 402946', 'Atlanta', 'Fulton', 'GA', '30384', '2086393000', NULL, 'PO Box 402946', 'Atlanta', 'Fulton', 'GA', '30384', '2086393000', '          ', '', '', '', '0.00', '15.00', '0.00', 3, '2011-06-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1720032535', 0, 'N', 0, '2011-08-09', NULL, NULL, 0, 0, NULL, NULL),
('953372911', 'W12013272', 'W12013272', 'ID02', 'Table Rock Dialysis', '', '', 'Table Rock Dialysis', 'Group', 'Dialysis Center', '', '', NULL, 'B', 'PO Box 402946', 'Atlanta', 'Fulton', 'GA', '30384', '2086588111', NULL, 'PO Box 402946', 'Atlanta', 'Fulton', 'GA', '30384', '2086588111', '          ', '', '', '', '0.00', '15.00', '0.00', 3, '2011-06-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1871545418', 0, 'N', 0, '2011-08-09', NULL, NULL, 0, 0, NULL, NULL),
('953372911', 'W12013275', 'W12013275', 'ID02', 'Nampa Dialysis Center', '', '', 'Nampa Dialysis Center', 'Group', 'Dialysis Center', '', '', NULL, 'O', '846 Parkcentre Way', 'Nampa', 'Canyon', 'ID', '83651', '2084675180', NULL, '846 Parkcentre Way', 'Nampa', 'Canyon', 'ID', '83651', '2084675180', '          ', '', '', '', '0.00', '15.00', '0.00', 3, '2011-06-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1225089915', 0, 'N', 0, '2011-08-09', NULL, NULL, 0, 0, NULL, NULL),
('953372911', 'W12013274', 'W12013274', 'ID02', 'Nampa Dialysis Center', '', '', 'Nampa Dialysis Center', 'Group', 'Dialysis Center', '', '', NULL, 'B', 'PO Box 402946', 'Atlanta', 'Fulton', 'GA', '30384', '2084675180', NULL, 'PO Box 402946', 'Atlanta', 'Fulton', 'GA', '30384', '2084675180', '          ', '', '', '', '0.00', '15.00', '0.00', 3, '2011-06-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1225089915', 0, 'N', 0, '2011-08-09', NULL, NULL, 0, 0, NULL, NULL),
('953372911', 'W12013278', 'W12013278', 'ID02', 'Caldwell Dialysis Center', '', '', 'Caldwell Dialysis Center', 'Group', 'Dialysis Center', '', '', NULL, 'O', '821 S Smeed Pkwy', 'Caldwell', 'Canyon', 'ID', '83605', '2084548260', NULL, '821 S Smeed Pkwy', 'Caldwell', 'Canyon', 'ID', '83605', '2084548260', '          ', '', '', '', '0.00', '15.00', '0.00', 3, '2011-06-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1619129020', 0, 'N', 0, '2011-08-09', NULL, NULL, 0, 0, NULL, NULL),
('953372911', 'W12013277', 'W12013277', 'ID02', 'Caldwell Dialysis Center', '', '', 'Caldwell Dialysis Center', 'Group', 'Dialysis Center', '', '', NULL, 'B', 'PO Box 402946', 'Atlanta', 'Fulton', 'GA', '30384', '2084548260', NULL, 'PO Box 402946', 'Atlanta', 'Fulton', 'GA', '30384', '2084548260', '          ', '', '', '', '0.00', '15.00', '0.00', 3, '2011-06-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1619129020', 0, 'N', 0, '2011-08-09', NULL, NULL, 0, 0, NULL, NULL),
('272481635', 'W12013280', 'W12013280', 'ID02', 'Saint Alphonsus Medical Center - Nampa', 'John', 'J', 'Loffarelli', 'DO', 'Hospitalist', '', '', NULL, 'B', 'PO Box 60000', 'San Francisco', 'San Francisco', 'CA', '94160', '2536821710', NULL, 'PO Box 60000', 'San Francisco', 'San Francisco', 'CA', '94160', '2536821710', '          ', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-07-21', '2012-09-01', 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1194728329', 0, 'N', 0, '2012-10-29', NULL, NULL, 0, 0, NULL, NULL),
('820482491', 'W12013281', 'W12013281', 'ID02', 'Intermountain Eye & Laser Centers PLLC', 'Adam', 'C', 'Reynolds', 'MD', 'Ophthalmology', NULL, NULL, NULL, 'B', '3090 E Gentry Way Ste 140', 'Meridian', 'Ada', 'ID', '83642', '2083758799', '2088989924', '3090 E Gentry Way Ste 140', 'Meridian', 'Ada', 'ID', '83642', '2083758799', '2088989924', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-08-15', NULL, 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1417916586', 0, 'Y', 0, '2011-08-09', NULL, NULL, 0, 0, NULL, NULL),
('820482491', 'W12013282', 'W12013282', 'SACN', 'Intermountain Eye & Laser Centers PLLC', 'Adam', 'C', 'Reynolds', 'MD', 'Ophthalmology', NULL, NULL, NULL, 'B', '3090 E Gentry Way Ste 140', 'Meridian', 'Ada', 'ID', '83642', '2083758799', '2083731216', '3090 E Gentry Way Ste 140', 'Meridian', 'Ada', 'ID', '83642', '2083758799', '2083731216', 'IDSINCLAIRL', '', '', '0.00', '15.00', '0.00', 3, '2011-08-15', NULL, 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1417916586', 0, 'N', 0, '2011-08-09', NULL, NULL, 0, 0, NULL, NULL),
('820482491', 'W12013285', 'W12013285', 'SACN', 'Intermountain Eye & Laser Centers', 'James', 'R', 'Swartley', 'MD', 'Ophthalmology', '', '', NULL, 'B', '3090 E Gentry Way Ste 140', 'Meridian', 'Ada', 'ID', '83642', '2083758799', '2083731216', '3090 E Gentry Way Ste 140', 'Meridian', 'Ada', 'ID', '83642', '2083758799', '2083731216', 'IDSINCLAIRL', '', '', '0.00', '15.00', '0.00', 3, '2011-08-15', '2013-08-07', 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|UB|', '1003861253', 0, 'N', 0, '2013-08-23', NULL, NULL, 0, 0, NULL, NULL),
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('820482491', 'W12013289', 'W12013289', 'ID02', 'Intermountain Eye & Laser Centers PLLC', 'James', 'P', 'Tweeten', 'MD', 'Ophthalmology', '', '', NULL, 'B', '3090 E Gentry Way Ste 140', 'Meridian', 'Ada', 'ID', '83642', '2083758799', '2088989924', '3090 E Gentry Way Ste 140', 'Meridian', 'Ada', 'ID', '83642', '2083758799', '2088989924', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-08-15', NULL, 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|UB|', '1396791513', 0, 'Y', 0, '2011-08-09', NULL, NULL, 0, 0, NULL, NULL),
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('260553931', 'W12013435', 'W12013435', 'ID01', 'Saint Alphonsus Medical Group Heart Care Boise', 'Charles', 'M', 'Rasmussen', 'MD', 'Cardiology', '', '', NULL, 'O', '6140 W Curtisian Ste 200', 'Boise', 'Ada', 'ID', '83704', '2083674278', '2083675200', '6140 W Curtisian Ste 200', 'Boise', 'Ada', 'ID', '83704', '2083674278', '2083675200', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2011-07-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1881611424', 0, 'N', 0, '2014-03-27', NULL, NULL, 43.6151, -116.256, NULL, NULL),
('260553931', 'W12013436', 'W12013436', 'ID01', 'Saint Alphonsus Medical Group Family Medicine Dominican', 'Christopher', '', 'Alessi', 'MD', 'Vascular Surgery', 'Cardiovascular Disease', '', NULL, 'O', '1118 NW 16th Ste A', 'Fruitland', 'Payette', 'ID', '83619', '2084526851', '2084522140', '1118 NW 16th Ste A', 'Fruitland', 'Payette', 'ID', '83619', '2084526851', '2084522140', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2010-07-08', '2010-11-15', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1598726960', 0, 'N', 0, '2014-03-03', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12013438', 'W12013438', 'ID01', 'Saint Alphonsus Medical Group Hospitalist Boise', 'Jenifer', '', 'Barry', 'MD', 'Hospitalist', '', '', NULL, 'B', '3340 E Goldstone', 'Meridian', 'Ada', 'ID', '83642', '2083675170', '2083675180', '3340 E Goldstone', 'Meridian', 'Ada', 'ID', '83642', '2083675170', '2083675180', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2011-07-21', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1164673968', 0, 'N', 0, '2014-06-20', NULL, NULL, 0, 0, NULL, NULL),
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('820200895', 'W12013441', 'W12013441', 'IDBOISTD', 'Saint Alphonsus Medical Group Pulmonary & Sleep Boise ', 'Michael', 'R', 'Blumhardt', 'MD', 'Pulmonary', '', '', NULL, 'O', '6140 W Curtisian Ste B10', 'Boise', 'Ada', 'ID', '83704', '2083678333', '2083672003', '6140 W Curtisian Ste B10', 'Boise', 'Ada', 'ID', '83704', '2083678333', '2083672003', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2011-07-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1952462798', 0, 'Y', 0, '2014-06-20', NULL, NULL, 43.6146, -116.258, NULL, NULL),
('260553931', 'W12013444', 'W12013444', 'ID01', 'Saint Alphonsus  Medical Group Coughlin Clinic Boise', 'Jackie', '', 'Callaway', 'PA-C', 'Family Practice', '', '', NULL, 'O', '1075 N Curtis Rd Ste 300', 'Boise', 'Ada', 'ID', '83706', '2083673330', '2083673331', '1075 N Curtis Rd Ste 300', 'Boise', 'Ada', 'ID', '83706', '2083673330', '2083673331', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2011-07-01', '2013-01-21', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, '', '', 'HCFA|UB|', '1801196720', 0, 'N', 0, '2013-11-22', NULL, NULL, 43.6143, -116.258, NULL, NULL),
('260553931', 'W12013445', 'W12013445', 'ID01', 'Saint Alphonsus Medical Group Maternal Fetal Medicine Boise', 'Patricia', '', 'Caplinger', 'MD', 'Hospitalist', '', '', NULL, 'O', '900 N Liberty Ste 206 and Ste 204', 'Boise', 'Ada', 'ID', '83704', '2083672229', '2083674242', '900 N Liberty Ste 206 and Ste 204', 'Boise', 'Ada', 'ID', '83704', '2083672229', '2083674242', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2011-07-01', '2012-08-19', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1588605364', 0, 'Y', 0, '2014-07-09', NULL, NULL, 43.6133, -116.259, NULL, NULL),
('260553931', 'W12014205', 'W12014205', 'ID01', 'Saint Alphonsus Medical Group Coughlin Clinic Boise ', 'Michael', 'J', 'Coughlin', 'MD; Foot/Ankle', 'Orthopedic Surgery', '', '', NULL, 'O', '1075 N Curtis Rd Ste 300', 'Boise', 'Ada', 'ID', '83706', '2083673330', '2083673331', '1075 N Curtis Rd Ste 300', 'Boise', 'Ada', 'ID', '83706', '2083673330', '2083673331', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2011-07-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1023010824', 0, 'N', 0, '2014-07-09', NULL, NULL, 43.6143, -116.258, NULL, NULL),
('820200895', 'W12013455', 'W12013455', 'ID01', 'Saint Alphonsus Medical Group Garrity', 'Seana', 'K', 'Daly', 'MD', 'Family Practice', '', '', NULL, 'O', '4400 E Flamingo Ave Ste 301', 'Nampa', 'Canyon', 'ID', '83687', '2084656900', '2084656910', '4400 E Flamingo Ave Ste 301', 'Nampa', 'Canyon', 'ID', '83687', '2084656900', '2084656910', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2011-07-18', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|', '1558301929', 0, 'N', 0, '2014-03-20', NULL, NULL, 43.5976, -116.517, NULL, NULL),
('820200895', 'W12013456', 'W12013456', 'ID01', 'Saint Alphonsus Medical Group NHP Family Medicine  ', 'Matthew', 'K', 'Eastman', 'DO', 'Family Practice', '', '', NULL, 'O', '4400 E Flamingo Ave Ste 301', 'Nampa', 'Canyon', 'ID', '83687', '2084656900', '2084656910', '4400 E Flamingo Ave Ste 301', 'Nampa', 'Canyon', 'ID', '83687', '2084656900', '2084656910', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2011-07-18', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1952344962', 0, 'N', 0, '2014-06-20', NULL, NULL, 43.5976, -116.517, NULL, NULL),
('820200895', 'W12013457', 'W12013457', 'ID01', 'Saint Alphonsus Medical Group MHP Family Medicine', 'Stephen', 'J', 'Focht', 'MD', 'Hospitalist', '', '', NULL, 'O', '3025 W Cherry Ln Ste B', 'Meridian', 'Ada', 'ID', '83642', '2083678550', '2083678555', '3025 W Cherry Ln Ste B', 'Meridian', 'Ada', 'ID', '83642', '2083678550', '2083678555', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2011-07-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|', '1043288004', 0, 'Y', 0, '2012-10-29', NULL, NULL, 43.6188, -116.431, NULL, NULL),
('820200895', 'W12013459', 'W12013459', 'ID01', 'CARE Maternal/Child Health Program - Do Not Publish', 'Karen', '', 'Godard', 'NPC', 'Nurse Practitioner', '', '', NULL, 'B', '3340 E Goldstone', 'Meridian', 'Ada', 'ID', '83642', '2083675170', '2083674505', '3340 E Goldstone', 'Meridian', 'Ada', 'ID', '83642', '2083675170', '2083674505', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2011-07-21', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1033102579', 0, 'N', 0, '2011-09-19', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12013461', 'W12013461', 'ID01', 'Saint Alphonsus Medical Group Occupational Medicine Associat', 'Michael', '', 'Hardesty', 'PAC', 'Family Practice', '', '', NULL, 'B', '3340 E Goldstone', 'Meridian', 'Ada', 'ID', '83642', '2083675170', NULL, '3340 E Goldstone', 'Meridian', 'Ada', 'ID', '83642', '2083675170', '          ', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2011-07-21', '2013-01-21', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|', '1912035999', 0, 'N', 0, '2013-11-22', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12013462', 'W12013462', 'ID01', 'Saint Alphonsus Medical Group Occupational Med EHP', 'Douglas', 'M', 'Hill', 'MD', 'Family Practice', 'Occupational Medicine', '', NULL, 'O', '323 Riverside Dr Ste 224', 'Eagle', 'Ada', 'ID', '83616', '2083675750', '2083675765', '323 Riverside Dr Ste 224', 'Eagle', 'Ada', 'ID', '83616', '2083675750', '2083675765', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2011-07-01', '2012-03-18', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', 'West Valley Medical Center', 'Saint Alphonsus Medical Center Nampa', 'HCFA|', '1699719674', 0, 'N', 0, '2012-05-09', NULL, NULL, 0, 0, NULL, NULL),
