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
('760512625', 'EDHEA0191', 'EDHEA0191', 'TXHOUSTD', 'Houston Eye Associates', 'Richard', 'L', 'Kimbrough', 'MD', 'Ophthalmology', '', '', NULL, 'B', 'PO Box 4958', 'Houston', 'Harris', 'TX', '77210', '7136686828', NULL, 'PO Box 4958', 'Houston', 'Harris', 'TX', '77210', '7136686828', '', 'Houston4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1437144615', 0, 'Y', 0, '2013-01-02', NULL, NULL, 0, 0, NULL, NULL),
('760512625', 'EDHEA0078', 'EDHEA0078', 'TXHOUSTD', 'Houston Eye Associates', 'Susan', 'E', 'Wittenberg', 'MD', 'Ophthalmology', '', '', NULL, 'O', '2855 Gramercy', 'Houston', 'Harris', 'TX', '77025', '7136686828', '7136683823', '2855 Gramercy', 'Houston', 'Harris', 'TX', '77025', '7136686828', '7136683823', 'Houston4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1437194396', 0, 'N', 0, '2013-01-02', NULL, NULL, 29.7044, -95.4225, NULL, NULL),
('760512625', 'EDHEA0145', 'EDHEA0145', 'TXHOUSTD', 'Houston Eye Associates', 'Susan', 'E', 'Wittenberg', 'MD', 'Ophthalmology', '', '', NULL, 'M', '7155 Old Katy Rd N100', 'Houston', 'Harris', 'TX', '77024', '7136686828', NULL, '7155 Old Katy Rd N100', 'Houston', 'Harris', 'TX', '77024', '7136686828', '', 'Houston4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1437194396', 0, 'Y', 0, '2013-01-02', NULL, NULL, 0, 0, NULL, NULL),
('760512625', 'EDHEA0216', 'EDHEA0216', 'TXHOUSTD', 'Houston Eye Associates', 'Susan', 'E', 'Wittenberg', 'MD', 'Ophthalmology', '', '', NULL, 'B', 'PO Box 4958', 'Houston', 'Harris', 'TX', '77210', '7136686828', NULL, 'PO Box 4958', 'Houston', 'Harris', 'TX', '77210', '7136686828', '', 'Houston4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1437194396', 0, 'Y', 0, '2013-01-02', NULL, NULL, 0, 0, NULL, NULL),
('760512625', 'EDHEA0062', 'EDHEA0062', 'TXHOUSTD', 'Houston Eye Associates', 'Kelly', 'L', 'Larkin', 'MD', 'Ophthalmology', '', '', NULL, 'O', '2855 Gramercy', 'Houston', 'Harris', 'TX', '77025', '7136686828', '7136683823', '2855 Gramercy', 'Houston', 'Harris', 'TX', '77025', '7136686828', '7136683823', 'Houston4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Houston Methodist Hospital', NULL, '', NULL, 'HCFA|UB|', '1497040471', 0, 'N', 0, '2013-01-02', NULL, NULL, 29.7044, -95.4225, NULL, NULL),
('760512625', 'EDHEA0124', 'EDHEA0124', 'TXHOUSTD', 'Houston Eye Associates', 'Kelly', 'L', 'Larkin', 'MD', 'Ophthalmology', '', '', NULL, 'M', '7155 Old Katy Rd N100', 'Houston', 'Harris', 'TX', '77024', '7136686828', NULL, '7155 Old Katy Rd N100', 'Houston', 'Harris', 'TX', '77024', '7136686828', '', 'Houston4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Houston Methodist Hospital', NULL, '', NULL, 'HCFA|UB|', '1497040471', 0, 'Y', 0, '2013-01-02', NULL, NULL, 0, 0, NULL, NULL),
('760512625', 'EDHEA0195', 'EDHEA0195', 'TXHOUSTD', 'Houston Eye Associates', 'Kelly', 'L', 'Larkin', 'MD', 'Ophthalmology', '', '', NULL, 'B', 'PO Box 4958', 'Houston', 'Harris', 'TX', '77210', '7136686828', NULL, 'PO Box 4958', 'Houston', 'Harris', 'TX', '77210', '7136686828', '          ', 'Houston4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', '2013-03-27', 0, 0, 0, 'Houston Methodist Hospital', NULL, '', NULL, 'HCFA|UB|', '1497040471', 0, 'Y', 0, '2013-03-27', NULL, NULL, 0, 0, NULL, NULL),
('760512625', 'EDHEA0010', 'EDHEA0010', 'TXHOUSTD', 'Houston Eye Associates', 'William', 'C', 'Stewart', 'MD', 'Ophthalmology', '', '', NULL, 'O', '1229 Campbell Rd', 'Houston', 'Harris', 'TX', '77055', '7134676600', '7134677914', '1229 Campbell Rd', 'Houston', 'Harris', 'TX', '77055', '7134676600', '7134677914', 'Houston4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1497740161', 0, 'N', 0, '2013-03-21', NULL, NULL, 29.7908, -95.5139, NULL, NULL),
('760512625', 'EDHEA0073', 'EDHEA0073', 'TXHOUSTD', 'Houston Eye Associates', 'William', 'C', 'Stewart', 'MD', 'Ophthalmology', '', '', NULL, 'O', '2855 Gramercy', 'Houston', 'Harris', 'TX', '77025', '7136686828', '7136683823', '2855 Gramercy', 'Houston', 'Harris', 'TX', '77025', '7136686828', '7136683823', 'Houston4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1497740161', 0, 'N', 0, '2013-03-21', NULL, NULL, 29.7044, -95.4225, NULL, NULL),
('760512625', 'EDHEA0097', 'EDHEA0097', 'TXHOUSTD', 'Houston Eye Associates', 'William', 'C', 'Stewart', 'MD', 'Ophthalmology', '', '', NULL, 'O', '590 Chimney Rock', 'Houston', 'Harris', 'TX', '77056', '7137824406', '7137822554', '590 Chimney Rock', 'Houston', 'Harris', 'TX', '77056', '7137824406', '7137822554', 'Houston4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1497740161', 0, 'N', 0, '2013-03-21', NULL, NULL, 29.7641, -95.478, NULL, NULL),
('760512625', 'EDHEA0139', 'EDHEA0139', 'TXHOUSTD', 'Houston Eye Associates', 'William', 'C', 'Stewart', 'MD', 'Ophthalmology', '', '', NULL, 'M', '7155 Old Katy Rd N100', 'Houston', 'Harris', 'TX', '77024', '7136686828', NULL, '7155 Old Katy Rd N100', 'Houston', 'Harris', 'TX', '77024', '7136686828', '', 'Houston4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1497740161', 0, 'Y', 0, '2013-03-21', NULL, NULL, 0, 0, NULL, NULL),
('760512625', 'EDHEA0210', 'EDHEA0210', 'TXHOUSTD', 'Houston Eye Associates', 'William', 'C', 'Stewart', 'MD', 'Ophthalmology', '', '', NULL, 'B', 'PO Box 4958', 'Houston', 'Harris', 'TX', '77210', '7136686828', NULL, 'PO Box 4958', 'Houston', 'Harris', 'TX', '77210', '7136686828', '', 'Houston4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1497740161', 0, 'Y', 0, '2013-03-21', NULL, NULL, 0, 0, NULL, NULL),
('760512625', 'EDHEA0086', 'EDHEA0086', 'TXHOUSTD', 'Houston Eye Associates', 'Larry', 'P', 'Alexander', 'MD', 'Ophthalmology', '', '', NULL, 'O', '5125 N Fairmont Pkwy', 'Pasadena', 'Harris', 'TX', '77505', '7134776929', '2815986475', '5125 N Fairmont Pkwy', 'Pasadena', 'Harris', 'TX', '77505', '7134776929', '2815986475', 'Houston4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Bayshore Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1497757850', 0, 'N', 0, '2013-07-31', NULL, NULL, 29.6499, -95.1648, NULL, NULL),
('760512625', 'EDHEA0100', 'EDHEA0100', 'TXHOUSTD', 'Houston Eye Associates', 'Larry', 'P', 'Alexander', 'MD', 'Ophthalmology', '', '', NULL, 'M', '7155 Old Katy Rd N100', 'Houston', 'Harris', 'TX', '77024', '7136686828', NULL, '7155 Old Katy Rd N100', 'Houston', 'Harris', 'TX', '77024', '7136686828', '          ', 'Houston4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Bayshore Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1497757850', 0, 'N', 0, '2013-07-31', NULL, NULL, 0, 0, NULL, NULL),
('760512625', 'EDHEA0171', 'EDHEA0171', 'TXHOUSTD', 'Houston Eye Associates', 'Larry', 'P', 'Alexander', 'MD', 'Ophthalmology', '', '', NULL, 'B', 'PO Box 4958', 'Houston', 'Harris', 'TX', '77210', '7136686828', NULL, 'PO Box 4958', 'Houston', 'Harris', 'TX', '77210', '7136686828', '', 'Houston4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Bayshore Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1497757850', 0, 'Y', 0, '2013-07-31', NULL, NULL, 0, 0, NULL, NULL),
('760512625', 'EDHEA0064', 'EDHEA0064', 'TXHOUSTD', 'Houston Eye Associates', 'John', 'M', 'Lim', 'MD', 'Ophthalmology', '', '', NULL, 'O', '2855 Gramercy', 'Houston', 'Harris', 'TX', '77025', '7136686828', '7136683823', '2855 Gramercy', 'Houston', 'Harris', 'TX', '77025', '7136686828', '7136683823', 'Houston4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1508851346', 0, 'N', 0, '2014-05-30', NULL, NULL, 29.7044, -95.4225, NULL, NULL),
('760512625', 'EDHEA0126', 'EDHEA0126', 'TXHOUSTD', 'Houston Eye Associates', 'John', 'M', 'Lim', 'MD', 'Ophthalmology', '', '', NULL, 'M', '7155 Old Katy Rd N100', 'Houston', 'Harris', 'TX', '77024', '7136686828', NULL, '7155 Old Katy Rd N100', 'Houston', 'Harris', 'TX', '77024', '7136686828', '', 'Houston4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1508851346', 0, 'Y', 0, '2014-05-30', NULL, NULL, 0, 0, NULL, NULL),
('760512625', 'EDHEA0151', 'EDHEA0151', 'TXHOUSTD', 'Houston Eye Associates', 'John', 'M', 'Lim', 'MD', 'Ophthalmology', '', '', NULL, 'O', '7777 Southwest Fwy Ste 804', 'Houston', 'Harris', 'TX', '77074', '7137776123', '7139881224', '7777 Southwest Fwy Ste 804', 'Houston', 'Harris', 'TX', '77074', '7137776123', '7139881224', 'Houston4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1508851346', 0, 'N', 0, '2014-05-30', NULL, NULL, 29.6947, -95.5234, NULL, NULL),
('760512625', 'EDHEA0197', 'EDHEA0197', 'TXHOUSTD', 'Houston Eye Associates', 'John', 'M', 'Lim', 'MD', 'Ophthalmology', '', '', NULL, 'B', 'PO Box 4958', 'Houston', 'Harris', 'TX', '77210', '7136686828', NULL, 'PO Box 4958', 'Houston', 'Harris', 'TX', '77210', '7136686828', '', 'Houston4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1508851346', 0, 'Y', 0, '2014-05-30', NULL, NULL, 0, 0, NULL, NULL),
('760512625', 'EDHEA0002', 'EDHEA0002', 'TXHOUSTD', 'Houston Eye Associates', 'Susan', 'K', 'Fish', 'MD', 'Ophthalmology', '', '', NULL, 'O', '1120 Medical Plaza Dr Ste 320', 'The Woodlands', 'Montgomery', 'TX', '77380', '2813632155', '2814654261', '1120 Medical Plaza Dr Ste 320', 'The Woodlands', 'Montgomery', 'TX', '77380', '2813632155', '2814654261', 'Houston4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Conroe Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1568411593', 0, 'N', 0, '2013-06-12', NULL, NULL, 30.1728, -95.455, NULL, NULL),
('760512625', 'EDHEA0082', 'EDHEA0082', 'TXHOUSTD', 'Houston Eye Associates', 'Susan', 'K', 'Fish', 'MD', 'Ophthalmology', '', '', NULL, 'O', '333 N Riverside Dr Ste 160', 'Conroe', 'Montgomery', 'TX', '77304', '9364412020', '9367560656', '333 N Riverside Dr Ste 160', 'Conroe', 'Montgomery', 'TX', '77304', '9364412020', '9367560656', 'Houston4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', '2013-05-31', 0, 0, 0, 'Conroe Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1568411593', 0, 'N', 0, '2013-06-13', NULL, NULL, 0, 0, NULL, NULL),
('760512625', 'EDHEA0111', 'EDHEA0111', 'TXHOUSTD', 'Houston Eye Associates', 'Susan', 'K', 'Fish', 'MD', 'Ophthalmology', '', '', NULL, 'M', '7155 Old Katy Rd N100', 'Houston', 'Harris', 'TX', '77024', '7136686828', NULL, '7155 Old Katy Rd N100', 'Houston', 'Harris', 'TX', '77024', '7136686828', '', 'Houston4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Conroe Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1568411593', 0, 'Y', 0, '2013-06-12', NULL, NULL, 0, 0, NULL, NULL),
('760512625', 'EDHEA0182', 'EDHEA0182', 'TXHOUSTD', 'Houston Eye Associates', 'Susan', 'K', 'Fish', 'MD', 'Ophthalmology', '', '', NULL, 'B', 'PO Box 4958', 'Houston', 'Harris', 'TX', '77210', '7136686828', NULL, 'PO Box 4958', 'Houston', 'Harris', 'TX', '77210', '7136686828', '', 'Houston4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Conroe Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1568411593', 0, 'Y', 0, '2013-06-12', NULL, NULL, 0, 0, NULL, NULL),
('760512625', 'EDHEA0072', 'EDHEA0072', 'TXHOUSTD', 'Houston Eye Associates', 'Paul', 'C', 'Salmonsen', 'MD', 'Ophthalmology', '', '', NULL, 'O', '2855 Gramercy', 'Houston', 'Harris', 'TX', '77025', '7136686828', '7136683823', '2855 Gramercy', 'Houston', 'Harris', 'TX', '77025', '7136686828', '7136683823', 'Houston4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1568457661', 0, 'N', 0, '2013-01-02', NULL, NULL, 29.7044, -95.4225, NULL, NULL),
('760512625', 'EDHEA0137', 'EDHEA0137', 'TXHOUSTD', 'Houston Eye Associates', 'Paul', 'C', 'Salmonsen', 'MD', 'Ophthalmology', '', '', NULL, 'M', '7155 Old Katy Rd N100', 'Houston', 'Harris', 'TX', '77024', '7136686828', NULL, '7155 Old Katy Rd N100', 'Houston', 'Harris', 'TX', '77024', '7136686828', '', 'Houston4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1568457661', 0, 'Y', 0, '2013-01-02', NULL, NULL, 0, 0, NULL, NULL),
('760512625', 'EDHEA0208', 'EDHEA0208', 'TXHOUSTD', 'Houston Eye Associates', 'Paul', 'C', 'Salmonsen', 'MD', 'Ophthalmology', '', '', NULL, 'B', 'PO Box 4958', 'Houston', 'Harris', 'TX', '77210', '7136686828', NULL, 'PO Box 4958', 'Houston', 'Harris', 'TX', '77210', '7136686828', '', 'Houston4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1568457661', 0, 'Y', 0, '2013-01-02', NULL, NULL, 0, 0, NULL, NULL),
('760512625', 'EDHEA0051', 'EDHEA0051', 'TXHOUSTD', 'Houston Eye Associates', 'Samih', '', 'Elchahal', 'MD', 'Ophthalmology', '', '', NULL, 'O', '2855 Gramercy', 'Houston', 'Harris', 'TX', '77025', '7136686828', '7136683823', '2855 Gramercy', 'Houston', 'Harris', 'TX', '77025', '7136686828', '7136683823', 'Houston4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Houston Methodist Hospital', NULL, '', NULL, 'HCFA|UB|', '1568512226', 0, 'N', 0, '2013-01-02', NULL, NULL, 29.7044, -95.4225, NULL, NULL),
('760512625', 'EDHEA0093', 'EDHEA0093', 'TXHOUSTD', 'Houston Eye Associates', 'Samih', '', 'Elchahal', 'MD', 'Ophthalmology', '', '', NULL, 'O', '590 Chimney Rock', 'Houston', 'Harris', 'TX', '77056', '7137824406', '7137822554', '590 Chimney Rock', 'Houston', 'Harris', 'TX', '77056', '7137824406', '7137822554', 'Houston4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Houston Methodist Hospital', NULL, '', NULL, 'HCFA|UB|', '1568512226', 0, 'N', 0, '2013-01-02', NULL, NULL, 29.7641, -95.478, NULL, NULL),
('760512625', 'EDHEA0110', 'EDHEA0110', 'TXHOUSTD', 'Houston Eye Associates', 'Samih', '', 'Elchahal', 'MD', 'Ophthalmology', '', '', NULL, 'M', '7155 Old Katy Rd N100', 'Houston', 'Harris', 'TX', '77024', '7136686828', NULL, '7155 Old Katy Rd N100', 'Houston', 'Harris', 'TX', '77024', '7136686828', '', 'Houston4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Houston Methodist Hospital', NULL, '', NULL, 'HCFA|UB|', '1568512226', 0, 'Y', 0, '2013-01-02', NULL, NULL, 0, 0, NULL, NULL),
('760512625', 'EDHEA0181', 'EDHEA0181', 'TXHOUSTD', 'Houston Eye Associates', 'Samih', '', 'Elchahal', 'MD', 'Ophthalmology', '', '', NULL, 'B', 'PO Box 4958', 'Houston', 'Harris', 'TX', '77210', '7136686828', NULL, 'PO Box 4958', 'Houston', 'Harris', 'TX', '77210', '7136686828', '', 'Houston4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Houston Methodist Hospital', NULL, '', NULL, 'HCFA|UB|', '1568512226', 0, 'Y', 0, '2013-01-02', NULL, NULL, 0, 0, NULL, NULL),
('760512625', 'EDHEA0042', 'EDHEA0042', 'TXHOUSTD', 'Houston Eye Associates', 'Andrew', 'C', 'Kopel', 'MD', 'Ophthalmology', '', '', NULL, 'O', '2424 W Holcombe Ste 203', 'Houston', 'Harris', 'TX', '77030', '7136657600', '7136657650', '2424 W Holcombe Ste 203', 'Houston', 'Harris', 'TX', '77030', '7136657600', '7136657650', 'Houston4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Houston Methodist Hospital', NULL, '', NULL, 'HCFA|UB|', '1568575140', 0, 'N', 0, '2013-01-02', NULL, NULL, 29.7063, -95.4152, NULL, NULL),
('760512625', 'EDHEA0059', 'EDHEA0059', 'TXHOUSTD', 'Houston Eye Associates', 'Andrew', 'C', 'Kopel', 'MD', 'Ophthalmology', '', '', NULL, 'O', '2855 Gramercy', 'Houston', 'Harris', 'TX', '77025', '7136686828', '7136683823', '2855 Gramercy', 'Houston', 'Harris', 'TX', '77025', '7136686828', '7136683823', 'Houston4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Houston Methodist Hospital', NULL, '', NULL, 'HCFA|UB|', '1568575140', 0, 'N', 0, '2013-01-02', NULL, NULL, 29.7044, -95.4225, NULL, NULL),
('760512625', 'EDHEA0121', 'EDHEA0121', 'TXHOUSTD', 'Houston Eye Associates', 'Andrew', 'C', 'Kopel', 'MD', 'Ophthalmology', '', '', NULL, 'M', '7155 Old Katy Rd N100', 'Houston', 'Harris', 'TX', '77024', '7136686828', NULL, '7155 Old Katy Rd N100', 'Houston', 'Harris', 'TX', '77024', '7136686828', '', 'Houston4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Houston Methodist Hospital', NULL, '', NULL, 'HCFA|UB|', '1568575140', 0, 'Y', 0, '2013-01-02', NULL, NULL, 0, 0, NULL, NULL),
('760512625', 'EDHEA0192', 'EDHEA0192', 'TXHOUSTD', 'Houston Eye Associates', 'Andrew', 'C', 'Kopel', 'MD', 'Ophthalmology', '', '', NULL, 'B', 'PO Box 4958', 'Houston', 'Harris', 'TX', '77210', '7136686828', NULL, 'PO Box 4958', 'Houston', 'Harris', 'TX', '77210', '7136686828', '', 'Houston4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Houston Methodist Hospital', NULL, '', NULL, 'HCFA|UB|', '1568575140', 0, 'Y', 0, '2013-01-02', NULL, NULL, 0, 0, NULL, NULL),
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('752547135', 'W12028027', 'W12028027', 'TXDALSTD', 'Texas Colon and Rectal Specialist', '', '', 'Texas Colon and Rectal Specialist', '', 'Colon and Rectal Surgery', '', '', NULL, 'O', '4320 Windsor Centre Trail Ste 200', 'Flower Mound', 'Denton', 'TX', '75028', '9727592040', '9727592045', '4320 Windsor Centre Trial Ste 200', 'Flower Mound', 'Denton', 'TX', '75028', '9727592040', '9727592045', 'TXCOLONREC', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1487693834', 0, 'Y', 0, '2013-01-02', NULL, NULL, 33.0393, -97.0632, NULL, NULL),
('752547135', 'W12028018', 'W12028018', 'TXDALSTD', 'Texas Colon and Rectal Specialist', '', '', 'Texas Colon and Rectal Specialist', '', 'Colon and Rectal Surgery', '', '', NULL, 'O', '4325 N Josey Ln Plaza III, Ste 203', 'Carrollton', 'Denton', 'TX', '75010', '9727592040', '9727592045', '4325 N Josey Ln Plaza III, Ste 203', 'Carrollton', 'Denton', 'TX', '75010', '9727592040', '9727592045', 'TXCOLONREC', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1487693834', 0, 'Y', 0, '2013-01-02', NULL, NULL, 33.0276, -96.8847, NULL, NULL),
('752547135', 'W12028024', 'W12028024', 'TXDALSTD', 'Texas Colon and Rectal Specialist', '', '', 'Texas Colon and Rectal Specialist', '', 'Colon and Rectal Surgery', '', '', NULL, 'O', '5236 W University Dr Ste 4300', 'McKinney', 'Collin', 'TX', '75071', '2148842332', '2144911984', '5236 W University Dr Ste 4300', 'Mckinney', 'Collin', 'TX', '75071', '2148842332', '2144911984', 'TXCOLONREC', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1487693834', 0, 'Y', 0, '2013-01-02', NULL, NULL, 33.2183, -96.684, NULL, NULL),
('752547135', 'W12028023', 'W12028023', 'TXDALSTD', 'Texas Colon and Rectal Specialist', '', '', 'Texas Colon and Rectal Specialist', '', 'Colon and Rectal Surgery', '', '', NULL, 'O', '6124 W Parker Rd Ste 3-534', 'Plano', 'Collin', 'TX', '75093', '9729818277', '8178656056', '6124 W Parker Rd Ste 3-534', 'Plano', 'Collin', 'TX', '75093', '9729818277', '8178656056', 'TXCOLONREC', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1487693834', 0, 'Y', 0, '2013-01-02', NULL, NULL, 33.0451, -96.8337, NULL, NULL),
('752547135', 'W12028019', 'W12028019', 'TXDALSTD', 'Texas Colon and Rectal Specialist', '', '', 'Texas Colon and Rectal Specialist', '', 'Colon and Rectal Surgery', '', '', NULL, 'O', '701 Tuscan Dr Ste 125', 'Irving', 'Dallas', 'TX', '75039', '9727592040', '9727592045', '701 Tuscan Dr Ste 125', 'Irving', 'Dallas', 'TX', '75039', '9727592040', '9727592045', 'TXCOLONREC', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1487693834', 0, 'Y', 0, '2013-01-02', NULL, NULL, 32.8979, -96.9587, NULL, NULL),
('752547135', 'W12028021', 'W12028021', 'TXDALSTD', 'Texas Colon and Rectal Specialist', '', '', 'Texas Colon and Rectal Specialist', '', 'Colon and Rectal Surgery', '', '', NULL, 'O', '7777 Forest Ln Ste A321', 'Dallas', 'Dallas', 'TX', '75230', '9726613575', '9722339120', '7777 Forest Ln Ste A321', 'Dallas', 'Dallas', 'TX', '75230', '9726613575', '9722339120', 'TXCOLONREC', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1487693834', 0, 'Y', 0, '2013-01-02', NULL, NULL, 32.9095, -96.7721, NULL, NULL),
('752547135', 'W12028025', 'W12028025', 'TXDALSTD', 'Texas Colon and Rectal Specialist', '', '', 'Texas Colon and Rectal Specialist', '', 'Colon and Rectal Surgery', '', '', NULL, 'O', '8220 Walnut Hill Ln Ste 205', 'Dallas', 'Dallas', 'TX', '75231', '2147395758', '2147390016', '8220 Walnut Hill Ln Ste 205', 'Dallas', 'Dallas', 'TX', '75231', '2147395758', '2147390016', 'TXCOLONREC', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1487693834', 0, 'Y', 0, '2013-01-02', NULL, NULL, 32.8833, -96.7628, NULL, NULL),
('752547135', 'W12028020', 'W12028020', 'TXDALSTD', 'Texas Colon and Rectal Specialist', '', '', 'Texas Colon and Rectal Specialist', '', 'Colon and Rectal Surgery', '', '', NULL, 'O', '8315 Walnut Hill Ln Ste 220', 'Dallas', 'Dallas', 'TX', '75231', '2143636123', '2147501512', '8315 Walnut Hill Ln Ste 220', 'Dallas', 'Dallas', 'TX', '75231', '2143636123', '2147501512', 'TXCOLONREC', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1487693834', 0, 'Y', 0, '2013-01-02', NULL, NULL, 32.8834, -96.762, NULL, NULL),
('201013664', 'EDBQA0077', 'EDBQA0077', 'TXDALSTD', 'Baylor Center for Pain Mgmt', 'Richard', 'L', 'Vera', 'MD', 'Pain Management', '', '', NULL, 'O', '1615 Lancaster Dr Ste 150', 'Grapevine', 'Tarrant', 'TX', '76051', '8174210279', NULL, '1615 Lancaster Dr Ste 150', 'Grapevine', 'Tarrant', 'TX', '76051', '8174210279', '          ', 'BQA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', '2013-08-14', 0, 0, 0, 'Baylor Medical Center at Garland', 'Baylor Regional Medical Center at Grapevine', NULL, NULL, 'HCFA|UB|', '1003866377', 0, 'Y', 0, '2013-11-11', NULL, NULL, 32.934, -97.0911, NULL, NULL),
('752547135', 'W12028029', 'W12028029', 'TXDALSTD', 'Texas Colon and Rectal Specialists', 'Dale', '', 'Burleson', 'MD', 'Colon and Rectal Surgery', '', '', NULL, 'O', '1518 Legacy Dr Ste 120', 'Frisco', 'Denton', 'TX', '75034', '2146183455', '9729857989', '1518 Legacy Dr Ste 120', 'Frisco', 'Denton', 'TX', '75034', '2146183455', '9729857989', 'TXCOLONREC', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Frisco', NULL, NULL, NULL, 'HCFA|UB|', '1366473092', 0, 'N', 0, '2013-01-02', NULL, NULL, 33.0906, -96.8391, NULL, NULL),
('752547135', 'W12028030', 'W12028030', 'TXDALSTD', 'Texas Colon and Rectal Specialists', 'Dale', '', 'Burleson', 'MD', 'Colon and Rectal Surgery', '', '', NULL, 'O', '4001 W 15th St Ste 280', 'Plano', 'Collin', 'TX', '75093', '9729857988', '0000000000', '4001 W 15th St Ste 280', 'Plano', 'Collin', 'TX', '75093', '9729857988', '0000000000', 'TXCOLONREC', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Frisco', NULL, NULL, NULL, 'HCFA|UB|', '1366473092', 0, 'N', 0, '2013-01-02', NULL, NULL, 33.0191, -96.7671, NULL, NULL),
('752547135', 'W12028032', 'W12028032', 'TXDALSTD', 'Texas Colon and Rectal Specialists', 'Randall', '', 'Crim', 'MD', 'Colon and Rectal Surgery', '', '', NULL, 'O', '4325 N Josey Ln Plaza II, Ste 103', 'Carrollton', 'Denton', 'TX', '75010', '9727592040', '9727592045', '4325 N Josey Ln Plaza II, Ste 103', 'Carrollton', 'Denton', 'TX', '75010', '9727592040', '9727592045', 'TXCOLONREC', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Irving', '', '', '', 'HCFA|UB|', '1063443703', 0, 'N', 0, '2014-05-08', NULL, NULL, 33.0276, -96.8847, NULL, NULL),
('752547135', 'W12028034', 'W12028034', 'TXDALSTD', 'Texas Colon and Rectal Specialist', 'Randall', '', 'Crim', 'MD', 'Colon and Rectal Surgery', '', '', NULL, 'B', '11551 Forest Central Dr Ste 133', 'Dallas', 'Dallas', 'TX', '75243', '2143438565', '0000000000', '11551 Forest Central Dr Ste 133', 'Dallas', 'Dallas', 'TX', '75243', '2143438565', '0000000000', 'TXCOLONREC', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Irving', '', '', '', 'HCFA|UB|', '1063443703', 0, 'N', 0, '2014-05-08', NULL, NULL, 0, 0, NULL, NULL),
('752547135', 'W12028033', 'W12028033', 'TXDALSTD', 'Texas Colon and Rectal Specialists', 'Randall', '', 'Crim', 'MD', 'Colon and Rectal Surgery', '', '', NULL, 'O', '701 Tuscan Dr Ste 125', 'Irving', 'Dallas', 'TX', '75039', '9727592040', '9727592045', '701 Tuscan Dr Ste 125', 'Irving', 'Dallas', 'TX', '75039', '9727592040', '9727592045', 'TXCOLONREC', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Irving', '', '', '', 'HCFA|UB|', '1063443703', 0, 'N', 0, '2014-05-08', NULL, NULL, 32.8979, -96.9587, NULL, NULL),
('752547135', 'W12028035', 'W12028035', 'TXDALSTD', 'Texas Colon and Rectal Specialist', 'Dale', '', 'Burleson', 'MD', 'Colon and Rectal Surgery', '', '', NULL, 'B', '11551 Forest Central Dr Ste 133', 'Dallas', 'Dallas', 'TX', '75243', '2143438565', '0000000000', '11551 Forest Central Dr Ste 133', 'Dallas', 'Dallas', 'TX', '75243', '2143438565', '0000000000', 'TXCOLONREC', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Frisco', NULL, NULL, NULL, 'HCFA|UB|', '1366473092', 0, 'N', 0, '2013-01-02', NULL, NULL, 0, 0, NULL, NULL),
('752547135', 'W12028037', 'W12028037', 'TXDALSTD', 'Texas Colon and Rectal Specialist', 'J', 'Marcus', 'Downs', 'MD', 'Colon and Rectal Surgery', '', '', NULL, 'B', '11551 Forest Central Dr Ste 133', 'Dallas', 'Dallas', 'TX', '75243', '2143438565', '2147501512', '11551 Forest Central Dr Ste 133', 'Dallas', 'Dallas', 'TX', '75243', '2143438565', '2147501512', 'TXCOLONREC', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at McKinney', NULL, '', '', 'HCFA|UB|', '1811922610', 0, 'N', 0, '2013-01-02', NULL, NULL, 0, 0, NULL, NULL),
('752547135', 'W12028038', 'W12028038', 'TXDALSTD', 'Texas Colon and Rectal Specialists', 'J', 'Marcus', 'Downs', 'MD', 'Colon and Rectal Surgery', '', '', NULL, 'O', '8315 Walnut Hill Ln Ste 220', 'Dallas', 'Dallas', 'TX', '75231', '2143636123', '2147501512', '8315 Walnut Hill Ln Ste 220', 'Dallas', 'Dallas', 'TX', '75231', '2143636123', '2147501512', 'TXCOLONREC', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at McKinney', NULL, '', '', 'HCFA|UB|', '1811922610', 0, 'N', 0, '2013-01-02', NULL, NULL, 32.8834, -96.762, NULL, NULL),
('752547135', 'W12028040', 'W12028040', 'TXDALSTD', 'Texas Colon and Rectal Specialist', 'Sharon', '', 'Gregorcyk', 'MD', 'Colon and Rectal Surgery', '', '', NULL, 'B', '11551 Forest Central Dr Ste 133', 'Dallas', 'Dallas', 'TX', '75243', '2143438565', '9722339120', '11551 Forest Central Dr Ste 133', 'Dallas', 'Dallas', 'TX', '75243', '2143438565', '9722339120', 'TXCOLONREC', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, '', '', 'HCFA|UB|', '1982647806', 0, 'N', 0, '2013-01-02', NULL, NULL, 0, 0, NULL, NULL),
('752547135', 'W12028041', 'W12028041', 'TXDALSTD', 'Texas Colon and Rectal Specialists', 'Sharon', '', 'Gregorcyk', 'MD', 'Colon and Rectal Surgery', '', '', NULL, 'O', '7777 Forest Ln Ste A321', 'Dallas', 'Dallas', 'TX', '75230', '9726613575', '9722339120', '7777 Forest Ln Ste A321', 'Dallas', 'Dallas', 'TX', '75230', '9726613575', '9722339120', 'TXCOLONREC', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, '', '', 'HCFA|UB|', '1982647806', 0, 'N', 0, '2013-01-02', NULL, NULL, 32.9095, -96.7721, NULL, NULL),
