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
('272273286', 'W12032194', 'W12032194', 'TXHOUSTD', 'PCP For Life Tidwell', '', '', 'PCP for Life PA', '', 'Internal Medicine', '', '', NULL, 'O', '2312 Tidwell Rd', 'Houston', 'Harris', 'TX', '77093', '2813507272', '8325598584', '2312 Tidwell Rd', 'Houston', 'Harris', 'TX', '77093', '2813507272', '8325598584', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1497071955', 0, 'Y', 0, '2013-05-10', NULL, NULL, 29.848, -95.3487, NULL, NULL),
('272273286', 'W12032195', 'W12032195', 'TXHOUSTD', 'PCP For Life Little York', '', '', 'PCP for Life PA', '', 'Internal Medicine', '', '', NULL, 'O', '2708 Little York Rd', 'Houston', 'Harris', 'TX', '77093', '2813507272', '8325598584', '2708 Little York Rd', 'Houston', 'Harris', 'TX', '77093', '2813507272', '8325598584', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1497071955', 0, 'Y', 0, '2013-05-10', NULL, NULL, 29.871, -95.344, NULL, NULL),
('272273286', 'W12032196', 'W12032196', 'TXHOUSTD', 'PCP For Life Bridgestone Family Practice', '', '', 'PCP for Life PA', '', 'Internal Medicine', '', '', NULL, 'O', '4915 FM 2920 Ste 200', 'Spring', 'Harris', 'TX', '77388', '2813507272', '8325598584', '4915 FM 2920 Ste 200', 'Spring', 'Harris', 'TX', '77388', '2813507272', '8325598584', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1497071955', 0, 'Y', 0, '2013-05-10', NULL, NULL, 30.0737, -95.494, NULL, NULL),
('272273286', 'W12032199', 'W12032199', 'TXHOUSTD', 'PCP For Life Greenspoint', 'Arunkumar', 'J', 'Shah', 'MD', 'Internal Medicine', '', '', NULL, 'O', '12130 Greenspoint Dr', 'Houston', 'Harris', 'TX', '77060', '2813507272', '8325598584', '12130 Greenspoint Dr', 'Houston', 'Harris', 'TX', '77060', '2813507272', '8325598584', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-05-01', NULL, 0, 0, 0, NULL, NULL, '', '', 'HCFA|UB|', '1205906286', 0, 'N', 0, '2013-04-15', NULL, NULL, 29.9437, -95.4075, NULL, NULL),
('272273286', 'W12032198', 'W12032198', 'TXHOUSTD', 'PCP For Life Lakewood Family Practice', 'Arunkumar', 'J', 'Shah', 'MD', 'Internal Medicine', '', '', NULL, 'O', '12015 Louetta Rd Ste 200', 'Houston', 'Harris', 'TX', '77070', '2813707272', '8325598584', '12015 Louetta Rd Ste 200', 'Houston', 'Harris', 'TX', '77070', '2813707272', '8325598584', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-05-01', NULL, 0, 0, 0, NULL, NULL, '', '', 'HCFA|UB|', '1205906286', 0, 'N', 0, '2013-04-15', NULL, NULL, 29.9966, -95.6013, NULL, NULL),
('272273286', 'W12032200', 'W12032200', 'TXHOUSTD', 'PCP For Life Lake Conroe Family Practice', 'Arunkumar', 'J', 'Shah', 'MD', 'Internal Medicine', '', '', NULL, 'O', '12621 Hwy 105 W Ste 104', 'Conroe', 'Montgomery', 'TX', '77304', '2813507272', '8325598584', '12621 Hwy 105 W Ste 104', 'Conroe', 'Montgomery', 'TX', '77304', '2813507272', '8325598584', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-05-01', NULL, 0, 0, 0, NULL, NULL, '', '', 'HCFA|UB|', '1205906286', 0, 'N', 0, '2013-04-15', NULL, NULL, 30.3428, -95.5512, NULL, NULL),
('272273286', 'W12032201', 'W12032201', 'TXHOUSTD', 'PCP For Life Splendora', 'Arunkumar', 'J', 'Shah', 'MD', 'Internal Medicine', '', '', NULL, 'O', '16401 1st St Ste 200', 'Splendora', 'Montgomery', 'TX', '77372', '2813507272', '8325598584', '16401 1st St Ste 200', 'Splendora', 'Montgomery', 'TX', '77372', '2813507272', '8325598584', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-05-01', NULL, 0, 0, 0, NULL, NULL, '', '', 'HCFA|UB|', '1205906286', 0, 'N', 0, '2013-04-15', NULL, NULL, 30.2068, -95.18, NULL, NULL),
('272273286', 'W12032202', 'W12032202', 'TXHOUSTD', 'PCP For Life Huntsville', 'Arunkumar', 'J', 'Shah', 'MD', 'Internal Medicine', '', '', NULL, 'O', '179 IH 45 S Ste 300', 'Huntsville', 'Walker', 'TX', '77340', '2813507272', '8325598584', '179 IH 45 S Ste 300', 'Huntsville', 'Walker', 'TX', '77340', '2813507272', '8325598584', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-05-01', NULL, 0, 0, 0, NULL, NULL, '', '', 'HCFA|UB|', '1205906286', 0, 'N', 0, '2013-04-15', NULL, NULL, 30.7124, -95.5665, NULL, NULL),
('272273286', 'W12032203', 'W12032203', 'TXHOUSTD', 'PCP For Life Lake Conroe Medical Clinic', 'Arunkumar', 'J', 'Shah', 'MD', 'Internal Medicine', '', '', NULL, 'O', '19380 Hwy 105 W', 'Montgomery', 'Montgomery', 'TX', '77356', '2813507272', '8325598584', '19380 Hwy 105 W', 'Montgomery', 'Montgomery', 'TX', '77356', '2813507272', '8325598584', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-05-01', NULL, 0, 0, 0, NULL, NULL, '', '', 'HCFA|UB|', '1205906286', 0, 'N', 0, '2013-04-15', NULL, NULL, 30.3847, -95.6629, NULL, NULL),
('272273286', 'W12032204', 'W12032204', 'TXHOUSTD', 'PCP For Life Tidwell', 'Arunkumar', 'J', 'Shah', 'MD', 'Internal Medicine', '', '', NULL, 'O', '2312 Tidwell Rd', 'Houston', 'Harris', 'TX', '77093', '2813507272', '8325598584', '2312 Tidwell Rd', 'Houston', 'Harris', 'TX', '77093', '2813507272', '8325598584', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-05-01', NULL, 0, 0, 0, NULL, NULL, '', '', 'HCFA|UB|', '1205906286', 0, 'N', 0, '2013-04-15', NULL, NULL, 29.848, -95.3487, NULL, NULL),
('272273286', 'W12032205', 'W12032205', 'TXHOUSTD', 'PCP For Life Little York', 'Arunkumar', 'J', 'Shah', 'MD', 'Internal Medicine', '', '', NULL, 'O', '2708 Little York Rd', 'Houston', 'Harris', 'TX', '77093', '2813507272', '8325598584', '2708 Little York Rd', 'Houston', 'Harris', 'TX', '77093', '2813507272', '8325598584', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-05-01', NULL, 0, 0, 0, NULL, NULL, '', '', 'HCFA|UB|', '1205906286', 0, 'N', 0, '2013-04-15', NULL, NULL, 29.871, -95.344, NULL, NULL),
('272273286', 'W12032206', 'W12032206', 'TXHOUSTD', 'PCP For Life Bridgestone Family Practice', 'Arunkumar', 'J', 'Shah', 'MD', 'Internal Medicine', '', '', NULL, 'O', '4915 FM 2920 Ste 200', 'Spring', 'Harris', 'TX', '77388', '2813507272', '8325598584', '4915 FM 2920 Ste 200', 'Spring', 'Harris', 'TX', '77388', '2813507272', '8325598584', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-05-01', NULL, 0, 0, 0, NULL, NULL, '', '', 'HCFA|UB|', '1205906286', 0, 'N', 0, '2013-04-15', NULL, NULL, 30.0737, -95.494, NULL, NULL),
('454333415', 'W12032207', 'W12032207', 'UT01', 'Red Rock Eye Care ', 'Paul', 'R', 'Gooch', 'OD', 'Optometry', NULL, NULL, NULL, 'O', '415 E Center St', 'Panguitch', 'Garfield', 'UT', '84759', '4356768646', '4356768647', '415 E Center St', 'Panguitch', 'Garfield', 'UT', '84759', '4356768646', '4356768647', 'WUTALBERT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-03-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1457498305', 0, 'N', 0, '2013-12-16', NULL, NULL, 37.8228, -112.428, NULL, NULL),
('200348433', 'W12032208', 'W12032208', 'UT01', 'Cedar Ridge Family Medicine', 'Jason', 'K', 'North', 'DO', 'Family Practice', '', '', NULL, 'O', '110 W 1325 N Ste 200', 'Cedar City', 'Iron', 'UT', '84721', '4355867676', '4355862290', '110 W 1325 N Ste 200', 'Cedar City', 'Iron', 'UT', '84721', '4355867676', '4355862290', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-05-01', NULL, 0, 0, 0, 'Valley View Medical Center', '', '', '', 'HCFA|UB|', '1285760132', 0, 'N', 0, '2014-06-03', NULL, NULL, 37.7011, -113.064, NULL, NULL),
('454333415', 'W12032210', 'W12032210', 'UT01', 'Red Rock Eye Care ', 'Ryan', 'E', 'Robison', 'OD', 'Optometry', '', '', NULL, 'O', '415 E Center St', 'Panguitch', 'Garfield', 'UT', '84759', '4356768646', '4356768647', '415 E Center St', 'Panguitch', 'Garfield', 'UT', '84759', '4356768646', '4356768647', 'WUTALBERT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-03-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1679686547', 0, 'N', 0, '2014-01-17', NULL, NULL, 37.8228, -112.428, NULL, NULL),
('870622942', 'W12032211', 'W12032211', 'UT01', 'Utah Imaging Associates', '', '', 'Utah Imaging Associates LLC', 'GROUP', 'Imaging Center', 'Mammography', '', NULL, 'O', '280 River Park Dr Ste 100', 'Provo', 'Utah', 'UT', '84604', '8012254515', '8012966199', '280 River Park Dr Ste 100', 'Provo', 'Utah', 'UT', '84604', '8012254515', '8012966199', 'WUUTIMAGE5', '', '', '0.00', '35.00', '0.00', 3, '2012-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1629076229', 0, 'Y', 0, '2013-04-15', NULL, NULL, 40.3037, -111.662, NULL, NULL),
('870622942', 'W12032214', 'W12032214', 'UT01', 'Utah Imaging Associates', 'Stephanie', 'L', 'Aston', 'PA-C', 'Diagnostic Radiology', '', '', NULL, 'M', '11460 N Meridian St 2nd Floor', 'Carmel', 'Hamilton', 'IN', '46032', '3178054155', '3174281055', '11460 N Meridian St 2nd Floor', 'Carmel', 'Hamilton', 'IN', '46032', '3178054155', '3174281055', 'WUUTIMAGE5', '', '', '0.00', '35.00', '0.00', 3, '2012-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1770891434', 0, 'N', 0, '2013-04-15', NULL, NULL, 0, 0, NULL, NULL),
('870622942', 'W12032215', 'W12032215', 'UT01', 'Utah Imaging Associates', 'Robert', 'M', 'Bell', 'MD', 'Radiologist', NULL, NULL, NULL, 'M', '11460 N Meridian St 2nd Floor', 'Carmel', 'Hamilton', 'IN', '46032', '3178054155', '3174281055', '11460 N Meridian St 2nd Floor', 'Carmel', 'Hamilton', 'IN', '46032', '3178054155', '3174281055', 'WUUTIMAGE5', '', '', '0.00', '35.00', '0.00', 3, '2012-11-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1831199918', 0, 'Y', 0, '2013-04-15', NULL, NULL, 0, 0, NULL, NULL),
('870622942', 'W12032216', 'W12032216', 'UT01', 'Utah Imaging Associates', 'Robert', 'M', 'Bell', 'MD', 'Radiologist', NULL, NULL, NULL, 'O', '280 River Park Dr Ste 100', 'Provo', 'Utah', 'UT', '84604', '8012254515', '8012966199', '280 River Park Dr Ste 100', 'Provo', 'Utah', 'UT', '84604', '8012254515', '8012966199', 'WUUTIMAGE5', '', '', '0.00', '35.00', '0.00', 3, '2012-11-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB', '1831199918', 0, 'Y', 0, '2013-04-15', NULL, NULL, 40.3037, -111.662, NULL, NULL),
('870622942', 'W12032217', 'W12032217', 'UT01', 'Utah Imaging Associates', 'Robert', 'M', 'Bell', 'MD', 'Radiologist', NULL, NULL, NULL, 'M', '380 N 200 W Ste 209', 'Bountiful', 'Davis', 'UT', '84010', '8017747006', '8012961715', '380 N 200 W Ste 209', 'Bountiful', 'Davis', 'UT', '84010', '8017747006', '8012961715', 'WUUTIMAGE5', '', '', '0.00', '35.00', '0.00', 3, '2012-11-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1831199918', 0, 'Y', 0, '2013-04-15', NULL, NULL, 0, 0, NULL, NULL),
('870622942', 'W12032218', 'W12032218', 'UT01', 'Utah Imaging Associates', 'James', 'G', 'Carlisle', 'MD', 'Radiation Oncology', '', '', NULL, 'M', '380 N 200 W Ste 209', 'Bountiful', 'Davis', 'UT', '84010', '8017747006', '8012961715', '380 N 200 W Ste 209', 'Bountiful', 'Davis', 'UT', '84010', '8017747006', '8012961715', 'WUUTIMAGE5', '', '', '0.00', '35.00', '0.00', 3, '2012-11-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1750478707', 0, 'Y', 0, '2013-04-15', NULL, NULL, 0, 0, NULL, NULL),
('870622942', 'W12032219', 'W12032219', 'UT01', 'Utah Imaging Associates', 'James', 'G', 'Carlisle', 'MD', 'Radiation Oncology', '', '', NULL, 'O', '280 River Park Dr Ste 100', 'Provo', 'Utah', 'UT', '84604', '8012254515', '8012966199', '280 River Park Dr Ste 100', 'Provo', 'Utah', 'UT', '84604', '8012254515', '8012966199', 'WUUTIMAGE5', '', '', '0.00', '35.00', '0.00', 3, '2012-11-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB', '1750478707', 0, 'Y', 0, '2013-04-15', NULL, NULL, 40.3037, -111.662, NULL, NULL),
('870622942', 'W12032220', 'W12032220', 'UT01', 'Utah Imaging Associates', 'James', 'G', 'Carlisle', 'MD', 'Radiation Oncology', '', '', NULL, 'M', '11460 N Meridian St 2nd Floor', 'Carmel', 'Hamilton', 'IN', '46032', '3178054155', '3174281055', '11460 N Meridian St 2nd Floor', 'Carmel', 'Hamilton', 'IN', '46032', '3178054155', '3174281055', 'WUUTIMAGE5', '', '', '0.00', '35.00', '0.00', 3, '2012-11-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1750478707', 0, 'Y', 0, '2013-04-15', NULL, NULL, 0, 0, NULL, NULL),
('870622942', 'W12032221', 'W12032221', 'UT01', 'Utah Imaging Associates', 'Craig', 'M', 'Carpenter', 'MD', 'Radiologist', NULL, NULL, NULL, 'M', '11460 N Meridian St 2nd Floor', 'Carmel', 'Hamilton', 'IN', '46032', '3178054155', '3174281055', '11460 N Meridian St 2nd Floor', 'Carmel', 'Hamilton', 'IN', '46032', '3178054155', '3174281055', 'WUUTIMAGE5', '', '', '0.00', '35.00', '0.00', 3, '2012-11-01', NULL, 0, 0, 0, 'Lakeview Hospital', 'St Marks Hospital', NULL, NULL, 'HCFA|UB|', '1326046558', 0, 'Y', 0, '2013-04-15', NULL, NULL, 0, 0, NULL, NULL),
('870622942', 'W12032222', 'W12032222', 'UT01', 'Utah Imaging Associates', 'Craig', 'M', 'Carpenter', 'MD', 'Radiologist', NULL, NULL, NULL, 'O', '280 River Park Dr Ste 100', 'Provo', 'Utah', 'UT', '84604', '8012254515', '8012966199', '280 River Park Dr Ste 100', 'Provo', 'Utah', 'UT', '84604', '8012254515', '8012966199', 'WUUTIMAGE5', '', '', '0.00', '35.00', '0.00', 3, '2012-11-01', NULL, 0, 0, 0, 'Lakeview Hospital', 'St Marks Hospital', NULL, NULL, 'HCFA|UB', '1326046558', 0, 'Y', 0, '2013-04-15', NULL, NULL, 40.3037, -111.662, NULL, NULL),
('870622942', 'W12032223', 'W12032223', 'UT01', 'Utah Imaging Associates', 'Craig', 'M', 'Carpenter', 'MD', 'Radiologist', NULL, NULL, NULL, 'M', '380 N 200 W Ste 209', 'Bountiful', 'Davis', 'UT', '84010', '8017747006', '8012961715', '380 N 200 W Ste 209', 'Bountiful', 'Davis', 'UT', '84010', '8017747006', '8012961715', 'WUUTIMAGE5', '', '', '0.00', '35.00', '0.00', 3, '2012-11-01', NULL, 0, 0, 0, 'Lakeview Hospital', 'St Marks Hospital', NULL, NULL, 'HCFA|UB|', '1326046558', 0, 'Y', 0, '2013-04-15', NULL, NULL, 0, 0, NULL, NULL),
('870622942', 'W12032224', 'W12032224', 'UT01', 'Utah Imaging Associates', 'John', 'V', 'Catasca', 'MD', 'Radiologist', NULL, NULL, NULL, 'M', '380 N 200 W Ste 209', 'Bountiful', 'Davis', 'UT', '84010', '8017747006', '8012961715', '380 N 200 W Ste 209', 'Bountiful', 'Davis', 'UT', '84010', '8017747006', '8012961715', 'WUUTIMAGE5', '', '', '0.00', '35.00', '0.00', 3, '2012-11-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1376542548', 0, 'Y', 0, '2013-06-04', NULL, NULL, 0, 0, NULL, NULL),
('870622942', 'W12032225', 'W12032225', 'UT01', 'Utah Imaging Associates', 'John', 'V', 'Catasca', 'MD', 'Radiologist', NULL, NULL, NULL, 'O', '280 River Park Dr Ste 100', 'Provo', 'Utah', 'UT', '84604', '8012254515', '8012966199', '280 River Park Dr Ste 100', 'Provo', 'Utah', 'UT', '84604', '8012254515', '8012966199', 'WUUTIMAGE5', '', '', '0.00', '35.00', '0.00', 3, '2012-11-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB', '1376542548', 0, 'Y', 0, '2013-06-04', NULL, NULL, 40.3037, -111.662, NULL, NULL),
('870622942', 'W12032226', 'W12032226', 'UT01', 'Utah Imaging Associates', 'John', 'V', 'Catasca', 'MD', 'Radiologist', NULL, NULL, NULL, 'M', '11460 N Meridian St 2nd Floor', 'Carmel', 'Hamilton', 'IN', '46032', '3178054155', '3174281055', '11460 N Meridian St 2nd Floor', 'Carmel', 'Hamilton', 'IN', '46032', '3178054155', '3174281055', 'WUUTIMAGE5', '', '', '0.00', '35.00', '0.00', 3, '2012-11-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1376542548', 0, 'Y', 0, '2013-06-04', NULL, NULL, 0, 0, NULL, NULL),
('870622942', 'W12032229', 'W12032229', 'UT01', 'Utah Imaging Associates', 'David', 'R', 'Dedrickson', 'MD', 'Radiologist', NULL, NULL, NULL, 'O', '280 River Park Dr Ste 100', 'Provo', 'Utah', 'UT', '84604', '8012254515', '8012966199', '280 River Park Dr Ste 100', 'Provo', 'Utah', 'UT', '84604', '8012254515', '8012966199', 'WUUTIMAGE5', '', '', '0.00', '35.00', '0.00', 3, '2012-11-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB', '1144222779', 0, 'Y', 0, '2013-04-15', NULL, NULL, 40.3037, -111.662, NULL, NULL),
('870622942', 'W12032230', 'W12032230', 'UT01', 'Utah Imaging Associates', 'David', 'R', 'Dedrickson', 'MD', 'Radiologist', NULL, NULL, NULL, 'M', '380 N 200 W Ste 209', 'Bountiful', 'Davis', 'UT', '84010', '8017747006', '8012961715', '380 N 200 W Ste 209', 'Bountiful', 'Davis', 'UT', '84010', '8017747006', '8012961715', 'WUUTIMAGE5', '', '', '0.00', '35.00', '0.00', 3, '2012-11-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1144222779', 0, 'Y', 0, '2013-04-15', NULL, NULL, 0, 0, NULL, NULL),
('870622942', 'W12032231', 'W12032231', 'UT01', 'Utah Imaging Associates', 'Aaron', 'E', 'Frodsham', 'MD', 'Radiology', '', '', NULL, 'M', '11460 N Meridian St 2nd Floor', 'Carmel', 'Hamilton', 'IN', '46032', '3178054155', '3174281055', '11460 N Meridian St 2nd Floor', 'Carmel', 'Hamilton', 'IN', '46032', '3178054155', '3174281055', 'WUUTIMAGE5', '', '', '0.00', '35.00', '0.00', 3, '2012-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1184807208', 0, 'N', 0, '2013-04-15', NULL, NULL, 0, 0, NULL, NULL),
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('800307419', 'W12032294', 'W12032294', 'WYT1', 'Wyoming Health Medical Group ', 'Mark', '', 'McGinley', 'MD', 'Internal Medicine', 'Pulmonary', 'Critical Care', NULL, 'O', '1233 E 2nd St', 'Casper', 'Natrona', 'WY', '82601', '3075777201', '3072371703', '1233 E 2nd St', 'Casper', 'Natrona', 'WY', '82601', '3075777201', '3072371703', '', '', '', '0.00', '18.00', '0.00', 3, '2013-04-15', NULL, 0, 0, 0, 'Wyoming Medical Center', '', '', '', 'HCFA|UB|', '1457324733', 0, 'N', 0, '2013-04-16', NULL, NULL, 0, 0, NULL, NULL),