('260553931', 'W12006759', 'W12006759', 'ID01', 'Saint Alphonsus Medical Group Heart Care Nampa', 'Tosha', 'J', 'Johnson', 'NPC', 'Cardiology', 'Nurse Practitioner', '', NULL, 'O', '1524 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2084635050', '2084635040', '1524 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2084635050', '2084635040', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2010-12-06', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1639214216', 0, 'N', 0, '2014-06-13', NULL, NULL, 43.5537, -116.573, NULL, NULL),
('820200895', 'W12014217', 'W12014217', 'ID01', 'Saint Alphonsus Medical Group NHP Family Medicine', 'Daniel', 'S', 'Knorpp', 'DO', 'Family Practice', '', '', NULL, 'O', '4400 E Flamingo Ste 301', 'Nampa', 'Canyon', 'ID', '83687', '2084656900', '2084656910', '4400 E Flamingo Ste 301', 'Nampa', 'Canyon', 'ID', '83687', '2084656900', '2084656910', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2011-08-05', '2012-08-19', 0, 0, 0, 'West Valley Medical Center', '', '', '', 'HCFA|', '1538214184', 0, 'N', 0, '2014-06-20', NULL, NULL, 43.5976, -116.517, NULL, NULL),
('460500210', 'W12013464', 'W12013464', 'ID01', 'Saint Alphonsus Oncology Physician Services', 'Alan', 'D', 'Langerak', 'MD', 'Hematology and Oncology', 'Oncology', '', NULL, 'O', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083673131', '2083673174', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083673131', '2083673174', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2011-07-21', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1902853294', 0, 'N', 0, '2014-05-28', NULL, NULL, 43.6127, -116.254, NULL, NULL),
('460500210', 'W12013466', 'W12013466', 'ID01', 'Saint Alphonsus Oncology Physician Services', 'Alan', 'D', 'Langerak', 'MD', 'Hematology and Oncology', 'Oncology', '', NULL, 'O', '1202 E Locust', 'Emmett', 'Gem', 'ID', '83617', '2083653561', '2083673174', '1202 E Locust', 'Emmett', 'Gem', 'ID', '83617', '2083653561', '2083673174', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2011-07-21', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1902853294', 0, 'N', 0, '2014-05-28', NULL, NULL, 43.8791, -116.485, NULL, NULL),
('460500210', 'W12013465', 'W12013465', 'ID01', 'Saint Alphonsus Oncology Physician Services', 'Alan', 'D', 'Langerak', 'MD', 'Hematology and Oncology', 'Oncology', '', NULL, 'O', '3123 Medical Dr', 'Caldwell', 'Canyon', 'ID', '83605', '2083674810', '2083674817', '3123 Medical Dr', 'Caldwell', 'Canyon', 'ID', '83605', '2083674810', '2083674817', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2011-07-21', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1902853294', 0, 'N', 0, '2014-05-28', NULL, NULL, 43.6596, -116.658, NULL, NULL),
('460500210', 'W12013467', 'W12013467', 'ID01', 'Saint Alphonsus Oncology Physician Services', 'Alan', 'D', 'Langerak', 'MD', 'Hematology and Oncology', 'Oncology', '', NULL, 'B', 'PO Box 9589', 'Boise', 'Ada', 'ID', '83707', '2084728115', '2083673174', 'PO Box 9589', 'Boise', 'Ada', 'ID', '83707', '2084728115', '2083673174', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2011-07-21', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1902853294', 0, 'N', 0, '2014-05-28', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12013468', 'W12013468', 'ID01', 'Saint Alphonsus Medical Group NHP Family Medicine  ', 'Brigitta', 'S', 'Lavergne', 'MD', 'Family Practice', '', '', NULL, 'O', '4400 E Flamingo Ave Ste 301', 'Nampa', 'Canyon', 'ID', '83687', '2084656900', '2084656910', '4400 E Flamingo Ave Ste 301', 'Nampa', 'Canyon', 'ID', '83687', '2084656900', '2084656910', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2011-07-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|', '1164596557', 0, 'N', 0, '2014-06-20', NULL, NULL, 43.5976, -116.517, NULL, NULL),
('820200895', 'W12013471', 'W12013471', 'ID01', 'Weiser Specialty ClinicWeiser', 'Helen', '', 'Lawler', 'PAC', 'Cardiology', 'Physician Assistant', '', NULL, 'B', '3340 E Goldstone', 'Meridian', 'Ada', 'ID', '83642', '2083675170', '2083675200', '3340 E Goldstone', 'Meridian', 'Ada', 'ID', '83642', '2083675170', '2083675200', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2011-07-21', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|', '1336184803', 0, 'N', 0, '2013-01-10', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12013472', 'W12013472', 'ID01', 'Saint Alphonsus Medical Group NHP Family Medicine  ', 'Mylynda', 'B', 'Massart', 'MD', 'Family Practice', '', '', NULL, 'O', '4400 E Flamingo Ave Ste 301', 'Nampa', 'Canyon', 'ID', '83687', '2084656900', '2084656910', '4400 E Flamingo Ave Ste 301', 'Nampa', 'Canyon', 'ID', '83687', '2084656900', '2084656910', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2011-07-18', '2012-08-19', 0, 0, 0, 'West Valley Medical Center', NULL, NULL, NULL, 'HCFA|', '1497936587', 0, 'N', 0, '2013-09-05', NULL, NULL, 43.5976, -116.517, NULL, NULL),
('260553931', 'W12013473', 'W12013473', 'ID01', 'Saint Alphonsus Medical Group Heart Care Twin Falls', 'Mark', 'G', 'Parent', 'MD', 'Cardiology', '', '', NULL, 'O', '1330 Filer Ave E', 'Twin Falls', 'Twin Falls', 'ID', '83301', '2083674278', '2083675200', '1330 Filer Ave E', 'Twin Falls', 'Twin Falls', 'ID', '83301', '2083674278', '2083675200', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2009-12-21', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1558301515', 0, 'Y', 0, '2013-01-10', NULL, NULL, 42.5701, -114.457, NULL, NULL),
('820200895', 'W12013474', 'W12013474', 'ID01', 'Saint Alphonsus Medical Group Shoreline Family Medicine', 'Susan', '', 'Paytash', 'PA-C', 'Physician Assistant', '', '', NULL, 'O', '1673 W Shoreline Dr Ste 120', 'Boise', 'Ada', 'ID', '83702', '2083678383', '2083678135', '1673 W Shoreline Dr Ste 120', 'Boise', 'Ada', 'ID', '83702', '2083678383', '2083678135', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2009-12-17', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|', '1912073370', 0, 'N', 0, '2012-10-12', NULL, NULL, 43.6174, -116.221, NULL, NULL),
('820200895', 'W12013476', 'W12013476', 'IDBOISTD', 'Saint Alphonsus Medical Group Garrity Family Medicine', 'Kristine', 'M', 'Reinhardt', 'NPC', 'Family Practice', 'Nurse Practitioner', '', NULL, 'B', '3340 E Goldstone', 'Meridian', 'Ada', 'ID', '83642', '2083675170', '2083672003', '3340 E Goldstone', 'Meridian', 'Ada', 'ID', '83642', '2083675170', '2083672003', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2011-07-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|', '1639490006', 0, 'N', 0, '2014-06-20', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12013477', 'W12013477', 'ID01', 'Saint Alphonsus Medical Group Neurology Fruitland', 'Mary', 'E', 'River', 'MD', 'Neurology', '', '', NULL, 'O', '1118 Nw 16th St Ste A', 'Fruitland', 'Payette', 'ID', '83619', '2083674000', '2083674052', '1118 Nw 16th St Ste A', 'Fruitland', 'Payette', 'ID', '83619', '2083674000', '2083674052', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2009-12-21', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1205882743', 0, 'N', 0, '2014-05-20', NULL, NULL, 44.025, -116.928, NULL, NULL),
('205395628', 'W12013478', 'W12013478', 'UTMH1', 'Behavioral Health Associates of Utah', 'Milo', 'F', 'Garcia', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '108 N Main Ste I', 'Richfield', 'Sevier', 'UT', '84701', '4358965165', NULL, '108 N Main Ste I', 'Richfield', 'Sevier', 'UT', '84701', '4358965165', '', 'UTMA', '', '', '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1710045455', 0, 'N', 0, '2014-05-08', NULL, NULL, 0, 0, NULL, NULL),
('830249721', 'W12013480', 'W12013480', 'WYT2', 'Johnson County Hospital District', '', '', 'Johnson County Hospital District', 'GROUP', 'Hospital', '', '', NULL, 'O', '497 W Lott', 'Buffalo', 'Johnson', 'WY', '82834', '3076846188', NULL, '497 W Lott', 'Buffalo', 'Johnson', 'WY', '82834', '3076846188', '          ', '', '', '', '0.00', '5.00', '0.00', 3, '2009-08-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000006978', 0, 'N', 0, '2011-08-23', NULL, NULL, 0, 0, NULL, NULL),
('260553931', 'W12013481', 'W12013481', 'ID01', 'Saint Alphonsus Medical Group Heart Care Twin Falls', 'Walter', 'L', 'Seale', 'MD', 'Cardiology', '', '', NULL, 'O', '1330 Filer Ave E', 'Twin Falls', 'Twin Falls', 'ID', '83301', '2083674278', '2083675200', '1330 Filer Ave E', 'Twin Falls', 'Twin Falls', 'ID', '83301', '2083674278', '2083675200', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2011-07-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1720033459', 0, 'Y', 0, '2014-01-24', NULL, NULL, 42.5701, -114.457, NULL, NULL),
('820200895', 'W12013482', 'W12013482', 'ID01', 'Saint Alphonsus Medical Group Family Practice Nampa Health Plaza', 'Cherese', 'R', 'Severson', 'NPC', 'Family Practice', '', '', NULL, 'O', '4400 E Flamingo Ave Ste 301', 'Nampa', 'Canyon', 'ID', '83687', '2084656900', '2084656910', '4400 E Flamingo Ave Ste 301', 'Nampa', 'Canyon', 'ID', '83687', '2084656900', '2084656910', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2011-07-18', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, NULL, NULL, 'HCFA|', '1275631244', 0, 'N', 0, '2013-09-05', NULL, NULL, 43.5976, -116.517, NULL, NULL),
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('260553931', 'W12013488', 'W12013488', 'ID01', 'Saint Alphonsus Medical Group Coughlin Clinic ', 'Faustin', '', 'Stevens', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '901 N Curtis Rd Ste 503', 'Boise', 'Ada', 'ID', '83706', '2083673330', '2083673331', '901 N Curtis Rd Ste 503', 'Boise', 'Ada', 'ID', '83706', '2083673330', '2083673331', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2011-07-21', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1942400536', 0, 'N', 0, '2011-09-19', NULL, NULL, 43.6126, -116.255, NULL, NULL),
('820200895', 'W12013490', 'W12013490', 'ID01', 'Saint Alphonsus Medical Group NHP  Family Medicine', 'Cynda', 'L', 'Tomlinson', 'MD', 'Family Practice', '', '', NULL, 'O', '4400  E Flamingo Ave Ste 301', 'Nampa', 'Canyon', 'ID', '83687', '2084656900', '2084656910', '4400  E Flamingo Ave Ste 301', 'Nampa', 'Canyon', 'ID', '83687', '2084656900', '2084656910', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2009-12-21', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1891703070', 0, 'N', 0, '2014-06-20', NULL, NULL, 43.5976, -116.517, NULL, NULL),
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('942854057', 'W12013504', 'W12013504', 'UTIHCPHY', 'River Road InstaCare', 'Matthew', 'S', 'McIff', 'MD', 'Family Medicine', 'Urgent Care', '', NULL, 'O', '577 S River Rd', 'St George', 'Washington', 'UT', '84790', '4356886300', '4356886333', '577 S River Rd', 'St George', 'Washington', 'UT', '84790', '4356886300', '4356886333', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2011-08-11', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1437358280', 0, 'Y', 0, '2013-12-30', NULL, NULL, 37.0986, -113.557, NULL, NULL),
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('841433992', 'W12013521', 'W12013521', 'UTIHCPHY', 'Rosenberg Cooley Metcalf', 'Vernon', 'J', 'Cooley', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '5848 S Fashion Blvd', 'Murray', 'Salt Lake', 'UT', '84107', '8017434500', NULL, '5848 S Fashion Blvd', 'Murray', 'Salt Lake', 'UT', '84107', '8017434500', '          ', 'WMETCALF', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-08-01', NULL, 0, 0, 0, 'Park City Medical Center', 'Heber Valley Medical Center', '', '', 'HCFA|UB|', '1891747291', 0, 'N', 0, '2011-11-21', NULL, NULL, 40.6447, -111.883, NULL, NULL),
('841433992', 'W12013522', 'W12013522', 'UTIHCPHY', 'Rosenberg Cooley Metcalf', 'Vernon', 'J', 'Cooley', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '900 Round Valley Dr Ste 100', 'Park City', 'Summit', 'UT', '84060', '4356556600', NULL, '900 Round Valley Dr Ste 100', 'Park City', 'Summit', 'UT', '84060', '4356556600', '          ', 'WMETCALF', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-08-01', NULL, 0, 0, 0, 'Park City Medical Center', 'Heber Valley Medical Center', '', '', 'HCFA|UB|', '1891747291', 0, 'N', 0, '2011-11-21', NULL, NULL, 40.6876, -111.468, NULL, NULL);
INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
('841433992', 'W12013523', 'W12013523', 'UTIHCPHY', 'Rosenberg Cooley Metcalf', 'Troy', 'S', 'Johnson', 'PA-C', 'Orthopedic Surgery', 'Family Practice', '', NULL, 'O', '900 Round Valley Dr Ste 100', 'Park City', 'Summit', 'UT', '84060', '4356556600', NULL, '900 Round Valley Dr Ste 100', 'Park City', 'Summit', 'UT', '84060', '4356556600', '          ', 'WMETCALF', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1730197252', 0, 'N', 0, '2013-10-16', NULL, NULL, 40.6876, -111.468, NULL, NULL),
('841433992', 'W12013524', 'W12013524', 'UTIHCPHY', 'Rosenberg Cooley Metcalf', 'Richard', 'S', 'Klatt', 'PA-C', 'Orthopedic Surgery', '', '', NULL, 'O', '5848 S Fashion Blvd', 'Murray', 'Salt Lake', 'UT', '84107', '8017434500', NULL, '5848 S Fashion Blvd', 'Murray', 'Salt Lake', 'UT', '84107', '8017434500', '          ', 'WMETCALF', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1710995386', 0, 'N', 0, '2012-01-30', NULL, NULL, 40.6447, -111.883, NULL, NULL),
