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
('752674367', 'W12040607', 'W12040607', 'TXDALSTD', 'Healthcare Associates of Irving', 'Terrence', 'M', 'Feehery', 'DO', 'Family Practice', '', '', NULL, 'O', '1110 Cottonwood Ln Ste L100', 'Irving', 'Dallas', 'TX', '75038', '9722587499', '9722558922', '1110 Cottonwood Ln Ste L100', 'Irving', 'Dallas', 'TX', '75038', '9722587499', '9722558922', 'DALLAS1', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-12-13', NULL, 0, 0, 0, 'Baylor Medical Center at Irving', NULL, '', '', 'HCFA|UB|', '1821060559', 0, 'N', 0, '2013-11-14', NULL, NULL, 32.8652, -96.9601, NULL, NULL),
('752674367', 'W12040608', 'W12040608', 'TXDALSTD', 'Healthcare Associates of Irving', 'Terrence', 'M', 'Feehery', 'DO', 'Family Practice', '', '', NULL, 'B', 'PO Box 224968', 'Irving', 'Dallas', 'TX', '75038', '9722587499', '9722558922', 'PO Box 224968', 'Irving', 'Dallas', 'TX', '75038', '9722587499', '9722558922', 'DALLAS1', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-12-13', NULL, 0, 0, 0, 'Baylor Medical Center at Irving', NULL, '', '', 'HCFA|UB|', '1821060559', 0, 'N', 0, '2013-11-14', NULL, NULL, 0, 0, NULL, NULL),
('752674367', 'W12040611', 'W12040611', 'TXDALSTD', 'Healthcare Associates of Irving', 'Walter', 'N', 'Gaman', 'MD', 'Family Practice', '', '', NULL, 'O', '1110 Cottonwood Ln Ste L100', 'Irving', 'Dallas', 'TX', '75038', '9722587499', '9722558922', '1110 Cottonwood Ln Ste L100', 'Irving', 'Dallas', 'TX', '75038', '9722587499', '9722558922', 'DALLAS1', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-12-13', NULL, 0, 0, 0, 'Baylor Medical Center at Irving', NULL, '', '', 'HCFA|UB|', '1780650291', 0, 'N', 0, '2013-11-14', NULL, NULL, 32.8652, -96.9601, NULL, NULL),
('752674367', 'W12040612', 'W12040612', 'TXDALSTD', 'Healthcare Associates of Irving', 'Walter', 'N', 'Gaman', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 224968', 'Irving', 'Dallas', 'TX', '75038', '9722587499', '9722558922', 'PO Box 224968', 'Irving', 'Dallas', 'TX', '75038', '9722587499', '9722558922', 'DALLAS1', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-12-13', NULL, 0, 0, 0, 'Baylor Medical Center at Irving', NULL, '', '', 'HCFA|UB|', '1780650291', 0, 'N', 0, '2013-11-14', NULL, NULL, 0, 0, NULL, NULL),
('752674367', 'W12040614', 'W12040614', 'TXDALSTD', 'Healthcare Associates of Irving', 'Mary', 'C', 'Ward', 'DO', 'Family Practice', '', '', NULL, 'O', '1110 Cottonwood Ln Ste L100', 'Irving', 'Dallas', 'TX', '75038', '9722587499', '9722558922', '1110 Cottonwood Ln Ste L100', 'Irving', 'Dallas', 'TX', '75038', '9722587499', '9722558922', 'DALLAS1', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-12-13', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1083687206', 0, 'N', 0, '2013-11-14', NULL, NULL, 32.8652, -96.9601, NULL, NULL),
('752674367', 'W12040615', 'W12040615', 'TXDALSTD', 'Healthcare Associates of Irving', 'Mary', 'C', 'Ward', 'DO', 'Family Practice', '', '', NULL, 'B', 'PO Box 224968', 'Irving', 'Dallas', 'TX', '75038', '9722587499', '9722558922', 'PO Box 224968', 'Irving', 'Dallas', 'TX', '75038', '9722587499', '9722558922', 'DALLAS1', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-12-13', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1083687206', 0, 'N', 0, '2013-11-14', NULL, NULL, 0, 0, NULL, NULL),
('752674367', 'W12040617', 'W12040617', 'TXDALSTD', 'Healthcare Associates of Irving', 'Charles', 'Lee', 'Powell', 'MD', 'Family Practice', '', '', NULL, 'O', '1110 Cottonwood Ln Ste L100', 'Irving', 'Dallas', 'TX', '75038', '9722587499', '9722558922', '1110 Cottonwood Ln Ste L100', 'Irving', 'Dallas', 'TX', '75038', '9722587499', '9722558922', 'DALLAS1', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-12-13', NULL, 0, 0, 0, 'Baylor Medical Center at Irving', NULL, '', '', 'HCFA|UB|', '1760458897', 0, 'N', 0, '2013-11-14', NULL, NULL, 32.8652, -96.9601, NULL, NULL),
('752674367', 'W12040618', 'W12040618', 'TXDALSTD', 'Healthcare Associates of Irving', 'Charles', 'Lee', 'Powell', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 224968', 'Irving', 'Dallas', 'TX', '75038', '9722587499', '9722558922', 'PO Box 224968', 'Irving', 'Dallas', 'TX', '75038', '9722587499', '9722558922', 'DALLAS1', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-12-13', NULL, 0, 0, 0, 'Baylor Medical Center at Irving', NULL, '', '', 'HCFA|UB|', '1760458897', 0, 'N', 0, '2013-11-14', NULL, NULL, 0, 0, NULL, NULL),
('752674367', 'W12040620', 'W12040620', 'TXDALSTD', 'Healthcare Associates of Irving', 'Vijayalakshmi', '', 'Raghu', 'MD', 'Family Practice', '', '', NULL, 'O', '1110 Cottonwood Ln Ste L100', 'Irving', 'Dallas', 'TX', '75038', '9722587499', '9722558922', '1110 Cottonwood Ln Ste L100', 'Irving', 'Dallas', 'TX', '75038', '9722587499', '9722558922', 'DALLAS1', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-12-13', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1225220940', 0, 'N', 0, '2013-12-20', NULL, NULL, 32.8652, -96.9601, NULL, NULL),
('752674367', 'W12040621', 'W12040621', 'TXDALSTD', 'Healthcare Associates of Irving', 'Vijayalakshmi', '', 'Raghu', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 224968', 'Irving', 'Dallas', 'TX', '75038', '9722587499', '9722558922', 'PO Box 224968', 'Irving', 'Dallas', 'TX', '75038', '9722587499', '9722558922', 'DALLAS1', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-12-13', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1225220940', 0, 'N', 0, '2013-12-20', NULL, NULL, 0, 0, NULL, NULL),
('270806125', 'W12040825', 'W12040825', 'NM01', 'Breathe America Albuquerque', 'Roland', 'Z', 'Gerencer', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '1650 Galisteo Ste 8', 'Santa Fe', 'Santa Fe', 'NM', '87505', '5058209870', '5059831265', '1650 Galisteo Ste 8', 'Santa Fe', 'Santa Fe', 'NM', '87505', '5058209870', '5059831265', 'NMALLERGY', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-12-01', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1144218892', 0, 'Y', 0, '2013-12-10', NULL, NULL, 35.6635, -105.949, NULL, NULL),
('320119960', 'W12040629', 'W12040629', 'TXDALSTD', 'Quang Trong Le', 'Amy', '', 'Ballard', 'DO', 'Internal Medicine', '', '', NULL, 'O', '2550 River Park Dr Ste 110', 'Fort Worth', 'Tarrant', 'TX', '76116', '8177311289', '8177311291', '2550 River Park Dr Ste 110', 'Fort Worth', 'Tarrant', 'TX', '76116', '8177311289', '8177311291', 'DALLAS1', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-12-13', NULL, 0, 0, 0, NULL, NULL, '', '', 'HCFA|UB|', '1538477674', 0, 'N', 0, '2013-11-14', NULL, NULL, 32.7042, -97.4222, NULL, NULL),
('320119960', 'W12040631', 'W12040631', 'TXDALSTD', 'Quang Trong Le', 'Nicole', '', 'Minshew', 'PA', 'Internal Medicine', '', '', NULL, 'O', '2550 River Park Dr Ste 110', 'Fort Worth', 'Tarrant', 'TX', '76116', '8177311289', '8177311291', '2550 River Park Dr Ste 110', 'Fort Worth', 'Tarrant', 'TX', '76116', '8177311289', '8177311291', 'DALLAS1', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-12-13', NULL, 0, 0, 0, NULL, NULL, '', '', 'HCFA|UB|', '1144461260', 0, 'N', 0, '2013-11-14', NULL, NULL, 32.7042, -97.4222, NULL, NULL),
('760523699', 'W12040635', 'W12040635', 'TXHOUSTD', 'Rukan Daccak', 'Rukan', '', 'DacCak', 'MD', 'Gastroenterology', '', '', NULL, 'O', '4450 E Sam Houston Pkwy Ste H2', 'Pasadena', 'Harris', 'TX', '77505', '7139107779', '7139107760', '4450 E Sam Houston Pkwy Ste H2', 'Pasadena', 'Harris', 'TX', '77505', '7139107779', '7139107760', 'TXGASTRO', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-13', NULL, 0, 0, 0, 'Bayshore Medical Center', NULL, '', '', 'HCFA|UB|', '1780629840', 0, 'N', 0, '2013-11-13', NULL, NULL, 29.6428, -95.1588, NULL, NULL),
('760523699', 'W12040636', 'W12040636', 'TXHOUSTD', 'Rukan Daccak', 'Rukan', '', 'DacCak', 'MD', 'Gastroenterology', '', '', NULL, 'B', 'PO Box 405', 'South Houston', 'Harris', 'TX', '77587', '7139107779', '7139107760', 'PO Box 405', 'South Houston', 'Harris', 'TX', '77587', '7139107779', '7139107760', 'TXGASTRO', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-13', NULL, 0, 0, 0, 'Bayshore Medical Center', NULL, '', '', 'HCFA|UB|', '1780629840', 0, 'N', 0, '2014-05-08', NULL, NULL, 29.663, -95.2248, NULL, NULL),
('721527725', 'W12040637', 'W12040637', 'UT01', 'Parzych Family Practice', 'Austin', 'P', 'Francom', 'APRN', 'Family Practice', '', '', NULL, 'O', '1151 E 3900 S B299', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8018920135', '8012662362', '1151 E 3900 S B299', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8018920135', '8012662362', 'WUSTDFAM5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-03-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1386839579', 0, 'N', 0, '2014-02-18', NULL, NULL, 0, 0, NULL, NULL),
('721527725', 'W12040638', 'W12040638', 'UT01', 'Parzych Family Practice', 'Austin', 'P', 'Francom', 'APRN', 'Family Practice', '', '', NULL, 'O', 'PO Box 572528', 'Salt Lake City', 'Salt Lake', 'UT', '84157', '8018920135', '8012662362', 'PO Box 572528', 'Salt Lake City', 'Salt Lake', 'UT', '84157', '8018920135', '8012662362', 'WUSTDFAM5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1386839579', 0, 'N', 0, '2014-02-18', NULL, NULL, 0, 0, NULL, NULL),
('870299862', 'W12040640', 'W12040640', 'UTMH1', 'LDS Family Services', 'Kenneth', 'J', 'Allred', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', '120 N 200 W', 'Salt Lake City', 'Salt Lake', 'UT', '84103', '8012940578', NULL, '120 N 200 W', 'Salt Lake City', 'Salt Lake', 'UT', '84103', '8012940578', '          ', 'MA', '', '', '0.00', '40.00', '0.00', 8, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1326061854', 0, 'N', 0, '2013-12-23', NULL, NULL, 0, 0, NULL, NULL),
('870299862', 'W12040639', 'W12040639', 'UTMH1', 'LDS Family Services', 'Kenneth', 'J', 'Allred', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '930 W Hillfield Rd Ste A', 'Layton', 'Davis', 'UT', '84041', '8013363040', '8013363041', '930 W Hillfield Rd Ste A', 'Layton', 'Davis', 'UT', '84041', '8013363040', '8013363041', 'MA', '', '', '0.00', '40.00', '0.00', 8, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1326061854', 0, 'N', 0, '2013-12-30', NULL, NULL, 41.072, -111.981, NULL, NULL),
('453004089', 'W12040641', 'W12040641', 'TXHOUSTD', 'Mani Khoshnejad', 'Mani', '', 'Khoshnejad', 'MD', 'Family Practice', '', '', NULL, 'O', '4301 Garth Rd Ste 309', 'Baytown', 'Harris', 'TX', '77521', '2814203565', '2814277808', '4301 Garth Rd Ste 309', 'Baytown', 'Harris', 'TX', '77521', '2814203565', '2814277808', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-15', NULL, 0, 0, 0, 'Houston Methodist San Jacinto Hospital ', NULL, '', '', 'HCFA|UB|', '1275732976', 0, 'N', 0, '2013-11-15', NULL, NULL, 29.7681, -94.9775, NULL, NULL),
('571201170', 'W12040642', 'W12040642', 'TXHOUSTD', 'TMHPO Neurosurgery Department', 'Alric', '', 'Hawkins', 'MD', 'Psychiatry', '', '', NULL, 'O', '6560 Fannin St Ste 900', 'Houston', 'Harris', 'TX', '77030', '7134413800', '7137931015', '6560 Fannin St Ste 900', 'Houston', 'Harris', 'TX', '77030', '7134413800', '7137931015', 'TMHPHOSPC', 'TXHCPCTMH', '', '0.00', '50.00', '0.00', 6, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1790989283', 0, 'Y', 0, '2013-11-13', NULL, NULL, 29.7109, -95.4, NULL, NULL),
('571201170', 'W12040643', 'W12040643', 'TXHOUSTD', 'TMHPO Neurosurgery Department', 'Alric', '', 'Hawkins', 'MD', 'Psychiatry', '', '', NULL, 'B', 'PO Box 4655', 'Houston', 'Harris', 'TX', '77210', '7134411808', NULL, 'PO Box 4655', 'Houston', 'Harris', 'TX', '77210', '7134411808', '          ', 'TMHPHOSPC', 'TXHCPCTMH', '', '0.00', '50.00', '0.00', 6, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1790989283', 0, 'Y', 0, '2013-11-13', NULL, NULL, 0, 0, NULL, NULL),
('571201170', 'W12040644', 'W12040644', 'TXHOUSTD', 'TMHPO Neurosurgery Department', 'Paul', '', 'Holman', 'MD', 'Neurosurgery', '', '', NULL, 'O', '6560 Fannin St Ste 900', 'Houston', 'Harris', 'TX', '77030', '7134413800', '7137931015', '6560 Fannin St Ste 900', 'Houston', 'Harris', 'TX', '77030', '7134413800', '7137931015', 'TMHPHOSPC', 'TXHCPCTMH', '', '0.00', '50.00', '0.00', 6, '2014-01-01', NULL, 0, 0, 0, 'Houston Methodist Hospital', NULL, '', '', 'HCFA|UB|', '1386698314', 0, 'N', 0, '2013-11-13', NULL, NULL, 29.7109, -95.4, NULL, NULL),
('571201170', 'W12040645', 'W12040645', 'TXHOUSTD', 'TMHPO Neurosurgery Department', 'Paul', '', 'Holman', 'MD', 'Neurosurgery', '', '', NULL, 'B', 'PO Box 4655', 'Houston', 'Harris', 'TX', '77210', '7134411808', NULL, 'PO Box 4655', 'Houston', 'Harris', 'TX', '77210', '7134411808', '          ', 'TMHPHOSPC', 'TXHCPCTMH', '', '0.00', '50.00', '0.00', 6, '2014-01-01', NULL, 0, 0, 0, 'Houston Methodist Hospital', NULL, '', '', 'HCFA|UB|', '1386698314', 0, 'N', 0, '2013-11-13', NULL, NULL, 0, 0, NULL, NULL),
('571201170', 'W12040646', 'W12040646', 'TXHOUSTD', 'TMHPO Neurosurgery Department', 'Pamela', '', 'New', 'MD', 'Neurology', '', '', NULL, 'O', '6560 Fannin St Ste 900', 'Houston', 'Harris', 'TX', '77030', '7134413800', '7137931015', '6560 Fannin St Ste 900', 'Houston', 'Harris', 'TX', '77030', '7134413800', '7137931015', 'TMHPHOSPC', 'TXHCPCTMH', '', '0.00', '50.00', '0.00', 6, '2014-01-01', NULL, 0, 0, 0, 'Houston Methodist Hospital', NULL, '', '', 'HCFA|UB|', '1881623718', 0, 'N', 0, '2013-11-13', NULL, NULL, 29.7109, -95.4, NULL, NULL),
('571201170', 'W12040647', 'W12040647', 'TXHOUSTD', 'TMHPO Neurosurgery Department', 'Pamela', '', 'New', 'MD', 'Neurology', '', '', NULL, 'B', 'PO Box 4655', 'Houston', 'Harris', 'TX', '77210', '7134411808', NULL, 'PO Box 4655', 'Houston', 'Harris', 'TX', '77210', '7134411808', '          ', 'TMHPHOSPC', 'TXHCPCTMH', '', '0.00', '50.00', '0.00', 6, '2014-01-01', NULL, 0, 0, 0, 'Houston Methodist Hospital', NULL, '', '', 'HCFA|UB|', '1881623718', 0, 'N', 0, '2013-11-13', NULL, NULL, 0, 0, NULL, NULL),
('571201170', 'W12040648', 'W12040648', 'TXHOUSTD', 'TMHPO Neurosurgery Department', 'Robert', 'G', 'Parrish', 'MD', 'Neurosurgery', '', '', NULL, 'O', '6560 Fannin St Ste 900', 'Houston', 'Harris', 'TX', '77030', '7134413800', '7137931015', '6560 Fannin St Ste 900', 'Houston', 'Harris', 'TX', '77030', '7134413800', '7137931015', 'TMHPHOSPC', 'TXHCPCTMH', '', '0.00', '50.00', '0.00', 6, '2014-01-01', NULL, 0, 0, 0, 'Houston Methodist Hospital', NULL, '', '', 'HCFA|UB|', '1194743773', 0, 'N', 0, '2013-11-13', NULL, NULL, 29.7109, -95.4, NULL, NULL),
('571201170', 'W12040649', 'W12040649', 'TXHOUSTD', 'TMHPO Neurosurgery Department', 'Robert', 'G', 'Parrish', 'MD', 'Neurosurgery', '', '', NULL, 'B', 'PO Box 4719', 'Houston', 'Harris', 'TX', '77210', '7134414347', NULL, 'PO Box 4719', 'Houston', 'Harris', 'TX', '77210', '7134414347', '          ', 'TMHPHOSPC', 'TXHCPCTMH', '', '41264.00', '50.00', '0.00', 6, '2014-01-01', NULL, 0, 41275, 0, 'Houston Methodist Hospital', NULL, '', '', 'HCFA|UB|', '1194743773', 0, 'N', 0, '2013-11-13', NULL, NULL, 0, 0, NULL, NULL),
('571201170', 'W12040650', 'W12040650', 'TXHOUSTD', 'TMHPO Neurosurgery Department', 'Richard', '', 'Simpson', 'MD', 'Neurosurgery', '', '', NULL, 'O', '6560 Fannin St Ste 900', 'Houston', 'Harris', 'TX', '77030', '7134413800', '7137931015', '6560 Fannin St Ste 900', 'Houston', 'Harris', 'TX', '77030', '7134413800', '7137931015', 'TMHPHOSPC', 'TXHCPCTMH', '', '0.00', '50.00', '0.00', 6, '2014-01-01', NULL, 0, 0, 0, 'Houston Methodist Hospital', NULL, '', '', 'HCFA|UB|', '1912925595', 0, 'N', 0, '2013-11-13', NULL, NULL, 29.7109, -95.4, NULL, NULL),
('571201170', 'W12040651', 'W12040651', 'TXHOUSTD', 'TMHPO Neurosurgery Department', 'Richard', '', 'Simpson', 'MD', 'Neurosurgery', '', '', NULL, 'B', 'PO Box 4655', 'Houston', 'Harris', 'TX', '77210', '7134411808', NULL, 'PO Box 4655', 'Houston', 'Harris', 'TX', '77210', '7134411808', '          ', 'TMHPHOSPC', 'TXHCPCTMH', '', '0.00', '50.00', '0.00', 6, '2014-01-01', NULL, 0, 0, 0, 'Houston Methodist Hospital', NULL, '', '', 'HCFA|UB|', '1912925595', 0, 'N', 0, '2013-11-13', NULL, NULL, 0, 0, NULL, NULL),
('571201170', 'W12040652', 'W12040652', 'TXHOUSTD', 'TMHPO Neurosurgery Department', 'Todd', '', 'Trask', 'MD', 'Neurosurgery', '', '', NULL, 'O', '6560 Fannin St Ste 900', 'Houston', 'Harris', 'TX', '77030', '7134413800', '7137931015', '6560 Fannin St Ste 900', 'Houston', 'Harris', 'TX', '77030', '7134413800', '7137931015', 'TMHPHOSPC', 'TXHCPCTMH', '', '0.00', '50.00', '0.00', 6, '2014-01-01', NULL, 0, 0, 0, 'Houston Methodist Hospital', NULL, '', '', 'HCFA|UB|', '1710905393', 0, 'N', 0, '2013-11-13', NULL, NULL, 29.7109, -95.4, NULL, NULL),
('571201170', 'W12040653', 'W12040653', 'TXHOUSTD', 'TMHPO Neurosurgery Department', 'Todd', '', 'Trask', 'MD', 'Neurosurgery', '', '', NULL, 'B', 'PO Box 4655', 'Houston', 'Harris', 'TX', '77210', '7134411808', NULL, 'PO Box 4655', 'Houston', 'Harris', 'TX', '77210', '7134411808', '          ', 'TMHPHOSPC', 'TXHCPCTMH', '', '0.00', '50.00', '0.00', 6, '2014-01-01', NULL, 0, 0, 0, 'Houston Methodist Hospital', NULL, '', '', 'HCFA|UB|', '1710905393', 0, 'N', 0, '2013-11-13', NULL, NULL, 0, 0, NULL, NULL),
('571201170', 'W12040654', 'W12040654', 'TXHOUSTD', 'TMHPO Neurosurgery Department', 'Yi', 'Jonathan', 'Zhang', 'MD', 'Neurosurgery', '', '', NULL, 'O', '6560 Fannin St Ste 900', 'Houston', 'Harris', 'TX', '77030', '7134413800', '7137931015', '6560 Fannin St Ste 900', 'Houston', 'Harris', 'TX', '77030', '7134413800', '7137931015', 'TMHPHOSPC', 'TXHCPCTMH', '', '0.00', '50.00', '0.00', 6, '2014-01-01', NULL, 0, 0, 0, 'Houston Methodist Hospital', NULL, '', '', 'HCFA|UB|', '1083666978', 0, 'N', 0, '2013-11-13', NULL, NULL, 29.7109, -95.4, NULL, NULL),
('571201170', 'W12040655', 'W12040655', 'TXHOUSTD', 'TMHPO Neurosurgery Department', 'Yi', 'Jonathan', 'Zhang', 'MD', 'Neurosurgery', '', '', NULL, 'B', 'PO Box 4655', 'Houston', 'Harris', 'TX', '77210', '7134411808', NULL, 'PO Box 4655', 'Houston', 'Harris', 'TX', '77210', '7134411808', '          ', 'TMHPHOSPC', 'TXHCPCTMH', '', '0.00', '50.00', '0.00', 6, '2014-01-01', NULL, 0, 0, 0, 'Houston Methodist Hospital', NULL, '', '', 'HCFA|UB|', '1083666978', 0, 'N', 0, '2013-11-13', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'W12040670', 'W12040670', 'ILCHIGSTD', 'Presence Healthcare Services', 'Timothy', 'J', 'McDonough', 'MD', 'Cardiology', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '8557647687', '6309142469', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '8557647687', '6309142469', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Presence Saint Francis Hospital', NULL, '', '', 'HCFA|UB|', '1740210533', 0, 'N', 0, '2013-11-13', NULL, NULL, 0, 0, NULL, NULL),
('571201170', 'W12040657', 'W12040657', 'TXHOUSTD', 'TMHPO Neurosurgery Department', 'Linda', '', 'Barloon', 'NP', 'Neurology', '', '', NULL, 'B', 'PO Box 4655', 'Houston', 'Harris', 'TX', '77210', '7134411808', NULL, 'PO Box 4655', 'Houston', 'Harris', 'TX', '77210', '7134411808', '          ', 'TMHPHOSPC', 'TXHCPCTMH', '', '0.00', '50.00', '0.00', 6, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1407291909', 0, 'N', 0, '2013-11-13', NULL, NULL, 0, 0, NULL, NULL),
('742431113', 'W12040682', 'W12040682', 'TXHOUSTD', 'Southwest Asthma and Allergy', '', '', 'Southwest Asthma and Allergy', '', 'Allergy and Immunology', '', '', NULL, 'O', '12606 W Houston Ctr Blvd Ste 260', 'Houston', 'Harris', 'TX', '77082', '2815314901', '2815317974', '12606 W Houston Ctr Blvd Ste 260', 'Houston', 'Harris', 'TX', '77082', '2815314901', '2815317974', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-13', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1033139498', 0, 'N', 0, '2013-11-13', NULL, NULL, 29.7268, -95.5925, NULL, NULL),
('571201170', 'W12040661', 'W12040661', 'TXHOUSTD', 'TMHPO Neurosurgery Department', 'Gavin', '', 'Britz', 'MD', 'Neurology', '', '', NULL, 'B', 'PO Box 4655', 'Houston', 'Harris', 'TX', '77210', '7134411808', NULL, 'PO Box 4655', 'Houston', 'Harris', 'TX', '77210', '7134411808', '          ', 'TMHPHOSPC', 'TXHCPCTMH', '', '0.00', '50.00', '0.00', 6, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1376686840', 0, 'N', 0, '2013-11-13', NULL, NULL, 0, 0, NULL, NULL),
('571201170', 'W12040663', 'W12040663', 'TXHOUSTD', 'TMHPO Neurosurgery Department', 'Mario', '', 'Dulay', 'PHD', 'Neurology', '', '', NULL, 'B', 'PO Box 4655', 'Houston', 'Harris', 'TX', '77210', '7134413800', '7137931015', 'PO Box 4655', 'Houston', 'Harris', 'TX', '77210', '7134413800', '7137931015', 'TMHPHOSPC', 'TXHCPCTMH', '', '0.00', '50.00', '0.00', 6, '2014-01-01', NULL, 0, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1841425469', 0, 'N', 0, '2013-11-13', NULL, NULL, 0, 0, NULL, NULL),
('742431113', 'W12040676', 'W12040676', 'TXHOUSTD', 'Southwest Asthma and Allergy', '', '', 'Southwest Asthma and Allergy', '', 'Allergy and Immunology', '', '', NULL, 'O', '1140 A Clear Lake City Blvd', 'Houston', 'Harris', 'TX', '77062', '2814613300', '2814613301', '1140 A Clear Lake City Blvd', 'Houston', 'Harris', 'TX', '77062', '2814613300', '2814613301', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-13', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1033139498', 0, 'N', 0, '2013-11-13', NULL, NULL, 29.5813, -95.1559, NULL, NULL),
('363330928', 'W12040669', 'W12040669', 'ILCHIGSTD', 'Presence Healthcare Services', 'Timothy', 'J', 'McDonough', 'MD', 'Cardiology', '', '', NULL, 'O', '355 Ridge Ave', 'Evanston', 'Cook', 'IL', '60202', '8473164000', '6309142499', '355 Ridge Ave', 'Evanston', 'Cook', 'IL', '60202', '8473164000', '6309142499', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Presence Saint Francis Hospital', NULL, '', '', 'HCFA|UB|', '1740210533', 0, 'N', 0, '2013-11-13', NULL, NULL, 42.024, -87.6852, NULL, NULL),
('571201170', 'W12040667', 'W12040667', 'TXHOUSTD', 'TMHPO Neurosurgery Department', 'Kathryn', '', 'Kerrigan', 'NP', 'Neurology', '', '', NULL, 'B', 'PO Box 4655', 'Houston', 'Harris', 'TX', '77210', '7134411808', NULL, 'PO Box 4655', 'Houston', 'Harris', 'TX', '77210', '7134411808', '          ', 'TMHPHOSPC', 'TXHCPCTMH', '', '0.00', '50.00', '0.00', 6, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1033448915', 0, 'N', 0, '2013-11-13', NULL, NULL, 0, 0, NULL, NULL),
('742431113', 'W12040673', 'W12040673', 'TXHOUSTD', 'Southwest Asthma and Allergy', '', '', 'Southwest Asthma and Allergy', '', 'Allergy and Immunology', '', '', NULL, 'O', '15400 SW Fwy Ste 125', 'Sugar Land', 'Fort Bend', 'TX', '77478', '2812420131', '2812427402', '15400 SW Fwy Ste 125', 'Sugar Land', 'Fort Bend', 'TX', '77478', '2812420131', '2812427402', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-13', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1033139498', 0, 'N', 0, '2013-11-13', NULL, NULL, 29.6056, -95.6159, NULL, NULL),
('742431113', 'W12040675', 'W12040675', 'TXHOUSTD', 'Southwest Asthma and Allergy', '', '', 'Southwest Asthma and Allergy', '', 'Allergy and Immunology', '', '', NULL, 'O', '1901 Kirby Dr Ste 101', 'Pearland', 'Brazoria', 'TX', '77584', '7134138100', '7134138101', '1901 Kirby Dr Ste 101', 'Pearland', 'Brazoria', 'TX', '77584', '7134138100', '7134138101', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-13', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1033139498', 0, 'N', 0, '2013-11-13', NULL, NULL, 29.5448, -95.3981, NULL, NULL),
('742431113', 'W12040698', 'W12040698', 'TXHOUSTD', 'Southwest Asthma and Allergy', 'Michael', 'L', 'Chou', 'MD', 'Allergy and Immunology', '', '', NULL, 'O', '1140 A Clear Lake City Blvd', 'Houston', 'Harris', 'TX', '77062', '2814613300', '2814613301', '1140 A Clear Lake City Blvd', 'Houston', 'Harris', 'TX', '77062', '2814613300', '2814613301', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-13', NULL, 0, 0, 0, 'Bayshore Medical Center', 'Clear Lake Regional Medical Center', NULL, NULL, 'HCFA|', '1134323363', 0, 'N', 0, '2013-11-14', NULL, NULL, 29.5813, -95.1559, NULL, NULL),
('742431113', 'W12040674', 'W12040674', 'TXHOUSTD', 'Southwest Asthma and Allergy', '', '', 'Southwest Asthma and Allergy', '', 'Allergy and Immunology', '', '', NULL, 'O', '21820 Kingsland Blvd Ste 110', 'Katy', 'Harris', 'TX', '77450', '2815787922', '2815783175', '21820 Kingsland Blvd Ste 110', 'Katy', 'Harris', 'TX', '77450', '2815787922', '2815783175', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-13', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1033139498', 0, 'N', 0, '2013-11-13', NULL, NULL, 29.7748, -95.7492, NULL, NULL),
('742431113', 'W12040681', 'W12040681', 'TXHOUSTD', 'Southwest Asthma and Allergy', '', '', 'Southwest Asthma and Allergy', '', 'Allergy and Immunology', '', '', NULL, 'O', '2900 Smith Ste 215', 'Houston', 'Harris', 'TX', '77006', '7137591086', '7135294145', '2900 Smith Ste 215', 'Houston', 'Harris', 'TX', '77006', '7137591086', '7135294145', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-13', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1033139498', 0, 'N', 0, '2013-11-13', NULL, NULL, 29.7456, -95.379, NULL, NULL),
('742431113', 'W12040679', 'W12040679', 'TXHOUSTD', 'Southwest Asthma and Allergy', '', '', 'Southwest Asthma and Allergy', '', 'Allergy and Immunology', '', '', NULL, 'O', '605 Rockmead Dr Ste 500', 'Kingwood', 'Harris', 'TX', '77339', '2813586788', '2813588422', '605 Rockmead Dr Ste 500', 'Kingwood', 'Harris', 'TX', '77339', '2813586788', '2813588422', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-13', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1033139498', 0, 'N', 0, '2013-11-13', NULL, NULL, 30.0533, -95.2449, NULL, NULL),
('742431113', 'W12040671', 'W12040671', 'TXHOUSTD', 'Southwest Asthma and Allergy', '', '', 'Southwest Asthma and Allergy', '', 'Allergy and Immunology', '', '', NULL, 'O', '6334 FM 2920 Ste 190', 'Spring', 'Harris', 'TX', '77379', '2813766644', '2813766645', '6334 FM 2920 Ste 190', 'Spring', 'Harris', 'TX', '77379', '2813766644', '2813766645', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-13', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1033139498', 0, 'N', 0, '2013-11-13', NULL, NULL, 30.074, -95.5203, NULL, NULL),
('742431113', 'W12040680', 'W12040680', 'TXHOUSTD', 'Southwest Asthma and Allergy', '', '', 'Southwest Asthma and Allergy', '', 'Allergy and Immunology', '', '', NULL, 'O', '8955 Hwy 6 N Ste 100', 'Houston', 'Harris', 'TX', '77095', '2818585708', '2818586339', '8955 Hwy 6 N Ste 100', 'Houston', 'Harris', 'TX', '77095', '2818585708', '2818586339', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-13', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1033139498', 0, 'N', 0, '2013-11-13', NULL, NULL, 29.9084, -95.6301, NULL, NULL),
('742431113', 'W12040678', 'W12040678', 'TXHOUSTD', 'Southwest Asthma and Allergy', '', '', 'Southwest Asthma and Allergy', '', 'Allergy and Immunology', '', '', NULL, 'O', '902 Frostwood Ste 302', 'Houston', 'Harris', 'TX', '77024', '7139730051', '7139737130', '902 Frostwood Ste 302', 'Houston', 'Harris', 'TX', '77024', '7139730051', '7139737130', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-13', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1033139498', 0, 'N', 0, '2013-11-13', NULL, NULL, 29.7795, -95.5478, NULL, NULL),
('742431113', 'W12040672', 'W12040672', 'TXHOUSTD', 'Southwest Asthma and Allergy', '', '', 'Southwest Asthma and Allergy', '', 'Allergy and Immunology', '', '', NULL, 'B', '9494 SW Fwy Ste 600', 'Houston', 'Harris', 'TX', '77074', '7135968500', '7135968560', '9494 SW Fwy Ste 600', 'Houston', 'Harris', 'TX', '77074', '7135968500', '7135968560', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-13', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1033139498', 0, 'N', 0, '2013-11-13', NULL, NULL, 0, 0, NULL, NULL),