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('363484044', 'W12032299', 'W12032299', 'ILCHIGSTD', 'Suresh Bhalla MD', 'Suresh', '', 'Bhalla', 'MD', 'Gastroenterology', '', '', NULL, 'O', '210 N Hammes Ave Ste 112', 'Joliet', 'Will', 'IL', '60435', '8157442123', '8157445823', '210 N Hammes Ave Ste 112', 'Joliet', 'Will', 'IL', '60435', '8157442123', '8157445823', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-04-16', NULL, 0, 0, 0, 'Presence Saint Joseph Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1811995426', 0, 'N', 0, '2013-05-30', NULL, NULL, 41.5253, -88.1319, NULL, NULL),
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('364210615', 'W12032302', 'W12032302', 'ILCHIGSTD', '', 'Marcos', 'A', 'Lopez', 'MD', 'Ophthalmology', '', '', NULL, 'O', '1431 N Western Ave Ste 301', 'Chicago', 'Cook', 'IL', '60622', '7733940400', '7084428009', '1431 N Western Ave Ste 301', 'Chicago', 'Cook', 'IL', '60622', '7733940400', '7084428009', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', NULL, NULL, NULL, 'HCFA|UB|', '1417967308', 0, 'N', 0, '2014-01-14', NULL, NULL, 41.9073, -87.6871, NULL, NULL),
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('364467374', 'W12032304', 'W12032304', 'ILCHIGSTD', 'Frederic K Renold MDSC', 'Frederic', '', 'Renold', 'MD', 'Allergy and Immunology', '', '', NULL, 'O', '800 W Biesterfield Rd Ste 206', 'Elk Grove Village', 'Cook', 'IL', '60007', '8479817300', '0000000000', '800 W Biesterfield Rd Ste 206', 'Elk Grove Village', 'Cook', 'IL', '60007', '8479817300', '0000000000', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-04-16', '2014-04-01', 0, 0, 0, 'Presence Resurrection Medical Center', '', '', '', 'HCFA|UB|', '1841278173', 0, 'N', 0, '2014-04-29', NULL, NULL, 42.0034, -88.0174, NULL, NULL),
('364467374', 'W12032305', 'W12032305', 'ILCHIGSTD', 'Allergy Partners of Chicago', 'Sol', '', 'Drapkin', 'MD', 'Allergy and Immunology', '', '', NULL, 'O', '800 W Biesterfield Rd Ste 206', 'Elk Grove Village', 'Cook', 'IL', '60007', '8479817300', '0000000000', '800 W Biesterfield Rd Ste 206', 'Elk Grove Village', 'Cook', 'IL', '60007', '8479817300', '0000000000', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-04-16', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1912986563', 0, 'N', 0, '2013-04-16', NULL, NULL, 42.0034, -88.0174, NULL, NULL),
('455498993', 'W12032306', 'W12032306', 'ILCHIGSTD', 'Lakeview Digestive Disease and Liver Center', 'Samuel', 'F', 'Castillo', 'MD', 'Gastroenterology', '', '', NULL, 'O', '1431 N Western Ave Ste 133', 'Chicago', 'Cook', 'IL', '60622', '7733426800', '0000000000', '1431 N Western Ave Ste 133', 'Chicago', 'Cook', 'IL', '60622', '7733426800', '0000000000', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-04-16', NULL, 0, 0, 0, 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', '', '', '', 'HCFA|UB|', '1205801313', 0, 'N', 0, '2013-04-16', NULL, NULL, 41.9073, -87.6871, NULL, NULL),
('264333033', 'W12032307', 'W12032307', 'TXSATSTD', 'Institute for Womens Health', 'Aspen', 'E', 'Laneman', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '3903 Wise Blvd Ste 200', 'San Antonio', 'Bexar', 'TX', '78251', '2103499300', NULL, '3903 Wise Blvd Ste 200', 'San Antonio', 'Bexar', 'TX', '78251', '2103499300', '          ', 'TXOBG', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-04-16', '2013-04-23', 0, 0, 0, 'St Lukes Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1619079274', 0, 'N', 0, '2013-08-26', NULL, NULL, 0, 0, NULL, NULL),
('272559167', 'W12032308', 'W12032308', 'TXSATSTD', 'Heart and Vascular Institute of Texas', 'Kalife', '', 'Kuri', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1050 Hwy 16 S', 'Bandera', 'Bandera', 'TX', '78003', '2104032926', NULL, '1050 Hwy 16 S', 'Bandera', 'Bandera', 'TX', '78003', '2104032926', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-04-16', NULL, 0, 0, 0, 'North Central Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1033008283', 0, 'N', 0, '2013-05-06', NULL, NULL, 29.7301, -99.0773, NULL, NULL),
('262199004', 'W12032309', 'W12032309', 'TXSATSTD', 'BHS Specialty Network  Inc.', 'Randy', 'N', 'Bergman', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1050 Hwy 16 S', 'Bandera', 'Bandera', 'TX', '78003', '2108046000', NULL, '1050 Hwy 16 S', 'Bandera', 'Bandera', 'TX', '78003', '2108046000', '          ', 'TXINT', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-04-16', '2013-04-24', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1457401101', 0, 'N', 0, '2013-05-06', NULL, NULL, 29.7305, -99.0578, NULL, NULL),
('760549217', 'W12032310', 'W12032310', 'TXBEAUSTD', 'Eye Centers of Southeast Texas', 'Mark', 'K', 'Harmon', 'MD', 'Ophthalmology', '', '', NULL, 'O', '3345 Plaza 10 Dr Ste B', 'Beaumont', 'Jefferson', 'TX', '77707', '4098330444', '4098339039', '3345 Plaza 10 Dr Ste B', 'Beaumont', 'Jefferson', 'TX', '77707', '4098330444', '4098339039', 'EYECTR', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-05-22', NULL, 0, 0, 0, 'Baptist Beaumont Hospital', NULL, '', '', 'HCFA|UB', '1932102290', 0, 'N', 0, '2014-02-12', NULL, NULL, 30.0782, -94.1369, NULL, NULL),
('263731885', 'W12032311', 'W12032311', 'TXDALSTD', 'Harmony Heart Group', 'Mordecai', 'N', 'Klein', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1600 Coit Rd Ste 304', 'Plano', 'Collin', 'TX', '75075', '9726124730', '9723489229', '1600 Coit Rd Ste 304', 'Plano', 'Collin', 'TX', '75075', '9726124730', '9723489229', 'DALLAS2', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-05-22', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', 'The Heart Hospital Baylor Plano', '', '', 'HCFA|UB|', '1881629541', 0, 'N', 0, '2014-05-02', NULL, NULL, 33.0202, -96.7675, NULL, NULL),
('263731885', 'W12032312', 'W12032312', 'TXDALSTD', 'Harmony Heart Group', 'Mordecai', 'N', 'Klein', 'MD', 'Cardiovascular Disease', '', '', NULL, 'B', 'PO Box 8887', 'Greenville', 'Hunt', 'TX', '75404', '9726124730', '9723489229', 'PO Box 8887', 'Greenville', 'Hunt', 'TX', '75404', '9726124730', '9723489229', 'DALLAS2', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-05-22', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', 'The Heart Hospital Baylor Plano', '', '', 'HCFA|UB|', '1881629541', 0, 'N', 0, '2014-05-02', NULL, NULL, 0, 0, NULL, NULL),
('760549217', 'W12032313', 'W12032313', 'TXBEAUSTD', 'Eye Centers of Southeast Texas', 'Vivek', '', 'Raizada', 'MD', 'Ophthalmology', '', '', NULL, 'O', '3345 Plaza 10 Dr Ste B', 'Beaumont', 'Jefferson', 'TX', '77707', '4098330444', '4098339039', '3345 Plaza 10 Dr Ste B', 'Beaumont', 'Jefferson', 'TX', '77707', '4098330444', '4098339039', 'EYECTR', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-05-22', NULL, 0, 0, 0, 'Baptist Beaumont Hospital', NULL, '', '', 'HCFA|UB', '1578564530', 0, 'N', 0, '2013-04-17', NULL, NULL, 30.0782, -94.1369, NULL, NULL),
('760549217', 'W12032317', 'W12032317', 'TXBEAUSTD', 'Eye Centers of Southeast', 'JoAnn', '', 'Hensel', 'MD', 'Ophthalmology', '', '', NULL, 'O', '3129 College St', 'Beaumont', 'Jefferson', 'TX', '77701', '4098383725', '4098384824', '3129 College St', 'Beaumont', 'Jefferson', 'TX', '77701', '4098383725', '4098384824', 'EYECTR', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-05-22', NULL, 0, 0, 0, 'Baptist Beaumont Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1487657821', 0, 'N', 0, '2013-04-17', NULL, NULL, 30.0685, -94.1213, NULL, NULL),
('760549217', 'W12032316', 'W12032316', 'TXBEAUSTD', 'Eye Centers of Southeast Texas', 'John', 'W', 'Miller', 'MD', 'Ophthalmology', '', '', NULL, 'O', '3129 College St', 'Beaumont', 'Jefferson', 'TX', '77701', '4098383725', '4098384824', '3129 College St', 'Beaumont', 'Jefferson', 'TX', '77701', '4098383725', '4098384824', 'EYECTR', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-05-22', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1578524286', 0, 'N', 0, '2013-04-17', NULL, NULL, 30.0685, -94.1213, NULL, NULL),
('760549217', 'W12032318', 'W12032318', 'TXBEAUSTD', 'Eye Centers of Southeast Texas', 'Min', '', 'Ren', 'MD', 'Ophthalmology', '', '', NULL, 'O', '3129 College St', 'Beaumont', 'Jefferson', 'TX', '77701', '4098383725', '4098384824', '3129 College St', 'Beaumont', 'Jefferson', 'TX', '77701', '4098383725', '4098384824', 'EYECTR', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-05-22', NULL, 0, 0, 0, 'Baptist Beaumont Hospital', NULL, NULL, NULL, 'HCFA|UB', '1467654798', 0, 'N', 0, '2013-04-17', NULL, NULL, 30.0685, -94.1213, NULL, NULL),
('760549217', 'W12032319', 'W12032319', 'TXBEAUSTD', 'Eye Centers of Southeast Texas', 'Alberto', '', 'Diaz-Saldana', 'MD', 'Ophthalmology', '', '', NULL, 'O', '3129 College St', 'Beaumont', 'Jefferson', 'TX', '77701', '4098383725', '4098384824', '3129 College St', 'Beaumont', 'Jefferson', 'TX', '77701', '4098383725', '4098384824', 'EYECTR', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-05-22', NULL, 0, 0, 0, 'Baptist Beaumont Hospital', NULL, '', '', 'HCFA|UB', '1225031602', 0, 'N', 0, '2013-04-17', NULL, NULL, 30.0685, -94.1213, NULL, NULL),
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('760549217', 'W12032322', 'W12032322', 'TXBEAUSTD', 'Eye Centers of Southeast Texas', 'Richard', 'A', 'Levacy', 'MD', 'Ophthalmology', '', '', NULL, 'O', '3345 Plaza 10 Dr Ste B', 'Beaumont', 'Jefferson', 'TX', '77707', '4098330444', '4098339039', '3345 Plaza 10 Dr Ste B', 'Beaumont', 'Jefferson', 'TX', '77707', '4098330444', '4098339039', 'EYECTR', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-05-22', NULL, 0, 0, 0, 'Baptist Beaumont Hospital', NULL, '', '', 'HCFA|UB', '1043213341', 0, 'N', 0, '2013-04-17', NULL, NULL, 30.0782, -94.1369, NULL, NULL),
('201435671', 'W12032323', 'W12032323', 'TXHOUSTD', 'Diabetes America', '', '', 'Diabetes America', '', 'Endocrinology', '', '', NULL, 'B', '13100 NW Fwy Ste 400', 'Houston', 'Harris', 'TX', '77040', '8666934223', '8882377954', '13100 NW Fwy Ste 400', 'Houston', 'Harris', 'TX', '77040', '8666934223', '8882377954', 'HOUSTON4', 'TXHCPC13', '', '0.00', '40.00', '0.00', 3, '2013-05-06', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1457396905', 0, 'N', 0, '2013-06-13', NULL, NULL, 0, 0, NULL, NULL),
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('272761438', 'W12032326', 'W12032326', 'TX01', 'Skin Surgery Center of San Antonio', 'Paula', 'S', 'Vogel', 'MD', 'Dermatology', '', '', NULL, 'O', '2632 Broadway Ste 201 North', 'San Antonio', 'Bexar', 'TX', '78215', '2105873286', NULL, '2632 Broadway Ste 201 North', 'San Antonio', 'Bexar', 'TX', '78215', '2105873286', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-04-01', '2014-04-02', 0, 0, 0, 'Baptist Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1881678779', 0, 'N', 0, '2014-03-04', NULL, NULL, 29.4514, -98.4736, NULL, NULL),
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('201435671', 'W12032418', 'W12032418', 'TXDALSTD', 'Diabetes America', 'Aysha', '', 'Kunju', 'MD', 'Endocrinology', '', '', NULL, 'B', '13100 NW Fwy Ste 400', 'Houston', 'Harris', 'TX', '77040', '8666934223', '8882377954', '13100 NW Fwy Ste 400', 'Houston', 'Harris', 'TX', '77040', '8666934223', '8882377954', 'HOUSTON4', 'TXHCPC13', '', '0.00', '40.00', '0.00', 3, '2013-05-06', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', NULL, NULL, NULL, 'HCFA|UB|', '1831114669', 0, 'N', 0, '2013-06-05', NULL, NULL, 0, 0, NULL, NULL),
('201435671', 'W12032419', 'W12032419', 'TXDALSTD', 'Diabetes America', 'Rosemarie', '', 'Lajara', 'MD', 'Endocrinology', '', '', NULL, 'B', '13100 NW Fwy Ste 400', 'Houston', 'Harris', 'TX', '77040', '8666934223', '8882377954', '13100 NW Fwy Ste 400', 'Houston', 'Harris', 'TX', '77040', '8666934223', '8882377954', 'HOUSTON4', 'TXHCPC13', '', '0.00', '40.00', '0.00', 3, '2013-05-06', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1780862102', 0, 'N', 0, '2013-06-05', NULL, NULL, 0, 0, NULL, NULL),
('201435671', 'W12032420', 'W12032420', 'TXHOUSTD', 'Diabetes America', 'Celia', '', 'Levesque', 'FNP', 'Endocrinology', '', '', NULL, 'B', '13100 NW Fwy Ste 400', 'Houston', 'Harris', 'TX', '77040', '8666934223', '8882377954', '13100 NW Fwy Ste 400', 'Houston', 'Harris', 'TX', '77040', '8666934223', '8882377954', 'HOUSTON4', 'TXHCPC13', '', '0.00', '40.00', '0.00', 3, '2013-05-06', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1316120363', 0, 'N', 0, '2013-04-18', NULL, NULL, 0, 0, NULL, NULL),
('201435671', 'W12032421', 'W12032421', 'TXDALSTD', 'Diabetes America', 'Paul', '', 'Lyde', 'MD', 'Endocrinology', '', '', NULL, 'B', '13100 NW Fwy Ste 400', 'Houston', 'Harris', 'TX', '77040', '8666934223', '8882377954', '13100 NW Fwy Ste 400', 'Houston', 'Harris', 'TX', '77040', '8666934223', '8882377954', 'HOUSTON4', 'TXHCPC13', '', '0.00', '40.00', '0.00', 3, '2013-05-06', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1336321207', 0, 'N', 0, '2013-06-05', NULL, NULL, 0, 0, NULL, NULL),
('201435671', 'W12032422', 'W12032422', 'TXHOUSTD', 'Diabetes America', 'Claudia', '', 'Makhoul', 'MD', 'Endocrinology', '', '', NULL, 'B', '13100 NW Fwy Ste 400', 'Houston', 'Harris', 'TX', '77040', '8666934223', '8882377954', '13100 NW Fwy Ste 400', 'Houston', 'Harris', 'TX', '77040', '8666934223', '8882377954', 'HOUSTON4', 'TXHCPC13', '', '0.00', '40.00', '0.00', 3, '2013-05-06', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1619028198', 0, 'N', 0, '2013-04-18', NULL, NULL, 0, 0, NULL, NULL),
('201435671', 'W12032423', 'W12032423', 'TXHOUSTD', 'Diabetes America', 'Samir', '', 'Ouais', 'MD', 'Endocrinology', '', '', NULL, 'B', '13100 NW Fwy Ste 400', 'Houston', 'Harris', 'TX', '77040', '8666934223', '8882377954', '13100 NW Fwy Ste 400', 'Houston', 'Harris', 'TX', '77040', '8666934223', '8882377954', 'HOUSTON4', 'TXHCPC13', '', '0.00', '40.00', '0.00', 3, '2013-05-06', NULL, 0, 0, 0, 'Kingwood Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1861559213', 0, 'N', 0, '2013-04-18', NULL, NULL, 0, 0, NULL, NULL),
('201435671', 'W12032425', 'W12032425', 'TXHOUSTD', 'Diabetes America', 'Shreya', '', 'Parikh', 'MD', 'Endocrinology', '', '', NULL, 'B', '13100 NW Fwy Ste 400', 'Houston', 'Harris', 'TX', '77040', '8666934223', '8882377954', '13100 NW Fwy Ste 400', 'Houston', 'Harris', 'TX', '77040', '8666934223', '8882377954', 'HOUSTON4', 'TXHCPC13', '', '0.00', '40.00', '0.00', 3, '2013-05-06', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1437488806', 0, 'N', 0, '2013-04-18', NULL, NULL, 0, 0, NULL, NULL),
('201435671', 'W12032426', 'W12032426', 'TXHOUSTD', 'Diabetes America', 'Charles', '', 'Reasner II', 'MD', 'Endocrinology', '', '', NULL, 'B', '13100 NW Fwy Ste 400', 'Houston', 'Harris', 'TX', '77040', '8666934223', '8882377954', '13100 NW Fwy Ste 400', 'Houston', 'Harris', 'TX', '77040', '8666934223', '8882377954', 'HOUSTON4', 'TXHCPC13', '', '0.00', '40.00', '0.00', 3, '2013-05-05', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1275543886', 0, 'N', 0, '2013-05-10', NULL, NULL, 0, 0, NULL, NULL),
('201435671', 'W12032427', 'W12032427', 'TXHOUSTD', 'Diabetes America', 'Shivani', '', 'Toma', 'MD', 'Endocrinology', '', '', NULL, 'B', '13100 NW Fwy Ste 400', 'Houston', 'Harris', 'TX', '77040', '8666934223', '8882377954', '13100 NW Fwy Ste 400', 'Houston', 'Harris', 'TX', '77040', '8666934223', '8882377954', 'HOUSTON4', 'TXHCPC13', '', '0.00', '40.00', '0.00', 3, '2013-05-06', '2013-01-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1063621175', 0, 'N', 0, '2013-08-19', NULL, NULL, 0, 0, NULL, NULL),
('201435671', 'W12032428', 'W12032428', 'TXHOUSTD', 'Diabetes America', 'Lloyd', '', 'Weddington', 'MD', 'Endocrinology', '', '', NULL, 'B', '13100 NW Fwy Ste 400', 'Houston', 'Harris', 'TX', '77040', '8666934223', '8882377954', '13100 NW Fwy Ste 400', 'Houston', 'Harris', 'TX', '77040', '8666934223', '8882377954', 'HOUSTON4', 'TXHCPC13', '', '0.00', '40.00', '0.00', 3, '2013-05-06', '2014-02-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1043288418', 0, 'N', 0, '2014-02-05', NULL, NULL, 0, 0, NULL, NULL),
('201435671', 'W12032429', 'W12032429', 'TXHOUSTD', 'Diabetes America', 'Cheryl', '', 'Winter', 'FNP', 'Endocrinology', '', '', NULL, 'B', '13100 NW Fwy Ste 400', 'Houston', 'Harris', 'TX', '77040', '8666934223', '8882377954', '13100 NW Fwy Ste 400', 'Houston', 'Harris', 'TX', '77040', '8666934223', '8882377954', 'HOUSTON4', 'TXHCPC13', '', '0.00', '40.00', '0.00', 3, '2013-05-06', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1215075825', 0, 'N', 0, '2013-04-18', NULL, NULL, 0, 0, NULL, NULL),
('201435671', 'W12032430', 'W12032430', 'TXHOUSTD', 'Diabetes America', 'Adriana', '', 'Wechsler', 'MD', 'Endocrinology', '', '', NULL, 'B', '13171 Misty Willow Dr', 'Houston', 'Harris', 'TX', '77070', '8322373500', '8882377954', '13171 Misty Willow Dr', 'Houston', 'Harris', 'TX', '77070', '8322373500', '8882377954', 'HOUSTON4', 'TXHCPC13', '', '0.00', '40.00', '0.00', 3, '2013-05-06', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1477595122', 0, 'N', 0, '2013-04-18', NULL, NULL, 0, 0, NULL, NULL),
('820425454', 'W12032435', 'W12032435', 'ID01', 'Boise Anesthesia, PA', 'Gary', 'D', 'Bevan', 'CRNA', 'Nurse Anesthetist', '', '', NULL, 'O', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083676416', '2083759530', '1055 N Curtis Rd    ', 'Boise', 'Ada', 'ID', '83706', '2083676416', '2083759530', 'IDSAMG3', '', '', '62.80', '10.00', '0.00', 3, '2013-04-01', NULL, 1, 15, 0, '', '', '', '', 'HCFA|UB|', '1174579742', 0, 'N', 0, '2013-04-19', NULL, NULL, 43.6145, -116.254, NULL, NULL),
('820425454', 'W12032434', 'W12032434', 'ID01', 'Boise Anesthesia PA', 'Jared', 'A', 'Bevan', 'CRNA', 'Nurse Anesthetist', '', '', NULL, 'B', 'PO Box 4268', 'Portland', 'Multnomah', 'OR', '97208', '8002758752', NULL, 'PO Box 4268', 'Portland', 'Multnomah', 'OR', '97208', '8002758752', '          ', 'IDSAMG3', '', '', '62.79', '10.00', '0.00', 3, '2013-04-01', '2013-04-01', 1, 15, 0, '', '', '', '', 'HCFA|UB|', '1609113927', 0, 'N', 0, '2013-10-29', NULL, NULL, 0, 0, NULL, NULL),
