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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('010885716', 'W40024860', 'W40024860', 'UTMH1', 'Riley Individual Family and Marriage Counseling', 'Noelle', 'K', 'Gardner', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '873 Baxter Dr', 'South Jordan', 'Salt Lake', 'UT', '84095', '8016570163', '8015687856', '873 Baxter Dr   ', 'South Jordan', 'Salt Lake', 'UT', '84095', '8016570163', '8015687856', 'UTMA', '', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1336442227', 0, 'N', 0, '2013-07-23', NULL, NULL, 40.5606, -111.915, NULL, NULL),
('010885716', 'W40024861', 'W40024861', 'UTMH1', 'Riley Individual Family and Marriage Counseling', 'Noelle', 'K', 'Gardner', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'B', 'PO Box 708458', 'Sandy', 'Salt Lake', 'UT', '84070', '8016570163', '8015687856', 'PO Box 708458    ', 'Sandy', 'Salt Lake', 'UT', '84070', '8016570163', '8015687856', 'UTMA', '', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1336442227', 0, 'N', 0, '2013-07-23', NULL, NULL, 0, 0, NULL, NULL),
('201312583', 'W40023836', 'W40023836', 'ID01', 'Life Counseling Center', 'Lindsey', 'M', 'McConnell-Soong', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '112 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2084655433', NULL, '112 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2084655433', '', 'IDMA', NULL, NULL, '0.00', '40.00', '0.00', 6, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1336474196', 0, 'n', 0, '2014-01-27', NULL, NULL, 43.5681, -116.573, NULL, NULL),
('421731029', 'W40005711', 'W40005711', 'UTMH1', 'Hearthstone Counseling PLLC', 'Cindy', 'L', 'Lee', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', '1379 N 1350 W', 'Provo', 'Utah', 'UT', '84604', '8017879229', NULL, '1379 N 1350 W', 'Provo', 'Utah', 'UT', '84604', '8017879229', '', 'UTMA', NULL, NULL, '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1346201894', 0, 'Y', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('421731029', 'W40005712', 'W40005712', 'UTMH1', 'Hearthstone Counseling PLLC', 'Cindy', 'L', 'Lee', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '286 S 600 E', 'Provo', 'Utah', 'UT', '84606', '8013778222', NULL, '286 S 600 E', 'Provo', 'Utah', 'UT', '84606', '8013778222', '', 'UTMA', NULL, NULL, '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1346201894', 0, 'N', 0, '2013-02-27', NULL, NULL, 40.2298, -111.648, NULL, NULL),
('942938348', 'W40006864', 'W40006864', 'UTMH1', 'Valley Mental Health  Inc', 'JODI ANN', NULL, 'SMITH', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', '5965 S 900 E Ste 430', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012637100', NULL, '5965 S 900 E Ste 430', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012637100', '', 'UTVMHMA', NULL, NULL, '0.00', '40.00', '0.00', 6, '2013-02-15', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1346211919', 0, 'Y', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('294463343', 'W40014598', 'W40014598', 'UTMH1', NULL, 'Sally', 'S', 'Burgin', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '508 E S Temple Ste A30', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015375008', NULL, '508 E S Temple Ste A30', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015375008', '', 'MA', NULL, NULL, '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1346219243', 0, 'n', 0, '2013-02-27', NULL, NULL, 40.7693, -111.877, NULL, NULL),
('942938348', 'W40006944', 'W40006944', 'UTMH1', 'Valley Mental Health  Inc', 'LIZABETH', NULL, 'MCGILL', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'B', '5965 S 900 E Ste 430', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012637100', NULL, '5965 S 900 E Ste 430', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012637100', '', 'UTVMHPHD', NULL, NULL, '0.00', '40.00', '0.00', 6, '2013-02-15', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1346226420', 0, 'Y', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('870625250', 'W40005668', 'W40005668', 'UTMH1', 'Sundance Behavioral Resources ', 'Alison', '', 'Musso', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '845 E 4800 S Ste 200', 'Murray', 'Salt Lake', 'UT', '84107', '8012649522', NULL, '845 E 4800 S Ste 200', 'Murray', 'Salt Lake', 'UT', '84107', '8012649522', '', 'PHD', NULL, NULL, '0.00', '40.00', '0.00', 6, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1346230802', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('870559169', 'W40015279', 'W40015279', 'UTMH1', 'Aspen Therapy', 'Rita', '', 'Edmonds', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '3707 N Canyon Rd Ste 2C', 'Provo', 'Utah', 'UT', '84604', '8012253111', NULL, '3707 N Canyon Rd Ste 2C', 'Provo', 'Utah', 'UT', '84604', '8012253111', '', 'UTMA', NULL, NULL, '0.00', '40.00', '0.00', 6, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1346322633', 0, 'n', 0, '2013-02-27', NULL, NULL, 40.282, -111.652, NULL, NULL),
('468543064', 'W40013593', 'W40013593', 'ID01', NULL, 'Mydell', 'L', 'Yeager', 'LCPC', 'Mental Health', 'Counseling', '', NULL, 'O', '3218 Overland', 'Boise', 'Ada', 'ID', '83705', '2083313999', NULL, '3218 Overland', 'Boise', 'Ada', 'ID', '83705', '2083313999', '', 'IDMA', NULL, NULL, '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1346328564', 0, 'n', 0, '2013-02-27', NULL, NULL, 43.5898, -116.221, NULL, NULL),
('870552351', 'W40013315', 'W40013315', 'UTMH1', '', 'Eva', '', 'Beatty', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '437 S Bluff St Ste 202', 'Moab', 'Grand', 'UT', '84077', '4352727974', NULL, '437 S Bluff St Ste 202', 'Moab', 'Grand', 'UT', '84077', '4352727974', '          ', 'UTMA', '', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1346462363', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('870524176', 'W40005193', 'W40005193', 'UTMH1', NULL, 'Melissa', 'J', 'Staska', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'B', '1208 E 3300 S', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8014831600', NULL, '1208 E 3300 S', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8014831600', '', 'UTMA', NULL, NULL, '0.00', '40.00', '0.00', 6, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1346469830', 0, 'Y', 0, '2013-03-12', NULL, NULL, 0, 0, NULL, NULL),
('870524176', 'W40005192', 'W40005192', 'UTMH1', 'Alpine Center for Behavioral Health', 'Melissa', 'J', 'Staska', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '475 W 50 N', 'American Fork', 'Utah', 'UT', '84003', '8017563664', NULL, '475 W 50 N', 'American Fork', 'Utah', 'UT', '84003', '8017563664', '', 'UTMA', NULL, NULL, '0.00', '40.00', '0.00', 6, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1346469830', 0, 'N', 0, '2013-03-12', NULL, NULL, 40.378, -111.811, NULL, NULL),
('010885716', 'W40019695', 'W40019695', 'UTMH1', 'Riley Individual Family and Marriage Counseling', 'Sandra', 'G', 'Moody', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '873 Baxter Dr', 'South Jordan', 'Salt Lake', 'UT', '84095', '8016570163', '8015687856', '873 Baxter Dr', 'South Jordan', 'Salt Lake', 'UT', '84095', '8016570163', '8015687856', 'UTMA', '', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1346514726', 0, 'N', 0, '2013-02-27', NULL, NULL, 40.5606, -111.915, NULL, NULL),
('010885716', 'W40019696', 'W40019696', 'UTMH1', 'Riley Individual Family and Marriage Counseling', 'Sandra', 'G', 'Moody', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', 'PO Box 708458', 'Sandy', 'Salt Lake', 'UT', '84070', '8016570163', '8015687856', 'PO Box 708458', 'Sandy', 'Salt Lake', 'UT', '84070', '8016570163', '8015687856', 'UTMA', '', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1346514726', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('870577591', 'W40014493', 'W40014493', 'UTMH1', 'Psychological Assessment and Treatment Specialists', 'Ryan', 'C', 'Gunnell', 'LMFT', 'Mental Health', '', '', NULL, 'O', '814 E Bamberger Dr Ste A', 'American Fork', 'Utah', 'UT', '84003', '8017720202', '8017567191', '814 E Bamberger Dr Ste A', 'American Fork', 'Utah', 'UT', '84003', '8017720202', '8017567191', 'MA', '', '', '0.00', '40.00', '0.00', 6, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1346550100', 0, 'N', 0, '2013-02-27', NULL, NULL, 40.378, -111.783, NULL, NULL),
('528418192', 'W40005545', 'W40005545', 'UTMH1', NULL, 'Stacey', 'M', 'Francone', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '262 E 3900 S Ste 125', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8012098690', NULL, '262 E 3900 S Ste 125', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8012098690', '', 'UTMA', NULL, NULL, '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1356321012', 0, 'n', 0, '2014-04-24', NULL, NULL, 40.687, -111.884, NULL, NULL),
('528418192', 'W40005546', 'W40005546', 'UTMH1', NULL, 'Stacey', 'M', 'Francone', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', '674 Mansfield Ave', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8012098690', NULL, '674 Mansfield Ave', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8012098690', '', 'UTMA', NULL, NULL, '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1356321012', 0, 'Y', 0, '2014-04-24', NULL, NULL, 0, 0, NULL, NULL),
('942938348', 'W40006866', 'W40006866', 'UTMH1', 'Valley Mental Health  Inc', 'DOUG', NULL, 'THOMAS', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', '5965 S 900 E Ste 430', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012637100', NULL, '5965 S 900 E Ste 430', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012637100', '', 'UTVMHMA', NULL, NULL, '0.00', '40.00', '0.00', 6, '2013-02-15', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1356327084', 0, 'Y', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('942938348', 'W40006906', 'W40006906', 'UTMH1', 'Valley Mental Health  Inc', 'LEROY', NULL, 'ANDERSON', 'MD', 'Mental Health', 'Psychiatry', '', NULL, 'B', '5965 S 900 E Ste 430', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012637100', NULL, '5965 S 900 E Ste 430', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012637100', '', 'UTMD-2', NULL, NULL, '0.00', '40.00', '0.00', 6, '2013-02-15', NULL, 0, 0, 0, 'University Health Care University Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1356328272', 0, 'Y', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('201773062', 'W40016633', 'W40016633', 'ID01', 'Access Behavioral Health Services', 'Stephen', 'T', 'Bushi', 'MD', 'Mental Health', 'Psychiatry', '', NULL, 'O', '1276 River St Ste 100', 'Boise', 'Ada', 'ID', '83702', '2083384699', '2083384699', '1276 River St Ste 100', 'Boise', 'Ada', 'ID', '83702', '2083384699', '2083384699', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2013-02-15', '2014-06-23', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1356336648', 0, 'N', 0, '2014-04-24', NULL, NULL, 43.6149, -116.215, NULL, NULL),
('201773062', 'W40016634', 'W40016634', 'ID01', 'Access Behavioral Health Services', 'Stephen', 'T', 'Bushi', 'MD', 'Mental Health', 'Psychiatry', '', NULL, 'O', '3307 Caldwell Blvd Ste 104', 'Nampa', 'Canyon', 'ID', '83651', '2084654833', '2083384699', '3307 Caldwell Blvd Ste 104', 'Nampa', 'Canyon', 'ID', '83651', '2084654833', '2083384699', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2013-02-15', '2014-06-23', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1356336648', 0, 'N', 0, '2014-04-24', NULL, NULL, 43.6156, -116.618, NULL, NULL),
('820482736', 'W40018993', 'W40018993', 'ID01', '', 'Stephen', 'T', 'Bushi', 'MD', 'Mental Health', 'Psychiatry', '', NULL, 'O', '1902 W Judith Ln Ste 110', 'Boise', 'Ada', 'ID', '83075', '2086580800', NULL, '1902 W Judith Ln Ste 110', 'Boise', 'Ada', 'ID', '83075', '2086580800', '', 'IDMD', '', '', '0.00', '40.00', '0.00', 6, '2013-02-15', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1356336648', 0, 'N', 0, '2014-04-24', NULL, NULL, 43.5914, -116.205, NULL, NULL),
('572378111', 'W40016585', 'W40016585', 'ID02', 'Bridge Tower Counseling Ctr', 'James', 'M', 'Seehof', 'LCPC LMFT', 'Mental Health', 'Marriage & Family Therapy', 'Counseling', NULL, 'O', '3120 W Belltower Dr Ste 175', 'Meridian', 'Ada', 'ID', '83646', '2088717475', NULL, '3120 W Belltower Dr Ste 175', 'Meridian', 'Ada', 'ID', '83646', '2088717475', '', 'IDMA', NULL, NULL, '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1356417265', 0, 'n', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('518869674', 'W40015262', 'W40015262', 'ID01', NULL, 'Cynthia', 'M', 'Andrews', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '2498 N Stokesburry Pl', 'Meridian', 'Ada', 'ID', '83646', '2089475380', NULL, '2498 N Stokesburry Pl', 'Meridian', 'Ada', 'ID', '83646', '2089475380', '', 'IDMA', NULL, NULL, '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1356445688', 0, 'n', 0, '2013-02-27', NULL, NULL, 43.6629, -116.423, NULL, NULL),
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('043673591', 'W40014070', 'W40014070', 'ID01', 'Eagle River Psychiatry and Counseling', 'Grant', 'B', 'Belnap', 'MD', 'Mental Health', 'Psychiatry', '', NULL, 'O', '1032 S Bridgeway Pl Ste 100', 'Eagle', 'Ada', 'ID', '83616', '2082460123', '          ', '1032 S Bridgeway Pl Ste 100', 'Eagle', 'Ada', 'ID', '83616', '2082460123', '          ', 'IDMD', '', '', '0.00', '40.00', '0.00', 6, '2013-02-15', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1356481790', 0, 'N', 0, '2014-05-15', NULL, NULL, 43.6872, -116.35, NULL, NULL),
('200123241', 'W40015269', 'W40015269', 'UTMH1', 'Aloha Behavioral Consultants Inc', 'Sheila', 'D', 'Taylor', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '707 24th St Ste D', 'Ogden', 'Weber', 'UT', '84401', '8013991818', NULL, '707 24th St Ste D', 'Ogden', 'Weber', 'UT', '84401', '8013991818', '', 'MA', NULL, NULL, '0.00', '40.00', '0.00', 6, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1356524847', 0, 'n', 0, '2013-02-27', NULL, NULL, 41.2226, -111.962, NULL, NULL),
('870524176', 'W40019627', 'W40019627', 'UTMH1', 'Comprehensive Psychological Services', 'Natalie', '', 'Herndon', 'LPC', 'Mental Health', 'Counseling', 'Psychology', NULL, 'O', '1208 E 3300 S', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8014831600', '8014831610', '1208 E 3300 S', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8014831600', '8014831610', 'MA', '', '', '0.00', '40.00', '0.00', 6, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1356537542', 0, 'N', 0, '2013-03-12', NULL, NULL, 40.6999, -111.857, NULL, NULL),
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('565766184', 'W40005494', 'W40005494', 'UTMH1', NULL, 'Sandy', 'K', 'Watson', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', 'PO Box 396', 'Clearfield', 'Davis', 'UT', '84089', '8017766906', NULL, 'PO Box 396', 'Clearfield', 'Davis', 'UT', '84089', '8017766906', '', 'UTMA', NULL, NULL, '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1396899712', 0, 'Y', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL);
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('870299862', 'W40007183', 'W40007183', 'UTMH1', 'LDS Family Services', 'Marsha', 'B', 'Wilburn', 'LPC', 'Mental Health', '', '', NULL, 'B', '125 N State St', 'Salt Lake City', 'Salt Lake', 'UT', '84150', '8012940578', '          ', '125 N State St', 'Salt Lake City', 'Salt Lake', 'UT', '84150', '8012940578', '          ', 'MA', '', '', '0.00', '40.00', '0.00', 8, '2013-02-15', '2014-07-17', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1396960480', 0, 'N', 0, '2014-07-22', NULL, NULL, 0, 0, NULL, NULL),
('870299862', 'W40007182', 'W40007182', 'UTMH1', 'LDS Family Services', 'Marsha', 'B', 'Wilburn', 'LPC', 'Mental Health', '', '', NULL, 'O', '94 E Pages Ln Ste A', 'Salt Lake City', 'Salt Lake', 'UT', '84104', '8012940578', '          ', '94 E Pages Ln Ste A', 'Salt Lake City', 'Salt Lake', 'UT', '84104', '8012940578', '          ', 'MA', '', '', '0.00', '40.00', '0.00', 8, '2013-02-15', '2014-07-17', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1396960480', 0, 'N', 0, '2014-07-22', NULL, NULL, 0, 0, NULL, NULL),
('870271413', 'W40012337', 'W40012337', 'UTMH1', 'Family Counseling Service', 'Sally', 'M', 'Anderson', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '3518 Washington Blvd', 'Ogden', 'Weber', 'UT', '84403', '8013991600', '8013991640', '3518 Washington Blvd', 'Ogden', 'Weber', 'UT', '84403', '8013991600', '8013991640', 'UTMA', '', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'University Health Care University Hospital', '', '', '', 'HCFA|UB|', '1396966594', 0, 'N', 0, '2014-07-22', NULL, NULL, 41.1994, -111.971, NULL, NULL),
('870524176', 'W40019625', 'W40019625', 'UTMH1', 'Comprehensive Psychological Services', 'Molly', 'K', 'Prentice', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '1208 E 3300 S', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8014831600', NULL, '1208 E 3300 S', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8014831600', '          ', 'MA', '', '', '0.00', '40.00', '0.00', 6, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1396970786', 0, 'N', 0, '2013-03-12', NULL, NULL, 40.6999, -111.857, NULL, NULL),
('870524176', 'W40019626', 'W40019626', 'UTMH1', 'Comprehensive Psychological Services', 'Molly', 'K', 'Prentice', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '3725 W 4100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8019653759', NULL, '3725 W 4100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8019653759', '          ', 'MA', '', '', '0.00', '40.00', '0.00', 6, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1396970786', 0, 'N', 0, '2013-03-12', NULL, NULL, 40.682, -111.979, NULL, NULL),
('142482544', 'W40025056', 'W40025056', 'ID02', 'Treasure Valley Mental Health', 'Donna', 'J', 'Christensen', 'NP', 'Mental Health', '', '', NULL, 'O', '335 Allumbaugh St', 'Boise', 'Ada', 'ID', '83704', '2083761611', '          ', '335 Allumbaugh St', 'Boise', 'Ada', 'ID', '83704', '2083761611', '          ', 'IDARNP', '', '', '0.00', '40.00', '0.00', 3, '2013-02-15', '2014-06-17', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1396978722', 0, 'N', 0, '2014-06-19', NULL, NULL, 0, 0, NULL, NULL),
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('942938348', 'W40017441', 'W40017441', 'UTMH1', ' Valley Mental Health Inc', 'Eleanor', 'M', 'Ulibarri', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', '5965 S 900 E Ste 430', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012637100', NULL, '5965 S 900 E Ste 430', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012637100', '          ', 'UTVMHMA', '', '', '0.00', '40.00', '0.00', 6, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1447237136', 0, 'Y', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL);
INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
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('460795531', 'W40025701', 'W40025701', 'UTMH1', 'Intermountain Psychological Services', 'Rocky', 'C', 'Underwood', 'PhD', 'Mental Health', 'Psychology', '', NULL, 'B', 'PO Box 1088', 'American Fork', 'Utah', 'UT', '84003', '8014408501', NULL, 'PO Box 1088', 'American Fork', 'Utah', 'UT', '84003', '8014408501', '          ', 'UTPHD', '', '', '0.00', '40.00', '0.00', 3, '2013-02-15', '2013-03-06', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1447322904', 0, 'N', 0, '2013-03-15', NULL, NULL, 0, 0, NULL, NULL),
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('363163610', 'ELEL00257', 'ELEL00257', 'ILCHIGSTD', 'M and M Orthopaedics Rush Copley Healthplex', 'Ernest', 'Brian', 'Lindell', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1900 Ogden Ave Ste 210', 'Aurora', 'Dupage', 'IL', '60504', '6303751900', '6303751900', '1900 Ogden Ave Ste 210', 'Aurora', 'Dupage', 'IL', '60504', '6303751900', '6303751900', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', '2013-06-30', 0, 0, 0, 'Edward Hospital', 'Elmhurst Memorial Hospital', '', '', 'HCFA|UB|', '1003802810', 0, 'N', 0, '2014-04-25', NULL, NULL, 41.7266, -88.2726, NULL, NULL),
('364079642', 'ELEL00320', 'ELEL00320', 'ILCHIGSTD', 'Elmhurst Orthopaedics', 'John', 'W', 'Nikoleit', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '300 W Butterfield Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '6308340491', '6308340602', '300 W Butterfield Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '6308340491', '6308340602', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1003823212', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.8661, -87.9484, NULL, NULL),
('363988559', 'ELEL00164', 'ELEL00164', 'ILCHIGSTD', 'Dr Anil Gulati', 'Anil', '', 'Gulati', 'MD', 'Neurology', '', '', NULL, 'O', '2422 W 22nd St Ste 209', 'Oak Brook', 'Dupage', 'IL', '60523', '6305740610', '6305740655', '2422 W 22nd St Ste 209', 'Oak Brook', 'Dupage', 'IL', '60523', '6305740610', '6305740655', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', '2014-01-11', 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1003899428', 0, 'N', 0, '2014-04-11', NULL, NULL, 41.8468, -87.955, NULL, NULL),
('364037473', 'ELEL00336', 'ELEL00336', 'ILCHIGSTD', 'Elmhurst Medical Associates', 'William', '', 'ORourke', 'MD', 'Internal Medicine', '', '', NULL, 'O', '183 Addison Ave', 'Elmhurst', 'Dupage', 'IL', '60126', '3312210000', '3312213991', '183 Addison Ave', 'Elmhurst', 'Dupage', 'IL', '60126', '3312210000', '3312213991', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1013013119', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.9029, -87.9416, NULL, NULL),
('741027730', 'ELEL00049', 'ELEL00049', 'ILCHIGSTD', 'Santa Maria Medical Center', 'Miguel', 'A', 'Burgos', 'MD', 'Family Practice', '', '', NULL, 'O', '229 W Grand Ave Ste QW', 'Bensenville', 'Dupage', 'IL', '60106', '6304221917', '6304227226', '229 W Grand Ave Ste QW', 'Bensenville', 'Dupage', 'IL', '60106', '6304221917', '6304227226', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '1013058379', 0, 'N', 0, '2014-04-25', NULL, NULL, 41.931, -87.9491, NULL, NULL),
('261699160', 'ELEL00063', 'ELEL00063', 'ILCHIGSTD', 'Jeffrey Chandler DDS MD', 'Jeffrey', '', 'Chandler', 'DDS', 'Oral/Maxillofacial Surgery', '', '', NULL, 'O', '360 W Butterfield Rd Ste 220', 'Elmhurst', 'Dupage', 'IL', '60126', '6308330395', '6308330399', '360 W Butterfield Rd Ste 220', 'Elmhurst', 'Dupage', 'IL', '60126', '6308330395', '6308330399', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1013064864', 0, 'Y', 0, '2013-07-25', NULL, NULL, 41.8648, -87.9509, NULL, NULL),
('362716924', 'ELEL00137', 'ELEL00137', 'ILCHIGSTD', 'RPW Obstetrics and Gynecology', 'William', 'A', 'Fitzmaurice', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '2434 S Wolf Rd', 'Westchester', 'Cook', 'IL', '60154', '6308324210', '6308328110', '2434 S Wolf Rd', 'Westchester', 'Cook', 'IL', '60154', '6308324210', '6308328110', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1013907393', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.844, -87.9012, NULL, NULL),
('362716924', 'ELEL00136', 'ELEL00136', 'ILCHIGSTD', 'RPW Obstetrics and Gynecology', 'William', 'A', 'Fitzmaurice', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '360 W Butterfield Rd Ste 250', 'Elmhurst', 'Dupage', 'IL', '60126', '6308324210', '6308328110', '360 W Butterfield Rd Ste 250', 'Elmhurst', 'Dupage', 'IL', '60126', '6308324210', '6308328110', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1013907393', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.8648, -87.9509, NULL, NULL),
('364037473', 'ELEL00318', 'ELEL00318', 'ILCHIGSTD', 'Elmhurst Memorial Hospital Family Birthing Center', 'Patricia', '', 'Naughton', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '3312211000', '3312213832', '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '3312211000', '3312213832', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1013940832', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.8616, -87.936, NULL, NULL),
('364037473', 'ELEL00471', 'ELEL00471', 'ILCHIGSTD', 'Elmhurst Clinic', 'Victoria', '', 'Uribe', 'MD', 'Pediatrics', '', '', NULL, 'O', '1200 S York Rd Ste 2000', 'Elmhurst', 'Dupage', 'IL', '60126', '6309414710', '6307588481', '1200 S York Rd Ste 2000', 'Elmhurst', 'Dupage', 'IL', '60126', '6309414710', '6307588481', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1013967124', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.865, -87.9322, NULL, NULL),
('364037473', 'ELEL00470', 'ELEL00470', 'ILCHIGSTD', 'Elmhurst Clinic', 'Victoria', '', 'Uribe', 'MD', 'Pediatrics', '', '', NULL, 'O', '303 W Lake St Ste 200', 'Addison', 'Dupage', 'IL', '60101', '3312219002', '3312213973', '303 W Lake St Ste 200', 'Addison', 'Dupage', 'IL', '60101', '3312219002', '3312213973', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1013967124', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.9356, -87.9965, NULL, NULL),
('364037473', 'ELEL00352', 'ELEL00352', 'ILCHIGSTD', 'Elmhurst Clinic', 'Maelen', 'M', 'Pantano', 'MD', 'Internal Medicine', '', '', NULL, 'O', '172 Schiller', 'Elmhurst', 'Dupage', 'IL', '60126', '6309412600', '6307588480', '172 Schiller', 'Elmhurst', 'Dupage', 'IL', '60126', '6309412600', '6307588480', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1023068152', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.9011, -87.9371, NULL, NULL),
('364037473', 'ELEL00351', 'ELEL00351', 'ILCHIGSTD', 'Elmhurst Clinic', 'Maelen', 'M', 'Pantano', 'MD', 'Internal Medicine', '', '', NULL, 'O', '303 W Lake St Ste 200', 'Addison', 'Dupage', 'IL', '60101', '3312219002', '3312213973', '303 W Lake St Ste 200', 'Addison', 'Dupage', 'IL', '60101', '3312219002', '3312213973', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1023068152', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.9356, -87.9965, NULL, NULL),
('362704738', 'ELEL00199', 'ELEL00199', 'ILCHIGSTD', 'Nuclear Oncology', 'Neelima', 'D', 'Kabre', 'MD', 'Radiation Oncology', '', '', NULL, 'O', '200 Berteau Ave', 'Elmhurst', 'Dupage', 'IL', '60126', '6307827900', '6307827910', '200 Berteau Ave', 'Elmhurst', 'Dupage', 'IL', '60126', '6307827900', '6307827910', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 6, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '1023096294', 0, 'N', 0, '2014-04-25', NULL, NULL, 41.9022, -87.9293, NULL, NULL),
('364037473', 'ELEL00080', 'ELEL00080', 'ILCHIGSTD', 'Elmhurst Clinic', 'Michelle', 'N', 'Conroy', 'DO', 'Pediatrics', '', '', NULL, 'O', '1200 S York Rd Ste 2000', 'Elmhurst', 'Dupage', 'IL', '60126', '6309414710', '6307588481', '1200 S York Rd Ste 2000', 'Elmhurst', 'Dupage', 'IL', '60126', '6309414710', '6307588481', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1023160710', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.865, -87.9322, NULL, NULL),
('364037473', 'ELEL00081', 'ELEL00081', 'ILCHIGSTD', 'Elmhurst Clinic', 'Michelle', 'N', 'Conroy', 'DO', 'Pediatrics', '', '', NULL, 'O', '130 S Main St', 'Lombard', 'Dupage', 'IL', '60148', '6309414710', '6307588481', '130 S Main St', 'Lombard', 'Dupage', 'IL', '60148', '6309414710', '6307588481', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1023160710', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.8856, -88.0184, NULL, NULL),
('364037473', 'ELEL00261', 'ELEL00261', 'ILCHIGSTD', 'Elmhurst Clinic', 'Ingrid', '', 'Liu', 'DO', 'Family Practice', '', '', NULL, 'O', '1100 Lake St Ste 230', 'Oak Park', 'Cook', 'IL', '60301', '7085241420', '7085241509', '1100 Lake St Ste 230', 'Oak Park', 'Cook', 'IL', '60301', '7085241420', '7085241509', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', '2014-06-30', 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1033102744', 0, 'N', 0, '2014-04-07', NULL, NULL, 41.8886, -87.8026, NULL, NULL),
('364359993', 'ELEL00425', 'ELEL00425', 'ILCHIGSTD', 'Muhammad A Shahzad', 'Muhammad', 'A', 'Shahzad', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1 S 376 Summit Ave Court C Unit 4B', 'Oak Brook Terrace', 'Dupage', 'IL', '60181', '6309539009', '6309539339', '1 S 376 Summit Ave Court C Unit 4B', 'Oak Brook Terrace', 'Dupage', 'IL', '60181', '6309539009', '6309539339', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, '', '', 'HCFA|UB|', '1033107685', 0, 'N', 0, '2014-04-22', NULL, NULL, 41.854, -87.9727, NULL, NULL),
('362886394', 'ELEL00384', 'ELEL00384', 'ILCHIGSTD', 'Lombard Family Health Center', 'Nicholas', 'G', 'Recchia', 'MD', 'Family Practice', '', '', NULL, 'O', '126 W St Charles Rd', 'Lombard', 'Dupage', 'IL', '60148', '6306276236', '6306291506', '126 W St Charles Rd', 'Lombard', 'Dupage', 'IL', '60148', '6306276236', '6306291506', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, '', NULL, 'HCFA|UB|', '1033149455', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.8868, -88.0204, NULL, NULL),
('010572989', 'ELEL00035', 'ELEL00035', 'ILCHIGSTD', 'Midwest Family Medicine Inc', 'Mary', 'L', 'Biskup', 'MD', 'Family Practice', '', '', NULL, 'O', '170 Bloomingdale Rd Ste 200', 'Bloomingdale', 'Dupage', 'IL', '60108', '6303511027', '6303511190', '170 Bloomingdale Rd Ste 200', 'Bloomingdale', 'Dupage', 'IL', '60108', '6303511027', '6303511190', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1033195680', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.9507, -88.0808, NULL, NULL),
('264168288', 'ELEL00414', 'ELEL00414', 'ILCHIGSTD', 'Aziz Family Medical Center Inc', 'Soha', '', 'Sattar', 'MD', 'Family Practice', '', '', NULL, 'O', '622 N Addison Rd', 'Villa Park', 'Dupage', 'IL', '60181', '6302799600', '6302799602', '622 N Addison Rd', 'Villa Park', 'Dupage', 'IL', '60181', '6302799600', '6302799602', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', '2014-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1033327143', 0, 'N', 0, '2014-03-26', NULL, NULL, 41.9017, -87.9885, NULL, NULL),
