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
('870395551', 'W11005009', 'W11005009', 'UT01', NULL, 'James', 'E', 'Vancho', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '102 W 11th Ste B', 'Post Falls', 'Kootenai', 'ID', '83854', '2087731868', '2087736956', '867 E 9400 S', 'Sandy', 'Kootenai', 'UT', '84094', NULL, NULL, 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', '0.00', '55.46', 3, '2008-01-01', '2010-10-31', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1346357647', 0, 'N', 0, '2008-06-01', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'W11005018', 'W11005018', 'UT01', NULL, 'Larry', 'G', 'Wilde', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '246 S 1100 E', 'American Fork', 'Utah', 'UT', '84003', '8017568833', NULL, '867 E 9400 S', 'Sandy', 'Utah', 'UT', '84094', NULL, NULL, 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', '0.00', '55.46', 3, '2006-04-01', '2010-10-31', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1770515934', 0, 'N', 0, '2008-06-01', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'W11005005', 'W11005005', 'UT01', 'Thomson Chiropractic', 'David', 'B', 'Thomson', 'DC', 'Chiropractic', '', '', NULL, 'O', '447 N 300 W Ste 6', 'Kaysville', 'Davis', 'UT', '84037', '8015476757', NULL, '447 N 300 W Ste 6', 'Kaysville', 'Davis', 'UT', '84037', '8015476757', '          ', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2006-04-01', '2010-10-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1902898927', 0, 'N', 0, '2011-08-05', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'W11005019', 'W11005019', 'UT01', NULL, 'J', 'Brad', 'Young', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '2112 N Hillfield Rd Ste 2B', 'Layton', 'Davis', 'UT', '84041', '8017740555', NULL, '867 E 9400 S', 'Sandy', 'Davis', 'UT', '84094', NULL, NULL, 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', '0.00', '55.46', 3, '2006-04-01', '2008-06-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000832080', 0, 'N', 0, '2008-06-01', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'W11005008', 'W11005008', 'UT01', NULL, 'Brandon', 'J', 'Trujillo', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '712 E 7200 S', 'Midvale', 'Salt Lake', 'UT', '84047', '8015622400', '8015682432', '867 E 9400 S', 'Sandy', 'Salt Lake', 'UT', '84094', NULL, NULL, 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', '0.00', '55.46', 3, '2008-04-04', '2010-10-31', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1619166063', 0, 'N', 0, '2008-06-01', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'W11005006', 'W11005006', 'UT01', '', 'Justin', '', 'Traveller', 'DC', 'Chiropractic', '', '', NULL, 'O', '3935 N 75 W', 'Hyde Park', 'Cache', 'UT', '84318', '4355634772', '4355630293', '3935 N 75 W', 'Hyde Park', 'Cache', 'UT', '84318', '4355634772', '4355630293', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2008-01-01', '2010-03-08', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1386820975', 0, 'N', 0, '2012-06-29', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'W11005011', 'W11005011', 'UT01', '', 'Brent', 'Nephi', 'Wall', 'DC', 'Chiropractic', '', '', NULL, 'O', '750 N Main St', 'Spanish Fork', 'Utah', 'UT', '84660', '8016021143', '2083224115', '750 N Main St', 'Spanish Fork', 'Utah', 'UT', '84660', '8016021143', '2083224115', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2008-01-01', '2010-10-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1346263100', 0, 'N', 0, '2012-12-19', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'W11005016', 'W11005016', 'UT01', NULL, 'Rebecca', NULL, 'Whittaker', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '1870 N Main St Ste 205', 'Cedar City', 'Iron', 'UT', '84720', '4355867575', '4355867575', '867 E 9400 S', 'Sandy', 'Iron', 'UT', '84094', NULL, NULL, 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', '0.00', '55.46', 3, '2006-04-01', '2010-10-31', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1285766816', 0, 'N', 0, '2008-06-01', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'W11005017', 'W11005017', 'UT01', NULL, 'Tyler', NULL, 'Whittaker', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '1870 N Main St Ste 205', 'Cedar City', 'Iron', 'UT', '84720', '4355867575', '4355867575', '867 E 9400 S', 'Sandy', 'Iron', 'UT', '84094', NULL, NULL, 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', '0.00', '55.46', 3, '2006-04-01', '2010-10-31', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1831216811', 0, 'N', 0, '2008-06-01', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'W11005001', 'W11005001', 'UT01', NULL, 'Bret', 'R', 'Staley', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '1170 N Moapa Valley Blvd Ste C', 'Overton', 'Clark', 'NV', '89040', '7023972273', '7023972705', '867 E 9400 S', 'Sandy', NULL, 'UT', '84094', NULL, NULL, 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', '0.00', '55.46', 3, '2008-01-01', '2010-10-31', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000008880', 0, 'N', 0, '2008-06-01', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'W11005003', 'W11005003', 'UT01', NULL, 'Wade', 'Alan', 'Taylor', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '2715 Argent Ave Ste 4', 'Elko', 'Elko', 'NV', '89801', '7797937387', '7797384918', '867 E 9400 S', 'Sandy', 'Elko', 'UT', '84094', NULL, NULL, 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', '0.00', '55.46', 3, '2008-01-01', '2010-10-31', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000009021', 0, 'N', 0, '2008-06-01', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'W11005012', 'W11005012', 'UT01', NULL, 'Dean', 'E', 'Ward', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '1250 Lamoille Hwy Ste 102', 'Elko', 'Elko', 'NV', '89801', '7757777066', '7757533674', '867 E 9400 S', 'Sandy', 'Elko', 'UT', '84094', NULL, NULL, 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', '0.00', '55.46', 3, '2008-01-01', '2010-10-31', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000009503', 0, 'N', 0, '2008-06-01', NULL, NULL, 0, 0, NULL, NULL),
('621650578', 'W11005031', 'W11005031', 'PEHPMTSTAR', 'Ogden Regional Medical Center', '', '', 'Ogden Regional Medical Center', 'GROUP', 'Hospital', '', '', NULL, 'B', 'PO Box 409654', 'Atlanta', 'Fulton', 'GA', '30384', '8014792922', NULL, 'PO Box 409654', 'Atlanta', 'Fulton', 'GA', '30384', '8014792922', '', '', NULL, NULL, '0.00', '31.00', '0.00', 6, '2008-04-01', NULL, 0, 0, 0, '', '', '', '', 'UB|', '1720031636', 0, 'y', 0, '2011-07-13', NULL, NULL, 0, 0, NULL, NULL),
('870322019', 'W11005037', 'W11005037', 'PEHPMTSTAR', 'Lakeview Hospital', '', '', 'Lakeview Hospital', 'GROUP', 'Hospital', '', '', NULL, 'B', 'PO Box 409672', 'Atlanta', 'Fulton', 'GA', '30384', '8012992524', NULL, 'PO Box 409672', 'Atlanta', 'Fulton', 'GA', '30384', '8012992524', '          ', '', '', '', '0.00', '31.00', '0.00', 6, '2008-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1528010451', 0, 'N', 0, '2013-07-25', NULL, NULL, 0, 0, NULL, NULL),
('870318837', 'W11005035', 'W11005035', 'PEHPMTSTAR', 'Brigham City Community Hospital', '', '', 'Brigham City Community Hospital', 'GROUP', 'Hospital', '', '', NULL, 'B', 'PO Box 409611', 'Atlanta', 'Fulton', 'GA', '30384', '4357344352', NULL, 'PO Box 409611', 'Atlanta', 'Fulton', 'GA', '30384', '4357344352', '          ', '', '', '', '0.00', '31.00', '0.00', 3, '2008-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1245282227', 0, 'N', 0, '2011-07-18', NULL, NULL, 0, 0, NULL, NULL),
('870333048', 'W11005040', 'W11005040', 'PEHPMTSTAR', 'Mountain View Hospital', '', '', 'Mountain View Hospital', 'GROUP', 'Hospital', '', '', NULL, 'B', 'PO Box 409636', 'Atlanta', 'Fulton', 'GA', '30384', '8014659201', NULL, 'PO Box 409636', 'Atlanta', 'Fulton', 'GA', '30384', '8014659201', '', '', NULL, NULL, '0.00', '31.00', '0.00', 3, '2008-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1487607669', 0, 'y', 0, '2011-07-13', NULL, NULL, 0, 0, NULL, NULL),
('201066535', 'W11005022', 'W11005022', 'PEHPMTSTAR', 'Millcreek Imaging Center', '', '', 'Millcreek Imaging Center', 'GROUP', 'Imaging Center', 'Radiology', '', NULL, 'B', 'PO Box 404894', 'Atlanta', 'Fulton', 'GA', '30384', '6153737600', NULL, 'PO Box 404894', 'Atlanta', 'Fulton', 'GA', '30384', '6153737600', '', '', NULL, NULL, '0.00', '31.00', '0.00', 3, '2008-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000904605', 0, 'y', 0, '2011-06-30', NULL, NULL, 0, 0, NULL, NULL),
('621650573', 'W11005029', 'W11005029', 'PEHPMTSTAR', 'St Marks Hospital', '', '', 'St Marks Hospital', 'GROUP', 'Hospital', '', '', NULL, 'B', 'PO Box 409655', 'Atlanta', 'Fulton', 'GA', '30384', '7028551012', '7028551013', 'PO Box 409655', 'Atlanta', 'Fulton', 'GA', '30384', '7028551012', '7028551013', '', NULL, NULL, '0.00', '31.00', '0.00', 3, '2008-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000830877', 0, 'y', 0, '2011-07-13', NULL, NULL, 0, 0, NULL, NULL),
('621831495', 'W11005033', 'W11005033', 'PEHPMTSTAR', 'Timpanogos Regional Hospital', '', '', 'Timpanogos Regional Hospital', 'GROUP', 'Hospital', '', '', NULL, 'B', 'PO Box 31172', 'Tampa', 'Hillsborough', 'FL', '33631', '8002604905', NULL, 'PO Box 31172', 'Tampa', 'Hillsborough', 'FL', '33631', '8002604905', '          ', '', '', '', '0.00', '31.00', '0.00', 3, '2008-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1497702195', 0, 'N', 0, '2011-07-13', NULL, NULL, 0, 0, NULL, NULL),
('870322019', 'W11005038', 'W11005038', 'PEHPMTSTAR', 'Lakeview Hospital', '', '', 'Lakeview Hospital', 'GROUP', 'Hospital', '', '', NULL, 'O', '630 Medical Dr', 'Bountiful', 'Davis', 'UT', '84010', '8012926231', NULL, '630 Medical Dr', 'Bountiful', 'Davis', 'UT', '84010', '8012926231', '          ', '', '', '', '0.00', '31.00', '0.00', 6, '2008-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1528010451', 0, 'N', 0, '2013-07-25', NULL, NULL, 0, 0, NULL, NULL),
('364581088', 'W11005025', 'W11005025', 'PEHPMTSTAR', 'Bountiful Surgery Center', '', '', 'Bountiful Surgery Center', 'GROUP', 'Ambulatory Surgery Center', '', '', NULL, 'O', '620 E Medical Dr Ste 200', 'Bountiful', 'Davis', 'UT', '84010', '8012962122', NULL, '620 E Medical Dr Ste 200', 'Bountiful', 'Davis', 'UT', '84010', '8012962122', '', '', NULL, NULL, '0.00', '31.00', '0.00', 3, '2008-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000005373', 0, 'n', 0, '2011-06-30', NULL, NULL, 0, 0, NULL, NULL),
('621831495', 'W11005034', 'W11005034', 'PEHPMTSTAR', 'Timpanogos Regional Hospital', '', '', 'Timpanogos Regional Hospital', 'GROUP', 'Hospital', '', '', NULL, 'O', '750 W 800 N', 'Orem', 'Utah', 'UT', '84057', '8017146000', NULL, '750 W 800 N', 'Orem', 'Utah', 'UT', '84057', '8017146000', '          ', '', '', '', '0.00', '31.00', '0.00', 3, '2008-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1497702195', 0, 'N', 0, '2011-07-13', NULL, NULL, 0, 0, NULL, NULL),
('562601697', 'W11005026', 'W11005026', 'PEHPMTSTAR', 'South Towne Surgery Center', '', '', 'South Towne Surgery Center', 'GROUP', 'Ambulatory Surgery Center', '', '', NULL, 'O', '10011 So Centennial Pkwy Ste 100', 'Sandy', 'Salt Lake', 'UT', '84094', '8012339300', NULL, '10011 So Centennial Pkwy Ste 100', 'Sandy', 'Salt Lake', 'UT', '84094', '8012339300', '', '', NULL, NULL, '0.00', '31.00', '0.00', 3, '2008-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1598772634', 0, 'N', 0, '2011-07-13', NULL, NULL, 0, 0, NULL, NULL),
('201066535', 'W11005023', 'W11005023', 'PEHPMTSTAR', 'Millcreek Imaging Center', '', '', 'Millcreek Imaging Center', 'GROUP', 'Imaging Center', 'Radiology', '', NULL, 'O', '3738 S 900 E', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8013131955', '8013131965', '3738 S 900 E', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8013131955', '8013131965', '', NULL, NULL, '0.00', '31.00', '0.00', 3, '2008-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000904605', 0, 'N', 0, '2011-06-30', NULL, NULL, 0, 0, NULL, NULL),
('352262646', 'W11005024', 'W11005024', 'PEHPMTSTAR', 'Synergies Surgery Center LP dba Mt Olympus Surgery Center', '', '', 'Synergies Surgery Center LP dba Mt Olympus Surgery Center', 'GROUP', 'Ambulatory Surgery Center', '', '', NULL, 'O', '348 E 4500 S', 'Salt Lake City', 'Salt Lake', 'UT', '84115', '8016856400', NULL, '348 E 4500 S', 'Salt Lake City', 'Salt Lake', 'UT', '84115', '8016856400', '', '', NULL, NULL, '0.00', '31.00', '0.00', 3, '2008-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000008978', 0, 'n', 0, '2011-07-13', NULL, NULL, 0, 0, NULL, NULL),
('621449273', 'W11005027', 'W11005027', 'PEHPMTSTAR', 'St Marks Outpatient Surgery Center', '', '', 'St Marks Outpatient Surgery Center', 'GROUP', 'Ambulatory Surgery Center', '', '', NULL, 'O', '1250 E 3900 S Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012620358', NULL, '1250 E 3900 S Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012620358', '', '', NULL, NULL, '0.00', '31.00', '0.00', 3, '2008-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000830868', 0, 'n', 0, '2011-07-13', NULL, NULL, 0, 0, NULL, NULL),
('621600427', 'W11005028', 'W11005028', 'PEHPMTSTAR', 'Wasatch Endoscopy Center', '', '', 'Wasatch Endoscopy Center', 'GROUP', 'Endoscopy Center', '', '', NULL, 'O', '1220 E 3900 S Ste 1B', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012813657', NULL, '1220 E 3900 S Ste 1B', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012813657', '', '', NULL, NULL, '0.00', '31.00', '0.00', 3, '2008-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1881701290', 0, 'n', 0, '2011-07-13', NULL, NULL, 0, 0, NULL, NULL),
('621650573', 'W11005030', 'W11005030', 'PEHPMTSTAR', 'St Marks Hospital', '', '', 'St Marks Hospital', 'GROUP', 'Hospital', '', '', NULL, 'O', '1200 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012687111', NULL, '1200 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012687111', '', '', NULL, NULL, '0.00', '31.00', '0.00', 3, '2008-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000830877', 0, 'N', 0, '2011-07-13', NULL, NULL, 0, 0, NULL, NULL),
('870318837', 'W11005036', 'W11005036', 'PEHPMTSTAR', 'Brigham City Community Hospital', '', '', 'Brigham City Community Hospital', 'GROUP', 'Hospital', '', '', NULL, 'O', '950 Medical Dr', 'Brigham City', 'Box Elder', 'UT', '84302', '4357349471', NULL, '950 Medical Dr', 'Brigham City', 'Box Elder', 'UT', '84302', '4357349471', '', '', NULL, NULL, '0.00', '31.00', '0.00', 3, '2008-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1245282227', 0, 'N', 0, '2011-07-18', NULL, NULL, 0, 0, NULL, NULL),
('621650578', 'W11005032', 'W11005032', 'PEHPMTSTAR', 'Ogden Regional Medical Center', '', '', 'Ogden Regional Medical Center', 'GROUP', 'Hospital', '', '', NULL, 'O', '5475 S 500 E', 'Ogden', 'Weber', 'UT', '84405', '8014792111', NULL, '5475 S 500 E', 'Ogden', 'Weber', 'UT', '84405', '8014792111', '', '', NULL, NULL, '0.00', '31.00', '0.00', 6, '2008-04-01', NULL, 0, 0, 0, '', '', '', '', 'UB|', '1720031636', 0, 'N', 0, '2011-07-13', NULL, NULL, 0, 0, NULL, NULL),
('870333048', 'W11005039', 'W11005039', 'PEHPMTSTAR', 'Mountain View Hospital', '', '', 'Mountain View Hospital', 'GROUP', 'Hospital', '', '', NULL, 'O', '1000 E 100 N', 'Payson', 'Utah', 'UT', '84651', '8014657000', NULL, '1000 E 100 N', 'Payson', 'Utah', 'UT', '84651', '8014657000', '', '', NULL, NULL, '0.00', '31.00', '0.00', 3, '2008-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1487607669', 0, 'N', 0, '2011-07-13', NULL, NULL, 0, 0, NULL, NULL),
('820526861', 'W11005062', 'W11005062', 'ID01', 'Caldwell  Cancer Care Center - Radiation Oncology', '', '', 'Caldwell  Cancer Care Center - Radiation Oncology', 'Group', 'Radiation Oncology', '', '', NULL, 'o', '3123 Medical Dr', 'Caldwell', 'Canyon', 'ID', '83605', '2084532033', NULL, '3123 Medical Dr', 'Caldwell', 'Canyon', 'ID', '83605', '2084532033', '          ', 'IDHOSPOP', '', '', '0.00', '10.00', '0.00', 3, '2008-07-01', '2012-09-19', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1053522961', 0, 'N', 0, '2012-10-10', NULL, NULL, 43.6596, -116.658, NULL, NULL),
('820200895', 'W11005061', 'W11005061', 'ID01', 'Caldwell  Cancer Care Center - Medical Oncology', '', '', 'Caldwell  Cancer Care Center - Medical Oncology', 'Group', 'Hematology and Oncology', 'Oncology', '', NULL, 'o', '3123 Medical Dr', 'Caldwell', 'Canyon', 'ID', '83605', '2084532033', NULL, '3123 Medical Dr', 'Caldwell', 'Canyon', 'ID', '83605', '2084532033', '', 'IDHOSPOP', NULL, '', '0.00', '20.00', '0.00', 6, '2008-07-01', '2012-08-19', 0, 0, 0, '', '', '', '', 'HCFA|', '0000005528', 0, 'N', 0, '2014-06-20', NULL, NULL, 43.6596, -116.658, NULL, NULL),
('841636078', 'W11005042', 'W11005042', 'ID01', 'River Medical Family Practice', 'Michael', 'R', 'Minas', 'MD', 'Family Practice', '', '', NULL, 'O', '100 Cottonwood Ct Ste 150', 'Eagle', 'Ada', 'ID', '83616', '2089393314', NULL, '100 Cottonwood Ct Ste 150', 'Eagle', 'Ada', 'ID', '83616', '2089393314', '', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2008-07-01', '2011-10-23', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1528178977', 0, 'N', 0, '2014-07-08', NULL, NULL, 0, 0, NULL, NULL),
('841636078', 'W11005043', 'W11005043', 'ID01', 'River Medical Family Practice', 'Michael', 'R', 'Minas', 'MD', 'Family Practice', '', '', NULL, 'B', '3210 E Chinden Blvd Ste 115', 'Eagle', 'Ada', 'ID', '83616', '2089393314', NULL, '3210 E Chinden Blvd Ste 115', 'Eagle', 'Ada', 'ID', '83616', '2089393314', '', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2008-07-01', '2012-08-19', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1528178977', 0, 'Y', 0, '2014-07-08', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W11005066', 'W11005066', 'ID01', 'Saint Alphonsus Rehabilitation Services (STARS)', '', '', 'Saint Alphonsus Rehabilitation Services (STARS)', 'Group', 'Physical Therapy', 'Occupational Therapy', 'Speech Therapy', NULL, 'o', '323 E Riverside Dr Ste 124', 'Eagle', 'Ada', 'ID', '83616', '2083675400', NULL, '323 E Riverside Dr Ste 124', 'Eagle', 'Ada', 'ID', '83616', '2083675400', '', 'IDHOSPOP', '', '', '0.00', '20.00', '0.00', 6, '2008-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1457414948', 0, 'N', 0, '2014-05-28', NULL, NULL, 43.6896, -116.35, NULL, NULL),
('820200895', 'W11005065', 'W11005065', 'ID01', 'Eagle Health Plaza Laboratory', NULL, NULL, 'Eagle Health Plaza Laboratory', 'Group', 'Laboratory', NULL, NULL, NULL, 'o', '323 E Riverside Dr', 'Eagle', 'Ada', 'ID', '83616', '2083672156', NULL, '323 E Riverside Dr', 'Eagle', 'Ada', 'ID', '83616', NULL, NULL, 'IDHOSPOP', NULL, NULL, '0.00', '20.00', '0.00', 6, '2008-07-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '0000006074', 0, 'N', 0, '2008-06-04', NULL, NULL, 43.6896, -116.35, NULL, NULL),
('820200895', 'W11005064', 'W11005064', 'ID01', 'Eagle Health Plaza', NULL, NULL, 'Eagle Health Plaza', 'Group', 'Emergency Services', NULL, NULL, NULL, 'o', '323 E Riverside Dr', 'Eagle', 'Ada', 'ID', '83616', NULL, NULL, '323 E Riverside Dr', 'Eagle', 'Ada', 'ID', '83616', NULL, NULL, 'IDHOSPOP', NULL, NULL, '0.00', '20.00', '0.00', 6, '2008-07-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '0000006073', 0, 'N', 0, '2008-06-04', NULL, NULL, 43.6896, -116.35, NULL, NULL),
('820200895', 'W11005063', 'W11005063', 'ID01', 'Eagle Health Plaza Surgery Center', NULL, NULL, 'Eagle Health Plaza Surgery Center', 'Group', 'Ambulatory Surgery Center', NULL, NULL, NULL, 'o', '323 E Riverside Dr', 'Eagle', 'Ada', 'ID', '83616', '2083765300', NULL, '323 E Riverside Dr', 'Eagle', 'Ada', 'ID', '83616', NULL, NULL, 'IDHOSPOP', NULL, NULL, '0.00', '20.00', '0.00', 6, '2008-07-01', '2009-12-31', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '0000006075', 0, 'N', 0, '2008-06-04', NULL, NULL, 43.6892, -116.351, NULL, NULL),
('820200895', 'W11005056', 'W11005056', 'ID01', 'Saint Alphonsus Rehabilitation Services (STARS)', '', '', 'Saint Alphonsus Rehabilitation Services (STARS)', 'Group', 'Physical Therapy', 'Occupational Therapy', 'Speech Therapy', NULL, 'o', '179 SW 5th Ave', 'Meridian', 'Ada', 'ID', '83642', '2083678282', NULL, '179 SW 5th Ave', 'Meridian', 'Ada', 'ID', '83642', '2083678282', '', 'IDHOSPOP', '', '', '0.00', '20.00', '0.00', 6, '2008-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1457414948', 0, 'N', 0, '2014-05-28', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W11005060', 'W11005060', 'ID01', 'Saint Alphonsus Rehabilitation Services (STARS)', '', '', 'Saint Alphonsus Rehabilitation Services (STARS)', 'Group', 'Physical Therapy', 'Occupational Therapy', 'Speech Therapy', NULL, 'o', '3025 W Cherry Ln Ste D', 'Meridian', 'Ada', 'ID', '83642', '2083678593', NULL, '3025 W Cherry Ln Ste D', 'Meridian', 'Ada', 'ID', '83642', '2083678593', '', 'IDHOSPOP', '', '', '0.00', '20.00', '0.00', 6, '2008-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1457414948', 0, 'N', 0, '2014-05-28', NULL, NULL, 43.6193, -116.431, NULL, NULL),
('820200895', 'W11005059', 'W11005059', 'ID01', 'Meridian Health Plaza Laboratory', NULL, NULL, 'Meridian Health Plaza Laboratory', 'Group', 'Laboratory', NULL, NULL, NULL, 'o', '3025 W Cherry Ln', 'Meridian', 'Ada', 'ID', '83642', '2083672156', NULL, '3025 W Cherry Ln', 'Meridian', 'Ada', 'ID', '83642', NULL, NULL, 'IDHOSPOP', NULL, NULL, '0.00', '20.00', '0.00', 6, '2008-07-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '0000007575', 0, 'N', 0, '2008-06-04', NULL, NULL, 43.6193, -116.431, NULL, NULL),
('820200895', 'W11005058', 'W11005058', 'ID01', 'Meridian Health Plaza Surgery Center', '', '', 'Meridian Health Plaza Surgery Center', 'Group', 'Ambulatory Surgery Center', '', '', NULL, 'o', '3025 W Cherry Ln', 'Meridian', 'Ada', 'ID', '83642', '2083678550', NULL, '3025 W Cherry Ln', 'Meridian', 'Ada', 'ID', '83642', '2083678550', '          ', 'IDHOSPOP', '', '', '0.00', '20.00', '0.00', 6, '2010-07-01', '2012-09-19', 0, 0, 0, '', '', '', '', 'HCFA|', '0000007576', 0, 'N', 0, '2012-09-24', NULL, NULL, 43.6188, -116.431, NULL, NULL),
('820533431', 'W11005041', 'W11005041', 'ID01', 'The Ear Nose & Throat Clinic', 'Lance', 'W', 'Coleman', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '520 S Eagle Rd Ste 1223', 'Meridian', 'Ada', 'ID', '83642', '2088884368', NULL, '520 S Eagle Rd Ste 1223', 'Meridian', 'Ada', 'ID', '83642', '2088884368', '          ', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2008-07-01', '2012-02-01', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|UB|', '1548204589', 0, 'N', 0, '2012-02-08', NULL, NULL, 43.5995, -116.352, NULL, NULL),
('202133636', 'W11005044', 'W11005044', 'ID01', 'Star Medical Center', 'Elmer', 'G (Rusty)', 'Dodge', 'FNP', 'Family Practice', '', '', NULL, 'O', '9858 W State St', 'Star', 'Ada', 'ID', '83669', '2082869471', NULL, '9858 W State St', 'Star', 'Ada', 'ID', '83669', '2082869471', '', 'IDSTD', 'WUSTDHCPC5', NULL, '0.00', '30.00', '0.00', 3, '2008-07-01', '2012-08-19', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1508918236', 0, 'n', 0, '2013-12-11', NULL, NULL, 43.6924, -116.476, NULL, NULL),
('202133636', 'W11005045', 'W11005045', 'ID01', 'Star Medical Center', 'Angela', 'P', 'Diemont', 'FNP', 'Family Practice', '', '', NULL, 'B', '9858 W State St', 'Star', 'Ada', 'ID', '83669', '2082869471', NULL, '9858 W State St', 'Star', 'Ada', 'ID', '83669', '2082869471', '', 'IDSTD', 'WUSTDHCPC5', NULL, '0.00', '30.00', '0.00', 3, '2008-07-01', '2012-08-19', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1063693950', 0, 'Y', 0, '2012-02-14', NULL, NULL, 43.6924, -116.476, NULL, NULL),
('820200895', 'W11005055', 'W11005055', 'ID01', 'Nampa Cancer Center ', NULL, NULL, 'Nampa Cancer Center ', 'Group', 'Hematology and Oncology', NULL, NULL, NULL, 'o', '1601 12th Ave Rd Ste 101', 'Nampa', 'Canyon', 'ID', '83686', '2084427872', NULL, '1601 12th Ave Rd ', 'Nampa', 'Canyon', 'ID', '83686', NULL, NULL, 'IDHOSPOP', NULL, NULL, '0.00', '20.00', '0.00', 6, '2008-07-01', '2008-10-27', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '0000007788', 0, 'N', 0, '2008-06-04', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W11005057', 'W11005057', 'ID01', 'Saint Alphonsus Rehabilitation Services (STARS)', '', '', 'Saint Alphonsus Rehabilitation Services (STARS)', 'Group', 'Physical Therapy', 'Occupational Therapy', 'Speech Therapy', NULL, 'o', '2707 Garrity Blvd Ste 3', 'Nampa', 'Canyon', 'ID', '83687', '2084422329', NULL, '2707 Garrity Blvd Ste 3', 'Nampa', 'Canyon', 'ID', '83687', '2084422329', '', 'IDHOSPOP', '', '', '0.00', '20.00', '0.00', 6, '2008-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1457414948', 0, 'N', 0, '2014-05-28', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W11005046', 'W11005046', 'ID01', 'Saint Alphonsus Rehabilitation Services (STARS)', '', '', 'Saint Alphonsus Rehabilitation Services (STARS)', 'Group', 'Physical Therapy', 'Occupational Therapy', 'Speech Therapy', NULL, 'o', '1050 W State St', 'Boise', 'Ada', 'ID', '83702', '2084248175', NULL, '1050 W State St', 'Boise', 'Ada', 'ID', '83702', '2084248175', '', 'IDHOSPOP', '', '', '0.00', '20.00', '0.00', 6, '2008-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1457414948', 0, 'N', 0, '2014-05-28', NULL, NULL, 43.6202, -116.203, NULL, NULL),
('820200895', 'W11005070', 'W11005070', 'ID01', 'Saint Alphonsus Rehabilitation Services (STARS)', '', '', 'Saint Alphonsus Rehabilitation Services (STARS)', 'Group', 'Physical Therapy', 'Occupational Therapy', 'Speech Therapy', NULL, 'o', '717 N Liberty', 'Boise', 'Ada', 'ID', '83704', '2083678989', NULL, '717 N Liberty', 'Boise', 'Ada', 'ID', '83704', '2083678989', '', 'IDHOSPOP', '', '', '0.00', '20.00', '0.00', 6, '2008-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1457414948', 0, 'N', 0, '2014-05-28', NULL, NULL, 43.6111, -116.261, NULL, NULL),
('820200895', 'W11005068', 'W11005068', 'ID01', 'Saint Alphonsus Addiction Recovery Center', NULL, NULL, 'Saint Alphonsus Addiction Recovery Center', 'Group', 'Mental Health Facility', '', '', NULL, 'o', '6138 Emerald', 'Boise', 'Ada', 'ID', '83704', '2083673553', NULL, '6138 Emerald', 'Boise', 'Ada', 'ID', '83704', '2083673553', '          ', 'IDHOSPOP', '', '', '0.00', '20.00', '0.00', 6, '2008-07-01', '2010-06-04', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '0000008535', 0, 'N', 0, '2008-06-04', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W11005049', 'W11005049', 'ID01', 'Saint Alphonsus Regional Medical Center', '', '', 'Saint Alphonsus Regional Medical Center ', 'Group', 'Hospital', '', '', NULL, 'o', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083672121', NULL, '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083672121', '', '', '', 'ID01', '0.00', '0.00', '0.00', 6, '2008-07-01', '2012-08-29', 1, 0, 0, '', '', '', '', 'HCFA|', '1861676298', 0, 'Y', 0, '2014-06-13', NULL, NULL, 43.6127, -116.254, NULL, NULL),
('820200895', 'W11005069', 'W11005069', 'ID01', 'Saint Alphonsus Breast Care Center', '', '', 'Saint Alphonsus Breast Care Center', 'Group', 'Imaging Center', 'Radiology', '', NULL, 'o', '6200 W Emerald', 'Boise', 'Ada', 'ID', '83706', '2083673336', '', '6200 W Emerald', 'Boise', 'Ada', 'ID', '83706', '2083673336', '', 'IDHOSPOP', '', '', '0.00', '20.00', '0.00', 6, '2008-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '0000008538', 0, 'N', 0, '2014-07-25', NULL, NULL, 43.6119, -116.259, NULL, NULL),
('820200895', 'W11005048', 'W11005048', 'ID01', 'Saint Alphonsus Cancer Care Center', '', '', 'Saint Alphonsus Cancer Care Center', 'Group', 'Hematology and Oncology', 'Oncology', '', NULL, 'O', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083673627', NULL, '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083673627', '', 'IDHOSPOP', '', '', '0.00', '20.00', '0.00', 6, '2008-07-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '0000008539', 0, 'N', 0, '2014-06-20', NULL, NULL, 43.6127, -116.254, NULL, NULL),
('820200895', 'W11005050', 'W11005050', 'ID01', 'Saint Alphonsus Laboratory', '', '', 'Saint Alphonsus Laboratory', 'Group', 'Laboratory', '', '', NULL, 'o', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083672156', '', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083672156', '', 'IDHOSPOP', '', '', '0.00', '20.00', '0.00', 6, '2008-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '0000008541', 0, 'N', 0, '2014-07-25', NULL, NULL, 43.6145, -116.254, NULL, NULL),
('820200895', 'W11005051', 'W11005051', 'ID01', 'Saint Alphonsus Radiology', '', '', 'Saint Alphonsus Radiology', 'Group', 'Radiologist', '', '', NULL, 'o', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083672161', '', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083672161', '', 'IDHOSPOP', '', '', '0.00', '20.00', '0.00', 6, '2008-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '0000008548', 0, 'N', 0, '2014-07-25', NULL, NULL, 43.6145, -116.254, NULL, NULL),
('820200895', 'W11005052', 'W11005052', 'ID01', 'Saint Alphonsus Rehabilitation Unit', '', '', 'Saint Alphonsus Rehabilitation Unit', 'Group', 'Rehabilitation Hospitals', '', '', NULL, 'o', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083673470', '', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083673470', '', 'IDHOSPOP', '', '', '0.00', '20.00', '0.00', 6, '2008-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '0000008550', 0, 'N', 0, '2014-07-25', NULL, NULL, 43.6145, -116.254, NULL, NULL),
('820200895', 'W11005053', 'W11005053', 'ID01', 'Saint Alphonsus Sleep Clinic', '', '', 'Saint Alphonsus Sleep Clinic', 'Group', 'Sleep Disorders', '', '', NULL, 'o', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083672008', '          ', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083672008', '          ', 'IDHOSPOP', '', '', '0.00', '20.00', '0.00', 6, '2008-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '0000008551', 0, 'N', 0, '2014-07-25', NULL, NULL, 43.6145, -116.254, NULL, NULL),
('820200895', 'W11005054', 'W11005054', 'ID01', 'Saint Alphonsus Behavioral Health', '', '', 'Saint Alphonsus Behavioral Health', 'Group', 'Mental Health Facility', '', '', NULL, 'o', '131 N Allumbaugh', 'Boise', 'Ada', 'ID', '83706', '2083672175', '', '131 N Allumbaugh', 'Boise', 'Ada', 'ID', '83706', '2083672175', '', 'IDHOSPOP', '', '', '0.00', '20.00', '0.00', 6, '2008-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '0000008536', 0, 'N', 0, '2014-07-25', NULL, NULL, 43.6062, -116.266, NULL, NULL),
('820200895', 'W11005071', 'W11005071', 'ID01', 'Saint Alphonsus Rehabilitation Services (STARS)', '', '', 'Saint Alphonsus Rehabilitation Services (STARS)', 'Group', 'Physical Therapy', 'Occupational Therapy', 'Speech Therapy', NULL, 'B', '901 N Curtis Ste 204', 'Boise', 'Ada', 'ID', '83706', '2083673315', NULL, '901 N Curtis Ste 204', 'Boise', 'Ada', 'ID', '83706', '2083673315', '', 'IDHOSPOP', '', '', '0.00', '20.00', '0.00', 6, '2008-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1457414948', 0, 'N', 0, '2014-05-28', NULL, NULL, 43.6126, -116.255, NULL, NULL),
('820200895', 'W11005047', 'W11005047', 'ID01', 'Saint Alphonsus Outpatient Surgery', '', '', 'Saint Alphonsus Outpatient Surgery ', 'Group', 'Ambulatory Surgery Center', '', '', NULL, 'o', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083672724', NULL, '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083672724', '', 'IDHOSPOP', '', '', '0.00', '20.00', '0.00', 6, '2008-07-01', '2012-09-19', 0, 0, 0, '', '', '', '', 'HCFA|', '0000008546', 0, 'N', 0, '2014-06-20', NULL, NULL, 43.6127, -116.254, NULL, NULL),
('820200895', 'W11005067', 'W11005067', 'ID01', 'Saint Alphonsus Rehabilitation Services (STARS)', '', '', 'Saint Alphonsus Rehabilitation Services (STARS)', 'Group', 'Physical Therapy', 'Occupational Therapy', 'Speech Therapy', NULL, 'o', '5959 N Discovery Way', 'Boise', 'Ada', 'ID', '83713', '2083780256', NULL, '5959 N Discovery Way', 'Boise', 'Ada', 'ID', '83713', '2083780256', '', 'IDHOSPOP', '', '', '0.00', '20.00', '0.00', 6, '2008-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1457414948', 0, 'N', 0, '2014-05-28', NULL, NULL, 43.6594, -116.341, NULL, NULL),
('113676182', 'W11005079', 'W11005079', 'TX01', 'The Podiatry Group of South Texas', 'Carmina', '', 'Fusco', 'DPM', 'Podiatry', '', '', NULL, 'O', '9135 Schaefer Rd', 'Converse', 'Bexar', 'TX', '78109', '2106595737', NULL, '9135 Schaefer Rd', 'Converse', 'Bexar', 'TX', '78109', '2106595737', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2008-06-01', '2011-04-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1104822683', 0, 'N', 0, '2011-04-28', NULL, NULL, 0, 0, NULL, NULL),
('113676182', 'W11005078', 'W11005078', 'TX01', 'The Podiatry Group of South Texas', 'Carmina', '', 'Fusco', 'DPM', 'Podiatry', '', '', NULL, 'B', 'PO Box 1277', 'San Antonio', 'Bexar', 'TX', '78295', '2105459100', NULL, 'PO Box 1277', 'San Antonio', 'Bexar', 'TX', '78295', '2105459100', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2008-06-01', '2011-04-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1104822683', 0, 'Y', 0, '2011-04-28', NULL, NULL, 0, 0, NULL, NULL),
('870649259', 'W11005091', 'W11005091', 'UT01', 'Alpine Orthopaedic Specialists', 'Kelly', 'W', 'Hubbard', 'MD', 'Dermatology', '', '', NULL, 'O', '44 N 100 E', 'Preston', 'Franklin', 'ID', '83263', '4357872000', NULL, '44 N 100 E', 'Preston', 'Franklin', 'ID', '83263', '4357872000', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', '2012-05-23', 0, 0, 0, 'Logan Regional Hospital', '', '', '', 'HCFA|UB|', '1871542308', 0, 'N', 0, '2014-03-20', NULL, NULL, 0, 0, NULL, NULL),
('820471484', 'W11005089', 'W11005089', 'ID01', 'Kuna Family Medical Clinic', 'Edward', 'H', 'Newcombe', 'MD', 'Internal Medicine', 'Family Practice', '', NULL, 'B', 'PO Box 68', 'Kuna', 'Ada', 'ID', '83634', '2089225130', NULL, 'PO Box 68', 'Kuna', 'Ada', 'ID', '83634', '2089225130', '', 'IDSTD', 'WUSTDHCPC5', NULL, '0.00', '30.00', '0.00', 3, '2008-07-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|UB|', '1063441343', 0, 'Y', 0, '2013-10-30', NULL, NULL, 0, 0, NULL, NULL),
('820471484', 'W11005090', 'W11005090', 'ID01', 'Kuna Family Medical Clinic', 'Myrna', '', 'Fisher', 'FNP', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 68', 'Kuna', 'Ada', 'ID', '83634', '2089225130', NULL, 'PO Box 68', 'Kuna', 'Ada', 'ID', '83634', '2089225130', '', 'IDSTD', 'WUSTDHCPC5', NULL, '0.00', '30.00', '0.00', 3, '2008-07-01', '2012-08-19', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1306839741', 0, 'Y', 0, '2014-01-24', NULL, NULL, 0, 0, NULL, NULL),
('820471484', 'W11005087', 'W11005087', 'ID01', 'Kuna Family Medical Clinic', 'Edward', 'H', 'Newcombe', 'MD', 'Internal Medicine', 'Family Practice', '', NULL, 'O', '190 W Main St', 'Kuna', 'Ada', 'ID', '83634', '2089225130', NULL, '190 W Main St', 'Kuna', 'Ada', 'ID', '83634', '2089225130', '', 'IDSTD', 'WUSTDHCPC5', NULL, '0.00', '30.00', '0.00', 3, '2008-07-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|UB|', '1063441343', 0, 'n', 0, '2013-10-30', NULL, NULL, 43.4909, -116.415, NULL, NULL),
('820471484', 'W11005088', 'W11005088', 'ID01', 'Kuna Family Medical Clinic', 'Myrna', '', 'Fisher', 'FNP', 'Internal Medicine', '', '', NULL, 'O', '190 W Main St', 'Kuna', 'Ada', 'ID', '83634', '2089225130', NULL, '190 W Main St', 'Kuna', 'Ada', 'ID', '83634', '2089225130', '          ', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2008-07-01', '2012-02-29', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1306839741', 0, 'N', 0, '2014-01-24', NULL, NULL, 43.4909, -116.415, NULL, NULL),
('200900688', 'W11005084', 'W11005084', 'ID01', 'Dermatology Center of Canyon County', 'Gavin', 'R', 'Powell', 'MD', 'Dermatology', '', '', NULL, 'O', '318 2nd St S', 'Nampa', 'Canyon', 'ID', '83651', '2084673006', NULL, '318 2nd St S', 'Nampa', 'Canyon', 'ID', '83651', '2084673006', '', 'IDSTD', 'WUSTDHCPC5', NULL, '0.00', '30.00', '0.00', 3, '2008-07-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, NULL, NULL, 'HCFA|UB|', '1215933940', 0, 'n', 0, '2014-03-20', NULL, NULL, 43.5843, -116.569, NULL, NULL),
('200900688', 'W11005086', 'W11005086', 'ID01', 'Dermatology Center of Canyon County', '', '', 'Dermatology Center of Canyon County', 'GROUP', 'Dermatology', '', '', NULL, 'B', '318 2nd St S', 'Nampa', 'Canyon', 'ID', '83651', '2084673006', NULL, '318 2nd St S', 'Nampa', 'Canyon', 'ID', '83651', '2084673006', '', 'IDSTD', 'WUSTDHCPC5', NULL, '0.00', '30.00', '0.00', 3, '2008-07-01', '2012-08-19', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1578694238', 0, 'Y', 0, '2012-02-13', NULL, NULL, 43.5843, -116.569, NULL, NULL),
('200900688', 'W11005085', 'W11005085', 'ID01', 'Dermatology Center of Canyon County', 'Seth', '', 'Permann', 'PA-C', 'Dermatology', '', '', NULL, 'O', '318 2nd St S', 'Nampa', 'Canyon', 'ID', '83651', '2084673006', NULL, '318 2nd St S', 'Nampa', 'Canyon', 'ID', '83651', '2084673006', '', 'IDSTD', 'WUSTDHCPC5', NULL, '0.00', '30.00', '0.00', 3, '2008-07-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, NULL, NULL, 'HCFA|UB|', '1508855974', 0, 'n', 0, '2012-02-13', NULL, NULL, 43.5843, -116.569, NULL, NULL),
('426257539', 'W11005080', 'W11005080', 'ID01', 'Boise Neurological Consultants', 'Barbara', 'R', 'Bess', 'MD', 'Neurology', '', '', NULL, 'O', '999 N Curtis Rd Ste 506', 'Boise', 'Ada', 'ID', '83706', '2083672800', NULL, '999 N Curtis Rd Ste 506', 'Boise', 'Ada', 'ID', '83706', '2083672800', '          ', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2008-07-01', '2009-02-01', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1063408243', 0, 'N', 0, '2011-02-09', NULL, NULL, 43.6132, -116.255, NULL, NULL),
('519376897', 'W11005081', 'W11005081', 'ID01', 'Boise Neurological Consultants', 'James', 'D', 'Redshaw', 'MD', 'Neurology', '', '', NULL, 'O', '999 N Curtis Rd Ste 506', 'Boise', 'Ada', 'ID', '83706', '2083672800', NULL, '999 N Curtis Rd Ste 506', 'Boise', 'Ada', 'ID', '83706', '2083672800', '', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2008-07-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1487640561', 0, 'n', 0, '2014-05-19', NULL, NULL, 43.6132, -116.255, NULL, NULL),
('208501652', 'W11005082', 'W11005082', 'ID01', 'Boise Neurological Consultants', 'George', 'R', 'Lyons', 'MD', 'Neurology', '', '', NULL, 'O', '999 N Curtis Rd Ste 506', 'Boise', 'Ada', 'ID', '83706', '2083672800', NULL, '999 N Curtis Rd Ste 506', 'Boise', 'Ada', 'ID', '83706', '2083672800', '', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2008-07-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1386630465', 0, 'n', 0, '2014-05-19', NULL, NULL, 43.6132, -116.255, NULL, NULL),
('097345729', 'W11005083', 'W11005083', 'ID01', 'Boise Neurological Consultants', 'Richard', 'W', 'Wilson', 'MD', 'Neurology', '', '', NULL, 'O', '999 N Curtis Rd Ste 506', 'Boise', 'Ada', 'ID', '83706', '2083672800', NULL, '999 N Curtis Rd Ste 506', 'Boise', 'Ada', 'ID', '83706', '2083672800', '', 'IDSTD', 'WUSTDHCPC5', NULL, '0.00', '30.00', '0.00', 3, '2008-07-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1982691598', 0, 'n', 0, '2012-03-06', NULL, NULL, 43.6132, -116.255, NULL, NULL),
('942854057', 'W11005114', 'W11005114', 'UTPEHP', 'IHC Bountiful Health Center', 'Heather', 'L', 'LeSieur', 'PA', 'Family Practice', '', '', NULL, 'O', '390 N Main St', 'Bountiful', 'Davis', 'UT', '84010', '8012941000', NULL, '390 N Main St', 'Bountiful', 'Davis', 'UT', '84010', '8012941000', '', 'PEHPMID', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1891726972', 0, 'N', 0, '2013-09-05', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11005113', 'W11005113', 'UTPEHP', 'IHC Bountiful Health Center', 'Sherlene', 'Tonia', 'Dean', 'APRN', '', '', '', NULL, 'O', '390 N Main St', 'Bountiful', 'Davis', 'UT', '84010', '8012941000', NULL, '390 N Main St', 'Bountiful', 'Davis', 'UT', '84010', '8012941000', '', 'PEHPMID', NULL, '', '0.00', '30.00', '0.00', 8, '2008-04-01', '2008-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1871603860', 0, 'N', 0, '2014-07-10', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11005112', 'W11005112', 'UTPEHP', 'IHC Bountiful Health Center', 'June', 'M', 'Steely', 'MD', 'Internal Medicine', NULL, NULL, NULL, 'O', '390 N Main St', 'Bountiful', 'Davis', 'UT', '84010', '8012941000', NULL, '390 N Main', 'Bountiful', 'Davis', 'UT', '84010', NULL, NULL, 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1891733374', 0, 'N', 0, '2008-06-16', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11005111', 'W11005111', 'UTPEHP', 'IHC Bountiful Health Center', 'David', 'Grant', 'Horsley', 'MD', 'Internal Medicine', NULL, NULL, NULL, 'O', '390 N Main St', 'Bountiful', 'Davis', 'UT', '84010', '8012941000', NULL, '390 N Main', 'Bountiful', 'Davis', 'UT', '84010', NULL, NULL, 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1750320552', 0, 'N', 0, '2008-06-16', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11005110', 'W11005110', 'UTPEHP', 'IHC Bountiful Health Center', 'Nedda', 'B', 'Hendler', 'MD', 'Internal Medicine', NULL, NULL, NULL, 'O', '390 N Main St', 'Bountiful', 'Davis', 'UT', '84010', '8012941000', NULL, '390 N Main', 'Bountiful', 'Davis', 'UT', '84010', NULL, NULL, 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1104863935', 0, 'N', 0, '2008-06-16', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11005115', 'W11005115', 'UTPEHP', 'IHC Bountiful Health Center', 'Cynthia', '0', 'Zumbrennen', 'PA', 'Family Practice', '', '', NULL, 'O', '390 N Main St', 'Bountiful', 'Davis', 'UT', '84010', '8012941000', NULL, '390 N Main', 'Bountiful', 'Davis', 'UT', '84010', '8012941000', '', 'PEHPMID', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, NULL, 0, 0, '', '', '', '', 'HCFA|UB|', '1255362323', 0, 'N', 0, '2010-05-24', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11005109', 'W11005109', 'UTPEHP', 'IHC Bountiful Health Center', 'David', 'A', 'VandeMerwe', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '390 N Main St', 'Bountiful', 'Davis', 'UT', '84010', '8012941000', NULL, '390 N Main', 'Bountiful', 'Davis', 'UT', '84010', NULL, NULL, 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1003859547', 0, 'N', 0, '2008-06-16', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11005105', 'W11005105', 'UTPEHP', 'IHC Bountiful Health Center', 'Scott', 'H', 'Beckstead', 'DO', 'Family Practice', NULL, NULL, NULL, 'O', '390 N Main St', 'Bountiful', 'Davis', 'UT', '84010', '8012941000', NULL, '390 N Main', 'Bountiful', 'Davis', 'UT', '84010', NULL, NULL, 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1508810854', 0, 'N', 0, '2010-01-12', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11005108', 'W11005108', 'UTPEHP', 'IHC Bountiful Health Center', 'Alisa', 'A', 'Knowlton', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '390 N Main St', 'Bountiful', 'Davis', 'UT', '84010', '8012941000', NULL, '390 N Main', 'Bountiful', 'Davis', 'UT', '84010', NULL, NULL, 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1124073556', 0, 'N', 0, '2008-06-16', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11005107', 'W11005107', 'UTPEHP', 'IHC Bountiful Health Center', 'Douglas', 'S', 'Kasteler', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '390 N Main St', 'Bountiful', 'Davis', 'UT', '84010', '8012941000', NULL, '390 N Main', 'Bountiful', 'Davis', 'UT', '84010', NULL, NULL, 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1659313583', 0, 'N', 0, '2008-06-16', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11005106', 'W11005106', 'UTPEHP', 'IHC Bountiful Health Center', 'Celia', 'Webb', 'Blackburn', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '390 N Main St', 'Bountiful', 'Davis', 'UT', '84010', '8012941000', NULL, '390 N Main', 'Bountiful', 'Davis', 'UT', '84010', NULL, NULL, 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1205873478', 0, 'N', 0, '2008-06-16', NULL, NULL, 0, 0, NULL, NULL),
('621795217', 'W11005096', 'W11005096', 'UT01', 'Davis Hospital Hyperbaric', 'Stacey', 'A', 'Raybuck', 'DO', 'Family Practice', 'Hyperbaric Wound', NULL, NULL, 'B', 'PO Box 160424', 'Clearfield', 'Davis', 'UT', '840160424', '8018077900', NULL, 'PO Box 160424', 'Clearfield', NULL, 'UT', '840160424', NULL, NULL, 'WUSTDINT5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2008-05-01', '2008-08-17', NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1720020076', 0, 'Y', 0, '2008-08-15', NULL, NULL, 0, 0, NULL, NULL),
('621795217', 'W11005095', 'W11005095', 'UT01', 'Davis Hospital Hyperbaric', 'Tommy', 'Lee', 'Love', 'MD', 'Hyperbaric Wound', NULL, NULL, NULL, 'B', 'PO Box 160424', 'Clearfield', 'Davis', 'UT', '840160424', '8018077900', NULL, 'PO Box 160424', 'Clearfield', NULL, 'UT', '840160424', NULL, NULL, 'WUSTDINT5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2007-06-01', '2008-08-17', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1164491403', 0, 'Y', 0, '2008-08-15', NULL, NULL, 0, 0, NULL, NULL),
('621795217', 'W11005094', 'W11005094', 'UT01', 'Hyperbaric and Wound Care', 'Stacey', 'A', 'Raybuck', 'DO', 'Family Practice', 'Hyperbaric Wound', NULL, NULL, 'O', '2132 N 1700 W Ste 100', 'Layton', 'Davis', 'UT', '84041', '8018077900', NULL, 'PO Box 160424', 'Clearfield', 'Davis', 'UT', '840160424', NULL, NULL, 'WUSTDINT5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2008-05-01', '2008-08-17', NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1720020076', 0, 'N', 0, '2008-08-15', NULL, NULL, 0, 0, NULL, NULL),
('920185134', 'W11005098', 'W11005098', 'UT01', 'Highland Family Practice', 'Malinda', '', 'Christensen', 'PA', 'Family Practice', '', '', NULL, 'O', '4460 Highland Dr Ste 400', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012724111', '8012725989', '4460 Highland Dr Ste 400', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012724111', '8012725989', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2008-01-01', '2008-01-01', 0, 0, 0, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1285812586', 0, 'N', 0, '2012-10-01', NULL, NULL, 0, 0, NULL, NULL),
('920185134', 'W11005097', 'W11005097', 'UT01', 'Highland Family Practice', 'Laura', '', 'Helm', 'PA', 'Family Practice', '', '', NULL, 'O', '4460 Highland Dr Ste 400', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012724111', '8012725989', '4460 Highland Dr Ste 400', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012724111', '8012725989', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2008-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1104003656', 0, 'N', 0, '2013-10-30', NULL, NULL, 40.6754, -111.842, NULL, NULL),
