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
('571201170', 'MH0400179', 'MH0400179', 'TXHOUSTD', 'TMH Physician Associates', 'George', '', 'Schroth', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '6550 Fannin St Ste 1901', 'Houston', 'Harris', 'TX', '77030', '7134411100', '7137969312', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1487665097', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('571201170', 'MH0400180', 'MH0400180', 'TXHOUSTD', 'TMH Physician Associates', 'Kamlesh', '', 'Thaker', 'MD', 'Hospitalist', '', '', NULL, 'O', '6565 Fannin St Ste B452', 'Houston', 'Harris', 'TX', '77030', '7134413620', '7137902082', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOHSP', '', NULL, '41264.00', '0.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1487680088', 0, 'Y', 0, '2013-09-13', NULL, NULL, 29.7108, -95.3999, NULL, NULL),
('571201170', 'MH0400181', 'MH0400181', 'TXHOUSTD', 'TMH Physician Associates', 'Kamlesh', '', 'Thaker', 'MD', 'Hospitalist', '', '', NULL, 'B', 'PO Box 4719', 'Houston', 'Harris', 'TX', '77210', '7134414347', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOHSP', '', NULL, '41264.00', '0.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1487680088', 0, 'Y', 0, '2013-09-13', NULL, NULL, 0, 0, NULL, NULL),
('571201170', 'MH0400182', 'MH0400182', 'TXHOUSTD', 'TMH Physician Associates', 'William', '', 'Zoghbi', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '6550 Fannin St Ste 1901', 'Houston', 'Harris', 'TX', '77030', '7134411100', '7137902643', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1487684783', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('571201170', 'MH0400183', 'MH0400183', 'TXHOUSTD', 'TMH Physician Associates', 'Jenny', '', 'Chang', 'MD', 'Oncology', '', '', NULL, 'O', '6445 Main St Ste OPC 21', 'Houston', 'Harris', 'TX', '77030', '7134419948', '7137931642', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1487734810', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.7126, -95.3999, NULL, NULL),
('571201170', 'MH0400184', 'MH0400184', 'TXHOUSTD', 'TMH Physician Associates', 'Angel', '', 'Rodriguez', 'MD', 'Oncology', '', '', NULL, 'O', '6445 Main St Ste OPC 21', 'Houston', 'Harris', 'TX', '77030', '7134419948', '7137931642', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', NULL, '', NULL, 'HCFA|UB|', '1487818811', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.7126, -95.3999, NULL, NULL),
('571201170', 'MH0400185', 'MH0400185', 'TXHOUSTD', 'TMH Physician Associates', 'Amy', '', 'Luczak', 'PAC', 'Physician Assistant Certified', '', '', NULL, 'O', '6550 Fannin St Ste 1401', 'Houston', 'Harris', 'TX', '77030', '7134415200', '7137987428', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1487884672', 0, 'Y', 0, '2013-09-13', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('571201170', 'MH0400186', 'MH0400186', 'TXHOUSTD', 'TMH Physician Associates', 'Christopher', '', 'Hawks', 'PAC', 'Physician Assistant Certified', '', '', NULL, 'O', '6550 Fannin St Ste 2600', 'Houston', 'Harris', 'TX', '77030', '7134419000', '7137902141', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1497028831', 0, 'Y', 0, '2013-09-13', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('571201170', 'MH0400187', 'MH0400187', 'TXHOUSTD', 'TMH Physician Associates', 'Tim', '', 'Tran', 'FNP', 'Family Practice', '', '', NULL, 'O', '18220 Tomball Pkwy Ste 400', 'Houston', 'Harris', 'TX', '77070', '7134419909', '7137902643', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOPCP', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', NULL, '', NULL, 'HCFA|UB|', '1497032528', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.9641, -95.5508, NULL, NULL),
('571201170', 'MH0400188', 'MH0400188', 'TXHOUSTD', 'TMH Physician Associates', 'Tim', '', 'Tran', 'FNP', 'Family Practice', '', '', NULL, 'B', 'PO Box 4719', 'Houston', 'Harris', 'TX', '77210', '7134416810', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOPCP', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', NULL, '', NULL, 'HCFA|UB|', '1497032528', 0, 'Y', 0, '2013-09-13', NULL, NULL, 0, 0, NULL, NULL),
('571201170', 'MH0400189', 'MH0400189', 'TXHOUSTD', 'TMH Physician Associates', 'Kathleen', '', 'Wyne', 'MD', 'Endocrinology', '', '', NULL, 'O', '6550 Fannin St Ste 1101', 'Houston', 'Harris', 'TX', '77030', '7134410006', '7137902727', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', NULL, '', NULL, 'HCFA|UB|', '1497731640', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('571201170', 'MH0400190', 'MH0400190', 'TXHOUSTD', 'TMH Physician Associates', 'Anakara', '', 'Sukumaran', 'MD', 'Hospitalist', '', '', NULL, 'O', '6565 Fannin St Ste B452', 'Houston', 'Harris', 'TX', '77030', '7134413620', '7137902082', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOHSP', '', NULL, '41264.00', '0.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1497763106', 0, 'Y', 0, '2013-09-13', NULL, NULL, 29.7108, -95.3999, NULL, NULL),
('571201170', 'MH0400191', 'MH0400191', 'TXHOUSTD', 'TMH Physician Associates', 'Anakara', '', 'Sukumaran', 'MD', 'Hospitalist', '', '', NULL, 'B', 'PO Box 4719', 'Houston', 'Harris', 'TX', '77210', '7134414347', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOHSP', '', NULL, '41264.00', '0.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1497763106', 0, 'Y', 0, '2013-09-13', NULL, NULL, 0, 0, NULL, NULL),
('571201170', 'MH0400192', 'MH0400192', 'TXHOUSTD', 'TMH Physician Associates', 'Yana', '', 'Finkelshteyn', 'MD', 'Family Practice', '', '', NULL, 'O', '16605 SW Fwy Ste 400', 'Sugar Land', 'Fort Bend', 'TX', '77479', '2812750800', '2812750801', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOPCP', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Sugar Land Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1497786651', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.5919, -95.6298, NULL, NULL),
('571201170', 'MH0400193', 'MH0400193', 'TXHOUSTD', 'TMH Physician Associates', 'Sheila', '', 'Tecson', 'MD', 'Family Practice', '', '', NULL, 'O', '18220 Tomball Pkwy Ste 390', 'Houston', 'Harris', 'TX', '77070', '2817370899', '2817370892', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOPCP', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Willowbrook Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1497876437', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.9641, -95.5508, NULL, NULL),
('571201170', 'MH0400194', 'MH0400194', 'TXHOUSTD', 'TMH Physician Associates', 'Rohit', '', 'Arora', 'MD', 'Hospitalist', '', '', NULL, 'O', '6565 Fannin St Ste 1003', 'Houston', 'Harris', 'TX', '77030', '7137906334', '7137906327', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOHSP', '', NULL, '41264.00', '0.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1508086885', 0, 'Y', 0, '2013-09-13', NULL, NULL, 29.7108, -95.3999, NULL, NULL),
('571201170', 'MH0400195', 'MH0400195', 'TXHOUSTD', 'TMH Physician Associates', 'Rohit', '', 'Arora', 'MD', 'Hospitalist', '', '', NULL, 'B', 'PO Box 4719', 'Houston', 'Harris', 'TX', '77210', '7134416810', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOHSP', '', NULL, '41264.00', '0.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1508086885', 0, 'Y', 0, '2013-09-13', NULL, NULL, 0, 0, NULL, NULL),
('571201170', 'MH0400196', 'MH0400196', 'TXHOUSTD', 'TMH Physician Associates', 'Seva', '', 'Papageorge', 'MD', 'Family Practice', '', '', NULL, 'O', '16605 SW Fwy Ste 400', 'Sugar Land', 'Fort Bend', 'TX', '77479', '2812750800', '2812750801', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOPCP', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Sugar Land Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1508836206', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.5919, -95.6298, NULL, NULL),
('571201170', 'MH0400197', 'MH0400197', 'TXHOUSTD', 'TMHPO Orthopedics Department', 'Daniel', 'Tran', 'Le', 'MD', 'Orthopedic Surgery', '', NULL, NULL, 'O', '13802 Centerfield Dr Ste 300', 'Houston', 'Harris', 'TX', '77070', '2817370999', '2817370926', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1518295682', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.967, -95.5471, NULL, NULL),
('571201170', 'MH0400198', 'MH0400198', 'TXHOUSTD', 'TMHPO Orthopedics Department', 'Daniel', 'Tran', 'Le', 'MD', 'Orthopedic Surgery', '', NULL, NULL, 'B', 'PO Box 4719', 'Houston', 'Harris', 'TX', '77210', '7134414838', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1518295682', 0, 'Y', 0, '2013-09-13', NULL, NULL, 0, 0, NULL, NULL),
('571201170', 'MH0400199', 'MH0400199', 'TXHOUSTD', 'TMH Physician Associates', 'Anna', '', 'Belcheva', 'MD', 'Oncology', '', '', NULL, 'O', '18220 Tomball Pkwy Ste 280', 'Houston', 'Harris', 'TX', '77070', '2817370435', '2817370429', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Willowbrook Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1518928514', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.9641, -95.5508, NULL, NULL),
('571201170', 'MH0400200', 'MH0400200', 'TXHOUSTD', 'TMH Physician Associates', 'Archana', '', 'Sadhu', 'MD', 'Endocrinology', '', '', NULL, 'O', '6550 Fannin St Ste 1101', 'Houston', 'Harris', 'TX', '77030', '7134410006', '7137902727', '6550 Fannin St Ste 1101', 'Houston', 'Harris', 'TX', '77030', '7134410006', '7137902727', 'TMHPHOSPC', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, 0, 41275, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1528088127', 0, 'N', 0, '2014-03-18', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('571201170', 'MH0400201', 'MH0400201', 'TXHOUSTD', 'TMH Physician Associates', 'Gregory', '', 'Seelhoefer', 'MD', 'Family Practice', '', '', NULL, 'O', '13802 Centerfield Dr Ste 300', 'Houston', 'Harris', 'TX', '77070', '2817370902', '2817370926', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOPCP', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1528224144', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.967, -95.5471, NULL, NULL),
('571201170', 'MH0400202', 'MH0400202', 'TXHOUSTD', 'TMH Physician Associates', 'Miguel', '', 'Quinones', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '6550 Fannin St Ste 1901', 'Houston', 'Harris', 'TX', '77030', '7134411100', '7137902643', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1538195466', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('571201170', 'MH0400203', 'MH0400203', 'TXHOUSTD', 'TMH Physician Associates', 'Muhammad', '', 'Khan', 'MD', 'Neurology', '', '', NULL, 'O', '16659 SW Fwy Ste 131', 'Sugar Land', 'Fort Bend', 'TX', '77479', '2814946387', '2814946410', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', NULL, '', NULL, 'HCFA|UB|', '1538233200', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.5904, -95.6321, NULL, NULL),
('571201170', 'MH0400204', 'MH0400204', 'TXHOUSTD', 'TMH Physician Associates', 'Lisa', '', 'Holloway', 'DO', 'Family Practice', '', '', NULL, 'O', '16605 SW Fwy Ste 400', 'Sugar Land', 'Fort Bend', 'TX', '77479', '2812750800', '2812750801', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOPCP', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', NULL, '', NULL, 'HCFA|UB|', '1548292360', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.5919, -95.6298, NULL, NULL),
('571201170', 'MH0400205', 'MH0400205', 'TXHOUSTD', 'TMH Physician Associates', 'Phillip', '', 'Bowden', 'ACNP', 'Acute Care Nurse Practitioner', '', '', NULL, 'O', '6550 Fannin St Ste 1601', 'Houston', 'Harris', 'TX', '77030', '7134415151', '7137906470', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1548341274', 0, 'Y', 0, '2013-09-13', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('571201170', 'MH0400206', 'MH0400206', 'TXHOUSTD', 'TMH Physician Associates', 'Phillip', '', 'Bowden', 'ACNP', 'Acute Care Nurse Practitioner', '', '', NULL, 'B', 'PO Box 4719', 'Houston', 'Harris', 'TX', '77210', '7134415125', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1548341274', 0, 'Y', 0, '2013-09-13', NULL, NULL, 0, 0, NULL, NULL),
('571201170', 'MH0400207', 'MH0400207', 'TXHOUSTD', 'Methodist Academic Medicine Associates', 'Veronica', 'Juanita', 'Carreon', 'FNP', 'Family Practice', '', '', NULL, 'O', '6550 Fannin Ste 1101', 'Houston', 'Harris', 'TX', '77030', '7134410006', '7137902727', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOPCP', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', NULL, '', '', 'HCFA|UB|', '1548595937', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('571201170', 'MH0400208', 'MH0400208', 'TXHOUSTD', 'Methodist Academic Medicine Associates', 'Veronica', 'Juanita', 'Carreon', 'FNP', 'Family Practice', '', '', NULL, 'B', 'PO Box 4719', 'Houston', 'Harris', 'TX', '77210', '7134414347', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOPCP', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', NULL, '', '', 'HCFA|UB|', '1548595937', 0, 'Y', 0, '2013-09-13', NULL, NULL, 0, 0, NULL, NULL),
('571201170', 'MH0400209', 'MH0400209', 'TXHOUSTD', 'TMH Physician Associates', 'Michael', '', 'Shen', 'MD', 'Hospitalist', '', '', NULL, 'O', '6565 Fannin St Ste F270', 'Houston', 'Harris', 'TX', '77030', '7134413020', '7137904207', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOHSP', '', NULL, '41264.00', '0.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1558471441', 0, 'Y', 0, '2013-09-13', NULL, NULL, 29.7108, -95.3999, NULL, NULL),
('571201170', 'MH0400210', 'MH0400210', 'TXHOUSTD', 'TMH Physician Associates', 'Michael', '', 'Shen', 'MD', 'Hospitalist', '', '', NULL, 'B', 'PO Box 4719', 'Houston', 'Harris', 'TX', '77210', '7134415129', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOHSP', '', NULL, '41264.00', '0.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1558471441', 0, 'Y', 0, '2013-09-13', NULL, NULL, 0, 0, NULL, NULL),
('571201170', 'MH0400211', 'MH0400211', 'TXHOUSTD', 'TMH Physician Associates', 'Laura', '', 'Batista', 'PAC', 'Physician Assistant Certified', '', '', NULL, 'O', '6565 Fannin St Ste B452', 'Houston', 'Harris', 'TX', '77030', '7137902082', '7137902082', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1558539239', 0, 'Y', 0, '2013-09-13', NULL, NULL, 29.7108, -95.3999, NULL, NULL),
('571201170', 'MH0400212', 'MH0400212', 'TXHOUSTD', 'TMH Physician Associates', 'Min', '', 'Kim', 'MD', 'Thoracic Surgery', '', '', NULL, 'O', '6550 Fannin St Ste 1601', 'Houston', 'Harris', 'TX', '77030', '7134415151', '7137906470', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', NULL, '', NULL, 'HCFA|UB|', '1558689661', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('571201170', 'MH0400213', 'MH0400213', 'TXHOUSTD', 'TMH Physician Associates', 'Tayma', '', 'Shaya', 'MD', 'Family Practice', '', '', NULL, 'O', '16605 SW Fwy Ste 400', 'Sugar Land', 'Fort Bend', 'TX', '77479', '2812750800', '2812750801', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOPCP', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Sugar Land Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1568411080', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.5919, -95.6298, NULL, NULL),
('571201170', 'MH0400214', 'MH0400214', 'TXHOUSTD', 'TMH Physician Associates', 'Kourosh', '', 'Jafarnia', 'MD', 'Hand Surgery', '', '', NULL, 'O', '13802 Centerfield Dr Ste 300', 'Houston', 'Harris', 'TX', '77070', '2817370999', '2817370926', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1568443562', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.967, -95.5471, NULL, NULL),
('571201170', 'MH0400215', 'MH0400215', 'TXHOUSTD', 'TMH Physician Associates', 'Craig', '', 'Pratt', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '6550 Fannin St Ste 1901', 'Houston', 'Harris', 'TX', '77030', '7134411100', '7137902643', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1578593877', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
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('571201170', 'MH0400217', 'MH0400217', 'TXHOUSTD', 'TMH Physician Associates', 'Janice', '', 'Zimmerman', 'MD', 'Hospitalist', '', '', NULL, 'O', '6565 Fannin St Ste F270', 'Houston', 'Harris', 'TX', '77030', '7134413020', '7137902727', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOHSP', '', NULL, '41264.00', '0.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1578652947', 0, 'Y', 0, '2013-09-13', NULL, NULL, 29.7108, -95.3999, NULL, NULL),
('571201170', 'MH0400218', 'MH0400218', 'TXHOUSTD', 'TMH Physician Associates', 'Janice', '', 'Zimmerman', 'MD', 'Hospitalist', '', '', NULL, 'B', 'PO Box 4719', 'Houston', 'Harris', 'TX', '77210', '7134415129', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOHSP', '', NULL, '41264.00', '0.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1578652947', 0, 'Y', 0, '2013-09-13', NULL, NULL, 0, 0, NULL, NULL),
('571201170', 'MH0400219', 'MH0400219', 'TXHOUSTD', 'TMH Physician Associates', 'Pedro', '', 'Cosculluela', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '6550 Fannin St Ste 2600', 'Houston', 'Harris', 'TX', '77030', '7134419000', '7137902043', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1588693386', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('571201170', 'MH0400220', 'MH0400220', 'TXHOUSTD', 'TMH Physician Associates', 'Lawrence', '', 'Rice', 'MD', 'Hematology', '', '', NULL, 'O', '6550 Fannin St Ste 1101', 'Houston', 'Harris', 'TX', '77030', '7134410006', '7137902727', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1588758510', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('571201170', 'MH0400221', 'MH0400221', 'TXHOUSTD', 'TMH Physician Associates', 'Raul', '', 'Sanchez Leon', 'MD', 'Hospitalist', '', '', NULL, 'O', '6565 Fannin St Ste F270', 'Houston', 'Harris', 'TX', '77030', '7134413020', '7137904207', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOHSP', '', NULL, '41264.00', '0.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1598758476', 0, 'Y', 0, '2013-09-13', NULL, NULL, 29.7108, -95.3999, NULL, NULL),
('571201170', 'MH0400222', 'MH0400222', 'TXHOUSTD', 'TMH Physician Associates', 'Raul', '', 'Sanchez Leon', 'MD', 'Hospitalist', '', '', NULL, 'B', 'PO Box 4719', 'Houston', 'Harris', 'TX', '77210', '7134414347', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOHSP', '', NULL, '41264.00', '0.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1598758476', 0, 'Y', 0, '2013-09-13', NULL, NULL, 0, 0, NULL, NULL),
('571201170', 'MH0400223', 'MH0400223', 'TXHOUSTD', 'TMH Physician Associates', 'Patricia', '', 'Brenza', 'ACNP', 'Acute Care Nurse Practitioner', '', '', NULL, 'O', '6565 Fannin St Ste B452', 'Houston', 'Harris', 'TX', '77030', '7134413620', '7137902082', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1598780173', 0, 'Y', 0, '2013-09-13', NULL, NULL, 29.7108, -95.3999, NULL, NULL),
('571201170', 'MH0400224', 'MH0400224', 'TXHOUSTD', 'Methodist Academic Medicine Associates', 'Raul', 'J', 'Gutierrez', 'ACNP', 'Nurse Practitioner', '', NULL, NULL, 'O', '6550 Fannin Ste 1101', 'Houston', 'Harris', 'TX', '77030', '7134410006', '7137902727', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOPCP', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, '', '', '', NULL, 'HCFA|UB|', '1609143460', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('571201170', 'MH0400225', 'MH0400225', 'TXHOUSTD', 'Methodist Academic Medicine Associates', 'Raul', 'J', 'Gutierrez', 'ACNP', 'Nurse Practitioner', '', NULL, NULL, 'B', 'PO Box 4719', 'Houston', 'Harris', 'TX', '77210', '7134415129', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOPCP', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, '', '', '', NULL, 'HCFA|UB|', '1609143460', 0, 'Y', 0, '2013-09-13', NULL, NULL, 0, 0, NULL, NULL),
('571201170', 'MH0400226', 'MH0400226', 'TXHOUSTD', 'TMH Physician Associates', 'Timothy', '', 'Boone', 'MD', 'Urology', '', '', NULL, 'O', '6560 Fannin St Ste 2100', 'Houston', 'Harris', 'TX', '77030', '7134416455', '7134416463', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1609965896', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.7109, -95.4, NULL, NULL),
('571201170', 'MH0400227', 'MH0400227', 'TXHOUSTD', 'TMH Physician Associates', 'Corey', '', 'Meisenbach', 'ACNP', 'Acute Care Nurse Practitioner', '', '', NULL, 'O', '6550 Fannin St Ste 1601', 'Houston', 'Harris', 'TX', '77030', '7134415153', '7137906470', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1619040367', 0, 'Y', 0, '2013-09-13', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('571201170', 'MH0400228', 'MH0400228', 'TXHOUSTD', 'TMH Physician Associates', 'Kesavan', '', 'Shan', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '16651 SW Fwy Ste 450', 'Sugar Land', 'Fort Bend', 'TX', '77479', '2812750330', '2812750331', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Sugar Land Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1619080843', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.5915, -95.6304, NULL, NULL),
('571201170', 'MH0400229', 'MH0400229', 'TXHOUSTD', 'TMH Physician Associates', 'Larry', '', 'Tran', 'MD', 'Neurology', '', '', NULL, 'O', '16659 SW Fwy Ste 131', 'Sugar Land', 'Fort Bend', 'TX', '77479', '2814946387', '2814946410', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Sugar Land Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1629259510', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.5904, -95.6321, NULL, NULL),
('571201170', 'MH0400230', 'MH0400230', 'TXHOUSTD', 'TMH Physician Associates', 'Jacobo', '', 'Nurko', 'MD', 'Vascular Surgery', '', '', NULL, 'O', '4301 Garth Rd Ste 212', 'Baytown', 'Harris', 'TX', '77521', '8325566625', '8325566650', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', NULL, '', NULL, 'HCFA|UB|', '1629262621', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.7681, -94.9775, NULL, NULL),
('571201170', 'MH0400231', 'MH0400231', 'TXHOUSTD', 'TMH Physician Associates', 'Tiffany', '', 'Burns', 'MD', 'Family Practice', '', '', NULL, 'O', '18220 Tomball Pkwy Ste 390', 'Houston', 'Harris', 'TX', '77070', '2817370899', '2817370892', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOPCP', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Willowbrook Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1629289897', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.9641, -95.5508, NULL, NULL),
('571201170', 'MH0400232', 'MH0400232', 'TXHOUSTD', 'TMH Physician Associates', 'Mark', '', 'Maffet', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1201 Brooks St', 'Sugar Land', 'Fort Bend', 'TX', '77478', '2816904678', '2815658808', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Sugar Land Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1639259039', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.6059, -95.6347, NULL, NULL),