('742431113', 'W12040685', 'W12040685', 'TXHOUSTD', 'Southwest Asthma and Allergy', 'R', 'Matthew', 'Bloebaum', 'MD', 'Allergy and Immunology', '', '', NULL, 'O', '6334 FM 2920 Ste 190', 'Spring', 'Harris', 'TX', '77379', '2813766644', '2813766645', '6334 FM 2920 Ste 190', 'Spring', 'Harris', 'TX', '77379', '2813766644', '2813766645', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-13', NULL, 0, 0, 0, 'Houston Methodist Willowbrook Hospital', NULL, NULL, NULL, 'HCFA|', '1467408039', 0, 'N', 0, '2013-11-14', NULL, NULL, 30.074, -95.5203, NULL, NULL),
('742431113', 'W12040686', 'W12040686', 'TXHOUSTD', 'Southwest Asthma and Allergy', 'R', 'Matthew', 'Bloebaum', 'MD', 'Allergy and Immunology', '', '', NULL, 'O', '8955 Hwy 6 N Ste 100', 'Houston', 'Harris', 'TX', '77095', '2818585708', '2818586339', '8955 Hwy 6 N Ste 100', 'Houston', 'Harris', 'TX', '77095', '2818585708', '2818586339', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-13', NULL, 0, 0, 0, 'Houston Methodist Willowbrook Hospital', NULL, NULL, NULL, 'HCFA|', '1467408039', 0, 'N', 0, '2013-11-14', NULL, NULL, 29.9084, -95.6301, NULL, NULL),
('742431113', 'W12040689', 'W12040689', 'TXHOUSTD', 'Southwest Asthma and Allergy', 'Lewis', 'A', 'Brown', 'MD', 'Allergy and Immunology', '', '', NULL, 'O', '15400 SW Fwy Ste 125', 'Sugar Land', 'Fort Bend', 'TX', '77478', '2812420131', '2812427402', '15400 SW Fwy Ste 125', 'Sugar Land', 'Fort Bend', 'TX', '77478', '2812420131', '2812427402', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-13', NULL, 0, 0, 0, 'Houston Methodist Sugar Land Hospital', 'West Houston Medical Center', NULL, NULL, 'HCFA|', '1659326726', 0, 'N', 0, '2013-11-14', NULL, NULL, 29.6056, -95.6159, NULL, NULL),
('742431113', 'W12040690', 'W12040690', 'TXHOUSTD', 'Southwest Asthma and Allergy', 'Lewis', 'A', 'Brown', 'MD', 'Allergy and Immunology', '', '', NULL, 'O', '12606 W Houston Ctr Blvd Ste 260', 'Houston', 'Harris', 'TX', '77082', '2815314901', '2815317974', '12606 W Houston Ctr Blvd Ste 260', 'Houston', 'Harris', 'TX', '77082', '2815314901', '2815317974', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-13', NULL, 0, 0, 0, 'Houston Methodist Sugar Land Hospital', 'West Houston Medical Center', NULL, NULL, 'HCFA|', '1659326726', 0, 'N', 0, '2013-11-14', NULL, NULL, 29.7268, -95.5925, NULL, NULL),
('742431113', 'W12040692', 'W12040692', 'TXHOUSTD', 'Southwest Asthma and Allergy', 'Yongxin', '', 'Chen', 'MD', 'Allergy and Immunology', '', '', NULL, 'O', '21820 Kingsland Blvd Ste 110', 'Katy', 'Harris', 'TX', '77450', '2815787922', '2815783175', '21820 Kingsland Blvd Ste 110', 'Katy', 'Harris', 'TX', '77450', '2815787922', '2815783175', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-13', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1801899737', 0, 'N', 0, '2013-11-14', NULL, NULL, 29.7748, -95.7492, NULL, NULL),
('742431113', 'W12040693', 'W12040693', 'TXHOUSTD', 'Southwest Asthma and Allergy', 'Yongxin', '', 'Chen', 'MD', 'Allergy and Immunology', '', '', NULL, 'O', '2900 Smith Ste 215', 'Houston', 'Harris', 'TX', '77006', '7137591086', '7135294145', '2900 Smith Ste 215', 'Houston', 'Harris', 'TX', '77006', '7137591086', '7135294145', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-13', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1801899737', 0, 'N', 0, '2013-11-14', NULL, NULL, 29.7456, -95.379, NULL, NULL),
('742431113', 'W12040696', 'W12040696', 'TXHOUSTD', 'Southwest Asthma and Allergy', 'Michael', 'L', 'Chou', 'MD', 'Allergy and Immunology', '', '', NULL, 'O', '1901 Kirby Dr Ste 101', 'Pearland', 'Brazoria', 'TX', '77584', '7134138100', '7134138101', '1901 Kirby Dr Ste 101', 'Pearland', 'Brazoria', 'TX', '77584', '7134138100', '7134138101', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-13', NULL, 0, 0, 0, 'Bayshore Medical Center', 'Clear Lake Regional Medical Center', NULL, NULL, 'HCFA|', '1134323363', 0, 'N', 0, '2013-11-14', NULL, NULL, 29.5448, -95.3981, NULL, NULL),
('742431113', 'W12040699', 'W12040699', 'TXHOUSTD', 'Southwest Asthma and Allergy', 'Michael', 'L', 'Chou', 'MD', 'Allergy and Immunology', '', '', NULL, 'O', '2900 Smith Ste 215', 'Houston', 'Harris', 'TX', '77006', '7137591086', '7135294145', '2900 Smith Ste 215', 'Houston', 'Harris', 'TX', '77006', '7137591086', '7135294145', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-13', NULL, 0, 0, 0, 'Bayshore Medical Center', 'Clear Lake Regional Medical Center', NULL, NULL, 'HCFA|', '1134323363', 0, 'N', 0, '2013-11-14', NULL, NULL, 29.7456, -95.379, NULL, NULL),
('742431113', 'W12040701', 'W12040701', 'TXHOUSTD', 'Southwest Asthma and Allergy', 'James', 'B', 'Cooper', 'MD', 'Allergy and Immunology', '', '', NULL, 'O', '1140 A Clear Lake City Blvd', 'Houston', 'Harris', 'TX', '77062', '2814613300', '2814613301', '1140 A Clear Lake City Blvd', 'Houston', 'Harris', 'TX', '77062', '2814613300', '2814613301', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-13', NULL, 0, 0, 0, 'Bayshore Medical Center', 'Clear Lake Regional Medical Center', NULL, NULL, 'HCFA|', '1639118482', 0, 'N', 0, '2013-11-14', NULL, NULL, 29.5813, -95.1559, NULL, NULL),
('742431113', 'W12040702', 'W12040702', 'TXHOUSTD', 'Southwest Asthma and Allergy', 'James', 'B', 'Cooper', 'MD', 'Allergy and Immunology', '', '', NULL, 'O', '1901 Kirby Dr Ste 101', 'Pearland', 'Brazoria', 'TX', '77584', '7134138100', '7134138101', '1901 Kirby Dr Ste 101', 'Pearland', 'Brazoria', 'TX', '77584', '7134138100', '7134138101', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-13', NULL, 0, 0, 0, 'Bayshore Medical Center', 'Clear Lake Regional Medical Center', NULL, NULL, 'HCFA|', '1639118482', 0, 'N', 0, '2013-11-14', NULL, NULL, 29.5448, -95.3981, NULL, NULL),
('742431113', 'W12040704', 'W12040704', 'TXHOUSTD', 'Southwest Asthma and Allergy', 'Salvador', '', 'Figueroa', 'MD', 'Allergy and Immunology', '', '', NULL, 'O', '6334 FM 2920 Ste 190', 'Spring', 'Harris', 'TX', '77379', '2813766644', '2813766645', '6334 FM 2920 Ste 190', 'Spring', 'Harris', 'TX', '77379', '2813766644', '2813766645', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-13', NULL, 0, 0, 0, 'Houston Methodist Willowbrook Hospital', NULL, NULL, NULL, 'HCFA|', '1821091760', 0, 'N', 0, '2013-11-14', NULL, NULL, 30.074, -95.5203, NULL, NULL),
('742431113', 'W12040705', 'W12040705', 'TXHOUSTD', 'Southwest Asthma and Allergy', 'Salvador', '', 'Figueroa', 'MD', 'Allergy and Immunology', '', '', NULL, 'O', '605 Rockmead Dr Ste 500', 'Kingwood', 'Harris', 'TX', '77339', '2813586788', '2813588422', '605 Rockmead Dr Ste 500', 'Kingwood', 'Harris', 'TX', '77339', '2813586788', '2813588422', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-13', NULL, 0, 0, 0, 'Houston Methodist Willowbrook Hospital', NULL, NULL, NULL, 'HCFA|', '1821091760', 0, 'N', 0, '2013-11-14', NULL, NULL, 30.0533, -95.2449, NULL, NULL),
('742431113', 'W12040707', 'W12040707', 'TXHOUSTD', 'Southwest Asthma and Allergy', 'Leonard', 'S', 'Hoffman', 'MD', 'Allergy and Immunology', '', '', NULL, 'O', '902 Frostwood Ste 302', 'Houston', 'Harris', 'TX', '77024', '7139730051', '7139737130', '902 Frostwood Ste 302', 'Houston', 'Harris', 'TX', '77024', '7139730051', '7139737130', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-13', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1154324069', 0, 'N', 0, '2013-11-14', NULL, NULL, 29.7795, -95.5478, NULL, NULL),
('760009637', 'LCHS00032', 'LCHS00032', 'TXHOUSTD', 'Legacy Community Health Services', 'Anika', '', 'Barber', 'NP', 'Family Practice', '', NULL, NULL, 'O', '6440 High Star', 'Houston', 'Harris', 'TX', '77074', '8325485000', '7135234897', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-15', NULL, NULL, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1659609097', 0, 'Y', 0, '2013-11-13', NULL, NULL, 0, 0, NULL, NULL),
('760009637', 'LCHS00091', 'LCHS00091', 'TXHOUSTD', 'Legacy Community Health Services', 'Anika', '', 'Barber', 'NP', 'Family Practice', '', NULL, NULL, 'B', 'PO Box 66308', 'Houston', 'Harris', 'TX', '77266', '8325485076', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-15', NULL, NULL, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1659609097', 0, 'Y', 0, '2013-11-13', NULL, NULL, 0, 0, NULL, NULL),
('760009637', 'LCHS00001', 'LCHS00001', 'TXHOUSTD', 'Legacy Community Health Services', 'Dalia', '', 'Batista', 'MD', 'Pediatrics', '', NULL, NULL, 'O', '1415 California St', 'Houston', 'Harris', 'TX', '77006', '8325485000', '7135234897', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-15', NULL, NULL, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1609031491', 0, 'N', 0, '2013-11-13', NULL, NULL, 29.7454, -95.3938, NULL, NULL),
('760009637', 'LCHS00060', 'LCHS00060', 'TXHOUSTD', 'Legacy Community Health Services', 'Dalia', '', 'Batista', 'MD', 'Pediatrics', '', NULL, NULL, 'B', 'PO Box 66308', 'Houston', 'Harris', 'TX', '77266', '8325485076', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-15', NULL, NULL, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1609031491', 0, 'Y', 0, '2013-11-13', NULL, NULL, 0, 0, NULL, NULL),
('760009637', 'LCHS00033', 'LCHS00033', 'TXHOUSTD', 'Legacy Community Health Services', 'Carlisa', '', 'Bowler', 'NP', 'Obstetrics and Gynecology', '', NULL, NULL, 'O', '6441 High Star', 'Houston', 'Harris', 'TX', '77074', '8325485000', '7135234897', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-15', NULL, NULL, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1750439428', 0, 'Y', 0, '2013-11-13', NULL, NULL, 29.7107, -95.495, NULL, NULL),
('760009637', 'LCHS00092', 'LCHS00092', 'TXHOUSTD', 'Legacy Community Health Services', 'Carlisa', '', 'Bowler', 'NP', 'Obstetrics and Gynecology', '', NULL, NULL, 'B', 'PO Box 66308', 'Houston', 'Harris', 'TX', '77266', '8325485076', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-15', NULL, NULL, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1750439428', 0, 'Y', 0, '2013-11-13', NULL, NULL, 0, 0, NULL, NULL),
('760009637', 'LCHS00002', 'LCHS00002', 'TXHOUSTD', 'Legacy Community Health Services', 'Larry', '', 'Caesar', 'MD', 'Pediatrics', '', NULL, NULL, 'O', '5602 Lyons Ave', 'Houston', 'Harris', 'TX', '77020', '8325485000', '7135234897', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-15', NULL, NULL, 0, 0, 'East Houston Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1760655245', 0, 'N', 0, '2013-11-13', NULL, NULL, 29.7765, -95.315, NULL, NULL),
('760009637', 'LCHS00061', 'LCHS00061', 'TXHOUSTD', 'Legacy Community Health Services', 'Larry', '', 'Caesar', 'MD', 'Pediatrics', '', NULL, NULL, 'B', 'PO Box 66308', 'Houston', 'Harris', 'TX', '77266', '8325485076', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-15', NULL, NULL, 0, 0, 'East Houston Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1760655245', 0, 'Y', 0, '2013-11-13', NULL, NULL, 0, 0, NULL, NULL),
('760009637', 'LCHS00034', 'LCHS00034', 'TXHOUSTD', 'Legacy Community Health Services', 'Deonna', '', 'Clark', 'NP', 'Obstetrics and Gynecology', '', NULL, NULL, 'O', '6441 High Star', 'Houston', 'Harris', 'TX', '77074', '8325485000', '7135234897', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-15', NULL, NULL, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1609145572', 0, 'Y', 0, '2013-11-13', NULL, NULL, 29.7107, -95.495, NULL, NULL),
('760009637', 'LCHS00093', 'LCHS00093', 'TXHOUSTD', 'Legacy Community Health Services', 'Deonna', '', 'Clark', 'NP', 'Obstetrics and Gynecology', '', NULL, NULL, 'B', 'PO Box 66308', 'Houston', 'Harris', 'TX', '77266', '8325485076', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-15', NULL, NULL, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1609145572', 0, 'Y', 0, '2013-11-13', NULL, NULL, 0, 0, NULL, NULL),
('760009637', 'LCHS00003', 'LCHS00003', 'TXHOUSTD', 'Legacy Community Health Services', 'Berta', '', 'Deleon Scaglia', 'MD', 'Family Practice', '', NULL, NULL, 'O', '6500 Rookin St Ste 200', 'Houston', 'Harris', 'TX', '77074', '8325485000', '7135234897', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-15', NULL, NULL, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1932201134', 0, 'N', 0, '2013-11-13', NULL, NULL, 29.7102, -95.4968, NULL, NULL),
('760009637', 'LCHS00062', 'LCHS00062', 'TXHOUSTD', 'Legacy Community Health Services', 'Berta', '', 'Deleon Scaglia', 'MD', 'Family Practice', '', NULL, NULL, 'B', 'PO Box 66308', 'Houston', 'Harris', 'TX', '77266', '8325485076', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-15', NULL, NULL, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1932201134', 0, 'Y', 0, '2013-11-13', NULL, NULL, 0, 0, NULL, NULL),
('760009637', 'LCHS00004', 'LCHS00004', 'TXHOUSTD', 'Legacy Community Health Services', 'Lacindy', '', 'Delvalle', 'MD', 'Pediatrics', '', NULL, NULL, 'O', '6550 Mapleridge Ste 106', 'Houston', 'Harris', 'TX', '77074', '8325485000', '7135234897', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-15', NULL, NULL, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1639278773', 0, 'N', 0, '2013-11-13', NULL, NULL, 29.71, -95.4742, NULL, NULL),
('760009637', 'LCHS00063', 'LCHS00063', 'TXHOUSTD', 'Legacy Community Health Services', 'Lacindy', '', 'Delvalle', 'MD', 'Pediatrics', '', NULL, NULL, 'B', 'PO Box 66308', 'Houston', 'Harris', 'TX', '77266', '8325485076', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-15', NULL, NULL, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1639278773', 0, 'Y', 0, '2013-11-13', NULL, NULL, 0, 0, NULL, NULL),
('760009637', 'LCHS00035', 'LCHS00035', 'TXHOUSTD', 'Legacy Community Health Services', 'Rhonda', '', 'Dixon', 'CNM', 'Obstetrics and Gynecology', '', NULL, NULL, 'O', '4450 Highland Ave', 'Beaumont', 'Jefferson', 'TX', '77705', '4098385423', '7135234897', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-15', NULL, NULL, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1093957417', 0, 'Y', 0, '2013-11-13', NULL, NULL, 30.0433, -94.0855, NULL, NULL),
('760009637', 'LCHS00094', 'LCHS00094', 'TXHOUSTD', 'Legacy Community Health Services', 'Rhonda', '', 'Dixon', 'CNM', 'Obstetrics and Gynecology', '', NULL, NULL, 'B', 'PO Box 66308', 'Houston', 'Harris', 'TX', '77266', '8325485076', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-15', NULL, NULL, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1093957417', 0, 'Y', 0, '2013-11-13', NULL, NULL, 0, 0, NULL, NULL),
('760009637', 'LCHS00005', 'LCHS00005', 'TXHOUSTD', 'Legacy Community Health Services', 'Ioana Ana', '', 'Dragoi', 'MD', 'Pediatrics', '', NULL, NULL, 'O', '6441 High Star', 'Houston', 'Harris', 'TX', '77074', '8325485000', '7135234897', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-15', NULL, NULL, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1235122235', 0, 'N', 0, '2013-11-13', NULL, NULL, 29.7107, -95.495, NULL, NULL),
('760009637', 'LCHS00064', 'LCHS00064', 'TXHOUSTD', 'Legacy Community Health Services', 'Ioana Ana', '', 'Dragoi', 'MD', 'Pediatrics', '', NULL, NULL, 'B', 'PO Box 66308', 'Houston', 'Harris', 'TX', '77266', '8325485076', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-15', NULL, NULL, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1235122235', 0, 'Y', 0, '2013-11-13', NULL, NULL, 0, 0, NULL, NULL),
('760009637', 'LCHS00006', 'LCHS00006', 'TXHOUSTD', 'Legacy Community Health Services', 'Deepali', 'J', 'Dubal', 'MD', 'Pediatrics', '', '', NULL, 'O', '6441 High Star', 'Houston', 'Harris', 'TX', '77074', '8325485000', '7135234897', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-15', NULL, NULL, 0, 0, '', '', '', '', 'HCFA|UB|', '1598959447', 0, 'N', 0, '2013-11-13', NULL, NULL, 29.7107, -95.495, NULL, NULL),
('760009637', 'LCHS00065', 'LCHS00065', 'TXHOUSTD', 'Legacy Community Health Services', 'Deepali', 'J', 'Dubal', 'MD', 'Pediatrics', '', '', NULL, 'B', 'PO Box 66308', 'Houston', 'Harris', 'TX', '77266', '8325485076', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-15', NULL, NULL, 0, 0, '', '', '', '', 'HCFA|UB|', '1598959447', 0, 'Y', 0, '2013-11-13', NULL, NULL, 0, 0, NULL, NULL),
('760009637', 'LCHS00036', 'LCHS00036', 'TXHOUSTD', 'Legacy Community Health Services', 'Jan', '', 'Dundas', 'NP', 'Pediatrics', '', NULL, NULL, 'O', '4450 Highland Ave', 'Beaumont', 'Jefferson', 'TX', '77705', '4098385423', '7135234897', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-15', NULL, NULL, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1205878592', 0, 'Y', 0, '2013-11-13', NULL, NULL, 30.0433, -94.0855, NULL, NULL),
('760009637', 'LCHS00095', 'LCHS00095', 'TXHOUSTD', 'Legacy Community Health Services', 'Jan', '', 'Dundas', 'NP', 'Pediatrics', '', NULL, NULL, 'B', 'PO Box 66308', 'Houston', 'Harris', 'TX', '77266', '8325485076', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-15', NULL, NULL, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1205878592', 0, 'Y', 0, '2013-11-13', NULL, NULL, 0, 0, NULL, NULL),
('760009637', 'LCHS00007', 'LCHS00007', 'TXHOUSTD', 'Legacy Community Health Services', 'Robert', 'B', 'Dundas', 'MD', 'Pediatrics', '', NULL, NULL, 'O', '4450 Highland Ave', 'Beaumont', 'Jefferson', 'TX', '77705', '4098385423', '7135234897', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-15', NULL, NULL, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1114920493', 0, 'N', 0, '2013-11-13', NULL, NULL, 30.0433, -94.0855, NULL, NULL),
('760009637', 'LCHS00066', 'LCHS00066', 'TXHOUSTD', 'Legacy Community Health Services', 'Robert', 'B', 'Dundas', 'MD', 'Pediatrics', '', NULL, NULL, 'B', 'PO Box 66308', 'Houston', 'Harris', 'TX', '77266', '8325485076', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-15', NULL, NULL, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1114920493', 0, 'Y', 0, '2013-11-13', NULL, NULL, 0, 0, NULL, NULL),
('760009637', 'LCHS00008', 'LCHS00008', 'TXHOUSTD', 'Legacy Community Health Services', 'G Russell', 'R', 'Edwards', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1415 California St', 'Houston', 'Harris', 'TX', '77006', '8325485000', '7135234897', '1415 California St', 'Houston', 'Harris', 'TX', '77006', '8325485000', '7135234897', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1801874433', 0, 'N', 0, '2014-02-12', NULL, NULL, 29.7454, -95.3938, NULL, NULL),
('760009637', 'LCHS00067', 'LCHS00067', 'TXHOUSTD', 'Legacy Community Health Services', 'G Russell', 'R', 'Edwards', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 66308', 'Houston', 'Harris', 'TX', '77266', '8325485076', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-15', NULL, NULL, 0, 0, '', '', '', '', 'HCFA|UB|', '1801874433', 0, 'Y', 0, '2013-11-13', NULL, NULL, 0, 0, NULL, NULL),
('760009637', 'LCHS00009', 'LCHS00009', 'TXHOUSTD', 'Legacy Community Health Services', 'Jennifer', '', 'Feldmann', 'MD', 'Pediatrics', '', NULL, NULL, 'O', '1415 California St', 'Houston', 'Harris', 'TX', '77006', '8325485000', '7135234897', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-15', NULL, NULL, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1699716001', 0, 'N', 0, '2013-11-13', NULL, NULL, 29.7454, -95.3938, NULL, NULL),
('760009637', 'LCHS00068', 'LCHS00068', 'TXHOUSTD', 'Legacy Community Health Services', 'Jennifer', '', 'Feldmann', 'MD', 'Pediatrics', '', NULL, NULL, 'B', 'PO Box 66308', 'Houston', 'Harris', 'TX', '77266', '8325485076', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-15', NULL, NULL, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1699716001', 0, 'Y', 0, '2013-11-13', 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
('760009637', 'LCHS00037', 'LCHS00037', 'TXHOUSTD', 'Legacy Community Health Services', 'Ron', '', 'Fernau', 'PA', 'Family Practice', '', NULL, NULL, 'O', '5602 Lyons Ave', 'Houston', 'Harris', 'TX', '77020', '8325485000', '7135234897', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-15', NULL, NULL, 0, 0, 'East Houston Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1063406650', 0, 'Y', 0, '2013-11-13', NULL, NULL, 29.7765, -95.315, NULL, NULL),
('760009637', 'LCHS00096', 'LCHS00096', 'TXHOUSTD', 'Legacy Community Health Services', 'Ron', '', 'Fernau', 'PA', 'Family Practice', '', NULL, NULL, 'B', 'PO Box 66308', 'Houston', 'Harris', 'TX', '77266', '8325485076', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-15', NULL, NULL, 0, 0, 'East Houston Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1063406650', 0, 'Y', 0, '2013-11-13', NULL, NULL, 0, 0, NULL, NULL),
('760009637', 'LCHS00010', 'LCHS00010', 'TXHOUSTD', 'Legacy Community Health Services', 'Dianne', '', 'Foster', 'MD', 'Pediatrics', '', NULL, NULL, 'O', '6441 High Star', 'Houston', 'Harris', 'TX', '77074', '8325485000', '7135234897', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-15', NULL, NULL, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1194738716', 0, 'N', 0, '2013-11-13', NULL, NULL, 29.7107, -95.495, NULL, NULL),
('760009637', 'LCHS00069', 'LCHS00069', 'TXHOUSTD', 'Legacy Community Health Services', 'Dianne', '', 'Foster', 'MD', 'Pediatrics', '', NULL, NULL, 'B', 'PO Box 66308', 'Houston', 'Harris', 'TX', '77266', '8325485076', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-15', NULL, NULL, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1194738716', 0, 'Y', 0, '2013-11-13', NULL, NULL, 0, 0, NULL, NULL),
('760009637', 'LCHS00011', 'LCHS00011', 'TXHOUSTD', 'Legacy Community Health Services', 'Margaret', '', 'Goetz', 'MD', 'Pediatrics', '', NULL, NULL, 'O', '6441 High Star', 'Houston', 'Harris', 'TX', '77074', '8325485000', '7135234897', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-15', NULL, NULL, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1750340956', 0, 'N', 0, '2013-11-13', NULL, NULL, 29.7107, -95.495, NULL, NULL),
('760009637', 'LCHS00070', 'LCHS00070', 'TXHOUSTD', 'Legacy Community Health Services', 'Margaret', '', 'Goetz', 'MD', 'Pediatrics', '', NULL, NULL, 'B', 'PO Box 66308', 'Houston', 'Harris', 'TX', '77266', '8325485076', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-15', NULL, NULL, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1750340956', 0, 'Y', 0, '2013-11-13', NULL, NULL, 0, 0, NULL, NULL),
('760009637', 'LCHS00012', 'LCHS00012', 'TXHOUSTD', 'Legacy Community Health Services', 'Lindsay', '', 'Hatzenbuehler', 'MD', 'Pediatrics', '', NULL, NULL, 'O', '6441 High Star', 'Houston', 'Harris', 'TX', '77074', '8325485000', '7135234897', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-15', NULL, NULL, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1063666758', 0, 'N', 0, '2013-11-13', NULL, NULL, 29.7107, -95.495, NULL, NULL),
('760009637', 'LCHS00071', 'LCHS00071', 'TXHOUSTD', 'Legacy Community Health Services', 'Lindsay', '', 'Hatzenbuehler', 'MD', 'Pediatrics', '', NULL, NULL, 'B', 'PO Box 66308', 'Houston', 'Harris', 'TX', '77266', '8325485076', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-15', NULL, NULL, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1063666758', 0, 'Y', 0, '2013-11-13', NULL, NULL, 0, 0, NULL, NULL),
('760009637', 'LCHS00013', 'LCHS00013', 'TXHOUSTD', 'Legacy Community Health Services', 'Patricia', '', 'Hayes', 'MD', 'Pediatrics', '', NULL, NULL, 'O', '6550 Mapleridge Ste 106', 'Houston', 'Harris', 'TX', '77081', '8325485000', '7135234897', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-15', NULL, NULL, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1992935597', 0, 'N', 0, '2013-11-13', NULL, NULL, 29.71, -95.4742, NULL, NULL),
('760009637', 'LCHS00072', 'LCHS00072', 'TXHOUSTD', 'Legacy Community Health Services', 'Patricia', '', 'Hayes', 'MD', 'Pediatrics', '', NULL, NULL, 'B', 'PO Box 66308', 'Houston', 'Harris', 'TX', '77266', '8325485076', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-15', NULL, NULL, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1992935597', 0, 'Y', 0, '2013-11-13', NULL, NULL, 0, 0, NULL, NULL),
('760009637', 'LCHS00014', 'LCHS00014', 'TXHOUSTD', 'Legacy Community Health Services', 'Diana', '', 'Hellman', 'MD', 'Pediatrics', '', NULL, NULL, 'O', '6441 High Star', 'Houston', 'Harris', 'TX', '77074', '8325485000', '7135234897', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-15', NULL, NULL, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1255663357', 0, 'N', 0, '2013-11-13', NULL, NULL, 29.7107, -95.495, NULL, NULL),
('760009637', 'LCHS00073', 'LCHS00073', 'TXHOUSTD', 'Legacy Community Health Services', 'Diana', '', 'Hellman', 'MD', 'Pediatrics', '', NULL, NULL, 'B', 'PO Box 66308', 'Houston', 'Harris', 'TX', '77266', '8325485076', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-15', NULL, NULL, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1255663357', 0, 'Y', 0, '2013-11-13', NULL, NULL, 0, 0, NULL, NULL),
('760009637', 'LCHS00059', 'LCHS00059', 'TXHOUSTD', 'Legacy Community Health Services', 'Carrie', '', 'Hermosa Chiu', 'MD', 'Pediatrics', '', NULL, NULL, 'O', '4301 Garth Rd Ste 400', 'Baytown', 'Harris', 'TX', '77521', '2814208400', '7135234897', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-15', NULL, NULL, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1952636839', 0, 'N', 0, '2013-11-13', NULL, NULL, 29.7681, -94.9775, NULL, NULL),
('760009637', 'LCHS00118', 'LCHS00118', 'TXHOUSTD', 'Legacy Community Health Services', 'Carrie', '', 'Hermosa Chiu', 'MD', 'Pediatrics', '', NULL, NULL, 'B', 'PO Box 66308', 'Houston', 'Harris', 'TX', '77266', '8325485076', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-15', NULL, NULL, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1952636839', 0, 'Y', 0, '2013-11-13', NULL, NULL, 0, 0, NULL, NULL),
('760009637', 'LCHS00038', 'LCHS00038', 'TXHOUSTD', 'Legacy Community Health Services', 'Katherine', '', 'Hinze', 'NP', 'Obstetrics and Gynecology', '', '', NULL, 'O', '6441 High Star', 'Houston', 'Harris', 'TX', '77074', '8325485000', '7135234897', '6441 High Star', 'Houston', 'Harris', 'TX', '77074', '8325485000', '7135234897', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1972551745', 0, 'Y', 0, '2014-02-12', NULL, NULL, 29.7107, -95.495, NULL, NULL),
('760009637', 'LCHS00097', 'LCHS00097', 'TXHOUSTD', 'Legacy Community Health Services', 'Katherine', '', 'Hinze', 'NP', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 66308', 'Houston', 'Harris', 'TX', '77266', '8325485076', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-15', NULL, NULL, 0, 0, '', '', '', '', 'HCFA|UB|', '1972551745', 0, 'Y', 0, '2013-11-13', NULL, NULL, 0, 0, NULL, NULL),
('760009637', 'LCHS00039', 'LCHS00039', 'TXHOUSTD', 'Legacy Community Health Services', 'Tara', '', 'Huckabee', 'NP', 'Pediatrics', '', NULL, NULL, 'O', '6441 High Star', 'Houston', 'Harris', 'TX', '77073', '8325485000', '7135234897', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-15', NULL, NULL, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1073820197', 0, 'Y', 0, '2013-11-13', NULL, NULL, 29.7107, -95.495, NULL, NULL),
('760009637', 'LCHS00098', 'LCHS00098', 'TXHOUSTD', 'Legacy Community Health Services', 'Tara', '', 'Huckabee', 'NP', 'Pediatrics', '', NULL, NULL, 'B', 'PO Box 66308', 'Houston', 'Harris', 'TX', '77266', '8325485076', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-15', NULL, NULL, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1073820197', 0, 'Y', 0, '2013-11-13', NULL, NULL, 0, 0, NULL, NULL),
('760009637', 'LCHS00015', 'LCHS00015', 'TXHOUSTD', 'Legacy Community Health Services', 'Tamisha', '', 'Jones', 'MD', 'Pediatrics', '', NULL, NULL, 'O', '5602 Lyons Ave', 'Houston', 'Harris', 'TX', '77020', '8325485000', '7135234897', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-15', NULL, NULL, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1033412077', 0, 'N', 0, '2013-11-13', NULL, NULL, 29.7765, -95.315, NULL, NULL),
