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
('202630141', 'W12036084', 'W12036084', 'IDBOISTD', 'Primary Health Medical Group', 'Joel', 'J', 'Burch', 'PA', 'Family Practice', '', '', NULL, 'O', '11197 W Fairview Ave', 'Boise', 'Ada', 'ID', '83713', '2083788011', '2083228095', '11197 W Fairview Ave', 'Boise', 'Ada', 'ID', '83713', '2083788011', '2083228095', 'IDPRIMARY', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1679918536', 0, 'Y', 0, '2014-01-31', NULL, NULL, 43.6195, -116.322, NULL, NULL),
('202630141', 'W12036085', 'W12036085', 'IDBOISTD', 'Primary Health Medical Group', 'Joel', 'J', 'Burch', 'PA', 'Family Practice', '', '', NULL, 'O', '6052 W State St', 'Boise', 'Ada', 'ID', '83703', '2083447799', '2089471945', '6052 W State St', 'Boise', 'Ada', 'ID', '83703', '2083447799', '2089471945', 'IDPRIMARY', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1679918536', 0, 'Y', 0, '2014-01-31', NULL, NULL, 43.6592, -116.264, NULL, NULL),
('202630141', 'W12036086', 'W12036086', 'IDBOISTD', 'Primary Health Medical Group', 'Joel', 'J', 'Burch', 'PA', 'Family Practice', '', '', NULL, 'O', '300 W Myrtle St Ste 100', 'Boise', 'Ada', 'ID', '83702', '2084729082', '2084729083', '300 W Myrtle', 'Boise', 'Ada', 'ID', '83702', '2084729082', '2084729083', 'IDPRIMARY', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2013-08-04', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1679918536', 0, 'Y', 0, '2014-01-31', NULL, NULL, 43.6096, -116.201, NULL, NULL),
('202630141', 'W12036087', 'W12036087', 'IDBOISTD', 'Primary Health Medical Group', 'Phillip ', 'B', 'Whittenberg', 'PA', 'Family Practice', '', '', NULL, 'O', '4815 Cleveland Blvd', 'Caldwell', 'Canyon', 'ID', '83605', '2084553545', '2084549690', '4815 Cleveland Blvd', 'Caldwell', 'Canyon', 'ID', '83605', '2084553545', '2084549690', 'IDPRIMARY', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2013-08-04', '2014-02-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1053385054', 0, 'N', 0, '2014-04-11', NULL, NULL, 43.6351, -116.647, NULL, NULL),
('202630141', 'W12036088', 'W12036088', 'IDBOISTD', 'Primary Health Medical Group', 'Phillip ', 'B', 'Whittenberg', 'PA', 'Family Practice', '', '', NULL, 'O', '435 S Eagle Rd', 'Eagle', 'Ada', 'ID', '83616', '2089398200', '2089398222', '435 S Eagle Rd', 'Eagle', 'Ada', 'ID', '83616', '2089398200', '2089398222', 'IDPRIMARY', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2013-08-04', '2014-02-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1053385054', 0, 'N', 0, '2014-04-11', NULL, NULL, 43.6918, -116.354, NULL, NULL),
('202630141', 'W12036089', 'W12036089', 'IDBOISTD', 'Primary Health Medical Group', 'Phillip ', 'B', 'Whittenberg', 'PA', 'Family Practice', '', '', NULL, 'O', '1130 E Fairview', 'Meridian', 'Ada', 'ID', '83642', '2088889393', '2088889525', '1130 E Fairview', 'Meridian', 'Ada', 'ID', '83642', '2088889393', '2088889525', 'IDPRIMARY', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2013-08-04', '2014-02-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1053385054', 0, 'N', 0, '2014-04-11', NULL, NULL, 43.6195, -116.38, NULL, NULL),
('202630141', 'W12036090', 'W12036090', 'IDBOISTD', 'Primary Health Medical Group', 'Phillip ', 'B', 'Whittenberg', 'PA', 'Family Practice', '', '', NULL, 'O', '700 Caldwell Blvd', 'Nampa', 'Canyon', 'ID', '83651', '2083451222', '2083451261', '700 Caldwell Blvd', 'Nampa', 'Canyon', 'ID', '83651', '2083451222', '2083451261', 'IDPRIMARY', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2013-08-04', '2014-02-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1053385054', 0, 'N', 0, '2014-04-11', NULL, NULL, 43.5963, -116.59, NULL, NULL),
('202630141', 'W12036091', 'W12036091', 'IDBOISTD', 'Primary Health Medical Group', 'Phillip ', 'B', 'Whittenberg', 'PA', 'Family Practice', '', '', NULL, 'O', '1115 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2084981080', '2084981081', '1115 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2084981080', '2084981081', 'IDPRIMARY', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2013-08-04', '2014-02-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1053385054', 0, 'N', 0, '2014-04-11', NULL, NULL, 43.5577, -116.573, NULL, NULL),
('202630141', 'W12036092', 'W12036092', 'IDBOISTD', 'Primary Health Medical Group', 'Phillip ', 'B', 'Whittenberg', 'PA', 'Family Practice', '', '', NULL, 'O', '1907 S Broadway Ave Ste 101', 'Boise', 'Ada', 'ID', '83706', '2083451222', '2083451261', '1907 S Broadway Ave Ste 101', 'Boise', 'Ada', 'ID', '83706', '2083451222', '2083451261', 'IDPRIMARY', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2013-08-04', '2014-02-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1053385054', 0, 'N', 0, '2014-04-11', NULL, NULL, 43.5897, -116.194, NULL, NULL),
('202630141', 'W12036093', 'W12036093', 'IDBOISTD', 'Primary Health Medical Group', 'Phillip ', 'B', 'Whittenberg', 'PA', 'Family Practice', '', '', NULL, 'O', '11197 W Fairview Ave', 'Boise', 'Ada', 'ID', '83713', '2083788011', '2083228095', '11197 W Fairview Ave', 'Boise', 'Ada', 'ID', '83713', '2083788011', '2083228095', 'IDPRIMARY', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2013-08-04', '2014-02-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1053385054', 0, 'N', 0, '2014-04-11', NULL, NULL, 43.6195, -116.322, NULL, NULL),
('202630141', 'W12036094', 'W12036094', 'IDBOISTD', 'Primary Health Medical Group', 'Phillip ', 'B', 'Whittenberg', 'PA', 'Family Practice', '', '', NULL, 'O', '6052 W State St', 'Boise', 'Ada', 'ID', '83703', '2083447799', '2089471945', '6052 W State St', 'Boise', 'Ada', 'ID', '83703', '2083447799', '2089471945', 'IDPRIMARY', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2013-08-04', '2014-02-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1053385054', 0, 'N', 0, '2014-04-11', NULL, NULL, 43.6592, -116.264, NULL, NULL),
('202630141', 'W12036095', 'W12036095', 'IDBOISTD', 'Primary Health Medical Group', 'Phillip ', 'B', 'Whittenberg', 'PA', 'Family Practice', '', '', NULL, 'O', '300 W Myrtle St Ste 100', 'Boise', 'Ada', 'ID', '83702', '2084729082', '2084729083', '300 W Myrtle St Ste 100', 'Boise', 'Ada', 'ID', '83702', '2084729082', '2084729083', 'IDPRIMARY', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2013-08-04', '2014-02-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1053385054', 0, 'N', 0, '2014-04-11', NULL, NULL, 43.6096, -116.201, NULL, NULL),
('261900472', 'W12036099', 'W12036099', 'IDBOISTD', 'Idaho Skin Surgery Center', 'Jared', '', 'Scott', 'MD', 'Dermatology', '', '', NULL, 'O', '1906 S Vista Ave', 'Boise', 'Ada', 'ID', '83705', '2084331114', NULL, '1906 S Vista Ave', 'Boise', 'Ada', 'ID', '83705', '2084331114', '          ', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2013-07-26', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1992808893', 0, 'N', 0, '2013-08-16', NULL, NULL, 43.5861, -116.214, NULL, NULL),
('261900472', 'W12036100', 'W12036100', 'Sinclair', 'Idaho Skin Surgery Center', 'Jared', '', 'Scott', 'MD', 'Dermatology', '', '', NULL, 'O', '1906 S Vista Ave', 'Boise', 'Ada', 'ID', '83705', '2084331114', NULL, '1906 S Vista Ave', 'Boise', 'Ada', 'ID', '83705', '2084331114', '          ', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2013-07-26', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1992808893', 0, 'N', 0, '2013-08-16', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W12036106', 'W12036106', 'UT01', 'West Valley Family Medicine', 'Christopher', 'Burgon', 'Valentine', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '3336 S 4155 W Ste 202', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019128230', '8012857222', '3336 S 4155 W Ste 202', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019128230', '8012857222', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-08-01', '2014-04-30', 0, 0, 0, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1598753501', 0, 'N', 0, '2013-09-20', NULL, NULL, 40.6991, -111.99, NULL, NULL),
('371625746', 'W12035923', 'W12035923', 'UT01', 'Northern Utah Cardiovascular Associates', 'Elaine', 'E', 'Archuleta', 'NP', 'Cardiovascular Disease', '', '', NULL, 'O', '5405 S 500 E Ste 204', 'Ogden', 'Weber', 'UT', '84405', '8014790184', '8014795642', '5405 S 500 E Ste 204', 'Ogden', 'Weber', 'UT', '84405', '8014790184', '8014795642', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-02-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB', '1760556310', 0, 'N', 0, '2014-04-03', NULL, NULL, 41.1655, -111.969, NULL, NULL),
('371625746', 'W12035924', 'W12035924', 'UT01', 'Northern Utah Cardiovascular Associates', 'Elaine', 'E', 'Archuleta', 'NP', 'Cardiovascular Disease', '', '', NULL, 'B', 'Po Box 741729', 'Atlanta', 'Fulton', 'GA', '30384', '8014790184', '8014795642', 'Po Box 741729', 'Atlanta', 'Fulton', 'GA', '30384', '8014790184', '8014795642', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-02-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB', '1760556310', 0, 'N', 0, '2014-04-03', NULL, NULL, 0, 0, NULL, NULL),
('760540476', 'W12035926', 'W12035926', 'TXHOUSTD', 'Oakbend Medical Group', 'Christopher', '', 'Banks', 'NP', 'Family Practice', '', '', NULL, 'O', '30525 First St Ste C', 'Rosenberg', 'Fort Bend', 'TX', '77471', '2816334950', '2816334985', '30525 First St Ste C', 'Rosenberg', 'Fort Bend', 'TX', '77471', '2816334950', '2816334985', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1558601211', 0, 'N', 0, '2013-08-27', NULL, NULL, 29.5491, -95.8087, NULL, NULL),
('760540476', 'W12035925', 'W12035925', 'TXHOUSTD', 'Oakbend Medical Group', 'Christopher', '', 'Banks', 'NP', 'Family Practice', '', '', NULL, 'O', '4911 Sand Hill Dr', 'Sugar Land', 'Fort Bend', 'TX', '77479', '2816334970', '2816334975', '4911 Sand Hill Dr', 'Sugar Land', 'Fort Bend', 'TX', '77479', '2816334970', '2816334975', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1558601211', 0, 'N', 0, '2013-09-06', NULL, NULL, 29.5995, -95.682, NULL, NULL),
('870179340', 'W12036108', 'W12036108', 'UT01', 'Standard Optical', 'Lloyd', 'B', 'Williams', 'MD', 'Ophthalmology', '', '', NULL, 'B', '1901 W Parkway Blvd', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8019720203', NULL, '1901 W Parkway Blvd', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8019720203', '          ', 'WUTALBERT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2014-02-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1730333741', 0, 'N', 0, '2014-01-24', NULL, NULL, 0, 0, NULL, NULL),
('870179340', 'W12036107', 'W12036107', 'UT01', 'Standard Optical', 'Lloyd', 'B', 'Williams', 'MD', 'Ophthalmology', '', '', NULL, 'O', '4878 S Highland Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012728861', '8012728867', '4878 S Highland Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012728861', '8012728867', 'WUTALBERT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2014-02-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1730333741', 0, 'N', 0, '2014-01-24', NULL, NULL, 40.6633, -111.838, NULL, NULL),
('202148889', 'W12036104', 'W12036104', 'TXSATSTD', 'Health Texas Medical Group of San Antonio', 'Kelly', 'G', 'Thurmon', 'DO', 'Internal Medicine', '', '', NULL, 'B', '6243 Ih W Ste 480', 'San Antonio', 'Bexar', 'TX', '78201', '2103714800', NULL, '6243 Ih W Ste 480', 'San Antonio', 'Bexar', 'TX', '78201', '2103714800', '          ', 'TXINT', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-11-01', NULL, 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1265624019', 0, 'N', 0, '2013-10-10', NULL, NULL, 0, 0, NULL, NULL),
('202148889', 'W12036103', 'W12036103', 'TXSATSTD', 'Health Texas Medical Group of San Antonio', 'Kelly', 'G', 'Thurmon', 'DO', 'Internal Medicine', '', '', NULL, 'O', '8542 Wurzbach Rd', 'San Antonio', 'Bexar', 'TX', '78240', '2106167300', '2106167359', '8542 Wurzbach Rd', 'San Antonio', 'Bexar', 'TX', '78240', '2106167300', '2106167359', 'TXINT', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-11-01', NULL, 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1265624019', 0, 'N', 0, '2013-10-10', NULL, NULL, 29.5207, -98.5727, NULL, NULL),
('202148889', 'W12036105', 'W12036105', 'TXSATSTD', 'Health Texas Medical Group of San Antonio', 'Kelly', 'G', 'Thurmon', 'DO', 'Internal Medicine', '', '', NULL, 'B', 'Po Box 100026', 'San Antonio', 'Bexar', 'TX', '78201', '2109242337', NULL, 'Po Box 100026', 'San Antonio', 'Bexar', 'TX', '78201', '2109242337', '          ', 'TXINT', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-11-01', NULL, 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1265624019', 0, 'N', 0, '2013-10-10', NULL, NULL, 0, 0, NULL, NULL),
('850275777', 'W12036101', 'W12036101', 'NM01', 'Southwest Medical Associates', 'Jeffrey', 'J', 'Thomas', 'MD', 'Family Practice', '', '', NULL, 'O', '8401 Constitution Ne Ste 150', 'Albuquerque', 'Bernalillo', 'NM', '87110', '5058231010', '5057974503', '8401 Constitution Ne Ste 150', 'Albuquerque', 'Bernalillo', 'NM', '87110', '5058231010', '5057974503', 'NMSWMED', '', '', '0.00', '10.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1215935531', 0, 'N', 0, '2013-08-22', NULL, NULL, 35.0946, -106.552, NULL, NULL),
('850275777', 'W12036102', 'W12036102', 'NM01', 'Southwest Medical Associates', 'Jeffrey', 'J', 'Thomas', 'MD', 'Family Practice', '', '', NULL, 'B', '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, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1215935531', 0, 'N', 0, '2013-08-22', NULL, NULL, 0, 0, NULL, NULL),
('364088232', 'W12036098', 'W12036098', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Kumar', 'B', 'Raigaga', 'DPM', 'Podiatry', '', '', NULL, 'O', '1221 N Highland Ave', 'Aurora', 'Kane', 'IL', '60506', '6308598700', '6308593248', '1221 N Highland Ave', 'Aurora', 'Kane', 'IL', '60506', '6308598700', '6308593248', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-07-19', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1285713669', 0, 'N', 0, '2014-04-04', NULL, NULL, 41.7821, -88.3293, NULL, NULL),
('364088232', 'W12036097', 'W12036097', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Kumar', 'B', 'Raigaga', 'DPM', 'Podiatry', '', '', NULL, 'B', '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6302648990', NULL, '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6302648990', '          ', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-07-19', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1285713669', 0, 'N', 0, '2013-07-30', NULL, NULL, 0, 0, NULL, NULL),
('870284475', 'W12036044', 'W12036044', 'UT01', 'Granger Medical Clinic ', 'Susan', 'E', 'Prater', 'MD', 'Family Practice', '', '', NULL, 'O', '11724 S State St', 'Draper', 'Salt Lake', 'UT', '84020', '8015762000', '8015762001', '11724 S State St', 'Draper', 'Salt Lake', 'UT', '84020', '8015762000', '8015762001', 'WUGRANGER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', '', '', '', 'HCFA|UB|', '1841430733', 0, 'N', 0, '2013-08-22', NULL, NULL, 40.5394, -111.891, NULL, NULL),
('870284475', 'W12036046', 'W12036046', 'UT01', 'Granger Medical Clinic', 'Susan', 'E', 'Prater', 'MD', 'Family Practice', '', '', NULL, 'B', 'Po Box 70658', 'Salt Lake City', 'Salt Lake', 'UT', '84170', '8019653720', '8019653740', 'Po Box 70658', 'Salt Lake City', 'Salt Lake', 'UT', '84170', '8019653720', '8019653740', 'WUGRANGER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', '', '', '', 'HCFA|UB|', '1841430733', 0, 'N', 0, '2013-08-22', NULL, NULL, 0, 0, NULL, NULL),
('611696015', 'W12041007', 'W12041007', 'UT01', 'Mountain Star Behavioral Health', 'Matthew', 'J', 'Gardiner', 'MD', 'Mental Health', 'Psychiatry', '', NULL, 'O', '630 Medical Dr', 'Bountiful', 'Davis', 'UT', '84010', '8012993781', '8012992415', '630 Medical Dr', 'Bountiful', 'Davis', 'UT', '84010', '8012993781', '8012992415', '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),
('621801973', 'W12036039', 'W12036039', 'UT01', 'Herriman Medical Clinic', 'Karen', '', 'Olson', '', 'Family Practice', '', '', NULL, 'O', '5746 W 13400 S Ste 200', 'Herriman', 'Salt Lake', 'UT', '84096', '8019877500', '8019877539', '5746 W 13400 S Ste 200', 'Herriman', 'Salt Lake', 'UT', '84096', '8019877500', '8019877539', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2012-10-15', '2014-04-30', 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1215154232', 0, 'N', 0, '2014-01-17', NULL, NULL, 40.5079, -112.027, NULL, NULL),
('621801973', 'W12036042', 'W12036042', 'UT01', 'Herriman Medical Clinic', 'Karen', '', 'Olson', '', 'Family Practice', '', '', NULL, 'B', 'Po Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', 'Po Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2012-10-15', '2014-04-30', 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1215154232', 0, 'N', 0, '2014-01-17', NULL, NULL, 0, 0, NULL, NULL),
('850275777', 'W12035985', 'W12035985', 'NM01', 'Southwest Medical Associates', 'Julieann', 'M', 'Nipp', 'NP', 'Family Practice', '', '', NULL, 'O', '4420 Irving Blvd Nw', 'Albuquerque', 'Bernalillo', 'NM', '87114', '5058231010', '5057974503', '4420 Irving Blvd Nw', 'Albuquerque', 'Bernalillo', 'NM', '87114', '5058231010', '5057974503', 'NMSWMED', '', '', '0.00', '10.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1174532741', 0, 'N', 0, '2013-08-22', NULL, NULL, 35.1902, -106.665, NULL, NULL),
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('830234097', 'W12035719', 'W12035719', 'WY01', 'OB/GYN Specialists', 'Jennifer', 'A', 'Linden', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '1405 W 4th St', 'Gillette', 'Campbell', 'WY', '82716', '0000000000', '0000000000', '1405 W 4th St', 'Gillette', 'Campbell', 'WY', '82716', '0000000000', '0000000000', '', '', '5001', '0.00', '0.00', '0.00', 6, '2013-09-01', '2013-08-31', 0, 0, 0, 'Campbell County Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1689793168', 0, 'N', 0, '2013-09-17', NULL, NULL, 0, 0, NULL, NULL),
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('850275777', 'W12035966', 'W12035966', 'NM01', 'Southwest Medical Associates', 'Patricia', '', 'Heinz', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'B', '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, '2013-08-01', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1093741985', 0, 'N', 0, '2013-10-30', NULL, NULL, 0, 0, NULL, NULL),
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('363759101', 'W12035960', 'W12035960', 'ILCHIGSTD', 'Affiliates in Primary Care', 'Mora', '', 'Guillermo', 'MD', 'Family Practice', '', '', NULL, 'O', '1111 W Superior St Ste 306', 'Melrose Park', 'Cook', 'IL', '60160', '7084500055', '7084500288', '1111 W Superior St Ste 306', 'Melrose Park', 'Cook', 'IL', '60160', '7084500055', '7084500288', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-07-09', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, '', '', 'HCFA|UB|', '1508188525', 0, 'N', 0, '2013-07-30', NULL, NULL, 41.8925, -87.8471, NULL, NULL),
('363759101', 'W12035961', 'W12035961', 'ILCHIGSTD', 'Affiliates in Primary Care', 'Mora', '', 'Guillermo', 'MD', 'Family Practice', '', '', NULL, 'O', '1200 S York Rd Ste 4250', 'Elmhurst', 'Dupage', 'IL', '60126', '6305303730', '6305303734', '1200 S York Rd Ste 4250', 'Elmhurst', 'Dupage', 'IL', '60126', '6305303730', '6305303734', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-07-09', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, '', '', 'HCFA|UB|', '1508188525', 0, 'N', 0, '2013-07-30', NULL, NULL, 41.865, -87.9322, NULL, NULL),
('621801973', 'W12035959', 'W12035959', 'UT01', 'Jordan Valley Internal Medicine', 'Matthew', '', 'Grantz', '', 'Neurology', NULL, NULL, NULL, 'O', '3570 W 9000 S Ste 100', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015692384', '8015698643', '3570 W 9000 S Ste 100', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015692384', '8015698643', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-09-01', '2014-04-30', 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1134373665', 0, 'N', 0, '2013-09-20', NULL, NULL, 40.588, -111.975, NULL, NULL),
('621801973', 'W12035958', 'W12035958', 'UT01', 'Jordan Valley Neurology', 'Matthew', '', 'Grantz', '', 'Neurology', NULL, NULL, NULL, 'O', '3590 W 9000 S Ste 240', 'West Jordan', 'Salt Lake', 'UT', '84088', '8013528373', '8013528459', '3590 W 9000 S Ste 240', 'West Jordan', 'Salt Lake', 'UT', '84088', '8013528373', '8013528459', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-09-01', '2014-04-30', 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1134373665', 0, 'N', 0, '2013-09-20', NULL, NULL, 40.5879, -111.976, NULL, NULL),
('621801973', 'W12035957', 'W12035957', 'UT01', 'Physician Group of Utah, Inc', 'Matthew', '', 'Grantz', '', 'Neurology', NULL, NULL, NULL, 'M', '406 W S Jordan Pkwy Ste 500', 'South Jordan', 'Salt Lake', 'UT', '84095', '8016014420', NULL, '406 W S Jordan Pkwy Ste 500', 'South Jordan', 'Salt Lake', 'UT', '84095', '8016014420', '          ', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-09-01', '2014-04-30', 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1134373665', 0, 'N', 0, '2013-09-20', NULL, NULL, 0, 0, NULL, NULL),
('202148889', 'W12035955', 'W12035955', 'TXSATSTD', 'Health Texas Medical Group', 'Andrine', 'K', 'Grant', 'MD', 'Family Practice', '', '', NULL, 'B', 'Po Box 100026', 'San Antonio', 'Bexar', 'TX', '78201', '2102490212', '          ', 'Po Box 100026', 'San Antonio', 'Bexar', 'TX', '78201', '2102490212', '          ', 'TXINT', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-11-01', NULL, 0, 0, 0, 'Baptist Medical Center', 'St Lukes Baptist Hospital', NULL, NULL, 'HCFA|UB|DEN|', '1356310908', 0, 'N', 0, '2014-06-13', NULL, NULL, 0, 0, NULL, NULL),
('202148889', 'W12035953', 'W12035953', 'TXSATSTD', 'Health Texas Medical Group of San Antonio', 'Andrine', 'K', 'Grant', 'MD', 'Family Practice', '', '', NULL, 'O', '1200 Brooklyn Ave Ste 240', 'San Antonio', 'Bexar', 'TX', '78212', '2102254511', '2102254514', '1200 Brooklyn Ave Ste 240', 'San Antonio', 'Bexar', 'TX', '78212', '2102254511', '2102254514', 'TXINT', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-11-01', NULL, 0, 0, 0, 'Baptist Medical Center', 'St Lukes Baptist Hospital', NULL, NULL, 'HCFA|UB|', '1356310908', 0, 'N', 0, '2014-06-13', NULL, NULL, 29.4395, -98.4904, NULL, NULL),
('202148889', 'W12035954', 'W12035954', 'TXSATSTD', 'Health Texas Medical Group', 'Andrine', 'K', 'Grant', 'MD', 'Family Practice', '', '', NULL, 'M', '6243 Ih 10 W Ste 480', 'San Antonio', 'Bexar', 'TX', '78201', '2102490212', '          ', '6243 Ih 10 W Ste 480', 'San Antonio', 'Bexar', 'TX', '78201', '2102490212', '          ', 'TXINT', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-11-01', NULL, 0, 0, 0, 'Baptist Medical Center', 'St Lukes Baptist Hospital', NULL, NULL, 'HCFA|UB|DEN|', '1356310908', 0, 'N', 0, '2014-06-13', NULL, NULL, 29.487, -98.5422, NULL, NULL),
('364088232', 'W12035942', 'W12035942', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Naveen', '', 'Divakaruni', 'DO', 'Urology', '', '', NULL, 'O', '1221 N Highland Ave', 'Aurora', 'Kane', 'IL', '60506', '6308598700', '6302648522', '1221 N Highland Ave', 'Aurora', 'Kane', 'IL', '60506', '6308598700', '6302648522', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-07-19', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, '', '', 'HCFA|UB|', '1386801751', 0, 'N', 0, '2013-07-30', NULL, NULL, 41.7821, -88.3293, NULL, NULL),
('364088232', 'W12035941', 'W12035941', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Naveen', '', 'Divakaruni', 'DO', 'Urology', '', '', NULL, 'B', '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6302648990', NULL, '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6302648990', '          ', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-07-19', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, '', '', 'HCFA|UB|', '1386801751', 0, 'N', 0, '2013-07-30', NULL, NULL, 0, 0, NULL, NULL),
('870520042', 'W12034093', 'W12034093', 'UT01', 'Nephrology Associates', 'Landon', 'E', 'Dickson', 'MD', 'Nephrology', '', '', NULL, 'O', '650 E 4500 S', 'Murray', 'Salt Lake', 'UT', '84107', '8012882634', NULL, '650 E 4500 S', 'Murray', 'Salt Lake', 'UT', '84107', '8012882634', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-10-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', '', '', '', 'HCFA|UB|', '1912168345', 0, 'N', 0, '2014-02-24', NULL, NULL, 40.6743, -111.874, NULL, NULL),
('260613704', 'W12036109', 'W12036109', 'TXHOUSTD', 'Nicholas A Fiore MD', 'Nicholas', 'A', 'Fiore', 'MD', 'Hand Surgery', '', '', NULL, 'O', '11307 Fm 1960 Rd W Ste 270', 'Houston', 'Harris', 'TX', '77065', '2809708002', '2819708770', '11307 Fm 1960 Rd W Ste 270', 'Houston', 'Harris', 'TX', '77065', '2809708002', '2819708770', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-15', NULL, 0, 0, 0, 'Houston Methodist Willowbrook Hospital', '', '', '', 'HCFA|UB|DEN|', '1306865456', 0, 'N', 0, '2014-04-24', NULL, NULL, 29.9295, -95.5906, NULL, NULL),
('752963882', 'W12036110', 'W12036110', 'TXDALSTD', 'Aruna Koney MD ', 'Aruna', '', 'Koney', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1151 N Buckner Blvd Ste 103', 'Dallas', 'Dallas', 'TX', '75218', '2143201200', '2143209400', '1151 N Buckner Blvd Ste 103', 'Dallas', 'Dallas', 'TX', '75218', '2143201200', '2143209400', 'DALLAS1', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-09-09', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1649372749', 0, 'N', 0, '2013-08-09', NULL, NULL, 32.8347, -96.7036, NULL, NULL),
('260613704', 'W12036111', 'W12036111', 'TXHOUSTD', 'Nicholas A Fiore MD', 'Nicholas', 'A', 'Fiore', 'MD', 'Hand Surgery', '', '', NULL, 'B', 'Dept 653 Po Box 4346', 'Houston', 'Harris', 'TX', '77210', '2809708002', '2819708770', 'Dept 653 Po Box 4346', 'Houston', 'Harris', 'TX', '77210', '2809708002', '2819708770', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-15', NULL, 0, 0, 0, 'Houston Methodist Willowbrook Hospital', '', '', '', 'HCFA|UB|DEN|', '1306865456', 0, 'N', 0, '2014-04-24', NULL, NULL, 0, 0, NULL, NULL),
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('201037151', 'SPA400090', 'SPA400090', 'TXDALSTD', 'Allergy and Asthma Associates of Allen', 'Hari', '', 'Reddy', 'DO', 'Allergy and Immunology', 'Pediatrics', '', NULL, 'O', '977 Raintree Cir Ste 100', 'Allen', 'Collin', 'TX', '75013', '9727477007', '9727477006', '977 Raintree Cir Ste 100', 'Allen', 'Collin', 'TX', '75013', '9727477007', '9727477006', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1235199621', 0, 'N', 0, '2013-11-11', NULL, NULL, 33.1111, -96.6793, NULL, NULL),
('751739707', 'SPA400073', 'SPA400073', 'TXDALSTD', 'Texoma Neurology Associates', 'Andres', '', 'Morales', 'DO', 'Neurology', '', '', NULL, 'O', '321 N Highland Ste 200', 'Sherman', 'Grayson', 'TX', '75092', '9038935141', '9038935891', '321 N Highland Ste 200', 'Sherman', 'Grayson', 'TX', '75092', '9038935141', '9038935891', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, NULL, '', NULL, NULL, 'HCFA|UB|', '1245276500', 0, 'N', 0, '2013-11-11', NULL, NULL, 33.6361, -96.623, NULL, NULL),
