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
('870546501', 'W12007940', 'W12007940', 'UT01', 'Alpine Pediatrics', 'Jesse', 'A', 'Alba', 'MD', 'Pediatrics', '', '', NULL, 'O', '3231 N 1120 E', 'Lehi', 'Utah', 'UT', '84043', '8017682800', '8019229370', '3231 N 1120 E', 'Lehi', 'Utah', 'UT', '84043', '8017682800', '8019229370', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-02-02', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1932386711', 0, 'N', 0, '2011-02-02', NULL, NULL, 40.4282, -111.832, NULL, NULL),
('870609595', 'W12007941', 'W12007941', 'UT01', 'Utah County Medical Associates', 'Frank', 'J', 'Archer', 'MD', 'Family Practice', '', '', NULL, 'O', '97 S Professional Way Ste 2', 'Payson', 'Utah', 'UT', '84651', '8014654896', NULL, '97 S Professional Way Ste 2', 'Payson', 'Utah', 'UT', '84651', '8014654896', '          ', 'WUTCTY', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-04-01', NULL, 0, 0, 0, 'Mountain View Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1093710998', 0, 'N', 0, '2013-10-15', NULL, NULL, 40.0429, -111.712, NULL, NULL),
('870609595', 'W12007942', 'W12007942', 'UT01', 'Utah County Medical Associates', 'Frank', 'J', 'Archer', 'MD', 'Family Practice', '', '', NULL, 'O', '376 E 400 S', 'Springville', 'Utah', 'UT', '84663', '8014654896', NULL, '376 E 400 S', 'Springville', 'Utah', 'UT', '84663', '8014654896', '          ', 'WUTCTY', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-04-01', NULL, 0, 0, 0, 'Mountain View Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1093710998', 0, 'N', 0, '2013-10-15', NULL, NULL, 40.1611, -111.604, NULL, NULL),
('870609595', 'W12007943', 'W12007943', 'UT01', 'Utah County Medical Associates', 'Frank', 'J', 'Archer', 'MD', 'Family Practice', '', '', NULL, 'O', '15 S 1000 E Ste 300', 'Payson', 'Utah', 'UT', '84651', '8014654896', NULL, '15 S 1000 E Ste 300', 'Payson', 'Utah', 'UT', '84651', '8014654896', '          ', 'WUTCTY', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-04-01', NULL, 0, 0, 0, 'Mountain View Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1093710998', 0, 'N', 0, '2013-10-15', NULL, NULL, 40.044, -111.716, NULL, NULL),
('870546501', 'W12007944', 'W12007944', 'UT01', 'Alpine Pediatrics', 'Bradley', 'C', 'Arnold', 'MD', 'Pediatrics', '', '', NULL, 'O', '77 E Commerce Dr', 'Saratoga Springs', 'Utah', 'UT', '84045', '8019229222', '8019229370', '77 E Commerce Dr', 'Saratoga Springs', 'Utah', 'UT', '84045', '8019229222', '8019229370', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-02-02', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1417995671', 0, 'N', 0, '2014-04-15', NULL, NULL, 40.3848, -111.914, NULL, NULL),
('870546501', 'W12007945', 'W12007945', 'UT01', 'Alpine Pediatrics', 'Bradley', 'C', 'Arnold', 'MD', 'Pediatrics', '', '', NULL, 'O', '3231 N 1120 E', 'Lehi', 'Utah', 'UT', '84043', '8017682800', NULL, '3231 N 1120 E', 'Lehi', 'Utah', 'UT', '84043', '8017682800', '', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-02-02', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1417995671', 0, 'N', 0, '2014-04-15', NULL, NULL, 40.4282, -111.832, NULL, NULL),
('870609595', 'W12007947', 'W12007947', 'UT01', 'Utah County Medical Associates', 'George', 'M', 'Baker', 'PA', 'Family Practice', '', '', NULL, 'O', '97 S Professional Way Ste 2', 'Payson', 'Utah', 'UT', '84651', '8014654896', NULL, '97 S Professional Way Ste 2', 'Payson', 'Utah', 'UT', '84651', '8014654896', '', 'WUTCTY', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-02-02', NULL, 0, 0, 0, 'Mountain View Hospital', '', '', '', 'HCFA|UB|', '1124046370', 0, 'Y', 0, '2014-07-16', NULL, NULL, 40.0429, -111.712, NULL, NULL),
('870609595', 'W12007948', 'W12007948', 'UT01', 'Utah County Medical Associates', 'George', 'M', 'Baker', 'PA', 'Family Practice', '', '', NULL, 'O', '376 E 400 S', 'Springville', 'Utah', 'UT', '84663', '8014654896', NULL, '376 E 400 S', 'Springville', 'Utah', 'UT', '84663', '8014654896', '', 'WUTCTY', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-02-02', NULL, 0, 0, 0, 'Mountain View Hospital', '', '', '', 'HCFA|UB|', '1124046370', 0, 'N', 0, '2014-07-16', NULL, NULL, 40.1611, -111.604, NULL, NULL),
('870609595', 'W12007949', 'W12007949', 'UT01', 'Utah County Medical Associates', 'George', 'M', 'Baker', 'PA', 'Family Practice', '', '', NULL, 'O', '15 S 1000 E Ste 300', 'Payson', 'Utah', 'UT', '84651', '8014654896', NULL, '15 S 1000 E Ste 300', 'Payson', 'Utah', 'UT', '84651', '8014654896', '', 'WUTCTY', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-02-02', NULL, 0, 0, 0, 'Mountain View Hospital', '', '', '', 'HCFA|UB|', '1124046370', 0, 'Y', 0, '2014-07-16', NULL, NULL, 40.044, -111.716, NULL, NULL),
('870609595', 'W12007950', 'W12007950', 'UT01', 'Utah County Medical Associates', 'George', 'M', 'Baker', 'PA', 'Family Practice', '', '', NULL, 'B', 'PO Box 9487', 'Belfast', 'Waldo', 'ME', '04915', '8014654896', NULL, 'PO Box 9487', 'Belfast', 'Waldo', 'ME', '04915', '8014654896', '', 'WUTCTY', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-02-02', NULL, 0, 0, 0, 'Mountain View Hospital', '', '', '', 'HCFA|UB|', '1124046370', 0, 'N', 0, '2014-07-16', NULL, NULL, 0, 0, NULL, NULL),
('680562677', 'W12007951', 'W12007951', 'UT01', 'Intermountain Ear Nose and Throat Specialists', 'John', 'R', 'Bennett', 'MD', 'Ear, Nose and Throat', 'Plastic Surgery', '', NULL, 'O', '756 E 12200 S', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013282522', '8015330589', '756 E 12200 S', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013282522', '8015330589', 'WiseOrtho', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-02-02', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1699800227', 0, 'N', 0, '2011-02-02', NULL, NULL, 0, 0, NULL, NULL),
('611572907', 'W12007955', 'W12007955', 'UT01', 'South Ogden Center for Family Medicine', 'James', 'A', 'Bledsoe', 'DO', 'Family Practice', '', '', NULL, 'O', '5740 Crestwood Dr', 'Ogden', 'Weber', 'UT', '84405', '8014797771', NULL, '5740 Crestwood Dr', 'Ogden', 'Weber', 'UT', '84405', '8014797771', '          ', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-11-01', '2012-06-30', 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1669467544', 0, 'N', 0, '2012-06-23', NULL, NULL, 0, 0, NULL, NULL),
('611572907', 'W12007956', 'W12007956', 'UT01', 'South Ogden Center for Family Medicine', 'James', 'A', 'Bledsoe', 'DO', 'Family Practice', '', '', NULL, 'B', 'PO Box 405714', 'Atlanta', 'Fulton', 'GA', '30384', '8014797771', NULL, 'PO Box 405714', 'Atlanta', 'Fulton', 'GA', '30384', '8014797771', '          ', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-11-01', '2012-06-30', 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1669467544', 0, 'N', 0, '2012-06-23', NULL, NULL, 0, 0, NULL, NULL),
('870293873', 'W12007977', 'W12007977', 'UT01', 'Tri City Medical Clinic', 'Elwood', 'J', 'Corry', 'MD', 'Family Practice', '', '', NULL, 'O', '275 W 200 N', 'Lindon', 'Utah', 'UT', '84042', '8017961333', NULL, '275 W 200 N', 'Lindon', 'Utah', 'UT', '84042', '8017961333', '          ', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-07-15', '2013-06-30', 0, 0, 0, 'Timpanogos Regional Hospital', 'Mountain View Hospital', '', '', 'HCFA|UB|', '1609984988', 0, 'N', 0, '2014-01-21', NULL, NULL, 0, 0, NULL, NULL),
('870577591', 'W12007963', 'W12007963', 'UTMH1', 'Psychological Assessment and Treatment Specialists', 'Jennifer', 'A', 'Cannon', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '814 E Bamberger Dr Ste A', 'American Fork', 'Utah', 'UT', '84003', '8017720202', '8017720139', '814 E Bamberger Dr Ste A', 'American Fork', 'Utah', 'UT', '84003', '8017720202', '8017720139', 'PHD', '', '', '0.00', '35.00', '0.00', 6, '2011-02-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1104127869', 0, 'N', 0, '2014-01-22', NULL, NULL, 0, 0, NULL, NULL),
('611572907', 'W12007964', 'W12007964', 'UT01', 'South Ogden Center for Family Medicine', 'Dan', '', 'Chapman', 'PA', 'Family Practice', '', '', NULL, 'O', '5740 Crestwood Dr', 'Ogden', 'Weber', 'UT', '84405', '8014797771', NULL, '5740 Crestwood Dr', 'Ogden', 'Weber', 'UT', '84405', '8014797771', '          ', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-11-01', '2012-02-16', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1346275716', 0, 'N', 0, '2012-04-24', NULL, NULL, 0, 0, NULL, NULL),
('611572907', 'W12007965', 'W12007965', 'UT01', 'South Ogden Center for Family Medicine', 'Dan', '', 'Chapman', 'PA', 'Family Practice', '', '', NULL, 'B', 'PO Box 405714', 'Atlanta', 'Fulton', 'GA', '30384', '8014797771', NULL, 'PO Box 405714', 'Atlanta', 'Fulton', 'GA', '30384', '8014797771', '          ', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-11-01', '2012-02-16', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1346275716', 0, 'N', 0, '2012-04-24', NULL, NULL, 0, 0, NULL, NULL),
('870609595', 'W12007966', 'W12007966', 'UT01', 'Utah County Medical Associates', 'Robert', 'B', 'Clark', 'MD', 'Family Practice', '', '', NULL, 'O', '97 S Professional Way Ste 2', 'Payson', 'Utah', 'UT', '84651', '8014654896', NULL, '97 S Professional Way Ste 2', 'Payson', 'Utah', 'UT', '84651', '8014654896', '          ', 'WUTCTY', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-04-01', NULL, 0, 0, 0, 'Mountain View Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1689692071', 0, 'N', 0, '2011-12-20', NULL, NULL, 40.0429, -111.712, NULL, NULL),
('870609595', 'W12007967', 'W12007967', 'UT01', 'Utah County Medical Associates', 'Robert', 'B', 'Clark', 'MD', 'Family Practice', '', '', NULL, 'O', '376 E 400 S', 'Springville', 'Utah', 'UT', '84663', '8014654896', NULL, '376 E 400 S', 'Springville', 'Utah', 'UT', '84663', '8014654896', '          ', 'WUTCTY', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-04-01', NULL, 0, 0, 0, 'Mountain View Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1689692071', 0, 'N', 0, '2011-12-20', NULL, NULL, 40.1611, -111.604, NULL, NULL),
('870609595', 'W12007968', 'W12007968', 'UT01', 'Utah County Medical Associates', 'Robert', 'B', 'Clark', 'MD', 'Family Practice', '', '', NULL, 'O', '15 S 1000 E Ste 300', 'Payson', 'Utah', 'UT', '84651', '8014657896', NULL, '15 S 1000 E Ste 300', 'Payson', 'Utah', 'UT', '84651', '8014657896', '          ', 'WUTCTY', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-04-01', NULL, 0, 0, 0, 'Mountain View Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1689692071', 0, 'N', 0, '2011-12-20', NULL, NULL, 40.044, -111.716, NULL, NULL),
('870609595', 'W12007969', 'W12007969', 'UT01', 'Utah County Medical Associates', 'Robert', 'B', 'Clark', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 9487', 'Belfast', 'Waldo', 'ME', '04915', '8014654896', NULL, 'PO Box 9487', 'Belfast', 'Waldo', 'ME', '04915', '8014654896', '          ', 'WUTCTY', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-04-01', NULL, 0, 0, 0, 'Mountain View Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1689692071', 0, 'N', 0, '2011-12-20', NULL, NULL, 0, 0, NULL, NULL),
('050569704', 'W12007970', 'W12007970', 'UT01', 'Pinnacle Family Care', 'Peter', 'C', 'Clemens', 'DO', 'Wound Care', 'Family Medicine', '', NULL, 'O', '434 E 5350 S', 'Ogden', 'Weber', 'UT', '84405', '8014757100', '8014757101', '434 E 5350 S', 'Ogden', 'Weber', 'UT', '84405', '8014757100', '8014757101', 'WUSTDFAM5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-01-11', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1487858940', 0, 'N', 0, '2011-11-15', NULL, NULL, 41.166, -111.97, NULL, NULL),
('272464625', 'W12007971', 'W12007971', 'UT01', 'Paramount Medical Care ', 'Peter', 'C', 'Clemens', 'DO', 'Wound Care', 'Family Medicine', '', NULL, 'O', '434 E 5350 S Ste B', 'Ogden', 'Weber', 'UT', '84405', '8014757100', '8014757101', '434 E 5350 S Ste B', 'Ogden', 'Weber', 'UT', '84405', '8014757100', '8014757101', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-03-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1487858940', 0, 'N', 0, '2011-11-15', NULL, NULL, 41.166, -111.97, NULL, NULL),
('263829375', 'W12007972', 'W12007972', 'UT01', 'Cedar Dermatology', 'Rand', 'L', 'Colbert', 'MD', 'Dermatology', 'Pathology', '', NULL, 'O', '200 N 400 E', 'Panguitch', 'Garfield', 'UT', '84759', '4355866440', '4358651477', '200 N 400 E', 'Panguitch', 'Garfield', 'UT', '84759', '4355866440', '4358651477', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-03-01', NULL, 0, 0, 0, 'Valley View Medical Center', '', '', '', 'HCFA|UB|', '1073692380', 0, 'N', 0, '2011-09-20', NULL, NULL, 37.8258, -112.428, NULL, NULL),
('870281299', 'W12007978', 'W12007978', 'UT01', 'American Fork Clinic', 'Michael', 'L', 'Cosgrave', 'MD', 'Family Practice', '', '', NULL, 'O', '226 N 1100 E', 'American Fork', 'Utah', 'UT', '84003', '8018553843', NULL, '226 N 1100 E', 'American Fork', 'Utah', 'UT', '84003', '8018553843', '          ', 'WUTANNER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-02-03', '2013-06-30', 0, 0, 0, 'Salt Lake Regional Medical Center', 'St Marks Hospital', NULL, NULL, 'HCFA|UB|', '1023127214', 0, 'N', 0, '2013-10-25', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W12007980', 'W12007980', 'UT01', 'Central Utah Clinic', 'Bruce', 'H', 'Chamberlain', 'MD', 'Internal Medicine', '', '', NULL, 'M', '1055 N 500 W', 'Provo', 'Utah', 'UT', '84604', '          ', NULL, '1055 N 500 W', 'Provo', 'Utah', 'UT', '84604', '          ', '          ', 'WUUVPN11', '', '', '0.00', '35.00', '0.00', 3, '2010-12-01', '2011-02-28', 0, 0, 0, 'Timpanogos Regional Hospital', 'Mountain View Hospital', '', '', 'HCFA|UB|', '1285664078', 0, 'N', 0, '2012-07-25', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W12007979', 'W12007979', 'UT01', 'Central Utah Clinic', 'Bruce', 'H', 'Chamberlain', 'MD', 'Internal Medicine', '', '', NULL, 'O', '750 W 800 N', 'Provo', 'Utah', 'UT', '84604', '          ', NULL, '750 W 800 N', 'Provo', 'Utah', 'UT', '84604', '          ', '          ', 'WUUVPN11', '', '', '0.00', '35.00', '0.00', 3, '2010-12-01', '2011-02-28', 0, 0, 0, 'Timpanogos Regional Hospital', 'Mountain View Hospital', '', '', 'HCFA|UB|', '1285664078', 0, 'N', 0, '2012-07-25', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W12007981', 'W12007981', 'UT01', 'Central Utah Clinic', 'Bruce', 'H', 'Chamberlain', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '          ', NULL, 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '          ', '          ', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-03-01', '2012-11-05', 0, 0, 0, 'Timpanogos Regional Hospital', 'Mountain View Hospital', '', '', 'HCFA|UB|', '1285664078', 0, 'N', 0, '2012-11-08', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W12007984', 'W12007984', 'UT01', 'Central Utah Clinic ', 'Ryan', 'F', 'Greenwood', 'MD', 'Internal Medicine', '', '', NULL, 'M', '1055 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8014654813', NULL, '1055 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8014654813', '          ', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-02-03', '2011-02-28', 0, 0, 0, 'Mountain View Hospital', '', '', '', 'HCFA|UB|', '1962680793', 0, 'N', 0, '2011-04-08', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W12007983', 'W12007983', 'UT01', 'Central Utah Clinic ', 'Ryan', 'F', 'Greenwood', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1120 E 1000 Ste 1', 'Payson', 'Utah', 'UT', '84651', '8014654813', NULL, '1120 E 1000 Ste 1', 'Payson', 'Utah', 'UT', '84651', '8014654813', '          ', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-02-03', '2011-02-28', 0, 0, 0, 'Mountain View Hospital', '', '', '', 'HCFA|UB|', '1962680793', 0, 'N', 0, '2011-04-08', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W12007985', 'W12007985', 'UT01', 'Central Utah Clinic PC', 'Ryan', 'F', 'Greenwood', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 30079', 'Provo', 'Utah', 'UT', '84604', '8014654813', NULL, 'PO Box 30079', 'Provo', 'Utah', 'UT', '84604', '8014654813', '          ', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-03-01', NULL, 0, 0, 0, 'Mountain View Hospital', '', '', '', 'HCFA|UB|', '1962680793', 0, 'N', 0, '2013-04-09', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W12007986', 'W12007986', 'UT01', 'Copper Canyon Womens Center', 'Shelley', 'S', 'Binkley', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '3336 S Pioneer Pkwy Ste 301', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019643865', '8019643894', '3336 S Pioneer Pkwy Ste 301', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019643865', '8019643894', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-02-01', '2014-04-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1497787576', 0, 'N', 0, '2014-05-29', NULL, NULL, 40.6991, -111.99, NULL, NULL),
('621801973', 'W12007987', 'W12007987', 'UT01', 'Copper Canyon Womens Center', 'Shelley', 'S', 'Binkley', 'MD', 'Obstetrics and Gynecology', '', '', 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, '2011-02-01', '2014-04-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1497787576', 0, 'N', 0, '2014-05-29', NULL, NULL, 0, 0, NULL, NULL),
('870609595', 'W12007988', 'W12007988', 'UT01', 'Utah County Medical Associates', 'Max', 'J', 'Crouch', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '376 E 400 S', 'Springville', 'Utah', 'UT', '84663', '8014654896', NULL, '376 E 400 S', 'Springville', 'Utah', 'UT', '84663', '8014654896', '', 'WUTCTY', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-04-01', NULL, 0, 0, 0, 'Mountain View Hospital', '', '', '', 'HCFA|UB|', '1861569261', 0, 'N', 0, '2014-04-17', NULL, NULL, 40.1611, -111.604, NULL, NULL),
('870609595', 'W12007989', 'W12007989', 'UT01', 'Utah County Medical Associates', 'Max', 'J', 'Crouch', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '97 S Professional Way Ste 2', 'Payson', 'Utah', 'UT', '84651', '8014654896', NULL, '97 S Professional Way Ste 2', 'Payson', 'Utah', 'UT', '84651', '8014654896', '', 'WUTCTY', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-04-01', NULL, 0, 0, 0, 'Mountain View Hospital', '', '', '', 'HCFA|UB|', '1861569261', 0, 'N', 0, '2014-04-17', NULL, NULL, 40.0429, -111.712, NULL, NULL),
('870609595', 'W12007990', 'W12007990', 'UT01', 'Utah County Medical Associates', 'Max', 'J', 'Crouch', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '15 S 1000 E Ste 300', 'Payson', 'Utah', 'UT', '84651', '8014654896', NULL, '15 S 1000 E Ste 300', 'Payson', 'Utah', 'UT', '84651', '8014654896', '', 'WUTCTY', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-04-01', NULL, 0, 0, 0, 'Mountain View Hospital', '', '', '', 'HCFA|UB|', '1861569261', 0, 'N', 0, '2014-04-17', NULL, NULL, 40.044, -111.716, NULL, NULL),
('870609595', 'W12007991', 'W12007991', 'UT01', 'Utah County Medical Associates', 'Max', 'J', 'Crouch', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 9487', 'Belfast', 'Waldo', 'ME', '04915', '8014654896', NULL, 'PO Box 9487', 'Belfast', 'Waldo', 'ME', '04915', '8014654896', '', 'WUTCTY', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-04-01', NULL, 0, 0, 0, 'Mountain View Hospital', '', '', '', 'HCFA|UB|', '1861569261', 0, 'N', 0, '2014-04-17', NULL, NULL, 0, 0, NULL, NULL),
('870293873', 'W12007993', 'W12007993', 'UT01', 'Tri City Medical Clinic', 'Michael', '', 'Curtis', 'MD', 'Family Practice', '', '', NULL, 'O', '275 W 200 N', 'Lindon', 'Utah', 'UT', '84042', '8017961333', NULL, '275 W 200 N', 'Lindon', 'Utah', 'UT', '84042', '8017961333', '', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-02-03', '2013-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1336280759', 0, 'N', 0, '2014-07-17', NULL, NULL, 0, 0, NULL, NULL),
('820447135', 'W12007994', 'W12007994', 'Sinclair', '(Sinclair Health Services\rProvider) Sun Valley Sports Rehabilitation Clinic', 'Colleen', 'A', 'Coyne', 'PT', 'Physical Therapy', '', '', NULL, 'O', '245 Raven Rd', 'Ketchum', 'Blaine', 'ID', '83340', '2087267246', NULL, '245 Raven Rd', 'Ketchum', 'Blaine', 'ID', '83340', '2087267246', '          ', 'IDSINCLAIRA', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1780779280', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('680562677', 'W12007995', 'W12007995', 'UT01', 'Intermountain Ear Nose and Throat Specialists', 'Matthew', 'E', 'Dahl', 'MD', 'Ear, Nose and Throat', 'Neck Surgery', '', NULL, 'O', '756 E 12200 S', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013282522', '8015330589', '756 E 12200 S', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013282522', '8015330589', 'WiseOrtho', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-02-03', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1679666556', 0, 'N', 0, '2013-07-10', NULL, NULL, 0, 0, NULL, NULL),
('680562677', 'W12007996', 'W12007996', 'UT01', 'Intermountain Ear Nose and Throat Specialists', 'Matthew', 'E', 'Dahl', 'MD', 'Ear, Nose and Throat', 'Neck Surgery', '', NULL, 'O', '1777 Sun Peak Dr Ste 105', 'Park City', 'Summit', 'UT', '84098', '4356494106', '8015330589', '1777 Sun Peak Dr Ste 105', 'Park City', 'Summit', 'UT', '84098', '4356494106', '8015330589', 'WiseOrtho', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-02-03', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1679666556', 0, 'N', 0, '2013-07-10', NULL, NULL, 40.6924, -111.545, NULL, NULL),
('830182821', 'W12007998', 'W12007998', 'WY01', 'Gottsche Rehabilitation Center', 'Brian', 'E', 'Dalton', 'PT', 'Physical Therapy', '', '', NULL, 'O', '639 W Coulter Ave', 'Powell', 'Park', 'WY', '82435', '3077549262', '          ', '639 W Coulter Ave', 'Powell', 'Park', 'WY', '82435', '3077549262', '          ', '', '', '', '0.00', '10.00', '0.00', 3, '2011-02-03', '2014-06-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1528150380', 0, 'N', 0, '2014-07-21', NULL, NULL, 44.7487, -108.766, NULL, NULL),
('830182821', 'W12007997', 'W12007997', 'WY01', 'Gottsche Rehabilitation Center', 'Brian', 'E', 'Dalton', 'PT', 'Physical Therapy', '', '', NULL, 'O', '720 Lindsay Ln', 'Cody', 'Park', 'WY', '82414', '3075781970', '          ', '720 Lindsay Ln', 'Cody', 'Park', 'WY', '82414', '3075781970', '          ', '', '', '', '0.00', '10.00', '0.00', 3, '2011-02-03', '2014-06-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1528150380', 0, 'N', 0, '2014-07-21', NULL, NULL, 44.5202, -109.074, NULL, NULL),
('260523843', 'W12007999', 'W12007999', 'UT01', '', 'Todd', 'E', 'Daynes', 'MD', 'Ophthalmology', '', '', NULL, 'O', '425 Medical Dr Ste 219', 'Bountiful', 'Davis', 'UT', '84010', '8012948855', '8012948866', '425 Medical Dr Ste 219', 'Bountiful', 'Davis', 'UT', '84010', '8012948855', '8012948866', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-02-03', '2011-03-31', 0, 0, 0, 'Lakeview Hospital', 'St Marks Hospital', '', '', 'HCFA|UB|', '1053412494', 0, 'N', 0, '2011-10-12', NULL, NULL, 0, 0, NULL, NULL),
('870609595', 'W12008000', 'W12008000', 'UT01', 'Utah County Medical Associates', 'Elizabeth', 'A', 'Dayton', 'MD', 'Family Practice', 'Obstetrics and Gynecology', '', NULL, 'O', '97 S Professional Way Ste 2', 'Payson', 'Utah', 'UT', '84651', '8014654896', NULL, '97 S Professional Way Ste 2', 'Payson', 'Utah', 'UT', '84651', '8014654896', '', 'WUTCTY', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-04-01', NULL, 0, 0, 0, 'Mountain View Hospital', '', '', '', 'HCFA|UB|', '1598799421', 0, 'N', 0, '2014-05-28', NULL, NULL, 40.0429, -111.712, NULL, NULL),
('870609595', 'W12008001', 'W12008001', 'UT01', 'Utah County Medical Associates', 'Elizabeth', 'A', 'Dayton', 'MD', 'Family Practice', 'Obstetrics and Gynecology', '', NULL, 'O', '376 E 400 S', 'Springville', 'Utah', 'UT', '84663', '8014654896', NULL, '376 E 400 S', 'Springville', 'Utah', 'UT', '84663', '8014654896', '', 'WUTCTY', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-04-01', NULL, 0, 0, 0, 'Mountain View Hospital', '', '', '', 'HCFA|UB|', '1598799421', 0, 'N', 0, '2014-05-28', NULL, NULL, 40.1611, -111.604, NULL, NULL),
('870609595', 'W12008002', 'W12008002', 'UT01', 'Utah County Medical Associates', 'Elizabeth', 'A', 'Dayton', 'MD', 'Family Practice', 'Obstetrics and Gynecology', '', NULL, 'O', '15 S 1000 E Ste 300', 'Payson', 'Utah', 'UT', '84651', '8014654896', NULL, '15 S 1000 E Ste 300', 'Payson', 'Utah', 'UT', '84651', '8014654896', '', 'WUTCTY', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-04-01', NULL, 0, 0, 0, 'Mountain View Hospital', '', '', '', 'HCFA|UB|', '1598799421', 0, 'N', 0, '2014-05-28', NULL, NULL, 40.044, -111.716, NULL, NULL),
('870609595', 'W12008003', 'W12008003', 'UT01', 'Utah County Medical Associates', 'Elizabeth', 'A', 'Dayton', 'MD', 'Family Practice', 'Obstetrics and Gynecology', '', NULL, 'B', 'PO Box 9487', 'Belfast', 'Waldo', 'ME', '04915', '8014654896', NULL, 'PO Box 9487', 'Belfast', 'Waldo', 'ME', '04915', '8014654896', '', 'WUTCTY', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-04-01', NULL, 0, 0, 0, 'Mountain View Hospital', '', '', '', 'HCFA|UB|', '1598799421', 0, 'N', 0, '2014-05-28', NULL, NULL, 0, 0, NULL, NULL),
('870293873', 'W12008008', 'W12008008', 'UT01', 'Tri City Medical Clinic', 'Sean', 'C', 'Doyle', 'MD', 'Family Practice', '', '', NULL, 'O', '275 W 200 N', 'Lindon', 'Utah', 'UT', '84042', '8017961333', '8017960625', '275 W 200 N', 'Lindon', 'Utah', 'UT', '84042', '8017961333', '8017960625', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-02-03', '2011-10-21', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1235138751', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W12008009', 'W12008009', 'UT01', 'Physicians Group of Utah', 'Cara', '', 'Drury', 'PA-C', 'General Surgery', 'Hospitalist', '', NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-11-22', '2014-04-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1730482209', 0, 'N', 0, '2014-04-08', NULL, NULL, 0, 0, NULL, NULL),
('870546501', 'W12008010', 'W12008010', 'UT01', 'Alpine Pediatrics', 'William', 'F', 'Edwards', 'MD', 'Pediatrics', '', '', NULL, 'O', '1912 W 930 N', 'Pleasant Grove', 'Utah', 'UT', '84062', '8014921999', '8014921991', '1912 W 930 N', 'Pleasant Grove', 'Utah', 'UT', '84062', '8014921999', '8014921991', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-02-03', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1063450328', 0, 'N', 0, '2013-09-25', NULL, NULL, 40.383, -111.744, NULL, NULL),
('870546501', 'W12008011', 'W12008011', 'UT01', 'Alpine Pediatrics', 'William', 'F', 'Edwards', 'MD', 'Pediatrics', '', '', NULL, 'O', '77 E Commerce Dr', 'Saratoga Springs', 'Utah', 'UT', '84045', '8019229222', '8014921991', '77 E Commerce Dr', 'Saratoga Springs', 'Utah', 'UT', '84045', '8019229222', '8014921991', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-02-03', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1063450328', 0, 'N', 0, '2013-09-25', NULL, NULL, 40.3848, -111.914, NULL, NULL),
('870546501', 'W12008012', 'W12008012', 'UT01', 'Alpine Pediatrics', 'William', 'F', 'Edwards', 'MD', 'Pediatrics', '', '', NULL, 'O', '3231 N 1120 E', 'Lehi', 'Utah', 'UT', '84043', '8017682800', '8014921991', '3231 N 1120 E', 'Lehi', 'Utah', 'UT', '84043', '8017682800', '8014921991', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-02-03', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1063450328', 0, 'N', 0, '2013-09-25', NULL, NULL, 40.4282, -111.832, NULL, NULL),
('870559136', 'W12008016', 'W12008016', 'UT01', 'Eye Prosthetics of Utah', '', '', 'Eye Prosthetics of Utah       ', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', '7400 Union Park Ave Ste 102', 'Midvale', 'Salt Lake', 'UT', '84047', '8019421600', '8019421717', '7400 Union Park Ave Ste 102', 'Midvale', 'Salt Lake', 'UT', '84047', '8019421600', '8019421717', 'WCSTEPU5', '', '', '0.00', '40.00', '0.00', 3, '2011-01-31', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1366475154', 0, 'N', 0, '2011-02-03', NULL, NULL, 40.6168, -111.859, NULL, NULL),
('260093564', 'W12008020', 'W12008020', 'UT01', 'Riverwoods Surgery Center', 'Rodney', '', 'Fisher', 'CRNA', 'Anesthesia', '', '', NULL, 'B', 'PO Box 1727', 'Provo', 'Utah', 'UT', '84603', '8013758049', NULL, 'PO Box 1727', 'Provo', 'Utah', 'UT', '84603', '8013758049', '          ', '', '', '1000', '49.44', '0.00', '0.00', 3, '2011-02-03', NULL, 0, 12, 0, '', '', '', '', 'HCFA|UB|', '1063534550', 0, 'N', 0, '2011-02-03', NULL, NULL, 0, 0, NULL, NULL),
('870546501', 'W12008021', 'W12008021', 'UT01', 'Alpine Pediatrics PC', 'Christopher', 'C', 'Foster', 'MD', 'Pediatrics', '', '', NULL, 'O', '1912 W 930 N', 'Pleasant Grove', 'Utah', 'UT', '84062', '8014921999', NULL, '1912 W 930 N', 'Pleasant Grove', 'Utah', 'UT', '84062', '8014921999', '          ', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-02-03', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1639399439', 0, 'N', 0, '2012-06-18', NULL, NULL, 40.383, -111.744, NULL, NULL),
('870546501', 'W12008022', 'W12008022', 'UT01', 'Alpine Pediatrics', 'Christopher', 'C', 'Foster', 'MD', 'Pediatrics', '', '', NULL, 'O', '77 E Commerce Dr', 'Saratoga Springs', 'Utah', 'UT', '84045', '8019229222', '8019229370', '77 E Commerce Dr', 'Saratoga Springs', 'Utah', 'UT', '84045', '8019229222', '8019229370', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-02-03', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1639399439', 0, 'N', 0, '2012-06-18', NULL, NULL, 40.3848, -111.914, NULL, NULL),
('870546501', 'W12008023', 'W12008023', 'UT01', 'Alpine Pediatrics', 'Christopher', 'C', 'Foster', 'MD', 'Pediatrics', '', '', NULL, 'O', '3231 N 1120 E', 'Lehi', 'Utah', 'UT', '84043', '8017682800', '8014921991', '3231 N 1120 E', 'Lehi', 'Utah', 'UT', '84043', '8017682800', '8014921991', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-02-03', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1639399439', 0, 'N', 0, '2012-06-18', NULL, NULL, 40.4282, -111.832, NULL, NULL),
('870516264', 'W12008024', 'W12008024', 'UT01', 'Utah County Surgical Associates', 'Karl', 'M', 'Francis', 'MD', 'General Surgery', '', '', NULL, 'O', '1000 E 15 S Ste 350', 'Payson', 'Utah', 'UT', '84651', '8014655602', '8014654480', '1000 E 15 S Ste 350', 'Payson', 'Utah', 'UT', '84651', '8014655602', '8014654480', 'UTCTYSURG', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-01-11', NULL, 0, 0, 0, 'Mountain View Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1669521571', 0, 'N', 0, '2013-05-06', NULL, NULL, 40.035, -111.736, NULL, NULL),
('272904966', 'W12008025', 'W12008025', 'WY01', 'The Eye Institute of Utah', 'Randy', 'L', 'Fuja', 'OD', 'Optometry', '', '', NULL, 'O', '2631 Foothill Blvd Ste A', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073624202', NULL, '2631 Foothill Blvd Ste A', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073624202', '          ', 'WYSTD', '', '', '0.00', '35.00', '0.00', 6, '2010-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1215979976', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.5823, -109.258, NULL, NULL),
('870682101', 'W12008028', 'W12008028', 'UT01', 'Salt Lake Orthopedic', 'Rosalie', 'C', 'Cuozzo', 'PA', 'Physician Assistant', '', '', NULL, 'O', '1160 E 3900 S Ste 5000', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012628486', '8012848699', '1160 E 3900 S Ste 5000', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012628486', '8012848699', 'WUSLORTH5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-02-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1295780682', 0, 'N', 0, '2011-06-23', NULL, NULL, 40.6871, -111.858, NULL, NULL),
('870293873', 'W12008029', 'W12008029', 'UT01', 'Tri City Medical Clinic', 'Glen', 'R', 'Fuller', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '275 W 200 N', 'Lindon', 'Utah', 'UT', '84042', '8017961333', NULL, '275 W 200 N', 'Lindon', 'Utah', 'UT', '84042', '8017961333', '          ', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-02-04', '2011-10-21', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1467557330', 0, 'N', 0, '2013-10-14', NULL, NULL, 0, 0, NULL, NULL),
('870516264', 'W12008030', 'W12008030', 'UT01', 'Utah Surgical Associates Inc', 'David', 'P', 'Garry', 'MD', 'General Surgery', NULL, NULL, NULL, 'O', '3550 N University Ave Ste 250', 'Provo', 'Utah', 'UT', '84604', '8013749625', '8013749690', '3550 N University Ave Ste 250', 'Provo', 'Utah', 'UT', '84604', '8013749625', '8013749690', 'UTCTYSURG', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-01-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1497702252', 0, 'N', 0, '2013-05-06', NULL, NULL, 40.2813, -111.658, NULL, NULL),
('264312395', 'W12008031', 'W12008031', 'UT01', '', 'Ryan', '', 'Gilbert', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '24 W Sergeant Dr Ste 102', 'Saratoga Springs', 'Utah', 'UT', '84045', '8014073048', '8014073049', '24 W Sergeant Dr Ste 102', 'Saratoga Springs', 'Utah', 'UT', '84045', '8014073048', '8014073049', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-01-03', NULL, 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1497930234', 0, 'N', 0, '2013-09-20', NULL, NULL, 0, 0, NULL, NULL),
('870516264', 'W12008032', 'W12008032', 'UT01', 'Utah Surgical Associates Inc', 'Brian', '', 'Gill', 'MD', 'General Surgery', '', '', NULL, 'O', '1055 N 300 W Ste 302', 'Provo', 'Utah', 'UT', '84604', '8013573938', '8013577444', '1055 N 300 W Ste 302', 'Provo', 'Utah', 'UT', '84604', '8013573938', '8013577444', 'UTCTYSURG', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1164528717', 0, 'N', 0, '2013-05-06', NULL, NULL, 40.2476, -111.664, NULL, NULL),
('870286381', 'W12008033', 'W12008033', 'UT01', 'Ogden Clinic Physical Therapy', 'Nathan', 'S', 'Goff', 'PT', 'Physical Therapy', '', '', NULL, 'B', '4650 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014794621', '8014762670', '4650 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014794621', '8014762670', '', '', '', '0.00', '0.00', '76.74', 6, '2011-02-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1629066675', 0, 'Y', 0, '2014-07-14', NULL, NULL, 0, 0, NULL, NULL),
('870286381', 'W12008034', 'W12008034', 'UT01', 'Ogden Clinic Physical Therapy', 'Nathan', 'S', 'Goff', 'PT', 'Physical Therapy', '', '', NULL, 'O', '4700 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014757010', '8014762670', '4700 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014757010', '8014762670', '', '', '', '0.00', '0.00', '76.74', 6, '2011-02-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1629066675', 0, 'N', 0, '2014-07-14', NULL, NULL, 41.1775, -111.949, NULL, NULL),
('870286381', 'W12008035', 'W12008035', 'UT01', 'Ogden Clinic Physical Therapy', 'Nathan', 'S', 'Goff', 'PT', 'Physical Therapy', '', '', NULL, 'O', '5430 S 1900 W Ste G1', 'Roy', 'Weber', 'UT', '84067', '8017799975', NULL, '5430 S 1900 W Ste G1', 'Roy', 'Weber', 'UT', '84067', '8017799975', '', '', '', '', '0.00', '0.00', '76.74', 6, '2011-02-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1629066675', 0, 'N', 0, '2014-07-14', NULL, NULL, 41.1651, -112.026, NULL, NULL),
('870281299', 'W12008038', 'W12008038', 'UT01', 'American Fork Clinic', 'David', 'K', 'Hafen', 'MD', 'Family Practice', '', '', NULL, 'O', '226 N 1100 E Ste A', 'American Fork', 'Utah', 'UT', '84003', '8018553843', NULL, '226 N 1100 E Ste A', 'American Fork', 'Utah', 'UT', '84003', '8018553843', '          ', 'WUTANNER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-02-01', '2013-06-30', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1134238207', 0, 'N', 0, '2013-10-25', NULL, NULL, 0, 0, NULL, NULL),
('870281299', 'W12008039', 'W12008039', 'UT01', 'American Fork Clinic', 'Mark', '', 'Hafen', 'DO', 'Family Practice', '', '', NULL, 'O', '226 N 1100 E Ste A', 'American Fork', 'Utah', 'UT', '84003', '8018553843', NULL, '226 N 1100 E Ste A', 'American Fork', 'Utah', 'UT', '84003', '8018553843', '          ', 'WUTANNER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-02-01', '2013-06-30', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1306952056', 0, 'N', 0, '2013-10-25', NULL, NULL, 0, 0, NULL, NULL),
('742719352', 'W12008040', 'W12008040', 'TX01', 'Urology of San Antonio', 'Samuel', '', 'Hakim', 'MD', 'Urology', '', '', NULL, 'O', '11212 Hwy 151 Ste 370', 'San Antonio', 'Bexar', 'TX', '78251', '2105217333', '2106793725', '11212 Hwy 151 Ste 370', 'San Antonio', 'Bexar', 'TX', '78251', '2105217333', '2106793725', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2011-01-18', '2012-08-19', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1669509006', 0, 'N', 0, '2014-04-08', NULL, NULL, 29.4666, -98.6958, NULL, NULL),