('760009637', 'LCHS00074', 'LCHS00074', 'TXHOUSTD', 'Legacy Community Health Services', 'Tamisha', '', 'Jones', 'MD', 'Pediatrics', '', NULL, NULL, 'B', 'PO Box 66308', 'Houston', 'Harris', 'TX', '77266', '8325485076', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-15', NULL, NULL, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1033412077', 0, 'Y', 0, '2013-11-13', NULL, NULL, 0, 0, NULL, NULL),
('760009637', 'LCHS00040', 'LCHS00040', 'TXHOUSTD', 'Legacy Community Health Services', 'Bernadette', '', 'King', 'NP', 'Obstetrics and Gynecology', '', NULL, NULL, 'O', '6441 High Star', 'Houston', 'Harris', 'TX', '77074', '8325485000', '7135234897', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-15', NULL, NULL, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1417905282', 0, 'Y', 0, '2013-11-13', NULL, NULL, 29.7107, -95.495, NULL, NULL),
('760009637', 'LCHS00099', 'LCHS00099', 'TXHOUSTD', 'Legacy Community Health Services', 'Bernadette', '', 'King', 'NP', 'Obstetrics and Gynecology', '', NULL, NULL, 'B', 'PO Box 66308', 'Houston', 'Harris', 'TX', '77266', '8325485076', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-15', NULL, NULL, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1417905282', 0, 'Y', 0, '2013-11-13', NULL, NULL, 0, 0, NULL, NULL),
('760009637', 'LCHS00041', 'LCHS00041', 'TXHOUSTD', 'Legacy Community Health Services', 'Amber', '', 'Knowles', 'NP', 'Pediatrics', '', NULL, NULL, 'O', '9618 Mesa Dr', 'Houston', 'Harris', 'TX', '77078', '8325485000', '7135234897', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-15', NULL, NULL, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1750658373', 0, 'Y', 0, '2013-11-13', NULL, NULL, 0, 0, NULL, NULL),
('760009637', 'LCHS00100', 'LCHS00100', 'TXHOUSTD', 'Legacy Community Health Services', 'Amber', '', 'Knowles', 'NP', 'Pediatrics', '', NULL, NULL, 'B', 'PO Box 66308', 'Houston', 'Harris', 'TX', '77266', '8325485076', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-15', NULL, NULL, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1750658373', 0, 'Y', 0, '2013-11-13', NULL, NULL, 0, 0, NULL, NULL),
('760009637', 'LCHS00016', 'LCHS00016', 'TXHOUSTD', 'Legacy Community Health Services', 'Ana', '', 'Lehmann', 'MD', 'Pediatrics', '', NULL, NULL, 'O', '12667 Bisonnett', 'Houston', 'Harris', 'TX', '77099', '8325485000', '7135234897', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-15', NULL, NULL, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1720309198', 0, 'N', 0, '2013-11-13', NULL, NULL, 29.6779, -95.6023, NULL, NULL),
('760009637', 'LCHS00075', 'LCHS00075', 'TXHOUSTD', 'Legacy Community Health Services', 'Ana', '', 'Lehmann', 'MD', 'Pediatrics', '', NULL, NULL, 'B', 'PO Box 66308', 'Houston', 'Harris', 'TX', '77266', '8325485076', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-15', NULL, NULL, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1720309198', 0, 'Y', 0, '2013-11-13', NULL, NULL, 0, 0, NULL, NULL),
('760009637', 'LCHS00017', 'LCHS00017', 'TXHOUSTD', 'Legacy Community Health Services', 'Mark', '', 'Levine', 'MD', 'Family Practice', '', NULL, NULL, 'O', '5602 Lyons Ave', 'Houston', 'Harris', 'TX', '77020', '8325485000', '7135234897', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-15', NULL, NULL, 0, 0, 'East Houston Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1285790170', 0, 'N', 0, '2013-11-13', NULL, NULL, 29.7765, -95.315, NULL, NULL),
('760009637', 'LCHS00076', 'LCHS00076', 'TXHOUSTD', 'Legacy Community Health Services', 'Mark', '', 'Levine', 'MD', 'Family Practice', '', NULL, NULL, 'B', 'PO Box 66308', 'Houston', 'Harris', 'TX', '77266', '8325485076', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-15', NULL, NULL, 0, 0, 'East Houston Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1285790170', 0, 'Y', 0, '2013-11-13', NULL, NULL, 0, 0, NULL, NULL),
('760009637', 'LCHS00042', 'LCHS00042', 'TXHOUSTD', 'Legacy Community Health Services', 'Blanca', '', 'Martinez', 'NP', 'Family Practice', '', NULL, NULL, 'O', '6441 High Star', 'Houston', 'Harris', 'TX', '77074', '8325485000', '7135234897', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-15', NULL, NULL, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1437403904', 0, 'Y', 0, '2013-11-13', NULL, NULL, 29.7107, -95.495, NULL, NULL),
('760009637', 'LCHS00101', 'LCHS00101', 'TXHOUSTD', 'Legacy Community Health Services', 'Blanca', '', 'Martinez', 'NP', 'Family Practice', '', NULL, NULL, 'B', 'PO Box 66308', 'Houston', 'Harris', 'TX', '77266', '8325485076', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-15', NULL, NULL, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1437403904', 0, 'Y', 0, '2013-11-13', NULL, NULL, 0, 0, NULL, NULL),
('760009637', 'LCHS00043', 'LCHS00043', 'TXHOUSTD', 'Legacy Community Health Services', 'Johanna', '', 'Matos', 'NP', 'Pediatrics', '', NULL, NULL, 'O', '5400 Martin Luther King Jr Blvd', 'Houston', 'Harris', 'TX', '77021', '8325485000', '7135234897', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-15', NULL, NULL, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1033445416', 0, 'Y', 0, '2013-11-13', NULL, NULL, 0, 0, NULL, NULL),
('760009637', 'LCHS00102', 'LCHS00102', 'TXHOUSTD', 'Legacy Community Health Services', 'Johanna', '', 'Matos', 'NP', 'Pediatrics', '', NULL, NULL, 'B', 'PO Box 66308', 'Houston', 'Harris', 'TX', '77266', '8325485076', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-15', NULL, NULL, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1033445416', 0, 'Y', 0, '2013-11-13', NULL, NULL, 0, 0, NULL, NULL),
('760009637', 'LCHS00018', 'LCHS00018', 'TXHOUSTD', 'Legacy Community Health Services', 'Omar', '', 'Matuk Villazon', 'MD', 'Pediatrics', '', NULL, NULL, 'O', '6441 High Star', 'Houston', 'Harris', 'TX', '77074', '8325485000', '7135234897', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-15', NULL, NULL, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1184938722', 0, 'N', 0, '2013-11-13', NULL, NULL, 29.7107, -95.495, NULL, NULL),
('760009637', 'LCHS00077', 'LCHS00077', 'TXHOUSTD', 'Legacy Community Health Services', 'Omar', '', 'Matuk Villazon', 'MD', 'Pediatrics', '', NULL, NULL, 'B', 'PO Box 66308', 'Houston', 'Harris', 'TX', '77266', '8325485076', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-15', NULL, NULL, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1184938722', 0, 'Y', 0, '2013-11-13', NULL, NULL, 0, 0, NULL, NULL),
('760009637', 'LCHS00044', 'LCHS00044', 'TXHOUSTD', 'Legacy Community Health Services', 'Cornel', '', 'Mckenzie', 'NP', 'Obstetrics and Gynecology', '', NULL, NULL, 'O', '6441 High Star', 'Houston', 'Harris', 'TX', '77074', '8325485000', '7135234897', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-15', NULL, NULL, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1982649604', 0, 'Y', 0, '2013-11-13', NULL, NULL, 29.7107, -95.495, NULL, NULL),
('760009637', 'LCHS00103', 'LCHS00103', 'TXHOUSTD', 'Legacy Community Health Services', 'Cornel', '', 'Mckenzie', 'NP', 'Obstetrics and Gynecology', '', NULL, NULL, 'B', 'PO Box 66308', 'Houston', 'Harris', 'TX', '77266', '8325485076', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-15', NULL, NULL, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1982649604', 0, 'Y', 0, '2013-11-13', NULL, NULL, 0, 0, NULL, NULL),
('760009637', 'LCHS00019', 'LCHS00019', 'TXHOUSTD', 'Legacy Community Health Services', 'Natali', 'Mattern', 'Muehe', 'MD', 'Pediatrics', '', NULL, NULL, 'O', '1415 California St', 'Houston', 'Harris', 'TX', '77006', '8325485000', '7135234897', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-15', NULL, NULL, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1043473176', 0, 'N', 0, '2013-11-13', NULL, NULL, 29.7454, -95.3938, NULL, NULL),
('760009637', 'LCHS00078', 'LCHS00078', 'TXHOUSTD', 'Legacy Community Health Services', 'Natali', 'Mattern', 'Muehe', 'MD', 'Pediatrics', '', NULL, NULL, 'B', 'PO Box 66308', 'Houston', 'Harris', 'TX', '77266', '8325485076', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-15', NULL, NULL, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1043473176', 0, 'Y', 0, '2013-11-13', NULL, NULL, 0, 0, NULL, NULL),
('760009637', 'LCHS00045', 'LCHS00045', 'TXHOUSTD', 'Legacy Community Health Services', 'Lois', '', 'Muhammad', 'NP', 'Family Practice', '', NULL, NULL, 'O', '4450 Highland Ave', 'Beaumont', 'Jefferson', 'TX', '77705', '4098385423', '7135234897', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-15', NULL, NULL, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1225190416', 0, 'Y', 0, '2013-11-13', NULL, NULL, 30.0433, -94.0855, NULL, NULL),
('760009637', 'LCHS00104', 'LCHS00104', 'TXHOUSTD', 'Legacy Community Health Services', 'Lois', '', 'Muhammad', 'NP', 'Family Practice', '', NULL, NULL, 'B', 'PO Box 66308', 'Houston', 'Harris', 'TX', '77266', '8325485076', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-15', NULL, NULL, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1225190416', 0, 'Y', 0, '2013-11-13', NULL, NULL, 0, 0, NULL, NULL),
('760009637', 'LCHS00020', 'LCHS00020', 'TXHOUSTD', 'Legacy Community Health Services', 'Lourdes', '', 'Murra', 'MD', 'Family Practice', '', NULL, NULL, 'O', '6500 Rookin St Ste 200', 'Houston', 'Harris', 'TX', '77074', '8325485000', '7135234897', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-15', NULL, NULL, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1164532008', 0, 'N', 0, '2013-11-13', NULL, NULL, 29.7102, -95.4968, NULL, NULL),
('760009637', 'LCHS00079', 'LCHS00079', 'TXHOUSTD', 'Legacy Community Health Services', 'Lourdes', '', 'Murra', 'MD', 'Family Practice', '', NULL, NULL, 'B', 'PO Box 66308', 'Houston', 'Harris', 'TX', '77266', '8325485076', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-15', NULL, NULL, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1164532008', 0, 'Y', 0, '2013-11-13', NULL, NULL, 0, 0, NULL, NULL),
('760009637', 'LCHS00021', 'LCHS00021', 'TXHOUSTD', 'Legacy Community Health Services', 'John', 'J', 'Nemecek', 'MD', 'Family Practice', '', NULL, NULL, 'O', '1415 California St', 'Houston', 'Harris', 'TX', '77006', '8325485000', '7135234897', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-15', NULL, NULL, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1629150487', 0, 'N', 0, '2013-11-13', NULL, NULL, 29.7454, -95.3938, NULL, NULL),
('760009637', 'LCHS00080', 'LCHS00080', 'TXHOUSTD', 'Legacy Community Health Services', 'John', 'J', 'Nemecek', 'MD', 'Family Practice', '', NULL, NULL, 'B', 'PO Box 66308', 'Houston', 'Harris', 'TX', '77266', '8325485076', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-15', NULL, NULL, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1629150487', 0, 'Y', 0, '2013-11-13', NULL, NULL, 0, 0, NULL, NULL),
('760009637', 'LCHS00046', 'LCHS00046', 'TXHOUSTD', 'Legacy Community Health Services', 'Mykal', '', 'Oshea', 'NP', 'Pediatrics', '', NULL, NULL, 'O', '10711 Kipp Way', 'Houston', 'Harris', 'TX', '77099', '8325485000', '7135234897', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-15', NULL, NULL, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1881974137', 0, 'Y', 0, '2013-11-13', NULL, NULL, 0, 0, NULL, NULL),
('760009637', 'LCHS00105', 'LCHS00105', 'TXHOUSTD', 'Legacy Community Health Services', 'Mykal', '', 'Oshea', 'NP', 'Pediatrics', '', NULL, NULL, 'B', 'PO Box 66308', 'Houston', 'Harris', 'TX', '77266', '8325485076', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-15', NULL, NULL, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1881974137', 0, 'Y', 0, '2013-11-13', NULL, NULL, 0, 0, NULL, NULL),
('760009637', 'LCHS00022', 'LCHS00022', 'TXHOUSTD', 'Legacy Community Health Services', 'Mary', '', 'Pastor', 'MD', 'Family Practice', '', '', NULL, 'O', '4450 Highland Ave', 'Beaumont', 'Jefferson', 'TX', '77705', '4098385423', '7135234897', '4450 Highland Ave', 'BEAUMONT', 'Jefferson', 'TX', '77705', '4098385423', '7135234897', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1518966647', 0, 'N', 0, '2013-11-14', NULL, NULL, 30.0433, -94.0855, NULL, NULL),
('760009637', 'LCHS00081', 'LCHS00081', 'TXHOUSTD', 'Legacy Community Health Services', 'Mary', '', 'Pastor', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 66308', 'Houston', 'Harris', 'TX', '77266', '8325485076', NULL, 'Po Box 66308', 'HOUSTON', 'Harris', 'TX', '77266', '8325485076', '', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1518966647', 0, 'Y', 0, '2013-11-14', NULL, NULL, 0, 0, NULL, NULL),
('760009637', 'LCHS00023', 'LCHS00023', 'TXHOUSTD', 'Legacy Community Health Services', 'Shruti', '', 'Patel', 'MD', 'Family Practice', '', NULL, NULL, 'O', '1415 California St', 'Houston', 'Harris', 'TX', '77006', '8325485000', '7135234897', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-15', NULL, NULL, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1447468772', 0, 'N', 0, '2013-11-13', NULL, NULL, 29.7454, -95.3938, NULL, NULL),
('760009637', 'LCHS00082', 'LCHS00082', 'TXHOUSTD', 'Legacy Community Health Services', 'Shruti', '', 'Patel', 'MD', 'Family Practice', '', NULL, NULL, 'B', 'PO Box 66308', 'Houston', 'Harris', 'TX', '77266', '8325485076', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-15', NULL, NULL, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1447468772', 0, 'Y', 0, '2013-11-13', NULL, NULL, 0, 0, NULL, NULL),
('760009637', 'LCHS00058', 'LCHS00058', 'TXHOUSTD', 'Legacy Community Health Services', 'Narmadha', '', 'Peter', 'NP', 'Obstetrics and Gynecology', '', NULL, NULL, 'O', '6441 High Star', 'Houston', 'Harris', 'TX', '77073', '8325485000', '7135234897', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-15', NULL, NULL, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1689963720', 0, 'Y', 0, '2013-11-13', NULL, NULL, 29.7107, -95.495, NULL, NULL),
('760009637', 'LCHS00117', 'LCHS00117', 'TXHOUSTD', 'Legacy Community Health Services', 'Narmadha', '', 'Peter', 'NP', 'Obstetrics and Gynecology', '', NULL, NULL, 'B', 'PO Box 66308', 'Houston', 'Harris', 'TX', '77266', '8325485076', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-15', NULL, NULL, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1689963720', 0, 'Y', 0, '2013-11-13', NULL, NULL, 0, 0, NULL, NULL),
('760009637', 'LCHS00047', 'LCHS00047', 'TXHOUSTD', 'Legacy Community Health Services', 'Padma', '', 'Ramaswamy', 'NP', 'Pediatrics', '', NULL, NULL, 'O', '6441 High Star', 'Houston', 'Harris', 'TX', '77074', '8325485000', '7135234897', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-15', NULL, NULL, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1164619441', 0, 'Y', 0, '2013-11-13', NULL, NULL, 29.7107, -95.495, NULL, NULL),
('760009637', 'LCHS00106', 'LCHS00106', 'TXHOUSTD', 'Legacy Community Health Services', 'Padma', '', 'Ramaswamy', 'NP', 'Pediatrics', '', NULL, NULL, 'B', 'PO Box 66308', 'Houston', 'Harris', 'TX', '77266', '8325485076', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-15', NULL, NULL, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1164619441', 0, 'Y', 0, '2013-11-13', NULL, NULL, 0, 0, NULL, NULL),
('760009637', 'LCHS00024', 'LCHS00024', 'TXHOUSTD', 'Legacy Community Health Services', 'Lia', '', 'Rodriguez', 'MD', 'Pediatrics', '', NULL, NULL, 'O', '6441 High Star', 'Houston', 'Harris', 'TX', '77074', '8325485000', '7135234897', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-15', NULL, NULL, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1013122944', 0, 'N', 0, '2013-11-13', NULL, NULL, 29.7107, -95.495, NULL, NULL),
('760009637', 'LCHS00083', 'LCHS00083', 'TXHOUSTD', 'Legacy Community Health Services', 'Lia', '', 'Rodriguez', 'MD', 'Pediatrics', '', NULL, NULL, 'B', 'PO Box 66308', 'Houston', 'Harris', 'TX', '77266', '8325485076', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-15', NULL, NULL, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1013122944', 0, 'Y', 0, '2013-11-13', NULL, NULL, 0, 0, NULL, NULL),
('760009637', 'LCHS00048', 'LCHS00048', 'TXHOUSTD', 'Legacy Community Health Services', 'Candice', '', 'Roman', 'NP', 'Pediatrics', '', NULL, NULL, 'O', '4610 E Crosstimbers', 'Houston', 'Harris', 'TX', '77016', '8325485000', '7135234897', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-15', NULL, NULL, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1841557550', 0, 'Y', 0, '2013-11-13', NULL, NULL, 29.831, -95.3228, NULL, NULL),
('760009637', 'LCHS00107', 'LCHS00107', 'TXHOUSTD', 'Legacy Community Health Services', 'Candice', '', 'Roman', 'NP', 'Pediatrics', '', NULL, NULL, 'B', 'PO Box 66308', 'Houston', 'Harris', 'TX', '77266', '8325485076', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-15', NULL, NULL, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1841557550', 0, 'Y', 0, '2013-11-13', NULL, NULL, 0, 0, NULL, NULL),
('760009637', 'LCHS00049', 'LCHS00049', 'TXHOUSTD', 'Legacy Community Health Services', 'Rachael', '', 'Rowland', 'NP', 'Family Practice', '', NULL, NULL, 'O', '11000 Scott St', 'Houston', 'Harris', 'TX', '77047', '8325485000', '7135234897', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-15', NULL, NULL, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1336585835', 0, 'Y', 0, '2013-11-13', NULL, NULL, 29.6408, -95.3684, NULL, NULL),
('760009637', 'LCHS00108', 'LCHS00108', 'TXHOUSTD', 'Legacy Community Health Services', 'Rachael', '', 'Rowland', 'NP', 'Family Practice', '', NULL, NULL, 'B', 'PO Box 66308', 'Houston', 'Harris', 'TX', '77266', '8325485076', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-15', NULL, NULL, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1336585835', 0, 'Y', 0, '2013-11-13', NULL, NULL, 0, 0, NULL, NULL),
('760009637', 'LCHS00025', 'LCHS00025', 'TXHOUSTD', 'Legacy Community Health Services', 'Jared', '', 'Rubenstein', 'MD', 'Pediatrics', '', NULL, NULL, 'O', '6441 High Star', 'Houston', 'Harris', 'TX', '77073', '8325485000', '7135234897', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-15', NULL, NULL, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1710115092', 0, 'N', 0, '2013-11-13', NULL, NULL, 29.7107, -95.495, NULL, NULL),
('760009637', 'LCHS00084', 'LCHS00084', 'TXHOUSTD', 'Legacy Community Health Services', 'Jared', '', 'Rubenstein', 'MD', 'Pediatrics', '', NULL, NULL, 'B', 'PO Box 66308', 'Houston', 'Harris', 'TX', '77266', '8325485076', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-15', NULL, NULL, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1710115092', 0, 'Y', 0, '2013-11-13', NULL, NULL, 0, 0, NULL, NULL),
('760009637', 'LCHS00026', 'LCHS00026', 'TXHOUSTD', 'Legacy Community Health Services', 'Meghana', '', 'Samant', 'MD', 'Pediatrics', '', NULL, NULL, 'O', '6441 High Star', 'Houston', 'Harris', 'TX', '77074', '8325485000', '7135234897', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-15', NULL, NULL, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1972596971', 0, 'N', 0, '2013-11-13', NULL, NULL, 29.7107, -95.495, NULL, NULL),
('760009637', 'LCHS00085', 'LCHS00085', 'TXHOUSTD', 'Legacy Community Health Services', 'Meghana', '', 'Samant', 'MD', 'Pediatrics', '', NULL, NULL, 'B', 'PO Box 66308', 'Houston', 'Harris', 'TX', '77266', '8325485076', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-15', NULL, NULL, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1972596971', 0, 'Y', 0, '2013-11-13', NULL, NULL, 0, 0, NULL, NULL),
('760009637', 'LCHS00031', 'LCHS00031', 'TXHOUSTD', 'Legacy Community Health Services', 'Scott', 'George', 'Sawyer', 'MD', 'Ophthalmology', '', '', NULL, 'O', '1415 California St', 'Houston', 'Harris', 'TX', '77074', '8325485000', '7135234897', '1415 California St', 'HOUSTON', 'Harris', 'TX', '77074', '8325485000', '7135234897', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-15', NULL, 0, 0, 0, 'Bayshore Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1750385712', 0, 'Y', 0, '2013-11-14', NULL, NULL, 29.7454, -95.3938, NULL, NULL),
('760009637', 'LCHS00090', 'LCHS00090', 'TXHOUSTD', 'Legacy Community Health Services', 'Scott', 'George', 'Sawyer', 'MD', 'Ophthalmology', '', '', NULL, 'B', 'PO Box 66308', 'Houston', 'Harris', 'TX', '77266', '8325485076', NULL, 'Po Box 66308', 'HOUSTON', 'Harris', 'TX', '77266', '8325485076', '', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-15', NULL, 0, 0, 0, 'Bayshore Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1750385712', 0, 'Y', 0, '2013-11-14', NULL, NULL, 0, 0, NULL, NULL),
('760009637', 'LCHS00050', 'LCHS00050', 'TXHOUSTD', 'Legacy Community Health Services', 'Mary', '', 'Shepard', 'NP', 'Family Practice', '', NULL, NULL, 'O', '6500 Rookin St Ste 200', 'Houston', 'Harris', 'TX', '77074', '8325485000', '7135234897', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-15', NULL, NULL, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1730131335', 0, 'Y', 0, '2013-11-13', NULL, NULL, 29.7102, -95.4968, NULL, NULL),
('760009637', 'LCHS00109', 'LCHS00109', 'TXHOUSTD', 'Legacy Community Health Services', 'Mary', '', 'Shepard', 'NP', 'Family Practice', '', NULL, NULL, 'B', 'PO Box 66308', 'Houston', 'Harris', 'TX', '77266', '8325485076', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-15', NULL, NULL, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1730131335', 0, 'Y', 0, '2013-11-13', NULL, NULL, 0, 0, NULL, NULL),
('760009637', 'LCHS00051', 'LCHS00051', 'TXHOUSTD', 'Legacy Community Health Services', 'Cindy', '', 'Solorzano', 'NP', 'Family Practice', '', NULL, NULL, 'O', '5402 Lawndale St', 'Houston', 'Harris', 'TX', '77023', '8325485000', '7135234897', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-15', NULL, NULL, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1669813002', 0, 'Y', 0, '2013-11-13', NULL, NULL, 29.7278, -95.3214, NULL, NULL),
('760009637', 'LCHS00110', 'LCHS00110', 'TXHOUSTD', 'Legacy Community Health Services', 'Cindy', '', 'Solorzano', 'NP', 'Family Practice', '', NULL, NULL, 'B', 'PO Box 66308', 'Houston', 'Harris', 'TX', '77266', '8325485076', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-15', NULL, NULL, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1669813002', 0, 'Y', 0, '2013-11-13', NULL, NULL, 0, 0, NULL, NULL),
('760009637', 'LCHS00027', 'LCHS00027', 'TXHOUSTD', 'Legacy Community Health Services', 'Pamela', '', 'St Amand', 'MD', 'Obstetrics and Gynecology', '', NULL, NULL, 'O', '2965 Harrison St Ste 320', 'Beaumont', 'Jefferson', 'TX', '77702', '4098991360', '7135234897', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-15', NULL, NULL, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1013900141', 0, 'Y', 0, '2013-11-13', NULL, NULL, 30.0895, -94.133, NULL, NULL),
('760009637', 'LCHS00086', 'LCHS00086', 'TXHOUSTD', 'Legacy Community Health Services', 'Pamela', '', 'St Amand', 'MD', 'Obstetrics and Gynecology', '', NULL, NULL, 'B', 'PO Box 66308', 'Houston', 'Harris', 'TX', '77266', '8325485076', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-15', NULL, NULL, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1013900141', 0, 'Y', 0, '2013-11-13', NULL, NULL, 0, 0, NULL, NULL),
('760009637', 'LCHS00052', 'LCHS00052', 'TXHOUSTD', 'Legacy Community Health Services', 'Joe', '', 'Stanfield', 'NP', 'Pediatrics', '', '', NULL, 'O', '6441 High Star', 'Houston', 'Harris', 'TX', '77074', '8325485000', '7135234897', '6441 High Star', 'Houston', 'Harris', 'TX', '77074', '8325485000', '7135234897', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-15', '2013-12-15', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1376729012', 0, 'Y', 0, '2014-05-27', NULL, NULL, 29.7107, -95.495, NULL, NULL),
('760009637', 'LCHS00111', 'LCHS00111', 'TXHOUSTD', 'Legacy Community Health Services', 'Joe', '', 'Stanfield', 'NP', 'Pediatrics', '', '', NULL, 'B', 'PO Box 66308', 'Houston', 'Harris', 'TX', '77266', '8325485076', '          ', 'PO Box 66308', 'Houston', 'Harris', 'TX', '77266', '8325485076', '          ', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-15', '2013-12-15', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1376729012', 0, 'Y', 0, '2014-05-27', NULL, NULL, 0, 0, NULL, NULL),
('760009637', 'LCHS00053', 'LCHS00053', 'TXHOUSTD', 'Legacy Community Health Services', 'Meghan', '', 'Stork', 'CNM', 'Obstetrics and Gynecology', '', NULL, NULL, 'O', '6441 High Star', 'Houston', 'Harris', 'TX', '77074', '8325485000', '7135234897', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-15', NULL, NULL, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1023124104', 0, 'Y', 0, '2013-11-13', NULL, NULL, 29.7107, -95.495, NULL, NULL),
('760009637', 'LCHS00112', 'LCHS00112', 'TXHOUSTD', 'Legacy Community Health Services', 'Meghan', '', 'Stork', 'CNM', 'Obstetrics and Gynecology', '', NULL, NULL, 'B', 'PO Box 66308', 'Houston', 'Harris', 'TX', '77266', '8325485076', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-15', NULL, NULL, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1023124104', 0, 'Y', 0, '2013-11-13', NULL, NULL, 0, 0, NULL, NULL),
('760009637', 'LCHS00054', 'LCHS00054', 'TXHOUSTD', 'Legacy Community Health Services', 'Mandi', '', 'Szynski', 'NP', 'Obstetrics and Gynecology', '', NULL, NULL, 'O', '1415 California St', 'Houston', 'Harris', 'TX', '77006', '8325485000', '7135234897', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-15', NULL, NULL, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1942540240', 0, 'Y', 0, '2013-11-13', NULL, NULL, 29.7454, -95.3938, NULL, NULL),
('760009637', 'LCHS00113', 'LCHS00113', 'TXHOUSTD', 'Legacy Community Health Services', 'Mandi', '', 'Szynski', 'NP', 'Obstetrics and Gynecology', '', NULL, NULL, 'B', 'PO Box 66308', 'Houston', 'Harris', 'TX', '77266', '8325485076', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-15', NULL, NULL, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1942540240', 0, 'Y', 0, '2013-11-13', NULL, NULL, 0, 0, NULL, NULL),
('760009637', 'LCHS00055', 'LCHS00055', 'TXHOUSTD', 'Legacy Community Health Services', 'Nicole', '', 'Triggs', 'NP', 'Pediatrics', '', '', NULL, 'O', '6441 High Star', 'Houston', 'Harris', 'TX', '77074', '8325485000', '7135234897', '6441 High Star', 'Houston', 'Harris', 'TX', '77074', '8325485000', '7135234897', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-15', '2014-04-04', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1093079311', 0, 'Y', 0, '2014-05-27', NULL, NULL, 29.7107, -95.495, NULL, NULL),
('760009637', 'LCHS00114', 'LCHS00114', 'TXHOUSTD', 'Legacy Community Health Services', 'Nicole', '', 'Triggs', 'NP', 'Pediatrics', '', '', NULL, 'B', 'PO Box 66308', 'Houston', 'Harris', 'TX', '77266', '8325485076', '          ', 'PO Box 66308', 'Houston', 'Harris', 'TX', '77266', '8325485076', '          ', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-15', '2014-04-04', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1093079311', 0, 'Y', 0, '2014-05-27', NULL, NULL, 0, 0, NULL, NULL),
('760009637', 'LCHS00028', 'LCHS00028', 'TXHOUSTD', 'Legacy Community Health Services', 'Natalie', '', 'Vanek', 'MD', 'Family Practice', '', NULL, NULL, 'O', '1415 California St', 'Houston', 'Harris', 'TX', '77006', '8325485000', '7135234897', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-15', NULL, NULL, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1023098282', 0, 'N', 0, '2013-11-13', NULL, NULL, 29.7454, -95.3938, NULL, NULL),
('760009637', 'LCHS00087', 'LCHS00087', 'TXHOUSTD', 'Legacy Community Health Services', 'Natalie', '', 'Vanek', 'MD', 'Family Practice', '', NULL, NULL, 'B', 'PO Box 66308', 'Houston', 'Harris', 'TX', '77266', '8325485076', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-15', NULL, NULL, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1023098282', 0, 'Y', 0, '2013-11-13', NULL, NULL, 0, 0, NULL, NULL),