('752547135', 'W12028043', 'W12028043', 'TXDALSTD', 'Texas Colon and Rectal Specialist', 'Jefferson', '', 'Hurley', 'MD', 'Colon and Rectal Surgery', '', '', NULL, 'B', '11551 Forest Central Dr Ste 133', 'Dallas', 'Dallas', 'TX', '75243', '2143438565', '9727592045', '11551 Forest Central Dr Ste 133', 'Dallas', 'Dallas', 'TX', '75243', '2143438565', '9727592045', 'TXCOLONREC', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Irving', NULL, NULL, NULL, 'HCFA|UB|', '1548295355', 0, 'N', 0, '2013-01-02', NULL, NULL, 0, 0, NULL, NULL),
('752547135', 'W12028044', 'W12028044', 'TXDALSTD', 'Texas Colon and Rectal Specialists', 'Jefferson', '', 'Hurley', 'MD', 'Colon and Rectal Surgery', '', '', NULL, 'O', '701 Tuscan Dr Ste 125', 'Irving', 'Dallas', 'TX', '75039', '9727592040', '9727592045', '701 Tuscan Dr Ste 125', 'Irving', 'Dallas', 'TX', '75039', '9727592040', '9727592045', 'TXCOLONREC', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Irving', NULL, NULL, NULL, 'HCFA|UB|', '1548295355', 0, 'N', 0, '2013-01-02', NULL, NULL, 32.8979, -96.9587, NULL, NULL),
('752547135', 'W12028045', 'W12028045', 'TXDALSTD', 'Texas Colon and Rectal Specialists', 'Jefferson', '', 'Hurley', 'MD', 'Colon and Rectal Surgery', '', '', NULL, 'O', '7777 Forest Ln Ste A321', 'Dallas', 'Dallas', 'TX', '75230', '9726613575', '9727592045', '7777 Forest Ln Ste A321', 'Dallas', 'Dallas', 'TX', '75230', '9726613575', '9727592045', 'TXCOLONREC', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Irving', NULL, NULL, NULL, 'HCFA|UB|', '1548295355', 0, 'N', 0, '2013-01-02', NULL, NULL, 32.9095, -96.7721, NULL, NULL),
('752547135', 'W12028048', 'W12028048', 'TXDALSTD', 'Texas Colon and Rectal Specialist', 'Jennifer', '', 'Lowney', 'MD', 'Colon and Rectal Surgery', '', '', NULL, 'B', '11551 Forest Central Dr Ste 133', 'Dallas', 'Dallas', 'TX', '75243', '2143438565', '0000000000', '11551 Forest Central Dr Ste 133', 'Dallas', 'Dallas', 'TX', '75243', '2143438565', '0000000000', 'TXCOLONREC', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Grapevine', NULL, NULL, NULL, 'HCFA|UB|', '1821016254', 0, 'N', 0, '2013-01-02', NULL, NULL, 0, 0, NULL, NULL),
('752547135', 'W12028047', 'W12028047', 'TXDALSTD', 'Texas Colon and Rectal Specialists', 'Jennifer', '', 'Lowney', 'MD', 'Colon and Rectal Surgery', '', '', NULL, 'O', '1600 W College St Ste 440', 'Grapevine', 'Tarrant', 'TX', '76051', '8178656200', '8178656056', '1600 W College St Ste 440', 'Grapevine', 'Tarrant', 'TX', '76051', '8178656200', '8178656056', 'TXCOLONREC', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Grapevine', NULL, NULL, NULL, 'HCFA|UB|', '1821016254', 0, 'N', 0, '2013-01-02', NULL, NULL, 32.9356, -97.0929, NULL, NULL),
('752547135', 'W12028049', 'W12028049', 'TXDALSTD', 'Texas Colon and Rectal Specialists', 'Jennifer', '', 'Lowney', 'MD', 'Colon and Rectal Surgery', '', '', NULL, 'O', '6124 W Parker Rd Ste 3-534', 'Plano', 'Collin', 'TX', '75093', '9729818277', '8178656056', '6124 W Parker Rd Ste 3-534', 'Plano', 'Collin', 'TX', '75093', '9729818277', '8178656056', 'TXCOLONREC', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Grapevine', NULL, NULL, NULL, 'HCFA|UB|', '1821016254', 0, 'N', 0, '2013-01-02', NULL, NULL, 33.0451, -96.8337, NULL, NULL),
('751942562', 'W12028077', 'W12028077', 'TXDALSTD', 'Surgical Associates of the Mid-Cities', 'Michael', 'W', 'Bryan', 'MD', 'General Surgery', '', '', NULL, 'O', '1604 Hospital Pkwy Ste 505', 'Bedford', 'Tarrant', 'TX', '76022', '8172672678', NULL, '1604 Hospital Pkwy Ste 505', 'Bedford', 'Tarrant', 'TX', '76022', '8172672678', '          ', 'BQA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Grapevine', NULL, NULL, NULL, 'HCFA|UB|', '1659410660', 0, 'N', 0, '2013-04-08', NULL, NULL, 32.8336, -97.1252, NULL, NULL),
('752547135', 'W12028051', 'W12028051', 'TXDALSTD', 'Texas Colon and Rectal Specialist', 'Anthony', '', 'Macaluso', 'MD', 'Colon and Rectal Surgery', '', '', NULL, 'B', '11551 Forest Central Dr Ste 133', 'Dallas', 'Dallas', 'TX', '75243', '2143438565', '0000000000', '11551 Forest Central Dr Ste 133', 'Dallas', 'Dallas', 'TX', '75243', '2143438565', '0000000000', 'TXCOLONREC', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, '', '', 'HCFA|UB|', '1649201385', 0, 'N', 0, '2013-01-02', NULL, NULL, 0, 0, NULL, NULL),
('752547135', 'W12028053', 'W12028053', 'TXDALSTD', 'Texas Colon and Rectal Specialists', 'Anthony', '', 'Macaluso', 'MD', 'Colon and Rectal Surgery', '', '', NULL, 'O', '4001 W 15th St Ste 280', 'Plano', 'Collin', 'TX', '75093', '9729857988', '9729857989', '4001 W 15th St Ste 280', 'Plano', 'Collin', 'TX', '75093', '9729857988', '9729857989', 'TXCOLONREC', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, '', '', 'HCFA|UB|', '1649201385', 0, 'N', 0, '2013-01-02', NULL, NULL, 33.0191, -96.7671, NULL, NULL),
('752547135', 'W12028052', 'W12028052', 'TXDALSTD', 'Texas Colon and Rectal Specialists', 'Anthony', '', 'Macaluso', 'MD', 'Colon and Rectal Surgery', '', '', NULL, 'O', '7777 Forest Ln Ste A321', 'Dallas', 'Dallas', 'TX', '75230', '9726613575', '9722339120', '7777 Forest Ln Ste A321', 'Dallas', 'Dallas', 'TX', '75230', '9726613575', '9722339120', 'TXCOLONREC', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, '', '', 'HCFA|UB|', '1649201385', 0, 'N', 0, '2013-01-02', NULL, NULL, 32.9095, -96.7721, NULL, NULL),
('752547135', 'W12028055', 'W12028055', 'TXDALSTD', 'Texas Colon and Rectal Specialist', 'Laurie', '', 'Novosad', 'MD', 'Colon and Rectal Surgery', '', '', NULL, 'B', '11551 Forest Central Dr Ste 133', 'Dallas', 'Dallas', 'TX', '75243', '2143438565', '2144911984', '11551 Forest Central Dr Ste 133', 'Dallas', 'Dallas', 'TX', '75243', '2143438565', '2144911984', 'TXCOLONREC', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at McKinney', NULL, '', '', 'HCFA|UB|', '1073763181', 0, 'N', 0, '2013-01-02', NULL, NULL, 0, 0, NULL, NULL),
('752547135', 'W12028056', 'W12028056', 'TXDALSTD', 'Texas Colon and Rectal Specialists', 'Laurie', '', 'Novosad', 'MD', 'Colon and Rectal Surgery', '', '', NULL, 'O', '5236 W University Dr Ste 4300', 'McKinney', 'Collin', 'TX', '75071', '2148842332', '2144911984', '5236 W University Dr Ste 4300', 'Mckinney', 'Collin', 'TX', '75071', '2148842332', '2144911984', 'TXCOLONREC', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at McKinney', NULL, '', '', 'HCFA|UB|', '1073763181', 0, 'N', 0, '2013-01-02', NULL, NULL, 33.2183, -96.684, NULL, NULL),
('752547135', 'W12028058', 'W12028058', 'TXDALSTD', 'Texas Colon and Rectal Specialist', 'Floyd', 'C', 'Odom', 'MD', 'Colon and Rectal Surgery', '', '', NULL, 'B', '11551 Forest Central Dr Ste 133', 'Dallas', 'Dallas', 'TX', '75243', '2143438565', '2147390016', '11551 Forest Central Dr Ste 133', 'Dallas', 'Dallas', 'TX', '75243', '2143438565', '2147390016', 'TXCOLONREC', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1346275146', 0, 'N', 0, '2013-04-05', NULL, NULL, 0, 0, NULL, NULL),
('752547135', 'W12028059', 'W12028059', 'TXDALSTD', 'Texas Colon and Rectal Specialists', 'Floyd', 'C', 'Odom', 'MD', 'Colon and Rectal Surgery', '', '', NULL, 'O', '8220 Walnut Hill Ln Ste 205', 'Dallas', 'Dallas', 'TX', '75231', '2147395758', '2147390016', '8220 Walnut Hill Ln Ste 205', 'Dallas', 'Dallas', 'TX', '75231', '2147395758', '2147390016', 'TXCOLONREC', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1346275146', 0, 'N', 0, '2013-04-05', NULL, NULL, 32.8833, -96.7628, NULL, NULL),
('752547135', 'W12028061', 'W12028061', 'TXDALSTD', 'Texas Colon and Rectal Specialist', 'Don', '', 'Read', 'MD', 'Colon and Rectal Surgery', '', '', NULL, 'B', '11551 Forest Central Dr Ste 133', 'Dallas', 'Dallas', 'TX', '75243', '2143438565', '0000000000', '11551 Forest Central Dr Ste 133', 'Dallas', 'Dallas', 'TX', '75243', '2143438565', '0000000000', 'TXCOLONREC', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, '', '', 'HCFA|UB|', '1417982224', 0, 'N', 0, '2013-01-02', NULL, NULL, 0, 0, NULL, NULL),
('752547135', 'W12028062', 'W12028062', 'TXDALSTD', 'Texas Colon and Rectal Specialists', 'Don', '', 'Read', 'MD', 'Colon and Rectal Surgery', '', '', NULL, 'O', '7777 Forest Ln Ste A321', 'Dallas', 'Dallas', 'TX', '75230', '9726613575', '9722339120', '7777 Forest Ln Ste A321', 'Dallas', 'Dallas', 'TX', '75230', '9726613575', '9722339120', 'TXCOLONREC', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, '', '', 'HCFA|UB|', '1417982224', 0, 'N', 0, '2013-01-02', NULL, NULL, 32.9095, -96.7721, NULL, NULL),
('752547135', 'W12028064', 'W12028064', 'TXDALSTD', 'Texas Colon and Rectal Specialist', 'Clifford', '', 'Simmang', 'MD', 'Colon and Rectal Surgery', '', '', NULL, 'B', '11551 Forest Central Dr Ste 133', 'Dallas', 'Dallas', 'TX', '75243', '2143438565', '8178656056', '11551 Forest Central Dr Ste 133', 'Dallas', 'Dallas', 'TX', '75243', '2143438565', '8178656056', 'TXCOLONREC', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Grapevine', NULL, NULL, NULL, 'HCFA|UB|', '1316972136', 0, 'N', 0, '2013-01-02', NULL, NULL, 0, 0, NULL, NULL),
('752547135', 'W12028065', 'W12028065', 'TXDALSTD', 'Texas Colon and Rectal Specialists', 'Clifford', '', 'Simmang', 'MD', 'Colon and Rectal Surgery', '', '', NULL, 'O', '1600 W College St Ste 440', 'Grapevine', 'Tarrant', 'TX', '76051', '8178656200', '8178656056', '1600 W College St Ste 440', 'Grapevine', 'Tarrant', 'TX', '76051', '8178656200', '8178656056', 'TXCOLONREC', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Grapevine', NULL, NULL, NULL, 'HCFA|UB|', '1316972136', 0, 'N', 0, '2013-01-02', NULL, NULL, 32.9356, -97.0929, NULL, NULL),
('752547135', 'W12028066', 'W12028066', 'TXDALSTD', 'Texas Colon and Rectal Specialists', 'Clifford', '', 'Simmang', 'MD', 'Colon and Rectal Surgery', '', '', NULL, 'O', '7777 Forest Ln Ste A321', 'Dallas', 'Dallas', 'TX', '75230', '9726613575', '9722339120', '7777 Forest Ln Ste A321', 'Dallas', 'Dallas', 'TX', '75230', '9726613575', '9722339120', 'TXCOLONREC', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Grapevine', NULL, NULL, NULL, 'HCFA|UB|', '1316972136', 0, 'N', 0, '2013-01-02', NULL, NULL, 32.9095, -96.7721, NULL, NULL),
('752547135', 'W12028071', 'W12028071', 'TXDALSTD', 'Texas Colon and Rectal Specialists', 'Ronney', '', 'Stadler', 'MD', 'Colon and Rectal Surgery', '', '', NULL, 'O', '701 Tuscan Dr Ste 125', 'Irving', 'Dallas', 'TX', '75039', '9727592040', '9727592045', '701 Tuscan Dr Ste 125', 'Irving', 'Dallas', 'TX', '75039', '9727592040', '9727592045', 'TXCOLONREC', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Irving', NULL, NULL, NULL, 'HCFA|UB|', '1356372098', 0, 'N', 0, '2013-07-29', NULL, NULL, 32.8979, -96.9587, NULL, NULL),
('752547135', 'W12028068', 'W12028068', 'TXDALSTD', 'Texas Colon and Rectal Specialist', 'Ronney', '', 'Stadler', 'MD', 'Colon and Rectal Surgery', '', '', NULL, 'B', '11551 Forest Central Dr Ste 133', 'Dallas', 'Dallas', 'TX', '75243', '2143438565', '9727592045', '11551 Forest Central Dr Ste 133', 'Dallas', 'Dallas', 'TX', '75243', '2143438565', '9727592045', 'TXCOLONREC', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Irving', NULL, NULL, NULL, 'HCFA|UB|', '1356372098', 0, 'N', 0, '2013-07-29', NULL, NULL, 0, 0, NULL, NULL),
('752547135', 'W12028069', 'W12028069', 'TXDALSTD', 'Texas Colon and Rectal Specialists', 'Ronney', '', 'Stadler', 'MD', 'Colon and Rectal Surgery', '', '', NULL, 'O', '1604 Hospital Pkwy Ste 501', 'Bedford', 'Tarrant', 'TX', '76022', '9727592040', '9727592045', '1604 Hospital Pkwy Ste 501', 'Bedford', 'Tarrant', 'TX', '76022', '9727592040', '9727592045', 'TXCOLONREC', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Irving', NULL, NULL, NULL, 'HCFA|UB|', '1356372098', 0, 'N', 0, '2013-07-29', NULL, NULL, 32.8336, -97.1252, NULL, NULL),
('752547135', 'W12028070', 'W12028070', 'TXDALSTD', 'Texas Colon and Rectal Specialists', 'Ronney', '', 'Stadler', 'MD', 'Colon and Rectal Surgery', '', '', NULL, 'O', '4320 Windsor Centre Trail Ste 200', 'Flower Mound', 'Denton', 'TX', '75028', '9727592040', '9727592045', '4320 Windsor Centre Trail Ste 200', 'Flower Mound', 'Denton', 'TX', '75028', '9727592040', '9727592045', 'TXCOLONREC', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Irving', NULL, NULL, NULL, 'HCFA|UB|', '1356372098', 0, 'N', 0, '2013-07-29', NULL, NULL, 33.0393, -97.0632, NULL, NULL),
('752285901', 'EDBQA0040', 'EDBQA0040', 'TXDALSTD', 'Texas Center for Orthopedics and Spine Disorders', 'Mark', 'P', 'Kuper', 'DO', 'Orthopedic Surgery', '', '', NULL, 'O', '7257 Hawkins View Dr', 'Fort Worth', 'Tarrant', 'TX', '76132', '8177359397', NULL, '7257 Hawkins View Dr', 'Fort Worth', 'Tarrant', 'TX', '76132', '8177359397', '', 'BQA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Carrollton', NULL, NULL, NULL, 'HCFA|UB|', '1013069780', 0, 'N', 0, '2013-03-07', NULL, NULL, 32.664, -97.4194, NULL, NULL),
('756064033', 'EDBQA0025', 'EDBQA0025', 'TXDALSTD', 'University of North Texas Health Science', 'Arnold', 'A', 'Fikkert', 'DO', 'General Surgery', '', '', NULL, 'O', '855 Montgomery St', 'Fort Worth', 'Tarrant', 'TX', '76107', '8177350525', NULL, '855 Montgomery St', 'Fort Worth', 'Tarrant', 'TX', '76107', '8177350525', '          ', 'BQA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor University Medical Center', 'Baylor Medical Center at Garland', '', '', 'HCFA|UB|', '1023050754', 0, 'N', 0, '2013-07-26', NULL, NULL, 32.7512, -97.3699, NULL, NULL),
('444483362', 'EDBQA0069', 'EDBQA0069', 'TXDALSTD', 'Fort Worth Lap Band', 'Adam', 'B', 'Smith', 'DO', 'General Surgery', '', '', NULL, 'O', '2501 Parkview Dr Ste 560', 'Fort Worth', 'Tarrant', 'TX', '76102', '8178501100', NULL, '2501 Parkview Dr Ste 560', 'Fort Worth', 'Tarrant', 'TX', '76102', '8178501100', '', 'BQA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', '2013-05-03', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1033109608', 0, 'N', 0, '2014-04-02', NULL, NULL, 32.7395, -97.3549, NULL, NULL),
('752535339', 'EDBQA0011', 'EDBQA0011', 'TXDALSTD', 'Christine Brown MD', 'Christine', 'D', 'Brown', 'MD', 'Dermatology', '', '', NULL, 'O', '3801 Gaston Ave Ste 302', 'Dallas', 'Dallas', 'TX', '75246', '2148280016', NULL, '3801 Gaston Ave Ste 302', 'Dallas', 'Dallas', 'TX', '75246', '2148280016', '          ', 'BQA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1063460715', 0, 'N', 0, '2013-05-28', NULL, NULL, 32.7919, -96.7792, NULL, NULL),
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('752543139', 'EDBQA0080', 'EDBQA0080', 'TXDALSTD', 'Deborah M Westergaard MD', 'Deborah', 'M', 'Westergaard', 'MD', 'Anesthesiology', '', '', NULL, 'O', '9301 N Central Expwy Ste 115', 'Dallas', 'Dallas', 'TX', '75231', '2147506200', NULL, '9301 N Central Expwy Ste 115', 'Dallas', 'Dallas', 'TX', '75231', '2147506200', '          ', 'BQA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1083667554', 0, 'Y', 0, '2013-07-23', NULL, NULL, 32.8748, -96.7706, NULL, NULL),
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('752694558', 'EDBQA0083', 'EDBQA0083', 'TXDALSTD', 'Advanced Heart Care PA', 'Venkata', 'R', 'Aligeti', 'MD', 'Cardiology', '', '', NULL, 'B', '8150 N Central Expwy Ste M1001', 'Dallas', 'Dallas', 'TX', '75206', '4693262636', NULL, '8150 N Central Expwy Ste M1001', 'Dallas', 'Dallas', 'TX', '75206', '4693262636', '          ', 'BQA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', '2013-08-14', 0, 0, 0, 'The Heart Hospital Baylor Plano', NULL, '', '', 'HCFA|UB|', '1093731267', 0, 'Y', 0, '2013-11-11', NULL, NULL, 0, 0, NULL, NULL),
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('455012558', 'EDBQA0095', 'EDBQA0095', 'TXDALSTD', 'Repromed Fertility Center', 'Anil', '', 'Pinto', 'MD', 'Reproductive Endocrinology', '', '', NULL, 'B', '935 W Ralph Hall Pkwy', 'Rockwall', 'Rockwall', 'TX', '75032', '2148278777', NULL, '935 W Ralph Hall Pkwy', 'Rockwall', 'Rockwall', 'TX', '75032', '2148278777', '', 'BQA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Waxahachie', 'Baylor Specialty Hospital', NULL, NULL, 'HCFA|UB|', '1104875673', 0, 'Y', 0, '2013-04-16', NULL, NULL, 0, 0, NULL, NULL),
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('751993843', 'EDBQA0063', 'EDBQA0063', 'TXDALSTD', 'Flower Mound Podiatry', 'Jerome', 'C', 'Schoffler', 'DPM', 'Podiatry', '', '', NULL, 'O', '3208 Long Prairie Rd Ste B', 'Flower Mound', 'Denton', 'TX', '75022', '9725398488', NULL, '3208 Long Prairie Rd Ste B', 'Flower Mound', 'Denton', 'TX', '75022', '9725398488', '', 'BQA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Carrollton', 'Baylor Surgical Hospital at Fort Worth', NULL, NULL, 'HCFA|UB|', '1154315448', 0, 'N', 0, '2013-03-08', NULL, NULL, 33.0294, -97.0707, NULL, NULL),
('752269378', 'EDBQA0079', 'EDBQA0079', 'TXDALSTD', 'Wallace, Charles', 'Charles', 'A', 'Wallace', 'MD', 'Plastic Surgery', '', '', NULL, 'O', '17110 N Dallas Pkwy Ste 100', 'Dallas', 'Dallas', 'TX', '75248', '9723807090', NULL, '17110 N Dallas Pkwy Ste 100', 'Dallas', 'Dallas', 'TX', '75248', '9723807090', '          ', 'BQA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Trophy Club', NULL, '', '', 'HCFA|UB|', '1164422481', 0, 'N', 0, '2013-04-17', NULL, NULL, 32.9813, -96.8285, NULL, NULL),
('421619524', 'EDBQA0038', 'EDBQA0038', 'TXDALSTD', 'Jett, G Kimbel', 'G', 'Kimbel', 'Jett', 'MD', 'Vascular Surgery', '', '', NULL, 'O', '5575 Warren Pkwy Ste 306', 'Frisco', 'Denton', 'TX', '75034', '9727317506', NULL, '5575 Warren Pkwy Ste 306', 'Frisco', 'Denton', 'TX', '75034', '9727317506', '          ', 'BQA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', '2013-08-14', 0, 0, 0, 'Baylor Medical Center at Frisco', NULL, NULL, NULL, 'HCFA|UB|', '1184690810', 0, 'N', 0, '2013-11-11', NULL, NULL, 33.1053, -96.839, NULL, NULL);
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('752694558', 'EDBQA0021', 'EDBQA0021', 'TXDALSTD', 'Advanced Heart Care PA', 'David', 'N', 'Edwards', 'MD', 'Cardiovascular Disease', 'Internal Medicine', '', NULL, 'O', '4708 Alliance Blvd Ste 650', 'Plano', 'Collin', 'TX', '75093', '4693262636', NULL, '4708 Alliance Blvd Ste 650', 'Plano', 'Collin', 'TX', '75093', '4693262636', '          ', 'BQA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', '2013-11-21', 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, NULL, NULL, 'HCFA|UB|', '1215089214', 0, 'N', 0, '2013-11-11', NULL, NULL, 33.0138, -96.7917, NULL, NULL),
('752694558', 'EDBQA0087', 'EDBQA0087', 'TXDALSTD', 'Advanced Heart Care PA', 'David', 'N', 'Edwards', 'MD', 'Cardiovascular Disease', 'Internal Medicine', '', NULL, 'B', '8150 N Central Expwy Ste M1001', 'Dallas', 'Dallas', 'TX', '75206', '4693262636', NULL, '8150 N Central Expwy Ste M1001', 'Dallas', 'Dallas', 'TX', '75206', '4693262636', '          ', 'BQA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', '2013-11-21', 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, NULL, NULL, 'HCFA|UB|', '1215089214', 0, 'Y', 0, '2013-11-11', NULL, NULL, 0, 0, NULL, NULL),
('752825783', 'EDBQA0068', 'EDBQA0068', 'TXDALSTD', 'Metroplex Foot and Ankle ', 'Scott', 'E', 'Smith', 'DPM', 'Podiatry', '', '', NULL, 'O', '3201 E President George Bush Hwy Ste 106', 'Richardson', 'Dallas', 'TX', '75082', '2142173668', NULL, '3201 E President George Bush Hwy Ste 106', 'Richardson', 'Dallas', 'TX', '75082', '2142173668', '          ', 'BQA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', '2013-08-14', 0, 0, 0, 'Baylor Medical Center at Garland', 'Baylor University Medical Center', NULL, NULL, 'HCFA|UB|', '1215161286', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.9907, -96.666, NULL, NULL),
('752145396', 'EDBQA0078', 'EDBQA0078', 'TXDALSTD', 'Manik, Vora', 'Manik', 'U', 'Vora', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '4333 N Josey Ln Ste 301', 'Carrollton', 'Denton', 'TX', '75010', '9724926300', NULL, '4333 N Josey Ln Ste 301', 'Carrollton', 'Denton', 'TX', '75010', '9724926300', '          ', 'BQA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Carrollton', NULL, NULL, NULL, 'HCFA|UB|', '1225090152', 0, 'N', 0, '2013-04-17', NULL, NULL, 33.0278, -96.8847, NULL, NULL),
('752694558', 'EDBQA0064', 'EDBQA0064', 'TXDALSTD', 'Advanced Heart Care PA', 'Brian', 'G', 'Schwartz', 'MD', 'Cardiology', '', '', NULL, 'O', '4708 Alliance Blvd Ste 650', 'Plano', 'Collin', 'TX', '75093', '4693262636', NULL, '4708 Alliance Blvd Ste 650', 'Plano', 'Collin', 'TX', '75093', '4693262636', '          ', 'BQA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', '2013-11-21', 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, NULL, NULL, 'HCFA|UB|', '1225246366', 0, 'N', 0, '2013-11-11', NULL, NULL, 33.0138, -96.7917, NULL, NULL),
('752694558', 'EDBQA0096', 'EDBQA0096', 'TXDALSTD', 'Advanced Heart Care PA', 'Brian', 'G', 'Schwartz', 'MD', 'Cardiology', '', '', NULL, 'B', '8150 N Central Expwy Ste M1001', 'Dallas', 'Dallas', 'TX', '75206', '4693262636', NULL, '8150 N Central Expwy Ste M1001', 'Dallas', 'Dallas', 'TX', '75206', '4693262636', '          ', 'BQA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', '2013-11-21', 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, NULL, NULL, 'HCFA|UB|', '1225246366', 0, 'Y', 0, '2013-11-11', NULL, NULL, 0, 0, NULL, NULL),
('752905340', 'EDBQA0049', 'EDBQA0049', 'TXDALSTD', 'Arlington Center for Dermatology', 'Angela', 'Y', 'Moore', 'MD', 'Dermatology', '', '', NULL, 'O', '711 E Lamar Blvd Ste 200', 'Arlington', 'Tarrant', 'TX', '76011', '8177957546', NULL, '711 E Lamar Blvd Ste 200', 'Arlington', 'Tarrant', 'TX', '76011', '8177957546', '', 'BQA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, '', '', 'HCFA|UB|', '1235142266', 0, 'N', 0, '2013-03-08', NULL, NULL, 32.7647, -97.1011, NULL, NULL),
('752145050', 'EDBQA0022', 'EDBQA0022', 'TXDALSTD', 'Eisenberg, David ', 'David', 'H', 'Eisenberg', 'DPM', 'Podiatry', '', '', NULL, 'O', '2572 Tarpley Rd Ste 100', 'Carrollton', 'Dallas', 'TX', '75006', '9724180788', NULL, '2572 Tarpley Rd Ste 100', 'Carrollton', 'Dallas', 'TX', '75006', '9724180788', '          ', 'BQA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Carrollton', NULL, NULL, NULL, 'HCFA|UB|', '1245394519', 0, 'N', 0, '2013-04-17', NULL, NULL, 32.9857, -96.8516, NULL, NULL),
('364702412', 'EDBQA0051', 'EDBQA0051', 'TXDALSTD', 'Meyers, Robert', 'Robert', 'Ian', 'Myers', 'MD', 'Internal Medicine', '', '', NULL, 'O', '3600 Gaston Ave Ste 508', 'Dallas', 'Dallas', 'TX', '75246', '2148244585', NULL, '3600 Gaston Ave Ste 508', 'Dallas', 'Dallas', 'TX', '75246', '2148244585', '          ', 'BQA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', '2013-08-14', 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1295833721', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.791, -96.7798, NULL, NULL),
('205641115', 'EDBQA0041', 'EDBQA0041', 'TXDALSTD', 'Ramarao Lankipalli MD', 'Ramarao', 'S', 'Lankipalli', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '3900 W 15th St Ste 503', 'Plano', 'Collin', 'TX', '75075', '9725965522', NULL, '3900 W 15th St Ste 503', 'Plano', 'Collin', 'TX', '75075', '9725965522', '          ', 'BQA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', '2013-08-14', 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, NULL, NULL, 'HCFA|UB|', '1336121193', 0, 'N', 0, '2013-11-11', NULL, NULL, 33.0192, -96.7653, NULL, NULL),
('202285582', 'EDBQA0067', 'EDBQA0067', 'TXDALSTD', 'Small, Greg', 'Gregg', 'L', 'Small', 'MD', 'Gynecology', '', '', NULL, 'O', '9301 N Central Expwy Ste 590', 'Dallas', 'Dallas', 'TX', '75231', '2142656001', NULL, '9301 N Central Expwy Ste 590', 'Dallas', 'Dallas', 'TX', '75231', '2142656001', '          ', 'BQA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1356384358', 0, 'N', 0, '2013-04-17', NULL, NULL, 32.8748, -96.7706, NULL, NULL),
('751731746', 'EDBQA0044', 'EDBQA0044', 'TXDALSTD', 'Major, William', 'William', 'C', 'Major', 'MD', 'General Surgery', '', '', NULL, 'O', '1626 W Hwy 287 Ste 101', 'Waxahachie', 'Ellis', 'TX', '75165', '9729376902', NULL, '1626 W Hwy 287 Ste 101', 'Waxahachie', 'Ellis', 'TX', '75165', '9729376902', '          ', 'BQA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', 'Baylor Medical Center at Waxahachie', NULL, NULL, 'HCFA|UB|', '1356394118', 0, 'N', 0, '2013-05-01', NULL, NULL, 32.4034, -96.825, NULL, NULL),
('752672533', 'EDBQA0008', 'EDBQA0008', 'TXDALSTD', 'Glen A Beede DPM', 'Glen', 'A', 'Beede', 'DPM', 'Podiatry', '', '', NULL, 'O', '5521 Bellaire Dr S Ste 116', 'Fort Worth', 'Tarrant', 'TX', '76109', '8177639383', NULL, '5521 Bellaire Dr S Ste 116', 'Fort Worth', 'Tarrant', 'TX', '76109', '8177639383', '', 'BQA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', NULL, '', '', 'HCFA|UB|', '1407033400', 0, 'N', 0, '2013-03-08', NULL, NULL, 32.6945, -97.4122, NULL, NULL),
('205308618', 'EDBQA0032', 'EDBQA0032', 'TXDALSTD', 'Southern Endocrinology and Diabetes Associates', 'Sreedevi', '', 'Guttikonda', 'MD', 'Endocrinology', '', '', NULL, 'O', '1621 N Belt Line Rd Ste A', 'Mesquite', 'Dallas', 'TX', '75149', '9726825700', NULL, '1621 N Belt Line Rd Ste A', 'Mesquite', 'Dallas', 'TX', '75149', '9726825700', '', 'BQA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1407050073', 0, 'N', 0, '2013-03-12', NULL, NULL, 32.7863, -96.5959, NULL, NULL),
('010557074', 'EDBQA0046', 'EDBQA0046', 'TXDALSTD', 'Medical Centre Pain Mgmt', 'Alfredo', 'L', 'Marti', 'MD', 'Anesthesiology', '', '', NULL, 'O', '1001 12th Ave Ste 170', 'Fort Worth', 'Tarrant', 'TX', '76109', '8178100500', '8178100502', '1001 12th Ave Ste 170', 'Fort Worth', 'Tarrant', 'TX', '76109', '8178100500', '8178100502', 'BQA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Surgical Hospital at Fort Worth', NULL, NULL, NULL, 'HCFA|UB|', '1407806326', 0, 'Y', 0, '2013-03-12', NULL, NULL, 32.7342, -97.3475, NULL, NULL),
