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
('201312583', 'W11024623', 'W11024623', 'ID01', 'Life Counseling Center', 'Lynnee', 'C', 'Rogers', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '112 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2084655433', NULL, '112 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2084655433', '', 'IDMA', NULL, NULL, '0.00', '35.00', '0.00', 6, '2010-03-04', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1972692804', 0, 'n', 0, '2013-07-11', NULL, NULL, 0, 0, NULL, NULL),
('870280459', 'W11024624', 'W11024624', 'UT01', 'Western GYN & OB Clinic', NULL, NULL, 'Western GYN & OB Clinic', 'GROUP', NULL, NULL, NULL, NULL, 'B', 'PO Box 572528', 'Salt Lake City', 'Salt Lake', 'UT', '84157', '8012854900', '8012854901', '5770 S 250 E', 'Murray', 'Salt Lake', 'UT', '84107', NULL, NULL, 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000009578', 0, 'y', 0, '2010-03-10', NULL, NULL, 0, 0, NULL, NULL),
('870649642', 'W11024625', 'W11024625', 'UT01', 'Eartech Audiology', 'Terry', 'D', 'Clawson', 'AUD', 'Audiology', '', '', NULL, 'O', '3955 Harrison Blvd Ste U7', 'Ogden', 'Weber', 'UT', '84403', '8013999955', NULL, '3955 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', NULL, NULL, 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2010-03-08', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1487652632', 0, 'N', 0, '2010-03-10', NULL, NULL, 41.191, -111.949, NULL, NULL),
('870649642', 'W11024626', 'W11024626', 'UT01', 'Eartech Audiology', 'Terry', 'D', 'Clawson', 'AUD', 'Audiology', '', '', NULL, 'O', '2850 N 2000 W', 'Farr West', 'Weber', 'UT', '84404', '8013999955', NULL, '2850 N 2000 W', 'Farr West', 'Weber', 'UT', '84404', '8013999955', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2010-03-08', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1487652632', 0, 'N', 0, '2014-02-27', NULL, NULL, 41.3105, -112.028, NULL, NULL),
('870649642', 'W11024627', 'W11024627', 'UT01', 'Eartech Audiology', 'Terry', 'D', 'Clawson', 'AUD', 'Audiology', '', '', NULL, 'O', '950 S Medical Dr Ste 103', 'Brigham City', 'Box Elder', 'UT', '84302', '8013999955', NULL, '3955 Harrison Blvd', 'Ogden', 'Box Elder', 'UT', '84403', NULL, NULL, 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2010-03-08', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1487652632', 0, 'N', 0, '2010-03-10', NULL, NULL, 41.4894, -112.026, NULL, NULL),
('261112301', 'W11024628', 'W11024628', 'WY01', 'Hope Counseling', 'Heather', '', 'Sanford', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '15 S 6th St', 'Greybull', 'Big Horn', 'WY', '82426', '3077652060', NULL, '15 S 6th St', 'Greybull', 'Big Horn', 'WY', '82426', '3077652060', '', 'WYMA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2010-03-08', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1851515431', 0, 'n', 0, '2014-02-27', NULL, NULL, 0, 0, NULL, NULL),
('870468116', 'W11024629', 'W11024629', 'UT01', '', 'Scott', 'A', 'Leckman', 'MD', 'General Surgery', '', '', NULL, 'B', 'PO Box 572528', 'Salt Lake City', 'Salt Lake', 'UT', '84157', '8012684924', NULL, 'PO Box 572528', 'Salt Lake City', 'Salt Lake', 'UT', '84157', '8012684924', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-03-01', '2013-01-31', 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1588637730', 0, 'N', 0, '2013-08-19', NULL, NULL, 0, 0, NULL, NULL),
('200123241', 'W11024630', 'W11024630', 'UTMH1', 'Aloha Behavioral Consultants Inc', 'Lanny', '', 'Sanders', 'LCSW', 'Mental Health', '', '', NULL, 'O', '707 24th St Ste D', 'Ogden', 'Weber', 'UT', '84401', '8013991818', NULL, '707 24th St Ste D', 'Ogden', 'Weber', 'UT', '84401', '8013991818', '', 'MA', NULL, NULL, '0.00', '35.00', '0.00', 6, '2010-03-15', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1225167638', 0, 'n', 0, '2014-03-31', NULL, NULL, 0, 0, NULL, NULL),
('271918813', 'W11024631', 'W11024631', 'UTMH1', 'All Ages & Life Stages Counseling ', 'Karson', 'S', 'Kinikini', 'LCSW', 'Mental Health', 'Counseling', 'Social Worker', NULL, 'O', '845 S Main St Ste B-8', 'Bountiful', 'Davis', 'UT', '84010', '8016283092', NULL, '845 S Main St Ste B-8', 'Bountiful', 'Davis', 'UT', '84010', '8016283092', '', 'MA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2010-03-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1396896858', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('528656496', 'W11024632', 'W11024632', 'UTMH1', 'Hope Haven Counseling', 'Ryan', 'W', 'Hamilton', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '9140 S State St Ste 101', 'Sandy', 'Salt Lake', 'UT', '84070', '8016768796', NULL, '9140 S State St Ste 101', 'Sandy', 'Salt Lake', 'UT', '84070', '8016768796', '          ', 'UTMA', '', '', '0.00', '35.00', '0.00', 3, '2010-03-09', '2010-09-28', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1295065712', 0, 'N', 0, '2013-09-11', NULL, NULL, 0, 0, NULL, NULL),
('830506152', 'W11024633', 'W11024633', 'UT01', '', 'Jayne', 'E', 'Clark', 'MD', 'Physical Medicine and Rehabilitation', '', '', NULL, 'O', '2180 E 4500 S Ste 185', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8012726972', NULL, '2180 E 4500 S Ste 185', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8012726972', '', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-03-08', '2011-06-23', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1295735728', 0, 'N', 0, '2014-04-16', NULL, NULL, 0, 0, NULL, NULL),
('201036270', 'W11024634', 'W11024634', 'UTDT01', '', 'Raymond J', '', 'Curtis', 'DDS', 'Dentist', '', '', NULL, 'O', '6770 S 900 E Ste 301', 'Midvale', 'Salt Lake', 'UT', '84047', '8012557101', NULL, '6770 S 900 E Ste 301', 'Midvale', 'Salt Lake', 'UT', '84047', '8012557101', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2010-01-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1083703649', 0, 'N', 0, '2013-12-06', NULL, NULL, 0, 0, NULL, NULL),
('271459587', 'W11024635', 'W11024635', 'UTDT01', 'Spring Creek Dental Associates', 'Todd M', '', 'Butler', 'DMD', 'Dentist', '', '', NULL, 'O', '274 N Spring Creek Pkwy', 'Providence', 'Cache', 'UT', '84332', '4357130096', NULL, '274 N Spring Creek Pkwy', 'Providence', 'Cache', 'UT', '84332', '4357130096', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2009-05-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000002066', 0, 'N', 0, '2012-08-22', NULL, NULL, 0, 0, NULL, NULL),
('271586641', 'W11024636', 'W11024636', 'UTDT01', 'Bloomington Courtyard Dental', 'Ashton', '', 'Prince', 'DMD', 'Dentist', '', '', NULL, 'O', '144 W Brigham Rd', 'St George', 'Washington', 'UT', '84790', '4356568003', NULL, '144 W Brigham Rd', 'St George', 'Washington', 'UT', '84790', '4356568003', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2009-06-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000002067', 0, 'N', 0, '2012-08-22', NULL, NULL, 0, 0, NULL, NULL),
('270827337', 'W11024637', 'W11024637', 'UTDT01', '', 'Christopher', '', 'Morgan', 'DDS', 'Dentist', '', '', NULL, 'O', '47 E Crestwood Rd Ste 5', 'Kaysville', 'Davis', 'UT', '84037', '8015462439', NULL, '47 E Crestwood Rd Ste 5', 'Kaysville', 'Davis', 'UT', '84037', '8015462439', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2009-10-15', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000002068', 0, 'N', 0, '2012-08-22', NULL, NULL, 0, 0, NULL, NULL),
('870321010', 'W11024638', 'W11024638', 'UTDT01', '', 'John  ', '', 'Braithwaite', 'DMD', 'Dentist', '', '', NULL, 'O', '1377 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012721199', NULL, '1377 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012721199', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2009-11-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000002069', 0, 'N', 0, '2012-08-22', NULL, NULL, 0, 0, NULL, NULL),
('262123558', 'W11024639', 'W11024639', 'UTDT01', 'Horizon Dental', 'Joshua', '', 'Frandsen', 'DDS', 'Dentist', '', '', NULL, 'O', '2195 W 5400 S Ste 203', 'West Valley', 'Salt Lake', 'UT', '84118', '8019696740', NULL, '2195 W 5400 S Ste 203', 'West Valley', 'Salt Lake', 'UT', '84118', '8019696740', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2009-11-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000002070', 0, 'N', 0, '2012-08-22', NULL, NULL, 0, 0, NULL, NULL),
('271501691', 'W11024640', 'W11024640', 'UTDT01', 'White Dental', 'Jared', '', 'White', 'DDS', 'Dentist', '', '', NULL, 'O', '431 W 600 N', 'Tremonton', 'Box Elder', 'UT', '84337', '4352573210', NULL, '431 W 600 N', 'Tremonton', 'Box Elder', 'UT', '84337', '4352573210', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2010-02-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000002071', 0, 'N', 0, '2012-08-22', NULL, NULL, 0, 0, NULL, NULL),
('264081422', 'W11024641', 'W11024641', 'UTDT01', '', 'P Bradley', '', 'Hills', 'DMD', 'Dentist', '', '', NULL, 'O', '560 S State Ste K2', 'Orem', 'Utah', 'UT', '84058', '8012252641', NULL, '560 S State Ste K2', 'Orem', 'Utah', 'UT', '84058', '8012252641', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2009-12-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000002072', 0, 'N', 0, '2012-08-22', NULL, NULL, 0, 0, NULL, NULL),
('870449804', 'W11024642', 'W11024642', 'UTDT01', '', 'Paul', '', 'Martinez', 'DDS', 'Dentist', '', '', NULL, 'O', '95 S 100 E', 'Price', 'Carbon', 'UT', '84501', '4356374545', NULL, '95 S 100 E', 'Price', 'Carbon', 'UT', '84501', '4356374545', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2010-02-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000002073', 0, 'N', 0, '2012-08-22', NULL, NULL, 0, 0, NULL, NULL),
('870581878', 'W11024643', 'W11024643', 'UTDT01', '', 'Scott H', '', 'Brown', 'DDS', 'Dentist', '', '', NULL, 'O', '415 N Main Ste 301', 'Cedar City', 'Iron', 'UT', '84720', '4355863885', NULL, '415 N Main Ste 301', 'Cedar City', 'Iron', 'UT', '84720', '4355863885', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2009-09-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000002074', 0, 'N', 0, '2012-08-22', NULL, NULL, 0, 0, NULL, NULL),
('820312175', 'W11024644', 'W11024644', 'ID01', 'Idaho Emergency Physicians PA', 'Jason', 'L', 'Wilhelmsen', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083221730', '2083221731', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083221730', '2083221731', 'IDSAMG3', NULL, NULL, '0.00', '10.00', '0.00', 3, '2010-02-04', NULL, 0, 0, 0, 'West Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1912964404', 0, 'n', 0, '2014-01-13', NULL, NULL, 43.6145, -116.254, NULL, NULL),
('820312175', 'W11024645', 'W11024645', 'ID01', 'Idaho Emergency Physicians PA', 'Jason', 'L', 'Wilhelmsen', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '323 E Riverside Dr', 'Eagle', 'Ada', 'ID', '83616', '2083221730', '2083221731', '323 E Riverside Dr', 'Eagle', 'Ada', 'ID', '83616', '2083221730', '2083221731', 'IDSAMG3', '', '', '0.00', '10.00', '0.00', 3, '2010-02-04', '2011-02-21', 0, 0, 0, 'West Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1912964404', 0, 'N', 0, '2014-01-13', NULL, NULL, 43.6892, -116.351, NULL, NULL),
('820312175', 'W11024646', 'W11024646', 'ID01', 'Idaho Emergency Physicians PA', 'Jason', 'L', 'Wilhelmsen', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '1717 Arlington', 'Caldwell', 'Canyon', 'ID', '83605', '2083221730', '2083221731', '1717 Arlington', 'Caldwell', 'Canyon', 'ID', '83605', '2083221730', '2083221731', 'IDSAMG3', NULL, NULL, '0.00', '10.00', '0.00', 3, '2010-02-04', NULL, 0, 0, 0, 'West Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1912964404', 0, 'n', 0, '2014-01-13', NULL, NULL, 43.6542, -116.696, NULL, NULL),
('820200895', 'W11024647', 'W11024647', 'ID01', 'Saint Alphonsus Medical Group Elm Family Medicine', 'Ryan', 'A', 'Moore', 'MD', 'Family Practice', '', '', NULL, 'O', '315 E Elm St Ste 100', 'Caldwell', 'Canyon', 'ID', '83605', '2084597415', '2084533307', '315 E Elm Ste 100', 'Caldwell', 'Canyon', 'ID', '83605', '2084597415', '2084533307', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2010-02-04', '2012-08-19', 0, 0, 0, 'West Valley Medical Center', NULL, NULL, NULL, 'HCFA|', '1386664654', 0, 'N', 0, '2012-11-15', NULL, NULL, 43.6539, -116.695, NULL, NULL),
('820200895', 'W11024650', 'W11024650', 'ID01', 'Saint Alphonsus Regional Medical Center Behavioral Health', 'Eric', '', 'Gilbreath', 'MD', 'Mental Health', 'Psychiatry', '', NULL, 'O', '131 N Allumbaugh', 'Boise', 'Ada', 'ID', '83704', '2083676500', '2083760285', '131 N Allumbaugh', 'Boise', 'Ada', 'ID', '83704', '2083676500', '2083760285', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2010-02-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1548290711', 0, 'N', 0, '2014-07-23', NULL, NULL, 43.6059, -116.267, NULL, NULL),
('460500210', 'W11024648', 'W11024648', 'ID01', 'Saint Alphonsus Outpatient Trauma Services', 'Dale', '', 'Strawn', '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, '2010-02-04', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1518059427', 0, 'N', 0, '2013-11-22', NULL, NULL, 43.6126, -116.255, NULL, NULL),
('460500210', 'W11024649', 'W11024649', 'ID01', 'Saint Alphonsus Trauma Physician Services', 'Dale', '', 'Strawn', 'MD', 'General Surgery', '', '', NULL, 'O', '1055 N Curtis', 'Boise', 'Ada', 'ID', '83706', '2083677676', '2083676849', '1055 N Curtis', 'Boise', 'Ada', 'ID', '83706', '2083677676', '2083676849', 'IDSAMG1', NULL, NULL, '0.00', '10.00', '0.00', 6, '2010-02-04', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1518059427', 0, 'N', 0, '2013-11-22', NULL, NULL, 43.6127, -116.254, NULL, NULL),
('820424691', 'W11024651', 'W11024651', 'ID02', 'Boise Family Medicine Center', 'Eric', 'S', 'Jacobsen', 'MD', 'Family Practice', '', '', NULL, 'O', '10798 W Overland Rd', 'Boise', 'Ada', 'ID', '83709', '2083773368', '2083224691', '10798 W Overland Rd', 'Boise', 'Ada', 'ID', '83709', '2083773368', '2083224691', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2010-01-29', '2012-12-31', 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|UB|', '1053405969', 0, 'N', 0, '2013-04-30', NULL, NULL, 0, 0, NULL, NULL),
('820424691', 'W11024652', 'W11024652', 'ID02', 'Boise Family Medicine Center', 'Dale', 'L', 'Mock', 'MD', 'Family Practice', '', '', NULL, 'O', '10798 W Overland Rd', 'Boise', 'Ada', 'ID', '83709', '2083773368', '2083224691', '10798 W Overland Rd', 'Boise', 'Ada', 'ID', '83709', '2083773368', '2083224691', 'IDACN', NULL, NULL, '0.00', '15.00', '0.00', 3, '2010-01-29', NULL, 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|UB|', '1215948351', 0, 'N', 0, '2011-06-29', NULL, NULL, 0, 0, NULL, NULL),
('930433692', 'W11024653', 'W11024653', 'ID02', 'Ontario Emergency Physicians', 'Brad', 'L', 'Barlow', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '351 SW 9th St', 'Ontario', '', 'OR', '97914', '5418817100', '5418817395', '351 SW 9th St', 'Ontario', '', 'OR', '97914', '5418817100', '5418817395', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2010-02-04', '2012-03-29', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1003870536', 0, 'N', 0, '2014-01-09', NULL, NULL, 44.0252, -116.976, NULL, NULL),