('752883930', 'SPA400063', 'SPA400063', 'TXDALSTD', 'Ricardo J Martinez MD', 'Ricardo', '', 'Martinez', 'MD', 'Family Practice', '', '', NULL, 'O', '8 Medical Pkwy Plz 2 Ste 106', 'Farmers Branch', 'Dallas', 'TX', '75234', '9724062896', '9724062767', '8 Medical Pkwy Plz 2 Ste 106', 'Farmers Branch', 'Dallas', 'TX', '75234', '9724062896', '9724062767', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Carrollton', NULL, '', NULL, 'HCFA|UB|', '1255472999', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.9221, -96.8839, NULL, NULL),
('273994556', 'SPA400084', 'SPA400084', 'TXDALSTD', 'John L Proffitt MD', 'John', 'L', 'Proffitt', 'MD', 'Dermatology', '', '', NULL, 'O', '3500 Oak Lawn Ave Ste 650', 'Dallas', 'Dallas', 'TX', '75219', '2145268100', '2145268105', '3500 Oak Lawn Ave Ste 650', 'Dallas', 'Dallas', 'TX', '75219', '2145268100', '2145268105', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, '', NULL, 'HCFA|UB|', '1285668780', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.8119, -96.8055, NULL, NULL),
('161664951', 'SPA400050', 'SPA400050', 'TXDALSTD', 'Northern Texas Facial and Oral Surgery', 'David', 'K', 'Hunter', 'DDS', 'Oral/Maxillofacial Surgery', '', '', NULL, 'O', '1612 Lancaster Dr', 'Grapevine', 'Tarrant', 'TX', '76051', '8173294979', '8174884483', '1612 Lancaster Dr', 'Grapevine', 'Tarrant', 'TX', '76051', '8173294979', '8174884483', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Trophy Club', 'Baylor Regional Medical Center at Plano', NULL, NULL, 'HCFA|UB|', '1285687582', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.9337, -97.0915, NULL, NULL),
('161664951', 'SPA400051', 'SPA400051', 'TXDALSTD', 'Northern Texas Facial and Oral Surgery', 'David', 'K', 'Hunter', 'DDS', 'Oral/Maxillofacial Surgery', '', '', NULL, 'O', '440 W I 635 Ste 445', 'Irving', 'Dallas', 'TX', '75063', '9724018301', '9724884483', '440 W I 635 Ste 445', 'Irving', 'Dallas', 'TX', '75063', '9724018301', '9724884483', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Trophy Club', 'Baylor Regional Medical Center at Plano', NULL, NULL, 'HCFA|UB|', '1285687582', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.9128, -96.9506, NULL, NULL),
('753050192', 'SPA400030', 'SPA400030', 'TXDALSTD', 'All Allergy Asthma and Immunology Clinic', 'Sonak', 'B', 'Daulat', 'MD', 'Allergy and Immunology', 'Internal Medicine', '', NULL, 'O', '10216 Garland Rd', 'Dallas', 'Dallas', 'TX', '75218', '2143283232', '2143280202', '10216 Garland Rd', 'Dallas', 'Dallas', 'TX', '75218', '2143283232', '2143280202', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1316904824', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.8404, -96.6939, NULL, NULL),
('753050192', 'SPA400031', 'SPA400031', 'TXDALSTD', 'All Allergy Asthma and Immunology Clinic', 'Sonak', 'B', 'Daulat', 'MD', 'Allergy and Immunology', 'Internal Medicine', '', NULL, 'O', '3600 Gaston Ave Ste 1056', 'Dallas', 'Dallas', 'TX', '75246', '2143283232', '2143280202', '3600 Gaston Ave Ste 1056', 'Dallas', 'Dallas', 'TX', '75246', '2143283232', '2143280202', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1316904824', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.7913, -96.7799, NULL, NULL),
('752018461', 'SPA400037', 'SPA400037', 'TXDALSTD', 'Clinical Pediatric Associates', 'Ernesto', '', 'Fernandez', 'MD', 'Pediatrics', '', '', NULL, 'O', '8355 Walnut Hill Ln Ste 105', 'Dallas', 'Dallas', 'TX', '75231', '2143683659', '2147398923', '8355 Walnut Hill Ln Ste 105', 'Dallas', 'Dallas', 'TX', '75231', '2143683659', '2147398923', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, '', '', 'Baylor University Medical Center', '', 'HCFA|UB|', '1346317054', 0, 'N', 0, '2014-03-31', NULL, NULL, 32.8834, -96.7604, NULL, NULL),
('260563794', 'SPA400077', 'SPA400077', 'TXDALSTD', 'Wyn D Nguyen MD', 'Wyn', 'D', 'Nguyen', 'MD', 'Colon and Rectal Surgery', 'General Surgery', '', NULL, 'O', '3O13 E Renner Rd Ste 120', 'Richardson', 'Dallas', 'TX', '75082', '9729189500', '9729189501', '3O13 E Renner Rd Ste 120', 'Richardson', 'Dallas', 'TX', '75082', '9729189500', '9729189501', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', 'Houston Methodist Hospital', NULL, NULL, 'HCFA|UB|', '1366440059', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.9971, -96.6591, NULL, NULL),
('260563794', 'SPA400078', 'SPA400078', 'TXDALSTD', 'Wyn D Nguyen MD', 'Wyn', 'D', 'Nguyen', 'MD', 'Colon and Rectal Surgery', 'General Surgery', '', NULL, 'O', '6435 SFM 549 Ste 107', 'Heath', 'Rockwall', 'TX', '75032', '9729189500', '9729189501', '6435 SFM 549 Ste 107', 'Heath', 'Rockwall', 'TX', '75032', '9729189500', '9729189501', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', 'Houston Methodist Hospital', NULL, NULL, 'HCFA|UB|', '1366440059', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.8642, -96.4405, NULL, NULL),
('260563794', 'SPA400076', 'SPA400076', 'TXDALSTD', 'Wyn D Nguyen MD', 'Wyn', 'D', 'Nguyen', 'MD', 'Colon and Rectal Surgery', 'General Surgery', '', NULL, 'B', 'PO Box 848907', 'Boston', 'Suffolk', 'MA', '02284', '9729189500', '9729189501', 'PO Box 848907', 'Boston', 'Suffolk', 'MA', '02284', '9729189500', '9729189501', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', 'Houston Methodist Hospital', NULL, NULL, 'HCFA|UB|', '1366440059', 0, 'Y', 0, '2013-11-11', NULL, NULL, 0, 0, NULL, NULL),
('462923863', 'SPA400087', 'SPA400087', 'TXDALSTD', 'Allergy Relief Clinics', 'Rafiquddin', '', 'Rahimi', 'MD', 'Allergy and Immunology', 'Internal Medicine', '', NULL, 'O', '3409 Spectrum Blvd Ste 300', 'Richardson', 'Dallas', 'TX', '75082', '9729071140', '9729071140', '3409 Spectrum Blvd Ste 300', 'Richardson', 'Dallas', 'TX', '75082', '9729071140', '9729071140', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1386713329', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.9973, -96.6623, NULL, NULL),
('462923863', 'SPA400086', 'SPA400086', 'TXDALSTD', 'Allergy Relief Clinics', 'Rafiquddin', '', 'Rahimi', 'MD', 'Allergy and Immunology', 'Internal Medicine', '', NULL, 'M', '4117 Tabernash', 'Richardson', 'Dallas', 'TX', '75082', '9723980051', '9723980059', '4117 Tabernash', 'Richardson', 'Dallas', 'TX', '75082', '9723980051', '9723980059', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1386713329', 0, 'Y', 0, '2013-11-11', NULL, NULL, 0, 0, NULL, NULL),
('462923863', 'SPA400085', 'SPA400085', 'TXDALSTD', 'Allergy Relief Clinics', 'Rafiquddin', '', 'Rahimi', 'MD', 'Allergy and Immunology', 'Internal Medicine', '', NULL, 'B', '7005 Chase Oaks Blvd', 'Plano', 'Collin', 'TX', '75025', '9723980051', '9723980059', '7005 Chase Oaks Blvd', 'Plano', 'Collin', 'TX', '75025', '9723980051', '9723980059', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1386713329', 0, 'Y', 0, '2013-11-11', NULL, NULL, 0, 0, NULL, NULL),
('751895233', 'SPA400101', 'SPA400101', 'TXDALSTD', 'Dr Bruce A Smith MD', 'Bruce', 'A', 'Smith', 'MD', 'General Surgery', '', '', NULL, 'O', '3600 Gaston Ave Ste 710', 'Dallas', 'Dallas', 'TX', '75246', '2148275820', '2148279208', '3600 Gaston Ave Ste 710', 'Dallas', 'Dallas', 'TX', '75246', '2148275820', '2148279208', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1396710224', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.7913, -96.7799, NULL, NULL),
('751739707', 'SPA400106', 'SPA400106', 'TXDALSTD', 'Texoma Neurology Associates', 'Bharathy', 'E', 'Sundaram', 'MD', 'Neurology', '', '', NULL, 'O', '2201 S Austin Ave', 'Denison', 'Grayson', 'TX', '75020', '9034634752', '9038935891', '2201 S Austin Ave', 'Denison', 'Grayson', 'TX', '75020', '9034634752', '9038935891', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1396743720', 0, 'N', 0, '2013-11-11', NULL, NULL, 33.7335, -96.5383, NULL, NULL),
('751739707', 'SPA400108', 'SPA400108', 'TXDALSTD', 'Texoma Neurology Associates', 'Bharathy', 'E', 'Sundaram', 'MD', 'Neurology', '', '', NULL, 'O', '321 N Highland Ste 200', 'Sherman', 'Grayson', 'TX', '75092', '9038935141', '9038935891', '321 N Highland Ste 200', 'Sherman', 'Grayson', 'TX', '75092', '9038935141', '9038935891', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1396743720', 0, 'N', 0, '2013-11-11', NULL, NULL, 33.6361, -96.623, NULL, NULL),
('752781692', 'SPA400092', 'SPA400092', 'TXDALSTD', 'Texas Dermatology Associates P A', 'Jessica', 'M', 'Saucier', 'MD', 'Dermatology', '', '', NULL, 'O', '13O5 W Jefferson Ste 115', 'Waxahachie', 'Ellis', 'TX', '75165', '9039231686', '9038728165', '13O5 W Jefferson Ste 115', 'Waxahachie', 'Ellis', 'TX', '75165', '9039231686', '9038728165', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1396935391', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.3865, -96.8483, NULL, NULL),
('752781692', 'SPA400093', 'SPA400093', 'TXDALSTD', 'Texas Dermatology Associates P A', 'Jessica', 'M', 'Saucier', 'MD', 'Dermatology', '', '', NULL, 'O', '3900 Junius St Ste 145', 'Dallas', 'Dallas', 'TX', '75246', '9723867546', '9727151460', '3900 Junius St Ste 145', 'Dallas', 'Dallas', 'TX', '75246', '9723867546', '9727151460', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1396935391', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.791, -96.7782, NULL, NULL),
('752781692', 'SPA400091', 'SPA400091', 'TXDALSTD', 'Texas Dermatology Associates P A', 'Jessica', 'M', 'Saucier', 'MD', 'Dermatology', '', '', NULL, 'B', 'PO Box 8596', 'Belfast', 'Waldo', 'ME', '04915', '9723867546', '9727151460', 'PO Box 8596', 'Belfast', 'Waldo', 'ME', '04915', '9723867546', '9727151460', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1396935391', 0, 'Y', 0, '2013-11-11', NULL, NULL, 0, 0, NULL, NULL),
('743140609', 'SPA400014', 'SPA400014', 'TXDALSTD', 'Meria G Aulds MD', 'Meria', 'G', 'Aulds', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1816 S FM 51 Ste 1200', 'Decatur', 'Wise', 'TX', '76234', '9406260052', '9406260082', '1816 S FM 51 Ste 1200', 'Decatur', 'Wise', 'TX', '76234', '9406260052', '9406260082', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, NULL, '', NULL, NULL, 'HCFA|UB|', '1427014539', 0, 'N', 0, '2013-11-11', NULL, NULL, 33.2139, -97.5982, NULL, NULL),
('751423564', 'SPA400097', 'SPA400097', 'TXDALSTD', 'David Shelmire MD', 'David', 'S', 'Shelmire', 'MD', 'Dermatology', '', '', NULL, 'O', '8226 Douglas Ave Ste 549', 'Dallas', 'Dallas', 'TX', '75225', '2147500504', '2147508896', '8226 Douglas Ave Ste 549', 'Dallas', 'Dallas', 'TX', '75225', '2147500504', '2147508896', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, '', NULL, 'HCFA|UB|', '1437262771', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.8629, -96.8086, NULL, NULL),
('161664951', 'SPA400025', 'SPA400025', 'TXDALSTD', 'Northern Texas Facial and Oral Surgery', 'Brandon', 'R', 'Brown', 'DDS', 'Oral/Maxillofacial Surgery', '', '', NULL, 'O', '1139 Keller Pkwy', 'Keller', 'Tarrant', 'TX', '76248', '8173791654', '8173791643', '1139 Keller Pkwy', 'Keller', 'Tarrant', 'TX', '76248', '8173791654', '8173791643', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Trophy Club', 'Baylor Regional Medical Center at Plano', NULL, NULL, 'HCFA|UB|', '1437291630', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.9344, -97.2254, NULL, NULL),
('161664951', 'SPA400026', 'SPA400026', 'TXDALSTD', 'Northern Texas Facial and Oral Surgery', 'Brandon', 'R', 'Brown', 'DDS', 'Oral/Maxillofacial Surgery', '', '', NULL, 'O', '1612 Lancaster Dr', 'Grapevine', 'Tarrant', 'TX', '76051', '8173294979', '8174884483', '1612 Lancaster Dr', 'Grapevine', 'Tarrant', 'TX', '76051', '8173294979', '8174884483', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Trophy Club', 'Baylor Regional Medical Center at Plano', NULL, NULL, 'HCFA|UB|', '1437291630', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.9337, -97.0915, NULL, NULL),
('453054917', 'SPA400095', 'SPA400095', 'TXDALSTD', 'Facial and Skin Surgery Center', 'Gilbert', 'T', 'Selkin', 'DMD MD', 'Oral/Maxillofacial Surgery', '', '', NULL, 'O', '4701 Medical Ctr Dr Ste 1B', 'McKinney', 'Collin', 'TX', '75069', '9729851920', '9729851176', '4701 Medical Ctr Dr Ste 1B', 'McKinney', 'Collin', 'TX', '75069', '9729851920', '9729851176', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', '', NULL, NULL, 'HCFA|UB|', '1447469762', 0, 'N', 0, '2013-11-11', NULL, NULL, 33.2125, -96.6184, NULL, NULL),
('453054917', 'SPA400096', 'SPA400096', 'TXDALSTD', 'Facial and Skin Surgery Center', 'Gilbert', 'T', 'Selkin', 'DMD MD', 'Oral/Maxillofacial Surgery', '', '', NULL, 'O', '5026 Tennyson Pkwy', 'Plano', 'Collin', 'TX', '75024', '9729851920', '9729851176', '5026 Tennyson Pkwy', 'Plano', 'Collin', 'TX', '75024', '9729851920', '9729851176', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', '', NULL, NULL, 'HCFA|UB|', '1447469762', 0, 'N', 0, '2013-11-11', NULL, NULL, 33.0646, -96.7977, NULL, NULL),
('752954588', 'SPA400075', 'SPA400075', 'TXDALSTD', 'RMD Medical Group', 'Ricardo', 'A', 'Murillo', 'MD', 'Internal Medicine', '', '', NULL, 'O', '3600 Gaston Ave Barnett Tower Ste 708', 'Dallas', 'Dallas', 'TX', '75246', '2148276200', '2148278480', '3600 Gaston Ave Barnett Tower Ste 708', 'Dallas', 'Dallas', 'TX', '75246', '2148276200', '2148278480', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1477566644', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.7913, -96.7799, NULL, NULL),
('752954588', 'SPA400074', 'SPA400074', 'TXDALSTD', 'RMD Medical Group', 'Ricardo', 'A', 'Murillo', 'MD', 'Internal Medicine', '', '', NULL, 'B', '8535 Ferndale Ste 4', 'Dallas', 'Dallas', 'TX', '75238', '2145031482', '2142616405', '8535 Ferndale Ste 4', 'Dallas', 'Dallas', 'TX', '75238', '2145031482', '2142616405', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1477566644', 0, 'Y', 0, '2013-11-11', NULL, NULL, 0, 0, NULL, NULL),
('752947630', 'SPA400079', 'SPA400079', 'TXDALSTD', 'Kid Care Pediatrics', 'Ijeoma', 'C', 'Nnamani', 'MD', 'Pediatrics', '', '', NULL, 'O', '23O N Rufe Snow', 'Keller', 'Tarrant', 'TX', '76248', '8173375503', '8173370110', '23O N Rufe Snow', 'Keller', 'Tarrant', 'TX', '76248', '8173375503', '8173370110', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, NULL, '', NULL, NULL, 'HCFA|UB|', '1487943239', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.937, -97.2293, NULL, NULL),
('752947630', 'SPA400080', 'SPA400080', 'TXDALSTD', 'Kid Care Pediatrics', 'Ijeoma', 'C', 'Nnamani', 'MD', 'Pediatrics', '', '', NULL, 'O', '6618 Fossil Bluff Dr Ste 116', 'Fort Worth', 'Tarrant', 'TX', '76137', '8178476420', '8178476412', '6618 Fossil Bluff Dr Ste 116', 'Fort Worth', 'Tarrant', 'TX', '76137', '8178476420', '8178476412', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, NULL, '', NULL, NULL, 'HCFA|UB|', '1487943239', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.8612, -97.3107, NULL, NULL),
('208799561', 'SPA400049', 'SPA400049', 'TXDALSTD', 'Catherine A Holt MD', 'Catherine', 'A', 'Holt', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '4461 Coit Rd Ste 211', 'Frisco', 'Collin', 'TX', '75035', '2142970000', '2142970001', '4461 Coit Rd Ste 211', 'Frisco', 'Collin', 'TX', '75035', '2142970000', '2142970001', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Frisco', NULL, NULL, NULL, 'HCFA|UB|', '1578672598', 0, 'N', 0, '2013-11-11', NULL, NULL, 33.1138, -96.7682, NULL, NULL),
('161664951', 'SPA400104', 'SPA400104', 'TXDALSTD', 'Northern Texas Facial and Oral Surgery', 'Dean', '', 'Spingola', 'DMD MD', 'Oral/Maxillofacial Surgery', '', '', NULL, 'O', '1612 Lancaster Dr', 'Grapevine', 'Tarrant', 'TX', '76051', '8173294979', '8174884483', '1612 Lancaster Dr', 'Grapevine', 'Tarrant', 'TX', '76051', '8173294979', '8174884483', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, NULL, NULL, 'HCFA|UB|', '1588615108', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.9337, -97.0915, NULL, NULL),
('161664951', 'SPA400105', 'SPA400105', 'TXDALSTD', 'Northern Texas Facial and Oral Surgery', 'Dean', '', 'Spingola', 'DMD MD', 'Oral/Maxillofacial Surgery', '', '', NULL, 'O', '440 W I Hwy 635 Plaza II Ste 445', 'Irving', 'Dallas', 'TX', '75063', '9724018301', '9724884483', '440 W I Hwy 635 Plaza II Ste 445', 'Irving', 'Dallas', 'TX', '75063', '9724018301', '9724884483', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, NULL, NULL, 'HCFA|UB|', '1588615108', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.9211, -96.985, NULL, NULL),
('205377681', 'SPA400072', 'SPA400072', 'TXDALSTD', 'Carlos Molina MD', 'Carlos', '', 'Molina', 'MD', 'Family Practice', '', '', NULL, 'O', '8 Medical Pkwy Plz 2 Ste 202', 'Dallas', 'Dallas', 'TX', '75234', '9726202626', '9726202527', '8 Medical Pkwy Plz 2 Ste 202', 'Dallas', 'Dallas', 'TX', '75234', '9726202626', '9726202527', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1629179338', 0, 'N', 0, '2014-04-02', NULL, NULL, 32.9221, -96.8839, NULL, NULL),
('201464324', 'SPA400119', 'SPA400119', 'TXDALSTD', 'Breast Diagnostics of North Texas', 'Priya', 'R', 'Venugopal', 'MD', 'Radiology', '', '', NULL, 'O', '2817 S Mayhill Rd Ste 270', 'Denton', 'Denton', 'TX', '76210', '9404839500', '9404839550', '2817 S Mayhill Rd Ste 270', 'Denton', 'Denton', 'TX', '76210', '9404839500', '9404839550', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-08-15', '2013-08-15', 0, 0, 0, NULL, 'Baylor All Saints Medical Center', NULL, NULL, 'HCFA|UB|', '1639159023', 0, 'Y', 0, '2013-11-11', NULL, NULL, 0, 0, NULL, NULL),
('201464324', 'SPA400120', 'SPA400120', 'TXDALSTD', 'Breast Diagnostics of North Texas', 'Priya', 'R', 'Venugopal', 'MD', 'Radiology', '', '', NULL, 'O', '300 Miron Dr', 'Southlake', 'Tarrant', 'TX', '76092', '8177492000', '8177492020', '300 Miron Dr', 'Southlake', 'Tarrant', 'TX', '76092', '8177492000', '8177492020', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-08-15', '2013-08-15', 0, 0, 0, NULL, 'Baylor All Saints Medical Center', NULL, NULL, 'HCFA|UB|', '1639159023', 0, 'Y', 0, '2013-11-11', NULL, NULL, 0, 0, NULL, NULL),
('201464324', 'SPA400118', 'SPA400118', 'TXDALSTD', 'Breast Diagnostics of North Texas', 'Priya', 'R', 'Venugopal', 'MD', 'Radiology', '', '', NULL, 'B', 'PO Box 92038', 'Southlake', 'Tarrant', 'TX', '76092', '8177492000', '8177492020', 'PO Box 92038', 'Southlake', 'Tarrant', 'TX', '76092', '8177492000', '8177492020', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-08-15', '2013-08-15', 0, 0, 0, NULL, 'Baylor All Saints Medical Center', NULL, NULL, 'HCFA|UB|', '1639159023', 0, 'Y', 0, '2013-11-11', NULL, NULL, 0, 0, NULL, NULL),
('752869959', 'SPA400128', 'SPA400128', 'TXDALSTD', 'Xuecheng Wang MD', 'Xuecheng', NULL, 'Wang', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 35761', 'Dallas', 'Dallas', 'TX', '75235', '9724811881', '9724811888', 'PO Box 35761', 'Dallas', 'Dallas', 'TX', '75235', '9724811881', '9724811888', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, NULL, NULL, '', NULL, 'HCFA|UB|', '1679531594', 0, 'Y', 0, '2013-11-11', NULL, NULL, 0, 0, NULL, NULL),
('751739707', 'SPA400107', 'SPA400107', 'TXDALSTD', 'Texoma Neurology Associates', 'Easwar', 'M', 'Sundaram', 'MD', 'Neurology', '', '', NULL, 'O', '2201 S Austin Ave', 'Denison', 'Grayson', 'TX', '75020', '9034634752', '9038935891', '2201 S Austin Ave', 'Denison', 'Grayson', 'TX', '75020', '9034634752', '9038935891', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1679571004', 0, 'N', 0, '2013-11-11', NULL, NULL, 33.7335, -96.5383, NULL, NULL),
('751739707', 'SPA400109', 'SPA400109', 'TXDALSTD', 'Texoma Neurology Associates', 'Easwar', 'M', 'Sundaram', 'MD', 'Neurology', '', '', NULL, 'O', '321 N Highland Ste 200', 'Sherman', 'Grayson', 'TX', '75092', '9038935141', '9038935891', '321 N Highland Ste 200', 'Sherman', 'Grayson', 'TX', '75092', '9038935141', '9038935891', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1679571004', 0, 'N', 0, '2013-11-11', NULL, NULL, 33.6361, -96.623, NULL, NULL),
('752018461', 'SPA400048', 'SPA400048', 'TXDALSTD', 'Clinical Pediatric Associates', 'J Patrick', '', 'Hieber', 'MD', 'Pediatrics', '', '', NULL, 'O', '8355 Walnut Hill Ln Ste 105', 'Dallas', 'Dallas', 'TX', '75231', '2143683659', '2147398923', '8355 Walnut Hill Ln Ste 105', 'Dallas', 'Dallas', 'TX', '75231', '2143683659', '2147398923', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, '', 'Baylor University Medical Center', '', '', 'HCFA|UB|', '1679640825', 0, 'N', 0, '2014-03-31', NULL, NULL, 32.8834, -96.7604, NULL, NULL),
('462485642', 'SPA400071', 'SPA400071', 'TXDALSTD', 'Excelmed', 'MonaLisa', 'M', 'Mitra', 'DO', 'Internal Medicine', '', '', NULL, 'O', '1650 W College St', 'Grapevine', 'Tarrant', 'TX', '76051', '2146418578', '8172831116', '1650 W College St', 'Grapevine', 'Tarrant', 'TX', '76051', '2146418578', '8172831116', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Grapevine', NULL, NULL, '', 'HCFA|UB|', '1710097456', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.9356, -97.0942, NULL, NULL),
('462485642', 'SPA400070', 'SPA400070', 'TXDALSTD', 'Excelmed', 'MonaLisa', 'M', 'Mitra', 'DO', 'Internal Medicine', '', '', NULL, 'B', '2805 Red Oak Ct', 'Colleyville', 'Tarrant', 'TX', '76034', '2146418578', '8172831116', '2805 Red Oak Ct', 'Colleyville', 'Tarrant', 'TX', '76034', '2146418578', '8172831116', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Grapevine', NULL, NULL, '', 'HCFA|UB|', '1710097456', 0, 'Y', 0, '2013-11-11', NULL, NULL, 0, 0, NULL, NULL),
('752564856', 'SPA400024', 'SPA400024', 'TXDALSTD', 'Texas Obstetrics and Gynecology Associates', 'George', 'B', 'Branning', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '5757 Warren Pkwy Ste 310', 'Frisco', 'Denton', 'TX', '75034', '2148242547', '2146188038', '5757 Warren Pkwy Ste 310', 'Frisco', 'Denton', 'TX', '75034', '2148242547', '2146188038', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Frisco', NULL, NULL, NULL, 'HCFA|UB|', '1720141146', 0, 'N', 0, '2013-11-11', NULL, NULL, 33.1067, -96.8387, NULL, NULL),
('752837463', 'SPA400009', 'SPA400009', 'TXDALSTD', 'Webb Royal Medical Group', 'Nauman', '', 'Anwar', 'MD', 'Internal Medicine', '', '', NULL, 'O', '2138 N Josey Ln Ste 102', 'Carrollton', 'Dallas', 'TX', '75038', '2143509334', '2143509338', '2138 N Josey Ln Ste 102', 'Carrollton', 'Dallas', 'TX', '75038', '2143509334', '2143509338', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Carrollton', NULL, NULL, NULL, 'HCFA|UB|', '1780697920', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.9725, -96.8898, NULL, NULL),
('752837463', 'SPA400010', 'SPA400010', 'TXDALSTD', 'Webb Royal Medical Group', 'Nauman', '', 'Anwar', 'MD', 'Internal Medicine', '', '', NULL, 'O', '4461 Coit Rd Ste 209', 'Frisco', 'Collin', 'TX', '75023', '2143877794', '2143877798', '4461 Coit Rd Ste 209', 'Frisco', 'Collin', 'TX', '75023', '2143877794', '2143877798', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Carrollton', NULL, NULL, NULL, 'HCFA|UB|', '1780697920', 0, 'N', 0, '2013-11-11', NULL, NULL, 33.1138, -96.7682, NULL, NULL),
('752837463', 'SPA400008', 'SPA400008', 'TXDALSTD', 'Webb Royal Medical Group', 'Nauman', '', 'Anwar', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 251268', 'Plano', 'Collin', 'TX', '75025', '2143509334', '2143509338', 'PO Box 251268', 'Plano', 'Collin', 'TX', '75025', '2143509334', '2143509338', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Carrollton', NULL, NULL, NULL, 'HCFA|UB|', '1780697920', 0, 'Y', 0, '2013-11-11', NULL, NULL, 0, 0, NULL, NULL),
('452957428', 'SPA400083', 'SPA400083', 'TXDALSTD', 'Texas Obstetrics and Gynecology Associates', 'Carrie', 'Kim', 'Patterson', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '5757 Warren Pkwy Ste 310', 'Frisco', 'Denton', 'TX', '75034', '2148242547', '2146188038', '5757 Warren Pkwy Ste 310', 'Frisco', 'Denton', 'TX', '75034', '2148242547', '2146188038', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Frisco', NULL, NULL, NULL, 'HCFA|UB|', '1831370055', 0, 'N', 0, '2013-11-11', NULL, NULL, 33.1067, -96.8387, NULL, NULL),
('752568567', 'SPA400040', 'SPA400040', 'TXDALSTD', 'Obstetrics and Gynecology Associates of Dallas', 'Ashwin', 'G', 'Gaitonde', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '3801 Gaston Ave Ste 200', 'Dallas', 'Dallas', 'TX', '75246', '2148239630', '2148213556', '3801 Gaston Ave Ste 200', 'Dallas', 'Dallas', 'TX', '75246', '2148239630', '2148213556', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1831395219', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.7919, -96.7792, NULL, NULL),
('751739707', 'SPA400064', 'SPA400064', 'TXDALSTD', 'Texoma Neurology Associates', 'Jose', 'A', 'Matus', 'MD', 'Neurology', '', '', NULL, 'O', '2201 S Austin Ave', 'Denison', 'Grayson', 'TX', '75020', '9034634752', '9038935891', '2201 S Austin Ave', 'Denison', 'Grayson', 'TX', '75020', '9034634752', '9038935891', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1841298270', 0, 'N', 0, '2013-11-11', NULL, NULL, 33.7335, -96.5383, NULL, NULL),
('751739707', 'SPA400065', 'SPA400065', 'TXDALSTD', 'Texoma Neurology Associates', 'Jose', 'A', 'Matus', 'MD', 'Neurology', '', '', NULL, 'O', '321 N Highland Ste 200', 'Sherman', 'Grayson', 'TX', '75092', '9038935141', '9038935891', '321 N Highland Ste 200', 'Sherman', 'Grayson', 'TX', '75092', '9038935141', '9038935891', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1841298270', 0, 'N', 0, '2013-11-11', NULL, NULL, 33.6361, -96.623, NULL, NULL),
('752729514', 'SPA400054', 'SPA400054', 'TXDALSTD', 'Najam Khan MD', 'Najam', 'H', 'Khan', 'MD', 'Internal Medicine', '', '', NULL, 'O', '4325 N Josey Ln Ste 301', 'Carrollton', 'Denton', 'TX', '75010', '9728201000', '9728208112', '4325 N Josey Ln Ste 301', 'Carrollton', 'Denton', 'TX', '75010', '9728201000', '9728208112', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Carrollton', NULL, NULL, NULL, 'HCFA|UB|', '1851315857', 0, 'N', 0, '2013-11-11', NULL, NULL, 33.0276, -96.8847, NULL, NULL),
('752729514', 'SPA400053', 'SPA400053', 'TXDALSTD', 'Najam Khan MD', 'Najam', 'H', 'Khan', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 116234', 'Carrollton', 'Dallas', 'TX', '75011', '9728201000', '9728208112', 'PO Box 116234', 'Carrollton', 'Dallas', 'TX', '75011', '9728201000', '9728208112', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Carrollton', NULL, NULL, NULL, 'HCFA|UB|', '1851315857', 0, 'Y', 0, '2013-11-11', NULL, NULL, 0, 0, NULL, NULL),
('030383721', 'SPA400039', 'SPA400039', 'TXDALSTD', 'Erik Furman MD', 'Erik', 'J', 'Furman', 'MD', 'Family Practice', '', '', NULL, 'O', '1910 W Henderson St Ste 100', 'Cleburne', 'Johnson', 'TX', '76033', '8175562559', '8175560035', '1910 W Henderson St Ste 100', 'Cleburne', 'Johnson', 'TX', '76033', '8175562559', '8175560035', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1861401168', 0, 'N', 0, '2014-04-01', NULL, NULL, 32.3312, -97.4316, NULL, NULL),