('274184401', 'W12008041', 'W12008041', 'UTMH1', '', 'Mark', 'T', 'Hales', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '1828 S 2265 W', 'Syracuse', 'Davis', 'UT', '84075', '8013892112', NULL, '1828 S 2265 W', 'Syracuse', 'Davis', 'UT', '84075', '8013892112', '          ', 'MA', '', '', '0.00', '35.00', '0.00', 3, '2011-01-28', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1588716039', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('870346198', 'W12008042', 'W12008042', 'UT01', 'Rocky Mountain Associated Physicians', 'R', 'C', 'Halversen', 'MD', 'General Surgery', '', '', NULL, 'O', '348 E 4500 S Ste 220', 'Murray', 'Salt Lake', 'UT', '84107', '8016478888', '8012683997', '348 E 4500 S Ste 220', 'Murray', 'Salt Lake', 'UT', '84107', '8016478888', '8012683997', 'WCSTRMAP5', 'WUSTDSURG5', '', '0.00', '35.00', '0.00', 3, '2011-02-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1275540585', 0, 'N', 0, '2013-10-04', NULL, NULL, 40.6743, -111.881, NULL, NULL),
('870516264', 'W12008044', 'W12008044', 'UT01', 'Utah Surgical Associates Inc', 'Bruce', 'B', 'Hill', 'MD', 'General Surgery', NULL, NULL, NULL, 'O', '1000 E 15 S Ste 350', 'Payson', 'Utah', 'UT', '84651', '8014655602', '8014654480', '1000 E 15 S Ste 350', 'Payson', 'Utah', 'UT', '84651', '8014655602', '8014654480', 'UTCTYSURG', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-01-11', NULL, 0, 0, 0, 'Mountain View Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1699715664', 0, 'N', 0, '2013-05-06', NULL, NULL, 40.035, -111.736, NULL, NULL),
('870179340', 'W12008045', 'W12008045', 'UT01', 'Standard Optical', 'Randall', 'C', 'Himes', 'OD', 'Optometry', '', '', NULL, 'O', '1455 S State', 'Orem', 'Utah', 'UT', '84057', '8012663044', NULL, '1455 S State', 'Orem', 'Utah', 'UT', '84057', '8012663044', '          ', 'WUTALBERT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1144380478', 0, 'N', 0, '2014-01-08', NULL, NULL, 0, 0, NULL, NULL),
('870281299', 'W12008048', 'W12008048', 'UT01', 'American Fork Clinic', 'Timo', 'J', 'Hoggard', 'MD', 'Family Practice', '', '', NULL, 'O', '226 N 1100 E Ste A', 'American Fork', 'Utah', 'UT', '84003', '8018553843', NULL, '226 N 1100 E Ste A', 'American Fork', 'Utah', 'UT', '84003', '8018553843', '          ', 'WUTANNER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-02-01', '2013-09-30', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1639288798', 0, 'N', 0, '2013-10-25', NULL, NULL, 0, 0, NULL, NULL),
('680562677', 'W12008051', 'W12008051', 'UT01', 'Intermountain Ear Nose And Throat Specialisl  ', '', '', 'Intermountain Ear Nose And Throat Specialisl  LLC', 'GROUP', '', '', '', NULL, 'O', '756 E 12200 S', 'Draper', 'Salt Lake', 'UT', '84020', '8013282522', '8015330589', '756 E 12200 S', 'Draper', 'Salt Lake', 'UT', '84020', '8013282522', '8015330589', 'WiseOrtho', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000006858', 0, 'N', 0, '2011-02-07', NULL, NULL, 40.5288, -111.87, NULL, NULL),
('870616123', 'W12008052', 'W12008052', 'UT01', 'Intermountain Orthopedic Care', '', '', 'Intermountain Orthopedic Care ', 'GROUP', 'Durable Medical Equipment', NULL, NULL, NULL, 'O', '1455 S State St Ste G', 'Orem', 'Utah', 'UT', '84097', '8013769004', '8014891329', '1455 S State St Ste G', 'Orem', 'Utah', 'UT', '84097', '8013769004', '8014891329', 'WUDME5', '', '', '0.00', '35.00', '0.00', 3, '2011-02-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1699798827', 0, 'N', 0, '2011-02-07', NULL, NULL, 40.2705, -111.683, NULL, NULL),
('870281299', 'W12008053', 'W12008053', 'UT01', 'American Fork Clinic', 'Cheryl', 'A', 'Johnson', 'MD', 'Family Practice', '', '', NULL, 'O', '226 N 1100 E Ste A', 'American Fork', 'Utah', 'UT', '84003', '8018553843', NULL, '226 N 1100 E Ste A', 'American Fork', 'Utah', 'UT', '84003', '8018553843', '          ', 'WUTANNER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-02-01', '2013-06-30', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1417066671', 0, 'N', 0, '2013-10-25', NULL, NULL, 0, 0, NULL, NULL),
('870281299', 'W12008054', 'W12008054', 'UT01', 'Lehi Medical Clinic', 'Cheryl', 'A', 'Johnson', 'MD', 'Family Practice', '', '', NULL, 'O', '680 E Main St', 'Lehi', 'Utah', 'UT', '84043', '8017680821', NULL, '680 E Main St', 'Lehi', 'Utah', 'UT', '84043', '8017680821', '          ', 'WUTANNER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-02-01', '2013-06-30', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1417066671', 0, 'N', 0, '2013-10-25', NULL, NULL, 0, 0, NULL, NULL),
('870546501', 'W12008056', 'W12008056', 'UT01', 'Alpine Pediatrics', 'David', 'S', 'Johnson', 'MD', 'Pediatrics', NULL, NULL, NULL, 'O', '77 E Commerce Dr', 'Saratoga Springs', 'Utah', 'UT', '84045', '8019229222', '8019229370', '77 E Commerce Dr', 'Saratoga Springs', 'Utah', 'UT', '84045', '8019229222', '8019229370', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-02-01', '2013-07-31', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1316985542', 0, 'N', 0, '2013-07-25', NULL, NULL, 0, 0, NULL, NULL),
('870546501', 'W12008057', 'W12008057', 'UT01', 'Alpine Pediatrics', 'David', 'S', 'Johnson', 'MD', 'Pediatrics', NULL, NULL, NULL, 'O', '1912 W 930 N', 'Pleasant Grove', 'Utah', 'UT', '84062', '8014921999', NULL, '1912 W 930 N', 'Pleasant Grove', 'Utah', 'UT', '84062', '8014921999', '          ', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-02-01', '2013-07-31', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1316985542', 0, 'N', 0, '2013-07-25', NULL, NULL, 0, 0, NULL, NULL),
('870546501', 'W12008058', 'W12008058', 'UT01', 'Alpine Pediatrics', 'David', 'S', 'Johnson', 'MD', 'Pediatrics', NULL, NULL, NULL, 'O', '3231 N 1120 E', 'Lehi', 'Utah', 'UT', '84043', '8017682800', NULL, '3231 N 1120 E', 'Lehi', 'Utah', 'UT', '84043', '8017682800', '          ', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-02-01', '2013-07-31', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1316985542', 0, 'N', 0, '2013-07-25', NULL, NULL, 0, 0, NULL, NULL),
('870281299', 'W12008059', 'W12008059', 'UT01', 'American Fork Clinic', 'G', 'Brent', 'Johnson', 'MD', 'Family Practice', '', '', NULL, 'O', '226 N 1100 E Ste A', 'American Fork', 'Utah', 'UT', '84003', '8018553843', NULL, '226 N 1100 E Ste A', 'American Fork', 'Utah', 'UT', '84003', '8018553843', '          ', 'WUTANNER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-02-01', '2011-10-21', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1902914427', 0, 'N', 0, '2011-10-24', NULL, NULL, 0, 0, NULL, NULL),
('611572907', 'W12008060', 'W12008060', 'UT01', 'South Ogden Center for Family Medicine', 'Tim', '', 'Katsma', 'PA', 'Family Practice', '', '', NULL, 'O', '5740 Crestwood Dr', 'Ogden', 'Weber', 'UT', '84405', '8014797771', NULL, '5740 Crestwood Dr', 'Ogden', 'Weber', 'UT', '84405', '8014797771', '', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-11-01', '2012-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1205089489', 0, 'Y', 0, '2014-04-09', NULL, NULL, 0, 0, NULL, NULL),
('870503202', 'W12008061', 'W12008061', 'UT01', 'Mountain West Ear Nose and Throat', 'Steven', 'M', 'Kelly', 'MD', 'Pediatric Ear, Nose and Throat', '', '', NULL, 'O', '2255 N 1700 W Ste 200', 'Layton', 'Davis', 'UT', '84041', '8017762180', '8017762534', '2255 N 1700 W Ste 200', 'Layton', 'Davis', 'UT', '84041', '8017762180', '8017762534', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-02-01', NULL, 0, 0, 0, 'Lakeview Hospital', 'Primary Childrens Medical Center', 'Davis Hospital', '', 'HCFA|UB|', '1841348240', 0, 'N', 0, '2014-07-25', NULL, NULL, 41.0887, -111.997, NULL, NULL),
('271918813', 'W12008062', 'W12008062', 'UTMH1', 'All Ages & Life Stages Counseling ', 'Karson', 'S', 'Kinikini', 'LCSW', 'Mental Health', 'Counseling', 'Social Worker', NULL, 'O', '2363 N Hillfield Rd Ste 5', 'Layton', 'Davis', 'UT', '84041', '8016285577', '8015939118', '2363 N Hillfield Rd Ste 5', 'Layton', 'Davis', 'UT', '84041', '8016285577', '8015939118', 'MA', '', '', '0.00', '35.00', '0.00', 3, '2010-12-03', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1396896858', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('870546501', 'W12008067', 'W12008067', 'UT01', 'Alpine Pediatrics', 'Brett', 'K', 'Knorr', 'MD', 'Pediatrics', NULL, NULL, NULL, 'O', '1912 W 930 N', 'Pleasant Grove', 'Utah', 'UT', '84062', '8014921999', NULL, '1912 W 930 N', 'Pleasant Grove', 'Utah', 'UT', '84062', '8014921999', '          ', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-02-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1083655120', 0, 'N', 0, '2013-09-20', NULL, NULL, 40.383, -111.744, NULL, NULL),
('870546501', 'W12008068', 'W12008068', 'UT01', 'Alpine Pediatrics', 'Brett', 'K', 'Knorr', 'MD', 'Pediatrics', NULL, NULL, NULL, 'O', '3231 N 1120 E', 'Lehi', 'Utah', 'UT', '84043', '8017682800', NULL, '3231 N 1120 E', 'Lehi', 'Utah', 'UT', '84043', '8017682800', '          ', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-02-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1083655120', 0, 'N', 0, '2013-09-20', NULL, NULL, 40.4282, -111.832, NULL, NULL),
('870546501', 'W12008069', 'W12008069', 'UT01', 'Alpine Pediatrics', 'Brett', 'K', 'Knorr', 'MD', 'Pediatrics', NULL, NULL, NULL, 'O', '77 E Commerce Dr', 'Saratoga Springs', 'Utah', 'UT', '84045', '8019229222', '8019229370', '77 E Commerce Dr', 'Saratoga Springs', 'Utah', 'UT', '84045', '8019229222', '8019229370', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-02-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1083655120', 0, 'N', 0, '2013-09-20', NULL, NULL, 40.3848, -111.914, NULL, NULL),
('870179340', 'W12008070', 'W12008070', 'UT01', 'Standard Optical', 'Duane', 'C', 'Knowles', 'OD', 'Optometry', '', '', NULL, 'O', '5289 S State St', 'Murray', 'Salt Lake', 'UT', '84107', '8015061111', NULL, '5289 S State St', 'Murray', 'Salt Lake', 'UT', '84107', '8015061111', '          ', 'WUTALBERT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-02-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1306935523', 0, 'N', 0, '2013-07-11', NULL, NULL, 40.6563, -111.888, NULL, NULL),
('870286381', 'W12008071', 'W12008071', 'UT01', 'Ogden Clinic Physical Therapy', 'Steve', 'P', 'Lane', 'DPT', 'Physical Therapy', '', '', NULL, 'O', '4650 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014753000', NULL, '4650 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014753000', '          ', '', '', '', '0.00', '0.00', '76.74', 6, '2011-02-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1609889534', 0, 'N', 0, '2012-03-15', NULL, NULL, 41.1787, -111.949, 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
('870516264', 'W12008072', 'W12008072', 'UT01', 'Utah Surgical Associates Inc', 'Wesley', 'R', 'Larsen', 'FNP', 'General Surgery', '', '', NULL, 'O', '3550 N University Ave Ste 250', 'Provo', 'Utah', 'UT', '84604', '8013749625', '8013749690', '3550 N University Ave Ste 250', 'Provo', 'Utah', 'UT', '84604', '8013749625', '8013749690', 'UTCTYSURG', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-01-11', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1174770440', 0, 'N', 0, '2014-03-21', NULL, NULL, 40.2813, -111.658, NULL, NULL),
('870179340', 'W12008073', 'W12008073', 'UT01', 'Standard Optical', 'Stephen', 'C', 'Lewis', 'OD', 'Optometry', '', '', NULL, 'O', '1455 S State St', 'Orem', 'Utah', 'UT', '84057', '8018027326', NULL, '1455 S State St', 'Orem', 'Utah', 'UT', '84057', '8018027326', '          ', 'WUTALBERT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-02-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1184653818', 0, 'N', 0, '2012-06-25', NULL, NULL, 40.2705, -111.683, NULL, NULL),
('870609595', 'W12008077', 'W12008077', 'UT01', 'Utah County Medical Associates', 'Nolan', 'B', 'Money', 'MD', 'Family Practice', '', '', NULL, 'O', '97 S Professional Way Ste 2', 'Payson', 'Utah', 'UT', '84651', '8014654896', NULL, '97 S Professional Way Ste 2', 'Payson', 'Utah', 'UT', '84651', '8014654896', '          ', 'WUTCTY', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-02-01', NULL, 0, 0, 0, 'Mountain View Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1194759027', 0, 'N', 0, '2013-11-12', NULL, NULL, 40.0429, -111.712, NULL, NULL),
('870179340', 'W12008080', 'W12008080', 'UT01', 'Standard Optical', 'Shelly', 'L', 'Nielsen', 'OD', 'Optometry', '', '', NULL, 'O', '1200 Provo Town Ctr Ste 1060', 'Provo', 'Utah', 'UT', '84601', '8013732254', '8018525014', '1200 Provo Town Ctr Ste 1060', 'Provo', 'Utah', 'UT', '84601', '8013732254', '8018525014', 'WUTALBERT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-02-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1699864801', 0, 'N', 0, '2014-01-17', NULL, NULL, 0, 0, NULL, NULL),
('870179340', 'W12008081', 'W12008081', 'UT01', 'Standard Optical', 'Rhett', 'D', 'Veater', 'OD', 'Optometry', '', '', NULL, 'O', '5289 S State St', 'Murray', 'Salt Lake', 'UT', '84107', '8015061111', NULL, '5289 S State St', 'Murray', 'Salt Lake', 'UT', '84107', '8015061111', '          ', 'WUTALBERT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-02-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1154438182', 0, 'N', 0, '2012-05-03', NULL, NULL, 40.6563, -111.888, NULL, NULL),
('540549986', 'W12008083', 'W12008083', 'ID01', '', 'Linda', 'M', 'McGuire', 'LCPC', 'Mental Health', 'Counseling', '', NULL, 'O', '2498 N stokesberry Pl Ste 140', 'Meridian', 'Ada', 'ID', '83646', '2088590464', '2086290409', '2498 N stokesberry Pl Ste 140', 'Meridian', 'Ada', 'ID', '83646', '2088590464', '2086290409', 'IDMA', '', '', '0.00', '35.00', '0.00', 3, '2011-02-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1841253051', 0, 'N', 0, '2012-10-30', NULL, NULL, 0, 0, NULL, NULL),
('540549986', 'W12008084', 'W12008084', 'ID01', '', 'Linda', 'M', 'McGuire', 'LCPC', 'Mental Health', 'Counseling', '', NULL, 'B', '3043 E Dagger Falls Dr', 'Eagle', 'Ada', 'ID', '83616', '2088590464', '2086290409', '3043 E Dagger Falls Dr', 'Eagle', 'Ada', 'ID', '83616', '2088590464', '2086290409', 'IDMA', '', '', '0.00', '35.00', '0.00', 3, '2011-02-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1841253051', 0, 'N', 0, '2012-10-30', NULL, NULL, 0, 0, NULL, NULL),
('611572907', 'W12008085', 'W12008085', 'UT01', 'Morgan Health Clinic', 'Bruce', 'C', 'McClellan', 'MD', 'Family Practice', '', '', NULL, 'O', '166 N State St', 'Morgan', 'Morgan', 'UT', '84050', '8018293426', '8018293135', '166 N State St', 'Morgan', 'Morgan', 'UT', '84050', '8018293426', '8018293135', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-10-12', '2012-06-30', 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1386731883', 1, 'N', 0, '2014-04-09', NULL, NULL, 0, 0, NULL, NULL),
('611572907', 'W12008086', 'W12008086', 'UT01', 'Morgan Health Clinic', 'Bruce', 'C', 'McClellan', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 405714', 'Atlanta', 'Fulton', 'GA', '30384', '8014797771', '8014797795', 'PO Box 405714', 'Atlanta', 'Fulton', 'GA', '30384', '8014797771', '8014797795', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-10-12', '2012-06-30', 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1386731883', 0, 'N', 0, '2014-04-09', NULL, NULL, 0, 0, NULL, NULL),
('870281299', 'W12008087', 'W12008087', 'UT01', 'American Fork Clinic', 'Tauaina', 'J', 'Ngatuvai', 'MD', 'Sports Medicine', '', '', NULL, 'O', '226 N 1100 E Ste A', 'American Fork', 'Utah', 'UT', '84003', '8018553843', NULL, '226 N 1100 E Ste A', 'American Fork', 'Utah', 'UT', '84003', '8018553843', '          ', 'WUTANNER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-02-01', '2013-06-30', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1003992470', 0, 'N', 0, '2013-10-25', NULL, NULL, 0, 0, NULL, NULL),
('870281299', 'W12008088', 'W12008088', 'UT01', 'Lehi Medical Clinic', 'Tauaina', 'J', 'Ngatuvai', 'MD', 'Sports Medicine', '', '', NULL, 'O', '680 E Main St', 'Lehi', 'Utah', 'UT', '84043', '8017681699', NULL, '680 E Main St', 'Lehi', 'Utah', 'UT', '84043', '8017681699', '          ', 'WUTANNER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-02-01', '2013-06-30', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1003992470', 0, 'N', 0, '2013-10-25', NULL, NULL, 0, 0, NULL, NULL),
('274412746', 'W12008089', 'W12008089', 'UT01', 'Olympus Eye Associates', 'Mike', 'K', 'Mitchell', 'OD', 'Optometry', '', '', NULL, 'O', '201 E 5900 S Ste 101', 'Murray', 'Salt Lake', 'UT', '84107', '8012686600', '8012686602', '201 E 5900 S Ste 101', 'Murray', 'Salt Lake', 'UT', '84107', '8012686600', '8012686602', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1851362339', 0, 'N', 0, '2012-05-22', NULL, NULL, 40.6426, -111.885, NULL, NULL),
('870516264', 'W12008092', 'W12008092', 'UT01', 'Utah Surgical Associates Inc', 'Douglas', 'J', 'Lichti', 'MD', 'General Surgery', NULL, NULL, NULL, 'O', '3550 N University Ave Ste 250', 'Provo', 'Utah', 'UT', '84604', '8013749625', '8013749690', '3550 N University Ave Ste 250', 'Provo', 'Utah', 'UT', '84604', '8013749625', '8013749690', 'UTCTYSURG', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-01-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1417995325', 0, 'N', 0, '2013-05-06', NULL, NULL, 40.2813, -111.658, NULL, NULL),
('870293873', 'W12008093', 'W12008093', 'UT01', 'Tri City Medical Clinic', 'Joseph', 'B', 'Liddle', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '275 W 200 N', 'Lindon', 'Utah', 'UT', '84042', '8017961333', NULL, '275 W 200 N', 'Lindon', 'Utah', 'UT', '84042', '8017961333', '          ', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-02-08', '2011-10-21', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1427166701', 0, 'N', 0, '2013-11-11', NULL, NULL, 0, 0, NULL, NULL),
('592852900', 'W12008094', 'W12008094', 'UT01', 'Lincare', '', '', 'Lincare', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', '268 S Hwy 55', 'Price', 'Carbon', 'UT', '84501', '4356373511', NULL, '268 S Hwy 55', 'Price', 'Carbon', 'UT', '84501', '4356373511', '          ', 'WLINCARE', '', '', '0.00', '20.00', '0.00', 8, '2011-02-08', NULL, 1, 0, 0, '', '', '', '', 'HCFA|UB|', '1194894667', 0, 'N', 0, '2013-06-18', NULL, NULL, 0, 0, NULL, NULL),
('528377718', 'W12008097', 'W12008097', 'UTMH1', 'UIPT', 'Brad', 'W', 'Lundahl', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '3900 S 715 E Ste 201-A', 'Murray', 'Salt Lake', 'UT', '84107', '8016354141', NULL, '3900 S 715 E Ste 201-A', 'Murray', 'Salt Lake', 'UT', '84107', '8016354141', '          ', 'PHD', '', '', '0.00', '35.00', '0.00', 3, '2011-02-01', '2012-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1033239827', 0, 'N', 0, '2012-01-16', NULL, NULL, 0, 0, NULL, NULL),
('870281299', 'W12008098', 'W12008098', 'UT01', 'American Fork Clinic', 'Toran', 'J', 'MacArthur', 'MD', 'Family Practice', '', '', NULL, 'O', '226 N 1100 E Ste A', 'American Fork', 'Utah', 'UT', '84003', '8018553843', NULL, '226 N 1100 E Ste A', 'American Fork', 'Utah', 'UT', '84003', '8018553843', '          ', 'WUTANNER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-02-01', '2013-06-30', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1063521177', 0, 'N', 0, '2013-10-25', NULL, NULL, 0, 0, NULL, NULL),
('870281299', 'W12008099', 'W12008099', 'UT01', 'Lehi Clinic', 'Toran', 'J', 'MacArthur', 'MD', 'Family Practice', '', '', NULL, 'O', '680 E Main St Ste 100', 'Lehi', 'Utah', 'UT', '84043', '8017681699', '8017684526', '680 E Main St Ste 100', 'Lehi', 'Utah', 'UT', '84043', '8017681699', '8017684526', 'WUTANNER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-02-01', '2013-06-30', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1063521177', 0, 'N', 0, '2013-10-25', NULL, NULL, 0, 0, NULL, NULL),
('870516264', 'W12008100', 'W12008100', 'UT01', 'Utah County Surgical Associates', 'Tavia', '', 'Mathers', 'APRN', 'General Surgery', '', '', NULL, 'O', '3550 N University Ave Ste 250', 'Provo', 'Utah', 'UT', '84604', '8013749625', '8013749690', '3550 N University Ave Ste 250', 'Provo', 'Utah', 'UT', '84604', '8013749625', '8013749690', 'UTCTYSURG', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-01-01', '2011-09-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1487802914', 0, 'N', 0, '2012-03-26', NULL, NULL, 0, 0, NULL, NULL),
('470897660', 'W12008101', 'W12008101', 'UT01', 'South Valley Ear Nose and Throat Associates', 'Garner', 'B', 'Meads', 'MD', 'Ear, Nose and Throat', NULL, NULL, NULL, 'O', '24 W Sergeant Ct Dr Ste 102', 'Saratoga Springs', 'Utah', 'UT', '84045', '8015668304', '8014073049', '24 W Sergeant Ct Dr Ste 102', 'Saratoga Springs', 'Utah', 'UT', '84045', '8015668304', '8014073049', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-01-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1760498026', 0, 'N', 0, '2012-05-02', NULL, NULL, 40.3915, -111.919, NULL, NULL),
('870293873', 'W12008102', 'W12008102', 'UT01', 'Tri City Medical Clinic', 'Melinda', 'M', 'Midgley', 'MD', 'Family Practice', '', '', NULL, 'O', '275 W 200 N', 'Lindon', 'Utah', 'UT', '84042', '8017961333', '8017561705', '275 W 200 N', 'Lindon', 'Utah', 'UT', '84042', '8017961333', '8017561705', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-02-01', '2011-10-21', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1760587653', 0, 'N', 0, '2013-11-04', NULL, NULL, 0, 0, NULL, NULL),
('680562677', 'W12008103', 'W12008103', 'UT01', 'Intermountain Ear Nose and Throat Specialists', 'Steven', 'K', 'Miller', 'MD', 'Ear, Nose and Throat', NULL, NULL, NULL, 'O', '756 E 12200 S', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013282522', '8015330589', '756 E 12200 S', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013282522', '8015330589', 'WiseOrtho', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-02-01', NULL, 0, 0, 0, 'Primary Childrens Medical Center', '', '', '', 'HCFA|UB|', '1942313796', 0, 'N', 0, '2013-10-04', NULL, NULL, 0, 0, NULL, NULL),
('870503202', 'W12008104', 'W12008104', 'UT01', 'Mountain West Ear Nose and Throat', 'Amanda', '', 'Milne', 'AUD', 'Audiology', '', '', NULL, 'O', '2255 N 1700 W Ste 200', 'Layton', 'Davis', 'UT', '84041', '8017762180', '8017762534', '2255 N 1700 W Ste 200', 'Layton', 'Davis', 'UT', '84041', '8017762180', '8017762534', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-02-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1801080270', 0, 'N', 0, '2013-08-20', NULL, NULL, 41.0887, -111.997, NULL, NULL),
('870503202', 'W12008108', 'W12008108', 'UT01', 'Mountain West Ear Nose and Throat', '', '', 'Mountain West Ear Nose and Throat', 'GROUP', '', '', '', NULL, 'O', '2255 N 1700 W Ste 200', 'Layton', 'Davis', 'UT', '84041', '8017762180', '8017762534', '2255 N 1700 W Ste 200', 'Layton', 'Davis', 'UT', '84041', '8017762180', '8017762534', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-01-20', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000007735', 0, 'N', 0, '2013-01-04', NULL, NULL, 41.0887, -111.997, NULL, NULL),
('680562677', 'W12008114', 'W12008114', 'UT01', 'Intermountain Ear Nose And Throat Specialisl  ', 'Craig', 'W', 'Anderson', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '756 E 12200 S', 'Draper', 'Salt Lake', 'UT', '84020', '8013282522', '8015330589', '756 E 12200 S', 'Draper', 'Salt Lake', 'UT', '84020', '8013282522', '8015330589', 'WiseOrtho', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-07-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1871541227', 0, 'N', 0, '2011-03-09', NULL, NULL, 40.5288, -111.87, NULL, NULL),
('260553931', 'W12008109', 'W12008109', 'ID01', 'Saint Alphonsus Medical Group Cardiothoracic Services Boise', 'Stephen', 'D', 'Jones', 'MD', 'Thoracic Surgery', 'Cardiovascular Disease', '', NULL, 'O', '6140 W Curtisian Ave Ste 102', 'Boise', 'Ada', 'ID', '83704', '2083677787', '2083677798', '6140 W Curtisian Ave Ste 102', 'Boise', 'Ada', 'ID', '83704', '2083677787', '2083677798', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2010-11-22', '2012-08-26', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1124004510', 0, 'N', 0, '2014-07-09', NULL, NULL, 43.6151, -116.256, NULL, NULL),
('820200895', 'W12008939', 'W12008939', 'IDBOISTD', 'Saint Alphonsus Medical Group Pulmonary & Sleep Boise ', 'Rory', 'R', 'Ramsey', 'MD', 'Pulmonary', 'Sleep Medicine', 'Sleep Disorders', NULL, 'O', '1055 N Curtis', 'Boise', 'Ada', 'ID', '83706', '2083673722', '2083672003', '1055 N Curtis', 'Boise', 'Ada', 'ID', '83706', '2083673722', '2083672003', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2011-01-28', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1174634737', 0, 'Y', 0, '2014-06-20', NULL, NULL, 43.6145, -116.254, NULL, NULL),
('260553931', 'W12008110', 'W12008110', 'ID01', 'Saint Alphonsus Medical Group Heart Care Nampa', 'Peter', 'G', 'Roan', 'MD', 'Cardiology', '', '', NULL, 'O', '1524 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2084635050', '2084635040', '1524 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2084635050', '2084635040', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2010-12-06', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1326037342', 0, 'N', 0, '2014-07-09', NULL, NULL, 43.5533, -116.573, NULL, NULL),
('260553931', 'W12008111', 'W12008111', 'ID01', 'Saint Alphonsus Medical Group Cardiology Nampa', 'Peter', 'G', 'Roan', 'MD', 'Cardiology', '', '', NULL, 'B', '3340 E Goldstone', 'Meridian', 'Ada', 'ID', '83642', '2083675170', '2084635040', '3340 E Goldstone', 'Meridian', 'Ada', 'ID', '83642', '2083675170', '2084635040', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2010-12-06', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1326037342', 0, 'N', 0, '2014-07-09', NULL, NULL, 0, 0, NULL, NULL),
('260553931', 'W12008112', 'W12008112', 'ID01', 'Saint Alphonsus Medical group Heart Care Nampa', 'Randolph', 'C', 'Byrd', 'MD', 'Cardiology', '', '', NULL, 'O', '1524 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2084635050', '2084635040', '1524 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2084635050', '2084635040', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2010-12-06', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1356339618', 0, 'N', 0, '2014-07-09', NULL, NULL, 43.5533, -116.573, NULL, NULL),
('260553931', 'W12008113', 'W12008113', 'ID01', 'Saint Alphonsus Medical Group Cardiology Nampa', 'Randolph', 'C', 'Byrd', 'MD', 'Cardiology', '', '', NULL, 'B', '3340 E Goldstone', 'Meridian', 'Ada', 'ID', '83642', '2083675170', '2084635040', '3340 E Goldstone', 'Meridian', 'Ada', 'ID', '83642', '2083675170', '2084635040', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2010-12-06', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1356339618', 0, 'N', 0, '2014-07-09', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12001607', 'W12001607', 'UTPEHP', 'Salt Lake Clinic', 'Cheryl', 'A', 'Torghele', 'OD', 'Optometry', '', '', NULL, 'O', '333 S 900 E', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8019336000', NULL, '333 S 900 E', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8019336000', '          ', 'PEHPPREF2', '', '', '0.00', '30.00', '0.00', 8, '2009-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1962416727', 0, 'N', 0, '2014-01-02', NULL, NULL, 0, 0, NULL, NULL),
('870281299', 'W12008115', 'W12008115', 'UT01', 'American Fork Clinic', 'Douglas', 'R', 'Mower', 'MD', 'Family Practice', '', '', NULL, 'O', '226 N 1100 E Ste A', 'American Fork', 'Utah', 'UT', '84003', '8018553843', NULL, '226 N 1100 E Ste A', 'American Fork', 'Utah', 'UT', '84003', '8018553843', '          ', 'WUTANNER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-02-01', '2013-06-30', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1033228283', 0, 'N', 0, '2013-12-19', NULL, NULL, 0, 0, NULL, NULL),
('870281299', 'W12008116', 'W12008116', 'UT01', 'American Fork Clinic', 'K', 'J', 'Murdock', 'MD', 'Family Practice', '', '', NULL, 'O', '226 N 1100 E Ste A', 'American Fork', 'Utah', 'UT', '84003', '8018553843', '8018553847', '226 N 1100 E Ste A', 'American Fork', 'Utah', 'UT', '84003', '8018553843', '8018553847', 'WUTANNER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-02-01', '2013-06-30', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1053429563', 0, 'N', 0, '2013-10-25', NULL, NULL, 0, 0, NULL, NULL),
('450579013', 'W12008119', 'W12008119', 'UT01', 'Monarch Womens Cancer Center', 'Bethany', 'A', 'Myers', 'PA', 'Gynecology', '', '', NULL, 'M', '3 Maryland Farms Ste 250', 'Brentwood', 'Williamson', 'TN', '37027', '8017434730', '8017434736', '3 Maryland Farms Ste 250', 'Brentwood', 'Williamson', 'TN', '37027', '8017434730', '8017434736', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-01-01', '2012-06-30', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1912215377', 0, 'N', 0, '2014-04-09', NULL, NULL, 0, 0, NULL, NULL),
('450579013', 'W12008117', 'W12008117', 'UT01', 'Monarch Womens Cancer Center', 'Bethany', 'A', 'Myers', 'PA', 'Gynecology', '', '', NULL, 'O', '1140 E 3900 S Ste 340', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8017434730', '8017434736', '1140 E 3900 S Ste 340', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8017434730', '8017434736', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-01-01', '2012-06-30', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1912215377', 0, 'N', 0, '2014-04-09', NULL, NULL, 0, 0, NULL, NULL),
('450579013', 'W12008118', 'W12008118', 'UT01', 'Monarch Womens Cancer Center', 'Bethany', 'A', 'Myers', 'PA', 'Gynecology', '', '', NULL, 'B', 'PO Box 198546', 'Atlanta', 'Fulton', 'GA', '30384', '8017434730', NULL, 'PO Box 198546', 'Atlanta', 'Fulton', 'GA', '30384', '8017434730', '', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-01-01', '2012-06-30', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1912215377', 0, 'N', 0, '2014-04-09', NULL, NULL, 0, 0, NULL, NULL),
('271647689', 'W12008120', 'W12008120', 'UT01', '', 'Jeffrey', 'J', 'Nelson', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '24 W Sergeant Ct Dr Ste 102', 'Saratoga Springs', 'Utah', 'UT', '84045', '8015668304', '8014076049', '24 W Sergeant Ct Dr Ste 102', 'Saratoga Springs', 'Utah', 'UT', '84045', '8015668304', '8014076049', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-02-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', '', '', '', 'HCFA|UB|', '1649433608', 0, 'N', 0, '2011-11-17', NULL, NULL, 40.3915, -111.919, NULL, NULL),
('680562677', 'W12008121', 'W12008121', 'UT01', 'Intermountain Ear Nose and Throat Specialists', 'Richard', 'W', 'Nielsen', 'MD', 'Ear, Nose and Throat', NULL, NULL, NULL, 'O', '756 E 12200 S', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013282522', '8015330589', '756 E 12200 S', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013282522', '8015330589', 'WiseOrtho', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-02-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', '', '', '', 'HCFA|UB|', '1427183052', 0, 'N', 0, '2012-05-25', NULL, NULL, 0, 0, NULL, NULL),
('820277763', 'W12008122', 'W12008122', 'ID01', 'Norco', '', '', 'Norco', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', '2324 Caldwell Blvd', 'Nampa', 'Canyon', 'ID', '83651', '2084673070', '2084673317', '2324 Caldwell Blvd', 'Nampa', 'Canyon', 'ID', '83651', '2084673070', '2084673317', 'DME80', '', '', '0.00', '35.00', '0.00', 3, '2011-02-01', '2014-03-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1326109059', 0, 'N', 0, '2014-05-15', NULL, NULL, 0, 0, NULL, NULL),
('820277763', 'W12008123', 'W12008123', 'ID01', 'Norco', '', '', 'Norco', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', '400 Main St', 'Boise', 'Ada', 'ID', '83702', '2083440299', '2083444327', '400 Main St', 'Boise', 'Ada', 'ID', '83702', '2083440299', '2083444327', 'DME80', '', '', '0.00', '35.00', '0.00', 3, '2011-02-01', '2014-03-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1326109059', 0, 'N', 0, '2014-05-15', NULL, NULL, 0, 0, NULL, NULL),
('820277763', 'W12008124', 'W12008124', 'ID01', 'Norco', '', '', 'Norco', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', '315 E Elm St', 'Caldwell', 'Canyon', 'ID', '83605', '2084020100', '2084020103', '315 E Elm St', 'Caldwell', 'Canyon', 'ID', '83605', '2084020100', '2084020103', 'DME80', '', '', '0.00', '35.00', '0.00', 3, '2011-02-01', '2014-03-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1326109059', 0, 'N', 0, '2014-05-15', NULL, NULL, 43.6534, -116.695, NULL, NULL),
('820277763', 'W12008125', 'W12008125', 'ID01', 'Norco', '', '', 'Norco', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', '2882 N Eagle Rd', 'Meridian', 'Ada', 'ID', '83646', '2088980202', '2088882266', '2882 N Eagle Rd', 'Meridian', 'Ada', 'ID', '83646', '2088980202', '2088882266', 'DME80', '', '', '0.00', '35.00', '0.00', 3, '2011-02-01', '2014-03-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1326109059', 0, 'N', 0, '2014-05-15', NULL, NULL, 0, 0, NULL, NULL),
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('680562677', 'W12008160', 'W12008160', 'UT01', 'Intermountain Ear Nose and Throat Specialists', 'Pramod', 'K', 'Sharma', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '756 E 12200 S', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013282522', '8015330589', '756 E 12200 S', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013282522', '8015330589', 'WiseOrtho', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-02-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1801986427', 0, 'N', 0, '2011-02-10', NULL, NULL, 0, 0, NULL, NULL),
('800544614', 'W12008164', 'W12008164', 'UT01', 'Sleep Dx', '', '', 'Sleep Dx', 'GROUP', 'Sleep Disorders', '', '', NULL, 'O', '1515 N 400 E Ste 101', 'Logan', 'Cache', 'UT', '84341', '4357557122', NULL, '1515 N 400 E Ste 101', 'Logan', 'Cache', 'UT', '84341', '4357557122', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1245404920', 0, 'N', 0, '2011-02-10', NULL, NULL, 41.7591, -111.824, NULL, NULL),
('800544614', 'W12008165', 'W12008165', 'UT01', 'Sleep Dx', '', '', 'Sleep Dx', 'GROUP', 'Sleep Disorders', '', '', NULL, 'B', '2660 Sierra Dr', 'Colorado Springs', 'El Paso', 'CO', '80917', '4357557122', NULL, '2660 Sierra Dr', 'Colorado Springs', 'El Paso', 'CO', '80917', '4357557122', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1245404920', 0, 'N', 0, '2011-02-10', NULL, NULL, 0, 0, NULL, NULL),
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('870516264', 'W12008168', 'W12008168', 'UT01', 'Utah Surgical Associates Inc', 'Jory', 'Q', 'Sorensen', 'FNP', 'General Surgery', NULL, NULL, NULL, 'O', '3550 N University Ave Ste 250', 'Provo', 'Utah', 'UT', '84604', '8013749625', '8013749690', '3550 N University Ave Ste 250', 'Provo', 'Utah', 'UT', '84604', '8013749625', '8013749690', 'UTCTYSURG', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-01-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1376689877', 0, 'N', 0, '2013-05-06', NULL, NULL, 40.2813, -111.658, NULL, NULL),
('870546501', 'W12008173', 'W12008173', 'UT01', 'Alpine Pediatrics', 'Weston', 'E', 'Spencer', 'MD', 'Pediatrics', NULL, NULL, NULL, 'O', '1912 W 930 N', 'Pleasant Grove', 'Utah', 'UT', '84062', '8014921999', '8014921991', '1912 W 930 N', 'Pleasant Grove', 'Utah', 'UT', '84062', '8014921999', '8014921991', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-02-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1649295809', 0, 'N', 0, '2013-08-20', NULL, NULL, 40.383, -111.744, NULL, NULL),
('870546501', 'W12008174', 'W12008174', 'UT01', 'Alpine Pediatrics', 'Weston', 'E', 'Spencer', 'MD', 'Pediatrics', NULL, NULL, NULL, 'O', '77 E Commerce Dr', 'Saratoga Springs', 'Utah', 'UT', '84045', '8019229222', '8019229370', '77 E Commerce Dr', 'Saratoga Springs', 'Utah', 'UT', '84045', '8019229222', '8019229370', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-02-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1649295809', 0, 'N', 0, '2013-08-20', NULL, NULL, 40.3848, -111.914, NULL, NULL),
('870546501', 'W12008175', 'W12008175', 'UT01', 'Alpine Pediatrics', 'Weston', 'E', 'Spencer', 'MD', 'Pediatrics', NULL, NULL, NULL, 'O', '3231 N 1120 E', 'Lehi', 'Utah', 'UT', '84043', '8017682800', NULL, '3231 N 1120 E', 'Lehi', 'Utah', 'UT', '84043', '8017682800', '          ', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-02-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1649295809', 0, 'N', 0, '2013-08-20', NULL, NULL, 40.4282, -111.832, NULL, NULL),
('830182821', 'W12008177', 'W12008177', 'WY01', 'Gottsche Rehabilitation Center', 'Timothy', 'P', 'Stecker', 'PT', 'Orthopedic Surgery', '', '', NULL, 'O', '639 W Coulter Ave', 'Powell', 'Park', 'WY', '82435', '3077549262', '          ', '639 W Coulter Ave', 'Powell', 'Park', 'WY', '82435', '3077549262', '          ', '', '', '', '0.00', '10.00', '0.00', 3, '2011-02-01', '2012-08-17', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1306938097', 0, 'N', 0, '2014-04-02', NULL, NULL, 44.7487, -108.766, NULL, NULL),
('830182821', 'W12008176', 'W12008176', 'WY01', 'Gottsche Rehabilitation Center', 'Timothy', 'P', 'Stecker', 'PT', 'Orthopedic Surgery', '', '', NULL, 'O', '720 Lindsay Ln', 'Cody', 'Park', 'WY', '82414', '3075781970', '          ', '720 Lindsay Ln', 'Cody', 'Park', 'WY', '82414', '3075781970', '          ', '', '', '', '0.00', '10.00', '0.00', 3, '2011-02-01', '2012-08-17', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1306938097', 0, 'N', 0, '2014-04-02', NULL, NULL, 44.5202, -109.074, NULL, NULL),