('841433992', 'W12013527', 'W12013527', 'UTIHCPHY', 'Rosenberg Cooley Metcalf', 'Charles', 'C', 'Lind', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '900 Round Valley Dr Ste 100', 'Park City', 'Summit', 'UT', '84060', '4356556600', NULL, '900 Round Valley Dr Ste 100', 'Park City', 'Summit', 'UT', '84060', '4356556600', '          ', 'WMETCALF', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-08-01', NULL, 0, 0, 0, 'Park City Medical Center', '', '', '', 'HCFA|UB|', '1275514499', 0, 'N', 0, '2011-10-03', NULL, NULL, 40.6876, -111.468, NULL, NULL),
('841433992', 'W12013526', 'W12013526', 'UTIHCPHY', 'Rosenberg Cooley Metcalf', 'Richard', 'S', 'Klatt', 'PA-C', 'Orthopedic Surgery', '', '', NULL, 'O', '900 Round Valley Dr Ste 100', 'Park City', 'Summit', 'UT', '84060', '4356556600', NULL, '900 Round Valley Dr Ste 100', 'Park City', 'Summit', 'UT', '84060', '4356556600', '          ', 'WMETCALF', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1710995386', 0, 'N', 0, '2012-01-30', NULL, NULL, 40.6876, -111.468, NULL, NULL),
('841433992', 'W12013528', 'W12013528', 'UTIHCPHY', 'Rosenberg Cooley Metcalf', 'Michael', 'H', 'Metcalf', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '5848 S Fashion Blvd', 'Murray', 'Salt Lake', 'UT', '84107', '8017434500', NULL, '5848 S Fashion Blvd', 'Murray', 'Salt Lake', 'UT', '84107', '8017434500', '          ', 'WMETCALF', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-08-01', NULL, 0, 0, 0, 'Heber Valley Medical Center', '', '', '', 'HCFA|UB|', '1750333092', 0, 'N', 0, '2014-02-06', NULL, NULL, 40.6447, -111.883, NULL, NULL),
('841433992', 'W12013529', 'W12013529', 'UTIHCPHY', 'Rosenberg Cooley Metcalf', 'Michael', 'H', 'Metcalf', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '900 Round Valley Dr Ste 100', 'Park City', 'Summit', 'UT', '84060', '4356556600', NULL, '900 Round Valley Dr Ste 100', 'Park City', 'Summit', 'UT', '84060', '4356556600', '          ', 'WMETCALF', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-08-01', NULL, 0, 0, 0, 'Heber Valley Medical Center', '', '', '', 'HCFA|UB|', '1750333092', 0, 'N', 0, '2014-02-06', NULL, NULL, 40.6876, -111.468, NULL, NULL),
('841433992', 'W12013530', 'W12013530', 'UTIHCPHY', 'Rosenberg Cooley Metcalf', 'Steven', 'B', 'Pearmain', 'PA', 'Orthopedic Surgery', '', '', NULL, 'O', '5848 S Fashion Blvd', 'Murray', 'Salt Lake', 'UT', '84107', '4356556600', NULL, '5848 S Fashion Blvd', 'Murray', 'Salt Lake', 'UT', '84107', '4356556600', '          ', 'WMETCALF', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-08-01', NULL, 0, 0, 0, 'Park City Medical Center', '', '', '', 'HCFA|UB|', '1720096324', 0, 'N', 0, '2014-02-06', NULL, NULL, 40.6447, -111.883, NULL, NULL),
('841433992', 'W12013531', 'W12013531', 'UTIHCPHY', 'Rosenberg Cooley Metcalf', 'Steven', 'B', 'Pearmain', 'PA', 'Orthopedic Surgery', '', '', NULL, 'O', '900 Round Valley Dr Ste 100', 'Park City', 'Summit', 'UT', '84060', '4356556600', NULL, '900 Round Valley Dr Ste 100', 'Park City', 'Summit', 'UT', '84060', '4356556600', '          ', 'WMETCALF', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-08-01', NULL, 0, 0, 0, 'Park City Medical Center', '', '', '', 'HCFA|UB|', '1720096324', 0, 'N', 0, '2014-02-06', NULL, NULL, 40.6876, -111.468, NULL, NULL),
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('841433992', 'W12013533', 'W12013533', 'UTIHCPHY', 'Rosenberg Cooley Metcalf', 'Thomas', 'D', 'Rosenberg', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '900 Round Valley Dr Ste 100', 'Park City', 'Summit', 'UT', '84060', '4356556600', NULL, '900 Round Valley Dr Ste 100', 'Park City', 'Summit', 'UT', '84060', '4356556600', '          ', 'WMETCALF', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-08-01', NULL, 0, 0, 0, 'Park City Medical Center', '', '', '', 'HCFA|UB|', '1144273905', 0, 'N', 0, '2011-10-05', NULL, NULL, 40.6876, -111.468, NULL, NULL),
('841433992', 'W12013534', 'W12013534', 'UTIHCPHY', 'Rosenberg Cooley Metcalf Clinic', '', '', 'Rosenberg Cooley Metcalf Clinic', 'GROUP', 'Orthopedic Surgery', '', '', NULL, 'B', '5848 S Fashion Blvd', 'Murray', 'Salt Lake', 'UT', '84107', '8017434500', NULL, '5848 S Fashion Blvd', 'Murray', 'Salt Lake', 'UT', '84107', '8017434500', '', 'WMETCALF', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1649374216', 0, 'Y', 0, '2014-06-06', NULL, NULL, 0, 0, NULL, NULL),
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('841433992', 'W12013537', 'W12013537', 'UTIHCPHY', 'Rosenberg Cooley Metcalf', 'Kyle', 'D', 'Wilkins', 'PA-C', 'Orthopedic Surgery', '', '', NULL, 'O', '900 Round Valley Dr Ste 100', 'Park City', 'Summit', 'UT', '84060', '4356556600', NULL, '900 Round Valley Dr Ste 100', 'Park City', 'Summit', 'UT', '84060', '4356556600', '          ', 'WMETCALF', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-08-01', '2011-08-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1689845364', 0, 'N', 0, '2012-04-13', NULL, NULL, 0, 0, NULL, NULL),
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('876000616', 'W12013541', 'W12013541', 'UT01', 'San Juan Clinic', 'Lance', 'O', 'Allen', 'DO', 'Family Practice', '', '', NULL, 'M', 'PO Box 1054', 'Monticello', 'San Juan', 'UT', '84535', '4355875054', '4355873004', 'PO Box 1054', 'Monticello', 'San Juan', 'UT', '84535', '4355875054', '4355873004', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2012-01-01', NULL, 0, 0, 0, 'San Juan Hospital', '', '', '', 'HCFA|UB|', '1609188713', 0, 'N', 0, '2012-12-05', NULL, NULL, 0, 0, NULL, NULL),
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('876000616', 'W12013545', 'W12013545', 'UT01', 'San Juan Clinic', 'Lance', 'O', 'Allen', 'DO', 'Family Practice', '', '', NULL, 'B', 'PO Box 958', 'Monticello', 'San Juan', 'UT', '84535', '4355875054', '4355873004', 'PO Box 958', 'Monticello', 'San Juan', 'UT', '84535', '4355875054', '4355873004', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2012-01-01', NULL, 0, 0, 0, 'San Juan Hospital', '', '', '', 'HCFA|UB|', '1609188713', 0, 'N', 0, '2012-12-05', NULL, NULL, 0, 0, NULL, NULL),
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('261737440', 'W12013547', 'W12013547', 'UT01', 'Desert Pain Specialists', 'Cortney', '', 'Bernardo', 'PA', 'Pain Management', '', '', NULL, 'O', '840 Pinnacle Ct Ste 10A', 'Mesquite', 'Clark', 'NV', '89027', '4352167000', '4352167001', '840 Pinnacle Ct Ste 10A', 'Mesquite', 'Clark', 'NV', '89027', '4352167000', '4352167001', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-11-15', NULL, 0, 0, 0, 'Dixie Regional Medical Center', '', '', '', 'HCFA|UB|', '1285735688', 0, 'N', 0, '2011-11-10', NULL, NULL, 36.8218, -114.069, NULL, NULL),
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('261737440', 'W12013549', 'W12013549', 'UT01', 'Desert Pain Specialists', 'Spencer', 'G', 'Wells', 'MD', 'Pain Management', '', '', NULL, 'O', '840 Pinnacle Ct Ste 10A', 'Mesquite', 'Clark', 'NV', '89027', '4352167000', '4352167001', '840 Pinnacle Ct Ste 10A', 'Mesquite', 'Clark', 'NV', '89027', '4352167000', '4352167001', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-11-10', NULL, 0, 0, 0, 'Dixie Regional Medical Center', '', '', '', 'HCFA|UB|', '1023151644', 0, 'N', 0, '2011-11-14', NULL, NULL, 36.8218, -114.069, NULL, NULL),
('870326862', 'W12013550', 'W12013550', 'UT01', 'Ogden Womens Clinic', 'Kirk', 'A', 'Lammi', 'DO', 'Obstetrics and Gynecology', '', '', NULL, 'O', '4403 Harrison Blvd Ste 4650', 'Ogden', 'Weber', 'UT', '84403', '8013874400', '8013874410', '4403 Harrison Blvd Ste 4650', 'Ogden', 'Weber', 'UT', '84403', '8013874400', '8013874410', 'Wise+', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-11-10', '2012-12-31', 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1851575344', 0, 'N', 0, '2012-12-06', NULL, NULL, 0, 0, NULL, NULL),
('820492308', 'W12013552', 'W12013552', 'ID02', 'Idaho Gastroenterology Associates', 'Eva', 'L', 'Michels', 'NP', 'Gastroenterology', 'Family Practice', '', NULL, 'O', '2235 E Gala St', 'Meridian', 'Ada', 'ID', '83642', '2088873724', '2088871682', '2235 E Gala St', 'Meridian', 'Ada', 'ID', '83642', '2088873724', '2088871682', 'IDPPONONFAC', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2011-10-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1104134089', 0, 'N', 0, '2014-06-11', NULL, NULL, 0, 0, NULL, NULL),
('820492308', 'W12013551', 'W12013551', 'ID02', 'Idaho Gastroenterology Associates', 'Eva', 'L', 'Michels', 'NP', 'Gastroenterology', 'Family Practice', '', NULL, 'O', '425 W Bannock St', 'Boise', 'Ada', 'ID', '83702', '2083436458', '2083435031', '425 W Bannock St', 'Boise', 'Ada', 'ID', '83702', '2083436458', '2083435031', 'IDPPONONFAC', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2011-10-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1104134089', 0, 'N', 0, '2014-06-11', NULL, NULL, 0, 0, NULL, NULL),
('205537931', 'W12013553', 'W12013553', 'UT01', '', 'Lisa', '', 'Miconi-Correa', 'NP', 'Family Practice', '', '', NULL, 'O', '5275 Adam Ave Ste A', 'Ogden', 'Weber', 'UT', '84405', '8014755335', '8014755558', '5275 Adam Ave Ste A', 'Ogden', 'Weber', 'UT', '84405', '8014755335', '8014755558', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-11-10', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1376830414', 0, 'N', 0, '2014-04-03', NULL, NULL, 41.168, -111.969, NULL, NULL),
('205537931', 'W12013554', 'W12013554', 'UT01', '', 'Lisa', '', 'Miconi-Correa', 'NP', 'Family Practice', '', '', NULL, 'B', 'PO Box 1468', 'Bountiful', 'Davis', 'UT', '84011', '8014755335', '          ', 'PO Box 1468', 'Bountiful', 'Davis', 'UT', '84011', '8014755335', '          ', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-11-10', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1376830414', 0, 'N', 0, '2014-04-03', NULL, NULL, 0, 0, NULL, NULL),
('208670470', 'W12013555', 'W12013555', 'UT01', 'Heart of Dixie', 'Theophilus', 'E', 'Owan', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1380 E Medical Ctr Dr Ste 4100', 'St George', 'Washington', 'UT', '84790', '4352512900', '4352512901', '1380 E Medical Ctr Dr Ste 4100', 'St George', 'Washington', 'UT', '84790', '4352512900', '4352512901', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-11-10', NULL, 0, 0, 0, 'Dixie Regional Medical Center', '', '', '', 'HCFA|UB|', '1982682647', 0, 'N', 0, '2012-04-10', NULL, NULL, 37.0998, -113.554, NULL, NULL),
('264565853', 'W12013556', 'W12013556', 'UTMH1', 'Life Stone Group', 'Anastasia', 'E', 'Pollock', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '7300 S 300 W Ste 101', 'Midvale', 'Salt Lake', 'UT', '84047', '8019841717', '8019841720', '7300 S 300 W Ste 101', 'Midvale', 'Salt Lake', 'UT', '84047', '8019841717', '8019841720', 'UTMA', '', '', '0.00', '35.00', '0.00', 3, '2011-11-10', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1417263138', 0, 'N', 0, '2014-05-08', NULL, NULL, 0, 0, NULL, NULL),
('264565853', 'W12013557', 'W12013557', 'UTMH1', 'Life Stone Group', 'Anastasia', 'E', 'Pollock', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '789 E Bamberger Dr Ste C', 'American Fork', 'Utah', 'UT', '84003', '8019841717', '8019841720', '789 E Bamberger Dr Ste C', 'American Fork', 'Utah', 'UT', '84003', '8019841717', '8019841720', 'UTMA', '', '', '0.00', '35.00', '0.00', 3, '2011-11-10', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1417263138', 0, 'N', 0, '2014-05-08', NULL, NULL, 0, 0, NULL, NULL),
('264565853', 'W12013558', 'W12013558', 'UTMH1', 'Life Stone Group', 'Anastasia', 'E', 'Pollock', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'B', 'PO Box 1249', 'Bountiful', 'Davis', 'UT', '84011', '8012962113', '8019841720', 'PO Box 1249', 'Bountiful', 'Davis', 'UT', '84011', '8012962113', '8019841720', 'UTMA', '', '', '0.00', '35.00', '0.00', 3, '2011-11-10', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1417263138', 0, 'N', 0, '2014-05-08', NULL, NULL, 0, 0, NULL, NULL),
('830306180', 'W12013559', 'W12013559', 'WY01', 'College Hill Womens Center', 'Vanessa', '', 'Rice', 'DO', 'Family Practice', '', '', NULL, 'O', '3000 College Dr Ste A', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073621861', '3073621277', '3000 College Dr Ste A', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073621861', '3073621277', '', '', '', '0.00', '10.00', '0.00', 3, '2011-11-10', NULL, 0, 0, 0, 'Memorial Hospital of Sweetwater County', NULL, NULL, NULL, 'HCFA|UB|', '1063554467', 0, 'N', 0, '2013-08-06', NULL, NULL, 41.5974, -109.242, NULL, NULL),
('830306180', 'W12013560', 'W12013560', 'WYT2', 'College Hill Womens Center', 'Vanessa', '', 'Rice', 'DO', 'Family Practice', '', '', NULL, 'O', '3000 College Dr Ste A', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073621861', '3073621277', '3000 College Dr Ste A', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073621861', '3073621277', '', '', '', '0.00', '10.00', '0.00', 3, '2011-11-10', NULL, 0, 0, 0, 'Memorial Hospital of Sweetwater County', NULL, NULL, NULL, 'HCFA|UB|', '1063554467', 0, 'N', 0, '2013-08-06', NULL, NULL, 0, 0, NULL, NULL),