('364079642', 'ELEL00229', 'ELEL00229', 'ILCHIGSTD', 'Elmhurst Orthopaedics', 'Kevin', '', 'Koutsky', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '300 W Butterfield Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '6308340491', '6308340602', '300 W Butterfield Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '6308340491', '6308340602', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1043225899', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.8661, -87.9484, NULL, NULL),
('364037473', 'ELEL00392', 'ELEL00392', 'ILCHIGSTD', 'Elmhurst Clinic', 'Scott', 'Charles', 'Rieger', 'DPM', 'Podiatry', '', '', NULL, 'O', '1200 S York Rd Ste 2000', 'Elmhurst', 'Dupage', 'IL', '60126', '6309412630', '6307588590', '1200 S York Rd Ste 2000', 'Elmhurst', 'Dupage', 'IL', '60126', '6309412630', '6307588590', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1043268113', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.865, -87.9322, NULL, NULL),
('364037473', 'ELEL00391', 'ELEL00391', 'ILCHIGSTD', 'Elmhurst Clinic', 'Scott', 'Charles', 'Rieger', 'DPM', 'Podiatry', '', '', NULL, 'O', '303 W Lake St Ste 200', 'Addison', 'Dupage', 'IL', '60101', '3312219002', '3312213973', '303 W Lake St Ste 200', 'Addison', 'Dupage', 'IL', '60101', '3312219002', '3312213973', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1043268113', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.9356, -87.9965, NULL, NULL),
('363163610', 'ELEL00355', 'ELEL00355', 'ILCHIGSTD', 'M and M Orthopaedics', 'Dalip', '', 'Pelinkovic', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1259 Rickert Dr Ste 101', 'Naperville', 'Dupage', 'IL', '60515', '6303551300', '6303553273', '1259 Rickert Dr Ste 101', 'Naperville', 'Dupage', 'IL', '60515', '6303551300', '6303553273', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', '2013-06-30', 0, 0, 0, 'Edward Hospital', 'Elmhurst Memorial Hospital', '', '', 'HCFA|UB|', '1043436819', 0, 'N', 0, '2014-04-25', NULL, NULL, 0, 0, NULL, NULL),
('363163610', 'ELEL00354', 'ELEL00354', 'ILCHIGSTD', 'M and M Orthopaedics Rush Copley Healthplex', 'Dalip', '', 'Pelinkovic', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1900 Ogden Ave Ste 210', 'Aurora', 'Dupage', 'IL', '60504', '6303751900', '6308511756', '1900 Ogden Ave Ste 210', 'Aurora', 'Dupage', 'IL', '60504', '6303751900', '6308511756', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', '2013-06-30', 0, 0, 0, 'Edward Hospital', 'Elmhurst Memorial Hospital', '', '', 'HCFA|UB|', '1043436819', 0, 'N', 0, '2014-04-25', NULL, NULL, 41.7266, -88.2726, NULL, NULL),
('203539308', 'ELEL00416', 'ELEL00416', 'ILCHIGSTD', 'Bozena Eigacz Medical Office', 'Bozena', 'E', 'Scigacz', 'MD', 'Internal Medicine', '', '', NULL, 'O', '28 W Lake St Ste 2', 'Addison', 'Dupage', 'IL', '60101', '6304580688', '6304580698', '28 W Lake St Ste 2', 'Addison', 'Dupage', 'IL', '60101', '6304580688', '6304580698', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '1053365577', 0, 'N', 0, '2014-04-25', NULL, NULL, 41.9324, -87.9898, NULL, NULL),
('363374001', 'ELEL00467', 'ELEL00467', 'ILCHIGSTD', 'Midwest Pulmonary Associates', 'Rong Shang', '', 'Tu', 'MD', 'Pulmonary', '', '', NULL, 'O', '2340 S Highland Ave Ste 230', 'Lombard', 'Dupage', 'IL', '60148', '6309322040', '6309321513', '2340 S Highland Ave Ste 230', 'Lombard', 'Dupage', 'IL', '60148', '6309322040', '6309321513', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1053369066', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.8429, -88.0115, NULL, NULL),
('363374001', 'ELEL00466', 'ELEL00466', 'ILCHIGSTD', 'Midwest Pulmonary Associates', 'Rong Shang', '', 'Tu', 'MD', 'Pulmonary', '', '', NULL, 'O', '800 Biesterfield Rd Ste 4002', 'Elk Grove Village', 'Cook', 'IL', '60007', '8479815575', '8669321513', '800 Biesterfield Rd Ste 4002', 'Elk Grove Village', 'Cook', 'IL', '60007', '8479815575', '8669321513', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1053369066', 0, 'N', 0, '2013-07-25', NULL, NULL, 42.0034, -88.0174, NULL, NULL),
('363820385', 'ELEL00242', 'ELEL00242', 'ILCHIGSTD', 'Joseph A Lagattuta MD', 'Joseph', 'A', 'Lagattuta', 'MD', 'Gastroenterology', '', '', NULL, 'O', '303 E Army Trail Rd Ste 203', 'Bloomingdale', 'Dupage', 'IL', '60108', '6303072600', '6303072751', '303 E Army Trail Rd Ste 203', 'Bloomingdale', 'Dupage', 'IL', '60108', '6303072600', '6303072751', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, '', NULL, 'HCFA|UB|', '1053388520', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.9391, -88.1019, NULL, NULL),
('260349836', 'ELEL00245', 'ELEL00245', 'ILCHIGSTD', 'Lamberti Ortho and Hand Surgery', 'Paul', 'M', 'Lamberti', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '2425 W 22nd St Ste 212', 'Oak Brook', 'Dupage', 'IL', '60523', '6302180011', '6302180033', '2425 W 22nd St Ste 212', 'Oak Brook', 'Dupage', 'IL', '60523', '6302180011', '6302180033', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '1053420893', 0, 'N', 0, '2014-04-25', NULL, NULL, 41.846, -87.9782, NULL, NULL),
('362657245', 'ELEL00138', 'ELEL00138', 'ILCHIGSTD', 'Ad Park Pediatric Associates', 'Sharon', 'T', 'Flint', 'MD', 'Pediatrics', '', '', NULL, 'O', '1640 W Lake St Ste 200', 'Addison', 'Dupage', 'IL', '60101', '6305433020', '6305431551', '1640 W Lake St Ste 200', 'Addison', 'Dupage', 'IL', '60101', '6305433020', '6305431551', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1053498626', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.9488, -88.0276, NULL, NULL),
('362657245', 'ELEL00139', 'ELEL00139', 'ILCHIGSTD', 'Ad Park Pediatric Associates', 'Sharon', 'T', 'Flint', 'MD', 'Pediatrics', '', '', NULL, 'O', '610 S Maple Ste 3150', 'Oak Park', 'Cook', 'IL', '60304', '7083833853', '7083837498', '610 S Maple Ste 3150', 'Oak Park', 'Cook', 'IL', '60304', '7083833853', '7083837498', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1053498626', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.878, -87.8038, NULL, NULL),
('364037473', 'ELEL00114', 'ELEL00114', 'ILCHIGSTD', 'Elmhurst Clinic', 'Lalitha', '', 'Dileep', 'MD', 'Hospitalist', '', '', NULL, 'O', '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '3312211174', '3312213782', '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '3312211174', '3312213782', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '1053549303', 0, 'N', 0, '2014-04-28', NULL, NULL, 41.8616, -87.936, NULL, NULL),
('364037473', 'ELEL00018', 'ELEL00018', 'ILCHIGSTD', 'Elmhurst Clinic', 'Asma', '', 'Ayub', 'MD', 'Family Practice', '', '', NULL, 'O', '172 Schiller', 'Elmhurst', 'Dupage', 'IL', '60126', '6308320000', '6307589720', '172 Schiller', 'Elmhurst', 'Dupage', 'IL', '60126', '6308320000', '6307589720', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1063413326', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.9011, -87.9371, NULL, NULL),
('364037473', 'ELEL00017', 'ELEL00017', 'ILCHIGSTD', 'Elmhurst Clinic', 'Asma', '', 'Ayub', 'MD', 'Family Practice', '', '', NULL, 'O', '303 W Lake St Ste 200', 'Addison', 'Dupage', 'IL', '60101', '3312219002', NULL, '303 W Lake St Ste 200', 'Addison', 'Dupage', 'IL', '60101', '3312219002', '', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1063413326', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.9356, -87.9965, NULL, NULL),
('272867016', 'ELEL00319', 'ELEL00319', 'ILCHIGSTD', 'Midwest Medical Home', 'Ruksana', '', 'Nazneen', 'MD', 'Family Practice', '', '', NULL, 'O', '18 W 511 Roosevelt Rd', 'Lombard', 'Dupage', 'IL', '60148', '6309534500', '6309534502', '18 W 511 Roosevelt Rd', 'Lombard', 'Dupage', 'IL', '60148', '6309534500', '6309534502', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '1063432474', 0, 'N', 0, '2014-04-25', NULL, NULL, 41.8595, -88.0341, NULL, NULL),
('364037473', 'ELEL00071', 'ELEL00071', 'ILCHIGSTD', 'Elmhurst Clinic', 'Scott', 'J', 'Cinel', 'MD', 'Urology', '', '', NULL, 'O', '1200 S York Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '6309412609', '6307588578', '1200 S York Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '6309412609', '6307588578', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1063462265', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.865, -87.9322, NULL, NULL),
('364390963', 'ELEL00050', 'ELEL00050', 'ILCHIGSTD', 'Comprehensive Clinical Services', 'Kenneth', 'G', 'Busch', 'MD', 'Psychiatry', '', '', NULL, 'O', '2340 S Highland Ave Ste 300', 'Lombard', 'Dupage', 'IL', '60148', '6302611210', '6302611211', '2340 S Highland Ave Ste 300', 'Lombard', 'Dupage', 'IL', '60148', '6302611210', '6302611211', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1063694362', 0, 'Y', 0, '2013-07-25', NULL, NULL, 41.8429, -88.0115, NULL, NULL),
('363236791', 'ELEL00213', 'ELEL00213', 'ILCHIGSTD', 'Marionjoy Medical Group Rush Copley Medical Center Physicians Office', 'Dennis', '', 'Keane', 'MD', 'Physical Medicine and Rehabilitation', '', '', NULL, 'O', '2020 W Ogden Ave Ste 365', 'Aurora', 'Dupage', 'IL', '60504', '6308510008', '6305850042', '2020 W Ogden Ave Ste 365', 'Aurora', 'Dupage', 'IL', '60504', '6308510008', '6305850042', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Edward Hospital', 'Elmhurst Memorial Hospital', '', '', 'HCFA|UB|', '1073681136', 0, 'N', 0, '2014-04-25', NULL, NULL, 41.728, -88.268, NULL, NULL),
('364037473', 'ELEL00418', 'ELEL00418', 'ILCHIGSTD', 'Elmhurst Clinic', 'Marianne', '', 'Senese', 'MD', 'Pediatrics', '', '', NULL, 'O', '1200 S York Rd Ste 2000', 'Elmhurst', 'Dupage', 'IL', '60126', '6309414710', '6307588481', '1200 S York Rd Ste 2000', 'Elmhurst', 'Dupage', 'IL', '60126', '6309414710', '6307588481', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1083664106', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.865, -87.9322, NULL, NULL),
('364037473', 'ELEL00417', 'ELEL00417', 'ILCHIGSTD', 'Elmhurst Clinic', 'Marianne', '', 'Senese', 'MD', 'Pediatrics', '', '', NULL, 'O', '303 W Lake St Ste 200', 'Addison', 'Dupage', 'IL', '60101', '3312219002', '3312213973', '303 W Lake St Ste 200', 'Addison', 'Dupage', 'IL', '60101', '3312219002', '3312213973', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1083664106', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.9356, -87.9965, NULL, NULL),
('362841646', 'ELEL00178', 'ELEL00178', 'ILCHIGSTD', 'Orthopedic Specialists', 'Ryon', 'M', 'Hennessy', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '360 W Butterfield Rd Ste 160', 'Elmhurst', 'Dupage', 'IL', '60126', '6307829600', '6307821643', '360 W Butterfield Rd Ste 160', 'Elmhurst', 'Dupage', 'IL', '60126', '6307829600', '6307821643', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1093717480', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.8648, -87.9509, NULL, NULL),
('362841646', 'ELEL00179', 'ELEL00179', 'ILCHIGSTD', 'Orthopedic Specialists', 'Ryon', 'M', 'Hennessy', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '675 W North Ave Ste 402', 'Melrose Park', 'Cook', 'IL', '60160', '7084505744', '7083380474', '675 W North Ave Ste 402', 'Melrose Park', 'Cook', 'IL', '60160', '7084505744', '7083380474', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1093717480', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.9083, -87.8421, NULL, NULL),
('363281182', 'ELEL00303', 'ELEL00303', 'ILCHIGSTD', 'AM Milinovich MD', 'Alexander', 'M', 'Milinovich', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '1200 S York Rd Ste 3190', 'Elmhurst', 'Dupage', 'IL', '60126', '6305300070', '6305304395', '1200 S York Rd Ste 3190', 'Elmhurst', 'Dupage', 'IL', '60126', '6305300070', '6305304395', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1093817256', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.865, -87.9322, NULL, NULL),
('363716513', 'ELEL00366', 'ELEL00366', 'ILCHIGSTD', 'Elmhurst Medical Physicians', 'Karla', 'H', 'Podrazik', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1200 S York Rd Ste 3250', 'Elmhurst', 'Dupage', 'IL', '60126', '6307588885', '6307588876', '1200 S York Rd Ste 3250', 'Elmhurst', 'Dupage', 'IL', '60126', '6307588885', '6307588876', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1104858703', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.865, -87.9322, NULL, NULL),
('362169147', 'ELEL00450', 'ELEL00450', 'ILCHIGSTD', 'Advocate Medical Group Midwest Heart Specialists', 'Daniel', 'P', 'Sullivan', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '133 E Brush Hill Rd Ste 202', 'Elmhurst', 'Dupage', 'IL', '60126', '6307824050', '6307825021', '133 E Brush Hill Rd Ste 202', 'Elmhurst', 'Dupage', 'IL', '60126', '6307824050', '6307825021', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 8, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '1104872944', 0, 'N', 0, '2014-04-25', NULL, NULL, 41.8616, -87.9371, NULL, NULL),
('362169147', 'ELEL00451', 'ELEL00451', 'ILCHIGSTD', 'Advocate Medical Group Midwest Heart Specialists', 'Daniel', 'P', 'Sullivan', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '3825 Highland Ave Ste 400', 'Downers Grove', 'Dupage', 'IL', '60515', '6307194799', '6309637420', '3825 Highland Ave Ste 400', 'Downers Grove', 'Dupage', 'IL', '60515', '6307194799', '6309637420', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 8, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '1104872944', 0, 'N', 0, '2014-04-25', NULL, NULL, 41.8181, -88.0102, NULL, NULL),
('364037473', 'ELEL00131', 'ELEL00131', 'ILCHIGSTD', 'Elmhurst Medical Associates', 'Diane', 'D', 'Fabrizius', 'MD', 'Internal Medicine', '', '', NULL, 'O', '183 Addison Ave', 'Elmhurst', 'Dupage', 'IL', '60126', '3312210000', '3312213991', '183 Addison Ave', 'Elmhurst', 'Dupage', 'IL', '60126', '3312210000', '3312213991', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1104922285', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.9029, -87.9416, NULL, NULL),
('364400429', 'ELEL00491', 'ELEL00491', 'ILCHIGSTD', 'Diabetes Osteoporosis Obesity Inc', 'Terri', '', 'Washington', 'MD', 'Endocrinology', '', '', NULL, 'O', '1200 S York Rd Ste 3150', 'Elmhurst', 'Dupage', 'IL', '60126', '7083452211', '7083452224', '1200 S York Rd Ste 3150', 'Elmhurst', 'Dupage', 'IL', '60126', '7083452211', '7083452224', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, '', NULL, 'HCFA|UB|', '1114120722', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.865, -87.9322, NULL, NULL),
('362841923', 'ELEL00109', 'ELEL00109', 'ILCHIGSTD', 'Advocate Medical Group Midwest Heart Specialists', 'Ewa', '', 'Dembowski', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '25 N Winfield Rd Ste 301', 'Winfield', 'Dupage', 'IL', '60190', '6305109244', '6305109557', '25 N Winfield Rd Ste 301', 'Winfield', 'Dupage', 'IL', '60190', '6305109244', '6305109557', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1114158821', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.8714, -88.1583, NULL, NULL),
('364037473', 'ELEL00108', 'ELEL00108', 'ILCHIGSTD', 'Elmhurst Clinic', 'Ewa', '', 'Dembowski', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '6309412600', '6309412632', '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '6309412600', '6309412632', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1114158821', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.8616, -87.936, NULL, NULL),
('364037473', 'ELEL00088', 'ELEL00088', 'ILCHIGSTD', 'Elmhurst Clinic', 'Cathleen', 'M', 'Cronin', 'MD', 'Ophthalmology', '', '', NULL, 'O', '1200 S York Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '6308341120', '6307588590', '1200 S York Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '6308341120', '6307588590', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1114986295', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.865, -87.9322, NULL, NULL),
('363265482', 'ELEL00468', 'ELEL00468', 'ILCHIGSTD', 'CVT Surgeons', 'Joao', 'G', 'Ubatuba', 'MD', 'Thoracic Surgery', '', '', NULL, 'O', '152 N Addison Ave Ste 202', 'Elmhurst', 'Dupage', 'IL', '60126', '6305169120', '6305169124', '152 N Addison Ave Ste 202', 'Elmhurst', 'Dupage', 'IL', '60126', '6305169120', '6305169124', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', '2014-06-13', 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '1114986676', 0, 'N', 0, '2014-06-13', NULL, NULL, 41.9019, -87.9416, NULL, NULL),
('205146678', 'ELEL00087', 'ELEL00087', 'ILCHIGSTD', 'Dental Sleep Center', 'Richard', 'A', 'Craig', 'DDS', 'Dentist', '', '', NULL, 'O', '120 Oakbrook Ctr Ste 726', 'Oak Brook', 'Dupage', 'IL', '60523', '6302181920', '8157447059', '120 Oakbrook Ctr Ste 726', 'Oak Brook', 'Dupage', 'IL', '60523', '6302181920', '8157447059', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1124041769', 0, 'Y', 0, '2013-07-25', NULL, NULL, 41.8477, -87.9519, NULL, NULL),
('362907660', 'ELEL00126', 'ELEL00126', 'ILCHIGSTD', 'Nephrology Associates of Northern Illinois', 'Sadaf', 'M', 'Elahi', 'MD', 'Nephrology', '', '', NULL, 'O', '5201 S Willow Springs Rd Ste 260', 'LaGrange', 'Cook', 'IL', '60525', '7083541306', '7083541538', '5201 S Willow Springs Rd Ste 260', 'LaGrange', 'Cook', 'IL', '60525', '7083541306', '7083541538', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, '', '', 'HCFA|UB|', '1124071147', 0, 'N', 0, '2014-04-25', NULL, NULL, 41.7974, -87.8884, NULL, NULL),
('362841923', 'ELEL00051', 'ELEL00051', 'ILCHIGSTD', 'Advocate Medical Group Midwest Heart Specialists', 'John', 'M', 'Cahill', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '133 E Brush Hill Rd Ste 202', 'Elmhurst', 'Dupage', 'IL', '60126', '6307824050', '6307825021', '133 E Brush Hill Rd Ste 202', 'Elmhurst', 'Dupage', 'IL', '60126', '6307824050', '6307825021', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1124071337', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.8616, -87.9371, NULL, NULL),
('364037473', 'ELEL00052', 'ELEL00052', 'ILCHIGSTD', 'Elmhurst Clinic', 'John', 'M', 'Cahill', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '6309412600', '6309412632', '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '6309412600', '6309412632', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1124071337', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.8616, -87.936, NULL, NULL),
('363394852', 'ELEL00401', 'ELEL00401', 'ILCHIGSTD', 'Addison Medical Associates', 'Mohammed', 'M', 'Saeed', 'MD', 'Internal Medicine', '', '', NULL, 'O', '276 W Fullerton Ave', 'Addison', 'Dupage', 'IL', '60101', '6305435454', '6305435471', '276 W Fullerton Ave', 'Addison', 'Dupage', 'IL', '60101', '6305435454', '6305435471', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, '', '', 'HCFA|UB|', '1124188081', 0, 'N', 0, '2014-04-25', NULL, NULL, 41.9198, -87.9956, NULL, NULL),
('364093804', 'ELEL00171', 'ELEL00171', 'ILCHIGSTD', 'Surgeons', 'John', 'A', 'Hamby', 'MD', 'General Surgery', '', '', NULL, 'O', '1200 S York Rd Ste 4220', 'Elmhurst', 'Dupage', 'IL', '60126', '6307588838', '6307588846', '1200 S York Rd Ste 4220', 'Elmhurst', 'Dupage', 'IL', '60126', '6307588838', '6307588846', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', '2014-01-01', 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '1134108657', 0, 'N', 0, '2014-04-28', NULL, NULL, 41.865, -87.9322, NULL, NULL),
('362169147', 'ELEL00321', 'ELEL00321', 'ILCHIGSTD', 'Advocate Medical Group Midwest Heart Specialists', 'Matthew', 'O', 'Nora', 'MD', 'Electrophysiology', '', '', NULL, 'O', '3825 Highland Ave Ste 400', 'Downers Grove', 'Dupage', 'IL', '60515', '6307194799', '6309637420', '3825 Highland Ave Ste 400', 'Downers Grove', 'Dupage', 'IL', '60515', '6307194799', '6309637420', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 8, '2013-04-01', NULL, 0, 0, 0, 'Edward Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1134174741', 0, 'Y', 0, '2013-09-10', NULL, NULL, 41.8181, -88.0102, NULL, NULL),
('362169147', 'ELEL00322', 'ELEL00322', 'ILCHIGSTD', 'Advocate Medical Group Midwest Heart Specialists', 'Matthew', 'O', 'Nora', 'MD', 'Electrophysiology', '', '', NULL, 'O', '801 S Washington St 4th Fl', 'Naperville', 'Dupage', 'IL', '60566', '6305272730', '6305272754', '801 S Washington St 4th Fl', 'Naperville', 'Dupage', 'IL', '60566', '6305272730', '6305272754', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 8, '2013-04-01', NULL, 0, 0, 0, 'Edward Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1134174741', 0, 'Y', 0, '2013-09-10', NULL, NULL, 41.7608, -88.149, NULL, NULL),
('364037473', 'ELEL00233', 'ELEL00233', 'ILCHIGSTD', 'Elmhurst Clinic', 'Jeffrey', 'J', 'Kulik', 'MD', 'Allergy and Immunology', '', '', NULL, 'O', '172 Schiller', 'Elmhurst', 'Dupage', 'IL', '60126', '6309412600', '6309412632', '172 Schiller', 'Elmhurst', 'Dupage', 'IL', '60126', '6309412600', '6309412632', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1134219942', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.9011, -87.9371, NULL, NULL),
('363163610', 'ELEL00094', 'ELEL00094', 'ILCHIGSTD', 'M and M Orthopaedics', 'Gregory', 'H', 'Dairyko', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '133 E Brush Hill Rd Ste 100', 'Elmhurst', 'Dupage', 'IL', '60126', '6309681881', '6305010646', '133 E Brush Hill Rd Ste 100', 'Elmhurst', 'Dupage', 'IL', '60126', '6309681881', '6305010646', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', '2013-06-30', 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '1134385677', 0, 'N', 0, '2014-04-25', NULL, NULL, 41.8628, -87.9376, NULL, NULL),
('363163610', 'ELEL00095', 'ELEL00095', 'ILCHIGSTD', 'M and M Orthopaedics', 'Gregory', 'H', 'Dairyko', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '4115 Fairview Ave', 'Downers Grove', 'Dupage', 'IL', '60515', '6309681881', '6309683762', '4115 Fairview Ave', 'Downers Grove', 'Dupage', 'IL', '60515', '6309681881', '6309683762', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', '2013-06-30', 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '1134385677', 0, 'N', 0, '2014-04-25', NULL, NULL, 41.8109, -87.9947, NULL, NULL),
('205613335', 'ELEL00234', 'ELEL00234', 'ILCHIGSTD', 'DuPage Cardiology Group', 'Vijay', 'P', 'Kumar', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '303 Army Trail Rd Ste 405', 'Bloomingdale', 'Dupage', 'IL', '60108', '6303070100', '6303070111', '303 Army Trail Rd Ste 405', 'Bloomingdale', 'Dupage', 'IL', '60108', '6303070100', '6303070111', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', '2014-02-10', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1144244146', 0, 'N', 0, '2014-03-26', NULL, NULL, 41.9391, -88.1019, NULL, NULL),
('364037473', 'ELEL00075', 'ELEL00075', 'ILCHIGSTD', 'Elmhurst Clinic', 'Michael', 'L', 'Cohan', 'MD', 'Internal Medicine', '', '', NULL, 'O', '133 E Brush Hill Rd Ste 310', 'Elmhurst', 'Dupage', 'IL', '60126', '6309412600', '6309412642', '133 E Brush Hill Rd Ste 310', 'Elmhurst', 'Dupage', 'IL', '60126', '6309412600', '6309412642', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1144271297', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.8616, -87.9371, NULL, NULL),
('363950044', 'ELEL00181', 'ELEL00181', 'ILCHIGSTD', 'Progressive Medical Center', 'Rolando', 'B', 'Henriquez', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1841 W Army Trail Rd', 'Addision', 'Dupage', 'IL', '60101', '6302389235', '6302380426', '1841 W Army Trail Rd', 'Addision', 'Dupage', 'IL', '60101', '6302389235', '6302380426', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1144370990', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.9317, -88.0341, NULL, NULL),
('363950044', 'ELEL00180', 'ELEL00180', 'ILCHIGSTD', 'Progressive Medical Center', 'Rolando', 'B', 'Henriquez', 'MD', 'Internal Medicine', '', '', NULL, 'O', '414 W Lake St', 'Addison', 'Dupage', 'IL', '60101', '6304581905', '6304581908', '414 W Lake St', 'Addison', 'Dupage', 'IL', '60101', '6304581905', '6304581908', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1144370990', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.9368, -87.9993, NULL, NULL),
('362670634', 'ELEL00409', 'ELEL00409', 'ILCHIGSTD', 'Oak Park Eye Center', 'Manuel', 'D', 'Santiago', 'MD', 'Ophthalmology', '', '', NULL, 'O', '1200 S York Rd Ste 3230', 'Elmhurst', 'Dupage', 'IL', '60126', '6302793673', '6302793843', '1200 S York Rd Ste 3230', 'Elmhurst', 'Dupage', 'IL', '60126', '6302793673', '6302793843', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', '2014-04-01', 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1154309821', 0, 'N', 0, '2014-04-11', NULL, NULL, 41.865, -87.9322, NULL, NULL),
('362670634', 'ELEL00410', 'ELEL00410', 'ILCHIGSTD', 'Oak Park Eye Center', 'Manuel', 'D', 'Santiago', 'MD', 'Ophthalmology', '', '', NULL, 'O', '7638 W North Ave', 'Elmwood Park', 'Cook', 'IL', '60707', '7084524257', '7084524283', '7638 W North Ave', 'Elmwood Park', 'Cook', 'IL', '60707', '7084524257', '7084524283', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', '2014-04-01', 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1154309821', 0, 'N', 0, '2014-04-11', NULL, NULL, 41.9087, -87.8171, NULL, NULL),
('362841646', 'ELEL00327', 'ELEL00327', 'ILCHIGSTD', 'Orthopedic Specialists', 'Daryl', '', 'OConnor', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '360 W Butterfield Rd Ste 160', 'Elmhurst', 'Dupage', 'IL', '60126', '6307829600', '6307821643', '360 W Butterfield Rd Ste 160', 'Elmhurst', 'Dupage', 'IL', '60126', '6307829600', '6307821643', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1154323541', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.8648, -87.9509, NULL, NULL),
('362841646', 'ELEL00328', 'ELEL00328', 'ILCHIGSTD', 'Orthopedic Specialists', 'Daryl', '', 'OConnor', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '675 W North Ave Ste 402', 'Melrose Park', 'Cook', 'IL', '60160', '7084505744', '7083380474', '675 W North Ave Ste 402', 'Melrose Park', 'Cook', 'IL', '60160', '7084505744', '7083380474', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1154323541', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.9083, -87.8421, NULL, NULL),
('364037473', 'ELEL00272', 'ELEL00272', 'ILCHIGSTD', 'Elmhurst Clinic', 'Roger', 'A', 'MacDuff', 'DO', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1200 S York Rd Ste 2000', 'Elmhurst', 'Dupage', 'IL', '60126', '6309412606', '6307588481', '1200 S York Rd Ste 2000', 'Elmhurst', 'Dupage', 'IL', '60126', '6309412606', '6307588481', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1154371359', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.865, -87.9322, NULL, NULL),
('364037473', 'ELEL00273', 'ELEL00273', 'ILCHIGSTD', 'Elmhurst Clinic', 'Roger', 'A', 'MacDuff', 'DO', 'Obstetrics and Gynecology', '', '', NULL, 'O', '130 S Main St', 'Lombard', 'Dupage', 'IL', '60148', '6306524200', '6307588481', '130 S Main St', 'Lombard', 'Dupage', 'IL', '60148', '6306524200', '6307588481', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1154371359', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.8856, -88.0184, NULL, NULL),
('364353850', 'ELEL00298', 'ELEL00298', 'ILCHIGSTD', 'Stephen P Boghossian MD', 'Stephen', 'J', 'Mendak', 'MD', 'General Surgery', '', '', NULL, 'O', '1200 S York Rd Ste 4240', 'Elmhurst', 'Dupage', 'IL', '60126', '6308347590', '6305169123', '1200 S York Rd Ste 4240', 'Elmhurst', 'Dupage', 'IL', '60126', '6308347590', '6305169123', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1154419257', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.865, -87.9322, NULL, NULL),
('362716924', 'ELEL00066', 'ELEL00066', 'ILCHIGSTD', 'RPW Obstetrics and Gynecology', 'Evelyn', 'E', 'Chen', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '2434 S Wolf Rd', 'Westchester', 'Cook', 'IL', '60154', '6308324210', '6308328110', '2434 S Wolf Rd', 'Westchester', 'Cook', 'IL', '60154', '6308324210', '6308328110', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1164412342', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.844, -87.9012, NULL, NULL),
('362716924', 'ELEL00065', 'ELEL00065', 'ILCHIGSTD', 'RPW Obstetrics and Gynecology', 'Evelyn', 'E', 'Chen', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '360 w Butterfield Rd Ste 250', 'Elmhurst', 'Dupage', 'IL', '60126', '6308324210', '6308328110', '360 w Butterfield Rd Ste 250', 'Elmhurst', 'Dupage', 'IL', '60126', '6308324210', '6308328110', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1164412342', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.8648, -87.9509, NULL, NULL),
('364037473', 'ELEL00191', 'ELEL00191', 'ILCHIGSTD', 'Elmhurst Clinic', 'Mary', 'C', 'Hutton', 'MD', 'Family Practice', '', '', NULL, 'O', '1100 Lake St Ste 230', 'Oak Park', 'Cook', 'IL', '60301', '7085241420', '7085241509', '1100 Lake St Ste 230', 'Oak Park', 'Cook', 'IL', '60301', '7085241420', '7085241509', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1164415808', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.8886, -87.8026, NULL, NULL),
('363163610', 'ELEL00194', 'ELEL00194', 'ILCHIGSTD', 'M and M Orthopaedics', 'Denise', '', 'Ibrahim', 'DO', 'Orthopedic Surgery', '', '', NULL, 'O', '15900 W 127th St Ste 111', 'Lemont', 'Cook', 'IL', '60439', '6302437385', '6302438302', '15900 W 127th St Ste 111', 'Lemont', 'Cook', 'IL', '60439', '6302437385', '6302438302', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', '2013-06-30', 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '1164418869', 0, 'N', 0, '2014-04-25', NULL, NULL, 41.655, -88.0075, NULL, NULL),
('363163610', 'ELEL00195', 'ELEL00195', 'ILCHIGSTD', 'M and M Orthopaedics', 'Denise', '', 'Ibrahim', 'DO', 'Orthopedic Surgery', '', '', NULL, 'O', '4115 Fairview Ave', 'Downers Grove', 'Dupage', 'IL', '60515', '6309681881', '6309683762', '4115 Fairview Ave', 'Downers Grove', 'Dupage', 'IL', '60515', '6309681881', '6309683762', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', '2013-06-30', 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '1164418869', 0, 'N', 0, '2014-04-25', NULL, NULL, 41.8109, -87.9947, NULL, NULL),
('364037473', 'ELEL00082', 'ELEL00082', 'ILCHIGSTD', 'Elmhurst Clinic', 'Douglas', 'L', 'Cotsamire', 'MD', 'Rheumatology', '', '', NULL, 'O', '1200 S York Rd Ste 2000', 'Elmhurst', 'Dupage', 'IL', '60126', '3312219001', '3312213957', '1200 S York Rd Ste 2000', 'Elmhurst', 'Dupage', 'IL', '60126', '3312219001', '3312213957', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1164487658', 0, 'N', 0, '2014-03-12', NULL, NULL, 41.865, -87.9322, NULL, NULL),