('820425454', 'W12032436', 'W12032436', 'ID01', 'Boise Anesthesia, PA', 'Gary', 'D', 'Bevan', 'CRNA', 'Nurse Anesthetist', '', '', NULL, 'O', '1717 Arlington Ave', 'Caldwell', 'Canyon', 'ID', '83605', '2084594641', '2083759530', '1717 Arlington Ave    ', 'Caldwell', 'Canyon', 'ID', '83605', '2084594641', '2083759530', 'IDSAMG3', '', '', '62.80', '10.00', '0.00', 3, '2013-04-01', NULL, 1, 15, 0, '', '', '', '', 'HCFA|UB|', '1174579742', 0, 'N', 0, '2013-04-19', NULL, NULL, 43.6542, -116.696, NULL, NULL),
('820425454', 'W12032437', 'W12032437', 'ID01', 'Boise Anesthesia, PA', 'Gary', 'D', 'Bevan', 'CRNA', 'Nurse Anesthetist', '', '', NULL, 'O', '3025 W Cherry Ln', 'Meridian', 'Ada', 'ID', '83642', '2083678500', '2083759530', '3025 W Cherry Ln    ', 'Meridian', 'Ada', 'ID', '83642', '2083678500', '2083759530', 'IDSAMG3', '', '', '62.80', '10.00', '0.00', 3, '2013-04-01', NULL, 1, 15, 0, '', '', '', '', 'HCFA|UB|', '1174579742', 0, 'N', 0, '2013-04-19', NULL, NULL, 43.6193, -116.431, NULL, NULL),
('820425454', 'W12032438', 'W12032438', 'ID01', 'Boise Anesthesia, PA', 'Gary', 'D', 'Bevan', 'CRNA', 'Nurse Anesthetist', '', '', NULL, 'O', '900 N Liberty St Ste 450', 'Boise', 'Ada', 'ID', '83704', '2083677431', '2083759530', '900 N Liberty St Ste 450', 'Boise', 'Ada', 'ID', '83704', '2083677431', '2083759530', 'IDSAMG3', '', '', '62.80', '10.00', '0.00', 3, '2013-04-01', NULL, 1, 15, 0, '', '', '', '', 'HCFA|UB|', '1174579742', 0, 'N', 0, '2013-04-19', NULL, NULL, 43.6124, -116.261, NULL, NULL),
('820425454', 'W12032439', 'W12032439', 'ID01', 'Boise Anesthesia, PA', 'Jared', 'A', 'Bevan', 'CRNA', 'Nurse Anesthetist', '', '', NULL, 'O', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083676416', '2083759530', '1055 N Curtis Rd    ', 'Boise', 'Ada', 'ID', '83706', '2083676416', '2083759530', 'IDSAMG3', '', '', '62.80', '10.00', '0.00', 3, '2013-04-01', NULL, 1, 15, 0, '', '', '', '', 'HCFA|UB|', '1609113927', 0, 'N', 0, '2013-10-29', NULL, NULL, 43.6145, -116.254, NULL, NULL),
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('820425454', 'W12032442', 'W12032442', 'ID01', 'Boise Anesthesia, PA', 'Jared', 'A', 'Bevan', 'CRNA', 'Nurse Anesthetist', '', '', NULL, 'O', '900 N Liberty St Ste 450', 'Boise', 'Ada', 'ID', '83704', '2083677431', '2083759530', '900 N Liberty St Ste 450', 'Boise', 'Ada', 'ID', '83704', '2083677431', '2083759530', 'IDSAMG3', '', '', '62.80', '10.00', '0.00', 3, '2013-04-01', NULL, 1, 15, 0, '', '', '', '', 'HCFA|UB|', '1609113927', 0, 'N', 0, '2013-10-29', NULL, NULL, 43.6124, -116.261, NULL, NULL),
('850275777', 'W12032446', 'W12032446', 'NM01', 'Southwest Medical Associates', 'Carmen', 'R', 'Gonzalez', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '4420 Irving Blvd NW', 'Albuquerque', 'Bernalillo', 'NM', '87114', '5058231010', '5057974503', '4420 Irving Blvd NW', 'Albuquerque', 'Bernalillo', 'NM', '87114', '5058231010', '5057974503', 'NMSWMED', '', '', '0.00', '10.00', '0.00', 3, '2013-06-01', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1629171046', 0, 'N', 0, '2013-10-30', NULL, NULL, 35.1902, -106.665, NULL, NULL),
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('454762655', 'W12032447', 'W12032447', 'UT01', 'GP Massand MD', 'Ghanshyam', 'P', 'Massand', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '6531 N Landmark Dr Ste E', 'Park City', 'Summit', 'UT', '84098', '4356493566', '0000000000', '6531 N Landmark Dr Ste E', 'Park City', 'Summit', 'UT', '84098', '4356493566', '0000000000', 'WURURAL5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-04-01', '2014-07-19', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1740245604', 0, 'N', 0, '2014-06-02', NULL, NULL, 40.7251, -111.548, NULL, NULL),
('454762655', 'W12032449', 'W12032449', 'UT01', 'GP Massand MD', 'Ghanshyam', 'P', 'Massand', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1485 S Hwy 40 Ste D', 'Heber City', 'Wasatch', 'UT', '84032', '4356543657', '0000000000', '1485 S Hwy 40 Ste D', 'Heber City', 'Wasatch', 'UT', '84032', '4356543657', '0000000000', 'WURURAL5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-04-01', '2014-07-19', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1740245604', 0, 'N', 0, '2014-06-02', NULL, NULL, 40.489, -111.409, NULL, NULL),
('454762655', 'W12032450', 'W12032450', 'UT01', 'GP Massand MD', 'Ghanshyam', 'P', 'Massand', 'MD', 'Orthopedic Surgery', '', '', NULL, 'M', 'PO Box 981147', 'Park City', 'Summit', 'UT', '84098', '0000000000', '4356558269', 'PO Box 981147', 'Park City', 'Summit', 'UT', '84098', '0000000000', '4356558269', 'WURURAL5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-04-01', '2014-07-19', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1740245604', 0, 'N', 0, '2014-06-02', NULL, NULL, 0, 0, NULL, NULL),
('245710825', 'W12032451', 'W12032451', 'UT01', 'Precision Health Services', '', '', 'Precision Health Services', 'GROUP', 'Sleep Disorders', 'Durable Medical Equipment', '', NULL, 'O', '4885 S 900 E Ste 107', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8012660399', '8012660421', '4885 S 900 E Ste 107', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8012660399', '8012660421', 'WCSTPHS5', 'DME8013', '', '0.00', '65.00', '0.00', 3, '2013-05-01', '2014-03-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000834822', 0, 'N', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('245712050', 'W12032452', 'W12032452', 'UT01', 'Precision Diagnostic Services', '', '', 'Precision Diagnostic Services ', 'GROUP', 'Sleep Disorders', '', '', NULL, 'O', '4885 S 900 E Ste 107', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8012660399', '8012660421', '4885 S 900 E Ste 107', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8012660399', '8012660421', 'WCSTPDS', 'DME8013', '', '0.00', '65.00', '0.00', 3, '2013-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1871691246', 0, 'N', 0, '2013-05-29', NULL, NULL, 0, 0, NULL, NULL),
('800307419', 'W12032454', 'W12032454', 'WY01', 'Wyoming Health Medical Group ', 'Tara', 'L', 'Taylor', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1233 E 2nd St', 'Casper', 'Natrona', 'WY', '82601', '3075777201', '3072371703', '1233 E 2nd St', 'Casper', 'Natrona', 'WY', '82601', '3075777201', '3072371703', '', '', '', '0.00', '18.00', '0.00', 3, '2013-04-25', NULL, 0, 0, 0, 'Wyoming Medical Center', '', '', '', 'HCFA|UB|', '1912931213', 0, 'N', 0, '2013-10-08', NULL, NULL, 42.8487, -106.309, NULL, NULL),
('800307419', 'W12032455', 'W12032455', 'WYT1', 'Wyoming Health Medical Group ', 'Tara', 'L', 'Taylor', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1233 E 2nd St', 'Casper', 'Natrona', 'WY', '82601', '3075777201', '3072371703', '1233 E 2nd St', 'Casper', 'Natrona', 'WY', '82601', '3075777201', '3072371703', '', '', '', '0.00', '18.00', '0.00', 3, '2013-04-25', NULL, 0, 0, 0, 'Wyoming Medical Center', '', '', '', 'HCFA|UB|', '1912931213', 0, 'N', 0, '2013-10-08', NULL, NULL, 0, 0, NULL, NULL),
('742698089', 'W12032467', 'W12032467', 'TXSATSTD', 'Alamo City Medical Group', '', '', 'Alamo City Medical Group', '', 'Family Practice', '', '', NULL, 'O', '2211 NW Military Dr Ste 201', 'San Antonio', 'Bexar', 'TX', '78213', '2106962264', '2103405276', '2211 NW Military Dr Ste 201', 'San Antonio', 'Bexar', 'TX', '78213', '2106962264', '2103405276', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '0000010111', 0, 'N', 0, '2013-11-05', NULL, NULL, 29.3571, -98.5291, NULL, NULL),
('742698089', 'W12032468', 'W12032468', 'TXSATSTD', 'Alamo City Medical Group', '', '', 'Alamo City Medical Group', '', 'Family Practice', '', '', NULL, 'O', '2235 Thousand Oaks Ste 117', 'San Antonio', 'Bexar', 'TX', '78232', '2104901000', '2104963590', '2235 Thousand Oaks Ste 117', 'San Antonio', 'Bexar', 'TX', '78232', '2104901000', '2104963590', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '0000010111', 0, 'N', 0, '2013-11-05', NULL, NULL, 29.588, -98.4523, NULL, NULL),
('742698089', 'W12032469', 'W12032469', 'TXSATSTD', 'Alamo City Medical Group', '', '', 'Alamo City Medical Group', '', 'Family Practice', '', '', NULL, 'O', '3453 IH 35 N Ste 207B', 'San Antonio', 'Bexar', 'TX', '78219', '2102278080', '2102233343', '3453 IH 35 N Ste 207B', 'San Antonio', 'Bexar', 'TX', '78219', '2102278080', '2102233343', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '0000010111', 0, 'N', 0, '2013-11-05', NULL, NULL, 29.4472, -98.4303, NULL, NULL),
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('742447500', 'W12032519', 'W12032519', 'TX01', 'Cardiology Clinic of San Antonio', '', '', 'Cardiology Clinic of San Antonio PLLC', '', 'Cardiovascular Disease', '', '', NULL, 'B', 'PO Box 119', 'San Antonio', 'Bexar', 'TX', '78291', '2104906000', NULL, 'PO Box 119', 'San Antonio', 'Bexar', 'TX', '78291', '2104906000', '', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2007-01-01', '2010-08-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1487965000', 0, 'Y', 0, '2014-05-06', NULL, NULL, 0, 0, NULL, NULL);
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('272713767', 'W12032632', 'W12032632', 'TXSATSTD', 'Cardiology Clinic of San Antonio', 'Christopher', '', 'Thompson', 'MD', 'Cardiovascular Disease', 'Internal Medicine', '', NULL, 'O', '4411 Medical Dr Ste 300', 'San Antonio', 'Bexar', 'TX', '78229', '2106145400', '          ', '4411 Medical Dr Ste 300', 'San Antonio', 'Bexar', 'TX', '78229', '2106145400', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2014-06-15', 0, 0, 0, 'Baptist Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1891774667', 0, 'N', 0, '2014-05-06', NULL, NULL, 29.5103, -98.5717, NULL, NULL),
('272713767', 'W12032633', 'W12032633', 'TX01', 'Cardiology Clinic of San Antonio', 'Christopher', '', 'Thompson', 'MD', 'Cardiovascular Disease', 'Internal Medicine', '', NULL, 'B', 'PO Box 741248', 'Atlanta', 'Fulton', 'GA', '30374', '2104906000', '2104904658', 'PO Box 741248', 'Atlanta', 'Fulton', 'GA', '30374', '2104906000', '2104904658', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2010-09-01', '2012-08-19', 0, 0, 0, 'Baptist Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1891774667', 0, 'N', 0, '2013-11-15', NULL, NULL, 0, 0, NULL, NULL),
('272713767', 'W12032634', 'W12032634', 'TXSATSTD', 'Cardiology Clinic of San Antonio', 'Christopher', '', 'Thompson', 'MD', 'Cardiovascular Disease', 'Internal Medicine', '', NULL, 'B', 'PO Box 741248', 'Atlanta', 'Fulton', 'GA', '30374', '2104906000', '2104904658', 'PO Box 741248', 'Atlanta', 'Fulton', 'GA', '30374', '2104906000', '2104904658', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2014-06-15', 0, 0, 0, 'Baptist Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1891774667', 0, 'Y', 0, '2014-05-06', NULL, NULL, 0, 0, NULL, NULL),
('272713767', 'W12032635', 'W12032635', 'TX01', 'Cardiology Clinic of San Antonio', 'Kevin', '', 'Steel', 'MD DO', 'Cardiovascular Disease', '', '', NULL, 'B', 'PO Box 741248', 'Atlanta', 'Fulton', 'GA', '30374', '2104906000', '2104904658', 'PO Box 741248', 'Atlanta', 'Fulton', 'GA', '30374', '2104906000', '2104904658', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2010-09-01', '2012-01-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1578624979', 0, 'N', 0, '2013-05-17', NULL, NULL, 0, 0, NULL, NULL),
('272713767', 'W12032636', 'W12032636', 'TXSATSTD', 'Cardiology Clinic of San Antonio', 'Kevin', '', 'Steel', 'MD DO', 'Cardiovascular Disease', '', '', NULL, 'B', 'PO Box 741248', 'Atlanta', 'Fulton', 'GA', '30374', '2104906000', '2104904658', 'PO Box 741248', 'Atlanta', 'Fulton', 'GA', '30374', '2104906000', '2104904658', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2012-08-20', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1578624979', 0, 'N', 0, '2013-05-17', NULL, NULL, 0, 0, NULL, NULL),
('272713767', 'W12032637', 'W12032637', 'TX01', 'Cardiology Clinic of San Antonio', 'Ahmad', 'M', 'Slim', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 741248', 'Atlanta', 'Fulton', 'GA', '30374', '2104906000', '2104904658', 'PO Box 741248', 'Atlanta', 'Fulton', 'GA', '30374', '2104906000', '2104904658', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2010-09-01', '2012-08-19', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1386615433', 0, 'N', 0, '2013-10-28', NULL, NULL, 0, 0, NULL, NULL),
('272713767', 'W12032638', 'W12032638', 'TXSATSTD', 'Cardiology Clinic of San Antonio', 'Ahmad', 'M', 'Slim', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 741248', 'Atlanta', 'Fulton', 'GA', '30374', '2104906000', '2104904658', 'PO Box 741248', 'Atlanta', 'Fulton', 'GA', '30374', '2104906000', '2104904658', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2014-06-15', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1386615433', 0, 'Y', 0, '2014-05-06', NULL, NULL, 0, 0, NULL, NULL),
('272713767', 'W12032639', 'W12032639', 'TX01', 'Cardiology Clinic of San Antonio', 'Daniel', 'J', 'Donovan', 'MD', 'Cardiovascular Disease', '', '', NULL, 'B', 'PO Box 741248', 'Atlanta', 'Fulton', 'GA', '30374', '2104906000', '2104904658', 'PO Box 741248', 'Atlanta', 'Fulton', 'GA', '30374', '2104906000', '2104904658', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2010-09-01', '2012-08-19', 0, 0, 0, 'St Lukes Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1730150160', 0, 'N', 0, '2013-10-28', NULL, NULL, 0, 0, NULL, NULL),
('272713767', 'W12032640', 'W12032640', 'TXSATSTD', 'Cardiology Clinic of San Antonio', 'Daniel', 'J', 'Donovan', 'MD', 'Cardiovascular Disease', '', '', NULL, 'B', 'PO Box 741248', 'Atlanta', 'Fulton', 'GA', '30374', '2104906000', '2104904658', 'PO Box 741248', 'Atlanta', 'Fulton', 'GA', '30374', '2104906000', '2104904658', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2014-06-15', 0, 0, 0, 'St Lukes Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1730150160', 0, 'Y', 0, '2014-05-06', NULL, NULL, 0, 0, NULL, NULL),
('272713767', 'W12032641', 'W12032641', 'TX01', 'Cardiology Clinic of San Antonio', 'John', 'H', 'Liu', 'MD', 'Cardiovascular Disease', '', '', NULL, 'B', 'PO Box 741248', 'Atlanta', 'Fulton', 'GA', '30374', '2104906000', '2104904658', 'PO Box 741248', 'Atlanta', 'Fulton', 'GA', '30374', '2104906000', '2104904658', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2010-09-01', '2012-08-19', 0, 0, 0, 'North Central Baptist Hospital', 'St Lukes Baptist Hospital', NULL, NULL, 'HCFA|UB|', '0000007301', 0, 'N', 0, '2013-10-28', NULL, NULL, 0, 0, NULL, NULL),
('272713767', 'W12032642', 'W12032642', 'TXSATSTD', 'Cardiology Clinic of San Antonio', 'John', 'H', 'Liu', 'MD', 'Cardiovascular Disease', '', '', NULL, 'B', 'PO Box 741248', 'Atlanta', 'Fulton', 'GA', '30374', '2104906000', '2104904658', 'PO Box 741248', 'Atlanta', 'Fulton', 'GA', '30374', '2104906000', '2104904658', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2014-06-15', 0, 0, 0, 'North Central Baptist Hospital', 'St Lukes Baptist Hospital', NULL, NULL, 'HCFA|UB|', '0000007301', 0, 'Y', 0, '2014-05-06', NULL, NULL, 0, 0, NULL, NULL),
('260859559', 'ELHCA2021', 'ELHCA2021', 'TXHOUSTD', 'Hidalgo County Family Practitioners', 'Hiram', '', 'Tavarez', 'MD', 'Internal Medicine', '', '', NULL, 'O', '8O1 S Main St Ste C', 'McAllen', 'Hidalgo', 'TX', '78501', '9566860575', '9566863301', '8O1 S Main St Ste C', 'McAllen', 'Hidalgo', 'TX', '78501', '9566860575', '9566863301', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-05-29', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1023146230', 0, 'Y', 0, '2014-03-18', NULL, NULL, 26.1972, -98.2356, NULL, NULL),
('260859559', 'ELHCA2048', 'ELHCA2048', 'TXHOUSTD', 'Hidalgo County Family Practitioners', 'Hiram', '', 'Tavarez', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 74159O', 'Atlanta', 'Fulton', 'GA', '30384', '9566860575', '9566863301', 'PO Box 74159O', 'Atlanta', 'Fulton', 'GA', '30384', '9566860575', '9566863301', 'HCA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-05-29', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1023146230', 0, 'Y', 0, '2014-03-18', NULL, NULL, 0, 0, NULL, NULL),
('201857850', 'W12032660', 'W12032660', 'ILCHIGSTD', 'Prairie Path Foot and Ankle ', 'Saera', '', 'Arain Saleem', 'DPM', 'Podiatry', '', '', NULL, 'O', '136 W Vallette Ste 2', 'Elmhurst', 'Dupage', 'IL', '60126', '6308343668', '6308344015', '136 W Vallette Ste 2', 'Elmhurst', 'Dupage', 'IL', '60126', '6308343668', '6308344015', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-02', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1225025059', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.8835, -87.9416, NULL, NULL),
('836000025', 'W12032644', 'W12032644', 'WY01 & WYT1', 'Memorial Hospital of Carbon County', '', '', 'Memorial Hospital of Carbon County', 'GROUP', 'Hospital', '', '', NULL, 'O', 'physician fee schedule Loaded for Master Record Future eff date', 'Rawlins', 'Carbon', 'WY', '82301', '0000000000', NULL, 'physician fee schedule Loaded for Master Record Future eff date', 'Rawlins', 'Carbon', 'WY', '82301', '0000000000', '          ', 'WISEWYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 6, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1417031311', 0, 'Y', 1, '2013-04-26', NULL, NULL, 0, 0, NULL, NULL),