('870331280', 'W12013561', 'W12013561', 'UT01', 'Southwest Utah Public Health Department', '', '', 'Southwest Utah Public Health Department', 'Group', 'Health Department', '', '', NULL, 'O', '620 S 400 E Ste 400', 'St George', 'Washington', 'UT', '84770', '4356524078', '4356286425', '620 S 400 E Ste 400', 'St George', 'Washington', 'UT', '84770', '4356524078', '4356286425', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-09-21', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1306841606', 0, 'N', 0, '2011-09-21', NULL, NULL, 37.0978, -113.575, NULL, NULL),
('452548739', 'W12013563', 'W12013563', 'UTMH1', 'Now Care', 'Dixie', '', 'Allen', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '1937 W 5700 S', 'Roy', 'Weber', 'UT', '84067', '8016214600', NULL, '1937 W 5700 S', 'Roy', 'Weber', 'UT', '84067', '8016214600', '          ', 'UTMA', '', '', '0.00', '35.00', '0.00', 3, '2011-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1013119726', 0, 'N', 0, '2013-12-04', NULL, NULL, 0, 0, NULL, NULL),
('452548739', 'W12013562', 'W12013562', 'UTMH1', 'Now Care', 'Dixie', '', 'Allen', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '698 12th St', 'West Jordan', 'Salt Lake', 'UT', '84084', '8016214600', NULL, '698 12th St', 'West Jordan', 'Salt Lake', 'UT', '84084', '8016214600', '          ', 'UTMA', '', '', '0.00', '35.00', '0.00', 3, '2011-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1013119726', 0, 'N', 0, '2013-12-04', NULL, NULL, 0, 0, NULL, NULL),
('205934739', 'W12013565', 'W12013565', 'ID02', 'Family Medicine Health Center', 'Marvin-Anthony', 'C', 'Alviso', '', 'Family Practice', '', '', NULL, 'O', '6094 W Emerald St', 'Boise', 'Ada', 'ID', '83704', '2085142505', '2085142504', '6094 W Emerald St', 'Boise', 'Ada', 'ID', '83704', '2085142505', '2085142504', 'IDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2011-09-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1932365533', 0, 'N', 0, '2014-06-05', NULL, NULL, 0, 0, NULL, NULL),
('205934739', 'W12013564', 'W12013564', 'ID02', 'Family Medicine Health Center', 'Marvin-Anthony', 'C', 'Alviso', '', 'Family Practice', '', '', NULL, 'O', '777 N Raymond St', 'Boise', 'Ada', 'ID', '83704', '2085142500', '2083227018', '777 N Raymond St', 'Boise', 'Ada', 'ID', '83704', '2085142500', '2083227018', 'IDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2011-09-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1932365533', 0, 'N', 0, '2014-06-05', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W12013566', 'W12013566', 'UT01', 'Central Utah Clinic PC', 'Michael', 'B', 'Anderson', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '11 S Main', 'Hurricane', 'Washington', 'UT', '84737', '8002399393', NULL, '11 S Main', 'Hurricane', 'Washington', 'UT', '84737', '8002399393', '          ', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-09-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', 'Kane County Hospital', NULL, NULL, 'HCFA|UB|', '1215964747', 0, 'N', 0, '2013-03-26', NULL, NULL, 37.1763, -113.288, NULL, NULL),
('870281028', 'W12013568', 'W12013568', 'UT01', 'Central Utah Clinic PC', 'Michael', 'B', 'Anderson', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1404 Sun River Pkwy Ste 101', 'Hurricane', 'Washington', 'UT', '87490', '8002399393', NULL, '1404 Sun River Pkwy Ste 101', 'Hurricane', 'Washington', 'UT', '87490', '8002399393', '          ', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-09-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', 'Kane County Hospital', NULL, NULL, 'HCFA|UB|', '1215964747', 0, 'N', 0, '2013-03-26', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W12013567', 'W12013567', 'UT01', 'Central Utah Clinic PC', 'Michael', 'B', 'Anderson', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '180 W 300 N', 'Kanab', 'Kane', 'UT', '84741', '8002399393', NULL, '180 W 300 N', 'Kanab', 'Kane', 'UT', '84741', '8002399393', '          ', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-09-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', 'Kane County Hospital', NULL, NULL, 'HCFA|UB|', '1215964747', 0, 'N', 0, '2013-03-26', NULL, NULL, 37.0533, -112.532, NULL, NULL),
('061506129', 'W12013569', 'W12013569', 'UT01', 'Wee Care Pediatrics', 'Vicki', 'L', 'Berger', 'PAC', 'Pediatrics', '', '', NULL, 'O', '2084 N 1700 W', 'Layton', 'Davis', 'UT', '84041', '8017738644', NULL, '2084 N 1700 W', 'Layton', 'Davis', 'UT', '84041', '8017738644', '', 'WUSTDPEDE5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-08-01', NULL, 0, 0, 0, 'Davis Hospital', '', '', '', 'HCFA|UB|', '1306821079', 0, 'N', 0, '2014-06-17', NULL, NULL, 41.0897, -111.997, NULL, NULL),
('263981143', 'W12013570', 'W12013570', 'UT01', 'Peak ENT Associates LLC', 'Kirt', 'S', 'Beus', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '48 W 1500 N', 'Nephi', 'Juab', 'UT', '84648', '8013577499', '8013735980', '48 W 1500 N', 'Nephi', 'Juab', 'UT', '84648', '8013577499', '8013735980', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-08-23', '2011-11-30', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1396765871', 0, 'N', 0, '2011-12-20', NULL, NULL, 0, 0, NULL, NULL),
('954893928', 'W12013572', 'W12013572', 'UT01', 'Exodus Healthcare Network', 'David', 'R', 'Boettger', 'MD', 'Pediatrics', '', '', NULL, 'O', '3336 S Pioneer Pkwy Ste 201', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8012509638', '8014170063', '3336 S Pioneer Pkwy Ste 201', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8012509638', '8014170063', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-08-23', NULL, 0, 0, 0, 'Primary Childrens Medical Center', '', '', '', 'HCFA|UB|', '1811937006', 0, 'N', 0, '2014-05-26', NULL, NULL, 40.6991, -111.99, NULL, NULL),
('954893928', 'W12013574', 'W12013574', 'UT01', 'Exodus Healthcare Network', 'David', 'R', 'Boettger', 'MD', 'Pediatrics', '', '', NULL, 'O', '3665 S 8400 W Ste 110', 'Magna', 'Salt Lake', 'UT', '84044', '8012509638', '8014170063', '3665 S 8400 W Ste 110', 'Magna', 'Salt Lake', 'UT', '84044', '8012509638', '8014170063', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-08-23', NULL, 0, 0, 0, 'Primary Childrens Medical Center', '', '', '', 'HCFA|UB|', '1811937006', 0, 'N', 0, '2014-05-26', NULL, NULL, 40.6928, -112.092, NULL, NULL),
('870373083', 'W12013578', 'W12013578', 'UT01', 'Heart and Lung Institute of Utah Inc', 'William', 'M', 'Brann', 'MD', 'Internal Medicine', '', '', NULL, 'O', '3336 S 4155 W Ste 203', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8012632370', '8012651200', '3336 S 4155 W Ste 203', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8012632370', '8012651200', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-09-01', '2014-04-30', 0, 0, 0, 'Jordan Valley Medical Center', 'University Health Care University Hospital', 'Salt Lake Regional Medical Center', '', 'HCFA|UB|', '1912087826', 0, 'N', 0, '2014-07-25', NULL, NULL, 40.6991, -111.99, NULL, NULL),
('870373083', 'W12013579', 'W12013579', 'UT01', 'Heart and Lung Institute of Utah Inc', 'William', 'M', 'Brann', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 847112', 'Dallas', 'Dallas', 'TX', '75284', '8012632370', '8012651200', 'PO Box 847112', 'Dallas', 'Dallas', 'TX', '75284', '8012632370', '8012651200', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-09-01', '2014-04-30', 0, 0, 0, 'Jordan Valley Medical Center', 'University Health Care University Hospital', 'Salt Lake Regional Medical Center', '', 'HCFA|UB|', '1912087826', 0, 'N', 0, '2014-07-25', NULL, NULL, 0, 0, NULL, NULL),
('205486699', 'W12013580', 'W12013580', 'UT01', 'Sorensen Cardiovascular Group', 'Gerald', 'Ira', 'Polukoff', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '5169 Cottonwood St Ste 610', 'Murray', 'Salt Lake', 'UT', '84107', '8015073656', '8015073657', '5169 Cottonwood St Ste 610', 'Murray', 'Salt Lake', 'UT', '84107', '8015073656', '8015073657', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-08-17', '2012-10-22', 0, 0, 0, 'Logan Regional Hospital', '', '', '', 'HCFA|UB|', '1215020045', 0, 'N', 0, '2014-05-22', NULL, NULL, 0, 0, NULL, NULL),
('270852226', 'W12013581', 'W12013581', 'UT01', 'Silverton Group', 'Smitha', '', 'Sadiq', 'MD', 'Internal Medicine', 'Pediatrics', 'Family Practice', NULL, 'O', '8th Ave C St', 'Salt Lake City', 'Salt Lake', 'UT', '84143', '8016145700', '8016145750', '8th Ave C St', 'Salt Lake City', 'Salt Lake', 'UT', '84143', '8016145700', '8016145750', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-09-01', '2013-05-20', 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1962490201', 0, 'Y', 0, '2014-07-10', NULL, NULL, 0, 0, NULL, NULL),
('820435599', 'W12013582', 'W12013582', 'UTMH1', '', 'Mark', 'D', 'Corgiat', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '3903 Harrison Blvd Ste 305', 'Ogden', 'Weber', 'UT', '84403', '8016216100', NULL, '3903 Harrison Blvd Ste 305', 'Ogden', 'Weber', 'UT', '84403', '8016216100', '', 'UTPHD', '', '', '0.00', '35.00', '0.00', 3, '2010-08-06', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1336296003', 0, 'N', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('870373083', 'W12013585', 'W12013585', 'UT01', 'Heart and Lung Institute', 'Adam', 'M', 'Elhaddi', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '3336 S 4155 W Ste 203', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8012632370', '8012651200', '3336 S 4155 W Ste 203', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8012632370', '8012651200', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-09-01', '2014-04-30', 0, 0, 0, 'Jordan Valley Medical Center', 'Salt Lake Regional Medical Center', NULL, NULL, 'HCFA|UB|', '1972713568', 0, 'N', 0, '2013-01-03', NULL, NULL, 40.6991, -111.99, NULL, NULL),
('870354442', 'W12013590', 'W12013590', 'UT01', 'Rocky Mountain Womens Health Center', 'Leslie', 'A', 'Ostler', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1580 W Antelope Dr Ste 290', 'Layton', 'Davis', 'UT', '84041', '8017760880', NULL, '1580 W Antelope Dr Ste 290', 'Layton', 'Davis', 'UT', '84041', '8017760880', '          ', 'WRYMTWOM', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-11-10', '2013-08-31', 0, 0, 0, 'Davis Hospital', 'St Marks Hospital', NULL, NULL, 'HCFA|UB|', '1568683738', 0, 'N', 0, '2014-01-14', NULL, NULL, 0, 0, NULL, NULL),
('201312583', 'W12013592', 'W12013592', 'ID01', 'Life Counseling Center', 'Lori', 'L', 'Farrens', 'LCPC', 'Mental Health', 'Counseling', '', NULL, 'O', '123 N Yale', 'Nampa', 'Canyon', 'ID', '83651', '2084655433', NULL, '123 N Yale', 'Nampa', 'Canyon', 'ID', '83651', '2084655433', '', 'IDMA', '', '', '0.00', '35.00', '0.00', 6, '2011-10-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1598954786', 0, 'N', 0, '2014-05-08', NULL, NULL, 0, 0, NULL, NULL),
('201312583', 'W12013591', 'W12013591', 'ID01', 'Life Counseling Center', 'Lori', 'L', 'Farrens', 'LCPC', 'Mental Health', 'Counseling', '', NULL, 'O', '112 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2084655433', NULL, '112 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2084655433', '', 'IDMA', '', '', '0.00', '35.00', '0.00', 6, '2011-10-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1598954786', 0, 'N', 0, '2014-05-08', NULL, NULL, 0, 0, NULL, NULL),
('860735726', 'W12013593', 'W12013593', 'Sinclair', '(Sinclair Health Services\rProvider) Flagstaff Bone and Joint', 'John', 'H', 'Flint', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1841 Morrow Ave', 'Kingman', 'Mohave', 'AZ', '86409', '9287732280', '9287732281', '1841 Morrow Ave', 'Kingman', 'Mohave', 'AZ', '86409', '9287732280', '9287732281', '', '', '', '0.00', '40.00', '0.00', 3, '2011-08-01', NULL, 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1700094125', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('870675814', 'W12013594', 'W12013594', 'UT01', 'Richens Eye Center', 'Reed', 'T', 'Gibb', 'OD', 'Ophthalmology', '', '', NULL, 'O', '161 W 200 N Ste 200', 'St George', 'Washington', 'UT', '84770', '4356524040', '4356524041', '161 W 200 N Ste 200', 'St George', 'Washington', 'UT', '84770', '4356524040', '4356524041', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-08-17', NULL, 0, 0, 0, 'Dixie Regional Medical Center', '', '', '', 'HCFA|UB|', '1568569721', 0, 'N', 0, '2014-04-23', NULL, NULL, 37.1116, -113.587, NULL, NULL),
('860735726', 'W12013595', 'W12013595', 'Sinclair', 'Flagstaff Bone and Joint', 'John ', '', 'Hall', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1841 Morrow Ave', 'Kingman', 'Mohave', 'AZ', '86409', '9287732280', '9287732281', '1841 Morrow Ave', 'Kingman', 'Mohave', 'AZ', '86409', '9287732280', '9287732281', '', '', '', '0.00', '40.00', '0.00', 3, '2011-08-01', NULL, 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1174533723', 0, 'N', 0, '2012-07-03', NULL, NULL, 0, 0, NULL, NULL),