('571201170', 'MH0400233', 'MH0400233', 'TXHOUSTD', 'TMH Physician Associates', 'Jean', '', 'Bismuth', 'MD', 'Vascular Surgery', '', '', NULL, 'O', '6550 Fannin St Ste 1401', 'Houston', 'Harris', 'TX', '77030', '7134415200', '7134417428', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1639330053', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('571201170', 'MH0400234', 'MH0400234', 'TXHOUSTD', 'TMH Physician Associates', 'Barry', '', 'Trachtenberg', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '6550 Fannin St Ste 1901', 'Houston', 'Harris', 'TX', '77030', '7134411100', '7137902643', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1639331473', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('571201170', 'MH0400235', 'MH0400235', 'TXHOUSTD', 'TMH Physician Associates', 'Jovan', '', 'Popovich', 'MD', 'Rheumatology', '', '', NULL, 'O', '6550 Fannin St Ste 1101', 'Houston', 'Harris', 'TX', '77030', '7134410006', '7137902727', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1649206822', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('571201170', 'MH0400236', 'MH0400236', 'TXHOUSTD', 'TMH Physician Associates', 'Bradley', '', 'Weiner', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '6550 Fannin St Ste 2600', 'Houston', 'Harris', 'TX', '77030', '7134419000', '7137902141', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1649234642', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('571201170', 'MH0400237', 'MH0400237', 'TXHOUSTD', 'TMH Physician Associates', 'Patrick', '', 'Reardon', 'MD', 'General Surgery', '', '', NULL, 'O', '6550 Fannin St Ste 2435', 'Houston', 'Harris', 'TX', '77030', '7137903140', '7137903235', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1649270265', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('571201170', 'MH0400238', 'MH0400238', 'TXHOUSTD', 'TMH Physician Associates', 'David', '', 'Mobley', 'MD', 'Urology', '', '', NULL, 'O', '18400 Katy Fwy Ste 350', 'Houston', 'Harris', 'TX', '77094', '8325228300', '8325228301', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist West Houston Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1649272170', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.7855, -95.6953, NULL, NULL),
('571201170', 'MH0400239', 'MH0400239', 'TXHOUSTD', 'TMH Physician Associates', 'Alan', '', 'Lumsden', 'MD', 'Vascular Surgery', '', '', NULL, 'O', '6550 Fannin St Ste 1401', 'Houston', 'Harris', 'TX', '77030', '7134415200', '7134417428', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1649350042', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('571201170', 'MH0400240', 'MH0400240', 'TXHOUSTD', 'TMH Physician Associates', 'John', '', 'Fetter', 'MD', 'Hospitalist', '', '', NULL, 'O', '6565 Fannin St Ste B452', 'Houston', 'Harris', 'TX', '77030', '7134413620', '7137902082', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOHSP', '', NULL, '41264.00', '0.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1659303287', 0, 'Y', 0, '2013-09-13', NULL, NULL, 29.7108, -95.3999, NULL, NULL),
('571201170', 'MH0400241', 'MH0400241', 'TXHOUSTD', 'TMH Physician Associates', 'John', '', 'Fetter', 'MD', 'Hospitalist', '', '', NULL, 'B', 'PO Box 4719', 'Houston', 'Harris', 'TX', '77210', '7134414347', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOHSP', '', NULL, '41264.00', '0.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1659303287', 0, 'Y', 0, '2013-09-13', NULL, NULL, 0, 0, NULL, NULL),
('571201170', 'MH0400242', 'MH0400242', 'TXHOUSTD', 'TMH Physician Associates', 'Jennifer', '', 'Diamond', 'MD', 'Family Practice', '', '', NULL, 'O', '16605 SW Fwy Ste 400', 'Sugar Land', 'Fort Bend', 'TX', '77479', '2812750800', '2812750801', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOPCP', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Sugar Land Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1659341717', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.5919, -95.6298, NULL, NULL),
('571201170', 'MH0400243', 'MH0400243', 'TXHOUSTD', 'TMH Physician Associates', 'Stephen', '', 'Little', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '6550 Fannin St Ste 1901', 'Houston', 'Harris', 'TX', '77030', '7134411100', '7134412643', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1659412336', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('571201170', 'MH0400244', 'MH0400244', 'TXHOUSTD', 'TMH Physician Associates', 'Emad', '', 'Asham', 'MD', 'General Surgery', '', '', NULL, 'O', '6550 Fannin St Ste 1601', 'Houston', 'Harris', 'TX', '77030', '7134415141', '7137906470', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', NULL, '', NULL, 'HCFA|UB|', '1659483287', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('571201170', 'MH0400245', 'MH0400245', 'TXHOUSTD', 'TMH Physician Associates', 'Divina', '', 'Tuazon', 'MD', 'Hospitalist', '', '', NULL, 'O', '6565 Fannin St Ste B452', 'Houston', 'Harris', 'TX', '77030', '7134413620', '7137902082', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOHSP', '', NULL, '41264.00', '0.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1669457826', 0, 'Y', 0, '2013-09-13', NULL, NULL, 29.7108, -95.3999, NULL, NULL),
('571201170', 'MH0400246', 'MH0400246', 'TXHOUSTD', 'TMH Physician Associates', 'Divina', '', 'Tuazon', 'MD', 'Hospitalist', '', '', NULL, 'B', 'PO Box 4719', 'Houston', 'Harris', 'TX', '77210', '7134414347', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOHSP', '', NULL, '41264.00', '0.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1669457826', 0, 'Y', 0, '2013-09-13', NULL, NULL, 0, 0, NULL, NULL),
('571201170', 'MH0400247', 'MH0400247', 'TXHOUSTD', 'TMH Physician Associates', 'Christopher', '', 'Robben', 'MD', 'Internal Medicine', '', '', NULL, 'O', '6560 Fannin St Ste 1950', 'Houston', 'Harris', 'TX', '77030', '7134414280', '7137902860', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOPCP', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1669458337', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.7109, -95.4, NULL, NULL),
('571201170', 'MH0400248', 'MH0400248', 'TXHOUSTD', 'TMH Physician Associates', 'Uy', '', 'Ngo', 'PAC', 'Physician Assistant Certified', '', '', NULL, 'O', '6550 Fannin St Ste 1401', 'Houston', 'Harris', 'TX', '77030', '7134415200', '7137970613', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1669552071', 0, 'Y', 0, '2013-09-13', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('571201170', 'MH0400249', 'MH0400249', 'TXHOUSTD', 'TMH Physician Associates', 'Ray', '', 'Valdez', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1201 Brooks St', 'Sugar Land', 'Fort Bend', 'TX', '77478', '2816904678', '2815658808', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Sugar Land Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1669586848', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.6059, -95.6347, NULL, NULL),
('571201170', 'MH0400250', 'MH0400250', 'TXHOUSTD', 'TMH Physician Associates', 'Lina', '', 'Ching', 'MD', 'Rheumatology', '', '', NULL, 'O', '6550 Fannin St Ste 1101', 'Houston', 'Harris', 'TX', '77030', '7134410006', '7137902727', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1689848996', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('571201170', 'MH0400251', 'MH0400251', 'TXHOUSTD', 'TMH Physician Associates', 'Nabil', '', 'Tariq', 'MD', 'General Surgery', '', '', NULL, 'O', '6550 Fannin St Ste 1601', 'Houston', 'Harris', 'TX', '77030', '7134415141', '7137906470', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', NULL, '', NULL, 'HCFA|UB|', '1689881740', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('571201170', 'MH0400252', 'MH0400252', 'TXHOUSTD', 'TMH Physician Associates', 'Nabil', '', 'Tariq', 'MD', 'General Surgery', '', '', NULL, 'B', 'PO Box 4719', 'Houston', 'Harris', 'TX', '77210', '7134415125', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', NULL, '', NULL, 'HCFA|UB|', '1689881740', 0, 'Y', 0, '2013-09-13', NULL, NULL, 0, 0, NULL, NULL),
('571201170', 'MH0400253', 'MH0400253', 'TXHOUSTD', 'TMH Physician Associates', 'Wesley', '', 'Ekeruo', 'MD', 'Urology', '', '', NULL, 'O', '18400 Katy Fwy Ste 350', 'Houston', 'Harris', 'TX', '77094', '7134416455', '7134416463', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist West Houston Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1689991408', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.7855, -95.6953, NULL, NULL),
('571201170', 'MH0400254', 'MH0400254', 'TXHOUSTD', 'TMH Physician Associates', 'Ana', '', 'Corteguera', 'DO', 'Family Practice', '', '', NULL, 'O', '16605 SW Fwy Ste 400', 'Sugar Land', 'Fort Bend', 'TX', '77479', '2812750800', '2812750801', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOPCP', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Sugar Land Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1699700765', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.5919, -95.6298, NULL, NULL),
('571201170', 'MH0400255', 'MH0400255', 'TXHOUSTD', 'TMH Physician Associates', 'Thomas', '', 'Kaleekal', 'MD', 'Pulmonary', '', '', NULL, 'O', '6550 Fannin St Ste 1101', 'Houston', 'Harris', 'TX', '77030', '7134410006', '7137902727', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', NULL, '', NULL, 'HCFA|UB|', '1699765420', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('571201170', 'MH0400256', 'MH0400256', 'TXHOUSTD', 'TMH Physician Associates', 'Richard', '', 'Day', 'MD', 'Hospitalist', '', '', NULL, 'O', '6565 Fannin St Ste B452', 'Houston', 'Harris', 'TX', '77030', '7134413620', '7137902082', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOHSP', '', NULL, '41264.00', '0.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1710965066', 0, 'Y', 0, '2013-09-13', NULL, NULL, 29.7108, -95.3999, NULL, NULL),
('571201170', 'MH0400257', 'MH0400257', 'TXHOUSTD', 'TMH Physician Associates', 'Richard', '', 'Day', 'MD', 'Hospitalist', '', '', NULL, 'B', 'PO Box 4719', 'Houston', 'Harris', 'TX', '77210', '7134414347', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOHSP', '', NULL, '41264.00', '0.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1710965066', 0, 'Y', 0, '2013-09-13', NULL, NULL, 0, 0, NULL, NULL),
('571201170', 'MH0400258', 'MH0400258', 'TXHOUSTD', 'TMH Physician Associates', 'Monika', '', 'Welborn', 'PAC', 'Physician Assistant Certified', '', '', NULL, 'O', '1201 Brooks St', 'Sugar Land', 'Fort Bend', 'TX', '77478', '2816904678', '2815658808', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Sugar Land Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1720157027', 0, 'Y', 0, '2013-09-13', NULL, NULL, 29.6059, -95.6347, NULL, NULL),
('571201170', 'MH0400259', 'MH0400259', 'TXHOUSTD', 'TMH Physician Associates', 'Monika', '', 'Welborn', 'PAC', 'Physician Assistant Certified', '', '', NULL, 'B', 'PO Box 4719', 'Houston', 'Harris', 'TX', '77210', '7134418691', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Sugar Land Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1720157027', 0, 'Y', 0, '2013-09-13', NULL, NULL, 0, 0, NULL, NULL),
('571201170', 'MH0400260', 'MH0400260', 'TXHOUSTD', 'TMH Physician Associates', 'Eddie', '', 'Patton', 'MD', 'Neurology', '', '', NULL, 'O', '16659 SW Fwy Ste 131', 'Sugar Land', 'Fort Bend', 'TX', '77479', '2814946387', '2814946410', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Sugar Land Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1720213770', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.5904, -95.6321, NULL, NULL),
('571201170', 'MH0400261', 'MH0400261', 'TXHOUSTD', 'TMH Physician Associates', 'Richard', '', 'Knight', 'MD', 'General Surgery', '', '', NULL, 'O', '6550 Fannin St Ste 1601', 'Houston', 'Harris', 'TX', '77030', '7134415141', '7137931840', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1730111345', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('571201170', 'MH0400262', 'MH0400262', 'TXHOUSTD', 'TMH Physician Associates', 'Tobin', '', 'Bushong', 'PAC', 'Physician Assistant Certified', '', '', NULL, 'O', '6550 Fannin St Ste 2600', 'Houston', 'Harris', 'TX', '77030', '7134419000', '7137902057', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1730164831', 0, 'Y', 0, '2013-09-13', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('571201170', 'MH0400263', 'MH0400263', 'TXHOUSTD', 'TMH Physician Associates', 'Drew', '', 'Ludwig', 'DO', 'Hospitalist', '', '', NULL, 'O', '6565 Fannin St Ste B452', 'Houston', 'Harris', 'TX', '77030', '7134413620', '7137902082', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOHSP', '', NULL, '41264.00', '0.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1730379355', 0, 'Y', 0, '2013-09-13', NULL, NULL, 29.7108, -95.3999, NULL, NULL),
('571201170', 'MH0400264', 'MH0400264', 'TXHOUSTD', 'TMH Physician Associates', 'Drew', '', 'Ludwig', 'DO', 'Hospitalist', '', '', NULL, 'B', 'PO Box 4719', 'Houston', 'Harris', 'TX', '77210', '7134414347', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOHSP', '', NULL, '41264.00', '0.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1730379355', 0, 'Y', 0, '2013-09-13', NULL, NULL, 0, 0, NULL, NULL),
('571201170', 'MH0400265', 'MH0400265', 'TXHOUSTD', 'TMH Physician Associates', 'Michael', '', 'Zwillman', 'MD', 'Hospitalist', '', '', NULL, 'O', '6565 Fannin St Ste B452', 'Houston', 'Harris', 'TX', '77030', '7134413620', '7137902082', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOHSP', '', NULL, '41264.00', '0.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1740209642', 0, 'Y', 0, '2013-09-13', NULL, NULL, 29.7108, -95.3999, NULL, NULL),
('571201170', 'MH0400266', 'MH0400266', 'TXHOUSTD', 'TMH Physician Associates', 'Michael', '', 'Zwillman', 'MD', 'Hospitalist', '', '', NULL, 'B', 'PO Box 4719', 'Houston', 'Harris', 'TX', '77210', '7134414347', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOHSP', '', NULL, '41264.00', '0.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1740209642', 0, 'Y', 0, '2013-09-13', NULL, NULL, 0, 0, NULL, NULL),
('571201170', 'MH0400267', 'MH0400267', 'TXHOUSTD', 'TMH Physician Associates', 'Marc', '', 'Boom', 'MD', 'Internal Medicine', '', '', NULL, 'O', '6550 Fannin St Ste 1101', 'Houston', 'Harris', 'TX', '77030', '7134410006', '7137902727', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOPCP', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1740210046', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('571201170', 'MH0400268', 'MH0400268', 'TXHOUSTD', 'TMH Physician Associates', 'Ronnie', '', 'Gentry', 'MD', 'Internal Medicine', '', '', NULL, 'O', '6560 Fannin St Ste 1950', 'Houston', 'Harris', 'TX', '77030', '7134414280', '7137902860', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOPCP', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1740266303', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.7109, -95.4, NULL, NULL),
('571201170', 'MH0400269', 'MH0400269', 'TXHOUSTD', 'TMH Physician Associates', 'Matthias', '', 'Loebe', 'MD', 'General Surgery', '', '', NULL, 'O', '6550 Fannin St Ste 1401', 'Houston', 'Harris', 'TX', '77030', '7134415200', '7137970613', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1740360148', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('571201170', 'MH0400270', 'MH0400270', 'TXHOUSTD', 'TMH Physician Associates', 'Suzanne', '', 'Weakley', 'MD', 'Allergy and Immunology', '', '', NULL, 'O', '18220 Tomball Pkwy Ste 130', 'Houston', 'Harris', 'TX', '77070', '8329121188', '2816408806', '18220 Tomball Pkwy Ste 130', 'Houston', 'Harris', 'TX', '77070', '8329121188', '2816408806', 'TMHPHOSPC', 'TXHCPCTMH', '', '41264.00', '50.00', '0.00', 6, '2013-10-01', '2014-02-10', 0, 41275, 0, '', '', '', '', 'HCFA|UB|', '1750385746', 0, 'N', 0, '2014-02-10', NULL, NULL, 29.966, -95.5513, NULL, NULL),
('571201170', 'MH0400271', 'MH0400271', 'TXHOUSTD', 'TMH Physician Associates', 'Janet', '', 'Hudkins', 'ACNP', 'Acute Care Nurse Practitioner', '', '', NULL, 'O', '6550 Fannin St Ste 1601', 'Houston', 'Harris', 'TX', '77030', '7134415153', '7137906470', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1750442349', 0, 'Y', 0, '2013-09-13', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('571201170', 'MH0400272', 'MH0400272', 'TXHOUSTD', 'TMH Physician Associates', 'Sushma', '', 'Yalamanchili', 'MD', 'Ophthalmology', '', '', NULL, 'O', '6560 Fannin St Ste 450', 'Houston', 'Harris', 'TX', '77030', '7134418843', '7137931636', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', NULL, '', NULL, 'HCFA|UB|', '1750471769', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.7109, -95.4, NULL, NULL),
('571201170', 'MH0400273', 'MH0400273', 'TXHOUSTD', 'TMH Physician Associates', 'Faisal', '', 'Uddin', 'MD', 'Hospitalist', '', '', NULL, 'O', '6565 Fannin St Ste B452', 'Houston', 'Harris', 'TX', '77030', '7134413620', '7137902082', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOHSP', '', NULL, '41264.00', '0.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1750541041', 0, 'Y', 0, '2013-09-13', NULL, NULL, 29.7108, -95.3999, 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
('571201170', 'MH0400274', 'MH0400274', 'TXHOUSTD', 'TMH Physician Associates', 'Faisal', '', 'Uddin', 'MD', 'Hospitalist', '', '', NULL, 'B', 'PO Box 4719', 'Houston', 'Harris', 'TX', '77210', '7134414347', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOHSP', '', NULL, '41264.00', '0.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1750541041', 0, 'Y', 0, '2013-09-13', NULL, NULL, 0, 0, NULL, NULL),
('571201170', 'MH0400275', 'MH0400275', 'TXHOUSTD', 'TMH Physician Associates', 'Sylvia', '', 'Martinez', 'MD', 'General Surgery', '', '', NULL, 'O', '6550 Fannin St Ste 1601', 'Houston', 'Harris', 'TX', '77030', '7134415141', '7137906470', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', NULL, '', NULL, 'HCFA|UB|', '1760634349', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('571201170', 'MH0400276', 'MH0400276', 'TXHOUSTD', 'TMH Physician Associates', 'Sylvia', '', 'Martinez', 'MD', 'General Surgery', '', '', NULL, 'B', 'PO Box 4719', 'Houston', 'Harris', 'TX', '77210', '7134415125', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', NULL, '', NULL, 'HCFA|UB|', '1760634349', 0, 'Y', 0, '2013-09-13', NULL, NULL, 0, 0, NULL, NULL),
('571201170', 'MH0400277', 'MH0400277', 'TXHOUSTD', 'TMH Physician Associates', 'Loren', '', 'Semones', 'ACNP', 'Adult Nurse Practitioner', '', '', NULL, 'O', '6550 Fannin St Ste 1901', 'Houston', 'Harris', 'TX', '77030', '7134411100', '7137902643', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1760693576', 0, 'Y', 0, '2013-09-13', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('571201170', 'MH0400278', 'MH0400278', 'TXHOUSTD', 'TMH Physician Associates', 'Loren', '', 'Semones', 'ACNP', 'Adult Nurse Practitioner', '', '', NULL, 'B', 'PO Box 4719', 'Houston', 'Harris', 'TX', '77210', '7134411892', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1760693576', 0, 'Y', 0, '2013-09-13', NULL, NULL, 0, 0, NULL, NULL),
('571201170', 'MH0400279', 'MH0400279', 'TXHOUSTD', 'Methodist DeBakey Cardiology Associates', 'Mina', '', 'Elnemr', 'MD', 'Hospitalist', '', NULL, NULL, 'O', '6565 Fannin Fondren 1003', 'Houston', 'Harris', 'TX', '77030', '7134411100', '7137902643', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOHSP', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', '', '', NULL, 'HCFA|UB|', '1760702302', 0, 'Y', 0, '2013-09-13', NULL, NULL, 29.7108, -95.3999, NULL, NULL),
('571201170', 'MH0400280', 'MH0400280', 'TXHOUSTD', 'Methodist DeBakey Cardiology Associates', 'Mina', '', 'Elnemr', 'MD', 'Hospitalist', '', NULL, NULL, 'B', 'PO Box 4719', 'Houston', 'Harris', 'TX', '77210', '7134416810', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOHSP', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', '', '', NULL, 'HCFA|UB|', '1760702302', 0, 'Y', 0, '2013-09-13', NULL, NULL, 0, 0, NULL, NULL),
('571201170', 'MH0400281', 'MH0400281', 'TXHOUSTD', 'TMH Physician Associates', 'Joseph', '', 'Sucher', 'MD', 'Critical Care', '', '', NULL, 'O', '6550 Fannin St Ste 1601', 'Houston', 'Harris', 'TX', '77030', '7134415141', '7137906470', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOHSP', '', NULL, '41264.00', '0.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1770515751', 0, 'Y', 0, '2013-09-13', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('571201170', 'MH0400282', 'MH0400282', 'TXHOUSTD', 'TMH Physician Associates', 'Joseph', '', 'Sucher', 'MD', 'Critical Care', '', '', NULL, 'B', 'PO Box 4719', 'Houston', 'Harris', 'TX', '77210', '7134415125', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOHSP', '', NULL, '41264.00', '0.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1770515751', 0, 'N', 0, '2013-09-13', NULL, NULL, 0, 0, NULL, NULL),
('571201170', 'MH0400283', 'MH0400283', 'TXHOUSTD', 'TMH Physician Associates', 'Elie', '', 'Azzi', 'MD', 'Hospitalist', '', '', NULL, 'O', '6565 Fannin St Ste F270', 'Houston', 'Harris', 'TX', '77030', '7134413620', '7137902082', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOHSP', '', NULL, '41264.00', '0.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1770548786', 0, 'Y', 0, '2013-09-13', NULL, NULL, 29.7108, -95.3999, NULL, NULL),
('571201170', 'MH0400284', 'MH0400284', 'TXHOUSTD', 'TMH Physician Associates', 'Elie', '', 'Azzi', 'MD', 'Hospitalist', '', '', NULL, 'B', 'PO Box 4719', 'Houston', 'Harris', 'TX', '77210', '7134414347', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOHSP', '', NULL, '41264.00', '0.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1770548786', 0, 'Y', 0, '2013-09-13', NULL, NULL, 0, 0, NULL, NULL),
('571201170', 'MH0400285', 'MH0400285', 'TXHOUSTD', 'TMH Physician Associates', 'Christopher', '', 'Smith', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1201 Brooks St', 'Sugar Land', 'Fort Bend', 'TX', '77478', '2816904678', '2815658808', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', 'Houston Methodist Sugar Land Hospital', NULL, NULL, 'HCFA|UB|', '1770585226', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.6059, -95.6347, NULL, NULL),
('571201170', 'MH0400286', 'MH0400286', 'TXHOUSTD', 'TMH Physician Associates', 'Ghassan', '', 'Noureddine', 'MD', 'Hospitalist', '', '', NULL, 'O', '6565 Fannin St Ste F270', 'Houston', 'Harris', 'TX', '77030', '7134413020', '7137904207', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOHSP', '', NULL, '41264.00', '0.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1770596736', 0, 'Y', 0, '2013-09-13', NULL, NULL, 29.7108, -95.3999, NULL, NULL),
('571201170', 'MH0400287', 'MH0400287', 'TXHOUSTD', 'TMH Physician Associates', 'Ghassan', '', 'Noureddine', 'MD', 'Hospitalist', '', '', NULL, 'B', 'PO Box 4719', 'Houston', 'Harris', 'TX', '77210', '7134415129', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOHSP', '', NULL, '41264.00', '0.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1770596736', 0, 'Y', 0, '2013-09-13', NULL, NULL, 0, 0, NULL, NULL),
('571201170', 'MH0400288', 'MH0400288', 'TXHOUSTD', 'TMH Physician Associates', 'HoSun', '', 'Hwang', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '13802 Centerfield Dr Ste 300', 'Houston', 'Harris', 'TX', '77070', '2817370999', '2817370926', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1770624793', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.967, -95.5471, NULL, NULL),
('571201170', 'MH0400289', 'MH0400289', 'TXHOUSTD', 'TMH Physician Associates', 'Soma', '', 'Jyothula', 'MD', 'Pulmonary', '', '', NULL, 'O', '6550 Fannin St Ste 1101', 'Houston', 'Harris', 'TX', '77030', '7134410006', '7137902727', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', NULL, '', NULL, 'HCFA|UB|', '1770669624', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('571201170', 'MH0400290', 'MH0400290', 'TXHOUSTD', 'TMH Physician Associates', 'Allison', '', 'Dublin', 'MD', 'Ophthalmology', '', '', NULL, 'O', '6560 Fannin St Ste 450', 'Houston', 'Harris', 'TX', '77030', '7134418843', '7137931636', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', NULL, '', NULL, 'HCFA|UB|', '1770791725', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.7109, -95.4, NULL, NULL),