('942854057', 'W11005099', 'W11005099', 'UTPEHP', 'McKay Dee Rheumatology', 'Deborah', 'A', 'Hackett', 'MD', 'Endocrinology', '', '', NULL, 'O', '4403 Harrison Blvd Ste 3630', 'Ogden', 'Weber', 'UT', '84403', '8013877901', NULL, '4403 Harrison Blvd Ste 3630', 'Ogden', 'Weber', 'UT', '84403', '8013877901', '', 'IHCPEHP', NULL, '', '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1821028903', 0, 'N', 0, '2014-06-27', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11005100', 'W11005100', 'UTPEHP', 'Intermountain Health Care', 'Jack', 'D', 'Wahlen', 'MD', 'Endocrinology', NULL, NULL, NULL, 'O', '4403 Harrison Blvd Ste 3630', 'Ogden', 'Weber', 'UT', '84403', '8013877901', NULL, '4403 Harrison Blvd  #3630', 'Ogden', 'Weber', 'UT', '84403', NULL, NULL, 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1033143508', 0, 'N', 0, '2008-06-16', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11005101', 'W11005101', 'UTPEHP', 'McKay Dee Rheumatology', 'Jeffrey', 'Edward', 'Booth', 'MD', 'Rheumatology', NULL, NULL, NULL, 'O', '4403 Harrison Blvd Ste 3630', 'Ogden', 'Weber', 'UT', '84403', '8013877125', NULL, '4403 Harrison Blvd  #3650', 'Ogden', 'Weber', 'UT', '84403', NULL, NULL, 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1174552830', 0, 'N', 0, '2008-06-16', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11005102', 'W11005102', 'UTPEHP', 'McKay Dee Rheumatology', 'Shelby', 'R', 'Dames', 'MD', 'Rheumatology', NULL, NULL, NULL, 'O', '4403 Harrison Blvd Ste 3630', 'Ogden', 'Weber', 'UT', '84403', '8013877125', NULL, '4403 Harrison Blvd #3650', 'Ogden', 'Weber', 'UT', '84403', NULL, NULL, 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1528000940', 0, 'N', 0, '2008-06-16', 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', 'W11005103', 'W11005103', 'UTPEHP', 'McKay Dee Rheumatology', 'John', 'Frits', 'Mijer', 'MD', 'Rheumatology', '', '', NULL, 'O', '4403 Harrison Blvd Ste 3630', 'Ogden', 'Weber', 'UT', '84403', '8013877125', NULL, '4403 Harrison Blvd  #3650', 'Ogden', 'Weber', 'UT', '84403', NULL, NULL, 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1154354090', 0, 'N', 0, '2008-06-16', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11005104', 'W11005104', 'UTPEHP', 'McKay Dee Rheumatology', 'Chara', 'J', 'Solich', 'MD', 'Rheumatology', NULL, NULL, NULL, 'O', '4403 Harrison Blvd Ste 3630', 'Ogden', 'Weber', 'UT', '84403', '8013877125', NULL, '4403 Harrison Blvd  #3650', 'Ogden', 'Weber', 'UT', '84403', NULL, NULL, 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-04-01', '2008-08-19', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1134158892', 0, 'N', 0, '2008-06-16', NULL, NULL, 0, 0, NULL, NULL),
('208676464', 'W11005092', 'W11005092', 'UT01', 'Ogden Nurse Midwives', 'Christina', 'M', 'Francis', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '5495 S 500 E Ste 320', 'Ogden', 'Weber', 'UT', '84405', '8014767300', NULL, '5495 S 500 E Ste 320', 'Ogden', 'Weber', 'UT', '84405', '8014767300', '          ', 'WISESTD', 'WUSTDHCPC', '', '0.00', '35.00', '0.00', 3, '2007-11-01', '2011-11-10', 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1780702605', 0, 'N', 0, '2011-12-20', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'W11005072', 'W11005072', 'UT01', 'Skaggs Chiropractic', 'Daniel', 'S', 'Skaggs', 'DC', 'Chiropractic', '', '', NULL, 'O', '2721 N Hwy 89 Ste 100', 'Pleasant View', 'Weber', 'UT', '84414', '8017824454', '8017824455', '2721 N Hwy 89 Ste 100', 'Pleasant View', 'Weber', 'UT', '84414', '8017824454', '8017824455', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2008-05-31', '2010-10-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1477684884', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('202785803', 'W11005093', 'W11005093', 'UT01', 'Color Country Pediatrics', 'Brian', 'C', 'McCune', 'MD', 'Pediatrics', '', '', NULL, 'B', 'PO Box 3040', 'Cedar City', 'Iron', 'UT', '84721', '4358650218', NULL, 'PO Box 3040', 'Cedar City', 'Iron', 'UT', '84721', '4358650218', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2007-01-01', '2008-12-31', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1790819241', 0, 'Y', 0, '2011-09-30', NULL, NULL, 0, 0, NULL, NULL),
('208670470', 'W11005077', 'W11005077', 'UT01', '', 'Mark', 'H', 'Keep', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '736 S 900 E Ste 108', 'St George', 'Washington', 'UT', '84790', '4356348383', NULL, '736 S 900 E Ste 108', 'St George', 'Washington', 'UT', '84790', '4356348383', '          ', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2008-02-01', '2011-08-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1609859297', 0, 'N', 0, '2011-11-15', NULL, NULL, 0, 0, NULL, NULL),
('208670470', 'W11005076', 'W11005076', 'UT01', '', 'Mary', 'A', 'McDonnell', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '736 S 900 E Ste 108', 'St George', 'Washington', 'UT', '84790', '4356348383', NULL, '736 S 900 E Ste 108', 'St George', 'Washington', 'UT', '84790', '4356348383', '          ', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2008-02-01', '2011-10-26', 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1316126410', 0, 'N', 0, '2012-11-05', NULL, NULL, 0, 0, NULL, NULL),
('208670470', 'W11005075', 'W11005075', 'UT01', '', 'David', 'C', 'Boorman', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '736 S 900 E Ste 108', 'St George', 'Washington', 'UT', '84790', '4356348383', NULL, '736 S 900 E Ste 108', 'St George', 'Washington', 'UT', '84790', '4356348383', '          ', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2008-02-01', '2011-10-26', 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1659344471', 0, 'N', 0, '2013-10-31', NULL, NULL, 0, 0, NULL, NULL),
('208670470', 'W11005074', 'W11005074', 'UT01', '', 'Gregory', 'D', 'Price', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '736 S 900 E Ste 108', 'St George', 'Washington', 'UT', '84790', '4356348383', NULL, '736 S 900 E Ste 108', 'St George', 'Washington', 'UT', '84790', '4356348383', '', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2008-02-01', '2011-10-27', 0, 0, 0, 'Dixie Regional Medical Center', '', '', '', 'HCFA|UB|', '1699761106', 0, 'N', 0, '2014-04-16', NULL, NULL, 0, 0, NULL, NULL),
('208670470', 'W11005073', 'W11005073', 'UT01', '', 'William', 'W', 'Barney', 'MD', 'Internal Medicine', 'Cardiovascular Disease', 'Hospitalist', NULL, 'O', '736 S 900 E Ste 108', 'St George', 'Washington', 'UT', '84790', '4356348383', NULL, '736 S 900 E Ste 108', 'St George', 'Washington', 'UT', '84790', '4356348383', '', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2008-02-01', '2011-07-27', 0, 0, 0, 'Dixie Regional Medical Center', '', '', '', 'HCFA|UB|', '1194799890', 0, 'N', 0, '2014-07-16', NULL, NULL, 0, 0, NULL, NULL),
('742083988', 'W11005124', 'W11005124', 'TX01', 'Renal Associates', 'Fadi', '', 'Abouzahr', 'MD', 'Nephrology', '', '', NULL, 'O', '4499 Medical Dr Ste 102', 'San Antonio', 'Bexar', 'TX', '78229', '2109490469', NULL, '4499 Medical Dr Ste 102', 'San Antonio', 'Bexar', 'TX', '78229', '2109490469', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2007-01-01', '2012-08-19', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1982695896', 0, 'N', 0, '2013-05-24', NULL, NULL, 29.5105, -98.5737, NULL, NULL),
('820477852', 'W11005160', 'W11005160', 'ID01', 'Saint Alphonsus Medical Group Eagle Health Plaza', 'Stacey', '', 'Townsend', 'MD', 'Pediatrics', '', '', NULL, 'O', '323 E Riverside Dr Ste 224', 'Eagle', 'Ada', 'ID', '83616', '2083675750', NULL, '323 E Riverside Dr Ste 224', 'Eagle', 'Ada', 'ID', '83616', '2083675750', '', 'IDSAMG2', NULL, '', '0.00', '10.00', '0.00', 6, '2008-07-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1962554568', 0, 'n', 0, '2014-06-20', NULL, NULL, 43.6892, -116.351, NULL, NULL),
('810623006', 'W11005146', 'W11005146', 'ID01', 'Millenium Podiatry', 'Randy', 'E', 'Lowe', 'DPM', 'Podiatry', NULL, NULL, NULL, 'O', '1828 S Millenium Way Ste 200', 'Meridian', 'Ada', 'ID', '83642', '2083870900', NULL, '230 W Mallard', 'Boise', 'Ada', 'ID', '83706', NULL, NULL, 'IDSTD', 'WUSTDHCPC5', NULL, '0.00', '30.00', '0.00', 3, '2008-07-01', '2008-12-29', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000007343', 0, 'n', 0, '2008-06-18', NULL, NULL, 0, 0, NULL, NULL),
('203276415', 'W11005147', 'W11005147', 'ID01', 'Ada West Dermatology', 'Laura', 'B', 'Allen', 'PA-C', 'Dermatology', '', '', NULL, 'O', '1618 S Millennium Way Ste 100', 'Meridian', 'Ada', 'ID', '83642', '2088843376', NULL, '1618 S Millennium Way Ste 100', 'Meridian', 'Ada', 'ID', '83642', '2088843376', '', 'IDSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2012-08-19', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1740476969', 0, 'n', 0, '2013-03-20', NULL, NULL, 43.5903, -116.368, NULL, NULL),
('203276415', 'W11005148', 'W11005148', 'ID01', 'Ada West Dermatology', 'Brian', 'D', 'Friedt', 'PA-C', 'Dermatology', '', '', NULL, 'O', '1618 S Millennium Way Ste 100', 'Meridian', 'Ada', 'ID', '83642', '2088843376', NULL, '1618 S Millennium Way Ste 100', 'Meridian', 'Ada', 'ID', '83642', '2088843376', '', 'IDSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2012-08-19', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1568499713', 0, 'n', 0, '2013-03-20', NULL, NULL, 43.5903, -116.368, NULL, NULL),
('203276415', 'W11005149', 'W11005149', 'ID01', 'Ada West Dermatology', 'Janice', '', 'Neilson', 'FNP-C', 'Dermatology', '', '', NULL, 'O', '1618 S Millennium Way Ste 100', 'Meridian', 'Ada', 'ID', '83642', '2088843376', NULL, '1618 S Millennium Way Ste 100', 'Meridian', 'Ada', 'ID', '83642', '2088843376', '          ', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2008-07-01', '2012-08-19', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1447289681', 0, 'N', 0, '2013-03-20', NULL, NULL, 43.5903, -116.368, NULL, NULL),
('203276415', 'W11005150', 'W11005150', 'ID01', 'Ada West Dermatology', 'Teresa', '', 'Graklanoff', 'PA-C', 'Dermatology', '', '', NULL, 'O', '1618 S Millennium Way Ste 100', 'Meridian', 'Ada', 'ID', '83642', '2088843376', NULL, '1618 S Millennium Way Ste 100', 'Meridian', 'Ada', 'ID', '83642', '2088843376', '', 'IDSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2012-08-19', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1265461479', 0, 'n', 0, '2013-03-20', NULL, NULL, 43.5903, -116.368, NULL, NULL),
('203276415', 'W11005151', 'W11005151', 'ID01', 'Ada West Dermatology', 'Alan', 'J', 'Pitt', 'MD PHD', 'Dermatology', '', '', NULL, 'O', '1618 S Millennium Way Ste 100', 'Meridian', 'Ada', 'ID', '83642', '2088843376', NULL, '1618 S Millennium Way Ste 100', 'Meridian', 'Ada', 'ID', '83642', '2088843376', '', 'IDSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1659301950', 0, 'n', 0, '2013-03-20', NULL, NULL, 43.5903, -116.368, NULL, NULL),
('203276415', 'W11005152', 'W11005152', 'ID01', 'Ada West Dermatology', 'Randall', 'D', 'Burr', 'MD', 'Dermatology', '', '', NULL, 'O', '1618 S Millennium Way Ste 100', 'Meridian', 'Ada', 'ID', '83642', '2088843376', NULL, '1618 S Millennium Way Ste 100', 'Meridian', 'Ada', 'ID', '83642', '2088843376', '', 'IDSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|UB|', '1740217603', 0, 'n', 0, '2014-04-17', NULL, NULL, 43.5903, -116.368, NULL, NULL),
('820487790', 'W11005153', 'W11005153', 'ID01', 'Selah Medical Center', 'Lawrence', 'E', 'Brown', 'MD', 'Family Practice', '', '', NULL, 'O', '1618 S Millennium Way Ste 220', 'Boise', 'Ada', 'ID', '83704', '2083775055', NULL, '1618 S Millennium Wy Ste 220', 'Boise', 'Ada', 'ID', '83704', '2083775055', '          ', 'IDPCPSELAH', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2008-07-01', '2011-12-15', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|UB|', '1922040021', 0, 'N', 0, '2012-01-25', NULL, NULL, 0, 0, NULL, NULL),
('810623006', 'W11005145', 'W11005145', 'ID01', 'Park Center Foot and Ankle Clinic', 'Randy', 'E', 'Lowe', 'DPM', 'Podiatry', NULL, NULL, NULL, 'O', '230 W Mallard Ste C', 'Boise', 'Ada', 'ID', '83706', '2083870900', NULL, '230 W Mallard', 'Boise', 'Ada', 'ID', '83706', NULL, NULL, 'IDSTD', 'WUSTDHCPC5', NULL, '0.00', '30.00', '0.00', 3, '2008-07-01', '2008-12-29', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000007343', 0, 'n', 0, '2008-06-18', NULL, NULL, 0, 0, NULL, NULL),
('820477852', 'W11005161', 'W11005161', 'ID01', 'Saint Alphonsus Medical Group Pediatrics', 'Stacey', '', 'Townsend', 'MD', 'Pediatrics', '', '', NULL, 'B', '999 N Curtis Rd Ste 407', 'Boise', 'Ada', 'ID', '83706', '2083674321', NULL, '999 N Curtis Rd Ste 407', 'Boise', 'Ada', 'ID', '83706', '2083674321', '', 'IDSAMG2', NULL, '', '0.00', '10.00', '0.00', 6, '2008-07-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1962554568', 0, 'Y', 0, '2014-06-20', NULL, NULL, 43.6132, -116.255, NULL, NULL),
('204969546', 'W11005155', 'W11005155', 'ID01', 'Meridian Pediatrics', 'Angella', 'M', 'Zieba', 'MD', 'Pediatrics', '', '', NULL, 'O', '3653 N Locust Grove Rd', 'Meridian', 'Ada', 'ID', '83646', '2083385437', NULL, '3653 N Locust Grove Rd', 'Meridian', 'Ada', 'ID', '83646', '2083385437', '', 'IDSTD10', 'WUSTDHCPC5', NULL, '0.00', '30.00', '0.00', 3, '2008-07-01', '2012-08-19', 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1730131905', 0, 'n', 0, '2012-04-24', NULL, NULL, 43.6379, -116.376, NULL, NULL),
('204969546', 'W11005154', 'W11005154', 'ID01', 'Meridian Pediatrics', 'Allyson', 'A', 'Van Steenbergen', 'MD', 'Pediatrics', '', '', NULL, 'O', '3653 N Locust Grove Rd', 'Meridian', 'Ada', 'ID', '83646', '2083385437', NULL, '3653 N Locust Grove Rd', 'Meridian', 'Ada', 'ID', '83646', '2083385437', '', 'IDSTD10', 'WUSTDHCPC5', NULL, '0.00', '30.00', '0.00', 3, '2008-07-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|UB|', '1174544829', 0, 'n', 0, '2012-04-13', NULL, NULL, 43.6379, -116.376, NULL, NULL),
('870639098', 'W11005117', 'W11005117', 'UT01', 'After Hours Urgent Care American Fork', 'Cheryl', 'L', 'Henley', 'MD', 'Occupational Therapy', 'Urgent Care', '', NULL, 'O', '476 N 900 W Ste C', 'American Fork', 'Utah', 'UT', '84003', '8014921611', '8014901480', '476 N 900 W Ste C', 'American Fork', 'Utah', 'UT', '84003', '8014921611', '8014901480', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2008-02-06', '2012-10-11', 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1982617809', 0, 'Y', 0, '2012-10-15', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W11005135', 'W11005135', 'UT01', 'Central Utah Clinic', 'Jerry', 'Dale', 'Walker, Jr', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1175 E 50 S Ste 251', 'American Fork', 'Utah', 'UT', '84003', '8014922815', '8018155500', '1175 E 50 S Ste 251', 'American Fork', 'Utah', 'UT', '84003', '8014922815', '8018155500', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-06-01', '2010-07-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1649238866', 0, 'N', 0, '2011-07-15', NULL, NULL, 0, 0, NULL, NULL),
('529082093', 'W11005159', 'W11005159', 'UTMH1', NULL, 'Larry', 'A', 'Anderson', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '845 S Main St Ste B-8', 'Bountiful', 'Davis', 'UT', '84010', '8012993411', NULL, '845 S Main St Ste B-8', 'Bountiful', 'Davis', 'UT', '84010', '8012993411', '', 'MA', NULL, '', '0.00', '35.00', '0.00', 3, '2008-07-01', '2008-08-20', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1700942281', 0, 'N', 0, '2014-05-08', NULL, NULL, 0, 0, NULL, NULL),
('870639098', 'W11005121', 'W11005121', 'UT01', 'After Hours Medical Company', 'Cheryl', 'L', 'Henley', 'MD', 'Occupational Therapy', 'Urgent Care', '', NULL, 'B', 'PO Box 1000', 'Draper', 'Salt Lake', 'UT', '84020', '8013529500', '8013529502', 'PO Box 1000', 'Draper', 'Salt Lake', 'UT', '84020', '8013529500', '8013529502', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2008-02-06', '2008-11-01', 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1982617809', 0, 'Y', 0, '2012-10-11', NULL, NULL, 0, 0, NULL, NULL),
('870639098', 'W11005120', 'W11005120', 'UT01', 'After Hours Urgent Care Draper', 'Cheryl', 'L', 'Henley', 'MD', 'Occupational Therapy', 'Urgent Care', '', NULL, 'O', '1126 Draper Pkwy', 'Draper', 'Salt Lake', 'UT', '84020', '8015450600', NULL, '1126 Draper Pkwy', 'Draper', 'Salt Lake', 'UT', '84020', '8015450600', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2008-02-06', '2012-10-11', 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1982617809', 0, 'Y', 0, '2012-10-15', NULL, NULL, 0, 0, NULL, NULL),
('870639098', 'W11005123', 'W11005123', 'UT01', 'After Hours Urgent Care Layton', 'Cheryl', 'L', 'Henley', 'MD', 'Occupational Therapy', 'Urgent Care', '', NULL, 'O', '1550 N Main St Ste E', 'Layton', 'Davis', 'UT', '84041', '8016149030', NULL, '1550 N Main St Ste E', 'Layton', 'Davis', 'UT', '84041', '8016149030', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2008-02-06', '2012-10-11', 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1982617809', 0, 'Y', 0, '2012-10-15', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W11005140', 'W11005140', 'UT01', 'Central Utah Clinic', 'Charles', 'F', 'Dahl', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '700 W 800 N Ste 230', 'Orem', 'Utah', 'UT', '84057', '8013734366', NULL, '700 W 800 N Ste 230', 'Orem', 'Utah', 'UT', '84057', '8013734366', '          ', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-01-01', '2010-07-14', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1912965344', 0, 'N', 0, '2013-07-19', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W11005134', 'W11005134', 'UT01', 'Central Utah Clinic', 'Melvin', 'E', 'Carter', 'MD', 'Cardiovascular Disease', 'Internal Medicine', '', NULL, 'O', '700 W 800 N Ste 230', 'Orem', 'Utah', 'UT', '84057', '8014922815', '8018155500', '700 W 800 N Ste 230', 'Orem', 'Utah', 'UT', '84057', '8014922815', '8018155500', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-06-01', '2010-07-14', 0, 0, 0, 'Timpanogos Regional Hospital', 'Mountain View Regional Hospital', '', '', 'HCFA|UB|', '1700815834', 0, 'N', 0, '2013-03-30', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W11005136', 'W11005136', 'UT01', 'Central Utah Clinic', 'Jerry', 'Dale', 'Walker, Jr', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '700 W 800 N Ste 230', 'Orem', 'Utah', 'UT', '84057', '8014922815', '8018155500', '700 W 800 N Ste 230', 'Orem', 'Utah', 'UT', '84057', '8014922815', '8018155500', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-06-01', '2010-07-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1649238866', 0, 'N', 0, '2011-07-15', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W11005137', 'W11005137', 'UT01', 'Central Utah Clinic', 'John', 'Kay', 'Frischknecht', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '700 W 800 N Ste 230', 'Orem', 'Utah', 'UT', '84057', '8013734366', NULL, '700 W 800 N Ste 230', 'Orem', 'Utah', 'UT', '84057', '8013734366', '          ', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-01-01', '2010-07-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1235197674', 0, 'N', 0, '2013-08-29', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W11005139', 'W11005139', 'UT01', 'Central Utah Clinic', 'Marvin', 'R', 'Allen', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '700 W 800 N Ste 230', 'Orem', 'Utah', 'UT', '84057', '8013734366', NULL, '700 W 800 N Ste 230', 'Orem', 'Utah', 'UT', '84057', '8013734366', '          ', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-01-01', '2010-07-14', 0, 0, 0, 'Timpanogos Regional Hospital', 'Mountain View Regional Hospital', '', '', 'HCFA|UB|', '1831154566', 0, 'N', 0, '2013-09-09', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W11005141', 'W11005141', 'UT01', 'Central Utah Clinic', 'Douglas', 'R', 'Smith', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '700 W 800 N Ste 230', 'Orem', 'Utah', 'UT', '84057', '8013734366', '', '700 W 800 N Ste 230', 'Orem', 'Utah', 'UT', '84057', '8013734366', '', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-01-01', '2010-07-14', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1144288580', 0, 'N', 0, '2014-07-22', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W11005138', 'W11005138', 'UT01', 'Central Utah Clinic', 'Scott', 'Eugene', 'Bingham', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '700 W 800 N Ste 230', 'Orem', 'Utah', 'UT', '84057', '8013734366', NULL, '700 W 800 N Ste 230', 'Orem', 'Utah', 'UT', '84057', '8013734366', '          ', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-01-01', '2010-07-14', 0, 0, 0, 'Timpanogos Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1487612214', 0, 'N', 0, '2011-04-08', NULL, NULL, 0, 0, NULL, NULL),
('573822399', 'W11005167', 'W11005167', 'UTMH1', 'Center for Care, Comfort and Connection', 'John', 'E', 'Boden', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '1392 W State St Ste 125', 'Pleasant Grove', 'Utah', 'UT', '84062', '8014000734', NULL, '1392 W State St Ste 125', 'Pleasant Grove', 'Utah', 'UT', '84062', '8014000734', '', 'UTMA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1952329351', 0, 'n', 0, '2014-05-05', NULL, NULL, 0, 0, NULL, NULL),
('204290817', 'W11005169', 'W11005169', 'UTMH1', 'Moose Mountain Healing Inc', 'Rita', 'B', 'Baden', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '1745 Sidewinder Ave', 'Park City', 'Summit', 'UT', '84060', '4356599275', NULL, '1745 Sidewinder Ave', 'Park City', 'Summit', 'UT', '84060', '4356599275', '', 'UTMA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1831252931', 0, 'n', 0, '2014-04-24', NULL, NULL, 0, 0, NULL, NULL),
('573822399', 'W11005166', 'W11005166', 'UTMH1', 'Counseling & Assessments', 'John', 'E', 'Boden', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '11075 S State St Ste 28', 'Sandy', 'Salt Lake', 'UT', '84070', '8015018444', NULL, '11075 S State St Ste 28', 'Sandy', 'Salt Lake', 'UT', '84070', '8015018444', '', 'UTMA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1952329351', 0, 'n', 0, '2014-05-05', NULL, NULL, 0, 0, NULL, NULL),
('573822399', 'W11005165', 'W11005165', 'UTMH1', 'Aspen Ridge Counseling', 'John', 'E', 'Boden', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '50 N Main St', 'Tooele', 'Tooele', 'UT', '84074', '8014000734', NULL, '50 N Main St', 'Tooele', 'Tooele', 'UT', '84074', '8014000734', '', 'UTMA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1952329351', 0, 'n', 0, '2014-05-05', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W11005132', 'W11005132', 'UT01', 'Center of Orthopedic & Rehabilitation Excellence', 'Armen', '', 'Khachatryan', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '3584 W 9000 S Ste 405', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015683480', '8015683482', '3584 W 9000 S Ste 405', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015683480', '8015683482', 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2008-06-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1114930781', 0, 'N', 0, '2011-10-10', NULL, NULL, 40.5879, -111.976, NULL, NULL),
('621801973', 'W11005126', 'W11005126', 'UT01', 'Jordan Valley Internal Medicine', 'Kenneth', 'W', 'Goldberg', 'MD', 'Internal Medicine', NULL, NULL, NULL, 'B', '406 W South Jordan Pkwy Ste 500', 'South Jordan', 'Salt Lake', 'UT', '84095', '8019643921', NULL, 'PO Box 150', 'West Jordan', 'Salt Lake', 'UT', '84088', NULL, NULL, 'WUSTDINT5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2008-06-01', '2014-04-30', 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1356465793', 0, 'Y', 0, '2008-06-17', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W11005127', 'W11005127', 'UT01', 'Jordan Valley Internal Medicine', 'Kenneth', 'W', 'Goldberg', 'MD', 'Internal Medicine', NULL, NULL, NULL, 'O', '3570 W 9000 S Ste 100', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015692384', '8015698643', '3590 W 9000 S', 'West Jordan', 'Salt Lake', 'UT', '84088', NULL, NULL, 'WUSTDINT5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2008-06-01', '2014-04-30', 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1356465793', 0, 'N', 0, '2008-06-17', NULL, NULL, 40.588, -111.975, NULL, NULL),
('621801973', 'W11005128', 'W11005128', 'UT01', NULL, 'Lori', 'R', 'Swenson', 'MD', 'General Surgery', '', '', NULL, 'B', '406 W South Jordan Pkwy Ste 500', 'South Jordan', 'Salt Lake', 'UT', '84095', '8019643921', NULL, '406 W South Jordan Pkwy Ste 500', 'South Jordan', 'Salt Lake', 'UT', '84095', '8019643921', '', 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2008-06-01', NULL, 0, 0, 0, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1972534279', 0, 'Y', 0, '2011-09-29', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W11005130', 'W11005130', 'UT01', 'Jordan Valley Internal Medicine', 'David', 'R', 'Zackrison', 'MD', 'Internal Medicine', NULL, NULL, NULL, 'B', '406 W South Jordan Pkwy Ste 500', 'South Jordan', 'Salt Lake', 'UT', '84095', '8019643921', NULL, 'PO Box 150', 'West Jordan', 'Salt Lake', 'UT', '84088', NULL, NULL, 'WUSTDINT5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2008-06-01', '2014-04-30', 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1346364775', 0, 'Y', 0, '2008-06-17', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W11005131', 'W11005131', 'UT01', 'Jordan Valley Internal Medicine', 'David', 'R', 'Zackrison', 'MD', 'Internal Medicine', NULL, NULL, NULL, 'O', '3570 W 9000 S Ste 100', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015692384', '8015698643', '3590 W 9000 S', 'West Jordan', 'Salt Lake', 'UT', '84088', NULL, NULL, 'WUSTDINT5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2008-06-01', '2014-04-30', 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1346364775', 0, 'n', 0, '2008-06-17', NULL, NULL, 40.588, -111.975, NULL, NULL),
('573822399', 'W11005168', 'W11005168', 'UTMH1', '', 'John', 'E', 'Boden', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'B', 'PO Box 900245', 'Sandy', 'Salt Lake', 'UT', '84090', '8014000734', '          ', 'PO Box 900245', 'Sandy', 'Salt Lake', 'UT', '84090', '8014000734', '          ', 'UTMA', '', '', '0.00', '35.00', '0.00', 3, '2008-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1952329351', 0, 'N', 0, '2014-05-29', NULL, NULL, 0, 0, NULL, NULL),
('870639098', 'W11005116', 'W11005116', 'UT01', 'After Hours Urgent Care Sandy', 'Cheryl', 'L', 'Henley', 'MD', 'Occupational Therapy', 'Urgent Care', '', NULL, 'O', '7998 S 1300 E', 'Sandy', 'Salt Lake', 'UT', '84094', '8012552000', NULL, '7998 S 1300 E', 'Sandy', 'Salt Lake', 'UT', '84094', '8012552000', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2008-02-06', '2012-10-11', 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1982617809', 0, 'Y', 0, '2012-10-15', NULL, NULL, 0, 0, NULL, NULL),
('870639098', 'W11005122', 'W11005122', 'UT01', 'After Hours Urgent Care South Jordan', 'Cheryl', 'L', 'Henley', 'MD', 'Occupational Therapy', 'Urgent Care', '', NULL, 'O', '10433 S Redwood Rd', 'South Jordan', 'Salt Lake', 'UT', '84095', '8015010500', '8012560696', '10433 S Redwood Rd', 'South Jordan', 'Salt Lake', 'UT', '84095', '8015010500', '8012560696', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2008-02-06', '2012-10-11', 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1982617809', 0, 'Y', 0, '2012-10-15', NULL, NULL, 0, 0, NULL, NULL),
('529376305', 'W11005163', 'W11005163', 'UTMH1', 'Aspen Grove Counseling', 'A', 'L', 'Beckstead', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '1400 S Foothill Dr Ste 24', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015810422', NULL, '1400 S Foothill Dr Ste 24', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015810422', '', 'PHD', NULL, '', '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1952364622', 0, 'n', 0, '2014-07-16', NULL, NULL, 0, 0, NULL, NULL),
('752984900', 'W11005156', 'W11005156', 'UTMH1', NULL, 'Gayle', 'B', 'Adams', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '275 E South Temple Ste 101', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8015317389', NULL, '275 E South Temple Ste 101', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8015317389', '', 'MA', NULL, '', '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1982610960', 0, 'n', 0, '2014-05-08', NULL, NULL, 0, 0, NULL, NULL),
('204290817', 'W11005170', 'W11005170', 'UTMH1', 'Precision Billing', 'Rita', 'B', 'Baden', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', 'PO Box 761003', 'Salt Lake City', 'Salt Lake', 'UT', '84116', '4356599275', NULL, 'PO Box 761003', 'Salt Lake City', 'Salt Lake', 'UT', '84116', '4356599275', '', 'UTMA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1831252931', 0, 'y', 0, '2014-04-24', NULL, NULL, 0, 0, NULL, NULL),
('528527752', 'W11005164', 'W11005164', 'UTMH1', NULL, 'Barbara', '', 'Belnap', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '5630 Waterbury Way Ste 104B', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8012728818', NULL, '5630 Waterbury Way Ste 104B', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8012728818', '', 'UTMA', NULL, '', '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1336118009', 0, 'N', 0, '2014-05-08', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W11005129', 'W11005129', 'UT01', 'Pioneer Valley Multi Specialty Clinic', 'Lori', 'R', 'Swenson', 'MD', 'General Surgery', '', '', NULL, 'O', '3336 S Pioneer Parkway Ste 306', 'West Valley', 'Salt Lake', 'UT', '84120', '8019643855', NULL, '3336 S Pioneer Parkway Ste 306', 'West Valley', 'Salt Lake', 'UT', '84120', '8019643855', '', 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2008-06-01', NULL, 0, 0, 0, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1972534279', 0, 'N', 0, '2011-09-29', NULL, NULL, 40.6991, -111.99, NULL, NULL),
('621801973', 'W11005133', 'W11005133', 'UT01', 'Associates in Orthopedic Surgery', 'Armen', '', 'Khachatryan', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '3336 S Pioneer Parkway Ste 102', 'West Valley', 'Salt Lake', 'UT', '84120', '8019643925', '8019643928', '3336 S Pioneer Parkway Ste 102', 'West Valley', 'Salt Lake', 'UT', '84120', '8019643925', '8019643928', 'WUSTDSURG5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2008-06-01', '2011-10-07', 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1114930781', 0, 'N', 0, '2011-10-10', NULL, NULL, 0, 0, NULL, NULL),
('870639098', 'W11005118', 'W11005118', 'UT01', 'After Hours Urgent Care WVC', 'Cheryl', 'L', 'Henley', 'MD', 'Occupational Therapy', 'Urgent Care', '', NULL, 'O', '3451 S 5600 W Ste F', 'West Valley', 'Salt Lake', 'UT', '84121', '8019570900', NULL, '3451 S 5600 W Ste F', 'West Valley', 'Salt Lake', 'UT', '84121', '8019570900', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2008-02-06', '2012-10-11', 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1982617809', 0, 'Y', 0, '2012-10-15', NULL, NULL, 0, 0, NULL, NULL),
('202800071', 'W11005157', 'W11005157', 'UTMH1', 'Alpine Center for Personal Growth', 'Katherine', 'M', 'Tolsma', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '5689 S Redwood Rd Ste 30', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8012681715', '8012681783', '5689 S Redwood Rd Ste 30', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8012681715', '8012681783', 'UTMA', NULL, NULL, '0.00', '35.00', '0.00', 6, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1417155227', 0, 'n', 0, '2014-04-15', NULL, NULL, 0, 0, NULL, NULL),
('202800071', 'W11005158', 'W11005158', 'UTMH1', 'Alpine Center for Personal Growth', 'Christopher', 'D', 'Wightman', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '5689 S Redwood Rd Ste 30', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8012681715', '8012681783', '5689 S Redwood Rd Ste 30', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8012681715', '8012681783', 'UTMA', NULL, NULL, '0.00', '35.00', '0.00', 6, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1740337864', 0, 'n', 0, '2013-07-24', NULL, NULL, 0, 0, NULL, NULL),
('870682101', 'W11005119', 'W11005119', 'UT01', 'Salt Lake Orthopaedic Clinic', 'Pierre', '', 'Bois', 'PT', 'Physical Therapy', '', '', NULL, 'O', '1160 E 3900 S Ste 5000', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012628486', '8012629752', '1160 E 3900 S Ste 5000', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012628486', '8012629752', 'WUSLORTH5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1720067796', 0, 'N', 0, '2011-09-19', NULL, NULL, 40.6871, -111.858, NULL, NULL),
('870649259', 'W11005144', 'W11005144', 'UT01', 'Alpine Orthopaedic Specialists', '', '', 'Alpine Orthopaedic Specialists', 'GROUP', 'Orthopedic Surgery', '', '', NULL, 'B', 'PO Box 6250', 'North Logan', 'Cache', 'UT', '84341', '4357872000', NULL, 'PO Box 6250', 'North Logan', 'Cache', 'UT', '84341', '4357872000', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', '2013-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1427184449', 0, 'Y', 0, '2013-06-26', NULL, NULL, 0, 0, NULL, NULL),
('870649259', 'W11005143', 'W11005143', 'UT01', 'Alpine Orthopaedic Specialists', 'Kelly', 'W', 'Hubbard', 'MD', 'Dermatology', '', '', NULL, 'B', 'PO Box 6250', 'N Logan', 'Cache', 'UT', '84341', '4357872000', NULL, 'PO Box 6250', 'N Logan', 'Cache', 'UT', '84341', '4357872000', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', '2012-05-23', 0, 0, 0, 'Logan Regional Hospital', '', '', '', 'HCFA|UB|', '1871542308', 0, 'Y', 0, '2014-03-20', NULL, NULL, 0, 0, NULL, NULL),
('555829270', 'W11005162', 'W11005162', 'UTMH1', '', 'Thomas', 'E', 'Atkin', 'PSYD', 'Mental Health', 'Psychology', '', NULL, 'O', '3000 N Main Ste 2B', 'Logan', 'Cache', 'UT', '84341', '4357920355', NULL, '3000 N Main Ste 2B', 'Logan', 'Cache', 'UT', '84341', '4357920355', '', 'UTPHD', '', '', '0.00', '35.00', '0.00', 3, '2008-07-01', '2011-09-30', 0, 0, 0, 'Logan Regional Hospital', '', '', '', 'HCFA|UB|', '1730232513', 0, 'N', 0, '2014-05-01', NULL, NULL, 0, 0, NULL, NULL),
('208487468', 'W11005125', 'W11005125', 'UT01', 'Advanced Pulmonary, Sleep Disorders and Internal Medicine', 'Mustufa', 'T', 'Saifee', 'MD', 'Pulmonary', 'Sleep Disorders', 'Critical Care Medicine', NULL, 'O', '110 W 1325 N Ste 175', 'Cedar City', 'Iron', 'UT', '84721', '4356887770', NULL, '110 W 1325 N Ste 175', 'Cedar City', 'Iron', 'UT', '84721', '4356887770', '', 'WISESTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2008-07-07', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1568428357', 0, 'n', 0, '2012-03-26', NULL, NULL, 37.7011, -113.064, NULL, NULL),
('870281028', 'W11005142', 'W11005142', 'UT01', 'Central Utah Clinic', 'Rodney', 'Seymour', 'Badger', 'MD', 'Cardiovascular Disease', 'Internal Medicine', '', NULL, 'O', '700 W 800 N Ste 230', 'Orem', 'Utah', 'UT', '84057', '8013734366', NULL, '1055 N 500 W', 'Provo', NULL, 'UT', '84604', NULL, NULL, 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2006-01-01', '2009-06-30', NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1003874439', 0, 'N', 0, '2010-04-06', NULL, NULL, 0, 0, NULL, NULL),
('363525049', 'W11005176', 'W11005176', 'ID01', 'West Valley Medical Center', '', '', 'West Valley Medical Center', 'GROUP', 'Hospital', '', '', NULL, 'B', 'PO Box 403025', 'Atlanta', 'Fulton', 'GA', '30384', '2084553719', NULL, 'PO Box 403025', 'Atlanta', 'Fulton', 'GA', '30384', '2084553719', '', '', '', 'ID01', '0.00', '0.00', '0.00', 3, '2008-07-01', '2012-08-29', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009576', 0, 'Y', 0, '2014-04-22', NULL, NULL, 0, 0, NULL, NULL),
('820425454', 'W11005190', 'W11005190', 'ID01', 'Boise Anesthesia, PA', 'Emily', '', 'Price', 'CRNA', 'Nurse Anesthetist', '', '', NULL, 'O', '1717 Arlington Ave', 'Caldwell', 'Canyon', 'ID', '83605', '2084594641', NULL, '1717 Arlington Ave', 'Caldwell', 'Canyon', 'ID', '83605', '2084594641', '', 'IDSAMG3', NULL, NULL, '55.81', '10.00', '0.00', 3, '2008-07-01', '2010-01-30', 0, 15, 0, '', '', '', '', 'HCFA|UB|', '1508803255', 0, 'n', 0, '2012-12-27', NULL, NULL, 0, 0, NULL, NULL),
('820425454', 'W12024547', 'W12024547', 'ID01', 'Boise Anesthesia, PA', 'Kittrick', 'R', 'DuBois', 'CRNA', 'Nurse Anesthetist', '', '', NULL, 'B', 'PO Box 4268', 'Portland', 'Multnomah', 'OR', '97208', '8002758752', NULL, 'PO Box 4268   ', 'Portland', 'Multnomah', 'OR', '97208', '8002758752', '          ', 'IDSAMG3', '', '', '57.48', '10.00', '0.00', 3, '2010-02-01', '2010-06-30', 1, 15, 0, '', '', '', '', 'HCFA|UB|', '1538115035', 0, 'N', 0, '2012-10-29', NULL, NULL, 0, 0, NULL, NULL),
('363525049', 'W11005175', 'W11005175', 'ID01', 'West Valley Medical Center', '', '', 'West Valley Medical Center', 'GROUP', 'Hospital', '', '', NULL, 'O', '1714 Arlington St', 'Caldwell', 'Canyon', 'ID', '83605', '2084553719', NULL, '1714 Arlington St', 'Caldwell', 'Canyon', 'ID', '83605', '2084553719', '', '', '', 'ID01', '0.00', '0.00', '0.00', 3, '2008-07-01', '2008-07-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009576', 0, 'N', 0, '2014-04-22', NULL, NULL, 0, 0, NULL, NULL),
('820425454', 'W11005191', 'W11005191', 'ID01', 'Boise Anesthesia, PA', 'Emily', '', 'Price', 'CRNA', 'Nurse Anesthetist', '', '', NULL, 'O', '1055 N Curtis', 'Boise', 'Ada', 'ID', '83706', '2083676416', '2083759530', '1055 N Curtis', 'Boise', 'Ada', 'ID', '83706', '2083676416', '2083759530', 'IDSAMG3', NULL, NULL, '55.81', '10.00', '0.00', 3, '2008-07-01', '2010-01-30', 0, 15, 0, '', '', '', '', 'HCFA|UB|', '1508803255', 0, 'n', 0, '2012-12-27', NULL, NULL, 43.6127, -116.254, NULL, NULL),
('870395551', 'W11005172', 'W11005172', 'UT01', NULL, 'Mark', 'H', 'Radandt', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '98 N West State Rd', 'American Fork', 'Utah', 'UT', '84003', '8017560111', '8017639063', '867 E 9400 S', 'Sandy', 'Utah', 'UT', '84094', NULL, NULL, 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', '0.00', '55.46', 3, '2008-05-29', '2010-10-31', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1932376464', 0, 'N', 0, '2008-06-20', NULL, NULL, 0, 0, NULL, NULL),
('125422121', 'W11005181', 'W11005181', 'UTMH1', 'LDS Family Services', 'Faline', 'B', 'Christensen', 'LMFT', 'Mental Health', 'Marriage and Family Therapy', '', NULL, 'B', '930 W Hillfield Rd Ste A', 'Layton', 'Davis', 'UT', '84041', '8013363040', NULL, '930 W Hillfield Rd Ste A', 'Layton', 'Davis', 'UT', '84041', '8013363040', '', 'UTPHD', NULL, '', '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1770543746', 0, 'Y', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('125422121', 'W11005180', 'W11005180', 'UTMH1', 'FBC Counseling', 'Faline', 'B', 'Christensen', 'LMFT', 'Mental Health', 'Marriage and Family Therapy', '', NULL, 'O', '475 N 350 W Ste 14', 'Kaysville', 'Davis', 'UT', '84037', '8016986701', NULL, '475 N 350 W Ste 14', 'Kaysville', 'Davis', 'UT', '84037', '8016986701', '', 'UTPHD', NULL, '', '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1770543746', 0, 'N', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('125422121', 'W11005182', 'W11005182', 'UTMH1', NULL, 'Faline', 'B', 'Christensen', 'LMFT', 'Mental Health', 'Marriage and Family Therapy', '', NULL, 'B', 'PO Box 235', 'Layton', 'Davis', 'UT', '84041', '8016986701', NULL, 'PO Box 235', 'Layton', 'Davis', 'UT', '84041', '8016986701', '', 'UTPHD', NULL, '', '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1770543746', 0, 'Y', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'W11005173', 'W11005173', 'UT01', NULL, 'Don', 'M', 'Stevens', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '115 E 7200 S', 'Midvale', 'Salt Lake', 'UT', '84047', '8015664357', '4357537654', '867 E 9400 S', 'Sandy', 'Salt Lake', 'UT', '84094', NULL, NULL, 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', '0.00', '55.46', 3, '2008-06-04', '2008-09-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1699976654', 0, 'N', 0, '2008-06-20', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'W11005174', 'W11005174', 'UT01', 'Rosquist Chiropractic', 'Gary', NULL, 'Rosquist', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '3409 W 12600 S Ste 200', 'Riverton', 'Salt Lake', 'UT', '84065', '8012661415', '8012661151', '867 E 9400 S', 'Sandy', 'Salt Lake', 'UT', '84094', NULL, NULL, 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', '0.00', '55.46', 3, '2008-06-02', '2010-10-31', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1427078666', 0, 'N', 0, '2008-06-20', NULL, NULL, 0, 0, NULL, NULL),
('452766405', 'W11005178', 'W11005178', 'UTMH1', NULL, 'Nancy', '', 'Bradish', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '1745 Sidewinder', 'Park City', 'Summit', 'UT', '84068', '4356492430', NULL, '1745 Sidewinder', 'Park City', 'Summit', 'UT', '84068', '4356492430', '', 'MA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1942340963', 0, 'N', 0, '2014-04-24', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'W11005171', 'W11005171', 'UT01', '', 'Aaron', 'B', 'Walker', 'DC', 'Chiropractic', '', '', NULL, 'O', '3300 N Running Creek Way Ste E200', 'Lehi', 'Utah', 'UT', '84043', '8017664113', '8017664776', '3300 N Running Creek Way Ste E200', 'Lehi', 'Utah', 'UT', '84043', '8017664113', '8017664776', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2009-05-01', '2010-10-31', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1942460043', 0, 'N', 0, '2008-06-20', NULL, NULL, 0, 0, NULL, NULL),
('208170529', 'W11005183', 'W11005183', 'UTMH1', '', 'Frank', 'G', 'Clayton', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '220 E 3900 S Ste 7', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8012449049', NULL, '220 E 3900 S Ste 7', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8012449049', '          ', 'UTMA', '', '', '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1700944741', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('529548615', 'W11005184', 'W11005184', 'UTMH1', 'SL Counseling Center', 'Velia', '', 'Coleman', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '151 E 5600 S Ste 204', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8012622400', NULL, '151 E 5600 S Ste 204', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8012622400', '', 'MA', '', '', '0.00', '35.00', '0.00', 3, '2008-07-01', '2011-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1154475929', 0, 'N', 0, '2014-05-19', NULL, NULL, 0, 0, NULL, NULL),
('870212455', 'W11005179', 'W11005179', 'UTMH1', 'Family Counseling Center', 'Karen', 'L', 'Cannon', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '5250 S Commerce Dr Ste 250', 'Murray', 'Salt Lake', 'UT', '84107', '8012613500', NULL, '5250 S Commerce Dr Ste 250', 'Murray', 'Salt Lake', 'UT', '84107', '8012613500', '', 'UTMA', NULL, '', '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1760545651', 0, 'n', 0, '2014-07-03', NULL, NULL, 0, 0, NULL, NULL),
('452766405', 'W11005177', 'W11005177', 'UTMH1', NULL, 'Nancy', '', 'Bradish', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '825 E 4800 S Spring Pines Office Plaza, Ste 250', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8012688809', NULL, '825 E 4800 S Spring Pines Office Plaza, Ste 250', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8012688809', '', 'MA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1942340963', 0, 'N', 0, '2014-04-24', NULL, NULL, 0, 0, NULL, NULL),
('529548615', 'W11005185', 'W11005185', 'UTMH1', NULL, 'Velia', '', 'Coleman', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'B', 'PO Box 17115', 'Holladay', 'Salt Lake', 'UT', '84117', '8012622400', NULL, 'PO Box 17115', 'Holladay', 'Salt Lake', 'UT', '84117', '8012622400', '', 'MA', NULL, '', '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1154475929', 0, 'Y', 0, '2014-05-19', NULL, NULL, 0, 0, NULL, NULL),
('870675814', 'W11005186', 'W11005186', 'UT01', 'Richens Eye Center', 'Reed', 'T', 'Gibb', 'OD', 'Ophthalmology', '', '', NULL, 'O', '619 S Bluff St Ste 1B', 'St George', 'Washington', 'UT', '84770', '4356524040', '4356524041', '619 S Bluff St Ste 1B', 'St George', 'Washington', 'UT', '84770', '4356524040', '4356524041', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2008-06-01', '2011-08-16', 0, 0, 0, 'Dixie Regional Medical Center', '', '', '', 'HCFA|UB|', '1568569721', 0, 'N', 0, '2014-04-23', NULL, NULL, 0, 0, NULL, NULL),
('870675814', 'W11005187', 'W11005187', 'UT01', 'Richens Eye Center', 'James', 'L', 'Beson', 'DO', 'Ophthalmology', '', '', NULL, 'O', '619 S Bluff St Ste 1B', 'St George', 'Washington', 'UT', '84770', '4356524040', '4356524041', '619 S Bluff St Ste 1B', 'St George', 'Washington', 'UT', '84770', '4356524040', '4356524041', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2008-05-01', '2011-08-23', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1114916178', 0, 'N', 0, '2013-01-07', NULL, NULL, 0, 0, NULL, NULL),
('341650951', 'W11005219', 'W11005219', 'NA01', 'Edgepark', '', '', 'Edgepark', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', 'Phone Number Only 8003075930', '', '', '', '', '8003075930', NULL, 'Phone Number Only 8003075930', '', '', '', '', '8003075930', '          ', 'WCSTEPSI5', 'DME80', '', '0.00', '35.00', '0.00', 3, '2007-01-01', '2012-03-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1609858729', 0, 'N', 0, '2014-01-27', NULL, NULL, 0, 0, NULL, NULL),
('770644336', 'W11005228', 'W11005228', 'NA01', 'eCardio Diagnostics ', '', '', 'eCardio Diagnostics LLC', 'GROUP', 'Cardiac Monitoring', '', '', NULL, 'O', 'Phone Number Only', NULL, NULL, NULL, NULL, '8884003522', NULL, 'Phone Number Only', '', '', '', '', '8884003522', '', 'wisecardio', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1063414258', 0, 'n', 0, '2012-09-24', NULL, NULL, 0, 0, NULL, NULL),
('541707322', 'W11005215', 'W11005215', 'NA01', 'Care Rehab and Orthopedic Products  (Muscle Stimulators)', '', '', 'Care Rehab and Orthopedic Products  (Muscle Stimulators)', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', 'Phone Number Only', NULL, NULL, NULL, NULL, '8004879644', NULL, 'Phone Number Only', '', '', '', '', '8004879644', '', 'WCSTCROP5', NULL, NULL, '0.00', '20.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1578562468', 0, 'N', 0, '2012-09-24', NULL, NULL, 0, 0, NULL, NULL),
('522165554', 'W11005216', 'W11005216', 'NA01', 'DJO (Orthopedic Supplies for Provider Use Only)', '', '', 'DJO (Orthopedic Supplies for Provider Use Only)', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', 'Phone Number Only 8008638010', '', '', '', '', '8008638010', NULL, 'Phone Number Only 8008638010', '', '', '', '', '8008638010', '          ', 'WISEDJO', '', '', '0.00', '35.00', '0.00', 3, '2008-01-01', '2008-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1023296035', 0, 'N', 0, '2012-09-24', NULL, NULL, 0, 0, NULL, NULL),
('411310335', 'W11005218', 'W11005218', 'NA01', 'Empi Inc (Neuromuscular Stimulator)', '', '', 'Empi Inc (Neuromuscular Stimulator)', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', 'Phone Number Only', NULL, NULL, NULL, NULL, '8003282536', NULL, 'Phone Number Only', '', '', '', '', '8003282536', '', 'WCSTEMPI5', 'DME90', NULL, '0.00', '15.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1174574032', 0, 'N', 0, '2012-09-24', NULL, NULL, 0, 0, NULL, NULL),