('364037473', 'ELEL00083', 'ELEL00083', 'ILCHIGSTD', 'Elmhurst Clinic', 'Douglas', 'L', 'Cotsamire', 'MD', 'Rheumatology', '', '', NULL, 'O', '130 S Main St', 'Lombard', 'Dupage', 'IL', '60148', '3312219001', '3312213957', '130 S Main St', 'Lombard', 'Dupage', 'IL', '60148', '3312219001', '3312213957', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1164487658', 0, 'N', 0, '2014-03-12', NULL, NULL, 41.8856, -88.0184, NULL, NULL),
('364037473', 'ELEL00440', 'ELEL00440', 'ILCHIGSTD', 'Elmhurst Medical Associates', 'Elaine', 'E', 'Spirakes', 'MD', 'Internal Medicine', '', '', NULL, 'O', '183 Addison Ave', 'Elmhurst', 'Dupage', 'IL', '60126', '3312210000', '3312213991', '183 Addison Ave', 'Elmhurst', 'Dupage', 'IL', '60126', '3312210000', '3312213991', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1164528253', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.9029, -87.9416, 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
('350600466', 'ELEL00515', 'ELEL00515', 'ILCHIGSTD', 'Mike Zangan MD', 'Michael', '', 'Zangan', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '135 Palmer Dr Ste 104', 'Elmhurst', 'Dupage', 'IL', '60126', '6309410046', '6309410042', '135 Palmer Dr Ste 104', 'Elmhurst', 'Dupage', 'IL', '60126', '6309410046', '6309410042', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1164537312', 0, 'N', 0, '2014-02-12', NULL, NULL, 41.8964, -87.9424, NULL, NULL),
('364037473', 'ELEL00349', 'ELEL00349', 'ILCHIGSTD', 'Elmhurst Clinic', 'Purani', '', 'Palaniswami', 'MD', 'Rheumatology', '', '', NULL, 'O', '1200 S York Rd Ste 2000', 'Elmhurst', 'Dupage', 'IL', '60126', '6309412600', '6306524222', '1200 S York Rd Ste 2000', 'Elmhurst', 'Dupage', 'IL', '60126', '6309412600', '6306524222', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1164568507', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.865, -87.9322, NULL, NULL),
('364037473', 'ELEL00350', 'ELEL00350', 'ILCHIGSTD', 'Elmhurst Clinic', 'Purani', '', 'Palaniswami', 'MD', 'Rheumatology', '', '', NULL, 'O', '130 S Main St', 'Lombard', 'Dupage', 'IL', '60148', '6306524200', '6306524222', '130 S Main St', 'Lombard', 'Dupage', 'IL', '60148', '6306524200', '6306524222', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1164568507', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.8856, -88.0184, NULL, NULL),
('363163610', 'ELEL00193', 'ELEL00193', 'ILCHIGSTD', 'M and M Orthopaedics', 'Kamal', '', 'Ibrahim', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '133 E Brush Hill Rd Ste 100', 'Elmhurst', 'Dupage', 'IL', '60126', '6309681881', '6305010646', '133 E Brush Hill Rd Ste 100', 'Elmhurst', 'Dupage', 'IL', '60126', '6309681881', '6305010646', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', '2013-06-30', 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '1174519862', 0, 'N', 0, '2013-09-18', NULL, NULL, 41.8628, -87.9376, NULL, NULL),
('364037473', 'ELEL00192', 'ELEL00192', 'ILCHIGSTD', 'Elmhurst Clinic', 'Kamal', '', 'Ibrahim', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1200 S York Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '6309412633', '6307588590', '1200 S York Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '6309412633', '6307588590', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '1174519862', 0, 'N', 0, '2013-09-18', NULL, NULL, 41.865, -87.9322, NULL, NULL),
('362169147', 'ELEL00022', 'ELEL00022', 'ILCHIGSTD', 'Advocate Medical Group Midwest Heart Specialists', 'Lawrence', 'A', 'Barr', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '133 E Brush Hill Rd Ste 202', 'Elmhurst', 'Dupage', 'IL', '60126', '6307824050', '6307825021', '133 E Brush Hill Rd Ste 202', 'Elmhurst', 'Dupage', 'IL', '60126', '6307824050', '6307825021', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 8, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1174560338', 0, 'N', 0, '2013-09-10', NULL, NULL, 41.8616, -87.9371, NULL, NULL),
('364037473', 'ELEL00142', 'ELEL00142', 'ILCHIGSTD', 'Elmhurst Clinic', 'Eric', '', 'Gabriel', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1200 S York Rd Ste 2000', 'Elmhurst', 'Dupage', 'IL', '60126', '6309412609', '6307588574', '1200 S York Rd Ste 2000', 'Elmhurst', 'Dupage', 'IL', '60126', '6309412609', '6307588574', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1174565238', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.865, -87.9322, NULL, NULL),
('364037473', 'ELEL00141', 'ELEL00141', 'ILCHIGSTD', 'Elmhurst Clinic', 'Eric', '', 'Gabriel', 'MD', 'Internal Medicine', '', '', NULL, 'O', '303 W Lake St Ste 200', 'Addison', 'Dupage', 'IL', '60101', '3312219002', '3312213973', '303 W Lake St Ste 200', 'Addison', 'Dupage', 'IL', '60101', '3312219002', '3312213973', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1174565238', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.9356, -87.9965, NULL, NULL),
('364089651', 'ELEL00026', 'ELEL00026', 'ILCHIGSTD', 'Center Street Medical', 'Paul', 'M', 'Baubly', 'MD', 'Internal Medicine', '', '', NULL, 'O', '103 N Haven Rd Ste 2', 'Elmhurst', 'Dupage', 'IL', '60126', '6305959988', '6305959514', '103 N Haven Rd Ste 2', 'Elmhurst', 'Dupage', 'IL', '60126', '6305959988', '6305959514', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1174681530', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.8994, -87.9364, NULL, NULL),
('362667448', 'ELEL00011', 'ELEL00011', 'ILCHIGSTD', 'Oak Brook Allergists', 'Hetal', 'S', 'Amin', 'MD', 'Allergy and Immunology', '', '', NULL, 'O', '120 Oak Brook Ctr Mall Ste 424', 'Oak Brook', 'Dupage', 'IL', '60523', '6305740460', '6305740470', '120 Oak Brook Ctr Mall Ste 424', 'Oak Brook', 'Dupage', 'IL', '60523', '6305740460', '6305740470', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1184665424', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.8477, -87.9519, NULL, NULL),
('362667448', 'ELEL00012', 'ELEL00012', 'ILCHIGSTD', 'Oak Brook Allergists', 'Hetal', 'S', 'Amin', 'MD', 'Allergy and Immunology', '', '', NULL, 'O', '1220 Hobson Rd Ste 136', 'Naperville', 'Dupage', 'IL', '60540', '6309612960', '6309613296', '1220 Hobson Rd Ste 136', 'Naperville', 'Dupage', 'IL', '60540', '6309612960', '6309613296', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1184665424', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.7528, -88.1191, NULL, NULL),
('364037473', 'ELEL00207', 'ELEL00207', 'ILCHIGSTD', 'Elmhurst Clinic', 'Ninel', '', 'Kandel', 'MD', 'Internal Medicine', '', '', NULL, 'O', '130 S Main St', 'Lombard', 'Dupage', 'IL', '60148', '6306524200', '6306524222', '130 S Main St', 'Lombard', 'Dupage', 'IL', '60148', '6306524200', '6306524222', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1184674376', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.8856, -88.0184, NULL, NULL),
('364037473', 'ELEL00206', 'ELEL00206', 'ILCHIGSTD', 'Elmhurst Clinic', 'Ninel', '', 'Kandel', 'MD', 'Internal Medicine', '', '', NULL, 'O', '172 Schiller', 'Elmhurst', 'Dupage', 'IL', '60126', '6309412600', '6309412632', '172 Schiller', 'Elmhurst', 'Dupage', 'IL', '60126', '6309412600', '6309412632', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1184674376', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.9011, -87.9371, NULL, NULL),
('363729867', 'ELEL00003', 'ELEL00003', 'ILCHIGSTD', 'Retina Associates', 'Mohamed', 'K', 'Adenwalla', 'MD', 'Ophthalmology', '', '', NULL, 'O', '1200 S York Rd Ste 4260', 'Elmhurst', 'Dupage', 'IL', '60126', '6305711501', '6305715679', '1200 S York Rd Ste 4260', 'Elmhurst', 'Dupage', 'IL', '60126', '6305711501', '6305715679', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1184679524', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.865, -87.9322, NULL, NULL),
('363729867', 'ELEL00004', 'ELEL00004', 'ILCHIGSTD', 'Retina Associates', 'Mohamed', 'K', 'Adenwalla', 'MD', 'Ophthalmology', '', '', NULL, 'O', '4700 W 95th St Ste LL8', 'Oak Lawn', 'Cook', 'IL', '60453', '7084994192', '7084995674', '4700 W 95th St Ste LL8', 'Oak Lawn', 'Cook', 'IL', '60453', '7084994192', '7084995674', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1184679524', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.7202, -87.7384, NULL, NULL),
('454555174', 'ELEL00006', 'ELEL00006', 'ILCHIGSTD', 'Advanced Cardiovascular Specialists', 'Mohamad', 'T', 'Alahadab', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1200 S York Rd Ste 4250', 'Elmhurst', 'Dupage', 'IL', '60126', '6307588630', '6307494493', '1200 S York Rd Ste 4250', 'Elmhurst', 'Dupage', 'IL', '60126', '6307588630', '6307494493', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, '', NULL, 'HCFA|UB|', '1184849747', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.865, -87.9322, NULL, NULL),
('454555174', 'ELEL00007', 'ELEL00007', 'ILCHIGSTD', 'Advanced Cardiovascular Specialists', 'Mohamad', 'T', 'Alahadab', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '130 S Main St Ste 306', 'Lombard', 'Dupage', 'IL', '60148', '6303177682', '6307494993', '130 S Main St Ste 306', 'Lombard', 'Dupage', 'IL', '60148', '6303177682', '6307494993', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, '', NULL, 'HCFA|UB|', '1184849747', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.8856, -88.0184, NULL, NULL),
('454555174', 'ELEL00008', 'ELEL00008', 'ILCHIGSTD', 'Advanced Cardiovascular Specialists', 'Mohamad', 'T', 'Alahadab', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1435 Coventry Ct', 'Darien', 'Dupage', 'IL', '60561', '6302724455', NULL, '1435 Coventry Ct', 'Darien', 'Dupage', 'IL', '60561', '6302724455', '', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, '', NULL, 'HCFA|UB|', '1184849747', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.7508, -87.9806, NULL, NULL),
('364028323', 'ELEL00118', 'ELEL00118', 'ILCHIGSTD', 'Oakbrook Behavioral Health', 'Donna', '', 'Dobrowolsky', 'MD', 'Psychiatry', '', '', NULL, 'O', '18W100 22nd St Ste 132', 'Oakbrook Terrace', 'Dupage', 'IL', '60181', '6304249204', '6304249208', '18W100 22nd St Ste 132', 'Oakbrook Terrace', 'Dupage', 'IL', '60181', '6304249204', '6304249208', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1194825851', 0, 'Y', 0, '2013-10-15', NULL, NULL, 41.8461, -87.9795, NULL, NULL),
('364390963', 'ELEL00279', 'ELEL00279', 'ILCHIGSTD', 'Comprehensive Clinical Services', 'Daniel', 'B', 'Martinez', 'MD', 'Psychiatry', '', '', NULL, 'O', '2340 S Highland Ave Ste 300', 'Lombard', 'Dupage', 'IL', '60148', '6302611210', '6302611211', '2340 S Highland Ave Ste 300', 'Lombard', 'Dupage', 'IL', '60148', '6302611210', '6302611211', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1194896878', 0, 'Y', 0, '2013-07-25', NULL, NULL, 41.8429, -88.0115, NULL, NULL),
('363878197', 'ELEL00508', 'ELEL00508', 'ILCHIGSTD', 'Rita Yadava MD', 'Gaurav', '', 'Yadava', 'MD', 'Pediatric Neurology', '', '', NULL, 'O', '1200 S York Rd Ste 4150', 'Elmhurst', 'Dupage', 'IL', '60126', '6305305577', '6305304477', '1200 S York Rd Ste 4150', 'Elmhurst', 'Dupage', 'IL', '60126', '6305305577', '6305304477', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1194974600', 0, 'Y', 0, '2013-07-25', NULL, NULL, 41.865, -87.9322, NULL, NULL),
('364449008', 'ELEL00445', 'ELEL00445', 'ILCHIGSTD', 'Ronald H Stefani Jr MD FACS', 'Ronald', 'H', 'Stefani', 'MD', 'Plastic Surgery', '', '', NULL, 'O', '629 S Main St', 'Lombard', 'Dupage', 'IL', '60148', '6304951000', '6304958545', '629 S Main St', 'Lombard', 'Dupage', 'IL', '60148', '6304951000', '6304958545', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1205821733', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.8742, -88.018, NULL, NULL),
('364037473', 'ELEL00476', 'ELEL00476', 'ILCHIGSTD', 'Elmhurst Clinic', 'Laura', '', 'Vetrone', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1200 S York Rd Ste 2000', 'Elmhurst', 'Dupage', 'IL', '60126', '6309412600', '6307588480', '1200 S York Rd Ste 2000', 'Elmhurst', 'Dupage', 'IL', '60126', '6309412600', '6307588480', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1205835980', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.865, -87.9322, NULL, NULL),
('364037473', 'ELEL00477', 'ELEL00477', 'ILCHIGSTD', 'Elmhurst Clinic', 'Laura', '', 'Vetrone', 'MD', 'Internal Medicine', '', '', NULL, 'O', '130 S Main St', 'Lombard', 'Dupage', 'IL', '60148', '6306524200', '6306524222', '130 S Main St', 'Lombard', 'Dupage', 'IL', '60148', '6306524200', '6306524222', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1205835980', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.8856, -88.0184, NULL, NULL),
('363374001', 'ELEL00306', 'ELEL00306', 'ILCHIGSTD', 'Midwest Pulmonary Associates', 'Nureain', 'Muhammad', 'Mirza', 'MD', 'Pulmonary', '', '', NULL, 'O', '2340 S Highland Ave Ste 230', 'Lombard', 'Dupage', 'IL', '60148', '6309322040', '6309321513', '2340 S Highland Ave Ste 230', 'Lombard', 'Dupage', 'IL', '60148', '6309322040', '6309321513', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1205876414', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.8429, -88.0115, NULL, NULL),
('363374001', 'ELEL00305', 'ELEL00305', 'ILCHIGSTD', 'Midwest Pulmonary Associates', 'Nureain', 'Muhammad', 'Mirza', 'MD', 'Pulmonary', '', '', NULL, 'O', '800 Biesterfield Rd Ste 4002', 'Elk Grove Village', 'Cook', 'IL', '60007', '8479815575', '8669321513', '800 Biesterfield Rd Ste 4002', 'Elk Grove Village', 'Cook', 'IL', '60007', '8479815575', '8669321513', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1205876414', 0, 'N', 0, '2013-07-25', NULL, NULL, 42.0034, -88.0174, NULL, NULL),
('364037473', 'ELEL00085', 'ELEL00085', 'ILCHIGSTD', 'Elmhurst Clinic', 'Phillip', 'J', 'Cozzi', 'MD', 'Pulmonary', '', '', NULL, 'O', '133 E Brush Hill Rd Ste 310', 'Elmhurst', 'Dupage', 'IL', '60126', '3312219003', '3312213978', '133 E Brush Hill Rd Ste 310', 'Elmhurst', 'Dupage', 'IL', '60126', '3312219003', '3312213978', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1205887353', 0, 'N', 0, '2014-06-17', NULL, NULL, 41.8616, -87.9371, NULL, NULL),
('364037473', 'ELEL00086', 'ELEL00086', 'ILCHIGSTD', 'Elmhurst Clinic', 'Phillip', 'J', 'Cozzi', 'MD', 'Pulmonary', '', '', NULL, 'O', '172 Schiller', 'Elmhurst', 'Dupage', 'IL', '60126', '6309412638', '6309412642', '172 Schiller', 'Elmhurst', 'Dupage', 'IL', '60126', '6309412638', '6309412642', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1205887353', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.9011, -87.9371, NULL, NULL),
('364410036', 'ELEL00265', 'ELEL00265', 'ILCHIGSTD', 'Laura E Loya Frank MD', 'Laura', '', 'Loya Frank', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '154 Broadway Ave Ste 1', 'Melrose Park', 'Cook', 'IL', '60160', '7083438512', '7083438529', '154 Broadway Ave Ste 1', 'Melrose Park', 'Cook', 'IL', '60160', '7083438512', '7083438529', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '1205895380', 0, 'N', 0, '2014-04-25', NULL, NULL, 41.8931, -87.8566, NULL, NULL),
('364166076', 'ELEL00188', 'ELEL00188', 'ILCHIGSTD', 'Blake Horio MD', 'Blake', '', 'Horio', 'MD', 'Ophthalmology', '', '', NULL, 'O', '710 N York Rd', 'Hinsdale', 'Dupage', 'IL', '60521', '6307342000', '6307341090', '710 N York Rd', 'Hinsdale', 'Dupage', 'IL', '60521', '6307342000', '6307341090', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, '', NULL, 'HCFA|UB|', '1205909447', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.8146, -87.9254, NULL, NULL),
('364166076', 'ELEL00187', 'ELEL00187', 'ILCHIGSTD', 'Blake Horio MD', 'Blake', '', 'Horio', 'MD', 'Ophthalmology', '', '', NULL, 'O', '7427 Lake St', 'River Forest', 'Cook', 'IL', '60305', '7087713334', '7087717321', '7427 Lake St', 'River Forest', 'Cook', 'IL', '60305', '7087713334', '7087717321', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, '', NULL, 'HCFA|UB|', '1205909447', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.8885, -87.8112, NULL, NULL),
('362169147', 'ELEL00248', 'ELEL00248', 'ILCHIGSTD', 'Advocate Medical Group Midwest Heart Specialists', 'Timothy', 'J', 'Larkin', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '801 S Washington St 4th Fl', 'Naperville', 'Dupage', 'IL', '60566', '6305272730', '6305272754', '801 S Washington St 4th Fl', 'Naperville', 'Dupage', 'IL', '60566', '6305272730', '6305272754', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 8, '2013-04-01', NULL, 0, 0, 0, 'Edward Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1215975578', 0, 'N', 0, '2013-09-10', NULL, NULL, 41.7608, -88.149, NULL, NULL),
('364037473', 'ELEL00509', 'ELEL00509', 'ILCHIGSTD', 'Elmhurst Clinic', 'Ved', 'P', 'Yadava', 'MD', 'Pulmonary', '', '', NULL, 'O', '133 E Brush Hill Rd Ste 310', 'Elmhurst', 'Dupage', 'IL', '60126', '6309412638', '6309412642', '133 E Brush Hill Rd Ste 310', 'Elmhurst', 'Dupage', 'IL', '60126', '6309412638', '6309412642', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1225035041', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.8616, -87.9371, NULL, NULL),
('362169147', 'ELEL00485', 'ELEL00485', 'ILCHIGSTD', 'Advocate Medical Group Midwest Heart Specialists', 'Marie', 'A', 'Wadas', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '133 E Brush Hill Rd Ste 202', 'Elmhurst', 'Dupage', 'IL', '60126', '6307824050', '6307825021', '133 E Brush Hill Rd Ste 202', 'Elmhurst', 'Dupage', 'IL', '60126', '6307824050', '6307825021', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 8, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1225082688', 0, 'N', 0, '2013-09-10', NULL, NULL, 41.8616, -87.9371, NULL, NULL),
('364037473', 'ELEL00486', 'ELEL00486', 'ILCHIGSTD', 'Elmhurst Clinic', 'Marie', 'A', 'Wadas', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '6309412600', '6309412632', '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '6309412600', '6309412632', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1225082688', 0, 'N', 0, '2013-09-10', NULL, NULL, 41.8616, -87.936, NULL, NULL),
('362169147', 'ELEL00339', 'ELEL00339', 'ILCHIGSTD', 'Advocate Medical Group Midwest Heart Specialists', 'Michael', 'F', 'OToole', 'MD', 'Electrophysiology', '', '', NULL, 'O', '133 E Brush Hill Rd Ste 202', 'Elmhurst', 'Dupage', 'IL', '60126', '6307824050', '6307825021', '133 E Brush Hill Rd Ste 202', 'Elmhurst', 'Dupage', 'IL', '60126', '6307824050', '6307825021', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 8, '2013-04-01', NULL, 0, 0, 0, 'Edward Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1225083462', 0, 'Y', 0, '2013-09-10', NULL, NULL, 41.8616, -87.9371, NULL, NULL),
('362169147', 'ELEL00340', 'ELEL00340', 'ILCHIGSTD', 'Advocate Medical Group Midwest Heart Specialists', 'Michael', 'F', 'OToole', 'MD', 'Electrophysiology', '', '', NULL, 'O', '3825 Highland Ave Ste 400', 'Downers Grove', 'Dupage', 'IL', '60515', '6307194799', '6309637420', '3825 Highland Ave Ste 400', 'Downers Grove', 'Dupage', 'IL', '60515', '6307194799', '6309637420', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 8, '2013-04-01', NULL, 0, 0, 0, 'Edward Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1225083462', 0, 'Y', 0, '2013-09-10', NULL, NULL, 41.8181, -88.0102, NULL, NULL),
('364037473', 'ELEL00162', 'ELEL00162', 'ILCHIGSTD', 'Elmhurst Memorial Hematology Oncology Services', 'Christine', '', 'Gresik', 'MD', 'General Surgery', '', '', NULL, 'O', '1200 S York Rd Ste 3280', 'Elmhurst', 'Dupage', 'IL', '60126', '6307588640', '6307588642', '1200 S York Rd Ste 3280', 'Elmhurst', 'Dupage', 'IL', '60126', '6307588640', '6307588642', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1225298045', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.865, -87.9322, NULL, NULL),
('364037473', 'ELEL00152', 'ELEL00152', 'ILCHIGSTD', 'Elmhurst Memorial Hematology Oncology Services', 'Amaryllis', '', 'Gil', 'MD', 'Oncology', '', '', NULL, 'O', '1200 S York Rd Ste 3280', 'Elmhurst', 'Dupage', 'IL', '60126', '6307588640', '6307588642', '1200 S York Rd Ste 3280', 'Elmhurst', 'Dupage', 'IL', '60126', '6307588640', '6307588642', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1235116591', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.865, -87.9322, NULL, NULL),
('364037473', 'ELEL00202', 'ELEL00202', 'ILCHIGSTD', 'Elmhurst Clinic', 'Joseph', 'S', 'Kaliski', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1200 S York Rd Ste 2000', 'Elmhurst', 'Dupage', 'IL', '60126', '6309412600', '6307588480', '1200 S York Rd Ste 2000', 'Elmhurst', 'Dupage', 'IL', '60126', '6309412600', '6307588480', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1235180381', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.865, -87.9322, NULL, NULL),
('364037473', 'ELEL00203', 'ELEL00203', 'ILCHIGSTD', 'Elmhurst Clinic', 'Joseph', 'S', 'Kaliski', 'MD', 'Internal Medicine', '', '', NULL, 'O', '130 S Main St', 'Lombard', 'Dupage', 'IL', '60148', '6306524200', '6306524222', '130 S Main St', 'Lombard', 'Dupage', 'IL', '60148', '6306524200', '6306524222', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1235180381', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.8856, -88.0184, NULL, NULL),
('364037473', 'ELEL00408', 'ELEL00408', 'ILCHIGSTD', 'Elmhurst Clinic', 'Armando', 'A', 'San Juan', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '133 E Brush Hill Rd Ste 308', 'Elmhurst', 'Dupage', 'IL', '60126', '6308331666', '6308331690', '133 E Brush Hill Rd Ste 308', 'Elmhurst', 'Dupage', 'IL', '60126', '6308331666', '6308331690', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1235220518', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.8616, -87.9371, NULL, NULL),
('364037473', 'ELEL00407', 'ELEL00407', 'ILCHIGSTD', 'Elmhurst Clinic', 'Armando', 'A', 'San Juan', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '303 W Lake St Ste 200', 'Addison', 'Dupage', 'IL', '60101', '3312219002', '3312213973', '303 W Lake St Ste 200', 'Addison', 'Dupage', 'IL', '60101', '3312219002', '3312213973', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1235220518', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.9356, -87.9965, NULL, NULL),
('364353850', 'ELEL00036', 'ELEL00036', 'ILCHIGSTD', 'Stephen P Boghossian MD', 'Stephen', 'P', 'Boghossian', 'MD', 'General Surgery', '', '', NULL, 'O', '1200 S York Rd Ste 4240', 'Elmhurst', 'Dupage', 'IL', '60126', '6308347590', '6305169123', '1200 S York Rd Ste 4240', 'Elmhurst', 'Dupage', 'IL', '60126', '6308347590', '6305169123', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1245210111', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.865, -87.9322, NULL, NULL),
('364390963', 'ELEL00402', 'ELEL00402', 'ILCHIGSTD', 'Comprehensive Clinical Services', 'Aamir', '', 'Safdar', 'MD', 'Psychiatry', '', '', NULL, 'O', '2340 S Highland Ave Ste 300', 'Lombard', 'Dupage', 'IL', '60148', '6302611210', '6302611211', '2340 S Highland Ave Ste 300', 'Lombard', 'Dupage', 'IL', '60148', '6302611210', '6302611211', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1245336205', 0, 'Y', 0, '2013-10-07', NULL, NULL, 41.8429, -88.0115, NULL, NULL),
('364093804', 'ELEL00430', 'ELEL00430', 'ILCHIGSTD', 'Surgeons', 'Harry', 'A', 'Siavelis', 'MD', 'General Surgery', '', '', NULL, 'O', '1200 S York Rd Ste 4220', 'Elmhurst', 'Dupage', 'IL', '60126', '6307588838', '6307588846', '1200 S York Rd Ste 4220', 'Elmhurst', 'Dupage', 'IL', '60126', '6307588838', '6307588846', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', '2014-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1255310736', 0, 'N', 0, '2014-02-06', NULL, NULL, 41.865, -87.9323, NULL, NULL),
('363322875', 'ELEL00090', 'ELEL00090', 'ILCHIGSTD', 'West Suburban MultiSpecialty', 'Timothy', 'M', 'Cullinane', 'MD', 'Psychiatry', '', '', NULL, 'O', '1140 Lake St Ste 504', 'Oak Park', 'Cook', 'IL', '60301', '6308341557', '6308343461', '1140 Lake St Ste 504', 'Oak Park', 'Cook', 'IL', '60301', '6308341557', '6308343461', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1255376232', 0, 'Y', 0, '2013-07-25', NULL, NULL, 41.8886, -87.8043, NULL, NULL),
('363322875', 'ELEL00089', 'ELEL00089', 'ILCHIGSTD', 'West Suburban MultiSpecialty', 'Timothy', 'M', 'Cullinane', 'MD', 'Psychiatry', '', '', NULL, 'O', '386 N York Rd Ste 100', 'Elmhurst', 'Dupage', 'IL', '60126', '6308341557', '6308343461', '386 N York Rd Ste 100', 'Elmhurst', 'Dupage', 'IL', '60126', '6308341557', '6308343461', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1255376232', 0, 'Y', 0, '2013-07-25', NULL, NULL, 41.9096, -87.9398, NULL, NULL),
('362169147', 'ELEL00428', 'ELEL00428', 'ILCHIGSTD', 'Advocate Medical Group', 'David', 'N', 'Sheftel', 'MD', 'Neonatology', '', '', NULL, 'O', '200 Berteau Ave', 'Elmhurst', 'Dupage', 'IL', '60126', '6308331400', NULL, '200 Berteau Ave', 'Elmhurst', 'Dupage', 'IL', '60126', '6308331400', '', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 8, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '1255443592', 0, 'Y', 0, '2014-04-25', NULL, NULL, 41.9022, -87.9293, NULL, NULL),
('362714102', 'ELEL00266', 'ELEL00266', 'ILCHIGSTD', 'RLT Neurologic Associates', 'Donald', 'H', 'Lussky', 'MD', 'Neurology', '', '', NULL, 'O', '255 W 1st St', 'Elmhurst', 'Dupage', 'IL', '60126', '6305304449', '6305304557', '255 W 1st St', 'Elmhurst', 'Dupage', 'IL', '60126', '6305304449', '6305304557', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1255447470', 0, 'N', 0, '2013-07-30', NULL, NULL, 41.9, -87.9468, NULL, NULL),
('362714102', 'ELEL00267', 'ELEL00267', 'ILCHIGSTD', 'RLT Neurologic Associates', 'Donald', 'H', 'Lussky', 'MD', 'Neurology', '', '', NULL, 'O', '3815 Highland Ave Ste 107', 'Downers Grove', 'Dupage', 'IL', '60515', '6305304449', '6305304557', '3815 Highland Ave Ste 107', 'Downers Grove', 'Dupage', 'IL', '60515', '6305304449', '6305304557', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', '2013-07-22', 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1255447470', 0, 'N', 0, '2013-07-30', NULL, NULL, 0, 0, NULL, NULL),
('362716924', 'ELEL00056', 'ELEL00056', 'ILCHIGSTD', 'RPW Obstetrics and Gynecology', 'Caroline', 'A', 'Casey', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '2434 S Wolf Rd', 'Westchester', 'Cook', 'IL', '60154', '6308324210', '6308328110', '2434 S Wolf Rd', 'Westchester', 'Cook', 'IL', '60154', '6308324210', '6308328110', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1265422844', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.844, -87.9012, NULL, NULL),
('362716924', 'ELEL00055', 'ELEL00055', 'ILCHIGSTD', 'RPW Obstetrics and Gynecology', 'Caroline', 'A', 'Casey', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '360 W Butterfield Rd Ste 250', 'Elmhurst', 'Dupage', 'IL', '60126', '6308324210', '6308328110', '360 W Butterfield Rd Ste 250', 'Elmhurst', 'Dupage', 'IL', '60126', '6308324210', '6308328110', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1265422844', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.8648, -87.9509, NULL, NULL),
('362169147', 'ELEL00047', 'ELEL00047', 'ILCHIGSTD', 'Advocate Medical Group Midwest Heart Specialists', 'Vincent', 'J', 'Bufalino', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '133 E Brush Hill Rd Ste 202', 'Elmhurst', 'Dupage', 'IL', '60126', '6307824050', '6307825021', '133 E Brush Hill Rd Ste 202', 'Elmhurst', 'Dupage', 'IL', '60126', '6307824050', '6307825021', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 8, '2013-04-01', NULL, 0, 0, 0, 'Edward Hospital', 'Elmhurst Memorial Hospital', NULL, NULL, 'HCFA|UB|', '1265486690', 0, 'N', 0, '2013-09-10', NULL, NULL, 41.8616, -87.9371, NULL, NULL),
('362169147', 'ELEL00048', 'ELEL00048', 'ILCHIGSTD', 'Advocate Medical Group Midwest Heart Specialists', 'Vincent', 'J', 'Bufalino', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '801 S Washington St 4th Fl', 'Naperville', 'Dupage', 'IL', '60566', '6305272730', '6305272754', '801 S Washington St 4th Fl', 'Naperville', 'Dupage', 'IL', '60566', '6305272730', '6305272754', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 8, '2013-04-01', NULL, 0, 0, 0, 'Edward Hospital', 'Elmhurst Memorial Hospital', NULL, NULL, 'HCFA|UB|', '1265486690', 0, 'N', 0, '2013-09-10', NULL, NULL, 41.7608, -88.149, NULL, NULL),
('364037473', 'ELEL00044', 'ELEL00044', 'ILCHIGSTD', 'Elmhurst Medical Associates', 'Timothy', 'J', 'Bresnahan', 'MD', 'Internal Medicine', '', '', NULL, 'O', '183 Addison Ave', 'Elmhurst', 'Dupage', 'IL', '60126', '3312210000', '3312213991', '183 Addison Ave', 'Elmhurst', 'Dupage', 'IL', '60126', '3312210000', '3312213991', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1265538433', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.9029, -87.9416, NULL, NULL),
('363716513', 'ELEL00151', 'ELEL00151', 'ILCHIGSTD', 'Elmhurst Medical Physicians', 'Charles', 'C', 'Giger', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1200 S York Rd Ste 3250', 'Elmhurst', 'Dupage', 'IL', '60126', '6307588885', '6307588876', '1200 S York Rd Ste 3250', 'Elmhurst', 'Dupage', 'IL', '60126', '6307588885', '6307588876', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1275558496', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.865, -87.9322, NULL, NULL),
('364037473', 'ELEL00309', 'ELEL00309', 'ILCHIGSTD', 'Elmhurst Clinic', 'Michael', '', 'Moore', 'MD', 'Pulmonary', '', '', NULL, 'O', '133 E Brush Hill Rd Ste 310', 'Elmhurst', 'Dupage', 'IL', '60126', '6309412638', '6309412642', '133 E Brush Hill Rd Ste 310', 'Elmhurst', 'Dupage', 'IL', '60126', '6309412638', '6309412642', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1285668772', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.8616, -87.9371, NULL, NULL),
('364037473', 'ELEL00310', 'ELEL00310', 'ILCHIGSTD', 'Elmhurst Clinic', 'Michael', '', 'Moore', 'MD', 'Pulmonary', '', '', NULL, 'O', '172 Schiller', 'Elmhurst', 'Dupage', 'IL', '60126', '6309412638', '6309412642', '172 Schiller', 'Elmhurst', 'Dupage', 'IL', '60126', '6309412638', '6309412642', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1285668772', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.9011, -87.9371, NULL, NULL),
