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', 'ABQ000323', 'ABQ000323', 'NM01', 'ABQ Health Partners', 'Phillip', '', 'Steinbaugh', 'PA-C', 'Hand Surgery', 'Orthopedic Surgery', '', NULL, 'O', '101 Hospital Loop NE Ste 201', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5052627375', '5052627776', '101 Hospital Loop NE Ste 201', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5052627375', '5052627776', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2012-01-01', '2013-06-28', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1508947466', 0, 'N', 0, '2013-06-21', NULL, NULL, 0, 0, NULL, NULL),
('204043287', 'ABQ001123', 'ABQ001123', 'NM01', 'ABQ Health Partners', 'Phillip', '', 'Steinbaugh', 'PA-C', 'Hand Surgery', 'Orthopedic Surgery', '', NULL, 'M', '5400 Gibson Blvd SE ', 'Albuquerque', 'Bernalillo', 'NM', '87108', '5052627375', '5052627776', '5400 Gibson Blvd SE ', 'Albuquerque', 'Bernalillo', 'NM', '87108', '5052627375', '5052627776', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2012-01-01', '2013-06-28', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1508947466', 0, 'N', 0, '2013-06-21', NULL, NULL, 0, 0, NULL, NULL),
('204043287', 'ABQ000723', 'ABQ000723', 'NM01', 'ABQ Health Partners', 'Phillip', '', 'Steinbaugh', 'PA-C', 'Hand Surgery', 'Orthopedic Surgery', '', NULL, 'B', 'PO Box 27829           ', 'Albuquerque', 'Bernalillo', 'NM', '87125', '5052627375', '5052627776', 'PO Box 27829           ', 'Albuquerque', 'Bernalillo', 'NM', '87125', '5052627375', '5052627776', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2012-01-01', '2013-06-28', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1508947466', 0, 'N', 0, '2013-06-21', NULL, NULL, 0, 0, NULL, NULL),
('204043287', 'ABQ000324', 'ABQ000324', 'NM01', 'ABQ Health Partners', 'Victoria', '', 'Stetson', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '5150 Journal Ctr Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5052546500', '5052623198', '5150 Journal Ctr Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5052546500', '5052623198', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, 'Lovelace Womens Hospital', '', '', '', 'HCFA|UB|', '1215950191', 0, 'N', 0, '2014-06-24', NULL, NULL, 35.1702, -106.586, NULL, NULL),
('204043287', 'ABQ001124', 'ABQ001124', 'NM01', 'ABQ Health Partners', 'Victoria', '', 'Stetson', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'M', '5400 Gibson Blvd SE ', 'Albuquerque', 'Bernalillo', 'NM', '87108', '5052546500', '5052623198', '5400 Gibson Blvd SE ', 'Albuquerque', 'Bernalillo', 'NM', '87108', '5052546500', '5052623198', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, 'Lovelace Womens Hospital', '', '', '', 'HCFA|UB|', '1215950191', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('204043287', 'ABQ000724', 'ABQ000724', 'NM01', 'ABQ Health Partners', 'Victoria', '', 'Stetson', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 27829           ', 'Albuquerque', 'Bernalillo', 'NM', '87125', '5052546500', '5052623198', 'PO Box 27829           ', 'Albuquerque', 'Bernalillo', 'NM', '87125', '5052546500', '5052623198', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, 'Lovelace Womens Hospital', '', '', '', 'HCFA|UB|', '1215950191', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('204043287', 'ABQ001125', 'ABQ001125', 'NM01', 'ABQ Health Partners', 'Thomas', '', 'Stuart', 'MD', 'Pathology', '', '', NULL, 'M', '5400 Gibson Blvd SE ', 'Albuquerque', 'Bernalillo', 'NM', '87108', '5057276450', '5057278391', '5400 Gibson Blvd SE ', 'Albuquerque', 'Bernalillo', 'NM', '87108', '5057276450', '5057278391', 'NMABQ', 'WUSTDHCPC5', NULL, '0.00', '40.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1780607887', 0, 'N', 0, '2011-10-20', NULL, NULL, 0, 0, NULL, NULL),
('204043287', 'ABQ000325', 'ABQ000325', 'NM01', 'ABQ Health Partners', 'Thomas', '', 'Stuart', 'MD', 'Pathology', '', '', NULL, 'O', '601 Dr Martin Luther King Jr Ave NE', 'Albuquerque', 'Bernalillo', 'NM', '87102', '5057276450', '5057278391', '601 Dr Martin Luther King Jr Ave NE', 'Albuquerque', 'Bernalillo', 'NM', '87102', '5057276450', '5057278391', 'NMABQ', 'WUSTDHCPC5', NULL, '0.00', '40.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1780607887', 0, 'N', 0, '2011-10-20', NULL, NULL, 35.0857, -106.64, NULL, NULL),
('204043287', 'ABQ000725', 'ABQ000725', 'NM01', 'ABQ Health Partners', 'Thomas', '', 'Stuart', 'MD', 'Pathology', '', '', NULL, 'B', 'PO Box 27829           ', 'Albuquerque', 'Bernalillo', 'NM', '87125', '5057276450', '5057278391', 'PO Box 27829           ', 'Albuquerque', 'Bernalillo', 'NM', '87125', '5057276450', '5057278391', 'NMABQ', 'WUSTDHCPC5', NULL, '0.00', '40.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1780607887', 0, 'N', 0, '2011-10-20', NULL, NULL, 0, 0, NULL, NULL),
('204043287', 'ABQ000326', 'ABQ000326', 'NM01', 'ABQ Health Partners', 'Cary', '', 'Suter', 'MD', 'Neurology', '', '', NULL, 'O', '5400 Gibson Blvd SE', 'Albuquerque', 'Bernalillo', 'NM', '87108', '5052627250', '5052627946', '5400 Gibson Blvd SE', 'Albuquerque', 'Bernalillo', 'NM', '87108', '5052627250', '5052627946', 'NMABQ', 'WUSTDHCPC5', NULL, '0.00', '40.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1407879745', 0, 'N', 0, '2011-10-20', NULL, NULL, 35.0583, -106.582, NULL, NULL),
('204043287', 'ABQ000726', 'ABQ000726', 'NM01', 'ABQ Health Partners', 'Cary', '', 'Suter', 'MD', 'Neurology', '', '', NULL, 'B', 'PO Box 27829           ', 'Albuquerque', 'Bernalillo', 'NM', '87125', '5052627250', '5052627946', 'PO Box 27829           ', 'Albuquerque', 'Bernalillo', 'NM', '87125', '5052627250', '5052627946', 'NMABQ', 'WUSTDHCPC5', NULL, '0.00', '40.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1407879745', 0, 'N', 0, '2011-10-20', NULL, NULL, 0, 0, NULL, NULL),
('850436842', 'W12014910', 'W12014910', 'NM01', 'Cardiac Care Consultants of New Mexico', 'Loutsios', '', 'Ierides', 'MD', 'Cardiology', '', '', NULL, 'O', '715 Dr Martin Luther King Jr Ave Ste 210', 'Albuquerque', 'Bernalillo', 'NM', '87102', '5052481800', '5052481917', '715 Dr Martin Luther King Jr Ave Ste 210', 'Albuquerque', 'Bernalillo', 'NM', '87102', '5052481800', '5052481917', 'NMRAD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, 'Lovelace Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1578601753', 0, 'N', 0, '2011-11-03', NULL, NULL, 35.0856, -106.639, NULL, NULL),
('204043287', 'ABQ001127', 'ABQ001127', 'NM01', 'ABQ Health Partners', 'William', '', 'Syme', 'MD', 'General Surgery', '', '', NULL, 'M', '5400 Gibson Blvd SE ', 'Albuquerque', 'Bernalillo', 'NM', '87108', '5052627281', '5052627622', '5400 Gibson Blvd SE ', 'Albuquerque', 'Bernalillo', 'NM', '87108', '5052627281', '5052627622', 'NMABQ', 'WUSTDHCPC5', NULL, '0.00', '40.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, 'Lovelace Westside Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1457374555', 0, 'N', 0, '2011-10-20', NULL, NULL, 0, 0, NULL, NULL),
('204043287', 'ABQ000727', 'ABQ000727', 'NM01', 'ABQ Health Partners', 'William', '', 'Syme', 'MD', 'General Surgery', '', '', NULL, 'B', 'PO Box 27829           ', 'Albuquerque', 'Bernalillo', 'NM', '87125', '5052627281', '5052627622', 'PO Box 27829           ', 'Albuquerque', 'Bernalillo', 'NM', '87125', '5052627281', '5052627622', 'NMABQ', 'WUSTDHCPC5', NULL, '0.00', '40.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, 'Lovelace Westside Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1457374555', 0, 'N', 0, '2011-10-20', NULL, NULL, 0, 0, NULL, NULL),
('204043287', 'ABQ000329', 'ABQ000329', 'NM01', 'ABQ Health Partners', 'Rachel', '', 'Tansey', 'NP', 'Gastroenterology', '', '', NULL, 'O', '5400 Gibson Blvd SE', 'Albuquerque', 'Bernalillo', 'NM', '87108', '5052627174', '5052623562', '5400 Gibson Blvd SE', 'Albuquerque', 'Bernalillo', 'NM', '87108', '5052627174', '5052623562', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2012-01-01', '2012-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1255363933', 0, 'N', 0, '2012-01-26', NULL, NULL, 0, 0, NULL, NULL),
('204043287', 'ABQ000729', 'ABQ000729', 'NM01', 'ABQ Health Partners', 'Rachel', '', 'Tansey', 'NP', 'Gastroenterology', '', '', NULL, 'B', 'PO Box 27829           ', 'Albuquerque', 'Bernalillo', 'NM', '87125', '5052627174', '5052623562', 'PO Box 27829           ', 'Albuquerque', 'Bernalillo', 'NM', '87125', '5052627174', '5052623562', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2012-01-01', '2012-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1255363933', 0, 'N', 0, '2012-01-26', NULL, NULL, 0, 0, NULL, NULL),
('204043287', 'ABQ000330', 'ABQ000330', 'NM01', 'ABQ Health Partners', 'Shawn', '', 'Tedford', 'PA-C', 'Orthopedic Surgery', '', '', NULL, 'O', '5150 Journal Ctr Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5053428400', '5053428401', '5150 Journal Ctr Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5053428400', '5053428401', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2012-01-01', '2013-10-25', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1063449072', 0, 'N', 0, '2013-10-21', NULL, NULL, 0, 0, NULL, NULL),
('204043287', 'ABQ001130', 'ABQ001130', 'NM01', 'ABQ Health Partners', 'Shawn', '', 'Tedford', 'PA-C', 'Orthopedic Surgery', '', '', NULL, 'M', '5400 Gibson Blvd SE ', 'Albuquerque', 'Bernalillo', 'NM', '87108', '5053428400', '5053428401', '5400 Gibson Blvd SE ', 'Albuquerque', 'Bernalillo', 'NM', '87108', '5053428400', '5053428401', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2012-01-01', '2013-10-25', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1063449072', 0, 'N', 0, '2013-10-21', NULL, NULL, 0, 0, NULL, NULL),
('204043287', 'ABQ000730', 'ABQ000730', 'NM01', 'ABQ Health Partners', 'Shawn', '', 'Tedford', 'PA-C', 'Orthopedic Surgery', '', '', NULL, 'B', 'PO Box 27829           ', 'Albuquerque', 'Bernalillo', 'NM', '87125', '5053428400', '5053428401', 'PO Box 27829           ', 'Albuquerque', 'Bernalillo', 'NM', '87125', '5053428400', '5053428401', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2012-01-01', '2013-10-25', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1063449072', 0, 'N', 0, '2013-10-21', NULL, NULL, 0, 0, NULL, NULL),
('204043287', 'ABQ000331', 'ABQ000331', 'NM01', 'ABQ Health Partners', 'Joel', '', 'Teicher', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '5150 Journal Ctr Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5052546500', '5052623198', '5150 Journal Center Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5052546500', '5052623198', 'NMABQ', 'WUSTDHCPC5', NULL, '0.00', '40.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, 'Lovelace Womens Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1326071812', 0, 'N', 0, '2011-10-20', NULL, NULL, 35.1702, -106.586, NULL, NULL),
('204043287', 'ABQ001131', 'ABQ001131', 'NM01', 'ABQ Health Partners', 'Joel', '', 'Teicher', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'M', '5400 Gibson Blvd SE ', 'Albuquerque', 'Bernalillo', 'NM', '87108', '5052546500', '5052623198', '5400 Gibson Blvd SE ', 'Albuquerque', 'Bernalillo', 'NM', '87108', '5052546500', '5052623198', 'NMABQ', 'WUSTDHCPC5', NULL, '0.00', '40.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, 'Lovelace Womens Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1326071812', 0, 'N', 0, '2011-10-20', NULL, NULL, 0, 0, NULL, NULL),
('204043287', 'ABQ000731', 'ABQ000731', 'NM01', 'ABQ Health Partners', 'Joel', '', 'Teicher', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 27829           ', 'Albuquerque', 'Bernalillo', 'NM', '87125', '5052546500', '5052623198', 'PO Box 27829           ', 'Albuquerque', 'Bernalillo', 'NM', '87125', '5052546500', '5052623198', 'NMABQ', 'WUSTDHCPC5', NULL, '0.00', '40.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, 'Lovelace Womens Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1326071812', 0, 'N', 0, '2011-10-20', NULL, NULL, 0, 0, NULL, NULL),
('204043287', 'ABQ000332', 'ABQ000332', 'NM01', 'ABQ Health Partners', 'Nancy', '', 'Tejedor-Velilla', 'MD', 'Internal Medicine', '', '', NULL, 'O', '5400 Gibson Blvd SE', 'Albuquerque', 'Bernalillo', 'NM', '87108', '5052627110', '5052627829', '5400 Gibson Blvd SE', 'Albuquerque', 'Bernalillo', 'NM', '87108', '5052627110', '5052627829', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2012-01-01', '2012-07-06', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1477629467', 0, 'N', 0, '2012-07-13', NULL, NULL, 0, 0, NULL, NULL),
('204043287', 'ABQ000732', 'ABQ000732', 'NM01', 'ABQ Health Partners', 'Nancy', '', 'Tejedor-Velilla', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 27829           ', 'Albuquerque', 'Bernalillo', 'NM', '87125', '5052627110', '5052627829', 'PO Box 27829           ', 'Albuquerque', 'Bernalillo', 'NM', '87125', '5052627110', '5052627829', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2012-01-01', '2012-07-06', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1477629467', 0, 'N', 0, '2012-07-13', NULL, NULL, 0, 0, NULL, NULL),
('204043287', 'ABQ000334', 'ABQ000334', 'NM01', 'ABQ Health Partners', 'Abderrahmane', '', 'Temmar', 'MD', 'Pulmonary', '', '', NULL, 'O', '4801 McMahon Blvd NW Ste 250', 'Albuquerque', 'Bernalillo', 'NM', '87114', '5052321190', '5052322355', '4801 McMahon Blvd NW Ste 250', 'Albuquerque', 'Bernalillo', 'NM', '87114', '5052321190', '5052322355', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, 'Lovelace Medical Center', 'Lovelace Womens Hospital', 'Lovelace Westside Hospital ', NULL, 'HCFA|UB|', '1114950615', 0, 'N', 0, '2011-10-20', NULL, NULL, 35.2069, -106.678, NULL, NULL),
('204043287', 'ABQ001133', 'ABQ001133', 'NM01', 'ABQ Health Partners', 'Abderrahmane', '', 'Temmar', 'MD', 'Pulmonary', '', '', NULL, 'M', '5400 Gibson Blvd SE ', 'Albuquerque', 'Bernalillo', 'NM', '87108', '5052321190', '5052322355', '5400 Gibson Blvd SE ', 'Albuquerque', 'Bernalillo', 'NM', '87108', '5052321190', '5052322355', 'NMABQ', 'WUSTDHCPC5', NULL, '0.00', '40.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, 'Lovelace Medical Center', 'Lovelace Womens Hospital', 'Lovelace Westside Hospital ', NULL, 'HCFA|UB|', '1114950615', 0, 'N', 0, '2011-10-20', NULL, NULL, 0, 0, NULL, NULL),
('204043287', 'ABQ000733', 'ABQ000733', 'NM01', 'ABQ Health Partners', 'Abderrahmane', '', 'Temmar', 'MD', 'Pulmonary', '', '', NULL, 'B', 'PO Box 27829           ', 'Albuquerque', 'Bernalillo', 'NM', '87125', '5052321190', '5052322355', 'PO Box 27829           ', 'Albuquerque', 'Bernalillo', 'NM', '87125', '5052321190', '5052322355', 'NMABQ', 'WUSTDHCPC5', NULL, '0.00', '40.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, 'Lovelace Medical Center', 'Lovelace Womens Hospital', 'Lovelace Westside Hospital ', NULL, 'HCFA|UB|', '1114950615', 0, 'N', 0, '2011-10-20', NULL, NULL, 0, 0, NULL, NULL),
('204043287', 'ABQ000335', 'ABQ000335', 'NM01', 'ABQ Health Partners', 'Andrea', '', 'Thelen', 'PA-C', 'Family Practice', '', '', NULL, 'O', '2121 Juan Tabo Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87112', '5052378800', '5052378817', '2121 Juan Tabo Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87112', '5052378800', '5052378817', 'NMABQ', 'WUSTDHCPC5', NULL, '0.00', '40.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1629394945', 0, 'N', 0, '2012-11-21', NULL, NULL, 35.1062, -106.516, NULL, NULL),
('204043287', 'ABQ001135', 'ABQ001135', 'NM01', 'ABQ Health Partners', 'Andrea', '', 'Thelen', 'PA-C', 'Family Practice', '', '', NULL, 'M', '5400 Gibson Blvd SE ', 'Albuquerque', 'Bernalillo', 'NM', '87108', '5052378800', '5052378817', '5400 Gibson Blvd SE ', 'Albuquerque', 'Bernalillo', 'NM', '87108', '5052378800', '5052378817', 'NMABQ', 'WUSTDHCPC5', NULL, '0.00', '40.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1629394945', 0, 'N', 0, '2012-11-21', NULL, NULL, 0, 0, NULL, NULL),
('204043287', 'ABQ000735', 'ABQ000735', 'NM01', 'ABQ Health Partners', 'Andrea', '', 'Thelen', 'PA-C', 'Family Practice', '', '', NULL, 'B', 'PO Box 27829           ', 'Albuquerque', 'Bernalillo', 'NM', '87125', '5052378800', '5052378817', 'PO Box 27829           ', 'Albuquerque', 'Bernalillo', 'NM', '87125', '5052378800', '5052378817', 'NMABQ', 'WUSTDHCPC5', NULL, '0.00', '40.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1629394945', 0, 'N', 0, '2012-11-21', NULL, NULL, 0, 0, NULL, NULL),
('204043287', 'ABQ001136', 'ABQ001136', 'NM01', 'ABQ Health Partners', 'Floyd', '', 'Thomas', 'MD', 'Family Practice', '', '', NULL, 'M', '5400 Gibson Blvd SE ', 'Albuquerque', 'Bernalillo', 'NM', '87108', '5052754288', '5052754203', '5400 Gibson Blvd SE ', 'Albuquerque', 'Bernalillo', 'NM', '87108', '5052754288', '5052754203', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2012-01-01', '2013-10-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1841225877', 0, 'N', 0, '2013-10-14', NULL, NULL, 0, 0, NULL, NULL),
('204043287', 'ABQ000336', 'ABQ000336', 'NM01', 'ABQ Health Partners', 'Floyd', '', 'Thomas', 'MD', 'Family Practice', '', '', NULL, 'O', '9101 Montgomery Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87111', '5052754288', '5052754203', '9101 Montgomery Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87111', '5052754288', '5052754203', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2012-01-01', '2013-10-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1841225877', 0, 'N', 0, '2013-10-14', NULL, NULL, 0, 0, NULL, NULL),
('204043287', 'ABQ000736', 'ABQ000736', 'NM01', 'ABQ Health Partners', 'Floyd', '', 'Thomas', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 27829           ', 'Albuquerque', 'Bernalillo', 'NM', '87125', '5052754288', '5052754203', 'PO Box 27829           ', 'Albuquerque', 'Bernalillo', 'NM', '87125', '5052754288', '5052754203', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2012-01-01', '2013-10-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1841225877', 0, 'N', 0, '2013-10-14', NULL, NULL, 0, 0, NULL, NULL),
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('030453435', 'W12013798', 'W12013798', 'NM01', '', 'Qi', '', 'Chu', 'DOM', 'Acupuncture', '', '', NULL, 'O', '3611 New Mexico Hwy 528 Ste A', 'Albuquerque', 'Bernalillo', 'NM', '87114', '5058986668', '5058989096', '3611 New Mexico Hwy 528 Ste A', 'Albuquerque', 'Bernalillo', 'NM', '87114', '5058986668', '5058989096', '', '', '', '0.00', '0.00', '75.00', 3, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1093722753', 0, 'N', 0, '2011-10-12', NULL, NULL, 0, 0, NULL, NULL),
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('585709022', 'W12013810', 'W12013810', 'NM01', '', 'Louis', 'E', 'Hubbard', 'DC', 'Chiropractic', '', '', NULL, 'O', '1413 Eubank Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87112', '5058831011', '5058830629', '1413 Eubank Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87112', '5058831011', '5058830629', 'NMCHIRO', 'WUSTDHCPC5', '', '0.00', '0.00', '38.00', 3, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1386726263', 0, 'N', 0, '2011-10-13', NULL, NULL, 35.0952, -106.533, NULL, NULL),
('850432810', 'W12013811', 'W12013811', 'NM01', '', 'Linda', 'X', 'Li', 'DOM', 'Acupuncture', '', '', NULL, 'O', '1659 Eubank NE Ste A', 'Albuquerque', 'Bernalillo', 'NM', '87112', '5052947368', '5052947424', '1659 Eubank NE Ste A', 'Albuquerque', 'Bernalillo', 'NM', '87112', '5052947368', '5052947424', '', '', '', '0.00', '0.00', '75.00', 3, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1992713523', 0, 'N', 0, '2014-04-23', NULL, NULL, 35.1, -106.533, NULL, NULL),
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('850459234', 'W12013817', 'W12013817', 'NM01', '', 'Lorella', '', 'Tapia-Reyes', 'DOM', 'Acupuncture', '', '', NULL, 'O', '427 Main St SW', 'Los Lunas', 'Valencia', 'NM', '87031', '5055654900', '5052759604', '427 Main St SW', 'Los Lunas', 'Valencia', 'NM', '87031', '5055654900', '5052759604', '', '', '', '0.00', '0.00', '75.00', 3, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1093813206', 0, 'N', 0, '2014-04-24', NULL, NULL, 34.8092, -106.739, NULL, NULL),
('742838103', 'W12013818', 'W12013818', 'NM01', 'Southwest Eyecare Specialists', 'John', 'J', 'Teahan', 'MD', 'Ophthalmology', '', '', NULL, 'O', '7110 Wyoming Blvd', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5053460500', '5053460164', '7110 Wyoming Blvd', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5053460500', '5053460164', 'NMSWEYE', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', '2012-01-01', 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1679545594', 0, 'Y', 0, '2011-10-19', NULL, NULL, 0, 0, NULL, NULL),
('264478548', 'W12013819', 'W12013819', 'NM01', '', 'Douglas', 'E', 'Weaver', 'DC', 'Chiropractic', '', '', NULL, 'O', '7100 Menaul Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87110', '5058835858', '5058830010', '7100 Menaul Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87110', '5058835858', '5058830010', 'NMCHIRO', 'WUSTDHCPC5', '', '0.00', '0.00', '38.00', 3, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1023185121', 0, 'N', 0, '2014-04-24', NULL, NULL, 35.1091, -106.566, NULL, NULL),
('850451142', 'W12013820', 'W12013820', 'NM01', 'Chinese Natural Therapy', 'Hua', '', 'Wu', 'DOM', 'Acupuncture', '', '', NULL, 'O', '5005 Prospect Ave NE Ste A', 'Albuquerque', 'Bernalillo', 'NM', '87110', '5058728238', '5058729378', '5005 Prospect Ave NE Ste A', 'Albuquerque', 'Bernalillo', 'NM', '87110', '5058728238', '5058729378', '', '', '', '0.00', '0.00', '75.00', 3, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1487712758', 0, 'N', 0, '2014-04-23', NULL, NULL, 35.1072, -106.588, NULL, NULL),
('870542586', 'W12014310', 'W12014310', 'UT01', 'University Health Care', 'Marcellus', 'S', 'Assiago', 'MD', 'Internal Medicine', 'Nephrology', '', NULL, 'O', '1277 Northfield Rd', 'Cedar City', 'Iron', 'UT', '84720', '8015816709', NULL, '1277 Northfield Rd', 'Cedar City', 'Iron', 'UT', '84720', '8015816709', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2011-09-20', '2012-04-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1235348897', 0, 'N', 0, '2012-04-12', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12013832', 'W12013832', 'UTIHC04', '', 'Paul', 'D', 'Dearing', 'MD', 'General Surgery', '', '', NULL, 'O', '1501 Hiland Ave', 'Burley', 'Cassia', 'ID', '83318', '2086784444', NULL, '1501 Hiland Ave', 'Burley', 'Cassia', 'ID', '83318', '2086784444', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2011-04-18', '2013-03-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1497789093', 0, 'N', 0, '2013-03-12', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12013835', 'W12013835', 'UTIHC01', 'Psychiatry', 'Peter', 'J', 'Gioia', 'MD', 'Pediatric Psychiatry', 'Mental Health', '', NULL, 'O', '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356884343', NULL, '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356884343', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2011-08-08', '2011-09-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1922019538', 0, 'N', 0, '2011-09-07', NULL, NULL, 0, 0, NULL, NULL),
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('450470447', 'W12013908', 'W12013908', 'UT01', 'Layton Physical Therapy & Sports Medicine Inc', 'Alan', 'John', 'Kerbs', 'PT', 'Physical Therapy', '', '', NULL, 'O', '2179 N 1700 W Ste 4', 'Layton', 'Davis', 'UT', '84041', '8017284624', '8017763087', '2179 N 1700 W Ste 4', 'Layton', 'Davis', 'UT', '84041', '8017284624', '8017763087', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '70.50', 3, '2011-09-01', '2012-03-31', 0, 0, 0, '', '', '', '', 'HCFA|', '1952485625', 0, 'N', 0, '2012-02-08', NULL, NULL, 0, 0, NULL, NULL);
INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
('450470447', 'W12013909', 'W12013909', 'UT01', 'Layton Physical Therapy & Sports Medicine Inc', 'Alan', 'John', 'Kerbs', 'PT', 'Physical Therapy', '', '', NULL, 'O', '2179 N 1700 W Ste 4', 'Layton', 'Davis', 'UT', '84041', '8017284624', '8017763087', '2179 N 1700 W Ste 4', 'Layton', 'Davis', 'UT', '84041', '8017284624', '8017763087', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2012-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1952485625', 0, 'N', 0, '2012-02-08', NULL, NULL, 41.089, -111.997, NULL, NULL),
