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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('462908086', 'W12036833', 'W12036833', 'TXDALSTD', 'Touchstone Imaging Burleson', '', '', 'Touchstone Imaging Burleson', '', 'Imaging Center', '', '', NULL, 'O', '665 NE Alsbury Blvd', 'Burleson', 'Johnson', 'TX', '76028', '8174473443', '0000000000', '665 NE Alsbury Blvd', 'Burleson', 'Johnson', 'TX', '76028', '8174473443', '0000000000', '', '', 'BAYLORTOUCH', '0.00', '0.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1508204959', 0, 'N', 0, '2013-08-16', NULL, NULL, 32.5623, -97.3247, NULL, NULL),
('462908086', 'W12036835', 'W12036835', 'TXDALSTD', 'Touchstone Imaging McKinney', '', '', 'Touchstone Imaging McKinney', '', 'Imaging Center', '', '', NULL, 'B', 'PO Box 102107', 'Atlanta', 'Fulton', 'GA', '30368', '0000000000', '0000000000', 'PO Box 102107', 'Atlanta', 'Fulton', 'GA', '30368', '0000000000', '0000000000', '', '', 'BAYLORTOUCH', '0.00', '0.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1932547460', 0, 'N', 0, '2013-08-16', NULL, NULL, 0, 0, NULL, NULL),
('462908086', 'W12036836', 'W12036836', 'TXDALSTD', 'Touchstone Imaging McKinney', '', '', 'Touchstone Imaging McKinney', '', 'Imaging Center', '', '', NULL, 'O', '5321 W University Dr', 'Mckinney', 'Collin', 'TX', '75071', '2142505089', '0000000000', '5321 W University Dr', 'Mckinney', 'Collin', 'TX', '75071', '2142505089', '0000000000', '', '', 'BAYLORTOUCH', '0.00', '0.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1932547460', 0, 'N', 0, '2013-08-16', NULL, NULL, 33.2183, -96.6849, NULL, NULL),
('462908086', 'W12036838', 'W12036838', 'TXDALSTD', 'Baylor Diagnostic Imaging Center at Junius', '', '', 'Baylor Diagnostic Imaging Center at Junius', '', 'Imaging Center', '', '', NULL, 'B', 'PO Box 102107', 'Atlanta', 'Fulton', 'GA', '30368', '0000000000', '0000000000', 'PO Box 102107', 'Atlanta', 'Fulton', 'GA', '30368', '0000000000', '0000000000', '', '', 'BAYLORTOUCH', '0.00', '0.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1982042305', 0, 'N', 0, '2013-08-16', NULL, NULL, 0, 0, NULL, NULL),
('462908086', 'W12036839', 'W12036839', 'TXDALSTD', 'Baylor Diagnostic Imaging Center at Junius', '', '', 'Baylor Diagnostic Imaging Center at Junius', '', 'Imaging Center', '', '', NULL, 'O', '3900 Junius St Ste 100', 'Dallas', 'Dallas', 'TX', '75246', '2148206900', '0000000000', '3900 Junius St Ste 100', 'Dallas', 'Dallas', 'TX', '75246', '2148206900', '0000000000', '', '', 'BAYLORTOUCH', '0.00', '0.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1982042305', 0, 'N', 0, '2013-08-16', NULL, NULL, 32.791, -96.7782, NULL, NULL),
('462908086', 'W12036841', 'W12036841', 'TXDALSTD', 'Advanced Imaging Center Tom Landry Center', '', '', 'Advanced Imaging Center Tom Landry Center', '', 'Imaging Center', '', '', NULL, 'B', 'PO Box 102107', 'Atlanta', 'Fulton', 'GA', '30368', '0000000000', '0000000000', 'PO Box 102107', 'Atlanta', 'Fulton', 'GA', '30368', '0000000000', '0000000000', '', '', 'BAYLORTOUCH', '0.00', '0.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1225476658', 0, 'N', 0, '2013-08-16', NULL, NULL, 0, 0, NULL, NULL),
('462908086', 'W12036842', 'W12036842', 'TXDALSTD', 'Advanced Imaging Center Tom Landry Center', '', '', 'Advanced Imaging Center Tom Landry Center', '', 'Imaging Center', '', '', NULL, 'O', '411 N Washington Ave Ste 1000', 'Dallas', 'Dallas', 'TX', '75246', '2148208770', '0000000000', '411 N Washington Ave Ste 1000', 'Dallas', 'Dallas', 'TX', '75246', '2148208770', '0000000000', '', '', 'BAYLORTOUCH', '0.00', '0.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1225476658', 0, 'N', 0, '2013-08-16', NULL, NULL, 32.7885, -96.7752, NULL, NULL),
('462908086', 'W12036844', 'W12036844', 'TXDALSTD', 'Baylor Diagnostic Imaging Center at N Dallas', '', '', 'Baylor Diagnostic Imaging Center at N Dallas', '', 'Imaging Center', '', '', NULL, 'B', 'PO Box 102107', 'Atlanta', 'Fulton', 'GA', '30368', '0000000000', '0000000000', 'PO Box 102107', 'Atlanta', 'Fulton', 'GA', '30368', '0000000000', '0000000000', '', '', 'BAYLORTOUCH', '0.00', '0.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1932547361', 0, 'N', 0, '2013-08-16', NULL, NULL, 0, 0, NULL, NULL),
('462908086', 'W12036845', 'W12036845', 'TXDALSTD', 'Baylor Diagnostic Imaging Center at N Dallas', '', '', 'Baylor Diagnostic Imaging Center at N Dallas', '', 'Imaging Center', '', '', NULL, 'O', '9101 N Central Expwy Ste 100', 'Dallas', 'Dallas', 'TX', '75231', '2148201606', '0000000000', '9101 N Central Expwy Ste 100', 'Dallas', 'Dallas', 'TX', '75231', '2148201606', '0000000000', '', '', 'BAYLORTOUCH', '0.00', '0.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1932547361', 0, 'N', 0, '2013-08-16', NULL, NULL, 32.873, -96.7706, NULL, NULL),
('462908086', 'W12036848', 'W12036848', 'TXDALSTD', 'Imaging and Diagnostic Center at Red Oak', '', '', 'Imaging and Diagnostic Center at Red Oak', '', 'Imaging Center', '', '', NULL, 'O', '305 E Ovilla Rd', 'Red Oak', 'Ellis', 'TX', '75154', '9726177731', '0000000000', '305 E Ovilla Rd', 'Red Oak', 'Ellis', 'TX', '75154', '9726177731', '0000000000', '', '', 'BAYLORTOUCH', '0.00', '0.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1841638277', 0, 'N', 0, '2013-08-16', NULL, NULL, 32.5318, -96.805, NULL, NULL),
('462908086', 'W12036847', 'W12036847', 'TXDALSTD', 'Imaging and Diagnostic Center at Red Oak', '', '', 'Imaging and Diagnostic Center at Red Oak', '', 'Imaging Center', '', '', NULL, 'B', 'PO Box 102107', 'Atlanta', 'Fulton', 'GA', '30368', '0000000000', '0000000000', 'PO Box 102107', 'Atlanta', 'Fulton', 'GA', '30368', '0000000000', '0000000000', '', '', 'BAYLORTOUCH', '0.00', '0.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1841638277', 0, 'N', 0, '2013-08-16', NULL, NULL, 0, 0, NULL, NULL),
('462908086', 'W12036850', 'W12036850', 'TXDALSTD', 'Baylor Charles A Sammons Cancer Center', '', '', 'Baylor Charles A Sammons Cancer Center', '', 'Imaging Center', '', '', NULL, 'B', 'PO Box 102107', 'Atlanta', 'Fulton', 'GA', '30368', '0000000000', '0000000000', 'PO Box 102107', 'Atlanta', 'Fulton', 'GA', '30368', '0000000000', '0000000000', '', '', 'BAYLORTOUCH', '0.00', '0.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1275971616', 0, 'N', 0, '2013-08-16', NULL, NULL, 0, 0, NULL, NULL),
('462908086', 'W12036851', 'W12036851', 'TXDALSTD', 'Baylor Charles A Sammons Cancer Center', '', '', 'Baylor Charles A Sammons Cancer Center', '', 'Imaging Center', '', '', NULL, 'O', '3410 Worth St Ste 770', 'Dallas', 'Dallas', 'TX', '75246', '2148202300', '0000000000', '3410 Worth St Ste 770', 'Dallas', 'Dallas', 'TX', '75246', '2148202300', '0000000000', '', '', 'BAYLORTOUCH', '0.00', '0.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1275971616', 0, 'N', 0, '2013-08-16', NULL, NULL, 32.7886, -96.779, NULL, NULL),
('462908086', 'W12036853', 'W12036853', 'TXDALSTD', 'Baylor Diagnostic Imaging Center Craig Ranch', '', '', 'Baylor Diagnostic Imaging Center Craig Ranch', '', 'Imaging Center', '', '', NULL, 'B', 'PO Box 102107', 'Atlanta', 'Fulton', 'GA', '30368', '0000000000', '0000000000', 'PO Box 102107', 'Atlanta', 'Fulton', 'GA', '30368', '0000000000', '0000000000', '', '', 'BAYLORTOUCH', '0.00', '0.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1184062523', 0, 'N', 0, '2013-08-16', NULL, NULL, 0, 0, NULL, NULL),
('462908086', 'W12036854', 'W12036854', 'TXDALSTD', 'Baylor Diagnostic Imaging Center Craig Ranch', '', '', 'Baylor Diagnostic Imaging Center Craig Ranch', '', 'Imaging Center', '', '', NULL, 'O', '8080 St Hwy 121 Ste 210A', 'Keller', 'Tarrant', 'TX', '76248', '9727277455', '0000000000', '8080 St Hwy 121 Ste 210A', 'Keller', 'Tarrant', 'TX', '76248', '9727277455', '0000000000', '', '', 'BAYLORTOUCH', '0.00', '0.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1184062523', 0, 'N', 0, '2013-08-16', NULL, NULL, 32.926, -97.2329, NULL, NULL),
('462908086', 'W12036856', 'W12036856', 'TXDALSTD', 'Baylor Diagnostic Imaging Center Keller', '', '', 'Baylor Diagnostic Imaging Center Keller', '', 'Imaging Center', '', '', NULL, 'B', 'PO Box 102107', 'Atlanta', 'Fulton', 'GA', '30368', '0000000000', '0000000000', 'PO Box 102107', 'Atlanta', 'Fulton', 'GA', '30368', '0000000000', '0000000000', '', '', 'BAYLORTOUCH', '0.00', '0.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1801234240', 0, 'N', 0, '2013-08-16', NULL, NULL, 0, 0, NULL, NULL),
('462908086', 'W12036857', 'W12036857', 'TXDALSTD', 'Baylor Diagnostic Imaging Center Keller', '', '', 'Baylor Diagnostic Imaging Center Keller', '', 'Imaging Center', '', '', NULL, 'O', '601 S Main St Ste 100', 'Keller', 'Tarrant', 'TX', '76248', '8174822000', '0000000000', '601 S Main St Ste 100', 'Keller', 'Tarrant', 'TX', '76248', '8174822000', '0000000000', '', '', 'BAYLORTOUCH', '0.00', '0.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1801234240', 0, 'N', 0, '2013-08-16', NULL, NULL, 32.9271, -97.2541, NULL, NULL),
('462908086', 'W12036860', 'W12036860', 'TXDALSTD', 'Baylor Diagnostic Imaging Center Grand Prairie', '', '', 'Baylor Diagnostic Imaging Center Grand Prairie', '', 'Imaging Center', '', '', NULL, 'O', '2740 N State Hwy 360 Ste 200', 'Grand Prairie', 'Dallas', 'TX', '75050', '0000000000', '0000000000', '2740 N State Hwy 360 Ste 200', 'Grand Prairie', 'Dallas', 'TX', '75050', '0000000000', '0000000000', '', '', 'BAYLORTOUCH', '0.00', '0.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1710325154', 0, 'N', 0, '2013-08-16', NULL, NULL, 32.797, -97.0554, NULL, NULL),
('462908086', 'W12036859', 'W12036859', 'TXDALSTD', 'Baylor Diagnostic Imaging Center Grand Prairie', '', '', 'Baylor Diagnostic Imaging Center Grand Prairie', '', 'Imaging Center', '', '', NULL, 'B', 'PO Box 102107', 'Atlanta', 'Fulton', 'GA', '30368', '0000000000', '0000000000', 'PO Box 102107', 'Atlanta', 'Fulton', 'GA', '30368', '0000000000', '0000000000', '', '', 'BAYLORTOUCH', '0.00', '0.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1710325154', 0, 'N', 0, '2013-08-16', NULL, NULL, 0, 0, NULL, NULL),
('462908086', 'W12036862', 'W12036862', 'TXDALSTD', 'Baylor Diagnostic Imaging Center Grapevine', '', '', 'Baylor Diagnostic Imaging Center Grapevine', '', 'Imaging Center', '', '', NULL, 'B', 'PO Box 102107', 'Atlanta', 'Fulton', 'GA', '30368', '0000000000', '0000000000', 'PO Box 102107', 'Atlanta', 'Fulton', 'GA', '30368', '0000000000', '0000000000', '', '', 'BAYLORTOUCH', '0.00', '0.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1265870604', 0, 'N', 0, '2013-08-16', NULL, NULL, 0, 0, NULL, NULL),
('462908086', 'W12036863', 'W12036863', 'TXDALSTD', 'Baylor Diagnostic Imaging Center Grapevine', '', '', 'Baylor Diagnostic Imaging Center Grapevine', '', 'Imaging Center', '', '', NULL, 'O', '2020 W Hwy 114 Ste 100', 'Temple', 'Bell', 'TX', '76501', '8173292501', '0000000000', '2020 W Hwy 114 Ste 100', 'Temple', 'Bell', 'TX', '76501', '8173292501', '0000000000', '', '', 'BAYLORTOUCH', '0.00', '0.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1265870604', 0, 'N', 0, '2013-08-16', NULL, NULL, 31.0491, -97.3256, NULL, NULL),
('462908086', 'W12036865', 'W12036865', 'TXDALSTD', 'Baylor Diagnostic Imaging Center at Mesquite', '', '', 'Baylor Diagnostic Imaging Center at Mesquite', '', 'Imaging Center', '', '', NULL, 'B', 'PO Box 102107', 'Atlanta', 'Fulton', 'GA', '30368', '0000000000', '0000000000', 'PO Box 102107', 'Atlanta', 'Fulton', 'GA', '30368', '0000000000', '0000000000', '', '', 'BAYLORTOUCH', '0.00', '0.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1174961510', 0, 'N', 0, '2013-08-16', NULL, NULL, 0, 0, NULL, NULL),
('462908086', 'W12036866', 'W12036866', 'TXDALSTD', 'Baylor Diagnostic Imaging Center at Mesquite', '', '', 'Baylor Diagnostic Imaging Center at Mesquite', '', 'Imaging Center', '', '', NULL, 'O', '1660 Republic Pkwy', 'Mesquite', 'Dallas', 'TX', '75150', '9726135696', '0000000000', '1660 Republic Pkwy', 'Mesquite', 'Dallas', 'TX', '75150', '9726135696', '0000000000', '', '', 'BAYLORTOUCH', '0.00', '0.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1174961510', 0, 'N', 0, '2013-08-16', NULL, NULL, 32.8289, -96.6257, NULL, NULL),
('462908086', 'W12036868', 'W12036868', 'TXDALSTD', 'Baylor Diagnostic Imaging Center Carrollton and Womens Imaging Center', '', '', 'Baylor Diagnostic Imaging Center Carrollton and Womens Imaging Center', '', 'Imaging Center', '', '', NULL, 'B', 'PO Box 102107', 'Atlanta', 'Fulton', 'GA', '30368', '0000000000', '0000000000', 'PO Box 102107', 'Atlanta', 'Fulton', 'GA', '30368', '0000000000', '0000000000', '', '', 'BAYLORTOUCH', '0.00', '0.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1083052427', 0, 'N', 0, '2013-08-16', NULL, NULL, 0, 0, NULL, NULL),
('462908086', 'W12036869', 'W12036869', 'TXDALSTD', 'Baylor Diagnostic Imaging Center Carrollton and Womens Imaging Center', '', '', 'Baylor Diagnostic Imaging Center Carrollton and Womens Imaging Center', '', 'Imaging Center', '', '', NULL, 'O', '4525 N Josey Ln', 'Carrollton', 'Denton', 'TX', '75010', '9723943657', '0000000000', '4525 N Josey Ln', 'Carrollton', 'Denton', 'TX', '75010', '9723943657', '0000000000', '', '', 'BAYLORTOUCH', '0.00', '0.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1083052427', 0, 'N', 0, '2013-08-16', NULL, NULL, 33.0329, -96.884, NULL, NULL),
('462908086', 'W12036871', 'W12036871', 'TXDALSTD', 'Baylor Diagnostic Imaging Center All Saints', '', '', 'Baylor Diagnostic Imaging Center All Saints', '', 'Imaging Center', '', '', NULL, 'B', 'PO Box 102107', 'Atlanta', 'Fulton', 'GA', '30368', '0000000000', '0000000000', 'PO Box 102107', 'Atlanta', 'Fulton', 'GA', '30368', '0000000000', '0000000000', '', '', 'BAYLORTOUCH', '0.00', '0.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1568800092', 0, 'N', 0, '2013-08-16', NULL, NULL, 0, 0, NULL, NULL),
('462908086', 'W12036872', 'W12036872', 'TXDALSTD', 'Baylor Diagnostic Imaging Center All Saints', '', '', 'Baylor Diagnostic Imaging Center All Saints', '', 'Imaging Center', '', '', NULL, 'O', '1701 W Rosedale', 'Fort Worth', 'Tarrant', 'TX', '76104', '8179227780', '0000000000', '1701 W Rosedale', 'Fort Worth', 'Tarrant', 'TX', '76104', '8179227780', '0000000000', '', '', 'BAYLORTOUCH', '0.00', '0.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1568800092', 0, 'N', 0, '2013-08-16', NULL, NULL, 32.7331, -97.3458, NULL, NULL),
('751673848', 'W12036874', 'W12036874', 'TXDALSTD', 'Dallas Allergy and Asthma Center ', '', '', 'Dallas Allergy and Asthma Center ', '', 'Allergy and Immunology', '', '', NULL, 'O', '5499 Glen Lakes Dr Ste 100', 'Dallas', 'Dallas', 'TX', '75231', '2146911330', '2146916405', '5499 Glen Lakes Dr Ste 100', 'Dallas', 'Dallas', 'TX', '75231', '2146911330', '2146916405', 'DALLAS4', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-09-21', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1285701102', 0, 'Y', 0, '2013-08-21', NULL, NULL, 32.8834, -96.7653, NULL, NULL),
('751673848', 'W12036877', 'W12036877', 'TXDALSTD', 'Dallas Allergy and Asthma Center ', 'Gary', 'N', 'Gross', 'MD', 'Allergy and Immunology', '', '', NULL, 'O', '5499 Glen Lakes Dr Ste 100', 'Dallas', 'Dallas', 'TX', '75231', '2146911330', '2146916405', '5499 Glen Lakes Dr Ste 100', 'Dallas', 'Dallas', 'TX', '75231', '2146911330', '2146916405', 'DALLAS4', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-09-21', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1285601336', 0, 'N', 0, '2013-08-30', NULL, NULL, 32.8834, -96.7653, NULL, NULL),
('760685635', 'W12036878', 'W12036878', 'TXHOUSTD', 'Houston Interventional Cardiology', '', '', 'Houston Interventional Cardiology', '', 'Cardiology', '', '', NULL, 'O', '21212 NW Fwy Ste 535', 'Cypress', 'Harris', 'TX', '77429', '8329126777', '2816646424', '21212 NW Fwy Ste 535', 'Cypress', 'Harris', 'TX', '77429', '8329126777', '2816646424', 'HOUSTON2', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-21', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1033251988', 0, 'Y', 0, '2013-08-21', NULL, NULL, 29.9265, -95.6349, NULL, NULL),
('760685635', 'W12036880', 'W12036880', 'TXHOUSTD', 'Houston Interventional Cardiology', 'Cyril', 'B', 'Tawa', 'MD', 'Cardiology', '', '', NULL, 'O', '21212 NW Fwy Ste 535', 'Cypress', 'Harris', 'TX', '77429', '8329126777', '2816646424', '21212 NW Fwy Ste 535', 'Cypress', 'Harris', 'TX', '77429', '8329126777', '2816646424', 'HOUSTON2', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-21', NULL, 0, 0, 0, 'Houston Methodist Willowbrook Hospital', NULL, '', '', 'HCFA|UB|', '1750336533', 0, 'N', 0, '2013-08-22', NULL, NULL, 29.9265, -95.6349, NULL, NULL),
('760685635', 'W12036882', 'W12036882', 'TXHOUSTD', 'Houston Interventional Cardiology', 'John', 'S', 'Nguyen', 'MD', 'Cardiology', '', '', NULL, 'O', '21212 NW Fwy Ste 535', 'Cypress', 'Harris', 'TX', '77429', '8329126777', '2816646424', '21212 NW Fwy Ste 535', 'Cypress', 'Harris', 'TX', '77429', '8329126777', '2816646424', 'HOUSTON2', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-21', NULL, 0, 0, 0, 'Houston Methodist Willowbrook Hospital', NULL, '', '', 'HCFA|UB|', '1831125319', 0, 'N', 0, '2013-08-22', NULL, NULL, 29.9265, -95.6349, NULL, NULL),
('742018542', 'W12036883', 'W12036883', 'TXHOUSTD', 'Humble Cardiology Associates', '', '', 'Humble Cardiology Associates', '', 'Cardiology', '', '', NULL, 'O', '9950 Memorial Ste 201', 'Humble', 'Harris', 'TX', '77338', '2814464638', '2814465386', '9950 Memorial Ste 201', 'Humble', 'Harris', 'TX', '77338', '2814464638', '2814465386', 'HOUSTON2', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-21', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1477768141', 0, 'Y', 0, '2013-08-21', NULL, NULL, 29.9939, -95.2737, NULL, NULL),
('742018542', 'W12036885', 'W12036885', 'TXHOUSTD', 'Humble Cardiology Associates', 'Madaiah', '', 'Revana', 'MD', 'Cardiology', '', '', NULL, 'O', '9950 Memorial Ste 201', 'Humble', 'Harris', 'TX', '77338', '2814464638', '2814465386', '9950 Memorial Ste 201', 'Humble', 'Harris', 'TX', '77338', '2814464638', '2814465386', 'HOUSTON2', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-21', NULL, 0, 0, 0, 'Kingwood Medical Center', NULL, '', '', 'HCFA|UB|', '1013997360', 0, 'N', 0, '2013-09-20', NULL, NULL, 29.9939, -95.2737, NULL, NULL),
('742018542', 'W12036887', 'W12036887', 'TXHOUSTD', 'Humble Cardiology Associates', 'Natasha', '', 'Iliskovic Holley', 'MD', 'Cardiology', '', '', NULL, 'O', '9950 Memorial Ste 201', 'Humble', 'Harris', 'TX', '77338', '2814464638', '2814465386', '9950 Memorial Ste 201', 'Humble', 'Harris', 'TX', '77338', '2814464638', '2814465386', 'HOUSTON2', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-21', NULL, 0, 0, 0, 'Kingwood Medical Center', NULL, '', '', 'HCFA|UB|', '1497782858', 0, 'N', 0, '2013-09-20', NULL, NULL, 29.9939, -95.2737, NULL, NULL),
('751673848', 'W12036889', 'W12036889', 'TXDALSTD', 'Dallas Allergy and Asthma Center ', 'Michael', 'E', 'Ruff', 'MD', 'Allergy and Immunology', '', '', NULL, 'O', '5499 Glen Lakes Dr Ste 100', 'Dallas', 'Dallas', 'TX', '75231', '2146911330', '2146916405', '5499 Glen Lakes Dr Ste 100', 'Dallas', 'Dallas', 'TX', '75231', '2146911330', '2146916405', 'DALLAS4', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-09-21', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1679532576', 0, 'N', 0, '2013-08-30', NULL, NULL, 32.8834, -96.7653, NULL, NULL),
('751673848', 'W12036891', 'W12036891', 'TXDALSTD', 'Dallas Allergy and Asthma Center ', 'Dania', 'A', 'Wierzbicki', 'MD', 'Allergy and Immunology', '', '', NULL, 'O', '5499 Glen Lakes Dr Ste 100', 'Dallas', 'Dallas', 'TX', '75231', '2146911330', '2146916405', '5499 Glen Lakes Dr Ste 100', 'Dallas', 'Dallas', 'TX', '75231', '2146911330', '2146916405', 'DALLAS4', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-09-21', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, '', '', 'HCFA|UB|', '1841222346', 0, 'N', 0, '2013-08-30', NULL, NULL, 32.8834, -96.7653, NULL, NULL),
('451632816', 'W12036892', 'W12036892', 'UT01', '', 'Kristin', 'J', 'Tarbet', 'MD', 'Ophthalmology', NULL, NULL, NULL, 'O', '558 E Riverside Dr Ste 200', 'St George', 'Washington', 'UT', '84790', '4356529355', '4356529358', '558 E Riverside Dr Ste 200', 'St George', 'Washington', 'UT', '84790', '4356529355', '4356529358', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-08-13', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1083659262', 0, 'N', 0, '2013-08-19', NULL, NULL, 37.0867, -113.572, NULL, NULL),
('870373083', 'W12036893', 'W12036893', 'UT01', 'Heart and Lung Institute of Utah', 'Garrett', 'R', 'Bird', 'MD', 'Pulmonary', '', '', 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, '2013-09-01', '2014-04-30', 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1164638573', 0, 'N', 0, '2013-10-07', NULL, NULL, 40.6991, -111.99, NULL, NULL),
('870373083', 'W12036894', 'W12036894', 'UT01', 'Heart and Lung Institute of Utah', 'Garrett', 'R', 'Bird', 'MD', 'Pulmonary', '', '', NULL, 'O', '3570 W 9000 S Ste 110', 'West Jordan', 'Salt Lake', 'UT', '84088', '8012632370', '8012651200', '3570 W 9000 S Ste 110', 'West Jordan', 'Salt Lake', 'UT', '84088', '8012632370', '8012651200', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-09-01', '2014-04-30', 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1164638573', 0, 'N', 0, '2013-10-07', NULL, NULL, 40.588, -111.975, NULL, NULL),
('870373083', 'W12036895', 'W12036895', 'UT01', 'Heart and Lung Institute of Utah', 'Garrett', 'R', 'Bird', 'MD', 'Pulmonary', '', '', NULL, 'O', '82 S 1100 E Ste 103', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8012632370', '8012651200', '82 S 1100 E Ste 103', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8012632370', '8012651200', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-09-01', '2014-04-30', 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1164638573', 0, 'N', 0, '2013-10-07', NULL, NULL, 40.7676, -111.86, NULL, NULL),
('770701557', 'W12036896', 'W12036896', 'UT01', 'Lone Peak Family Medicine', 'Todd', 'W', 'Furness', 'DO', 'Family Practice', '', '', 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', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-12-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1285941310', 0, 'N', 0, '2013-11-13', NULL, NULL, 40.5377, -111.871, NULL, NULL),
('770701557', 'W12036897', 'W12036897', 'UT01', 'Lone Peak Family Medicine', 'Todd', 'W', 'Furness', 'DO', 'Family Practice', '', '', NULL, 'B', 'PO Box 198560', 'Atlanta', 'Fulton', 'GA', '30384', '6153737800', '0000000000', 'PO Box 198560', 'Atlanta', 'Fulton', 'GA', '30384', '6153737800', '0000000000', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-12-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1285941310', 0, 'N', 0, '2013-11-13', NULL, NULL, 0, 0, NULL, NULL),
('364088232', 'W12036898', 'W12036898', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Mary', 'K', 'Formea', 'MS PT', 'Physical Therapy', '', '', NULL, 'O', '2500 W Fabyan Pkwy', 'Batavia', 'Kane', 'IL', '60510', '6308792110', '6307624774', '2500 W Fabyan Pkwy', 'Batavia', 'Kane', 'IL', '60510', '6308792110', '6307624774', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-08-12', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1558467613', 0, 'Y', 0, '2013-08-19', NULL, NULL, 41.8633, -88.269, NULL, NULL),
('371643195', 'W12036899', 'W12036899', 'UT01', 'Timpanogos Professional Services', 'Sean', 'D', 'Overton', 'MD', 'Anesthesiology', '', '', NULL, 'O', '7500 W 800 N', 'Orem', 'Utah', 'UT', '84057', '8017146387', '8017146596', '7500 W 800 N', 'Orem', 'Utah', 'UT', '84057', '8017146387', '8017146596', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-09-01', '2014-02-12', 0, 0, 0, '', '', '', '', 'HCFA|UB', '1659580777', 0, 'Y', 0, '2014-02-13', NULL, NULL, 0, 0, NULL, NULL),
('371643195', 'W12036900', 'W12036900', 'UT01', 'Timpanogos Professional Services', 'Sean', 'D', 'Overton', 'MD', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 741904', 'Atlanta', 'Fulton', 'GA', '30374', '8017146387', '0000000000', 'PO Box 741904', 'Atlanta', 'Fulton', 'GA', '30374', '8017146387', '0000000000', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1659580777', 0, 'N', 0, '2013-08-23', NULL, NULL, 0, 0, NULL, NULL),
('371643195', 'W12036901', 'W12036901', 'UT01', 'Mountainstar Intensivist Services ', 'Stephanie', 'M', 'Woolley', 'MD', 'Hospitalist', '', '', NULL, 'O', '1200 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012687111', '8663153628', '1200 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012687111', '8663153628', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1952332876', 0, 'Y', 0, '2013-08-29', NULL, NULL, 40.6871, -111.856, NULL, NULL),
('371643195', 'W12036902', 'W12036902', 'UT01', 'Mountainstar Intensivist Services ', 'Stephanie', 'M', 'Woolley', 'MD', 'Hospitalist', '', '', NULL, 'B', 'PO Box 741904', 'Atlanta', 'Fulton', 'GA', '30374', '8017146387', '8017146596', 'PO Box 741904', 'Atlanta', 'Fulton', 'GA', '30374', '8017146387', '8017146596', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1952332876', 0, 'N', 0, '2013-09-06', NULL, NULL, 0, 0, NULL, NULL),
('900900818', 'W12036907', 'W12036907', 'IDBOISTD', 'Eastern Idaho RMC Behavioral Health', 'Stevan', 'R', 'Lund', 'MD', 'Mental Health', '', '', NULL, 'B', 'PO Box 742358', 'Atlanta', 'Fulton', 'GA', '30374', '6153737490', '0000000000', 'PO Box 742358', 'Atlanta', 'Fulton', 'GA', '30374', '6153737490', '0000000000', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1982663761', 0, 'N', 1, '2013-10-02', NULL, NULL, 0, 0, NULL, NULL),
('204043287', 'W12036908', 'W12036908', 'NM01', 'ABQ Health Partners', 'Tambra', '', 'Bensch', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '4010 Montgomery Blvd', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5052546500', '5052546532', '4010 Montgomery Blvd', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5052546500', '5052546532', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Lovelace Womens Hospital', 'Lovelace Westside Hospital', '', '', 'HCFA|UB|', '1528091014', 0, 'N', 0, '2014-06-24', NULL, NULL, 35.1308, -106.6, NULL, NULL),
('900900818', 'W12036905', 'W12036905', 'IDBOISTD', 'Eastern Idaho RMC Behavioral Health', 'Stevan', 'R', 'Lund', 'MD', 'Mental Health', '', '', NULL, 'O', '2280 E 25th St', 'Idaho Falls', 'Bonneville', 'ID', '83404', '2085354566', '8773025323', '2280 E 25th St', 'Idaho Falls', 'Bonneville', 'ID', '83404', '2085354566', '8773025323', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1982663761', 0, 'N', 1, '2013-10-02', NULL, NULL, 0, 0, NULL, NULL),
('204043287', 'W12036910', 'W12036910', 'NM01', 'ABQ Health Partners', 'Siri', '', 'Casey', 'CDE', 'Diabetic Education', '', '', NULL, 'O', '5150 Journal Center Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5052627455', '5052623955', '5150 Journal Center Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5052627455', '5052623955', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2013-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1144243437', 0, 'N', 0, '2013-09-09', NULL, NULL, 35.1702, -106.586, NULL, NULL),
('204043287', 'W12036911', 'W12036911', 'NM01', 'ABQ Health Partners', 'Siri', '', 'Casey', 'CDE', 'Diabetic Education', '', '', NULL, 'O', '9101 Montgomery Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87111', '5052627455', '5052623955', '9101 Montgomery Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87111', '5052627455', '5052623955', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2013-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1144243437', 0, 'N', 0, '2013-09-09', NULL, NULL, 35.1307, -106.542, NULL, NULL),
('204043287', 'W12036912', 'W12036912', 'NM01', 'ABQ Health Partners', 'Siri', '', 'Casey', 'CDE', 'Diabetic Education', '', '', NULL, 'O', '1721 Rio Rancho Blvd SE', 'Rio Rancho', 'Sandoval', 'NM', '87124', '5052627455', '5052623955', '1721 Rio Rancho Blvd SE', 'Rio Rancho', 'Sandoval', 'NM', '87124', '5052627455', '5052623955', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2013-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1144243437', 0, 'N', 0, '2013-09-09', NULL, NULL, 35.2284, -106.66, NULL, NULL),
('204043287', 'W12036913', 'W12036913', 'NM01', 'ABQ Health Partners', 'Siri', '', 'Casey', 'CDE', 'Diabetic Education', '', '', NULL, 'O', '3901 Carlisle Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87107', '5052627455', '5052623955', '3901 Carlisle Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87107', '5052627455', '5052623955', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2013-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1144243437', 0, 'N', 0, '2013-09-09', NULL, NULL, 35.1252, -106.604, NULL, NULL),
('204043287', 'W12036914', 'W12036914', 'NM01', 'ABQ Health Partners', 'Siri', '', 'Casey', 'CDE', 'Diabetic Education', '', '', NULL, 'O', '4705 Montgomery Blvd NE Ste 301-302', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5052627455', '5052623955', '4705 Montgomery Blvd NE Ste 301-302', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5052627455', '5052623955', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2013-08-01', '2013-09-03', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1144243437', 0, 'N', 0, '2013-09-09', NULL, NULL, 0, 0, NULL, NULL),
('204043287', 'W12036915', 'W12036915', 'NM01', 'ABQ Health Partners', 'Siri', '', 'Casey', 'CDE', 'Diabetic Education', '', '', NULL, 'O', '200 Rio Bravo Blvd SE', 'Albuquerque', 'Bernalillo', 'NM', '87105', '5052627455', '5052623955', '200 Rio Bravo Blvd SE', 'Albuquerque', 'Bernalillo', 'NM', '87105', '5052627455', '5052623955', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2013-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1144243437', 0, 'N', 0, '2013-09-09', NULL, NULL, 35.027, -106.655, NULL, NULL),
('204043287', 'W12036917', 'W12036917', 'NM01', 'ABQ Health Partners', 'Siri', '', 'Casey', 'CDE', 'Diabetic Education', '', '', NULL, 'O', '2121 Juan Tabo Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87112', '5052627455', '5052623955', '2121 Juan Tabo Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87112', '5052627455', '5052623955', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2013-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1144243437', 0, 'N', 0, '2013-09-09', NULL, NULL, 35.1062, -106.516, NULL, NULL),
('204043287', 'W12036918', 'W12036918', 'NM01', 'ABQ Health Partners', 'Siri', '', 'Casey', 'CDE', 'Diabetic Education', '', '', NULL, 'O', '13701 Encantado Rd NE', 'Albuquerque', 'Bernalillo', 'NM', '87123', '5052627455', '5052623955', '13701 Encantado Rd NE', 'Albuquerque', 'Bernalillo', 'NM', '87123', '5052627455', '5052623955', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2013-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1144243437', 0, 'N', 0, '2013-09-09', NULL, NULL, 35.0743, -106.497, NULL, NULL),
('204043287', 'W12036919', 'W12036919', 'NM01', 'ABQ Health Partners', 'Siri', '', 'Casey', 'CDE', 'Diabetic Education', '', '', NULL, 'O', '10511 Golf Course Rd', 'Albuquerque', 'Bernalillo', 'NM', '87114', '5052627455', '5052623955', '10511 Golf Course Rd', 'Albuquerque', 'Bernalillo', 'NM', '87114', '5052627455', '5052623955', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2013-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1144243437', 0, 'N', 0, '2013-09-09', NULL, NULL, 35.2073, -106.676, NULL, NULL),
('204043287', 'W12036920', 'W12036920', 'NM01', 'ABQ Health Partners', 'Patricia', '', 'Glasrud', 'CDE', 'Diabetic Education', '', '', NULL, 'O', '10511 Golf Course Rd', 'Albuquerque', 'Bernalillo', 'NM', '87114', '5052627455', '5052623955', '10511 Golf Course Rd', 'Albuquerque', 'Bernalillo', 'NM', '87114', '5052627455', '5052623955', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2013-08-01', '2014-03-03', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1548293111', 0, 'N', 0, '2014-04-29', NULL, NULL, 35.2073, -106.676, NULL, NULL),
('204043287', 'W12036921', 'W12036921', 'NM01', 'ABQ Health Partners', 'Patricia', '', 'Glasrud', 'CDE', 'Diabetic Education', '', '', NULL, 'O', '13701 Encantado Rd NE', 'Albuquerque', 'Bernalillo', 'NM', '87123', '5052627455', '5052623955', '13701 Encantado Rd NE', 'Albuquerque', 'Bernalillo', 'NM', '87123', '5052627455', '5052623955', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2013-08-01', '2014-03-03', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1548293111', 0, 'N', 0, '2014-04-29', NULL, NULL, 35.0743, -106.497, NULL, NULL),