('364037473', 'ELEL00209', 'ELEL00209', 'ILCHIGSTD', 'Elmhurst Memorial Primary Care Associates', 'Kristina', 'M', 'Katzovitz', 'MD', 'Internal Medicine', '', '', NULL, 'O', '305 N York Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '3312214350', '3312213934', '305 N York Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '3312214350', '3312213934', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1285711051', 0, 'N', 0, '2014-04-11', NULL, NULL, 41.9069, -87.9399, NULL, NULL),
('364037473', 'ELEL00210', 'ELEL00210', 'ILCHIGSTD', 'Elmhurst Memorial Primary Care Associates', 'Kristina', 'M', 'Katzovitz', 'MD', 'Internal Medicine', '', '', NULL, 'O', '675 W North Ave Ste 505', 'Melrose Park', 'Cook', 'IL', '60160', '6308340400', '7083442629', '675 W North Ave Ste 505', 'Melrose Park', 'Cook', 'IL', '60160', '6308340400', '7083442629', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1285711051', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.9083, -87.8421, NULL, NULL),
('364377319', 'ELEL00204', 'ELEL00204', 'ILCHIGSTD', 'Dr C Kalsi and Associates', 'Charanjit', 'K', 'Kalsi', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1200 S York Rd Ste 4250', 'Elmhurst', 'Dupage', 'IL', '60126', '6307588750', '6307588751', '1200 S York Rd Ste 4250', 'Elmhurst', 'Dupage', 'IL', '60126', '6307588750', '6307588751', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1285851584', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.865, -87.9322, NULL, NULL),
('362876572', 'ELEL00224', 'ELEL00224', 'ILCHIGSTD', 'Midwest Associates in Neurology', 'Ricardo', '', 'Kohn', 'MD', 'Neurology', '', '', NULL, 'O', '1 Erie Ct Ste 7020', 'Oak Park', 'Cook', 'IL', '60302', '7085242440', '7085242463', '1 Erie Ct Ste 7020', 'Oak Park', 'Cook', 'IL', '60302', '7085242440', '7085242463', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, '', '', 'HCFA|UB|', '1295720886', 0, 'N', 0, '2014-04-25', NULL, NULL, 41.8919, -87.775, NULL, NULL),
('364037473', 'ELEL00347', 'ELEL00347', 'ILCHIGSTD', 'Elmhurst Clinic', 'Cynthia', '', 'Page', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1200 S York Rd Ste 2000', 'Elmhurst', 'Dupage', 'IL', '60126', '6308341120', '6307588480', '1200 S York Rd Ste 2000', 'Elmhurst', 'Dupage', 'IL', '60126', '6308341120', '6307588480', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1295786366', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.865, -87.9322, NULL, NULL),
('364037473', 'ELEL00348', 'ELEL00348', 'ILCHIGSTD', 'Elmhurst Clinic', 'Cynthia', '', 'Page', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '130 S Main St', 'Lombard', 'Dupage', 'IL', '60148', '6309412606', '6307588481', '130 S Main St', 'Lombard', 'Dupage', 'IL', '60148', '6309412606', '6307588481', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1295786366', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.8856, -88.0184, NULL, NULL),
('363819436', 'ELEL00091', 'ELEL00091', 'ILCHIGSTD', 'Cardiac Surgery Associates', 'David', 'J', 'Cziperle', 'MD', 'Cardiothoracic Surgery', '', '', NULL, 'O', '1890 Silver Cross Blvd Ste 275', 'New Lenox', 'Will', 'IL', '60451', '8157178785', '7083339105', '1890 Silver Cross Blvd Ste 275', 'New Lenox', 'Will', 'IL', '60451', '8157178785', '7083339105', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 6, '2013-04-01', NULL, 0, 0, 0, 'Edward Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1295797900', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.5443, -87.986, NULL, NULL),
('363819436', 'ELEL00092', 'ELEL00092', 'ILCHIGSTD', 'Cardiac Surgery Associates', 'David', 'J', 'Cziperle', 'MD', 'Cardiothoracic Surgery', '', '', NULL, 'O', '801 S Washington St 4th Fl', 'Naperville', 'Dupage', 'IL', '60566', '6304168500', '6304168694', '801 S Washington St 4th Fl', 'Naperville', 'Dupage', 'IL', '60566', '6304168500', '6304168694', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 6, '2013-04-01', NULL, 0, 0, 0, 'Edward Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1295797900', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.7608, -88.149, NULL, NULL),
('202042779', 'ELEL00478', 'ELEL00478', 'ILCHIGSTD', 'Suburban Retina', 'Susan', 'G', 'Vierling', 'MD', 'Ophthalmology', '', '', NULL, 'O', '130 S Main St Ste 203', 'Lombard', 'Dupage', 'IL', '60148', '6304249877', '6304249878', '130 S Main St Ste 203', 'Lombard', 'Dupage', 'IL', '60148', '6304249877', '6304249878', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1306825930', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.8856, -88.0184, NULL, NULL),
('202042779', 'ELEL00479', 'ELEL00479', 'ILCHIGSTD', 'Suburban Retina', 'Susan', 'G', 'Vierling', 'MD', 'Ophthalmology', '', '', NULL, 'O', '715 Lake St Ste 120', 'Oak Park', 'Cook', 'IL', '60301', '7083580701', '7083580702', '715 Lake St Ste 120', 'Oak Park', 'Cook', 'IL', '60301', '7083580701', '7083580702', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1306825930', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.8886, -87.793, NULL, NULL),
('363966745', 'ELEL00029', 'ELEL00029', 'ILCHIGSTD', 'Metro Infectious Disease Consultants', 'David', 'W', 'Beezhold', 'DO', 'Infectious Disease', '', '', NULL, 'O', '13755 S Cicero Ave', 'Crestwood', 'Cook', 'IL', '60445', '8882206432', '6306544253', '13755 S Cicero Ave', 'Crestwood', 'Cook', 'IL', '60445', '8882206432', '6306544253', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 6, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1306832860', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.6422, -87.7378, NULL, NULL),
('363966745', 'ELEL00030', 'ELEL00030', 'ILCHIGSTD', 'Metro Infectious Disease Consultants', 'David', 'W', 'Beezhold', 'DO', 'Infectious Disease', '', '', NULL, 'O', '901 McClintock Dr Ste 202', 'Burr Ridge', 'Dupage', 'IL', '60527', '6306544201', '6306544253', '901 McClintock Dr Ste 202', 'Burr Ridge', 'Dupage', 'IL', '60527', '6306544201', '6306544253', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 6, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1306832860', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.7543, -87.9095, NULL, NULL),
('362841923', 'ELEL00373', 'ELEL00373', 'ILCHIGSTD', 'Advocate Medical Group Midwest Heart Specialists', 'Anand', 'V', 'Ramanathan', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '801 S Washington St 4th Fl', 'Naperville', 'Dupage', 'IL', '60566', '6305272730', '6305272754', '801 S Washington St 4th Fl', 'Naperville', 'Dupage', 'IL', '60566', '6305272730', '6305272754', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', 'Edward Hospital', NULL, NULL, 'HCFA|UB|', '1306892229', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.7608, -88.149, NULL, NULL),
('364037473', 'ELEL00372', 'ELEL00372', 'ILCHIGSTD', 'Elmhurst Clinic', 'Anand', 'V', 'Ramanathan', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '6309412600', '6309412632', '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '6309412600', '6309412632', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', 'Edward Hospital', NULL, NULL, 'HCFA|UB|', '1306892229', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.8616, -87.936, NULL, NULL),
('363101537', 'ELEL00093', 'ELEL00093', 'ILCHIGSTD', 'Narendra Dabhade MD', 'Narendra', 'D', 'Dabhade', 'MD', 'Internal Medicine', '', '', NULL, 'O', '9722 W Grand Ave Ste 1', 'Franklin Park', 'Cook', 'IL', '60131', '8474553302', '8474552539', '9722 W Grand Ave Ste 1', 'Franklin Park', 'Cook', 'IL', '60131', '8474553302', '8474552539', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1306995808', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.9298, -87.8682, NULL, NULL),
('363163610', 'ELEL00252', 'ELEL00252', 'ILCHIGSTD', 'M and M Orthopaedics', 'Lawrence', '', 'Lieber', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '15900 W 127th St Ste 111', 'Lemont', 'Cook', 'IL', '60439', '6302437385', '6302438302', '15900 W 127th St Ste 111', 'Lemont', 'Cook', 'IL', '60439', '6302437385', '6302438302', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', '2013-06-30', 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '1316933120', 0, 'N', 0, '2014-04-25', NULL, NULL, 41.655, -88.0075, NULL, NULL),
('363163610', 'ELEL00253', 'ELEL00253', 'ILCHIGSTD', 'M and M Orthopaedics', 'Lawrence', '', 'Lieber', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '4115 Fairview Ave', 'Downers Grove', 'Dupage', 'IL', '60515', '6309681881', '6309683762', '4115 Fairview Ave', 'Downers Grove', 'Dupage', 'IL', '60515', '6309681881', '6309683762', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', '2013-06-30', 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '1316933120', 0, 'N', 0, '2014-04-25', NULL, NULL, 41.8109, -87.9947, NULL, NULL),
('362169147', 'ELEL00146', 'ELEL00146', 'ILCHIGSTD', 'Advocate Medical Group Midwest Heart Specialists', 'Apoor', 'S', 'Gami', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '133 E Brush Hill Rd Ste 202', 'Elmhurst', 'Dupage', 'IL', '60126', '6307824050', '6307825021', '133 E Brush Hill Rd Ste 202', 'Elmhurst', 'Dupage', 'IL', '60126', '6307824050', '6307825021', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 8, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1326026840', 0, 'N', 0, '2013-09-10', NULL, NULL, 41.8616, -87.9371, NULL, NULL),
('364037473', 'ELEL00147', 'ELEL00147', 'ILCHIGSTD', 'Elmhurst Clinic', 'Apoor', 'S', 'Gami', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '6309412600', '6309412632', '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '6309412600', '6309412632', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1326026840', 0, 'N', 0, '2013-09-10', NULL, NULL, 41.8616, -87.936, NULL, NULL),
('364020961', 'ELEL00448', 'ELEL00448', 'ILCHIGSTD', 'Associates in Digestive Diseases', 'Gerard', 'A', 'Sublette', 'MD', 'Gastroenterology', '', '', NULL, 'O', '1200 S York Rd Ste 3250', 'Elmhurst', 'Dupage', 'IL', '60126', '6307588889', '6307588705', '1200 S York Rd Ste 3250', 'Elmhurst', 'Dupage', 'IL', '60126', '6307588889', '6307588705', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1326030735', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.865, -87.9322, NULL, NULL),
('364020961', 'ELEL00449', 'ELEL00449', 'ILCHIGSTD', 'Associates in Digestive Diseases', 'Gerard', 'A', 'Sublette', 'MD', 'Gastroenterology', '', '', NULL, 'O', '675 W North Ave Ste 501', 'Melrose Park', 'Cook', 'IL', '60160', '6307588889', '6307588705', '675 W North Ave Ste 501', 'Melrose Park', 'Cook', 'IL', '60160', '6307588889', '6307588705', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1326030735', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.9083, -87.8421, NULL, NULL),
('363323937', 'ELEL00148', 'ELEL00148', 'ILCHIGSTD', 'Robert H Geller MD', 'Robert', '', 'Geller', 'MD', 'General Surgery', '', '', NULL, 'O', '1200 S York Rd Ste 4280', 'Elmhurst', 'Dupage', 'IL', '60126', '7084500462', '7084501591', '1200 S York Rd Ste 4280', 'Elmhurst', 'Dupage', 'IL', '60126', '7084500462', '7084501591', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', '2013-04-01', 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '1326068677', 0, 'N', 0, '2013-10-24', NULL, NULL, 41.865, -87.9323, NULL, NULL),
('362841923', 'ELEL00399', 'ELEL00399', 'ILCHIGSTD', 'Advocate Medical Group Midwest Heart Specialists', 'Gaile', 'K', 'Sabaliauskas', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '3825 Highland Ave Ste 400', 'Downers Grove', 'Dupage', 'IL', '60515', '6307194799', '6309637420', '3825 Highland Ave Ste 400', 'Downers Grove', 'Dupage', 'IL', '60515', '6307194799', '6309637420', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1326094699', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.8181, -88.0102, NULL, NULL),
('364037473', 'ELEL00398', 'ELEL00398', 'ILCHIGSTD', 'Elmhurst Clinic', 'Gaile', 'K', 'Sabaliauskas', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '6309412600', '6309412632', '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '6309412600', '6309412632', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1326094699', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.8616, -87.936, NULL, NULL),
('364037473', 'ELEL00060', 'ELEL00060', 'ILCHIGSTD', 'Elmhurst Clinic', 'Carlos', 'M', 'Cespedes', 'DO', 'Family Practice', '', '', NULL, 'O', '130 S Main St', 'Lombard', 'Dupage', 'IL', '60148', '6306524200', '6306524222', '130 S Main St', 'Lombard', 'Dupage', 'IL', '60148', '6306524200', '6306524222', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1326099474', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.8856, -88.0184, NULL, NULL),
('364037473', 'ELEL00058', 'ELEL00058', 'ILCHIGSTD', 'Elmhurst Clinic', 'Carlos', 'M', 'Cespedes', 'DO', 'Family Practice', '', '', NULL, 'O', '303 W Lake St Ste 200', 'Addison', 'Dupage', 'IL', '60101', '3312219002', NULL, '303 W Lake St Ste 200', 'Addison', 'Dupage', 'IL', '60101', '3312219002', '', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1326099474', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.9356, -87.9965, NULL, NULL),
('362961412', 'ELEL00317', 'ELEL00317', 'ILCHIGSTD', 'Nagpal and Arora Associates', 'Krishan', 'C', 'Nagpal', 'MD', 'Ophthalmology', '', '', NULL, 'O', '135 Robert Palmer Dr Ste 25', 'Elmhurst', 'Dupage', 'IL', '60126', '6308323055', '6308320927', '135 Robert Palmer Dr Ste 25', 'Elmhurst', 'Dupage', 'IL', '60126', '6308323055', '6308320927', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1326123381', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.8981, -87.9383, NULL, NULL),
('364037473', 'ELEL00043', 'ELEL00043', 'ILCHIGSTD', 'Elmhurst Clinic', 'Antonio', 'J', 'Bravo', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '133 E Brush Hill Rd Ste 308', 'Elmhurst', 'Dupage', 'IL', '60126', '6308331666', '6308331690', '133 E Brush Hill Rd Ste 308', 'Elmhurst', 'Dupage', 'IL', '60126', '6308331666', '6308331690', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1326139676', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.8616, -87.9371, 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
('364037473', 'ELEL00042', 'ELEL00042', 'ILCHIGSTD', 'Elmhurst Clinic', 'Antonio', 'J', 'Bravo', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '303 W Lake St Ste 200', 'Addison', 'Dupage', 'IL', '60101', '3312219002', '6308331690', '303 W Lake St Ste 200', 'Addison', 'Dupage', 'IL', '60101', '3312219002', '6308331690', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1326139676', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.9356, -87.9965, NULL, NULL),
('363163610', 'ELEL00154', 'ELEL00154', 'ILCHIGSTD', 'M and M Orthopaedics', 'Rahul', '', 'Gokhale', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '133 E Brush Hill Rd Ste 100', 'Elmhurst', 'Dupage', 'IL', '60126', '6309681881', '6305010646', '133 E Brush Hill Rd Ste 100', 'Elmhurst', 'Dupage', 'IL', '60126', '6309681881', '6305010646', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', '2013-06-30', 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '1326140435', 0, 'N', 0, '2014-04-25', NULL, NULL, 41.8628, -87.9376, NULL, NULL),
('363163610', 'ELEL00155', 'ELEL00155', 'ILCHIGSTD', 'M and M Orthopaedics', 'Rahul', '', 'Gokhale', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '4115 Fairview Ave', 'Downers Grove', 'Dupage', 'IL', '60515', '6309681881', '6309683762', '4115 Fairview Ave', 'Downers Grove', 'Dupage', 'IL', '60515', '6309681881', '6309683762', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', '2013-06-30', 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '1326140435', 0, 'N', 0, '2014-04-25', NULL, NULL, 41.8109, -87.9947, NULL, NULL),
('364037473', 'ELEL00064', 'ELEL00064', 'ILCHIGSTD', 'Elmhurst Medical Associates', 'Ronald', 'F', 'Cheff', 'MD', 'Internal Medicine', '', '', NULL, 'O', '183 Addison Ave', 'Elmhurst', 'Dupage', 'IL', '60126', '3312210000', '3312213991', '183 Addison Ave', 'Elmhurst', 'Dupage', 'IL', '60126', '3312210000', '3312213991', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1326144643', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.9029, -87.9416, NULL, NULL),
('364157155', 'ELEL00301', 'ELEL00301', 'ILCHIGSTD', 'Patricia A Merwick MD and Associates', 'Patricia', 'A', 'Merwick', 'MD', 'Internal Medicine', '', '', NULL, 'O', '533 W North Ave Ste 101', 'Elmhurst', 'Dupage', 'IL', '60126', '6302798771', '6302798576', '533 W North Ave Ste 101', 'Elmhurst', 'Dupage', 'IL', '60126', '6302798771', '6302798576', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1336117084', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.9059, -87.9599, NULL, NULL),
('364030005', 'ELEL00105', 'ELEL00105', 'ILCHIGSTD', 'Consultants in Cardiovascular Medicine', 'Ajanta', '', 'De', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '675 W North Ave Ste 210', 'Melrose Park', 'Cook', 'IL', '60160', '7088381448', '7083440508', '675 W North Ave Ste 210', 'Melrose Park', 'Cook', 'IL', '60160', '7088381448', '7083440508', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, '', '', 'HCFA|UB|', '1336198878', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.9083, -87.8421, NULL, NULL),
('364037473', 'ELEL00200', 'ELEL00200', 'ILCHIGSTD', 'Elmhurst Clinic', 'Janet', 'M', 'Kaczor', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '1200 S York Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '6309412603', '3312213998', '1200 S York Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '6309412603', '3312213998', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1336199538', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.865, -87.9322, NULL, NULL),
('364037473', 'ELEL00488', 'ELEL00488', 'ILCHIGSTD', 'Elmhurst Clinic', 'Marybeth', '', 'Waldorf', 'CNM', 'Certified Nurse Midwife', '', '', NULL, 'O', '1200 S York Rd Ste 4120', 'Elmhurst', 'Dupage', 'IL', '60126', '3312219009', '3312213977', '1200 S York Rd Ste 4120', 'Elmhurst', 'Dupage', 'IL', '60126', '3312219009', '3312213977', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '1336395805', 0, 'N', 0, '2014-06-10', NULL, NULL, 41.865, -87.9322, NULL, NULL),
('364037473', 'ELEL00487', 'ELEL00487', 'ILCHIGSTD', 'Elmhurst Clinic', 'Marybeth', '', 'Waldorf', 'CNM', 'Certified Nurse Midwife', '', '', NULL, 'O', '303 W Lake St Ste 200', 'Addison', 'Dupage', 'IL', '60101', '3312219002', '3312213973', '303 W Lake St Ste 200', 'Addison', 'Dupage', 'IL', '60101', '3312219002', '3312213973', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '1336395805', 0, 'Y', 0, '2014-06-10', NULL, NULL, 41.9356, -87.9965, NULL, NULL),
('364400429', 'ELEL00001', 'ELEL00001', 'ILCHIGSTD', 'Diabetes Osteoporosis Obesity Inc', 'Maha', 'H', 'Abboud', 'MD', 'Endocrinology', '', '', NULL, 'O', '1200 S York Rd Ste 3150', 'Elmhurst', 'Dupage', 'IL', '60126', '7083452211', '7083452224', '1200 S York Rd Ste 3150', 'Elmhurst', 'Dupage', 'IL', '60126', '7083452211', '7083452224', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, '', NULL, 'HCFA|UB|', '1346208956', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.865, -87.9322, NULL, NULL),
('364400429', 'ELEL00002', 'ELEL00002', 'ILCHIGSTD', 'Diabetes Osteoporosis Obesity Inc', 'Maha', 'H', 'Abboud', 'MD', 'Endocrinology', '', '', NULL, 'O', '9629 Southwest Hwy', 'Oak Lawn', 'Cook', 'IL', '60453', '7083452211', '7083452224', '9629 Southwest Hwy', 'Oak Lawn', 'Cook', 'IL', '60453', '7083452211', '7083452224', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, '', NULL, 'HCFA|UB|', '1346208956', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.7168, -87.7715, NULL, NULL),
('363163610', 'ELEL00284', 'ELEL00284', 'ILCHIGSTD', 'M and M Orthopaedics', 'Steven', '', 'Mather', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '15900 W 127th St Ste 111', 'Lemont', 'Cook', 'IL', '60439', '6302437385', '6302438302', '15900 W 127th St Ste 111', 'Lemont', 'Cook', 'IL', '60439', '6302437385', '6302438302', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', '2013-06-30', 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '1346236163', 0, 'N', 0, '2014-04-25', NULL, NULL, 41.655, -88.0075, NULL, NULL),
('363163610', 'ELEL00285', 'ELEL00285', 'ILCHIGSTD', 'M and M Orthopaedics', 'Steven', '', 'Mather', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '4115 Fairview Ave', 'Downers Grove', 'Dupage', 'IL', '60515', '6309681881', '6309683762', '4115 Fairview Ave', 'Downers Grove', 'Dupage', 'IL', '60515', '6309681881', '6309683762', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', '2013-06-30', 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '1346236163', 0, 'N', 0, '2014-04-25', NULL, NULL, 41.8109, -87.9947, NULL, NULL),
('364330223', 'ELEL00458', 'ELEL00458', 'ILCHIGSTD', 'Comprehensive Pediatric Care', 'Shahida', '', 'Tanveer', 'MD', 'Pediatrics', '', '', NULL, 'O', '130 S Main St Ste 304', 'Lombard', 'Dupage', 'IL', '60148', '6309161400', '7088910681', '130 S Main St Ste 304', 'Lombard', 'Dupage', 'IL', '60148', '6309161400', '7088910681', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', '2013-04-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1346313160', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.8846, -88.019, NULL, NULL),
('203493835', 'ELEL00227', 'ELEL00227', 'ILCHIGSTD', 'Optimum Kidney Care', 'Rajani', '', 'Kosuri', 'MD', 'Nephrology', '', '', NULL, 'O', '1111 W Superior St Ste 204', 'Melrose Park', 'Cook', 'IL', '60160', '7735254701', '7084420046', '1111 W Superior St Ste 204', 'Melrose Park', 'Cook', 'IL', '60160', '7735254701', '7084420046', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 6, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '1346455185', 0, 'N', 0, '2014-04-25', NULL, NULL, 41.8925, -87.8471, NULL, NULL),
('203493835', 'ELEL00228', 'ELEL00228', 'ILCHIGSTD', 'Optimum Kidney Care', 'Rajani', '', 'Kosuri', 'MD', 'Nephrology', '', '', NULL, 'O', '3023 N Ashland Ave Ste 1', 'Chicago', 'Cook', 'IL', '60657', '7735254701', '7733263539', '3023 N Ashland Ave Ste 1', 'Chicago', 'Cook', 'IL', '60657', '7735254701', '7733263539', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 6, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '1346455185', 0, 'N', 0, '2014-04-25', NULL, NULL, 41.9369, -87.6685, NULL, NULL),
('364079642', 'ELEL00382', 'ELEL00382', 'ILCHIGSTD', 'Elmhurst Orthopaedics', 'Ashish', 'M', 'Rawal', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '300 W Butterfield Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '6308340491', '6308340602', '300 W Butterfield Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '6308340491', '6308340602', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', '2014-05-16', 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1356392252', 0, 'N', 0, '2014-04-11', NULL, NULL, 41.8661, -87.9484, NULL, NULL),
('364037473', 'ELEL00268', 'ELEL00268', 'ILCHIGSTD', 'Elmhurst Clinic', 'Patrick', 'J', 'Lynch', 'MD', 'Gastroenterology', '', '', NULL, 'O', '1200 S York Rd Ste 2000', 'Elmhurst', 'Dupage', 'IL', '60126', '6309412608', '6309412632', '1200 S York Rd Ste 2000', 'Elmhurst', 'Dupage', 'IL', '60126', '6309412608', '6309412632', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1356392419', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.865, -87.9322, NULL, NULL),
('364037473', 'ELEL00269', 'ELEL00269', 'ILCHIGSTD', 'Elmhurst Clinic', 'Patrick', 'J', 'Lynch', 'MD', 'Gastroenterology', '', '', NULL, 'O', '133 E Brush Hill Rd Ste 310', 'Elmhurst', 'Dupage', 'IL', '60126', '6309412608', '6309412632', '133 E Brush Hill Rd Ste 310', 'Elmhurst', 'Dupage', 'IL', '60126', '6309412608', '6309412632', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1356392419', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.8616, -87.9371, NULL, NULL),
('362907660', 'ELEL00397', 'ELEL00397', 'ILCHIGSTD', 'Nephrology Associates of Northern Illinois', 'Madhavi', 'E', 'Ryali', 'MD', 'Nephrology', '', '', NULL, 'O', '183 Addison Ave', 'Elmhurst', 'Dupage', 'IL', '60126', '6308322183', '6308322184', '183 Addison Ave', 'Elmhurst', 'Dupage', 'IL', '60126', '6308322183', '6308322184', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1356453823', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.9029, -87.9416, NULL, NULL),
('363028040', 'ELEL00304', 'ELEL00304', 'ILCHIGSTD', 'Dean R Milos MD', 'Dean', 'R', 'Milos', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '332 N York Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '6308346055', '6308343128', '332 N York Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '6308346055', '6308343128', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, '', '', 'HCFA|UB|', '1356491732', 0, 'N', 0, '2014-04-25', NULL, NULL, 41.9078, -87.9398, NULL, NULL),
('363819436', 'ELEL00465', 'ELEL00465', 'ILCHIGSTD', 'Cardiac Surgery Associates', 'Lambros', '', 'Tsonis', 'MD', 'Thoracic Surgery', '', '', NULL, 'O', '133 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '6307821500', '6305010446', '133 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '6307821500', '6305010446', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 6, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, '', '', 'HCFA|UB|', '1356504278', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.8616, -87.9371, NULL, NULL),
('364037473', 'ELEL00150', 'ELEL00150', 'ILCHIGSTD', 'Elmhurst Clinic', 'Nirali', 'J', 'Ghia', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1200 S York Rd Ste 2000', 'Elmhurst', 'Dupage', 'IL', '60126', '6308341120', '6307588480', '1200 S York Rd Ste 2000', 'Elmhurst', 'Dupage', 'IL', '60126', '6308341120', '6307588480', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1366492555', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.865, -87.9322, NULL, NULL),
('364037473', 'ELEL00149', 'ELEL00149', 'ILCHIGSTD', 'Elmhurst Clinic', 'Nirali', 'J', 'Ghia', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '303 W Lake St Ste 200', 'Addison', 'Dupage', 'IL', '60101', '3312219002', '3312213973', '303 W Lake St Ste 200', 'Addison', 'Dupage', 'IL', '60101', '3312219002', '3312213973', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1366492555', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.9356, -87.9965, NULL, NULL),
('273529755', 'ELEL00005', 'ELEL00005', 'ILCHIGSTD', 'Summit Dermatology and Aesthetic Surgery', 'Rania', '', 'Agha', 'MD', 'Dermatology', '', '', NULL, 'O', '1 S 210 Summit Ave', 'Oakbrook Terrace', 'Dupage', 'IL', '60181', '6302826004', '6302824664', '1 S 210 Summit Ave', 'Oakbrook Terrace', 'Dupage', 'IL', '60181', '6302826004', '6302824664', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1366601312', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.8568, -87.9729, NULL, NULL),
('363966745', 'ELEL00358', 'ELEL00358', 'ILCHIGSTD', 'Metro Infectious Disease Consultants', 'Russell', 'M', 'Petrak', 'MD', 'Infectious Disease', '', '', NULL, 'O', '901 McClintock Dr Ste 202', 'Burr Ridge', 'Dupage', 'IL', '60527', '6306544201', '6306541865', '901 McClintock Dr Ste 202', 'Burr Ridge', 'Dupage', 'IL', '60527', '6306544201', '6306541865', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 6, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1376539692', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.7543, -87.9095, NULL, NULL),
('363759101', 'ELEL00513', 'ELEL00513', 'ILCHIGSTD', 'Affiliates in Primary Care', 'Samuel', 'M', 'Yunez', 'MD', 'Family Practice', '', '', NULL, 'O', '1111 W Superior St Ste 306', 'Melrose Park', 'Cook', 'IL', '60160', '7084500055', '7084500288', '1111 W Superior St Ste 306', 'Melrose Park', 'Cook', 'IL', '60160', '7084500055', '7084500288', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1376685636', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.8925, -87.8471, NULL, NULL),
('363759101', 'ELEL00511', 'ELEL00511', 'ILCHIGSTD', 'Affiliates in Primary Care', 'Samuel', 'M', 'Yunez', 'MD', 'Family Practice', '', '', NULL, 'O', '1200 S York Rd Ste 4250', 'Elmhurst', 'Dupage', 'IL', '60126', '6305303730', '6305303734', '1200 S York Rd Ste 4250', 'Elmhurst', 'Dupage', 'IL', '60126', '6305303730', '6305303734', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1376685636', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.865, -87.9322, NULL, NULL),
('363163610', 'ELEL00460', 'ELEL00460', 'ILCHIGSTD', 'M and M Orthopaedics', 'Vijay', '', 'Thangamani', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '4115 Fairview Ave', 'Downers Grove', 'Dupage', 'IL', '60515', '6309681881', '6309683762', '4115 Fairview Ave', 'Downers Grove', 'Dupage', 'IL', '60515', '6309681881', '6309683762', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', '2013-06-30', 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '1376709204', 0, 'N', 0, '2013-09-18', NULL, NULL, 41.8109, -87.9947, NULL, NULL),
('364037473', 'ELEL00459', 'ELEL00459', 'ILCHIGSTD', 'Elmhurst Clinic', 'Vijay', '', 'Thangamani', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1200 S York Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '6309412630', '6307588590', '1200 S York Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '6309412630', '6307588590', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '1376709204', 0, 'N', 0, '2013-09-18', NULL, NULL, 41.865, -87.9322, NULL, NULL),
('363819436', 'ELEL00100', 'ELEL00100', 'ILCHIGSTD', 'Cardiac Surgery Associates', 'Michael', 'J', 'DaValle', 'MD', 'Thoracic Surgery', '', '', NULL, 'O', '2650 Warrenville Rd Ste 280', 'Downers Grove', 'Dupage', 'IL', '60515', '6303247916', '6303247946', '2650 Warrenville Rd Ste 280', 'Downers Grove', 'Dupage', 'IL', '60515', '6303247916', '6303247946', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 6, '2013-04-01', NULL, 0, 0, 0, 'Edward Hospital', 'Elmhurst Memorial Hospital', NULL, NULL, 'HCFA|UB|', '1386600039', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.8077, -88.0488, NULL, NULL),