('364288180', 'W12013893', 'W12013893', 'UT01', 'Cache Valley Specialty Hospital', 'Ryan', 'Jade', 'Green', 'PT', 'Physical Therapy', '', '', NULL, 'B', 'PO Box 6220', 'Logan', 'Cache', 'UT', '84341', '4357879030', '4357879033', 'PO Box 6220', 'Logan', 'Cache', 'UT', '84341', '4357879030', '4357879033', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '70.50', 8, '2011-09-01', '2012-03-31', 0, 0, 0, '', '', '', '', 'HCFA|', '1255479184', 0, 'N', 0, '2011-09-08', NULL, NULL, 0, 0, NULL, NULL),
('364288180', 'W12013894', 'W12013894', 'UT01', 'Cache Valley Specialty Hospital', 'Ryan', 'Jade', 'Green', 'PT', 'Physical Therapy', '', '', NULL, 'B', 'PO Box 6220', 'Logan', 'Cache', 'UT', '84341', '4357879030', '4357879033', 'PO Box 6220', 'Logan', 'Cache', 'UT', '84341', '4357879030', '4357879033', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 8, '2012-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1255479184', 0, 'N', 0, '2011-09-08', NULL, NULL, 0, 0, NULL, NULL),
('364288180', 'W12013900', 'W12013900', 'UT01', 'Cache Valley Specialty Hospital', 'Craig', 'D', 'Pabst', 'PT', 'Physical Therapy', '', '', NULL, 'O', '2310 N 400 E Ste B', 'Logan', 'Cache', 'UT', '84341', '4357879030', '4357879033', '2310 N 400 E Ste B', 'Logan', 'Cache', 'UT', '84341', '4357879030', '4357879033', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '70.50', 8, '2011-09-01', '2012-03-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1346465895', 0, 'N', 0, '2011-09-08', NULL, NULL, 0, 0, NULL, NULL),
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('161384798', 'W12013992', 'W12013992', 'NM01', '', 'Susan', 'M', 'Libit', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '1400 Carlisle NE Ste A', 'Albuquerque', 'Bernalillo', 'NM', '87110', '5052560026', '5052925233', '1400 Carlisle NE Ste A', 'Albuquerque', 'Bernalillo', 'NM', '87110', '5052560026', '5052925233', 'NMMA', '', '', '0.00', '35.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1629088422', 0, 'N', 0, '2014-04-21', NULL, NULL, 35.0946, -106.604, NULL, NULL),
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('850395469', 'W12013996', 'W12013996', 'NM01', 'Fifty n Fit', 'Lisa', 'R', 'Page', 'DPT', 'Physical Therapy', '', '', NULL, 'B', '11801 Menaul Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87112', '5053458050', '5053438050', '11801 Menaul Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87112', '5053458050', '5053438050', '', '', '', '0.00', '0.00', '75.00', 3, '2012-01-01', '2013-09-19', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1366403305', 0, 'N', 0, '2013-07-15', NULL, NULL, 0, 0, NULL, NULL),
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('452410465', 'W12014000', 'W12014000', 'NM01', 'Rasmussen Counseling', 'Martin', '', 'Rasmussen', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'B', 'PO Box 21182', 'Albuquerque', 'Bernalillo', 'NM', '87154', '5052639375', '8668581870', 'PO Box 21182', 'Albuquerque', 'Bernalillo', 'NM', '87154', '5052639375', '8668581870', 'NMMA', '', '', '0.00', '35.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1821324336', 0, 'N', 0, '2014-05-16', NULL, NULL, 0, 0, NULL, NULL),
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('261620420', 'W12014003', 'W12014003', 'NM01', '', 'Neal', 'P', 'Sirwinski', 'DOM', 'Acupuncture', '', '', NULL, 'O', '3816 Carlisle NE', 'Albuquerque', 'Bernalillo', 'NM', '87107', '5058372335', '5058888857', '3816 Carlisle NE', 'Albuquerque', 'Bernalillo', 'NM', '87107', '5058372335', '5058888857', '', '', '', '0.00', '0.00', '75.00', 3, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1396845947', 0, 'N', 0, '2014-05-08', NULL, NULL, 35.1244, -106.604, NULL, NULL),
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('330057155', 'W12014031', 'W12014031', 'TX01', 'Apria Healthcare LLC', '', '', 'Apria Healthcare LLC', 'Group', 'Durable Medical Equipment', '', '', NULL, 'O', '4706 College Park', 'San Antonio', 'Bexar', 'TX', '78249', '2104940203', '2104967893', '4706 College Park', 'San Antonio', 'Bexar', 'TX', '78249', '2104940203', '2104967893', 'Wpraxair', '', '', '0.00', '20.00', '0.00', 3, '2011-03-04', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1902915093', 0, 'N', 0, '2013-07-31', NULL, NULL, 0, 0, NULL, NULL),
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('330057155', 'W12014038', 'W12014038', 'WY01', 'Apria Healthcare LLC', '', '', 'Apria Healthcare LLC', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', '515 E Carlson St Ste 104', 'Cheyenne', 'Laramie', 'WY', '82009', '3076347121', '3076346648', '515 E Carlson St Ste 104', 'Cheyenne', 'Laramie', 'WY', '82009', '3076347121', '3076346648', 'Wpraxair', '', '', '0.00', '20.00', '0.00', 3, '2011-03-04', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1790794386', 0, 'N', 0, '2013-07-31', NULL, NULL, 0, 0, NULL, NULL),
('330057155', 'W12014042', 'W12014042', 'NM01', 'Apria Healthcare LLC', '', '', 'Apria Healthcare LLC', 'Group', 'Durable Medical Equipment', '', '', NULL, 'O', '4421 McLeod Blvd NE Ste A', 'Albuquerque', 'Bernalillo', 'NM', '87109', '8884927742', '8884920010', '4421 McLeod Blvd NE Ste A', 'Albuquerque', 'Bernalillo', 'NM', '87109', '8884927742', '8884920010', 'Wpraxair', '', '', '0.00', '20.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1558378661', 0, 'N', 0, '2013-07-31', NULL, NULL, 0, 0, NULL, NULL),
('330057155', 'W12014041', 'W12014041', 'NM01', 'Apria Healthcare LLC', '', '', 'Apria Healthcare LLC', 'Group', 'Durable Medical Equipment', '', '', NULL, 'B', 'PO Box 31001-0685', 'Pasadena', 'Los Angeles', 'CA', '91110', '8008523535', NULL, 'PO Box 31001-0685', 'Pasadena', 'Los Angeles', 'CA', '91110', '8008523535', '          ', 'Wpraxair', '', '', '0.00', '20.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1558378661', 0, 'N', 0, '2013-07-31', NULL, NULL, 0, 0, NULL, NULL),
('141920853', 'W12014045', 'W12014045', 'UT01', 'Cope Family Medicine', 'Mark', 'E', 'Christian', 'MD', 'Family Practice', '', '', NULL, 'O', '620 S Medical Dr Ste 150', 'Bountiful', 'Davis', 'UT', '84010', '8012984112', '8012985397', '620 S Medical Dr Ste 150', 'Bountiful', 'Davis', 'UT', '84010', '8012984112', '8012985397', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', NULL, 0, 0, 0, 'Lakeview Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1184688533', 0, 'N', 0, '2011-09-19', NULL, NULL, 40.8869, -111.869, NULL, NULL),
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('141920853', 'W12014047', 'W12014047', 'UT01', 'Cope Family Medicine', 'David', 'G', 'Cope', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '620 S Medical Dr Ste 150', 'Bountiful', 'Davis', 'UT', '84010', '8012984112', '8012985397', '620 S Medical Dr Ste 150', 'Bountiful', 'Davis', 'UT', '84010', '8012984112', '8012985397', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', NULL, 0, 0, 0, 'Lakeview Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1285698241', 0, 'N', 0, '2011-09-20', NULL, NULL, 40.8869, -111.869, NULL, NULL),
('841394394', 'W12014048', 'W12014048', 'UT01', 'Eye Care for You', 'Jeffrey', 'L', 'Cromwell', 'OD', 'Optometry', '', '', NULL, 'O', '1300 N 200 E Ste 104', 'Logan', 'Cache', 'UT', '84321', '4357526453', NULL, '1300 N 200 E Ste 104', 'Logan', 'Cache', 'UT', '84321', '4357526453', '', 'WUTALBERT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-09-12', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1801902333', 0, 'N', 0, '2014-03-28', NULL, NULL, 41.7547, -111.829, NULL, NULL),
('263513247', 'W12014049', 'W12014049', 'UT01', 'Eye Care for You', 'Phillip', 'G', 'Cromwell', 'OD', 'Optometry', '', '', NULL, 'O', '1300 N 200 E Ste 104', 'Logan', 'Cache', 'UT', '84321', '4357526453', '4357526486', '1300 N 200 E Ste 104', 'Logan', 'Cache', 'UT', '84321', '4357526453', '4357526486', 'WUTALBERT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-09-12', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1720194632', 0, 'N', 0, '2014-02-21', NULL, NULL, 41.7547, -111.829, NULL, NULL),
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('261996389', 'W12014102', 'W12014102', 'UT01', '', 'Spence', 'D', 'Harper', 'DPM', 'Podiatry', '', '', NULL, 'O', '4578 S Highland Dr Ste 380', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8015055277', NULL, '4578 S Highland Dr Ste 380', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8015055277', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-09-12', NULL, 0, 0, 0, 'Heber Valley Medical Center', 'St Marks Hospital', 'Park City Medical Center', NULL, 'HCFA|UB|', '1851394803', 0, 'N', 0, '2012-01-05', NULL, NULL, 40.6723, -111.841, NULL, NULL),
('161767581', 'W12014103', 'W12014103', 'UT01', 'Layton Family Practice', 'Mont', 'C', 'Robins', 'PA', 'Family Practice', '', '', NULL, 'O', '3100 N Church St Ste ', 'Layton', 'Davis', 'UT', '84040', '8015469441', NULL, '3100 N Church St Ste ', 'Layton', 'Davis', 'UT', '84040', '8015469441', '', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-09-30', '2011-09-30', 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1467440701', 0, 'N', 0, '2014-04-09', NULL, NULL, 0, 0, NULL, NULL),
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('364288180', 'W12014112', 'W12014112', 'UT01', 'Cache Valley Specialty Hospital', 'Brad', '', 'Thomas', 'PT', 'Physical Therapy', '', '', NULL, 'O', '169 N Gateway Dr Ste 140', 'Providence', 'Cache', 'UT', '84332', '4357558500', '4357552836', '169 N Gateway Dr Ste 140', 'Providence', 'Cache', 'UT', '84332', '4357558500', '4357552836', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 8, '2012-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1902021538', 0, 'N', 0, '2011-09-21', NULL, NULL, 41.7118, -111.829, NULL, NULL),
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('141920853', 'W12014114', 'W12014114', 'UT01', 'Cope Family Medicine', 'Raymond', 'P', 'Ward', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '620 S Medical Dr Ste 150', 'Bountiful', 'Davis', 'UT', '84010', '8012984112', '8012985397', '620 S Medical Dr Ste 150', 'Bountiful', 'Davis', 'UT', '84010', '8012984112', '8012985397', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', NULL, 0, 0, 0, 'Lakeview Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1043273386', 0, 'N', 0, '2011-09-21', NULL, NULL, 40.8869, -111.869, NULL, NULL),
('161767581', 'W12014115', 'W12014115', 'UT01', 'Layton Family Practice', 'Jonathan', 'A', 'Weeks', 'MD', 'Family Practice', '', '', NULL, 'O', '3100 N Church St', 'Layton', 'Davis', 'UT', '84040', '8015469441', NULL, '3100 N Church St', 'Layton', 'Davis', 'UT', '84040', '8015469441', '          ', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-10-01', '2011-10-01', 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1649364803', 0, 'N', 0, '2013-10-30', NULL, NULL, 0, 0, NULL, NULL),
('870525682', 'W12014116', 'W12014116', 'UT01', 'Retina Associates of Utah', 'Kirk', 'E', 'Winward', 'MD', 'Ophthalmology', NULL, NULL, NULL, 'O', '2132 N 1700 W Ste 130', 'Layton', 'Davis', 'UT', '84041', '8013577999', '8013577020', '2132 N 1700 W Ste 130', 'Layton', 'Davis', 'UT', '84041', '8013577999', '8013577020', 'WUTCTY', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-09-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1962487611', 0, 'N', 0, '2013-08-05', NULL, NULL, 41.0892, -111.997, NULL, NULL),
('010624198', 'W12014117', 'W12014117', 'TX01', 'Alamo Mental Health Group', 'Amie ', 'C', 'Yanover', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '4242 Medical Dr Ste 6300', 'San Antonio', 'Bexar', 'TX', '78229', '2106148400', NULL, '4242 Medical Dr Ste 6300', 'San Antonio', 'Bexar', 'TX', '78229', '2106148400', '', 'TXALAMOPHD', '', '', '0.00', '35.00', '0.00', 6, '2011-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1447262720', 0, 'N', 0, '2014-05-01', NULL, NULL, 29.5146, -98.5673, NULL, NULL),
('953372911', 'W12014119', 'W12014119', 'ID02', 'Four Rivers Dialysis', '', '', 'Four Rivers Dialysis', 'GROUP', 'Dialysis Center', '', '', NULL, 'B', 'PO Box 402946', 'Atlanta', 'Fulton', 'GA', '30384', '2084675180', NULL, 'PO Box 402946', 'Atlanta', 'Fulton', 'GA', '30384', '2084675180', '          ', '', '', '', '0.00', '15.00', '0.00', 3, '2011-06-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1053363689', 0, 'N', 0, '2011-09-13', NULL, NULL, 0, 0, NULL, NULL),
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('820299231', 'W12014128', 'W12014128', 'ID02', 'Saltzer Medical Group-Hearing & Balance', 'Nicholas', '', 'Lewis', 'MD', 'Internal Medicine', '', '', NULL, 'O', '210 W Georgia Ave Ste 100', 'Nampa', 'Canyon', 'ID', '83686', '2084685940', '2084633055', '210 W Georgia Ave Ste 100', 'Nampa', 'Canyon', 'ID', '83686', '2084685940', '2084633055', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-08-29', '2012-12-31', 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1134372386', 0, 'N', 0, '2013-07-18', NULL, NULL, 43.5564, -116.575, NULL, NULL),
('820299231', 'W12014122', 'W12014122', 'ID02', 'Saltzer Medical Group', 'Nicholas', '', 'Lewis', 'MD', 'Internal Medicine', '', '', NULL, 'O', '215 E Hawaii Ave', 'Nampa', 'Canyon', 'ID', '83686', '2084633000', '2084633044', '215 E Hawaii Ave', 'Nampa', 'Canyon', 'ID', '83686', '2084633000', '2084633044', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-08-29', '2012-12-31', 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1134372386', 0, 'N', 0, '2013-07-18', NULL, NULL, 0, 0, NULL, NULL),
('820299231', 'W12014121', 'W12014121', 'ID02', 'Saltzer Medical Group', 'Nicholas', '', 'Lewis', 'MD', 'Internal Medicine', '', '', NULL, 'B', '217 W Georgia Ave Ste 115', 'Nampa', 'Canyon', 'ID', '83686', '2084633280', '2082884987', '217 W Georgia Ave Ste 115', 'Nampa', 'Canyon', 'ID', '83686', '2084633280', '2082884987', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-08-29', '2012-12-31', 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1134372386', 0, 'N', 0, '2013-07-18', NULL, NULL, 0, 0, NULL, NULL),
('820299231', 'W12014123', 'W12014123', 'ID02', 'Saltzer Medical Group Rehab', 'Nicholas', '', 'Lewis', 'MD', 'Internal Medicine', '', '', NULL, 'O', '290 W Georgia Ave', 'Nampa', 'Canyon', 'ID', '83686', '2084685940', '2084633055', '290 W Georgia Ave', 'Nampa', 'Canyon', 'ID', '83686', '2084685940', '2084633055', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-08-29', '2012-12-31', 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1134372386', 0, 'N', 0, '2013-07-18', NULL, NULL, 0, 0, NULL, NULL),
('820299231', 'W12014127', 'W12014127', 'ID02', 'Saltzer Medical Group-Portico', 'Nicholas', '', 'Lewis', 'MD', 'Internal Medicine', '', '', NULL, 'O', '3277 E Louise Dr Ste 200', 'Meridian', 'Ada', 'ID', '83642', '2084685940', '2084633055', '3277 E Louise Dr Ste 200', 'Meridian', 'Ada', 'ID', '83642', '2084685940', '2084633055', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-08-29', '2012-12-31', 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1134372386', 0, 'N', 0, '2013-07-18', NULL, NULL, 0, 0, NULL, NULL),
('820299231', 'W12014125', 'W12014125', 'ID02', 'Saltzer Medical Group North', 'Nicholas', '', 'Lewis', 'MD', 'Internal Medicine', '', '', NULL, 'O', '4400 E Flamingo Ave', 'Nampa', 'Canyon', 'ID', '83684', '2084685940', '2084633055', '4400 E Flamingo Ave', 'Nampa', 'Canyon', 'ID', '83684', '2084685940', '2084633055', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-08-29', '2012-12-31', 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1134372386', 0, 'N', 0, '2013-07-18', NULL, NULL, 0, 0, NULL, NULL),
('820299231', 'W12014124', 'W12014124', 'ID02', 'Saltzer Medical Group-Sleep', 'Nicholas', '', 'Lewis', 'MD', 'Internal Medicine', '', '', NULL, 'O', '7272 W Potomac Dr', 'Boise', 'Ada', 'ID', '83704', '2084685940', '2084633055', '7272 W Potomac Dr', 'Boise', 'Ada', 'ID', '83704', '2084685940', '2084633055', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-08-29', '2012-12-31', 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1134372386', 0, 'N', 0, '2013-07-18', NULL, NULL, 0, 0, NULL, NULL),
('820309671', 'W12014130', 'W12014130', 'ID02', 'OB/GYN Associates PA (PPO Access Applies to this provider at this location only)', 'Jessica', '', 'Fu', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '315 E Elm St Ste 310', 'Caldwell', 'Canyon', 'ID', '83605', '2084542035', '2084551784', '315 E Elm St Ste 310', 'Caldwell', 'Canyon', 'ID', '83605', '2084542035', '2084551784', 'IDACN', '', '', '0.00', '15.00', '0.00', 8, '2011-08-29', '2014-07-14', 0, 0, 1, 'West Valley Medical Center', '', '', '', 'HCFA|UB|', '1710185111', 0, 'N', 0, '2014-07-09', NULL, NULL, 43.6539, -116.695, NULL, NULL),
('820309671', 'W12014131', 'W12014131', 'ID02', 'OB/GYN Associates PA (PPO Access Applies to this provider at this location only)', 'Jessica', '', 'Fu', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '520 S Eagle Rd', 'Meridian', 'Ada', 'ID', '83642', '2089550350', '2084551784', '520 S Eagle Rd', 'Meridian', 'Ada', 'ID', '83642', '2089550350', '2084551784', 'IDACN', '', '', '0.00', '15.00', '0.00', 8, '2011-08-29', '2011-08-29', 0, 0, 1, 'West Valley Medical Center', '', '', '', 'HCFA|UB|', '1710185111', 0, 'N', 0, '2014-07-09', NULL, NULL, 43.5995, -116.352, NULL, NULL),
('820482491', 'W12014132', 'W12014132', 'ID02', 'Intermountain Eye and Laser Center', 'Luke', 'K', 'Hopstad', 'OD', 'Optometry', '', '', NULL, 'O', '4400 E Flamingo Rd', 'Nampa', 'Canyon', 'ID', '83687', '2084662222', '2084653441', '4400 E Flamingo Rd', 'Nampa', 'Canyon', 'ID', '83687', '2084662222', '2084653441', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-01-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1598742561', 0, 'N', 0, '2011-09-13', NULL, NULL, 0, 0, NULL, NULL);
INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
('820299231', 'W12014135', 'W12014135', 'ID02', 'Saltzer Medical Group- Caldwell', 'Keith', 'G', 'Holley', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1818 S 10th Ave Ste 120 or Ste 220', 'Caldwell', 'Canyon', 'ID', '83605', '2084685940', '2084633055', '1818 S 10th Ave Ste 120 or Ste 220', 'Caldwell', 'Canyon', 'ID', '83605', '2084685940', '2084633055', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-08-29', '2012-11-11', 0, 0, 1, 'Saint Alphonsus Regional Medical Center', 'Saint Alphonsus Medical Center Nampa', '', '', 'HCFA|UB|', '1386616183', 0, 'N', 0, '2014-03-20', NULL, NULL, 43.6538, -116.693, NULL, NULL),
('820299231', 'W12014137', 'W12014137', 'ID02', 'Saltzer Medical Group-Hearing & Balance', 'Keith', 'G', 'Holley', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '210 W Georgia Ave Ste 100', 'Nampa', 'Canyon', 'ID', '83686', '2084685940', '2084633055', '210 W Georgia Ave Ste 100', 'Nampa', 'Canyon', 'ID', '83686', '2084685940', '2084633055', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-08-29', '2012-11-11', 0, 0, 1, 'Saint Alphonsus Regional Medical Center', 'Saint Alphonsus Medical Center Nampa', '', '', 'HCFA|UB|', '1386616183', 0, 'N', 0, '2014-03-20', NULL, NULL, 43.5564, -116.575, NULL, NULL),
('820299231', 'W12014141', 'W12014141', 'ID02', 'Saltzer Medical Group', 'Keith', 'G', 'Holley', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '215 E Hawaii Ave', 'Nampa', 'Canyon', 'ID', '83686', '2084685910', '2084633046', '215 E Hawaii Ave', 'Nampa', 'Canyon', 'ID', '83686', '2084685910', '2084633046', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-08-29', '2012-11-11', 0, 0, 1, 'Saint Alphonsus Regional Medical Center', 'Saint Alphonsus Medical Center Nampa', '', '', 'HCFA|UB|', '1386616183', 0, 'N', 0, '2014-03-20', NULL, NULL, 0, 0, NULL, NULL),
('820299231', 'W12014134', 'W12014134', 'ID02', 'Saltzer Medical Group', 'Keith', 'G', 'Holley', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', '217 W Georgia Ave Ste 115', 'Nampa', 'Canyon', 'ID', '83686', '2084633280', '2082884987', '217 W Georgia Ave Ste 115', 'Nampa', 'Canyon', 'ID', '83686', '2084633280', '2082884987', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-08-29', '2012-11-11', 0, 0, 1, 'Saint Alphonsus Regional Medical Center', 'Saint Alphonsus Medical Center Nampa', '', '', 'HCFA|UB|', '1386616183', 0, 'N', 0, '2014-03-20', NULL, NULL, 0, 0, NULL, NULL),
('820299231', 'W12014140', 'W12014140', 'ID02', 'Saltzer Medical Group Rehab', 'Keith', 'G', 'Holley', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '290 W Georgia Ave', 'Nampa', 'Canyon', 'ID', '83686', '2084633000', '2084633044', '290 W Georgia Ave', 'Nampa', 'Canyon', 'ID', '83686', '2084633000', '2084633044', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-08-29', '2012-11-11', 0, 0, 1, 'Saint Alphonsus Regional Medical Center', 'Saint Alphonsus Medical Center Nampa', '', '', 'HCFA|UB|', '1386616183', 0, 'N', 0, '2014-03-20', NULL, NULL, 0, 0, NULL, NULL),
('820299231', 'W12014136', 'W12014136', 'ID02', 'Saltzer Medical Group-Portico', 'Keith', 'G', 'Holley', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '3277 E Louise Dr Ste 200', 'Meridian', 'Ada', 'ID', '83642', '2084633000', '2084633044', '3277 E Louise Dr Ste 200', 'Meridian', 'Ada', 'ID', '83642', '2084633000', '2084633044', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-08-29', '2012-11-11', 0, 0, 1, 'Saint Alphonsus Regional Medical Center', 'Saint Alphonsus Medical Center Nampa', '', '', 'HCFA|UB|', '1386616183', 0, 'N', 0, '2014-03-20', NULL, NULL, 0, 0, NULL, NULL),
('820299231', 'W12014138', 'W12014138', 'ID02', 'Saltzer Medical Group North', 'Keith', 'G', 'Holley', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '4400 E Flamingo Ave', 'Nampa', 'Canyon', 'ID', '83687', '2084633000', '2084633044', '4400 E Flamingo Ave', 'Nampa', 'Canyon', 'ID', '83687', '2084633000', '2084633044', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-08-29', '2012-11-11', 0, 0, 1, 'Saint Alphonsus Regional Medical Center', 'Saint Alphonsus Medical Center Nampa', '', '', 'HCFA|UB|', '1386616183', 0, 'N', 0, '2014-03-20', NULL, NULL, 43.5976, -116.517, NULL, NULL),
('820299231', 'W12014139', 'W12014139', 'ID02', 'Saltzer Medical Group-Sleep', 'Keith', 'G', 'Holley', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '7272 W Potomac Dr', 'Boise', 'Ada', 'ID', '83704', '2084633000', '2084633044', '7272 W Potomac Dr', 'Boise', 'Ada', 'ID', '83704', '2084633000', '2084633044', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-08-29', '2012-11-11', 0, 0, 1, 'Saint Alphonsus Regional Medical Center', 'Saint Alphonsus Medical Center Nampa', '', '', 'HCFA|UB|', '1386616183', 0, 'N', 0, '2014-03-20', NULL, NULL, 0, 0, NULL, NULL),
('820299260', 'W12014145', 'W12014145', 'ID02', 'West Idaho Orthopedic & Sports Medicine', 'Michael', '', 'Shevlin', 'MD; General, Shoulder, Jnt Replace/Reconst', 'Orthopedic Surgery', '', '', NULL, 'O', '1202 E Locust St', 'Emmett', 'Gem', 'ID', '83617', '2084594511', '2084596602', '1202 E Locust St', 'Emmett', 'Gem', 'ID', '83617', '2084594511', '2084596602', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-08-29', NULL, 0, 0, 1, 'West Valley Medical Center', '', '', '', 'HCFA|UB|', '1407075328', 0, 'N', 0, '2012-10-18', NULL, NULL, 43.8791, -116.485, NULL, NULL),
('820299260', 'W12014146', 'W12014146', 'ID02', 'West Idaho Orthopedic & Sports Medicine', 'Michael', '', 'Shevlin', 'MD; General, Shoulder, Jnt Replace/Reconst', 'Orthopedic Surgery', '', '', NULL, 'O', '1210 NW 16th St', 'Fruitland', 'Payette', 'ID', '83619', '2084594511', '2084596602', '1210 NW 16th St', 'Fruitland', 'Payette', 'ID', '83619', '2084594511', '2084596602', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-08-29', NULL, 0, 0, 1, 'West Valley Medical Center', '', '', '', 'HCFA|UB|', '1407075328', 0, 'N', 0, '2012-10-18', NULL, NULL, 0, 0, NULL, NULL),