('860735726', 'W12013596', 'W12013596', 'Sinclair', '(Sinclair Health Services\rProvider) Flagstaff Bone and Joint', 'Frank ', '', 'Maher', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1841 Morrow Ave', 'Kingman', 'Mohave', 'AZ', '86409', '9287732280', '9287732281', '1841 Morrow Ave', 'Kingman', 'Mohave', 'AZ', '86409', '9287732280', '9287732281', '', '', '', '0.00', '40.00', '0.00', 3, '2011-08-01', '2013-02-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1467436659', 0, 'N', 0, '2013-01-23', NULL, NULL, 0, 0, NULL, NULL),
('870373083', 'W12013597', 'W12013597', 'UT01', 'Heart and Lung Institute', 'Bruce', 'R', 'Kenwood', 'DO', 'Cardiovascular Disease', NULL, NULL, NULL, 'O', '3336 S 4155 W Ste 203', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8012632370', '8012651200', '3336 S 4155 W Ste 203', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8012632370', '8012651200', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-09-01', '2014-04-30', 0, 0, 0, 'Jordan Valley Medical Center', 'Salt Lake Regional Medical Center', NULL, NULL, 'HCFA|UB|', '1144279019', 0, 'N', 0, '2012-05-01', NULL, NULL, 40.6991, -111.99, NULL, NULL),
('870373083', 'W12013601', 'W12013601', 'UT01', 'Heart and Lung Institute', 'Bard', 'R', 'Madsen', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '3336 S 4155 W Ste 203', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8012632370', '8012651200', '3336 S 4155 W Ste 203', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8012632370', '8012651200', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-09-01', '2014-04-30', 0, 0, 0, 'Jordan Valley Medical Center', 'Salt Lake Regional Medical Center', NULL, NULL, 'HCFA|UB|', '1497738074', 0, 'N', 0, '2014-02-10', NULL, NULL, 40.6991, -111.99, NULL, NULL),
('870373083', 'W12013602', 'W12013602', 'UT01', 'Heart and Lung Institute', 'David', 'S', 'Massinople', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '3336 S 4155 W Ste 203', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8012632370', '8012651200', '3336 S 4155 W Ste 203', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8012632370', '8012651200', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-09-01', '2014-04-30', 0, 0, 0, 'Jordan Valley Medical Center', 'Salt Lake Regional Medical Center', '', '', 'HCFA|UB|', '1255541785', 0, 'N', 0, '2014-06-23', NULL, NULL, 40.6991, -111.99, NULL, NULL),
('205934739', 'W12013604', 'W12013604', 'ID02', 'Family Medicine Health Center', 'Margaret', 'K', 'Mortimer', 'NP', 'Family Practice', '', '', NULL, 'O', '6094 W Emerald', 'Boise', 'Ada', 'ID', '83704', '2085142510', '2085142511', '6094 W Emerald', 'Boise', 'Ada', 'ID', '83704', '2085142510', '2085142511', 'IDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2011-08-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1770532780', 0, 'N', 0, '2014-06-05', NULL, NULL, 0, 0, NULL, NULL),
('800701770', 'W12013607', 'W12013607', 'UT01', 'Mountainstar Medical Group Neurosurgery', 'James', 'C', 'Pingree', 'MD', 'Neurosurgery', 'Oncology', '', NULL, 'O', '1220 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012618507', '8012618511', '1220 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012618507', '8012618511', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-09-01', '2012-06-30', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1730249582', 0, 'N', 0, '2014-07-25', NULL, NULL, 0, 0, NULL, NULL),
('800701770', 'W12013608', 'W12013608', 'UT01', 'Mountainstar Medical Group Neurosurgery', 'James', 'C', 'Pingree', 'MD', 'Neurosurgery', 'Oncology', '', NULL, 'B', 'PO Box 741648', 'Atlanta', 'Fulton', 'GA', '30374', '6153737490', '8012618511', 'PO Box 741648', 'Atlanta', 'Fulton', 'GA', '30374', '6153737490', '8012618511', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-09-01', '2012-06-30', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1730249582', 0, 'N', 0, '2014-07-25', NULL, NULL, 0, 0, NULL, NULL),
('270852226', 'W12013609', 'W12013609', 'UT01', 'Silverton Group', 'Roopika', 'M', 'Reddy', 'MD', 'Hospitalist', '', '', NULL, 'O', '8th Ave C', 'Salt Lake City', 'Salt Lake', 'UT', '84143', '8013504110', '8012961715', '8th Ave C', 'Salt Lake City', 'Salt Lake', 'UT', '84143', '8013504110', '8012961715', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-10-01', '2012-06-15', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1760618516', 0, 'N', 0, '2013-04-15', NULL, NULL, 0, 0, NULL, NULL),
('870675814', 'W12013610', 'W12013610', 'UT01', 'Richens Eye Center', 'Sharon', '', 'Richens', 'MD', 'Ophthalmology', NULL, NULL, NULL, 'O', '161 W 200 N Ste 200', 'St George', 'Washington', 'UT', '84770', '4356524040', '4356524041', '161 W 200 N Ste 200', 'St George', 'Washington', 'UT', '84770', '4356524040', '4356524041', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-08-17', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1497769368', 0, 'N', 0, '2011-11-14', NULL, NULL, 37.1116, -113.587, NULL, NULL),
('800701770', 'W12013611', 'W12013611', 'UT01', 'Mountainstar Medical Group Neurosurgery', 'Richard', 'H', 'Schwartz', 'MD', 'Neurosurgery', '', '', NULL, 'O', '1220 E 3900 S Ste 4E', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012618507', '8012618511', '1220 E 3900 S Ste 4E', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012618507', '8012618511', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-09-01', '2012-06-30', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1336148063', 0, 'N', 0, '2012-06-28', NULL, NULL, 0, 0, NULL, NULL),
('800701770', 'W12013612', 'W12013612', 'UT01', 'Mountainstar Medical Group Neurosurgery', 'Richard', 'H', 'Schwartz', 'MD', 'Neurosurgery', '', '', NULL, 'B', 'PO Box 741648', 'Atlanta', 'Fulton', 'GA', '30374', '6153737490', '8012618511', 'PO Box 741648', 'Atlanta', 'Fulton', 'GA', '30374', '6153737490', '8012618511', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-09-01', '2012-06-30', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1336148063', 0, 'N', 0, '2012-06-28', NULL, NULL, 0, 0, NULL, NULL),
('870373083', 'W12013616', 'W12013616', 'UT01', 'Heart and Lung Institute', 'Konstantyn', 'Y', 'Szwajkun', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '3336 S 4155 W Ste 203', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8012632370', '8012651200', '3336 S 4155 W Ste 203', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8012632370', '8012651200', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-09-01', '2014-04-30', 0, 0, 0, 'Jordan Valley Medical Center', 'Salt Lake Regional Medical Center', NULL, NULL, 'HCFA|UB|', '1508849191', 0, 'N', 0, '2012-06-26', NULL, NULL, 40.6991, -111.99, NULL, NULL),
('870675814', 'W12013617', 'W12013617', 'UT01', 'Richens Eye Center', 'Kristin', 'J', 'Tarbet', 'MD', 'Ophthalmology', NULL, NULL, NULL, 'O', '161 W 200 N Ste 200', 'St George', 'Washington', 'UT', '84770', '4356524040', '4356524041', '161 W 200 N Ste 200', 'St George', 'Washington', 'UT', '84770', '4356524040', '4356524041', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-08-17', '2013-08-12', 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1083659262', 0, 'N', 0, '2013-08-19', NULL, NULL, 0, 0, NULL, NULL),
('451614087', 'W12013618', 'W12013618', 'UT01', 'Woodmead Medical Clinic', 'Bradley', 'A', 'Urie', 'MD', 'Pain Management', '', '', NULL, 'O', '3263 S Hwy 89 Ste 300', 'Bountiful', 'Davis', 'UT', '84010', '8012960600', '8012951700', '3263 S Hwy 89 Ste 300', 'Bountiful', 'Davis', 'UT', '84010', '8012960600', '8012951700', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-08-01', NULL, 0, 0, 0, 'Davis Hospital', '', '', '', 'HCFA|UB|', '1588688360', 0, 'N', 0, '2011-09-21', NULL, NULL, 40.8539, -111.902, NULL, NULL),
('450703776', 'W12013619', 'W12013619', 'UT01', 'Woodmead Medical Clinic', 'Gavin', 'N', 'Vanstaden', 'MD', 'Family Practice', '', '', NULL, 'O', '3263 S Hwy 89 Ste 300', 'Bountiful', 'Davis', 'UT', '84010', '8012960600', '8012951700', '3263 S Hwy 89 Ste 300', 'Bountiful', 'Davis', 'UT', '84010', '8012960600', '8012951700', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-07-01', NULL, 0, 0, 0, 'Davis Hospital', 'Ogden Regional Medical Center', '', '', 'HCFA|UB|', '1841380433', 0, 'N', 0, '2012-03-01', NULL, NULL, 40.8539, -111.902, NULL, NULL),
('770701557', 'W12013623', 'W12013623', 'UT01', 'Lone Peak Family Medicine', 'Jonathan', '', 'Vellinga', 'MD', 'Internal Medicine', '', '', NULL, 'O', '11760 S 700 E Ste 111', 'Draper', 'Salt Lake', 'UT', '84020', '8015768855', '8015769800', '11760 S 700 E Ste 111', 'Draper', 'Salt Lake', 'UT', '84020', '8015768855', '8015769800', 'WUSTDFAM5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-10-01', '2012-06-30', 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1225291727', 0, 'N', 0, '2013-12-02', NULL, NULL, 0, 0, NULL, NULL),
('770701557', 'W12013622', 'W12013622', 'UT01', 'St Marks Millcreek Primary Care', 'Jonathan', '', 'Vellinga', 'MD', 'Internal Medicine', '', '', NULL, 'O', '4465 S 900 E Ste 200', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012662777', '8012661377', '4465 S 900 E Ste 200', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012662777', '8012661377', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-10-01', '2012-06-30', 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1225291727', 0, 'N', 0, '2013-12-02', NULL, NULL, 0, 0, NULL, NULL),
('770701557', 'W12013621', 'W12013621', 'UT01', 'Alta Internal Medicine', 'Jonathan', '', 'Vellinga', 'MD', 'Internal Medicine', '', '', NULL, 'O', '74 Kimballs Ln Ste 300', 'Draper', 'Salt Lake', 'UT', '84020', '8015720311', '8015721363', '74 Kimballs Ln Ste 300', 'Draper', 'Salt Lake', 'UT', '84020', '8015720311', '8015721363', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-10-01', '2012-06-30', 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1225291727', 0, 'N', 0, '2013-12-02', NULL, NULL, 0, 0, NULL, NULL),
('770701557', 'W12013620', 'W12013620', 'UT01', 'Lone Peak Family Medicine', 'Jonathan', '', 'Vellinga', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 198560', 'Atlanta', 'Fulton', 'GA', '30384', '8006613365', '8664015413', 'PO Box 198560', 'Atlanta', 'Fulton', 'GA', '30384', '8006613365', '8664015413', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-10-01', '2012-06-30', 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1225291727', 0, 'N', 0, '2013-12-02', NULL, NULL, 0, 0, NULL, NULL),
('061506129', 'W12013624', 'W12013624', 'UT01', 'Wee Care Pediatrics 24 hrs a day 7 days a week (Appts Preferred)', '', '', 'Wee Care Pediatrics (Appts Required)', 'GROUP', 'Urgent Care', '', '', NULL, 'O', '2084 N 1700 W Ste A', 'Layton', 'Davis', 'UT', '84041', '8017738644', '8019271591', '2084 N 1700 W Ste A', 'Layton', 'Davis', 'UT', '84041', '8017738644', '8019271591', 'WUSTDPEDE5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000834768', 0, 'N', 0, '2013-07-03', NULL, NULL, 41.0897, -111.997, NULL, NULL),
('770701557', 'W12006969', 'W12006969', 'UT01', 'Alta Internal Medicine', 'Barbara', 'E', 'Smith-Holmen', 'NP', 'Family Practice', '', '', NULL, 'O', '74 Kimballs Ln Ste 300', 'Draper', 'Salt Lake', 'UT', '84020', '8015720311', '8015711369', '74 Kimballs Ln Ste 300', 'Draper', 'Salt Lake', 'UT', '84020', '8015720311', '8015711369', 'wise+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-10-01', '2012-06-30', 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1568665784', 0, 'N', 0, '2012-06-28', NULL, NULL, 0, 0, NULL, NULL),
('770701557', 'W12006970', 'W12006970', 'UT01', 'Alta Internal Medicine', 'Barbara', 'E', 'Smith-Holmen', 'NP', 'Family Practice', '', '', NULL, 'B', 'PO Box 198560', 'Atlanta', 'Fulton', 'GA', '30384', '6153737600', '8015711369', 'PO Box 198560', 'Atlanta', 'Fulton', 'GA', '30384', '6153737600', '8015711369', 'wise+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-10-01', '2012-06-30', 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1568665784', 0, 'N', 0, '2012-06-28', NULL, NULL, 0, 0, NULL, NULL),
('870616960', 'W12013630', 'W12013630', 'UTMH1', '', 'Josh', 'P', 'Biesinger', 'LMFT', 'Mental Health', 'Marriage and Family Therapy', '', NULL, 'O', '4699 S Harrison Blvd Ste 301', 'Ogden', 'Weber', 'UT', '84403', '8017558799', '8016859237', '4699 S Harrison Blvd Ste 301', 'Ogden', 'Weber', 'UT', '84403', '8017558799', '8016859237', 'MA', '', '', '0.00', '35.00', '0.00', 3, '2011-08-25', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1093774101', 0, 'N', 0, '2014-05-08', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W12013633', 'W12013633', 'UT01', 'Central Utah Clinic PC', 'John', 'A', 'Griffin', 'MD', 'Colon and Rectal Surgery', '', '', NULL, 'O', '676 S Bluff St', 'St George', 'Washington', 'UT', '84770', '8012659139', '8012659478', '676 S Bluff St', 'St George', 'Washington', 'UT', '84770', '8012659139', '8012659478', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-07-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1821014903', 0, 'N', 0, '2014-07-17', NULL, NULL, 37.0967, -113.587, NULL, NULL),