('571201170', 'MH0400291', 'MH0400291', 'TXHOUSTD', 'TMH Physician Associates', 'Travis', '', 'Hanson', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '13802 Centerfield Dr Ste 300', 'Houston', 'Harris', 'TX', '77070', '2817370999', '2817370926', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1780666024', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.967, -95.5471, NULL, NULL),
('571201170', 'MH0400292', 'MH0400292', 'TXHOUSTD', 'TMH Physician Associates', 'Mickey', '', 'Bush', 'MD', 'Family Practice', '', '', NULL, 'O', '3424 FM 1092 Ste 220', 'Missouri City', 'Fort Bend', 'TX', '77459', '2812083388', '2812083393', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOPCP', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', NULL, '', NULL, 'HCFA|UB|', '1780678698', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.5715, -95.5641, NULL, NULL),
('571201170', 'MH0400293', 'MH0400293', 'TXHOUSTD', 'TMH Physician Associates', 'Brian', '', 'Miles', 'MD', 'Urology', '', '', NULL, 'O', '6560 Fannin St Ste 2100', 'Houston', 'Harris', 'TX', '77030', '7134416455', '7134416463', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1780774752', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.7109, -95.4, NULL, NULL),
('571201170', 'MH0400294', 'MH0400294', 'TXHOUSTD', 'TMH Physician Associates', 'Julie', '', 'Nguyen', 'MD', 'Hospitalist', '', '', NULL, 'O', '6550 Fannin St Ste 1101', 'Houston', 'Harris', 'TX', '77030', '7134410006', '7137902727', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOHSP', '', NULL, '41264.00', '0.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1780811810', 0, 'Y', 0, '2013-09-13', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('571201170', 'MH0400295', 'MH0400295', 'TXHOUSTD', 'TMH Physician Associates', 'Julie', '', 'Nguyen', 'MD', 'Hospitalist', '', '', NULL, 'B', 'PO Box 4719', 'Houston', 'Harris', 'TX', '77210', '7134415129', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOHSP', '', NULL, '41264.00', '0.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1780811810', 0, 'Y', 0, '2013-09-13', NULL, NULL, 0, 0, NULL, NULL),
('571201170', 'MH0400296', 'MH0400296', 'TXHOUSTD', 'TMH Physician Associates', 'Diane', '', 'Garib', 'ACNP', 'Acute Care Nurse Practitioner', '', '', NULL, 'O', '6565 Fannin St Ste B452', 'Houston', 'Harris', 'TX', '77030', '7134413620', '7137902082', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1780896696', 0, 'Y', 0, '2013-09-13', NULL, NULL, 29.7108, -95.3999, NULL, NULL),
('571201170', 'MH0400297', 'MH0400297', 'TXHOUSTD', 'TMH Physician Associates', 'Kenneth', '', 'Yun', 'MD', 'Urology', '', '', NULL, 'O', '18220 Tomball Pkwy Ste 400', 'Houston', 'Harris', 'TX', '77070', '7134416455', '7134416463', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', NULL, '', NULL, 'HCFA|UB|', '1780916833', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.9641, -95.5508, NULL, NULL),
('571201170', 'MH0400298', 'MH0400298', 'TXHOUSTD', 'TMH Physician Associates', 'Richard', '', 'Robbins', 'MD', 'Endocrinology', '', '', NULL, 'O', '6550 Fannin St Ste 1101', 'Houston', 'Harris', 'TX', '77030', '7134410006', '7134412727', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1790713428', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('571201170', 'MH0400299', 'MH0400299', 'TXHOUSTD', 'TMH Physician Associates', 'Mona', '', 'Sheth', 'MD', 'Family Practice', '', '', NULL, 'O', '16605 SW Fwy Ste 400', 'Sugar Land', 'Fort Bend', 'TX', '77479', '2812750800', '2812750801', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOPCP', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Sugar Land Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1790816791', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.5919, -95.6298, NULL, NULL),
('571201170', 'MH0400300', 'MH0400300', 'TXHOUSTD', 'TMH Physician Associates', 'Madiha', '', 'Ashraf', 'MD', 'Infectious Disease', '', '', NULL, 'O', '6550 Fannin St Ste 1101', 'Houston', 'Harris', 'TX', '77030', '7134410006', '7137902727', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', NULL, '', NULL, 'HCFA|UB|', '1790936144', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('571201170', 'MH0400301', 'MH0400301', 'TXHOUSTD', 'TMH Physician Associates', 'Zoulficar', '', 'Kobeissi', 'MD', 'Hospitalist', '', '', NULL, 'O', '6565 Fannin St Ste F270', 'Houston', 'Harris', 'TX', '77030', '7134413020', '7137904207', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOHSP', '', NULL, '41264.00', '0.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1801864905', 0, 'Y', 0, '2013-09-13', NULL, NULL, 29.7108, -95.3999, NULL, NULL),
('571201170', 'MH0400302', 'MH0400302', 'TXHOUSTD', 'TMH Physician Associates', 'Zoulficar', '', 'Kobeissi', 'MD', 'Hospitalist', '', '', NULL, 'B', 'PO Box 4719', 'Houston', 'Harris', 'TX', '77210', '7134414347', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOHSP', '', NULL, '41264.00', '0.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1801864905', 0, 'Y', 0, '2013-09-13', NULL, NULL, 0, 0, NULL, NULL),
('571201170', 'MH0400303', 'MH0400303', 'TXHOUSTD', 'TMH Physician Associates', 'Daniel', '', 'Lehane', 'MD', 'Oncology', '', '', NULL, 'O', '6445 Main St Ste OPC 21', 'Houston', 'Harris', 'TX', '77030', '7134419948', '7137931642', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1801939202', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.7126, -95.3999, NULL, NULL),
('571201170', 'MH0400304', 'MH0400304', 'TXHOUSTD', 'TMH Physician Associates', 'Jorge', '', 'Darcourt', 'MD', 'Oncology', '', '', NULL, 'O', '16659 SW Fwy Ste 151', 'Sugar Land', 'Fort Bend', 'TX', '77479', '7134419523', '7137931642', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', NULL, '', NULL, 'HCFA|UB|', '1811133697', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.5904, -95.6321, NULL, NULL),
('571201170', 'MH0400305', 'MH0400305', 'TXHOUSTD', 'TMH Physician Associates', 'Nancy', '', 'Yarbrough', 'ACNP', 'Acute Care Nurse Practitioner', '', '', NULL, 'O', '6550 Fannin St Ste 1601', 'Houston', 'Harris', 'TX', '77030', '7134415141', '7137906470', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1811253131', 0, 'Y', 0, '2013-09-13', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('571201170', 'MH0400306', 'MH0400306', 'TXHOUSTD', 'TMH Physician Associates', 'Nancy', '', 'Yarbrough', 'ACNP', 'Acute Care Nurse Practitioner', '', '', NULL, 'B', 'PO Box 4719', 'Houston', 'Harris', 'TX', '77210', '7134415125', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1811253131', 0, 'Y', 0, '2013-09-13', NULL, NULL, 0, 0, NULL, NULL),
('571201170', 'MH0400307', 'MH0400307', 'TXHOUSTD', 'TMH Physician Associates', 'Mark', '', 'Franklin', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '4201 Garth Rd Ste 107', 'Baytown', 'Harris', 'TX', '77521', '2814277400', '2814278750', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', NULL, '', NULL, 'HCFA|UB|', '1811985328', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.7677, -94.9775, NULL, NULL),
('571201170', 'MH0400308', 'MH0400308', 'TXHOUSTD', 'TMH Physician Associates', 'Guillermo', '', 'Torre', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '6550 Fannin St Ste 1901', 'Houston', 'Harris', 'TX', '77030', '7134411100', '7137902643', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1821024019', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('571201170', 'MH0400309', 'MH0400309', 'TXHOUSTD', 'TMH Physician Associates', 'Vadim', '', 'Sherman', 'MD', 'General Surgery', '', '', NULL, 'O', '6550 Fannin St Ste 1661', 'Houston', 'Harris', 'TX', '77030', '7134415155', '7137906470', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1821028267', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('571201170', 'MH0400310', 'MH0400310', 'TXHOUSTD', 'TMH Physician Associates', 'Byron', '', 'Ellis', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '7777 SW Fwy Ste 420', 'Houston', 'Harris', 'TX', '77074', '7137769500', '7139889153', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', NULL, '', NULL, 'HCFA|UB|', '1821046780', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.6947, -95.5234, NULL, NULL),
('571201170', 'MH0400311', 'MH0400311', 'TXHOUSTD', 'TMH Physician Associates', 'Jeffrey', '', 'Jackson', 'MD', 'Neurology', '', '', NULL, 'O', '16659 SW Fwy Ste 131', 'Sugar Land', 'Fort Bend', 'TX', '77479', '2814946387', '2814946410', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', NULL, '', NULL, 'HCFA|UB|', '1821090697', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.5904, -95.6321, NULL, NULL),
('571201170', 'MH0400312', 'MH0400312', 'TXHOUSTD', 'TMH Physician Associates', 'Carl', '', 'Hicks', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1201 Brooks St', 'Sugar Land', 'Fort Bend', 'TX', '77478', '2816904678', '2815658808', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Sugar Land Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1821100827', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.6059, -95.6347, NULL, NULL),
('571201170', 'MH0400313', 'MH0400313', 'TXHOUSTD', 'TMH Physician Associates', 'Michael', '', 'Feltovich', 'MD', 'Internal Medicine', '', '', NULL, 'O', '6550 Fannin St Ste 1101', 'Houston', 'Harris', 'Tx', '77030', '7134410006', '7137902727', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOPCP', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', NULL, '', NULL, 'HCFA|UB|', '1821137241', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('571201170', 'MH0400314', 'MH0400314', 'TXHOUSTD', 'TMH Physician Associates', 'Dana', '', 'Martin', 'MD', 'Hospitalist', '', '', NULL, 'O', '6565 Fannin St Ste F270', 'Houston', 'Harris', 'TX', '77030', '7134413620', '7137904207', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOHSP', '', NULL, '41264.00', '0.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1821170200', 0, 'Y', 0, '2013-09-13', NULL, NULL, 29.7108, -95.3999, NULL, NULL),
('571201170', 'MH0400315', 'MH0400315', 'TXHOUSTD', 'TMH Physician Associates', 'Dana', '', 'Martin', 'MD', 'Hospitalist', '', '', NULL, 'B', 'PO Box 4719', 'Houston', 'Harris', 'TX', '77210', '7134414347', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOHSP', '', NULL, '41264.00', '0.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1821170200', 0, 'Y', 0, '2013-09-13', NULL, NULL, 0, 0, NULL, NULL),
('571201170', 'MH0400316', 'MH0400316', 'TXHOUSTD', 'TMH Physician Associates', 'Ashish', '', 'Saharia', 'MD', 'General Surgery', '', '', NULL, 'O', '6550 Fannin St Ste 1601', 'Houston', 'Harris', 'TX', '77030', '7134415141', '7137906470', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1821241571', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('571201170', 'MH0400317', 'MH0400317', 'TXHOUSTD', 'TMH Physician Associates', 'Eddie', '', 'Matsu', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1201 Brooks St', 'Sugar Land', 'Fort Bend', 'TX', '77478', '2816904678', '2815658808', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Sugar Land Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1831187889', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.6059, -95.6347, NULL, NULL),
('571201170', 'MH0400318', 'MH0400318', 'TXHOUSTD', 'TMH Physician Associates', 'Prashanth', '', 'Anumandla', 'ACNP', 'Acute Care Nurse Practitioner', '', '', NULL, 'O', '6550 Fannin St Ste 1901', 'Houston', 'Harris', 'TX', '77030', '7134411100', '7137902643', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1831208966', 0, 'Y', 0, '2013-09-13', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('571201170', 'MH0400319', 'MH0400319', 'TXHOUSTD', 'TMH Physician Associates', 'Saundra', '', 'Hendricks', 'FNP', 'Family Practice', '', '', NULL, 'O', '6550 Fannin St Ste 1101', 'Houston', 'Harris', 'TX', '77030', '7134410006', '7137902727', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOPCP', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1841255726', 0, 'Y', 0, '2013-09-13', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('571201170', 'MH0400320', 'MH0400320', 'TXHOUSTD', 'TMH Physician Associates', 'Miguel', '', 'Valderrabano', 'MD', 'Cardiology', '', '', NULL, 'O', '6550 Fannin St Ste 1901', 'Houston', 'Harris', 'TX', '77030', '7134411100', '7137902643', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1851334908', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
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('571201170', 'MH0400322', 'MH0400322', 'TXHOUSTD', 'TMH Physician Associates', 'Colin', '', 'Barker', 'MD', 'Cardiology', '', '', NULL, 'O', '6550 Fannin St Ste 1901', 'Houston', 'Harris', 'TX', '77030', '7134411100', '7137902643', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1851551238', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
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('571201170', 'MH0400347', 'MH0400347', 'TXHOUSTD', 'TMH Physician Associates', 'Gena', '', 'Marshall', 'PAC', 'Physician Assistant Certified', '', '', NULL, 'O', '1201 Brooks St', 'Sugar Land', 'Fort Bend', 'TX', '77478', '2816904678', '2815658808', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Sugar Land Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1922095173', 0, 'Y', 0, '2013-09-13', NULL, NULL, 29.6059, -95.6347, NULL, NULL),
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('571201170', 'MH0400349', 'MH0400349', 'TXHOUSTD', 'TMH Physician Associates', 'Shaikh', '', 'Hai', 'MD', 'Critical Care', '', '', NULL, 'B', 'PO Box 4719', 'Houston', 'Harris', 'TX', '77210', '7134415125', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOHSP', '', NULL, '41264.00', '0.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1932120144', 0, 'N', 0, '2013-09-13', NULL, NULL, 0, 0, NULL, NULL),
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('571201170', 'MH0400353', 'MH0400353', 'TXHOUSTD', 'TMH Physician Associates', 'Wesley', '', 'Mayer', 'MD', 'Urology', '', '', NULL, 'O', '6560 Fannin St Ste 2100', 'Houston', 'Harris', 'TX', '77030', '7134416455', '7134416463', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1952467367', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.7109, -95.4, NULL, NULL),
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('571201170', 'MH0400366', 'MH0400366', 'TXHOUSTD', 'TMH Physician Associates', 'Gregory', '', 'Terry', 'MD', 'Family Practice', '', '', NULL, 'O', '2610 N Alexander Dr Ste 201', 'Baytown', 'Harris', 'TX', '77520', '2814284411', '2814284384', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOPCP', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Willowbrook Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1972501773', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.7485, -94.9467, NULL, NULL),
('571201170', 'MH0400367', 'MH0400367', 'TXHOUSTD', 'TMH Physician Associates', 'David', '', 'Braunreiter', 'MD', 'Family Practice', '', '', NULL, 'O', '1201 Brooks St', 'Sugar Land', 'Fort Bend', 'TX', '77478', '2816904678', '2815658808', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOPCP', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Sugar Land Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1972572055', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.6059, -95.6347, 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
('571201170', 'MH0400368', 'MH0400368', 'TXHOUSTD', 'TMH Physician Associates', 'James', '', 'Gundersen', 'ACNP', 'Acute Care Nurse Practitioner', '', '', NULL, 'O', '6565 Fannin St Ste B452', 'Houston', 'Harris', 'TX', '77030', '7134413620', '7137902082', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1972683274', 0, 'Y', 0, '2013-09-13', NULL, NULL, 29.7108, -95.3999, NULL, NULL),
('571201170', 'MH0400369', 'MH0400369', 'TXHOUSTD', 'TMHPO Surgery Department', 'Puja', '', 'Khaitan', 'MD', 'Thoracic Surgery', 'General Surgery', '', NULL, 'O', '6550 Fannin Ste 1601', 'Houston', 'Harris', 'TX', '77030', '7134415151', '7137906470', '6550 Fannin Ste 1601', 'Houston', 'Harris', 'TX', '77030', '7134415151', '7137906470', 'TMHPHOSPC', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, 0, 41275, 0, 'Houston Methodist Hospital', '', '', '', 'HCFA|UB|', '1972774735', 0, 'N', 0, '2014-04-15', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('571201170', 'MH0400370', 'MH0400370', 'TXHOUSTD', 'TMHPO Surgery Department', 'Puja', '', 'Khaitan', 'MD', 'Thoracic Surgery', 'General Surgery', '', NULL, 'B', 'PO Box 4719', 'Houston', 'Harris', 'TX', '77210', '7134415151', NULL, 'PO Box 4719', 'Houston', 'Harris', 'TX', '77210', '7134415151', '', 'TMHPHOSPC', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, 0, 41275, 0, 'Houston Methodist Hospital', '', '', '', 'HCFA|UB|', '1972774735', 0, 'Y', 0, '2014-04-15', NULL, NULL, 0, 0, NULL, NULL),
('571201170', 'MH0400371', 'MH0400371', 'TXHOUSTD', 'TMH Physician Associates', 'Laura', '', 'Murphy Fertak', 'PAC', 'Physician Assistant Certified', '', '', NULL, 'O', '6550 Fannin St Ste 2600', 'Houston', 'Harris', 'TX', '77030', '7134419000', '7137912058', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1982604658', 0, 'Y', 0, '2013-09-13', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('571201170', 'MH0400372', 'MH0400372', 'TXHOUSTD', 'TMH Physician Associates', 'Plinio', '', 'Caldera', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '13802 Centerfield Dr Ste 300', 'Houston', 'Harris', 'TX', '77070', '2817370999', '2817370926', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1982668695', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.967, -95.5471, NULL, NULL),
('571201170', 'MH0400373', 'MH0400373', 'TXHOUSTD', 'TMH Physician Associates', 'Dale', '', 'Hamilton', 'MD', 'Endocrinology', '', '', NULL, 'O', '6550 Fannin St Ste 1101', 'Houston', 'Harris', 'TX', '77030', '7134410006', '7137902727', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1982669875', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('571201170', 'MH0400374', 'MH0400374', 'TXHOUSTD', 'TMH Physician Associates', 'Janine', '', 'Hyden', 'ACNP', 'Acute Care Nurse Practitioner', '', '', NULL, 'O', '6550 Fannin St Ste 1601', 'Houston', 'Harris', 'TX', '77030', '7134415141', '7137906470', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1982700464', 0, 'Y', 0, '2013-09-13', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('571201170', 'MH0400375', 'MH0400375', 'TXHOUSTD', 'TMH Physician Associates', 'Margaret', '', 'Clark', 'ACNP', 'Adult Nurse Practitioner', '', '', NULL, 'O', '1429 Hwy 6 South Ste 303', 'Sugar Land', 'Fort Bend', 'TX', '77478', '2813250005', '2813250039', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1982950903', 0, 'Y', 0, '2013-09-13', NULL, NULL, 29.6021, -95.6325, NULL, NULL),
('571201170', 'MH0400376', 'MH0400376', 'TXHOUSTD', 'TMH Physician Associates', 'Anthony', '', 'Muffoletto', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1201 Brooks St', 'Sugar Land', 'Fort Bend', 'TX', '77478', '2816904678', '2815658808', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Sugar Land Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1992817993', 0, 'N', 0, '2013-09-13', NULL, NULL, 29.6059, -95.6347, NULL, NULL),
('571201170', 'MH0400377', 'MH0400377', 'TXHOUSTD', 'TMH Physician Associates', 'Tiffany', '', 'Street', 'ACNP', 'Acute Care Nurse Practitioner', '', '', NULL, 'O', '6550 Fannin St Ste 1401', 'Houston', 'Harris', 'TX', '77030', '7134415200', '7134416298', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1992902738', 0, 'Y', 0, '2013-09-13', NULL, NULL, 29.7111, -95.3999, NULL, NULL),
('571201170', 'MH0400378', 'MH0400378', 'TXHOUSTD', 'TMH Physician Associates', 'Tiffany', '', 'Street', 'ACNP', 'Acute Care Nurse Practitioner', '', '', NULL, 'B', 'PO Box 4719', 'Houston', 'Harris', 'TX', '77210', '7134414347', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'TMHPHOSPC', 'TXHCPCTMH', NULL, '41264.00', '50.00', '0.00', 6, '2013-10-01', NULL, NULL, 41275, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1992902738', 0, 'Y', 0, '2013-09-13', NULL, NULL, 0, 0, NULL, NULL),
('453136848', 'W12038093', 'W12038093', 'ILCHIGSTD', 'EMP of Will County', 'Kristin', '', 'Daugherty', 'MD', 'Emergency Medicine', '', '', NULL, 'B', 'PO Box 637527', 'Cincinnati', 'Hamilton', 'OH', '45263', '8157417660', '8157417599', 'PO Box 637527', 'Cincinnati', 'Hamilton', 'OH', '45263', '8157417660', '8157417599', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-08-22', '2013-11-22', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1548596711', 0, 'N', 0, '2014-01-20', NULL, NULL, 0, 0, NULL, NULL),
('453136848', 'W12038092', 'W12038092', 'ILCHIGSTD', 'EMP of Will County', 'Kristin', '', 'Daugherty', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '333 N Madison St', 'Joliet', 'Will', 'IL', '60435', '8157417660', '8157417599', '333 N Madison St', 'Joliet', 'Will', 'IL', '60435', '8157417660', '8157417599', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-08-22', '2013-11-22', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1548596711', 0, 'N', 0, '2014-01-20', NULL, NULL, 41.5279, -88.1354, NULL, NULL),
('453136848', 'W12038095', 'W12038095', 'ILCHIGSTD', 'EMP of Will County', 'Gail', '', 'Bayliss', 'MD', 'Emergency Medicine', '', '', NULL, 'B', 'PO Box 637527', 'Cincinnati', 'Hamilton', 'OH', '45263', '8157417660', '8157417599', 'PO Box 637527', 'Cincinnati', 'Hamilton', 'OH', '45263', '8157417660', '8157417599', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-08-22', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1639117724', 0, 'N', 0, '2013-09-16', NULL, NULL, 0, 0, NULL, NULL),
('453136848', 'W12038096', 'W12038096', 'ILCHIGSTD', 'EMP of Will County', 'Gail', '', 'Bayliss', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '333 N Madison St', 'Joliet', 'Will', 'IL', '60435', '8157417660', '8157417599', '333 N Madison St', 'Joliet', 'Will', 'IL', '60435', '8157417660', '8157417599', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-08-22', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1639117724', 0, 'N', 0, '2013-09-16', NULL, NULL, 41.528, -88.1346, NULL, NULL),
('453136848', 'W12038098', 'W12038098', 'ILCHIGSTD', 'EMP of Will County', 'Anar', 'J', 'Patel', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '333 N Madison St', 'Joliet', 'Will', 'IL', '60435', '8157417660', '8157417599', '333 N Madison St', 'Joliet', 'Will', 'IL', '60435', '8157417660', '8157417599', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-08-22', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1174573240', 0, 'N', 0, '2013-09-16', NULL, NULL, 41.528, -88.1346, NULL, NULL),
('453136848', 'W12038099', 'W12038099', 'ILCHIGSTD', 'EMP of Will County', 'Anar', 'J', 'Patel', 'MD', 'Emergency Medicine', '', '', NULL, 'B', 'PO Box 637527', 'Cincinnati', 'Hamilton', 'OH', '45263', '8157417660', '8157417599', 'PO Box 637527', 'Cincinnati', 'Hamilton', 'OH', '45263', '8157417660', '8157417599', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-08-22', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1174573240', 0, 'N', 0, '2013-09-16', NULL, NULL, 0, 0, NULL, NULL),
('364088232', 'W12038100', 'W12038100', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Christina', 'L', 'Willis', 'APN', 'Pediatrics', '', '', NULL, 'O', '3310 W Main St Ste 200', 'Saint Charles', 'Kane', 'IL', '60175', '6308976044', '6308970180', '3310 W Main St Ste 200', 'Saint Charles', 'Kane', 'IL', '60175', '6308976044', '6308970180', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-09-06', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1942241492', 0, 'Y', 0, '2013-09-16', NULL, NULL, 41.9157, -88.3538, NULL, NULL),