('820299260', 'W12014143', 'W12014143', 'ID02', 'West Idaho Orthopedic & Sports Medicine', 'Michael', '', 'Shevlin', 'MD; General, Shoulder, Jnt Replace/Reconst', 'Orthopedic Surgery', '', '', NULL, 'O', '206 E Elm', 'Caldwell', 'Canyon', 'ID', '83605', '2084594511', '2084596602', '206 E Elm', 'Caldwell', 'Canyon', 'ID', '83605', '2084594511', '2084596602', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-08-29', NULL, 0, 0, 1, 'West Valley Medical Center', '', '', '', 'HCFA|UB|', '1407075328', 0, 'N', 0, '2012-10-18', NULL, NULL, 0, 0, NULL, NULL),
('820299260', 'W12014144', 'W12014144', 'ID02', 'West Idaho Orthopedic & Sports Medicine', 'Michael', '', 'Shevlin', 'MD; General, Shoulder, Jnt Replace/Reconst', 'Orthopedic Surgery', '', '', NULL, 'O', '3875 E Overland', 'Meridian', 'Ada', 'ID', '83642', '2088950888', '2084596602', '3875 E Overland', 'Meridian', 'Ada', 'ID', '83642', '2088950888', '2084596602', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-08-29', NULL, 0, 0, 1, 'West Valley Medical Center', '', '', '', 'HCFA|UB|', '1407075328', 0, 'N', 0, '2012-10-18', NULL, NULL, 0, 0, NULL, NULL),
('830327475', 'W12014148', 'W12014148', 'WYT2', 'Physical Therapy/Health & Wellness Center', '', '', 'Evanston Regional Hospital - PT', 'GROUP', 'Physical Therapy', '', '', NULL, 'O', '196 Arrowhead Dr Ste 3', 'Evanston', 'Uinta', 'WY', '82930', '3077838220', '3077838217', '196 Arrowhead Dr Ste 3', 'Evanston', 'Uinta', 'WY', '82930', '3077838220', '3077838217', '', '', '', '0.00', '100.00', '58.00', 6, '2011-09-15', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '0000006170', 0, 'N', 0, '2011-09-20', NULL, NULL, 0, 0, NULL, NULL),
('830327475', 'W12014149', 'W12014149', 'WY01', 'Bridger Valley Physical Therapy Clinic', '', '', 'Evanston Regional Hospital - PT', 'GROUP', 'Physical Therapy', '', '', NULL, 'O', '531 Pkwy Dr', 'Mountain View', 'Uinta', 'WY', '82939', '3077827574', '3077827625', '531 Pkwy Dr', 'Mountain View', 'Uinta', 'WY', '82939', '3077827574', '3077827625', '', '', '', '0.00', '100.00', '58.00', 6, '2011-09-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000006170', 0, 'N', 0, '2011-09-20', NULL, NULL, 41.2702, -110.337, NULL, NULL),
('830327475', 'W12014150', 'W12014150', 'WYT2', 'Bridger Valley Physical Therapy Clinic', '', '', 'Evanston Regional Hospital - PT', 'GROUP', 'Physical Therapy', '', '', NULL, 'O', '531 Pkwy Dr', 'Mountain View', 'Uinta', 'WY', '82939', '3077827574', '3077827625', '531 Pkwy Dr', 'Mountain View', 'Uinta', 'WY', '82939', '3077827574', '3077827625', '', '', '', '0.00', '100.00', '58.00', 6, '2011-09-15', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '0000006170', 0, 'N', 0, '2011-09-20', NULL, NULL, 0, 0, NULL, NULL),
('331064921', 'W12014153', 'W12014153', 'UT01', '', 'Ryan', 'K', 'Anderson', 'DPM', 'Podiatry', '', '', NULL, 'O', '1551 S Renaissance Towne Dr Ste 370', 'Bountiful', 'Davis', 'UT', '84010', '8012924425', '8013971938', '1551 S Renaissance Towne Dr Ste 370', 'Bountiful', 'Davis', 'UT', '84010', '8012924425', '8013971938', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-09-14', NULL, 0, 0, 0, 'Lakeview Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1053334730', 0, 'N', 0, '2014-03-13', NULL, NULL, 40.8737, -111.888, NULL, NULL),
('546789274', 'W12014155', 'W12014155', 'NM01', '', 'Gregory', 'E', 'Cannon', 'DC', 'Chiropractic', '', '', NULL, 'O', '8002 Menaul NE', 'Albuquerque', 'Bernalillo', 'NM', '87110', '5052947646', NULL, '8002 Menaul NE', 'Albuquerque', 'Bernalillo', 'NM', '87110', '5052947646', '', 'NMCHIRO', '', '', '0.00', '0.00', '35.00', 3, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1790791911', 0, 'N', 0, '2014-05-08', NULL, NULL, 35.1091, -106.556, NULL, NULL),
('263829375', 'W12014163', 'W12014163', 'UT01', 'Cedar Dermatology', 'Rand', 'L', 'Colbert', 'MD', 'Dermatology', 'Pathology', '', NULL, 'O', '126 S White Sage Ave', 'Delta', 'Millard', 'UT', '84624', '4358645113', '4358644186', '126 S White Sage Ave', 'Delta', 'Millard', 'UT', '84624', '4358645113', '4358644186', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-09-14', NULL, 0, 0, 0, 'Valley View Medical Center', '', '', '', 'HCFA|UB|', '1073692380', 0, 'N', 0, '2011-09-20', NULL, NULL, 39.3506, -112.56, NULL, NULL),
('263829375', 'W12014164', 'W12014164', 'UT01', 'Cedar Dermatology', 'Rand', 'L', 'Colbert', 'MD', 'Dermatology', 'Pathology', '', NULL, 'O', '700 S Hwy 99', 'Fillmore', 'Millard', 'UT', '84631', '4357435555', '4357435764', '700 S Hwy 99', 'Fillmore', 'Millard', 'UT', '84631', '4357435555', '4357435764', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-09-14', NULL, 0, 0, 0, 'Valley View Medical Center', '', '', '', 'HCFA|UB|', '1073692380', 0, 'N', 0, '2011-09-20', NULL, NULL, 38.953, -112.341, NULL, NULL),
('411536255', 'W12014167', 'W12014167', 'UT01', '', 'Gary', 'A', 'Green', 'DPM', 'Podiatry', '', '', NULL, 'O', '670 W Shepard Ln Ste 102', 'Farmington', 'Davis', 'UT', '84025', '8014517500', NULL, '670 W Shepard Ln Ste 102', 'Farmington', 'Davis', 'UT', '84025', '8014517500', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-09-14', NULL, 0, 0, 0, 'Lakeview Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1801896816', 0, 'N', 0, '2014-02-26', NULL, NULL, 41.0008, -111.902, NULL, NULL),
('870767026', 'W12011768', 'W12011768', 'ID01', 'West Valley Medical Group', 'Steven', 'L', 'Fuller', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 277976', 'Atlanta', 'Fulton', 'GA', '30384', '2087955075', '2084426520', 'PO Box 277976', 'Atlanta', 'Fulton', 'GA', '30384', '2087955075', '2084426520', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2011-09-01', '2012-08-19', 0, 0, 0, 'West Valley Medical Center', '', '', '', 'HCFA|UB|', '1760423438', 0, 'N', 0, '2012-07-05', NULL, NULL, 0, 0, NULL, NULL),
('870767026', 'W12011767', 'W12011767', 'ID01', 'West Valley Medical Group', 'Steven', 'L', 'Fuller', 'MD', 'Internal Medicine', '', '', NULL, 'O', '16459 N Midland Blvd', 'Nampa', 'Canyon', 'ID', '83687', '2087955075', '2084426520', '16459 N Midland Blvd', 'Nampa', 'Canyon', 'ID', '83687', '2087955075', '2084426520', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2011-09-01', '2012-08-19', 0, 0, 0, 'West Valley Medical Center', '', '', '', 'HCFA|UB|', '1760423438', 0, 'N', 0, '2012-07-05', NULL, NULL, 43.6116, -116.593, NULL, NULL),
('870767026', 'W12011766', 'W12011766', 'ID01', 'West Valley Medical Group', 'Steven', 'L', 'Fuller', 'MD', 'Internal Medicine', '', '', NULL, 'O', '211 E Logan St Ste 303', 'Caldwell', 'Canyon', 'ID', '83605', '2087955201', '2084593372', '211 E Logan St Ste 303', 'Caldwell', 'Canyon', 'ID', '83605', '2087955201', '2084593372', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2011-09-01', '2012-08-19', 0, 0, 0, 'West Valley Medical Center', '', '', '', 'HCFA|UB|', '1760423438', 0, 'N', 0, '2012-07-05', NULL, NULL, 43.6554, -116.697, NULL, NULL),
('850421589', 'W12014174', 'W12014174', 'NM01', '', 'Katherine', 'J', 'Abernathy-Carver', 'MD', 'Allergy and Immunology', '', '', NULL, 'O', '2509 Virginia NE Ste B', 'Albuquerque', 'Bernalillo', 'NM', '87110', '5052941471', '5052937148', '2509 Virginia NE Ste B', 'Albuquerque', 'Bernalillo', 'NM', '87110', '5052941471', '5052937148', 'NMSPEC1', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1437158664', 0, 'N', 0, '2012-03-27', NULL, NULL, 35.1094, -106.553, NULL, NULL),
('850449232', 'W12014182', 'W12014182', 'NM01', 'Podiatry Associates of New Mexico', 'Shanti', '', 'Balkissoon-Castillo', 'DPM', 'Podiatry', '', '', NULL, 'O', '8300 Carmel NE Ste 501', 'Albuquerque', 'Bernalillo', 'NM', '87122', '5057971001', '5058281571', '8300 Carmel NE Ste 501', 'Albuquerque', 'Bernalillo', 'NM', '87122', '5057971001', '5058281571', 'NMSPEC1', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1063418556', 0, 'N', 0, '2011-10-19', NULL, NULL, 35.1757, -106.552, NULL, NULL),
('820470652', 'W12014185', 'W12014185', 'ID02', 'Riverside Rehab', 'Tori', '', 'Beauclaire', 'LPCP', 'Mental Health', 'Counseling', '', NULL, 'O', '7735 W Riverside Dr', 'Garden City', 'Ada', 'ID', '83714', '2088538536', NULL, '7735 W Riverside Dr', 'Garden City', 'Ada', 'ID', '83714', '2088538536', '          ', 'IDMA', '', '', '0.00', '35.00', '0.00', 3, '2011-11-15', '2013-02-14', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1366517401', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('200971948', 'W12014186', 'W12014186', 'NM01', '', 'Ping', '', 'Chen', 'DOM', 'Acupuncture', '', '', NULL, 'O', '5000 Cutler Ave NE Ste A', 'Albuquerque', 'Bernalillo', 'NM', '87110', '5058886700', '5058886701', '5000 Cutler Ave NE Ste A', 'Albuquerque', 'Bernalillo', 'NM', '87110', '5058886700', '5058886701', '', '', '', '0.00', '0.00', '75.00', 3, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1194898239', 0, 'N', 0, '2011-10-12', NULL, NULL, 35.1055, -106.59, NULL, NULL),
('800302819', 'W12014309', 'W12014309', 'NM01', 'Albuquerque Associated Podiatrists', 'Mark', '', 'Haas', 'DPM', 'Podiatry', '', '', NULL, 'O', '8080 Academy NE Ste C', 'Albuquerque', 'Bernalillo', 'NM', '87111', '5052474164', '5052474561', '8080 Academy NE Ste C', 'Albuquerque', 'Bernalillo', 'NM', '87111', '5052474164', '5052474561', 'NMSPEC1', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1790782837', 0, 'N', 0, '2011-12-19', NULL, NULL, 35.1481, -106.549, NULL, NULL),
('820496280', 'W12014201', 'W12014201', 'ID01', 'Dermatology Clinic of ID', 'Naomi', '', 'Brooks', 'MD', 'Dermatology', '', '', NULL, 'O', '271 Duffers Ln', 'Cascade', 'Valley', 'ID', '83611', '2089394599', '2083227370', '271 Duffers Ln', 'Cascade', 'Valley', 'ID', '83611', '2089394599', '2083227370', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-01-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1972653566', 0, 'N', 0, '2013-07-02', NULL, NULL, 44.5085, -116.058, NULL, NULL),
('820496280', 'W12014200', 'W12014200', 'ID01', 'Dermatology Clinic of ID', 'Naomi', '', 'Brooks', 'MD', 'Dermatology', '', '', NULL, 'O', '661 S Rivershore Ln Ste 130', 'Eagle', 'Ada', 'ID', '83616', '2089394599', '2083227370', '661 S Rivershore Ln Ste 130', 'Eagle', 'Ada', 'ID', '83616', '2089394599', '2083227370', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-01-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1972653566', 0, 'N', 0, '2011-12-19', NULL, NULL, 43.6886, -116.356, NULL, NULL),
('820496280', 'W12014199', 'W12014199', 'ID01', 'Dermatology Clinic of ID', 'Naomi', '', 'Brooks', 'MD', 'Dermatology', '', '', NULL, 'O', '7733 W Emerald', 'Boise', 'Ada', 'ID', '83704', '2089394599', '2083227370', '7733 W Emerald', 'Boise', 'Ada', 'ID', '83704', '2089394599', '2083227370', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-01-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1972653566', 0, 'N', 0, '2011-12-19', NULL, NULL, 43.6127, -116.278, NULL, NULL),
('260553931', 'W12014202', 'W12014202', 'ID01', 'Saint Alphonsus Medical Group Heart Care Garrity', 'Michael', 'A', 'Codina', 'MD', 'Cardiology', '', '', NULL, 'B', '3340 E Goldstone', 'Meridian', 'Ada', 'ID', '83642', '2083675170', NULL, '3340 E Goldstone', 'Meridian', 'Ada', 'ID', '83642', '2083675170', '', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2011-07-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', 'Saint Alphonsus Regional Medical Center', '', '', 'HCFA|UB|', '1871540708', 0, 'N', 0, '2014-07-09', NULL, NULL, 0, 0, NULL, NULL),
('460500210', 'W12014203', 'W12014203', 'ID01', 'Saint Alphonsus Oncology Physician Services', 'Laura', 'L', 'Asaro', 'NP-C', 'Oncology', 'Hematology and Oncology', 'Orthopedic Surgery', NULL, 'O', '1512 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2082884679', NULL, '1512 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2082884679', '', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2011-08-08', '2012-08-19', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1003916636', 0, 'N', 0, '2014-05-28', NULL, NULL, 43.5537, -116.573, NULL, NULL),
('460500210', 'W12014204', 'W12014204', 'ID01', 'Saint Alphonsus Outpatient Trauma Services', 'Steven', 'R', 'Casos', 'MD', 'General Surgery', '', '', NULL, 'O', '1512 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2082884679', '2083676849', '1512 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2082884679', '2083676849', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2011-07-19', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1609849959', 0, 'N', 0, '2013-07-18', NULL, NULL, 43.5537, -116.573, NULL, NULL),
('820200895', 'W12014206', 'W12014206', 'ID01', 'Saint Alphonsus Medical Group General Surgery Nampa', 'Derek', '', 'Derkacs', 'PA', 'Urology', 'General Surgery', '', NULL, 'O', '1603 12th Ave Rd Ste E', 'Nampa', 'Canyon', 'ID', '83686', '2084656940', '2084656949', '1603 12th Ave Rd Ste E', 'Nampa', 'Canyon', 'ID', '83686', '2084656940', '2084656949', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 3, '2011-08-31', '2012-03-03', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, '', '', 'HCFA|', '1720157720', 0, 'N', 0, '2013-12-10', NULL, NULL, 0, 0, NULL, NULL),
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('272481635', 'W12014208', 'W12014208', 'ID02', 'Saint Alphonsus Medical Center Nampa', 'Stephen', 'J', 'Focht', 'MD', 'Hospitalist', '', '', NULL, 'O', '1215 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2536821710', '2532841881', '1215 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2536821710', '2532841881', 'IDACN', '', '', '0.00', '15.00', '0.00', 6, '2011-07-26', '2012-09-01', 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1043288004', 0, 'N', 0, '2012-10-29', NULL, NULL, 0, 0, NULL, NULL),
('460500210', 'W12014211', 'W12014211', 'ID01', 'Saint Alphonsus Oncology Physician Services ', 'Alan', 'B', 'Grossett', 'MD', 'Hematology and Oncology', '', '', NULL, 'O', '1717 Arlington Ave', 'Caldwell', 'Canyon', 'ID', '83605', '2082884679', '2083673174', '1717 Arlington Ave', 'Caldwell', 'Canyon', 'ID', '83605', '2082884679', '2083673174', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2011-05-26', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1689667263', 0, 'N', 0, '2013-05-07', NULL, NULL, 0, 0, NULL, NULL),
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('260553931', 'W12014213', 'W12014213', 'ID01', 'Saint Alphonsus Medical Group Coughlin Clinic Boise ', 'Christopher', 'B', 'Hirose', 'MD; Foot/Ankle', 'Orthopedic Surgery', NULL, NULL, NULL, 'O', '1075 N Curtis Rd Ste 300', 'Boise', 'Ada', 'ID', '83706', '2083673330', '2083673331', '1075 N Curtis Rd Ste 300', 'Boise', 'Ada', 'ID', '83706', '2083673330', '2083673331', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2011-07-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1437111267', 0, 'N', 0, '2013-09-17', NULL, NULL, 43.6143, -116.258, NULL, NULL),
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('460500210', 'W12014215', 'W12014215', 'ID01', 'Saint Alphonsus Oncology Physician Services ', 'Stephanie', 'B', 'Hodson', 'MD', 'Hematology and Oncology', 'Oncology', '', NULL, 'O', '1717 Arlington Ave', 'Caldwell', 'Canyon', 'ID', '83605', '2083673131', '2083673174', '1717 Arlington Ave', 'Caldwell', 'Canyon', 'ID', '83605', '2083673131', '2083673174', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2011-01-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', 'West Valley Medical Center', 'Saint Alphonsus Medical Center Nampa', 'HCFA|UB|', '1265478374', 0, 'N', 0, '2014-05-28', NULL, NULL, 0, 0, NULL, NULL),
('260553931', 'W12014216', 'W12014216', 'ID01', 'Saint Alphonsus Medical Group Coughlin Clinic Boise ', 'Travis', 'J', 'Kemp', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1075 N Curtis Rd Ste 300', 'Boise', 'Ada', 'ID', '83706', '2083673330', '2083673331', '1075 N Curtis Rd Ste 300', 'Boise', 'Ada', 'ID', '83706', '2083673330', '2083673331', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2011-07-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1669607172', 0, 'N', 0, '2014-01-06', NULL, NULL, 43.6143, -116.258, NULL, NULL),
('460500210', 'W12014218', 'W12014218', 'ID01', 'Saint Alphonsus Oncology Physician Services ', 'Alan', 'D', 'Langerak', 'MD', 'Hematology and Oncology', 'Oncology', '', NULL, 'O', '1512 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2082884679', '2083673174', '1512 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2082884679', '2083673174', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2011-08-08', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1902853294', 0, 'N', 0, '2014-05-28', NULL, NULL, 43.5537, -116.573, NULL, NULL),
('460500210', 'W12014219', 'W12014219', 'ID01', 'Saint Alphonsus Oncology Physician Services ', 'Alan', 'D', 'Langerak', 'MD', 'Hematology and Oncology', 'Oncology', '', NULL, 'O', '1717 Arlington Ave', 'Caldwell', 'Canyon', 'ID', '83605', '2082884679', '2083673174', '1717 Arlington Ave', 'Caldwell', 'Canyon', 'ID', '83605', '2082884679', '2083673174', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2011-08-08', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1902853294', 0, 'N', 0, '2014-05-28', NULL, NULL, 0, 0, NULL, NULL),
('460500210', 'W12014221', 'W12014221', 'ID01', 'Saint Alphonsus Trauma Physician Services', 'Rhoda', '', 'Linch', 'PAC', 'Family Practice', '', '', NULL, 'B', 'PO Box 9589', 'Boise', 'Ada', 'ID', '83707', '2084728111', NULL, 'PO Box 9589', 'Boise', 'Ada', 'ID', '83707', '2084728111', '', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2011-08-29', '2013-01-21', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1700164092', 0, 'N', 0, '2014-06-20', NULL, NULL, 0, 0, NULL, NULL),
('260553931', 'W12014222', 'W12014222', 'ID01', 'Saint Alphonsus Medical Group Hip & Knee Recon ', 'Dennis', '', 'McGee', 'MD; Jnt Replace/Reconst', 'Orthopedic Surgery', '', '', NULL, 'O', '1075 N Curtis Rd Ste 300', 'Boise', 'Ada', 'ID', '83706', '2083673330', '2083673331', '1075 N Curtis Rd Ste 300', 'Boise', 'Ada', 'ID', '83706', '2083673330', '2083673331', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2011-07-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1679584577', 0, 'N', 0, '2014-07-09', NULL, NULL, 43.6143, -116.258, NULL, NULL),
('460500210', 'W12014223', 'W12014223', 'ID01', 'Saint Alphonsus Trauma Physician Services', 'Billy', 'R', 'Morgan', 'MD', 'General Surgery', '', '', NULL, 'O', '1215 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2082884679', NULL, '1215 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2082884679', '', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2011-07-19', '2011-07-09', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1891747663', 0, 'N', 0, '2014-07-09', NULL, NULL, 0, 0, NULL, NULL),
('460500210', 'W12014224', 'W12014224', 'ID01', 'Saint Alphonsus Trauma Physician Services', 'Aziz', 'G', 'Munayirji', 'MD', 'General Surgery', '', '', NULL, 'O', '1215 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2082884679', NULL, '1215 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2082884679', '0         ', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2011-07-19', '2011-07-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1003869629', 0, 'N', 0, '2013-11-22', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12014226', 'W12014226', 'ID01', 'Saint Alphonsus Medical Group Pulmonary & Sleep Boise ', 'Anil', '', 'Patel', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1075 N Curtis Ste 200 Bldg 6 Ste 201', 'Boise', 'Ada', 'ID', '83704', '2083678333', '2083672003', '1075 N Curtis Ste 200 Bldg 6 Ste 201', 'Boise', 'Ada', 'ID', '83704', '2083678333', '2083672003', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2011-08-29', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1356350664', 0, 'N', 0, '2014-06-20', NULL, NULL, 43.6143, -116.258, NULL, NULL),
('820200895', 'W12014228', 'W12014228', 'ID01', 'Saint Alphonsus Medical Group Pulmonary & Sleep Nampa', 'Anil', '', 'Patel', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1512 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2084671171', '2084635050', '1512 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2084671171', '2084635050', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2011-08-29', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1356350664', 0, 'N', 0, '2014-06-20', NULL, NULL, 43.5537, -116.573, NULL, NULL),
('820200895', 'W12014229', 'W12014229', 'ID01', 'Saint Alphonsus Medical Group Pulmonary & Sleep Boise ', 'Anil', '', 'Patel', 'MD', 'Internal Medicine', '', '', NULL, 'B', '3340 E Goldstone', 'Meridian', 'Ada', 'ID', '83642', '2083675170', '2083672003', '3340 E Goldstone', 'Meridian', 'Ada', 'ID', '83642', '2083675170', '2083672003', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2011-08-29', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1356350664', 0, 'N', 0, '2014-06-20', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12014227', 'W12014227', 'ID01', 'Saint Alphonsus Medical Group Pulmonary & Sleep Boise ', 'Anil', '', 'Patel', 'MD', 'Internal Medicine', '', '', NULL, 'O', '6140 W Curtisian Ste B10', 'Boise', 'Ada', 'ID', '83704', '2083678333', '2083672003', '6140 W Curtisian Ste B10', 'Boise', 'Ada', 'ID', '83704', '2083678333', '2083672003', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2011-08-29', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1356350664', 0, 'N', 0, '2014-06-20', NULL, NULL, 43.6151, -116.256, NULL, NULL),
('820312175', 'W12014232', 'W12014232', 'ID01', 'Idaho Emergency Physicians PA', 'Kari', '', 'Peterson', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83704', '2083221730', '2083221731', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83704', '2083221730', '2083221731', 'IDSAMG3', '', '', '0.00', '10.00', '0.00', 3, '2011-08-29', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', 'West Valley Medical Center', NULL, NULL, 'HCFA|UB|', '1346363694', 0, 'N', 0, '2012-01-31', NULL, NULL, 43.6145, -116.254, NULL, NULL),
('820312175', 'W12014234', 'W12014234', 'ID01', 'Idaho Emergency Physicians PA', 'Kari', '', 'Peterson', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '1717 Arlington', 'Caldwell', 'Canyon', 'ID', '83605', '2083221730', '2083221731', '1717 Arlington', 'Caldwell', 'Canyon', 'ID', '83605', '2083221730', '2083221731', 'IDSAMG3', '', '', '0.00', '10.00', '0.00', 3, '2011-08-29', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', 'West Valley Medical Center', NULL, NULL, 'HCFA|UB|', '1346363694', 0, 'N', 0, '2012-01-31', NULL, NULL, 43.6542, -116.696, NULL, NULL),
('820312175', 'W12014235', 'W12014235', 'ID01', 'Idaho Emergency Physicians PA', 'Kari', '', 'Peterson', 'MD', 'Emergency Medicine', '', '', NULL, 'B', '2963 E Copper Point Dr', 'Meridian', 'Ada', 'ID', '83642', '2083221730', '2083221731', '2963 E Copper Point Dr', 'Meridian', 'Ada', 'ID', '83642', '2083221730', '2083221731', 'IDSAMG3', '', '', '0.00', '10.00', '0.00', 3, '2011-08-29', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', 'West Valley Medical Center', NULL, NULL, 'HCFA|UB|', '1346363694', 0, 'N', 0, '2012-01-31', NULL, NULL, 0, 0, NULL, NULL),
('820312175', 'W12014233', 'W12014233', 'ID01', 'Idaho Emergency Physicians PA', 'Kari', '', 'Peterson', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '323 E Riverside Dr', 'Eagle', 'Ada', 'ID', '83616', '2083221730', '2083221731', '323 E Riverside Dr', 'Eagle', 'Ada', 'ID', '83616', '2083221730', '2083221731', 'IDSAMG3', '', '', '0.00', '10.00', '0.00', 3, '2011-08-29', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', 'West Valley Medical Center', NULL, NULL, 'HCFA|UB|', '1346363694', 0, 'N', 0, '2012-01-31', NULL, NULL, 43.6896, -116.35, NULL, NULL),
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('460500210', 'W12014238', 'W12014238', 'ID01', 'Saint Alphonsus Oncology Physician Services ', 'Andrew', '', 'Pierson', 'MD', 'Hematology and Oncology', 'Oncology', '', NULL, 'O', '1717 Arlington Ave', 'Caldwell', 'Canyon', 'ID', '83605', '2082884679', '2082884679', '1717 Arlington Ave', 'Caldwell', 'Canyon', 'ID', '83605', '2082884679', '2082884679', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2011-08-08', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1992760664', 0, 'N', 0, '2014-05-28', NULL, NULL, 0, 0, NULL, NULL),