('752018461', 'SPA400094', 'SPA400094', 'TXDALSTD', 'Clinical Pediatric Associates', 'Roger', 'O', 'Schorlemer', 'MD', 'Pediatrics', '', '', NULL, 'O', '8355 Walnut Hill Ln Ste 105', 'Dallas', 'Dallas', 'TX', '75231', '2143683659', '2147398923', '8355 Walnut Hill Ln Ste 105', 'Dallas', 'Dallas', 'TX', '75231', '2143683659', '2147398923', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor University Medical Center', '', '', '', 'HCFA|UB|', '1861569584', 0, 'N', 0, '2014-03-31', NULL, NULL, 32.8834, -96.7604, NULL, NULL),
('342008023', 'SPA400115', 'SPA400115', 'TXDALSTD', 'Ulanoski Associates', 'Pamela', '', 'Ulanoski', 'MD', 'Pediatrics', '', '', NULL, 'O', '220 S Denton Tap Rd Ste 201', 'Coppell', 'Dallas', 'TX', '75019', '9723938181', '9723935151', '220 S Denton Tap Rd Ste 201', 'Coppell', 'Dallas', 'TX', '75019', '9723938181', '9723935151', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, NULL, '', NULL, NULL, 'HCFA|UB|', '1861586547', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.9645, -96.9935, NULL, NULL),
('752182475', 'SPA400058', 'SPA400058', 'TXDALSTD', 'Mark Leshin MD FACP', 'Mark', '', 'Leshin', 'MD', 'Endocrinology', 'Internal Medicine', '', NULL, 'O', '3600 Gaston Ave Ste 1160', 'Dallas', 'Dallas', 'TX', '75246', '2148281276', '2148280213', '3600 Gaston Ave Ste 1160', 'Dallas', 'Dallas', 'TX', '75246', '2148281276', '2148280213', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1871592485', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.7913, -96.7799, NULL, NULL),
('752568567', 'SPA400044', 'SPA400044', 'TXDALSTD', 'Obstetrics and Gynecology Associates of Dallas', 'Steven', 'A', 'Harris', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '3801 Gaston Ave Ste 200', 'Dallas', 'Dallas', 'TX', '75246', '2148239630', '2148213556', '3801 Gaston Ave Ste 200', 'Dallas', 'Dallas', 'TX', '75246', '2148239630', '2148213556', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1912985631', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.7919, -96.7792, NULL, NULL),
('752568567', 'SPA400045', 'SPA400045', 'TXDALSTD', 'Obstetrics and Gynecology Associates of Dallas', 'Steven', 'A', 'Harris', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '5575 Warren Pkwy Ste 204', 'Frisco', 'Denton', 'TX', '75034', '2148239630', NULL, '5575 Warren Pkwy Ste 204', 'Frisco', 'Denton', 'TX', '75034', '2148239630', '', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1912985631', 0, 'N', 0, '2013-11-11', NULL, NULL, 33.1067, -96.8401, NULL, NULL),
('752781692', 'SPA400082', 'SPA400082', 'TXDALSTD', 'Texas Dermatology Associates P A', 'John', 'C', 'OBrien', 'MD', 'General Surgery', '', '', NULL, 'O', '3900 Junius St Ste 145', 'Dallas', 'Dallas', 'TX', '75246', '9723867546', '9727151460', '3900 Junius St Ste 145', 'Dallas', 'Dallas', 'TX', '75246', '9723867546', '9727151460', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1952300022', 0, 'N', 0, '2013-08-05', NULL, NULL, 32.791, -96.7782, NULL, NULL),
('752781692', 'SPA400081', 'SPA400081', 'TXDALSTD', 'Texas Dermatology Associates P A', 'John', 'C', 'OBrien', 'MD', 'General Surgery', '', '', NULL, 'B', 'PO Box 8596', 'Belfast', 'Waldo', 'ME', '04915', '9723867546', '9727151460', 'PO Box 8596', 'Belfast', 'Waldo', 'ME', '04915', '9723867546', '9727151460', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1952300022', 0, 'Y', 0, '2013-08-05', NULL, NULL, 0, 0, NULL, NULL),
('300413731', 'SPA400066', 'SPA400066', 'TXDALSTD', 'Practical Pediatrics', 'Michael', 'W', 'McCoy', 'MD', 'Pediatrics', '', '', NULL, 'O', '811 Ira E Woods', 'Grapevine', 'Tarrant', 'TX', '76051', '8174813585', '8174216529', '811 Ira E Woods', 'Grapevine', 'Tarrant', 'TX', '76051', '8174813585', '8174216529', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Grapevine', NULL, NULL, NULL, 'HCFA|UB|', '1962518191', 0, 'N', 0, '2013-08-05', NULL, NULL, 32.9322, -97.0851, NULL, NULL),
('752393741', 'SPA400038', 'SPA400038', 'TXDALSTD', 'S Sam Finn MD', 'S Sam', '', 'Finn', 'MD', 'Neurosurgery', '', '', NULL, 'O', '3600 Gaston Ave Ste 856', 'Dallas', 'Dallas', 'TX', '75246', '2148232161', '2148231632', '3600 Gaston Ave Ste 856', 'Dallas', 'Dallas', 'TX', '75246', '2148232161', '2148231632', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Specialty Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1962598805', 0, 'N', 0, '2013-08-05', NULL, NULL, 32.7913, -96.7799, NULL, NULL),
('201312545', 'SPA400016', 'SPA400016', 'TXDALSTD', 'Allen Diagnostic Associates', 'Robert', 'M', 'Barnett', 'MD', 'Internal Medicine', '', '', NULL, 'O', '997 Raintree Cir Ste 130', 'Allen', 'Collin', 'TX', '75013', '9723907667', '9723901557', '997 Raintree Cir Ste 130', 'Allen', 'Collin', 'TX', '75013', '9723907667', '9723901557', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, '', NULL, 'HCFA|UB|', '1982750816', 0, 'N', 0, '2013-08-05', NULL, NULL, 33.1111, -96.6789, NULL, NULL),
('201312545', 'SPA400015', 'SPA400015', 'TXDALSTD', 'Allen Diagnostic Associates', 'Robert', 'M', 'Barnett', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 260553', 'Plano', 'Collin', 'TX', '75026', '8664232486', '9723599653', 'PO Box 260553', 'Plano', 'Collin', 'TX', '75026', '8664232486', '9723599653', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, '', NULL, 'HCFA|UB|', '1982750816', 0, 'Y', 0, '2013-08-05', NULL, NULL, 0, 0, NULL, NULL),
('752825783', 'SPA400001', 'SPA400001', 'TXDALSTD', 'Metroplex Foot and Ankle', 'Timothy', '', 'Abigail', 'DPM', 'Podiatry', '', '', NULL, 'O', '3201 E Pres George Bush Hwy Ste 106', 'Richardson', 'Dallas', 'TX', '75082', '2142173668', '2142173669', '3201 E Pres George Bush Hwy Ste 106', 'Richardson', 'Dallas', 'TX', '75082', '2142173668', '2142173669', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', NULL, NULL, NULL, 'HCFA|UB|', '1669409793', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.991, -96.6669, NULL, NULL),
('752825783', 'SPA400002', 'SPA400002', 'TXDALSTD', 'Metroplex Foot and Ankle', 'Timothy', '', 'Abigail', 'DPM', 'Podiatry', '', '', NULL, 'O', '633O Broadway Blvd Ste D2', 'Garland', 'Dallas', 'TX', '75043', '9722260774', '9722269727', '633O Broadway Blvd Ste D2', 'Garland', 'Dallas', 'TX', '75043', '9722260774', '9722269727', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', NULL, NULL, NULL, 'HCFA|UB|', '1669409793', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.8436, -96.5916, NULL, NULL),
('752825783', 'SPA400006', 'SPA400006', 'TXDALSTD', 'Metroplex Foot and Ankle', 'Robert', 'T', 'Angelier', 'DPM', 'Podiatry', '', '', NULL, 'O', '3201 E Pres George Bush Hwy Ste 106', 'Richardson', 'Dallas', 'TX', '75082', '2142173668', '2142173669', '3201 E Pres George Bush Hwy Ste 106', 'Richardson', 'Dallas', 'TX', '75082', '2142173668', '2142173669', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', 'Baylor University Medical Center', NULL, NULL, 'HCFA|UB|', '1720017205', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.991, -96.6669, NULL, NULL),
('752825783', 'SPA400007', 'SPA400007', 'TXDALSTD', 'Metroplex Foot and Ankle', 'Robert', 'T', 'Angelier', 'DPM', 'Podiatry', '', '', NULL, 'O', '633O Broadway Blvd Ste D2', 'Garland', 'Dallas', 'TX', '75043', '9722260774', '9722269727', '633O Broadway Blvd Ste D2', 'Garland', 'Dallas', 'TX', '75043', '9722260774', '9722269727', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', 'Baylor University Medical Center', NULL, NULL, 'HCFA|UB|', '1720017205', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.8436, -96.5916, NULL, NULL),
('752919329', 'SPA400022', 'SPA400022', 'TXDALSTD', 'Neurology Specialists of Dallas', 'Ziad', '', 'Blaik', 'MD', 'Neurology', '', '', NULL, 'O', '7515 Greenville Ave Ste 500', 'Dallas', 'Dallas', 'TX', '75231', '2143791100', '2143791101', '7515 Greenville Ave Ste 500', 'Dallas', 'Dallas', 'TX', '75231', '2143791100', '2143791101', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', NULL, NULL, NULL, 'HCFA|UB|', '1912013756', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.8839, -96.7591, NULL, NULL),
('752919329', 'SPA400023', 'SPA400023', 'TXDALSTD', 'Neurology Specialists of Dallas', 'Ziad', '', 'Blaik', 'MD', 'Neurology', '', '', NULL, 'O', '9101 N Central Expy Ste 450', 'Dallas', 'Dallas', 'TX', '75231', '2143791100', '2143791101', '9101 N Central Expy Ste 450', 'Dallas', 'Dallas', 'TX', '75231', '2143791100', '2143791101', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', NULL, NULL, NULL, 'HCFA|UB|', '1912013756', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.873, -96.7706, NULL, NULL),
('752825783', 'SPA400032', 'SPA400032', 'TXDALSTD', 'Metroplex Foot and Ankle', 'Bryan', '', 'De Yoe', 'DPM', 'Podiatry', '', '', NULL, 'O', '3201 E Pres George Bush Hwy Ste 106', 'Richardson', 'Dallas', 'TX', '75082', '2142173668', '2142173669', '3201 E Pres George Bush Hwy Ste 106', 'Richardson', 'Dallas', 'TX', '75082', '2142173668', '2142173669', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', 'Baylor University Medical Center', NULL, NULL, 'HCFA|UB|', '1780629709', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.991, -96.6669, NULL, NULL),
('752825783', 'SPA400033', 'SPA400033', 'TXDALSTD', 'Metroplex Foot and Ankle', 'Bryan', '', 'De Yoe', 'DPM', 'Podiatry', '', '', NULL, 'O', '633O Broadway Blvd Ste D2', 'Garland', 'Dallas', 'TX', '75043', '9722260774', '9722269727', '633O Broadway Blvd Ste D2', 'Garland', 'Dallas', 'TX', '75043', '9722260774', '9722269727', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', 'Baylor University Medical Center', NULL, NULL, 'HCFA|UB|', '1780629709', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.8436, -96.5916, NULL, NULL),
('752919329', 'SPA400036', 'SPA400036', 'TXDALSTD', 'Neurology Specialists of Dallas', 'Elmyra', 'V', 'Encarnacion', 'MD', 'Neurology', '', '', NULL, 'O', '9101 N Central Expy Ste 450', 'Dallas', 'Dallas', 'TX', '75231', '2143791100', '2143791101', '9101 N Central Expy Ste 450', 'Dallas', 'Dallas', 'TX', '75231', '2143791100', '2143791101', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1093762270', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.873, -96.7706, NULL, NULL),
('751766889', 'SPA400041', 'SPA400041', 'TXDALSTD', 'James H Gray', 'James', 'H', 'Gray', 'MD', 'Ophthalmology', '', '', NULL, 'O', '3600 Gaston Ave Ste 760', 'Dallas', 'Dallas', 'TX', '75246', '2148266110', '2148289127', '3600 Gaston Ave Ste 760', 'Dallas', 'Dallas', 'TX', '75246', '2148266110', '2148289127', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1720193329', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.7913, -96.7799, NULL, NULL),
('752919329', 'SPA400043', 'SPA400043', 'TXDALSTD', 'Neurology Specialists of Dallas', 'Anwarul', '', 'Haq', 'MD', 'Neurology', '', '', NULL, 'O', '9101 N Central Expy Ste 450', 'Dallas', 'Dallas', 'TX', '75231', '2143791100', '2143791101', '9101 N Central Expy Ste 450', 'Dallas', 'Dallas', 'TX', '75231', '2143791100', '2143791101', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', 'Baylor University Medical Center', NULL, NULL, 'HCFA|UB|', '1568480689', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.873, -96.7706, NULL, NULL),
('203721744', 'SPA400052', 'SPA400052', 'TXDALSTD', 'Kristen N Innes MD PA', 'Kristen', 'N', 'Innes', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '3880 Parkwood Blvd Bldg 4 Ste 403', 'Frisco', 'Denton', 'TX', '75034', '2146182802', '2146183208', '3880 Parkwood Blvd Bldg 4 Ste 403', 'Frisco', 'Denton', 'TX', '75034', '2146182802', '2146183208', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Frisco', NULL, NULL, NULL, 'HCFA|UB|', '1457327884', 0, 'N', 0, '2013-11-11', NULL, NULL, 33.112, -96.8158, NULL, NULL),
('752911073', 'SPA400060', 'SPA400060', 'TXDALSTD', 'Humberto Lopez MD', 'Humberto', '', 'Lopez', 'MD', 'Family Practice', '', '', NULL, 'O', '10 Medical Pkwy Plz 3 Ste 208', 'Farmers Branch', 'Dallas', 'TX', '75234', '9722439607', '9724883323', '10 Medical Pkwy Plz 3 Ste 208', 'Farmers Branch', 'Dallas', 'TX', '75234', '9722439607', '9724883323', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Carrollton', NULL, '', '', 'HCFA|UB|', '1598845885', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.9221, -96.8839, NULL, NULL),
('262478258', 'SPA400088', 'SPA400088', 'TXDALSTD', 'Hardeep Rai MD', 'Hardeep', 'S', 'Rai', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1913 Walnut Plaza', 'Carrollton', 'Dallas', 'TX', '75006', '9724165902', '9724182214', '1913 Walnut Plaza', 'Carrollton', 'Dallas', 'TX', '75006', '9724165902', '9724182214', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1043324098', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.9561, -96.8896, 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
('752919329', 'SPA400099', 'SPA400099', 'TXDALSTD', 'Neurology Specialists of Dallas', 'Nicole', '', 'Simpkins', 'MD', 'Neurology', '', '', NULL, 'O', '505 N Hwy 77 Ste 200', 'Waxahachie', 'Ellis', 'TX', '75165', '2143791100', '2143791101', '505 N Hwy 77 Ste 200', 'Waxahachie', 'Ellis', 'TX', '75165', '2143791100', '2143791101', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', NULL, NULL, NULL, 'HCFA|UB|', '1396940532', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.3965, -96.8453, NULL, NULL),
('752919329', 'SPA400100', 'SPA400100', 'TXDALSTD', 'Neurology Specialists of Dallas', 'Nicole', '', 'Simpkins', 'MD', 'Neurology', '', '', NULL, 'O', '9101 N Central Expy Ste 450', 'Dallas', 'Dallas', 'TX', '75231', '2143791100', '2143791101', '9101 N Central Expy Ste 450', 'Dallas', 'Dallas', 'TX', '75231', '2143791100', '2143791101', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', NULL, NULL, NULL, 'HCFA|UB|', '1396940532', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.873, -96.7706, NULL, NULL),
('752825783', 'SPA400102', 'SPA400102', 'TXDALSTD', 'Metroplex Foot and Ankle', 'Scott', 'E', 'Smith', 'DPM', 'Podiatry', '', '', NULL, 'O', '3600 Gaston Ave Wadley Tower Ste 1056', 'Dallas', 'Dallas', 'TX', '75246', '2148278864', '2142173669', '3600 Gaston Ave Wadley Tower Ste 1056', 'Dallas', 'Dallas', 'TX', '75246', '2148278864', '2142173669', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-08-15', '2013-08-22', 0, 0, 0, 'Baylor Medical Center at Garland', 'Baylor University Medical Center', NULL, NULL, 'HCFA|UB|', '1215161286', 0, 'N', 0, '2013-11-11', NULL, NULL, 0, 0, NULL, NULL),
('752825783', 'SPA400103', 'SPA400103', 'TXDALSTD', 'Metroplex Foot and Ankle', 'Scott', 'E', 'Smith', 'DPM', 'Podiatry', '', '', NULL, 'O', '633O Broadway Blvd Ste D2', 'Garland', 'Dallas', 'TX', '75043', '9722260774', '2142173669', '633O Broadway Blvd Ste D2', 'Garland', 'Dallas', 'TX', '75043', '9722260774', '2142173669', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', 'Baylor University Medical Center', NULL, NULL, 'HCFA|UB|', '1215161286', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.8436, -96.5916, NULL, NULL),
('752919329', 'SPA400116', 'SPA400116', 'TXDALSTD', 'Neurology Specialists of Dallas', 'Robert', 'F', 'Ulrich', 'MD', 'Neurology', '', '', NULL, 'O', '7515 Greenville Ave Ste 500', 'Dallas', 'Dallas', 'TX', '75231', '2143791100', '2143791101', '7515 Greenville Ave Ste 500', 'Dallas', 'Dallas', 'TX', '75231', '2143791100', '2143791101', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', NULL, NULL, NULL, 'HCFA|UB|', '1215982699', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.8839, -96.7591, NULL, NULL),
('752919329', 'SPA400117', 'SPA400117', 'TXDALSTD', 'Neurology Specialists of Dallas', 'Robert', 'F', 'Ulrich', 'MD', 'Neurology', '', '', NULL, 'O', '9101 N Central Expy Ste 450', 'Dallas', 'Dallas', 'TX', '75231', '2143791100', '2143791101', '9101 N Central Expy Ste 450', 'Dallas', 'Dallas', 'TX', '75231', '2143791100', '2143791101', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', NULL, NULL, NULL, 'HCFA|UB|', '1215982699', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.873, -96.7706, NULL, NULL),
('260553931', 'W12037042', 'W12037042', 'IDBOISTD', 'Saint Alphonsus Medical Group General Surgery MHP', 'Forrest', 'R', 'Fredline', 'DO', 'General Surgery', '', '', NULL, 'O', '3025 W Cherry Ln Ste A', 'Meridian', 'Ada', 'ID', '83642', '2084656940', '2084656949', '3025 W Cherry Ln Ste A', 'Meridian', 'Ada', 'ID', '83642', '2084656940', '2084656949', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2013-08-05', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, NULL, NULL, 'HCFA|UB|', '1245493840', 0, 'N', 0, '2013-08-21', NULL, NULL, 43.6193, -116.431, NULL, NULL),
('870639098', 'W12036296', 'W12036296', 'UT01', 'After Hours Urgent Care South Jordan', 'James', 'S', 'McIntyre', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 15161', 'Loves Park', 'Winnebago', 'IL', '61132', '8015010500', '8012560696', 'PO Box 15161', 'Loves Park', 'Winnebago', 'IL', '61132', '8015010500', '8012560696', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1043446602', 0, 'Y', 0, '2013-08-22', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'W12036135', 'W12036135', 'TXDALSTD', 'Health Texas Provider Network', 'Phuong', 'Denise', 'Dang', 'MD', 'Family Practice', '', '', NULL, 'O', '4897 Hwy 121 Ste 100', 'The Colony', 'Denton', 'TX', '75056', '4698004950', '4698004959', '4897 Hwy 121 Ste 100', 'The Colony', 'Denton', 'TX', '75056', '4698004950', '4698004959', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1265611685', 0, 'N', 0, '2013-07-31', NULL, NULL, 33.0684, -96.8843, NULL, NULL),
('752536818', 'W12036136', 'W12036136', 'TXDALSTD', 'Health Texas Provider Network', 'Carlos', '', 'Bazaldua', 'MD', 'Internal Medicine', '', '', NULL, 'O', '2020 W Hwy 114 Ste 120', 'Grapevine', 'Tarrant', 'TX', '76051', '8179128300', '8179128310', '2020 W Hwy 114 Ste 120', 'Grapevine', 'Tarrant', 'TX', '76051', '8179128300', '8179128310', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-07-15', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Grapevine', NULL, NULL, NULL, 'HCFA|UB|', '1487683744', 0, 'N', 0, '2013-07-31', NULL, NULL, 32.9362, -97.0975, NULL, NULL),
('752536818', 'W12036137', 'W12036137', 'TXDALSTD', 'Baylor Family Medical Center at Grapevine', 'Saira', '', 'Jamal', 'MD', 'Family Practice', '', '', NULL, 'O', '2020 W Hwy 114 Ste 120', 'Grapevine', 'Tarrant', 'TX', '76051', '8179128300', '8179128310', '2020 W Hwy 114 Ste 120', 'Grapevine', 'Tarrant', 'TX', '76051', '8179128300', '8179128310', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-07-15', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Grapevine', NULL, NULL, NULL, 'HCFA|UB|', '1760496004', 0, 'N', 0, '2013-07-31', NULL, NULL, 32.9362, -97.0975, NULL, NULL),
('752536818', 'W12036138', 'W12036138', 'TXDALSTD', 'Baylor Family Medical Center at Grapevine', 'Paul', '', 'Kim', 'MD', 'Family Practice', '', '', NULL, 'O', '2020 W Hwy 114 Ste 120', 'Grapevine', 'Tarrant', 'TX', '76051', '8179128300', '8179129310', '2020 W Hwy 114 Ste 120', 'Grapevine', 'Tarrant', 'TX', '76051', '8179128300', '8179129310', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-07-15', '2014-03-02', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1659524304', 0, 'N', 0, '2014-03-20', NULL, NULL, 32.9362, -97.0975, NULL, NULL),
('911947573', 'W12036139', 'W12036139', 'TXDALSTD', 'Surgical Oncology Specialists', 'Keith', 'M', 'Cavaness', 'DO', 'General Surgery', '', '', NULL, 'O', '310 E Highway 67', 'Duncanville', 'Dallas', 'TX', '75137', '2148202302', '2148202303', '310 E Highway 67', 'Duncanville', 'Dallas', 'TX', '75137', '2148202302', '2148202303', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-07-10', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', NULL, NULL, NULL, 'HCFA|UB|', '1679695068', 0, 'N', 0, '2013-07-31', NULL, NULL, 32.6287, -96.9038, NULL, NULL),
('911947573', 'W12036140', 'W12036140', 'TXDALSTD', 'Surgical Oncology Specialists', 'Scott', 'A', 'Celinski', 'MD', 'General Surgery', '', '', NULL, 'O', '310 E Highway 67', 'Duncanville', 'Dallas', 'TX', '75137', '2148202302', '2148202303', '310 E Highway 67', 'Duncanville', 'Dallas', 'TX', '75137', '2148202302', '2148202303', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-07-10', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', NULL, NULL, NULL, 'HCFA|UB|', '1982872453', 0, 'N', 0, '2013-07-31', NULL, NULL, 32.6287, -96.9038, NULL, NULL),
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('390816848', 'W12036225', 'W12036225', 'ILCHIGSTD', 'Mercy McHenry Medical Center', 'Sandra', 'N', 'Jackson', 'MD', 'Internal Medicine', '', '', NULL, 'O', '3922 Mercy Dr', 'Mchenry', 'Mchenry', 'IL', '60050', '8155782020', '8153444779', '3922 Mercy Dr', 'Mchenry', 'Mchenry', 'IL', '60050', '8155782020', '8153444779', 'CHIG9', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-04-28', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1063640563', 0, 'N', 0, '2013-08-01', NULL, NULL, 42.3167, -88.2738, NULL, NULL),
('390816848', 'W12036230', 'W12036230', 'ILCHIGSTD', 'Mercy Harvard Hospital', 'James', 'H', 'Sullivan', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '901 Grant St', 'Harvard', 'Mchenry', 'IL', '60033', '8159435431', '8159430659', '901 Grant St', 'Harvard', 'Mchenry', 'IL', '60033', '8159435431', '8159430659', 'CHIG9', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-07-20', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1891805081', 0, 'N', 0, '2013-08-01', NULL, NULL, 42.4257, -88.6078, NULL, NULL),
('752536818', 'W12036236', 'W12036236', 'TXDALSTD', 'Health Texas Provider Network', 'Christina', 'T', 'Doan', 'DO', 'Internal Medicine', '', '', NULL, 'B', 'Po Box 844128', 'San Antonio', 'Bexar', 'TX', '78284', '8663771650', '4694675905', 'Po Box 844128', 'San Antonio', 'Bexar', 'TX', '78284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Baylor Medical Center at Waxahachie', NULL, '', '', 'HCFA|UB|DEN|', '1447576087', 0, 'Y', 0, '2013-08-01', NULL, NULL, 0, 0, NULL, NULL),
('390816848', 'W12036232', 'W12036232', 'ILCHIGSTD', 'Mercy McHenry Medical Center', 'Craig', 'S', 'Michelsen', 'MD', 'Family Practice', '', '', NULL, 'O', '3922 Mercy Dr', 'Mchenry', 'Mchenry', 'IL', '60050', '8155782020', '8153444779', '3922 Mercy Dr', 'Mchenry', 'Mchenry', 'IL', '60050', '8155782020', '8153444779', 'CHIG9', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1922085083', 0, 'N', 0, '2013-08-01', NULL, NULL, 42.3167, -88.2738, NULL, NULL),
('390816848', 'W12036234', 'W12036234', 'ILCHIGSTD', 'Mercy McHenry Medical Center', 'John', 'E', 'Albanese', 'MD', 'Family Practice', '', '', NULL, 'O', '3922 Mercy Dr', 'Mchenry', 'Mchenry', 'IL', '60050', '8153444499', '8153444779', '3922 Mercy Dr', 'Mchenry', 'Mchenry', 'IL', '60050', '8153444499', '8153444779', 'CHIG9', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-06-03', '2013-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB', '1699860635', 0, 'N', 0, '2014-06-13', NULL, NULL, 42.3167, -88.2738, NULL, NULL),
('752536818', 'W12036235', 'W12036235', 'TXDALSTD', 'Health Texas Provider Network', 'Christina', 'T', 'Doan', 'DO', 'Internal Medicine', '', '', NULL, 'O', '1901 N Macarthur Blvd', 'Irving', 'Dallas', 'TX', '75061', '9725798484', '9725793972', '1901 N Macarthur Blvd', 'Irving', 'Dallas', 'TX', '75061', '9725798484', '9725793972', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Baylor Medical Center at Waxahachie', NULL, '', '', 'HCFA|UB|DEN|', '1447576087', 0, 'N', 0, '2013-08-01', NULL, NULL, 32.8341, -96.9592, 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
('752536818', 'W12036237', 'W12036237', 'TXDALSTD', 'Health Texas Provider Network', 'Christina', 'T', 'Doan', 'DO', 'Internal Medicine', '', '', NULL, 'O', '1405 W Jefferson St', 'Waxahachie', 'Ellis', 'TX', '75165', '9729237144', '9729237145', '1405 W Jefferson St', 'Waxahachie', 'Ellis', 'TX', '75165', '9729237144', '9729237145', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Baylor Medical Center at Waxahachie', NULL, '', '', 'HCFA|UB|DEN|', '1447576087', 0, 'N', 0, '2013-08-01', NULL, NULL, 32.3968, -96.865, NULL, NULL),
('752536818', 'W12036238', 'W12036238', 'TXDALSTD', 'Health Texas Provider Network', 'Christina', 'T', 'Doan', 'DO', 'Internal Medicine', '', '', NULL, 'B', 'Po Box 842001', 'Dallas', 'Dallas', 'TX', '75284', '9729237144', '9729237145', 'Po Box 842001', 'Dallas', 'Dallas', 'TX', '75284', '9729237144', '9729237145', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Baylor Medical Center at Waxahachie', NULL, '', '', 'HCFA|UB|DEN|', '1447576087', 0, 'Y', 0, '2013-08-01', NULL, NULL, 0, 0, NULL, NULL),
('390816848', 'W12036241', 'W12036241', 'ILCHIGSTD', 'Mercy Harvard Hospital', 'Myroslav', '', 'Harasym', 'MD', 'Anesthesiology', '', '', NULL, 'O', '901 Grant St', 'Harvard', 'Mchenry', 'IL', '60033', '8159435431', '8159430659', '901 Grant St', 'Harvard', 'Mchenry', 'IL', '60033', '8159435431', '8159430659', 'CHIG9', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-06-24', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1215101704', 0, 'N', 0, '2013-08-01', NULL, NULL, 42.4257, -88.6078, NULL, NULL),
('752536818', 'W12036245', 'W12036245', 'TXDALSTD', 'Health Texas Provider Network', 'Betsy', 'A', 'George', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1305 W Jefferson Ste 100', 'Dallas', 'Dallas', 'TX', '78165', '9729237292', '9729238089', '1305 W Jefferson Ste 100', 'Dallas', 'Dallas', 'TX', '78165', '9729237292', '9729238089', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, '', '', 'HCFA|UB|DEN|', '1679644371', 0, 'N', 0, '2013-08-01', NULL, NULL, 32.7439, -96.8429, NULL, NULL),
('390816848', 'W12036243', 'W12036243', 'ILCHIGSTD', 'Mercy Woodstock Medical Center', 'Kelly', 'M', 'Winkelman', 'APNP', 'Gastroenterology', '', '', NULL, 'O', '2000 Lake Ave', 'Woodstock', 'Mchenry', 'IL', '60098', '8153377100', '8153374793', '2000 Lake Ave', 'Woodstock', 'Mchenry', 'IL', '60098', '8153377100', '8153374793', 'CHIG9', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-07-22', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1649523838', 0, 'N', 0, '2013-08-01', NULL, NULL, 42.2896, -88.422, NULL, NULL),
('752536818', 'W12036244', 'W12036244', 'TXDALSTD', 'Health Texas Provider Network', 'Betsy', 'A', 'George', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '621 N Hall St Ste 400', 'Dallas', 'Dallas', 'TX', '75226', '2148248721', '2142376529', '621 N Hall St Ste 400', 'Dallas', 'Dallas', 'TX', '75226', '2148248721', '2142376529', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, '', '', 'HCFA|UB|DEN|', '1679644371', 0, 'N', 0, '2013-08-01', NULL, NULL, 32.7879, -96.7802, NULL, NULL),
('752536818', 'W12036247', 'W12036247', 'TXDALSTD', 'Health Texas Provider Network', 'Betsy', 'A', 'George', 'MD', 'Cardiovascular Disease', '', '', NULL, 'B', 'Po Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'Po Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, '', '', 'HCFA|UB|DEN|', '1679644371', 0, 'Y', 0, '2013-08-01', NULL, NULL, 0, 0, NULL, NULL),