('850327237', 'W12014580', 'W12014580', 'NM01', 'Lovelace Medical Center', '', '', 'Lovelace Medical Center', 'Group', 'Hospital', '', '', NULL, 'O', '601 Dr Martin Luther King Jr Ave NE', 'Albuquerque', 'Bernalillo', 'NM', '87102', '5057278000', NULL, '601 Dr Martin Luther King Jr Ave NE', 'Albuquerque', 'Bernalillo', 'NM', '87102', '5057278000', '', '', '', 'NM1', '0.00', '0.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1306914213', 0, 'N', 0, '2014-05-20', NULL, NULL, 35.0857, -106.64, NULL, NULL),
('383845435', 'W12013673', 'W12013673', 'UT01', 'University Health Care', '', '', 'University of Utah Vascular Neurology Department of University', 'Group', 'Clinics', '', '', NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015856387', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015856387', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2011-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1538448774', 0, 'N', 0, '2013-01-25', NULL, NULL, 0, 0, NULL, NULL),
('383845435', 'W12013674', 'W12013674', 'UT01', 'University of Utah Vascular Neurology Department of University', '', '', 'University of Utah Vascular Neurology Department of University', 'Group', 'Clinics', '', '', NULL, 'B', 'PO Box 413027', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', NULL, 'PO Box 413027', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2011-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1538448774', 0, 'N', 0, '2013-01-25', NULL, NULL, 0, 0, NULL, NULL),
('208798561', 'W12013677', 'W12013677', 'UTMH1', '', 'Joyce', 'A', 'Kelen', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '925 E 900 S Ste 26', 'Salt Lake City', 'Salt Lake', 'UT', '84105', '8015377523', NULL, '925 E 900 S Ste 26', 'Salt Lake City', 'Salt Lake', 'UT', '84105', '8015377523', '          ', 'UTMA', '', '', '0.00', '35.00', '0.00', 3, '2011-07-28', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1609947712', 0, 'N', 0, '2011-09-20', NULL, NULL, 0, 0, NULL, NULL),
('450618187', 'W12013680', 'W12013680', 'UTMH1', 'Redwood Therapy Group', 'Jennifer', '', 'Fairbourn', 'LMFT', 'Mental Health', 'Counseling', '', NULL, 'O', '8541 S Redwood Rd Ste C', 'South Jordan', 'Salt Lake', 'UT', '84095', '8018784220', '8018789846', '8541 S Redwood Rd Ste C', 'South Jordan', 'Salt Lake', 'UT', '84095', '8018784220', '8018789846', 'UTMA', '', '', '0.00', '35.00', '0.00', 3, '2011-11-10', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1992977383', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('450618187', 'W12013681', 'W12013681', 'UTMH1', 'Redwood Therapy Group', 'Jennifer', '', 'Fairbourn', 'LMFT', 'Mental Health', 'Counseling', '', NULL, 'B', 'PO Box 64', 'West Jordan', 'Salt Lake', 'UT', '84084', '8018784220', '8018789846', 'PO Box 64', 'West Jordan', 'Salt Lake', 'UT', '84084', '8018784220', '8018789846', 'UTMA', '', '', '0.00', '35.00', '0.00', 3, '2011-11-10', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1992977383', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('264664897', 'W12013682', 'W12013682', 'UT01', 'Advanced Family Health Care', 'Ellen', 'F', 'Gardner', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '1760 N Main St Ste 103', 'Cedar City', 'Iron', 'UT', '84721', '4358670644', '4358670645', '1760 N Main St Ste 103', 'Cedar City', 'Iron', 'UT', '84721', '4358670644', '4358670645', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-11-10', '2013-05-17', 0, 0, 0, 'Valley View Medical Center', '', '', '', 'HCFA|UB|', '1013939024', 0, 'N', 0, '2013-05-13', NULL, NULL, 0, 0, NULL, NULL);
INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
('451275567', 'W12013683', 'W12013683', 'UT01', '', 'Dustin', 'J', 'Hopkin', 'DDS', 'Oral Surgeon', '', '', NULL, 'O', '2180 E 4500 S Ste 285', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8012773942', '8012774505', '2180 E 4500 S Ste 285', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8012773942', '8012774505', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2011-10-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1265690028', 0, 'N', 0, '2014-05-16', NULL, NULL, 40.6742, -111.829, NULL, NULL),
('870635889', 'W12013684', 'W12013684', 'UT01', 'Tooele Clinic Corp', 'Alan', 'C', 'Jones', 'DO', 'Ear, Nose and Throat', '', '', NULL, 'O', '1959 N Aaron Dr Ste F', 'Tooele', 'Tooele', 'UT', '84074', '4357759966', NULL, '1959 N Aaron Dr Ste F', 'Tooele', 'Tooele', 'UT', '84074', '4357759966', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-11-10', NULL, 0, 0, 0, 'Mountain West Medical Center', '', '', '', 'HCFA|UB|', '1598743973', 0, 'N', 0, '2011-11-11', NULL, NULL, 40.5653, -112.298, NULL, NULL),
('870635889', 'W12013685', 'W12013685', 'UT01', 'Tooele Clinic Corp', 'Alan', 'C', 'Jones', 'DO', 'Ear, Nose and Throat', '', '', NULL, 'M', 'PO Box 689022', 'Franklin', 'Williamson', 'TN', '37068', '4357759966', NULL, 'PO Box 689022', 'Franklin', 'Williamson', 'TN', '37068', '4357759966', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-11-10', NULL, 0, 0, 0, 'Mountain West Medical Center', '', '', '', 'HCFA|UB|', '1598743973', 0, 'N', 0, '2011-11-11', NULL, NULL, 0, 0, NULL, NULL),
('870635889', 'W12013686', 'W12013686', 'UT01', 'Tooele Clinic Corp', 'Alan', 'C', 'Jones', 'DO', 'Ear, Nose and Throat', '', '', NULL, 'B', 'PO Box 848416', 'Boston', 'Suffolk', 'MA', '02284', '4357759966', NULL, 'PO Box 848416', 'Boston', 'Suffolk', 'MA', '02284', '4357759966', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-11-10', NULL, 0, 0, 0, 'Mountain West Medical Center', '', '', '', 'HCFA|UB|', '1598743973', 0, 'N', 0, '2011-11-11', NULL, NULL, 0, 0, NULL, NULL),
('205089251', 'W12013687', 'W12013687', 'UTMH1', 'Holistic Balance', 'Kim', 'M', 'Palmer', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '865 E 4800 S Ste 222', 'Murray', 'Salt Lake', 'UT', '84107', '8012662418', '8012663358', '865 E 4800 S Ste 222', 'Murray', 'Salt Lake', 'UT', '84107', '8012662418', '8012663358', 'UTMA', '', '', '0.00', '35.00', '0.00', 3, '2011-11-10', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1467571174', 0, 'N', 0, '2014-05-08', NULL, NULL, 0, 0, NULL, NULL),
('205089251', 'W12013688', 'W12013688', 'UTMH1', 'Holistic Balance', 'Kim', 'M', 'Palmer', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'B', 'PO Box 18415', 'Taylorsville', 'Salt Lake', 'UT', '84118', '8012662418', '8012663358', 'PO Box 18415', 'Taylorsville', 'Salt Lake', 'UT', '84118', '8012662418', '8012663358', 'UTMA', '', '', '0.00', '35.00', '0.00', 3, '2011-11-10', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1467571174', 0, 'N', 0, '2014-05-08', NULL, NULL, 0, 0, NULL, NULL),
('742412898', 'W12013689', 'W12013689', 'UT01', '', 'Frank', 'J', 'Powers', 'MD', 'Family Practice', '', '', NULL, 'O', '1365 W 1000 N', 'Salt Lake City', 'Salt Lake', 'UT', '84116', '8013285750', '8015217463', '1365 W 1000 N', 'Salt Lake City', 'Salt Lake', 'UT', '84116', '8013285750', '8015217463', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-11-10', '2014-04-11', 0, 0, 0, 'University Health Care University Hospital', '', '', '', 'HCFA|UB|', '1447412135', 0, 'Y', 0, '2014-04-22', NULL, NULL, 40.791, -111.931, NULL, NULL),
('742412898', 'W12013690', 'W12013690', 'UT01', '', 'Frank', 'J', 'Powers', 'MD', 'Family Practice', '', '', NULL, 'B', '220 W 7200 S Ste A', 'Midvale', 'Salt Lake', 'UT', '84047', '8018583468', '8018583470', '220 W 7200 S Ste A', 'Midvale', 'Salt Lake', 'UT', '84047', '8018583468', '8018583470', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-11-10', NULL, 0, 0, 0, 'University Health Care University Hospital', '', '', '', 'HCFA|UB|', '1447412135', 0, 'N', 0, '2014-04-22', NULL, NULL, 0, 0, NULL, NULL),
('201391282', 'W12013691', 'W12013691', 'WY01', 'Thunder Basin Orthopedics and Sports', 'James', 'A', 'Ulibarri', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '111 S 5th St', 'Douglas', 'Converse', 'WY', '82633', '3073586200', '3073583748', '111 S 5th St', 'Douglas', 'Converse', 'WY', '82633', '3073586200', '3073583748', 'WYORTHO10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-11-10', '2013-12-31', 0, 0, 0, 'Sheridan Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1578586269', 0, 'N', 0, '2014-01-03', NULL, NULL, 0, 0, NULL, NULL),
('201391282', 'W12013693', 'W12013693', 'WY01', 'Thunder Basin Orthopedics and Sports', 'James', 'A', 'Ulibarri', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', 'PO Box 688', 'Douglas', 'Converse', 'WY', '82633', '3073586200', '3073583748', 'PO Box 688', 'Douglas', 'Converse', 'WY', '82633', '3073586200', '3073583748', 'WYORTHO10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-11-10', NULL, 0, 0, 0, 'Sheridan Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1578586269', 0, 'N', 0, '2012-06-25', NULL, NULL, 0, 0, NULL, NULL),
('201391282', 'W12013692', 'W12013692', 'WYT2', 'Thunder Basin Orthopedics and Sports', 'James', 'A', 'Ulibarri', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '111 S 5th St', 'Douglas', 'Converse', 'WY', '82633', '3073586200', '3073583748', '111 S 5th St', 'Douglas', 'Converse', 'WY', '82633', '3073586200', '3073583748', 'WYORTHO10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-11-10', '2013-12-31', 0, 0, 0, 'Sheridan Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1578586269', 0, 'N', 0, '2014-01-03', NULL, NULL, 0, 0, NULL, NULL),
('201391282', 'W12013694', 'W12013694', 'WYT2', 'Thunder Basin Orthopedics and Sports', 'James', 'A', 'Ulibarri', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', 'PO Box 688', 'Douglas', 'Converse', 'WY', '82633', '3073586200', '3073583748', 'PO Box 688', 'Douglas', 'Converse', 'WY', '82633', '3073586200', '3073583748', 'WYORTHO10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-11-10', NULL, 0, 0, 1, 'Sheridan Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1578586269', 0, 'N', 0, '2012-06-25', NULL, NULL, 0, 0, NULL, NULL),
('870635889', 'W12013695', 'W12013695', 'UT01', 'Tooele Clinic Corp', 'Amy', 'G', 'Williams', 'MD', 'Pediatrics', '', '', NULL, 'O', '210 Millpond Rd', 'Tooele', 'Tooele', 'UT', '84074', '4358433647', NULL, '210 Millpond Rd', 'Tooele', 'Tooele', 'UT', '84074', '4358433647', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-11-10', '2012-11-07', 0, 0, 0, 'Mountain West Medical Center', '', '', '', 'HCFA|UB|', '1649319674', 0, 'Y', 0, '2012-12-04', NULL, NULL, 0, 0, NULL, NULL),
('870635889', 'W12013696', 'W12013696', 'UT01', 'Tooele Clinic Corp', 'Amy', 'G', 'Williams', 'MD', 'Pediatrics', '', '', NULL, 'M', 'PO Box 689022', 'Franklin', 'Williamson', 'TN', '37068', '4358433647', NULL, 'PO Box 689022', 'Franklin', 'Williamson', 'TN', '37068', '4358433647', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-11-10', NULL, 0, 0, 0, 'Mountain West Medical Center', '', '', '', 'HCFA|UB|', '1649319674', 0, 'Y', 0, '2011-11-14', NULL, NULL, 0, 0, NULL, NULL),
('870635889', 'W12013697', 'W12013697', 'UT01', 'Tooele Clinic Corp', 'Amy', 'G', 'Williams', 'MD', 'Pediatrics', '', '', NULL, 'B', 'PO Box 848416', 'Boston', 'Suffolk', 'MA', '02284', '6174021000', '6174021099', 'PO Box 848416', 'Boston', 'Suffolk', 'MA', '02284', '6174021000', '6174021099', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-11-10', NULL, 0, 0, 0, 'Mountain West Medical Center', '', '', '', 'HCFA|UB|', '1649319674', 0, 'Y', 0, '2012-12-04', NULL, NULL, 0, 0, NULL, NULL),
('061506129', 'W12013700', 'W12013700', 'UT01', 'Wee Care Pediatrics', 'Justin', 'C', 'Alvey', 'MD', 'Pediatrics', '', '', NULL, 'B', '2086 N 1700 W Ste C', 'Layton', 'Davis', 'UT', '84041', '8017738644', '8019271591', '2086 N 1700 W Ste C', 'Layton', 'Davis', 'UT', '84041', '8017738644', '8019271591', 'WUSTDPEDE5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-08-01', '2013-01-05', 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1346248465', 0, 'N', 0, '2013-03-12', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W12013701', 'W12013701', 'UT01', 'Rocky Mountain Womens Health Center at West Valley Campus', 'Lynne', 'G', 'Atwood', 'FNP', 'Obstetrics and Gynecology', '', '', NULL, 'O', '225 Sky Hawk Dr', 'Wendover', 'Tooele', 'UT', '84083', '4355793846', '8019643894', '225 Sky Hawk Dr', 'Wendover', 'Tooele', 'UT', '84083', '4355793846', '8019643894', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-08-23', '2014-04-30', 0, 0, 0, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1275590960', 0, 'N', 0, '2013-10-18', NULL, NULL, 40.7373, -114.036, NULL, NULL),
('841367175', 'W12013703', 'W12013703', 'UT01', 'Canyon View Medical Group', 'Jonathen', '', 'Bartholomew', 'DO', 'Pediatrics', '', '', NULL, 'O', '1000 E 15 S Ste 100', 'Payson', 'Utah', 'UT', '84651', '8014659480', '8014659823', '1000 E 15 S Ste 100', 'Payson', 'Utah', 'UT', '84651', '8014659480', '8014659823', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-10-01', '2012-09-01', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1073672135', 0, 'N', 0, '2013-12-10', NULL, NULL, 0, 0, NULL, NULL),