('271712426', 'ELHCA2016', 'ELHCA2016', 'TXHOUSTD', 'Corpus Christi Primary Care Associates', 'Norma', '', 'Murphy', 'NP', 'Family Practice', '', '', NULL, 'O', '3301 S Alameda Ste 201', 'Corpus Christi', 'Nueces', 'TX', '78411', '3618572900', '3618578321', '3301 S Alameda Ste 201', 'Corpus Christi', 'Nueces', 'TX', '78411', '3618572900', '3618578321', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-05-29', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1073891321', 0, 'Y', 0, '2013-09-19', NULL, NULL, 27.7545, -97.3884, NULL, NULL),
('271712426', 'ELHCA2043', 'ELHCA2043', 'TXHOUSTD', 'Corpus Christi Primary Care Associates', 'Norma', '', 'Murphy', 'NP', 'Family Practice', '', '', NULL, 'B', 'PO Box 741O75', 'Atlanta', 'Fulton', 'GA', '30374', '3618572900', '3618578321', 'PO Box 741O75', 'Atlanta', 'Fulton', 'GA', '30374', '3618572900', '3618578321', 'HCA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-05-29', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1073891321', 0, 'Y', 0, '2013-09-19', NULL, NULL, 0, 0, NULL, NULL),
('271712426', 'ELHCA2025', 'ELHCA2025', 'TXHOUSTD', 'Corpus Christi Primary Care Associates', 'Gerard J', '', 'Voorhees', 'MD', 'Hospitalist', '', '', NULL, 'O', '1625 Rodd Field Rd Ste 200', 'Corpus Christi', 'Nueces', 'TX', '78412', '3619852573', '3619850647', '1625 Rodd Field Rd Ste 200', 'Corpus Christi', 'Nueces', 'TX', '78412', '3619852573', '3619850647', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-05-29', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1104828540', 0, 'Y', 0, '2014-03-18', NULL, NULL, 27.6916, -97.3426, NULL, NULL),
('271712426', 'ELHCA2052', 'ELHCA2052', 'TXHOUSTD', 'Corpus Christi Primary Care Associates', 'Gerard J', '', 'Voorhees', 'MD', 'Hospitalist', '', '', NULL, 'B', 'PO Box 741O75', 'Atlanta', 'Fulton', 'GA', '30374', '3619852573', '3619850647', 'PO Box 741O75', 'Atlanta', 'Fulton', 'GA', '30374', '3619852573', '3619850647', 'HCA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-05-29', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1104828540', 0, 'Y', 0, '2014-03-18', NULL, NULL, 0, 0, NULL, NULL),
('272485384', 'ELHCA2018', 'ELHCA2018', 'TXHOUSTD', 'Rio Grande Valley Cardiology', 'Guillermo', '', 'Salinas', 'MD', 'Cardiology', '', '', NULL, 'O', '1O1 B East Ridge Rd', 'McAllen', 'Hidalgo', 'TX', '78503', '9566825665', '9566825597', '1O1 B East Ridge Rd', 'McAllen', 'Hidalgo', 'TX', '78503', '9566825665', '9566825597', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-05-29', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1215065529', 0, 'Y', 0, '2014-03-18', NULL, NULL, 26.1847, -98.2157, NULL, NULL),
('272485384', 'ELHCA2045', 'ELHCA2045', 'TXHOUSTD', 'Rio Grande Valley Cardiology', 'Guillermo', '', 'Salinas', 'MD', 'Cardiology', '', '', NULL, 'B', 'PO Box 741151', 'Atlanta', 'Fulton', 'GA', '30374', '9566825665', '9566825597', 'PO Box 741151', 'Atlanta', 'Fulton', 'GA', '30374', '9566825665', '9566825597', 'HCA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-05-29', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1215065529', 0, 'Y', 0, '2014-03-18', NULL, NULL, 0, 0, NULL, NULL),
('271712426', 'ELHCA2026', 'ELHCA2026', 'TXHOUSTD', 'Corpus Christi Primary Care Associates', 'Tammy Rene', '', 'Wall', 'PA', 'Family Practice', '', '', NULL, 'O', '3301 S Alameda Ste 201', 'Corpus Christi', 'Nueces', 'TX', '78411', '3618572900', '3618578321', '3301 S Alameda Ste 201', 'Corpus Christi', 'Nueces', 'TX', '78411', '3618572900', '3618578321', 'HCA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-05-29', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1245348358', 0, 'Y', 0, '2013-08-30', NULL, NULL, 27.7545, -97.3884, NULL, NULL),
('271712426', 'ELHCA2053', 'ELHCA2053', 'TXHOUSTD', 'Corpus Christi Primary Care Associates', 'Tammy Rene', '', 'Wall', 'PA', 'Family Practice', '', '', NULL, 'B', 'PO Box 741O75', 'Atlanta', 'Fulton', 'GA', '30374', '3618572900', '3618578321', 'PO Box 741O75', 'Atlanta', 'Fulton', 'GA', '30374', '3618572900', '3618578321', 'HCA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-05-29', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1245348358', 0, 'Y', 0, '2013-08-30', NULL, NULL, 0, 0, NULL, NULL),
('201657769', 'ELHCA2014', 'ELHCA2014', 'TXHOUSTD', 'Southern Texas Physicians Network', 'Andrea', '', 'McNiel', 'PAC', 'Physician Assistant Certified', '', '', NULL, 'O', '500 Medical Ctr Blvd Ste 340', 'Conroe', 'Montgomery', 'TX', '77304', '9364942201', '9364942217', '500 Medical Ctr Blvd Ste 340', 'Conroe', 'Montgomery', 'TX', '77304', '9364942201', '9364942217', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-05-29', '2013-09-30', 0, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1255384061', 0, 'Y', 0, '2013-12-02', NULL, NULL, 30.2849, -95.466, NULL, NULL),
('201657769', 'ELHCA2041', 'ELHCA2041', 'TXHOUSTD', 'Southern Texas Physicians Network', 'Andrea', '', 'McNiel', 'PAC', 'Physician Assistant Certified', '', '', NULL, 'B', 'PO Box 4O4554', 'Atlanta', 'Fulton', 'GA', '30384', '9364942201', '9364942217', 'PO Box 4O4554', 'Atlanta', 'Fulton', 'GA', '30384', '9364942201', '9364942217', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-05-29', '2013-09-30', 0, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1255384061', 0, 'Y', 0, '2013-12-02', NULL, NULL, 0, 0, NULL, NULL),
('271712426', 'ELHCA2001', 'ELHCA2001', 'TXHOUSTD', 'Corpus Christi Primary Care Associates', 'Charles', '', 'Breeling', 'MD', 'Family Practice', '', '', NULL, 'O', '3301 S Alameda Ste 201', 'Corpus Christi', 'Nueces', 'TX', '78411', '3618572900', '3618578321', '3301 S Alameda Ste 201', 'Corpus Christi', 'Nueces', 'TX', '78411', '3618572900', '3618578321', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-05-29', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1346358413', 0, 'Y', 0, '2013-12-03', NULL, NULL, 27.7545, -97.3884, NULL, NULL),
('271712426', 'ELHCA2028', 'ELHCA2028', 'TXHOUSTD', 'Corpus Christi Primary Care Associates', 'Charles', '', 'Breeling', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 741O75', 'Atlanta', 'Fulton', 'GA', '30374', '3618572900', '3618578321', 'PO Box 741O75', 'Atlanta', 'Fulton', 'GA', '30374', '3618572900', '3618578321', 'HCA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-05-29', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1346358413', 0, 'Y', 0, '2013-12-03', NULL, NULL, 0, 0, NULL, NULL),
('201657769', 'ELHCA2015', 'ELHCA2015', 'TXHOUSTD', 'Southern Texas Physicians Network', 'Edgar', '', 'Moncada', 'MD', 'General Surgery', '', '', NULL, 'O', '100 E Alton Gloor Bldg B Ste 260', 'Brownsville', 'Cameron', 'TX', '78526', '9563503901', '9563503900', '100 E Alton Gloor Bldg B Ste 260', 'Brownsville', 'Cameron', 'TX', '78526', '9563503901', '9563503900', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-05-29', NULL, 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1356335855', 0, 'Y', 0, '2014-04-01', NULL, NULL, 25.9791, -97.516, NULL, NULL),
('201657769', 'ELHCA2042', 'ELHCA2042', 'TXHOUSTD', 'Southern Texas Physicians Network', 'Edgar', '', 'Moncada', 'MD', 'General Surgery', '', '', NULL, 'B', 'PO Box 4O4554', 'Atlanta', 'Fulton', 'GA', '30384', '9563503901', '9563503900', 'PO Box 4O4554', 'Atlanta', 'Fulton', 'GA', '30384', '9563503901', '9563503900', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-05-29', NULL, 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1356335855', 0, 'Y', 0, '2014-04-01', NULL, NULL, 0, 0, NULL, NULL),
('201657769', 'ELHCA2024', 'ELHCA2024', 'TXHOUSTD', 'Southern Texas Physicians Network', 'Jaime', '', 'Villarreal', 'MD', 'Cardiovascular Surgery', '', '', NULL, 'O', '100 E Alton Gloor Bldg B Ste 260', 'Brownsville', 'Cameron', 'TX', '78526', '9563503901', '9563503900', '100 E Alton Gloor Bldg B Ste 260', 'Brownsville', 'Cameron', 'TX', '78526', '9563503901', '9563503900', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-05-29', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1396766838', 0, 'Y', 0, '2014-04-01', NULL, NULL, 25.9791, -97.516, NULL, NULL),
('201657769', 'ELHCA2051', 'ELHCA2051', 'TXHOUSTD', 'Southern Texas Physicians Network', 'Jaime', '', 'Villarreal', 'MD', 'Cardiovascular Surgery', '', '', NULL, 'B', 'PO Box 4O4554', 'Atlanta', 'Fulton', 'GA', '30384', '9563503901', '9563503900', 'PO Box 4O4554', 'Atlanta', 'Fulton', 'GA', '30384', '9563503901', '9563503900', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-05-29', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1396766838', 0, 'Y', 0, '2014-04-01', NULL, NULL, 0, 0, NULL, NULL),
('271712426', 'ELHCA2002', 'ELHCA2002', 'TXHOUSTD', 'Corpus Christi Primary Care Associates', 'Agnes', '', 'Campbell', 'PA', 'Family Practice', '', '', NULL, 'O', '3301 S Alameda Ste 201', 'Corpus Christi', 'Nueces', 'TX', '78411', '3618572900', '3618578321', '3301 S Alameda Ste 201', 'Corpus Christi', 'Nueces', 'TX', '78411', '3618572900', '3618578321', 'HCA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-05-29', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1417086828', 0, 'Y', 0, '2013-09-11', NULL, NULL, 27.7545, -97.3884, NULL, NULL),
('271712426', 'ELHCA2029', 'ELHCA2029', 'TXHOUSTD', 'Corpus Christi Primary Care Associates', 'Agnes', '', 'Campbell', 'PA', 'Family Practice', '', '', NULL, 'B', 'PO Box 741O75', 'Atlanta', 'Fulton', 'GA', '30374', '3618572900', '3618578321', 'PO Box 741O75', 'Atlanta', 'Fulton', 'GA', '30374', '3618572900', '3618578321', 'HCA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-05-29', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1417086828', 0, 'Y', 0, '2013-09-11', NULL, NULL, 0, 0, NULL, NULL),
('271712426', 'ELHCA2003', 'ELHCA2003', 'TXHOUSTD', 'Corpus Christi Primary Care Associates', 'William', '', 'Dennis', 'MD', 'Family Practice', '', '', NULL, 'O', '3301 S Alameda Ste 201', 'Corpus Christi', 'Nueces', 'TX', '78411', '3618572900', '3618578321', '3301 S Alameda Ste 201', 'Corpus Christi', 'Nueces', 'TX', '78411', '3618572900', '3618578321', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-05-29', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1427166503', 0, 'Y', 0, '2014-03-18', NULL, NULL, 27.7545, -97.3884, NULL, NULL),
('271712426', 'ELHCA2030', 'ELHCA2030', 'TXHOUSTD', 'Corpus Christi Primary Care Associates', 'William', '', 'Dennis', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 741O75', 'Atlanta', 'Fulton', 'GA', '30374', '3618572900', '3618578321', 'PO Box 741O75', 'Atlanta', 'Fulton', 'GA', '30374', '3618572900', '3618578321', 'HCA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-05-29', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1427166503', 0, 'Y', 0, '2013-11-15', NULL, NULL, 0, 0, NULL, NULL),
('201657769', 'ELHCA2023', 'ELHCA2023', 'TXHOUSTD', 'Southern Texas Physicians Network', 'Dominique', '', 'Vande Maele', 'MD', 'General Surgery', '', '', NULL, 'O', '100 E Alton Gloor Bldg B Ste 260', 'Brownsville', 'Cameron', 'TX', '78526', '9563503901', '9563503900', '100 E Alton Gloor Bldg B Ste 260', 'Brownsville', 'Cameron', 'TX', '78526', '9563503901', '9563503900', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-05-29', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1437256815', 0, 'Y', 0, '2014-04-01', NULL, NULL, 25.9791, -97.516, NULL, NULL),
('201657769', 'ELHCA2050', 'ELHCA2050', 'TXHOUSTD', 'Southern Texas Physicians Network', 'Dominique', '', 'Vande Maele', 'MD', 'General Surgery', '', '', NULL, 'B', 'PO Box 4O4554', 'Atlanta', 'Fulton', 'GA', '30384', '9563503901', '9563503900', 'PO Box 4O4554', 'Atlanta', 'Fulton', 'GA', '30384', '9563503901', '9563503900', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-05-29', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1437256815', 0, 'Y', 0, '2014-04-01', NULL, NULL, 0, 0, NULL, NULL),
('261891316', 'ELHCA2005', 'ELHCA2005', 'TXHOUSTD', 'Houston Pediatric Specialty Group', 'Sarah', NULL, 'Farnia', 'PA', 'Pediatrics', '', '', NULL, 'O', '7900 Fannin Ste 3200', 'Houston', 'Harris', 'TX', '77054', '7137961600', '7137960397', '79OO Fannin Ste 3200', 'Houston', 'Harris', 'TX', '77054', '7137961600', '7137960397', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-05-29', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1508102542', 0, 'Y', 0, '2013-05-01', NULL, NULL, 29.6896, -95.4034, NULL, NULL),
('261891316', 'ELHCA2032', 'ELHCA2032', 'TXHOUSTD', 'Houston Pediatric Specialty Group', 'Sarah', NULL, 'Farnia', 'PA', 'Pediatrics', '', '', NULL, 'B', 'PO Box 281OO9', 'Atlanta', 'Fulton', 'GA', '30384', '7137961600', '7137960397', 'PO Box 281OO9', 'Atlanta', 'Fulton', 'GA', '30384', '7137961600', '7137960397', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-05-29', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1508102542', 0, 'Y', 0, '2013-05-01', NULL, NULL, 0, 0, NULL, NULL),
('611684739', 'ELHCA2027', 'ELHCA2027', 'TXHOUSTD', 'Conroe Montgomery Physicians Group', 'Jerome', NULL, 'Young', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '508 Medical Center Blvd Ste 100', 'Conroe', 'Montgomery', 'TX', '77304', '9367604600', '9367604601', '5O8 Medical Center Blvd Ste 100', 'Conroe', 'Montgomery', 'TX', '77304', '9367604600', '9367604601', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-05-29', NULL, 0, 0, 0, 'Conroe Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1518958230', 0, 'N', 0, '2013-05-01', NULL, NULL, 30.283, -95.4694, NULL, NULL),
('611684739', 'ELHCA2054', 'ELHCA2054', 'TXHOUSTD', 'Conroe Montgomery Physicians Group', 'Jerome', NULL, 'Young', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 742183', 'Atlanta', 'Fulton', 'GA', '30374', '9367604600', '9367604601', 'PO Box 742183', 'Atlanta', 'Fulton', 'GA', '30374', '9367604600', '9367604601', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-05-29', NULL, 0, 0, 0, 'Conroe Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1518958230', 0, 'Y', 0, '2013-05-01', NULL, NULL, 0, 0, NULL, NULL),
('030573692', 'ELHCA2011', 'ELHCA2011', 'TXHOUSTD', 'Occupational and Family Medicine of South Texas', 'Ronald', '', 'Kirkwood', 'DO', 'Family Practice', '', '', NULL, 'O', '2231 Center St Ste D', 'Deer Park', 'Harris', 'TX', '77536', '2814793670', '2814793674', '2231 Center St Ste D', 'Deer Park', 'Harris', 'TX', '77536', '2814793670', '2814793674', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-05-29', NULL, 0, 0, 0, 'Bayshore Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1528043221', 0, 'N', 0, '2013-07-24', NULL, NULL, 29.6913, -95.1235, NULL, NULL),
('836000025', 'W12032666', 'W12032666', 'WY01', 'Wagon Circle Clinic', 'Duane', 'E', 'Abels', 'MD', 'Urgent Care', '', '', NULL, 'O', '2012 W Elm St', 'Rawlins', 'Carbon', 'WY', '82301', '3073245346', NULL, '2012 W Elm St', 'Rawlins', 'Carbon', 'WY', '82301', '3073245346', '          ', 'WISEWYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 6, '2013-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1700945789', 0, 'N', 0, '2013-06-28', NULL, NULL, 41.7872, -107.259, NULL, NULL),
('452218152', 'ELHCA2008', 'ELHCA2008', 'TXHOUSTD', 'East Houston Specialists', 'Gerardo', NULL, 'Kalife', 'MD', 'Cardiology', '', '', NULL, 'O', '114O Westmont', 'Houston', 'Harris', 'TX', '77015', '7137971620', '7137971543', '114O Westmont', 'Houston', 'Harris', 'TX', '77015', '7137971620', '7137971543', 'HCA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-05-29', NULL, 0, 0, 0, 'Bayshore Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1538132030', 0, 'N', 0, '2013-05-01', NULL, NULL, 29.7766, -95.2005, NULL, NULL),
('452218152', 'ELHCA2035', 'ELHCA2035', 'TXHOUSTD', 'East Houston Specialists', 'Gerardo', NULL, 'Kalife', 'MD', 'Cardiology', '', '', NULL, 'B', 'PO Box 74178O', 'Atlanta', 'Fulton', 'GA', '30374', '7137971620', '7137971543', 'PO Box 74178O', 'Atlanta', 'Fulton', 'GA', '30374', '7137971620', '7137971543', 'HCA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-05-29', NULL, 0, 0, 0, 'Bayshore Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1538132030', 0, 'Y', 0, '2013-05-01', NULL, NULL, 0, 0, NULL, NULL),
('261891316', 'ELHCA2006', 'ELHCA2006', 'TXHOUSTD', 'Houston Pediatric Specialty Group', 'Jennifer', '', 'Garza', 'MD', 'Pediatric Surgery', '', '', NULL, 'O', '6316 N 1Oth St Ste F', 'McAllen', 'Hidalgo', 'TX', '78501', '9566313713', '9566310215', '6316 N 1Oth St Ste F', 'McAllen', 'Hidalgo', 'TX', '78501', '9566313713', '9566310215', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-05-29', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1568502912', 0, 'Y', 0, '2014-04-01', NULL, NULL, 26.2597, -98.2204, NULL, NULL),
('261891316', 'ELHCA2033', 'ELHCA2033', 'TXHOUSTD', 'Houston Pediatric Specialty Group', 'Jennifer', '', 'Garza', 'MD', 'Pediatric Surgery', '', '', NULL, 'B', 'PO Box 281OO9', 'Atlanta', 'Fulton', 'GA', '30384', '9566313713', '9566310215', 'PO Box 281OO9', 'Atlanta', 'Fulton', 'GA', '30384', '9566313713', '9566310215', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-05-29', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1568502912', 0, 'Y', 0, '2014-04-01', NULL, NULL, 0, 0, NULL, NULL),
('271712426', 'ELHCA2017', 'ELHCA2017', 'TXHOUSTD', 'Corpus Christi Primary Care Associates', 'Velma', '', 'Parris', 'NP', 'Family Practice', '', '', NULL, 'O', '3301 S Alameda Ste 201', 'Corpus Christi', 'Nueces', 'TX', '78411', '3618572900', '3618578321', '3301 S Alameda Ste 201', 'Corpus Christi', 'Nueces', 'TX', '78411', '3618572900', '3618578321', 'HCA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-05-29', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1649403056', 0, 'Y', 0, '2013-10-07', NULL, NULL, 27.7545, -97.3884, NULL, NULL),