('390816848', 'W12036248', 'W12036248', 'ILCHIGSTD', 'Mercy Harvard Hospital', 'Rajesh', '', 'Balagani', 'DO', 'Pulmonary', 'Sleep Medicine', '', NULL, 'O', '901 Grant St', 'Harvard', 'Mchenry', 'IL', '60033', '8159430659', '8159430659', '901 Grant St', 'Harvard', 'Mchenry', 'IL', '60033', '8159430659', '8159430659', 'CHIG9', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-07-22', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1477754927', 0, 'N', 0, '2013-08-01', NULL, NULL, 42.4257, -88.6078, NULL, NULL),
('331177233', 'W12036252', 'W12036252', 'UT01', 'Ogden Internal Medicine and Urology', 'Fawad', '', 'Tanvir', 'MD', 'Infectious Disease', '', '', NULL, 'B', 'PO Box 100925', 'Atlanta', 'Fulton', 'GA', '30384', '8014767500', '8014750960', 'PO Box 100925', 'Atlanta', 'Fulton', 'GA', '30384', '8014767500', '8014750960', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-11-15', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1164425294', 0, 'N', 0, '2013-11-13', NULL, NULL, 0, 0, NULL, NULL),
('331177233', 'W12036251', 'W12036251', 'UT01', 'Ogden Internal Medicine and Urology', 'Fawad', '', 'Tanvir', 'MD', 'Infectious Disease', '', '', NULL, 'O', '5405 S 500 E Ste 100', 'Ogden', 'Weber', 'UT', '84405', '8014767500', '8014750960', '5405 S 500 E Ste 100', 'Ogden', 'Weber', 'UT', '84405', '8014767500', '8014750960', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-11-15', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1164425294', 0, 'N', 0, '2013-11-13', NULL, NULL, 41.1655, -111.969, NULL, NULL),
('911947573', 'W12036249', 'W12036249', 'TXDALSTD', 'Health Texas Provider Network', 'Gary', 'P', 'Graham', 'MD', 'General Surgery', '', '', NULL, 'O', '1305 W Jefferson Ste 120', 'Waxahachie', 'Ellis', 'TX', '75165', '9729231457', '9729231304', '1305 W Jefferson Ste 120', 'Waxahachie', 'Ellis', 'TX', '75165', '9729231457', '9729231304', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Baylor Medical Center at Waxahachie', NULL, '', '', 'HCFA|UB|DEN|', '1356508287', 0, 'N', 0, '2013-08-01', NULL, NULL, 32.3961, -96.8638, NULL, NULL),
('911947573', 'W12036253', 'W12036253', 'TXDALSTD', 'Health Texas Provider Network', 'Gary', 'P', 'Graham', 'MD', 'General Surgery', '', '', NULL, 'B', 'Po Box 842001', 'Dallas', 'Dallas', 'TX', '75284', '9729230620', '9729380528', 'Po Box 842001', 'Dallas', 'Dallas', 'TX', '75284', '9729230620', '9729380528', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Baylor Medical Center at Waxahachie', NULL, '', '', 'HCFA|UB|DEN|', '1356508287', 0, 'Y', 0, '2013-08-01', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'W12036254', 'W12036254', 'TXDALSTD', 'Health Texas Provider Network', 'Katherine', 'B', 'Harrington', 'MD', 'Thoracic Surgery', '', '', NULL, 'O', '4716 Alliance Blvd Pav Ii Se 310', 'Plano', 'Collin', 'TX', '75093', '4698006200', '4698006210', '4716 Alliance Blvd Pav Ii Se 310', 'Plano', 'Collin', 'TX', '75093', '4698006200', '4698006210', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, '', '', 'HCFA|UB|DEN|', '1538349360', 0, 'N', 0, '2013-09-17', NULL, NULL, 33.0145, -96.7926, NULL, NULL),
('752536818', 'W12036255', 'W12036255', 'TXDALSTD', 'Health Texas Provider Network', 'Katherine', 'B', 'Harrington', 'MD', 'Thoracic Surgery', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, '', '', 'HCFA|UB|DEN|', '1538349360', 0, 'Y', 0, '2013-09-17', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'W12036257', 'W12036257', 'TXDALSTD', 'Health Texas Provider Network', 'Kelly', 'A', 'Hutcheson', 'MD', 'Thoracic Surgery', '', '', NULL, 'B', 'Po Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'Po Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, '', '', 'HCFA|UB|DEN|', '1518162650', 0, 'Y', 0, '2013-08-01', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'W12036256', 'W12036256', 'TXDALSTD', 'Health Texas Provider Network', 'Kelly', 'A', 'Hutcheson', 'MD', 'Thoracic Surgery', '', '', NULL, 'O', '4716 Alliance Blvd Pav Ii Ste 310', 'Plano', 'Collin', 'TX', '75093', '4698006200', '4698006210', '4716 Alliance Blvd Pav Ii Ste 310', 'Plano', 'Collin', 'TX', '75093', '4698006200', '4698006210', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, '', '', 'HCFA|UB|DEN|', '1518162650', 0, 'N', 0, '2013-08-01', NULL, NULL, 33.0145, -96.7926, NULL, NULL),
('870281028', 'W12036258', 'W12036258', 'UT01', 'Central Utah Clinic', 'M', 'S', 'Nizam', 'MD', 'Endocrinology', 'Internal Medicine', '', NULL, 'O', '910 E 100 N Ste 105', 'Payson', 'Utah', 'UT', '84651', '8014298008', '8014180928', '910 E 100 N Ste 105', 'Payson', 'Utah', 'UT', '84651', '8014298008', '8014180928', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-07-30', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1326203514', 0, 'N', 0, '2013-08-01', NULL, NULL, 40.0445, -111.717, NULL, NULL),
('364130066', 'W12036259', 'W12036259', 'ILCHIGSTD', 'Advanced Foot and Ankle Center', 'Julia', 'M', 'Sinclair', 'DPM', 'Podiatry', '', '', NULL, 'O', '30 S Michigan Ave Ste 302', 'Chicago', 'Cook', 'IL', '60603', '3123723117', '3123723871', '30 S Michigan Ave Ste 302', 'Chicago', 'Cook', 'IL', '60603', '3123723117', '3123723871', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-08-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, '', '', 'HCFA|UB|', '1336419241', 0, 'N', 0, '2013-08-01', NULL, NULL, 41.8817, -87.6245, NULL, NULL),
('363383867', 'W12036261', 'W12036261', 'ILCHIGSTD', 'Little Company of Mary Affiliated Services', 'Kimberly', '', 'Johnson', 'MD', 'Family Practice', '', '', NULL, 'O', '736 W 95th St', 'Chicago', 'Cook', 'IL', '60628', '7734879500', '7734870900', '736 W 95th St', 'Chicago', 'Cook', 'IL', '60628', '7734879500', '7734870900', 'CHIG8', 'CHIHCPCS01', '', '0.00', '40.00', '0.00', 3, '2013-08-05', NULL, 0, 0, 0, 'Little Company of Mary Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1346407319', 0, 'N', 0, '2013-08-01', NULL, NULL, 41.7215, -87.6421, NULL, NULL),
('363383867', 'W12036262', 'W12036262', 'ILCHIGSTD', 'Little Company of Mary Affiliated Services', 'Kimberly', '', 'Johnson', 'MD', 'Family Practice', '', '', NULL, 'B', '2800 W 87th St', 'Chicago', 'Cook', 'IL', '60652', '7738637550', '7738637542', '2800 W 87th St', 'Chicago', 'Cook', 'IL', '60652', '7738637550', '7738637542', 'CHIG8', 'CHIHCPCS01', '', '0.00', '40.00', '0.00', 3, '2013-08-05', NULL, 0, 0, 0, 'Little Company of Mary Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1346407319', 0, 'N', 0, '2013-08-01', NULL, NULL, 0, 0, NULL, NULL),
('363383867', 'W12036264', 'W12036264', 'ILCHIGSTD', 'Little Company of Mary Affiliated Services', 'Ginny', '', 'Hendricks', 'MD', 'Family Practice', '', '', NULL, 'B', '2800 W 87th St', 'Chicago', 'Cook', 'IL', '60652', '7738637550', '7738637542', '2800 W 87th St', 'Chicago', 'Cook', 'IL', '60652', '7738637550', '7738637542', 'CHIG8', 'CHIHCPCS01', '', '0.00', '40.00', '0.00', 3, '2013-08-12', NULL, 0, 0, 0, 'Little Company of Mary Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1487883831', 0, 'N', 0, '2013-08-01', NULL, NULL, 0, 0, NULL, NULL),
('363383867', 'W12036265', 'W12036265', 'ILCHIGSTD', 'Little Company of Mary Affiliated Services', 'Ginny', '', 'Hendricks', 'MD', 'Family Practice', '', '', NULL, 'O', '2850 W 95th St Ste 101', 'Evergreen Park', 'Cook', 'IL', '60805', '7086369205', '7084225505', '2850 W 95th St Ste 101', 'Evergreen Park', 'Cook', 'IL', '60805', '7086369205', '7084225505', 'CHIG8', 'CHIHCPCS01', '', '0.00', '40.00', '0.00', 3, '2013-08-12', NULL, 0, 0, 0, 'Little Company of Mary Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1487883831', 0, 'N', 0, '2013-08-01', NULL, NULL, 41.7209, -87.6938, NULL, NULL),
('752536818', 'W12036268', 'W12036268', 'TXDALSTD', 'Health Texas Provider Network', 'Soma', 'B', 'Johari', 'MD', 'Family Practice', '', '', NULL, 'B', 'Po Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'Po Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', NULL, '', '', 'HCFA|UB|DEN|', '1902866163', 0, 'Y', 0, '2013-08-01', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'W12036266', 'W12036266', 'TXDALSTD', 'Health Texas Provider Network', 'Soma', 'B', 'Johari', 'MD', 'Family Practice', '', '', NULL, 'O', '5345 N George Bush Frwy', 'Garland', 'Dallas', 'TX', '75040', '9724955888', '9724950588', '5345 N George Bush Frwy', 'Garland', 'Dallas', 'TX', '75040', '9724955888', '9724950588', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', NULL, '', '', 'HCFA|UB|DEN|', '1902866163', 0, 'N', 0, '2013-08-01', NULL, NULL, 32.9651, -96.6418, NULL, NULL),
('364130066', 'W12036270', 'W12036270', 'ILCHIGSTD', 'Premier Foot and Ankle Center', 'Amy', 'M', 'McPherson', 'DPM', 'Podiatry', '', '', NULL, 'O', '1 S 067 Summit Ave', 'Villa Park', 'Dupage', 'IL', '60181', '6302619500', '6302619504', '1 S 067 Summit Ave', 'Villa Park', 'Dupage', 'IL', '60181', '6302619500', '6302619504', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1538471867', 0, 'N', 0, '2013-08-01', NULL, NULL, 41.8577, -87.9728, NULL, NULL),
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('752600832', 'W12036281', 'W12036281', 'TXDALSTD', 'Health Texas Provider Network', 'Deidra', '', 'Johnson', 'MS', 'Diabetic Education', '', '', NULL, 'O', '3434 Swiss Ave Ste 410', 'Dallas', 'Dallas', 'TX', '75204', '2148285010', '2148285011', '3434 Swiss Ave Ste 410', 'Dallas', 'Dallas', 'TX', '75204', '2148285010', '2148285011', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|DEN|', '1699017871', 0, 'N', 0, '2013-08-01', NULL, NULL, 32.7915, -96.7824, NULL, NULL),
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('201435671', 'W12036293', 'W12036293', 'TXHOUSTD', 'Diabetes America', 'Augustus', 'A', 'Policarpio', 'MD', 'Endocrinology', '', '', NULL, 'O', '1545 S Mason Rd', 'Katy', 'Harris', 'TX', '77450', '7138405150', '0000000000', '1545 S Mason Rd', 'Katy', 'Harris', 'TX', '77450', '7138405150', '0000000000', 'HOUSTON4', 'TXHCPC13', '', '0.00', '40.00', '0.00', 3, '2013-09-09', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1356671515', 0, 'N', 0, '2013-08-01', NULL, NULL, 29.7595, -95.7514, NULL, NULL),
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('204043287', 'W12036307', 'W12036307', 'NM01', 'ABQ Health Partners', '', '', 'ABQ Health Partners', '', 'Family Practice', '', '', NULL, 'O', '5150 Journal Center Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87109', '0000000000', '0000000000', '5150 Journal Center Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87109', '0000000000', '0000000000', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '0000009773', 0, 'Y', 0, '2014-06-19', NULL, NULL, 35.1702, -106.586, NULL, NULL),
('204043287', 'W12036306', 'W12036306', 'NM01', 'ABQ Health Partners', '', '', 'ABQ Health Partners', '', 'Family Practice', '', '', NULL, 'B', 'PO Box 27829', 'Albuquerque', 'Bernalillo', 'NM', '87125', '0000000000', '0000000000', 'PO Box 27829', 'Albuquerque', 'Bernalillo', 'NM', '87125', '0000000000', '0000000000', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '0000009773', 0, 'Y', 0, '2014-06-19', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'W12036309', 'W12036309', 'TXDALSTD', 'Health Texas Provider Network', 'Christopher', 'L', 'White', 'MD', 'Physical Medicine and Rehabilitation', '', '', NULL, 'O', '2990 Legacy Dr', 'Frisco', 'Denton', 'TX', '75034', '4698885200', '4698885222', '2990 Legacy Dr', 'Frisco', 'Denton', 'TX', '75034', '4698885200', '4698885222', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1992948640', 0, 'N', 0, '2013-08-02', NULL, NULL, 33.104, -96.8414, NULL, NULL),
('752536818', 'W12036310', 'W12036310', 'TXDALSTD', 'Health Texas Provider Network', 'Christopher', 'L', 'White', 'MD', 'Physical Medicine and Rehabilitation', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '4698885200', '4698885222', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '4698885200', '4698885222', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1992948640', 0, 'N', 0, '2013-08-02', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W12036311', 'W12036311', 'UT01', 'Rocky Mountain Womens Health Center at West Valley Campus', 'Theresa (Tina)', 'M', 'Fought', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '3336 S 4155 W Ste 301', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019643865', '0000000000', '3336 S 4155 W Ste 301', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019643865', '0000000000', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-07-01', '2014-04-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1942390547', 0, 'N', 0, '2013-10-18', NULL, NULL, 40.6991, -111.99, NULL, NULL),
('752536818', 'W12036312', 'W12036312', 'TXDALSTD', 'Health Texas Provider Network', 'Seema', 'R', 'Sikka', 'MD', 'Physical Medicine and Rehabilitation', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, '', '', 'HCFA|UB', '1740414226', 0, 'N', 0, '2013-08-02', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'W12036313', 'W12036313', 'TXDALSTD', 'Health Texas Provider Network', 'Seema', 'R', 'Sikka', 'MD', 'Physical Medicine and Rehabilitation', '', '', NULL, 'O', '909 N Washington', 'Dallas', 'Dallas', 'TX', '75246', '2148209593', '9724808356', '909 N Washington', 'Dallas', 'Dallas', 'TX', '75246', '2148209593', '9724808356', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, '', '', 'HCFA|UB', '1740414226', 0, 'N', 0, '2013-08-02', NULL, NULL, 32.7918, -96.7791, NULL, NULL),
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('911947573', 'W12036317', 'W12036317', 'TXDALSTD', 'Health Texas Provider Network', 'Anh', '', 'Nguyen', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 842001', 'Dallas', 'Dallas', 'TX', '75284', '2148203000', '2148203022', 'PO Box 842001', 'Dallas', 'Dallas', 'TX', '75284', '2148203000', '2148203022', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, '', '', 'HCFA|UB|', '1265759823', 0, 'N', 0, '2013-08-02', NULL, NULL, 0, 0, NULL, NULL),
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('197328116', 'SPA500010', 'SPA500010', 'TXDALSTD', 'Womens Integrated Healthcare PA', 'Katrina', 'E', 'Allen', 'MD', 'Radiation Oncology', '', '', NULL, 'O', '12606 Greenville Ave Ste 160', 'Dallas', 'Dallas', 'TX', '75243', '4693647880', NULL, '12606 Greenville Ave Ste 160', 'Dallas', 'Dallas', 'TX', '75243', '4693647880', '', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-12-05', NULL, 0, 0, 0, '', 'Baylor Medical Center at Garland', '', '', 'HCFA|UB|', '1700849163', 0, 'N', 0, '2014-04-16', NULL, NULL, 32.9187, -96.7424, NULL, NULL),
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('752402478', 'SPA500007', 'SPA500007', 'TXDALSTD', 'Christian Sanchez MD', 'Christian', '', 'Sanchez', 'MD', 'Urology', '', '', NULL, 'O', '5300 W Plano Pkwy Ste 200', 'Plano', 'Collin', 'TX', '75093', '9726128037', '9726124414', '5300 W Plano Pkwy Ste 200', 'Plano', 'Collin', 'TX', '75093', '9726128037', '9726124414', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', '', '', '', 'HCFA|UB|', '1346204492', 0, 'N', 0, '2014-04-25', NULL, NULL, 32.9165, -96.742, NULL, NULL),
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('272486219', 'SPA500027', 'SPA500027', 'TXDALSTD', 'Park Cities Pediatrics', 'Matthew', 'L', 'Simon', 'MD', 'Pediatrics', '', '', NULL, 'O', '8215 Westchester Ste 111', 'Dallas', 'Dallas', 'TX', '75225', '2143617185', '2143734841', '9101 LBJ Fwy Ste 710', 'Dallas', 'Dallas', 'TX', '75243', '9727925727', '2145752245', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, NULL, '', NULL, NULL, 'HCFA|UB|', '1407809254', 0, 'N', 0, '2014-04-02', NULL, NULL, 32.8624, -96.8066, NULL, NULL),
('461202759', 'SPA500018', 'SPA500018', 'TXDALSTD', '', 'Jim', 'P', 'Hussey', 'DO', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 543154', 'Grand Prairie', 'Dallas', 'TX', '75054', '4694433300', NULL, 'PO Box 543154', 'Grand Prairie', 'Dallas', 'TX', '75054', '4694433300', '', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-12-05', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1720225816', 0, 'Y', 0, '2013-11-11', NULL, NULL, 32.9754, -96.7253, NULL, NULL),
('263667940', 'SPA500030', 'SPA500030', 'TXDALSTD', 'Jim Hussey DO PA', 'Jim', 'P', 'Hussey', 'DO', 'Nephrology', '', '', NULL, 'B', 'PO Box 864049', 'Plano', 'Collin', 'TX', '75086', '9726120010', NULL, 'PO Box 864049', 'Plano', 'Collin', 'TX', '75086', '9726120010', '', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-12-05', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, NULL, NULL, 'HCFA|UB|', '1417915844', 0, 'Y', 0, '2013-11-11', NULL, NULL, 0, 0, NULL, NULL),
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('800814807', 'SPA500032', 'SPA500032', 'TXDALSTD', 'Retina Specialists', 'Santosh', 'C', 'Patel', 'MD', 'Ophthalmology', '', '', NULL, 'B', 'PO Box 730990', 'Dallas', 'Dallas', 'TX', '75373', '9725999098', '9725991489', 'PO Box 674151', 'Dallas', 'Dallas', 'TX', '75267', '9728844400', '9725914605', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-05', '2014-01-31', 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, NULL, NULL, 'HCFA|UB|', '1396906673', 0, 'Y', 0, '2014-01-27', NULL, NULL, 0, 0, NULL, NULL),
('197328116', 'SPA500012', 'SPA500012', 'TXDALSTD', 'Womens Integrated Healthcare PA', 'Barbara', 'A', 'Coulter Smith', 'DO', 'Obstetrics and Gynecology', '', '', NULL, 'O', '6957 W Plano Pkwy Ste 1300', 'Plano', 'Collin', 'TX', '75093', '4693647888', NULL, '6957 W Plano Pkwy Ste 1300', 'Plano', 'Collin', 'TX', '75093', '4693647888', '', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-12-05', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Grapevine', NULL, NULL, NULL, 'HCFA|UB|', '1700849163', 0, 'N', 0, '2014-04-16', NULL, NULL, 32.9333, -97.0916, NULL, NULL),
('263905031', 'SPA500046', 'SPA500046', 'TXDALSTD', 'Womens Integrated Healthcare PA', 'Barbara', 'A', 'Coulter Smith', 'DO', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1664 Sylvan Ave', 'Dallas', 'Dallas', 'TX', '75208', '9726448577', '2149428625', '1664 Sylvan Ave', 'Dallas', 'Dallas', 'TX', '75208', '9726448577', '2149428625', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-12-05', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Grapevine', NULL, NULL, NULL, 'HCFA|UB|', '1619948213', 0, 'Y', 0, '2014-04-01', NULL, NULL, 32.9342, -97.2358, 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
('208369279', 'SPA500014', 'SPA500014', 'TXDALSTD', 'Womens Integrated Healthcare PA', 'Monica', 'E', 'Lopez', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1625 Lancaster Dr', 'Grapevine', 'Tarrant', 'TX', '76051', '8174162229', '8174163667', '8245 Precinct Line Rd Ste 100', 'N Richland Hills', 'Tarrant', 'TX', '76182', '8175038800', '8175038801', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-12-05', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', NULL, '', '', 'HCFA|UB|', '1467525808', 0, 'N', 0, '2013-11-12', NULL, NULL, 32.9333, -97.0916, NULL, NULL),
('752924037', 'SPA500048', 'SPA500048', 'TXDALSTD', 'Sanjay Btel MD', 'Sanjay', '', 'Patel', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1120 W Campbell Rd Ste 109', 'Richardson', 'Dallas', 'TX', '75080', '2145752663', '2145752664', '816 Keller Pkwy', 'Keller', 'Dallas', 'TX', '75248', '8174162229', '8174163667', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Medical Center at McKinney', NULL, NULL, NULL, 'HCFA|UB|', '1508081316', 0, 'Y', 0, '2013-11-11', NULL, NULL, 32.9783, -96.7585, NULL, NULL),
('461253869', 'SPA500038', 'SPA500038', 'TXDALSTD', 'North Dallas Urology Associates PA', 'Mark', '', 'Allen', 'MD', 'Urology', '', '', NULL, 'O', '4325 N Josey Ln Ste 210', 'Carrollton', 'Denton', 'TX', '75010', '972 492 7606', NULL, '4325 N Josey Ln Ste 210', 'Carrollton', 'Denton', 'TX', '75010', '972 492 7606', '', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-12-05', NULL, 0, 0, 0, 'Baylor Medical Center at Frisco', '', '', '', 'HCFA|UB|', '1861601049', 0, 'N', 0, '2014-04-25', NULL, NULL, 32.9735, -96.7258, NULL, NULL),
('203643223', 'SPA500004', 'SPA500004', 'TXDALSTD', 'Texas Renal Care', 'Adeel', '', 'Ijaz', 'MD', 'Urology', '', '', NULL, 'O', '5300 W Plano Pkwy Ste 200', 'Plano', 'Collin', 'TX', '75093', '9726128037', '9726124414', '4201 Medical Ctr Dr Ste 260', 'McKinney', 'Collin', 'TX', '75069', '9725425482', '', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-05', NULL, 0, 0, 0, 'Baylor Medical Center at Frisco', '', '', '', 'HCFA|UB|', '1386695724', 0, 'N', 0, '2014-05-15', NULL, NULL, 33.1619, -96.6356, NULL, NULL),
('203643223', 'SPA500013', 'SPA500013', 'TXDALSTD', 'Womens Integrated Healthcare PA', 'Wendy', 'A', 'Kindrick', 'DO', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'O', '4085 Ohio Dr Ste 100', 'Frisco', 'Collin', 'TX', '75035', '9726689713', '9726689744', '4085 Ohio Dr Ste 100', 'Frisco', 'Collin', 'TX', '75035', '9726689713', '9726689744', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-12-05', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Grapevine', NULL, NULL, NULL, 'HCFA|UB|', '1598797060', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.9333, -97.0916, NULL, NULL),
('263905031', 'SPA500047', 'SPA500047', 'TXDALSTD', 'Womens Integrated Healthcare PA', 'Wendy', 'A', 'Kindrick', 'DO', 'Internal Medicine', '', '', NULL, 'B', '9603 White Rock Trail Ste 200', 'Dallas', 'Dallas', 'TX', '75238', '9726448577', '9726448056', '9603 White Rock Trail Ste 200', 'Dallas', 'Dallas', 'TX', '75238', '9726448577', '9726448056', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-12-05', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1619948213', 0, 'Y', 0, '2014-04-01', NULL, NULL, 32.9342, -97.2358, NULL, NULL),
('061780691', 'SPA500008', 'SPA500008', 'TXDALSTD', 'North Dallas Urology Associates PA', 'Manoj', 'A', 'Reddy', 'MD', 'Internal Medicine', '', '', NULL, 'B', '9603 White Rock Trail Ste 200', 'Dallas', 'Dallas', 'TX', '75238', '9726448577', NULL, '9603 White Rock Trail Ste 200', 'Dallas', 'Dallas', 'TX', '75238', '9726448577', '', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-12-05', NULL, 0, 0, 0, '', NULL, '', '', 'HCFA|UB|', '1932188208', 0, 'Y', 0, '2014-04-02', NULL, NULL, 33.0166, -96.8068, NULL, NULL),
('204053067', 'SPA500042', 'SPA500042', 'TXDALSTD', 'North Dallas Urology Associates PA', 'Manoj', 'A', 'Reddy', 'MD', 'Dermatology', '', '', NULL, 'O', '12222 Coit Rd Ste 102', 'Dallas', 'Dallas', 'TX', '75251', '9727266647', '9727266797', '12222 Coit Rd Ste 102', 'Dallas', 'Dallas', 'TX', '75251', '9727266647', '9727266797', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-12-05', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', NULL, '', '', 'HCFA|UB|', '1841458619', 0, 'N', 0, '2014-04-25', NULL, NULL, 33.0452, -96.8255, NULL, NULL),
('264052650', 'SPA500035', 'SPA500035', 'TXDALSTD', 'Center for Dermatology and Cosmetic Laser Surgery', 'Neda', '', 'Nosrati', 'MD', 'Ophthalmology', '', '', NULL, 'O', '1706 Preston Park Blvd', 'Plano', 'Collin', 'TX', '75093', '9725999098', '9725991459', '1706 Preston Park Blvd', 'Plano', 'Collin', 'TX', '75093', '9725999098', '9725991459', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-05', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, NULL, NULL, 'HCFA|UB|', '1043470297', 0, 'N', 0, '2014-01-16', NULL, NULL, 33.2125, -96.6184, NULL, NULL),
('452715973', 'W12047664', 'W12047664', 'Sinclair', 'St Lukes Clinic Wood River LLC', 'Jill', '', 'Mendenhall', 'PA', 'Family Practice', '', '', NULL, 'O', '191 W 5th St', 'Ketchum', 'Blaine', 'ID', '83340', '2087265027', '2087268948', '191 W 5th St', 'Ketchum', 'Blaine', 'ID', '83340', '2087265027', '2087268948', 'IDSINCLAIRD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1790030518', 0, 'N', 1, '2014-07-02', NULL, NULL, 0, 0, NULL, NULL),
('752415520', 'SPA500001', 'SPA500001', 'TXDALSTD', 'Retina Specialists', 'Henry', '', 'Choi', 'MD', 'Ophthalmology', '', '', NULL, 'O', '2625 Bolton Boone', 'Desoto', 'Dallas', 'TX', '75115', '9722831516', '9722831448', '4401 Coit Rd Ste 203', 'Frisco', 'Collin', 'TX', '75035', '2147052119', '2148723641', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, NULL, NULL, 'HCFA|UB|', '1699734723', 0, 'N', 0, '2014-04-09', NULL, NULL, 33.1129, -96.7682, NULL, NULL),
('800814807', 'SPA500031', 'SPA500031', 'TXDALSTD', 'Retina Specialists', 'Henry', '', 'Choi', 'MD', 'Ophthalmology', '', '', NULL, 'O', '10400 N Central Expy', 'Dallas', 'Dallas', 'TX', '75231', '9728844400', '9725914605', '10400 N Central Expy', 'Dallas', 'Dallas', 'TX', '75231', '9728844400', '9725914605', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-05', '2014-01-31', 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, NULL, NULL, 'HCFA|UB|', '1396906673', 0, 'N', 0, '2014-01-27', NULL, NULL, 32.8877, -96.7695, NULL, NULL),
('383862114', 'SPA500020', 'SPA500020', 'TXDALSTD', 'New Leaf Plastic and Reconstructive Surgery', 'Candis', 'M', 'Lovelace', 'MD', 'Family Practice', '', '', NULL, 'O', '4400 Heritage Trace Pkwy Ste 200', 'Ft Worth', 'Tarrant', 'TX', '76244', '8173801087', '8173821088', 'PO Box 840711', 'Dallas', 'Dallas', 'TX', '75284', '8886100839', '3367746896', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1811037245', 0, 'N', 0, '2014-04-09', NULL, NULL, 32.9148, -97.2877, NULL, NULL),
('208487468', 'W12049343', 'W12049343', 'UT01', 'Advanced Pulmonary, Sleep Disorders and Internal Medicine', 'Steven', 'R', 'Fowler', 'PA', 'Sleep Disorders', '', '', NULL, 'O', '640 E 700 S Ste 105', 'St George', 'Washington', 'UT', '84770', '4356887770', '4356888122', '640 E 700 S Ste 105', 'St George', 'Washington', 'UT', '84770', '4356887770', '4356888122', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1508817628', 0, 'N', 1, '2014-07-10', NULL, NULL, 0, 0, NULL, NULL),
('752415520', 'SPA500037', 'SPA500037', 'TXDALSTD', 'Retina Specialists', 'Robert', 'E', 'Torti', 'MD', 'Ophthalmology', '', '', NULL, 'O', '1706 Preston Park Blvd', 'Plano', 'Collin', 'TX', '75093', '9725999098', '9725991489', '1706 Preston Park Blvd', 'Plano', 'Collin', 'TX', '75093', '9725999098', '9725991489', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, NULL, NULL, 'HCFA|UB|', '1851337166', 0, 'N', 0, '2014-01-16', NULL, NULL, 33.0144, -96.7924, NULL, NULL),
('203643223', 'SPA500003', 'SPA500003', 'TXDALSTD', 'Texas Renal Care', 'Adeel', '', 'Ijaz', 'MD', 'Ophthalmology', '', '', NULL, 'O', '2625 Bolton Boone', 'DeSoto', 'Dallas', 'TX', '75115', '9722831516', '9722831448', '4085 Ohio Dr Ste 100', 'Frisco', 'Collin', 'TX', '75035', '9726689713', '9726689744', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-05', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, NULL, NULL, 'HCFA|UB|', '1386695724', 0, 'N', 0, '2014-05-15', NULL, NULL, 32.6429, -96.8785, NULL, NULL),