('362657618', 'W12038101', 'W12038101', 'ILCHIGSTD', 'M and M Orthopaedics', 'Gregory', 'H', 'Dairyko', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '133 E Brush Hill Rd Ste 100', 'Elmhurst', 'Dupage', 'IL', '60126', '6309681881', '6305010646', '133 E Brush Hill Rd Ste 100', 'Elmhurst', 'Dupage', 'IL', '60126', '6309681881', '6305010646', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 8, '2013-07-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '1134385677', 0, 'N', 0, '2014-04-25', NULL, NULL, 41.8616, -87.9371, NULL, NULL),
('362657618', 'W12038102', 'W12038102', 'ILCHIGSTD', 'M and M Orthopaedics', 'Gregory', 'H', 'Dairyko', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '4115 Fairview Ave', 'Downers Grove', 'Dupage', 'IL', '60515', '6309681881', '6309683762', '4115 Fairview Ave', 'Downers Grove', 'Dupage', 'IL', '60515', '6309681881', '6309683762', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 8, '2013-07-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '1134385677', 0, 'N', 0, '2014-04-25', NULL, NULL, 41.8114, -87.9953, NULL, NULL),
('752536818', 'W12038103', 'W12038103', 'TXDALSTD', '', 'Jeffrey', 'M', 'Kopita', 'MD', 'Pulmonary', '', '', NULL, 'O', '3600 Gaston Ave Wadley Tower Ste 550', 'Dallas', 'Dallas', 'TX', '75246', '9724510219', '2148221193', '3600 Gaston Ave Wadley Tower Ste 550', 'Dallas', 'Dallas', 'TX', '75246', '9724510219', '2148221193', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-09-01', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, '', '', 'HCFA|UB|', '1821034257', 0, 'N', 0, '2013-09-16', NULL, NULL, 32.7913, -96.7799, NULL, NULL),
('911947573', 'W12038104', 'W12038104', 'TXDALSTD', 'North Texas Orthopaedic Specialists', 'Jonathan', 'S', 'Quinby', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1575 I-30', 'Mesquite', 'Dallas', 'TX', '75150', '2148207010', '2148207015', '1575 I-30', 'Mesquite', 'Dallas', 'TX', '75150', '2148207010', '2148207015', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-09-10', NULL, 0, 0, 0, 'Baylor University Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1679572499', 0, 'N', 0, '2013-09-16', NULL, NULL, 32.8297, -96.6193, NULL, NULL),
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INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
('830234097', 'W12038183', 'W12038183', 'WY01', 'Campbell County Memorial Hospital', 'Robert', '', 'Neuwirth', 'MD', 'Nephrology', 'Hospitalist', '', NULL, 'B', 'PO Box 3046', 'Gillette', 'Campbell', 'WY', '82717', '3076881000', NULL, 'PO Box 3046', 'Gillette', 'Campbell', 'WY', '82717', '3076881000', '          ', '', '', '5001', '0.00', '0.00', '0.00', 6, '2013-09-01', NULL, 0, 0, 0, 'Campbell County Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '0000007826', 0, 'Y', 0, '2013-09-17', NULL, NULL, 0, 0, NULL, NULL),
('830234097', 'W12038184', 'W12038184', 'WYT1', 'Campbell County Memorial Hospital', 'Robert', '', 'Neuwirth', 'MD', 'Nephrology', 'Hospitalist', '', NULL, 'B', 'PO Box 3046', 'Gillette', 'Campbell', 'WY', '82717', '3076881000', NULL, 'PO Box 3046', 'Gillette', 'Campbell', 'WY', '82717', '3076881000', '          ', '', '', '', '0.00', '21.00', '0.00', 6, '2013-09-01', NULL, 0, 0, 0, 'Campbell County Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '0000007826', 0, 'Y', 0, '2013-09-17', NULL, NULL, 0, 0, NULL, NULL),
('830234097', 'W12038185', 'W12038185', 'WY01', 'Oncology-Cancer Care', '', '', 'Oncology-Cancer Care', 'GROUP', 'Oncology', 'Hematology and Oncology', '', NULL, 'B', 'PO Box 3046', 'Gillette', 'Campbell', 'WY', '82717', '3076881900', NULL, 'PO Box 3046', 'Gillette', 'Campbell', 'WY', '82717', '3076881900', '          ', '', '', '5001', '0.00', '0.00', '0.00', 6, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000007970', 0, 'N', 0, '2013-09-17', NULL, NULL, 0, 0, NULL, NULL),
('830234097', 'W12038186', 'W12038186', 'WYT1', 'Oncology-Cancer Care', '', '', 'Oncology-Cancer Care', 'GROUP', 'Oncology', 'Hematology and Oncology', '', NULL, 'B', 'PO Box 3046', 'Gillette', 'Campbell', 'WY', '82717', '3076881900', NULL, 'PO Box 3046', 'Gillette', 'Campbell', 'WY', '82717', '3076881900', '          ', '', '', '', '0.00', '21.00', '0.00', 6, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000007970', 0, 'N', 0, '2013-09-17', NULL, NULL, 0, 0, NULL, NULL),
('830234097', 'W12038187', 'W12038187', 'WY01', 'Sagebrush ENT', 'Brian', '', 'Peshek', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'B', 'PO Box 3046', 'Gillette', 'Campbell', 'WY', '82717', '3076851442', NULL, 'PO Box 3046', 'Gillette', 'Campbell', 'WY', '82717', '3076851442', '          ', '', '', '5001', '0.00', '0.00', '0.00', 6, '2013-09-01', NULL, 0, 0, 0, 'Campbell County Memorial Hospital', '', '', '', 'HCFA|UB|', '1952528572', 0, 'N', 0, '2013-09-17', NULL, NULL, 0, 0, NULL, NULL),
('830234097', 'W12038188', 'W12038188', 'WYT1', 'Sagebrush ENT', 'Brian', '', 'Peshek', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'B', 'PO Box 3046', 'Gillette', 'Campbell', 'WY', '82717', '3076851442', NULL, 'PO Box 3046', 'Gillette', 'Campbell', 'WY', '82717', '3076851442', '          ', '', '', '', '0.00', '21.00', '0.00', 6, '2013-09-01', NULL, 0, 0, 0, 'Campbell County Memorial Hospital', '', '', '', 'HCFA|UB|', '1952528572', 0, 'N', 0, '2013-09-17', NULL, NULL, 0, 0, NULL, NULL),
('830234097', 'W12038189', 'W12038189', 'WY01', 'Powder River Orthopedics and Spine', 'Roxanne', 'L', 'Peters', 'PAC', 'Orthopedic Surgery', '', '', NULL, 'B', 'PO Box 3046', 'Gillette', 'Campbell', 'WY', '82717', '3076861413', '3076821113', 'PO Box 3046', 'Gillette', 'Campbell', 'WY', '82717', '3076861413', '3076821113', '', '', '5001', '0.00', '0.00', '0.00', 6, '2013-09-01', NULL, 0, 0, 0, 'Campbell County Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1558593731', 0, 'N', 0, '2013-09-17', NULL, NULL, 0, 0, NULL, NULL),
('830234097', 'W12038190', 'W12038190', 'WYT1', 'Powder River Orthopedics and Spine', 'Roxanne', 'L', 'Peters', 'PAC', 'Orthopedic Surgery', '', '', NULL, 'B', 'PO Box 3046', 'Gillette', 'Campbell', 'WY', '82717', '3076861413', '3076821113', 'PO Box 3046', 'Gillette', 'Campbell', 'WY', '82717', '3076861413', '3076821113', '', '', '', '0.00', '21.00', '0.00', 6, '2013-09-01', NULL, 0, 0, 0, 'Campbell County Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1558593731', 0, 'N', 0, '2013-09-17', NULL, NULL, 0, 0, NULL, NULL),
('830234097', 'W12038191', 'W12038191', 'WY01', 'Pioneer Manor', '', '', 'Pioneer Manor', 'GROUP', 'Skilled Nursing Facility', '', '', NULL, 'B', 'PO Box 3046', 'Gillette', 'Campbell', 'WY', '82717', '3076824709', NULL, 'PO Box 3046', 'Gillette', 'Campbell', 'WY', '82717', '3076824709', '          ', '', '', '5001', '0.00', '0.00', '0.00', 6, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000008208', 0, 'N', 0, '2013-09-17', NULL, NULL, 0, 0, NULL, NULL),
('830234097', 'W12038192', 'W12038192', 'WYT1', 'Pioneer Manor', '', '', 'Pioneer Manor', 'GROUP', 'Skilled Nursing Facility', '', '', NULL, 'B', 'PO Box 3046', 'Gillette', 'Campbell', 'WY', '82717', '3076824709', NULL, 'PO Box 3046', 'Gillette', 'Campbell', 'WY', '82717', '3076824709', '          ', '', '', '', '0.00', '19.00', '0.00', 6, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000008208', 0, 'N', 0, '2013-09-17', NULL, NULL, 0, 0, NULL, NULL),
('830234097', 'W12038193', 'W12038193', 'WY01', 'Campbell County Memorial Hospital', 'Mark', 'D', 'Prince', 'MD', 'Hospitalist', '', '', NULL, 'B', 'PO Box 3046', 'Gillette', 'Campbell', 'WY', '82717', '3076881000', NULL, 'PO Box 3046', 'Gillette', 'Campbell', 'WY', '82717', '3076881000', '          ', '', '', '5001', '0.00', '0.00', '0.00', 6, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000008265', 0, 'Y', 0, '2013-09-17', NULL, NULL, 0, 0, NULL, NULL),
('830234097', 'W12038194', 'W12038194', 'WYT1', 'Campbell County Memorial Hospital', 'Mark', 'D', 'Prince', 'MD', 'Hospitalist', '', '', NULL, 'B', 'PO Box 3046', 'Gillette', 'Campbell', 'WY', '82717', '3076881000', NULL, 'PO Box 3046', 'Gillette', 'Campbell', 'WY', '82717', '3076881000', '          ', '', '', '', '0.00', '21.00', '0.00', 6, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000008265', 0, 'Y', 0, '2013-09-17', NULL, NULL, 0, 0, NULL, NULL),
('830234097', 'W12038195', 'W12038195', 'WY01', 'Campbell County Memorial Hospital', '', '', 'Rehabilitation Services', 'GROUP', 'Speech Therapy', 'Occupational Medicine', 'Physical Therapy', NULL, 'B', 'PO Box 3046', 'Gillette', 'Campbell', 'WY', '82717', '3076888000', NULL, 'PO Box 3046', 'Gillette', 'Campbell', 'WY', '82717', '3076888000', '          ', '', '', '5001', '0.00', '0.00', '0.00', 6, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000008349', 0, 'N', 0, '2013-09-17', NULL, NULL, 0, 0, NULL, NULL),
('830234097', 'W12038197', 'W12038197', 'WYT1', 'Campbell County Memorial Hospital', '', '', 'Rehabilitation Services', 'GROUP', 'Speech Therapy', 'Occupational Medicine', 'Physical Therapy', NULL, 'B', 'PO Box 3046', 'Gillette', 'Campbell', 'WY', '82717', '3076888000', NULL, 'PO Box 3046', 'Gillette', 'Campbell', 'WY', '82717', '3076888000', '          ', '', '', '', '0.00', '21.00', '0.00', 6, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000008349', 0, 'N', 0, '2013-09-17', NULL, NULL, 0, 0, NULL, NULL),
('830234097', 'W12038198', 'W12038198', 'WY01', 'Campbell County Clinics Walk in Clinic', 'Laine', '', 'Russell', 'DO', 'Family Practice', '', '', NULL, 'B', 'PO Box 3046', 'Gillette', 'Campbell', 'WY', '82717', '3076821441', NULL, 'PO Box 3046', 'Gillette', 'Campbell', 'WY', '82717', '3076821441', '          ', '', '', '5001', '0.00', '0.00', '0.00', 6, '2013-09-01', NULL, 0, 0, 0, 'Campbell County Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1578552444', 0, 'N', 0, '2013-10-18', NULL, NULL, 0, 0, NULL, NULL),
('830234097', 'W12038199', 'W12038199', 'WYT1', 'Campbell County Clinics Walk in Clinic', 'Laine', '', 'Russell', 'DO', 'Family Practice', '', '', NULL, 'B', 'PO Box 3046', 'Gillette', 'Campbell', 'WY', '82717', '3076821441', NULL, 'PO Box 3046', 'Gillette', 'Campbell', 'WY', '82717', '3076821441', '          ', '', '', '', '0.00', '21.00', '0.00', 6, '2013-09-01', NULL, 0, 0, 0, 'Campbell County Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1578552444', 0, 'N', 0, '2013-10-18', NULL, NULL, 0, 0, NULL, NULL),
('830234097', 'W12038200', 'W12038200', 'WY01', 'Powder River Orthopedics and Spine', 'Nathan', 'S', 'Simpson', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', 'PO Box 3046', 'Gillette', 'Campbell', 'WY', '82717', '3076851413', '3076821113', 'PO Box 3046', 'Gillette', 'Campbell', 'WY', '82717', '3076851413', '3076821113', '', '', '5001', '0.00', '0.00', '0.00', 6, '2013-09-01', NULL, 0, 0, 0, 'Campbell County Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1427042936', 0, 'N', 0, '2013-09-17', NULL, NULL, 0, 0, NULL, NULL),
('830234097', 'W12038201', 'W12038201', 'WYT1', 'Powder River Orthopedics and Spine', 'Nathan', 'S', 'Simpson', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', 'PO Box 3046', 'Gillette', 'Campbell', 'WY', '82717', '3076851413', '3076821113', 'PO Box 3046', 'Gillette', 'Campbell', 'WY', '82717', '3076851413', '3076821113', '', '', '', '0.00', '21.00', '0.00', 6, '2013-09-01', NULL, 0, 0, 0, 'Campbell County Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1427042936', 0, 'N', 0, '2013-09-17', NULL, NULL, 0, 0, NULL, NULL),
('830234097', 'W12038202', 'W12038202', 'WY01', 'Campbell County Memorial Hospital', 'Shailendra', '', 'Singh', 'MD', 'Hospitalist', '', '', NULL, 'B', 'PO Box 3046', 'Gillette', 'Campbell', 'WY', '82717', '3076881000', NULL, 'PO Box 3046', 'Gillette', 'Campbell', 'WY', '82717', '3076881000', '          ', '', '', '5001', '0.00', '0.00', '0.00', 6, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000008728', 0, 'Y', 0, '2013-09-17', NULL, NULL, 0, 0, NULL, NULL),
('830234097', 'W12038203', 'W12038203', 'WYT1', 'Campbell County Memorial Hospital', 'Shailendra', '', 'Singh', 'MD', 'Hospitalist', '', '', NULL, 'B', 'PO Box 3046', 'Gillette', 'Campbell', 'WY', '82717', '3076881000', NULL, 'PO Box 3046', 'Gillette', 'Campbell', 'WY', '82717', '3076881000', '          ', '', '', '', '0.00', '21.00', '0.00', 6, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000008728', 0, 'Y', 0, '2013-09-17', NULL, NULL, 0, 0, NULL, NULL),
('830234097', 'W12038205', 'W12038205', 'WY01', 'Campbell County Memorial Hospital', 'Michael', '', 'Stolpe', 'MD', 'Emergency Medicine', '', '', NULL, 'B', 'PO Box 3046', 'Gillette', 'Campbell', 'WY', '82717', '3076881000', NULL, 'PO Box 3046', 'Gillette', 'Campbell', 'WY', '82717', '3076881000', '          ', '', '', '5001', '0.00', '0.00', '0.00', 6, '2013-09-01', NULL, 0, 0, 0, 'Campbell County Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '0000008930', 0, 'Y', 0, '2013-09-17', NULL, NULL, 0, 0, NULL, NULL),
('830234097', 'W12038206', 'W12038206', 'WYT1', 'Campbell County Memorial Hospital', 'Michael', '', 'Stolpe', 'MD', 'Emergency Medicine', '', '', NULL, 'B', 'PO Box 3046', 'Gillette', 'Campbell', 'WY', '82717', '3076881000', NULL, 'PO Box 3046', 'Gillette', 'Campbell', 'WY', '82717', '3076881000', '          ', '', '', '', '0.00', '21.00', '0.00', 6, '2013-09-01', NULL, 0, 0, 0, 'Campbell County Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '0000008930', 0, 'Y', 0, '2013-09-17', NULL, NULL, 0, 0, NULL, NULL),
('830234097', 'W12038207', 'W12038207', 'WY01', 'Campbell County Clinics Walk in Clinic', '', '', 'Campbell County Clinics Walk in Clinic', 'GROUP', 'Urgent Care', '', '', NULL, 'B', 'PO Box 3046', 'Gillette', 'Campbell', 'WY', '82717', '3076889255', NULL, 'PO Box 3046', 'Gillette', 'Campbell', 'WY', '82717', '3076889255', '          ', '', '', '5001', '0.00', '0.00', '0.00', 6, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1922271386', 0, 'Y', 0, '2013-11-04', NULL, NULL, 0, 0, NULL, NULL),
('830234097', 'W12038208', 'W12038208', 'WYT1', 'Campbell County Clinics Walk in Clinic', '', '', 'Campbell County Clinics Walk in Clinic', 'GROUP', 'Urgent Care', '', '', NULL, 'O', '407 Medical Arts Ct Ste C', 'Gillette', 'Campbell', 'WY', '82716', '3076889255', NULL, '407 Medical Arts Ct Ste C', 'Gillette', 'Campbell', 'WY', '82716', '3076889255', '          ', '', '', '', '0.00', '19.00', '0.00', 6, '2011-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1922271386', 0, 'Y', 0, '2013-11-04', NULL, NULL, 0, 0, NULL, NULL),
('830234097', 'W12038209', 'W12038209', 'WYT1', 'Campbell County Clinics Walk in Clinic', '', '', 'Campbell County Clinics Walk in Clinic', 'GROUP', 'Urgent Care', '', '', NULL, 'B', 'PO Box 3046', 'Gillette', 'Campbell', 'WY', '82717', '3076889255', NULL, 'PO Box 3046', 'Gillette', 'Campbell', 'WY', '82717', '3076889255', '          ', '', '', '', '0.00', '19.00', '0.00', 6, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1922271386', 0, 'Y', 0, '2013-11-04', NULL, NULL, 0, 0, NULL, NULL),
('830234097', 'W12038210', 'W12038210', 'WY01', 'Wellness Health Works', '', '', 'Wellness Health Works', 'GROUP', 'Clinic', '', '', NULL, 'B', 'PO Box 3046', 'Gillette', 'Campbell', 'WY', '82717', '3076888000', NULL, 'PO Box 3046', 'Gillette', 'Campbell', 'WY', '82717', '3076888000', '          ', '', '', '5001', '0.00', '0.00', '0.00', 6, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009566', 0, 'N', 0, '2013-09-17', NULL, NULL, 0, 0, NULL, NULL),
('830234097', 'W12038211', 'W12038211', 'WYT1', 'Wellness Health Works', '', '', 'Wellness Health Works', 'GROUP', 'Clinic', '', '', NULL, 'B', 'PO Box 3046', 'Gillette', 'Campbell', 'WY', '82717', '3076888000', NULL, 'PO Box 3046', 'Gillette', 'Campbell', 'WY', '82717', '3076888000', '          ', '', '', '', '0.00', '21.00', '0.00', 6, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009566', 0, 'N', 0, '2013-09-17', NULL, NULL, 0, 0, NULL, NULL),
('362657618', 'W12038212', 'W12038212', 'ILCHIGSTD', 'M and M Orthopaedics', 'Rahul', '', 'Gokhale', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '133 E Brush Hill Rd Ste 100', 'Elmhurst', 'Dupage', 'IL', '60126', '6309681881', '6305010646', '133 E Brush Hill Rd Ste 100', 'Elmhurst', 'Dupage', 'IL', '60126', '6309681881', '6305010646', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 8, '2013-07-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '1326140435', 0, 'N', 0, '2014-04-25', NULL, NULL, 41.8616, -87.9371, NULL, NULL),
('362657618', 'W12038213', 'W12038213', 'ILCHIGSTD', 'M and M Orthopaedics', 'Rahul', '', 'Gokhale', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '4115 Fairview Ave', 'Downers Grove', 'Dupage', 'IL', '60515', '6309681881', '6309683762', '4115 Fairview Ave', 'Downers Grove', 'Dupage', 'IL', '60515', '6309681881', '6309683762', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 8, '2013-07-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '1326140435', 0, 'N', 0, '2014-04-25', NULL, NULL, 41.8114, -87.9953, NULL, NULL),
('362657618', 'W12038214', 'W12038214', 'ILCHIGSTD', 'M and M Orthopaedics', 'Denise', '', 'Ibrahim', 'DO', 'Orthopedic Surgery', '', '', NULL, 'O', '15900 W 127th St Ste 111', 'Lemont', 'Cook', 'IL', '60439', '6302437385', '6302438302', '15900 W 127th St Ste 111', 'Lemont', 'Cook', 'IL', '60439', '6302437385', '6302438302', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 8, '2013-07-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '1164418869', 0, 'N', 0, '2014-04-25', NULL, NULL, 41.6565, -88.0051, NULL, NULL),
('362657618', 'W12038215', 'W12038215', 'ILCHIGSTD', 'M and M Orthopaedics', 'Denise', '', 'Ibrahim', 'DO', 'Orthopedic Surgery', '', '', NULL, 'O', '4115 Fairview Ave', 'Downers Grove', 'Dupage', 'IL', '60515', '6309681881', '6309683762', '4115 Fairview Ave', 'Downers Grove', 'Dupage', 'IL', '60515', '6309681881', '6309683762', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 8, '2013-07-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '1164418869', 0, 'N', 0, '2014-04-25', NULL, NULL, 41.8114, -87.9953, NULL, NULL),
('362657618', 'W12038216', 'W12038216', 'ILCHIGSTD', 'M and M Orthopaedics', 'Kamal', '', 'Ibrahim', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '133 E Brush Hill Rd Ste 100', 'Elmhurst', 'Dupage', 'IL', '60126', '6309681881', '6305010646', '133 E Brush Hill Rd Ste 100', 'Elmhurst', 'Dupage', 'IL', '60126', '6309681881', '6305010646', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 8, '2013-07-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '1174519862', 0, 'N', 0, '2013-09-18', NULL, NULL, 41.8616, -87.9371, NULL, NULL),
('362657618', 'W12038217', 'W12038217', 'ILCHIGSTD', 'M and M Orthopaedics', 'Christina', '', 'Kuo', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '15900 W 127th St Ste 111', 'Lemont', 'Cook', 'IL', '60439', '6302437385', '6302438302', '15900 W 127th St Ste 111', 'Lemont', 'Cook', 'IL', '60439', '6302437385', '6302438302', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 8, '2013-07-01', '2014-06-13', 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '1992745681', 0, 'N', 0, '2014-06-13', NULL, NULL, 41.6565, -88.0051, NULL, NULL),
('362657618', 'W12038218', 'W12038218', 'ILCHIGSTD', 'M and M Orthopaedics', 'Christina', '', 'Kuo', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '4115 Fairview Ave', 'Downers Grove', 'Dupage', 'IL', '60515', '6309681881', '6309683762', '4115 Fairview Ave', 'Downers Grove', 'Dupage', 'IL', '60515', '6309681881', '6309683762', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 8, '2013-07-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '1992745681', 0, 'N', 0, '2014-06-13', NULL, NULL, 41.8114, -87.9953, NULL, NULL),
('362657618', 'W12038219', 'W12038219', 'ILCHIGSTD', 'M and M Orthopaedics', 'Joanne', 'E', 'Labriola', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '133 E Brush Hill Rd Ste 100', 'Elmhurst', 'Dupage', 'IL', '60126', '6305010630', '6305010645', '133 E Brush Hill Rd Ste 100', 'Elmhurst', 'Dupage', 'IL', '60126', '6305010630', '6305010645', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 8, '2013-07-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '1518904739', 0, 'N', 0, '2014-04-25', NULL, NULL, 41.8616, -87.9371, NULL, NULL),
('362657618', 'W12038220', 'W12038220', 'ILCHIGSTD', 'M and M Orthopaedics', 'Joanne', 'E', 'Labriola', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '4115 Fairview Ave', 'Downers Grove', 'Dupage', 'IL', '60515', '6309681881', '6309681719', '4115 Fairview Ave', 'Downers Grove', 'Dupage', 'IL', '60515', '6309681881', '6309681719', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 8, '2013-07-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '1518904739', 0, 'N', 0, '2014-04-25', NULL, NULL, 41.8114, -87.9953, NULL, NULL),
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('830207671', 'W12038248', 'W12038248', 'WYT2', 'West Park Hospital ', 'Victoria ', 'H', 'Anderson', 'MD', 'Mental Health', 'Psychiatry', '', NULL, 'B', '707 Sheridan Ave', 'Cody', 'Park', 'WY', '82414', '3075782283', NULL, '707 Sheridan Ave', 'Cody', 'Park', 'WY', '82414', '3075782283', '          ', '', '', '', '0.00', '12.00', '0.00', 3, '2013-09-19', NULL, 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1407006083', 0, 'N', 0, '2013-09-19', NULL, NULL, 0, 0, NULL, NULL),
('760647154', 'W12038249', 'W12038249', 'TXHOUSTD', 'HemOnc Physicians Enterprise', 'Sahba', 'Q', 'Nadeem', 'MD', 'Hematology and Oncology', '', '', NULL, 'O', '11914 Astoria Ste 355', 'Houston', 'Harris', 'TX', '77089', '2814642832', '2814642835', '11914 Astoria Ste 355', 'Houston', 'Harris', 'TX', '77089', '2814642832', '2814642835', 'HOUSTON5', 'TXONCHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-11-01', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', NULL, '', '', 'HCFA|UB', '1992869937', 0, 'N', 0, '2013-10-01', NULL, NULL, 29.5851, -95.2071, NULL, NULL),
('272109369', 'W12038250', 'W12038250', 'TXHOUSTD', 'Murdock Pediatric Services', 'Trina', 'L', 'Taylor', 'MD', 'Pediatrics', '', '', NULL, 'O', '212 N Bonham', 'Cleveland', 'Harris', 'TX', '77346', '2814327400', '2814327401', '212 N Bonham', 'Cleveland', 'Harris', 'TX', '77346', '2814327400', '2814327401', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1972502664', 0, 'N', 0, '2013-10-01', NULL, NULL, 30.3427, -95.0856, NULL, NULL),
('043687564', 'W12038251', 'W12038251', 'TXHOUSTD', 'Lone Star Eye Center', 'Matthew', '', 'McMenemy', 'MD', 'Ophthalmology', '', '', NULL, 'O', '3515 Town Ctr Blvd S', 'Sugar Land', 'Fort Bend', 'TX', '77479', '2812778400', '2812778408', '3515 Town Ctr Blvd S', 'Sugar Land', 'Fort Bend', 'TX', '77479', '2812778400', '2812778408', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-11-01', NULL, 0, 0, 0, 'Houston Methodist West Houston Hospital', '', '', '', 'HCFA|UB|', '1700842267', 0, 'N', 0, '2014-04-24', NULL, NULL, 29.5874, -95.63, NULL, NULL),
('870635460', 'W12038252', 'W12038252', 'UT01', 'Comfort Care Pediatrics', 'Cynthia ', 'L', 'Carmack', 'MD', 'Pediatrics', '', '', NULL, 'O', '4546 S Atherton Dr Ste 204', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8015958844', '8015060188', '4546 S Atherton Dr Ste 204', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8015958844', '8015060188', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-03-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1548254360', 0, 'N', 0, '2014-03-17', NULL, NULL, 0, 0, NULL, NULL),