('363819436', 'ELEL00101', 'ELEL00101', 'ILCHIGSTD', 'Cardiac Surgery Associates', 'Michael', 'J', 'DaValle', 'MD', 'Thoracic Surgery', '', '', NULL, 'O', '900 S Frontage Rd Ste 110', 'Woodridge', 'Dupage', 'IL', '60517', '6309850036', NULL, '900 S Frontage Rd Ste 110', 'Woodridge', 'Dupage', 'IL', '60517', '6309850036', '          ', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 6, '2013-04-01', NULL, 0, 0, 0, 'Edward Hospital', 'Elmhurst Memorial Hospital', NULL, NULL, 'HCFA|UB|', '1386600039', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.7157, -88.0043, NULL, NULL),
('364258453', 'ELEL00230', 'ELEL00230', 'ILCHIGSTD', 'Kovach Eye Institute', 'Kevin', '', 'Kovach', 'MD', 'Ophthalmology', '', '', NULL, 'O', '152 N Addison Ave', 'Elmhurst', 'Dupage', 'IL', '60126', '6308339621', '6308339465', '152 N Addison Ave', 'Elmhurst', 'Dupage', 'IL', '60126', '6308339621', '6308339465', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1386643658', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.9019, -87.9416, NULL, NULL),
('364258453', 'ELEL00231', 'ELEL00231', 'ILCHIGSTD', 'Kovach Eye Institute', 'Kevin', '', 'Kovach', 'MD', 'Ophthalmology', '', '', NULL, 'O', '1960 Springbrook Square Dr Ste 110', 'Naperville', 'Will', 'IL', '60564', '6303556222', '6303556219', '1960 Springbrook Square Dr Ste 110', 'Naperville', 'Will', 'IL', '60564', '6303556222', '6303556219', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1386643658', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.7307, -88.204, NULL, NULL),
('362169147', 'ELEL00405', 'ELEL00405', 'ILCHIGSTD', 'Advocate Medical Group Midwest Heart Specialists', 'Moeen', '', 'Saleem', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '25 N Winfield Rd Ste 301', 'Winfield', 'Dupage', 'IL', '60190', '6305109244', '6305109557', '25 N Winfield Rd Ste 301', 'Winfield', 'Dupage', 'IL', '60190', '6305109244', '6305109557', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 8, '2013-04-01', NULL, 0, 0, 0, 'Edward Hospital', 'Elmhurst Memorial Hospital', '', '', 'HCFA|UB|', '1386696508', 0, 'N', 0, '2014-04-25', NULL, NULL, 41.8714, -88.1583, NULL, NULL),
('362841923', 'ELEL00406', 'ELEL00406', 'ILCHIGSTD', 'Advocate Medical Group Midwest Heart Specialists', 'Moeen', '', 'Saleem', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '801 S Washington St 4th Fl', 'Naperville', 'Dupage', 'IL', '60566', '6305272730', '6305272754', '801 S Washington St 4th Fl', 'Naperville', 'Dupage', 'IL', '60566', '6305272730', '6305272754', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Edward Hospital', 'Elmhurst Memorial Hospital', '', '', 'HCFA|UB|', '1386696508', 0, 'N', 0, '2014-04-25', NULL, NULL, 41.7608, -88.149, NULL, NULL),
('363163610', 'ELEL00388', 'ELEL00388', 'ILCHIGSTD', 'M and M Orthopaedics', 'John', '', 'Reilly', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1259 Rickert Dr Ste 101', 'Naperville', 'Dupage', 'IL', '60515', '6303551300', '6303553273', '1259 Rickert Dr Ste 101', 'Naperville', 'Dupage', 'IL', '60515', '6303551300', '6303553273', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', '2013-06-30', 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '1396731014', 0, 'N', 0, '2014-04-25', NULL, NULL, 0, 0, NULL, NULL),
('363163610', 'ELEL00387', 'ELEL00387', 'ILCHIGSTD', 'M and M Orthopaedics', 'John', '', 'Reilly', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '4115 Fairview Ave', 'Downers Grove', 'Dupage', 'IL', '60515', '6309681881', '6309683762', '4115 Fairview Ave', 'Downers Grove', 'Dupage', 'IL', '60515', '6309681881', '6309683762', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', '2013-06-30', 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '1396731014', 0, 'N', 0, '2014-04-25', NULL, NULL, 41.8109, -87.9947, NULL, NULL),
('362841923', 'ELEL00371', 'ELEL00371', 'ILCHIGSTD', 'Advocate Medical Group Midwest Heart Specialists', 'Manfred', 'J', 'Pyka', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '25 N Winfield Rd Ste 301', 'Winfield', 'Dupage', 'IL', '60190', '6305109244', '6305109557', '25 N Winfield Rd Ste 301', 'Winfield', 'Dupage', 'IL', '60190', '6305109244', '6305109557', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1396796389', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.8714, -88.1583, NULL, NULL),
('364037473', 'ELEL00370', 'ELEL00370', 'ILCHIGSTD', 'Elmhurst Clinic', 'Manfred', 'J', 'Pyka', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '6309412600', '6309412632', '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '6309412600', '6309412632', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1396796389', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.8616, -87.936, NULL, NULL),
('364037473', 'ELEL00184', 'ELEL00184', 'ILCHIGSTD', 'Elmhurst Clinic', 'Michael', 'T', 'Hoffman', 'MD', 'Pediatrics', '', '', NULL, 'O', '1200 S York Rd Ste 2000', 'Elmhurst', 'Dupage', 'IL', '60126', '6309414710', '6309412642', '1200 S York Rd Ste 2000', 'Elmhurst', 'Dupage', 'IL', '60126', '6309414710', '6309412642', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1396796447', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.865, -87.9322, NULL, NULL),
('364037473', 'ELEL00183', 'ELEL00183', 'ILCHIGSTD', 'Elmhurst Clinic', 'Michael', 'T', 'Hoffman', 'MD', 'Pediatrics', '', '', NULL, 'O', '471 W Army Trail Ste 103', 'Bloomingdale', 'Dupage', 'IL', '60108', '6306718020', '6306916721', '471 W Army Trail Ste 103', 'Bloomingdale', 'Dupage', 'IL', '60108', '6306718020', '6306916721', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1396796447', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.9396, -88.1216, NULL, NULL),
('364037473', 'ELEL00346', 'ELEL00346', 'ILCHIGSTD', 'Elmhurst Clinic', 'Nathaniel', 'H', 'Pae', 'MD', 'Family Practice', '', '', NULL, 'O', '172 Schiller', 'Elmhurst', 'Dupage', 'IL', '60126', '6308320000', '6309939685', '172 Schiller', 'Elmhurst', 'Dupage', 'IL', '60126', '6308320000', '6309939685', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1396796462', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.9011, -87.9371, NULL, NULL),
('364037473', 'ELEL00345', 'ELEL00345', 'ILCHIGSTD', 'Elmhurst Clinic', 'Nathaniel', 'H', 'Pae', 'MD', 'Family Practice', '', '', NULL, 'O', '303 W Lake St Ste 200', 'Addison', 'Dupage', 'IL', '60101', '3312219002', NULL, '303 W Lake St Ste 200', 'Addison', 'Dupage', 'IL', '60101', '3312219002', '', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1396796462', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.9356, -87.9965, NULL, NULL),
('362778710', 'ELEL00514', 'ELEL00514', 'ILCHIGSTD', 'Endocrinology Associates SC', 'Jacek', '', 'Zajac', 'MD', 'Internal Medicine', 'Endocrinology', '', NULL, 'O', '130 S Main St Ste 303', 'Lombard', 'Dupage', 'IL', '60148', '6306293610', '6306294878', '130 S Main St Ste 303', 'Lombard', 'Dupage', 'IL', '60148', '6306293610', '6306294878', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1396817912', 0, 'N', 0, '2014-02-25', NULL, NULL, 41.8856, -88.0184, NULL, NULL),
('520725914', 'ELEL00034', 'ELEL00034', 'ILCHIGSTD', 'KG Bennet', 'Kenneth', 'G', 'Bennet', 'MD', 'Nuclear Medicine', '', '', NULL, 'O', '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '6308331400', '6307827860', '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '6308331400', '6307827860', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1396855185', 0, 'Y', 0, '2013-07-25', NULL, NULL, 41.8616, -87.936, NULL, NULL),
('363950044', 'ELEL00325', 'ELEL00325', 'ILCHIGSTD', 'Progressive Medical Center', 'Ausencio', '', 'Nunez', 'MD', 'Pediatrics', '', '', NULL, 'O', '1841 W Army Trail Rd', 'Addision', 'Dupage', 'IL', '60101', '6302389235', '6302380426', '1841 W Army Trail Rd', 'Addision', 'Dupage', 'IL', '60101', '6302389235', '6302380426', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1407996564', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.9317, -88.0341, NULL, NULL),
('363950044', 'ELEL00324', 'ELEL00324', 'ILCHIGSTD', 'Progressive Medical Center', 'Ausencio', '', 'Nunez', 'MD', 'Pediatrics', '', '', NULL, 'O', '414 W Lake St', 'Addison', 'Dupage', 'IL', '60101', '6304581905', '6304581908', '414 W Lake St', 'Addison', 'Dupage', 'IL', '60101', '6304581905', '6304581908', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1407996564', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.9368, -87.9993, NULL, NULL),
('364037473', 'ELEL00439', 'ELEL00439', 'ILCHIGSTD', 'Elmhurst Clinic', 'Matthew', 'J', 'Spiewak', 'DO', 'Family Practice', '', '', NULL, 'O', '172 Schiller', 'Elmhurst', 'Dupage', 'IL', '60126', '6308320000', '6309939685', '172 Schiller', 'Elmhurst', 'Dupage', 'IL', '60126', '6308320000', '6309939685', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1417908583', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.9011, -87.9371, NULL, NULL),
('363819436', 'ELEL00489', 'ELEL00489', 'ILCHIGSTD', 'Cardiac Surgery Associates', 'James', 'J', 'Walsh', 'MD', 'Vascular Surgery', '', '', NULL, 'O', '2650 Warrenville Rd Ste 280', 'Downers Grove', 'Dupage', 'IL', '60515', '6303247927', '6303241813', '2650 Warrenville Rd Ste 280', 'Downers Grove', 'Dupage', 'IL', '60515', '6303247927', '6303241813', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 6, '2013-04-01', NULL, 0, 0, 0, 'Edward Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1417913161', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.8077, -88.0488, NULL, NULL),
('363819436', 'ELEL00490', 'ELEL00490', 'ILCHIGSTD', 'Cardiac Surgery Associates', 'James', 'J', 'Walsh', 'MD', 'Vascular Surgery', '', '', NULL, 'O', '3825 Highland Ave Ste 310 Tower 2', 'Downers Grove', 'Dupage', 'IL', '60515', '6306631100', NULL, '3825 Highland Ave Ste 310 Tower 2', 'Downers Grove', 'Dupage', 'IL', '60515', '6306631100', '          ', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 6, '2013-04-01', '2014-03-03', 0, 0, 0, 'Edward Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1417913161', 0, 'N', 0, '2014-03-11', NULL, NULL, 41.8181, -88.0102, NULL, NULL),
('344467261', 'ELEL00057', 'ELEL00057', 'ILCHIGSTD', 'Gregory Castello DO', 'Gregory', 'C', 'Castello', 'DO', 'Family Practice', '', '', NULL, 'O', '244 E Roosevelt Rd', 'Lombard', 'Dupage', 'IL', '60148', '6306206311', '6306209500', '244 E Roosevelt Rd', 'Lombard', 'Dupage', 'IL', '60148', '6306206311', '6306209500', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Edward Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1417939323', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.8602, -88.0109, NULL, NULL),
('364037473', 'ELEL00062', 'ELEL00062', 'ILCHIGSTD', 'Elmhurst Memorial Primary Care Associates', 'Maggie', '', 'Chacko', 'MD', 'Internal Medicine', '', '', NULL, 'O', '305 N York Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '3312214350', '3312213934', '305 N York Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '3312214350', '3312213934', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1417993734', 0, 'N', 0, '2014-06-17', NULL, NULL, 41.9069, -87.9399, NULL, NULL),
('363095792', 'ELEL00413', 'ELEL00413', 'ILCHIGSTD', 'Midwest Pediatrics', 'Rodolfo', 'A', 'Sarmiento', 'MD', 'Pediatrics', '', '', NULL, 'O', '2340 S Highland Ave Ste 150', 'Lombard', 'Dupage', 'IL', '60148', '6309322015', '6309321589', '2340 S Highland Ave Ste 150', 'Lombard', 'Dupage', 'IL', '60148', '6309322015', '6309321589', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1427013689', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.8429, -88.0115, NULL, NULL),
('010572989', 'ELEL00186', 'ELEL00186', 'ILCHIGSTD', 'Midwest Family Medicine Inc', 'Eyad', '', 'Homedi', 'MD', 'Family Practice', '', '', NULL, 'O', '170 Bloomingdale Rd Ste 200', 'Bloomingdale', 'Dupage', 'IL', '60108', '6303511027', '6303511190', '170 Bloomingdale Rd Ste 200', 'Bloomingdale', 'Dupage', 'IL', '60108', '6303511027', '6303511190', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1427034073', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.9507, -88.0808, NULL, NULL),
('362841923', 'ELEL00276', 'ELEL00276', 'ILCHIGSTD', 'Advocate Medical Group Midwest Heart Specialists', 'Justin', 'Tze Howe', 'Mao', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '133 E Brush Hill Rd Ste 202', 'Elmhurst', 'Dupage', 'IL', '60126', '6307824050', '6307825021', '133 E Brush Hill Rd Ste 202', 'Elmhurst', 'Dupage', 'IL', '60126', '6307824050', '6307825021', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, '', '', 'HCFA|UB|', '1427052273', 0, 'N', 0, '2014-04-25', NULL, NULL, 41.8616, -87.9371, NULL, NULL),
('364037473', 'ELEL00041', 'ELEL00041', 'ILCHIGSTD', 'Elmhurst Clinic', 'Laura', '', 'Boyd', 'MD', 'Family Practice', '', '', NULL, 'O', '303 W Lake St Ste 200', 'Addison', 'Dupage', 'IL', '60101', '3312219002', '3312213971', '303 W Lake St Ste 200', 'Addison', 'Dupage', 'IL', '60101', '3312219002', '3312213971', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1427251503', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.9356, -87.9965, NULL, NULL),
('362169147', 'ELEL00380', 'ELEL00380', 'ILCHIGSTD', 'Advocate Medical Group Midwest Heart Specialists', 'R', 'Andrew', 'Rauh', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '133 E Brush Hill Rd Ste 202', 'Elmhurst', 'Dupage', 'IL', '60126', '6307824050', '6307825021', '133 E Brush Hill Rd Ste 202', 'Elmhurst', 'Dupage', 'IL', '60126', '6307824050', '6307825021', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 8, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1437103256', 0, 'N', 0, '2013-09-10', NULL, NULL, 41.8616, -87.9371, NULL, NULL),
('362841923', 'ELEL00381', 'ELEL00381', 'ILCHIGSTD', 'Elmhurst Clinic', 'R', 'Andrew', 'Rauh', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1100 Lake St', 'Oak Park', 'Cook', 'IL', '60301', '6307824050', '6307825021', '1100 Lake St', 'Oak Park', 'Cook', 'IL', '60301', '6307824050', '6307825021', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1437103256', 0, 'N', 0, '2013-09-10', NULL, NULL, 41.8886, -87.8026, NULL, NULL),
('364157155', 'ELEL00332', 'ELEL00332', 'ILCHIGSTD', 'Patricia A Merwick MD and Associates', 'Patrick', 'M', 'OMeara', 'MD', 'Internal Medicine', '', '', NULL, 'O', '533 W North Ave Ste 101', 'Elmhurst', 'Dupage', 'IL', '60126', '6302798771', '6302798576', '533 W North Ave Ste 101', 'Elmhurst', 'Dupage', 'IL', '60126', '6302798771', '6302798576', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1437127891', 0, 'N', 0, '2013-09-06', NULL, NULL, 41.9059, -87.9599, NULL, NULL),
('363107745', 'ELEL00289', 'ELEL00289', 'ILCHIGSTD', 'Firdausi F Mazda MD', 'Firdausi', 'F', 'Mazda', 'MD', 'Urology', '', '', NULL, 'O', '360 W Butterfield Rd Ste 245', 'Elmhurst', 'Dupage', 'IL', '60126', '6309412646', '6309413464', '360 W Butterfield Rd Ste 245', 'Elmhurst', 'Dupage', 'IL', '60126', '6309412646', '6309413464', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, '', '', 'HCFA|UB|', '1437138245', 0, 'N', 0, '2014-04-25', NULL, NULL, 41.8648, -87.9509, NULL, NULL),
('363107745', 'ELEL00288', 'ELEL00288', 'ILCHIGSTD', 'Firdausi F Mazda MD', 'Firdausi', 'F', 'Mazda', 'MD', 'Urology', '', '', NULL, 'O', '800 Biesterfield Rd Ste 4005', 'Elk Grove Village', 'Cook', 'IL', '60007', '8473037951', '6309413464', '800 Biesterfield Rd Ste 4005', 'Elk Grove Village', 'Cook', 'IL', '60007', '8473037951', '6309413464', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, '', '', 'HCFA|UB|', '1437138245', 0, 'N', 0, '2014-04-25', NULL, NULL, 42.0034, -88.0174, NULL, NULL),
('363392962', 'ELEL00394', 'ELEL00394', 'ILCHIGSTD', 'Thomas L Rodts MD', 'Thomas', 'L', 'Rodts', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '183 Addison Ave Ste 120', 'Elmhurst', 'Dupage', 'IL', '60126', '6305304200', '6305304217', '183 Addison Ave Ste 120', 'Elmhurst', 'Dupage', 'IL', '60126', '6305304200', '6305304217', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1437196383', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.9029, -87.9416, NULL, NULL),
('364037473', 'ELEL00218', 'ELEL00218', 'ILCHIGSTD', 'Elmhurst Clinic', 'Petras', 'V', 'Kisielius', 'MD', 'Urology', '', '', NULL, 'O', '1200 S York Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '6309412609', '6307588574', '1200 S York Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '6309412609', '6307588574', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1447200563', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.865, -87.9322, NULL, NULL),
('364235953', 'ELEL00356', 'ELEL00356', 'ILCHIGSTD', 'Alvaro Pena MD', 'Alvaro', 'Enrique', 'Pena', 'MD', 'Family Practice', '', '', NULL, 'O', '440 S York Rd', 'Bensenville', 'Dupage', 'IL', '60106', '6305219700', '6305219797', '440 S York Rd', 'Bensenville', 'Dupage', 'IL', '60106', '6305219700', '6305219797', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, '', NULL, 'HCFA|UB|', '1447220959', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.9472, -87.9396, NULL, NULL),
('364037473', 'ELEL00499', 'ELEL00499', 'ILCHIGSTD', 'Elmhurst Memorial Primary Care Associates', 'Don', '', 'Williams', 'MD', 'Internal Medicine', '', '', NULL, 'O', '7355 W North Ave', 'River Forest', 'Cook', 'IL', '60305', '7087710921', '7087710925', '7355 W North Ave', 'River Forest', 'Cook', 'IL', '60305', '7087710921', '7087710925', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', '2013-04-15', 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1447288287', 0, 'N', 0, '2013-07-25', NULL, NULL, 0, 0, NULL, NULL),
('363804266', 'ELEL00251', 'ELEL00251', 'ILCHIGSTD', 'Dale E Liaugminas', 'Dalius', '', 'Liaugminas', 'MD', 'Gynecology', '', '', NULL, 'O', '303 E Army Trail Rd Ste 202', 'Bloomingdale', 'Dupage', 'IL', '60108', '6306288450', '6306288091', '303 E Army Trail Rd Ste 202', 'Bloomingdale', 'Dupage', 'IL', '60108', '6306288450', '6306288091', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, '', '', 'HCFA|UB|', '1447335658', 0, 'N', 0, '2014-04-25', NULL, NULL, 41.9391, -88.1019, NULL, NULL),
('363804266', 'ELEL00250', 'ELEL00250', 'ILCHIGSTD', 'Dale Liaugminas MD', 'Dalius', '', 'Liaugminas', 'MD', 'Gynecology', '', '', NULL, 'O', '303 W Lake St Ste 201', 'Addison', 'Dupage', 'IL', '60101', '6306288450', '6306288091', '303 W Lake St Ste 201', 'Addison', 'Dupage', 'IL', '60101', '6306288450', '6306288091', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, '', '', 'HCFA|UB|', '1447335658', 0, 'N', 0, '2014-04-25', NULL, NULL, 41.9356, -87.9965, NULL, NULL),
('363934698', 'ELEL00300', 'ELEL00300', 'ILCHIGSTD', 'Mercado Foot and Ankle Clinic', 'O', 'Kent', 'Mercado', 'DPM', 'Podiatry', '', '', NULL, 'O', '2940 Rolling Ridge Rd Ste 204', 'Naperville', 'Will', 'IL', '60564', '6309227722', '6309227727', '2940 Rolling Ridge Rd Ste 204', 'Naperville', 'Will', 'IL', '60564', '6309227722', '6309227727', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '1447360896', 0, 'N', 0, '2014-04-18', NULL, NULL, 41.6988, -88.2064, NULL, NULL),
('363934698', 'ELEL00299', 'ELEL00299', 'ILCHIGSTD', 'Mercado Foot and Ankle Clinic', 'O', 'Kent', 'Mercado', 'DPM', 'Podiatry', '', '', NULL, 'O', '501 Thornhill Ste 100', 'Carol Stream', 'Dupage', 'IL', '60540', '6306903338', '6306903488', '501 Thornhill Ste 100', 'Carol Stream', 'Dupage', 'IL', '60540', '6306903338', '6306903488', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', '2014-04-11', 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '1447360896', 0, 'N', 0, '2014-04-18', NULL, NULL, 41.892, -88.1052, NULL, NULL),
('364037473', 'ELEL00472', 'ELEL00472', 'ILCHIGSTD', 'Elmhurst Clinic', 'Philip', 'J', 'Van Reken', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1200 S York Rd Ste 2000', 'Elmhurst', 'Dupage', 'IL', '60126', '6309412600', '6309412632', '1200 S York Rd Ste 2000', 'Elmhurst', 'Dupage', 'IL', '60126', '6309412600', '6309412632', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1457302523', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.865, -87.9322, NULL, NULL),
('364037473', 'ELEL00473', 'ELEL00473', 'ILCHIGSTD', 'Elmhurst Clinic', 'Philip', 'J', 'Van Reken', 'MD', 'Internal Medicine', '', '', NULL, 'O', '172 Schiller', 'Elmhurst', 'Dupage', 'IL', '60126', '6309412600', '6309412632', '172 Schiller', 'Elmhurst', 'Dupage', 'IL', '60126', '6309412600', '6309412632', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1457302523', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.9011, -87.9371, NULL, NULL),
('364037473', 'ELEL00112', 'ELEL00112', 'ILCHIGSTD', 'Elmhurst Memorial Primary Care Associates', 'Aman', '', 'Dhawan', 'MD', 'Family Practice', '', '', NULL, 'O', '3005 Wolf Rd', 'Westchester', 'Cook', 'IL', '60154', '6305325500', '6305325501', '3005 Wolf Rd', 'Westchester', 'Cook', 'IL', '60154', '6305325500', '6305325501', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1457384109', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.8351, -87.9006, NULL, NULL),
('205146678', 'ELEL00262', 'ELEL00262', 'ILCHIGSTD', 'Dental Sleep Center', 'Charles', '', 'Lockhart', 'DDS', 'Dentist', '', '', NULL, 'O', '7501 Lemont Rd Ste 300', 'Woodridge', 'Dupage', 'IL', '60517', '8157447055', '8157447059', '7501 Lemont Rd Ste 300', 'Woodridge', 'Dupage', 'IL', '60517', '8157447055', '8157447059', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1457579682', 0, 'Y', 0, '2013-07-25', NULL, NULL, 41.7509, -88.0288, NULL, NULL),
('371350071', 'ELEL00353', 'ELEL00353', 'ILCHIGSTD', 'Antonois Papadopoulos MD', 'Antonios', '', 'Papadopoulos', 'MD', 'Internal Medicine', '', '', NULL, 'O', '240 E Lake St Ste 102', 'Addison', 'Dupage', 'IL', '60101', '6307829780', '6307829781', '240 E Lake St Ste 102', 'Addison', 'Dupage', 'IL', '60101', '6307829780', '6307829781', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, '', NULL, 'HCFA|UB|', '1467562116', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.9302, -87.9823, NULL, NULL),
('364037473', 'ELEL00165', 'ELEL00165', 'ILCHIGSTD', 'Elmhurst Memorial Hematology Oncology Services', 'Srilata', '', 'Gundala', 'MD', 'Oncology', '', '', NULL, 'O', '1200 S York Rd Ste 3280', 'Elmhurst', 'Dupage', 'IL', '60126', '6307588640', '6307588642', '1200 S York Rd Ste 3280', 'Elmhurst', 'Dupage', 'IL', '60126', '6307588640', '6307588642', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1467646141', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.865, -87.9322, NULL, NULL),
('362120183', 'ELEL00153', 'ELEL00153', 'ILCHIGSTD', 'Villa Medical Arts', 'Alan', 'D', 'Glassman', 'MD', 'Internal Medicine', '', '', NULL, 'O', '10 E Central Blvd', 'Villa Park', 'Dupage', 'IL', '60181', '6308329000', '6308329049', '10 E Central Blvd', 'Villa Park', 'Dupage', 'IL', '60181', '6308329000', '6308329049', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1477592921', 0, 'N', 0, '2013-07-30', NULL, NULL, 41.8839, -87.9787, NULL, NULL),
('364037473', 'ELEL00287', 'ELEL00287', 'ILCHIGSTD', 'Elmhurst Clinic', 'David', 'M', 'Matusiak', 'DO', 'Pediatrics', '', '', NULL, 'O', '1200 S York Rd Ste 2000', 'Elmhurst', 'Dupage', 'IL', '60126', '6309414710', '6309412642', '1200 S York Rd Ste 2000', 'Elmhurst', 'Dupage', 'IL', '60126', '6309414710', '6309412642', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1487605556', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.865, -87.9322, NULL, NULL),
('364037473', 'ELEL00286', 'ELEL00286', 'ILCHIGSTD', 'Elmhurst Clinic', 'David', 'M', 'Matusiak', 'DO', 'Pediatrics', '', '', NULL, 'O', '471 W Army Trail Ste 103', 'Bloomingdale', 'Dupage', 'IL', '60108', '6306718020', '6305100235', '471 W Army Trail Ste 103', 'Bloomingdale', 'Dupage', 'IL', '60108', '6306718020', '6305100235', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1487605556', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.9396, -88.1216, NULL, NULL),
('260191270', 'ELEL00293', 'ELEL00293', 'ILCHIGSTD', 'McCarthy Eye Center', 'Timothy', 'J', 'McCarthy', 'DO', 'Ophthalmology', '', '', NULL, 'O', '1200 S York Rd Ste 3290', 'Elmhurst', 'Dupage', 'IL', '60126', '7088482030', '7088482070', '1200 S York Rd Ste 3290', 'Elmhurst', 'Dupage', 'IL', '60126', '7088482030', '7088482070', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '1487632782', 0, 'N', 0, '2014-04-25', NULL, NULL, 41.865, -87.9322, NULL, NULL),
('260191270', 'ELEL00295', 'ELEL00295', 'ILCHIGSTD', 'McCarthy Eye Center', 'Timothy', 'J', 'McCarthy', 'DO', 'Ophthalmology', '', '', NULL, 'O', '7055 W North Ave', 'Oak Park', 'Cook', 'IL', '60302', '7088482030', '7088482070', '7055 W North Ave', 'Oak Park', 'Cook', 'IL', '60302', '7088482030', '7088482070', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '1487632782', 0, 'N', 0, '2014-04-25', NULL, NULL, 41.9089, -87.8036, NULL, NULL),
('271248611', 'ELEL00117', 'ELEL00117', 'ILCHIGSTD', 'Reproductive Medicine Institute', 'W', 'Paul', 'Dmowski', 'MD', 'Reproductive Endocrinology', '', '', NULL, 'O', '2425 W 22nd St Ste 200', 'Oak Brook', 'Dupage', 'IL', '60523', '6309540054', '6309540064', '2425 W 22nd St Ste 200', 'Oak Brook', 'Dupage', 'IL', '60523', '6309540054', '6309540064', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '1487657318', 0, 'N', 0, '2014-04-25', NULL, NULL, 41.846, -87.9782, NULL, NULL),
('731665201', 'ELEL00415', 'ELEL00415', 'ILCHIGSTD', 'Aesthetic Plastic Reconstructive Surg', 'Alexandrina', 'S', 'Saulis', 'MD', 'Plastic Surgery', '', '', NULL, 'O', '120 E Ogden Ave Ste 224E', 'Hinsdale', 'Dupage', 'IL', '60521', '6309209404', '6309209447', '120 E Ogden Ave Ste 224E', 'Hinsdale', 'Dupage', 'IL', '60521', '6309209404', '6309209447', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, '', NULL, 'HCFA|UB|', '1487765277', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.8156, -87.9276, NULL, NULL),
('364037473', 'ELEL00220', 'ELEL00220', 'ILCHIGSTD', 'Elmhurst Clinic', 'Margaret', '', 'Knight', 'DO', 'Hospitalist', '', '', NULL, 'O', '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '3312211174', '3312213782', '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '3312211174', '3312213782', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '1487864070', 0, 'N', 0, '2014-04-28', NULL, NULL, 41.8616, -87.936, NULL, NULL),
('364037473', 'ELEL00280', 'ELEL00280', 'ILCHIGSTD', 'Elmhurst Clinic', 'Marco', 'L', 'Martinez', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1100 Lake St Ste 230', 'Oak Park', 'Cook', 'IL', '60302', '7085241420', '7085241509', '1100 Lake St Ste 230', 'Oak Park', 'Cook', 'IL', '60302', '7085241420', '7085241509', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1497706535', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.8886, -87.8026, NULL, NULL),
('364037473', 'ELEL00278', 'ELEL00278', 'ILCHIGSTD', 'Elmhurst Clinic', 'Marco', 'L', 'Martinez', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '133 E Brush Hill Rd Ste 308', 'Elmhurst', 'Dupage', 'IL', '60126', '3312219006', '3312213945', '133 E Brush Hill Rd Ste 308', 'Elmhurst', 'Dupage', 'IL', '60126', '3312219006', '3312213945', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1497706535', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.8616, -87.9371, NULL, NULL),
('364188969', 'ELEL00122', 'ELEL00122', 'ILCHIGSTD', 'Advanced Cancer Clinic', 'Maciej', 'K', 'Drazkiewicz', 'MD', 'Hematology', '', '', NULL, 'O', '2222 W Division St Ste 215', 'Chicago', 'Cook', 'IL', '60622', '7732278807', '7732278907', '2222 W Division St Ste 215', 'Chicago', 'Cook', 'IL', '60622', '7732278807', '7732278907', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Presence Our Lady Of The Resurrection Medical Center', 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', NULL, NULL, 'HCFA|UB|', '1497709333', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.9032, -87.6826, 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
('364037473', 'ELEL00232', 'ELEL00232', 'ILCHIGSTD', 'Elmhurst Medical Associates', 'David', 'J', 'Kraman', 'MD', 'Internal Medicine', '', '', NULL, 'O', '183 Addison Ave', 'Elmhurst', 'Dupage', 'IL', '60126', '3312210000', '3312213991', '183 Addison Ave', 'Elmhurst', 'Dupage', 'IL', '60126', '3312210000', '3312213991', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1497851570', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.9029, -87.9416, NULL, NULL),
('362716924', 'ELEL00226', 'ELEL00226', 'ILCHIGSTD', 'RPW Obstetrics and Gynecology', 'Jennifer', 'B', 'Kossoris', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '2434 S Wolf Rd', 'Westchester', 'Cook', 'IL', '60154', '6308324210', '6308328110', '2434 S Wolf Rd', 'Westchester', 'Cook', 'IL', '60154', '6308324210', '6308328110', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1497928873', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.844, -87.9012, NULL, NULL),
('362716924', 'ELEL00225', 'ELEL00225', 'ILCHIGSTD', 'RPW Obstetrics and Gynecology', 'Jennifer', 'B', 'Kossoris', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '360 W Butterfield Rd Ste 250', 'Elmhurst', 'Dupage', 'IL', '60126', '6308324210', '6308328110', '360 W Butterfield Rd Ste 250', 'Elmhurst', 'Dupage', 'IL', '60126', '6308324210', '6308328110', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1497928873', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.8648, -87.9509, NULL, NULL),
('364166842', 'ELEL00271', 'ELEL00271', 'ILCHIGSTD', 'Lyon Foot and Ankle Clinic', 'Esther', 'H', 'Lyon', 'DPM', 'Podiatry', '', '', NULL, 'O', '190 W Irving Park Rd', 'Wood Dale', 'Dupage', 'IL', '60191', '6304951240', '6304951993', '190 W Irving Park Rd', 'Wood Dale', 'Dupage', 'IL', '60191', '6304951240', '6304951993', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, '', NULL, 'HCFA|UB|', '1508844275', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.9641, -87.9835, NULL, NULL),
('364166842', 'ELEL00270', 'ELEL00270', 'ILCHIGSTD', 'Lyon Foot and Ankle Clinic', 'Esther', 'H', 'Lyon', 'DPM', 'Podiatry', '', '', NULL, 'O', '6 E St Charles Rd Ste 100', 'Lombard', 'Dupage', 'IL', '60148', '6304951240', '6304951993', '6 E St Charles Rd Ste 100', 'Lombard', 'Dupage', 'IL', '60148', '6304951240', '6304951993', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, '', NULL, 'HCFA|UB|', '1508844275', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.8873, -88.0182, NULL, NULL),