('800814807', 'SPA500033', 'SPA500033', 'TXDALSTD', 'Retina Specialists', 'Robert', 'E', 'Torti', 'MD', 'Pain Management', '', '', NULL, 'B', 'PO Box 730990', 'Dallas', 'Dallas', 'TX', '75373', '9725999098', '9725991489', '3060 Communications Pkwy Ste 104', 'Plano', 'Collin', 'TX', '75093', '8173580100', '          ', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-05', '2014-01-31', 0, 0, 0, 'Vista Hospital of Dallas', '', '', '', 'HCFA|UB|', '1396906673', 0, 'Y', 0, '2014-01-27', NULL, NULL, 33.0424, -96.833, NULL, NULL),
('264023585', 'SPA500022', 'SPA500022', 'TXDALSTD', 'The Heflin Family Clinic', 'Linda', '', 'Heflin', 'MD', 'Family Practice', '', '', NULL, 'O', '725 N Graham Ste 700', 'Stephenville', 'Erath', 'TX', '76401', '2549651160', '2549651167', '4375 Booth Calloway Ste 208', 'N Richland Hills', 'Tarrant', 'TX', '76180', '8172840936', '', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-12-05', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1194746735', 0, 'N', 0, '2014-03-31', NULL, NULL, 32.2261, -98.2058, NULL, NULL),
('203643223', 'SPA500023', 'SPA500023', 'TXDALSTD', 'The Heflin Family Clinic', 'Jearald', 'D', 'Heflin', 'MD', 'Nephrology', '', '', NULL, 'O', '4085 Ohio Dr Ste 100', 'Frisco', 'Collin', 'TX', '75035', '9726689713', '9726689744', '4085 Ohio Dr Ste 100', 'Frisco', 'Collin', 'TX', '75035', '9726689713', '9726689744', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-12-05', '2013-12-31', 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1235123209', 0, 'N', 0, '2014-04-02', NULL, NULL, 32.2261, -98.2058, NULL, NULL),
('205216056', 'SPA500021', 'SPA500021', 'TXDALSTD', 'Pure Health Family Practice', 'Jayshri', 'R', 'Chasmawala', 'DO', 'Family Practice', NULL, NULL, NULL, 'O', '6301 Gaston Ave Ste 325 W', 'Dallas', 'Dallas', 'TX', '75214', '2148246700', '2148246701', '15950 El Dorado Pkwy Ste 400', 'Frisco', 'Collin', 'TX', '75035', '9723475778', '', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, NULL, NULL, '', '', 'HCFA|UB|', '1932266988', 0, 'N', 0, '2014-04-09', NULL, NULL, 33.1742, -96.7356, NULL, NULL),
('752402478', 'SPA500040', 'SPA500040', 'TXDALSTD', 'Forest Medical Care', 'Ramon', 'D', 'Garcia', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 150', 'Rowlett', 'Dallas', 'TX', '75030', '9724944494', '9724944450', '375 Municipal Dr Ste 126', 'Richardson', 'Dallas', 'TX', '75080', '9724800877', '9722359919', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1962469635', 0, 'Y', 0, '2014-04-25', NULL, NULL, 32.9735, -96.7258, NULL, NULL),
('752402478', 'SPA500006', 'SPA500006', 'TXDALSTD', 'Center for Dermatology and Cosmetic Laser Surgery', 'Bryan', 'A', 'Selkin', 'MD', 'Urology', '', '', NULL, 'O', '5300 W Plano Pkwy Ste 200', 'Plano', 'Collin', 'TX', '75093', '9726128037', '9726124414', '5300 W Plano Pkwy Ste 200', 'Plano', 'Collin', 'TX', '75093', '9726128037', '9726124414', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', '', '', '', 'HCFA|UB|', '1962469635', 0, 'N', 0, '2014-04-25', NULL, NULL, 33.0166, -96.8068, NULL, NULL),
('752496433', 'SPA500025', 'SPA500025', 'TXDALSTD', 'Warthan Dermatology Associates', 'Mandy', 'L', 'Warthan', 'MD', 'Internal Medicine', '', '', NULL, 'O', '5971 Virginia Pkwy Ste 100', 'McKinney', 'Collin', 'TX', '75071', '9725424646', '9725420909', '3555 W Walnut St Ste A', 'Garland', 'Dallas', 'TX', '75042', '9722768879', '', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-12-05', NULL, 0, 0, 0, 'Baylor Medical Center at Garland', NULL, NULL, NULL, 'HCFA|UB|', '1659475028', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.9172, -96.6839, NULL, NULL),
('462253072', 'SPA500016', 'SPA500016', 'TXDALSTD', 'MISI Associates', 'Gabriel', 'A', 'Rodriguez', 'MD', 'Pain Management', NULL, NULL, NULL, 'B', 'PO Box 674151', 'Dallas', 'Dallas', 'TX', '75267', '9728844400', '9725914605', '2821 E Pres George Bush Hwy Ste 300', 'Richardson', 'Dallas', 'TX', '75082', '9722319144', '9722319174', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Irving-Coppell Surgical Hospital', '', '', '', 'HCFA|UB|', '1720037435', 0, 'Y', 0, '2014-04-25', NULL, NULL, 32.9863, -96.6734, NULL, NULL),
('462253072', 'SPA500028', 'SPA500028', 'TXDALSTD', 'Center for Dermatology and Cosmetic Laser Surgery', 'Michael', 'J', 'Wells', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '5044 Tennyson Pkwy Ste B', 'Plano', 'Collin', 'TX', '75024', '9729859003', '9729851176', '9101 LBJ Fwy Ste 710', 'Dallas', 'Dallas', 'TX', '75243', '9727925727', '9727925727', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, '', '', 'HCFA|UB|', '1720037435', 0, 'N', 0, '2014-04-25', NULL, NULL, 33.0646, -96.7984, NULL, NULL),
('820424691', 'W12036340', 'W12036340', 'ID02', 'Boise Family Medicine Center', 'Tara', 'J', 'Brumpton', 'PA-C', 'Family Practice', '', '', NULL, 'O', '10798 W Overland Rd', 'Boise', 'Ada', 'ID', '83709', '2083773368', '2083224691', '10798 W Overland Rd', 'Boise', 'Ada', 'ID', '83709', '2083773368', '2083224691', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2013-07-18', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1285986778', 0, 'N', 0, '2013-08-06', NULL, NULL, 0, 0, NULL, NULL),
('271789847', 'W12036342', 'W12036342', 'ID02', 'Ontario Emergency Specialists', 'Kent', 'M', 'Sandquist', 'PA-C', 'Emergency Medicine', '', '', NULL, 'O', '351 SW 9th St', 'Ontario', 'Malheur', 'OR', '97914', '5418817102', '5418817395', '351 SW 9th St', 'Ontario', 'Malheur', 'OR', '97914', '5418817102', '5418817395', 'IDACN', '', '', '0.00', '15.00', '0.00', 8, '2013-07-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA', '1407918501', 0, 'N', 0, '2014-05-21', NULL, NULL, 44.0252, -116.976, NULL, NULL),
('911947573', 'W12036344', 'W12036344', 'TXDALSTD', 'Health Texas Provider Network', 'Kellee', 'L', 'Randle', 'DO', 'Internal Medicine', '', '', NULL, 'O', '1405 W Jefferson St', 'Waxahachie', 'Ellis', 'TX', '75165', '9729237144', '9729237145', '1405 W Jefferson St', 'Waxahachie', 'Ellis', 'TX', '75165', '9729237144', '9729237145', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, 'Baylor Medical Center at Waxahachie', NULL, '', '', 'HCFA|UB|', '1932449055', 0, 'N', 0, '2013-08-06', NULL, NULL, 32.3968, -96.865, NULL, NULL),
('911947573', 'W12036345', 'W12036345', 'TXDALSTD', 'Health Texas Provider Network', 'Kellee', 'L', 'Randle', 'DO', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 842001', 'Dallas', 'Dallas', 'TX', '75284', '9729230620', '9729380528', 'PO Box 842001', 'Dallas', 'Dallas', 'TX', '75284', '9729230620', '9729380528', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, 'Baylor Medical Center at Waxahachie', NULL, '', '', 'HCFA|UB|', '1932449055', 0, 'N', 0, '2013-08-09', NULL, NULL, 0, 0, NULL, NULL),
('911947573', 'W12036347', 'W12036347', 'TXDALSTD', 'Health Texas Provider Network', 'Danny', '', 'Luong', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 842001', 'Dallas', 'Dallas', 'TX', '75284', '2148203000', '2148203022', 'PO Box 842001', 'Dallas', 'Dallas', 'TX', '75284', '2148203000', '2148203022', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, '', '', 'HCFA|UB|', '1942524707', 0, 'N', 0, '2013-08-06', NULL, NULL, 0, 0, NULL, NULL),
('911947573', 'W12036348', 'W12036348', 'TXDALSTD', 'Health Texas Provider Network', 'Danny', '', 'Luong', 'MD', 'Internal Medicine', '', '', NULL, 'O', '3500 Gaston Ave 4 Roberts', 'Dallas', 'Dallas', 'TX', '75246', '2148203000', '2148203022', '3500 Gaston Ave 4 Roberts', 'Dallas', 'Dallas', 'TX', '75246', '2148203000', '2148203022', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, '', '', 'HCFA|UB|', '1942524707', 0, 'N', 0, '2013-08-06', NULL, NULL, 32.793, -96.7738, NULL, NULL),
('752536818', 'W12036351', 'W12036351', 'TXDALSTD', 'Health Texas Provider Network', 'Padmavathi', '', 'Koduri', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, 'Baylor Medical Center at McKinney', NULL, '', '', 'HCFA|UB', '1669567061', 0, 'N', 0, '2013-08-06', NULL, NULL, 0, 0, NULL, NULL),
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('752536818', 'W12036411', 'W12036411', 'TXDALSTD', 'Health Texas Provider Network', 'Christopher', 'C', 'Breuder', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Grapevine', '', '', '', 'HCFA|UB|', '1730361437', 0, 'N', 0, '2014-05-08', NULL, NULL, 0, 0, NULL, NULL),
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('830207671', 'W12036431', 'W12036431', 'WYT1', 'West Park Hospital District', 'Scott', 'E', 'Pollard', 'MD', 'Mental Health', 'Psychiatry', '', NULL, 'O', '707 Sheridan Ave', 'Cody', 'Park', 'WY', '82414', '3075782500', '3075782492', '707 Sheridan Ave', 'Cody', 'Park', 'WY', '82414', '3075782500', '3075782492', '', '', '', '0.00', '12.00', '0.00', 3, '2013-12-15', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1851366314', 0, 'N', 0, '2013-12-11', NULL, NULL, 0, 0, NULL, NULL),
('204936173', 'W12036432', 'W12036432', 'TXHOUSTD', 'Vasudeva R Boosupalli', 'Vasudeva', '', 'Boosupalli', 'MD', 'Pediatric Neurology', '', '', NULL, 'O', '11914 Astoria Blvd Ste 400', 'Houston', 'Harris', 'TX', '77089', '2814810002', '2814810007', '11914 Astoria Blvd Ste 400', 'Houston', 'Harris', 'TX', '77089', '2814810002', '2814810007', 'HOUSTON5', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1881666964', 0, 'Y', 0, '2014-04-01', NULL, NULL, 29.5851, -95.2071, NULL, NULL),
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('850275777', 'W12036434', 'W12036434', 'NM01', 'Southwest Medical Associates', 'Cheryl', 'C', 'Clarke', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '6100 Pan American Fwy, Ne Ste 100', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058231010', '5058231010', '6100 Pan American Fwy, Ne Ste 100', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058231010', '5058231010', 'NMSWMED', '', '', '0.00', '10.00', '0.00', 3, '2013-10-01', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1568420313', 0, 'N', 0, '2013-10-30', NULL, NULL, 35.1537, -106.587, NULL, NULL),
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('870284475', 'W12036450', 'W12036450', 'UT01', 'Granger Medical Clinic ', 'Layne', 'A', 'Smith', 'MD', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'O', '11724 S State St', 'Draper', 'Salt Lake', 'UT', '84020', '8015762000', '8015762001', '11724 S State St', 'Draper', 'Salt Lake', 'UT', '84020', '8015762000', '8015762001', 'WUGRANGER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', '', '', '', 'HCFA|UB|', '1770693251', 0, 'N', 0, '2013-08-07', NULL, NULL, 40.5394, -111.891, NULL, NULL),
('870286381', 'W12036451', 'W12036451', 'UT01', 'Ogden Clinic', 'Gregory', '', 'Reeves', 'PA-C', 'Dermatology', '', '', NULL, 'O', '4650 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014753098', '8014753089', '4650 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014753098', '8014753089', 'WUOGDCLIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1396184487', 0, 'N', 0, '2013-09-10', NULL, NULL, 41.1787, -111.949, NULL, NULL);
INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
('621801973', 'W12036452', 'W12036452', 'UT01', 'Physician Group of Utah', 'Matthew', '', 'Grantz', '', 'Neurology', NULL, NULL, NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '0000000000', '0000000000', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '0000000000', '0000000000', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-09-01', '2014-04-30', 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1134373665', 0, 'N', 0, '2013-09-20', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'W12036454', 'W12036454', 'TXDALSTD', 'Health Texas Provider Network', 'Eric', 'J', 'Coligado', 'MD', 'Physical Medicine and Rehabilitation', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-09-01', '2013-09-01', 0, 0, 0, 'Baylor Regional Medical Center at Grapevine', NULL, '', '', 'HCFA|UB|', '1821081811', 0, 'N', 0, '2013-11-11', NULL, NULL, 0, 0, NULL, NULL),
('621762573', 'W12036458', 'W12036458', 'UT01', 'Castleview Physician Practice', 'Russell', 'O', 'Beecher', 'DO', 'Pain Management', '', '', NULL, 'B', '280 N Hospital Dr Ste 4', 'Price', 'Carbon', 'UT', '84501', '4356137246', '4356137247', '280 N Hospital Dr Ste 4', 'Price', 'Carbon', 'UT', '84501', '4356137246', '4356137247', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-08-02', NULL, 0, 0, 0, 'Castleview Hospital', 'Castleview Hospital', NULL, NULL, 'HCFA|UB|', '1265630941', 0, 'N', 0, '2013-08-07', NULL, NULL, 0, 0, NULL, NULL),
('830306180', 'W12036459', 'W12036459', 'WY01', 'College Hill Womens Center', 'Vanessa', '', 'Rice', 'DO', 'Family Practice', '', '', NULL, 'O', '2180 W Teton', 'Green River', 'Sweetwater', 'WY', '82935', '3073621861', '3073621277', '2180 W Teton', 'Green River', 'Sweetwater', 'WY', '82935', '3073621861', '3073621277', '', '', '', '0.00', '10.00', '0.00', 3, '2013-08-26', NULL, 0, 0, 0, 'Memorial Hospital of Sweetwater County', NULL, NULL, NULL, 'HCFA|UB|', '1063554467', 0, 'N', 0, '2013-08-07', NULL, NULL, 0, 0, NULL, NULL),
('830306180', 'W12036460', 'W12036460', 'WYT2', 'College Hill Womens Center', 'Vanessa', '', 'Rice', 'DO', 'Family Practice', '', '', NULL, 'O', '2180 W Teton', 'Green River', 'Sweetwater', 'WY', '82935', '3073621861', '3073621277', '2180 W Teton', 'Green River', 'Sweetwater', 'WY', '82935', '3073621861', '3073621277', '', '', '', '0.00', '10.00', '0.00', 3, '2013-08-26', NULL, 0, 0, 0, 'Memorial Hospital of Sweetwater County', NULL, NULL, NULL, 'HCFA|UB|', '1063554467', 0, 'N', 0, '2013-08-07', NULL, NULL, 0, 0, NULL, NULL),
('830306180', 'W12036461', 'W12036461', 'WY01', 'College Hill Womens Center', 'Jeffery', '', 'Wheeler', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '2180 W Teton', 'Green River', 'Sweetwater', 'WY', '82935', '3073621861', '3073621277', '2180 W Teton', 'Green River', 'Sweetwater', 'WY', '82935', '3073621861', '3073621277', '', '', '', '0.00', '10.00', '0.00', 3, '2013-08-26', NULL, 0, 0, 0, 'Memorial Hospital of Sweetwater County', NULL, NULL, NULL, 'HCFA|UB|', '1053562280', 0, 'N', 0, '2013-08-07', NULL, NULL, 0, 0, NULL, NULL),
('830306180', 'W12036462', 'W12036462', 'WYT2', 'College Hill Womens Center', 'Jeffery', '', 'Wheeler', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '2180 W Teton', 'Green River', 'Sweetwater', 'WY', '82935', '3073621861', '3073621277', '2180 W Teton', 'Green River', 'Sweetwater', 'WY', '82935', '3073621861', '3073621277', '', '', '', '0.00', '10.00', '0.00', 3, '2013-08-26', NULL, 0, 0, 0, 'Memorial Hospital of Sweetwater County', NULL, NULL, NULL, 'HCFA|UB|', '1053562280', 0, 'N', 0, '2013-08-07', NULL, NULL, 0, 0, NULL, NULL),
('830306180', 'W12036463', 'W12036463', 'WY01', 'College Hill Womens Center', 'Starla ', '', 'Yerkovich', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '2180 W Teton', 'Green River', 'Sweetwater', 'WY', '82935', '3073621861', '3073621277', '2180 W Teton', 'Green River', 'Sweetwater', 'WY', '82935', '3073621861', '3073621277', '', '', '', '0.00', '10.00', '0.00', 3, '2013-08-26', NULL, 0, 0, 0, 'Memorial Hospital of Sweetwater County', NULL, NULL, NULL, 'HCFA|UB|', '1922103431', 0, 'N', 0, '2013-08-07', NULL, NULL, 0, 0, NULL, NULL),
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('830306180', 'W12036465', 'W12036465', 'WY01', 'College Hill Womens Center', 'Samer', '', 'Kattan', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '2180 W Teton', 'Green River', 'Sweetwater', 'WY', '82935', '3073621861', '3073621277', '2180 W Teton', 'Green River', 'Sweetwater', 'WY', '82935', '3073621861', '3073621277', '', '', '', '0.00', '10.00', '0.00', 3, '2013-08-26', NULL, 0, 0, 0, 'Memorial Hospital of Sweetwater County', '', '', '', 'HCFA|UB|', '1750502753', 0, 'N', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
('830306180', 'W12036466', 'W12036466', 'WYT2', 'College Hill Womens Center', 'Samer', '', 'Kattan', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '2180 W Teton', 'Green River', 'Sweetwater', 'WY', '82935', '3073621861', '3073621277', '2180 W Teton', 'Green River', 'Sweetwater', 'WY', '82935', '3073621861', '3073621277', '', '', '', '0.00', '10.00', '0.00', 3, '2013-08-26', NULL, 0, 0, 0, 'Memorial Hospital of Sweetwater County', '', '', '', 'HCFA|UB|', '1750502753', 0, 'N', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
('830306180', 'W12036467', 'W12036467', 'WY01', 'College Hill Womens Center', 'Amr', '', 'Etman', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '2180 W Teton', 'Green River', 'Sweetwater', 'WY', '82935', '3073621861', '3073621277', '2180 W Teton', 'Green River', 'Sweetwater', 'WY', '82935', '3073621861', '3073621277', '', '', '', '0.00', '10.00', '0.00', 3, '2013-08-26', NULL, 0, 0, 0, 'Memorial Hospital of Sweetwater County', NULL, NULL, NULL, 'HCFA|UB|', '1932362985', 0, 'N', 0, '2013-08-07', NULL, NULL, 0, 0, NULL, NULL),
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('830306180', 'W12036469', 'W12036469', 'WY01', 'College Hill Womens Center', 'Louanna', '', 'Bradley', 'NP', 'Family Practice', '', '', NULL, 'O', '2180 W Teton', 'Green River', 'Sweetwater', 'WY', '82935', '3073621861', '3073621277', '2180 W Teton', 'Green River', 'Sweetwater', 'WY', '82935', '3073621861', '3073621277', '', '', '', '0.00', '10.00', '0.00', 3, '2013-08-26', NULL, 0, 0, 0, 'Memorial Hospital of Sweetwater County', NULL, NULL, NULL, 'HCFA|UB|', '1295830743', 0, 'N', 0, '2013-08-07', NULL, NULL, 0, 0, NULL, NULL),
('830306180', 'W12036470', 'W12036470', 'WYT2', 'College Hill Womens Center', 'Louanna', '', 'Bradley', 'NP', 'Family Practice', '', '', NULL, 'O', '2180 W Teton', 'Green River', 'Sweetwater', 'WY', '82935', '3073621861', '3073621277', '2180 W Teton', 'Green River', 'Sweetwater', 'WY', '82935', '3073621861', '3073621277', '', '', '', '0.00', '10.00', '0.00', 3, '2013-08-26', NULL, 0, 0, 0, 'Memorial Hospital of Sweetwater County', NULL, NULL, NULL, 'HCFA|UB|', '1295830743', 0, 'N', 0, '2013-08-07', NULL, NULL, 0, 0, NULL, NULL),
('830306180', 'W12036471', 'W12036471', 'WY01', 'College Hill Womens Center', 'Peter', 'G', 'Allyn', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '2180 W Teton', 'Green River', 'Sweetwater', 'WY', '82935', '3073621861', '3073621277', '2180 W Teton', 'Green River', 'Sweetwater', 'WY', '82935', '3073621861', '3073621277', '', '', '', '0.00', '10.00', '0.00', 3, '2013-08-26', NULL, 0, 0, 0, 'Memorial Hospital of Sweetwater County', '', '', '', 'HCFA|UB|', '1801991013', 0, 'N', 0, '2014-03-03', NULL, NULL, 0, 0, NULL, NULL),
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('611442064', 'W12036481', 'W12036481', 'TXHOUSTD', 'Alief Geriatrics Associates PA', 'Chris', 'H', 'Ojeih', 'MD', 'Family Practice', '', '', NULL, 'O', '7500 Beechnut Ste 262', 'Houston', 'Harris', 'TX', '77074', '7137724377', '7137724379', '7500 Beechnut Ste 262', 'Houston', 'Harris', 'TX', '77074', '7137724377', '7137724379', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-08-01', NULL, 0, 0, 0, 'West Houston Medical Center', NULL, '', '', 'HCFA|UB|', '1164490470', 0, 'N', 0, '2013-08-09', NULL, NULL, 29.6912, -95.5182, NULL, NULL),
('942854057', 'W12036485', 'W12036485', 'UTIHCPHY', 'North Cache Valley Clinic', '', '', 'Summit Clinic', 'Group', 'Clinic', '', '', 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, '2013-07-23', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1740324581', 0, 'N', 0, '2013-08-09', NULL, NULL, 0, 0, NULL, NULL),
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('760055318', 'W12036487', 'W12036487', 'TXHOUSTD', '', 'Susan ', 'C', 'Jacob', 'MD', 'Allergy and Immunology', '', '', NULL, 'O', '8901 FM 1960 By Pass Rd Ste 301', 'Humble', 'Harris', 'TX', '77338', '2815401730', '2815401983', '8901 FM 1960 By Pass Rd Ste 301', 'Humble', 'Harris', 'TX', '77338', '2815401730', '2815401983', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-15', NULL, 0, 0, 0, 'Kingwood Medical Center', 'The Womans Hospital of Texas', 'Houston Methodist Hospital', '', 'HCFA|UB|', '1699865881', 0, 'N', 0, '2014-06-06', NULL, NULL, 30.005, -95.2895, NULL, NULL),
('841274104', 'W12036504', 'W12036504', 'WY01', 'Rocky Mountain Pediatric Gastroenterology', 'Chad', '', 'Best', 'MD - Does not admit to an in-network facility', 'Pediatric Gastroenterology', '', '', NULL, 'O', '940 W 3rd St Ste 201', 'Casper', 'Natrona', 'WY', '82602', '3037901515', '3037901989', '940 W 3rd St Ste 201', 'Casper', 'Natrona', 'WY', '82602', '3037901515', '3037901989', 'CO150', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA', '1992907315', 0, 'N', 0, '2013-09-04', NULL, NULL, 42.8518, -106.325, NULL, NULL),
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('841274104', 'W12036523', 'W12036523', 'WY01', 'Rocky Mountain Pediatric Gastroenterology', 'Chad', '', 'Best', 'MD - Does not admit to an in-network facility', 'Pediatric Gastroenterology', '', '', NULL, 'O', '501 S Burma Ave', 'Gillette', 'Campbell', 'WY', '82717', '3037901515', '3037901989', '501 S Burma Ave', 'Gillette', 'Campbell', 'WY', '82717', '3037901515', '3037901989', 'CO150', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA', '1992907315', 0, 'N', 0, '2013-09-04', NULL, NULL, 44.2903, -105.52, NULL, NULL),
('841274104', 'W12036524', 'W12036524', 'WYT1', 'Rocky Mountain Pediatric Gastroenterology', 'Chad', '', 'Best', 'MD - Does not admit to an in-network facility', 'Pediatric Gastroenterology', '', '', NULL, 'O', '501 S Burma Ave', 'Gillette', 'Campbell', 'WY', '82717', '3037901515', '3037901989', '501 S Burma Ave', 'Gillette', 'Campbell', 'WY', '82717', '3037901515', '3037901989', 'CO150', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA', '1992907315', 0, 'N', 0, '2013-09-04', NULL, NULL, 0, 0, NULL, NULL),
('264077148', 'W12036525', 'W12036525', 'WY01', 'Rocky Mountain Family Medicine', 'Eric', 'J', 'Lawrence', 'DO', 'Family Practice', '', '', NULL, 'O', '2241 Farnum St Ste 102', 'Casper', 'Natrona', 'WY', '82609', '3073156133', '3073156134', '2241 Farnum St Ste 102', 'Casper', 'Natrona', 'WY', '82609', '3073156133', '3073156134', '', '', '', '0.00', '15.00', '0.00', 3, '2013-12-01', NULL, 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1326223751', 0, 'N', 0, '2014-04-11', NULL, NULL, 42.8371, -106.297, NULL, NULL),
('264077148', 'W12036526', 'W12036526', 'WYT1', 'Rocky Mountain Family Medicine', 'Eric', 'J', 'Lawrence', 'DO', 'Family Practice', '', '', NULL, 'O', '2241 Farnum St Ste 102', 'Casper', 'Natrona', 'WY', '82609', '3073156133', '3073156134', '2241 Farnum St Ste 102', 'Casper', 'Natrona', 'WY', '82609', '3073156133', '3073156134', '', '', '', '0.00', '15.00', '0.00', 3, '2013-12-01', NULL, 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1326223751', 0, 'N', 0, '2014-04-11', NULL, NULL, 0, 0, NULL, NULL),
('264077148', 'W12036527', 'W12036527', 'WY01', 'Rocky Mountain Family Medicine', 'Jane', '', 'Fleming', 'APRN', 'Family Practice', '', '', NULL, 'O', '2241 Farnum St Ste 102', 'Casper', 'Natrona', 'WY', '82609', '3073156133', '3073156134', '2241 Farnum St Ste 102', 'Casper', 'Natrona', 'WY', '82609', '3073156133', '3073156134', '', '', '', '0.00', '15.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Wyoming Medical Center ', NULL, NULL, NULL, 'HCFA|UB|', '1104126358', 0, 'N', 0, '2013-09-20', NULL, NULL, 42.8371, -106.297, NULL, NULL),
('264077148', 'W12036528', 'W12036528', 'WYT1', 'Rocky Mountain Family Medicine', 'Jane', '', 'Fleming', 'APRN', 'Family Practice', '', '', NULL, 'O', '2241 Farnum St Ste 102', 'Casper', 'Natrona', 'WY', '82609', '3073156133', '3073156134', '2241 Farnum St Ste 102', 'Casper', 'Natrona', 'WY', '82609', '3073156133', '3073156134', '', '', '', '0.00', '15.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Wyoming Medical Center ', NULL, NULL, NULL, 'HCFA|UB|', '1104126358', 0, 'N', 0, '2013-09-20', NULL, NULL, 0, 0, NULL, NULL),
('870635889', 'W12036529', 'W12036529', 'UT01', 'Tooele Clinic Corp', 'Steven', '', 'Rich', 'DO', 'Pediatrics', '', '', NULL, 'O', '196 E 2000 N Ste 100', 'Tooele', 'Tooele', 'UT', '84074', '4358829035', NULL, '196 E 2000 N Ste 100', 'Tooele', 'Tooele', 'UT', '84074', '4358829035', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-10-01', NULL, 0, 0, 0, 'Mountain West Medical Center', '', '', '', 'HCFA|UB|', '1902118714', 0, 'N', 0, '2013-09-23', NULL, NULL, 40.5656, -112.294, NULL, NULL),
('870635889', 'W12036530', 'W12036530', 'UT01', 'Tooele Clinic Corp', 'Steven', '', 'Rich', 'DO', 'Pediatrics', '', '', NULL, 'M', 'PO Box 689022', 'Franklin', 'Williamson', 'TN', '37068', '4358829035', NULL, 'PO Box 689022', 'Franklin', 'Williamson', 'TN', '37068', '4358829035', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-10-01', NULL, 0, 0, 0, 'Mountain West Medical Center', '', '', '', 'HCFA|UB|', '1902118714', 0, 'N', 0, '2013-09-23', NULL, NULL, 0, 0, NULL, NULL),
('870635889', 'W12036531', 'W12036531', 'UT01', 'Tooele Clinic Corp', 'Steven', '', 'Rich', 'DO', 'Pediatrics', '', '', NULL, 'B', 'PO Box 848416', 'Boston', 'Suffolk', 'MA', '02284', '4358829035', NULL, 'PO Box 848416', 'Boston', 'Suffolk', 'MA', '02284', '4358829035', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-10-01', NULL, 0, 0, 0, 'Mountain West Medical Center', '', '', '', 'HCFA|UB|', '1902118714', 0, 'N', 0, '2013-09-23', NULL, NULL, 0, 0, NULL, NULL),
('760577426', 'W12036532', 'W12036532', 'TXHOUSTD', 'Miguel J Flores ', 'Miguel', 'J', 'Flores', 'MD', 'Family Practice', '', '', NULL, 'O', '804 W Dallas Ste 4', 'Conroe', 'Montgomery', 'TX', '77301', '9367602300', '9367567331', '804 W Dallas Ste 4', 'Conroe', 'Montgomery', 'TX', '77301', '9367602300', '9367567331', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-15', NULL, 0, 0, 0, 'Conroe Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1891715157', 0, 'N', 0, '2013-08-15', NULL, NULL, 30.3198, -95.4645, NULL, NULL),
('273782425', 'W12036533', 'W12036533', 'WY01', 'Canyon Hand Therapy', 'Whitney', 'L', 'Schilling', 'OT', 'Occupational Therapy', '', '', NULL, 'O', '1726 Beck Ave', 'Cody', 'Park', 'WY', '82414', '3075879789', '3075879787', '1726 Beck Ave', 'Cody', 'Park', 'WY', '82414', '3075879789', '3075879787', 'WYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1750667895', 0, 'N', 0, '2013-09-23', NULL, NULL, 44.525, -109.055, NULL, NULL),
('273782425', 'W12036534', 'W12036534', 'WYT1', 'Canyon Hand Therapy', 'Whitney', 'L', 'Schilling', 'OT', 'Occupational Therapy', '', '', NULL, 'O', '1726 Beck Ave', 'Cody', 'Park', 'WY', '82414', '3075879789', '3075879787', '1726 Beck Ave', 'Cody', 'Park', 'WY', '82414', '3075879789', '3075879787', 'WYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1750667895', 0, 'N', 0, '2013-09-23', NULL, NULL, 0, 0, NULL, NULL),