('930433692', 'W11024654', 'W11024654', 'ID02', 'Ontario Emergency Physicians', 'Kenneth', 'L', 'Bean', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '351 SW 9th St', 'Ontario', 'Malheur', 'OR', '97914', '5418817100', '5418817395', '351 SW 9th St', 'Ontario', 'Malheur', 'OR', '97914', '5418817100', '5418817395', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2010-02-04', '2012-03-29', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1346274115', 0, 'N', 0, '2014-07-09', NULL, NULL, 44.0252, -116.976, NULL, NULL),
('930433692', 'W11024655', 'W11024655', 'ID02', 'Ontario Emergency Physicians', 'Jason', 'L', 'Wilhelmsen', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '351 SW 9th St', 'Ontario', 'Malheur', 'OR', '97914', '5418817100', '5418817395', '351 SW 9th St', 'Ontario', 'Malheur', 'OR', '97914', '5418817100', '5418817395', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2010-02-04', '2013-06-30', 0, 0, 1, 'West Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1912964404', 0, 'N', 0, '2014-01-13', NULL, NULL, 44.0252, -116.976, NULL, NULL),
('930433692', 'W11024656', 'W11024656', 'ID02', 'Ontario Emergency Physicians', 'Rick', 'L', 'Wright', 'DO', 'Emergency Medicine', '', '', NULL, 'O', '351 SW 9th St', 'Ontario', '', 'OR', '97914', '5418817100', '5418817395', '351 SW 9th St', 'Ontario', '', 'OR', '97914', '5418817100', '5418817395', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2010-02-04', '2012-04-03', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1780706283', 0, 'N', 0, '2014-01-13', NULL, NULL, 44.0252, -116.976, NULL, NULL),
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('830322385', 'W11024695', 'W11024695', 'Sinclair', 'Sharons Home Health', '', '', 'Sharons Home Health', 'GROUP', 'Home Health Agency', '', '', NULL, 'O', '1737 E 2nd St', 'Casper', 'Natrona', 'WY', '82601', '3074736889', NULL, '1737 E 2nd St', 'Casper', 'Natrona', 'WY', '82601', '3074736889', '          ', '', '', '', '0.00', '30.00', '0.00', 3, '2010-03-11', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1679712384', 0, 'N', 0, '2011-06-15', NULL, NULL, 0, 0, NULL, NULL),
('830322385', 'W11024696', 'W11024696', 'Sinclair', 'Sharons Home Health', '', '', 'Sharons Home Health', 'GROUP', 'Home Health Agency', '', '', NULL, 'O', '116 D Littlehorn', 'Moorcroft', 'Crook', 'WY', '82721', '3077563344', NULL, '116 D Littlehorn', 'Moorcroft', 'Crook', 'WY', '82721', '3077563344', '          ', '', '', '', '0.00', '30.00', '0.00', 3, '2010-03-11', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1679712384', 0, 'N', 0, '2011-06-15', NULL, NULL, 0, 0, NULL, NULL),
('571188761', 'W11024697', 'W11024697', 'UT01', 'West View Womens Center', 'Pragati', '', 'Hooda', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 1569', 'Bountiful', 'Davis', 'UT', '84011', '8019631880', NULL, 'PO Box 1569', 'Bountiful', 'Davis', 'UT', '84011', '8019631880', '', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-03-10', '2011-05-01', 0, 0, 0, 'Pioneer Valley Hospital', '', '', '', 'HCFA|UB|', '1962735670', 0, 'Y', 0, '2014-04-16', NULL, NULL, 0, 0, NULL, NULL),
('571188761', 'W11024698', 'W11024698', 'UT01', 'West View Womens Center', 'Pragati', '', 'Hooda', 'MD', 'Family Practice', '', '', NULL, 'O', '3451 S 5600 W Ste E', 'West Valley', 'Salt Lake', 'UT', '84120', '8019631880', NULL, '3451 S 5600 W Ste E', 'West Valley', 'Salt Lake', 'UT', '84120', '8019631880', '', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-03-10', '2011-05-01', 0, 0, 0, 'Pioneer Valley Hospital', '', '', '', 'HCFA|UB|', '1962735670', 0, 'Y', 0, '2014-04-16', NULL, NULL, 0, 0, NULL, NULL),
('270248138', 'W11024699', 'W11024699', 'WY01', 'Big Horn Urgent Care', 'Travis', 'M', 'Preszler', 'PA-C', 'Urgent Care', '', '', NULL, 'O', '813 Highland Ave', 'Sheridan', 'Sheridan', 'WY', '82801', '3076735501', NULL, '813 Highland Ave', 'Sheridan', 'Sheridan', 'WY', '82801', '3076735501', '', 'WYSTD', 'wyhcpcs', NULL, '0.00', '35.00', '0.00', 3, '2010-03-10', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1770565764', 0, 'n', 0, '2013-06-18', NULL, NULL, 44.8053, -106.973, NULL, NULL),
('742083988', 'W11024700', 'W11024700', 'TX01', 'Renal Associates', 'Robert', 'E', 'Stevens', 'MD', 'Nephrology', '', '', NULL, 'O', '16620 US Hway 281 N Ste 300', 'San Antonio', 'Bexar', 'TX', '78232', '2106141231', NULL, '16620 US Hway 281 N Ste 300', 'San Antonio', 'Bexar', 'TX', '78232', '2106141231', '', 'TXSTD', 'TXHCPCS', NULL, '0.00', '50.00', '0.00', 3, '2007-01-01', '2012-08-19', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1528035185', 0, 'N', 0, '2013-05-06', NULL, NULL, 29.6548, -98.446, NULL, NULL),
('710950589', 'W11024701', 'W11024701', 'UTMH1', 'Park City Psychotherapy', 'Donn', 'W', 'Peters', 'PSYD', 'Mental Health', NULL, NULL, NULL, 'O', '2720 Homestead Ste 30', 'Park City', 'Summit', 'UT', '84098', '4356496838', NULL, '2720 Homestead Ste 30', 'Park City', 'Summit', 'UT', '84098', '4356496838', '', 'PHD', NULL, NULL, '0.00', '35.00', '0.00', 3, '2010-03-10', '2013-02-14', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1598971889', 0, 'n', 0, '2013-10-22', NULL, NULL, 0, 0, NULL, NULL),
('710950589', 'W11024702', 'W11024702', 'UTMH1', 'Park City Psychotherapy', 'Donn', 'W', 'Peters', 'PSYD', 'Mental Health', NULL, NULL, NULL, 'B', '555 E 4500 S Ste C150', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '4356496838', NULL, '555 E 4500 S Ste C150', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '4356496838', '', 'PHD', NULL, NULL, '0.00', '35.00', '0.00', 3, '2010-03-10', '2013-02-14', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1598971889', 0, 'y', 0, '2013-10-22', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W11024703', 'W11024703', 'UT01', 'Hyperbaric and Wound Care', 'Douglas', 'P', 'Barney', 'MD', 'Wound Care', 'Hyperbaric Wound', 'Family Practice', NULL, 'O', '2132 N 1700 W Ste 100', 'Layton', 'Davis', 'UT', '84041', '8018077900', NULL, '2132 N 1700 W Ste 100', 'Layton', 'Davis', 'UT', '84041', '8018077900', '', 'WUSTDINT5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2010-03-08', '2014-04-30', 0, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1013081801', 0, 'N', 0, '2014-02-04', NULL, NULL, 41.0892, -111.997, NULL, NULL),
('621801973', 'W11024704', 'W11024704', 'UT01', 'Hyperbaric and Wound Care', 'Douglas', 'P', 'Barney', 'MD', 'Wound Care', 'Hyperbaric Wound', 'Family Practice', NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8018077900', NULL, 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8018077900', '', 'WUSTDINT5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2010-03-08', '2014-04-30', 0, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1013081801', 0, 'y', 0, '2014-02-04', NULL, NULL, 0, 0, NULL, NULL),
('010624198', 'W11024705', 'W11024705', 'TX01', 'Alamo Mental Health Group', 'Italo', 'A', 'Samano', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '4242 Medical Dr Ste 6300', 'San Antonio', 'Bexar', 'TX', '78229', '2106148400', NULL, '4242 Medical Dr Ste 6300', 'San Antonio', 'Bexar', 'TX', '78229', '2106148400', '          ', 'TXMHPHD10', '', '', '0.00', '35.00', '0.00', 3, '2010-03-15', '2011-06-23', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1770530974', 0, 'N', 0, '2014-01-17', NULL, NULL, 0, 0, NULL, NULL),
('114689326', 'W11024706', 'W11024706', 'TX01', 'Alamo Mental Health Group', 'Yousuf', '', 'Allawala', 'MD', 'Mental Health', 'Psychiatry', '', NULL, 'O', '4242 Medical Dr Ste 6300', 'San Antonio', 'Bexar', 'TX', '78229', '2106148400', NULL, '4242 Medical Dr Ste 6300', 'San Antonio', 'Bexar', 'TX', '78229', '2106148400', '          ', 'TXMHMD10', '', '', '0.00', '45.00', '0.00', 3, '2010-03-15', '2011-03-28', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1497709810', 0, 'N', 0, '2011-03-28', NULL, NULL, 0, 0, NULL, NULL),
('331064921', 'W11024707', 'W11024707', 'UT01', 'Advanced Foot & Ankle', 'Bryan', 'L', 'Seagle', 'DPM', 'Podiatry', '', '', NULL, 'O', '1551 S Renaissance Towne Dr Ste 370', 'Bountiful', 'Davis', 'UT', '84010', '8012924425', NULL, '1551 S Renaissance Towne Dr Ste 370', 'Bountiful', 'Davis', 'UT', '84010', '8012924425', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2010-03-15', NULL, 0, 0, 0, 'Lakeview Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1194799247', 0, 'N', 0, '2014-01-17', NULL, NULL, 40.8737, -111.888, NULL, NULL),
('010624198', 'W11024708', 'W11024708', 'TX01', 'Alamo Mental Health Group', 'John', 'W', 'Perry', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '4242 Medical Dr', 'San Antonio', 'Bexar', 'TX', '78229', '2106148400', NULL, '4242 Medical Dr', 'San Antonio', 'Bexar', 'TX', '78229', '2106148400', '          ', 'TXMHPHD10', '', '', '0.00', '35.00', '0.00', 3, '2010-03-15', '2011-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1184635468', 0, 'N', 0, '2014-01-22', NULL, NULL, 0, 0, NULL, NULL),
('202965326', 'W11024709', 'W11024709', 'UT01', 'Wasatch Neonatal LC', 'Margrit', 'L', 'Gronseth', 'APRN', 'Neonatology', '', '', NULL, 'O', '730 W 800 N Ste 340B', 'Orem', 'Utah', 'UT', '84057', '8016555425', NULL, '730 W 800 N Ste 340B', 'Orem', 'Utah', 'UT', '84057', '8016555425', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2010-03-15', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1700061520', 0, 'N', 0, '2014-02-06', NULL, NULL, 40.3121, -111.713, NULL, NULL),
('870471479', 'W11024710', 'W11024710', 'UT01', 'Wasatch Medical Center', 'Maynard', 'R', 'Olsen', 'MD', 'Family Practice', '', '', NULL, 'O', '575 S State St', 'Orem', 'Utah', 'UT', '84058', '8012252926', NULL, '575 S State St', 'Orem', 'Utah', 'UT', '84058', '8012252926', '          ', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-03-15', '2010-07-14', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1518067347', 0, 'N', 0, '2014-02-25', NULL, NULL, 0, 0, NULL, NULL),
('447288243', 'W11024711', 'W11024711', 'TX01', 'Behavioral Science Associates', 'Rosemary', 'J', 'Stauber', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '359 E Hildebrand', 'San Antonio', 'Bexar', 'TX', '78212', '2108283624', NULL, '359 E Hildebrand', 'San Antonio', 'Bexar', 'TX', '78212', '2108283624', '          ', 'TXMHPHD10', '', '', '0.00', '35.00', '0.00', 3, '2010-03-15', '2014-02-11', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1649382722', 0, 'N', 0, '2014-02-19', NULL, NULL, 0, 0, NULL, NULL),
('870653551', 'W11024712', 'W11024712', 'UT01', 'Park City Healthcare', 'Shari', 'L', 'Bloom', 'PA', 'Family Practice', '', '', NULL, 'B', 'PO Box 572528', 'Salt Lake City', 'Salt Lake', 'UT', '84157', '4356497640', '4356491365', 'PO Box 572528', 'Salt Lake City', 'Salt Lake', 'UT', '84157', '4356497640', '4356491365', 'WURURAL10', 'wUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2010-03-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1053564179', 0, 'Y', 0, '2012-09-06', NULL, NULL, 0, 0, NULL, NULL),
('870653551', 'W11024713', 'W11024713', 'UT01', 'Park City Healthcare', 'Shari', 'L', 'Bloom', 'PA', 'Family Practice', '', '', NULL, 'O', '1665 Bonanza Dr', 'Park City', 'Summit', 'UT', '84060', '4356497640', '4356491365', '1665 Bonanza Dr', 'Park City', 'Summit', 'UT', '84060', '4356497640', '4356491365', 'WURURAL10', 'wUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2010-03-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1053564179', 0, 'N', 0, '2012-09-06', NULL, NULL, 40.6623, -111.5, NULL, NULL),
('870395551', 'W11024714', 'W11024714', 'UT01', NULL, 'Stephanie', 'A', 'Hoglund', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '428 E 2600 N Ste 4', 'North Ogden', 'Weber', 'UT', '84414', '8017820987', '8014440424', '867 E 9400 S', 'Sandy', 'Weber', 'UT', '84094', NULL, NULL, 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', NULL, '55.46', 3, '2000-01-01', '2000-01-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1912118225', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('205958022', 'W11024715', 'W11024715', 'UT01', 'Mountain Land Ivins', 'Adam', 'Boyd', 'Webb', 'PT', 'Physical Therapy', '', '', NULL, 'O', '575 S 200 E Ste 2', 'Ivins', 'Washington', 'UT', '84738', '4356742115', '4356741783', '575 S 200 E Ste 2', 'Ivins', 'Washington', 'UT', '84738', '4356742115', '4356741783', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '68.00', 3, '2010-01-01', '2011-03-31', 0, 0, 0, '', '', '', '', 'HCFA|', '1720180599', 0, 'N', 0, '2013-10-16', NULL, NULL, 0, 0, NULL, NULL),
('205958022', 'W11024716', 'W11024716', 'UT01', 'Mountain Land Mendenhall', 'Ronnie', 'L', 'Mendenhall', 'PT', 'Physical Therapy', '', '', NULL, 'O', '754 S Main Ste 4', 'St George', 'Washington', 'UT', '84770', '4356730191', '4356730192', '754 S Main Ste 4', 'St George', 'Washington', 'UT', '84770', '4356730191', '4356730192', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '68.00', 3, '2010-01-01', '2011-03-31', 0, 0, 0, '', '', '', '', 'HCFA|', '1346310661', 0, 'N', 0, '2011-04-20', NULL, NULL, 0, 0, NULL, NULL),
('202906249', 'W11024717', 'W11024717', 'UT01', 'Advanced Motion Physical Therapy', 'Robert', 'Lance', 'Dougher', 'PT', 'Physical Therapy', NULL, NULL, NULL, 'O', '3665 S 8400 W Ste 210', 'Magna', 'Salt Lake', 'UT', '84044', '8012506733', '8012505038', '3665 S 8400 W Ste 210', 'Magna', 'Salt Lake', 'UT', '84044', '8012506733', '8012505038', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '68.00', 3, '2010-01-01', '2011-03-31', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1669458220', 0, 'N', 0, '2010-03-12', NULL, NULL, 0, 0, NULL, NULL),
('202906249', 'W11024718', 'W11024718', 'UT01', 'Advanced Motion Physical Therapy', 'Daniel', '', 'Mcatee', 'DPT', 'Physical Therapy', '', '', NULL, 'O', '3665 S 8400 W Ste 210', 'Magna', 'Salt Lake', 'UT', '84044', '8012506733', '8012505038', '3665 S 8400 W Ste 210', 'Magna', 'Salt Lake', 'UT', '84044', '8012506733', '8012505038', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '68.00', 3, '2010-01-01', '2011-03-31', 0, 0, 0, '', '', '', '', 'HCFA|', '1215057617', 0, 'N', 0, '2013-09-30', NULL, NULL, 0, 0, NULL, NULL),
('870669626', 'W11024719', 'W11024719', 'UT01', 'ARC Physical Therapy', 'Mike J', '', 'Greenwood', 'PT', 'Physical Therapy', '', '', NULL, 'O', '3785 Harrison Blvd Ste 40', 'Ogden', '', 'UT', '84403', '8017780555', '8017780080', '3785 Harrison Blvd Ste 40', 'Ogden', '', 'UT', '84403', '8017780555', '8017780080', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '68.00', 3, '2010-01-01', '2011-03-31', 0, 0, 0, '', '', '', '', 'HCFA|', '1558343533', 0, 'N', 0, '2011-05-19', 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
('870574059', 'W11024720', 'W11024720', 'UT01', 'Mountain Land Rehabilitation Home', 'Debra', 'G', 'Marton', 'PT', 'Physical Therapy', '', '', NULL, 'O', '1952 E 7000 S Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019423311', '8019425955', '1952 E 7000 S Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019423311', '8019425955', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '68.00', 3, '2010-01-01', '2011-03-31', 0, 0, 0, '', '', '', '', 'HCFA|', '1154588143', 0, 'N', 0, '2013-07-08', NULL, NULL, 0, 0, NULL, NULL),