('204043287', 'W12036922', 'W12036922', 'NM01', 'ABQ Health Partners', 'Patricia', '', 'Glasrud', 'CDE', 'Diabetic Education', '', '', NULL, 'O', '2121 Juan Tabo Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87112', '5052627455', '5052623955', '2121 Juan Tabo Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87112', '5052627455', '5052623955', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2013-08-01', '2014-03-03', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1548293111', 0, 'N', 0, '2014-04-29', NULL, NULL, 35.1062, -106.516, NULL, NULL),
('204043287', 'W12036923', 'W12036923', 'NM01', 'ABQ Health Partners', 'Patricia', '', 'Glasrud', 'CDE', 'Diabetic Education', '', '', NULL, 'O', '200 Rio Bravo Blvd SE', 'Albuquerque', 'Bernalillo', 'NM', '87105', '5052627455', '5052623955', '200 Rio Bravo Blvd SE', 'Albuquerque', 'Bernalillo', 'NM', '87105', '5052627455', '5052623955', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2013-08-01', '2014-03-03', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1548293111', 0, 'N', 0, '2014-04-29', NULL, NULL, 35.027, -106.655, NULL, NULL),
('204043287', 'W12036924', 'W12036924', 'NM01', 'ABQ Health Partners', 'Patricia', '', 'Glasrud', 'CDE', 'Diabetic Education', '', '', NULL, 'O', '4705 Montgomery Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5052627455', '5052623955', '4705 Montgomery Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5052627455', '5052623955', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2013-08-01', '2013-09-03', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1548293111', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('204043287', 'W12036925', 'W12036925', 'NM01', 'ABQ Health Partners', 'Patricia', '', 'Glasrud', 'CDE', 'Diabetic Education', '', '', NULL, 'O', '5150 Journal Center Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5052627455', '5052623955', '5150 Journal Center Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5052627455', '5052623955', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2013-08-01', '2014-03-03', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1548293111', 0, 'N', 0, '2014-04-29', NULL, NULL, 35.1702, -106.586, NULL, NULL),
('204043287', 'W12036926', 'W12036926', 'NM01', 'ABQ Health Partners', 'Patricia', '', 'Glasrud', 'CDE', 'Diabetic Education', '', '', NULL, 'O', '9101 Montgomery Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87111', '5052627455', '5052623955', '9101 Montgomery Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87111', '5052627455', '5052623955', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2013-08-01', '2014-03-03', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1548293111', 0, 'N', 0, '2014-04-29', NULL, NULL, 35.1307, -106.542, NULL, NULL),
('204043287', 'W12036927', 'W12036927', 'NM01', 'ABQ Health Partners', 'Patricia', '', 'Glasrud', 'CDE', 'Diabetic Education', '', '', NULL, 'O', '1721 Rio Rancho Blvd SE', 'Rio Rancho', 'Sandoval', 'NM', '87124', '5052627455', '5052623955', '1721 Rio Rancho Blvd SE', 'Rio Rancho', 'Sandoval', 'NM', '87124', '5052627455', '5052623955', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2013-08-01', '2014-03-03', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1548293111', 0, 'N', 0, '2014-04-29', NULL, NULL, 35.2284, -106.66, NULL, NULL),
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('204043287', 'W12036947', 'W12036947', 'NM01', 'ABQ Health Partners', 'Teresa', '', 'Marroquin-Elizondo', 'CDE', 'Diabetic Education', '', '', NULL, 'O', '10511 Golf Course Rd', 'Albuquerque', 'Bernalillo', 'NM', '87114', '5052627455', '5052623955', '10511 Golf Course Rd', 'Albuquerque', 'Bernalillo', 'NM', '87114', '5052627455', '5052623955', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2013-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1457384018', 0, 'N', 0, '2013-09-09', NULL, NULL, 35.2073, -106.676, NULL, NULL),
('204043287', 'W12036948', 'W12036948', 'NM01', 'ABQ Health Partners', 'Rebecca', '', 'Coalson', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '5150 Journal Center Blvd', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5052546500', '5052546532', '5150 Journal Center Blvd', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5052546500', '5052546532', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2012-08-12', NULL, 0, 0, 0, 'Lovelace Womens Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1265606149', 0, 'N', 0, '2013-08-19', NULL, NULL, 35.1702, -106.586, 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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('204043287', 'W12036950', 'W12036950', 'NM01', 'ABQ Health Partners', 'Terri', '', 'Caspary-Schmidt', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '4010 Montgomery Blvd', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5052546500', '5052546532', '4010 Montgomery Blvd', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5052546500', '5052546532', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Lovelace Womens Hospital', 'Lovelace Westside Hospital', '', '', 'HCFA|UB|', '1396778981', 0, 'N', 0, '2014-06-24', NULL, NULL, 35.1308, -106.6, NULL, NULL),
('204043287', 'W12036951', 'W12036951', 'NM01', 'ABQ Health Partners', 'Yvonne', '', 'Castillo', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '4010 Montgomery Blvd', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5052546500', '5052546532', '4010 Montgomery Blvd', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5052546500', '5052546532', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1396778809', 0, 'N', 0, '2014-06-24', NULL, NULL, 35.1308, -106.6, NULL, NULL),
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('202695346', 'W12036393', 'W12036393', 'UT01', 'North Valley Anesthesia', '', '', 'North Valley Anesthesia', '', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 3810 MD', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8014322677', '0000000000', 'PO Box 3810 MD', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8014322677', '0000000000', '', '', '', '56.00', '25.00', '0.00', 6, '2014-07-01', '2015-06-30', 0, 12, 0, '', '', '', '', 'HCFA|', '1780908152', 0, 'N', 0, '2013-09-30', NULL, NULL, 0, 0, NULL, NULL),
('202695346', 'W12036394', 'W12036394', 'UT01', 'North Valley Anesthesia', '', '', 'North Valley Anesthesia', '', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 3810 MD', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8014322677', '0000000000', 'PO Box 3810 MD', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8014322677', '0000000000', '', '', '', '57.00', '25.00', '0.00', 6, '2015-07-01', NULL, 0, 12, 0, '', '', '', '', 'HCFA|', '1780908152', 0, 'N', 0, '2014-06-23', NULL, NULL, 0, 0, NULL, NULL),
('460496790', 'W12036979', 'W12036979', 'TXHOUSTD', 'Vipulkumar G. Patel, MD', 'Vipulkumar', 'G', 'Patel', 'MD', 'Internal Medicine', '', '', NULL, 'O', '3828 Huges Ct Ste 105', 'Dickinson', 'Galveston', 'TX', '77539', '2815348800', '2815348826', '3828 Huges Ct Ste 105', 'Dickinson', 'Galveston', 'TX', '77539', '2815348800', '2815348826', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-21', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1710987995', 0, 'N', 0, '2013-08-21', NULL, NULL, 29.4459, -95.0778, NULL, NULL),
('460496790', 'W12036980', 'W12036980', 'TXHOUSTD', 'Vipulkumar G. Patel, MD', 'Vipulkumar', 'G', 'Patel', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 58233', 'Webster', 'Harris', 'TX', '77598', '2815348800', '2815438826', 'PO Box 58233', 'Webster', 'Harris', 'TX', '77598', '2815348800', '2815438826', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-21', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1710987995', 0, 'N', 0, '2013-08-21', NULL, NULL, 0, 0, NULL, NULL),
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('850275777', 'W12036983', 'W12036983', 'NM01', 'Southwest Medical Associates', 'Sahar', 'A', 'Nouri', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'M', '6100 Pan American Fwy NE Ste 100', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058231010', NULL, '6100 Pan American Fwy NE Ste 100', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058231010', '          ', 'NMSWMED', '', '', '0.00', '10.00', '0.00', 3, '2013-10-01', NULL, 0, 0, 0, 'Lovelace Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1184884801', 0, 'N', 0, '2013-10-30', NULL, NULL, 0, 0, NULL, NULL),
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('870286381', 'W12036987', 'W12036987', 'UT01', 'Ogden Clinic', 'Kerry', 'R', 'Reynolds', 'PA', 'Family Practice', '', '', NULL, 'O', '1159 E 12th St', 'Ogden', 'Weber', 'UT', '84404', '8014753700', '8014753701', '1159 E 12th St', 'Ogden', 'Weber', 'UT', '84404', '8014753700', '8014753701', 'WUOGDCLIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-10-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB', '1306034616', 0, 'N', 0, '2013-09-10', NULL, NULL, 41.244, -111.95, NULL, NULL),
('870286381', 'W12036988', 'W12036988', 'UT01', 'Ogden Clinic', 'Kerry', 'R', 'Reynolds', 'PA', 'Family Practice', '', '', NULL, 'B', '4650 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014753000', NULL, '4650 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014753000', '          ', 'WUOGDCLIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-10-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1306034616', 0, 'N', 0, '2013-09-10', NULL, NULL, 0, 0, NULL, NULL),
('262072378', 'W12036990', 'W12036990', 'UT01', 'Valley Obstetrics & Gynecology PC', 'Heather', 'A', 'Dabling', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1055 N 300 W Ste 110', 'Provo', 'Utah', 'UT', '84604', '8013741801', '8012168357', '1055 N 300 W Ste 110', 'Provo', 'Utah', 'UT', '84604', '8013741801', '8012168357', 'ValleyOB', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-11-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1598931016', 0, 'N', 0, '2013-10-11', NULL, NULL, 40.2476, -111.664, NULL, NULL),
('262072378', 'W12036989', 'W12036989', 'UT01', 'Valley Obstetrics & Gynecology PC', 'Heather', 'A', 'Dabling', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '585 N 500 W', 'Provo', 'Utah', 'UT', '84601', '8013741801', '8012168357', '585 N 500 W', 'Provo', 'Utah', 'UT', '84601', '8013741801', '8012168357', 'ValleyOB', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-11-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1598931016', 0, 'N', 0, '2013-10-11', NULL, NULL, 40.2415, -111.667, NULL, NULL),
('870474130', 'W12036991', 'W12036991', 'UT01', 'Northeastern Utah Medical Group', 'John', '', 'Nolte', 'MD', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'M', '250 E 300 N', 'Roosevelt', 'Duchesne', 'UT', '84066', '4357257448', '4357229291', '250 E 300 N', 'Roosevelt', 'Duchesne', 'UT', '84066', '4357257448', '4357229291', 'WURURAL5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-08-16', NULL, 0, 0, 0, 'Uintah Basin Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1194786095', 0, 'N', 0, '2013-08-22', NULL, NULL, 0, 0, NULL, NULL),
('870474130', 'W12036992', 'W12036992', 'UT01', 'Northeastern Utah Medical Group', 'John', '', 'Nolte', 'MD', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'O', '205 W 300 N', 'Roosevelt', 'Duchesne', 'UT', '84066', '4357226104', '4357224652', '205 W 300 N', 'Roosevelt', 'Duchesne', 'UT', '84066', '4357226104', '4357224652', 'WURURAL5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-08-16', NULL, 0, 0, 0, 'Uintah Basin Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1194786095', 0, 'N', 0, '2013-08-22', NULL, NULL, 40.3034, -109.995, NULL, NULL),
('320340482', 'W12036994', 'W12036994', 'UT01', 'Perry Family Medicine', 'Cynthia', 'L', 'Duncan', 'NP', 'Family Practice', '', '', NULL, 'O', '1030 S Medical Dr Ste A', 'Brigham City', 'Box Elder', 'UT', '84302', '4357234500', '4357234504', '1030 S Medical Dr Ste A', 'Brigham City', 'Box Elder', 'UT', '84302', '4357234500', '4357234504', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-08-09', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1922242262', 0, 'N', 0, '2013-08-20', NULL, NULL, 41.488, -112.027, NULL, NULL),
('320340482', 'W12036995', 'W12036995', 'UT01', 'Perry Family Medicine', 'Cynthia', 'L', 'Duncan', 'NP', 'Family Practice', '', '', NULL, 'M', '3263 S Hwy 89 Ste 400', 'Bountiful', 'Davis', 'UT', '84010', '8015050821', '8015050803', '3263 S Hwy 89 Ste 400', 'Bountiful', 'Davis', 'UT', '84010', '8015050821', '8015050803', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-08-09', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1922242262', 0, 'N', 0, '2013-08-20', NULL, NULL, 0, 0, NULL, NULL),
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('260553931', 'W12037045', 'W12037045', 'IDBOISTD', '', 'Britani', 'R', 'Hill', 'MD', 'General Surgery', '', '', NULL, 'O', '901 N Curtis Rd Ste 401', 'Boise', 'Ada', 'ID', '83706', '2083677676', '2083676849', '901 N Curtis Rd Ste 401', 'Boise', 'Ada', 'ID', '83706', '2083677676', '2083676849', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2013-08-05', '2013-12-15', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, '', '', 'HCFA|UB|', '1275718595', 0, 'N', 0, '2014-01-24', NULL, NULL, 43.6126, -116.255, NULL, NULL),
('260553931', 'W12037047', 'W12037047', 'IDBOISTD', 'Saint Alphonsus Medical Group Coughlin Clinic Boise ', 'James', 'R', 'Jastifer', 'MD', '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, '2013-08-05', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, '', '', 'HCFA|UB|', '1821257957', 0, 'N', 0, '2013-08-21', NULL, NULL, 43.6148, -116.254, NULL, NULL),
('820200895', 'W12037049', 'W12037049', 'IDBOISTD', 'Saint Alphonsus Medical Group Elm Family Medicine', 'Josh', '', 'Leavitt', 'DO', 'Family Practice', '', '', NULL, 'O', '315 E Elm St Ste 100', 'Caldwell', 'Canyon', 'ID', '83605', '2084597415', '2084533307', '315 E Elm St Ste 100', 'Caldwell', 'Canyon', 'ID', '83605', '2084597415', '2084533307', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2013-08-05', '2013-11-04', 0, 0, 0, 'West Valley Medical Center', '', '', '', 'HCFA|', '1174834246', 0, 'N', 0, '2014-06-13', NULL, NULL, 43.6539, -116.695, NULL, NULL),
('820200895', 'W12037050', 'W12037050', 'IDBOISTD', 'Saint Alphonsus Regional Medical Center', 'Allen', 'C', 'Han', 'MD', 'Neurology', '', '', NULL, 'O', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083676238', '2083670285', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083676238', '2083670285', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2013-08-05', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1801825724', 0, 'N', 0, '2014-04-25', NULL, NULL, 43.6145, -116.254, NULL, NULL),
('752590432', 'W12037053', 'W12037053', 'TXDALSTD', 'Texas Independent Osteopathic Physician Association', '', '', 'Texas Independent Osteopathic Physician Association', '', 'Clinics', '', '', NULL, 'O', '1701 River Run Rd Ste 1103', 'Fort Worth', 'Tarrant', 'TX', '76107', '8174846274', '8174209661', '1701 River Run Rd Ste 1103', 'Fort Worth', 'Tarrant', 'TX', '76107', '8174846274', '8174209661', 'TIOPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000010139', 0, 'Y', 0, '2014-03-05', NULL, NULL, 0, 0, NULL, NULL),
('752904719', 'TIOPA0001', 'TIOPA0001', 'TXDALSTD', 'Acton Medical Clinic', 'Shellie', 'D', 'Shepherd', 'PA-C', 'Family Practice', '', '', NULL, 'O', '2006 Fall Creek Hwy', 'Granbury', 'Hood', 'TX', '76049', '8173263440', '8179109421', '2006 Fall Creek Hwy', 'Granbury', 'Hood', 'TX', '76049', '8173263440', '8179109421', 'TIOPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-15', NULL, 0, 0, 0, '', '', '', NULL, 'HCFA|UB|', '1043252299', 0, 'N', 0, '2013-08-22', NULL, NULL, 32.4594, -97.6905, NULL, NULL),
('752904719', 'TIOPA0002', 'TIOPA0002', 'TXDALSTD', 'Acton Medical Clinic', 'Shellie', 'D', 'Shepherd', 'PA-C', 'Family Practice', '', '', NULL, 'B', 'PO Box 5334', 'Granbury', 'Hood', 'TX', '76049', '8173263440', '8179109421', 'PO Box 5334', 'Granbury', 'Hood', 'TX', '76049', '8173263440', '8179109421', 'TIOPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-15', NULL, 0, 0, 0, '', '', '', NULL, 'HCFA|UB|', '1043252299', 0, 'Y', 0, '2013-08-22', NULL, NULL, 0, 0, NULL, NULL),
('861111440', 'TIOPA0003', 'TIOPA0003', 'TXDALSTD', 'Associates of Internal Medicine PA', 'Aasia', 'D', 'Janjua', 'MD', 'Internal Medicine', '', '', NULL, 'O', '2260 College Ave', 'Fort Worth', 'Tarrant', 'TX', '76110', '8178703627', '8178703636', '2260 College Ave', 'Fort Worth', 'Tarrant', 'TX', '76110', '8178703627', '8178703636', 'TIOPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1043517402', 0, 'N', 0, '2014-03-28', NULL, NULL, 32.7187, -97.3351, NULL, NULL),
('364665071', 'W12046147', 'W12046147', 'UT01', 'Wasatch Physical Therapy & Rehabilitation', 'Marlee', 'K', 'Dalton', 'CNM', 'Obstetrics and Gynecology', 'Family Practice', '', NULL, 'O', '823 E 400 S', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013633918', '8015963796', '823 E 400 S', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013633918', '8015963796', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-02-01', NULL, 0, 0, 0, 'Mountain West Medical Center', '', '', '', 'HCFA|UB|', '1730175761', 0, 'N', 0, '2014-03-28', NULL, NULL, 0, 0, NULL, NULL),
('861111440', 'TIOPA0004', 'TIOPA0004', 'TXDALSTD', 'Associates of Internal Medicine PA', 'Aasia', 'D', 'Janjua', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 12056', 'Fort Worth', 'Tarrant', 'TX', '76110', '8178703627', '8178703636', 'PO Box 12056', 'Fort Worth', 'Tarrant', 'TX', '76110', '8178703627', '8178703636', 'TIOPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1043517402', 0, 'Y', 0, '2014-03-28', NULL, NULL, 0, 0, NULL, NULL),
('752943323', 'TIOPA0005', 'TIOPA0005', 'TXDALSTD', 'Walnut Grove Family Health Center', 'John', 'S', 'Hanley', 'MD', 'Family Practice', '', '', NULL, 'O', '4440 E Hwy 287', 'Midlothian', 'Ellis', 'TX', '76065', '9727235590', '9727235592', '4440 E Hwy 287', 'Midlothian', 'Ellis', 'TX', '76065', '9727235590', '9727235592', 'TIOPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-15', NULL, 0, 0, 0, 'Baylor Medical Center at Carrollton', NULL, '', NULL, 'HCFA|UB|', '1043533664', 0, 'N', 0, '2013-08-22', NULL, NULL, 32.4673, -96.9768, NULL, NULL),
('411429268', 'TIOPA0006', 'TIOPA0006', 'TXDALSTD', 'Shashi Rastogi MD', 'Shashi', 'Prabha', 'Rastogi', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1001 12th Ave Ste 174', 'Fort Worth', 'Tarrant', 'TX', '76104', '8173480701', '8173480702', '1001 12th Ave Ste 174', 'Fort Worth', 'Tarrant', 'TX', '76104', '8173480701', '8173480702', 'TIOPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-15', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', NULL, '', '', 'HCFA|UB|', '1053379339', 0, 'N', 0, '2014-03-28', NULL, NULL, 32.7342, -97.3475, NULL, NULL),
('201253329', 'TIOPA0007', 'TIOPA0007', 'TXDALSTD', 'Tarrant Community Pediatrics', 'Kalaimani', '', 'Subramanian', 'MD', 'Pediatrics', '', '', NULL, 'O', '7290 Glenview Dr', 'North Richland Hills', 'Tarrant', 'TX', '76180', '8175959944', '8175958835', '7290 Glenview Dr', 'North Richland Hills', 'Tarrant', 'TX', '76180', '8175959944', '8175958835', 'TIOPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1063558161', 0, 'N', 0, '2014-06-17', NULL, NULL, 32.8238, -97.2236, 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
('751879515', 'TIOPA0008', 'TIOPA0008', 'TXDALSTD', 'Total Pain Medicine and Anesthesiology PA', 'Albert', 'L', 'Shaw', 'MD', 'Pain Management', '', '', NULL, 'O', '729 W Bedford Euless Rd Ste 111', 'Hurst', 'Tarrant', 'TX', '76053', '8178681109', '8175458266', '729 W Bedford Euless Rd Ste 111', 'Hurst', 'Tarrant', 'TX', '76053', '8178681109', '8175458266', 'TIOPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-15', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', '', '', '', 'HCFA|UB|', '1073518833', 0, 'N', 0, '2014-03-28', NULL, NULL, 32.834, -97.1847, NULL, NULL),
('751879515', 'TIOPA0009', 'TIOPA0009', 'TXDALSTD', 'Total Pain Medicine and Anesthesiology Billing', 'Albert', 'L', 'Shaw', 'MD', 'Pain Management', '', '', NULL, 'B', 'PO Box 780', 'Colleyville', 'Tarrant', 'TX', '76034', '8178681109', '8175458266', 'PO Box 780', 'Colleyville', 'Tarrant', 'TX', '76034', '8178681109', '8175458266', 'TIOPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-15', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', '', '', '', 'HCFA|UB|', '1073518833', 0, 'Y', 0, '2014-03-28', NULL, NULL, 0, 0, NULL, NULL),
('752569767', 'TIOPA0010', 'TIOPA0010', 'TXDALSTD', 'Mukhtar Anees MD PA', 'Mukhtar', '', 'Anees', 'MD', 'Gastroenterology', '', '', NULL, 'O', '701 E Rendon Crowley Rd', 'Burleson', 'Johnson', 'TX', '76028', '8172939292', '8175510616', '701 E Rendon Crowley Rd', 'Burleson', 'Johnson', 'TX', '76028', '8172939292', '8175510616', 'TIOPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-15', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', NULL, '', '', 'HCFA|UB|', '1073714200', 0, 'N', 0, '2014-03-28', NULL, NULL, 32.58, -97.307, NULL, NULL),
('760405845', 'W12037056', 'W12037056', 'TXHOUSTD', 'Lake Side Family Practice', 'John', 'D', 'Handley', 'MD', 'Family Practice', '', '', NULL, 'O', '4632 Nasa Pkwy', 'Seabrook', 'Harris', 'TX', '77586', '2813265525', '2813262590', '4632 Nasa Pkwy', 'Seabrook', 'Harris', 'TX', '77586', '2813265525', '2813262590', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1932282019', 0, 'N', 0, '2013-08-30', NULL, NULL, 29.5667, -95.0604, NULL, NULL),
('455012558', 'TIOPA0013', 'TIOPA0013', 'TXDALSTD', 'Kraig R Pepper DO PA', 'Steven', 'L', 'Skiles', 'PA-C', 'Orthopedic Surgery', '', '', NULL, 'O', '2200 James Rd', 'Granbury', 'Hood', 'TX', '76049', '8177359397', '8177358340', '2200 James Rd', 'Granbury', 'Hood', 'TX', '76049', '8177359397', '8177358340', 'TIOPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-15', NULL, 0, 0, 0, 'Baylor Medical Center at Carrollton', NULL, NULL, NULL, 'HCFA|UB|', '1083621569', 0, 'N', 0, '2013-08-22', NULL, NULL, 32.4585, -97.7168, NULL, NULL),
('455012558', 'TIOPA0012', 'TIOPA0012', 'TXDALSTD', 'Kraig R Pepper DO PA', 'Steven', 'L', 'Skiles', 'PA-C', 'Orthopedic Surgery', '', '', NULL, 'O', '7257 Hawkins Dr', 'Fort Worth', 'Tarrant', 'TX', '76132', '8177359397', '8177358340', '7257 Hawkins Dr', 'Fort Worth', 'Tarrant', 'TX', '76132', '8177359397', '8177358340', 'TIOPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-15', NULL, 0, 0, 0, 'Baylor Medical Center at Carrollton', NULL, NULL, NULL, 'HCFA|UB|', '1083621569', 0, 'N', 0, '2013-08-22', NULL, NULL, 32.6642, -97.4189, NULL, NULL),
('752904719', 'TIOPA0014', 'TIOPA0014', 'TXDALSTD', 'Acton Medical Clinic', 'Summer', 'D', 'Cumba', 'PA-C', 'Family Practice', '', '', NULL, 'O', '2006 Fall Creek Hwy', 'Granbury', 'Hood', 'TX', '76049', '8173263440', '8179109421', '2006 Fall Creek Hwy', 'Granbury', 'Hood', 'TX', '76049', '8173263440', '8179109421', 'TIOPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-15', NULL, 0, 0, 0, '', '', '', NULL, 'HCFA|UB|', '1104927136', 0, 'N', 0, '2013-08-22', NULL, NULL, 32.4594, -97.6905, NULL, NULL),
('752904719', 'TIOPA0015', 'TIOPA0015', 'TXDALSTD', 'Acton Medical Clinic', 'Summer', 'D', 'Cumba', 'PA-C', 'Family Practice', '', '', NULL, 'B', 'PO Box 5334', 'Granbury', 'Hood', 'TX', '76049', '8173263440', '8179109421', 'PO Box 5334', 'Granbury', 'Hood', 'TX', '76049', '8173263440', '8179109421', 'TIOPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-15', NULL, 0, 0, 0, '', '', '', NULL, 'HCFA|UB|', '1104927136', 0, 'Y', 0, '2013-08-22', NULL, NULL, 0, 0, NULL, NULL),
('751831575', 'TIOPA0016', 'TIOPA0016', 'TXDALSTD', 'DFW Urology Consultants', 'Wayne', 'David', 'Hey', 'DO', 'Urology', '', '', NULL, 'O', '4809 Brentwood Stair Rd', 'Fort Worth', 'Tarrant', 'TX', '76103', '8177310316', '8173772081', '4809 Brentwood Stair Rd', 'Fort Worth', 'Tarrant', 'TX', '76103', '8177310316', '8173772081', 'TIOPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-15', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', 'Baylor Surgical Hospital at Fort Worth', NULL, NULL, 'HCFA|UB|', '1114114279', 0, 'N', 0, '2013-08-22', NULL, NULL, 32.7584, -97.2504, NULL, NULL),
('262836114', 'TIOPA0017', 'TIOPA0017', 'TXDALSTD', 'Crowley Saade Clinic PA', 'Carolyn', 'L', 'Scott', 'MD', 'Family Practice', '', '', NULL, 'O', '1005 S Crowley Rd', 'Crowley', 'Tarrant', 'TX', '76036', '8172974455', '8172953022', '1005 S Crowley Rd', 'Crowley', 'Tarrant', 'TX', '76036', '8172974455', '8172953022', 'TIOPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1114263530', 0, 'N', 0, '2014-03-28', NULL, NULL, 32.5638, -97.352, NULL, NULL),
('273004792', 'TIOPA0018', 'TIOPA0018', 'TXDALSTD', 'Hulen Total Care PA', 'Carolyn', 'L', 'Scott', 'MD', 'Family Practice', '', '', NULL, 'O', '6049 S Hulen St', 'Fort Worth', 'Tarrant', 'TX', '76132', '8173463313', '8173463491', '6049 S Hulen St', 'Fort Worth', 'Tarrant', 'TX', '76132', '8173463313', '8173463491', 'TIOPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1114263530', 0, 'N', 0, '2014-03-28', NULL, NULL, 32.6603, -97.4008, NULL, NULL),
('752778381', 'TIOPA0019', 'TIOPA0019', 'TXDALSTD', 'Roy Louis Caivano DO', 'Roy', 'Louis', 'Caivano', 'DO', 'Internal Medicine', '', '', NULL, 'O', '714 SW Wilshire Blvd', 'Burleson', 'Johnson', 'TX', '76028', '8174479900', '8174475010', '714 SW Wilshire Blvd', 'Burleson', 'Johnson', 'TX', '76028', '8174479900', '8174475010', 'TIOPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-15', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', NULL, '', '', 'HCFA|UB|', '1124063995', 0, 'N', 0, '2014-03-28', NULL, NULL, 32.5333, -97.3368, NULL, NULL),
('273401223', 'TIOPA0021', 'TIOPA0021', 'TXDALSTD', 'Donald P Frusher', 'Donald', 'P', 'Frusher', 'DO', 'Internal Medicine', '', '', NULL, 'O', '104 Grapevine Hwy Ste 200', 'Hurst', 'Tarrant', 'TX', '76054', '8174790050', '8174790054', '104 Grapevine Hwy Ste 200', 'Hurst', 'Tarrant', 'TX', '76054', '8174790050', '8174790054', 'TIOPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1124087044', 0, 'N', 0, '2014-03-28', NULL, NULL, 32.872, -97.1663, NULL, NULL),
('265179926', 'TIOPA0022', 'TIOPA0022', 'TXDALSTD', 'Charles Bamberger MD', 'Charles', '', 'Bamberger', 'MD', 'Urology', '', '', NULL, 'O', '416 S Henderson', 'Fort Worth', 'Tarrant', 'TX', '76104', '8173384636', '8173355421', '416 S Henderson', 'Fort Worth', 'Tarrant', 'TX', '76104', '8173384636', '8173355421', 'TIOPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-15', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', NULL, '', '', 'HCFA|UB|', '1164506226', 0, 'N', 0, '2014-03-28', NULL, NULL, 32.7404, -97.3377, NULL, NULL),
('270852226', 'W12046162', 'W12046162', 'UT01', 'Silverton Group', 'Gregory', 'K', 'Call', 'MD', 'Neurology', '', '', NULL, 'O', '8th Ave C St', 'Salt Lake City', 'Salt Lake', 'UT', '84143', '8014087100', '8012961715', '8th Ave C St', 'Salt Lake City', 'Salt Lake', 'UT', '84143', '8014087100', '8012961715', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-04-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1407839608', 0, 'N', 0, '2014-05-27', NULL, NULL, 0, 0, NULL, NULL),
('861111440', 'TIOPA0024', 'TIOPA0024', 'TXDALSTD', 'Associates of Internal Medicine PA', 'Morvarid', '', 'Rezaie', 'DO', 'Internal Medicine', '', '', NULL, 'O', '2260 College Ave', 'Fort Worth', 'Tarrant', 'TX', '76110', '8178703627', '8178703636', '2260 College Ave', 'Fort Worth', 'Tarrant', 'TX', '76110', '8178703627', '8178703636', 'TIOPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-15', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', '', NULL, '', 'HCFA|UB|', '1164692026', 0, 'N', 0, '2014-03-28', NULL, NULL, 32.7187, -97.3351, NULL, NULL),
('861111440', 'TIOPA0025', 'TIOPA0025', 'TXDALSTD', 'Associates of Internal Medicine PA', 'Morvarid', '', 'Rezaie', 'DO', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 12056', 'Fort Worth', 'Tarrant', 'TX', '76110', '8178703627', '8178703636', 'PO Box 12056', 'Fort Worth', 'Tarrant', 'TX', '76110', '8178703627', '8178703636', 'TIOPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-15', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', '', NULL, '', 'HCFA|UB|', '1164692026', 0, 'Y', 0, '2014-03-28', NULL, NULL, 0, 0, NULL, NULL),
('752279838', 'TIOPA0026', 'TIOPA0026', 'TXDALSTD', 'Dale Brancel DO', 'Dale', 'H', 'Brancel', 'DO', 'General Surgery', '', '', NULL, 'O', '809 W Harwood Rd Ste 201', 'Hurst', 'Tarrant', 'TX', '76054', '8175450022', '8176858829', '809 W Harwood Rd Ste 201', 'Hurst', 'Tarrant', 'TX', '76054', '8175450022', '8176858829', 'TIOPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-15', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Grapevine', 'Baylor Medical Center at Trophy Club', '', '', 'HCFA|UB|', '1174526024', 0, 'N', 0, '2014-03-28', NULL, NULL, 32.8441, -97.1892, NULL, NULL),
('201566087', 'TIOPA0030', 'TIOPA0030', 'TXDALSTD', 'Imre Kocsis DO', 'Imre', 'J', 'Kocsis', 'DO', 'Family Practice', '', '', NULL, 'O', '4798 Hwy 377 So', 'Fort Worth', 'Tarrant', 'TX', '76116', '8172449500', '8172449502', '4798 Hwy 377 So', 'Fort Worth', 'Tarrant', 'TX', '76116', '8172449500', '8172449502', 'TIOPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-15', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', 'Baylor Medical Center at Carrollton', NULL, NULL, 'HCFA|UB|', '1174668933', 0, 'N', 0, '2013-08-22', NULL, NULL, 32.7018, -97.4499, NULL, NULL),
('742220542', 'TIOPA0029', 'TIOPA0029', 'TXDALSTD', 'Imre Kocsis DO', 'Imre', 'J', 'Kocsis', 'DO', 'Family Practice', '', '', NULL, 'O', '2609 Jacksboro Hwy', 'Fort Worth', 'Tarrant', 'TX', '76114', '8176250163', '8176250563', '2609 Jacksboro Hwy', 'Fort Worth', 'Tarrant', 'TX', '76114', '8176250163', '8176250563', 'TIOPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-15', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', 'Baylor Medical Center at Carrollton', NULL, NULL, 'HCFA|UB|', '1174668933', 0, 'N', 0, '2013-08-22', NULL, NULL, 32.7873, -97.3855, NULL, NULL),
('742220542', 'TIOPA0028', 'TIOPA0028', 'TXDALSTD', 'Imre Kocsis DO', 'Imre', 'J', 'Kocsis', 'DO', 'Family Practice', '', '', NULL, 'O', '4798 Hwy 377 So', 'Fort Worth', 'Tarrant', 'TX', '76116', '8172449500', '8172449502', '4798 Hwy 377 So', 'Fort Worth', 'Tarrant', 'TX', '76116', '8172449500', '8172449502', 'TIOPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-15', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', 'Baylor Medical Center at Carrollton', NULL, NULL, 'HCFA|UB|', '1174668933', 0, 'N', 0, '2013-08-22', NULL, NULL, 32.7018, -97.4499, NULL, NULL),
('262836114', 'TIOPA0032', 'TIOPA0032', 'TXDALSTD', 'Crowley Saade Clinic PA', 'Raja', 'H', 'Saade', 'MD', 'Family Practice', '', '', NULL, 'O', '1005 S Crowley Rd', 'Crowley', 'Tarrant', 'TX', '76036', '8172974455', '8172953022', '1005 S Crowley Rd', 'Crowley', 'Tarrant', 'TX', '76036', '8172974455', '8172953022', 'TIOPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1225044126', 0, 'N', 0, '2014-03-28', NULL, NULL, 32.5638, -97.352, NULL, NULL),
('273004792', 'TIOPA0031', 'TIOPA0031', 'TXDALSTD', 'Hulen Total Care PA', 'Raja', 'H', 'Saade', 'MD', 'Family Practice', '', '', NULL, 'O', '6049 S Hulen St', 'Fort Worth', 'Tarrant', 'TX', '76132', '8173463313', '8173463491', '6049 S Hulen St', 'Fort Worth', 'Tarrant', 'TX', '76132', '8173463313', '8173463491', 'TIOPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1225044126', 0, 'N', 0, '2014-03-28', NULL, NULL, 32.6603, -97.4008, NULL, NULL),
('043767348', 'TIOPA0034', 'TIOPA0034', 'TXDALSTD', 'Metroplex Pediatrics PA', 'Babatunde', 'Idowu', 'Dosu', 'MD', 'Pediatrics', '', '', NULL, 'O', '6010 Curzon Ave Ste B', 'Fort Worth', 'Tarrant', 'TX', '76116', '8173869900', '8173869910', '6010 Curzon Ave Ste B', 'Fort Worth', 'Tarrant', 'TX', '76116', '8173869900', '8173869910', 'TIOPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-15', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1225061104', 0, 'N', 0, '2013-08-22', NULL, NULL, 32.7303, -97.4136, NULL, NULL),
('043767348', 'TIOPA0033', 'TIOPA0033', 'TXDALSTD', 'Metroplex Pediatrics PA', 'Babatunde', 'Idowu', 'Dosu', 'MD', 'Pediatrics', '', '', NULL, 'O', '900 Jerome St Ste 102', 'Fort Worth', 'Tarrant', 'TX', '76104', '8173869900', '8173869910', '900 Jerome St Ste 102', 'Fort Worth', 'Tarrant', 'TX', '76104', '8173869900', '8173869910', 'TIOPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-15', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1225061104', 0, 'N', 0, '2013-08-22', NULL, NULL, 32.7348, -97.3458, NULL, NULL),