('460500210', 'W12014239', 'W12014239', 'ID01', 'Saint Alphonsus Oncology Physician Services ', 'Andrew', '', 'Pierson', 'MD', 'Hematology and Oncology', 'Oncology', '', NULL, 'B', 'PO Box 9589', 'Boise', 'Ada', 'ID', '83707', '2084728115', '2082884679', 'PO Box 9589', 'Boise', 'Ada', 'ID', '83707', '2084728115', '2082884679', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2011-08-08', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1992760664', 0, 'N', 0, '2014-05-28', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12014240', 'W12014240', 'ID01', 'Saint Alphonsus Medical Group Elm Family Medicine', 'Samantha', 'J', 'Portenier', 'MD', 'Family Practice', '', '', NULL, 'O', '4400 E Flamingo Ste 301', 'Nampa', 'Canyon', 'ID', '83687', '2084656900', '2084656910', '4400 E Flamingo Ste 301', 'Nampa', 'Canyon', 'ID', '83687', '2084656900', '2084656910', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2011-08-05', '2012-08-19', 0, 0, 0, 'West Valley Medical Center', '', '', '', 'HCFA|', '1356385132', 0, 'N', 0, '2014-06-20', NULL, NULL, 43.5976, -116.517, NULL, NULL),
('460500210', 'W12014241', 'W12014241', 'ID01', 'Saint Alphonsus Oncology Physician Services', 'Kerry', 'P', 'Pulver', 'MD', 'Hematology and Oncology', 'Oncology', '', NULL, 'O', '1512 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2082884679', '2083673174', '1512 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2082884679', '2083673174', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2011-08-08', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', 'West Valley Medical Center', 'Saint Alphonsus Medical Center Nampa', 'HCFA|UB|', '1376596247', 0, 'N', 0, '2014-05-28', NULL, NULL, 43.5537, -116.573, NULL, NULL),
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('820200895', 'W12014243', 'W12014243', 'ID01', 'Saint Alphonsus Medical Group NHP Family Medicine', 'Michael', 'L', 'Roach', 'MD', 'Family Practice', '', '', NULL, 'O', '4400 E Flamingo Ste 301', 'Nampa', 'Canyon', 'ID', '83687', '2084656900', '2084656910', '4400 E Flamingo Ste 301', 'Nampa', 'Canyon', 'ID', '83687', '2084656900', '2084656910', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2011-08-05', '2012-08-19', 0, 0, 0, 'West Valley Medical Center', NULL, NULL, NULL, 'HCFA|', '1528004389', 0, 'N', 0, '2013-09-05', NULL, NULL, 43.5976, -116.517, NULL, NULL),
('460500210', 'W12014244', 'W12014244', 'ID01', 'Saint Alphonsus Oncology Physician Services ', 'Karl', 'J', 'Schultheiss', 'MD', 'Hematology and Oncology', 'Oncology', '', NULL, 'O', '1512 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2082884679', '2083673174', '1512 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2082884679', '2083673174', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2011-08-08', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', 'West Valley Medical Center', 'Saint Alphonsus Medical Center Nampa', 'HCFA|UB|', '1265478325', 0, 'N', 0, '2014-05-28', NULL, NULL, 43.5537, -116.573, NULL, NULL),
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('460500210', 'W12014246', 'W12014246', 'ID01', 'Saint Alphonsus Oncology Physician Services ', 'Esther', '', 'Sears', 'NPC', 'Nurse Practitioner', '', '', NULL, 'O', '1512 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2082884679', '2083673174', '1512 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2082884679', '2083673174', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2011-08-08', '2012-07-13', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1932137684', 0, 'N', 0, '2012-09-07', NULL, NULL, 43.5537, -116.573, NULL, NULL),
('460500210', 'W12014247', 'W12014247', 'ID01', 'Saint Alphonsus Oncology Physician Services ', 'Jennifer', 'T', 'Shalz', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1512 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2082884679', NULL, '1512 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2082884679', '          ', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2011-08-08', '2011-10-05', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1245346303', 0, 'N', 0, '2012-07-23', NULL, NULL, 43.5537, -116.573, NULL, NULL),
('820200895', 'W12014249', 'W12014249', 'ID01', 'Saint Alphonsus Medical Group MHP Family Medicine ', 'Yelena', '', 'Shuey', 'PAC', 'Physician Assistant', '', '', NULL, 'B', '3340 E Goldstone Way', 'Meridian', 'Ada', 'ID', '83642', '2083675170', NULL, '3340 E Goldstone Way', 'Meridian', 'Ada', 'ID', '83642', '2083675170', '', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2011-08-29', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1124029939', 0, 'N', 0, '2014-04-18', NULL, NULL, 0, 0, NULL, NULL),
('460500210', 'W12014250', 'W12014250', 'ID01', 'Saint Alphonsus Trauma Physician Services', 'Harry', 'K', 'Stinger', 'MD', 'General Surgery', '', '', NULL, 'O', '1215 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2082884679', '2083673174', '1215 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2082884679', '2083673174', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2011-07-19', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1518935055', 0, 'N', 0, '2013-11-22', NULL, NULL, 0, 0, NULL, NULL),
('460500210', 'W12014251', 'W12014251', 'ID01', 'Saint Alphonsus Trauma Physician Services', 'Dale', '', 'Strawn', 'MD', 'General Surgery', '', '', NULL, 'O', '1215 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2083677676', '2083676849', '1215 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2083677676', '2083676849', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2011-07-19', '2011-07-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1518059427', 0, 'N', 0, '2013-11-22', NULL, NULL, 0, 0, NULL, NULL),
('460500210', 'W12014253', 'W12014253', 'ID01', 'Saint Alphonsus Oncology Physician Services', 'Holly', '', 'Swensen', 'NP', 'Hematology and Oncology', 'Oncology', '', NULL, 'O', '1512 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2082884679', '2083673174', '1512 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2082884679', '2083673174', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2011-06-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1386672012', 0, 'N', 0, '2014-06-20', NULL, NULL, 43.5537, -116.573, NULL, NULL),
('260553931', 'W12014254', 'W12014254', 'ID01', 'Saint Alphonsus Medical Group Neurosurgery Boise 503', 'Ann Marie', '', 'Yost', 'MD', 'Neurosurgery', '', '', NULL, 'O', '901 N Curtis Ste 503', 'Boise', 'Ada', 'ID', '83706', '2083674000', '2083674052', '901 N Curtis Ste 503', 'Boise', 'Ada', 'ID', '83706', '2083674000', '2083674052', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2011-09-05', '2012-04-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1730217704', 0, 'N', 0, '2012-03-29', NULL, NULL, 43.6126, -116.255, NULL, NULL),
('460500210', 'W12014256', 'W12014256', 'ID01', 'Saint Alphonsus Oncology Physician Services ', 'Bruce', 'H', 'Zietz', 'MD', 'Hematology and Oncology', '', '', NULL, 'O', '1512 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2082884679', '2083673174', '1512 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2082884679', '2083673174', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2011-08-08', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1184689002', 0, 'N', 0, '2012-11-16', NULL, NULL, 43.5537, -116.573, NULL, NULL),
('460500210', 'W12014257', 'W12014257', 'ID01', 'Saint Alphonsus Oncology Physician Services ', 'Bruce', 'H', 'Zietz', 'MD', 'Hematology and Oncology', '', '', NULL, 'O', '1717 Arlington Ave', 'Caldwell', 'Canyon', 'ID', '83605', '2082884679', '2083673174', '1717 Arlington Ave', 'Caldwell', 'Canyon', 'ID', '83605', '2082884679', '2083673174', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2011-08-08', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1184689002', 0, 'N', 0, '2012-11-16', NULL, NULL, 0, 0, NULL, NULL),
('460500210', 'W12014258', 'W12014258', 'ID01', 'Saint Alphonsus Oncology Physician Services ', 'Bruce', 'H', 'Zietz', 'MD', 'Hematology and Oncology', '', '', NULL, 'B', 'PO Box 9589', 'Boise', 'Ada', 'ID', '83708', '2084728115', '2083673174', 'PO Box 9589', 'Boise', 'Ada', 'ID', '83708', '2084728115', '2083673174', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2011-08-08', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1184689002', 0, 'N', 0, '2012-11-16', NULL, NULL, 0, 0, NULL, NULL),
('742412898', 'W12014260', 'W12014260', 'UT01', 'Oquirrh View Clinic', 'Benjamin', 'W', 'Cady', 'MD', 'Family Practice', '', '', NULL, 'B', '220 W 7200 S Ste A', 'Midvale', 'Salt Lake', 'UT', '84047', '8019646214', '8019829232', '220 W 7200 S Ste A', 'Midvale', 'Salt Lake', 'UT', '84047', '8019646214', '8019829232', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-03-01', '2012-07-17', 0, 0, 0, 'University Health Care University Hospital', '', '', '', 'HCFA|UB|', '1487899662', 0, 'N', 0, '2014-04-11', NULL, NULL, 0, 0, NULL, NULL),
('742412898', 'W12014259', 'W12014259', 'UT01', 'Oquirrh View Clinic', 'Benjamin', 'W', 'Cady', 'MD', 'Family Practice', '', '', NULL, 'O', '4745 S 3200 W', 'Taylorsville', 'Salt Lake', 'UT', '84118', '8019646214', '8019829232', '4745 S 3200 W', 'Taylorsville', 'Salt Lake', 'UT', '84118', '8019646214', '8019829232', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-03-01', '2012-07-17', 0, 0, 0, 'University Health Care University Hospital', '', '', '', 'HCFA|UB|', '1487899662', 0, 'N', 0, '2014-04-11', NULL, NULL, 40.6664, -111.967, NULL, NULL),
('273291370', 'W12014261', 'W12014261', 'ID02', 'Northwest Neurobehavioral Health', 'James', 'W', 'Connelly', 'PSYD', 'Mental Health', 'Psychology', '', NULL, 'O', '2076 S Eagle Rd', 'Meridian', 'Ada', 'ID', '83642', '2089557333', '2089557330', '2076 S Eagle Rd', 'Meridian', 'Ada', 'ID', '83642', '2089557333', '2089557330', 'IDPHD', '', '', '0.00', '35.00', '0.00', 3, '2011-11-15', '2013-02-14', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1841324332', 0, 'N', 0, '2011-11-10', NULL, NULL, 0, 0, NULL, NULL),
('820470652', 'W12014262', 'W12014262', 'ID02', 'Riverside Rehab', 'Gayle', 'J', 'Detweiler', 'PA', 'Mental Health', 'Psychiatry', '', NULL, 'O', '7735 W Riverside Dr', 'Garden City', 'Ada', 'ID', '83714', '2088538536', NULL, '7735 W Riverside Dr', 'Garden City', 'Ada', 'ID', '83714', '2088538536', '          ', 'IDMD', '', '', '0.00', '35.00', '0.00', 3, '2011-11-01', '2012-02-29', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1548339211', 0, 'N', 0, '2012-03-01', NULL, NULL, 0, 0, NULL, NULL),
('850449232', 'W12014263', 'W12014263', 'NM01', 'Podiatry Associates of New Mexico', 'Roderick', 'D', 'Farley', 'DPM', 'Podiatry', '', '', NULL, 'O', '8300 Carmel NE Ste 501', 'Albuquerque', 'Bernalillo', 'NM', '87122', '5057971001', '5058281571', '8300 Carmel NE Ste 501', 'Albuquerque', 'Bernalillo', 'NM', '87122', '5057971001', '5058281571', 'NMSPEC1', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1427294982', 0, 'N', 0, '2013-11-12', NULL, NULL, 35.1757, -106.552, NULL, NULL),
('543560339', 'W12014265', 'W12014265', 'UTMH1', '', 'Lauralee', 'L', 'Gardner', 'LMFT', 'Mental Health', 'Counseling', '', NULL, 'B', '123 W 1550 N', 'Bountiful', 'Davis', 'UT', '84010', '8012982000', '8019511490', '123 W 1550 N', 'Bountiful', 'Davis', 'UT', '84010', '8012982000', '8019511490', 'MA', '', '', '0.00', '35.00', '0.00', 3, '2011-11-10', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1730246521', 0, 'N', 0, '2013-09-23', NULL, NULL, 0, 0, NULL, NULL),
('543560339', 'W12014264', 'W12014264', 'UTMH1', '', 'Lauralee', 'L', 'Gardner', 'LMFT', 'Mental Health', 'Counseling', '', NULL, 'O', '386 N Main St', 'Centerville', 'Davis', 'UT', '84014', '8012982000', '8019511490', '386 N Main St', 'Centerville', 'Davis', 'UT', '84014', '8012982000', '8019511490', 'MA', '', '', '0.00', '35.00', '0.00', 3, '2011-11-10', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1730246521', 0, 'N', 0, '2013-09-23', NULL, NULL, 0, 0, NULL, NULL),
('841617523', 'W12014266', 'W12014266', 'NM01', 'Northside Family Medicine', 'Catherine ', 'A', 'Gray', 'NP', 'Family Practice', '', '', NULL, 'O', '6100 Pan American Fwy NE Ste 390', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058231805', '5058231844', '6100 Pan American Fwy NE Ste 390', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058231805', '5058231844', 'NMSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1558419887', 0, 'N', 0, '2011-10-13', NULL, NULL, 35.1537, -106.587, NULL, NULL),
('841617523', 'W12014267', 'W12014267', 'NM01', 'Northside Family Medicine', 'Heidi', 'H', 'Rogers', 'NP', 'Family Practice', '', '', NULL, 'O', '6100 Pan American Fwy NE Ste 390', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058231805', '5058231844', '6100 Pan American Fwy NE Ste 390', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058231805', '5058231844', 'NMSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, 'Lovelace Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1528042579', 0, 'N', 0, '2011-10-11', NULL, NULL, 35.1537, -106.587, NULL, NULL),
('841617523', 'W12014268', 'W12014268', 'NM01', 'Northside Family Medicine', 'P. James', '', 'Romero', 'NP', 'Family Practice', '', '', NULL, 'O', '6100 Pan American Fwy NE Ste 390', 'Albuquerque', 'Bernalillo', 'NM', '87105', '5058231805', '5058231844', '6100 Pan American Fwy NE Ste 390', 'Albuquerque', 'Bernalillo', 'NM', '87105', '5058231805', '5058231844', 'NMSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-11-01', '2013-10-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1396047957', 0, 'N', 0, '2013-10-04', NULL, NULL, 0, 0, NULL, NULL),
('841617523', 'W12014269', 'W12014269', 'NM01', 'Northside Family Medicine', 'Martha ', 'J', 'Kent', 'MD', 'Family Practice', '', '', NULL, 'O', '6100 Pan American Fwy NE Ste 390', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058231805', '5058231844', '6100 Pan American Fwy NE Ste 390', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058231805', '5058231844', 'NMSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1629001219', 0, 'N', 0, '2011-10-04', NULL, NULL, 35.1537, -106.587, 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
('841617523', 'W12014270', 'W12014270', 'NM01', 'Northside Family Medicine', 'Margaret ', 'W', 'Royson', 'DO', 'Family Practice', '', '', NULL, 'O', '6100 Pan American Fwy NE Ste 390', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058231805', '5058231844', '6100 Pan American Fwy NE Ste 390', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058231805', '5058231844', 'NMSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1902814023', 0, 'N', 0, '2011-10-17', NULL, NULL, 35.1537, -106.587, NULL, NULL),
('841617523', 'W12014271', 'W12014271', 'NM01', 'Northside Family Medicine', 'Laura ', 'R', 'Stern', 'MD', 'Family Practice', '', '', NULL, 'O', '6100 Pan American Fwy NE Ste 390', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058231805', '5058231844', '6100 Pan American Fwy NE Ste 390', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058231805', '5058231844', 'NMSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1336154460', 0, 'N', 0, '2011-10-14', NULL, NULL, 35.1537, -106.587, NULL, NULL),
('841617523', 'W12014272', 'W12014272', 'NM01', 'Northside Family Medicine', 'Virginia ', '', 'Valentine', 'NP', 'Family Practice', '', '', NULL, 'O', '6100 Pan American Fwy NE Ste 390', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058231805', '5058231844', '6100 Pan American Fwy NE Ste 390', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058231805', '5058231844', 'NMSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1740338086', 0, 'N', 0, '2011-10-14', NULL, NULL, 35.1537, -106.587, NULL, NULL),
('271550858', 'W12014273', 'W12014273', 'UT01', 'Alan Young Audiology ', 'Alan', '', 'Young', 'AUD', 'Audiology', NULL, NULL, NULL, 'O', '5642 S 980 E Ste 1', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8017130101', '8012621091', '5642 S 980 E Ste 1', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8017130101', '8012621091', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-11-10', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1588691380', 0, 'N', 0, '2013-11-15', NULL, NULL, 0, 0, NULL, NULL),
('830313108', 'W12014274', 'W12014274', 'WY01', 'Northern Wyoming Ophthalmology', 'Barry', 'P', 'Welch', 'MD', 'Ophthalmology', '', '', NULL, 'O', '424 Yellowstone Ave Ste 110', 'Cody', 'Park', 'WY', '82414', '3075875538', '3075874896', '424 Yellowstone Ave Ste 110', 'Cody', 'Park', 'WY', '82414', '3075875538', '3075874896', 'WYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-11-10', '2013-09-09', 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1437157484', 0, 'N', 0, '2013-07-30', NULL, NULL, 0, 0, NULL, NULL),
('020705251', 'W12014275', 'W12014275', 'WY01', 'Timberland Chiropractic', 'Richard', 'T', 'Guild', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '1050 N Hwy 414', 'Mountain View', 'Uinta', 'WY', '82939', '3077823180', '3077823181', '1050 N Hwy 414', 'Mountain View', 'Uinta', 'WY', '82939', '3077823180', '3077823181', 'WISEWYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1114947256', 0, 'N', 0, '2011-11-10', NULL, NULL, 41.2702, -110.337, NULL, NULL),
('020705251', 'W12014277', 'W12014277', 'WY01', 'Timberland Chiropractic', 'Richard', 'T', 'Guild', 'DC', 'Chiropractic', NULL, NULL, NULL, 'B', 'PO Box 895', 'Mountain View', 'Uinta', 'WY', '82939', '3077823180', '3077823181', 'PO Box 895', 'Mountain View', 'Uinta', 'WY', '82939', '3077823180', '3077823181', 'WISEWYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1114947256', 0, 'N', 0, '2011-11-10', NULL, NULL, 0, 0, NULL, NULL),
('020705251', 'W12014276', 'W12014276', 'WYT1', 'Timberland Chiropractic', 'Richard', 'T', 'Guild', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '1050 N Hwy 414', 'Mountain View', 'Uinta', 'WY', '82939', '3077823180', '3077823181', '1050 N Hwy 414', 'Mountain View', 'Uinta', 'WY', '82939', '3077823180', '3077823181', 'WISEWYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1114947256', 0, 'N', 0, '2011-11-10', NULL, NULL, 0, 0, NULL, NULL),
('020705251', 'W12014278', 'W12014278', 'WYT1', 'Timberland Chiropractic', 'Richard', 'T', 'Guild', 'DC', 'Chiropractic', NULL, NULL, NULL, 'B', 'PO Box 895', 'Mountain View', 'Uinta', 'WY', '82939', '3077823180', '3077823181', 'PO Box 895', 'Mountain View', 'Uinta', 'WY', '82939', '3077823180', '3077823181', 'WISEWYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1114947256', 0, 'N', 0, '2011-11-10', NULL, NULL, 0, 0, NULL, NULL),
('742835366', 'W12014279', 'W12014279', 'NM01', '', 'Linda', 'L', 'Hao', 'DOM', 'Acupuncture', '', '', NULL, 'O', '10151 Montgomery NE Ste 2A', 'Albuquerque', 'Bernalillo', 'NM', '87111', '5058229878', '5058229869', '10151 Montgomery NE Ste 2A', 'Albuquerque', 'Bernalillo', 'NM', '87111', '5058229878', '5058229869', '', '', '', '0.00', '0.00', '75.00', 3, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1669539821', 0, 'N', 0, '2011-10-17', NULL, NULL, 35.1307, -106.527, NULL, NULL),
('850236039', 'W12014350', 'W12014350', 'NM01', 'Beatty Chiropractic Center', 'Herbert', '', 'Beatty', 'DC', 'Chiropractic', '', '', NULL, 'O', '8004 Pennsylvania Cir NE', 'Albuquerque', 'Bernalillo', 'NM', '87110', '5052682465', '5052680820', '8004 Pennsylvania Cir NE', 'Albuquerque', 'Bernalillo', 'NM', '87110', '5052682465', '5052680820', 'NMCHIRO', 'WUSTDHCPC5', '', '0.00', '0.00', '38.00', 3, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1801873799', 0, 'N', 0, '2013-10-08', NULL, NULL, 35.0896, -106.558, NULL, NULL),
('204974140', 'W12014281', 'W12014281', 'WY01', 'Rocky Mountain Vein Clinic', 'Jonie', '', 'Hines', 'MD', 'Family Practice', '', '', NULL, 'O', '125 W Yellowstone Ave', 'Cody', 'Park', 'WY', '82414', '3075277129', '3075877394', '125 W Yellowstone Ave', 'Cody', 'Park', 'WY', '82414', '3075277129', '3075877394', '', '', '', '0.00', '7.00', '0.00', 3, '2011-11-10', NULL, 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1578507380', 0, 'N', 0, '2013-10-03', NULL, NULL, 44.5145, -109.1, NULL, NULL),
('204974140', 'W12014282', 'W12014282', 'WY01', 'Rocky Mountain Vein Clinic', 'Jonie', '', 'Hines', 'MD', 'Family Practice', '', '', NULL, 'O', '2800 Central Ave Ste A', 'Billings', 'Yellowstone', 'MT', '59102', '4062528346', '4066568303', '2800 Central Ave Ste A', 'Billings', 'Yellowstone', 'MT', '59102', '4062528346', '4066568303', '', '', '', '0.00', '7.00', '0.00', 3, '2011-11-10', NULL, 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1578507380', 0, 'N', 0, '2013-10-03', NULL, NULL, 45.7697, -108.586, NULL, NULL),
('204974140', 'W12014283', 'W12014283', 'WY01', 'Rocky Mountain Vein Clinic', 'Jonie', '', 'Hines', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 1155', 'Cody', 'Park', 'WY', '82414', '3075277129', '3075877394', 'PO Box 1155', 'Cody', 'Park', 'WY', '82414', '3075277129', '3075877394', '', '', '', '0.00', '7.00', '0.00', 3, '2011-11-10', NULL, 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1578507380', 0, 'N', 0, '2013-10-03', NULL, NULL, 0, 0, NULL, NULL),
('820470652', 'W12014285', 'W12014285', 'ID02', 'Professional Counseling Services', 'Evelynn', 'L', 'Horton', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '113 N Commercial', 'Emmett', 'Gem', 'ID', '83617', '2083988473', NULL, '113 N Commercial', 'Emmett', 'Gem', 'ID', '83617', '2083988473', '          ', 'IDMA', '', '', '0.00', '35.00', '0.00', 3, '2011-11-10', '2013-02-14', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1326368655', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('820470652', 'W12014284', 'W12014284', 'ID02', 'Riverside Rehab', 'Evelynn', 'L', 'Horton', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '7735 W Riverside Dr', 'Garden City', 'Ada', 'ID', '83714', '2088538536', NULL, '7735 W Riverside Dr', 'Garden City', 'Ada', 'ID', '83714', '2088538536', '          ', 'IDMA', '', '', '0.00', '35.00', '0.00', 3, '2011-11-10', '2012-02-29', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1326368655', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('272876802', 'W12014286', 'W12014286', 'UTMH1', 'Solutions Counseling and Consulting', 'Mary', '', 'Jarman', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '11487 S 700 E', 'Draper', 'Salt Lake', 'UT', '84020', '8016711020', '8015238476', '11487 S 700 E', 'Draper', 'Salt Lake', 'UT', '84020', '8016711020', '8015238476', 'UTMA', '', '', '0.00', '35.00', '0.00', 3, '2011-11-10', '2012-09-03', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1881648574', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('202800071', 'W12014287', 'W12014287', 'UTMH1', 'Alpine Center for Personal Growth', 'James ', 'G', 'Johnson', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '5689 S Redwood Rd Ste 30', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8012681715', '8012681783', '5689 S Redwood Rd Ste 30', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8012681715', '8012681783', 'UTMA', '', '', '0.00', '35.00', '0.00', 6, '2011-11-10', '2012-05-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1336317650', 0, 'N', 0, '2013-07-24', NULL, NULL, 0, 0, NULL, NULL),
('850449232', 'W12014288', 'W12014288', 'NM01', 'Podiatry Associates of New Mexico', 'Gerard', 'J', 'Kerbleski', 'DPM', 'Podiatry', '', '', NULL, 'O', '8300 Carmel NE Ste 501', 'Albuquerque', 'Bernalillo', 'NM', '87122', '5057971001', '5058281571', '8300 Carmel NE Ste 501', 'Albuquerque', 'Bernalillo', 'NM', '87122', '5057971001', '5058281571', 'NMSPEC1', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1366448839', 0, 'N', 0, '2011-10-04', NULL, NULL, 35.1757, -106.552, NULL, NULL),
('850373613', 'W12014289', 'W12014289', 'NM01', '', 'Bhalachandra', '', 'Kulkarni', 'MD', 'Family Practice', '', '', NULL, 'O', '12836 Lomas NE', 'Albuquerque', 'Bernalillo', 'NM', '87112', '5052980230', '5052960131', '12836 Lomas NE', 'Albuquerque', 'Bernalillo', 'NM', '87112', '5052980230', '5052960131', 'NMSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', '2012-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1609953272', 0, 'Y', 0, '2012-02-17', NULL, NULL, 0, 0, NULL, NULL),