('870635460', 'W12038253', 'W12038253', 'UT01', 'Comfort Care Pediatrics', 'Cynthia ', 'L', 'Carmack', 'MD', 'Pediatrics', '', '', NULL, 'B', 'PO Box 30015 Dept 71', 'Salt Lake City', 'Salt Lake', 'UT', '84103', '8015958844', '8015060188', 'PO Box 30015 Dept 71', 'Salt Lake City', 'Salt Lake', 'UT', '84103', '8015958844', '8015060188', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-03-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1548254360', 0, 'N', 0, '2014-03-17', NULL, NULL, 0, 0, NULL, NULL),
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('621801973', 'W12038280', 'W12038280', 'UT01', 'Jordan Valley Surgical Specialists', 'Anne', '', 'Kieryn', '', 'General Surgery', '', '', NULL, 'B', '406 W South Jordan Pkwy Ste 500', 'South Jordan', 'Salt Lake', 'UT', '84095', '8016014423', NULL, '406 W South Jordan Pkwy Ste 500', 'South Jordan', 'Salt Lake', 'UT', '84095', '8016014423', '          ', 'WUSTDSURG5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-09-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1770652232', 0, 'N', 0, '2013-09-20', NULL, NULL, 0, 0, NULL, NULL),
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INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
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('363330928', 'W12038282', 'W12038282', 'ILCHIGSTD', 'Presence Healthcare Services', 'Androni', 'J', 'Henry', 'MD', 'Emergency Medicine', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '8557647687', '6309142469', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '8557647687', '6309142469', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1821389685', 0, 'N', 0, '2013-09-20', NULL, NULL, 0, 0, NULL, NULL),
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('621801973', 'W12038284', 'W12038284', 'UT01', 'Jordan Valley Neurology', 'Wonhong', 'D', 'Min', 'MD', 'Neurosurgery', '', '', 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', 'WUSTDSURG5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-10-14', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1053304204', 0, 'N', 0, '2013-09-20', NULL, NULL, 40.5879, -111.976, NULL, NULL),
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('760363583', 'W12038286', 'W12038286', 'TXHOUSTD', 'Fondren Orthopedic Group', '', '', 'Fondren Orthopedic Group', '', 'Orthopedic Surgery', '', '', NULL, 'O', '520 Blossom', 'Webster', 'Harris', 'TX', '77598', '2813329537', NULL, '520 Blossom', 'Webster', 'Harris', 'TX', '77598', '2813329537', '          ', 'FONDREN', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-30', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1609830595', 0, 'Y', 1, '2013-09-20', NULL, NULL, 29.542, -95.1292, NULL, NULL),
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('621762570', 'W12038361', 'W12038361', 'UT01', 'Roosevelt Community Clinic', 'Jason', 'E', 'Crook', 'NP', 'Family Practice', '', '', NULL, 'O', '409 S 200 E', 'Roosevelt', 'Duchesne', 'UT', '84066', '4357253327', '4357253331', '409 S 200 E', 'Roosevelt', 'Duchesne', 'UT', '84066', '4357253327', '4357253331', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1194161190', 0, 'N', 0, '2014-06-27', NULL, NULL, 40.294, -109.989, NULL, NULL),
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('850424076', 'W12038363', 'W12038363', 'NM01', 'New Mexico Heart Institute', 'Bradford', 'L', 'Gwyther', 'PA', 'Cardiac Electrophysiology Cardiology', '', '', NULL, 'B', 'PO Box 8387', 'Albuquerque', 'Bernalillo', 'NM', '87198', '5058411000', '5058432593', 'PO Box 8387', 'Albuquerque', 'Bernalillo', 'NM', '87198', '5058411000', '5058432593', 'NMHEART', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-10-20', '2014-06-08', 0, 0, 0, 'Heart Hospital of New Mexico', '', '', '', 'HCFA|UB|', '1356381701', 0, 'N', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
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('876000528', 'W12009288', 'W12009288', 'UT01', 'USU Speech Language Hearing Center', '', '', 'USU Speech Language Hearing Center', '', 'Clinic', '', '', NULL, 'O', '1000 Old Main Hill', 'Logan', 'Cache', 'UT', '84322', '4357971346', '4357970221', '1000 Old Main Hill', 'Logan', 'Cache', 'UT', '84322', '4357971346', '4357970221', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2008-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1235374984', 0, 'N', 0, '2013-11-26', NULL, NULL, 41.7409, -111.81, NULL, NULL),
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('751008430', 'W12038374', 'W12038374', 'TXSATMAR', 'Baylor All Saints Medical Center for Transplants', '', '', 'Baylor All Saints Medical Center', '', 'Hospital', NULL, NULL, NULL, 'B', 'PO Box 848108', 'Dallas', 'Dallas', 'TX', '75284', '8179262544', NULL, 'PO Box 848108', 'Dallas', 'Dallas', 'TX', '75284', '8179262544', '          ', '', '', 'BAYHEALTHD', '0.00', '0.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1669472387', 0, 'N', 0, '2013-09-23', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12038375', 'W12038375', 'WYBILLINGS', 'Billings Clinic - Cancer Center', 'Robert', 'B.', 'Geller', '', 'Oncology', '', '', NULL, 'O', '801 N 29th St', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062382469', '801 N 29th St', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062382469', '', '', '', '0.00', '17.00', '0.00', 3, '2013-10-01', '2013-10-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1861673121', 0, 'N', 0, '2013-10-03', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12038377', 'W12038377', 'WYBILLINGS', 'Billings Clinic', 'Robert', 'B.', 'Geller', '', 'Oncology', '', '', NULL, 'B', 'PO Box 31315', 'Billings', 'Yellowstone', 'MT', '59107', '4062382617', '0000000000', 'PO Box 31315', 'Billings', 'Yellowstone', 'MT', '59107', '4062382617', '0000000000', '', '', '', '0.00', '17.00', '0.00', 3, '2013-10-01', '2013-10-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1861673121', 0, 'N', 0, '2013-10-03', NULL, NULL, 0, 0, NULL, NULL),
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('460906063', 'W12038382', 'W12038382', 'UTMH1', 'The Counseling Center', 'Karen', '', 'Redd', 'CMHC', 'Mental Health', 'Counseling', '', NULL, 'B', '502 Pheasant Way', 'Centerville', 'Davis', 'UT', '84014', '8012982000', '8019511490', '502 Pheasant Way', 'Centerville', 'Davis', 'UT', '84014', '8012982000', '8019511490', 'UTMA', '', '', '0.00', '40.00', '0.00', 3, '2013-09-02', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1114266988', 0, 'N', 0, '2014-03-11', NULL, NULL, 40.9225, -111.874, NULL, NULL),
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('460906063', 'W12038384', 'W12038384', 'UTMH1', 'The Counseling Center', 'Richard', '', 'Cox', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '502 Pheasant Way', 'Centerville', 'Davis', 'UT', '84014', '8012982000', '8019511490', '502 Pheasant Way', 'Centerville', 'Davis', 'UT', '84014', '8012982000', '8019511490', 'UTMA', '', '', '0.00', '40.00', '0.00', 3, '2013-09-02', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1265527402', 0, 'N', 0, '2013-09-23', NULL, NULL, 40.9225, -111.874, NULL, NULL),
('460906063', 'W12038385', 'W12038385', 'UTMH1', 'The Counseling Center', 'Aaron ', '', 'Gardner', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '502 Pheasant Way', 'Centerville', 'Davis', 'UT', '84014', '8012982000', '8019511490', '502 Pheasant Way', 'Centerville', 'Davis', 'UT', '84014', '8012982000', '8019511490', 'UTMA', '', '', '0.00', '40.00', '0.00', 3, '2013-09-02', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1952666232', 0, 'N', 0, '2013-12-19', NULL, NULL, 40.9225, -111.874, NULL, NULL),
('460906063', 'W12038386', 'W12038386', 'UTMH1', 'The Counseling Center', 'Lauralee', 'L', 'Gardner', 'LMFT', 'Mental Health', 'Counseling', '', NULL, 'O', '502 Pheasant Way', 'Centerville', 'Davis', 'UT', '84014', '8012982000', '8019511490', '502 Pheasant Way', 'Centerville', 'Davis', 'UT', '84014', '8012982000', '8019511490', 'UTMA', '', '', '0.00', '40.00', '0.00', 3, '2013-09-02', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1730246521', 0, 'N', 0, '2013-09-23', NULL, NULL, 40.9225, -111.874, NULL, NULL),
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('460906063', 'W12038389', 'W12038389', 'UTMH1', 'The Counseling Center', 'Hilary', 'C', 'Madsen', 'LCSW', 'Mental Health', '', '', NULL, 'O', '502 Pheasant Way', 'Centerville', 'Davis', 'UT', '84014', '8012982000', '8019511490', '502 Pheasant Way', 'Centerville', 'Davis', 'UT', '84014', '8012982000', '8019511490', 'UTMA', '', '', '0.00', '40.00', '0.00', 3, '2013-09-02', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1528214327', 0, 'N', 0, '2013-09-23', NULL, NULL, 40.9225, -111.874, NULL, NULL),
('460906063', 'W12038390', 'W12038390', 'UTMH1', 'The Counseling Center', 'Cindie ', '', 'Parker', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '502 Pheasant Way', 'Centerville', 'Davis', 'UT', '84014', '8012982000', '8019511490', '502 Pheasant Way', 'Centerville', 'Davis', 'UT', '84014', '8012982000', '8019511490', 'UTMA', '', '', '0.00', '40.00', '0.00', 3, '2013-09-02', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1669623765', 0, 'N', 0, '2013-09-23', NULL, NULL, 40.9225, -111.874, NULL, NULL),
('460906063', 'W12038391', 'W12038391', 'UTMH1', 'The Counseling Center', 'Paul', 'J', 'Peterson', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '502 Pheasant Way', 'Centerville', 'Davis', 'UT', '84014', '8012982000', '8019511490', '502 Pheasant Way', 'Centerville', 'Davis', 'UT', '84014', '8012982000', '8019511490', 'UTMA', '', '', '0.00', '40.00', '0.00', 3, '2013-09-02', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1528114667', 0, 'N', 0, '2013-09-23', NULL, NULL, 40.9225, -111.874, NULL, NULL),
('460906063', 'W12038392', 'W12038392', 'UTMH1', 'The Counseling Center', 'Victoria', '', 'Winsett', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '502 Pheasant Way', 'Centerville', 'Davis', 'UT', '84014', '8012982000', '8019511490', '502 Pheasant Way', 'Centerville', 'Davis', 'UT', '84014', '8012982000', '8019511490', 'UTMA', '', '', '0.00', '40.00', '0.00', 3, '2013-09-02', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1629352117', 0, 'N', 0, '2013-09-23', NULL, NULL, 40.9225, -111.874, NULL, NULL),
('850275777', 'W12038395', 'W12038395', 'NM01', 'Southwest Medical Associates', 'Dianna', 'L', 'Fury', 'MD', 'Family Practice', '', '', NULL, 'O', '6100 Pan American Fwy NE Ste 100', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058231010', '5057974503', '6100 Pan American Fwy NE Ste 100', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058231010', '5057974503', 'NMSWMED', '', '', '0.00', '10.00', '0.00', 3, '2013-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1790784973', 0, 'N', 0, '2013-10-10', NULL, NULL, 35.1537, -106.587, NULL, NULL),
('850275777', 'W12038396', 'W12038396', 'NM01', 'Southwest Medical Associates', 'Dianna', 'L', 'Fury', 'MD', 'Family Practice', '', '', 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, '', '', '', '', 'HCFA|UB|', '1790784973', 0, 'N', 0, '2013-10-10', NULL, NULL, 35.2073, -106.676, NULL, NULL),
('850275777', 'W12038397', 'W12038397', 'NM01', 'Southwest Medical Associates', 'Dianna', 'L', 'Fury', 'MD', '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, '2013-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1790784973', 0, 'N', 0, '2013-10-10', NULL, NULL, 35.1902, -106.665, NULL, NULL),
('850275777', 'W12038398', 'W12038398', 'NM01', 'Southwest Medical Associates', 'Dianna', 'L', 'Fury', 'MD', 'Family Practice', '', '', NULL, 'O', '4705 Montgomery Blvd NE Ste 301-302', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058231010', '5057974503', '4705 Montgomery Blvd NE Ste 301-302', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058231010', '5057974503', 'NMSWMED', '', '', '0.00', '10.00', '0.00', 3, '2013-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1790784973', 0, 'N', 0, '2013-10-10', NULL, NULL, 35.131, -106.591, NULL, NULL),
('850275777', 'W12038399', 'W12038399', 'NM01', 'Southwest Medical Associates', 'Dianna', 'L', 'Fury', '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, '2013-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1790784973', 0, 'N', 0, '2013-10-10', NULL, NULL, 35.0946, -106.552, NULL, NULL),
('461724355', 'W12038405', 'W12038405', 'UT01', 'Salt Lake City Foot and Ankle Clinic', 'Christiaan', 'H', 'Goebel', 'DPM', 'Podiatry', '', '', NULL, 'O', '101 E Fort Union Blvd Ste B', 'Midvale', 'Salt Lake', 'UT', '84047', '8015611011', '8012742126', '101 E Fort Union Blvd Ste B', 'Midvale', 'Salt Lake', 'UT', '84047', '8015611011', '8012742126', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-10-15', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1659683381', 0, 'N', 0, '2013-10-08', NULL, NULL, 40.6208, -111.888, NULL, NULL),
('461724355', 'W12038404', 'W12038404', 'UT01', 'Salt Lake City Foot and Ankle Clinic', 'Christiaan', 'H', 'Goebel', 'DPM', 'Podiatry', '', '', NULL, 'O', '4578 S Highland Dr Ste 380', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8012749060', '8012742126', '4578 S Highland Dr Ste 380', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8012749060', '8012742126', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-10-15', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1659683381', 0, 'N', 0, '2013-10-08', NULL, NULL, 40.6723, -111.841, NULL, NULL),
('274478152', 'W12038406', 'W12038406', 'ILCHIGSTD', 'Advanced Urology Center', 'Alan', 'Y', 'Sadah', 'MD', 'Urology', '', '', NULL, 'O', '2735 N Harlem Ave', 'Elmwood Park', 'Cook', 'IL', '60707', '7733856069', '7733856281', '2735 N Harlem Ave', 'Elmwood Park', 'Cook', 'IL', '60707', '7733856069', '7733856281', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Our Lady Of The Resurrection Medical Center', NULL, '', '', 'HCFA|UB|', '1679510275', 0, 'N', 0, '2013-09-24', NULL, NULL, 41.9297, -87.8064, NULL, NULL),
('204043287', 'W12038409', 'W12038409', 'NM01', 'ABQ Health Partners', 'Denise', '', 'Aamodt', 'MD', 'Family Practice', '', '', NULL, 'O', '1721 Rio Rancho Blvd SE', 'Rio Rancho', 'Sandoval', 'NM', '87124', '5058968600', '5058968618', '1721 Rio Rancho Blvd SE', 'Rio Rancho', 'Sandoval', 'NM', '87124', '5058968600', '5058968618', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2013-11-01', NULL, 0, 0, 0, 'Lovelace Medical Center', 'Lovelace Womens Hospital', 'Lovelace Westside Hospital ', NULL, 'HCFA|UB|', '1336172998', 0, 'N', 0, '2013-09-24', NULL, NULL, 35.2284, -106.66, NULL, NULL),
('204043287', 'W12038408', 'W12038408', 'NM01', 'ABQ Health Partners', 'Heather', '', 'Drager', 'PA-C', 'Family Practice', '', '', NULL, 'O', '1721 Rio Rancho Blvd SE', 'Rio Rancho', 'Sandoval', 'NM', '87124', '5058968600', '5058968618', '1721 Rio Rancho Blvd SE', 'Rio Rancho', 'Sandoval', 'NM', '87124', '5058968600', '5058968618', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2013-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1467475558', 0, 'N', 0, '2013-09-24', NULL, NULL, 35.2284, -106.66, NULL, NULL),
('204043287', 'W12038410', 'W12038410', 'NM01', 'ABQ Health Partners', 'Paul', '', 'Warfield', 'MD', 'Gastroenterology', '', '', NULL, 'O', '10511 Golf Course Rd Ste 202', 'Albuquerque', 'Bernalillo', 'NM', '87114', '5052627604', '5052321161', '10511 Golf Course Rd Ste 202', 'Albuquerque', 'Bernalillo', 'NM', '87114', '5052627604', '5052321161', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2013-09-06', NULL, 0, 0, 0, 'Lovelace Medical Center', 'Lovelace Westside Hospital', NULL, NULL, 'HCFA|UB|', '1841206422', 0, 'N', 0, '2013-09-24', NULL, NULL, 35.2073, -106.676, NULL, NULL),
('204043287', 'W12038411', 'W12038411', 'NM01', 'ABQ Health Partners', 'Thomas', '', 'Whigham', 'MD', 'Gastroenterology', '', '', NULL, 'O', '10511 Golf Course Rd Ste 203', 'Albuquerque', 'Bernalillo', 'NM', '87114', '5052627604', '5052321161', '10511 Golf Course Rd Ste 203', 'Albuquerque', 'Bernalillo', 'NM', '87114', '5052627604', '5052321161', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2013-09-06', NULL, 0, 0, 0, 'Lovelace Westside Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1619902715', 0, 'N', 0, '2013-09-24', NULL, NULL, 35.2073, -106.676, 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
('204043287', 'W12038412', 'W12038412', 'NM01', 'ABQ Health Partners', 'Jeff', '', 'Zabel', 'MD', 'Gastroenterology', '', '', NULL, 'O', '10511 Golf Course Rd Ste 203', 'Albuquerque', 'Bernalillo', 'NM', '87114', '5052627604', '5052321161', '10511 Golf Course Rd Ste 203', 'Albuquerque', 'Bernalillo', 'NM', '87114', '5052627604', '5052321161', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2013-09-06', NULL, 0, 0, 0, 'Lovelace Westside Hospital ', '', '', '', 'HCFA|UB|', '1609849975', 0, 'N', 0, '2013-09-24', NULL, NULL, 35.2073, -106.676, NULL, NULL),
('850275777', 'W12038413', 'W12038413', 'NM01', 'Southwest Medical Associates', 'Willis', 'H', 'Kephart', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '4705 Montgomery Blvd NE Ste 301-302', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058231010', '5057974503', '4705 Montgomery Blvd NE Ste 301-302', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058231010', '5057974503', 'NMSWMED', '', '', '0.00', '10.00', '0.00', 3, '2013-10-14', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1306872940', 0, 'N', 0, '2013-10-30', NULL, NULL, 35.131, -106.591, NULL, NULL),
('850275777', 'W12038415', 'W12038415', 'NM01', 'Southwest Medical Associates', 'Linell', '', 'Thompson', 'NP', 'Gynecology', '', '', NULL, 'O', '4705 Montgomery Blvd NE Ste 301-302', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058231010', '5057974503', '4705 Montgomery Blvd NE Ste 301-302', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058231010', '5057974503', 'NMSWMED', '', '', '0.00', '10.00', '0.00', 3, '2013-10-14', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1043493166', 0, 'N', 0, '2013-10-30', NULL, NULL, 35.131, -106.591, NULL, NULL),
('870373083', 'W12038416', 'W12038416', 'UT01', 'Heart and Lung Institute', 'Stephen', 'A', 'Spurlock', 'PA-C', 'Pulmonary', '', '', NULL, 'O', '82 S 1100 E Ste 103', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8012632370', '8012651200', '82 S 1100 E Ste 103', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8012632370', '8012651200', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-11-01', '2014-04-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1790093201', 0, 'N', 0, '2013-10-11', NULL, NULL, 40.7676, -111.86, NULL, NULL),
('870373083', 'W12038417', 'W12038417', 'UT01', 'Heart and Lung Institute', 'Stephen', 'A', 'Spurlock', 'PA-C', 'Pulmonary', '', '', NULL, 'O', '5979 S Fashion Blvd', 'Murray', 'Salt Lake', 'UT', '84107', '8012632370', '8012651200', '5979 S Fashion Blvd', 'Murray', 'Salt Lake', 'UT', '84107', '8012632370', '8012651200', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-11-01', '2014-04-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1790093201', 0, 'N', 0, '2013-10-11', NULL, NULL, 40.6415, -111.883, NULL, NULL),
('870373083', 'W12038418', 'W12038418', 'UT01', 'Heart and Lung Institute', 'Stephen', 'A', 'Spurlock', 'PA-C', 'Pulmonary', '', '', NULL, 'B', 'PO Box 847112', 'Dallas', 'Dallas', 'TX', '75284', '8012632370', '8012651200', 'PO Box 847112', 'Dallas', 'Dallas', 'TX', '75284', '8012632370', '8012651200', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-11-01', '2014-04-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1790093201', 0, 'N', 0, '2013-10-11', NULL, NULL, 0, 0, NULL, NULL),
('870373083', 'W12038419', 'W12038419', 'UT01', 'Heart And Lung Institute', 'Stephen', 'A', 'Spurlock', 'PA-C', 'Pulmonary', '', '', NULL, 'O', '3570 W 9000 S Ste 110', 'West Jordan', 'Salt Lake', 'UT', '84088', '8012632370', '8012651200', '3570 W 9000 S Ste 110', 'West Jordan', 'Salt Lake', 'UT', '84088', '8012632370', '8012651200', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-11-01', '2014-04-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1790093201', 0, 'N', 0, '2013-10-11', NULL, NULL, 40.588, -111.975, NULL, NULL),
('870373083', 'W12038420', 'W12038420', 'UT01', 'Heart and Lung Institute', 'Stephen', 'A', 'Spurlock', 'PA-C', 'Pulmonary', '', '', NULL, 'O', '3336 S 4155 W Ste 203', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8012632370', '8012651200', '3336 S 4155 W Ste 203', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8012632370', '8012651200', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-11-01', '2014-04-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1790093201', 0, 'N', 0, '2013-10-11', NULL, NULL, 40.6991, -111.99, NULL, NULL),
('870284475', 'W12038421', 'W12038421', 'UT01', 'Granger Medical Clinic ', 'Carrie', '', 'Chandler', 'FNP', 'Nurse Practitioner', '', '', 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, '2013-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1326229782', 0, 'N', 0, '2013-10-11', NULL, NULL, 40.5394, -111.891, NULL, NULL),
('870284475', 'W12038423', 'W12038423', 'UT01', 'Granger Medical Clinic', 'Carrie', '', 'Chandler', 'FNP', 'Nurse Practitioner', '', '', NULL, 'B', 'PO Box 70658', 'Salt Lake City', 'Salt Lake', 'UT', '84170', '          ', NULL, 'PO Box 70658', 'Salt Lake City', 'Salt Lake', 'UT', '84170', '          ', '          ', 'WUGRANGER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1326229782', 0, 'N', 0, '2013-10-11', NULL, NULL, 0, 0, NULL, NULL),
('742915297', 'W12038424', 'W12038424', 'TXSATSTD', 'Arthur Rosenthal MD', 'Arthur', '', 'Rosenthal', 'MD', 'General Surgery', '', '', NULL, 'O', '8042 Wurzbach Rd Ste 480', 'San Antonio', 'Bexar', 'TX', '78229', '2106160657', NULL, '8042 Wurzbach Rd Ste 480', 'San Antonio', 'Bexar', 'TX', '78229', '2106160657', '          ', 'TXSURGA', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-09-20', NULL, 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1154393247', 0, 'N', 0, '2014-01-24', NULL, NULL, 29.514, -98.5778, NULL, NULL),
('870284475', 'W12038427', 'W12038427', 'UT01', 'Granger Medical Park City', 'Ashleigh', '', 'Byrne', 'MD', 'Pain Management', '', '', NULL, 'O', '1600 Snow Creek Dr Ste B', 'Park City', 'Summit', 'UT', '84060', '8013525900', '          ', '1600 Snow Creek Dr Ste B', 'Park City', 'Summit', 'UT', '84060', '8013525900', '          ', 'WUGRANGER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', '', '', '', 'HCFA|UB|', '1023269537', 0, 'N', 0, '2014-04-21', NULL, NULL, 0, 0, NULL, NULL),
('870284475', 'W12038426', 'W12038426', 'UT01', 'Granger Medical Clinic', 'Ashleigh', '', 'Byrne', 'MD', 'Pain Management', '', '', NULL, 'O', '2356 N 400 E Ste 201', 'Tooele', 'Tooele', 'UT', '84074', '8013525900', '8013525914', '2356 N 400 E Ste 201', 'Tooele', 'Tooele', 'UT', '84074', '8013525900', '8013525914', 'WUGRANGER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', '', '', '', 'HCFA|UB|', '1023269537', 0, 'N', 0, '2014-04-21', NULL, NULL, 0, 0, NULL, NULL),
('870284475', 'W12038425', 'W12038425', 'UT01', 'Granger Medical Clinic ', 'Ashleigh', '', 'Byrne', 'MD', 'Pain Management', '', '', NULL, 'O', '3181 W 9000 S', 'West Jordan', 'Salt Lake', 'UT', '84088', '8013525900', '          ', '3181 W 9000 S', 'West Jordan', 'Salt Lake', 'UT', '84088', '8013525900', '          ', 'WUGRANGER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', '', '', '', 'HCFA|UB|', '1023269537', 0, 'N', 0, '2014-04-21', NULL, NULL, 0, 0, NULL, NULL),