('203721744', 'EDBQA0037', 'EDBQA0037', 'TXDALSTD', 'Trostel OB-GYN', 'Kristen', 'N', 'Innes', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '3880 Parkwood Blvd Ste 403', 'Frisco', 'Denton', 'TX', '75034', '2146182802', NULL, '3880 Parkwood Blvd Ste 403', 'Frisco', 'Denton', 'TX', '75034', '2146182802', '          ', 'BQA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', '2013-08-14', 0, 0, 0, 'Baylor Medical Center at Frisco', NULL, NULL, NULL, 'HCFA|UB|', '1457327884', 0, 'N', 0, '2013-11-11', NULL, NULL, 33.1106, -96.8149, NULL, NULL),
('752694558', 'EDBQA0082', 'EDBQA0082', 'TXDALSTD', 'Advanced Heart Care PA', 'Donald', 'D', 'Wurzburg', 'MD', 'Cardiology', '', '', NULL, 'O', '4708 Alliance Blvd Ste 650', 'Plano', 'Collin', 'TX', '75093', '4693262636', NULL, '4708 Alliance Blvd Ste 650', 'Plano', 'Collin', 'TX', '75093', '4693262636', '          ', 'BQA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, NULL, NULL, 'HCFA|UB|', '1457397598', 0, 'N', 0, '2013-07-17', NULL, NULL, 33.0145, -96.7925, NULL, NULL),
('752694558', 'EDBQA0100', 'EDBQA0100', 'TXDALSTD', 'Advanced Heart Care PA', 'Donald', 'D', 'Wurzburg', 'MD', 'Cardiology', '', '', NULL, 'B', '8150 N Central Expwy Ste M1001', 'Dallas', 'Dallas', 'TX', '75206', '4693262636', NULL, '8150 N Central Expwy Ste M1001', 'Dallas', 'Dallas', 'TX', '75206', '4693262636', '          ', 'BQA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, NULL, NULL, 'HCFA|UB|', '1457397598', 0, 'Y', 0, '2013-07-17', NULL, NULL, 0, 0, NULL, NULL),
('208661762', 'EDBQA0015', 'EDBQA0015', 'TXDALSTD', 'Park Lane Allergy and Asthma Center', 'Steven', 'L', 'Cole', 'DO', 'Allergy and Immunology', '', '', NULL, 'O', '9101 N Central Expwy Ste 430', 'Dallas', 'Dallas', 'TX', '75231', '2143638889', NULL, '9101 N Central Expwy Ste 430', 'Dallas', 'Dallas', 'TX', '75231', '2143638889', '', 'BQA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1457480055', 0, 'N', 0, '2013-03-08', NULL, NULL, 32.873, -96.7706, NULL, NULL),
('752878179', 'EDBQA0014', 'EDBQA0014', 'TXDALSTD', 'Colon and Rectal Specialist of Dallas', 'Robert', 'R', 'Cloud', 'MD', 'Colon and Rectal Surgery', '', '', NULL, 'O', '1005 W Ralph Hall Pkwy Ste 241', 'Rockwall', 'Rockwall', 'TX', '75032', '9727884442', NULL, '1005 W Ralph Hall Pkwy Ste 241', 'Rockwall', 'Rockwall', 'TX', '75032', '9727884442', '', 'BQA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', '2013-08-14', 0, 0, 0, 'Baylor University Medical Center', NULL, '', '', 'HCFA|UB|', '1467440073', 0, 'N', 0, '2014-04-25', NULL, NULL, 32.8867, -96.4699, NULL, NULL),
('453796432', 'EDBQA0053', 'EDBQA0053', 'TXDALSTD', 'Kidney and Hypertension Associates of Dallas', 'Hoang Lan', '', 'Nguyen', 'DO', 'Nephrology', '', '', NULL, 'O', '3900 Junius St Ste 615', 'Dallas', 'Dallas', 'TX', '75246', '9723885970', NULL, '3900 Junius St Ste 615', 'Dallas', 'Dallas', 'TX', '75246', '9723885970', '          ', 'BQA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', '2013-08-14', 0, 0, 0, 'Baylor University Medical Center', '', '', '', 'HCFA|UB|', '1467611582', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.7913, -96.7775, NULL, NULL),
('453796432', 'EDBQA0094', 'EDBQA0094', 'TXDALSTD', 'Kidney and Hypertension Associates of Dallas', 'Hoang Lan', '', 'Nguyen', 'DO', 'Nephrology', '', '', NULL, 'B', 'PO Box 7824 ', 'Belfast', 'Waldo', 'ME', '04915', '9723885970', NULL, 'PO Box 7824 ', 'Belfast', 'Waldo', 'ME', '04915', '9723885970', '          ', 'BQA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', '2013-08-14', 0, 0, 0, 'Baylor University Medical Center', '', '', '', 'HCFA|UB|', '1467611582', 0, 'Y', 0, '2013-11-11', NULL, NULL, 0, 0, NULL, NULL),
('752624323', 'EDBQA0074', 'EDBQA0074', 'TXDALSTD', 'Tran, Anthony ', 'Anthony', 'T', 'Tran', 'MD', 'Plastic Surgery', '', '', NULL, 'O', '3300 Matlock Rd', 'Arlington', 'Tarrant', 'TX', '76015', '8174675081', NULL, '3300 Matlock Rd', 'Arlington', 'Tarrant', 'TX', '76015', '8174675081', '          ', 'BQA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1477503316', 0, 'N', 0, '2013-04-17', NULL, NULL, 32.6927, -97.115, NULL, NULL),
('330607210', 'EDBQA0024', 'EDBQA0024', 'TXDALSTD', 'Fort Worth Lap Band', 'Craig', 'A', 'Ferrara', 'DO', 'Vascular Surgery', '', '', NULL, 'O', '2501 Parkview Dr Ste 560', 'Fort Worth', 'Tarrant', 'TX', '76102', '8178501100', NULL, '2501 Parkview Dr Ste 560', 'Fort Worth', 'Tarrant', 'TX', '76102', '8178501100', '', 'BQA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', '', '', '', 'HCFA|UB|', '1477552073', 0, 'N', 0, '2013-06-04', NULL, NULL, 32.7405, -97.3528, NULL, NULL),
('752830419', 'EDBQA0081', 'EDBQA0081', 'TXDALSTD', 'Wood, Kathryn', 'Kathryn', 'J', 'Wood', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '5575 Warren Pkwy Ste 208', 'Frisco', 'Denton', 'TX', '75034', '9727699663', NULL, '5575 Warren Pkwy Ste 208', 'Frisco', 'Denton', 'TX', '75034', '9727699663', '          ', 'BQA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Frisco', NULL, NULL, NULL, 'HCFA|UB|', '1487640744', 0, 'N', 0, '2013-04-17', NULL, NULL, 33.1067, -96.8401, NULL, NULL),
('205308618', 'EDBQA0027', 'EDBQA0027', 'TXDALSTD', 'Southern Endocrinology and Diabetes Associates', 'Sumana', '', 'Gangi', 'MD', 'Endocrinology', '', '', NULL, 'O', '1621 N Belt Line Rd Ste A', 'Mesquite', 'Dallas', 'TX', '75149', '9726825700', NULL, '1621 N Belt Line Rd Ste A', 'Mesquite', 'Dallas', 'TX', '75149', '9726825700', '          ', 'BQA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', '2013-08-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1487679213', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.7851, -96.5959, NULL, NULL),
('352415950', 'EDBQA0010', 'EDBQA0010', 'TXDALSTD', 'Bryan D Brewer MD', 'Bryan', 'D', 'Brewer', 'MD', 'General Surgery', '', '', NULL, 'O', '4300 Windsor Centre Trail Ste 400', 'Flower Mound', 'Denton', 'TX', '75028', '9722196800', '9722190053', '4300 Windsor Centre Trail Ste 400', 'Flower Mound', 'Denton', 'TX', '75028', '9722196800', '9722190053', 'BQA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', '2013-08-14', 0, 0, 0, 'Baylor Medical Center at Carrollton', NULL, '', '', 'HCFA|UB|', '1487865457', 0, 'N', 0, '2013-11-11', NULL, NULL, 0, 0, NULL, NULL),
('751942562', 'EDBQA0060', 'EDBQA0060', 'TXDALSTD', 'Surgical Associates of the Mid-Cities', 'James', 'D', 'Poettcker', 'MD', 'General Surgery', '', '', NULL, 'O', '1604 Hospital Pkwy Ste 505', 'Bedford', 'Tarrant', 'TX', '76022', '8172672678', NULL, '1604 Hospital Pkwy Ste 505', 'Bedford', 'Tarrant', 'TX', '76022', '8172672678', '', 'BQA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Grapevine', NULL, NULL, NULL, 'HCFA|UB|', '1831142868', 0, 'N', 0, '2013-03-11', NULL, NULL, 32.8336, -97.1252, NULL, NULL),
('752280307', 'EDBQA0034', 'EDBQA0034', 'TXDALSTD', 'Baylor Center for Pain Mgmt', 'Robert', '', 'Haynsworth', 'MD', 'Anesthesiology', '', '', NULL, 'O', '530 Clara Barton Blvd Ste 400', 'Garland', 'Dallas', 'TX', '75042', '9722311591', NULL, '530 Clara Barton Blvd Ste 400', 'Garland', 'Dallas', 'TX', '75042', '9722311591', '          ', 'BQA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', '2013-08-14', 0, 0, 0, 'Baylor Medical Center at Garland', NULL, NULL, NULL, 'HCFA|UB|', '1528046414', 0, 'Y', 0, '2013-07-26', NULL, NULL, 0, 0, NULL, NULL),
('271112439', 'EDBQA0073', 'EDBQA0073', 'TXDALSTD', 'East Dallas Neurological Service', 'Amir', 'M', 'Torabi', 'MD', 'Neurology', '', '', NULL, 'O', '2540 N Galloway Ave Ste 101', 'Mesquite', 'Navarro', 'TX', '75105', '9722260405', NULL, '2540 N Galloway Ave Ste 101', 'Mesquite', 'Navarro', 'TX', '75105', '9722260405', '', 'BQA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, '', '', 'HCFA|UB|', '1548223324', 0, 'N', 0, '2013-03-08', NULL, NULL, 32.8001, -96.6112, NULL, NULL),
('752846193', 'EDBQA0009', 'EDBQA0009', 'TXDALSTD', 'Sports Medicine Clinic of North Texas', 'Shawn', 'C', 'Bonsell', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1015 N Carroll Ste 2000', 'Dallas', 'Dallas', 'TX', '75204', '2148247744', NULL, '1015 N Carroll Ste 2000', 'Dallas', 'Dallas', 'TX', '75204', '2148247744', '          ', 'BQA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', '2013-08-14', 0, 0, 0, 'Baylor All Saints Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1558373423', 0, 'N', 0, '2013-11-11', NULL, NULL, 0, 0, NULL, NULL),
('752694558', 'EDBQA0036', 'EDBQA0036', 'TXDALSTD', 'Advanced Heart Care PA', 'Trieu', 'Q', 'Ho', 'MD', 'Internal Medicine', '', '', NULL, 'O', '4708 Alliance Blvd Ste 650', 'Plano', 'Collin', 'TX', '75093', '4693262636', NULL, '4708 Alliance Blvd Ste 650', 'Plano', 'Collin', 'TX', '75093', '4693262636', '          ', 'BQA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'The Heart Hospital Baylor Plano', NULL, '', '', 'HCFA|UB|', '1568634681', 0, 'N', 0, '2013-07-17', NULL, NULL, 33.0145, -96.7925, NULL, NULL),
('752694558', 'EDBQA0092', 'EDBQA0092', 'TXDALSTD', 'Advanced Heart Care PA', 'Trieu', 'Q', 'Ho', 'MD', 'Internal Medicine', '', '', NULL, 'B', '8150 N Central Expwy Ste M1001', 'Dallas', 'Dallas', 'TX', '75206', '4693262636', NULL, '8150 N Central Expwy Ste M1001', 'Dallas', 'Dallas', 'TX', '75206', '4693262636', '          ', 'BQA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'The Heart Hospital Baylor Plano', NULL, '', '', 'HCFA|UB|', '1568634681', 0, 'Y', 0, '2013-07-17', NULL, NULL, 0, 0, NULL, NULL),
('751826334', 'EDBQA0004', 'EDBQA0004', 'TXDALSTD', 'Garland Neurologic Clinic', 'Mahmood', 'S', 'Akhavi', 'MD', 'Neurology', '', '', NULL, 'O', '315 N Shiloh Rd Ste 103', 'Garland', 'Dallas', 'TX', '75042', '9724941100', NULL, '315 N Shiloh Rd Ste 103', 'Garland', 'Dallas', 'TX', '75042', '9724941100', '', 'BQA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', NULL, NULL, NULL, 'HCFA|UB|', '1598759276', 0, 'N', 0, '2013-03-11', NULL, NULL, 32.9146, -96.6654, NULL, NULL),
('710882833', 'EDBQA0033', 'EDBQA0033', 'TXDALSTD', 'Hargrave Eye Center', 'Sylvia', 'L', 'Hargrave', 'MD', 'Ophthalmology', '', '', NULL, 'O', '1411 N Beckley Ave Ste 460 Pavilion III', 'Dallas', 'Dallas', 'TX', '75203', '9725726262', NULL, '1411 N Beckley Ave Ste 460 Pavilion III', 'Dallas', 'Dallas', 'TX', '75203', '9725726262', '          ', 'BQA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1609841501', 0, 'N', 0, '2013-05-28', NULL, NULL, 32.761, -96.823, NULL, NULL),
('752633311', 'EDBQA0054', 'EDBQA0054', 'TXDALSTD', 'Alliance Foot and Ankle Specialists', 'Richard', 'A', 'Nichols', 'DPM', 'Podiatry', '', '', NULL, 'O', '1600 Lancaster Dr Ste 102', 'Grapevine', 'Tarrant', 'TX', '76051', '8174814000', '8014210732', '1600 Lancaster Dr Ste 102', 'Grapevine', 'Tarrant', 'TX', '76051', '8174814000', '8014210732', 'BQA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Grapevine', NULL, NULL, NULL, 'HCFA|UB|', '1619082294', 0, 'N', 0, '2013-03-12', NULL, NULL, 32.9356, -97.0914, NULL, NULL),
('752061371', 'EDBQA0065', 'EDBQA0065', 'TXDALSTD', 'Cardiology Consultants of North Dallas', 'Dhiren', 'L', 'Shah', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '700 Walter Reed Blvd Ste 205', 'Garland', 'Dallas', 'TX', '75042', '9724871117', NULL, '700 Walter Reed Blvd Ste 205', 'Garland', 'Dallas', 'TX', '75042', '9724871117', '', 'BQA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', '2013-08-14', 0, 0, 0, 'Baylor Medical Center at Garland', '', '', '', 'HCFA|UB|', '1629054358', 0, 'N', 0, '2014-05-07', NULL, NULL, 32.9192, -96.6635, NULL, NULL),
('752788839', 'ELUC00032', 'ELUC00032', 'TXDALSTD', 'Urology Clinics of North Texas', 'Wilson', 'L', 'Hernandez', 'MD', 'Urology', '', '', NULL, 'O', '9900 Central Expwy Ste 120', 'Dallas', 'Dallas', 'TX', '75231', '2146919377', '2145802270', '9900 Central Expwy Ste 120', 'Dallas', 'Dallas', 'TX', '75231', '2146919377', '2145802270', 'DALLAS4', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, '', '', 'HCFA|UB|', '1023007739', 0, 'N', 0, '2013-06-05', NULL, NULL, 32.8827, -96.7697, NULL, NULL),
('752825783', 'EDBQA0001', 'EDBQA0001', 'TXDALSTD', 'Metroplex Foot and Ankle ', 'Robert', 'T', 'Angelier', 'DPM', 'Podiatry', '', '', NULL, 'O', '3201 E President George Bush Hwy Ste 106', 'Richardson', 'Dallas', 'TX', '75082', '2142173668', NULL, '3201 E President George Bush Hwy Ste 106', 'Richardson', 'Dallas', 'TX', '75082', '2142173668', '          ', 'BQA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', '2013-08-14', 0, 0, 0, 'Baylor Medical Center at Garland', 'Baylor University Medical Center', NULL, NULL, 'HCFA|UB|', '1720017205', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.9907, -96.666, NULL, NULL),
('752660876', 'EDBQA0075', 'EDBQA0075', 'TXDALSTD', 'Trostel OB-GYN', 'Steven', 'G', 'Trostel', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '3880 Parkwood Blvd Ste 403', 'Frisco', 'Denton', 'TX', '75034', '2146182802', NULL, '3880 Parkwood Blvd Ste 403', 'Frisco', 'Denton', 'TX', '75034', '2146182802', '          ', 'BQA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', '2013-08-14', 0, 0, 0, 'Baylor Medical Center at Frisco', NULL, NULL, NULL, 'HCFA|UB|', '1689667735', 0, 'N', 0, '2013-11-11', NULL, NULL, 33.1106, -96.8149, NULL, NULL),
('721564187', 'EDBQA0043', 'EDBQA0043', 'TXDALSTD', 'Walter X Loyola MD', 'Walter', 'X', 'Loyola', 'MD', 'Neurosurgery', '', '', NULL, 'O', '3060 Communications Pkwy Ste 100', 'Plano', 'Collin', 'TX', '75093', '9723120607', '9723120805', '3060 Communications Pkwy Ste 100', 'Plano', 'Collin', 'TX', '75093', '9723120607', '9723120805', 'BQA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', '', '', '', 'HCFA|UB|', '1689676520', 0, 'N', 0, '2014-06-17', NULL, NULL, 33.0424, -96.833, NULL, NULL),
('751639037', 'EDBQA0050', 'EDBQA0050', 'TXDALSTD', 'Chandramohan Mudaliar MD', 'Chandramohan', '', 'Mudaliar', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1220 5th Ave', 'Fort Worth', 'Tarrant', 'TX', '76104', '8173323002', NULL, '1220 5th Ave', 'Fort Worth', 'Tarrant', 'TX', '76104', '8173323002', '          ', 'BQA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', '2013-01-01', 0, 0, 0, 'Baylor All Saints Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1699749077', 0, 'N', 0, '2013-09-13', NULL, NULL, 32.7311, -97.3388, NULL, NULL),
('752694558', 'EDBQA0016', 'EDBQA0016', 'TXDALSTD', 'Advanced Heart Care PA', 'Manuel', 'W', 'Cruz', 'MD', 'Cardiology', '', '', NULL, 'O', '4708 Alliance Blvd Ste 650', 'Plano', 'Collin', 'TX', '75093', '4693262636', NULL, '4708 Alliance Blvd Ste 650', 'Plano', 'Collin', 'TX', '75093', '4693262636', '          ', 'BQA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, NULL, NULL, 'HCFA|UB|', '1700833902', 0, 'N', 0, '2013-07-17', NULL, NULL, 33.0145, -96.7925, NULL, NULL),
('752694558', 'EDBQA0084', 'EDBQA0084', 'TXDALSTD', 'Advanced Heart Care PA', 'Manuel', 'W', 'Cruz', 'MD', 'Cardiology', '', '', NULL, 'B', '8150 N Central Expwy Ste M1001', 'Dallas', 'Dallas', 'TX', '75206', '4693262636', NULL, '8150 N Central Expwy Ste M1001', 'Dallas', 'Dallas', 'TX', '75206', '4693262636', '          ', 'BQA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, NULL, NULL, 'HCFA|UB|', '1700833902', 0, 'Y', 0, '2013-07-17', NULL, NULL, 0, 0, NULL, NULL),
('197328116', 'EDBQA0028', 'EDBQA0028', 'TXDALSTD', 'Northpoint Cancer Center', 'Edward', 'H', 'Gilbert', 'MD', 'Radiation Oncology', '', '', NULL, 'O', '12606 Greenville Ave Ste 160', 'Dallas', 'Dallas', 'TX', '75243', '4693647880', NULL, '12606 Greenville Ave Ste 160', 'Dallas', 'Dallas', 'TX', '75243', '4693647880', '', 'BQA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', '2013-12-04', 0, 0, 0, '', 'Baylor Medical Center at Garland', '', '', 'HCFA|UB|', '1700849163', 0, 'N', 0, '2014-04-16', NULL, NULL, 32.9184, -96.7416, NULL, NULL),
('197328116', 'EDBQA0089', 'EDBQA0089', 'TXDALSTD', 'Northpoint Cancer Center', 'Edward', 'H', 'Gilbert', 'MD', 'Radiation Oncology', '', '', NULL, 'B', 'PO Box 126706 Section 91', 'Oklahoma City', 'Oklahoma', 'OK', '73126', '4693647880', NULL, 'PO Box 126706 Section 91', 'Oklahoma City', 'Oklahoma', 'OK', '73126', '4693647880', '', 'BQA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', '2013-12-04', 0, 0, 0, '', 'Baylor Medical Center at Garland', '', '', 'HCFA|UB|', '1700849163', 0, 'Y', 0, '2014-04-16', NULL, NULL, 0, 0, NULL, NULL),
('751766889', 'EDBQA0030', 'EDBQA0030', 'TXDALSTD', 'Baylor Medical Plaza', 'James', 'H', 'Gray', 'MD', 'Ophthalmology', '', '', NULL, 'O', '3600 Gaston Ave Ste 760', 'Dallas', 'Dallas', 'TX', '75246', '2148266110', '2148289127', '3600 Gaston Ave Ste 760', 'Dallas', 'Dallas', 'TX', '75246', '2148266110', '2148289127', 'BQA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', '2013-08-14', 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1720193329', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.791, -96.7798, NULL, NULL),
('752656838', 'EDBQA0039', 'EDBQA0039', 'TXDALSTD', 'Kunkel, Kelly', 'Kelly', 'R', 'Kunkel', 'MD', 'Plastic Surgery', '', '', NULL, 'O', '1830 8th Ave', 'Fort Worth', 'Tarrant', 'TX', '76110', '8173355200', NULL, '1830 8th Ave', 'Fort Worth', 'Tarrant', 'TX', '76110', '8173355200', '', 'BQA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', '2013-09-14', 0, 0, 0, 'Baylor All Saints Medical Center', NULL, '', '', 'HCFA|UB|', '1730144502', 0, 'N', 0, '2014-03-28', NULL, NULL, 32.7243, -97.3441, NULL, NULL),
('743112782', 'EDBQA0070', 'EDBQA0070', 'TXDALSTD', 'Pediatric and Adolescent Healthcare Associates of Waxahachie', 'Mary', 'J', 'Strength', 'MD', 'Pediatrics', '', '', NULL, 'O', '1710 W 287 Business Ste 100', 'Waxahachie', 'Ellis', 'TX', '75165', '9729371221', NULL, '1710 W 287 Business Ste 100', 'Waxahachie', 'Ellis', 'TX', '75165', '9729371221', '', 'BQA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Waxahachie', NULL, NULL, NULL, 'HCFA|UB|', '1730203126', 0, 'N', 0, '2013-03-08', NULL, NULL, 32.3989, -96.8651, NULL, NULL),
('453796432', 'EDBQA0003', 'EDBQA0003', 'TXDALSTD', 'Kidney and Hypertension Associates of Dallas', 'Sana', '', 'Ahmed', 'MD', 'Nephrology', '', '', NULL, 'O', '3900 Junius St Ste 615', 'Dallas', 'Dallas', 'TX', '75246', '9723885970', NULL, '3900 Junius St Ste 615', 'Dallas', 'Dallas', 'TX', '75246', '9723885970', '          ', 'BQA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', '2013-08-14', 0, 0, 0, 'Baylor Medical Center at Uptown', NULL, NULL, NULL, 'HCFA|UB|', '1730495037', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.7913, -96.7775, NULL, NULL),
('522438324', 'EDBQA0056', 'EDBQA0056', 'TXDALSTD', 'North Central Urology', 'Dennis', 'L', 'Ortiz', 'DO', 'Urology', '', '', NULL, 'O', '4218 Gateway Dr Ste 100', 'Colleyville', 'Tarrant', 'TX', '76034', '8172831860', NULL, '4218 Gateway Dr Ste 100', 'Colleyville', 'Tarrant', 'TX', '76034', '8172831860', '', 'BQA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1740232149', 0, 'N', 0, '2013-03-07', NULL, NULL, 32.8848, -97.1012, NULL, NULL),
('752694558', 'EDBQA0026', 'EDBQA0026', 'TXDALSTD', 'Advanced Heart Care PA', 'Jason', 'S', 'Finkelstein', 'MD', 'Cardiology', '', '', NULL, 'O', '4708 Alliance Blvd Ste 650', 'Plano', 'Collin', 'TX', '75093', '4693262636', NULL, '4708 Alliance Blvd Ste 650', 'Plano', 'Collin', 'TX', '75093', '4693262636', '', 'BQA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'The Heart Hospital Baylor Plano', NULL, '', '', 'HCFA|UB|', '1750355103', 0, 'N', 0, '2014-04-25', NULL, NULL, 33.0145, -96.7925, NULL, NULL),
('752694558', 'EDBQA0088', 'EDBQA0088', 'TXDALSTD', 'Advanced Heart Care PA', 'Jason', 'S', 'Finkelstein', 'MD', 'Cardiology', '', '', NULL, 'B', '8150 N Central Expwy Ste M1001', 'Dallas', 'Dallas', 'TX', '75206', '4693262636', NULL, '8150 N Central Expwy Ste M1001', 'Dallas', 'Dallas', 'TX', '75206', '4693262636', '', 'BQA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'The Heart Hospital Baylor Plano', NULL, '', '', 'HCFA|UB|', '1750355103', 0, 'Y', 0, '2014-04-25', NULL, NULL, 0, 0, NULL, NULL),
('752472444', 'EDBQA0055', 'EDBQA0055', 'TXDALSTD', 'Lake Lewisville Pediatrics ', 'John', 'Glen', 'Ogden', 'MD', 'Pediatrics', '', '', NULL, 'O', '2141 S Edmonds Ln', 'Lewisville', 'Denton', 'TX', '75067', '9723158500', NULL, '2141 S Edmonds Ln', 'Lewisville', 'Denton', 'TX', '75067', '9723158500', '', 'BQA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Carrollton', '', '', '', 'HCFA|UB|', '1750386850', 0, 'N', 0, '2014-07-17', NULL, NULL, 33.0071, -97.0056, NULL, NULL),
('751942562', 'W12028080', 'W12028080', 'TXDALSTD', 'Surgical Associates of the Mid-Cities', 'Robert', 'S', 'Pollard', 'MD', 'General Surgery', '', '', NULL, 'O', '1604 Hospital Pkwy Ste 505', 'Bedford', 'Tarrant', 'TX', '76022', '8172672678', NULL, '1604 Hospital Pkwy Ste 505', 'Bedford', 'Tarrant', 'TX', '76022', '8172672678', '          ', 'BQA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Grapevine', NULL, NULL, NULL, 'HCFA|UB|', '1235184433', 0, 'N', 0, '2013-03-11', NULL, NULL, 32.8336, -97.1252, NULL, NULL),
('752825783', 'EDBQA0018', 'EDBQA0018', 'TXDALSTD', 'Metroplex Foot and Ankle ', 'Bryan', '', 'De Yoe', 'DPM', 'Podiatry', '', '', NULL, 'O', '3201 E President George Bush Hwy Ste 106', 'Richardson', 'Dallas', 'TX', '75082', '2142173668', NULL, '3201 E President George Bush Hwy Ste 106', 'Richardson', 'Dallas', 'TX', '75082', '2142173668', '          ', 'BQA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', '2013-08-14', 0, 0, 0, 'Baylor Medical Center at Garland', 'Baylor University Medical Center', NULL, NULL, 'HCFA|UB|', '1780629709', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.9907, -96.666, NULL, NULL),
('203774683', 'EDBQA0047', 'EDBQA0047', 'TXDALSTD', 'Muhammad Memon MD', 'Muhammad', 'A', 'Memon', 'MD', 'Gastroenterology', '', '', NULL, 'O', '2800 E Broad St Ste 500', 'Mansfield', 'Tarrant', 'TX', '76063', '8174775500', NULL, '2800 E Broad St Ste 500', 'Mansfield', 'Tarrant', 'TX', '76063', '8174775500', '          ', 'BQA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', NULL, '', '', 'HCFA|UB|', '1780691923', 0, 'Y', 0, '2013-05-28', NULL, NULL, 32.5706, -97.0932, NULL, NULL),
('202198373', 'EDBQA0072', 'EDBQA0072', 'TXDALSTD', 'Stroud, Robert', 'Robert', 'G', 'Stroud', 'DO', 'Urology', '', '', NULL, 'O', '1101 University', 'Fort Worth', 'Tarrant', 'TX', '76107', '8173350199', NULL, '1101 University', 'Fort Worth', 'Tarrant', 'TX', '76107', '8173350199', '', 'BQA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', '2013-09-14', 0, 0, 0, 'Baylor All Saints Medical Center', NULL, '', '', 'HCFA|UB|', '1801859376', 0, 'N', 0, '2014-03-28', NULL, NULL, 0, 0, NULL, NULL),
('455272070', 'W12046150', 'W12046150', 'UT01', 'General Surgery at Northpointe LLC', 'Marlee', 'K', 'Dalton', 'CNM', 'Obstetrics and Gynecology', 'Family Practice', '', NULL, 'M', 'PO Box 572528', 'Salt Lake City', 'Salt Lake', 'UT', '84157', '4358828111', '4358822111', 'PO Box 572528', 'Salt Lake City', 'Salt Lake', 'UT', '84157', '4358828111', '4358822111', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-03-24', NULL, 0, 0, 0, 'Mountain West Medical Center', '', '', '', 'HCFA|UB|', '1730175761', 0, 'N', 0, '2014-03-28', NULL, NULL, 0, 0, NULL, NULL),
('752763764', 'EDBQA0007', 'EDBQA0007', 'TXDALSTD', 'Garland Spine Center', 'Richard', 'David', 'Bauer', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1130 Beltline Rd Ste 135', 'Garland', 'Dallas', 'TX', '75040', '9725309933', NULL, '1130 Beltline Rd Ste 135', 'Garland', 'Dallas', 'TX', '75040', '9725309933', '          ', 'BQA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', NULL, NULL, NULL, 'HCFA|UB|', '1841250735', 0, 'N', 0, '2013-06-14', NULL, NULL, 32.9433, -96.6437, NULL, NULL),
('455012558', 'EDBQA0058', 'EDBQA0058', 'TXDALSTD', 'Texas Center for Orthopedics and Spine Disorders', 'Kraig', 'R', 'Pepper', 'DO', 'Orthopedic Surgery', '', '', NULL, 'O', '7257 Hawkins View Dr', 'Fort Worth', 'Tarrant', 'TX', '76132', '8177359397', NULL, '7257 Hawkins View Dr', 'Fort Worth', 'Tarrant', 'TX', '76132', '8177359397', '', 'BQA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Carrollton', NULL, NULL, NULL, 'HCFA|UB|', '1851652457', 0, 'N', 0, '2013-03-08', NULL, NULL, 32.664, -97.4194, NULL, NULL),
('270826164', 'EDBQA0071', 'EDBQA0071', 'TXDALSTD', 'Strong Eye Care', 'Bradley', 'D', 'Strong', 'MD', 'Ophthalmology', '', '', NULL, 'O', '4131 N Central Expwy Ste 725', 'Dallas', 'Dallas', 'TX', '75204', '2145226380', NULL, '4131 N Central Expwy Ste 725', 'Dallas', 'Dallas', 'TX', '75204', '2145226380', '', 'BQA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, '', '', 'HCFA|UB|', '1881827475', 0, 'N', 0, '2013-03-07', NULL, NULL, 32.8144, -96.7904, NULL, NULL),
('453796432', 'EDBQA0035', 'EDBQA0035', 'TXDALSTD', 'Kidney and Hypertension Associates of Dallas', 'Christopher', '', 'Hebert', 'MD', 'Nephrology', '', '', NULL, 'O', '3900 Junius St Ste 615', 'Dallas', 'Dallas', 'TX', '75246', '9723885970', NULL, '3900 Junius St Ste 615', 'Dallas', 'Dallas', 'TX', '75246', '9723885970', '          ', 'BQA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', '2013-08-14', 0, 0, 0, 'Baylor Medical Center at Uptown', 'Baylor Regional Medical Center at Grapevine', NULL, NULL, 'HCFA|UB|', '1912966045', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.7913, -96.7775, NULL, NULL),
('453796432', 'EDBQA0091', 'EDBQA0091', 'TXDALSTD', 'Kidney and Hypertension Associates of Dallas', 'Christopher', '', 'Hebert', 'MD', 'Nephrology', '', '', NULL, 'B', 'PO Box 7824', 'Belfast', 'Waldo', 'ME', '04915', '9723885970', NULL, 'PO Box 7824', 'Belfast', 'Waldo', 'ME', '04915', '9723885970', '          ', 'BQA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', '2013-08-14', 0, 0, 0, 'Baylor Medical Center at Uptown', 'Baylor Regional Medical Center at Grapevine', NULL, NULL, 'HCFA|UB|', '1912966045', 0, 'Y', 0, '2013-11-11', NULL, NULL, 0, 0, NULL, NULL),
('752694558', 'EDBQA0042', 'EDBQA0042', 'TXDALSTD', 'Advanced Heart Care PA', 'Bradley', 'M', 'Leonard', 'MD', 'Cardiology', '', '', NULL, 'O', '4708 Alliance Blvd Ste 650', 'Plano', 'Collin', 'TX', '75093', '4693262636', NULL, '4708 Alliance Blvd Ste 650', 'Plano', 'Collin', 'TX', '75093', '4693262636', '          ', 'BQA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, NULL, NULL, 'HCFA|UB|', '1932156213', 0, 'N', 0, '2013-07-17', NULL, NULL, 33.0145, -96.7925, NULL, NULL),