('870516264', 'W12008178', 'W12008178', 'UT01', 'Utah Surgical Associates Inc', 'Cindy', '', 'Stock', 'APRN', 'General Surgery', 'Family Practice', '', NULL, 'O', '3550 N University Ave Ste 250', 'Provo', 'Utah', 'UT', '84604', '8013749625', '8013749690', '3550 N University Ave Ste 250', 'Provo', 'Utah', 'UT', '84604', '8013749625', '8013749690', 'UTCTYSURG', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1841470879', 0, 'N', 0, '2013-05-06', NULL, NULL, 40.2813, -111.658, NULL, NULL),
('870503202', 'W12008179', 'W12008179', 'UT01', 'Mountain West Ear Nose and Throat', 'Curt', 'R', 'Stock', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '2255 N 1700 W Ste 200', 'Layton', 'Davis', 'UT', '84041', '8017762180', '8017762534', '2255 N 1700 W Ste 200', 'Layton', 'Davis', 'UT', '84041', '8017762180', '8017762534', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-01-20', NULL, 0, 0, 0, 'Davis Hospital', 'Lakeview Hospital', 'Primary Childrens Medical Center', 'Star Valley Medical Center', 'HCFA|UB|', '1275681686', 0, 'N', 0, '2013-08-16', NULL, NULL, 41.0887, -111.997, NULL, NULL),
('204941789', 'W12008181', 'W12008181', 'UT01', 'Medway Medical', '', '', 'Medway Medical', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', '12393 Gateway Park Place', 'Draper', 'Salt Lake', 'UT', '84020', '8776554243', NULL, '12393 Gateway Park Place', 'Draper', 'Salt Lake', 'UT', '84020', '8776554243', '', 'DME80', '', '', '0.00', '35.00', '0.00', 3, '2011-01-01', '2012-08-07', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1962438358', 0, 'N', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('204941789', 'W12008180', 'W12008180', 'UT01', 'Medway Medical', '', '', 'Medway Medical', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', '1115 N 200 E Ste 230', 'Logan', 'Cache', 'UT', '84341', '4357559600', NULL, '1115 N 200 E Ste 230', 'Logan', 'Cache', 'UT', '84341', '4357559600', '', 'DME80', '', '', '0.00', '35.00', '0.00', 3, '2011-01-01', '2013-07-22', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1962438358', 0, 'N', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('680562677', 'W12008182', 'W12008182', 'UT01', 'Intermountain Ear Nose and Throat Specialists', 'Bryan', 'C', 'Tagge', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '756 E 12200 S', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013282522', '8015330589', '756 E 12200 S', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013282522', '8015330589', 'WiseOrtho', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-01-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1164557583', 0, 'N', 0, '2013-12-11', NULL, NULL, 0, 0, NULL, NULL),
('870516264', 'W12008187', 'W12008187', 'UT01', 'Utah Surgical Associates Inc', 'Richard', 'M', 'Thomas', 'MD', 'General Surgery', NULL, NULL, NULL, 'O', '3550 N University Ave Ste 250', 'Provo', 'Utah', 'UT', '84604', '8013749625', '8013749690', '3550 N University Ave Ste 250', 'Provo', 'Utah', 'UT', '84604', '8013749625', '8013749690', 'UTCTYSURG', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-01-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', 'Mountain View Hospital', '', '', 'HCFA|UB|', '1215977517', 0, 'N', 0, '2013-05-06', NULL, NULL, 40.2813, -111.658, NULL, NULL),
('870503202', 'W12008188', 'W12008188', 'UT01', 'Mountain West Ear Nose and Throat', 'Scott', 'K', 'Thompson', 'MD', 'Ear, Nose and Throat', 'Plastic Surgery', NULL, NULL, 'O', '2255 N 1700 W Ste 200', 'Layton', 'Davis', 'UT', '84041', '8017762180', '8017762534', '2255 N 1700 W Ste 200', 'Layton', 'Davis', 'UT', '84041', '8017762180', '8017762534', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-01-20', NULL, 0, 0, 0, 'Davis Hospital', 'Primary Childrens Medical Center', 'Lakeview Hospital', NULL, 'HCFA|UB|', '1356378095', 0, 'N', 0, '2013-08-19', NULL, NULL, 41.0887, -111.997, NULL, NULL),
('262072378', 'W12008189', 'W12008189', 'UT01', 'Valley Obstetrics & Gynecology PC', 'Jefforey', 'R', 'Thorpe', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '700 W 800 N Ste 200', 'Orem', 'Utah', 'UT', '84057', '8017569635', '8012168357', '700 W 800 N Ste 200', 'Orem', 'Utah', 'UT', '84057', '8017569635', '8012168357', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-02-01', '2013-05-31', 0, 0, 0, 'Timpanogos Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1225153828', 0, 'N', 0, '2013-06-03', NULL, NULL, 0, 0, NULL, NULL),
('262072378', 'W12008190', 'W12008190', 'UT01', 'Valley Obstetrics & Gynecology PC', 'Jefforey', 'R', 'Thorpe', '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', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-02-01', '2013-05-31', 0, 0, 0, 'Timpanogos Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1225153828', 0, 'N', 0, '2013-06-03', 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
('870609595', 'W12008191', 'W12008191', 'UT01', 'Utah County Medical Associates', 'David', 'J', 'Tipton', 'MD', 'Family Practice', '', '', NULL, 'O', '97 S Professional Way Ste 2', 'Payson', 'Utah', 'UT', '84651', '8014654896', NULL, '97 S Professional Way Ste 2', 'Payson', 'Utah', 'UT', '84651', '8014654896', '', 'WUTCTY', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-02-01', NULL, 0, 0, 0, 'Mountain View Hospital', '', '', '', 'HCFA|UB|', '1811915051', 0, 'Y', 0, '2014-05-26', NULL, NULL, 40.0429, -111.712, NULL, NULL),
('870609595', 'W12008192', 'W12008192', 'UT01', 'Utah County Medical Associates', 'David', 'J', 'Tipton', 'MD', 'Family Practice', '', '', NULL, 'O', '376 E 400 S', 'Springville', 'Utah', 'UT', '84663', '8014654896', NULL, '376 E 400 S', 'Springville', 'Utah', 'UT', '84663', '8014654896', '', 'WUTCTY', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-02-01', NULL, 0, 0, 0, 'Mountain View Hospital', '', '', '', 'HCFA|UB|', '1811915051', 0, 'N', 0, '2014-05-26', NULL, NULL, 40.1611, -111.604, NULL, NULL),
('870609595', 'W12008193', 'W12008193', 'UT01', 'Utah County Medical Associates', 'David', 'J', 'Tipton', 'MD', 'Family Practice', '', '', NULL, 'O', '15 S 1000 E Ste 300', 'Payson', 'Utah', 'UT', '84651', '8014654896', NULL, '15 S 1000 E Ste 300', 'Payson', 'Utah', 'UT', '84651', '8014654896', '', 'WUTCTY', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-02-01', NULL, 0, 0, 0, 'Mountain View Hospital', '', '', '', 'HCFA|UB|', '1811915051', 0, 'Y', 0, '2014-05-26', NULL, NULL, 40.044, -111.716, NULL, NULL),
('870516264', 'W12008194', 'W12008194', 'UT01', 'Utah Surgical Associates Inc', 'Jennifer', 'J', 'Tittensor', 'MD', 'General Surgery', NULL, NULL, NULL, 'O', '1159 E 200 N Ste 350', 'American Fork', 'Utah', 'UT', '84003', '8017569132', '8017565091', '1159 E 200 N Ste 350', 'American Fork', 'Utah', 'UT', '84003', '8017569132', '8017565091', 'UTCTYSURG', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-01-11', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1568497634', 0, 'N', 0, '2013-05-06', NULL, NULL, 40.3805, -111.769, NULL, NULL),
('260093564', 'W12008195', 'W12008195', 'UT01', 'Riverwoods Surgery Center', 'Trevor', 'K', 'Tomlinson', 'CRNA', 'CRNA', '', '', NULL, 'B', 'PO Box 1727', 'Provo', 'Utah', 'UT', '84603', '8013758049', NULL, 'PO Box 1727', 'Provo', 'Utah', 'UT', '84603', '8013758049', '          ', '', '', '1000', '49.44', '0.00', '0.00', 3, '2011-02-01', NULL, 1, 12, 0, '', '', '', '', 'HCFA|UB|', '1659305134', 0, 'N', 0, '2012-06-29', NULL, NULL, 0, 0, NULL, NULL),
('260093564', 'W12008199', 'W12008199', 'UT01', 'Riverwoods Surgery Center', 'James', 'R', 'Uhl', 'DO', 'Anesthesia', '', '', NULL, 'B', 'PO Box 1727', 'Provo', 'Utah', 'UT', '84603', '8013758049', NULL, 'PO Box 1727', 'Provo', 'Utah', 'UT', '84603', '8013758049', '          ', '', '', '1000', '49.44', '0.00', '0.00', 3, '2011-02-01', NULL, 1, 12, 0, '', '', '', '', 'HCFA|UB|', '1578531497', 0, 'N', 0, '2011-02-10', NULL, NULL, 0, 0, NULL, NULL),
('870546501', 'W12008200', 'W12008200', 'UT01', 'Alpine Pediatrics', 'Beverly', 'L', 'Vargo', 'MD', 'Pediatrics', '', '', NULL, 'O', '1912 W 930 N', 'Pleasant Grove', 'Utah', 'UT', '84062', '8014921999', NULL, '1912 W 930 N', 'Pleasant Grove', 'Utah', 'UT', '84062', '8014921999', '', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-02-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1316991565', 0, 'N', 0, '2014-04-15', NULL, NULL, 40.383, -111.744, NULL, NULL),
('870546501', 'W12008201', 'W12008201', 'UT01', 'Alpine Pediatrics', 'Beverly', 'L', 'Vargo', 'MD', 'Pediatrics', '', '', NULL, 'O', '77 E Commerce Dr', 'Saratoga Springs', 'Utah', 'UT', '84045', '8019229222', '8019229370', '77 E Commerce Dr', 'Saratoga Springs', 'Utah', 'UT', '84045', '8019229222', '8019229370', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-02-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1316991565', 0, 'N', 0, '2014-04-15', NULL, NULL, 40.3848, -111.914, NULL, NULL),
('870546501', 'W12008202', 'W12008202', 'UT01', 'Alpine Pediatrics', 'Beverly', 'L', 'Vargo', 'MD', 'Pediatrics', '', '', NULL, 'O', '3231 N 1120 E', 'Lehi', 'Utah', 'UT', '84043', '8017682800', NULL, '3231 N 1120 E', 'Lehi', 'Utah', 'UT', '84043', '8017682800', '', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-02-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1316991565', 0, 'N', 0, '2014-04-15', NULL, NULL, 40.4282, -111.832, NULL, NULL),
('870503202', 'W12008203', 'W12008203', 'UT01', 'Mountain West Ear Nose and Throat', 'Karen', 'L', 'Walker', 'AUD', 'Audiology', '', '', NULL, 'O', '2255 N 1700 W', 'Layton', 'Davis', 'UT', '84041', '8017762180', '8017762534', '2255 N 1700 W', 'Layton', 'Davis', 'UT', '84041', '8017762180', '8017762534', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-01-20', '2011-09-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1629102553', 0, 'N', 0, '2011-09-21', NULL, NULL, 0, 0, NULL, NULL),
('870516264', 'W12008204', 'W12008204', 'UT01', 'Utah Surgical Associates Inc', 'David', 'M', 'Watts', 'MD', 'General Surgery', '', '', NULL, 'O', '1055 N 300 W Ste 302', 'Provo', 'Utah', 'UT', '84604', '8013573938', '8013577444', '1055 N 300 W Ste 302', 'Provo', 'Utah', 'UT', '84604', '8013573938', '8013577444', 'UTCTYSURG', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-01-11', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1700932068', 0, 'N', 0, '2014-04-17', NULL, NULL, 40.2476, -111.664, NULL, NULL),
('260093564', 'W12008205', 'W12008205', 'UT01', 'Riverwoods Surgery Center', 'Joyce', '', 'Westphal', 'CRNA', 'Anesthesia', '', '', NULL, 'B', 'PO Box 1727', 'Provo', 'Utah', 'UT', '84603', '8013758049', NULL, 'PO Box 1727', 'Provo', 'Utah', 'UT', '84603', '8013758049', '          ', '', '', '1000', '49.44', '0.00', '0.00', 3, '2011-02-01', NULL, 1, 12, 0, '', '', '', '', 'HCFA|UB|', '1144366048', 0, 'N', 0, '2012-11-26', NULL, NULL, 0, 0, NULL, NULL),
('260093564', 'W12008206', 'W12008206', 'UT01', 'Riverwoods Surgery Center', 'Jed', 'T', 'Widdison', 'CRNA', 'Anesthesia', '', '', NULL, 'B', 'PO Box 1727', 'Provo', 'Utah', 'UT', '84603', '8013758049', NULL, 'PO Box 1727', 'Provo', 'Utah', 'UT', '84603', '8013758049', '          ', '', '', '1000', '49.44', '0.00', '0.00', 3, '2011-02-01', NULL, 1, 12, 0, '', '', '', '', 'HCFA|UB|', '1598731598', 0, 'N', 0, '2012-11-26', NULL, NULL, 0, 0, NULL, NULL),
('870546501', 'W12008208', 'W12008208', 'UT01', 'Alpine Pediatrics', 'David', 'T', 'Whiting', 'MD', 'Pediatrics', NULL, NULL, NULL, 'B', '1912 W 930 N', 'Pleasant Grove', 'Utah', 'UT', '84062', '8014921999', NULL, '1912 W 930 N', 'Pleasant Grove', 'Utah', 'UT', '84062', '8014921999', '          ', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-02-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1023056298', 0, 'N', 0, '2013-09-23', NULL, NULL, 0, 0, NULL, NULL),
('260093564', 'W12008207', 'W12008207', 'UT01', 'Riverwoods Surgery Center', 'Mark ', '', 'Wisniewski', 'MD', 'Anesthesia', '', '', NULL, 'B', 'PO Box 1727', 'Provo', 'Utah', 'UT', '84603', '8013758049', NULL, 'PO Box 1727', 'Provo', 'Utah', 'UT', '84603', '8013758049', '          ', '', '', '1000', '49.44', '0.00', '0.00', 3, '2011-02-01', NULL, 0, 12, 0, '', '', '', '', 'HCFA|UB|', '1669537072', 0, 'N', 0, '2011-02-10', NULL, NULL, 0, 0, NULL, NULL),
('870546501', 'W12008209', 'W12008209', 'UT01', 'Alpine Pediatrics', 'David', 'T', 'Whiting', 'MD', 'Pediatrics', NULL, NULL, NULL, 'O', '77 E Commerce Dr', 'Saratoga Springs', 'Utah', 'UT', '84045', '8019229222', '8019229370', '77 E Commerce Dr', 'Saratoga Springs', 'Utah', 'UT', '84045', '8019229222', '8019229370', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-02-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1023056298', 0, 'N', 0, '2013-09-23', NULL, NULL, 40.3848, -111.914, NULL, NULL),
('870546501', 'W12008210', 'W12008210', 'UT01', 'Alpine Pediatrics', 'David', 'T', 'Whiting', 'MD', 'Pediatrics', NULL, NULL, NULL, 'O', '3231 N 1120 E', 'Lehi', 'Utah', 'UT', '84043', '8017682800', NULL, '3231 N 1120 E', 'Lehi', 'Utah', 'UT', '84043', '8017682800', '          ', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-02-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1023056298', 0, 'N', 0, '2013-09-23', NULL, NULL, 40.4282, -111.832, NULL, NULL),
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('870286381', 'W12008212', 'W12008212', 'UT01', 'Ogden Clinic Physical Therapy', 'Dorian', 'M', 'Wood', 'PT', 'Physical Therapy', '', '', NULL, 'B', '4650 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014794621', '8014762670', '4650 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014794621', '8014762670', '', '', '', '0.00', '0.00', '76.74', 6, '2011-02-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1376532911', 0, 'N', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
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('836000025', 'W12008228', 'W12008228', 'WY01', 'Wagon Circle Surgery Clinic', 'Gary', 'E', 'Chizever', 'MD', 'General Surgery', '', '', NULL, 'O', '2012 W Elm St', 'Rawlins', 'Carbon', 'WY', '82301', '3073246022', '3073248232', '2012 W Elm St', 'Rawlins', 'Carbon', 'WY', '82301', '3073246022', '3073248232', 'WISEWYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 6, '2011-04-01', '2011-10-01', 0, 0, 0, 'Memorial Hospital of Carbon County', '', '', '', 'HCFA|', '1295752988', 0, 'Y', 0, '2012-04-27', NULL, NULL, 0, 0, NULL, NULL),
('836000025', 'W12008229', 'W12008229', 'WY01', 'Wagon Circle Surgery Clinic', 'Gary', 'E', 'Chizever', 'MD', 'General Surgery', '', '', NULL, 'B', '2221 W Elm St', 'Rawlins', 'Carbon', 'WY', '82301', '3073246022', '3073248232', '2221 W Elm St', 'Rawlins', 'Carbon', 'WY', '82301', '3073246022', '3073248232', 'WISEWYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 6, '2011-04-01', '2011-10-01', 0, 0, 0, 'Memorial Hospital of Carbon County', '', '', '', 'HCFA|', '1295752988', 0, 'N', 0, '2012-04-27', NULL, NULL, 0, 0, NULL, NULL),
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('870507858', 'W12008232', 'W12008232', 'UT01', 'Neurological Associates', 'Mohammad', 'E', 'Taher', 'MD', 'Neurology', NULL, NULL, NULL, 'B', '41 N 400 W', 'Payson', 'Utah', 'UT', '84651', '8014654800', '8014659119', '41 N 400 W', 'Payson', 'Utah', 'UT', '84651', '8014654800', '8014659119', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-02-01', NULL, 0, 0, 0, 'Evanston Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1992762918', 0, 'N', 0, '2011-06-10', NULL, NULL, 0, 0, NULL, NULL),
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('820200895', 'W12008259', 'W12008259', 'ID01', 'Saint Alphonsus Medical Group NHP Family Medicine ', 'Brian', 'E', 'Cothern', 'MD', 'Family Practice', 'Hospitalist', '', NULL, 'O', '4400 Flamingo Ave E Ste 301', 'Nampa', 'Canyon', 'ID', '83687', '2084656900', '2084656910', '4400 Flamingo Ave E Ste 301', 'Nampa', 'Canyon', 'ID', '83687', '2084656900', '2084656910', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2011-01-31', '2012-03-29', 0, 0, 0, '', '', '', 'Saint Alphonsus Medical Center Nampa', 'HCFA|', '1295774149', 0, 'N', 0, '2012-03-29', NULL, NULL, 0, 0, NULL, NULL),
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('820200895', 'W12008261', 'W12008261', 'ID01', 'Saint Alphonsus Medical Group NHP Family Medicine', 'Tricia', 'L', 'Keefe', 'DO', 'Family Practice', '', '', NULL, 'O', '4400 Flamingo Ave E Ste 301', 'Nampa', 'Canyon', 'ID', '83687', '2084656900', '2084656910', '4400 Flamingo Ave E Ste 301', 'Nampa', 'Canyon', 'ID', '83687', '2084656900', '2084656910', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2010-12-06', '2012-03-30', 0, 0, 0, '', '', '', 'Saint Alphonsus Medical Center Nampa', 'HCFA|', '1730123043', 0, 'N', 0, '2012-03-30', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12008262', 'W12008262', 'ID01', 'Saint Alphonsus Medical Group NHP Family Medicine ', 'John', '', 'Johnson', 'MD', 'Family Practice', 'Sports Medicine', '', NULL, 'O', '4400 Flamingo Ave E Ste 301', 'Nampa', 'Canyon', 'ID', '83687', '2084656970', '2084656990', '4400 Flamingo Ave E Ste 301', 'Nampa', 'Canyon', 'ID', '83687', '2084656970', '2084656990', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2011-01-31', '2012-03-29', 0, 0, 0, '', '', '', '', 'HCFA|', '1164402681', 0, 'N', 0, '2012-03-29', NULL, NULL, 0, 0, NULL, NULL),
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('942854057', 'W12008309', 'W12008309', 'UTPEHP', 'Heart Rhythm Specialists', 'Joanne', '', 'Nam', 'NP', 'Cardiovascular Disease', '', '', NULL, 'O', '5169 S Cottonwood St Ste 510', 'Murray', 'Salt Lake', 'UT', '84107', '8015073513', '8015073584', '5169 S Cottonwood St Ste 510', 'Murray', 'Salt Lake', 'UT', '84107', '8015073513', '8015073584', 'PEHPMID', '', '', '0.00', '30.00', '0.00', 8, '2011-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1861583692', 0, 'N', 0, '2011-02-15', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12008310', 'W12008310', 'UTPEHP', 'Heart Rhythm Specialists Murray', 'Joanne', '', 'Nam', 'NP', 'Cardiovascular Disease', '', '', NULL, 'O', '5292 S College Dr Ste 200', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8012814278', '8012815960', '5292 S College Dr Ste 200', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8012814278', '8012815960', 'PEHPMID', '', '', '0.00', '30.00', '0.00', 8, '2011-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1861583692', 0, 'N', 0, '2011-02-15', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12008311', 'W12008311', 'UTPEHP', 'Heart Rhythm Specialists Logan', 'Heather', 'A', 'Mauro', 'ARNP', 'Cardiovascular Disease', '', '', NULL, 'O', '1300 N 500 E Ste 320', 'Logan', 'Cache', 'UT', '84341', '8015073513', '8015073584', '1300 N 500 E Ste 320', 'Logan', 'Cache', 'UT', '84341', '8015073513', '8015073584', 'PEHPMID', '', '', '0.00', '30.00', '0.00', 8, '2011-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1114018934', 0, 'N', 0, '2012-05-29', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12008312', 'W12008312', 'utpehp', 'Heart Rhythm Specialists', 'Heather', 'A', 'Mauro', 'ARNP', 'Cardiovascular Disease', '', '', NULL, 'O', '5169 S Cottonwood St Ste 510', 'Murray', 'Salt Lake', 'UT', '84107', '8015073513', '8015073584', '5169 S Cottonwood St Ste 510', 'Murray', 'Salt Lake', 'UT', '84107', '8015073513', '8015073584', 'PEHPMID', '', '', '0.00', '30.00', '0.00', 8, '2011-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1114018934', 0, 'N', 0, '2012-05-29', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12008313', 'W12008313', 'UTPEHP', 'Heart Rhythm Specialists Murray', 'Heather', 'A', 'Mauro', 'ARNP', 'Cardiovascular Disease', '', '', NULL, 'O', '5292 S College Dr Ste 200', 'Murray', 'Salt Lake', 'UT', '84107', '8012814278', '8012815960', '5292 S College Dr Ste 200', 'Murray', 'Salt Lake', 'UT', '84107', '8012814278', '8012815960', 'PEHPMID', '', '', '0.00', '30.00', '0.00', 8, '2011-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1114018934', 0, 'N', 0, '2012-05-29', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12008314', 'W12008314', 'UTPEHP', 'Dixie Neonatology', 'Amiee', '', 'Mitchell', 'APRN', 'Neonatology', '', '', NULL, 'O', '544 E 400 E', 'St George', 'Washington', 'UT', '84770', '4356884640', '4356884601', '544 E 400 E', 'St George', 'Washington', 'UT', '84770', '4356884640', '4356884601', 'PEHPMID', '', '', '0.00', '30.00', '0.00', 8, '2011-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1457679284', 0, 'N', 0, '2011-02-15', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12008315', 'W12008315', 'UTPEHP2', 'Dixie Neonatology', 'Garry', 'G', 'Lipsey', 'APRN', 'Neonatology', 'Neonatal Nurse Practitioner', '', NULL, 'O', '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356884640', NULL, '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356884640', '          ', 'PEHPMID', '', '', '0.00', '30.00', '0.00', 8, '2011-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1477737583', 0, 'N', 0, '2011-02-15', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12008316', 'W12008316', 'UTPEHP', 'Heart Rhythm Specialists Logan', 'David', 'L', 'Johnson', 'PA', 'Cardiovascular Disease', '', '', NULL, 'O', '1300 N 500 E Ste 320', 'Logan', 'Cache', 'UT', '84341', '8015073513', '8015073584', '1300 N 500 E Ste 320', 'Logan', 'Cache', 'UT', '84341', '8015073513', '8015073584', 'PEHPMID', '', '', '0.00', '30.00', '0.00', 8, '2011-01-01', '2011-10-29', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1326248022', 0, 'N', 0, '2011-12-01', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12008317', 'W12008317', 'UTPEHP', 'Heart Rhythm Specialists', 'David', 'L', 'Johnson', 'PA', 'Cardiovascular Disease', '', '', NULL, 'O', '5169 S Cottonwood St Ste 510', 'Murray', 'Salt Lake', 'UT', '84107', '8015073513', '8015073584', '5169 S Cottonwood St Ste 510', 'Murray', 'Salt Lake', 'UT', '84107', '8015073513', '8015073584', 'PEHPMID', '', '', '0.00', '30.00', '0.00', 8, '2011-01-01', '2011-10-29', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1326248022', 0, 'N', 0, '2011-12-01', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12008318', 'W12008318', 'UTPEHP', 'Heart Rhythm Specialists Murray', 'David', 'L', 'Johnson', 'PA', 'Cardiovascular Disease', '', '', NULL, 'O', '5292 S College Dr Ste 200', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8012814278', '8012815960', '5292 S College Dr Ste 200', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8012814278', '8012815960', 'PEHPMID', '', '', '0.00', '30.00', '0.00', 8, '2011-01-01', '2011-10-29', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1326248022', 0, 'N', 0, '2011-12-01', 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
('942854057', 'W12008319', 'W12008319', 'UTPEHP', 'Heart Rhythm Specialists Logan', 'Jared', 'B', 'Hains', 'PA-C', 'Cardiovascular Disease', '', '', NULL, 'O', '1300 N 500 E Ste 320', 'Logan', 'Cache', 'UT', '84341', '8015073513', '8015073584', '1300 N 500 E Ste 320', 'Logan', 'Cache', 'UT', '84341', '8015073513', '8015073584', 'PEHPMID', '', '', '0.00', '30.00', '0.00', 8, '2011-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1780750091', 0, 'N', 0, '2011-02-15', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12008320', 'W12008320', 'UTPEHP', 'Heart Rhythm Specialists', 'Jared', 'B', 'Hains', 'PA-C', 'Cardiovascular Disease', '', '', NULL, 'O', '5169 S Cottonwood St Ste 510', 'Murray', 'Salt Lake', 'UT', '84107', '8015073513', '8015073584', '5169 S Cottonwood St Ste 510', 'Murray', 'Salt Lake', 'UT', '84107', '8015073513', '8015073584', 'PEHPMID', '', '', '0.00', '30.00', '0.00', 8, '2011-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1780750091', 0, 'N', 0, '2011-02-15', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12008321', 'W12008321', 'UTPEHP', 'Heart Rhythm Specialists Murray', 'Jared', 'B', 'Hains', 'PA-C', 'Cardiovascular Disease', '', '', NULL, 'O', '5292 S College Dr Ste 200', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8012814278', '8012815960', '5292 S College Dr Ste 200', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8012814278', '8012815960', 'PEHPMID', '', '', '0.00', '30.00', '0.00', 8, '2011-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1780750091', 0, 'N', 0, '2011-02-15', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12008324', 'W12008324', 'UTPEHP', 'Bountiful Clinic', 'Kelly', 'D', 'Garrett', 'PhD', 'Mental Health', 'Psychology', '', NULL, 'O', '390 N Main St', 'Bountiful', 'Davis', 'UT', '84010', '8012941000', '8012928369', '390 N Main St', 'Bountiful', 'Davis', 'UT', '84010', '8012941000', '8012928369', 'PEHPPHD', '', '', '0.00', '30.00', '0.00', 8, '2011-02-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1245251776', 0, 'N', 0, '2012-07-02', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12008323', 'W12008323', 'UTPEHP', 'Dixie Wound and Hyperbaric', 'Diedre', 'D', 'Bacon', 'APRN', 'Family Practice', '', '', NULL, 'O', '544 E 400 E', 'St George', 'Washington', 'UT', '84770', '4356884293', NULL, '544 E 400 E', 'St George', 'Washington', 'UT', '84770', '4356884293', '          ', 'PEHPMID', '', '', '0.00', '30.00', '0.00', 8, '2010-10-04', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1700020369', 0, 'N', 0, '2013-03-11', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12008325', 'W12008325', 'UTPEHP', '', 'Annie', 'M', 'Deming', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '5770 S 1500 W', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8013137700', NULL, '5770 S 1500 W', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8013137700', '          ', 'PEHPPHD', '', '', '0.00', '30.00', '0.00', 8, '2010-10-12', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1386945566', 0, 'N', 0, '2011-02-15', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12008326', 'W12008326', 'UTPEHP', 'Mt Pleasant Clinic', 'Mark', 'Lee', 'Wardle', 'DO', 'Family Practice', '', '', NULL, 'O', '1100 S Medical Dr', 'Mount Pleasant', 'Sanpete', 'UT', '84647', '4354623471', NULL, '1100 S Medical Dr', 'Mount Pleasant', 'Sanpete', 'UT', '84647', '4354623471', '          ', 'IHCPEHP', '', '', '0.00', '30.00', '0.00', 8, '2007-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1639274574', 0, 'N', 0, '2013-08-27', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12008327', 'W12008327', 'UTPEHP', 'Moroni Clinic', 'Mark', 'Lee', 'Wardle', 'DO', 'Family Practice', '', '', NULL, 'O', '51 E Main St', 'Moroni', 'Sanpete', 'UT', '84646', '4354365250', NULL, '51 E Main St', 'Moroni', 'Sanpete', 'UT', '84646', '4354365250', '          ', 'IHCPEHP', '', '', '0.00', '30.00', '0.00', 8, '2007-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1639274574', 0, 'N', 0, '2013-08-27', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12008330', 'W12008330', 'UTPEHP', 'Utah Valley Neonatology', 'Anna', 'D', 'Cheatham', 'MD', 'Neonatology', 'Pediatrics', '', NULL, 'O', '1034 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013577707', NULL, '1034 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013577707', '          ', 'IHCPEHP', '', '', '0.00', '30.00', '0.00', 8, '2010-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1427094028', 0, 'N', 0, '2011-02-15', NULL, NULL, 0, 0, NULL, NULL),
('841433620', 'W12008331', 'W12008331', 'UT01', 'Jordan Oaks Chiropractic', 'Alan', 'John', 'Adams', 'DC', 'Chiropractic', '', '', NULL, 'O', '7555 S Ctr View Ct Ste 102', 'West Jordan', 'Salt Lake', 'UT', '84084', '8015689222', '8015689559', '7555 S Ctr View Ct Ste 102', 'West Jordan', 'Salt Lake', 'UT', '84084', '8015689222', '8015689559', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2010-11-01', '2012-07-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1598894685', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('870424894', 'W12008332', 'W12008332', 'UT01', 'Campbell Chiropractic', 'Craig', 'D', 'Campbell', 'DC', 'Chiropractic', '', '', NULL, 'O', '115 E 7200 S', 'Midvale', 'Salt Lake', 'UT', '84047', '8015664357', '8015664476', '115 E 7200 S', 'Midvale', 'Salt Lake', 'UT', '84047', '8015664357', '8015664476', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2010-11-01', '2012-07-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1013023282', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('607075915', 'W12008333', 'W12008333', 'UT01', 'Carter Chiropractic Center', 'Brandon', '', 'Carter', 'DC', 'Chiropractic', '', '', NULL, 'O', '10684 S River Front Pkwy', 'South Jordan', 'Salt Lake', 'UT', '84095', '8018160332', '8018160331', '10684 S River Front Pkwy', 'South Jordan', 'Salt Lake', 'UT', '84095', '8018160332', '8018160331', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2011-01-01', '2012-07-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1093996373', 0, 'N', 0, '2012-10-15', NULL, NULL, 0, 0, NULL, NULL),
('528942300', 'W12008334', 'W12008334', 'UT01', '', 'Brian', 'N', 'Hardy', 'DC', 'Chiropractic', '', '', NULL, 'O', '301 N 200 E Ste 1C', 'St George', 'Washington', 'UT', '84770', '4356888830', '4356882240', '301 N 200 E Ste 1C', 'St George', 'Washington', 'UT', '84770', '4356888830', '4356882240', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2011-01-01', '2012-03-23', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1831255033', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('204890438', 'W12008335', 'W12008335', 'UT01', 'Horsley Chiropractic', 'Erik', 'Spence', 'Horsley', 'DC', 'Chiropractic', '', '', NULL, 'O', '3855 W 7800 S Ste 125', 'West Jordan', 'Salt Lake', 'UT', '84088', '8012807777', '8012807797', '3855 W 7800 S Ste 125', 'West Jordan', 'Salt Lake', 'UT', '84088', '8012807777', '8012807797', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2011-01-01', '2012-07-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1952341802', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('870627188', 'W12008336', 'W12008336', 'UT01', 'Canyon Ridge Chiropractic Inc', 'Jason', 'L', 'Smith', 'DC', 'Chiropractic', '', '', NULL, 'O', '425 S Medical Dr Ste 216', 'Bountiful', 'Davis', 'UT', '84010', '8012924400', '8013353209', '425 S Medical Dr Ste 216', 'Bountiful', 'Davis', 'UT', '84010', '8012924400', '8013353209', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2010-11-01', '2012-01-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1558391169', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12008338', 'W12008338', 'UTPEHP', 'Heart Rhythm Specialists Tooele', 'T', 'Jared', 'Bunch', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '196 E 2000 N', 'Tooele', 'Tooele', 'UT', '84074', '8015073513', '8015073584', '196 E 2000 N', 'Tooele', 'Tooele', 'UT', '84074', '8015073513', '8015073584', 'IHCPEHP', '', '', '0.00', '30.00', '0.00', 8, '2011-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1790757516', 0, 'N', 0, '2013-12-30', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12008339', 'W12008339', 'UTPEHP', 'Heart Rhythm Specialists', 'T', 'Jared', 'Bunch', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '5169 S Cottonwood St Ste 510', 'Murray', 'Salt Lake', 'UT', '84107', '8015073513', '8015073584', '5169 S Cottonwood St Ste 510', 'Murray', 'Salt Lake', 'UT', '84107', '8015073513', '8015073584', 'IHCPEHP', '', '', '0.00', '30.00', '0.00', 8, '2011-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1790757516', 0, 'N', 0, '2013-12-30', NULL, NULL, 0, 0, NULL, NULL),
('841421665', 'W12008340', 'W12008340', 'Sinclair', '(Sinclair Health Services \rProvider) St Lukes Wood River Medical Center ', '', '', 'St Lukes Wood River Medical Center', 'Group', 'Hospital', '', '', NULL, 'O', '100 Hospital Dr', 'Ketchum', 'Blaine', 'ID', '83340', '2087278800', NULL, '100 Hospital Dr', 'Ketchum', 'Blaine', 'ID', '83340', '2087278800', '          ', '', '', '', '0.00', '14.00', '0.00', 3, '2011-03-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1508869470', 0, 'N', 0, '2014-03-11', NULL, NULL, 43.6485, -114.35, NULL, NULL),
('942854057', 'W12008344', 'W12008344', 'UTPEHP', 'Southwest Spine & Pain Center', 'James', 'E', 'Cain', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '652 S Medical Ctr Dr Ste 110', 'St George', 'Washington', 'UT', '84790', '4352513700', '4352513701', '652 S Medical Ctr Dr Ste 110', 'St George', 'Washington', 'UT', '84790', '4352513700', '4352513701', 'IHCPEHP', '', '', '0.00', '30.00', '0.00', 8, '2011-02-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1235133257', 0, 'N', 0, '2011-02-16', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12008345', 'W12008345', 'UTPEHP', 'Dixie Neonatology', 'Patrick', 'D', 'Carroll', '', 'Neonatology', '', '', NULL, 'O', '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356884640', '4356884601', '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356884640', '4356884601', 'IHCPEHP', '', '', '0.00', '30.00', '0.00', 8, '2010-01-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', '', '', '', 'HCFA|UB|', '1275719445', 0, 'N', 0, '2011-02-16', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12008346', 'W12008346', 'UTPEHP', 'Heart Rhythm Specialists', 'Brian', 'G', 'Crandall', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '5169 S Cottonwood St Ste 510', 'Murray', 'Salt Lake', 'UT', '84107', '8015073513', '8015073584', '5169 S Cottonwood St Ste 510', 'Murray', 'Salt Lake', 'UT', '84107', '8015073513', '8015073584', 'IHCPEHP', '', '', '0.00', '30.00', '0.00', 8, '2011-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1669440269', 0, 'N', 0, '2011-02-16', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12008347', 'W12008347', 'UTPEHP', 'Heart Rhythm Specialists', 'John', 'D', 'Day', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '5169 S Cottonwood St Ste 510', 'Murray', 'Salt Lake', 'UT', '84107', '8015073513', '8015073584', '5169 S Cottonwood St Ste 510', 'Murray', 'Salt Lake', 'UT', '84107', '8015073513', '8015073584', 'IHCPEHP', '', '', '0.00', '30.00', '0.00', 8, '2011-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1811965122', 0, 'N', 0, '2011-06-29', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12008348', 'W12008348', 'UTPEHP', 'Heart Rhythm Specialists Murray', 'John', 'D', 'Day', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '5292 S College Dr Ste 200', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8012814278', '8012815960', '5292 S College Dr Ste 200', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8012814278', '8012815960', 'IHCPEHP', '', '', '0.00', '30.00', '0.00', 8, '2011-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1811965122', 0, 'N', 0, '2011-06-29', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12008349', 'W12008349', 'UTPEHP', 'Dixie Neonatology', 'Larry', 'D', 'Eggert', 'MD', 'Neonatology', '', '', NULL, 'O', '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356884640', '4356884601', '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356884640', '4356884601', 'IHCPEHP', '', '', '0.00', '30.00', '0.00', 8, '2011-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1043257587', 0, 'N', 0, '2011-02-16', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12008350', 'W12008350', 'UTPEHP', 'Park City Specialty Clinic', 'G David', '', 'Munday', 'MD', 'Urology', '', '', NULL, 'O', '900 Round Valley Dr Ste 200', 'Park City', 'Summit', 'UT', '84060', '4356587400', '4536587401', '900 Round Valley Dr Ste 200', 'Park City', 'Summit', 'UT', '84060', '4356587400', '4536587401', 'IHCPEHP', '', '', '0.00', '30.00', '0.00', 8, '2011-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1235108432', 0, 'N', 0, '2014-07-09', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12008351', 'W12008351', 'UTPEHP', 'Heart Rhythm Specialists Panguitch', 'Jeffrey', 'S', 'Osborn', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '200 N 400 E', 'Panguitch', 'Garfield', 'UT', '84759', '8015073513', '8015073584', '200 N 400 E', 'Panguitch', 'Garfield', 'UT', '84759', '8015073513', '8015073584', 'IHCPEHP', '', '', '0.00', '30.00', '0.00', 8, '2011-01-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', '', '', '', 'HCFA|UB|', '1043288368', 0, 'N', 0, '2011-02-16', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12008352', 'W12008352', 'UTPEHP', 'Heart Rhythm Specialists', 'Jeffrey', 'S', 'Osborn', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '5169 S Cottonwood St Ste 510', 'Murray', 'Salt Lake', 'UT', '84107', '8015073513', '8015073584', '5169 S Cottonwood St Ste 510', 'Murray', 'Salt Lake', 'UT', '84107', '8015073513', '8015073584', 'IHCPEHP', '', '', '0.00', '30.00', '0.00', 8, '2011-01-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', '', '', '', 'HCFA|UB|', '1043288368', 0, 'N', 0, '2011-02-16', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12008353', 'W12008353', 'UTPEHP', 'Utah Heart-Riverton', 'Rex', 'A', 'Outtrim', 'MD', 'Cardiovascular Disease', NULL, NULL, NULL, 'O', '3741 W 12600 S', 'Riverton', 'Salt Lake', 'UT', '84065', '8015073500', '8018173503', '3741 W 12600 S', 'Riverton', 'Salt Lake', 'UT', '84065', '8015073500', '8018173503', 'IHCPEHP', '', '', '0.00', '30.00', '0.00', 8, '2011-01-28', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1558355313', 0, 'N', 0, '2012-06-04', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12008354', 'W12008354', 'UTPEHP', 'Dixie Neonatology', 'Robert', 'E', 'Ridout', 'MD', 'Neonatology', '', '', NULL, 'O', '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356884640', '4356884601', '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356884640', '4356884601', 'IHCPEHP', '', '', '0.00', '30.00', '0.00', 8, '2011-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1407847239', 0, 'N', 0, '2011-02-16', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12008356', 'W12008356', 'UTPEHP', 'Salt Lake Clinic Radiology', 'Jason', 'J', 'Smythe', 'MD', 'Radiology', '', '', NULL, 'O', '333 S 900 E', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015358206', NULL, '333 S 900 E', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015358206', '          ', 'IHCPEHP', '', '', '0.00', '30.00', '0.00', 8, '2010-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1831361963', 0, 'N', 0, '2011-02-16', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12008357', 'W12008357', 'UTPEHP', 'Park City Specialty Clinic', 'Andrew', 'P', 'Talbott', 'MD', 'Pain Management', 'Anesthesiology', '', NULL, 'O', '900 Round Valley Dr Ste 200', 'Park City', 'Summit', 'UT', '84060', '4356587400', '4536587401', '900 Round Valley Dr Ste 200', 'Park City', 'Summit', 'UT', '84060', '4356587400', '4536587401', 'IHCPEHP', '', '', '0.00', '30.00', '0.00', 8, '2011-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1619932761', 0, 'N', 0, '2014-07-09', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12008359', 'W12008359', 'UTPEHP', '', 'Kirk', 'G', 'Watkins', 'MD', 'Sleep Medicine', NULL, NULL, NULL, 'O', '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356884000', NULL, '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356884000', '          ', 'IHCPEHP', '', '', '0.00', '30.00', '0.00', 8, '2008-12-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1326220559', 0, 'N', 0, '2012-02-07', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12008360', 'W12008360', 'UTPEHP', 'Dixie Sleep Disorders Center', 'Kirk', 'G', 'Watkins', 'MD', 'Sleep Medicine', NULL, NULL, NULL, 'O', '652 S Medical Ctr Dr Ste 310', 'St George', 'Washington', 'UT', '84790', '4352513940', '4352513941', '652 S Medical Ctr Dr Ste 310', 'St George', 'Washington', 'UT', '84790', '4352513940', '4352513941', 'IHCPEHP', '', '', '0.00', '30.00', '0.00', 8, '2009-08-03', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1326220559', 0, 'N', 0, '2012-02-07', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12008361', 'W12008361', 'UTIHC04', 'Dixie Regional Medical Center', 'Kirk', 'G', 'Watkins', 'MD', 'Sleep Medicine', NULL, NULL, NULL, 'o', '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356884000', NULL, '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356884000', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2008-12-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1326220559', 0, 'N', 0, '2012-02-07', NULL, NULL, 37.0989, -113.575, NULL, NULL),