('271712426', 'ELHCA2044', 'ELHCA2044', 'TXHOUSTD', 'Corpus Christi Primary Care Associates', 'Velma', '', 'Parris', 'NP', 'Family Practice', '', '', NULL, 'B', 'PO Box 741O75', 'Atlanta', 'Fulton', 'GA', '30374', '3618572900', '3618578321', 'PO Box 741O75', 'Atlanta', 'Fulton', 'GA', '30374', '3618572900', '3618578321', 'HCA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-05-29', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1649403056', 0, 'Y', 0, '2013-10-07', NULL, NULL, 0, 0, NULL, NULL),
('260859559', 'ELHCA2022', 'ELHCA2022', 'TXHOUSTD', 'Hidalgo County Family Practitioners', 'Marvin', '', 'Tavarez', 'MD', 'Internal Medicine', '', '', NULL, 'O', '8O1 S Main St Ste C', 'McAllen', 'Hidalgo', 'TX', '78501', '9566860575', '9566863301', '8O1 S Main St Ste C', 'McAllen', 'Hidalgo', 'TX', '78501', '9566860575', '9566863301', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-05-29', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1679601876', 0, 'Y', 0, '2014-03-18', NULL, NULL, 26.2117, -98.2335, NULL, NULL),
('260859559', 'ELHCA2049', 'ELHCA2049', 'TXHOUSTD', 'Hidalgo County Family Practitioners', 'Marvin', '', 'Tavarez', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 74159O', 'Atlanta', 'Fulton', 'GA', '30384', '9566860575', '9566863301', 'PO Box 74159O', 'Atlanta', 'Fulton', 'GA', '30384', '9566860575', '9566863301', 'HCA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-05-29', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1679601876', 0, 'Y', 0, '2014-03-18', NULL, NULL, 0, 0, NULL, NULL),
('263091562', 'ELHCA2007', 'ELHCA2007', 'TXHOUSTD', 'Mainland Primary Care Physicians', 'Katie', '', 'Gibbons', 'PA', 'Family Practice', '', '', NULL, 'O', '6807 Emmett F Lowry Expy Ste 103', 'Texas City', 'Galveston', 'TX', '77591', '4099381770', '4099380701', '6807 Emmett F Lowry Expy Ste 103', 'Texas City', 'Galveston', 'TX', '77591', '4099381770', '4099380701', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-05-29', '2013-11-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1801132980', 0, 'Y', 0, '2013-11-14', NULL, NULL, 0, 0, NULL, NULL),
('263091562', 'ELHCA2034', 'ELHCA2034', 'TXHOUSTD', 'Mainland Primary Care Physicians', 'Katie', '', 'Gibbons', 'PA', 'Family Practice', '', '', NULL, 'B', 'PO Box 4O547O', 'Atlanta', 'Fulton', 'GA', '30384', '4099381770', '4099380701', 'PO Box 4O547O', 'Atlanta', 'Fulton', 'GA', '30384', '4099381770', '4099380701', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-05-29', '2013-11-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1801132980', 0, 'Y', 0, '2013-11-14', NULL, NULL, 0, 0, NULL, NULL),
('030573692', 'ELHCA2020', 'ELHCA2020', 'TXHOUSTD', 'Occupational and Family Medicine of South Texas', 'Noah', '', 'Smith', 'PA', 'Family Practice', '', '', NULL, 'O', '4001 Preston Ave Ste 110', 'Pasadena', 'Harris', 'TX', '77505', '2812492273', '2819982123', '4OO1 Preston Ave Ste 110', 'Pasadena', 'Harris', 'TX', '77505', '2812492273', '2819982123', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-05-29', NULL, 0, 0, 0, 'Bayshore Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1801871058', 0, 'Y', 0, '2013-05-01', NULL, NULL, 29.6504, -95.1714, NULL, NULL),
('030573692', 'ELHCA2047', 'ELHCA2047', 'TXHOUSTD', 'Occupational and Family Medicine of South Texas', 'Noah', '', 'Smith', 'PA', 'Family Practice', '', '', NULL, 'B', 'PO Box 277268', 'Atlanta', 'Fulton', 'GA', '30384', '2812492273', '2819982123', 'PO Box 277268', 'Atlanta', 'Fulton', 'GA', '30384', '2812492273', '2819982123', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-05-29', NULL, 0, 0, 0, 'Bayshore Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1801871058', 0, 'Y', 0, '2013-05-01', NULL, NULL, 0, 0, NULL, NULL),
('836000025', 'W12032662', 'W12032662', 'WY01', 'Energy Basin Clinic', 'Cindy', '', 'Faulkner', 'PA', 'Orthopedic Surgery', '', '', NULL, 'O', '1008 Feldspar Ct', 'Hanna', 'Carbon', 'WY', '82327', '3073256590', NULL, '1008 Feldspar Ct', 'Hanna', 'Carbon', 'WY', '82327', '3073256590', '          ', 'WISEWYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 6, '2013-04-01', NULL, 0, 0, 0, 'Memorial Hospital of Carbon County', '', '', '', 'HCFA|', '1619957685', 0, 'N', 0, '2013-05-08', NULL, NULL, 41.8741, -106.549, NULL, NULL),
('836000025', 'W12032667', 'W12032667', 'WYT1', 'Wagon Circle Clinic', 'Duane', 'E', 'Abels', 'MD', 'Urgent Care', '', '', NULL, 'O', '2012 W Elm St', 'Rawlins', 'Carbon', 'WY', '82301', '3073245346', NULL, '2012 W Elm St', 'Rawlins', 'Carbon', 'WY', '82301', '3073245346', '          ', 'WISEWYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 6, '2013-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1700945789', 0, 'Y', 0, '2013-06-28', NULL, NULL, 0, 0, NULL, NULL),
('263127628', 'ELHCA2013', 'ELHCA2013', 'TXHOUSTD', 'OB GYN of Brownsville', 'Ricardo', '', 'Lemus', 'DO', 'Obstetrics and Gynecology', '', '', NULL, 'O', '3355 Boca Chica Blvd Ste F', 'Brownsville', 'Cameron', 'TX', '78521', '9565422410', '9565422470', '3355 Boca Chica Blvd Ste F', 'Brownsville', 'Cameron', 'TX', '78521', '9565422410', '9565422470', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-05-29', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1972550366', 0, 'Y', 0, '2014-04-01', NULL, NULL, 25.9209, -97.4683, NULL, NULL),
('263127628', 'ELHCA2040', 'ELHCA2040', 'TXHOUSTD', 'OB GYN of Brownsville', 'Ricardo', '', 'Lemus', 'DO', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 4O5492', 'Atlanta', 'Fulton', 'GA', '30384', '9565422410', '9565422470', 'PO Box 4O5492', 'Atlanta', 'Fulton', 'GA', '30384', '9565422410', '9565422470', 'HCA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-05-29', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1972550366', 0, 'Y', 0, '2014-04-01', NULL, NULL, 0, 0, NULL, NULL),
('272485384', 'ELHCA2004', 'ELHCA2004', 'TXHOUSTD', 'Rio Grande Valley Cardiology', 'Jeremy', '', 'Enslein', 'DO', 'Cardiology', '', '', NULL, 'O', '1O1 B East Ridge Rd', 'McAllen', 'Hidalgo', 'TX', '78503', '9566860661', '9566860561', '1O1 B East Ridge Rd', 'McAllen', 'Hidalgo', 'TX', '78503', '9566860661', '9566860561', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-05-29', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1982681946', 0, 'Y', 0, '2014-03-18', NULL, NULL, 26.1847, -98.2157, NULL, NULL),
('272485384', 'ELHCA2031', 'ELHCA2031', 'TXHOUSTD', 'Rio Grande Valley Cardiology', 'Jeremy', '', 'Enslein', 'DO', 'Cardiology', '', '', NULL, 'B', 'PO Box 4O4554', 'Atlanta', 'Fulton', 'GA', '30384', '9566860661', '9566860561', 'PO Box 4O4554', 'Atlanta', 'Fulton', 'GA', '30384', '9566860661', '9566860561', 'HCA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-05-29', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1982681946', 0, 'Y', 0, '2013-11-15', NULL, NULL, 0, 0, NULL, NULL),
('272481635', 'W12034160', 'W12034160', 'ID02', 'Saint Alphonsus Medical Center Nampa (Sound)', 'Mark', 'E', 'Mering', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 742128', 'Los Angeles', 'Los Angeles', 'CA', '90074', '2536826050', '0000000000', 'PO Box 742128   ', 'Los Angeles', 'Los Angeles', 'CA', '90074', '2536826050', '0000000000', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2013-05-24', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1578527990', 0, 'N', 0, '2013-11-22', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W12032648', 'W12032648', 'UT01', 'Central Utah Clinic PC', 'Braden', 'J', 'Taylor', 'PT', 'Physical Therapy', '', '', NULL, 'O', '1055 N 500 W Ste 122 Bldg C', 'Provo', 'Utah', 'UT', '84604', '8014290610', '0000000000', '1055 N 500 W Ste 122 Bldg C', 'Provo', 'Utah', 'UT', '84604', '8014290610', '0000000000', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1598788036', 0, 'N', 0, '2013-08-15', NULL, NULL, 40.248, -111.667, NULL, NULL),
('870281028', 'W12032646', 'W12032646', 'UT01', 'Central Utah Clinic PC', 'Braden', 'J', 'Taylor', 'PT', 'Physical Therapy', '', '', NULL, 'M', '1055 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013548225', '8014298150', '1055 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013548225', '8014298150', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-04-02', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1598788036', 0, 'N', 0, '2013-08-15', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W12032647', 'W12032647', 'UT01', 'Central Utah Clinic PC', 'Braden', 'J', 'Taylor', 'PT', 'Physical Therapy', '', '', NULL, 'B', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', '8014298180', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', '8014298180', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1598788036', 0, 'N', 0, '2013-08-15', NULL, NULL, 0, 0, NULL, NULL),
('454970317', 'W12032649', 'W12032649', 'UT01', 'Cancer Rehabilitation Centers', 'Christopher', 'W', 'Harper', 'PT', 'Physical Therapy', '', '', NULL, 'O', '11333 S 1000 E Ste 101 B', 'Sandy', 'Salt Lake', 'UT', '84094', '8014569898', '8014569899', '11333 S 1000 E Ste 101 B', 'Sandy', 'Salt Lake', 'UT', '84094', '8014569898', '8014569899', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2013-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1902900426', 0, 'N', 0, '2013-05-06', NULL, NULL, 40.5455, -111.863, NULL, NULL),
('201328719', 'W12032650', 'W12032650', 'WY01', 'Urgent Care of Casper', '', '', 'Urgent Care Now', 'GROUP', 'Urgent Care', '', '', NULL, 'O', '2546 E 2nd St Ste 200', 'Casper', 'Natrona', 'WY', '82609', '3072651110', '3072651108', '2546 E 2nd St Ste 200', 'Casper', 'Natrona', 'WY', '82609', '3072651110', '3072651108', '', '', '', '0.00', '30.00', '0.00', 3, '2013-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1932396199', 0, 'N', 0, '2013-04-26', NULL, NULL, 42.8488, -106.294, NULL, NULL),
('201328719', 'W12032651', 'W12032651', 'WYT1', 'Urgent Care of Casper', '', '', 'Urgent Care Now', 'GROUP', 'Urgent Care', '', '', NULL, 'O', '2546 E 2nd St Ste 200', 'Casper', 'Natrona', 'WY', '82609', '3072651110', '3072651108', '2546 E 2nd St Ste 200', 'Casper', 'Natrona', 'WY', '82609', '3072651110', '3072651108', '', '', '', '0.00', '30.00', '0.00', 3, '2013-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1932396199', 0, 'N', 0, '2013-04-26', NULL, NULL, 0, 0, NULL, NULL),
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('621801973', 'W12032694', 'W12032694', 'UT01', '', 'Nazia', '', 'Junejo', 'MD', 'Internal Medicine', 'Nephrology', '', NULL, 'O', '3336 S 4155 W Ste 203', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '0000000000', '0000000000', '3336 S 4155 W Ste 203', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '0000000000', '0000000000', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-06-01', '2014-04-30', 0, 0, 0, 'Jordan Valley Medical Center', 'St Marks Hospital', 'Pioneer Valley Hospital', '', 'HCFA|UB|', '1346218047', 0, 'N', 0, '2013-04-26', NULL, NULL, 40.6991, -111.99, NULL, NULL),
('621801973', 'W12032695', 'W12032695', 'UT01', '', 'Nazia', '', 'Junejo', 'MD', 'Internal Medicine', 'Nephrology', '', NULL, 'M', '406 W S Jordan Pkwy Ste 450', 'South Jordan', 'Salt Lake', 'UT', '84095', '0000000000', '0000000000', '406 W S Jordan Pkwy Ste 450', 'South Jordan', 'Salt Lake', 'UT', '84095', '0000000000', '0000000000', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-06-01', '2014-04-30', 0, 0, 0, 'Jordan Valley Medical Center', 'St Marks Hospital', 'Pioneer Valley Hospital', '', 'HCFA|UB|', '1346218047', 0, 'N', 0, '2013-04-26', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W12032696', 'W12032696', 'UT01', '', 'Nazia', '', 'Junejo', 'MD', 'Internal Medicine', 'Nephrology', '', NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '0000000000', '0000000000', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '0000000000', '0000000000', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-06-01', '2014-04-30', 0, 0, 0, 'Jordan Valley Medical Center', 'St Marks Hospital', 'Pioneer Valley Hospital', '', 'HCFA|UB|', '1346218047', 0, 'N', 0, '2013-04-26', NULL, NULL, 0, 0, NULL, NULL),
('870373083', 'W12032699', 'W12032699', 'UT01', 'Heart And Lung Institute of Utah', 'Chakravarthy', 'B', 'Reddy', 'MD', 'Pulmonary', 'Critical Care Medicine', '', NULL, 'O', '1050 E S Temple', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8012632370', '8012651200', '1050 E S Temple', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8012632370', '8012651200', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-05-01', '2014-04-30', 0, 0, 0, 'University Health Care University Hospital', '', '', '', 'HCFA|UB|', '1508962176', 0, 'N', 0, '2013-06-27', NULL, NULL, 40.7694, -111.861, NULL, NULL),
('870459414', 'W12032698', 'W12032698', 'UT01', 'Allergy Associates of Utah', 'Eric ', 'C', 'Chenworth', 'DO', 'Allergy and Immunology', '', '', NULL, 'O', '3855 W 7800 S Ste 225', 'West Jordan', 'Salt Lake', 'UT', '84088', '8012828700', '8012823305', '3855 W 7800 S Ste 225', 'West Jordan', 'Salt Lake', 'UT', '84088', '8012828700', '8012823305', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-03-26', '2013-10-17', 0, 0, 0, 'Salt Lake Regional Medical Center', '', '', '', 'HCFA|UB|', '1700859907', 0, 'N', 0, '2013-11-04', NULL, NULL, 0, 0, NULL, NULL),
('870459414', 'W12032697', 'W12032697', 'UT01', 'Allergy Associates of Utah', 'Eric ', 'C', 'Chenworth', 'DO', 'Allergy and Immunology', '', '', NULL, 'O', '6095 Fashion Blvd Ste 100', 'Murray', 'Salt Lake', 'UT', '84107', '8012638700', '8012638693', '6095 Fashion Blvd Ste 100', 'Murray', 'Salt Lake', 'UT', '84107', '8012638700', '8012638693', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-03-26', '2013-10-17', 0, 0, 0, 'Salt Lake Regional Medical Center', '', '', '', 'HCFA|UB|', '1700859907', 0, 'N', 0, '2013-11-04', NULL, NULL, 0, 0, NULL, NULL),
('870373083', 'W12032700', 'W12032700', 'UT01', 'Heart and Lung Institute of Utah', 'Chakravarthy', 'B', 'Reddy', 'MD', 'Pulmonary', 'Critical Care Medicine', '', NULL, 'M', '5979 S Fashion Blvd', 'Murray', 'Salt Lake', 'UT', '84107', '8012632370', '8012651200', '5979 S Fashion Blvd', 'Murray', 'Salt Lake', 'UT', '84107', '8012632370', '8012651200', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-05-01', '2014-04-30', 0, 0, 0, 'University Health Care University Hospital', '', '', '', 'HCFA|UB|', '1508962176', 0, 'N', 0, '2013-06-27', NULL, NULL, 0, 0, NULL, NULL),
('870373083', 'W12032701', 'W12032701', 'UT01', 'Heart and Lung Institute of Utah', 'Chakravarthy', 'B', 'Reddy', 'MD', 'Pulmonary', 'Critical Care Medicine', '', NULL, 'B', 'PO Box 847112', 'Dallas', 'Dallas', 'TX', '75284', '8012632370', '8012651200', 'PO Box 847112', 'Dallas', 'Dallas', 'TX', '75284', '8012632370', '8012651200', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-05-01', '2014-04-30', 0, 0, 0, 'University Health Care University Hospital', '', '', '', 'HCFA|UB|', '1508962176', 0, 'N', 0, '2013-06-27', NULL, NULL, 0, 0, NULL, NULL),
('870373083', 'W12032702', 'W12032702', 'UT01', 'Heart And Lung Institute of Utah', 'Chakravarthy', 'B', 'Reddy', 'MD', 'Pulmonary', 'Critical Care Medicine', '', NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8012632370', '8012651200', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8012632370', '8012651200', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-05-01', '2014-04-30', 0, 0, 0, 'University Health Care University Hospital', '', '', '', 'HCFA|UB|', '1508962176', 0, 'N', 0, '2013-06-27', NULL, NULL, 40.7685, -111.837, NULL, NULL),
('800307419', 'W12032703', 'W12032703', 'WY01', 'Wyoming Health Medical Group', 'David ', '', 'Erk', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1020 S Connell St', 'Casper', 'Natrona', 'WY', '82601', '3072658300', '3072338230', '1020 S Connell St', 'Casper', 'Natrona', 'WY', '82601', '3072658300', '3072338230', '', '', '', '0.00', '18.00', '0.00', 3, '2013-04-25', '2013-06-26', 0, 0, 0, 'Wyoming Medical Center ', NULL, NULL, NULL, 'HCFA|UB|', '1396713046', 0, 'N', 0, '2013-06-27', NULL, NULL, 0, 0, NULL, NULL),
('800307419', 'W12032704', 'W12032704', 'WYT1', 'Wyoming Health Medical Group', 'David ', '', 'Erk', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1020 S Connell St', 'Casper', 'Natrona', 'WY', '82601', '3072658300', '3072338230', '1020 S Connell St', 'Casper', 'Natrona', 'WY', '82601', '3072658300', '3072338230', '', '', '', '0.00', '18.00', '0.00', 3, '2013-04-25', '2013-06-26', 0, 0, 0, 'Wyoming Medical Center ', NULL, NULL, NULL, 'HCFA|UB|', '1396713046', 0, 'N', 0, '2013-06-27', NULL, NULL, 0, 0, NULL, NULL),
('461214792', 'W12032705', 'W12032705', 'UT01', 'Intermountain Allergy and Asthma Draper', 'Duane', 'J', 'Harris', 'MD', 'Allergy and Immunology', '', '', NULL, 'O', '12422 S 450 E Ste C', 'Draper', 'Salt Lake', 'UT', '84020', '8015531900', '8015539995', '12422 S 450 E Ste C', 'Draper', 'Salt Lake', 'UT', '84020', '8015531900', '8015539995', 'WiseSTD6A', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-05-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', '', '', '', 'HCFA|UB|', '1275535411', 0, 'N', 0, '2013-06-04', NULL, NULL, 40.5256, -111.878, NULL, NULL),
('263243700', 'W12032706', 'W12032706', 'TXDALSTD', 'Adesubomi Agoro MD', 'Adesubomi', '', 'Agoro', 'MD', 'Pulmonary', 'Internal Medicine', 'Critical Care', NULL, 'O', '1339 East St', 'Graham', 'Young', 'TX', '76450', '8177635550', '8178701280', '1339 East St', 'Graham', 'Young', 'TX', '76450', '8177635550', '8178701280', 'DALLAS4', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-06-06', NULL, 0, 0, 0, NULL, NULL, '', '', 'HCFA|UB|', '1073583076', 0, 'N', 0, '2013-09-16', NULL, NULL, 33.0909, -98.5844, NULL, NULL),