('261205315', 'TIOPA0035', 'TIOPA0035', 'TXDALSTD', 'Leslie C Hardick DO PA FACOOG', 'Leslie', 'C', 'Hardick', 'DO', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1325 Pennsylvania Ave Ste 350', 'Fort Worth', 'Tarrant', 'TX', '76104', '8179242216', '8179245602', '1325 Pennsylvania Ave Ste 350', 'Fort Worth', 'Tarrant', 'TX', '76104', '8179242216', '8179245602', 'TIOPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-15', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', '', '', '', 'HCFA|UB|', '1235143744', 0, 'N', 0, '2014-03-28', NULL, NULL, 32.7385, -97.3404, NULL, NULL),
('010742725', 'TIOPA0037', 'TIOPA0037', 'TXDALSTD', 'Pohn Inthanousay DO', 'Pohn', 'P', 'Inthanousay', 'DO', 'Family Practice', '', '', NULL, 'O', '4401 Little Rd Ste 520', 'Arlington', 'Tarrant', 'TX', '76016', '8175729890', '8175729887', '4401 Little Rd Ste 520', 'Arlington', 'Tarrant', 'TX', '76016', '8175729890', '8175729887', 'TIOPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1245289495', 0, 'N', 0, '2014-03-28', NULL, NULL, 32.6764, -97.1975, NULL, NULL),
('263018359', 'TIOPA0038', 'TIOPA0038', 'TXDALSTD', 'Pohn Inthanousay DO', 'Pohn', 'P', 'Inthanousay', 'DO', 'Family Practice', '', '', NULL, 'O', '3310 S Watson Rd', 'Arlington', 'Tarrant', 'TX', '76014', '8177046930', '8177046935', '3310 S Watson Rd', 'Arlington', 'Tarrant', 'TX', '76014', '8177046930', '8177046935', 'TIOPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1245289495', 0, 'N', 0, '2014-03-28', NULL, NULL, 32.7027, -97.0633, NULL, NULL),
('273228599', 'TIOPA0039', 'TIOPA0039', 'TXDALSTD', 'Basanti Vrushab MD', 'Basanti', 'R', 'Vrushab', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1615 Precinct Line Rd Ste 101', 'Hurst', 'Tarrant', 'TX', '76054', '8172814910', '8172813107', '1615 Precinct Line Rd Ste 101', 'Hurst', 'Tarrant', 'TX', '76054', '8172814910', '8172813107', 'TIOPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1265436943', 0, 'N', 0, '2014-03-28', NULL, NULL, 32.8427, -97.1862, NULL, NULL),
('651249880', 'TIOPA0042', 'TIOPA0042', 'TXDALSTD', 'Children Medicaid Clinic', 'Harminder', 'Singh', 'Dhaliwal', 'MD', 'Pediatrics', '', '', NULL, 'O', '11751 Alta Vista Rd Ste 103', 'Fort Worth', 'Tarrant', 'TX', '76244', '8176232012', '8176232009', '11751 Alta Vista Rd Ste 103', 'Fort Worth', 'Tarrant', 'TX', '76244', '8176232012', '8176232009', 'TIOPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-15', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, NULL, NULL, 'HCFA|UB|', '1285661140', 0, 'N', 0, '2013-08-22', NULL, NULL, 32.945, -97.2814, NULL, NULL),
('752765246', 'TIOPA0043', 'TIOPA0043', 'TXDALSTD', 'Alliance Family Medicine / A1 Kids Doc', 'Harminder', 'Singh', 'Dhaliwal', 'MD', 'Pediatrics', '', '', NULL, 'O', '11751 Alta Vista Rd Ste 101', 'Fort Worth', 'Tarrant', 'TX', '76248', '8174314224', '8176232009', '11751 Alta Vista Rd Ste 101', 'Fort Worth', 'Tarrant', 'TX', '76248', '8174314224', '8176232009', 'TIOPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-15', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, NULL, NULL, 'HCFA|UB|', '1285661140', 0, 'N', 0, '2014-01-17', NULL, NULL, 32.945, -97.2814, NULL, NULL),
('752765246', 'TIOPA0041', 'TIOPA0041', 'TXDALSTD', 'Pediatric and Family Physicians PA', 'Harminder', 'Singh', 'Dhaliwal', 'MD', 'Pediatrics', '', '', NULL, 'O', '4900 Long Prairie Rd Ste 100', 'Flower Mound', 'Denton', 'TX', '75028', '9726914100', '9726914118', '4900 Long Prairie Rd Ste 100', 'Flower Mound', 'Denton', 'TX', '75028', '9726914100', '9726914118', 'TIOPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-15', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, NULL, NULL, 'HCFA|UB|', '1285661140', 0, 'N', 0, '2013-08-22', NULL, NULL, 33.0522, -97.0739, NULL, NULL),
('752904719', 'TIOPA0045', 'TIOPA0045', 'TXDALSTD', 'Acton Medical Clinic', 'Paul', 'Stephen', 'Bishop', 'DO', 'Family Practice', '', '', NULL, 'O', '2006 Fall Creek Hwy', 'Granbury', 'Hood', 'TX', '76049', '8173263440', '8179109421', '2006 Fall Creek Hwy', 'Granbury', 'Hood', 'TX', '76049', '8173263440', '8179109421', 'TIOPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1295700300', 0, 'N', 0, '2014-03-28', NULL, NULL, 32.4594, -97.6905, NULL, NULL),
('752904719', 'TIOPA0044', 'TIOPA0044', 'TXDALSTD', 'Acton Medical Clinic', 'Paul', 'Stephen', 'Bishop', 'DO', 'Family Practice', '', '', NULL, 'B', 'PO Box 5334', 'Granbury', 'Hood', 'TX', '76049', '8173263440', '8179109421', 'PO Box 5334', 'Granbury', 'Hood', 'TX', '76049', '8173263440', '8179109421', 'TIOPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1295700300', 0, 'Y', 0, '2014-03-28', NULL, NULL, 0, 0, NULL, NULL),
('043649417', 'TIOPA0046', 'TIOPA0046', 'TXDALSTD', 'Ginger Suzanne Goodchild DO', 'Ginger', 'Suzanne', 'Goodchild', 'DO', 'Family Practice', '', '', NULL, 'O', '2200 James Rd', 'Granbury', 'Hood', 'TX', '76049', '8173262727', '8173265737', '2200 James Rd', 'Granbury', 'Hood', 'TX', '76049', '8173262727', '8173265737', 'TIOPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-15', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', '', '', '', 'HCFA|UB|', '1306894894', 0, 'N', 0, '2014-03-28', NULL, NULL, 32.4585, -97.7168, NULL, NULL),
('043649417', 'TIOPA0047', 'TIOPA0047', 'TXDALSTD', 'Ginger Suzanne Goodchild DO', 'Ginger', 'Suzanne', 'Goodchild', 'DO', 'Family Practice', '', '', NULL, 'B', 'PO Box 2459', 'Granbury', 'Hood', 'TX', '76048', '8173262727', '8173262757', 'PO Box 2459', 'Granbury', 'Hood', 'TX', '76048', '8173262727', '8173262757', 'TIOPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-15', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', '', '', '', 'HCFA|UB|', '1306894894', 0, 'Y', 0, '2014-03-28', NULL, NULL, 0, 0, NULL, NULL),
('751738652', 'TIOPA0049', 'TIOPA0049', 'TXDALSTD', 'Jay G Beckwith DO PA', 'Jay', 'G', 'Beckwith', 'DO', 'Gastroenterology', '', '', NULL, 'O', '1051 Haskell St Ste 208', 'Fort Worth', 'Tarrant', 'TX', '76107', '8177373166', '8177374881', '1051 Haskell St Ste 208', 'Fort Worth', 'Tarrant', 'TX', '76107', '8177373166', '8177374881', 'TIOPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-15', NULL, 0, 0, 0, 'Baylor Surgical Hospital at Fort Worth', '', '', NULL, 'HCFA|UB|', '1306946934', 0, 'N', 0, '2013-08-22', NULL, NULL, 32.7492, -97.3715, NULL, NULL),
('223864262', 'TIOPA0051', 'TIOPA0051', 'TXDALSTD', 'The Physicians Clinic PA', 'Andrew', 'Edward', 'Bentley', 'MD', 'Family Practice', '', '', NULL, 'O', '921 Shiloh Rd Ste C100', 'Tyler', 'Smith', 'TX', '75703', '9035617030', '9035617073', '921 Shiloh Rd Ste C100', 'Tyler', 'Smith', 'TX', '75703', '9035617030', '9035617073', 'TIOPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1326151523', 0, 'N', 0, '2014-03-28', NULL, NULL, 32.2954, -95.2913, NULL, NULL),
('455127835', 'TIOPA0052', 'TIOPA0052', 'TXDALSTD', 'Ready to Change Counseling', 'Montica', 'A', 'OBarr', 'LCDC', 'Mental Health', 'Counseling', '', NULL, 'O', '206 YMCA Dr Ste 103', 'Waxahachie', 'Ellis', 'TX', '75165', '9722687030', '4695171138', '206 YMCA Dr Ste 103', 'Waxahachie', 'Ellis', 'TX', '75165', '9722687030', '4695171138', 'TIOPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-15', NULL, 0, 0, 0, '', '', '', NULL, 'HCFA|UB|', '1346505849', 0, 'Y', 0, '2014-04-01', NULL, NULL, 32.4279, -96.8418, NULL, NULL),
('800466626', 'TIOPA0053', 'TIOPA0053', 'TXDALSTD', 'Lake Country FAMILY PRACTICE PA', 'Yung', 'Sieu', 'Chen', 'DO', 'Family Practice', '', '', NULL, 'O', '8465 Boat Club Rd Ste 115', 'Fort Worth', 'Tarrant', 'TX', '76179', '8172600535', '8179008779', '8465 Boat Club Rd Ste 115', 'Fort Worth', 'Tarrant', 'TX', '76179', '8172600535', '8179008779', 'TIOPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1366411845', 0, 'N', 0, '2014-03-28', NULL, NULL, 32.8773, -97.4259, NULL, NULL),
('800466626', 'TIOPA0054', 'TIOPA0054', 'TXDALSTD', 'Lake Country FAMILY PRACTICE PA', 'Yung', 'Sieu', 'Chen', 'DO', 'Family Practice', '', '', NULL, 'O', '926 Creekbend Dr', 'Keller', 'Tarrant', 'TX', '76248', '8175579616', '8175572359', '926 Creekbend Dr', 'Keller', 'Tarrant', 'TX', '76248', '8175579616', '8175572359', 'TIOPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1366411845', 0, 'N', 0, '2014-03-28', NULL, NULL, 32.897, -97.2295, NULL, NULL),
('542077274', 'TIOPA0055', 'TIOPA0055', 'TXDALSTD', 'Salam Al Hafidh MD', 'Salam', '', 'Al Hafidh', 'MD', 'Internal Medicine', '', '', NULL, 'O', '7505 Glenview Dr Ste 151', 'North Richland Hills', 'Tarrant', 'TX', '76180', '8172849922', '8172849926', '7505 Glenview Dr Ste 151', 'North Richland Hills', 'Tarrant', 'TX', '76180', '8172849922', '8172849926', 'TIOPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-15', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', '', '', '', 'HCFA|UB|', '1366417842', 0, 'N', 0, '2014-03-28', NULL, NULL, 32.8238, -97.2156, NULL, NULL),
('752943323', 'TIOPA0057', 'TIOPA0057', 'TXDALSTD', 'Walnut Grove Family Health Center', 'Earl', 'C', 'Ruby', 'DO', 'Family Practice', '', '', NULL, 'O', '4440 E Hwy 287', 'Midlothian', 'Ellis', 'TX', '76065', '9727235590', '9727235592', '4440 E Hwy 287', 'Midlothian', 'Ellis', 'TX', '76065', '9727235590', '9727235592', 'TIOPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-15', NULL, 0, 0, 0, 'Baylor Medical Center at Waxahachie', '', '', '', 'HCFA|UB|', '1396969176', 0, 'N', 0, '2014-03-28', NULL, NULL, 32.4673, -96.9768, NULL, NULL),
('262836114', 'TIOPA0059', 'TIOPA0059', 'TXDALSTD', 'Crowley Saade Clinic PA', 'Moluk', 'M', 'Ragland', 'DO', 'Family Practice', '', '', NULL, 'O', '1005 S Crowley Rd', 'Crowley', 'Tarrant', 'TX', '76036', '8172974455', '8172953022', '1005 S Crowley Rd', 'Crowley', 'Tarrant', 'TX', '76036', '8172974455', '8172953022', 'TIOPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1407094873', 0, 'N', 0, '2014-03-28', NULL, NULL, 32.5638, -97.352, NULL, NULL),
('273004792', 'TIOPA0058', 'TIOPA0058', 'TXDALSTD', 'Hulen Total Care PA', 'Moluk', 'M', 'Ragland', 'DO', 'Family Practice', '', '', NULL, 'O', '6049 S Hulen St', 'Fort Worth', 'Tarrant', 'TX', '76132', '8173463313', '8173463491', '6049 S Hulen St', 'Fort Worth', 'Tarrant', 'TX', '76132', '8173463313', '8173463491', 'TIOPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1407094873', 0, 'N', 0, '2014-03-28', NULL, NULL, 32.6603, -97.4008, NULL, NULL),
('752672533', 'TIOPA0060', 'TIOPA0060', 'TXDALSTD', 'Glen Beede DPM PA', 'Glen', 'Alan', 'Beede', 'DPM', 'Podiatry', '', '', NULL, 'O', '5521 Bellaire Dr So Ste 116', 'Fort Worth', 'Tarrant', 'TX', '76109', '8177639383', '8177639385', '5521 Bellaire Dr So Ste 116', 'Fort Worth', 'Tarrant', 'TX', '76109', '8177639383', '8177639385', 'TIOPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-15', NULL, 0, 0, 0, '', '', 'Baylor All Saints Medical Center', '', 'HCFA|UB|', '1407854920', 0, 'N', 0, '2014-03-28', NULL, NULL, 32.6945, -97.4122, NULL, NULL),
('752869967', 'TIOPA0061', 'TIOPA0061', 'TXDALSTD', 'Frood Eelani DO', 'Frood', '', 'Eelani', 'DO', 'Internal Medicine', '', '', NULL, 'O', '1315 Sixth Ave', 'Fort Worth', 'Tarrant', 'TX', '76104', '8179213626', '8179210391', '1315 Sixth Ave', 'Fort Worth', 'Tarrant', 'TX', '76104', '8179213626', '8179210391', 'TIOPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-15', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', NULL, '', '', 'HCFA|UB|', '1417977703', 0, 'N', 0, '2014-03-28', NULL, NULL, 32.7305, -97.3403, NULL, NULL),
('453576949', 'TIOPA0066', 'TIOPA0066', 'TXDALSTD', 'M3 Physical Therapy and Industrial Rehab', 'Randy', 'W', 'Villard', 'PT', 'Physical Therapy', '', '', NULL, 'O', '3801 Lakeview Pkwy Ste 500', 'Rowlett', 'Dallas', 'TX', '75088', '4698657297', '9729055516', '3801 Lakeview Pkwy Ste 500', 'Rowlett', 'Dallas', 'TX', '75088', '4698657297', '9729055516', 'TIOPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-15', NULL, 0, 0, 0, '', '', '', NULL, 'HCFA|UB|', '1457461915', 0, 'N', 0, '2013-08-22', NULL, NULL, 32.9077, -96.5654, NULL, NULL),
('453576949', 'TIOPA0067', 'TIOPA0067', 'TXDALSTD', 'M3 Physical Therapy and Industrial Rehab', 'Randy', 'W', 'Villard', 'PT', 'Physical Therapy', '', '', NULL, 'O', '8080 Hwy 121 Ste 320', 'McKinney', 'Collin', 'TX', '75070', '4698148126', '9729055516', '8080 Hwy 121 Ste 320', 'McKinney', 'Collin', 'TX', '75070', '4698148126', '9729055516', 'TIOPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-15', NULL, 0, 0, 0, '', '', '', NULL, 'HCFA|UB|', '1457461915', 0, 'N', 0, '2013-08-22', NULL, NULL, 33.1795, -96.6921, NULL, NULL),
('352439678', 'TIOPA0071', 'TIOPA0071', 'TXDALSTD', 'AMA Counseling', 'Alexandra', 'M', 'Asirvadam', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '1700 Commerce Ste 410', 'Dallas', 'Dallas', 'TX', '75201', '2147334747', '9726177656', '1700 Commerce Ste 410', 'Dallas', 'Dallas', 'TX', '75201', '2147334747', '9726177656', 'TIOPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-15', NULL, 0, 0, 0, '', '', '', NULL, 'HCFA|UB|', '1457636987', 0, 'Y', 0, '2014-04-01', NULL, NULL, 32.7804, -96.7969, NULL, NULL),
('352439678', 'TIOPA0072', 'TIOPA0072', 'TXDALSTD', 'AMA Counseling', 'Alexandra', 'M', 'Asirvadam', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '206 YMCA Dr Ste 103', 'Waxahachie', 'Ellis', 'TX', '75165', '2147334747', '9726177656', '206 YMCA Dr Ste 103', 'Waxahachie', 'Ellis', 'TX', '75165', '2147334747', '9726177656', 'TIOPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-15', NULL, 0, 0, 0, '', '', '', NULL, 'HCFA|UB|', '1457636987', 0, 'Y', 0, '2014-04-01', NULL, NULL, 32.4279, -96.8418, NULL, NULL),
('352439678', 'TIOPA0068', 'TIOPA0068', 'TXDALSTD', 'AMA Counseling', 'Alexandra', 'M', 'Asirvadam', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '2309 Boll St', 'Dallas', 'Dallas', 'TX', '75204', '2147334747', '9726177656', '2309 Boll St', 'Dallas', 'Dallas', 'TX', '75204', '2147334747', '9726177656', 'TIOPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-15', NULL, 0, 0, 0, '', '', '', NULL, 'HCFA|UB|', '1457636987', 0, 'Y', 0, '2014-04-01', NULL, NULL, 32.7953, -96.7989, NULL, NULL),
('352439678', 'TIOPA0070', 'TIOPA0070', 'TXDALSTD', 'AMA Counseling', 'Alexandra', 'M', 'Asirvadam', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '2321 Beltline Ste 110', 'Grand Prairie', 'Dallas', 'TX', '75051', '2147334747', '9726177656', '2321 Beltline Ste 110', 'Grand Prairie', 'Dallas', 'TX', '75051', '2147334747', '9726177656', 'TIOPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-15', NULL, 0, 0, 0, '', '', '', NULL, 'HCFA|UB|', '1457636987', 0, 'Y', 0, '2014-04-01', NULL, NULL, 32.7116, -96.9942, NULL, NULL),
('352439678', 'TIOPA0069', 'TIOPA0069', 'TXDALSTD', 'AMA Counseling', 'Alexandra', 'M', 'Asirvadam', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'B', '316 Pebble Creek Dr', 'Red Oak', 'Ellis', 'TX', '75154', '2147334747', '9726177656', '316 Pebble Creek Dr', 'Red Oak', 'Ellis', 'TX', '75154', '2147334747', '9726177656', 'TIOPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-15', NULL, 0, 0, 0, '', '', '', NULL, 'HCFA|UB|', '1457636987', 0, 'Y', 0, '2014-04-01', NULL, NULL, 0, 0, NULL, NULL),
('201367269', 'TIOPA0075', 'TIOPA0075', 'TXDALSTD', 'Arlington Pain and Therapy', 'Aimee', 'LeAnn', 'Whitfield', 'PT', 'Physical Therapy', '', '', NULL, 'O', '2001 SE Green Oaks Blvd Ste 130', 'Arlington', 'Tarrant', 'TX', '76018', '8174196111', '8174199582', '2001 SE Green Oaks Blvd Ste 130', 'Arlington', 'Tarrant', 'TX', '76018', '8174196111', '8174199582', 'TIOPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-15', NULL, 0, 0, 0, '', '', '', NULL, 'HCFA|UB|', '1497882757', 0, 'N', 0, '2013-08-22', NULL, NULL, 32.6555, -97.0752, NULL, NULL),
('262836114', 'TIOPA0076', 'TIOPA0076', 'TXDALSTD', 'Crowley Saade Clinic PA', 'Janice', 'J', 'Bradley', 'ANP', 'Family Practice', '', '', NULL, 'O', '1005 S Crowley Rd', 'Crowley', 'Tarrant', 'TX', '76036', '8172974455', '8172953022', '1005 S Crowley Rd', 'Crowley', 'Tarrant', 'TX', '76036', '8172974455', '8172953022', 'TIOPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-15', NULL, 0, 0, 0, '', '', '', NULL, 'HCFA|UB|', '1508879875', 0, 'N', 0, '2013-08-22', NULL, NULL, 32.5638, -97.352, NULL, NULL),
('273004792', 'TIOPA0077', 'TIOPA0077', 'TXDALSTD', 'Hulen Total Care PA', 'Janice', 'J', 'Bradley', 'ANP', 'Family Practice', '', '', NULL, 'O', '6049 S Hulen St', 'Fort Worth', 'Tarrant', 'TX', '76132', '8173463313', '8173463491', '6049 S Hulen St', 'Fort Worth', 'Tarrant', 'TX', '76132', '8173463313', '8173463491', 'TIOPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-15', NULL, 0, 0, 0, '', '', '', NULL, 'HCFA|UB|', '1508879875', 0, 'N', 0, '2013-08-22', NULL, NULL, 32.6603, -97.4008, NULL, NULL),
('262836114', 'TIOPA0079', 'TIOPA0079', 'TXDALSTD', 'Crowley Saade Clinic PA', 'Walid', '', 'Saade', 'MD', 'Family Practice', '', '', NULL, 'O', '1005 S Crowley Rd', 'Crowley', 'Tarrant', 'TX', '76036', '8172974455', '8172953022', '1005 S Crowley Rd', 'Crowley', 'Tarrant', 'TX', '76036', '8172974455', '8172953022', 'TIOPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1518970805', 0, 'N', 0, '2014-03-28', NULL, NULL, 32.5638, -97.352, NULL, NULL),
('273004792', 'TIOPA0078', 'TIOPA0078', 'TXDALSTD', 'Hulen Total Care PA', 'Walid', '', 'Saade', 'MD', 'Family Practice', '', '', NULL, 'O', '6049 S Hulen St', 'Fort Worth', 'Tarrant', 'TX', '76132', '8173463313', '8173463491', '6049 S Hulen St', 'Fort Worth', 'Tarrant', 'TX', '76132', '8173463313', '8173463491', 'TIOPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1518970805', 0, 'N', 0, '2014-03-28', NULL, NULL, 32.6603, -97.4008, NULL, NULL),
('752838801', 'TIOPA0081', 'TIOPA0081', 'TXDALSTD', 'Dennis Tran MD', 'Dennis', 'D', 'Tran', 'MD', 'Internal Medicine', '', '', NULL, 'O', '2535 E Arkansas Ln Ste 321', 'Arlington', 'Tarrant', 'TX', '76010', '8172779740', '8172773082', '2535 E Arkansas Ln Ste 321', 'Arlington', 'Tarrant', 'TX', '76010', '8172779740', '8172773082', 'TIOPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1528068301', 0, 'N', 0, '2014-03-28', NULL, NULL, 32.7062, -97.0656, NULL, NULL),
('752440405', 'TIOPA0082', 'TIOPA0082', 'TXDALSTD', 'All Care Clinics', 'Rick', 'L', 'Enlow', 'ANP', 'Family Practice', '', '', NULL, 'O', '6805 NE Loop 820 Ste 414', 'North Richland Hills', 'Tarrant', 'TX', '76180', '8175817246', '8175817248', '6805 NE Loop 820 Ste 414', 'North Richland Hills', 'Tarrant', 'TX', '76180', '8175817246', '8175817248', 'TIOPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-15', NULL, 0, 0, 0, '', '', '', NULL, 'HCFA|UB|', '1548267651', 0, 'N', 0, '2013-08-22', NULL, NULL, 32.8407, -97.2371, NULL, NULL),
('262277350', 'TIOPA0088', 'TIOPA0088', 'TXDALSTD', 'Mark Kuper DO PA', 'Kraig', 'R', 'Pepper', 'DO', 'Orthopedic Surgery', '', '', NULL, 'O', '2200 James Rd', 'Granbury', 'Hood', 'TX', '76049', '8177359397', '8177358340', '2200 James Rd', 'Granbury', 'Hood', 'TX', '76049', '8177359397', '8177358340', 'TIOPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-15', NULL, 0, 0, 0, 'Baylor Medical Center at Carrollton', NULL, NULL, NULL, 'HCFA|UB|', '1568444107', 0, 'N', 0, '2013-08-22', NULL, NULL, 32.4585, -97.7168, NULL, NULL),
('262277350', 'TIOPA0086', 'TIOPA0086', 'TXDALSTD', 'Mark Kuper DO PA', 'Kraig', 'R', 'Pepper', 'DO', 'Orthopedic Surgery', '', '', NULL, 'O', '7257 Hawkins Dr', 'Fort Worth', 'Tarrant', 'TX', '76132', '8177359397', '8177358340', '7257 Hawkins Dr', 'Fort Worth', 'Tarrant', 'TX', '76132', '8177359397', '8177358340', 'TIOPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-15', NULL, 0, 0, 0, 'Baylor Medical Center at Carrollton', NULL, NULL, NULL, 'HCFA|UB|', '1568444107', 0, 'N', 0, '2013-08-22', NULL, NULL, 32.6642, -97.4189, NULL, NULL),
('455012558', 'TIOPA0089', 'TIOPA0089', 'TXDALSTD', 'Kraig R Pepper DO PA', 'Kraig', 'R', 'Pepper', 'DO', 'Orthopedic Surgery', '', '', NULL, 'O', '2200 James Rd', 'Granbury', 'Hood', 'TX', '76049', '8177359397', '8177358340', '2200 James Rd', 'Granbury', 'Hood', 'TX', '76049', '8177359397', '8177358340', 'TIOPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-15', NULL, 0, 0, 0, 'Baylor Medical Center at Carrollton', NULL, NULL, NULL, 'HCFA|UB|', '1568444107', 0, 'N', 0, '2013-08-22', NULL, NULL, 32.4585, -97.7168, NULL, NULL),
('455012558', 'TIOPA0087', 'TIOPA0087', 'TXDALSTD', 'Kraig R Pepper DO PA', 'Kraig', 'R', 'Pepper', 'DO', 'Orthopedic Surgery', '', '', NULL, 'O', '7257 Hawkins Dr', 'Fort Worth', 'Tarrant', 'TX', '76132', '8177359397', '8177358340', '7257 Hawkins Dr', 'Fort Worth', 'Tarrant', 'TX', '76132', '8177359397', '8177358340', 'TIOPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-15', NULL, 0, 0, 0, 'Baylor Medical Center at Carrollton', NULL, NULL, NULL, 'HCFA|UB|', '1568444107', 0, 'N', 0, '2013-08-22', NULL, NULL, 32.6642, -97.4189, NULL, NULL),
('342020859', 'TIOPA0091', 'TIOPA0091', 'TXDALSTD', 'MANSFIELD URGENT CARE', 'Jeffery', 'J', 'Fisher', 'MD', 'Family Practice', '', '', NULL, 'O', '1811 Hwy 287 N Ste 150', 'Mansfield', 'Tarrant', 'TX', '76063', '8174733979', '6825188919', '1811 Hwy 287 N Ste 150', 'Mansfield', 'Tarrant', 'TX', '76063', '8174733979', '6825188919', 'TIOPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1588669691', 0, 'N', 0, '2014-03-28', NULL, NULL, 32.5916, -97.1432, NULL, NULL),
('342020859', 'TIOPA0092', 'TIOPA0092', 'TXDALSTD', 'GRAND PRAIRIE URGENT CARE', 'Jeffery', 'J', 'Fisher', 'MD', 'Family Practice', '', '', NULL, 'O', '5204 S Hwy 360 Ste 400', 'Grand Prairie', 'Dallas', 'TX', '75052', '9727551785', '9726024521', '5204 S Hwy 360 Ste 400', 'Grand Prairie', 'Dallas', 'TX', '75052', '9727551785', '9726024521', 'TIOPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1588669691', 0, 'N', 0, '2014-03-28', NULL, NULL, 32.6479, -97.0608, NULL, NULL),
('900511642', 'TIOPA0093', 'TIOPA0093', 'TXDALSTD', 'Neighborhood Medical Care', 'Russell', 'W', 'Phillips', 'DO', 'Family Practice', '', '', NULL, 'O', '171 N Denton Tap Rd Ste 200', 'Coppell', 'Dallas', 'TX', '75019', '9727454446', '9727452597', '171 N Denton Tap Rd Ste 200', 'Coppell', 'Dallas', 'TX', '75019', '9727454446', '9727452597', 'TIOPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-15', NULL, 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1629041827', 0, 'N', 0, '2013-08-22', NULL, NULL, 32.9728, -96.9938, NULL, NULL),
('208903587', 'TIOPA0096', 'TIOPA0096', 'TXDALSTD', 'Peak Physical Therapy and Sports Medicine Center', 'R Chad', '', 'Fair', 'PT', 'Physical Therapy', '', '', NULL, 'O', '2021 Heritage Pkwy', 'Sherman', 'Grayson', 'TX', '75092', '9038924800', '9038924444', '2021 Heritage Pkwy', 'Sherman', 'Grayson', 'TX', '75092', '9038924800', '9038924444', 'TIOPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-15', NULL, 0, 0, 0, '', '', '', NULL, 'HCFA|UB|', '1710127329', 0, 'N', 0, '2013-08-22', NULL, NULL, 33.6407, -96.6427, NULL, NULL),
('201178443', 'TIOPA0098', 'TIOPA0098', 'TXDALSTD', 'Mark A Dirnberger DO PA', 'Jason', 'R', 'Butler', 'MD', 'Sports Medicine', '', '', NULL, 'O', '2001 SE Green Oaks Blvd Ste 130', 'Arlington', 'Tarrant', 'TX', '76018', '8174196111', '8174199582', '2001 SE Green Oaks Blvd Ste 130', 'Arlington', 'Tarrant', 'TX', '76018', '8174196111', '8174199582', 'TIOPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-15', NULL, 0, 0, 0, 'Baylor Orthopedic and Spine Hospital at Arlington', NULL, '', '', 'HCFA|UB|', '1710142484', 0, 'N', 0, '2014-03-28', NULL, NULL, 32.6555, -97.0752, NULL, NULL),
('861111440', 'TIOPA0101', 'TIOPA0101', 'TXDALSTD', 'Associates of Internal Medicine PA', 'Niraj', 'M', 'Mehta', 'DO', 'Internal Medicine', '', '', NULL, 'O', '2260 College Ave', 'Fort Worth', 'Tarrant', 'TX', '76110', '8178703627', '8178703636', '2260 College Ave', 'Fort Worth', 'Tarrant', 'TX', '76110', '8178703627', '8178703636', 'TIOPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-15', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', '', '', '', 'HCFA|UB|', '1730186230', 0, 'N', 0, '2014-03-28', NULL, NULL, 32.7187, -97.3351, NULL, NULL),
('861111440', 'TIOPA0102', 'TIOPA0102', 'TXDALSTD', 'Associates of Internal Medicine PA', 'Niraj', 'M', 'Mehta', 'DO', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 12056', 'Fort Worth', 'Tarrant', 'TX', '76110', '8178703627', '8178703636', 'PO Box 12056', 'Fort Worth', 'Tarrant', 'TX', '76110', '8178703627', '8178703636', 'TIOPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-15', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', '', '', '', 'HCFA|UB|', '1730186230', 0, 'Y', 0, '2014-03-28', NULL, NULL, 0, 0, NULL, NULL),
('263276864', 'TIOPA0103', 'TIOPA0103', 'TXDALSTD', 'Cleburne Digestive Health', 'Yevgeniy', '', 'Ostrinsky', 'MD', 'Gastroenterology', '', '', NULL, 'O', '203 Walls Dr Ste 100', 'Cleburne', 'Johnson', 'TX', '76033', '8177600234', '8176413355', '203 Walls Dr Ste 100', 'Cleburne', 'Johnson', 'TX', '76033', '8177600234', '8176413355', 'TIOPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1790998771', 0, 'N', 0, '2014-03-28', NULL, NULL, 32.3302, -97.4456, NULL, NULL),
('751654999', 'TIOPA0106', 'TIOPA0106', 'TXDALSTD', 'Fort Worth Eye Associates', 'H', 'William', 'Ranelle', 'DO', 'Ophthalmology', '', '', NULL, 'O', '5000 Collinwood Ave', 'Fort Worth', 'Tarrant', 'TX', '76107', '8177325593', '8173420388', '5000 Collinwood Ave', 'Fort Worth', 'Tarrant', 'TX', '76107', '8177325593', '8173420388', 'TIOPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-15', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', '', '', '', 'HCFA|UB|', '1831192046', 0, 'N', 0, '2014-03-28', NULL, NULL, 32.7377, -97.395, NULL, NULL),
('751654999', 'TIOPA0107', 'TIOPA0107', 'TXDALSTD', 'Fort Worth Eye Associates Weatherford', 'H', 'William', 'Ranelle', 'DO', 'Ophthalmology', '', '', NULL, 'O', '925 Santa Fe Dr', 'Weatherford', 'Parker', 'TX', '76086', '8173411600', '8173411603', '925 Santa Fe Dr', 'Weatherford', 'Parker', 'TX', '76086', '8173411600', '8173411603', 'TIOPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-15', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', '', '', '', 'HCFA|UB|', '1831192046', 0, 'N', 0, '2014-03-28', NULL, NULL, 32.7484, -97.7832, NULL, NULL),
('861111440', 'TIOPA0108', 'TIOPA0108', 'TXDALSTD', 'Associates of Internal Medicine PA', 'Pavani', '', 'Bellary', 'DO', 'Internal Medicine', '', '', NULL, 'O', '2260 College Ave', 'Fort Worth', 'Tarrant', 'TX', '76110', '8178703627', '8178703636', '2260 College Ave', 'Fort Worth', 'Tarrant', 'TX', '76110', '8178703627', '8178703636', 'TIOPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-15', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', '', NULL, '', 'HCFA|UB|', '1841297330', 0, 'N', 0, '2014-03-28', NULL, NULL, 32.7187, -97.3351, NULL, NULL),
('861111440', 'TIOPA0109', 'TIOPA0109', 'TXDALSTD', 'Associates of Internal Medicine PA', 'Pavani', '', 'Bellary', 'DO', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 12056', 'Fort Worth', 'Tarrant', 'TX', '76110', '8178703627', '8178703636', 'PO Box 12056', 'Fort Worth', 'Tarrant', 'TX', '76110', '8178703627', '8178703636', 'TIOPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-15', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', '', NULL, '', 'HCFA|UB|', '1841297330', 0, 'Y', 0, '2014-03-28', NULL, NULL, 0, 0, NULL, NULL),
('861111440', 'TIOPA0111', 'TIOPA0111', 'TXDALSTD', 'Associates of Internal Medicine PA', 'Stephanie', 'J', 'Hiraki', 'DO', 'Internal Medicine', '', '', NULL, 'O', '2260 College Ave', 'Fort Worth', 'Tarrant', 'TX', '76110', '8178703627', '8178703636', '2260 College Ave', 'Fort Worth', 'Tarrant', 'TX', '76110', '8178703627', '8178703636', 'TIOPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1841587284', 0, 'N', 0, '2014-03-28', NULL, NULL, 32.7187, -97.3351, NULL, NULL),
('861111440', 'TIOPA0112', 'TIOPA0112', 'TXDALSTD', 'Associates of Internal Medicine PA', 'Stephanie', 'J', 'Hiraki', 'DO', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 12056', 'Fort Worth', 'Tarrant', 'TX', '76110', '8178703627', '8178703636', 'PO Box 12056', 'Fort Worth', 'Tarrant', 'TX', '76110', '8178703627', '8178703636', 'TIOPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1841587284', 0, 'Y', 0, '2014-03-28', NULL, NULL, 0, 0, NULL, NULL),
('300213899', 'TIOPA0113', 'TIOPA0113', 'TXDALSTD', 'Body Mechanix Rehabilitation', 'Jimmie', '', 'Flythe', 'PT', 'Physical Therapy', '', '', NULL, 'O', '16633 N Dallas Pkwy Ste 150', 'Addison', 'Dallas', 'TX', '75001', '9723800000', '9723800042', '16633 N Dallas Pkwy Ste 150', 'Addison', 'Dallas', 'TX', '75001', '9723800000', '9723800042', 'TIOPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-15', NULL, 0, 0, 0, '', '', '', NULL, 'HCFA|UB|', '1851532642', 0, 'N', 0, '2013-08-22', NULL, NULL, 32.9794, -96.8284, NULL, NULL),
('300213899', 'TIOPA0114', 'TIOPA0114', 'TXDALSTD', 'Body Mechanix Rehabilitation Billing', 'Jimmie', '', 'Flythe', 'PT', 'Physical Therapy', '', '', NULL, 'O', '6101 Long Prairie Rd Ste 145', 'Flower Mound', 'Denton', 'TX', '75028', '8178348214', '8179232913', '6101 Long Prairie Rd Ste 145', 'Flower Mound', 'Denton', 'TX', '75028', '8178348214', '8179232913', 'TIOPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-15', NULL, 0, 0, 0, '', '', '', NULL, 'HCFA|UB|', '1851532642', 0, 'N', 0, '2013-08-22', NULL, NULL, 33.0691, -97.0825, NULL, NULL),
('751743967', 'TIOPA0115', 'TIOPA0115', 'TXDALSTD', 'James H Kravetz DO', 'James', 'H', 'Kravetz', 'DO', 'Family Practice', '', '', NULL, 'O', '2100 Virginia Ste G', 'Grand Prairie', 'Dallas', 'TX', '75051', '9722642331', '9722642333', '2100 Virginia Ste G', 'Grand Prairie', 'Dallas', 'TX', '75051', '9722642331', '9722642333', 'TIOPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1861478901', 0, 'N', 0, '2014-03-28', NULL, NULL, 32.7182, -97.0136, NULL, NULL),
('320183871', 'TIOPA0116', 'TIOPA0116', 'TXDALSTD', 'Angels Star Wellness Center PA', 'Chau', 'Ngoc', 'Pham', 'DO', 'Geriatrics', '', '', NULL, 'O', '8325 Whitley Rd Ste 100', 'Watauga', 'Tarrant', 'TX', '76148', '8177502777', '8177502789', '8325 Whitley Rd Ste 100', 'Watauga', 'Tarrant', 'TX', '76148', '8177502777', '8177502789', 'TIOPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-15', NULL, 0, 0, 0, '', '', '', NULL, 'HCFA|UB|', '1881659381', 0, 'Y', 0, '2014-04-01', NULL, NULL, 32.8872, -97.2576, NULL, NULL),
('752604687', 'TIOPA0119', 'TIOPA0119', 'TXDALSTD', 'Clinical Nephrology Associates PA', 'Phuc', 'Thanh', 'Nguyen', 'DO', 'Nephrology', '', '', NULL, 'O', '1700 Mistletoe Blvd', 'Fort Worth', 'Tarrant', 'TX', '76104', '8179238050', '8179238832', '1700 Mistletoe Blvd', 'Fort Worth', 'Tarrant', 'TX', '76104', '8179238050', '8179238832', 'TIOPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-15', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1881798270', 0, 'N', 0, '2013-08-22', NULL, NULL, 32.7315, -97.3459, NULL, NULL),
('752604687', 'TIOPA0120', 'TIOPA0120', 'TXDALSTD', 'Clinical Nephrology Associates PA', 'Phuc', 'Thanh', 'Nguyen', 'DO', 'Nephrology', '', '', NULL, 'O', '920 Santa Fe Dr Ste 103', 'Weatherford', 'Parker', 'TX', '76086', '8179238050', '8179238832', '920 Santa Fe Dr Ste 103', 'Weatherford', 'Parker', 'TX', '76086', '8179238050', '8179238832', 'TIOPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-15', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1881798270', 0, 'N', 0, '2013-08-22', NULL, NULL, 32.7492, -97.7841, NULL, NULL),
('752604687', 'TIOPA0118', 'TIOPA0118', 'TXDALSTD', 'Clinical Nephrology Associates PA', 'Phuc', 'Thanh', 'Nguyen', 'DO', 'Nephrology', '', '', NULL, 'B', 'PO Box 470787', 'Fort Worth', 'Tarrant', 'TX', '76104', '8179238050', '8179238832', 'PO Box 470787', 'Fort Worth', 'Tarrant', 'TX', '76104', '8179238050', '8179238832', 'TIOPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-15', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1881798270', 0, 'Y', 0, '2013-08-22', NULL, NULL, 0, 0, NULL, NULL),
('364523608', 'TIOPA0122', 'TIOPA0122', 'TXDALSTD', 'Southwest Orthopedic Associates', 'Richard', 'W', 'McGrath', 'PT', 'Physical Therapy', '', '', NULL, 'O', '4441 Bryant Irvin Rd', 'Fort Worth', 'Tarrant', 'TX', '76107', '8177319400', '8179164690', '4441 Bryant Irvin Rd', 'Fort Worth', 'Tarrant', 'TX', '76107', '8177319400', '8179164690', 'TIOPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-15', NULL, 0, 0, 0, '', '', '', NULL, 'HCFA|UB|', '1891915716', 0, 'N', 0, '2013-09-30', NULL, NULL, 32.6864, -97.4136, NULL, NULL),