('742106017', 'W12036535', 'W12036535', 'TXHOUSTD', 'M A Quraisai MD', 'Mohanmmed', 'A', 'Quraishi', 'MD', 'Hematology and Oncology', '', '', NULL, 'O', '3326 Watters Rd Bldg A', 'Pasadena', 'Harris', 'TX', '77504', '7139413400', '7139415573', '3326 Watters Rd Bldg A', 'Pasadena', 'Harris', 'TX', '77504', '7139413400', '7139415573', 'HOUSTON5', 'TXONCHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-16', NULL, 0, 0, 0, 'Bayshore Medical Center', NULL, NULL, NULL, 'HCFA|UB', '1588661490', 0, 'N', 0, '2013-08-16', NULL, NULL, 29.6622, -95.1795, NULL, NULL),
('752584390', 'W12036538', 'W12036538', 'TXDALSTD', 'Craig C Callewart MD', 'Craig ', 'C ', 'Callewart', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', '16970 Dallas Pkwy Ste 500', 'Dallas', 'Dallas', 'TX', '75248', '2142714585', '2142714581', '16970 Dallas Pkwy Ste 500', 'Dallas', 'Dallas', 'TX', '75248', '2142714585', '2142714581', 'DALLAS4', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-09-16', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', NULL, NULL, NULL, 'HCFA|UB|', '1457596561', 0, 'N', 0, '2013-08-16', NULL, NULL, 0, 0, NULL, NULL),
('752584390', 'W12036537', 'W12036537', 'TXDALSTD', 'Craig C Callewart MD', 'Craig ', 'C ', 'Callewart', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '411 N Washington Ste 7500', 'Dallas', 'Dallas', 'TX', '75246', '2142714585', '2142714581', '411 N Washington Ste 7500', 'Dallas', 'Dallas', 'TX', '75246', '2142714585', '2142714581', 'DALLAS4', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-09-16', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', NULL, NULL, NULL, 'HCFA|UB|', '1457596561', 0, 'N', 0, '2013-08-16', NULL, NULL, 32.7885, -96.7752, NULL, NULL),
('752584390', 'W12036536', 'W12036536', 'TXDALSTD', 'Craig C Callewart MD', 'Craig ', 'C ', 'Callewart', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '9101 N Central Expwy Ste 360', 'Dallas', 'Dallas', 'TX', '75231', '2142714585', '2142714581', '9101 N Central Expwy Ste 360', 'Dallas', 'Dallas', 'TX', '75231', '2142714585', '2142714581', 'DALLAS4', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-09-16', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', NULL, NULL, NULL, 'HCFA|UB|', '1457596561', 0, 'N', 0, '2013-08-16', NULL, NULL, 32.873, -96.7706, NULL, NULL),
('870635889', 'W12036539', 'W12036539', 'UT01', 'Tooele Clinic Corp', 'Rachel', 'K', 'Oliver', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '196 E 2000 N Ste 101', 'Tooele', 'Tooele', 'UT', '84074', '4358433678', NULL, '196 E 2000 N Ste 101', 'Tooele', 'Tooele', 'UT', '84074', '4358433678', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-10-01', NULL, 0, 0, 0, 'Mountain West Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1043449366', 0, 'N', 0, '2013-09-23', NULL, NULL, 40.5656, -112.294, NULL, NULL),
('870635889', 'W12036540', 'W12036540', 'UT01', 'Tooele Clinic Corp', 'Rachel', 'K', 'Oliver', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'M', 'PO Box 689022', 'Franklin', 'Williamson', 'TN', '37068', '4358433678', NULL, 'PO Box 689022', 'Franklin', 'Williamson', 'TN', '37068', '4358433678', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-10-01', NULL, 0, 0, 0, 'Mountain West Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1043449366', 0, 'N', 0, '2013-09-23', NULL, NULL, 0, 0, NULL, NULL),
('870635889', 'W12036541', 'W12036541', 'UT01', 'Tooele Clinic Corp', 'Rachel', 'K', 'Oliver', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 848416', 'Boston', 'Suffolk', 'MA', '02284', '4358433678', NULL, 'PO Box 848416', 'Boston', 'Suffolk', 'MA', '02284', '4358433678', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-10-01', NULL, 0, 0, 0, 'Mountain West Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1043449366', 0, 'N', 0, '2013-09-23', NULL, NULL, 0, 0, NULL, NULL),
('760151142', 'W12036543', 'W12036543', 'TXHOUSTD', 'Mehta Medical Group', '', '', 'Mehta Medical Group', '', 'Clinics', '', '', NULL, 'O', '5510 Atascocita Rd Ste 260', 'Humble', 'Harris', 'TX', '77346', '2818121846', '2818122778', '5510 Atascocita Rd Ste 260', 'Humble', 'Harris', 'TX', '77346', '2818121846', '2818122778', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-22', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1780708321', 0, 'Y', 0, '2013-09-06', NULL, NULL, 29.9892, -95.1906, NULL, NULL),
('760151142', 'W12036542', 'W12036542', 'TXHOUSTD', 'Mehta Medical Group', '', '', 'Mehta Medical Group', '', 'Clinics', '', '', NULL, 'O', '8901 FM 1960 Bypass Rd W Ste 101', 'Humble', 'Harris', 'TX', '77338', '2814467173', '2814463841', '8901 FM 1960 Bypass Rd W Ste 101', 'Humble', 'Harris', 'TX', '77338', '2814467173', '2814463841', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-22', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1780708321', 0, 'Y', 0, '2013-09-06', NULL, NULL, 30.005, -95.2895, NULL, NULL),
('760151142', 'W12036545', 'W12036545', 'TXHOUSTD', 'Mehta Medical Group', 'Ismael', '', 'Diaz', 'MD', 'Family Practice', '', '', NULL, 'O', '5510 Atascocita Rd Ste 260', 'Humble', 'Harris', 'TX', '77346', '2818121846', '2818122778', '5510 Atascocita Rd Ste 260', 'Humble', 'Harris', 'TX', '77346', '2818121846', '2818122778', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-22', NULL, 0, 0, 0, 'Kingwood Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1831187004', 0, 'N', 0, '2013-09-06', NULL, NULL, 29.9892, -95.1906, NULL, NULL),
('760151142', 'W12036547', 'W12036547', 'TXHOUSTD', 'Mehta Medical Group', 'Jeff', 'C', 'Wang', 'MD', 'Internal Medicine', '', '', NULL, 'O', '8901 FM 1960 Bypass Rd W Ste 101', 'Humble', 'Harris', 'TX', '77338', '2814467173', '2814463841', '8901 FM 1960 Bypass Rd W Ste 101', 'Humble', 'Harris', 'TX', '77338', '2814467173', '2814463841', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-22', NULL, 0, 0, 0, 'Kingwood Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1558357988', 0, 'N', 0, '2013-09-06', NULL, NULL, 30.005, -95.2895, NULL, NULL),
('760151142', 'W12036549', 'W12036549', 'TXHOUSTD', 'Mehta Medical Group', 'Tejas', 'N', 'Mehta', 'MD', 'Internal Medicine', '', '', NULL, 'O', '8901 FM 1960 Bypass Rd W Ste 101', 'Humble', 'Harris', 'TX', '77338', '2814467173', '2814463841', '8901 FM 1960 Bypass Rd W Ste 101', 'Humble', 'Harris', 'TX', '77338', '2814467173', '2814463841', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-22', NULL, 0, 0, 0, 'Kingwood Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1518956143', 0, 'N', 0, '2013-09-06', NULL, NULL, 30.005, -95.2895, NULL, NULL),
('760151142', 'W12036551', 'W12036551', 'TXHOUSTD', 'Mehta Medical Group', 'Chhay', '', 'Tay', 'MD', 'Endocrinology', '', '', NULL, 'O', '8901 FM 1960 Bypass Rd W Ste 101', 'Humble', 'Harris', 'TX', '77338', '2814467173', '2814463841', '8901 FM 1960 Bypass Rd W Ste 101', 'Humble', 'Harris', 'TX', '77338', '2814467173', '2814463841', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-22', NULL, 0, 0, 0, 'Kingwood Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1962460741', 0, 'N', 0, '2013-09-06', NULL, NULL, 30.005, -95.2895, NULL, NULL),
('760151142', 'W12036553', 'W12036553', 'TXHOUSTD', 'Mehta Medical Group', 'Navnit', 'R', 'Mehta', 'MD', 'Family Practice', '', '', NULL, 'O', '8901 FM 1960 Bypass Rd W Ste 101', 'Humble', 'Harris', 'TX', '77338', '2814467173', '2814463841', '8901 FM 1960 Bypass Rd W Ste 101', 'Humble', 'Harris', 'TX', '77338', '2814467173', '2814463841', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-22', NULL, 0, 0, 0, 'Kingwood Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1629064373', 0, 'N', 0, '2014-02-12', NULL, NULL, 30.005, -95.2895, NULL, NULL),
('760584749', 'W12036554', 'W12036554', 'TXHOUSTD', 'John Codwell', 'John', '', 'Codwell', 'DPM', 'Podiatry', '', '', NULL, 'O', '5105 San Jacinto', 'Houston', 'Harris', 'TX', '77004', '7135260600', '7135267121', '5105 San Jacinto', 'Houston', 'Harris', 'TX', '77004', '7135260600', '7135267121', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-15', NULL, 0, 0, 0, 'The Womans Hospital of Texas', NULL, NULL, NULL, 'HCFA|UB', '1649260092', 0, 'N', 0, '2013-08-15', NULL, NULL, 29.7281, -95.3853, NULL, NULL),
('202160478', 'W12036555', 'W12036555', 'TXHOUSTD', 'Silverlake Pediatric Clinic ', 'Nita', 'S', 'Gandhi', 'MD', 'Pediatrics', '', '', NULL, 'O', '9721 Broadway St Ste 111', 'Pearland', 'Brazoria', 'TX', '77584', '7134363637', '7134363639', '9721 Broadway St Ste 111', 'Pearland', 'Brazoria', 'TX', '77584', '7134363637', '7134363639', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-22', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1467422956', 0, 'N', 0, '2013-08-22', NULL, NULL, 29.5563, -95.3715, NULL, NULL),
('202160478', 'W12036556', 'W12036556', 'TXHOUSTD', 'Silverlake Pediatric Clinic ', 'Nita', 'S', 'Gandhi', 'MD', 'Pediatrics', '', '', NULL, 'B', 'PO Box 891445', 'Houston', 'Harris', 'TX', '77289', '7134363637', '7134363639', 'PO Box 891445', 'Houston', 'Harris', 'TX', '77289', '7134363637', '7134363639', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-22', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1467422956', 0, 'N', 0, '2013-08-22', NULL, NULL, 0, 0, NULL, NULL),
('462944049', 'W12036558', 'W12036558', 'ID01', 'St Alphonsus Regional Medical Center', 'Abhilash', 'K', 'Desai', 'MD', 'Mental Health', 'Psychiatry', '', NULL, 'O', '131 N Allumbaugh', 'Boise', 'Ada', 'ID', '83704', '2083672175', '2083760285', '131 N Allumbaugh', 'Boise', 'Ada', 'ID', '83704', '2083672175', '2083760285', 'IDMD', '', '', '0.00', '40.00', '0.00', 3, '2013-10-22', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1366519084', 0, 'N', 0, '2013-10-22', NULL, NULL, 43.6062, -116.266, NULL, NULL),
('462944049', 'W12036557', 'W12036557', 'ID01', 'Idaho Memory and Aging Center', 'Abhilash', 'K', 'Desai', 'MD', 'Mental Health', 'Psychiatry', '', NULL, 'O', '413 N Allumbaugh Ste 101', 'Boise', 'Ada', 'ID', '83704', '2083231125', '2083239604', '413 N Allumbaugh Ste 101', 'Boise', 'Ada', 'ID', '83704', '2083231125', '2083239604', 'IDMD', '', '', '0.00', '40.00', '0.00', 3, '2013-10-22', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1366519084', 0, 'N', 0, '2013-10-22', NULL, NULL, 43.6087, -116.266, NULL, NULL),
('364286236', 'W12036561', 'W12036561', 'ILCHIGSTD', 'Presence Advanced Imaging Presence Center for Health', '', '', 'Presence Advanced Imaging Presence Center for Health', '', 'Imaging Center', NULL, NULL, NULL, 'B', 'PO Box 6670', 'River Forest', 'Cook', 'IL', '60305', '7086758161', NULL, 'PO Box 6670', 'River Forest', 'Cook', 'IL', '60305', '7086758161', '          ', 'PRE150ASPDME', 'PRES150', '', '0.00', '0.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1851628630', 0, 'N', 0, '2013-12-09', NULL, NULL, 0, 0, NULL, NULL),
('364286236', 'W12036560', 'W12036560', 'ILCHIGSTD', 'Presence Advanced Imaging Presence Center for Health', '', '', 'Presence Advanced Imaging Presence Center for Health', '', 'Imaging Center', NULL, NULL, NULL, 'O', '3101 N Harlem Ave', 'Chicago', 'Cook', 'IL', '60634', '7738369360', NULL, '3101 N Harlem Ave', 'Chicago', 'Cook', 'IL', '60634', '7738369360', '          ', 'PRE150ASPDME', 'PRES150', '', '0.00', '0.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1851628630', 0, 'Y', 0, '2013-12-09', NULL, NULL, 41.9364, -87.8067, NULL, NULL),
('364286236', 'W12036563', 'W12036563', 'ILCHIGSTD', 'Presence Advanced Imaging Center', '', '', 'Presence Advanced Imaging Center', '', 'Imaging Center', '', '', NULL, 'O', '205 S NW Hwy Ste 110', 'Park Ridge', 'Cook', 'IL', '60068', '8472925200', NULL, '205 S NW Hwy Ste 110', 'Park Ridge', 'Cook', 'IL', '60068', '8472925200', '          ', 'PRE150ASPDME', 'PRES150', '', '0.00', '0.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1164780144', 0, 'Y', 0, '2013-08-14', NULL, NULL, 42.0091, -87.8262, NULL, NULL),
('364286236', 'W12036564', 'W12036564', 'ILCHIGSTD', 'Resurrection Health Care Physicians', '', '', 'Presence Advanced Imaging Center', '', 'Imaging Center', '', '', NULL, 'B', '62311 Collections Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '8002732614', NULL, '62311 Collections Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '8002732614', '          ', 'PRE150ASPDME', 'PRES150', '', '0.00', '0.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1164780144', 0, 'N', 0, '2013-08-14', NULL, NULL, 0, 0, NULL, NULL),
('460483581', 'W12036569', 'W12036569', 'ILCHIGSTD', 'Presence Home Health Joliet', '', '', 'Presence Home Care Joliet', '', 'Home Health Agency', NULL, NULL, NULL, 'O', '1060 Essington Rd', 'Joliet', 'Will', 'IL', '60435', '8157417371', NULL, '1060 Essington Rd', 'Joliet', 'Will', 'IL', '60435', '8157417371', '          ', 'PRE150ASPDME', 'PRES150', '', '0.00', '0.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1881645125', 0, 'Y', 0, '2013-09-11', NULL, NULL, 41.541, -88.1608, NULL, NULL),
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('870526286', 'W12036580', 'W12036580', 'UT01', 'Wasatch Internal Medicine', 'Joseph', '', 'Nelson', 'DO', 'Family Practice', '', '', NULL, 'B', 'PO Box 29675 Dept 2062', 'Phoenix', 'Maricopa', 'AZ', '85038', '8017477265', '8017477237', 'PO Box 29675 Dept 2062', 'Phoenix', 'Maricopa', 'AZ', '85038', '8017477265', '8017477237', 'WUWASIM5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-08-15', NULL, 0, 0, 0, 'Mountain West Medical Center', '', '', '', 'HCFA|UB|', '1316122427', 0, 'N', 0, '2013-08-16', NULL, NULL, 0, 0, NULL, NULL),
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('621801973', 'W12036583', 'W12036583', 'UT01', 'Pioneer Valley Hospital Outpatient Behavioral Health Unit', 'Enrique', '', 'Alfaro', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '0000000000', '0000000000', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '0000000000', '0000000000', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-08-01', '2013-08-01', 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1184606279', 0, 'N', 0, '2014-02-26', NULL, NULL, 0, 0, NULL, NULL),
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('752536818', 'W12036584', 'W12036584', 'TXDALSTD', 'Health Texas Provider Network', 'Eric', 'E', 'Robinson', 'DO', 'Internal Medicine', '', '', NULL, 'O', '1901 N MacArthur Blvd', 'Irving', 'Dallas', 'TX', '75061', '9725798485', '9725793972', '1901 N MacArthur Blvd', 'Irving', 'Dallas', 'TX', '75061', '9725798485', '9725793972', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Baylor Medical Center at Irving', NULL, '', '', 'HCFA|UB|', '1922324359', 0, 'N', 0, '2013-09-17', NULL, NULL, 32.8341, -96.9592, NULL, NULL),
('911947573', 'W12036586', 'W12036586', 'TXDALSTD', '', 'Eric', 'E', 'Robinson', 'DO', 'Internal Medicine', '', '', NULL, 'O', '1405 W Jefferson St', 'Waxahachie', 'Ellis', 'TX', '75165', '9729237144', '9729237145', '1405 W Jefferson St', 'Waxahachie', 'Ellis', 'TX', '75165', '9729237144', '9729237145', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Baylor Medical Center at Irving', NULL, '', '', 'HCFA|UB|', '1922324359', 0, 'N', 0, '2014-01-24', NULL, NULL, 32.3968, -96.865, 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
('911947573', 'W12036587', 'W12036587', 'TXDALSTD', '', 'Eric', 'E', 'Robinson', 'DO', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 842001', 'Dallas', 'Dallas', 'TX', '75284', '9729237144', '9729237145', 'PO Box 842001', 'Dallas', 'Dallas', 'TX', '75284', '9729237144', '9729237145', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Baylor Medical Center at Irving', NULL, '', '', 'HCFA|UB|', '1922324359', 0, 'N', 0, '2014-01-24', NULL, NULL, 0, 0, NULL, NULL),
('850275777', 'W12036588', 'W12036588', 'NM01', 'Southwest Medical Associates', 'Katherine', 'E', 'Schwarz', 'MD', 'Gynecology', '', '', NULL, 'O', '4420 Irving Blvd NW', 'Albuquerque', 'Bernalillo', 'NM', '87114', '5058231010', '5057974503', '4420 Irving Blvd NW', 'Albuquerque', 'Bernalillo', 'NM', '87114', '5058231010', '5057974503', 'NMSWMED', '', '', '0.00', '10.00', '0.00', 3, '2013-09-15', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1952574006', 0, 'N', 0, '2014-01-08', NULL, NULL, 35.1902, -106.665, NULL, NULL),
('850275777', 'W12036589', 'W12036589', 'NM01', 'Southwest Medical Associates', 'Katherine', 'E', 'Schwarz', 'MD', 'Gynecology', '', '', NULL, 'O', '8401 Constitution NE Ste 150', 'Albuquerque', 'Bernalillo', 'NM', '87110', '5058231010', '5057974503', '8401 Constitution NE Ste 150', 'Albuquerque', 'Bernalillo', 'NM', '87110', '5058231010', '5057974503', 'NMSWMED', '', '', '0.00', '10.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1952574006', 0, 'N', 0, '2014-01-08', NULL, NULL, 35.0946, -106.552, NULL, NULL),
('850275777', 'W12036590', 'W12036590', 'NM01', 'Southwest Medical Associates', 'Katherine', 'E', 'Schwarz', 'MD', 'Gynecology', '', '', NULL, 'O', '10511 Golf Course Rd Ste 205', 'Albuquerque', 'Bernalillo', 'NM', '87114', '5058231010', '5057974503', '10511 Golf Course Rd Ste 205', 'Albuquerque', 'Bernalillo', 'NM', '87114', '5058231010', '5057974503', 'NMSWMED', '', '', '0.00', '10.00', '0.00', 3, '2013-11-01', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1952574006', 0, 'N', 0, '2014-01-08', NULL, NULL, 35.2073, -106.676, NULL, NULL),
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('850275777', 'W12036592', 'W12036592', 'NM01', 'Southwest Medical Associates', 'Ronald', '', 'Deyhle ', 'MD', 'Gynecology', '', '', NULL, 'O', '4705 Montgomery Blvd NE Ste 301-302', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5057274500', '5057974503', '4705 Montgomery Blvd NE Ste 301-302', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5057274500', '5057974503', 'NMSWMED', '', '', '0.00', '10.00', '0.00', 3, '2013-10-14', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1740259977', 0, 'N', 0, '2014-07-18', NULL, NULL, 35.131, -106.591, NULL, NULL),
('850275777', 'W12036593', 'W12036593', 'NM01', 'Southwest Medical Associates', 'Ronald', '', 'Deyhle ', 'MD', 'Gynecology', '', '', NULL, 'O', '8401 Constitution NE Ste 150', 'Albuquerque', 'Bernalillo', 'NM', '87110', '5058231010', '5057974503', '8401 Constitution NE Ste 150', 'Albuquerque', 'Bernalillo', 'NM', '87110', '5058231010', '5057974503', 'NMSWMED', '', '', '0.00', '10.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1740259977', 0, 'N', 0, '2013-10-30', NULL, NULL, 35.0946, -106.552, NULL, NULL),
('850275777', 'W12036594', 'W12036594', 'NM01', 'Southwest Medical Associates', 'Ronald', '', 'Deyhle ', 'MD', 'Gynecology', '', '', NULL, 'O', '4420 Irving Blvd NW', 'Albuquerque', 'Bernalillo', 'NM', '87114', '5058231010', '5057974503', '4420 Irving Blvd NW', 'Albuquerque', 'Bernalillo', 'NM', '87114', '5058231010', '5057974503', 'NMSWMED', '', '', '0.00', '10.00', '0.00', 3, '2013-09-15', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1740259977', 0, 'N', 0, '2013-10-30', NULL, NULL, 35.1902, -106.665, NULL, NULL),
('850275777', 'W12036595', 'W12036595', 'NM01', 'Southwest Medical Associates', 'Ronald', '', 'Deyhle ', 'MD', 'Gynecology', '', '', NULL, 'O', '10511 Golf Course Rd Ste 205', 'Albuquerque', 'Bernalillo', 'NM', '87114', '5058231010', '5057974503', '10511 Golf Course Rd Ste 205', 'Albuquerque', 'Bernalillo', 'NM', '87114', '5058231010', '5057974503', 'NMSWMED', '', '', '0.00', '10.00', '0.00', 3, '2013-11-01', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1740259977', 0, 'N', 0, '2013-10-30', NULL, NULL, 35.2073, -106.676, NULL, NULL),
('742592013', 'W12036597', 'W12036597', 'TXSATSTD', 'Dermatology Associates of San Antonio', 'Karla', 'N', 'Munoz', 'MD', 'Dermatology', '', '', NULL, 'O', '15900 LaCantera Pkwy Ste 20270', 'San Antonio', 'Bexar', 'TX', '78256', '2106419500', NULL, '15900 LaCantera Pkwy Ste 20270', 'San Antonio', 'Bexar', 'TX', '78256', '2106419500', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-12-01', NULL, 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1740324862', 0, 'N', 0, '2013-11-13', NULL, NULL, 29.5892, -98.6196, NULL, NULL),
('412237612', 'W12036601', 'W12036601', 'ILCHIGSTD', 'Belmont Harlem Surgery Center', '', '', 'Belmont Harlem Surgery Center', '', 'Ambulatory Surgery Center', '', '', NULL, 'B', '3115 N Harlem', 'Chicago', 'Cook', 'IL', '60634', '7738892000', '7737973606', '3115 N Harlem', 'Chicago', 'Cook', 'IL', '60634', '7738892000', '7737973606', 'PRE150ASPDME', 'PRES150', '', '0.00', '0.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1003939554', 0, 'Y', 0, '2013-08-14', NULL, NULL, 0, 0, NULL, NULL),
('412237612', 'W12036600', 'W12036600', 'ILCHIGSTD', 'Belmont Harlem Surgery Center', '', '', 'Belmont Harlem Surgery Center', '', 'Ambulatory Surgery Center', '', '', NULL, 'O', '3101 N Harlem Ave', 'Chicago', 'Cook', 'IL', '60634', '7738892000', '7737973606', '3101 N Harlem Ave', 'Chicago', 'Cook', 'IL', '60634', '7738892000', '7737973606', 'PRE150ASPDME', 'PRES150', '', '0.00', '0.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1003939554', 0, 'Y', 0, '2013-08-14', NULL, NULL, 41.9364, -87.8067, NULL, NULL),
('362893936', 'W12036603', 'W12036603', 'ILCHIGSTD', 'Presence Home Care Services', '', '', 'Presence Home Care Services', '', 'Home Health Agency', NULL, NULL, NULL, 'O', '2380 E Dempster', 'Des Plaines', 'Cook', 'IL', '60016', '8474934800', NULL, '2380 E Dempster', 'Des Plaines', 'Cook', 'IL', '60016', '8474934800', '          ', 'PRE150ASPDME', 'PRES150', '', '0.00', '0.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1821198946', 0, 'Y', 0, '2013-09-11', NULL, NULL, 42.0392, -87.8651, NULL, NULL),
('262819763', 'W12036607', 'W12036607', 'ILCHIGSTD', 'Presence Sleep Care', '', '', 'Presence Sleep Care', '', 'Sleep Studies', '', '', NULL, 'O', '7411 W Lake St Ste Lower Level 110', 'River Forest', 'Cook', 'IL', '60305', '6306527900', NULL, '7411 W Lake St Ste Lower Level 110', 'River Forest', 'Cook', 'IL', '60305', '6306527900', '          ', 'PRE150ASPDME', 'PRES150', '', '0.00', '0.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1952538803', 0, 'Y', 0, '2013-10-09', NULL, NULL, 41.8885, -87.8103, NULL, NULL),
('262819763', 'W12036608', 'W12036608', 'ILCHIGSTD', 'Presence Sleep Care', '', '', 'Presence Sleep Care', '', 'Sleep Studies', '', '', NULL, 'B', '1300 S Main St Unit F', 'Lombard', 'Dupage', 'IL', '60148', '6306527900', NULL, '1300 S Main St Unit F', 'Lombard', 'Dupage', 'IL', '60148', '6306527900', '          ', 'PRE150ASPDME', 'PRES150', '', '0.00', '0.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1952538803', 0, 'Y', 0, '2013-10-09', NULL, NULL, 0, 0, NULL, NULL),
('237061646', 'W12036610', 'W12036610', 'ILCHIGSTD', 'Presence Ballard Nursing Center', '', '', 'Presence Ballard Nursing Center', '', 'Skilled Nursing Facility', NULL, NULL, NULL, 'O', '9300 Ballard Rd', 'Des Plaines', 'Cook', 'IL', '60016', '8472942300', NULL, '9300 Ballard Rd', 'Des Plaines', 'Cook', 'IL', '60016', '8472942300', '          ', 'PRE150ASPDME', 'PRES150', '', '0.00', '0.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1932497625', 0, 'N', 0, '2013-12-09', NULL, NULL, 42.0433, -87.8569, NULL, NULL),
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('362709982', 'W12036627', 'W12036627', 'ILCHIGSTD', 'Presence Behavioral Health', '', '', 'Presence Behavioral Health', '', 'Mental Health', NULL, NULL, NULL, 'O', '1820 S 25th Ave', 'Broadview', 'Cook', 'IL', '60155', '7083383806', '          ', '1820 S 25th Ave', 'Broadview', 'Cook', 'IL', '60155', '7083383806', '          ', 'PRE150ASPDME', 'PRES150', '', '0.00', '0.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1477622298', 0, 'Y', 0, '2014-04-01', NULL, NULL, 41.8698, -87.8635, NULL, NULL),
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('362709982', 'W12036633', 'W12036633', 'ILCHIGSTD', 'Presence Behavioral Health', '', '', 'Presence Behavioral Health', '', 'Mental Health', NULL, NULL, NULL, 'O', '355 Ridge Ave', 'Evanston', 'Cook', 'IL', '60202', '7084100615', NULL, '355 Ridge Ave', 'Evanston', 'Cook', 'IL', '60202', '7084100615', '          ', 'PRE150ASPDME', 'PRES150', '', '0.00', '0.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1477622298', 0, 'Y', 0, '2013-10-15', NULL, NULL, 42.024, -87.6852, NULL, NULL),
('362709982', 'W12036634', 'W12036634', 'ILCHIGSTD', 'Presence Behavioral Health', '', '', 'Presence Behavioral Health', '', 'Mental Health', NULL, NULL, NULL, 'O', '7435 W Talcott Ave', 'Chicago', 'Cook', 'IL', '60631', '7084100615', NULL, '7435 W Talcott Ave', 'Chicago', 'Cook', 'IL', '60631', '7084100615', '          ', 'PRE150ASPDME', 'PRES150', '', '0.00', '0.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1477622298', 0, 'Y', 0, '2013-10-15', NULL, NULL, 41.9884, -87.8124, NULL, NULL),
('362709982', 'W12036635', 'W12036635', 'ILCHIGSTD', 'Presence Behavioral Health', '', '', 'Presence Behavioral Health', '', 'Mental Health', NULL, NULL, NULL, 'O', '5645 W Addison St', 'Chicago', 'Cook', 'IL', '60634', '7084100615', NULL, '5645 W Addison St', 'Chicago', 'Cook', 'IL', '60634', '7084100615', '          ', 'PRE150ASPDME', 'PRES150', '', '0.00', '0.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1477622298', 0, 'Y', 0, '2013-10-15', NULL, NULL, 41.9459, -87.7678, NULL, NULL),
('362709982', 'W12036636', 'W12036636', 'ILCHIGSTD', 'Presence Behavioral Health', '', '', 'Presence Behavioral Health', '', 'Mental Health', NULL, NULL, NULL, 'O', '117 S 6th Ave', 'Maywood', 'Cook', 'IL', '60153', '7084100615', '          ', '117 S 6th Ave', 'Maywood', 'Cook', 'IL', '60153', '7084100615', '          ', 'PRE150ASPDME', 'PRES150', '', '0.00', '0.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1477622298', 0, 'Y', 0, '2014-04-01', NULL, NULL, 41.8875, -87.8401, NULL, NULL),
('461214792', 'W12036637', 'W12036637', 'UT01', 'Intermountain Allergy and Asthma Draper', 'Duane', 'J', 'Harris', 'MD', 'Allergy and Immunology', '', '', NULL, 'O', '1490 E Foremaster Dr Ste 300', 'St George', 'Washington', 'UT', '84790', '8015531900', '8015539995', '1490 E Foremaster Dr Ste 300', 'St George', 'Washington', 'UT', '84790', '8015531900', '8015539995', 'WiseSTD6A', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-08-07', NULL, 0, 0, 0, 'Jordan Valley Medical Center', '', '', '', 'HCFA|UB|', '1275535411', 0, 'N', 0, '2013-08-14', NULL, NULL, 37.0959, -113.551, NULL, NULL),
('363330928', 'W12036638', 'W12036638', 'ILCHIGSTD', 'Presence Healthcare Services', 'Warren', 'M', 'Brandwein', 'MD', 'Diagnostic Radiology', '', '', NULL, 'O', '7435 W Talcott Ave', 'Chicago', 'Cook', 'IL', '60631', '7737925199', '7735947981', '7435 W Talcott Ave', 'Chicago', 'Cook', 'IL', '60631', '7737925199', '7735947981', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1255537858', 0, 'Y', 0, '2014-04-01', NULL, NULL, 41.9884, -87.8124, NULL, NULL),
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('363330928', 'W12036641', 'W12036641', 'ILCHIGSTD', 'Presence Ambulatory Services', 'Warren', 'M', 'Brandwein', 'MD', 'Diagnostic Radiology', '', '', NULL, 'O', '205 S NW Hwy', 'Park Ridge', 'Cook', 'IL', '60068', '8472925200', '8472925239', '205 S NW Hwy', 'Park Ridge', 'Cook', 'IL', '60068', '8472925200', '8472925239', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1255537858', 0, 'Y', 0, '2014-04-01', NULL, NULL, 42.0091, -87.8262, NULL, NULL),