('261322751', 'W12008362', 'W12008362', 'UTPEHP', 'Therapeutic Milestones ', 'Jay', '', 'Langford', 'PT', 'Physical Therapy', '', '', NULL, 'O', '26 E 1000 N Ste B', 'Richfield', 'Sevier', 'UT', '84701', '4358965090', '4358965083', '26 E 1000 N Ste B', 'Richfield', 'Sevier', 'UT', '84701', '4358965090', '4358965083', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '70.50', 3, '2011-02-01', '2011-09-15', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1043539497', 0, 'N', 0, '2011-09-20', NULL, NULL, 0, 0, NULL, NULL),
('261322751', 'W12008363', 'W12008363', 'UTPEHP', 'Therapeutic Milestones ', 'Jay', '', 'Langford', 'PT', 'Physical Therapy', '', '', NULL, 'B', 'PO Box 833', 'Richfield', 'Sevier', 'UT', '84701', '4358965090', '4358965083', 'PO Box 833', 'Richfield', 'Sevier', 'UT', '84701', '4358965090', '4358965083', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '70.50', 3, '2011-02-01', '2011-09-15', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1043539497', 0, 'N', 0, '2011-09-20', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12008364', 'W12008364', 'UTPEHP', 'Heart Rhythm Specialists', 'J Peter', '', 'Weiss', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '5169 S Cottonwood St Ste 510', 'Murray', 'Salt Lake', 'UT', '84107', '8015073513', '8015073584', '5169 S Cottonwood St Ste 510', 'Murray', 'Salt Lake', 'UT', '84107', '8015073513', '8015073584', 'IHCPEHP', '', '', '0.00', '30.00', '0.00', 8, '2011-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1528036654', 0, 'N', 0, '2011-06-29', NULL, NULL, 0, 0, NULL, NULL),
('300222138', 'W12006814', 'W12006814', 'UTDT01', 'Canyon Pointe Dental', 'Devin', '', 'Christensen', 'DDS', 'Dentist', '', '', NULL, 'O', '114 E 12450 S Ste 102', 'Draper', 'Salt Lake', 'UT', '84020', '8015761100', NULL, '114 E 12450 S Ste 102', 'Draper', 'Salt Lake', 'UT', '84020', '8015761100', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2010-10-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000004097', 0, 'N', 0, '2011-02-16', NULL, NULL, 0, 0, NULL, NULL),
('271291733', 'W12006802', 'W12006802', 'UTDT01', 'Masterpiece Smiles', 'Dennis', '', 'Blume', 'DDS', 'Dentist', '', '', NULL, 'O', '1802 N State St', 'Orem', 'Utah', 'UT', '84057', '8012240320', NULL, '1802 N State St', 'Orem', 'Utah', 'UT', '84057', '8012240320', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2010-10-01', '2011-09-01', 0, 0, 0, '', '', '', '', 'DEN|', '0000005336', 0, 'N', 0, '2012-01-20', NULL, NULL, 0, 0, NULL, NULL),
('800009868', 'W12006817', 'W12006817', 'UTDT01', '', 'J Bryan', '', 'Gilbert', 'DDS', 'Dentist', '', '', NULL, 'O', '5685 S 1475 E', 'Ogden', 'Weber', 'UT', '84403', '8014767299', NULL, '5685 S 1475 E', 'Ogden', 'Weber', 'UT', '84403', '8014767299', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2010-10-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000004098', 0, 'N', 0, '2011-02-16', NULL, NULL, 0, 0, NULL, NULL),
('529191593', 'W12006821', 'W12006821', 'UTDT01', '', 'Lance', 'F', 'Gunnell', 'DDS', 'Dentist', '', '', NULL, 'O', '1320 N 600 E Ste 2', 'Logan', 'Cache', 'UT', '84341', '4357521747', NULL, '1320 N 600 E Ste 2', 'Logan', 'Cache', 'UT', '84341', '4357521747', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2010-10-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000004099', 0, 'N', 0, '2011-02-16', NULL, NULL, 0, 0, NULL, NULL),
('529191593', 'W12006820', 'W12006820', 'UTDT01', '', 'Lance', 'F', 'Gunnell', 'DDS', 'Dentist', '', '', NULL, 'O', '26 W Main St', 'Hurricane', 'Washington', 'UT', '84737', '4352450550', NULL, '26 W Main St', 'Hurricane', 'Washington', 'UT', '84737', '4352450550', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2010-10-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000004099', 0, 'N', 0, '2011-02-16', NULL, NULL, 0, 0, NULL, NULL),
('260389199', 'W12006841', 'W12006841', 'UTDT01', 'Hammons Dental', 'Matthew', '', 'Hammons', 'DDS', 'Dentist', '', '', NULL, 'O', '2107 W Sunset Blvd', 'St George', 'Washington', 'UT', '84771', '4356286644', NULL, '2107 W Sunset Blvd', 'St George', 'Washington', 'UT', '84771', '4356286644', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2010-10-01', NULL, 0, 0, 0, '', '', '', '', 'Den|', '0000004100', 0, 'N', 0, '2011-02-16', NULL, NULL, 0, 0, NULL, NULL),
('870639825', 'W12006852', 'W12006852', 'UTDT01', 'Alta View Dental Care', 'Richard', '', 'Hughes', 'DMD', 'Dentist', '', '', NULL, 'O', '9844 S 1300 E Ste 304', 'Sandy', 'Salt Lake', 'UT', '84094', '8015724261', NULL, '9844 S 1300 E Ste 304', 'Sandy', 'Salt Lake', 'UT', '84094', '8015724261', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2010-10-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000004101', 0, 'N', 0, '2011-02-16', NULL, NULL, 0, 0, NULL, NULL),
('870641366', 'W12006854', 'W12006854', 'UTDT01', '', 'Ryan', '', 'McNeil', 'DDS', 'Dentist', '', '', NULL, 'O', '6895 S 900 E', 'Midvale', 'Salt Lake', 'UT', '84047', '8012554655', NULL, '6895 S 900 E', 'Midvale', 'Salt Lake', 'UT', '84047', '8012554655', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2010-10-01', '2012-07-01', 0, 0, 0, '', '', '', '', 'DEN|', '0000004102', 0, 'N', 0, '2012-07-03', NULL, NULL, 0, 0, NULL, NULL),
('870617336', 'W12006855', 'W12006855', 'UTDT01', 'Monarch Dental', 'Benjamin', '', 'Menlove', 'DDS', 'Dentist', '', '', NULL, 'O', '25 S 500 W Ste A', 'Bountiful', 'Davis', 'UT', '84011', '8012961607', NULL, '25 S 500 W Ste A', 'Bountiful', 'Davis', 'UT', '84011', '8012961607', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2010-10-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000007569', 0, 'N', 0, '2011-05-16', NULL, NULL, 0, 0, NULL, NULL),
('870622460', 'W12006857', 'W12006857', 'UTDT01', 'Powell Dental', 'David', 'B', 'Powell ', 'DDS', 'Dentist', '', '', NULL, 'O', '7478 S Campus View Dr Ste 202', 'West Jordan', 'Salt Lake', 'UT', '84088', '8102806911', NULL, '7478 S Campus View Dr Ste 202', 'West Jordan', 'Salt Lake', 'UT', '84088', '8102806911', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2010-10-01', '2011-04-01', 0, 0, 0, '', '', '', '', 'DEN|', '0000004103', 0, 'N', 0, '2011-05-16', NULL, NULL, 0, 0, NULL, NULL),
('205802910', 'W12006859', 'W12006859', 'UTDT01', '', 'PJ', '', 'Sutton', 'DDS', 'Dentist', '', '', NULL, 'O', '102 E Forest St', 'Brigham City', 'Box Elder', 'UT', '84302', '4357236009', NULL, '102 E Forest St', 'Brigham City', 'Box Elder', 'UT', '84302', '4357236009', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2010-10-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000004104', 0, 'N', 0, '2011-02-16', NULL, NULL, 0, 0, NULL, NULL),
('870625160', 'W12006862', 'W12006862', 'UTDT01', 'Trapnell Orthodontics', 'Brian', '', 'Trapnell', 'DMD', 'Orthodontist', '', '', NULL, 'O', '187 E 400 S', 'Springville', 'Utah', 'UT', '84663', '8014899475', NULL, '187 E 400 S', 'Springville', 'Utah', 'UT', '84663', '8014899475', '          ', '', '', '', '0.00', '20.00', '0.00', 8, '2010-10-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000004105', 0, 'N', 0, '2011-02-16', NULL, NULL, 0, 0, NULL, NULL),
('870625160', 'W12006863', 'W12006863', 'UTDT01', 'Trapnell Orthodontics', 'Jeffrey', '', 'Trapnell', 'DDS', 'Orthodontist', '', '', NULL, 'O', '3610 N University Ave Ste 175', 'Provo', 'Utah', 'UT', '84604', '8013448887', NULL, '3610 N University Ave Ste 175', 'Provo', 'Utah', 'UT', '84604', '8013448887', '          ', '', '', '', '0.00', '20.00', '0.00', 8, '2010-10-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000004106', 0, 'N', 0, '2011-02-16', NULL, NULL, 0, 0, NULL, NULL),
('202853765', 'W12006865', 'W12006865', 'UTDT01', '', 'Timothy', '', 'Anger', 'DMD', 'Dentist', '', '', NULL, 'O', '1356 S 2100 E', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015810054', NULL, '1356 S 2100 E', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015810054', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000004107', 0, 'N', 0, '2011-02-16', NULL, NULL, 0, 0, NULL, NULL),
('270689636', 'W12006867', 'W12006867', 'UTDT01', '', 'Christian', '', 'Bahr', 'DDS', 'Dentist', '', '', NULL, 'O', '460 S 400 E', 'Bountiful', 'Davis', 'UT', '84010', '8012955586', NULL, '460 S 400 E', 'Bountiful', 'Davis', 'UT', '84010', '8012955586', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1730328865', 0, 'N', 0, '2014-03-20', NULL, NULL, 0, 0, NULL, NULL),
('201986696', 'W12006869', 'W12006869', 'UTDT01', '', 'Randell', '', 'Capener', 'DDS', 'Dentist', '', '', NULL, 'O', '515 W Forrest St', 'Brigham City', 'Box Elder', 'UT', '84302', '4357236211', NULL, '515 W Forrest St', 'Brigham City', 'Box Elder', 'UT', '84302', '4357236211', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2010-11-01', '2011-05-01', 0, 0, 0, '', '', '', '', 'DEN|', '0000004109', 0, 'N', 0, '2011-05-16', NULL, NULL, 0, 0, NULL, NULL),
('273441428', 'W12006871', 'W12006871', 'UTDT01', 'Utah Oral Surgery & Dental Implan Clinic', 'Bryan S', '', 'Christensen', 'DMD', 'Oral Surgeon', '', '', NULL, 'O', '6243 S Redwood Rd Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8012691110', NULL, '6243 S Redwood Rd Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8012691110', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|HCFA|', '0000004110', 0, 'N', 0, '2014-01-21', NULL, NULL, 0, 0, NULL, NULL),
('870454724', 'W12006873', 'W12006873', 'UTDT01', '', 'Glade', '', 'Crowther', 'DMD', 'Dentist', '', '', NULL, 'O', '60 S Main St', 'Coalville', 'Summit', 'UT', '84017', '4353362657', NULL, '60 S Main St', 'Coalville', 'Summit', 'UT', '84017', '4353362657', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000004111', 0, 'N', 0, '2012-11-28', NULL, NULL, 0, 0, NULL, NULL),
('870617336', 'W12006875', 'W12006875', 'UTDT01', 'Monarch Dental', 'Thomas', '', 'Davenport', 'DDS', 'Dentist', '', '', NULL, 'O', '476 N 900 W Ste A', 'American Fork', 'Utah', 'UT', '84003', '8017565522', NULL, '476 N 900 W Ste A', 'American Fork', 'Utah', 'UT', '84003', '8017565522', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000004112', 0, 'N', 0, '2011-02-16', NULL, NULL, 0, 0, NULL, NULL),
('870344080', 'W12006878', 'W12006878', 'UTDT01', '', 'Dennis ', 'L', 'DeDecker', 'DDS', 'Oral and Maxillofacial Surgery', '', '', NULL, 'O', '2185 N 1700 W Ste 204', 'Layton', 'Davis', 'UT', '84041', '8017739750', NULL, '2185 N 1700 W Ste 204', 'Layton', 'Davis', 'UT', '84041', '8017739750', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2010-11-01', NULL, 0, 0, 0, 'Davis Hospital', '', '', '', 'DEN|', '1073516688', 0, 'N', 0, '2012-03-20', NULL, NULL, 0, 0, NULL, NULL),
('870344080', 'W12006877', 'W12006877', 'UTDT01', '', 'Dennis ', 'L', 'DeDecker', 'DDS', 'Oral and Maxillofacial Surgery', '', '', NULL, 'O', '625 E 500 S', 'Bountiful', 'Davis', 'UT', '84010', '8017739750', NULL, '625 E 500 S', 'Bountiful', 'Davis', 'UT', '84010', '8017739750', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2010-11-01', NULL, 0, 0, 0, 'Davis Hospital', '', '', '', 'DEN|', '1073516688', 0, 'N', 0, '2012-03-20', NULL, NULL, 0, 0, NULL, NULL),
('870617336', 'W12006880', 'W12006880', 'UTDT01', 'Monarch Dental', 'Darin', '', 'Dickerson', 'DDS', 'Dentist', '', '', NULL, 'O', '1492 W Antelope Dr Ste 201', 'Layton', 'Davis', 'UT', '84041', '8017766566', NULL, '1492 W Antelope Dr Ste 201', 'Layton', 'Davis', 'UT', '84041', '8017766566', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000004114', 0, 'N', 0, '2013-06-18', NULL, NULL, 0, 0, NULL, NULL),
('273653836', 'W12006881', 'W12006881', 'UTDT01', 'Rock Canyon Dental', 'Randy', '', 'Downing', 'DDS', 'Dentist', '', '', NULL, 'O', '1275 N University Ave Ste 7', 'Murray', 'Salt Lake', 'UT', '84107', '8013752273', '', '1275 N University Ave Ste 7', 'Murray', 'Salt Lake', 'UT', '84107', '8013752273', '', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2010-11-01', '2011-07-01', 0, 0, 0, '', '', '', '', 'DEN|', '1235234287', 0, 'N', 0, '2014-07-24', NULL, NULL, 0, 0, NULL, NULL),
('770640930', 'W12006917', 'W12006917', 'UTDT01', 'Professional Dental', 'Randy', '', 'Downing', 'DDS', 'Dentist', '', '', NULL, 'O', '3648 W 9800 S', 'South Jordan', 'Salt Lake', 'UT', '84095', '8012600700', '          ', '3648 W 9800 S', 'South Jordan', 'Salt Lake', 'UT', '84095', '8012600700', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2010-12-01', '2014-07-24', 0, 0, 0, '', '', '', '', 'DEN|', '1235234287', 0, 'N', 0, '2014-07-24', NULL, NULL, 0, 0, NULL, NULL),
('529648132', 'W12006883', 'W12006883', 'UTDT01', '', 'Phillip', '', 'Hall', 'DDS', 'Dentist', '', '', NULL, 'O', '382 S Bluff St Ste 250', 'St George', 'Washington', 'UT', '84770', '4356568111', NULL, '382 S Bluff St Ste 250', 'St George', 'Washington', 'UT', '84770', '4356568111', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000004115', 0, 'N', 0, '2011-02-16', NULL, NULL, 0, 0, NULL, NULL),
('204840137', 'W12006885', 'W12006885', 'UTDT01', 'Advanced Family Dental', 'Brad', '', 'Halverson', 'DMD', 'Dentist', '', '', NULL, 'O', '1760 N Main St Ste 103', 'Cedar City', 'Iron', 'UT', '84720', '4358670644', NULL, '1760 N Main St Ste 103', 'Cedar City', 'Iron', 'UT', '84720', '4358670644', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000004116', 0, 'N', 0, '2011-02-16', NULL, NULL, 0, 0, NULL, NULL),
('200496285', 'W12006888', 'W12006888', 'UTDT01', '', 'Raymond K', '', 'Hendrickson', 'DDS', 'Dentist', '', '', NULL, 'O', '140 E 200 N', 'Richfield', 'Sevier', 'UT', '84701', '4358916444', NULL, '140 E 200 N', 'Richfield', 'Sevier', 'UT', '84701', '4358916444', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1013120245', 0, 'N', 0, '2013-09-06', NULL, NULL, 0, 0, NULL, NULL),
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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
('263404006', 'W12007144', 'W12007144', 'UTDT01', 'Pine View Dental', 'Julie', '', 'McDonald', 'DDS', 'Dentist', '', '', NULL, 'O', '5924 S 1900 W', 'Roy', 'Weber', 'UT', '84067', '8016140082', NULL, '5924 S 1900 W', 'Roy', 'Weber', 'UT', '84067', '8016140082', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2011-01-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000004150', 0, 'N', 0, '2011-02-17', NULL, NULL, 0, 0, NULL, NULL),
('870565180', 'W12007146', 'W12007146', 'UTDT01', '', 'Matthew', '', 'Valantine', 'DDS', 'Dentist', '', '', NULL, 'O', '10 Diagonal St Ste 201', 'St George', 'Washington', 'UT', '84770', '4356737373', NULL, '10 Diagonal St Ste 201', 'St George', 'Washington', 'UT', '84770', '4356737373', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2011-01-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000004151', 0, 'N', 0, '2011-02-17', NULL, NULL, 0, 0, NULL, NULL),
('870617336', 'W12007149', 'W12007149', 'UTDT01', 'Monarch Dental', 'Aaron', '', 'Wright', 'DMD', 'Dentist', '', '', NULL, 'O', '1492 W Antelope Dr Ste 201', 'Layton', 'Davis', 'UT', '84041', '8017766566', NULL, '1492 W Antelope Dr Ste 201', 'Layton', 'Davis', 'UT', '84041', '8017766566', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2011-01-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000009681', 0, 'N', 0, '2011-05-16', NULL, NULL, 0, 0, NULL, NULL),
('870617336', 'W12007151', 'W12007151', 'UTDT01', 'Monarch Dental', 'Aaron', '', 'Wright', 'DMD', 'Dentist', '', '', NULL, 'O', '10011 S Centennial Pkwy Ste 330', 'Sandy', 'Salt Lake', 'UT', '84070', '8012563700', NULL, '10011 S Centennial Pkwy Ste 330', 'Sandy', 'Salt Lake', 'UT', '84070', '8012563700', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2011-01-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000009681', 0, 'N', 0, '2011-05-16', NULL, NULL, 0, 0, NULL, NULL),
('870617336', 'W12007148', 'W12007148', 'UTDT01', 'Monarch Dental', 'Aaron', '', 'Wright', 'DMD', 'Dentist', '', '', NULL, 'O', '24 S 500 W Ste A', 'Bountiful', 'Davis', 'UT', '84010', '8012961606', NULL, '24 S 500 W Ste A', 'Bountiful', 'Davis', 'UT', '84010', '8012961606', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2011-01-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000009681', 0, 'N', 0, '2011-05-16', NULL, NULL, 0, 0, NULL, NULL),
('870617336', 'W12007152', 'W12007152', 'UTDT01', 'Monarch Dental', 'Aaron', '', 'Wright', 'DMD', 'Dentist', '', '', NULL, 'O', '370 E South Temple Ste 350', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8013219810', NULL, '370 E South Temple Ste 350', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8013219810', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2011-01-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000009681', 0, 'N', 0, '2011-05-16', NULL, NULL, 0, 0, NULL, NULL),
('870617336', 'W12007153', 'W12007153', 'UTDT01', 'Monarch Dental', 'Aaron', '', 'Wright', 'DMD', 'Dentist', '', '', NULL, 'O', '3730 W 4700 S', 'Taylorsville', 'Salt Lake', 'UT', '84118', '8019551900', NULL, '3730 W 4700 S', 'Taylorsville', 'Salt Lake', 'UT', '84118', '8019551900', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2011-01-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000009681', 0, 'N', 0, '2011-05-16', NULL, NULL, 0, 0, NULL, NULL),
('870617336', 'W12007147', 'W12007147', 'UTDT01', 'Monarch Dental', 'Aaron', '', 'Wright', 'DMD', 'Dentist', '', '', NULL, 'O', '476 N 900 W Ste A', 'American Fork', 'Utah', 'UT', '84003', '8017565522', NULL, '476 N 900 W Ste A', 'American Fork', 'Utah', 'UT', '84003', '8017565522', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2011-01-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000009681', 0, 'N', 0, '2011-05-16', NULL, NULL, 0, 0, NULL, NULL),
('870617336', 'W12007154', 'W12007154', 'UTDT01', 'Monarch Dental', 'Aaron', '', 'Wright', 'DMD', 'Dentist', '', '', NULL, 'O', '5419 S Redwood Rd', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8012636400', NULL, '5419 S Redwood Rd', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8012636400', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2011-01-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000009681', 0, 'N', 0, '2011-05-16', NULL, NULL, 0, 0, NULL, NULL),
('870617336', 'W12007150', 'W12007150', 'UTDT01', 'Monarch Dental', 'Aaron', '', 'Wright', 'DMD', 'Dentist', '', '', NULL, 'O', '575 E University Pkwy Ste A-24', 'Orem', 'Utah', 'UT', '84057', '8012253300', NULL, '575 E University Pkwy Ste A-24', 'Orem', 'Utah', 'UT', '84057', '8012253300', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2011-01-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000009681', 0, 'N', 0, '2011-05-16', NULL, NULL, 0, 0, NULL, NULL),
('870617336', 'W12007155', 'W12007155', 'UTDT01', 'Monarch Dental', 'Aaron', '', 'Wright', 'DMD', 'Dentist', '', '', NULL, 'O', '5974 S Fashion Pointe Dr Ste 210', 'Ogden', 'Weber', 'UT', '84403', '8014756121', NULL, '5974 S Fashion Pointe Dr Ste 210', 'Ogden', 'Weber', 'UT', '84403', '8014756121', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2011-01-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000009681', 0, 'N', 0, '2011-05-16', NULL, NULL, 0, 0, NULL, NULL),
('820277763', 'W12008372', 'W12008372', 'Sinclair', 'Norco', '', '', 'Norco', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', '400 Main St', 'Boise', 'Ada', 'ID', '83702', '2083440299', '2083444327', '400 Main St', 'Boise', 'Ada', 'ID', '83702', '2083440299', '2083444327', 'DME80', '', '', '0.00', '35.00', '0.00', 3, '2011-01-01', '2014-03-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1326109059', 0, 'N', 0, '2014-05-15', NULL, NULL, 0, 0, NULL, NULL),
('820277763', 'W12008373', 'W12008373', 'Sinclair', 'Norco', '', '', 'Norco', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', '203 S Park', 'Twin Falls', 'Twin Falls', 'ID', '83301', '2087338171', '2087338177', '203 S Park', 'Twin Falls', 'Twin Falls', 'ID', '83301', '2087338171', '2087338177', 'DME80', '', '', '0.00', '35.00', '0.00', 3, '2011-01-01', '2014-03-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1326109059', 0, 'N', 0, '2014-05-15', NULL, NULL, 0, 0, NULL, NULL),
('820277763', 'W12008374', 'W12008374', 'Sinclair', 'Norco', '', '', 'Norco', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', '573 Addison Ave', 'Twin Falls', 'Twin Falls', 'ID', '83301', '2087349330', '2087349014', '573 Addison Ave', 'Twin Falls', 'Twin Falls', 'ID', '83301', '2087349330', '2087349014', 'DME80', '', '', '0.00', '35.00', '0.00', 3, '2011-01-01', '2014-03-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1326109059', 0, 'N', 0, '2014-05-15', NULL, NULL, 0, 0, NULL, NULL),
('820277763', 'W12008375', 'W12008375', 'Sinclair', 'Norco', '', '', 'Norco', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', '2150 E Fairview Ave', 'Lake Montezuma', 'Yavapai', 'AZ', '86342', '2088980202', '2088882266', '2150 E Fairview Ave', 'Lake Montezuma', 'Yavapai', 'AZ', '86342', '2088980202', '2088882266', 'DME80', '', '', '0.00', '35.00', '0.00', 3, '2011-01-01', '2014-03-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1326109059', 0, 'N', 0, '2014-05-15', NULL, NULL, 0, 0, NULL, NULL),
('820277763', 'W12008376', 'W12008376', 'Sinclair', 'Norco', '', '', 'Norco', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', '2076 Century Way', 'Boise', 'Ada', 'ID', '83709', '2083754150', '2083223971', '2076 Century Way', 'Boise', 'Ada', 'ID', '83709', '2083754150', '2083223971', 'DME80', '', '', '0.00', '35.00', '0.00', 3, '2011-01-01', '2014-03-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1326109059', 0, 'N', 0, '2014-05-15', NULL, NULL, 0, 0, NULL, NULL),
('820277763', 'W12008377', 'W12008377', 'Sinclair', 'Norco', '', '', 'Norco', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', '198 N Overland', 'Burley', 'Cassia', 'ID', '83318', '2086788558', '2086789344', '198 N Overland', 'Burley', 'Cassia', 'ID', '83318', '2086788558', '2086789344', 'DME80', '', '', '0.00', '35.00', '0.00', 3, '2011-01-01', '2014-03-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1326109059', 0, 'N', 0, '2014-05-15', NULL, NULL, 0, 0, NULL, NULL),
('518681918', 'W12008379', 'W12008379', 'Sinclair', '(Sinclair Health Services\rProvider) ', 'Martin  ', 'B', 'Durtschi', 'MD', 'General Surgery', '', '', NULL, 'O', '100 Hospital Dr Ste 105', 'Ketchum', 'Blaine', 'ID', '83340', '2087278862', NULL, '100 Hospital Dr Ste 105', 'Ketchum', 'Blaine', 'ID', '83340', '2087278862', '          ', 'IDSINCLAIRB', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1245381946', 0, 'N', 0, '2012-08-30', NULL, NULL, 43.6485, -114.35, NULL, NULL),
('518681918', 'W12008380', 'W12008380', 'Sinclair', '(Sinclair Health Services\rProvider) ', 'Martin  ', 'B', 'Durtschi', 'MD', 'General Surgery', '', '', NULL, 'B', 'PO Box 6885', 'Ketchum', 'Blaine', 'ID', '83340', '2088984982', NULL, 'PO Box 6885', 'Ketchum', 'Blaine', 'ID', '83340', '2088984982', '          ', 'IDSINCLAIRB', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1245381946', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('680541263', 'W12008381', 'W12008381', 'IDREC', 'Idaho Pediatric Gastroenterology PA', 'Barbara', 'R', 'Doherty', 'CRNP (Recognized but not Contracted)', 'Pediatric Gastroenterology', '', '', NULL, 'O', '100 E Idaho Ste 316', 'Boise', 'Ada', 'ID', '83712', '2083817310', NULL, '100 E Idaho Ste 316', 'Boise', 'Ada', 'ID', '83712', '2083817310', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2011-03-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1467508697', 0, 'N', 0, '2014-02-24', NULL, NULL, 43.6123, -116.194, NULL, NULL),
('680541263', 'W12008382', 'W12008382', 'IDREC', 'Idaho Pediatric Gastroenterology PA', 'Jason', 'M', 'Ellison', 'MD (Recognized but not Contracted)', 'Pediatric Gastroenterology', '', '', NULL, 'O', '100 E Idaho Ste 316', 'Boise', 'Ada', 'ID', '83712', '2083817310', NULL, '100 E Idaho Ste 316', 'Boise', 'Ada', 'ID', '83712', '2083817310', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2011-03-01', NULL, 0, 0, 1, '', NULL, '', '', 'HCFA|UB|', '1740231455', 0, 'N', 0, '2014-02-24', NULL, NULL, 43.6123, -116.194, NULL, NULL),
('680541263', 'W12008383', 'W12008383', 'IDREC', 'Idaho Pediatric Gastroenterology PA', 'Cass', 'R', 'Smith', 'MD (Recognized but not Contracted)', 'Pediatric Gastroenterology', '', '', NULL, 'O', '100 E Idaho Ste 316', 'Boise', 'Ada', 'ID', '83712', '2083817310', NULL, '100 E Idaho Ste 316', 'Boise', 'Ada', 'ID', '83712', '2083817310', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2011-03-01', NULL, 0, 0, 1, '', NULL, '', '', 'HCFA|UB|', '1760434534', 0, 'N', 0, '2014-02-24', NULL, NULL, 43.6123, -116.194, NULL, NULL),
('680541263', 'W12008384', 'W12008384', 'IDREC', 'Idaho Pediatric Gastroenterology PA', 'Henry', 'R', 'Thompson', 'MD (Recognized but not Contracted)', 'Pediatric Gastroenterology', '', '', NULL, 'O', '100 E Idaho Ste 316', 'Boise', 'Ada', 'ID', '83712', '2083817310', NULL, '100 E Idaho Ste 316', 'Boise', 'Ada', 'ID', '83712', '2083817310', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2011-03-01', NULL, 0, 0, 1, '', NULL, '', '', 'HCFA|UB|', '1306898051', 0, 'N', 0, '2014-02-24', NULL, NULL, 43.6123, -116.194, NULL, NULL),
('820161600', 'W12008386', 'W12008386', 'ID02', 'Pediatric Ophthalmology & Adult Strabismus', 'Katherine', 'A', 'Lee', 'MD', 'Ophthalmology', 'Pediatric Ophthalmology', '', NULL, 'O', '222 N 2nd Ste 215', 'Boise', 'Ada', 'ID', '83702', '2083422706', '2083362278', '222 N 2nd Ste 215', 'Boise', 'Ada', 'ID', '83702', '2083422706', '2083362278', 'IDACN', '', '', '0.00', '15.00', '0.00', 8, '2011-02-18', '2011-06-01', 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1386738839', 0, 'Y', 0, '2011-02-18', NULL, NULL, 43.6131, -116.195, NULL, NULL),
('820161600', 'W12008385', 'W12008385', 'ID02', 'Pediatric Ophthalmology & Adult Strabismus', 'Katherine', 'A', 'Lee', 'MD', 'Ophthalmology', 'Pediatric Ophthalmology', '', NULL, 'B', '6063 Corporal Ln', 'Boise', 'Ada', 'ID', '83704', '2083758799', '2088989924', '6063 Corporal Ln', 'Boise', 'Ada', 'ID', '83704', '2083758799', '2088989924', 'IDACN', '', '', '0.00', '15.00', '0.00', 8, '2011-02-18', '2011-06-01', 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1386738839', 0, 'Y', 0, '2011-02-18', NULL, NULL, 0, 0, NULL, NULL),
('870635889', 'W12008388', 'W12008388', 'UT01', 'Tooele Clinic Corp', 'Lauren', '', 'Bonjour', 'PA', 'Family Practice', '', '', NULL, 'M', '7100 Commcerce Way Ste 180', 'Brentwood', 'Williamson', 'TN', '37027', '4358843578', '', '7100 Commcerce Way Ste 180', 'Brentwood', 'Williamson', 'TN', '37027', '4358843578', '', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-03-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1609051416', 0, 'N', 0, '2014-07-21', NULL, NULL, 0, 0, NULL, NULL),
('870635889', 'W12008387', 'W12008387', 'UT01', 'Tooele Clinic Corp', 'Lauren', '', 'Bonjour', 'PA', 'Family Practice', '', '', NULL, 'O', '822 E Main St', 'Grantsville', 'Tooele', 'UT', '84029', '4358843578', '', '822 E Main St', 'Grantsville', 'Tooele', 'UT', '84029', '4358843578', '', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-03-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1609051416', 0, 'N', 0, '2014-07-21', NULL, NULL, 40.5996, -112.426, NULL, NULL),
('870635889', 'W12008389', 'W12008389', 'UT01', 'Tooele Clinic Corp', 'Lauren', '', 'Bonjour', 'PA', 'Family Practice', '', '', NULL, 'B', 'PO Box 848416', 'Boston', 'Suffolk', 'MA', '02284', '4358843578', '', 'PO Box 848416', 'Boston', 'Suffolk', 'MA', '02284', '4358843578', '', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-03-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1609051416', 0, 'N', 0, '2014-07-21', NULL, NULL, 0, 0, NULL, NULL),
('870639748', 'W12008390', 'W12008390', 'UT01', 'Hoopes Vision Correction Center', 'Michael', 'J', 'Bradley', 'MD', 'Ophthalmology', '', '', NULL, 'O', '10011 S Centennial Pkwy Ste 400', 'Sandy', 'Salt Lake', 'UT', '84070', '8015680200', '8015630200', '10011 S Centennial Pkwy Ste 400', 'Sandy', 'Salt Lake', 'UT', '84070', '8015680200', '8015630200', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-04-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1225131444', 0, 'N', 0, '2014-07-21', NULL, NULL, 40.5696, -111.895, NULL, NULL),
('263510730', 'W12008391', 'W12008391', 'UTMH1', 'Autism Assesment and Treat', 'Michele', 'R', 'DeCremer', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '4505 S Wasatch Blvd Ste 190', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8013868069', '8016184279', '4505 S Wasatch Blvd Ste 190', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8013868069', '8016184279', 'UTMA', '', '', '0.00', '35.00', '0.00', 3, '2011-03-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1407057797', 0, 'N', 0, '2014-03-13', NULL, NULL, 0, 0, NULL, NULL),
('870635889', 'W12008392', 'W12008392', 'UT01', 'Tooele Clinic Corp', 'Aaron', 'S', 'Elswood', 'PA', 'Family Practice', '', '', NULL, 'M', '7100 Commcerce Way Ste 180', 'Brentwood', 'Williamson', 'TN', '37027', '4358843578', '', '7100 Commcerce Way Ste 180', 'Brentwood', 'Williamson', 'TN', '37027', '4358843578', '', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-03-01', '2011-03-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1275619975', 0, 'N', 0, '2014-07-22', NULL, NULL, 0, 0, NULL, NULL),
('870635889', 'W12008013', 'W12008013', 'UT01', 'Tooele Clinic Corp', 'Aaron', 'S', 'Elswood', 'PA', 'Family Practice', '', '', NULL, 'O', '822 E Main St Ste 107', 'Grantsville', 'Tooele', 'UT', '84029', '4358843578', '', '822 E Main St Ste 107', 'Grantsville', 'Tooele', 'UT', '84029', '4358843578', '', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-03-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1275619975', 0, 'N', 0, '2014-07-22', NULL, NULL, 40.5996, -112.426, NULL, NULL),
('870635889', 'W12008393', 'W12008393', 'UT01', 'Tooele Clinic Corp', 'Aaron', 'S', 'Elswood', 'PA', 'Family Practice', '', '', NULL, 'B', 'PO Box 848416', 'Boston', 'Suffolk', 'MA', '02284', '4358843578', '', 'PO Box 848416', 'Boston', 'Suffolk', 'MA', '02284', '4358843578', '', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-03-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1275619975', 0, 'N', 0, '2014-07-22', NULL, NULL, 0, 0, NULL, NULL),
('830182821', 'W12008394', 'W12008394', 'WY01', 'Gottsche Rehabilitation Center', 'Troy', 'M', 'Fulton', 'PT', 'Physical Therapy', '', '', NULL, 'O', '639 W Coulter Ave', 'Powell', 'Park', 'WY', '82435', '3077549262', '          ', '639 W Coulter Ave', 'Powell', 'Park', 'WY', '82435', '3077549262', '          ', '', '', '', '0.00', '10.00', '0.00', 3, '2011-03-15', '2011-07-09', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1013009786', 0, 'N', 0, '2014-04-02', NULL, NULL, 44.7487, -108.766, NULL, NULL),
('830182821', 'W12008395', 'W12008395', 'WY01', 'Gottsche Rehabilitation Center', 'Kerry', 'A', 'Breen', 'PT', 'Physical Therapy', '', '', NULL, 'O', '720 Lindsay Ln', 'Cody', 'Park', 'WY', '82414', '3075781971', '          ', '720 Lindsay Ln', 'Cody', 'Park', 'WY', '82414', '3075781971', '          ', '', '', '', '0.00', '10.00', '0.00', 3, '2011-03-15', '2014-06-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1497847164', 0, 'N', 0, '2014-07-21', NULL, NULL, 44.5202, -109.074, NULL, NULL),
('870524176', 'W12008396', 'W12008396', 'UTMH1', 'Comprehensive Psychological Services', 'Jemal', 'R', 'Knowles', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '1208 E 3300 S', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8014831600', '8014831610', '1208 E 3300 S', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8014831600', '8014831610', 'UTMA', '', '', '0.00', '35.00', '0.00', 6, '2011-03-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1710035811', 0, 'N', 0, '2014-04-24', NULL, NULL, 0, 0, NULL, NULL),
('830182821', 'W12008397', 'W12008397', 'WY01', 'Gottsche Rehabilitation Center', 'Amanda', 'M', 'Kolstad', 'DPT', 'Physical Therapy', '', '', NULL, 'O', '639 W Coulter Ave', 'Powell', 'Park', 'WY', '82435', '3077549262', '          ', '639 W Coulter Ave', 'Powell', 'Park', 'WY', '82435', '3077549262', '          ', '', '', '', '0.00', '10.00', '0.00', 3, '2011-03-01', '2012-03-29', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1497868673', 0, 'N', 0, '2014-04-02', NULL, NULL, 44.7487, -108.766, NULL, NULL),
('830182821', 'W12008398', 'W12008398', 'WY01', 'Gottsche Rehabilitation Center', 'Amanda', 'M', 'Kolstad', 'DPT', 'Physical Therapy', '', '', NULL, 'O', '720 Lindsay Ln', 'Cody', 'Park', 'WY', '82414', '3075781970', '          ', '720 Lindsay Ln', 'Cody', 'Park', 'WY', '82414', '3075781970', '          ', '', '', '', '0.00', '10.00', '0.00', 3, '2011-03-01', '2012-03-29', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1497868673', 0, 'N', 0, '2014-04-02', NULL, NULL, 44.5202, -109.074, NULL, NULL),
('830333437', 'W12008399', 'W12008399', 'WY01', 'Teton Therapy', 'Benjamin', 'R', 'Larsen', 'DPT', 'Physical Therapy', '', '', NULL, 'O', '820 W Main', 'Riverton', 'Fremont', 'WY', '82501', '3078577074', '3078566549', '820 W Main', 'Riverton', 'Fremont', 'WY', '82501', '3078577074', '3078566549', 'WISEWYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2011-03-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1487974887', 0, 'N', 0, '2014-03-18', NULL, NULL, 43.0246, -108.401, NULL, NULL),
('836000295', 'W12008400', 'W12008400', 'WY01', 'Sweetwater Medical Group', 'Michael', '', 'McInnis', 'MD', 'Family Practice', '', '', NULL, 'O', '1204 Hilltop Ste 108', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073528193', '3073528126', '1204 Hilltop Ste 108', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073528193', '3073528126', '', '', '', '0.00', '5.00', '0.00', 3, '2030-01-01', '2030-01-01', 0, 0, 0, 'Memorial Hospital of Sweetwater County', '', '', '', 'HCFA|UB|', '1992037667', 0, 'N', 0, '2013-03-27', NULL, NULL, 0, 0, NULL, NULL),
('870299862', 'W12008402', 'W12008402', 'UT01', 'LDS Family Services', 'Oliver', 'Lamont', 'McPherson', 'MD', 'Mental Health', 'Psychiatry', '', NULL, 'B', '50 E N Temple', 'Salt Lake City', 'Salt Lake', 'UT', '84150', '8013363040', NULL, '50 E N Temple', 'Salt Lake City', 'Salt Lake', 'UT', '84150', '8013363040', '          ', 'MD', '', '', '0.00', '35.00', '0.00', 8, '2030-01-01', '2030-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1053302786', 0, 'N', 0, '2013-03-27', NULL, NULL, 0, 0, NULL, NULL),