('760009637', 'LCHS00029', 'LCHS00029', 'TXHOUSTD', 'Legacy Community Health Services', 'Salma', '', 'Vawda', 'MD', 'Pediatrics', '', NULL, NULL, 'O', '6441 High Star', 'Houston', 'Harris', 'TX', '77074', '8325485000', '7135234897', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-15', NULL, NULL, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1831131606', 0, 'N', 0, '2013-11-13', NULL, NULL, 29.7107, -95.495, NULL, NULL),
('760009637', 'LCHS00088', 'LCHS00088', 'TXHOUSTD', 'Legacy Community Health Services', 'Salma', '', 'Vawda', 'MD', 'Pediatrics', '', NULL, NULL, 'B', 'PO Box 66308', 'Houston', 'Harris', 'TX', '77266', '8325485076', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-15', NULL, NULL, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1831131606', 0, 'Y', 0, '2013-11-13', NULL, NULL, 0, 0, NULL, NULL),
('760009637', 'LCHS00056', 'LCHS00056', 'TXHOUSTD', 'Legacy Community Health Services', 'Deena', '', 'Velazquez', 'NP', 'Family Practice', '', NULL, NULL, 'O', '6500 Rookin St Ste 200', 'Houston', 'Harris', 'TX', '77074', '8325485000', '7135234897', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-15', NULL, NULL, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1114281243', 0, 'Y', 0, '2013-11-13', NULL, NULL, 29.7102, -95.4968, NULL, NULL),
('760009637', 'LCHS00115', 'LCHS00115', 'TXHOUSTD', 'Legacy Community Health Services', 'Deena', '', 'Velazquez', 'NP', 'Family Practice', '', NULL, NULL, 'B', 'PO Box 66308', 'Houston', 'Harris', 'TX', '77266', '8325485076', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-15', NULL, NULL, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1114281243', 0, 'Y', 0, '2013-11-13', NULL, NULL, 0, 0, NULL, NULL),
('760009637', 'LCHS00057', 'LCHS00057', 'TXHOUSTD', 'Legacy Community Health Services', 'Kandie', '', 'Waller', 'NP', 'Family Practice', '', NULL, NULL, 'O', '5400 Martin Luther King Jr Blvd', 'Houston', 'Harris', 'TX', '77021', '8325485000', '7135234897', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-15', NULL, NULL, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1235563297', 0, 'Y', 0, '2013-11-13', NULL, NULL, 0, 0, NULL, NULL),
('760009637', 'LCHS00116', 'LCHS00116', 'TXHOUSTD', 'Legacy Community Health Services', 'Kandie', '', 'Waller', 'NP', 'Family Practice', '', NULL, NULL, 'B', 'PO Box 66308', 'Houston', 'Harris', 'TX', '77266', '8325485076', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-15', NULL, NULL, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1235563297', 0, 'Y', 0, '2013-11-13', NULL, NULL, 0, 0, NULL, NULL),
('760009637', 'LCHS00030', 'LCHS00030', 'TXHOUSTD', 'Legacy Community Health Services', 'Faith', '', 'Whittier', 'MD', 'Obstetrics and Gynecology', '', NULL, NULL, 'O', '6441 High Star', 'Houston', 'Harris', 'TX', '77074', '8325485000', '7135234897', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-15', NULL, NULL, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1770526006', 0, 'Y', 0, '2013-11-13', NULL, NULL, 29.7107, -95.495, NULL, NULL),
('760009637', 'LCHS00089', 'LCHS00089', 'TXHOUSTD', 'Legacy Community Health Services', 'Faith', '', 'Whittier', 'MD', 'Obstetrics and Gynecology', '', NULL, NULL, 'B', 'PO Box 66308', 'Houston', 'Harris', 'TX', '77266', '8325485076', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-15', NULL, NULL, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1770526006', 0, 'Y', 0, '2013-11-13', NULL, NULL, 0, 0, NULL, NULL),
('320047747', 'W12040724', 'W12040724', 'TXHOUSTD', 'Vincent Y Wang MD', 'Vincent', 'Y', 'Wang', 'MD', 'Neurosurgery', '', '', NULL, 'B', 'PO Box 67', 'Houston', 'Harris', 'TX', '77001', '2813130031', '2813130032', 'PO Box 67', 'Houston', 'Harris', 'TX', '77001', '2813130031', '2813130032', 'HOUSTON5', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-15', NULL, 0, 0, 0, 'Houston Methodist Sugar Land Hospital', NULL, '', '', 'HCFA|UB|', '1568584159', 0, 'N', 0, '2014-04-25', NULL, NULL, 0, 0, NULL, NULL),
('760420935', 'W12040725', 'W12040725', 'TXHOUSTD', '', 'Thai', 'D', 'Nguyen', 'MD', 'Neurology', '', '', NULL, 'O', '18648 McKay Blvd Ste 200', 'Humble', 'Harris', 'TX', '77338', '2814467316', '2814460551', '18648 McKay Blvd Ste 200', 'Humble', 'Harris', 'TX', '77338', '2814467316', '2814460551', 'HOUSTON5', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-21', NULL, 0, 0, 0, 'Kingwood Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1982677381', 0, 'N', 0, '2013-11-21', NULL, NULL, 30.005, -95.2893, NULL, NULL),
('752811085', 'W12040726', 'W12040726', 'TXDALSTD', '', 'Vicki ', 'L', 'Seidmeyer', 'DO', 'Family Practice', '', '', NULL, 'O', '2760 Virigina Pkwy Ste 100', 'Mckinney', 'Collin', 'TX', '75071', '9725421180', '9725425395', '2760 Virigina Pkwy Ste 100', 'Mckinney', 'Collin', 'TX', '75071', '9725421180', '9725425395', 'DALLAS1', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-12-21', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1699738286', 0, 'N', 0, '2013-11-21', NULL, NULL, 33.1989, -96.6522, NULL, NULL),
('760420935', 'W12040727', 'W12040727', 'TXHOUSTD', '', 'Khanh', '', 'Nguyen', 'MD', 'Neurology', '', '', NULL, 'O', '18648 McKay Blvd Ste 200', 'Humble', 'Harris', 'TX', '77338', '2814467316', '2814460551', '18648 McKay Blvd Ste 200', 'Humble', 'Harris', 'TX', '77338', '2814467316', '2814460551', 'HOUSTON5', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-21', NULL, 0, 0, 0, 'Kingwood Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1629043500', 0, 'N', 0, '2013-11-21', NULL, NULL, 30.005, -95.2893, NULL, NULL),
('742431113', 'W12040719', 'W12040719', 'TXHOUSTD', 'Southwest Asthma and Allergy', 'Juan', 'C', 'Zambrano', 'MD', 'Allergy and Immunology', '', '', NULL, 'O', '8955 Hwy 6 N Ste 100', 'Houston', 'Harris', 'TX', '77095', '2818585708', '2818586339', '8955 Hwy 6 N Ste 100', 'Houston', 'Harris', 'TX', '77095', '2818585708', '2818586339', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-13', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1487693222', 0, 'N', 0, '2013-11-14', NULL, NULL, 29.9084, -95.6301, NULL, NULL),
('742431113', 'W12040720', 'W12040720', 'TXHOUSTD', 'Southwest Asthma and Allergy', 'Juan', 'C', 'Zambrano', 'MD', 'Allergy and Immunology', '', '', NULL, 'O', '902 Frostwood Ste 302', 'Houston', 'Harris', 'TX', '77024', '7139730051', '7139737130', '902 Frostwood Ste 302', 'Houston', 'Harris', 'TX', '77024', '7139730051', '7139737130', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-13', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1487693222', 0, 'N', 0, '2013-11-14', NULL, NULL, 29.7795, -95.5478, NULL, NULL),
('742431113', 'W12040716', 'W12040716', 'TXHOUSTD', 'Southwest Asthma and Allergy', 'L', 'Reed', 'Shirley', 'MD', 'Allergy and Immunology', '', '', NULL, 'O', '12606 W Houston Ctr Blvd Ste 260', 'Houston', 'Harris', 'TX', '77082', '2815314901', '2815317974', '12606 W Houston Ctr Blvd Ste 260', 'Houston', 'Harris', 'TX', '77082', '2815314901', '2815317974', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-13', NULL, 0, 0, 0, 'Houston Methodist Sugar Land Hospital', 'West Houston Medical Center', NULL, NULL, 'HCFA|', '1114920063', 0, 'N', 0, '2013-11-14', NULL, NULL, 29.7268, -95.5925, NULL, NULL),
('742431113', 'W12040715', 'W12040715', 'TXHOUSTD', 'Southwest Asthma and Allergy', 'L', 'Reed', 'Shirley', 'MD', 'Allergy and Immunology', '', '', NULL, 'O', '15400 SW Fwy Ste 125', 'Sugar Land', 'Fort Bend', 'TX', '77478', '2812420131', '2812427402', '15400 SW Fwy Ste 125', 'Sugar Land', 'Fort Bend', 'TX', '77478', '2812420131', '2812427402', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-13', NULL, 0, 0, 0, 'Houston Methodist Sugar Land Hospital', 'West Houston Medical Center', NULL, NULL, 'HCFA|', '1114920063', 0, 'N', 0, '2013-11-14', NULL, NULL, 29.6056, -95.6159, NULL, NULL),
('742431113', 'W12040717', 'W12040717', 'TXHOUSTD', 'Southwest Asthma and Allergy', 'L', 'Reed', 'Shirley', 'MD', 'Allergy and Immunology', '', '', NULL, 'O', '21820 Kingsland Blvd Ste 110', 'Katy', 'Harris', 'TX', '77450', '2815787922', '2815783175', '21820 Kingsland Blvd Ste 110', 'Katy', 'Harris', 'TX', '77450', '2815787922', '2815783175', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-13', NULL, 0, 0, 0, 'Houston Methodist Sugar Land Hospital', 'West Houston Medical Center', NULL, NULL, 'HCFA|', '1114920063', 0, 'N', 0, '2013-11-14', NULL, NULL, 29.7748, -95.7492, NULL, NULL),
('742431113', 'W12040712', 'W12040712', 'TXHOUSTD', 'Southwest Asthma and Allergy', 'Kenneth', 'T', 'Kray', 'MD', 'Allergy and Immunology', '', '', NULL, 'O', '605 Rockmead Dr Ste 500', 'Kingwood', 'Harris', 'TX', '77339', '2813586788', '2813588422', '605 Rockmead Dr Ste 500', 'Kingwood', 'Harris', 'TX', '77339', '2813586788', '2813588422', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-13', NULL, 0, 0, 0, 'Houston Methodist Willowbrook Hospital', NULL, NULL, NULL, 'HCFA|', '1427003458', 0, 'N', 0, '2013-11-14', NULL, NULL, 30.0533, -95.2449, 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
('742431113', 'W12040713', 'W12040713', 'TXHOUSTD', 'Southwest Asthma and Allergy', 'Kenneth', 'T', 'Kray', 'MD', 'Allergy and Immunology', '', '', NULL, 'O', '6334 FM 2920 Ste 190', 'Spring', 'Harris', 'TX', '77379', '2813766644', '2813766645', '6334 FM 2920 Ste 190', 'Spring', 'Harris', 'TX', '77379', '2813766644', '2813766645', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-13', NULL, 0, 0, 0, 'Houston Methodist Willowbrook Hospital', NULL, NULL, NULL, 'HCFA|', '1427003458', 0, 'N', 0, '2013-11-14', NULL, NULL, 30.074, -95.5203, NULL, NULL),
('742431113', 'W12040710', 'W12040710', 'TXHOUSTD', 'Southwest Asthma and Allergy', 'Glenn', 'B', 'Kline', 'MD', 'Allergy and Immunology', '', '', NULL, 'O', '21820 Kingsland Blvd Ste 110', 'Katy', 'Harris', 'TX', '77450', '2815787922', '2815783175', '21820 Kingsland Blvd Ste 110', 'Katy', 'Harris', 'TX', '77450', '2815787922', '2815783175', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-13', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1689677510', 0, 'N', 0, '2013-11-14', NULL, NULL, 29.7748, -95.7492, NULL, NULL),
('742431113', 'W12040709', 'W12040709', 'TXHOUSTD', 'Southwest Asthma and Allergy', 'Glenn', 'B', 'Kline', 'MD', 'Allergy and Immunology', '', '', NULL, 'O', '902 Frostwood Ste 302', 'Houston', 'Harris', 'TX', '77024', '7139730051', '7139737130', '902 Frostwood Ste 302', 'Houston', 'Harris', 'TX', '77024', '7139730051', '7139737130', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-13', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1689677510', 0, 'N', 0, '2013-11-14', NULL, NULL, 29.7795, -95.5478, NULL, NULL),
('760041008', 'W12040728', 'W12040728', 'TXHOUSTD', 'The DeWitt Clinic PA', '', '', 'The DeWitt Clinic', '', 'Family Practice', '', '', NULL, 'O', '304 Medic Ln Ste B', 'Alvin', 'Brazoria', 'TX', '77511', '2813312062', '2813318070', '304 Medic Ln Ste B', 'Alvin', 'Brazoria', 'TX', '77511', '2813312062', '2813318070', 'HOUSTONPCP13', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-21', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1043202997', 0, 'Y', 0, '2013-11-21', NULL, NULL, 29.4316, -95.2429, NULL, NULL),
('760041008', 'W12040730', 'W12040730', 'TXHOUSTD', 'The DeWitt Clinic PA', 'Robert', 'D', 'DeWitt', 'MD', 'Internal Medicine', '', '', NULL, 'O', '304 Medic Ln Ste B', 'Alvin', 'Brazoria', 'TX', '77511', '2813312062', '2813318070', '304 Medic Ln Ste B', 'Alvin', 'Brazoria', 'TX', '77511', '2813312062', '2813318070', 'HOUSTONPCP13', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-21', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1972589737', 0, 'N', 0, '2013-11-21', NULL, NULL, 29.4316, -95.2429, NULL, NULL),
('760041008', 'W12040732', 'W12040732', 'TXHOUSTD', 'The DeWitt Clinic PA', 'Katherine', 'S', 'Herring', 'MD', 'Family Practice', '', '', NULL, 'O', '304 Medic Ln Ste B', 'Alvin', 'Brazoria', 'TX', '77511', '2813312062', '2813318070', '304 Medic Ln Ste B', 'Alvin', 'Brazoria', 'TX', '77511', '2813312062', '2813318070', 'HOUSTONPCP13', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-21', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1154313005', 0, 'N', 0, '2013-11-21', NULL, NULL, 29.4316, -95.2429, NULL, NULL),
('273225359', 'W12040734', 'W12040734', 'TXHOUSTD', 'Calder Urgent Care and Family Practice', 'Erica', '', 'Palafox-Chua', 'NP', 'Family Practice', '', '', NULL, 'B', 'PO Box 741371', 'Atlanta', 'Fulton', 'GA', '30374', '          ', NULL, 'PO Box 741371', 'Atlanta', 'Fulton', 'GA', '30374', '          ', '          ', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1275967887', 0, 'Y', 0, '2013-12-13', NULL, NULL, 0, 0, NULL, NULL),
('273225359', 'W12040733', 'W12040733', 'TXHOUSTD', 'Calder Urgent Care and Family Practice', 'Erica', '', 'Palafox-Chua', 'NP', 'Family Practice', '', '', NULL, 'O', '1108 S Gulf Fwy Ste 230', 'League City', 'Galveston', 'TX', '77573', '2815574404', '2715574443', '1108 S Gulf Fwy Ste 230', 'League City', 'Galveston', 'TX', '77573', '2815574404', '2715574443', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1275967887', 0, 'Y', 0, '2013-12-13', NULL, NULL, 29.495, -95.1088, NULL, NULL),
('810231784', 'W12040735', 'W12040735', 'WYBILLINGS', 'Billings Clinic', 'Michael', 'P', 'Temporal', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 31315', 'Billings', 'Yellowstone', 'MT', '59107', '4062382617', '0000000000', 'PO Box 31315', 'Billings', 'Yellowstone', 'MT', '59107', '4062382617', '0000000000', '', '', '', '0.00', '17.00', '0.00', 3, '2013-10-18', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1982695151', 0, 'N', 0, '2013-11-18', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12040736', 'W12040736', 'WYBILLINGS', 'Billings Clinic', 'Michael', 'P', 'Temporal', 'MD', 'Family Practice', '', '', NULL, 'M', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', '0000000000', '0000000000', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', '0000000000', '0000000000', '', '', '', '0.00', '17.00', '0.00', 3, '2013-10-18', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1982695151', 0, 'N', 0, '2013-11-18', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12040739', 'W12040739', 'WYBILLINGS', 'Billings Clinic', 'Zachary', 'J', 'Appel', 'PA', 'Cardiology', '', '', NULL, 'M', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', '0000000000', '0000000000', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', '0000000000', '0000000000', '', '', '', '0.00', '17.00', '0.00', 3, '2013-11-05', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1720417249', 0, 'N', 0, '2013-11-14', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12040740', 'W12040740', 'WYBILLINGS', 'Billings Clinic - Cardiology', 'Zachary', 'J', 'Appel', 'PA', 'Cardiology', '', '', NULL, 'O', '1020 N 27th St', 'Billings', 'Yellowstone', 'MT', '59101', '4062382000', '4062382066', '1020 N 27th St', 'Billings', 'Yellowstone', 'MT', '59101', '4062382000', '4062382066', '', '', '', '0.00', '17.00', '0.00', 3, '2013-11-05', '2014-03-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1720417249', 0, 'N', 0, '2014-03-13', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12040738', 'W12040738', 'WYBILLINGS', 'Billings Clinic', 'Zachary', 'J', 'Appel', 'PA', 'Cardiology', '', '', NULL, 'B', 'PO Box 31315', 'Billings', 'Yellowstone', 'MT', '59107', '4062382617', '0000000000', 'PO Box 31315', 'Billings', 'Yellowstone', 'MT', '59107', '4062382617', '0000000000', '', '', '', '0.00', '17.00', '0.00', 3, '2013-11-05', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1720417249', 0, 'N', 0, '2013-11-14', NULL, NULL, 0, 0, NULL, NULL),
('320271992', 'W12040741', 'W12040741', 'UTMH1', '', 'Laurel', 'A', 'Abts', 'LMFT', 'Mental Health', 'Marriage and Family Therapy', '', NULL, 'O', '11616 S State St Ste 1503', 'Draper', 'Salt Lake', 'UT', '84020', '8019300020', '8013051395', '11616 S State St Ste 1503', 'Draper', 'Salt Lake', 'UT', '84020', '8019300020', '8013051395', 'UTMA', '', '', '0.00', '40.00', '0.00', 3, '2013-09-27', '2014-07-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1992886105', 0, 'N', 0, '2014-05-12', NULL, NULL, 40.541, -111.891, NULL, NULL),
('621801973', 'W12040742', 'W12040742', 'UT01', 'Associates in Orthopaedic Surgery', 'Christopher', 'G', 'Belton', 'DO', 'Orthopedic Surgery', '', '', NULL, 'O', '2356 N 400 E Ste 201', 'Tooele', 'Tooele', 'UT', '84074', '4358822350', '4358822039', '2356 N 400 E Ste 201', 'Tooele', 'Tooele', 'UT', '84074', '4358822350', '4358822039', 'WUSTDSURG5', 'WUSTDHCPC5', '', '0.00', '0.00', '0.00', 6, '2013-11-01', NULL, 0, 35, 0, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1710920590', 0, 'N', 0, '2013-11-14', NULL, NULL, 40.5621, -112.293, NULL, NULL),
('621801973', 'W12040743', 'W12040743', 'UT01', 'Associates in Orthopaedic Surgery', 'Kavon', 'S', 'Rahimzadegan', 'PA-C', 'Orthopedic Surgery', '', '', NULL, 'O', '2356 N 400 E Ste 201', 'Tooele', 'Tooele', 'UT', '84074', '4358822350', '4358822039', '2356 N 400 E Ste 201', 'Tooele', 'Tooele', 'UT', '84074', '4358822350', '4358822039', 'WUSTDSURG5', 'WUSTDHCPC5', '', '0.00', '0.00', '0.00', 6, '2013-11-01', NULL, 0, 35, 0, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1366793622', 0, 'N', 0, '2013-11-14', NULL, NULL, 40.5621, -112.293, NULL, NULL),
('621801973', 'W12040744', 'W12040744', 'UT01', 'Associates in Orthopaedic Surgery', 'Peter', '', 'Silvero', '', 'Orthopedic Surgery', '', '', NULL, 'O', '2356 N 400 E Ste 201', 'Tooele', 'Tooele', 'UT', '84074', '4358822350', '4358822039', '2356 N 400 E Ste 201', 'Tooele', 'Tooele', 'UT', '84074', '4358822350', '4358822039', 'WUSTDSURG5', 'WUSTDHCPC5', '', '0.00', '0.00', '0.00', 6, '2013-11-01', NULL, 0, 35, 0, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1699844001', 0, 'N', 0, '2013-11-14', NULL, NULL, 40.5621, -112.293, NULL, NULL),
('621801973', 'W12040745', 'W12040745', 'UT01', 'Associates in Orthopaedic Surgery', 'Ross', 'M', 'Jarrett', 'PA', 'Orthopedic Surgery', NULL, NULL, NULL, 'O', '2356 N 400 E Ste 201', 'Tooele', 'Tooele', 'UT', '84074', '4358822350', '4358822039', '2356 N 400 E Ste 201', 'Tooele', 'Tooele', 'UT', '84074', '4358822350', '4358822039', 'WUSTDSURG5', 'WUSTDHCPC5', '', '0.00', '0.00', '0.00', 6, '2013-11-01', NULL, 0, 35, 0, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1396789558', 0, 'N', 0, '2013-11-14', NULL, NULL, 40.5621, -112.293, NULL, NULL),
('621801973', 'W12040746', 'W12040746', 'UT01', 'Associates in Orthopaedic Surgery', 'J', 'Douglas', 'Burrows', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '2356 N 400 E Ste 201', 'Tooele', 'Tooele', 'UT', '84074', '4358822350', '4358822039', '2356 N 400 E Ste 201', 'Tooele', 'Tooele', 'UT', '84074', '4358822350', '4358822039', 'WUSTDSURG5', 'WUSTDHCPC5', '', '0.00', '0.00', '0.00', 6, '2013-11-01', NULL, 0, 35, 0, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1477506913', 0, 'N', 0, '2013-11-14', NULL, NULL, 40.5621, -112.293, NULL, NULL),
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('830216112', 'W12040793', 'W12040793', 'WYT2', 'Lander Medical Clinic', 'Edward', '', 'Dowie', 'PA', 'Family Practice', '', '', NULL, 'O', '1620 Riverview Rd', 'Riverton', 'Fremont', 'WY', '82501', '3078566591', '3073321920', '1620 Riverview Rd', 'Riverton', 'Fremont', 'WY', '82501', '3078566591', '3073321920', '', '', '', '0.00', '10.00', '0.00', 3, '2013-11-13', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1366538969', 0, 'N', 0, '2013-11-14', NULL, NULL, 0, 0, NULL, NULL),
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('830216112', 'W12040781', 'W12040781', 'WY01', 'Lander Medical Clinic ', 'Kacie', '', 'Gallo', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 9432', 'Belfast', 'Waldo', 'ME', '04915', '3078566591', '3073321920', 'PO Box 9432', 'Belfast', 'Waldo', 'ME', '04915', '3078566591', '3073321920', '', '', '', '0.00', '10.00', '0.00', 3, '2013-11-13', NULL, 0, 0, 0, 'SageWest Health Care', NULL, NULL, NULL, 'HCFA|UB|', '1285853622', 0, 'N', 0, '2013-11-14', NULL, NULL, 0, 0, NULL, NULL),
('830216112', 'W12040782', 'W12040782', 'WYT2', 'Lander Medical Clinic ', 'Kacie', '', 'Gallo', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 9432', 'Belfast', 'Waldo', 'ME', '04915', '3078566591', '3073321920', 'PO Box 9432', 'Belfast', 'Waldo', 'ME', '04915', '3078566591', '3073321920', '', '', '', '0.00', '10.00', '0.00', 3, '2013-11-13', NULL, 0, 0, 0, 'SageWest Health Care', NULL, NULL, NULL, 'HCFA|UB|', '1285853622', 0, 'N', 0, '2013-11-14', NULL, NULL, 0, 0, NULL, NULL),
('830216112', 'W12040794', 'W12040794', 'WY01', 'Lander Medical Clinic', 'Kacie', '', 'Gallo', 'MD', 'Family Practice', '', '', NULL, 'O', '1620 Riverview Rd', 'Riverton', 'Fremont', 'WY', '82501', '3078566591', '3073321920', '1620 Riverview Rd', 'Riverton', 'Fremont', 'WY', '82501', '3078566591', '3073321920', '', '', '', '0.00', '10.00', '0.00', 3, '2013-11-13', NULL, 0, 0, 0, 'SageWest Health Care', NULL, NULL, NULL, 'HCFA|UB|', '1285853622', 0, 'N', 0, '2013-11-14', NULL, NULL, 43.0263, -108.445, NULL, NULL),
('830216112', 'W12040795', 'W12040795', 'WYT2', 'Lander Medical Clinic', 'Kacie', '', 'Gallo', 'MD', 'Family Practice', '', '', NULL, 'O', '1620 Riverview Rd', 'Riverton', 'Fremont', 'WY', '82501', '3078566591', '3073321920', '1620 Riverview Rd', 'Riverton', 'Fremont', 'WY', '82501', '3078566591', '3073321920', '', '', '', '0.00', '10.00', '0.00', 3, '2013-11-13', NULL, 0, 0, 0, 'SageWest Health Care', NULL, NULL, NULL, 'HCFA|UB|', '1285853622', 0, 'N', 0, '2013-11-14', NULL, NULL, 0, 0, NULL, NULL),
('830216112', 'W12040796', 'W12040796', 'WY01', 'Lander Medical Clinic', 'Donald', '', 'Gullickson', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1620 Riverview Rd', 'Riverton', 'Fremont', 'WY', '82501', '3078566591', '3073321920', '1620 Riverview Rd', 'Riverton', 'Fremont', 'WY', '82501', '3078566591', '3073321920', '', '', '', '0.00', '10.00', '0.00', 3, '2013-11-13', NULL, 0, 0, 0, 'SageWest Health Care', NULL, NULL, NULL, 'HCFA|UB|', '1497840110', 0, 'N', 0, '2013-11-14', NULL, NULL, 43.0263, -108.445, NULL, NULL),
('830216112', 'W12040797', 'W12040797', 'WYT2', 'Lander Medical Clinic', 'Donald', '', 'Gullickson', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1620 Riverview Rd', 'Riverton', 'Fremont', 'WY', '82501', '3078566591', '3073321920', '1620 Riverview Rd', 'Riverton', 'Fremont', 'WY', '82501', '3078566591', '3073321920', '', '', '', '0.00', '10.00', '0.00', 3, '2013-11-13', NULL, 0, 0, 0, 'SageWest Health Care', NULL, NULL, NULL, 'HCFA|UB|', '1497840110', 0, 'N', 0, '2013-11-14', NULL, NULL, 0, 0, NULL, NULL),
('830216112', 'W12040798', 'W12040798', 'WY01', 'Lander Medical Clinic', 'Donald', '', 'Gullickson', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 9432', 'Belfast', 'Waldo', 'ME', '04915', '3073322941', '3073321920', 'PO Box 9432', 'Belfast', 'Waldo', 'ME', '04915', '3073322941', '3073321920', '', '', '', '0.00', '10.00', '0.00', 3, '2013-11-13', NULL, 0, 0, 0, 'SageWest Health Care', NULL, NULL, NULL, 'HCFA|UB|', '1497840110', 0, 'N', 0, '2013-11-14', NULL, NULL, 0, 0, NULL, NULL),
('830216112', 'W12040799', 'W12040799', 'WYT2', 'Lander Medical Clinic', 'Donald', '', 'Gullickson', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 9432', 'Belfast', 'Waldo', 'ME', '04915', '3073322941', '3073321920', 'PO Box 9432', 'Belfast', 'Waldo', 'ME', '04915', '3073322941', '3073321920', '', '', '', '0.00', '10.00', '0.00', 3, '2013-11-13', NULL, 0, 0, 0, 'SageWest Health Care', NULL, NULL, NULL, 'HCFA|UB|', '1497840110', 0, 'N', 0, '2013-11-14', NULL, NULL, 0, 0, NULL, NULL),
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('452716222', 'W12040845', 'W12040845', 'ID02', 'St Lukes Clinic Orthopedics', 'Stanley', 'W', 'Moss', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', 'PO Box 604', 'Boise', 'Ada', 'ID', '83701', '2087065000', '0000000000', 'PO Box 604', 'Boise', 'Ada', 'ID', '83701', '2087065000', '0000000000', 'IDACN', '', '', '0.00', '15.00', '0.00', 8, '2013-09-24', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1831138692', 0, 'N', 0, '2013-11-15', NULL, NULL, 0, 0, NULL, NULL),
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('260553931', 'W12040849', 'W12040849', 'IDBOISTD', 'Saint Alphonsus Medical Group General Surgery Emmett', 'Barry', '', 'Smith', 'DO', 'General Surgery', '', '', NULL, 'O', '1024 E Locust', 'Emmett', 'Gem', 'ID', '83617', '2083652338', '2083654992', '1024 E Locust', 'Emmett', 'Gem', 'ID', '83617', '2083652338', '2083654992', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2013-10-14', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, NULL, NULL, 'HCFA|UB|', '1083731103', 0, 'N', 0, '2013-11-15', NULL, NULL, 43.8791, -116.487, NULL, NULL),
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('260553931', 'W12040853', 'W12040853', 'IDBOISTD', 'Saint Alphonsus Medical Group Heart Care Ontario', 'Walter', 'L', 'Seale', 'MD', 'Cardiology', '', '', NULL, 'O', '1050 SW 3rd Ave Ste 400', 'Ontario', 'Malheur', 'OR', '97914', '2083674278', '2083675200', '1050 SW 3rd Ave Ste 400', 'Ontario', 'Malheur', 'OR', '97914', '2083674278', '2083675200', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2013-11-01', '2013-11-01', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1720033459', 0, 'Y', 0, '2014-01-24', NULL, NULL, 44.0257, -116.977, NULL, NULL),
('260553931', 'W12040854', 'W12040854', 'IDBOISTD', 'Saint Alphonsus Medical Group Heart Care Ontario', 'Walter', 'L', 'Seale', 'MD', 'Cardiology', '', '', NULL, 'O', '351 SW 9th St', 'Ontario', 'Malheur', 'OR', '97914', '2083674278', '2083675200', '351 SW 9th St', 'Ontario', 'Malheur', 'OR', '97914', '2083674278', '2083675200', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2013-11-01', '2013-11-01', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1720033459', 0, 'Y', 0, '2014-01-24', NULL, NULL, 44.0252, -116.976, 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
('260553931', 'W12040855', 'W12040855', 'IDBOISTD', 'Saint Alphonsus Medical Group Heart Care La Grande', 'Walter', 'L', 'Seale', 'MD', 'Cardiology', '', '', NULL, 'O', '506 4th St', 'La Grande', 'Union', 'OR', '97850', '5419638421', '0000000000', '506 4th St', 'La Grande', 'Union', 'OR', '97850', '5419638421', '0000000000', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2013-11-01', '2013-11-01', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1720033459', 0, 'Y', 0, '2014-01-24', NULL, NULL, 0, 0, NULL, NULL),
('260553931', 'W12040856', 'W12040856', 'IDBOISTD', 'Saint Alphonsus Medical Group Heart Care La Grande', 'Walter', 'L', 'Seale', 'MD', 'Cardiology', '', '', NULL, 'O', '900 Sunset Dr', 'La Grande', 'Union', 'OR', '97850', '5416633138', '2083675200', '900 Sunset Dr', 'La Grande', 'Union', 'OR', '97850', '5416633138', '2083675200', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2013-11-01', '2013-11-01', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1720033459', 0, 'Y', 0, '2014-01-24', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12040858', 'W12040858', 'IDBOISTD', 'Saint Alphonsus Medical Group OBGYN', 'Amy', 'E', 'English-Burt', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1072 N Liberty Ste 100', 'Boise', 'Ada', 'ID', '83704', '2083674224', '2083677806', '1072 N Liberty Ste 100', 'Boise', 'Ada', 'ID', '83704', '2083674224', '2083677806', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2013-10-04', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|', '1568407765', 0, 'N', 0, '2014-01-13', NULL, NULL, 43.6156, -116.261, NULL, NULL),