('455326091', 'W12032708', 'W12032708', 'UT01', 'Eastern Utah Womens Health ', 'Danielle', 'K', 'Howa Pendergrass', 'NP', 'Obstetrics and Gynecology', '', '', NULL, 'O', 'PO Box 656', 'Price', 'Carbon', 'UT', '84501', '4356370313', '4356370317', 'PO Box 656', 'Price', 'Carbon', 'UT', '84501', '4356370313', '4356370317', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1225257819', 0, 'N', 0, '2013-07-02', NULL, NULL, 39.5856, -110.806, NULL, NULL),
('830330554', 'W12032709', 'W12032709', 'WY01', 'Evanston Clinic', 'Karen', 'M', 'Rodeffer Evans', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '150 Arrowhead Dr Ste 2', 'Evanston', 'Uinta', 'WY', '82930', '3077898881', '3077896470', '150 Arrowhead Dr Ste 2', 'Evanston', 'Uinta', 'WY', '82930', '3077898881', '3077896470', 'WYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2013-06-01', NULL, 0, 0, 0, 'Evanston Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1063518595', 0, 'N', 0, '2013-07-15', NULL, NULL, 41.2425, -110.995, NULL, NULL),
('830330554', 'W12032710', 'W12032710', 'WY01', 'Evanston Clinic', 'Karen', 'M', 'Rodeffer Evans', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '531 Parkway Dr', 'Mountain View', 'Uinta', 'WY', '82939', '3077827560', '3077827584', '531 Parkway Dr', 'Mountain View', 'Uinta', 'WY', '82939', '3077827560', '3077827584', 'WYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2013-06-01', NULL, 0, 0, 0, 'Evanston Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1063518595', 0, 'N', 0, '2013-07-15', NULL, NULL, 41.2702, -110.337, NULL, NULL),
('830330554', 'W12032711', 'W12032711', 'WY01', 'Evanston Clinic', 'Karen', 'M', 'Rodeffer Evans', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 848407', 'Boston', 'Suffolk', 'MA', '02284', '0000000000', '0000000000', 'PO Box 848407', 'Boston', 'Suffolk', 'MA', '02284', '0000000000', '0000000000', 'WYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2013-06-01', NULL, 0, 0, 0, 'Evanston Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1063518595', 0, 'N', 0, '2013-07-15', NULL, NULL, 0, 0, NULL, NULL),
('830330554', 'W12032712', 'W12032712', 'WYT1', 'Evanston Clinic', 'Karen', 'M', 'Rodeffer Evans', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '150 Arrowhead Dr Ste 2', 'Evanston', 'Uinta', 'WY', '82930', '3077898881', '3077896470', '150 Arrowhead Dr Ste 2', 'Evanston', 'Uinta', 'WY', '82930', '3077898881', '3077896470', 'WYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2013-06-01', NULL, 0, 0, 0, 'Evanston Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1063518595', 0, 'N', 0, '2013-07-15', NULL, NULL, 0, 0, NULL, NULL),
('830330554', 'W12032713', 'W12032713', 'WYT1', 'Evanston Clinic', 'Karen', 'M', 'Rodeffer Evans', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '531 Parkway Dr', 'Mountain View', 'Uinta', 'WY', '82939', '3077827560', '3077827584', '531 Parkway Dr', 'Mountain View', 'Uinta', 'WY', '82939', '3077827560', '3077827584', 'WYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2013-06-01', NULL, 0, 0, 0, 'Evanston Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1063518595', 0, 'N', 0, '2013-07-15', NULL, NULL, 0, 0, NULL, NULL),
('830330554', 'W12032714', 'W12032714', 'WYT1', 'Evanston Clinic', 'Karen', 'M', 'Rodeffer Evans', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 848407', 'Boston', 'Suffolk', 'MA', '02284', '0000000000', '0000000000', 'PO Box 848407', 'Boston', 'Suffolk', 'MA', '02284', '0000000000', '0000000000', 'WYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2013-06-01', NULL, 0, 0, 0, 'Evanston Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1063518595', 0, 'N', 0, '2013-07-15', NULL, NULL, 0, 0, NULL, NULL),
('273995478', 'W12032717', 'W12032717', 'UT01', 'Southwest Spine and Pain Care Specialists', 'Brian', 'F', 'Richardson', 'MD', 'Pain Management', '', '', NULL, 'O', '1400 N 550 E Ste X & Y', 'Logan', 'Cache', 'UT', '84341', '4357878146', '4357878149', '1400 N 550 E Ste X & Y', 'Logan', 'Cache', 'UT', '84341', '4357878146', '4357878149', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-07-15', NULL, 0, 0, 0, 'Logan Regional Hospital', '', '', '', 'HCFA|UB', '1437127826', 0, 'N', 0, '2013-07-15', NULL, NULL, 0, 0, NULL, NULL),
('273995478', 'W12032718', 'W12032718', 'UT01', 'Southwest Spine and Pain Care Specialists', 'Brian', 'F', 'Richardson', 'MD', 'Pain Management', '', '', NULL, 'B', '652 S Medical Center Dr Ste 110', 'St George', 'Washington', 'UT', '84790', '4357878146', '4357878149', '652 S Medical Center Dr Ste 110', 'St George', 'Washington', 'UT', '84790', '4357878146', '4357878149', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-07-15', NULL, 0, 0, 0, 'Logan Regional Hospital', '', '', '', 'HCFA|UB', '1437127826', 0, 'N', 0, '2013-07-15', NULL, NULL, 0, 0, NULL, NULL),
('751843390', 'W12032719', 'W12032719', 'TXDALSTD', 'Andrew B Burke MD', 'Andrew', 'B', 'Burke', 'DO', 'Family Practice', '', '', NULL, 'O', '1717 N Garrett Ave', 'Dallas', 'Dallas', 'TX', '75206', '2148276880', '2148279096', '1717 N Garrett Ave', 'Dallas', 'Dallas', 'TX', '75206', '2148276880', '2148279096', 'DALLAS1', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', NULL, NULL, NULL, 'HCFA|UB', '1255392031', 0, 'N', 0, '2013-05-21', NULL, NULL, 32.8083, -96.7748, NULL, NULL),
('830380627', 'W12032720', 'W12032720', 'TXDALSTD', 'Rauinder Puar MD', 'Ravinder', 'K', 'Puar', 'MD', 'Family Practice', '', '', NULL, 'O', '2761 E Trinity Mills Ste 100', 'Carrollton', 'Dallas', 'TX', '75006', '9724788800', '9724788813', '2761 E Trinity Mills Ste 100', 'Carrollton', 'Dallas', 'TX', '75006', '9724788800', '9724788813', 'DALLAS1', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, 'Baylor Medical Center at Carrollton', NULL, NULL, NULL, 'HCFA|UB|', '1871586768', 0, 'N', 0, '2014-02-12', NULL, NULL, 32.9868, -96.858, NULL, NULL),
('261885676', 'W12032721', 'W12032721', 'TXDALSTD', 'Advanced OBGYN Associates', '', '', 'Advanced OBGYN Associates', '', 'Obstetrics and Gynecology', '', '', NULL, 'O', '3201 E President George Bush Hwy Ste 107', 'Richardson', 'Dallas', 'TX', '75082', '9722769902', '9722769819', '3201 E President George Bush Hwy Ste 107', 'Richardson', 'Dallas', 'TX', '75082', '9722769902', '9722769819', 'DALLAS3', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-06-06', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|D', '1760660088', 0, 'Y', 0, '2013-04-30', NULL, NULL, 32.991, -96.6669, NULL, NULL),
('261885676', 'W12032723', 'W12032723', 'TXDALSTD', 'Advanced OBGYN Associates', 'William', 'R', 'Salter', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '3201 E President George Bush Hwy Ste 107', 'Richardson', 'Dallas', 'TX', '75082', '9722769902', '9722769819', '3201 E President George Bush Hwy Ste 107', 'Richardson', 'Dallas', 'TX', '75082', '9722769902', '9722769819', 'DALLAS3', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-06-06', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', NULL, NULL, NULL, 'HCFA|UB|D', '1811999600', 0, 'N', 0, '2013-05-03', NULL, NULL, 32.991, -96.6669, NULL, NULL),
('261885676', 'W12032725', 'W12032725', 'TXDALSTD', 'Advanced OBGYN Associates', 'Teresa', 'J', 'Bascom', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '3201 E President George Bush Hwy Ste 107', 'Richardson', 'Dallas', 'TX', '75082', '9722769902', '9722769819', '3201 E President George Bush Hwy Ste 107', 'Richardson', 'Dallas', 'TX', '75082', '9722769902', '9722769819', 'DALLAS3', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-06-06', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', NULL, NULL, NULL, 'HCFA|UB|D', '1275535049', 0, 'N', 0, '2013-05-03', NULL, NULL, 32.991, -96.6669, NULL, NULL),
('261885676', 'W12032727', 'W12032727', 'TXDALSTD', 'Advanced OBGYN Associates', 'Nicholas', 'E', 'Lux', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '3201 E President George Bush Hwy Ste 107', 'Richardson', 'Dallas', 'TX', '75082', '9722769902', '9722769819', '3201 E President George Bush Hwy Ste 107', 'Richardson', 'Dallas', 'TX', '75082', '9722769902', '9722769819', 'DALLAS3', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-06-06', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', NULL, NULL, NULL, 'HCFA|UB|D', '1922000710', 0, 'N', 0, '2013-05-03', NULL, NULL, 32.991, -96.6669, NULL, NULL),
('870269438', 'W12032728', 'W12032728', 'UT01', 'Shields Orthotic Prosthetic Services', '', '', 'Shields Orthotic Prosthetic Services', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', '5687 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014675483', '8014844591', '5687 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014675483', '8014844591', 'DME9013', '', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2014-03-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1346245065', 0, 'N', 0, '2014-06-02', NULL, NULL, 0, 0, NULL, NULL),
('870269438', 'W12032729', 'W12032729', 'UT01', 'Shields Orthotic Prosthetic Services', '', '', 'Shields Orthotic Prosthetic Services', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', '2785 E 3300 S', 'Salt Lake City', 'Salt Lake', 'UT', '84109', '8014675483', '8014844591', '2785 E 3300 S', 'Salt Lake City', 'Salt Lake', 'UT', '84109', '8014675483', '8014844591', 'DME9013', '', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2014-03-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1346245065', 0, 'N', 0, '2014-06-02', NULL, NULL, 0, 0, NULL, NULL),
('820309671', 'W12032730', 'W12032730', 'ID02', 'OB/GYN Associates PA', 'Karen', 'E', 'Carloy', 'NPC', 'Nurse Practitioner', '', '', NULL, 'O', '222 W Iowa Ave', 'Nampa', 'Canyon', 'ID', '83686', '2084551784', '2089550352', '222 W Iowa Ave', 'Nampa', 'Canyon', 'ID', '83686', '2084551784', '2089550352', 'IDACN', '', '', '0.00', '15.00', '0.00', 8, '2013-04-17', '2014-07-14', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1700949260', 0, 'N', 0, '2014-07-09', NULL, NULL, 0, 0, NULL, NULL),
('260553931', 'W12032731', 'W12032731', 'IDBOISTD', 'Saint Alphonsus Medical Group Neurosurgery Fruitland', 'Stephanie', '', 'Hilpert', 'NP-C', 'Neurosurgery', 'Nurse Practitioner', '', NULL, 'O', '910 NW 16th St Ste 101', 'Fruitland', 'Payette', 'ID', '83619', '2083674000', '2083674052', '910 NW 16th St Ste 101', 'Fruitland', 'Payette', 'ID', '83619', '2083674000', '2083674052', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-10-15', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1760584346', 0, 'N', 0, '2014-07-09', NULL, NULL, 44.0254, -116.925, NULL, NULL),
('271789847', 'W12032784', 'W12032784', 'IDONTSTD', 'Saint Alphonsus Medical Group Wound Ontario', 'Barry', 'L', 'Acor', 'MD', 'Family Practice', '', '', NULL, 'O', '351 SW 9th Street', 'Ontario', 'Malheur', 'OR', '97914', '2083675170', '0000000000', '351 SW 9th Street', 'Ontario', 'Malheur', 'OR', '97914', '2083675170', '0000000000', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 8, '2013-05-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1154633642', 0, 'N', 0, '2014-06-13', NULL, NULL, 44.0255, -116.975, NULL, NULL),
('271789847', 'W12032785', 'W12032785', 'IDONTSTD', 'Saint Alphonsus Medical Group Family Medicine Fruitland Heights Plaza', 'William', 'Z', 'Allen', 'PA-C', 'Family Practice', '', '', NULL, 'O', '910 NW 16th St Ste 101', 'Fruitland', 'Payette', 'ID', '83619', '2084526851', '2084522140', '910 NW 16th St Ste 101', 'Fruitland', 'Payette', 'ID', '83619', '2084526851', '2084522140', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 8, '2013-05-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1730497520', 0, 'Y', 0, '2014-07-09', NULL, NULL, 44.0254, -116.925, NULL, NULL),
('820309671', 'W12032740', 'W12032740', 'ID02', 'OB/GYN Associates PA', '', '', 'Saint Alphonsus Health Alliance PPO', '', 'Master', '', '', NULL, 'O', '222 W Iowa Ave', 'Nampa', 'Canyon', 'ID', '83686', '2084551784', '2089550352', '222 W Iowa Ave', 'Nampa', 'Canyon', 'ID', '83686', '2084551784', '2089550352', 'IDACN', '', '', '0.00', '15.00', '0.00', 8, '2013-04-17', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '0000009765', 0, 'Y', 0, '2014-01-15', NULL, NULL, 0, 0, NULL, NULL),
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INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
('271789847', 'W12032786', 'W12032786', 'IDONTSTD', 'Saint Alphonsus Medical Group Wound Ontario', 'Donna', '', 'Messersmith', 'NP', 'Family Practice', '', '', NULL, 'O', '1050 SW 3rd Ave Ste 1600', 'Ontario', 'Malheur', 'OR', '97914', '5418812360', '5418812364', '1050 SW 3rd Ave Ste 1600', 'Ontario', 'Malheur', 'OR', '97914', '5418812360', '5418812364', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 8, '2013-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1952325458', 0, 'Y', 0, '2014-06-13', NULL, NULL, 44.0258, -116.977, NULL, NULL),
('271789847', 'W12032787', 'W12032787', 'IDONTSTD', 'Saint Alphonsus Medical Group Wound Ontario', 'Donna', '', 'Messersmith', 'NP', 'Family Practice', '', '', NULL, 'O', '351 SW 9th Street', 'Ontario', 'Malheur', 'OR', '97914', '2083675170', '0000000000', '351 SW 9th Street', 'Ontario', 'Malheur', 'OR', '97914', '2083675170', '0000000000', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 8, '2013-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1952325458', 0, 'Y', 0, '2014-06-13', NULL, NULL, 44.0255, -116.975, NULL, NULL),
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('820200895', 'W12032789', 'W12032789', 'IDBOISTD', 'Saint Alphonsus Medical Group Elm Family Medicine', 'Jocele', 'A', 'Skinner', 'MD', 'Family Practice', '', '', NULL, 'O', '315 E Elm St Ste 100', 'Caldwell', 'Canyon', 'ID', '83605', '2084597415', '2084533307', '315 E Elm St Ste 100', 'Caldwell', 'Canyon', 'ID', '83605', '2084597415', '2084533307', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2013-05-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1831133164', 0, 'N', 0, '2014-06-13', NULL, NULL, 43.6534, -116.695, NULL, NULL),
('271789847', 'W12032790', 'W12032790', 'IDONTSTD', 'Saint Alphonsus Medical Group Family Medicine Fruitland Heights Plaza', 'Roy', 'A', 'Sternes', 'PA-C', 'Family Practice', '', '', NULL, 'O', '910 NW 16th St Ste 101', 'Fruitland', 'Payette', 'ID', '83619', '2084526851', '2084522140', '910 NW 16th St Ste 101', 'Fruitland', 'Payette', 'ID', '83619', '2084526851', '2084522140', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 8, '2013-05-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', 'Saint Alphonsus Medical Center Nampa', '', '', 'HCFA|UB|', '1437166550', 0, 'N', 0, '2014-06-13', NULL, NULL, 44.0254, -116.925, NULL, NULL),
('271789847', 'W12032791', 'W12032791', 'IDBOISTD', 'Saint Alphonsus Medical Group Family Medicine Fruitland Heights Plaza', 'John', 'E', 'White', 'MD', 'Family Practice', '', '', NULL, 'O', '910 NW 16th S Ste 101', 'Fruitland', 'Payette', 'ID', '83619', '2084526851', '2084522140', '910 NW 16th S Ste 101', 'Fruitland', 'Payette', 'ID', '83619', '2084526851', '2084522140', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 8, '2013-05-01', '2013-07-15', 0, 0, 0, '', '', '', '', 'HCFA|', '1013982081', 0, 'N', 0, '2014-01-23', NULL, NULL, 44.0254, -116.925, NULL, NULL),
('271789847', 'W12032792', 'W12032792', 'IDBOISTD', 'Saint Alphonsus Medical Group Family Medicine Fruitland Heights Plaza', 'Belinda', 'R', 'Roberts', 'NP', 'Family Practice', '', '', NULL, 'O', '910 NW 16th St Ste 101', 'Fruitland', 'Payette', 'ID', '83619', '2084526851', '2084522140', '910 NW 16th St Ste 101', 'Fruitland', 'Payette', 'ID', '83619', '2084526851', '2084522140', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 8, '2013-05-01', '2014-04-01', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1457669863', 0, 'N', 0, '2014-05-19', NULL, NULL, 44.0254, -116.925, NULL, NULL),
('820200895', 'W12032793', 'W12032793', 'IDBOISTD', 'Saint Alphonsus Medical Group Garrity Family Medicine', 'Belinda', 'R', 'Roberts', 'NP', 'Family Practice', '', '', NULL, 'O', '1200 Garrity Blvd', 'Nampa', 'Canyon', 'ID', '83687', '2084669092', '2084665322', '1200 Garrity Blvd', 'Nampa', 'Canyon', 'ID', '83687', '2084669092', '2084665322', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2013-05-01', '2014-04-01', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1457669863', 0, 'N', 0, '2014-05-19', NULL, NULL, 43.5867, -116.549, NULL, NULL),
('820200895', 'W12032794', 'W12032794', 'IDBOISTD', 'Saint Alphonsus Medical Group MHP Family Medicine', 'Belinda', 'R', 'Roberts', 'NP', 'Family Practice', '', '', NULL, 'O', '3025 W Cherry Ln Ste B', 'Meridian', 'Ada', 'ID', '83642', '2083678550', '2083678555', '3025 W Cherry Ln Ste B', 'Meridian', 'Ada', 'ID', '83642', '2083678550', '2083678555', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2013-05-01', '2014-04-01', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1457669863', 0, 'N', 0, '2014-05-19', NULL, NULL, 43.6193, -116.431, NULL, NULL),
('820200895', 'W12032795', 'W12032795', 'IDBOISTD', 'Saint Alphonsus Medical Group Elm Family Medicine', 'Belinda', 'R', 'Roberts', 'NP', 'Family Practice', '', '', NULL, 'O', '315 E Elm St Ste 100', 'Caldwell', 'Canyon', 'ID', '83605', '2084597415', '2084533307', '315 E Elm St Ste 100', 'Caldwell', 'Canyon', 'ID', '83605', '2084597415', '2084533307', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2013-05-01', '2014-04-01', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1457669863', 0, 'N', 0, '2014-05-19', NULL, NULL, 43.6534, -116.695, NULL, NULL),