('752694558', 'EDBQA0093', 'EDBQA0093', 'TXDALSTD', 'Advanced Heart Care PA', 'Bradley', 'M', 'Leonard', 'MD', 'Cardiology', '', '', NULL, 'B', '8150 N Central Expwy Ste M1001', 'Dallas', 'Dallas', 'TX', '75206', '4693262636', NULL, '8150 N Central Expwy Ste M1001', 'Dallas', 'Dallas', 'TX', '75206', '4693262636', '          ', 'BQA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, NULL, NULL, 'HCFA|UB|', '1932156213', 0, 'Y', 0, '2013-07-17', NULL, NULL, 0, 0, NULL, NULL),
('752694558', 'EDBQA0019', 'EDBQA0019', 'TXDALSTD', 'Advanced Heart Care PA', 'Saritha', '', 'Dodla', 'MD', 'Cardiology', '', '', NULL, 'O', '4708 Alliance Blvd Ste 650', 'Plano', 'Collin', 'TX', '75093', '4693262636', NULL, '4708 Alliance Blvd Ste 650', 'Plano', 'Collin', 'TX', '75093', '4693262636', '', 'BQA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'The Heart Hospital Baylor Plano', NULL, '', '', 'HCFA|UB|', '1932294469', 0, 'N', 0, '2014-04-25', NULL, NULL, 33.0145, -96.7925, NULL, NULL),
('752694558', 'EDBQA0086', 'EDBQA0086', 'TXDALSTD', 'Advanced Heart Care PA', 'Saritha', '', 'Dodla', 'MD', 'Cardiology', '', '', NULL, 'B', '8150 N Central Expwy Ste M1001', 'Dallas', 'Dallas', 'TX', '75206', '4693262636', NULL, '8150 N Central Expwy Ste M1001', 'Dallas', 'Dallas', 'TX', '75206', '4693262636', '', 'BQA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'The Heart Hospital Baylor Plano', NULL, '', '', 'HCFA|UB|', '1932294469', 0, 'Y', 0, '2014-04-25', NULL, NULL, 0, 0, NULL, NULL),
('752061371', 'EDBQA0002', 'EDBQA0002', 'TXDALSTD', 'Cardiology Consultants of North Dallas', 'Kanti', 'L', 'Agrawal', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '700 Walter Reed Blvd Ste 205', 'Garland', 'Dallas', 'TX', '75042', '9724871117', NULL, '700 Walter Reed Blvd Ste 205', 'Garland', 'Dallas', 'TX', '75042', '9724871117', '          ', 'BQA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', '2013-08-14', 0, 0, 0, 'Baylor Medical Center at Garland', NULL, NULL, NULL, 'HCFA|UB|', '1942285671', 0, 'N', 0, '2013-08-05', NULL, NULL, 32.9192, -96.6635, NULL, NULL),
('752694558', 'EDBQA0066', 'EDBQA0066', 'TXDALSTD', 'Advanced Heart Care PA', 'Adam', 'R', 'Shapira', 'MD', 'Internal Medicine', '', '', NULL, 'O', '4708 Alliance Blvd Ste 650', 'Plano', 'Collin', 'TX', '75093', '4693262636', NULL, '4708 Alliance Blvd Ste 650', 'Plano', 'Collin', 'TX', '75093', '4693262636', '          ', 'BQA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, NULL, NULL, 'HCFA|UB|', '1942472386', 0, 'N', 0, '2013-07-17', NULL, NULL, 33.0145, -96.7925, NULL, NULL),
('752694558', 'EDBQA0097', 'EDBQA0097', 'TXDALSTD', 'Advanced Heart Care PA', 'Adam', 'R', 'Shapira', 'MD', 'Internal Medicine', '', '', NULL, 'B', '8150 N Central Expwy Ste M1001', 'Dallas', 'Dallas', 'TX', '75206', '4693262636', NULL, '8150 N Central Expwy Ste M1001', 'Dallas', 'Dallas', 'TX', '75206', '4693262636', '          ', 'BQA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, NULL, NULL, 'HCFA|UB|', '1942472386', 0, 'Y', 0, '2013-07-17', NULL, NULL, 0, 0, NULL, NULL),
('752694558', 'EDBQA0029', 'EDBQA0029', 'TXDALSTD', 'Advanced Heart Care PA', 'Bruce', 'M', 'Gordon', 'MD', 'Cardiology', '', '', NULL, 'O', '4708 Alliance Blvd Ste 650', 'Plano', 'Collin', 'TX', '75093', '4693262636', NULL, '4708 Alliance Blvd Ste 650', 'Plano', 'Collin', 'TX', '75093', '4693262636', '          ', 'BQA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', '2013-11-21', 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, NULL, NULL, 'HCFA|UB|', '1952348153', 0, 'N', 0, '2013-10-31', NULL, NULL, 33.0138, -96.7917, NULL, NULL),
('752694558', 'EDBQA0090', 'EDBQA0090', 'TXDALSTD', 'Advanced Heart Care PA', 'Bruce', 'M', 'Gordon', 'MD', 'Cardiology', '', '', NULL, 'B', '8150 N Central Expwy Ste M1001', 'Dallas', 'Dallas', 'TX', '75206', '4693262636', NULL, '8150 N Central Expwy Ste M1001', 'Dallas', 'Dallas', 'TX', '75206', '4693262636', '          ', 'BQA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', '2013-11-21', 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, NULL, NULL, 'HCFA|UB|', '1952348153', 0, 'Y', 0, '2013-10-31', NULL, NULL, 0, 0, NULL, NULL),
('364712381', 'EDBQA0045', 'EDBQA0045', 'TXDALSTD', 'Lakeside Surgery PA', 'Katherine', 'R', 'Makohon', 'MD', 'General Surgery', '', '', NULL, 'O', '3142 Horizon Rd Ste 206', 'Rockwall', 'Rockwall', 'TX', '75032', '9727223290', NULL, '3142 Horizon Rd Ste 206', 'Rockwall', 'Rockwall', 'TX', '75032', '9727223290', '', 'BQA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', '2013-08-14', 0, 0, 0, 'Baylor Medical Center at Garland', '', '', '', 'HCFA|UB|', '1952393415', 0, 'N', 0, '2014-05-09', NULL, NULL, 32.8858, -96.4645, NULL, NULL),
('752694558', 'EDBQA0076', 'EDBQA0076', 'TXDALSTD', 'Advanced Heart Care PA', 'Jai', '', 'Varma', 'MD', 'Cardiology', '', '', NULL, 'O', '4708 Alliance Blvd Ste 650', 'Plano', 'Collin', 'TX', '75093', '4693262636', NULL, '4708 Alliance Blvd Ste 650', 'Plano', 'Collin', 'TX', '75093', '4693262636', '          ', 'BQA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', '2013-11-21', 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, NULL, NULL, 'HCFA|UB|', '1952520488', 0, 'N', 0, '2013-10-28', NULL, NULL, 33.0138, -96.7917, NULL, NULL),
('752694558', 'EDBQA0098', 'EDBQA0098', 'TXDALSTD', 'Advanced Heart Care PA', 'Jai', '', 'Varma', 'MD', 'Cardiology', '', '', NULL, 'B', '8150 N Central Expwy Ste M1001', 'Dallas', 'Dallas', 'TX', '75206', '4693262636', NULL, '8150 N Central Expwy Ste M1001', 'Dallas', 'Dallas', 'TX', '75206', '4693262636', '          ', 'BQA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', '2013-11-21', 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, NULL, NULL, 'HCFA|UB|', '1952520488', 0, 'Y', 0, '2013-10-28', NULL, NULL, 0, 0, NULL, NULL),
('752710490', 'EDBQA0052', 'EDBQA0052', 'TXDALSTD', 'Contemporary OB-GYN of Grapevine', 'Troy', 'Gerald', 'New', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1600 West College St Ste 340', 'Grapevine', 'Tarrant', 'TX', '76051', '8173290389', NULL, '1600 West College St Ste 340', 'Grapevine', 'Tarrant', 'TX', '76051', '8173290389', '          ', 'BQA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', '2013-08-14', 0, 0, 0, 'Baylor Regional Medical Center at Grapevine', NULL, NULL, NULL, 'HCFA|UB|', '1962408062', 0, 'N', 0, '2013-08-05', NULL, NULL, 0, 0, NULL, NULL),
('900524948', 'EDBQA0013', 'EDBQA0013', 'TXDALSTD', 'Chung, Andrew', 'Andrew', '', 'Chung', 'MD', 'Internal Medicine', '', '', NULL, 'O', '3600 Gaston Ave Ste 703', 'Dallas', 'Dallas', 'TX', '75246', '2148234200', NULL, '3600 Gaston Ave Ste 703', 'Dallas', 'Dallas', 'TX', '75246', '2148234200', '          ', 'BQA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, '', '', 'HCFA|UB|', '1962500413', 0, 'N', 0, '2013-04-17', NULL, NULL, 32.7913, -96.7799, NULL, NULL),
('752627054', 'EDBQA0057', 'EDBQA0057', 'TXDALSTD', 'Pedro, Steven', 'Steven', 'D', 'Pedro', 'MD', 'Dermatology', '', '', NULL, 'O', '7833 Oakmont Blvd', 'Fort Worth', 'Tarrant', 'TX', '76132', '8173360661', NULL, '7833 Oakmont Blvd', 'Fort Worth', 'Tarrant', 'TX', '76132', '8173360661', '          ', 'BQA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1982634481', 0, 'N', 0, '2013-04-17', NULL, NULL, 32.6656, -97.4255, NULL, NULL),
('751608686', 'ELBQA2028', 'ELBQA2028', 'TXDALSTD', 'Southwest Cardiac Associates', 'Norvin', '', 'Parr', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '5310 N Galloway Ave Ste 100', 'Mesquite', 'Dallas', 'TX', '75150', '9722260507', NULL, '5310 N Galloway Ave Ste 100', 'Mesquite', 'Dallas', 'TX', '75150', '9722260507', '          ', 'BQA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-02-01', '2013-02-01', 0, 0, 0, 'The Heart Hospital Baylor Plano', NULL, '', '', 'HCFA|UB|', '1548230378', 0, 'N', 0, '2013-04-05', NULL, NULL, 0, 0, NULL, NULL),
('752788839', 'ELUC00033', 'ELUC00033', 'TXDALSTD', 'Urology Clinics of North Texas', 'Wilson', 'L', 'Hernandez', 'MD', 'Urology', '', '', NULL, 'B', '7515 Greenville Ave Ste 900', 'Dallas', 'Dallas', 'TX', '75231', '2146928262', '2146964190', '7515 Greenville Ave Ste 900', 'Dallas', 'Dallas', 'TX', '75231', '2146928262', '2146964190', 'DALLAS4', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, '', '', 'HCFA|UB|', '1023007739', 0, 'Y', 0, '2013-06-05', NULL, NULL, 32.884, -96.7598, NULL, NULL),
('751942562', 'W12028081', 'W12028081', 'TXDALSTD', 'Surgical Associates of the Mid-Cities', 'Thomas', 'J', 'Purgett', 'MD', 'General Surgery', '', '', NULL, 'O', '1604 Hospital Pkwy Ste 505', 'Bedford', 'Tarrant', 'TX', '76022', '8172672678', NULL, '1604 Hospital Pkwy Ste 505', 'Bedford', 'Tarrant', 'TX', '76022', '8172672678', '          ', 'BQA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Grapevine', NULL, NULL, NULL, 'HCFA|UB|', '1063468635', 0, 'N', 0, '2013-03-11', NULL, NULL, 32.8336, -97.1252, NULL, NULL),
('751942562', 'W12028078', 'W12028078', 'TXDALSTD', 'Surgical Associates of the Mid-Cities', 'Jerome', 'P', 'Eaton', 'MD', 'General Surgery', '', '', NULL, 'O', '1604 Hospital Pkwy Ste 505', 'Bedford', 'Tarrant', 'TX', '76022', '8172672678', '8073540854', '1604 Hospital Pkwy Ste 505', 'Bedford', 'Tarrant', 'TX', '76022', '8172672678', '8073540854', 'BQA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Grapevine', NULL, NULL, NULL, 'HCFA|UB|', '1760438113', 0, 'N', 0, '2013-04-05', NULL, NULL, 32.8336, -97.1252, NULL, NULL),
('752788839', 'ELUC00056', 'ELUC00056', 'TXDALSTD', 'Urology Clinics of North Texas', 'Eric', 'B', 'Smith', 'MD', 'Urology', '', '', NULL, 'O', '3600 Gaston Ave Barnett Tower Ste 1002', 'Dallas', 'Dallas', 'TX', '75246', '2148266235', '2148284633', '3600 Gaston Ave Barnett Tower Ste 1002', 'Dallas', 'Dallas', 'TX', '75246', '2148266235', '2148284633', 'DALLAS4', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1033138102', 0, 'N', 0, '2013-06-05', NULL, NULL, 32.7913, -96.7799, NULL, NULL),
('752788839', 'ELUC00057', 'ELUC00057', 'TXDALSTD', 'Urology Clinics of North Texas', 'Eric', 'B', 'Smith', 'MD', 'Urology', '', '', NULL, 'B', '7515 Greenville Ave Ste 900', 'Dallas', 'Dallas', 'TX', '75231', '2146928262', '2146964190', '7515 Greenville Ave Ste 900', 'Dallas', 'Dallas', 'TX', '75231', '2146928262', '2146964190', 'DALLAS4', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1033138102', 0, 'Y', 0, '2013-06-05', NULL, NULL, 32.884, -96.7598, NULL, NULL),
('752788839', 'ELUC00011', 'ELUC00011', 'TXDALSTD', 'Urology Clinics of North Texas', 'David', 'H', 'Ewalt', 'MD', 'Urology', '', '', NULL, 'O', '4001 W 15th St Ste 300', 'Plano', 'Collin', 'TX', '75093', '2147500808', '2147500120', '4001 W 15th St Ste 300', 'Plano', 'Collin', 'TX', '75093', '2147500808', '2147500120', 'DALLAS4', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, '', '', 'HCFA|UB|', '1043257686', 0, 'N', 0, '2013-06-05', NULL, NULL, 33.0191, -96.7671, NULL, NULL);
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('752788839', 'ELUC00010', 'ELUC00010', 'TXDALSTD', 'Urology Clinics of North Texas', 'David', 'H', 'Ewalt', 'MD', 'Urology', '', '', NULL, 'O', '8315 Walnut Hill Ln Ste 205', 'Dallas', 'Dallas', 'TX', '75231', '2147500808', '2147500120', '8315 Walnut Hill Ln Ste 205', 'Dallas', 'Dallas', 'TX', '75231', '2147500808', '2147500120', 'DALLAS4', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, '', '', 'HCFA|UB|', '1043257686', 0, 'N', 0, '2013-06-05', NULL, NULL, 32.8834, -96.762, NULL, NULL),
('752788839', 'ELUC00004', 'ELUC00004', 'TXDALSTD', 'Urology Clinics of North Texas', 'Bryan', 'C', 'Bruner', 'MD', 'Urology', '', '', NULL, 'O', '1600 W College St  Ste 140', 'Grapevine', 'Tarrant', 'TX', '76051', '2148266021', '2148239745', '1600 W College St  Ste 140', 'Grapevine', 'Tarrant', 'TX', '76051', '2148266021', '2148239745', 'DALLAS4', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Grapevine', NULL, NULL, NULL, 'HCFA|UB|', '1043439920', 0, 'N', 0, '2013-06-05', NULL, NULL, 32.9356, -97.0929, NULL, NULL),
('752788839', 'ELUC00005', 'ELUC00005', 'TXDALSTD', 'Urology Clinics of North Texas', 'Bryan', 'C', 'Bruner', 'MD', 'Urology', '', '', NULL, 'B', '7515 Greenville Ave Ste 900', 'Dallas', 'Dallas', 'TX', '75231', '2146928262', '2146964190', '7515 Greenville Ave Ste 900', 'Dallas', 'Dallas', 'TX', '75231', '2146928262', '2146964190', 'DALLAS4', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Grapevine', NULL, NULL, NULL, 'HCFA|UB|', '1043439920', 0, 'Y', 0, '2013-06-05', NULL, NULL, 32.884, -96.7598, NULL, NULL),
('752788839', 'ELUC00063', 'ELUC00063', 'TXDALSTD', 'Urology Clinics of North Texas', 'John', 'R', 'Ware', 'MD', 'Urology', '', '', NULL, 'O', '3600 Gaston Ave Barnett Tower Ste 1205', 'Dallas', 'Dallas', 'TX', '75246', '2148266021', '2148239745', '3600 Gaston Ave Barnett Tower Ste 1205', 'Dallas', 'Dallas', 'TX', '75246', '2148266021', '2148239745', 'DALLAS4', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, '', '', 'HCFA|UB|', '1063459856', 0, 'N', 0, '2013-06-05', NULL, NULL, 32.7913, -96.7799, NULL, NULL),
('752788839', 'ELUC00064', 'ELUC00064', 'TXDALSTD', 'Urology Clinics of North Texas', 'John', 'R', 'Ware', 'MD', 'Urology', '', '', NULL, 'B', '7515 Greenville Ave Ste 900', 'Dallas', 'Dallas', 'TX', '75231', '2146928262', '2146964190', '7515 Greenville Ave Ste 900', 'Dallas', 'Dallas', 'TX', '75231', '2146928262', '2146964190', 'DALLAS4', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, '', '', 'HCFA|UB|', '1063459856', 0, 'Y', 0, '2013-06-05', NULL, NULL, 32.884, -96.7598, NULL, NULL),
('752788839', 'ELUC00051', 'ELUC00051', 'TXDALSTD', 'Urology Clinics of North Texas', 'Homa ', 'J', 'Porter', 'MD', 'Urology', '', '', NULL, 'B', '7515 Greenville Ave Ste 900', 'Dallas', 'Dallas', 'TX', '75231', '2146928262', '2146964190', '7515 Greenville Ave Ste 900', 'Dallas', 'Dallas', 'TX', '75231', '2146928262', '2146964190', 'DALLAS4', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, '', '', 'HCFA|UB|', '1073560058', 0, 'Y', 0, '2013-06-05', NULL, NULL, 32.884, -96.7598, NULL, NULL),
('752788839', 'ELUC00050', 'ELUC00050', 'TXDALSTD', 'Urology Clinics of North Texas', 'Homa ', 'J', 'Porter', 'MD', 'Urology', '', '', NULL, 'O', '8230 Walnut Hill Ln Ste 700', 'Dallas', 'Dallas', 'TX', '75231', '2146911902', '2149871945', '8230 Walnut Hill Ln Ste 700', 'Dallas', 'Dallas', 'TX', '75231', '2146911902', '2149871945', 'DALLAS4', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, '', '', 'HCFA|UB|', '1073560058', 0, 'N', 0, '2013-06-05', NULL, NULL, 32.8833, -96.7617, NULL, NULL),
('752788839', 'ELUC00039', 'ELUC00039', 'TXDALSTD', 'Urology Clinics of North Texas', 'Meredith', 'L', 'Lightfoot', 'MD', 'Urology', '', '', NULL, 'O', '6124 W Parker Rd Ste 434', 'Plano', 'Collin', 'TX', '75093', '2146911902', '2149871945', '6124 W Parker Rd Ste 434', 'Plano', 'Collin', 'TX', '75093', '2146911902', '2149871945', 'DALLAS4', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1083661052', 0, 'Y', 0, '2014-04-28', NULL, NULL, 33.0451, -96.8337, NULL, NULL),
('752788839', 'ELUC00040', 'ELUC00040', 'TXDALSTD', 'Urology Clinics of North Texas', 'Meredith', 'L', 'Lightfoot', 'MD', 'Urology', '', '', NULL, 'B', '7515 Greenville Ave Ste 900', 'Dallas', 'Dallas', 'TX', '75231', '2146928262', '2146964190', '7515 Greenville Ave Ste 900', 'Dallas', 'Dallas', 'TX', '75231', '2146928262', '2146964190', 'DALLAS4', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1083661052', 0, 'Y', 0, '2013-06-05', NULL, NULL, 32.884, -96.7598, NULL, NULL),
('752788839', 'ELUC00052', 'ELUC00052', 'TXDALSTD', 'Urology Clinics of North Texas', 'Robert ', 'C', 'Schoenvogel', 'MD', 'Urology', '', '', NULL, 'O', '3409 Worth St Ste 540', 'Dallas', 'Dallas', 'TX', '75246', '2148271602', '2148281021', '3409 Worth St Ste 540', 'Dallas', 'Dallas', 'TX', '75246', '2148271602', '2148281021', 'DALLAS4', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Waxahachie', NULL, NULL, NULL, 'HCFA|UB|', '1134156664', 0, 'N', 0, '2013-06-05', NULL, NULL, 32.7886, -96.779, NULL, NULL),
('752788839', 'ELUC00053', 'ELUC00053', 'TXDALSTD', 'Urology Clinics of North Texas', 'Robert ', 'C', 'Schoenvogel', 'MD', 'Urology', '', '', NULL, 'B', '7515 Greenville Ave Ste 900', 'Dallas', 'Dallas', 'TX', '75231', '2146928262', '2146964190', '7515 Greenville Ave Ste 900', 'Dallas', 'Dallas', 'TX', '75231', '2146928262', '2146964190', 'DALLAS4', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Waxahachie', NULL, NULL, NULL, 'HCFA|UB|', '1134156664', 0, 'Y', 0, '2013-06-05', NULL, NULL, 32.884, -96.7598, NULL, NULL),
('752788839', 'ELUC00058', 'ELUC00058', 'TXDALSTD', 'Urology Clinics of North Texas', 'William', 'R', 'Strand ', 'MD', 'Urology', '', '', NULL, 'O', '4001 W 15th St Ste 300', 'Plano', 'Collin', 'TX', '75093', '2147500808', '2147500120', '4001 W 15th St Ste 300', 'Plano', 'Collin', 'TX', '75093', '2147500808', '2147500120', 'DALLAS4', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, '', '', 'HCFA|UB|', '1134166127', 0, 'N', 0, '2013-06-05', NULL, NULL, 33.0191, -96.7671, NULL, NULL),
('752788839', 'ELUC00059', 'ELUC00059', 'TXDALSTD', 'Urology Clinics of North Texas', 'William', 'R', 'Strand ', 'MD', 'Urology', '', '', NULL, 'B', '7515 Greenville Ave Ste 900', 'Dallas', 'Dallas', 'TX', '75231', '2146928262', '2146964190', '7515 Greenville Ave Ste 900', 'Dallas', 'Dallas', 'TX', '75231', '2146928262', '2146964190', 'DALLAS4', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, '', '', 'HCFA|UB|', '1134166127', 0, 'Y', 0, '2013-06-05', NULL, NULL, 32.884, -96.7598, NULL, NULL),
('752788839', 'ELUC00007', 'ELUC00007', 'TXDALSTD', 'Urology Clinics of North Texas', 'James', 'S', 'Cochran', 'MD', 'Urology', '', '', NULL, 'B', '7515 Greenville Ave Ste 900', 'Dallas', 'Dallas', 'TX', '75231', '2146928262', '2146964190', '7515 Greenville Ave Ste 900', 'Dallas', 'Dallas', 'TX', '75231', '2146928262', '2146964190', 'DALLAS4', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1174577704', 0, 'Y', 0, '2013-06-05', NULL, NULL, 32.884, -96.7598, NULL, NULL),
('752788839', 'ELUC00006', 'ELUC00006', 'TXDALSTD', 'Urology Clinics of North Texas', 'James', 'S', 'Cochran', 'MD', 'Urology', '', '', NULL, 'O', '8230 Walnut Hill Ln Ste 700', 'Dallas', 'Dallas', 'TX', '75231', '2146911902', '2149871945', '8230 Walnut Hill Ln Ste 700', 'Dallas', 'Dallas', 'TX', '75231', '2146911902', '2149871945', 'DALLAS4', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1174577704', 0, 'Y', 0, '2014-04-28', NULL, NULL, 32.8833, -96.7617, NULL, NULL),
('752788839', 'ELUC00035', 'ELUC00035', 'TXDALSTD', 'Urology Clinics of North Texas', 'Alfred ', 'M', 'Holden', 'MD', 'Urology', '', '', NULL, 'B', '7515 Greenville Ave Ste 900', 'Dallas', 'Dallas', 'TX', '75231', '2146928262', '2146964190', '7515 Greenville Ave Ste 900', 'Dallas', 'Dallas', 'TX', '75231', '2146928262', '2146964190', 'DALLAS4', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, NULL, NULL, 'HCFA|UB|', '1205899952', 0, 'Y', 0, '2013-06-14', NULL, NULL, 32.884, -96.7598, NULL, NULL),
('752788839', 'ELUC00034', 'ELUC00034', 'TXDALSTD', 'Urology Clinics of North Texas', 'Alfred ', 'M', 'Holden', 'MD', 'Urology', '', '', NULL, 'O', '9330 Poppy Dr Ste 400', 'Dallas', 'Dallas', 'TX', '75218', '2143283221', '9725667179', '9330 Poppy Dr Ste 400', 'Dallas', 'Dallas', 'TX', '75218', '2143283221', '9725667179', 'DALLAS4', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, NULL, NULL, 'HCFA|UB|', '1205899952', 0, 'N', 0, '2013-06-14', NULL, NULL, 32.8353, -96.7055, NULL, NULL),
('752788839', 'ELUC00017', 'ELUC00017', 'TXDALSTD', 'Urology Clinics of North Texas', 'Myron', 'G', 'Fine', 'MD', 'Urology', '', '', NULL, 'O', '3600 Gaston Ave Barnett Tower Ste 1002', 'Dallas', 'Dallas', 'TX', '75246', '2148266235', '2148284633', '3600 Gaston Ave Barnett Tower Ste 1002', 'Dallas', 'Dallas', 'TX', '75246', '2148266235', '2148284633', 'DALLAS4', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1235187014', 0, 'N', 0, '2013-06-05', NULL, NULL, 32.7913, -96.7799, NULL, NULL),
('752788839', 'ELUC00018', 'ELUC00018', 'TXDALSTD', 'Urology Clinics of North Texas', 'Myron', 'G', 'Fine', 'MD', 'Urology', '', '', NULL, 'B', '7515 Greenville Ave Ste 900', 'Dallas', 'Dallas', 'TX', '75231', '2146928262', '2146964190', '7515 Greenville Ave Ste 900', 'Dallas', 'Dallas', 'TX', '75231', '2146928262', '2146964190', 'DALLAS4', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1235187014', 0, 'Y', 0, '2013-06-05', NULL, NULL, 32.884, -96.7598, NULL, NULL),
('752788839', 'ELUC00068', 'ELUC00068', 'TXDALSTD', 'Urology Clinics of North Texas', 'Matthew', 'L', 'Wilner', 'MD', 'Urology', '', '', NULL, 'B', '7515 Greenville Ave Ste 900', 'Dallas', 'Dallas', 'TX', '75231', '2146928262', '2146964190', '7515 Greenville Ave Ste 900', 'Dallas', 'Dallas', 'TX', '75231', '2146928262', '2146964190', 'DALLAS4', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1245284785', 0, 'Y', 0, '2013-06-05', NULL, NULL, 32.884, -96.7598, NULL, NULL),
('752788839', 'ELUC00067', 'ELUC00067', 'TXDALSTD', 'Urology Clinics of North Texas', 'Matthew', 'L', 'Wilner', 'MD', 'Urology', '', '', NULL, 'O', '8230 Walnut Hill Ln Ste 700IH', 'Dallas', 'Dallas', 'TX', '75231', '2146911902', '2149871945', '8230 Walnut Hill Ln Ste 700IH', 'Dallas', 'Dallas', 'TX', '75231', '2146911902', '2149871945', 'DALLAS4', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1245284785', 0, 'Y', 0, '2014-04-28', NULL, NULL, 32.8833, -96.7617, NULL, NULL),
('752788839', 'ELUC00070', 'ELUC00070', 'TXDALSTD', 'Urology Clinics of North Texas', 'Aimee', 'L', 'Carr', 'MD', 'Urology', '', '', NULL, 'B', '7515 Greenville Ave Ste 900', 'Dallas', 'Dallas', 'TX', '75231', '2146928262', '2146964190', '7515 Greenville Ave Ste 900', 'Dallas', 'Dallas', 'TX', '75231', '2146928262', '2146964190', 'DALLAS4', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', NULL, NULL, NULL, 'HCFA|UB|', '1245492032', 0, 'Y', 0, '2014-03-24', NULL, NULL, 32.884, -96.7598, NULL, NULL),
('752788839', 'ELUC00069', 'ELUC00069', 'TXDALSTD', 'Urology Clinics of North Texas', 'Aimee', 'L', 'Carr', 'MD', 'Urology', '', '', NULL, 'O', '890 Rockwall Pkwy  Ste 110', 'Rockwall', 'Rockwall', 'TX', '75032', '9722766191', '9724943712', '890 Rockwall Pkwy  Ste 110', 'Rockwall', 'Rockwall', 'TX', '75032', '9722766191', '9724943712', 'DALLAS4', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', NULL, NULL, NULL, 'HCFA|UB|', '1245492032', 0, 'N', 0, '2014-03-24', NULL, NULL, 32.8925, -96.4626, NULL, NULL),
('752788839', 'ELUC00022', 'ELUC00022', 'TXDALSTD', 'Urology Clinics of North Texas', 'Pat', 'F', 'Fulgham', 'MD', 'Urology', '', '', NULL, 'B', '7515 Greenville Ave Ste 900', 'Dallas', 'Dallas', 'TX', '75231', '2146928262', '2146964190', '7515 Greenville Ave Ste 900', 'Dallas', 'Dallas', 'TX', '75231', '2146928262', '2146964190', 'DALLAS4', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, '', '', 'HCFA|UB|', '1295788206', 0, 'Y', 0, '2013-06-05', NULL, NULL, 32.884, -96.7598, NULL, NULL),
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('752788839', 'ELUC00066', 'ELUC00066', 'TXDALSTD', 'Urology Clinics of North Texas', 'Winston', 'S', 'Webster', 'MD', 'Urology', '', '', NULL, 'B', '7515 Greenville Ave Ste 900', 'Dallas', 'Dallas', 'TX', '75231', '2146928262', '2146964190', '7515 Greenville Ave Ste 900', 'Dallas', 'Dallas', 'TX', '75231', '2146928262', '2146964190', 'DALLAS4', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Waxahachie', NULL, NULL, NULL, 'HCFA|UB|', '1336128214', 0, 'Y', 0, '2013-06-05', NULL, NULL, 32.884, -96.7598, NULL, NULL),
('752788839', 'ELUC00037', 'ELUC00037', 'TXDALSTD', 'Urology Clinics of North Texas', 'Keith', 'T', 'Kadesky', 'MD', 'Urology', '', '', NULL, 'O', '6124 W Parker Rd Ste 434', 'Plano', 'Collin', 'TX', '75093', '2146911902', '2149871945', '6124 W Parker Rd Ste 434', 'Plano', 'Collin', 'TX', '75093', '2146911902', '2149871945', 'DALLAS4', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1396798211', 0, 'Y', 0, '2014-04-28', NULL, NULL, 33.0451, -96.8337, NULL, NULL),
('752788839', 'ELUC00038', 'ELUC00038', 'TXDALSTD', 'Urology Clinics of North Texas', 'Keith', 'T', 'Kadesky', 'MD', 'Urology', '', '', NULL, 'B', '7515 Greenville Ave Ste 900', 'Dallas', 'Dallas', 'TX', '75231', '2146928262', '2146964190', '7515 Greenville Ave Ste 900', 'Dallas', 'Dallas', 'TX', '75231', '2146928262', '2146964190', 'DALLAS4', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1396798211', 0, 'Y', 0, '2013-06-05', NULL, NULL, 32.884, -96.7598, NULL, NULL),
('752788839', 'ELUC00036', 'ELUC00036', 'TXDALSTD', 'Urology Clinics of North Texas', 'Keith', 'T', 'Kadesky', 'MD', 'Urology', '', '', NULL, 'O', '8230 Walnut Hill Ln Ste 700', 'Dallas', 'Dallas', 'TX', '75231', '2146911902', '2149871945', '8230 Walnut Hill Ln Ste 700', 'Dallas', 'Dallas', 'TX', '75231', '2146911902', '2149871945', 'DALLAS4', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1396798211', 0, 'Y', 0, '2014-04-28', NULL, NULL, 32.8833, -96.7617, NULL, NULL),
('752788839', 'ELUC00061', 'ELUC00061', 'TXDALSTD', 'Urology Clinics of North Texas', 'Ahn Hong', 'H', 'Tran', 'MD', 'Urology', '', '', NULL, 'O', '4708 Alliance Blvd Ste 630', 'Plano ', 'Collin', 'TX', '75093', '9725667765', '9725667179', '4708 Alliance Blvd Ste 630', 'Plano ', 'Collin', 'TX', '75093', '9725667765', '9725667179', 'DALLAS4', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, NULL, NULL, 'HCFA|UB|', '1437353224', 0, 'N', 0, '2013-06-05', NULL, NULL, 33.0145, -96.7925, NULL, NULL),
('752788839', 'ELUC00062', 'ELUC00062', 'TXDALSTD', 'Urology Clinics of North Texas', 'Ahn Hong', 'H', 'Tran', 'MD', 'Urology', '', '', NULL, 'B', '7515 Greenville Ave Ste 900', 'Dallas', 'Dallas', 'TX', '75231', '2146928262', '2146964190', '7515 Greenville Ave Ste 900', 'Dallas', 'Dallas', 'TX', '75231', '2146928262', '2146964190', 'DALLAS4', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, NULL, NULL, 'HCFA|UB|', '1437353224', 0, 'Y', 0, '2013-06-05', NULL, NULL, 32.884, -96.7598, NULL, NULL),