('260553931', 'W12040859', 'W12040859', 'IDBOISTD', 'Saint Alphonsus Medical Group Heart Care Emmett', 'Gerard', 'P', 'Connor', 'MD', 'Gynecologic Oncology', '', '', NULL, 'O', '1202 E Locust Dr', 'Emmett', 'Gem', 'ID', '83617', '2083675227', '2083675225', '1202 E Locust Dr', 'Emmett', 'Gem', 'ID', '83617', '2083675227', '2083675225', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2013-12-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1669470274', 0, 'N', 0, '2014-03-17', NULL, NULL, 43.8791, -116.485, NULL, NULL),
('204043287', 'W12040860', 'W12040860', 'NM01', 'ABQ Health Partners', 'Jeffrey', '', 'Morehouse', 'MD', 'Plastic Surgery', '', ' ', NULL, 'O', '9101 Montgomery Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87111', '5052754259', '5052754223', '9101 Montgomery Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87111', '5052754259', '5052754223', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2013-09-15', NULL, 0, 0, 0, 'Lovelace Womens Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1487687067', 0, 'Y', 0, '2013-11-15', NULL, NULL, 35.1307, -106.542, NULL, NULL),
('204043287', 'W12040861', 'W12040861', 'NM01', 'ABQ Health Partners', 'Ruben', 'P', 'Franco', 'PA-C', 'Pain Management', '', '', NULL, 'O', '9101 Montgomery Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87111', '5052627724', '5052623476', '9101 Montgomery Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87111', '5052627724', '5052623476', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2013-11-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1104908839', 0, 'Y', 0, '2013-11-15', NULL, NULL, 35.1307, -106.542, NULL, NULL),
('204043287', 'W12040862', 'W12040862', 'NM01', 'ABQ Health Partners ', 'Kathie', '', 'Maxwell', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '200 Rio Bravo Blvd SE ', 'Albuquerque', 'Bernalillo', 'NM', '87105', '5052546500', '5052546532', '200 Rio Bravo Blvd SE ', 'Albuquerque', 'Bernalillo', 'NM', '87105', '5052546500', '5052546532', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2013-11-11', NULL, 0, 0, 0, 'Lovelace Womens Hospital', 'Lovelace Westside Hospital', '', '', 'HCFA|UB|', '1609897388', 0, 'N', 0, '2014-06-24', NULL, NULL, 35.027, -106.655, NULL, NULL),
('204043287', 'W12040863', 'W12040863', 'NM01', 'ABQ Health Partners ', 'Elizabeth', '', 'Heath-West', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '200 Rio Bravo Blvd SE ', 'Albuquerque', 'Bernalillo', 'NM', '87105', '5052546500', '5052546532', '200 Rio Bravo Blvd SE ', 'Albuquerque', 'Bernalillo', 'NM', '87105', '5052546500', '5052546532', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2013-11-11', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1134152721', 0, 'N', 0, '2014-06-24', NULL, NULL, 35.027, -106.655, NULL, NULL),
('760650265', 'W12041145', 'W12041145', 'TXHOUSTD', 'Sugar Lakes Family Practice', 'Benita', 'R', 'Brown', 'PA-C', 'Family Practice', '', '', NULL, 'O', '16902 SW Fwy Ste 100', 'Sugar Land', 'Fort Bend', 'TX', '77479', '2815652800', '2815652801', '16902 SW Fwy Ste 100', 'Sugar Land', 'Fort Bend', 'TX', '77479', '2815652800', '2815652801', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-21', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1114056736', 0, 'Y', 0, '2013-11-21', NULL, NULL, 29.5906, -95.6366, NULL, NULL),
('263981143', 'W12040864', 'W12040864', 'UT01', 'Hearing and Balance Institute', 'Douglas', 'K', 'Worthington', 'AUD', 'Audiology', '', '', NULL, 'O', '1055 N 300 W Ste 211', 'Provo', 'Utah', 'UT', '84604', '8018529696', '8018529697', '1055 N 300 W Ste 211', 'Provo', 'Utah', 'UT', '84604', '8018529696', '8018529697', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-11-08', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1467460246', 0, 'N', 0, '2013-11-15', NULL, NULL, 40.2476, -111.664, NULL, NULL),
('263981143', 'W12040865', 'W12040865', 'UT01', 'Peak ENT Associates ', 'Kirt', 'S', 'Beus', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '802 S 200 W Ste A', 'Blanding', 'San Juan', 'UT', '84511', '4356378000', '8013735980', '802 S 200 W Ste A', 'Blanding', 'San Juan', 'UT', '84511', '4356378000', '8013735980', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-11-08', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1396765871', 0, 'N', 0, '2013-11-15', NULL, NULL, 37.6098, -109.479, NULL, NULL),
('263981143', 'W12040866', 'W12040866', 'UT01', 'Peak ENT Associates ', 'Curtis', '', 'Thomas', 'AUD, SLP', 'Audiology', 'Speech Therapy', '', NULL, 'O', '325 W Ctr St', 'Spanish Fork', 'Utah', 'UT', '84660', '8014235375', '8013735980', '325 W Ctr St', 'Spanish Fork', 'Utah', 'UT', '84660', '8014235375', '8013735980', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-11-08', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1184761736', 0, 'N', 0, '2014-01-27', NULL, NULL, 40.1099, -111.66, NULL, NULL),
('263981143', 'W12040867', 'W12040867', 'UT01', 'Peak ENT Associates ', 'Curtis', '', 'Thomas', 'AUD, SLP', 'Audiology', 'Speech Therapy', '', NULL, 'O', '48 W 1500 N', 'Nephi', 'Juab', 'UT', '84648', '8013577499', '8013735980', '48 W 1500 N', 'Nephi', 'Juab', 'UT', '84648', '8013577499', '8013735980', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-11-08', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1184761736', 0, 'N', 0, '2014-01-27', NULL, NULL, 39.7306, -111.839, NULL, NULL),
('263981143', 'W12040868', 'W12040868', 'UT01', 'Peak ENT Associates ', 'Curtis', '', 'Thomas', 'AUD, SLP', 'Audiology', 'Speech Therapy', '', NULL, 'O', '1100 S Medical Dr', 'Mount Pleasant', 'Sanpete', 'UT', '84647', '8013577499', '8013735980', '1100 S Medical Dr', 'Mount Pleasant', 'Sanpete', 'UT', '84647', '8013577499', '8013735980', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-11-08', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1184761736', 0, 'N', 0, '2014-01-27', NULL, NULL, 39.5318, -111.461, NULL, NULL),
('263981143', 'W12040869', 'W12040869', 'UT01', 'Hearing and Balance Institute', 'Curtis', '', 'Thomas', 'AUD, SLP', 'Audiology', 'Speech Therapy', '', NULL, 'O', '1055 N 300 W Ste 211', 'Provo', 'Utah', 'UT', '84604', '8018529696', '8018529697', '1055 N 300 W Ste 211', 'Provo', 'Utah', 'UT', '84604', '8018529696', '8018529697', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-11-08', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1184761736', 0, 'N', 0, '2014-01-27', NULL, NULL, 40.2476, -111.664, NULL, NULL),
('263981143', 'W12040870', 'W12040870', 'UT01', 'Peak ENT Associates', 'Joseph ', 'E', 'Dansie', 'AUD', 'Audiology', '', '', NULL, 'O', '220 N 1200 E Ste 101', 'Lehi', 'Utah', 'UT', '84043', '8017683500', '8017683506', '220 N 1200 E Ste 101', 'Lehi', 'Utah', 'UT', '84043', '8017683500', '8017683506', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-11-08', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1972818185', 0, 'N', 0, '2014-07-24', NULL, NULL, 40.3914, -111.83, NULL, NULL),
('263981143', 'W12040871', 'W12040871', 'UT01', 'Hearing and Balance Institute', 'Joseph ', 'E', 'Dansie', 'AUD', 'Audiology', '', '', NULL, 'O', '1055 N 300 W Ste 211', 'Provo', 'Utah', 'UT', '84604', '8018529696', '8018529697', '1055 N 300 W Ste 211', 'Provo', 'Utah', 'UT', '84604', '8018529696', '8018529697', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-11-08', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1972818185', 0, 'N', 0, '2014-07-24', NULL, NULL, 40.2476, -111.664, NULL, NULL),
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('452425098', 'W12040873', 'W12040873', 'TXHOUSTD', 'Kingwood Urgent Care and Special Clinic', '', '', 'Kingwood Urgent Care and Special Clinic', '', 'Urgent Care', '', '', NULL, 'O', '2601 W Lake Houston Pkwy', 'Kingwood', 'Harris', 'TX', '77339', '2813607502', '2813600587', '2601 W Lake Houston Pkwy', 'Kingwood', 'Harris', 'TX', '77339', '2813607502', '2813600587', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-21', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1144588740', 0, 'N', 0, '2014-05-02', NULL, NULL, 30.0438, -95.1802, NULL, NULL),
('452425098', 'W12040875', 'W12040875', 'TXHOUSTD', 'Kingwood Urgent Care and Special Clinic', 'Hamidreza', '', 'Iranmanesh', 'MD', 'Urgent Care', '', '', NULL, 'O', '2601 W Lake Houston Pkwy', 'Kingwood', 'Harris', 'TX', '77339', '2813607502', '2813600587', '2601 W Lake Houston Pkwy', 'Kingwood', 'Harris', 'TX', '77339', '2813607502', '2813600587', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-21', NULL, 0, 0, 0, 'Kingwood Medical Center', NULL, '', '', 'HCFA|UB|', '1710189097', 0, 'Y', 0, '2014-05-02', NULL, NULL, 30.0438, -95.1802, NULL, NULL),
('452425098', 'W12040877', 'W12040877', 'TXHOUSTD', 'Kingwood Urgent Care and Special Clinic', 'Payman', '', 'Zamirpour', 'MD', 'Urgent Care', '', '', NULL, 'O', '2601 W Lake Houston Pkwy', 'Kingwood', 'Harris', 'TX', '77339', '2813607502', '2813600587', '2601 W Lake Houston Pkwy', 'Kingwood', 'Harris', 'TX', '77339', '2813607502', '2813600587', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-21', NULL, 0, 0, 0, 'Houston Methodist San Jacinto Hospital', '', '', '', 'HCFA|UB|', '1124229547', 0, 'Y', 0, '2014-05-02', NULL, NULL, 30.0438, -95.1802, NULL, NULL),
('760528826', 'W12040879', 'W12040879', 'TXHOUSTD', 'Millennium Physicians Association', '', '', 'Millennium Physicians Association', '', 'Hematology and Oncology', '', '', NULL, 'B', '22710 Professional Dr', 'Kingwood', 'Harris', 'TX', '77339', '2812988444', '2812987720', '22710 Professional Dr', 'Kingwood', 'Harris', 'TX', '77339', '2812988444', '2812987720', 'HOUSTON5', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-21', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1255397733', 0, 'Y', 0, '2013-11-21', NULL, NULL, 30.0481, -95.2573, NULL, NULL),
('760528826', 'W12040878', 'W12040878', 'TXHOUSTD', 'Millennium Physicians Association', '', '', 'Millennium Physicians Association', '', 'Hematology and Oncology', '', '', NULL, 'O', '9319 Pinecroft Ste 100', 'The Woodlands', 'Montgomery', 'TX', '77380', '2812988444', '2812987720', '9319 Pinecroft Ste 100', 'The Woodlands', 'Montgomery', 'TX', '77380', '2812988444', '2812987720', 'HOUSTON5', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-21', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1255397733', 0, 'Y', 0, '2013-11-21', NULL, NULL, 30.173, -95.4566, NULL, NULL),
('760528826', 'W12040881', 'W12040881', 'TXHOUSTD', 'Millennium Physicians Association', 'Samer', 'S', 'Suki', 'MD', 'Hematology and Oncology', '', '', NULL, 'O', '22710 Professional Dr Ste 100', 'Kingwood', 'Harris', 'TX', '77339', '2813582850', '2813582817', '22710 Professional Dr Ste 100', 'Kingwood', 'Harris', 'TX', '77339', '2813582850', '2813582817', 'HOUSTON5', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-21', NULL, 0, 0, 0, 'Kingwood Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1639132962', 0, 'N', 0, '2013-11-21', NULL, NULL, 30.0473, -95.2579, NULL, NULL),
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('200680660', 'W12040988', 'W12040988', 'TXHOUSTD', 'Fairfield Family Physicians', 'Chiao-Ya', 'Grace', 'Fan', 'MD', 'Family Practice', '', '', NULL, 'O', 'PMB 314', 'Cypress', 'Harris', 'TX', '77433', '2813730162', '2813730765', 'PMB 314', 'Cypress', 'Harris', 'TX', '77433', '2813730162', '2813730765', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-21', NULL, 0, 0, 0, NULL, NULL, '', '', 'HCFA|UB|', '1114089240', 0, 'N', 0, '2013-11-21', NULL, NULL, 0, 0, NULL, NULL),
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('463323392', 'W12040993', 'W12040993', 'UT01', 'Uintah Basin Medical Center Anesthesiology', 'Steven', 'R', 'Knight', 'CRNA', 'Certified Nurse Anesthetist', '', '', NULL, 'O', '250 W 300 N', 'Roosevelt', 'Duchesne', 'UT', '84066', '4357224691', '4357229291', '250 W 300 N', 'Roosevelt', 'Duchesne', 'UT', '84066', '4357224691', '4357229291', '', '', '', '55.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 12, 0, '', '', '', '', 'HCFA|UB|', '1982667945', 0, 'Y', 0, '2013-12-19', NULL, NULL, 40.3034, -109.996, NULL, NULL),
('463323392', 'W12040994', 'W12040994', 'UT01', 'Uintah Basin Medical Center Anesthesiology', 'Steven', 'R', 'Knight', 'CRNA', 'Certified Nurse Anesthetist', '', '', NULL, 'B', 'PO Box 3750', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8008803566', '8016765961', 'PO Box 3750', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8008803566', '8016765961', '', '', '', '55.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 12, 0, '', '', '', '', 'HCFA|UB|', '1982667945', 0, 'N', 0, '2013-12-19', NULL, NULL, 0, 0, NULL, NULL),
('200680660', 'W12041002', 'W12041002', 'TXHOUSTD', 'Fairfield Family Physicians', 'Trung', 'D', 'Dinh', 'MD', 'Family Practice', '', '', NULL, 'O', '15201 Mason Rd Ste 1200 PMG 314', 'Cypress', 'Harris', 'TX', '77433', '2813730162', '2813730765', '15201 Mason Rd Ste 1200 PMG 314', 'Cypress', 'Harris', 'TX', '77433', '2813730162', '2813730765', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-21', NULL, 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1083710271', 0, 'N', 0, '2014-05-08', NULL, NULL, 29.9927, -95.739, NULL, NULL),
('200680660', 'W12041003', 'W12041003', 'TXHOUSTD', 'Fairfield Family Physicians', 'Trung', 'D', 'Dinh', 'MD', 'Family Practice', '', '', NULL, 'O', 'PMB 314', 'Cypress', 'Harris', 'TX', '77433', '2813730162', '2813730765', 'PMB 314', 'Cypress', 'Harris', 'TX', '77433', '2813730162', '2813730765', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-21', '2013-12-21', 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1083710271', 0, 'N', 0, '2014-05-08', NULL, NULL, 0, 0, NULL, NULL),
('043673591', 'W12041004', 'W12041004', 'ID01', 'Brhe A Minkler', 'Brhe', 'A', 'Minkler', 'LCPC', 'Mental Health', 'Counseling', '', NULL, 'O', '1032 S Bridgeway Pl Ste 100', 'Eagle', 'Ada', 'ID', '83616', '2082460123', '2082460125', '1032 S Bridgeway Pl Ste 100', 'Eagle', 'Ada', 'ID', '83616', '2082460123', '2082460125', 'IDMA', '', '', '0.00', '40.00', '0.00', 6, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1093097388', 0, 'N', 0, '2014-05-14', NULL, NULL, 43.6872, -116.35, NULL, NULL),
('202148889', 'W12041005', 'W12041005', 'TXSATSTD', 'Health Texas Medical Group of San Antonio', 'Dan', 'C', 'Powell', 'MD', 'Family Practice', '', '', NULL, 'O', '20821 US Hwy 281 N Ste 122', 'San Antonio', 'Bexar', 'TX', '78258', '          ', '2105461610', '20821 US Hwy 281 N Ste 122', 'San Antonio', 'Bexar', 'TX', '78258', '          ', '2105461610', 'TXINT', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-12-01', NULL, 0, 0, 0, 'North Central Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|DEN|', '1912921701', 0, 'N', 0, '2013-12-23', NULL, NULL, 29.6379, -98.4561, NULL, NULL),
('611696015', 'W12041008', 'W12041008', 'UT01', 'Mountain Star Behavioral Health', 'Matthew', 'J', 'Gardiner', 'MD', 'Mental Health', 'Psychiatry', '', NULL, 'B', 'PO Box 742353', 'Atlanta', 'Fulton', 'GA', '30384', '6153737490', '0000000000', 'PO Box 742353', 'Atlanta', 'Fulton', 'GA', '30384', '6153737490', '0000000000', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'Lakeview Hospital', '', '', '', 'HCFA|UB', '1629084710', 0, 'N', 0, '2014-04-18', NULL, NULL, 0, 0, NULL, NULL),
('850232628', 'W12041010', 'W12041010', 'NM01', 'Womens Specialists of NM', 'Wendy', '', 'Kimmelman', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '201 Cedar St SE Ste 5640', 'Albuquerque', 'Bernalillo', 'NM', '87106', '5058436168', '5052479743', '201 Cedar St SE Ste 5640', 'Albuquerque', 'Bernalillo', 'NM', '87106', '5058436168', '5052479743', 'NMWOMENS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1003849662', 0, 'N', 0, '2013-12-12', NULL, NULL, 35.0813, -106.634, NULL, NULL),
('942854057', 'W12041011', 'W12041011', 'UTIHC04', 'Primary Childrens Medical Center', 'Keeley', 'J', 'Mendenhall', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '5770 S 1500 W', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8013137770', NULL, '5770 S 1500 W', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8013137770', '', '', '', '', '0.00', '10.00', '0.00', 8, '2013-10-21', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1588801401', 0, 'N', 0, '2014-06-18', NULL, NULL, 40.6462, -111.934, NULL, NULL),
('942854057', 'W12041012', 'W12041012', 'UTIHC04', 'Park City Medical Center Rehab Services', 'Laura', 'Newman', 'Varier', 'AUD', 'Audiology', '', '', NULL, 'O', '3773 W 12600 S', 'Riverton', 'Salt Lake', 'UT', '84065', '8016624949', NULL, '3773 W 12600 S', 'Riverton', 'Salt Lake', 'UT', '84065', '8016624949', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2013-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1821244245', 0, 'N', 0, '2013-11-18', NULL, NULL, 40.5222, -111.981, NULL, NULL),
('942854057', 'W12041014', 'W12041014', 'UTIHC04', 'Park City Medical Center', 'Mohammad', '', 'Dbeisi', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', NULL, '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1689686370', 0, 'N', 0, '2013-11-18', NULL, NULL, 40.6876, -111.468, NULL, NULL),
('942854057', 'W12041016', 'W12041016', 'UTIHC04', 'Primary Childrens Medical Center Inpatient Physical Therapy', 'Rick', 'C', 'Reigle', 'DPT', 'Physical Therapy', '', '', NULL, 'O', '100 Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016624980', NULL, '100 Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016624980', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2013-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1518304948', 0, 'N', 0, '2013-11-18', NULL, NULL, 40.7663, -111.837, NULL, NULL),
('262655922', 'W12041035', 'W12041035', 'TXHOUSTD', 'Nephrology Internal Medicine', 'Mohammed', 'A', 'Dada', 'MD', 'Nephrology', '', '', NULL, 'O', '200 Medical Ctr Ct Ste 100', 'Bay City', 'Matagorda', 'TX', '77414', '9792452421', '9792456263', '200 Medical Ctr Ct Ste 100', 'Bay City', 'Matagorda', 'TX', '77414', '9792452421', '9792456263', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-01-06', NULL, 0, 0, 0, 'Houston Methodist Sugar Land Hospital', NULL, '', '', 'HCFA|UB|', '1942287826', 0, 'N', 0, '2013-12-06', NULL, NULL, 28.9671, -95.9529, NULL, NULL),
('262655922', 'W12041037', 'W12041037', 'TXHOUSTD', 'Nephrology Internal Medicine', 'Mohammed', 'A', 'Dada', 'MD', 'Nephrology', '', '', NULL, 'O', '311 Green Ave', 'Palacios', 'Matagorda', 'TX', '77465', '9792452421', '9792456263', '311 Green Ave', 'Palacios', 'Matagorda', 'TX', '77465', '9792452421', '9792456263', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-01-06', NULL, 0, 0, 0, 'Houston Methodist Sugar Land Hospital', NULL, '', '', 'HCFA|UB|', '1942287826', 0, 'N', 0, '2013-12-06', NULL, NULL, 28.7175, -96.2136, NULL, NULL),
('262655922', 'W12041036', 'W12041036', 'TXHOUSTD', 'Nephrology Internal Medicine', 'Mohammed', 'A', 'Dada', 'MD', 'Nephrology', '', '', NULL, 'O', '513 S Columbia Dr', 'West Columbia', 'Brazoria', 'TX', '77486', '9793452027', '9793454922', '513 S Columbia Dr', 'West Columbia', 'Brazoria', 'TX', '77486', '9793452027', '9793454922', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-01-06', NULL, 0, 0, 0, 'Houston Methodist Sugar Land Hospital', NULL, '', '', 'HCFA|UB|', '1942287826', 0, 'N', 0, '2013-12-06', NULL, NULL, 29.1421, -95.6554, NULL, NULL),
('262655922', 'W12041034', 'W12041034', 'TXHOUSTD', 'Nephrology Internal Medicine', 'Mohammed', 'A', 'Dada', 'MD', 'Nephrology', '', '', NULL, 'B', 'PO Box 2660', 'Bay City', 'Matagorda', 'TX', '77404', '0000000000', '0000000000', 'PO Box 2660', 'Bay City', 'Matagorda', 'TX', '77404', '0000000000', '0000000000', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-01-06', NULL, 0, 0, 0, 'Houston Methodist Sugar Land Hospital', NULL, '', '', 'HCFA|UB|', '1942287826', 0, 'N', 0, '2013-12-06', NULL, NULL, 0, 0, NULL, NULL),
('752584105', 'W12041038', 'W12041038', 'TXDALSTD', 'William R Sheldon', 'William', 'R', 'Sheldon', 'MD', 'Endocrinology', '', '', NULL, 'O', '5930 W Parker Rd Ste 700', 'Plano', 'Collin', 'TX', '75093', '9729437626', '9726085223', '5930 W Parker Rd Ste 700', 'Plano', 'Collin', 'TX', '75093', '9729437626', '9726085223', 'DALLAS4', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-12-21', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1386651180', 0, 'N', 0, '2014-02-24', NULL, NULL, 33.0451, -96.8244, NULL, NULL),
('262655922', 'W12041042', 'W12041042', 'TXHOUSTD', 'Nephrology Internal Medicine', 'Vinitha', '', 'Vellanki', 'MD', 'Nephrology', '', '', NULL, 'O', '16605 SW Fwy Ste 530', 'Sugar Land', 'Fort Bend', 'TX', '77479', '8325327836', '9792456263', '16605 SW Fwy Ste 530', 'Sugar Land', 'Fort Bend', 'TX', '77479', '8325327836', '9792456263', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-01-06', NULL, 0, 0, 0, 'Houston Methodist Sugar Land Hospital', NULL, '', '', 'HCFA|UB|', '1427256700', 0, 'N', 0, '2013-12-13', NULL, NULL, 29.5919, -95.6298, NULL, NULL),
('262655922', 'W12041040', 'W12041040', 'TXHOUSTD', 'Nephrology Internal Medicine', 'Vinitha', '', 'Vellanki', 'MD', 'Nephrology', '', '', NULL, 'O', '200 Medical Ctr Ct Ste 100', 'Bay City', 'Matagorda', 'TX', '77414', '9792452421', '9792456263', '200 Medical Ctr Ct Ste 100', 'Bay City', 'Matagorda', 'TX', '77414', '9792452421', '9792456263', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-01-06', NULL, 0, 0, 0, 'Houston Methodist Sugar Land Hospital', NULL, '', '', 'HCFA|UB|', '1427256700', 0, 'N', 0, '2013-12-13', NULL, NULL, 28.9671, -95.9529, NULL, NULL),
('262655922', 'W12041041', 'W12041041', 'TXHOUSTD', 'Nephrology Internal Medicine', 'Vinitha', '', 'Vellanki', 'MD', 'Nephrology', '', '', NULL, 'O', '513 S Columbia Dr', 'West Columbia', 'Brazoria', 'TX', '77486', '9793452027', '9793454922', '513 S Columbia Dr', 'West Columbia', 'Brazoria', 'TX', '77486', '9793452027', '9793454922', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-01-06', NULL, 0, 0, 0, 'Houston Methodist Sugar Land Hospital', NULL, '', '', 'HCFA|UB|', '1427256700', 0, 'N', 0, '2013-12-13', NULL, NULL, 29.1421, -95.6554, NULL, NULL),
('262655922', 'W12041039', 'W12041039', 'TXHOUSTD', 'Nephrology Internal Medicine', 'Vinitha', '', 'Vellanki', 'MD', 'Nephrology', '', '', NULL, 'B', 'PO Box 2660', 'Bay City', 'Matagorda', 'TX', '77404', '0000000000', '0000000000', 'PO Box 2660', 'Bay City', 'Matagorda', 'TX', '77404', '0000000000', '0000000000', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-01-06', NULL, 0, 0, 0, 'Houston Methodist Sugar Land Hospital', NULL, '', '', 'HCFA|UB|', '1427256700', 0, 'N', 0, '2013-12-13', NULL, NULL, 0, 0, NULL, NULL),
('463756705', 'W12041047', 'W12041047', 'ID01', 'Western Pacemaker Clinic', 'Walter', 'L', 'Seale', 'MD', 'Cardiology', '', '', NULL, 'O', '745 S Progress Ave', 'Meridian', 'Ada', 'ID', '83642', '2088884600', '2082880800', '745 S Progress Ave', 'Meridian', 'Ada', 'ID', '83642', '2088884600', '2082880800', 'IDSTDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1720033459', 0, 'N', 0, '2014-01-24', NULL, NULL, 43.5979, -116.391, NULL, NULL),
('463756705', 'W12041048', 'W12041048', 'ID01', 'Western Pacemaker Clinic', 'Walter', 'L', 'Seale', 'MD', 'Cardiology', '', '', NULL, 'B', 'PO Box 45822', 'Boise', 'Ada', 'ID', '83711', '2088884600', '2082880800', 'PO Box 45822', 'Boise', 'Ada', 'ID', '83711', '2088884600', '2082880800', 'IDSTDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1720033459', 0, 'N', 0, '2014-01-24', NULL, NULL, 0, 0, NULL, NULL),
('760677165', 'W12041049', 'W12041049', 'TXHOUSTD', 'Katy Medical Arts', 'Thomas', 'G', 'Diaz', 'MD', 'Family Practice', '', '', NULL, 'O', '1331 W Grand Pkwy', 'Katy', 'Harris', 'TX', '77493', '2813988044', '2815743972', '1331 W Grand Pkwy', 'Katy', 'Harris', 'TX', '77493', '2813988044', '2815743972', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-21', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1750398590', 0, 'N', 0, '2013-11-21', NULL, NULL, 29.7912, -95.7774, NULL, NULL),
('203639077', 'W12041050', 'W12041050', 'TXDALSTD', 'Jayaprakash N Reddy', 'Jayaprakash', 'N', 'Reddy', 'MD', 'Internal Medicine', '', '', NULL, 'O', '713 W Broad St Ste 100', 'Forney', 'Kaufman', 'TX', '75126', '9725523330', '9725523303', '713 W Broad St Ste 100', 'Forney', 'Kaufman', 'TX', '75126', '9725523330', '9725523303', 'DALLAS1', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-12-21', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1902826977', 0, 'N', 0, '2013-11-21', NULL, NULL, 32.7581, -96.4777, NULL, NULL),
('760616911', 'W12041052', 'W12041052', 'TXHOUSTD', 'Aman Jafar ', 'Aman', '', 'Jafar', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1856 FM 359 Rd', 'Richmond', 'Fort Bend', 'TX', '77406', '8324716956', '8324716957', '1856 FM 359 Rd', 'Richmond', 'Fort Bend', 'TX', '77406', '8324716956', '8324716957', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-21', NULL, 0, 0, 0, 'West Houston Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1912999426', 0, 'N', 0, '2013-11-21', NULL, NULL, 29.6207, -95.7435, NULL, NULL),
('760616911', 'W12041051', 'W12041051', 'TXHOUSTD', 'Aman Jafar ', 'Aman', '', 'Jafar', 'MD', 'Internal Medicine', '', '', NULL, 'O', '3531 Town Ctr Blvd S Ste 101', 'Sugar Land', 'Fort Bend', 'TX', '77479', '2814913225', '2814911702', '3531 Town Ctr Blvd S Ste 101', 'Sugar Land', 'Fort Bend', 'TX', '77479', '2814913225', '2814911702', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-21', NULL, 0, 0, 0, 'West Houston Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1912999426', 0, 'N', 0, '2013-11-21', NULL, NULL, 29.5873, -95.6305, NULL, NULL),
('731653079', 'W12041221', 'W12041221', 'TXHOUSTD', 'Step Pediatrics', 'Diana', '', 'El-Zaim', 'MD', 'Pediatrics', '', '', NULL, 'B', 'PO Box 4346 Dept 697', 'Houston', 'Harris', 'TX', '77210', '2813648600', '2812982005', 'PO Box 4346 Dept 697', 'Houston', 'Harris', 'TX', '77210', '2813648600', '2812982005', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1902859572', 0, 'N', 0, '2013-11-21', NULL, NULL, 0, 0, NULL, NULL),
('731653079', 'W12041220', 'W12041220', 'TXHOUSTD', 'Step Pediatrics', 'Diana', '', 'El-Zaim', 'MD', 'Pediatrics', '', '', NULL, 'O', '4800 W Panther Creek Ste 100', 'Spring', 'Montgomery', 'TX', '77381', '2813648600', '2812982005', '4800 W Panther Creek Ste 100', 'Spring', 'Montgomery', 'TX', '77381', '2813648600', '2812982005', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1902859572', 0, 'N', 0, '2013-11-21', NULL, NULL, 30.1664, -95.5024, NULL, NULL),
('760405358', 'W12041226', 'W12041226', 'TXHOUSTD', 'Renal Physicians of Montgomery County', 'Barry', '', 'Neeland', 'MD', 'Nephrology', '', '', NULL, 'O', '200 River Pointe Dr Ste 200', 'Conroe', 'Montgomery', 'TX', '77304', '9367562555', '9367562534', '200 River Pointe Dr Ste 200', 'Conroe', 'Montgomery', 'TX', '77304', '9367562555', '9367562534', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-21', NULL, 0, 0, 0, 'Conroe Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1821094376', 0, 'N', 0, '2013-11-21', NULL, NULL, 30.2837, -95.4613, NULL, NULL),
('731653079', 'W12041223', 'W12041223', 'TXHOUSTD', 'Step Pediatrics', 'Joseph', 'P', 'Edralin', 'MD', 'Pediatrics', '', '', NULL, 'B', 'PO Box 4346 Dept 697', 'Houston', 'Harris', 'TX', '77210', '2813648600', '2812982005', 'PO Box 4346 Dept 697', 'Houston', 'Harris', 'TX', '77210', '2813648600', '2812982005', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1821028655', 0, 'N', 0, '2013-11-21', NULL, NULL, 0, 0, NULL, NULL),