('870574059', 'W11024721', 'W11024721', 'UT01', 'Mountain Land Rehabilitation Home', 'Michael', NULL, 'Palmieri', 'PT', 'Physical Therapy', '', '', NULL, 'O', '1952 E 7000 S Ste 100', 'Salt Lake City', '', 'UT', '84121', '8019423311', '8019425955', '1952 E 7000 S Ste 100', 'Salt Lake City', '', 'UT', '84121', '8019423311', '8019425955', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '68.00', 3, '2010-01-01', '2010-09-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1679593230', 0, 'N', 0, '2010-03-12', NULL, NULL, 0, 0, NULL, NULL),
('870574059', 'W11024722', 'W11024722', 'ID02', 'Mountain Land Eagle', 'Jeffrey', '', 'Box', 'PT', 'Physical Therapy', '', '', NULL, 'O', '875 E Plaza Dr Ste 103', 'Eagle', 'Ada', 'ID', '83616', '8019423311', '8019455955', '875 E Plaza Dr Ste 103', 'Eagle', 'Ada', 'ID', '83616', '8019423311', '8019455955', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '68.00', 3, '2010-01-01', '2011-03-31', 0, 0, 1, '', '', '', '', 'HCFA|', '1104928258', 0, 'N', 0, '2011-04-20', NULL, NULL, 0, 0, NULL, NULL),
('870574059', 'W11024723', 'W11024723', 'ID02', 'Mountain Land Eagle', 'Faith', 'Virginia', 'Morton', 'DPT', 'Physical Therapy', '', '', NULL, 'O', '875 E Plaza Dr Ste 103', 'Eagle', 'Ada', 'ID', '83616', '8019423311', '8019455955', '875 E Plaza Dr Ste 103', 'Eagle', 'Ada', 'ID', '83616', '8019423311', '8019455955', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '68.00', 3, '2010-01-01', '2010-10-01', 0, 0, 1, NULL, NULL, NULL, NULL, 'HCFA|', '1407025158', 0, 'N', 0, '2010-03-12', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W11024725', 'W11024725', 'ID01', 'Saint Alphonsus Medical Group Family Medicine Dominican', 'Ryan', 'A', 'Moore', 'MD', 'Family Practice', '', '', NULL, 'O', '1118 NW 16th St Ste A', 'Fruitland', 'Payette', 'ID', '83619', '2084526851', '2083676170', '1118 NW 16th St Ste A', 'Fruitland', 'Payette', 'ID', '83619', '2084526851', '2083676170', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2010-03-06', '2012-08-19', 0, 0, 0, 'West Valley Medical Center', NULL, NULL, NULL, 'HCFA|', '1386664654', 0, 'N', 0, '2012-11-15', NULL, NULL, 44.025, -116.928, NULL, NULL),
('820200895', 'W11024726', 'W11024726', 'ID01', 'Dominican Health Services', 'Leck', '', 'Read', 'MD', 'Family Practice', '', '', NULL, 'O', '1118 NW 16th St Ste A', 'Fruitland', 'Payette', 'ID', '83619', '2084526851', '2083676170', '1118 NW 16th St Ste A', 'Fruitland', 'Payette', 'ID', '83619', '2084526851', '2083676170', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2010-03-06', '2011-04-01', 0, 0, 0, '', '', '', '', 'HCFA|', '1316965239', 0, 'N', 0, '2011-06-29', NULL, NULL, 44.025, -116.928, NULL, NULL),
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('820503498', 'W11024803', 'W11024803', 'ID02', 'Craniofacial Pain Center of Idaho', 'Cameron', 'A', 'Kuehne', 'DMD', 'Dentist', 'Sleep Apnea Device', '', NULL, 'O', '8119 Ustick Rd', 'Boise', 'Ada', 'ID', '83704', '2083763600', NULL, '8119 Ustick Rd', 'Boise', 'Ada', 'ID', '83704', '2083763600', '', '', NULL, '', '0.00', '20.00', '0.00', 3, '2010-03-19', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|DEN|', '1013145754', 0, 'n', 0, '2014-05-08', NULL, NULL, 0, 0, NULL, NULL),
('820503498', 'W11024804', 'W11024804', 'ID02', 'Craniofacial Pain Center of Idaho', 'Cameron', 'A', 'Kuehne', 'DMD', 'Dentist', 'Sleep Apnea Device', '', NULL, 'O', '590 Falls Ave', 'Twin Falls', 'Twin Falls', 'ID', '83301', '2083763600', NULL, '590 Falls Ave', 'Twin Falls', 'Twin Falls', 'ID', '83301', '2083763600', '', '', NULL, '', '0.00', '20.00', '0.00', 3, '2010-03-19', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|DEN|', '1013145754', 0, 'n', 0, '2014-05-08', NULL, NULL, 0, 0, NULL, NULL),
('820503498', 'W11024805', 'W11024805', 'ID02', 'Craniofacial Pain Center of Idaho', 'Jamison', 'R', 'Spencer', 'DMD', 'Dentist', 'Sleep Apnea Device', '', NULL, 'O', '8119 Ustick Rd', 'Boise', 'Ada', 'ID', '83704', '2083763600', NULL, '8119 Ustick Rd', 'Boise', 'Ada', 'ID', '83704', '2083763600', '', '', NULL, NULL, '0.00', '20.00', '0.00', 3, '2010-03-19', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|DEN|', '1285654848', 0, 'n', 0, '2012-07-10', NULL, NULL, 0, 0, NULL, NULL),
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('260028886', 'W11024807', 'W11024807', 'UT01', 'Taylor Optical', 'Kurt', 'P', 'Hepworth', 'OD', 'Optometry', '', '', NULL, 'O', '6556 S Big Cottonwood Canyon Rd Ste 400', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012780438', NULL, '6556 S Big Cottonwood Canyon Rd Ste 400', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012780438', '', 'WUTALBERT5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2010-05-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1457531428', 0, 'n', 0, '2012-07-31', NULL, NULL, 40.6309, -111.805, NULL, NULL),
('830327251', 'W11024808', 'W11024808', 'WY01', 'Star Valley Medical Center', 'Christian', 'M', 'Morgan', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 579', 'Afton', 'Lincoln', 'WY', '83110', '3078855817', '', 'PO Box 579', 'Afton', 'Lincoln', 'WY', '83110', '3078855817', '', 'WSTARV', 'wyhcpcs', '', '0.00', '10.00', '0.00', 6, '2010-03-19', NULL, 0, 0, 0, 'Star Valley Medical Center', '', '', '', 'HCFA|UB|', '1457358962', 0, 'Y', 0, '2014-07-24', NULL, NULL, 0, 0, NULL, NULL),
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('942938348', 'W11024810', 'W11024810', 'UTMH1', 'Valley Mental Health  Inc', 'Angelique', 'M', 'Poncelet', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'B', '5965 S 900 E Ste 430', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012637100', NULL, '5965 S 900 E Ste 430', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012637100', '', 'UTVMHMA', NULL, NULL, '0.00', '35.00', '0.00', 6, '2010-03-19', '2013-02-14', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1467775882', 0, 'Y', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W11024811', 'W11024811', 'UT01', 'Davis Comprehensive Health Psychiatric Services', 'Matthew', 'J', 'Gardiner', 'MD', 'Mental Health', 'Psychiatry', '', NULL, 'O', '1600 W Antelope Dr', 'Layton', 'Davis', 'UT', '84041', '8018077377', NULL, '1600 W Antelope Dr', 'Layton', 'Davis', 'UT', '84041', '8018077377', '          ', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-03-19', '2011-09-14', 0, 0, 0, 'Lakeview Hospital', '', '', '', 'HCFA|UB|', '1629084710', 0, 'N', 0, '2014-03-20', 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
('621801973', 'W11024812', 'W11024812', 'UT01', 'Davis Comprehensive Health Psychiatric Services', 'Matthew', 'J', 'Gardiner', 'MD', 'Mental Health', 'Psychiatry', '', NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8018077377', NULL, 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8018077377', '          ', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-03-19', '2011-09-14', 0, 0, 0, 'Lakeview Hospital', '', '', '', 'HCFA|UB|', '1629084710', 0, 'N', 0, '2014-03-20', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W11024813', 'W11024813', 'UT01', 'Davis Comp Health', 'Robert', '', 'Stauffer', 'MD', 'Mental Health', 'Psychiatry', '', NULL, 'O', '1600 W Antelope Dr', 'Layton', 'Davis', 'UT', '84041', '8018077377', NULL, '1600 W Antelope Dr', 'Layton', 'Davis', 'UT', '84041', '8018077377', '          ', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-03-19', '2014-04-30', 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1427109685', 0, 'Y', 0, '2011-11-15', NULL, NULL, 41.0893, -111.995, NULL, NULL),
('621801973', 'W11024814', 'W11024814', 'UT01', 'Davis Comp Health', 'Robert', '', 'Stauffer', 'MD', 'Mental Health', 'Psychiatry', '', NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8018077377', NULL, 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8018077377', '', 'WUSTDINT5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2010-03-19', '2014-04-30', 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1427109685', 0, 'y', 0, '2011-11-15', NULL, NULL, 0, 0, NULL, NULL),
('742915297', 'W11024815', 'W11024815', 'TX01', 'South Texas Oncology and Hematology', 'Ronald', 'L', 'Drengler', 'MD', 'Oncology', '', '', NULL, 'O', '4383 Medical Dr', 'San Antonio', 'Bexar', 'TX', '78229', '2106165700', NULL, '4383 Medical Dr', 'San Antonio', 'Bexar', 'TX', '78229', '2106165700', '', 'TXONCOL', 'TXHCPCS', NULL, '0.00', '50.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, 'North East Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '0000006033', 0, 'N', 0, '2011-07-26', NULL, NULL, 29.511, -98.5709, NULL, NULL),
('810231784', 'W11024816', 'W11024816', 'WYBILLINGS', 'Billings Clinic - Allergy', 'Laura', 'M', 'Moore', 'MD', 'Allergy and Immunology', NULL, NULL, NULL, 'O', '801 N 29th St', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062382805', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', NULL, NULL, '', NULL, NULL, '0.00', '17.00', '0.00', 3, '2010-03-22', NULL, NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1710977822', 0, 'N', 0, '2010-03-23', NULL, NULL, 0, 0, NULL, NULL),
('412212686', 'W11024817', 'W11024817', 'ID02', 'Complex Care Hospital of Idaho', '', '', 'Vibra Hospital of Boise', 'GROUP', 'Long Term Acute Care Facility', '', '', NULL, 'O', '2131 S Bonito Way', 'Meridian', 'Ada', 'ID', '83642', '2084899500', NULL, '2131 S Bonito Way', 'Meridian', 'Ada', 'ID', '83642', '2084899500', '          ', 'IDSTD', '', 'ID01', '0.00', '100.00', '0.00', 3, '2010-04-01', '2013-05-31', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1194908056', 0, 'N', 0, '2013-08-21', NULL, NULL, 0, 0, NULL, NULL),
('412212686', 'W11024818', 'W11024818', 'ID02', 'Complex Care Hospital of Idaho', '', '', 'Vibra Hospital of Boise', 'GROUP', 'Long Term Acute Care Facility', '', '', NULL, 'B', 'PO Box 972693', 'Dallas', 'Dallas', 'TX', '75397', '2084899500', NULL, 'PO Box 972693', 'Dallas', 'Dallas', 'TX', '75397', '2084899500', '          ', '', '', 'ID01', '0.00', '100.00', '0.00', 3, '2010-04-01', '2011-12-11', 1, 0, 1, '', '', '', '', 'HCFA|UB|', '1194908056', 0, 'N', 0, '2013-08-21', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'W11024819', 'W11024819', 'ID02', NULL, 'Benjamin', 'E', 'Jeppe', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '12375 W Chinden Blvd Ste H', 'Boise', 'Ada', 'ID', '83713', '2089397710', '2083220339', '867 E 9400 S', 'Sandy', 'Ada', 'UT', '84094', NULL, NULL, 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', '0.00', '55.46', 3, '2010-03-15', '2010-10-31', 0, 0, 1, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1861672446', 0, 'N', 0, '2010-03-24', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'W11024820', 'W11024820', 'ID02', NULL, 'Frances', 'E', 'De Melo', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '12375 W Chinden Blvd Ste H', 'Boise', 'Ada', 'ID', '83713', '2089397710', '2083220339', '867 E 9400 S', 'Sandy', 'Ada', 'UT', '84094', NULL, NULL, 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', '0.00', '55.46', 3, '2010-03-15', '2010-10-31', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1245271477', 0, 'N', 0, '2010-03-24', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'W11024821', 'W11024821', 'UT01', '', 'Stephanie', 'A', 'Hoglund', 'DC', 'Chiropractic', '', '', NULL, 'O', '428 E 2600 N Ste 4', 'North Ogden', 'Weber', 'UT', '84414', '8017820987', '8017370810', '428 E 2600 N Ste 4', 'North Ogden', 'Weber', 'UT', '84414', '8017820987', '8017370810', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2010-03-01', '2010-06-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1912118225', 0, 'N', 0, '2010-03-24', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'W11024822', 'W11024822', 'UT01', NULL, 'Thomas', 'R', 'Fletcher', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '9300 S 1300 E', 'Sandy', 'Salt Lake', 'UT', '84094', '8015698787', NULL, '867 E 9400 S', 'Sandy', 'Salt Lake', 'UT', '84094', NULL, NULL, 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', '0.00', '55.46', 3, '2010-03-04', '2010-10-31', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1467784181', 0, 'N', 0, '2010-03-24', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W11024823', 'W11024823', 'WYBILLINGS', 'Billings Clinic - Cardiology', 'Robert', NULL, 'Zelman', 'DO', 'Cardovascular Disease', NULL, NULL, NULL, 'O', '1020 N 27th St', 'Billings', 'Yellowstone', 'MT', '59101', '4062382000', '4062382066', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', NULL, NULL, '', NULL, NULL, '0.00', '17.00', '0.00', 3, '2010-03-24', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1669472395', 0, 'N', 0, '2010-03-24', NULL, NULL, 0, 0, NULL, NULL),
('870622942', 'W11024826', 'W11024826', 'UT01', 'Utah Imaging Associates ', '', '', 'Utah Imaging Associates LLC', 'GROUP', 'Imaging Center', 'Mammography', '', NULL, 'O', '3715 W 4100 S Ste 150', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019240029', NULL, '3715 W 4100 S Ste 150', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019240029', '', 'WUUTIMAGE5', NULL, NULL, '0.00', '35.00', '0.00', 3, '2010-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1629076229', 0, 'Y', 0, '2013-04-15', NULL, NULL, 40.682, -111.979, NULL, NULL),
('870622942', 'W11024827', 'W11024827', 'UT01', 'Utah Imaging Associates ', '', '', 'Utah Imaging Associates LLC', 'GROUP', 'Imaging Center', 'Mammography', '', NULL, 'O', '5322 S 400 E', 'Ogden', 'Weber', 'UT', '84405', '8014750800', NULL, '5322 S 400 E', 'Ogden', 'Weber', 'UT', '84405', '8014750800', '', 'WUUTIMAGE5', NULL, NULL, '0.00', '35.00', '0.00', 3, '2010-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1629076229', 0, 'Y', 0, '2013-04-15', NULL, NULL, 41.1654, -111.959, NULL, NULL),
('870480520', 'W11024828', 'W11024828', 'UT01', 'Dept of Neurology School of Medicine U of U', 'Wendy', 'M', 'Rusin', 'APRN', 'General Surgery', 'Neurology', '', NULL, 'B', 'PO Box 413027', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413027', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2010-01-26', '2012-08-09', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1235282872', 0, 'N', 0, '2012-08-10', NULL, NULL, 0, 0, NULL, NULL),
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('311651314', 'W11024897', 'W11024897', 'WY01', 'EBI LLC (Bone Stimulators)', '', '', 'EBI LLC (Bone Stimulators)', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'B', '100 Interpace Pkwy', 'Parsippany', 'Morris', 'NJ', '07054', '9732999300', '          ', '100 Interpace Pkwy', 'Parsippany', 'Morris', 'NJ', '07054', '9732999300', '          ', 'DME80', '', '', '0.00', '35.00', '0.00', 3, '2009-08-01', '2014-03-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1366423220', 0, 'Y', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('311651314', 'W11024898', 'W11024898', 'TX01', 'EBI LLC (Bone Stimulators)', '', '', 'EBI LLC (Bone Stimulators)', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'B', '100 Interpace Pkwy', 'Parsippany', 'Morris', 'NJ', '07054', '9732999300', '          ', '100 Interpace Pkwy', 'Parsippany', 'Morris', 'NJ', '07054', '9732999300', '          ', 'DME80', '', '', '0.00', '35.00', '0.00', 3, '2009-08-01', '2014-03-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1366423220', 0, 'Y', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('311651314', 'W11024899', 'W11024899', 'ID02', 'EBI LLC (Bone Stimulators)', '', '', 'EBI LLC (Bone Stimulators)', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'B', '100 Interpace Pkwy', 'Parsippany', 'Morris', 'NJ', '07054', '9732999300', '          ', '100 Interpace Pkwy', 'Parsippany', 'Morris', 'NJ', '07054', '9732999300', '          ', 'DME80', '', '', '0.00', '35.00', '0.00', 3, '2009-08-01', '2014-03-31', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1366423220', 0, 'Y', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('743134250', 'W11024900', 'W11024900', 'UT01', 'Pediatric Critical Care-Department of University of Utah', 'Mara', 'B', 'Chavolla-Calderon', 'MD', 'Pediatric Internal Medicine', 'Pediatrics', 'Pediatric Critical Care', NULL, 'B', 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2009-09-01', '2012-07-26', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1487889747', 0, 'N', 0, '2013-01-22', NULL, NULL, 0, 0, NULL, NULL),