('870284475', 'W12038428', 'W12038428', 'UT01', 'Granger Medical Clinic', 'Ashleigh', '', 'Byrne', 'MD', 'Pain Management', '', '', NULL, 'M', '3725 W 4100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '0000000000', '0000000000', '3725 W 4100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '0000000000', '0000000000', 'WUGRANGER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', '', '', '', 'HCFA|UB|', '1023269537', 0, 'N', 0, '2014-04-21', NULL, NULL, 0, 0, NULL, NULL),
('870284475', 'W12038429', 'W12038429', 'UT01', 'Granger Medical Clinic', 'Ashleigh', '', 'Byrne', 'MD', 'Pain Management', '', '', NULL, 'B', 'PO Box 70658', 'Salt Lake City', 'Salt Lake', 'UT', '84170', '          ', '          ', 'PO Box 70658', 'Salt Lake City', 'Salt Lake', 'UT', '84170', '          ', '          ', 'WUGRANGER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', '', '', '', 'HCFA|UB|', '1023269537', 0, 'N', 0, '2014-04-21', NULL, NULL, 0, 0, NULL, NULL),
('954893928', 'W12038431', 'W12038431', 'UT01', 'Exodus Healthcare Network', 'Danee', 'S', 'Young', 'MD', 'Gynecology', NULL, NULL, NULL, 'O', '3665 S 8400 W Ste 110', 'Magna', 'Salt Lake', 'UT', '84044', '8012509638', '8012503204', '3665 S 8400 W Ste 110', 'Magna', 'Salt Lake', 'UT', '84044', '8012509638', '8012503204', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2030-01-01', '2030-01-01', 0, 0, 0, 'Pioneer Valley Hospital', 'Jordan Valley Medical Center', '', '', 'HCFA|UB|', '1417953662', 0, 'N', 1, '2013-12-16', NULL, NULL, 0, 0, NULL, NULL),
('954893928', 'W12038430', 'W12038430', 'UT01', 'Exodus Healthcare Network', 'Danee', 'S', 'Young', 'MD', 'Gynecology', NULL, NULL, NULL, 'O', '3336 S Pioneer Pkwy Ste 201', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8012509638', '8012503204', '3336 S Pioneer Pkwy Ste 201', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8012509638', '8012503204', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2030-01-01', '2030-01-01', 0, 0, 0, 'Pioneer Valley Hospital', 'Jordan Valley Medical Center', '', '', 'HCFA|UB|', '1417953662', 0, 'N', 1, '2013-12-16', NULL, NULL, 0, 0, NULL, NULL),
('820500162', 'W12038434', 'W12038434', 'ID01', 'Anesthesiology Consultants of ID', 'Christopher', 'L', 'Berentzen', 'MD', 'Anesthesiology', '', '', NULL, 'O', '1512 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2084635029', '2084635081', '1512 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2084635029', '2084635081', '', '', '', '59.62', '0.00', '0.00', 3, '2013-09-17', NULL, 0, 15, 0, '', '', '', '', 'HCFA|UB|', '1699917831', 0, 'N', 0, '2013-09-24', NULL, NULL, 43.5537, -116.573, NULL, NULL),
('820500162', 'W12038435', 'W12038435', 'ID01', 'Anesthesiology Consultants of Idaho', 'Christopher', 'L', 'Berentzen', 'MD', 'Anesthesiology', '', '', NULL, 'B', '104 W 5th Ave Ste 250E', 'Spokane', 'Spokane', 'WA', '99204', '8662631223', '0000000000', '104 W 5th Ave Ste 250E', 'Spokane', 'Spokane', 'WA', '99204', '8662631223', '0000000000', '', '', '', '59.62', '0.00', '0.00', 3, '2013-09-17', NULL, 0, 15, 0, '', '', '', '', 'HCFA|UB|', '1699917831', 0, 'N', 0, '2013-09-24', NULL, NULL, 0, 0, NULL, NULL),
('820500162', 'W12038437', 'W12038437', 'ID01', 'Anesthesiology Consultants of Idaho', 'Randall', 'A', 'Black', 'DO', 'Anesthesia', '', '', NULL, 'O', '4400 E Flamingo Ave', 'Nampa', 'Canyon', 'ID', '83687', '2084635029', '2084635081', '4400 E Flamingo Ave', 'Nampa', 'Canyon', 'ID', '83687', '2084635029', '2084635081', '', '', '', '59.62', '0.00', '0.00', 3, '2012-06-01', NULL, 1, 15, 0, 'Saint Alphonsus Medical Center Nampa', NULL, NULL, NULL, 'HCFA|UB|', '1922028083', 0, 'N', 0, '2013-09-24', NULL, NULL, 43.5966, -116.519, NULL, NULL),
('820500162', 'W12038438', 'W12038438', 'ID01', 'Anesthesiology Consultants of Idaho', 'Russell', 'D', 'Crawford', 'DO', 'Anesthesia', '', '', NULL, 'O', '4400 E Flamingo Ave', 'Nampa', 'Canyon', 'ID', '83687', '2084635029', '2084635081', '4400 E Flamingo Ave', 'Nampa', 'Canyon', 'ID', '83687', '2084635029', '2084635081', '', '', '', '59.62', '0.00', '0.00', 3, '2012-06-01', NULL, 1, 15, 0, 'Saint Alphonsus Medical Center Nampa', NULL, NULL, NULL, 'HCFA|UB|', '1609968635', 0, 'N', 0, '2013-09-24', NULL, NULL, 43.5966, -116.519, NULL, NULL),
('820500162', 'W12038439', 'W12038439', 'ID01', 'Anesthesiology Consultants of Idaho', 'Ryan', 'H', 'Mecham', 'MD', 'Anesthesia', '', '', NULL, 'O', '4400 E Flamingo Ave', 'Nampa', 'Canyon', 'ID', '83687', '2084635029', '2084635081', '4400 E Flamingo Ave', 'Nampa', 'Canyon', 'ID', '83687', '2084635029', '2084635081', '', '', '', '59.62', '0.00', '0.00', 3, '2012-06-01', NULL, 1, 15, 0, '', '', '', '', 'HCFA|UB|', '1255423265', 0, 'N', 0, '2013-09-24', NULL, NULL, 43.5966, -116.519, NULL, NULL),
('820500162', 'W12038440', 'W12038440', 'ID01', 'Anesthesiology Consultants of Idaho', 'Paul', '', 'Morgan', 'DO', 'Anesthesia', '', '', NULL, 'O', '4400 E Flamingo Ave', 'Nampa', 'Canyon', 'ID', '83687', '2084635029', '2084635081', '4400 E Flamingo Ave', 'Nampa', 'Canyon', 'ID', '83687', '2084635029', '2084635081', '', '', '', '59.62', '0.00', '0.00', 3, '2012-06-01', NULL, 1, 15, 0, 'Saint Alphonsus Medical Center Nampa', NULL, NULL, NULL, 'HCFA|UB|', '1598798498', 0, 'N', 0, '2013-09-24', NULL, NULL, 43.5966, -116.519, NULL, NULL),
('820500162', 'W12038441', 'W12038441', 'ID01', 'Anesthesiology Consultants of Idaho', 'Joseph', '', 'Mortensen', 'MD', 'Anesthesiology', '', '', NULL, 'O', '4400 E Flamingo Ave', 'Nampa', 'Canyon', 'ID', '83687', '2084635029', '2084635081', '4400 E Flamingo Ave', 'Nampa', 'Canyon', 'ID', '83687', '2084635029', '2084635081', '', '', '', '59.62', '0.00', '0.00', 3, '2012-06-01', NULL, 1, 15, 0, '', '', '', '', 'HCFA|UB|', '1942461850', 0, 'N', 0, '2013-09-24', NULL, NULL, 43.5966, -116.519, NULL, NULL),
('820500162', 'W12038442', 'W12038442', 'ID01', 'Anesthesiology Consultants of Idaho', 'Dennis', 'J', 'Page', 'MD', 'Anesthesia', '', '', NULL, 'O', '4400 E Flamingo Ave', 'Nampa', 'Canyon', 'ID', '83687', '2084635029', '2084635081', '4400 E Flamingo Ave', 'Nampa', 'Canyon', 'ID', '83687', '2084635029', '2084635081', '', '', '', '59.62', '0.00', '0.00', 3, '2012-06-01', NULL, 1, 15, 0, 'Saint Alphonsus Medical Center Nampa', NULL, NULL, NULL, 'HCFA|UB|', '1528057445', 0, 'N', 0, '2013-09-24', NULL, NULL, 43.5966, -116.519, NULL, NULL),
('820500162', 'W12038443', 'W12038443', 'ID01', 'Anesthesiology Consultants of Idaho', 'Christopher', 'A', 'Pierce', 'DO', 'Anesthesia', '', '', NULL, 'O', '4400 E Flamingo Ave', 'Nampa', 'Canyon', 'ID', '83687', '2084635029', '2084635081', '4400 E Flamingo Ave', 'Nampa', 'Canyon', 'ID', '83687', '2084635029', '2084635081', '', '', '', '59.62', '0.00', '0.00', 3, '2012-06-01', '2012-06-01', 1, 15, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1285623876', 0, 'N', 0, '2013-10-07', NULL, NULL, 43.5976, -116.517, NULL, NULL),
('820500162', 'W12038444', 'W12038444', 'ID01', 'Anesthesiology Consultants of Idaho', 'Curtis', 'T', 'Rigby', 'DO', 'Anesthesia', '', '', NULL, 'O', '4400 E Flamingo Ave', 'Nampa', 'Canyon', 'ID', '83687', '2084635029', '2084635081', '4400 E Flamingo Ave', 'Nampa', 'Canyon', 'ID', '83687', '2084635029', '2084635081', '', '', '', '59.62', '0.00', '0.00', 3, '2012-06-01', NULL, 1, 15, 0, 'Saint Alphonsus Medical Center Nampa', NULL, NULL, NULL, 'HCFA|UB|', '1821200742', 0, 'N', 0, '2013-09-24', NULL, NULL, 43.5966, -116.519, NULL, NULL),
('820500162', 'W12038446', 'W12038446', 'ID01', 'Anesthesiology Consultants of Idaho', 'Shawn', '', 'States', 'MD', 'Anesthesia', '', '', NULL, 'O', '4400 E Flamingo Ave', 'Nampa', 'Canyon', 'ID', '83687', '2084635029', '2084635081', '4400 E Flamingo Ave', 'Nampa', 'Canyon', 'ID', '83687', '2084635029', '2084635081', '', '', '', '59.62', '0.00', '0.00', 3, '2012-06-01', NULL, 1, 15, 0, 'Saint Alphonsus Medical Center Nampa', NULL, NULL, NULL, 'HCFA|UB|', '1144312182', 0, 'N', 0, '2013-10-15', NULL, NULL, 43.5966, -116.519, NULL, NULL),
('820500162', 'W12038447', 'W12038447', 'ID01', 'Anesthesiology Consultants of Idaho', 'Michael', '', 'Stratton', 'DO', 'Anesthesia', '', '', NULL, 'O', '4400 E Flamingo Ave', 'Nampa', 'Canyon', 'ID', '83687', '2084635029', '2084635081', '4400 E Flamingo Ave', 'Nampa', 'Canyon', 'ID', '83687', '2084635029', '2084635081', '', '', '', '59.62', '0.00', '0.00', 3, '2012-06-01', NULL, 1, 15, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1710169966', 0, 'N', 0, '2013-09-24', NULL, NULL, 43.5966, -116.519, NULL, NULL),
('820500162', 'W12038448', 'W12038448', 'ID01', 'Anesthesiology Consultants of Idaho', 'Kerri', 'D', 'Trainer', 'DO', 'Anesthesia', '', '', NULL, 'O', '4400 E Flamingo Ave', 'Nampa', 'Canyon', 'ID', '83687', '2084635029', '2084635081', '4400 E Flamingo Ave', 'Nampa', 'Canyon', 'ID', '83687', '2084635029', '2084635081', '', '', '', '59.62', '0.00', '0.00', 3, '2012-06-01', NULL, 1, 15, 0, 'Saint Alphonsus Medical Center Nampa', NULL, NULL, NULL, 'HCFA|UB|', '1477537280', 0, 'N', 0, '2013-09-24', NULL, NULL, 43.5966, -116.519, NULL, NULL),
('452716222', 'W12038456', 'W12038456', 'ID02', 'St Lukes Clinic Pediatric Cardiology', 'Eloisa', 'S', 'Walker', '(accepting newborn pediatric patients only)', 'Pediatric Cardiology', '', '', NULL, 'B', 'PO Box 640', 'Boise', 'Ada', 'ID', '83701', '2087065000', '0000000000', 'PO Box 640', 'Boise', 'Ada', 'ID', '83701', '2087065000', '0000000000', 'IDACN', '', '', '0.00', '15.00', '0.00', 8, '2013-02-05', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1760433601', 0, 'N', 0, '2014-06-20', NULL, NULL, 0, 0, NULL, NULL),
('452716222', 'W12038459', 'W12038459', 'ID02', 'St Lukes Clinic Pediatric Cardiology', 'Eloisa', 'S', 'Walker', '(accepting newborn pediatric patients only)', 'Pediatric Cardiology', '', '', NULL, 'O', '100 E Idaho Ste 200', 'Boise', 'Ada', 'ID', '83712', '2083817384', '2083817387', '100 E Idaho Ste 200', 'Boise', 'Ada', 'ID', '83712', '2083817384', '2083817387', 'IDACN', '', '', '0.00', '15.00', '0.00', 8, '2013-09-24', '2013-10-30', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1760433601', 0, 'N', 0, '2014-06-20', NULL, NULL, 43.6123, -116.194, NULL, NULL),
('452716222', 'W12038460', 'W12038460', 'ID02', 'St Lukes Childrens Cardiology of Idaho', 'Eloisa', 'S', 'Walker', '(accepting newborn pediatric patients only)', 'Pediatric Cardiology', '', '', NULL, 'O', '1210 NW 16th St', 'Fruitland', 'Payette', 'ID', '83619', '2083369188', '2083362636', '1210 NW 16th St', 'Fruitland', 'Payette', 'ID', '83619', '2083369188', '2083362636', 'IDSTD', '', '', '0.00', '30.00', '0.00', 8, '2013-09-24', '2013-09-24', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1760433601', 0, 'N', 0, '2014-06-20', NULL, NULL, 0, 0, NULL, NULL),
('452716222', 'W12038461', 'W12038461', 'ID02', 'St Lukes Clinic Pediatric Cardiology', 'Eloisa', 'S', 'Walker', '(accepting newborn pediatric patients only)', 'Pediatric Cardiology', '', '', NULL, 'O', '3525 E Louise Ste 250', 'Meridian', 'Ada', 'ID', '83642', '2083369188', '2083362636', '3525 E Louise Ste 250', 'Meridian', 'Ada', 'ID', '83642', '2083369188', '2083362636', 'IDACN', '', '', '0.00', '15.00', '0.00', 8, '2013-09-24', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1760433601', 0, 'N', 0, '2014-06-20', NULL, NULL, 0, 0, NULL, NULL),
('850481404', 'W12038464', 'W12038464', 'NM01', 'After Hours Pediatrics', '', '', 'After Hours Pediatrics', '', 'Pediatrics', '', '', NULL, 'O', '5904 Holly Ave', 'Albuquerque', 'Bernalillo', 'NM', '87113', '5052982505', NULL, '5904 Holly Ave', 'Albuquerque', 'Bernalillo', 'NM', '87113', '5052982505', '          ', 'AFTERHOURS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1588730360', 0, 'N', 0, '2013-09-30', NULL, NULL, 35.1757, -106.579, NULL, NULL),
('850481404', 'W12038465', 'W12038465', 'NM01', 'After Hours Pediatrics', '', '', 'After Hours Pediatrics', '', 'Pediatrics', '', '', NULL, 'O', '9201 Montgomery Blvd NE Ste 201', 'Albuquerque', 'Bernalillo', 'NM', '87111', '5052982505', NULL, '9201 Montgomery Blvd NE Ste 201', 'Albuquerque', 'Bernalillo', 'NM', '87111', '5052982505', '          ', 'AfterHours', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1588730360', 0, 'N', 0, '2013-09-30', NULL, NULL, 35.1308, -106.54, NULL, NULL),
('850481404', 'W12038466', 'W12038466', 'NM01', 'After Hours Pediatrics', '', '', 'After Hours Pediatrics', '', 'Pediatrics', '', '', NULL, 'O', '9210 Golf Course Rd NW', 'Albuquerque', 'Bernalillo', 'NM', '87114', '5052982505', NULL, '9210 Golf Course Rd NW', 'Albuquerque', 'Bernalillo', 'NM', '87114', '5052982505', '          ', 'AfterHours', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1588730360', 0, 'N', 0, '2013-09-30', NULL, NULL, 35.1866, -106.685, NULL, NULL),
('461214867', 'W12038467', 'W12038467', 'UT01', 'IAA Ogden ', 'Joseph', 'R', 'Anderson', 'MD', 'Allergy and Immunology', '', '', NULL, 'O', '1490 E Foremaster Dr Ste 300', 'St George', 'Washington', 'UT', '84790', '8666765536', '', '1490 E Foremaster Dr Ste 300', 'St George', 'Washington', 'UT', '84790', '8666765536', '', 'WiseSTD6A', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-10-01', NULL, 0, 0, 0, 'Primary Childrens Medical Center', '', '', '', 'HCFA|UB|', '1720080062', 0, 'Y', 0, '2014-07-25', NULL, NULL, 37.0959, -113.551, NULL, NULL),
('461214867', 'W12038468', 'W12038468', 'UT01', 'IAA Ogden', 'Joseph', 'R', 'Anderson', 'MD', 'Allergy and Immunology', '', '', NULL, 'O', '5929 S Fashion Point Ste 101', 'Ogden', 'Weber', 'UT', '84403', '8014760052', '', '5929 S Fashion Point Ste 101', 'Ogden', 'Weber', 'UT', '84403', '8014760052', '', 'WiseSTD6A', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-10-01', NULL, 0, 0, 0, 'Primary Childrens Medical Center', '', '', '', 'HCFA|UB|', '1720080062', 0, 'N', 0, '2014-07-25', NULL, NULL, 41.1548, -111.938, NULL, NULL),
('264333033', 'W12038471', 'W12038471', 'TXSATSTD', 'Institute for Womens Health', 'Aurora', '', 'Dominguez', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '1210 Arion Pkwy', 'San Antonio', 'Bexar', 'TX', '78216', '2106563040', NULL, '1210 Arion Pkwy         ', 'San Antonio', 'Bexar', 'TX', '78216', '2106563040', '          ', 'TXOBG', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-12-01', NULL, 0, 0, 0, 'North Central Baptist Hospital', NULL, '', '', 'HCFA|UB|', '1568697944', 0, 'N', 0, '2013-11-13', NULL, NULL, 0, 0, NULL, NULL),
('264333033', 'W12038469', 'W12038469', 'TXSATSTD', 'Institute for Womens Health', 'Aurora', '', 'Dominguez', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1303 McCullough Ave Ste GL70', 'San Antonio', 'Bexar', 'TX', '78212', '2102269705', '2102234555', '1303 McCullough Ave Ste GL70', 'San Antonio', 'Bexar', 'TX', '78212', '2102269705', '2102234555', 'TXOBG', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-12-01', NULL, 0, 0, 0, 'North Central Baptist Hospital', NULL, '', '', 'HCFA|UB|', '1568697944', 0, 'N', 0, '2013-11-13', NULL, NULL, 29.4407, -98.4918, NULL, NULL),
('264333033', 'W12038470', 'W12038470', 'TXSATSTD', 'Institute for Womens Health', 'Aurora', '', 'Dominguez', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '18707 Hardy Oak Ste 230   ', 'San Antonio', 'Bexar', 'TX', '78258', '2104942000', '2104946119', '18707 Hardy Oak Ste 230   ', 'San Antonio', 'Bexar', 'TX', '78258', '2104942000', '2104946119', 'TXOBG', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-12-01', NULL, 0, 0, 0, 'North Central Baptist Hospital', NULL, '', '', 'HCFA|UB|', '1568697944', 0, 'N', 0, '2013-11-13', NULL, NULL, 29.6374, -98.4905, NULL, NULL),
('363330928', 'W12038472', 'W12038472', 'ILCHIGSTD', 'Presence Healthcare Services', 'Jennifer', '', 'Boklewski', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '5645 W Addison St', 'Chicago', 'Cook', 'IL', '60634', '7732827000', '6309142499', '5645 W Addison St', 'Chicago', 'Cook', 'IL', '60634', '7732827000', '6309142499', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1598084956', 0, 'N', 0, '2013-09-25', NULL, NULL, 41.9459, -87.7678, NULL, NULL),
('363330928', 'W12038473', 'W12038473', 'ILCHIGSTD', 'Presence Healthcare Services', 'Jennifer', '', 'Boklewski', 'MD', 'Emergency Medicine', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '8557647687', '6309142469', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '8557647687', '6309142469', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1598084956', 0, 'N', 0, '2013-09-25', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'W12038475', 'W12038475', 'ILCHIGSTD', 'Presence Healthcare Services', 'Urszula', '', 'Jablonska', 'MD', 'Family Practice', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7732028444', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7732028444', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-05-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', '', '', 'HCFA|UB|', '1851303945', 0, 'N', 0, '2013-09-25', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'W12038474', 'W12038474', 'ILCHIGSTD', 'Presence Healthcare Services', 'Urszula', '', 'Jablonska', 'MD', 'Family Practice', '', '', NULL, 'O', '5251 N Milwaukee Ave', 'Chicago', 'Cook', 'IL', '60630', '7732839300', '6309142499', '5251 N Milwaukee Ave', 'Chicago', 'Cook', 'IL', '60630', '7732839300', '6309142499', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-05-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', '', '', 'HCFA|UB|', '1851303945', 0, 'N', 0, '2013-09-25', NULL, NULL, 41.9758, -87.7678, NULL, NULL),
('201780406', 'W12038476', 'W12038476', 'ILCHIGSTD', 'UroPartners', 'Steven', '', 'Koopman', 'MD', 'Urology', '', '', NULL, 'O', '836 W Wellington Ave 4th Fl', 'Chicago', 'Cook', 'IL', '60657', '7738787555', '7738788545', '836 W Wellington Ave 4th Fl', 'Chicago', 'Cook', 'IL', '60657', '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, 41.9364, -87.6508, NULL, NULL),
('621801973', 'W12038477', 'W12038477', 'UT01', 'Salt Lake Regional Medical Center', 'Ruth Ann', '', 'Dickinson', 'MD', 'Psychiatry', '', '', NULL, 'O', '1050 E S Temple', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013504111', NULL, '1050 E S Temple', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013504111', '          ', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-09-03', '2014-04-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1598785800', 0, 'N', 0, '2013-09-25', NULL, NULL, 40.7694, -111.861, NULL, NULL),
('621801973', 'W12038478', 'W12038478', 'UT01', 'Physician Group of Utah', 'Ruth Ann', '', 'Dickinson', 'MD', 'Psychiatry', '', '', 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, '2013-09-03', '2014-04-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1598785800', 0, 'N', 0, '2013-09-25', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W12038479', 'W12038479', 'UT01', 'Physician Group of Utah', 'Ruth Ann', '', 'Dickinson', 'MD', 'Psychiatry', '', '', NULL, 'M', '406 W S Jordan Pkwy Ste 450', 'South Jordan', 'Salt Lake', 'UT', '84095', '0000000000', NULL, '406 W S Jordan Pkwy Ste 450', 'South Jordan', 'Salt Lake', 'UT', '84095', '0000000000', '          ', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-09-03', '2014-04-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1598785800', 0, 'N', 0, '2013-09-25', NULL, NULL, 0, 0, NULL, NULL),
('820554961', 'W12038480', 'W12038480', 'NM01', '', 'Jan', 'C', 'Jay', 'DOM', 'Acupuncture', '', '', NULL, 'O', '5200 Eubank Blvd NE Ste C-3', 'Albuquerque', 'Bernalillo', 'NM', '87111', '5053238100', '5052920555', '5200 Eubank Blvd NE Ste C-3', 'Albuquerque', 'Bernalillo', 'NM', '87111', '5053238100', '5052920555', '', '', '', '0.00', '0.00', '75.00', 3, '2013-09-09', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1376555359', 0, 'N', 0, '2013-09-25', NULL, NULL, 35.1381, -106.533, NULL, NULL),
('870635889', 'W12038481', 'W12038481', 'UT01', 'Oquirrh Family Practice', 'Mark ', 'S', 'Jorgensen', 'MD', 'Family Practice', '', '', NULL, 'O', '196 E 2000 N Ste 110', 'Tooele', 'Tooele', 'UT', '84074', '4358822692', '4358820536', '196 E 2000 N Ste 110', 'Tooele', 'Tooele', 'UT', '84074', '4358822692', '4358820536', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-10-01', '2014-05-02', 0, 0, 0, 'Mountain West Medical Center', '', '', '', 'HCFA|UB|', '1407083710', 0, 'N', 0, '2014-06-02', NULL, NULL, 40.5656, -112.294, NULL, NULL),
('364088232', 'W12038483', 'W12038483', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Aruna', '', 'Galla Pagadala', 'MD', 'Family Practice', '', '', NULL, 'B', '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', '          ', '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', '          ', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-09-20', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, '', '', 'HCFA|UB|', '1033310024', 0, 'N', 0, '2014-04-04', NULL, NULL, 0, 0, NULL, NULL),
('364088232', 'W12038482', 'W12038482', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Aruna', '', 'Galla Pagadala', 'MD', 'Family Practice', '', '', NULL, 'O', '1870 W Galena Blvd', 'Aurora', 'Kane', 'IL', '60506', '6308596700', '6308596811', '1870 W Galena Blvd', 'Aurora', 'Kane', 'IL', '60506', '6308596700', '6308596811', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-09-20', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, '', '', 'HCFA|UB|', '1033310024', 0, 'N', 0, '2014-04-04', NULL, NULL, 41.7642, -88.3626, NULL, NULL),
('272853029', 'W12038486', 'W12038486', 'UTDT01', 'Kids Town Pediatric Dentistry', 'Renn', '', 'Veater', 'DMD', 'Pedodontist', '', '', NULL, 'O', '2940 N Church St Ste 301', 'Layton', 'Davis', 'UT', '84040', '8017792900', NULL, '2940 N Church St Ste 301', 'Layton', 'Davis', 'UT', '84040', '8017792900', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1548411598', 0, 'N', 0, '2013-09-25', NULL, NULL, 0, 0, NULL, NULL),
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('451810554', 'W12038489', 'W12038489', 'UTDT01', 'Smart Pediatric Dentistry', 'John', '', 'Blankenship', 'DDS', 'Pedodontist', '', '', NULL, 'O', '2230 N University Pkwy Ste B', 'Provo', 'Utah', 'UT', '84604', '8013776400', NULL, '2230 N University Pkwy Ste B', 'Provo', 'Utah', 'UT', '84604', '8013776400', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1760828834', 0, 'N', 0, '2014-03-14', NULL, NULL, 0, 0, NULL, NULL),
('870618654', 'W12038491', 'W12038491', 'UTDT01', 'Century Dental West', 'Aaron', '', 'Ward', 'DMD', 'Periodontist', '', '', NULL, 'O', '4445 W 3500 S', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019680798', NULL, '4445 W 3500 S', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019680798', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1265582696', 0, 'N', 0, '2013-12-31', NULL, NULL, 0, 0, NULL, NULL),
('261147126', 'W12038493', 'W12038493', 'UTDT01', '3G Family Dentistry', 'Landon', '', 'Bell', 'DDS', 'Dentist', '', '', NULL, 'O', '10011 Centennial Pkwy Ste 210', 'Sandy', 'Salt Lake', 'UT', '84070', '8019963437', NULL, '10011 Centennial Pkwy Ste 210', 'Sandy', 'Salt Lake', 'UT', '84070', '8019963437', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1417395666', 0, 'N', 0, '2013-10-23', NULL, NULL, 0, 0, NULL, NULL),
('261147126', 'W12038494', 'W12038494', 'UTDT01', '3G Family Dentistry', 'Landon', '', 'Bell', 'DDS', 'Dentist', '', '', NULL, 'O', '2000 S 1300 E', 'Salt Lake City', 'Salt Lake', 'UT', '84105', '8014848893', NULL, '2000 S 1300 E', 'Salt Lake City', 'Salt Lake', 'UT', '84105', '8014848893', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1417395666', 0, 'N', 0, '2013-10-23', NULL, NULL, 0, 0, NULL, NULL),