('731653079', 'W12041222', 'W12041222', 'TXHOUSTD', 'Step Pediatrics', 'Joseph', 'P', 'Edralin', 'MD', 'Pediatrics', '', '', NULL, 'O', '4800 W Panther Creek Ste 100', 'Spring', 'Montgomery', 'TX', '77381', '2813648600', '2812982005', '4800 W Panther Creek Ste 100', 'Spring', 'Montgomery', 'TX', '77381', '2813648600', '2812982005', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1821028655', 0, 'N', 0, '2013-11-21', NULL, NULL, 30.1664, -95.5024, NULL, NULL),
('731653079', 'W12041219', 'W12041219', 'TXHOUSTD', 'Step Pediatrics', 'Joan', 'S', 'Purcell', 'MD', 'Pediatrics', '', '', NULL, 'B', 'PO Box 4346 Dept 697', 'Houston', 'Harris', 'TX', '77210', '2813648600', '2812982005', 'PO Box 4346 Dept 697', 'Houston', 'Harris', 'TX', '77210', '2813648600', '2812982005', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1023045978', 0, 'N', 0, '2013-11-25', NULL, NULL, 0, 0, NULL, NULL),
('731653079', 'W12041218', 'W12041218', 'TXHOUSTD', 'Step Pediatrics', 'Joan', 'S', 'Purcell', 'MD', 'Pediatrics', '', '', NULL, 'O', '4800 W Panther Creek Ste 100', 'Spring', 'Montgomery', 'TX', '77381', '2813648600', '2812982005', '4800 W Panther Creek Ste 100', 'Spring', 'Montgomery', 'TX', '77381', '2813648600', '2812982005', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1023045978', 0, 'N', 0, '2013-11-25', NULL, NULL, 30.1664, -95.5024, NULL, NULL),
('760307861', 'W12041066', 'W12041066', 'TXHOUSTD', 'Robert L McKowen', 'Robert', 'L', 'McKowen', 'MD', 'Cardiovascular Disease', 'Thoracic Surgery', '', NULL, 'O', '12121 Richmond Ave Ste 402', 'Houston', 'Harris', 'TX', '77082', '2814961700', '2814969081', '12121 Richmond Ave Ste 402', 'Houston', 'Harris', 'TX', '77082', '2814961700', '2814969081', 'HOUSTON2', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-21', NULL, 0, 0, 0, 'West Houston Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1861534828', 0, 'N', 0, '2013-11-21', NULL, NULL, 29.7306, -95.5937, NULL, NULL),
('760533483', 'W12041069', 'W12041069', 'TXHOUSTD', 'Yasmeen Jalal', 'Yasmeen', '', 'Jalal', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '11302 Fallbrook Dr Ste 110', 'Houston', 'Harris', 'TX', '77065', '2812651160', '2812651260', '11302 Fallbrook Dr Ste 110', 'Houston', 'Harris', 'TX', '77065', '2812651160', '2812651260', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-21', NULL, 0, 0, 0, 'Houston Methodist Sugar Land Hospital', NULL, '', '', 'HCFA|UB|', '1376565861', 0, 'N', 0, '2013-11-21', NULL, NULL, 29.9256, -95.5888, NULL, NULL),
('760533483', 'W12041068', 'W12041068', 'TXHOUSTD', 'Yasmeen Jalal', 'Yasmeen', '', 'Jalal', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '3521 Town Ctr Blvd S Ste B', 'Sugar Land', 'Fort Bend', 'TX', '77479', '2812651160', '2812651260', '3521 Town Ctr Blvd S Ste B', 'Sugar Land', 'Fort Bend', 'TX', '77479', '2812651160', '2812651260', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-21', NULL, 0, 0, 0, 'Houston Methodist Sugar Land Hospital', NULL, '', '', 'HCFA|UB|', '1376565861', 0, 'N', 0, '2013-11-21', NULL, NULL, 29.5874, -95.6301, NULL, NULL),
('760476011', 'W12041070', 'W12041070', 'TXHOUSTD', 'San Jacinto Regional Eye', 'Thomas', 'E', 'Marshall', 'MD', 'Ophthalmology', '', '', NULL, 'O', '4301 Garth Rd Ste 100', 'Baytown', 'Harris', 'TX', '77521', '2814222020', '2814224959', '4301 Garth Rd Ste 100', 'Baytown', 'Harris', 'TX', '77521', '2814222020', '2814224959', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-21', NULL, 0, 0, 0, 'Houston Methodist San Jacinto Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1376571687', 0, 'N', 0, '2013-11-21', NULL, NULL, 29.7681, -94.9775, NULL, NULL),
('743098445', 'W12041072', 'W12041072', 'TXHOUSTD', 'Suleman Lalani', 'Suleman', '', 'Lalani', 'MD', 'Internal Medicine', 'Geriatrics', '', NULL, 'O', '1856 FM 359 Rd', 'Richmond', 'Fort Bend', 'TX', '77406', '8324716956', '8324716957', '1856 FM 359 Rd', 'Richmond', 'Fort Bend', 'TX', '77406', '8324716956', '8324716957', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-21', NULL, 0, 0, 0, 'West Houston Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1396825394', 0, 'N', 0, '2013-11-21', NULL, NULL, 29.6207, -95.7435, NULL, NULL),
('743098445', 'W12041071', 'W12041071', 'TXHOUSTD', 'Suleman Lalani', 'Suleman', '', 'Lalani', 'MD', 'Internal Medicine', 'Geriatrics', '', NULL, 'O', '3531 Town Ctr Blvd S Ste 101', 'Sugar Land', 'Fort Bend', 'TX', '77479', '2814913225', '2814911702', '3531 Town Ctr Blvd S Ste 101', 'Sugar Land', 'Fort Bend', 'TX', '77479', '2814913225', '2814911702', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-21', NULL, 0, 0, 0, 'West Houston Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1396825394', 0, 'N', 0, '2013-11-21', NULL, NULL, 29.5873, -95.6305, NULL, NULL),
('274442695', 'W12041075', 'W12041075', 'TXHOUSTD', 'Salman Aly', 'Salman', '', 'Aly', 'MD', 'Internal Medicine', 'Geriatrics', '', NULL, 'O', '1856 FM 359 Rd', 'Richmond', 'Fort Bend', 'TX', '77406', '8324716956', '8324716957', '1856 FM 359 Rd', 'Richmond', 'Fort Bend', 'TX', '77406', '8324716956', '8324716957', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-21', '2013-12-21', 0, 0, 0, 'Provider no longer with practice', NULL, '', '', 'HCFA|UB|', '1467750752', 0, 'N', 0, '2014-05-02', NULL, NULL, 29.6207, -95.7435, NULL, NULL),
('274442695', 'W12041073', 'W12041073', 'TXHOUSTD', 'Salman Aly', 'Salman', '', 'Aly', 'MD', 'Internal Medicine', 'Geriatrics', '', NULL, 'O', '3531 Town Ctr Blvd S Ste 101', 'Sugar Land', 'Fort Bend', 'TX', '77479', '2814913225', '2814911702', '3531 Town Ctr Blvd S Ste 101', 'Sugar Land', 'Fort Bend', 'TX', '77479', '2814913225', '2814911702', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-21', '2013-12-21', 0, 0, 0, 'Provider no longer with practice', NULL, '', '', 'HCFA|UB|', '1467750752', 0, 'N', 0, '2014-05-02', NULL, NULL, 29.5873, -95.6305, NULL, NULL),
('261354040', 'W12041076', 'W12041076', 'TXHOUSTD', 'James Maher', 'James', 'A', 'Maher', 'MD', 'Gastroenterology', '', '', NULL, 'O', '21392 Provincial Blvd', 'Katy', 'Harris', 'TX', '77450', '2819455190', '2819455194', '21392 Provincial Blvd', 'Katy', 'Harris', 'TX', '77450', '2819455190', '2819455194', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-21', NULL, 0, 0, 0, 'Houston Methodist West Houston Hospital', '', '', '', 'HCFA|UB|', '1497743165', 0, 'N', 0, '2014-04-24', NULL, NULL, 29.7771, -95.7406, NULL, NULL),
('760476011', 'W12041077', 'W12041077', 'TXHOUSTD', 'San Jacinto Regional Eye', 'Martin', 'J', 'Arisco', 'MD', 'Ophthalmology', '', '', NULL, 'O', '4301 Garth Rd Ste 100', 'Baytown', 'Harris', 'TX', '77521', '2814222020', '2814224959', '4301 Garth Rd Ste 100', 'Baytown', 'Harris', 'TX', '77521', '2814222020', '2814224959', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-21', NULL, 0, 0, 0, 'Houston Methodist San Jacinto Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1619904398', 0, 'N', 0, '2013-11-21', NULL, NULL, 29.7681, -94.9775, NULL, NULL),
('452778493', 'W12041079', 'W12041079', 'ID02', '', 'Roxanne', '', 'Nichols', 'LCPC', 'Mental Health', 'Counseling', '', NULL, 'O', '100 Main St Ste 203', 'Boise', 'Ada', 'ID', '83702', '2088418109', '2082879426', '100 Main St Ste 203', 'Boise', 'Ada', 'ID', '83702', '2088418109', '2082879426', 'IDMA', '', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|', '1003101189', 0, 'N', 0, '2013-12-23', NULL, NULL, 0, 0, NULL, NULL),
('452778493', 'W12041080', 'W12041080', 'ID02', '', 'Roxanne', '', 'Nichols', 'LCPC', 'Mental Health', 'Counseling', '', NULL, 'B', '2965 E Tarpon Dr Ste 150', 'Meridian', 'Ada', 'ID', '83642', '2088418109', '2082879426', '2965 E Tarpon Dr Ste 150', 'Meridian', 'Ada', 'ID', '83642', '2088418109', '2082879426', 'IDMA', '', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|', '1003101189', 0, 'N', 0, '2013-12-23', NULL, NULL, 0, 0, NULL, NULL),
('200274667', 'W12041067', 'W12041067', 'TXHOUSTD', 'J P Surgical Associates ', 'Jo', '', 'Pollack', 'MD', 'General Surgery', '', '', NULL, 'O', '18400 Katy Fwy Ste 330', 'Houston', 'Harris', 'TX', '77094', '7134611013', '7134611593', '18400 Katy Fwy Ste 330', 'Houston', 'Harris', 'TX', '77094', '7134611013', '7134611593', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-21', NULL, 0, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1225118193', 0, 'N', 0, '2013-11-21', NULL, NULL, 29.7855, -95.6953, NULL, NULL),
('760131043', 'W12041063', 'W12041063', 'TXHOUSTD', 'LeRoy Odom', 'LeRoy', '', 'Odom', 'MD', 'Gastroenterology', '', '', NULL, 'O', '2000 Cranford Ste 1300', 'Houston', 'Harris', 'TX', '77002', '7136588660', '7136580205', '2000 Cranford Ste 1300', 'Houston', 'Harris', 'TX', '77002', '7136588660', '7136580205', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-01-06', NULL, 0, 0, 0, 'Houston Methodist Hospital', 'Houston Methodist West Houston Hospital', '', '', 'HCFA|UB|', '1144274234', 0, 'N', 0, '2013-12-06', NULL, NULL, 29.7461, -95.3659, NULL, NULL),
('760131043', 'W12041065', 'W12041065', 'TXHOUSTD', 'LeRoy Odom MD', 'LeRoy', '', 'Odom', 'MD', 'Gastroenterology', '', '', NULL, 'O', '705 S Fry Rd Ste 285', 'Katy', 'Harris', 'TX', '77450', '2815993670', '7136580205', '705 S Fry Rd Ste 285', 'Katy', 'Harris', 'TX', '77450', '2815993670', '7136580205', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-01-06', NULL, 0, 0, 0, 'Houston Methodist Hospital', 'Houston Methodist West Houston Hospital', '', '', 'HCFA|UB|', '1144274234', 0, 'N', 0, '2013-12-06', NULL, NULL, 29.7765, -95.7189, NULL, NULL),
('942854057', 'W12041081', 'W12041081', 'UTIHCPHY', 'Logan InstaCare', 'David', 'S', 'Aamodt', 'MD', 'Urgent Care', 'Family Practice', '', NULL, 'O', '412 N 200 E', 'Logan', 'Cache', 'UT', '84321', '4357132710', '4357132746', '412 N 200 E', 'Logan', 'Cache', 'UT', '84321', '4357132710', '4357132746', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-08-05', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1619928140', 0, 'Y', 0, '2013-11-25', NULL, NULL, 41.7393, -111.83, NULL, NULL),
('942854057', 'W12041082', 'W12041082', 'UTIHCPHY', 'Logan InstaCare', 'David', 'S', 'Aamodt', 'MD', 'Urgent Care', 'Family Practice', '', NULL, 'O', 'PO Box 27128', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '0000000000', '0000000000', 'PO Box 27128', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '0000000000', '0000000000', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-08-05', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1619928140', 0, 'Y', 0, '2013-11-25', NULL, NULL, 40.7259, -111.939, NULL, NULL),
('942854057', 'W12041087', 'W12041087', 'UTIHCPHY', 'McKay Dee Endocrine & Diabetes Clinic', 'Laura', '', 'Burton', 'APRN', 'Endocrinology', 'Obstetrics and Gynecology', 'Family Practice', NULL, 'O', '4403 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8013877900', '8013877910', '4403 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8013877900', '8013877910', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-09-16', '2013-12-26', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1942390539', 0, 'Y', 0, '2014-02-05', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12041085', 'W12041085', 'UTIHCPHY', 'Int Heart Cardiology-LDSH', 'Monica', 'O', 'Bell', 'APRN', 'Cardiology', '', '', NULL, 'O', '8th Ave and C St 7th Floor', 'Salt Lake City', 'Salt Lake', 'UT', '84143', '8015073500', '8015073505', '8th Ave and C St 7th Floor', 'Salt Lake City', 'Salt Lake', 'UT', '84143', '8015073500', '8015073505', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-09-19', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1720410871', 0, 'Y', 0, '2013-11-19', NULL, NULL, 40.7785, -111.881, NULL, NULL),
('942854057', 'W12041084', 'W12041084', 'UTIHCPHY', 'Int Heart Cardiology-RVH', 'Monica', 'O', 'Bell', 'APRN', 'Cardiology', '', '', NULL, 'O', '3741 W 12600 S Ste 160 A', 'Riverton', 'Salt Lake', 'UT', '84065', '8015073500', '8015073505', '3741 W 12600 S Ste 160 A', 'Riverton', 'Salt Lake', 'UT', '84065', '8015073500', '8015073505', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-09-19', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1720410871', 0, 'Y', 0, '2013-11-19', NULL, NULL, 40.5222, -111.98, NULL, NULL),
('942854057', 'W12041086', 'W12041086', 'UTIHCPHY', 'Int Heart Cardiology-AVH', 'Monica', 'O', 'Bell', 'APRN', 'Cardiology', '', '', NULL, 'O', '9690 S 1300 E Ste 200', 'Sandy', 'Salt Lake', 'UT', '84094', '8015073500', '8015073505', '9690 S 1300 E Ste 200', 'Sandy', 'Salt Lake', 'UT', '84094', '8015073500', '8015073505', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-09-19', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1720410871', 0, 'Y', 0, '2013-11-19', NULL, NULL, 40.5743, -111.853, NULL, NULL),
('942854057', 'W12041088', 'W12041088', 'UTIHCPHY', 'Int Heart Cardiology-AVH', 'Monica', 'O', 'Bell', 'APRN', 'Cardiology', '', '', NULL, 'B', 'PO Box 27128', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '8015073500', '8015073505', 'PO Box 27128', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '8015073500', '8015073505', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-09-19', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1720410871', 0, 'N', 0, '2013-11-19', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12041090', 'W12041090', 'UTIHCPHY', 'Hurricane Valley InstaCare M-Sat 9am-9pm', 'Clayton', '', 'Fuller', 'MD', 'Urgent Care', '', '', NULL, 'O', '75 N 2260 W', 'Hurricane', 'Washington', 'UT', '84737', '4356356550', '4356356549', '75 N 2260 W', 'Hurricane', 'Washington', 'UT', '84737', '4356356550', '4356356549', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-10-03', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1801840962', 0, 'Y', 0, '2013-11-19', NULL, NULL, 37.1771, -113.33, NULL, NULL),
('942854057', 'W12041091', 'W12041091', 'UTIHCPHY', 'Sunset InstaCare M-Sat 9am-9pm', 'Clayton', '', 'Fuller', 'MD', 'Urgent Care', '', '', NULL, 'o', '1739 W Sunset Blvd', 'St George', 'Washington', 'UT', '84770', '4356346050', '4356346033', '1739 W Sunset Blvd', 'St George', 'Washington', 'UT', '84770', '4356346050', '4356346033', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-10-03', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1801840962', 0, 'Y', 0, '2013-11-19', NULL, NULL, 37.1227, -113.62, NULL, NULL),
('942854057', 'W12041092', 'W12041092', 'UTIHCPHY', 'River Road InstaCare M-Sun 9am-9pm', 'Clayton', '', 'Fuller', 'MD', 'Urgent Care', '', '', NULL, 'o', '577 S River Road', 'St George', 'Washington', 'UT', '84790', '4356886300', '4356886333', '577 S River Road', 'St George', 'Washington', 'UT', '84790', '4356886300', '4356886333', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-10-03', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1801840962', 0, 'Y', 0, '2013-11-19', NULL, NULL, 37.0986, -113.557, NULL, NULL),
('942854057', 'W12041093', 'W12041093', 'UTIHCPHY', 'Intermountain Medical Group', 'Clayton', '', 'Fuller', 'MD', 'Urgent Care', '', '', NULL, 'B', 'PO Box 27128', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '4356346050', '4356346033', 'PO Box 27128', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '4356346050', '4356346033', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-10-03', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1801840962', 0, 'Y', 0, '2013-11-19', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12041095', 'W12041095', 'UTIHCPHY', 'Southridge Pediatrics', 'James', '', 'Gottlieb', 'MD', 'Pediatrics', '', '', NULL, 'O', '3723 W 12600 S Ste 450', 'Riverton', 'Salt Lake', 'UT', '84065', '8012854543', '8012854540', '3723 W 12600 S Ste 450', 'Riverton', 'Salt Lake', 'UT', '84065', '8012854543', '8012854540', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1811213838', 0, 'N', 0, '2013-11-19', NULL, NULL, 40.5222, -111.98, NULL, NULL),
('942854057', 'W12041096', 'W12041096', 'UTIHCPHY', 'Intermountain Medical Group', 'James', '', 'Gottlieb', 'MD', 'Pediatrics', '', '', NULL, 'B', 'PO Box 27128', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '8012854543', '8012854540', 'PO Box 27128', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '8012854543', '8012854540', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1811213838', 0, 'N', 0, '2013-11-19', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12041097', 'W12041097', 'UTIHCPHY', 'Park City Bonanza InstaCare', 'Jordan', 'L', 'Inouye', 'DO', 'Family Practice', '', '', NULL, 'O', '1665 Bonanza Dr', 'Park City', 'Summit', 'UT', '84060', '4356497640', '4356457768', '1665 Bonanza Dr', 'Park City', 'Summit', 'UT', '84060', '4356497640', '4356457768', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1073675112', 0, 'N', 0, '2014-05-12', NULL, NULL, 40.6623, -111.5, NULL, NULL),
('942854057', 'W12041098', 'W12041098', 'UTIHCPHY', 'Bountiful KidsCare', 'Sandra', 'A', 'Phillips', 'MD', 'Pediatrics', NULL, NULL, 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, '2013-09-25', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1205059458', 0, 'Y', 0, '2013-11-19', NULL, NULL, 40.8935, -111.881, NULL, NULL),
('942854057', 'W12041099', 'W12041099', 'UTIHCPHY', 'Southwest Urology', 'Brent', 'D', 'Pitcher', 'PA', 'Urology', '', '', NULL, 'O', '1380 E Medical Ctr Dr Ste 2100', 'St George', 'Washington', 'UT', '84790', '4352513250', '4352513251', '1380 E Medical Ctr Dr Ste 2100', 'St George', 'Washington', 'UT', '84790', '4352513250', '4352513251', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-11-01', NULL, 0, 0, 0, 'Logan Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1881876860', 0, 'N', 0, '2013-11-19', NULL, NULL, 37.0998, -113.554, NULL, NULL),
('942854057', 'W12041100', 'W12041100', 'UTIHCPHY', 'Dixie Inpatient Psychiatry', 'Carl', '', 'Rasmusen', 'MD', 'Mental Health', 'Psychiatry', '', NULL, 'O', '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356884343', '4356885331', '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356884343', '4356885331', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-09-30', NULL, 0, 0, 0, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1619048964', 0, 'N', 0, '2013-11-19', NULL, NULL, 37.0989, -113.575, NULL, NULL),
('942854057', 'W12041107', 'W12041107', 'UTIHCPHY', 'Southwest Regional Cancer Clinic', 'Lincoln', '', 'Nadauld', 'MD', '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, '2013-06-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1548414097', 0, 'N', 0, '2013-11-20', NULL, NULL, 37.0989, -113.575, NULL, NULL),
('942854057', 'W12041109', 'W12041109', 'UTIHCPHY', 'Heber Valley Clinic', 'Cory', '', 'Nelson', 'DO', 'Urgent Care', '', '', NULL, 'O', '1473 S Hwy 40 Ste E', 'Heber City', 'Wasatch', 'UT', '84032', '4356574400', '4356574460', '1473 S Hwy 40 Ste E', 'Heber City', 'Wasatch', 'UT', '84032', '4356574400', '4356574460', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1124339460', 0, 'Y', 0, '2013-11-20', NULL, NULL, 40.4893, -111.409, NULL, NULL);
INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
('942854057', 'W12041111', 'W12041111', 'UTIHCPHY', 'Southern Utah Surgical Associates', 'Alan', 'H', 'Pearson', 'APRN', 'Family Practice', '', '', NULL, 'O', '166 W 1325 N Ste 350', 'Cedar City', 'Iron', 'UT', '84720', '4355868192', '4355867564', '166 W 1325 N Ste 350', 'Cedar City', 'Iron', 'UT', '84720', '4355868192', '4355867564', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-10-03', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1699781666', 0, 'Y', 0, '2013-11-20', NULL, NULL, 37.7011, -113.065, NULL, NULL),
('942854057', 'W12041113', 'W12041113', 'UTIHCPHY', 'North Cache Valley Clinic', 'Ryan', 'B', 'Rigby', 'DPM', 'Podiatry', '', '', NULL, 'O', '4088 N Hwy 91', 'Hyde Park', 'Cache', 'UT', '84318', '4355633222', '4355633390', '4088 N Hwy 91', 'Hyde Park', 'Cache', 'UT', '84318', '4355633222', '4355633390', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-10-07', '2013-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1356505259', 0, 'N', 0, '2014-05-12', NULL, NULL, 41.8075, -111.833, NULL, NULL),
('942854057', 'W12041114', 'W12041114', 'UTIHCPHY', 'Logan Regional Orthopedics', 'Ryan', 'B', 'Rigby', 'DPM', 'Podiatry', '', '', NULL, 'O', '1300 N 500 E Ste 130', 'Logan', 'Cache', 'UT', '84341', '4357162800', '4357162809', '1300 N 500 E Ste 130', 'Logan', 'Cache', 'UT', '84341', '4357162800', '4357162809', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-10-07', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1356505259', 0, 'N', 0, '2014-05-12', NULL, NULL, 41.7563, -111.821, NULL, NULL),
('942854057', 'W12041116', 'W12041116', 'UTIHCPHY', 'Heber Valley Clinic', 'Marilee', 'C', 'Slade', 'APRN', 'Family Practice', '', '', NULL, 'O', '1473 S Hwy 40 Ste E', 'Heber City', 'Wasatch', 'UT', '84032', '4356574400', '4356574460', '1473 S Hwy 40 Ste E', 'Heber City', 'Wasatch', 'UT', '84032', '4356574400', '4356574460', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1235480799', 0, 'Y', 0, '2013-11-20', NULL, NULL, 40.4893, -111.409, NULL, NULL),
('942854057', 'W12041118', 'W12041118', 'UTIHCPHY', 'River Road InstaCare', 'David', 'R', 'Warnick', 'MD', 'Urgent Care', '', '', NULL, 'O', '577 S River Rd', 'St George', 'Washington', 'UT', '84790', '4356886300', '4356886333', '577 S River Rd', 'St George', 'Washington', 'UT', '84790', '4356886300', '4356886333', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-09-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1699035113', 0, 'Y', 0, '2013-11-25', NULL, NULL, 37.0986, -113.557, NULL, NULL),
('760748436', 'W12041119', 'W12041119', 'TXHOUSTD', 'Family Futures', '', '', 'Family Futures', '', 'Obstetrics and Gynecology', '', '', NULL, 'O', '12121 Richmond Ave Ste 201', 'Houston', 'Harris', 'TX', '77082', '2814962496', '2814962419', '12121 Richmond Ave Ste 201', 'Houston', 'Harris', 'TX', '77082', '2814962496', '2814962419', 'HOUSTON3', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-21', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1508981994', 0, 'Y', 0, '2013-11-21', NULL, NULL, 29.7306, -95.5937, NULL, NULL),
('760748436', 'W12041120', 'W12041120', 'TXHOUSTD', 'Family Futures', '', '', 'Family Futures', '', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 1139', 'Bellaire', 'Harris', 'TX', '77402', '2814962496', '2814962419', 'PO Box 1139', 'Bellaire', 'Harris', 'TX', '77402', '2814962496', '2814962419', 'HOUSTON3', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-21', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1508981994', 0, 'Y', 0, '2013-11-21', NULL, NULL, 0, 0, NULL, NULL),
('760748436', 'W12041122', 'W12041122', 'TXHOUSTD', 'Family Futures', 'Elvis', '', 'Torres', 'DO', 'Obstetrics and Gynecology', '', '', NULL, 'O', '12121 Richmond Ave Ste 201', 'Houston', 'Harris', 'TX', '77082', '2814962496', '2814962419', '12121 Richmond Ave Ste 201', 'Houston', 'Harris', 'TX', '77082', '2814962496', '2814962419', 'HOUSTON3', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-21', NULL, 0, 0, 0, 'West Houston Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1225146491', 0, 'N', 0, '2013-11-21', NULL, NULL, 29.7306, -95.5937, NULL, NULL),
('760748436', 'W12041123', 'W12041123', 'TXHOUSTD', 'Family Futures', 'Elvis', '', 'Torres', 'DO', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 1139', 'Bellaire', 'Harris', 'TX', '77402', '2814962496', '2814962419', 'PO Box 1139', 'Bellaire', 'Harris', 'TX', '77402', '2814962496', '2814962419', 'HOUSTON3', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-21', NULL, 0, 0, 0, 'West Houston Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1225146491', 0, 'N', 0, '2013-11-21', NULL, NULL, 0, 0, NULL, NULL),
('760748436', 'W12041125', 'W12041125', 'TXHOUSTD', 'Family Futures', 'Gilbert', '', 'Sayegh', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '12121 Richmond Ave Ste 201', 'Houston', 'Harris', 'TX', '77082', '2814962496', '2814962419', '12121 Richmond Ave Ste 201', 'Houston', 'Harris', 'TX', '77082', '2814962496', '2814962419', 'HOUSTON3', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-21', NULL, 0, 0, 0, 'West Houston Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1356526438', 0, 'N', 0, '2013-11-21', NULL, NULL, 29.7306, -95.5937, NULL, NULL),
('760748436', 'W12041126', 'W12041126', 'TXHOUSTD', 'Family Futures', 'Gilbert', '', 'Sayegh', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 1139', 'Bellaire', 'Harris', 'TX', '77402', '2814962496', '2814962419', 'PO Box 1139', 'Bellaire', 'Harris', 'TX', '77402', '2814962496', '2814962419', 'HOUSTON3', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-21', NULL, 0, 0, 0, 'West Houston Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1356526438', 0, 'N', 0, '2013-11-21', NULL, NULL, 0, 0, NULL, NULL),
('760650265', 'W12041127', 'W12041127', 'TXHOUSTD', 'Sugar Lakes Family Practice', '', '', 'Sugar Lakes Family Practice ', '', 'Family Practice', '', '', NULL, 'O', '16902 SW Fwy Ste 100', 'Sugar Land', 'Fort Bend', 'TX', '77479', '2815652800', '2815652801', '16902 SW Fwy Ste 100', 'Sugar Land', 'Fort Bend', 'TX', '77479', '2815652800', '2815652801', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-21', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1588789986', 0, 'Y', 0, '2013-11-21', NULL, NULL, 29.5906, -95.6366, NULL, NULL),
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('731684200', 'W12041174', 'W12041174', 'Sinclair', '(Sinclair Health Services\rProvider) Rocky Mountain Oncology Center', 'Robert', '', 'Tobin', 'MD', 'Oncology', '', '', NULL, 'O', '2221 W Elm St', 'Rawlins', 'Carbon', 'WY', '82301', '3072355433', '3072334700', '2221 W Elm St', 'Rawlins', 'Carbon', 'WY', '82301', '3072355433', '3072334700', '', '', '', '0.00', '10.00', '0.00', 3, '2013-11-14', NULL, 0, 0, 0, 'Wyoming Medical Center ', NULL, NULL, NULL, 'HCFA|UB|', '1912967050', 0, 'N', 0, '2014-04-25', NULL, NULL, 0, 0, NULL, NULL),
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('731684200', 'W12041180', 'W12041180', 'Sinclair', '(Sinclair Health Services\rProvider) Rocky Mountain Oncology Center', 'John ', '', 'Purviance', 'MD', 'Radiation Oncology', '', '', NULL, 'O', '467 Lott', 'Buffalo', 'Johnson', 'WY', '82834', '3072355433', '3072334700', '467 Lott', 'Buffalo', 'Johnson', 'WY', '82834', '3072355433', '3072334700', '', '', '', '0.00', '10.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, 'Wyoming Medical Center ', NULL, NULL, NULL, 'HCFA|UB|', '1437279692', 0, 'N', 0, '2014-04-25', NULL, NULL, 0, 0, NULL, NULL),
('731684200', 'W12041181', 'W12041181', 'WY01', 'Rocky Mountain Oncology Center', 'John ', '', 'Purviance', 'MD', 'Radiation Oncology', '', '', NULL, 'O', '467 Lott', 'Buffalo', 'Johnson', 'WY', '82834', '3072355433', '3072334700', '467 Lott', 'Buffalo', 'Johnson', 'WY', '82834', '3072355433', '3072334700', '', '', '', '0.00', '10.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, 'Wyoming Medical Center ', NULL, NULL, NULL, 'HCFA|UB|', '1437279692', 0, 'N', 0, '2014-04-25', NULL, NULL, 0, 0, NULL, NULL),
('731684200', 'W12041182', 'W12041182', 'WYT2', 'Rocky Mountain Oncology Center', 'John ', '', 'Purviance', 'MD', 'Radiation Oncology', '', '', NULL, 'O', '467 Lott', 'Buffalo', 'Johnson', 'WY', '82834', '3072355433', '3072334700', '467 Lott', 'Buffalo', 'Johnson', 'WY', '82834', '3072355433', '3072334700', '', '', '', '0.00', '10.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, 'Wyoming Medical Center ', NULL, NULL, NULL, 'HCFA|UB|', '1437279692', 0, 'N', 0, '2014-04-25', NULL, NULL, 0, 0, NULL, NULL),
('731684200', 'W12041183', 'W12041183', 'Sinclair', '(Sinclair Health Services\rProvider) Rocky Mountain Oncology Center', 'John ', '', 'Purviance', 'MD', 'Radiation Oncology', '', '', NULL, 'O', '2221 W Elm St', 'Rawlins', 'Carbon', 'WY', '82301', '3072355433', '3072334700', '2221 W Elm St', 'Rawlins', 'Carbon', 'WY', '82301', '3072355433', '3072334700', '', '', '', '0.00', '10.00', '0.00', 3, '2013-11-14', NULL, 0, 0, 0, 'Wyoming Medical Center ', NULL, NULL, NULL, 'HCFA|UB|', '1437279692', 0, 'N', 0, '2014-04-25', NULL, NULL, 0, 0, NULL, NULL),