('364523608', 'TIOPA0121', 'TIOPA0121', 'TXDALSTD', 'Southwest Orthopedic Associates', 'Richard', 'W', 'McGrath', 'PT', 'Physical Therapy', '', '', NULL, 'O', '6311 Southwest Blvd', 'Fort Worth', 'Tarrant', 'TX', '76132', '8177319400', '8177314282', '6311 Southwest Blvd', 'Fort Worth', 'Tarrant', 'TX', '76132', '8177319400', '8177314282', 'TIOPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-15', NULL, 0, 0, 0, '', '', '', NULL, 'HCFA|UB|', '1891915716', 0, 'N', 0, '2013-08-22', NULL, NULL, 32.6911, -97.4177, NULL, NULL),
('452720365', 'TIOPA0125', 'TIOPA0125', 'TXDALSTD', 'The Neighborhood Star Medical Center PA', 'Alicia', '', 'Wilkerson', 'DO', 'Family Practice', '', '', NULL, 'O', '5201 S Cooper St Ste 111', 'Arlington', 'Tarrant', 'TX', '76017', '8174689999', '8174689733', '5201 S Cooper St Ste 111', 'Arlington', 'Tarrant', 'TX', '76017', '8174689999', '8174689733', 'TIOPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1902937808', 0, 'N', 0, '2014-03-28', NULL, NULL, 32.6632, -97.1342, NULL, NULL),
('752231612', 'TIOPA0124', 'TIOPA0124', 'TXDALSTD', 'The Neighborhood Doctor', 'Alicia', '', 'Wilkerson', 'DO', 'Family Practice', '', '', NULL, 'O', '5201 S Cooper St Ste 111', 'Arlington', 'Tarrant', 'TX', '76017', '8174689999', '8174689733', '5201 S Cooper St Ste 111', 'Arlington', 'Tarrant', 'TX', '76017', '8174689999', '8174689733', 'TIOPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1902937808', 0, 'N', 0, '2014-03-28', NULL, NULL, 32.6632, -97.1342, 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
('752291663', 'TIOPA0123', 'TIOPA0123', 'TXDALSTD', 'The Neighborhood Doctor', 'Alicia', '', 'Wilkerson', 'DO', 'Family Practice', '', '', NULL, 'O', '1001 NE Green Oaks Ste 190', 'Arlington', 'Tarrant', 'TX', '76006', '8174697171', '8177954255', '1001 NE Green Oaks Ste 190', 'Arlington', 'Tarrant', 'TX', '76006', '8174697171', '8177954255', 'TIOPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1902937808', 0, 'N', 0, '2014-03-28', NULL, NULL, 32.7847, -97.0944, NULL, NULL),
('751862577', 'TIOPA0126', 'TIOPA0126', 'TXDALSTD', 'Edward Baker MD', 'Edward', 'L', 'Baker', 'DO', 'Family Practice', '', '', NULL, 'O', '125 S Texas St', 'Crowley', 'Tarrant', 'TX', '76036', '8172974309', '8172977183', '125 S Texas St', 'Crowley', 'Tarrant', 'TX', '76036', '8172974309', '8172977183', 'TIOPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-15', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', NULL, '', '', 'HCFA|UB|', '1912911439', 0, 'N', 0, '2014-03-28', NULL, NULL, 32.5785, -97.3604, NULL, NULL),
('263526678', 'TIOPA0137', 'TIOPA0137', 'TXDALSTD', 'DFW Family Clinic', 'Adila', 'N', 'Siddiqi', 'DO', 'Family Practice', '', '', NULL, 'O', '2771 Sherman Dr', 'Grand Prairie', 'Dallas', 'TX', '75051', '9726470550', '9726471010', '2771 Sherman Dr', 'Grand Prairie', 'Dallas', 'TX', '75051', '9726470550', '9726471010', 'TIOPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1932180296', 0, 'N', 0, '2014-03-28', NULL, NULL, 32.7351, -97.0491, NULL, NULL),
('263526678', 'TIOPA0138', 'TIOPA0138', 'TXDALSTD', 'Athena Health', 'Adila', 'N', 'Siddiqi', 'DO', 'Family Practice', '', '', NULL, 'B', 'PO Box 4836', 'Belfast', 'Waldo', 'ME', '04915', '9726470550', '9726471010', 'PO Box 4836', 'Belfast', 'Waldo', 'ME', '04915', '9726470550', '9726471010', 'TIOPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1932180296', 0, 'Y', 0, '2014-03-28', NULL, NULL, 0, 0, NULL, NULL),
('751879515', 'TIOPA0139', 'TIOPA0139', 'TXDALSTD', 'Total Pain Medicine and Anesthesiology PA', 'George', 'Antoun', 'Farhat', 'MD', 'Pain Management', '', '', NULL, 'O', '729 W Bedford Euless Rd Ste 111', 'Hurst', 'Tarrant', 'TX', '76053', '8178681109', '8175458266', '729 W Bedford Euless Rd Ste 111', 'Hurst', 'Tarrant', 'TX', '76053', '8178681109', '8175458266', 'TIOPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-15', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', NULL, '', '', 'HCFA|UB|', '1942205067', 0, 'N', 0, '2014-03-28', NULL, NULL, 32.834, -97.1847, NULL, NULL),
('751879515', 'TIOPA0140', 'TIOPA0140', 'TXDALSTD', 'Total Pain Medicine and Anesthesiology Billing', 'George', 'Antoun', 'Farhat', 'MD', 'Pain Management', '', '', NULL, 'B', 'PO Box 780', 'Colleyville', 'Tarrant', 'TX', '76034', '8178681109', '8175458266', 'PO Box 780', 'Colleyville', 'Tarrant', 'TX', '76034', '8178681109', '8175458266', 'TIOPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-15', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', NULL, '', '', 'HCFA|UB|', '1942205067', 0, 'Y', 0, '2014-03-28', NULL, NULL, 0, 0, NULL, NULL),
('752440405', 'TIOPA0141', 'TIOPA0141', 'TXDALSTD', 'All Care Clinics', 'James', 'G', 'Purgason', 'MD', 'Family Practice', '', '', NULL, 'O', '6805 NE Loop 820 Ste 414', 'North Richland Hills', 'Tarrant', 'TX', '76180', '8175817246', '8175817248', '6805 NE Loop 820 Ste 414', 'North Richland Hills', 'Tarrant', 'TX', '76180', '8175817246', '8175817248', 'TIOPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-09-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1962472449', 0, 'N', 0, '2014-03-28', NULL, NULL, 32.8407, -97.2371, NULL, NULL),
('751654999', 'TIOPA0073', 'TIOPA0073', 'TXDALSTD', 'Fort Worth Eye Associates', 'Shanna', 'J', 'Brown', 'MD', 'Ophthalmology', '', '', NULL, 'O', '5000 Collinwood Ave', 'Fort Worth', 'Tarrant', 'TX', '76164', '8177325593', '8173420388', '5000 Collinwood Ave', 'Fort Worth', 'Tarrant', 'TX', '76164', '8177325593', '8173420388', 'TIOPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-15', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', '', '', '', 'HCFA|UB|', '1467613513', 0, 'N', 0, '2013-08-22', NULL, NULL, 32.7377, -97.395, NULL, NULL),
('751654999', 'TIOPA0074', 'TIOPA0074', 'TXDALSTD', 'Fort Worth Eye Associates Weatherford', 'Shanna', 'J', 'Brown', 'MD', 'Ophthalmology', '', '', NULL, 'O', '925 Santa Fe Dr', 'Weatherford', 'Parker', 'TX', '76086', '8173411600', '8173411603', '925 Santa Fe Dr', 'Weatherford', 'Parker', 'TX', '76086', '8173411600', '8173411603', 'TIOPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-15', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', '', '', '', 'HCFA|UB|', '1467613513', 0, 'N', 0, '2013-08-22', NULL, NULL, 32.7484, -97.7832, NULL, NULL),
('751465533', 'TIOPA0095', 'TIOPA0095', 'TXDALSTD', 'Jarvis Bull DO', 'Jarvis', 'L', 'Bull', 'MD', 'Family Practice', '', '', NULL, 'O', '1615 Precinct Line Rd Ste 101', 'Hurst', 'Tarrant', 'TX', '76054', '8172814910', '8172813107', '1615 Precinct Line Rd Ste 101', 'Hurst', 'Tarrant', 'TX', '76054', '8172814910', '8172813107', 'TIOPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-15', NULL, 0, 0, 0, 'Baylor Regional Medical Center At Grapevine', 'Baylor All Saints Medical Center', '', '', 'HCFA|UB|', '1649277914', 0, 'N', 0, '2014-03-28', NULL, NULL, 32.8427, -97.1862, NULL, NULL),
('201178443', 'TIOPA0110', 'TIOPA0110', 'TXDALSTD', 'Mark A Dirnberger DO PA', 'Mark', '', 'Dirnberger', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '2001 SE Green Oaks Blvd Ste 130', 'Arlington', 'Tarrant', 'TX', '76018', '8174196111', '8174199582', '2001 SE Green Oaks Blvd Ste 130', 'Arlington', 'Tarrant', 'TX', '76018', '8174196111', '8174199582', 'TIOPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-15', NULL, 0, 0, 0, 'Baylor Orthopedic and Spine Hospital at Arlington', NULL, '', '', 'HCFA|UB|', '1841366465', 0, 'N', 0, '2014-03-28', NULL, NULL, 32.6555, -97.0752, NULL, NULL),
('752604687', 'TIOPA0128', 'TIOPA0128', 'TXDALSTD', 'Clinical Nephrology Associates PA', 'Jack', 'O', 'Gratch', 'DO', 'Nephrology', '', '', NULL, 'O', '1700 Mistletoe Blvd', 'Fort Worth', 'Tarrant', 'TX', '76104', '8179272612', '8179200562', '1700 Mistletoe Blvd', 'Fort Worth', 'Tarrant', 'TX', '76104', '8179272612', '8179200562', 'TIOPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-15', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', NULL, '', '', 'HCFA|UB|', '1912938267', 0, 'N', 0, '2014-03-28', NULL, NULL, 32.7315, -97.3459, NULL, NULL),
('752604687', 'TIOPA0131', 'TIOPA0131', 'TXDALSTD', 'Clinical Nephrology Associates PA', 'Jack', 'O', 'Gratch', 'DO', 'Nephrology', '', '', NULL, 'O', '920 Santa Fe Dr Ste 103', 'Weatherford', 'Parker', 'TX', '76086', '8179238050', '8179238832', '920 Santa Fe Dr Ste 103', 'Weatherford', 'Parker', 'TX', '76086', '8179238050', '8179238832', 'TIOPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-15', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', NULL, '', '', 'HCFA|UB|', '1912938267', 0, 'N', 0, '2014-03-28', NULL, NULL, 32.7492, -97.7841, NULL, NULL),
('364665071', 'W12046146', 'W12046146', 'UT01', 'Wasatch Physical Therapy & Rehabilitation', 'Marlee', 'K', 'Dalton', 'CNM', 'Obstetrics and Gynecology', 'Family Practice', '', NULL, 'O', '5323 S Woodrow St Ste 204', 'Murray', 'Salt Lake', 'UT', '84107', '8017130610', '8017130613', '5323 S Woodrow St Ste 204', 'Murray', 'Salt Lake', 'UT', '84107', '8017130610', '8017130613', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-02-01', NULL, 0, 0, 0, 'Mountain West Medical Center', '', '', '', 'HCFA|UB|', '1730175761', 0, 'N', 0, '2014-03-28', NULL, NULL, 0, 0, NULL, NULL),
('752604687', 'TIOPA0129', 'TIOPA0129', 'TXDALSTD', 'Clinical Nephrology Associates PA', 'Jack', 'O', 'Gratch', 'DO', 'Nephrology', '', '', NULL, 'B', 'PO Box 470787', 'Fort Worth', 'Tarrant', 'TX', '76147', '8177375081', '8177375188', 'PO Box 470787', 'Fort Worth', 'Tarrant', 'TX', '76147', '8177375081', '8177375188', 'TIOPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-15', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', NULL, '', '', 'HCFA|UB|', '1912938267', 0, 'Y', 0, '2014-03-28', NULL, NULL, 0, 0, NULL, NULL),
('201831246', 'TIOPA0090', 'TIOPA0090', 'TXDALSTD', 'Family Health Services', 'Jamie', '', 'Inman', 'MS DO', 'Family Practice', '', '', NULL, 'O', '4305 S Hulen St', 'Fort Worth', 'Tarrant', 'TX', '76109', '8179274600', '8179274604', '4305 S Hulen St', 'Fort Worth', 'Tarrant', 'TX', '76109', '8179274600', '8179274604', 'TIOPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1578745907', 0, 'N', 0, '2014-03-28', NULL, NULL, 32.6848, -97.3923, NULL, NULL),
('752656838', 'TIOPA0099', 'TIOPA0099', 'TXDALSTD', 'Kelly Kunkel MD', 'Kelly', 'R', 'Kunkel', 'MD', 'Plastic Surgery', '', '', NULL, 'O', '1830 8th Ave', 'Fort Worth', 'Tarrant', 'TX', '76110', '8173365200', '8179230780', '1830 8th Ave', 'Fort Worth', 'Tarrant', 'TX', '76110', '8173365200', '8179230780', 'TIOPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-15', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', NULL, '', '', 'HCFA|UB|', '1730144502', 0, 'N', 0, '2014-03-28', NULL, NULL, 32.7248, -97.3437, NULL, NULL),
('752604687', 'TIOPA0132', 'TIOPA0132', 'TXDALSTD', 'Clinical Nephrology Associates PA', 'Teresa', 'A', 'McLemore', 'PA', 'Nephrology', '', '', NULL, 'O', '1700 Mistletoe Blvd', 'Fort Worth', 'Tarrant', 'TX', '76104', '8179272612', '8179200562', '1700 Mistletoe Blvd', 'Fort Worth', 'Tarrant', 'TX', '76104', '8179272612', '8179200562', 'TIOPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-15', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', '', '', '', 'HCFA|UB|', '1922258268', 0, 'N', 0, '2014-03-28', NULL, NULL, 32.7315, -97.3459, NULL, NULL),
('752604687', 'TIOPA0135', 'TIOPA0135', 'TXDALSTD', 'Clinical Nephrology Associates PA', 'Teresa', 'A', 'McLemore', 'PA', 'Nephrology', '', '', NULL, 'O', '920 Santa Fe Dr Ste 103', 'Weatherford', 'Parker', 'TX', '76086', '8179238050', '8179238832', '920 Santa Fe Dr Ste 103', 'Weatherford', 'Parker', 'TX', '76086', '8179238050', '8179238832', 'TIOPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-15', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', '', '', '', 'HCFA|UB|', '1922258268', 0, 'N', 0, '2014-03-28', NULL, NULL, 32.7492, -97.7841, NULL, NULL),
('752604687', 'TIOPA0133', 'TIOPA0133', 'TXDALSTD', 'Clinical Nephrology Associates PA', 'Teresa', 'A', 'McLemore', 'PA', 'Nephrology', '', '', NULL, 'B', 'PO Box 470787', 'Fort Worth', 'Tarrant', 'TX', '76147', '8179272612', '8179200562', 'PO Box 470787', 'Fort Worth', 'Tarrant', 'TX', '76147', '8179272612', '8179200562', 'TIOPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-15', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', '', '', '', 'HCFA|UB|', '1922258268', 0, 'Y', 0, '2014-03-28', NULL, NULL, 0, 0, NULL, NULL),
('752844839', 'TIOPA0083', 'TIOPA0083', 'TXDALSTD', 'North Texas Lung and Sleep Clinic', 'Raymond', 'C', 'Perkins II', 'MD', 'Pulmonary', '', '', NULL, 'O', '2801 S Hulen St Ste 600', 'Fort Worth', 'Tarrant', 'TX', '76109', '8177310230', '8177317046', '2801 S Hulen St Ste 600', 'Fort Worth', 'Tarrant', 'TX', '76109', '8177310230', '8177317046', 'TIOPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-15', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1548268501', 0, 'N', 0, '2013-08-22', NULL, NULL, 32.711, -97.3861, NULL, NULL),
('752844839', 'TIOPA0085', 'TIOPA0085', 'TXDALSTD', 'North Texas Lung and Sleep Clinic', 'Raymond', 'C', 'Perkins II', 'MD', 'Pulmonary', '', '', NULL, 'O', '731 E Solake Blvd', 'Southlake', 'Tarrant', 'TX', '76092', '8177310230', '8177317046', '731 E Solake Blvd', 'Southlake', 'Tarrant', 'TX', '76092', '8177310230', '8177317046', 'TIOPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-15', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1548268501', 0, 'N', 0, '2013-08-22', NULL, NULL, 32.941, -97.1405, NULL, NULL),
('752844839', 'TIOPA0084', 'TIOPA0084', 'TXDALSTD', 'North Texas Lung and Sleep Clinic', 'Raymond', 'C', 'Perkins II', 'MD', 'Pulmonary', '', '', NULL, 'B', 'PO Box 100189', 'Fort Worth', 'Tarrant', 'TX', '76185', '8177316121', '8177328015', 'PO Box 100189', 'Fort Worth', 'Tarrant', 'TX', '76185', '8177316121', '8177328015', 'TIOPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-15', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1548268501', 0, 'Y', 0, '2013-08-22', NULL, NULL, 0, 0, NULL, NULL),
('751654999', 'TIOPA0064', 'TIOPA0064', 'TXDALSTD', 'Fort Worth Eye Associates', 'Ann', 'E', 'Ranelle', 'DO', 'Ophthalmology', '', '', NULL, 'O', '5000 Collinwood Ave', 'Fort Worth', 'Tarrant', 'TX', '76107', '8177325593', '8173420388', '5000 Collinwood Ave', 'Fort Worth', 'Tarrant', 'TX', '76107', '8177325593', '8173420388', 'TIOPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-15', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', NULL, '', '', 'HCFA|UB|', '1427030139', 0, 'N', 0, '2014-03-28', NULL, NULL, 32.7377, -97.395, NULL, NULL),
('751654999', 'TIOPA0065', 'TIOPA0065', 'TXDALSTD', 'Fort Worth Eye Associates Weatherford', 'Ann', 'E', 'Ranelle', 'DO', 'Ophthalmology', '', '', NULL, 'O', '925 Santa Fe Dr', 'Weatherford', 'Parker', 'TX', '76086', '8173411600', '8173411603', '925 Santa Fe Dr', 'Weatherford', 'Parker', 'TX', '76086', '8173411600', '8173411603', 'TIOPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-15', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', NULL, '', '', 'HCFA|UB|', '1427030139', 0, 'N', 0, '2014-03-28', NULL, NULL, 32.7484, -97.7832, NULL, NULL),
('202198373', 'TIOPA0104', 'TIOPA0104', 'TXDALSTD', 'Dr Robert Stroud PA', 'Robert', 'G', 'Stroud', 'DO', 'Urology', '', '', NULL, 'O', '1101 University Dr', 'Fort Worth', 'Tarrant', 'TX', '76107', '8173350199', '8177312107', '1101 University Dr', 'Fort Worth', 'Tarrant', 'TX', '76107', '8173350199', '8177312107', 'TIOPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-15', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', NULL, '', '', 'HCFA|UB|', '1801859376', 0, 'N', 0, '2014-03-28', NULL, NULL, 32.7483, -97.3619, NULL, NULL),
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('741886573', 'W12037067', 'W12037067', 'TXHOUSTD', 'Pasadena Eye Associates', 'Scott', 'E', 'Segal', 'MD', 'Ophthalmology', '', '', NULL, 'O', '4450 E Sam Houston Pkwy S Ste E', 'Pasadena', 'Harris', 'TX', '77505', '7134735715', '7134733314', '4450 E Sam Houston Pkwy S Ste E', 'Pasadena', 'Harris', 'TX', '77505', '7134735715', '7134733314', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-27', NULL, 0, 0, 0, 'Bayshore Medical Center', NULL, '', '', 'HCFA|UB|', '1154373942', 0, 'N', 0, '2013-08-27', NULL, NULL, 29.6428, -95.1588, NULL, NULL),
('203495271', 'W12037083', 'W12037083', 'ID02', 'John D Foote MD', 'Kacey', '', 'Andreasen', 'PA-C', 'General Surgery', '', '', NULL, 'O', '1050 SW 3rd Ave Ste 1200', 'Ontario', 'Malheur', 'OR', '97914', '5418893111', '5418893999', '1050 SW 3rd Ave Ste 1200', 'Ontario', 'Malheur', 'OR', '97914', '5418893111', '5418893999', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2013-07-26', '2014-04-30', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1215160510', 0, 'N', 0, '2014-06-05', NULL, NULL, 44.0257, -116.977, NULL, NULL),
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('621560557', 'W12037087', 'W12037087', 'ID02', 'West Valley Clinic at New Plymouth', 'Kristin', '', 'Christensen', 'PA', 'Family Practice', '', '', NULL, 'O', '112 S Plymouth St', 'New Plymouth', 'Payette', 'ID', '83655', '2082783406', '2082783418', '112 S Plymouth St', 'New Plymouth', 'Payette', 'ID', '83655', '2082783406', '2082783418', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2013-07-25', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1558351569', 0, 'N', 0, '2013-08-23', NULL, NULL, 0, 0, NULL, NULL),
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('621560557', 'W12037089', 'W12037089', 'ID02', 'West Valley Clinic at Wilder', 'Kristin', '', 'Christensen', 'PA', 'Family Practice', '', '', NULL, 'O', '124 5th St Ste A', 'Wilder', 'Canyon', 'ID', '83676', '2084827430', '2084827272', '124 5th St Ste A', 'Wilder', 'Canyon', 'ID', '83676', '2084827430', '2084827272', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2013-07-25', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1558351569', 0, 'N', 0, '2013-08-23', NULL, NULL, 0, 0, NULL, NULL),
('203495271', 'W12037092', 'W12037092', 'ID02', 'John D Foote MD', 'John', '', 'Foote', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1818 S 10th Ave Ste 250', 'Caldwell', 'Canyon', 'ID', '83605', '5418893111', '5418893999', '1818 S 10th Ave Ste 250', 'Caldwell', 'Canyon', 'ID', '83605', '5418893111', '5418893999', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2013-07-26', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1154310597', 0, 'N', 0, '2014-06-05', NULL, NULL, 43.6538, -116.693, NULL, NULL),
('203495271', 'W12037093', 'W12037093', 'ID02', 'John D Foote MD', 'John', '', 'Foote', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1050 SW 3rd Ave Ste 1200', 'Ontario', 'Malheur', 'OR', '97914', '5418893111', '5418893999', '1050 SW 3rd Ave Ste 1200', 'Ontario', 'Malheur', 'OR', '97914', '5418893111', '5418893999', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2013-07-26', '2014-04-30', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1154310597', 0, 'N', 0, '2014-06-05', NULL, NULL, 44.0257, -116.977, NULL, NULL),
('621560557', 'W12037109', 'W12037109', 'ID02', 'West Valley Clinic at New Plymouth', 'Kristine', '', 'Kingery', 'PA', 'Family Practice', '', '', NULL, 'O', '112 S Plymouth St', 'New Plymouth', 'Payette', 'ID', '83655', '2082783406', '2082783418', '112 S Plymouth St', 'New Plymouth', 'Payette', 'ID', '83655', '2082783406', '2082783418', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2013-07-24', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1679517155', 0, 'N', 0, '2013-11-12', NULL, NULL, 0, 0, NULL, NULL),
('621560557', 'W12037097', 'W12037097', 'ID02', 'West Valley Clinic at New Plymouth', 'Amber', 'A', 'Hackenberg', 'PA-C', 'Family Practice', '', '', NULL, 'O', '112 S Plymouth St', 'New Plymouth', 'Payette', 'ID', '83655', '2082783406', '2082783418', '112 S Plymouth St', 'New Plymouth', 'Payette', 'ID', '83655', '2082783406', '2082783418', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2013-05-06', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1326357070', 0, 'N', 0, '2013-11-12', NULL, NULL, 0, 0, NULL, NULL),
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('621560557', 'W12037099', 'W12037099', 'ID02', 'West Valley Clinic at Wilder', 'Amber', 'A', 'Hackenberg', 'PA-C', 'Family Practice', '', '', NULL, 'O', '124 5th St Ste A', 'Wilder', 'Canyon', 'ID', '83676', '2084827430', '2084827272', '124 5th St Ste A', 'Wilder', 'Canyon', 'ID', '83676', '2084827430', '2084827272', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2013-05-06', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1326357070', 0, 'N', 0, '2013-11-12', NULL, NULL, 0, 0, NULL, NULL),
('621560557', 'W12037100', 'W12037100', 'ID02', 'West Valley Clinic', 'Amber', 'A', 'Hackenberg', 'PA-C', 'Family Practice', '', '', NULL, 'B', '1717 Arlington Ave', 'Caldwell', 'Canyon', 'ID', '83605', '2084553908', '0000000000', '1717 Arlington Ave', 'Caldwell', 'Canyon', 'ID', '83605', '2084553908', '0000000000', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2013-05-06', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1326357070', 0, 'N', 0, '2013-11-12', NULL, NULL, 0, 0, NULL, NULL),
('460544997', 'W12037106', 'W12037106', 'ID02', 'Simply Womens Health', 'Stephanie', 'L', 'Terrell', 'NP', 'Family Practice', '', '', NULL, 'B', 'PO Box 190780', 'Boise', 'Ada', 'ID', '83719', '2089945700', '0000000000', 'PO Box 190780', 'Boise', 'Ada', 'ID', '83719', '2089945700', '0000000000', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2013-07-18', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1336127190', 0, 'N', 0, '2013-08-23', NULL, NULL, 0, 0, NULL, NULL),
('460544997', 'W12037105', 'W12037105', 'ID02', 'Simply Womens Health', 'Stephanie', 'L', 'Terrell', 'NP', 'Family Practice', '', '', NULL, 'O', '2273 E Gala St Ste 110', 'Meridian', 'Ada', 'ID', '83642', '2089945700', '2089945700', '2273 E Gala St Ste 110', 'Meridian', 'Ada', 'ID', '83642', '2089945700', '2089945700', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2013-07-18', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1336127190', 0, 'N', 0, '2013-08-23', NULL, NULL, 0, 0, NULL, NULL),
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('202695346', 'NVA000017', 'NVA000017', 'UT01', 'North Valley Anesthesia', 'Michael', 'D', 'Taylor', 'MD', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 3810', 'SLC', 'Salt Lake', 'UT', '84110', '8014322609', NULL, 'PO Box 3810', 'SLC', 'Salt Lake', 'UT', '84110', '8014322609', '', '', '', '', '55.00', '25.00', '0.00', 6, '2013-08-01', '2014-06-30', 0, 12, 0, '', '', '', '', 'HCFA|UB|', '1952451429', 0, 'Y', 0, '2013-10-15', NULL, NULL, 0, 0, NULL, NULL),
('202695346', 'NVA000038', 'NVA000038', 'UT01', 'North Valley Anesthesia', 'Michael', 'D', 'Taylor', 'MD', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 3810', 'SLC', 'Salt Lake', 'UT', '84110', '8014322609', NULL, 'PO Box 3810', 'SLC', 'Salt Lake', 'UT', '84110', '8014322609', '', '', '', '', '56.00', '25.00', '0.00', 6, '2014-07-01', '2015-06-30', 0, 12, 0, '', '', '', '', 'HCFA|UB|', '1952451429', 0, 'Y', 0, '2013-10-15', 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
('202695346', 'NVA000018', 'NVA000018', 'UT01', 'North Valley Anesthesia', 'Kyle', 'B', 'Turner', 'CRNA', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 3810', 'SLC', 'Salt Lake', 'UT', '84110', '8014322609', NULL, 'PO Box 3810', 'SLC', 'Salt Lake', 'UT', '84110', '8014322609', '', '', '', '', '45.00', '25.00', '0.00', 6, '2013-08-01', '2014-06-30', 0, 12, 0, '', '', '', '', 'HCFA|UB|', '1972757771', 0, 'Y', 0, '2013-10-15', NULL, NULL, 0, 0, NULL, NULL),
('202695346', 'NVA000039', 'NVA000039', 'UT01', 'North Valley Anesthesia', 'Kyle', 'B', 'Turner', 'CRNA', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 3810', 'SLC', 'Salt Lake', 'UT', '84110', '8014322609', NULL, 'PO Box 3810', 'SLC', 'Salt Lake', 'UT', '84110', '8014322609', '', '', '', '', '46.00', '25.00', '0.00', 6, '2014-07-01', '2015-06-30', 0, 12, 0, '', '', '', '', 'HCFA|UB|', '1972757771', 0, 'Y', 0, '2013-10-15', NULL, NULL, 0, 0, NULL, NULL),
('202695346', 'NVA000019', 'NVA000019', 'UT01', 'North Valley Anesthesia', 'Kevin', '', 'Vick', 'CRNA', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 3810', 'SLC', 'Salt Lake', 'UT', '84110', '8014322609', NULL, 'PO Box 3810', 'SLC', 'Salt Lake', 'UT', '84110', '8014322609', '', '', '', '', '45.00', '25.00', '0.00', 6, '2013-08-01', '2014-06-30', 0, 12, 0, '', '', '', '', 'HCFA|UB|', '1831294784', 0, 'Y', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
('202695346', 'NVA000040', 'NVA000040', 'UT01', 'North Valley Anesthesia', 'Kevin', '', 'Vick', 'CRNA', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 3810', 'SLC', 'Salt Lake', 'UT', '84110', '8014322609', NULL, 'PO Box 3810', 'SLC', 'Salt Lake', 'UT', '84110', '8014322609', '', '', '', '', '46.00', '25.00', '0.00', 6, '2014-07-01', '2015-06-30', 0, 12, 0, '', '', '', '', 'HCFA|UB|', '1831294784', 0, 'Y', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
('202695346', 'NVA000020', 'NVA000020', 'UT01', 'North Valley Anesthesia', 'Erin', '', 'Welker', 'CRNA', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 3810', 'SLC', 'Salt Lake', 'UT', '84110', '8014322609', NULL, 'PO Box 3810', 'SLC', 'Salt Lake', 'UT', '84110', '8014322609', '', '', '', '', '45.00', '25.00', '0.00', 6, '2013-08-01', '2014-06-30', 0, 12, 0, '', '', '', '', 'HCFA|UB|', '1285952622', 0, 'Y', 0, '2013-10-15', NULL, NULL, 0, 0, NULL, NULL),
('202695346', 'NVA000041', 'NVA000041', 'UT01', 'North Valley Anesthesia', 'Erin', '', 'Welker', 'CRNA', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 3810', 'SLC', 'Salt Lake', 'UT', '84110', '8014322609', NULL, 'PO Box 3810', 'SLC', 'Salt Lake', 'UT', '84110', '8014322609', '', '', '', '', '46.00', '25.00', '0.00', 6, '2014-07-01', '2015-06-30', 0, 12, 0, '', '', '', '', 'HCFA|UB|', '1285952622', 0, 'Y', 0, '2013-10-15', NULL, NULL, 0, 0, NULL, NULL),
('202695346', 'NVA000021', 'NVA000021', 'UT01', 'North Valley Anesthesia', 'Bryan', 'G', 'Wright', 'CRNA', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 3810', 'SLC', 'Salt Lake', 'UT', '84110', '8014322609', NULL, 'PO Box 3810', 'SLC', 'Salt Lake', 'UT', '84110', '8014322609', '', '', '', '', '45.00', '25.00', '0.00', 6, '2013-08-01', '2014-06-30', 0, 12, 0, '', '', '', '', 'HCFA|UB|', '1437255288', 0, 'Y', 0, '2013-08-23', NULL, NULL, 0, 0, NULL, NULL),
('202695346', 'NVA000042', 'NVA000042', 'UT01', 'North Valley Anesthesia', 'Bryan', 'G', 'Wright', 'CRNA', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 3810', 'SLC', 'Salt Lake', 'UT', '84110', '8014322609', NULL, 'PO Box 3810', 'SLC', 'Salt Lake', 'UT', '84110', '8014322609', '', '', '', '', '46.00', '25.00', '0.00', 6, '2014-07-01', '2015-06-30', 0, 12, 0, '', '', '', '', 'HCFA|UB|', '1437255288', 0, 'Y', 0, '2013-08-23', NULL, NULL, 0, 0, NULL, NULL),
('621560557', 'W12037112', 'W12037112', 'ID02', 'West Valley Clinic at New Plymouth', 'Kelly', '', 'Pesnell', 'NP', 'Family Practice', '', '', NULL, 'O', '112 S Plymouth St', 'New Plymouth', 'Payette', 'ID', '83655', '2082783406', '2082783418', '112 S Plymouth St', 'New Plymouth', 'Payette', 'ID', '83655', '2082783406', '2082783418', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2013-07-25', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1992785463', 0, 'N', 0, '2013-11-12', NULL, NULL, 0, 0, NULL, NULL),
('621560557', 'W12037113', 'W12037113', 'ID02', 'West Valley Clinic at Parma', 'Kelly', '', 'Pesnell', 'NP', 'Family Practice', '', '', NULL, 'O', '307 Grove St', 'Parma', 'Canyon', 'ID', '83660', '2087225147', '2087225148', '307 Grove St', 'Parma', 'Canyon', 'ID', '83660', '2087225147', '2087225148', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2013-07-25', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1992785463', 0, 'N', 0, '2013-11-12', NULL, NULL, 0, 0, NULL, NULL),
('363525049', 'W12037114', 'W12037114', 'ID02', 'West Valley Clinic at Middleton', 'Kelly', '', 'Pesnell', 'NP', 'Family Practice', '', '', NULL, 'O', '381 B S Middleton Rd', 'Middleton', 'Canyon', 'ID', '83644', '2085856311', '2085856221', '381 B S Middleton Rd', 'Middleton', 'Canyon', 'ID', '83644', '2085856311', '2085856221', 'IDACN', '', '', '0.00', '15.00', '0.00', 6, '2013-07-25', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1992785463', 0, 'N', 0, '2013-11-12', NULL, NULL, 0, 0, NULL, NULL),
('202695346', 'NVA000047', 'NVA000047', 'UT01', 'North Valley Anesthesia', 'Michael', 'D', 'Cragun', 'CRNA', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 3810', 'SLC', 'Salt Lake', 'UT', '84110', '8014322609', '          ', 'PO Box 3810', 'SLC', 'Salt Lake', 'UT', '84110', '8014322609', '          ', '', '', '', '47.00', '25.00', '0.00', 6, '2015-07-01', NULL, 0, 12, 0, '', '', '', '', 'HCFA|UB|', '1164528832', 0, 'Y', 0, '2014-06-23', NULL, NULL, 0, 0, NULL, NULL),
('202695346', 'NVA000061', 'NVA000061', 'UT01', 'North Valley Anesthesia', 'Kevin', '', 'Vick', 'CRNA', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 3810', 'SLC', 'Salt Lake', 'UT', '84110', '8014322609', '          ', 'PO Box 3810', 'SLC', 'Salt Lake', 'UT', '84110', '8014322609', '          ', '', '', '', '47.00', '25.00', '0.00', 6, '2015-07-01', NULL, 0, 12, 0, '', '', '', '', 'HCFA|UB|', '1831294784', 0, 'Y', 0, '2014-06-23', NULL, NULL, 0, 0, NULL, NULL),
('202695346', 'NVA000063', 'NVA000063', 'UT01', 'North Valley Anesthesia', 'Bryan', 'G', 'Wright', 'CRNA', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 3810', 'SLC', 'Salt Lake', 'UT', '84110', '8014322609', '          ', 'PO Box 3810', 'SLC', 'Salt Lake', 'UT', '84110', '8014322609', '          ', '', '', '', '47.00', '25.00', '0.00', 6, '2015-07-01', NULL, 0, 12, 0, '', '', '', '', 'HCFA|UB|', '1437255288', 0, 'Y', 0, '2014-06-23', NULL, NULL, 0, 0, NULL, NULL),
('202695346', 'NVA000043', 'NVA000043', 'UT01', 'North Valley Anesthesia', 'Matthew', 'S', 'Adams', 'CRNA', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 3810', 'SLC', 'Salt Lake', 'UT', '84110', '8014322609', '          ', 'PO Box 3810', 'SLC', 'Salt Lake', 'UT', '84110', '8014322609', '          ', '', '', '', '47.00', '25.00', '0.00', 6, '2015-07-01', NULL, 0, 12, 0, '', '', '', '', 'HCFA|UB|', '1013013838', 0, 'Y', 0, '2014-07-22', NULL, NULL, 0, 0, NULL, NULL),
('202695346', 'NVA000044', 'NVA000044', 'UT01', 'North Valley Anesthesia', 'Blaine', 'W', 'Brown', 'MD', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 3810', 'SLC', 'Salt Lake', 'UT', '84110', '8014322609', '          ', 'PO Box 3810', 'SLC', 'Salt Lake', 'UT', '84110', '8014322609', '          ', '', '', '', '57.00', '25.00', '0.00', 6, '2015-07-01', NULL, 0, 12, 0, '', '', '', '', 'HCFA|UB|', '1689692774', 0, 'Y', 0, '2014-06-23', NULL, NULL, 0, 0, NULL, NULL),
('202695346', 'NVA000045', 'NVA000045', 'UT01', 'North Valley Anesthesia', 'Daniel', 'W', 'Bunker', 'CRNA', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 3810', 'SLC', 'Salt Lake', 'UT', '84110', '8014322609', '          ', 'PO Box 3810', 'SLC', 'Salt Lake', 'UT', '84110', '8014322609', '          ', '', '', '', '47.00', '25.00', '0.00', 6, '2015-07-01', NULL, 0, 12, 0, '', '', '', '', 'HCFA|UB|', '1619115367', 0, 'Y', 0, '2014-06-23', NULL, NULL, 0, 0, NULL, NULL),
('202695346', 'NVA000046', 'NVA000046', 'UT01', 'North Valley Anesthesia', 'Richard', 'M', 'Coley', 'CRNA', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 3810', 'SLC', 'Salt Lake', 'UT', '84110', '8014322609', '          ', 'PO Box 3810', 'SLC', 'Salt Lake', 'UT', '84110', '8014322609', '          ', '', '', '', '47.00', '25.00', '0.00', 6, '2015-07-01', NULL, 0, 12, 0, '', '', '', '', 'HCFA|UB|', '1811098395', 0, 'Y', 0, '2014-06-23', NULL, NULL, 0, 0, NULL, NULL),
('202695346', 'NVA000048', 'NVA000048', 'UT01', 'North Valley Anesthesia', 'Ryan', 'S', 'Dryer', 'CRNA', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 3810', 'SLC', 'Salt Lake', 'UT', '84110', '8014322609', '          ', 'PO Box 3810', 'SLC', 'Salt Lake', 'UT', '84110', '8014322609', '          ', '', '', '', '47.00', '25.00', '0.00', 6, '2015-07-01', NULL, 0, 12, 0, '', '', '', '', 'HCFA|UB|', '1134220106', 0, 'Y', 0, '2014-06-23', NULL, NULL, 0, 0, NULL, NULL),
('202695346', 'NVA000049', 'NVA000049', 'UT01', 'North Valley Anesthesia', 'Kuhia', 'L', 'Fisher', 'MD', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 3810', 'SLC', 'Salt Lake', 'UT', '84110', '8014322609', '          ', 'PO Box 3810', 'SLC', 'Salt Lake', 'UT', '84110', '8014322609', '          ', '', '', '', '57.00', '25.00', '0.00', 6, '2015-07-01', NULL, 0, 12, 0, '', '', '', '', 'HCFA|UB|', '1740278084', 0, 'Y', 0, '2014-06-23', NULL, NULL, 0, 0, NULL, NULL),