('743134250', 'W11024901', 'W11024901', 'UT01', 'University Health Care', 'Mara', 'B', 'Chavolla-Calderon', 'MD', 'Pediatric Internal Medicine', 'Pediatrics', 'Pediatric Critical Care', NULL, 'O', '100 Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016622402', NULL, '100 Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016622402', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2009-09-01', '2012-07-26', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1487889747', 0, 'N', 0, '2013-01-22', NULL, NULL, 0, 0, NULL, NULL),
('205977241', 'W11024902', 'W11024902', 'TX01', 'Toyota Family Health Center', '', '', 'Toyota Family Health Center', 'GROUP', '', '', '', NULL, 'B', '205 Miller Spring Ct', 'Franklin', 'Williamson', 'TN', '37064', '2102635700', NULL, '205 Miller Spring Ct', 'Franklin', 'Williamson', 'TN', '37064', '2102635700', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2007-07-01', '2010-04-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009153', 0, 'N', 0, '2010-11-05', NULL, NULL, 0, 0, NULL, NULL),
('205977241', 'W11024903', 'W11024903', 'TX01', 'Toyota Family Health Center', 'Jeanne', 'D', 'Thacker', 'FNP', 'Family Practice', '', '', NULL, 'O', '1 Lone Star Pass Bldg 46', 'San Antonio', 'Bexar', 'TX', '78264', '2102635700', NULL, '1 Lone Star Pass Bldg 46', 'San Antonio', 'Bexar', 'TX', '78264', '2102635700', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2010-04-01', '2010-10-21', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1962479774', 0, 'Y', 0, '2010-10-26', NULL, NULL, 0, 0, NULL, NULL),
('205977241', 'W11024904', 'W11024904', 'TX01', 'Toyota Family Health Center', 'Lillian', 'E', 'Perez', 'DO', 'Family Practice', '', '', NULL, 'O', '1 Lone Star Pass Bldg 46', 'San Antonio', 'Bexar', 'TX', '78264', '2102635700', NULL, '1 Lone Star Pass Bldg 46', 'San Antonio', 'Bexar', 'TX', '78264', '2102635700', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2010-04-01', '2012-08-19', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1710925805', 0, 'Y', 0, '2013-07-25', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W11024905', 'W11024905', 'UT01', 'Davis Comp Health', 'William', 'A', 'Forsyth', 'MD', 'Mental Health', 'Psychiatry', '', NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8018077377', NULL, 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8018077377', '          ', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-03-25', '2011-09-14', 0, 0, 0, 'Davis Hospital', '', '', '', 'HCFA|UB|', '1467440669', 0, 'N', 0, '2012-12-28', 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
('621801973', 'W11024906', 'W11024906', 'UT01', 'Davis Comp Health', 'William', 'A', 'Forsyth', 'MD', 'Mental Health', 'Psychiatry', '', NULL, 'O', '1600 W Antelope Dr', 'Layton', 'Davis', 'UT', '84041', '8018077377', NULL, '1600 W Antelope Dr', 'Layton', 'Davis', 'UT', '84041', '8018077377', '          ', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-03-25', '2011-09-14', 0, 0, 0, 'Davis Hospital', '', '', '', 'HCFA|UB|', '1467440669', 0, 'N', 0, '2012-12-28', NULL, NULL, 0, 0, NULL, NULL),
('271414479', 'W11024907', 'W11024907', 'ID02', '', 'Stephanie', 'L', 'Hauser', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '6203 W Franklin Rd', 'Boise', 'Ada', 'ID', '83709', '2089493056', NULL, '6203 W Franklin Rd', 'Boise', 'Ada', 'ID', '83709', '2089493056', '          ', 'IDMA', '', '', '0.00', '35.00', '0.00', 3, '2010-02-01', '2013-02-14', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1316042799', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('205067728', 'W11024908', 'W11024908', 'WY01', 'Mountain View Regional Hospital', '', '', 'Mountain View Regional Hospital', 'GROUP', 'Hospital', '', '', NULL, 'O', '6550 E 2nd St', 'Casper', 'Natrona', 'WY', '82609', '3074738499', NULL, '6550 E 2nd St', 'Casper', 'Natrona', 'WY', '82609', '3074738499', '', '', NULL, NULL, '0.00', '15.00', '0.00', 3, '2010-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000013030', 0, 'n', 0, '2012-11-19', NULL, NULL, 42.8398, -106.227, NULL, NULL),
('205067728', 'W11024909', 'W11024909', 'WY01', 'Mountain View Regional Hospital', '', '', 'Mountain View Regional Hospital', 'GROUP', 'Hospital', '', '', NULL, 'B', 'PO Box 51888', 'Casper', 'Natrona', 'WY', '82609', '3079958105', NULL, 'PO Box 51888', 'Casper', 'Natrona', 'WY', '82609', '3079958105', '', '', NULL, NULL, '0.00', '15.00', '0.00', 3, '2010-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000013030', 0, 'y', 0, '2012-11-19', NULL, NULL, 0, 0, NULL, NULL),
('841394018', 'W11024910', 'W11024910', 'UTMH1', 'San Juan Counseling', 'Craig', 'R', 'Herzog', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '356 S Main St', 'Blanding', 'San Juan', 'UT', '84511', '4356782992', NULL, '356 S Main St', 'Blanding', 'San Juan', 'UT', '84511', '4356782992', '', 'UTMA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2010-03-31', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1639365026', 0, 'n', 0, '2012-02-24', NULL, NULL, 0, 0, NULL, NULL),
('841394018', 'W11024911', 'W11024911', 'UTMH1', 'San Juan Counseling', 'Lauren', 'S', 'Mitchell Fife', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '356 S Main St', 'Blanding', 'San Juan', 'UT', '84511', '4356782992', NULL, '356 S Main St', 'Blanding', 'San Juan', 'UT', '84511', '4356782992', '', 'UTMA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2010-03-31', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1609006915', 0, 'n', 0, '2014-02-27', NULL, NULL, 0, 0, NULL, NULL),
('270851585', 'W11024913', 'W11024913', 'UT01', 'Utah Hearing and Balance', 'Molly', 'M', 'Leroy', 'AUD', 'Audiology', '', '', NULL, 'O', '1588 E 3300 S', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8012056207', NULL, '1588 E 3300 S', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8012056207', '', 'WISESTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2010-04-10', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1033442959', 0, 'n', 0, '2014-01-17', NULL, NULL, 0, 0, NULL, NULL),
('870365095', 'W11024914', 'W11024914', 'UT01', 'Cedar City Paiute Medical Clinic', 'William', 'S', 'Albrecht', 'OD', 'Optometry', '', '', NULL, 'O', '440 N Paiute Dr', 'Cedar City', 'Iron', 'UT', '84721', '4358671520', NULL, '440 N Paiute Dr', 'Cedar City', 'Iron', 'UT', '84721', '4358671520', '', 'WISESTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2010-04-10', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1427140417', 0, 'n', 0, '2013-11-06', NULL, NULL, 37.683, -113.059, NULL, NULL),
('870365095', 'W11024915', 'W11024915', 'UT01', 'Kanosh Paiute Medical Clinic', 'William', 'S', 'Albrecht', 'OD', 'Optometry', '', '', NULL, 'O', '157 N Reservation Dr', 'Kanosh', 'Millard', 'UT', '84637', '4357592610', NULL, '157 N Reservation Dr', 'Kanosh', 'Millard', 'UT', '84637', '4357592610', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-04-10', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1427140417', 0, 'N', 0, '2013-11-06', NULL, NULL, 38.8012, -112.438, NULL, NULL),
('870365095', 'W11024916', 'W11024916', 'UT01', 'Koosharem Paiute Medical Clinic', 'William', 'S', 'Albrecht', 'OD', 'Optometry', '', '', NULL, 'O', '826 N 100 E', 'Richfield', 'Sevier', 'UT', '84701', '4358930977', NULL, '826 N 100 E', 'Richfield', 'Sevier', 'UT', '84701', '4358930977', '', 'WISESTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2010-04-10', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1427140417', 0, 'n', 0, '2013-11-06', NULL, NULL, 38.7891, -112.08, NULL, NULL),
('870365095', 'W11024917', 'W11024917', 'UT01', 'Shivwits Paiute Medical Clinic', 'William', 'S', 'Albrecht', 'OD', 'Optometry', '', '', NULL, 'O', '6109 W 3700 N', 'Ivins', 'Washington', 'UT', '84738', '4356888198', NULL, '6109 W 3700 N', 'Ivins', 'Washington', 'UT', '84738', '4356888198', '', 'WISESTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2010-04-10', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1427140417', 0, 'n', 0, '2013-11-06', NULL, NULL, 37.187, -113.733, NULL, NULL),
('810231784', 'W11024918', 'W11024918', 'WYBILLINGS', 'Billings Clinic - Orthopedics & Sports Medicine', 'Erik', NULL, 'Digby', 'PT', 'Physical Therapy', '', '', NULL, 'O', '2702 8th Ave N', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4066573782', '2702 8th Ave N', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4066573782', '', '', '', '0.00', '17.00', '0.00', 3, '2010-04-02', '2010-07-03', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1710201728', 0, 'N', 0, '2010-04-02', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W11024919', 'W11024919', 'WYBILLINGS', 'Billings Clinic - Cardiology', 'Wayne', NULL, 'Cheng', 'MD', 'Cardovascular Disease', NULL, NULL, NULL, 'O', '1020 N 27th St', 'Billings', 'Yellowstone', 'MT', '59101', '4062382000', '4062382066', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', NULL, NULL, '', NULL, NULL, '0.00', '17.00', '0.00', 3, '2010-04-02', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1881783074', 0, 'N', 0, '2010-04-06', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W11024920', 'W11024920', 'WYBILLINGS', 'Billings Clinic - Miles City Clinic', 'Nancie', 'L', 'Nordwick', 'MD', 'Pediatrics', '', '', NULL, 'O', '620 S Haynes', 'Miles City', 'Custer', 'MT', '59301', '4062337000', NULL, '620 S Haynes', 'Miles City', 'Custer', 'MT', '59301', '4062337000', '          ', '', '', '', '0.00', '17.00', '0.00', 3, '2010-04-02', '2010-06-09', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1952380404', 0, 'N', 0, '2010-04-06', NULL, NULL, 0, 0, NULL, NULL),
('870685140', 'W11024951', 'W11024951', 'UT01', 'UNI Home Project', '', '', 'UNI Home Project', 'GROUP', 'Mental Health', '', '', NULL, 'B', 'PO Box 30294', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8015873103', NULL, 'PO Box 30294', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8015873103', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2007-01-01', '2012-09-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009270', 0, 'N', 0, '2012-10-01', NULL, NULL, 0, 0, NULL, NULL),
('876000525', 'W11024961', 'W11024961', 'UT01', 'University of Utah Hospital', 'Rebecca', NULL, 'Good', 'OT', 'Occupational Therapy', NULL, NULL, NULL, 'B', 'PO Box 510721', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8015873422', NULL, NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, '', NULL, '1', '0.00', '0.00', '0.00', 6, '2009-11-05', NULL, NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '0000003015', 0, 'Y', 0, '2010-04-06', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W11024921', 'W11024921', 'WYBILLINGS', 'Billings Clinic - Pathology', 'Ronald', 'L', 'Linfesty', 'MD', 'Pathology', '', '', NULL, 'O', '2800 10th Ave N', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4066574349', '2800 10th Ave N', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4066574349', '', NULL, NULL, '0.00', '17.00', '0.00', 3, '2010-03-31', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1972583045', 0, 'N', 0, '2013-07-09', NULL, NULL, 0, 0, NULL, NULL),
('820455497', 'W11024922', 'W11024922', 'Sinclair', '(Sinclair Health Services\rProvider) Wood River Counseling Center', 'Sally', 'E', 'McCollum', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '220 Second Ave S', 'Hailey', 'Blaine', 'ID', '83333', '2087885625', NULL, '220 Second Ave S', 'Hailey', 'Blaine', 'ID', '83333', '2087885625', '', '', NULL, NULL, '0.00', '10.00', '0.00', 3, '2010-04-05', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1609984210', 0, 'n', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('820455497', 'W11024923', 'W11024923', 'Sinclair', '(Sinclair Health Services\rProvider) ', 'Sally', 'E', 'McCollum', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '171 W First St Ste 1', 'Ketchum', 'Blaine', 'ID', '83340', '2087268926', NULL, '171 W First St Ste 1', 'Ketchum', 'Blaine', 'ID', '83340', '2087268926', '', '', NULL, NULL, '0.00', '10.00', '0.00', 3, '2010-04-05', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1609984210', 0, 'n', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('870567427', 'W11024924', 'W11024924', 'UT01', 'U of U Emergency Physicians', 'Christy', 'L', 'Hopkins', 'MD', 'Emergency Medicine', '', '', NULL, 'B', 'PO Box 510726', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8012133800', NULL, 'PO Box 510726', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8012133800', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2006-08-01', '2012-09-19', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1558451161', 0, 'Y', 0, '2012-09-19', NULL, NULL, 0, 0, NULL, NULL),
('870567427', 'W11024925', 'W11024925', 'UT01', 'University Health Care', 'Christy', 'L', 'Hopkins', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015812292', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015812292', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2006-08-01', '2012-09-19', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1558451161', 0, 'N', 0, '2012-09-19', NULL, NULL, 0, 0, NULL, NULL),
('876000525', 'W11024926', 'W11024926', 'UT01', 'University of Utah Hospital', 'Amber', NULL, 'Mann', 'OT', 'Occupational Therapy', NULL, NULL, NULL, 'B', 'PO Box 510721', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8015812121', NULL, NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, '', NULL, '1', '0.00', '0.00', '0.00', 6, '2010-01-26', NULL, 1, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1801025499', 0, 'Y', 0, '2010-04-06', NULL, NULL, 0, 0, NULL, NULL),
('876000525', 'W11024927', 'W11024927', 'UT01', 'University Health Care', 'Amber', NULL, 'Mann', 'OT', 'Occupational Therapy', NULL, NULL, NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015812121', NULL, NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, '', NULL, '1', '0.00', '0.00', '0.00', 6, '2010-01-26', NULL, 1, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1801025499', 0, 'N', 0, '2010-04-06', NULL, NULL, 40.7685, -111.837, NULL, NULL),
('870685140', 'W11024928', 'W11024928', 'UT01', 'UNI Home Project', 'Rhonda', 'G', 'Lee', 'PA', 'Obstetrics and Gynecology', 'Physician Assistant', '', NULL, 'B', 'PO Box 30294', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8015873103', NULL, 'PO Box 30294', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8015873103', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-01-20', '2012-09-18', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1174583793', 0, 'N', 0, '2012-09-18', NULL, NULL, 0, 0, NULL, NULL),