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('731684200', 'W12041186', 'W12041186', 'Sinclair', '(Sinclair Health Services\rProvider) Rocky Mountain Oncology Center', 'John ', '', 'Purviance', 'MD', 'Radiation Oncology', '', '', NULL, 'B', 'PO Box 306141', 'Nashville', 'Davidson', 'TN', '37230', '3072355433', '6154677400', 'PO Box 306141', 'Nashville', 'Davidson', 'TN', '37230', '3072355433', '6154677400', '', '', '', '0.00', '10.00', '0.00', 3, '2013-11-14', NULL, 0, 0, 0, 'Wyoming Medical Center ', NULL, NULL, NULL, 'HCFA|UB|', '1437279692', 0, 'N', 0, '2014-04-25', NULL, NULL, 0, 0, NULL, NULL),
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('731684200', 'W12041188', 'W12041188', 'WYT2', 'Rocky Mountain Oncology Center', 'Elie', '', 'Fahed', 'MD', 'Oncology', '', '', NULL, 'O', '2221 W Elm St', 'Rawlins', 'Carbon', 'WY', '82301', '3072355433', '3072334700', '2221 W Elm St', 'Rawlins', 'Carbon', 'WY', '82301', '3072355433', '3072334700', '', '', '', '0.00', '10.00', '0.00', 3, '2013-11-14', NULL, 0, 0, 0, 'Wyoming Medical Center ', NULL, NULL, NULL, 'HCFA|UB|', '1356492482', 0, 'N', 0, '2014-04-22', NULL, NULL, 0, 0, NULL, NULL),
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('850275777', 'W12041200', 'W12041200', 'NM01', 'Southwest Medical Associates', 'Karla', 'K', 'Giese', 'NP', 'Endocrinology', '', '', NULL, 'O', '6100 Pan American Fwy NE Ste 100', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058231010', '5057974503', '6100 Pan American Fwy NE Ste 100', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058231010', '5057974503', 'NMSWMED', '', '', '0.00', '10.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1780676262', 0, 'N', 0, '2013-11-20', NULL, NULL, 35.1537, -106.587, NULL, NULL),
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('850275777', 'W12041203', 'W12041203', 'NM01', 'Southwest Medical Associates', 'Karla', 'K', 'Giese', 'NP', 'Endocrinology', '', '', NULL, 'O', '4801 McMahon Blvd Ste 110', 'Albuquerque', 'Bernalillo', 'NM', '87114', '5057274025', '5057274030', '4801 McMahon Blvd Ste 110', 'Albuquerque', 'Bernalillo', 'NM', '87114', '5057274025', '5057274030', 'NMSWMED', '', '', '0.00', '10.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1780676262', 0, 'N', 0, '2013-11-20', NULL, NULL, 35.2069, -106.678, NULL, NULL),
('850275777', 'W12041204', 'W12041204', 'NM01', 'Southwest Medical Associates', 'Karla', 'K', 'Giese', 'NP', 'Endocrinology', '', '', NULL, 'O', '4705 Montgomery Blvd NE Ste 301-302', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058231010', '5057974503', '4705 Montgomery Blvd NE Ste 301-302', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058231010', '5057974503', 'NMSWMED', '', '', '0.00', '10.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1780676262', 0, 'N', 0, '2013-11-20', NULL, NULL, 35.131, -106.591, NULL, NULL),
('850275777', 'W12041205', 'W12041205', 'NM01', 'Southwest Medical Associates', 'Karla', 'K', 'Giese', 'NP', 'Endocrinology', '', '', NULL, 'O', '9501 Paseo del Norte Ste C & D', 'Albuquerque', 'Bernalillo', 'NM', '87122', '5057274000', '5057274014', '9501 Paseo del Norte Ste C & D', 'Albuquerque', 'Bernalillo', 'NM', '87122', '5057274000', '5057274014', 'NMSWMED', '', '', '0.00', '10.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1780676262', 0, 'N', 0, '2013-11-20', NULL, NULL, 0, 0, NULL, NULL),
('870550275', 'W12041206', 'W12041206', 'UT01', 'Wasatch Pediatrics', 'Claudia', 'J', 'Fruin', 'MD', 'Pediatrics', '', '', NULL, 'O', '7138 S 2000 E Ste 106', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019421800', '8019441865', '7138 S 2000 E Ste 106', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019421800', '8019441865', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-12-01', NULL, 0, 0, 0, 'Lakeview Hospital', '', '', '', 'HCFA|UB|', '1619959319', 0, 'N', 0, '2013-12-19', NULL, NULL, 40.6215, -111.834, NULL, NULL),
('870550275', 'W12041207', 'W12041207', 'UT01', 'Wasatch Pediatrics', 'Claudia', 'J', 'Fruin', 'MD', 'Pediatrics', '', '', NULL, 'B', 'PO Box 71550', 'Salt Lake City', 'Salt Lake', 'UT', '84171', '8019470830', '8019470864', 'PO Box 71550', 'Salt Lake City', 'Salt Lake', 'UT', '84171', '8019470830', '8019470864', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-12-01', NULL, 0, 0, 0, 'Lakeview Hospital', '', '', '', 'HCFA|UB|', '1619959319', 0, 'N', 0, '2013-12-19', NULL, NULL, 0, 0, NULL, NULL),
('260859911', 'W12041211', 'W12041211', 'TXHOUSTD', 'Surgical Specialists of Clear Lake ', 'Michael', 'P', 'Mays', 'MD', 'General Surgery', '', '', NULL, 'B', 'PO Box 100559 ', 'Atlanta', 'Fulton', 'GA', '30384', '6153737490', NULL, 'PO Box 100559 ', 'Atlanta', 'Fulton', 'GA', '30384', '6153737490', '', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-11-01', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', '', '', '', 'HCFA|UB|', '1780722322', 0, 'N', 0, '2014-04-24', NULL, NULL, 0, 0, NULL, NULL),
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('731653079', 'W12041216', 'W12041216', 'TXHOUSTD', 'Step Pediatrics', '', '', 'Step Pediatrics', '', 'Pediatrics', '', '', NULL, 'O', '4800 W Panther Creek Ste 100', 'Spring', 'Montgomery', 'TX', '77381', '2813648600', '2812982005', '4800 W Panther Creek Ste 100', 'Spring', 'Montgomery', 'TX', '77381', '2813648600', '2812982005', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1346465960', 0, 'Y', 0, '2013-11-21', NULL, NULL, 30.1664, -95.5024, NULL, NULL),
('731653079', 'W12041217', 'W12041217', 'TXHOUSTD', 'Step Pediatrics', '', '', 'Step Pediatrics', '', 'Pediatrics', '', '', NULL, 'B', 'PO Box 4346 Dept 697', 'Houston', 'Harris', 'TX', '77210', '2813648600', '2812982005', 'PO Box 4346 Dept 697', 'Houston', 'Harris', 'TX', '77210', '2813648600', '2812982005', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1346465960', 0, 'N', 0, '2013-11-21', NULL, NULL, 0, 0, NULL, NULL),
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('270337810', 'W12041043', 'W12041043', 'TXHOUSTD', 'Nephrology Internal Medicine', 'Vinitha', '', 'Vellanki', 'MD', 'Nephrology', '', '', NULL, 'O', '16605 SW Fwy Ste 530', 'Sugar Land', 'Fort Bend', 'TX', '77479', '8325327836', '9792456263', '16605 SW Fwy Ste 530', 'Sugar Land', 'Fort Bend', 'TX', '77479', '8325327836', '9792456263', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-01-06', NULL, 0, 0, 0, 'Houston Methodist Sugar Land Hospital', NULL, '', '', 'HCFA|UB|', '1427256700', 0, 'Y', 0, '2013-12-13', NULL, NULL, 29.5919, -95.6298, NULL, NULL),
('270337810', 'W12041044', 'W12041044', 'TXHOUSTD', 'Nephrology Internal Medicine', 'Vinitha', '', 'Vellanki', 'MD', 'Nephrology', '', '', NULL, 'O', '200 Medical Ctr Ct Ste 100', 'Bay City', 'Matagorda', 'TX', '77414', '9792452421', '9792456263', '200 Medical Ctr Ct Ste 100', 'Bay City', 'Matagorda', 'TX', '77414', '9792452421', '9792456263', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-01-06', NULL, 0, 0, 0, 'Houston Methodist Sugar Land Hospital', NULL, '', '', 'HCFA|UB|', '1427256700', 0, 'Y', 0, '2013-12-13', NULL, NULL, 28.9671, -95.9529, NULL, NULL),
('270337810', 'W12041045', 'W12041045', 'TXHOUSTD', 'Nephrology Internal Medicine', 'Vinitha', '', 'Vellanki', 'MD', 'Nephrology', '', '', NULL, 'O', '513 S Columbia Dr', 'West Columbia', 'Brazoria', 'TX', '77486', '9793452027', '9793454922', '513 S Columbia Dr', 'West Columbia', 'Brazoria', 'TX', '77486', '9793452027', '9793454922', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-01-06', NULL, 0, 0, 0, 'Houston Methodist Sugar Land Hospital', NULL, '', '', 'HCFA|UB|', '1427256700', 0, 'Y', 0, '2013-12-13', NULL, NULL, 29.1421, -95.6554, 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
('270337810', 'W12041046', 'W12041046', 'TXHOUSTD', 'Nephrology Internal Medicine', 'Vinitha', '', 'Vellanki', 'MD', 'Nephrology', '', '', NULL, 'B', 'PO Box 2660', 'Bay City', 'Matagorda', 'TX', '77404', '0000000000', '0000000000', 'PO Box 2660', 'Bay City', 'Matagorda', 'TX', '77404', '0000000000', '0000000000', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-01-06', NULL, 0, 0, 0, 'Houston Methodist Sugar Land Hospital', NULL, '', '', 'HCFA|UB|', '1427256700', 0, 'Y', 0, '2013-12-13', NULL, NULL, 0, 0, NULL, NULL),
('760405358', 'W12041232', 'W12041232', 'TXHOUSTD', 'Renal Physicians of Montgomery County', 'Michael', '', 'Walls', 'MD', 'Nephrology', '', '', NULL, 'O', '200 River Pointe Dr Ste 120', 'Conroe', 'Montgomery', 'TX', '77304', '9367562555', '9367562534', '200 River Pointe Dr Ste 120', 'Conroe', 'Montgomery', 'TX', '77304', '9367562555', '9367562534', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-21', NULL, 0, 0, 0, 'Conroe Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1679579791', 0, 'N', 0, '2013-11-21', NULL, NULL, 30.2837, -95.4613, NULL, NULL),
('260553931', 'W12041233', 'W12041233', 'IDBOISTD', '', 'Britani', 'R', 'Hill', 'MD', 'General Surgery', '', '', NULL, 'O', '999 N Curtis Rd Ste 407', 'Boise', 'Ada', 'ID', '83706', '2083677676', '2083676849', '999 N Curtis Rd Ste 407', 'Boise', 'Ada', 'ID', '83706', '2083677676', '2083676849', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2013-12-16', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, '', '', 'HCFA|UB|', '1275718595', 0, 'N', 0, '2014-01-24', NULL, NULL, 43.6134, -116.254, NULL, NULL),
('260553931', 'W12041235', 'W12041235', 'IDBOISTD', 'Saint Alphonsus Medical Group Orthopedics Hartman', 'Keith', 'G', 'Holley', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1075 N Curtis Rd Ste 101', 'Boise', 'Ada', 'ID', '83706', '2082884700', '2082884720', '1075 N Curtis Rd Ste 101', 'Boise', 'Ada', 'ID', '83706', '2082884700', '2082884720', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2013-12-16', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', 'Saint Alphonsus Medical Center Nampa', '', '', 'HCFA|UB|', '1386616183', 0, 'N', 0, '2014-03-20', NULL, NULL, 43.6148, -116.254, NULL, NULL),
('260553931', 'W12041236', 'W12041236', 'IDBOISTD', '', 'John', 'C', 'Mayberry', 'MD', 'General Surgery', '', '', NULL, 'O', '999 N Curtis Rd Ste 407', 'Boise', 'Ada', 'ID', '83706', '2083677676', '2083676849', '999 N Curtis Rd Ste 407', 'Boise', 'Ada', 'ID', '83706', '2083677676', '2083676849', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2013-12-16', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, '', '', 'HCFA|UB|', '1528074077', 0, 'N', 0, '2014-01-24', NULL, NULL, 43.6134, -116.254, NULL, NULL),
('260553931', 'W12037568', 'W12037568', 'IDBOISTD', '', 'John', 'C', 'Mayberry', 'MD', 'General Surgery', '', '', NULL, 'O', '901 N Curtis Rd Ste 401', 'Boise', 'Ada', 'ID', '83706', '2083677676', '2083676849', '901 N Curtis Rd Ste 401', 'Boise', 'Ada', 'ID', '83706', '2083677676', '2083676849', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2013-08-14', '2013-12-15', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, '', '', 'HCFA|UB|', '1528074077', 0, 'N', 1, '2014-01-24', NULL, NULL, 43.6126, -116.255, NULL, NULL),
('760528826', 'W12040900', 'W12040900', 'TXHOUSTD', 'Millennium Physicians Association', 'Pierre', 'N', 'Khoury', 'MD', 'Hematology and Oncology', '', '', NULL, 'O', '130 Medical Ctr Pkwy Ste 5', 'Huntsville', 'Walker', 'TX', '77340', '9364390500', '9364390504', '130 Medical Ctr Pkwy Ste 5', 'Huntsville', 'Montgomery', 'TX', '77340', '9364390500', '9364390504', 'HOUSTON5', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-21', NULL, 0, 0, 0, 'Kingwood Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1548223878', 0, 'N', 0, '2013-11-21', NULL, NULL, 30.7099, -95.5613, NULL, NULL),
('760528826', 'W12040898', 'W12040898', 'TXHOUSTD', 'Millennium Physicians Association', 'Pierre', 'N', 'Khoury', 'MD', 'Hematology and Oncology', '', '', NULL, 'O', '213 S College', 'Cleveland', 'Liberty', 'TX', '77327', '2816590420', '2816590425', '213 S College', 'Cleveland', 'Montgomery', 'TX', '77327', '2816590420', '2816590425', 'HOUSTON5', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-21', NULL, 0, 0, 0, 'Kingwood Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1548223878', 0, 'N', 0, '2013-11-21', NULL, NULL, 30.3408, -95.0881, NULL, NULL),
('760528826', 'W12040899', 'W12040899', 'TXHOUSTD', 'Millennium Physicians Association', 'Pierre', 'N', 'Khoury', 'MD', 'Hematology and Oncology', '', '', NULL, 'O', '22710 Professional Dr Ste 100', 'Kingwood', 'Harris', 'TX', '77339', '2813582850', '2813582817', '22710 Professional Dr Ste 100', 'Kingwood', 'Montgomery', 'TX', '77339', '2813582850', '2813582817', 'HOUSTON5', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-21', NULL, 0, 0, 0, 'Kingwood Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1548223878', 0, 'N', 0, '2013-11-21', NULL, NULL, 30.0473, -95.2579, NULL, NULL),
('760528826', 'W12040897', 'W12040897', 'TXHOUSTD', 'Millennium Physicians Association', 'Pierre', 'N', 'Khoury', 'MD', 'Hematology and Oncology', '', '', NULL, 'O', '506 Graham Ste 120', 'Tomball', 'Harris', 'TX', '77375', '2815160236', '2815160609', '506 Graham Ste 120', 'Tomball', 'Montgomery', 'TX', '77375', '2815160236', '2815160609', 'HOUSTON5', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-21', NULL, 0, 0, 0, 'Kingwood Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1548223878', 0, 'N', 0, '2013-11-21', NULL, NULL, 30.0915, -95.6127, NULL, NULL),
('760528826', 'W12040896', 'W12040896', 'TXHOUSTD', 'Millennium Physicians Association', 'Pierre', 'N', 'Khoury', 'MD', 'Hematology and Oncology', '', '', NULL, 'O', '800 Peakwood Ste 5-D', 'Houston', 'Harris', 'TX', '77090', '2815860200', '2815860202', '800 Peakwood Ste 5-D', 'Houston', 'Montgomery', 'TX', '77090', '2815860200', '2815860202', 'HOUSTON5', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-21', NULL, 0, 0, 0, 'Kingwood Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1548223878', 0, 'N', 0, '2013-11-21', NULL, NULL, 30.0222, -95.4426, NULL, NULL),
('271789847', 'W12041244', 'W12041244', 'IDONTSTD', 'Saint Alphonsus Medical Center - Ontario', '', '', 'Saint Alphonsus Medical Center - Ontario', '', 'Hospital', '', '', NULL, 'O', '351 SW 9th St', 'Ontario', 'Malheur', 'OR', '97914', '5418817000', '          ', '351 SW 9th St', 'Ontario', 'Malheur', 'OR', '97914', '5418817000', '          ', '', '', '', '0.00', '27.00', '0.00', 8, '2013-11-22', '2014-04-30', 0, 0, 0, '', '', '', '', '|UB|', '1891891792', 0, 'N', 0, '2014-07-25', NULL, NULL, 44.0252, -116.976, NULL, NULL),
('271789847', 'W12041243', 'W12041243', 'IDONTSTD', 'Saint Alphonsus Medical Center - Ontario', '', '', 'Saint Alphonsus Medical Center - Ontario', '', 'Hospital', '', '', NULL, 'B', 'PO Box 31001', 'Pasadena', 'Los Angeles', 'CA', '91110', '8666267272', '          ', 'PO Box 31001', 'Pasadena', 'Los Angeles', 'CA', '91110', '8666267272', '          ', '', '', '', '0.00', '27.00', '0.00', 8, '2013-11-22', '2014-04-30', 0, 0, 0, '', '', '', '', '|UB|', '1891891792', 0, 'N', 0, '2014-07-25', NULL, NULL, 0, 0, NULL, NULL),
('260553931', 'W12041245', 'W12041245', 'IDBOISTD', '', 'Billy', 'R', 'Morgan', 'MD', 'General Surgery', '', '', NULL, 'O', '999 N Curtis Rd Ste 407', 'Boise', 'Ada', 'ID', '83706', '2083677676', '2083676849', '999 N Curtis Rd Ste 407', 'Boise', 'Ada', 'ID', '83706', '2083677676', '2083676849', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2013-12-16', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1891747663', 0, 'N', 0, '2014-07-09', NULL, NULL, 43.6134, -116.254, NULL, NULL),
('260553931', 'W12041246', 'W12041246', 'IDBOISTD', '', 'Aziz', 'G', 'Munayirji', 'MD', 'General Surgery', '', '', NULL, 'O', '999 N Curtis Rd Ste 407', 'Boise', 'Ada', 'ID', '83706', '2083677676', '2083676849', '999 N Curtis Rd Ste 407', 'Boise', 'Ada', 'ID', '83706', '2083677676', '2083676849', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2013-12-16', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1003869629', 0, 'N', 0, '2014-01-24', NULL, NULL, 43.6134, -116.254, NULL, NULL),
('260553931', 'W12041247', 'W12041247', 'IDBOISTD', '', 'Joanmarie', '', 'Pellegrini', 'MD', 'General Surgery', '', '', NULL, 'O', '999 N Curtis Rd Ste 407', 'Boise', 'Ada', 'ID', '83706', '2083677676', '2083676849', '999 N Curtis Rd Ste 407', 'Boise', 'Ada', 'ID', '83706', '2083677676', '2083676849', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2013-12-16', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, '', '', 'HCFA|UB|', '1265402242', 0, 'N', 0, '2014-01-24', NULL, NULL, 43.6134, -116.254, NULL, NULL),
('260553931', 'W12041248', 'W12041248', 'IDBOISTD', '', 'David', 'B', 'Safran', 'MD', 'General Surgery', '', '', NULL, 'O', '999 N Curtis Rd Ste 407', 'Boise', 'Ada', 'ID', '83706', '2083677676', '2083676849', '999 N Curtis Rd Ste 407', 'Boise', 'Ada', 'ID', '83706', '2083677676', '2083676849', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2013-12-16', '2014-05-13', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1659488674', 0, 'N', 0, '2014-05-13', NULL, NULL, 43.6134, -116.254, NULL, NULL),
('452484160', 'W12047464', 'W12047464', 'WY01', 'Goose Creek Family Practice', 'Debra', 'A', 'Kawulok', 'FNP', 'Family Practice', '', '', NULL, 'O', '304 Coffeen Ave', 'Sheridan', 'Sheridan', 'WY', '82801', '3076741744', '3076741752', '304 Coffeen Ave', 'Sheridan', 'Sheridan', 'WY', '82801', '3076741744', '3076741752', 'WISEA2013', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2014-06-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1134407356', 0, 'N', 0, '2014-06-11', NULL, NULL, 0, 0, NULL, NULL),
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('731684200', 'W12036445', 'W12036445', 'Sinclair', 'Rocky Mountain Oncology Center', 'J. Claire', '', 'Morris', 'LD, RD', 'Dietician', '', '', NULL, 'M', '104 Woodmont Blvd Ste 500', 'Nashville', 'Davidson', 'TN', '37205', '3072355433', '          ', '104 Woodmont Blvd Ste 500', 'Nashville', 'Davidson', 'TN', '37205', '3072355433', '          ', '', '', '', '0.00', '10.00', '0.00', 3, '2013-12-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1003258286', 0, 'Y', 0, '2014-04-22', NULL, NULL, 0, 0, NULL, NULL),
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('731684200', 'W12036435', 'W12036435', 'Sinclair', 'Rocky Mountain Oncology Center', 'J. Claire', '', 'Morris', 'LD, RD', 'Dietician', '', '', NULL, 'O', '6501 E 2nd St', 'Casper', 'Natrona', 'WY', '82609', '3072355433', '          ', '6501 E 2nd St', 'Casper', 'Natrona', 'WY', '82609', '3072355433', '          ', '', '', '', '0.00', '10.00', '0.00', 3, '2013-12-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1003258286', 0, 'N', 0, '2014-04-22', NULL, NULL, 0, 0, NULL, NULL),
('731684200', 'W12036447', 'W12036447', 'Sinclair', 'Rocky Mountain Oncology Center', 'J. Claire', '', 'Morris', 'LD, RD', 'Dietician', '', '', NULL, 'B', 'PO Box 306141', 'Nashville', 'Davidson', 'TN', '37230', '3072355433', NULL, 'PO Box 306141', 'Nashville', 'Davidson', 'TN', '37230', '3072355433', '', '', '', '', '0.00', '10.00', '0.00', 3, '2013-12-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1003258286', 0, 'N', 0, '2014-04-22', NULL, NULL, 0, 0, NULL, NULL),
('731684200', 'W12036443', 'W12036443', 'WY01', 'Rocky Mountain Oncology Center', 'J. Claire', '', 'Morris', 'LD, RD', 'Dietician', '', '', NULL, 'M', '104 Woodmont Blvd Ste 500', 'Nashville', 'Davidson', 'TN', '37205', '3072355433', '          ', '104 Woodmont Blvd Ste 500', 'Nashville', 'Davidson', 'TN', '37205', '3072355433', '          ', '', '', '', '0.00', '10.00', '0.00', 3, '2013-12-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1003258286', 0, 'N', 0, '2014-04-22', NULL, NULL, 0, 0, NULL, NULL),
('731684200', 'W12036439', 'W12036439', 'WY01', 'Rocky Mountain Oncology Center', 'J. Claire', '', 'Morris', 'LD, RD', 'Dietician', '', '', NULL, 'O', '15 Shrine Club Rd', 'Lander', 'Fremont', 'WY', '82520', '3072355433', '          ', '15 Shrine Club Rd', 'Lander', 'Fremont', 'WY', '82520', '3072355433', '          ', '', '', '', '0.00', '10.00', '0.00', 3, '2013-12-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1003258286', 0, 'N', 0, '2014-04-22', NULL, NULL, 42.8444, -108.711, NULL, NULL),
('731684200', 'W12036437', 'W12036437', 'WY01', 'Rocky Mountain Oncology Center', 'J. Claire', '', 'Morris', 'LD, RD', 'Dietician', '', '', NULL, 'O', '6501 E 2nd St', 'Casper', 'Natrona', 'WY', '82609', '3072355433', NULL, '6501 E 2nd St', 'Casper', 'Natrona', 'WY', '82609', '3072355433', '', '', '', '', '0.00', '10.00', '0.00', 3, '2013-12-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1003258286', 0, 'N', 0, '2014-04-22', NULL, NULL, 42.8441, -106.261, NULL, NULL),
('731684200', 'W12036442', 'W12036442', 'WY01', 'Rocky Mountain Oncology Center', 'J. Claire', '', 'Morris', 'LD, RD', 'Dietician', '', '', NULL, 'B', 'PO Box 306141', 'Nashville', 'Davidson', 'TN', '37230', '3072355433', NULL, 'PO Box 306141', 'Nashville', 'Davidson', 'TN', '37230', '3072355433', '', '', '', '', '0.00', '10.00', '0.00', 3, '2013-12-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1003258286', 0, 'N', 0, '2014-04-22', NULL, NULL, 0, 0, NULL, NULL),
('731684200', 'W12036444', 'W12036444', 'WYT2', 'Rocky Mountain Oncology Center', 'J. Claire', '', 'Morris', 'LD, RD', 'Dietician', '', '', NULL, 'M', '104 Woodmont Blvd Ste 500', 'Nashville', 'Davidson', 'TN', '37205', '3072355433', '          ', '104 Woodmont Blvd Ste 500', 'Nashville', 'Davidson', 'TN', '37205', '3072355433', '          ', '', '', '', '0.00', '10.00', '0.00', 3, '2013-12-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1003258286', 0, 'N', 0, '2014-04-22', NULL, NULL, 0, 0, NULL, NULL),
('731684200', 'W12036440', 'W12036440', 'WYT2', 'Rocky Mountain Oncology Center', 'J. Claire', '', 'Morris', 'LD, RD', 'Dietician', '', '', NULL, 'O', '15 Shrine Club Rd', 'Lander', 'Fremont', 'WY', '82520', '3072355433', '          ', '15 Shrine Club Rd', 'Lander', 'Fremont', 'WY', '82520', '3072355433', '          ', '', '', '', '0.00', '10.00', '0.00', 3, '2013-12-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1003258286', 0, 'N', 0, '2014-04-22', NULL, NULL, 0, 0, NULL, NULL),
('731684200', 'W12036438', 'W12036438', 'WYT2', 'Rocky Mountain Oncology Center', 'J. Claire', '', 'Morris', 'LD, RD', 'Dietician', '', '', NULL, 'O', '6501 E 2nd St', 'Casper', 'Natrona', 'WY', '82609', '3072355433', NULL, '6501 E 2nd St', 'Casper', 'Natrona', 'WY', '82609', '3072355433', '', '', '', '', '0.00', '10.00', '0.00', 3, '2013-12-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1003258286', 0, 'N', 0, '2014-04-22', NULL, NULL, 0, 0, NULL, NULL),
('731684200', 'W12036441', 'W12036441', 'WYT2', 'Rocky Mountain Oncology Center', 'J. Claire', '', 'Morris', 'LD, RD', 'Dietician', '', '', NULL, 'B', 'PO Box 306141', 'Nashville', 'Davidson', 'TN', '37230', '3072355433', NULL, 'PO Box 306141', 'Nashville', 'Davidson', 'TN', '37230', '3072355433', '', '', '', '', '0.00', '10.00', '0.00', 3, '2013-12-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1003258286', 0, 'N', 0, '2014-04-22', NULL, NULL, 0, 0, NULL, NULL),
('205012203', 'W12041294', 'W12041294', 'TXHOUSTD', 'Harvey E Slusky MD PA', 'Harvey', 'E', 'Slusky', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '17500 Hwy 3 Ste B', 'Webster', 'Harris', 'TX', '77598', '2813382098', '2815574369', '17500 Hwy 3 Ste B', 'Webster', 'Harris', 'TX', '77598', '2813382098', '2815574369', 'HOUSTON2', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-01-06', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1700816790', 0, 'N', 0, '2013-12-06', NULL, NULL, 29.5411, -95.1213, NULL, NULL),
('205012203', 'W12041295', 'W12041295', 'TXHOUSTD', 'Harvey E Slusky MD PA', 'Harvey', 'E', 'Slusky', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', 'PO Box 57849', 'Webster', 'Harris', 'TX', '77598', '2813382098', '2815574369', 'PO Box 57849', 'Webster', 'Harris', 'TX', '77598', '2813382098', '2815574369', 'HOUSTON2', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-01-06', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1700816790', 0, 'N', 0, '2013-12-06', NULL, NULL, 29.5434, -95.1439, NULL, NULL),
('039450402', 'W12041301', 'W12041301', 'TXHOUSTD', '', 'Renu', '', 'Garg', 'MD', 'Pediatrics', '', '', NULL, 'O', '1919 N Loop W Ste 200', 'Houston', 'Harris', 'TX', '77008', '7138680029', '7138804706', '1919 N Loop W Ste 200', 'Houston', 'Harris', 'TX', '77008', '7138680029', '7138804706', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-06', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1457360992', 0, 'N', 0, '2013-12-06', NULL, NULL, 29.8115, -95.434, NULL, NULL),
('364088232', 'W12041304', 'W12041304', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Yaquta', 'M', 'Patni', 'MD', 'Family Practice', 'Geriatrics', '', NULL, 'B', '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', NULL, '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', '          ', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-11-15', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, '', '', 'HCFA|UB|', '1689779357', 0, 'N', 0, '2013-11-25', NULL, NULL, 0, 0, NULL, NULL),
('364088232', 'W12041303', 'W12041303', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Yaquta', 'M', 'Patni', 'MD', 'Family Practice', 'Geriatrics', '', NULL, 'O', '1870 W Galena Blvd', 'Aurora', 'Kane', 'IL', '60506', '6309065379', '6308593248', '1870 W Galena Blvd', 'Aurora', 'Kane', 'IL', '60506', '6309065379', '6308593248', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-11-15', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, '', '', 'HCFA|UB|', '1689779357', 0, 'N', 0, '2013-11-25', NULL, NULL, 41.7642, -88.3626, NULL, NULL),
('452715973', 'W12041310', 'W12041310', 'Sinclair', 'St Lukes Clinic Wood River', 'Amy', '', 'Drumm', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 640', 'Ketchum', 'Blaine', 'ID', '83340', '2087883434', '2087882025', 'PO Box 640', 'Ketchum', 'Blaine', 'ID', '83340', '2087883434', '2087882025', 'IDSINCLAIRD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1083842272', 0, 'N', 0, '2014-03-05', NULL, NULL, 0, 0, NULL, NULL),
('452715973', 'W12041309', 'W12041309', 'Sinclair', 'St Lukes Clinic Wood River', 'Amy', '', 'Drumm', 'MD', 'Family Practice', '', '', NULL, 'O', '1450 Aviation Dr Ste 100', 'Hailey', 'Blaine', 'ID', '83333', '2087883434', '2087882025', '1450 Aviation Dr Ste 100', 'Hailey', 'Blaine', 'ID', '83333', '2087883434', '2087882025', 'IDSINCLAIRD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1083842272', 0, 'N', 0, '2014-02-19', NULL, NULL, 0, 0, NULL, NULL),
('201780406', 'W12040822', 'W12040822', 'ILCHIGSTD', 'UroPartners', 'Alexandra', '', 'Smolina', 'PA-C', 'Urology', '', '', NULL, 'O', '900 Rand Rd Ste 120', 'Des Plaines', 'Cook', 'IL', '60016', '8478233185', '8478233318', '900 Rand Rd Ste 120', 'Des Plaines', 'Cook', 'IL', '60016', '8478233185', '8478233318', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-11-18', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1477802395', 0, 'N', 0, '2014-04-24', NULL, NULL, 42.0564, -87.9023, NULL, NULL),
('201780406', 'W12040823', 'W12040823', 'ILCHIGSTD', 'UroPartners', 'Alexandra', '', 'Smolina', 'PA-C', 'Urology', '', '', NULL, 'B', '3183 Paysphere Cr', 'Chicago', 'Cook', 'IL', '60674', '2242603100', '8479988112', '3183 Paysphere Cr', 'Chicago', 'Cook', 'IL', '60674', '2242603100', '8479988112', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-11-18', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1477802395', 0, 'N', 0, '2014-04-24', NULL, NULL, 0, 0, NULL, NULL),