('870299862', 'W12008401', 'W12008401', 'UT01', 'LDS Family Services', 'Oliver', 'Lamont', 'McPherson', 'MD', 'Mental Health', 'Psychiatry', '', NULL, 'O', '930 W Hill Field Rd Ste A', 'Layton', 'Davis', 'UT', '84041', '8013363040', NULL, '930 W Hill Field Rd Ste A', 'Layton', 'Davis', 'UT', '84041', '8013363040', '          ', 'MD', '', '', '0.00', '35.00', '0.00', 8, '2030-01-01', '2030-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1053302786', 0, 'N', 0, '2013-03-27', NULL, NULL, 0, 0, NULL, NULL),
('271616362', 'W12007873', 'W12007873', 'UT01', 'Eye Site of Farmington', 'Chelle', '', 'Nickle', 'OD', 'Optometry', '', '', NULL, 'O', '57 N Main', 'Farmington', 'Davis', 'UT', '84025', '8014474393', '8014474393', '57 N Main', 'Farmington', 'Davis', 'UT', '84025', '8014474393', '8014474393', 'WUTALBERT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-12-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1144303983', 0, 'N', 0, '2014-01-21', NULL, NULL, 40.9814, -111.888, NULL, NULL),
('271616362', 'W12007874', 'W12007874', 'UT01', 'Eye Site of Farmington', 'Chelle', '', 'Nickle', 'OD', 'Optometry', '', '', NULL, 'B', 'PO Box 942', 'Farmington', 'Davis', 'UT', '84025', '8014474393', '8014474393', 'PO Box 942', 'Farmington', 'Davis', 'UT', '84025', '8014474393', '8014474393', 'WUTALBERT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-12-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1144303983', 0, 'N', 0, '2014-01-21', NULL, NULL, 0, 0, NULL, NULL),
('841522090', 'W12008403', 'W12008403', 'UT01', '', 'Hope', 'K', 'Barkhurst', 'MD', 'Family Practice', '', '', NULL, 'O', '2095 N Dolores Rd', 'Cortez', 'Montezuma', 'CO', '81321', '9705648086', NULL, '2095 N Dolores Rd', 'Cortez', 'Montezuma', 'CO', '81321', '9705648086', '          ', 'PEHPSWPHO', '', '', '0.00', '30.00', '0.00', 3, '2011-02-11', NULL, 0, 0, 0, 'Southwest Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1205857406', 0, 'N', 0, '2011-07-13', NULL, NULL, 37.37, -108.554, NULL, NULL),
('841522090', 'W12008404', 'W12008404', 'UT01', '', 'Hope', 'K', 'Barkhurst', 'MD', 'Family Practice', '', '', NULL, 'B', 'Po Box 1687', 'Cortez', 'Montezuma', 'CO', '81321', '9705648086', NULL, 'Po Box 1687', 'Cortez', 'Montezuma', 'CO', '81321', '9705648086', '          ', 'PEHPSWPHO', '', '', '0.00', '30.00', '0.00', 3, '2011-02-11', NULL, 0, 0, 0, 'Southwest Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1205857406', 0, 'Y', 0, '2011-07-13', NULL, NULL, 0, 0, NULL, NULL),
('841522090', 'W12008405', 'W12008405', 'UT01', '', 'Theresa', '', 'Brown', 'CNP', 'Family Practice', '', '', NULL, 'O', '2095 N Dolores Rd', 'Cortez', 'Montezuma', 'CO', '81321', '9705648086', NULL, '2095 N Dolores Rd', 'Cortez', 'Montezuma', 'CO', '81321', '9705648086', '          ', 'PEHPSWPHO', '', '', '0.00', '30.00', '0.00', 3, '2011-02-11', NULL, 0, 0, 0, 'Southwest Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1255450458', 0, 'N', 0, '2011-07-13', NULL, NULL, 37.37, -108.554, NULL, NULL),
('841522090', 'W12008406', 'W12008406', 'UT01', '', 'Theresa', '', 'Brown', 'CNP', 'Family Practice', '', '', NULL, 'B', 'Po Box 1687', 'Cortez', 'Montezuma', 'CO', '81321', '9705648086', NULL, 'Po Box 1687', 'Cortez', 'Montezuma', 'CO', '81321', '9705648086', '          ', 'PEHPSWPHO', '', '', '0.00', '30.00', '0.00', 3, '2011-02-11', NULL, 0, 0, 0, 'Southwest Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1255450458', 0, 'Y', 0, '2011-07-13', NULL, NULL, 0, 0, NULL, NULL),
('841526641', 'W12008407', 'W12008407', 'UT01', '', 'Leonard', '', 'Cain', 'MD', 'Family Practice', '', '', NULL, 'O', '2095 N Dolores Rd Ste C', 'Cortez', 'Montezuma', 'CO', '81321', '9705648177', NULL, '2095 N Dolores Rd Ste C', 'Cortez', 'Montezuma', 'CO', '81321', '9705648177', '          ', 'PEHPSWPHO', '', '', '0.00', '30.00', '0.00', 3, '2011-02-11', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1336290741', 0, 'N', 0, '2011-07-13', NULL, NULL, 37.37, -108.554, NULL, NULL),
('841337350', 'W12008408', 'W12008408', 'UT01', '', 'Dianna', 'L', 'Fury', 'MD', 'Family Practice', '', '', NULL, 'O', '33 N Elm St', 'Cortez', 'Montezuma', 'CO', '81321', '9705658556', NULL, '33 N Elm St', 'Cortez', 'Montezuma', 'CO', '81321', '9705658556', '          ', 'PEHPSWPHO', '', '', '0.00', '30.00', '0.00', 6, '2011-02-11', '2011-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1790784973', 0, 'N', 0, '2013-10-10', NULL, NULL, 0, 0, NULL, NULL),
('841337350', 'W12008409', 'W12008409', 'UT01', '', 'Dianna', 'L', 'Fury', 'MD', 'Family Practice', '', '', NULL, 'B', 'Po Box 1780', 'Cortez', 'Montezuma', 'CO', '81321', '9705658556', NULL, 'Po Box 1780', 'Cortez', 'Montezuma', 'CO', '81321', '9705658556', '          ', 'PEHPSWPHO', '', '', '0.00', '30.00', '0.00', 6, '2011-02-11', '2011-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1790784973', 0, 'Y', 0, '2013-10-10', NULL, NULL, 0, 0, NULL, NULL),
('841337350', 'W12008410', 'W12008410', 'UT01', '', 'Marilyn', '', 'Griebel', 'CNP', 'Family Practice', '', '', NULL, 'O', '33 N Elm St', 'Cortez', 'Montezuma', 'CO', '81321', '9705658556', NULL, '33 N Elm St', 'Cortez', 'Montezuma', 'CO', '81321', '9705658556', '          ', 'PEHPSWPHO', '', '', '0.00', '30.00', '0.00', 6, '2011-02-11', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1649249434', 0, 'N', 0, '2011-07-13', NULL, NULL, 37.3489, -108.588, NULL, NULL),
('841337350', 'W12008411', 'W12008411', 'UT01', '', 'Marilyn', '', 'Griebel', 'CNP', 'Family Practice', '', '', NULL, 'B', 'Po Box 1780', 'Cortez', 'Montezuma', 'CO', '81321', '9705658556', NULL, 'Po Box 1780', 'Cortez', 'Montezuma', 'CO', '81321', '9705658556', '          ', 'PEHPSWPHO', '', '', '0.00', '30.00', '0.00', 6, '2011-02-11', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1649249434', 0, 'Y', 0, '2011-07-13', NULL, NULL, 0, 0, NULL, NULL),
('841337350', 'W12008412', 'W12008412', 'UT01', '', 'Manda', '', 'Guilette', 'PA', 'Family Practice', '', '', NULL, 'O', '33 N Elm St', 'Cortez', 'Montezuma', 'CO', '81321', '9705642130', NULL, '33 N Elm St', 'Cortez', 'Montezuma', 'CO', '81321', '9705642130', '          ', 'PEHPSWPHO', '', '', '0.00', '30.00', '0.00', 6, '2011-02-11', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1699764092', 0, 'N', 0, '2011-07-13', NULL, NULL, 37.3489, -108.588, NULL, NULL),
('841337350', 'W12008413', 'W12008413', 'UT01', '', 'Manda', '', 'Guilette', 'PA', 'Family Practice', '', '', NULL, 'B', 'PO Box 1780', 'Cortez', 'Montezuma', 'CO', '81321', '9705642130', NULL, 'PO Box 1780', 'Cortez', 'Montezuma', 'CO', '81321', '9705642130', '          ', 'PEHPSWPHO', '', '', '0.00', '30.00', '0.00', 6, '2011-02-11', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1699764092', 0, 'Y', 0, '2011-07-13', NULL, NULL, 0, 0, NULL, NULL),
('840830451', 'W12008414', 'W12008414', 'UT01', '', 'Robert', 'A', 'Heyl', 'MD', 'Family Practice', '', '', NULL, 'O', '1413 N Mildred Rd', 'Cortez', 'Montezuma', 'CO', '81321', '9705654436', NULL, '1413 N Mildred Rd', 'Cortez', 'Montezuma', 'CO', '81321', '9705654436', '          ', 'PEHPSWPHO', '', '', '0.00', '30.00', '0.00', 3, '2011-02-11', NULL, 0, 0, 0, 'Southwest Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1194809749', 0, 'N', 0, '2011-07-13', NULL, NULL, 37.3637, -108.573, NULL, NULL),
('204094183', 'W12008415', 'W12008415', 'UT01', '', 'Marcus', 'T', 'Higi', 'MD', 'Family Practice', 'Emergency Medicine', '', NULL, 'B', '1423 E Main St Ste 404', 'Cortez', 'Montezuma', 'CO', '81321', '9705648177', NULL, '1423 E Main St Ste 404', 'Cortez', 'Montezuma', 'CO', '81321', '9705648177', '          ', 'PEHPSWPHO', '', '', '0.00', '30.00', '0.00', 3, '2011-02-11', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1437125200', 0, 'Y', 0, '2011-02-22', NULL, NULL, 0, 0, NULL, NULL),
('204094183', 'W12008416', 'W12008416', 'UT01', '', 'Marcus', 'T', 'Higi', 'MD', 'Family Practice', 'Emergency Medicine', '', NULL, 'O', '2095 N Dolores Rd Ste C', 'Cortez', 'Montezuma', 'CO', '81321', '9705648177', NULL, '2095 N Dolores Rd Ste C', 'Cortez', 'Montezuma', 'CO', '81321', '9705648177', '          ', 'PEHPSWPHO', '', '', '0.00', '30.00', '0.00', 3, '2011-02-11', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1437125200', 0, 'N', 0, '2011-02-22', NULL, NULL, 37.37, -108.554, NULL, NULL),
('451749515', 'W12008417', 'W12008417', 'UT01', '', 'Carolyn', 'J', 'Johnson', 'MD', 'Family Practice', '', '', NULL, 'O', '1413 N Mildred Rd', 'Cortez', 'Montezuma', 'CO', '81321', '9705654436', NULL, '1413 N Mildred Rd', 'Cortez', 'Montezuma', 'CO', '81321', '9705654436', '          ', 'PEHPSWPHO', '', '', '0.00', '30.00', '0.00', 3, '2011-02-11', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1073697447', 0, 'N', 0, '2011-07-13', NULL, NULL, 37.3637, -108.573, NULL, NULL),
('841337350', 'W12008418', 'W12008418', 'UT01', '', 'Douglas', '', 'Bagge', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '208 W N Street', 'Cortez', 'Montezuma', 'CO', '81321', '9705652600', NULL, '208 W N Street', 'Cortez', 'Montezuma', 'CO', '81321', '9705652600', '          ', 'PEHPSWPHO', '', '', '0.00', '30.00', '0.00', 6, '2011-02-11', NULL, 0, 0, 0, 'Southwest Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1891765020', 0, 'N', 0, '2011-07-13', NULL, NULL, 37.3497, -108.588, NULL, NULL),
('841337350', 'W12008419', 'W12008419', 'UT01', '', 'Douglas', '', 'Bagge', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', '2233 E Main St', 'Montrose', 'Montrose', 'CO', '81401', '9705652600', NULL, '2233 E Main St', 'Montrose', 'Montrose', 'CO', '81401', '9705652600', '          ', 'PEHPSWPHO', '', '', '0.00', '30.00', '0.00', 6, '2011-02-11', NULL, 0, 0, 0, 'Southwest Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1891765020', 0, 'Y', 0, '2011-07-13', NULL, NULL, 0, 0, NULL, NULL),
('263373277', 'W12008420', 'W12008420', 'ut01', 'Cedar Diagnostics', '', '', 'Cedar Diagnostics', 'Group', 'Laboratory', '', '', NULL, 'O', '1011 N Mildred Rd', 'Cortez', 'Montezuma', 'CO', '81321', '9705658482', '9705658478', '1011 N Mildred Rd', 'Cortez', 'Montezuma', 'CO', '81321', '9705658482', '9705658478', 'LAB10010', '', '', '0.00', '35.00', '0.00', 3, '2011-02-11', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1386895969', 0, 'N', 0, '2011-02-22', NULL, NULL, 0, 0, NULL, NULL),
('263373277', 'W12008421', 'W12008421', 'UT01', 'Cedar Diagnostics', '', '', 'Cedar Diagnostics', 'Group', 'Laboratory', '', '', NULL, 'O', '575 Rivergate Ln Ste 106', 'Durango', 'La Plata', 'CO', '81301', '9702470937', '9702479579', '575 Rivergate Ln Ste 106', 'Durango', 'La Plata', 'CO', '81301', '9702470937', '9702479579', 'LAB10010', '', '', '0.00', '35.00', '0.00', 3, '2011-02-11', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1386895969', 0, 'N', 0, '2011-02-22', NULL, NULL, 37.3341, -107.8, NULL, NULL),
('263373277', 'W12008422', 'W12008422', 'UT01', 'Cedar Diagnostics', '', '', 'Cedar Diagnostics', 'Group', 'Laboratory', '', '', NULL, 'B', 'PO Box 876', 'Cortez', 'Montezuma', 'CO', '81321', '9705658482', '9705658478', 'PO Box 876', 'Cortez', 'Montezuma', 'CO', '81321', '9705658482', '9705658478', 'LAB10010', '', '', '0.00', '35.00', '0.00', 3, '2011-02-11', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1386895969', 0, 'N', 0, '2011-02-22', NULL, NULL, 0, 0, NULL, NULL),
('870579394', 'W12008423', 'W12008423', 'UT01', '', 'Terry', 'R', 'Cook', 'DPM', 'Podiatry', '', '', NULL, 'O', '1280 N Mildred Rd Ste 1', 'Cortez', 'Montezuma', 'CO', '81321', '9705658336', NULL, '1280 N Mildred Rd Ste 1', 'Cortez', 'Montezuma', 'CO', '81321', '9705658336', '          ', 'PEHPSWPHO', '', '', '0.00', '30.00', '0.00', 3, '2011-02-11', NULL, 0, 0, 0, 'Southwest Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1285636449', 0, 'N', 0, '2011-10-14', NULL, NULL, 37.3631, -108.573, NULL, NULL),
('870579394', 'W12008424', 'W12008424', 'UT01', '', 'Terry', 'R', 'Cook', 'DPM', 'Podiatry', '', '', NULL, 'O', '262 E Hwy', 'Montezuma Creek', 'San Juan', 'UT', '84534', '4356513291', NULL, '262 E Hwy', 'Montezuma Creek', 'San Juan', 'UT', '84534', '4356513291', '          ', 'PEHPSWPHO', '', '', '0.00', '30.00', '0.00', 3, '2011-02-11', NULL, 0, 0, 0, 'Southwest Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1285636449', 0, 'N', 0, '2011-10-14', NULL, NULL, 37.2619, -109.306, NULL, NULL),
('270003566', 'W12008425', 'W12008425', 'UT01', '', 'Karla', 'J', 'Demby', 'MD', 'Internal Medicine', '', '', NULL, 'O', '111 N Park St', 'Cortez', 'Montezuma', 'CO', '81321', '9705648730', NULL, '111 N Park St', 'Cortez', 'Montezuma', 'CO', '81321', '9705648730', '          ', 'PEHPSWPHO', '', '', '0.00', '30.00', '0.00', 3, '2011-02-11', NULL, 0, 0, 0, 'Southwest Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1194895094', 0, 'N', 0, '2011-07-13', NULL, NULL, 37.3499, -108.575, NULL, NULL),
('201180391', 'W12008426', 'W12008426', 'UT01', '', 'Karen', 'D', 'Libsch', 'MD', 'Family Practice', '', '', NULL, 'O', '118 N Chestnut St', 'Cortez', 'Montezuma', 'CO', '81321', '9705649777', NULL, '118 N Chestnut St', 'Cortez', 'Montezuma', 'CO', '81321', '9705649777', '          ', 'PEHPSWPHO', '', '', '0.00', '30.00', '0.00', 3, '2011-02-11', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1114996428', 0, 'N', 0, '2011-07-13', NULL, NULL, 37.3499, -108.587, NULL, NULL),
('201180391', 'W12008427', 'W12008427', 'UT01', '', 'Karen', 'D', 'Libsch', 'MD', 'Family Practice', '', '', NULL, 'B', 'Po Box 1297', 'Cortez', 'Montezuma', 'CO', '81321', '9705659777', NULL, 'Po Box 1297', 'Cortez', 'Montezuma', 'CO', '81321', '9705659777', '          ', 'PEHPSWPHO', '', '', '0.00', '30.00', '0.00', 3, '2011-02-11', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1114996428', 0, 'Y', 0, '2011-07-13', NULL, NULL, 0, 0, NULL, NULL),
('841611938', 'W12008428', 'W12008428', 'UT01', '', 'Kevin', 'M', 'Matteson', 'MD', 'General Surgery', '', '', NULL, 'O', '111 N Park St', 'Cortez', 'Montezuma', 'CO', '81321', '9705656670', NULL, '111 N Park St', 'Cortez', 'Montezuma', 'CO', '81321', '9705656670', '          ', 'PEHPSWPHO', '', '', '0.00', '30.00', '0.00', 3, '2011-02-11', NULL, 0, 0, 0, 'Southwest Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1407853013', 0, 'N', 0, '2011-10-19', NULL, NULL, 37.3499, -108.575, NULL, NULL),
('270003566', 'W12008429', 'W12008429', 'UT01', '', 'Andrew', 'M', 'Mcalpin', 'MD', 'Internal Medicine', '', '', NULL, 'O', '111 N Park St', 'Cortez', 'Montezuma', 'CO', '81321', '9705648730', NULL, '111 N Park St', 'Cortez', 'Montezuma', 'CO', '81321', '9705648730', '          ', 'PEHPSWPHO', '', '', '0.00', '30.00', '0.00', 3, '2011-02-11', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1386714129', 0, 'N', 0, '2011-07-13', NULL, NULL, 37.3499, -108.575, NULL, NULL),
('270003566', 'W12008430', 'W12008430', 'UT01', '', 'Robin', 'E', 'Page', 'MD', 'Internal Medicine', '', '', NULL, 'O', '111 N Park St', 'Cortez', 'Montezuma', 'CO', '81321', '9705648730', NULL, '111 N Park St', 'Cortez', 'Montezuma', 'CO', '81321', '9705648730', '          ', 'PEHPSWPHO', '', '', '0.00', '30.00', '0.00', 3, '2011-02-11', NULL, 0, 0, 0, 'Southwest Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1306916218', 0, 'N', 0, '2011-07-13', NULL, NULL, 37.3499, -108.575, NULL, NULL),
('841337350', 'W12008431', 'W12008431', 'UT01', '', 'Blair', 'W', 'Pyle', 'MD', 'Internal Medicine', '', '', NULL, 'O', '33 N Elm St', 'Cortez', 'Montezuma', 'CO', '81321', '9705658556', NULL, '33 N Elm St', 'Cortez', 'Montezuma', 'CO', '81321', '9705658556', '          ', 'PEHPSWPHO', '', '', '0.00', '30.00', '0.00', 6, '2011-02-11', NULL, 0, 0, 0, 'Southwest Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1619913670', 0, 'N', 0, '2011-07-13', NULL, NULL, 37.3489, -108.588, NULL, NULL),
('841337350', 'W12008432', 'W12008432', 'UT01', '', 'Blair', 'W', 'Pyle', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 1780', 'Cortez', 'Montezuma', 'CO', '81321', '9705658556', NULL, 'PO Box 1780', 'Cortez', 'Montezuma', 'CO', '81321', '9705658556', '          ', 'PEHPSWPHO', '', '', '0.00', '30.00', '0.00', 6, '2011-02-11', NULL, 0, 0, 0, 'Southwest Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1619913670', 0, 'Y', 0, '2011-07-13', NULL, NULL, 0, 0, NULL, NULL),
('841299115', 'W12008433', 'W12008433', 'UT01', '', 'William', 'G', 'Rainer', 'MD', 'General Surgery', '', '', NULL, 'O', '106 E First St', 'Cortez', 'Montezuma', 'CO', '81321', '9705654500', NULL, '106 E First St', 'Cortez', 'Montezuma', 'CO', '81321', '9705654500', '          ', 'PEHPSWPHO', '', '', '0.00', '30.00', '0.00', 3, '2011-02-11', NULL, 0, 0, 0, 'Southwest Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1821067190', 0, 'N', 0, '2011-07-13', NULL, NULL, 37.3476, -108.584, NULL, NULL),
('841337350', 'W12008434', 'W12008434', 'UT01', '', 'Kameo', 'L', 'Smith', 'DO', 'Family Practice', '', '', NULL, 'O', '33 N Elm St', 'Cortez', 'Montezuma', 'CO', '81321', '9705658556', NULL, '33 N Elm St', 'Cortez', 'Montezuma', 'CO', '81321', '9705658556', '          ', 'PEHPSWPHO', '', '', '0.00', '30.00', '0.00', 6, '2011-02-11', NULL, 0, 0, 0, 'Southwest Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1083645881', 0, 'N', 0, '2011-07-13', NULL, NULL, 37.3489, -108.588, NULL, NULL),
('841337350', 'W12008435', 'W12008435', 'UT01', '', 'Kameo', 'L', 'Smith', 'DO', 'Family Practice', '', '', NULL, 'B', 'Po Box 1780', 'Cortez', 'Montezuma', 'CO', '81321', '9705658556', NULL, 'Po Box 1780', 'Cortez', 'Montezuma', 'CO', '81321', '9705658556', '          ', 'PEHPSWPHO', '', '', '0.00', '30.00', '0.00', 6, '2011-02-11', NULL, 0, 0, 0, 'Southwest Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1083645881', 0, 'Y', 0, '2011-07-13', NULL, NULL, 0, 0, NULL, NULL),
('841337350', 'W12008436', 'W12008436', 'UT01', 'Southwest Memorial Hospital', '', '', 'Southwest Memorial Hospital', '', 'Hospital', '', '', NULL, 'O', '1311 N Mildred Rd', 'Cortez', 'Montezuma', 'CO', '81321', '9705656666', NULL, '1311 N Mildred Rd', 'Cortez', 'Montezuma', 'CO', '81321', '9705656666', '          ', '', '', '', '0.00', '10.00', '0.00', 6, '2011-02-11', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1649241571', 0, 'N', 0, '2011-02-22', NULL, NULL, 37.3633, -108.573, NULL, NULL),
('841337350', 'W12008437', 'W12008437', 'UT01', 'Southwest Memorial Hospital', '', '', 'Southwest Memorial Hospital', '', 'Hospital', '', '', NULL, 'B', 'Po Drawer L', 'Cortez', 'Montezuma', 'CO', '81321', '9705642130', NULL, 'Po Drawer L', 'Cortez', 'Montezuma', 'CO', '81321', '9705642130', '          ', '', '', '', '0.00', '10.00', '0.00', 6, '2011-02-11', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1649241571', 0, 'Y', 0, '2011-02-22', NULL, NULL, 0, 0, NULL, NULL),
('850462068', 'W12008438', 'W12008438', 'UT01', '', 'Eugene', 'P', 'Toner', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1280 N Mildred Rd Ste 1', 'Cortez', 'Montezuma', 'CO', '81321', '9705659500', NULL, '1280 N Mildred Rd Ste 1', 'Cortez', 'Montezuma', 'CO', '81321', '9705659500', '          ', 'PEHPSWPHO', '', '', '0.00', '30.00', '0.00', 3, '2011-02-11', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1720075443', 0, 'N', 0, '2011-07-13', NULL, NULL, 37.3631, -108.573, NULL, NULL),
('850462068', 'W12008439', 'W12008439', 'UT01', '', 'Eugene', 'P', 'Toner', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', 'Po Box 1593', 'Cortez', 'Montezuma', 'CO', '81321', '9705659500', NULL, 'Po Box 1593', 'Cortez', 'Montezuma', 'CO', '81321', '9705659500', '          ', 'PEHPSWPHO', '', '', '0.00', '30.00', '0.00', 3, '2011-02-11', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1720075443', 0, 'Y', 0, '2011-07-13', NULL, NULL, 0, 0, NULL, NULL),
('204203827', 'W12008440', 'W12008440', 'UTMH1', '', 'Desiree', 'L', 'Porter', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '1355 N Main St', 'Bountiful', 'Davis', 'UT', '84010', '8014997869', NULL, '1355 N Main St', 'Bountiful', 'Davis', 'UT', '84010', '8014997869', '          ', 'MA', '', '', '0.00', '35.00', '0.00', 3, '2011-03-01', '2011-06-25', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1447568449', 0, 'N', 0, '2014-02-06', NULL, NULL, 0, 0, NULL, NULL),
('204203827', 'W12008441', 'W12008441', 'UTMH1', '', 'Desiree', 'L', 'Porter', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'M', '704 N 2050 W', 'Farmington', 'Davis', 'UT', '84025', '8014997869', NULL, '704 N 2050 W', 'Farmington', 'Davis', 'UT', '84025', '8014997869', '          ', 'MA', '', '', '0.00', '35.00', '0.00', 3, '2011-03-01', '2011-06-25', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1447568449', 0, 'N', 0, '2014-02-06', NULL, NULL, 0, 0, NULL, NULL),
('592852900', 'W12008443', 'W12008443', 'UT01', 'Lincare', '', '', 'Lincare', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', '248 S Main', 'Logan', 'Cache', 'UT', '84321', '4357524336', NULL, '248 S Main', 'Logan', 'Cache', 'UT', '84321', '4357524336', '          ', 'WLINCARE', '', '', '0.00', '20.00', '0.00', 8, '2011-02-23', NULL, 1, 0, 0, '', '', '', '', 'HCFA|UB|', '1215945399', 0, 'N', 0, '2013-06-18', NULL, NULL, 0, 0, NULL, NULL),
('870299862', 'W12008448', 'W12008448', 'UTMH1', 'LDS Family Services', 'Adam ', 'B', 'Capel', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '930 W Hillfield Rd', 'Layton', 'Davis', 'UT', '84041', '8013363040', '', '930 W Hillfield Rd', 'Layton', 'Davis', 'UT', '84041', '8013363040', '', 'MA', '', '', '0.00', '35.00', '0.00', 8, '2011-04-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1790761518', 0, 'N', 0, '2014-07-23', NULL, NULL, 0, 0, NULL, NULL),
('870299862', 'W12008449', 'W12008449', 'UTMH1', 'Davis Behavioral Health', 'Adam ', 'B', 'Capel', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '950 S Main', 'Layton', 'Davis', 'UT', '84041', '8015461168', '', '950 S Main', 'Layton', 'Davis', 'UT', '84041', '8015461168', '', 'MA', '', '', '0.00', '35.00', '0.00', 8, '2011-04-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1790761518', 0, 'Y', 0, '2014-07-23', NULL, NULL, 0, 0, NULL, NULL),
('300481005', 'W12008450', 'W12008450', 'WY01', 'Achieve Sports Medicine Physical Therapy', 'Randall', 'C', 'Christopherson', 'PT', 'Physical Therapy', '', '', NULL, 'O', '109 S Main St Ste D', 'Lyman', 'Uinta', 'WY', '82937', '3077474627', '3077876212', '109 S Main St Ste D', 'Lyman', 'Uinta', 'WY', '82937', '3077474627', '3077876212', 'WISEWYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2011-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1639184096', 0, 'N', 0, '2014-07-11', NULL, NULL, 41.3273, -110.293, NULL, NULL),
('300481005', 'W12008451', 'W12008451', 'WY01', 'Achieve Sports Medicine Physical Therapy', 'Randall', 'C', 'Christopherson', 'PT', 'Physical Therapy', '', '', NULL, 'B', 'PO Box 301', 'Lyman', 'Uinta', 'WY', '82937', '3077474627', '3077876212', 'PO Box 301', 'Lyman', 'Uinta', 'WY', '82937', '3077474627', '3077876212', 'WISEWYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2011-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1639184096', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('870635889', 'W12008452', 'W12008452', 'UT01', 'Tooele Clinic Corp', 'Ana', 'I', 'Holtey', 'DO', 'Family Practice', '', '', NULL, 'O', '230 S Main St Ste 100', 'Tooele', 'Tooele', 'UT', '84074', '4358822692', NULL, '230 S Main St Ste 100', 'Tooele', 'Tooele', 'UT', '84074', '4358822692', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-05-01', NULL, 0, 0, 0, 'Mountain West Medical Center', '', '', '', 'HCFA|UB|', '1689875049', 0, 'N', 0, '2011-05-03', NULL, NULL, 40.5261, -112.299, NULL, NULL),
('870609595', 'W12008078', 'W12008078', 'UT01', 'Utah County Medical Associates', 'Nolan', 'B', 'Money', 'MD', 'Family Practice', '', '', NULL, 'O', '376 E 400 S', 'Springville', 'Utah', 'UT', '84663', '8014654896', NULL, '376 E 400 S', 'Springville', 'Utah', 'UT', '84663', '8014654896', '          ', 'WUTCTY', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-05-01', NULL, 0, 0, 0, 'Mountain View Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1194759027', 0, 'N', 0, '2013-11-12', NULL, NULL, 40.1611, -111.604, NULL, NULL),
('870635889', 'W12008455', 'W12008455', 'UT01', 'Tooele Clinic Corp', 'Ana', 'I', 'Holtey', 'DO', 'Family Practice', '', '', NULL, 'B', 'PO Box 848416', 'Boston', 'Suffolk', 'MA', '02284', '4358822692', NULL, 'PO Box 848416', 'Boston', 'Suffolk', 'MA', '02284', '4358822692', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-05-01', NULL, 0, 0, 0, 'Mountain West Medical Center', '', '', '', 'HCFA|UB|', '1689875049', 0, 'N', 0, '2011-05-03', NULL, NULL, 0, 0, NULL, NULL),
('274279163', 'W12008456', 'W12008456', 'WY01', '', 'Christopher ', 'C', 'Brown', 'MD', 'Internal Medicine', 'Infectious Disease', '', NULL, 'O', '1458 W 5th St', 'Sheridan', 'Sheridan', 'WY', '82801', '3076744633', '3076720348', '1458 W 5th St', 'Sheridan', 'Sheridan', 'WY', '82801', '3076744633', '3076720348', 'WISEWYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2011-04-01', NULL, 0, 0, 0, 'Campbell County Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1376569202', 0, 'N', 0, '2011-06-10', NULL, NULL, 44.8075, -106.977, NULL, NULL),
('870343122', 'W12008457', 'W12008457', 'UT01', 'Intermountain Skin Cancer and Aesthetics Center', 'David', 'M', 'Allen', 'MD', 'Dermatology', '', '', NULL, 'O', '3860 Jackson Ave Ste 2', 'Ogden', 'Weber', 'UT', '84403', '8016270515', '8016270517', '3860 Jackson Ave Ste 2', 'Ogden', 'Weber', 'UT', '84403', '8016270515', '8016270517', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-08-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1487672986', 0, 'N', 0, '2014-04-16', NULL, NULL, 41.1918, -111.954, NULL, NULL),
('870524176', 'W12008458', 'W12008458', 'UTMH1', 'Comprehensive Psychological Services', 'John', 'W', 'Thatcher', 'MD', 'Mental Health', 'Psychiatry', '', NULL, 'O', '1208 E 3300 S', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8014831600', '8014831610', '1208 E 3300 S', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8014831600', '8014831610', 'UTMD', '', '', '0.00', '35.00', '0.00', 6, '2011-04-01', '2012-04-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1407933708', 0, 'N', 0, '2014-04-24', NULL, NULL, 0, 0, NULL, NULL),
('202500191', 'W12008459', 'W12008459', 'UTMH1', 'Draper Psychological Services', 'Frances', 'L', 'Thompson', 'MD', 'Mental Health', 'Pediatric Psychiatry', '', NULL, 'O', '668 E 12225 S Ste 202', 'Draper', 'Salt Lake', 'UT', '84020', '8016193569', '8015767540', '668 E 12225 S Ste 202', 'Draper', 'Salt Lake', 'UT', '84020', '8016193569', '8015767540', 'UTPHD', '', '', '0.00', '35.00', '0.00', 3, '2011-05-01', '2012-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1760532162', 0, 'N', 0, '2012-09-11', NULL, NULL, 0, 0, NULL, NULL),
('830182821', 'W12008460', 'W12008460', 'WY01', 'Gottsche Rehabilitation Center', 'Allison', 'A', 'Tipton', 'OTR', 'Occupational Therapy', '', '', NULL, 'O', '720 Lindsay Ln', 'Cody', 'Park', 'WY', '82414', '3075781971', '3075781973', '720 Lindsay Ln', 'Cody', 'Park', 'WY', '82414', '3075781971', '3075781973', '', '', '', '0.00', '10.00', '0.00', 3, '2011-05-01', '2011-01-24', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1871685560', 0, 'N', 0, '2014-04-02', NULL, NULL, 44.5202, -109.074, NULL, NULL),
('942854057', 'W12012492', 'W12012492', 'UTIHC04', 'Family Medicine', 'Anna', '', 'Makovec-Fuller', 'APRN', 'Advanced Practice Registered Nurse', '', '', NULL, 'O', '1501 Hiland Ave Ste K', 'Burley', 'Cassia', 'ID', '83318', '2086781126', NULL, '1501 Hiland Ave Ste K', 'Burley', 'Cassia', 'ID', '83318', '2086781126', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2011-05-01', '2013-01-02', 0, 0, 0, 'Cassia Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1750396222', 0, 'Y', 0, '2013-01-03', NULL, NULL, 0, 0, NULL, NULL),
('876000616', 'W12008462', 'W12008462', 'UT01', 'San Juan Clinic', 'Edwin', 'M', 'Wyman', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '380 W 100 N', 'Monticello', 'San Juan', 'UT', '84535', '4355875054', '4355873004', '380 W 100 N', 'Monticello', 'San Juan', 'UT', '84535', '4355875054', '4355873004', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1730171620', 0, 'N', 0, '2012-01-23', NULL, NULL, 37.8741, -109.348, 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
('876000616', 'W12008463', 'W12008463', 'UT01', 'San Juan Clinic', 'Edwin', 'M', 'Wyman', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', 'PO Box 1054', 'Monticello', 'San Juan', 'UT', '84535', '4355875054', '4355873004', 'PO Box 1054', 'Monticello', 'San Juan', 'UT', '84535', '4355875054', '4355873004', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1730171620', 0, 'N', 0, '2012-01-23', NULL, NULL, 0, 0, NULL, NULL),
('621762573', 'W12008464', 'W12008464', 'UT01', 'Castleview Surgical Associates', 'Richard', 'J', 'Yarger', 'MD', 'General Surgery', '', '', NULL, 'O', '280 N Hospital Dr Ste 5', 'Price', 'Carbon', 'UT', '84501', '4356374590', '', '280 N Hospital Dr Ste 5', 'Price', 'Carbon', 'UT', '84501', '4356374590', '', 'WURURAL5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-05-01', NULL, 0, 0, 0, 'Castleview Hospital', '', '', '', 'HCFA|UB|', '1962596668', 0, 'N', 0, '2014-07-21', NULL, NULL, 39.6047, -110.831, NULL, NULL),
('272660267', 'W12008465', 'W12008465', 'ID01', '', 'Angela', 'M', 'Young', 'DC', 'Chiropractic', '', '', NULL, 'O', '2300 S Orchard Ste A', 'Boise', 'Ada', 'ID', '83705', '2083853703', '2083853702', '2300 S Orchard Ste A', 'Boise', 'Ada', 'ID', '83705', '2083853703', '2083853702', 'IDCHIRO1', '', '', '0.00', '35.00', '0.00', 3, '2011-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1457655052', 0, 'N', 0, '2014-07-21', NULL, NULL, 43.5816, -116.244, NULL, NULL),
('830333437', 'W12008466', 'W12008466', 'WY01', 'Teton Therapy', 'Margaret', 'A', 'Zeiss', 'PT', 'Physical Therapy', '', '', NULL, 'O', '820 W Main', 'Riverton', 'Fremont', 'WY', '82501', '3078577074', '3078566549', '820 W Main', 'Riverton', 'Fremont', 'WY', '82501', '3078577074', '3078566549', 'WISEWYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2011-03-01', '2014-01-02', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1386663813', 0, 'N', 0, '2014-02-04', NULL, NULL, 0, 0, NULL, NULL),
('810587644', 'W12008468', 'W12008468', 'WY01', '', 'Michael', 'D', 'Adams', 'MD', 'Family Practice', '', '', NULL, 'B', '1515 N 400 E', 'Logan', 'Cache', 'UT', '84341', '3077898290', NULL, '1515 N 400 E', 'Logan', 'Cache', 'UT', '84341', '3077898290', '          ', 'wystd', 'wyhcpcs', '', '0.00', '35.00', '0.00', 3, '2011-02-24', NULL, 0, 0, 0, 'Evanston Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1922005347', 0, 'N', 0, '2013-03-07', NULL, NULL, 0, 0, NULL, NULL),
('810587644', 'W12008467', 'W12008467', 'WY01', '', 'Michael', 'D', 'Adams', 'MD', 'Family Practice', '', '', NULL, 'O', '75 Yellow Creek Rd', 'Evanston', 'Uinta', 'WY', '82930', '3077898290', NULL, '75 Yellow Creek Rd', 'Evanston', 'Uinta', 'WY', '82930', '3077898290', '          ', 'wystd', 'wyhcpcs', '', '0.00', '35.00', '0.00', 3, '2011-02-24', NULL, 0, 0, 0, 'Evanston Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1922005347', 0, 'N', 0, '2013-03-07', NULL, NULL, 41.2591, -110.967, NULL, NULL),
('870373083', 'W12008469', 'W12008469', 'UT01', 'Heart and Lung Institute', 'Ali', '', 'Ahmed', 'MD', 'Pulmonary', 'Critical Care', '', NULL, 'B', 'PO Box 847112', 'Dallas', 'Dallas', 'TX', '75284', '8012632370', '8012651200', 'PO Box 847112', 'Dallas', 'Dallas', 'TX', '75284', '8012632370', '8012651200', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-03-01', '2011-04-01', 0, 0, 0, 'Jordan Valley Medical Center', '', '', '', 'HCFA|UB|', '1013994813', 0, 'N', 0, '2014-06-16', NULL, NULL, 0, 0, NULL, NULL),
('870373083', 'W12008470', 'W12008470', 'UT01', 'Heart and Lung Institute', 'David', 'G', 'Dienhart', 'MD', 'Pulmonary', 'Sleep Medicine', 'Critical Care', NULL, 'B', 'PO Box 847112', 'Dallas', 'Dallas', 'TX', '75284', '8012632370', '8012651200', 'PO Box 847112', 'Dallas', 'Dallas', 'TX', '75284', '8012632370', '8012651200', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-03-01', '2011-04-01', 0, 0, 0, 'Jordan Valley Medical Center', '', '', '', 'HCFA|UB|', '1184601940', 0, 'N', 0, '2013-12-10', NULL, NULL, 0, 0, NULL, NULL),
('870373083', 'W12008471', 'W12008471', 'UT01', 'Heart and Lung Institute', 'Adam', 'M', 'Elhaddi', 'MD', 'Cardiovascular Disease', '', '', NULL, 'B', 'PO Box 847112', 'Dallas', 'Dallas', 'TX', '75284', '8012632370', '8012651200', 'PO Box 847112', 'Dallas', 'Dallas', 'TX', '75284', '8012632370', '8012651200', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-03-01', '2014-04-30', 0, 0, 0, 'Jordan Valley Medical Center', 'Salt Lake Regional Medical Center', NULL, NULL, 'HCFA|UB|', '1972713568', 0, 'N', 0, '2013-01-03', NULL, NULL, 0, 0, NULL, NULL),
('870373083', 'W12008472', 'W12008472', 'UT01', 'Heart and Lung Institute', 'Bruce', 'R', 'Kenwood', 'DO', 'Cardiovascular Disease', NULL, NULL, NULL, 'B', 'PO Box 847112', 'Dallas', 'Dallas', 'TX', '75284', '8012632370', '8012651200', 'PO Box 847112', 'Dallas', 'Dallas', 'TX', '75284', '8012632370', '8012651200', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-03-01', '2014-04-30', 0, 0, 0, 'Jordan Valley Medical Center', 'Salt Lake Regional Medical Center', NULL, NULL, 'HCFA|UB|', '1144279019', 0, 'N', 0, '2012-05-01', NULL, NULL, 0, 0, NULL, NULL),
('870373083', 'W12008473', 'W12008473', 'UT01', 'Heart and Lung Institute', 'Bard', 'R', 'Madsen', 'MD', 'Cardiovascular Disease', '', '', NULL, 'B', 'PO Box 847112', 'Dallas', 'Dallas', 'TX', '75284', '8012632370', '8012651200', 'PO Box 847112', 'Dallas', 'Dallas', 'TX', '75284', '8012632370', '8012651200', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-03-01', '2014-04-30', 0, 0, 0, 'Jordan Valley Medical Center', 'Salt Lake Regional Medical Center', NULL, NULL, 'HCFA|UB|', '1497738074', 0, 'N', 0, '2014-02-10', NULL, NULL, 0, 0, NULL, NULL),
('870373083', 'W12008474', 'W12008474', 'UT01', 'Heart and Lung Institute', 'David', 'S', 'Massinople', 'MD', 'Cardiovascular Disease', '', '', NULL, 'B', 'PO Box 847112', 'Dallas', 'Dallas', 'TX', '75284', '8012632370', '8012651200', 'PO Box 847112', 'Dallas', 'Dallas', 'TX', '75284', '8012632370', '8012651200', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-03-01', '2014-04-30', 0, 0, 0, 'Jordan Valley Medical Center', 'Salt Lake Regional Medical Center', '', '', 'HCFA|UB|', '1255541785', 0, 'N', 0, '2014-06-23', NULL, NULL, 0, 0, NULL, NULL),
('870373083', 'W12008476', 'W12008476', 'UT01', 'Heart and Lung Institute', 'Patricia', 'L', 'Nelson', 'MD', 'Pulmonary', '', '', NULL, 'B', 'PO Box 847112', 'Dallas', 'Dallas', 'TX', '75284', '8012632370', '8012651200', 'PO Box 847112', 'Dallas', 'Dallas', 'TX', '75284', '8012632370', '8012651200', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-03-01', '2011-04-01', 0, 0, 0, 'Lone Peak Hospital', '', '', '', 'HCFA|UB|', '1629051206', 0, 'N', 0, '2011-05-11', NULL, NULL, 0, 0, NULL, NULL),
('870373083', 'W12008477', 'W12008477', 'UT01', 'Heart and Lung Institute', 'Sunny', '', 'Pandita', 'MD', 'Pulmonary', 'Sleep Medicine', 'Critical Care', NULL, 'B', 'PO Box 847112', 'Dallas', 'Dallas', 'TX', '75284', '8012632370', '8012651200', 'PO Box 847112', 'Dallas', 'Dallas', 'TX', '75284', '8012632370', '8012651200', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-03-01', '2011-03-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1023095809', 0, 'N', 0, '2012-02-09', NULL, NULL, 0, 0, NULL, NULL),
('870373083', 'W12008478', 'W12008478', 'UT01', 'Heart and Lung Institute', 'Konstantyn', 'Y', 'Szwajkun', 'MD', 'Cardiovascular Disease', '', '', NULL, 'B', 'PO Box 847112', 'Dallas', 'Dallas', 'TX', '75284', '8012632370', '8012651200', 'PO Box 847112', 'Dallas', 'Dallas', 'TX', '75284', '8012632370', '8012651200', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-03-01', '2014-04-30', 0, 0, 0, 'Jordan Valley Medical Center', 'Salt Lake Regional Medical Center', NULL, NULL, 'HCFA|UB|', '1508849191', 0, 'N', 0, '2012-06-26', NULL, NULL, 0, 0, NULL, NULL),
('262072378', 'W12008480', 'W12008480', 'UT01', 'Valley Obstetrics & Gynecology PC', 'Jennifer', 'A', 'Booth', 'NP', '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', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-02-24', '2013-05-31', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1821114505', 0, 'N', 0, '2013-06-03', NULL, NULL, 0, 0, NULL, NULL),
('262072378', 'W12008479', 'W12008479', 'UT01', 'Valley Obstetrics & Gynecology PC', 'Jennifer', 'A', 'Booth', 'NP', 'Obstetrics and Gynecology', '', '', NULL, 'O', '700 W 800 N Ste 200', 'Orem', 'Utah', 'UT', '84057', '8014344443', '8012168357', '700 W 800 N Ste 200', 'Orem', 'Utah', 'UT', '84057', '8014344443', '8012168357', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-02-24', '2013-05-31', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1821114505', 0, 'N', 0, '2013-06-03', NULL, NULL, 0, 0, NULL, NULL),