('870685140', 'W11024929', 'W11024929', 'UT01', 'University Health Care', 'Rhonda', 'G', 'Lee', 'PA', 'Obstetrics and Gynecology', 'Physician Assistant', '', NULL, 'O', '650 S Komas Dr Ste 200', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015853828', NULL, '650 S Komas Dr Ste 200', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015853828', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-01-20', '2012-09-18', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1174583793', 0, 'N', 0, '2012-09-18', NULL, NULL, 0, 0, NULL, NULL),
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('201391282', 'W11025001', 'W11025001', 'WY01', 'Thunder Basin Orthopedics and Sports Medicine', 'Patrick', 'C', 'Robertson', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '111 S 5th St', 'Douglas', 'Converse', 'WY', '82633', '3073586200', NULL, '111 S 5th St', 'Douglas', 'Converse', 'WY', '82633', '3073586200', '          ', 'WYORTHO10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-04-09', '2013-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1194715037', 0, 'N', 0, '2014-01-03', NULL, NULL, 0, 0, NULL, NULL);
INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
('287467577', 'W11025002', 'W11025002', 'Sinclair', '(Sinclair Health Services\rProvider) Wood River Counseling Center', 'Frank', 'M', 'Andrews', 'PHD', 'Mental Health', 'Psychology', 'Pediatric Psychology', NULL, 'O', '220 2nd Ave S', 'Hailey', 'Blaine', 'ID', '83333', '2087885625', NULL, '220 2nd Ave S', 'Hailey', 'Blaine', 'ID', '83333', '2087885625', '', '', NULL, NULL, '0.00', '20.00', '0.00', 3, '2010-04-09', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1053461186', 0, 'n', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('742047021', 'W11025003', 'W11025003', 'TX01', 'Central Texas Allergy and Asthma', 'Priyanka', '', 'Gupta', 'MD', 'Allergy and Immunology', '', '', NULL, 'O', '705  Landa St Ste F', 'New Braunfels', 'Comal', 'TX', '78130', '8306257612', NULL, '705  Landa St', 'New Braunfels', 'Comal', 'TX', '78130', '8306257612', '', 'TXSTD', 'TXHCPCS', NULL, '0.00', '50.00', '0.00', 3, '2010-04-09', '2012-08-19', NULL, 0, 0, 'North East Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1346281839', 0, 'N', 0, '2010-09-13', NULL, NULL, 29.7008, -98.1437, NULL, NULL),
('742047021', 'W11025004', 'W11025004', 'TX01', 'Central Texas Allergy and Asthma', 'Priyanka', '', 'Gupta', 'MD', 'Allergy and Immunology', '', '', NULL, 'O', '12501 Judson Rd Ste 202', 'San Antonio', 'Bexar', 'TX', '78233', '2106540944', NULL, '705  Landa St', 'New Braunfels', 'Bexar', 'TX', '78130', '2106540944', '', 'TXSTD', 'TXHCPCS', NULL, '0.00', '50.00', '0.00', 3, '2010-04-09', '2012-08-19', NULL, 0, 0, 'North East Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1346281839', 0, 'N', 0, '2010-09-13', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W11025005', 'W11025005', 'UT01', 'Central Utah Clinic', 'Erica', 'C', 'Nelson', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8017565288', NULL, 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8017565288', '', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-04-09', '2010-07-14', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1386974525', 0, 'Y', 0, '2014-05-28', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W11025006', 'W11025006', 'UT01', 'Central Utah Clinic', 'Erica', 'C', 'Nelson', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1886 W 800 N', 'Pleasant Grove', 'Utah', 'UT', '84062', '8017565288', NULL, '1886 W 800 N', 'Pleasant Grove', 'Utah', 'UT', '84062', '8017565288', '', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-04-09', '2010-07-14', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1386974525', 0, 'N', 0, '2014-05-28', NULL, NULL, 0, 0, NULL, NULL),
('264333033', 'W11025007', 'W11025007', 'TX01', 'Consultants in Womens Health', 'Adrienne', 'W', 'Askew', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '1210 Arion Pkwy', 'San Antonio', 'Bexar', 'TX', '78216', '2103499300', NULL, '1210 Arion Pkwy', 'San Antonio', 'Bexar', 'TX', '78216', '2103499300', '', 'TXOBG', 'TXHCPCS', NULL, '0.00', '50.00', '0.00', 3, '2010-04-09', '2012-08-19', 0, 0, 0, 'North Central Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1861699456', 0, 'y', 0, '2013-08-27', NULL, NULL, 0, 0, NULL, NULL),
('264333033', 'W11025008', 'W11025008', 'TX01', 'Institute for Womens Health', 'Adrienne', 'W', 'Askew', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1303 McCullough Ave Ste GL70', 'San Antonio', 'Bexar', 'TX', '78212', '2102269705', NULL, '1303 McCullough Ave Ste GL70', 'San Antonio', 'Bexar', 'TX', '78212', '2102269705', '', 'TXOBG', 'TXHCPCS', NULL, '0.00', '50.00', '0.00', 3, '2010-04-09', '2012-08-19', 0, 0, 0, 'North Central Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1861699456', 0, 'N', 0, '2013-08-27', NULL, NULL, 29.4412, -98.4924, NULL, NULL),
('264333033', 'W11025009', 'W11025009', 'TX01', 'Consultants in Womens Health', 'Adrienne', 'W', 'Askew', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '540 Madison Oak Dr Ste 450', 'San Antonio', 'Bexar', 'TX', '78258', '2104942000', NULL, '540 Madison Oak Dr Ste 450', 'San Antonio', 'Bexar', 'TX', '78258', '2104942000', '', 'TXOBG', 'TXHCPCS', NULL, '0.00', '50.00', '0.00', 3, '2010-04-09', '2012-08-19', 0, 0, 0, 'North Central Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1861699456', 0, 'N', 0, '2013-08-27', NULL, NULL, 29.6203, -98.4928, NULL, NULL),
('826003449', 'W11025010', 'W11025010', 'UT01', '', 'Jacob', 'K', 'Curtis', 'DO', 'Family Practice', 'Obstetrics and Gynecology', '', NULL, 'O', '43 N 1st E', 'Preston', 'Franklin', 'ID', '83263', '2088529355', NULL, '43 N 1st E', 'Preston', 'Franklin', 'ID', '83263', '2088529355', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-04-09', NULL, 0, 0, 0, 'Franklin County Medical Center ', NULL, NULL, NULL, 'HCFA|UB|', '1770684003', 0, 'N', 0, '2013-12-10', NULL, NULL, 42.0971, -111.874, NULL, NULL),
('870653551', 'W11025011', 'W11025011', 'UT01', 'Park City Healthcare', 'Ranae', 'Lynn', 'Power', 'APRN', 'Family Practice', '', '', NULL, 'B', 'PO Box 572528', 'Salt Lake City', 'Salt Lake', 'UT', '84157', '4356497640', '4356491365', 'PO Box 572528', 'Salt Lake City', 'Salt Lake', 'UT', '84157', '4356497640', '4356491365', 'WURURAL10', 'wUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2010-04-15', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1770540783', 0, 'Y', 0, '2013-10-23', NULL, NULL, 0, 0, NULL, NULL),
('870653551', 'W11025012', 'W11025012', 'UT01', 'Park City Healthcare', 'Ranae', 'Lynn', 'Power', 'APRN', 'Family Practice', '', '', NULL, 'O', '1665 Bonanza Dr', 'Park City', 'Summit', 'UT', '84060', '4356497640', '4356491365', '1665 Bonanza Dr', 'Park City', 'Summit', 'UT', '84060', '4356497640', '4356491365', 'WURURAL10', 'wUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2010-04-15', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1770540783', 0, 'N', 0, '2013-10-23', NULL, NULL, 40.6623, -111.5, NULL, NULL),
('261741164', 'W11025013', 'W11025013', 'UT01', 'Southern Kidney & Hypertension Institute ', 'Carlos', 'A', 'Mercado', 'MD', 'Nephrology', '', '', NULL, 'O', '1173 S 250 W Ste 402', 'St George', 'Washington', 'UT', '84770', '4356521135', NULL, '1173 S 250 W Ste 402', 'St George', 'Washington', 'UT', '84770', '4356521135', '', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-04-15', NULL, 0, 0, 0, 'Dixie Regional Medical Center', '', '', '', 'HCFA|UB|', '1366444051', 0, 'N', 0, '2014-05-17', NULL, NULL, 37.1151, -113.593, NULL, NULL),
('261741164', 'W11025014', 'W11025014', 'UT01', 'Southern Kidney & Hypertension Institute ', 'Carlos', 'A', 'Mercado', 'MD', 'Nephrology', '', '', NULL, 'B', 'PO Box 10348', 'Uniondale', 'Nassau', 'NY', '11555', '4356521135', NULL, 'PO Box 10348', 'Uniondale', 'Nassau', 'NY', '11555', '4356521135', '', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-04-15', NULL, 0, 0, 0, 'Dixie Regional Medical Center', '', '', '', 'HCFA|UB|', '1366444051', 0, 'N', 0, '2014-05-17', NULL, NULL, 0, 0, NULL, NULL),
('208920300', 'W11025015', 'W11025015', 'UT01', 'Kidney and Hypertension Institute of Utah PLLC', 'Hamid', 'A', 'Mian', 'MD', 'Nephrology', '', '', NULL, 'O', '4780 Old Post Rd', 'Ogden', 'Weber', 'UT', '84403', '8014763400', NULL, '4780 Old Post Rd', 'Ogden', 'Weber', 'UT', '84403', '8014763400', '', 'WISESTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2010-04-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1871520387', 0, 'n', 0, '2013-07-09', NULL, NULL, 41.1764, -111.948, NULL, NULL),
('208920300', 'W11025016', 'W11025016', 'UT01', 'Kidney and Hypertension Institute of Utah PLLC', 'Hamid', 'A', 'Mian', 'MD', 'Nephrology', '', '', NULL, 'B', 'PO Box 10273', 'Uniondale', 'Nassau', 'NY', '11555', '8014763400', NULL, 'PO Box 10273', 'Uniondale', 'Nassau', 'NY', '11555', '8014763400', '', 'WISESTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2010-04-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1871520387', 0, 'y', 0, '2013-07-09', NULL, NULL, 0, 0, NULL, NULL),
('208920300', 'W11025017', 'W11025017', 'UT01', 'Kidney and Hypertension Institute of Utah PLLC', 'Robert', 'J', 'Leach', 'MD', 'Nephrology', NULL, NULL, NULL, 'B', 'PO Box 10273', 'Uniondale', 'Nassau', 'NY', '11555', '8017793500', NULL, '2132 N 1700 W', 'Layton', 'Nassau', 'UT', '84041', NULL, NULL, 'WISESTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2010-04-15', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1114910411', 0, 'y', 0, '2010-04-12', NULL, NULL, 0, 0, NULL, NULL),
('208920300', 'W11025018', 'W11025018', 'UT01', 'Kidney and Hypertension Institute of Utah PLLC', 'Robert', 'J', 'Leach', 'MD', 'Nephrology', NULL, NULL, NULL, 'O', '2132 N 1700 W Ste 110', 'Layton', 'Davis', 'UT', '84041', '8017793500', NULL, '2132 N 1700 W', 'Layton', 'Davis', 'UT', '84041', NULL, NULL, 'WISESTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2010-04-15', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1114910411', 0, 'N', 0, '2010-04-12', NULL, NULL, 41.0892, -111.997, NULL, NULL),
('870554446', 'W11025019', 'W11025019', 'UTPEHP', 'Therapy West', 'Derek', 'Cornell', 'Overly', 'PT', 'Physical Therapy', '', '', NULL, 'B', 'PO Box 396', 'Gunnison', 'Sanpete', 'UT', '84634', '4355287575', NULL, 'PO Box 396', 'Gunnison', 'Sanpete', 'UT', '84634', NULL, NULL, 'WESTREHAB', 'WUSTDHCPC5', NULL, '0.00', '0.00', '68.00', 3, '2010-03-01', NULL, NULL, 0, 0, '', '', '', '', 'HCFA|', '1326092339', 0, 'Y', 0, '2010-04-12', NULL, NULL, 0, 0, NULL, NULL),
('870554446', 'W11025020', 'W11025020', 'UTPEHP', 'Therapy West', 'Derek', 'Cornell', 'Overly', 'PT', 'Physical Therapy', '', '', NULL, 'O', '13 E Ctr St', 'Gunnison', 'Sanpete', 'UT', '84634', '4355287575', NULL, 'PO Box 396', 'Gunnison', 'Sanpete', 'UT', '84634', NULL, NULL, 'WESTREHAB', 'WUSTDHCPC5', NULL, '0.00', '0.00', '68.00', 3, '2010-03-01', NULL, NULL, 0, 0, '', '', '', '', 'HCFA|', '1326092339', 0, 'N', 0, '2010-04-12', NULL, NULL, 0, 0, NULL, NULL),
('870554446', 'W11025021', 'W11025021', 'UTPEHP', 'Therapy West', 'Derek', 'Cornell', 'Overly', 'PT', 'Physical Therapy', '', '', NULL, 'O', '1050 S Medical Dr', 'Mt Pleasant', 'Sanpete', 'UT', '84647', '4354620178', NULL, 'PO Box 396', 'Gunnison', 'Sanpete', 'UT', '84634', NULL, NULL, 'WESTREHAB', 'WUSTDHCPC5', NULL, '0.00', '0.00', '68.00', 3, '2010-03-01', NULL, NULL, 0, 0, '', '', '', '', 'HCFA|', '1326092339', 0, 'N', 0, '2010-04-12', NULL, NULL, 0, 0, NULL, NULL),
('870554446', 'W11025022', 'W11025022', 'UTPEHP', 'Therapy West', 'Joseph', 'E', 'Howe', 'PT', 'Physical Therapy', NULL, NULL, NULL, 'B', 'PO Box 396', 'Gunnison', 'Sanpete', 'UT', '84634', '4355287575', NULL, 'PO Box 396', 'Gunnison', 'Sanpete', 'UT', '84634', NULL, NULL, 'WESTREHAB', 'WUSTDHCPC5', NULL, '0.00', '0.00', '68.00', 3, '2010-03-01', NULL, NULL, 0, 0, '', '', '', '', 'HCFA|', '1861444952', 0, 'Y', 0, '2010-04-12', NULL, NULL, 0, 0, NULL, NULL),
('870554446', 'W11025023', 'W11025023', 'UTPEHP', 'Therapy West', 'Joseph', 'E', 'Howe', 'PT', 'Physical Therapy', NULL, NULL, NULL, 'O', '59 W 700 S', 'Ephraim', 'Sanpete', 'UT', '84627', '4352836334', NULL, 'PO Box 396', 'Gunnison', 'Sanpete', 'UT', '84634', NULL, NULL, 'WESTREHAB', 'WUSTDHCPC5', NULL, '0.00', '0.00', '68.00', 3, '2010-03-01', NULL, NULL, 0, 0, '', '', '', '', 'HCFA|', '1861444952', 0, 'N', 0, '2010-04-12', NULL, NULL, 0, 0, NULL, NULL),
('870554446', 'W11025024', 'W11025024', 'UTPEHP', 'Therapy West', 'Joseph', 'E', 'Howe', 'PT', 'Physical Therapy', NULL, NULL, NULL, 'O', '128 S 300 W', 'Bicknell', 'Wayne', 'UT', '84715', '4354253719', NULL, 'PO Box 396', 'Gunnison', 'Wayne', 'UT', '84634', NULL, NULL, 'WESTREHAB', 'WUSTDHCPC5', NULL, '0.00', '0.00', '68.00', 3, '2010-03-01', NULL, NULL, 0, 0, '', '', '', '', 'HCFA|', '1861444952', 0, 'N', 0, '2010-04-12', NULL, NULL, 0, 0, NULL, NULL),
('870554446', 'W11025025', 'W11025025', 'UTPEHP', 'Therapy West', 'Benjamin', 'Ray', 'Robinson', 'DPT', 'Physical Therapy', NULL, NULL, NULL, 'B', 'PO Box 396', 'Gunnison', 'Sanpete', 'UT', '84634', '4355287575', NULL, 'PO Box 396', 'Gunnison', 'Sanpete', 'UT', '84634', NULL, NULL, 'WESTREHAB', 'WUSTDHCPC5', NULL, '0.00', '0.00', '68.00', 3, '2010-03-01', NULL, NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1386729556', 0, 'Y', 0, '2010-04-12', NULL, NULL, 0, 0, NULL, NULL),
('870554446', 'W11025026', 'W11025026', 'UTPEHP', 'Therapy West', 'Benjamin', 'Ray', 'Robinson', 'DPT', 'Physical Therapy', NULL, NULL, NULL, 'O', '1050 S Medical Dr', 'Mt Pleasant', 'Sanpete', 'UT', '84647', '4354620178', NULL, 'PO Box 396', 'Gunnison', 'Sanpete', 'UT', '84634', NULL, NULL, 'WESTREHAB', 'WUSTDHCPC5', NULL, '0.00', '0.00', '68.00', 3, '2010-03-01', NULL, NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1386729556', 0, 'N', 0, '2010-04-12', NULL, NULL, 0, 0, NULL, NULL),
('870554446', 'W11025027', 'W11025027', 'UTPEHP', 'Therapy West', 'Benjamin', 'Ray', 'Robinson', 'DPT', 'Physical Therapy', NULL, NULL, NULL, 'O', '59 W 700 S', 'Ephraim', 'Sanpete', 'UT', '84627', '4352836334', NULL, 'PO Box 396', 'Gunnison', 'Sanpete', 'UT', '84634', NULL, NULL, 'WESTREHAB', 'WUSTDHCPC5', NULL, '0.00', '0.00', '68.00', 3, '2010-03-01', NULL, NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1386729556', 0, 'N', 0, '2010-04-12', NULL, NULL, 0, 0, NULL, NULL),
('870554446', 'W11025028', 'W11025028', 'UTPEHP', 'Therapy West', 'Dallas', 'Clayton', 'Overly', 'PT', 'Physical Therapy', '', '', NULL, 'B', 'PO Box 396', 'Gunnison', 'Sanpete', 'UT', '84634', '4355287575', NULL, 'PO Box 396', 'Gunnison', 'Sanpete', 'UT', '84634', NULL, NULL, 'WESTREHAB', 'WUSTDHCPC5', NULL, '0.00', '0.00', '68.00', 3, '2010-03-01', NULL, NULL, 0, 0, '', '', '', '', 'HCFA|', '1558317743', 0, 'Y', 0, '2010-04-12', NULL, NULL, 0, 0, NULL, NULL),