('752788839', 'ELUC00060', 'ELUC00060', 'TXDALSTD', 'Urology Clinics of North Texas', 'Ahn Hong', 'H', 'Tran', 'MD', 'Urology', '', '', NULL, 'O', '7777 Forest Ln Ste A230', 'Dallas', 'Dallas', 'TX', '75230', '9725667765', '9725667179', '7777 Forest Ln Ste A230', 'Dallas', 'Dallas', 'TX', '75230', '9725667765', '9725667179', 'DALLAS4', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, NULL, NULL, 'HCFA|UB|', '1437353224', 0, 'N', 0, '2013-06-05', NULL, NULL, 32.9095, -96.7721, NULL, NULL),
('752788839', 'ELUC00030', 'ELUC00030', 'TXDALSTD', 'Urology Clinics of North Texas', 'Michael', 'B', 'Gross', 'MD', 'Urology', '', '', NULL, 'O', '6124 W Parker Rd Ste 434', 'Plano', 'Collin', 'TX', '75093', '2146911902', '2149871945', '6124 W Parker Rd Ste 434', 'Plano', 'Collin', 'TX', '75093', '2146911902', '2149871945', 'DALLAS4', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1447207493', 0, 'Y', 0, '2014-04-28', NULL, NULL, 33.0451, -96.8337, NULL, NULL),
('752788839', 'ELUC00031', 'ELUC00031', 'TXDALSTD', 'Urology Clinics of North Texas', 'Michael', 'B', 'Gross', 'MD', 'Urology', '', '', NULL, 'B', '7515 Greenville Ave Ste 900', 'Dallas', 'Dallas', 'TX', '75231', '2146928262', '2146964190', '7515 Greenville Ave Ste 900', 'Dallas', 'Dallas', 'TX', '75231', '2146928262', '2146964190', 'DALLAS4', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1447207493', 0, 'Y', 0, '2013-07-29', NULL, NULL, 32.884, -96.7598, NULL, NULL),
('752788839', 'ELUC00015', 'ELUC00015', 'TXDALSTD', 'Urology Clinics of North Texas', 'Joshua ', 'K', 'Fine', 'MD', 'Urology', '', '', NULL, 'O', '3600 Gaston Ave Barnett Tower Ste 1002', 'Dallas', 'Dallas', 'TX', '75246', '2148266235', '2148284633', '3600 Gaston Ave Barnett Tower Ste 1002', 'Dallas', 'Dallas', 'TX', '75246', '2148266235', '2148284633', 'DALLAS4', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1447245683', 0, 'N', 0, '2013-06-05', NULL, NULL, 32.7913, -96.7799, NULL, NULL),
('752788839', 'ELUC00016', 'ELUC00016', 'TXDALSTD', 'Urology Clinics of North Texas', 'Joshua ', 'K', 'Fine', 'MD', 'Urology', '', '', NULL, 'B', '7515 Greenville Ave Ste 900', 'Dallas', 'Dallas', 'TX', '75231', '2146928262', '2146964190', '7515 Greenville Ave Ste 900', 'Dallas', 'Dallas', 'TX', '75231', '2146928262', '2146964190', 'DALLAS4', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1447245683', 0, 'Y', 0, '2013-06-05', NULL, NULL, 32.884, -96.7598, NULL, NULL),
('752788839', 'ELUC00019', 'ELUC00019', 'TXDALSTD', 'Urology Clinics of North Texas', 'Steve', 'F', 'Frost', 'MD', 'Urology', '', '', NULL, 'O', '3600 Gaston Ave Barnett Tower Ste 1002', 'Dallas', 'Dallas', 'TX', '75246', '2148266021', '2148239745', '3600 Gaston Ave Barnett Tower Ste 1002', 'Dallas', 'Dallas', 'TX', '75246', '2148266021', '2148239745', 'DALLAS4', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Waxahachie', NULL, NULL, NULL, 'HCFA|UB|', '1497794663', 0, 'N', 0, '2013-06-05', NULL, NULL, 32.7913, -96.7799, NULL, NULL),
('752788839', 'ELUC00020', 'ELUC00020', 'TXDALSTD', 'Urology Clinics of North Texas', 'Steve', 'F', 'Frost', 'MD', 'Urology', '', '', NULL, 'B', '7515 Greenville Ave Ste 900', 'Dallas', 'Dallas', 'TX', '75231', '2146928262', '2146964190', '7515 Greenville Ave Ste 900', 'Dallas', 'Dallas', 'TX', '75231', '2146928262', '2146964190', 'DALLAS4', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Waxahachie', NULL, NULL, NULL, 'HCFA|UB|', '1497794663', 0, 'Y', 0, '2013-06-05', NULL, NULL, 32.884, -96.7598, NULL, NULL),
('752788839', 'ELUC00008', 'ELUC00008', 'TXDALSTD', 'Urology Clinics of North Texas', 'Scott', '', 'Davidson', 'MD', 'Urology', '', '', NULL, 'O', '1600 W College St  Ste 140', 'Grapevine', 'Tarrant', 'TX', '76051', '2148266021', '2148239745', '1600 W College St  Ste 140', 'Grapevine', 'Tarrant', 'TX', '76051', '2148266021', '2148239745', 'DALLAS4', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Grapevine', NULL, NULL, NULL, 'HCFA|UB|', '1568495398', 0, 'N', 0, '2013-07-25', NULL, NULL, 32.9356, -97.0929, NULL, NULL),
('752788839', 'ELUC00009', 'ELUC00009', 'TXDALSTD', 'Urology Clinics of North Texas', 'Scott', '', 'Davidson', 'MD', 'Urology', '', '', NULL, 'B', '7515 Greenville Ave Ste 900', 'Dallas', 'Dallas', 'TX', '75231', '2146928262', '2146964190', '7515 Greenville Ave Ste 900', 'Dallas', 'Dallas', 'TX', '75231', '2146928262', '2146964190', 'DALLAS4', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Grapevine', NULL, NULL, NULL, 'HCFA|UB|', '1568495398', 0, 'Y', 0, '2013-07-25', NULL, NULL, 32.884, -96.7598, NULL, NULL),
('752788839', 'ELUC00026', 'ELUC00026', 'TXDALSTD', 'Urology Clinics of North Texas', 'Lon ', 'M', 'Goldstein', 'MD', 'Urology', '', '', NULL, 'O', '3600 Gaston Ave Barnett Tower Ste 1205', 'Dallas', 'Dallas', 'TX', '75246', '2148266021', '2148239745', '3600 Gaston Ave Barnett Tower Ste 1205', 'Dallas', 'Dallas', 'TX', '75246', '2148266021', '2148239745', 'DALLAS4', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, '', '', 'HCFA|UB|', '1578502373', 0, 'N', 0, '2013-06-05', NULL, NULL, 32.7913, -96.7799, NULL, NULL),
('752788839', 'ELUC00027', 'ELUC00027', 'TXDALSTD', 'Urology Clinics of North Texas', 'Lon ', 'M', 'Goldstein', 'MD', 'Urology', '', '', NULL, 'B', '7515 Greenville Ave Ste 900', 'Dallas', 'Dallas', 'TX', '75231', '2146928262', '2146964190', '7515 Greenville Ave Ste 900', 'Dallas', 'Dallas', 'TX', '75231', '2146928262', '2146964190', 'DALLAS4', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, '', '', 'HCFA|UB|', '1578502373', 0, 'Y', 0, '2013-06-05', NULL, NULL, 32.884, -96.7598, NULL, NULL),
('752788839', 'ELUC00024', 'ELUC00024', 'TXDALSTD', 'Urology Clinics of North Texas', 'Aldo', 'A', 'Ghobriel', 'MD', 'Urology', '', '', NULL, 'O', '618 Clara Barton Blvd Ste E', 'Garland', 'Dallas', 'TX', '75042', '9724946764', '9724943712', '618 Clara Barton Blvd Ste E', 'Garland', 'Dallas', 'TX', '75042', '9724946764', '9724943712', 'DALLAS4', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', NULL, NULL, NULL, 'HCFA|UB|', '1619919289', 0, 'N', 0, '2013-06-14', NULL, NULL, 32.9177, -96.6619, NULL, NULL),
('752788839', 'ELUC00025', 'ELUC00025', 'TXDALSTD', 'Urology Clinics of North Texas', 'Aldo', 'A', 'Ghobriel', 'MD', 'Urology', '', '', NULL, 'B', '7515 Greenville Ave Ste 900', 'Dallas', 'Dallas', 'TX', '75231', '2146928262', '2146964190', '7515 Greenville Ave Ste 900', 'Dallas', 'Dallas', 'TX', '75231', '2146928262', '2146964190', 'DALLAS4', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', NULL, NULL, NULL, 'HCFA|UB|', '1619919289', 0, 'Y', 0, '2013-06-14', NULL, NULL, 32.884, -96.7598, NULL, NULL),
('752788839', 'ELUC00023', 'ELUC00023', 'TXDALSTD', 'Urology Clinics of North Texas', 'Aldo', 'A', 'Ghobriel', 'MD', 'Urology', '', '', NULL, 'O', '890 Rockwall Pkwy  Ste 110', 'Rockwall', 'Rockwall', 'TX', '75032', '9722766191', '9724943712', '890 Rockwall Pkwy  Ste 110', 'Rockwall', 'Rockwall', 'TX', '75032', '9722766191', '9724943712', 'DALLAS4', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', NULL, NULL, NULL, 'HCFA|UB|', '1619919289', 0, 'N', 0, '2013-06-14', NULL, NULL, 32.8925, -96.4626, NULL, NULL),
('752788839', 'ELUC00042', 'ELUC00042', 'TXDALSTD', 'Urology Clinics of North Texas', 'Mitchell', 'Owen', 'Moskowitz', 'MD', 'Urology', '', '', NULL, 'O', '4708 Alliance Blvd Ste 630', 'Plano ', 'Collin', 'TX', '75093', '9725667765', '9725667179', '4708 Alliance Blvd Ste 630', 'Plano ', 'Collin', 'TX', '75093', '9725667765', '9725667179', 'DALLAS4', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, NULL, NULL, 'HCFA|UB|', '1700849189', 0, 'N', 0, '2013-06-11', NULL, NULL, 33.0145, -96.7925, NULL, NULL),
('752788839', 'ELUC00043', 'ELUC00043', 'TXDALSTD', 'Urology Clinics of North Texas', 'Mitchell', 'Owen', 'Moskowitz', 'MD', 'Urology', '', '', NULL, 'B', '7515 Greenville Ave Ste 900', 'Dallas', 'Dallas', 'TX', '75231', '2146928262', '2146964190', '7515 Greenville Ave Ste 900', 'Dallas', 'Dallas', 'TX', '75231', '2146928262', '2146964190', 'DALLAS4', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, NULL, NULL, 'HCFA|UB|', '1700849189', 0, 'Y', 0, '2013-06-11', NULL, NULL, 32.884, -96.7598, NULL, NULL),
('752788839', 'ELUC00041', 'ELUC00041', 'TXDALSTD', 'Urology Clinics of North Texas', 'Mitchell', 'Owen', 'Moskowitz', 'MD', 'Urology', '', '', NULL, 'O', '7777 Forest Ln Ste A230', 'Dallas', 'Dallas', 'TX', '75230', '9725667765', '9725667179', '7777 Forest Ln Ste A230', 'Dallas', 'Dallas', 'TX', '75230', '9725667765', '9725667179', 'DALLAS4', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, NULL, NULL, 'HCFA|UB|', '1700849189', 0, 'N', 0, '2013-06-11', NULL, NULL, 32.9095, -96.7721, NULL, NULL),
('752788839', 'ELUC00054', 'ELUC00054', 'TXDALSTD', 'Urology Clinics of North Texas', 'Matthew', 'D', 'Shuford', 'MD', 'Urology', '', '', NULL, 'O', '3600 Gaston Ave Barnett Tower Ste 1205', 'Dallas', 'Dallas', 'TX', '75246', '2148266021', '2148239745', '3600 Gaston Ave Barnett Tower Ste 1205', 'Dallas', 'Dallas', 'TX', '75246', '2148266021', '2148239745', 'DALLAS4', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Waxahachie', NULL, NULL, NULL, 'HCFA|UB|', '1710932140', 0, 'N', 0, '2013-06-05', NULL, NULL, 32.7913, -96.7799, NULL, NULL),
('752788839', 'ELUC00055', 'ELUC00055', 'TXDALSTD', 'Urology Clinics of North Texas', 'Matthew', 'D', 'Shuford', 'MD', 'Urology', '', '', NULL, 'B', '7515 Greenville Ave Ste 900', 'Dallas', 'Dallas', 'TX', '75231', '2146928262', '2146964190', '7515 Greenville Ave Ste 900', 'Dallas', 'Dallas', 'TX', '75231', '2146928262', '2146964190', 'DALLAS4', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Waxahachie', NULL, NULL, NULL, 'HCFA|UB|', '1710932140', 0, 'Y', 0, '2013-06-05', NULL, NULL, 32.884, -96.7598, NULL, NULL),
('752788839', 'ELUC00048', 'ELUC00048', 'TXDALSTD', 'Urology Clinics of North Texas', 'Glynn', 'J', 'Pickens ', 'MD', 'Urology', '', '', NULL, 'O', '618 Clara Barton Blvd Ste E', 'Garland', 'Dallas', 'TX', '75042', '9724946764', '9724943712', '618 Clara Barton Blvd Ste E', 'Garland', 'Dallas', 'TX', '75042', '9724946764', '9724943712', 'DALLAS4', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', NULL, NULL, NULL, 'HCFA|UB|', '1720023070', 0, 'N', 0, '2013-06-14', NULL, NULL, 32.9177, -96.6619, NULL, NULL),
('752788839', 'ELUC00049', 'ELUC00049', 'TXDALSTD', 'Urology Clinics of North Texas', 'Glynn', 'J', 'Pickens ', 'MD', 'Urology', '', '', NULL, 'B', '7515 Greenville Ave Ste 900', 'Dallas', 'Dallas', 'TX', '75231', '2146928262', '2146964190', '7515 Greenville Ave Ste 900', 'Dallas', 'Dallas', 'TX', '75231', '2146928262', '2146964190', 'DALLAS4', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', NULL, NULL, NULL, 'HCFA|UB|', '1720023070', 0, 'Y', 0, '2013-06-14', NULL, NULL, 32.884, -96.7598, NULL, NULL),
('752788839', 'ELUC00047', 'ELUC00047', 'TXDALSTD', 'Urology Clinics of North Texas', 'Glynn', 'J', 'Pickens ', 'MD', 'Urology', '', '', NULL, 'O', '890 Rockwall Pkwy  Ste 110', 'Rockwall', 'Rockwall', 'TX', '75032', '9722766191', '9724943712', '890 Rockwall Pkwy  Ste 110', 'Rockwall', 'Rockwall', 'TX', '75032', '9722766191', '9724943712', 'DALLAS4', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', NULL, NULL, NULL, 'HCFA|UB|', '1720023070', 0, 'N', 0, '2013-06-14', NULL, NULL, 32.8925, -96.4626, NULL, NULL),
('752788839', 'ELUC00028', 'ELUC00028', 'TXDALSTD', 'Urology Clinics of North Texas', 'Chester', 'F', 'Graham', 'MD', 'Urology', '', '', NULL, 'O', '1105 Central N Expwy Ste 360', 'Allen', 'Collin', 'TX', '75013', '2146911902', '2149871945', '1105 Central N Expwy Ste 360', 'Allen', 'Collin', 'TX', '75013', '2146911902', '2149871945', 'DALLAS4', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1720034804', 0, 'N', 0, '2013-06-05', NULL, NULL, 33.1161, -96.6711, NULL, NULL),
('752788839', 'ELUC00029', 'ELUC00029', 'TXDALSTD', 'Urology Clinics of North Texas', 'Chester', 'F', 'Graham', 'MD', 'Urology', '', '', NULL, 'B', '7515 Greenville Ave Ste 900', 'Dallas', 'Dallas', 'TX', '75231', '2146928262', '2146964190', '7515 Greenville Ave Ste 900', 'Dallas', 'Dallas', 'TX', '75231', '2146928262', '2146964190', 'DALLAS4', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1720034804', 0, 'Y', 0, '2013-06-05', NULL, NULL, 32.884, -96.7598, NULL, NULL),
('752788839', 'ELUC00002', 'ELUC00002', 'TXDALSTD', 'Urology Clinics of North Texas', 'Elie', 'A', 'Benaim', 'MD', 'Urology', '', '', NULL, 'O', '4708 Alliance Blvd Ste 630', 'Plano ', 'Collin', 'TX', '75093', '4694671188', '9725667179', '4708 Alliance Blvd Ste 630', 'Plano ', 'Collin', 'TX', '75093', '4694671188', '9725667179', 'DALLAS4', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, NULL, NULL, 'HCFA|UB|', '1790748176', 0, 'N', 0, '2013-06-05', NULL, NULL, 33.0145, -96.7925, NULL, NULL),
('752788839', 'ELUC00003', 'ELUC00003', 'TXDALSTD', 'Urology Clinics of North Texas', 'Elie', 'A', 'Benaim', 'MD', 'Urology', '', '', NULL, 'B', '7515 Greenville Ave Ste 900', 'Dallas', 'Dallas', 'TX', '75231', '2146928262', '2146964190', '7515 Greenville Ave Ste 900', 'Dallas', 'Dallas', 'TX', '75231', '2146928262', '2146964190', 'DALLAS4', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, NULL, NULL, 'HCFA|UB|', '1790748176', 0, 'Y', 0, '2013-06-05', NULL, NULL, 32.884, -96.7598, NULL, NULL),
('752788839', 'ELUC00001', 'ELUC00001', 'TXDALSTD', 'Urology Clinics of North Texas', 'Elie', 'A', 'Benaim', 'MD', 'Urology', '', '', NULL, 'O', '7777 Forest Ln Ste A230', 'Dallas', 'Dallas', 'TX', '75230', '9725667765', '9725667179', '7777 Forest Ln Ste A230', 'Dallas', 'Dallas', 'TX', '75230', '9725667765', '9725667179', 'DALLAS4', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, NULL, NULL, 'HCFA|UB|', '1790748176', 0, 'N', 0, '2013-06-05', NULL, NULL, 32.9095, -96.7721, NULL, NULL),
('752788839', 'ELUC00014', 'ELUC00014', 'TXDALSTD', 'Urology Clinics of North Texas', 'Christopher', 'D', 'Fetner', 'MD', 'Urology', '', '', NULL, 'B', '7515 Greenville Ave Ste 900', 'Dallas', 'Dallas', 'TX', '75231', '2146928262', '2146964190', '7515 Greenville Ave Ste 900', 'Dallas', 'Dallas', 'TX', '75231', '2146928262', '2146964190', 'DALLAS4', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2014-06-21', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', '', '', '', 'HCFA|UB|', '1801859285', 0, 'Y', 0, '2014-05-21', NULL, NULL, 32.884, -96.7598, NULL, NULL),
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('331082073', 'W12028815', 'W12028815', 'TXSATSTD', 'Southeast Baptist Imaging Center', '', '', 'Southeast Baptist Imaging Center', 'Group', 'Imaging Center', 'Radiology', '', NULL, 'O', '4212 E Southcross Blvd', 'San Antonio', 'Bexar', 'TX', '78222', '2103043430', NULL, '4212 E Southcross Blvd', 'San Antonio', 'Bexar', 'TX', '78222', '2103043430', '          ', 'TXIMAG', '', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000008842', 0, 'N', 0, '2013-01-18', NULL, NULL, 29.3748, -98.412, NULL, NULL),
('363330928', 'ELRHC0182', 'ELRHC0182', 'ILCHIGSTD', 'Presence Center for Health', 'John', NULL, 'Evans', 'MD', 'Family Practice', '', '', NULL, 'O', '205 S NW Hwy', 'Park Ridge', 'Cook', 'IL', '60068', '8472925200', '8476923884', '205 S NW Hwy', 'Park Ridge', 'Cook', 'IL', '60068', '8472925200', '8476923884', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1003964156', 0, 'N', 0, '2013-02-27', NULL, NULL, 42.0091, -87.8262, NULL, NULL),
('362340313', 'W12028107', 'W12028107', 'ILCHIGSTD', 'NCH Immediate Care Center', '', '', 'NCH Immediate Care Center', '', 'Urgent Care', '', '', NULL, 'B', 'PO Box 95865', 'Chicago', 'Cook', 'IL', '60694', '8476181000', NULL, 'PO Box 95865', 'Chicago', 'Cook', 'IL', '60694', '8476181000', '          ', '', '', 'NCH', '0.00', '0.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000010032', 0, 'N', 0, '2013-01-03', NULL, NULL, 0, 0, NULL, NULL),
('760567380', 'W12025808', 'W12025808', 'TXHOUSTD', 'Respiratory and Sleep Disorders Specialists', '', '', 'Respiratory and Sleep Disorders Specialists', '', 'Clinics', '', '', NULL, 'B', 'PO Box 8307', 'The Woodlands', 'Montgomery', 'TX', '77387', '          ', NULL, 'PO Box 8307', 'The Woodlands', 'Montgomery', 'TX', '77387', '          ', '          ', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1851342794', 0, 'N', 0, '2013-01-09', NULL, NULL, 0, 0, NULL, NULL),
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('362170866', 'W12028088', 'W12028088', 'ILCHIGSTD', 'Ingalls Calumet City Family Care ', '', '', 'Ingalls Family Care Center', '', 'Urgent Care', '', '', NULL, 'O', '1600 Torrence Ave', 'Calumet City', 'Cook', 'IL', '60409', '7087301300', '7089152754', '1600 Torrence Ave', 'Calumet City', 'Cook', 'IL', '60409', '7087301300', '7089152754', '', '', '', '0.00', '62.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000010031', 0, 'N', 0, '2013-01-31', NULL, NULL, 41.5904, -87.5589, NULL, NULL),
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('362340313', 'W12028100', 'W12028100', 'ILCHIGSTD', 'NCH Immediate Care Center', '', '', 'NCH Immediate Care Center', '', 'Urgent Care', '', '', NULL, 'O', '519 S Roselle Rd', 'Schaumburg', 'Cook', 'IL', '60193', '8479850600', NULL, '519 S Roselle Rd', 'Schaumburg', 'Cook', 'IL', '60193', '8479850600', '          ', '', '', 'NCH', '0.00', '0.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000010032', 0, 'N', 0, '2013-01-03', NULL, NULL, 42.0183, -88.0799, NULL, NULL),
('450480099', 'ELIHR0025', 'ELIHR0025', 'TXDALSTD', 'American Radiology Consultants ', 'Mark', '', 'Hamilton', 'MD', 'Radiology', '', '', NULL, 'O', '712 N Washington Ave Ste 101', 'Dallas', 'Dallas', 'TX', '75246', '2148268822', '2148269792', '712 N Washington Ave Ste 101', 'Dallas', 'Dallas', 'TX', '75246', '2148268822', '2148269792', 'AMRAD', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', 'Baylor University Medical Center', NULL, NULL, 'HCFA|UB|', '1023062833', 0, 'Y', 0, '2014-02-12', NULL, NULL, 32.7913, -96.7785, NULL, NULL);
INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
('450480099', 'ELIHR0026', 'ELIHR0026', 'TXDALSTD', 'American Radiology Consultants ', 'Mark', '', 'Hamilton', 'MD', 'Radiology', '', '', NULL, 'B', 'PO Box 678253', 'Dallas', 'Dallas', 'TX', '75267', '2148268822', '2148269792', 'PO Box 678253', 'Dallas', 'Dallas', 'TX', '75267', '2148268822', '2148269792', 'AMRAD', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', 'Baylor University Medical Center', NULL, NULL, 'HCFA|UB|', '1023062833', 0, 'Y', 0, '2013-01-03', NULL, NULL, 0, 0, NULL, NULL),
('450480099', 'ELIHR0067', 'ELIHR0067', 'TXDALSTD', 'American Radiology Consultants ', 'Michael', NULL, 'Opatowsky', 'MD', 'Radiology', '', '', NULL, 'O', '712 N Washington Ave Ste 101', 'Dallas', 'Dallas', 'TX', '75246', '2148268822', '2148269792', '712 N Washington Ave Ste 101', 'Dallas', 'Dallas', 'TX', '75246', '2148268822', '2148269792', 'AMRAD', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', 'Baylor University Medical Center', NULL, NULL, 'HCFA|UB|', '1033163399', 0, 'Y', 0, '2013-01-03', NULL, NULL, 32.7913, -96.7785, NULL, NULL),
('450480099', 'ELIHR0068', 'ELIHR0068', 'TXDALSTD', 'American Radiology Consultants ', 'Michael', NULL, 'Opatowsky', 'MD', 'Radiology', '', '', NULL, 'B', 'PO Box 678253', 'Dallas', 'Dallas', 'TX', '75267', '2148268822', '2148269792', 'PO Box 678253', 'Dallas', 'Dallas', 'TX', '75267', '2148268822', '2148269792', 'AMRAD', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', 'Baylor University Medical Center', NULL, NULL, 'HCFA|UB|', '1033163399', 0, 'Y', 0, '2013-01-03', NULL, NULL, 0, 0, NULL, NULL),
('450480099', 'ELIHR0075', 'ELIHR0075', 'TXDALSTD', 'American Radiology Consultants ', 'Marco ', NULL, 'Cura', 'MD', 'Radiology', '', '', NULL, 'O', '712 N Washington Ave Ste 101', 'Dallas', 'Dallas', 'TX', '75246', '2148268822', '2148269792', '712 N Washington Ave Ste 101', 'Dallas', 'Dallas', 'TX', '75246', '2148268822', '2148269792', 'AMRAD', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1043327026', 0, 'Y', 0, '2013-01-03', NULL, NULL, 32.7913, -96.7785, NULL, NULL),
('450480099', 'ELIHR0076', 'ELIHR0076', 'TXDALSTD', 'American Radiology Consultants ', 'Marco ', NULL, 'Cura', 'MD', 'Radiology', '', '', NULL, 'B', 'PO Box 678253', 'Dallas', 'Dallas', 'TX', '75267', '2148268822', '2148269792', 'PO Box 678253', 'Dallas', 'Dallas', 'TX', '75267', '2148268822', '2148269792', 'AMRAD', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1043327026', 0, 'Y', 0, '2013-01-03', NULL, NULL, 0, 0, NULL, NULL),
('450480099', 'ELIHR0021', 'ELIHR0021', 'TXDALSTD', 'American Radiology Consultants ', 'Mark', NULL, 'Fulmer', 'MD', 'Radiology', '', '', NULL, 'O', '712 N Washington Ave Ste 101', 'Dallas', 'Dallas', 'TX', '75246', '2148268822', '2148269792', '712 N Washington Ave Ste 101', 'Dallas', 'Dallas', 'TX', '75246', '2148268822', '2148269792', 'AMRAD', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', 'Baylor University Medical Center', 'Baylor Medical Center at Uptown', NULL, 'HCFA|UB|', '1053364844', 0, 'Y', 0, '2013-01-03', NULL, NULL, 32.7913, -96.7785, NULL, NULL),
('450480099', 'ELIHR0022', 'ELIHR0022', 'TXDALSTD', 'American Radiology Consultants ', 'Mark', NULL, 'Fulmer', 'MD', 'Radiology', '', '', NULL, 'B', 'PO Box 678253', 'Dallas', 'Dallas', 'TX', '75267', '2148268822', '2148269792', 'PO Box 678253', 'Dallas', 'Dallas', 'TX', '75267', '2148268822', '2148269792', 'AMRAD', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', 'Baylor University Medical Center', 'Baylor Medical Center at Uptown', NULL, 'HCFA|UB|', '1053364844', 0, 'Y', 0, '2013-01-03', NULL, NULL, 0, 0, NULL, NULL),
('450480099', 'ELIHR0013', 'ELIHR0013', 'TXDALSTD', 'American Radiology Consultants ', 'Dee', NULL, 'Dockery', 'MD', 'Radiology', '', '', NULL, 'O', '712 N Washington Ave Ste 101', 'Dallas', 'Dallas', 'TX', '75246', '2148268822', '2148269792', '712 N Washington Ave Ste 101', 'Dallas', 'Dallas', 'TX', '75246', '2148268822', '2148269792', 'AMRAD', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', 'Baylor University Medical Center', NULL, NULL, 'HCFA|UB|', '1053364927', 0, 'Y', 0, '2013-01-03', NULL, NULL, 32.7913, -96.7785, NULL, NULL),
('450480099', 'ELIHR0014', 'ELIHR0014', 'TXDALSTD', 'American Radiology Consultants ', 'Dee', NULL, 'Dockery', 'MD', 'Radiology', '', '', NULL, 'B', 'PO Box 678253', 'Dallas', 'Dallas', 'TX', '75267', '2148268822', '2148269792', 'PO Box 678253', 'Dallas', 'Dallas', 'TX', '75267', '2148268822', '2148269792', 'AMRAD', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', 'Baylor University Medical Center', NULL, NULL, 'HCFA|UB|', '1053364927', 0, 'Y', 0, '2013-01-03', NULL, NULL, 0, 0, NULL, NULL),
('450480099', 'ELIHR0103', 'ELIHR0103', 'TXDALSTD', 'American Radiology Consultants ', 'Umesh', NULL, 'Oza', 'MD', 'Radiology', '', '', NULL, 'O', '712 N Washington Ave Ste 101', 'Dallas', 'Dallas', 'TX', '75246', '2148268822', '2148269792', '712 N Washington Ave Ste 101', 'Dallas', 'Dallas', 'TX', '75246', '2148268822', '2148269792', 'AMRAD', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', 'Baylor University Medical Center', NULL, NULL, 'HCFA|UB|', '1093768053', 0, 'Y', 0, '2013-01-03', NULL, NULL, 32.7913, -96.7785, NULL, NULL),
('450480099', 'ELIHR0104', 'ELIHR0104', 'TXDALSTD', 'American Radiology Consultants ', 'Umesh', NULL, 'Oza', 'MD', 'Radiology', '', '', NULL, 'B', 'PO Box 678253', 'Dallas', 'Dallas', 'TX', '75267', '2148268822', '2148269792', 'PO Box 678253', 'Dallas', 'Dallas', 'TX', '75267', '2148268822', '2148269792', 'AMRAD', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', 'Baylor University Medical Center', NULL, NULL, 'HCFA|UB|', '1093768053', 0, 'Y', 0, '2013-01-03', NULL, NULL, 0, 0, NULL, NULL),
('450480099', 'ELIHR0079', 'ELIHR0079', 'TXDALSTD', 'American Radiology Consultants ', 'James', NULL, 'Meler', 'MD', 'Radiology', '', '', NULL, 'O', '712 N Washington Ave Ste 101', 'Dallas', 'Dallas', 'TX', '75246', '2148268822', '2148269792', '712 N Washington Ave Ste 101', 'Dallas', 'Dallas', 'TX', '75246', '2148268822', '2148269792', 'AMRAD', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1114966702', 0, 'Y', 0, '2013-01-03', NULL, NULL, 32.7913, -96.7785, NULL, NULL),
('450480099', 'ELIHR0080', 'ELIHR0080', 'TXDALSTD', 'American Radiology Consultants ', 'James', NULL, 'Meler', 'MD', 'Radiology', '', '', NULL, 'B', 'PO Box 678253', 'Dallas', 'Dallas', 'TX', '75267', '2148268822', '2148269792', 'PO Box 678253', 'Dallas', 'Dallas', 'TX', '75267', '2148268822', '2148269792', 'AMRAD', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1114966702', 0, 'Y', 0, '2013-01-03', NULL, NULL, 0, 0, NULL, NULL),
('450480099', 'ELIHR0039', 'ELIHR0039', 'TXDALSTD', 'American Radiology Consultants ', 'Greg', NULL, 'Schucany', 'MD', 'Radiology', '', '', NULL, 'O', '712 N Washington Ave Ste 101', 'Dallas', 'Dallas', 'TX', '75246', '2148268822', '2148269792', '712 N Washington Ave Ste 101', 'Dallas', 'Dallas', 'TX', '75246', '2148268822', '2148269792', 'AMRAD', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', 'Baylor University Medical Center', NULL, NULL, 'HCFA|UB|', '1114970910', 0, 'Y', 0, '2013-01-03', NULL, NULL, 32.7913, -96.7785, NULL, NULL),
('450480099', 'ELIHR0040', 'ELIHR0040', 'TXDALSTD', 'American Radiology Consultants ', 'Greg', NULL, 'Schucany', 'MD', 'Radiology', '', '', NULL, 'B', 'PO Box 678253', 'Dallas', 'Dallas', 'TX', '75267', '2148268822', '2148269792', 'PO Box 678253', 'Dallas', 'Dallas', 'TX', '75267', '2148268822', '2148269792', 'AMRAD', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', 'Baylor University Medical Center', NULL, NULL, 'HCFA|UB|', '1114970910', 0, 'Y', 0, '2013-01-03', NULL, NULL, 0, 0, NULL, NULL),
('450480099', 'ELIHR0023', 'ELIHR0023', 'TXDALSTD', 'American Radiology Consultants ', 'Karl', NULL, 'Glastad', 'MD', 'Radiology', '', '', NULL, 'O', '712 N Washington Ave Ste 101', 'Dallas', 'Dallas', 'TX', '75246', '2148268822', '2148269792', '712 N Washington Ave Ste 101', 'Dallas', 'Dallas', 'TX', '75246', '2148268822', '2148269792', 'AMRAD', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', 'Baylor University Medical Center', NULL, NULL, 'HCFA|UB|', '1114971165', 0, 'Y', 0, '2013-01-03', NULL, NULL, 32.7913, -96.7785, NULL, NULL),