('870616123', 'W11005220', 'W11005220', 'NA01', 'Intermountain Orthopedic Care ', NULL, NULL, 'Intermountain Orthopedic Care ', 'GROUP', 'Durable Medical Equipment', NULL, NULL, NULL, 'O', ' ', NULL, NULL, NULL, NULL, '8013769004', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUDME5', NULL, NULL, '0.00', '35.00', NULL, 3, '2007-01-01', '2007-01-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1699798827', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('522212112', 'W11005221', 'W11005221', 'NA01', 'LifeWatch', '', '', 'LifeWatch Inc', 'GROUP', 'Cardiac Monitoring', '', '', NULL, 'O', 'Phone Number Only', '', '', '', '', '8777749846', NULL, 'Phone Number Only', '', '', '', '', '8777749846', '          ', 'WCSTLWI5', '', '', '0.00', '100.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1255367843', 0, 'N', 0, '2013-06-18', NULL, NULL, 0, 0, NULL, NULL),
('752608036', 'W11005222', 'W11005222', 'NA01', 'Orthofix Inc (Bone Growth Stimulators Physicians Only)', '', '', 'Orthofix Inc (Bone Growth Stimulators Physicians Only)', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', 'Phone Number Only', '', '', '', '', '8005270404', '          ', 'Phone Number Only', '', '', '', '', '8005270404', '          ', 'WCSTORFIX5', '', '', '0.00', '100.00', '0.00', 3, '2007-01-01', '2014-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1235136060', 0, 'N', 0, '2014-07-23', NULL, NULL, 0, 0, NULL, NULL),
('911490213', 'W11005223', 'W11005223', 'NA01', 'RS Medical (Muscle Stimulators)', '', '', 'RS Medical (Muscle Stimulators)', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', 'Phone Number Only', NULL, NULL, NULL, NULL, '8006830353', NULL, 'Phone Number Only', '', '', '', '', '8006830353', '', 'WCSTRSMED5', NULL, NULL, '0.00', '25.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1992791230', 0, 'N', 0, '2012-09-24', 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
('510123924', 'W11005224', 'W11005224', 'NA01', 'Smith Nephew Inc (Muscle Stimulators)', '', '', 'Smith Nephew Inc (Muscle Stimulators)', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', 'Phone Number Only', NULL, NULL, NULL, NULL, '8008215700', NULL, 'Phone Number Only', '', '', '', '', '8008215700', '', '', NULL, '1002', '0.00', '30.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1568532901', 0, 'N', 0, '2012-09-24', NULL, NULL, 0, 0, NULL, NULL),
('061287427', 'W11005225', 'W11005225', 'NA01', 'Raytel Cardiac Services Inc', '', '', 'Raytel Cardiac Services Inc', 'GROUP', 'Cardiac Monitoring', '', '', NULL, 'O', 'Phone Number Only', NULL, NULL, NULL, NULL, '8003670300', NULL, 'Phone Number Only 8003670300', '', '', '', '', '8003670300', '', 'WCSTRCS5', NULL, NULL, '0.00', '100.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1194776518', 0, 'N', 0, '2011-12-19', NULL, NULL, 0, 0, NULL, NULL),
('061725406', 'W11005226', 'W11005226', 'NA01', 'Gentiva Rehab Without Walls', '', '', 'Gentiva Rehab Without Walls LLC', 'GROUP', 'Home Health Agency', NULL, NULL, NULL, 'O', ' ', NULL, NULL, NULL, NULL, '8002443221', NULL, '488 E 6400 S', 'Salt Lake City', NULL, 'UT', '84107', NULL, NULL, NULL, NULL, '4', '0.00', NULL, NULL, 3, '2007-01-01', '2007-01-01', 1, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '833759', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('840611484', 'W11005227', 'W11005227', 'NA01', 'LabCorp of America Holdings', '', '', 'LabCorp of America Holdings', 'GROUP', 'Laboratory', '', '', NULL, 'O', 'Phone Number Only', NULL, NULL, NULL, NULL, '8885222677', NULL, 'Phone Number Only', '', '', '', '', '8885222677', '', 'WULABCORP5', NULL, NULL, '0.00', '35.00', '0.00', 3, '2006-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1104829159', 0, 'N', 0, '2013-10-30', NULL, NULL, 0, 0, NULL, NULL),
('521262870', 'W11005217', 'W11005217', 'NA01', 'Dynasplint Systems Inc  (Custom Braces)', '', '', 'Dynasplint Systems Inc  (Custom Braces)', 'GROUP', 'Durable Medical Equipment', 'Custom Splints', '', NULL, 'O', 'Phone Number Only', NULL, NULL, NULL, NULL, '8006386771', NULL, 'Phone Number Only', '', '', '', '', '8006386771', '', 'WCSTDSS5', NULL, NULL, '0.00', '100.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1386643856', 0, 'N', 0, '2012-09-24', NULL, NULL, 0, 0, NULL, NULL),
('820425454', 'W12024512', 'W12024512', 'ID01', 'Boise Anesthesia, PA', 'Terry', '', 'Black', 'CRNA', 'Nurse Anesthetist', '', '', NULL, 'B', 'PO Box 4268', 'Portland', 'Multnomah', 'OR', '97208', '8002758752', NULL, 'PO Box 4268        ', 'Portland', 'Multnomah', 'OR', '97208', '8002758752', '          ', 'IDSAMG3', '', '', '62.80', '10.00', '0.00', 3, '2012-07-01', NULL, 1, 15, 0, '', '', '', '', 'HCFA|UB|', '1902843584', 0, 'N', 0, '2012-10-29', NULL, NULL, 0, 0, NULL, NULL),
('820425454', 'W11005204', 'W11005204', 'ID01', 'Boise Anesthesia, PA', 'John', '', 'Goeddertz', 'CRNA', 'Nurse Anesthetist', '', '', NULL, 'O', '1717 Arlington Ave', 'Caldwell', 'Canyon', 'ID', '83605', '2084594641', NULL, '1717 Arlington Ave', 'Caldwell', 'Canyon', 'ID', '83605', '2084594641', '', 'IDSAMG3', NULL, NULL, '55.81', '10.00', '0.00', 3, '2008-07-01', '2010-01-30', 0, 15, 0, '', '', '', '', 'HCFA|UB|', '1659424125', 0, 'n', 0, '2011-09-19', NULL, NULL, 0, 0, NULL, NULL),
('133757370', 'W11005214', 'W11005214', 'ID01', 'LabCorp Draw Station', NULL, NULL, 'LabCorp Draw Station', 'GROUP', 'Laboratory', NULL, NULL, NULL, 'O', '6086 W Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083765359', NULL, '5626 Oberlin Dr', 'San Diego', 'Ada', 'CA', '92121', NULL, NULL, 'WULABCORP5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000007170', 0, 'N', 0, '2008-06-23', NULL, NULL, 0, 0, NULL, NULL),
('820425454', 'W11005206', 'W11005206', 'ID01', 'Boise Anesthesia, PA', 'John', '', 'Goeddertz', 'CRNA', 'Nurse Anesthetist', '', '', NULL, 'O', '1055 N Curtis', 'Boise', 'Ada', 'ID', '83706', '2083676416', '2083759530', '1055 N Curtis', 'Boise', 'Ada', 'ID', '83706', '2083676416', '2083759530', 'IDSAMG3', NULL, NULL, '55.81', '10.00', '0.00', 3, '2008-07-01', '2010-01-30', 0, 15, 0, '', '', '', '', 'HCFA|UB|', '1659424125', 0, 'n', 0, '2011-09-19', NULL, NULL, 43.6127, -116.254, NULL, NULL),
('460500210', 'W11005195', 'W11005195', 'ID01', 'Saint Alphonsus Trauma Physician Services', 'Steven', 'R', 'Casos', 'MD', 'General Surgery', '', '', NULL, 'B', '1055 N Curtis', 'Boise', 'Ada', 'ID', '83706', '2083673079', NULL, '1055 N Curtis', 'Boise', 'Ada', 'ID', '83706', '2083673079', '', 'IDSAMG1', NULL, NULL, '0.00', '10.00', '0.00', 6, '2008-07-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1609849959', 0, 'Y', 0, '2013-07-18', NULL, NULL, 43.6127, -116.254, NULL, NULL),
('460500210', 'W11005202', 'W11005202', 'ID01', 'Saint Alphonsus Outpatient Trauma Services', 'Steven', 'R', 'Casos', 'MD', 'General Surgery', '', '', NULL, 'O', '901 N Curtis Rd Ste 401', 'Boise', 'Ada', 'ID', '83706', '2083677676', '2083676849', '901 N Curtis Rd Ste 401', 'Boise', 'Ada', 'ID', '83706', '2083677676', '2083676849', 'IDSAMG1', NULL, NULL, '0.00', '10.00', '0.00', 6, '2008-07-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1609849959', 0, 'N', 0, '2013-07-18', NULL, NULL, 43.6126, -116.255, NULL, NULL),
('870281028', 'W12019487', 'W12019487', 'UT01', 'Central Utah Clinic PC', 'S', 'Bret', 'Chipman', 'MD', 'Family Practice', '', '', NULL, 'O', '97 Professional Way Ste 2', 'Payson', 'Utah', 'UT', '84651', '8014654896', '8014654107', '97 Professional Way Ste 2', 'Payson', 'Utah', 'UT', '84651', '8014654896', '8014654107', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2012-06-01', NULL, 0, 0, 0, 'Mountain View Hospital', '', '', '', 'HCFA|UB|', '1992734057', 0, 'N', 0, '2014-06-16', NULL, NULL, 40.0429, -111.712, NULL, NULL),
('870524176', 'W11005199', 'W11005199', 'UTMH1', 'Alpine Center for Behavioral Health', 'Victoria', 'E', 'Anderson', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'o', '475 W 50 N', 'American Fork', 'Utah', 'UT', '84003', '8017563664', NULL, '475 W 50 N', 'American Fork', 'Utah', 'UT', '84003', '8017563664', '          ', 'UTPHD', '', '', '0.00', '35.00', '0.00', 6, '2008-07-01', '2012-10-22', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1548323017', 0, 'N', 0, '2013-03-12', NULL, NULL, 0, 0, NULL, NULL),
('870524176', 'W11005192', 'W11005192', 'UTMH1', 'Alpine Center for Behavioral Health', 'Melissa', 'J', 'Staska', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '475 W 50 N', 'American Fork', 'Utah', 'UT', '84003', '8017563664', NULL, '475 W 50 N', 'American Fork', 'Utah', 'UT', '84003', '8017563664', '', 'UTMA', NULL, NULL, '0.00', '35.00', '0.00', 6, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1346469830', 0, 'N', 0, '2013-03-12', NULL, NULL, 0, 0, NULL, NULL),
('870524176', 'W11005194', 'W11005194', 'UTMH1', 'Alpine Center for Behavioral Health', 'Doug', 'T', 'Wagstaff', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '475 W 50 N', 'American Fork', 'Utah', 'UT', '84003', '8017563664', NULL, '475 W 50 N', 'American Fork', 'Utah', 'UT', '84003', '8017563664', '          ', 'UTMA', '', '', '0.00', '35.00', '0.00', 6, '2008-07-01', '2012-10-22', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1457414930', 0, 'N', 0, '2013-03-12', NULL, NULL, 0, 0, NULL, NULL),
('870524176', 'W11005198', 'W11005198', 'UTMH1', 'Alpine Center for Behavioral Health', 'Douglas', 'L', 'Nielsen', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '475 W 50 N', 'American Fork', 'Utah', 'UT', '84003', '8017563664', NULL, '475 W 50 N', 'American Fork', 'Utah', 'UT', '84003', '8017563664', '', 'UTPHD', '', '', '0.00', '35.00', '0.00', 6, '2008-07-01', '2012-10-22', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1548323025', 0, 'N', 0, '2014-05-01', NULL, NULL, 0, 0, NULL, NULL),
('870465986', 'W11005212', 'W11005212', 'UTMH1', 'Behavioral Health Services', 'Thomas', 'C', 'Fairbank', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'B', '1767 N 2525 E', 'Layton', 'Davis', 'UT', '84040', '8017737177', NULL, '1767 N 2525 E', 'Layton', 'Davis', 'UT', '84040', '8017737177', '', 'PHD', NULL, NULL, '0.00', '35.00', '0.00', 6, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1194709980', 0, 'Y', 0, '2014-05-01', NULL, NULL, 0, 0, NULL, NULL),
('870465986', 'W11005211', 'W11005211', 'UTMH1', 'Behavioral Health Services', 'Thomas', 'C', 'Fairbank', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '2084 N 1700 W Ste 6', 'Layton', 'Davis', 'UT', '84040', '8017737177', NULL, '2084 N 1700 W Ste 6', 'Layton', 'Davis', 'UT', '84040', '8017737177', '', 'PHD', '', '', '0.00', '35.00', '0.00', 6, '2008-07-01', '2011-07-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1194709980', 0, 'N', 0, '2014-05-01', NULL, NULL, 0, 0, NULL, NULL),
('870470032', 'W11005205', 'W11005205', 'UTMH1', 'A/D Psychotherapy  & Clinical', 'Michael', 'E', 'Dusoe', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '8465 S 700 E', 'Sandy', 'Salt Lake', 'UT', '84070', '8012338577', NULL, '8465 S 700 E', 'Sandy', 'Salt Lake', 'UT', '84070', '8012338577', '', 'PHD', NULL, '', '0.00', '35.00', '0.00', 6, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1477664670', 0, 'N', 0, '2014-05-08', NULL, NULL, 0, 0, NULL, NULL),
('870470032', 'W11005207', 'W11005207', 'UTMH1', NULL, 'Michael', 'E', 'Dusoe', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', 'PO Box 901662', 'Sandy', 'Salt Lake', 'UT', '84090', '8012338577', NULL, 'PO Box 901662', 'Sandy', 'Salt Lake', 'UT', '84090', '8012338577', '', 'PHD', NULL, '', '0.00', '35.00', '0.00', 6, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1477664670', 0, 'Y', 0, '2014-05-08', NULL, NULL, 0, 0, NULL, NULL),
('870524176', 'W11005197', 'W11005197', 'UTMH1', '', 'Douglas', 'L', 'Nielsen', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'B', '1208 E 3300 S', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8014831600', NULL, '1208 E 3300 S', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8014831600', '', 'UTPHD', '', '', '0.00', '35.00', '0.00', 6, '2008-07-01', '2012-10-22', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1548323025', 0, 'Y', 0, '2014-05-01', NULL, NULL, 0, 0, NULL, NULL),
('870524176', 'W11005196', 'W11005196', 'UTMH1', '', 'Doug', 'T', 'Wagstaff', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'B', '1208 E 3300 S', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8017563664', NULL, '1208 E 3300 S', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8017563664', '          ', 'UTMA', '', '', '0.00', '35.00', '0.00', 6, '2008-07-01', '2012-10-22', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1457414930', 0, 'Y', 0, '2013-03-12', NULL, NULL, 0, 0, NULL, NULL),
('870524176', 'W11005193', 'W11005193', 'UTMH1', NULL, 'Melissa', 'J', 'Staska', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'B', '1208 E 3300 S', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8014831600', NULL, '1208 E 3300 S', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8014831600', '', 'UTMA', NULL, NULL, '0.00', '35.00', '0.00', 6, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1346469830', 0, 'Y', 0, '2013-03-12', NULL, NULL, 0, 0, NULL, NULL),
('870524176', 'W11005200', 'W11005200', 'UTMH1', 'Comprehensive Psychological Services', 'Victoria', 'E', 'Anderson', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'B', '1208 E 3300 S', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8017563664', NULL, '1208 E 3300 S', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8017563664', '          ', 'UTPHD', '', '', '0.00', '35.00', '0.00', 6, '2008-07-01', '2012-10-22', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1548323017', 0, 'Y', 0, '2013-03-12', NULL, NULL, 0, 0, NULL, NULL),
('870212455', 'W11005203', 'W11005203', 'UTMH1', 'Family Counseling Center', 'Kathryn', '', 'Della-Piana', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '5250 S Commerce Dr Ste 250', 'Murray', 'Salt Lake', 'UT', '84107', '8012613500', NULL, '5250 S Commerce Dr Ste 250', 'Murray', 'Salt Lake', 'UT', '84107', '8012613500', '', 'UTMA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1518024231', 0, 'n', 0, '2014-04-24', NULL, NULL, 0, 0, NULL, NULL),
('870212455', 'W11005213', 'W11005213', 'UTMH1', 'Family Counseling Center', 'Kathryn', 'S', 'Johnson', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '5250 S Commerce St Ste 250', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8012613500', NULL, '5250 S Commerce St Ste 250', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8012613500', '          ', 'UTMA', '', '', '0.00', '35.00', '0.00', 3, '2008-07-01', '2011-05-17', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1154486728', 0, 'N', 0, '2012-01-19', NULL, NULL, 0, 0, NULL, NULL),
('820435599', 'W11005201', 'W11005201', 'UTMH1', NULL, 'Mark', 'D', 'Corgiat', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '4590 Harrison Blvd Ste 100', 'Ogden', 'Weber', 'UT', '84403', '8016216100', NULL, '4590 Harrison Blvd Ste 100', 'Ogden', 'Weber', 'UT', '84403', '8016216100', '', 'UTPHD', NULL, '', '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1336296003', 0, 'n', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('519767704', 'W11005210', 'W11005210', 'UTMH1', 'Canyon Counseling Center', 'Shawn', 'C', 'Edgington', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '3651 N 100 E Ste 100', 'Provo', 'Utah', 'UT', '84604', '8013560014', NULL, '3651 N 100 E Ste 100', 'Provo', 'Utah', 'UT', '84604', '8013560014', '          ', 'UTPHD', '', '', '0.00', '35.00', '0.00', 3, '2008-07-01', '2011-10-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1457498271', 0, 'N', 0, '2011-12-20', NULL, NULL, 0, 0, NULL, NULL),
('133757370', 'W11005229', 'W11005229', 'ID01', 'LabCorp of America Holdings', NULL, NULL, 'LabCorp of America Holdings', 'GROUP', 'Laboratory', NULL, NULL, NULL, 'B', 'PO Box 2270', 'Burlington', 'Alamance', 'NC', '27216', '8002227566', NULL, '5626 Oberlin Dr', 'San Diego', 'Alamance', 'CA', '92121', NULL, NULL, 'WULABCORP5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000007171', 0, 'y', 0, '2008-07-31', NULL, NULL, 0, 0, NULL, NULL),
('270002825', 'W11005286', 'W11005286', 'WY01', 'A Womans Place', 'Lisa', '', 'Williams', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1443 Beck Ave', 'Cody', 'Park', 'WY', '82414', '3075277811', NULL, '1443 Beck Ave', 'Cody', 'Park', 'WY', '82414', '3075277811', '          ', '', '', '', '0.00', '20.00', '0.00', 3, '2008-07-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1750376083', 0, 'N', 0, '2012-05-07', NULL, NULL, 44.5249, -109.061, NULL, NULL),
('270002825', 'W11005287', 'W11005287', 'WY01', 'A Womans Place', 'Lisa', '', 'Williams', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 1000', 'Cody', 'Park', 'WY', '82414', '3075277811', NULL, 'PO Box 1000', 'Cody', 'Park', 'WY', '82414', '3075277811', '          ', '', '', '', '0.00', '20.00', '0.00', 3, '2008-07-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1750376083', 0, 'Y', 0, '2012-05-07', NULL, NULL, 0, 0, NULL, NULL),
('260553931', 'W11005282', 'W11005282', 'ID01', 'Saint Alphonsus Express Care', '', '', 'Saint Alphonsus Express Care', 'GROUP', 'Urgent Care', '', '', NULL, 'O', '2809 E Cleveland Blvd', 'Caldwell', 'Canyon', 'ID', '83605', '2084551094', NULL, '2809 E Cleveland Blvd', 'Caldwell', 'Canyon', 'ID', '83605', '2084551094', '', '', NULL, '', '0.00', '0.00', '0.00', 6, '2008-07-01', '2008-11-27', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1033304886', 0, 'n', 0, '2014-06-20', NULL, NULL, 0, 0, NULL, NULL),
('205898813', 'W11005295', 'W11005295', 'ID01', 'Initial Point Family Medicine', 'Paul', 'V', 'Ryan', 'MD', 'Family Practice', '', '', NULL, 'O', '2640 S Eagle Rd', 'Meridian', 'Ada', 'ID', '83642', '2088840835', NULL, '2640 S Eagle Rd', 'Meridian', 'Ada', 'ID', '83642', '2088840835', '', 'IDPCPEM5', 'WUSTDHCPC5', NULL, '0.00', '30.00', '0.00', 3, '2008-07-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|UB|', '1962439356', 0, 'n', 0, '2011-12-14', NULL, NULL, 43.5804, -116.354, NULL, NULL),
('201300128', 'W11005233', 'W11005233', 'ID01', 'Idaho Urologic Institute', 'Stephen', 'J', 'Miller', 'MD', 'Urology', '', '', NULL, 'O', '2855 E Magic View Dr', 'Meridian', 'Ada', 'ID', '83642', '2086394900', NULL, '2855 E Magic View Dr', 'Meridian', 'Ada', 'ID', '83642', '2086394900', '', 'IDUROLOGY', 'WUSTDHCPC5', NULL, '0.00', '20.00', '0.00', 3, '2008-07-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, NULL, NULL, 'HCFA|UB|', '1164474664', 0, 'n', 0, '2013-07-31', NULL, NULL, 43.599, -116.36, NULL, NULL),
('201300128', 'W11005231', 'W11005231', 'ID01', 'Idaho Urologic Institute', 'Eric', 'W', 'Klein', 'MD', 'Urology', '', '', NULL, 'O', '2855 E Magic View Dr', 'Meridian', 'Ada', 'ID', '83642', '2086394900', NULL, '2855 E Magic View Dr', 'Meridian', 'Ada', 'ID', '83642', '2086394900', '', 'IDUROLOGY', 'WUSTDHCPC5', NULL, '0.00', '20.00', '0.00', 3, '2008-07-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, NULL, NULL, 'HCFA|UB|', '1023013109', 0, 'n', 0, '2014-03-20', NULL, NULL, 43.599, -116.36, NULL, NULL),
('260553931', 'W11005283', 'W11005283', 'ID01', 'Saint Alphonsus Express Care', '', '', 'Saint Alphonsus Express Care', 'GROUP', 'Urgent Care', '', '', NULL, 'B', '3340 E Goldstone Way', 'Meridian', 'Ada', 'ID', '83642', '2083675178', NULL, '3340 E Goldstone Way', 'Meridian', 'Ada', 'ID', '83642', '2083675178', '', '', NULL, '', '0.00', '0.00', '0.00', 6, '2008-07-01', '2008-11-27', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1033304886', 0, 'Y', 0, '2014-06-20', NULL, NULL, 0, 0, NULL, NULL),
('205898813', 'W11005294', 'W11005294', 'ID01', 'Initial Point Family Medicine', 'Mark', 'S', 'Grajcar', 'DO', 'Family Practice', '', '', NULL, 'O', '2640 S Eagle Rd', 'Meridian', 'Ada', 'ID', '83642', '2088840835', NULL, '2640 S Eagle Rd', 'Meridian', 'Ada', 'ID', '83642', '2088840835', '', 'IDPCPEM5', 'WUSTDHCPC5', NULL, '0.00', '30.00', '0.00', 3, '2008-07-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|UB|', '1669416137', 0, 'n', 0, '2011-12-14', NULL, NULL, 43.5804, -116.354, NULL, NULL),
('201300128', 'W11005230', 'W11005230', 'ID01', 'Idaho Urologic Institute', 'Cynthia', 'A', 'Fairfax', 'MD', 'Urology', 'Pediatric Urology', '', NULL, 'O', '2855 E Magic View Dr', 'Meridian', 'Ada', 'ID', '83642', '2086394900', NULL, '2855 E Magic View Dr', 'Meridian', 'Ada', 'ID', '83642', '2086394900', '          ', 'IDUROLOGY', 'WUSTDHCPC5', '', '0.00', '20.00', '0.00', 3, '2008-07-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, NULL, NULL, 'HCFA|UB|', '1417906330', 0, 'N', 0, '2013-07-31', NULL, NULL, 43.599, -116.36, NULL, NULL),
('201300128', 'W11005242', 'W11005242', 'ID01', 'Idaho Urologic Institute', 'Derek', '', 'Derkacs', 'PA', 'Urology', 'General Surgery', '', NULL, 'O', '2855 E Magic View Dr', 'Meridian', 'Ada', 'ID', '83642', '2086394900', NULL, '2855 E Magic View Dr', 'Meridian', 'Ada', 'ID', '83642', '2086394900', '          ', 'IDUROLOGY', 'WUSTDHCPC5', '', '0.00', '20.00', '0.00', 3, '2008-07-01', '2011-08-30', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, '', '', 'HCFA|UB|', '1720157720', 0, 'N', 0, '2013-12-10', NULL, NULL, 43.599, -116.36, NULL, NULL),
('201300128', 'W11005240', 'W11005240', 'ID01', 'Idaho Urologic Institute', 'Nicolas', '', 'Allen', 'PA-C', 'Physician Assistant', '', '', NULL, 'O', '2855 E Magic View Dr', 'Meridian', 'Ada', 'ID', '83642', '2086394900', NULL, '2855 E Magic View Dr', 'Meridian', 'Ada', 'ID', '83642', '2086394900', '', 'IDUROLOGY', 'WUSTDHCPC5', '', '0.00', '20.00', '0.00', 3, '2008-07-01', '2011-08-30', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1205910551', 0, 'N', 0, '2014-04-15', NULL, NULL, 43.599, -116.36, NULL, NULL),
('201300128', 'W11005239', 'W11005239', 'ID01', 'Idaho Urologic Institute', 'John', 'A', 'Greer', 'MD', 'Urology', '', '', NULL, 'O', '2855 E Magic View Dr', 'Meridian', 'Ada', 'ID', '83642', '2086394900', NULL, '2855 E Magic View Dr', 'Meridian', 'Ada', 'ID', '83642', '2086394900', '', 'IDUROLOGY', 'WUSTDHCPC5', NULL, '0.00', '20.00', '0.00', 3, '2008-07-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, NULL, NULL, 'HCFA|UB|', '1356393227', 0, 'n', 0, '2012-02-13', NULL, NULL, 43.599, -116.36, NULL, NULL),
('201300128', 'W11005238', 'W11005238', 'ID01', 'Idaho Urologic Institute', 'Joseph', 'H', 'Williams', 'MD', 'Urology', '', '', NULL, 'O', '2855 E Magic View Dr', 'Meridian', 'Ada', 'ID', '83642', '2086394900', NULL, '2855 E Magic View Dr', 'Meridian', 'Ada', 'ID', '83642', '2086394900', '', 'IDUROLOGY', 'WUSTDHCPC5', NULL, '0.00', '20.00', '0.00', 3, '2008-07-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, NULL, NULL, 'HCFA|UB|', '1194777060', 0, 'n', 0, '2013-07-29', NULL, NULL, 43.599, -116.36, NULL, NULL),
('201300128', 'W11005237', 'W11005237', 'ID01', 'Idaho Urologic Institute', 'William', 'H', 'Fredriksson', 'MD', 'Urology', '', '', NULL, 'O', '2855 E Magic View Dr', 'Meridian', 'Ada', 'ID', '83642', '2086394900', NULL, '2855 E Magic View Dr', 'Meridian', 'Ada', 'ID', '83642', '2086394900', '', 'IDUROLOGY', 'WUSTDHCPC5', NULL, '0.00', '20.00', '0.00', 3, '2008-07-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, NULL, NULL, 'HCFA|UB|', '1841280872', 0, 'n', 0, '2014-03-20', NULL, NULL, 43.599, -116.36, NULL, NULL),
('201300128', 'W11005236', 'W11005236', 'ID01', 'Idaho Urologic Institute', 'David', 'B', 'Rice', 'MD', 'Urology', '', '', NULL, 'O', '2855 E Magic View Dr', 'Meridian', 'Ada', 'ID', '83642', '2086394900', NULL, '2855 E Magic View Dr', 'Meridian', 'Ada', 'ID', '83642', '2086394900', '', 'IDUROLOGY', 'WUSTDHCPC5', NULL, '0.00', '20.00', '0.00', 3, '2008-07-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, NULL, NULL, 'HCFA|UB|', '1740232248', 0, 'n', 0, '2012-02-29', NULL, NULL, 43.599, -116.36, NULL, NULL),
('201300128', 'W11005235', 'W11005235', 'ID01', 'Idaho Urologic Institute', 'Dawn', 'K', 'King Menzner', 'MD', 'Urology', '', '', NULL, 'O', '2855 E Magic View Dr', 'Meridian', 'Ada', 'ID', '83642', '2086394900', NULL, '2855 E Magic View Dr', 'Meridian', 'Ada', 'ID', '83642', '2086394900', '', 'IDUROLOGY', 'WUSTDHCPC5', NULL, '0.00', '20.00', '0.00', 3, '2008-07-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, NULL, NULL, 'HCFA|UB|', '1568413763', 0, 'n', 0, '2013-07-31', NULL, NULL, 43.599, -116.36, NULL, NULL),
('201300128', 'W11005243', 'W11005243', 'ID01', 'Idaho Urologic Institute', 'Todd', 'M', 'Waldmann', 'MD', 'Urology', 'Pediatric Urology', '', NULL, 'O', '2855 E Magic View Dr', 'Meridian', 'Ada', 'ID', '83642', '2086394900', NULL, '2855 E Magic View Dr', 'Meridian', 'Ada', 'ID', '83642', '2086394900', '', 'IDUROLOGY', 'WUSTDHCPC5', NULL, '0.00', '20.00', '0.00', 3, '2008-07-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, NULL, NULL, 'HCFA|UB|', '1104877299', 0, 'n', 0, '2013-07-31', NULL, NULL, 43.599, -116.36, NULL, NULL),
('201300128', 'W11005268', 'W11005268', 'ID01', 'Idaho Urologic Institute', 'William', 'H', 'Fredriksson', 'MD', 'Urology', '', '', NULL, 'O', '1613 12th Ave Rd Ste B', 'Nampa', 'Canyon', 'ID', '83686', '2086394900', NULL, '1613 12th Ave Rd Ste B', 'Nampa', 'Canyon', 'ID', '83686', '2086394900', '', 'IDUROLOGY', 'WUSTDHCPC5', NULL, '0.00', '20.00', '0.00', 3, '2008-07-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, NULL, NULL, 'HCFA|UB|', '1841280872', 0, 'n', 0, '2014-03-20', NULL, NULL, 43.5533, -116.573, NULL, NULL),
('201300128', 'W11005266', 'W11005266', 'ID01', 'Idaho Urologic Institute', 'Derek', '', 'Derkacs', 'PA', 'Urology', 'General Surgery', '', NULL, 'O', '1613 12th Ave Rd Ste B', 'Nampa', 'Canyon', 'ID', '83686', '2086394900', NULL, '1613 12th Ave Rd Ste B', 'Nampa', 'Canyon', 'ID', '83686', '2086394900', '          ', 'IDUROLOGY', 'WUSTDHCPC5', '', '0.00', '20.00', '0.00', 3, '2008-07-01', '2011-08-30', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, '', '', 'HCFA|UB|', '1720157720', 0, 'N', 0, '2013-12-10', NULL, NULL, 43.5533, -116.573, NULL, NULL),
('201300128', 'W11005273', 'W11005273', 'ID01', 'Idaho Urologic Institute', 'Eric', 'W', 'Klein', 'MD', 'Urology', '', '', NULL, 'O', '1613 12th Ave Rd Ste B', 'Nampa', 'Canyon', 'ID', '83686', '2086394900', NULL, '1613 12th Ave Rd Ste B', 'Nampa', 'Canyon', 'ID', '83686', '2086394900', '', 'IDUROLOGY', 'WUSTDHCPC5', NULL, '0.00', '20.00', '0.00', 3, '2008-07-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, NULL, NULL, 'HCFA|UB|', '1023013109', 0, 'n', 0, '2014-03-20', NULL, NULL, 43.5533, -116.573, NULL, NULL),
('201300128', 'W11005252', 'W11005252', 'ID01', 'Idaho Urologic Institute', 'Dawn', 'K', 'King Menzner', 'MD', 'Urology', '', '', NULL, 'O', '333 N 1st Ste 100', 'Boise', 'Ada', 'ID', '83702', '2086394900', NULL, '333 N 1st Ste 100', 'Boise', 'Ada', 'ID', '83702', '2086394900', '          ', 'IDUROLOGY', 'WUSTDHCPC5', '', '0.00', '20.00', '0.00', 3, '2008-07-01', '2012-02-24', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, NULL, NULL, 'HCFA|UB|', '1568413763', 0, 'N', 0, '2013-07-31', NULL, NULL, 43.6135, -116.194, NULL, NULL),
('201300128', 'W11005259', 'W11005259', 'ID01', 'Idaho Urologic Institute', 'Joseph', 'H', 'Williams', 'MD', 'Urology', '', '', NULL, 'O', '333 N 1st Ste 100', 'Boise', 'Ada', 'ID', '83702', '2086394900', NULL, '333 N 1st Ste 100', 'Boise', 'Ada', 'ID', '83702', '2086394900', '          ', 'IDUROLOGY', 'WUSTDHCPC5', '', '0.00', '20.00', '0.00', 3, '2008-07-01', '2012-02-24', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, NULL, NULL, 'HCFA|UB|', '1194777060', 0, 'N', 0, '2013-07-29', NULL, NULL, 43.6135, -116.194, NULL, NULL),
('260553931', 'W11005281', 'W11005281', 'ID01', 'Saint Alphonsus Express Care (No X-ray)', '', '', 'Saint Alphonsus Express Care', 'GROUP', 'Urgent Care', '', '', NULL, 'O', '1515 W State St', 'Boise', 'Ada', 'ID', '83702', '2083456768', NULL, '1515 W State St', 'Boise', 'Ada', 'ID', '83702', '2083456768', '', '', '', '', '0.00', '0.00', '0.00', 6, '2008-07-01', '2008-11-27', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1033304886', 0, 'N', 0, '2014-06-20', NULL, NULL, 43.6228, -116.21, NULL, NULL),
('201300128', 'W11005260', 'W11005260', 'ID01', 'Idaho Urologic Institute', 'Todd', 'M', 'Waldmann', 'MD', 'Urology', 'Pediatric Urology', '', NULL, 'O', '333 N 1st Ste 100', 'Boise', 'Ada', 'ID', '83702', '2086394900', NULL, '333 N 1st Ste 100', 'Boise', 'Ada', 'ID', '83702', '2086394900', '          ', 'IDUROLOGY', 'WUSTDHCPC5', '', '0.00', '20.00', '0.00', 3, '2008-07-01', '2012-02-24', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, NULL, NULL, 'HCFA|UB|', '1104877299', 0, 'N', 0, '2013-07-31', NULL, NULL, 43.6135, -116.194, NULL, NULL),
('201300128', 'W11005248', 'W11005248', 'ID01', 'Idaho Urologic Institute', 'Cynthia', 'A', 'Fairfax', 'MD', 'Urology', 'Pediatric Urology', '', NULL, 'O', '333 N 1st Ste 100', 'Boise', 'Ada', 'ID', '83702', '2086394900', NULL, '333 N 1st Ste 100', 'Boise', 'Ada', 'ID', '83702', '2086394900', '          ', 'IDUROLOGY', 'WUSTDHCPC5', '', '0.00', '20.00', '0.00', 3, '2008-07-01', '2012-02-24', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, NULL, NULL, 'HCFA|UB|', '1417906330', 0, 'N', 0, '2013-07-31', NULL, NULL, 43.6135, -116.194, NULL, NULL),
('201300128', 'W11005249', 'W11005249', 'ID01', 'Idaho Urologic Institute', 'Stephen', 'J', 'Miller', 'MD', 'Urology', '', '', NULL, 'O', '333 N 1st Ste 100', 'Boise', 'Ada', 'ID', '83702', '2086394900', NULL, '333 N 1st Ste 100', 'Boise', 'Ada', 'ID', '83702', '2086394900', '          ', 'IDUROLOGY', 'WUSTDHCPC5', '', '0.00', '20.00', '0.00', 3, '2008-07-01', '2012-02-24', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, NULL, NULL, 'HCFA|UB|', '1164474664', 0, 'N', 0, '2013-07-31', NULL, NULL, 43.6135, -116.194, NULL, NULL),
('331078261', 'W11005297', 'W11005297', 'ID01', 'Saint Alphonsus Physicians PA', 'Karin', '', 'Lindholm', 'MD', 'Neurology', '', '', NULL, 'O', '901 N Curtis Ste 403', 'Boise', 'Ada', 'ID', '83706', '2083673330', '2083673331', '901 N Curtis Ste 403', 'Boise', 'Ada', 'ID', '83706', '2083673330', '2083673331', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 3, '2008-07-01', '2012-04-03', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1083660586', 0, 'N', 0, '2012-04-03', NULL, NULL, 43.6126, -116.255, NULL, NULL),
('331078261', 'W11005296', 'W11005296', 'ID01', 'Saint Alphonsus Physicians PA', 'Mary', 'E', 'River', 'MD', 'Neurology', '', '', NULL, 'O', '901 N Curtis Ste 403', 'Boise', 'Ada', 'ID', '83706', '2083673330', '2083673331', '901 N Curtis Ste 403', 'Boise', 'Ada', 'ID', '83706', '2083673330', '2083673331', 'IDSAMG1', NULL, '', '0.00', '10.00', '0.00', 3, '2008-07-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1205882743', 0, 'n', 0, '2014-05-20', NULL, NULL, 43.6126, -116.255, NULL, NULL),
('260553931', 'W11005280', 'W11005280', 'ID01', 'Saint Alphonsus Express Care', '', '', 'Saint Alphonsus Express Care', 'GROUP', 'Urgent Care', '', '', NULL, 'O', '660 E Boise Ave', 'Boise', 'Ada', 'ID', '83706', '2083451162', NULL, '660 E Boise Ave', 'Boise', 'Ada', 'ID', '83706', '2083451162', '', '', NULL, '', '0.00', '0.00', '0.00', 6, '2008-07-01', '2008-11-27', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1033304886', 0, 'n', 0, '2014-06-20', NULL, NULL, 0, 0, NULL, NULL),
('200945062', 'W11005302', 'W11005302', 'ID02', 'Deer Point Family Practice PC', 'Gary', 'A', 'Tubbs', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 4979', 'Boise', 'Ada', 'ID', '83711', '2083227284', NULL, 'PO Box 4979', 'Boise', 'Ada', 'ID', '83711', '2083227284', '', 'IDPCPEM5', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2008-07-01', '2014-01-31', 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1902848989', 0, 'Y', 0, '2014-06-18', NULL, NULL, 0, 0, NULL, NULL),
('260553931', 'W11005278', 'W11005278', 'ID01', 'Saint Alphonsus Express Care (No X-ray)', '', '', 'Saint Alphonsus Express Care', 'GROUP', 'Urgent Care', '', '', NULL, 'O', '4700 N Eagle Rd', 'Boise', 'Ada', 'ID', '83713', '2089384797', NULL, '4700 N Eagle Rd', 'Boise', 'Ada', 'ID', '83713', '2089384797', '', '', '', '', '0.00', '0.00', '0.00', 6, '2008-07-01', '2008-11-27', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1033304886', 0, 'N', 0, '2014-06-20', NULL, NULL, 43.6474, -116.352, NULL, NULL),
('200945062', 'W11005301', 'W11005301', 'ID02', 'Deer Point Family Practice PC', 'Gary', 'A', 'Tubbs', 'MD', 'Family Practice', '', '', NULL, 'O', '6023 N Eagle Rd', 'Boise', 'Ada', 'ID', '83713', '2083227284', NULL, '6023 N Eagle Rd', 'Boise', 'Ada', 'ID', '83713', '2083227284', '', 'IDPCPEM5', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2008-07-01', '2014-01-31', 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1902848989', 0, 'N', 0, '2014-06-18', NULL, NULL, 43.6597, -116.355, NULL, NULL),
('841399775', 'W11005284', 'W11005284', 'ID01', 'Eagles View Family Medicine PC', 'William', '', 'Brus', 'MD', 'Family Practice', '', '', NULL, 'O', '6023 N Eagle Rd', 'Boise', 'Ada', 'ID', '83713', '2089385524', NULL, '6023 N Eagle Rd', 'Boise', 'Ada', 'ID', '83713', '2089385524', '', 'IDPCPEM5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1427007632', 0, 'n', 0, '2011-09-15', NULL, NULL, 43.6597, -116.355, NULL, NULL),
('841399775', 'W11005285', 'W11005285', 'ID01', 'Eagles View Family Medicine PC', 'Nancy', 'A', 'Brus', 'MD', 'Family Practice', '', '', NULL, 'O', '6023 N Eagle Rd', 'Boise', 'Ada', 'ID', '83713', '2089385524', NULL, '6023 N Eagle Rd', 'Boise', 'Ada', 'ID', '83713', '2089385524', '', 'IDPCPEM5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1952412702', 0, 'n', 0, '2013-09-25', NULL, NULL, 43.6597, -116.355, NULL, NULL),
('260553931', 'W11005279', 'W11005279', 'ID01', 'Saint Alphonsus Express Care', '', '', 'Saint Alphonsus Express Care', 'GROUP', 'Urgent Care', '', '', NULL, 'O', '6560 S Federal Way', 'Boise', 'Ada', 'ID', '83716', '2083361645', NULL, '6560 S Federal Way', 'Boise', 'Ada', 'ID', '83716', '2083361645', '', '', NULL, '', '0.00', '0.00', '0.00', 6, '2008-07-01', '2008-11-27', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1033304886', 0, 'n', 0, '2014-06-20', NULL, NULL, 0, 0, NULL, NULL),
('189364826', 'W11005300', 'W11005300', 'UTMH1', NULL, 'Jeanne', 'M', 'Hansel', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', '2185 Wood Hollow Way', 'Bountiful', 'Davis', 'UT', '84010', '8019150329', NULL, '2185 Wood Hollow Way', 'Bountiful', 'Davis', 'UT', '84010', '8019150329', '', 'UTMA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1013051481', 0, 'Y', 0, '2014-05-06', NULL, NULL, 0, 0, NULL, NULL),
('189364826', 'W11005299', 'W11005299', 'UTMH1', NULL, 'Jeanne', 'M', 'Hansel', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '466 N Main St Ste 201', 'Clearfield', 'Davis', 'UT', '84015', '8019150329', NULL, '466 N Main St Ste 201', 'Clearfield', 'Davis', 'UT', '84015', '8019150329', '', 'UTMA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1013051481', 0, 'N', 0, '2014-05-06', NULL, NULL, 0, 0, NULL, NULL),
('870465986', 'W11005271', 'W11005271', 'UTMH1', 'Behavioral Health Services', 'David', 'L', 'Haggerty', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '2084 N 1700 W Ste 6', 'Layton', 'Davis', 'UT', '84040', '8017737177', NULL, '2084 N 1700 W Ste 6', 'Layton', 'Davis', 'UT', '84040', '8017737177', '', 'MA', '', '', '0.00', '35.00', '0.00', 6, '2008-07-01', '2011-07-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1164406963', 0, 'N', 0, '2014-04-24', NULL, NULL, 0, 0, NULL, NULL),
('870465986', 'W11005272', 'W11005272', 'UTMH1', 'Behavioral Health Services', 'David', 'L', 'Haggerty', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', '1767 N 2525 E', 'Layton', 'Davis', 'UT', '84040', '8017737177', NULL, '1767 N 2525 E', 'Layton', 'Davis', 'UT', '84040', '8017737177', '', 'MA', NULL, NULL, '0.00', '35.00', '0.00', 6, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1164406963', 0, 'Y', 0, '2014-04-24', NULL, NULL, 0, 0, NULL, NULL),
('470888755', 'W11005261', 'W11005261', 'UTMH1', 'Counseling & Assessments', 'Jared', 'D', 'Froerer', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '11075 S State St Ste 28', 'Sandy', 'Salt Lake', 'UT', '84070', '8015018444', NULL, '11075 S State St Ste 28', 'Sandy', 'Salt Lake', 'UT', '84070', '8015018444', '', 'MA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1558337477', 0, 'N', 0, '2011-05-27', NULL, NULL, 0, 0, NULL, NULL),
('470888755', 'W11005262', 'W11005262', 'UTMH1', 'Aspen Ridge Counseling', 'Jared', 'D', 'Froerer', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '50 N Main St', 'Tooele', 'Tooele', 'UT', '84074', '8015018444', NULL, '50 N Main St', 'Tooele', 'Tooele', 'UT', '84074', '8015018444', '', 'MA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1558337477', 0, 'N', 0, '2011-05-27', NULL, NULL, 0, 0, NULL, NULL),
('470888755', 'W11005263', 'W11005263', 'UTMH1', NULL, 'Jared', 'D', 'Froerer', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'B', 'PO Box 900245', 'Sandy', 'Salt Lake', 'UT', '84090', '8015018444', NULL, 'PO Box 900245', 'Sandy', 'Salt Lake', 'UT', '84090', '8015018444', '', 'MA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1558337477', 0, 'Y', 0, '2011-05-27', NULL, NULL, 0, 0, NULL, NULL),
('203422024', 'W11005275', 'W11005275', 'UTMH1', NULL, 'Nancy', 'C', 'Hanson', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '8160 Highland Dr Ste 204', 'Sandy', 'Salt Lake', 'UT', '84093', '8019424444', NULL, '8160 Highland Dr Ste 204', 'Sandy', 'Salt Lake', 'UT', '84093', '8019424444', '', 'MA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1992758767', 0, 'N', 0, '2014-04-23', NULL, NULL, 0, 0, NULL, NULL),
('260817300', 'W11005292', 'W11005292', 'UT01', 'Utah Vein Specialists', 'Peter', 'E', 'Jensen', 'MD', 'Vascular Surgery', 'Cardiovascular Disease', '', NULL, 'O', '9690 S 1300 E Ste 224', 'Sandy', 'Salt Lake', 'UT', '84094', '8015018346', NULL, '9690 S 1300 E Ste 224', 'Sandy', 'Salt Lake', 'UT', '84094', '8015018346', '', 'WISESTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1033215686', 0, 'n', 0, '2012-02-08', NULL, NULL, 40.5743, -111.853, NULL, NULL),
('010759642', 'W11005289', 'W11005289', 'UT01', 'Rocky Mountain Multiple Sclerosis Clinic', 'John', 'F', 'Foley', 'MD', 'Neurology', '', '', NULL, 'B', 'PO Box 95970', 'South Jordan', 'Salt Lake', 'UT', '84095', '8014085700', NULL, 'PO Box 95970', 'South Jordan', 'Salt Lake', 'UT', '84095', '8014085700', '', 'WISESTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', NULL, 0, 0, 0, 'University Health Care University Hospital', '', '', '', 'HCFA|UB|', '1073538047', 0, 'Y', 0, '2011-07-15', NULL, NULL, 0, 0, NULL, NULL),
('870525858', 'W11005247', 'W11005247', 'UTMH1', 'Interface Psychological', 'Thomas', 'M', 'Foster', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '2180 E 4500 S Ste 245', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8013288817', NULL, '2180 E 4500 S Ste 245', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8013288817', '', 'MA', NULL, '', '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1972633667', 0, 'N', 0, '2014-05-08', NULL, NULL, 0, 0, NULL, NULL),
('010759642', 'W11005291', 'W11005291', 'UT01', 'Rocky Mountain Multiple Sclerosis Clinic', 'John', 'F', 'Foley', 'MD', 'Neurology', '', '', NULL, 'O', '370 E 9th Ave Ste 106', 'Salt Lake City', 'Salt Lake', 'UT', '84103', '8014085702', NULL, '370 E 9th Ave Ste 106', 'Salt Lake City', 'Salt Lake', 'UT', '84103', '8014085702', '', 'WISESTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', NULL, 0, 0, 0, 'University Health Care University Hospital', '', '', '', 'HCFA|UB|', '1073538047', 0, 'N', 0, '2011-07-15', NULL, NULL, 40.7796, -111.878, NULL, NULL),
('010759642', 'W11005290', 'W11005290', 'UT01', 'Rocky Mountain Multiple Sclerosis Clinic', 'John', 'F', 'Foley', 'MD', 'Neurology', NULL, NULL, NULL, 'O', '370 E 9th Ave Ste 106', 'Salt Lake City', 'Salt Lake', 'UT', '84103', '8014085700', NULL, 'PO Box 95970', 'South Jordan', 'Salt Lake', 'UT', '84095', NULL, NULL, 'WISESTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2000-01-01', '2000-01-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1073538047', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('562382988', 'W11005241', 'W11005241', 'UTMH1', 'PATHWAYS . . . A Counseling and Learning Center, Inc.', 'Michael', 'C', 'Flowers', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '1104 E Ashton St Ste  114', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8015588650', NULL, '1104 E Ashton St Ste  114', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8015588650', '', 'UTMA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1043297716', 0, 'n', 0, '2014-04-24', NULL, NULL, 0, 0, NULL, NULL),
('208912468', 'W11005288', 'W11005288', 'UT01', 'Salt Lake Eye Associates', 'Darcy', 'H', 'Wolsey', 'MD', 'Ophthalmology', '', '', NULL, 'O', '1025 E 3300 S Ste B', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8012812020', '8014873689', '1025 E 3300 S Ste B', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8012812020', '8014873689', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2008-07-01', '2010-03-11', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1174575153', 0, 'N', 0, '2014-04-16', NULL, NULL, 0, 0, NULL, NULL),
('870212455', 'W11005277', 'W11005277', 'UTMH1', 'Family Counseling Center', 'Nancy', 'M', 'Hogarty-Baker', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '5250 S Commerce Dr Ste 250', 'Murray', 'Salt Lake', 'UT', '84107', '8012613500', NULL, '5250 S Commerce Dr Ste 250', 'Murray', 'Salt Lake', 'UT', '84107', '8012613500', '', 'UTMA', NULL, '', '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1003973611', 0, 'n', 0, '2014-07-03', NULL, NULL, 0, 0, NULL, NULL),
('562382988', 'W11005246', 'W11005246', 'UTMH1', NULL, 'Michael', 'C', 'Flowers', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', 'PO Box 9128', 'Salt Lake City', 'Salt Lake', 'UT', '84109', '8015588650', NULL, 'PO Box 9128', 'Salt Lake City', 'Salt Lake', 'UT', '84109', '8015588650', '', 'UTMA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1043297716', 0, 'Y', 0, '2014-04-24', NULL, NULL, 0, 0, NULL, NULL),
('562382988', 'W11005244', 'W11005244', 'UTMH1', 'Community Health Centers, Inc', 'Michael', 'C', 'Flowers', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '461 S 400 E', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8015398617', NULL, '461 S 400 E', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8015398617', '', 'UTMA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1043297716', 0, 'n', 0, '2014-04-24', NULL, NULL, 0, 0, NULL, NULL),
('920189245', 'W11005274', 'W11005274', 'UTMH1', 'Psychological Services', 'Eric', 'J', 'Hanson', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '2040 Murray Holladay Rd Ste 222', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8012780499', NULL, '2040 Murray Holladay Rd Ste 222', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8012780499', '          ', 'UTPHD', '', '', '0.00', '35.00', '0.00', 3, '2008-07-01', '2012-01-11', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1619939063', 0, 'N', 0, '2012-01-19', NULL, NULL, 0, 0, NULL, NULL),
('870525799', 'W11005303', 'W11005303', 'UTMH1', 'West Counseling Service', 'Janet', 'E', 'Hooper', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '2880 W 4700 S Ste A', 'West Valley', 'Salt Lake', 'UT', '84118', '8019642465', NULL, '2880 W 4700 S Ste A', 'West Valley', 'Salt Lake', 'UT', '84118', '8019642465', '          ', 'MA', '', '', '0.00', '35.00', '0.00', 3, '2008-07-01', '2011-06-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1336111277', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('562382988', 'W11005245', 'W11005245', 'UTMH1', 'Oquirrh View Clinic', 'Michael', 'C', 'Flowers', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '4745 S 3200 W', 'Salt Lake City', 'Salt Lake', 'UT', '84118', '8019646214', NULL, '4745 S 3200 W', 'Salt Lake City', 'Salt Lake', 'UT', '84118', '8019646214', '', 'UTMA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1043297716', 0, 'n', 0, '2014-04-24', NULL, NULL, 0, 0, NULL, NULL),
('260817300', 'W11005293', 'W11005293', 'UT01', 'Utah Vein Specialists', 'Peter', 'E', 'Jensen', 'MD', 'Vascular Surgery', 'Cardiovascular Disease', '', NULL, 'B', 'PO Box 57945', 'Salt Lake City', 'Salt Lake', 'UT', '84157', '8015018346', NULL, 'PO Box 57945', 'Salt Lake City', 'Salt Lake', 'UT', '84157', '8015018346', '', 'WISESTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1033215686', 0, 'Y', 0, '2012-02-08', NULL, NULL, 0, 0, NULL, NULL),
('870680078', 'W11005276', 'W11005276', 'UTMH1', 'Summit Counseling Services', 'Michael', 'K', 'Hinds', 'LMFT', 'Mental Health', 'Counseling', '', NULL, 'O', '95 W 100 S Ste 130', 'Logan', 'Cache', 'UT', '84321', '4357524646', NULL, '95 W 100 S Ste 130', 'Logan', 'Cache', 'UT', '84321', '4357524646', '', 'UTMA', '', '', '0.00', '35.00', '0.00', 3, '2008-07-01', '2011-06-27', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1376538033', 0, 'N', 0, '2014-05-08', NULL, NULL, 0, 0, NULL, NULL),
('529216375', 'W11005234', 'W11005234', 'UTMH1', 'LDS Family Services', 'Michele', 'W', 'Ashdown', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', '1525 Lincoln Ave', 'Ogden', 'Weber', 'UT', '84401', '8016216510', NULL, '1525 Lincoln Ave', 'Ogden', 'Weber', 'UT', '84401', '8016216510', '', 'UTMA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1497876346', 0, 'Y', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('870271413', 'W11005251', 'W11005251', 'UTMH1', 'LDS Family Services', 'Michele', 'W', 'Ashdown', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '1525 Lincoln Ave', 'Ogden', 'Weber', 'UT', '84401', '8016216510', NULL, '1525 Lincoln Ave', 'Ogden', 'Weber', 'UT', '84401', '8016216510', '', 'UTMA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1497876346', 0, 'n', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('870271413', 'W11005250', 'W11005250', 'UTMH1', 'Family Counseling Service', 'Michele', 'W', 'Ashdown', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '3518 Washington Blvd', 'Ogden', 'Weber', 'UT', '84403', '8013991600', NULL, '3518 Washington Blvd', 'Ogden', 'Weber', 'UT', '84403', '8013991600', '          ', 'UTMA', '', '', '0.00', '35.00', '0.00', 3, '2008-07-01', '2009-12-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1497876346', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('870271413', 'W11005253', 'W11005253', 'UTMH1', 'Family Counseling Service', 'Aubrey', 'M', 'Myers', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '3518 Washington Blvd', 'Ogden', 'Weber', 'UT', '84403', '8013991600', NULL, '3518 Washington Blvd', 'Ogden', 'Weber', 'UT', '84403', '8013991600', '          ', 'UTMA', '', '', '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-01-08', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000007777', 0, 'N', 0, '2013-01-11', NULL, NULL, 0, 0, NULL, NULL),
('870271413', 'W11005254', 'W11005254', 'UTMH1', 'Family Counseling Service', 'Jeffrey', 'P', 'Baird', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '3518 Washington Blvd', 'Ogden', 'Weber', 'UT', '84403', '8013991600', NULL, '3518 Washington Blvd', 'Ogden', 'Weber', 'UT', '84403', '8013991600', '          ', 'UTMA', '', '', '0.00', '35.00', '0.00', 3, '2008-07-01', '2009-12-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1750434049', 0, 'N', 0, '2013-01-02', NULL, NULL, 0, 0, NULL, NULL),