('272752875', 'W12014290', 'W12014290', 'UT01', 'Hofmann Arthritis Institute ', 'Trevor', 'H', 'Magee', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '24 S 1100 E Ste 101 & 105', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013556468', '8013553450', '24 S 1100 E Ste 101 & 105', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013556468', '8013553450', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-11-10', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', '', '', '', 'HCFA|UB|', '1154543361', 0, 'N', 0, '2014-05-27', NULL, NULL, 40.7689, -111.86, NULL, NULL),
('272752875', 'W12014291', 'W12014291', 'UT01', 'Hofmann Arthritis Institute ', 'Trevor', 'H', 'Magee', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', 'PO Box 413062', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8017477265', '8017477237', 'PO Box 413062', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8017477265', '8017477237', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-11-10', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', '', '', '', 'HCFA|UB|', '1154543361', 0, 'N', 0, '2014-05-27', NULL, NULL, 0, 0, NULL, NULL),
('272589872', 'W12014292', 'W12014292', 'UT01', 'Mountain Land Rehabilitation Home Health', '', '', 'Mountain Land Rehabilitation Home Health', 'Group', 'Home Health Agency', '', '', NULL, 'O', '1952 E 7000 S', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8014955255', '8019433989', '1952 E 7000 S', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8014955255', '8019433989', '', '', '4', '0.00', '40.00', '0.00', 3, '2011-11-10', NULL, 1, 0, 0, '', '', '', '', 'HCFA|UB|', '1578882403', 0, 'N', 0, '2011-11-14', NULL, NULL, 40.6243, -111.836, NULL, NULL),
('452668976', 'W12014295', 'W12014295', 'UTMH1', '', 'Doug', 'E', 'Nielsen', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '2363 N Hillfield Rd Ste 5', 'Layton', 'Davis', 'UT', '84041', '8013914356', '8017797808', '2363 N Hillfield Rd Ste 5', 'Layton', 'Davis', 'UT', '84041', '8013914356', '8017797808', 'MA', '', '', '0.00', '35.00', '0.00', 3, '2011-11-10', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1003034240', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('452668976', 'W12014296', 'W12014296', 'UTMH1', 'LDS Family Services', 'Doug', 'E', 'Nielsen', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '930 W Hill Field Rd', 'Layton', 'Davis', 'UT', '84041', '8013363040', '8013363041', '930 W Hill Field Rd', 'Layton', 'Davis', 'UT', '84041', '8013363040', '8013363041', 'MA', '', '', '0.00', '35.00', '0.00', 3, '2011-11-10', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1003034240', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('528176534', 'W12014298', 'W12014298', 'UTMH1', '', 'Cindie ', '', 'Parker', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', '123 W 1550 N', 'Centerville', 'Davis', 'UT', '84014', '8012982000', '8019511490', '123 W 1550 N', 'Centerville', 'Davis', 'UT', '84014', '8012982000', '8019511490', 'MA', '', '', '0.00', '35.00', '0.00', 3, '2011-11-10', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1669623765', 0, 'N', 0, '2013-09-23', NULL, NULL, 0, 0, NULL, NULL),
('528176534', 'W12014297', 'W12014297', 'UTMH1', '', 'Cindie ', '', 'Parker', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '386 N Main St', 'Centerville', 'Davis', 'UT', '84014', '8012982000', '8019511490', '386 N Main St', 'Centerville', 'Davis', 'UT', '84014', '8012982000', '8019511490', 'MA', '', '', '0.00', '35.00', '0.00', 3, '2011-11-10', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1669623765', 0, 'N', 0, '2013-09-23', NULL, NULL, 0, 0, NULL, NULL),
('850439578', 'W12014299', 'W12014299', 'NM01', 'Family Physicians of Albuquerque', 'Donald ', 'E', 'Pichler', 'MD', 'Family Practice', '', '', NULL, 'O', '3825 Eubank NE', 'Albuquerque', 'Bernalillo', 'NM', '87111', '5052924080', '5052921839', '3825 Eubank NE', 'Albuquerque', 'Bernalillo', 'NM', '87111', '5052924080', '5052921839', 'NMSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', '2012-01-01', 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1861434342', 0, 'N', 1, '2012-07-31', NULL, NULL, 0, 0, NULL, NULL),
('870639748', 'W12014300', 'W12014300', 'UT01', 'Hoopes Vision Correction Center', 'Robert', 'P', 'Rivera', 'MD', 'Ophthalmology', '', '', NULL, 'O', '10011 Centennial Pkwy Ste 400', 'Sandy', 'Salt Lake', 'UT', '84070', '8015680200', '8015630200', '10011 Centennial Pkwy Ste 400', 'Sandy', 'Salt Lake', 'UT', '84070', '8015680200', '8015630200', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-03-01', '2012-11-28', 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1982759122', 0, 'N', 0, '2013-01-04', NULL, NULL, 0, 0, NULL, NULL),
('870639748', 'W12014301', 'W12014301', 'UT01', 'Hoopes Vision Correction Center', 'Robert', 'P', 'Rivera', 'MD', 'Ophthalmology', '', '', NULL, 'O', '4400 S 700 E', 'Murray', 'Salt Lake', 'UT', '84107', '8012880067', '8012880091', '4400 S 700 E', 'Murray', 'Salt Lake', 'UT', '84107', '8012880067', '8012880091', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-03-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1982759122', 0, 'N', 0, '2012-03-10', NULL, NULL, 40.6758, -111.871, NULL, NULL),
('270852226', 'W12014302', 'W12014302', 'UT01', 'Silverton Group', 'Amrapali', 'M', 'Shah', 'MD', 'Hospitalist', '', '', NULL, 'O', '8th Ave C St', 'Salt Lake City', 'Salt Lake', 'UT', '84143', '8014087100', '8012961715', '8th Ave C St', 'Salt Lake City', 'Salt Lake', 'UT', '84143', '8014087100', '8012961715', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-11-10', NULL, 0, 0, 0, 'University Health Care University Hospital', '', '', '', 'HCFA|UB|', '1407889033', 0, 'N', 0, '2013-03-06', NULL, NULL, 40.7785, -111.881, NULL, NULL),
('270852226', 'W12014303', 'W12014303', 'UT01', 'Silverton Group', 'Amrapali', 'M', 'Shah', 'MD', 'Hospitalist', '', '', NULL, 'B', 'PO Box 1249', 'Bountiful', 'Davis', 'UT', '84011', '8014087100', '8012961715', 'PO Box 1249', 'Bountiful', 'Davis', 'UT', '84011', '8014087100', '8012961715', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-11-10', NULL, 0, 0, 0, 'University Health Care University Hospital', '', '', '', 'HCFA|UB|', '1407889033', 0, 'N', 0, '2013-03-06', NULL, NULL, 0, 0, NULL, NULL),
('850449232', 'W12014304', 'W12014304', 'NM01', 'Podiatry Associates of New Mexico', 'Janet', 'E', 'Simon', 'DPM', 'Podiatry', '', '', NULL, 'O', '8300 Carmel NE Ste 501', 'Albuquerque', 'Bernalillo', 'NM', '87122', '5057971001', '5058281571', '8300 Carmel NE Ste 501', 'Albuquerque', 'Bernalillo', 'NM', '87122', '5057971001', '5058281571', 'NMSPEC1', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1316943897', 0, 'N', 0, '2011-10-19', NULL, NULL, 35.1757, -106.552, NULL, NULL),
('870542403', 'W12014305', 'W12014305', 'UT01', 'Intermountain Anesthesia', 'Benjamin', 'L', 'Smith', 'CRNA', 'Anesthesia', '', '', NULL, 'B', 'PO Box 3930', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8017272086', '8014322668', 'PO Box 3930', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8017272086', '8014322668', '', '', '1000', '41.23', '0.00', '0.00', 6, '2012-03-01', NULL, 1, 12, 0, '', '', '', '', 'HCFA|UB|', '1659602001', 0, 'Y', 0, '2012-03-06', NULL, NULL, 0, 0, NULL, NULL),
('870560763', 'W12014306', 'W12014306', 'UT01', 'Utah Navajo Health System', 'Roberta', 'L', 'Ward', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '262 E Hwy', 'Montezuma Creek', 'San Juan', 'UT', '84534', '4356513291', '4356513376', '262 E Hwy', 'Montezuma Creek', 'San Juan', 'UT', '84534', '4356513291', '4356513376', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2012-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1679686034', 0, 'N', 0, '2013-07-25', NULL, NULL, 37.2619, -109.306, NULL, NULL),
('870560763', 'W12014307', 'W12014307', 'UT01', 'Utah Navajo Health System', 'Roberta', 'L', 'Ward', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 130', 'Montezuma Creek', 'San Juan', 'UT', '84534', '4356513291', '4356513376', 'PO Box 130', 'Montezuma Creek', 'San Juan', 'UT', '84534', '4356513291', '4356513376', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2012-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1679686034', 0, 'N', 0, '2013-07-25', NULL, NULL, 0, 0, NULL, NULL),
('850464177', 'W12014308', 'W12014308', 'NM01', 'The Relationship Company', 'Rosemary', 'E', 'Clarke', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '7709 Constitution NE', 'Albuquerque', 'Bernalillo', 'NM', '87110', '5052711884', '5052710039', '7709 Constitution NE', 'Albuquerque', 'Bernalillo', 'NM', '87110', '5052711884', '5052710039', '', '', '', '0.00', '0.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1386650372', 0, 'N', 0, '2013-11-01', NULL, NULL, 35.0952, -106.559, NULL, NULL),
('810587644', 'W12014311', 'W12014311', 'UT01', 'Cache Valley Community Health Ctr', 'David', 'J', 'Ballingham', 'PA', 'Family Practice', '', '', NULL, 'O', '1515 N 400 E Ste 104', 'Logan', 'Cache', 'UT', '84341', '4352456988', NULL, '1515 N 400 E Ste 104', 'Logan', 'Cache', 'UT', '84341', '4352456988', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-09-20', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1821216722', 0, 'N', 0, '2013-06-17', NULL, NULL, 41.7591, -111.824, NULL, NULL),
('270003942', 'W12014313', 'W12014313', 'UT01', 'Nebo Vision Clinic', 'James', 'A', 'Cope', 'OD', 'Optometry', '', '', NULL, 'O', '360 E Main Ste A1', 'Delta', 'Millard', 'UT', '84624', '4356232100', '4356231671', '360 E Main Ste A1', 'Delta', 'Millard', 'UT', '84624', '4356232100', '4356231671', '', '', 'OPT01', '0.00', '35.00', '0.00', 3, '2011-09-20', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1780611954', 0, 'N', 0, '2013-11-15', NULL, NULL, 39.3529, -112.564, NULL, NULL),
('870519084', 'W12014314', 'W12014314', 'UT01', '', 'David', 'A', 'Debenham', 'MD', 'Anesthesiology', NULL, NULL, NULL, 'O', '620 S 400 E Ste 201', 'St George', 'Washington', 'UT', '84770', '4356560029', NULL, '620 S 400 E Ste 201', 'St George', 'Washington', 'UT', '84770', '4356560029', '          ', 'WUSTDPAIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-09-20', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1053491183', 0, 'Y', 0, '2011-09-20', NULL, NULL, 37.0978, -113.575, NULL, NULL),
('870498345', 'W12014315', 'W12014315', 'UT01', '', 'Laurie', 'J', 'Ellis', 'NP', 'Dermatology', '', '', NULL, 'O', '1548 E 4500 S Ste 202', 'Salt Lake City', 'Salt Lake', 'UT', '84114', '8012668841', '8012660449', '1548 E 4500 S Ste 202', 'Salt Lake City', 'Salt Lake', 'UT', '84114', '8012668841', '8012660449', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-09-20', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1770578254', 0, 'N', 0, '2014-07-01', NULL, NULL, 40.6743, -111.846, NULL, NULL),
('870767026', 'W12014316', 'W12014316', 'ID01', 'West Valley Medical Group', 'Suzanne ', 'F', 'McConnaughey', 'DO', 'Internal Medicine', '', '', NULL, 'O', '211 E Logan St Ste 203 and 303', 'Caldwell', 'Canyon', 'ID', '83605', '2084594667', '2084593372', '211 E Logan St Ste 203 and 303', 'Caldwell', 'Canyon', 'ID', '83605', '2084594667', '2084593372', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2011-11-01', '2012-06-30', 0, 0, 0, 'West Valley Medical Center', '', '', '', 'HCFA|UB|', '1538142609', 0, 'N', 0, '2014-04-04', NULL, NULL, 43.6554, -116.697, NULL, NULL),
('870767026', 'W12014317', 'W12014317', 'ID01', 'West Valley Medical Group', 'Suzanne ', 'F', 'McConnaughey', 'DO', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 277976', 'Atlanta', 'Fulton', 'GA', '30384', '2084594667', '2084593372', 'PO Box 277976', 'Atlanta', 'Fulton', 'GA', '30384', '2084594667', '2084593372', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2011-11-01', '2012-06-30', 0, 0, 0, 'West Valley Medical Center', '', '', '', 'HCFA|UB|', '1538142609', 0, 'N', 0, '2014-04-04', NULL, NULL, 0, 0, NULL, NULL),
('530781199', 'W12014318', 'W12014318', 'UT01', 'Moab Family Medicine', 'Jonas', 'S', 'Munger', 'MD', 'Family Practice', '', '', NULL, 'O', '476 Williams Way', 'Moab', 'Grand', 'UT', '84532', '4352597121', '4355293112', '476 Williams Wy', 'Moab', 'Grand', 'UT', '84532', '4352597121', '4355293112', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-09-20', '2012-05-31', 0, 0, 0, 'Moab Regional Hospital', '', '', '', 'HCFA|UB|', '1801879721', 0, 'N', 0, '2013-03-14', NULL, NULL, 0, 0, NULL, NULL),
('870218917', 'W12014319', 'W12014319', 'UT01', 'Tanner Memorial Clinic', 'Jon', 'C', 'Oberg', 'MD', 'General Surgery', 'Vascular Surgery', '', NULL, 'O', '620 Medical Dr', 'Bountiful', 'Davis', 'UT', '84010', '8017734840', '8015258101', '620 Medical Dr', 'Bountiful', 'Davis', 'UT', '84010', '8017734840', '8015258101', 'WUTANNER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-09-20', '2011-09-20', 0, 0, 0, 'Davis Hospital', 'Lakeview Hospital', '', '', 'HCFA|UB|', '1316035942', 0, 'N', 0, '2014-04-17', NULL, NULL, 0, 0, NULL, NULL),
('870504725', 'W12014320', 'W12014320', 'UT01', '', 'Robert', 'L', 'Orme', 'MD', 'Dermatology', NULL, NULL, NULL, 'O', '11760 S 700 E Ste 210', 'Draper', 'Salt Lake', 'UT', '84020', '8015728043', '8015764285', '11760 S 700 E Ste 210', 'Draper', 'Salt Lake', 'UT', '84020', '8015728043', '8015764285', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-09-20', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1174635403', 0, 'N', 0, '2011-09-21', NULL, NULL, 40.5377, -111.871, NULL, NULL),
('870474130', 'W12014321', 'W12014321', 'UT01', 'Northeastern Utah Medical Group', 'Shane', 'K', 'Powell', 'MD', 'Ophthalmology', '', '', NULL, 'O', '150 W 100N Ste 101', 'Vernal', 'Uintah', 'UT', '84078', '4357812030', NULL, '150 W 100N Ste 101', 'Vernal', 'Uintah', 'UT', '84078', '4357812030', '          ', 'WURURAL5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-09-20', NULL, 0, 0, 0, 'Uintah Basin Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1750342655', 0, 'N', 0, '2014-01-17', NULL, NULL, 40.4571, -109.534, NULL, NULL),
('870650753', 'W12014322', 'W12014322', 'UT01', 'Cedar Valley Medical Clinic', 'Brett', 'E', 'Robbins', 'FNP', 'Family Practice', NULL, NULL, NULL, 'O', '2002 N Main Ste 3', 'Cedar City', 'Iron', 'UT', '84721', '4358671960', '4358671962', '2002 N Main Ste 3', 'Cedar City', 'Iron', 'UT', '84721', '4358671960', '4358671962', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-09-20', NULL, 0, 0, 0, 'Valley View Medical Center', '', '', '', 'HCFA|UB|', '1023068426', 0, 'N', 0, '2013-12-02', NULL, NULL, 37.7117, -113.061, NULL, NULL),
('621795211', 'W12014323', 'W12014323', 'UT01', 'Multispecialty Partners', 'James', 'C', 'Stringham', 'MD', 'Cardiovascular Disease', 'Pulmonary', NULL, NULL, 'O', '82 S 1000 E Ste 103', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8017464440', NULL, '82 S 1000 E Ste 103', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8017464440', '          ', 'WUSTDSURG5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2007-02-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1538182449', 0, 'N', 0, '2012-10-12', NULL, NULL, 0, 0, NULL, NULL),
('870284475', 'W12014326', 'W12014326', 'UT01', 'Granger Medical Clinic', 'Doran', 'J', 'Schneider', 'DO', 'General Surgery', '', '', NULL, 'O', '12391 S 4000 W', 'Riverton', 'Salt Lake', 'UT', '84065', '8013021708', NULL, '12391 S 4000 W', 'Riverton', 'Salt Lake', 'UT', '84065', '8013021708', '          ', 'WUGRANGER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2030-01-01', '2030-01-01', 0, 0, 0, 'Jordan Valley Medical Center', '', '', '', 'HCFA|UB|', '1831160712', 0, 'N', 1, '2013-04-16', NULL, NULL, 0, 0, NULL, NULL),
('870284475', 'W12014327', 'W12014327', 'UT01', 'Granger Medical Clinic', 'Doran', 'J', 'Schneider', 'DO', 'General Surgery', '', '', NULL, 'O', '3725 W 4100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8017653600', NULL, '3725 W 4100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8017653600', '          ', 'WUGRANGER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2030-01-01', '2030-01-01', 0, 0, 0, 'Jordan Valley Medical Center', '', '', '', 'HCFA|UB|', '1831160712', 0, 'N', 1, '2013-04-16', NULL, NULL, 0, 0, NULL, NULL),
('870284475', 'W12014325', 'W12014325', 'UT01', 'Granger Medical Clinic', 'Doran', 'J', 'Schneider', 'DO', 'General Surgery', '', '', NULL, 'B', 'PO Box 70658', 'Salt Lake City', 'Salt Lake', 'UT', '84170', '8019653600', NULL, 'PO Box 70658', 'Salt Lake City', 'Salt Lake', 'UT', '84170', '8019653600', '          ', 'WUGRANGER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2030-01-01', '2030-01-01', 0, 0, 0, 'Jordan Valley Medical Center', '', '', '', 'HCFA|UB|', '1831160712', 0, 'N', 1, '2013-04-16', NULL, NULL, 0, 0, NULL, NULL),
('470905811', 'W12014328', 'W12014328', 'UT01', 'Asthma & Allergy Clinic of Utah', 'Amit', 'J', 'Shah', 'MD', 'Allergy and Immunology', '', '', NULL, 'O', '74 E 11800 S Ste 360', 'Draper', 'Salt Lake', 'UT', '84020', '8012811300', '8012865973', '74 E 11800 S Ste 360', 'Draper', 'Salt Lake', 'UT', '84020', '8012811300', '8012865973', 'WiseSTD8', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-05-26', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1134246770', 0, 'N', 0, '2011-10-10', NULL, NULL, 40.537, -111.889, NULL, NULL),
('870498345', 'W12014329', 'W12014329', 'UT01', '', 'Michael', 'R', 'Swinyer', 'PA', 'Dermatology', NULL, NULL, NULL, 'O', '1548 E 4500 S Ste 202', 'Salt Lake City', 'Salt Lake', 'UT', '84114', '8012668841', '8012660449', '1548 E 4500 S Ste 202', 'Salt Lake City', 'Salt Lake', 'UT', '84114', '8012668841', '8012660449', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-09-21', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1790724847', 0, 'N', 0, '2012-05-29', NULL, NULL, 40.6743, -111.846, NULL, NULL),
('203298020', 'W12014330', 'W12014330', 'UT01', 'Tucker Medical Group', 'Stephen', '', 'Tucker', 'MD', 'Pediatric Internal Medicine', 'Family Practice', '', NULL, 'O', '1310 Madera Hills Dr', 'Bountiful', 'Davis', 'UT', '84010', '8016608687', '8663328067', '1310 Madera Hills Dr', 'Bountiful', 'Davis', 'UT', '84010', '8016608687', '8663328067', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-09-21', '2014-07-08', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1538179247', 0, 'Y', 0, '2014-07-15', NULL, NULL, 0, 0, NULL, NULL),
('470905811', 'W12014331', 'W12014331', 'UT01', 'Asthma & Allergy Clinic of Utah', 'Kay', 'B', 'Walker', 'MD', 'Allergy and Immunology', 'Asthma', '', NULL, 'O', '74 E 11800 S Ste 360', 'Draper', 'Salt Lake', 'UT', '84020', '8012811300', '8012865973', '74 E 11800 S Ste 360', 'Draper', 'Salt Lake', 'UT', '84020', '8012811300', '8012865973', 'WiseSTD8', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-09-21', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1083608095', 0, 'N', 0, '2013-10-30', NULL, NULL, 40.537, -111.889, NULL, NULL),
('043115329', 'W12014333', 'W12014333', 'NM01', 'Critical Care Systems ', '', '', 'Critical Care Systems ', 'GROUP', 'Infusion Agency', NULL, NULL, NULL, 'O', 'Phone Number Only 8669789600', '', '', '', '', '8669789600', '8019780020', 'Phone Number Only 8669789600', '', '', '', '', '8669789600', '8019780020', '', '', '1001', '0.00', '100.00', '0.00', 3, '2012-01-01', '2012-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1588692164', 0, 'Y', 0, '2012-02-13', NULL, NULL, 0, 0, NULL, NULL),
('820499335', 'W12014336', 'W12014336', 'ID01', 'Omega Mental Health', '', '', 'Omega Mental Health', 'MD', 'Mental Health Facility', 'Mental Health', '', NULL, 'O', '5985 W State St', 'Boise', 'Ada', 'ID', '83703', '2088530071', NULL, '5985 W State St', 'Boise', 'Ada', 'ID', '83703', '2088530071', '          ', 'IDMD', '', '', '0.00', '35.00', '0.00', 3, '2011-09-21', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1407887623', 0, 'N', 0, '2013-11-01', NULL, NULL, 43.6587, -116.263, NULL, NULL),
('870474130', 'W12014337', 'W12014337', 'UT01', 'Northeastern Utah Medical Group', 'James', '', 'White', 'MD', 'Physical Medicine and Rehabilitation', NULL, NULL, NULL, 'O', '150 W 100 N Ste 101', 'Vernal', 'Uintah', 'UT', '84078', '4357894489', NULL, '150 W 100 N Ste 101', 'Vernal', 'Uintah', 'UT', '84078', '4357894489', '          ', 'WURURAL5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-11-01', '2011-09-20', 0, 0, 0, 'Uintah Basin Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1316908122', 0, 'N', 0, '2013-09-09', NULL, NULL, 0, 0, NULL, NULL),
('742719352', 'W12014339', 'W12014339', 'TX01', 'Urology of San Antonio', 'Michael', 'A', 'White', 'DO', 'Urology', '', '', NULL, 'O', '12709 Toepperwein Rd Ste 206', 'San Antonio', 'Bexar', 'TX', '78233', '2105648000', '2106793732', '12709 Toepperwein Rd Ste 206', 'San Antonio', 'Bexar', 'TX', '78233', '2105648000', '2106793732', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2011-11-01', '2012-08-19', 0, 0, 0, 'North Central Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1295955086', 0, 'N', 0, '2014-01-24', NULL, NULL, 29.5532, -98.3483, NULL, NULL),
('742719352', 'W12014338', 'W12014338', 'TX01', 'Urology of San Antonio', 'Michael', 'A', 'White', 'DO', 'Urology', '', '', NULL, 'O', '414 Navarro Ste 900', 'San Antonio', 'Bexar', 'TX', '78205', '2104747020', '2106793733', '414 Navarro Ste 900', 'San Antonio', 'Bexar', 'TX', '78205', '2104747020', '2106793733', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2011-11-01', '2012-08-19', 0, 0, 0, 'North Central Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1295955086', 0, 'N', 0, '2014-01-24', NULL, NULL, 29.4256, -98.4895, NULL, NULL),
('742719352', 'W12014340', 'W12014340', 'TX01', 'Urology of San Antonio', 'Michael', 'A', 'White', 'DO', 'Urology', '', '', NULL, 'M', '7909 Fredericksburg Rd Ste 110', 'San Antonio', 'Bexar', 'TX', '78229', '2106144544', '2105825655', '7909 Fredericksburg Rd Ste 110', 'San Antonio', 'Bexar', 'TX', '78229', '2106144544', '2105825655', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2011-11-01', '2012-08-19', 0, 0, 0, 'North Central Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1295955086', 0, 'N', 0, '2014-01-24', NULL, NULL, 29.5113, -98.5683, NULL, NULL),
('742719352', 'W12014341', 'W12014341', 'TX01', 'Urology of San Antonio', 'Michael', 'A', 'White', 'DO', 'Urology', '', '', NULL, 'B', 'PO Box 2952', 'San Antonio', 'Bexar', 'TX', '78299', '2105648000', '2106793732', 'PO Box 2952', 'San Antonio', 'Bexar', 'TX', '78299', '2105648000', '2106793732', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2011-11-01', '2012-08-19', 0, 0, 0, 'North Central Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1295955086', 0, 'N', 0, '2014-01-24', NULL, NULL, 0, 0, NULL, NULL),
('529069313', 'W12014342', 'W12014342', 'UT01', 'Moab Family Medicine', 'Katherine', 'K', 'Williams', 'MD', 'Family Practice', '', '', NULL, 'O', '476 Williams Way', 'Moab', 'Grand', 'UT', '84532', '4352597121', '4352593112', '476 Williams Way', 'Moab', 'Grand', 'UT', '84532', '4352597121', '4352593112', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-09-21', '2012-05-31', 0, 0, 0, 'Moab Regional Hospital', '', '', '', 'HCFA|UB|', '1669455580', 0, 'N', 0, '2014-06-17', NULL, NULL, 0, 0, NULL, NULL),
('469686528', 'W12014343', 'W12014343', 'UT01', 'Moab Family Medicine', 'Kenneth', 'L', 'Williams', 'MD', 'Family Practice', '', '', NULL, 'O', '476 Williams Way', 'Moab', 'Grand', 'UT', '84532', '4352597121', '4352593112', '476 Williams Way', 'Moab', 'Grand', 'UT', '84532', '4352597121', '4352593112', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-09-21', '2012-05-31', 0, 0, 0, 'Moab Regional Hospital', '', '', '', 'HCFA|UB|', '1023091931', 0, 'N', 0, '2014-06-03', NULL, NULL, 0, 0, NULL, NULL),