('202695346', 'NVA000050', 'NVA000050', 'UT01', 'North Valley Anesthesia', 'Tisha', 'C', 'Gordon', 'CRNA', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 3810', 'SLC', 'Salt Lake', 'UT', '84110', '8014322609', '          ', 'PO Box 3810', 'SLC', 'Salt Lake', 'UT', '84110', '8014322609', '          ', '', '', '', '47.00', '25.00', '0.00', 6, '2015-07-01', NULL, 0, 12, 0, '', '', '', '', 'HCFA|UB|', '1720310253', 0, 'Y', 0, '2014-06-23', NULL, NULL, 0, 0, NULL, NULL),
('202695346', 'NVA000051', 'NVA000051', 'UT01', 'North Valley Anesthesia', 'Benjamin', 'W', 'Guercio', 'CRNA', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 3810', 'SLC', 'Salt Lake', 'UT', '84110', '8014322609', '          ', 'PO Box 3810', 'SLC', 'Salt Lake', 'UT', '84110', '8014322609', '          ', '', '', '', '47.00', '25.00', '0.00', 6, '2015-07-01', NULL, 0, 12, 0, '', '', '', '', 'HCFA|UB|', '1972763381', 0, 'Y', 0, '2014-06-23', NULL, NULL, 0, 0, NULL, NULL),
('202695346', 'NVA000052', 'NVA000052', 'UT01', 'North Valley Anesthesia', 'John', 'O', 'Harmon', 'CRNA', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 3810', 'SLC', 'Salt Lake', 'UT', '84110', '8014322609', '          ', 'PO Box 3810', 'SLC', 'Salt Lake', 'UT', '84110', '8014322609', '          ', '', '', '', '47.00', '25.00', '0.00', 6, '2015-07-01', NULL, 0, 12, 0, '', '', '', '', 'HCFA|UB|', '1639276942', 0, 'Y', 0, '2014-06-23', NULL, NULL, 0, 0, NULL, NULL),
('202695346', 'NVA000053', 'NVA000053', 'UT01', 'North Valley Anesthesia', 'William', 'R', 'Lyman', 'MD', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 3810', 'SLC', 'Salt Lake', 'UT', '84110', '8014322609', '          ', 'PO Box 3810', 'SLC', 'Salt Lake', 'UT', '84110', '8014322609', '          ', '', '', '', '57.00', '25.00', '0.00', 6, '2015-07-01', NULL, 0, 12, 0, '', '', '', '', 'HCFA|UB|', '1174620827', 0, 'Y', 0, '2014-06-23', NULL, NULL, 0, 0, NULL, NULL),
('202695346', 'NVA000054', 'NVA000054', 'UT01', 'North Valley Anesthesia', 'Jonathan', 'T', 'Meyers', 'MD', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 3810', 'SLC', 'Salt Lake', 'UT', '84110', '8014322609', '          ', 'PO Box 3810', 'SLC', 'Salt Lake', 'UT', '84110', '8014322609', '          ', '', '', '', '57.00', '25.00', '0.00', 6, '2015-07-01', NULL, 0, 12, 0, '', '', '', '', 'HCFA|UB|', '1992882781', 0, 'Y', 0, '2014-06-23', NULL, NULL, 0, 0, NULL, NULL),
('202695346', 'NVA000055', 'NVA000055', 'UT01', 'North Valley Anesthesia', 'Alvin', 'Kirk', 'Nichols', 'CRNA', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 3810', 'SLC', 'Salt Lake', 'UT', '84110', '8014322609', '          ', 'PO Box 3810', 'SLC', 'Salt Lake', 'UT', '84110', '8014322609', '          ', '', '', '', '47.00', '25.00', '0.00', 6, '2015-07-01', NULL, 0, 12, 0, '', '', '', '', 'HCFA|UB|', '1548366347', 0, 'Y', 0, '2014-06-23', NULL, NULL, 0, 0, NULL, NULL),
('202695346', 'NVA000056', 'NVA000056', 'UT01', 'North Valley Anesthesia', 'Jay', 'Todd', 'Nilson', 'MD', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 3810', 'SLC', 'Salt Lake', 'UT', '84110', '8014322609', '          ', 'PO Box 3810', 'SLC', 'Salt Lake', 'UT', '84110', '8014322609', '          ', '', '', '', '57.00', '25.00', '0.00', 6, '2015-07-01', NULL, 0, 12, 0, '', '', '', '', 'HCFA|UB|', '1275639122', 0, 'Y', 0, '2014-06-23', NULL, NULL, 0, 0, NULL, NULL),
('202695346', 'NVA000057', 'NVA000057', 'UT01', 'North Valley Anesthesia', 'Bart', 'R', 'Preston', 'CRNA', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 3810', 'SLC', 'Salt Lake', 'UT', '84110', '8014322609', '          ', 'PO Box 3810', 'SLC', 'Salt Lake', 'UT', '84110', '8014322609', '          ', '', '', '', '47.00', '25.00', '0.00', 6, '2015-07-01', NULL, 0, 12, 0, '', '', '', '', 'HCFA|UB|', '1598861304', 0, 'Y', 0, '2014-06-23', NULL, NULL, 0, 0, NULL, NULL),
('202695346', 'NVA000058', 'NVA000058', 'UT01', 'North Valley Anesthesia', 'Michael', 'J', 'Slye', 'CRNA', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 3810', 'SLC', 'Salt Lake', 'UT', '84110', '8014322609', '          ', 'PO Box 3810', 'SLC', 'Salt Lake', 'UT', '84110', '8014322609', '          ', '', '', '', '47.00', '25.00', '0.00', 6, '2015-07-01', NULL, 0, 12, 0, '', '', '', '', 'HCFA|UB|', '1124124961', 0, 'Y', 0, '2014-06-23', NULL, NULL, 0, 0, NULL, NULL),
('202695346', 'NVA000059', 'NVA000059', 'UT01', 'North Valley Anesthesia', 'Michael', 'D', 'Taylor', 'MD', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 3810', 'SLC', 'Salt Lake', 'UT', '84110', '8014322609', '          ', 'PO Box 3810', 'SLC', 'Salt Lake', 'UT', '84110', '8014322609', '          ', '', '', '', '57.00', '25.00', '0.00', 6, '2015-07-01', NULL, 0, 12, 0, '', '', '', '', 'HCFA|UB|', '1952451429', 0, 'Y', 0, '2014-06-23', NULL, NULL, 0, 0, NULL, NULL),
('202695346', 'NVA000060', 'NVA000060', 'UT01', 'North Valley Anesthesia', 'Kyle', 'B', 'Turner', 'CRNA', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 3810', 'SLC', 'Salt Lake', 'UT', '84110', '8014322609', '          ', 'PO Box 3810', 'SLC', 'Salt Lake', 'UT', '84110', '8014322609', '          ', '', '', '', '47.00', '25.00', '0.00', 6, '2015-07-01', NULL, 0, 12, 0, '', '', '', '', 'HCFA|UB|', '1972757771', 0, 'Y', 0, '2014-06-23', NULL, NULL, 0, 0, NULL, NULL),
('850291612', 'W12039314', 'W12039314', 'NM01', 'New Mexico Orthopaedics Associates', '', '', 'New Mexico Orthopaedic Associates', '', 'Orthopedic Surgery', '', '', NULL, 'O', '201 Cedar St SE Ste 6600', 'Albuquerque', 'Bernalillo', 'NM', '87106', '5057687507', '5057244384', '201 Cedar St SE Ste 6600', 'Albuquerque', 'Bernalillo', 'NM', '87106', '5057687507', '5057244384', 'NMORTHO', 'TXONCHCPC13', '', '0.00', '40.00', '0.00', 3, '2013-10-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1407898299', 0, 'N', 0, '2014-03-17', NULL, NULL, 35.0813, -106.634, NULL, NULL),
('870386904', 'W12002969', 'W12002969', 'UT01', '', 'David', 'C', 'Nuttall', 'MD', 'Pediatrics', '', '', NULL, 'O', '120 N 1220 E Ste 1', 'American Fork', 'Utah', 'UT', '84003', '8017566092', NULL, '120 N 1220 E Ste 1', 'American Fork', 'Utah', 'UT', '84003', '8017566092', '          ', 'WUTCTY', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-01-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1780701862', 0, 'N', 0, '2013-08-23', NULL, NULL, 40.379, -111.765, NULL, NULL),
('760540476', 'W12036011', 'W12036011', 'TXHOUSTD', 'Oakbend Medical Group', 'Ian', '', 'Smalling', 'NP', 'Family Practice', '', '', NULL, 'O', '4911 Sand Hill Dr', 'Sugar Land', 'Fort Bend', 'TX', '77479', '2812387870', '2816334975', '4911 Sand Hill Dr', 'Sugar Land', 'Fort Bend', 'TX', '77479', '2812387870', '2816334975', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1114971033', 0, 'N', 0, '2013-08-23', NULL, NULL, 29.5995, -95.682, NULL, NULL),
('760540476', 'W12036015', 'W12036015', 'TXHOUSTD', 'Oakbend Medical Group', 'Ian', '', 'Smalling', 'NP', 'Family Practice', '', '', NULL, 'O', '30525 First St Ste C', 'Fulshear', 'Fort Bend', 'TX', '77471', '2816334950', '2816334955', '30525 First St Ste C', 'Fulshear', 'Fort Bend', 'TX', '77471', '2816334950', '2816334955', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1114971033', 0, 'N', 0, '2013-08-23', NULL, NULL, 29.691, -95.9008, NULL, NULL),
('760540476', 'W12036020', 'W12036020', 'TXHOUSTD', 'Oakbend Medical Group', 'Karen', '', 'Dubose', 'NP', 'Family Practice', '', '', NULL, 'O', '30525 First St Ste C', 'Fulshear', 'Fort Bend', 'TX', '77471', '2816334950', '2816334955', '30525 First St Ste C', 'Fulshear', 'Fort Bend', 'TX', '77471', '2816334950', '2816334955', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1154365195', 0, 'N', 0, '2013-08-23', NULL, NULL, 29.691, -95.9008, NULL, NULL),
('760540476', 'W12036017', 'W12036017', 'TXHOUSTD', 'Oakbend Medical Group', 'Karen', '', 'Dubose', 'NP', 'Family Practice', '', '', NULL, 'O', '4911 Sand Hill Dr', 'Sugar Land', 'Fort Bend', 'TX', '77479', '2812387870', '2816334985', '4911 Sand Hill Dr', 'Sugar Land', 'Fort Bend', 'TX', '77479', '2812387870', '2816334985', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1154365195', 0, 'N', 0, '2013-08-23', NULL, NULL, 29.5995, -95.682, NULL, NULL),
('760540476', 'W12036022', 'W12036022', 'TXHOUSTD', 'Oakbend Medical Group', 'Margarita', '', 'Bentley', 'NP', 'Family Practice', '', '', NULL, 'O', '30525 First St Ste C', 'Fulshear', 'Fort Bend', 'TX', '77471', '2816334950', '2816334955', '30525 First St Ste C', 'Fulshear', 'Fort Bend', 'TX', '77471', '2816334950', '2816334955', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1255673307', 0, 'N', 0, '2013-08-23', NULL, NULL, 29.691, -95.9008, NULL, NULL),
('760540476', 'W12036021', 'W12036021', 'TXHOUSTD', 'Oakbend Medical Group', 'Margarita', '', 'Bentley', 'NP', 'Family Practice', '', '', NULL, 'O', '4911 Sand Hill Dr', 'Sugar Land', 'Fort Bend', 'TX', '77479', '2812387870', '2816334985', '4911 Sand Hill Dr', 'Sugar Land', 'Fort Bend', 'TX', '77479', '2812387870', '2816334985', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1255673307', 0, 'N', 0, '2013-08-23', NULL, NULL, 29.5995, -95.682, NULL, NULL),
('760540476', 'W12036028', 'W12036028', 'TXHOUSTD', 'Oakbend Medical Group', 'Chinh ', '', 'Pham', 'MD', 'Family Practice', '', '', NULL, 'O', '30525 First St Ste C', 'Fulshear', 'Fort Bend', 'TX', '77471', '2816334950', '2816334955', '30525 First St Ste C', 'Fulshear', 'Fort Bend', 'TX', '77471', '2816334950', '2816334955', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1619148715', 0, 'N', 0, '2013-08-23', NULL, NULL, 29.691, -95.9008, NULL, NULL),
('760540476', 'W12036027', 'W12036027', 'TXHOUSTD', 'Oakbend Medical Group', 'Chinh ', '', 'Pham', 'MD', 'Family Practice', '', '', NULL, 'O', '4911 Sand Hill Dr', 'Sugar Land', 'Fort Bend', 'TX', '77479', '2812387870', '2816334985', '4911 Sand Hill Dr', 'Sugar Land', 'Fort Bend', 'TX', '77479', '2812387870', '2816334985', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1619148715', 0, 'N', 0, '2013-08-23', NULL, NULL, 29.5995, -95.682, NULL, NULL),
('264260933', 'W12037116', 'W12037116', 'TXHOUSTD', 'Houston Womens Care Associates ', 'Jacquin "Jackie"', '', 'Coombs', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '7400 Fannin St Ste 1050', 'Houston', 'Harris', 'TX', '77054', '7137951000', '7137961087', '7400 Fannin St Ste 1050', 'Houston', 'Harris', 'TX', '77054', '7137951000', '7137961087', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-26', NULL, 0, 0, 0, 'The Womans Hospital of Texas', NULL, NULL, NULL, 'HCFA|UB|', '1346349842', 0, 'N', 0, '2014-03-27', NULL, NULL, 29.6956, -95.4009, NULL, NULL),
('264260933', 'W12037117', 'W12037117', 'TXHOUSTD', 'Houston  Womens Care Associates', 'Jacquin "Jackie"', '', 'Coombs', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 281928', 'Atlanta', 'Fulton', 'GA', '30384', '7137951000', '7137961087', 'PO Box 281928', 'Atlanta', 'Fulton', 'GA', '30384', '7137951000', '7137961087', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-26', NULL, 0, 0, 0, 'The Womans Hospital of Texas', NULL, NULL, NULL, 'HCFA|UB|', '1346349842', 0, 'N', 0, '2014-03-27', NULL, NULL, 0, 0, NULL, NULL),
('263091124', 'W12037119', 'W12037119', 'TXHOUSTD', 'Womans Health Group', 'Heidi', '', 'Purcell', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '7580 Fannin St Ste 335', 'Houston', 'Harris', 'TX', '77054', '7137970060', '7137911630', '7580 Fannin St Ste 335', 'Houston', 'Harris', 'TX', '77054', '7137970060', '7137911630', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-26', NULL, 0, 0, 0, 'The Womans Hospital of Texas', NULL, NULL, NULL, 'HCFA|UB|', '1275888513', 0, 'N', 0, '2013-08-26', NULL, NULL, 29.6931, -95.401, NULL, NULL),
('263091124', 'W12037120', 'W12037120', 'TXHOUSTD', 'Womans Health Group', 'Heidi', '', 'Purcell', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 405477', 'Atlanta', 'Fulton', 'GA', '30384', '7137970060', '7137911630', 'PO Box 405477', 'Atlanta', 'Fulton', 'GA', '30384', '7137970060', '7137911630', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-26', NULL, 0, 0, 0, 'The Womans Hospital of Texas', NULL, NULL, NULL, 'HCFA|UB|', '1275888513', 0, 'N', 0, '2013-09-06', NULL, NULL, 0, 0, NULL, NULL),
('201657769', 'W12037122', 'W12037122', 'TXHOUSTD', 'Southern Texas Physicians Network', 'Steven', '', 'Schwartz', 'MD', 'Neurosurgery', '', '', NULL, 'O', '500 Medical Ctr Blvd Ste 340', 'Conroe', 'Montgomery', 'TX', '77304', '9364942201', '9364942217', '500 Medical Ctr Blvd Ste 340', 'Conroe', 'Montgomery', 'TX', '77304', '9364942201', '9364942217', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-26', NULL, 0, 0, 0, 'Conroe Regional Medical Center', NULL, '', '', 'HCFA|UB|', '1538104351', 0, 'N', 0, '2014-04-28', NULL, NULL, 30.2831, -95.4693, NULL, NULL),
('201657769', 'W12037123', 'W12037123', 'TXHOUSTD', 'Southern Texas Physicians Network', 'Steven', '', 'Schwartz', 'MD', 'Neurosurgery', '', '', NULL, 'B', 'PO Box 404554', 'Atlanta', 'Fulton', 'GA', '30384', '9364942201', '9364942217', 'PO Box 404554', 'Atlanta', 'Fulton', 'GA', '30384', '9364942201', '9364942217', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-26', NULL, 0, 0, 0, 'Conroe Regional Medical Center', NULL, '', '', 'HCFA|UB|', '1538104351', 0, 'N', 0, '2014-04-28', NULL, NULL, 0, 0, NULL, NULL),
('460595398', 'W12036996', 'W12036996', 'UT01', 'Family Vision Care', 'Rich', 'H', 'Humpherys', 'OD', 'Optometry', '', '', NULL, 'O', '1055 N Washington Blvd', 'Ogden', 'Weber', 'UT', '84404', '8013945709', NULL, '1055 N Washington Blvd', 'Ogden', 'Weber', 'UT', '84404', '8013945709', '', 'WUTALBERT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-11-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1275569444', 0, 'N', 0, '2014-04-23', NULL, NULL, 41.2765, -111.969, NULL, NULL),
('870666061', 'W12037126', 'W12037126', 'UT01', 'Copperview Medical Center', 'Kathy', 'S', 'Garcia', 'MD', 'Pediatrics', '', '', NULL, 'O', '3556 W 9800 S Ste 101', 'South Jordan', 'Salt Lake', 'UT', '84095', '8015679780', '8015679826', '3556 W 9800 S Ste 101', 'South Jordan', 'Salt Lake', 'UT', '84095', '8015679780', '8015679826', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-12-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA', '1366767147', 0, 'N', 0, '2013-11-26', NULL, NULL, 40.5732, -111.975, NULL, NULL),
('870666061', 'W12037127', 'W12037127', 'UT01', 'Copperview Medical Center', 'Curtis', '', 'Andrews', 'MD', 'Pediatrics', '', '', NULL, 'O', '3556 W 9800 S 101', 'South Jordan', 'Salt Lake', 'UT', '84095', '8015679780', '8015679826', '3556 W 9800 S 101', 'South Jordan', 'Salt Lake', 'UT', '84095', '8015679780', '8015679826', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-12-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|', '1265606735', 0, 'N', 0, '2013-11-26', NULL, NULL, 40.5732, -111.975, NULL, NULL),
('586402841', 'W12037128', 'W12037128', 'TXHOUSTD', 'Fort Bend Urology', 'Henry', 'T', 'Pham', 'MD', 'Urology', '', '', NULL, 'O', '16659 SW Fwy Ste 141', 'Sugar Land', 'Fort Bend', 'TX', '77479', '2814948333', '2814948334', '16659 SW Fwy Ste 141', 'Sugar Land', 'Fort Bend', 'TX', '77479', '2814948333', '2814948334', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB', '1144222647', 0, 'N', 0, '2013-09-10', NULL, NULL, 29.5904, -95.6321, NULL, NULL),
('760265980', 'W12037129', 'W12037129', 'TXHOUSTD', 'Mahon Jacob ', 'Mohan', '', 'Jacob', 'MD PA', 'Cardiology', '', '', NULL, 'O', '18955 Memorial N Ste 440', 'Humble', 'Harris', 'TX', '77338', '2814465555', '2815481002', '18955 Memorial N Ste 440', 'Humble', 'Harris', 'TX', '77338', '2814465555', '2815481002', 'HOUSTON2', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, 'Kingwood Medical Center', NULL, '', '', 'HCFA|UB|', '1942267448', 0, 'N', 0, '2013-09-10', NULL, NULL, 29.9948, -95.2752, NULL, NULL),
('760611675', 'W12037130', 'W12037130', 'TXHOUSTD', 'Barry J Lieroni', 'Barry', 'J', 'Liberoni', 'MD', 'Internal Medicine', '', '', NULL, 'O', '720 Ave F N Ste 3', 'Bay City', 'Matagorda', 'TX', '77414', '9792459797', '9792459789', '720 Ave F N Ste 3', 'Bay City', 'Matagorda', 'TX', '77414', '9792459797', '9792459789', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, 'Houston Methodist Sugar Land Hospital', NULL, '', '', 'HCFA|UB|', '1861470361', 0, 'N', 0, '2013-08-30', NULL, NULL, 29.0108, -95.9737, NULL, NULL),
('760603543', 'W12037140', 'W12037140', 'TXHOUSTD', 'Craig C Kuglen Jr MD', 'Craig', 'C', 'Kuglen Jr', 'MD', 'Ophthalmology', '', '', NULL, 'O', '3361 Montgomery Rd', 'Huntsville', 'Walker', 'TX', '77340', '9362940218', '9362940307', '3361 Montgomery Rd', 'Huntsville', 'Walker', 'TX', '77340', '9362940218', '9362940307', 'HOUSTON4', 'TXHCPC13', '', '0.00', '0.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, 'Conroe Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1639172422', 0, 'N', 0, '2013-08-30', NULL, NULL, 30.6921, -95.5562, NULL, NULL),
('451632816', 'W12037131', 'W12037131', 'UT01', 'Amara Health and Wellness', 'Michael', 'D', 'Symond', 'MD', 'Family Practice', '', '', NULL, 'O', '558 E Riverside Dr Ste 200', 'St George', 'Washington', 'UT', '84790', '4356529355', '4356529358', '558 E Riverside Dr Ste 200', 'St George', 'Washington', 'UT', '84790', '4356529355', '4356529358', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-10-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', '', '', '', 'HCFA|UB|', '1790772135', 0, 'N', 0, '2013-10-25', NULL, NULL, 37.0867, -113.572, NULL, NULL),
('742126114', 'W12037133', 'W12037133', 'TXHOUSTD', 'Gary Mason', 'Gary', '', 'Mason', 'MD', 'Ophthalmology', '', '', NULL, 'O', '6111 FM 1960 W Ste 212', 'Houston', 'Harris', 'TX', '77069', '2814445222', '7139882053', '6111 FM 1960 W Ste 212', 'Houston', 'Harris', 'TX', '77069', '2814445222', '7139882053', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1629079777', 0, 'N', 0, '2013-08-30', NULL, NULL, 29.9755, -95.5208, NULL, NULL),
('742126114', 'W12037132', 'W12037132', 'TXHOUSTD', 'Gary Mason', 'Gary', '', 'Mason', 'MD', 'Ophthalmology', '', '', NULL, 'O', '7777 SW Fwy Ste 934', 'Houston', 'Harris', 'TX', '77074', '7139882020', '7139882053', '7777 SW Fwy Ste 934', 'Houston', 'Harris', 'TX', '77074', '7139882020', '7139882053', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1629079777', 0, 'N', 0, '2013-08-30', NULL, NULL, 29.6947, -95.5234, NULL, NULL),
('203368164', 'W12037134', 'W12037134', 'TXHOUSTD', '', 'Ulla-Britt', '', 'Larka', 'DPM', 'Podiatry', '', '', NULL, 'O', '2041 W Alabama St', 'Houston', 'Harris', 'TX', '77098', '7135261441', '7135263886', '2041 W Alabama St', 'Houston', 'Harris', 'TX', '77098', '7135261441', '7135263886', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-27', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', NULL, '', '', 'HCFA|UB|', '1982733275', 0, 'N', 0, '2013-08-27', NULL, NULL, 29.7386, -95.4096, NULL, NULL),
('810608733', 'W12037136', 'W12037136', 'UT01', 'Nexus Pain Care', 'James', 'C', 'Wilson', 'MD', 'Physical Medicine and Rehabilitation', 'Pain Management', '', NULL, 'O', '3585 N University Ave Ste 150', 'Provo', 'Utah', 'UT', '84604', '8013566100', '8013562113', '3585 N University Ave Ste 150', 'Provo', 'Utah', 'UT', '84604', '8013566100', '8013562113', 'WUSTDPAIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-12-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1922234970', 0, 'N', 0, '2013-11-26', NULL, NULL, 40.2818, -111.658, NULL, NULL),
('810608733', 'W12037137', 'W12037137', 'UT01', 'Nexus Pain Care', 'James', 'C', 'Wilson', 'MD', 'Physical Medicine and Rehabilitation', 'Pain Management', '', NULL, 'B', 'PO Box 15109', 'Springfield', 'Hampden', 'MA', '01115', '8013566100', '8013562113', 'PO Box 15109', 'Springfield', 'Hampden', 'MA', '01115', '8013566100', '8013562113', 'WUSTDPAIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-12-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1922234970', 0, 'N', 0, '2013-11-26', NULL, NULL, 0, 0, NULL, NULL),
('760603543', 'W12037138', 'W12037138', 'TXHOUSTD', 'Craig C Kuglen Jr MD', 'Craig', 'C', 'Kuglen Jr', 'MD', 'Ophthalmology', '', '', NULL, 'O', '400 S Loop 336 W', 'Conroe', 'Montgomery', 'TX', '77304', '9365394500', '9365394534', '400 S Loop 336 W', 'Conroe', 'Montgomery', 'TX', '77304', '9365394500', '9365394534', 'HOUSTON4', 'TXHCPC13', '', '0.00', '0.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, 'Conroe Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1639172422', 0, 'N', 0, '2013-08-30', NULL, NULL, 30.3051, -95.5095, NULL, NULL),
('760603543', 'W12037139', 'W12037139', 'TXHOUSTD', 'Craig C Kuglen Jr MD', 'Craig', 'C', 'Kuglen Jr', 'MD', 'Ophthalmology', '', '', NULL, 'O', '9201 Pinecroft', 'Spring', 'Montgomery', 'TX', '77380', '2817195214', '2817195448', '9201 Pinecroft', 'Spring', 'Montgomery', 'TX', '77380', '2817195214', '2817195448', 'HOUSTON4', 'TXHCPC13', '', '0.00', '0.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, 'Conroe Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1639172422', 0, 'N', 0, '2013-08-30', NULL, NULL, 30.1746, -95.4563, NULL, NULL),
('263553949', 'W12037141', 'W12037141', 'TXDALSTD', 'Podiatric Medicine', 'Justin', 'G', 'Wade', 'DPM', 'Podiatry', '', '', NULL, 'O', '1601 Beltline Rd', 'Mesquite', 'Dallas', 'TX', '75149', '9722887441', '9722898025', '1601 Beltline Rd', 'Mesquite', 'Dallas', 'TX', '75149', '9722887441', '9722898025', 'DALLAS4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1770744211', 0, 'N', 1, '2013-08-26', NULL, NULL, 32.7848, -96.5959, NULL, NULL),
('263553949', 'W12037142', 'W12037142', 'TXDALSTD', 'Podiatric Medicine', 'Justin', 'G', 'Wade', 'DPM', 'Podiatry', '', '', NULL, 'O', '763 E US Hwy 80 Ste 100', 'Forney', 'Kaufman', 'TX', '75126', '9722887441', '9722898025', '763 E US Hwy 80 Ste 100', 'Forney', 'Dallas', 'TX', '75126', '9722887441', '9722898025', 'DALLAS4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1770744211', 0, 'N', 1, '2013-08-26', NULL, NULL, 32.7419, -96.4528, NULL, NULL),
('263553949', 'W12037143', 'W12037143', 'TXDALSTD', 'Podiatric Medicine', 'Justin', 'G', 'Wade', 'DPM', 'Podiatry', '', '', NULL, 'B', 'PO Box 975517', 'Dallas', 'Dallas', 'TX', '75397', '9722887441', '9722898025', 'PO Box 975517', 'Dallas', 'Kaufman', 'TX', '75397', '9722887441', '9722898025', 'DALLAS4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1770744211', 0, 'N', 1, '2013-08-26', NULL, NULL, 0, 0, NULL, NULL),
('271740523', 'W12037147', 'W12037147', 'ID02', 'Rocky Mountain Foot and Ankle', 'Phillip', 'R', 'Burk', 'DPM', 'Podiatry', '', '', NULL, 'O', '1818 10th Ave Ste 250', 'Caldwell', 'Canyon', 'ID', '83605', '2084590891', '2084598628', '1818 10th Ave Ste 250', 'Caldwell', 'Canyon', 'ID', '83605', '2084590891', '2084598628', 'IDACN', '', '', '0.00', '15.00', '0.00', 8, '2013-07-24', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1306064258', 0, 'N', 0, '2014-03-26', NULL, NULL, 0, 0, NULL, NULL),
('870574059', 'W12037148', 'W12037148', 'ID02', 'Mountain Land Caldwell ', 'Nate', 'I', 'Allen', 'DPT', 'Physical Therapy', '', '', NULL, 'O', '4623 Enterprise Way', 'Caldwell', 'Canyon', 'ID', '83605', '2084554231', '2084591626', '4623 Enterprise Way', 'Caldwell', 'Canyon', 'ID', '83605', '2084554231', '2084591626', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2013-08-19', '2014-01-29', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1003173360', 0, 'N', 0, '2014-02-10', NULL, NULL, 0, 0, NULL, NULL),
('870574059', 'W12037149', 'W12037149', 'ID02', 'Mountain Land Nampa', 'Nate', 'I', 'Allen', 'DPT', 'Physical Therapy', '', '', NULL, 'O', '5251 E Exchange Way', 'Nampa', 'Canyon', 'ID', '83687', '2084669642', '2084669104', '5251 E Exchange Way', 'Nampa', 'Canyon', 'ID', '83687', '2084669642', '2084669104', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2013-08-19', '2014-01-29', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1003173360', 0, 'N', 0, '2014-02-10', NULL, NULL, 0, 0, NULL, NULL),
('870623034', 'W12037151', 'W12037151', 'UT01', 'Rocky Mountain Therapy Services North', 'Robert', 'B', 'Cragun', 'PT', 'Physical Therapy', '', '', NULL, 'O', '3725 W 4100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8016790123', '8019968743', '3725 W 4100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8016790123', '8019968743', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1073628954', 0, 'N', 0, '2013-12-04', NULL, NULL, 40.682, -111.979, NULL, NULL),
('870623034', 'W12037152', 'W12037152', 'UT01', 'Rocky Mountain Therapy Services North', 'Robert', 'B', 'Cragun', 'PT', 'Physical Therapy', '', '', NULL, 'B', 'PO Box 540640', 'North Salt Lake', 'Davis', 'UT', '84054', '8016790123', '8019968743', 'PO Box 540640', 'North Salt Lake', 'Davis', 'UT', '84054', '8016790123', '8019968743', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1073628954', 0, 'N', 0, '2013-12-04', NULL, NULL, 0, 0, NULL, NULL),
('200405981', 'W12037154', 'W12037154', 'UT01', 'Morgan Physical Therapy & Fitness Center Inc', 'Daniel', '', 'Goodrich', 'DPT', 'Physical Therapy', '', '', NULL, 'O', '129 N Commercial St', 'Morgan', 'Morgan', 'UT', '84050', '8018451403', '8018451404', '129 N Commercial St', 'Morgan', 'Morgan', 'UT', '84050', '8018451403', '8018451404', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1205273588', 0, 'N', 0, '2013-12-04', NULL, NULL, 41.0421, -111.668, NULL, NULL),
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('752825783', 'W12037159', 'W12037159', 'TXDALSTD', 'Metroplex Foot and Ankle', 'Scott', 'E', 'Smith', 'DPM', 'Podiatry', '', '', NULL, 'O', '3600 Gaston Ave Wadley Tower Ste 1056', 'Dallas', 'Dallas', 'TX', '75246', '2148278864', '2142173669', '3600 Gaston Ave Wadley Tower Ste 1056', 'Dallas', 'Dallas', 'TX', '75246', '2148278864', '2142173669', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-08-23', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', 'Baylor University Medical Center', NULL, NULL, 'HCFA|UB|', '1215161286', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.7913, -96.7799, NULL, NULL),
('760009637', 'W12037160', 'W12037160', 'TXHOUSTD', 'Legacy Community Health Services', '', '', 'Legacy Community Health Services,', '', 'Family Practice', '', '', NULL, 'O', '4301 Garth Rd Ste 400', 'Baytown', 'Harris', 'TX', '77521', '2814208400', '7135234897', '4301 Garth Rd Ste 400', 'Baytown', 'Harris', 'TX', '77521', '2814208400', '7135234897', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1174875470', 0, 'Y', 0, '2013-12-02', NULL, NULL, 29.7681, -94.9775, NULL, NULL),
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('760009637', 'W12037180', 'W12037180', 'TXHOUSTD', 'Legacy Community Health Services', 'Clare', '', 'Hawkins', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 66308', 'Houston', 'Harris', 'TX', '77266', '2814208400', '7135234897', 'PO Box 66308', 'Houston', 'Harris', 'TX', '77266', '2814208400', '7135234897', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1831171495', 0, 'N', 0, '2013-08-30', NULL, NULL, 0, 0, NULL, NULL),
('760009637', 'W12037182', 'W12037182', 'TXHOUSTD', 'Legacy Community Health Services', 'Bomi', 'K', 'Hormazdi', 'MD', 'Pediatrics', '', '', NULL, 'O', '12667 Bisonnett', 'Houston', 'Harris', 'TX', '77099', '8325485000', '7135234897', '12667 Bisonnett', 'Houston', 'Harris', 'TX', '77099', '8325485000', '7135234897', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1659438141', 0, 'N', 0, '2013-09-04', NULL, NULL, 29.6779, -95.6023, 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
('760009637', 'W12037184', 'W12037184', 'TXHOUSTD', 'Legacy Community Health Services', 'Bomi', 'K', 'Hormazdi', 'MD', 'Pediatrics', '', '', NULL, 'B', 'PO Box 66308', 'Houston', 'Harris', 'TX', '77266', '2814208400', '7135234897', 'PO Box 66308', 'Houston', 'Harris', 'TX', '77266', '2814208400', '7135234897', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1659438141', 0, 'N', 0, '2013-09-04', NULL, NULL, 0, 0, NULL, NULL),
('760009637', 'W12037185', 'W12037185', 'TXHOUSTD', 'Legacy Community Health Services', 'Louis', 'B', 'Hughes', 'MD', 'Family Practice', '', '', NULL, 'O', '4301 Garth Rd Ste 400', 'Baytown', 'Harris', 'TX', '77521', '2814208400', '7135234897', '4301 Garth Rd Ste 400', 'Baytown', 'Harris', 'TX', '77521', '2814208400', '7135234897', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1699758805', 0, 'N', 0, '2013-08-30', NULL, NULL, 29.7681, -94.9775, NULL, NULL),
('760009637', 'W12037186', 'W12037186', 'TXHOUSTD', 'Legacy Community Health Services', 'Louis', 'B', 'Hughes', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 66308', 'Houston', 'Harris', 'TX', '77266', '2814208400', '7135234897', 'PO Box 66308', 'Houston', 'Harris', 'TX', '77266', '2814208400', '7135234897', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1699758805', 0, 'N', 0, '2013-08-30', NULL, NULL, 0, 0, NULL, NULL),
('760009637', 'W12037187', 'W12037187', 'TXHOUSTD', 'Legacy Community Health Services', 'Jennifer', '', 'Mahand', 'MD', 'Family Practice', '', '', NULL, 'O', '4301 Garth Rd Ste 400', 'Baytown', 'Harris', 'TX', '77521', '2814208400', '7135234897', '4301 Garth Rd Ste 400', 'Baytown', 'Harris', 'TX', '77521', '2814208400', '7135234897', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1508093733', 0, 'N', 0, '2013-12-20', NULL, NULL, 29.7681, -94.9775, NULL, NULL),
('760009637', 'W12037188', 'W12037188', 'TXHOUSTD', 'Legacy Community Health Services', 'Jennifer', '', 'Mahand', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 66308', 'Houston', 'Harris', 'TX', '77266', '2814208400', '7135234897', 'PO Box 66308', 'Houston', 'Harris', 'TX', '77266', '2814208400', '7135234897', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1508093733', 0, 'N', 0, '2013-12-20', NULL, NULL, 0, 0, NULL, NULL),
('760009637', 'W12037189', 'W12037189', 'TXHOUSTD', 'Legacy Community Health Services', 'Jennifer', '', 'Mahand', 'MD', 'Family Practice', '', '', NULL, 'O', '1415 California St', 'Houston', 'Harris', 'TX', '77006', '8325485000', '7138303079', '1415 California St', 'Houston', 'Harris', 'TX', '77006', '8325485000', '7138303079', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1508093733', 0, 'N', 0, '2013-12-20', NULL, NULL, 29.7454, -95.3938, NULL, NULL),
('760009637', 'W12037190', 'W12037190', 'TXHOUSTD', 'Legacy Community Health Services', 'Lakshmi', '', 'Puppala', 'MD', 'Family Practice', '', '', NULL, 'O', '4301 Garth Rd Ste 400', 'Baytown', 'Harris', 'TX', '77521', '2814208400', '7135234897', '4301 Garth Rd Ste 400', 'Baytown', 'Harris', 'TX', '77521', '2814208400', '7135234897', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1477755510', 0, 'N', 0, '2013-08-30', NULL, NULL, 29.7681, -94.9775, NULL, NULL),
('760009637', 'W12037191', 'W12037191', 'TXHOUSTD', 'Legacy Community Health Services', 'Lakshmi', '', 'Puppala', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 66308', 'Houston', 'Harris', 'TX', '77266', '2814208400', '7135234897', 'PO Box 66308', 'Houston', 'Harris', 'TX', '77266', '2814208400', '7135234897', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1477755510', 0, 'N', 0, '2013-08-30', NULL, NULL, 0, 0, NULL, NULL),
('760009637', 'W12037192', 'W12037192', 'TXHOUSTD', 'Legacy Community Health Services', 'Hubert', '', 'Williston', 'MD', 'Family Practice', '', '', NULL, 'O', '4301 Garth Rd Ste 400', 'Baytown', 'Harris', 'TX', '77521', '2814208400', '7135234897', '4301 Garth Rd Ste 400', 'Baytown', 'Harris', 'TX', '77521', '2814208400', '7135234897', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1902888381', 0, 'N', 0, '2013-08-30', NULL, NULL, 29.7681, -94.9775, NULL, NULL),
('760009637', 'W12037193', 'W12037193', 'TXHOUSTD', 'Legacy Community Health Services', 'Hubert', '', 'Williston', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 66308', 'Houston', 'Harris', 'TX', '77266', '2814208400', '7135234897', 'PO Box 66308', 'Houston', 'Harris', 'TX', '77266', '2814208400', '7135234897', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1902888381', 0, 'N', 0, '2013-08-30', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'W12037267', 'W12037267', 'ILCHIGSTD', 'Presence Healthcare Services', 'Gema', '', 'Ramos', 'MD', 'Family Practice', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '8557647687', '6309142469', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '8557647687', '6309142469', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-08-01', NULL, 0, 0, 0, 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', NULL, NULL, NULL, 'HCFA|UB|', '1588978365', 0, 'N', 0, '2013-08-27', NULL, NULL, 0, 0, NULL, NULL),