('870271413', 'W11005255', 'W11005255', 'UTMH1', 'Family Counseling Service', 'William', 'J', 'Endy', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '3518 Washington Blvd', 'Ogden', 'Weber', 'UT', '84403', '8013991600', NULL, '3518 Washington Blvd', 'Ogden', 'Weber', 'UT', '84403', '8013991600', '          ', 'UTMA', '', '', '0.00', '35.00', '0.00', 3, '2008-07-01', '2011-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1295887503', 0, 'N', 0, '2012-01-03', NULL, NULL, 0, 0, NULL, NULL),
('870271413', 'W11005256', 'W11005256', 'UTMH1', 'Family Counseling Service', 'Brent', 'W', 'Innes', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '3518 Washington Blvd', 'Ogden', 'Weber', 'UT', '84403', '8013991600', NULL, '3518 Washington Blvd', 'Ogden', 'Weber', 'UT', '84403', '8013991600', '', 'UTMA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1639225956', 0, 'n', 0, '2013-10-22', NULL, NULL, 0, 0, NULL, NULL),
('870271413', 'W11005258', 'W11005258', 'UTMH1', 'Family Counseling Service', 'Garry', 'F', 'Sahleen', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '3518 Washington Blvd', 'Ogden', 'Weber', 'UT', '84403', '8013991600', NULL, '3518 Washington Blvd', 'Ogden', 'Weber', 'UT', '84403', '8013991600', '          ', 'UTMA', '', '', '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-01-08', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000003047', 0, 'N', 0, '2013-01-11', 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
('529216375', 'W11005232', 'W11005232', 'UTMH1', 'Family Counseling Service', 'Michele', 'W', 'Ashdown', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '3518 Washington Blvd', 'Ogden', 'Weber', 'UT', '84403', '8013991600', NULL, '3518 Washington Blvd', 'Ogden', 'Weber', 'UT', '84403', '8013991600', '          ', 'UTMA', '', '', '0.00', '35.00', '0.00', 3, '2008-07-01', '2009-12-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1497876346', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('870271413', 'W11005257', 'W11005257', 'UTMH1', 'Family Counseling Service', 'Tab', 'L', 'Uno', 'LCSW', 'Mental Health', 'Social Worker', NULL, NULL, 'O', '3518 Washington Blvd', 'Ogden', 'Weber', 'UT', '84403', '8013991600', NULL, '3518 Washington Blvd', 'Ogden', 'Weber', 'UT', '84403', NULL, NULL, 'UTMA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2008-11-24', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1194920991', 0, 'n', 0, '2008-06-23', NULL, NULL, 0, 0, NULL, NULL),
('528624487', 'W11005269', 'W11005269', 'UTMH1', 'Crystal Cocoon Center', 'M', 'M', 'Green', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '5582 S 1750 E', 'Ogden', 'Weber', 'UT', '84405', '8014768885', NULL, '5582 S 1750 E', 'Ogden', 'Weber', 'UT', '84405', '8014768885', '', 'UTMA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2008-12-26', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1780771147', 0, 'n', 0, '2012-02-02', NULL, NULL, 0, 0, NULL, NULL),
('528624487', 'W11005270', 'W11005270', 'UTMH1', 'Alternate Billing c/o Mary Bybe', 'M', 'M', 'Green', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', 'PO Box 150173', 'Ogden', 'Weber', 'UT', '84415', '8014768885', NULL, 'PO Box 150173', 'Ogden', 'Weber', 'UT', '84415', '8014768885', '', 'UTMA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2008-12-26', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1780771147', 0, 'n', 0, '2012-02-02', NULL, NULL, 0, 0, NULL, NULL),
('870645936', 'W11005265', 'W11005265', 'UTMH1', 'Mountain View Counseling Center', 'Samuel', 'A', 'Giovanini', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '23 S Carbon Ave Ste 16', 'Price', 'Carbon', 'UT', '84501', '4356131160', NULL, '23 S Carbon Ave Ste 16', 'Price', 'Carbon', 'UT', '84501', '4356131160', '', 'MA', '', '', '0.00', '35.00', '0.00', 3, '2008-07-01', '2008-07-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1861676405', 0, 'N', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('870552514', 'W11005298', 'W11005298', 'UTMH1', '', 'Clark', 'B', 'Holladay', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '656 N Main St', 'Nephi', 'Juab', 'UT', '84648', '4356235044', NULL, '656 N Main St', 'Nephi', 'Juab', 'UT', '84648', '4356235044', '          ', 'MA', '', '', '0.00', '35.00', '0.00', 3, '2008-07-01', '2012-03-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1619172806', 0, 'N', 0, '2012-04-09', NULL, NULL, 0, 0, NULL, NULL),
('205395628', 'W11005264', 'W11005264', 'UTMH1', 'Behavioral Health Associates of Utah', 'Milo', 'F', 'Garcia', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '108 N Suite I', 'Richfield', 'Sevier', 'UT', '84701', '4358965165', NULL, '108 N Suite I', 'Richfield', 'Sevier', 'UT', '84701', '4358965165', '', 'UTMA', '', '', '0.00', '35.00', '0.00', 3, '2008-07-01', '2008-07-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1710045455', 0, 'N', 0, '2014-05-08', NULL, NULL, 0, 0, NULL, NULL),
('870645936', 'W11005267', 'W11005267', 'UTMH1', 'Mountain View Counseling Center', 'Samuel', 'A', 'Giovanini', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '146 N Main Ste 4', 'Richfield', 'Sevier', 'UT', '84701', '4358967739', NULL, '146 N Main Ste 4', 'Richfield', 'Sevier', 'UT', '84701', '4358967739', '', 'MA', NULL, '', '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1861676405', 0, 'N', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('870525799', 'W11005304', 'W11005304', 'UTMH1', 'Counseling Associates', 'Janet', 'E', 'Hooper', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '750 Ridgeview Dr Ste 103', 'St George', 'Washington', 'UT', '84770', '4356686398', NULL, '750 Ridgeview Dr Ste 103', 'St George', 'Washington', 'UT', '84770', '4356686398', '', 'MA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1336111277', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('201939139', 'W11005309', 'W11005309', 'ID01', 'Micron Family Health Center', 'Kathleen', '', 'Scanlan', 'MD', 'Family Practice', 'Urgent Care', '', NULL, 'B', '8000 S Federal Way', 'Boise', 'Ada', 'ID', '83716', '2083685656', NULL, '8000 S Federal Way', 'Boise', 'Ada', 'ID', '83716', '2083685656', '', 'IDSTD', 'WUSTDHCPC5', NULL, '0.00', '30.00', '0.00', 3, '2008-07-01', '2012-08-19', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000008604', 0, 'Y', 0, '2014-04-09', NULL, NULL, 43.5301, -116.149, NULL, NULL),
('201939139', 'W11005308', 'W11005308', 'ID01', 'Micron Family Health Center', 'Heidi', '', 'Munro', 'PA', 'Family Practice', 'Urgent Care', '', NULL, 'B', '8000 S Federal Way', 'Boise', 'Ada', 'ID', '83716', '2083685656', NULL, '8000 S Federal Way', 'Boise', 'Ada', 'ID', '83716', '2083685656', '', 'IDSTD', 'WUSTDHCPC5', NULL, '0.00', '30.00', '0.00', 3, '2008-07-01', '2012-08-19', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000007762', 0, 'Y', 0, '2014-04-09', NULL, NULL, 43.5301, -116.149, NULL, NULL),
('201939139', 'W11005307', 'W11005307', 'ID01', 'Micron Family Health Center', 'Cory', '', 'Huffine', 'NP-C', 'Wound Care', '', '', NULL, 'B', '8000 S Federal Way', 'Boise', 'Ada', 'ID', '83716', '2083685656', NULL, '8000 S Federal Way', 'Boise', 'Ada', 'ID', '83716', '2083685656', '', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2008-07-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1700879459', 0, 'Y', 0, '2014-06-20', NULL, NULL, 43.5301, -116.149, NULL, NULL),
('201939139', 'W11005306', 'W11005306', 'ID01', 'Micron Family Health Center (No X-ray)', '', '', 'Micron Family Health Center (X-ray)', 'MD', 'Laboratory', 'Urgent Care', '', 'Family Practice', 'O', '8000 S Federal Way', 'Boise', 'Ada', 'ID', '83716', '2083685656', NULL, '8000 S Federal Way', 'Boise', 'Ada', 'ID', '83716', '2083685656', '          ', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2008-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000007596', 0, 'Y', 0, '2012-06-15', NULL, NULL, 43.5285, -116.15, NULL, NULL),
('201939139', 'W11005305', 'W11005305', 'ID01', 'Micron Family Health Center', 'Scott', '', 'Lossmann', 'MD', 'Family Practice', 'Urgent Care', '', NULL, 'B', '8000 S Federal Way', 'Boise', 'Ada', 'ID', '83716', '2083685656', NULL, '8000 S Federal Way', 'Boise', 'Ada', 'ID', '83716', '2083685656', '', 'IDSTD', 'WUSTDHCPC5', NULL, '0.00', '30.00', '0.00', 3, '2008-07-01', '2012-08-19', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000007334', 0, 'Y', 0, '2014-04-09', NULL, NULL, 43.5301, -116.149, NULL, NULL),
('953382344', 'W11005311', 'W11005311', 'UT01', 'Choice Source Caremark', '', '', 'Choice Source Caremark', 'GROUP', 'Infusion Agency', 'Mail Order Pharmacy', 'Specialty Pharmacy', NULL, 'O', 'Phone Number Only', NULL, NULL, NULL, NULL, '8002372767', NULL, 'Phone Number Only', '', '', '', '', '8002372767', '', '', NULL, '1001', '0.00', '0.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1013998921', 0, 'Y', 0, '2012-09-24', NULL, NULL, 0, 0, NULL, NULL),
('953382344', 'W11005310', 'W11005310', 'NA01', 'Choice Source Caremark', '', '', 'Choice Source Caremark', 'GROUP', 'Infusion Agency', 'Mail Order Pharmacy', 'Specialty Pharmacy', NULL, 'O', 'Phone Number Only', NULL, NULL, NULL, NULL, '8002372767', NULL, 'Phone Number Only', '', '', '', '', '8002372767', '', '', NULL, '1001', '0.00', '0.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1013998921', 0, 'Y', 0, '2012-09-24', NULL, NULL, 0, 0, NULL, NULL),
('820306254', 'W11005333', 'W11005333', 'ID01', 'Boise OBGYN Associates', 'Heather', 'E', 'Quinn', 'MD', 'Family Practice', '', '', NULL, 'O', '5966 Curtisian', 'Boise', 'Ada', 'ID', '83704', '2083758100', NULL, '5966 Curtisian', 'Boise', 'Ada', 'ID', '83704', '2083758100', '', 'IDOB2', 'WUSTDHCPC5', NULL, '0.00', '30.00', '0.00', 3, '2008-07-01', '2009-07-20', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1386698744', 0, 'n', 0, '2012-01-23', NULL, NULL, 43.6149, -116.256, NULL, NULL),
('820306254', 'W11005340', 'W11005340', 'ID01', 'Boise OBGYN Associates', 'Beverly', NULL, 'Ludders', 'MD', 'Family Practice', 'Obstetrics and Gynecology', NULL, NULL, 'O', '5966 Curtisian', 'Boise', 'Ada', 'ID', '83704', '2083758100', NULL, '5966 Curtisian', 'Boise', 'Ada', 'ID', '83704', NULL, NULL, 'IDOB2', 'WUSTDHCPC5', NULL, '0.00', '30.00', '0.00', 3, '2008-07-01', '2008-11-14', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1033158787', 0, 'n', 0, '2009-07-21', NULL, NULL, 43.6149, -116.256, NULL, NULL),
('820306254', 'W11005341', 'W11005341', 'ID01', 'Boise OBGYN Associates', 'Darrell', 'J', 'Ludders', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '5966 Curtisian', 'Boise', 'Ada', 'ID', '83704', '2083758100', NULL, '5966 Curtisian', 'Boise', 'Ada', 'ID', '83704', '2083758100', '', 'IDOB2', 'WUSTDHCPC5', NULL, '0.00', '30.00', '0.00', 3, '2008-07-01', '2009-07-31', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1548214927', 0, 'n', 0, '2013-10-23', NULL, NULL, 43.6149, -116.256, NULL, NULL),
('820306254', 'W11005337', 'W11005337', 'ID01', 'Boise OBGYN Associates', 'Cynthia', 'R', 'Hayes', 'MD', 'Family Practice', 'Obstetrics and Gynecology', NULL, NULL, 'O', '5966 Curtisian', 'Boise', 'Ada', 'ID', '83704', '2083758100', NULL, '5966 Curtisian', 'Boise', 'Ada', 'ID', '83704', NULL, NULL, 'IDOB2', 'WUSTDHCPC5', NULL, '0.00', '30.00', '0.00', 3, '2008-07-01', '2008-08-27', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, NULL, NULL, 'HCFA|UB|', '1386697399', 0, 'n', 0, '2008-10-01', NULL, NULL, 43.6149, -116.256, NULL, NULL),
('820306254', 'W11005336', 'W11005336', 'ID01', 'Boise OBGYN Associates', 'Lisa', 'M', 'Minge', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '5966 Curtisian', 'Boise', 'Ada', 'ID', '83704', '2083758100', NULL, '5966 Curtisian', 'Boise', 'Ada', 'ID', '83704', '2083758100', '', 'IDOB2', 'WUSTDHCPC5', NULL, '0.00', '30.00', '0.00', 3, '2008-07-01', '2009-07-31', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1467405787', 0, 'n', 0, '2013-07-03', NULL, NULL, 43.6149, -116.256, NULL, NULL),
('820306254', 'W11005335', 'W11005335', 'ID01', 'Boise OBGYN Associates', 'Jon', 'R', 'Kattenhorn', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '5966 Curtisian', 'Boise', 'Ada', 'ID', '83704', '2083758100', NULL, '5966 Curtisian', 'Boise', 'Ada', 'ID', '83704', '2083758100', '', 'IDOB2', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2008-07-01', '2009-07-31', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1881648251', 0, 'n', 0, '2014-06-20', NULL, NULL, 43.6149, -116.256, NULL, NULL),
('870499318', 'W11005324', 'W11005324', 'UTMH1', 'Resolutions Inc', 'Kathie', '', 'Keeler', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '70 N Main Ste 103', 'Bountiful', 'Davis', 'UT', '84010', '8012985222', NULL, '70 N Main Ste 103', 'Bountiful', 'Davis', 'UT', '84010', '8012985222', '', 'MA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1386758498', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('300338744', 'W11005314', 'W11005314', 'UTMH1', 'Behavioral Medicine', 'Austin', 'B', 'Imus', 'DO', 'Mental Health', 'Psychiatry', NULL, NULL, 'B', '630 E Medical Dr', 'Bountiful', 'Davis', 'UT', '84010', '8012992186', NULL, '630 E Medical Dr', 'Bountiful', 'Davis', 'UT', '84010', NULL, NULL, 'UTMD', NULL, NULL, '0.00', '35.00', NULL, 3, '2000-01-01', '2000-01-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1417923251', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('300338744', 'W11005313', 'W11005313', 'UTMH1', 'Lakeview Hospital', 'Austin', 'B', 'Imus', 'DO', 'Mental Health', 'Psychiatry', '', NULL, 'O', '630 E Medical Dr', 'Bountiful', 'Davis', 'UT', '84010', '8012992186', NULL, '630 E Medical Dr', 'Bountiful', 'Davis', 'UT', '84010', '8012992186', '          ', 'UTMD', '', '', '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1417923251', 0, 'Y', 0, '2013-07-10', NULL, NULL, 0, 0, NULL, NULL),
('546963662', 'W11005325', 'W11005325', 'UTMH1', NULL, 'Lorraine', 'S', 'Kilpatrick', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '6925  Union Park Ctr Ste 490', 'Midvale', 'Salt Lake', 'UT', '84047', '8015662622', NULL, '6925  Union Park Ctr Ste 490', 'Midvale', 'Salt Lake', 'UT', '84047', '8015662622', '', 'MA', NULL, '', '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1528089711', 0, 'N', 0, '2014-05-12', NULL, NULL, 0, 0, NULL, NULL),
('529503025', 'W11005338', 'W11005338', 'UTMH1', 'Guiding Path PLLC', 'James', 'B', 'Lewis', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '9500 S 500 W Ste 107', 'Sandy', 'Salt Lake', 'UT', '84070', '8016731447', NULL, '9500 S 500 W Ste 107', 'Sandy', 'Salt Lake', 'UT', '84070', '8016731447', '          ', 'UTMA', '', '', '0.00', '35.00', '0.00', 3, '2008-07-01', '2012-07-10', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1720203995', 0, 'N', 0, '2012-04-11', NULL, NULL, 0, 0, NULL, NULL),
('870575977', 'W11005320', 'W11005320', 'UTMH1', '', 'Roderick', 'V', 'Johnson', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '185 N Main Ste 601', 'Tooele', 'Tooele', 'UT', '84074', '4358822207', NULL, '185 N Main Ste 601', 'Tooele', 'Tooele', 'UT', '84074', '4358822207', '', 'UTMA', '', '', '0.00', '35.00', '0.00', 3, '2008-07-01', '2011-09-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1780672915', 0, 'N', 0, '2014-05-08', NULL, NULL, 0, 0, NULL, NULL),
('870575977', 'W11005322', 'W11005322', 'UTMH1', NULL, 'Roderick', 'V', 'Johnson', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', 'PO Box 955', 'Tooele', 'Tooele', 'UT', '84074', '4358822207', NULL, 'PO Box 955', 'Tooele', 'Tooele', 'UT', '84074', '4358822207', '', 'UTMA', NULL, '', '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1780672915', 0, 'Y', 0, '2014-05-08', NULL, NULL, 0, 0, NULL, NULL),
('528844386', 'W11005328', 'W11005328', 'UTMH1', NULL, 'Jeff', 'C', 'Kocherhans', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'B', 'PO Box 901904', 'Sandy', 'Salt Lake', 'UT', '84090', '8014831600', NULL, 'PO Box 901904', 'Sandy', 'Salt Lake', 'UT', '84090', '8014831600', '', 'UTPHD', NULL, '', '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1700836996', 0, 'Y', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('529503025', 'W11005339', 'W11005339', 'UTMH1', '', 'James', 'B', 'Lewis', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', '10987 Chapada Way', 'Sandy', 'Salt Lake', 'UT', '84094', '8016731447', NULL, '10987 Chapada Wy', 'Sandy', 'Salt Lake', 'UT', '84094', '8016731447', '          ', 'UTMA', '', '', '0.00', '35.00', '0.00', 3, '2008-07-01', '2012-07-10', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1720203995', 0, 'Y', 0, '2012-04-11', NULL, NULL, 0, 0, NULL, NULL),
('870672047', 'W11005330', 'W11005330', 'UTMH1', '', 'Matt', 'G', 'Larson', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '1325 W S Jordan Pkwy Ste 101', 'South Jordan', 'Salt Lake', 'UT', '84095', '8015996396', NULL, '1325 W S Jordan Pkwy Ste 101', 'South Jordan', 'Salt Lake', 'UT', '84095', '8015996396', '          ', 'MA', '', '', '0.00', '35.00', '0.00', 3, '2008-07-01', '2012-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1326002437', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('870672047', 'W11005331', 'W11005331', 'UTMH1', NULL, 'Matt', 'G', 'Larson', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', 'PO Box 1221', 'Salt Lake City', 'Salt Lake', 'UT', '84101', '8015996396', NULL, 'PO Box 1221', 'Salt Lake City', 'Salt Lake', 'UT', '84101', '8015996396', '', 'MA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1326002437', 0, 'Y', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('870557015', 'W11005317', 'W11005317', 'UTMH1', 'UIPT', 'Penny', 'B', 'Jameson', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '505 E 200 S Ste 303', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013500118', NULL, '505 E 200 S Ste 303', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013500118', '', 'PHD', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1334125776', 0, 'N', 0, '2014-03-24', NULL, NULL, 0, 0, NULL, NULL),
('870491988', 'W11005326', 'W11005326', 'UTMH1', 'UIPT', 'Nanci', 'C', 'Klein', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '505 E 200 S Ste 303', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013500116', NULL, '505 E 200 S Ste 303', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013500116', '', 'PHD', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1194940908', 0, 'n', 0, '2014-05-01', NULL, NULL, 0, 0, NULL, NULL),
('870672047', 'W11005329', 'W11005329', 'UTMH1', NULL, 'Matt', 'G', 'Larson', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '24 S 600 E Ste 6', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015996396', NULL, '24 S 600 E Ste 6', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015996396', '', 'MA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1326002437', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('528844386', 'W11005327', 'W11005327', 'UTMH1', 'Comprehensive Psychological Services', 'Jeff', 'C', 'Kocherhans', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '1208 E 3300 S', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8014831600', NULL, '1208 E 3300 S', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8014831600', '', 'UTPHD', NULL, '', '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1700836996', 0, 'n', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('205607289', 'W11005323', 'W11005323', 'UTMH1', NULL, 'Kristin', '', 'Jones', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '684 E Vine St Ste 4A', 'Murray', 'Salt Lake', 'UT', '84107', '8013803846', NULL, '684 E Vine St Ste 4A', 'Murray', 'Salt Lake', 'UT', '84107', '8013803846', '', 'UTMA', NULL, '', '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1083674592', 0, 'n', 0, '2014-05-08', NULL, NULL, 0, 0, NULL, NULL),
('870575977', 'W11005321', 'W11005321', 'UTMH1', NULL, 'Roderick', 'V', 'Johnson', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '860 E 4500 S Ste 302', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8016859600', NULL, '860 E 4500 S Ste 302', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8016859600', '', 'UTMA', NULL, '', '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1780672915', 0, 'N', 0, '2014-05-08', NULL, NULL, 0, 0, NULL, NULL),
('870212455', 'W11005315', 'W11005315', 'UTMH1', 'Family Counseling Center', 'Janelle', '', 'Iverson', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '5250 S Commerce Dr Ste 250', 'Murray', 'Salt Lake', 'UT', '84107', '8012613500', NULL, '5250 S Commerce Dr Ste 250', 'Murray', 'Salt Lake', 'UT', '84107', '8012613500', '', 'UTMA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1780731356', 0, 'n', 0, '2013-03-14', NULL, NULL, 0, 0, NULL, NULL),
('030481448', 'W11005334', 'W11005334', 'UTMH1', NULL, 'Mary', 'K', 'Lehto', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '684 E Vine St Ste 4A', 'Murray', 'Salt Lake', 'UT', '84107', '8016470752', NULL, '684 E Vine St Ste 4A', 'Murray', 'Salt Lake', 'UT', '84107', '8016470752', '', 'MA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1235198722', 0, 'n', 0, '2014-04-24', NULL, NULL, 0, 0, NULL, NULL),
('113714417', 'W11005332', 'W11005332', 'UTMH1', NULL, 'Kent', 'G', 'Larson', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '3578 W 4850 S Ste 16', 'Salt Lake City', 'Salt Lake', 'UT', '84118', '8019679638', NULL, '3578 W 4850 S Ste 16', 'Salt Lake City', 'Salt Lake', 'UT', '84118', '8019679638', '', 'UTMA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1073656906', 0, 'N', 0, '2013-10-28', NULL, NULL, 0, 0, NULL, NULL),
('450510082', 'W11005316', 'W11005316', 'UTMH1', NULL, 'Bruce', 'K', 'Jacobson', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '4190 S Highland Dr Ste 211', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012720614', NULL, '4190 S Highland Dr Ste 211', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012720614', '', 'PHD', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1417913575', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('562423565', 'W11005319', 'W11005319', 'UTMH1', NULL, 'Michael', 'D', 'Jensen', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', 'PO Box 936', 'Gunnison', 'Sanpete', 'UT', '84634', '4355287048', NULL, 'PO Box 936', 'Gunnison', 'Sanpete', 'UT', '84634', '4355287048', '', 'UTMA', NULL, '', '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1124230115', 0, 'Y', 0, '2014-05-08', NULL, NULL, 0, 0, NULL, NULL),
('562423565', 'W11005318', 'W11005318', 'UTMH1', 'New Beginnings Family Counseling Inc', 'Michael', 'D', 'Jensen', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '50 S Main Ste 25', 'Manti', 'Sanpete', 'UT', '84642', '4355287048', NULL, '50 S Main Ste 25', 'Manti', 'Sanpete', 'UT', '84642', '4355287048', '', 'UTMA', NULL, '', '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1124230115', 0, 'N', 0, '2014-05-08', NULL, NULL, 0, 0, NULL, NULL),
('565154242', 'W11005312', 'W11005312', 'UTMH1', 'LBH Counseling', 'Lisa', 'B', 'Hughes', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '14 N Main', 'Springville', 'Utah', 'UT', '84663', '8014890124', NULL, '14 N Main', 'Springville', 'Utah', 'UT', '84663', '8014890124', '', 'UTMA', NULL, '', '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1730237249', 0, 'n', 0, '2014-05-08', NULL, NULL, 0, 0, NULL, NULL),
('820312070', 'W11005376', 'W11005376', 'ID01', 'Boise Valley Asthma and Allergy Clinic', 'Michael', 'V', 'Keiley', 'MD', 'Allergy and Immunology', 'Pediatric Allergy and Immunology', '', NULL, 'O', '1721 S 10th Ave Rd', 'Caldwell', 'Canyon', 'ID', '83605', '2083780080', NULL, '1721 S 10th Ave Rd', 'Caldwell', 'Canyon', 'ID', '83605', '2083780080', '', 'IDALLERGY', 'WUSTDHCPC5', NULL, '0.00', '30.00', '0.00', 3, '2008-07-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1679569149', 0, 'n', 0, '2012-02-29', NULL, NULL, 43.5918, -116.694, NULL, NULL),
('820312070', 'W11005371', 'W11005371', 'ID01', 'Boise Valley Asthma and Allergy Clinic', 'Heidi', 'S', 'Peters', 'FNP', 'Allergy and Immunology', '', '', NULL, 'O', '323 E Riverside Dr Ste 204', 'Eagle', 'Ada', 'ID', '83616', '2083780080', NULL, '323 E Riverside Dr Ste 204', 'Eagle', 'Ada', 'ID', '83616', '2083780080', '', 'IDALLERGY', 'WUSTDHCPC5', NULL, '0.00', '30.00', '0.00', 3, '2008-07-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1447246905', 0, 'n', 0, '2012-02-29', NULL, NULL, 43.6892, -116.351, NULL, NULL),
('820312070', 'W11005370', 'W11005370', 'ID01', 'Boise Valley Asthma and Allergy Clinic', 'George', 'W', 'Palmer', 'MD', 'Allergy and Immunology', '', '', NULL, 'O', '323 E Riverside Dr Ste 204', 'Eagle', 'Ada', 'ID', '83616', '2083780080', NULL, '323 E Riverside Dr Ste 204', 'Eagle', 'Ada', 'ID', '83616', '2083780080', '', 'IDALLERGY', 'WUSTDHCPC5', NULL, '0.00', '30.00', '0.00', 3, '2008-07-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1033105259', 0, 'n', 0, '2013-06-11', NULL, NULL, 43.6892, -116.351, NULL, NULL),
('820312070', 'W11005369', 'W11005369', 'ID01', 'Boise Valley Asthma and Allergy Clinic', 'Michael', 'V', 'Keiley', 'MD', 'Allergy and Immunology', 'Pediatric Allergy and Immunology', '', NULL, 'O', '323 E Riverside Dr Ste 204', 'Eagle', 'Ada', 'ID', '83616', '2083780080', NULL, '323 E Riverside Dr Ste 204', 'Eagle', 'Ada', 'ID', '83616', '2083780080', '', 'IDALLERGY', 'WUSTDHCPC5', NULL, '0.00', '30.00', '0.00', 3, '2008-07-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1679569149', 0, 'n', 0, '2012-02-29', NULL, NULL, 43.6892, -116.351, NULL, NULL),
('820312070', 'W11005368', 'W11005368', 'ID01', 'Boise Valley Asthma and Allergy Clinic', 'John', 'D', 'Jeppson', 'MD', 'Allergy and Immunology', 'Pediatric Allergy and Immunology', '', NULL, 'O', '323 E Riverside Dr Ste 204', 'Eagle', 'Ada', 'ID', '83616', '2083780080', NULL, '323 E Riverside Dr Ste 204', 'Eagle', 'Ada', 'ID', '83616', '2083780080', '', 'IDALLERGY', 'WUSTDHCPC5', NULL, '0.00', '30.00', '0.00', 3, '2008-07-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1417943622', 0, 'n', 0, '2012-03-01', NULL, NULL, 43.6892, -116.351, NULL, NULL),
('820312070', 'W11005365', 'W11005365', 'ID01', 'Boise Valley Asthma and Allergy Clinic', 'Michael', 'V', 'Keiley', 'MD', 'Allergy and Immunology', 'Pediatric Allergy and Immunology', '', NULL, 'O', '2320 E Gala Ste 500', 'Meridian', 'Ada', 'ID', '83642', '2083780080', NULL, '2320 E Gala Ste 500', 'Meridian', 'Ada', 'ID', '83642', '2083780080', '', 'IDALLERGY', 'WUSTDHCPC5', NULL, '0.00', '30.00', '0.00', 3, '2008-07-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1679569149', 0, 'n', 0, '2012-02-29', NULL, NULL, 43.59, -116.365, NULL, NULL),
('820525090', 'W11005399', 'W11005399', 'ID01', 'Boise Orthopedic Clinic', 'Jeffry', 'P', 'Menzner', 'MD This Provider will terminate on July 1st', 'Orthopedic Surgery', 'Hematology and Oncology', '', NULL, 'O', '520 S Eagle Rd Ste 3213', 'Meridian', 'Ada', 'ID', '83642', '2088980100', NULL, '520 S Eagle Rd Ste 3213', 'Meridian', 'Ada', 'ID', '83642', '2088980100', '          ', 'IDORTHO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2008-07-01', '2010-05-31', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|UB|', '1487607198', 0, 'N', 0, '2012-05-31', NULL, NULL, 43.5995, -116.352, NULL, NULL),
('820525090', 'W11005398', 'W11005398', 'ID01', 'Boise Orthopedic Clinic', 'Ronald', 'M', 'Kristensen', 'MD This Provider will terminate on July 1st', 'Orthopedic Surgery', '', '', NULL, 'O', '520 S Eagle Rd Ste 3213', 'Meridian', 'Ada', 'ID', '83642', '2088980100', NULL, '520 S Eagle Rd Ste 3213', 'Meridian', 'Ada', 'ID', '83642', '2088980100', '          ', 'IDORTHO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2008-07-01', '2010-05-31', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|UB|', '1215948807', 0, 'N', 0, '2012-05-31', NULL, NULL, 43.5995, -116.352, NULL, NULL),
('820525090', 'W11005397', 'W11005397', 'ID01', 'Boise Orthopedic Clinic', 'Mary Ann', '', 'Ozier', 'PA-C', 'Orthopedic Surgery', '', '', NULL, 'B', '520 S Eagle Rd Ste 3213', 'Meridian', 'Ada', 'ID', '83642', '2088980100', NULL, '520 S Eagle Rd Ste 3213', 'Meridian', 'Ada', 'ID', '83642', '2088980100', '          ', 'IDORTHO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2008-07-01', '2010-05-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1811002900', 0, 'Y', 0, '2013-07-03', NULL, NULL, 43.5995, -116.352, NULL, NULL),
('820525090', 'W11005395', 'W11005395', 'ID01', 'Boise Orthopedic Clinic', 'Charles', 'T', 'Floyd', 'MD; Spine', 'Orthopedic Surgery', '', '', NULL, 'B', '520 S Eagle Rd Ste 3213', 'Meridian', 'Ada', 'ID', '83642', '2088980100', NULL, '520 S Eagle Rd Ste 3213', 'Meridian', 'Ada', 'ID', '83642', '2088980100', '', 'IDORTHO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2008-07-01', '2010-05-31', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1124039714', 0, 'Y', 0, '2014-07-09', NULL, NULL, 43.5995, -116.352, NULL, NULL),
('820525090', 'W11005393', 'W11005393', 'ID01', 'Boise Orthopedic Clinic', 'John', 'G', 'Kloss', 'MD; Hand, Shoulder', 'Orthopedic Surgery', 'Hand Surgery', '', NULL, 'B', '520 S Eagle Rd Ste 3213', 'Meridian', 'Ada', 'ID', '83642', '2088980100', NULL, '520 S Eagle Rd Ste 3213', 'Meridian', 'Ada', 'ID', '83642', '2088980100', '', 'IDORTHO', 'WUSTDHCPC5', NULL, '0.00', '30.00', '0.00', 3, '2008-07-01', '2008-09-23', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|UB|', '1922021500', 0, 'Y', 0, '2012-10-18', NULL, NULL, 43.5995, -116.352, NULL, NULL),
('820525090', 'W11005400', 'W11005400', 'ID01', 'Boise Orthopedic Clinic', 'Darby', '', 'Webb', 'MD This Provider will terminate on July 1st', 'Orthopedic Surgery', 'Sports Medicine', '', NULL, 'O', '520 S Eagle Rd Ste 3213', 'Meridian', 'Ada', 'ID', '83642', '2088980100', NULL, '520 S Eagle Rd Ste 3213', 'Meridian', 'Ada', 'ID', '83642', '2088980100', '          ', 'IDORTHO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2008-07-01', '2010-05-31', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|UB|', '1043226715', 0, 'N', 0, '2012-05-31', NULL, NULL, 43.5995, -116.352, NULL, NULL),
('820312070', 'W11005364', 'W11005364', 'ID01', 'Boise Valley Asthma and Allergy Clinic', 'John', 'D', 'Jeppson', 'MD', 'Allergy and Immunology', 'Pediatric Allergy and Immunology', '', NULL, 'O', '2320 E Gala Ste 500', 'Meridian', 'Ada', 'ID', '83642', '2083780080', NULL, '2320 E Gala Ste 500', 'Meridian', 'Ada', 'ID', '83642', '2083780080', '', 'IDALLERGY', 'WUSTDHCPC5', NULL, '0.00', '30.00', '0.00', 3, '2008-07-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1417943622', 0, 'n', 0, '2012-03-01', NULL, NULL, 43.59, -116.365, NULL, NULL),
('820525090', 'W11005396', 'W11005396', 'ID01', 'Boise Orthopedic Clinic', 'Laura', 'L', 'Asaro', 'NP-C', 'Oncology', 'Hematology and Oncology', 'Orthopedic Surgery', NULL, 'B', '520 S Eagle Rd Ste 3213', 'Meridian', 'Ada', 'ID', '83642', '2088980100', NULL, '520 S Eagle Rd Ste 3213', 'Meridian', 'Ada', 'ID', '83642', '2088980100', '', 'IDORTHO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2008-07-01', '2008-09-23', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1003916636', 0, 'Y', 0, '2014-05-28', NULL, NULL, 43.5995, -116.352, NULL, NULL),
('820312070', 'W11005366', 'W11005366', 'ID01', 'Boise Valley Asthma and Allergy Clinic', 'George', 'W', 'Palmer', 'MD', 'Allergy and Immunology', '', '', NULL, 'O', '2320 E Gala Ste 500', 'Meridian', 'Ada', 'ID', '83642', '2083780080', NULL, '2320 E Gala Ste 500', 'Meridian', 'Ada', 'ID', '83642', '2083780080', '', 'IDALLERGY', 'WUSTDHCPC5', NULL, '0.00', '30.00', '0.00', 3, '2008-07-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1033105259', 0, 'n', 0, '2013-06-11', NULL, NULL, 43.59, -116.365, NULL, NULL),
('820312070', 'W11005367', 'W11005367', 'ID01', 'Boise Valley Asthma and Allergy Clinic', 'Heidi', 'S', 'Peters', 'FNP', 'Allergy and Immunology', '', '', NULL, 'O', '2320 E Gala Ste 500', 'Meridian', 'Ada', 'ID', '83642', '2083780080', NULL, '2320 E Gala Ste 500', 'Meridian', 'Ada', 'ID', '83642', '2083780080', '', 'IDALLERGY', 'WUSTDHCPC5', NULL, '0.00', '30.00', '0.00', 3, '2008-07-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1447246905', 0, 'n', 0, '2012-02-29', NULL, NULL, 43.59, -116.365, NULL, NULL),
('820525090', 'W11005407', 'W11005407', 'ID01', 'Boise Orthopedic Clinic', 'James', 'M', 'Johnston', 'MD This Provider will terminate on July 1st', 'Orthopedic Surgery', 'Sports Medicine', '', NULL, 'O', '520 S Eagle Rd Ste 3213', 'Meridian', 'Ada', 'ID', '83642', '2088980100', NULL, '520 S Eagle Rd Ste 3213', 'Meridian', 'Ada', 'ID', '83642', '2088980100', '          ', 'IDORTHO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2008-07-01', '2010-05-31', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|UB|', '1114940699', 0, 'N', 0, '2012-05-31', NULL, NULL, 43.5995, -116.352, NULL, NULL),
('820306254', 'W11005353', 'W11005353', 'ID01', 'Boise OBGYN Associates', 'Jon', 'R', 'Kattenhorn', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '520 S Eagle Rd Ste 1233', 'Meridian', 'Ada', 'ID', '83642', '2083758100', NULL, '520 S Eagle Rd Ste 1233', 'Meridian', 'Ada', 'ID', '83642', '2083758100', '', 'IDOB2', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2008-07-01', '2009-07-31', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1881648251', 0, 'n', 0, '2014-06-20', NULL, NULL, 43.5995, -116.352, NULL, NULL),
('820525090', 'W11005401', 'W11005401', 'ID01', 'Boise Orthopedic Clinic', 'Gannon', NULL, 'Randolph', 'MD', 'Orthopedic Surgery', NULL, NULL, NULL, 'O', '520 S Eagle Rd Ste 3213', 'Meridian', 'Ada', 'ID', '83642', '2088980100', NULL, '1075 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', NULL, NULL, 'IDORTHO', 'WUSTDHCPC5', NULL, '0.00', '30.00', '0.00', 3, '2008-07-01', '2008-09-23', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, NULL, NULL, 'HCFA|UB|', '1528173697', 0, 'N', 0, '2008-06-25', NULL, NULL, 43.5995, -116.352, NULL, NULL),
('820306254', 'W11005352', 'W11005352', 'ID01', 'Boise OBGYN Associates', 'Lisa', 'M', 'Minge', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '520 S Eagle Rd Ste 1233', 'Meridian', 'Ada', 'ID', '83642', '2083758100', NULL, '520 S Eagle Rd Ste 1233', 'Meridian', 'Ada', 'ID', '83642', '2083758100', '', 'IDOB2', 'WUSTDHCPC5', NULL, '0.00', '30.00', '0.00', 3, '2008-07-01', '2009-07-31', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1467405787', 0, 'n', 0, '2013-07-03', NULL, NULL, 43.5995, -116.352, NULL, NULL),
('820306254', 'W11005351', 'W11005351', 'ID01', 'Boise OBGYN Associates', 'Cynthia', 'R', 'Hayes', 'MD', 'Family Practice', 'Obstetrics and Gynecology', NULL, NULL, 'O', '520 S Eagle Rd Ste 1233', 'Meridian', 'Ada', 'ID', '83642', '2083758100', NULL, '5966 Curtisian', 'Boise', 'Ada', 'ID', '83704', NULL, NULL, 'IDOB2', 'WUSTDHCPC5', NULL, '0.00', '30.00', '0.00', 3, '2008-07-01', '2008-08-27', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, NULL, NULL, 'HCFA|UB|', '1386697399', 0, 'n', 0, '2008-10-01', NULL, NULL, 43.5995, -116.352, NULL, NULL),
('820525090', 'W11005394', 'W11005394', 'ID01', 'Boise Orthopedic Clinic', 'David', 'M', 'Lamey', 'MD: OSM', 'Orthopedic Surgery', '', '', NULL, 'B', '520 S Eagle Rd Ste 3213', 'Meridian', 'Ada', 'ID', '83642', '2088980100', NULL, '520 S Eagle Rd Ste 3213', 'Meridian', 'Ada', 'ID', '83642', '2088980100', '', 'IDORTHO', 'WUSTDHCPC5', NULL, '0.00', '30.00', '0.00', 3, '2008-07-01', '2008-09-23', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|UB|', '1124073549', 0, 'Y', 0, '2012-10-17', NULL, NULL, 43.5995, -116.352, NULL, NULL),
('820306254', 'W11005350', 'W11005350', 'ID01', 'Boise OBGYN Associates', 'Darrell', 'J', 'Ludders', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '520 S Eagle Rd Ste 1233', 'Meridian', 'Ada', 'ID', '83642', '2083758100', NULL, '520 S Eagle Rd Ste 1233', 'Meridian', 'Ada', 'ID', '83642', '2083758100', '', 'IDOB2', 'WUSTDHCPC5', NULL, '0.00', '30.00', '0.00', 3, '2008-07-01', '2009-07-31', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1548214927', 0, 'n', 0, '2013-10-23', NULL, NULL, 43.5995, -116.352, NULL, NULL),
('820525090', 'W11005406', 'W11005406', 'ID01', 'Boise Orthopedic Clinic', 'Christopher', 'T', 'Lawler', 'MD This Provider will terminate on July 1st', 'Sports Medicine', 'Emergency Medicine', '', NULL, 'O', '520 S Eagle Rd Ste 3213', 'Meridian', 'Ada', 'ID', '83642', '2088980100', NULL, '520 S Eagle Rd Ste 3213', 'Meridian', 'Ada', 'ID', '83642', '2088980100', '          ', 'IDORTHO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2008-07-01', '2010-05-31', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', 'West Valley Medical Center', NULL, NULL, 'HCFA|UB|', '1801801576', 0, 'N', 0, '2012-05-31', NULL, NULL, 43.5995, -116.352, NULL, NULL),
('820525090', 'W11005405', 'W11005405', 'ID01', 'Boise Orthopedic Clinic', 'Robert', 'N', 'Walker', 'MD This Provider will terminate on July 1st', 'Orthopedic Surgery', 'Sports Medicine', '', NULL, 'O', '520 S Eagle Rd Ste 3213', 'Meridian', 'Ada', 'ID', '83642', '2088980100', NULL, '520 S Eagle Rd Ste 3213', 'Meridian', 'Ada', 'ID', '83642', '2088980100', '          ', 'IDORTHO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2008-07-01', '2010-05-31', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|UB|', '1306856471', 0, 'N', 0, '2012-05-31', NULL, NULL, 43.5995, -116.352, NULL, NULL),
('820525090', 'W11005404', 'W11005404', 'ID01', 'Boise Orthopedic Clinic', 'Michelle', NULL, 'Ardesson', 'PA-C', 'Orthopedic Surgery', '', '', NULL, 'O', '520 S Eagle Rd Ste 3213', 'Meridian', 'Ada', 'ID', '83642', '2088980100', NULL, '520 S Eagle Rd Ste 3213', 'Meridian', 'Ada', 'ID', '83642', '2088980100', '          ', 'IDORTHO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2008-07-01', '2010-05-31', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1780691816', 0, 'N', 0, '2008-06-25', NULL, NULL, 43.5995, -116.352, NULL, NULL),
('820525090', 'W11005403', 'W11005403', 'ID01', 'Boise Orthopedic Clinic', 'Benjamin', '', 'Hochhalter', 'PA-C', 'Orthopedic Surgery', '', '', NULL, 'O', '520 S Eagle Rd Ste 3213', 'Meridian', 'Ada', 'ID', '83642', '2088980100', NULL, '520 S Eagle Rd Ste 3213', 'Meridian', 'Ada', 'ID', '83642', '2088980100', '          ', 'IDORTHO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2008-07-01', '2010-05-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1326023417', 0, 'N', 0, '2012-06-14', NULL, NULL, 43.5995, -116.352, NULL, NULL),
('820525090', 'W11005402', 'W11005402', 'ID01', 'Boise Orthopedic Clinic', 'Benjamin', 'T', 'Kerns', 'PA-C This Provider will terminate on July 1st', 'Orthopedic Surgery', '', '', NULL, 'O', '520 S Eagle Rd Ste 3213', 'Meridian', 'Ada', 'ID', '83642', '2088980100', NULL, '520 S Eagle Rd Ste 3213', 'Meridian', 'Ada', 'ID', '83642', '2088980100', '          ', 'IDORTHO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2008-07-01', '2010-05-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1659388783', 0, 'N', 0, '2012-05-31', NULL, NULL, 43.5995, -116.352, NULL, NULL),
('820312070', 'W11005375', 'W11005375', 'ID01', 'Boise Valley Asthma and Allergy Clinic', 'Heidi', 'S', 'Peters', 'FNP', 'Allergy and Immunology', '', '', NULL, 'O', '16060 Idaho Ctr Blvd', 'Nampa', 'Canyon', 'ID', '83687', '2083780080', NULL, '16060 Idaho Ctr Blvd', 'Nampa', 'Canyon', 'ID', '83687', '2083780080', '', 'IDALLERGY', 'WUSTDHCPC5', NULL, '0.00', '30.00', '0.00', 3, '2008-07-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1447246905', 0, 'n', 0, '2012-02-29', NULL, NULL, 0, 0, NULL, NULL),
('820312070', 'W11005374', 'W11005374', 'ID01', 'Boise Valley Asthma and Allergy Clinic', 'George', 'W', 'Palmer', 'MD', 'Allergy and Immunology', '', '', NULL, 'O', '16060 Idaho Ctr Blvd', 'Nampa', 'Canyon', 'ID', '83687', '2083780080', NULL, '16060 Idaho Ctr Blvd', 'Nampa', 'Canyon', 'ID', '83687', '2083780080', '', 'IDALLERGY', 'WUSTDHCPC5', NULL, '0.00', '30.00', '0.00', 3, '2008-07-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1033105259', 0, 'n', 0, '2013-06-11', NULL, NULL, 0, 0, NULL, NULL),
('820312070', 'W11005372', 'W11005372', 'ID01', 'Boise Valley Asthma and Allergy Clinic', 'John', 'D', 'Jeppson', 'MD', 'Allergy and Immunology', 'Pediatric Allergy and Immunology', '', NULL, 'O', '16060 Idaho Ctr Blvd', 'Nampa', 'Canyon', 'ID', '83687', '2083780080', NULL, '16060 Idaho Ctr Blvd', 'Nampa', 'Canyon', 'ID', '83687', '2083780080', '', 'IDALLERGY', 'WUSTDHCPC5', NULL, '0.00', '30.00', '0.00', 3, '2008-07-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1417943622', 0, 'n', 0, '2012-03-01', NULL, NULL, 0, 0, NULL, NULL),
('820312070', 'W11005373', 'W11005373', 'ID01', 'Boise Valley Asthma and Allergy Clinic', 'Michael', 'V', 'Keiley', 'MD', 'Allergy and Immunology', 'Pediatric Allergy and Immunology', '', NULL, 'O', '16060 Idaho Ctr Blvd', 'Nampa', 'Canyon', 'ID', '83687', '2083780080', NULL, '16060 Idaho Ctr Blvd', 'Nampa', 'Canyon', 'ID', '83687', '2083780080', '', 'IDALLERGY', 'WUSTDHCPC5', NULL, '0.00', '30.00', '0.00', 3, '2008-07-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1679569149', 0, 'n', 0, '2012-02-29', NULL, NULL, 0, 0, NULL, NULL),
('680569751', 'W11005377', 'W11005377', 'ID01', 'Davis Family Medicine', 'A', 'Marie', 'Osborn', 'FNP', 'Family Practice', '', '', NULL, 'O', '222 N 2nd St Ste 204', 'Boise', 'Ada', 'ID', '83702', '2084299100', NULL, '222 N 2nd St Ste 204', 'Boise', 'Ada', 'ID', '83702', '2084299100', '', 'IDSTD', 'WUSTDHCPC5', NULL, '0.00', '30.00', '0.00', 3, '2008-07-01', '2012-08-19', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1679630362', 0, 'n', 0, '2012-01-30', NULL, NULL, 43.6131, -116.195, NULL, NULL),
('820306254', 'W11005345', 'W11005345', 'ID01', 'Boise OBGYN Associates', 'Georgianna', '', 'Ainslie', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '5966 Curtisian', 'Boise', 'Ada', 'ID', '83704', '2083758100', NULL, '5966 Curtisian', 'Boise', 'Ada', 'ID', '83704', '2083758100', '', 'IDOB2', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2008-07-01', '2009-07-31', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1073566089', 0, 'n', 0, '2014-06-20', NULL, NULL, 43.6149, -116.256, NULL, NULL),
('820306254', 'W11005347', 'W11005347', 'ID01', 'Boise OBGYN Associates', 'Barbara', NULL, 'Gehrke', 'CNP', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'O', '5966 Curtisian', 'Boise', 'Ada', 'ID', '83704', '2083758100', NULL, '5966 Curtisian', 'Boise', 'Ada', 'ID', '83704', NULL, NULL, 'IDOB2', 'WUSTDHCPC5', NULL, '0.00', '30.00', '0.00', 3, '2008-07-01', '2009-07-20', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1790738706', 0, 'n', 0, '2008-06-24', NULL, NULL, 43.6149, -116.256, NULL, NULL),
('820466680', 'W11005359', 'W11005359', 'ID01', 'Boise Minor Emergency Center PA (X-ray)', '', '', 'Boise Minor Emergency Center PA (X-ray)', 'GROUP', 'Urgent Care', '', '', NULL, 'O', '2993 N Cole Rd', 'Boise', 'Ada', 'ID', '83704', '2083780400', NULL, '2993 N Cole Rd', 'Boise', 'Ada', 'ID', '83704', '2083780400', '          ', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2008-07-01', '2012-09-19', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000005344', 0, 'N', 0, '2013-07-15', NULL, NULL, 0, 0, NULL, NULL),
('820306254', 'W11005344', 'W11005344', 'ID01', 'Boise OBGYN Associates', 'JoAnn', 'M', 'Johnson', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '5966 Curtisian', 'Boise', 'Ada', 'ID', '83704', '2083758100', NULL, '5966 Curtisian', 'Boise', 'Ada', 'ID', '83704', '2083758100', '', 'IDOB2', 'WUSTDHCPC5', NULL, '0.00', '30.00', '0.00', 3, '2008-07-01', '2009-07-31', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1801842257', 0, 'n', 0, '2013-07-03', NULL, NULL, 43.6149, -116.256, NULL, NULL),
('820306254', 'W11005348', 'W11005348', 'ID01', 'Boise OBGYN Associates', 'Gloria', '', 'Beery', 'CNP', 'Family Practice', 'Obstetrics and Gynecology', '', NULL, 'O', '5966 Curtisian', 'Boise', 'Ada', 'ID', '83704', '2083758100', NULL, '5966 Curtisian', 'Boise', 'Ada', 'ID', '83704', '2083758100', '', 'IDOB2', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2008-07-01', '2008-11-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1043263064', 0, 'n', 0, '2014-05-20', NULL, NULL, 43.6149, -116.256, NULL, NULL),
('820466680', 'W11005357', 'W11005357', 'ID01', 'Boise Minor Emergency Center PA', 'Gary', '', 'Canova', 'MD', 'Family Practice', 'Emergency Medicine', '', NULL, 'O', '2993 N Cole Rd', 'Boise', 'Ada', 'ID', '83704', '2083780400', NULL, '2993 N Cole Rd', 'Boise', 'Ada', 'ID', '83704', '2083780400', '', 'IDSTD', 'WUSTDHCPC5', NULL, '0.00', '30.00', '0.00', 3, '2008-07-01', '2012-08-19', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1265454680', 0, 'n', 0, '2012-11-01', NULL, NULL, 0, 0, NULL, NULL),
('820466680', 'W11005358', 'W11005358', 'ID01', 'Boise Minor Emergency Center PA', 'Adam', 'C', 'Husney', 'MD', 'Family Practice', 'Emergency Medicine', '', NULL, 'O', '2993 N Cole Rd', 'Boise', 'Ada', 'ID', '83704', '2083780400', NULL, '2993 N Cole Rd', 'Boise', 'Ada', 'ID', '83704', '2083780400', '', 'IDSTD', 'WUSTDHCPC5', NULL, '0.00', '30.00', '0.00', 3, '2008-07-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, '', '', 'HCFA|UB|', '1497773196', 0, 'n', 0, '2014-02-07', NULL, NULL, 0, 0, NULL, NULL),
('820312070', 'W11005360', 'W11005360', 'ID01', 'Boise Valley Asthma and Allergy Clinic', 'John', 'D', 'Jeppson', 'MD', 'Allergy and Immunology', 'Pediatric Allergy and Immunology', '', NULL, 'O', '901 N Curtis Rd Ste 100', 'Boise', 'Ada', 'ID', '83706', '2083780080', NULL, '901 N Curtis Rd Ste 100', 'Boise', 'Ada', 'ID', '83706', '2083780080', '', 'IDALLERGY', 'WUSTDHCPC5', NULL, '0.00', '30.00', '0.00', 3, '2008-07-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1417943622', 0, 'n', 0, '2012-03-01', NULL, NULL, 43.6126, -116.255, NULL, NULL),
('820312070', 'W11005361', 'W11005361', 'ID01', 'Boise Valley Asthma and Allergy Clinic', 'Michael', 'V', 'Keiley', 'MD', 'Allergy and Immunology', 'Pediatric Allergy and Immunology', '', NULL, 'O', '901 N Curtis Rd Ste 100', 'Boise', 'Ada', 'ID', '83706', '2083780080', NULL, '901 N Curtis Rd Ste 100', 'Boise', 'Ada', 'ID', '83706', '2083780080', '', 'IDALLERGY', 'WUSTDHCPC5', NULL, '0.00', '30.00', '0.00', 3, '2008-07-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1679569149', 0, 'n', 0, '2012-02-29', NULL, NULL, 43.6126, -116.255, NULL, NULL),
('820312070', 'W11005362', 'W11005362', 'ID01', 'Boise Valley Asthma and Allergy Clinic', 'George', 'W', 'Palmer', 'MD', 'Allergy and Immunology', '', '', NULL, 'O', '901 N Curtis Rd Ste 100', 'Boise', 'Ada', 'ID', '83706', '2083780080', NULL, '901 N Curtis Rd Ste 100', 'Boise', 'Ada', 'ID', '83706', '2083780080', '', 'IDALLERGY', 'WUSTDHCPC5', NULL, '0.00', '30.00', '0.00', 3, '2008-07-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1033105259', 0, 'n', 0, '2013-06-11', NULL, NULL, 43.6126, -116.255, NULL, NULL),