('841367175', 'W12013702', 'W12013702', 'UT01', 'Canyon View Medical Group', 'Jonathen', '', 'Bartholomew', 'DO', 'Pediatrics', '', '', NULL, 'O', '325 W Ctr St', 'Spanish Fork', 'Utah', 'UT', '84660', '8017987301', '8017988513', '325 W Ctr St', 'Spanish Fork', 'Utah', 'UT', '84660', '8017987301', '8017988513', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-10-01', '2012-09-01', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1073672135', 0, 'N', 0, '2013-12-10', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W12013704', 'W12013704', 'UT01', 'Copper Canyon Womens Center', 'Joseph', 'W', 'Bell', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '225 Sky Hawk Dr', 'Wendover', 'Tooele', 'UT', '84083', '4355793846', '8019643894', '225 Sky Hawk Dr', 'Wendover', 'Tooele', 'UT', '84083', '4355793846', '8019643894', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-08-23', '2014-04-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1851471767', 0, 'N', 0, '2011-10-04', NULL, NULL, 40.7373, -114.036, NULL, NULL),
('061506129', 'W12013705', 'W12013705', 'UT01', 'Wee Care Pediatrics', 'Stacy', 'A', 'Bond-Jorgensen', 'APRN', 'Pediatrics', 'Asthma', '', NULL, 'M', '2086 N 1700 W Ste C', 'Layton', 'Davis', 'UT', '84041', '8017738644', '8019271591', '2086 N 1700 W Ste C', 'Layton', 'Davis', 'UT', '84041', '8017738644', '8019271591', 'WUSTDPEDE5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-08-01', NULL, 0, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1295850626', 0, 'N', 0, '2012-01-04', NULL, NULL, 0, 0, NULL, NULL),
('452516258', 'W12013706', 'W12013706', 'ID01', 'Caldwell Psychological Serices', 'Phares', 'L', 'Book', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '815 Fillmore Ave', 'Caldwell', 'Canyon', 'ID', '83605', '2084596962', NULL, '815 Fillmore Ave', 'Caldwell', 'Canyon', 'ID', '83605', '2084596962', '          ', 'IDPHD', '', '', '0.00', '35.00', '0.00', 3, '2011-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1104083724', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('061506129', 'W12013707', 'W12013707', 'UT01', 'Wee Care Pediatrics', 'Bob', '', 'Bunnell', 'PA', 'Pediatrics', '', '', NULL, 'M', '2086 N 1700 W Ste C', 'Layton', 'Davis', 'UT', '84041', '8017738644', '8019271591', '2086 N 1700 W Ste C', 'Layton', 'Davis', 'UT', '84041', '8017738644', '8019271591', 'WUSTDPEDE5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-08-01', NULL, 0, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1831175272', 0, 'N', 0, '2012-01-05', NULL, NULL, 0, 0, NULL, NULL),
('061506129', 'W12013708', 'W12013708', 'UT01', 'Wee Care Pediatrics', 'Priscilla', 'Aye', 'Chen', 'MD', 'Pediatrics', '', '', NULL, 'M', '2086 N 1700 W Ste C', 'Layton', 'Davis', 'UT', '84041', '8017738644', '8019271591', '2086 N 1700 W Ste C', 'Layton', 'Davis', 'UT', '84041', '8017738644', '8019271591', 'WUSTDPEDE5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-08-01', NULL, 0, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1750346599', 0, 'N', 0, '2012-01-04', NULL, NULL, 0, 0, NULL, NULL),
('870617263', 'W12013709', 'W12013709', 'UT01', 'St Marks Family Medicine', 'Camille', '', 'Collett', 'MD', 'Family Practice', '', '', NULL, 'O', '1250 E 3900 S Ste 260', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012652000', '8012652008', '1250 E 3900 S Ste 260', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012652000', '8012652008', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1275530305', 0, 'N', 0, '2014-04-17', NULL, NULL, 40.6871, -111.856, NULL, NULL),
('870354442', 'W12013710', 'W12013710', 'UT01', 'Rocky Mountain Womens Health Center', 'Vivian', '', 'Dearden', 'CNM', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'B', 'PO Box 844839', 'Dallas', 'Dallas', 'TX', '75284', '8017760880', NULL, 'PO Box 844839', 'Dallas', 'Dallas', 'TX', '75284', '8017760880', '          ', 'WRYMTWOM', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-07-01', '2014-04-30', 0, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1437260510', 0, 'N', 0, '2011-09-20', NULL, NULL, 0, 0, NULL, NULL),
('870354442', 'W12013711', 'W12013711', 'UT01', 'Rocky Mountain Womens Health Center', 'Teresa', 'V', 'Durbin', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 844839', 'Dallas', 'Dallas', 'TX', '75284', '8017760880', NULL, 'PO Box 844839', 'Dallas', 'Dallas', 'TX', '75284', '8017760880', '', 'WRYMTWOM', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-07-01', '2014-04-30', 0, 0, 0, 'Davis Hospital', '', '', '', 'HCFA|UB|', '1609987791', 0, 'N', 0, '2014-04-02', NULL, NULL, 0, 0, NULL, NULL),
('870354442', 'W12013712', 'W12013712', 'UT01', 'Rocky Mountain Womens Health Center', 'Maria', 'D', 'Hernandez', 'MD', 'Urogynecology', 'Gynecology', '', NULL, 'B', 'PO Box 844839', 'Dallas', 'Dallas', 'TX', '75284', '8017760880', NULL, 'PO Box 844839', 'Dallas', 'Dallas', 'TX', '75284', '8017760880', '', 'WRYMTWOM', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-07-01', '2014-04-30', 0, 0, 0, 'Davis Hospital', '', '', '', 'HCFA|UB|', '1891960738', 0, 'N', 0, '2014-07-14', NULL, NULL, 0, 0, NULL, NULL),
('870354442', 'W12013713', 'W12013713', 'UT01', 'Rocky Mountain Womens Health Center', 'William', 'G', 'Hughes', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 844839', 'Dallas', 'Dallas', 'TX', '75284', '8017760880', NULL, 'PO Box 844839', 'Dallas', 'Dallas', 'TX', '75284', '8017760880', '          ', 'WRYMTWOM', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-07-01', '2014-04-30', 0, 0, 0, 'Davis Hospital', '', '', '', 'HCFA|UB|', '1881787885', 0, 'N', 0, '2014-03-25', NULL, NULL, 0, 0, NULL, NULL),
('870354442', 'W12013714', 'W12013714', 'UT01', 'Rocky Mountain Womens Health Center', 'Patricia', 'M', 'James', 'NP', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 844839', 'Dallas', 'Dallas', 'TX', '75284', '8017760880', NULL, 'PO Box 844839', 'Dallas', 'Dallas', 'TX', '75284', '8017760880', '          ', 'WRYMTWOM', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-07-01', '2013-01-16', 0, 0, 0, 'Davis Hospital', '', '', '', 'HCFA|UB|', '1508046772', 0, 'N', 0, '2013-03-20', NULL, NULL, 0, 0, NULL, NULL),
('870354442', 'W12013715', 'W12013715', 'UT01', 'Rocky Mountain Womens Health Center', 'Charles', 'W', 'Joseph', 'MD', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'B', 'PO Box 844839', 'Dallas', 'Dallas', 'TX', '75284', '8017760880', NULL, 'PO Box 844839', 'Dallas', 'Dallas', 'TX', '75284', '8017760880', '          ', 'WRYMTWOM', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-07-01', '2014-04-30', 0, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1609978238', 0, 'N', 0, '2013-07-22', NULL, NULL, 0, 0, NULL, NULL),
('870354442', 'W12013716', 'W12013716', 'UT01', 'Rocky Mountain Womens Health Center', 'Linda', 'S', 'Koenen', 'NP', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 844839', 'Dallas', 'Dallas', 'TX', '75284', '8017760880', NULL, 'PO Box 844839', 'Dallas', 'Dallas', 'TX', '75284', '8017760880', '          ', 'WRYMTWOM', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-07-01', '2014-04-30', 0, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1407949415', 0, 'N', 0, '2011-09-20', NULL, NULL, 0, 0, NULL, NULL),
('061506129', 'W12013717', 'W12013717', 'UT01', 'Wee Care Pediatrics', 'James', 'A', 'Fennell', 'MD', 'Pediatrics', '', '', NULL, 'M', '2086 N 1700 W Ste C', 'Layton', 'Davis', 'UT', '84041', '8017738644', '8019271591', '2086 N 1700 W Ste C', 'Layton', 'Davis', 'UT', '84041', '8017738644', '8019271591', 'WUSTDPEDE5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-08-01', NULL, 0, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1912905035', 0, 'N', 0, '2013-04-11', NULL, NULL, 0, 0, NULL, NULL),
('061506129', 'W12013718', 'W12013718', 'UT01', 'Wee Care Pediatrics', 'Alvin', 'A', 'Gabrielsen', 'MD', 'Pediatrics', '', '', NULL, 'M', '2086 N 1700 W Ste C', 'Layton', 'Davis', 'UT', '84041', '8017738644', '8019271591', '2086 N 1700 W Ste C', 'Layton', 'Davis', 'UT', '84041', '8017738644', '8019271591', 'WUSTDPEDE5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-08-01', NULL, 0, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1992703029', 0, 'N', 0, '2012-01-04', NULL, NULL, 0, 0, NULL, NULL),
('061506129', 'W12013719', 'W12013719', 'UT01', 'Wee Care Pediatrics', 'Jennifer', 'M', 'Gilsoul', 'MD', 'Pediatrics', '', '', NULL, 'M', '2086 N 1700 W Ste C', 'Layton', 'Davis', 'UT', '84041', '8017738644', '8019271591', '2086 N 1700 W Ste C', 'Layton', 'Davis', 'UT', '84041', '8017738644', '8019271591', 'WUSTDPEDE5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-08-01', NULL, 0, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1164402202', 0, 'N', 0, '2014-02-10', NULL, NULL, 0, 0, NULL, NULL),
('061506129', 'W12013720', 'W12013720', 'UT01', 'Wee Care Pediatrics', 'Cody', 'J', 'Hawkes', 'DO', 'Pediatrics', '', '', NULL, 'M', '2086 N 1700 W Ste C', 'Layton', 'Davis', 'UT', '84041', '8017738644', '8019271591', '2086 N 1700 W Ste C', 'Layton', 'Davis', 'UT', '84041', '8017738644', '8019271591', 'WUSTDPEDE5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-08-01', NULL, 0, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1457535114', 0, 'N', 0, '2012-01-04', NULL, NULL, 0, 0, NULL, NULL),
('061506129', 'W12013721', 'W12013721', 'UT01', 'Wee Care Pediatrics', 'Michael', 'P', 'Husseman', 'MD', 'Pediatrics', '', '', NULL, 'M', '2086 N 1700 W Ste C', 'Layton', 'Davis', 'UT', '84041', '8017738644', '8019271591', '2086 N 1700 W Ste C', 'Layton', 'Davis', 'UT', '84041', '8017738644', '8019271591', 'WUSTDPEDE5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-08-01', NULL, 0, 0, 0, 'Davis Hospital', '', '', '', 'HCFA|UB|', '1053319186', 0, 'N', 0, '2014-04-16', NULL, NULL, 0, 0, NULL, NULL),
('061506129', 'W12013722', 'W12013722', 'UT01', 'Wee Care Pediatrics', 'Michael', 'Brian', 'Lloyd', 'MD', 'Pediatric Neurology', 'Pediatrics', '', NULL, 'M', '2086 N 1700 W Ste C', 'Layton', 'Davis', 'UT', '84041', '8017738644', '8019271591', '2086 N 1700 W Ste C', 'Layton', 'Davis', 'UT', '84041', '8017738644', '8019271591', 'WUSTDPEDE5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-08-01', '2012-08-31', 0, 0, 0, 'Primary Childrens Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1497753354', 0, 'N', 0, '2012-09-04', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W12013723', 'W12013723', 'UT01', 'Coral Desert Spine Surgery', 'Armen', '', 'Khachatryan', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1490 E Formaster Dr Ste 220', 'St George', 'Washington', 'UT', '84790', '4356568366', '4356568370', '1490 E Formaster Dr Ste 220', 'St George', 'Washington', 'UT', '84790', '4356568366', '4356568370', 'WUSTDSURG5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-08-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1114930781', 0, 'N', 0, '2011-10-10', NULL, NULL, 37.0959, -113.551, NULL, NULL),
('621801973', 'W12013724', 'W12013724', 'UT01', 'Coral Desert Spine Surgery', 'Armen', '', 'Khachatryan', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', 'WUSTDSURG5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-08-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1114930781', 0, 'N', 0, '2011-10-10', NULL, NULL, 0, 0, NULL, NULL),
('061506129', 'W12013729', 'W12013729', 'UT01', 'Wee Care Pediatrics', 'Elenor', '', 'MacGregor', 'DO', 'Pediatrics', '', '', NULL, 'M', '2086 N 1700 W Ste C', 'Layton', 'Davis', 'UT', '84041', '8017738644', '8019271591', '2086 N 1700 W Ste C', 'Layton', 'Davis', 'UT', '84041', '8017738644', '8019271591', 'WUSTDPEDE5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-08-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', 'Davis Hospital', '', '', 'HCFA|UB|', '1740509223', 0, 'N', 0, '2014-07-21', NULL, NULL, 0, 0, NULL, NULL),
('061506129', 'W12013730', 'W12013730', 'UT01', 'Wee Care Pediatrics', 'Anthony', 'G', 'Pruitt', 'MD', 'Pediatrics', '', '', NULL, 'M', '2086 N 1700 W Ste C', 'Layton', 'Davis', 'UT', '84041', '8017738644', '8019271591', '2086 N 1700 W Ste C', 'Layton', 'Davis', 'UT', '84041', '8017738644', '8019271591', 'WUSTDPEDE5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-08-01', NULL, 0, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1700884848', 0, 'N', 0, '2013-04-15', NULL, NULL, 0, 0, NULL, NULL),
('870284475', 'W12013731', 'W12013731', 'UT01', 'Granger Medical Clinic', 'Mindy', '', 'Ruhlman', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '3181 W 9000 S', 'West Jordan', 'Salt Lake', 'UT', '84088', '8013525900', '8013525914', '3181 W 9000 S', 'West Jordan', 'Salt Lake', 'UT', '84088', '8013525900', '8013525914', 'WUGRANGER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-09-01', '2012-07-31', 0, 0, 0, 'Pioneer Valley Hospital', 'Jordan Valley Medical Center', '', '', 'HCFA|UB|', '1164453536', 0, 'N', 0, '2014-01-27', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W12013733', 'W12013733', 'UT01', 'Comprehensive Neurology of Utah', 'Mohammad', '', 'Shoari', 'MD', 'Neurology', '', '', NULL, 'O', '3110 W 300 N Ste A', 'West Point', 'Davis', 'UT', '84015', '8017739902', '8016145144', '3110 W 300 N Ste A', 'West Point', 'Davis', 'UT', '84015', '8017739902', '8016145144', 'WUSTDSURG5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-07-29', NULL, 0, 0, 0, 'Davis Hospital', 'Salt Lake Regional Medical Center', NULL, NULL, 'HCFA|UB|', '1740483395', 0, 'N', 0, '2014-01-06', NULL, NULL, 41.1181, -112.086, NULL, NULL),