('271789847', 'W12032796', 'W12032796', 'IDONTSTD', 'Saint Alphonsus Medical Group Family Medicine Fruitland Heights Plaza', 'Jenifer', '', 'Stewart Greene', 'NP-C', 'Family Practice', '', '', NULL, 'O', '910 NW 16th St Ste 101', 'Fruitland', 'Payette', 'ID', '83619', '2084526851', '2084522140', '910 NW 16th St Ste 101', 'Fruitland', 'Payette', 'ID', '83619', '2084526851', '2084522140', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 8, '2013-05-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1679892335', 0, 'N', 0, '2014-06-13', NULL, NULL, 44.0254, -116.925, NULL, NULL),
('820200895', 'W12032798', 'W12032798', 'IDBOISTD', 'Saint Alphonsus Medical Group Family Medicine Dominican', 'Jenifer', '', 'Stewart Greene', 'NP-C', 'Family Practice', '', '', NULL, 'O', '1118 NW 16th St Ste A', 'Fruitland', 'Payette', 'ID', '83619', '2084526851', '2084522140', '1118 NW 16th St Ste A', 'Fruitland', 'Payette', 'ID', '83619', '2084526851', '2084522140', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2013-05-01', '2013-12-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1679892335', 0, 'N', 0, '2014-06-13', NULL, NULL, 44.025, -116.928, NULL, NULL),
('820200895', 'W12032799', 'W12032799', 'IDBOISTD', 'Saint Alphonsus Medical Group Garrity Family Medicine', 'Jenifer', '', 'Stewart Greene', 'NP-C', 'Family Practice', '', '', NULL, 'O', '1200 Garrity Blvd', 'Nampa', 'Canyon', 'ID', '83687', '2084669092', '2083672968', '1200 Garrity Blvd', 'Nampa', 'Canyon', 'ID', '83687', '2084669092', '2083672968', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2013-05-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1679892335', 0, 'N', 0, '2014-06-13', NULL, NULL, 43.5867, -116.549, NULL, NULL),
('820200895', 'W12032800', 'W12032800', 'IDBOISTD', 'Saint Alphonsus Medical Group MHP Family Medicine', 'Jenifer', '', 'Stewart Greene', 'NP-C', 'Family Practice', '', '', NULL, 'O', '3025 W Cherry Ln Ste B', 'Meridian', 'Ada', 'ID', '83642', '2083678550', '2083678555', '3025 W Cherry Ln Ste B', 'Meridian', 'Ada', 'ID', '83642', '2083678550', '2083678555', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2013-05-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1679892335', 0, 'N', 0, '2014-06-13', NULL, NULL, 43.6193, -116.431, NULL, NULL),
('820200895', 'W12032801', 'W12032801', 'IDBOISTD', 'Saint Alphonsus Medical Group Elm Family Medicine', 'Jenifer', '', 'Stewart Greene', 'NP-C', 'Family Practice', '', '', NULL, 'O', '315 E Elm St Ste 100', 'Caldwell', 'Canyon', 'ID', '83605', '2084597415', '2084533307', '315 E Elm St Ste 100', 'Caldwell', 'Canyon', 'ID', '83605', '2084597415', '2084533307', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2013-05-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1679892335', 0, 'N', 0, '2014-06-13', NULL, NULL, 43.6534, -116.695, NULL, NULL),
('820200895', 'W12032802', 'W12032802', 'IDBOISTD', 'Saint Alphonsus Medical Group Emerald Family Medicine', 'Jenifer', '', 'Stewart Greene', 'NP-C', 'Family Practice', '', '', NULL, 'O', '6533 Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083674170', '2083678135', '6533 Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083674170', '2083678135', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2013-05-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1679892335', 0, 'N', 0, '2014-06-13', NULL, NULL, 43.6119, -116.263, NULL, NULL),
('470854596', 'W12032804', 'W12032804', 'TXDALSTD', 'Durbin Family Practice PA', 'Sherril', 'E', 'Durbin', 'DO', 'Family Practice', '', '', NULL, 'O', '319 Osler Dr Ste 160', 'Arlington', 'Tarrant', 'TX', '76010', '8176405412', '8176336630', '319 Osler Dr Ste 160', 'Arlington', 'Tarrant', 'TX', '76010', '8176405412', '8176336630', 'DALLAS1', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1245235993', 0, 'N', 0, '2013-05-21', NULL, NULL, 32.7333, -97.0586, NULL, NULL),
('452783909', 'W12032805', 'W12032805', 'TXHOUSTD', '', 'Damaris', '', 'Vega', 'MD', 'Endocrinology', '', '', NULL, 'O', '22485 Tomball Pkwy Ste 300', 'Houston', 'Harris', 'TX', '77070', '2812515234', '2812517868', '22485 Tomball Pkwy Ste 300', 'Houston', 'Harris', 'TX', '77070', '2812515234', '2812517868', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-06-15', NULL, 0, 0, 0, 'Houston Methodist Willowbrook Hospital', NULL, '', '', 'HCFA|UB|', '1245519529', 0, 'N', 0, '2013-05-08', NULL, NULL, 30.0103, -95.5895, NULL, NULL),
('830216112', 'W12032806', 'W12032806', 'WY01', 'Lander Medical Clinic PC', 'Robert', 'L', 'Fischer', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '745 Buena Vista', 'Lander', 'Fremont', 'WY', '82520', '3073322941', '3073321920', '745 Buena Vista', 'Lander', 'Fremont', 'WY', '82520', '3073322941', '3073321920', '', '', '', '0.00', '10.00', '0.00', 3, '2030-01-01', '2030-01-01', 0, 0, 0, 'SageWest Health Care', '', '', '', 'HCFA|UB|', '1336198696', 0, 'N', 1, '2013-10-04', NULL, NULL, 0, 0, NULL, NULL),
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('952667855', 'W12032891', 'W12032891', 'TXDALSTD', 'Hanger Prosthetics and Orthotics West Inc', '', '', 'Hanger Prosthetics and Orthotics West Inc', '', 'Durable Medical Equipment', '', '', NULL, 'O', '3801 W 15th St Ste 155', 'Plano', 'Collin', 'TX', '75075', '9725967909', '9729640653', '3801 W 15th St Ste 155', 'Plano', 'Collin', 'TX', '75075', '9725967909', '9729640653', 'DME8013', '', '', '0.00', '25.00', '0.00', 3, '2013-05-01', '2014-03-31', 0, 0, 0, '', '', '', '', 'HCFA|UB', '1215001102', 0, 'N', 0, '2014-04-29', NULL, NULL, 33.0194, -96.7646, NULL, NULL),
('742083988', 'W12032895', 'W12032895', 'TXSATSTD', 'Renal Associates', 'Fadi', '', 'Abouzahr', 'MD', 'Nephrology', '', '', NULL, 'O', '5131 Medical Dr Ste 120', 'San Antonio', 'Bexar', 'TX', '78229', '2106141515', NULL, '5131 Medical Dr Ste 120', 'San Antonio', 'Bexar', 'TX', '78229', '2106141515', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-05-06', NULL, 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1982695896', 0, 'N', 0, '2013-05-24', NULL, NULL, 29.5112, -98.5853, NULL, NULL),
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('742143569', 'W12032899', 'W12032899', 'TXSATSTD', 'Medical Center Ophthalmology Associates', 'Jorge', 'A', 'De La Chapa', 'DO', 'Ophthalmology', '', '', NULL, 'O', '315 N San Saba Ste 970', 'San Antonio', 'Bexar', 'TX', '78207', '2106972020', NULL, '315 N San Saba Ste 970', 'San Antonio', 'Bexar', 'TX', '78207', '2106972020', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-05-06', '2013-09-01', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1710026596', 0, 'N', 0, '2014-01-31', NULL, NULL, 29.4279, -98.5002, NULL, NULL),
('742083988', 'W12032900', 'W12032900', 'TXSATSTD', 'Renal Associates', 'Michael', 'V', 'DeGaetano', 'DO', 'Internal Medicine', '', '', NULL, 'O', '5131 Medical Dr Ste 120', 'San Antonio', 'Bexar', 'TX', '78229', '2106141515', '2106156904', '5131 Medical Dr Ste 120', 'San Antonio', 'Bexar', 'TX', '78229', '2106141515', '2106156904', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-05-06', NULL, 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1881660454', 0, 'N', 0, '2013-05-06', NULL, NULL, 29.5112, -98.5853, NULL, NULL),
('742143569', 'W12032901', 'W12032901', 'TXSATSTD', 'Medical Center Ophthalmology Associates', 'Steven', 'J', 'Fisher', 'MD', 'Ophthalmology', '', '', NULL, 'O', '315 N San Saba Ste 970', 'San Antonio', 'Bexar', 'TX', '78207', '2106972020', NULL, '315 N San Saba Ste 970', 'San Antonio', 'Bexar', 'TX', '78207', '2106972020', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-05-06', NULL, 0, 0, 0, 'Baptist Medical Center', 'North Central Baptist Hospital', NULL, NULL, 'HCFA|UB|', '1144226358', 0, 'N', 0, '2014-01-17', NULL, NULL, 29.4277, -98.4999, NULL, NULL),
('742083988', 'W12032902', 'W12032902', 'TXSATSTD', 'Renal Associates', 'Iliana', '', 'Fred-Miranda', 'MD', 'Nephrology', '', '', NULL, 'O', '5131 Medical Dr Ste 120', 'San Antonio', 'Bexar', 'TX', '78229', '2106141515', '2106156904', '5131 Medical Dr Ste 120', 'San Antonio', 'Bexar', 'TX', '78229', '2106141515', '2106156904', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-05-06', NULL, 0, 0, 0, 'Baptist Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1851366785', 0, 'N', 0, '2013-05-24', NULL, NULL, 29.5112, -98.5853, NULL, NULL),
('742083988', 'W12032903', 'W12032903', 'TXSATSTD', 'Renal Associates', 'Melissa', 'R', 'Isbell', 'MD', 'Nephrology', '', '', NULL, 'O', '5131 Medical Dr Ste 120', 'San Antonio', 'Bexar', 'TX', '78229', '2106141515', '2106156904', '5131 Medical Dr Ste 120', 'San Antonio', 'Bexar', 'TX', '78229', '2106141515', '2106156904', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-05-06', NULL, 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1881660660', 0, 'N', 0, '2013-08-09', NULL, NULL, 29.5112, -98.5853, NULL, NULL),
('820200895', 'W12032980', 'W12032980', 'IDBOISTD', 'Saint Alphonsus Medical Group Pulmonary & Sleep Nampa', 'Beverlee', 'K', 'Furner', 'NPC', 'Family Practice', '', '', NULL, 'O', '1512 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2083678333', '2083672003', '1512 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2083678333', '2083672003', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2013-05-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|', '1487816500', 0, 'N', 0, '2013-12-10', NULL, NULL, 43.5537, -116.573, NULL, NULL);
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('742743906', 'W12032907', 'W12032907', 'TXSATSTD', 'San Antonio Kidney Disease Center', 'Elzbieta', 'B', 'McMurtrie', 'MD', 'Nephrology', '', '', NULL, 'O', '495 10th St Ste 102', 'Floresville', 'Wilson', 'TX', '78114', '2103374911', NULL, '495 10th St Ste 102', 'Floresville', 'Wilson', 'TX', '78114', '2103374911', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-05-06', NULL, 0, 0, 0, 'Baptist Medical Center', 'Mission Trail Baptist Hospital', NULL, NULL, 'HCFA|UB|', '1891770343', 0, 'N', 0, '2013-05-06', NULL, NULL, 29.1587, -98.1724, NULL, NULL),
('742143569', 'W12032908', 'W12032908', 'TXSATSTD', 'Medical Center Ophthalmology Associates', '', '', 'Medical Center Ophthalmology Associates', 'MD', 'Ophthalmology', '', '', NULL, 'O', '315 N San Saba Ste 970', 'San Antonio', 'Bexar', 'TX', '78207', '2106972020', NULL, '315 N San Saba Ste 970', 'San Antonio', 'Bexar', 'TX', '78207', '2106972020', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-05-06', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000007546', 0, 'Y', 0, '2013-05-06', NULL, NULL, 29.4277, -98.4999, NULL, NULL),
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('742083988', 'W12032911', 'W12032911', 'TXSATSTD', 'Renal Associates', 'Paraic', 'J', 'Mulgrew', 'MD', 'Nephrology', '', '', NULL, 'O', '5131 Medical Dr Ste 120', 'San Antonio', 'Bexar', 'TX', '78229', '2106141515', '2106156904', '5131 Medical Dr Ste 120', 'San Antonio', 'Bexar', 'TX', '78229', '2106141515', '2106156904', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-05-06', NULL, 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1730155755', 0, 'N', 0, '2013-05-06', NULL, NULL, 29.5112, -98.5853, NULL, NULL),
('742083988', 'W12032912', 'W12032912', 'TXSATSTD', 'Renal Associates', 'Jessica', 'L', 'Pierce', 'MD', 'Nephrology', '', '', NULL, 'O', '5131 Medical Dr Ste 120', 'San Antonio', 'Bexar', 'TX', '78229', '2106141515', '2106156904', '5131 Medical Dr Ste 120', 'San Antonio', 'Bexar', 'TX', '78229', '2106141515', '2106156904', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-05-06', NULL, 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1831120344', 0, 'N', 0, '2013-05-06', NULL, NULL, 29.5112, -98.5853, NULL, NULL),
('742083988', 'W12032913', 'W12032913', 'TXSATSTD', 'Renal Associates', '', '', 'Renal Associates PA', 'GROUP', 'Nephrology', '', '', NULL, 'O', '5131 Medical Dr Ste 120', 'San Antonio', 'Bexar', 'TX', '78229', '2106141515', '2106156904', '5131 Medical Dr Ste 120', 'San Antonio', 'Bexar', 'TX', '78229', '2106141515', '2106156904', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-05-06', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000008357', 0, 'Y', 0, '2013-05-06', NULL, NULL, 29.5112, -98.5853, NULL, NULL),
('742083988', 'W12032914', 'W12032914', 'TXSATSTD', 'Renal Associates', '', '', 'Renal Associates PA', 'GROUP', 'Nephrology', '', '', NULL, 'O', '540 Madison Oak Dr Ste 220', 'San Antonio', 'Bexar', 'TX', '78258', '2106558470', '0000000000', '540 Madison Oak Dr Ste 220', 'San Antonio', 'Bexar', 'TX', '78258', '2106558470', '0000000000', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-05-06', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000008357', 0, 'Y', 0, '2013-05-06', NULL, NULL, 29.6212, -98.4921, NULL, NULL),
('742083988', 'W12032915', 'W12032915', 'TXSATSTD', 'Renal Associates', '', '', 'Renal Associates PA', 'GROUP', 'Nephrology', '', '', NULL, 'O', '128 S Moss St Ste 100', 'Seguin', 'Guadalupe', 'TX', '78155', '8303038770', NULL, '128 S Moss St Ste 100', 'Seguin', 'Guadalupe', 'TX', '78155', '8303038770', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-05-06', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000008357', 0, 'Y', 0, '2013-05-06', NULL, NULL, 29.5689, -97.9484, NULL, NULL),
('742915297', 'W12032916', 'W12032916', 'TXSATSTD', 'South Texas Oncology and Hematology', 'Mark', 'C', 'Rittenhouse', 'MD', 'General Surgery', '', '', NULL, 'O', '4383 Medical Dr', 'San Antonio', 'Bexar', 'TX', '78229', '2105935700', NULL, '4383 Medical Dr', 'San Antonio', 'Bexar', 'TX', '78229', '2105935700', '          ', 'TXONCOL', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-05-06', NULL, 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1538155270', 0, 'N', 0, '2013-05-06', NULL, NULL, 29.511, -98.5709, NULL, NULL),
('742083988', 'W12032917', 'W12032917', 'TXSATSTD', 'Renal Associates', 'Navid', 'Q', 'Saigal', 'MD', 'Nephrology', '', '', NULL, 'O', '11481 Toepperwein Ste 1202', 'San Antonio', 'Bexar', 'TX', '78233', '2106558470', NULL, '11481 Toepperwein Ste 1202', 'San Antonio', 'Bexar', 'TX', '78233', '2106558470', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-05-06', NULL, 0, 0, 0, 'North East Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1427024231', 0, 'N', 0, '2013-05-06', NULL, NULL, 29.5428, -98.3399, NULL, NULL),
('742143569', 'W12032918', 'W12032918', 'TXSATSTD', 'Medical Center Ophthalmology Associates', 'Michael', 'A', 'Singer', 'MD', 'Ophthalmology', '', '', NULL, 'O', '315 N San Saba Ste 970', 'San Antonio', 'Bexar', 'TX', '78207', '2106972020', NULL, '315 N San Saba Ste 970', 'San Antonio', 'Bexar', 'TX', '78207', '2106972020', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-05-06', NULL, 0, 0, 0, 'Baptist Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1912902651', 0, 'N', 0, '2013-06-21', NULL, NULL, 29.4277, -98.4999, NULL, NULL),
('900120192', 'W12032919', 'W12032919', 'TXSATSTD', 'Sports Medicine Associates of San Antonio', 'Richard', 'T', 'Steffen', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '5921 Broadway St', 'San Antonio', 'Bexar', 'TX', '78216', '2106998326', NULL, '5921 Broadway St', 'San Antonio', 'Bexar', 'TX', '78216', '2106998326', '', 'TXORTHO', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-05-06', NULL, 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1770630469', 0, 'N', 0, '2014-07-18', NULL, NULL, 29.4811, -98.4652, NULL, NULL),
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('742083988', 'W12032922', 'W12032922', 'TXSATSTD', 'Renal Associates', 'Victor', 'Herman', 'Villarreal', 'MD', 'Nephrology', '', '', NULL, 'O', '5131 Medical Dr Ste 120', 'San Antonio', 'Bexar', 'TX', '78229', '2106141515', '2106156904', '5131 Medical Dr Ste 120', 'San Antonio', 'Bexar', 'TX', '78229', '2106141515', '2106156904', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-05-06', NULL, 0, 0, 0, 'Baptist Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1649246463', 0, 'N', 0, '2013-05-06', NULL, NULL, 29.5112, -98.5853, NULL, NULL),
('742083988', 'W12032923', 'W12032923', 'TXSATSTD', 'Renal Associates', 'Fahim', '', 'Zaman', 'MD', 'Nephrology', '', '', NULL, 'O', '11481 Toepperwein Ste 1202', 'San Antonio', 'Bexar', 'TX', '78233', '2106558470', NULL, '11481 Toepperwein Ste 1202', 'San Antonio', 'Bexar', 'TX', '78233', '2106558470', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-05-06', NULL, 0, 0, 0, 'North Central Baptist Hospital', 'North East Baptist Hospital', NULL, NULL, 'HCFA|UB|', '1174577050', 0, 'N', 0, '2013-05-06', NULL, NULL, 29.5428, -98.3399, NULL, NULL),
('272559167', 'W12032924', 'W12032924', 'TXSATSTD', 'Heart and Vascular Institute of Texas', 'Christopher', 'W', 'Casey', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '944 S Hwy 123 2nd Floor', 'Seguin', 'Guadalupe', 'TX', '78155', '8303791666', NULL, '944 S Hwy 123 2nd Floor', 'Seguin', 'Guadalupe', 'TX', '78155', '8303791666', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-05-06', NULL, 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1932129806', 0, 'N', 0, '2013-05-06', NULL, NULL, 29.5651, -97.9414, NULL, NULL),
('751453852', 'W12032930', 'W12032930', 'TXDALSTD', 'Retina Institute of Texas', 'Scott', 'R', 'Witherspoon', 'MD', 'Ophthalmology', '', '', NULL, 'O', '1010 E I-20', 'Arlington', 'Tarrant', 'TX', '76018', '8174177769', '8174177405', '1010 E I-20    ', 'Arlington', 'Tarrant', 'TX', '76018', '8174177769', '8174177405', 'DALLAS4', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-07-01', '2013-08-14', 0, 0, 0, 'Baylor Medical Center at Waxahachie', NULL, NULL, NULL, 'HCFA|UB|', '1639203169', 0, 'N', 0, '2013-11-11', NULL, NULL, 0, 0, NULL, NULL),