('850401380', 'W12014346', 'W12014346', 'NM01', '', 'Blair', 'T', 'Alexander', 'DC', 'Chiropractic', '', '', NULL, 'O', '3800 Wyoming NE', 'Albuquerque', 'Bernalillo', 'NM', '87111', '5052961639', '5052965610', '3800 Wyoming NE', 'Albuquerque', 'Bernalillo', 'NM', '87111', '5052961639', '5052965610', 'NMCHIRO', 'WUSTDHCPC5', '', '0.00', '0.00', '38.00', 3, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1134235005', 0, 'N', 0, '2011-10-04', NULL, NULL, 35.1268, -106.551, 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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('850424076', 'W12014401', 'W12014401', 'NM01', 'New Mexico Heart Institute', 'Brian', 'D', 'Castlemain', 'MD', 'Thoracic Surgery', '', '', NULL, 'B', 'PO Box 8387', 'Albuquerque', 'Bernalillo', 'NM', '87198', '5058432800', '5058432592', 'PO Box 8387', 'Albuquerque', 'Bernalillo', 'NM', '87198', '5058432800', '5058432592', 'NMHEART', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', '2014-06-08', 0, 0, 0, 'Heart Hospital of New Mexico', '', '', '', 'HCFA|UB|', '1285726802', 0, 'N', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
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('870553496', 'W12014405', 'W12014405', 'UT01', 'Riverton Family Health Center', 'John', '', 'Zachary', 'PA', 'Family Practice', '', '', NULL, 'O', '1756 W Park Ave', 'Riverton', 'Salt Lake', 'UT', '84065', '8012540309', NULL, '1756 W Park Ave', 'Riverton', 'Salt Lake', 'UT', '84065', '8012540309', '', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-05-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', '', '', '', 'HCFA|UB|', '1871580829', 0, 'N', 0, '2014-06-03', NULL, NULL, 40.519, -111.94, NULL, NULL),
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('760215922', 'W12014407', 'W12014407', 'NM01', 'Coram Alternate Site Services', '', '', 'Coram, Inc', 'Group', 'Infusion Agency', '', '', NULL, 'B', 'PO Box 74798', 'Chicago', 'Cook', 'IL', '60694', '5057983500', NULL, 'PO Box 74798', 'Chicago', 'Cook', 'IL', '60694', '5057983500', '          ', '', '', '1001', '0.00', '60.00', '0.00', 3, '2012-01-01', NULL, 1, 0, 0, '', '', '', '', 'HCFA|UB|', '1528070992', 0, 'N', 0, '2011-10-05', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12014409', 'W12014409', 'UTIHCPHY', 'Dixie Endo-Diabetes Clinic', '', '', 'Dixie Endo-Diabetes Clinic', 'Group', 'Clinic', '', '', NULL, 'O', '348 E 600 S', 'St George', 'Washington', 'UT', '84770', '4352512888', '4359866873', '348 E 600 S', 'St George', 'Washington', 'UT', '84770', '4352512888', '4359866873', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2011-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1679854863', 0, 'N', 0, '2011-09-23', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12014411', 'W12014411', 'UTIHCPHY', 'DRMC Wound and Hyperbaric', '', '', 'DRMC Wound and Hyperbaric', 'Group', 'Clinic', '', '', NULL, 'O', '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356884900', '4356884901', '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356884900', '4356884901', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2011-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1417238601', 0, 'N', 0, '2011-09-23', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12014413', 'W12014413', 'UTIHCPHY', 'DRMC Sleep Disorders Center', '', '', 'DRMC Sleep Disorders Center', 'Group', 'Clinic', '', '', NULL, 'O', '652 S Medical Ctr Dr Ste 310', 'St George', 'Washington', 'UT', '84790', '4352513940', '4352513941', '652 S Medical Ctr Dr Ste 310', 'St George', 'Washington', 'UT', '84790', '4352513940', '4352513941', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2011-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1225319411', 0, 'N', 0, '2011-09-23', NULL, NULL, 37.0498, -113.574, NULL, NULL),
('870566149', 'W12014416', 'W12014416', 'Group', 'Pediatrix - Utah', '', '', 'Pediatrix - Utah', '', 'Neonatology', '', '', NULL, '', 'Change', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '          ', NULL, 'Change', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '          ', '          ', '', '', '', '0.00', '20.00', '0.00', 3, '2009-04-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|DEN|', '0000009780', 0, 'N', 0, '2013-02-13', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12014420', 'W12014420', 'UTIHCPHY', 'Heber Valley Clinic', 'Andree', 'J', 'Jones', 'DO', 'Urgent Care', 'Family Practice', '', NULL, 'O', '1473 S Hwy 40 Ste E', 'Heber City', 'Wasatch', 'UT', '84032', '4356542500', '4356574460', '1473 S Hwy 40 Ste E', 'Heber City', 'Wasatch', 'UT', '84032', '4356542500', '4356574460', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2010-12-30', '2011-07-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1386828333', 0, 'N', 0, '2011-09-26', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12014421', 'W12014421', 'UTIHCPHY', 'Ephraim Clinic', 'Robert', 'D', 'Armstrong', 'MD', 'Family Practice', '', '', NULL, 'O', '525 N Main St', 'Ephraim', 'Sanpete', 'UT', '84627', '4352834076', '4352834078', '525 N Main St', 'Ephraim', 'Sanpete', 'UT', '84627', '4352834076', '4352834078', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2011-07-01', NULL, 0, 0, 0, 'Sanpete Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1194766782', 0, 'N', 0, '2011-09-26', NULL, NULL, 39.371, -111.587, NULL, NULL),
('942854057', 'W12014422', 'W12014422', 'UTIHCPHY', 'Moroni Clinic', 'Robert', 'D', 'Armstrong', 'MD', 'Family Practice', '', '', NULL, 'O', '51 E Main St', 'Moroni', 'Sanpete', 'UT', '84646', '4354365250', '4354365265', '51 E Main St', 'Moroni', 'Sanpete', 'UT', '84646', '4354365250', '4354365265', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2011-07-01', NULL, 0, 0, 0, 'Sanpete Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1194766782', 0, 'N', 0, '2011-09-26', NULL, NULL, 39.5249, -111.584, NULL, NULL),
('942854057', 'W12014424', 'W12014424', 'UTIHCPHY', 'McKay Dee Rheumatology Clinic', 'A', 'Kristen', 'Bacani', 'MD', 'Rheumatology', '', '', NULL, 'O', '4403 Harrison Blvd Ste 3650', 'Ogden', 'Weber', 'UT', '84403', '8013877125', '8013877130', '4403 Harrison Blvd Ste 3650', 'Ogden', 'Weber', 'UT', '84403', '8013877125', '8013877130', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2011-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1730163239', 0, 'N', 0, '2014-06-27', NULL, NULL, 41.1828, -111.949, NULL, NULL),
('942854057', 'W12014425', 'W12014425', 'UT01', 'Park City Specialty East', 'Scott', '', 'Bramble', 'PA-C', 'General Surgery', '', '', NULL, 'O', '750 Round Valley Dr Ste 101', 'Park City', 'Summit', 'UT', '84060', '4356587246', '4356587456', '750 Round Valley Dr Ste 101', 'Park City', 'Summit', 'UT', '84060', '4356587246', '4356587456', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2011-09-01', '2012-04-07', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1598913022', 0, 'N', 0, '2013-05-06', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12014426', 'W12014426', 'UTIHCPHY', 'Dixie Hospitalists', 'N', 'C', 'Busk', 'MD', 'Family Practice', '', '', NULL, 'O', '1380 E Medical Ctr Dr', 'St George', 'Washington', 'UT', '84790', '4356886200', '4356886222', '1380 E Medical Ctr Dr', 'St George', 'Washington', 'UT', '84790', '4356886200', '4356886222', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2011-07-15', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1134212954', 0, 'N', 0, '2011-10-27', NULL, NULL, 37.0998, -113.554, NULL, NULL),
('942854057', 'W12014429', 'W12014429', 'UTIHCPHY', 'Moroni Clinic', 'Tristy', 'L', 'Christensen', 'MD', 'Family Practice', '', '', NULL, 'O', '51 E Main St', 'Moroni', 'Sanpete', 'UT', '84646', '4354365250', '4354365265', '51 E Main St', 'Moroni', 'Sanpete', 'UT', '84646', '4354365250', '4354365265', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2011-07-01', NULL, 0, 0, 0, 'Sanpete Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1093753469', 0, 'N', 0, '2011-09-26', NULL, NULL, 39.5249, -111.584, NULL, NULL),
('942854057', 'W12014428', 'W12014428', 'UTIHCPHY', 'Dixie High Risk OB', 'Robert', 'Wallace', 'Chalmers', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356884770', '4356884835', '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356884770', '4356884835', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2011-07-13', NULL, 0, 0, 0, 'Dixie Regional Medical Center', '', '', '', 'HCFA|UB|', '1114973708', 0, 'N', 0, '2014-05-08', NULL, NULL, 37.0989, -113.575, NULL, NULL),
('942854057', 'W12014430', 'W12014430', 'UTIHCPHY', 'Manti Family Clinic', 'Tristy', 'L', 'Christensen', 'MD', 'Family Practice', '', '', NULL, 'O', '159 N Main St', 'Manti', 'Sanpete', 'UT', '84642', '4358353344', '4358353081', '159 N Main St', 'Manti', 'Sanpete', 'UT', '84642', '4358353344', '4358353081', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2011-07-01', NULL, 0, 0, 0, 'Sanpete Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1093753469', 0, 'N', 0, '2011-09-26', NULL, NULL, 39.2677, -111.643, NULL, NULL),
('942854057', 'W12014432', 'W12014432', 'UTIHCPHY', 'Budge Clinic Surgical Specialists', 'Andrew', 'L', 'Cobabe', 'Aud', 'Audiology', '', '', NULL, 'O', '1350 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357520422', '4357921692', '1350 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357520422', '4357921692', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2011-06-01', '2012-08-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1104119106', 0, 'N', 0, '2012-12-05', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12014433', 'W12014433', 'UTIHCPHY', 'Manti Family Clinic', 'Gary', 'Monroe', 'Cole', 'DO', 'Family Practice', '', '', NULL, 'O', '159 N Main St', 'Manti', 'Sanpete', 'UT', '84642', '4358353344', '4358353081', '159 N Main St', 'Manti', 'Sanpete', 'UT', '84642', '4358353344', '4358353081', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2011-07-01', NULL, 0, 0, 0, 'Sanpete Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1598705139', 0, 'N', 0, '2012-03-26', NULL, NULL, 39.2677, -111.643, NULL, NULL),
('942854057', 'W12014434', 'W12014434', 'UTIHCPHY', 'Ephraim Clinic', 'Gary', 'Monroe', 'Cole', 'DO', 'Family Practice', '', '', NULL, 'O', '525 N Main St', 'Ephraim', 'Sanpete', 'UT', '84627', '4352834076', '4352834078', '525 N Main St', 'Ephraim', 'Sanpete', 'UT', '84627', '4352834076', '4352834078', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2011-07-01', NULL, 0, 0, 0, 'Sanpete Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1598705139', 0, 'N', 0, '2012-03-26', NULL, NULL, 39.371, -111.587, NULL, NULL),
('942854057', 'W12014435', 'W12014435', 'UTIHCPHY', 'Moroni Clinic', 'Allen', 'M', 'Day', 'MD', 'Family Practice', '', '', NULL, 'O', '51 E Main St', 'Moroni', 'Sanpete', 'UT', '84646', '4354365250', '4354365265', '51 E Main St', 'Moroni', 'Sanpete', 'UT', '84646', '4354365250', '4354365265', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2011-07-01', '2012-09-01', 0, 0, 0, 'Sanpete Valley Hospital', '', '', '', 'HCFA|UB|', '1518908110', 0, 'N', 0, '2013-04-15', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12014436', 'W12014436', 'UTIHCPHY', 'Ephraim Clinic', 'Allen', 'M', 'Day', 'MD', 'Family Practice', '', '', NULL, 'O', '525 N Main St', 'Ephraim', 'Sanpete', 'UT', '84627', '4352834076', '4352834078', '525 N Main St', 'Ephraim', 'Sanpete', 'UT', '84627', '4352834076', '4352834078', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2011-07-01', '2012-09-01', 0, 0, 0, 'Sanpete Valley Hospital', '', '', '', 'HCFA|UB|', '1518908110', 0, 'N', 0, '2013-04-15', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12014437', 'W12014437', 'UTIHCPHY', 'Manti Family Clinic', 'Allen', 'M', 'Day', 'MD', 'Family Practice', '', '', NULL, 'O', '159 N Main St', 'Manti', 'Sanpete', 'UT', '84642', '4358353344', '4358353081', '159 N Main St', 'Manti', 'Sanpete', 'UT', '84642', '4358353344', '4358353081', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2011-07-01', '2012-09-01', 0, 0, 0, 'Sanpete Valley Hospital', '', '', '', 'HCFA|UB|', '1518908110', 0, 'N', 0, '2013-04-15', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12014439', 'W12014439', 'UTIHCPHY', 'Dixie High Risk OB', 'Kendreia', '', 'Dickens-Williams', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356884770', '4356884835', '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356884770', '4356884835', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2011-07-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1932199684', 0, 'N', 0, '2011-09-26', NULL, NULL, 37.0989, -113.575, NULL, NULL),
('942854057', 'W12014440', 'W12014440', 'UTIHCPHY', 'Heber Valley Clinic', 'Lynsey', 'J', 'Drew', 'DO', 'Urgent Care', '', '', NULL, 'O', '1473 S Hwy 40 Ste E', 'Heber City', 'Wasatch', 'UT', '84032', '4356542500', '4356574460', '1473 S Hwy 40 Ste E', 'Heber City', 'Wasatch', 'UT', '84032', '4356542500', '4356574460', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2011-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1194953216', 0, 'Y', 0, '2014-06-27', NULL, NULL, 40.4893, -111.409, NULL, NULL),
('942854057', 'W12014441', 'W12014441', 'UTIHCPHY', 'Dixie High Risk OB', 'Diane', 'E', 'Ellis', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356884770', '4356884835', '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356884770', '4356884835', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2011-07-21', '2012-06-14', 0, 0, 0, 'University Health Care University Hospital', '', '', '', 'HCFA|UB|', '1447448865', 0, 'N', 0, '2014-04-25', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12014442', 'W12014442', 'UTIHCPHY', 'Dixie High Risk Fertility', 'Robert', 'J', 'Fagnant', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356884770', '4356884835', '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356884770', '4356884835', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2011-07-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1093734360', 0, 'N', 0, '2012-09-06', NULL, NULL, 37.0989, -113.575, NULL, NULL),
('942854057', 'W12014443', 'W12014443', 'UTIHCPHY', 'North Sevier Medical Clinic', 'Derek', 'L', 'Frieden', 'MD', 'Pain Management', 'Anesthesiology', '', NULL, 'O', '530 N 250 W', 'Salina', 'Sevier', 'UT', '84654', '4355297411', '4355297458', '530 N 250 W', 'Salina', 'Sevier', 'UT', '84654', '4355297411', '4355297458', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2011-09-01', '2011-09-12', 0, 0, 0, 'Dixie Regional Medical Center', '', '', '', 'HCFA|UB|', '1528059201', 0, 'N', 0, '2013-05-23', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12014444', 'W12014444', 'UTIHCPHY', 'Moroni Clinic', 'Michael', 'S', 'Frischknecht', 'MD', 'Family Practice', '', '', NULL, 'O', '51 E Main St', 'Moroni', 'Sanpete', 'UT', '84646', '4354365250', '4354365265', '51 E Main St', 'Moroni', 'Sanpete', 'UT', '84646', '4354365250', '4354365265', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2011-07-01', '2012-12-31', 0, 0, 0, 'Sanpete Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1629019229', 0, 'N', 0, '2013-11-18', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12014445', 'W12014445', 'UTIHCPHY', 'Ephraim Clinic', 'Michael', 'S', 'Frischknecht', 'MD', 'Family Practice', '', '', NULL, 'O', '525 N Main St', 'Ephraim', 'Sanpete', 'UT', '84627', '4352834076', '4352834078', '525 N Main St', 'Ephraim', 'Sanpete', 'UT', '84627', '4352834076', '4352834078', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2011-07-01', '2012-12-31', 0, 0, 0, 'Sanpete Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1629019229', 0, 'N', 0, '2013-11-18', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12014446', 'W12014446', 'UTIHCPHY', 'Heber Valley Clinic', 'Jeremy', 'R', 'Hadley', 'MD', 'Urgent Care', 'Family Practice', '', NULL, 'O', '1473 S Hwy 40 Ste E', 'Heber City', 'Wasatch', 'UT', '84032', '4356542500', '4356574460', '1473 S Hwy 40 Ste E', 'Heber City', 'Wasatch', 'UT', '84032', '4356542500', '4356574460', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2011-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1093943078', 0, 'Y', 0, '2014-04-08', NULL, NULL, 40.4893, -111.409, NULL, NULL),
('942854057', 'W12014447', 'W12014447', 'UTIHCPHY', 'Manti Family Clinic', 'Eileen', 'K', 'Jackson', 'MD', 'Family Practice', '', '', NULL, 'O', '159 N Main St', 'Manti', 'Sanpete', 'UT', '84642', '4358353344', '4358353081', '159 N Main St', 'Manti', 'Sanpete', 'UT', '84642', '4358353344', '4358353081', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2011-07-01', NULL, 0, 0, 0, 'Sanpete Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1518906320', 0, 'N', 0, '2011-09-26', NULL, NULL, 39.2677, -111.643, NULL, NULL),
('942854057', 'W12014448', 'W12014448', 'UTIHCPHY', 'Moroni Clinic', 'Eileen', 'K', 'Jackson', 'MD', 'Family Practice', '', '', NULL, 'O', '51 E Main St', 'Moroni', 'Sanpete', 'UT', '84646', '4354365250', '4354365265', '51 E Main St', 'Moroni', 'Sanpete', 'UT', '84646', '4354365250', '4354365265', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2011-07-01', NULL, 0, 0, 0, 'Sanpete Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1518906320', 0, 'N', 0, '2011-09-26', NULL, NULL, 39.5249, -111.584, NULL, NULL),
('942854057', 'W12014449', 'W12014449', 'UTIHCPHY', 'Valley View Heart-Garfield', 'Aarush', '', 'Manchanda', 'MD', 'Cardiovascular Disease', 'Internal Medicine', '', NULL, 'O', '200 N 400 E', 'Panguitch', 'Garfield', 'UT', '84759', '4358685570', '4358685575', '200 N 400 E', 'Panguitch', 'Garfield', 'UT', '84759', '4358685570', '4358685575', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2011-09-01', NULL, 0, 0, 0, 'Valley View Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1609027986', 0, 'N', 0, '2011-12-01', NULL, NULL, 37.8258, -112.428, NULL, NULL),
('942854057', 'W12014450', 'W12014450', 'UTIHCPHY', 'Heber Valley Clinic', 'Aarush', '', 'Manchanda', 'MD', 'Cardiovascular Disease', 'Internal Medicine', '', NULL, 'O', '1473 S Highway 40 Ste E', 'Heber City', 'Wasatch', 'UT', '84032', '4356542500', '4356574460', '1473 S Highway 40 Ste E', 'Heber City', 'Wasatch', 'UT', '84032', '4356542500', '4356574460', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2011-09-01', '2011-09-30', 0, 0, 0, 'Valley View Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1609027986', 0, 'N', 0, '2011-12-01', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12014452', 'W12014452', 'UTIHCPHY', 'Southern Utah Behavioral Health', 'Michelle', 'R', 'Moran', 'MD', 'Mental Health', 'Psychiatry', '', NULL, 'O', '1054 E Riverside Dr Ste 202', 'St George', 'Washington', 'UT', '84790', '4356346100', '4356346129', '1054 E Riverside Dr Ste 202', 'St George', 'Washington', 'UT', '84790', '4356346100', '4356346129', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2011-08-15', '2012-03-26', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1336230911', 0, 'N', 0, '2012-05-04', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12014453', 'W12014453', 'UTIHCPHY', 'Moroni Clinic', 'Charles', 'E', 'Nunn', 'MD', 'Family Practice', '', '', NULL, 'O', '51 E Main St', 'Moroni', 'Sanpete', 'UT', '84646', '4354365250', '4354365265', '51 E Main St', 'Moroni', 'Sanpete', 'UT', '84646', '4354365250', '4354365265', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2011-07-01', '2012-09-30', 0, 0, 0, 'Sanpete Valley Hospital', '', '', '', 'HCFA|UB|', '1346280955', 0, 'N', 0, '2013-04-15', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12014454', 'W12014454', 'UTIHCPHY', 'Manti Family Clinic', 'Charles', 'E', 'Nunn', 'MD', 'Family Practice', '', '', NULL, 'O', '159 N Main St', 'Manti', 'Sanpete', 'UT', '84642', '4358353344', '4358353081', '159 N Main St', 'Manti', 'Sanpete', 'UT', '84642', '4358353344', '4358353081', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2011-07-01', '2012-09-30', 0, 0, 0, 'Sanpete Valley Hospital', '', '', '', 'HCFA|UB|', '1346280955', 0, 'N', 0, '2013-04-15', NULL, NULL, 0, 0, NULL, NULL),
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('830234097', 'W12016432', 'W12016432', 'WY01', 'Cottonwood Medical', 'Bernadette', '', 'Meade', 'DO', 'Internal Medicine', '', '', NULL, 'B', '1405 W 4th St', 'Gillette', 'Campbell', 'WY', '82716', '3076883636', '3076883640', '1405 W 4th St', 'Gillette', 'Campbell', 'WY', '82716', '3076883636', '3076883640', '', '', '5001', '0.00', '0.00', '0.00', 6, '2012-02-01', '2013-08-31', 0, 0, 0, 'Campbell County Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1033100953', 0, 'N', 0, '2013-09-17', NULL, NULL, 0, 0, NULL, NULL),
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('850424076', 'W12014510', 'W12014510', 'NM01', 'New Mexico Heart Institute', 'Sean ', 'P', 'Mazer', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '502 Elm St NE', 'Albuquerque', 'Bernalillo', 'NM', '87102', '5058411000', '5058432853', '502 Elm St NE', 'Albuquerque', 'Bernalillo', 'NM', '87102', '5058411000', '5058432853', 'NMHEART', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, 'Heart Hospital of New Mexico', '', '', '', 'HCFA|UB|', '1821025545', 0, 'N', 0, '2014-06-09', NULL, NULL, 35.0865, -106.638, NULL, NULL),
('850424076', 'W12014509', 'W12014509', 'NM01', 'New Mexico Heart Institute', 'Sean ', 'P', 'Mazer', 'MD', 'Cardiovascular Disease', '', '', NULL, 'B', 'PO Box 8387', 'Albuquerque', 'Bernalillo', 'NM', '87198', '5058432800', '5058432592', 'PO Box 8387', 'Albuquerque', 'Bernalillo', 'NM', '87198', '5058432800', '5058432592', 'NMHEART', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', '2014-06-08', 0, 0, 0, 'Heart Hospital of New Mexico', '', '', '', 'HCFA|UB|', '1821025545', 0, 'N', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL);
INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
('850424076', 'W12014511', 'W12014511', 'NM01', 'New Mexico Heart Institute', 'Jay', 'E', 'Tiongson', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '502 Elm St NE', 'Albuquerque', 'Bernalillo', 'NM', '87102', '5058411000', '5058432853', '502 Elm St NE', 'Albuquerque', 'Bernalillo', 'NM', '87102', '5058411000', '5058432853', 'NMHEART', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, 'Heart Hospital of New Mexico', '', '', '', 'HCFA|UB|', '1609082312', 0, 'N', 0, '2014-06-09', NULL, NULL, 35.0865, -106.638, NULL, NULL),
('850424076', 'W12014512', 'W12014512', 'NM01', 'New Mexico Heart Institute', 'Jay', 'E', 'Tiongson', 'MD', 'Cardiovascular Disease', '', '', NULL, 'B', 'PO Box 8387', 'Albuquerque', 'Bernalillo', 'NM', '87198', '5058432800', '5058432592', 'PO Box 8387', 'Albuquerque', 'Bernalillo', 'NM', '87198', '5058432800', '5058432592', 'NMHEART', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', '2014-06-08', 0, 0, 0, 'Heart Hospital of New Mexico', '', '', '', 'HCFA|UB|', '1609082312', 0, 'N', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
('204166249', 'W12014513', 'W12014513', 'UT01', 'Deseret Medical Clinic', 'Heath', 'M', 'Scott', 'PA', 'Family Practice', NULL, NULL, NULL, 'O', '3856 W 5400 S Ste 200', 'Taylorsville', 'Salt Lake', 'UT', '84129', '8019664600', NULL, '3856 W 5400 S Ste 200', 'Taylorsville', 'Salt Lake', 'UT', '84129', '8019664600', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1437176229', 0, 'N', 0, '2011-09-29', NULL, NULL, 40.6531, -111.983, NULL, NULL),
('200091935', 'W12014514', 'W12014514', 'UT01', '', 'Jeffrey', 'G', 'Miles', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '4052 W Pioneer Pkwy Ste 109', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8018402200', NULL, '4052 W Pioneer Pkwy Ste 109', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8018402200', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-09-01', '2012-04-01', 0, 0, 0, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1952399966', 0, 'N', 0, '2012-05-31', NULL, NULL, 0, 0, NULL, NULL),
('223889298', 'W12014516', 'W12014516', 'UT01', 'Belnap Surgical Associates', 'LeGrand', 'P', 'Belnap', 'MD', 'General Surgery', '', '', NULL, 'O', '470 E 3900 S Ste 200', 'Murray', 'Salt Lake', 'UT', '84107', '8012629782', '8012629782', '470 E 3900 S Ste 200', 'Murray', 'Salt Lake', 'UT', '84107', '8012629782', '8012629782', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-09-28', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1225060676', 0, 'N', 0, '2011-09-28', NULL, NULL, 40.6871, -111.878, NULL, NULL),