('061506129', 'W12013740', 'W12013740', 'UT01', 'Wee Care Pediatrics', 'Laurent', 'C', 'Sigg', 'MD', 'Pediatrics', '', '', NULL, 'M', '2086 N 1700 W Ste C', 'Layton', 'Davis', 'UT', '84041', '8017738644', '8019271591', '2086 N 1700 W Ste C', 'Layton', 'Davis', 'UT', '84041', '8017738644', '8019271591', 'WUSTDPEDE5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-08-01', NULL, 0, 0, 0, 'Davis Hospital', '', '', '', 'HCFA|UB|', '1750389805', 0, 'N', 0, '2014-03-27', NULL, NULL, 0, 0, NULL, NULL),
('061506129', 'W12013741', 'W12013741', 'UT01', 'Wee Care Pediatrics', 'Peter', 'E', 'Silas', 'MD', 'Pediatrics', '', '', NULL, 'M', '2086 N 1700 W Ste C', 'Layton', 'Davis', 'UT', '84041', '8017738644', '8019271591', '2086 N 1700 W Ste C', 'Layton', 'Davis', 'UT', '84041', '8017738644', '8019271591', 'WUSTDPEDE5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-08-01', NULL, 0, 0, 0, 'Davis Hospital', '', '', '', 'HCFA|UB|', '1295733343', 0, 'N', 0, '2014-03-25', NULL, NULL, 0, 0, NULL, NULL),
('870644792', 'W12013742', 'W12013742', 'UT01', '', 'David', 'A', 'Smith', 'OD', 'Optometry', '', '', NULL, 'O', '276 N Springcreek Pkwy', 'Providence', 'Cache', 'UT', '84332', '4357134444', '4357871235', '276 N Springcreek Pkwy', 'Providence', 'Cache', 'UT', '84332', '4357134444', '4357871235', 'WUTALBERT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1417067950', 0, 'N', 0, '2014-04-24', NULL, NULL, 41.7135, -111.828, NULL, NULL),
('061506129', 'W12013743', 'W12013743', 'UT01', 'Wee Care Pediatrics', 'Carmen', 'M', 'Taveras Espinal', 'MD', 'Pediatrics', '', '', NULL, 'M', '2086 N 1700 W Ste C', 'Layton', 'Davis', 'UT', '84041', '8017738644', '8019271591', '2086 N 1700 W Ste C', 'Layton', 'Davis', 'UT', '84041', '8017738644', '8019271591', 'WUSTDPEDE5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-08-01', '2011-09-30', 0, 0, 0, 'Primary Childrens Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1831400589', 0, 'N', 0, '2012-01-24', NULL, NULL, 0, 0, NULL, NULL),
('273780811', 'W12013745', 'W12013745', 'ID02', 'The Pain Center', 'Sandra', 'A', 'Thompson', 'MD', 'Pain Management', '', '', NULL, 'O', '1673 W Shoreline Ste 140', 'Boise', 'Ada', 'ID', '83702', '2083429800', '2083424223', '1673 W Shoreline Ste 140', 'Boise', 'Ada', 'ID', '83702', '2083429800', '2083424223', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-01-01', NULL, 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1326085713', 0, 'N', 0, '2012-02-07', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W12013746', 'W12013746', 'UT01', 'Oval Sports Medicine (Practice emphasis on Sports Medicine)', 'Russell', 'A', 'Toronto', 'MD', 'General Practice', '', '', NULL, 'O', '5662 S Cougar Ln Ste 311', 'Taylorsville', 'Salt Lake', 'UT', '84118', '8019128210', '8019128209', '5662 S Cougar Ln Ste 311', 'Taylorsville', 'Salt Lake', 'UT', '84118', '8019128210', '8019128209', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-08-04', '2014-04-30', 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1528005618', 0, 'N', 0, '2011-10-25', NULL, NULL, 40.6466, -112.006, NULL, NULL),
('500502274', 'W12013750', 'W12013750', 'SACN', 'Meridian Psychological Center', 'Bill', 'R', 'Arnold', 'PhD', 'Psychology', '', '', NULL, 'O', '2770 E Franklin Rd', 'Meridian', 'Ada', 'ID', '83642', '2088550660', '2088989433', '2770 E Franklin Rd', 'Meridian', 'Ada', 'ID', '83642', '2088550660', '2088989433', 'IDSINCLAIRL', '', '', '0.00', '15.00', '0.00', 3, '2011-01-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1447269055', 0, 'N', 0, '2011-08-30', NULL, NULL, 0, 0, NULL, NULL),
('850247709', 'W12013751', 'W12013751', 'NM01', '', 'Lawrence', 'S', 'Barkalow', 'DC', 'Chiropractic', '', '', NULL, 'O', '215 W Reinken Ave', 'Belen', 'Valencia', 'NM', '87002', '5058647657', '5058647699', '215 W Reinken Ave', 'Belen', 'Valencia', 'NM', '87002', '5058647657', '5058647699', 'NMCHIRO', '', '', '0.00', '0.00', '38.00', 3, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1245223908', 0, 'N', 0, '2014-04-23', NULL, NULL, 34.6617, -106.769, NULL, NULL),
('742838103', 'W12013754', 'W12013754', 'NM01', 'Southwest Eyecare Specialists', 'R', 'J', 'Cannon', 'MD', 'Ophthalmology', '', '', NULL, 'O', '7110 Wyoming Blvd', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5053460500', '5053460164', '7110 Wyoming Blvd', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5053460500', '5053460164', 'NMSWEYE', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', '2012-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1215900717', 0, 'Y', 0, '2011-10-19', NULL, NULL, 0, 0, NULL, NULL),
('850421108', 'W12013753', 'W12013753', 'NM01', '', 'Jennifer', 'J', 'Burns', 'DC', 'Chiropractic', '', '', NULL, 'O', '3636 Menaul Blvd NE Ste 307', 'Albuquerque', 'Bernalillo', 'NM', '87110', '5058835443', '5058812705', '3636 Menaul Blvd NE Ste 307', 'Albuquerque', 'Bernalillo', 'NM', '87110', '5058835443', '5058812705', 'NMCHIRO', '', '', '0.00', '0.00', '38.00', 3, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1366415952', 0, 'N', 0, '2014-05-08', NULL, NULL, 35.1092, -106.603, NULL, NULL),
('742838103', 'W12013755', 'W12013755', 'NM01', 'Southwest Eyecare Specialists', 'Peter', 'T', 'Beaudette', 'MD', 'Ophthalmology', '', '', NULL, 'O', '7110 Wyoming Blvd', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5053460500', '5053460164', '7110 Wyoming Blvd', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5053460500', '5053460164', 'NMSWEYE', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', '2012-01-01', 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1720053200', 0, 'Y', 0, '2011-10-19', NULL, NULL, 0, 0, NULL, NULL),
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('850437151', 'W12013757', 'W12013757', 'NM01', 'Pediatric Associates', 'Melissa', 'E', 'Mason', 'MD', 'Pediatrics', '', '', NULL, 'O', '3410 Indian School Rd NE', 'Albuquerque', 'Bernalillo', 'NM', '87106', '5052657817', '5052661543', '3410 Indian School Rd NE', 'Albuquerque', 'Bernalillo', 'NM', '87106', '5052657817', '5052661543', 'NMSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1851398804', 0, 'N', 0, '2011-10-04', NULL, NULL, 35.1019, -106.607, NULL, NULL),
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('742838103', 'W12013762', 'W12013762', 'NM01', 'Southwest Eyecare Specialists', 'Paul', 'A', 'Sanchez', 'MD', 'Ophthalmology', '', '', NULL, 'O', '7110 Wyoming Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5053460500', '5053460164', '7110 Wyoming Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5053460500', '5053460164', 'NMSWEYE', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1811106685', 0, 'N', 0, '2011-10-19', NULL, NULL, 35.1597, -106.56, NULL, NULL),
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('943479199', 'W12013765', 'W12013765', 'NM01', '', 'Li', '', 'Xu', 'DOM', 'Acupuncture', '', '', NULL, 'B', '6709 Tesoro Pl NE', 'Albuquerque', 'Bernalillo', 'NM', '87113', '5055506859', '5057965089', '6709 Tesoro Pl NE', 'Albuquerque', 'Bernalillo', 'NM', '87113', '5055506859', '5057965089', '', '', '', '0.00', '0.00', '75.00', 3, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1821284522', 0, 'N', 0, '2014-04-17', NULL, NULL, 0, 0, NULL, NULL),
('943479199', 'W12013764', 'W12013764', 'NM01', '', 'Li', '', 'Xu', 'DOM', 'Acupuncture', '', '', NULL, 'O', '7801 Academy Rd NE', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5055506859', '5057965089', '7801 Academy Rd NE', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5055506859', '5057965089', '', '', '', '0.00', '0.00', '75.00', 3, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1821284522', 0, 'N', 0, '2014-04-17', NULL, NULL, 35.1454, -106.559, NULL, NULL),
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('204043287', 'W12036308', 'W12036308', 'NM01', 'ABQ Health Partners', '', '', 'ABQ Health Partners', '', 'Family Practice', '', '', NULL, 'O', '10511 Golf Course Rd NW', 'Albuquerque', 'Bernalillo', 'NM', '87114', '0000000000', '0000000000', '10511 Golf Course Rd NW', 'Albuquerque', 'Bernalillo', 'NM', '87114', '0000000000', '0000000000', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '0000009773', 0, 'Y', 0, '2014-06-19', NULL, NULL, 35.2073, -106.676, NULL, NULL),
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('850424076', 'W12014498', 'W12014498', 'NM01', 'New Mexico Heart Institute', 'Anita', 'M', 'Ralstin', 'NP', 'Cardiovascular Disease', '', '', NULL, 'O', '502 Elm St NE', 'Albuquerque', 'Bernalillo', 'NM', '87102', '5058411000', '5058432853', '502 Elm St NE', 'Albuquerque', 'Bernalillo', 'NM', '87102', '5058411000', '5058432853', 'NMHEART', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, 'Heart Hospital of New Mexico', NULL, NULL, NULL, 'HCFA|UB|', '1881698785', 0, 'N', 0, '2011-10-04', NULL, NULL, 35.0865, -106.638, NULL, NULL),
('204043287', 'ABQ000802', 'ABQ000802', 'NM01', 'ABQ Health Partners', 'Margaret', '', 'Abeyta', 'NP', 'Family Practice', '', '', NULL, 'M', '5400 Gibson Blvd SE ', 'Albuquerque', 'Bernalillo', 'NM', '87108', '5052754288', '5052754203', '5400 Gibson Blvd SE ', 'Albuquerque', 'Bernalillo', 'NM', '87108', '5052754288', '5052754203', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2012-01-01', '2013-12-06', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1326061417', 0, 'N', 0, '2013-12-10', NULL, NULL, 0, 0, NULL, NULL),
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('204043287', 'ABQ000403', 'ABQ000403', 'NM01', 'ABQ Health Partners', 'Sergio', '', 'Abriola', 'MD', 'Hospitalist', '', '', NULL, 'B', 'PO Box 27829           ', 'Albuquerque', 'Bernalillo', 'NM', '87125', '5057278039', '5057278086', 'PO Box 27829           ', 'Albuquerque', 'Bernalillo', 'NM', '87125', '5057278039', '5057278086', 'NMABQ', 'WUSTDHCPC5', NULL, '0.00', '40.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, 'Lovelace Medical Center', 'Lovelace Womens Hospital', 'Lovelace Westside Hospital ', NULL, 'HCFA|UB|', '1588757322', 0, 'N', 0, '2011-10-20', NULL, NULL, 0, 0, NULL, NULL),
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('204043287', 'ABQ000006', 'ABQ000006', 'NM01', 'ABQ Health Partners', 'James', '', 'Allman', 'PA-C', 'Orthopedic Surgery', '', '', NULL, 'O', '5150 Journal Ctr Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5053428400', '5053428401', '5150 Journal Center Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5053428400', '5053428401', 'NMABQ', 'WUSTDHCPC5', NULL, '0.00', '40.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, 'Lovelace Womens Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1811915275', 0, 'N', 0, '2011-10-20', NULL, NULL, 35.1702, -106.586, NULL, NULL),
('204043287', 'ABQ000806', 'ABQ000806', 'NM01', 'ABQ Health Partners', 'James', '', 'Allman', 'PA-C', 'Orthopedic Surgery', '', '', NULL, 'M', '5400 Gibson Blvd SE ', 'Albuquerque', 'Bernalillo', 'NM', '87108', '5053428400', '5053428401', '5400 Gibson Blvd SE ', 'Albuquerque', 'Bernalillo', 'NM', '87108', '5053428400', '5053428401', 'NMABQ', 'WUSTDHCPC5', NULL, '0.00', '40.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, 'Lovelace Womens Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1811915275', 0, 'N', 0, '2011-10-20', NULL, NULL, 0, 0, NULL, NULL),
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('204043287', 'ABQ000407', 'ABQ000407', 'NM01', 'ABQ Health Partners', 'Peter', '', 'Anderson', 'OD', 'Optometry', '', '', NULL, 'B', 'PO Box 27829           ', 'Albuquerque', 'Bernalillo', 'NM', '87125', '5052623937', '5052627147', 'PO Box 27829           ', 'Albuquerque', 'Bernalillo', 'NM', '87125', '5052623937', '5052627147', 'NMABQ', 'WUSTDHCPC5', NULL, '0.00', '40.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1942235924', 0, 'N', 0, '2011-10-20', NULL, NULL, 0, 0, NULL, NULL),
('204043287', 'ABQ000008', 'ABQ000008', 'NM01', 'ABQ Health Partners', 'Claudia', '', 'Anison', 'MD', 'Hospitalist', '', '', NULL, 'O', '500 Walter St NE Ste 401', 'Albuquerque', 'Bernalillo', 'NM', '87102', '5057278039', '5057278086', '500 Walter St NE Ste 401', 'Albuquerque', 'Bernalillo', 'NM', '87102', '5057278039', '5057278086', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, 'Lovelace Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1770516270', 0, 'N', 0, '2014-06-13', NULL, NULL, 35.0863, -106.64, NULL, NULL),
('204043287', 'ABQ000808', 'ABQ000808', 'NM01', 'ABQ Health Partners', 'Claudia', '', 'Anison', 'MD', 'Hospitalist', '', '', NULL, 'M', '5400 Gibson Blvd SE ', 'Albuquerque', 'Bernalillo', 'NM', '87108', '5057278039', '5057278086', '5400 Gibson Blvd SE ', 'Albuquerque', 'Bernalillo', 'NM', '87108', '5057278039', '5057278086', 'NMABQ', 'WUSTDHCPC5', NULL, '0.00', '40.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, 'Lovelace Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1770516270', 0, 'N', 0, '2011-10-20', NULL, NULL, 0, 0, NULL, NULL);