('621801973', 'W12036642', 'W12036642', 'UT01', 'PVH Outpatient Behavioral Health Unit', 'Nancy', '', 'Lieu', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '4052 W Pioneer Pkwy Ste 105', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019643111', '8019643752', '4052 W Pioneer Pkwy Ste 105', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019643111', '8019643752', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-08-01', '2014-04-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1205124021', 0, 'N', 0, '2014-02-04', NULL, NULL, 40.6985, -111.988, NULL, NULL),
('621801973', 'W12036643', 'W12036643', 'UT01', 'PVH Outpatient Behavioral Health Unit', 'Nancy', '', 'Lieu', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-08-01', '2014-04-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1205124021', 0, 'N', 0, '2014-02-04', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W12036644', 'W12036644', 'UT01', 'Physician Group of Utah', 'Nancy', '', 'Lieu', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'M', '406 W South Jordan Pkwy Ste 450', 'South Jordan', 'Salt Lake', 'UT', '84095', '0000000000', NULL, '406 W South Jordan Pkwy Ste 450', 'South Jordan', 'Salt Lake', 'UT', '84095', '0000000000', '          ', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-08-01', '2014-04-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1205124021', 0, 'N', 0, '2014-02-04', NULL, NULL, 0, 0, NULL, NULL),
('454751081', 'W12036645', 'W12036645', 'UTMH1', 'Centered Approach Counseling ', 'Nancy', '', 'Lieu', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '4190 S Highland Dr Ste 220', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8016489156', '8669238689', '4190 S Highland Dr Ste 220', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8016489156', '8669238689', 'UTMA', '', '', '0.00', '40.00', '0.00', 3, '2013-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1205124021', 0, 'N', 0, '2014-02-04', NULL, NULL, 40.6807, -111.843, NULL, NULL),
('454751081', 'W12036646', 'W12036646', 'UTMH1', 'Centered Approach Counseling ', 'AmberMae', '', 'Adams', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '4190 S Highland Dr Ste 220', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8016489156', '8669238689', '4190 S Highland Dr Ste 220', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8016489156', '8669238689', 'UTMA', '', '', '0.00', '40.00', '0.00', 3, '2013-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1598030447', 0, 'N', 0, '2014-01-02', NULL, NULL, 40.6807, -111.843, NULL, NULL),
('454751081', 'W12036648', 'W12036648', 'UTMH1', 'Centered Approach Counseling ', 'Phuong', '', 'Le', 'LCSW', 'Mental Health', 'Counseling', '', NULL, 'O', '4190 S Highland Dr Ste 220', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8016489156', '8669238689', '4190 S Highland Dr Ste 220', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8016489156', '8669238689', 'UTMA', '', '', '0.00', '40.00', '0.00', 3, '2013-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1831169341', 0, 'N', 0, '2014-02-04', NULL, NULL, 40.6807, -111.843, NULL, NULL),
('621801973', 'W12036649', 'W12036649', 'UT01', 'Pioneer Valley Hospital Outpatient Behavioral Health Unit', 'Phuong', '', 'Le', 'LCSW', 'Mental Health', 'Counseling', '', NULL, 'O', '4052 W Pioneer Pkwy Ste 105', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019643111', '8019643752', '4052 W Pioneer Pkwy Ste 105', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019643111', '8019643752', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-08-01', '2014-04-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1831169341', 0, 'N', 0, '2014-02-04', NULL, NULL, 40.6985, -111.988, NULL, NULL),
('621801973', 'W12036650', 'W12036650', 'UT01', 'Pioneer Valley Hospital Outpatient Behavioral Health Unit', 'Phuong', '', 'Le', 'LCSW', 'Mental Health', 'Counseling', '', NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-08-01', '2014-04-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1831169341', 0, 'N', 0, '2014-02-04', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W12036651', 'W12036651', 'UT01', 'Pioneer Valley Hospital Outpatient Behavioral Health Unit', 'Phuong', '', 'Le', 'LCSW', 'Mental Health', 'Counseling', '', NULL, 'M', '406 W South Jordan Pkwy Ste 450', 'South Jordan', 'Salt Lake', 'UT', '84095', '0000000000', '0000000000', '406 W South Jordan Pkwy Ste 450', 'South Jordan', 'Salt Lake', 'UT', '84095', '0000000000', '0000000000', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-08-01', '2014-04-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1831169341', 0, 'N', 0, '2014-02-04', NULL, NULL, 0, 0, NULL, NULL),
('870519691', 'W12036652', 'W12036652', 'UT01', 'Utah Cancer Specialists', 'Justin', 'A', 'Call', 'MD', 'Hematology and Oncology', '', '', NULL, 'O', '3590 W 9000 S Ste 100', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015628732', '8012675633', '3590 W 9000 S Ste 100', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015628732', '8012675633', 'WUSTDONC5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-10-01', NULL, 0, 0, 0, 'St Marks Hospital', 'Lakeview Hospital', '', '', 'HCFA|UB|', '1124172697', 0, 'N', 0, '2013-09-10', NULL, NULL, 40.5879, -111.976, NULL, NULL),
('870519691', 'W12036654', 'W12036654', 'UT01', 'Utah Cancer Specialists', 'Justin', 'A', 'Call', 'MD', 'Hematology and Oncology', '', '', NULL, 'B', '1121 E 3900 S Bldg C Ste 240', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012660878', NULL, '1121 E 3900 S Bldg C Ste 240', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012660878', '          ', 'WUSTDONC5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-10-01', NULL, 0, 0, 0, 'St Marks Hospital', 'Lakeview Hospital', '', '', 'HCFA|UB|', '1124172697', 0, 'N', 0, '2013-09-10', NULL, NULL, 0, 0, NULL, NULL),
('870519691', 'W12036655', 'W12036655', 'UT01', 'Utah Cancer Specialists', 'Justin', 'A', 'Call', 'MD', 'Hematology and Oncology', '', '', NULL, 'B', '3838 S 700 E Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8012690231', '8012690304', '3838 S 700 E Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8012690231', '8012690304', 'WUSTDONC5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-10-01', NULL, 0, 0, 0, 'St Marks Hospital', 'Lakeview Hospital', '', '', 'HCFA|UB|', '1124172697', 0, 'N', 0, '2013-09-10', NULL, NULL, 0, 0, NULL, NULL),
('870519691', 'W12036653', 'W12036653', 'UT01', 'Utah Cancer Specialists', 'Justin', 'A', 'Call', 'MD', 'Hematology and Oncology', '', '', NULL, 'O', '5131 S Cottonwood St Ste L-2', 'Murray', 'Salt Lake', 'UT', '84107', '8012633416', '8012633428', '5131 S Cottonwood St Ste L-2', 'Murray', 'Salt Lake', 'UT', '84107', '8012633416', '8012633428', 'WUSTDONC5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-10-01', NULL, 0, 0, 0, 'St Marks Hospital', 'Lakeview Hospital', '', '', 'HCFA|UB|', '1124172697', 0, 'N', 0, '2013-09-10', NULL, NULL, 40.6594, -111.894, NULL, NULL),
('202630141', 'W12036656', 'W12036656', 'IDBOISTD', 'Primary Health Medical Group', 'Cyrus', 'H', 'Vania', 'DO', 'Family Practice', '', '', NULL, 'O', '8971 W Overland', 'Boise', 'Ada', 'ID', '83709', '2083784288', '2083784297', '8971 W Overland', 'Boise', 'Ada', 'ID', '83709', '2083784288', '2083784297', 'IDPRIMARY', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2013-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1740593862', 0, 'N', 0, '2013-09-10', NULL, NULL, 43.5903, -116.294, NULL, NULL),
('202630141', 'W12036657', 'W12036657', 'IDBOISTD', 'Primary Health Medical Group', 'Cyrus', 'H', 'Vania', 'DO', 'Family Practice', '', '', NULL, 'B', 'PO Box 191050', 'Boise', 'Ada', 'ID', '83719', '2083784288', '2083784297', 'PO Box 191050', 'Boise', 'Ada', 'ID', '83719', '2083784288', '2083784297', 'IDPRIMARY', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2013-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1740593862', 0, 'N', 0, '2013-09-10', NULL, NULL, 0, 0, NULL, NULL),
('870519691', 'W12036659', 'W12036659', 'UT01', 'Utah Cancer Specialists', 'Gregory', '', 'Chipman', 'MD', 'Hematology and Oncology', '', '', NULL, 'O', '1034 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013577200', '8013577201', '1034 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013577200', '8013577201', 'WUSTDONC5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-10-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', '', '', '', 'HCFA|UB|', '1457493967', 0, 'N', 0, '2013-09-10', NULL, NULL, 40.2469, -111.667, NULL, NULL),
('870519691', 'W12036658', 'W12036658', 'UT01', 'Utah Cancer Specialists', 'Gregory', '', 'Chipman', 'MD', 'Hematology and Oncology', '', '', NULL, 'B', '1121 E 3900 S Ste C230', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '0000000000', NULL, '1121 E 3900 S Ste C230', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '0000000000', '          ', 'WUSTDONC5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-10-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', '', '', '', 'HCFA|UB|', '1457493967', 0, 'N', 0, '2013-09-10', NULL, NULL, 0, 0, NULL, NULL),
('870519691', 'W12036660', 'W12036660', 'UT01', 'Utah Cancer Specialists', 'Gregory', '', 'Chipman', 'MD', 'Hematology and Oncology', '', '', NULL, 'O', '48 N 1100 E Ste B', 'American Fork', 'Utah', 'UT', '84003', '8014929934', '8014929936', '48 N 1100 E Ste B', 'American Fork', 'Utah', 'UT', '84003', '8014929934', '8014929936', 'WUSTDONC5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-10-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', '', '', '', 'HCFA|UB|', '1457493967', 0, 'N', 0, '2013-09-10', NULL, NULL, 40.3774, -111.769, NULL, NULL),
('611582055', 'W12036674', 'W12036674', 'TXDALSTD', 'Nadia Malik MD', 'Nadia', '', 'Malik', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 294', 'Colleyville', 'Tarrant', 'TX', '76034', '8174581525', '8175454438', 'PO Box 294', 'Colleyville', 'Tarrant', 'TX', '76034', '8174581525', '8175454438', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-15', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Grapevine', NULL, '', '', 'HCFA|UB', '1891834172', 0, 'N', 0, '2013-11-11', NULL, NULL, 0, 0, NULL, NULL),
('611582055', 'W12036673', 'W12036673', 'TXDALSTD', 'Nadia Malik MD', 'Nadia', '', 'Malik', 'MD', 'Internal Medicine', '', '', NULL, 'O', '4100 Heritage Ave Ste 105', 'Grapevine', 'Tarrant', 'TX', '76051', '6829998446', '8175454438', '4100 Heritage Ave Ste 105', 'Grapevine', 'Tarrant', 'TX', '76051', '6829998446', '8175454438', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-15', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Grapevine', NULL, '', '', 'HCFA|UB', '1891834172', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.8922, -97.1055, NULL, NULL),
('752242607', 'W12036671', 'W12036671', 'TXDALSTD', 'Ear Consultants of the Southwest', 'Cherie', 'L', 'Booth', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '4104 Junius St', 'Dallas', 'Dallas', 'TX', '75246', '2147422194', '2148270162', '4104 Junius St', 'Dallas', 'Dallas', 'TX', '75246', '2147422194', '2148270162', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, '', '', 'HCFA|UB', '1003096819', 0, 'N', 0, '2014-04-25', NULL, NULL, 32.793, -96.7758, NULL, NULL),
('752242607', 'W12036672', 'W12036672', 'TXDALSTD', 'Ear Consultants of the Southwest', 'Cherie', 'L', 'Booth', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '4708 Alliance Blvd Pav I Ste 860', 'Plano', 'Collin', 'TX', '75093', '4698140928', '4698140955', '4708 Alliance Blvd Pav I Ste 860', 'Plano', 'Collin', 'TX', '75093', '4698140928', '4698140955', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, '', '', 'HCFA|UB', '1003096819', 0, 'N', 0, '2014-04-25', NULL, NULL, 33.0145, -96.7925, NULL, NULL),
('208866512', 'W12036676', 'W12036676', 'TXDALSTD', 'Felicia Ochei MD PLLC', 'Nnalu', 'F', 'Ochei', 'MD', 'Pediatrics', '', '', NULL, 'O', '860 Hebron Pkwy Ste 202', 'Lewisville', 'Denton', 'TX', '75057', '9723153705', '9723153502', '860 Hebron Pkwy Ste 202', 'Lewisville', 'Denton', 'TX', '75057', '9723153705', '9723153502', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-15', NULL, 0, 0, 0, 'Baylor Medical Center at Waxahachie', NULL, NULL, NULL, 'HCFA|UB|', '1912010034', 0, 'N', 0, '2013-11-11', NULL, NULL, 33.0141, -96.9602, NULL, NULL),
('752242607', 'W12036679', 'W12036679', 'TXDALSTD', 'Ear Consultants of the Southwest', 'Fred', 'D', 'Owens', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '1001 12th Ave Ste 130', 'Fort Worth', 'Tarrant', 'TX', '76104', '8173323277', '8173323299', '1001 12th Ave Ste 130', 'Fort Worth', 'Tarrant', 'TX', '76104', '8173323277', '8173323299', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, '', '', 'HCFA|UB', '1003884768', 0, 'N', 0, '2014-04-25', NULL, NULL, 32.7342, -97.3475, NULL, NULL),
('752242607', 'W12036678', 'W12036678', 'TXDALSTD', 'Ear Consultants of the Southwest', 'Fred', 'D', 'Owens', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '4104 Junius St', 'Dallas', 'Dallas', 'TX', '75246', '2147422194', '2148270162', '4104 Junius St', 'Dallas', 'Dallas', 'TX', '75246', '2147422194', '2148270162', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, '', '', 'HCFA|UB', '1003884768', 0, 'N', 0, '2014-04-25', NULL, NULL, 32.793, -96.7758, NULL, NULL),
('752242607', 'W12036681', 'W12036681', 'TXDALSTD', 'Ear Consultants of the Southwest', 'Robert', '', 'Owens', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '4104 Junius St', 'Dallas', 'Dallas', 'TX', '75246', '2147422194', '2148270162', '4104 Junius St', 'Dallas', 'Dallas', 'TX', '75246', '2147422194', '2148270162', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, '', '', 'HCFA|UB', '1194792739', 0, 'N', 0, '2014-04-25', NULL, NULL, 32.793, -96.7758, NULL, NULL),
('752242607', 'W12036682', 'W12036682', 'TXDALSTD', 'Ear Consultants of the Southwest', 'Robert', '', 'Owens', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '1001 12th Ave Ste 130', 'Fort Worth', 'Tarrant', 'TX', '76104', '8173323277', '8173323299', '1001 12th Ave Ste 130', 'Fort Worth', 'Tarrant', 'TX', '76104', '8173323277', '8173323299', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-15', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, '', '', 'HCFA|UB', '1194792739', 0, 'N', 0, '2014-04-25', NULL, NULL, 32.7342, -97.3475, NULL, NULL),
('263181533', 'W12036684', 'W12036684', 'TXDALSTD', 'Mansfield Dermatology', 'Jeannine', 'K', 'Hoang', 'MD', 'Dermatology', '', '', NULL, 'B', '2800 E Broad St Ste 124', 'Mansfield', 'Tarrant', 'TX', '76063', '8175390959', '8175390480', '2800 E Broad St Ste 124', 'Mansfield', 'Tarrant', 'TX', '76063', '8175390959', '8175390480', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1578513933', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.5684, -97.0945, NULL, NULL),
('263181533', 'W12036685', 'W12036685', 'TXDALSTD', 'Mansfield Dermatology', 'Jeannine', 'K', 'Hoang', 'MD', 'Dermatology', '', '', NULL, 'O', '723 N Fielder Rd Ste C', 'Arlington', 'Tarrant', 'TX', '76012', '8172611122', '8172611123', '723 N Fielder Rd Ste C', 'Arlington', 'Tarrant', 'TX', '76012', '8172611122', '8172611123', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1578513933', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.7442, -97.1318, NULL, NULL),
('201762867', 'W12036687', 'W12036687', 'TXDALSTD', 'Vani Duvuuri MD PA', 'Vani', '', 'Duvuuri', 'MD', 'Endocrinology', '', '', NULL, 'O', '399 W Campbell Rd Ste 303', 'Richardson', 'Dallas', 'TX', '75080', '9722313129', '9722313067', '399 W Campbell Rd Ste 303', 'Richardson', 'Dallas', 'TX', '75080', '9722313129', '9722313067', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1124063714', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.9754, -96.7253, NULL, NULL),
('752912332', 'W12036688', 'W12036688', 'TXDALSTD', 'Cornea Associates', 'Henry', '', 'Gelender', 'MD', 'Ophthalmology', '', '', NULL, 'O', '900 W Magnolia Ave Ste 203', 'Fort Worth', 'Tarrant', 'TX', '76104', '8178509282', '8178509218', '900 W Magnolia Ave Ste 203', 'Fort Worth', 'Tarrant', 'TX', '76104', '8178509282', '8178509218', 'DALLAS4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-03-23', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1619919008', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.7306, -97.3342, NULL, NULL),
('752912332', 'W12036689', 'W12036689', 'TXDALSTD', 'Cornea Associates', 'Walter', 'E', 'Beebe', 'MD', 'Ophthalmology', '', '', NULL, 'O', '301 Hospital Dr', 'Corsicana', 'Navarro', 'TX', '75110', '9038724611', '9038740701', '301 Hospital Dr', 'Corsicana', 'Navarro', 'TX', '75110', '9038724611', '9038740701', 'DALLAS4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-03-23', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1093742207', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.0811, -96.5005, NULL, NULL),
('205934739', 'W12036690', 'W12036690', 'ID02', 'Family Medicine Health Center', 'Tyler', 'H', 'Wheeler', 'MD', 'Family Practice', '', '', NULL, 'O', '777 N Raymond St', 'Boise', 'Ada', 'ID', '83704', '2085142500', '2083752217', '777 N Raymond St', 'Boise', 'Ada', 'ID', '83704', '2085142500', '2083752217', 'IDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1912225707', 0, 'N', 0, '2014-06-05', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W12036693', 'W12036693', 'UT01', 'Central Utah Clinic PC', 'David', '', 'Row', 'MD', 'Colon and Rectal Surgery', '', '', NULL, 'M', '1055 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8018124673', '8014180941', '1055 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8018124673', '8014180941', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2014-01-01', NULL, 0, 0, 0, 'St Marks Hospital', 'St Marks Hospital', '', '', 'HCFA|UB|', '1871797118', 0, 'N', 0, '2013-12-10', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W12036691', 'W12036691', 'UT01', 'Central Utah Clinic PC', 'David', '', 'Row', 'MD', 'Colon and Rectal Surgery', '', '', NULL, 'O', '1250 E 3900 S Ste 220', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012659139', '8012659478', '1250 E 3900 S Ste 220', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012659139', '8012659478', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2014-01-01', NULL, 0, 0, 0, 'St Marks Hospital', 'St Marks Hospital', '', '', 'HCFA|UB|', '1871797118', 0, 'N', 0, '2013-12-10', NULL, NULL, 40.6871, -111.856, NULL, NULL),
('870281028', 'W12036695', 'W12036695', 'UT01', 'Central Utah Clinic PC', 'David', '', 'Row', 'MD', 'Colon and Rectal Surgery', '', '', NULL, 'O', '1665 Bonanza Dr', 'Park City', 'Summit', 'UT', '84068', '8012659139', '8012659478', '1665 Bonanza Dr', 'Park City', 'Summit', 'UT', '84068', '8012659139', '8012659478', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2014-01-01', NULL, 0, 0, 0, 'St Marks Hospital', 'St Marks Hospital', '', '', 'HCFA|UB|', '1871797118', 0, 'N', 0, '2013-12-10', NULL, NULL, 40.6623, -111.5, NULL, NULL),
('870281028', 'W12036694', 'W12036694', 'UT01', 'Central Utah Clinic PC', 'David', '', 'Row', 'MD', 'Colon and Rectal Surgery', '', '', NULL, 'O', '736 S 500 E Ste 201', 'St George', 'Washington', 'UT', '84790', '8012659139', '8012659478', '736 S 500 E Ste 201', 'St George', 'Washington', 'UT', '84790', '8012659139', '8012659478', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2014-01-01', NULL, 0, 0, 0, 'St Marks Hospital', 'St Marks Hospital', '', '', 'HCFA|UB|', '1871797118', 0, 'N', 0, '2013-12-10', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W12036692', 'W12036692', 'UT01', 'Central Utah Clinic PC', 'David', '', 'Row', 'MD', 'Colon and Rectal Surgery', '', '', NULL, 'B', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', '8014298180', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', '8014298180', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2014-01-01', NULL, 0, 0, 0, 'St Marks Hospital', 'St Marks Hospital', '', '', 'HCFA|UB|', '1871797118', 0, 'N', 0, '2013-12-10', NULL, NULL, 0, 0, NULL, NULL),
('760681988', 'W12036697', 'W12036697', 'TXHOUSTD', 'C Funsho Fagbohun MD', 'Sarah', 'D', 'Nelson', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1601 Main St Ste A', 'Richmond', 'Fort Bend', 'TX', '77469', '2813426962', '2813426963', '1601 Main St Ste A', 'Richmond', 'Fort Bend', 'TX', '77469', '2813426962', '2813426963', 'HOUSTON3', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Houston Methodist Sugar Land Hospital', NULL, '', '', 'HCFA', '1730314634', 0, 'N', 0, '2013-08-15', NULL, NULL, 29.5772, -95.7691, NULL, NULL),
('760681988', 'W12036699', 'W12036699', 'TXHOUSTD', 'C Funsho Fagbohun MD', 'Cynthia', 'I', 'Rios', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1601 Main St Ste A', 'Richmond', 'Fort Bend', 'TX', '77469', '2813426962', '2813426963', '1601 Main St Ste A', 'Richmond', 'Fort Bend', 'TX', '77469', '2813426962', '2813426963', 'HOUSTON3', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA', '1922295427', 0, 'N', 0, '2013-08-15', NULL, NULL, 29.5772, -95.7691, NULL, NULL),
('760681988', 'W12036701', 'W12036701', 'TXHOUSTD', 'C Funsho Fagbohun MD', 'Kesha', 'S', 'Robertson', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1601 Main St Ste A', 'Richmond', 'Fort Bend', 'TX', '77469', '2813426962', '2813426963', '1601 Main St Ste A', 'Richmond', 'Fort Bend', 'TX', '77469', '2813426962', '2813426963', 'HOUSTON3', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Houston Methodist Sugar Land Hospital', NULL, '', '', 'HCFA', '1790932499', 0, 'N', 0, '2013-08-15', NULL, NULL, 29.5772, -95.7691, NULL, NULL),
('201780406', 'W12036702', 'W12036702', 'ILCHIGSTD', 'UroPartners', 'Matthew', 'A', 'Meadows', 'MD', 'Urology', '', '', NULL, 'O', '5215 N California Ave Ste F803', 'Chicago', 'Cook', 'IL', '60625', '7738787555', '7738788545', '5215 N California Ave Ste F803', 'Chicago', 'Cook', 'IL', '60625', '7738787555', '7738788545', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-10-01', NULL, 0, 0, 0, 'Presence Saint Francis Hospital', 'Presence Saint Joseph Hospital Chicago', '', '', 'HCFA|UB|', '1275599219', 0, 'N', 0, '2014-04-25', NULL, NULL, 41.9761, -87.6989, NULL, NULL),
('201780406', 'W12036703', 'W12036703', 'ILCHIGSTD', 'UroPartners', 'Daniel', 'S', 'Merrick', 'MD', 'Urology', '', '', NULL, 'O', '5215 N California Ave Ste F803', 'Chicago', 'Cook', 'IL', '60625', '7738787555', '7738788545', '5215 N California Ave Ste F803', 'Chicago', 'Cook', 'IL', '60625', '7738787555', '7738788545', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-10-01', NULL, 0, 0, 0, 'Presence Saint Francis Hospital', 'Presence Saint Joseph Hospital Chicago', '', '', 'HCFA|UB|', '1184680654', 0, 'N', 0, '2014-04-25', NULL, NULL, 41.9761, -87.6989, NULL, NULL),
('201780406', 'W12036704', 'W12036704', 'ILCHIGSTD', 'UroPartners', 'Steven', '', 'Koopman', 'MD', 'Urology', '', '', NULL, 'O', '5215 N California Ave Ste F803', 'Chicago', 'Cook', 'IL', '60625', '7738787555', '7738788545', '5215 N California Ave Ste F803', 'Chicago', 'Cook', 'IL', '60625', '7738787555', '7738788545', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-10-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, '', '', 'HCFA|UB|', '1811199573', 0, 'N', 0, '2014-03-24', NULL, NULL, 41.9761, -87.6989, NULL, NULL),
('204941789', 'W12036707', 'W12036707', 'UT01', 'Medway Medical', '', '', 'Medway Medical', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', '1837 S 4130 W Unit B', 'Salt Lake City', 'Salt Lake', 'UT', '84104', '4357559600', '          ', '1837 S 4130 W Unit B', 'Salt Lake City', 'Salt Lake', 'UT', '84104', '4357559600', '          ', 'DME80', '', '', '0.00', '35.00', '0.00', 3, '2013-07-23', '2014-03-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1962438358', 0, 'N', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('000009769', 'W12036714', 'W12036714', 'UT01', '', '', '', 'Western Rehabilation Health Network', 'Group', 'Physical Medicine and Rehabilitation', '', '', NULL, 'B', 'PO Box 27677 UT01', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '8019422729', NULL, 'PO Box 27677 UT01', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '8019422729', '          ', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009769', 0, 'Y', 0, '2013-08-22', NULL, NULL, 0, 0, NULL, NULL),
('364288180', 'W12036715', 'W12036715', 'UT01', 'Cache Valley Specialty Hospital', '', '', 'Western Rehabilation Health Network', 'Group', 'Physical Medicine and Rehabilitation', '', '', NULL, 'B', 'PO Box 6220 CVSH', 'Logan', 'Cache', 'UT', '84341', '4357879030', '4357879033', 'PO Box 6220 CVSH', 'Logan', 'Cache', 'UT', '84341', '4357879030', '4357879033', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 8, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009769', 0, 'Y', 0, '2013-08-22', NULL, NULL, 0, 0, NULL, NULL),
('000009769', 'W12036713', 'W12036713', 'ID02', '', '', '', 'Western Rehabilation Health Network', 'Group', 'Physical Medicine and Rehabilitation', '', '', NULL, 'B', 'PO Box 27677 ID02', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '8019422729', NULL, 'PO Box 27677 ID02', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '8019422729', '          ', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2030-01-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '0000009769', 0, 'Y', 0, '2013-08-22', NULL, NULL, 0, 0, NULL, NULL);
INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
('870574059', 'W12036716', 'W12036716', 'ID02', 'Mountain Land Kuna', 'Joseph', 'P', 'Jannuzzi', 'DPT', 'Physical Therapy', '', '', NULL, 'O', '672 E Wythe Creek Ct Ste 103', 'Kuna', 'Ada', 'ID', '83634', '2089229828', '2089223499', '672 E Wythe Creek Ct Ste 103', 'Kuna', 'Ada', 'ID', '83634', '2089229828', '2089223499', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2013-08-01', '2014-07-11', 0, 0, 1, '', '', '', '', 'HCFA|', '1053756882', 0, 'N', 0, '2014-07-18', NULL, NULL, 0, 0, NULL, NULL),
('870574059', 'W12036717', 'W12036717', 'ID02', 'Mountain Land Kuna', 'Joseph', 'P', 'Jannuzzi', 'DPT', 'Physical Therapy', '', '', NULL, 'B', 'PO Box 711185', 'Salt Lake City', 'Salt Lake', 'UT', '84171', '2089229828', '2089223499', 'PO Box 711185', 'Salt Lake City', 'Salt Lake', 'UT', '84171', '2089229828', '2089223499', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2013-08-01', '2014-07-11', 0, 0, 1, '', '', '', '', 'HCFA|', '1053756882', 0, 'N', 0, '2014-07-18', NULL, NULL, 0, 0, NULL, NULL),
('870656811', 'W12036719', 'W12036719', 'UT01', 'ProRehab Physical Therapy', 'Michael', 'J', 'Terry', 'DPT', 'Physical Therapy', '', '', NULL, 'O', '200 Park Pl', 'East Carbon', 'Carbon', 'UT', '84520', '4356131500', '4356131501', '200 Park Pl', 'East Carbon', 'Carbon', 'UT', '84520', '4356131500', '4356131501', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 6, '2013-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1225475668', 0, 'N', 0, '2013-12-02', NULL, NULL, 39.5436, -110.418, NULL, NULL),