('820525090', 'W11005381', 'W11005381', 'ID01', 'Boise Orthopedic Clinic', 'David', 'M', 'Lamey', 'MD: OSM', 'Orthopedic Surgery', '', '', NULL, 'O', '1075 N Curtis Rd Ste 300', 'Boise', 'Ada', 'ID', '83706', '2083232600', NULL, '1075 N Curtis Rd Ste 300', 'Boise', 'Ada', 'ID', '83706', '2083232600', '', 'IDORTHO', 'WUSTDHCPC5', NULL, '0.00', '30.00', '0.00', 3, '2008-07-01', '2008-09-23', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|UB|', '1124073549', 0, 'n', 0, '2012-10-17', NULL, NULL, 43.6143, -116.258, NULL, NULL),
('820312070', 'W11005363', 'W11005363', 'ID01', 'Boise Valley Asthma and Allergy Clinic', 'Heidi', 'S', 'Peters', 'FNP', 'Allergy and Immunology', '', '', NULL, 'O', '901 N Curtis Rd Ste 100', 'Boise', 'Ada', 'ID', '83706', '2083780080', NULL, '901 N Curtis Rd Ste 100', 'Boise', 'Ada', 'ID', '83706', '2083780080', '', 'IDALLERGY', 'WUSTDHCPC5', NULL, '0.00', '30.00', '0.00', 3, '2008-07-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1447246905', 0, 'n', 0, '2012-02-29', NULL, NULL, 43.6126, -116.255, 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
('820525090', 'W11005387', 'W11005387', 'ID01', 'Boise Orthopedic Clinic', 'Christopher', 'T', 'Lawler', 'MD This Provider will terminate on July 1st', 'Sports Medicine', 'Emergency Medicine', '', NULL, 'O', '1075 N Curtis Rd Ste 300', 'Boise', 'Ada', 'ID', '83706', '2083232600', NULL, '1075 N Curtis Rd Ste 300', 'Boise', 'Ada', 'ID', '83706', '2083232600', '          ', 'IDORTHO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2008-07-01', '2010-05-31', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', 'West Valley Medical Center', NULL, NULL, 'HCFA|UB|', '1801801576', 0, 'N', 0, '2012-05-31', NULL, NULL, 43.6143, -116.258, NULL, NULL),
('820525090', 'W11005379', 'W11005379', 'ID01', 'Boise Orthopedic Clinic', 'John', 'G', 'Kloss', 'MD; Hand, Shoulder', 'Orthopedic Surgery', 'Hand Surgery', '', NULL, 'O', '1075 N Curtis Rd Ste 300', 'Boise', 'Ada', 'ID', '83706', '2083232600', NULL, '1075 N Curtis Rd Ste 300', 'Boise', 'Ada', 'ID', '83706', '2083232600', '', 'IDORTHO', 'WUSTDHCPC5', NULL, '0.00', '30.00', '0.00', 3, '2008-07-01', '2008-09-23', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|UB|', '1922021500', 0, 'n', 0, '2012-10-18', NULL, NULL, 43.6143, -116.258, NULL, NULL),
('202882697', 'W11005415', 'W11005415', 'ID01', 'The Pediatric & Adolescent Center', 'Katherine', 'D', 'Stevens', 'MD', 'Pediatrics', '', '', NULL, 'O', '1070 N Curtis Rd Ste 150', 'Boise', 'Ada', 'ID', '83706', '2083225437', NULL, '1070 N Curtis Rd Ste 150', 'Boise', 'Ada', 'ID', '83706', '2083225437', '          ', 'IDSTD10', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2008-07-01', '2012-06-30', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|UB|', '1124017462', 0, 'N', 0, '2012-07-20', NULL, NULL, 43.6141, -116.253, NULL, NULL),
('820525090', 'W11005391', 'W11005391', 'ID01', 'Boise Orthopedic Clinic', 'Benjamin', '', 'Hochhalter', 'PA-C', 'Orthopedic Surgery', '', '', NULL, 'O', '1075 N Curtis Rd Ste 300', 'Boise', 'Ada', 'ID', '83706', '2083232600', NULL, '1075 N Curtis Rd Ste 300', 'Boise', 'Ada', 'ID', '83706', '2083232600', '          ', 'IDORTHO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2008-07-01', '2010-05-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1326023417', 0, 'N', 0, '2012-06-14', NULL, NULL, 43.6143, -116.258, NULL, NULL),
('820525090', 'W11005390', 'W11005390', 'ID01', 'Boise Orthopedic Clinic', 'Benjamin', 'T', 'Kerns', 'PA-C This Provider will terminate on July 1st', 'Orthopedic Surgery', '', '', NULL, 'O', '1075 N Curtis Rd Ste 300', 'Boise', 'Ada', 'ID', '83706', '2083232600', NULL, '1075 N Curtis Rd Ste 300', 'Boise', 'Ada', 'ID', '83706', '2083232600', '          ', 'IDORTHO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2008-07-01', '2010-05-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1659388783', 0, 'N', 0, '2012-05-31', NULL, NULL, 43.6143, -116.258, NULL, NULL),
('820525090', 'W11005388', 'W11005388', 'ID01', 'Boise Orthopedic Clinic', 'Laura', 'L', 'Asaro', 'NP-C', 'Oncology', 'Hematology and Oncology', 'Orthopedic Surgery', NULL, 'O', '1075 N Curtis Rd Ste 300', 'Boise', 'Ada', 'ID', '83706', '2083232600', NULL, '1075 N Curtis Rd Ste 300', 'Boise', 'Ada', 'ID', '83706', '2083232600', '', 'IDORTHO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2008-07-01', '2008-09-23', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1003916636', 0, 'n', 0, '2014-05-28', NULL, NULL, 43.6143, -116.258, NULL, NULL),
('820525090', 'W11005392', 'W11005392', 'ID01', 'Boise Orthopedic Clinic', 'Michelle', NULL, 'Ardesson', 'PA-C', 'Orthopedic Surgery', '', '', NULL, 'O', '1075 N Curtis Rd Ste 300', 'Boise', 'Ada', 'ID', '83706', '2083232600', NULL, '1075 N Curtis Rd Ste 300', 'Boise', 'Ada', 'ID', '83706', '2083232600', '          ', 'IDORTHO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2008-07-01', '2010-05-31', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1780691816', 0, 'N', 0, '2008-06-25', NULL, NULL, 43.6143, -116.258, NULL, NULL),
('820525090', 'W11005386', 'W11005386', 'ID01', 'Boise Orthopedic Clinic', 'Gannon', NULL, 'Randolph', 'MD', 'Orthopedic Surgery', NULL, NULL, NULL, 'O', '1075 N Curtis Rd Ste 300', 'Boise', 'Ada', 'ID', '83706', '2083232600', NULL, '1075 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', NULL, NULL, 'IDORTHO', 'WUSTDHCPC5', NULL, '0.00', '30.00', '0.00', 3, '2008-07-01', '2008-09-23', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, NULL, NULL, 'HCFA|UB|', '1528173697', 0, 'n', 0, '2008-06-25', NULL, NULL, 43.6143, -116.258, NULL, NULL),
('820525090', 'W11005385', 'W11005385', 'ID01', 'Boise Orthopedic Clinic', 'Darby', '', 'Webb', 'MD This Provider will terminate on July 1st', 'Orthopedic Surgery', 'Sports Medicine', '', NULL, 'O', '1075 N Curtis Rd Ste 300', 'Boise', 'Ada', 'ID', '83706', '2083232600', NULL, '1075 N Curtis Rd Ste 300', 'Boise', 'Ada', 'ID', '83706', '2083232600', '          ', 'IDORTHO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2008-07-01', '2010-05-31', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|UB|', '1043226715', 0, 'N', 0, '2012-05-31', NULL, NULL, 43.6143, -116.258, NULL, NULL),
('820525090', 'W11005384', 'W11005384', 'ID01', 'Boise Orthopedic Clinic', 'James', 'M', 'Johnston', 'MD This Provider will terminate on July 1st', 'Orthopedic Surgery', 'Sports Medicine', '', NULL, 'O', '1075 N Curtis Rd Ste 300', 'Boise', 'Ada', 'ID', '83706', '2083232600', NULL, '1075 N Curtis Rd Ste 300', 'Boise', 'Ada', 'ID', '83706', '2083232600', '          ', 'IDORTHO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2008-07-01', '2010-05-31', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|UB|', '1114940699', 0, 'N', 0, '2012-05-31', NULL, NULL, 43.6143, -116.258, NULL, NULL),
('820525090', 'W11005383', 'W11005383', 'ID01', 'Boise Orthopedic Clinic', 'Jeffry', 'P', 'Menzner', 'MD This Provider will terminate on July 1st', 'Orthopedic Surgery', 'Hematology and Oncology', '', NULL, 'O', '1075 N Curtis Rd Ste 300', 'Boise', 'Ada', 'ID', '83706', '2083232600', NULL, '1075 N Curtis Rd Ste 300', 'Boise', 'Ada', 'ID', '83706', '2083232600', '          ', 'IDORTHO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2008-07-01', '2010-05-31', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|UB|', '1487607198', 0, 'N', 0, '2012-05-31', NULL, NULL, 43.6143, -116.258, NULL, NULL),
('820525090', 'W11005382', 'W11005382', 'ID01', 'Boise Orthopedic Clinic', 'Charles', 'T', 'Floyd', 'MD; Spine', 'Orthopedic Surgery', '', '', NULL, 'O', '1075 N Curtis Rd Ste 300', 'Boise', 'Ada', 'ID', '83706', '2083232600', NULL, '1075 N Curtis Rd Ste 300', 'Boise', 'Ada', 'ID', '83706', '2083232600', '', 'IDORTHO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2008-07-01', '2010-05-31', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1124039714', 0, 'Y', 0, '2014-07-09', NULL, NULL, 43.6143, -116.258, NULL, NULL),
('202882697', 'W11005417', 'W11005417', 'ID01', 'The Pediatric & Adolescent Center', 'Vaun', '', 'Archibald', 'DO', 'Pediatrics', '', '', NULL, 'O', '1070 N Curtis Rd Ste 150', 'Boise', 'Ada', 'ID', '83706', '2083225694', NULL, '1070 N Curtis Rd Ste 150', 'Boise', 'Ada', 'ID', '83706', '2083225694', '', 'IDSTD10', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2008-07-01', '2010-12-31', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1417937517', 0, 'N', 0, '2014-06-20', NULL, NULL, 43.6141, -116.253, NULL, NULL),
('820525090', 'W11005380', 'W11005380', 'ID01', 'Boise Orthopedic Clinic', 'Ronald', 'M', 'Kristensen', 'MD This Provider will terminate on July 1st', 'Orthopedic Surgery', '', '', NULL, 'O', '1075 N Curtis Rd Ste 300', 'Boise', 'Ada', 'ID', '83706', '2083232600', NULL, '1075 N Curtis Rd Ste 300', 'Boise', 'Ada', 'ID', '83706', '2083232600', '          ', 'IDORTHO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2008-07-01', '2010-05-31', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|UB|', '1215948807', 0, 'N', 0, '2012-05-31', NULL, NULL, 43.6143, -116.258, NULL, NULL),
('202882697', 'W11005416', 'W11005416', 'ID01', 'The Pediatric & Adolescent Center', 'Cathy', '', 'Sandstrom', 'MD', 'Pediatrics', '', '', NULL, 'O', '1070 N Curtis Rd Ste 150', 'Boise', 'Ada', 'ID', '83706', '2083225694', NULL, '1070 N Curtis Rd Ste 150', 'Boise', 'Ada', 'ID', '83706', '2083225694', '', 'IDSTD10', 'WUSTDHCPC5', NULL, '0.00', '30.00', '0.00', 3, '2008-07-01', '2012-08-19', 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1215926845', 0, 'N', 0, '2013-07-02', NULL, NULL, 43.6141, -116.253, NULL, NULL),
('820525090', 'W11005389', 'W11005389', 'ID01', 'Boise Orthopedic Clinic', 'Mary Ann', '', 'Ozier', 'PA-C', 'Orthopedic Surgery', '', '', NULL, 'O', '1075 N Curtis Rd Ste 300', 'Boise', 'Ada', 'ID', '83706', '2083232600', NULL, '1075 N Curtis Rd Ste 300', 'Boise', 'Ada', 'ID', '83706', '2083232600', '          ', 'IDORTHO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2008-07-01', '2010-05-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1811002900', 0, 'N', 0, '2013-07-03', NULL, NULL, 43.6143, -116.258, NULL, NULL),
('680569751', 'W11005378', 'W11005378', 'ID01', 'Davis Family Medicine', 'A', 'Marie', 'Osborn', 'FNP', 'Family Practice', '', '', NULL, 'B', 'PO Box 44613', 'Boise', 'Ada', 'ID', '83711', '2084299100', NULL, 'PO Box 44613', 'Boise', 'Ada', 'ID', '83711', '2084299100', '', 'IDSTD', 'WUSTDHCPC5', NULL, '0.00', '30.00', '0.00', 3, '2008-07-01', '2012-08-19', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1679630362', 0, 'Y', 0, '2012-01-30', NULL, NULL, 0, 0, NULL, NULL),
('202882697', 'W11005411', 'W11005411', 'ID01', 'The Pediatric & Adolescent Center', 'Renee', '', 'Kindler', 'FNP', 'Pediatrics', '', '', NULL, 'O', '6148 N Discovery Way Ste 100', 'Boise', 'Ada', 'ID', '83713', '2083225437', NULL, '6148 N Discovery Way Ste 100', 'Boise', 'Ada', 'ID', '83713', '2083225437', '          ', 'IDSTD10', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2008-07-01', '2010-02-09', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1588653828', 0, 'N', 0, '2012-10-12', NULL, NULL, 43.6607, -116.341, NULL, NULL),
('202882697', 'W11005414', 'W11005414', 'ID01', 'The Pediatric & Adolescent Center', 'Katherine', 'D', 'Stevens', 'MD', 'Pediatrics', '', '', NULL, 'B', '6148 N Discovery Way Ste 100', 'Boise', 'Ada', 'ID', '83713', '2083225437', NULL, '6148 N Discovery Way Ste 100', 'Boise', 'Ada', 'ID', '83713', '2083225437', '          ', 'IDSTD10', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2008-07-01', '2012-06-30', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|UB|', '1124017462', 0, 'Y', 0, '2012-07-20', NULL, NULL, 43.6607, -116.341, NULL, NULL),
('202882697', 'W11005413', 'W11005413', 'ID01', 'The Pediatric & Adolescent Center', 'Vaun', '', 'Archibald', 'DO', 'Pediatrics', '', '', NULL, 'O', '6148 N Discovery Way Ste 100', 'Boise', 'Ada', 'ID', '83713', '2083225437', NULL, '6148 N Discovery Way Ste 100', 'Boise', 'Ada', 'ID', '83713', '2083225437', '', 'IDSTD10', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2008-07-01', '2010-12-31', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1417937517', 0, 'N', 0, '2014-06-20', NULL, NULL, 43.6607, -116.341, NULL, NULL),
('202882697', 'W11005412', 'W11005412', 'ID01', 'The Pediatric & Adolescent Center', 'Nancy', '', 'Miller', 'FNP', 'Pediatrics', '', '', NULL, 'O', '6148 N Discovery Way Ste 100', 'Boise', 'Ada', 'ID', '83713', '2083225437', NULL, '6148 N Discovery Way Ste 100', 'Boise', 'Ada', 'ID', '83713', '2083225437', '', 'IDSTD10', 'WUSTDHCPC5', NULL, '0.00', '30.00', '0.00', 3, '2008-07-01', '2012-08-19', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1164411864', 0, 'n', 0, '2012-04-17', NULL, NULL, 43.6607, -116.341, NULL, NULL),
('202882697', 'W11005410', 'W11005410', 'ID01', 'The Pediatric & Adolescent Center', 'Cathy', '', 'Sandstrom', 'MD', 'Pediatrics', '', '', NULL, 'O', '6148 N Discovery Way Ste 100', 'Boise', 'Ada', 'ID', '83713', '2083225437', NULL, '6148 N Discovery Way Ste 100', 'Boise', 'Ada', 'ID', '83713', '2083225437', '', 'IDSTD10', 'WUSTDHCPC5', NULL, '0.00', '30.00', '0.00', 3, '2008-07-01', '2012-08-19', 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1215926845', 0, 'n', 0, '2013-07-02', NULL, NULL, 43.6607, -116.341, NULL, NULL),
('202882697', 'W11005409', 'W11005409', 'ID01', 'The Pediatric & Adolescent Center', 'William', 'S', 'Bourquard', 'MD', 'Pediatrics', '', '', NULL, 'O', '6148 N Discovery Way Ste 100', 'Boise', 'Ada', 'ID', '83713', '2083225437', NULL, '6148 N Discovery Way Ste 100', 'Boise', 'Ada', 'ID', '83713', '2083225437', '', 'IDSTD10', 'WUSTDHCPC5', NULL, '0.00', '30.00', '0.00', 3, '2008-07-01', '2012-08-19', 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1568451193', 0, 'n', 0, '2012-04-17', NULL, NULL, 43.6607, -116.341, NULL, NULL),
('202882697', 'W11005408', 'W11005408', 'ID01', 'The Pediatric & Adolescent Center', 'Steven', 'K', 'Dahlke', 'MD', 'Pediatrics', '', '', NULL, 'O', '6148 N Discovery Way Ste 100', 'Boise', 'Ada', 'ID', '83713', '2083225437', NULL, '6148 N Discovery Way Ste 100', 'Boise', 'Ada', 'ID', '83713', '2083225437', '', 'IDSTD10', 'WUSTDHCPC5', NULL, '0.00', '30.00', '0.00', 3, '2008-07-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, NULL, NULL, 'HCFA|UB|', '1710976337', 0, 'n', 0, '2013-03-18', NULL, NULL, 43.6607, -116.341, NULL, NULL),
('528617479', 'W11005355', 'W11005355', 'UTMH1', 'LDS Family Services', 'Jade', 'C', 'Mangus', 'LCSW', 'Mental Health', 'Social Worker', NULL, NULL, 'B', '94 E Pages Ln Ste A', 'Centerville', 'Davis', 'UT', '84014', '8018086516', NULL, '7992 S 7110 W', 'West Jordan', 'Davis', 'UT', '84088', NULL, NULL, 'UTMA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2008-11-21', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1710006770', 0, 'Y', 0, '2008-06-24', NULL, NULL, 0, 0, NULL, NULL),
('528711825', 'W11005346', 'W11005346', 'UTMH1', 'New Directions Counseling', 'Matthew', 'T', 'Loveland', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '31 W Ctr St', 'Kaysville', 'Davis', 'UT', '84037', '8016605557', NULL, '31 W Ctr St', 'Kaysville', 'Davis', 'UT', '84037', '8016605557', '', 'UTMA', NULL, '', '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1326054222', 0, 'n', 0, '2014-05-16', NULL, NULL, 0, 0, NULL, NULL),
('528617479', 'W11005356', 'W11005356', 'UTMH1', NULL, 'Jade', 'C', 'Mangus', 'LCSW', 'Mental Health', 'Social Worker', NULL, NULL, 'B', '7992 S 7110 W', 'West Jordan', 'Salt Lake', 'UT', '84088', '8018086516', NULL, '7992 S 7110 W', 'West Jordan', 'Salt Lake', 'UT', '84088', NULL, NULL, 'UTMA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2008-11-21', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1710006770', 0, 'Y', 0, '2008-06-24', NULL, NULL, 0, 0, NULL, NULL),
('870621824', 'W11005343', 'W11005343', 'UTMH1', 'Intermountain Center for Cognitive Therapy', 'Randy', 'S', 'Linnell', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '111 E 5600 S Ste 318', 'Murray', 'Salt Lake', 'UT', '84107', '8012682887', NULL, '111 E 5600 S Ste 318', 'Murray', 'Salt Lake', 'UT', '84107', '8012682887', '', 'UTMA', NULL, NULL, '0.00', '35.00', '0.00', 6, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1457480204', 0, 'N', 0, '2014-05-01', NULL, NULL, 0, 0, NULL, NULL),
('527254929', 'W11005349', 'W11005349', 'UTMH1', NULL, 'Mindy', '', 'MacDougall', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '124 S 400 E Ste 301', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8013223923', '8013220798', '124 S 400 E Ste 301', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8013223923', '8013220798', 'UTMA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1336158872', 0, 'N', 0, '2013-10-03', NULL, NULL, 0, 0, NULL, NULL),
('528617479', 'W11005354', 'W11005354', 'UTMH1', 'AAIM Counseling', 'Jade', 'C', 'Mangus', 'LCSW', 'Mental Health', 'Social Worker', NULL, NULL, 'O', '352 Denver St Ste 320', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8018086516', NULL, '7992 S 7110 W', 'West Jordan', 'Salt Lake', 'UT', '84088', NULL, NULL, 'UTMA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2008-11-21', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1710006770', 0, 'n', 0, '2008-06-24', NULL, NULL, 0, 0, NULL, NULL),
('820477852', 'W11005438', 'W11005438', 'ID01', 'Saint Alphonsus Medical Group Urgent Care Elm (X-ray)', '', '', 'Saint Alphonsus Medical Group Urgent Care Clinics', '', 'Urgent Care', '', '', NULL, 'O', '315 E Elm St Ste 100', 'Caldwell', 'Canyon', 'ID', '83605', '2084540526', '2084545107', '315 E Elm St Ste 100', 'Caldwell', 'Canyon', 'ID', '83605', '2084540526', '2084545107', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2008-07-01', '2012-09-19', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000008549', 0, 'N', 0, '2014-06-13', NULL, NULL, 43.6539, -116.695, NULL, NULL),
('820525090', 'W11005432', 'W11005432', 'ID01', 'Cascade Medical Center', 'Benjamin', 'T', 'Kerns', 'PA-C This Provider will terminate on July 1st', 'Orthopedic Surgery', '', '', NULL, 'B', '402 Old State Hwy', 'Cascade', 'Valley', 'ID', '83611', '2083232600', NULL, '402 Old State Hwy', 'Cascade', 'Valley', 'ID', '83611', '2083232600', '          ', 'IDORTHO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2008-07-01', '2010-05-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1659388783', 0, 'N', 0, '2012-05-31', NULL, NULL, 0, 0, NULL, NULL),
('820525090', 'W11005434', 'W11005434', 'ID01', 'Cascade Medical Center', 'Ronald', 'M', 'Kristensen', 'MD This Provider will terminate on July 1st', 'Orthopedic Surgery', '', '', NULL, 'B', '402 Old State Hwy', 'Cascade', 'Valley', 'ID', '83611', '2083232600', NULL, '402 Old State Hwy', 'Cascade', 'Valley', 'ID', '83611', '2083232600', '          ', 'IDORTHO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2008-07-01', '2010-05-31', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|UB|', '1215948807', 0, 'N', 0, '2012-05-31', NULL, NULL, 0, 0, NULL, NULL),
('820525090', 'W11005426', 'W11005426', 'ID01', 'Payette Lakes Medical Clinic', 'Michelle', NULL, 'Ardesson', 'PA-C', 'Orthopedic Surgery', '', '', NULL, 'B', '211 W Forrest', 'McCall', 'Valley', 'ID', '83638', '2083232600', NULL, '211 W Forrest', 'McCall', 'Valley', 'ID', '83638', '2083232600', '          ', 'IDORTHO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2008-07-01', '2010-05-31', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1780691816', 0, 'N', 0, '2008-06-25', NULL, NULL, 0, 0, NULL, NULL),
('820525090', 'W11005429', 'W11005429', 'ID01', 'Payette Lakes Medical Clinic', 'Darby', '', 'Webb', 'MD This Provider will terminate on July 1st', 'Orthopedic Surgery', 'Sports Medicine', '', NULL, 'B', '211 W Forrest', 'McCall', 'Valley', 'ID', '83638', '2083232600', NULL, '211 W Forrest', 'McCall', 'Valley', 'ID', '83638', '2083232600', '          ', 'IDORTHO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2008-07-01', '2010-05-31', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|UB|', '1043226715', 0, 'N', 0, '2012-05-31', NULL, NULL, 0, 0, NULL, NULL),
('820525090', 'W11005430', 'W11005430', 'ID01', 'Payette Lakes Medical Clinic', 'Gannon', NULL, 'Randolph', 'MD', 'Orthopedic Surgery', NULL, NULL, NULL, 'B', '211 W Forrest', 'Payette', 'Valley', 'ID', '83638', '2083232600', NULL, '1075 N Curtis Rd', 'Boise', 'Valley', 'ID', '83706', NULL, NULL, 'IDORTHO', 'WUSTDHCPC5', NULL, '0.00', '30.00', '0.00', 3, '2008-07-01', '2008-09-23', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, NULL, NULL, 'HCFA|UB|', '1528173697', 0, 'N', 0, '2008-06-25', NULL, NULL, 0, 0, NULL, NULL),
('820477852', 'W11005437', 'W11005437', 'ID01', 'Saint Alphonsus Medical Group Urgent Care Cherry Lane (X-ray)', '', '', 'Saint Alphonsus Medical Group Urgent Care Clinics', '', 'Urgent Care', '', '', NULL, 'O', '3025 W Cherry Ln Ste B', 'Meridian', 'Ada', 'ID', '83642', '2083678699', '2083678555', '3025 W Cherry Ln Ste B', 'Meridian', 'Ada', 'ID', '83642', '2083678699', '2083678555', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2008-07-01', '2012-09-19', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000008549', 0, 'N', 0, '2014-06-13', NULL, NULL, 43.6188, -116.431, NULL, NULL),
('820525090', 'W11005428', 'W11005428', 'ID01', 'Elmore Medical Center', 'Darby', '', 'Webb', 'MD This Provider will terminate on July 1st', 'Orthopedic Surgery', 'Sports Medicine', '', NULL, 'o', '895 N 6th E', 'Mountain Home', 'Elmore', 'ID', '83647', '2083232600', NULL, '895 N 6th E', 'Mountain Home', 'Elmore', 'ID', '83647', '2083232600', '          ', 'IDORTHO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2008-07-01', '2010-05-31', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|UB|', '1043226715', 0, 'N', 0, '2012-05-31', NULL, NULL, 43.1388, -115.693, NULL, NULL),
('820525090', 'W11005427', 'W11005427', 'ID01', 'Elmore Medical Center', 'Michelle', NULL, 'Ardesson', 'PA-C', 'Orthopedic Surgery', '', '', NULL, 'o', '895 N 6th E', 'Mountain Home', 'Elmore', 'ID', '83647', '2083232600', NULL, '895 N 6th E', 'Mountain Home', 'Elmore', 'ID', '83647', '2083232600', '          ', 'IDORTHO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2008-07-01', '2010-05-31', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1780691816', 0, 'N', 0, '2008-06-25', NULL, NULL, 43.1388, -115.693, NULL, NULL),
('820477852', 'W11005439', 'W11005439', 'ID01', 'Saint Alphonsus Medical Group Urgent Care Garrity (X-ray)', '', '', 'Saint Alphonsus Medical Group Urgent Care Clinics', '', 'Urgent Care', '', '', NULL, 'O', '1200 Garrity Blvd', 'Nampa', 'Canyon', 'ID', '83687', '2084422388', '2084665322', '1200 Garrity Blvd', 'Nampa', 'Canyon', 'ID', '83687', '2084422388', '2084665322', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2008-07-01', '2012-09-19', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000008549', 0, 'N', 0, '2014-06-13', NULL, NULL, 43.587, -116.549, NULL, NULL),
('820537848', 'W11005443', 'W11005443', 'ID01', 'The Shoulder Clinic of Idaho', 'Robert', 'J', 'Buzzini', 'PA-C', 'Orthopedic Surgery', '', '', NULL, 'O', '8854 W Emerald Ste 102', 'Boise', 'Ada', 'ID', '83704', '2083234747', NULL, '8854 W Emerald Ste 102', 'Boise', 'Ada', 'ID', '83704', '2083234747', '', 'IDORTHO2', 'WUSTDHCPC5', NULL, '0.00', '30.00', '0.00', 3, '2008-07-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1497703730', 0, 'n', 0, '2011-08-09', NULL, NULL, 43.6123, -116.292, NULL, NULL),
('820477852', 'W11005440', 'W11005440', 'ID01', 'Saint Alphonsus Medical Group Urgent Care Emerald (X-ray)', '', '', 'Saint Alphonsus Medical Group Urgent Care Clinics', '', 'Urgent Care', '', '', NULL, 'O', '6533 Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083674170', '2083678135', '6533 Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083674170', '2083678135', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2008-07-01', '2012-09-19', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000008549', 0, 'N', 0, '2014-06-13', NULL, NULL, 43.6119, -116.268, NULL, NULL),
('820537848', 'W11005444', 'W11005444', 'ID01', 'The Shoulder Clinic of Idaho', 'Thomas', 'M', 'Chopp', 'MD; Shoulder', 'Orthopedic Surgery', '', '', NULL, 'O', '8854 W Emerald Ste 102', 'Boise', 'Ada', 'ID', '83704', '2083234747', NULL, '8854 W Emerald Ste 102', 'Boise', 'Ada', 'ID', '83704', '2083234747', '', 'IDORTHO2', 'WUSTDHCPC5', NULL, '0.00', '30.00', '0.00', 3, '2008-07-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1720081060', 0, 'n', 0, '2012-10-18', NULL, NULL, 43.6123, -116.292, NULL, NULL),
('820537848', 'W11005441', 'W11005441', 'ID01', 'The Shoulder Clinic of Idaho', 'Thomas', 'E', 'Goodwin', 'MD; Shoulder', 'Orthopedic Surgery', '', '', NULL, 'O', '8854 W Emerald Ste 102', 'Boise', 'Ada', 'ID', '83704', '2083234747', NULL, '8854 W Emerald Ste 102', 'Boise', 'Ada', 'ID', '83704', '2083234747', '', 'IDORTHO2', 'WUSTDHCPC5', NULL, '0.00', '30.00', '0.00', 3, '2008-07-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1649208851', 0, 'n', 0, '2012-10-18', NULL, NULL, 43.6123, -116.292, NULL, NULL),
('820537848', 'W11005442', 'W11005442', 'ID01', 'The Shoulder Clinic of Idaho', 'Kathryn', 'A', 'Colson', 'PA-C', 'Orthopedic Surgery', '', '', NULL, 'O', '8854 W Emerald Ste 102', 'Boise', 'Ada', 'ID', '83704', '2083234747', NULL, '8854 W Emerald Ste 102', 'Boise', 'Ada', 'ID', '83704', '2083234747', '', 'IDORTHO2', 'WUSTDHCPC5', NULL, '0.00', '30.00', '0.00', 3, '2008-07-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1457363970', 0, 'n', 0, '2012-04-24', NULL, NULL, 43.6123, -116.292, NULL, NULL),
('870470032', 'W11005423', 'W11005423', 'UTMH1', 'A/D Psychotherapy  & Clinical', 'Michael', 'O', 'Measom', 'MD', 'Mental Health', 'Psychiatry', '', NULL, 'O', '8465 S 700 E', 'Sandy', 'Salt Lake', 'UT', '84070', '8012338577', NULL, '8465 S 700 E', 'Sandy', 'Salt Lake', 'UT', '84070', '8012338577', '', 'UTMD-2', NULL, NULL, '0.00', '35.00', '0.00', 6, '2008-07-01', '2013-02-14', 0, 0, 0, 'University Health Care University Hospital', '', '', '', 'HCFA|UB|', '1861479701', 0, 'N', 0, '2014-04-17', NULL, NULL, 0, 0, NULL, NULL),
('528801213', 'W11005421', 'W11005421', 'UTMH1', '', 'Patricia', '', 'McWhorter', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '40 S Main St', 'Tooele', 'Tooele', 'UT', '84074', '4358437060', NULL, '40 S Main St', 'Tooele', 'Tooele', 'UT', '84074', '4358437060', '', 'PHD', '', '', '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1881750644', 0, 'N', 0, '2014-05-01', NULL, NULL, 0, 0, NULL, NULL),
('870470032', 'W11005424', 'W11005424', 'UTMH1', NULL, 'Michael', 'O', 'Measom', 'MD', 'Mental Health', 'Psychiatry', '', NULL, 'B', 'PO Box 901662', 'Sandy', 'Salt Lake', 'UT', '84090', '8012338577', NULL, 'PO Box 901662', 'Sandy', 'Salt Lake', 'UT', '84090', '8012338577', '', 'UTMD-2', NULL, NULL, '0.00', '35.00', '0.00', 6, '2008-07-01', '2013-02-14', 0, 0, 0, 'University Health Care University Hospital', '', '', '', 'HCFA|UB|', '1861479701', 0, 'Y', 0, '2014-04-17', NULL, NULL, 0, 0, NULL, NULL),
('528801213', 'W11005422', 'W11005422', 'UTMH1', 'Advanced Professional Services', 'Patricia', '', 'McWhorter', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'B', 'PO Box 132', 'Sandy', 'Salt Lake', 'UT', '84091', '4358437060', NULL, 'PO Box 132', 'Sandy', 'Salt Lake', 'UT', '84091', '4358437060', '', 'PHD', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1881750644', 0, 'Y', 0, '2014-05-01', NULL, NULL, 0, 0, NULL, NULL),
('528445834', 'W11005419', 'W11005419', 'UTMH1', 'Interface Psychological Services', 'J', 'R', 'Macfarlane', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '2180 E 4500 S Ste 245', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8013288817', NULL, '2180 E 4500 S Ste 245', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8013288817', '', 'MA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1992835680', 0, 'N', 0, '2014-04-21', NULL, NULL, 0, 0, NULL, NULL),
('551332200', 'W11005425', 'W11005425', 'UTMH1', 'Sugarhouse Counseling Center', 'Leslee', '', 'Miller', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '1415 E 2100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84105', '8015581460', NULL, '1415 E 2100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84105', '8015581460', '', 'UTMA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1194999037', 0, 'n', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('870550021', 'W11005436', 'W11005436', 'UT01', 'Utah Physicians Care Center', 'Allison', 'E', 'Kierstead', 'MD', 'Internal Medicine', '', '', NULL, 'B', '5630 Waterbury Way', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012619651', '8012619656', '5630 Waterbury Way', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012619651', '8012619656', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-12-31', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1457552085', 0, 'Y', 0, '2014-03-20', NULL, NULL, 0, 0, NULL, NULL),
('646505898', 'W11005420', 'W11005420', 'UTMH1', NULL, 'Valentina', 'V', 'Masse', 'LMFT', 'Mental Health', 'Counseling', 'Marriage and Family Therapy', NULL, 'O', '5667 S Redwood Rd Ste 5B', 'Taylorsville', 'Salt Lake', 'UT', '84123', '8013368389', NULL, '5667 S Redwood Rd Ste 5B', 'Taylorsville', 'Salt Lake', 'UT', '84123', '8013368389', '', 'MA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1699780460', 0, 'n', 0, '2011-09-21', NULL, NULL, 0, 0, NULL, NULL),
('870550021', 'W11005435', 'W11005435', 'UT01', 'Utah Physicians Care Center', 'Allison', 'E', 'Kierstead', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1160 E 3900 S Ste 1200', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012619651', '8012619656', '1160 E 3900 S Ste 1200', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012619651', '8012619656', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-12-31', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1457552085', 0, 'N', 0, '2014-03-20', NULL, NULL, 40.6871, -111.858, NULL, NULL),
('493522194', 'W11005418', 'W11005418', 'UTMH1', 'OCCA', 'Gregory', 'L', 'Mayer', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '4699 Harrison Blvd Ste 300', 'Ogden', 'Weber', 'UT', '84403', '8014798286', NULL, '4699 Harrison Blvd Ste 300', 'Ogden', 'Weber', 'UT', '84403', '8014798286', '', 'PHD', '', '', '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-13', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1518048917', 0, 'N', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('721594562', 'W11005433', 'W11005433', 'UTMH1', NULL, 'Craig', 'T', 'Mitchell', 'LCSW', 'Mental Health', 'Social Worker', NULL, NULL, 'O', '5922 S 2125 E', 'Ogden', 'Weber', 'UT', '84403', '8016263649', NULL, '5922 S 2125 E', 'Ogden', 'Weber', 'UT', '84403', NULL, NULL, 'UTMA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1720038060', 0, 'n', 0, '2008-06-25', NULL, NULL, 0, 0, NULL, NULL),
('721594562', 'W11005431', 'W11005431', 'UTMH1', 'Circle of Life Womens Center', 'Craig', 'T', 'Mitchell', 'LCSW', 'Mental Health', 'Social Worker', NULL, NULL, 'O', '1525 E 6000 S', 'Ogden', 'Weber', 'UT', '84405', '8016263649', NULL, '5922 S 2125 E', 'Ogden', 'Weber', 'UT', '84403', NULL, NULL, 'UTMA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1720038060', 0, 'n', 0, '2008-06-25', NULL, NULL, 0, 0, NULL, NULL),
('820457091', 'W11005482', 'W11005482', 'ID01', 'Idaho Diabetes & Endocrine Associates PA', 'Theodore', 'S', 'Roosevelt', 'MD', 'Endocrinology', '', '', NULL, 'O', '9196 W Emerald St Ste 160', 'Boise', 'Ada', 'ID', '83704', '2083892213', '2083894659', '9196 W Emerald St Ste 160', 'Boise', 'Ada', 'ID', '83704', '2083892213', '2083894659', 'IDPCPEM5', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2008-07-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|UB|', '1699754697', 0, 'N', 0, '2013-07-12', NULL, NULL, 43.6116, -116.297, NULL, NULL),
('529862403', 'W11005480', 'W11005480', 'UTMH1', '', 'David', 'T', 'Ballard', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', '594 N 900 E', 'American Fork', 'Utah', 'UT', '84003', '8017630662', NULL, '594 N 900 E', 'American Fork', 'Utah', 'UT', '84003', '8017630662', '          ', 'MA', '', '', '0.00', '35.00', '0.00', 3, '2008-07-01', '2011-06-20', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1023143211', 0, 'Y', 0, '2011-06-19', NULL, NULL, 0, 0, NULL, NULL),
('529480464', 'W11005485', 'W11005485', 'UTMH1', NULL, 'Anne', 'R', 'Brockbank', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', 'PO Box 1176', 'Bountiful', 'Davis', 'UT', '84011', '8012928685', NULL, 'PO Box 1176', 'Bountiful', 'Davis', 'UT', '84011', '8012928685', '', 'UTMA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1083795702', 0, 'Y', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('529480464', 'W11005484', 'W11005484', 'UTMH1', NULL, 'Anne', 'R', 'Brockbank', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '1199 S Main', 'Centerville', 'Davis', 'UT', '84014', '8012928685', NULL, '1199 S Main', 'Centerville', 'Davis', 'UT', '84014', '8012928685', '', 'UTMA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1083795702', 0, 'n', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('528743870', 'W11005503', 'W11005503', 'UTMH1', 'The Cove', 'Vera', 'E', 'Christensen', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '1105 S State St', 'Clearfield', 'Davis', 'UT', '84015', '8017748675', NULL, '1105 S State St', 'Clearfield', 'Davis', 'UT', '84015', '8017748675', '', 'UTMA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1952472557', 0, 'n', 0, '2011-10-07', NULL, NULL, 0, 0, NULL, NULL),
('870624721', 'W11005446', 'W11005446', 'UTMH1', 'David Newbold & Associates ', 'David', '', 'Newbold', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '370 S 500 E Ste 180', 'Clearfield', 'Davis', 'UT', '84015', '8017761954', NULL, '370 S 500 E Ste 180', 'Clearfield', 'Davis', 'UT', '84015', '8017761954', '', 'UTPHD', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1578643771', 0, 'N', 0, '2014-05-01', NULL, NULL, 0, 0, NULL, NULL),
('565766184', 'W11005493', 'W11005493', 'UTMH1', NULL, 'Sandy', 'K', 'Watson', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '466 N Main St Ste 201C', 'Clearfield', 'Davis', 'UT', '84015', '8017766906', NULL, '466 N Main St Ste 201C', 'Clearfield', 'Davis', 'UT', '84015', '8017766906', '', 'UTMA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1396899712', 0, 'n', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('528743870', 'W11005504', 'W11005504', 'UTMH1', 'The Cove', 'Vera', 'E', 'Christensen', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', 'PO Box 160276', 'Clearfield', 'Davis', 'UT', '84016', '8017748675', NULL, 'PO Box 160276', 'Clearfield', 'Davis', 'UT', '84016', '8017748675', '', 'UTMA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1952472557', 0, 'Y', 0, '2011-10-07', NULL, NULL, 0, 0, NULL, NULL),
('202500191', 'W11005505', 'W11005505', 'UTMH1', 'Draper Pyschological Services', 'Scott', 'W', 'Fidler', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '782 E Pioneer Rd Ste D-1', 'Draper', 'Salt Lake', 'UT', '84020', '8016193569', NULL, '782 E Pioneer Rd Ste D-1', 'Draper', 'Salt Lake', 'UT', '84020', '8016193569', '', 'UTPHD', '', '', '0.00', '35.00', '0.00', 3, '2008-07-01', '2011-10-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1164589669', 0, 'N', 0, '2014-04-14', NULL, NULL, 0, 0, NULL, NULL),
('528468230', 'W11005465', 'W11005465', 'UTMH1', '', 'Marcia', 'L', 'Thompson', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '1111 E Draper Pkwy Ste 116', 'Draper', 'Salt Lake', 'UT', '84020', '8015017974', NULL, '1111 E Draper Pkwy Ste 116', 'Draper', 'Salt Lake', 'UT', '84020', '8015017974', '          ', 'UTMA', '', '', '0.00', '35.00', '0.00', 3, '2008-07-01', '2012-01-11', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1679790240', 0, 'N', 0, '2013-12-02', NULL, NULL, 0, 0, NULL, NULL),
('261733497', 'W11005449', 'W11005449', 'UTMH1', 'CJP Counseling, LLC', 'Holly', '', 'Passey-Simpson', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '1466 N Hwy 89 Ste 230', 'Farmington', 'Davis', 'UT', '84025', '8016888059', NULL, '1466 N Hwy 89 Ste 230', 'Farmington', 'Davis', 'UT', '84025', '8016888059', '          ', 'UTMA', '', '', '0.00', '35.00', '0.00', 3, '2008-07-01', '2011-10-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1568537504', 0, 'N', 0, '2011-09-19', NULL, NULL, 0, 0, NULL, NULL),
('870624721', 'W11005447', 'W11005447', 'UTMH1', 'David Newbold & Associates ', 'David', '', 'Newbold', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'B', 'PO Box 212', 'Kaysville', 'Davis', 'UT', '84037', '8017761954', NULL, 'PO Box 212', 'Kaysville', 'Davis', 'UT', '84037', '8017761954', '', 'UTPHD', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1578643771', 0, 'Y', 0, '2014-05-01', NULL, NULL, 0, 0, NULL, NULL),
('286543058', 'W11005497', 'W11005497', 'UTMH1', NULL, 'Dennis', 'M', 'Scott', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '1454 N Hillfield Rd Ste 1', 'Layton', 'Davis', 'UT', '84041', '8015936000', NULL, '1454 N Hillfield Rd Ste 1', 'Layton', 'Davis', 'UT', '84041', '8015936000', '', 'UTMA', NULL, '', '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1447340278', 0, 'n', 0, '2014-05-08', NULL, NULL, 0, 0, NULL, NULL),
('529023594', 'W11005460', 'W11005460', 'UTMH1', '', 'Jan', 'M', 'Malmberg', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '7321 S State Ste A&B', 'Midvale', 'Salt Lake', 'UT', '84047', '8018593523', NULL, '7321 S State Ste A&B', 'Midvale', 'Salt Lake', 'UT', '84047', '8018593523', '          ', 'UTMA', '', '', '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1225193998', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('870652224', 'W11005462', 'W11005462', 'UTMH1', 'Counseling & Education Associates', 'Kenneth', 'L', 'Hennefer', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '7321 S State Ste A-B', 'Midvale', 'Salt Lake', 'UT', '84047', '8013522844', NULL, '7321 S State Ste A-B', 'Midvale', 'Salt Lake', 'UT', '84047', '8013522844', '', 'UTPHD', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1538207154', 0, 'n', 0, '2013-11-14', NULL, NULL, 0, 0, NULL, NULL),
('870540241', 'W11005486', 'W11005486', 'UTMH1', NULL, 'Susan', 'S', 'Christensen', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '448 W 300 S', 'Orem', 'Utah', 'UT', '84058', '8014268862', NULL, '448 W 300 S', 'Orem', 'Utah', 'UT', '84058', '8014268862', '', 'UTMA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1699752733', 0, 'n', 0, '2011-09-22', NULL, NULL, 0, 0, NULL, NULL),
('870540241', 'W11005487', 'W11005487', 'UTMH1', NULL, 'Susan', 'S', 'Christensen', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', 'PO Box 2185', 'Orem', 'Utah', 'UT', '84059', '8014268862', NULL, 'PO Box 2185', 'Orem', 'Utah', 'UT', '84059', '8014268862', '', 'UTMA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1699752733', 0, 'Y', 0, '2011-09-22', NULL, NULL, 0, 0, NULL, NULL),
('371555030', 'W11005445', 'W11005445', 'UTMH1', 'Heritage Counseling, PLLC', 'Diana', 'L', 'Newberry', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '1747 Heritage Ln Ste B103', 'Syracuse', 'Davis', 'UT', '84075', '8015256975', NULL, '1747 Heritage Ln Ste B103', 'Syracuse', 'Davis', 'UT', '84075', '8015256975', '', 'MA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1629049218', 0, 'n', 0, '2014-04-24', NULL, NULL, 0, 0, NULL, NULL),
('542369340', 'W11005463', 'W11005463', 'UTMH1', '', 'Robert', 'B', 'Johnson', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '9287 S Redwood Rd', 'West Jordan', 'Salt Lake', 'UT', '84088', '8019499554', NULL, '9287 S Redwood Rd', 'West Jordan', 'Salt Lake', 'UT', '84088', '8019499554', '', 'UTMA', '', '', '0.00', '35.00', '0.00', 3, '2008-07-01', '2011-11-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1609946375', 0, 'N', 0, '2014-05-01', NULL, NULL, 0, 0, NULL, NULL),
('565766184', 'W11005494', 'W11005494', 'UTMH1', NULL, 'Sandy', 'K', 'Watson', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', 'PO Box 396', 'Clearfield', 'Davis', 'UT', '84089', '8017766906', NULL, 'PO Box 396', 'Clearfield', 'Davis', 'UT', '84089', '8017766906', '', 'UTMA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1396899712', 0, 'Y', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('528869999', 'W11005478', 'W11005478', 'UTMH1', NULL, 'Marlin', 'V', 'Andrus', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '1196 W S Jordan Pkwy Ste A3', 'South Jordan', 'Salt Lake', 'UT', '84095', '8012533169', NULL, '1196 W S Jordan Pkwy Ste A3', 'South Jordan', 'Salt Lake', 'UT', '84095', '8012533169', '', 'UTMA', NULL, '', '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1215085691', 0, 'n', 0, '2014-05-08', NULL, NULL, 0, 0, NULL, NULL),
('262310872', 'W11005475', 'W11005475', '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', NULL, '', '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1407917537', 0, 'Y', 0, '2014-07-14', NULL, NULL, 0, 0, NULL, NULL),
('550846881', 'W11005481', 'W11005481', 'UTMH1', '', 'Stephen', 'H', 'Emerson', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '150 S 600 E Ste 7B', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8014871091', NULL, '150 S 600 E Ste 7B', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8014871091', '          ', 'UTMA', '', '', '0.00', '35.00', '0.00', 3, '2008-07-01', '2011-03-08', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1891744017', 0, 'Y', 0, '2011-03-17', NULL, NULL, 0, 0, NULL, NULL),
('529621982', 'W11005458', 'W11005458', 'UTMH1', NULL, 'Valerie', 'K', 'Lambert', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '508 E S Temple Ste 128', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015335632', NULL, '508 E S Temple Ste 128', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015335632', '', 'UTMA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1497835375', 0, 'n', 0, '2011-09-23', NULL, NULL, 0, 0, NULL, NULL),
('585328802', 'W11005483', 'W11005483', 'UTMH1', NULL, 'Cynthia', 'A', 'Hunt', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '171 E 3rd Ave Ste 707', 'Salt Lake City', 'Salt Lake', 'UT', '84103', '8013555888', NULL, '171 E 3rd Ave Ste 707', 'Salt Lake City', 'Salt Lake', 'UT', '84103', '8013555888', '', 'UTMA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1851432553', 0, 'n', 0, '2011-11-03', NULL, NULL, 0, 0, NULL, NULL),
('529841145', 'W11005490', 'W11005490', 'UTMH1', '', 'Kristin', 'K', 'Urry', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '1399 S 700 E Ste 15', 'Salt Lake City', 'Salt Lake', 'UT', '84105', '8017066487', NULL, '1399 S 700 E Ste 15', 'Salt Lake City', 'Salt Lake', 'UT', '84105', '8017066487', '', 'UTMA', '', '', '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1427126499', 0, 'N', 0, '2014-04-22', NULL, NULL, 0, 0, NULL, NULL),
('242904849', 'W11005498', 'W11005498', 'UTMH1', '', 'Jennifer', 'L', 'Mowery', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '1399 S 700 E Ste 15', 'Salt Lake City', 'Salt Lake', 'UT', '84105', '8014832755', NULL, '1399 S 700 E Ste 15', 'Salt Lake City', 'Salt Lake', 'UT', '84105', '8014832755', '', 'UTMA', '', '', '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1467472928', 0, 'N', 0, '2014-04-24', NULL, NULL, 0, 0, NULL, NULL),
('382365817', 'W11005448', 'W11005448', 'UTMH1', NULL, 'Melvin', 'F', 'Nosanchuk', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '1646 Kensington Ave', 'Salt Lake City', 'Salt Lake', 'UT', '84105', '8014674875', NULL, '1646 Kensington Ave', 'Salt Lake City', 'Salt Lake', 'UT', '84105', '8014674875', '', 'PHD', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1265467831', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('542369340', 'W11005464', 'W11005464', 'UTMH1', NULL, 'Robert', 'B', 'Johnson', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'B', '3434 Brookview Ln', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8019499554', NULL, '3434 Brookview Ln', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8019499554', '', 'UTMA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1609946375', 0, 'Y', 0, '2014-05-01', NULL, NULL, 0, 0, NULL, NULL),
('205619034', 'W11005469', 'W11005469', 'UTMH1', 'Psychodynamic Solutions', 'Jessica', 'L', 'Wolfinger', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '684 E Vine St Ste 4A', 'Murray', 'Salt Lake', 'UT', '84107', '8012326372', NULL, '684 E Vine St Ste 4A', 'Murray', 'Salt Lake', 'UT', '84107', '8012326372', '          ', 'UTMA', '', '', '0.00', '35.00', '0.00', 3, '2008-07-01', '2012-04-17', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1134189277', 0, 'N', 0, '2012-01-18', NULL, NULL, 0, 0, NULL, NULL),
('567621335', 'W11005456', 'W11005456', 'UTMH1', NULL, 'Sharon', 'C', 'Rishe', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', '555 E 4500 S Ste C150', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8019663700', NULL, '555 E 4500 S Ste C150', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8019663700', '', 'MA', NULL, '', '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1760490767', 0, 'Y', 0, '2014-05-08', NULL, NULL, 0, 0, NULL, NULL),
('870212455', 'W11005499', 'W11005499', 'UTMH1', 'Family Counseling Center', 'Valerie', '', 'Poltoratzsky', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '5250 S Commerce Dr Ste 250', 'Murray', 'Salt Lake', 'UT', '84107', '8012613500', NULL, '5250 S Commerce Dr Ste 250', 'Murray', 'Salt Lake', 'UT', '84107', '8012613500', '', 'UTMA', NULL, '', '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1932293958', 0, 'n', 0, '2014-07-02', NULL, NULL, 0, 0, NULL, NULL),
('870385919', 'W11005454', 'W11005454', 'UTMH1', NULL, 'Harvey', 'L', 'Rishe', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'B', '555 E 4500 S Ste C150', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8019663700', NULL, '555 E 4500 S Ste C150', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8019663700', '', 'PHD', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1396762118', 0, 'Y', 0, '2014-05-01', NULL, NULL, 0, 0, NULL, NULL),
('526354226', 'W11005492', 'W11005492', 'UTMH1', NULL, 'Jennifer', 'A', 'McNaught', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '860 E 4500 S Ste 302', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8017069272', NULL, '860 E 4500 S Ste 302', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8017069272', '', 'UTMA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1376731281', 0, 'n', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('512341568', 'W11005467', 'W11005467', 'UTMH1', NULL, 'Janice', 'D', 'Nelson', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '2319 Foothill Dr Ste 275', 'Salt Lake City', 'Salt Lake', 'UT', '84109', '8014668123', NULL, '2319 Foothill Dr Ste 275', 'Salt Lake City', 'Salt Lake', 'UT', '84109', '8014668123', '', 'UTPHD', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1942391925', 0, 'n', 0, '2014-05-01', NULL, NULL, 0, 0, NULL, NULL),