('870363826', 'W12014517', 'W12014517', 'UT01', '', 'Harrison', 'M', 'Lazarus', 'MD', 'General Surgery', 'Vascular Surgery', NULL, NULL, 'O', '3584 W 9000 S Ste 400', 'Salt Lake City', 'Salt Lake', 'UT', '84104', '8012630778', '8015325717', '3584 W 9000 S Ste 400', 'Salt Lake City', 'Salt Lake', 'UT', '84104', '8012630778', '8015325717', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-09-28', NULL, 0, 0, 0, 'Primary Childrens Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1407854821', 0, 'N', 0, '2011-09-28', NULL, NULL, 0, 0, NULL, NULL),
('870550275', 'W12014518', 'W12014518', 'UT01', 'Grow Up Great', 'Kathleen', 'M', 'Liou', 'MD', 'Pediatrics', NULL, NULL, NULL, 'O', '620 E Medical Dr Ste 100', 'Bountiful', 'Davis', 'UT', '84010', '8012952888', '8012950311', '620 E Medical Dr Ste 100', 'Bountiful', 'Davis', 'UT', '84010', '8012952888', '8012950311', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', NULL, 0, 0, 0, 'Lakeview Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1013999721', 0, 'N', 0, '2013-08-27', NULL, NULL, 40.8869, -111.869, NULL, NULL),
('870566149', 'W12014520', 'W12014520', 'UT01', 'St Marks MFM Clinic', 'Sig-Linda', '', 'Jacobson', 'MD', 'Maternal Fetal Medicine', '', '', NULL, 'O', '1140 E 3900 S Ste 390', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8017434713', NULL, '1140 E 3900 S Ste 390', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8017434713', '          ', '', '', '', '0.00', '20.00', '0.00', 3, '2011-11-01', '2012-03-31', 0, 0, 0, 'St Marks Hospital', 'Ogden Regional Medical Center', 'Timpanogos Regional Hospital', '', 'HCFA|UB|', '1033291323', 0, 'N', 0, '2012-04-23', NULL, NULL, 0, 0, NULL, NULL),
('870566149', 'W12014521', 'W12014521', 'UT01', 'St Marks Hospital', 'Sig-Linda', '', 'Jacobson', 'MD', 'Maternal Fetal Medicine', '', '', NULL, 'O', '1200 S 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012687111', NULL, '1200 S 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012687111', '          ', '', '', '', '0.00', '20.00', '0.00', 3, '2011-11-01', '2012-03-31', 0, 0, 0, 'St Marks Hospital', 'Ogden Regional Medical Center', 'Timpanogos Regional Hospital', '', 'HCFA|UB|', '1033291323', 0, 'N', 0, '2012-04-23', NULL, NULL, 0, 0, NULL, NULL),
('870566149', 'W12014522', 'W12014522', 'UT01', 'St Marks MFM Clinic', 'Sig-Linda', '', 'Jacobson', 'MD', 'Maternal Fetal Medicine', '', '', NULL, 'M', '4722 N 24th Ste 150', 'Phoenix', 'Maricopa', 'AZ', '85016', '8017434713', NULL, '4722 N 24th Ste 150', 'Phoenix', 'Maricopa', 'AZ', '85016', '8017434713', '          ', '', '', '', '0.00', '20.00', '0.00', 3, '2011-11-01', '2012-03-31', 0, 0, 0, 'St Marks Hospital', 'Ogden Regional Medical Center', 'Timpanogos Regional Hospital', '', 'HCFA|UB|', '1033291323', 0, 'N', 0, '2012-04-23', NULL, NULL, 0, 0, NULL, NULL),
('870566149', 'W12014519', 'W12014519', 'UT01', 'Pediatrix Medical Group', 'Sig-Linda', '', 'Jacobson', 'MD', 'Maternal Fetal Medicine', '', '', NULL, 'B', 'PO Box 840532', 'Dallas', 'Dallas', 'TX', '75284', '8014764280', NULL, 'PO Box 840532', 'Dallas', 'Dallas', 'TX', '75284', '8014764280', '          ', '', '', '', '0.00', '20.00', '0.00', 3, '2011-11-01', NULL, 0, 0, 0, 'St Marks Hospital', 'Ogden Regional Medical Center', 'Timpanogos Regional Hospital', '', 'HCFA|UB|', '1033291323', 0, 'N', 0, '2012-04-24', NULL, NULL, 0, 0, NULL, NULL),
('870550275', 'W12014523', 'W12014523', 'UT01', 'Grow Up Great', 'Jacqueline', 'K', 'Giannini', 'MD', 'Pediatrics', '', '', NULL, 'O', '620 E Medical Dr Ste 100', 'Bountiful', 'Davis', 'UT', '84010', '8012952888', '8012950311', '620 E Medical Dr Ste 100', 'Bountiful', 'Davis', 'UT', '84010', '8012952888', '8012950311', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', NULL, 0, 0, 0, 'Lakeview Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1881676583', 0, 'N', 0, '2014-03-05', NULL, NULL, 40.8869, -111.869, NULL, NULL),
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('870566149', 'W12014527', 'W12014527', 'UT01', 'St Marks MFM Clinic', 'Sterling', 'W', 'McColgin', 'MD', 'Maternal Fetal Medicine', '', '', NULL, 'M', '4722 N 24th St Ste 150', 'Phoenix', 'Maricopa', 'AZ', '85016', '8017434713', NULL, '4722 N 24th St Ste 150', 'Phoenix', 'Maricopa', 'AZ', '85016', '8017434713', '          ', '', '', '', '0.00', '20.00', '0.00', 3, '2011-11-01', '2012-03-31', 0, 0, 0, 'Ogden Regional Medical Center', 'Timpanogos Regional Hospital', 'St Marks Hospital', '', 'HCFA|UB|', '1760513204', 0, 'N', 0, '2012-04-17', NULL, NULL, 0, 0, NULL, NULL),
('870566149', 'W12014526', 'W12014526', 'UT01', 'Pediatrix Medical Group', 'Sterling', 'W', 'McColgin', 'MD', 'Maternal Fetal Medicine', '', '', NULL, 'B', 'PO Box 840532', 'Dallas', 'Dallas', 'TX', '75284', '8014764280', NULL, 'PO Box 840532', 'Dallas', 'Dallas', 'TX', '75284', '8014764280', '          ', '', '', '', '0.00', '20.00', '0.00', 3, '2011-11-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', 'Timpanogos Regional Hospital', 'St Marks Hospital', '', 'HCFA|UB|', '1760513204', 0, 'N', 0, '2012-04-24', NULL, NULL, 0, 0, NULL, NULL),
('870316543', 'W12014528', 'W12014528', 'UT01', '', 'J', 'B', 'Robb', 'MD', 'General Surgery', '', '', NULL, 'O', '1250 E 3900 S Ste 330', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012682531', '          ', '1250 E 3900 S Ste 330', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012682531', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-09-28', '2014-07-21', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1740356328', 0, 'N', 0, '2014-07-24', NULL, NULL, 40.6871, -111.856, NULL, NULL),
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('870550275', 'W12014530', 'W12014530', 'UT01', 'Grow Up Great', 'Claudia', 'J', 'Fruin', 'MD', 'Pediatrics', '', '', NULL, 'O', '620 E Medical Dr Ste 100', 'Bountiful', 'Davis', 'UT', '84010', '8012952888', '8012950311', '620 E Medical Dr Ste 100', 'Bountiful', 'Davis', 'UT', '84010', '8012952888', '8012950311', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', '2012-12-31', 0, 0, 0, 'Lakeview Hospital', '', '', '', 'HCFA|UB|', '1619959319', 0, 'N', 0, '2014-03-05', NULL, NULL, 0, 0, NULL, NULL),
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('870566149', 'W12014534', 'W12014534', 'UT01', 'St Marks MFM Clinic', 'Melissa', 'A', 'Herbst', 'MD', 'Perinatology', '', '', NULL, 'M', '4722 N 24th St Ste 150', 'Phoenix', 'Maricopa', 'AZ', '85016', '8017434713', NULL, '4722 N 24th St Ste 150', 'Phoenix', 'Maricopa', 'AZ', '85016', '8017434713', '          ', '', '', '', '0.00', '20.00', '0.00', 3, '2030-01-01', '2030-01-01', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1326199571', 0, 'N', 0, '2012-04-17', NULL, NULL, 0, 0, NULL, NULL),
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('870550275', 'W12014536', 'W12014536', 'UT01', 'Grow Up Great', 'Allison', 'M', 'Groebs', 'MD', 'Pediatrics', '', '', NULL, 'O', '620 E Medical Dr Ste 100', 'Bountiful', 'Davis', 'UT', '84010', '8012952888', '8012950311', '620 E Medical Dr Ste 100', 'Bountiful', 'Davis', 'UT', '84010', '8012952888', '8012950311', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', NULL, 0, 0, 0, 'Lakeview Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1235111949', 0, 'N', 0, '2014-03-05', NULL, NULL, 40.8869, -111.869, NULL, NULL),
('870550275', 'W12014537', 'W12014537', 'UT01', 'Grow Up Great', 'Earl', 'R', 'Judd', 'MD', 'Pediatrics', '', '', NULL, 'O', '620 E Medical Dr Ste 100', 'Bountiful', 'Davis', 'UT', '84010', '8012952888', '8012950311', '620 E Medical Dr Ste 100', 'Bountiful', 'Davis', 'UT', '84010', '8012952888', '8012950311', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', NULL, 0, 0, 0, 'Lakeview Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1679555387', 0, 'N', 0, '2014-03-05', NULL, NULL, 40.8869, -111.869, NULL, NULL),
('954893928', 'W12014538', 'W12014538', 'UT01', 'Exodus Healthcare Network', 'Kevin', '', 'MacFarlane', 'PA', 'Family Practice', '', '', 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, '2011-09-01', NULL, 0, 0, 0, 'Pioneer Valley Hospital', '', '', '', 'HCFA|UB|', '1922163401', 0, 'N', 0, '2014-06-04', NULL, NULL, 40.6991, -111.99, NULL, NULL),
('954893928', 'W12014539', 'W12014539', 'UT01', 'Exodus Healthcare Network', 'Kevin', '', 'MacFarlane', 'PA', 'Family Practice', '', '', 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, '2011-09-01', NULL, 0, 0, 0, 'Pioneer Valley Hospital', '', '', '', 'HCFA|UB|', '1922163401', 0, 'N', 0, '2014-06-04', NULL, NULL, 40.6928, -112.092, NULL, NULL),
('271534643', 'W12014540', 'W12014540', 'UT01', 'Horizon Home Health', '', '', 'Home Health Specialists', 'Group', 'Home Health Agency', '', '', NULL, 'O', '2835 E 3300 S', 'Salt Lake City', 'Salt Lake', 'UT', '84109', '8012938700', NULL, '2835 E 3300 S', 'Salt Lake City', 'Salt Lake', 'UT', '84109', '8012938700', '          ', '', '', '4', '0.00', '40.00', '0.00', 3, '2011-09-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1811226772', 0, 'N', 0, '2012-07-02', NULL, NULL, 40.6999, -111.812, NULL, NULL),
('900657284', 'W12013576', 'W12013576', 'UT01', 'Gynecology Specialists of Utah', 'Amber', 'D', 'Bradshaw', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'M', '3 Maryland Farms Ste 250', 'Brentwood', 'Williamson', 'TN', '37027', '8014764200', '8014762070', '3 Maryland Farms Ste 250', 'Brentwood', 'Williamson', 'TN', '37027', '8014764200', '8014762070', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-10-01', '2012-06-30', 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1659589737', 0, 'N', 0, '2012-06-23', NULL, NULL, 0, 0, NULL, NULL),
('900657284', 'W12013575', 'W12013575', 'UT01', 'Gynecology Specialists of Utah', 'Amber', 'D', 'Bradshaw', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '5495 S 500 E Ste 320', 'Ogden', 'Weber', 'UT', '84405', '8014764200', '8014762070', '5495 S 500 E Ste 320', 'Ogden', 'Weber', 'UT', '84405', '8014764200', '8014762070', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-10-01', '2012-06-30', 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1659589737', 0, 'N', 0, '2012-06-23', NULL, NULL, 0, 0, NULL, NULL),
('900657284', 'W12013577', 'W12013577', 'UT01', 'Gynecology Specialists of Utah', 'Amber', 'D', 'Bradshaw', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 741617', 'Atlanta', 'Fulton', 'GA', '30374', '8014764200', '8014762070', 'PO Box 741617', 'Atlanta', 'Fulton', 'GA', '30374', '8014764200', '8014762070', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-10-01', '2012-06-30', 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1659589737', 0, 'N', 0, '2012-06-23', NULL, NULL, 0, 0, NULL, NULL),
('010624198', 'W12014019', 'W12014019', 'TX01', 'Alamo Mental Health Group', 'Dawn', 'K', 'Brown', 'MD', 'Mental Health', 'Pediatric Psychiatry', '', NULL, 'O', '4242 Medical Dr Ste 6300', 'San Antonio', 'Bexar', 'TX', '78229', '2106148400', '          ', '4242 Medical Dr Ste 6300', 'San Antonio', 'Bexar', 'TX', '78229', '2106148400', '          ', 'TXALAMOMD', '', '', '0.00', '35.00', '0.00', 6, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1740481118', 0, 'N', 0, '2014-04-02', NULL, NULL, 29.5146, -98.5673, NULL, NULL),
('954893928', 'W12014541', 'W12014541', 'UT01', 'Exodus Healthcare Network', 'Cathy', '', 'Baxter', 'NP', 'Family Practice', '', '', NULL, 'O', '3336 S Pioneer Pkwy Ste 201', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8012509638', NULL, '3336 S Pioneer Pkwy Ste 201', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8012509638', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1962437251', 0, 'N', 0, '2011-09-29', NULL, NULL, 40.6991, -111.99, NULL, NULL),
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('954893928', 'W12014543', 'W12014543', 'UT01', 'Exodus Healthcare Network', 'Kwanza', 'N', 'Devlin', 'MD', 'Family Practice', 'Obstetrics and Gynecology', '', NULL, 'O', '3665 S 8400 Ste 110', 'Magna', 'Salt Lake', 'UT', '84044', '8012509638', NULL, '3665 S 8400 Ste 110', 'Magna', 'Salt Lake', 'UT', '84044', '8012509638', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-09-01', '2011-09-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1871716845', 0, 'N', 0, '2012-10-25', NULL, NULL, 0, 0, NULL, NULL),
('954893928', 'W12014544', 'W12014544', 'UT01', 'Exodus Healthcare Network', 'Juanita', '', 'Allen', 'APRN', 'Family Practice', '', '', NULL, 'O', '3665 S 8400 W Ste 110', 'Magna', 'Salt Lake', 'UT', '84044', '8012509638', NULL, '3665 S 8400 W Ste 110', 'Magna', 'Salt Lake', 'UT', '84044', '8012509638', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-09-01', NULL, 0, 0, 0, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1821125295', 0, 'N', 0, '2013-07-09', NULL, NULL, 40.6928, -112.092, NULL, NULL),
('954893928', 'W12014590', 'W12014590', 'UT01', 'Exodus Healthcare Network', 'Marliese', '', 'Lloyd', 'PA', 'Family Practice', '', '', NULL, 'O', '3655 S 8400 W Ste 110', 'Magna', 'Salt Lake', 'UT', '84044', '8012509638', '8012503204', '3655 S 8400 W Ste 110', 'Magna', 'Salt Lake', 'UT', '84044', '8012509638', '8012503204', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1710918586', 0, 'N', 0, '2014-06-23', NULL, NULL, 40.693, -112.092, NULL, NULL),
('954893928', 'W12014546', 'W12014546', 'UT01', 'Exodus Healthcare Network', 'Cecilia', 'N I', 'Ahanonu', 'MPAS', 'Family Practice', '', '', NULL, 'O', '3665 S 8400 W Ste 110', 'Magna', 'Salt Lake', 'UT', '84044', '8012509638', NULL, '3665 S 8400 W Ste 110', 'Magna', 'Salt Lake', 'UT', '84044', '8012509638', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1720231368', 0, 'N', 0, '2011-09-29', NULL, NULL, 40.6928, -112.092, NULL, NULL),
('954893928', 'W12014547', 'W12014547', 'UT01', 'Exodus Healthcare Network', 'Janee', '', 'Gillette', 'PA', 'Family Practice', 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, '2011-09-01', NULL, 0, 0, 0, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1669407979', 0, 'N', 0, '2011-09-29', NULL, NULL, 40.6991, -111.99, NULL, NULL),
('954893928', 'W12014548', 'W12014548', 'UT01', 'Exodus Healthcare Network', 'Janee', '', 'Gillette', 'PA', 'Family Practice', 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, '2011-09-01', NULL, 0, 0, 0, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1669407979', 0, 'N', 0, '2011-09-29', NULL, NULL, 40.6928, -112.092, NULL, NULL),
('954893928', 'W12014549', 'W12014549', 'UT01', 'Exodus Healthcare Network', 'Rodolfo', '', 'Martinez-Ferrate', 'MD', 'Family Practice', '', '', 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, '2011-09-01', '2014-06-24', 0, 0, 0, 'Pioneer Valley Hospital', '', '', '', 'HCFA|UB|', '1598738270', 0, 'N', 0, '2014-06-30', NULL, NULL, 40.6928, -112.092, NULL, NULL),
('262792136', 'W12014550', 'W12014550', 'ID02', 'Advanced Therapy Care', 'Allyson', '', 'Overton', 'SLP', 'Speech Therapy', '', '', NULL, 'O', '1550 N Crestmont Ste E', 'Meridian', 'Ada', 'ID', '83642', '2088980988', '2088989022', '1550 N Crestmont Ste E', 'Meridian', 'Ada', 'ID', '83642', '2088980988', '2088989022', 'IDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2011-11-10', '2014-06-03', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1346474681', 0, 'N', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
('262792136', 'W12014551', 'W12014551', 'ID02', 'Advanced Therapy Care', 'Allyson', '', 'Overton', 'SLP', 'Speech Therapy', '', '', NULL, 'O', '245 N 3rd E', 'Mountain Home', 'Elmore', 'ID', '83647', '2085878255', '2085874475', '245 N 3rd E', 'Mountain Home', 'Elmore', 'ID', '83647', '2085878255', '2085874475', 'IDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2011-11-10', '2014-06-03', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1346474681', 0, 'N', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
('954893928', 'W12014552', 'W12014552', 'UT01', 'Exodus Healthcare Network', 'Tate', '', 'Jensen', 'PA', 'Family Practice', '', '', NULL, 'O', '3336 S Pioneer Pkwy Ste 201', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8012509638', NULL, '3336 S Pioneer Pkwy Ste 201', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8012509638', '', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-09-01', NULL, 0, 0, 0, 'Pioneer Valley Hospital', '', '', '', 'HCFA|UB|', '1285652867', 0, 'N', 0, '2014-06-04', NULL, NULL, 40.6991, -111.99, NULL, NULL),
('954893928', 'W12014553', 'W12014553', 'UT01', 'Exodus Healthcare Network', 'Tate', '', 'Jensen', 'PA', 'Family Practice', '', '', NULL, 'O', '3665 S 8400 W Ste 110', 'Magna', 'Salt Lake', 'UT', '84044', '8012509638', NULL, '3665 S 8400 W Ste 110', 'Magna', 'Salt Lake', 'UT', '84044', '8012509638', '', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-09-01', NULL, 0, 0, 0, 'Pioneer Valley Hospital', '', '', '', 'HCFA|UB|', '1285652867', 0, 'N', 0, '2014-06-04', NULL, NULL, 40.6928, -112.092, NULL, NULL),
('954893928', 'W12014554', 'W12014554', 'UT01', 'Exodus Healthcare Network', 'Carol', 'F', 'Rasmussen', 'FNP', 'Family Practice', '', '', NULL, 'O', '3336 S Pioneer Pkwy Ste 201', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8012509638', NULL, '3336 S Pioneer Pkwy Ste 201', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8012509638', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-09-01', NULL, 0, 0, 0, 'Pioneer Valley Hospital', '', '', '', 'HCFA|UB|', '1245397637', 0, 'N', 0, '2013-07-16', NULL, NULL, 40.6991, -111.99, NULL, NULL),
('850424076', 'W12014556', 'W12014556', 'NM01', 'New Mexico Heart Institute', 'Charles', 'B', 'Kim', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '502 Elm St NE', 'Albuquerque', 'Bernalillo', 'NM', '87102', '5058411000', '5058432853', '502 Elm St NE', 'Albuquerque', 'Bernalillo', 'NM', '87102', '5058411000', '5058432853', 'NMHEART', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, 'Heart Hospital of New Mexico', '', '', '', 'HCFA|UB|', '1710912829', 0, 'N', 0, '2014-06-09', NULL, NULL, 35.0865, -106.638, NULL, NULL),
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('954893928', 'W12014592', 'W12014592', 'UT01', 'Exodus Healthcare Network', 'Carol', 'F', 'Rasmussen', 'FNP', 'Family Practice', '', '', NULL, 'O', '3655 S 8400 W Ste 110', 'Magna', 'Salt Lake', 'UT', '84044', '8012509638', '8012503204', '3655 S 8400 W Ste 110', 'Magna', 'Salt Lake', 'UT', '84044', '8012509638', '8012503204', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-09-01', NULL, 0, 0, 0, 'Pioneer Valley Hospital', '', '', '', 'HCFA|UB|', '1245397637', 0, 'N', 0, '2013-07-16', NULL, NULL, 40.693, -112.092, NULL, NULL),
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('555829270', 'W12014563', 'W12014563', 'UTMH1', '', 'Thomas', 'E', 'Atkin', 'PSYD', 'Mental Health', 'Psychology', '', NULL, 'B', 'PO Box 6427', 'Logan', 'Cache', 'UT', '84341', '4357920355', '4357970356', 'PO Box 6427', 'Logan', 'Cache', 'UT', '84341', '4357920355', '4357970356', 'UTPHD', '', '', '0.00', '35.00', '0.00', 3, '2011-10-01', '2013-02-14', 0, 0, 0, 'Logan Regional Hospital', '', '', '', 'HCFA|UB|', '1730232513', 0, 'N', 0, '2014-05-01', NULL, NULL, 0, 0, NULL, NULL),
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('850424076', 'W12014564', 'W12014564', 'NM01', 'New Mexico Heart Institute', 'Robert', 'C', 'Orchard', 'MD', 'Cardiovascular Disease', '', '', NULL, 'B', 'PO Box 8387', 'Albuquerque', 'Bernalillo', 'NM', '87198', '5058432800', '5058432592', 'PO Box 8387', 'Albuquerque', 'Bernalillo', 'NM', '87198', '5058432800', '5058432592', 'NMHEART', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', '2014-06-08', 0, 0, 0, 'Heart Hospital of New Mexico', '', '', '', 'HCFA|UB|', '1659375558', 0, 'N', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
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('200933683', 'W12014568', 'W12014568', 'UT01', 'Hospice specialists', '', '', 'Homecare Specialists', 'GROUP', 'Hospice', '', '', NULL, 'O', '2835 W 3300 S', 'Salt Lake City', 'Salt Lake', 'UT', '84109', '8012948600', NULL, '2835 W 3300 S', 'Salt Lake City', 'Salt Lake', 'UT', '84109', '8012948600', '          ', '', '', '3', '0.00', '30.00', '0.00', 3, '2011-09-15', NULL, 1, 0, 0, '', '', '', '', 'HCFA|UB|', '0000006764', 0, 'N', 0, '2011-12-12', NULL, NULL, 0, 0, NULL, NULL),
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('954893928', 'W12014591', 'W12014591', 'UT01', 'Exodus Healthcare Network', 'Jill', 'D', 'McBride', 'MD', 'Family Practice', '', '', NULL, 'O', '3655 S 8400 W Ste 110', 'Magna', 'Salt Lake', 'UT', '84044', '8012509638', '8012503204', '3655 S 8400 W Ste 110', 'Magna', 'Salt Lake', 'UT', '84044', '8012509638', '8012503204', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-09-01', NULL, 0, 0, 0, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1992718902', 0, 'N', 0, '2011-09-30', NULL, NULL, 40.693, -112.092, NULL, NULL),
('453191565', 'W12014572', 'W12014572', 'UT01', 'Express Med Family Care', 'Mark', 'A', 'Frazier', 'MD', 'Family Practice', '', '', NULL, 'O', '415 N Main St', 'Spanish Fork', 'Utah', 'UT', '84660', '8017989715', '8017983131', '415 N Main St', 'Spanish Fork', 'Utah', 'UT', '84660', '8017989715', '8017983131', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-09-01', NULL, 0, 0, 0, 'Castleview Hospital', 'Castleview Hospital', '', '', 'HCFA|UB|', '1801113147', 0, 'N', 0, '2014-07-25', NULL, NULL, 40.1152, -111.655, NULL, NULL),
('453191565', 'W12014573', 'W12014573', 'UT01', 'Express Med Family Care', 'Mark', 'A', 'Frazier', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 540610', 'North Salt Lake', 'Davis', 'UT', '84054', '8017989715', '8017983131', 'PO Box 540610', 'North Salt Lake', 'Davis', 'UT', '84054', '8017989715', '8017983131', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-09-01', NULL, 0, 0, 0, 'Castleview Hospital', 'Castleview Hospital', '', '', 'HCFA|UB|', '1801113147', 0, 'N', 0, '2014-07-25', NULL, NULL, 0, 0, NULL, NULL),
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('850424076', 'W12014574', 'W12014574', 'NM01', 'New Mexico Heart Institute', 'Mark', 'C', 'Bieniarz', 'MD', 'Cardiovascular Disease', '', '', NULL, 'B', 'PO Box 8387', 'Albuquerque', 'Bernalillo', 'NM', '87198', '5058432800', '5058432592', 'PO Box 8387', 'Albuquerque', 'Bernalillo', 'NM', '87198', '5058432800', '5058432592', 'NMHEART', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', '2014-05-31', 0, 0, 0, 'Heart Hospital of New Mexico', '', '', '', 'HCFA|UB|', '1174776868', 0, 'N', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
('621795215', 'W12014577', 'W12014577', 'UT01', 'Jordan Valley Internal Medicine', 'Kevin', 'B', 'Johnson', 'MD', 'Internal Medicine', '', '', NULL, 'O', '3570 W 9000 S Ste 100', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015692384', NULL, '3570 W 9000 S Ste 100', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015692384', '          ', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-09-29', NULL, 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1255456497', 0, 'N', 0, '2011-09-29', NULL, NULL, 40.588, -111.975, NULL, NULL),
('850327237', 'W12014581', 'W12014581', 'NM01', 'Lovelace Medical Center', '', '', 'Lovelace Medical Center', 'Group', 'Mental Health Facility', '', '', NULL, 'O', '601 Dr Martin Luther King Jr Ave NE', 'Albuquerque', 'Bernalillo', 'NM', '87102', '5057278000', NULL, '601 Dr Martin Luther King Jr Ave NE', 'Albuquerque', 'Bernalillo', 'NM', '87102', '5057278000', '          ', '', '', 'NM1', '0.00', '0.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1518137041', 0, 'N', 0, '2012-01-12', NULL, NULL, 35.0857, -106.64, NULL, NULL),
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('850327237', 'W12014595', 'W12014595', 'NM01', 'Lovelace Womens Hospital', '', '', 'Lovelace Womens Hospital', 'Group', 'Hospital', '', '', NULL, 'O', '4701 Montromery Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5057277800', NULL, '4701 Montromery Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5057277800', '          ', '', '', 'NM1', '0.00', '0.00', '0.00', 3, '2012-01-01', '2012-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1982799375', 0, 'Y', 0, '2012-01-11', NULL, NULL, 0, 0, NULL, NULL),