('870554446', 'W11025029', 'W11025029', 'UTPEHP', 'Therapy West', 'Dallas', 'Clayton', 'Overly', 'PT', 'Physical Therapy', '', '', NULL, 'O', '13 E Ctr St', 'Gunnison', 'Sanpete', 'UT', '84634', '4355287575', NULL, 'PO Box 396', 'Gunnison', 'Sanpete', 'UT', '84634', NULL, NULL, 'WESTREHAB', 'WUSTDHCPC5', NULL, '0.00', '0.00', '68.00', 3, '2010-03-01', NULL, NULL, 0, 0, '', '', '', '', 'HCFA|', '1558317743', 0, 'N', 0, '2010-04-12', NULL, NULL, 0, 0, NULL, NULL),
('870554446', 'W11025030', 'W11025030', 'UTPEHP', 'Therapy West', 'Dallas', 'Clayton', 'Overly', 'PT', 'Physical Therapy', '', '', NULL, 'O', '128 S 300 W', 'Bicknell', 'Wayne', 'UT', '84715', '4354253719', NULL, 'PO Box 396', 'Gunnison', 'Wayne', 'UT', '84634', NULL, NULL, 'WESTREHAB', 'WUSTDHCPC5', NULL, '0.00', '0.00', '68.00', 3, '2010-03-01', NULL, NULL, 0, 0, '', '', '', '', 'HCFA|', '1558317743', 0, 'N', 0, '2010-04-12', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W11025031', 'W11025031', 'UT01', 'Rocky Mountain Womens Health Center at West Valley Campus', 'Theresa (Tina)', 'M', 'Fought', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019643865', NULL, 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019643865', '          ', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-04-15', '2014-04-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1942390547', 0, 'N', 0, '2013-10-18', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W11025032', 'W11025032', 'UT01', 'Copper Canyon Womens Center', 'Theresa (Tina)', 'M', 'Fought', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '3336 S 4155 W Ste 301', 'West Valley', 'Salt Lake', 'UT', '84120', '8019643865', NULL, '3336 S 4155 W Ste 301', 'West Valley', 'Salt Lake', 'UT', '84120', '8019643865', '          ', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-04-15', '2011-10-03', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1942390547', 0, 'N', 0, '2013-08-01', NULL, NULL, 0, 0, NULL, NULL),
('522943864', 'W11025033', 'W11025033', 'Sinclair', '(Sinclair Health Services\rProvider) ', 'Rachel', 'M', 'Brannon', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '208 Spruce Ave N Ste C2', 'Ketchum', 'Blaine', 'ID', '83340', '2087203225', NULL, '208 Spruce Ave N Ste C2', 'Ketchum', 'Blaine', 'ID', '83340', '2087203225', '', 'IDMA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2010-04-06', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1396896718', 0, 'n', 0, '2014-02-27', NULL, NULL, 0, 0, NULL, NULL),
('522943864', 'W11025034', 'W11025034', 'Sinclair', '(Sinclair Health Services\rProvider) ', 'Rachel', 'M', 'Brannon', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', 'PO Box 2193', 'Sun Valley', 'Blaine', 'ID', '83353', '2087203225', NULL, 'PO Box 2193', 'Sun Valley', 'Blaine', 'ID', '83353', '2087203225', '', 'IDMA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2010-04-06', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1396896718', 0, 'y', 0, '2013-12-13', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W11025035', 'W11025035', 'WYBILLINGS', 'Billings Clinic - Internal Medicine', 'Scott', 'L', 'Marchant', 'DPM', 'Podiatry', NULL, NULL, NULL, 'O', '801 N 29th St', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062382413', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', NULL, NULL, '', NULL, NULL, '0.00', '17.00', '0.00', 3, '2010-04-03', NULL, NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1073612453', 0, 'N', 0, '2010-04-13', NULL, NULL, 0, 0, NULL, NULL),
('245710270', 'W11025036', 'W11025036', 'UT01', 'Epic Ogden Regional Medical Center Afim', 'Hamid', 'A', 'Mian', 'MD', 'Nephrology', '', '', NULL, 'O', '5475 S 500 E', 'Ogden', 'Weber', 'UT', '84405', '8014792111', NULL, '5475 S 500 E', 'Ogden', 'Weber', 'UT', '84405', '8014792111', '', 'WUSTDINT5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2010-04-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1871520387', 0, 'n', 0, '2013-07-09', NULL, NULL, 41.1635, -111.969, NULL, NULL),
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('942854057', 'W11025038', 'W11025038', 'UTPEHP', 'South Cache Valley Clinic', 'Jeremy', 'W', 'Broadhurst', 'DO', 'Family Practice', '', '', NULL, 'o', '190 S Hwy 165', 'Providence', 'Cache', 'UT', '84332', '4357553300', NULL, '190 S Hwy 165', 'Providence', 'Cache', 'UT', '84332', '4357553300', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2009-07-13', NULL, 0, 0, 0, 'Logan Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1114115664', 0, 'n', 0, '2010-06-18', NULL, NULL, 0, 0, NULL, NULL),
('742586908', 'W11025039', 'W11025039', 'TX01', '', 'Judith', 'E', 'Craig', 'PHD', 'Mental Health', 'Psychology', NULL, NULL, 'O', '359 E Hildebrand Ste 100', 'San Antonio', 'Bexar', 'TX', '78212', '2108243391', NULL, '359 E Hildebrawd', 'San Antonio', 'Bexar', 'TX', '78212', '2108243391', '          ', 'TXMHPHD10', '', '', '0.00', '35.00', '0.00', 3, '2010-04-15', NULL, NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1023119823', 0, 'N', 0, '2010-04-13', NULL, NULL, 29.4665, -98.4876, NULL, NULL),
('272033825', 'W11025040', 'W11025040', 'WY01', 'Clear Creek Counseling', 'Virginia', 'K', 'Oedekoven', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '801 E 4th St Ste 24', 'Gillette', 'Campbell', 'WY', '82716', '3076869422', NULL, '801 E 4th St Ste 24', 'Gillette', 'Campbell', 'WY', '82716', '3076869422', '          ', 'WYMA', '', '', '0.00', '35.00', '0.00', 3, '2010-03-17', '2010-03-17', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1700988854', 0, 'N', 0, '2011-05-18', NULL, NULL, 0, 0, NULL, NULL),
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('942938348', 'W11025042', 'W11025042', 'UTMH1', 'Valley Mental Health  Inc', 'Danet', 'J', 'Yazzie', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', '5965 S 900 E Ste 430', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012637100', NULL, '5965 S 900 E Ste 430', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012637100', '', 'UTVMHMA', NULL, NULL, '0.00', '35.00', '0.00', 6, '2010-04-08', '2013-02-14', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1881838126', 0, 'Y', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('830212533', 'W11025043', 'W11025043', 'Sinclair', 'Carbon Co Counseling', 'Peggy', '', 'Hayes', 'LMFT', 'Mental Health', 'Marriage & Family Therapy', '', NULL, 'B', 'PO Box 1056', 'Rawlins', 'Carbon', 'WY', '82301', '3073247156', NULL, 'PO Box 1056', 'Rawlins', 'Carbon', 'WY', '82301', '3073247156', '          ', 'WYMA', '', '', '0.00', '35.00', '0.00', 3, '2010-04-08', '2012-03-20', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1154455293', 0, 'N', 0, '2012-01-23', NULL, NULL, 0, 0, NULL, NULL),
('264828548', 'W11025044', 'W11025044', 'UT01', 'Crestwood Care Center', NULL, NULL, 'Crestwood Care Center', 'GROUP', 'Skilled Nursing Facility', NULL, NULL, NULL, 'O', '3665 Brinker Ave', 'Ogden', 'Weber', 'UT', '84403', '8016272273', NULL, '3665 Brinker Ave', 'Ogden', 'Weber', 'UT', '84403', NULL, NULL, '', NULL, '7', '0.00', '100.00', '0.00', 3, '2010-04-01', NULL, 1, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1417186693', 0, 'n', 0, '2010-04-13', NULL, NULL, 41.1964, -111.95, NULL, NULL),
('621801973', 'W11025045', 'W11025045', 'UT01', 'Salt Lake Regional Womens Center', 'John', 'S', 'Oglesby', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '82 S 1100 E Ste 305', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8012147650', '8012147651', '82 S 1100 E Ste 305', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8012147650', '8012147651', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-02-01', '2014-04-30', 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1245385962', 0, 'N', 0, '2013-06-13', NULL, NULL, 40.7676, -111.86, NULL, NULL),
('870280459', 'W11025046', 'W11025046', 'UT01', 'Western GYN & OB Clinic', 'Monte', 'G', 'Merrell', 'MD', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'O', '12600 S 3723 W Ste 350', 'Riverton', 'Salt Lake', 'UT', '84065', '8012854800', '8012854901', 'PO Box 572528', 'Salt Lake City', 'Salt Lake', 'UT', '84065', NULL, NULL, 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2010-04-20', NULL, 0, 0, 0, 'Riverton Childrens Unit Operated by Primary Childrens Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1295900165', 0, 'N', 0, '2010-04-13', NULL, NULL, 40.5104, -111.952, NULL, NULL),
('870280459', 'W11025047', 'W11025047', 'UT01', 'Western GYN & OB Clinic', 'Monte', 'G', 'Merrell', 'MD', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'B', 'PO Box 572528', 'Salt Lake City', 'Salt Lake', 'UT', '84065', '8012854800', '8012854901', 'PO Box 572528', 'Salt Lake City', 'Salt Lake', 'UT', '84065', NULL, NULL, 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2010-04-20', NULL, 0, 0, 0, 'Riverton Childrens Unit Operated by Primary Childrens Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1295900165', 0, 'y', 0, '2010-04-13', NULL, NULL, 0, 0, NULL, NULL),
('820471484', 'W11025048', 'W11025048', 'ID01', 'Kuna Family Medical Clinic', 'Annie', '', 'Johnson', 'PA-C', '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, '2010-04-20', '2012-08-19', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1003067984', 0, 'n', 0, '2013-06-28', NULL, NULL, 43.4909, -116.415, NULL, NULL),
('820471484', 'W11025049', 'W11025049', 'ID01', 'Kuna Family Medical Clinic', 'Annie', '', 'Johnson', 'PA-C', '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, '2010-04-20', '2012-08-19', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1003067984', 0, 'y', 0, '2013-06-28', NULL, NULL, 0, 0, NULL, NULL),
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('202630141', 'W11025051', 'W11025051', 'ID02', 'Primary Health Medical Group', 'Becky', NULL, 'Wells', 'PA', 'Family Practice', '', '', NULL, 'O', '6052 W State St', 'Boise', 'Ada', 'ID', '83703', '2083447799', NULL, '6052 W State St', 'Boise', 'Ada', 'ID', '83703', '2083447799', '', 'IDSTDPPO', 'WUSTDHCPC5', NULL, '0.00', '30.00', '0.00', 3, '2010-04-20', '2013-02-28', 0, 0, 1, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1780617811', 0, 'N', 0, '2013-02-28', NULL, NULL, 43.6597, -116.264, NULL, NULL),
('202630141', 'W11025052', 'W11025052', 'ID02', 'Primary Health Medical Group', 'Becky', NULL, 'Wells', 'PA', 'Family Practice', '', '', NULL, 'B', 'PO Box 191050', 'Boise', 'Ada', 'ID', '83719', '2083447799', NULL, 'PO Box 191050', 'Boise', 'Ada', 'ID', '83719', '2083447799', '', 'IDSTDPPO', 'WUSTDHCPC5', NULL, '0.00', '30.00', '0.00', 3, '2010-04-20', '2013-02-28', 0, 0, 1, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1780617811', 0, 'y', 0, '2013-02-28', NULL, NULL, 0, 0, NULL, NULL),
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('142482544', 'W11025055', 'W11025055', 'ID02', 'Star Medical Center', 'Donna', 'J', 'Christensen', 'NP', 'Mental Health', '', '', NULL, 'O', '9858 W State St', 'Star', 'Ada', 'ID', '83669', '2082869471', NULL, '9858 W State St', 'Star', 'Ada', 'ID', '83669', '2082869471', '', 'IDARNP', NULL, NULL, '0.00', '35.00', '0.00', 3, '2010-04-20', '2013-02-14', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1396978722', 0, 'n', 0, '2013-02-27', NULL, NULL, 43.6924, -116.476, NULL, NULL),
('142482544', 'W11025056', 'W11025056', 'ID02', 'Treasure Valley Mental Health', 'Donna', 'J', 'Christensen', 'NP', 'Mental Health', '', '', NULL, 'O', '335 Allumbaugh St', 'Boise', 'Ada', 'ID', '83704', '2083761611', NULL, '335 Allumbaugh St', 'Boise', 'Ada', 'ID', '83704', '2083761611', '', 'IDARNP', NULL, NULL, '0.00', '35.00', '0.00', 3, '2010-04-20', '2013-02-14', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1396978722', 0, 'n', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('870767026', 'W11025057', 'W11025057', 'ID01', 'Caldwell Medical Clinics', 'Melissa', 'L', 'Park', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 277976', 'Atlanta', 'Fulton', 'GA', '30384', '2084594667', NULL, 'PO Box 277976', 'Atlanta', 'Fulton', 'GA', '30384', '2084594667', '', 'IDCALDINT', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2010-04-20', '2010-08-31', 0, 0, 0, 'West Valley Medical Center', '', '', '', 'HCFA|UB|', '1386676039', 0, 'y', 0, '2014-06-26', NULL, NULL, 0, 0, NULL, NULL),
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('830306207', 'W11025061', 'W11025061', 'WY01', 'Big Horn Pediatrics', 'Ambrose', '', 'Soler', 'MD', 'Pediatrics', '', '', NULL, 'O', '1308 W Fourth St', 'Gillette', 'Campbell', 'WY', '82716', '3076874300', NULL, '1308 W Fourth St', 'Gillette', 'Campbell', 'WY', '82716', '3076874300', '          ', '', '', '', '0.00', '12.00', '0.00', 3, '2010-04-20', '2013-07-08', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1710915525', 0, 'N', 0, '2013-07-09', NULL, NULL, 0, 0, NULL, NULL),
('571188761', 'W11025060', 'W11025060', 'UT01', 'Westview Womens Center', 'Stephen', 'E', 'Wight', 'MD', 'OB/GYN', '', '', NULL, 'O', '3451 S 5600 W Ste E', 'West Valley', 'Salt Lake', 'UT', '84120', '8019631880', NULL, '3451 S 5600 W Ste E', 'West Valley', 'Salt Lake', 'UT', '84120', '8019631880', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-04-20', '2011-05-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1134178437', 0, 'Y', 0, '2013-07-09', NULL, NULL, 0, 0, NULL, NULL),
('742503534', 'W11025062', 'W11025062', 'TX01', 'South Texas Spinal Clinic', 'Gregg', 'S', 'Gurwitz', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', 'PO Box 120037', 'San Antonio', 'Bexar', 'TX', '78212', '2106146432', NULL, 'PO Box 120037', 'San Antonio', 'Bexar', 'TX', '78212', '2106146432', '', 'TXNEURO', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2010-04-20', '2012-08-19', 0, 0, 0, 'North Central Baptist Hospital', '', '', '', 'HCFA|UB|', '1598764813', 0, 'Y', 0, '2014-06-16', NULL, NULL, 0, 0, NULL, NULL),
('742503534', 'W11025063', 'W11025063', 'TX01', 'South Texas Spinal Clinic', 'Gregg', 'S', 'Gurwitz', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '18626 Hardy Oak Blvd Ste 300', 'San Antonio', 'Bexar', 'TX', '78258', '2104959047', NULL, '18626 Hardy Oak Blvd Ste 300', 'San Antonio', 'Bexar', 'TX', '78258', '2104959047', '', 'TXNEURO', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2010-04-20', '2012-08-19', 0, 0, 0, 'North Central Baptist Hospital', '', '', '', 'HCFA|UB|', '1598764813', 0, 'N', 0, '2014-06-16', NULL, NULL, 29.6139, -98.4774, NULL, NULL),
('820484256', 'W11025091', 'W11025091', 'ID01', 'Balance Chiropractic Clinics', 'Troy', 'D', 'Norris', 'DC', 'Chiropractic', '', '', NULL, 'O', '6013 W Overland Rd Ste 101', 'Boise', 'Ada', 'ID', '83709', '2083444469', NULL, '6013 W Overland Rd Ste 101', 'Boise', 'Ada', 'ID', '83709', '2083444469', '', 'IDCHIRO1', NULL, NULL, '0.00', '35.00', '0.00', 3, '2010-04-20', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1578525986', 0, 'n', 0, '2011-05-23', NULL, NULL, 43.5899, -116.257, NULL, NULL),
('870281028', 'W11025064', 'W11025064', 'UT01', 'Central Utah Clinic', 'Justin', 'E', 'Jones', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8018125033', NULL, 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8018125033', '', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-04-20', '2010-07-14', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1760547699', 0, 'Y', 0, '2014-06-16', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W11025065', 'W11025065', 'UT01', 'Central Utah Clinic', 'Justin', 'E', 'Jones', 'MD', 'Family Practice', '', '', NULL, 'O', '1055 N 500 W Ste 205', 'Provo', 'Utah', 'UT', '84604', '8018125033', NULL, '1055 N 500 W Ste 205', 'Provo', 'Utah', 'UT', '84604', '8018125033', '', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-04-20', '2010-07-14', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1760547699', 0, 'N', 0, '2014-06-16', NULL, NULL, 0, 0, NULL, NULL),