('680585689', 'W11005471', 'W11005471', 'UTMH1', NULL, 'Diane', '', 'Hill', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'B', 'PO Box 161003', 'Salt Lake City', 'Salt Lake', 'UT', '84116', '8012780499', NULL, 'PO Box 161003', 'Salt Lake City', 'Salt Lake', 'UT', '84116', '8012780499', '', 'UTPHD', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1710045679', 0, 'Y', 0, '2014-05-01', 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
('680585689', 'W11005470', 'W11005470', 'UTMH1', NULL, 'Diane', '', 'Hill', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '2040 E Murray Holladay Rd Ste 222', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8012780499', NULL, '2040 E Murray Holladay Rd Ste 222', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8012780499', '', 'UTPHD', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1710045679', 0, 'n', 0, '2014-05-01', NULL, NULL, 0, 0, NULL, NULL),
('534604243', 'W11005500', 'W11005500', 'UTMH1', NULL, 'Paulette', '', 'Caprai-Findlay', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '3940 W  4100 S', 'West Valley', 'Salt Lake', 'UT', '84120', '8019663700', NULL, '3940 W  4100 S', 'West Valley', 'Salt Lake', 'UT', '84120', '8019663700', '', 'UTMA', NULL, '', '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1174639231', 0, 'n', 0, '2014-05-08', NULL, NULL, 0, 0, NULL, NULL),
('534604243', 'W11005501', 'W11005501', 'UTMH1', NULL, 'Paulette', '', 'Caprai-Findlay', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', '555 E 4500 S', 'West Valley', 'Salt Lake', 'UT', '84120', '8019663700', NULL, '555 E 4500 S', 'West Valley', 'Salt Lake', 'UT', '84120', '8019663700', '', 'UTMA', NULL, '', '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1174639231', 0, 'Y', 0, '2014-05-08', NULL, NULL, 0, 0, NULL, NULL),
('870385919', 'W11005453', 'W11005453', 'UTMH1', NULL, 'Harvey', 'L', 'Rishe', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '3940 W 4100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019663700', NULL, '3940 W 4100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019663700', '', 'PHD', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1396762118', 0, 'N', 0, '2014-05-01', NULL, NULL, 0, 0, NULL, NULL),
('567621335', 'W11005455', 'W11005455', 'UTMH1', NULL, 'Sharon', 'C', 'Rishe', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '3940 W 4100 S', 'West Valley', 'Salt Lake', 'UT', '84120', '8019663700', NULL, '3940 W 4100 S', 'West Valley', 'Salt Lake', 'UT', '84120', '8019663700', '', 'MA', NULL, '', '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1760490767', 0, 'N', 0, '2014-05-08', NULL, NULL, 0, 0, NULL, NULL),
('190462129', 'W11005466', 'W11005466', 'UTMH1', 'Mountain States Counseling Center', 'Barbara', 'A', 'Scoville', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '5635 S Waterbury Way Ste C202', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012780200', NULL, '5635 S Waterbury Way Ste C202', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012780200', '', 'UTMA', NULL, '', '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1538149141', 0, 'n', 0, '2014-07-21', NULL, NULL, 0, 0, NULL, NULL),
('870503867', 'W11005476', 'W11005476', 'UTMH1', 'Mountain States Counseling Center', 'David', 'E', 'Simpson', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '5635 S Waterbury Way Ste C202', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012780200', '', '5635 S Waterbury Way Ste C202', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012780200', '', 'UTMA', '', '', '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1477632925', 0, 'n', 0, '2014-07-22', NULL, NULL, 0, 0, NULL, NULL),
('009264426', 'W11005495', 'W11005495', 'UTMH1', 'Mountain States Counseling Center', 'Richard', 'S', 'Schneiman', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '5635 S Waterbury Way Ste C202', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012780200', '', '5635 S Waterbury Way Ste C202', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012780200', '', 'UTPHD', '', '', '0.00', '0.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1427128461', 0, 'N', 0, '2014-07-21', NULL, NULL, 0, 0, NULL, NULL),
('529023594', 'W11005461', 'W11005461', 'UTMH1', NULL, 'Jan', 'M', 'Malmberg', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '4214 S 500 W', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8018593523', NULL, '4214 S 500 W', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8018593523', '', 'UTMA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1225193998', 0, 'n', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('432646789', 'W11005451', 'W11005451', 'UTMH1', 'Millbrook Counseling', 'Donald', 'A', 'Price', 'LMFT', 'Mental Health', 'Marriage and Family Therapy', '', NULL, 'O', '2118 E 3900 S Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012773620', NULL, '2118 E 3900 S Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012773620', '', 'PHD', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1427055110', 0, 'N', 0, '2013-10-21', NULL, NULL, 0, 0, NULL, NULL),
('430984097', 'W11005452', 'W11005452', 'UTMH1', 'Millbrook Counseling', 'Linda', 'M', 'Price', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '2118 E 3900 S Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012773620', NULL, '2118 E 3900 S Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012773620', '', 'PHD', NULL, '', '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1497753057', 0, 'N', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('512341568', 'W11005468', 'W11005468', 'UTMH1', NULL, 'Janice', 'D', 'Nelson', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'B', 'PO Box 58264', 'Salt Lake City', 'Salt Lake', 'UT', '84158', '8014668123', NULL, 'PO Box 58264', 'Salt Lake City', 'Salt Lake', 'UT', '84158', '8014668123', '', 'UTPHD', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1942391925', 0, 'Y', 0, '2014-05-01', NULL, NULL, 0, 0, NULL, NULL),
('529621982', 'W11005459', 'W11005459', 'UTMH1', NULL, 'Valerie', 'K', 'Lambert', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', 'PO Box 58292', 'Salt Lake City', 'Salt Lake', 'UT', '84158', '8015335632', NULL, 'PO Box 58292', 'Salt Lake City', 'Salt Lake', 'UT', '84158', '8015335632', '', 'UTMA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1497835375', 0, 'Y', 0, '2011-09-23', NULL, NULL, 0, 0, NULL, NULL),
('017543315', 'W11005502', 'W11005502', 'UTMH1', 'Family Institute of Northern Utah', 'Jeannine', 'D', 'Nielson', 'LMFT', 'Mental Health', 'Marriage and Family Therapy', '', NULL, 'O', '965 S 100 W Ste 203', 'Logan', 'Cache', 'UT', '84321', '4357521976', NULL, '965 S 100 W Ste 203', 'Logan', 'Cache', 'UT', '84321', '4357521976', '          ', 'UTMA', '', '', '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1093881799', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('529564823', 'W11005450', 'W11005450', 'UTMH1', 'Licensed Clinical Associates', 'Joseph', 'E', 'Prantil', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '3544 Lincoln Ave Ste C', 'Ogden', 'Weber', 'UT', '84401', '8013935010', NULL, '3544 Lincoln Ave Ste C', 'Ogden', 'Weber', 'UT', '84401', '8013935010', '', 'UTMA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1396851432', 0, 'N', 0, '2013-11-14', NULL, NULL, 0, 0, NULL, NULL),
('530245274', 'W11005477', 'W11005477', 'UTMH1', 'Licenced Clinical Associates', 'James', 'H', 'Christensen', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '3544 Lincoln Ave Ste C', 'Ogden', 'Weber', 'UT', '84401', '8013935010', NULL, '3544 Lincoln Ave Ste C', 'Ogden', 'Weber', 'UT', '84401', '8013935010', '', 'UTMA', NULL, '', '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1942316088', 0, 'n', 0, '2014-07-14', NULL, NULL, 0, 0, NULL, NULL),
('260707688', 'W11005496', 'W11005496', 'UTMH1', '', 'Callie', 'A', 'Murray', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '2721 N 400 E Ste 8', 'North Ogden', 'Weber', 'UT', '84414', '8017371301', NULL, '2721 N 400 E Ste 8', 'North Ogden', 'Weber', 'UT', '84414', '8017371301', '          ', 'UTMA', '', '', '0.00', '35.00', '0.00', 3, '2008-07-01', '2011-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1114933033', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('942982973', 'W11005457', 'W11005457', 'UTMH1', NULL, 'Joan', '', 'Sangree', 'LMFT', 'Mental Health', 'Marriage and Family Therapy', '', NULL, 'O', '50 E Ctr St Ste 3', 'Moab', 'Grand', 'UT', '84532', '4352594113', NULL, '50 E Ctr St Ste 3', 'Moab', 'Grand', 'UT', '84532', '4352594113', '', 'UTMA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1891820114', 0, 'n', 0, '2014-04-21', NULL, NULL, 0, 0, NULL, NULL),
('262310872', 'W11005474', 'W11005474', '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, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1407917537', 0, 'N', 0, '2014-07-14', NULL, NULL, 0, 0, NULL, NULL),
('529862403', 'W11005479', 'W11005479', 'UTMH1', '', 'David', 'T', 'Ballard', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '3325 N University Ave Ste 300', 'Provo', 'Utah', 'UT', '84604', '8017630662', NULL, '3325 N University Ave Ste 300', 'Provo', 'Utah', 'UT', '84604', '8017630662', '          ', 'MA', '', '', '0.00', '35.00', '0.00', 3, '2008-07-01', '2011-06-20', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1023143211', 0, 'N', 0, '2011-06-19', NULL, NULL, 0, 0, NULL, NULL),
('870522400', 'W11005491', 'W11005491', 'UTMH1', 'Sierra Counseling Associates', 'John', 'P', 'Lilly', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '286 S 600 E Ste C', 'Provo', 'Utah', 'UT', '84606', '8013778222', NULL, '286 S 600 E Ste C', 'Provo', 'Utah', 'UT', '84606', '8013778222', '', 'UTMA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1023169620', 0, 'n', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('870650541', 'W11005488', 'W11005488', 'UTMH1', 'Abbey Road Counseling', 'Gary', 'W', 'Munn', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '415 N Main Ste 104', 'Cedar City', 'Iron', 'UT', '84721', '4355869521', NULL, '415 N Main Ste 104', 'Cedar City', 'Iron', 'UT', '84721', '4355869521', '', 'UTMA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1083701338', 0, 'n', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('529083607', 'W11005472', 'W11005472', 'UTMH1', '', 'Keith', 'T', 'Einfeldt', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '115 N Main Ste 204', 'Cedar City', 'Iron', 'UT', '84720', '4358651188', NULL, '115 N Main Ste 204', 'Cedar City', 'Iron', 'UT', '84720', '4358651188', '          ', 'UTMA', '', '', '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-12', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1548327158', 0, 'N', 0, '2013-02-14', NULL, NULL, 0, 0, NULL, NULL),
('870650541', 'W11005489', 'W11005489', 'UTMH1', 'Abbey Road Counseling', 'Gary', 'W', 'Munn', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '415 N State St Ste 102', 'Hurricane', 'Washington', 'UT', '84737', '4356351101', NULL, '415 N State St Ste 102', 'Hurricane', 'Washington', 'UT', '84737', '4356351101', '', 'UTMA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1083701338', 0, 'n', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('529083607', 'W11005473', 'W11005473', 'UTMH1', '', 'Keith', 'T', 'Einfeldt', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '95 E Main', 'Panguitch', 'Garfield', 'UT', '84759', '4358651188', NULL, '95 E Main', 'Panguitch', 'Garfield', 'UT', '84759', '4358651188', '          ', 'UTMA', '', '', '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-12', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1548327158', 0, 'N', 0, '2013-02-14', NULL, NULL, 0, 0, NULL, NULL),
('860919753', 'W11005536', 'W11005536', 'ID01', 'Mountain States Medical', 'Richard', 'J', 'McChrystal', 'PA-C', 'Family Practice', '', '', NULL, 'O', '4809 W Fairview Ave', 'Boise', 'Ada', 'ID', '83706', '2083782840', NULL, '4809 W Fairview Ave', 'Boise', 'Ada', 'ID', '83706', '2083782840', '          ', 'IDPCPEM5', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2008-07-01', '2011-02-28', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1659464923', 0, 'N', 0, '2012-04-02', NULL, NULL, 0, 0, NULL, NULL),
('860919753', 'W11005535', 'W11005535', 'ID01', 'Mountain States Medical (X-ray)', '', '', 'Mountain States Medical', 'GROUP', 'Family Practice', 'Urgent Care', '', NULL, 'O', '4809 W Fairview Ave', 'Boise', 'Ada', 'ID', '83706', '2083782840', NULL, '4809 W Fairview Ave', 'Boise', 'Ada', 'ID', '83706', '2083782840', '          ', 'IDPCPEM5', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2008-07-01', '2011-02-28', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1730272006', 0, 'N', 0, '2012-04-02', NULL, NULL, 0, 0, NULL, NULL),
('860919753', 'W11005537', 'W11005537', 'ID01', 'Mountain States Medical', 'Carl', 'R', 'Andrus', 'PA-C', 'Family Practice', '', '', NULL, 'O', '4809 W Fairview Ave', 'Boise', 'Ada', 'ID', '83706', '2083782840', NULL, '4809 W Fairview Ave', 'Boise', 'Ada', 'ID', '83706', '2083782840', '          ', 'IDPCPEM5', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2008-07-01', '2011-02-28', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1215949532', 0, 'N', 0, '2013-01-07', NULL, NULL, 0, 0, NULL, NULL),
('860919753', 'W11005538', 'W11005538', 'ID01', 'Mountain States Medical', 'Colin', 'R', 'Soares', 'PA-C', 'Family Practice', '', '', NULL, 'O', '4809 W Fairview Ave', 'Boise', 'Ada', 'ID', '83706', '2083782840', NULL, '4809 W Fairview Ave', 'Boise', 'Ada', 'ID', '83706', '2083782840', '          ', 'IDPCPEM5', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2008-07-01', '2012-02-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1588757850', 0, 'N', 0, '2013-02-28', NULL, NULL, 0, 0, NULL, NULL),
('860919753', 'W11005539', 'W11005539', 'ID01', 'Mountain States Medical', 'Lillian', 'E', 'Maresca', 'MD', 'Family Practice', '', '', NULL, 'O', '4809 W Fairview Ave', 'Boise', 'Ada', 'ID', '83706', '2083782840', NULL, '4809 W Fairview Ave', 'Boise', 'Ada', 'ID', '83706', '2083782840', '          ', 'IDPCPEM5', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2008-07-01', '2011-02-28', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1144271412', 0, 'N', 0, '2012-04-02', NULL, NULL, 0, 0, NULL, NULL),
('860919753', 'W11005540', 'W11005540', 'ID01', 'Mountain States Medical', '', '', 'Mountain States Medical', 'GROUP', 'Family Practice', 'Urgent Care', '', NULL, 'B', 'PO Box 4236', 'Boise', 'Ada', 'ID', '83711', '2083782840', NULL, 'PO Box 4236', 'Boise', 'Ada', 'ID', '83711', '2083782840', '          ', 'IDPCPEM5', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2008-07-01', '2011-02-28', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1730272006', 0, 'Y', 0, '2012-04-02', NULL, NULL, 0, 0, NULL, NULL),
('860919753', 'W11005542', 'W11005542', 'ID01', 'Mountain States Medical', 'Carl', 'R', 'Andrus', 'PA-C', 'Family Practice', '', '', NULL, 'B', 'PO Box 4236', 'Boise', 'Ada', 'ID', '83711', '2083782840', NULL, 'PO Box 4236', 'Boise', 'Ada', 'ID', '83711', '2083782840', '          ', 'IDPCPEM5', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2008-07-01', '2011-02-28', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1215949532', 0, 'Y', 0, '2013-01-07', NULL, NULL, 0, 0, NULL, NULL),
('860919753', 'W11005543', 'W11005543', 'ID01', 'Mountain States Medical', 'Colin', 'R', 'Soares', 'PA-C', 'Family Practice', '', '', NULL, 'B', 'PO Box 4236', 'Boise', 'Ada', 'ID', '83711', '2083782840', NULL, 'PO Box 4236', 'Boise', 'Ada', 'ID', '83711', '2083782840', '          ', 'IDPCPEM5', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2008-07-01', '2012-02-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1588757850', 0, 'Y', 0, '2013-02-28', NULL, NULL, 0, 0, NULL, NULL),
('860919753', 'W11005544', 'W11005544', 'ID01', 'Mountain States Medical', 'Lillian', 'E', 'Maresca', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 4236', 'Boise', 'Ada', 'ID', '83711', '2083782840', NULL, 'PO Box 4236', 'Boise', 'Ada', 'ID', '83711', '2083782840', '          ', 'IDPCPEM5', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2008-07-01', '2011-02-28', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1144271412', 0, 'Y', 0, '2012-04-02', NULL, NULL, 0, 0, NULL, NULL),
('860919753', 'W11005541', 'W11005541', 'ID01', 'Mountain States Medical', 'Richard', 'J', 'McChrystal', 'PA-C', 'Family Practice', '', '', NULL, 'B', 'PO Box 4236', 'Boise', 'Ada', 'ID', '83711', '2083782840', NULL, 'PO Box 4236', 'Boise', 'Ada', 'ID', '83711', '2083782840', '          ', 'IDPCPEM5', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2008-07-01', '2011-02-28', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1659464923', 0, 'Y', 0, '2012-04-02', NULL, NULL, 0, 0, NULL, NULL),
('550881842', 'W11005506', 'W11005506', 'UTMH1', 'Bountiful Counseling Center', 'Richard', '', 'Schuurman', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '545 W 500 S Ste 110', 'Bountiful', 'Davis', 'UT', '84010', '8012960223', NULL, '545 W 500 S Ste 110', 'Bountiful', 'Davis', 'UT', '84010', '8012960223', '          ', 'MA', '', '', '0.00', '35.00', '0.00', 3, '2008-07-01', '2011-05-15', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1790837771', 0, 'N', 0, '2011-12-19', NULL, NULL, 0, 0, NULL, NULL),
('870638284', 'W11005525', 'W11005525', 'UTMH1', 'Draper Family Therapy', 'Joseph', 'M', 'Timmins', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '12176 S 1000 E Ste C', 'Draper', 'Salt Lake', 'UT', '84020', '8015723750', NULL, '12176 S 1000 E Ste C', 'Draper', 'Salt Lake', 'UT', '84020', '8015723750', '', 'MA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1780652271', 0, 'N', 0, '2014-04-10', NULL, NULL, 0, 0, NULL, NULL),
('261591365', 'W11005517', 'W11005517', 'UTMH1', 'Springer Counseling Services', 'Alan', 'K', 'Springer', 'LMFT', 'Mental Health', 'Marriage and Family Therapy', '', NULL, 'O', '11075 S State St Ste 28', 'Sandy', 'Salt Lake', 'UT', '84070', '8015018444', NULL, '11075 S State St Ste 28', 'Sandy', 'Salt Lake', 'UT', '84070', '8015018444', '', 'PHD', NULL, '', '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1518089911', 0, 'n', 0, '2014-05-19', NULL, NULL, 0, 0, NULL, NULL),
('342004379', 'W11005508', 'W11005508', 'UTMH1', NULL, 'Karl', 'E', 'Seashore', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '50 N Main St', 'Tooele', 'Tooele', 'UT', '84074', '8012720613', NULL, '50 N Main St', 'Tooele', 'Tooele', 'UT', '84074', '8012720613', '', 'MA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1649247883', 0, 'n', 0, '2011-05-27', NULL, NULL, 0, 0, NULL, NULL),
('262402290', 'W11005528', 'W11005528', 'UTMH1', '', 'Richard', 'L', 'Tucker', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', '2092 N 250 W', 'Sunset', 'Davis', 'UT', '84015', '8017631554', NULL, '2092 N 250 W', 'Sunset', 'Davis', 'UT', '84015', '8017631554', '          ', 'UTMA', '', '', '0.00', '35.00', '0.00', 3, '2008-07-01', '2002-01-03', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1417984485', 0, 'Y', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('261591365', 'W11005518', 'W11005518', 'UTMH1', 'Counseling & Assessments', 'Alan', 'K', 'Springer', 'LMFT', 'Mental Health', 'Marriage and Family Therapy', '', NULL, 'B', 'PO Box 900245', 'Sandy', 'Salt Lake', 'UT', '84090', '8015018444', NULL, 'PO Box 900245', 'Sandy', 'Salt Lake', 'UT', '84090', '8015018444', '', 'PHD', NULL, '', '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1518089911', 0, 'Y', 0, '2014-05-19', NULL, NULL, 0, 0, NULL, NULL),
('870476172', 'W11005512', 'W11005512', 'UTMH1', 'Shepherds Staff Counseling Center Inc', 'Robert', 'F', 'Pramann', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '731 E 8600 S', 'Sandy', 'Salt Lake', 'UT', '84094', '8015619987', NULL, '731 E 8600 S', 'Sandy', 'Salt Lake', 'UT', '84094', '8015619987', '', 'PHD', NULL, '', '0.00', '35.00', '0.00', 6, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1487622908', 0, 'N', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('870476172', 'W11005509', 'W11005509', 'UTMH1', 'Shepherds Staff Christian Counseling Center Inc', 'Angie', 'S', 'Hendren', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '731 E 8600 S', 'Sandy', 'Salt Lake', 'UT', '84094', '8015619987', NULL, '731 E 8600 S', 'Sandy', 'Salt Lake', 'UT', '84094', '8015619987', '', 'MA', NULL, NULL, '0.00', '35.00', '0.00', 6, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1649225533', 0, 'N', 0, '2013-01-10', NULL, NULL, 0, 0, NULL, NULL),
('870476172', 'W11005510', 'W11005510', 'UTMH1', 'Shepherds Staff Counseling Center Inc', 'James', 'T', 'Northrop', 'PHD', 'Mental Health', 'Counseling', NULL, NULL, 'O', '731 E 8600 S', 'Sandy', 'Salt Lake', 'UT', '84094', '8015619987', NULL, '731 E 8600 S', 'Sandy', NULL, 'UT', '84094', NULL, NULL, 'MA', NULL, NULL, '0.00', '35.00', '0.00', 6, '2008-07-01', '2013-02-14', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1700842069', 0, 'N', 0, '2008-06-26', NULL, NULL, 0, 0, NULL, NULL),
('870639164', 'W11005516', 'W11005516', 'UTMH1', 'Sycamore Counseling Center ', 'Mary', 'L', 'Smith', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '900 S State Rd', 'Orem', 'Utah', 'UT', '84097', '8012243322', NULL, '900 S State Rd', 'Orem', 'Utah', 'UT', '84097', '8012243322', '', 'MA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1093836553', 0, 'N', 0, '2014-04-10', NULL, NULL, 0, 0, NULL, NULL),
('484768121', 'W11005533', 'W11005533', 'UTMH1', NULL, 'Pamela', 'C', 'Wilkison', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '2700 Homestead Rd Ste 40', 'Park City', 'Summit', 'UT', '84098', '4359014307', NULL, '2700 Homestead Rd Ste 40', 'Park City', 'Summit', 'UT', '84098', '4359014307', '', 'PHD', NULL, '', '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1518923226', 0, 'N', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('870639511', 'W11005519', 'W11005519', 'UTMH1', NULL, 'Daniel', 'P', 'Sternberg', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '150 S 600 E Ste 4C', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013642779', NULL, '150 S 600 E Ste 4C', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013642779', '', 'UTPHD', NULL, '', '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1215900915', 0, 'N', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('870474993', 'W11005526', 'W11005526', 'UTMH1', 'Lifetree Pain Clinic', 'Thomas', 'K', 'Trauba', 'MD', 'Mental Health', 'Psychiatry', 'Pain Management', NULL, 'O', '3838 S 700 E Ste 200', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8012614988', NULL, '3838 S 700 E Ste 200', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8012614988', '', 'UTMD', NULL, NULL, '0.00', '35.00', '0.00', 6, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1891793147', 0, 'n', 0, '2014-04-16', NULL, NULL, 0, 0, NULL, NULL),
('528418192', 'W11005546', 'W11005546', 'UTMH1', NULL, 'Stacey', 'M', 'Francone', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', '674 Mansfield Ave', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8012098690', NULL, '674 Mansfield Ave', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8012098690', '', 'UTMA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1356321012', 0, 'Y', 0, '2014-04-24', NULL, NULL, 0, 0, NULL, NULL),
('010764960', 'W11005524', 'W11005524', 'UTMH1', NULL, 'Robert', 'J', 'Thomas', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '675 E 2100 S Ste 250', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8014843089', NULL, '675 E 2100 S Ste 250', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8014843089', '', 'PHD', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1215011408', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('528418192', 'W11005545', 'W11005545', 'UTMH1', NULL, 'Stacey', 'M', 'Francone', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '262 E 3900 S Ste 125', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8012098690', NULL, '262 E 3900 S Ste 125', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8012098690', '', 'UTMA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1356321012', 0, 'n', 0, '2014-04-24', NULL, NULL, 0, 0, NULL, NULL),
('529199737', 'W11005522', 'W11005522', 'UTMH1', NULL, 'Julie', 'A', 'Stout', 'LMFT', 'Mental Health', 'Marriage and Family Therapy', '', NULL, 'O', '5667 S Redwood Rd Unit 5', 'Taylorsville', 'Salt Lake', 'UT', '84123', '8016994149', NULL, '5667 S Redwood Rd Unit 5', 'Taylorsville', 'Salt Lake', 'UT', '84123', '8016994149', '', 'MA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1770543241', 0, 'N', 0, '2011-11-14', NULL, NULL, 0, 0, NULL, NULL),
('342004379', 'W11005507', 'W11005507', 'UTMH1', NULL, 'Karl', 'E', 'Seashore', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '4190 Highland Dr Ste 211', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012720613', NULL, '4190 Highland Dr Ste 211', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012720613', '', 'MA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1649247883', 0, 'n', 0, '2011-05-27', NULL, NULL, 0, 0, NULL, NULL),
('870639511', 'W11005520', 'W11005520', 'UTMH1', NULL, 'Daniel', 'P', 'Sternberg', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'B', 'PO Box 58275', 'Salt Lake City', 'Salt Lake', 'UT', '84158', '8013642779', NULL, 'PO Box 58275', 'Salt Lake City', 'Salt Lake', 'UT', '84158', '8013642779', '', 'UTPHD', NULL, '', '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1215900915', 0, 'Y', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('010773190', 'W11005515', 'W11005515', 'UTMH1', NULL, 'Jean', 'C', 'Smith', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', '3544 Lincoln Ave Ste C', 'Ogden', 'Weber', 'UT', '84401', '8019286838', NULL, '3544 Lincoln Ave Ste C', 'Ogden', 'Weber', 'UT', '84401', '8019286838', '', 'UTMA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1851499123', 0, 'Y', 0, '2014-04-23', NULL, NULL, 0, 0, NULL, NULL),
('870476172', 'W11005511', 'W11005511', 'UTMH1', 'Shepherds Staff Counseling Center Inc', 'James', 'T', 'Northrop', 'PHD', 'Mental Health', 'Counseling', NULL, NULL, 'O', '575 23RD ST', 'Ogden', 'Weber', 'UT', '84401', '8015619987', NULL, '731 E 8600 S', 'Sandy', NULL, 'UT', '84094', NULL, NULL, 'MA', NULL, NULL, '0.00', '35.00', '0.00', 6, '2008-07-01', '2013-02-14', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1700842069', 0, 'N', 0, '2008-06-26', NULL, NULL, 0, 0, NULL, NULL),
('870476172', 'W11005513', 'W11005513', 'UTMH1', 'Shepherds Staff Counseling Center Inc', 'Robert', 'F', 'Pramann', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '575 23RD ST', 'Ogden', 'Weber', 'UT', '84401', '8015619987', NULL, '575 23RD ST', 'Ogden', 'Weber', 'UT', '84401', '8015619987', '', 'PHD', NULL, '', '0.00', '35.00', '0.00', 6, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1487622908', 0, 'N', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('529426724', 'W11005531', 'W11005531', 'UTMH1', 'Associated Therapists', 'Steven', 'L', 'Watson', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '3670 Quincy Ave Ste 103', 'Ogden', 'Weber', 'UT', '84403', '8014799073', NULL, '3670 Quincy Ave Ste 103', 'Ogden', 'Weber', 'UT', '84403', '8014799073', '', 'UTMA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1619905098', 0, 'N', 0, '2013-11-11', NULL, NULL, 0, 0, NULL, NULL),
('262402290', 'W11005527', 'W11005527', 'UTMH1', '', 'Richard', 'L', 'Tucker', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '2562 Washington Blvd', 'Ogden', 'Weber', 'UT', '84401', '8016447129', NULL, '2562 Washington Blvd', 'Ogden', 'Weber', 'UT', '84401', '8016447129', '          ', 'UTMA', '', '', '0.00', '35.00', '0.00', 3, '2008-07-01', '2011-01-03', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1417984485', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('010773190', 'W11005514', 'W11005514', 'UTMH1', NULL, 'Jean', 'C', 'Smith', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '555 E 5300 S Ste 6', 'Ogden', 'Weber', 'UT', '84405', '8019286838', NULL, '555 E 5300 S Ste 6', 'Ogden', 'Weber', 'UT', '84405', '8019286838', '', 'UTMA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1851499123', 0, 'n', 0, '2014-04-23', NULL, NULL, 0, 0, NULL, NULL),
('060488333', 'W11005529', 'W11005529', 'UTMH1', NULL, 'Kimberly', 'R', 'Walsh', 'PSYD', 'Mental Health', 'Psychology', '', NULL, 'O', '1452 E Ridgeline Dr Ste 151', 'South Ogden', 'Weber', 'UT', '84405', '8014797009', NULL, '1452 E Ridgeline Dr Ste 151', 'South Ogden', 'Weber', 'UT', '84405', '8014797009', '', 'UTPHD', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1699750018', 0, 'N', 0, '2014-05-01', NULL, NULL, 0, 0, NULL, NULL),
('870577721', 'W11005521', 'W11005521', 'UTMH1', 'St John Therapeutic Services Inc', 'Sharon', 'A', 'St John', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '555 E 5300 S Bldg 2 Ste 6', 'So Ogden', 'Weber', 'UT', '84405', '8013171895', NULL, '555 E 5300 S Bldg 2 Ste 6', 'So Ogden', 'Weber', 'UT', '84405', '8013171895', '', 'UTMA', '', '', '0.00', '35.00', '0.00', 3, '2008-07-01', '2012-03-18', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1437121357', 0, 'N', 0, '2014-05-06', NULL, NULL, 0, 0, NULL, NULL),
('870491581', 'W11005532', 'W11005532', 'UTMH1', NULL, 'Chris', 'K', 'Wehl', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '505 E 200 S Ste 303', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013500115', NULL, '505 E 200 S Ste 303', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013500115', '', 'PHD', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1396867479', 0, 'n', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('060488333', 'W11005530', 'W11005530', 'UTMH1', NULL, 'Kimberly', 'R', 'Walsh', 'PSYD', 'Mental Health', 'Psychology', '', NULL, 'B', 'PO Box 150214', 'Ogden', 'Weber', 'UT', '84415', '8014797009', NULL, 'PO Box 150214', 'Ogden', 'Weber', 'UT', '84415', '8014797009', '', 'UTPHD', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1699750018', 0, 'Y', 0, '2014-05-01', NULL, NULL, 0, 0, NULL, NULL),
('520808921', 'W11005534', 'W11005534', 'UTMH1', '', 'Ellie', 'L', 'Young', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '14 N Main St', 'Springville', 'Utah', 'UT', '84663', '8014726294', NULL, '14 N Main St', 'Springville', 'Utah', 'UT', '84663', '8014726294', '          ', 'UTPHD', '', '', '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1235261983', 0, 'N', 0, '2013-02-28', NULL, NULL, 0, 0, NULL, NULL),
('203215794', 'W11005523', 'W11005523', 'UTMH1', 'Family Life Therapy Center', 'Norman', 'E', 'Thibault', 'LMFT', 'Mental Health', 'Marriage and Family Therapy', '', NULL, 'O', '1173 S 250 W Ste 202B', 'St George', 'Washington', 'UT', '84770', '4356528585', NULL, '1173 S 250 W Ste 202B', 'St George', 'Washington', 'UT', '84770', '4356528585', '', 'UTPHD', '', '', '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1154342731', 0, 'N', 0, '2014-05-05', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W11005585', 'W11005585', 'UT01', 'Physician Group of Utah Inc', 'Joseph', 'W', 'Bell', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '406 W South Jordan Pkwy Ste 500', 'South Jordan', 'Salt Lake', 'UT', '84095', '8016014420', '8016014421', '406 W South Jordan Pkwy Ste 500', 'South Jordan', 'Salt Lake', 'UT', '84095', '8016014420', '8016014421', 'WUSTDINT5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2008-07-01', '2014-04-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1851471767', 0, 'Y', 0, '2011-10-04', NULL, NULL, 0, 0, NULL, NULL),
('870657192', 'W11005576', 'W11005576', 'UTMH1', NULL, 'Dallas', '', 'Empey', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'B', 'PO Box 1176', 'Bountiful', 'Davis', 'UT', '84011', '8014987500', NULL, 'PO Box 1176', 'Bountiful', 'Davis', 'UT', '84011', '8014987500', '', 'PHD', NULL, '', '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1316937410', 0, 'Y', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('551311368', 'W11005559', 'W11005559', 'UTMH1', NULL, 'Mark', '', 'Treuhaft', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '12300 S 1111 E Ste 102', 'Draper', 'Salt Lake', 'UT', '84020', '8014816662', NULL, '12300 S 1111 E Ste 102', 'Draper', 'Salt Lake', 'UT', '84020', '8014816662', '', 'MA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1871719799', 0, 'N', 0, '2011-09-21', NULL, NULL, 0, 0, NULL, NULL),
('721179820', 'W11005555', 'W11005555', 'UTMH1', NULL, 'Scott', 'W', 'Boyle', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '1361 N 1075 W Ste 11', 'Farmington', 'Davis', 'UT', '84025', '8013907007', NULL, '1361 N 1075 W Ste 11', 'Farmington', 'Davis', 'UT', '84025', '8013907007', '', 'UTPHD', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1043330178', 0, 'n', 0, '2014-04-24', NULL, NULL, 0, 0, NULL, NULL),
('870616960', 'W11005566', 'W11005566', 'UTMH1', NULL, 'Josh', 'P', 'Biesinger', 'LMFT', 'Mental Health', 'Marriage and Family Therapy', '', NULL, 'B', '323 E 200 S', 'Farmington', 'Davis', 'UT', '84025', '8017558799', NULL, '323 E 200 S', 'Farmington', 'Davis', 'UT', '84025', '8017558799', '', 'MA', NULL, '', '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1093774101', 0, 'Y', 0, '2014-05-08', NULL, NULL, 0, 0, NULL, NULL),
('721179820', 'W11005556', 'W11005556', 'UTMH1', NULL, 'Scott', 'W', 'Boyle', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'B', '1516 S 700 E', 'Kaysville', 'Davis', 'UT', '84037', '8013907007', NULL, '1516 S 700 E', 'Kaysville', 'Davis', 'UT', '84037', '8013907007', '', 'UTPHD', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1043330178', 0, 'Y', 0, '2014-04-24', NULL, NULL, 0, 0, NULL, NULL),
('870657192', 'W11005575', 'W11005575', 'UTMH1', '', 'Dallas', '', 'Empey', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '523 E Happy Hollow Ln', 'Kaysville', 'Davis', 'UT', '84037', '8014987500', NULL, '523 E Happy Hollow Ln', 'Kaysville', 'Davis', 'UT', '84037', '8014987500', '', 'PHD', '', '', '0.00', '35.00', '0.00', 3, '2008-07-01', '2011-07-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1316937410', 0, 'N', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('870298699', 'W11005560', 'W11005560', 'UTMH1', 'The Gathering Place', 'Timothy', 'E', 'Adams', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '251 E 1200 S', 'Orem', 'Utah', 'UT', '84058', '8012262255', NULL, '251 E 1200 S', 'Orem', 'Utah', 'UT', '84058', '8012262255', '          ', 'MA', '', '', '0.00', '35.00', '0.00', 3, '2008-07-01', '2012-04-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1922290436', 0, 'N', 0, '2012-04-25', NULL, NULL, 0, 0, NULL, NULL),
('529854702', 'W11005578', 'W11005578', 'UTMH1', 'Northeastern Utah Medical Group', 'Matthew', 'S', 'Duncan', 'MD', 'Mental Health', 'Psychology', '', NULL, 'O', '210 W 300 N Ste 75-3', 'Roosevelt', 'Duchesne', 'UT', '84066', '4357226144', NULL, '210 W 300 N Ste 75-3', 'Roosevelt', 'Duchesne', 'UT', '84066', '4357226144', '          ', 'UTMD', '', '', '0.00', '35.00', '0.00', 3, '2008-07-01', '2011-09-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1710061577', 0, 'N', 0, '2012-03-28', NULL, NULL, 0, 0, NULL, NULL),
('870616151', 'W11005583', 'W11005583', 'UTMH1', NULL, 'John', 'R', 'Taylor', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'B', 'PO Box 682077', 'Park City', 'Summit', 'UT', '84068', '4356472911', NULL, 'PO Box 682077', 'Park City', 'Summit', 'UT', '84068', '4356472911', '', 'UTPHD', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1659431401', 0, 'Y', 0, '2014-05-01', NULL, NULL, 0, 0, NULL, NULL),
('870616151', 'W11005582', 'W11005582', 'UTMH1', NULL, 'John', 'R', 'Taylor', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '136 Heber Ave', 'Park City', 'Summit', 'UT', '84068', '4356472911', NULL, '136 Heber Ave', 'Park City', 'Summit', 'UT', '84068', '4356472911', '', 'UTPHD', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1659431401', 0, 'n', 0, '2014-05-01', NULL, NULL, 0, 0, NULL, NULL),
('261752159', 'W11005551', 'W11005551', 'UTMH1', 'Hope Haven Counseling Inc', 'Miriam', 'R', 'Harper', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '9125 S 150 W Ste D', 'Sandy', 'Salt Lake', 'UT', '84070', '8016768796', NULL, '9125 S 150 W Ste D', 'Sandy', 'Salt Lake', 'UT', '84070', '8016768796', '          ', 'UTMA', '', '', '0.00', '35.00', '0.00', 3, '2008-07-01', '2008-07-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1780647123', 0, 'N', 0, '2013-09-11', NULL, NULL, 0, 0, NULL, NULL),
('870486136', 'W11005561', 'W11005561', 'UTMH1', 'Positive Connections Inc', 'Lewis', 'L', 'Boone', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '954 E North Union Ave', 'Midvale', 'Salt Lake', 'UT', '84070', '8017481442', NULL, '954 E North Union Ave', 'Midvale', 'Salt Lake', 'UT', '84070', '8017481442', '', 'MA', NULL, '', '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1134208051', 0, 'N', 0, '2014-05-08', NULL, NULL, 0, 0, NULL, NULL),
('481297302', 'W11005586', 'W11005586', 'UTMH1', NULL, 'Chris', 'C', 'Hakes', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '50 N Main St', 'Tooele', 'Tooele', 'UT', '84074', '8014143252', NULL, '50 N Main St', 'Tooele', 'Tooele', 'UT', '84074', '8014143252', '', 'UTMA', NULL, '', '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1194785378', 0, 'n', 0, '2014-05-08', NULL, NULL, 0, 0, NULL, NULL),
('529854702', 'W11005579', 'W11005579', 'UTMH1', 'Ashley Family Clinic', 'Matthew', 'S', 'Duncan', 'MD', 'Mental Health', 'Psychology', '', NULL, 'O', '38 E 100 N', 'Vernal', 'Uintah', 'UT', '84078', '4357818000', NULL, '38 E 100 N', 'Vernal', 'Uintah', 'UT', '84078', '4357818000', '          ', 'UTMD', '', '', '0.00', '35.00', '0.00', 3, '2008-07-01', '2009-09-20', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1710061577', 0, 'N', 0, '2012-04-02', NULL, NULL, 0, 0, NULL, NULL),
('481297302', 'W11005587', 'W11005587', 'UTMH1', NULL, 'Chris', 'C', 'Hakes', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', 'PO Box 900245', 'Sandy', 'Salt Lake', 'UT', '84090', '8014143252', NULL, 'PO Box 900245', 'Sandy', 'Salt Lake', 'UT', '84090', '8014143252', '', 'UTMA', NULL, '', '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1194785378', 0, 'Y', 0, '2014-05-08', NULL, NULL, 0, 0, NULL, NULL),
('558821397', 'W11005558', 'W11005558', 'UTMH1', NULL, 'Patricia', 'A', 'Voorhes', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', '1343 Longdale Dr', 'Sandy', 'Salt Lake', 'UT', '84092', '8017125792', NULL, '1343 Longdale Dr', 'Sandy', 'Salt Lake', 'UT', '84092', '8017125792', '', 'UTMA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1932144565', 0, 'Y', 0, '2014-04-17', NULL, NULL, 0, 0, NULL, NULL),
('870638168', 'W11005550', 'W11005550', 'UTMH1', NULL, 'J Manuel', '', 'de la Torre', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '1579 W 600 S', 'Salt Lake City', 'Salt Lake', 'UT', '84104', '8019730655', NULL, '1579 W 600 S', 'Salt Lake City', 'Salt Lake', 'UT', '84104', '8019730655', '', 'UTMA', NULL, '', '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1164586061', 0, 'n', 0, '2014-05-08', NULL, NULL, 0, 0, NULL, NULL),
('880413974', 'W11005554', 'W11005554', 'UTMH1', NULL, 'Lucille', '', 'Hesse', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '1399 S 700 E Ste 8', 'Salt Lake City', 'Salt Lake', 'UT', '84105', '8014851271', NULL, '1399 S 700 E Ste 8', 'Salt Lake City', 'Salt Lake', 'UT', '84105', '8014851271', '', 'UTMA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1821122268', 0, 'n', 0, '2011-10-14', NULL, NULL, 0, 0, NULL, NULL),
('558821397', 'W11005557', 'W11005557', 'UTMH1', NULL, 'Patricia', 'A', 'Voorhes', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '1399 S 700 E Ste 1', 'Salt Lake City', 'Salt Lake', 'UT', '84105', '8017125792', NULL, '1399 S 700 E Ste 1', 'Salt Lake City', 'Salt Lake', 'UT', '84105', '8017125792', '', 'UTMA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1932144565', 0, 'n', 0, '2014-04-17', NULL, NULL, 0, 0, NULL, NULL),
('870580537', 'W11005548', 'W11005548', 'UTMH1', 'Advanced Behavioral Care', 'Gail', 'T', 'Szykula', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '1545 E  3300 S', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8014782780', NULL, '1545 E  3300 S', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8014782780', '', 'UTMA', NULL, '', '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1043284953', 0, 'n', 0, '2014-05-08', NULL, NULL, 0, 0, NULL, NULL),
('870344043', 'W11005574', 'W11005574', 'UTMH1', NULL, 'Glen', 'E', 'Johnson', 'MD', 'Mental Health', 'Psychiatry', '', NULL, 'B', '555 E 4500 S Ste C150', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8019663700', NULL, '555 E 4500 S Ste C150', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8019663700', '', 'UTMD-2', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1326157298', 0, 'Y', 0, '2014-04-17', NULL, NULL, 0, 0, NULL, NULL),
('870580537', 'W11005549', 'W11005549', 'UTMH1', 'Advanced Behavioral Care', 'Gail', 'T', 'Szykula', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'B', 'PO Box 9527', 'Salt Lake City', 'Salt Lake', 'UT', '84109', '8014782780', NULL, 'PO Box 9527', 'Salt Lake City', 'Salt Lake', 'UT', '84109', '8014782780', '', 'UTMA', NULL, '', '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1043284953', 0, 'Y', 0, '2014-05-08', NULL, NULL, 0, 0, NULL, NULL),
('260019198', 'W11005567', 'W11005567', 'UTMH1', '', 'Amanda', 'A', 'Andrus', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '275 E S Temple Ste 101', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8015317389', NULL, '275 E S Temple Ste 101', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8015317389', '          ', 'MA', '', '', '0.00', '35.00', '0.00', 3, '2008-07-01', '2012-05-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1093883027', 0, 'N', 0, '2012-05-14', NULL, NULL, 0, 0, NULL, NULL),
('870483656', 'W11005580', 'W11005580', 'UTMH1', 'Holladay Family & Child Guidance Clinic', 'Wilfred', 'H', 'Higashi', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '4667 S Holladay Blvd Ste 2', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8012778025', NULL, '4667 S Holladay Blvd Ste 2', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8012778025', '          ', 'UTPHD', '', '', '0.00', '35.00', '0.00', 3, '2008-07-01', '2011-10-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1992754907', 0, 'N', 0, '2011-09-30', NULL, NULL, 0, 0, NULL, NULL),
('529682676', 'W11005547', 'W11005547', 'UTMH1', 'West Counseling', 'Jean', 'N', 'Soderquist', 'LMFT', 'Mental Health', 'Marriage and Family Therapy', '', NULL, 'O', '2880 W 4700 S Ste A', 'Salt Lake City', 'Salt Lake', 'UT', '84118', '8019642465', NULL, '2880 W 4700 S Ste A', 'Salt Lake City', 'Salt Lake', 'UT', '84118', '8019642465', '', 'UTPHD', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1063480580', 0, 'n', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W11005584', 'W11005584', 'UT01', 'Copper Canyon Womens Center', 'Joseph', 'W', 'Bell', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '3336 S Pioneer Parkway Ste 301', 'West Valley', 'Salt Lake', 'UT', '84120', '8019643865', '8019643894', '3336 S Pioneer Parkway Ste 301', 'West Valley', 'Salt Lake', 'UT', '84120', '8019643865', '8019643894', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2008-07-01', '2014-04-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1851471767', 0, 'N', 0, '2011-10-04', NULL, NULL, 40.6991, -111.99, NULL, NULL),
('870344043', 'W11005573', 'W11005573', 'UTMH1', NULL, 'Glen', 'E', 'Johnson', 'MD', 'Mental Health', 'Psychiatry', '', NULL, 'O', '3940 W 4100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019663700', NULL, '3940 W 4100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019663700', '', 'UTMD-2', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1326157298', 0, 'N', 0, '2014-04-17', NULL, NULL, 0, 0, NULL, NULL),
('202800071', 'W11005553', 'W11005553', 'UTMH1', 'Alpine Center for Personal Growth', 'Tracy', 'B', 'Anderson', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '5689 S Redwood Rd Ste 30', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8012681715', '8012681783', '5689 S Redwood Rd Ste 30', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8012681715', '8012681783', 'UTMA', NULL, NULL, '0.00', '35.00', '0.00', 6, '2008-07-01', '2013-02-14', 0, 0, 0, 'Lakeview Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1568595106', 0, 'n', 0, '2013-07-24', NULL, NULL, 0, 0, NULL, NULL),
('870616960', 'W11005565', 'W11005565', 'UTMH1', NULL, 'Josh', 'P', 'Biesinger', 'LMFT', 'Mental Health', 'Marriage and Family Therapy', '', NULL, 'O', '5667 S Redwood Rd Ste 5B', 'Taylorsville', 'Salt Lake', 'UT', '84123', '8017558799', NULL, '5667 S Redwood Rd Ste 5B', 'Taylorsville', 'Salt Lake', 'UT', '84123', '8017558799', '', 'MA', NULL, '', '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1093774101', 0, 'N', 0, '2014-05-08', NULL, NULL, 0, 0, NULL, NULL),
('342046139', 'W11005590', 'W11005590', 'UTMH1', NULL, 'Patricia', 'A', 'Mason', 'LCSW', 'Mental Health', '', '', NULL, 'O', '435 E 700 S', 'Brigham City', 'Box Elder', 'UT', '84302', '4357235600', NULL, '435 E 700 S', 'Brigham City', 'Box Elder', 'UT', '84302', '4357235600', '', 'UTMA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1376633701', 0, 'n', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('205030541', 'W11005552', 'W11005552', 'UTMH1', NULL, 'Merilyn', 'H', 'Wright', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '550 N Main Ste 222', 'Logan', 'Cache', 'UT', '84321', '4355128830', NULL, '550 N Main Ste 222', 'Logan', 'Cache', 'UT', '84321', '4355128830', '', 'UTMA', NULL, '', '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1962502641', 0, 'n', 0, '2014-05-29', 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
('200117354', 'W11005588', 'W11005588', 'UTMH1', 'Summit Counseling', 'Charles', 'K', 'Hinds', 'LMFT', 'Mental Health', 'Marriage and Family Therapy', '', NULL, 'O', '95 W 100 S Ste 130', 'Logan', 'Cache', 'UT', '84321', '4357524646', NULL, '95 W 100 S Ste 130', 'Logan', 'Cache', 'UT', '84321', '4357524646', '', 'UTMA', '', '', '0.00', '35.00', '0.00', 3, '2008-07-01', '2011-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1013928175', 0, 'N', 0, '2014-05-29', NULL, NULL, 0, 0, NULL, NULL),
('342046139', 'W11005589', 'W11005589', 'UTMH1', 'Life Management', 'Patricia', 'A', 'Mason', 'LCSW', 'Mental Health', '', '', NULL, 'O', '707 24th St Ste C', 'Ogden', 'Weber', 'UT', '84401', '8013944522', NULL, '707 24th St Ste C', 'Ogden', 'Weber', 'UT', '84401', '8013944522', '', 'UTMA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1376633701', 0, 'n', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('870483656', 'W11005581', 'W11005581', 'UTMH1', 'Professional Services Corp', 'Wilfred', 'H', 'Higashi', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '533 - 26th St Ste 102', 'Ogden', 'Weber', 'UT', '84401', '8016213624', NULL, '533 - 26th St Ste 102', 'Ogden', 'Weber', 'UT', '84401', '8016213624', '          ', 'UTPHD', '', '', '0.00', '35.00', '0.00', 3, '2008-07-01', '2011-10-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1992754907', 0, 'N', 0, '2011-09-30', NULL, NULL, 0, 0, NULL, NULL),