('450480099', 'ELIHR0024', 'ELIHR0024', 'TXDALSTD', 'American Radiology Consultants ', 'Karl', NULL, 'Glastad', 'MD', 'Radiology', '', '', NULL, 'B', 'PO Box 678253', 'Dallas', 'Dallas', 'TX', '75267', '2148268822', '2148269792', 'PO Box 678253', 'Dallas', 'Dallas', 'TX', '75267', '2148268822', '2148269792', 'AMRAD', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', 'Baylor University Medical Center', NULL, NULL, 'HCFA|UB|', '1114971165', 0, 'Y', 0, '2013-01-03', NULL, NULL, 0, 0, NULL, NULL),
('450480099', 'ELIHR0029', 'ELIHR0029', 'TXDALSTD', 'American Radiology Consultants ', 'Louba', NULL, 'Laurie', 'MD', 'Radiology', '', '', NULL, 'O', '712 N Washington Ave Ste 101', 'Dallas', 'Dallas', 'TX', '75246', '2148268822', '2148269792', '712 N Washington Ave Ste 101', 'Dallas', 'Dallas', 'TX', '75246', '2148268822', '2148269792', 'AMRAD', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', 'Baylor University Medical Center', NULL, NULL, 'HCFA|UB|', '1124067798', 0, 'Y', 0, '2013-01-03', NULL, NULL, 32.7913, -96.7785, NULL, NULL),
('450480099', 'ELIHR0030', 'ELIHR0030', 'TXDALSTD', 'American Radiology Consultants ', 'Louba', NULL, 'Laurie', 'MD', 'Radiology', '', '', NULL, 'B', 'PO Box 678253', 'Dallas', 'Dallas', 'TX', '75267', '2148268822', '2148269792', 'PO Box 678253', 'Dallas', 'Dallas', 'TX', '75267', '2148268822', '2148269792', 'AMRAD', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', 'Baylor University Medical Center', NULL, NULL, 'HCFA|UB|', '1124067798', 0, 'Y', 0, '2013-01-03', NULL, NULL, 0, 0, NULL, NULL),
('450480099', 'ELIHR0053', 'ELIHR0053', 'TXDALSTD', 'American Radiology Consultants ', 'Mark', NULL, 'Zibilich', 'MD', 'Radiology', '', '', NULL, 'O', '712 N Washington Ave Ste 101', 'Dallas', 'Dallas', 'TX', '75246', '2148268822', '2148269792', '712 N Washington Ave Ste 101', 'Dallas', 'Dallas', 'TX', '75246', '2148268822', '2148269792', 'AMRAD', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', 'Baylor University Medical Center', NULL, NULL, 'HCFA|UB|', '1134168735', 0, 'Y', 0, '2013-01-03', NULL, NULL, 32.7913, -96.7785, NULL, NULL),
('450480099', 'ELIHR0054', 'ELIHR0054', 'TXDALSTD', 'American Radiology Consultants ', 'Mark', NULL, 'Zibilich', 'MD', 'Radiology', '', '', NULL, 'B', 'PO Box 678253', 'Dallas', 'Dallas', 'TX', '75267', '2148268822', '2148269792', 'PO Box 678253', 'Dallas', 'Dallas', 'TX', '75267', '2148268822', '2148269792', 'AMRAD', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', 'Baylor University Medical Center', NULL, NULL, 'HCFA|UB|', '1134168735', 0, 'Y', 0, '2013-01-03', NULL, NULL, 0, 0, NULL, NULL),
('450480099', 'ELIHR0033', 'ELIHR0033', 'TXDALSTD', 'American Radiology Consultants ', 'Julie', NULL, 'OConner', 'MD', 'Radiology', '', '', NULL, 'O', '712 N Washington Ave Ste 101', 'Dallas', 'Dallas', 'TX', '75246', '2148268822', '2148269792', '712 N Washington Ave Ste 101', 'Dallas', 'Dallas', 'TX', '75246', '2148268822', '2148269792', 'AMRAD', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', 'Baylor University Medical Center', NULL, NULL, 'HCFA|UB|', '1164632360', 0, 'Y', 0, '2013-01-03', NULL, NULL, 32.7913, -96.7785, NULL, NULL),
('450480099', 'ELIHR0034', 'ELIHR0034', 'TXDALSTD', 'American Radiology Consultants ', 'Julie', NULL, 'OConner', 'MD', 'Radiology', '', '', NULL, 'B', 'PO Box 678253', 'Dallas', 'Dallas', 'TX', '75267', '2148268822', '2148269792', 'PO Box 678253', 'Dallas', 'Dallas', 'TX', '75267', '2148268822', '2148269792', 'AMRAD', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', 'Baylor University Medical Center', NULL, NULL, 'HCFA|UB|', '1164632360', 0, 'Y', 0, '2013-01-03', NULL, NULL, 0, 0, NULL, NULL),
('450480099', 'ELIHR0065', 'ELIHR0065', 'TXDALSTD', 'American Radiology Consultants ', 'Kenneth', NULL, 'Layton', 'MD', 'Radiology', '', '', NULL, 'O', '712 N Washington Ave Ste 101', 'Dallas', 'Dallas', 'TX', '75246', '2148268822', '2148269792', '712 N Washington Ave Ste 101', 'Dallas', 'Dallas', 'TX', '75246', '2148268822', '2148269792', 'AMRAD', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', 'Baylor University Medical Center', NULL, NULL, 'HCFA|UB|', '1194705301', 0, 'Y', 0, '2013-01-03', NULL, NULL, 32.7913, -96.7785, NULL, NULL),
('450480099', 'ELIHR0066', 'ELIHR0066', 'TXDALSTD', 'American Radiology Consultants ', 'Kenneth', NULL, 'Layton', 'MD', 'Radiology', '', '', NULL, 'B', 'PO Box 678253', 'Dallas', 'Dallas', 'TX', '75267', '2148268822', '2148269792', 'PO Box 678253', 'Dallas', 'Dallas', 'TX', '75267', '2148268822', '2148269792', 'AMRAD', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', 'Baylor University Medical Center', NULL, NULL, 'HCFA|UB|', '1194705301', 0, 'Y', 0, '2013-01-03', NULL, NULL, 0, 0, NULL, NULL),
('450480099', 'ELIHR0005', 'ELIHR0005', 'TXDALSTD', 'American Radiology Consultants ', 'Walter', NULL, 'Cannon', 'MD', 'Radiology', '', '', NULL, 'O', '712 N Washington Ave Ste 101', 'Dallas', 'Dallas', 'TX', '75246', '2148268822', '2148269792', '712 N Washington Ave Ste 101', 'Dallas', 'Dallas', 'TX', '75246', '2148268822', '2148269792', 'AMRAD', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', 'Baylor University Medical Center', NULL, NULL, 'HCFA|UB|', '1205889003', 0, 'Y', 0, '2013-01-03', NULL, NULL, 32.7913, -96.7785, NULL, NULL),
('450480099', 'ELIHR0006', 'ELIHR0006', 'TXDALSTD', 'American Radiology Consultants ', 'Walter', NULL, 'Cannon', 'MD', 'Radiology', '', '', NULL, 'B', 'PO Box 678253', 'Dallas', 'Dallas', 'TX', '75267', '2148268822', '2148269792', 'PO Box 678253', 'Dallas', 'Dallas', 'TX', '75267', '2148268822', '2148269792', 'AMRAD', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', 'Baylor University Medical Center', NULL, NULL, 'HCFA|UB|', '1205889003', 0, 'Y', 0, '2013-01-03', NULL, NULL, 0, 0, NULL, NULL),
('450480099', 'ELIHR0049', 'ELIHR0049', 'TXDALSTD', 'American Radiology Consultants ', 'Gregory', '', 'Weisbruch', 'MD', 'Radiology', '', '', NULL, 'O', '712 N Washington Ave Ste 101', 'Dallas', 'Dallas', 'TX', '75246', '2148268822', '2148269792', '712 N Washington Ave Ste 101', 'Dallas', 'Dallas', 'TX', '75246', '2148268822', '2148269792', 'AMRAD', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', 'Baylor University Medical Center', NULL, NULL, 'HCFA|UB|', '1215980040', 0, 'Y', 0, '2013-06-11', NULL, NULL, 32.7913, -96.7785, NULL, NULL),
('450480099', 'ELIHR0050', 'ELIHR0050', 'TXDALSTD', 'American Radiology Consultants ', 'Gregory', '', 'Weisbruch', 'MD', 'Radiology', '', '', NULL, 'B', 'PO Box 678253', 'Dallas', 'Dallas', 'TX', '75267', '2148268822', '2148269792', 'PO Box 678253', 'Dallas', 'Dallas', 'TX', '75267', '2148268822', '2148269792', 'AMRAD', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', 'Baylor University Medical Center', NULL, NULL, 'HCFA|UB|', '1215980040', 0, 'Y', 0, '2013-06-11', NULL, NULL, 0, 0, NULL, NULL),
('450480099', 'ELIHR0003', 'ELIHR0003', 'TXDALSTD', 'American Radiology Consultants ', 'Erin', NULL, 'Bowman', 'MD', 'Radiology', '', '', NULL, 'O', '712 N Washington Ave Ste 101', 'Dallas', 'Dallas', 'TX', '75246', '2148268822', '2148269792', '712 N Washington Ave Ste 101', 'Dallas', 'Dallas', 'TX', '75246', '2148268822', '2148269792', 'AMRAD', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', 'Baylor University Medical Center', NULL, NULL, 'HCFA|UB|', '1265642524', 0, 'Y', 0, '2013-01-03', NULL, NULL, 32.7913, -96.7785, NULL, NULL),
('450480099', 'ELIHR0004', 'ELIHR0004', 'TXDALSTD', 'American Radiology Consultants ', 'Erin', NULL, 'Bowman', 'MD', 'Radiology', '', '', NULL, 'B', 'PO Box 678253', 'Dallas', 'Dallas', 'TX', '75267', '2148268822', '2148269792', 'PO Box 678253', 'Dallas', 'Dallas', 'TX', '75267', '2148268822', '2148269792', 'AMRAD', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', 'Baylor University Medical Center', NULL, NULL, 'HCFA|UB|', '1265642524', 0, 'Y', 0, '2013-01-03', NULL, NULL, 0, 0, NULL, NULL),
('450480099', 'ELIHR0027', 'ELIHR0027', 'TXDALSTD', 'American Radiology Consultants ', 'David', NULL, 'Hurst', 'MD', 'Radiology', '', '', NULL, 'O', '712 N Washington Ave Ste 101', 'Dallas', 'Dallas', 'TX', '75246', '2148268822', '2148269792', '712 N Washington Ave Ste 101', 'Dallas', 'Dallas', 'TX', '75246', '2148268822', '2148269792', 'AMRAD', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', 'Baylor University Medical Center', NULL, NULL, 'HCFA|UB|', '1306899109', 0, 'Y', 0, '2013-01-03', NULL, NULL, 32.7913, -96.7785, NULL, NULL),
('450480099', 'ELIHR0028', 'ELIHR0028', 'TXDALSTD', 'American Radiology Consultants ', 'David', NULL, 'Hurst', 'MD', 'Radiology', '', '', NULL, 'B', 'PO Box 678253', 'Dallas', 'Dallas', 'TX', '75267', '2148268822', '2148269792', 'PO Box 678253', 'Dallas', 'Dallas', 'TX', '75267', '2148268822', '2148269792', 'AMRAD', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', 'Baylor University Medical Center', NULL, NULL, 'HCFA|UB|', '1306899109', 0, 'Y', 0, '2013-01-03', NULL, NULL, 0, 0, NULL, NULL),
('450480099', 'ELIHR0091', 'ELIHR0091', 'TXDALSTD', 'American Radiology Consultants ', 'Joseph', '', 'Spigel', 'MD', 'Radiology', '', '', NULL, 'O', '712 N Washington Ave Ste 101', 'Dallas', 'Dallas', 'TX', '75246', '2148268822', '2148269792', '712 N Washington Ave Ste 101', 'Dallas', 'Dallas', 'TX', '75246', '2148268822', '2148269792', 'AMRAD', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', 'Baylor Medical Center at Uptown', 'Baylor University Medical Center', NULL, 'HCFA|UB|', '1306899133', 0, 'Y', 0, '2013-06-11', NULL, NULL, 32.7913, -96.7785, NULL, NULL),
('450480099', 'ELIHR0092', 'ELIHR0092', 'TXDALSTD', 'American Radiology Consultants ', 'Joseph', '', 'Spigel', 'MD', 'Radiology', '', '', NULL, 'B', 'PO Box 678253', 'Dallas', 'Dallas', 'TX', '75267', '2148268822', '2148269792', 'PO Box 678253', 'Dallas', 'Dallas', 'TX', '75267', '2148268822', '2148269792', 'AMRAD', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', 'Baylor Medical Center at Uptown', 'Baylor University Medical Center', NULL, 'HCFA|UB|', '1306899133', 0, 'Y', 0, '2013-06-11', NULL, NULL, 0, 0, NULL, NULL),
('450480099', 'ELIHR0047', 'ELIHR0047', 'TXDALSTD', 'American Radiology Consultants ', 'Heather', NULL, 'Webb', 'MD', 'Radiology', '', '', NULL, 'O', '712 N Washington Ave Ste 101', 'Dallas', 'Dallas', 'TX', '75246', '2148268822', '2148269792', '712 N Washington Ave Ste 101', 'Dallas', 'Dallas', 'TX', '75246', '2148268822', '2148269792', 'AMRAD', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', 'Baylor University Medical Center', NULL, NULL, 'HCFA|UB|', '1316157977', 0, 'Y', 0, '2013-01-03', NULL, NULL, 32.7913, -96.7785, NULL, NULL),
('450480099', 'ELIHR0048', 'ELIHR0048', 'TXDALSTD', 'American Radiology Consultants ', 'Heather', NULL, 'Webb', 'MD', 'Radiology', '', '', NULL, 'B', 'PO Box 678253', 'Dallas', 'Dallas', 'TX', '75267', '2148268822', '2148269792', 'PO Box 678253', 'Dallas', 'Dallas', 'TX', '75267', '2148268822', '2148269792', 'AMRAD', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', 'Baylor University Medical Center', NULL, NULL, 'HCFA|UB|', '1316157977', 0, 'Y', 0, '2013-01-03', NULL, NULL, 0, 0, NULL, NULL),
('450480099', 'ELIHR0041', 'ELIHR0041', 'TXDALSTD', 'American Radiology Consultants ', 'Rich', NULL, 'Seggerman', 'MD', 'Radiology', '', '', NULL, 'O', '712 N Washington Ave Ste 101', 'Dallas', 'Dallas', 'TX', '75246', '2148268822', '2148269792', '712 N Washington Ave Ste 101', 'Dallas', 'Dallas', 'TX', '75246', '2148268822', '2148269792', 'AMRAD', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', 'Baylor University Medical Center', NULL, NULL, 'HCFA|UB|', '1366495798', 0, 'Y', 0, '2013-06-11', NULL, NULL, 32.7913, -96.7785, NULL, NULL),
('450480099', 'ELIHR0042', 'ELIHR0042', 'TXDALSTD', 'American Radiology Consultants ', 'Rich', NULL, 'Seggerman', 'MD', 'Radiology', '', '', NULL, 'B', 'PO Box 678253', 'Dallas', 'Dallas', 'TX', '75267', '2148268822', '2148269792', 'PO Box 678253', 'Dallas', 'Dallas', 'TX', '75267', '2148268822', '2148269792', 'AMRAD', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', 'Baylor University Medical Center', NULL, NULL, 'HCFA|UB|', '1366495798', 0, 'Y', 0, '2013-01-03', NULL, NULL, 0, 0, NULL, NULL),
('450480099', 'ELIHR0089', 'ELIHR0089', 'TXDALSTD', 'American Radiology Consultants ', 'Zeeshan', NULL, 'Shah', 'MD', 'Radiology', '', '', NULL, 'O', '712 N Washington Ave Ste 101', 'Dallas', 'Dallas', 'TX', '75246', '2148268822', '2148269792', '712 N Washington Ave Ste 101', 'Dallas', 'Dallas', 'TX', '75246', '2148268822', '2148269792', 'AMRAD', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', 'Baylor University Medical Center', 'Baylor Medical Center at Uptown', NULL, 'HCFA|UB|', '1407834963', 0, 'Y', 0, '2013-01-03', NULL, NULL, 32.7913, -96.7785, NULL, NULL),
('450480099', 'ELIHR0090', 'ELIHR0090', 'TXDALSTD', 'American Radiology Consultants ', 'Zeeshan', NULL, 'Shah', 'MD', 'Radiology', '', '', NULL, 'B', 'PO Box 678253', 'Dallas', 'Dallas', 'TX', '75267', '2148268822', '2148269792', 'PO Box 678253', 'Dallas', 'Dallas', 'TX', '75267', '2148268822', '2148269792', 'AMRAD', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', 'Baylor University Medical Center', 'Baylor Medical Center at Uptown', NULL, 'HCFA|UB|', '1407834963', 0, 'Y', 0, '2013-01-03', NULL, NULL, 0, 0, NULL, NULL),
('450480099', 'ELIHR0009', 'ELIHR0009', 'TXDALSTD', 'American Radiology Consultants ', 'Amy', NULL, 'Childs', 'MD', 'Radiology', '', '', NULL, 'O', '712 N Washington Ave Ste 101', 'Dallas', 'Dallas', 'TX', '75246', '2148268822', '2148269792', '712 N Washington Ave Ste 101', 'Dallas', 'Dallas', 'TX', '75246', '2148268822', '2148269792', 'AMRAD', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', 'Baylor University Medical Center', NULL, NULL, 'HCFA|UB|', '1407895063', 0, 'Y', 0, '2013-01-03', NULL, NULL, 32.7913, -96.7785, NULL, NULL),
('450480099', 'ELIHR0010', 'ELIHR0010', 'TXDALSTD', 'American Radiology Consultants ', 'Amy', NULL, 'Childs', 'MD', 'Radiology', '', '', NULL, 'B', 'PO Box 678253', 'Dallas', 'Dallas', 'TX', '75267', '2148268822', '2148269792', 'PO Box 678253', 'Dallas', 'Dallas', 'TX', '75267', '2148268822', '2148269792', 'AMRAD', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', 'Baylor University Medical Center', NULL, NULL, 'HCFA|UB|', '1407895063', 0, 'Y', 0, '2013-01-03', NULL, NULL, 0, 0, NULL, NULL),
('450480099', 'ELIHR0001', 'ELIHR0001', 'TXDALSTD', 'American Radiology Consultants ', 'Julia ', NULL, 'Agostini', 'MD', 'Radiology', '', '', NULL, 'O', '712 N Washington Ave Ste 101', 'Dallas', 'Dallas', 'TX', '75246', '2148268822', '2148269792', '712 N Washington Ave Ste 101', 'Dallas', 'Dallas', 'TX', '75246', '2148268822', '2148269792', 'AMRAD', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', 'Baylor University Medical Center', NULL, NULL, 'HCFA|UB|', '1417900390', 0, 'Y', 0, '2013-01-03', NULL, NULL, 32.7913, -96.7785, NULL, NULL),
('450480099', 'ELIHR0002', 'ELIHR0002', 'TXDALSTD', 'American Radiology Consultants ', 'Julia ', NULL, 'Agostini', 'MD', 'Radiology', '', '', NULL, 'B', 'PO Box 678253', 'Dallas', 'Dallas', 'TX', '75267', '2148268822', '2148269792', 'PO Box 678253', 'Dallas', 'Dallas', 'TX', '75267', '2148268822', '2148269792', 'AMRAD', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', 'Baylor University Medical Center', NULL, NULL, 'HCFA|UB|', '1417900390', 0, 'Y', 0, '2013-01-03', NULL, NULL, 0, 0, NULL, NULL),
('450480099', 'ELIHR0085', 'ELIHR0085', 'TXDALSTD', 'American Radiology Consultants ', 'Guillermo', 'W', 'DeLeon', 'MD', 'Radiology', '', '', NULL, 'O', '712 N Washington Ave Ste 101', 'Dallas', 'Dallas', 'TX', '75246', '2148268822', '2148269792', '712 N Washington Ave Ste 101', 'Dallas', 'Dallas', 'TX', '75246', '2148268822', '2148269792', 'AMRAD', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', 'Baylor University Medical Center', 'Baylor Medical Center at Uptown', NULL, 'HCFA|UB|', '1427001320', 0, 'Y', 0, '2014-02-12', NULL, NULL, 32.7913, -96.7785, NULL, NULL),
('450480099', 'ELIHR0086', 'ELIHR0086', 'TXDALSTD', 'American Radiology Consultants ', 'Guillermo', 'W', 'DeLeon', 'MD', 'Radiology', '', '', NULL, 'B', 'PO Box 678253', 'Dallas', 'Dallas', 'TX', '75267', '2148268822', '2148269792', 'PO Box 678253', 'Dallas', 'Dallas', 'TX', '75267', '2148268822', '2148269792', 'AMRAD', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', 'Baylor University Medical Center', 'Baylor Medical Center at Uptown', NULL, 'HCFA|UB|', '1427001320', 0, 'Y', 0, '2013-01-03', NULL, NULL, 0, 0, NULL, NULL),
('450480099', 'ELIHR0011', 'ELIHR0011', 'TXDALSTD', 'American Radiology Consultants ', 'Gregory', '', 'DePrisco', 'MD', 'Radiology', '', '', NULL, 'O', '712 N Washington Ave Ste 101', 'Dallas', 'Dallas', 'TX', '75246', '2148268822', '2148269792', '712 N Washington Ave Ste 101', 'Dallas', 'Dallas', 'TX', '75246', '2148268822', '2148269792', 'AMRAD', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', 'Baylor University Medical Center', NULL, NULL, 'HCFA|UB|', '1437357142', 0, 'Y', 0, '2013-06-11', NULL, NULL, 32.7913, -96.7785, NULL, NULL),
('450480099', 'ELIHR0012', 'ELIHR0012', 'TXDALSTD', 'American Radiology Consultants ', 'Gregory', '', 'DePrisco', 'MD', 'Radiology', '', '', NULL, 'B', 'PO Box 678253', 'Dallas', 'Dallas', 'TX', '75267', '2148268822', '2148269792', 'PO Box 678253', 'Dallas', 'Dallas', 'TX', '75267', '2148268822', '2148269792', 'AMRAD', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', 'Baylor University Medical Center', NULL, NULL, 'HCFA|UB|', '1437357142', 0, 'Y', 0, '2013-06-11', NULL, NULL, 0, 0, NULL, NULL),
('450480099', 'ELIHR0057', 'ELIHR0057', 'TXDALSTD', 'American Radiology Consultants ', 'Manu', NULL, 'Gupta', 'MD', 'Radiology', '', '', NULL, 'O', '712 N Washington Ave Ste 101', 'Dallas', 'Dallas', 'TX', '75246', '2148268822', '2148269792', '712 N Washington Ave Ste 101', 'Dallas', 'Dallas', 'TX', '75246', '2148268822', '2148269792', 'AMRAD', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', 'Baylor University Medical Center', NULL, NULL, 'HCFA|UB|', '1477507234', 0, 'Y', 0, '2013-01-03', NULL, NULL, 32.7913, -96.7785, NULL, NULL),
('450480099', 'ELIHR0058', 'ELIHR0058', 'TXDALSTD', 'American Radiology Consultants ', 'Manu', NULL, 'Gupta', 'MD', 'Radiology', '', '', NULL, 'B', 'PO Box 678253', 'Dallas', 'Dallas', 'TX', '75267', '2148268822', '2148269792', 'PO Box 678253', 'Dallas', 'Dallas', 'TX', '75267', '2148268822', '2148269792', 'AMRAD', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', 'Baylor University Medical Center', NULL, NULL, 'HCFA|UB|', '1477507234', 0, 'Y', 0, '2013-01-03', NULL, NULL, 0, 0, NULL, NULL),
('450480099', 'ELIHR0051', 'ELIHR0051', 'TXDALSTD', 'American Radiology Consultants ', 'Wendy', NULL, 'Wong', 'MD', 'Radiology', '', '', NULL, 'O', '712 N Washington Ave Ste 101', 'Dallas', 'Dallas', 'TX', '75246', '2148268822', '2148269792', '712 N Washington Ave Ste 101', 'Dallas', 'Dallas', 'TX', '75246', '2148268822', '2148269792', 'AMRAD', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', 'Baylor University Medical Center', NULL, NULL, 'HCFA|UB|', '1508810136', 0, 'Y', 0, '2013-01-03', NULL, NULL, 32.7913, -96.7785, NULL, NULL),
('450480099', 'ELIHR0052', 'ELIHR0052', 'TXDALSTD', 'American Radiology Consultants ', 'Wendy', NULL, 'Wong', 'MD', 'Radiology', '', '', NULL, 'B', 'PO Box 678253', 'Dallas', 'Dallas', 'TX', '75267', '2148268822', '2148269792', 'PO Box 678253', 'Dallas', 'Dallas', 'TX', '75267', '2148268822', '2148269792', 'AMRAD', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', 'Baylor University Medical Center', NULL, NULL, 'HCFA|UB|', '1508810136', 0, 'Y', 0, '2013-01-03', NULL, NULL, 0, 0, NULL, NULL),
('450480099', 'ELIHR0083', 'ELIHR0083', 'TXDALSTD', 'American Radiology Consultants ', 'Patricia', NULL, 'DeLeon', 'MD', 'Radiology', '', '', NULL, 'O', '712 N Washington Ave Ste 101', 'Dallas', 'Dallas', 'TX', '75246', '2148268822', '2148269792', '712 N Washington Ave Ste 101', 'Dallas', 'Dallas', 'TX', '75246', '2148268822', '2148269792', 'AMRAD', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', 'Baylor Medical Center at Uptown', 'Baylor University Medical Center', NULL, 'HCFA|UB|', '1518910413', 0, 'Y', 0, '2013-01-03', NULL, NULL, 32.7913, -96.7785, NULL, NULL),
('450480099', 'ELIHR0084', 'ELIHR0084', 'TXDALSTD', 'American Radiology Consultants ', 'Patricia', NULL, 'DeLeon', 'MD', 'Radiology', '', '', NULL, 'B', 'PO Box 678253', 'Dallas', 'Dallas', 'TX', '75267', '2148268822', '2148269792', 'PO Box 678253', 'Dallas', 'Dallas', 'TX', '75267', '2148268822', '2148269792', 'AMRAD', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', 'Baylor Medical Center at Uptown', 'Baylor University Medical Center', NULL, 'HCFA|UB|', '1518910413', 0, 'Y', 0, '2013-01-03', NULL, NULL, 0, 0, NULL, NULL),
('450480099', 'ELIHR0037', 'ELIHR0037', 'TXDALSTD', 'American Radiology Consultants ', 'Aarthi', NULL, 'Sankaran', 'MD', 'Radiology', '', '', NULL, 'O', '712 N Washington Ave Ste 101', 'Dallas', 'Dallas', 'TX', '75246', '2148268822', '2148269792', '712 N Washington Ave Ste 101', 'Dallas', 'Dallas', 'TX', '75246', '2148268822', '2148269792', 'AMRAD', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', 'Baylor University Medical Center', NULL, NULL, 'HCFA|UB|', '1538219373', 0, 'Y', 0, '2013-01-03', NULL, NULL, 32.7913, -96.7785, NULL, NULL),
('450480099', 'ELIHR0038', 'ELIHR0038', 'TXDALSTD', 'American Radiology Consultants ', 'Aarthi', NULL, 'Sankaran', 'MD', 'Radiology', '', '', NULL, 'B', 'PO Box 678253', 'Dallas', 'Dallas', 'TX', '75267', '2148268822', '2148269792', 'PO Box 678253', 'Dallas', 'Dallas', 'TX', '75267', '2148268822', '2148269792', 'AMRAD', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', 'Baylor University Medical Center', NULL, NULL, 'HCFA|UB|', '1538219373', 0, 'Y', 0, '2013-01-03', NULL, NULL, 0, 0, NULL, NULL),
('450480099', 'ELIHR0035', 'ELIHR0035', 'TXDALSTD', 'American Radiology Consultants ', 'Suraj', NULL, 'Reddy', 'MD', 'Radiology', '', '', NULL, 'O', '712 N Washington Ave Ste 101', 'Dallas', 'Dallas', 'TX', '75246', '2148268822', '2148269792', '712 N Washington Ave Ste 101', 'Dallas', 'Dallas', 'TX', '75246', '2148268822', '2148269792', 'AMRAD', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', 'Baylor University Medical Center', NULL, NULL, 'HCFA|UB|', '1538379805', 0, 'Y', 0, '2013-01-03', NULL, NULL, 32.7913, -96.7785, NULL, NULL),
('450480099', 'ELIHR0036', 'ELIHR0036', 'TXDALSTD', 'American Radiology Consultants ', 'Suraj', NULL, 'Reddy', 'MD', 'Radiology', '', '', NULL, 'B', 'PO Box 678253', 'Dallas', 'Dallas', 'TX', '75267', '2148268822', '2148269792', 'PO Box 678253', 'Dallas', 'Dallas', 'TX', '75267', '2148268822', '2148269792', 'AMRAD', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', 'Baylor University Medical Center', NULL, NULL, 'HCFA|UB|', '1538379805', 0, 'Y', 0, '2013-01-03', NULL, NULL, 0, 0, NULL, NULL),
('450480099', 'ELIHR0063', 'ELIHR0063', 'TXDALSTD', 'American Radiology Consultants ', 'Joseph', '', 'Hise', 'MD', 'Radiology', '', '', NULL, 'O', '712 N Washington Ave Ste 101', 'Dallas', 'Dallas', 'TX', '75246', '2148268822', '2148269792', '712 N Washington Ave Ste 101', 'Dallas', 'Dallas', 'TX', '75246', '2148268822', '2148269792', 'AMRAD', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', 'Baylor University Medical Center', NULL, NULL, 'HCFA|UB|', '1568415230', 0, 'Y', 0, '2013-06-11', NULL, NULL, 32.7913, -96.7785, NULL, NULL),
('450480099', 'ELIHR0064', 'ELIHR0064', 'TXDALSTD', 'American Radiology Consultants ', 'Joseph', '', 'Hise', 'MD', 'Radiology', '', '', NULL, 'B', 'PO Box 678253', 'Dallas', 'Dallas', 'TX', '75267', '2148268822', '2148269792', 'PO Box 678253', 'Dallas', 'Dallas', 'TX', '75267', '2148268822', '2148269792', 'AMRAD', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', 'Baylor University Medical Center', NULL, NULL, 'HCFA|UB|', '1568415230', 0, 'Y', 0, '2013-06-11', NULL, NULL, 0, 0, NULL, NULL),
('450480099', 'ELIHR0081', 'ELIHR0081', 'TXDALSTD', 'American Radiology Consultants ', 'Chet', NULL, 'Rees', 'MD', 'Radiology', '', '', NULL, 'O', '712 N Washington Ave Ste 101', 'Dallas', 'Dallas', 'TX', '75246', '2148268822', '2148269792', '712 N Washington Ave Ste 101', 'Dallas', 'Dallas', 'TX', '75246', '2148268822', '2148269792', 'AMRAD', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1568416329', 0, 'Y', 0, '2013-01-03', NULL, NULL, 32.7913, -96.7785, NULL, NULL),
('450480099', 'ELIHR0082', 'ELIHR0082', 'TXDALSTD', 'American Radiology Consultants ', 'Chet', NULL, 'Rees', 'MD', 'Radiology', '', '', NULL, 'B', 'PO Box 678253', 'Dallas', 'Dallas', 'TX', '75267', '2148268822', '2148269792', 'PO Box 678253', 'Dallas', 'Dallas', 'TX', '75267', '2148268822', '2148269792', 'AMRAD', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1568416329', 0, 'Y', 0, '2013-01-03', NULL, NULL, 0, 0, NULL, NULL),
('450480099', 'ELIHR0055', 'ELIHR0055', 'TXDALSTD', 'American Radiology Consultants ', 'Steven', '', 'Gilbert', 'MD', 'Radiology', '', '', NULL, 'O', '712 N Washington Ave Ste 101', 'Dallas', 'Dallas', 'TX', '75246', '2148268822', '2148269792', '712 N Washington Ave Ste 101', 'Dallas', 'Dallas', 'TX', '75246', '2148268822', '2148269792', 'AMRAD', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', 'Baylor University Medical Center', NULL, NULL, 'HCFA|UB|', '1578516993', 0, 'Y', 0, '2013-06-11', NULL, NULL, 32.7913, -96.7785, NULL, NULL),
('450480099', 'ELIHR0056', 'ELIHR0056', 'TXDALSTD', 'American Radiology Consultants ', 'Steven', '', 'Gilbert', 'MD', 'Radiology', '', '', NULL, 'B', 'PO Box 678253', 'Dallas', 'Dallas', 'TX', '75267', '2148268822', '2148269792', 'PO Box 678253', 'Dallas', 'Dallas', 'TX', '75267', '2148268822', '2148269792', 'AMRAD', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', 'Baylor University Medical Center', NULL, NULL, 'HCFA|UB|', '1578516993', 0, 'Y', 0, '2013-06-11', NULL, NULL, 0, 0, NULL, NULL),
('450480099', 'ELIHR0017', 'ELIHR0017', 'TXDALSTD', 'American Radiology Consultants ', 'Kathryn', NULL, 'Ferry', 'MD', 'Radiology', '', '', NULL, 'O', '712 N Washington Ave Ste 101', 'Dallas', 'Dallas', 'TX', '75246', '2148268822', '2148269792', '712 N Washington Ave Ste 101', 'Dallas', 'Dallas', 'TX', '75246', '2148268822', '2148269792', 'AMRAD', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1578527776', 0, 'Y', 0, '2013-01-03', NULL, NULL, 32.7913, -96.7785, NULL, NULL),