('202630141', 'W12037222', 'W12037222', 'IDBOISTD', 'Primary Health Medical Group', 'Ramon', 'A', 'Relyea', 'PA', 'Family Practice', '', '', NULL, 'B', 'PO Box 191050', 'Boise', 'Ada', 'ID', '83719', '2083447799', '2083447152', 'PO Box 191050', 'Boise', 'Ada', 'ID', '83719', '2083447799', '2083447152', 'IDPRIMARY', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2013-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1972805943', 0, 'N', 0, '2014-01-30', NULL, NULL, 0, 0, NULL, NULL),
('760555903', 'W12037205', 'W12037205', 'TXHOUSTD', 'Surgical Associates of Houston', 'Zhen', '', 'Fan', 'MD', 'General Surgery', '', '', NULL, 'O', '1140 Business Ctr Dr Ste 403', 'Houston', 'Harris', 'TX', '77043', '7139359758', '7134676209', '1140 Business Ctr Dr Ste 403', 'Houston', 'Harris', 'TX', '77043', '7139359758', '7134676209', 'HOUSTON2', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Houston Methodist West Houston Hospital', NULL, '', '', 'HCFA|', '1184876179', 0, 'N', 0, '2013-09-11', NULL, NULL, 29.7894, -95.568, NULL, NULL),
('760555903', 'W12037206', 'W12037206', 'TXHOUSTD', 'Surgical Associates of Houston', 'Amer', '', 'Sabbagh', 'MD', 'Vascular Surgery', '', '', NULL, 'O', '1140 Business Ctr Dr Ste 403', 'Houston', 'Harris', 'TX', '77043', '7139359758', '7134676209', '1140 Business Ctr Dr Ste 403', 'Houston', 'Harris', 'TX', '77043', '7139359758', '7134676209', 'HOUSTON2', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-10-13', NULL, 0, 0, 0, 'Houston Methodist West Houston Hospital', NULL, '', '', 'HCFA|', '1821064981', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.7894, -95.568, NULL, NULL),
('760259571', 'W12037208', 'W12037208', 'TXHOUSTD', 'Keith W Kiser', 'Keith', 'W', 'Kiser', 'MD', 'Family Practice', '', '', NULL, 'O', '2205 Williams Trace Blvd Ste 105', 'Sugar Land', 'Fort Bend', 'TX', '77478', '2819802722', '2819808879', '2205 Williams Trace Blvd Ste 105', 'Sugar Land', 'Fort Bend', 'TX', '77478', '2819802722', '2819808879', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-10-13', NULL, 0, 0, 0, 'Houston Methodist Sugar Land Hospital', NULL, NULL, NULL, 'HCFA|', '1801898218', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.5951, -95.6037, NULL, NULL),
('820491054', 'W12037209', 'W12037209', 'IDBOISTD', 'Glen S Lovelace', 'Angela', 'M', 'Latta', 'NP', 'Obstetrics and Gynecology', '', '', NULL, 'O', '333 N 1st Ste 260', 'Boise', 'Ada', 'ID', '83702', '2083453136', '2083450984', '333 N 1st Ste 260', 'Boise', 'Ada', 'ID', '83702', '2083453136', '2083450984', 'IDOB2', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1346687654', 0, 'N', 0, '2013-12-23', NULL, NULL, 43.6132, -116.194, NULL, NULL),
('870280459', 'W12037211', 'W12037211', 'UT01', 'Western GYN & OB Clinic', 'David', 'J', 'Matthews', 'DO', 'Obstetrics and Gynecology', '', '', NULL, 'O', '12600 S 3723 W Ste 350', 'Riverton', 'Salt Lake', 'UT', '84065', '8012854800', '8012854901', '12600 S 3723 W Ste 350', 'Riverton', 'Salt Lake', 'UT', '84065', '8012854800', '8012854901', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-10-01', NULL, 0, 0, 0, 'Riverton Childrens Unit Operated by Primary Childrens Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1043447394', 0, 'N', 0, '2013-09-23', NULL, NULL, 40.5104, -111.952, NULL, NULL),
('272798183', 'W12037212', 'W12037212', 'UT01', 'ARC Therapy Services', 'Mike J', '', 'Greenwood', 'PT', 'Physical Therapy', '', '', NULL, 'O', '275 W 200 N Ste 9', 'Kaysville', 'Davis', 'UT', '84037', '8017780555', '8017780080', '275 W 200 N Ste 9', 'Kaysville', 'Davis', 'UT', '84037', '8017780555', '8017780080', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2013-08-16', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1558343533', 0, 'N', 0, '2013-08-27', NULL, NULL, 41.0381, -111.944, NULL, NULL),
('870549057', 'W12037213', 'W12037213', 'UT01', 'Utah Valley Pediatrics', 'Garron', 'E', 'Miller', 'MD', 'Pediatrics', '', '', NULL, 'O', '15 S 1000 Ste 200', 'Payson', 'Utah', 'UT', '84651', '8014652800', '8014654770', '15 S 1000 Ste 200', 'Payson', 'Utah', 'UT', '84651', '8014652800', '8014654770', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-08-22', NULL, 0, 0, 0, 'Mountain View Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1114992856', 0, 'N', 0, '2013-08-27', NULL, NULL, 40.044, -111.716, NULL, NULL),
('870281028', 'W12037216', 'W12037216', 'UT01', 'Central Utah Clinic', 'Mohammad', 'M', 'Alsolaiman', 'MD', 'Gastroenterology', '', '', NULL, 'O', '1175 E 50 S Ste 231', 'American Fork', 'Utah', 'UT', '84003', '8017720775', '8017721941', '1175 E 50 S Ste 231', 'American Fork', 'Utah', 'UT', '84003', '8017720775', '8017721941', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-08-15', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1215986484', 0, 'N', 0, '2013-08-27', NULL, NULL, 40.3757, -111.77, NULL, NULL),
('263553949', 'W12037218', 'W12037218', 'TXDALSTD', 'Podiatric Medical Partners of Texas', 'Michael', 'J', 'Miller', 'DPM', 'Podiatry', '', '', NULL, 'O', '1675 Republic Pkwy Ste 101', 'Mesquite', 'Dallas', 'TX', '75150', '9722707627', '9722707759', '1675 Republic Pkwy Ste 101', 'Mesquite', 'Dallas', 'TX', '75150', '9722707627', '9722707759', 'DALLAS4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1326073115', 0, 'N', 0, '2013-08-27', NULL, NULL, 32.8287, -96.6264, NULL, NULL),
('263553949', 'W12037219', 'W12037219', 'TXDALSTD', 'Podiatric Medical Partners of Texas', 'Michael', 'J', 'Miller', 'DPM', 'Podiatry', '', '', NULL, 'O', '1411 N Beckley Ave', 'Dallas', 'Dallas', 'TX', '75203', '2149432621', '2149438139', '1411 N Beckley Ave', 'Dallas', 'Dallas', 'TX', '75203', '2149432621', '2149438139', 'DALLAS4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1326073115', 0, 'N', 0, '2013-08-27', NULL, NULL, 32.761, -96.823, NULL, NULL),
('263553949', 'W12037217', 'W12037217', 'TXDALSTD', 'Podiatric Medical Partners of Texas', 'Michael', 'J', 'Miller', 'DPM', 'Podiatry', '', '', NULL, 'B', 'PO Box 975517', 'Dallas', 'Dallas', 'TX', '75397', '3212072839', '3212562966', 'PO Box 975517', 'Dallas', 'Dallas', 'TX', '75397', '3212072839', '3212562966', 'DALLAS4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1326073115', 0, 'N', 0, '2013-08-27', NULL, NULL, 0, 0, NULL, NULL),
('870340605', 'W12037220', 'W12037220', 'UT01', 'Southwest Internal Medicine', 'Daniel', 'B', 'Madsen', 'MD', 'Internal Medicine', '', '', NULL, 'O', '736 S 900 E Ste 104', 'St George', 'Washington', 'UT', '84790', '4356289200', '4356738557', '736 S 900 E Ste 104', 'St George', 'Washington', 'UT', '84790', '4356289200', '4356738557', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-08-22', '2014-02-12', 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1497749451', 0, 'N', 0, '2014-02-19', NULL, NULL, 0, 0, NULL, NULL),
('202630141', 'W12037221', 'W12037221', 'IDBOISTD', 'Primary Health Medical Group', 'Ramon', 'A', 'Relyea', 'PA', 'Family Practice', '', '', NULL, 'O', '6052 W State St', 'Boise', 'Ada', 'ID', '83703', '2083447799', '2083447152', '6052 W State St', 'Boise', 'Ada', 'ID', '83703', '2083447799', '2083447152', 'IDPRIMARY', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2013-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1972805943', 0, 'Y', 0, '2014-01-31', NULL, NULL, 43.6592, -116.264, NULL, NULL),
('942854057', 'W12037224', 'W12037224', 'UTIHCPHY', 'North Cache Valley Instacare', 'Delwin', 'Barton', 'Avery', 'MD', 'Family Practice', '', '', NULL, 'O', '4088 N Hwy 91', 'Hyde Park', 'Cache', 'UT', '84318', '4355634888', '4355634890', '4088 N Hwy 91', 'Hyde Park', 'Cache', 'UT', '84318', '4355634888', '4355634890', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-07-29', NULL, 0, 0, 0, 'Logan Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1780698316', 0, 'Y', 0, '2013-08-27', NULL, NULL, 41.8075, -111.833, NULL, NULL),
('942854057', 'W12037226', 'W12037226', 'UTIHCPHY', 'North Cache Valley Instacare', 'Delwin', 'Barton', 'Avery', 'MD', 'Family Practice', '', '', NULL, 'O', 'PO Box 27128', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '4355634888', '4355634890', 'PO Box 27128', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '4355634888', '4355634890', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-07-29', NULL, 0, 0, 0, 'Logan Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1780698316', 0, 'Y', 0, '2013-08-27', NULL, NULL, 40.7259, -111.939, NULL, NULL),
('942854057', 'W12037227', 'W12037227', 'UTIHCPHY', 'Moroni Clinic', 'Brian', 'T', 'Boden', 'PA-C', 'Urgent Care', 'Family Practice', '', NULL, 'O', '51 E Main St', 'Moroni', 'Sanpete', 'UT', '84646', '4354365250', '4354365265', '51 E Main St', 'Moroni', 'Sanpete', 'UT', '84646', '4354365250', '4354365265', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-08-01', NULL, 0, 0, 0, 'Lakeview Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1316938673', 0, 'Y', 0, '2013-08-27', NULL, NULL, 39.5249, -111.584, NULL, NULL),
('942854057', 'W12001968', 'W12001968', 'UTIHCPHY', 'Heber Valley Clinic', 'Brian', 'T', 'Boden', 'PA-C', 'Urgent Care', 'Family Practice', '', NULL, 'O', '1473 S Hwy 40 Ste E', 'Heber City', 'Wasatch', 'UT', '84032', '4356542500', NULL, '1473 S Hwy 40 Ste E', 'Heber City', 'Wasatch', 'UT', '84032', '4356542500', '          ', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2008-11-03', NULL, 0, 0, 0, 'Lakeview Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1316938673', 0, 'Y', 0, '2013-08-27', NULL, NULL, 40.4893, -111.409, NULL, NULL),
('942854057', 'W12037228', 'W12037228', 'UTIHCPHY', 'Moroni Clinic', 'Brian', 'T', 'Boden', 'PA-C', 'Urgent Care', 'Family Practice', '', NULL, 'B', 'PO Box 27128', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '4354365250', '4354365265', 'PO Box 27128', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '4354365250', '4354365265', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-08-01', NULL, 0, 0, 0, 'Lakeview Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1316938673', 0, 'N', 0, '2013-08-27', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12037229', 'W12037229', 'UTIHCPHY', 'Manti Family Clinic', 'Brian', 'T', 'Boden', 'PA-C', 'Urgent Care', 'Family Practice', '', NULL, 'O', '159 N Main St', 'Manti', 'Sanpete', 'UT', '84642', '4358353344', '4358353081', '159 N Main St', 'Manti', 'Sanpete', 'UT', '84642', '4358353344', '4358353081', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-08-01', NULL, 0, 0, 0, 'Lakeview Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1316938673', 0, 'Y', 0, '2013-08-27', NULL, NULL, 39.2677, -111.643, NULL, NULL),
('942854057', 'W12037230', 'W12037230', 'UTIHCPHY', 'Ephraim Clinic', 'Brian', 'T', 'Boden', 'PA-C', 'Urgent Care', 'Family Practice', '', NULL, 'O', '525 N Main St', 'Ephraim', 'Sanpete', 'UT', '84627', '4352834076', '4352834078', '525 N Main St', 'Ephraim', 'Sanpete', 'UT', '84627', '4352834076', '4352834078', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-08-01', NULL, 0, 0, 0, 'Lakeview Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1316938673', 0, 'Y', 0, '2013-08-27', NULL, NULL, 39.371, -111.587, NULL, NULL),
('942854057', 'W12037231', 'W12037231', 'UTIHCPHY', 'Mt Pleasant Clinic', 'Brian', 'T', 'Boden', 'PA-C', 'Urgent Care', 'Family Practice', '', NULL, 'O', '1100 S Medical Dr', 'Mount Pleasant', 'Sanpete', 'UT', '84647', '4354623471', '4354623354', '1100 S Medical Dr', 'Mount Pleasant', 'Sanpete', 'UT', '84647', '4354623471', '4354623354', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-08-01', NULL, 0, 0, 0, 'Lakeview Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1316938673', 0, 'Y', 0, '2013-08-27', NULL, NULL, 39.5318, -111.461, NULL, NULL),
('942854057', 'W12037232', 'W12037232', 'UTIHCPHY', 'Salt Lake Clinic', 'James', 'Lee', 'Burke', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '389 S 900 E', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015073500', '8015073505', '389 S 900 E', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015073500', '8015073505', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1154399459', 0, 'N', 0, '2014-05-19', NULL, NULL, 40.761, -111.865, NULL, NULL),
('942854057', 'W12037233', 'W12037233', 'UTIHCPHY', 'Salt Lake Clinic', 'James', 'Lee', 'Burke', 'MD', 'Cardiovascular Disease', '', '', NULL, 'B', 'PO Box 27128', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '8015073500', '8015073505', 'PO Box 27128', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '8015073500', '8015073505', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1154399459', 0, 'N', 0, '2014-05-19', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12037238', 'W12037238', 'UTIHCPHY', 'Intermountain Medical Group', 'Kyle', 'J', 'Christensen', 'PA', 'Family Practice', '', '', NULL, 'B', 'PO Box 27128', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '4358965496', '4358969369', 'PO Box 27128', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '4358965496', '4358969369', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-07-07', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1831290790', 0, 'N', 0, '2013-08-27', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12037236', 'W12037236', 'UTIHCPHY', 'Richfield Family Practice', 'Kyle', 'J', 'Christensen', 'PA', 'Family Practice', '', '', NULL, 'O', '460 N Main St', 'Richfield', 'Sevier', 'UT', '84701', '4358965496', '4358969369', '460 N Main St', 'Richfield', 'Sevier', 'UT', '84701', '4358965496', '4358969369', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-07-07', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1831290790', 0, 'Y', 0, '2013-08-27', NULL, NULL, 38.7745, -112.085, NULL, NULL),
('942854057', 'W12037237', 'W12037237', 'UTIHCPHY', 'Sevier Valley Clinic', 'Kyle', 'J', 'Christensen', 'PA', 'Family Practice', '', '', NULL, 'O', '70 E 1000 N', 'Richfield', 'Sevier', 'UT', '84701', '4358930580', '4358968420', '70 E 1000 N', 'Richfield', 'Sevier', 'UT', '84701', '4358930580', '4358968420', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-07-07', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1831290790', 0, 'Y', 0, '2013-08-27', NULL, NULL, 38.8608, -111.967, NULL, NULL),
('942854057', 'W12037239', 'W12037239', 'UTIHCPHY', 'North Cache Valley Instacare', 'Thomas', 'H', 'Clark', 'MD', 'Family Practice', '', '', NULL, 'O', '4088 N Hwy 91', 'Hyde Park', 'Cache', 'UT', '84318', '4355634888', '4355634890', '4088 N Hwy 91', 'Hyde Park', 'Cache', 'UT', '84318', '4355634888', '4355634890', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-07-29', NULL, 0, 0, 0, 'Logan Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1295741114', 0, 'Y', 0, '2013-08-27', NULL, NULL, 41.8075, -111.833, NULL, NULL),
('942854057', 'W12037241', 'W12037241', 'UTIHCPHY', 'White Sage Family Medicine Clinic', 'Rhett', '', 'Crapo', 'DO', 'Emergency Medicine', '', '', NULL, 'O', '130 White Sage Ave', 'Delta', 'Millard', 'UT', '84624', '4358642708', '4358642855', '130 White Sage Ave', 'Delta', 'Millard', 'UT', '84624', '4358642708', '4358642855', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1720309578', 0, 'N', 0, '2013-08-27', NULL, NULL, 39.3505, -112.56, NULL, NULL),
('942854057', 'W12037242', 'W12037242', 'UTIHCPHY', 'Fillmore Clinic', 'Rhett', '', 'Crapo', 'DO', 'Emergency Medicine', '', '', NULL, 'O', '700 S Hwy 99 Ste 3', 'Fillmore', 'Millard', 'UT', '84631', '4357435555', '4357435764', '700 S Hwy 99 Ste 3', 'Fillmore', 'Millard', 'UT', '84631', '4357435555', '4357435764', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1720309578', 0, 'N', 0, '2013-08-27', NULL, NULL, 38.953, -112.341, NULL, NULL),
('942854057', 'W12037243', 'W12037243', 'UTIHCPHY', 'Intermountain Medical Group', 'Rhett', '', 'Crapo', 'DO', 'Emergency Medicine', '', '', NULL, 'B', 'PO Box 27128', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '4357435555', '4357435764', 'PO Box 27128', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '4357435555', '4357435764', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1720309578', 0, 'N', 0, '2013-08-27', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12037244', 'W12037244', 'UTIHCPHY', 'Salt Lake Clinic', 'Ritesh', '', 'Dhar', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '389 S 900 E', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015073500', '8015073505', '389 S 900 E', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015073500', '8015073505', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1144310939', 0, 'N', 0, '2013-08-27', NULL, NULL, 40.761, -111.865, NULL, NULL),
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('942854057', 'W12037263', 'W12037263', 'UTIHCPHY', 'Salt Lake Clinic', 'Kent', 'Guy', 'Meredith', 'MD', 'Cardiovascular Disease', 'Internal Medicine', '', NULL, 'O', '389 S 900 E', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015073500', '8015073505', '389 S 900 E', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015073500', '8015073505', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1598966822', 0, 'N', 0, '2013-08-27', NULL, NULL, 40.761, -111.865, NULL, NULL),
('942854057', 'W12037264', 'W12037264', 'UTIHCPHY', 'Salt Lake Clinic', 'Edward', 'C', 'Miner', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '389 S 900 E', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015073500', '8015073505', '389 S 900 E', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015073500', '8015073505', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1447387386', 0, 'N', 0, '2013-08-27', NULL, NULL, 40.761, -111.865, NULL, NULL),
('942854057', 'W12037265', 'W12037265', 'UTIHCPHY', 'North Cache Valley Instacare', 'John', 'J', 'Murdock', 'MD', 'Urgent Care', '', '', NULL, 'O', '4088 N Hwy 91', 'Hyde Park', 'Cache', 'UT', '84318', '4355634888', '4355634890', '4088 N Hwy 91', 'Hyde Park', 'Cache', 'UT', '84318', '4355634888', '4355634890', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-07-29', '2013-11-30', 0, 0, 0, 'Logan Regional Hospital', '', '', '', 'HCFA|UB|', '1891786968', 0, 'Y', 0, '2014-04-08', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'W12037266', 'W12037266', 'ILCHIGSTD', 'Presence Healthcare Services', 'Gema', '', 'Ramos', 'MD', 'Family Practice', '', '', NULL, 'O', '5322 W Fullerton Ave', 'Chicago', 'Cook', 'IL', '60639', '7736220056', NULL, '5322 W Fullerton Ave', 'Chicago', 'Cook', 'IL', '60639', '7736220056', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-08-01', NULL, 0, 0, 0, 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', NULL, NULL, NULL, 'HCFA|UB|', '1588978365', 0, 'N', 0, '2013-08-27', NULL, NULL, 41.9241, -87.7596, NULL, NULL),
('621801973', 'W12037268', 'W12037268', 'UT01', 'Rock Run Medical', 'Kevin', '', 'Rarick', 'PA', 'Family Practice', NULL, NULL, NULL, 'O', '5991 S 3500 W Ste 400', 'Roy', 'Weber', 'UT', '84067', '8017732838', '8017733025', '5991 S 3500 W Ste 400', 'Roy', 'Weber', 'UT', '84067', '8017732838', '8017733025', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-08-05', '2014-04-30', 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1609971506', 0, 'N', 0, '2013-10-30', NULL, NULL, 41.1545, -112.064, NULL, NULL),
('621801973', 'W12037269', 'W12037269', 'UT01', 'Physician Group of Utah Inc', 'Kevin', '', 'Rarick', 'PA', 'Family Practice', NULL, NULL, NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-08-05', '2014-04-30', 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1609971506', 0, 'N', 0, '2013-10-30', NULL, NULL, 0, 0, NULL, NULL),
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('770701557', 'W12037271', 'W12037271', 'UT01', 'MountainStar Jordan Family Health', 'William', 'J', 'Yavelak', 'MD', 'Family Practice', '', '', NULL, 'O', '8846 S Redwood Rd Ste E-121', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015691999', '8015692001', '8846 S Redwood Rd Ste E-121', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015691999', '8015692001', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1659491181', 0, 'N', 0, '2013-09-10', NULL, NULL, 40.5911, -111.939, NULL, NULL),
('850275777', 'W12037273', 'W12037273', 'NM01', 'Southwest Medical Associates', 'Amal', 'A', 'Awwad', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '6100 Pan American Fwy, Ne Ste 100', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058231010', '5058231010', '6100 Pan American Fwy, Ne Ste 100', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058231010', '5058231010', 'NMSWMED', '', '', '0.00', '10.00', '0.00', 3, '2013-12-01', NULL, 0, 0, 0, 'Lovelace Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1710952635', 0, 'N', 0, '2013-11-18', NULL, NULL, 0, 0, NULL, NULL),
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('870299862', 'W12037274', 'W12037274', 'UTMH1', 'LDS Family Services', 'Louise', 'B', 'Jorgensen', 'LPC', 'Mental Health', '', '', NULL, 'O', '930 W Hill Field Rd Ste A', 'Layton', 'Davis', 'UT', '84041', '8013363040', '8013363041', '930 W Hill Field Rd Ste A', 'Layton', 'Davis', 'UT', '84041', '8013363040', '8013363041', 'ma', '', '', '0.00', '40.00', '0.00', 8, '2013-08-28', '2014-07-22', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1821280280', 0, 'N', 0, '2014-07-24', NULL, NULL, 41.072, -111.981, NULL, NULL),
('201328719', 'W12037275', 'W12037275', 'WY01', 'Urgent Care of Casper', '', '', 'Urgent Care Now', 'GROUP', 'Urgent Care', '', '', NULL, 'B', 'PO Box 2881', 'Loves Park', 'Winnebago', 'IL', '61132', '8157132600', '8156548020', 'PO Box 2881', 'Loves Park', 'Winnebago', 'IL', '61132', '8157132600', '8156548020', '', '', '', '0.00', '30.00', '0.00', 3, '2013-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1932396199', 0, 'N', 0, '2013-08-27', NULL, NULL, 0, 0, NULL, NULL),
('201328719', 'W12037276', 'W12037276', 'WYT1', 'Urgent Care of Casper', '', '', 'Urgent Care Now', 'GROUP', 'Urgent Care', '', '', NULL, 'B', 'PO Box 2881', 'Loves Park', 'Winnebago', 'IL', '61132', '8157132600', '8156548020', 'PO Box 2881', 'Loves Park', 'Winnebago', 'IL', '61132', '8157132600', '8156548020', '', '', '', '0.00', '30.00', '0.00', 3, '2013-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1932396199', 0, 'N', 0, '2013-08-27', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W12037277', 'W12037277', 'UT01', 'Central Utah Clinic', 'Darlene', '', 'Petersen', 'MD', 'Family Practice', '', '', NULL, 'O', '5991 S 3500 W Ste 400', 'Roy', 'Weber', 'UT', '84067', '8017732838', '8017732838', '5991 S 3500 W Ste 400', 'Roy', 'Weber', 'UT', '84067', '8017732838', '8017732838', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-10-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1376744433', 0, 'N', 0, '2013-09-10', NULL, NULL, 41.1545, -112.064, NULL, NULL),
('870281028', 'W12037278', 'W12037278', 'UT01', 'Central Utah Clinic', 'Darlene', '', 'Petersen', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', '8014298180', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', '8014298180', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-10-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1376744433', 0, 'N', 0, '2013-09-10', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W12037279', 'W12037279', 'UT01', 'Central Utah Clinic', 'Darlene', '', 'Petersen', 'MD', 'Family Practice', '', '', NULL, 'O', '1055 N 500 W Ste 101', 'Provo', 'Utah', 'UT', '84604', '8018124673', '8014180941', '1055 N 500 W Ste 101', 'Provo', 'Utah', 'UT', '84604', '8018124673', '8014180941', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-10-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1376744433', 0, 'N', 0, '2013-09-10', NULL, NULL, 40.248, -111.667, NULL, NULL),
('263553949', 'W12037280', 'W12037280', 'TXDALSTD', 'Podiatric Medical Partners of Texas', 'Martin', 'N', 'Jackson', 'DPM', 'Podiatry', '', '', NULL, 'O', '1675 Republic Pkwy Ste 101', 'Mesquite', 'Dallas', 'TX', '75150', '9722707627', '9722707759', '1675 Republic Pkwy Ste 101', 'Mesquite', 'Dallas', 'TX', '75150', '9722707627', '9722707759', 'DALLAS4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1730114430', 0, 'N', 0, '2013-09-03', NULL, NULL, 32.8287, -96.6264, NULL, NULL),
('263553949', 'W12037281', 'W12037281', 'TXDALSTD', 'Podiatric Medical Partners of Texas', 'Martin', 'N', 'Jackson', 'DPM', 'Podiatry', '', '', NULL, 'O', '1411 N Beckley Ave', 'Dallas', 'Dallas', 'TX', '75203', '2149432621', '2149438139', '1411 N Beckley Ave', 'Dallas', 'Dallas', 'TX', '75203', '2149432621', '2149438139', 'DALLAS4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1730114430', 0, 'N', 0, '2013-09-03', NULL, NULL, 32.761, -96.823, NULL, NULL),
('263553949', 'W12037282', 'W12037282', 'TXDALSTD', 'Podiatric Medical Partners of Texas', 'Martin', 'N', 'Jackson', 'DPM', 'Podiatry', '', '', NULL, 'B', 'PO Box 975517', 'Dallas', 'Dallas', 'TX', '75397', '3212072839', '3212562966', 'PO Box 975517', 'Dallas', 'Dallas', 'TX', '75397', '3212072839', '3212562966', 'DALLAS4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1730114430', 0, 'N', 0, '2013-09-03', NULL, NULL, 0, 0, NULL, NULL),
('320146550', 'W12037283', 'W12037283', 'UT01', 'Jordan River Family Health', 'Heather', 'D', 'Sojourner', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '1868 W 9800 S Ste 100', 'South Jordan', 'Salt Lake', 'UT', '84095', '8014332873', '8014335734', '1868 W 9800 S Ste 100', 'South Jordan', 'Salt Lake', 'UT', '84095', '8014332873', '8014335734', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-08-27', NULL, 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1992719884', 0, 'N', 0, '2013-08-27', NULL, NULL, 40.5732, -111.941, NULL, NULL),
('942854057', 'W12037284', 'W12037284', 'UTIHCPHY', 'North Cache Valley Instacare', 'Steven', '', 'Nail', 'MD', 'Hyperbaric Medicine', '', '', NULL, 'O', '4088 N Hwy 91', 'Hyde Park', 'Cache', 'UT', '84318', '4355634888', '4355634890', '4088 N Hwy 91', 'Hyde Park', 'Cache', 'UT', '84318', '4355634888', '4355634890', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-07-29', NULL, 0, 0, 0, 'Logan Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1114978137', 0, 'Y', 0, '2013-08-27', NULL, NULL, 41.8075, -111.833, NULL, NULL),
('942854057', 'W12037285', 'W12037285', 'UTIHCPHY', 'Dixie Inpatient Psychiatry', 'Cantril', '', 'Nielsen', 'MD', 'Mental Health', 'Psychiatry', '', NULL, 'O', '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356884343', '4356885331', '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356884343', '4356885331', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-07-18', NULL, 0, 0, 0, 'Dixie Regional Medical Center', '', '', '', 'HCFA|UB|', '1942364435', 0, 'Y', 0, '2013-08-27', NULL, NULL, 37.0989, -113.575, NULL, NULL),
('942854057', 'W12037287', 'W12037287', 'UTIHCPHY', 'Bountiful KidsCare', 'Meghan', 'M', 'O Connor', 'MD', 'Pediatrics', NULL, NULL, NULL, 'O', '390 N Main St', 'Bountiful', 'Davis', 'UT', '84010', '8012949933', '8012941183', '390 N Main St', 'Bountiful', 'Davis', 'UT', '84010', '8012949933', '8012941183', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1801021423', 0, 'Y', 0, '2013-08-27', NULL, NULL, 40.8935, -111.881, NULL, NULL),
('942854057', 'W12037288', 'W12037288', 'UTIHCPHY', 'Salt Lake Clinic', 'James', 'L', 'Orford', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '389 S 900 E', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015073500', '8015073505', '389 S 900 E', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015073500', '8015073505', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1902843931', 0, 'N', 0, '2013-08-27', NULL, NULL, 40.761, -111.865, NULL, NULL),
('942854057', 'W12037290', 'W12037290', 'UTIHCPHY', 'Logan InstaCare', 'Roger', 'T', 'Park', 'DO', 'Urgent Care', '', '', NULL, 'o', '412 N 200 E', 'Logan', 'Cache', 'UT', '84321', '4357132710', '4357132746', '412 N 200 E', 'Logan', 'Cache', 'UT', '84321', '4357132710', '4357132746', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-07-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1295713444', 0, 'Y', 0, '2013-08-27', NULL, NULL, 41.7393, -111.83, NULL, NULL),
('942854057', 'W12037291', 'W12037291', 'UTIHCPHY', 'North Cache Valley Instacare', 'Roger', 'T', 'Park', 'DO', 'Urgent Care', '', '', NULL, 'O', '4088 N Hwy 91', 'Hyde Park', 'Cache', 'UT', '84318', '4355634888', '4355634890', '4088 N Hwy 91', 'Hyde Park', 'Cache', 'UT', '84318', '4355634888', '4355634890', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-07-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1295713444', 0, 'Y', 0, '2013-08-27', NULL, NULL, 41.8075, -111.833, NULL, NULL),
('942854057', 'W12037293', 'W12037293', 'UTIHCPHY', 'American Fork Surgical Associates', 'Shannoon', 'L', 'Peck', 'PA-C', 'Family Practice', '', '', NULL, 'O', '1159 E 200 N Ste 350', 'American Fork', 'Utah', 'UT', '84003', '8018552941', '8017565091', '1159 E 200 N Ste 350', 'American Fork', 'Utah', 'UT', '84003', '8018552941', '8017565091', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-06-14', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1346531928', 0, 'Y', 0, '2013-08-27', NULL, NULL, 40.3805, -111.769, NULL, NULL),
('942854057', 'W12037294', 'W12037294', 'UTIHCPHY', 'Int Heart Cardiology-LDSH', 'Sheralee', 'D', 'Petersen', 'PA-C', 'Family Practice', '', '', NULL, 'O', '8th Ave and C St 7th Floor', 'Salt Lake City', 'Salt Lake', 'UT', '84143', '8015073500', '8015073505', '8th Ave and C St 7th Floor', 'Salt Lake City', 'Salt Lake', 'UT', '84143', '8015073500', '8015073505', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1114110921', 0, 'Y', 0, '2013-08-27', NULL, NULL, 40.7785, -111.881, NULL, NULL),
('942854057', 'W12037295', 'W12037295', 'UTIHCPHY', 'North Cache Valley Instacare', 'Rebecca', 'Copp', 'Phillips', 'MD', 'Urgent Care', '', '', NULL, 'O', '4088 N Hwy 91', 'Hyde Park', 'Cache', 'UT', '84318', '4355634888', '4355634890', '4088 N Hwy 91', 'Hyde Park', 'Cache', 'UT', '84318', '4355634888', '4355634890', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-07-29', NULL, 0, 0, 0, 'Logan Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1871696898', 0, 'Y', 0, '2013-08-27', NULL, NULL, 41.8075, -111.833, NULL, NULL),
('942854057', 'W12037296', 'W12037296', 'UTIHCPHY', 'Salt Lake Clinic', 'James', 'R', 'Revenaugh', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '389 S 900 E', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015073500', '8015073505', '389 S 900 E', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015073500', '8015073505', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1316915952', 0, 'N', 0, '2014-05-19', NULL, NULL, 40.761, -111.865, NULL, NULL),
('942854057', 'W12037297', 'W12037297', 'UTIHCPHY', 'North Cache Valley Instacare', 'Andrew', 'B', 'Sanders', 'MD', 'Urgent Care', '', '', NULL, 'O', '4088 N Hwy 91', 'Hyde Park', 'Cache', 'UT', '84318', '4355634888', '4355634890', '4088 N Hwy 91', 'Hyde Park', 'Cache', 'UT', '84318', '4355634888', '4355634890', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-07-29', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1538458138', 0, 'Y', 0, '2013-08-27', NULL, NULL, 41.8075, -111.833, NULL, NULL),
('942854057', 'W12037299', 'W12037299', 'UTIHCPHY', 'Southwest Neurology Associates', 'Diane', 'M', 'Vroenen', 'DO', 'Physical Medicine and Rehabilitation', '', '', NULL, 'O', '652 S Medical Ctr Dr Ste 320', 'St George', 'Washington', 'UT', '84790', '4352513950', '4352513951', '652 S Medical Ctr Dr Ste 320', 'St George', 'Washington', 'UT', '84790', '4352513950', '4352513951', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-07-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', '', '', '', 'HCFA|UB|', '1093899924', 0, 'N', 0, '2014-05-13', NULL, NULL, 37.0498, -113.574, NULL, NULL),
('942854057', 'W12037301', 'W12037301', 'UTIHCPHY', 'Salt Lake Clinic', 'Kevin', 'J', 'Walsh', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '389 S 900 E', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015073500', '8015073505', '389 S 900 E', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015073500', '8015073505', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1609845734', 0, 'N', 0, '2014-05-19', NULL, NULL, 40.761, -111.865, NULL, NULL),