('452683955', 'W12038498', 'W12038498', 'UTDT01', 'DB Knoles DDS', 'Dennis', '', 'Knoles', 'DDS', 'Orthodontist', '', '', NULL, 'O', '281 S Main', 'Centerville', 'Davis', 'UT', '84014', '8012983000', NULL, '281 S Main', 'Centerville', 'Davis', 'UT', '84014', '8012983000', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1881729903', 0, 'N', 0, '2013-09-25', NULL, NULL, 0, 0, NULL, NULL),
('453959382', 'W12038496', 'W12038496', 'UTDT01', 'Alpenglow Dental', 'Chris M', '', 'Jolley', 'DDS', 'Dentist', '', '', NULL, 'O', '533 W State St Ste 201', 'Pleasant Grove', 'Utah', 'UT', '84062', '8017960344', NULL, '533 W State St Ste 201', 'Pleasant Grove', 'Utah', 'UT', '84062', '8017960344', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1134168495', 0, 'N', 0, '2013-09-25', NULL, NULL, 0, 0, NULL, NULL),
('680529791', 'W12038500', 'W12038500', 'UTDT01', 'Dental Care Center', 'Reed', '', 'Jarvis', 'DDS', 'Dentist', '', '', NULL, 'O', '573 N 1000 W', 'Clearfield', 'Davis', 'UT', '84015', '8017761000', NULL, '573 N 1000 W', 'Clearfield', 'Davis', 'UT', '84015', '8017761000', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1295848190', 0, 'N', 0, '2013-09-25', NULL, NULL, 0, 0, NULL, NULL),
('272891247', 'W12038502', 'W12038502', 'UTDT01', 'Midland Dental', 'Joseph', '', 'Kuchenmeister', 'DDS', 'Dentist', '', '', NULL, 'O', '4040 S Midland Dr Ste 1', 'Roy', 'Weber', 'UT', '84067', '8013174407', NULL, '4040 S Midland Dr Ste 1', 'Roy', 'Weber', 'UT', '84067', '8013174407', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1942564125', 0, 'N', 0, '2013-09-25', NULL, NULL, 0, 0, NULL, NULL),
('870520179', 'W12038503', 'W12038503', 'UTDT01', 'Mountain View Dental', 'Joseph', '', 'Kuchenmeister', 'DDS', 'Dentist', '', '', NULL, 'O', '2717 N Hwy 89 Ste 100', 'Ogden', 'Weber', 'UT', '84414', '8017372410', NULL, '2717 N Hwy 89 Ste 100', 'Ogden', 'Weber', 'UT', '84414', '8017372410', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1942564125', 0, 'N', 0, '2013-09-25', NULL, NULL, 0, 0, NULL, NULL),
('870621575', 'W12038504', 'W12038504', 'UTDT01', 'Samuel Knight DDS PC', 'Samuel', '', 'Knight', 'DDS', 'Dentist', '', '', NULL, 'O', '1761 N 2000 W', 'Ogden', 'Weber', 'UT', '84404', '8017313200', NULL, '1761 N 2000 W', 'Ogden', 'Weber', 'UT', '84404', '8017313200', '          ', 'UT000B', '', '', '0.00', '0.00', '0.00', 8, '2013-06-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1083705149', 0, 'N', 0, '2013-09-25', NULL, NULL, 0, 0, NULL, NULL),
('462500960', 'W12038513', 'W12038513', 'NM01', 'NextCare Urgent Care', '', '', 'NextCare Urgent Care', '', 'Urgent Care', '', '', NULL, 'O', '8201 Golf Course Rd NW Ste A3', 'Albuquerque', 'Bernalillo', 'NM', '87120', '5058007070', '5058007075', '8201 Golf Course Rd NW Ste A3', 'Albuquerque', 'Bernalillo', 'NM', '87120', '5058007070', '5058007075', '', '', 'NMOP', '0.00', '100.00', '0.00', 3, '2013-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1619300118', 0, 'N', 0, '2013-12-17', NULL, NULL, 35.1779, -106.688, NULL, NULL),
('462500960', 'W12038514', 'W12038514', 'NM01', 'NextCare Urgent Care', '', '', 'NextCare Urgent Care', '', 'Urgent Care', '', '', NULL, 'M', '2550 N Thunderbird Cir Ste 303', 'Mesa', 'Maricopa', 'AZ', '85215', '0000000000', '0000000000', '2550 N Thunderbird Cir Ste 303', 'Mesa', 'Maricopa', 'AZ', '85215', '0000000000', '0000000000', '', '', 'NMOP', '0.00', '100.00', '0.00', 3, '2013-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1619300118', 0, 'N', 0, '2013-12-17', NULL, NULL, 0, 0, NULL, NULL),
('462500960', 'W12038515', 'W12038515', 'NM01', 'NextCare Urgent Care', '', '', 'NextCare Urgent Care', '', 'Urgent Care', '', '', NULL, 'B', 'PO Box 844692', 'Los Angeles', 'Los Angeles', 'CA', '90084', '5058007070', '5058007075', 'PO Box 844692', 'Los Angeles', 'Los Angeles', 'CA', '90084', '5058007070', '5058007075', '', '', 'NMOP', '0.00', '100.00', '0.00', 3, '2013-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1619300118', 0, 'N', 0, '2013-12-17', NULL, NULL, 0, 0, NULL, NULL),
('760673289', 'W12038516', 'W12038516', 'TXHOUSTD', 'Hanh Truong', 'Hanh', '', 'Truong', 'MD', 'Internal Medicine', '', '', NULL, 'O', '16651 SW Fwy Ste 340', 'Sugar Land', 'Fort Bend', 'TX', '77479', '2812655505', '2812776513', '16651 SW Fwy Ste 340', 'Sugar Land', 'Fort Bend', 'TX', '77479', '2812655505', '2812776513', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-11-01', NULL, 0, 0, 0, 'Houston Methodist Sugar Land Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1962666230', 0, 'N', 0, '2013-10-01', NULL, NULL, 29.5915, -95.6304, NULL, NULL),
('462795152', 'W12038517', 'W12038517', 'TXHOUSTD', 'Conroe Foot Specialists', 'Timothy', 'C', 'Casperson', 'DPM', 'Podiatry', '', '', NULL, 'O', '100 Medical Ctr Blvd  Ste 216', 'Conroe', 'Montgomery', 'TX', '77304', '9367569191', '9367569197', '100 Medical Ctr Blvd  Ste 216', 'Conroe', 'Montgomery', 'TX', '77304', '9367569191', '9367569197', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-11-01', NULL, 0, 0, 0, 'Conroe Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1881857951', 0, 'N', 0, '2013-10-01', NULL, NULL, 30.2879, -95.4628, NULL, NULL),
('462795152', 'W12038518', 'W12038518', 'TXHOUSTD', 'Huntsville Podiatry', 'Timothy', 'C', 'Casperson', 'DPM', 'Podiatry', '', '', NULL, 'O', '133 Medical Park Ln Ste A', 'Conroe', 'Montgomery', 'TX', '77304', '9362917878', '9362955716', '133 Medical Park Ln Ste A', 'Conroe', 'Montgomery', 'TX', '77304', '9362917878', '9362955716', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-11-01', NULL, 0, 0, 0, 'Conroe Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1881857951', 0, 'N', 0, '2013-10-01', NULL, NULL, 30.2276, -95.2951, NULL, NULL),
('830306180', 'W12038519', 'W12038519', 'WY01', 'College Hill Health Center', 'Stacy', 'R', 'Thompson', 'NP', 'Family Practice', '', '', NULL, 'O', '3000 College Dr', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073621861', '3073621277', '3000 College Dr', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073621861', '3073621277', '', '', '', '0.00', '10.00', '0.00', 3, '2013-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1659719706', 0, 'N', 0, '2013-10-18', NULL, NULL, 41.5974, -109.242, NULL, NULL),
('830306180', 'W12038520', 'W12038520', 'WYT2', 'College Hill Health Center', 'Stacy', 'R', 'Thompson', 'NP', 'Family Practice', '', '', NULL, 'O', '3000 College Dr', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073621861', '3073621277', '3000 College Dr', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073621861', '3073621277', '', '', '', '0.00', '10.00', '0.00', 3, '2013-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1659719706', 0, 'N', 0, '2013-10-18', NULL, NULL, 0, 0, NULL, NULL),
('514606091', 'W12038522', 'W12038522', 'TXHOUSTD', 'Conroe Foot Specialists', 'Gene', '', 'Barclay', 'DPM', 'Podiatry', '', '', NULL, 'O', '100 Medical Ctr Blvd Ste 216', 'Conroe', 'Montgomery', 'TX', '77304', '9367569191', '9367569197', '100 Medical Ctr Blvd Ste 216', 'Conroe', 'Montgomery', 'TX', '77304', '9367569191', '9367569197', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-11-01', NULL, 0, 0, 0, 'Conroe Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1538195151', 0, 'N', 0, '2013-10-01', NULL, NULL, 30.2879, -95.4628, NULL, NULL),
('514606091', 'W12038521', 'W12038521', 'TXHOUSTD', 'Woodlands Foot Specialists', 'Gene', '', 'Barclay', 'DPM', 'Podiatry', '', '', NULL, 'O', '17198 St Lukes Way Ste 550', 'Conroe', 'Montgomery', 'TX', '77384', '9363211221', '9362710707', '17198 St Lukes Way Ste 550', 'Conroe', 'Montgomery', 'TX', '77384', '9363211221', '9362710707', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-11-01', NULL, 0, 0, 0, 'Conroe Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1538195151', 0, 'N', 0, '2013-10-01', NULL, NULL, 30.2057, -95.4608, NULL, NULL),
('760299371', 'W12038523', 'W12038523', 'TXHOUSTD', 'Conroe Foot Specialists', 'Dimitrios', 'S', 'Mantzoros', 'DPM', 'Podiatry', '', '', NULL, 'O', '100 Medical Ctr Blvd Ste 216', 'Conroe', 'Montgomery', 'TX', '77304', '9367569191', '9367569192', '100 Medical Ctr Blvd Ste 216', 'Conroe', 'Montgomery', 'TX', '77304', '9367569191', '9367569192', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-11-01', NULL, 0, 0, 0, 'Conroe Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1285660803', 0, 'N', 0, '2013-10-01', NULL, NULL, 30.2879, -95.4628, NULL, NULL),
('760299371', 'W12038524', 'W12038524', 'TXHOUSTD', 'Huntsville Podiatry', 'Dimitrios', 'S', 'Mantzoros', 'DPM', 'Podiatry', '', '', NULL, 'O', '133 Medical Park Ln Ste A', 'Huntsville', 'Walker', 'TX', '77340', '9362917878', '9362955716', '133 Medical Park Ln Ste A', 'Huntsville', 'Walker', 'TX', '77340', '9362917878', '9362955716', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-11-01', NULL, 0, 0, 0, 'Conroe Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1285660803', 0, 'N', 0, '2013-10-01', NULL, NULL, 30.7099, -95.5613, NULL, NULL),
('741654878', 'W12038525', 'W12038525', 'TXSATSTD', 'Neurosurgical Associates of San Antonio', 'Ram', 'R', 'Vasudevan', 'MD', 'Neurosurgery', '', '', NULL, 'O', '4410 Medical Dr Ste 610', 'San Antonio', 'Bexar', 'TX', '78229', '2106142453', '2106144457', '4410 Medical Dr Ste 610', 'San Antonio', 'Bexar', 'TX', '78229', '2106142453', '2106144457', 'TXNEURO', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-11-04', NULL, 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1053623546', 0, 'Y', 0, '2013-10-04', NULL, NULL, 29.5102, -98.5717, NULL, NULL),
('271918031', 'W12038526', 'W12038526', 'TXHOUSTD', 'Kristen V Garrett', 'Kristen', 'V', 'Garrett', 'PA', 'Dermatology', '', '', NULL, 'O', '440 Rayford Rd Ste 140', 'Spring', 'Montgomery', 'TX', '77386', '2813858189', '2812035037', '440 Rayford Rd Ste 140', 'Spring', 'Montgomery', 'TX', '77386', '2813858189', '2812035037', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1013352434', 0, 'Y', 0, '2013-10-01', NULL, NULL, 30.1271, -95.437, NULL, NULL),
('461385664', 'W12038527', 'W12038527', 'WY01', 'Uinta Home Sleep Testing', '', '', 'Uinta Home Sleep Testing', '', 'Sleep Studies', '', '', NULL, 'O', '724 Front St Ste 523', 'Evanston', 'Uinta', 'WY', '82930', '3077892205', '3077892593', '724 Front St Ste 523', 'Evanston', 'Uinta', 'WY', '82930', '3077892205', '3077892593', '', '', 'WYOP', '0.00', '0.00', '0.00', 3, '2013-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1568706117', 0, 'N', 0, '2013-10-21', NULL, NULL, 0, 0, NULL, NULL),
('461385664', 'W12038528', 'W12038528', 'WYT1', 'Uinta Home Sleep Testing', '', '', 'Uinta Home Sleep Testing', '', 'Sleep Studies', '', '', NULL, 'O', '724 Front St Ste 523', 'Evanston', 'Uinta', 'WY', '82930', '3077892205', '3077892593', '724 Front St Ste 523', 'Evanston', 'Uinta', 'WY', '82930', '3077892205', '3077892593', '', '', 'WYOP', '0.00', '0.00', '0.00', 3, '2013-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1568706117', 0, 'N', 0, '2013-10-21', NULL, NULL, 0, 0, NULL, NULL),
('841401924', 'W12038531', 'W12038531', 'UT01', 'Alpine Medical Group', '', '', 'Alpine Medical Group', 'GROUP', 'Clinic', '', '', NULL, 'O', '1060 E 100 S INT Ste L-10', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013282640', '8013504361', '1060 E 100 S INT Ste L-10', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013282640', '8013504361', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-09-26', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000004987', 0, 'Y', 0, '2014-07-22', NULL, NULL, 0, 0, NULL, NULL),
('841401924', 'W12038530', 'W12038530', 'UT01', 'Alpine Medical Group', '', '', 'Alpine Medical Group', 'GROUP', 'Clinic', '', '', NULL, 'O', '1060 E 100 S MULT Ste L-10', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013282640', '8013504361', '1060 E 100 S MULT Ste L-10', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013282640', '8013504361', 'WUSTDMULT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-09-26', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000004987', 0, 'Y', 0, '2014-07-22', NULL, NULL, 0, 0, NULL, NULL),
('841401924', 'W12038532', 'W12038532', 'UT01', 'Alpine Medical Group', '', '', 'Alpine Medical Group', 'GROUP', 'Clinic', '', '', NULL, 'O', '1060 E 100 S ANES Ste L-10', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013282640', '8013504361', '1060 E 100 S ANES Ste L-10', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013282640', '8013504361', '', '', '1000', '47.25', '0.00', '0.00', 6, '2013-09-26', NULL, 0, 12, 0, '', '', '', '', 'HCFA|UB|', '0000004987', 0, 'Y', 0, '2014-07-22', NULL, NULL, 0, 0, NULL, NULL),
('870281299', 'W12038533', 'W12038533', 'UT01', 'The Clinic', '', '', 'American Fork Clinic', 'GROUP', 'Primary Care with Extended Hours', '', '', NULL, 'O', '76 E Commerce Dr Ste 204', 'Saratoga Springs', 'Utah', 'UT', '84045', '8017668427', '8017665657', '76 E Commerce Dr Ste 204', 'Saratoga Springs', 'Utah', 'UT', '84045', '8017668427', '8017665657', 'WUTANNER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-09-26', '2013-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1942311006', 0, 'N', 0, '2013-10-25', NULL, NULL, 0, 0, NULL, NULL),
('450480099', 'W12038543', 'W12038543', 'TXDALSTD', 'American Radiology Consultants', '', '', 'American Radiology Consultants PLLC', '', 'Radiology', '', '', NULL, 'B', 'PO Box 678253', 'Dallas', 'Dallas', 'TX', '75267', '2148268822', '2148269792', 'PO Box 678253', 'Dallas', 'Dallas', 'TX', '75267', '2148268822', '2148269792', 'AMRAD', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-09-26', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1669425195', 0, 'Y', 0, '2013-10-23', NULL, NULL, 0, 0, NULL, NULL),
('760605200', 'W12038546', 'W12038546', 'TXHOUSTD', 'Oncology Consultants PA', '', '', 'Oncology Consultants PA', '', 'Hematology and Oncology', '', '', NULL, 'O', '10405 Katy Fwy Ste 150E', 'Houston', 'Harris', 'TX', '77024', '7137229660', '7137229664', '10405 Katy Fwy Ste 150E', 'Houston', 'Harris', 'TX', '77024', '7137229660', '7137229664', 'HOUSTON5', 'TXONCHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1023180858', 0, 'Y', 0, '2013-10-02', NULL, NULL, 29.7838, -95.5544, NULL, NULL),
('760605200', 'W12038549', 'W12038549', 'TXHOUSTD', 'Oncology Consultants PA', '', '', 'Oncology Consultants PA', '', 'Hematology and Oncology', '', '', NULL, 'O', '1631 N Loop W Ste 155', 'Houston', 'Harris', 'TX', '77008', '7138029000', '7138022701', '1631 N Loop W Ste 155', 'Houston', 'Harris', 'TX', '77008', '7138029000', '7138022701', 'HOUSTON5', 'TXONCHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1023180858', 0, 'Y', 0, '2013-10-02', NULL, NULL, 29.8123, -95.4307, NULL, NULL),
('760605200', 'W12038550', 'W12038550', 'TXHOUSTD', 'Oncology Consultants PA', '', '', 'Oncology Consultants PA', '', 'Hematology and Oncology', '', '', NULL, 'O', '2130 W Holcombe Blvd 10th Fl', 'Houston', 'Harris', 'TX', '77030', '7136000900', '7136000070', '2130 W Holcombe Blvd 10th Fl', 'Houston', 'Harris', 'TX', '77030', '7136000900', '7136000070', 'HOUSTON5', 'TXONCHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1023180858', 0, 'Y', 0, '2013-10-02', NULL, NULL, 29.7063, -95.4069, NULL, NULL);
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('760605200', 'W12038545', 'W12038545', 'TXHOUSTD', 'Oncology Consultants PA', '', '', 'Oncology Consultants PA', '', 'Hematology and Oncology', '', '', NULL, 'M', '902 Frostwood Ste 315', 'Houston', 'Harris', 'TX', '77024', '0000000000', '0000000000', '902 Frostwood Ste 315', 'Houston', 'Harris', 'TX', '77024', '0000000000', '0000000000', 'HOUSTON5', 'TXONCHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1023180858', 0, 'N', 0, '2013-10-02', NULL, NULL, 29.78, -95.5467, NULL, NULL),
('760605200', 'W12038548', 'W12038548', 'TXHOUSTD', 'Oncology Consultants PA', '', '', 'Oncology Consultants PA', '', 'Hematology and Oncology', '', '', NULL, 'O', '925 Gessner Ste 600', 'Houston', 'Harris', 'TX', '77024', '7138279525', '7134683561', '925 Gessner Ste 600', 'Houston', 'Harris', 'TX', '77024', '7138279525', '7134683561', 'HOUSTON5', 'TXONCHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1023180858', 0, 'Y', 0, '2013-10-02', NULL, NULL, 29.7812, -95.5444, NULL, NULL),
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('760605200', 'W12038555', 'W12038555', 'TXHOUSTD', 'Oncology Consultants PA', 'Paul', 'Y', 'Holoye', 'MD', 'Oncology', '', '', NULL, 'O', '2130 W Holcombe Blvd 10th Fl', 'Houston', 'Harris', 'TX', '77030', '7136000900', '7136000070', '2130 W Holcombe Blvd 10th Fl', 'Houston', 'Harris', 'TX', '77030', '7136000900', '7136000070', 'HOUSTON5', 'TXONCHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-11-01', NULL, 0, 0, 0, 'Houston Methodist Hospital', NULL, '', '', 'HCFA|UB|', '1497716401', 0, 'N', 0, '2013-10-02', NULL, NULL, 29.7063, -95.4069, NULL, NULL),
('760605200', 'W12038556', 'W12038556', 'TXHOUSTD', 'Oncology Consultants PA', 'Paul', 'Y', 'Holoye', 'MD', 'Oncology', '', '', NULL, 'M', '902 Frostwood Ste 315', 'Houston', 'Harris', 'TX', '77024', '0000000000', '0000000000', '902 Frostwood Ste 315', 'Houston', 'Harris', 'TX', '77024', '0000000000', '0000000000', 'HOUSTON5', 'TXONCHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-11-01', NULL, 0, 0, 0, 'Houston Methodist Hospital', NULL, '', '', 'HCFA|UB|', '1497716401', 0, 'N', 0, '2013-10-02', NULL, NULL, 29.78, -95.5467, NULL, NULL),
('760605200', 'W12038558', 'W12038558', 'TXHOUSTD', 'Oncology Consultants PA', 'Charles', 'E', 'Manner', 'MD', 'Hematology', '', '', NULL, 'O', '2130 W Holcombe Blvd 10th Fl', 'Houston', 'Harris', 'TX', '77030', '7136000900', '7136000070', '2130 W Holcombe Blvd 10th Fl', 'Houston', 'Harris', 'TX', '77030', '7136000900', '7136000070', 'HOUSTON5', 'TXONCHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-11-01', NULL, 0, 0, 0, 'Houston Methodist Hospital', NULL, '', '', 'HCFA|UB|', '1760443782', 0, 'N', 0, '2013-10-02', NULL, NULL, 29.7063, -95.4069, NULL, NULL),
('760605200', 'W12038559', 'W12038559', 'TXHOUSTD', 'Oncology Consultants PA', 'Charles', 'E', 'Manner', 'MD', 'Hematology', '', '', NULL, 'M', '902 Frostwood Ste 315', 'Houston', 'Harris', 'TX', '77024', '0000000000', '0000000000', '902 Frostwood Ste 315', 'Houston', 'Harris', 'TX', '77024', '0000000000', '0000000000', 'HOUSTON5', 'TXONCHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-11-01', NULL, 0, 0, 0, 'Houston Methodist Hospital', NULL, '', '', 'HCFA|UB|', '1760443782', 0, 'N', 0, '2013-10-02', NULL, NULL, 29.78, -95.5467, NULL, NULL),
('760605200', 'W12038562', 'W12038562', 'TXHOUSTD', 'Oncology Consultants PA', 'Miguel', '', 'Miro-Quesada', 'MD', 'Hematology and Oncology', '', '', NULL, 'M', '902 Frostwood Ste 315', 'Houston', 'Harris', 'TX', '77024', '0000000000', '0000000000', '902 Frostwood Ste 315', 'Houston', 'Harris', 'TX', '77024', '0000000000', '0000000000', 'HOUSTON5', 'TXONCHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-11-01', NULL, 0, 0, 0, 'Houston Methodist West Houston Hospital', NULL, '', '', 'HCFA|UB|', '1164483178', 0, 'N', 0, '2013-10-02', NULL, NULL, 29.78, -95.5467, NULL, NULL),
('760605200', 'W12038561', 'W12038561', 'TXHOUSTD', 'Oncology Consultants PA', 'Miguel', '', 'Miro-Quesada', 'MD', 'Hematology and Oncology', '', '', NULL, 'O', '925 Gessner Ste 600', 'Houston', 'Harris', 'TX', '77024', '7138279525', '7134683561', '925 Gessner Ste 600', 'Houston', 'Harris', 'TX', '77024', '7138279525', '7134683561', 'HOUSTON5', 'TXONCHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-11-01', NULL, 0, 0, 0, 'Houston Methodist West Houston Hospital', NULL, '', '', 'HCFA|UB|', '1164483178', 0, 'N', 0, '2013-10-02', NULL, NULL, 29.7812, -95.5444, NULL, NULL),
('760605200', 'W12038564', 'W12038564', 'TXHOUSTD', 'Oncology Consultants PA', 'Alex', 'P', 'Nguyen', 'MD', 'Oncology', '', '', NULL, 'O', '925 Gessner Ste 600', 'Houston', 'Harris', 'TX', '77024', '7138279525', '7134683561', '925 Gessner Ste 600', 'Houston', 'Harris', 'TX', '77024', '7138279525', '7134683561', 'HOUSTON5', 'TXONCHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-11-01', NULL, 0, 0, 0, 'West Houston Medical Center', NULL, '', '', 'HCFA|UB|', '1922069624', 0, 'N', 0, '2013-10-02', NULL, NULL, 29.7812, -95.5444, NULL, NULL),
('760605200', 'W12038565', 'W12038565', 'TXHOUSTD', 'Oncology Consultants PA', 'Alex', 'P', 'Nguyen', 'MD', 'Oncology', '', '', NULL, 'M', '902 Frostwood Ste 315', 'Houston', 'Harris', 'TX', '77024', '0000000000', '0000000000', '902 Frostwood Ste 315', 'Houston', 'Harris', 'TX', '77024', '0000000000', '0000000000', 'HOUSTON5', 'TXONCHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-11-01', NULL, 0, 0, 0, 'West Houston Medical Center', NULL, '', '', 'HCFA|UB|', '1922069624', 0, 'N', 0, '2013-10-02', NULL, NULL, 29.78, -95.5467, NULL, NULL),
('760605200', 'W12038567', 'W12038567', 'TXHOUSTD', 'Oncology Consultants PA', 'Devesh', '', 'Pandya', 'MD', 'Hematology and Oncology', '', '', NULL, 'O', '2130 W Holcombe Blvd 10th Fl', 'Houston', 'Harris', 'TX', '77030', '7136000900', '7136000070', '2130 W Holcombe Blvd 10th Fl', 'Houston', 'Harris', 'TX', '77030', '7136000900', '7136000070', 'HOUSTON5', 'TXONCHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-11-01', NULL, 0, 0, 0, 'Houston Methodist Sugar Land Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1770768210', 0, 'N', 0, '2013-10-09', NULL, NULL, 29.7063, -95.4069, NULL, NULL),
('760605200', 'W12038568', 'W12038568', 'TXHOUSTD', 'Oncology Consultants PA', 'Devesh', '', 'Pandya', 'MD', 'Hematology and Oncology', '', '', NULL, 'M', '902 Frostwood Ste 315', 'Houston', 'Harris', 'TX', '77024', '0000000000', '0000000000', '902 Frostwood Ste 315', 'Houston', 'Harris', 'TX', '77024', '0000000000', '0000000000', 'HOUSTON5', 'TXONCHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-11-01', NULL, 0, 0, 0, 'Houston Methodist Sugar Land Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1770768210', 0, 'N', 0, '2013-10-09', NULL, NULL, 29.78, -95.5467, NULL, NULL),
('760605200', 'W12038571', 'W12038571', 'TXHOUSTD', 'Oncology Consultants PA', 'Julio', '', 'Peguero', 'MD', 'Hematology and Oncology', '', '', NULL, 'M', '902 Frostwood Ste 315', 'Houston', 'Harris', 'TX', '77024', '0000000000', '0000000000', '902 Frostwood Ste 315', 'Houston', 'Harris', 'TX', '77024', '0000000000', '0000000000', 'HOUSTON5', 'TXONCHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-11-01', NULL, 0, 0, 0, 'Houston Methodist Willowbrook Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1659569507', 0, 'N', 0, '2013-10-02', NULL, NULL, 29.78, -95.5467, NULL, NULL),
('760605200', 'W12038570', 'W12038570', 'TXHOUSTD', 'Oncology Consultants PA', 'Julio', '', 'Peguero', 'MD', 'Hematology and Oncology', '', '', NULL, 'O', '925 Gessner Ste 600', 'Houston', 'Harris', 'TX', '77024', '7138279525', '7134683561', '925 Gessner Ste 600', 'Houston', 'Harris', 'TX', '77024', '7138279525', '7134683561', 'HOUSTON5', 'TXONCHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-11-01', NULL, 0, 0, 0, 'Houston Methodist Willowbrook Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1659569507', 0, 'N', 0, '2013-10-02', NULL, NULL, 29.7812, -95.5444, NULL, NULL),