('362167784', 'ELEL00143', 'ELEL00143', 'ILCHIGSTD', 'Elmhurst Memorial Occupational Health Services', 'William', 'V', 'Galassi', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '200 Berteau Ave', 'Elmhurst', 'Dupage', 'IL', '60126', '3312210570', '6307588221', '200 Berteau Ave', 'Elmhurst', 'Dupage', 'IL', '60126', '3312210570', '6307588221', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 6, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '1508900366', 0, 'N', 0, '2013-07-30', NULL, NULL, 41.9022, -87.9293, NULL, NULL),
('362167784', 'ELEL00144', 'ELEL00144', 'ILCHIGSTD', 'Elmhurst Memorial Occupational Health Services', 'William', 'V', 'Galassi', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '230 E Irving Park Rd', 'Wood Dale', 'Dupage', 'IL', '60191', '6302852010', '6302852011', '230 E Irving Park Rd', 'Wood Dale', 'Dupage', 'IL', '60191', '6302852010', '6302852011', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 6, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '1508900366', 0, 'N', 0, '2013-07-30', NULL, NULL, 41.9627, -87.973, NULL, NULL),
('363254389', 'ELEL00120', 'ELEL00120', 'ILCHIGSTD', 'Advanced Oral and Maxillofacial Surgery', 'Anthony', '', 'Dohse', 'DDS', 'Oral/Maxillofacial Surgery', '', '', NULL, 'O', '533 W North Ave Ste 200', 'Elmhurst', 'Dupage', 'IL', '60126', '6309413400', '6309413421', '533 W North Ave Ste 200', 'Elmhurst', 'Dupage', 'IL', '60126', '6309413400', '6309413421', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1518039718', 0, 'Y', 0, '2013-10-15', NULL, NULL, 41.9059, -87.9599, NULL, NULL),
('363163610', 'ELEL00239', 'ELEL00239', 'ILCHIGSTD', 'M and M Orthopaedics', 'Joanne', 'E', 'Labriola', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '133 E Brush Hill Rd Ste 100', 'Elmhurst', 'Dupage', 'IL', '60126', '6305010630', '6305010645', '133 E Brush Hill Rd Ste 100', 'Elmhurst', 'Dupage', 'IL', '60126', '6305010630', '6305010645', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', '2013-06-30', 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '1518904739', 0, 'N', 0, '2014-04-25', NULL, NULL, 41.8628, -87.9376, NULL, NULL),
('363163610', 'ELEL00240', 'ELEL00240', 'ILCHIGSTD', 'M and M Orthopaedics', 'Joanne', 'E', 'Labriola', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '4115 Fairview Ave', 'Downers Grove', 'Dupage', 'IL', '60515', '6309681881', '6309681719', '4115 Fairview Ave', 'Downers Grove', 'Dupage', 'IL', '60515', '6309681881', '6309681719', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', '2013-06-30', 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '1518904739', 0, 'N', 0, '2014-04-25', NULL, NULL, 41.8109, -87.9947, NULL, NULL),
('362169147', 'ELEL00116', 'ELEL00116', 'ILCHIGSTD', 'Advocate Medical Group Midwest Heart Specialists', 'Thomas', 'J', 'Discher', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '25 N Winfield Rd Ste 301', 'Winfield', 'Dupage', 'IL', '60190', '6305109244', '6305109557', '25 N Winfield Rd Ste 301', 'Winfield', 'Dupage', 'IL', '60190', '6305109244', '6305109557', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 8, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '1518905819', 0, 'N', 0, '2013-09-10', NULL, NULL, 41.8714, -88.1583, NULL, NULL),
('364037473', 'ELEL00115', 'ELEL00115', 'ILCHIGSTD', 'Elmhurst Clinic', 'Thomas', 'J', 'Discher', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '3312211174', '3312213782', '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '3312211174', '3312213782', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '1518905819', 0, 'N', 0, '2013-09-10', NULL, NULL, 41.8616, -87.936, NULL, NULL),
('362169147', 'ELEL00053', 'ELEL00053', 'ILCHIGSTD', 'Advocate Medical Group Midwest Heart Specialists', 'Cash', '', 'Casey', 'MD', 'Electrophysiology', '', '', NULL, 'O', '133 E Brush Hill Rd Ste 202', 'Elmhurst', 'Dupage', 'IL', '60126', '6307824050', '6307825021', '133 E Brush Hill Rd Ste 202', 'Elmhurst', 'Dupage', 'IL', '60126', '6307824050', '6307825021', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 8, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1518910306', 0, 'Y', 0, '2013-09-10', NULL, NULL, 41.8616, -87.9371, NULL, NULL),
('364037473', 'ELEL00054', 'ELEL00054', 'ILCHIGSTD', 'Elmhurst Clinic', 'Cash', '', 'Casey', 'MD', 'Electrophysiology', '', '', NULL, 'O', '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '6309412600', '6309412632', '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '6309412600', '6309412632', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1518910306', 0, 'Y', 0, '2013-09-10', NULL, NULL, 41.8616, -87.936, NULL, NULL),
('362169147', 'ELEL00434', 'ELEL00434', 'ILCHIGSTD', 'Advocate Medical Group Midwest Heart Specialists', 'Stanislaw', 'J', 'Skaluba', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '801 S Washington St 4th Fl', 'Naperville', 'Dupage', 'IL', '60566', '6305272730', '6305272754', '801 S Washington St 4th Fl', 'Naperville', 'Dupage', 'IL', '60566', '6305272730', '6305272754', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 8, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', 'Edward Hospital', NULL, NULL, 'HCFA|UB|', '1528011988', 0, 'N', 0, '2013-09-10', NULL, NULL, 41.7608, -88.149, NULL, NULL),
('364037473', 'ELEL00433', 'ELEL00433', 'ILCHIGSTD', 'Elmhurst Clinic', 'Stanislaw', 'J', 'Skaluba', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '6309412600', '6309412632', '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '6309412600', '6309412632', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', 'Edward Hospital', NULL, NULL, 'HCFA|UB|', '1528011988', 0, 'N', 0, '2013-09-10', NULL, NULL, 41.8616, -87.936, NULL, NULL),
('362169147', 'ELEL00104', 'ELEL00104', 'ILCHIGSTD', 'Advocate Medical Group Midwest Heart Specialists', 'Ann', 'R', 'Davis', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '801 S Washington St 4th Fl', 'Naperville', 'Dupage', 'IL', '60566', '6305272730', '6305272754', '801 S Washington St 4th Fl', 'Naperville', 'Dupage', 'IL', '60566', '6305272730', '6305272754', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 8, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', 'Edward Hospital', NULL, NULL, 'HCFA|UB|', '1528012846', 0, 'N', 0, '2013-09-10', NULL, NULL, 41.7608, -88.149, NULL, NULL),
('364037473', 'ELEL00103', 'ELEL00103', 'ILCHIGSTD', 'Elmhurst Clinic', 'Ann', 'R', 'Davis', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '6309412600', '6309412632', '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '6309412600', '6309412632', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', 'Edward Hospital', NULL, NULL, 'HCFA|UB|', '1528012846', 0, 'N', 0, '2013-09-10', NULL, NULL, 41.8616, -87.936, NULL, NULL),
('364037473', 'ELEL00461', 'ELEL00461', 'ILCHIGSTD', 'Elmhurst Clinic', 'Kathryn', 'M', 'Thomas', 'MD', 'Dermatology', '', '', NULL, 'O', '172 Schiller', 'Elmhurst', 'Dupage', 'IL', '60126', '6309412619', '6307589720', '172 Schiller', 'Elmhurst', 'Dupage', 'IL', '60126', '6309412619', '6307589720', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1528019692', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.9011, -87.9371, NULL, NULL),
('364037473', 'ELEL00429', 'ELEL00429', 'ILCHIGSTD', 'Elmhurst Clinic', 'Lori', 'S', 'Shelnitz', 'MD', 'Dermatology', '', '', NULL, 'O', '172 Schiller', 'Elmhurst', 'Dupage', 'IL', '60126', '6309412619', '6307589720', '172 Schiller', 'Elmhurst', 'Dupage', 'IL', '60126', '6309412619', '6307589720', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1538119938', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.9011, -87.9371, NULL, NULL),
('364778025', 'ELEL00368', 'ELEL00368', 'ILCHIGSTD', 'Subarna P Pradhan MD', 'Subarna', 'P', 'Pradhan', 'MD', 'Internal Medicine', '', '', NULL, 'O', '9722 W Grand Ave', 'Franklin Park', 'Cook', 'IL', '60131', '8474550110', '8474550199', '9722 W Grand Ave', 'Franklin Park', 'Cook', 'IL', '60131', '8474550110', '8474550199', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', '2013-04-01', 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1538282256', 0, 'N', 0, '2014-02-03', NULL, NULL, 41.9298, -87.8688, NULL, NULL),
('262826085', 'ELEL00360', 'ELEL00360', 'ILCHIGSTD', 'Phillips Family Medical Center', 'Ofelia', '', 'Phillips', 'MD', 'Family Practice', '', '', NULL, 'O', '675 North Ave Ste 309', 'Melrose Park', 'Cook', 'IL', '60160', '6308346246', '6308343355', '675 North Ave Ste 309', 'Melrose Park', 'Cook', 'IL', '60160', '6308346246', '6308343355', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1548240328', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.9083, -87.8421, NULL, NULL),
('262826088', 'ELEL00359', 'ELEL00359', 'ILCHIGSTD', 'Phillips Family Medical Center', 'Ofelia', '', 'Phillips', 'MD', 'Family Practice', '', '', NULL, 'O', '242 N York St Ste 106', 'Elmhurst', 'Dupage', 'IL', '60126', '6308346246', '6308343355', '242 N York St Ste 106', 'Elmhurst', 'Dupage', 'IL', '60126', '6308346246', '6308343355', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1548240328', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.9047, -87.9399, NULL, NULL),
('300291080', 'ELEL00501', 'ELEL00501', 'ILCHIGSTD', 'Neurology Clinical Neurophysiology and Sleep Medicine', 'John', 'R', 'Wilson', 'MD', 'Neurology', '', '', NULL, 'O', '1 S 443 Summit Ave Ste 203', 'Oakbrook Terrace', 'Dupage', 'IL', '60181', '7086817879', '7086817886', '1 S 443 Summit Ave Ste 203', 'Oakbrook Terrace', 'Dupage', 'IL', '60181', '7086817879', '7086817886', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', 'Presence Resurrection Medical Center', NULL, NULL, 'HCFA|UB|', '1548243678', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.8534, -87.9727, NULL, NULL),
('300291080', 'ELEL00500', 'ELEL00500', 'ILCHIGSTD', 'Neurology Clinical Neurophysiology and Sleep Medicine', 'John', 'R', 'Wilson', 'MD', 'Neurology', '', '', NULL, 'O', '675 W North Ave Ste 608', 'Melrose Park', 'Cook', 'IL', '60160', '7086817879', '7086817886', '675 W North Ave Ste 608', 'Melrose Park', 'Cook', 'IL', '60160', '7086817879', '7086817886', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', 'Presence Resurrection Medical Center', NULL, NULL, 'HCFA|UB|', '1548243678', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.9083, -87.8421, NULL, NULL),
('362120183', 'ELEL00255', 'ELEL00255', 'ILCHIGSTD', 'Villa Medical Arts', 'Anthony', '', 'Lin', 'MD', 'Family Practice', '', '', NULL, 'O', '10 E Central Blvd', 'Villa Park', 'Dupage', 'IL', '60181', '6308329000', '6308329049', '10 E Central Blvd', 'Villa Park', 'Dupage', 'IL', '60181', '6308329000', '6308329049', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1548258197', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.8839, -87.9787, NULL, NULL),
('364404269', 'ELEL00168', 'ELEL00168', 'ILCHIGSTD', 'William M Hadesman MD', 'William', '', 'Hadesman', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '360 W Butterfield Rd Ste 150', 'Elmhurst', 'Dupage', 'IL', '60126', '6305161680', '6305161686', '360 W Butterfield Rd Ste 150', 'Elmhurst', 'Dupage', 'IL', '60126', '6305161680', '6305161686', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1548284003', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.8648, -87.9509, NULL, NULL),
('710870653', 'ELEL00163', 'ELEL00163', 'ILCHIGSTD', 'Family Medical Care', 'Nancy', '', 'Gryniewicz Sika', 'MD', 'Family Practice', '', '', NULL, 'O', '965 Lake St', 'Oak Park', 'Cook', 'IL', '60301', '7083830400', '7083834314', '965 Lake St', 'Oak Park', 'Cook', 'IL', '60301', '7083830400', '7083834314', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, '', NULL, 'HCFA|UB|', '1558368043', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.8887, -87.7993, NULL, NULL),
('260359718', 'ELEL00357', 'ELEL00357', 'ILCHIGSTD', 'A to Z Pediatric and Youth Healthcare', 'Walter', 'Daniel', 'Perez', 'MD', 'Pediatrics', '', '', NULL, 'O', '721 W Lake St Ste 202', 'Addison', 'Cook', 'IL', '60601', '6307574010', '6307574011', '721 W Lake St Ste 202', 'Addison', 'Cook', 'IL', '60601', '6307574010', '6307574011', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', '2013-04-01', 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '1558475996', 0, 'N', 0, '2014-04-25', NULL, NULL, 0, 0, NULL, NULL),
('364037473', 'ELEL00312', 'ELEL00312', 'ILCHIGSTD', 'Elmhurst Clinic', 'Uzma', '', 'Muneer', 'DO', 'Pediatrics', '', '', NULL, 'O', '1200 S York Rd Ste 2000', 'Elmhurst', 'Dupage', 'IL', '60126', '6309414710', '6307588481', '1200 S York Rd Ste 2000', 'Elmhurst', 'Dupage', 'IL', '60126', '6309414710', '6307588481', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1558477604', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.865, -87.9322, NULL, NULL),
('364037473', 'ELEL00314', 'ELEL00314', 'ILCHIGSTD', 'Elmhurst Clinic', 'Uzma', '', 'Muneer', 'DO', 'Pediatrics', '', '', NULL, 'O', '130 S Main St', 'Lombard', 'Dupage', 'IL', '60148', '6309414710', '6307588481', '130 S Main St', 'Lombard', 'Dupage', 'IL', '60148', '6309414710', '6307588481', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1558477604', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.8856, -88.0184, NULL, NULL),
('362167784', 'ELEL00078', 'ELEL00078', 'ILCHIGSTD', 'Elmhurst Memorial Occupational Health Services', 'Janet', '', 'Collins', 'MD', 'Occupational Medicine', '', '', NULL, 'O', '200 Berteau Ave', 'Elmhurst', 'Dupage', 'IL', '60126', '3312210570', '6307588221', '200 Berteau Ave', 'Elmhurst', 'Dupage', 'IL', '60126', '3312210570', '6307588221', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 6, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '1558488015', 0, 'Y', 0, '2013-07-25', NULL, NULL, 41.9022, -87.9293, NULL, NULL),
('362167784', 'ELEL00079', 'ELEL00079', 'ILCHIGSTD', 'Elmhurst Memorial Occupational Health Services', 'Janet', '', 'Collins', 'MD', 'Occupational Medicine', '', '', NULL, 'O', '230 E Irving Park Rd', 'Wood Dale', 'Dupage', 'IL', '60191', '6302852010', '6302852011', '230 E Irving Park Rd', 'Wood Dale', 'Dupage', 'IL', '60191', '6302852010', '6302852011', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 6, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '1558488015', 0, 'Y', 0, '2013-07-25', NULL, NULL, 41.9627, -87.973, NULL, NULL),
('362907660', 'ELEL00235', 'ELEL00235', 'ILCHIGSTD', 'Nephrology Associates of Northern Illinois', 'Samir', 'T', 'Kumar', 'MD', 'Nephrology', '', '', NULL, 'O', '3825 Highland Ave Ste 4C', 'Downers Grove', 'Dupage', 'IL', '60515', '6309681595', '6309681590', '3825 Highland Ave Ste 4C', 'Downers Grove', 'Dupage', 'IL', '60515', '6309681595', '6309681590', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Edward Hospital', 'Elmhurst Memorial Hospital', '', '', 'HCFA|UB|', '1568460145', 0, 'N', 0, '2014-04-25', NULL, NULL, 41.8181, -88.0102, NULL, NULL),
('362169147', 'ELEL00212', 'ELEL00212', 'ILCHIGSTD', 'Advocate Medical Group Midwest Heart Specialists', 'Raymond', 'N', 'Kawasaki', 'MD', 'Electrophysiology', '', '', NULL, 'O', '1555 N Barrington Rd DB III Ste 3200', 'Hoffman Estates', 'Cook', 'IL', '60194', '8478828448', '8478828481', '1555 N Barrington Rd DB III Ste 3200', 'Hoffman Estates', 'Cook', 'IL', '60194', '8478828448', '8478828481', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 8, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '1578514188', 0, 'Y', 0, '2013-09-10', NULL, NULL, 42.0542, -88.1444, NULL, NULL),
('364037473', 'ELEL00211', 'ELEL00211', 'ILCHIGSTD', 'Elmhurst Clinic', 'Raymond', 'N', 'Kawasaki', 'MD', 'Electrophysiology', '', '', NULL, 'O', '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '3312211174', '3312213782', '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '3312211174', '3312213782', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '1578514188', 0, 'Y', 0, '2013-09-10', NULL, NULL, 41.8616, -87.936, NULL, NULL),
('364037473', 'ELEL00333', 'ELEL00333', 'ILCHIGSTD', 'Elmhurst Clinic', 'Adebukola', '', 'Onibokun', 'MD', 'Neurosurgery', '', '', NULL, 'O', '1200 S York Rd Ste 3160', 'Elmhurst', 'Dupage', 'IL', '60126', '3312219090', '6309412642', '1200 S York Rd Ste 3160', 'Elmhurst', 'Dupage', 'IL', '60126', '3312219090', '6309412642', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1578746749', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.865, -87.9322, NULL, NULL),
('364037473', 'ELEL00013', 'ELEL00013', 'ILCHIGSTD', 'Elmhurst Clinic', 'Robert', 'S', 'Andersen', 'MD', 'Pediatrics', '', '', NULL, 'O', '1200 S York Rd Ste 2000', 'Elmhurst', 'Dupage', 'IL', '60126', '6309414710', '6307588481', '1200 S York Rd Ste 2000', 'Elmhurst', 'Dupage', 'IL', '60126', '6309414710', '6307588481', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1588615637', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.865, -87.9322, NULL, NULL),
('364037473', 'ELEL00014', 'ELEL00014', 'ILCHIGSTD', 'Elmhurst Clinic', 'Robert', 'S', 'Andersen', 'MD', 'Pediatrics', '', '', NULL, 'O', '130 S Main St', 'Lombard', 'Dupage', 'IL', '60148', '6306524200', '6306524222', '130 S Main St', 'Lombard', 'Dupage', 'IL', '60148', '6306524200', '6306524222', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1588615637', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.8856, -88.0184, NULL, NULL),
('362841923', 'ELEL00132', 'ELEL00132', 'ILCHIGSTD', 'Elmhurst Clinic', 'Patrick', 'C', 'Fenner', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '6309412600', '6309412632', '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '6309412600', '6309412632', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, '', '', 'HCFA|UB|', '1588616585', 0, 'N', 0, '2014-04-25', NULL, NULL, 41.8616, -87.936, NULL, NULL),
('362841923', 'ELEL00133', 'ELEL00133', 'ILCHIGSTD', 'Advocate Medical Group Midwest Heart Specialists', 'Patrick', 'C', 'Fenner', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '25 N Winfield Rd Ste 301', 'Winfield', 'Dupage', 'IL', '60190', '6305109244', '6305109557', '25 N Winfield Rd Ste 301', 'Winfield', 'Dupage', 'IL', '60190', '6305109244', '6305109557', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, '', '', 'HCFA|UB|', '1588616585', 0, 'N', 0, '2014-04-25', NULL, NULL, 41.8714, -88.1583, NULL, NULL),
('364037473', 'ELEL00107', 'ELEL00107', 'ILCHIGSTD', 'Elmhurst Clinic', 'Steven', 'B', 'Deliduka', 'MD', 'Dermatology', '', '', NULL, 'O', '130 S Main St', 'Lombard', 'Dupage', 'IL', '60148', '6306524200', '6306524222', '130 S Main St', 'Lombard', 'Dupage', 'IL', '60148', '6306524200', '6306524222', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1598712937', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.8856, -88.0184, NULL, NULL),
('364037473', 'ELEL00106', 'ELEL00106', 'ILCHIGSTD', 'Elmhurst Clinic', 'Steven', 'B', 'Deliduka', 'MD', 'Dermatology', '', '', NULL, 'O', '172 Schiller', 'Elmhurst', 'Dupage', 'IL', '60126', '6309412619', '6307589720', '172 Schiller', 'Elmhurst', 'Dupage', 'IL', '60126', '6309412619', '6307589720', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1598712937', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.9011, -87.9371, NULL, NULL),
('364037473', 'ELEL00323', 'ELEL00323', 'ILCHIGSTD', 'Elmhurst Clinic', 'Michael', 'T', 'Nosek', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1200 S York Rd Ste 2000', 'Elmhurst', 'Dupage', 'IL', '60126', '6309412600', '6307588480', '1200 S York Rd Ste 2000', 'Elmhurst', 'Dupage', 'IL', '60126', '6309412600', '6307588480', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1598716656', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.865, -87.9322, NULL, NULL),
('363643379', 'ELEL00374', 'ELEL00374', 'ILCHIGSTD', 'Reproductive Medicine Institute', 'Nasiruddin', '', 'Rana', 'MD', 'Reproductive Endocrinology', '', '', NULL, 'O', '2425 W 22nd St Ste 200', 'Oak Brook', 'Dupage', 'IL', '60523', '6309540054', '6309540064', '2425 W 22nd St Ste 200', 'Oak Brook', 'Dupage', 'IL', '60523', '6309540054', '6309540064', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '1598768640', 0, 'N', 0, '2014-04-25', NULL, NULL, 41.846, -87.9782, NULL, NULL),
('363643379', 'ELEL00375', 'ELEL00375', 'ILCHIGSTD', 'Chicago Endometriosis Endoscopy Center', 'Nasiruddin', '', 'Rana', 'MD', 'Reproductive Endocrinology', '', '', NULL, 'O', '60 E Delaware 15th Fl', 'Chicago', 'Cook', 'IL', '60611', '3128673636', '3128674114', '60 E Delaware 15th Fl', 'Chicago', 'Cook', 'IL', '60611', '3128673636', '3128674114', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '1598768640', 0, 'N', 0, '2014-04-25', NULL, NULL, 41.8992, -87.6256, NULL, NULL),
('362169147', 'ELEL00046', 'ELEL00046', 'ILCHIGSTD', 'Advocate Medical Group Midwest Heart Specialists', 'Michael', 'D', 'Brottman', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '133 E Brush Hill Rd Ste 202', 'Elmhurst', 'Dupage', 'IL', '60126', '6307824050', '6307825021', '133 E Brush Hill Rd Ste 202', 'Elmhurst', 'Dupage', 'IL', '60126', '6307824050', '6307825021', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 8, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1609820919', 0, 'N', 0, '2013-09-10', NULL, NULL, 41.8616, -87.9371, NULL, NULL),
('362667448', 'ELEL00221', 'ELEL00221', 'ILCHIGSTD', 'Oak Brook Allergists', 'David', 'J', 'Knysak', 'MD', 'Allergy and Immunology', '', '', NULL, 'O', '120 Oak Brook Ctr Mall Ste 424', 'Oak Brook', 'Dupage', 'IL', '60523', '6305740460', '6305740470', '120 Oak Brook Ctr Mall Ste 424', 'Oak Brook', 'Dupage', 'IL', '60523', '6305740460', '6305740470', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Edward Hospital', 'Elmhurst Memorial Hospital', NULL, NULL, 'HCFA|UB|', '1609876101', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.8477, -87.9519, NULL, NULL),
('362667448', 'ELEL00222', 'ELEL00222', 'ILCHIGSTD', 'Oak Brook Allergists', 'David', 'J', 'Knysak', 'MD', 'Allergy and Immunology', '', '', NULL, 'O', '1220 Hobson Rd Ste 136', 'Naperville', 'Dupage', 'IL', '60540', '6309612960', '6309613296', '1220 Hobson Rd Ste 136', 'Naperville', 'Dupage', 'IL', '60540', '6309612960', '6309613296', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Edward Hospital', 'Elmhurst Memorial Hospital', NULL, NULL, 'HCFA|UB|', '1609876101', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.7528, -88.1191, NULL, NULL),
('364450398', 'ELEL00453', 'ELEL00453', 'ILCHIGSTD', 'Fairview Ogden Medical Group', 'Zainulabuddin', '', 'Syed', 'MD', 'Internal Medicine', '', '', NULL, 'O', '4121 Fairview Ave Ste 100', 'Downers Grove', 'Dupage', 'IL', '60515', '6309684790', '6309688755', '4121 Fairview Ave Ste 100', 'Downers Grove', 'Dupage', 'IL', '60515', '6309684790', '6309688755', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, '', NULL, 'HCFA|UB|', '1609876424', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.8113, -87.9953, NULL, NULL),
('364138353', 'ELEL00326', 'ELEL00326', 'ILCHIGSTD', 'Dupage Center for Surgery and Breast Health', 'Linh', 'Nguyen', 'OConnor', 'MD', 'General Surgery', '', '', NULL, 'O', '1200 S York Rd Ste 4250', 'Elmhurst', 'Dupage', 'IL', '60126', '6308568677', '6308569909', '1200 S York Rd Ste 4250', 'Elmhurst', 'Dupage', 'IL', '60126', '6308568677', '6308569909', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 6, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, '', '', 'HCFA|UB|', '1609940287', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.865, -87.9322, NULL, NULL),
('364138353', 'ELEL00329', 'ELEL00329', 'ILCHIGSTD', 'Dupage Center for Surgery and Breast Health', 'Linh', 'Nguyen', 'OConnor', 'MD', 'General Surgery', '', '', NULL, 'O', '199 S Addison Rd Ste 108', 'Wood Dale', 'Dupage', 'IL', '60191', '6308568677', '6308569909', '199 S Addison Rd Ste 108', 'Wood Dale', 'Dupage', 'IL', '60191', '6308568677', '6308569909', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 6, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, '', '', 'HCFA|UB|', '1609940287', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.9521, -87.9889, NULL, NULL),
('364444033', 'ELEL00197', 'ELEL00197', 'ILCHIGSTD', 'Renu Jain MD', 'Renu', '', 'Jain', 'MD', 'Pediatrics', '', '', NULL, 'O', '33 N Addison Rd Ste 106', 'Addison', 'Dupage', 'IL', '60101', '6305302224', '6305302267', '33 N Addison Rd Ste 106', 'Addison', 'Dupage', 'IL', '60101', '6305302224', '6305302267', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, '', NULL, 'HCFA|UB|', '1619079977', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.9279, -87.9886, NULL, NULL),
('364037473', 'ELEL00493', 'ELEL00493', 'ILCHIGSTD', 'Elmhurst Clinic', 'Colleen', '', 'Weiler', 'DO', 'Family Practice', '', '', NULL, 'O', '1100 Lake St Ste 230', 'Oak Park', 'Cook', 'IL', '60301', '7085241420', '7085241509', '1100 Lake St Ste 230', 'Oak Park', 'Cook', 'IL', '60301', '7085241420', '7085241509', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1619134996', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.8886, -87.8026, NULL, NULL),
('364037473', 'ELEL00480', 'ELEL00480', 'ILCHIGSTD', 'Elmhurst Clinic', 'Marcelo', 'E', 'Virgili', 'MD', 'General Surgery', '', '', NULL, 'O', '1200 S York Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '6309412633', '6307588578', '1200 S York Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '6309412633', '6307588578', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1619927738', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.865, -87.9322, NULL, NULL),
('272295237', 'ELEL00020', 'ELEL00020', 'ILCHIGSTD', 'Midwest Hand Surgery', 'Nabil', 'A', 'Barakat', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1200 S York Rd Ste 3200', 'Elmhurst', 'Dupage', 'IL', '60126', '6303596888', '6303596889', '1200 S York Rd Ste 3200', 'Elmhurst', 'Dupage', 'IL', '60126', '6303596888', '6303596889', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Presence Saint Joseph Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1619993268', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.865, -87.9322, NULL, NULL),
('272295237', 'ELEL00021', 'ELEL00021', 'ILCHIGSTD', 'Midwest Hand Surgery', 'Nabil', 'A', 'Barakat', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '7460 W College Dr 2nd Fl', 'Palos Heights', 'Cook', 'IL', '60463', '7088272888', '7088272889', '7460 W College Dr 2nd Fl', 'Palos Heights', 'Cook', 'IL', '60463', '7088272888', '7088272889', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Presence Saint Joseph Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1619993268', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.6752, -87.8034, NULL, NULL),
('362169147', 'ELEL00073', 'ELEL00073', 'ILCHIGSTD', 'Advocate Medical Group Midwest Heart Specialists', 'Stanley', 'E', 'Clark', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '801 S Washington St 4th Fl', 'Naperville', 'Dupage', 'IL', '60566', '6305272730', '6305272754', '801 S Washington St 4th Fl', 'Naperville', 'Dupage', 'IL', '60566', '6305272730', '6305272754', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 8, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', 'Edward Hospital', NULL, NULL, 'HCFA|UB|', '1629016951', 0, 'N', 0, '2013-09-10', NULL, NULL, 41.7608, -88.149, NULL, NULL),
('364037473', 'ELEL00072', 'ELEL00072', 'ILCHIGSTD', 'Elmhurst Clinic', 'Stanley', 'E', 'Clark', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '172 Schiller', 'Elmhurst', 'Dupage', 'IL', '60126', '6309412600', '6309412632', '172 Schiller', 'Elmhurst', 'Dupage', 'IL', '60126', '6309412600', '6309412632', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', 'Edward Hospital', NULL, NULL, 'HCFA|UB|', '1629016951', 0, 'N', 0, '2013-09-10', NULL, NULL, 41.9011, -87.9371, NULL, NULL),
('611486620', 'ELEL00102', 'ELEL00102', 'ILCHIGSTD', 'Elmhurst Dermatology', 'Todd', 'T', 'Davis', 'MD', 'Dermatology', '', '', NULL, 'O', '103 N Haven Rd Ste 7', 'Elmhurst', 'Dupage', 'IL', '60126', '6308322111', '6308325199', '103 N Haven Rd Ste 7', 'Elmhurst', 'Dupage', 'IL', '60126', '6308322111', '6308325199', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1629063169', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.8994, -87.9364, NULL, NULL),
('363163610', 'ELEL00282', 'ELEL00282', 'ILCHIGSTD', 'M and M Orthopaedics', 'Steven', '', 'Mash', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '15900 W 127th St Ste 111', 'Lemont', 'Cook', 'IL', '60439', '6302437385', '6302438302', '15900 W 127th St Ste 111', 'Lemont', 'Cook', 'IL', '60439', '6302437385', '6302438302', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, '', '', 'HCFA|UB|', '1629064449', 0, 'N', 0, '2013-09-18', NULL, NULL, 41.6565, -88.0051, NULL, NULL),
('363163610', 'ELEL00283', 'ELEL00283', 'ILCHIGSTD', 'M and M Orthopaedics', 'Steven', '', 'Mash', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '4115 Fairview Ave', 'Downers Grove', 'Dupage', 'IL', '60515', '6309681881', '6307588592', '4115 Fairview Ave', 'Downers Grove', 'Dupage', 'IL', '60515', '6309681881', '6307588592', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, '', '', 'HCFA|UB|', '1629064449', 0, 'N', 0, '2013-09-18', NULL, NULL, 41.8114, -87.9953, NULL, NULL),
('362714102', 'ELEL00335', 'ELEL00335', 'ILCHIGSTD', 'RLT Neurologic Associates', 'Daniel', 'F', 'OReilly', 'MD', 'Neurology', '', '', NULL, 'O', '255 W 1st St', 'Elmhurst', 'Dupage', 'IL', '60126', '6305304449', '6305304557', '255 W 1st St', 'Elmhurst', 'Dupage', 'IL', '60126', '6305304449', '6305304557', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1629184833', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.9, -87.9468, NULL, NULL),
('362714102', 'ELEL00334', 'ELEL00334', 'ILCHIGSTD', 'RLT Neurologic Associates', 'Daniel', 'F', 'OReilly', 'MD', 'Neurology', '', '', NULL, 'O', '303 E Army Trail Rd Ste 300', 'Bloomingdale', 'Dupage', 'IL', '60108', '6305304449', '6305304557', '303 E Army Trail Rd Ste 300', 'Bloomingdale', 'Dupage', 'IL', '60108', '6305304449', '6305304557', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1629184833', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.9391, -88.1019, NULL, NULL),