('820161600', 'W12008481', 'W12008481', 'ID01', 'Boise Orthopedic Clinic', 'Charles', 'T', 'Floyd', 'MD; Spine', 'Orthopedic Surgery', '', '', NULL, 'O', '703 S Americana Blvd Ste 120', 'Boise', 'Ada', 'ID', '83702', '2083232600', NULL, '703 S Americana Blvd Ste 120', 'Boise', 'Ada', 'ID', '83702', '2083232600', '', 'IDORTHO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 8, '2011-02-24', '2012-07-01', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1124039714', 0, 'N', 0, '2014-07-09', NULL, NULL, 0, 0, NULL, NULL),
('820161600', 'W12008482', 'W12008482', 'ID01', 'Boise Orthopedic Clinic', 'Benjamin', '', 'Hochhalter', 'PA-C', 'Orthopedic Surgery', '', '', NULL, 'O', '703 S Americana Blvd Ste 120', 'Boise', 'Ada', 'ID', '83702', '2083232600', NULL, '703 S Americana Blvd Ste 120', 'Boise', 'Ada', 'ID', '83702', '2083232600', '          ', 'IDORTHO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 8, '2011-02-23', '2012-07-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1326023417', 0, 'N', 0, '2012-06-14', NULL, NULL, 0, 0, NULL, NULL),
('820161600', 'W12008483', 'W12008483', 'ID01', 'Boise Orthopedic Clinic', 'James', 'M', 'Johnston', 'MD This Provider will terminate on July 1st', 'Orthopedic Surgery', 'Sports Medicine', '', NULL, 'O', '703 S Americana Blvd Ste 120', 'Boise', 'Ada', 'ID', '83702', '2083232600', NULL, '703 S Americana Blvd Ste 120', 'Boise', 'Ada', 'ID', '83702', '2083232600', '          ', 'IDORTHO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 8, '2011-02-23', '2012-07-01', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|UB|', '1114940699', 0, 'N', 0, '2012-05-31', NULL, NULL, 0, 0, NULL, NULL),
('820161600', 'W12008484', 'W12008484', 'ID01', 'Boise Orthopedic Clinic', 'Benjamin', 'T', 'Kerns', 'PA-C This Provider will terminate on July 1st', 'Orthopedic Surgery', '', '', NULL, 'O', '703 S Americana Blvd Ste 120', 'Boise', 'Ada', 'ID', '83702', '2083232600', NULL, '703 S Americana Blvd Ste 120', 'Boise', 'Ada', 'ID', '83702', '2083232600', '          ', 'IDORTHO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 8, '2011-02-23', '2012-07-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1659388783', 0, 'N', 0, '2012-05-31', NULL, NULL, 0, 0, NULL, NULL),
('820161600', 'W12008485', 'W12008485', 'ID01', 'Boise Orthopedic Clinic', 'Ronald', 'M', 'Kristensen', 'MD This Provider will terminate on July 1st', 'Orthopedic Surgery', '', '', NULL, 'O', '703 S Americana Blvd Ste 120', 'Boise', 'Ada', 'ID', '83702', '2083232600', NULL, '703 S Americana Blvd Ste 120', 'Boise', 'Ada', 'ID', '83702', '2083232600', '          ', 'IDORTHO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 8, '2011-02-23', '2012-07-01', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|UB|', '1215948807', 0, 'N', 0, '2012-05-31', NULL, NULL, 0, 0, NULL, NULL),
('820161600', 'W12008486', 'W12008486', 'ID01', 'Boise Orthopedic Clinic', 'Stefanie', 'J', 'Magee', 'PA', 'Orthopedic Surgery', '', '', NULL, 'O', '703 S Americana Blvd Ste 120', 'Boise', 'Ada', 'ID', '83702', '2083232600', NULL, '703 S Americana Blvd Ste 120', 'Boise', 'Ada', 'ID', '83702', '2083232600', '          ', 'IDORTHO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 8, '2011-02-23', '2012-07-01', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1639403041', 0, 'N', 0, '2013-11-22', NULL, NULL, 0, 0, NULL, NULL),
('820161600', 'W12008487', 'W12008487', 'ID01', 'Boise Orthopedic Clinic', 'Jeffry', 'P', 'Menzner', 'MD This Provider will terminate on July 1st', 'Orthopedic Surgery', 'Hematology and Oncology', '', NULL, 'O', '703 S Americana Blvd Ste 120', 'Boise', 'Ada', 'ID', '83702', '2083232600', NULL, '703 S Americana Blvd Ste 120', 'Boise', 'Ada', 'ID', '83702', '2083232600', '          ', 'IDORTHO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 8, '2011-02-23', '2012-07-01', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|UB|', '1487607198', 0, 'N', 0, '2012-05-31', NULL, NULL, 0, 0, NULL, NULL),
('820161600', 'W12008488', 'W12008488', 'ID01', 'Boise Orthopedic Clinic', 'K Russell', '', 'Swainston', 'This Provider will terminate on July 1st', 'Orthopedic Surgery', '', '', NULL, 'O', '703 S Americana Blvd Ste 120', 'Boise', 'Ada', 'ID', '83702', '2083232600', NULL, '703 S Americana Blvd Ste 120', 'Boise', 'Ada', 'ID', '83702', '2083232600', '          ', 'IDORTHO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 8, '2011-02-23', '2012-07-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1437143161', 0, 'N', 0, '2012-05-31', NULL, NULL, 0, 0, NULL, NULL),
('820161600', 'W12008489', 'W12008489', 'ID01', 'Boise Orthopedic Clinic', 'Robert', 'N', 'Walker', 'MD This Provider will terminate on July 1st', 'Orthopedic Surgery', 'Sports Medicine', '', NULL, 'O', '703 S Americana Blvd Ste 120', 'Boise', 'Ada', 'ID', '83702', '2083232600', NULL, '703 S Americana Blvd Ste 120', 'Boise', 'Ada', 'ID', '83702', '2083232600', '          ', 'IDORTHO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 8, '2011-02-23', '2012-07-01', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|UB|', '1306856471', 0, 'N', 0, '2012-05-31', NULL, NULL, 0, 0, NULL, NULL),
('820161600', 'W12008490', 'W12008490', 'ID01', 'Boise Orthopedic Clinic', 'Darby', '', 'Webb', 'MD This Provider will terminate on July 1st', 'Orthopedic Surgery', 'Sports Medicine', '', NULL, 'O', '703 S Americana Blvd Ste 120', 'Boise', 'Ada', 'ID', '83702', '2083232600', NULL, '703 S Americana Blvd Ste 120', 'Boise', 'Ada', 'ID', '83702', '2083232600', '          ', 'IDORTHO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 8, '2011-02-23', '2012-07-01', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|UB|', '1043226715', 0, 'N', 0, '2012-05-31', NULL, NULL, 0, 0, NULL, NULL),
('870609595', 'W12008079', 'W12008079', 'UT01', 'Utah County Medical Associates', 'Nolan', 'B', 'Money', 'MD', 'Family Practice', '', '', NULL, 'O', '15 S 1000 E Ste 300', 'Payson', 'Utah', 'UT', '84651', '8014654896', NULL, '15 S 1000 E Ste 300', 'Payson', 'Utah', 'UT', '84651', '8014654896', '          ', 'WUTCTY', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-05-01', NULL, 0, 0, 0, 'Mountain View Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1194759027', 0, 'N', 0, '2013-11-12', NULL, NULL, 40.044, -111.716, NULL, NULL),
('942854057', 'W12008492', 'W12008492', 'UTIHCPHY', 'Southwest Neurology Associates', '', '', 'Southwest Neurology Associates', 'Group', 'Neurology', '', '', 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, '2009-02-17', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1306081187', 0, 'N', 0, '2011-02-25', NULL, NULL, 37.0498, -113.574, NULL, NULL),
('942854057', 'W12008494', 'W12008494', 'UTIHCPHY', 'Southwest Rheumatology Associates', '', '', 'Southwest Rheumatology Associates', 'Group', 'Rheumatology', '', '', NULL, 'O', '577 S River Rd', 'St George', 'Washington', 'UT', '84790', '4356886262', '4356886263', '577 S River Rd', 'St George', 'Washington', 'UT', '84790', '4356886262', '4356886263', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2009-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1093958605', 0, 'N', 0, '2011-02-25', NULL, NULL, 37.0986, -113.557, NULL, NULL),
('942854057', 'W12008496', 'W12008496', 'UTIHCPHY', 'Southwest Spine & Pain Center', '', '', 'Southwest Spine & Pain Center', 'Group', 'Pain Management', '', '', NULL, 'O', '652 S Medical Ctr Dr Ste 110', 'St George', 'Washington', 'UT', '84790', '4352513700', '4352513701', '652 S Medical Ctr Dr Ste 110', 'St George', 'Washington', 'UT', '84790', '4352513700', '4352513701', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2009-04-20', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1649413303', 0, 'N', 0, '2011-02-25', NULL, NULL, 37.0498, -113.574, NULL, NULL),
('942854057', 'W12008498', 'W12008498', 'UTIHCPHY', 'Summit Clinic', '', '', 'Summit Clinic', 'Group', 'Clinic', '', '', NULL, 'O', '502 S Main', 'Smithfield', 'Cache', 'UT', '84335', '4355633222', '4355633390', '502 S Main', 'Smithfield', 'Cache', 'UT', '84335', '4355633222', '4355633390', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2008-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1740324581', 0, 'N', 0, '2013-08-09', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12008499', 'W12008499', 'UTIHCPHY', 'Budge Clinic Radiology', '', '', 'Budge Clinic Radiology', '', 'Radiology', '', '', NULL, 'O', ' 1350 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357530401', NULL, ' 1350 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357530401', '          ', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2008-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1982732186', 0, 'N', 0, '2011-02-25', NULL, NULL, 41.7565, -111.821, NULL, NULL),
('942854057', 'W12008501', 'W12008501', 'UTIHCPHY', 'Budge Clinic Support', '', '', 'Budge Clinic Support', 'Group', 'Clinic', '', '', NULL, 'O', '1350 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357520422', '4357530401', '1350 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357520422', '4357530401', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2008-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1912023300', 0, 'N', 0, '2011-02-25', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12008503', 'W12008503', 'UTIHCPHY', 'South Cache Valley Clinic', '', '', 'South Cache Valley Clinic', 'Group', 'Clinic', '', '', NULL, 'O', '190 S Hwy 165', 'Providence', 'Cache', 'UT', '84332', '4357553300', '4357553330', '190 S Hwy 165', 'Providence', 'Cache', 'UT', '84332', '4357553300', '4357553330', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2008-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1982748737', 0, 'N', 0, '2011-02-25', NULL, NULL, 41.7032, -111.828, NULL, NULL),
('942854057', 'W12008505', 'W12008505', 'UTIHCPHY', 'Isom Plastic Surgery', '', '', 'Isom Plastic Surgery', 'Group', 'Clinic', '', '', NULL, 'O', '1350 N 500 E Ste 310', 'Logan', 'Cache', 'UT', '84341', '4357871108', '4357874244', '1350 N 500 E Ste 310', 'Logan', 'Cache', 'UT', '84341', '4357871108', '4357874244', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2008-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1477680270', 0, 'N', 0, '2011-02-25', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12008517', 'W12008517', 'UTIHCPHY', 'Logan Hospitalists', '', '', 'Logan Hospitalists', 'Group', 'Clinic', '', '', NULL, 'O', '1400 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357161000', '4357165588', '1400 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357161000', '4357165588', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2008-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1992951396', 0, 'N', 0, '2011-02-25', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12008511', 'W12008511', 'UTIHCPHY', 'Cache Valley Heart Clinic', '', '', 'Cache Valley Heart Clinic', 'Group', 'Clinic', '', '', NULL, 'O', '1300 N 500 E Ste 320', 'Logan', 'Cache', 'UT', '84341', '4357558200', '4357526094', '1300 N 500 E Ste 320', 'Logan', 'Cache', 'UT', '84341', '4357558200', '4357526094', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2010-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1801114459', 0, 'N', 0, '2011-02-25', NULL, NULL, 41.7563, -111.821, NULL, NULL),
('942854057', 'W12008507', 'W12008507', 'UTIHCPHY', 'Canyon View Orthopedics & Podiatry Associates', '', '', 'Canyon View Orthopedics & Podiatry Associates', 'Group', 'Clinic', '', '', NULL, 'O', '1300 N 500 E Ste 130', 'Logan', 'Cache', 'UT', '84341', '4357162800', '4357162809', '1300 N 500 E Ste 130', 'Logan', 'Cache', 'UT', '84341', '4357162800', '4357162809', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2008-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1205963105', 0, 'N', 0, '2011-02-25', NULL, NULL, 41.7563, -111.821, NULL, NULL),
('942854057', 'W12008509', 'W12008509', 'UTIHCPHY', 'Budge Clinic Obstetrics & Gynecology', '', '', 'Budge Clinic Obstetrics & Gynecology', 'Group', 'Clinic', '', '', NULL, 'O', '1400 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357161920', '4357921677', '1400 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357161920', '4357921677', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2008-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1013045384', 0, 'N', 0, '2011-02-25', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12008513', 'W12008513', 'UTIHCPHY', 'Logan Clinic', '', '', 'Logan Clinic', 'Group', 'Clinic', '', '', NULL, 'O', '412 N 200 E', 'Logan', 'Cache', 'UT', '84321', '4357132800', '4357132834', '412 N 200 E', 'Logan', 'Cache', 'UT', '84321', '4357132800', '4357132834', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2008-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1376688416', 0, 'N', 0, '2011-02-25', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12008515', 'W12008515', 'UTIHCPHY', 'Bear River Specialists', '', '', 'Bear River Specialists', 'Group', 'Clinic', '', '', NULL, 'O', '935 N 1000 W', 'Tremonton', 'Box Elder', 'UT', '84337', '4352074800', '4352074808', '935 N 1000 W', 'Tremonton', 'Box Elder', 'UT', '84337', '4352074800', '4352074808', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2008-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1063556157', 0, 'N', 0, '2011-02-25', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12008578', 'W12008578', 'UTIHCPHY', 'Sunset Family Practice', '', '', 'Sunset Family Practice', 'Group', 'Clinic', '', '', NULL, 'O', '1739 W Sunset Blvd', 'St George', 'Washington', 'UT', '84770', '4356346000', '4356346033', '1739 W Sunset Blvd', 'St George', 'Washington', 'UT', '84770', '4356346000', '4356346033', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2008-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1942408422', 0, 'N', 0, '2011-02-28', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12008526', 'W12008526', 'UTIHCPHY', 'Fillmore Clinic', '', '', 'Fillmore Clinic', 'group', 'Clinic', '', '', 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, '2008-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1023159381', 0, 'N', 0, '2011-02-28', NULL, NULL, 38.953, -112.341, NULL, NULL),
('942854057', 'W12008519', 'W12008519', 'UTIHCPHY', 'Logan Maternal Fetal Medicine', '', '', 'Logan Maternal Fetal Medicine', 'Group', 'Clinic', '', '', NULL, 'O', '1400 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357161958', '4357921677', '1400 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357161958', '4357921677', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2011-03-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1356669907', 0, 'N', 0, '2011-02-25', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12008521', 'W12008521', 'UTIHCPHY', 'Southwest Cardiology-St. George', '', '', 'Southwest Cardiology-St. George', 'Group', 'Clinic', '', '', 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, '2008-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1477698223', 0, 'N', 0, '2011-02-25', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12008536', 'W12008536', 'UTIHCPHY', 'Moroni Clinic', '', '', 'Moroni Clinic', 'Group', 'Clinic', '', '', 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, '2009-08-27', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1225266901', 0, 'N', 0, '2011-02-28', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12008523', 'W12008523', 'UTIHCPHY', 'Cardiovascular & Thoracic Surgery - St. George', '', '', 'Cardiovascular & Thoracic Surgery - St. George', 'Group', 'Clinic', '', '', NULL, 'O', '1380 E Medical Ctr Dr Ste 2600', 'St George', 'Washington', 'UT', '84790', '4352512700', '4356564907', '1380 E Medical Ctr Dr Ste 2600', 'St George', 'Washington', 'UT', '84790', '4352512700', '4356564907', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2008-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1326173394', 0, 'N', 0, '2011-02-25', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12008528', 'W12008528', 'UTIHCPHY', 'Snow College Clinic', '', '', 'Snow College Clinic', 'Group', 'Clinic', '', '', NULL, 'O', '150 E College Ave', 'Ephraim', 'Sanpete', 'UT', '84627', '4352837216', '4352837217', '150 E College Ave', 'Ephraim', 'Sanpete', 'UT', '84627', '4352837216', '4352837217', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2008-07-01', '2010-11-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1861696411', 0, 'N', 0, '2011-05-24', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12008530', 'W12008530', 'UTIHCPHY', 'Ephraim Clinic', '', '', 'Ephraim Clinic', 'Group', 'Clinic', '', '', NULL, 'O', '525 N Main', 'Ephraim', 'Sanpete', 'UT', '84627', '4352834076', '4352834078', '525 N Main', 'Ephraim', 'Sanpete', 'UT', '84627', '4352834076', '4352834078', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2008-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1013058395', 0, 'N', 0, '2011-02-28', NULL, NULL, 39.371, -111.587, NULL, NULL),
('942854057', 'W12008532', 'W12008532', 'UTIHCPHY', 'Mt. Pleasant Clinic', '', '', 'Mt. Pleasant Clinic', 'Group', 'Clinic', '', '', 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, '2008-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1750425815', 0, 'N', 0, '2011-02-28', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12008534', 'W12008534', 'UTIHCPHY', 'Manti Family Clinic', '', '', 'Manti Family Clinic', 'Group', 'Clinic', '', '', NULL, 'O', '159 N Main', 'Manti', 'Sanpete', 'UT', '84642', '4358353344', '4358353081', '159 N Main', 'Manti', 'Sanpete', 'UT', '84642', '4358353344', '4358353081', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2008-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1356485411', 0, 'N', 0, '2011-02-28', NULL, NULL, 39.2677, -111.643, NULL, NULL),
('942854057', 'W12008542', 'W12008542', 'UTIHCPHY', 'Sevier Valley Clinic', '', '', 'Sevier Valley Clinic', 'Group', 'Clinic', '', '', NULL, 'O', '460 N Main', 'Richfield', 'Sevier', 'UT', '84701', '4358965496', '4358969369', '460 N Main', 'Richfield', 'Sevier', 'UT', '84701', '4358965496', '4358969369', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2008-07-01', '2013-11-24', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1265576326', 0, 'N', 0, '2013-12-05', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12008538', 'W12008538', 'UTIHCPHY', 'North Sevier Medical Clinic', '', '', 'North Sevier Medical Clinic', 'Group', 'Clinic', '', '', NULL, 'O', '530 N 250 W', 'Salina', 'Sevier', 'UT', '84654', '4355297411', '4355297458', '530 N 250 W', 'Salina', 'Sevier', 'UT', '84654', '4355297411', '4355297458', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2008-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1538283163', 0, 'N', 0, '2011-02-28', NULL, NULL, 38.9534, -111.863, NULL, NULL),
('942854057', 'W12008540', 'W12008540', 'UTIHCPHY', 'Sevier Valley Specialty Clinic', '', '', 'Sevier Valley Specialty Clinic', 'Group', 'Clinic', '', '', 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, '2008-07-01', '2013-11-24', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1396872073', 0, 'N', 0, '2013-12-05', NULL, NULL, 38.8608, -111.967, NULL, NULL),
('942854057', 'W12008548', 'W12008548', 'UTIHCPHY', 'Rim Rock Orthopaedics', '', '', 'Rim Rock Orthopaedics-DSC', 'Group', 'Clinic', '', '', NULL, 'O', '652 S Medical Ctr Dr Ste 120', 'St George', 'Washington', 'UT', '84790', '4356284460', '4356284469', '652 S Medical Ctr Dr Ste 120', 'St George', 'Washington', 'UT', '84790', '4356284460', '4356284469', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2008-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1508995325', 0, 'N', 0, '2013-12-05', NULL, NULL, 37.0498, -113.574, NULL, NULL),
('942854057', 'W12008544', 'W12008544', 'UTIHCPHY', 'Bear River Clinic', '', '', 'Bear River Family Medicine', 'Group', 'Clinic', '', '', NULL, 'O', '935 N 1000 W', 'Tremonton', 'Box Elder', 'UT', '84337', '4352074800', '4352074808', '935 N 1000 W', 'Tremonton', 'Box Elder', 'UT', '84337', '4352074800', '4352074808', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2008-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1487853826', 0, 'N', 0, '2014-03-31', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12008560', 'W12008560', 'UTIHCPHY', 'Cedar City Clinic', '', '', 'Cedar City Clinic', 'GROUP', 'Clinic', '', '', NULL, 'O', '1303 N Main', 'Cedar City', 'Iron', 'UT', '84720', '4358685500', '4358685504', '1303 N Main', 'Cedar City', 'Iron', 'UT', '84720', '4358685500', '4358685504', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2008-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1922132828', 0, 'N', 0, '2011-02-28', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12008546', 'W12008546', 'UTIHCPHY', 'Pulmonary Medicine Clinic - St George', '', '', 'Pulmonary Medicine Clinic - St George', 'Group', 'Clinic', '', '', NULL, 'O', '1380 E Medical Ctr Dr Ste 2200', 'St George', 'Washington', 'UT', '84790', '4352512600', '4352512610', '1380 E Medical Ctr Dr Ste 2200', 'St George', 'Washington', 'UT', '84790', '4352512600', '4352512610', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2008-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1497885453', 0, 'N', 0, '2011-02-28', NULL, NULL, 37.0998, -113.554, NULL, NULL),
('942854057', 'W12008550', 'W12008550', 'UTIHCPHY', 'Intermountain Psychiatry & Counseling', '', '', 'Intermountain Psychiatry & Counseling', 'Group', 'Clinic', '', '', NULL, 'O', '1054 E Riverside Dr Ste 202', 'St George', 'Washington', 'UT', '84790', '4356346100', '4356346129', '1054 E Riverside Dr Ste 202', 'St George', 'Washington', 'UT', '84790', '4356346100', '4356346129', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2008-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1457496531', 0, 'N', 0, '2014-02-05', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12008552', 'W12008552', 'UTIHCPHY', 'Hurricane Valley Clinic', '', '', 'Hurricane Valley Clinic', 'Group', 'Clinic', '', '', NULL, 'O', '75 N 2260 W', 'Hurricane', 'Washington', 'UT', '84737', '4356356500', '4356356549', '75 N 2260 W', 'Hurricane', 'Washington', 'UT', '84737', '4356356500', '4356356549', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2008-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1386789477', 0, 'N', 0, '2011-02-28', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12008554', 'W12008554', 'UTIHCPHY', 'River Road Family Medicine', '', '', 'River Road Family Medicine', 'Group', 'Clinic', '', '', NULL, 'O', '577 S River Rd', 'St George', 'Washington', 'UT', '84790', '4356886100', '4356886111', '577 S River Rd', 'St George', 'Washington', 'UT', '84790', '4356886100', '4356886111', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2008-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1417092883', 0, 'N', 0, '2013-12-30', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12008556', 'W12008556', 'UTIHCPHY', 'Canyon View Family Practice', '', '', 'Canyon View Family Practice', 'Group', 'Clinic', '', '', NULL, 'O', '15 E 400 N', 'Parowan', 'Iron', 'UT', '84761', '4354773317', '4354779805', '15 E 400 N', 'Parowan', 'Iron', 'UT', '84761', '4354773317', '4354779805', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2008-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1447380589', 0, 'N', 0, '2011-02-28', NULL, NULL, 37.8411, -112.83, NULL, NULL),
('942854057', 'W12008558', 'W12008558', 'UTIHCPHY', 'Southern Utah Surgical Associates', '', '', 'Southern Utah Surgical Associates', 'Group', 'Clinic', '', '', NULL, 'O', '166 W 1325 N', 'Cedar City', 'Iron', 'UT', '84720', '4355868192', '4355867564', '166 W 1325 N', 'Cedar City', 'Iron', 'UT', '84720', '4355868192', '4355867564', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2008-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1730219387', 0, 'N', 0, '2011-02-28', NULL, NULL, 37.7011, -113.065, NULL, NULL),
('942854057', 'W12008566', 'W12008566', 'UTIHCPHY', 'Redrock Pediatrics', '', '', 'Redrock Pediatrics', 'GROUP', 'Clinic', '', '', NULL, 'O', '1380 E Medical Ctr Dr', 'St George', 'Washington', 'UT', '84790', '4352512740', '4352512741', '1380 E Medical Ctr Dr', 'St George', 'Washington', 'UT', '84790', '4352512740', '4352512741', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2008-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1922136126', 0, 'N', 0, '2011-02-28', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12008562', 'W12008562', 'UTIHCPHY', 'Valley View Heart Clinic', '', '', 'Valley View Heart Clinic', 'Group', 'Clinic', '', '', NULL, 'O', '1303 N Main', 'Cedar City', 'Iron', 'UT', '84720', '4358685500', '4358685504', '1303 N Main', 'Cedar City', 'Iron', 'UT', '84720', '4358685500', '4358685504', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2008-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1922132729', 0, 'N', 0, '2011-02-28', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12008564', 'W12008564', 'UTIHCPHY', 'Zion Orthopaedics & Sports Medicine', '', '', 'Zion Orthopaedics & Sports Medicine', 'GROUP', 'Clinic', '', '', NULL, 'O', '652 S Medical Ctr Dr', 'St George', 'Washington', 'UT', '84790', '4352512650', '4352512668', '652 S Medical Ctr Dr', 'St George', 'Washington', 'UT', '84790', '4352512650', '4352512668', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '0008-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1104953652', 0, 'N', 0, '2011-02-28', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12008572', 'W12008572', 'UTIHCPHY', 'River Road Internal Medicine', '', '', 'River Road Internal Medicine', 'Group', 'Clinic', '', '', NULL, 'O', '577 S River Rd', 'St George', 'Washington', 'UT', '84790', '4356886200', '4356886222', '577 S River Rd', 'St George', 'Washington', 'UT', '84790', '4356886200', '4356886222', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2008-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1467582429', 0, 'N', 0, '2011-02-28', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12008568', 'W12008568', 'UTIHCPHY', 'Southwest Urology', '', '', 'Southwest Urology', 'GROUP', 'Clinic', '', '', NULL, 'O', '1380 E Medical Ctr Dr', 'St George', 'Washington', 'UT', '84790', '4352513250', '4352513251', '1380 E Medical Ctr Dr', 'St George', 'Washington', 'UT', '84790', '4352513250', '4352513251', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2011-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1457671513', 0, 'N', 0, '2011-02-28', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12008570', 'W12008570', 'UTIHCPHY', 'Intermountain Womens Health Specialists', '', '', 'Intermountain Womens Health Specialists', 'Group', 'Clinic', '', '', NULL, 'O', '346 E 600 S', 'St George', 'Washington', 'UT', '84770', '4356884600', '4356884601', '346 E 600 S', 'St George', 'Washington', 'UT', '84770', '4356884600', '4356884601', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2008-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1679603807', 0, 'N', 0, '2011-02-28', NULL, NULL, 37.098, -113.576, NULL, NULL),
('942854057', 'W12008574', 'W12008574', 'UTIHCPHY', 'Dixie Hospitalists', '', '', 'Dixie Hospitalists', 'GROUP', 'Clinic', '', '', NULL, 'O', '1380 E Medical Ctr Dr', 'St George', 'Washington', 'UT', '84790', '4356886200', '4356886222', '1380 E Medical Ctr Dr', 'St George', 'Washington', 'UT', '84790', '4356886200', '4356886222', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2008-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1861522799', 0, 'N', 0, '2011-02-28', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12008576', 'W12008576', 'UTIHCPHY', 'Southwest Regional Cancer Clinic', '', '', 'Southwest Regional Cancer Clinic', 'GROUP', 'Clinic', '', '', NULL, 'O', '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356884900', '4356884901', '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356884900', '4356884901', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2008-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1447420401', 0, 'N', 0, '2011-12-19', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12008584', 'W12008584', 'UTIHCPHY', 'Northern Utah Surgeons', '', '', 'Northern Utah Surgeons', 'GROUP', 'Clinic', '', '', NULL, 'O', '4403 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8013877450', '8013877130', '4403 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8013877450', '8013877130', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2008-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1053456764', 0, 'N', 0, '2011-02-28', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12008580', 'W12008580', 'UTIHCPHY', 'Dixie Plastic & Reconstructive Surgery', '', '', 'Dixie Plastic & Reconstructive Surgery', 'GROUP', 'Clinic', '', '', NULL, 'O', '652 S Medical Ctr Dr', 'St George', 'Washington', 'UT', '84790', '4352513670', '4352513671', '652 S Medical Ctr Dr', 'St George', 'Washington', 'UT', '84790', '4352513670', '4352513671', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2008-07-01', '2013-02-11', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1285825059', 0, 'N', 0, '2014-02-05', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12008582', 'W12008582', 'UTIHCPHY', 'Sports Medicine-St George', '', '', 'Sports Medicine-St George', 'GROUP', 'Clinic', '', '', NULL, 'O', '652 S Medical Ctr Dr', 'St George', 'Washington', 'UT', '84790', '4352512677', '4352512678', '652 S Medical Ctr Dr', 'St George', 'Washington', 'UT', '84790', '4352512677', '4352512678', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2008-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1649426800', 0, 'N', 0, '2011-02-28', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12008598', 'W12008598', 'UTIHCPHY', 'Mountain View Pediatrics', '', '', 'Mountain View Pediatrics', 'GROUP', 'Clinic', '', '', NULL, 'O', '9720 S 1300 E', 'Sandy', 'Salt Lake', 'UT', '84094', '8015718550', '8015711689', '9720 S 1300 E', 'Sandy', 'Salt Lake', 'UT', '84094', '8015718550', '8015711689', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2008-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1699802348', 0, 'N', 0, '2011-02-28', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12008586', 'W12008586', 'UTIHCPHY', 'McKay Dee Endocrine & Diabetes Clinic', '', '', 'McKay Dee Endocrine & Diabetes Clinic', 'Group', 'Clinic', '', '', NULL, 'O', '4403 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8013877900', '8013877910', '4403 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8013877900', '8013877910', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2008-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1033249198', 0, 'N', 0, '2012-01-30', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12008588', 'W12008588', 'UTIHCPHY', 'Herefordshire Clinic', '', '', 'Herefordshire Clinic', 'GROUP', 'Clinic', '', '', NULL, 'O', '1915 W 5950 S', 'Roy', 'Weber', 'UT', '84067', '8013878100', '8013878246', '1915 W 5950 S', 'Roy', 'Weber', 'UT', '84067', '8013878100', '8013878246', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2008-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1053441873', 0, 'N', 0, '2011-02-28', NULL, NULL, 41.1558, -112.026, NULL, NULL),
('942854057', 'W12008590', 'W12008590', 'UTIHCPHY', 'McKay Dee Rheumatology Clinic', '', '', 'McKay Dee Rheumatology Clinic', 'GROUP', 'Clinic', '', '', NULL, 'O', '4403 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8013877125', '8013877130', '4403 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8013877125', '8013877130', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2008-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1396773834', 0, 'N', 0, '2011-02-28', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12008592', 'W12008592', 'UTIHCPHY', 'Bountiful Clinic', '', '', 'Bountiful Clinic', 'Group', 'Clinic', '', '', NULL, 'O', '390 N Main St', 'Bountiful', 'Davis', 'UT', '84010', '8012941000', '8012928369', '390 N Main St', 'Bountiful', 'Davis', 'UT', '84010', '8012941000', '8012928369', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2008-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1588799654', 0, 'N', 0, '2011-06-27', NULL, NULL, 40.8935, -111.881, NULL, NULL),
('942854057', 'W12008594', 'W12008594', 'UTIHCPHY', 'Holladay Pediatrics', '', '', 'Holladay Pediatrics', 'GROUP', 'Clinic', '', '', NULL, 'O', '2180 E 4500 S', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8019474242', '8012728579', '2180 E 4500 S', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8019474242', '8012728579', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2008-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1396880522', 0, 'N', 0, '2011-02-28', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12008612', 'W12008612', 'UTIHCPHY', 'Utah Heart', '', '', 'Utah Heart', 'GROUP', 'Clinic', '', '', NULL, 'O', '5169 S Cottonwood St', 'Murray', 'Salt Lake', 'UT', '84107', '8015073500', '8015073505', '5169 S Cottonwood St', 'Murray', 'Salt Lake', 'UT', '84107', '8015073500', '8015073505', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2009-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1982833398', 0, 'N', 0, '2011-02-28', NULL, NULL, 40.659, -111.894, NULL, NULL),
('942854057', 'W12008596', 'W12008596', 'UTIHCPHY', 'Holladay Pediatrics North', '', '', 'Holladay Pediatrics North', 'GROUP', 'Clinic', '', '', NULL, 'O', '2160 E 4500 S', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8012784693', '8012784850', '2160 E 4500 S', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8012784693', '8012784850', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2008-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1558496745', 0, 'N', 0, '2011-02-28', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12008604', 'W12008604', 'UTIHCPHY', 'Alta View Specialty Clinic', '', '', 'Alta View Specialty Clinic', 'GROUP', 'Clinic', '', '', NULL, 'O', '9450 S 1300 E', 'Sandy', 'Salt Lake', 'UT', '84094', '8015016333', '8015016225', '9450 S 1300 E', 'Sandy', 'Salt Lake', 'UT', '84094', '8015016333', '8015016225', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2010-06-14', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1902126204', 0, 'N', 0, '2011-02-28', NULL, NULL, 40.579, -111.853, NULL, NULL),
('942854057', 'W12008600', 'W12008600', 'UTIHCPHY', 'LDS Hospital Hospitalists', '', '', 'LDS Hospital Hospitalists', 'GROUP', 'Clinic', '', '', NULL, 'O', '8th Ave & C St', 'Salt Lake City', 'Salt Lake', 'UT', '84143', '8014085482', '8014088698', '8th Ave & C St', 'Salt Lake City', 'Salt Lake', 'UT', '84143', '8014085482', '8014088698', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2008-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1164554069', 0, 'N', 0, '2011-02-28', NULL, NULL, 40.7785, -111.881, NULL, NULL),
('942854057', 'W12008606', 'W12008606', 'UTIHCPHY', 'Hillcrest Pediatrics', '', '', 'Hillcrest Pediatrics', 'GROUP', 'Clinic', '', '', NULL, 'O', '5063 S Cottonwood St', 'Murray', 'Salt Lake', 'UT', '84107', '8015071850', '8015871875', '5063 S Cottonwood St', 'Murray', 'Salt Lake', 'UT', '84107', '8015071850', '8015871875', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2008-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1659569358', 0, 'N', 0, '2011-02-28', NULL, NULL, 40.6615, -111.893, NULL, NULL),
('942854057', 'W12008602', 'W12008602', 'UTIHCPHY', 'Intermountain Plastic Surgery Center', '', '', 'Intermountain Plastic Surgery Center', 'GROUP', 'Clinic', '', '', NULL, 'O', '5169 S Cottonwood St', 'Murray', 'Salt Lake', 'UT', '84107', '8015071650', '8015071625', '5169 S Cottonwood St', 'Murray', 'Salt Lake', 'UT', '84107', '8015071650', '8015071625', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2008-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1881721363', 0, 'N', 0, '2011-02-28', NULL, NULL, 40.659, -111.894, NULL, NULL),
('942854057', 'W12008608', 'W12008608', 'UTIHCPHY', 'Central ENT Head-Neck Surgery', '', '', 'Central ENT Head-Neck Surgery', 'GROUP', 'Clinic', '', '', NULL, 'O', '5169 S Cottonwood St Ste 640 S', 'Murray', 'Salt Lake', 'UT', '84107', '8015073680', '8015073685', '5169 S Cottonwood St Ste 640 S', 'Murray', 'Salt Lake', 'UT', '84107', '8015073680', '8015073685', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2008-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1942462569', 0, 'N', 0, '2013-12-30', NULL, NULL, 40.659, -111.894, NULL, NULL),
('942854057', 'W12008610', 'W12008610', 'UTIHCPHY', 'Southridge Pediatrics', '', '', 'Southridge Pediatrics', 'GROUP', 'Clinic', '', '', NULL, 'O', '3723 W 12600 S', 'Riverton', 'Salt Lake', 'UT', '84065', '8012854543', '8012854540', '3723 W 12600 S', 'Riverton', 'Salt Lake', 'UT', '84065', '8012854543', '8012854540', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2009-08-10', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1518108166', 0, 'N', 0, '2011-02-28', NULL, NULL, 40.5222, -111.98, NULL, NULL),