('870656811', 'W12036720', 'W12036720', 'UT01', 'ProRehab Physical Therapy', 'Michael', 'J', 'Terry', 'DPT', 'Physical Therapy', '', '', NULL, 'B', 'PO Box 933', 'East Carbon', 'Carbon', 'UT', '8451', '4356131500', '4356131501', 'PO Box 933', 'East Carbon', 'Carbon', 'UT', '8451', '4356131500', '4356131501', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 6, '2013-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1225475668', 0, 'N', 0, '2013-12-02', NULL, NULL, 0, 0, NULL, NULL),
('870656811', 'W12036721', 'W12036721', 'UT01', 'ProRehab Physical Therapy', 'Michael', 'J', 'Terry', 'DPT', 'Physical Therapy', '', '', NULL, 'O', '590 E 100 N Ste 1-2', 'Price', 'Carbon', 'UT', '84501', '4356131500', '4356131501', '590 E 100 N Ste 1-2', 'Price', 'Carbon', 'UT', '84501', '4356131500', '4356131501', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 6, '2013-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1225475668', 0, 'N', 0, '2013-12-02', NULL, NULL, 39.601, -110.8, NULL, NULL),
('870285547', 'W12036722', 'W12036722', 'UT01', 'Registered Physical Therapists', 'Joshua', '', 'Harward', 'MPT', 'Physical Therapy', NULL, NULL, NULL, 'O', '74 E Kimball Ln Ste 200', 'Draper', 'Salt Lake', 'UT', '84020', '8014322070', '8014322058', '74 E Kimball Ln Ste 200', 'Draper', 'Salt Lake', 'UT', '84020', '8014322070', '8014322058', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2013-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1922003417', 0, 'N', 0, '2013-08-16', NULL, NULL, 40.537, -111.889, NULL, NULL),
('870502207', 'W12036725', 'W12036725', 'UT01', 'Wasatch Therapy', 'Samantha', 'J', 'Wirth', 'DPT', 'Physical Therapy', '', '', NULL, 'O', '1916 N 700 W Ste 240', 'Layton', 'Davis', 'UT', '84041', '8017847373', '8017847532', '1916 N 700 W Ste 240', 'Layton', 'Davis', 'UT', '84041', '8017847373', '8017847532', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2013-08-01', '2013-11-13', 0, 0, 0, '', '', '', '', 'HCFA|UB', '1982961678', 0, 'N', 0, '2013-12-06', NULL, NULL, 0, 0, NULL, NULL),
('870502207', 'W12036727', 'W12036727', 'UT01', 'Wasatch Therapy', 'Samantha', 'J', 'Wirth', 'DPT', 'Physical Therapy', '', '', NULL, 'O', '1967 W 5700 S', 'Roy', 'Weber', 'UT', '84067', '8017748600', '8017748681', '1967 W 5700 S', 'Roy', 'Weber', 'UT', '84067', '8017748600', '8017748681', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2013-08-01', '2013-11-13', 0, 0, 0, '', '', '', '', 'HCFA|UB', '1982961678', 0, 'N', 0, '2013-12-06', NULL, NULL, 0, 0, NULL, NULL),
('870502207', 'W12036726', 'W12036726', 'UT01', 'Wasatch Therapy', 'Samantha', 'J', 'Wirth', 'DPT', 'Physical Therapy', '', '', NULL, 'O', '5349 S Adams Ave Ste A', 'Ogden', 'Weber', 'UT', '84405', '8015938300', '8015938307', '5349 S Adams Ave Ste A', 'Ogden', 'Weber', 'UT', '84405', '8015938300', '8015938307', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2013-08-01', '2013-11-13', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1982961678', 0, 'N', 0, '2013-12-06', NULL, NULL, 0, 0, NULL, NULL),
('810232125', 'W12036728', 'W12036728', 'UT01', 'Easter Seals Goodwill Northern Rocky Mountain Inc', 'Madelyn', '', 'Mauer', 'OT', 'Occupational Therapy', '', '', NULL, 'O', '350 S 400 E', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8019461860', '8015825540', '350 S 400 E', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8019461860', '8015825540', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2013-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1891016242', 0, 'N', 0, '2013-08-15', NULL, NULL, 40.7618, -111.88, NULL, NULL),
('810232125', 'W12036729', 'W12036729', 'UT01', 'Easter Seals Goodwill Northern Rocky Mountain Inc', 'Madelyn', '', 'Mauer', 'OT', 'Occupational Therapy', '', '', NULL, 'O', 'PO Box 2509', 'Great Falls', 'Cascade', 'MT', '59403', '8019461860', '8015825540', 'PO Box 2509', 'Great Falls', 'Cascade', 'MT', '59403', '8019461860', '8015825540', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2013-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1891016242', 0, 'N', 0, '2013-08-15', NULL, NULL, 0, 0, NULL, NULL),
('870546052', 'W12036731', 'W12036731', 'UT01', 'Professional Physical Therapy & Sports Medicine', 'Karen', 'L', 'Carter', 'PT', 'Physical Therapy', '', '', NULL, 'O', '1325 S 800 E Ste 215', 'Orem', 'Utah', 'UT', '84097', '8013731053', '8013754644', '1325 S 800 E Ste 215', 'Orem', 'Utah', 'UT', '84097', '8013731053', '8013754644', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2013-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1649319211', 0, 'N', 0, '2013-08-15', NULL, NULL, 40.2722, -111.676, NULL, NULL),
('455125865', 'W12036732', 'W12036732', 'UT01', 'Utah Physical Therapy, Inc.', 'Chad', '', 'Tenney', 'MPT', 'Physical Therapy', '', '', NULL, 'B', 'PO Box 66', 'Hooper', 'Weber', 'UT', '84315', '8016890200', '8016890201', 'PO Box 66', 'Hooper', 'Weber', 'UT', '84315', '8016890200', '8016890201', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1215910161', 0, 'N', 0, '2013-08-15', NULL, NULL, 0, 0, NULL, NULL),
('205934739', 'W12035612', 'W12035612', 'ID02', 'Family Medicine Health Center', 'Mark', 'A', 'Curry', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '777 N Raymond St', 'Boise', 'Ada', 'ID', '83704', '2083676042', '2083227018', '777 N Raymond St', 'Boise', 'Ada', 'ID', '83704', '2083676042', '2083227018', 'IDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2013-08-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1720022437', 0, 'N', 0, '2014-06-05', NULL, NULL, 0, 0, NULL, NULL),
('205934739', 'W12035611', 'W12035611', 'ID02', 'Family Medicine Health Center', 'Mark', 'A', 'Curry', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '121 E Fort St', 'Boise', 'Ada', 'ID', '83712', '2083816102', '2083811776', '121 E Fort St', 'Boise', 'Ada', 'ID', '83712', '2083816102', '2083811776', 'IDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2013-08-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1720022437', 0, 'N', 0, '2014-06-05', NULL, NULL, 0, 0, NULL, NULL),
('300038860', 'W12035803', 'W12035803', 'TXHOUSTD', 'Lone Star Family Health Center', 'Marwan', 'M', 'Al Khudhair', 'MD', 'Family Practice', '', '', NULL, 'O', '605 S Conroe Medical Dr', 'Conroe', 'Montgomery', 'TX', '77304', '8365394004', '3965393635', '605 S Conroe Medical Dr', 'Conroe', 'Montgomery', 'TX', '77304', '8365394004', '3965393635', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-02', NULL, 0, 0, 0, 'Conroe Regional Medical Center', NULL, '', '', 'HCFA|UB', '1245466762', 0, 'N', 0, '2014-01-16', NULL, NULL, 30.3427, -95.551, NULL, NULL),
('452809513', 'W12036734', 'W12036734', 'TXHOUSTD', 'Family Practice Doctors ', 'Chukwuemeka', 'L', 'Oragwu', 'MD', 'Family Practice', '', '', NULL, 'O', '1485 FM 1960 E Rd Bypass STE 100', 'Humble', 'Harris', 'TX', '77346', '2815702606', '2815702611', '1485 FM 1960 E Rd Bypass STE 100', 'Humble', 'Harris', 'TX', '77346', '2815702606', '2815702611', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1932385911', 0, 'N', 0, '2013-09-16', NULL, NULL, 30.0037, -95.252, NULL, NULL),
('753143209', 'W12036735', 'W12036735', 'WY01', 'Big Horn Basin Bone and Joint', 'Jared', 'T', 'Lee', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '720 Lindsay Ln Ste C', 'Cody', 'Park', 'WY', '82414', '3075781955', '3075781996', '720 Lindsay Ln Ste C', 'Cody', 'Park', 'WY', '82414', '3075781955', '3075781996', '', '', '', '0.00', '25.00', '0.00', 3, '2013-10-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1568667145', 0, 'N', 0, '2013-09-23', NULL, NULL, 44.5202, -109.074, NULL, NULL),
('753143209', 'W12036736', 'W12036736', 'WYT1', 'Big Horn Basin Bone and Joint', 'Jared', 'T', 'Lee', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '720 Lindsay Ln Ste C', 'Cody', 'Park', 'WY', '82414', '3075781955', '3075781996', '720 Lindsay Ln Ste C', 'Cody', 'Park', 'WY', '82414', '3075781955', '3075781996', '', '', '', '0.00', '25.00', '0.00', 3, '2013-10-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1568667145', 0, 'N', 0, '2013-09-23', NULL, NULL, 0, 0, NULL, NULL),
('273118536', 'W12036737', 'W12036737', 'TXDALSTD', 'Dr Kurt L Pflieger', 'Kurt', 'L', 'Pflieger', 'MD', 'Pediatrics', '', '', NULL, 'O', '2504 Ridge Rd Ste 102', 'Rockwall', 'Rockwall', 'TX', '75087', '9727711794', '9727711648', '2504 Ridge Rd Ste 102', 'Rockwall', 'Rockwall', 'TX', '75087', '9727711794', '9727711648', 'DALLAS1', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-10-01', NULL, 0, 0, 0, NULL, NULL, '', '', 'HCFA|UB|', '1710003264', 0, 'N', 0, '2013-08-19', NULL, NULL, 32.9002, -96.4681, NULL, NULL),
('204158432', 'W12036738', 'W12036738', 'TXHOUSTD', '', 'Angela ', 'D', 'Houghton', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '450 Blossom St Ste C', 'Webster', 'Harris', 'TX', '77598', '2815571760', '2815571836', '450 Blossom St Ste C', 'Webster', 'Harris', 'TX', '77598', '2815571760', '2815571836', 'HOUSTON3', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-21', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1407840606', 0, 'N', 0, '2013-08-21', NULL, NULL, 29.5419, -95.1283, NULL, NULL),
('204158432', 'W12036739', 'W12036739', 'TXHOUSTD', '', 'Angela ', 'D', 'Houghton', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 57747', 'Webster', 'Harris', 'TX', '77598', '2815571760', '2815571836', 'PO Box 57747', 'Webster', 'Harris', 'TX', '77598', '2815571760', '2815571836', 'HOUSTON3', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-21', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1407840606', 0, 'N', 0, '2013-08-21', NULL, NULL, 0, 0, NULL, NULL),
('760264063', 'W12036740', 'W12036740', 'TXHOUSTD', 'Ping S Chu MD ', 'Ping', 'S', 'Chu', 'MD', 'Hematology', '', '', NULL, 'O', '1015 Med Ctr Blvd Ste 2800', 'Webster', 'Harris', 'TX', '77598', '2813382006', '2813325264', '1015 Med Ctr Blvd Ste 2800', 'Webster', 'Harris', 'TX', '77598', '2813382006', '2813325264', 'HOUSTON5', 'TXONCHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-16', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB', '1316957368', 0, 'N', 0, '2013-08-16', NULL, NULL, 29.5362, -95.1332, NULL, NULL),
('760264063', 'W12036741', 'W12036741', 'TXHOUSTD', 'Ping S Chu MD ', 'Ping', 'S', 'Chu', 'MD', 'Hematology', '', '', NULL, 'O', '6560 Fannin Ste 1726', 'Houston', 'Harris', 'TX', '77030', '2813382006', '2813325264', '6560 Fannin Ste 1726', 'Houston', 'Harris', 'TX', '77030', '2813382006', '2813325264', 'HOUSTON5', 'TXONCHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-16', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB', '1316957368', 0, 'N', 0, '2013-08-16', NULL, NULL, 29.7109, -95.4, NULL, NULL),
('760432182', 'W12036745', 'W12036745', 'TXHOUSTD', 'Houston Nephrology Group', '', '', 'Houston Nephrology Group,', '', 'Nephrology', '', '', NULL, 'O', '13300 Hargrave Ste 505', 'Houston', 'Harris', 'TX', '77077', '7134685440', '7139730778', '13300 Hargrave Ste 505', 'Houston', 'Harris', 'TX', '77077', '7134685440', '7139730778', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-21', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1174593032', 0, 'Y', 0, '2013-08-21', NULL, NULL, 29.9687, -95.552, NULL, NULL),
('760432182', 'W12036743', 'W12036743', 'TXHOUSTD', 'Houston Nephrology Group', '', '', 'Houston Nephrology Group,', '', 'Nephrology', '', '', NULL, 'O', '1331 Grand Pkwy Ste 320', 'Katy', 'Harris', 'TX', '77493', '7134685440', '7139730778', '1331 Grand Pkwy Ste 320', 'Katy', 'Harris', 'TX', '77493', '7134685440', '7139730778', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-21', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1174593032', 0, 'Y', 0, '2013-08-21', NULL, NULL, 29.7912, -95.7774, NULL, NULL),
('760432182', 'W12036744', 'W12036744', 'TXHOUSTD', 'Houston Nephrology Group', '', '', 'Houston Nephrology Group,', '', 'Nephrology', '', '', NULL, 'O', '21216 NW Fwy Ste 410', 'Cypress', 'Harris', 'TX', '77429', '7134685440', '7139730778', '21216 NW Fwy Ste 410', 'Cypress', 'Harris', 'TX', '77429', '7134685440', '7139730778', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-21', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1174593032', 0, 'Y', 0, '2013-08-21', NULL, NULL, 29.9265, -95.635, NULL, NULL),
('760432182', 'W12036742', 'W12036742', 'TXHOUSTD', 'Houston Nephrology Group', '', '', 'Houston Nephrology Group,', '', 'Nephrology', '', '', NULL, 'O', '915 Gessner Ste 360', 'Houston', 'Harris', 'TX', '77024', '7134685440', '7139730778', '915 Gessner Ste 360', 'Houston', 'Harris', 'TX', '77024', '7134685440', '7139730778', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-21', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1174593032', 0, 'Y', 0, '2013-08-21', NULL, NULL, 29.7804, -95.5445, NULL, NULL),
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('462908086', 'W12036794', 'W12036794', 'TXDALSTD', 'Touchstone Imaging Lewisville', '', '', 'Touchstone Imaging Lewisville', '', 'Imaging Center', '', '', NULL, 'O', '190 Civic Cir Ste 125', 'Lewisville', 'Denton', 'TX', '75067', '9724346737', '0000000000', '190 Civic Cir Ste 125', 'Lewisville', 'Denton', 'TX', '75067', '9724346737', '0000000000', '', '', 'BAYLORTOUCH', '0.00', '0.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1528406964', 0, 'N', 0, '2013-08-16', NULL, NULL, 33.0439, -97.0246, NULL, NULL),
('462908086', 'W12036793', 'W12036793', 'TXDALSTD', 'Touchstone Imaging Lewisville', '', '', 'Touchstone Imaging Lewisville', '', 'Imaging Center', '', '', NULL, 'B', 'PO Box 102107', 'Atlanta', 'Fulton', 'GA', '30368', '0000000000', '0000000000', 'PO Box 102107', 'Atlanta', 'Fulton', 'GA', '30368', '0000000000', '0000000000', '', '', 'BAYLORTOUCH', '0.00', '0.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1528406964', 0, 'N', 0, '2013-08-16', NULL, NULL, 0, 0, NULL, NULL),
('462908086', 'W12036797', 'W12036797', 'TXDALSTD', 'Touchstone Imaging Plano', '', '', 'Touchstone Imaging Plano', '', 'Imaging Center', '', '', NULL, 'O', '3304 Communications Pkwy Ste 201', 'Plano', 'Collin', 'TX', '75093', '9723786858', '0000000000', '3304 Communications Pkwy Ste 201', 'Plano', 'Collin', 'TX', '75093', '9723786858', '0000000000', '', '', 'BAYLORTOUCH', '0.00', '0.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1255779690', 0, 'N', 0, '2013-08-16', NULL, NULL, 33.0455, -96.8329, NULL, NULL),
('462908086', 'W12036796', 'W12036796', 'TXDALSTD', 'Touchstone Imaging Plano', '', '', 'Touchstone Imaging Plano', '', 'Imaging Center', '', '', NULL, 'B', 'PO Box 102107', 'Atlanta', 'Fulton', 'GA', '30368', '0000000000', '0000000000', 'PO Box 102107', 'Atlanta', 'Fulton', 'GA', '30368', '0000000000', '0000000000', '', '', 'BAYLORTOUCH', '0.00', '0.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1255779690', 0, 'N', 0, '2013-08-16', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'W12036314', 'W12036314', 'TXDALSTD', 'Health Texas Provider Network', 'Vivek', '', 'Talwar', 'MD', 'Family Practice', '', '', NULL, 'O', '5236 W University Dr Ste 1500', 'Mckinney', 'Collin', 'TX', '75071', '4698005100', '4698005110', '5236 W University Dr Ste 1500', 'Mckinney', 'Collin', 'TX', '75071', '4698005100', '4698005110', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Baylor Medical Center at McKinney', NULL, '', '', 'HCFA|UB|', '1588687404', 0, 'N', 0, '2013-08-16', NULL, NULL, 33.2183, -96.684, NULL, NULL),
('752536818', 'W12036315', 'W12036315', 'TXDALSTD', 'Health Texas Provider Network', 'Vivek', '', 'Talwar', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Baylor Medical Center at McKinney', NULL, '', '', 'HCFA|UB', '1588687404', 0, 'N', 0, '2013-08-16', NULL, NULL, 0, 0, NULL, NULL),
('462908086', 'W12036799', 'W12036799', 'TXDALSTD', 'Touchstone Imaging Mesquite', '', '', 'Touchstone Imaging Mesquite', '', 'Imaging Center', '', '', NULL, 'B', 'PO Box 102107', 'Atlanta', 'Fulton', 'GA', '30368', '0000000000', '0000000000', 'PO Box 102107', 'Atlanta', 'Fulton', 'GA', '30368', '0000000000', '0000000000', '', '', 'BAYLORTOUCH', '0.00', '0.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1073951414', 0, 'N', 0, '2013-08-16', NULL, NULL, 0, 0, NULL, NULL),
('462908086', 'W12036800', 'W12036800', 'TXDALSTD', 'Touchstone Imaging Mesquite', '', '', 'Touchstone Imaging Mesquite', '', 'Imaging Center', '', '', NULL, 'O', '1425 Gross Rd Ste 130', 'Mesquite', 'Dallas', 'TX', '75149', '9722895558', '0000000000', '1425 Gross Rd Ste 130', 'Mesquite', 'Dallas', 'TX', '75149', '9722895558', '0000000000', '', '', 'BAYLORTOUCH', '0.00', '0.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1073951414', 0, 'N', 0, '2013-08-16', NULL, NULL, 32.7833, -96.6279, NULL, NULL),
('462908086', 'W12036802', 'W12036802', 'TXDALSTD', 'Touchstone Imaging Garland', '', '', 'Touchstone Imaging Garland', '', 'Imaging Center', '', '', NULL, 'B', 'PO Box 102107', 'Atlanta', 'Fulton', 'GA', '30368', '0000000000', '0000000000', 'PO Box 102107', 'Atlanta', 'Fulton', 'GA', '30368', '0000000000', '0000000000', '', '', 'BAYLORTOUCH', '0.00', '0.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1982042321', 0, 'N', 0, '2013-08-16', NULL, NULL, 0, 0, NULL, NULL),
('462908086', 'W12036803', 'W12036803', 'TXDALSTD', 'Touchstone Imaging Garland', '', '', 'Touchstone Imaging Garland', '', 'Imaging Center', '', '', NULL, 'O', '6850 N Shiloh Rd Ste R', 'Garland', 'Dallas', 'TX', '75044', '9724957756', '0000000000', '6850 N Shiloh Rd Ste R', 'Garland', 'Dallas', 'TX', '75044', '9724957756', '0000000000', '', '', 'BAYLORTOUCH', '0.00', '0.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1982042321', 0, 'N', 0, '2013-08-16', NULL, NULL, 32.9782, -96.6652, NULL, NULL),
('462908086', 'W12036806', 'W12036806', 'TXDALSTD', 'Touchstone Imaging Richardson', '', '', 'Touchstone Imaging Richardson', '', 'Imaging Center', '', '', NULL, 'O', '1910 N Collins Blvd', 'Richardson', 'Dallas', 'TX', '75080', '9727440882', '0000000000', '1910 N Collins Blvd', 'Richardson', 'Dallas', 'TX', '75080', '9727440882', '0000000000', '', '', 'BAYLORTOUCH', '0.00', '0.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1528406972', 0, 'N', 0, '2013-08-16', NULL, NULL, 32.9743, -96.7232, NULL, NULL),
('462908086', 'W12036805', 'W12036805', 'TXDALSTD', 'Touchstone Imaging Richardson', '', '', 'Touchstone Imaging Richardson', '', 'Imaging Center', '', '', NULL, 'B', 'PO Box 102107', 'Atlanta', 'Fulton', 'GA', '30368', '0000000000', '0000000000', 'PO Box 102107', 'Atlanta', 'Fulton', 'GA', '30368', '0000000000', '0000000000', '', '', 'BAYLORTOUCH', '0.00', '0.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1528406972', 0, 'N', 0, '2013-08-16', NULL, NULL, 0, 0, NULL, NULL),
('462908086', 'W12036809', 'W12036809', 'TXDALSTD', 'Touchstone Imaging Flower Mound', '', '', 'Touchstone Imaging Flower Mound', '', 'Imaging Center', '', '', NULL, 'O', '3101 Churchill Dr Ste 100', 'Flower Mound', 'Denton', 'TX', '75022', '9727240100', '0000000000', '3101 Churchill Dr Ste 100', 'Flower Mound', 'Denton', 'TX', '75022', '9727240100', '0000000000', '', '', 'BAYLORTOUCH', '0.00', '0.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1629416292', 0, 'N', 0, '2013-08-16', NULL, NULL, 33.0351, -97.0754, NULL, NULL),
('462908086', 'W12036808', 'W12036808', 'TXDALSTD', 'Touchstone Imaging Flower Mound', '', '', 'Touchstone Imaging Flower Mound', '', 'Imaging Center', '', '', NULL, 'B', 'PO Box 102107', 'Atlanta', 'Fulton', 'GA', '30368', '0000000000', '0000000000', 'PO Box 102107', 'Atlanta', 'Fulton', 'GA', '30368', '0000000000', '0000000000', '', '', 'BAYLORTOUCH', '0.00', '0.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1629416292', 0, 'N', 0, '2013-08-16', NULL, NULL, 0, 0, NULL, NULL),
('462908086', 'W12036811', 'W12036811', 'TXDALSTD', 'Touchstone Imaging Oaktree Plaza', '', '', 'Touchstone Imaging Oaktree Plaza', '', 'Imaging Center', '', '', NULL, 'B', 'PO Box 102107', 'Atlanta', 'Fulton', 'GA', '30368', '0000000000', '0000000000', 'PO Box 102107', 'Atlanta', 'Fulton', 'GA', '30368', '0000000000', '0000000000', '', '', 'BAYLORTOUCH', '0.00', '0.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1164860516', 0, 'N', 0, '2013-08-16', NULL, NULL, 0, 0, NULL, NULL),
('462908086', 'W12036812', 'W12036812', 'TXDALSTD', 'Touchstone Imaging Oaktree Plaza', '', '', 'Touchstone Imaging Oaktree Plaza', '', 'Imaging Center', '', '', NULL, 'O', '1435 S Loop 288 Ste 101', 'Denton', 'Denton', 'TX', '76205', '9403206901', '0000000000', '1435 S Loop 288 Ste 101', 'Denton', 'Denton', 'TX', '76205', '9403206901', '0000000000', '', '', 'BAYLORTOUCH', '0.00', '0.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1164860516', 0, 'N', 0, '2013-08-16', NULL, NULL, 33.1948, -97.0933, NULL, NULL),
('462908086', 'W12036814', 'W12036814', 'TXDALSTD', 'Touchstone Imaging Arlington', '', '', 'Touchstone Imaging Arlington', '', 'Imaging Center', '', '', NULL, 'B', 'PO Box 102107', 'Atlanta', 'Fulton', 'GA', '30368', '0000000000', '0000000000', 'PO Box 102107', 'Atlanta', 'Fulton', 'GA', '30368', '0000000000', '0000000000', '', '', 'BAYLORTOUCH', '0.00', '0.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1790123149', 0, 'N', 0, '2013-08-16', NULL, NULL, 0, 0, NULL, NULL),
('462908086', 'W12036815', 'W12036815', 'TXDALSTD', 'Touchstone Imaging Arlington', '', '', 'Touchstone Imaging Arlington', '', 'Imaging Center', '', '', NULL, 'O', '601 W Arbrook Blvd', 'Arlington', 'Tarrant', 'TX', '76014', '8174720801', '0000000000', '601 W Arbrook Blvd', 'Arlington', 'Tarrant', 'TX', '76014', '8174720801', '0000000000', '', '', 'BAYLORTOUCH', '0.00', '0.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1790123149', 0, 'N', 0, '2013-08-16', NULL, NULL, 32.6852, -97.1143, NULL, NULL),
('462908086', 'W12036818', 'W12036818', 'TXDALSTD', 'Touchstone Imaging Fort Worth', '', '', 'Touchstone Imaging Fort Worth', '', 'Imaging Center', '', '', NULL, 'O', '6001 Harris Pkwy', 'Fort Worth', 'Tarrant', 'TX', '76132', '8172941131', '0000000000', '6001 Harris Pkwy', 'Fort Worth', 'Tarrant', 'TX', '76132', '8172941131', '0000000000', '', '', 'BAYLORTOUCH', '0.00', '0.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1609214055', 0, 'N', 0, '2013-08-16', NULL, NULL, 32.6617, -97.4204, NULL, NULL),
('462908086', 'W12036817', 'W12036817', 'TXDALSTD', 'Touchstone Imaging Fort Worth', '', '', 'Touchstone Imaging Fort Worth', '', 'Imaging Center', '', '', NULL, 'B', 'PO Box 102107', 'Atlanta', 'Fulton', 'GA', '30368', '0000000000', '0000000000', 'PO Box 102107', 'Atlanta', 'Fulton', 'GA', '30368', '0000000000', '0000000000', '', '', 'BAYLORTOUCH', '0.00', '0.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1609214055', 0, 'N', 0, '2013-08-16', NULL, NULL, 0, 0, NULL, NULL),
('462908086', 'W12036820', 'W12036820', 'TXDALSTD', 'Touchstone Imaging Hurst', '', '', 'Touchstone Imaging Hurst', '', 'Imaging Center', '', '', NULL, 'B', 'PO Box 102107', 'Atlanta', 'Fulton', 'GA', '30368', '0000000000', '0000000000', 'PO Box 102107', 'Atlanta', 'Fulton', 'GA', '30368', '0000000000', '0000000000', '', '', 'BAYLORTOUCH', '0.00', '0.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1245678697', 0, 'N', 0, '2013-08-16', NULL, NULL, 0, 0, NULL, NULL),
('462908086', 'W12036821', 'W12036821', 'TXDALSTD', 'Touchstone Imaging Hurst', '', '', 'Touchstone Imaging Hurst', '', 'Imaging Center', '', '', NULL, 'O', '1717 Precinct Line Rd Ste 103', 'Hurst', 'Tarrant', 'TX', '76054', '8174986575', '0000000000', '1717 Precinct Line Rd Ste 103', 'Hurst', 'Tarrant', 'TX', '76054', '8174986575', '0000000000', '', '', 'BAYLORTOUCH', '0.00', '0.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1245678697', 0, 'N', 0, '2013-08-16', NULL, NULL, 32.8456, -97.1862, NULL, NULL),
('462908086', 'W12036824', 'W12036824', 'TXDALSTD', 'Touchstone Imaging Fossil Creek', '', '', 'Touchstone Imaging Fossil Creek', '', 'Imaging Center', '', '', NULL, 'O', '5455 Basswood Blvd Ste 550', 'Fort Worth', 'Tarrant', 'TX', '76137', '8174285002', '0000000000', '5455 Basswood Blvd Ste 550', 'Fort Worth', 'Tarrant', 'TX', '76137', '8174285002', '0000000000', '', '', 'BAYLORTOUCH', '0.00', '0.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1154769503', 0, 'N', 0, '2013-08-16', NULL, NULL, 32.8743, -97.2672, NULL, NULL),
('462908086', 'W12036823', 'W12036823', 'TXDALSTD', 'Touchstone Imaging Fossil Creek', '', '', 'Touchstone Imaging Fossil Creek', '', 'Imaging Center', '', '', NULL, 'B', 'PO Box 102107', 'Atlanta', 'Fulton', 'GA', '30368', '0000000000', '0000000000', 'PO Box 102107', 'Atlanta', 'Fulton', 'GA', '30368', '0000000000', '0000000000', '', '', 'BAYLORTOUCH', '0.00', '0.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1154769503', 0, 'N', 0, '2013-08-16', NULL, NULL, 0, 0, NULL, NULL),
('462908086', 'W12036826', 'W12036826', 'TXDALSTD', 'Touchstone Imaging Euless', '', '', 'Touchstone Imaging Euless', '', 'Imaging Center', '', '', NULL, 'B', 'PO Box 102107', 'Atlanta', 'Fulton', 'GA', '30368', '0000000000', '0000000000', 'PO Box 102107', 'Atlanta', 'Fulton', 'GA', '30368', '0000000000', '0000000000', '', '', 'BAYLORTOUCH', '0.00', '0.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1063850410', 0, 'N', 0, '2013-08-16', NULL, NULL, 0, 0, NULL, NULL),
('462908086', 'W12036827', 'W12036827', 'TXDALSTD', 'Touchstone Imaging Euless', '', '', 'Touchstone Imaging Euless', '', 'Imaging Center', '', '', NULL, 'O', '350 Westpark Way Ste 100 & 105', 'Euless', 'Tarrant', 'TX', '76040', '8172834641', '0000000000', '350 Westpark Way Ste 100 & 105', 'Euless', 'Tarrant', 'TX', '76040', '8172834641', '0000000000', '', '', 'BAYLORTOUCH', '0.00', '0.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1063850410', 0, 'N', 0, '2013-08-16', NULL, NULL, 32.8333, -97.1199, NULL, NULL),
('462908086', 'W12036829', 'W12036829', 'TXDALSTD', 'Touchstone Imaging Downtown Forth Worth', '', '', 'Touchstone Imaging Downtown Forth Worth', '', 'Imaging Center', '', '', NULL, 'B', 'PO Box 102107', 'Atlanta', 'Fulton', 'GA', '30368', '0000000000', '0000000000', 'PO Box 102107', 'Atlanta', 'Fulton', 'GA', '30368', '0000000000', '0000000000', '', '', 'BAYLORTOUCH', '0.00', '0.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1972941326', 0, 'N', 0, '2013-08-16', NULL, NULL, 0, 0, NULL, NULL),
('462908086', 'W12036830', 'W12036830', 'TXDALSTD', 'Touchstone Imaging Downtown Forth Worth', '', '', 'Touchstone Imaging Downtown Forth Worth', '', 'Imaging Center', '', '', NULL, 'O', '1101 Sixth Ave', 'Fort Worth', 'Tarrant', 'TX', '76104', '8173364637', '0000000000', '1101 Sixth Ave', 'Fort Worth', 'Tarrant', 'TX', '76104', '8173364637', '0000000000', '', '', 'BAYLORTOUCH', '0.00', '0.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1972941326', 0, 'N', 0, '2013-08-16', NULL, NULL, 0, 0, NULL, NULL);