('760605200', 'W12038573', 'W12038573', 'TXHOUSTD', 'Oncology Consultants PA', 'Harry', 'R', 'Price', 'MD', 'Oncology', '', '', NULL, 'O', '2130 W Holcombe Blvd 10th Fl', 'Houston', 'Harris', 'TX', '77030', '7136000900', '7136000070', '2130 W Holcombe Blvd 10th Fl', 'Houston', 'Harris', 'TX', '77030', '7136000900', '7136000070', 'HOUSTON5', 'TXONCHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-11-01', NULL, 0, 0, 0, 'Houston Methodist Hospital', NULL, '', '', 'HCFA|UB|', '1174584874', 0, 'N', 0, '2013-10-02', NULL, NULL, 29.7063, -95.4069, NULL, NULL),
('760605200', 'W12038574', 'W12038574', 'TXHOUSTD', 'Oncology Consultants PA', 'Harry', 'R', 'Price', 'MD', 'Oncology', '', '', NULL, 'M', '902 Frostwood Ste 315', 'Houston', 'Harris', 'TX', '77024', '0000000000', '0000000000', '902 Frostwood Ste 315', 'Houston', 'Harris', 'TX', '77024', '0000000000', '0000000000', 'HOUSTON5', 'TXONCHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-11-01', NULL, 0, 0, 0, 'Houston Methodist Hospital', NULL, '', '', 'HCFA|UB|', '1174584874', 0, 'N', 0, '2013-10-02', NULL, NULL, 29.78, -95.5467, NULL, NULL),
('760605200', 'W12038576', 'W12038576', 'TXHOUSTD', 'Oncology Consultants PA', 'Yuval', '', 'Raizen', 'MD', 'Hematology and Oncology', '', '', NULL, 'O', '2130 W Holcombe Blvd 10th Fl', 'Houston', 'Harris', 'TX', '77030', '7136000900', '7136000070', '2130 W Holcombe Blvd 10th Fl', 'Houston', 'Harris', 'TX', '77030', '7136000900', '7136000070', 'HOUSTON5', 'TXONCHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-11-01', NULL, 0, 0, 0, 'Houston Methodist Sugar Land Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1639339153', 0, 'N', 0, '2013-10-02', NULL, NULL, 29.7063, -95.4069, NULL, NULL),
('760605200', 'W12038577', 'W12038577', 'TXHOUSTD', 'Oncology Consultants PA', 'Yuval', '', 'Raizen', 'MD', 'Hematology and Oncology', '', '', NULL, 'M', '902 Frostwood Ste 315', 'Houston', 'Harris', 'TX', '77024', '0000000000', '0000000000', '902 Frostwood Ste 315', 'Houston', 'Harris', 'TX', '77024', '0000000000', '0000000000', 'HOUSTON5', 'TXONCHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-11-01', NULL, 0, 0, 0, 'Houston Methodist Sugar Land Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1639339153', 0, 'N', 0, '2013-10-02', NULL, NULL, 29.78, -95.5467, NULL, NULL),
('760605200', 'W12038580', 'W12038580', 'TXHOUSTD', 'Oncology Consultants PA', 'Ronjay', '', 'Rakkhit', 'MD', 'Hematology and Oncology', '', '', NULL, 'O', '18400 Katy Fwy Ste 670', 'Houston', 'Harris', 'TX', '77094', '2815780201', '2815780217', '18400 Katy Fwy Ste 670', 'Houston', 'Harris', 'TX', '77094', '2815780201', '2815780217', 'HOUSTON5', 'TXONCHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-11-01', NULL, 0, 0, 0, 'Houston Methodist Willowbrook Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1982644498', 0, 'N', 0, '2013-10-02', NULL, NULL, 29.7855, -95.6953, NULL, NULL),
('760605200', 'W12038579', 'W12038579', 'TXHOUSTD', 'Oncology Consultants PA', 'Ronjay', '', 'Rakkhit', 'MD', 'Hematology and Oncology', '', '', NULL, 'M', '902 Frostwood Ste 315', 'Houston', 'Harris', 'TX', '77024', '0000000000', '0000000000', '902 Frostwood Ste 315', 'Houston', 'Harris', 'TX', '77024', '0000000000', '0000000000', 'HOUSTON5', 'TXONCHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-11-01', NULL, 0, 0, 0, 'Houston Methodist Willowbrook Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1982644498', 0, 'N', 0, '2013-10-02', NULL, NULL, 29.78, -95.5467, NULL, NULL),
('760605200', 'W12038581', 'W12038581', 'TXHOUSTD', 'Oncology Consultants PA', '', '', 'Oncology Consultants PA', '', 'Hematology and Oncology', '', '', NULL, 'O', '18400 Katy Fwy Ste 670', 'Houston', 'Harris', 'TX', '77094', '2815780201', '2815780217', '18400 Katy Fwy Ste 670', 'Houston', 'Harris', 'TX', '77094', '2815780201', '2815780217', 'HOUSTON5', 'TXONCHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1023180858', 0, 'Y', 0, '2013-10-02', NULL, NULL, 29.7855, -95.6953, NULL, NULL),
('760605200', 'W12038583', 'W12038583', 'TXHOUSTD', 'Oncology Consultants PA', 'David', 'B', 'Sanford', 'MD', 'Hematology and Oncology', '', '', NULL, 'O', '2130 W Holcombe Blvd 10th Fl', 'Houston', 'Harris', 'TX', '77030', '7136000900', '7136000070', '2130 W Holcombe Blvd 10th Fl', 'Houston', 'Harris', 'TX', '77030', '7136000900', '7136000070', 'HOUSTON5', 'TXONCHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-11-01', NULL, 0, 0, 0, 'Houston Methodist Hospital', NULL, '', '', 'HCFA|UB|', '1629039342', 0, 'N', 0, '2013-10-02', NULL, NULL, 29.7063, -95.4069, NULL, NULL),
('760605200', 'W12038584', 'W12038584', 'TXHOUSTD', 'Oncology Consultants PA', 'David', 'B', 'Sanford', 'MD', 'Hematology and Oncology', '', '', NULL, 'M', '902 Frostwood Ste 315', 'Houston', 'Harris', 'TX', '77024', '0000000000', '0000000000', '902 Frostwood Ste 315', 'Houston', 'Harris', 'TX', '77024', '0000000000', '0000000000', 'HOUSTON5', 'TXONCHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-11-01', NULL, 0, 0, 0, 'Houston Methodist Hospital', NULL, '', '', 'HCFA|UB|', '1629039342', 0, 'N', 0, '2013-10-02', NULL, NULL, 29.78, -95.5467, NULL, NULL),
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('760605200', 'W12038595', 'W12038595', 'TXHOUSTD', 'Oncology Consultants PA', 'Tse-Kuan', '', 'Yu', 'MD', 'Radiation Oncology', '', '', NULL, 'M', '902 Frostwood Ste 315', 'Houston', 'Harris', 'TX', '77024', '0000000000', '0000000000', '902 Frostwood Ste 315', 'Houston', 'Harris', 'TX', '77024', '0000000000', '0000000000', 'HOUSTON5', 'TXONCHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-11-01', NULL, 0, 0, 0, 'Houston Methodist West Houston Hospital', NULL, '', '', 'HCFA|UB|', '1396841268', 0, 'N', 0, '2013-10-02', NULL, NULL, 29.78, -95.5467, NULL, NULL),
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('820315557', 'W12038604', 'W12038604', 'ID01', 'Boise Psychological Services', 'Barbara', 'A', 'Stevens', 'LCPC', 'Mental Health', 'Counseling', '', NULL, 'O', '315 N Allumbaugh', 'Boise', 'Ada', 'ID', '83704', '2083763546', '2083769792', '315 N Allumbaugh', 'Boise', 'Ada', 'ID', '83704', '2083763546', '2083769792', 'IDMA', '', '', '0.00', '40.00', '0.00', 6, '2013-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1699924738', 0, 'N', 0, '2013-10-18', NULL, NULL, 43.6081, -116.266, NULL, NULL),
('470958788', 'W12038610', 'W12038610', 'TXDALSTD', 'Gupta DO and Associates', 'Sat', 'Parkash', 'Gupta', 'DO', 'Urgent Care', 'Family Practice', '', NULL, 'O', '7447 N MacArthur Blvd Ste 190', 'Irving', 'Dallas', 'TX', '75063', '9728615200', '9728615205', '7447 N MacArthur Blvd Ste 190', 'Irving', 'Dallas', 'TX', '75063', '9728615200', '9728615205', 'TIOPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-10-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1013999549', 0, 'N', 0, '2013-09-30', NULL, NULL, 32.9081, -96.9588, NULL, NULL),
('751585785', 'W12038607', 'W12038607', 'TXDALSTD', '', 'Farooq', 'I', 'Selod', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '800 8th Ave Ste 506', 'Fort Worth', 'Tarrant', 'TX', '76104', '8173367188', '8173359039', '800 8th Ave Ste 506', 'Fort Worth', 'Tarrant', 'TX', '76104', '8173367188', '8173359039', 'TIOPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-10-15', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', NULL, NULL, NULL, 'HCFA|UB', '1174571368', 0, 'N', 0, '2013-09-30', NULL, NULL, 32.7365, -97.3437, NULL, NULL),
('470958788', 'W12038609', 'W12038609', 'TXDALSTD', 'Gupta DO and Associates', 'Sat', 'Parkash', 'Gupta', 'DO', 'Urgent Care', 'Family Practice', '', NULL, 'O', '116 E I-20 Ste 155', 'Weatherford', 'Parker', 'TX', '76087', '8175964313', '8173412394', '116 E I-20 Ste 155', 'Weatherford', 'Parker', 'TX', '76087', '8175964313', '8173412394', 'TIOPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-10-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1013999549', 0, 'N', 0, '2013-09-30', NULL, NULL, 32.699, -97.7707, NULL, NULL),
('204555669', 'W12038612', 'W12038612', 'TXDALSTD', 'Medical Clinic of Farmers Branch', 'Dan', 'D', 'Nguyen', 'DO', 'Family Practice', '', '', NULL, 'O', '12879 Josey Ln Ste 100', 'Dallas', 'Dallas', 'TX', '75234', '9722473600', '9722473602', '12879 Josey Ln Ste 100', 'Dallas', 'Dallas', 'TX', '75234', '9722473600', '9722473602', 'TIOPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-10-15', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', NULL, '', '', 'HCFA|UB|', '1407934987', 0, 'N', 0, '2013-09-30', NULL, NULL, 32.9218, -96.8818, NULL, NULL),
('870388269', 'W12038614', 'W12038614', 'UT01', 'Hand & Orthopedic Rehabilitation Specialists', 'Justin', 'L', 'Carrier', 'DPT', 'Physical Therapy', '', '', NULL, 'O', '5151 S 900 E Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8012613321', '8012615942', '5151 S 900 E Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8012613321', '8012615942', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1881989804', 0, 'N', 0, '2013-09-30', NULL, NULL, 40.6575, -111.866, NULL, NULL),
('363383867', 'W12038616', 'W12038616', 'ILCHIGSTD', 'Little Company of Mary Affiliated Services', 'Fred', '', 'Richardson', 'MD', 'Family Practice', '', '', NULL, 'O', '736 W 95th St', 'Chicago', 'Cook', 'IL', '60628', '7734870363', '7734870900', '736 W 95th St', 'Chicago', 'Cook', 'IL', '60628', '7734870363', '7734870900', 'CHIG8', 'CHIHCPCS01', '', '0.00', '40.00', '0.00', 3, '2013-10-01', NULL, 0, 0, 0, 'Little Company of Mary Hospital', NULL, '', '', 'HCFA|UB|', '1194702092', 0, 'N', 0, '2013-09-30', NULL, NULL, 41.7215, -87.6421, NULL, NULL),
('870460580', 'W12038617', 'W12038617', 'UT01', 'Baldwin Optical', 'Alan', 'T', 'Rees', 'OD', 'Optometry', '', '', NULL, 'O', '1451 N 200 E Ste 195', 'Logan', 'Cache', 'UT', '84341', '8017762020', '8017764321', '1451 N 200 E Ste 195', 'Logan', 'Cache', 'UT', '84341', '8017762020', '8017764321', 'WUTALBERT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1194854265', 0, 'N', 0, '2014-01-17', NULL, NULL, 41.7582, -111.829, NULL, NULL),
('460703284', 'W12038619', 'W12038619', 'ID02', 'JC Hospitalists', 'Ann', 'C', 'Agnew', 'MD', 'Hospitalist', '', '', NULL, 'O', '2131 S Bonito Way', 'Meridian', 'Ada', 'ID', '83642', '2084899500', '2084899599', '2131 S Bonito Way', 'Meridian', 'Ada', 'ID', '83642', '2084899500', '2084899599', 'IDSAMG1', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2013-10-01', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1497797302', 0, 'N', 0, '2013-09-30', NULL, NULL, 0, 0, NULL, NULL),
('460703284', 'W12038618', 'W12038618', 'ID02', 'JC Hospitalists', 'Ann', 'C', 'Agnew', 'MD', 'Hospitalist', '', '', NULL, 'O', '6651 W Franklin Rd', 'Boise', 'Ada', 'ID', '83709', '2086852400', '2086852369', '6651 W Franklin Rd', 'Boise', 'Ada', 'ID', '83709', '2086852400', '2086852369', 'IDSAMG1', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2013-10-01', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1497797302', 0, 'N', 0, '2013-09-30', NULL, NULL, 0, 0, NULL, NULL),
('460703284', 'W12038620', 'W12038620', 'ID02', 'JC Hospitalists', 'Ann', 'C', 'Agnew', 'MD', 'Hospitalist', '', '', NULL, 'M', 'PO Box 4477', 'Boise', 'Ada', 'ID', '83711', '0000000000', '0000000000', 'PO Box 4477', 'Boise', 'Ada', 'ID', '83711', '0000000000', '0000000000', 'IDSAMG1', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2013-10-01', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1497797302', 0, 'N', 0, '2013-09-30', NULL, NULL, 0, 0, NULL, NULL),
('273300487', 'W12038621', 'W12038621', 'NM01', 'Wendy Buckels and Associates ', 'Wendy', 'D', 'Buckels', 'SLP', 'Speech Therapy', '', '', NULL, 'O', '3212 Monte Vista NE', 'Albuquerque', 'Bernalillo', 'NM', '87106', '5052551100', '5058190505', '3212 Monte Vista NE', 'Albuquerque', 'Bernalillo', 'NM', '87106', '5052551100', '5058190505', '', '', '', '0.00', '0.00', '75.00', 3, '2013-09-24', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1588729107', 0, 'N', 0, '2013-09-30', NULL, NULL, 35.0822, -106.61, NULL, NULL),
('273300487', 'W12038622', 'W12038622', 'NM01', 'Wendy Buckels and Associates ', 'Wendy', 'D', 'Buckels', 'SLP', 'Speech Therapy', '', '', NULL, 'O', '2410 Venetian Way SW', 'Albuquerque', 'Bernalillo', 'NM', '87105', '5052551100', '5058190505', '2410 Venetian Way SW', 'Albuquerque', 'Bernalillo', 'NM', '87105', '5052551100', '5058190505', '', '', '', '0.00', '0.00', '75.00', 3, '2013-09-24', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1588729107', 0, 'N', 0, '2013-09-30', NULL, NULL, 34.9595, -106.705, NULL, NULL),
('202148889', 'W12038631', 'W12038631', 'TXSATSTD', 'Health Texas Medical Group of San Antonio', 'Shannon', 'R', 'Prevette', 'MD', 'Family Practice', '', '', NULL, 'O', '6428 Bandera Rd', 'San Antonio', 'Bexar', 'TX', '78238', '2105204455', '2105204421', '6428 Bandera Rd', 'San Antonio', 'Bexar', 'TX', '78238', '2105204455', '2105204421', 'TXINT', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-11-01', NULL, 0, 0, 0, 'St Lukes Baptist Hospital', '', '', '', 'HCFA|UB|', '1780681510', 0, 'N', 0, '2014-06-24', NULL, NULL, 29.49, -98.6115, NULL, NULL),
('202148889', 'W12038632', 'W12038632', 'TXSATSTD', 'Health Texas Medical Group of San Antonio', 'Shannon', 'R', 'Prevette', 'MD', 'Family Practice', '', '', NULL, 'B', '6243 IH 10 W Ste 480', 'San Antonio', 'Bexar', 'TX', '78201', '2103714800', NULL, '6243 IH 10 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, 'St Lukes Baptist Hospital', '', '', '', 'HCFA|UB|', '1780681510', 0, 'N', 0, '2014-06-24', NULL, NULL, 29.487, -98.5422, NULL, NULL),
('202148889', 'W12038633', 'W12038633', 'TXSATSTD', 'Health Texas Medical Group of San Antonio', 'Shannon', 'R', 'Prevette', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 100026', 'San Antonio', 'Bexar', 'TX', '78201', '2103714800', NULL, 'PO Box 100026', 'San Antonio', 'Bexar', 'TX', '78201', '2103714800', '', 'TXINT', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2013-11-01', NULL, 0, 0, 0, 'St Lukes Baptist Hospital', '', '', '', 'HCFA|UB|', '1780681510', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('300176561', 'W12038635', 'W12038635', 'ILCHIGSTD', 'Midwest Orthopaedics at Rush', 'Brian', '', 'Forsythe', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '25 N Winfield Rd', 'Winfield', 'Dupage', 'IL', '60190', '6306825653', '6306828946', '25 N Winfield Rd', 'Winfield', 'Dupage', 'IL', '60190', '6306825653', '6306828946', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-09-10', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '1770557811', 0, 'N', 0, '2014-04-25', NULL, NULL, 41.8714, -88.1583, NULL, NULL),
('300176561', 'W12038634', 'W12038634', 'ILCHIGSTD', 'Midwest Orthopaedics at Rush', 'Brian', '', 'Forsythe', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', 'Insurance Payments Dept 4559', 'Carol Stream', 'Dupage', 'IL', '60122', '7082362607', '7084925607', 'Insurance Payments Dept 4559', 'Carol Stream', 'Dupage', 'IL', '60122', '7082362607', '7084925607', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-09-10', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '1770557811', 0, 'N', 0, '2014-04-25', NULL, NULL, 0, 0, NULL, NULL),
('300176561', 'W12038636', 'W12038636', 'ILCHIGSTD', 'Midwest Orthopaedics at Rush', 'Brian', '', 'Forsythe', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1611 W Harrison Ste 400', 'Chicago', 'Cook', 'IL', '60612', '3122434244', '3129421517', '1611 W Harrison Ste 400', 'Chicago', 'Cook', 'IL', '60612', '3122434244', '3129421517', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-09-10', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '1770557811', 0, 'N', 0, '2014-04-25', NULL, NULL, 41.8742, -87.6669, NULL, NULL),
('300176561', 'W12038637', 'W12038637', 'ILCHIGSTD', 'Midwest Orthopaedics at Rush', 'Brian', '', 'Forsythe', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '2450 S Wolf Rd Ste F', 'Westchester', 'Cook', 'IL', '60154', '7082362750', '7085626875', '2450 S Wolf Rd Ste F', 'Westchester', 'Cook', 'IL', '60154', '7082362750', '7085626875', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-09-10', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '1770557811', 0, 'N', 0, '2014-04-25', NULL, NULL, 41.8438, -87.9012, NULL, NULL),
('742592013', 'W12038638', 'W12038638', 'TXSATSTD', 'Dermatology Associates of San Antonio', 'Karla', 'N', 'Munoz', 'MD', 'Dermatology', '', '', NULL, 'B', '7832 Pat Booker Rd', 'San Antonio', 'Bexar', 'TX', '78233', '2106579338', NULL, '7832 Pat Booker Rd', 'San Antonio', 'Bexar', 'TX', '78233', '2106579338', '          ', '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, 29.5623, -98.3334, NULL, NULL),
('205934739', 'W12038639', 'W12038639', 'ID02', 'Family Medicine Health Center', 'James', 'W', 'Gardner', '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, '2013-10-01', NULL, 0, 0, 1, 'West Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1730275876', 0, 'N', 0, '2014-06-05', NULL, NULL, 0, 0, NULL, NULL),
('453836973', 'W12038641', 'W12038641', 'UT01', 'Creekside Oral and Facial Surgery', 'Jared', 'M', 'Brown', 'MD DDS', 'Oral Surgeon', '', '', NULL, 'M', '6878 W Ivie Farms Dr', 'Herriman', 'Salt Lake', 'UT', '84096', '0000000000', '0000000000', '6878 W Ivie Farms Dr', 'Herriman', 'Salt Lake', 'UT', '84096', '0000000000', '0000000000', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-12-15', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1326167354', 0, 'N', 0, '2014-06-23', NULL, NULL, 0, 0, NULL, NULL),
('461204337', 'W12038640', 'W12038640', 'UT01', 'Southwest Oral and Facial Surgery', 'Jared', 'M', 'Brown', 'MD DDS', 'Oral Surgeon', '', '', NULL, 'O', '11748 S 3600 W', 'South Jordan', 'Salt Lake', 'UT', '84095', '8014557593', '0000000000', '11748 S 3600 W', 'South Jordan', 'Salt Lake', 'UT', '84095', '8014557593', '0000000000', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-12-15', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1326167354', 0, 'N', 0, '2014-06-20', NULL, NULL, 40.5378, -111.977, NULL, NULL),
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('850224417', 'W12038667', 'W12038667', 'NM01', 'Renal Medicine Associates', 'Michele', 'L', 'Head', 'CNP', 'Nephrology', '', '', NULL, 'O', '3821 Masthead NE Ste 800', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5059987400', '5059987743', '3821 Masthead NE Ste 800', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5059987400', '5059987743', 'NMRENAL', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-08-27', '2014-04-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1386881076', 0, 'N', 0, '2014-06-09', NULL, NULL, 35.1664, -106.601, NULL, NULL);
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('850481404', 'AFT000003', 'AFT000003', 'NM01', 'After Hours Pediatrics', 'Lisa', '', 'Jimenez', 'MD', 'Pediatrics', '', '', NULL, 'O', '5904 Holly Ave', 'Albuquerque', 'Bernalillo', 'NM', '87113', '5052982505', NULL, '5904 Holly Ave', 'Albuquerque', 'Bernalillo', 'NM', '87113', '5052982505', '', 'AFTERHOURS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1619902806', 0, 'Y', 0, '2013-09-30', NULL, NULL, 35.1757, -106.579, NULL, NULL),
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('262933572', 'W12038694', 'W12038694', 'TXDALSTD', 'Sumit Kumar MD', 'Shaun', 'P', 'Kaiser', 'MD', 'Nephrology', '', '', NULL, 'O', '9900 N Central Expy Ste 215', 'Dallas', 'Dallas', 'TX', '75231', '2143964950', '8774235360', '9900 N Central Expy Ste 215', 'Dallas', 'Dallas', 'TX', '75231', '2143964950', '8774235360', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-10-15', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', NULL, NULL, NULL, 'HCFA|UB|', '1538327150', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.8827, -96.7697, NULL, NULL),
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('751908980', 'W12038708', 'W12038708', 'TXDALSTD', 'Nick Nicholson MD PA', 'Chad', 'J', 'Carlton', 'MD', 'General Surgery', '', '', NULL, 'O', '11970 N Central Expy Ste 460', 'Dallas', 'Dallas', 'TX', '75243', '9724943100', '9726080005', '11970 N Central Expy Ste 460', 'Dallas', 'Dallas', 'TX', '75243', '9724943100', '9726080005', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-10-15', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', NULL, '', '', 'HCFA|UB', '1245561109', 0, 'N', 0, '2014-04-25', NULL, NULL, 32.9122, -96.7682, NULL, NULL),
('751908980', 'W12038706', 'W12038706', 'TXDALSTD', 'Nick Nicholson MD PA', 'Chad', 'J', 'Carlton', 'MD', 'General Surgery', '', '', NULL, 'O', '5425 W Spring Creek Pkwy Ste 140', 'Plano', 'Collin', 'TX', '75024', '9724943100', '9726080005', '5425 W Spring Creek Pkwy Ste 140', 'Plano', 'Collin', 'TX', '75024', '9724943100', '9726080005', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-10-15', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', NULL, '', '', 'HCFA|UB', '1245561109', 0, 'N', 0, '2014-04-25', NULL, NULL, 33.0605, -96.8105, NULL, NULL),
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('850327237', 'W12038711', 'W12038711', 'NM01', 'LHS Pro Billing', 'Ruby', '', 'Bendersky', 'MD', 'Cardiology', '', '', NULL, 'B', '4411 The 25 Way Ste 100', 'Albuquerque', 'Bernalillo', 'NM', '87109', '0000000000', NULL, '4411 The 25 Way Ste 100', 'Albuquerque', 'Bernalillo', 'NM', '87109', '0000000000', '          ', '', '', '', '0.00', '55.00', '0.00', 3, '2013-10-01', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1598868119', 0, 'N', 0, '2013-10-03', NULL, NULL, 0, 0, NULL, NULL),
('850327237', 'W12038710', 'W12038710', 'NM01', 'Lovelace Womens Hospital Pavilion', 'Ruby', '', 'Bendersky', 'MD', 'Cardiology', '', '', NULL, 'O', '4705 Montgomery NE Ste 101', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5057276971', NULL, '4705 Montgomery NE Ste 101', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5057276971', '          ', '', '', '', '0.00', '55.00', '0.00', 3, '2013-10-01', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1598868119', 0, 'N', 0, '2013-10-03', NULL, NULL, 35.131, -106.591, NULL, NULL),
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('850327237', 'W12038714', 'W12038714', 'NM01', 'LHS Pro Billing', 'E', 'D', 'Bowers', 'MD', 'General Surgery', '', '', NULL, 'B', '4411 The 25 Way Ste 100', 'Albuquerque', 'Bernalillo', 'NM', '87109', '0000000000', NULL, '4411 The 25 Way Ste 100', 'Albuquerque', 'Bernalillo', 'NM', '87109', '0000000000', '          ', '', '', '', '0.00', '55.00', '0.00', 3, '2013-10-01', NULL, 0, 0, 0, 'Lovelace Womens Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1386679314', 0, 'N', 0, '2013-10-03', NULL, NULL, 0, 0, NULL, NULL),
('850327237', 'W12038717', 'W12038717', 'NM01', 'Lovelace Pulmonary Clinic', 'James', 'P', 'Bradley', 'MD', 'Pulmonary', 'Critical Care', 'Sleep Medicine', NULL, 'O', '500 Walter NE Ste 501', 'Albuquerque', 'Bernalillo', 'NM', '87102', '5057273170', NULL, '500 Walter NE Ste 501', 'Albuquerque', 'Bernalillo', 'NM', '87102', '5057273170', '          ', '', '', '', '0.00', '55.00', '0.00', 3, '2013-10-15', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1083607196', 0, 'Y', 0, '2013-12-09', NULL, NULL, 35.0863, -106.64, NULL, NULL),
('850327237', 'W12038716', 'W12038716', 'NM01', 'LHS Pro Billing', 'James', 'P', 'Bradley', 'MD', 'Pulmonary', 'Critical Care', 'Sleep Medicine', NULL, 'B', '4411 The 25 Way Ste 100', 'Albuquerque', 'Bernalillo', 'NM', '87109', '0000000000', NULL, '4411 The 25 Way Ste 100', 'Albuquerque', 'Bernalillo', 'NM', '87109', '0000000000', '          ', '', '', '', '0.00', '55.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1083607196', 0, 'Y', 0, '2013-12-09', NULL, NULL, 0, 0, NULL, NULL);