('942854057', 'W12008618', 'W12008618', 'UTIHCPHY', 'Bryner Clinic', '', '', 'Bryner Clinic', 'GROUP', 'Clinic', '', '', NULL, 'O', '525 E 100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015197100', '8015213091', '525 E 100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015197100', '8015213091', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2008-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1225163702', 0, 'N', 0, '2011-02-28', NULL, NULL, 40.7672, -111.876, NULL, NULL),
('942854057', 'W12008614', 'W12008614', 'UTIHCPHY', 'Heber Valley Clinic', '', '', 'Heber Valley Clinic', 'GROUP', 'Urgent Care', '', '', NULL, 'O', '1473 S Hwy 40', 'Heber City', 'Wasatch', 'UT', '84032', '4356542500', '4356574460', '1473 S Hwy 40', 'Heber City', 'Wasatch', 'UT', '84032', '4356542500', '4356574460', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2008-07-01', '2010-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1063616282', 0, 'N', 0, '2011-05-20', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12008620', 'W12008620', 'UTIHCPHY', 'Tooele InstaCare', '', '', 'Tooele InstaCare', 'GROUP', 'Clinic', '', '', NULL, 'O', '777 N Main St', 'Tooele', 'Tooele', 'UT', '84074', '4352281200', '4352281298', '777 N Main St', 'Tooele', 'Tooele', 'UT', '84074', '4352281200', '4352281298', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2011-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1699071357', 0, 'N', 0, '2011-02-28', NULL, NULL, 40.5451, -112.298, 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
('942854057', 'W12008616', 'W12008616', 'UTIHCPHY', 'Park City Specialty Clinic', '', '', 'Park City Specialty Clinic', 'GROUP', 'Clinic', '', '', NULL, 'O', '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587400', '4536587401', '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587400', '4536587401', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2009-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1205066495', 0, 'N', 0, '2011-02-28', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12008626', 'W12008626', 'UTIHCPHY', 'Sandy Clinic', '', '', 'Sandy Clinic', 'GROUP', 'Clinic', '', '', NULL, 'O', '9500 S 1300 E', 'Sandy', 'Salt Lake', 'UT', '84094', '8015012100', '8015012107', '9500 S 1300 E', 'Sandy', 'Salt Lake', 'UT', '84094', '8015012100', '8015012107', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2008-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1164558847', 0, 'N', 0, '2011-02-28', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12008622', 'W12008622', 'UTIHCPHY', 'Salt Lake Clinic', '', '', 'Salt Lake Clinic Administration', 'GROUP', 'Clinic', '', '', NULL, 'O', '333 S 900 E', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8019336000', '8013554011', '333 S 900 E', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8019336000', '8013554011', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2008-07-01', '2013-11-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1629107305', 0, 'N', 0, '2013-12-05', NULL, NULL, 40.7622, -111.865, NULL, NULL),
('942854057', 'W12008624', 'W12008624', 'UTIHCPHY', 'Memorial Clinic', '', '', 'Memorial Clinic', 'GROUP', 'Clinic', '', '', NULL, 'O', '2000 S 900 E', 'Salt Lake City', 'Salt Lake', 'UT', '84105', '8014647500', '8014647876', '2000 S 900 E', 'Salt Lake City', 'Salt Lake', 'UT', '84105', '8014647500', '8014647876', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2008-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1508904947', 0, 'N', 0, '2011-02-28', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12008628', 'W12008628', 'UTIHCPHY', 'Provo Radiation Oncology', '', '', 'Provo Radiation Oncology', 'GROUP', 'Clinic', '', '', NULL, 'O', '1034 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013572480', '8014423263', '1034 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013572480', '8014423263', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2008-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1972631042', 0, 'N', 0, '2011-02-28', NULL, NULL, 40.2469, -111.667, NULL, NULL),
('273381165', 'W12008629', 'W12008629', 'UTDT01', 'Dental Works ', 'Wade', '', 'Arkoudas', 'DDS', 'Pedodontist', '', '', NULL, 'O', '2112 Hillfield Rd Ste 1', 'Layton', 'Davis', 'UT', '84041', '8017740770', NULL, '2112 Hillfield Rd Ste 1', 'Layton', 'Davis', 'UT', '84041', '8017740770', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2010-10-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000005079', 0, 'N', 0, '2011-02-28', NULL, NULL, 0, 0, NULL, NULL),
('870355462', 'W12008630', 'W12008630', 'UTDT01', '', 'Brent J', '', 'Isakson', 'DMD', 'Dentist', '', '', NULL, 'O', '5139 S 1900 W', 'Roy', 'Weber', 'UT', '84067', '8017738212', NULL, '5139 S 1900 W', 'Roy', 'Weber', 'UT', '84067', '8017738212', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2005-04-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000006876', 0, 'N', 0, '2011-02-28', NULL, NULL, 0, 0, NULL, NULL),
('200526048', 'W12008631', 'W12008631', 'UTDT01', '', 'Brian W', '', 'Smith', 'DDS', 'Dentist', '', '', NULL, 'O', '6360 S 3000 E Ste 330', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019435443', NULL, '6360 S 3000 E Ste 330', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019435443', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2003-06-01', '2012-09-06', 0, 0, 0, '', '', '', '', 'DEN|', '0000008755', 0, 'N', 0, '2012-11-21', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12008656', 'W12008656', 'UTIHCPHY', 'Heart Rhythm Specialists Murray', '', '', 'Heart Rhythm Specialists Murray', 'GROUP', 'Clinic', '', '', NULL, 'O', '5292 S College Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8012814278', '8012815960', '5292 S College Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8012814278', '8012815960', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2011-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1629260880', 0, 'N', 0, '2011-12-19', NULL, NULL, 40.6557, -111.905, NULL, NULL),
('942854057', 'W12008645', 'W12008645', 'UTIHCPHY', 'Utah Valley Womens Center', '', '', 'Utah Valley Womens Center', 'GROUP', 'Clinic', '', '', NULL, 'O', '1034 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013577009', '8013578132', '1034 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013577009', '8013578132', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2011-02-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1922309723', 0, 'N', 0, '2011-03-01', NULL, NULL, 40.2469, -111.667, NULL, NULL),
('942854057', 'W12008635', 'W12008635', 'UTIHCPHY', 'American Fork Surgical Associates', '', '', 'American Fork Surgical Associates', 'GROUP', 'Clinic', '', '', 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, '2008-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1710136742', 0, 'N', 0, '2014-03-31', NULL, NULL, 40.3805, -111.769, NULL, NULL),
('942854057', 'W12008637', 'W12008637', 'UTIHCPHY', 'North Canyon Family Practice', '', '', 'North Canyon Family Practice', 'GROUP', 'Clinic', '', '', NULL, 'O', '3200 N Canyon Rd Ste D', 'Provo', 'Utah', 'UT', '84604', '8013733300', '8013547900', '3200 N Canyon Rd Ste D', 'Provo', 'Utah', 'UT', '84604', '8013733300', '8013547900', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2008-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1992831218', 0, 'N', 0, '2011-03-01', NULL, NULL, 40.276, -111.651, NULL, NULL),
('942854057', 'W12008639', 'W12008639', 'UTIHCPHY', 'Utah Valley Heart & Lung Surgical Associates', '', '', 'Utah Valley Heart & Lung Surgical Associates', 'GROUP', 'Clinic', '', '', NULL, 'O', '1134 N 500 W Ste 100', 'Provo', 'Utah', 'UT', '84604', '8013577081', '8013577351', '1134 N 500 W Ste 100', 'Provo', 'Utah', 'UT', '84604', '8013577081', '8013577351', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2008-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1225165988', 0, 'N', 0, '2011-03-01', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12008641', 'W12008641', 'UTIHCPHY', 'Utah Valley Pulmonary Clinic', '', '', 'Utah Valley Pulmonary Clinic', 'GROUP', 'Clinic', '', '', NULL, 'O', '1055 N 300 W Ste 500', 'Provo', 'Utah', 'UT', '84604', '8013577291', '8013577919', '1055 N 300 W Ste 500', 'Provo', 'Utah', 'UT', '84604', '8013577291', '8013577919', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2008-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1295862951', 0, 'N', 0, '2011-03-01', NULL, NULL, 40.2476, -111.664, NULL, NULL),
('942854057', 'W12008643', 'W12008643', 'UTIHCPHY', 'Utah Valley Ear Nose & Throat - North Valley', '', '', 'Utah Valley Ear Nose & Throat - North Valley', 'GROUP', 'Clinic', '', '', NULL, 'O', '872 N 2000 W', 'Pleasant Grove', 'Utah', 'UT', '84062', '8014928900', '8014928910', '872 N 2000 W', 'Pleasant Grove', 'Utah', 'UT', '84062', '8014928900', '8014928910', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2010-07-11', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1508177072', 0, 'N', 0, '2014-03-31', NULL, NULL, 40.3706, -111.769, NULL, NULL),
('942854057', 'W12008647', 'W12008647', 'UTIHCPHY', 'Budge Surgical Specialists-Preston', '', '', 'Budge Surgical Specialists-Preston', 'GROUP', 'Clinic', '', '', NULL, 'O', '44 N 100 E', 'Preston', 'Franklin', 'ID', '83263', '4357921950', '4357921653', '44 N 100 E', 'Preston', 'Franklin', 'ID', '83263', '4357921950', '4357921653', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2009-05-06', '2014-06-11', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1255565107', 0, 'N', 0, '2014-06-17', NULL, NULL, 42.0971, -111.874, NULL, NULL),
('942854057', 'W12008649', 'W12008649', 'UTIHCPHY', 'Utah Valley Sports Med-Am Fork (CLOSED 4/1/10)', '', '', 'Utah Valley Sports Med-Am Fork (CLOSED 4/1/10)', 'GROUP', 'Clinic', '', '', NULL, 'O', '1159 E 200 N', 'American Fork', 'Utah', 'UT', '84003', '8018553438', '8018553851', '1159 E 200 N', 'American Fork', 'Utah', 'UT', '84003', '8018553438', '8018553851', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2009-05-06', '2010-04-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1649304445', 0, 'N', 0, '2011-03-01', NULL, NULL, 40.3805, -111.769, NULL, NULL),
('942854057', 'W12008657', 'W12008657', 'UTIHCPHY', 'American Fork Surgical Associates', 'Stephen', 'Dale', 'Neeleman', 'MD', 'General Surgery', '', '', 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, '2008-12-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1578523882', 0, 'N', 0, '2011-03-01', NULL, NULL, 40.3805, -111.769, NULL, NULL),
('942854057', 'W12008663', 'W12008663', 'UTIHCPHY', 'Utah Heart', 'Nancy', 'E', 'Gundersen', 'MD', 'Internal Medicine', 'Hospitalist', '', NULL, 'O', '5169 S Cottonwood St Ste 520', 'Murray', 'Salt Lake', 'UT', '84107', '8015073500', '8015073505', '5169 S Cottonwood St Ste 520', 'Murray', 'Salt Lake', 'UT', '84107', '8015073500', '8015073505', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2010-01-28', '2014-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1609080720', 0, 'N', 0, '2014-06-27', NULL, NULL, 40.659, -111.894, NULL, NULL),
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('942854057', 'W12008708', 'W12008708', 'UTIHC02', 'Rehab', 'Molly', 'W', 'Moosman', 'SLP', 'Speech Language Pathology', '', '', NULL, 'O', '870 E 9400 S Ste 112', 'Sandy', 'Salt Lake', 'UT', '84094', '8015713081', NULL, '870 E 9400 S Ste 112', 'Sandy', 'Salt Lake', 'UT', '84094', '8015713081', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2011-01-17', '2011-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1932430139', 0, 'N', 0, '2012-09-13', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12008707', 'W12008707', 'UTIHC01', 'Rehab', 'Molly', 'W', 'Moosman', 'SLP', 'Speech Language Pathology', '', '', NULL, 'O', '870 E 9400 S Ste 112', 'Sandy', 'Salt Lake', 'UT', '84094', '8015713081', NULL, '870 E 9400 S Ste 112', 'Sandy', 'Salt Lake', 'UT', '84094', '8015713081', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2011-01-17', '2011-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1932430139', 0, 'N', 0, '2012-09-13', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12008709', 'W12008709', 'UTIHC03', 'Rehab', 'Molly', 'W', 'Moosman', 'SLP', 'Speech Language Pathology', '', '', NULL, 'O', '870 E 9400 S Ste 112', 'Sandy', 'Salt Lake', 'UT', '84094', '8015713081', NULL, '870 E 9400 S Ste 112', 'Sandy', 'Salt Lake', 'UT', '84094', '8015713081', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2011-01-17', '2011-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1932430139', 0, 'N', 0, '2012-09-13', NULL, NULL, 0, 0, NULL, NULL),
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('942854057', 'W12008715', 'W12008715', 'UTIHC04', 'Emergency Room', 'Brad', 'S', 'Goldman', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '126 S White Sage Ave', 'Delta', 'Millard', 'UT', '84624', '4358645591', NULL, '126 S White Sage Ave', 'Delta', 'Millard', 'UT', '84624', '4358645591', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2011-03-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1700877933', 0, 'N', 0, '2011-03-01', NULL, NULL, 39.3506, -112.56, NULL, NULL),
('942854057', 'W12008712', 'W12008712', 'UTIHC04', 'Emergency Room', 'John', 'R', 'Dayton', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', NULL, '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2011-02-10', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1285801704', 0, 'N', 0, '2011-03-01', NULL, NULL, 40.6876, -111.468, NULL, NULL),
('743061661', 'W12008722', 'W12008722', 'UT01', 'Northwest Eyecare Center', 'Timothy', '', 'Byers', 'MD', 'Ophthalmology', '', '', NULL, 'O', '1111 W Victory Way', 'Craig', 'Moffat', 'CO', '81625', '9708243488', '9708248132', '1111 W Victory Way', 'Craig', 'Moffat', 'CO', '81625', '9708243488', '9708248132', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-05-01', NULL, 0, 0, 0, 'Castleview Hospital', 'Castleview Hospital', NULL, NULL, 'HCFA|UB|', '1073620324', 0, 'N', 0, '2014-02-24', NULL, NULL, 40.5142, -107.56, NULL, NULL),
('743061661', 'W12008719', 'W12008719', 'UT01', '', 'Timothy', '', 'Byers', 'MD', 'Ophthalmology', '', '', NULL, 'B', '200 N Fairgrounds Rd', 'Price', 'Carbon', 'UT', '84501', '4352599411', NULL, '200 N Fairgrounds Rd', 'Price', 'Carbon', 'UT', '84501', '4352599411', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-05-01', NULL, 0, 0, 0, 'Castleview Hospital', 'Castleview Hospital', NULL, NULL, 'HCFA|UB|', '1073620324', 0, 'N', 0, '2014-01-29', NULL, NULL, 0, 0, NULL, NULL),
('743061661', 'W12008720', 'W12008720', 'UT01', 'San Juan Vision Clinic', 'Timothy', '', 'Byers', 'MD', 'Ophthalmology', '', '', NULL, 'O', '46 N Main St', 'Blanding', 'San Juan', 'UT', '84511', '4356782324', NULL, '46 N Main St', 'Blanding', 'San Juan', 'UT', '84511', '4356782324', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-05-01', NULL, 0, 0, 0, 'Castleview Hospital', 'Castleview Hospital', NULL, NULL, 'HCFA|UB|', '1073620324', 0, 'N', 0, '2014-01-29', NULL, NULL, 37.6261, -109.478, NULL, NULL),
('743061661', 'W12008716', 'W12008716', 'UT01', '', 'Timothy', '', 'Byers', 'MD', 'Ophthalmology', '', '', NULL, 'O', '471 S Main', 'Moab', 'Grand', 'UT', '84532', '4352599411', NULL, '471 S Main', 'Moab', 'Grand', 'UT', '84532', '4352599411', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-05-01', NULL, 0, 0, 0, 'Castleview Hospital', 'Castleview Hospital', NULL, NULL, 'HCFA|UB|', '1073620324', 0, 'N', 0, '2014-01-29', NULL, NULL, 38.5666, -109.551, NULL, NULL),
('743061661', 'W12008717', 'W12008717', 'UT01', 'Allen Memorial Hospital', 'Timothy', '', 'Byers', 'MD', 'Ophthalmology', '', '', NULL, 'O', '719 W 400 N', 'Moab', 'Grand', 'UT', '84532', '4352597191', NULL, '719 W 400 N', 'Moab', 'Grand', 'UT', '84532', '4352597191', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-05-01', NULL, 0, 0, 0, 'Castleview Hospital', 'Castleview Hospital', NULL, NULL, 'HCFA|UB|', '1073620324', 0, 'N', 0, '2014-01-29', NULL, NULL, 38.5794, -109.565, NULL, NULL),
('743061661', 'W12008723', 'W12008723', 'UT01', 'Northwest Eyecare Center', 'Timothy', '', 'Byers', 'MD', 'Ophthalmology', '', '', NULL, 'O', '750 Hospital Loop Rd', 'Craig', 'Moffat', 'CO', '81625', '9708249411', '9708248132', '750 Hospital Loop Rd', 'Craig', 'Moffat', 'CO', '81625', '9708249411', '9708248132', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-05-01', '2030-01-01', 0, 0, 0, 'Castleview Hospital', 'Castleview Hospital', NULL, NULL, 'HCFA|UB|', '1073620324', 0, 'Y', 0, '2014-01-29', NULL, NULL, 40.5119, -107.687, NULL, NULL),
('743061661', 'W12008721', 'W12008721', 'UT01', '', 'Timothy', '', 'Byers', 'MD', 'Ophthalmology', '', '', NULL, 'O', '802 S 200 W', 'Blanding', 'San Juan', 'UT', '84511', '4356783993', NULL, '802 S 200 W', 'Blanding', 'San Juan', 'UT', '84511', '4356783993', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-05-01', NULL, 0, 0, 0, 'Castleview Hospital', 'Castleview Hospital', NULL, NULL, 'HCFA|UB|', '1073620324', 0, 'N', 0, '2014-01-29', NULL, NULL, 37.6098, -109.479, NULL, NULL),
('743061661', 'W12008718', 'W12008718', 'UT01', '', 'Timothy', '', 'Byers', 'MD', 'Ophthalmology', '', '', NULL, 'M', '811 N 400 E', 'Price', 'Carbon', 'UT', '84501', '4352599411', NULL, '811 N 400 E', 'Price', 'Carbon', 'UT', '84501', '4352599411', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-05-01', NULL, 0, 0, 0, 'Castleview Hospital', 'Castleview Hospital', NULL, NULL, 'HCFA|UB|', '1073620324', 0, 'N', 0, '2014-01-29', NULL, NULL, 0, 0, NULL, NULL),
('264827902', 'W12008725', 'W12008725', 'ID01', 'Remedy Counseling Center', 'Melanie', 'T', 'Twite', 'LCPC', 'Mental Health', 'Counseling', '', NULL, 'O', '750 W Ustick Rd Ste 120', 'Meridian', 'Ada', 'ID', '83646', '2083404181', '2083661602', '750 W Ustick Rd Ste 120', 'Meridian', 'Ada', 'ID', '83646', '2083404181', '2083661602', 'IDMA', '', '', '0.00', '35.00', '0.00', 6, '2011-03-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1851510531', 0, 'N', 0, '2013-07-24', NULL, NULL, 0, 0, NULL, NULL),
('870550275', 'W12008728', 'W12008728', 'UT01', 'Wasatch Pediatrics Inc', 'Nathanael ', 'W', 'Ridge', 'PHD', 'Pediatrics', '', '', NULL, 'O', '5770 S 250 E Ste 290', 'Murray', 'Salt Lake', 'UT', '84107', '8017478700', '8017478701', '5770 S 250 E Ste 290', 'Murray', 'Salt Lake', 'UT', '84107', '8017478700', '8017478701', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-04-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1134424641', 0, 'N', 0, '2014-03-05', NULL, NULL, 40.6452, -111.884, NULL, NULL),
('870550275', 'W12008729', 'W12008729', 'UT01', 'Wasatch Pediatrics Inc', 'Nathanael ', 'W', 'Ridge', 'PHD', 'Pediatrics', '', '', NULL, 'O', '9071 S 1300 W Ste 301', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015651162', '8015651168', '9071 S 1300 W Ste 301', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015651162', '8015651168', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-04-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1134424641', 0, 'N', 0, '2013-12-27', NULL, NULL, 40.5864, -111.929, NULL, NULL),
('870550275', 'W12008730', 'W12008730', 'UT01', 'Wasatch Pediatrics Inc', 'Nathanael ', 'W', 'Ridge', 'PHD', 'Pediatrics', '', '', NULL, 'B', 'PO Box 71550', 'Salt Lake City', 'Salt Lake', 'UT', '84171', '8019470830', '8019470864', 'PO Box 71550', 'Salt Lake City', 'Salt Lake', 'UT', '84171', '8019470830', '8019470864', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-04-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1134424641', 0, 'N', 0, '2013-12-27', NULL, NULL, 0, 0, NULL, NULL),
('270285894', 'W12008136', 'W12008136', 'TX01', 'Mind Works', 'Erin', 'R', 'Porche', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '8207 Callaghan Rd Ste 240', 'San Antonio', 'Bexar', 'TX', '78230', '2103663700', '2103663700', '8207 Callaghan Rd Ste 240', 'San Antonio', 'Bexar', 'TX', '78230', '2103663700', '2103663700', 'TXMA', '', '', '0.00', '100.00', '0.00', 6, '2011-03-01', '2011-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1912210428', 0, 'N', 0, '2014-04-23', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W12008724', 'W12008724', 'UT01', 'Central Utah Clinic PC', '', '', 'Central Utah Clinic PC', 'GROUP', '', '', '', 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, '2011-03-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000005619', 0, 'Y', 0, '2014-07-22', NULL, NULL, 0, 0, NULL, NULL),
('061506129', 'W12008731', 'W12008731', 'UT01', 'Wee Care Pediatrics', 'Brad', '', 'Pace', 'PA', 'Family Practice', '', '', NULL, 'O', '5991 S 3500 W Ste 100', 'Roy', 'Weber', 'UT', '84067', '8017738644', '8019850486', '5991 S 3500 W Ste 100', 'Roy', 'Weber', 'UT', '84067', '8017738644', '8019850486', 'WUSTDPEDE5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-03-01', NULL, 0, 0, 0, 'Bear River Valley Hospital', 'Davis Hospital', NULL, NULL, 'HCFA|UB|', '1275530156', 0, 'N', 0, '2013-11-12', NULL, NULL, 41.1545, -112.064, NULL, NULL),
('061506129', 'W12008732', 'W12008732', 'UT01', 'Wee Care Pediatrics', 'Brad', '', 'Pace', 'PA', 'Family Practice', '', '', NULL, 'O', '1792 W 1700 S Ste 102', 'Syracuse', 'Davis', 'UT', '84075', '8017738644', '8018254161', '1792 W 1700 S Ste 102', 'Syracuse', 'Davis', 'UT', '84075', '8017738644', '8018254161', 'WUSTDPEDE5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-03-01', NULL, 0, 0, 0, 'Bear River Valley Hospital', 'Davis Hospital', NULL, NULL, 'HCFA|UB|', '1275530156', 0, 'N', 0, '2013-11-12', NULL, NULL, 41.0891, -112.061, NULL, NULL),
('262072378', 'W12008734', 'W12008734', 'UT01', 'Valley Obstetrics & Gynecology PC', 'Heidi ', '', 'McSweeney', 'NP', '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', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2030-01-01', '2030-01-01', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1063538775', 0, 'Y', 0, '2013-04-01', NULL, NULL, 0, 0, NULL, NULL),
('262072378', 'W12008733', 'W12008733', 'UT01', 'Valley Obstetrics & Gynecology PC', 'Heidi ', '', 'McSweeney', 'NP', 'Obstetrics and Gynecology', '', '', NULL, 'O', '700 W 800 N Ste 200', 'Orem', 'Utah', 'UT', '84057', '8017569635', '8012168357', '700 W 800 N Ste 200', 'Orem', 'Utah', 'UT', '84057', '8017569635', '8012168357', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-05-01', '2013-05-31', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1063538775', 0, 'N', 0, '2013-06-03', NULL, NULL, 0, 0, NULL, NULL),
('870284475', 'W12008735', 'W12008735', 'UT01', 'Granger Medical Clinic', 'Qamar', 'R', 'Khan', 'DO', 'Physical Medicine and Rehabilitation', 'Pain Management', '', NULL, 'O', '2376 N 400 E Ste 203', 'Tooele', 'Tooele', 'UT', '84074', '8019653634', '8019653467', '2376 N 400 E Ste 203', 'Tooele', 'Tooele', 'UT', '84074', '8019653634', '8019653467', 'WUGRANGER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-03-01', '2013-01-15', 0, 0, 0, 'Pioneer Valley Hospital', '', '', '', 'HCFA|UB|', '1407026420', 0, 'N', 0, '2013-11-04', NULL, NULL, 0, 0, NULL, NULL),
('742152396', 'W12008736', 'W12008736', 'UT01', 'KCI USA Inc (Wound Vac Only)', '', '', 'KCI USA Inc. ', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', '1761 S 900 W', 'Salt Lake City', 'Salt Lake', 'UT', '84104', '8002754524', NULL, '1761 S 900 W', 'Salt Lake City', 'Salt Lake', 'UT', '84104', '8002754524', '          ', 'KCI', '', '', '0.00', '100.00', '0.00', 3, '2011-03-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1366439507', 0, 'N', 0, '2013-03-12', NULL, NULL, 0, 0, NULL, NULL),
('262072378', 'W12008738', 'W12008738', 'UT01', 'Valley Obstetrics & Gynecology PC', 'Christy', '', 'Jorgensen', 'NP', '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', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-09-01', '2013-05-31', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1699927418', 0, 'N', 0, '2013-06-03', NULL, NULL, 0, 0, NULL, NULL),
('262072378', 'W12008737', 'W12008737', 'UT01', 'Valley Obstetrics & Gynecology PC', 'Christy', '', 'Jorgensen', 'NP', 'Obstetrics and Gynecology', '', '', NULL, 'O', '700 W 800 N Ste 200', 'Orem', 'Utah', 'UT', '84057', '8014344443', '8012168357', '700 W 800 N Ste 200', 'Orem', 'Utah', 'UT', '84057', '8014344443', '8012168357', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-09-01', '2013-05-31', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1699927418', 0, 'N', 0, '2013-06-03', NULL, NULL, 0, 0, NULL, NULL),
('270285894', 'W12008043', 'W12008043', 'TX01', 'Mind Works', 'Tammy ', 'F', 'Hicks', 'LPC', 'Mental Health', '', '', NULL, 'O', '8207 Callaghan Rd Ste 240', 'San Antonio', 'Bexar', 'TX', '78230', '2103663700', '2103663700', '8207 Callaghan Rd Ste 240', 'San Antonio', 'Bexar', 'TX', '78230', '2103663700', '2103663700', 'TXMA', '', '', '0.00', '100.00', '0.00', 6, '2011-03-01', '2011-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1306172317', 0, 'N', 0, '2013-10-15', NULL, NULL, 0, 0, NULL, NULL),
('530421292', 'W12008741', 'W12008741', 'UTMH1', 'Riverwoods Behavioral  Health', 'Patricia', '', 'Henrie', 'CMHC', 'Mental Health', 'Counseling', '', NULL, 'O', '280 W  River Park Dr Ste 350', 'Provo', 'Utah', 'UT', '84604', '8017879855', NULL, '280 W  River Park Dr Ste 350', 'Provo', 'Utah', 'UT', '84604', '8017879855', '', 'UTPHD', '', '', '0.00', '35.00', '0.00', 3, '2011-01-27', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1407917537', 0, 'N', 0, '2014-07-14', NULL, NULL, 0, 0, NULL, NULL),
('530421292', 'W12008740', 'W12008740', 'UTMH1', 'Riverwoods Behavioral  Health', 'Patricia', '', 'Henrie', 'CMHC', 'Mental Health', 'Counseling', '', NULL, 'B', 'PO Box 970392', 'Orem', 'Utah', 'UT', '84097', '8017879855', NULL, 'PO Box 970392', 'Orem', 'Utah', 'UT', '84097', '8017879855', '', 'UTPHD', '', '', '0.00', '35.00', '0.00', 3, '2011-01-27', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1407917537', 0, 'Y', 0, '2014-07-14', NULL, NULL, 0, 0, NULL, NULL),
('529503331', 'W12008742', 'W12008742', 'UT01', 'Kings Medical Imaging', 'Gary', 'L', 'Halversen', 'MD', 'Diagnostic Radiology', 'Radiology', '', NULL, 'B', 'Dept 1384', 'Denver', 'Denver', 'CO', '80256', '8012889671', NULL, 'Dept 1384', 'Denver', 'Denver', 'CO', '80256', '8012889671', '          ', 'WUSTDRAD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-12-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1740286970', 0, 'Y', 0, '2013-11-14', NULL, NULL, 0, 0, NULL, NULL),
('870520350', 'W12007011', 'W12007011', 'UT01', '', 'Thomas', 'M', 'Malin', 'DC', 'Chiropractic', '', '', NULL, 'O', '291 E 4500 S Ste C', 'Murray', 'Salt Lake', 'UT', '84107', '8012641235', '8012641805', '291 E 4500 S Ste C', 'Murray', 'Salt Lake', 'UT', '84107', '8012641235', '8012641805', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.45', 3, '2011-01-01', '2012-07-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1760430359', 0, 'N', 0, '2014-04-14', NULL, NULL, 0, 0, NULL, NULL),
('810608733', 'W12007896', 'W12007896', 'UT01', 'Nexus Pain Care', 'Syed', 'R', 'Ahmed', 'DO', 'Physical Medicine and Rehabilitation', '', '', NULL, 'O', '1575 W 7000 S', 'West Jordan', 'Salt Lake', 'UT', '84084', '8018336569', NULL, '1575 W 7000 S', 'West Jordan', 'Salt Lake', 'UT', '84084', '8018336569', '          ', 'WUSTDPAIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-04-01', '2014-01-27', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1891993176', 0, 'N', 0, '2014-01-31', NULL, NULL, 0, 0, NULL, NULL),
('810608733', 'W12007895', 'W12007895', 'UT01', 'Nexus Pain Care', 'Syed', 'R', 'Ahmed', 'DO', 'Physical Medicine and Rehabilitation', '', '', NULL, 'O', '3336 S Pioneer Pkwy Ste 201', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8018657428', NULL, '3336 S Pioneer Pkwy Ste 201', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8018657428', '          ', 'WUSTDPAIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-04-01', '2011-11-15', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1891993176', 0, 'N', 0, '2011-11-18', NULL, NULL, 0, 0, NULL, NULL),
('810608733', 'W12007894', 'W12007894', 'UT01', 'Nexus Pain Care', 'Syed', 'R', 'Ahmed', 'DO', 'Physical Medicine and Rehabilitation', '', '', NULL, 'M', '3585 N University Ave Ste 150', 'Provo', 'Utah', 'UT', '84604', '8013566100', NULL, '3585 N University Ave Ste 150', 'Provo', 'Utah', 'UT', '84604', '8013566100', '          ', 'WUSTDPAIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-04-01', '2014-01-27', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1891993176', 0, 'N', 0, '2014-01-31', NULL, NULL, 0, 0, NULL, NULL),
('810608733', 'W12007897', 'W12007897', 'UT01', 'Nexus Pain Care', 'Syed', 'R', 'Ahmed', 'DO', 'Physical Medicine and Rehabilitation', '', '', NULL, 'B', 'PO Box 15109', 'Springfield', 'Hampden', 'MA', '01115', '8772733100', NULL, 'PO Box 15109', 'Springfield', 'Hampden', 'MA', '01115', '8772733100', '          ', 'WUSTDPAIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-04-01', '2014-01-27', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1891993176', 0, 'N', 0, '2014-01-31', NULL, NULL, 0, 0, NULL, NULL),
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('810608733', 'W12008107', 'W12008107', 'UT01', 'Nexus Pain Care', 'Rebeca ', 'M', 'Monreal', 'DO', 'Physical Medicine and Rehabilitation', '', '', NULL, 'B', 'PO Box 15109', 'Springfield', 'Hampden', 'MA', '01115', '8772733100', NULL, 'PO Box 15109', 'Springfield', 'Hampden', 'MA', '01115', '8772733100', '          ', 'WUSTDPAIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-04-01', '2014-01-27', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1144428079', 0, 'N', 0, '2014-01-31', NULL, NULL, 0, 0, NULL, NULL),
('270285894', 'W12008004', 'W12008004', 'TX01', 'Mind Works', 'Mary', 'A', 'Dom', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '8207 Callaghan Rd Ste 240', 'San Antonio', 'Bexar', 'TX', '78230', '2103663700', '2103663700', '8207 Callaghan Rd Ste 240', 'San Antonio', 'Bexar', 'TX', '78230', '2103663700', '2103663700', 'TXMA', '', '', '0.00', '100.00', '0.00', 6, '2011-02-03', '2011-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1356507586', 0, 'N', 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
('870609622', 'W12008746', 'W12008746', 'UT01', 'Snow Canyon Clinic', 'Robert', 'H', 'Lemon', 'MD', 'Oncology', 'Hematology and Oncology', '', NULL, 'O', '110 W 1325 N Ste 200', 'Cedar City', 'Iron', 'UT', '84721', '4359862300', NULL, '110 W 1325 N Ste 200', 'Cedar City', 'Iron', 'UT', '84721', '4359862300', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-03-15', '2011-08-15', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1992867147', 0, 'N', 0, '2013-04-25', NULL, NULL, 0, 0, NULL, NULL),
('870609622', 'W12008747', 'W12008747', 'UT01', 'Snow Canyon Clinic', 'Gary', 'L', 'Jones', 'MD', 'Neurology', '', '', NULL, 'O', '110 W 1325 N Ste 200', 'Cedar City', 'Iron', 'UT', '84721', '4359862300', '          ', '110 W 1325 N Ste 200', 'Cedar City', 'Iron', 'UT', '84721', '4359862300', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-03-15', '2014-02-25', 0, 0, 0, 'Dixie Regional Medical Center', '', '', '', 'HCFA|UB|', '1770540619', 0, 'N', 0, '2014-05-21', NULL, NULL, 37.7011, -113.064, NULL, NULL),
('870609622', 'W12008748', 'W12008748', 'UT01', 'Snow Canyon Clinic', 'Vernon', 'H', 'Kirk', 'MD', 'Neurology', 'Sleep Medicine', '', NULL, 'O', '110 W 1325 N Ste 200', 'Cedar City', 'Iron', 'UT', '84721', '4359862300', NULL, '110 W 1325 N Ste 200', 'Cedar City', 'Iron', 'UT', '84721', '4359862300', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-03-15', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1750343372', 0, 'N', 0, '2012-06-25', NULL, NULL, 37.7011, -113.064, NULL, NULL),
('870609622', 'W12008749', 'W12008749', 'UT01', 'Snow Canyon Clinic', 'Laura', 'J', 'Schlagel', 'MD', 'Neurology', '', '', NULL, 'O', '110 W 1325 N Ste 200', 'Cedar City', 'Iron', 'UT', '84721', '4359862300', NULL, '110 W 1325 N Ste 200', 'Cedar City', 'Iron', 'UT', '84721', '4359862300', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-03-15', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1306803226', 0, 'N', 0, '2013-07-08', NULL, NULL, 37.7011, -113.064, NULL, NULL),
('870609622', 'W12008750', 'W12008750', 'UT01', 'Snow Canyon Clinic', 'John', 'G', 'Schmidt', 'MD', 'Neurology', NULL, NULL, NULL, 'O', '110 W 1325 N Ste 200', 'Cedar City', 'Iron', 'UT', '84721', '4359862300', NULL, '110 W 1325 N Ste 200', 'Cedar City', 'Iron', 'UT', '84721', '4359862300', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-03-15', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1295786507', 0, 'N', 0, '2013-10-24', NULL, NULL, 37.7011, -113.064, NULL, NULL),
('870609622', 'W12008751', 'W12008751', 'UT01', 'Snow Canyon Clinic', 'Carl', 'P', 'Hallenborg', 'MD', 'Pulmonary', 'Sleep Medicine', '', NULL, 'O', '110 W 1325 N Ste 200', 'Cedar City', 'Iron', 'UT', '84721', '4359862300', NULL, '110 W 1325 N Ste 200', 'Cedar City', 'Iron', 'UT', '84721', '4359862300', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-03-15', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1508978651', 0, 'N', 0, '2012-06-25', NULL, NULL, 37.7011, -113.064, NULL, NULL),
('263744367', 'W12008755', 'W12008755', 'UT01', 'Jenco Prosthetics and Orthotics ', '', '', 'Jenco Prosthetics and Orthotics LLC', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', '1153 N Main St Ste B-140', 'Logan', 'Cache', 'UT', '84341', '4357506579', '8015665790', '1153 N Main St Ste B-140', 'Logan', 'Cache', 'UT', '84341', '4357506579', '8015665790', 'WUDME5', '', '', '0.00', '35.00', '0.00', 3, '2011-01-26', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009363', 0, 'N', 0, '2011-08-11', NULL, NULL, 41.753, -111.834, NULL, NULL),
('263744367', 'W12008754', 'W12008754', 'UT01', 'Jenco Prosthetics and Orthotics ', '', '', 'Jenco Prosthetics and Orthotics LLC', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', '7026 S Commerce Park Dr Ste 2', 'Midvale', 'Salt Lake', 'UT', '84047', '8015665795', '8015665790', '7026 S Commerce Park Dr Ste 2', 'Midvale', 'Salt Lake', 'UT', '84047', '8015665795', '8015665790', 'WUDME5', '', '', '0.00', '35.00', '0.00', 3, '2011-01-26', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009363', 0, 'N', 0, '2011-08-11', NULL, NULL, 0, 0, NULL, NULL),
('260553931', 'W12019246', 'W12019246', 'ID01', 'Saint Alphonsus Medical Group Heart Care Nampa', 'Michael', 'D', 'Hostetler', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1524 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2084635050', '2084635040', '1524 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2084635050', '2084635040', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-02-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1932155082', 0, 'Y', 0, '2014-07-09', NULL, NULL, 43.5533, -116.573, NULL, NULL),
('731714968', 'W12008756', 'W12008756', 'UT01', 'Rocky Mountain Anesthesiology', 'Krystal', 'M', 'Tipping', 'CRNA', 'Anesthesia', '', '', NULL, 'B', 'PO Box 3750', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8008803566', '8014322668', 'PO Box 3750', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8008803566', '8014322668', '', '', '', '0.00', '19.00', '0.00', 3, '2011-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1053551531', 0, 'N', 0, '2012-04-19', NULL, NULL, 0, 0, NULL, NULL),
('810608733', 'W12008757', 'W12008757', 'UT01', 'Nexus Pain Care', 'Syed', 'R', 'Ahmed', 'DO', 'Physical Medicine and Rehabilitation', '', '', NULL, 'O', '377 N Fairgrounds Rd', 'Price', 'Carbon', 'UT', '84501', '4356309297', NULL, '377 N Fairgrounds Rd', 'Price', 'Carbon', 'UT', '84501', '4356309297', '          ', 'WUSTDPAIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-04-01', '2014-01-27', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1891993176', 0, 'N', 0, '2014-01-31', NULL, NULL, 0, 0, NULL, NULL),
('810608733', 'W12008758', 'W12008758', 'UT01', 'Nexus Pain Care', 'Syed', 'R', 'Ahmed', 'DO', 'Physical Medicine and Rehabilitation', '', '', NULL, 'O', '35 S 500 E', 'Heber City', 'Wasatch', 'UT', '84032', '4356029259', NULL, '35 S 500 E', 'Heber City', 'Wasatch', 'UT', '84032', '4356029259', '          ', 'WUSTDPAIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-04-01', '2011-11-15', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1891993176', 0, 'N', 0, '2011-11-18', NULL, NULL, 0, 0, NULL, NULL),
('810608733', 'W12008759', 'W12008759', 'UT01', 'Nexus Pain Care', 'Rebeca ', 'M', 'Monreal', 'DO', 'Physical Medicine and Rehabilitation', '', '', NULL, 'O', '3336 S Pioneer Pkwy Ste 201', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8018657428', NULL, '3336 S Pioneer Pkwy Ste 201', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8018657428', '          ', 'WUSTDPAIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-04-01', '2011-11-17', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1144428079', 0, 'N', 0, '2011-11-21', NULL, NULL, 0, 0, NULL, NULL),