('870519691', 'W11025066', 'W11025066', 'UT01', 'Utah Cancer Specialists', 'Anna', '', 'Beck', 'MD', 'Hematology and Oncology', 'Oncology', '', NULL, 'O', '82 S 1100 E Ste 403', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013641006', NULL, '82 S 1100 E Ste 403', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013641006', '', 'WUSTDONC5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2010-04-01', NULL, 0, 0, 0, 'University Health Care University Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1719036265', 0, 'N', 0, '2012-01-27', NULL, NULL, 40.7676, -111.86, NULL, NULL),
('830234097', 'W11025067', 'W11025067', 'WY01', 'Campbell County Memorial Hospital', 'Jeffrey', 'A', 'Gilles', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '501 S Burma Ave Ste 3500', 'Gillette', 'Campbell', 'WY', '82717', '3076883510', NULL, '501 S Burma Ave Ste 3500', 'Gillette', 'Campbell', 'WY', '82717', '3076883510', '          ', '', '', '5001', '0.00', '0.00', '0.00', 6, '2010-04-14', '2013-09-19', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1417004334', 0, 'N', 0, '2013-09-23', NULL, NULL, 0, 0, NULL, NULL),
('830234097', 'W11025068', 'W11025068', 'WYWSBAIT', 'Campbell County Memorial Hospital', 'Jeffrey', 'A', 'Gilles', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '501 S Burma Ave Ste 3500', 'Gillette', 'Campbell', 'WY', '82717', '3076883510', NULL, '501 S Burma Ave Ste 3500', 'Gillette', 'Campbell', 'WY', '82717', '3076883510', '          ', '', '', '5001A', '0.00', '0.00', '0.00', 3, '2010-04-14', '2011-06-30', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1417004334', 0, 'N', 0, '2013-09-19', NULL, NULL, 0, 0, NULL, NULL),
('870507114', 'W11025069', 'W11025069', 'UT01', NULL, 'Brian', 'W', 'Heaton', 'MD', 'Urology', NULL, NULL, NULL, 'O', '4403 Harrison Blvd Ste 4400', 'Ogden', 'Weber', 'UT', '84403', '8013874550', NULL, '4403 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', NULL, NULL, 'WISESTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2010-04-20', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1245248236', 0, 'n', 0, '2010-04-14', NULL, NULL, 41.1828, -111.949, NULL, NULL),
('204077312', 'W11025070', 'W11025070', 'WY01', NULL, 'Charles', 'G', 'Welch', 'MD', 'General Surgery', '', '', NULL, 'O', '1613 Stampede Ave Ste A', 'Cody', 'Park', 'WY', '82414', '3075879800', NULL, '1613 Stampede Ave Ste A', 'Cody', 'Park', 'WY', '82414', '3075879800', '', '', NULL, '', '0.00', '10.00', '0.00', 3, '2010-04-20', NULL, 0, 0, 0, 'West Park Hospital District', '', '', '', 'HCFA|UB|', '1366631285', 0, 'n', 0, '2014-05-20', NULL, NULL, 44.5188, -109.056, NULL, NULL),
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('870365095', 'W11025097', 'W11025097', 'UT01', 'Shivwits Paiute Medical Clinic', 'Steven', 'Richard', 'Newman', 'MD', 'Family Practice', 'Sports Medicine', 'Occupational Therapy', NULL, 'O', '6109 W 3700 N', 'Ivins', 'Washington', 'UT', '84738', '4356888198', NULL, '6109 W 3700 N', 'Ivins', 'Washington', 'UT', '84738', '4356888198', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-04-20', '2013-03-31', 0, 0, 0, 'Valley View Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1134157613', 0, 'N', 0, '2013-04-15', NULL, NULL, 0, 0, NULL, NULL),
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('942854057', 'W11014952', 'W11014952', 'ID01', 'PCMC Neuropsychologist - Outpatient', 'Nancy', 'L', 'Cantor', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'B', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8015883938', '          ', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8015883938', '          ', '', '', '', '0.00', '0.00', '0.00', 8, '2008-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1144243312', 0, 'Y', 0, '2014-06-18', 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', 'W11014953', 'W11014953', 'ID01', 'Psychiatry', 'Karen', 'Kay', 'Christian', 'MD', 'Mental Health', 'Pediatric Psychiatry', 'Psychiatry', NULL, 'B', '5770 S 1500 W', 'Taylorsville', 'Salt Lake', 'UT', '84123', '8013137770', NULL, '5770 S 1500 W', 'Taylorsville', 'Salt Lake', 'UT', '84123', '8013137770', '          ', '', '', '', '0.00', '0.00', '0.00', 8, '2008-10-01', '2010-09-23', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1255482097', 0, 'Y', 0, '2012-07-02', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11014954', 'W11014954', 'ID01', 'Primary Childrens Center for Counseling', 'Matthew', 'D', 'Christiansen', 'PhD', 'Mental Health', 'Psychology', '', NULL, 'B', '5770 S 1500 W Ste G', 'Taylorsville', 'Salt Lake', 'UT', '84123', '8012653000', NULL, '5770 S 1500 W Ste G', 'Taylorsville', 'Salt Lake', 'UT', '84123', '8012653000', '          ', '', '', '', '0.00', '0.00', '0.00', 8, '2008-10-01', '2010-01-19', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1639136088', 0, 'Y', 0, '2010-01-12', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11014955', 'W11014955', 'ID01', 'Taylorsville Physical Therapy', 'Holly', 'M', 'Jensen', 'PT', 'Physical Therapy', '', '', NULL, 'B', '3845 W 4700 S', 'Taylorsville', 'Salt Lake', 'UT', '84118', '8018404360', NULL, '3845 W 4700 S', 'Taylorsville', 'Salt Lake', 'UT', '84118', '8018404360', '          ', '', '', '', '0.00', '0.00', '0.00', 8, '2008-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1639343502', 0, 'Y', 0, '2013-08-29', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11014956', 'W11014956', 'ID01', 'Center for Counseling', 'John', 'E', 'Clift', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', '5770 S 1500 W Ste G', 'Taylorsville', 'Salt Lake', 'UT', '84123', '8013137770', NULL, '5770 S 1500 W Ste G', 'Taylorsville', 'Salt Lake', 'UT', '84123', '8013137770', '          ', '', '', '', '0.00', '0.00', '0.00', 8, '2008-10-01', '2011-08-04', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1649293408', 0, 'Y', 0, '2010-01-12', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11014958', 'W11014958', 'ID01', 'Onc / BMT Dept PCMC', 'Paul', 'David', 'Colte', 'PsyD', 'Mental Health', 'Psychology', NULL, NULL, 'B', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8015882882', NULL, '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8015882882', '          ', '', '', '', '0.00', '0.00', '0.00', 8, '2008-10-01', '2009-01-12', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1912055229', 0, 'Y', 0, '2013-08-28', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11014959', 'W11014959', 'ID01', 'PCMC Rehab Sandy', 'Jonel', 'M', 'Condra', 'SLP', 'Speech Therapy', 'Speech Language Pathology', '', NULL, 'B', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016624980', NULL, '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016624980', '          ', '', '', '', '0.00', '0.00', '0.00', 8, '2008-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1649365248', 0, 'Y', 0, '2012-04-10', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11014960', 'W11014960', 'ID01', 'PCMC Rehab Sandy', 'Jonel', 'M', 'Condra', 'SLP', 'Speech Therapy', 'Speech Language Pathology', '', NULL, 'B', '870 E 9400 S Ste 112', 'Sandy', 'Salt Lake', 'UT', '84094', '8015713081', NULL, '870 E 9400 S Ste 112', 'Sandy', 'Salt Lake', 'UT', '84094', '8015713081', '', '', NULL, NULL, '0.00', '0.00', '0.00', 8, '2008-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1649365248', 0, 'Y', 0, '2012-04-10', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11014961', 'W11014961', 'ID01', 'Primary Childrens Medical Center', 'Thomas', 'G', 'Conover', 'MD', 'Mental Health', 'Pediatric Psychiatry', 'Pediatric Psychiatry', NULL, 'B', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84143', '8015883938', NULL, '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84143', '8015883938', '', '', NULL, NULL, '0.00', '0.00', '0.00', 8, '2008-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1093805228', 0, 'Y', 0, '2012-01-26', NULL, NULL, 0, 0, NULL, NULL),
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('942854057', 'W11014963', 'W11014963', 'ID01', 'PCMC Rehab Sandy', 'Martina', 'H', 'Costello', 'SLP', 'Speech Therapy', 'Speech Language Pathology', NULL, NULL, 'B', '870 E 9400 S Ste 112', 'Sandy', 'Salt Lake', 'UT', '84094', '8015713081', NULL, NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, '', NULL, NULL, '0.00', '0.00', '0.00', 8, '2008-10-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1578657599', 0, 'Y', 0, '2010-01-12', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11014964', 'W11014964', 'ID01', 'PCMC Rehab Sandy', 'Martina', 'H', 'Costello', 'SLP', 'Speech Therapy', 'Speech Language Pathology', NULL, NULL, 'B', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016624949', NULL, NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, '', NULL, NULL, '0.00', '0.00', '0.00', 8, '2008-10-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1578657599', 0, 'Y', 0, '2010-01-12', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11014965', 'W11014965', 'ID01', 'Physical Therapy', 'Craig', 'M', 'Crookston', 'PT', 'Physical Therapy', NULL, NULL, NULL, 'B', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016624949', NULL, NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, '', NULL, NULL, '0.00', '0.00', '0.00', 8, '2008-10-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000005841', 0, 'Y', 0, '2008-10-23', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11014966', 'W11014966', 'ID01', 'Center for Counseling', 'Ronda', 'D', 'Davis', 'MD', 'Mental Health', 'Pediatric Psychiatry', 'Pediatric Psychiatry', NULL, 'B', '5770 S 1500 W', 'Taylorsville', 'Salt Lake', 'UT', '84123', '8013137770', NULL, '5770 S 1500 W', 'Taylorsville', 'Salt Lake', 'UT', '84123', '8013137770', '          ', '', '', '', '0.00', '0.00', '0.00', 8, '2008-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1568564227', 0, 'Y', 0, '2011-02-03', NULL, NULL, 0, 0, NULL, NULL),
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('942854057', 'W11014968', 'W11014968', 'ID01', 'Residential Treatment', 'Renae', '', 'Decker-Cahoon', 'APRN', 'Mental Health', 'Advanced Practice Registered Nurse', '', NULL, 'B', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8015883938', '          ', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8015883938', '          ', '', '', '', '0.00', '0.00', '0.00', 8, '2008-10-01', '2013-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1699785824', 0, 'Y', 0, '2014-06-18', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11014969', 'W11014969', 'ID01', 'Residential Treatment', 'Renae', '', 'Decker-Cahoon', 'APRN', 'Mental Health', 'Advanced Practice Registered Nurse', '', NULL, 'B', '5770 S 1500 W', 'Taylorsville', 'Salt Lake', 'UT', '84123', '8013137770', '          ', '5770 S 1500 W', 'Taylorsville', 'Salt Lake', 'UT', '84123', '8013137770', '          ', '', '', '', '0.00', '0.00', '0.00', 8, '2008-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1699785824', 0, 'Y', 0, '2014-06-18', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11014970', 'W11014970', 'ID01', 'Utah Diabetes Center', 'David', 'L', 'Donaldson', 'MD', 'Pediatric Endocrinology', '', '', NULL, 'B', '615 Arapeen Dr Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015817761', NULL, '615 Arapeen Dr Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015817761', '          ', '', '', '', '0.00', '0.00', '0.00', 8, '2008-10-01', NULL, 0, 0, 0, 'University Health Care University Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1063584290', 0, 'Y', 0, '2013-08-28', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11014971', 'W11014971', 'ID01', 'PCMC Rehab Taylorsville', 'Natalie', 'Brooke', 'Edwards', 'SLP', 'Speech Therapy', 'Speech Language Pathology', NULL, NULL, 'B', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016624949', NULL, NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, '', NULL, NULL, '0.00', '0.00', '0.00', 8, '2008-10-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1427279926', 0, 'Y', 0, '2010-01-12', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11014972', 'W11014972', 'ID01', 'PCMC Rehab Taylorsville', 'Natalie', 'Brooke', 'Edwards', 'SLP', 'Speech Therapy', 'Speech Language Pathology', NULL, NULL, 'B', '3845 W 4700 S', 'Taylorsville', 'Salt Lake', 'UT', '84118', '8018404360', NULL, NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, '', NULL, NULL, '0.00', '0.00', '0.00', 8, '2008-10-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1427279926', 0, 'Y', 0, '2010-01-12', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11014973', 'W11014973', 'ID01', 'Adolescent Residential and Day Treatment', 'Louise', 'D', 'Elliott', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', '5770 S 1500 W', 'Taylorsville', 'Salt Lake', 'UT', '84123', '8013137770', NULL, '5770 S 1500 W', 'Taylorsville', 'Salt Lake', 'UT', '84123', '8013137770', '          ', '', '', '', '0.00', '0.00', '0.00', 8, '2008-10-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1457544280', 0, 'Y', 0, '2010-01-12', NULL, NULL, 0, 0, NULL, NULL),