('450480099', 'ELIHR0018', 'ELIHR0018', 'TXDALSTD', 'American Radiology Consultants ', 'Kathryn', NULL, 'Ferry', 'MD', 'Radiology', '', '', NULL, 'B', 'PO Box 678253', 'Dallas', 'Dallas', 'TX', '75267', '2148268822', '2148269792', 'PO Box 678253', 'Dallas', 'Dallas', 'TX', '75267', '2148268822', '2148269792', 'AMRAD', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1578527776', 0, 'Y', 0, '2013-01-03', NULL, NULL, 0, 0, NULL, NULL),
('450480099', 'ELIHR0087', 'ELIHR0087', 'TXDALSTD', 'American Radiology Consultants ', 'Raynal', NULL, 'Hamilton', 'MD', 'Radiology', '', '', NULL, 'O', '712 N Washington Ave Ste 101', 'Dallas', 'Dallas', 'TX', '75246', '2148268822', '2148269792', '712 N Washington Ave Ste 101', 'Dallas', 'Dallas', 'TX', '75246', '2148268822', '2148269792', 'AMRAD', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', 'Baylor University Medical Center', 'Baylor Medical Center at Uptown', NULL, 'HCFA|UB|', '1598975237', 0, 'Y', 0, '2013-01-03', NULL, NULL, 32.7913, -96.7785, NULL, NULL),
('450480099', 'ELIHR0088', 'ELIHR0088', 'TXDALSTD', 'American Radiology Consultants ', 'Raynal', NULL, 'Hamilton', 'MD', 'Radiology', '', '', NULL, 'B', 'PO Box 678253', 'Dallas', 'Dallas', 'TX', '75267', '2148268822', '2148269792', 'PO Box 678253', 'Dallas', 'Dallas', 'TX', '75267', '2148268822', '2148269792', 'AMRAD', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', 'Baylor University Medical Center', 'Baylor Medical Center at Uptown', NULL, 'HCFA|UB|', '1598975237', 0, 'Y', 0, '2013-01-03', NULL, NULL, 0, 0, NULL, NULL),
('450480099', 'ELIHR0099', 'ELIHR0099', 'TXDALSTD', 'American Radiology Consultants ', 'Kristin', NULL, 'Joyner', 'MD', 'Radiology', '', '', NULL, 'O', '712 N Washington Ave Ste 101', 'Dallas', 'Dallas', 'TX', '75246', '2148268822', '2148269792', '712 N Washington Ave Ste 101', 'Dallas', 'Dallas', 'TX', '75246', '2148268822', '2148269792', 'AMRAD', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', 'Baylor University Medical Center', NULL, NULL, 'HCFA|UB|', '1609925098', 0, 'Y', 0, '2013-01-03', NULL, NULL, 32.7913, -96.7785, NULL, NULL),
('450480099', 'ELIHR0100', 'ELIHR0100', 'TXDALSTD', 'American Radiology Consultants ', 'Kristin', NULL, 'Joyner', 'MD', 'Radiology', '', '', NULL, 'B', 'PO Box 678253', 'Dallas', 'Dallas', 'TX', '75267', '2148268822', '2148269792', 'PO Box 678253', 'Dallas', 'Dallas', 'TX', '75267', '2148268822', '2148269792', 'AMRAD', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', 'Baylor University Medical Center', NULL, NULL, 'HCFA|UB|', '1609925098', 0, 'Y', 0, '2013-01-03', NULL, NULL, 0, 0, NULL, NULL),
('450480099', 'ELIHR0071', 'ELIHR0071', 'TXDALSTD', 'American Radiology Consultants ', 'Joseph', NULL, 'Philip', 'MD', 'Radiology', '', '', NULL, 'O', '712 N Washington Ave Ste 101', 'Dallas', 'Dallas', 'TX', '75246', '2148268822', '2148269792', '712 N Washington Ave Ste 101', 'Dallas', 'Dallas', 'TX', '75246', '2148268822', '2148269792', 'AMRAD', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', 'Baylor University Medical Center', NULL, NULL, 'HCFA|UB|', '1619920402', 0, 'Y', 0, '2013-01-03', NULL, NULL, 32.7913, -96.7785, NULL, NULL),
('450480099', 'ELIHR0072', 'ELIHR0072', 'TXDALSTD', 'American Radiology Consultants ', 'Joseph', NULL, 'Philip', 'MD', 'Radiology', '', '', NULL, 'B', 'PO Box 678253', 'Dallas', 'Dallas', 'TX', '75267', '2148268822', '2148269792', 'PO Box 678253', 'Dallas', 'Dallas', 'TX', '75267', '2148268822', '2148269792', 'AMRAD', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', 'Baylor University Medical Center', NULL, NULL, 'HCFA|UB|', '1619920402', 0, 'Y', 0, '2013-01-03', NULL, NULL, 0, 0, NULL, NULL),
('450480099', 'ELIHR0019', 'ELIHR0019', 'TXDALSTD', 'American Radiology Consultants ', 'Kenneth', '', 'Ford', 'MD', 'Radiology', '', '', NULL, 'O', '712 N Washington Ave Ste 101', 'Dallas', 'Dallas', 'TX', '75246', '2148268822', '2148269792', '712 N Washington Ave Ste 101', 'Dallas', 'Dallas', 'TX', '75246', '2148268822', '2148269792', 'AMRAD', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', 'Baylor University Medical Center', NULL, NULL, 'HCFA|UB|', '1639122427', 0, 'Y', 0, '2013-06-11', NULL, NULL, 32.7913, -96.7785, NULL, NULL),
('450480099', 'ELIHR0020', 'ELIHR0020', 'TXDALSTD', 'American Radiology Consultants ', 'Kenneth', '', 'Ford', 'MD', 'Radiology', '', '', NULL, 'B', 'PO Box 678253', 'Dallas', 'Dallas', 'TX', '75267', '2148268822', '2148269792', 'PO Box 678253', 'Dallas', 'Dallas', 'TX', '75267', '2148268822', '2148269792', 'AMRAD', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', 'Baylor University Medical Center', NULL, NULL, 'HCFA|UB|', '1639122427', 0, 'Y', 0, '2013-06-11', NULL, NULL, 0, 0, NULL, NULL),
('450480099', 'ELIHR0061', 'ELIHR0061', 'TXDALSTD', 'American Radiology Consultants ', 'Jeffrey ', NULL, 'Haithcock', 'MD', 'Radiology', '', '', NULL, 'O', '712 N Washington Ave Ste 101', 'Dallas', 'Dallas', 'TX', '75246', '2148268822', '2148269792', '712 N Washington Ave Ste 101', 'Dallas', 'Dallas', 'TX', '75246', '2148268822', '2148269792', 'AMRAD', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1649360900', 0, 'Y', 0, '2013-01-03', NULL, NULL, 32.7913, -96.7785, NULL, NULL),
('450480099', 'ELIHR0062', 'ELIHR0062', 'TXDALSTD', 'American Radiology Consultants ', 'Jeffrey ', NULL, 'Haithcock', 'MD', 'Radiology', '', '', NULL, 'B', 'PO Box 678253', 'Dallas', 'Dallas', 'TX', '75267', '2148268822', '2148269792', 'PO Box 678253', 'Dallas', 'Dallas', 'TX', '75267', '2148268822', '2148269792', 'AMRAD', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1649360900', 0, 'Y', 0, '2013-01-03', NULL, NULL, 0, 0, NULL, NULL),
('450480099', 'ELIHR0045', 'ELIHR0045', 'TXDALSTD', 'American Radiology Consultants ', 'Eric', NULL, 'Tingle', 'MD', 'Radiology', '', '', NULL, 'O', '712 N Washington Ave Ste 101', 'Dallas', 'Dallas', 'TX', '75246', '2148268822', '2148269792', '712 N Washington Ave Ste 101', 'Dallas', 'Dallas', 'TX', '75246', '2148268822', '2148269792', 'AMRAD', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', 'Baylor University Medical Center', NULL, NULL, 'HCFA|UB|', '1700096906', 0, 'Y', 0, '2013-01-03', NULL, NULL, 32.7913, -96.7785, NULL, NULL),
('450480099', 'ELIHR0046', 'ELIHR0046', 'TXDALSTD', 'American Radiology Consultants ', 'Eric', NULL, 'Tingle', 'MD', 'Radiology', '', '', NULL, 'B', 'PO Box 678253', 'Dallas', 'Dallas', 'TX', '75267', '2148268822', '2148269792', 'PO Box 678253', 'Dallas', 'Dallas', 'TX', '75267', '2148268822', '2148269792', 'AMRAD', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', 'Baylor University Medical Center', NULL, NULL, 'HCFA|UB|', '1700096906', 0, 'Y', 0, '2013-01-03', NULL, NULL, 0, 0, NULL, NULL),
('450480099', 'ELIHR0073', 'ELIHR0073', 'TXDALSTD', 'American Radiology Consultants ', 'Ike', NULL, 'Thacker', 'MD', 'Radiology', '', '', NULL, 'O', '712 N Washington Ave Ste 101', 'Dallas', 'Dallas', 'TX', '75246', '2148268822', '2148269792', '712 N Washington Ave Ste 101', 'Dallas', 'Dallas', 'TX', '75246', '2148268822', '2148269792', 'AMRAD', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', 'Baylor University Medical Center', NULL, NULL, 'HCFA|UB|', '1720031511', 0, 'Y', 0, '2013-01-03', NULL, NULL, 32.7913, -96.7785, NULL, NULL),
('450480099', 'ELIHR0074', 'ELIHR0074', 'TXDALSTD', 'American Radiology Consultants ', 'Ike', NULL, 'Thacker', 'MD', 'Radiology', '', '', NULL, 'B', 'PO Box 678253', 'Dallas', 'Dallas', 'TX', '75267', '2148268822', '2148269792', 'PO Box 678253', 'Dallas', 'Dallas', 'TX', '75267', '2148268822', '2148269792', 'AMRAD', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', 'Baylor University Medical Center', NULL, NULL, 'HCFA|UB|', '1720031511', 0, 'Y', 0, '2013-01-03', NULL, NULL, 0, 0, NULL, NULL),
('450480099', 'ELIHR0007', 'ELIHR0007', 'TXDALSTD', 'American Radiology Consultants ', 'Brett', NULL, 'Carter', 'MD', 'Radiology', '', '', NULL, 'O', '712 N Washington Ave Ste 101', 'Dallas', 'Dallas', 'TX', '75246', '2148268822', '2148269792', '712 N Washington Ave Ste 101', 'Dallas', 'Dallas', 'TX', '75246', '2148268822', '2148269792', 'AMRAD', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1740490903', 0, 'Y', 0, '2013-01-03', NULL, NULL, 32.7913, -96.7785, NULL, NULL),
('450480099', 'ELIHR0008', 'ELIHR0008', 'TXDALSTD', 'American Radiology Consultants ', 'Brett', NULL, 'Carter', 'MD', 'Radiology', '', '', NULL, 'B', 'PO Box 678253', 'Dallas', 'Dallas', 'TX', '75267', '2148268822', '2148269792', 'PO Box 678253', 'Dallas', 'Dallas', 'TX', '75267', '2148268822', '2148269792', 'AMRAD', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1740490903', 0, 'Y', 0, '2013-01-03', NULL, NULL, 0, 0, NULL, NULL),
('450480099', 'ELIHR0097', 'ELIHR0097', 'TXDALSTD', 'American Radiology Consultants ', 'Hamid', NULL, 'Latifi', 'MD', 'Radiology', '', '', NULL, 'O', '712 N Washington Ave Ste 101', 'Dallas', 'Dallas', 'TX', '75246', '2148268822', '2148269792', '712 N Washington Ave Ste 101', 'Dallas', 'Dallas', 'TX', '75246', '2148268822', '2148269792', 'AMRAD', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', 'Baylor University Medical Center', NULL, NULL, 'HCFA|UB|', '1750335527', 0, 'Y', 0, '2013-01-03', NULL, NULL, 32.7913, -96.7785, NULL, NULL);
INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
('450480099', 'ELIHR0098', 'ELIHR0098', 'TXDALSTD', 'American Radiology Consultants ', 'Hamid', NULL, 'Latifi', 'MD', 'Radiology', '', '', NULL, 'B', 'PO Box 678253', 'Dallas', 'Dallas', 'TX', '75267', '2148268822', '2148269792', 'PO Box 678253', 'Dallas', 'Dallas', 'TX', '75267', '2148268822', '2148269792', 'AMRAD', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', 'Baylor University Medical Center', NULL, NULL, 'HCFA|UB|', '1750335527', 0, 'Y', 0, '2013-01-03', NULL, NULL, 0, 0, NULL, NULL),
('450480099', 'ELIHR0031', 'ELIHR0031', 'TXDALSTD', 'American Radiology Consultants ', 'Tyler', NULL, 'Leete', 'MD', 'Radiology', '', '', NULL, 'O', '712 N Washington Ave Ste 101', 'Dallas', 'Dallas', 'TX', '75246', '2148268822', '2148269792', '712 N Washington Ave Ste 101', 'Dallas', 'Dallas', 'TX', '75246', '2148268822', '2148269792', 'AMRAD', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', 'Baylor University Medical Center', NULL, NULL, 'HCFA|UB|', '1760692115', 0, 'Y', 0, '2013-01-03', NULL, NULL, 32.7913, -96.7785, NULL, NULL),
('450480099', 'ELIHR0032', 'ELIHR0032', 'TXDALSTD', 'American Radiology Consultants ', 'Tyler', NULL, 'Leete', 'MD', 'Radiology', '', '', NULL, 'B', 'PO Box 678253', 'Dallas', 'Dallas', 'TX', '75267', '2148268822', '2148269792', 'PO Box 678253', 'Dallas', 'Dallas', 'TX', '75267', '2148268822', '2148269792', 'AMRAD', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', 'Baylor University Medical Center', NULL, NULL, 'HCFA|UB|', '1760692115', 0, 'Y', 0, '2013-01-03', NULL, NULL, 0, 0, NULL, NULL),
('450480099', 'ELIHR0069', 'ELIHR0069', 'TXDALSTD', 'American Radiology Consultants ', 'Brian', NULL, 'ORourke', 'MD', 'Radiology', '', '', NULL, 'O', '712 N Washington Ave Ste 101', 'Dallas', 'Dallas', 'TX', '75246', '2148268822', '2148269792', '712 N Washington Ave Ste 101', 'Dallas', 'Dallas', 'TX', '75246', '2148268822', '2148269792', 'AMRAD', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', 'Baylor University Medical Center', NULL, NULL, 'HCFA|UB|', '1770537540', 0, 'Y', 0, '2013-01-03', NULL, NULL, 32.7913, -96.7785, NULL, NULL),
('450480099', 'ELIHR0070', 'ELIHR0070', 'TXDALSTD', 'American Radiology Consultants ', 'Brian', NULL, 'ORourke', 'MD', 'Radiology', '', '', NULL, 'B', 'PO Box 678253', 'Dallas', 'Dallas', 'TX', '75267', '2148268822', '2148269792', 'PO Box 678253', 'Dallas', 'Dallas', 'TX', '75267', '2148268822', '2148269792', 'AMRAD', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', 'Baylor University Medical Center', NULL, NULL, 'HCFA|UB|', '1770537540', 0, 'Y', 0, '2013-01-03', NULL, NULL, 0, 0, NULL, NULL),
('450480099', 'ELIHR0015', 'ELIHR0015', 'TXDALSTD', 'American Radiology Consultants ', 'Daniel', '', 'Felter', 'MD', 'Radiology', '', '', NULL, 'O', '712 N Washington Ave Ste 101', 'Dallas', 'Dallas', 'TX', '75246', '2148268822', '2148269792', '712 N Washington Ave Ste 101', 'Dallas', 'Dallas', 'TX', '75246', '2148268822', '2148269792', 'AMRAD', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', 'Baylor University Medical Center', NULL, NULL, 'HCFA|UB|', '1780894147', 0, 'Y', 0, '2013-06-11', NULL, NULL, 32.7913, -96.7785, NULL, NULL),
('450480099', 'ELIHR0016', 'ELIHR0016', 'TXDALSTD', 'American Radiology Consultants ', 'Daniel', '', 'Felter', 'MD', 'Radiology', '', '', NULL, 'B', 'PO Box 678253', 'Dallas', 'Dallas', 'TX', '75267', '2148268822', '2148269792', 'PO Box 678253', 'Dallas', 'Dallas', 'TX', '75267', '2148268822', '2148269792', 'AMRAD', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', 'Baylor University Medical Center', NULL, NULL, 'HCFA|UB|', '1780894147', 0, 'Y', 0, '2013-06-11', NULL, NULL, 0, 0, NULL, NULL),
('450480099', 'ELIHR0059', 'ELIHR0059', 'TXDALSTD', 'American Radiology Consultants ', 'Conan', NULL, 'Gomez', 'MD', 'Radiology', '', '', NULL, 'O', '712 N Washington Ave Ste 101', 'Dallas', 'Dallas', 'TX', '75246', '2148268822', '2148269792', '712 N Washington Ave Ste 101', 'Dallas', 'Dallas', 'TX', '75246', '2148268822', '2148269792', 'AMRAD', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', 'Baylor University Medical Center', NULL, NULL, 'HCFA|UB|', '1801006523', 0, 'Y', 0, '2013-01-03', NULL, NULL, 32.7913, -96.7785, NULL, NULL),
('450480099', 'ELIHR0060', 'ELIHR0060', 'TXDALSTD', 'American Radiology Consultants ', 'Conan', NULL, 'Gomez', 'MD', 'Radiology', '', '', NULL, 'B', 'PO Box 678253', 'Dallas', 'Dallas', 'TX', '75267', '2148268822', '2148269792', 'PO Box 678253', 'Dallas', 'Dallas', 'TX', '75267', '2148268822', '2148269792', 'AMRAD', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', 'Baylor University Medical Center', NULL, NULL, 'HCFA|UB|', '1801006523', 0, 'Y', 0, '2013-01-03', NULL, NULL, 0, 0, NULL, NULL),
('450480099', 'ELIHR0043', 'ELIHR0043', 'TXDALSTD', 'American Radiology Consultants ', 'Michael', '', 'Smerud', 'MD', 'Radiology', '', '', NULL, 'O', '712 N Washington Ave Ste 101', 'Dallas', 'Dallas', 'TX', '75246', '2148268822', '2148269792', '712 N Washington Ave Ste 101', 'Dallas', 'Dallas', 'TX', '75246', '2148268822', '2148269792', 'AMRAD', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', 'Baylor University Medical Center', NULL, NULL, 'HCFA|UB|', '1841244613', 0, 'Y', 0, '2013-06-11', NULL, NULL, 32.7913, -96.7785, NULL, NULL),
('450480099', 'ELIHR0044', 'ELIHR0044', 'TXDALSTD', 'American Radiology Consultants ', 'Michael', '', 'Smerud', 'MD', 'Radiology', '', '', NULL, 'B', 'PO Box 678253', 'Dallas', 'Dallas', 'TX', '75267', '2148268822', '2148269792', 'PO Box 678253', 'Dallas', 'Dallas', 'TX', '75267', '2148268822', '2148269792', 'AMRAD', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', 'Baylor University Medical Center', NULL, NULL, 'HCFA|UB|', '1841244613', 0, 'Y', 0, '2013-06-11', NULL, NULL, 0, 0, NULL, NULL),
('450480099', 'ELIHR0095', 'ELIHR0095', 'TXDALSTD', 'American Radiology Consultants ', 'Landis', NULL, 'Griffeth', 'MD', 'Radiology', '', '', NULL, 'O', '712 N Washington Ave Ste 101', 'Dallas', 'Dallas', 'TX', '75246', '2148268822', '2148269792', '712 N Washington Ave Ste 101', 'Dallas', 'Dallas', 'TX', '75246', '2148268822', '2148269792', 'AMRAD', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1861446635', 0, 'Y', 0, '2013-01-03', NULL, NULL, 32.7913, -96.7785, NULL, NULL),
('450480099', 'ELIHR0096', 'ELIHR0096', 'TXDALSTD', 'American Radiology Consultants ', 'Landis', NULL, 'Griffeth', 'MD', 'Radiology', '', '', NULL, 'B', 'PO Box 678253', 'Dallas', 'Dallas', 'TX', '75267', '2148268822', '2148269792', 'PO Box 678253', 'Dallas', 'Dallas', 'TX', '75267', '2148268822', '2148269792', 'AMRAD', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1861446635', 0, 'Y', 0, '2013-01-03', NULL, NULL, 0, 0, NULL, NULL),
('450480099', 'ELIHR0093', 'ELIHR0093', 'TXDALSTD', 'American Radiology Consultants ', 'Jean', NULL, 'Wang', 'MD', 'Radiology', '', '', NULL, 'O', '712 N Washington Ave Ste 101', 'Dallas', 'Dallas', 'TX', '75246', '2148268822', '2148269792', '712 N Washington Ave Ste 101', 'Dallas', 'Dallas', 'TX', '75246', '2148268822', '2148269792', 'AMRAD', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', 'Baylor University Medical Center', 'Baylor Medical Center at Uptown', NULL, 'HCFA|UB|', '1932153988', 0, 'Y', 0, '2013-01-03', NULL, NULL, 32.7913, -96.7785, NULL, NULL),
('450480099', 'ELIHR0094', 'ELIHR0094', 'TXDALSTD', 'American Radiology Consultants ', 'Jean', NULL, 'Wang', 'MD', 'Radiology', '', '', NULL, 'B', 'PO Box 678253', 'Dallas', 'Dallas', 'TX', '75267', '2148268822', '2148269792', 'PO Box 678253', 'Dallas', 'Dallas', 'TX', '75267', '2148268822', '2148269792', 'AMRAD', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', 'Baylor University Medical Center', 'Baylor Medical Center at Uptown', NULL, 'HCFA|UB|', '1932153988', 0, 'Y', 0, '2013-01-03', NULL, NULL, 0, 0, NULL, NULL),
('450480099', 'ELIHR0077', 'ELIHR0077', 'TXDALSTD', 'American Radiology Consultants ', 'Norman', '', 'Diamond', 'MD', 'Radiology', '', '', NULL, 'O', '712 N Washington Ave Ste 101', 'Dallas', 'Dallas', 'TX', '75246', '2148268822', '2148269792', '712 N Washington Ave Ste 101', 'Dallas', 'Dallas', 'TX', '75246', '2148268822', '2148269792', 'AMRAD', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1982657888', 0, 'Y', 0, '2013-01-03', NULL, NULL, 32.7913, -96.7785, NULL, NULL),
('450480099', 'ELIHR0078', 'ELIHR0078', 'TXDALSTD', 'American Radiology Consultants ', 'Norman', '', 'Diamond', 'MD', 'Radiology', '', '', NULL, 'B', 'PO Box 678253', 'Dallas', 'Dallas', 'TX', '75267', '2148268822', '2148269792', 'PO Box 678253', 'Dallas', 'Dallas', 'TX', '75267', '2148268822', '2148269792', 'AMRAD', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1982657888', 0, 'Y', 0, '2013-01-03', NULL, NULL, 0, 0, NULL, NULL),
('760567380', 'ELIHSD013', 'ELIHSD013', 'TXHOUSTD', 'Respiratory and Sleep Disorders Specialists', 'Jefy', 'M', 'Mathew', 'MD', 'Pulmonary', '', '', NULL, 'O', '1111 Medical Plaza Dr Ste 250', 'The Woodlands', 'Montgomery', 'TX', '77380', '2812968788', '2814191291', '1111 Medical Plaza Dr Ste 250', 'The Woodlands', 'Montgomery', 'TX', '77380', '2812968788', '2814191291', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1083602080', 0, 'N', 0, '2013-01-03', NULL, NULL, 30.1726, -95.455, NULL, NULL),
('760567380', 'ELIHSD015', 'ELIHSD015', 'TXHOUSTD', 'Respiratory and Sleep Disorders Specialists', 'Jefy', 'M', 'Mathew', 'MD', 'Pulmonary', '', '', NULL, 'O', '1125 Cypress Station Dr Ste E', 'Houston', 'Harris', 'TX', '77090', '2815376300', '2815377575', '1125 Cypress Station Dr Ste E', 'Houston', 'Harris', 'TX', '77090', '2815376300', '2815377575', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1083602080', 0, 'N', 0, '2013-01-03', NULL, NULL, 30.0241, -95.4395, NULL, NULL),
('760567380', 'ELIHSD014', 'ELIHSD014', 'TXHOUSTD', 'Respiratory and Sleep Disorders Specialists', 'Jefy', 'M', 'Mathew', 'MD', 'Pulmonary', '', '', NULL, 'O', '17350 St Lukes Way Ste 470', 'The Woodlands', 'Montgomery', 'TX', '77384', '9363215100', '9363215120', '17350 St Lukes Wy Ste 470', 'The Woodlands', 'Montgomery', 'TX', '77384', '9363215100', '9363215120', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1083602080', 0, 'N', 0, '2013-01-03', NULL, NULL, 30.2017, -95.4595, NULL, NULL),
('760567380', 'ELIHSD016', 'ELIHSD016', 'TXHOUSTD', 'Respiratory and Sleep Disorders Specialists', 'Jefy', 'M', 'Mathew', 'MD', 'Pulmonary', '', '', NULL, 'O', '20207 Chasewood Park Dr Ste 203', 'Houston', 'Harris', 'TX', '77070', '2815376300', '2815377575', '20207 Chasewood Park Dr Ste 203', 'Houston', 'Harris', 'TX', '77070', '2815376300', '2815377575', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1083602080', 0, 'N', 0, '2013-01-03', NULL, NULL, 29.989, -95.5702, NULL, NULL),
('760567380', 'ELIHSD021', 'ELIHSD021', 'TXHOUSTD', 'Respiratory and Sleep Disorders Specialists', 'William', NULL, 'Rhoton', 'MD', 'Pulmonary', '', '', NULL, 'O', '1111 Medical Plaza Dr Ste 250', 'The Woodlands', 'Montgomery', 'TX', '77380', '2812968788', '2814191291', '1111 Medical Plaza Dr Ste 250', 'The Woodlands', 'Montgomery', 'TX', '77380', '2812968788', '2814191291', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1154597300', 0, 'N', 0, '2013-01-03', NULL, NULL, 30.1726, -95.455, NULL, NULL),
('760567380', 'ELIHSD023', 'ELIHSD023', 'TXHOUSTD', 'Respiratory and Sleep Disorders Specialists', 'William', NULL, 'Rhoton', 'MD', 'Pulmonary', '', '', NULL, 'O', '1125 Cypress Station Dr Ste E', 'Houston', 'Harris', 'TX', '77090', '2815376300', '2815377575', '1125 Cypress Station Dr Ste E', 'Houston', 'Harris', 'TX', '77090', '2815376300', '2815377575', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1154597300', 0, 'N', 0, '2013-01-03', NULL, NULL, 30.0241, -95.4395, NULL, NULL),
('760567380', 'ELIHSD022', 'ELIHSD022', 'TXHOUSTD', 'Respiratory and Sleep Disorders Specialists', 'William', NULL, 'Rhoton', 'MD', 'Pulmonary', '', '', NULL, 'O', '17350 St Lukes Way Ste 470', 'The Woodlands', 'Montgomery', 'TX', '77384', '9363215100', '9363215120', '17350 St Lukes Wy Ste 470', 'The Woodlands', 'Montgomery', 'TX', '77384', '9363215100', '9363215120', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1154597300', 0, 'N', 0, '2013-01-03', NULL, NULL, 30.2017, -95.4595, NULL, NULL),
('760567380', 'ELIHSD024', 'ELIHSD024', 'TXHOUSTD', 'Respiratory and Sleep Disorders Specialists', 'William', NULL, 'Rhoton', 'MD', 'Pulmonary', '', '', NULL, 'O', '20207 Chasewood Park Dr Ste 203', 'Houston', 'Harris', 'TX', '77070', '2815376300', '2815377575', '20207 Chasewood Park Dr Ste 203', 'Houston', 'Harris', 'TX', '77070', '2815376300', '2815377575', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1154597300', 0, 'N', 0, '2013-01-03', NULL, NULL, 29.989, -95.5702, NULL, NULL),
('760567380', 'ELIHSD017', 'ELIHSD017', 'TXHOUSTD', 'Respiratory and Sleep Disorders Specialists', 'Rami', 'S', 'El Wali', 'MD', 'Pulmonary', '', '', NULL, 'O', '1111 Medical Plaza Dr Ste 250', 'The Woodlands', 'Montgomery', 'TX', '77380', '2812968788', '2814191291', '1111 Medical Plaza Dr Ste 250', 'The Woodlands', 'Montgomery', 'TX', '77380', '2812968788', '2814191291', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1235183203', 0, 'N', 0, '2013-01-03', NULL, NULL, 30.1726, -95.455, NULL, NULL),
('760567380', 'ELIHSD019', 'ELIHSD019', 'TXHOUSTD', 'Respiratory and Sleep Disorders Specialists', 'Rami', 'S', 'El Wali', 'MD', 'Pulmonary', '', '', NULL, 'O', '1125 Cypress Station Dr Ste E', 'Houston', 'Harris', 'TX', '77090', '2815376300', '2815377575', '1125 Cypress Station Dr Ste E', 'Houston', 'Harris', 'TX', '77090', '2815376300', '2815377575', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1235183203', 0, 'N', 0, '2013-01-03', NULL, NULL, 30.0241, -95.4395, NULL, NULL),
('760567380', 'ELIHSD018', 'ELIHSD018', 'TXHOUSTD', 'Respiratory and Sleep Disorders Specialists', 'Rami', 'S', 'El Wali', 'MD', 'Pulmonary', '', '', NULL, 'O', '17350 St Lukes Way Ste 470', 'The Woodlands', 'Montgomery', 'TX', '77384', '9363215100', '9363215120', '17350 St Lukes Wy Ste 470', 'The Woodlands', 'Montgomery', 'TX', '77384', '9363215100', '9363215120', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1235183203', 0, 'N', 0, '2013-01-03', NULL, NULL, 30.2017, -95.4595, NULL, NULL),
('760567380', 'ELIHSD020', 'ELIHSD020', 'TXHOUSTD', 'Respiratory and Sleep Disorders Specialists', 'Rami', 'S', 'El Wali', 'MD', 'Pulmonary', '', '', NULL, 'O', '20207 Chasewood Park Dr Ste 203', 'Houston', 'Harris', 'TX', '77070', '2815376300', '2815377575', '20207 Chasewood Park Dr Ste 203', 'Houston', 'Harris', 'TX', '77070', '2815376300', '2815377575', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1235183203', 0, 'N', 0, '2013-01-03', NULL, NULL, 29.989, -95.5702, NULL, NULL),
('760567380', 'ELIHSD025', 'ELIHSD025', 'TXHOUSTD', 'Respiratory and Sleep Disorders Specialists', 'Amarbir', 'S', 'Mattewal', 'MD', 'Pulmonary', '', '', NULL, 'O', '1111 Medical Plaza Dr Ste 250', 'The Woodlands', 'Montgomery', 'TX', '77380', '2812968788', '2814191291', '1111 Medical Plaza Dr Ste 250', 'The Woodlands', 'Montgomery', 'TX', '77380', '2812968788', '2814191291', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1346462660', 0, 'N', 0, '2013-01-03', NULL, NULL, 30.1726, -95.455, NULL, NULL),
('760567380', 'ELIHSD027', 'ELIHSD027', 'TXHOUSTD', 'Respiratory and Sleep Disorders Specialists', 'Amarbir', 'S', 'Mattewal', 'MD', 'Pulmonary', '', '', NULL, 'O', '1125 Cypress Station Dr Ste E', 'Houston', 'Harris', 'TX', '77090', '2815376300', '2815377575', '1125 Cypress Station Dr Ste E', 'Houston', 'Harris', 'TX', '77090', '2815376300', '2815377575', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1346462660', 0, 'N', 0, '2013-01-03', NULL, NULL, 30.0241, -95.4395, NULL, NULL),
('760567380', 'ELIHSD026', 'ELIHSD026', 'TXHOUSTD', 'Respiratory and Sleep Disorders Specialists', 'Amarbir', 'S', 'Mattewal', 'MD', 'Pulmonary', '', '', NULL, 'O', '17350 St Lukes Way Ste 470', 'The Woodlands', 'Montgomery', 'TX', '77384', '9363215100', '9363215120', '17350 St Lukes Wy Ste 470', 'The Woodlands', 'Montgomery', 'TX', '77384', '9363215100', '9363215120', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1346462660', 0, 'N', 0, '2013-01-03', NULL, NULL, 30.2017, -95.4595, NULL, NULL),
('760567380', 'ELIHSD028', 'ELIHSD028', 'TXHOUSTD', 'Respiratory and Sleep Disorders Specialists', 'Amarbir', 'S', 'Mattewal', 'MD', 'Pulmonary', '', '', NULL, 'O', '20207 Chasewood Park Dr Ste 203', 'Houston', 'Harris', 'TX', '77070', '2815376300', '2815377575', '20207 Chasewood Park Dr Ste 203', 'Houston', 'Harris', 'TX', '77070', '2815376300', '2815377575', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1346462660', 0, 'N', 0, '2013-01-03', NULL, NULL, 29.989, -95.5702, NULL, NULL),