('810608733', 'W12008760', 'W12008760', 'UT01', 'Nexus Pain Care', 'Rebeca ', 'M', 'Monreal', 'DO', 'Physical Medicine and Rehabilitation', '', '', NULL, 'O', '1575 W 7000 S', 'West Jordan', 'Salt Lake', 'UT', '84084', '8018336569', NULL, '1575 W 7000 S', 'West Jordan', 'Salt Lake', 'UT', '84084', '8018336569', '          ', 'WUSTDPAIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-04-01', '2014-01-27', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1144428079', 0, 'N', 0, '2014-01-31', NULL, NULL, 0, 0, NULL, NULL),
('810608733', 'W12008761', 'W12008761', 'UT01', 'Nexus Pain Care', 'Rebeca ', 'M', 'Monreal', 'DO', 'Physical Medicine and Rehabilitation', '', '', NULL, 'O', '377 N Fairgrounds Rd', 'Price', 'Carbon', 'UT', '84501', '4356309297', NULL, '377 N Fairgrounds Rd', 'Price', 'Carbon', 'UT', '84501', '4356309297', '          ', 'WUSTDPAIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-04-01', '2014-01-27', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1144428079', 0, 'N', 0, '2014-01-31', NULL, NULL, 0, 0, NULL, NULL),
('810608733', 'W12008762', 'W12008762', 'UT01', 'Nexus Pain Care', 'Rebeca ', 'M', 'Monreal', 'DO', 'Physical Medicine and Rehabilitation', '', '', NULL, 'O', '35 S 500 E', 'Heber City', 'Wasatch', 'UT', '84032', '4356029259', NULL, '35 S 500 E', 'Heber City', 'Wasatch', 'UT', '84032', '4356029259', '          ', 'WUSTDPAIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-04-01', '2011-11-17', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1144428079', 0, 'N', 0, '2011-11-21', NULL, NULL, 0, 0, NULL, NULL),
('810608733', 'W12008763', 'W12008763', 'UT01', 'Nexus Pain Care', 'Chad', 'E', 'Austin', 'MD', 'Physical Medicine and Rehabilitation', 'Pain Management', '', NULL, 'O', '3336 S Pioneer Pkwy Ste 201', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8018657428', NULL, '3336 S Pioneer Pkwy Ste 201', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8018657428', '          ', 'WUSTDPAIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-09-15', '2010-07-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1659581551', 0, 'N', 0, '2011-04-29', NULL, NULL, 0, 0, NULL, NULL),
('810608733', 'W12008764', 'W12008764', 'UT01', 'Nexus Pain Care', 'Chad', 'E', 'Austin', 'MD', 'Physical Medicine and Rehabilitation', 'Pain Management', '', NULL, 'O', '1575 W 7000 S', 'West Jordan', 'Salt Lake', 'UT', '84084', '8018336569', NULL, '1575 W 7000 S', 'West Jordan', 'Salt Lake', 'UT', '84084', '8018336569', '          ', 'WUSTDPAIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-09-15', '2010-07-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1659581551', 0, 'N', 0, '2011-04-29', NULL, NULL, 0, 0, NULL, NULL),
('810608733', 'W12008765', 'W12008765', 'UT01', 'Nexus Pain Care', 'Chad', 'E', 'Austin', 'MD', 'Physical Medicine and Rehabilitation', 'Pain Management', '', NULL, 'O', '377 N Fairgrounds Rd', 'Price', 'Carbon', 'UT', '84501', '4356309297', NULL, '377 N Fairgrounds Rd', 'Price', 'Carbon', 'UT', '84501', '4356309297', '          ', 'WUSTDPAIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-09-15', '2010-07-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1659581551', 0, 'N', 0, '2011-04-29', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12008768', 'W12008768', 'UTIHCPHY', 'Bountiful Clinic', 'John', 'E', 'Robison', 'MD', 'Dermatology', '', '', NULL, 'O', '390 N Main', 'Bountiful', 'Davis', 'UT', '84010', '8012941000', NULL, '390 N Main', 'Bountiful', 'Davis', 'UT', '84010', '8012941000', '          ', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2008-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1629187638', 0, 'N', 0, '2011-03-07', NULL, NULL, 40.8935, -111.881, NULL, NULL),
('841367175', 'W12008778', 'W12008778', 'UT01', 'Canyon View Medical Group', '', '', 'Canyon View Medical Group', 'Group', 'Family Practice', '', '', NULL, 'O', '325 N Ctr', 'Spanish Fork', 'Utah', 'UT', '84660', '8017987301', '8017988513', '325 N Ctr', 'Spanish Fork', 'Utah', 'UT', '84660', '8017987301', '8017988513', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-03-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1538194477', 0, 'Y', 0, '2014-04-21', NULL, NULL, 0, 0, NULL, NULL),
('800386273', 'W12008772', 'W12008772', 'UT01', 'Best Life Chiropractic PLLC', 'Blaine', 'A', 'Ford', 'DC', 'Chiropractic', '', '', NULL, 'O', '96 N Main St Ste 103', 'Cedar City', 'Iron', 'UT', '84720', '4358678986', '4358676233', '96 N Main St Ste 103', 'Cedar City', 'Iron', 'UT', '84720', '4358678986', '4358676233', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2011-03-01', '2012-07-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1457582694', 0, 'N', 0, '2013-10-08', NULL, NULL, 0, 0, NULL, NULL),
('841397698', 'W12008773', 'W12008773', 'UT01', 'Thomson Chiropractic', 'David', 'B', 'Thomson', 'DC', 'Chiropractic', '', '', NULL, 'O', '447 N 300 W Ste 6', 'Kaysville', 'Davis', 'UT', '84037', '8015476688', '8015476757', '447 N 300 W Ste 6', 'Kaysville', 'Davis', 'UT', '84037', '8015476688', '8015476757', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2011-03-01', '2011-04-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1902898927', 0, 'N', 0, '2011-08-05', NULL, NULL, 0, 0, NULL, NULL),
('263281909', 'W12008774', 'W12008774', 'UT01', 'Elevate Sports Medicine', 'Henry', 'D', 'Hunt', 'DPT', 'Physical Therapy', '', '', NULL, 'O', '147 W 400 N', 'Orem', 'Utah', 'UT', '84057', '8012219060', '8012219071', '147 W 400 N', 'Orem', 'Utah', 'UT', '84057', '8012219060', '8012219071', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '68.00', 3, '2010-10-01', '2011-03-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1598701773', 0, 'N', 0, '2011-07-18', NULL, NULL, 0, 0, NULL, NULL),
('870622425', 'W12008775', 'W12008775', 'UTIHC01', 'Human Performance Institute PC', 'Sharla', 'I', 'Natter', 'PT', 'Physical Therapy', '', '', NULL, 'O', '1184 E 80 N', 'American Fork', 'Utah', 'UT', '84003', '8017567777', '8017633890', '1184 E 80 N', 'American Fork', 'Utah', 'UT', '84003', '8017567777', '8017633890', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '68.00', 3, '2011-03-01', '2011-03-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1336454636', 0, 'N', 0, '2013-10-16', NULL, NULL, 0, 0, NULL, NULL),
('201746792', 'W12008777', 'W12008777', 'ID01', 'Idaho Orthotic and Prosthetic Services', '', '', 'Idaho Orthotic and Prosthetic Services', '', 'Durable Medical Equipment', '', '', NULL, 'O', '1859 S Topaz Way Ste 100', 'Meridian', 'Ada', 'ID', '83642', '2088841294', '          ', '1859 S Topaz Way Ste 100', 'Meridian', 'Ada', 'ID', '83642', '2088841294', '          ', 'DME90ID', '', '', '0.00', '35.00', '0.00', 3, '2011-03-08', '2014-03-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1801942354', 0, 'N', 0, '2014-05-15', NULL, NULL, 0, 0, NULL, NULL),
('870635889', 'W12008780', 'W12008780', 'UT01', 'Tooele Clinic Corp', 'Jeffrey ', 'D', 'Lee', 'MD', 'Family Practice', '', '', NULL, 'M', '7100 Commcerce Way Ste 180', 'Brentwood', 'Williamson', 'TN', '37027', '4358843578', NULL, '7100 Commcerce Way Ste 180', 'Brentwood', 'Williamson', 'TN', '37027', '4358843578', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-06-01', '2011-06-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1639221526', 0, 'N', 0, '2011-10-19', NULL, NULL, 0, 0, NULL, NULL),
('870635889', 'W12008779', 'W12008779', 'UT01', 'Tooele Clinic Corp', 'Jeffrey ', 'D', 'Lee', 'MD', 'Family Practice', '', '', NULL, 'O', '822 E Main St Ste 7', 'Grantsville', 'Tooele', 'UT', '84029', '4358843578', NULL, '822 E Main St Ste 7', 'Grantsville', 'Tooele', 'UT', '84029', '4358843578', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1639221526', 0, 'N', 0, '2011-10-19', NULL, NULL, 40.5996, -112.426, NULL, NULL),
('870635889', 'W12008781', 'W12008781', 'UT01', 'Tooele Clinic Corp', 'Jeffrey ', 'D', 'Lee', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 848416', 'Boston', 'Suffolk', 'MA', '02284', '4358843578', NULL, 'PO Box 848416', 'Boston', 'Suffolk', 'MA', '02284', '4358843578', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1639221526', 0, 'N', 0, '2011-10-19', NULL, NULL, 0, 0, NULL, NULL),
('371614424', 'W12008782', 'W12008782', 'UT01', 'Mountain West Surgery Center', '', '', 'Mountain West Surgery Center', '', 'Ambulatory Surgery Center', '', '', NULL, 'O', '1551 S Renaissance Towne Dr Ste 200', 'Bountiful', 'Davis', 'UT', '84010', '8013831111', NULL, '1551 S Renaissance Towne Dr Ste 200', 'Bountiful', 'Davis', 'UT', '84010', '8013831111', '          ', '', '', '', '0.00', '31.00', '0.00', 3, '2011-03-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1003119470', 0, 'N', 0, '2011-03-16', NULL, NULL, 40.8737, -111.888, NULL, NULL),
('371614424', 'W12008783', 'W12008783', 'UT01', '', '', '', 'Mountain West Surgery Center', '', 'Ambulatory Surgery Center', '', '', NULL, 'O', 'PO Box 741490', 'Atlanta', 'Fulton', 'GA', '30374', '8013831111', NULL, 'PO Box 741490', 'Atlanta', 'Fulton', 'GA', '30374', '8013831111', '          ', '', '', '', '0.00', '31.00', '0.00', 3, '2011-03-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1003119470', 0, 'N', 0, '2011-03-16', NULL, NULL, 0, 0, NULL, NULL),
('841367175', 'W12008785', 'W12008785', 'UT01', 'Canyon View Medical Group', 'John', 'N', 'Bennett', 'MD', 'Pediatrics', '', '', NULL, 'O', '325 W Ctr St', 'Spanish Fork', 'Utah', 'UT', '84660', '8017987301', NULL, '325 W Ctr St', 'Spanish Fork', 'Utah', 'UT', '84660', '8017987301', '          ', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-01-01', NULL, 0, 0, 0, 'Mountain View Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1508968777', 0, 'N', 0, '2011-03-07', NULL, NULL, 40.1099, -111.66, NULL, NULL),
('841367175', 'W12008786', 'W12008786', 'UT01', 'Canyon View Medical Group', 'Jared', 'L', 'Bingham', 'MD', 'Family Practice', '', '', NULL, 'O', '94 W Main', 'Santaquin', 'Utah', 'UT', '84655', '8017543122', NULL, '94 W Main', 'Santaquin', 'Utah', 'UT', '84655', '8017543122', '          ', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-01-01', NULL, 0, 0, 0, 'Mountain View Hospital', '', '', '', 'HCFA|UB|', '1932154200', 0, 'N', 0, '2013-09-13', NULL, NULL, 39.9756, -111.787, NULL, NULL),
('810608733', 'W12008787', 'W12008787', 'UT01', 'Nexus Pain Care', 'Michael', 'M', 'Chen', 'DO', 'Physical Medicine and Rehabilitation', '', '', NULL, 'O', '3336 S Pioneer Pkwy Ste 201', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8018657428', NULL, '3336 S Pioneer Pkwy Ste 201', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8018657428', '          ', 'WUSTDPAIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', '2008-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1487711123', 0, 'N', 0, '2011-04-29', NULL, NULL, 0, 0, NULL, NULL),
('810608733', 'W12008788', 'W12008788', 'UT01', 'Nexus Pain Care', 'Michael', 'M', 'Chen', 'DO', 'Physical Medicine and Rehabilitation', '', '', NULL, 'O', '1575 W 7000 S', 'West Jordan', 'Salt Lake', 'UT', '84084', '8018336569', NULL, '1575 W 7000 S', 'West Jordan', 'Salt Lake', 'UT', '84084', '8018336569', '          ', 'WUSTDPAIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', '2008-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1487711123', 0, 'N', 0, '2011-04-29', NULL, NULL, 0, 0, NULL, NULL),
('810608733', 'W12008790', 'W12008790', 'UT01', 'Nexus Pain Care', 'Michael', 'M', 'Chen', 'DO', 'Physical Medicine and Rehabilitation', '', '', NULL, 'O', '377 N Fairgrounds Rd', 'Price', 'Carbon', 'UT', '84501', '4356309297', NULL, '377 N Fairgrounds Rd', 'Price', 'Carbon', 'UT', '84501', '4356309297', '          ', 'WUSTDPAIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', '2008-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1487711123', 0, 'N', 0, '2011-04-29', NULL, NULL, 0, 0, NULL, NULL),
('810608733', 'W12008791', 'W12008791', 'UT01', 'Nexus Pain Care', 'Michael', 'M', 'Chen', 'DO', 'Physical Medicine and Rehabilitation', '', '', NULL, 'O', '35 S 500 E', 'Heber City', 'Wasatch', 'UT', '84032', '4356029259', NULL, '35 S 500 E', 'Heber City', 'Wasatch', 'UT', '84032', '4356029259', '          ', 'WUSTDPAIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', '2008-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1487711123', 0, 'N', 0, '2011-04-29', NULL, NULL, 0, 0, NULL, NULL),
('810608733', 'W12008792', 'W12008792', 'UT01', 'Nexus Pain Care', 'James', 'H', 'Cloyd', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '3336 S Pioneer Pkwy Ste 201', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8018657428', NULL, '3336 S Pioneer Pkwy Ste 201', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8018657428', '', 'WUSTDPAIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-10-25', '2011-11-15', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1750450953', 0, 'N', 0, '2014-06-04', NULL, NULL, 0, 0, NULL, NULL),
('810608733', 'W12008793', 'W12008793', 'UT01', 'Nexus Pain Care', 'James', 'H', 'Cloyd', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '1575 W 7000 S', 'West Jordan', 'Salt Lake', 'UT', '84084', '8018336569', NULL, '1575 W 7000 S', 'West Jordan', 'Salt Lake', 'UT', '84084', '8018336569', '', 'WUSTDPAIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-10-25', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1750450953', 0, 'N', 0, '2014-06-04', NULL, NULL, 40.6241, -111.936, NULL, NULL),
('810608733', 'W12008794', 'W12008794', 'UT01', 'Nexus Pain Care', 'James', 'H', 'Cloyd', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '377 N Fairgrounds Rd', 'Price', 'Carbon', 'UT', '84501', '4356309297', NULL, '377 N Fairgrounds Rd', 'Price', 'Carbon', 'UT', '84501', '4356309297', '', 'WUSTDPAIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-10-25', '2014-01-27', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1750450953', 0, 'N', 0, '2014-06-04', NULL, NULL, 0, 0, NULL, NULL),
('810608733', 'W12008795', 'W12008795', 'UT01', 'Nexus Pain Care', 'James', 'H', 'Cloyd', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '35 S 500 E', 'Heber City', 'Wasatch', 'UT', '84032', '4356029259', NULL, '35 S 500 E', 'Heber City', 'Wasatch', 'UT', '84032', '4356029259', '', 'WUSTDPAIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-10-25', '2011-11-15', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1750450953', 0, 'N', 0, '2014-06-04', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W12008796', 'W12008796', 'UT01', 'Comprehensive Orthopedic and Sports Medicine', 'David', 'J', 'Howe', 'MD', 'Orthopedic Surgery', NULL, NULL, NULL, 'O', '82 S 1100 E Ste 303', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015332002', '8013239546', '82 S 1100 E Ste 303', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015332002', '8013239546', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-03-01', '2014-04-30', 0, 0, 0, 'Salt Lake Regional Medical Center', 'St Marks Hospital', NULL, NULL, 'HCFA|UB|', '1578667226', 0, 'N', 0, '2014-04-04', NULL, NULL, 40.7676, -111.86, NULL, NULL),
('621801973', 'W12008797', 'W12008797', 'UT01', 'Comprehensive Orthopedic and Sports Medicine', 'David', 'J', 'Howe', 'MD', 'Orthopedic Surgery', NULL, NULL, NULL, 'O', '9350 S 150 E Ste 460', 'Sandy', 'Salt Lake', 'UT', '84070', '8015332002', '8013239546', '9350 S 150 E Ste 460', 'Sandy', 'Salt Lake', 'UT', '84070', '8015332002', '8013239546', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-03-01', '2014-04-30', 0, 0, 0, 'Salt Lake Regional Medical Center', 'St Marks Hospital', NULL, NULL, 'HCFA|UB|', '1578667226', 0, 'N', 0, '2014-04-04', NULL, NULL, 40.5814, -111.887, NULL, NULL),
('621801973', 'W12008798', 'W12008798', 'UT01', 'Comprehensive Orthopedic and Sports Medicine', 'David', 'J', 'Howe', 'MD', 'Orthopedic Surgery', NULL, NULL, NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-03-01', '2014-04-30', 0, 0, 0, 'Salt Lake Regional Medical Center', 'St Marks Hospital', NULL, NULL, 'HCFA|UB|', '1578667226', 0, 'N', 0, '2014-04-04', NULL, NULL, 0, 0, NULL, NULL),
('841375365', 'W12008801', 'W12008801', 'UT01', 'Canyon Rim Physical Therapy', 'Cynthia', 'S', 'Peterson', 'PT', 'Physical Therapy', '', '', NULL, 'O', '2295 S Foothill Blvd', 'Salt Lake City', 'Salt Lake', 'UT', '84109', '8014867542', '8014843110', '2295 S Foothill Blvd', 'Salt Lake City', 'Salt Lake', 'UT', '84109', '8014867542', '8014843110', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '68.00', 8, '2010-04-01', '2011-03-31', 1, 0, 0, '', '', '', '', 'HCFA|', '0000004152', 0, 'N', 0, '2014-07-15', NULL, NULL, 0, 0, NULL, NULL),
('870373083', 'W12008805', 'W12008805', 'UT01', 'Heart and Lung Institute of Utah Inc', 'William', 'M', 'Brann', 'MD', 'Internal Medicine', '', '', NULL, 'O', '3570 W 9000 S Ste 110', 'West Jordan', 'Salt Lake', 'UT', '84084', '8012632370', '8012651200', '3570 W 9000 S Ste 110', 'West Jordan', 'Salt Lake', 'UT', '84084', '8012632370', '8012651200', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-06-01', '2014-04-30', 0, 0, 0, 'Jordan Valley Medical Center', 'University Health Care University Hospital', 'Salt Lake Regional Medical Center', '', 'HCFA|UB|', '1912087826', 0, 'N', 0, '2014-07-25', NULL, NULL, 40.588, -111.975, NULL, NULL),
('870373083', 'W12008804', 'W12008804', 'UT01', 'Heart and Lung Institute of Utah Inc', 'William', 'M', 'Brann', 'MD', 'Internal Medicine', '', '', NULL, 'O', '5979 S Fashion Blvd', 'Murray', 'Salt Lake', 'UT', '84107', '8012632370', '8012651200', '5979 S Fashion Blvd', 'Murray', 'Salt Lake', 'UT', '84107', '8012632370', '8012651200', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-06-01', '2014-04-30', 0, 0, 0, 'Jordan Valley Medical Center', 'University Health Care University Hospital', 'Salt Lake Regional Medical Center', '', 'HCFA|UB|', '1912087826', 0, 'N', 0, '2014-07-25', NULL, NULL, 40.6415, -111.883, NULL, NULL),
('272118774', 'W12008808', 'W12008808', 'UT01', 'Advanced Spine and Pain Specialists', 'Vikas', '', 'Garg', 'MD', 'Pain Management', NULL, NULL, NULL, 'O', '196 Arrowhead Dr Ste 5', 'Evanston', 'Uinta', 'WY', '82930', '4357139681', '4357531201', '196 Arrowhead Dr Ste 5', 'Evanston', 'Uinta', 'WY', '82930', '4357139681', '4357531201', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-03-01', NULL, 0, 0, 0, 'Lakeview Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1104852599', 0, 'N', 0, '2013-11-13', NULL, NULL, 41.2435, -110.998, NULL, NULL),
('272118774', 'W12008809', 'W12008809', 'UT01', 'Advanced Spine and Pain Specialists', 'Vikas', '', 'Garg', 'MD', 'Pain Management', NULL, NULL, NULL, 'B', '274 N Main St', 'Logan', 'Cache', 'UT', '84341', '4357531600', '4357539521', '274 N Main St', 'Logan', 'Cache', 'UT', '84341', '4357531600', '4357539521', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-03-01', '2013-10-31', 0, 0, 0, 'Lakeview Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1104852599', 0, 'N', 0, '2013-11-13', NULL, NULL, 0, 0, NULL, NULL),
('272118774', 'W12008807', 'W12008807', 'UT01', 'Advanced Spine and Pain Specialists', 'Vikas', '', 'Garg', 'MD', 'Pain Management', '', '', NULL, 'O', '520 E Medical Dr Ste 100', 'Bountiful', 'Davis', 'UT', '84010', '8012996824', '8012996825', '520 E Medical Dr Ste 100', 'Bountiful', 'Davis', 'UT', '84010', '8012996824', '8012996825', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-03-01', NULL, 0, 0, 0, 'Lakeview Hospital', '', '', '', 'HCFA|UB|', '1104852599', 0, 'N', 0, '2014-07-23', NULL, NULL, 40.8873, -111.87, NULL, NULL),
('943295573', 'W12008814', 'W12008814', 'UT01', 'InfuSystem Inc', '', '', 'InfuSystem, Inc.', '', 'Durable Medical Equipment', '', '', NULL, 'B', '16886 Collections Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '8009629656', '2485461160', '16886 Collections Center Dr', 'Chicago', 'Cook', 'IL', '60693', '8009629656', '2485461160', 'DME95', '', '', '0.00', '40.00', '0.00', 3, '2011-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1790730596', 0, 'N', 1, '2011-03-09', NULL, NULL, 0, 0, NULL, NULL),
('943295573', 'W12008813', 'W12008813', 'UT01', 'InfuSystem Inc', '', '', 'InfuSystem, Inc.', '', 'Durable Medical Equipment', '', '', NULL, 'O', '31700 Research Park Dr', 'Madison Heights', 'Oakland', 'MI', '48071', '8009629656', '2485461160', '31700 Research Park Dr', 'Madison Heights', 'Cook', 'MI', '48071', '8009629656', '2485461160', 'DME95', '', '', '0.00', '40.00', '0.00', 3, '2011-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1790730596', 0, 'N', 1, '2011-03-09', NULL, NULL, 0, 0, NULL, NULL),
('870629575', 'W12008815', 'W12008815', 'UT01', 'Central Utah Pathology', 'Blair', 'F', 'McGirk', 'MD', 'Pathology', '', '', NULL, 'B', 'PO Box 276', 'Midvale', 'Salt Lake', 'UT', '84047', '8012630810', NULL, 'PO Box 276', 'Midvale', 'Salt Lake', 'UT', '84047', '8012630810', '          ', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-03-09', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1093761595', 0, 'N', 0, '2011-06-29', NULL, NULL, 0, 0, NULL, NULL),
('274578060', 'W12008816', 'W12008816', 'UTMH1', '', 'Stephanie', '', 'Farnes', 'LMFT', 'Mental Health', 'Counseling', '', NULL, 'O', '2636 N Hillfield Rd Ste 5', 'Layton', 'Davis', 'UT', '84041', '8017191803', '8017797801', '2636 N Hillfield Rd Ste 5', 'Layton', 'Davis', 'UT', '84041', '8017191803', '8017797801', 'MA', '', '', '0.00', '35.00', '0.00', 3, '2011-01-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1114186202', 0, 'N', 0, '2014-07-22', NULL, NULL, 0, 0, NULL, NULL),
('200353976', 'W12008817', 'W12008817', 'UTMH1', 'Center for Stress Reduction', 'David', 'B', 'Tate', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '920 W 437 S Ste 202', 'St George', 'Washington', 'UT', '84770', '4356560506', '4356749380', '920 W 437 S Ste 202', 'St George', 'Washington', 'UT', '84770', '4356560506', '4356749380', 'PHD', '', '', '0.00', '35.00', '0.00', 3, '2011-03-08', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1093992711', 0, 'N', 0, '2014-06-16', NULL, NULL, 0, 0, NULL, NULL),
('841367175', 'W12008818', 'W12008818', 'UT01', 'Canyon View Womens Care', 'W', 'L', 'Warner', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '15 S 1000 E Ste 125', 'Payson', 'Utah', 'UT', '84651', '8014652559', NULL, '15 S 1000 E Ste 125', 'Payson', 'Utah', 'UT', '84651', '8014652559', '          ', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-01-01', NULL, 0, 0, 0, 'Mountain View Hospital', '', '', '', 'HCFA|UB|', '1508954348', 0, 'N', 0, '2013-07-31', NULL, NULL, 40.044, -111.716, NULL, NULL),
('841367175', 'W12008819', 'W12008819', 'UT01', 'Canyon View Medical Group', 'W', 'L', 'Warner', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '325 W Ctr St', 'Spanish Fork', 'Utah', 'UT', '84660', '8017987301', NULL, '325 W Ctr St', 'Spanish Fork', 'Utah', 'UT', '84660', '8017987301', '          ', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-01-01', NULL, 0, 0, 0, 'Mountain View Hospital', '', '', '', 'HCFA|UB|', '1508954348', 0, 'N', 0, '2013-07-31', NULL, NULL, 40.1099, -111.66, NULL, NULL),
('841367175', 'W12008820', 'W12008820', 'UT01', 'Canyon View Medical Group', 'Reed', 'J', 'Skinner', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '325 W Ctr St', 'Spanish Fork', 'Utah', 'UT', '84660', '8017987301', NULL, '325 W Ctr St', 'Spanish Fork', 'Utah', 'UT', '84660', '8017987301', '          ', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-01-01', NULL, 0, 0, 0, 'Mountain View Hospital', '', '', '', 'HCFA|UB|', '1427259415', 0, 'N', 0, '2013-07-31', NULL, NULL, 40.1099, -111.66, NULL, NULL),
('841367175', 'W12008821', 'W12008821', 'UT01', 'Canyon View Womens Care', 'Reed', 'J', 'Skinner', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '15 S 1000 E Ste 125', 'Payson', 'Utah', 'UT', '84651', '8014652559', NULL, '15 S 1000 E Ste 125', 'Payson', 'Utah', 'UT', '84651', '8014652559', '          ', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-01-01', NULL, 0, 0, 0, 'Mountain View Hospital', '', '', '', 'HCFA|UB|', '1427259415', 0, 'N', 0, '2013-07-31', NULL, NULL, 40.044, -111.716, NULL, NULL),
('841367175', 'W12008822', 'W12008822', 'UT01', 'Canyon View Womens Care', 'David', 'E', 'Ludlow', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '15 S 1000 E Ste 125', 'Payson', 'Utah', 'UT', '84651', '8014652559', NULL, '15 S 1000 E Ste 125', 'Payson', 'Utah', 'UT', '84651', '8014652559', '          ', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-01-01', NULL, 0, 0, 0, 'Mountain View Hospital', '', '', '', 'HCFA|UB|', '1104864412', 0, 'N', 0, '2013-07-31', NULL, NULL, 40.044, -111.716, NULL, NULL),
('841367175', 'W12008823', 'W12008823', 'UT01', 'Canyon View Medical Group', 'David', 'E', 'Ludlow', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '325 W Ctr St', 'Spanish Fork', 'Utah', 'UT', '84660', '8017987301', NULL, '325 W Ctr St', 'Spanish Fork', 'Utah', 'UT', '84660', '8017987301', '          ', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-01-01', NULL, 0, 0, 0, 'Mountain View Hospital', '', '', '', 'HCFA|UB|', '1104864412', 0, 'N', 0, '2013-07-31', NULL, NULL, 40.1099, -111.66, NULL, NULL),
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('201312583', 'W12008833', 'W12008833', '', 'Life Counseling Center', '', '', 'Life Counseling Center', '', 'Mental Health', '', '', NULL, '', 'Change', 'Nampa', 'Canyon', 'ID', '83686', '          ', NULL, 'Change', 'Nampa', 'Canyon', 'ID', '83686', '          ', '          ', '', '', '', '0.00', '0.00', '0.00', 6, '2008-09-09', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|DEN|', '0000002086', 0, 'Y', 0, '2013-07-24', NULL, NULL, 0, 0, NULL, NULL),
('942938348', 'W12008834', 'W12008834', 'UTMH1', 'Valley Mental Health', '', '', 'Valley Mental Health', '', 'Mental Health', '', '', NULL, '', 'Change', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8889494864', '          ', 'Change', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8889494864', '          ', '', '', '', '0.00', '0.00', '0.00', 6, '2008-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|DEN|', '0000002087', 0, 'Y', 0, '2014-07-21', NULL, NULL, 0, 0, NULL, NULL),
('820478504', 'W12008835', 'W12008835', 'ID01', 'Personal Solutions', '', '', 'Personal Solutions', '', 'Mental Health', '', '', NULL, '', 'Change', 'Meridian', 'Ada', 'ID', '83646', '          ', NULL, 'Change', 'Meridian', 'Ada', 'ID', '83646', '          ', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2008-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|DEN|', '0000002088', 0, 'Y', 0, '2012-10-22', NULL, NULL, 0, 0, NULL, NULL),
('592852900', 'W12008836', 'W12008836', '', 'Lincare Group Record', '', '', 'Lincare Group Record', '', 'Durable Medical Equipment', '', '', NULL, '', 'Change', '', '', '', '11111', '          ', NULL, 'Change', '', '', '', '11111', '          ', '          ', '', '', '', '0.00', '0.00', '0.00', 8, '2007-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|DEN|', '0000002085', 0, 'Y', 0, '2013-07-25', NULL, NULL, 0, 0, NULL, NULL),
('820500162', 'W12006611', 'W12006611', 'ID01', 'Anesthesiology Consultants of Idaho', '', '', 'Anesthesiology Consultants of Idaho', 'Group', 'Anesthesiology', '', '', NULL, 'B', '3633 Pacific Ave Ste 204', 'Tacoma', 'Pierce', 'WA', '98418', '2084671171', NULL, '3633 Pacific Ave Ste 204', 'Tacoma', 'Pierce', 'WA', '98418', '2084671171', '          ', '', '', '', '59.62', '0.00', '0.00', 3, '2010-12-01', NULL, 1, 15, 0, '', '', '', '', 'HCFA|UB|', '1093703340', 0, 'N', 0, '2013-09-18', NULL, NULL, 0, 0, NULL, NULL),
('820500162', 'W12006612', 'W12006612', 'ID01', 'Anesthesiology Consultants of Idaho', '', '', 'Anesthesiology Consultants of Idaho', 'Group', 'Anesthesiology', '', '', NULL, 'O', '1512 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2084671171', NULL, '1512 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2084671171', '          ', '', '', '', '59.62', '0.00', '0.00', 3, '2010-12-01', NULL, 1, 15, 0, '', '', '', '', 'HCFA|UB|', '1093703340', 0, 'N', 0, '2013-09-24', NULL, NULL, 43.5537, -116.573, NULL, NULL),
('820500162', 'W12008838', 'W12008838', 'ID01', 'Anesthesiology Consultants of ID', 'Randall', 'A', 'Black', 'DO', 'Anesthesia', '', '', NULL, 'B', '3633 Pacific Ave Ste 204', 'Tacoma', 'Pierce', 'WA', '98418', '2084671171', NULL, '3633 Pacific Ave Ste 204', 'Tacoma', 'Pierce', 'WA', '98418', '2084671171', '          ', '', '', '', '59.62', '0.00', '0.00', 3, '2011-03-03', '2011-03-03', 1, 15, 0, 'Saint Alphonsus Medical Center Nampa', NULL, NULL, NULL, 'HCFA|UB|', '1922028083', 0, 'N', 0, '2013-09-24', NULL, NULL, 0, 0, NULL, NULL),
('820500162', 'W12008840', 'W12008840', 'ID01', 'Anesthesiology Consultants of ID', 'Russell', 'D', 'Crawford', 'DO', 'Anesthesia', '', '', NULL, 'B', '3633 Pacific Ave Ste 204', 'Tacoma', 'Pierce', 'WA', '98418', '2084671171', NULL, '3633 Pacific Ave Ste 204', 'Tacoma', 'Pierce', 'WA', '98418', '2084671171', '          ', '', '', '', '59.62', '0.00', '0.00', 3, '2011-03-03', '2011-03-03', 1, 15, 0, 'Saint Alphonsus Medical Center Nampa', NULL, NULL, NULL, 'HCFA|UB|', '1609968635', 0, 'N', 0, '2013-09-24', NULL, NULL, 0, 0, NULL, NULL),
('870635889', 'W12008841', 'W12008841', 'UT01', 'Tooele Clinic Corp', 'Aaron', 'S', 'Elswood', 'PA', 'Family Practice', '', '', NULL, 'M', '7100 Commerce Way Ste 180', 'Brentwood', 'Williamson', 'TN', '37027', '4358843578', '', '7100 Commerce Way Ste 180', 'Brentwood', 'Williamson', 'TN', '37027', '4358843578', '', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-03-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1275619975', 0, 'N', 0, '2014-07-22', NULL, NULL, 0, 0, NULL, NULL),
('870658401', 'W12008842', 'W12008842', 'UT01', 'Timpanogos Family Medicine', 'Donald', 'N', 'Harline', 'MD', 'Family Practice', '', '', NULL, 'O', '423 N Orem Blvd', 'Orem', 'Utah', 'UT', '84057', '8014268141', '8014268142', '423 N Orem Blvd', 'Orem', 'Utah', 'UT', '84057', '8014268141', '8014268142', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-03-09', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1659305126', 0, 'N', 0, '2014-02-10', NULL, NULL, 40.3049, -111.701, NULL, NULL),
('272481635', 'W12008844', 'W12008844', 'ID02', 'Saint Alphonsus Medical Center - Nampa', 'Peter', '', 'Anderson', 'MD', 'Hospitalist', '', '', NULL, 'B', 'PO Box 60000', 'San Francisco', 'San Francisco', 'CA', '94160', '2536821710', NULL, 'PO Box 60000', 'San Francisco', 'San Francisco', 'CA', '94160', '2536821710', '          ', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-02-15', '2012-09-01', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1114967858', 0, 'N', 0, '2013-09-13', NULL, NULL, 0, 0, NULL, NULL),
('200197373', 'W12008846', 'W12008846', 'ID02', 'Pain Center Boise', 'William', 'G', 'Binegar', 'MD', 'Pain Management', '', '', NULL, 'B', 'MS 310096 PO Box 84686', 'Seattle', 'King', 'WA', '98124', '5033722740', '5033722754', 'MS 310096 PO Box 84686', 'Seattle', 'King', 'WA', '98124', '5033722740', '5033722754', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-03-14', '2011-03-14', 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1457393811', 0, 'Y', 0, '2011-06-29', NULL, NULL, 0, 0, NULL, NULL),
('820299231', 'W12008848', 'W12008848', 'ID02', 'Saltzer Medical Group', 'Daranee', 'S', 'Hatch', 'PT', 'Physical Therapy', '', '', NULL, 'B', '217 W Georgia Ave Ste 115', 'Nampa', 'Canyon', 'ID', '83686', '2084633280', '2082884987', '217 W Georgia Ave Ste 115', 'Nampa', 'Canyon', 'ID', '83686', '2084633280', '2082884987', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-03-03', '2012-12-31', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1649243015', 0, 'N', 0, '2013-02-21', NULL, NULL, 0, 0, NULL, NULL),
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('820299231', 'W12008854', 'W12008854', 'ID02', 'Saltzer Medical Group-Portico', 'Daranee', 'S', 'Hatch', 'PT', 'Physical Therapy', '', '', NULL, 'O', '3277 E Louise Dr Ste 200', 'Meridian', 'Ada', 'ID', '83642', '2084633000', '2082884987', '3277 E Louise Dr Ste 200', 'Meridian', 'Ada', 'ID', '83642', '2084633000', '2082884987', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-03-03', '2012-12-31', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1649243015', 0, 'N', 0, '2013-02-21', NULL, NULL, 0, 0, NULL, NULL),
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('820299231', 'W12008862', 'W12008862', 'ID02', 'Saltzer Medical Group- Caldwell', 'Rosemary', 'C', 'Howell', '', 'Physical Therapy', '', '', NULL, 'O', '1818 S 10th Ave Ste 120 or Ste 220', 'Caldwell', 'Canyon', 'ID', '83605', '2084633000', '2082884987', '1818 S 10th Ave Ste 120 or Ste 220', 'Caldwell', 'Canyon', 'ID', '83605', '2084633000', '2082884987', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-03-03', '2012-12-31', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1194033514', 0, 'N', 0, '2013-02-21', NULL, NULL, 43.6538, -116.693, NULL, NULL),
('820299231', 'W12008864', 'W12008864', 'ID02', 'Saltzer Medical Group', 'Rosemary', 'C', 'Howell', '', 'Physical Therapy', '', '', NULL, 'O', '215 E Hawaii Ave', 'Nampa', 'Canyon', 'ID', '83686', '2084633000', '2082884987', '215 E Hawaii Ave', 'Nampa', 'Canyon', 'ID', '83686', '2084633000', '2082884987', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-03-03', '2012-12-31', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1194033514', 0, 'N', 0, '2013-02-21', NULL, NULL, 0, 0, NULL, NULL),
('820299231', 'W12008865', 'W12008865', 'ID02', 'Saltzer Medical Group', 'Rosemary', 'C', 'Howell', '', 'Physical Therapy', '', '', NULL, 'B', '217 W Georgia Ave Ste 115', 'Nampa', 'Canyon', 'ID', '83686', '2084633280', '2082884987', '217 W Georgia Ave Ste 115', 'Nampa', 'Canyon', 'ID', '83686', '2084633280', '2082884987', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-03-03', '2012-12-31', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1194033514', 0, 'N', 0, '2013-02-21', NULL, NULL, 0, 0, NULL, NULL),
('820299231', 'W12008866', 'W12008866', 'ID02', 'Saltzer Medical Group Rehab', 'Rosemary', 'C', 'Howell', '', 'Physical Therapy', '', '', NULL, 'O', '290 W Georgia Ave', 'Nampa', 'Canyon', 'ID', '83686', '2084685970', '2082884987', '290 W Georgia Ave', 'Nampa', 'Canyon', 'ID', '83686', '2084685970', '2082884987', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-03-03', '2012-12-31', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1194033514', 0, 'N', 0, '2013-02-21', NULL, NULL, 0, 0, NULL, NULL),
('820299231', 'W12008867', 'W12008867', 'ID02', 'Saltzer Medical Group-Portico', 'Rosemary', 'C', 'Howell', '', 'Physical Therapy', '', '', NULL, 'O', '3277 E Louise Dr Ste 200', 'Meridian', 'Ada', 'ID', '83642', '2084633000', '2082884987', '3277 E Louise Dr Ste 200', 'Meridian', 'Ada', 'ID', '83642', '2084633000', '2082884987', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-03-03', '2012-12-31', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1194033514', 0, 'N', 0, '2013-02-21', NULL, NULL, 0, 0, NULL, NULL),
('820299231', 'W12008861', 'W12008861', 'ID02', 'Saltzer Medical Group North', 'Rosemary', 'C', 'Howell', '', 'Physical Therapy', '', '', NULL, 'O', '4400 E Flamingo Ave', 'Nampa', 'Canyon', 'ID', '83687', '2084685970', '2082884987', '4400 E Flamingo Ave', 'Nampa', 'Canyon', 'ID', '83687', '2084685970', '2082884987', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-03-03', '2012-12-31', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1194033514', 0, 'N', 0, '2013-02-21', NULL, NULL, 43.5976, -116.517, NULL, NULL),
('820299231', 'W12008860', 'W12008860', 'ID02', 'Saltzer Medical Group-Sleep', 'Rosemary', 'C', 'Howell', '', 'Physical Therapy', '', '', NULL, 'O', '7272 W Potomac Dr', 'Boise', 'Ada', 'ID', '83704', '2084633000', '2082884987', '7272 W Potomac Dr', 'Boise', 'Ada', 'ID', '83704', '2084633000', '2082884987', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-03-03', '2012-12-31', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1194033514', 0, 'N', 0, '2013-02-21', NULL, NULL, 0, 0, NULL, NULL),
('820299231', 'W12008870', 'W12008870', 'ID02', 'Saltzer Medical Group- Caldwell', 'Deanna', 'C', 'Kinsman', 'PT', 'Physical Therapy', '', '', NULL, 'O', '1818 S 10th Ave Ste 120 or Ste 220', 'Caldwell', 'Canyon', 'ID', '83605', '2084633000', '2082884987', '1818 S 10th Ave Ste 120 or Ste 220', 'Caldwell', 'Canyon', 'ID', '83605', '2084633000', '2082884987', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-03-03', '2012-12-31', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1831386762', 0, 'N', 0, '2013-02-21', NULL, NULL, 43.6538, -116.693, NULL, NULL),
('820299231', 'W12008871', 'W12008871', 'ID02', 'Saltzer Medical Group-Sleep', 'Deanna', 'C', 'Kinsman', 'PT', 'Physical Therapy', '', '', NULL, 'O', '7272 W Potomac Dr', 'Boise', 'Ada', 'ID', '83704', '2084633000', '2082884987', '7272 W Potomac Dr', 'Boise', 'Ada', 'ID', '83704', '2084633000', '2082884987', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-03-03', '2012-12-31', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1831386762', 0, 'N', 0, '2013-02-21', NULL, NULL, 0, 0, NULL, NULL);