('364037473', 'ELEL00113', 'ELEL00113', 'ILCHIGSTD', 'Elmhurst Memorial Hematology Oncology Services', 'Lucio', '', 'Di Nunno', 'MD', 'Oncology', '', '', NULL, 'O', '1200 S York Rd Ste 3280', 'Elmhurst', 'Dupage', 'IL', '60126', '6307588640', '6307588642', '1200 S York Rd Ste 3280', 'Elmhurst', 'Dupage', 'IL', '60126', '6307588640', '6307588642', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1639132343', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.865, -87.9322, NULL, NULL),
('364060043', 'ELEL00379', 'ELEL00379', 'ILCHIGSTD', 'Advanced Renal Care', 'Anis', 'A', 'Rauf', 'DO', 'Nephrology', '', '', NULL, 'O', '333 Chestnut St Ste L06', 'Hinsdale', 'Dupage', 'IL', '60521', '6304959356', '6304959357', '333 Chestnut St Ste L06', 'Hinsdale', 'Dupage', 'IL', '60521', '6304959356', '6304959357', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', '2014-03-25', 0, 0, 0, 'Edward Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1639259740', 0, 'N', 0, '2014-03-26', NULL, NULL, 41.8019, -87.9344, NULL, NULL),
('364600437', 'ELEL00378', 'ELEL00378', 'ILCHIGSTD', 'Advanced Renal Care', 'Anis', 'A', 'Rauf', 'DO', 'Nephrology', '', '', NULL, 'O', '2340 S Highland Ave Ste 160', 'Lombard', 'Dupage', 'IL', '60148', '6304959356', '6304959357', '2340 S Highland Ave Ste 160', 'Lombard', 'Dupage', 'IL', '60148', '6304959356', '6304959357', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Edward Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1639259740', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.8429, -88.0115, NULL, NULL),
('364037473', 'ELEL00097', 'ELEL00097', 'ILCHIGSTD', 'Elmhurst Medical Associates', 'Jeff', 'A', 'DAmico', 'DO', 'Internal Medicine', '', '', NULL, 'O', '183 Addison Ave', 'Elmhurst', 'Dupage', 'IL', '60126', '3312210000', '3312213991', '183 Addison Ave', 'Elmhurst', 'Dupage', 'IL', '60126', '3312210000', '3312213991', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1639350978', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.9029, -87.9416, NULL, NULL),
('364410408', 'ELEL00205', 'ELEL00205', 'ILCHIGSTD', 'Dr H Kalsi and Associates', 'Harcharan', 'S', 'Kalsi', 'MD', 'General Practice', '', '', NULL, 'O', '1200 S York Rd Ste 4250', 'Elmhurst', 'Dupage', 'IL', '60126', '6307588766', '6307588751', '1200 S York Rd Ste 4250', 'Elmhurst', 'Dupage', 'IL', '60126', '6307588766', '6307588751', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1639393002', 0, 'Y', 0, '2013-07-25', NULL, NULL, 41.865, -87.9322, NULL, NULL),
('362907660', 'ELEL00385', 'ELEL00385', 'ILCHIGSTD', 'Nephrology Associates of Northern Illinois', 'Naveen', '', 'Reddy', 'MD', 'Nephrology', '', '', NULL, 'O', '329 Remington Blvd Ste 105', 'Bolingbrook', 'Will', 'IL', '60440', '6306855699', '6302269750', '329 Remington Blvd Ste 105', 'Bolingbrook', 'Will', 'IL', '60440', '6306855699', '6302269750', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Edward Hospital', 'Elmhurst Memorial Hospital', '', '', 'HCFA|UB|', '1649217829', 0, 'N', 0, '2014-04-25', NULL, NULL, 41.6837, -88.0774, NULL, NULL),
('362907660', 'ELEL00386', 'ELEL00386', 'ILCHIGSTD', 'Nephrology Associates of Northern Illinois', 'Naveen', '', 'Reddy', 'MD', 'Nephrology', '', '', NULL, 'O', '3825 Highland Ave Ste 4C', 'Downers Grove', 'Dupage', 'IL', '60515', '6309681595', '6309681590', '3825 Highland Ave Ste 4C', 'Downers Grove', 'Dupage', 'IL', '60515', '6309681595', '6309681590', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Edward Hospital', 'Elmhurst Memorial Hospital', '', '', 'HCFA|UB|', '1649217829', 0, 'N', 0, '2014-04-25', NULL, NULL, 41.8181, -88.0102, NULL, NULL),
('364037473', 'ELEL00219', 'ELEL00219', 'ILCHIGSTD', 'Elmhurst Clinic', 'Martin', 'K', 'Kittaka', 'MD', 'Internal Medicine', '', '', NULL, 'O', '133 E Brush Hill Rd Ste 310', 'Elmhurst', 'Dupage', 'IL', '60126', '6309412600', '6309412649', '133 E Brush Hill Rd Ste 310', 'Elmhurst', 'Dupage', 'IL', '60126', '6309412600', '6309412649', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1649220765', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.8616, -87.9371, NULL, NULL),
('364037473', 'ELEL00260', 'ELEL00260', 'ILCHIGSTD', 'Elmhurst Clinic', 'Jonathan', 'HW', 'Littman', 'MD', 'Family Practice', '', '', NULL, 'O', '1100 Lake St Ste 230', 'Oak Park', 'Cook', 'IL', '60301', '7085241420', '7085241509', '1100 Lake St Ste 230', 'Oak Park', 'Cook', 'IL', '60301', '7085241420', '7085241509', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1649221714', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.8886, -87.8026, NULL, NULL),
('364037473', 'ELEL00259', 'ELEL00259', 'ILCHIGSTD', 'Elmhurst Clinic', 'Jonathan', 'HW', 'Littman', 'MD', 'Family Practice', '', '', NULL, 'O', '172 Schiller', 'Elmhurst', 'Dupage', 'IL', '60126', '6308320000', '6309939685', '172 Schiller', 'Elmhurst', 'Dupage', 'IL', '60126', '6308320000', '6309939685', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1649221714', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.9011, -87.9371, NULL, NULL),
('362169147', 'ELEL00469', 'ELEL00469', 'ILCHIGSTD', 'Advocate Medical Group', 'Faheem', '', 'Uraizee', 'MD', 'Neonatology', '', '', NULL, 'O', '200 Berteau Ave', 'Elmhurst', 'Dupage', 'IL', '60126', '6308331400', NULL, '200 Berteau Ave', 'Elmhurst', 'Dupage', 'IL', '60126', '6308331400', '', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 8, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '1649361270', 0, 'Y', 0, '2014-04-25', NULL, NULL, 41.9022, -87.9293, NULL, NULL),
('364037473', 'ELEL00275', 'ELEL00275', 'ILCHIGSTD', 'Elmhurst Clinic', 'Mary Ann', '', 'Malloy', 'MD', 'Internal Medicine', '', '', NULL, 'O', '172 Schiller', 'Elmhurst', 'Dupage', 'IL', '60126', '6309412600', '6309412632', '172 Schiller', 'Elmhurst', 'Dupage', 'IL', '60126', '6309412600', '6309412632', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1659322790', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.9011, -87.9371, NULL, NULL),
('363254389', 'ELEL00504', 'ELEL00504', 'ILCHIGSTD', 'Advanced Oral and Maxillofacial Surgery', 'Mark', 'R', 'Wolf', 'DDS', 'Oral/Maxillofacial Surgery', '', '', NULL, 'O', '1580 N Northwest Hwy Ste 300', 'Park Ridge', 'Cook', 'IL', '60068', '8473908200', NULL, '1580 N Northwest Hwy Ste 300', 'Park Ridge', 'Cook', 'IL', '60068', '8473908200', '', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1659441103', 0, 'Y', 0, '2013-07-25', NULL, NULL, 42.0361, -87.8661, NULL, NULL),
('363254389', 'ELEL00505', 'ELEL00505', 'ILCHIGSTD', 'Advanced Oral and Maxillofacial Surgery', 'Mark', 'R', 'Wolf', 'DDS', 'Oral/Maxillofacial Surgery', '', '', NULL, 'O', '533 W North Ave Ste 200', 'Elmhurst', 'Dupage', 'IL', '60126', '6309413400', '6309413421', '533 W North Ave Ste 200', 'Elmhurst', 'Dupage', 'IL', '60126', '6309413400', '6309413421', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1659441103', 0, 'Y', 0, '2013-07-25', NULL, NULL, 41.9059, -87.9599, NULL, NULL),
('362657245', 'ELEL00045', 'ELEL00045', 'ILCHIGSTD', 'Ad Park Pediatric Associates', 'Merrick', 'J', 'Bromberg', 'MD', 'Pediatrics', '', '', NULL, 'O', '1640 W Lake St Ste 200', 'Addison', 'Dupage', 'IL', '60101', '6305433020', '6305431551', '1640 W Lake St Ste 200', 'Addison', 'Dupage', 'IL', '60101', '6305433020', '6305431551', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1659481778', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.9488, -88.0276, NULL, NULL),
('364037473', 'ELEL00190', 'ELEL00190', 'ILCHIGSTD', 'Elmhurst Clinic', 'Susan', 'M', 'Hudec', 'MD', 'Endocrinology', '', '', NULL, 'O', '133 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '3312219003', '6302219003', '133 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '3312219003', '6302219003', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1659539070', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.8616, -87.9371, NULL, NULL),
('364037473', 'ELEL00189', 'ELEL00189', 'ILCHIGSTD', 'Elmhurst Clinic', 'Susan', 'M', 'Hudec', 'MD', 'Endocrinology', '', '', NULL, 'O', '303 W Lake St Ste 200', 'Addison', 'Dupage', 'IL', '60101', '3312219002', NULL, '303 W Lake St Ste 200', 'Addison', 'Dupage', 'IL', '60101', '3312219002', '', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1659539070', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.9356, -87.9965, NULL, NULL),
('364037473', 'ELEL00216', 'ELEL00216', 'ILCHIGSTD', 'Elmhurst Clinic', 'Julie', 'L', 'Kim', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1200 S York Rd Ste 2000', 'Elmhurst', 'Dupage', 'IL', '60126', '6309412606', '6307588481', '1200 S York Rd Ste 2000', 'Elmhurst', 'Dupage', 'IL', '60126', '6309412606', '6307588481', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1669423703', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.865, -87.9322, NULL, NULL),
('364037473', 'ELEL00217', 'ELEL00217', 'ILCHIGSTD', 'Elmhurst Clinic', 'Julie', 'L', 'Kim', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '130 S Main St', 'Lombard', 'Dupage', 'IL', '60148', '6306524200', '6306524222', '130 S Main St', 'Lombard', 'Dupage', 'IL', '60148', '6306524200', '6306524222', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1669423703', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.8856, -88.0184, NULL, NULL),
('364037473', 'ELEL00198', 'ELEL00198', 'ILCHIGSTD', 'Elmhurst Clinic', 'Raymond', 'V', 'Janevicius', 'MD', 'Plastic Surgery', '', '', NULL, 'O', '360 W Butterfield Rd Ste 230', 'Elmhurst', 'Dupage', 'IL', '60126', '3312219500', '3312213990', '360 W Butterfield Rd Ste 230', 'Elmhurst', 'Dupage', 'IL', '60126', '3312219500', '3312213990', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1669475794', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.8648, -87.9509, NULL, NULL),
('364037473', 'ELEL00032', 'ELEL00032', 'ILCHIGSTD', 'Elmhurst Clinic', 'John', 'A', 'Benages', 'MD', 'Family Practice', '', '', NULL, 'O', '172 Schiller', 'Elmhurst', 'Dupage', 'IL', '60126', '3312219001', '6309939685', '172 Schiller', 'Elmhurst', 'Dupage', 'IL', '60126', '3312219001', '6309939685', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1679524722', 0, 'N', 0, '2014-06-17', NULL, NULL, 41.9011, -87.9371, NULL, NULL),
('364037473', 'ELEL00031', 'ELEL00031', 'ILCHIGSTD', 'Elmhurst Clinic', 'John', 'A', 'Benages', 'MD', 'Family Practice', '', '', NULL, 'O', '303 W Lake St Ste 200', 'Addison', 'Dupage', 'IL', '60101', '3312219002', NULL, '303 W Lake St Ste 200', 'Addison', 'Dupage', 'IL', '60101', '3312219002', '', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1679524722', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.9356, -87.9965, 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
('363095792', 'ELEL00423', 'ELEL00423', 'ILCHIGSTD', 'Midwest Pediatrics', 'Varsha', 'J', 'Shah', 'MD', 'Pediatrics', '', '', NULL, 'O', '1020 E Ogden Ave Ste 306', 'Naperville', 'Dupage', 'IL', '60563', '6303551093', '6303559390', '1020 E Ogden Ave Ste 306', 'Naperville', 'Dupage', 'IL', '60563', '6303551093', '6303559390', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1689630071', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.7909, -88.1306, NULL, NULL),
('363095792', 'ELEL00420', 'ELEL00420', 'ILCHIGSTD', 'Midwest Pediatrics', 'Varsha', 'J', 'Shah', 'MD', 'Pediatrics', '', '', NULL, 'O', '2340 S Highland Ave Ste 150', 'Lombard', 'Dupage', 'IL', '60148', '6309322015', '6309321589', '2340 S Highland Ave Ste 150', 'Lombard', 'Dupage', 'IL', '60148', '6309322015', '6309321589', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1689630071', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.8429, -88.0115, NULL, NULL),
('204047031', 'ELEL00243', 'ELEL00243', 'ILCHIGSTD', 'DuPage Ophthalmology', 'Sheridan', '', 'Lam', 'MD', 'Ophthalmology', '', '', NULL, 'O', '2500 S Highland Ave Ste 110', 'Lombard', 'Dupage', 'IL', '60148', '6304952220', '6304952279', '2500 S Highland Ave Ste 110', 'Lombard', 'Dupage', 'IL', '60148', '6304952220', '6304952279', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1689673964', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.8412, -88.0115, NULL, NULL),
('204047031', 'ELEL00244', 'ELEL00244', 'ILCHIGSTD', 'DuPage Ophthalmology', 'Sheridan', '', 'Lam', 'MD', 'Ophthalmology', '', '', NULL, 'O', '2602 W 83rd St', 'Darien', 'Dupage', 'IL', '60561', '6304952220', '6304952279', '2602 W 83rd St', 'Darien', 'Dupage', 'IL', '60561', '6304952220', '6304952279', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', '2014-03-24', 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1689673964', 0, 'N', 0, '2014-03-26', NULL, NULL, 41.7366, -88.0083, NULL, NULL),
('061654745', 'ELEL00274', 'ELEL00274', 'ILCHIGSTD', 'MGM Medical Associates', 'Meera', 'G', 'Madappallil', 'MD', 'Internal Medicine', '', '', NULL, 'O', '2425 W 22nd St Ste 210', 'Oak Brook', 'Dupage', 'IL', '60523', '6303683909', '6303683958', '2425 W 22nd St Ste 210', 'Oak Brook', 'Dupage', 'IL', '60523', '6303683909', '6303683958', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '1699721142', 0, 'N', 0, '2014-04-25', NULL, NULL, 41.846, -87.9782, NULL, NULL),
('362886394', 'ELEL00510', 'ELEL00510', 'ILCHIGSTD', 'Lombard Family Health Center', 'Gary', 'K', 'Yong', 'MD', 'Family Practice', '', '', NULL, 'O', '126 W St Charles Rd', 'Lombard', 'Dupage', 'IL', '60148', '6306290017', '6306291506', '126 W St Charles Rd', 'Lombard', 'Dupage', 'IL', '60148', '6306290017', '6306291506', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1699762757', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.8868, -88.0204, NULL, NULL),
('364037473', 'ELEL00061', 'ELEL00061', 'ILCHIGSTD', 'Elmhurst Clinic', 'David', 'B', 'Cespedes', 'DO', 'Family Practice', '', '', NULL, 'O', '130 S Main St', 'Lombard', 'Dupage', 'IL', '60148', '6306524200', '6306524222', '130 S Main St', 'Lombard', 'Dupage', 'IL', '60148', '6306524200', '6306524222', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1699775650', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.8856, -88.0184, NULL, NULL),
('364037473', 'ELEL00059', 'ELEL00059', 'ILCHIGSTD', 'Elmhurst Clinic', 'David', 'B', 'Cespedes', 'DO', 'Family Practice', '', '', NULL, 'O', '303 W Lake St Ste 200', 'Addison', 'Dupage', 'IL', '60101', '6308320000', '6309533302', '303 W Lake St Ste 200', 'Addison', 'Dupage', 'IL', '60101', '6308320000', '6309533302', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1699775650', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.9356, -87.9965, NULL, NULL),
('362167784', 'ELEL00009', 'ELEL00009', 'ILCHIGSTD', 'Elmhurst Memorial Professional Services', 'Ghassan', '', 'Aldurra', 'MD', 'Psychiatry', '', '', NULL, 'O', '200 Berteau Ave', 'Elmhurst', 'Dupage', 'IL', '60126', '6308331400', NULL, '200 Berteau Ave', 'Elmhurst', 'Dupage', 'IL', '60126', '6308331400', '          ', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 6, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '1699781310', 0, 'Y', 0, '2013-10-04', NULL, NULL, 41.9022, -87.9293, NULL, NULL),
('362778710', 'ELEL00452', 'ELEL00452', 'ILCHIGSTD', 'Endocrinology Associates SC', 'Terrence', 'F', 'Swade', 'MD', 'Internal Medicine', 'Endocrinology', '', NULL, 'O', '130 S Main St Ste 303', 'Lombard', 'Dupage', 'IL', '60148', '6306293610', '6306294878', '130 S Main St Ste 303', 'Lombard', 'Dupage', 'IL', '60148', '6306293610', '6306294878', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 1, 0, 0, 'Elmhurst Memorial Hospital', NULL, '', '', 'HCFA|UB|', '1699847202', 0, 'N', 0, '2014-02-25', NULL, NULL, 41.8856, -88.0184, NULL, NULL),
('362704738', 'ELEL00446', 'ELEL00446', 'ILCHIGSTD', 'Nuclear Oncology', 'Andy', 'Wei Hao', 'Su', 'MD', 'Radiation Oncology', '', '', NULL, 'O', '200 Berteau Ave', 'Elmhurst', 'Dupage', 'IL', '60126', '6307827900', '6307827910', '200 Berteau Ave', 'Elmhurst', 'Dupage', 'IL', '60126', '6307827900', '6307827910', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 6, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1699897306', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.9022, -87.9293, NULL, NULL),
('362714102', 'ELEL00497', 'ELEL00497', 'ILCHIGSTD', 'RLT Neurologic Associates', 'Lawrence', 'D', 'Wilkin', 'MD', 'Nephrology', '', '', NULL, 'O', '255 W 1st St', 'Elmhurst', 'Dupage', 'IL', '60126', '6305304449', '6305304557', '255 W 1st St', 'Elmhurst', 'Dupage', 'IL', '60126', '6305304449', '6305304557', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1710948997', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.9, -87.9468, NULL, NULL),
('362907660', 'ELEL00367', 'ELEL00367', 'ILCHIGSTD', 'Nephrology Associates of Northern Illinois', 'Leonard', '', 'Potempa', 'MD', 'Nephrology', '', '', NULL, 'O', '5201 S Willow Springs Rd Ste 260', 'LaGrange', 'Cook', 'IL', '60525', '7083541306', '7083541538', '5201 S Willow Springs Rd Ste 260', 'LaGrange', 'Cook', 'IL', '60525', '7083541306', '7083541538', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, '', '', 'HCFA|UB|', '1710984646', 0, 'N', 0, '2014-04-25', NULL, NULL, 41.7974, -87.8884, NULL, NULL),
('263341995', 'ELEL00201', 'ELEL00201', 'ILCHIGSTD', 'Illinois Dermatology Institute', 'John', 'B', 'Kalis', 'MD', 'Dermatology', '', '', NULL, 'O', '120 Oakbrook Ctr Ste 410', 'Oak Brook', 'Dupage', 'IL', '60523', '6305745860', '6305745866', '120 Oakbrook Ctr Ste 410', 'Oak Brook', 'Dupage', 'IL', '60523', '6305745860', '6305745866', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '1720061526', 0, 'N', 0, '2014-04-25', NULL, NULL, 41.8477, -87.9519, NULL, NULL),
('363470152', 'ELEL00441', 'ELEL00441', 'ILCHIGSTD', 'Rajammal Srinivasan MD', 'Rajammal', '', 'Srinivasan', 'MD', 'Internal Medicine', '', '', NULL, 'O', '707 N York Rd Ste 101', 'Elmhurst', 'Dupage', 'IL', '60126', '6308322810', '6308322876', '707 N York Rd Ste 101', 'Elmhurst', 'Dupage', 'IL', '60126', '6308322810', '6308322876', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, '', NULL, 'HCFA|UB|', '1730126012', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.9197, -87.9398, NULL, NULL),
('363163610', 'ELEL00482', 'ELEL00482', 'ILCHIGSTD', 'M and M Orthopaedics', 'Ellen', '', 'Voronov', 'MD', 'Physical Medicine and Rehabilitation', '', '', NULL, 'O', '1259 Rickert Dr Ste 101', 'Naperville', 'Dupage', 'IL', '60515', '6303551300', '6303553727', '1259 Rickert Dr Ste 101', 'Naperville', 'Dupage', 'IL', '60515', '6303551300', '6303553727', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', '2013-06-30', 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '1730170523', 0, 'N', 0, '2014-04-25', NULL, NULL, 0, 0, NULL, NULL),
('363163610', 'ELEL00481', 'ELEL00481', 'ILCHIGSTD', 'M and M Orthopaedics', 'Ellen', '', 'Voronov', 'MD', 'Physical Medicine and Rehabilitation', '', '', NULL, 'O', '133 E Brush Hill Rd Ste 100', 'Elmhurst', 'Dupage', 'IL', '60126', '6309681881', '6305010646', '133 E Brush Hill Rd Ste 100', 'Elmhurst', 'Dupage', 'IL', '60126', '6309681881', '6305010646', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', '2013-06-30', 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '1730170523', 0, 'N', 0, '2014-04-25', NULL, NULL, 41.8628, -87.9376, NULL, NULL),
('363966745', 'ELEL00010', 'ELEL00010', 'ILCHIGSTD', 'Metro Infectious Disease Consultants', 'James', 'E', 'Allen', 'MD', 'Infectious Disease', '', '', NULL, 'O', '901 McClintock Dr Ste 202', 'Burr Ridge', 'Dupage', 'IL', '60527', '6306544201', '6306541865', '901 McClintock Dr Ste 202', 'Burr Ridge', 'Dupage', 'IL', '60527', '6306544201', '6306541865', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 6, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1730175290', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.7543, -87.9095, NULL, NULL),
('364037473', 'ELEL00518', 'ELEL00518', 'ILCHIGSTD', 'Elmhurst Clinic', 'Fuad', '', 'Ziai', 'MD', 'Pediatric Endocrinology', '', '', NULL, 'O', '1200 S York Rd Ste 2000', 'Elmhurst', 'Dupage', 'IL', '60126', '6309414710', '6307588481', '1200 S York Rd Ste 2000', 'Elmhurst', 'Dupage', 'IL', '60126', '6309414710', '6307588481', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1730250424', 0, 'Y', 0, '2013-07-25', NULL, NULL, 41.865, -87.9322, NULL, NULL),
('364037473', 'ELEL00432', 'ELEL00432', 'ILCHIGSTD', 'Elmhurst Clinic', 'Vineet', '', 'Singla', 'DO', 'Family Practice', '', '', NULL, 'O', '172 Schiller', 'Elmhurst', 'Dupage', 'IL', '60126', '6308320000', '6307589720', '172 Schiller', 'Elmhurst', 'Dupage', 'IL', '60126', '6308320000', '6307589720', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1740228840', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.9011, -87.9371, NULL, NULL),
('364037473', 'ELEL00431', 'ELEL00431', 'ILCHIGSTD', 'Elmhurst Clinic', 'Vineet', '', 'Singla', 'DO', 'Family Practice', '', '', NULL, 'O', '303 W Lake St Ste 200', 'Addison', 'Dupage', 'IL', '60101', '3312219002', NULL, '303 W Lake St Ste 200', 'Addison', 'Dupage', 'IL', '60101', '3312219002', '', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1740228840', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.9356, -87.9965, NULL, NULL),
('364037473', 'ELEL00338', 'ELEL00338', 'ILCHIGSTD', 'Elmhurst Clinic', 'John', 'D', 'Ortega', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '1100 Lake St Ste 230', 'Oak Park', 'Cook', 'IL', '60301', '7085241420', '7085241509', '1100 Lake St Ste 230', 'Oak Park', 'Cook', 'IL', '60301', '7085241420', '7085241509', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1740231810', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.8886, -87.8026, NULL, NULL),
('364037473', 'ELEL00337', 'ELEL00337', 'ILCHIGSTD', 'Elmhurst Clinic', 'John', 'D', 'Ortega', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '1200 S York Rd Ste 4180', 'Elmhurst', 'Dupage', 'IL', '60126', '6309412603', '3312213998', '1200 S York Rd Ste 4180', 'Elmhurst', 'Dupage', 'IL', '60126', '6309412603', '3312213998', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1740231810', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.865, -87.9322, NULL, NULL),
('364037473', 'ELEL00444', 'ELEL00444', 'ILCHIGSTD', 'Elmhurst Clinic', 'George', '', 'Stathopoulos', 'MD', 'Gastroenterology', '', '', NULL, 'O', '133 E Brush Hill Rd Ste 310', 'Elmhurst', 'Dupage', 'IL', '60126', '6309412608', '6309412642', '133 E Brush Hill Rd Ste 310', 'Elmhurst', 'Dupage', 'IL', '60126', '6309412608', '6309412642', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1740231828', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.8616, -87.9371, NULL, NULL),
('364030005', 'ELEL00426', 'ELEL00426', 'ILCHIGSTD', 'Consultants in Cardiovascular Medicine', 'Jeffrey', 'G', 'Shanes', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '130 S Main St', 'Lombard', 'Dupage', 'IL', '60148', '7084505094', '7083440508', '130 S Main St', 'Lombard', 'Dupage', 'IL', '60148', '7084505094', '7083440508', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, '', NULL, 'HCFA|UB|', '1740236835', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.8856, -88.0184, NULL, NULL),
('364030005', 'ELEL00427', 'ELEL00427', 'ILCHIGSTD', 'Consultants in Cardiovascular Medicine', 'Jeffrey', 'G', 'Shanes', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '675 W North Ave', 'Melrose Park', 'Cook', 'IL', '60160', '7088381448', '7083440508', '675 W North Ave', 'Melrose Park', 'Cook', 'IL', '60160', '7088381448', '7083440508', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, '', NULL, 'HCFA|UB|', '1740236835', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.9083, -87.8421, NULL, NULL),
('362716924', 'ELEL00436', 'ELEL00436', 'ILCHIGSTD', 'RPW Obstetrics and Gynecology', 'Brian', 'D', 'Sklar', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '2434 S Wolf Rd', 'Westchester', 'Cook', 'IL', '60154', '6308324210', '6308328110', '2434 S Wolf Rd', 'Westchester', 'Cook', 'IL', '60154', '6308324210', '6308328110', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1740270024', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.844, -87.9012, NULL, NULL),
('362716924', 'ELEL00435', 'ELEL00435', 'ILCHIGSTD', 'RPW Obstetrics and Gynecology', 'Brian', 'D', 'Sklar', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '360 W Butterfield Rd Ste 250', 'Elmhurst', 'Dupage', 'IL', '60126', '6308324210', '6308328110', '360 W Butterfield Rd Ste 250', 'Elmhurst', 'Dupage', 'IL', '60126', '6308324210', '6308328110', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1740270024', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.8648, -87.9509, NULL, NULL),
('364037473', 'ELEL00393', 'ELEL00393', 'ILCHIGSTD', 'Elmhurst Clinic', 'Forrest', 'J', 'Robinson', 'DO', 'Family Practice', '', '', NULL, 'O', '1100 Lake St', 'Oak Park', 'Cook', 'IL', '60301', '7085241420', '7085241509', '1100 Lake St', 'Oak Park', 'Cook', 'IL', '60301', '7085241420', '7085241509', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1740283803', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.8886, -87.8026, NULL, NULL),
('364028323', 'ELEL00214', 'ELEL00214', 'ILCHIGSTD', 'Oak Brook Behavioral Health', 'Khadija', 'T', 'Khan', 'MD', 'Psychiatry', '', '', NULL, 'O', '18W100 22nd St Ste 130', 'Oakbrook Terrace', 'Dupage', 'IL', '60181', '6304249204', '6304249208', '18W100 22nd St Ste 130', 'Oakbrook Terrace', 'Dupage', 'IL', '60181', '6304249204', '6304249208', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1740387547', 0, 'Y', 0, '2013-07-25', NULL, NULL, 41.8461, -87.9795, NULL, NULL),
('364037473', 'ELEL00096', 'ELEL00096', 'ILCHIGSTD', 'Elmhurst Clinic', 'John', 'A', 'Damergis', 'MD', 'Internal Medicine', '', '', NULL, 'O', '172 Schiller', 'Elmhurst', 'Dupage', 'IL', '60126', '6309412600', '6307588480', '172 Schiller', 'Elmhurst', 'Dupage', 'IL', '60126', '6309412600', '6307588480', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1750332896', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.9011, -87.9371, NULL, NULL),
('364037473', 'ELEL00412', 'ELEL00412', 'ILCHIGSTD', 'Elmhurst Clinic', 'Mary', '', 'Saracco', 'CNM', 'Certified Nurse Midwife', '', '', NULL, 'O', '1100 Lake St', 'Oak Park', 'Cook', 'IL', '60301', '3312219300', '3312213940', '1100 Lake St', 'Oak Park', 'Cook', 'IL', '60301', '3312219300', '3312213940', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '1750416467', 0, 'N', 0, '2014-06-10', NULL, NULL, 41.8886, -87.8026, NULL, NULL),
('364037473', 'ELEL00411', 'ELEL00411', 'ILCHIGSTD', 'Elmhurst Clinic', 'Mary', '', 'Saracco', 'CNM', 'Certified Nurse Midwife', '', '', NULL, 'O', '1200 S York Rd Ste 4120', 'Elmhurst', 'Dupage', 'IL', '60126', '3312219004', '3312213998', '1200 S York Rd Ste 4120', 'Elmhurst', 'Dupage', 'IL', '60126', '3312219004', '3312213998', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '1750416467', 0, 'N', 0, '2014-06-10', NULL, NULL, 41.865, -87.9322, NULL, NULL),
('364028323', 'ELEL00196', 'ELEL00196', 'ILCHIGSTD', 'Oakbrook Behavioral Health', 'Farozan', '', 'Islam', 'DO', 'Psychiatry', '', '', NULL, 'O', '18W100 22nd St Ste 132', 'Oakbrook Terrace', 'Dupage', 'IL', '60181', '6304240652', '6304244783', '18W100 22nd St Ste 132', 'Oakbrook Terrace', 'Dupage', 'IL', '60181', '6304240652', '6304244783', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1750426540', 0, 'Y', 0, '2013-07-25', NULL, NULL, 41.8461, -87.9795, NULL, NULL),
('363254389', 'ELEL00506', 'ELEL00506', 'ILCHIGSTD', 'Advanced Oral and Maxillofacial Surgery', 'Robert', '', 'Wolf', 'DDS', 'Oral/Maxillofacial Surgery', '', '', NULL, 'O', '533 W North Ave Ste 200', 'Elmhurst', 'Dupage', 'IL', '60126', '6309413400', '6309413421', '533 W North Ave Ste 200', 'Elmhurst', 'Dupage', 'IL', '60126', '6309413400', '6309413421', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1750432001', 0, 'Y', 0, '2013-07-25', NULL, NULL, 41.9059, -87.9599, NULL, NULL),
('202042779', 'ELEL00341', 'ELEL00341', 'ILCHIGSTD', 'Suburban Retina', 'Daniel', 'Philip', 'Owens', 'MD', 'Ophthalmology', '', '', NULL, 'O', '130 S Main St Ste 206', 'Lombard', 'Dupage', 'IL', '60148', '6304249877', '6304249878', '130 S Main St Ste 206', 'Lombard', 'Dupage', 'IL', '60148', '6304249877', '6304249878', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1750544250', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.8856, -88.0184, NULL, NULL),
('202042779', 'ELEL00342', 'ELEL00342', 'ILCHIGSTD', 'Suburban Retina', 'Daniel', 'Philip', 'Owens', 'MD', 'Ophthalmology', '', '', NULL, 'O', '715 Lake St', 'Oak Park', 'Cook', 'IL', '60301', '7083580701', '7083580702', '715 Lake St', 'Oak Park', 'Cook', 'IL', '60301', '7083580701', '7083580702', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1750544250', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.8886, -87.793, NULL, NULL),
('364037473', 'ELEL00040', 'ELEL00040', 'ILCHIGSTD', 'Elmhurst Clinic', 'Christopher', 'A', 'Boutin', 'MD', 'Gastroenterology', '', '', NULL, 'O', '133 E Brush Hill Rd Ste 310', 'Elmhurst', 'Dupage', 'IL', '60126', '6309412608', '6309412642', '133 E Brush Hill Rd Ste 310', 'Elmhurst', 'Dupage', 'IL', '60126', '6309412608', '6309412642', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1760440259', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.8616, -87.9371, NULL, NULL),
('364037473', 'ELEL00039', 'ELEL00039', 'ILCHIGSTD', 'Elmhurst Clinic', 'Christopher', 'A', 'Boutin', 'MD', 'Gastroenterology', '', '', NULL, 'O', '303 W Lake St Ste 200', 'Addison', 'Dupage', 'IL', '60101', '3312219002', '3312213973', '303 W Lake St Ste 200', 'Addison', 'Dupage', 'IL', '60101', '3312219002', '3312213973', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1760440259', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.9356, -87.9965, NULL, NULL),
('363878197', 'ELEL00507', 'ELEL00507', 'ILCHIGSTD', 'Rita Yadava MD', 'Rita', '', 'Yadava', 'MD', 'Pediatric Neurology', '', '', NULL, 'O', '1200 S York Rd Ste 4150', 'Elmhurst', 'Dupage', 'IL', '60126', '6305305577', '6305304477', '1200 S York Rd Ste 4150', 'Elmhurst', 'Dupage', 'IL', '60126', '6305305577', '6305304477', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1760461867', 0, 'Y', 0, '2013-07-25', NULL, NULL, 41.865, -87.9322, NULL, NULL),