('870437180', 'W11005563', 'W11005563', 'UTMH1', 'Crystal Cacoon', 'Anna', 'J', 'Waters', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '5582 S 1750 E', 'Ogden', 'Weber', 'UT', '84403', '8014768888', '8014768887', '5582 S 1750 E', 'Ogden', 'Weber', 'UT', '84403', '8014768888', '8014768887', 'UTMA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1285715425', 0, 'n', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('870616960', 'W11005562', 'W11005562', 'UTMH1', NULL, 'Josh', 'P', 'Biesinger', 'LMFT', 'Mental Health', 'Marriage and Family Therapy', '', NULL, 'O', '425 E 5350 S Ste 280', 'Washington Terrace', 'Weber', 'UT', '84405', '8017558799', NULL, '425 E 5350 S Ste 280', 'Washington Terrace', 'Weber', 'UT', '84405', '8017558799', '', 'MA', NULL, '', '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1093774101', 0, 'N', 0, '2014-05-08', NULL, NULL, 0, 0, NULL, NULL),
('870437180', 'W11005564', 'W11005564', 'UTMH1', 'Crystal Cocoon', 'Anna', 'J', 'Waters', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'B', 'PO Box 150173', 'Ogden', 'Weber', 'UT', '84415', '8014790601', '8014768887', 'PO Box 150173', 'Ogden', 'Weber', 'UT', '84415', '8014790601', '8014768887', 'UTMA', '', '', '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1285715425', 0, 'Y', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('528725798', 'W11005569', 'W11005569', 'UTMH1', NULL, 'James', 'A', 'Ferro', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'B', 'PO Box 325', 'Moab', 'Grand', 'UT', '84532', '4352601138', NULL, 'PO Box 325', 'Moab', 'Grand', 'UT', '84532', '4352601138', '', 'UTPHD', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1225173685', 0, 'Y', 0, '2014-05-01', NULL, NULL, 0, 0, NULL, NULL),
('528725798', 'W11005568', 'W11005568', 'UTMH1', NULL, 'James', 'A', 'Ferro', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '76 S Main St Ste 6', 'Moab', 'Grand', 'UT', '84532', '4352601138', NULL, '76 S Main St Ste 6', 'Moab', 'Grand', 'UT', '84532', '4352601138', '', 'UTPHD', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1225173685', 0, 'n', 0, '2014-05-01', NULL, NULL, 0, 0, NULL, NULL),
('870529329', 'W11005570', 'W11005570', 'UTMH1', 'Aspen Therapy', 'Page', '', 'Speiser', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '3707 N Canyon Rd Ste 2C', 'Provo', 'Utah', 'UT', '84604', '8012253111', NULL, '3707 N Canyon Rd Ste 2C', 'Provo', 'Utah', 'UT', '84604', '8012253111', '', 'MA', NULL, '', '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1104928654', 0, 'n', 0, '2014-06-04', NULL, NULL, 0, 0, NULL, NULL),
('870478408', 'W11005571', 'W11005571', 'UTMH1', 'Preferred Family Clinic', 'Randall', 'F', 'Hyde', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '1355 N University Ave Ste 200', 'Provo', 'Utah', 'UT', '84604', '8012210223', NULL, '1355 N University Ave Ste 200', 'Provo', 'Utah', 'UT', '84604', '8012210223', '', 'PHD', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1265526347', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('529676822', 'W11005572', 'W11005572', 'UTMH1', 'Preferred Family Clinic', 'Summer', 'A', 'Morris', 'LPC', 'Mental Health', 'Counseling', NULL, NULL, 'O', '1355 N University Ave Ste 200', 'Provo', 'Utah', 'UT', '84604', '8012210223', NULL, '1355 N University Ave', 'Provo', 'Utah', 'UT', '84604', NULL, NULL, 'MA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1578767737', 0, 'n', 0, '2008-06-30', NULL, NULL, 0, 0, NULL, NULL),
('529928396', 'W11005577', 'W11005577', 'UTMH1', 'Counseling Center', 'Ronni', 'H', 'Eggen', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '345 Willowbrook Dr', 'Richfield', 'Sevier', 'UT', '84701', '4358932366', NULL, '345 Willowbrook Dr', 'Richfield', 'Sevier', 'UT', '84701', '4358932366', '', 'MA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1598802183', 0, 'n', 0, '2014-05-06', NULL, NULL, 0, 0, NULL, NULL),
('262615003', 'W11005676', 'W11005676', 'UTMH1', NULL, 'David', 'O', 'Williams', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'B', '3525 Ruffed Grouse Rd', 'Eagle Mountain', 'Utah', 'UT', '84005', '8018368678', NULL, '3525 Ruffed Grouse Rd', 'Eagle Mountain', 'Utah', 'UT', '84005', '8018368678', '', 'MA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1255496212', 0, 'Y', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('208039597', 'W11005674', 'W11005674', 'UTMH1', 'Hart Plaza', 'Janine', 'B', 'Hansen', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '1325 N Main Ste 3', 'Bountiful', 'Davis', 'UT', '84010', '8013972100 ext 26', NULL, '1325 N Main Ste 3', 'Bountiful', 'Davis', 'UT', '84010', '8013972100 ext 26', '', 'UTMA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1710034392', 0, 'n', 0, '2013-01-10', NULL, NULL, 0, 0, NULL, NULL),
('560256913', 'W11005602', 'W11005602', 'UTMH1', 'Gardner Counseling', 'Monica', 'L', 'Gardner', 'LMFT', 'Mental Health', 'Marriage and Family Therapy', '', NULL, 'O', '952 S 800 E', 'Centerville', 'Davis', 'UT', '84014', '8012991772', NULL, '952 S 800 E', 'Centerville', 'Davis', 'UT', '84014', '8012991772', '', 'UTMA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2008-11-21', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1033398383', 0, 'n', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('560256913', 'W11005603', 'W11005603', 'UTMH1', 'LDS Family Services', 'Monica', 'L', 'Gardner', 'LMFT', 'Mental Health', 'Marriage and Family Therapy', '', NULL, 'B', '94 E Pages Ln', 'Centerville', 'Davis', 'UT', '84014', '8012940578', NULL, '94 E Pages Ln', 'Centerville', 'Davis', 'UT', '84014', '8012940578', '', 'UTMA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2008-11-21', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1033398383', 0, 'Y', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('141977599', 'W11005593', 'W11005593', 'UTMH1', 'Cutlers Counseling PLLC', 'Scott', '', 'Cutler', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '224 S Main', 'Centerville', 'Davis', 'UT', '84014', '8012922404', NULL, '224 S Main', 'Centerville', 'Davis', 'UT', '84014', '8012922404', '', 'UTPHD', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1992918924', 0, 'n', 0, '2014-04-07', NULL, NULL, 0, 0, NULL, NULL),
('870533611', 'W11005725', 'W11005725', 'UT01', 'North Davis Anesthesiology', 'Melvin', 'K', 'Richardson', 'MD', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 160354', 'Clearfield', 'Davis', 'UT', '84016', '8017748992', NULL, 'PO Box 160354', 'Clearfield', 'Davis', 'UT', '84016', '8017748992', '          ', '', '', '1000', '49.50', '0.00', '0.00', 6, '2008-07-01', '2012-06-14', 1, 12, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1467401737', 0, 'Y', 0, '2012-06-12', NULL, NULL, 0, 0, NULL, NULL),
('870533611', 'W11005724', 'W11005724', 'UT01', 'North Davis Anesthesiology', 'Clay', '', 'Richardson', 'DO', 'Anesthesiology', '', '', NULL, 'B', '1652 Wildcat Ln', 'Ogden', 'Weber', 'UT', '84403', '8013932249', NULL, '1652 Wildcat Ln', 'Ogden', 'Weber', 'UT', '84403', '8013932249', '          ', '', '', '1000', '49.50', '0.00', '0.00', 6, '2008-07-01', '2012-06-14', 1, 12, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1295950731', 0, 'Y', 0, '2012-06-12', NULL, NULL, 0, 0, NULL, NULL),
('870533611', 'W11005723', 'W11005723', 'UT01', 'North Davis Anesthesiology', '', '', 'North Davis Anesthesiology', 'GROUP', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 160354', 'Clearfield', 'Davis', 'UT', '84016', '8017748992', NULL, 'PO Box 160354', 'Clearfield', 'Davis', 'UT', '84016', '8017748992', '          ', '', '', '1000', '49.50', '0.00', '0.00', 6, '2008-07-01', '2012-06-14', 1, 12, 0, '', '', '', '', 'HCFA|UB|', '1679525901', 0, 'Y', 0, '2012-06-12', NULL, NULL, 0, 0, NULL, NULL),
('870533611', 'W11005722', 'W11005722', 'UT01', 'North Davis Anesthesiology', '', '', 'North Davis Anesthesiology', 'GROUP', 'Anesthesiology', '', '', NULL, 'O', '1652 Wildcat Ln Ste 1', 'Ogden', 'Weber', 'UT', '84403', '8013932249', NULL, '1652 Wildcat Ln Ste 1', 'Ogden', 'Weber', 'UT', '84403', '8013932249', '          ', '', '', '1000', '49.50', '0.00', '0.00', 6, '2008-07-01', '2012-06-14', 1, 12, 0, '', '', '', '', 'HCFA|UB|', '1679525901', 0, 'Y', 0, '2012-06-12', NULL, NULL, 0, 0, NULL, NULL),
('870533611', 'W11005721', 'W11005721', 'UT01', 'North Davis Anesthesiology', '', '', 'North Davis Anesthesiology', 'GROUP', 'Anesthesiology', '', '', NULL, 'O', '1600 W Antelope Dr', 'Layton', 'Davis', 'UT', '84041', '8017748992', '8015250347', '1600 W Antelope Dr', 'Layton', 'Davis', 'UT', '84041', '8017748992', '8015250347', '', '', '1000', '49.50', '0.00', '0.00', 6, '2008-07-01', '2012-06-14', 1, 12, 0, '', '', '', '', 'HCFA|UB|', '1679525901', 0, 'Y', 0, '2012-06-12', NULL, NULL, 0, 0, NULL, NULL),
('870533611', 'W11005720', 'W11005720', 'UT01', 'North Davis Anesthesiology', 'Brian', 'C', 'Hales', 'MD', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 160354', 'Clearfield', 'Davis', 'UT', '84016', '8017748992', NULL, 'PO Box 160354', 'Clearfield', 'Davis', 'UT', '84016', '8017748992', '          ', '', '', '1000', '49.50', '0.00', '0.00', 6, '2008-07-01', '2012-06-14', 1, 12, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1053396770', 0, 'Y', 0, '2012-06-13', NULL, NULL, 0, 0, NULL, NULL),
('870533611', 'W11005719', 'W11005719', 'UT01', 'North Davis Anesthesiology', 'Mark', 'R', 'Gillis', 'MD', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 160354', 'Clearfield', 'Davis', 'UT', '84016', '8017748992', NULL, 'PO Box 160354', 'Clearfield', 'Davis', 'UT', '84016', '8017748992', '          ', '', '', '1000', '49.50', '0.00', '0.00', 6, '2008-07-01', '2012-06-14', 1, 12, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1154390177', 0, 'Y', 0, '2012-06-12', NULL, NULL, 0, 0, NULL, NULL),
('870533611', 'W11005726', 'W11005726', 'UT01', 'North Davis Anesthesiology', 'Mark', 'E', 'Rush', 'MD', 'Pain Management', 'Anesthesiology', '', NULL, 'B', 'PO Box 160354', 'Clearfield', 'Davis', 'UT', '84016', '8017748992', NULL, 'PO Box 160354', 'Clearfield', 'Davis', 'UT', '84016', '8017748992', '          ', '', '', '1000', '49.50', '0.00', '0.00', 6, '2008-07-01', '2012-06-14', 1, 12, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1801840806', 0, 'Y', 0, '2012-06-12', NULL, NULL, 0, 0, NULL, NULL),
('204703824', 'W11005672', 'W11005672', 'UTMH1', '', 'Jeffrey', 'J', 'Gregson', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '722 W Shepard Ln Ste 105', 'Farmington', 'Davis', 'UT', '84025', '8015292334', '8018258222', '722 W Shepard Ln Ste 105', 'Farmington', 'Davis', 'UT', '84025', '8015292334', '8018258222', 'MA', '', '', '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1952450678', 0, 'N', 0, '2013-01-10', NULL, NULL, 0, 0, NULL, NULL),
('876000299', 'W11005717', 'W11005717', 'UTMH1', 'Heber Valley Counseling', 'Jennifer', '', 'Pinter', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '55 S 500 E', 'Heber City', 'Wasatch', 'UT', '84032', '4356543003', NULL, '55 S 500 E', 'Heber City', 'Wasatch', 'UT', '84032', '4356543003', '          ', 'UTMA', '', '', '0.00', '35.00', '0.00', 8, '2008-07-01', '2012-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1801012190', 0, 'N', 0, '2013-01-21', NULL, NULL, 0, 0, NULL, NULL),
('876000299', 'W11005714', 'W11005714', 'UTMH1', 'Heber Valley Counseling', 'Sharon', 'J', 'Jensen', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '55 S 500 E', 'Heber City', 'Wasatch', 'UT', '84032', '4356543003', NULL, '55 S 500 E', 'Heber City', 'Wasatch', 'UT', '84032', '4356543003', '          ', 'UTMA', '', '', '0.00', '35.00', '0.00', 8, '2008-07-01', '2011-06-22', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1265658520', 0, 'N', 0, '2011-06-22', NULL, NULL, 0, 0, NULL, NULL),
('876000299', 'W11005716', 'W11005716', 'UTMH1', 'Heber Valley Counseling', 'Dennis', 'A', 'Hansen', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '55 S 500 E', 'Heber City', 'Wasatch', 'UT', '84032', '4356543003', NULL, '55 S 500 E', 'Heber City', 'Wasatch', 'UT', '84032', '4356543003', '          ', 'UTMA', '', '', '0.00', '35.00', '0.00', 8, '2008-07-01', '2013-01-02', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1518183813', 0, 'N', 0, '2013-01-11', NULL, NULL, 0, 0, NULL, NULL),
('528469723', 'W11005634', 'W11005634', 'UTMH1', 'Neil G Anderton Counseling', 'Neil', 'G', 'Anderton', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '135 S Main St Ste 211', 'Heber City', 'Wasatch', 'UT', '84032', '4356570660', NULL, '135 S Main St Ste 211', 'Heber City', 'Wasatch', 'UT', '84032', '4356570660', '          ', 'UTMA', '', '', '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1427101518', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('876000299', 'W11005718', 'W11005718', 'UTMH1', 'Heber Valley Counseling', 'Joshua', 'J', 'Turner', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '55 S 500 E', 'Heber City', 'Wasatch', 'UT', '84032', '4356543003', NULL, '55 S 500 E', 'Heber City', 'Wasatch', 'UT', '84032', '4356543003', '          ', 'UTMA', '', '', '0.00', '35.00', '0.00', 8, '2008-07-01', '2011-06-22', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1144409756', 0, 'N', 0, '2011-06-22', NULL, NULL, 0, 0, NULL, NULL),
('876000299', 'W11005715', 'W11005715', 'UTMH1', 'Heber Valley Counseling', 'Gerald', 'M', 'Lazar', 'MD', 'Mental Health', 'Psychiatry', '', NULL, 'O', '55 S 500 E', 'Heber City', 'Wasatch', 'UT', '84032', '4356543003', NULL, '55 S 500 E', 'Heber City', 'Wasatch', 'UT', '84032', '4356543003', '          ', 'UTMD', '', '', '0.00', '35.00', '0.00', 8, '2008-07-01', '2013-01-02', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1003883349', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('551739198', 'W11005710', 'W11005710', 'UTMH1', 'NCS', 'Michael', 'A', 'Negrette', 'LMFT', 'Mental Health', 'Marriage and Family Therapy', 'Social Worker', NULL, 'O', '475 N 300 W Ste 14', 'Kaysville', 'Davis', 'UT', '84037', '8013903210', NULL, '475 N 300 W Ste 14', 'Kaysville', 'Davis', 'UT', '84037', '8013903210', '', 'UTMA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1255462016', 0, 'n', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('208964171', 'W11005664', 'W11005664', 'UTMH1', 'Thayne Consulting', 'Melissa', 'E', 'Thayne', 'LCSW', 'Mental Health', 'Social Worker', NULL, NULL, 'O', '3051 W Maple Loop Dr Ste 201', 'Lehi', 'Utah', 'UT', '84043', '8014272607', NULL, '3051 W Mapleloop', 'Lehi', 'Utah', 'UT', '84043', NULL, NULL, 'MA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2008-12-19', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1467515932', 0, 'n', 0, '2008-06-29', NULL, NULL, 0, 0, NULL, NULL),
('870392388', 'W11005633', 'W11005633', 'UTMH1', 'South Valley Associates', 'David', 'B', 'Adams', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '6925 S Union Park Ctr Ste 490', 'Midvale', 'Salt Lake', 'UT', '84047', '8015662622', NULL, '6925 S Union Park Ctr Ste 490', 'Midvale', 'Salt Lake', 'UT', '84047', '8015662622', '', 'PHD', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1326080367', 0, 'N', 0, '2014-04-24', NULL, NULL, 0, 0, NULL, NULL),
('870410605', 'W11005695', 'W11005695', 'UTMH1', 'Family Support & Treatment Center', 'Jessica', 'L', 'Salmon', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'o', '1255 N 1200 W', 'Orem', 'Utah', 'UT', '84057', '8012291181', NULL, '1255 N 1200 W', 'Orem', 'Utah', 'UT', '84057', '8012291181', '', 'UTMA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1154594018', 0, 'n', 0, '2014-02-27', NULL, NULL, 0, 0, NULL, NULL),
('870410605', 'W11005694', 'W11005694', 'UTMH1', 'Family Support & Treatment Center', 'Kerri', 'F', 'Robinson', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '1255 N 1200 W', 'Orem', 'Utah', 'UT', '84057', '8012291181', NULL, '1255 N 1200 W', 'Orem', 'Utah', 'UT', '84057', '8012291181', '', 'UTMA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1528028495', 0, 'n', 0, '2014-01-09', NULL, NULL, 0, 0, NULL, NULL),
('870410605', 'W11005696', 'W11005696', 'UTMH1', 'Family Support & Treatment Center', 'Stuart', 'D', 'Harper', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '1255 N 1200 W', 'Orem', 'Utah', 'UT', '84057', '8012291181', NULL, '1255 N 1200 W', 'Orem', 'Utah', 'UT', '84057', '8012291181', '', 'UTMA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1225097900', 0, 'n', 0, '2014-05-06', NULL, NULL, 0, 0, NULL, NULL),
('870410605', 'W11005697', 'W11005697', 'UTMH1', 'Family Support & Treatment Center', 'Larry', 'A', 'Krause', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '1255 N 1200 W', 'Orem', 'Utah', 'UT', '84057', '8012291181', NULL, '1255 N 1200 W', 'Orem', 'Utah', 'UT', '84057', '8012291181', '', 'UTMA', NULL, '', '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1982663670', 0, 'n', 0, '2014-05-08', NULL, NULL, 0, 0, NULL, NULL),
('870410605', 'W11005698', 'W11005698', 'UTMH1', 'Family Support & Treatment Center', 'Mary', 'A', 'Carter', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '1255 N 1200 W', 'Orem', 'Utah', 'UT', '84057', '8012291181', NULL, '1255 N 1200 W', 'Orem', 'Utah', 'UT', '84057', '8012291181', '', 'UTMA', NULL, '', '0.00', '35.00', '0.00', 3, '2008-07-01', '2009-09-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1518926880', 0, 'n', 0, '2014-05-08', NULL, NULL, 0, 0, NULL, NULL),
('262615003', 'W11005675', 'W11005675', 'UTMH1', 'Choosing Joy Wellness Clinic', 'David', 'O', 'Williams', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '313 E 1200 St Ste 101', 'Orem', 'Utah', 'UT', '84058', '8019605388', NULL, '313 E 1200 St Ste 101', 'Orem', 'Utah', 'UT', '84058', '8019605388', '          ', 'MA', '', '', '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1255496212', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('027448199', 'W11005612', 'W11005612', 'UTMH1', 'Ad Psychotherapy', 'Valerie', 'J', 'Flattes', 'APRN', 'Mental Health', 'Adult Nurse Practitioner', '', NULL, 'O', '8465 S 700 E', 'Sandy', 'Salt Lake', 'UT', '84070', '8012338577', NULL, '8465 S 700 E', 'Sandy', 'Salt Lake', 'UT', '84070', '8012338577', '', 'ARNP', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1972650836', 0, 'n', 0, '2013-03-15', NULL, NULL, 0, 0, NULL, NULL),
('522828100', 'W11005709', 'W11005709', 'UTMH1', NULL, 'Bryan', 'D', 'Bingham', 'LMFT', 'Mental Health', 'Marriage and Family Therapy', '', NULL, 'B', '2727 W Sandi Dr', 'Layton', 'Davis', 'UT', '84075', '8015256975', NULL, '2727 W Sandi Dr', 'Layton', 'Davis', 'UT', '84075', '8015256975', '', 'MA', NULL, '', '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1164508487', 0, 'Y', 0, '2014-05-28', NULL, NULL, 0, 0, NULL, NULL),
('522828100', 'W11005708', 'W11005708', 'UTMH1', '', 'Bryan', 'D', 'Bingham', 'LMFT', 'Mental Health', 'Marriage and Family Therapy', '', NULL, 'O', '1747 S Heritage Ln Ste B 103', 'Syracuse', 'Davis', 'UT', '84075', '8015256975', NULL, '1747 S Heritage Ln Ste B 103', 'Syracuse', 'Davis', 'UT', '84075', '8015256975', '', 'MA', '', '', '0.00', '35.00', '0.00', 3, '2008-07-01', '2011-04-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1164508487', 0, 'N', 0, '2014-05-28', NULL, NULL, 0, 0, NULL, NULL),
('528469723', 'W11005635', 'W11005635', 'UTMH1', 'Neil G Anderton Counseling', 'Neil', 'G', 'Anderton', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '110 E 100 S Ste 1', 'Vernal', 'Uintah', 'UT', '84078', '4355131315', NULL, '110 E 100 S Ste 1', 'Vernal', 'Uintah', 'UT', '84078', '4355131315', '', 'UTMA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1427101518', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('231741072', 'W11005642', 'W11005642', 'UTMH1', 'Ashley Family Clinic', 'Carol', 'Sue', 'Brooks', 'PHD', 'Mental Health', 'Psychology', NULL, NULL, 'O', '38 E 100 N', 'Vernal', 'Uintah', 'UT', '84078', '4357818000', NULL, '38 E 100 N', 'Vernal', 'Uintah', 'UT', '84078', NULL, NULL, 'PHD', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2008-07-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1992983803', 0, 'n', 0, '2008-06-29', NULL, NULL, 0, 0, NULL, NULL),
('870666077', 'W11005643', 'W11005643', 'UTMH1', 'Ashley Family Clinic', 'Dan', 'B', 'Goodkind', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '38 E 100 N', 'Vernal', 'Uintah', 'UT', '84078', '4357818000', NULL, '38 E 100 N', 'Vernal', 'Uintah', 'UT', '84078', '4357818000', '          ', 'PHD', '', '', '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-20', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1578645297', 0, 'N', 0, '2013-02-22', NULL, NULL, 0, 0, NULL, NULL),
('556900160', 'W11005641', 'W11005641', 'UTMH1', 'Basin Family Clinic', 'Carolyn', 'S', 'Henry', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '379 N 500 W Ste 1A', 'Vernal', 'Uintah', 'UT', '84078', '4357891165', NULL, '379 N 500 W Ste 1A', 'Vernal', 'Uintah', 'UT', '84078', '4357891165', '', 'MA', '', '', '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, 'Uintah Basin Medical Center', '', '', '', 'HCFA|UB|', '1194814475', 0, 'N', 0, '2014-07-21', NULL, NULL, 0, 0, NULL, NULL),
('870524176', 'W11005681', 'W11005681', 'UTMH1', 'Comprehensive Psychological Services', 'Michael', 'J', 'Bjornson', 'PHD', 'Psychology', '', '', NULL, 'O', '335 W 50 N Ste 17', 'Vernal', 'Uintah', 'UT', '84078', '4357818989', NULL, '335 W 50 N Ste 17', 'Vernal', 'Uintah', 'UT', '84078', '4357818989', '', 'UTPHD', NULL, NULL, '0.00', '35.00', '0.00', 6, '2008-07-01', '2008-12-15', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1558411025', 0, 'N', 0, '2014-04-14', NULL, NULL, 0, 0, NULL, NULL),
('202887567', 'W11005640', 'W11005640', 'UTMH1', 'Ashley Family Clinic', 'Jeffery', 'P', 'Henderson', 'PHD', 'Mental Health', 'Psychology', NULL, NULL, 'O', '38 E 100 N', 'Vernal', 'Uintah', 'UT', '84078', '4357818000', NULL, '38E 100 N', 'Vernal', 'Uintah', 'UT', '84078', NULL, NULL, 'PHD', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2009-02-15', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1255413118', 0, 'N', 0, '2008-06-29', NULL, NULL, 0, 0, NULL, NULL),
('529865884', 'W11005665', 'W11005665', 'UTMH1', 'Titensor Enterprises', 'Steven', 'D', 'Titensor', 'LMFT', 'Mental Health', 'Marriage and Family Therapy', '', NULL, 'O', '2205 S 800 W', 'Wood Cross', 'Davis', 'UT', '84087', '8012980336', NULL, '2205 S 800 W', 'Wood Cross', 'Davis', 'UT', '84087', '8012980336', '', 'UTMA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1720120710', 0, 'n', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('870710584', 'W11005692', 'W11005692', 'UTMH1', 'Jordan West Family Counseling', 'Jennifer', 'E', 'JAMES', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '9263 B Redwood Rd', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015660749', NULL, '9263 B Redwood Rd', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015660749', '', 'MA', NULL, NULL, '0.00', '35.00', '0.00', 6, '2008-07-01', '2008-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1720131899', 0, 'n', 0, '2012-01-18', NULL, NULL, 0, 0, NULL, NULL),
('870710584', 'W11005693', 'W11005693', 'UTMH1', 'Jordan West Family Counseling', 'Tod', '', 'Johnson', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '9263 B Redwood Rd', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015660749', NULL, '9263 B Redwood Rd', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015660749', '', 'MA', NULL, NULL, '0.00', '35.00', '0.00', 6, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1629089180', 0, 'n', 0, '2012-04-23', NULL, NULL, 0, 0, NULL, NULL),
('870710584', 'W11005611', 'W11005611', 'UTMH1', 'Jordan West Family Counseling', 'Paul', 'L', 'Carver', 'LPC', 'Mental Health', 'Counseling', NULL, NULL, 'O', '9263 B Redwood Rd', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015660749', NULL, '9263 B Redwood Rd', 'West Jordan', 'Salt Lake', 'UT', '84088', NULL, NULL, 'MA', NULL, NULL, '0.00', '35.00', '0.00', 6, '2008-07-01', '2008-09-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1831242072', 0, 'n', 0, '2008-06-29', NULL, NULL, 0, 0, NULL, NULL),
('870710584', 'W11005605', 'W11005605', 'UTMH1', 'Jordan West Family Counseling', 'Laurel', 'A', 'Abts', 'LMFT', 'Mental Health', 'Marriage and Family Therapy', '', NULL, 'O', '9263 S Redwood Rd', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015660749', NULL, '9263 S Redwood Rd', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015660749', '', 'MA', NULL, NULL, '0.00', '35.00', '0.00', 6, '2008-07-01', '2008-10-10', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1992886105', 0, 'n', 0, '2012-03-29', NULL, NULL, 0, 0, NULL, NULL),
('870710584', 'W11005610', 'W11005610', 'UTMH1', 'Jordan West Family Counseling', 'T', 'L', 'Burnham', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '9263 B Redwood Rd', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015660749', NULL, '9263 B Redwood Rd', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015660749', '', 'PHD', NULL, '', '0.00', '35.00', '0.00', 6, '2008-07-01', '2009-03-09', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1356303218', 0, 'n', 0, '2014-06-23', NULL, NULL, 0, 0, NULL, NULL),
('870710584', 'W11005609', 'W11005609', 'UTMH1', 'Jordan West Family Counseling', 'Terry', 'R', 'Yockey', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '9263 B Redwood Rd', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015660749', NULL, '9263 B Redwood Rd', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015660749', '', 'MA', NULL, NULL, '0.00', '35.00', '0.00', 6, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1730370834', 0, 'n', 0, '2014-04-07', NULL, NULL, 0, 0, NULL, NULL),
('870710584', 'W11005608', 'W11005608', 'UTMH1', 'Jordan West Family Counseling', 'Spencer', 'G', 'Morgan', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '9263 B Redwood Rd', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015660749', NULL, '9263 B Redwood Rd', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015660749', '', 'MA', NULL, NULL, '0.00', '35.00', '0.00', 6, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1023058096', 0, 'n', 0, '2014-04-24', NULL, NULL, 0, 0, NULL, NULL),
('870710584', 'W11005607', 'W11005607', 'UTMH1', 'Jordan West Family Counseling', 'Betty', 'J', 'Owen', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '9263 B Redwood Rd', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015660749', NULL, '9263 B Redwood Rd', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015660749', '', 'MA', NULL, '', '0.00', '35.00', '0.00', 6, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1295877512', 0, 'n', 0, '2014-07-17', NULL, NULL, 0, 0, NULL, NULL),
('870710584', 'W11005606', 'W11005606', 'UTMH1', 'Jordan West Family Counseling', 'Romeo', '', 'Kistler', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '9263 B Redwood Rd', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015660749', NULL, '9263 B Redwood Rd', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015660749', '          ', 'MA', '', '', '0.00', '35.00', '0.00', 6, '2008-07-01', '2010-08-13', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1023172269', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('870710584', 'W11005604', 'W11005604', 'UTMH1', 'Jordan West Family Counseling', 'Rick', 'G', 'Lambert', 'LCSW, LMFT', 'Mental Health', 'Social Worker', 'Marriage and Family Therapy', NULL, 'O', '9263 B Redwood Rd', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015660749', NULL, '9263 B Redwood Rd', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015660749', '          ', 'MA', '', '', '0.00', '35.00', '0.00', 6, '2008-07-01', '2010-12-20', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1063528248', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('412186882', 'W11005700', 'W11005700', 'UTMH1', 'Institute of Change', 'Melissa', '', 'Zahn', 'LCSW', 'Mental Health', 'Counseling', '', NULL, 'O', '11190 S 958 E', 'Sandy', 'Salt Lake', 'UT', '84094', '8015714565', NULL, '11190 S 958 E', 'Sandy', 'Salt Lake', 'UT', '84094', '8015714565', '', 'UTMA', '', '', '0.00', '35.00', '0.00', 6, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000003073', 0, 'N', 0, '2014-04-21', NULL, NULL, 0, 0, NULL, NULL),
('340622082', 'W11005699', 'W11005699', 'UTMH1', 'Institute of Change', 'Jonathon', 'B', 'Scheffres', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '11190 S 958 E', 'Sandy', 'Salt Lake', 'UT', '84094', '8015714565', NULL, '11190 S 958 E', 'Sandy', 'Salt Lake', 'UT', '84094', '8015714565', '', 'UTMA', NULL, '', '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1770762742', 0, 'n', 0, '2014-07-16', NULL, NULL, 0, 0, NULL, NULL),
('563609733', 'W11005595', 'W11005595', 'UTMH1', '', 'Gary', 'G', 'Taylor', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '1325 W S Jordan Pkwy Ste 101', 'South Jordan', 'Salt Lake', 'UT', '84095', '8018150354', NULL, '1325 W S Jordan Pkwy Ste 101', 'South Jordan', 'Salt Lake', 'UT', '84095', '8018150354', '          ', 'UTPHD', '', '', '0.00', '35.00', '0.00', 3, '2008-07-01', '2011-10-15', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1447271929', 0, 'N', 0, '2011-10-03', NULL, NULL, 0, 0, NULL, NULL),
('102403214', 'W11005592', 'W11005592', 'UTMH1', NULL, 'Joyce', 'A', 'Kelen', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '925 E 900 S Ste 26', 'Salt Lake City', 'Salt Lake', 'UT', '84105', '8015377523', NULL, '925 E 900 S Ste 26', 'Salt Lake City', 'Salt Lake', 'UT', '84105', '8015377523', '', 'UTMA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1609947712', 0, 'n', 0, '2011-09-20', NULL, NULL, 0, 0, NULL, NULL),
('870524176', 'W11005683', 'W11005683', 'UTMH1', 'Comprehensive Psychological Services', 'James', 'A', 'Miller', 'MD', 'Mental Health', 'Psychiatry', '', NULL, 'O', '1208 E 3300 S', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8014831600', NULL, '1208 E 3300 S', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8014831600', '          ', 'UTMD', '', '', '0.00', '35.00', '0.00', 6, '2008-07-01', '2012-02-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1629006358', 0, 'N', 0, '2013-03-12', NULL, NULL, 0, 0, NULL, NULL),
('529560317', 'W11005713', 'W11005713', 'UTMH1', 'Affiliated Psychotherapists', 'Rick', 'G', 'Lambert', 'LCSW, LMFT', 'Mental Health', 'Social Worker', 'Marriage and Family Therapy', NULL, 'O', '3098 S Highland Dr Ste 305', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8014676255', NULL, '3098 S Highland Dr Ste 305', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8014676255', '', 'UTMA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1063528248', 0, 'n', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('870524176', 'W11005691', 'W11005691', 'UTMH1', 'Comprehensive Psychological Services', 'Allison', 'E', 'Martinez', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '1208 E 3300 S', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8014831600', NULL, '1208 E 3300 S', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8014831600', '', 'UTMA', NULL, NULL, '0.00', '35.00', '0.00', 6, '2008-07-01', '2008-08-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1568659332', 0, 'N', 0, '2013-03-12', NULL, NULL, 0, 0, NULL, NULL),
('870524176', 'W11005690', 'W11005690', 'UTMH1', 'Comprehensive Psychological Services', 'Monika', 'D', 'Singhal', 'MD', 'Mental Health', 'Psychiatry', '', NULL, 'O', '1208 E 3300 S', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8014831600', NULL, '1208 E 3300 S', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8014831600', '          ', 'UTMD', '', '', '0.00', '35.00', '0.00', 6, '2008-07-01', '2010-08-01', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1306938410', 0, 'N', 0, '2013-03-12', NULL, NULL, 0, 0, NULL, NULL),
('870524176', 'W11005689', 'W11005689', 'UTMH1', 'Comprehensive Psychological Services', 'Mark', 'D', 'Neuman', 'MD', 'Mental Health', 'Psychiatry', '', NULL, 'O', '1208 E 3300 S', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8014831600', NULL, '1208 E 3300 S', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8014831600', '          ', 'UTMD', '', '', '0.00', '35.00', '0.00', 6, '2008-07-01', '2012-04-30', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1194824961', 0, 'N', 0, '2013-03-12', NULL, NULL, 0, 0, NULL, NULL),
('870524176', 'W11005688', 'W11005688', 'UTMH1', 'Comprehensive Psychological Services', 'Nancy', 'E', 'Foster', 'APRN', 'Mental Health', 'Psychiatry', '', NULL, 'O', '1208 E 3300 S', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8014831600', NULL, '1208 E 3300 S', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8014831600', '          ', 'UTMA', '', '', '0.00', '35.00', '0.00', 6, '2008-07-01', '2010-03-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1194938316', 0, 'N', 0, '2013-03-12', NULL, NULL, 0, 0, NULL, NULL),
('870524176', 'W11005686', 'W11005686', 'UTMH1', 'Comprehensive Psychological Services', 'Susan', 'E', 'Hollenbeck', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '1208 E 3300 S', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8014831600', NULL, '1208 E 3300 S', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8014831600', '', 'UTMA', NULL, NULL, '0.00', '35.00', '0.00', 6, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1194762997', 0, 'N', 0, '2013-03-12', NULL, NULL, 0, 0, NULL, NULL),
('870524176', 'W11005685', 'W11005685', 'UTMH1', 'Comprehensive Psychological Services', 'Steven', 'A', 'Szykula', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '1208 E 3300 S', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8014831600', NULL, '1208 E 3300 S', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8014831600', '', 'UTPHD', '', '', '0.00', '35.00', '0.00', 6, '2008-07-01', '2012-04-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1942224829', 0, 'N', 0, '2014-05-01', NULL, NULL, 0, 0, NULL, NULL),
('870524176', 'W11005679', 'W11005679', 'UTMH1', 'Comprehensive Psychological Services', 'Paul', '', 'Stratton', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '1208 E 3300 S', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8014831600', NULL, '1208 E 3300 S', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8014831600', '          ', 'UTPHD', '', '', '0.00', '35.00', '0.00', 6, '2008-07-01', '2010-04-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1730122318', 0, 'N', 0, '2013-03-12', NULL, NULL, 0, 0, NULL, NULL),
('870524176', 'W11005684', 'W11005684', 'UTMH1', 'Comprehensive Psychological Services', 'Howard', 'G', 'Ingle', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '1208 E 3300 S', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8014831600', NULL, '1208 E 3300 S', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8014831600', '          ', 'UTMA', '', '', '0.00', '35.00', '0.00', 6, '2008-07-01', '2012-04-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1992854079', 0, 'N', 0, '2013-03-12', NULL, NULL, 0, 0, NULL, NULL),
('870524176', 'W11005682', 'W11005682', 'UTMH1', 'Comprehensive Psychological Services', 'Timothy', 'S', 'Enniss', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '1208 E 3300 S', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8014831600', NULL, '1208 E 3300 S', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8014831600', '', 'UTMA', '', '', '0.00', '35.00', '0.00', 6, '2008-07-01', '2012-04-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1750487864', 0, 'N', 0, '2014-05-08', NULL, NULL, 0, 0, NULL, NULL),
('870524176', 'W11005680', 'W11005680', 'UTMH1', 'Comprehensive Psychological Services', 'Michael', 'J', 'Bjornson', 'PHD', 'Psychology', '', '', NULL, 'O', '1208 E 3300 S', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8014831600', NULL, '1208 E 3300 S', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8014831600', '', 'UTPHD', NULL, NULL, '0.00', '35.00', '0.00', 6, '2008-07-01', '2008-12-15', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1558411025', 0, 'N', 0, '2014-04-14', NULL, NULL, 0, 0, NULL, NULL),
('870524176', 'W11005678', 'W11005678', 'UTMH1', 'Comprehensive Psychological Services', 'Kayleen', 'M', 'Fuller', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '1208 E 3300 S', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8014831600', NULL, '1208 E 3300 S', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8014831600', '          ', 'UTPHD', '', '', '0.00', '35.00', '0.00', 6, '2008-07-01', '2011-12-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1073552402', 0, 'N', 0, '2013-03-12', NULL, NULL, 0, 0, NULL, NULL),
('870524176', 'W11005677', 'W11005677', 'UTMH1', 'Comprehensive Psychological Services', 'Shannon', 'M', 'McQuade', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '1208 E 3300 S', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8014831600', NULL, '1208 E 3300 S', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8014831600', '          ', 'UTMA', '', '', '0.00', '35.00', '0.00', 6, '2008-07-01', '2012-04-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1053587824', 0, 'N', 0, '2013-03-12', NULL, NULL, 0, 0, NULL, NULL),
('870625250', 'W11005660', 'W11005660', 'UTMH1', 'Sundance Behavioral Resources ', 'Duane', 'R', 'Banks', 'MD', 'Mental Health', 'Psychiatry', '', NULL, 'O', '845 E 4800 S Ste 200', 'Murray', 'Salt Lake', 'UT', '84107', '8012649522', NULL, '845 E 4800 S Ste 200', 'Murray', 'Salt Lake', 'UT', '84107', '8012649522', '', 'MD-3', NULL, NULL, '0.00', '35.00', '0.00', 6, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1013092360', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('870625250', 'W11005663', 'W11005663', 'UTMH1', 'Sundance Behavioral Resources LLC', 'Rachel', 'A', 'Weir', 'MD', 'Mental Health', 'Psychiatry', 'Pediatric Psychiatry', NULL, 'O', '845 E 4800 S Ste 200', 'Murray', 'Salt Lake', 'UT', '84107', '8012649522', NULL, '845 E 4800 S Ste 200', 'Murray', 'Salt Lake', 'UT', '84107', '8012649522', '', 'MD-3', NULL, NULL, '0.00', '35.00', '0.00', 6, '2008-07-01', '2009-09-24', 0, 0, 0, 'University Health Care University Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1487779955', 0, 'N', 0, '2012-01-26', NULL, NULL, 0, 0, NULL, NULL),
('870625250', 'W11005667', 'W11005667', 'UTMH1', 'Sundance Behavioral Resources ', 'Dex', '', 'Whitehead', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '845 E 4800 S Ste 200', 'Murray', 'Salt Lake', 'UT', '84107', '8012649522', NULL, '845 E 4800 S Ste 200', 'Murray', 'Salt Lake', 'UT', '84107', '8012649522', '', 'MA', NULL, NULL, '0.00', '35.00', '0.00', 6, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1487721841', 0, 'N', 0, '2014-04-14', NULL, NULL, 0, 0, NULL, NULL),
('870625250', 'W11005661', 'W11005661', 'UTMH1', 'Sundance Behavioral Resources LLC', 'Sajid', '', 'Faizi', 'MD', 'Mental Health', 'Psychiatry', '', NULL, 'O', '845 E 4800 S Ste 200', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8012649522', NULL, '845 E 4800 S Ste 200', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8012649522', '', 'MD-3', NULL, NULL, '0.00', '35.00', '0.00', 6, '2008-07-01', '2008-08-28', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1659386357', 0, 'N', 0, '2013-08-14', NULL, NULL, 0, 0, NULL, NULL),
('870625250', 'W11005668', 'W11005668', 'UTMH1', 'Sundance Behavioral Resources ', 'Alison', '', 'Musso', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '845 E 4800 S Ste 200', 'Murray', 'Salt Lake', 'UT', '84107', '8012649522', NULL, '845 E 4800 S Ste 200', 'Murray', 'Salt Lake', 'UT', '84107', '8012649522', '', 'PHD', NULL, NULL, '0.00', '35.00', '0.00', 6, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1346230802', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('870212455', 'W11005615', 'W11005615', 'UTMH1', 'Family Counseling Center', 'Nicole', 'S', 'Turville', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '5250 S Commerce Dr Ste 250', 'Murray', 'Salt Lake', 'UT', '84107', '8012613500', NULL, '5250 S Commerce Dr Ste 250', 'Murray', 'Salt Lake', 'UT', '84107', '8012613500', '', 'UTMA', NULL, '', '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1568548378', 0, 'n', 0, '2014-07-07', NULL, NULL, 0, 0, NULL, NULL),
('870625250', 'W11005671', 'W11005671', 'UTMH1', 'Sundance Behavioral Resources ', 'Trudy', '', 'Bach-Whitehead', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '845 E 4800 S Ste 200', 'Murray', 'Salt Lake', 'UT', '84107', '8012649522', NULL, '845 E 4800 S Ste 200', 'Murray', 'Salt Lake', 'UT', '84107', '8012649522', '', 'MA', NULL, NULL, '0.00', '35.00', '0.00', 6, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1265529267', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('870625250', 'W11005666', 'W11005666', 'UTMH1', 'Sundance Behavioral Resources ', 'Cynthia', '', 'Kimberlin-Flanders', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '845 E 4800 S Ste 200', 'Murray', 'Salt Lake', 'UT', '84107', '8012649522', NULL, '845 E 4800 S Ste 200', 'Murray', 'Salt Lake', 'UT', '84107', '8012649522', '', 'MA', NULL, NULL, '0.00', '35.00', '0.00', 6, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1164588703', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('870625250', 'W11005662', 'W11005662', 'UTMH1', 'Sundance Behavioral Resources ', 'Peter', 'M', 'Loffler', 'MD', 'Mental Health', 'Psychiatry', '', NULL, 'O', '845 E 4800 S Ste 200', 'Murray', 'Salt Lake', 'UT', '84107', '8012649522', '', '845 E 4800 S Ste 200', 'Murray', 'Salt Lake', 'UT', '84107', '8012649522', '', 'MD-3', '', '', '0.00', '35.00', '0.00', 6, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1376605436', 0, 'N', 0, '2014-07-25', NULL, NULL, 0, 0, NULL, NULL),
('870625250', 'W11005670', 'W11005670', 'UTMH1', 'Sundance Behavioral Resources ', 'George', '', 'Brown', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '845 E 4800 S Ste 200', 'Murray', 'Salt Lake', 'UT', '84107', '8012649522', NULL, '845 E 4800 S Ste 200', 'Murray', 'Salt Lake', 'UT', '84107', '8012649522', '', 'PHD', NULL, NULL, '0.00', '35.00', '0.00', 6, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1790846137', 0, 'N', 0, '2011-11-21', NULL, NULL, 0, 0, NULL, NULL),
('870625250', 'W11005669', 'W11005669', 'UTMH1', 'Sundance Behavioral Resources ', 'Carolyn', '', 'Heninger', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '845 E 4800 S Ste 200', 'Murray', 'Salt Lake', 'UT', '84107', '8012649522', '', '845 E 4800 S Ste 200', 'Murray', 'Salt Lake', 'UT', '84107', '8012649522', '', 'MA', '', '', '0.00', '35.00', '0.00', 6, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1891864567', 0, 'N', 0, '2014-07-21', NULL, NULL, 0, 0, NULL, NULL),
('529582097', 'W11005673', 'W11005673', 'UTMH1', NULL, 'Robert', 'L', 'Halpin', 'LCSW', 'Mental Health', 'Social Worker', 'Marriage and Family Therapy', NULL, 'O', '151 E 5600 S Ste 110', 'Murray', 'Salt Lake', 'UT', '84107', '8012667858', NULL, '151 E 5600 S', 'Murray', 'Salt Lake', 'UT', '84107', NULL, NULL, 'UTMA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1720113046', 0, 'n', 0, '2008-06-29', NULL, NULL, 0, 0, NULL, NULL),
('412174570', 'W11005594', 'W11005594', 'UTMH1', 'Dynamic Play', 'Tamar', 'A', 'Prero', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '3191 S Valley St Ste 120', 'Salt Lake City', 'Salt Lake', 'UT', '84109', '8014033357', NULL, '3191 S Valley St Ste 120', 'Salt Lake City', 'Salt Lake', 'UT', '84109', '8014033357', '', 'UTMA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1144287632', 0, 'n', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('800036736', 'W11005591', 'W11005591', 'UTMH1', 'Pride Counseling Inc', 'Jerry', '', 'Buie', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '231 E 400 S Ste 208', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8015950666', NULL, '231 E 400 S Ste 208', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8015950666', '          ', 'UTMA', '', '', '0.00', '35.00', '0.00', 3, '2008-07-01', '2011-05-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1174599393', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('876114073', 'W11005645', 'W11005645', 'UTMH1', 'The Childrens Center', 'Laraine', '', 'Miner', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'B', '1855 E Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84112', '8019664251', NULL, '1855 E Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84112', '8019664251', '', 'UTMA', '', '', '0.00', '35.00', '0.00', 6, '2008-07-01', '2011-06-15', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1871571638', 0, 'Y', 0, '2014-05-06', NULL, NULL, 0, 0, NULL, NULL),
('876114073', 'W11005646', 'W11005646', 'UTMH1', 'The Childrens Center', 'LeAnne', 'H', 'Beale', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'B', '1855 E Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84112', '8019664251', NULL, '1855 E Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84112', '8019664251', '          ', 'UTPHD', '', '', '0.00', '35.00', '0.00', 6, '2008-07-01', '2011-06-15', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1407028525', 0, 'Y', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('876114073', 'W11005654', 'W11005654', 'UTMH1', 'The Childrens Center', 'Joel', '', 'Wendel', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', '1855 E Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84112', '8019664251', NULL, '1855 E Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84112', '8019664251', '          ', 'UTMA', '', '', '0.00', '35.00', '0.00', 6, '2008-07-01', '2009-10-15', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1508030453', 0, 'Y', 0, '2012-04-24', NULL, NULL, 0, 0, NULL, NULL),
('876114073', 'W11005649', 'W11005649', 'UTMH1', 'The Childrens Center', 'Eve', '', 'Smith', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '1855 E Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84112', '8015825534', NULL, '1855 E Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84112', '8015825534', '', 'UTMA', '', '', '0.00', '35.00', '0.00', 6, '2008-07-01', '2011-06-15', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1639107758', 0, 'N', 0, '2014-04-09', 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
('876114073', 'W11005651', 'W11005651', 'UTMH1', 'The Childrens Center', 'Suzanne', 'M', 'Fields', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', '1855 E Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84112', '8019664251', NULL, '1855 E Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84112', '8019664251', '', 'UTMA', '', '', '0.00', '35.00', '0.00', 6, '2008-07-01', '2011-06-15', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1093790552', 0, 'Y', 0, '2014-04-24', NULL, NULL, 0, 0, NULL, NULL),