('364286236', 'W12041312', 'W12041312', 'ILCHIGSTD', 'Resurrection Ambulatory Services', '', '', 'Presence Advanced Imaging Presence Center for Health', '', 'Imaging Center', NULL, NULL, NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '          ', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '          ', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-12-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1851628630', 0, 'N', 0, '2013-12-09', NULL, NULL, 0, 0, NULL, NULL),
('362704738', 'W12041315', 'W12041315', 'ILCHIGSTD', 'Nuclear Oncology', 'Brian', '', 'Blonigen', 'MD', 'Radiation Oncology', '', '', NULL, 'B', '15 Salt Creek Ln Ste 19', 'Hinsdale', 'Dupage', 'IL', '60521', '6307349560', '0000000000', '15 Salt Creek Ln Ste 19', 'Hinsdale', 'Dupage', 'IL', '60521', '6307349560', '0000000000', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 6, '2013-05-06', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, '', '', 'HCFA|UB|', '1134330426', 0, 'N', 0, '2013-11-25', NULL, NULL, 0, 0, NULL, NULL),
('362704738', 'W12041314', 'W12041314', 'ILCHIGSTD', 'Nuclear Oncology  ', 'Brian', '', 'Blonigen', 'MD', 'Radiation Oncology', '', '', NULL, 'O', '2614 W Jefferson St', 'Joliet', 'Will', 'IL', '60435', '8157251355', '8157303020', '2614 W Jefferson St', 'Joliet', 'Will', 'IL', '60435', '8157251355', '8157303020', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 6, '2013-05-06', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, '', '', 'HCFA|UB|', '1134330426', 0, 'N', 0, '2013-11-25', NULL, NULL, 41.522, -88.1474, NULL, NULL),
('362645598', 'W12041317', 'W12041317', 'ILCHIGSTD', 'Parkview Orthopaedic Group', 'Intesar', '', 'Hussain', 'MD', 'Pain Management', '', '', NULL, 'O', '688 Cedar Crossing Dr', 'New Lenox', 'Will', 'IL', '60451', '8157273030', '8157404964', '688 Cedar Crossing Dr', 'New Lenox', 'Will', 'IL', '60451', '8157273030', '8157404964', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-06-14', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1588827646', 0, 'Y', 0, '2014-04-01', NULL, NULL, 41.5094, -87.963, NULL, NULL),
('320241110', 'W12041318', 'W12041318', 'ILCHIGSTD', 'The Pain Center of Illinois', 'Intesar', '', 'Hussain', 'MD', 'Pain Management', '', '', NULL, 'O', '830 N Ashland Ave', 'Chicago', 'Cook', 'IL', '60622', '3126249783', '3129293323', '830 N Ashland Ave', 'Chicago', 'Cook', 'IL', '60622', '3126249783', '3129293323', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-06-14', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1588827646', 0, 'Y', 0, '2014-04-01', NULL, NULL, 41.8969, -87.6674, NULL, NULL),
('453136848', 'W12041322', 'W12041322', 'ILCHIGSTD', 'EMP of Will County', 'Raymundo', '', 'Forcada Lowrie', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '333 N Madison St', 'Joliet', 'Will', 'IL', '60435', '8157417660', '8157417599', '333 N Madison St', 'Joliet', 'Will', 'IL', '60435', '8157417660', '8157417599', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-06-24', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1982829941', 0, 'N', 0, '2013-11-25', NULL, NULL, 41.528, -88.1346, NULL, NULL),
('453136848', 'W12041323', 'W12041323', 'ILCHIGSTD', 'EMP of Will County', 'Raymundo', '', 'Forcada Lowrie', 'MD', 'Emergency Medicine', '', '', NULL, 'B', 'PO Box 637527', 'Cincinnati', 'Hamilton', 'OH', '45263', '3304934443', '0000000000', 'PO Box 637527', 'Cincinnati', 'Hamilton', 'OH', '45263', '3304934443', '0000000000', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-06-24', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1982829941', 0, 'N', 0, '2013-11-25', NULL, NULL, 0, 0, NULL, NULL),
('453136848', 'W12041325', 'W12041325', 'ILCHIGSTD', 'EMP of Will County', 'Jessen', 'D', 'Schiebout', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '333 N Madison St', 'Joliet', 'Will', 'IL', '60435', '8157417660', '8157417599', '333 N Madison St', 'Joliet', 'Will', 'IL', '60435', '8157417660', '8157417599', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-06-24', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1225272172', 0, 'N', 0, '2013-11-25', NULL, NULL, 41.528, -88.1346, NULL, NULL),
('453136848', 'W12041326', 'W12041326', 'ILCHIGSTD', 'EMP of Will County', 'Jessen', 'D', 'Schiebout', 'MD', 'Emergency Medicine', '', '', NULL, 'B', 'PO Box 637527', 'Cincinnati', 'Hamilton', 'OH', '45263', '3304934443', '0000000000', 'PO Box 637527', 'Cincinnati', 'Hamilton', 'OH', '45263', '3304934443', '0000000000', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-06-24', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1225272172', 0, 'N', 0, '2013-11-25', NULL, NULL, 0, 0, NULL, NULL),
('453136848', 'W12041328', 'W12041328', 'ILCHIGSTD', 'EMP of Will County', 'Neema', 'M', 'Patel', 'MD', 'Emergency Medicine', '', '', NULL, 'B', 'PO Box 637527', 'Cincinnati', 'Hamilton', 'OH', '45263', '3304934443', '0000000000', 'PO Box 637527', 'Cincinnati', 'Hamilton', 'OH', '45263', '3304934443', '0000000000', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-06-24', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1598994121', 0, 'N', 0, '2013-11-25', NULL, NULL, 0, 0, NULL, NULL),
('453136848', 'W12041329', 'W12041329', 'ILCHIGSTD', 'EMP of Will County', 'Neema', 'M', 'Patel', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '333 N Madison St', 'Joliet', 'Will', 'IL', '60435', '8157417660', '8157417599', '333 N Madison St', 'Joliet', 'Will', 'IL', '60435', '8157417660', '8157417599', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-06-24', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1598994121', 0, 'N', 0, '2013-11-25', NULL, NULL, 41.528, -88.1346, NULL, NULL),
('453136848', 'W12041331', 'W12041331', 'ILCHIGSTD', 'EMP of Will County', 'Kathrine', 'E', 'Hughes', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '333 N Madison St', 'Joliet', 'Will', 'IL', '60435', '8157417660', '8157417599', '333 N Madison St', 'Joliet', 'Will', 'IL', '60435', '8157417660', '8157417599', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-10-24', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1699971325', 0, 'N', 0, '2013-11-25', NULL, NULL, 41.528, -88.1346, NULL, NULL),
('453136848', 'W12041332', 'W12041332', 'ILCHIGSTD', 'EMP of Will County', 'Kathrine', 'E', 'Hughes', 'MD', 'Emergency Medicine', '', '', NULL, 'B', 'PO Box 637527', 'Cincinnati', 'Hamilton', 'OH', '45263', '3304934443', '0000000000', 'PO Box 637527', 'Cincinnati', 'Hamilton', 'OH', '45263', '3304934443', '0000000000', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-10-24', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1699971325', 0, 'N', 0, '2013-11-25', NULL, NULL, 0, 0, NULL, NULL),
('453136848', 'W12041334', 'W12041334', 'ILCHIGSTD', 'EMP of Will County', 'Amit', 'D', 'Arwindekar', 'MD', 'Emergency Medicine', '', '', NULL, 'B', 'PO Box 637527', 'Cincinnati', 'Hamilton', 'OH', '45263', '3304934443', '0000000000', 'PO Box 637527', 'Cincinnati', 'Hamilton', 'OH', '45263', '3304934443', '0000000000', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-10-24', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1487816237', 0, 'N', 0, '2013-11-25', NULL, NULL, 0, 0, NULL, NULL),
('453136848', 'W12041335', 'W12041335', 'ILCHIGSTD', 'EMP of Will County', 'Amit', 'D', 'Arwindekar', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '333 N Madison St', 'Joliet', 'Will', 'IL', '60435', '8157417660', '8157417599', '333 N Madison St', 'Joliet', 'Will', 'IL', '60435', '8157417660', '8157417599', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-10-24', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1487816237', 0, 'N', 0, '2013-11-25', NULL, NULL, 41.528, -88.1346, NULL, NULL),
('363852678', 'W12041337', 'W12041337', 'ILCHIGSTD', '', 'Marionette', '', 'Jayaprakash', 'MD', 'Internal Medicine', '', '', NULL, 'O', '2000 Glenwood Ave Ste 107', 'Joliet', 'Will', 'IL', '60435', '8157414445', '8157413047', '2000 Glenwood Ave Ste 107', 'Joliet', 'Will', 'IL', '60435', '8157414445', '8157413047', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-10-24', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, '', '', 'HCFA|UB|', '1760655187', 0, 'N', 0, '2014-01-24', NULL, NULL, 41.5298, -88.1298, NULL, NULL),
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('262655922', 'W12041297', 'W12041297', 'TXHOUSTD', 'Nephrology Internal Medicine', 'Fabio', '', 'Aglieco', 'DO', 'Nephrology', '', '', NULL, 'B', 'PO Box 2660', 'Bay City', 'Matagorda', 'TX', '77404', '0000000000', '0000000000', 'PO Box 2660', 'Bay City', 'Matagorda', 'TX', '77404', '0000000000', '0000000000', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-01-06', NULL, 0, 0, 0, 'Houston Methodist Sugar Land Hospital', NULL, '', '', 'HCFA|UB|', '1801031992', 0, 'N', 0, '2013-12-06', NULL, NULL, 0, 0, NULL, NULL),
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('485506911', 'W12041356', 'W12041356', 'TXDALSTD', 'Southwest Physician Associates', 'Marvin', '', 'Van Hal', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '2301 S Hampton Rd  Ste 800', 'Dallas', 'Dallas', 'TX', '75224', '2143339946', '2143331610', '2301 S Hampton Rd  Ste 800', 'Dallas', 'Dallas', 'TX', '75224', '2143339946', '2143331610', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-03', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Grapevine', NULL, '', '', 'HCFA|UB', '1912933631', 0, 'N', 0, '2014-04-25', NULL, NULL, 32.723, -96.8571, NULL, NULL),
('751292006', 'W12041358', 'W12041358', 'TXDALSTD', 'Southwest Physician Associates', 'David', 'G', 'Bonnett', 'MD', 'Family Practice', '', '', NULL, 'O', '403 W Campbell Rd Ste 103', 'Richardson', 'Dallas', 'TX', '75080', '9722358311', '9722352663', '403 W Campbell Rd Ste 103', 'Richardson', 'Dallas', 'TX', '75080', '9722358311', '9722352663', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-20', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1982612180', 0, 'N', 0, '2013-11-25', NULL, NULL, 32.9754, -96.7254, NULL, NULL),
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('751292006', 'W12041374', 'W12041374', 'TXDALSTD', 'Southwest Physician Associates', 'Paul', 'Heng-Pei', 'Yu', 'MD', 'Family Practice', '', '', NULL, 'O', '403 W Campbell Rd Ste 103', 'Richardson', 'Dallas', 'TX', '75080', '9722358311', '9722352663', '403 W Campbell Rd Ste 103', 'Richardson', 'Dallas', 'TX', '75080', '9722358311', '9722352663', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-20', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1497763627', 0, 'N', 0, '2013-12-02', NULL, NULL, 32.9754, -96.7254, NULL, NULL),
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('201857850', 'W12041389', 'W12041389', 'ILCHIGSTD', 'Prairie Path Foot and Ankle ', 'Lauren', '', 'Doyle', 'DPM', 'Podiatry', '', '', NULL, 'O', '136 W Vallette Ste 2', 'Elmhurst', 'Dupage', 'IL', '60126', '6308343668', '6305591038', '136 W Vallette Ste 2', 'Elmhurst', 'Dupage', 'IL', '60126', '6308343668', '6305591038', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-11-05', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1689961757', 0, 'N', 0, '2013-11-26', NULL, NULL, 41.8835, -87.9416, NULL, NULL),
('364031683', 'W12041387', 'W12041387', 'ILCHIGSTD', 'Elmhurst PHO', 'Richard', '', 'Keen', 'MD', 'Vascular Surgery', '', '', NULL, 'B', 'PO Box 608', 'Palos Park', 'Cook', 'IL', '60464', '6305758789', '6305750720', 'PO Box 608', 'Palos Park', 'Cook', 'IL', '60464', '6305758789', '6305750720', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-11-05', '2014-04-08', 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1841394129', 0, 'N', 0, '2014-04-11', NULL, NULL, 0, 0, NULL, NULL),
('383704007', 'W12041391', 'W12041391', 'ILCHIGSTD', 'Elmhurst PHO', 'Peter', 'J', 'Grant', 'MD', 'Family Practice', '', '', NULL, 'O', '610 S Maple Ave Ste 3000', 'Oak Park', 'Cook', 'IL', '60304', '7085241747', '7083832741', '610 S Maple Ave Ste 3000', 'Oak Park', 'Cook', 'IL', '60304', '7085241747', '7083832741', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-11-05', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, '', '', 'HCFA|UB|', '1306853858', 0, 'N', 0, '2013-11-26', NULL, NULL, 41.878, -87.8038, NULL, NULL),
('383704007', 'W12041392', 'W12041392', 'ILCHIGSTD', 'Elmhurst PHO', 'Peter', 'J', 'Grant', 'MD', 'Family Practice', '', '', NULL, 'O', '159 N Marion St Ste 214', 'Oak Park', 'Cook', 'IL', '60301', '7085241747', '7083832741', '159 N Marion St Ste 214', 'Oak Park', 'Cook', 'IL', '60301', '7085241747', '7083832741', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-11-05', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, '', '', 'HCFA|UB|', '1306853858', 0, 'N', 0, '2013-11-26', NULL, NULL, 41.8892, -87.8026, NULL, NULL),
('364011839', 'W12041394', 'W12041394', 'ILCHIGSTD', 'Elmhurst PHO', 'Diane', 'M', 'Drugas', 'MD', 'General Surgery', '', '', NULL, 'O', '2425 W 22nd St Ste 211', 'Oak Brook', 'Dupage', 'IL', '60523', '6305758789', '6305750720', '2425 W 22nd St Ste 211', 'Oak Brook', 'Dupage', 'IL', '60523', '6305758789', '6305750720', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-11-05', '2014-03-11', 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '1457436776', 0, 'N', 0, '2014-03-26', NULL, NULL, 41.846, -87.9782, NULL, NULL),
('364011839', 'W12041395', 'W12041395', 'ILCHIGSTD', 'Elmhurst PHO', 'Diane', 'M', 'Drugas', 'MD', 'General Surgery', '', '', NULL, 'B', 'PO Box 607', 'Palos Park', 'Cook', 'IL', '60464', '6305758789', '6305750720', 'PO Box 607', 'Palos Park', 'Cook', 'IL', '60464', '6305758789', '6305750720', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-11-05', '2014-03-11', 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '1457436776', 0, 'N', 0, '2014-03-26', NULL, NULL, 0, 0, NULL, NULL),
('362671035', 'W12041397', 'W12041397', 'ILCHIGSTD', 'Elmhurst PHO', 'Kris', 'J', 'Alden', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1 Erie Ct Ste 7120', 'Oak Park', 'Cook', 'IL', '60302', '7088484662', '7088487113', '1 Erie Ct Ste 7120', 'Oak Park', 'Cook', 'IL', '60302', '7088484662', '7088487113', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-11-05', NULL, 0, 0, 0, 'Edward Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1992842132', 0, 'N', 0, '2013-11-26', NULL, NULL, 41.8919, -87.775, NULL, NULL),
('362671035', 'W12041398', 'W12041398', 'ILCHIGSTD', 'Elmhurst PHO', 'Kris', 'J', 'Alden', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1200 S York Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '6302792401', '6302792519', '1200 S York Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '6302792401', '6302792519', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-11-05', NULL, 0, 0, 0, 'Edward Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1992842132', 0, 'N', 0, '2013-11-26', NULL, NULL, 41.865, -87.9322, NULL, NULL),
('362671035', 'W12041399', 'W12041399', 'ILCHIGSTD', 'Elmhurst PHO', 'Kris', 'J', 'Alden', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '2940 Rolling Ridge Rd Ste 102', 'Naperville', 'Will', 'IL', '60564', '6305796500', '6305795860', '2940 Rolling Ridge Rd Ste 102', 'Naperville', 'Will', 'IL', '60564', '6305796500', '6305795860', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-11-05', NULL, 0, 0, 0, 'Edward Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1992842132', 0, 'N', 0, '2013-11-26', NULL, NULL, 41.6988, -88.2064, NULL, NULL),
('362671035', 'W12041400', 'W12041400', 'ILCHIGSTD', 'Elmhurst PHO', 'Kris', 'J', 'Alden', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', 'PO Box 914', 'La Grange', 'Cook', 'IL', '60525', '6303712718', '6303234358', 'PO Box 914', 'La Grange', 'Cook', 'IL', '60525', '6303712718', '6303234358', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-11-05', NULL, 0, 0, 0, 'Edward Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1992842132', 0, 'N', 0, '2013-11-26', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12041402', 'W12041402', 'WYBILLINGS', 'Billings Clinic - Orthopedics & Sports Medicine', 'Noah', '', 'Marks', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '2702 8th Ave N', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062385218', '2702 8th Ave N', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062385218', '', '', '', '0.00', '17.00', '0.00', 3, '2013-11-04', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1457521882', 0, 'N', 0, '2013-12-02', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12041403', 'W12041403', 'WYBILLINGS', 'Billings Clinic', 'Noah', '', 'Marks', 'MD', 'Orthopedic Surgery', '', '', NULL, 'M', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', '0000000000', '0000000000', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', '0000000000', '0000000000', '', '', '', '0.00', '17.00', '0.00', 3, '2013-11-04', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1457521882', 0, 'N', 0, '2013-11-26', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12041405', 'W12041405', 'WYBILLINGS', 'Billings Clinic', 'Dwight', 'G', 'Harley', 'PA', 'Family Practice', '', '', NULL, 'B', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', '0000000000', '0000000000', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', '0000000000', '0000000000', '', '', '', '0.00', '17.00', '0.00', 3, '2013-11-14', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1124091632', 0, 'N', 0, '2013-11-26', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12041406', 'W12041406', 'WYBILLINGS', 'Billings Clinic - Family Medicine', 'Dwight', 'G', 'Harley', 'PA', 'Family Practice', '', '', NULL, 'O', '801 N 29th St', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062382413', '801 N 29th St', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062382413', '', '', '', '0.00', '17.00', '0.00', 3, '2013-11-14', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1124091632', 0, 'N', 0, '2013-11-26', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12041408', 'W12041408', 'WYBILLINGS', 'Billings Clinic - Gastro', 'Augustin', 'R', 'Attwell', 'MD', 'Gastroenterology', '', '', NULL, 'O', '801 N 29th St', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062382763', '801 N 29th St', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062382763', '', '', '', '0.00', '17.00', '0.00', 3, '2013-11-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1275620304', 0, 'N', 0, '2013-11-26', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12041409', 'W12041409', 'WYBILLINGS', 'Billings Clinic', 'Augustin', 'R', 'Attwell', 'MD', 'Gastroenterology', '', '', NULL, 'B', 'PO Box 31315', 'Billings', 'Yellowstone', 'MT', '59107', '4062382617', '0000000000', 'PO Box 31315', 'Billings', 'Yellowstone', 'MT', '59107', '4062382617', '0000000000', '', '', '', '0.00', '17.00', '0.00', 3, '2013-11-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1275620304', 0, 'N', 0, '2013-11-26', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12041411', 'W12041411', 'WYBILLINGS', 'Billings Clinic', 'Lindsey', '', 'Kinelman-Lande', 'APRN', 'Physical Medicine and Rehabilitation', '', '', NULL, 'B', 'PO Box 31315', 'Billings', 'Yellowstone', 'MT', '59107', '4062382617', '0000000000', 'PO Box 31315', 'Billings', 'Yellowstone', 'MT', '59107', '4062382617', '0000000000', '', '', '', '0.00', '17.00', '0.00', 3, '2013-11-13', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1689003691', 0, 'N', 0, '2013-11-26', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12041412', 'W12041412', 'WYBILLINGS', 'Billings Clinic - Rehab', 'Lindsey', '', 'Kinelman-Lande', 'APRN', 'Physical Medicine and Rehabilitation', '', '', NULL, 'O', '801 N 29th St', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062382978', '801 N 29th St', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062382978', '', '', '', '0.00', '17.00', '0.00', 3, '2013-11-13', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1689003691', 0, 'N', 0, '2013-11-26', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12041414', 'W12041414', 'WYBILLINGS', 'Billings Clinic - Hospitalist', 'Rebecca', '', 'Kellum', 'MD', 'Hospitalist', '', '', NULL, 'O', '2800 10th Ave N', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062382572', '2800 10th Ave N', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062382572', '', '', '', '0.00', '17.00', '0.00', 3, '2013-11-12', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '1992894372', 0, 'Y', 0, '2014-02-06', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12041415', 'W12041415', 'WYBILLINGS', 'Billings Clinic', 'Rebecca', '', 'Kellum', 'MD', 'Hospitalist', '', '', NULL, 'B', 'PO Box 31315', 'Billings', 'Yellowstone', 'MT', '59107', '4062382617', '0000000000', 'PO Box 31315', 'Billings', 'Yellowstone', 'MT', '59107', '4062382617', '0000000000', '', '', '', '0.00', '17.00', '0.00', 3, '2013-11-12', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '1992894372', 0, 'Y', 0, '2014-02-06', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12041417', 'W12041417', 'WYBILLINGS', 'Billings Clinic', 'Jade', 'D', 'Small', 'PA', 'Family Practice', '', '', NULL, 'B', 'PO Box 31315', 'Billings', 'Yellowstone', 'MT', '59107', '4062382617', '0000000000', 'PO Box 31315', 'Billings', 'Yellowstone', 'MT', '59107', '4062382617', '0000000000', '', '', '', '0.00', '17.00', '0.00', 3, '2013-11-13', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1023304417', 0, 'N', 0, '2014-01-15', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12041418', 'W12041418', 'WYBILLINGS', 'Billings Clinic - Family Medicine', 'Jade', 'D', 'Small', 'PA', 'Family Practice', '', '', NULL, 'O', '801 N 29th St', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062382253', '801 N 29th St', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062382253', '', '', '', '0.00', '17.00', '0.00', 3, '2013-11-13', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1023304417', 0, 'N', 0, '2014-01-15', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12041419', 'W12041419', 'WYBILLINGS', 'Billings Clinic', 'Dwight', 'G', 'Harley', 'PA', 'Family Practice', '', '', NULL, 'B', 'PO Box 31315', 'Billings', 'Yellowstone', 'MT', '59107', '4062382617', '0000000000', 'PO Box 31315', 'Billings', 'Yellowstone', 'MT', '59107', '4062382617', '0000000000', '', '', '', '0.00', '17.00', '0.00', 3, '2013-11-14', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1124091632', 0, 'N', 0, '2013-11-26', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12041420', 'W12041420', 'WYBILLINGS', 'Billings Clinic', 'Noah', '', 'Marks', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', 'PO Box 31315', 'Billings', 'Yellowstone', 'MT', '59107', '4062382617', '0000000000', 'PO Box 31315', 'Billings', 'Yellowstone', 'MT', '59107', '4062382617', '0000000000', '', '', '', '0.00', '17.00', '0.00', 3, '2013-11-04', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1457521882', 0, 'N', 0, '2013-12-02', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12041421', 'W12041421', 'WYBILLINGS', 'Billings Clinic', 'Augustin', 'R', 'Attwell', 'MD', 'Gastroenterology', '', '', NULL, 'M', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', '0000000000', '0000000000', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', '0000000000', '0000000000', '', '', '', '0.00', '17.00', '0.00', 3, '2013-11-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1275620304', 0, 'N', 0, '2013-11-26', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12041422', 'W12041422', 'WYBILLINGS', 'Billings Clinic', 'Lindsey', '', 'Kinelman-Lande', 'APRN', 'Physical Medicine and Rehabilitation', '', '', NULL, 'M', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', '0000000000', '0000000000', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', '0000000000', '0000000000', '', '', '', '0.00', '17.00', '0.00', 3, '2013-11-13', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1689003691', 0, 'N', 0, '2013-11-26', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12041423', 'W12041423', 'WYBILLINGS', 'Billings Clinic', 'Rebecca', '', 'Kellum', 'MD', 'Hospitalist', '', '', NULL, 'M', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', '0000000000', '0000000000', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', '0000000000', '0000000000', '', '', '', '0.00', '17.00', '0.00', 3, '2013-11-12', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '1992894372', 0, 'Y', 0, '2014-02-06', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12041424', 'W12041424', 'WYBILLINGS', 'Billings Clinic', 'Jade', 'D', 'Small', 'PA', 'Family Practice', '', '', NULL, 'M', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', '0000000000', '0000000000', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', '0000000000', '0000000000', '', '', '', '0.00', '17.00', '0.00', 3, '2013-11-13', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1023304417', 0, 'N', 0, '2014-01-15', NULL, NULL, 0, 0, NULL, NULL),
('876000528', 'W12041426', 'W12041426', 'UT01', 'USU Speech Language Hearing Center', 'Heather', '', 'Jensen', 'AUD', 'Audiology', '', '', NULL, 'O', '1000 Old Main Hill', 'Logan', 'Cache', 'UT', '84322', '4357971346', '4357970221', '1000 Old Main Hill', 'Logan', 'Cache', 'UT', '84322', '4357971346', '4357970221', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1053518563', 0, 'N', 0, '2014-01-06', NULL, NULL, 41.7409, -111.81, NULL, NULL),
('876000528', 'W12041428', 'W12041428', 'UT01', 'USU Speech Language Hearing Center', 'Jeff', '', 'Larsen', 'AUD', 'Audiology', '', '', NULL, 'O', '1000 Old Main Hill', 'Logan', 'Cache', 'UT', '84322', '4357971346', '4357970221', '1000 Old Main Hill', 'Logan', 'Cache', 'UT', '84322', '4357971346', '4357970221', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1033441308', 0, 'N', 0, '2013-12-30', NULL, NULL, 41.7409, -111.81, NULL, NULL),
('876000528', 'W12041430', 'W12041430', 'UT01', 'USU Speech Language Hearing Center', 'Karen', '', 'Munoz', 'AUD', 'Audiology', '', '', NULL, 'O', '1000 Old Main Hill', 'Logan', 'Cache', 'UT', '84322', '4357971346', '4357970221', '1000 Old Main Hill', 'Logan', 'Cache', 'UT', '84322', '4357971346', '4357970221', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1811078124', 0, 'N', 0, '2014-01-06', NULL, NULL, 41.7409, -111.81, NULL, NULL),
('876000528', 'W12041431', 'W12041431', 'UT01', 'USU Speech Language Hearing Center', 'Cache', 'L', 'Pitt', 'AUD', 'Audiology', '', '', NULL, 'O', '1000 Old Main Hill', 'Logan', 'Cache', 'UT', '84322', '4357971346', '4357970221', '1000 Old Main Hill', 'Logan', 'Cache', 'UT', '84322', '4357971346', '4357970221', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1871509356', 0, 'N', 0, '2014-01-06', NULL, NULL, 41.7409, -111.81, NULL, NULL),
('876000528', 'W12041433', 'W12041433', 'UT01', 'USU Speech Language Hearing Center', 'Amy', '', 'Porter', 'AUD', 'Audiology', '', '', NULL, 'O', '1000 Old Main Hill', 'Logan', 'Cache', 'UT', '84322', '4357971346', '4357970221', '1000 Old Main Hill', 'Logan', 'Cache', 'UT', '84322', '4357971346', '4357970221', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1649475633', 0, 'N', 0, '2014-01-06', NULL, NULL, 41.7409, -111.81, NULL, NULL),
('876000528', 'W12041435', 'W12041435', 'UT01', 'USU Speech Language Hearing Center', 'Elizabeth', '', 'Preston', 'AUD', 'Audiology', '', '', NULL, 'O', '1000 Old Main Hill', 'Logan', 'Cache', 'UT', '84322', '4357971346', '4357970221', '1000 Old Main Hill', 'Logan', 'Cache', 'UT', '84322', '4357971346', '4357970221', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1710158803', 0, 'N', 0, '2014-02-04', NULL, NULL, 41.7409, -111.81, NULL, NULL),
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