('751453852', 'W12032931', 'W12032931', 'TXDALSTD', 'Retina Institute of Texas', 'Scott', 'R', 'Witherspoon', 'MD', 'Ophthalmology', '', '', NULL, 'O', '3331 Unicorn Lake Blvd', 'Denton', 'Denton', 'TX', '76210', '9403819100', '9403819106', '3331 Unicorn Lake Blvd    ', 'Denton', 'Denton', 'TX', '76210', '9403819100', '9403819106', 'DALLAS4', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-07-01', '2013-08-14', 0, 0, 0, 'Baylor Medical Center at Waxahachie', NULL, NULL, NULL, 'HCFA|UB|', '1639203169', 0, 'N', 0, '2013-11-11', NULL, NULL, 0, 0, NULL, NULL),
('751453852', 'W12032927', 'W12032927', 'TXDALSTD', 'Retina Institute of Texas', 'Scott', 'R', 'Witherspoon', 'MD', 'Ophthalmology', '', '', NULL, 'O', '3414 Oak Grove Ave', 'Dallas', 'Dallas', 'TX', '75204', '2145211153', '2142193651', '3414 Oak Grove Ave   ', 'Dallas', 'Dallas', 'TX', '75204', '2145211153', '2142193651', 'DALLAS4', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-07-01', '2013-08-14', 0, 0, 0, 'Baylor Medical Center at Waxahachie', NULL, NULL, NULL, 'HCFA|UB|', '1639203169', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.8042, -96.7971, NULL, NULL),
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('870516264', 'W12032942', 'W12032942', 'UT01', 'Utah Surgical Associates Inc', '', '', 'Utah County Surgical Associates', '', 'General Surgery', '', '', NULL, 'O', '3550 N University Ave Ste 250', 'Provo', 'Utah', 'UT', '84604', '8013749625', '8013749690', '3550 N University Ave Ste 250', 'Provo', 'Utah', 'UT', '84604', '8013749625', '8013749690', 'UTCTYSURG', '', '', '0.00', '35.00', '0.00', 6, '2013-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|DEN|', '1851450720', 0, 'Y', 0, '2013-07-25', NULL, NULL, 40.2813, -111.658, NULL, NULL),
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('460800066', 'W12032995', 'W12032995', 'WYT1', 'Cedars Health', '', '', 'Cedars Health', '', 'Urgent Care', '', '', NULL, 'O', '1453A Dewar Dr', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073822466', '3073822068', '1453A Dewar Dr', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073822466', '3073822068', '', '', '', '0.00', '19.00', '0.00', 3, '2013-05-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1306196209', 0, 'N', 0, '2013-05-31', NULL, NULL, 0, 0, NULL, NULL),
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('529605918', 'W12032964', 'W12032964', 'UTMH1', 'Family Institute of Northern Utah', 'Susan', 'S', 'Campbell', 'PHD LMFT', 'Mental Health', 'Psychology', 'Marriage & Family Therapy', NULL, 'O', '274 N Main St', 'Logan', 'Cache', 'UT', '84321', '4357531600', '0000000000', '274 N Main St', 'Logan', 'Cache', 'UT', '84321', '4357531600', '0000000000', 'PHD', '', '', '0.00', '35.00', '0.00', 3, '2013-05-01', '2014-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1417061789', 0, 'N', 0, '2014-03-05', NULL, NULL, 41.7367, -111.835, NULL, NULL),
('364088232', 'W12032965', 'W12032965', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Scott', 'R', 'Goodwin', 'MD', 'Endocrinology', '', '', NULL, 'O', '1877 W Downer Pl', 'Aurora', 'Kane', 'IL', '60506', '0000000000', NULL, '1877 W Downer Pl', 'Aurora', 'Kane', 'IL', '60506', '0000000000', '          ', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-05-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, '', '', 'HCFA|UB|', '1831310226', 0, 'Y', 0, '2013-05-07', NULL, NULL, 41.7618, -88.3621, NULL, NULL),
('010858905', 'W12032966', 'W12032966', 'ID01', 'Booth Psychological Solutions', 'Raydell', 'J', 'Booth', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '2700 N Cloverdale Rd Ste 215', 'Boise', 'Ada', 'ID', '83713', '2083771131', '2089087129', '2700 N Cloverdale Rd Ste 215', 'Boise', 'Ada', 'ID', '83713', '2083771131', '2089087129', 'IDPHD', '', '', '0.00', '40.00', '0.00', 3, '2013-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1184661175', 0, 'N', 0, '2013-05-07', NULL, NULL, 0, 0, NULL, NULL),
('830207671', 'W12032967', 'W12032967', 'WY01', 'West Park Hospital District ', 'Thomas', 'H', 'Etter', 'DO', 'General Surgery', '', '', NULL, 'O', '424 Yellowstone Ave Ste 220', 'Cody', 'Park', 'WY', '82414', '3075782947', '3075782968', '424 Yellowstone Ave Ste 220', 'Cody', 'Park', 'WY', '82414', '3075782947', '3075782968', '', '', '', '0.00', '12.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1154562791', 0, 'N', 0, '2013-12-17', NULL, NULL, 44.517, -109.083, NULL, NULL),
('830207671', 'W12032969', 'W12032969', 'WYT1', 'West Park Hospital District ', 'Thomas', 'H', 'Etter', 'DO', 'General Surgery', '', '', NULL, 'O', '424 Yellowstone Ave Ste 220', 'Cody', 'Park', 'WY', '82414', '3075782947', '3075782968', '424 Yellowstone Ave Ste 220', 'Cody', 'Park', 'WY', '82414', '3075782947', '3075782968', '', '', '', '0.00', '12.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1154562791', 0, 'N', 0, '2013-12-17', NULL, NULL, 0, 0, NULL, NULL),
('830207671', 'W12032970', 'W12032970', 'WYT1', 'West Park Hospital District', 'Thomas', 'H', 'Etter', 'DO', 'General Surgery', '', '', NULL, 'O', '707 Sheridan Ave', 'Cody', 'Park', 'WY', '82414', '3075782500', '3075782492', '707 Sheridan Ave', 'Cody', 'Park', 'WY', '82414', '3075782500', '3075782492', '', '', '', '0.00', '12.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1154562791', 0, 'N', 0, '2013-12-17', NULL, NULL, 0, 0, NULL, NULL),
('428542333', 'W12032971', 'W12032971', 'UTMH1', '', 'Ralph', 'W', 'Gant', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '5525 S 900 E Sports Mall Plaza II, Ste 102', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8012623700', '8012623712', '5525 S 900 E Sports Mall Plaza II, Ste 102', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8012623700', '8012623712', 'UTPHD', '', '', '0.00', '40.00', '0.00', 3, '2013-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1831117886', 0, 'N', 0, '2013-06-17', NULL, NULL, 40.6512, -111.866, NULL, NULL),
('274412746', 'W12032972', 'W12032972', 'UT01', 'Olympus Eye Associates PC ', 'Stephen', 'R', 'Brockbank', 'OD', 'Optometry', '', '', NULL, 'O', '6065 S Fashion Blvd Ste 125', 'Murray', 'Salt Lake', 'UT', '84107', '8012610726', '8012622838', '6065 S Fashion Blvd Ste 125', 'Murray', 'Salt Lake', 'UT', '84107', '8012610726', '8012622838', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-07-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1508973397', 0, 'N', 0, '2013-07-09', NULL, NULL, 40.6391, -111.883, NULL, NULL),
('270852226', 'W12032973', 'W12032973', 'UT01', 'Silverton Group', 'Jared', 'A', 'Johnstun', '', 'Hospitalist', '', '', NULL, 'O', '8th Ave C St', 'Salt Lake City', 'Salt Lake', 'UT', '84143', '8014087100', '8012961715', '8th Ave C St', 'Salt Lake City', 'Salt Lake', 'UT', '84143', '8014087100', '8012961715', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1487944096', 0, 'N', 0, '2013-06-04', NULL, NULL, 40.7785, -111.881, NULL, NULL),
('270852226', 'W12032974', 'W12032974', 'UT01', 'Silverton Group', 'Jared', 'A', 'Johnstun', '', 'Hospitalist', '', '', NULL, 'B', 'PO Box 1249', 'Bountiful', 'Davis', 'UT', '84011', '0000000000', '0000000000', 'PO Box 1249', 'Bountiful', 'Davis', 'UT', '84011', '0000000000', '0000000000', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1487944096', 0, 'N', 0, '2013-06-04', NULL, NULL, 0, 0, NULL, NULL),
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('270852226', 'W12032975', 'W12032975', 'UT01', 'Silverton Group', 'Barbara', 'E', 'Jones', '', 'Hospitalist', '', '', NULL, 'B', 'PO Box 1249', 'Bountiful', 'Davis', 'UT', '84011', '0000000000', '0000000000', 'PO Box 1249', 'Bountiful', 'Davis', 'UT', '84011', '0000000000', '0000000000', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1316115082', 0, 'N', 0, '2013-06-04', NULL, NULL, 0, 0, NULL, NULL),
('260553931', 'W12032979', 'W12032979', 'IDBOISTD', 'Saint Alphonsus Medical Group Heart Care Fruitland Heights Plaza', 'Beth', '', 'Malasky', 'MD', 'Cardiology', '', '', NULL, 'O', '910 NW 16th St Ste 101', 'Fruitland', 'Payette', 'ID', '83619', '2084526851', '2084522140', '910 NW 16th St Ste 101', 'Fruitland', 'Payette', 'ID', '83619', '2084526851', '2084522140', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2013-04-18', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1730285719', 0, 'N', 0, '2014-01-24', NULL, NULL, 44.0254, -116.925, NULL, NULL),
('271789847', 'W12032981', 'W12032981', 'IDBOISTD', 'Saint Alphonsus Medical Group New Plymouth', 'Roy', 'A', 'Sternes', 'PA-C', 'Family Practice', '', '', NULL, 'O', '213 N Plymouth Ave', 'New Plymouth', 'Payette', 'ID', '83655', '2086741444', '2086741440', '213 N Plymouth Ave', 'New Plymouth', 'Payette', 'ID', '83655', '2086741444', '2086741440', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 8, '2013-05-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', 'Saint Alphonsus Medical Center Nampa', '', '', 'HCFA|UB|', '1437166550', 0, 'N', 0, '2014-06-13', NULL, NULL, 43.9717, -116.82, NULL, NULL),
('760508619', 'GULF10017', 'GULF10017', 'TXHOUSTD', 'Texas Gulf Coast Medical Group', 'Rajeswari', 'T', 'Rajan', 'MD', 'Family Practice', '', '', NULL, 'O', '25O Blossom St Ste 400', 'Webster', 'Harris', 'TX', '77598', '2816041300', '2817240175', '25O Blossom St Ste 400', 'Webster', 'Harris', 'TX', '77598', '2816041300', '2817240175', 'GULFCSTMED', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', NULL, '', '', 'HCFA|UB|', '1023002342', 0, 'N', 0, '2013-05-21', NULL, NULL, 29.5402, -95.1307, NULL, NULL),
('760508619', 'GULF10010', 'GULF10010', 'TXHOUSTD', 'Texas Gulf Coast Medical Group', 'Caryl', '', 'Guillermo', 'MD', 'Family Practice', '', '', NULL, 'O', '25O Blossom St Ste 400', 'Webster', 'Harris', 'TX', '77598', '2816041300', '2817240160', '25O Blossom St Ste 400', 'Webster', 'Harris', 'TX', '77598', '2816041300', '2817240160', 'GULFCSTMED', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', NULL, '', '', 'HCFA|UB|', '1093043358', 0, 'N', 0, '2013-05-21', NULL, NULL, 29.5402, -95.1307, NULL, NULL),
('760508619', 'GULF10011', 'GULF10011', 'TXHOUSTD', 'Texas Gulf Coast Medical Group', 'Steven', '', 'Kloeris', 'MD', 'Family Practice', '', '', NULL, 'O', '25O Blossom St Ste 400', 'Webster', 'Harris', 'TX', '77598', '2816041300', '2817240160', '25O Blossom St Ste 400', 'Webster', 'Harris', 'TX', '77598', '2816041300', '2817240160', 'GULFCSTMED', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', NULL, '', '', 'HCFA|UB|', '1104810472', 0, 'N', 0, '2013-05-21', NULL, NULL, 29.5402, -95.1307, NULL, NULL),
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('760508619', 'GULF10019', 'GULF10019', 'TXHOUSTD', 'Texas Gulf Coast Medical Group', 'Dennis', '', 'Tang', 'MD', 'Internal Medicine', '', '', NULL, 'O', '25O Blossom St Ste 400', 'Webster', 'Harris', 'TX', '77598', '2816041300', '2817240175', '25O Blossom St Ste 400', 'Webster', 'Harris', 'TX', '77598', '2816041300', '2817240175', 'GULFCSTMED', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', NULL, '', '', 'HCFA|UB|', '1154315349', 0, 'N', 0, '2013-05-21', NULL, NULL, 29.5402, -95.1307, NULL, NULL),
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('760508619', 'GULF10014', 'GULF10014', 'TXHOUSTD', 'Texas Gulf Coast Medical Group', 'Kathi', 'S', 'McCree', 'MD', 'Family Practice', '', '', NULL, 'O', '25O Blossom St Ste 400', 'Webster', 'Harris', 'TX', '77598', '2816041300', '2817240160', '25O Blossom St Ste 400', 'Webster', 'Harris', 'TX', '77598', '2816041300', '2817240160', 'GULFCSTMED', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', NULL, '', '', 'HCFA|UB|', '1497749816', 0, 'N', 0, '2013-05-21', NULL, NULL, 29.5402, -95.1307, NULL, NULL),
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('760508619', 'GULF10006', 'GULF10006', 'TXHOUSTD', 'Texas Gulf Coast Medical Group', 'Leticia', '', 'Cantu', 'MD', 'Family Practice', '', '', NULL, 'O', '25O Blossom St Ste 400', 'Webster', 'Harris', 'TX', '77598', '2816041300', '2817240175', '25O Blossom St Ste 400', 'Webster', 'Harris', 'TX', '77598', '2816041300', '2817240175', 'GULFCSTMED', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', NULL, '', '', 'HCFA|UB|', '1669617502', 0, 'N', 0, '2013-05-21', NULL, NULL, 29.5402, -95.1307, NULL, NULL),
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('760508619', 'GULF10018', 'GULF10018', 'TXHOUSTD', 'Texas Gulf Coast Medical Group', 'Leila', '', 'Sim', 'MD', 'Pediatrics', '', '', NULL, 'O', '25O Blossom St Ste 300', 'Webster', 'Harris', 'TX', '77598', '2816041300', '2817240365', '25O Blossom St Ste 300', 'Webster', 'Harris', 'TX', '77598', '2816041300', '2817240365', 'GULFCSTMED', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', NULL, '', '', 'HCFA|UB|', '1730173642', 0, 'N', 0, '2013-05-21', NULL, NULL, 29.5402, -95.1307, NULL, NULL),
('760508619', 'GULF10009', 'GULF10009', 'TXHOUSTD', 'Texas Gulf Coast Medical Group', 'Benjamin', 'V', 'Guillermo', 'MD', 'Family Practice', '', '', NULL, 'O', '25O Blossom St Ste 400', 'Webster', 'Harris', 'TX', '77598', '2816041300', '2817240160', '25O Blossom St Ste 400', 'Webster', 'Harris', 'TX', '77598', '2816041300', '2817240160', 'GULFCSTMED', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', NULL, '', '', 'HCFA|UB|', '1851385272', 0, 'N', 0, '2013-05-21', NULL, NULL, 29.5402, -95.1307, NULL, NULL),
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('760508619', 'GULF10013', 'GULF10013', 'TXHOUSTD', 'Texas Gulf Coast Medical Group', 'Michael', '', 'Lyons', 'DO', 'Family Practice', '', '', NULL, 'O', '25O Blossom St Ste 400', 'Webster', 'Harris', 'TX', '77598', '2816041300', '2817240160', '25O Blossom St Ste 400', 'Webster', 'Harris', 'TX', '77598', '2816041300', '2817240160', 'GULFCSTMED', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', NULL, '', '', 'HCFA|UB|', '1881688042', 0, 'N', 0, '2013-05-21', NULL, NULL, 29.5402, -95.1307, NULL, NULL),
('760508619', 'GULF10005', 'GULF10005', 'TXHOUSTD', 'Texas Gulf Coast Medical Group', 'Allassia', '', 'Burns', 'MD', 'Endocrinology', '', '', NULL, 'O', '25O Blossom St Ste 400', 'Webster', 'Harris', 'TX', '77598', '2816041300', '2817240175', '25O Blossom St Ste 400', 'Webster', 'Harris', 'TX', '77598', '2816041300', '2817240175', 'GULFCSTMED', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', NULL, '', '', 'HCFA|UB|', '1942406970', 0, 'N', 0, '2013-05-21', NULL, NULL, 29.5402, -95.1307, NULL, NULL),
('460800066', 'W12033005', 'W12033005', 'WYT1', 'Cedars Health', '', '', 'Cedars Health', '', 'Urgent Care', '', '', NULL, 'O', '428 S Durbin St Ste 104', 'Casper', 'Natrona', 'WY', '82601', '3072779424', '3076735434', '428 S Durbin St Ste 104', 'Casper', 'Natrona', 'WY', '82601', '3072779424', '3076735434', '', '', '', '0.00', '19.00', '0.00', 3, '2013-05-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1306196209', 0, 'Y', 0, '2013-05-31', NULL, NULL, 0, 0, NULL, NULL),
('460800066', 'W12033002', 'W12033002', 'WYT1', 'Cedars Health', '', '', 'Cedars Health', '', 'Urgent Care', '', '', NULL, 'O', '4620 Grandview Ave Ste 104', 'Cheyenne', 'Laramie', 'WY', '82009', '3076376707', '3076376730', '4620 Grandview Ave Ste 104', 'Cheyenne', 'Laramie', 'WY', '82009', '3076376707', '3076376730', '', '', '', '0.00', '19.00', '0.00', 3, '2013-05-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1306196209', 0, 'N', 0, '2013-05-31', NULL, NULL, 0, 0, NULL, NULL),
('460800066', 'W12033000', 'W12033000', 'WYT1', 'Cedars Health', '', '', 'Cedars Health', '', 'Urgent Care', '', '', NULL, 'O', '519 8th St', 'Rawlins', 'Carbon', 'WY', '82301', '3073242294', '3073281964', '519 8th St', 'Rawlins', 'Carbon', 'WY', '82301', '3073242294', '3073281964', '', '', '', '0.00', '19.00', '0.00', 3, '2013-05-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1306196209', 0, 'N', 0, '2013-05-31', NULL, NULL, 0, 0, NULL, NULL),
('460800066', 'W12032998', 'W12032998', 'WYT1', 'Cedars Health', '', '', 'Cedars Health', '', 'Urgent Care', '', '', NULL, 'O', '716 College View Dr', 'Riverton', 'Fremont', 'WY', '82501', '3072779424', '3076735434', '716 College View Dr', 'Riverton', 'Fremont', 'WY', '82501', '3072779424', '3076735434', '', '', '', '0.00', '19.00', '0.00', 3, '2013-05-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1306196209', 0, 'Y', 0, '2013-05-31', NULL, NULL, 0, 0, NULL, NULL),
('870373083', 'W12033014', 'W12033014', 'UT01', 'Heart and Lung Institute of Utah Inc', 'Brian', 'C', 'Kolski', 'MD', 'Cardiology', '', '', NULL, 'O', '3336 S 4155 W  Ste 203', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8012632370', '8012651200', '3336 S 4155 W  Ste 203', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8012632370', '8012651200', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-09-01', '2014-04-30', 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1851449896', 0, 'N', 0, '2013-08-22', NULL, NULL, 40.6991, -111.99, NULL, NULL),
('870373083', 'W12033012', 'W12033012', 'UT01', 'Heart and Lung Institute of Utah Inc', 'Brian', 'C', 'Kolski', 'MD', 'Cardiology', '', '', NULL, 'O', '3570 W 9000 S Ste 110', 'West Jordan', 'Salt Lake', 'UT', '84084', '8012632370', '8012651200', '3570 W 9000 S Ste 110', 'West Jordan', 'Salt Lake', 'UT', '84084', '8012632370', '8012651200', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-09-01', '2014-04-30', 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1851449896', 0, 'N', 0, '2013-08-22', NULL, NULL, 40.588, -111.975, NULL, NULL);