('876114073', 'W11005652', 'W11005652', 'UTMH1', 'The Childrens Center', 'Katherine', '', 'Gardiner', 'LPC', 'Mental Health', '', '', NULL, 'O', '1855 E Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84112', '8019664251', NULL, '1855 E Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84112', '8019664251', '          ', 'UTMA', '', '', '0.00', '35.00', '0.00', 6, '2008-07-01', '2011-06-15', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1669408019', 0, 'N', 0, '2012-01-19', NULL, NULL, 0, 0, NULL, NULL),
('876114073', 'W11005656', 'W11005656', 'UTMH1', 'The Childrens Center', 'Nancy', '', 'Coyne', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', '1855 E Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84112', '8019664251', NULL, '1855 E Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84112', '8019664251', '', 'UTMA', '', '', '0.00', '35.00', '0.00', 6, '2008-07-01', '2011-06-15', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1912179375', 0, 'Y', 0, '2014-05-12', NULL, NULL, 0, 0, NULL, NULL),
('876114073', 'W11005657', 'W11005657', 'UTMH1', 'The Childrens Center', 'Kristina', 'F', 'Hindert', 'MD', 'Mental Health', 'Psychiatry', '', NULL, 'O', '1855 E Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84112', '8015825534', NULL, '1855 E Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84112', '8015825534', '', 'UTMD', '', '', '0.00', '35.00', '0.00', 6, '2008-07-01', '2011-06-15', 0, 0, 0, 'Pioneer Valley Hospital', '', '', '', 'HCFA|UB|', '1003873373', 0, 'N', 0, '2014-04-16', NULL, NULL, 0, 0, NULL, NULL),
('876114073', 'W11005648', 'W11005648', 'UTMH1', 'The Childrens Center', 'JENNIFER', 'E', 'NELSON', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '1855 E Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84112', '8019664251', NULL, '1855 E Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84112', '8019664251', '          ', 'UTMA', '', '', '0.00', '35.00', '0.00', 6, '2008-07-01', '2011-06-15', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1063600377', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('528545034', 'W11005701', 'W11005701', 'UTMH1', NULL, 'Carolyn', 'R', 'Sanders', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '2046 Murray Holladay Rd', 'Holladay', 'Salt Lake', 'UT', '84117', '8015419078', NULL, '2046 Murray Holladay Rd', 'Holladay', 'Salt Lake', 'UT', '84117', '8015419078', '', 'UTMA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1841268406', 0, 'n', 0, '2013-10-10', NULL, NULL, 0, 0, NULL, NULL),
('528545034', 'W11005702', 'W11005702', 'UTMH1', NULL, 'Carolyn', 'R', 'Sanders', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', '4835 Harper St', 'Holladay', 'Salt Lake', 'UT', '84117', '8015419078', NULL, '4835 Harper St', 'Holladay', 'Salt Lake', 'UT', '84117', '8015419078', '', 'UTMA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1841268406', 0, 'Y', 0, '2013-10-10', NULL, NULL, 0, 0, NULL, NULL),
('876114073', 'W11005644', 'W11005644', 'UTMH1', 'The Childrens Center', 'Laraine', '', 'Miner', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '5242 S 4820 W', 'Kearns', 'Salt Lake', 'UT', '84118', '8019664251', NULL, '5242 S 4820 W', 'Kearns', 'Salt Lake', 'UT', '84118', '8019664251', '', 'UTMA', NULL, NULL, '0.00', '35.00', '0.00', 6, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1871571638', 0, 'n', 0, '2014-05-06', NULL, NULL, 0, 0, NULL, NULL),
('876114073', 'W11005658', 'W11005658', 'UTMH1', 'The Childrens Center', 'Kristina', 'F', 'Hindert', 'MD', 'Mental Health', 'Psychiatry', '', NULL, 'O', '5242 So 4820 W', 'Kearns', 'Salt Lake', 'UT', '84118', '8019664251', NULL, '5242 So 4820 W', 'Kearns', 'Salt Lake', 'UT', '84118', '8019664251', '', 'UTMD', NULL, NULL, '0.00', '35.00', '0.00', 6, '2008-07-01', '2013-02-14', 0, 0, 0, 'Pioneer Valley Hospital', '', '', '', 'HCFA|UB|', '1003873373', 0, 'N', 0, '2014-04-16', NULL, NULL, 0, 0, NULL, NULL),
('876114073', 'W11005655', 'W11005655', 'UTMH1', 'The Childrens Center', 'Nancy', '', 'Coyne', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '5242 S 4820 W', 'Kearns', 'Salt Lake', 'UT', '84118', '8019664251', NULL, '5242 S 4820 W', 'Kearns', 'Salt Lake', 'UT', '84118', '8019664251', '', 'UTMA', NULL, '', '0.00', '35.00', '0.00', 6, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1912179375', 0, 'n', 0, '2014-05-12', NULL, NULL, 0, 0, NULL, NULL),
('876114073', 'W11005653', 'W11005653', 'UTMH1', 'The Childrens Center', 'Joel', '', 'Wendel', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '5242 S 4820 W', 'Kearns', 'Salt Lake', 'UT', '84118', '8019664251', NULL, '5242 S 4820 W', 'Kearns', 'Salt Lake', 'UT', '84118', '8019664251', '          ', 'UTMA', '', '', '0.00', '35.00', '0.00', 6, '2008-07-01', '2009-10-15', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1508030453', 0, 'N', 0, '2012-04-24', NULL, NULL, 0, 0, NULL, NULL),
('876114073', 'W11005650', 'W11005650', 'UTMH1', 'The Childrens Center', 'Suzanne', 'M', 'Fields', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '5242 S 4820 W', 'Kearns', 'Salt Lake', 'UT', '84118', '8019664251', NULL, '5242 S 4820 W', 'Kearns', 'Salt Lake', 'UT', '84118', '8019664251', '', 'UTMA', NULL, NULL, '0.00', '35.00', '0.00', 6, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1093790552', 0, 'n', 0, '2014-04-24', NULL, NULL, 0, 0, NULL, NULL),
('876114073', 'W11005647', 'W11005647', 'UTMH1', 'The Childrens Center', 'LeAnne', 'H', 'Beale', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '5242 S 4820 W', 'Kearns', 'Salt Lake', 'UT', '84118', '8019664251', NULL, '5242 S 4820 W', 'Kearns', 'Salt Lake', 'UT', '84118', '8019664251', '          ', 'UTPHD', '', '', '0.00', '35.00', '0.00', 6, '2008-07-01', '2012-04-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1407028525', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('870524176', 'W11005687', 'W11005687', 'UTMH1', 'Granger Medical Clinic', 'Susan', 'E', 'Hollenbeck', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '3725 W 4100 S', 'West Valley', 'Salt Lake', 'UT', '84120', '8019653759', NULL, '3725 W 4100 S', 'West Valley', 'Salt Lake', 'UT', '84120', '8019653759', '          ', 'UTMA', '', '', '0.00', '35.00', '0.00', 6, '2008-07-01', '2011-11-20', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1194762997', 0, 'N', 0, '2013-03-12', NULL, NULL, 0, 0, NULL, NULL),
('566641446', 'W11005613', 'W11005613', 'UTMH1', NULL, 'Sheryl', 'L', 'Ginsberg', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '1343 S 1100 E', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8018654618', NULL, '1343 S 1100 E', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8018654618', '', 'UTMA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1982679742', 0, 'n', 0, '2012-06-29', NULL, NULL, 0, 0, NULL, NULL),
('566641446', 'W11005614', 'W11005614', 'UTMH1', NULL, 'Sheryl', 'L', 'Ginsberg', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', 'PO Box 9', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8018654618', NULL, 'PO Box 9', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8018654618', '', 'UTMA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1982679742', 0, 'Y', 0, '2012-06-29', NULL, NULL, 0, 0, NULL, NULL),
('529601121', 'W11005637', 'W11005637', 'UTMH1', 'Associated Psychotherapists', 'John', 'C', 'Christensen', 'LMFT', 'Mental Health', 'Marriage and Family Therapy', '', NULL, 'O', '120 N Main', 'Brigham City', 'Box Elder', 'UT', '84302', '4357232881', '4357342719', '120 N Main', 'Brigham City', 'Box Elder', 'UT', '84302', '4357232881', '4357342719', 'MA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1992877104', 0, 'N', 0, '2011-10-03', NULL, NULL, 0, 0, NULL, NULL),
('208351371', 'W11005639', 'W11005639', 'UTMH1', 'Associated Psychotherapists', 'Jason', 'J', 'Williams', 'LMFT', 'Mental Health', 'Marriage and Family Therapy', '', NULL, 'O', '120 N Main', 'Brigham City', 'Box Elder', 'UT', '84302', '4357232881', '4357342719', '120 N Main', 'Brigham City', 'Box Elder', 'UT', '84302', '4357232881', '4357342719', 'UTMA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1104908482', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('528459481', 'W11005636', 'W11005636', 'UTMH1', 'Associated Psychotherapists', 'Diana', 'S', 'Ayotte', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '120 N Main', 'Brigham City', 'Box Elder', 'UT', '84302', '4357232881', '4357342719', '120 N Main', 'Brigham City', 'Box Elder', 'UT', '84302', '4357232881', '4357342719', 'UTMA', '', '', '0.00', '35.00', '0.00', 3, '2008-07-01', '2011-01-11', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1326110412', 0, 'N', 0, '2014-05-08', NULL, NULL, 0, 0, NULL, NULL),
('870633050', 'W11005638', 'W11005638', 'UTMH1', 'Associated Psychotherapists', 'John', 'W', 'Arrington', 'LMFT', 'Mental Health', 'Marriage and Family Therapy', '', NULL, 'O', '120 N Main', 'Brigham City', 'Box Elder', 'UT', '84302', '4357232881', '4357342719', '120 N Main', 'Brigham City', 'Box Elder', 'UT', '84302', '4357232881', '4357342719', 'UTMA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1730251828', 0, 'N', 0, '2013-10-02', NULL, NULL, 0, 0, NULL, NULL),
('870678064', 'W11005629', 'W11005629', 'UTMH1', 'Axis-One Inc', 'Allison', 'E', 'Martinez', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '53 N Tremont St', 'Tremonton', 'Box Elder', 'UT', '84337', '4352576999', NULL, '53 N Tremont St', 'Tremonton', 'Box Elder', 'UT', '84337', '4352576999', '          ', 'MA', '', '', '0.00', '35.00', '0.00', 6, '2008-07-01', '2011-08-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1568659332', 0, 'N', 0, '2013-03-12', NULL, NULL, 0, 0, NULL, NULL),
('870678064', 'W11005631', 'W11005631', 'UTMH1', 'Axis-One Inc', 'Larry', 'K', 'Jacobson', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '53 N Tremont St', 'Tremonton', 'Box Elder', 'UT', '84337', '4352576999', NULL, '53 N Tremont St', 'Tremonton', 'Box Elder', 'UT', '84337', '4352576999', '          ', 'MA', '', '', '0.00', '35.00', '0.00', 6, '2008-07-01', '2011-08-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1124127766', 0, 'N', 0, '2011-05-11', NULL, NULL, 0, 0, NULL, NULL),
('870678064', 'W11005626', 'W11005626', 'UTMH1', 'Axis-One Inc', 'B', 'S', 'Harmon', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '53 N Tremont St', 'Tremonton', 'Box Elder', 'UT', '84337', '4352576999', NULL, '53 N Tremont St', 'Tremonton', 'Box Elder', 'UT', '84337', '4352576999', '', 'MA', '', '', '0.00', '35.00', '0.00', 6, '2008-07-01', '2011-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1700882172', 0, 'N', 0, '2014-05-06', NULL, NULL, 0, 0, NULL, NULL),
('870678064', 'W11005623', 'W11005623', 'UTMH1', 'Axis-One Inc', 'Paula', '', 'Sever', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '53 N Tremont St', 'Tremonton', 'Box Elder', 'UT', '84337', '4352576999', NULL, '53 N Tremont St', 'Tremonton', 'Box Elder', 'UT', '84337', '4352576999', '          ', 'MA', '', '', '0.00', '35.00', '0.00', 6, '2008-07-01', '2011-08-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1154300234', 0, 'N', 0, '2011-05-11', NULL, NULL, 0, 0, NULL, NULL),
('870678064', 'W11005619', 'W11005619', 'UTMH1', 'Axis-One Inc', 'Theresa', 'S', 'Kay', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '53 N Tremont St', 'Tremonton', 'Box Elder', 'UT', '84337', '4352576999', NULL, '53 N Tremont St', 'Tremonton', 'Box Elder', 'UT', '84337', '4352576999', '', 'PHD', NULL, NULL, '0.00', '35.00', '0.00', 6, '2008-07-01', '2010-03-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1053466169', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('870678064', 'W11005620', 'W11005620', 'UTMH1', 'Axis-One Inc', 'June', 'C', 'Singletary', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '53 N Tremont St', 'Tremonton', 'Box Elder', 'UT', '84337', '4352576999', NULL, '53 N Tremont St', 'Tremonton', 'Box Elder', 'UT', '84337', '4352576999', '          ', 'MA', '', '', '0.00', '35.00', '0.00', 6, '2008-07-01', '2011-08-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1396891420', 0, 'N', 0, '2011-05-11', NULL, NULL, 0, 0, NULL, NULL),
('870678064', 'W11005624', 'W11005624', 'UTMH1', 'Axis-One Inc', 'Cheryl', '', 'Kelstrom-Smith', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '53 N Tremont St', 'Tremonton', 'Box Elder', 'UT', '84337', '4352576999', NULL, '53 N Tremont St', 'Tremonton', 'Box Elder', 'UT', '84337', '4352576999', '', 'MA', '', '', '0.00', '35.00', '0.00', 6, '2008-07-01', '2011-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1740335850', 0, 'N', 0, '2014-05-08', NULL, NULL, 0, 0, NULL, NULL),
('258112241', 'W11005616', 'W11005616', 'UTMH1', 'The Crystal Cocoon Center', 'Robin', 'P', 'Naniex', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '5582 S 1750 E', 'So Ogden', 'Weber', 'UT', '84403', '8014768885', NULL, '5582 S 1750 E', 'So Ogden', 'Weber', 'UT', '84403', '8014768885', '          ', 'UTMA', '', '', '0.00', '35.00', '0.00', 3, '2008-07-01', '2011-05-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1982878245', 0, 'N', 0, '2011-05-11', NULL, NULL, 0, 0, NULL, NULL),
('870271413', 'W11005632', 'W11005632', 'UTMH1', 'Family Counseling Service', 'Carol', 'Ann', 'Anglesey', 'LCSW', 'Mental Health', 'Social Worker', NULL, NULL, 'O', '3518 Washington Blvd', 'Ogden', 'Weber', 'UT', '84403', '8013991600', NULL, '3518 Washington Blvd', 'Ogden', 'Weber', 'UT', '84403', NULL, NULL, 'UTMA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2008-11-21', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000003045', 0, 'n', 0, '2008-06-29', NULL, NULL, 0, 0, NULL, NULL),
('870678064', 'W11005630', 'W11005630', 'UTMH1', 'Axis-One Inc', 'Larry', 'K', 'Jacobson', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '5149 S 1500 W', 'Riverdale', 'Weber', 'UT', '84405', '8014750402', NULL, '5149 S 1500 W', 'Riverdale', 'Weber', 'UT', '84405', '8014750402', '          ', 'MA', '', '', '0.00', '35.00', '0.00', 6, '2008-07-01', '2011-08-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1124127766', 0, 'N', 0, '2011-05-11', NULL, NULL, 0, 0, NULL, NULL),
('870678064', 'W11005618', 'W11005618', 'UTMH1', 'Axis-One Inc', 'Theresa', 'S', 'Kay', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '5149 S 1500 W', 'Riverdale', 'Weber', 'UT', '84405', '8014750402', NULL, '5149 S 1500 W', 'Riverdale', 'Weber', 'UT', '84405', '8014750402', '', 'PHD', NULL, NULL, '0.00', '35.00', '0.00', 6, '2008-07-01', '2010-03-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1053466169', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('870678064', 'W11005625', 'W11005625', 'UTMH1', 'Axis-One Inc', 'Cheryl', '', 'Kelstrom-Smith', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '5149 S 1500 W', 'Riverdale', 'Weber', 'UT', '84405', '8014750402', NULL, '5149 S 1500 W', 'Riverdale', 'Weber', 'UT', '84405', '8014750402', '', 'MA', '', '', '0.00', '35.00', '0.00', 6, '2008-07-01', '2011-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1740335850', 0, 'N', 0, '2014-05-08', NULL, NULL, 0, 0, NULL, NULL),
('870678064', 'W11005628', 'W11005628', 'UTMH1', 'Axis-One Inc', 'Allison', 'E', 'Martinez', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '5149 S 1500 W', 'Riverdale', 'Weber', 'UT', '84405', '8014750402', NULL, '5149 S 1500 W', 'Riverdale', 'Weber', 'UT', '84405', '8014750402', '          ', 'MA', '', '', '0.00', '35.00', '0.00', 6, '2008-07-01', '2011-08-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1568659332', 0, 'N', 0, '2013-03-12', NULL, NULL, 0, 0, NULL, NULL),
('870678064', 'W11005627', 'W11005627', 'UTMH1', 'Axis-One Inc', 'B', 'S', 'Harmon', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '5149 S 1500 W', 'Riverdale', 'Weber', 'UT', '84405', '8014750402', NULL, '5149 S 1500 W', 'Riverdale', 'Weber', 'UT', '84405', '8014750402', '', 'MA', '', '', '0.00', '35.00', '0.00', 6, '2008-07-01', '2011-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1700882172', 0, 'N', 0, '2014-05-06', NULL, NULL, 0, 0, NULL, NULL),
('870678064', 'W11005621', 'W11005621', 'UTMH1', 'Axis-One Inc', 'June', 'C', 'Singletary', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '5149 S 1500 W', 'Riverdale', 'Weber', 'UT', '84405', '8014750402', NULL, '5149 S 1500 W', 'Riverdale', 'Weber', 'UT', '84405', '8014750402', '          ', 'MA', '', '', '0.00', '35.00', '0.00', 6, '2008-07-01', '2011-08-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1396891420', 0, 'N', 0, '2011-05-11', NULL, NULL, 0, 0, NULL, NULL),
('870678064', 'W11005622', 'W11005622', 'UTMH1', 'Axis-One Inc', 'Paula', '', 'Sever', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '5149 S 1500 W', 'Riverdale', 'Weber', 'UT', '84405', '8014750402', NULL, '5149 S 1500 W', 'Riverdale', 'Weber', 'UT', '84405', '8014750402', '          ', 'MA', '', '', '0.00', '35.00', '0.00', 6, '2008-07-01', '2011-08-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1154300234', 0, 'N', 0, '2011-05-11', NULL, NULL, 0, 0, NULL, NULL),
('876114073', 'W11005659', 'W11005659', 'UTMH1', 'The Childrens Center', 'Douglas', '', 'Goldsmith', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '1855 E Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84112', '8015825534', NULL, '1855 E Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84112', '8015825534', '', 'UTPHD', '', '', '0.00', '35.00', '0.00', 6, '2008-07-01', '2011-06-15', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1376570820', 0, 'N', 0, '2014-05-01', NULL, NULL, 0, 0, NULL, NULL),
('258112241', 'W11005617', 'W11005617', 'UTMH1', 'Alternate Billing', 'Robin', 'P', 'Naniex', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'B', 'PO Box 150173', 'Ogden', 'Weber', 'UT', '84415', '8014790601', NULL, 'PO Box 150173', 'Ogden', 'Weber', 'UT', '84415', '8014790601', '          ', 'UTMA', '', '', '0.00', '35.00', '0.00', 3, '2008-07-01', '2011-05-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1982878245', 0, 'Y', 0, '2011-05-11', NULL, NULL, 0, 0, NULL, NULL),
('421731029', 'W11005711', 'W11005711', 'UTMH1', 'Hearthstone Counseling PLLC', 'Cindy', 'L', 'Lee', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', '1379 N 1350 W', 'Provo', 'Utah', 'UT', '84604', '8017879229', NULL, '1379 N 1350 W', 'Provo', 'Utah', 'UT', '84604', '8017879229', '', 'UTMA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1346201894', 0, 'Y', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('870648301', 'W11005707', 'W11005707', 'UTMH1', 'LDS Family Services', 'Susan', 'M', 'Reynolds', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'B', '1190 N 900 E', 'Provo', 'Utah', 'UT', '84604', '8014227620', NULL, '1190 N 900 E', 'Provo', 'Utah', 'UT', '84604', '8014227620', '', 'UTMA', NULL, '', '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1982751301', 0, 'Y', 0, '2014-05-08', NULL, NULL, 0, 0, NULL, NULL),
('421731029', 'W11005712', 'W11005712', 'UTMH1', 'Hearthstone Counseling PLLC', 'Cindy', 'L', 'Lee', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '286 S 600 E', 'Provo', 'Utah', 'UT', '84606', '8013778222', NULL, '286 S 600 E', 'Provo', 'Utah', 'UT', '84606', '8013778222', '', 'UTMA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1346201894', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('870660020', 'W11005706', 'W11005706', 'UTMH1', 'Rocky Mountain Behavioral Consultants', 'Kevin', 'V', 'Knutson', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '45 N State St Ste 3', 'Salina', 'Sevier', 'UT', '84654', '4359795218', NULL, '45 N State St Ste 3', 'Salina', 'Sevier', 'UT', '84654', '4359795218', '', 'UTMA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1326254731', 0, 'n', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('870660020', 'W11005705', 'W11005705', 'UTMH1', 'Rocky Mountain Behavioral Consultants', 'Brandon', 'M', 'Burr', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '45 N State St Ste 3', 'Salina', 'Sevier', 'UT', '84654', '4359795218', NULL, '45 N State St Ste 3', 'Salina', 'Sevier', 'UT', '84654', '4359795218', '', 'UTMA', NULL, '', '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1225191984', 0, 'n', 0, '2014-07-18', NULL, NULL, 0, 0, NULL, NULL),
('870660020', 'W11005703', 'W11005703', 'UTMH1', 'Rocky Mountain Behavioral Consultants', 'Kevin', 'V', 'Knutson', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'B', 'PO Box 771', 'Richfield', 'Sevier', 'UT', '84701', '4359795218', NULL, 'PO Box 771', 'Richfield', 'Sevier', 'UT', '84701', '4359795218', '', 'UTMA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1326254731', 0, 'Y', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('870660020', 'W11005704', 'W11005704', 'UTMH1', 'Rocky Mountain Behavioral Consultants', 'Brandon', 'M', 'Burr', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', 'PO Box 771', 'Richfield', 'Sevier', 'UT', '84701', '4359795218', NULL, 'PO Box 771', 'Richfield', 'Sevier', 'UT', '84701', '4359795218', '', 'UTMA', NULL, '', '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1225191984', 0, 'Y', 0, '2014-07-18', NULL, NULL, 0, 0, NULL, NULL),
('202839360', 'W11005598', 'W11005598', 'UTMH1', 'East Wing Associates', 'Sarah', 'L', 'Bacon', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', 'PO Box 178', 'Kanab', 'Kane', 'UT', '84741', '4356442735', NULL, 'PO Box 178', 'Kanab', 'Kane', 'UT', '84741', '4356442735', '          ', 'UTMA', '', '', '0.00', '35.00', '0.00', 3, '2009-09-28', '2012-06-28', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000003059', 0, 'Y', 0, '2012-07-02', NULL, NULL, 0, 0, NULL, NULL),
('202839360', 'W11005599', 'W11005599', 'UTMH1', 'East Wing Associates PLLC', 'Jaime', 'L', 'Bacon', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', 'PO Box 178', 'Kanab', 'Kane', 'UT', '84741', '4356442735', NULL, 'PO Box 178', 'Kanab', 'Kane', 'UT', '84741', '4356442735', '', 'UTMA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1376758342', 0, 'Y', 0, '2014-01-08', NULL, NULL, 0, 0, NULL, NULL),
('202839360', 'W11005600', 'W11005600', 'UTMH1', 'East Wing Associates', 'Sarah', 'L', 'Bacon', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '329 S 350 E Ste 2', 'Kanab', 'Kane', 'UT', '84741', '4356442735', NULL, '329 S 350 E Ste 2', 'Kanab', 'Kane', 'UT', '84741', '4356442735', '          ', 'UTMA', '', '', '0.00', '35.00', '0.00', 3, '2009-09-28', '2012-06-28', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000003059', 0, 'N', 0, '2012-07-02', NULL, NULL, 0, 0, NULL, NULL),
('202839360', 'W11005601', 'W11005601', 'UTMH1', 'East Wing Associates PLLC', 'Jaime', 'L', 'Bacon', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '220 W 300 N Ste 4', 'Kanab', 'Kane', 'UT', '84741', '4356442735', NULL, '220 W 300 N Ste 4', 'Kanab', 'Kane', 'UT', '84741', '4356442735', '', 'UTMA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1376758342', 0, 'N', 0, '2014-01-08', NULL, NULL, 0, 0, NULL, NULL),
('593804126', 'W11005596', 'W11005596', 'UTMH1', 'Community counseling Center of Southern Utah', 'Chris', 'A', 'Doss', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '168 N 100 E Ste 204', 'St George', 'Washington', 'UT', '84770', '4356524142', NULL, '168 N 100 E Ste 204', 'St George', 'Washington', 'UT', '84770', '4356524142', '', 'UTMA', NULL, '', '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1861682494', 0, 'n', 0, '2014-06-23', NULL, NULL, 0, 0, NULL, NULL),
('593804126', 'W11005597', 'W11005597', 'UTMH1', 'Community counseling Center of Southern Utah', 'Chris', 'A', 'Doss', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', 'PO Box 1277', 'St George', 'Washington', 'UT', '84771', '4356524142', NULL, 'PO Box 1277', 'St George', 'Washington', 'UT', '84771', '4356524142', '', 'UTMA', NULL, '', '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1861682494', 0, 'Y', 0, '2014-06-23', NULL, NULL, 0, 0, NULL, NULL),
('870571510', 'W11005736', 'W11005736', 'UT01', 'Layton Ambulatory Anesthesia', '', '', 'Layton Ambulatory Anesthesia', 'Group', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 160354', 'Clearfield', 'Davis', 'UT', '84016', '8017748992', '8015250347', 'PO Box 160354', 'Clearfield', 'Davis', 'UT', '84016', '8017748992', '8015250347', '', '', '1000', '49.50', '0.00', '0.00', 3, '2008-07-01', '2012-06-30', 0, 12, 0, '', '', '', '', 'HCFA|UB|', '1013950286', 0, 'Y', 0, '2012-06-22', NULL, NULL, 0, 0, NULL, NULL),
('870571510', 'W11005734', 'W11005734', 'UT01', 'Layton Ambulatory Anesthesia', 'Blake', 'J', 'Brown', 'MD', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 160354', 'Clearfield', 'Davis', 'UT', '84016', '8017748992', '8015250347', 'PO Box 160354', 'Clearfield', 'Davis', 'UT', '84016', '8017748992', '8015250347', '', '', '1000', '49.50', '0.00', '0.00', 3, '2008-07-01', '2012-06-30', 0, 12, 0, '', '', '', '', 'HCFA|UB|', '1427060912', 0, 'Y', 0, '2012-06-21', NULL, NULL, 0, 0, NULL, NULL),
('870571510', 'W11005733', 'W11005733', 'UT01', 'Layton Ambulatory Anesthesia', 'Robert', 'M', 'Sorensen', 'MD', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 160354', 'Clearfield', 'Davis', 'UT', '84016', '8017748992', '8015250347', 'PO Box 160354', 'Clearfield', 'Davis', 'UT', '84016', '8017748992', '8015250347', '', '', '1000', '49.50', '0.00', '0.00', 3, '2008-07-01', '2012-06-30', 0, 12, 0, '', '', '', '', 'HCFA|UB|', '1609852243', 0, 'Y', 0, '2012-06-22', NULL, NULL, 0, 0, NULL, NULL),
('870571510', 'W11005732', 'W11005732', 'UT01', 'Layton Ambulatory Anesthesia', 'Christopher', 'G', 'Reveley', 'MD', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 160354', 'Clearfield', 'Davis', 'UT', '84016', '8017748992', '8015250347', 'PO Box 160354', 'Clearfield', 'Davis', 'UT', '84016', '8017748992', '8015250347', '', '', '1000', '49.50', '0.00', '0.00', 3, '2008-07-01', '2012-06-30', 0, 12, 0, '', '', '', '', 'HCFA|UB|', '1144206723', 0, 'Y', 0, '2012-06-22', NULL, NULL, 0, 0, NULL, NULL),
('870571510', 'W11005731', 'W11005731', 'UT01', 'Layton Ambulatory Anesthesia', 'Clark', 'E', 'Petersen', 'MD', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 160354', 'Clearfield', 'Davis', 'UT', '84016', '8017748992', '8015250347', 'PO Box 160354', 'Clearfield', 'Davis', 'UT', '84016', '8017748992', '8015250347', '', '', '1000', '49.50', '0.00', '0.00', 3, '2008-07-01', '2012-06-30', 0, 12, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1275519894', 0, 'Y', 0, '2012-06-22', NULL, NULL, 0, 0, NULL, NULL),
('870571510', 'W11005730', 'W11005730', 'UT01', 'Layton Ambulatory Anesthesia', 'Earl', 'K', 'Leeman', 'MD', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 160354', 'Clearfield', 'Davis', 'UT', '84016', '8017748992', '8015250347', 'PO Box 160354', 'Clearfield', 'Davis', 'UT', '84016', '8017748992', '8015250347', '', '', '1000', '49.50', '0.00', '0.00', 3, '2008-07-01', '2012-06-30', 0, 12, 0, '', '', '', '', 'HCFA|UB|', '1831174333', 0, 'Y', 0, '2012-06-22', NULL, NULL, 0, 0, NULL, NULL),
('870571510', 'W11005729', 'W11005729', 'UT01', 'Layton Ambulatory Anesthesia', 'Bryan', 'G', 'Holbrook', 'MD', 'Pain Management', 'Anesthesiology', '', NULL, 'B', 'PO Box 160354', 'Clearfield', 'Davis', 'UT', '84016', '8017748992', '8015250347', 'PO Box 160354', 'Clearfield', 'Davis', 'UT', '84016', '8017748992', '8015250347', '', '', '1000', '49.50', '0.00', '0.00', 3, '2008-07-01', '2012-06-30', 0, 12, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1427034081', 0, 'Y', 0, '2012-06-21', NULL, NULL, 0, 0, NULL, NULL),
('529676822', 'W11005727', 'W11005727', 'UTMH1', 'Preferred Family Clinic', 'Summer', 'A', 'Morris', 'LPC', 'Mental Health', 'Counseling', NULL, NULL, 'O', '584 E 12300 S Ste 1', 'Draper', 'Salt Lake', 'UT', '84020', '8017482192', NULL, '1355 N University Ave', 'Provo', 'Uintah', 'UT', '84604', NULL, NULL, 'MA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1578767737', 0, 'n', 0, '2008-06-30', NULL, NULL, 0, 0, NULL, NULL),
('870571510', 'W11005728', 'W11005728', 'UT01', 'Layton Ambulatory Anesthesia', '', '', 'Layton Ambulatory Anesthesia', 'Group', 'Anesthesiology', '', '', NULL, 'O', '1544 W Antelope Dr', 'Layton', 'Davis', 'UT', '84041', '8017748992', '8015250347', '1544 W Antelope Dr', 'Layton', 'Davis', 'UT', '84041', '8017748992', '8015250347', '', '', '1000', '49.50', '0.00', '0.00', 3, '2008-07-01', '2012-06-30', 0, 12, 0, '', '', '', '', 'HCFA|UB|', '1013950286', 0, 'Y', 0, '2012-06-22', NULL, NULL, 0, 0, NULL, NULL),
('160405127', 'W11005735', 'W11005735', 'UTMH1', NULL, 'Michael', 'A', 'Kligman', 'MD', 'Mental Health', 'Psychiatry', '', NULL, 'O', '650 S Komas Dr Ste 207E', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015857831', NULL, '650 S Komas Dr Ste 207E', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015857831', '', 'MD-2', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1679615918', 0, 'n', 0, '2011-09-21', NULL, NULL, 0, 0, NULL, NULL),
('331078261', 'W11005739', 'W11005739', 'ID01', 'Saint Alphonsus Physicians PA', 'Jeffrey', '', 'Shilt', 'MD; General, Pediatrics', 'Pediatric Orthopedic Surgery', NULL, NULL, NULL, 'O', '6500 W Emerald', 'Boise', 'Ada', 'ID', '83704', '2083770777', NULL, '6500 W Emerald', 'Boise', 'Ada', 'ID', '83704', '2083770777', '          ', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 3, '2008-07-01', '2012-12-26', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1730165366', 0, 'N', 0, '2013-08-21', NULL, NULL, 0, 0, NULL, NULL),
('331078261', 'W11005740', 'W11005740', 'ID01', 'Saint Alphonsus Physicians PA', 'Jeffrey', '', 'Shilt', 'MD; General, Pediatrics', 'Pediatric Orthopedic Surgery', NULL, NULL, NULL, 'B', '999 N Curtis Ste 407', 'Boise', 'Ada', 'ID', '83706', '2083770777', NULL, '999 N Curtis Ste 407', 'Boise', 'Ada', 'ID', '83706', '2083770777', '          ', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 3, '2008-07-01', '2010-08-01', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1730165366', 0, 'Y', 0, '2013-08-21', NULL, NULL, 43.6132, -116.255, NULL, NULL),
('331078261', 'W11005741', 'W11005741', 'ID01', 'Saint Alphonsus Physicians PA', 'Jeffrey', '', 'Shilt', 'MD; General, Pediatrics', 'Pediatric Orthopedic Surgery', NULL, NULL, NULL, 'B', '1055 N Curtis', 'Boise', 'Ada', 'ID', '83706', '2083770777', NULL, '1055 N Curtis', 'Boise', 'Ada', 'ID', '83706', '2083770777', '          ', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 3, '2008-07-01', '2010-08-01', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1730165366', 0, 'Y', 0, '2013-08-21', NULL, NULL, 43.6127, -116.254, NULL, NULL),
('043115329', 'W11005738', 'W11005738', 'ID01', 'Critical Care Systems', '', '', 'Critical Care Systems ', 'GROUP', 'Infusion Agency', NULL, NULL, NULL, 'O', '12301 W Explorer Dr Ste 126', 'Boise', 'Ada', 'ID', '83713', '2083228868', NULL, '12301 W Explorer Dr Ste 126', 'Boise', 'Ada', 'ID', '83713', '2083228868', '', '', NULL, '1001', '0.00', '100.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1588692164', 0, 'N', 0, '2012-02-13', NULL, NULL, 0, 0, NULL, NULL),
('870623917', 'W11005749', 'W11005749', 'UTMH1', NULL, 'Barbara', '', 'Morrell-Hughes', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '1580 W Antelope Dr Ste 280', 'Layton', 'Davis', 'UT', '84041', '8017261388', NULL, '1580 W Antelope Dr Ste 280', 'Layton', 'Davis', 'UT', '84041', '8017261388', '', 'UTMA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, 'Davis Hospital', '', '', '', 'HCFA|UB|', '1558415489', 0, 'n', 0, '2011-09-21', NULL, NULL, 0, 0, NULL, NULL),
('870621824', 'W11005759', 'W11005759', 'UTMH1', 'Intermountain Center for Cognitive Therapy', 'Donna', 'E', 'Castleton', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '560 S State Ste G1', 'Orem', 'Utah', 'UT', '84058', '8018028608', NULL, '560 S State Ste G1', 'Orem', 'Utah', 'UT', '84058', '8018028608', '', 'UTMA', NULL, NULL, '0.00', '35.00', '0.00', 6, '2008-07-01', '2008-07-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1598809642', 0, 'N', 0, '2014-05-06', NULL, NULL, 0, 0, NULL, NULL),
('870621824', 'W11005760', 'W11005760', 'UTMH1', 'Intermountain Center for Cognitive Therapy', 'Nancy', 'L', 'Belliston', 'LCSW', 'Mental Health', 'Social Worker', 'Counseling', NULL, 'O', '560 S State Ste G1', 'Orem', 'Utah', 'UT', '84058', '8018028608', NULL, '560 S State Ste G1', 'Orem', 'Utah', 'UT', '84058', '8018028608', '', 'UTMA', '', '', '0.00', '35.00', '0.00', 6, '2008-07-01', '2008-07-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1841468147', 0, 'Y', 0, '2014-05-16', NULL, NULL, 0, 0, NULL, NULL),
('111111111', 'RX0000004', 'RX0000004', 'HDRX', 'WAL-MART PHARMACY', NULL, NULL, 'WAL-MART PHARMACY', NULL, 'Pharmacy', NULL, NULL, NULL, 'O', '2470 W PULLMAN RD', 'MOSCOW', 'Latah', 'ID', '83843', '2088821344', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1881961381', 0, 'N', 0, '2012-10-02', NULL, NULL, 0, 0, NULL, NULL),
('111111111', 'RX0000003', 'RX0000003', 'HDRX', 'WAL-MART PHARMACY', NULL, NULL, 'WAL-MART PHARMACY', NULL, 'Pharmacy', NULL, NULL, NULL, 'O', '550 W HONEYSUCKLE AVE', 'HAYDEN', 'Kootenai', 'ID', '83835', '2082094081', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1730493834', 0, 'N', 0, '2012-10-02', NULL, NULL, 0, 0, NULL, NULL),
('870621824', 'W11005758', 'W11005758', 'UTMH1', 'Intermountain Center for Cognitive Therapy', 'Donna', 'E', 'Castleton', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '111 E 5600 S Ste 318', 'Murray', 'Salt Lake', 'UT', '84107', '8012682887', NULL, '111 E 5600 S Ste 318', 'Murray', 'Salt Lake', 'UT', '84107', '8012682887', '', 'UTMA', NULL, NULL, '0.00', '35.00', '0.00', 6, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1598809642', 0, 'N', 0, '2014-05-06', NULL, NULL, 0, 0, NULL, NULL),
('870621824', 'W11005757', 'W11005757', 'UTMH1', 'Intermountain Center for Cognitive Therapy', 'Nancy', 'L', 'Belliston', 'LCSW', 'Mental Health', 'Social Worker', 'Counseling', NULL, 'o', '111 E 5600 S Ste 318', 'Murray', 'Salt Lake', 'UT', '84107', '8012682887', NULL, '111 E 5600 S Ste 318', 'Murray', 'Salt Lake', 'UT', '84107', '8012682887', '', 'UTMA', NULL, '', '0.00', '35.00', '0.00', 6, '2008-07-01', '2009-03-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1841468147', 0, 'n', 0, '2014-05-16', NULL, NULL, 0, 0, NULL, NULL),
('870212455', 'W11005753', 'W11005753', 'UTMH1', 'Family Counseling Center', 'Martin', 'T', 'O''Donnell', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '5250 S Commerce Dr Ste 250', 'Murray', 'Salt Lake', 'UT', '84107', '8012613500', NULL, '5250 S Commerce Dr', 'Murray', 'Salt Lake', 'UT', '84107', NULL, NULL, 'UTMA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1982774832', 0, 'n', 0, '2011-08-25', NULL, NULL, 0, 0, NULL, NULL),
('111111111', 'RX0000002', 'RX0000002', 'HDRX', 'WAL-MART PHARMACY', NULL, NULL, 'WAL-MART PHARMACY', NULL, 'Pharmacy', NULL, NULL, NULL, 'O', '6405 W POINTE PARKWAY', 'POST FALLS', 'Kootenai', 'ID', '83854', '2087774214', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '100.00', NULL, 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1134430713', 0, 'N', 0, '2012-10-02', NULL, NULL, 0, 0, NULL, NULL),
('870560190', 'W11005752', 'W11005752', 'UTMH1', 'Utah Groups', 'Beth', '', 'Hughes', 'LMFT', 'Mental Health', 'Marriage & Family Therapy', '', NULL, 'O', '1255 E 3900 S Ste 107', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012667435', NULL, '1255 E 3900 S Ste 107', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012667435', '', 'UTMA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1033289301', 0, 'n', 0, '2013-08-01', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11005744', 'W11005744', 'UTIHCPHY', 'Logan Radiation Oncology', 'Gary', 'L', 'Whipple', 'MD', 'Radiation Oncology', NULL, NULL, NULL, 'B', 'PO Box 27128', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '8013877400', NULL, NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, 'USTDMULT', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 8, '2008-07-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1083621361', 0, 'Y', 0, '2008-07-29', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11005748', 'W11005748', 'UTIHCPHY', 'Logan Radiation Oncology', 'Leslye', 'L', 'Ingersoll', 'MD', 'Radiation Oncology', NULL, NULL, NULL, 'B', 'PO Box 27128', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '8014517634', NULL, NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, 'USTDMULT', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 8, '2008-07-01', '2008-11-05', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1568475846', 0, 'Y', 0, '2008-07-29', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11005746', 'W11005746', 'UTIHCPHY', 'Logan Radiation Oncology', 'Leslye', 'L', 'Ingersoll', 'MD', 'Radiation Oncology', NULL, NULL, NULL, 'O', '1400 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357161000', NULL, '1400 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357161000', '          ', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2008-07-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1568475846', 0, 'N', 0, '2008-07-29', NULL, NULL, 41.7569, -111.821, NULL, NULL),
('942854057', 'W11005743', 'W11005743', 'UTIHCPHY', 'Logan Radiation Oncology', 'Gary', 'L', 'Whipple', 'MD', 'Radiation Oncology', NULL, NULL, NULL, 'O', '1400 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357161000', NULL, NULL, NULL, 'Cache', NULL, NULL, NULL, NULL, 'USTDMULT', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 8, '2008-07-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1083621361', 0, 'n', 0, '2008-07-29', NULL, NULL, 41.7569, -111.821, NULL, NULL),
('942854057', 'W11005745', 'W11005745', 'UTIHCPHY', 'McKay Dee Radiation Oncology', 'Leslye', 'L', 'Ingersoll', 'MD', 'Radiation Oncology', NULL, NULL, NULL, 'O', '4401 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8013877400', NULL, NULL, NULL, 'Weber', NULL, NULL, NULL, NULL, 'USTDMULT', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 8, '2008-07-01', '2008-11-05', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1568475846', 0, 'n', 0, '2008-07-29', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11005742', 'W11005742', 'UTIHCPHY', 'McKay Dee Radiation Oncology', 'Gary', 'L', 'Whipple', 'MD', 'Radiation Oncology', NULL, NULL, NULL, 'O', '4401 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8013877400', NULL, NULL, NULL, 'Weber', NULL, NULL, NULL, NULL, 'USTDMULT', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 8, '2008-07-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1083621361', 0, 'n', 0, '2008-07-29', NULL, NULL, 41.1828, -111.949, NULL, NULL),
('554756642', 'W11005747', 'W11005747', 'UTMH1', '', 'Jennifer', 'A', 'Morrill', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '3325 N University Ave Ste 300D', 'Provo', 'Utah', 'UT', '84604', '8013772014', NULL, '3325 N University Ave Ste 300D', 'Provo', 'Utah', 'UT', '84604', '8013772014', '          ', 'UTPHD', '', '', '0.00', '35.00', '0.00', 3, '2008-07-01', '2012-02-29', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1881730604', 0, 'N', 0, '2012-07-11', NULL, NULL, 0, 0, NULL, NULL),
('201012599', 'W11005750', 'W11005750', 'UTMH1', 'Turning Leaf Wellness Center', 'Kwinten', 'M', 'Kemp', 'LPC', 'Mental Health', 'Counseling', NULL, NULL, 'O', '1071 E 100 S Ste C7', 'St George', 'Washington', 'UT', '84770', '4356521202', NULL, '1071 E 100 S', 'St George', 'Washington', 'UT', '84770', NULL, NULL, 'MA', NULL, NULL, '0.00', '35.00', '0.00', 6, '2008-07-01', '2008-08-19', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1689858631', 0, 'n', 0, '2008-06-30', NULL, NULL, 0, 0, NULL, NULL),
('201012599', 'W11005751', 'W11005751', 'UTMH1', 'Turning Leaf Wellness Center', 'Richard', 'Y', 'Moody', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '1240 E 100 S Bldg 22 Ste 121', 'St George', 'Washington', 'UT', '84790', '4356521202', NULL, '1240 E 100 S Bldg 22 Ste 121', 'St George', 'Washington', 'UT', '84790', '4356521202', '', 'PHD', NULL, NULL, '0.00', '35.00', '0.00', 6, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1609821693', 0, 'n', 0, '2014-02-12', NULL, NULL, 0, 0, NULL, NULL),
('043115329', 'W11005737', 'W11005737', 'ID01', 'Critical Care Systems', '', '', 'Critical Care Systems ', 'GROUP', 'Infusion Agency', NULL, NULL, NULL, 'B', 'PO Box 52777', 'Phoenix', 'Maricopa', 'AZ', '85072', '8669789600', '6038884701', 'PO Box 52777', 'Phoenix', 'Maricopa', 'AZ', '85072', '8669789600', '6038884701', '', NULL, '1001', '0.00', '100.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1588692164', 0, 'Y', 0, '2012-02-13', NULL, NULL, 0, 0, NULL, NULL),
('331078261', 'W11005775', 'W11005775', 'ID01', 'Saint Alphonsus Medical Group Eagle Health Plaza', 'Scott', 'R', 'Hiatt', 'DO', 'Cardiovascular Disease', '', '', NULL, 'O', '323 E Riverside Dr Ste 224', 'Eagle', 'Ada', 'ID', '83616', '2083675750', NULL, '323 E Riverside Dr Ste 224', 'Eagle', 'Ada', 'ID', '83616', '2083675750', '', 'IDSAMG1', NULL, NULL, '0.00', '10.00', '0.00', 3, '2008-07-01', '2009-11-26', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', 'Saint Alphonsus Medical Center Nampa', 'HCFA|UB|', '1093705030', 0, 'n', 0, '2011-02-09', NULL, NULL, 43.6892, -116.351, NULL, NULL),
('331078261', 'W11005776', 'W11005776', 'ID01', 'Saint Alphonsus Medical Group Garrity', 'Scott', 'R', 'Hiatt', 'DO', 'Cardiovascular Disease', '', '', NULL, 'O', '1200 Garrity Blvd', 'Nampa', 'Canyon', 'ID', '83687', '2084669092', NULL, '1200 Garrity Blvd', 'Nampa', 'Canyon', 'ID', '83687', '2084669092', '', 'IDSAMG1', NULL, NULL, '0.00', '10.00', '0.00', 3, '2008-07-01', '2009-11-26', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', 'Saint Alphonsus Medical Center Nampa', 'HCFA|UB|', '1093705030', 0, 'n', 0, '2011-02-09', NULL, NULL, 43.587, -116.549, NULL, NULL),
('331078261', 'W11005777', 'W11005777', 'ID01', 'Saint Alphonsus Physicians PA', 'Scott', 'R', 'Hiatt', 'DO', 'Cardiovascular Disease', '', '', NULL, 'O', '6140 W Curtisian Ste 200', 'Boise', 'Ada', 'ID', '83704', '2083674278', NULL, '6140 W Curtisian Ste 200', 'Boise', 'Ada', 'ID', '83704', '2083674278', '', 'IDSAMG1', NULL, NULL, '0.00', '10.00', '0.00', 3, '2008-07-01', '2009-11-26', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', 'Saint Alphonsus Medical Center Nampa', 'HCFA|UB|', '1093705030', 0, 'n', 0, '2011-02-09', NULL, NULL, 43.6151, -116.256, NULL, NULL),
('820200895', 'W11005778', 'W11005778', 'ID01', 'Saint Alphonsus Regional Medical Center', 'Scott', 'R', 'Hiatt', 'DO', 'Cardiovascular Disease', '', '', NULL, 'B', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083673722', NULL, '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083673722', '          ', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2008-07-01', '2009-11-26', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', 'Saint Alphonsus Medical Center Nampa', 'HCFA|', '1093705030', 0, 'N', 0, '2011-02-09', NULL, NULL, 43.6127, -116.254, NULL, NULL),
('261703236', 'W11005773', 'W11005773', 'UTMH1', 'Clinical Consultants LLC', 'Daniel', 'J', 'Thornhill', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '391 A S State St', 'Clearfield', 'Davis', 'UT', '84015', '8017768673', NULL, '391 A S State St', 'Clearfield', 'Davis', 'UT', '84015', '8017768673', '          ', 'UTMA', '', '', '0.00', '35.00', '0.00', 6, '2008-07-01', '2011-08-20', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1578737755', 0, 'N', 0, '2011-11-30', NULL, NULL, 0, 0, NULL, NULL),
('261703236', 'W11005772', 'W11005772', 'UTMH1', 'Clinical Consultants LLC', 'Kerry', 'S', 'Kennedy-Pressey', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '391 A S State St', 'Clearfield', 'Davis', 'UT', '84015', '8017768670', NULL, '391 A S State St', 'Clearfield', 'Davis', 'UT', '84015', '8017768670', '          ', 'UTPHD', '', '', '0.00', '35.00', '0.00', 6, '2008-07-01', '2009-09-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1134393341', 0, 'N', 0, '2008-07-01', NULL, NULL, 0, 0, NULL, NULL),
('870685835', 'W11005762', 'W11005762', 'UTMH1', 'Institute for Cognitive Therapy', 'Donna', 'E', 'Castleton', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '560 S State Ste G1', 'Orem', 'Utah', 'UT', '84058', '8018028608', NULL, '560 S State Ste G1', 'Orem', 'Utah', 'UT', '84058', '8018028608', '', 'UTMA', NULL, NULL, '0.00', '35.00', '0.00', 6, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1598809642', 0, 'N', 0, '2014-05-06', NULL, NULL, 0, 0, NULL, NULL),
('870685835', 'W11005761', 'W11005761', 'UTMH1', 'Institute for Cognitive Therapy', 'Randy', 'S', 'Linnell', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '560 S State Ste G1', 'Orem', 'Utah', 'UT', '84058', '8018028608', NULL, '560 S State Ste G1', 'Orem', 'Utah', 'UT', '84058', '8018028608', '', 'UTMA', NULL, NULL, '0.00', '35.00', '0.00', 6, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1457480204', 0, 'N', 0, '2014-05-01', NULL, NULL, 0, 0, NULL, NULL),
('261703236', 'W11005770', 'W11005770', 'UTMH1', 'Clinical Consultants LLC', 'James', 'B', 'Meservy', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '8541 S Redwood Rd Bld A', 'West Jordan', 'Salt Lake', 'UT', '84088', '8012338670', NULL, '8541 S Redwood Rd Bld A', 'West Jordan', 'Salt Lake', 'UT', '84088', '8012338670', '          ', 'UTMA', '', '', '0.00', '35.00', '0.00', 6, '2008-07-01', '2010-06-21', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1790959807', 0, 'N', 0, '2011-12-01', NULL, NULL, 0, 0, NULL, NULL),
('261703236', 'W11005763', 'W11005763', 'UTMH1', 'Clinical Consultants LLC', 'Kerry', 'S', 'Kennedy-Pressey', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '8541 S Redwood Rd Bld A', 'West Jordan', 'Salt Lake', 'UT', '84088', '8012338670', NULL, '8541 S Redwood Rd Bld A', 'West Jordan', 'Salt Lake', 'UT', '84088', '8012338670', '          ', 'UTPHD', '', '', '0.00', '35.00', '0.00', 6, '2008-07-01', '2009-09-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1134393341', 0, 'N', 0, '2008-07-01', NULL, NULL, 0, 0, NULL, NULL),
('261703236', 'W11005764', 'W11005764', 'UTMH1', 'Clinical Consultants LLC', 'Daniel', 'J', 'Thornhill', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '8541 S Redwood Rd Bld A', 'West Jordan', 'Salt Lake', 'UT', '84088', '8012338670', NULL, '8541 S Redwood Rd Bld A', 'West Jordan', 'Salt Lake', 'UT', '84088', '8012338670', '          ', 'UTMA', '', '', '0.00', '35.00', '0.00', 6, '2008-07-01', '2010-06-21', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1578737755', 0, 'N', 0, '2011-11-30', NULL, NULL, 0, 0, NULL, NULL),
('261703236', 'W11005765', 'W11005765', 'UTMH1', 'Clinical Consultants LLC', 'Wayne', 'R', 'Sears', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '8541 S Redwood Rd Bld A', 'West Jordan', 'Salt Lake', 'UT', '84088', '8012338670', NULL, '8541 S Redwood Rd Bld A', 'West Jordan', 'Salt Lake', 'UT', '84088', '8012338670', '', 'UTMA', '', '', '0.00', '35.00', '0.00', 6, '2008-07-01', '2010-06-21', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1063686160', 0, 'N', 0, '2014-06-02', NULL, NULL, 0, 0, NULL, NULL);