('760567380', 'ELIHSD009', 'ELIHSD009', 'TXHOUSTD', 'Respiratory and Sleep Disorders Specialists', 'Mohsin', 'K', 'Bajwa', 'MD', 'Pulmonary', '', '', NULL, 'O', '1111 Medical Plaza Dr Ste 250', 'The Woodlands', 'Montgomery', 'TX', '77380', '2812968788', '2814191291', '1111 Medical Plaza Dr Ste 250', 'The Woodlands', 'Montgomery', 'TX', '77380', '2812968788', '2814191291', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1497743462', 0, 'N', 0, '2013-01-03', NULL, NULL, 30.1726, -95.455, NULL, NULL),
('760567380', 'ELIHSD011', 'ELIHSD011', 'TXHOUSTD', 'Respiratory and Sleep Disorders Specialists', 'Mohsin', 'K', 'Bajwa', 'MD', 'Pulmonary', '', '', NULL, 'O', '1125 Cypress Station Dr Ste E', 'Houston', 'Harris', 'TX', '77090', '2815376300', '2815377575', '1125 Cypress Station Dr Ste E', 'Houston', 'Harris', 'TX', '77090', '2815376300', '2815377575', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1497743462', 0, 'N', 0, '2013-01-03', NULL, NULL, 30.0241, -95.4395, NULL, NULL),
('760567380', 'ELIHSD010', 'ELIHSD010', 'TXHOUSTD', 'Respiratory and Sleep Disorders Specialists', 'Mohsin', 'K', 'Bajwa', 'MD', 'Pulmonary', '', '', NULL, 'O', '17350 St Lukes Way Ste 470', 'The Woodlands', 'Montgomery', 'TX', '77384', '9363215100', '9363215120', '17350 St Lukes Wy Ste 470', 'The Woodlands', 'Montgomery', 'TX', '77384', '9363215100', '9363215120', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1497743462', 0, 'N', 0, '2013-01-03', NULL, NULL, 30.2017, -95.4595, NULL, NULL),
('760567380', 'ELIHSD012', 'ELIHSD012', 'TXHOUSTD', 'Respiratory and Sleep Disorders Specialists', 'Mohsin', 'K', 'Bajwa', 'MD', 'Pulmonary', '', '', NULL, 'O', '20207 Chasewood Park Dr Ste 203', 'Houston', 'Harris', 'TX', '77070', '2815376300', '2815377575', '20207 Chasewood Park Dr Ste 203', 'Houston', 'Harris', 'TX', '77070', '2815376300', '2815377575', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1497743462', 0, 'N', 0, '2013-01-03', NULL, NULL, 29.989, -95.5702, NULL, NULL),
('760567380', 'ELIHSD001', 'ELIHSD001', 'TXHOUSTD', 'Respiratory and Sleep Disorders Specialists', 'Wael', NULL, 'Asi', 'MD', 'Pulmonary', '', '', NULL, 'O', '1111 Medical Plaza Dr Ste 250', 'The Woodlands', 'Montgomery', 'TX', '77380', '2812968788', '2814191291', '1111 Medical Plaza Dr Ste 250', 'The Woodlands', 'Montgomery', 'TX', '77380', '2812968788', '2814191291', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1578551537', 0, 'N', 0, '2013-01-03', NULL, NULL, 30.1726, -95.455, NULL, NULL),
('760567380', 'ELIHSD003', 'ELIHSD003', 'TXHOUSTD', 'Respiratory and Sleep Disorders Specialists', 'Wael', NULL, 'Asi', 'MD', 'Pulmonary', '', '', NULL, 'O', '1125 Cypress Station Dr Ste E', 'Houston', 'Harris', 'TX', '77090', '2815376300', '2815377575', '1125 Cypress Station Dr Ste E', 'Houston', 'Harris', 'TX', '77090', '2815376300', '2815377575', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1578551537', 0, 'N', 0, '2013-01-03', NULL, NULL, 30.0241, -95.4395, NULL, NULL),
('760567380', 'ELIHSD002', 'ELIHSD002', 'TXHOUSTD', 'Respiratory and Sleep Disorders Specialists', 'Wael', NULL, 'Asi', 'MD', 'Pulmonary', '', '', NULL, 'O', '17350 St Lukes Way Ste 470', 'The Woodlands', 'Montgomery', 'TX', '77384', '9363215100', '9363215120', '17350 St Lukes Wy Ste 470', 'The Woodlands', 'Montgomery', 'TX', '77384', '9363215100', '9363215120', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1578551537', 0, 'N', 0, '2013-01-03', NULL, NULL, 30.2017, -95.4595, NULL, NULL),
('760567380', 'ELIHSD004', 'ELIHSD004', 'TXHOUSTD', 'Respiratory and Sleep Disorders Specialists', 'Wael', NULL, 'Asi', 'MD', 'Pulmonary', '', '', NULL, 'O', '20207 Chasewood Park Dr Ste 203', 'Houston', 'Harris', 'TX', '77070', '2815376300', '2815377575', '20207 Chasewood Park Dr Ste 203', 'Houston', 'Harris', 'TX', '77070', '2815376300', '2815377575', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1578551537', 0, 'N', 0, '2013-01-03', NULL, NULL, 29.989, -95.5702, NULL, NULL),
('760567380', 'ELIHSD005', 'ELIHSD005', 'TXHOUSTD', 'Respiratory and Sleep Disorders Specialists', 'Ather', 'J', 'Siddiqi', 'MD', 'Pulmonary', '', '', NULL, 'O', '1111 Medical Plaza Dr Ste 250', 'The Woodlands', 'Montgomery', 'TX', '77380', '2812968788', '2814191291', '1111 Medical Plaza Dr Ste 250', 'The Woodlands', 'Montgomery', 'TX', '77380', '2812968788', '2814191291', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1700874716', 0, 'N', 0, '2013-01-03', NULL, NULL, 30.1726, -95.455, NULL, NULL),
('760567380', 'ELIHSD007', 'ELIHSD007', 'TXHOUSTD', 'Respiratory and Sleep Disorders Specialists', 'Ather', 'J', 'Siddiqi', 'MD', 'Pulmonary', '', '', NULL, 'O', '1125 Cypress Station Dr Ste E', 'Houston', 'Harris', 'TX', '77090', '2815376300', '2815377575', '1125 Cypress Station Dr Ste E', 'Houston', 'Harris', 'TX', '77090', '2815376300', '2815377575', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1700874716', 0, 'N', 0, '2013-01-03', NULL, NULL, 30.0241, -95.4395, NULL, NULL),
('760567380', 'ELIHSD006', 'ELIHSD006', 'TXHOUSTD', 'Respiratory and Sleep Disorders Specialists', 'Ather', 'J', 'Siddiqi', 'MD', 'Pulmonary', '', '', NULL, 'O', '17350 St Lukes Way Ste 470', 'The Woodlands', 'Montgomery', 'TX', '77384', '9363215100', '9363215120', '17350 St Lukes Wy Ste 470', 'The Woodlands', 'Montgomery', 'TX', '77384', '9363215100', '9363215120', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1700874716', 0, 'N', 0, '2013-01-03', NULL, NULL, 30.2017, -95.4595, NULL, NULL),
('760567380', 'ELIHSD008', 'ELIHSD008', 'TXHOUSTD', 'Respiratory and Sleep Disorders Specialists', 'Ather', 'J', 'Siddiqi', 'MD', 'Pulmonary', '', '', NULL, 'O', '20207 Chasewood Park Dr Ste 203', 'Houston', 'Harris', 'TX', '77070', '2815376300', '2815377575', '20207 Chasewood Park Dr Ste 203', 'Houston', 'Harris', 'TX', '77070', '2815376300', '2815377575', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1700874716', 0, 'N', 0, '2013-01-03', NULL, NULL, 29.989, -95.5702, NULL, NULL),
('274450635', 'W12028113', 'W12028113', 'UT01', '', 'Cynthia', '', 'Canga-Siao', 'MD', 'Internal Medicine', '', '', NULL, 'O', '415 Medical Dr Ste C201', 'Bountiful', 'Davis', 'UT', '84010', '8019923130', '8019923146', '415 Medical Dr Ste C201', 'Bountiful', 'Davis', 'UT', '84010', '8019923130', '8019923146', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Lakeview Hospital', '', '', '', 'HCFA|UB|', '1669497558', 0, 'N', 0, '2014-01-21', NULL, NULL, 40.8873, -111.872, NULL, NULL),
('274450635', 'W12028114', 'W12028114', 'UT01', '', 'Cynthia', '', 'Canga-Siao', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 95970', 'South Jordan', 'Salt Lake', 'UT', '84095', '8019923130', '8019923146', 'PO Box 95970', 'South Jordan', 'Salt Lake', 'UT', '84095', '8019923130', '8019923146', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Lakeview Hospital', '', '', '', 'HCFA|UB|', '1669497558', 0, 'N', 0, '2014-01-21', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12028446', 'W12028446', 'IDBOISTD', '', '', '', 'Saint Alphonsus Health Alliance MHPN', '', '', '', '', NULL, 'O', '900 N Liberty Ste 100', 'Boise', 'Ada', 'ID', '83704', '2083676130', '2083677316', '900 N Liberty Ste 100', 'Boise', 'Ada', 'ID', '83704', '2083676130', '2083677316', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '0000009966', 0, 'N', 0, '2014-06-13', NULL, NULL, 43.6133, -116.259, NULL, NULL),
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('870639748', 'W12028157', 'W12028157', 'UT01', 'Hoopes Vision Correction Center', 'Richard', '', 'Yardley', 'OD', 'Ophthalmology', '', '', NULL, 'O', '11820 S State Ste 200', 'Draper', 'Salt Lake', 'UT', '84020', '8015680200', '8015630200', '11820 S State Ste 200', 'Draper', 'Salt Lake', 'UT', '84020', '8015680200', '8015630200', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-11-29', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1013018084', 0, 'N', 0, '2014-07-15', NULL, NULL, 40.5381, -111.891, NULL, NULL),
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('870286381', 'W12028162', 'W12028162', 'UT01', 'Ogden Clinic', 'Brett', '', 'Arbon', 'NP', 'Family Practice', '', '', NULL, 'O', '1100 W 2700 N', 'Ogden', 'Weber', 'UT', '84404', '8014753600', '8014753601', '1100 W 2700 N', 'Ogden', 'Weber', 'UT', '84404', '8014753600', '8014753601', 'WUOGDCLIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1578527909', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.3068, -112.007, NULL, NULL),
('870286381', 'W12028163', 'W12028163', 'UT01', 'Ogden Clinic', 'Brett', '', 'Arbon', 'NP', 'Family Practice', '', '', NULL, 'B', '4650 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014753600', '8014753601', '4650 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014753600', '8014753601', 'WUOGDCLIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1578527909', 0, 'N', 0, '2013-07-25', NULL, NULL, 0, 0, NULL, NULL);
INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
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('870639748', 'W12028165', 'W12028165', 'UT01', 'Hoopes Vision Correction Center', 'Robert', 'P', 'Rivera', 'MD', 'Ophthalmology', '', '', NULL, 'O', '11820 S State Ste 200', 'Draper', 'Salt Lake', 'UT', '84020', '8015680200', '8015630200', '11820 S State Ste 200', 'Draper', 'Salt Lake', 'UT', '84020', '8015680200', '8015630200', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-11-29', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1982759122', 0, 'N', 0, '2013-09-03', NULL, NULL, 40.5381, -111.891, NULL, NULL),
('760225946', 'W12028169', 'W12028169', 'TXHOUSTD', 'Interventional Cardiology Associates', '', '', 'Interventional Cardiology Associates', '', 'Cardiology', '', '', NULL, 'O', '6550 Fannin St Ste 2021', 'Houston', 'Harris', 'TX', '77030', '7137909125', '7137901802', '6550 Fannin St Ste 2021', 'Houston', 'Harris', 'TX', '77030', '7137909125', '7137901802', 'HOUSTON2', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1710070875', 0, 'Y', 0, '2013-01-09', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
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('450579013', 'W12028183', 'W12028183', 'UT01', 'St Marks Gynecology Oncology Care', 'Catherine', 'J', 'Wheeler', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '3100 Channing Way', 'Idaho Falls', 'Bonneville', 'ID', '83404', '2085296111', '0000000000', '3100 Channing Way', 'Idaho Falls', 'Bonneville', 'ID', '83404', '2085296111', '0000000000', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-12-14', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1720055742', 0, 'N', 0, '2013-01-07', NULL, NULL, 43.4696, -111.99, NULL, NULL),
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('450579013', 'W12028186', 'W12028186', 'UT01', 'St Marks Gynocology Oncology Care', 'Denise', '', 'Gitlin', 'APRN', 'Gynecologic Oncology', '', '', NULL, 'O', '4465 S 900 E Ste 224', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012726100', '8012726101', '4465 S 900 E Ste 224', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012726100', '8012726101', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-12-14', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1487744082', 0, 'N', 0, '2013-01-10', NULL, NULL, 40.6753, -111.866, NULL, NULL),
('450579013', 'W12028187', 'W12028187', 'UT01', 'St. Marks Gynecology Oncology Care', 'Patricia', '', 'Bearnson', 'MD', 'Gynecology', NULL, NULL, NULL, 'O', '1140 E 3900 S Ste 340', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8017434730', '8017434736', '1140 E 3900 S Ste 340', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8017434730', '8017434736', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-11-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1013920677', 0, 'N', 0, '2014-04-24', NULL, NULL, 40.6871, -111.859, NULL, NULL),
('450579013', 'W12028188', 'W12028188', 'UT01', 'St. Marks Gynecology Oncology Care', 'Patricia', '', 'Bearnson', 'MD', 'Gynecology', NULL, NULL, NULL, 'O', '3100 Channing Way', 'Idaho Falls', 'Bonneville', 'ID', '83404', '2085296111', '0000000000', '3100 Channing Way', 'Idaho Falls', 'Bonneville', 'ID', '83404', '2085296111', '0000000000', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-12-14', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1013920677', 0, 'N', 0, '2013-01-07', NULL, NULL, 43.4696, -111.99, NULL, NULL),
('202231203', 'W12028279', 'W12028279', 'TXHOUSTD', 'Kingwood Neurology and Sleep', '', '', 'Kingwood Neurology and Sleep PA', '', 'Neurology', '', '', NULL, 'O', '22999 Hwy 59 N Ste 194', 'Kingwood', 'Harris', 'TX', '77339', '2813595981', '2813593591', '22999 Hwy 59 N Ste 194', 'Kingwood', 'Harris', 'TX', '77339', '2813595981', '2813593591', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1457541237', 0, 'Y', 0, '2013-01-10', NULL, NULL, 30.048, -95.2535, NULL, NULL),
('202231203', 'W12028282', 'W12028282', 'TXHOUSTD', 'Kingwood Neurology and Sleep', 'Wendell', 'A', 'Grogan', 'MD', 'Neurology', '', '', NULL, 'O', '22999 Hwy 59 N Ste 194', 'Kingwood', 'Harris', 'TX', '77339', '2813595981', '2813593591', '22999 Hwy 59 N Ste 194', 'Kingwood', 'Harris', 'TX', '77339', '2813595981', '2813593591', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Kingwood Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1063502912', 0, 'N', 0, '2013-01-10', NULL, NULL, 30.048, -95.2535, NULL, NULL),
('202231203', 'W12028280', 'W12028280', 'TXHOUSTD', 'Kingwood Neurology and Sleep', '', '', 'Kingwood Neurology and Sleep PA', '', 'Neurology', '', '', NULL, 'B', 'PO Box 9547', 'Belfast', 'Waldo', 'ME', '04915', '2813595981', '2813593591', 'PO Box 9547', 'Belfast', 'Waldo', 'ME', '04915', '2813595981', '2813593591', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1457541237', 0, 'Y', 0, '2013-01-10', NULL, NULL, 0, 0, NULL, NULL),
('760194878', 'W12028201', 'W12028201', 'TXHOUSTD', 'Gastroenterology Consultants', '', '', 'Gastroenterology Consultants PA', '', 'Gastroenterology', '', '', NULL, 'O', '2060 Space Park Dr Ste 409', 'Nassau Bay', 'Harris', 'TX', '77058', '2814819400', '2814819490', '2060 Space Park Dr Ste 409', 'Nassau Bay', 'Harris', 'TX', '77058', '2814819400', '2814819490', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-02-10', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1295728632', 0, 'Y', 0, '2013-01-09', NULL, NULL, 29.5482, -95.0867, NULL, NULL),
('760194878', 'W12028198', 'W12028198', 'TXHOUSTD', 'Gastroenterology Consultants', '', '', 'Gastroenterology Consultants PA', '', 'Gastroenterology', '', '', NULL, 'O', '250 Blossom Ste 210', 'Webster', 'Harris', 'TX', '77598', '2814819400', '2814819490', '250 Blossom Ste 210', 'Webster', 'Harris', 'TX', '77598', '2814819400', '2814819490', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-02-10', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1295728632', 0, 'Y', 0, '2013-01-09', NULL, NULL, 29.5436, -95.126, NULL, NULL),
('760194878', 'W12028199', 'W12028199', 'TXHOUSTD', 'Gastroenterology Consultants', '', '', 'Gastroenterology Consultants PA', '', 'Gastroenterology', '', '', NULL, 'O', '3801 Vista Ste 490', 'Pasadena', 'Harris', 'TX', '77504', '2814819400', '2814819490', '3801 Vista Ste 490', 'Pasadena', 'Harris', 'TX', '77504', '2814819400', '2814819490', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-02-10', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1295728632', 0, 'Y', 0, '2013-01-09', NULL, NULL, 29.6587, -95.1845, NULL, NULL),
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('942854057', 'W12028307', 'W12028307', 'UTIHCPHY', 'Utah Valley Pulmonary - Critical Care', 'Branden', 'D', 'Rosenhan', '', 'Hospitalist', '', '', NULL, 'O', '1055 N 300 W Ste 500', 'Provo', 'Utah', 'UT', '84604', '8013577291', '8013577919', '1055 N 300 W Ste 500', 'Provo', 'Utah', 'UT', '84604', '8013577291', '8013577919', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2012-11-09', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1912160060', 0, 'N', 0, '2014-06-03', NULL, NULL, 40.2476, -111.664, NULL, NULL),
('942854057', 'W12028308', 'W12028308', 'UTIHCPHY', 'Rock Canyon Pediatric Specialists', 'Eric', 'R', 'Scaife', 'MD', 'Pediatric Surgery', NULL, NULL, NULL, 'O', '1055 N 300 W Ste 110', 'Provo', 'Utah', 'UT', '84604', '8013571700', '8013571709', '1055 N 300 W Ste 110', 'Provo', 'Utah', 'UT', '84604', '8013571700', '8013571709', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2012-09-01', NULL, 0, 0, 0, 'Primary Childrens Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1902996523', 0, 'N', 0, '2013-01-09', NULL, NULL, 40.2476, -111.664, NULL, NULL),
('942854057', 'W12028310', 'W12028310', 'UTIHCPHY', 'Bountiful KidsCare', 'Danielle', 'E', 'Smith', 'MD', 'Urgent Care', '', '', NULL, 'O', '390 N Main St', 'Bountiful', 'Davis', 'UT', '84010', '8012949933', '8012941183', '390 N Main St', 'Bountiful', 'Davis', 'UT', '84010', '8012949933', '8012941183', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2012-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1093969495', 0, 'Y', 0, '2013-03-11', NULL, NULL, 40.8935, -111.881, NULL, NULL),
('942854057', 'W12028311', 'W12028311', 'UTIHCPHY', 'Southwest Regional Cancer Clinic', 'Brian', 'P', 'Tudor', 'MD', 'Hematology and Oncology', 'Oncology', '', NULL, 'O', '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356884900', '4356884901', '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356884900', '4356884901', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2012-12-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', 'Valley View Medical Center', NULL, NULL, 'HCFA|UB|', '1699877308', 0, 'N', 0, '2013-05-17', NULL, NULL, 37.0989, -113.575, NULL, NULL),
('455125865', 'W12028312', 'W12028312', 'UT01', 'Utah Physical Therapy, Inc.', 'Chad', '', 'Tenney', 'MPT', 'Physical Therapy', '', '', NULL, 'O', '4640 S 3500 W Ste 3', 'Ogden', 'Weber', 'UT', '84401', '8016890200', '8016890201', '4640 S 3500 W Ste 3', 'Ogden', 'Weber', 'UT', '84401', '8016890200', '8016890201', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1215910161', 0, 'N', 0, '2013-08-15', NULL, NULL, 41.1794, -112.064, NULL, NULL),
('454788597', 'W12028315', 'W12028315', 'UT01', 'Genesis Chiropractic', 'Tiffani', '', 'Fries', 'DC', 'Chiropractic', '', '', NULL, 'O', '1548 E 4500 S Ste 1', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8016760243', '8016760245', '1548 E 4500 S Ste 1', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8016760243', '8016760245', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '57.12', 3, '2013-01-01', '2014-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1114977105', 0, 'N', 0, '2014-06-24', NULL, NULL, 40.6743, -111.846, NULL, NULL),
('455125865', 'W12028314', 'W12028314', 'UT01', 'Utah Physical Therapy, Inc.', 'Chad', '', 'Tenney', 'MPT', 'Physical Therapy', '', '', NULL, 'B', 'PO Box 208', 'Herriman', 'Salt Lake', 'UT', '84096', '8016890200', '8016890201', 'PO Box 208', 'Herriman', 'Salt Lake', 'UT', '84096', '8016890200', '8016890201', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2013-01-01', '2013-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1215910161', 0, 'N', 0, '2013-08-15', NULL, NULL, 0, 0, NULL, NULL),
('273945978', 'W12028317', 'W12028317', 'UT01', 'Zion Health Management Services', 'Richard', 'S', 'Jensen', 'DC', 'Chiropractic', '', '', NULL, 'O', '237 N Bluff St Ste A', 'St George', 'Washington', 'UT', '84770', '4356742626', '4356285999', '237 N Bluff St Ste A', 'St George', 'Washington', 'UT', '84770', '4356742626', '4356285999', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '57.12', 3, '2013-01-01', '2014-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1801104740', 0, 'N', 0, '2014-06-24', NULL, NULL, 37.1122, -113.595, NULL, NULL),
('760649747', 'W12028674', 'W12028674', 'TXHOUSTD', 'Calvary Medical Clinic', '', '', 'Calvary Medical Clinic', '', 'Clinics', '', '', NULL, 'O', '108 S William Barnett', 'Cleveland', 'Liberty', 'TX', '77327', '2815929775', '2814320548', '108 S William Barnett', 'Cleveland', 'Liberty', 'TX', '77327', '2815929775', '2814320548', 'CALVARY', 'TXHCPC13', '', '0.00', '25.00', '0.00', 3, '2013-02-22', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1265568042', 0, 'Y', 0, '2013-05-10', NULL, NULL, 30.3411, -95.0853, NULL, NULL),
('362784592', 'W12028324', 'W12028324', 'ILCHIGSTD', 'Consultants in Neurology', '', '', 'Consultants in Neurology', '', 'Neurology', '', '', NULL, 'O', '71 Waukegan Rd Ste 8500', 'Lake Bluff', 'Lake', 'IL', '60044', '8472511800', '8472511866', '71 Waukegan Rd Ste 8500', 'Lake Bluff', 'Lake', 'IL', '60044', '8472511800', '8472511866', 'CHIG4', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-18', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000010035', 0, 'Y', 0, '2013-01-11', NULL, NULL, 42.2746, -87.8753, NULL, NULL),
('362784592', 'W12028321', 'W12028321', 'ILCHIGSTD', 'Consultants in Neurology', '', '', 'Consultants in Neurology', '', 'Neurology', '', '', NULL, 'B', 'PO Box 443', 'Winnetka', 'Cook', 'IL', '60093', '8475090270', '8475090273', 'PO Box 443', 'Winnetka', 'Cook', 'IL', '60093', '8475090270', '8475090273', 'CHIG4', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-18', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000010035', 0, 'Y', 0, '2013-01-11', NULL, NULL, 0, 0, NULL, NULL),
('362784592', 'W12028323', 'W12028323', 'ILCHIGSTD', 'Consultants in Neurology', '', '', 'Consultants in Neurology', '', 'Neurology', '', '', NULL, 'O', '1535 Lake Cook Rd Ste 601', 'Northbrook', 'Cook', 'IL', '60062', '8475090270', '8475090273', '1535 Lake Cook Rd Ste 601', 'Northbrook', 'Cook', 'IL', '60062', '8475090270', '8475090273', 'CHIG4', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-18', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000010035', 0, 'Y', 0, '2013-01-11', NULL, NULL, 42.1524, -87.8039, NULL, NULL),
('362784592', 'W12028326', 'W12028326', 'ILCHIGSTD', 'Consultants in Neurology', 'Neil', '', 'Allen', 'MD', 'Neurology', '', '', NULL, 'O', '71 Waukegan Rd Ste 8500', 'Lake Bluff', 'Lake', 'IL', '60044', '8472511800', '8472511866', '71 Waukegan Rd Ste 8500', 'Lake Bluff', 'Lake', 'IL', '60044', '8472511800', '8472511866', 'CHIG4', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-18', NULL, 0, 0, 0, 'Northwestern Lake Forest Hospital', NULL, '', '', 'HCFA|UB|', '1255325023', 0, 'N', 0, '2013-01-11', NULL, NULL, 42.2746, -87.8753, NULL, NULL),
('362784592', 'W12028327', 'W12028327', 'ILCHIGSTD', 'Consultants in Neurology', 'Neil', '', 'Allen', 'MD', 'Neurology', '', '', NULL, 'B', 'PO Box 443', 'Winnetka', 'Cook', 'IL', '60093', '8475090270', '8475090273', 'PO Box 443', 'Winnetka', 'Cook', 'IL', '60093', '8475090270', '8475090273', 'CHIG4', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-18', NULL, 0, 0, 0, 'Northwestern Lake Forest Hospital', NULL, '', '', 'HCFA|UB|', '1255325023', 0, 'N', 0, '2013-01-11', NULL, NULL, 0, 0, NULL, NULL),
('362784592', 'W12028329', 'W12028329', 'ILCHIGSTD', 'Consultants in Neurology', 'Daniel', '', 'Wynn', 'MD', 'Neurology', '', '', NULL, 'O', '1535 Lake Cook Rd Ste 601', 'Northbrook', 'Cook', 'IL', '60062', '8475090270', '8475090273', '1535 Lake Cook Rd Ste 601', 'Northbrook', 'Cook', 'IL', '60062', '8475090270', '8475090273', 'CHIG4', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-18', NULL, 0, 0, 0, 'Northwestern Lake Forest Hospital', NULL, '', '', 'HCFA|UB|', '1710971700', 0, 'N', 0, '2013-01-11', NULL, NULL, 42.1524, -87.8039, NULL, NULL),
('362784592', 'W12028330', 'W12028330', 'ILCHIGSTD', 'Consultants in Neurology', 'Daniel', '', 'Wynn', 'MD', 'Neurology', '', '', NULL, 'O', '71 Waukegan Rd Ste 8500', 'Lake Bluff', 'Lake', 'IL', '60044', '8472511800', '8472511866', '71 Waukegan Rd Ste 8500', 'Lake Bluff', 'Lake', 'IL', '60044', '8472511800', '8472511866', 'CHIG4', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-18', NULL, 0, 0, 0, 'Northwestern Lake Forest Hospital', NULL, '', '', 'HCFA|UB|', '1710971700', 0, 'N', 0, '2013-01-11', NULL, NULL, 42.2746, -87.8753, NULL, NULL),
('362784592', 'W12028331', 'W12028331', 'ILCHIGSTD', 'Consultants in Neurology', 'Daniel', '', 'Wynn', 'MD', 'Neurology', '', '', NULL, 'B', 'PO Box 443', 'Winnetka', 'Cook', 'IL', '60093', '8475090270', '8475090273', 'PO Box 443', 'Winnetka', 'Cook', 'IL', '60093', '8475090270', '8475090273', 'CHIG4', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-18', NULL, 0, 0, 0, 'Northwestern Lake Forest Hospital', NULL, '', '', 'HCFA|UB|', '1710971700', 0, 'N', 0, '2013-01-11', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12028332', 'W12028332', 'IDBOISTD', 'Saint Alphonsus Medial Group Pulmonary & Sleep Boise ', 'Natalia', '', 'Khochay', 'NPC', 'Pulmonary', 'Sleep Medicine', 'Sleep Disorders', NULL, 'O', '1075 N Curtis Ste 200 Bldg 6', 'Boise', 'Ada', 'ID', '83706', '2083678333', '2083672003', '1075 N Curtis Ste 200 Bldg 6', 'Boise', 'Ada', 'ID', '83706', '2083678333', '2083672003', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2013-01-10', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|', '1255653796', 0, 'Y', 0, '2013-07-31', NULL, NULL, 43.6148, -116.254, NULL, NULL),
('820200895', 'W12028333', 'W12028333', 'IDBOISTD', 'Saint Alphonsus Medical Group OBGYN EHP', 'Christina', 'M', 'Knutson', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '323 E Riverside Dr Ste 224', 'Eagle', 'Ada', 'ID', '83616', '2083674278', '2083675765', '323 E Riverside Dr Ste 224', 'Eagle', 'Ada', 'ID', '83616', '2083674278', '2083675765', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-08-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|', '1649212119', 0, 'Y', 0, '2014-03-18', NULL, NULL, 43.6896, -116.35, NULL, NULL),
('621742196', 'W12028419', 'W12028419', 'TXHOUSTD', 'Sugar Land Ambulatory Surgery Center', '', '', 'Sugar Land Ambulatory Surgery Center', '', 'Ambulatory Surgery Center', NULL, NULL, NULL, 'B', 'PO Box 277595', 'Atlanta', 'Fulton', 'GA', '30384', '2812746670', '2812746610', 'PO Box 277595', 'Atlanta', 'Fulton', 'GA', '30384', '2812746670', '2812746610', '', '', 'HCA', '0.00', '0.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1659316917', 0, 'N', 0, '2013-02-15', NULL, NULL, 0, 0, NULL, NULL);