('942854057', 'W12037302', 'W12037302', 'UTIHCPHY', 'Heber Valley Clinic', 'Mark', 'Lee', 'Wardle', 'DO', 'Family Practice', '', '', NULL, 'O', '1473 S Hwy 40 Ste E', 'Heber City', 'Wasatch', 'UT', '84032', '4356574400', '4356574460', '1473 S Hwy 40 Ste E', 'Heber City', 'Wasatch', 'UT', '84032', '4356574400', '4356574460', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1639274574', 0, 'Y', 0, '2013-08-27', NULL, NULL, 40.4893, -111.409, NULL, NULL),
('942854057', 'W12037303', 'W12037303', 'UTIHCPHY', 'Southwest Cardiology St George', 'Zachary', 'R', 'Williams', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1380 E Medical Ctr Dr Ste 1500', 'St George', 'Washington', 'UT', '84790', '4352512500', '4356564907', '1380 E Medical Ctr Dr Ste 1500', 'St George', 'Washington', 'UT', '84790', '4352512500', '4356564907', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-07-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1134372584', 0, 'N', 0, '2013-08-27', NULL, NULL, 37.0998, -113.554, NULL, NULL),
('201780406', 'W12037306', 'W12037306', 'ILCHIGSTD', 'UroPartners', 'Natalia', 'E', 'Pajak', 'PA-C', 'Family Practice', '', '', NULL, 'O', '7900 N Milwaukee Ave Ste 17', 'Niles', 'Cook', 'IL', '60714', '8474701500', '8474701550', '7900 N Milwaukee Ave Ste 17', 'Niles', 'Cook', 'IL', '60714', '8474701500', '8474701550', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-07-24', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1487096855', 0, 'N', 0, '2013-08-27', NULL, NULL, 42.0244, -87.8126, NULL, NULL),
('201780406', 'W12037307', 'W12037307', 'ILCHIGSTD', 'UroPartners', 'Natalia', 'E', 'Pajak', 'PA-C', 'Family Practice', '', '', NULL, 'B', '3183 Paysphere Cr', 'Chicago', 'Cook', 'IL', '60674', '2242603100', '8479988112', '3183 Paysphere Cr', 'Chicago', 'Cook', 'IL', '60674', '2242603100', '8479988112', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-07-24', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1487096855', 0, 'N', 0, '2013-08-27', NULL, NULL, 0, 0, NULL, NULL),
('201780406', 'W12037309', 'W12037309', 'ILCHIGSTD', 'UroPartners', 'Kathryn', 'L', 'Roggow', 'PA-C', 'Family Practice', '', '', NULL, 'B', '3183 Paysphere Cr', 'Chicago', 'Cook', 'IL', '60674', '2242603100', '8479988112', '3183 Paysphere Cr', 'Chicago', 'Cook', 'IL', '60674', '2242603100', '8479988112', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-07-24', '2013-11-16', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1447682679', 0, 'N', 0, '2013-11-25', 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
('201780406', 'W12037310', 'W12037310', 'ILCHIGSTD', 'UroPartners', 'Kathryn', 'L', 'Roggow', 'PA-C', 'Family Practice', '', '', NULL, 'O', '7900 N Milwaukee Ave Ste 17', 'Niles', 'Cook', 'IL', '60714', '8474701500', '8474701550', '7900 N Milwaukee Ave Ste 17', 'Niles', 'Cook', 'IL', '60714', '8474701500', '8474701550', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-07-24', '2013-11-16', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1447682679', 0, 'N', 0, '2013-11-25', NULL, NULL, 42.0249, -87.8141, NULL, NULL),
('363852678', 'W12037313', 'W12037313', 'ILCHIGSTD', '', 'Zenabu', '', 'Sidiki', 'MD', 'Family Practice', '', '', NULL, 'O', '2000 Glenwood Ave Ste 107', 'Joliet', 'Will', 'IL', '60435', '8157414445', '8157413047', '2000 Glenwood Ave Ste 107', 'Joliet', 'Will', 'IL', '60435', '8157414445', '8157413047', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Presence Saint Joseph Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1932377660', 0, 'N', 0, '2014-01-24', NULL, NULL, 41.5298, -88.1298, NULL, NULL),
('942854057', 'W12037320', 'W12037320', 'UTIHC04', 'Spina Bifida Clinic', 'Robert', 'J', 'Bollo', 'MD', 'Pediatric Neurosurgery', NULL, NULL, NULL, 'O', '100 Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621000', NULL, '100 Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621000', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2013-06-19', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1013129584', 0, 'N', 0, '2013-08-28', NULL, NULL, 40.7663, -111.837, NULL, NULL),
('942854057', 'W12037321', 'W12037321', 'UTIHC04', 'Diabetic Clinic', 'Scott', 'A', 'Clements', 'MD', 'Pediatric Endocrinology', NULL, NULL, NULL, 'O', '3773 W 12600 S', 'Riverton', 'Salt Lake', 'UT', '84065', '8016624949', NULL, '3773 W 12600 S', 'Riverton', 'Salt Lake', 'UT', '84065', '8016624949', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2013-06-19', NULL, 0, 0, 0, 'University Health Care University Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1649478512', 0, 'N', 0, '2013-08-28', NULL, NULL, 40.5222, -111.981, NULL, NULL),
('942854057', 'W12037322', 'W12037322', 'UTIHC04', 'Diabetic Clinic', 'Scott', 'A', 'Clements', 'MD', 'Pediatric Endocrinology', NULL, NULL, NULL, 'O', '1134 N 500 W Ste 103', 'Provo', 'Utah', 'UT', '84604', '8013577546', NULL, '1134 N 500 W Ste 103', 'Provo', 'Utah', 'UT', '84604', '8013577546', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2013-06-19', NULL, 0, 0, 0, 'University Health Care University Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1649478512', 0, 'N', 0, '2013-08-28', NULL, NULL, 40.2484, -111.667, NULL, NULL),
('942854057', 'W12037323', 'W12037323', 'UTIHC04', 'Diabetic Clinic', 'Scott', 'A', 'Clements', 'MD', 'Pediatric Endocrinology', NULL, NULL, NULL, 'O', '4403 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8013877900', NULL, '4403 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8013877900', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2013-06-19', NULL, 0, 0, 0, 'University Health Care University Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1649478512', 0, 'N', 0, '2013-08-28', NULL, NULL, 41.1828, -111.949, NULL, NULL),
('942854057', 'W12037324', 'W12037324', 'UTIHC04', 'Diabetic Clinic', 'Scott', 'A', 'Clements', 'MD', 'Pediatric Endocrinology', NULL, NULL, NULL, 'O', '268 E 600 S', 'St George', 'Washington', 'UT', '84790', '4352512888', NULL, '268 E 600 S', 'St George', 'Washington', 'UT', '84790', '4352512888', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2013-06-19', NULL, 0, 0, 0, 'University Health Care University Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1649478512', 0, 'N', 0, '2013-08-28', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12037325', 'W12037325', 'UTIHC04', 'PCMC Oncology/BMT', 'Paul', 'David', 'Colte', 'PsyD', 'Mental Health', 'Psychology', NULL, NULL, 'O', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016624552', NULL, '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016624552', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1912055229', 0, 'N', 0, '2013-08-28', NULL, NULL, 40.7663, -111.837, NULL, NULL),
('942854057', 'W12037326', 'W12037326', 'UTIHC04', 'Diabetic Clinic', 'David', 'L', 'Donaldson', 'MD', 'Pediatric Endocrinology', '', '', NULL, 'O', '615 Arapeen Dr Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015873922', NULL, '615 Arapeen Dr Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015873922', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2013-06-19', NULL, 0, 0, 0, 'University Health Care University Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1063584290', 0, 'N', 0, '2013-08-28', NULL, NULL, 40.7552, -111.827, NULL, NULL),
('760341875', 'W12037332', 'W12037332', 'TXHOUSTD', 'West Houston Surgical Associates', 'Steven', 'M', 'Thomas', 'MD', 'General Surgery', '', '', NULL, 'O', '12121 Richmond Ave Ste 312', 'Houston', 'Harris', 'TX', '77082', '2814970296', '2814970825', '12121 Richmond Ave Ste 312', 'Houston', 'Harris', 'TX', '77082', '2814970296', '2814970825', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, 'West Houston Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1144297169', 0, 'N', 0, '2013-08-30', NULL, NULL, 29.7306, -95.5937, NULL, NULL),
('760341875', 'W12037333', 'W12037333', 'TXHOUSTD', 'West Houston Surgical Associates', 'Steven', 'M', 'Thomas', 'MD', 'General Surgery', '', '', NULL, 'B', 'PO Box 1759 Dept 518', 'Houston', 'Harris', 'TX', '77251', '2814970296', '2814970825', 'PO Box 1759 Dept 518', 'Houston', 'Harris', 'TX', '77251', '2814970296', '2814970825', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, 'West Houston Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1144297169', 0, 'N', 0, '2013-08-30', NULL, NULL, 0, 0, NULL, NULL),
('010593260', 'W12037409', 'W12037409', 'TXHOUSTD', 'Digestive and Liver Specialists of Houston', 'Paul', 'Martin', 'Mauk', 'MD', 'Gastroenterology', '', '', NULL, 'O', '915 Gessner Ste 850', 'Houston', 'Harris', 'TX', '77024', '7134611026', '7134614358', '915 Gessner Ste 850', 'Houston', 'Harris', 'TX', '77024', '7134611026', '7134614358', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-10-06', NULL, 0, 0, 0, 'Houston Methodist West Houston Hospital', '', '', '', 'HCFA|UB|', '1568437531', 0, 'N', 0, '2014-04-24', NULL, NULL, 29.7804, -95.5445, NULL, NULL),
('760341875', 'W12037335', 'W12037335', 'TXHOUSTD', 'West Houston Surgical Associates', 'Christopher', 'L', 'Reilly', 'MD', 'General Surgery', '', '', NULL, 'O', '12121 Richmond Ave Ste 312', 'Houston', 'Harris', 'TX', '77082', '2814970296', '2814970825', '12121 Richmond Ave Ste 312', 'Houston', 'Harris', 'TX', '77082', '2814970296', '2814970825', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, 'West Houston Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1346298577', 0, 'N', 0, '2013-08-30', NULL, NULL, 29.7306, -95.5937, NULL, NULL),
('760341875', 'W12037336', 'W12037336', 'TXHOUSTD', 'West Houston Surgical Associates', 'Christopher', 'L', 'Reilly', 'MD', 'General Surgery', '', '', NULL, 'B', 'PO Box 1759 Dept 518', 'Houston', 'Harris', 'TX', '77251', '2814970296', '2814970825', 'PO Box 1759 Dept 518', 'Houston', 'Harris', 'TX', '77251', '2814970296', '2814970825', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, 'West Houston Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1346298577', 0, 'N', 0, '2013-08-30', NULL, NULL, 0, 0, NULL, NULL),
('760556911', 'W12037342', 'W12037342', 'TXHOUSTD', 'Tyreen Vidal Heybeck', 'Tyreen', '', 'Heybeck', 'DPM', 'Podiatry', '', '', NULL, 'O', '18700 W Lake Houston Pkwy Ste A-105', 'Livingston', 'Polk', 'TX', '77351', '2818122890', '2813617411', '18700 W Lake Houston Pkwy Ste A-105', 'Livingston', 'Polk', 'TX', '77351', '2818122890', '2813617411', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-10-06', NULL, 0, 0, 0, 'Kingwood Medical Center', NULL, NULL, NULL, 'HCFA|', '1003144593', 0, 'N', 0, '2013-09-06', NULL, NULL, 29.9655, -95.1596, NULL, NULL),
('760556911', 'W12037340', 'W12037340', 'TXHOUSTD', 'Tyreen Vidal Heybeck', 'Tyreen', '', 'Heybeck', 'DPM', 'Podiatry', '', '', NULL, 'O', '400 Bypass Ln Ste 110', 'Livingston', 'Polk', 'TX', '77351', '9363274400', '2813617411', '400 Bypass Ln Ste 110', 'Livingston', 'Polk', 'TX', '77351', '9363274400', '2813617411', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-10-06', NULL, 0, 0, 0, 'Kingwood Medical Center', NULL, NULL, NULL, 'HCFA|', '1003144593', 0, 'N', 0, '2013-09-06', NULL, NULL, 30.6345, -94.828, NULL, NULL),
('760556911', 'W12037341', 'W12037341', 'TXHOUSTD', 'Tyreen Vidal Heybeck', 'Tyreen', '', 'Heybeck', 'DPM', 'Podiatry', '', '', NULL, 'B', '8 N Main St Ste P', 'Kingwood', 'Harris', 'TX', '77339', '9363274400', '2813617411', '8 N Main St Ste P', 'Kingwood', 'Harris', 'TX', '77339', '9363274400', '2813617411', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-10-06', NULL, 0, 0, 0, 'Kingwood Medical Center', NULL, NULL, NULL, 'HCFA|', '1003144593', 0, 'N', 0, '2013-09-06', NULL, NULL, 0, 0, NULL, NULL),
('760405084', 'W12037344', 'W12037344', 'TXHOUSTD', 'Medical Chest Associates', 'Ajay', '', 'Jain', 'MD', 'Pulmonary', '', '', NULL, 'O', '701 S Fry Rd Ste 116', 'Katy', 'Harris', 'TX', '77450', '2816460220', '2816460230', '701 S Fry Rd Ste 116', 'Katy', 'Harris', 'TX', '77450', '2816460220', '2816460230', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, 'Houston Methodist West Houston Hospital', NULL, '', '', 'HCFA|UB', '1063426674', 0, 'N', 0, '2013-08-30', NULL, NULL, 29.7766, -95.7189, NULL, NULL),
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('800169878', 'W12037354', 'W12037354', 'TXHOUSTD', 'David Stapenhorst MD', 'David', '', 'Stapenhorst', 'MD', 'Plastic Surgery', '', '', NULL, 'O', '4665 Sweetwater Blvd Ste 110', 'Sugar Land', 'Fort Bend', 'TX', '77479', '2819800999', '2819800444', '4665 Sweetwater Blvd Ste 110', 'Sugar Land', 'Fort Bend', 'TX', '77479', '2819800999', '2819800444', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, 'Houston Methodist Sugar Land Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1316110638', 0, 'N', 0, '2013-08-30', NULL, NULL, 29.5829, -95.6309, NULL, NULL),
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('942854057', 'W12037360', 'W12037360', 'UTIHC04', 'Primary Childrens Medical Center', 'Grant', 'A', 'Fairbanks', 'MD', 'Plastic Surgery', '', '', NULL, 'O', '736 S 900 E Ste 107', 'St George', 'Washington', 'UT', '84790', '4352512888', NULL, '736 S 900 E Ste 107', 'St George', 'Washington', 'UT', '84790', '4352512888', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2013-06-19', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1013056357', 0, 'N', 0, '2013-08-29', NULL, NULL, 37.0956, -113.564, NULL, NULL),
('942854057', 'W12037361', 'W12037361', 'UTIHC04', 'Spina Bifida Clinic', 'Lynne', 'M', 'Kerr', 'MD', 'Pediatric Neurology', 'Pediatrics', 'Pediatric Psychiatry', NULL, 'O', '100 Mario Capecchi Dr ', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621000', NULL, '100 Mario Capecchi Dr ', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621000', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2013-06-19', NULL, 0, 0, 0, 'Primary Childrens Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1578638474', 0, 'N', 0, '2013-08-29', NULL, NULL, 40.7663, -111.837, NULL, NULL),
('942854057', 'W12037363', 'W12037363', 'UTIHC04', 'PCMC Pulmonolgy', 'Brian', 'M', 'McGinley', 'MD', 'Sleep Medicine', '', '', NULL, 'O', '100 Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016626200', NULL, '100 Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016626200', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1790737708', 0, 'Y', 0, '2013-08-29', NULL, NULL, 40.7663, -111.837, NULL, NULL),
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('300520570', 'METH10025', 'METH10025', 'TXHOUSTD', 'TMHPO ICU Physicians', 'Rachel', 'Ann', 'Beauchamp', 'ACNP', 'Nurse Practitioner', '', NULL, NULL, 'B', 'PO Box 4719', 'Houston', 'Harris', 'TX', '77210', '7134414347', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOPCP', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-07-29', '2013-09-30', NULL, 0, 0, 'Houston Methodist Hospital', '', '', NULL, 'HCFA|UB|', '1114241643', 0, 'Y', 0, '2013-08-29', NULL, NULL, 0, 0, NULL, NULL),
('571201170', 'METH10003', 'METH10003', 'TXHOUSTD', 'Methodist Primary Care Group', 'Rachel', 'Dara', 'Bishop', 'MD', 'Internal Medicine', '', NULL, NULL, 'O', '6560 Fannin Ste 2100', 'Houston', 'Harris', 'TX', '77030', '7134419040', '7137904456', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOPCP', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-07-29', NULL, NULL, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1356348940', 0, 'N', 0, '2013-08-29', NULL, NULL, 29.7109, -95.4, NULL, NULL),
('571201170', 'METH10026', 'METH10026', 'TXHOUSTD', 'Methodist Primary Care Group', 'Rachel', 'Dara', 'Bishop', 'MD', 'Internal Medicine', '', NULL, NULL, 'B', 'PO Box 4655', 'Houston', 'Harris', 'TX', '77210', '7134414280', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOPCP', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-07-29', NULL, NULL, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1356348940', 0, 'Y', 0, '2013-08-29', NULL, NULL, 0, 0, NULL, NULL),
('134298938', 'METH10004', 'METH10004', 'TXHOUSTD', 'Institute for Reconstructive Surgery', 'Rodger', 'Hamilton', 'Brown', 'MD', 'Plastic Surgery', '', '', NULL, 'O', '18400 Katy Fwy Ste 500', 'Houston', 'Harris', 'TX', '77094', '8325228400', '8325228401', '18400 Katy Fwy Ste 500', 'Houston', 'Harris', 'TX', '77094', '8325228400', '8325228401', 'TMHPHOSPC', 'TXHCPCTMH', '', '0.00', '50.00', '0.00', 6, '2013-07-29', '2014-03-31', 0, 0, 0, 'Houston Methodist Hospital', 'Houston Methodist West Houston Hospital', '', '', 'HCFA|UB|', '1255576328', 0, 'N', 0, '2014-02-13', NULL, NULL, 29.7855, -95.6953, NULL, NULL),
('134298938', 'METH10047', 'METH10047', 'TXHOUSTD', 'Institute for Reconstructive Surgery', 'Rodger', 'Hamilton', 'Brown', 'MD', 'Plastic Surgery', '', '', NULL, 'O', '6560 Fannin Ste 2200', 'Houston', 'Harris', 'TX', '77030', '7134416106', '7137998428', '6560 Fannin Ste 2200', 'Houston', 'Harris', 'TX', '77030', '7134416106', '7137998428', 'TMHPHOSPC', 'TXHCPCTMH', '', '0.00', '50.00', '0.00', 6, '2013-07-29', '2014-03-31', 0, 0, 0, 'Houston Methodist Hospital', 'Houston Methodist West Houston Hospital', '', '', 'HCFA|UB|', '1255576328', 0, 'N', 0, '2014-02-13', NULL, NULL, 29.7109, -95.4, NULL, NULL),
('134298938', 'METH10027', 'METH10027', 'TXHOUSTD', 'Institute for Reconstructive Surgery', 'Rodger', 'Hamilton', 'Brown', 'MD', 'Plastic Surgery', '', '', NULL, 'B', 'PO Box 4682', 'Houston', 'Harris', 'TX', '77210', '7134416679', NULL, 'PO Box 4682', 'Houston', 'Harris', 'TX', '77210', '7134416679', '          ', 'TMHPHOSPC', 'TXHCPCTMH', '', '0.00', '50.00', '0.00', 6, '2013-07-29', '2014-03-31', 0, 0, 0, 'Houston Methodist Hospital', 'Houston Methodist West Houston Hospital', '', '', 'HCFA|UB|', '1255576328', 0, 'Y', 0, '2014-02-13', NULL, NULL, 0, 0, NULL, NULL),
('300520570', 'METH10023', 'METH10023', 'TXHOUSTD', 'Methodist Academic Medicine Associates', 'Veronica', 'Juanita', 'Carreon', 'FNP', 'Family Practice', '', '', NULL, 'O', '6550 Fannin Ste 1101', 'Houston', 'Harris', 'TX', '77030', '7134410006', '7137902727', '6550 Fannin Ste 1101', 'Houston', 'Harris', 'TX', '77030', '7134410006', '7137902727', 'TMHPHOPCP', 'TXHCPCTMH', '', '0.00', '50.00', '0.00', 6, '2013-07-29', '2013-09-30', 0, 0, 0, 'Houston Methodist Hospital', NULL, '', '', 'HCFA|UB|', '1548595937', 0, 'N', 0, '2013-08-29', NULL, NULL, 29.712, -95.3995, NULL, NULL),
('300520570', 'METH10046', 'METH10046', 'TXHOUSTD', 'Methodist Academic Medicine Associates', 'Veronica', 'Juanita', 'Carreon', 'FNP', 'Family Practice', '', '', NULL, 'B', 'PO Box 4719', 'Houston', 'Harris', 'TX', '77210', '7134414347', NULL, 'PO Box 4719', 'Houston', 'Harris', 'TX', '77210', '7134414347', '', 'TMHPHOPCP', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-07-29', '2013-09-30', 0, 0, 0, 'Houston Methodist Hospital', NULL, '', '', 'HCFA|UB|', '1548595937', 0, 'Y', 0, '2013-08-29', NULL, NULL, 0, 0, NULL, NULL),
('300520570', 'METH10005', 'METH10005', 'TXHOUSTD', 'Methodist DeBakey Cardiology Associates', 'Mina', '', 'Elnemr', 'MD', 'Hospitalist', '', NULL, NULL, 'O', '6565 Fannin Fondren 1003', 'Houston', 'Harris', 'TX', '77030', '7134411100', '7137902643', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOHSP', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-07-29', '2013-09-30', NULL, 0, 0, 'Houston Methodist Hospital', '', '', NULL, 'HCFA|UB|', '1760702302', 0, 'Y', 0, '2013-08-29', NULL, NULL, 29.7098, -95.3999, NULL, NULL),
('300520570', 'METH10028', 'METH10028', 'TXHOUSTD', 'Methodist DeBakey Cardiology Associates', 'Mina', '', 'Elnemr', 'MD', 'Hospitalist', '', NULL, NULL, 'B', 'PO Box 4719', 'Houston', 'Harris', 'TX', '77210', '7134416810', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOHSP', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-07-29', '2013-09-30', NULL, 0, 0, 'Houston Methodist Hospital', '', '', NULL, 'HCFA|UB|', '1760702302', 0, 'Y', 0, '2013-08-29', NULL, NULL, 0, 0, NULL, NULL),
('300520570', 'METH10006', 'METH10006', 'TXHOUSTD', 'TMHPO Surgery Department', 'Puja', '', 'Khaitan', 'MD', 'Thoracic Surgery', 'General Surgery', '', NULL, 'O', '6550 Fannin Ste 1601', 'Houston', 'Harris', 'TX', '77030', '7134415151', '7137906470', '6550 Fannin Ste 1601', 'Houston', 'Harris', 'TX', '77030', '7134415151', '7137906470', 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-07-29', '2013-09-30', 0, 0, 0, 'Houston Methodist Hospital', '', '', '', 'HCFA|UB|', '1972774735', 0, 'N', 0, '2014-04-15', NULL, NULL, 29.712, -95.3995, NULL, NULL),
('300520570', 'METH10029', 'METH10029', 'TXHOUSTD', 'TMHPO Surgery Department', 'Puja', '', 'Khaitan', 'MD', 'Thoracic Surgery', 'General Surgery', '', NULL, 'B', 'PO Box 4719', 'Houston', 'Harris', 'TX', '77210', '7134415151', NULL, 'PO Box 4719', 'Houston', 'Harris', 'TX', '77210', '7134415151', '', 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-07-29', '2013-09-30', 0, 0, 0, 'Houston Methodist Hospital', '', '', '', 'HCFA|UB|', '1972774735', 0, 'Y', 0, '2014-04-15', NULL, NULL, 0, 0, NULL, NULL),
('300520570', 'METH10021', 'METH10021', 'TXHOUSTD', 'Methodist Academic Medicine Associates', 'Raul', 'J', 'Gutierrez', 'ACNP', 'Nurse Practitioner', '', NULL, NULL, 'O', '6550 Fannin Ste 1101', 'Houston', 'Harris', 'TX', '77030', '7134410006', '7137902727', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOPCP', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-07-29', '2013-09-30', NULL, 0, 0, '', '', '', NULL, 'HCFA|UB|', '1609143460', 0, 'N', 0, '2013-08-29', NULL, NULL, 29.712, -95.3995, NULL, NULL),
('300520570', 'METH10044', 'METH10044', 'TXHOUSTD', 'Methodist Academic Medicine Associates', 'Raul', 'J', 'Gutierrez', 'ACNP', 'Nurse Practitioner', '', NULL, NULL, 'B', 'PO Box 4719', 'Houston', 'Harris', 'TX', '77210', '7134415129', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOPCP', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-07-29', '2013-09-30', NULL, 0, 0, '', '', '', NULL, 'HCFA|UB|', '1609143460', 0, 'Y', 0, '2013-08-29', NULL, NULL, 0, 0, NULL, NULL),
('571201170', 'METH10007', 'METH10007', 'TXHOUSTD', 'Methodist Radiology Oncology Group', 'Amy', 'Cherlene', 'Hardy Covey', 'FNP', 'Family Practice', '', NULL, NULL, 'O', '6565 Fannin Ste DB 1 077', 'Houston', 'Harris', 'TX', '77030', '7134414800', '7134414493', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOPCP', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-07-29', NULL, NULL, 0, 0, 'Houston Methodist Hospital', NULL, '', NULL, 'HCFA|UB|', '1801041728', 0, 'N', 0, '2013-08-29', NULL, NULL, 29.7108, -95.3999, NULL, NULL),
('571201170', 'METH10030', 'METH10030', 'TXHOUSTD', 'Methodist Radiology Oncology Group', 'Amy', 'Cherlene', 'Hardy Covey', 'FNP', 'Family Practice', '', NULL, NULL, 'B', 'PO Box 4655', 'Houston', 'Harris', 'TX', '77210', '7134414347', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOPCP', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-07-29', NULL, NULL, 0, 0, 'Houston Methodist Hospital', NULL, '', NULL, 'HCFA|UB|', '1801041728', 0, 'Y', 0, '2013-08-29', NULL, NULL, 0, 0, NULL, NULL),
('300520570', 'METH10008', 'METH10008', 'TXHOUSTD', 'TMHPO Surgery Department', 'Charles', 'Arthur', 'Hill', 'MD', 'General Surgery', '', NULL, NULL, 'O', '6550 Fannin Ste 2435', 'Houston', 'Harris', 'TX', '77030', '7137903140', '7137903235', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-07-29', '2013-09-30', NULL, 0, 0, 'Houston Methodist Hospital', '', '', NULL, 'HCFA|UB|', '1407039845', 0, 'N', 0, '2013-08-29', NULL, NULL, 29.712, -95.3995, NULL, NULL),
('300520570', 'METH10031', 'METH10031', 'TXHOUSTD', 'TMHPO Surgery Department', 'Charles', 'Arthur', 'Hill', 'MD', 'General Surgery', '', NULL, NULL, 'B', 'PO Box 4719', 'Houston', 'Harris', 'TX', '77210', '7134415151', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-07-29', '2013-09-30', NULL, 0, 0, 'Houston Methodist Hospital', '', '', NULL, 'HCFA|UB|', '1407039845', 0, 'Y', 0, '2013-08-29', NULL, NULL, 0, 0, NULL, NULL),
('300520570', 'METH10009', 'METH10009', 'TXHOUSTD', 'Methodist Orthopaedic Specialists of Texas', 'Jeffrey', 'Alan', 'Kozak', 'DO', 'Family Practice', '', '', NULL, 'O', '1201 Brooks St', 'Sugar Land', 'Fort Bend', 'TX', '77478', '2816904678', '2815658808', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOPCP', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-07-29', '2013-09-30', NULL, 0, 0, 'Houston Methodist Sugar Land Hospital', '', '', '', 'HCFA|UB|', '1316279326', 0, 'N', 0, '2013-08-29', NULL, NULL, 29.6043, -95.634, NULL, NULL),
('300520570', 'METH10048', 'METH10048', 'TXHOUSTD', 'Methodist Orthopaedic Specialists of Texas', 'Jeffrey', 'Alan', 'Kozak', 'DO', 'Family Practice', '', '', NULL, 'O', '1327 Lake Pointe Pkwy Ste 425', 'Sugar Land', 'Fort Bend', 'TX', '77478', '2816904678', '2814994490', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOPCP', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-07-29', '2013-09-30', NULL, 0, 0, 'Houston Methodist Sugar Land Hospital', '', '', '', 'HCFA|UB|', '1316279326', 0, 'N', 0, '2013-08-29', NULL, NULL, 29.6044, -95.6204, NULL, NULL),
('300520570', 'METH10032', 'METH10032', 'TXHOUSTD', 'Methodist Orthopaedic Specialists of Texas', 'Jeffrey', 'Alan', 'Kozak', 'DO', 'Family Practice', '', '', NULL, 'B', 'PO Box 4719', 'Houston', 'Harris', 'TX', '77210', '2816904678', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOPCP', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-07-29', '2013-09-30', NULL, 0, 0, 'Houston Methodist Sugar Land Hospital', '', '', '', 'HCFA|UB|', '1316279326', 0, 'Y', 0, '2013-08-29', NULL, NULL, 0, 0, NULL, NULL),
('571201170', 'METH10010', 'METH10010', 'TXHOUSTD', 'Methodist Cardiovascular Surgery Associates', 'Gerald', 'Murray', 'Lawrie', 'MD', 'Cardiovascular Surgery', 'Cardiothoracic Surgery', NULL, NULL, 'O', '6560 Fannin Ste 1750', 'Houston', 'Harris', 'TX', '77030', '7137565314', '7137568616', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-07-29', NULL, NULL, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1457351074', 0, 'N', 0, '2013-08-29', NULL, NULL, 29.7109, -95.4, NULL, NULL),
('571201170', 'METH10033', 'METH10033', 'TXHOUSTD', 'Methodist Cardiovascular Surgery Associates', 'Gerald', 'Murray', 'Lawrie', 'MD', 'Cardiovascular Surgery', 'Cardiothoracic Surgery', NULL, NULL, 'B', 'PO Box 4655', 'Houston', 'Harris', 'TX', '77210', '7134415151', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-07-29', NULL, NULL, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1457351074', 0, 'Y', 0, '2013-08-29', NULL, NULL, 0, 0, NULL, NULL),
('300520570', 'METH10011', 'METH10011', 'TXHOUSTD', 'TMHPO Orthopedics Department', 'Daniel', 'Tran', 'Le', 'MD', 'Orthopedic Surgery', '', NULL, NULL, 'O', '13802 Centerfield Dr Ste 300', 'Houston', 'Harris', 'TX', '77070', '2817370999', '2817370926', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-07-29', '2013-09-30', NULL, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1518295682', 0, 'N', 0, '2013-08-29', NULL, NULL, 29.9694, -95.5506, NULL, NULL),
('300520570', 'METH10034', 'METH10034', 'TXHOUSTD', 'TMHPO Orthopedics Department', 'Daniel', 'Tran', 'Le', 'MD', 'Orthopedic Surgery', '', NULL, NULL, 'B', 'PO Box 4719', 'Houston', 'Harris', 'TX', '77210', '7134414838', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-07-29', '2013-09-30', NULL, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1518295682', 0, 'Y', 0, '2013-08-29', NULL, NULL, 0, 0, NULL, NULL),
('571201170', 'METH10012', 'METH10012', 'TXHOUSTD', 'TMHPO Surgery Department', 'Sherry', 'Ji', 'Lim', 'MD', 'General Surgery', '', NULL, NULL, 'O', '6560 Fannin Ste 1750', 'Houston', 'Harris', 'TX', '77030', '7137904830', '7137937824', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-07-29', NULL, NULL, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1659465300', 0, 'N', 0, '2013-08-29', NULL, NULL, 29.7109, -95.4, NULL, NULL),
('571201170', 'METH10035', 'METH10035', 'TXHOUSTD', 'TMHPO Surgery Department', 'Sherry', 'Ji', 'Lim', 'MD', 'General Surgery', '', NULL, NULL, 'B', 'PO Box 4655', 'Houston', 'Harris', 'TX', '77210', '7134415151', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-07-29', NULL, NULL, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1659465300', 0, 'Y', 0, '2013-08-29', NULL, NULL, 0, 0, NULL, NULL),
('300520570', 'METH10013', 'METH10013', 'TXHOUSTD', 'TMHPO Surgery Department', 'Laurie', 'Jean', 'Punch', 'MD', 'General Surgery', 'Critical Care', NULL, NULL, 'O', '6550 Fannin Ste 1601', 'Houston', 'Harris', 'TX', '77030', '7134415141', '7137906470', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-07-29', '2013-09-30', NULL, 0, 0, 'Houston Methodist Hospital', '', '', NULL, 'HCFA|UB|', '1013042100', 0, 'N', 0, '2013-08-29', NULL, NULL, 29.712, -95.3995, NULL, NULL),
('300520570', 'METH10036', 'METH10036', 'TXHOUSTD', 'TMHPO Surgery Department', 'Laurie', 'Jean', 'Punch', 'MD', 'General Surgery', 'Critical Care', NULL, NULL, 'B', 'PO Box 4719', 'Houston', 'Harris', 'TX', '77210', '7134415151', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-07-29', '2013-09-30', NULL, 0, 0, 'Houston Methodist Hospital', '', '', NULL, 'HCFA|UB|', '1013042100', 0, 'Y', 0, '2013-08-29', NULL, NULL, 0, 0, NULL, NULL),
('571201170', 'METH10014', 'METH10014', 'TXHOUSTD', 'TMHPO Surgery Department', 'Wade', 'Ronald', 'Rosenberg', 'MD', 'General Surgery', 'Vascular Surgery', NULL, NULL, 'O', '6560 Fannin Ste 1750', 'Houston', 'Harris', 'TX', '77030', '7137904830', '7137937824', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-07-29', NULL, NULL, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1881694404', 0, 'N', 0, '2013-08-29', NULL, NULL, 29.7109, -95.4, NULL, NULL),
('571201170', 'METH10037', 'METH10037', 'TXHOUSTD', 'TMHPO Surgery Department', 'Wade', 'Ronald', 'Rosenberg', 'MD', 'General Surgery', 'Vascular Surgery', NULL, NULL, 'B', 'PO Box 4655', 'Houston', 'Harris', 'TX', '77210', '7134415151', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-07-29', NULL, NULL, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1881694404', 0, 'Y', 0, '2013-08-29', NULL, NULL, 0, 0, NULL, NULL),
('571201170', 'METH10015', 'METH10015', 'TXHOUSTD', 'Methodist Cardiovascular Surgery Associates', 'Scott', 'Alan', 'Scheinin', 'MD', 'Cardiothoracic Surgery', '', NULL, NULL, 'O', '6560 Fannin St Ste 1750', 'Houston', 'Harris', 'TX', '77030', '7137565314', '7137568616', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-07-29', NULL, NULL, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1619977238', 0, 'N', 0, '2013-08-29', NULL, NULL, 29.7109, -95.4, NULL, NULL),
('571201170', 'METH10038', 'METH10038', 'TXHOUSTD', 'Methodist Cardiovascular Surgery Associates', 'Scott', 'Alan', 'Scheinin', 'MD', 'Cardiothoracic Surgery', '', NULL, NULL, 'B', 'PO Box 4655', 'Houston', 'Harris', 'TX', '77210', '7134415151', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-07-29', NULL, NULL, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1619977238', 0, 'Y', 0, '2013-08-29', NULL, NULL, 0, 0, NULL, NULL),
('300520570', 'METH10049', 'METH10049', 'TXHOUSTD', 'TMHPO Surgery Department', 'Julie', 'Nicole', 'Stewart', 'MD', 'Urology', '', NULL, NULL, 'O', '18220 Tomball Pkwy Ste 400', 'Houston', 'Harris', 'TX', '77070', '2817370930', '2817370971', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-07-29', '2013-09-30', NULL, 0, 0, 'Houston Methodist Hospital', 'Houston Methodist Sugar Land Hospital', 'Houston Methodist Willowbrook Hospital', NULL, 'HCFA|UB|', '1891931283', 0, 'N', 0, '2013-08-29', NULL, NULL, 29.966, -95.5513, NULL, NULL),
('300520570', 'METH10016', 'METH10016', 'TXHOUSTD', 'TMHPO Surgery Department', 'Julie', 'Nicole', 'Stewart', 'MD', 'Urology', '', NULL, NULL, 'O', '6560 Fannin Ste 2100', 'Houston', 'Harris', 'TX', '77030', '7134416455', '7134416463', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-07-29', '2013-09-30', NULL, 0, 0, 'Houston Methodist Hospital', 'Houston Methodist Sugar Land Hospital', 'Houston Methodist Willowbrook Hospital', NULL, 'HCFA|UB|', '1891931283', 0, 'N', 0, '2013-08-29', NULL, NULL, 29.7109, -95.4002, NULL, NULL),
('300520570', 'METH10039', 'METH10039', 'TXHOUSTD', 'TMHPO Surgery Department', 'Julie', 'Nicole', 'Stewart', 'MD', 'Urology', '', NULL, NULL, 'B', 'PO Box 4719', 'Houston', 'Harris', 'TX', '77210', '7134418655', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-07-29', '2013-09-30', NULL, 0, 0, 'Houston Methodist Hospital', 'Houston Methodist Sugar Land Hospital', 'Houston Methodist Willowbrook Hospital', NULL, 'HCFA|UB|', '1891931283', 0, 'Y', 0, '2013-08-29', NULL, NULL, 0, 0, NULL, NULL),