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('942854057', 'W11015063', 'W11015063', 'ID01', 'Adolescent Residential and Day Treatment', 'Kim', 'D', 'Peterson', 'LCSW', 'Mental Health', 'Social Worker', NULL, NULL, 'B', '5770 S 1500 W', 'Taylorsville', 'Salt Lake', 'UT', '84123', '8012653142', NULL, NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, '', NULL, NULL, '0.00', '0.00', '0.00', 8, '2008-10-01', NULL, NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000008162', 0, 'Y', 0, '2010-01-12', 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', 'W11015064', 'W11015064', 'ID01', 'PCMC Audiology', 'Cache', 'L', 'Pitt', 'AUD', 'Audiology', '', '', NULL, 'B', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016624949', NULL, '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016624949', '', '', NULL, NULL, '0.00', '0.00', '0.00', 8, '2008-10-01', '2009-06-03', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1871509356', 0, 'Y', 0, '2013-12-02', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11015065', 'W11015065', 'ID01', 'PCMC Audiology', 'Cache', 'L', 'Pitt', 'AUD', 'Audiology', '', '', NULL, 'B', '280 N Main', 'Bountiful', 'Davis', 'UT', '84010', '8012928665', NULL, '280 N Main', 'Bountiful', 'Davis', 'UT', '84010', '8012928665', '', '', NULL, NULL, '0.00', '0.00', '0.00', 8, '2008-10-01', '2009-06-03', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1871509356', 0, 'Y', 0, '2013-12-02', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11015066', 'W11015066', 'ID01', 'Center for Counseling', 'Jason', 'L', 'Pola', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', '5770 S 1500 W Ste G', 'Taylorsville', 'Salt Lake', 'UT', '84123', '8013137770', NULL, '5770 S 1500 W Ste G', 'Taylorsville', 'Salt Lake', 'UT', '84123', '8013137770', '          ', '', '', '', '0.00', '0.00', '0.00', 8, '2008-10-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1750304515', 0, 'Y', 0, '2010-01-12', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11015067', 'W11015067', 'ID01', 'Residential Treatment', 'Bruce', 'C', 'Poulsen', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'B', '5770 S 1500 W', 'Taylorsville', 'Salt Lake', 'UT', '84123', '8013137770', NULL, '5770 S 1500 W', 'Taylorsville', 'Salt Lake', 'UT', '84123', '8013137770', '          ', '', '', '', '0.00', '0.00', '0.00', 8, '2008-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1376669085', 0, 'Y', 0, '2011-02-07', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11015068', 'W11015068', 'ID01', 'Primary Childrens Medical Center', 'Michael', 'David', 'Puchalski', 'MD', 'Pediatric Cardiology', 'Pediatrics', '', NULL, 'B', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8015882000', NULL, '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8015882000', '          ', '', '', '', '0.00', '0.00', '0.00', 8, '2008-10-01', '2011-04-25', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1639258106', 0, 'Y', 0, '2012-05-03', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11015069', 'W11015069', 'ID01', 'PCMC Audiology', 'Paula', 'J', 'Rasmussen', 'SLP', 'Speech Therapy', NULL, NULL, NULL, 'B', '3845 W 4700 S', 'Taylorsville', 'Salt Lake', 'UT', '84118', '8018404360', NULL, NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, '', NULL, NULL, '0.00', '0.00', '0.00', 8, '2008-10-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1821015710', 0, 'Y', 0, '2010-01-12', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11015070', 'W11015070', 'ID01', 'PCMC Audiology', 'Paula', 'J', 'Rasmussen', 'SLP', 'Speech Therapy', NULL, NULL, NULL, 'B', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016624949', NULL, NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, '', NULL, NULL, '0.00', '0.00', '0.00', 8, '2008-10-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1821015710', 0, 'Y', 0, '2010-01-12', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11015071', 'W11015071', 'ID01', 'PCMC Rehab Ogden', 'Tera', 'C', 'Robinson', 'OT', 'Occupational Therapy', NULL, NULL, NULL, 'B', '2955 Harrison Blvd Ste 101', 'Ogden', 'Weber', 'UT', '84403', '8013952634', NULL, NULL, NULL, 'Weber', NULL, NULL, NULL, NULL, '', NULL, NULL, '0.00', '0.00', '0.00', 8, '2008-10-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1922192798', 0, 'Y', 0, '2010-01-12', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11015072', 'W11015072', 'ID01', 'PCMC Rehab Ogden', 'Tera', 'C', 'Robinson', 'OT', 'Occupational Therapy', NULL, NULL, NULL, 'B', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016624949', NULL, NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, '', NULL, NULL, '0.00', '0.00', '0.00', 8, '2008-10-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1922192798', 0, 'Y', 0, '2010-01-12', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11015073', 'W11015073', 'ID01', 'PCMC Rehab Taylorsville', 'Amy', 'Jo', 'Rosello', 'OT', 'Occupational Therapy', NULL, NULL, NULL, 'B', '3845 W 4700 S', 'Taylorsville', 'Salt Lake', 'UT', '84118', '8018404360', NULL, NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, '', NULL, NULL, '0.00', '0.00', '0.00', 8, '2008-10-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1801953690', 0, 'Y', 0, '2010-01-12', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11015074', 'W11015074', 'ID01', 'PCMC Rehab Taylorsville', 'Amy', 'Jo', 'Rosello', 'OT', 'Occupational Therapy', NULL, NULL, NULL, 'B', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016624949', NULL, NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, '', NULL, NULL, '0.00', '0.00', '0.00', 8, '2008-10-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1801953690', 0, 'Y', 0, '2010-01-12', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11015075', 'W11015075', 'ID01', 'Center for Counseling', 'Mark', 'G', 'Schwei', 'MD PHD', 'Mental Health', 'Psychiatry', '', NULL, 'B', '5770 S 1500 W Ste G', 'Taylorsville', 'Salt Lake', 'UT', '84123', '8013137770', '          ', '5770 S 1500 W Ste G', 'Taylorsville', 'Salt Lake', 'UT', '84123', '8013137770', '          ', '', '', '', '0.00', '0.00', '0.00', 8, '2008-10-01', NULL, 0, 0, 0, 'Primary Childrens Medical Center', '', '', '', 'HCFA|UB|', '1639199110', 0, 'Y', 0, '2014-06-18', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11015076', 'W11015076', 'ID01', 'Consult Liaison', 'Mark', 'G', 'Schwei', 'MD PHD', 'Mental Health', 'Psychiatry', '', NULL, 'B', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8015883938', '          ', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8015883938', '          ', '', '', '', '0.00', '0.00', '0.00', 8, '2008-10-01', '2013-12-31', 0, 0, 0, 'Primary Childrens Medical Center', '', '', '', 'HCFA|UB|', '1639199110', 0, 'Y', 0, '2014-06-18', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11015077', 'W11015077', 'ID01', 'Primary Childrens Medical Center', 'Robert', 'E', 'Shaddy', 'MD', 'Pediatric Cardiology', NULL, NULL, NULL, 'B', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8015882000', NULL, NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, '', NULL, NULL, '0.00', '0.00', '0.00', 8, '2008-10-01', '2009-01-29', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1508975749', 0, 'Y', 0, '2010-01-12', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11015078', 'W11015078', 'ID01', 'Center for Counseling', 'L', 'Kristin H', 'Shadow', 'MD', 'Mental Health', 'Pediatric Psychiatry', NULL, NULL, 'B', '5770 S 1500 W Ste G', 'Taylorsville', 'Salt Lake', 'UT', '84123', '8012653000', NULL, NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, '', NULL, NULL, '0.00', '0.00', '0.00', 8, '2008-10-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1922028497', 0, 'Y', 0, '2010-01-12', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11015079', 'W11015079', 'ID01', 'Consult Liaison', 'L', 'Kristin H', 'Shadow', 'MD', 'Mental Health', 'Pediatric Psychiatry', NULL, NULL, 'B', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8015883938', NULL, NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, '', NULL, NULL, '0.00', '0.00', '0.00', 8, '2008-10-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1922028497', 0, 'Y', 0, '2010-01-12', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11015080', 'W11015080', 'ID01', 'PCMC Rehab Taylorsville', 'Kalomyra "Myra"', 'C', 'Shenk', 'SLP', 'Speech Therapy', 'Speech Language Pathology', NULL, NULL, 'B', '3845 W 4700 S', 'Taylorsville', 'Salt Lake', 'UT', '84118', '8018404360', NULL, NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, '', NULL, NULL, '0.00', '0.00', '0.00', 8, '2008-10-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1700970845', 0, 'Y', 0, '2010-01-12', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11015081', 'W11015081', 'ID01', 'PCMC Rehab Taylorsville', 'Kalomyra "Myra"', 'C', 'Shenk', 'SLP', 'Speech Therapy', 'Speech Language Pathology', NULL, NULL, 'B', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016624949', NULL, NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, '', NULL, NULL, '0.00', '0.00', '0.00', 8, '2008-10-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1700970845', 0, 'Y', 0, '2010-01-12', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11015082', 'W11015082', 'ID01', 'PCMC Rehab Sandy', 'Elizabeth', 'Anne', 'Siebert', 'PT', 'Physical Therapy', NULL, NULL, NULL, 'B', '870 E 9400 S Ste 112', 'Sandy', 'Salt Lake', 'UT', '84094', '8015713081', NULL, NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, '', NULL, NULL, '0.00', '0.00', '0.00', 8, '2008-10-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1417041450', 0, 'Y', 0, '2010-01-12', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11015083', 'W11015083', 'ID01', 'PCMC Rehab Sandy', 'Elizabeth', 'Anne', 'Siebert', 'PT', 'Physical Therapy', NULL, NULL, NULL, 'B', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016624949', NULL, NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, '', NULL, NULL, '0.00', '0.00', '0.00', 8, '2008-10-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1417041450', 0, 'Y', 0, '2010-01-12', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11015084', 'W11015084', 'ID01', 'Utah Diabetes Center', 'Marie', 'F', 'Couldwell', 'MD', 'Pediatric Endocrinology', '', '', NULL, 'B', '615 Arapeen Dr Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015817761', NULL, '615 Arapeen Dr Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015817761', '          ', '', '', '', '0.00', '0.00', '0.00', 8, '2008-10-01', NULL, 0, 0, 0, 'University Health Care University Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1083793558', 0, 'Y', 0, '2013-12-26', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11015085', 'W11015085', 'ID01', 'Center for Counseling', 'Kirk', 'A', 'Simon', 'MD', 'Mental Health', 'Psychiatry', '', NULL, 'O', '5770 S 1500 W Ste C', 'Taylorsville', 'Salt Lake', 'UT', '84123', '8013137954', '          ', '5770 S 1500 W Ste C', 'Taylorsville', 'Salt Lake', 'UT', '84123', '8013137954', '          ', '', '', '', '0.00', '0.00', '0.00', 8, '2008-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1043399611', 0, 'N', 0, '2014-06-18', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11015086', 'W11015086', 'ID01', 'Inpatient Psych', 'Kirk', 'A', 'Simon', 'MD', 'Mental Health', 'Psychiatry', '', NULL, 'B', '497 Colorow Way', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8016626400', '          ', '497 Colorow Way', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8016626400', '          ', '', '', '', '0.00', '0.00', '0.00', 8, '2008-10-01', '2014-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1043399611', 0, 'Y', 0, '2014-06-18', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11015087', 'W11015087', 'ID01', 'Consult Liaison', 'Kirk', 'A', 'Simon', 'MD', 'Mental Health', 'Psychiatry', '', NULL, 'B', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8015883938', '          ', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8015883938', '          ', '', '', '', '0.00', '0.00', '0.00', 8, '2008-10-01', '2013-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1043399611', 0, 'Y', 0, '2014-06-18', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11015088', 'W11015088', 'ID01', 'Neuropsychology', 'Julien', 'T', 'Smith', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'B', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016625982', NULL, '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016625982', '', '', NULL, NULL, '0.00', '0.00', '0.00', 8, '2008-10-01', '2009-10-20', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1326069022', 0, 'Y', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11015089', 'W11015089', 'ID01', 'Primary Childrens Medical Center', 'Patricia', 'A', 'Smith', 'PT', 'Physical Therapy', '', '', NULL, 'B', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8015882000', NULL, '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8015882000', '', '', NULL, NULL, '0.00', '0.00', '0.00', 8, '2008-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1184852931', 0, 'Y', 0, '2010-07-15', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11015090', 'W11015090', 'ID01', 'Safe and Healthy Families', 'Amy', '', 'Spratling', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'B', '5770 S 1500 W Ste C', 'Taylorsville', 'Salt Lake', 'UT', '84123', '8012653180', NULL, '5770 S 1500 W Ste C', 'Taylorsville', 'Salt Lake', 'UT', '84123', '8012653180', '          ', '', '', '', '0.00', '0.00', '0.00', 8, '2008-10-01', '2008-10-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1598973414', 0, 'Y', 0, '2011-04-11', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11015091', 'W11015091', 'ID01', 'Orthopedic Surgery', 'Peter', 'M', 'Stevens', 'MD', 'Pediatric Orthopedic Surgery', 'Pediatric Orthopedic Radiology', 'Orthopedic Surgery', NULL, 'B', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8015882000', NULL, '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8015882000', '          ', '', '', '', '0.00', '0.00', '0.00', 8, '2008-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1881649929', 0, 'N', 0, '2014-02-24', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11015092', 'W11015092', 'ID01', 'Adolescent Residential and Day Treatment', 'Carla', 'J', 'Stoddard', 'LCSW', 'Mental Health', 'Social Worker', NULL, NULL, 'B', '5770 S 1500 W', 'Taylorsville', 'Salt Lake', 'UT', '84123', '8012653142', NULL, NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, '', NULL, NULL, '0.00', '0.00', '0.00', 8, '2008-10-01', NULL, NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000008921', 0, 'Y', 0, '2010-01-12', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11015093', 'W11015093', 'ID01', 'Rehab', 'Kelly', 'L', 'Stoddard', 'SLP', 'Speech Therapy', NULL, NULL, NULL, 'B', '870 E 9400 S Ste 112', 'Sandy', 'Salt Lake', 'UT', '84094', '8015713081', NULL, NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, '', NULL, NULL, '0.00', '0.00', '0.00', 8, '2008-10-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000008922', 0, 'Y', 0, '2008-10-23', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11015094', 'W11015094', 'ID01', 'Rehab', 'Kelly', 'L', 'Stoddard', 'SLP', 'Speech Therapy', NULL, NULL, NULL, 'B', '280 N Main St', 'Bountiful', 'Davis', 'UT', '84010', '8012928665', NULL, NULL, NULL, 'Davis', NULL, NULL, NULL, NULL, '', NULL, NULL, '0.00', '0.00', '0.00', 8, '2008-10-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000008922', 0, 'Y', 0, '2008-10-23', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11015095', 'W11015095', 'ID01', 'Rehab', 'Kelly', 'L', 'Stoddard', 'SLP', 'Speech Therapy', NULL, NULL, NULL, 'B', '3845 W 4700 S', 'Taylorsville', 'Salt Lake', 'UT', '84118', '8018404360', NULL, NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, '', NULL, NULL, '0.00', '0.00', '0.00', 8, '2008-10-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000008922', 0, 'Y', 0, '2008-10-23', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11015096', 'W11015096', 'ID01', 'Center for Counseling', 'Claire', 'R', 'Stoecker', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', '5770 S 1500 W Ste G', 'Taylorsville', 'Salt Lake', 'UT', '84123', '8013137770', NULL, '5770 S 1500 W Ste G', 'Taylorsville', 'Salt Lake', 'UT', '84123', '8013137770', '          ', '', '', '', '0.00', '0.00', '0.00', 8, '2008-10-01', '2013-08-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1093735565', 0, 'Y', 0, '2013-09-03', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11015097', 'W11015097', 'ID01', 'PCMC Audiology', 'Nanette', 'L', 'Sturgill', 'AUD', 'Audiology', NULL, NULL, NULL, 'B', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016624949', NULL, NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, '', NULL, NULL, '0.00', '0.00', '0.00', 8, '2008-10-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1659387165', 0, 'Y', 0, '2010-01-12', NULL, NULL, 0, 0, NULL, NULL),
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