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('870639098', 'W12012597', 'W12012597', 'UT01', 'After Hours Medical ', 'Farrant', 'H', 'Sakaguchi', 'MD', 'Urgent Care', '', '', NULL, 'B', 'PO Box 8476', 'Belfast', 'Waldo', 'ME', '04915', '8015010500', '8013257185', 'PO Box 8476', 'Belfast', 'Waldo', 'ME', '04915', '8015010500', '8013257185', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1841451473', 0, 'N', 0, '2012-10-11', NULL, NULL, 0, 0, NULL, NULL),
('850300232', 'W12014755', 'W12014755', 'NM01', 'Southwest Gastroenterology Associates', 'John', 'A', 'Burdon', 'MD', 'Gastroenterology', '', '', NULL, 'O', '7788 Jefferson NE', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5059991600', '5059991650', '7788 Jefferson NE', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5059991600', '5059991650', 'NMGASTRO', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1134128416', 0, 'N', 0, '2011-12-20', NULL, NULL, 35.1708, -106.589, NULL, NULL),
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('870519691', 'W12014605', 'W12014605', 'UT01', 'Utah Cancer Specialists', 'Clyde', 'D', 'Ford', 'MD', 'Hematology and Oncology', 'Oncology', '', NULL, 'O', '5131 S Cottonwood St Ste L2', 'Salt Lake City', 'Salt Lake', 'UT', '84157', '8012633416', NULL, '5131 S Cottonwood St Ste L2', 'Salt Lake City', 'Salt Lake', 'UT', '84157', '8012633416', '          ', 'WUSTDONC5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1568496958', 0, 'N', 0, '2012-01-19', NULL, NULL, 40.6594, -111.894, NULL, NULL),
('870680539', 'W12014606', 'W12014606', 'UT01', 'Jordan River Family Health', 'Michael', 'D', 'Jones', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '1868 W 9800 S Ste 100', 'South Jordan', 'Salt Lake', 'UT', '84095', '8014332873', '8014335734', '1868 W 9800 S Ste 100', 'South Jordan', 'Salt Lake', 'UT', '84095', '8014332873', '8014335734', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-10-03', NULL, 0, 0, 0, 'Jordan Valley Medical Center', '', '', '', 'HCFA|UB|', '1538173422', 0, 'N', 0, '2013-09-09', NULL, NULL, 40.5732, -111.941, NULL, NULL),
('870577952', 'W12014607', 'W12014607', 'UT01', 'Western Newborn Specialists', 'Timothy', 'R', 'LaPine', 'MD', 'Neonatology', 'Pediatrics', NULL, NULL, 'O', '1200 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8017436520', '8017436534', '1200 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8017436520', '8017436534', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-10-03', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1760481162', 0, 'N', 0, '2011-10-04', NULL, NULL, 40.6871, -111.856, NULL, NULL),
('870577952', 'W12014608', 'W12014608', 'UT01', 'Western Newborn Specialists', 'Ellen', '', 'Liu', 'MD', 'Neonatology', NULL, NULL, NULL, 'O', '1200 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8017436520', '8017436534', '1200 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8017436520', '8017436534', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-10-03', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1790784965', 0, 'N', 0, '2012-05-29', NULL, NULL, 40.6871, -111.856, 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
('870670595', 'W12014609', 'W12014609', 'UT01', 'Cedar Ridge Family Medicine', 'Jason', 'K', 'North', 'DO', 'Family Practice', '', '', NULL, 'O', '110 W 1325 N Ste 200', 'Cedar City', 'Iron', 'UT', '84721', '4355867676', NULL, '110 W 1325 N Ste 200', 'Cedar City', 'Iron', 'UT', '84721', '4355867676', '', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-10-03', NULL, 0, 0, 0, 'Valley View Medical Center', '', '', '', 'HCFA|UB|', '1285760132', 0, 'N', 0, '2014-06-03', NULL, NULL, 37.7011, -113.064, NULL, NULL),
('876000545', 'W12014610', 'W12014610', 'UT01', 'Health Clinics Of Utah', 'John', 'Edward', 'Smith', 'MD', 'Family Practice', '', '', NULL, 'O', '168 N 1950 W Ste 201', 'Salt Lake City', 'Salt Lake', 'UT', '84116', '8014680354', '8014680353', '168 N 1950 W Ste 201', 'Salt Lake City', 'Salt Lake', 'UT', '84116', '8014680354', '8014680353', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-10-03', '2014-05-13', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1669526950', 0, 'N', 0, '2014-05-13', NULL, NULL, 40.773, -111.947, NULL, NULL),
('870577952', 'W12014611', 'W12014611', 'UT01', 'Western Newborn Specialists', 'Robin', 'S', 'Smith', 'MD', 'Neonatology', NULL, NULL, NULL, 'O', '1200 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8017436520', '8017436534', '1200 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8017436520', '8017436534', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-10-03', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1245239649', 0, 'N', 0, '2011-10-04', NULL, NULL, 40.6871, -111.856, NULL, NULL),
('352295113', 'W12014612', 'W12014612', 'UT01', 'Jordan River Family Health', 'Benjamin', 'N', 'Storz', 'MD', 'Family Practice', '', '', NULL, 'O', '1868 W 9800 S Ste 100', 'South Jordan', 'Salt Lake', 'UT', '84095', '8014332873', NULL, '1868 W 9800 S Ste 100', 'South Jordan', 'Salt Lake', 'UT', '84095', '8014332873', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-10-03', NULL, 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1568417160', 0, 'N', 0, '2011-12-16', NULL, NULL, 40.5732, -111.941, NULL, NULL),
('850424076', 'W12014499', 'W12014499', 'NM01', 'New Mexico Heart Institute', 'Anita', 'M', 'Ralstin', 'NP', 'Cardiovascular Disease', '', '', NULL, 'B', 'PO Box 8387', 'Albuquerque', 'Bernalillo', 'NM', '87198', '5058432800', '5058432592', 'PO Box 8387', 'Albuquerque', 'Bernalillo', 'NM', '87198', '5058432800', '5058432592', 'NMHEART', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', '2014-06-08', 0, 0, 0, 'Heart Hospital of New Mexico', NULL, NULL, NULL, 'HCFA|UB|', '1881698785', 0, 'N', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W12014613', 'W12014613', 'UT01', 'Copper Canyon Womens Center', 'Theresa (Tina)', 'M', 'Fought', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '3336 S Pioneer Pkwy Ste 301', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019643865', NULL, '3336 S Pioneer Pkwy Ste 301', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019643865', '          ', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-10-04', '2013-08-07', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1942390547', 0, 'N', 0, '2013-08-14', NULL, NULL, 0, 0, NULL, NULL),
('870543342', 'W12014614', 'W12014614', 'UT01', 'Canyonlands Medical Clinic', 'Kris', 'A', 'Hayes', 'MD', 'General Surgery', '', '', NULL, 'O', '476 W Williams Way Ste B', 'Moab', 'Grand', 'UT', '84532', '4352592772', NULL, '476 W Williams Way Ste B', 'Moab', 'Grand', 'UT', '84532', '4352592772', '          ', '', '', '', '0.00', '10.00', '0.00', 6, '2011-10-04', '2013-04-26', 0, 0, 0, 'Moab Regional Hospital', '', '', '', 'HCFA|UB|', '1689654238', 0, 'N', 0, '2014-02-20', NULL, NULL, 0, 0, NULL, NULL),
('870543342', 'W12014615', 'W12014615', 'UT01', 'Canyonlands Medical Clinic', 'Robert', 'G', 'Kloepper', 'MD', 'Orthopedic Surgery', NULL, NULL, NULL, 'O', '476 W Williams Way Ste B', 'Moab', 'Grand', 'UT', '84532', '4352592772', NULL, '476 W Williams Way Ste B', 'Moab', 'Grand', 'UT', '84532', '4352592772', '          ', '', '', '', '0.00', '10.00', '0.00', 6, '2011-10-04', '2013-04-26', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1295705481', 0, 'N', 0, '2013-04-30', NULL, NULL, 0, 0, NULL, NULL),
('870540729', 'W12014616', 'W12014616', 'UT01', '', 'Douglas', 'M', 'Vogeler', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '8706 S 700 E Ste 203', 'Sandy', 'Salt Lake', 'UT', '84094', '8015720443', NULL, '8706 S 700 E Ste 203', 'Sandy', 'Salt Lake', 'UT', '84094', '8015720443', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-10-04', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1790869550', 0, 'N', 0, '2012-05-18', NULL, NULL, 40.5933, -111.872, NULL, NULL),
('850304731', 'W12014620', 'W12014620', 'NM01', 'Radiation Oncology Associates', 'Paul', 'A', 'Anthony', 'MD', 'Radiation Oncology', '', '', NULL, 'O', '4650 Jefferson Ln NE', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5057277900', '5057277942', '4650 Jefferson Ln NE', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5057277900', '5057277942', 'NMSPEC1', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, 'Lovelace Womens Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1952306219', 0, 'N', 0, '2011-10-11', NULL, NULL, 35.1342, -106.593, NULL, NULL),
('850304731', 'W12014621', 'W12014621', 'NM01', 'Radiation Oncology Associates', 'Paul', 'A', 'Anthony', 'MD', 'Radiation Oncology', '', '', NULL, 'O', '601 Dr Martin Luther King Blvd', 'Albuquerque', 'Bernalillo', 'NM', '87102', '5057278240', '5057277347', '601 Dr Martin Luther King Blvd', 'Albuquerque', 'Bernalillo', 'NM', '87102', '5057278240', '5057277347', 'NMSPEC1', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, 'Lovelace Womens Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1952306219', 0, 'N', 0, '2011-10-11', NULL, NULL, 35.0843, -106.65, NULL, NULL),
('850304731', 'W12014622', 'W12014622', 'NM01', 'Radiation Oncology Associates', 'Shalini', '', 'Singh', 'PA', 'Radiation Oncology', '', '', NULL, 'O', '4650 Jefferson Ln NE', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5057277900', '5057277942', '4650 Jefferson Ln NE', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5057277900', '5057277942', 'NMSPEC1', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, 'Lovelace Womens Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1174611958', 0, 'N', 0, '2011-10-10', NULL, NULL, 35.1342, -106.593, NULL, NULL),
('850304731', 'W12014623', 'W12014623', 'NM01', 'Radiation Oncology Associates', 'Shalini', '', 'Singh', 'PA', 'Radiation Oncology', '', '', NULL, 'O', '601 Dr Martin Luther King Blvd', 'Albuquerque', 'Bernalillo', 'NM', '87102', '5057278240', '5057277347', '601 Dr Martin Luther King Blvd', 'Albuquerque', 'Bernalillo', 'NM', '87102', '5057278240', '5057277347', 'NMSPEC1', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, 'Lovelace Womens Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1174611958', 0, 'N', 0, '2011-10-10', NULL, NULL, 35.0843, -106.65, NULL, NULL),
('850304731', 'W12014624', 'W12014624', 'NM01', 'Radiation Oncology Associates', 'Amanda', 'J', 'Story', 'MD', 'Radiation Oncology', '', '', NULL, 'O', '4650 Jefferson Ln NE', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5057277900', '5057277942', '4650 Jefferson Ln NE', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5057277900', '5057277942', 'NMSPEC1', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, 'Lovelace Womens Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1346245594', 0, 'N', 0, '2011-10-10', NULL, NULL, 35.1342, -106.593, NULL, NULL),
('850304731', 'W12014625', 'W12014625', 'NM01', 'Radiation Oncology Associates', 'Amanda', 'J', 'Story', 'MD', 'Radiation Oncology', '', '', NULL, 'O', '601 Dr Martin Luther King Blvd', 'Albuquerque', 'Bernalillo', 'NM', '87102', '5057278240', '5057277347', '601 Dr Martin Luther King Blvd', 'Albuquerque', 'Bernalillo', 'NM', '87102', '5057278240', '5057277347', 'NMSPEC1', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, 'Lovelace Womens Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1346245594', 0, 'N', 0, '2011-10-10', NULL, NULL, 35.0843, -106.65, NULL, NULL),
('870413860', 'W12014627', 'W12014627', 'UT01', 'Now Care Clinic', 'Sean', 'J', 'Carver', 'PA', 'Family Practice', '', '', NULL, 'O', '5896 S Ridgeline Dr', 'Ogden', 'Weber', 'UT', '84405', '8018660170', '8018660169', '5896 S Ridgeline Dr', 'Ogden', 'Weber', 'UT', '84405', '8018660170', '8018660169', 'NOWCARE', '', '', '0.00', '35.00', '0.00', 3, '2011-10-05', '2013-08-31', 0, 0, 0, 'Brigham City Community Hospital', 'Ogden Regional Medical Center', '', '', 'HCFA|UB|', '1548288020', 0, 'N', 0, '2014-05-12', NULL, NULL, 0, 0, NULL, NULL),
('850424076', 'W12014630', 'W12014630', 'NM01', 'New Mexico Heart Institute', 'Brendan', 'J', 'Cavanaugh', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '4824 McMahon Blvd NW Ste 109', 'Albuquerque', 'Bernalillo', 'NM', '87114', '5057921137', '5057921140', '4824 McMahon Blvd NW Ste 109', 'Albuquerque', 'Bernalillo', 'NM', '87114', '5057921137', '5057921140', 'NMHEART', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', '2012-09-05', 0, 0, 0, 'Heart Hospital of New Mexico', '', '', '', 'HCFA|UB|', '1013947639', 0, 'N', 0, '2014-06-09', NULL, NULL, 35.2071, -106.679, NULL, NULL),
('850424076', 'W12014629', 'W12014629', 'NM01', 'New Mexico Heart Institute', 'Brendan', 'J', 'Cavanaugh', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '502 Elm St NE', 'Albuquerque', 'Bernalillo', 'NM', '87102', '5058411000', '5058432853', '502 Elm St NE', 'Albuquerque', 'Bernalillo', 'NM', '87102', '5058411000', '5058432853', 'NMHEART', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, 'Heart Hospital of New Mexico', '', '', '', 'HCFA|UB|', '1013947639', 0, 'N', 0, '2014-06-09', NULL, NULL, 35.0865, -106.638, NULL, NULL),
('850424076', 'W12014628', 'W12014628', 'NM01', 'New Mexico Heart Institute', 'Brendan', 'J', 'Cavanaugh', 'MD', 'Cardiovascular Disease', '', '', NULL, 'B', 'PO Box 8387', 'Albuquerque', 'Bernalillo', 'NM', '87198', '5058432800', '5058432592', 'PO Box 8387', 'Albuquerque', 'Bernalillo', 'NM', '87198', '5058432800', '5058432592', 'NMHEART', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', '2014-06-08', 0, 0, 0, 'Heart Hospital of New Mexico', '', '', '', 'HCFA|UB|', '1013947639', 1, 'N', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
('870656576', 'W12014634', 'W12014634', 'UT01', '', 'Shaun', 'D', 'Larsen', 'OD', 'Optometry', NULL, NULL, NULL, 'O', '3665 S 8400 W Ste 100', 'Magna', 'Salt Lake', 'UT', '84044', '8012505745', '8012505981', '3665 S 8400 W Ste 100', 'Magna', 'Salt Lake', 'UT', '84044', '8012505745', '8012505981', 'WUTALBERT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-10-05', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1073540167', 0, 'N', 0, '2012-03-13', NULL, NULL, 40.6928, -112.092, NULL, NULL),
('850424076', 'W12014636', 'W12014636', 'NM01', 'New Mexico Heart Institute', 'Erica', 'J', 'Lopez', 'PA-C', 'Cardiovascular Disease', '', '', NULL, 'O', '502 Elm St NE', 'Albuquerque', 'Bernalillo', 'NM', '87102', '5058411000', '5058432853', '502 Elm St NE', 'Albuquerque', 'Bernalillo', 'NM', '87102', '5058411000', '5058432853', 'NMHEART', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1295762912', 0, 'N', 0, '2014-06-09', NULL, NULL, 35.0865, -106.638, NULL, NULL),
('850424076', 'W12014635', 'W12014635', 'NM01', 'New Mexico Heart Institute', 'Erica', 'J', 'Lopez', 'PA-C', 'Cardiovascular Disease', '', '', NULL, 'B', 'PO Box 8387', 'Albuquerque', 'Bernalillo', 'NM', '87198', '5058432800', '5058432592', 'PO Box 8387', 'Albuquerque', 'Bernalillo', 'NM', '87198', '5058432800', '5058432592', 'NMHEART', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', '2014-06-08', 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1295762912', 0, 'N', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
('431971561', 'W12014637', 'W12014637', 'UT01', '', 'David', 'K', 'Masihdas', 'OD', 'Optometry', NULL, NULL, NULL, 'O', '150 S 1000 E Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013632851', '8013637186', '150 S 1000 E Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013632851', '8013637186', 'WUTALBERT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-10-05', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1821079989', 0, 'N', 0, '2012-05-08', NULL, NULL, 40.7661, -111.862, NULL, NULL),
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('850224417', 'W12014683', 'W12014683', 'NM01', 'Renal Medicine Associates', 'Chundi', 'N', 'Adi', 'MD', 'Nephrology', '', '', NULL, 'O', '201 Cedar St SE Ste 800', 'Albuquerque', 'Bernalillo', 'NM', '87106', '5055632800', '5055632831', '201 Cedar St SE Ste 800', 'Albuquerque', 'Bernalillo', 'NM', '87106', '5055632800', '5055632831', 'NMRENAL', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', '2013-08-26', 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1992980015', 0, 'N', 0, '2013-09-30', NULL, NULL, 0, 0, NULL, NULL),
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('850224417', 'W12014709', 'W12014709', 'NM01', 'Renal Medicine Associates', 'Richard', 'S', 'Goldman', 'MD', 'Nephrology', '', '', NULL, 'O', '201 Cedar St SE Ste 800', 'Albuquerque', 'Bernalillo', 'NM', '87106', '5055632800', '5055632831', '201 Cedar St SE Ste 800', 'Albuquerque', 'Bernalillo', 'NM', '87106', '5055632800', '5055632831', 'NMRENAL', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', '2013-08-26', 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1346264082', 0, 'N', 0, '2013-09-30', NULL, NULL, 0, 0, NULL, NULL),
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('850224417', 'W12014715', 'W12014715', 'NM01', 'Renal Medicine Associates', 'Jayant', '', 'Kumar', 'MD', 'Nephrology', '', '', NULL, 'O', '201 Cedar St SE Ste 800', 'Albuquerque', 'Bernalillo', 'NM', '87106', '5055632800', '5055632831', '201 Cedar St SE Ste 800', 'Albuquerque', 'Bernalillo', 'NM', '87106', '5055632800', '5055632831', 'NMRENAL', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', '2013-08-26', 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1558451039', 0, 'N', 0, '2013-09-30', NULL, NULL, 0, 0, NULL, NULL),
('850224417', 'W12014716', 'W12014716', 'NM01', 'Renal Medicine Associates', 'Jayant', '', 'Kumar', 'MD', 'Nephrology', '', '', NULL, 'O', '4824 McMahon Blvd NW Ste 114', 'Albuquerque', 'Bernalillo', 'NM', '87114', '5058974343', '5058976311', '4824 McMahon Blvd NW Ste 114', 'Albuquerque', 'Bernalillo', 'NM', '87114', '5058974343', '5058976311', 'NMRENAL', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', '2013-08-26', 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1558451039', 0, 'N', 0, '2013-09-30', NULL, NULL, 0, 0, NULL, NULL),
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('850300232', 'W12014725', 'W12014725', 'NM01', 'Southwest Gastroenterology Associates', 'Michael', 'K', 'Bay', 'MD', 'Gastroenterology', '', '', NULL, 'O', '7788 Jefferson NE', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5059991600', '5059991650', '7788 Jefferson NE', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5059991600', '5059991650', 'NMGASTRO', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1437143195', 0, 'N', 0, '2011-10-20', NULL, NULL, 35.1708, -106.589, NULL, NULL),
('850300232', 'W12014726', 'W12014726', 'NM01', 'Southwest Gastroenterology Associates', 'Michael', 'K', 'Bay', 'MD', 'Gastroenterology', '', '', NULL, 'B', 'PO Box 851', 'Albuquerque', 'Bernalillo', 'NM', '87103', '5059991600', '5059991650', 'PO Box 851', 'Albuquerque', 'Bernalillo', 'NM', '87103', '5059991600', '5059991650', 'NMGASTRO', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1437143195', 0, 'N', 0, '2011-10-20', NULL, NULL, 0, 0, NULL, NULL),
('850300232', 'W12014728', 'W12014728', 'NM01', 'Southwest Gastroenterology Associates', 'Antoine', 'F', 'Jakiche', 'MD', 'Gastroenterology', '', '', NULL, 'O', '7788 Jefferson NE', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5059991600', '5059991650', '7788 Jefferson NE', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5059991600', '5059991650', 'NMGASTRO', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1609875996', 0, 'N', 0, '2011-10-13', NULL, NULL, 35.1708, -106.589, NULL, NULL),
('850300232', 'W12014729', 'W12014729', 'NM01', 'Southwest Gastroenterology Associates', 'Antoine', 'F', 'Jakiche', 'MD', 'Gastroenterology', '', '', NULL, 'B', 'PO Box 851', 'Albuquerque', 'Bernalillo', 'NM', '87103', '5059991600', '5059991650', 'PO Box 851', 'Albuquerque', 'Bernalillo', 'NM', '87103', '5059991600', '5059991650', 'NMGASTRO', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1609875996', 0, 'N', 0, '2011-10-13', NULL, NULL, 0, 0, NULL, NULL),
('850300232', 'W12014731', 'W12014731', 'NM01', 'Southwest Gastroenterology Associates', 'Robert', 'M', 'Lynn', 'MD', 'Gastroenterology', '', '', NULL, 'O', '7788 Jefferson NE', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5059991600', '5059991650', '7788 Jefferson NE', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5059991600', '5059991650', 'NMGASTRO', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1679572697', 0, 'N', 0, '2011-10-13', NULL, NULL, 35.1708, -106.589, NULL, NULL),
('850300232', 'W12014730', 'W12014730', 'NM01', 'Southwest Gastroenterology Associates', 'Robert', 'M', 'Lynn', 'MD', 'Gastroenterology', '', '', NULL, 'B', 'PO Box 851', 'Albuquerque', 'Bernalillo', 'NM', '87103', '5059991600', '5059991650', 'PO Box 851', 'Albuquerque', 'Bernalillo', 'NM', '87103', '5059991600', '5059991650', 'NMGASTRO', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1679572697', 0, 'N', 0, '2011-10-13', NULL, NULL, 0, 0, NULL, NULL),
('850300232', 'W12014732', 'W12014732', 'NM01', 'Southwest Gastroenterology Associates', 'Andrew', 'C', 'Mason', 'MD', 'Gastroenterology', '', '', NULL, 'O', '7788 Jefferson NE', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5059991600', '5059991650', '7788 Jefferson NE', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5059991600', '5059991650', 'NMGASTRO', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1265431563', 0, 'N', 0, '2011-10-13', NULL, NULL, 35.1708, -106.589, NULL, NULL),
('850300232', 'W12014733', 'W12014733', 'NM01', 'Southwest Gastroenterology Associates', 'Andrew', 'C', 'Mason', 'MD', 'Gastroenterology', '', '', NULL, 'B', 'PO Box 851', 'Albuquerque', 'Bernalillo', 'NM', '87103', '5059991600', '5059991650', 'PO Box 851', 'Albuquerque', 'Bernalillo', 'NM', '87103', '5059991600', '5059991650', 'NMGASTRO', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1265431563', 0, 'N', 0, '2011-10-13', NULL, NULL, 0, 0, NULL, NULL),
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('850300232', 'W12014734', 'W12014734', 'NM01', 'Southwest Gastroenterology Associates', 'H', 'N', 'Mojtahed', 'MD', 'Gastroenterology', '', '', NULL, 'B', 'PO Box 851', 'Albuquerque', 'Bernalillo', 'NM', '87103', '5059991600', '5059991650', 'PO Box 851', 'Albuquerque', 'Bernalillo', 'NM', '87103', '5059991600', '5059991650', 'NMGASTRO', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1598764805', 0, 'N', 0, '2011-10-13', NULL, NULL, 0, 0, NULL, NULL),
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('850300232', 'W12014736', 'W12014736', 'NM01', 'Southwest Gastroenterology Associates', 'Nikki', 'L', 'Parker-Ray', 'MD', 'Gastroenterology', '', '', NULL, 'O', '7788 Jefferson NE', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5059991600', '5059991650', '7788 Jefferson NE', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5059991600', '5059991650', 'NMGASTRO', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1861531857', 0, 'N', 0, '2011-10-13', NULL, NULL, 35.1708, -106.589, NULL, NULL),
('850300232', 'W12014740', 'W12014740', 'NM01', 'Southwest Gastroenterology Associates', 'Mitchal', 'A', 'Schreiner', 'MD', 'Gastroenterology', '', '', NULL, 'O', '7788 Jefferson NE', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5059991600', '5059991650', '7788 Jefferson NE', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5059991600', '5059991650', 'NMGASTRO', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1255544268', 0, 'N', 0, '2011-10-13', NULL, NULL, 35.1708, -106.589, NULL, NULL),
('850300232', 'W12014739', 'W12014739', 'NM01', 'Southwest Gastroenterology Associates', 'Mitchal', 'A', 'Schreiner', 'MD', 'Gastroenterology', '', '', NULL, 'B', 'PO Box 851', 'Albuquerque', 'Bernalillo', 'NM', '87103', '5059991600', '5059991650', 'PO Box 851', 'Albuquerque', 'Bernalillo', 'NM', '87103', '5059991600', '5059991650', 'NMGASTRO', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1255544268', 0, 'N', 0, '2011-10-13', NULL, NULL, 0, 0, NULL, NULL),
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