('300520570', 'METH10022', 'METH10022', 'TXHOUSTD', 'TMHPO ICU Physicians', 'Janalei', 'Eve', 'Stovall', 'ACNP', 'Nurse Practitioner', '', NULL, NULL, 'O', '6565 Fannin Ste B452', 'Houston', 'Harris', 'TX', '77030', '7134413620', '7137902082', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOPCP', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-07-29', '2013-09-30', NULL, 0, 0, '', '', '', NULL, 'HCFA|UB|', '1215281472', 0, 'N', 0, '2013-08-29', NULL, NULL, 29.7098, -95.3999, NULL, NULL),
('300520570', 'METH10045', 'METH10045', 'TXHOUSTD', 'TMHPO ICU Physicians', 'Janalei', 'Eve', 'Stovall', 'ACNP', 'Nurse Practitioner', '', NULL, NULL, 'B', 'PO Box 4719', 'Houston', 'Harris', 'TX', '77210', '7134414347', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOPCP', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-07-29', '2013-09-30', NULL, 0, 0, '', '', '', NULL, 'HCFA|UB|', '1215281472', 0, 'Y', 0, '2013-08-29', NULL, NULL, 0, 0, NULL, NULL),
('571201170', 'METH10017', 'METH10017', 'TXHOUSTD', 'TMHPO Obstetrics and Gynecology Department', 'Anuj', '', 'Suri', 'MD', 'Gynecologic Oncology', '', NULL, NULL, 'O', '6550 Fannin Ste 901', 'Houston', 'Harris', 'TX', '77030', '7134411026', '7137902049', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-07-29', NULL, NULL, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1326366691', 0, 'N', 0, '2013-08-29', NULL, NULL, 29.7111, -95.3999, 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
('571201170', 'METH10040', 'METH10040', 'TXHOUSTD', 'TMHPO Obstetrics and Gynecology Department', 'Anuj', '', 'Suri', 'MD', 'Gynecologic Oncology', '', NULL, NULL, 'B', 'PO Box 4655', 'Houston', 'Harris', 'TX', '77210', '7134413208', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-07-29', NULL, NULL, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1326366691', 0, 'Y', 0, '2013-08-29', NULL, NULL, 0, 0, NULL, NULL),
('571201170', 'METH10018', 'METH10018', 'TXHOUSTD', 'Methodist Primary Care Group', 'George', 'Storm', 'Walmsley', 'MD', 'Family Practice', '', NULL, NULL, 'O', '3711 Garth Road Ste 306', 'Baytown', 'Harris', 'TX', '77521', '2814287373', '2814287035', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOPCP', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-07-29', NULL, NULL, 0, 0, 'Houston Methodist San Jacinto Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1598795916', 0, 'N', 0, '2013-08-29', NULL, NULL, 29.763, -94.9774, NULL, NULL),
('571201170', 'METH10041', 'METH10041', 'TXHOUSTD', 'Methodist Primary Care Group', 'George', 'Storm', 'Walmsley', 'MD', 'Family Practice', '', NULL, NULL, 'B', 'PO Box 4655', 'Houston', 'Harris', 'TX', '77210', '2814287373', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOPCP', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-07-29', NULL, NULL, 0, 0, 'Houston Methodist San Jacinto Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1598795916', 0, 'Y', 0, '2013-08-29', NULL, NULL, 0, 0, NULL, NULL),
('571201170', 'METH10019', 'METH10019', 'TXHOUSTD', 'Methodist Primary Care Group', 'Dara', 'Rosalie', 'Wang', 'MD', 'Internal Medicine', '', NULL, NULL, 'O', '18220 Tomball Pkwy Ste 400', 'Houston', 'Harris', 'TX', '77070', '2813762828', '2813208143', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOPCP', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-07-29', NULL, NULL, 0, 0, 'Houston Methodist Willowbrook Hospital', '', '', NULL, 'HCFA|UB|', '1417277724', 0, 'N', 0, '2013-08-29', NULL, NULL, 29.9641, -95.5508, NULL, NULL),
('571201170', 'METH10042', 'METH10042', 'TXHOUSTD', 'Methodist Primary Care Group', 'Dara', 'Rosalie', 'Wang', 'MD', 'Internal Medicine', '', NULL, NULL, 'B', 'PO Box 4655', 'Houston', 'Harris', 'TX', '77210', '2813762828', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOPCP', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-07-29', NULL, NULL, 0, 0, 'Houston Methodist Willowbrook Hospital', '', '', NULL, 'HCFA|UB|', '1417277724', 0, 'Y', 0, '2013-08-29', NULL, NULL, 0, 0, NULL, NULL),
('571201170', 'W12037366', 'W12037366', 'TXHOUSTD', 'TMHPO Obstetrics and Gynecology Department', 'Tarrik', '', 'Zaid', 'MD', 'Gynecologic Oncology', '', NULL, NULL, 'O', '16605 SW Fwy Ste 450', 'Sugar Land', 'Fort Bend', 'TX', '77479', '2812750860', '2812750861', '16605 SW Fwy Ste 450', 'Sugar Land', 'Fort Bend', 'TX', '77479', '2812750860', '2812750861', 'TMHPHOSPC', 'TXHCPCTMH', '', '0.00', '50.00', '0.00', 6, '2013-07-29', NULL, 0, 0, 0, 'Houston Methodist Sugar Land Hospital', 'Houston Methodist Hospital', '', NULL, 'HCFA|UB|', '1487834883', 0, 'N', 0, '2013-09-06', NULL, NULL, 29.5919, -95.6298, NULL, NULL),
('571201170', 'METH10050', 'METH10050', 'TXHOUSTD', 'TMHPO Obstetrics and Gynecology Department', 'Tarrik', '', 'Zaid', 'MD', 'Gynecologic Oncology', '', NULL, NULL, 'O', '6550 Fannin Ste 901', 'Houston', 'Harris', 'TX', '77030', '7134411026', '7137902049', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-07-29', NULL, NULL, 0, 0, 'Houston Methodist Sugar Land Hospital', 'Houston Methodist Hospital', '', NULL, 'HCFA|UB|', '1487834883', 0, 'N', 0, '2013-08-29', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('571201170', 'METH10043', 'METH10043', 'TXHOUSTD', 'TMHPO Obstetrics and Gynecology Department', 'Tarrik', '', 'Zaid', 'MD', 'Gynecologic Oncology', '', NULL, NULL, 'B', 'PO Box 4655', 'Houston', 'Harris', 'TX', '77210', '7134413208', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '0.00', '50.00', '0.00', 6, '2013-07-29', NULL, NULL, 0, 0, 'Houston Methodist Sugar Land Hospital', 'Houston Methodist Hospital', '', NULL, 'HCFA|UB|', '1487834883', 0, 'Y', 0, '2013-08-29', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12037367', 'W12037367', 'UTIHC04', 'Primary Childrens Medical Center', 'Louis', '', 'Morales', 'MD', 'Plastic Surgery', '', '', NULL, 'O', '736 S 900 E Ste 107', 'St George', 'Washington', 'UT', '84790', '4352512888', NULL, '736 S 900 E Ste 107', 'St George', 'Washington', 'UT', '84790', '4352512888', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2013-06-19', NULL, 0, 0, 0, 'Primary Childrens Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1821060948', 0, 'N', 0, '2013-08-29', NULL, NULL, 37.0956, -113.564, NULL, NULL),
('942854057', 'W12037369', 'W12037369', 'UTIHC04', 'PCMC Plastic Surgery', 'David', 'S', 'Motoki', 'MD', 'Plastic Surgery', '', '', NULL, 'O', '100 Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621000', NULL, '100 Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621000', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2013-07-01', NULL, 0, 0, 0, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1992874358', 0, 'N', 0, '2013-08-29', NULL, NULL, 40.7663, -111.837, NULL, NULL),
('942854057', 'W12037368', 'W12037368', 'UTIHC04', 'Primary Childrens Medical Center', 'David', 'S', 'Motoki', 'MD', 'Plastic Surgery', '', '', NULL, 'O', '736 S 900 E Ste 107', 'St George', 'Washington', 'UT', '84790', '4352512888', NULL, '736 S 900 E Ste 107', 'St George', 'Washington', 'UT', '84790', '4352512888', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2013-06-19', NULL, 0, 0, 0, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1992874358', 0, 'N', 0, '2013-08-29', NULL, NULL, 37.0956, -113.564, NULL, NULL),
('942854057', 'W12037370', 'W12037370', 'UTIHC04', '', 'Harlan', 'R', 'Muntz', 'MD', 'Ear, Nose and Throat', 'Pediatric Ear, Nose and Throat', '', NULL, 'O', '736 S 900 E Ste 107', 'St George', 'Washington', 'UT', '84790', '4352512888', NULL, '736 S 900 E Ste 107', 'St George', 'Washington', 'UT', '84790', '4352512888', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2013-06-19', NULL, 0, 0, 0, 'Primary Childrens Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1255421863', 0, 'N', 0, '2013-08-29', NULL, NULL, 37.0956, -113.564, NULL, NULL),
('942854057', 'W12037372', 'W12037372', 'UTIHC04', 'PCMC Rehab Sandy', 'Kelcey', 'O', 'Murdoch', 'OT', 'Occupational Therapy', '', '', NULL, 'O', '870 E 9400 S', 'Sandy', 'Salt Lake', 'UT', '84094', '8015713081', NULL, '870 E 9400 S', 'Sandy', 'Salt Lake', 'UT', '84094', '8015713081', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1164863551', 0, 'N', 0, '2013-08-29', NULL, NULL, 40.5806, -111.867, NULL, NULL),
('942854057', 'W12037373', 'W12037373', 'UTIHC04', 'Diabetic Clinic', 'Mary', 'A', 'Murray', 'MD', 'Pediatric Endocrinology', '', '', NULL, 'O', '615 Arapeen Dr Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015873922', NULL, '615 Arapeen Dr Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015873922', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2013-06-19', NULL, 0, 0, 0, 'University Health Care University Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1427097237', 0, 'N', 0, '2013-08-29', NULL, NULL, 40.7552, -111.827, NULL, NULL),
('900068348', 'W12037375', 'W12037375', 'TXHOUSTD', 'Peracha Waseem, MD', 'Waseem', '', 'Peracha', 'MD', 'Nephrology', '', '', NULL, 'B', '11152 Westheimer Rd Ste 702', 'Houston', 'Harris', 'TX', '77042', '2815588260', '2815318087', '11152 Westheimer Rd Ste 702', 'Houston', 'Harris', 'TX', '77042', '2815588260', '2815318087', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-10-13', NULL, 0, 0, 0, 'West Houston Medical Center', NULL, NULL, NULL, 'HCFA|', '1710986294', 0, 'N', 0, '2013-09-13', NULL, NULL, 0, 0, NULL, NULL),
('900068348', 'W12037374', 'W12037374', 'TXHOUSTD', 'Peracha Waseem, MD', 'Waseem', '', 'Peracha', 'MD', 'Nephrology', '', '', NULL, 'O', '12051 Westpark Dr Ste 200', 'Houston', 'Harris', 'TX', '77082', '2815588260', '2815318087', '12051 Westpark Dr Ste 200', 'Houston', 'Harris', 'TX', '77082', '2815588260', '2815318087', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-10-13', NULL, 0, 0, 0, 'West Houston Medical Center', NULL, NULL, NULL, 'HCFA|', '1710986294', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.7245, -95.5914, NULL, NULL),
('760635436', 'W12037376', 'W12037376', 'TXHOUSTD', 'Baptiste J DeJean', 'Baptiste', 'J', 'DeJean', 'MD', 'Ophthalmology', '', '', NULL, 'O', '400 S Loop 336 W', 'Conroe', 'Montgomery', 'TX', '77304', '9365394500', '9365394534', '400 S Loop 336 W', 'Conroe', 'Montgomery', 'TX', '77304', '9365394500', '9365394534', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, 'Conroe Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1669475455', 0, 'N', 0, '2013-08-30', NULL, NULL, 30.3051, -95.5095, NULL, NULL),
('760635436', 'W12037377', 'W12037377', 'TXHOUSTD', 'Baptiste J DeJean', 'Baptiste', 'J', 'DeJean', 'MD', 'Ophthalmology', '', '', NULL, 'O', '9201 Pinecroft', 'The Woodlands', 'Montgomery', 'TX', '77380', '2817195214', '2817195448', '9201 Pinecroft', 'The Woodlands', 'Montgomery', 'TX', '77380', '2817195214', '2817195448', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, 'Conroe Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1669475455', 0, 'N', 0, '2013-08-30', NULL, NULL, 30.1746, -95.4563, NULL, NULL),
('760635436', 'W12037378', 'W12037378', 'TXHOUSTD', 'Baptiste J DeJean', 'Baptiste', 'J', 'DeJean', 'MD', 'Ophthalmology', '', '', NULL, 'O', '3361 Montgomery Rd', 'Huntsville', 'Walker', 'TX', '77340', '9362940218', '9362940307', '3361 Montgomery Rd', 'Huntsville', 'Walker', 'TX', '77340', '9362940218', '9362940307', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, 'Conroe Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1669475455', 0, 'N', 0, '2013-08-30', NULL, NULL, 30.6921, -95.5562, NULL, NULL),
('760405084', 'W12037379', 'W12037379', 'TXHOUSTD', 'Medical Chest Associates', 'George', 'T', 'Keith', 'MD', 'Internal Medicine', '', '', NULL, 'O', '902 Frostwood Ste 172', 'Houston', 'Harris', 'TX', '77024', '7134678888', '7134675569', '902 Frostwood Ste 172', 'Houston', 'Harris', 'TX', '77024', '7134678888', '7134675569', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1598748873', 0, 'N', 0, '2013-08-30', NULL, NULL, 29.7795, -95.5478, NULL, NULL),
('760556911', 'W12037353', 'W12037353', 'TXHOUSTD', 'Tyreen Vidal Heybeck', 'Stephen', 'G', 'Eichelsdorfer', 'DPM', 'Podiatry', '', '', NULL, 'O', '18700 W Lake Houston Pkwy Ste A-105', 'Atascocita', 'Harris', 'TX', '77346', '2818122890', '2813617411', '18700 W Lake Houston Pkwy Ste A-105', 'Atascocita', 'Harris', 'TX', '77346', '2818122890', '2813617411', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-10-06', NULL, 0, 0, 0, 'Kingwood Medical Center', NULL, NULL, NULL, 'HCFA|', '1588642532', 0, 'N', 0, '2013-09-06', NULL, NULL, 29.99, -95.1615, NULL, NULL),
('760556911', 'W12037352', 'W12037352', 'TXHOUSTD', 'Tyreen Vidal Heybeck', 'Stephen', 'G', 'Eichelsdorfer', 'DPM', 'Podiatry', '', '', NULL, 'O', '400 Bypass Ln Ste 110', 'Livingston', 'Polk', 'TX', '77351', '9363274400', '2813617411', '400 Bypass Ln Ste 110', 'Livingston', 'Polk', 'TX', '77351', '9363274400', '2813617411', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-10-06', NULL, 0, 0, 0, 'Kingwood Medical Center', NULL, NULL, NULL, 'HCFA|', '1588642532', 0, 'N', 0, '2013-09-06', NULL, NULL, 30.6345, -94.828, NULL, NULL),
('760556911', 'W12037351', 'W12037351', 'TXHOUSTD', 'Tyreen Vidal Heybeck', 'Stephen', 'G', 'Eichelsdorfer', 'DPM', 'Podiatry', '', '', NULL, 'B', '8 N Main St Ste P', 'Kingwood', 'Harris', 'TX', '77339', '9363274400', '2813617411', '8 N Main St Ste P', 'Kingwood', 'Harris', 'TX', '77339', '9363274400', '2813617411', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-10-06', NULL, 0, 0, 0, 'Kingwood Medical Center', NULL, NULL, NULL, 'HCFA|', '1588642532', 0, 'N', 0, '2013-09-06', NULL, NULL, 0, 0, NULL, NULL),
('760123983', 'W12037380', 'W12037380', 'TXHOUSTD', 'Kuldip Kaul', 'Kuldip', '', 'Kaul', 'MD', 'Endocrinology', '', '', NULL, 'O', '2060 Spruce Park Dr Ste 400', 'Houston', 'Harris', 'TX', '77058', '2813332812', '2813335072', '2060 Spruce Park Dr Ste 400', 'Houston', 'Harris', 'TX', '77058', '2813332812', '2813335072', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, 'Bayshore Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1538154042', 0, 'N', 0, '2013-08-30', NULL, NULL, 29.7202, -95.6514, NULL, NULL),
('760123983', 'W12037381', 'W12037381', 'TXHOUSTD', 'Kuldip Kaul', 'Kuldip', '', 'Kaul', 'MD', 'Endocrinology', '', '', NULL, 'O', '3357 Plainview St Ste A-7', 'Pasadena', 'Harris', 'TX', '77504', '2813332812', '2813335072', '3357 Plainview St Ste A-7', 'Pasadena', 'Harris', 'TX', '77504', '2813332812', '2813335072', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, 'Bayshore Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1538154042', 0, 'N', 0, '2013-08-30', NULL, NULL, 29.6604, -95.1823, NULL, NULL),
('760405084', 'W12037382', 'W12037382', 'TXHOUSTD', 'Medical Chest Associates', 'Minh', 'A', 'Tran', 'MD', 'Pulmonary', '', '', NULL, 'O', '902 Frostwood Ste 172', 'Houston', 'Harris', 'TX', '77024', '7134678888', '7134675569', '902 Frostwood Ste 172', 'Houston', 'Harris', 'TX', '77024', '7134678888', '7134675569', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, 'Houston Methodist West Houston Hospital', NULL, '', '', 'HCFA|UB', '1457334443', 0, 'N', 0, '2013-08-30', NULL, NULL, 29.7795, -95.5478, NULL, NULL),
('760497726', 'W12037384', 'W12037384', 'TXHOUSTD', '', 'Shashi', 'S', 'Bellur', 'MD', 'Interventional Cardiology', '', '', NULL, 'O', '116 Medical Park Ln Ste A', 'Huntsville', 'Walker', 'TX', '77340', '9362958484', '9367568464', '116 Medical Park Ln Ste A', 'Huntsville', 'Walker', 'TX', '77340', '9362958484', '9367568464', 'HOUSTON2', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-10-06', NULL, 0, 0, 0, 'Conroe Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1346276557', 0, 'N', 0, '2013-09-06', NULL, NULL, 30.7099, -95.5613, NULL, NULL),
('760497726', 'W12037383', 'W12037383', 'TXHOUSTD', '', 'Shashi', 'S', 'Bellur', 'MD', 'Interventional Cardiology', '', '', NULL, 'O', '600 River Pointe Dr Ste 101', 'Conroe', 'Montgomery', 'TX', '77304', '9367568484', '9367568465', '600 River Pointe Dr Ste 101', 'Conroe', 'Montgomery', 'TX', '77304', '9367568484', '9367568465', 'HOUSTON2', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-10-06', NULL, 0, 0, 0, 'Conroe Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1346276557', 0, 'N', 0, '2013-09-06', NULL, NULL, 30.2861, -95.4684, NULL, NULL),
('820200895', 'W12037504', 'W12037504', 'IDBOISTD', 'Saint Alphonsus Medical Group Neurology Boise', 'Lukas', 'T', 'Clark', 'MD', 'Neurology', '', '', NULL, 'O', '901 N Curtis St Ste 403', 'Boise', 'Ada', 'ID', '83706', '2083677272', '2083677111', '901 N Curtis St Ste 403', 'Boise', 'Ada', 'ID', '83706', '2083677272', '2083677111', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2013-08-21', '2014-05-26', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1659519593', 0, 'N', 0, '2014-05-14', NULL, NULL, 43.6126, -116.254, NULL, NULL),
('010593260', 'W12037387', 'W12037387', 'TXHOUSTD', 'Digestive and Liver Specialists of Houston', '', '', 'Digestive and Liver Specialists of Houston', '', 'Gastroenterology', '', '', NULL, 'O', '915 Gessner Ste 850', 'Houston', 'Harris', 'TX', '77024', '7134611026', '7134614358', '915 Gessner Ste 850', 'Houston', 'Harris', 'TX', '77024', '7134611026', '7134614358', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-10-06', NULL, 0, 0, 0, 'Houston Methodist West Houston Hospital', '', '', '', 'HCFA|UB|', '1619942778', 0, 'Y', 0, '2014-04-24', NULL, NULL, 29.7804, -95.5445, NULL, NULL),
('760697877', 'W12037389', 'W12037389', 'TXHOUSTD', '', 'Cynthia', '', 'Sloan', 'PA', 'Neurology', '', '', NULL, 'O', '2255 N Loop 336 W Ste B', 'Conroe', 'Montgomery', 'TX', '77304', '9367882233', '9367882330', '2255 N Loop 336 W Ste B', 'Conroe', 'Montgomery', 'TX', '77304', '9367882233', '9367882330', 'HOUSTON5', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-10-06', NULL, 0, 0, 0, 'Conroe Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1235117821', 0, 'N', 0, '2013-09-06', NULL, NULL, 30.3295, -95.4933, NULL, NULL),
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('952667855', 'W12037424', 'W12037424', 'NM01', 'Hanger Clinic (Orthotics, Prosthetics & Breast Prosthetics)', '', '', 'Hanger Prosthetics & Orthotics Inc', '', 'Durable Medical Equipment', '', '', NULL, 'O', '715 Martin Luther King Jr Blvd Ste 101', 'Albuquerque', 'Bernalillo', 'NM', '87102', '5052249632', '5052242718', '715 Martin Luther King Jr Blvd Ste 101', 'Albuquerque', 'Bernalillo', 'NM', '87102', '5052249632', '5052242718', 'DME8013', '', '', '0.00', '25.00', '0.00', 3, '2013-05-01', '2014-03-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1831229145', 0, 'N', 0, '2014-04-29', NULL, NULL, 35.0856, -106.639, NULL, NULL),
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('942854057', 'W12037433', 'W12037433', 'UTIHC04', 'Spina Bifida Clinic', 'John', 'T', 'Smith', 'MD', 'Pediatric Orthopedic Surgery', 'Pediatric Orthopedic Radiology', 'Orthopedic Surgery', NULL, 'O', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621000', NULL, '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621000', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2013-06-19', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1255432001', 0, 'N', 0, '2014-01-31', NULL, NULL, 40.7663, -111.837, NULL, NULL),
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('942854057', 'W12037437', 'W12037437', 'UTIHC04', 'Cleft', 'Helene', 'Mary', 'Taylor', 'SLP', 'Speech Therapy', 'Speech Language Pathology', '', NULL, 'O', '736 S 900 E Ste 107', 'St George', 'Washington', 'UT', '84790', '4352512888', NULL, '736 S 900 E Ste 107', 'St George', 'Washington', 'UT', '84790', '4352512888', '', '', '', '', '0.00', '10.00', '0.00', 8, '2013-06-19', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1568470664', 0, 'N', 0, '2014-05-22', NULL, NULL, 37.0956, -113.564, NULL, NULL),
('942854057', 'W12037439', 'W12037439', 'UTIHC04', 'Cleft', 'Amy', 'L', 'Walton', 'SLP', 'Speech Therapy', '', '', NULL, 'O', '736 S 900 E Ste 107', 'St George', 'Washington', 'UT', '84790', '4352512888', NULL, '736 S 900 E Ste 107', 'St George', 'Washington', 'UT', '84790', '4352512888', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2013-06-19', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1649462631', 0, 'N', 0, '2013-09-03', NULL, NULL, 37.0956, -113.564, NULL, NULL),
('942854057', 'W12037440', 'W12037440', 'UTIHC04', 'Cleft', 'Steven', 'H', 'Warnock', 'MD', 'Plastic Surgery', '', '', NULL, 'O', '736 S 900 E Ste 107', 'St George', 'Washington', 'UT', '84790', '4352512888', NULL, '736 S 900 E Ste 107', 'St George', 'Washington', 'UT', '84790', '4352512888', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2013-06-19', NULL, 0, 0, 0, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1457337594', 0, 'N', 0, '2013-09-19', NULL, NULL, 37.0956, -113.564, NULL, NULL),
('942854057', 'W12037443', 'W12037443', 'UTIHC04', 'Cleft', 'Duane', 'K', 'Yamashiro', 'DDS', 'Pedodontist', '', '', NULL, 'O', '736 S 900 E Ste 107', 'St George', 'Washington', 'UT', '84790', '4352512888', NULL, '736 S 900 E Ste 107', 'St George', 'Washington', 'UT', '84790', '4352512888', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2013-06-19', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1629275151', 0, 'N', 0, '2013-09-03', NULL, NULL, 37.0956, -113.564, NULL, NULL),
('942854057', 'W12037442', 'W12037442', 'UTIHC04', 'Cleft', 'Duane', 'K', 'Yamashiro', 'DDS', 'Pedodontist', '', '', NULL, 'O', '100 Mario Capecchi Dr ', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621630', NULL, '100 Mario Capecchi Dr ', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621630', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2013-06-19', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1629275151', 0, 'N', 0, '2013-09-03', NULL, NULL, 40.7663, -111.837, NULL, NULL),
('364088232', 'W12037449', 'W12037449', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Thomas', 'M', 'Zabiega', 'MD', 'Neurology', '', '', NULL, 'O', '4100 Healthway Dr', 'Aurora', 'Dupage', 'IL', '60504', '6308513105', '6309786669', '4100 Healthway Dr', 'Aurora', 'Dupage', 'IL', '60504', '6308513105', '6309786669', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-08-22', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, '', '', 'HCFA|UB|', '1386755916', 0, 'N', 0, '2013-09-03', NULL, NULL, 41.7522, -88.2131, NULL, NULL),
('364088232', 'W12037450', 'W12037450', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Thomas', 'M', 'Zabiega', 'MD', 'Neurology', '', '', NULL, 'O', '1870 W Galena Blvd', 'Aurora', 'Kane', 'IL', '60506', '6308596700', '6308597284', '1870 W Galena Blvd', 'Aurora', 'Kane', 'IL', '60506', '6308596700', '6308597284', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-08-22', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, '', '', 'HCFA|UB|', '1386755916', 0, 'N', 0, '2013-09-03', NULL, NULL, 41.7642, -88.3626, NULL, NULL),
('364088232', 'W12037451', 'W12037451', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Thomas', 'M', 'Zabiega', 'MD', 'Neurology', '', '', NULL, 'B', '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', NULL, '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', '          ', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-08-22', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, '', '', 'HCFA|UB|', '1386755916', 0, 'N', 0, '2013-09-03', NULL, NULL, 0, 0, NULL, NULL),
('364088232', 'W12037453', 'W12037453', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Travis', 'L', 'Falls', 'PT', 'Physical Therapy', '', '', NULL, 'B', '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', NULL, '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', '          ', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-08-26', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1821344128', 0, 'N', 0, '2013-09-09', NULL, NULL, 0, 0, NULL, NULL),
('364088232', 'W12037457', 'W12037457', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Travis', 'L', 'Falls', 'PT', 'Physical Therapy', '', '', NULL, 'O', '1221 N Highland Ave', 'Aurora', 'Kane', 'IL', '60506', '6308598700', '6302648444', '1221 N Highland Ave', 'Aurora', 'Kane', 'IL', '60506', '6308598700', '6302648444', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-08-26', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1821344128', 0, 'N', 0, '2013-09-09', NULL, NULL, 41.7821, -88.3293, NULL, NULL),
('364088232', 'W12037456', 'W12037456', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Travis', 'L', 'Falls', 'PT', 'Physical Therapy', '', '', NULL, 'O', '1870 W Galena Blvd', 'Aurora', 'Kane', 'IL', '60506', '6308596700', '6308596811', '1870 W Galena Blvd', 'Aurora', 'Kane', 'IL', '60506', '6308596700', '6308596811', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-08-26', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1821344128', 0, 'N', 0, '2013-09-09', NULL, NULL, 41.7642, -88.3626, NULL, NULL),
('364088232', 'W12037455', 'W12037455', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Travis', 'L', 'Falls', 'PT', 'Physical Therapy', '', '', NULL, 'O', '2500 W Fabyan Pkwy', 'Batavia', 'Kane', 'IL', '60510', '6308792110', '6307624779', '2500 W Fabyan Pkwy', 'Batavia', 'Kane', 'IL', '60510', '6308792110', '6307624779', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-08-26', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1821344128', 0, 'N', 0, '2013-09-09', NULL, NULL, 41.8633, -88.269, NULL, NULL),
('364088232', 'W12037454', 'W12037454', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Travis', 'L', 'Falls', 'PT', 'Physical Therapy', '', '', NULL, 'O', '80 Templeton Dr', 'Oswego', 'Kendall', 'IL', '60543', '6305543456', '6305512933', '80 Templeton Dr', 'Oswego', 'Kendall', 'IL', '60543', '6305543456', '6305512933', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-08-26', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1821344128', 0, 'N', 0, '2013-09-09', NULL, NULL, 41.6724, -88.3381, NULL, NULL),
('752942548', 'W12037458', 'W12037458', 'TXDALSTD', 'Comprehensive Orthopaedics and Rehabilitation', 'Virenda', '', 'Patel', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1120 W Campbell Rd Ste 109', 'Richardson', 'Dallas', 'TX', '75080', '2145752663', '2145752664', '1120 W Campbell Rd Ste 109', 'Richardson', 'Dallas', 'TX', '75080', '2145752663', '2145752664', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, '', '', 'HCFA|UB|', '1669654398', 0, 'N', 0, '2014-04-25', NULL, NULL, 32.9783, -96.7585, NULL, NULL),
('850275777', 'W12037459', 'W12037459', 'NM01', 'Southwest Medical Associates', 'Michelle', 'D', 'Barone', 'ANP-C', 'Family Practice', '', '', NULL, 'O', '8401 Constitution NE Ste 150', 'Albuquerque', 'Bernalillo', 'NM', '87110', '5058231010', '5057974503', '8401 Constitution NE Ste 150', 'Albuquerque', 'Bernalillo', 'NM', '87110', '5058231010', '5057974503', 'NMSWMED', '', '', '0.00', '10.00', '0.00', 3, '2013-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1255640140', 0, 'N', 0, '2013-09-10', NULL, NULL, 35.0946, -106.552, NULL, NULL),
('850275777', 'W12037460', 'W12037460', 'NM01', 'Southwest Medical Associates', 'Michelle', 'D', 'Barone', 'ANP-C', 'Family Practice', '', '', NULL, 'B', '6100 Pan American Fwy, Ne Ste 100', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058231010', '5058231010', '6100 Pan American Fwy, Ne Ste 100', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058231010', '5058231010', 'NMSWMED', '', '', '0.00', '10.00', '0.00', 3, '2013-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1255640140', 0, 'N', 0, '2013-09-10', NULL, NULL, 0, 0, NULL, NULL),
('300176561', 'W12037463', 'W12037463', 'ILCHIGSTD', 'Midwest Orthopaedics at Rush', 'Brett', 'R', 'Levine', 'MD', 'Orthopedic Surgery', '', '', NULL, 'M', '2450 S Wolf Rd Ste F', 'Westchester', 'Cook', 'IL', '60154', '7082362750', '7085626875', '2450 S Wolf Rd Ste F', 'Westchester', 'Cook', 'IL', '60154', '7082362750', '7085626875', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-08-06', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '1578542882', 0, 'N', 0, '2014-04-25', NULL, NULL, 41.8456, -87.9013, NULL, NULL),
('300176561', 'W12037461', 'W12037461', 'ILCHIGSTD', 'Midwest Orthopaedics at Rush', 'Brett', 'R', 'Levine', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1611 W Harrison Ste 400', 'Chicago', 'Cook', 'IL', '60612', '3122434244', '3129421517', '1611 W Harrison Ste 400', 'Chicago', 'Cook', 'IL', '60612', '3122434244', '3129421517', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-08-06', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '1578542882', 0, 'N', 0, '2014-04-25', NULL, NULL, 41.8742, -87.6669, NULL, NULL),
('300176561', 'W12037462', 'W12037462', 'ILCHIGSTD', 'Midwest Orthopaedics at Rush', 'Brett', 'R', 'Levine', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '610 S Maple Ave Ste 1400', 'Oak Park', 'Cook', 'IL', '60304', '7083830770', '7083835673', '610 S Maple Ave Ste 1400', 'Oak Park', 'Cook', 'IL', '60304', '7083830770', '7083835673', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-08-06', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '1578542882', 0, 'N', 0, '2014-04-25', NULL, NULL, 41.878, -87.8038, NULL, NULL),
('300176561', 'W12037464', 'W12037464', 'ILCHIGSTD', 'Midwest Orthopaedics at Rush', 'Brett', 'R', 'Levine', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', 'Insurance Payments Dept 4559', 'Carol Stream', 'Dupage', 'IL', '60122', '7082362607', '7084925607', 'Insurance Payments Dept 4559', 'Carol Stream', 'Dupage', 'IL', '60122', '7082362607', '7084925607', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-08-06', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '1578542882', 0, 'N', 0, '2014-04-25', NULL, NULL, 0, 0, NULL, NULL),
('300176561', 'W12037465', 'W12037465', 'ILCHIGSTD', 'Midwest Orthopaedics at Rush', 'Scott', '', 'Schonner', 'MD', 'Orthopedic Surgery', '', '', NULL, 'M', '2450 S Wolf Rd Ste F', 'Westchester', 'Cook', 'IL', '60154', '7082362750', '7085626875', '2450 S Wolf Rd Ste F', 'Westchester', 'Cook', 'IL', '60154', '7082362750', '7085626875', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-08-06', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '1043299795', 0, 'N', 0, '2014-04-25', NULL, NULL, 41.8456, -87.9013, NULL, NULL),
('300176561', 'W12037466', 'W12037466', 'ILCHIGSTD', 'Midwest Orthopaedics at Rush', 'Scott', '', 'Schonner', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1611 W Harrison Ste 400', 'Chicago', 'Cook', 'IL', '60612', '3122434244', '3129421517', '1611 W Harrison Ste 400', 'Chicago', 'Cook', 'IL', '60612', '3122434244', '3129421517', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-08-06', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '1043299795', 0, 'N', 0, '2014-04-25', NULL, NULL, 41.8742, -87.6669, NULL, NULL),
('300176561', 'W12037467', 'W12037467', 'ILCHIGSTD', 'Midwest Orthopaedics at Rush', 'Scott', '', 'Schonner', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', 'Insurance Payments Dept 4559', 'Carol Stream', 'Dupage', 'IL', '60122', '7082362607', '7084925607', 'Insurance Payments Dept 4559', 'Carol Stream', 'Dupage', 'IL', '60122', '7082362607', '7084925607', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-08-06', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '1043299795', 0, 'N', 0, '2014-04-25', NULL, NULL, 0, 0, NULL, NULL),
('300176561', 'W12037468', 'W12037468', 'ILCHIGSTD', 'Midwest Orthopaedics at Rush', 'Scott', '', 'Schonner', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '25 N Winfield Rd', 'Winfield', 'Dupage', 'IL', '60190', '6306825653', '6306828946', '25 N Winfield Rd', 'Winfield', 'Dupage', 'IL', '60190', '6306825653', '6306828946', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-08-06', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '1043299795', 0, 'N', 0, '2014-04-25', NULL, NULL, 41.8714, -88.1583, NULL, NULL),
('911947573', 'W12037470', 'W12037470', 'TXDALSTD', 'Health Texas Provider Network', 'Mandees', '', 'Behzad-Noori', 'MD', 'Internal Medicine', '', '', NULL, 'O', '3500 Gaston Ave Roberts Tower 4th Fl', 'Dallas', 'Dallas', 'TX', '75246', '2148203000', '2148203022', '3500 Gaston Ave Roberts Tower 4th Fl', 'Dallas', 'Dallas', 'TX', '75246', '2148203000', '2148203022', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1790002202', 0, 'Y', 0, '2013-09-11', NULL, NULL, 32.7911, -96.7802, NULL, NULL),
('911947573', 'W12037471', 'W12037471', 'TXDALSTD', 'Health Texas Provider Network', 'Mandees', '', 'Behzad-Noori', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 842001', 'Dallas', 'Dallas', 'TX', '75284', '2148203000', '2148203022', 'PO Box 842001', 'Dallas', 'Dallas', 'TX', '75284', '2148203000', '2148203022', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1790002202', 0, 'N', 0, '2013-09-11', NULL, NULL, 0, 0, NULL, NULL);