('362120183', 'ELEL00383', 'ELEL00383', 'ILCHIGSTD', 'Villa Medical Arts', 'Abdul', '', 'Razzaq', 'MD', 'Internal Medicine', '', '', NULL, 'O', '10 E Central Blvd', 'Villa Park', 'Dupage', 'IL', '60181', '6308329000', '6308329049', '10 E Central Blvd', 'Villa Park', 'Dupage', 'IL', '60181', '6308329000', '6308329049', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1760470314', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.8839, -87.9787, NULL, NULL),
('364037473', 'ELEL00130', 'ELEL00130', 'ILCHIGSTD', 'Elmhurst Memorial Hematology Oncology Associates', 'Marilyn', 'L', 'Evrard', 'MD', 'Oncology', '', '', NULL, 'O', '2560 Foxfield Dr Ste 180', 'St Charles', 'Kane', 'IL', '60174', '3312211890', '3312211899', '2560 Foxfield Dr Ste 180', 'St Charles', 'Kane', 'IL', '60174', '3312211890', '3312211899', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1760471031', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.9247, -88.2788, NULL, NULL),
('362657245', 'ELEL00249', 'ELEL00249', 'ILCHIGSTD', 'Ad Park Pediatric Associates', 'Rachel', 'K', 'Levin', 'MD', 'Pediatrics', '', '', NULL, 'O', '1640 W Lake St Ste 200', 'Addison', 'Dupage', 'IL', '60101', '6305433020', '6305431551', '1640 W Lake St Ste 200', 'Addison', 'Dupage', 'IL', '60101', '6305433020', '6305431551', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1760542146', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.9488, -88.0276, NULL, NULL),
('364037473', 'ELEL00121', 'ELEL00121', 'ILCHIGSTD', 'Elmhurst Clinic', 'Salil', 'V', 'Doshi', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '1200 S York Rd Ste 4180', 'Elmhurst', 'Dupage', 'IL', '60126', '6309412603', '6307588574', '1200 S York Rd Ste 4180', 'Elmhurst', 'Dupage', 'IL', '60126', '6309412603', '6307588574', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1760591903', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.865, -87.9322, NULL, NULL),
('263341995', 'ELEL00157', 'ELEL00157', 'ILCHIGSTD', 'Illinois Dermatology Institute', 'Steven', '', 'Goulder', 'MD', 'Dermatology', '', '', NULL, 'O', '120 Oakbrook Ctr Ste 410', 'Oak Brook', 'Dupage', 'IL', '60523', '6305745860', NULL, '120 Oakbrook Ctr Ste 410', 'Oak Brook', 'Dupage', 'IL', '60523', '6305745860', '', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', '2014-03-24', 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '1770560831', 0, 'N', 0, '2014-04-25', NULL, NULL, 41.8477, -87.9519, NULL, NULL),
('263341995', 'ELEL00156', 'ELEL00156', 'ILCHIGSTD', 'Illinois Dermatology Institute', 'Steven', '', 'Goulder', 'MD', 'Dermatology', '', '', NULL, 'O', '500 E Ogden Ave Ste 200', 'Hinsdale', 'Dupage', 'IL', '60521', '6303256647', '6303254500', '500 E Ogden Ave Ste 200', 'Hinsdale', 'Dupage', 'IL', '60521', '6303256647', '6303254500', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '1770560831', 0, 'N', 0, '2014-04-25', NULL, NULL, 41.8179, -87.9183, NULL, NULL),
('010645296', 'ELEL00134', 'ELEL00134', 'ILCHIGSTD', 'Finegold Primary Care', 'Richard', 'D', 'Finegold', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1555 N Barrington Rd Ste 601', 'Hoffman Estates', 'Cook', 'IL', '60194', '8477816000', '8478437793', '1555 N Barrington Rd Ste 601', 'Hoffman Estates', 'Cook', 'IL', '60194', '8477816000', '8478437793', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', '2013-04-15', 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '1770564122', 0, 'N', 0, '2014-04-25', NULL, NULL, 0, 0, NULL, NULL),
('010645296', 'ELEL00135', 'ELEL00135', 'ILCHIGSTD', 'Finegold Primary Care', 'Richard', 'D', 'Finegold', 'MD', 'Internal Medicine', '', '', NULL, 'O', '6645 W North Ave', 'Oak Park', 'Cook', 'IL', '60302', '7084525809', '7083835153', '6645 W North Ave', 'Oak Park', 'Cook', 'IL', '60302', '7084525809', '7083835153', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '1770564122', 0, 'N', 0, '2014-04-25', NULL, NULL, 41.909, -87.7924, NULL, NULL),
('611486620', 'ELEL00129', 'ELEL00129', 'ILCHIGSTD', 'Elmhurst Dermatology', 'Ana', 'M', 'Eng', 'MD', 'Dermatology', '', '', NULL, 'O', '103 N Haven Rd Ste 7', 'Elmhurst', 'Dupage', 'IL', '60126', '6308322111', '6308325199', '103 N Haven Rd Ste 7', 'Elmhurst', 'Dupage', 'IL', '60126', '6308322111', '6308325199', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1770578114', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.8994, -87.9364, NULL, NULL),
('362907660', 'ELEL00069', 'ELEL00069', 'ILCHIGSTD', 'Nephrology Associates of Northern Illinois', 'May', 'T', 'Chow', 'MD', 'Nephrology', '', '', NULL, 'O', '3825 Highland Ave Ste 4C', 'Downers Grove', 'Dupage', 'IL', '60515', '6309681595', '6309681590', '3825 Highland Ave Ste 4C', 'Downers Grove', 'Dupage', 'IL', '60515', '6309681595', '6309681590', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, '', '', 'HCFA|UB|', '1770580870', 0, 'N', 0, '2014-04-25', NULL, NULL, 41.8181, -88.0102, NULL, NULL),
('362907660', 'ELEL00070', 'ELEL00070', 'ILCHIGSTD', 'Nephrology Associates of Northern Illinois', 'May', 'T', 'Chow', 'MD', 'Nephrology', '', '', NULL, 'O', '5201 S Willow Springs Rd Ste 260', 'LaGrange', 'Cook', 'IL', '60525', '7083541306', '7083541538', '5201 S Willow Springs Rd Ste 260', 'LaGrange', 'Cook', 'IL', '60525', '7083541306', '7083541538', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, '', '', 'HCFA|UB|', '1770580870', 0, 'N', 0, '2014-04-25', NULL, NULL, 41.7974, -87.8884, NULL, NULL),
('362931577', 'ELEL00172', 'ELEL00172', 'ILCHIGSTD', 'CMBY Clinic', 'Charles', 'John', 'Hamby', 'MD', 'Internal Medicine', '', '', NULL, 'O', '135 S Cottage Hill Ave', 'Elmhurst', 'Dupage', 'IL', '60126', '6308326633', '6308326653', '135 S Cottage Hill Ave', 'Elmhurst', 'Dupage', 'IL', '60126', '6308326633', '6308326653', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1780672147', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.8981, -87.9424, NULL, NULL),
('364037473', 'ELEL00308', 'ELEL00308', 'ILCHIGSTD', 'Elmhurst Clinic', 'Shirley', '', 'Moore', 'CNM', 'Certified Nurse Midwife', '', '', NULL, 'O', '1200 S York Rd Ste 4120', 'Elmhurst', 'Dupage', 'IL', '60126', '3312219004', '3312213998', '1200 S York Rd Ste 4120', 'Elmhurst', 'Dupage', 'IL', '60126', '3312219004', '3312213998', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '1780719104', 0, 'N', 0, '2014-06-10', NULL, NULL, 41.865, -87.9322, NULL, NULL),
('364037473', 'ELEL00307', 'ELEL00307', 'ILCHIGSTD', 'Elmhurst Clinic', 'Shirley', '', 'Moore', 'CNM', 'Certified Nurse Midwife', '', '', NULL, 'O', '303 W Lake St Ste 200', 'Addison', 'Dupage', 'IL', '60101', '3312219002', '3312213973', '303 W Lake St Ste 200', 'Addison', 'Dupage', 'IL', '60101', '3312219002', '3312213973', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '1780719104', 0, 'Y', 0, '2014-06-10', NULL, NULL, 41.9356, -87.9965, NULL, NULL),
('200341553', 'ELEL00208', 'ELEL00208', 'ILCHIGSTD', 'Khalil Y Karim MD', 'Khalil', 'Y', 'Karim', 'MD', 'Family Practice', '', '', NULL, 'O', '1111 W Superior St Ste 402', 'Melrose Park', 'Cook', 'IL', '60160', '7084507788', '7084509464', '1111 W Superior St Ste 402', 'Melrose Park', 'Cook', 'IL', '60160', '7084507788', '7084509464', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '1780760124', 0, 'N', 0, '2014-04-25', NULL, NULL, 41.8925, -87.8471, NULL, NULL),
('363729867', 'ELEL00390', 'ELEL00390', 'ILCHIGSTD', 'Retina Associates', 'Kenneth', 'I', 'Resnick', 'MD', 'Ophthalmology', '', '', NULL, 'O', '2425 W 22nd St Ste 207', 'Oak Brook', 'Dupage', 'IL', '60523', '6305711501', '6305715679', '2425 W 22nd St Ste 207', 'Oak Brook', 'Dupage', 'IL', '60523', '6305711501', '6305715679', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1790724045', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.846, -87.9782, NULL, NULL),
('363729867', 'ELEL00389', 'ELEL00389', 'ILCHIGSTD', 'Retina Associates', 'Kenneth', 'I', 'Resnick', 'MD', 'Ophthalmology', '', '', NULL, 'O', '2555 W Lincoln Hwy Ste 205', 'Olympia Fields', 'Cook', 'IL', '60461', '7085034176', '7085034118', '2555 W Lincoln Hwy Ste 205', 'Olympia Fields', 'Cook', 'IL', '60461', '7085034176', '7085034118', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1790724045', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.5063, -87.6782, NULL, NULL),
('362704738', 'ELEL00496', 'ELEL00496', 'ILCHIGSTD', 'Nuclear Oncology', 'James', 'S', 'Welsh', 'MD', 'Radiation Oncology', '', '', NULL, 'O', '200 Berteau Ave', 'Elmhurst', 'Dupage', 'IL', '60126', '6307827900', '6307827910', '200 Berteau Ave', 'Elmhurst', 'Dupage', 'IL', '60126', '6307827900', '6307827910', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 6, '2013-04-01', '2013-12-31', 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1790748317', 0, 'N', 0, '2014-02-25', NULL, NULL, 41.9022, -87.9293, NULL, NULL),
('362704738', 'ELEL00033', 'ELEL00033', 'ILCHIGSTD', 'Nuclear Oncology', 'Dhananjay', 'D', 'Bendre', 'MD', 'Radiation Oncology', '', '', NULL, 'O', '200 Berteau Ave', 'Elmhurst', 'Dupage', 'IL', '60126', '6307827900', '6307827910', '200 Berteau Ave', 'Elmhurst', 'Dupage', 'IL', '60126', '6307827900', '6307827910', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 6, '2013-04-01', '2013-08-23', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1790786846', 0, 'N', 0, '2013-09-30', NULL, NULL, 41.9023, -87.9304, NULL, NULL),
('527816647', 'ELEL00330', 'ELEL00330', 'ILCHIGSTD', 'Arun Ohri MD', 'Arun', '', 'Ohri', 'MD', 'Gastroenterology', '', '', NULL, 'O', '1200 S York Rd Ste 4250', 'Elmhurst', 'Dupage', 'IL', '60126', '6305307882', '6305304477', '1200 S York Rd Ste 4250', 'Elmhurst', 'Dupage', 'IL', '60126', '6305307882', '6305304477', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', '2014-02-04', 0, 0, 0, 'Presence Resurrection Medical Center', '', '', '', 'HCFA|UB|', '1790787331', 0, 'N', 0, '2014-07-22', NULL, NULL, 41.865, -87.9323, NULL, NULL),
('527816647', 'ELEL00331', 'ELEL00331', 'ILCHIGSTD', 'Arun Ohri MD and Paul V Fahrenbach MD', 'Arun', '', 'Ohri', 'MD', 'Gastroenterology', '', '', NULL, 'O', '7447 W Talcott Ave Bldg C Ste 209', 'Chicago', 'Cook', 'IL', '60631', '7736312728', '7736318083', '7447 W Talcott Ave Bldg C Ste 209', 'Chicago', 'Cook', 'IL', '60631', '7736312728', '7736318083', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', '2014-07-21', 0, 0, 0, 'Presence Resurrection Medical Center', '', '', '', 'HCFA|UB|', '1790787331', 0, 'N', 0, '2014-07-22', NULL, NULL, 41.9887, -87.8131, NULL, NULL),
('364390340', 'ELEL00475', 'ELEL00475', 'ILCHIGSTD', 'Chicago Pediatric Care Inc', 'Sara', '', 'Verghese', 'MD', 'Pediatrics', '', '', NULL, 'O', '1725 W Harrison Ste 940', 'Chicago', 'Cook', 'IL', '60612', '3125633438', '7083434632', '1725 W Harrison Ste 940', 'Chicago', 'Cook', 'IL', '60612', '3125633438', '7083434632', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, '', NULL, 'HCFA|UB|', '1790841732', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.8741, -87.6698, NULL, NULL),
('364390340', 'ELEL00474', 'ELEL00474', 'ILCHIGSTD', 'Chicago Pediatric Care Inc', 'Sara', '', 'Verghese', 'MD', 'Pediatrics', '', '', NULL, 'O', '9902 W Roosevelt Rd', 'Westchester', 'Cook', 'IL', '60154', '7083434620', '7083434632', '9902 W Roosevelt Rd', 'Westchester', 'Cook', 'IL', '60154', '7083434620', '7083434632', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, '', NULL, 'HCFA|UB|', '1790841732', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.8636, -87.8715, NULL, NULL),
('363729867', 'ELEL00495', 'ELEL00495', 'ILCHIGSTD', 'Retina Associates', 'Aaron', 'B', 'Weinberg', 'MD', 'Ophthalmology', '', '', NULL, 'O', '2425 W 22nd St Ste 207', 'Oak Brook', 'Dupage', 'IL', '60523', '6305711501', '6305715679', '2425 W 22nd St Ste 207', 'Oak Brook', 'Dupage', 'IL', '60523', '6305711501', '6305715679', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1801834676', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.846, -87.9782, NULL, NULL),
('363729867', 'ELEL00494', 'ELEL00494', 'ILCHIGSTD', 'Retina Associates', 'Aaron', 'B', 'Weinberg', 'MD', 'Ophthalmology', '', '', NULL, 'O', '715 W Lake St Ste 120', 'Oak Park', 'Cook', 'IL', '60301', '7083865448', '7083865449', '715 W Lake St Ste 120', 'Oak Park', 'Cook', 'IL', '60301', '7083865448', '7083865449', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1801834676', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.8886, -87.793, NULL, NULL),
('363134359', 'ELEL00456', 'ELEL00456', 'ILCHIGSTD', 'Srikrishna Talluri MD', 'Srikrishna', 'M', 'Talluri', 'MD', 'Urology', '', '', NULL, 'O', '2200 W Higgins Ste 245', 'Hoffman Estates', 'Cook', 'IL', '60195', '6303230024', '6303236670', '2200 W Higgins Ste 245', 'Hoffman Estates', 'Cook', 'IL', '60195', '6303230024', '6303236670', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, '', '', 'HCFA|UB|', '1801849807', 0, 'N', 0, '2014-04-25', NULL, NULL, 42.0562, -88.1347, NULL, NULL),
('363134359', 'ELEL00457', 'ELEL00457', 'ILCHIGSTD', 'Srikrishna Talluri MD', 'Srikrishna', 'M', 'Talluri', 'MD', 'Urology', '', '', NULL, 'O', '3825 Highland Ave Ste 205 Tower 2', 'Downers Grove', 'Dupage', 'IL', '60515', '6303230024', '6303236670', '3825 Highland Ave Ste 205 Tower 2', 'Downers Grove', 'Dupage', 'IL', '60515', '6303230024', '6303236670', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, '', '', 'HCFA|UB|', '1801849807', 0, 'N', 0, '2014-04-25', NULL, NULL, 41.8181, -88.0102, NULL, NULL),
('364390963', 'ELEL00215', 'ELEL00215', 'ILCHIGSTD', 'Comprehensive Clinical Services', 'Samina', '', 'Khattak', 'MD', 'Psychiatry', '', '', NULL, 'O', '2340 S Highland Ave Ste 300', 'Lombard', 'Dupage', 'IL', '60148', '6302611210', '6302611211', '2340 S Highland Ave Ste 300', 'Lombard', 'Dupage', 'IL', '60148', '6302611210', '6302611211', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1801888037', 0, 'Y', 0, '2013-07-25', NULL, NULL, 41.8429, -88.0115, NULL, NULL),
('263732449', 'ELEL00169', 'ELEL00169', 'ILCHIGSTD', 'SHIFA Senior Health Initiative for Aging Well', 'Afshan', '', 'Hafiz Ahmed', 'MD', 'Family Practice', '', '', NULL, 'O', '142 E Lake St Ste C', 'Bloomingdale', 'Dupage', 'IL', '60108', '6303510775', '6303078021', '142 E Lake St Ste C', 'Bloomingdale', 'Dupage', 'IL', '60108', '6303510775', '6303078021', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '1801956768', 0, 'N', 0, '2014-04-25', NULL, NULL, 41.9577, -88.0768, NULL, NULL),
('263732449', 'ELEL00170', 'ELEL00170', 'ILCHIGSTD', 'SHIFA Senior Health Initiative for Aging Well', 'Afshan', '', 'Hafiz Ahmed', 'MD', 'Family Practice', '', '', NULL, 'O', '3800 S Highland Ave Ste 111', 'Downers Grove', 'Dupage', 'IL', '60515', '6303510775', '6303078021', '3800 S Highland Ave Ste 111', 'Downers Grove', 'Dupage', 'IL', '60515', '6303510775', '6303078021', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '1801956768', 0, 'N', 0, '2014-04-25', NULL, NULL, 41.8202, -88.0104, NULL, NULL),
('363270909', 'ELEL00223', 'ELEL00223', 'ILCHIGSTD', 'Ko Surgical Associates', 'Sung Tao', '', 'Ko', 'MD', 'General Surgery', '', '', NULL, 'O', '386 N York Rd Ste 201', 'Elmhurst', 'Dupage', 'IL', '60126', '6308330386', '6308330092', '386 N York Rd Ste 201', 'Elmhurst', 'Dupage', 'IL', '60126', '6308330386', '6308330092', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1811096936', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.9096, -87.9398, NULL, NULL),
('364037473', 'ELEL00038', 'ELEL00038', 'ILCHIGSTD', 'Elmhurst Clinic', 'Tanja', 'S', 'Boskov', 'MD', 'Family Practice', '', '', NULL, 'O', '172 Schiller', 'Elmhurst', 'Dupage', 'IL', '60126', '6308320000', '6309939685', '172 Schiller', 'Elmhurst', 'Dupage', 'IL', '60126', '6308320000', '6309939685', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1811943632', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.9011, -87.9371, NULL, NULL),
('364037473', 'ELEL00037', 'ELEL00037', 'ILCHIGSTD', 'Elmhurst Clinic', 'Tanja', 'S', 'Boskov', 'MD', 'Family Practice', '', '', NULL, 'O', '303 W Lake St Ste 200', 'Addison', 'Dupage', 'IL', '60101', '3312219002', NULL, '303 W Lake St Ste 200', 'Addison', 'Dupage', 'IL', '60101', '3312219002', '', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1811943632', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.9356, -87.9965, NULL, NULL),
('364037473', 'ELEL00517', 'ELEL00517', 'ILCHIGSTD', 'Elmhurst Clinic', 'Kirsten', 'E', 'Zeitler', 'MD', 'Pediatrics', '', '', NULL, 'O', '1200 S York Rd Ste 2000', 'Elmhurst', 'Dupage', 'IL', '60126', '6309414710', '6307588481', '1200 S York Rd Ste 2000', 'Elmhurst', 'Dupage', 'IL', '60126', '6309414710', '6307588481', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1811947930', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.865, -87.9322, NULL, NULL),
('364037473', 'ELEL00516', 'ELEL00516', 'ILCHIGSTD', 'Elmhurst Clinic', 'Kirsten', 'E', 'Zeitler', 'MD', 'Pediatrics', '', '', NULL, 'O', '471 W Army Trail Ste 103', 'Bloomingdale', 'Dupage', 'IL', '60108', '6306718020', '6306916721', '471 W Army Trail Ste 103', 'Bloomingdale', 'Dupage', 'IL', '60108', '6306718020', '6306916721', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1811947930', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.9396, -88.1216, NULL, NULL),
('260191270', 'ELEL00292', 'ELEL00292', 'ILCHIGSTD', 'McCarthy Eye Center', 'James', 'L', 'McCarthy', 'MD', 'Ophthalmology', '', '', NULL, 'O', '1200 S York Rd Ste 3290', 'Elmhurst', 'Dupage', 'IL', '60126', '6302792030', '7088482070', '1200 S York Rd Ste 3290', 'Elmhurst', 'Dupage', 'IL', '60126', '6302792030', '7088482070', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '1811975410', 0, 'N', 0, '2014-06-13', NULL, NULL, 41.865, -87.9322, NULL, NULL),
('260191270', 'ELEL00294', 'ELEL00294', 'ILCHIGSTD', 'McCarthy Eye Center', 'James', 'L', 'McCarthy', 'MD', 'Ophthalmology', '', '', NULL, 'O', '7055 W North Ave', 'Oak Park', 'Cook', 'IL', '60302', '7088482030', '7088482070', '7055 W North Ave', 'Oak Park', 'Cook', 'IL', '60302', '7088482030', '7088482070', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '1811975410', 0, 'N', 0, '2014-06-13', NULL, NULL, 41.9089, -87.8036, NULL, NULL),
('364037473', 'ELEL00492', 'ELEL00492', 'ILCHIGSTD', 'Elmhurst Memorial Primary Care Associates', 'Thomas', '', 'Webb', 'MD', 'Internal Medicine', '', '', NULL, 'O', '303 W Lake St Ste 301', 'Addison', 'Dupage', 'IL', '60101', '3312214300', '3312214037', '303 W Lake St Ste 301', 'Addison', 'Dupage', 'IL', '60101', '3312214300', '3312214037', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '1811984222', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.9356, -87.9965, NULL, NULL),
('030459693', 'ELEL00074', 'ELEL00074', 'ILCHIGSTD', 'Westchester Integrated Health Care', 'Yolanda', 'RY', 'Co', 'MD', 'Internal Medicine', '', '', NULL, 'O', '10001 W Roosevelt Rd Ste 201', 'Westchester', 'Cook', 'IL', '60154', '7083432657', '7083432793', '10001 W Roosevelt Rd Ste 201', 'Westchester', 'Cook', 'IL', '60154', '7083432657', '7083432793', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1811985054', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.8635, -87.8727, NULL, NULL),
('364348888', 'ELEL00016', 'ELEL00016', 'ILCHIGSTD', 'Arenson Podiatric Services', 'Donald', 'Jay', 'Arenson', 'DPM', 'Podiatry', '', '', NULL, 'O', '1200 S York Rd Ste 3150', 'Elmhurst', 'Dupage', 'IL', '60126', '6308330365', '6308335331', '1200 S York Rd Ste 3150', 'Elmhurst', 'Dupage', 'IL', '60126', '6308330365', '6308335331', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', '2014-01-07', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1821014622', 0, 'N', 0, '2014-03-26', NULL, NULL, 41.865, -87.9322, NULL, NULL),
('364348888', 'ELEL00015', 'ELEL00015', 'ILCHIGSTD', 'Dr Donald Jay Arenson', 'Donald', 'Jay', 'Arenson', 'DPM', 'Podiatry', '', '', NULL, 'O', '800 Biesterfield Rd Ste 403', 'Elk Grove Village', 'Cook', 'IL', '60007', '6308330365', '8473649003', '800 Biesterfield Rd Ste 403', 'Elk Grove Village', 'Cook', 'IL', '60007', '6308330365', '8473649003', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', '2014-01-07', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1821014622', 0, 'N', 0, '2014-03-26', NULL, NULL, 42.0034, -88.0174, NULL, NULL),
('363374001', 'ELEL00363', 'ELEL00363', 'ILCHIGSTD', 'Midwest Pulmonary Associates', 'Jacek', 'H', 'Pieta', 'MD', 'Pulmonary', '', '', NULL, 'O', '2340 S Highland Ave Ste 230', 'Lombard', 'Dupage', 'IL', '60148', '6309322040', '6309321513', '2340 S Highland Ave Ste 230', 'Lombard', 'Dupage', 'IL', '60148', '6309322040', '6309321513', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1821056540', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.8429, -88.0115, NULL, NULL),
('363374001', 'ELEL00362', 'ELEL00362', 'ILCHIGSTD', 'Midwest Pulmonary Associates', 'Jacek', 'H', 'Pieta', 'MD', 'Pulmonary', '', '', NULL, 'O', '800 Biesterfield Rd Ste 4002', 'Elk Grove Village', 'Cook', 'IL', '60007', '8479815575', '8669321513', '800 Biesterfield Rd Ste 4002', 'Elk Grove Village', 'Cook', 'IL', '60007', '8479815575', '8669321513', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1821056540', 0, 'N', 0, '2013-07-25', NULL, NULL, 42.0034, -88.0174, NULL, NULL),
('364028323', 'ELEL00316', 'ELEL00316', 'ILCHIGSTD', 'Oak Brook Behavioral Health', 'Lavinia', '', 'Myers', 'MD', 'Pediatric Psychiatry', '', '', NULL, 'O', '18W100 22nd St Ste 132', 'Oakbrook Terrace', 'Dupage', 'IL', '60181', '6304240652', '6304244783', '18W100 22nd St Ste 132', 'Oakbrook Terrace', 'Dupage', 'IL', '60181', '6304240652', '6304244783', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1821194325', 0, 'Y', 0, '2013-07-25', NULL, NULL, 41.8461, -87.9795, NULL, NULL),
('271248611', 'ELEL00464', 'ELEL00464', 'ILCHIGSTD', 'Reproductive Medicine Institute', 'Elena', '', 'Trukhacheva', 'MD', 'Reproductive Endocrinology', '', '', NULL, 'O', '2425 W 22nd St Ste 200', 'Oak Brook', 'Dupage', 'IL', '60523', '6309540054', '6309540064', '2425 W 22nd St Ste 200', 'Oak Brook', 'Dupage', 'IL', '60523', '6309540054', '6309540064', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '1821227588', 0, 'N', 0, '2014-04-25', NULL, NULL, 41.846, -87.9782, NULL, NULL),
('352186223', 'ELEL00124', 'ELEL00124', 'ILCHIGSTD', 'Americas Family Medical Center', 'Hugo', 'E', 'Dulce', 'MD', 'Family Practice', '', '', NULL, 'O', '114 Bartlett Plaza', 'Bartlett', 'Dupage', 'IL', '60103', '6304830665', '6304830526', '114 Bartlett Plaza', 'Bartlett', 'Dupage', 'IL', '60103', '6304830665', '6304830526', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1831140797', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.9884, -88.1842, NULL, NULL),
('352186223', 'ELEL00123', 'ELEL00123', 'ILCHIGSTD', 'Americas Family Medical Center', 'Hugo', 'E', 'Dulce', 'MD', 'Family Practice', '', '', NULL, 'O', '580 E Lake St', 'Addison', 'Dupage', 'IL', '60101', '6308335838', '6308333266', '580 E Lake St', 'Addison', 'Dupage', 'IL', '60101', '6308335838', '6308333266', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1831140797', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.9275, -87.9738, 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
('362169147', 'ELEL00068', 'ELEL00068', 'ILCHIGSTD', 'Advocate Medical Group Midwest Heart Specialists', 'Steven', 'P', 'Chough', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '25 N Winfield Rd Ste 301', 'Winfield', 'Dupage', 'IL', '60190', '6305109244', '6305109557', '25 N Winfield Rd Ste 301', 'Winfield', 'Dupage', 'IL', '60190', '6305109244', '6305109557', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 8, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '1831145051', 0, 'N', 0, '2013-09-10', NULL, NULL, 41.8714, -88.1583, NULL, NULL),
('364037473', 'ELEL00067', 'ELEL00067', 'ILCHIGSTD', 'Elmhurst Clinic', 'Steven', 'P', 'Chough', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '3312211174', '3312213782', '155 E Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '3312211174', '3312213782', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '1831145051', 0, 'N', 0, '2013-09-10', NULL, NULL, 41.8616, -87.936, NULL, NULL),
('363019131', 'ELEL00254', 'ELEL00254', 'ILCHIGSTD', 'Mali Lin MD and Associates', 'Mali', '', 'Lin', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '386 N York Rd Ste 201', 'Elmhurst', 'Dupage', 'IL', '60126', '6308326711', '6308326855', '386 N York Rd Ste 201', 'Elmhurst', 'Dupage', 'IL', '60126', '6308326711', '6308326855', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1831297548', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.9096, -87.9398, NULL, NULL),
('364037473', 'ELEL00277', 'ELEL00277', 'ILCHIGSTD', 'Elmhurst Clinic', 'Robert', 'J', 'Marselle', 'MD', 'Ophthalmology', '', '', NULL, 'O', '1200 S York Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '6309412626', '6307588590', '1200 S York Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '6309412626', '6307588590', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1841241981', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.865, -87.9322, NULL, NULL),
('364093804', 'ELEL00281', 'ELEL00281', 'ILCHIGSTD', 'Surgeons', 'Michael', '', 'Martirano', 'MD', 'General Surgery', '', '', NULL, 'O', '1200 S York Rd Ste 4220', 'Elmhurst', 'Dupage', 'IL', '60126', '6307588838', '6307588846', '1200 S York Rd Ste 4220', 'Elmhurst', 'Dupage', 'IL', '60126', '6307588838', '6307588846', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', '2014-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1841279387', 0, 'N', 0, '2014-02-06', NULL, NULL, 41.865, -87.9323, NULL, NULL),
('363910599', 'ELEL00119', 'ELEL00119', 'ILCHIGSTD', 'Asthma and Allergy Clinic', 'Jahangeer', 'H', 'Dogar', 'MD', 'Allergy and Immunology', '', '', NULL, 'O', '1 S 132 Summit Ave Ste 102', 'OakBrook Terrace', 'Dupage', 'IL', '60181', '6302611000', '6302611047', '1 S 132 Summit Ave Ste 102', 'OakBrook Terrace', 'Dupage', 'IL', '60181', '6302611000', '6302611047', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, '', NULL, 'HCFA|UB|', '1841304938', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.8574, -87.9729, NULL, NULL),
('364235179', 'ELEL00447', 'ELEL00447', 'ILCHIGSTD', 'Mahrukh Subhani MD', 'Mahrukh', '', 'Subhani', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1 Tiffany Point Ste G15', 'Bloomingdale', 'Dupage', 'IL', '60108', '6302958943', '6302958948', '1 Tiffany Point Ste G15', 'Bloomingdale', 'Dupage', 'IL', '60108', '6302958943', '6302958948', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1841369279', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.9574, -88.0899, NULL, NULL),
('364037473', 'ELEL00377', 'ELEL00377', 'ILCHIGSTD', 'Elmhurst Clinic', 'Ahmad', 'O', 'Raslan', 'MD', 'Pulmonary', '', '', NULL, 'O', '120 S Main St', 'Lombard', 'Dupage', 'IL', '60148', '6309412638', '6309412642', '120 S Main St', 'Lombard', 'Dupage', 'IL', '60148', '6309412638', '6309412642', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1841371648', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.8858, -88.0184, NULL, NULL),
('364037473', 'ELEL00376', 'ELEL00376', 'ILCHIGSTD', 'Elmhurst Clinic', 'Ahmad', 'O', 'Raslan', 'MD', 'Pulmonary', '', '', NULL, 'O', '172 Schiller', 'Elmhurst', 'Dupage', 'IL', '60126', '6309412638', '6309412642', '172 Schiller', 'Elmhurst', 'Dupage', 'IL', '60126', '6309412638', '6309412642', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1841371648', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.9011, -87.9371, NULL, NULL),
('300291080', 'ELEL00503', 'ELEL00503', 'ILCHIGSTD', 'Neurology Clinical Neurophysiology and Sleep Medicine', 'Craig', 'A', 'Wlodarek', 'MD', 'Neurology', '', '', NULL, 'O', '1 S 443 Summit Ave Ste 601', 'Oakbrook Terrace', 'Cook', 'IL', '60160', '7086817879', '7086817886', '1 S 443 Summit Ave Ste 601', 'Oakbrook Terrace', 'Cook', 'IL', '60160', '7086817879', '7086817886', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', 'Presence Resurrection Medical Center', NULL, NULL, 'HCFA|UB|', '1851442230', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.8534, -87.9727, NULL, NULL),
('300291080', 'ELEL00502', 'ELEL00502', 'ILCHIGSTD', 'Neurology Clinical Neurophysiology and Sleep Medicine', 'Craig', 'A', 'Wlodarek', 'MD', 'Neurology', '', '', NULL, 'O', '675 W North Ave Ste 608', 'Melrose Park', 'Cook', 'IL', '60160', '7086817879', '7086817886', '675 W North Ave Ste 608', 'Melrose Park', 'Cook', 'IL', '60160', '7086817879', '7086817886', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', 'Presence Resurrection Medical Center', NULL, NULL, 'HCFA|UB|', '1851442230', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.9083, -87.8421, NULL, NULL),
('363394852', 'ELEL00498', 'ELEL00498', 'ILCHIGSTD', 'Addison Medical Associates', 'Michael', '', 'Williams', 'DPM', 'Podiatry', '', '', NULL, 'O', '276 W Fullerton Ave', 'Addison', 'Dupage', 'IL', '60101', '6305435454', '6305435471', '276 W Fullerton Ave', 'Addison', 'Dupage', 'IL', '60101', '6305435454', '6305435471', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, '', '', 'HCFA|UB|', '1851499917', 0, 'N', 0, '2014-04-25', NULL, NULL, 41.9198, -87.9956, NULL, NULL),
('363374001', 'ELEL00174', 'ELEL00174', 'ILCHIGSTD', 'Midwest Pulmonary Associates', 'Hesham', 'A', 'Hassaballa', 'MD', 'Pulmonary', '', '', NULL, 'O', '2340 S Highland Ave Ste 230', 'Lombard', 'Dupage', 'IL', '60148', '6309322040', '6309321513', '2340 S Highland Ave Ste 230', 'Lombard', 'Dupage', 'IL', '60148', '6309322040', '6309321513', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', '2013-04-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1861440893', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.8427, -88.0115, NULL, NULL),
('363374001', 'ELEL00173', 'ELEL00173', 'ILCHIGSTD', 'Midwest Pulmonary Associates', 'Hesham', 'A', 'Hassaballa', 'MD', 'Pulmonary', '', '', NULL, 'O', '800 Biesterfield Rd Ste 4002', 'Elk Grove Village', 'Cook', 'IL', '60007', '8479815575', '8669321513', '800 Biesterfield Rd Ste 4002', 'Elk Grove Village', 'Cook', 'IL', '60007', '8479815575', '8669321513', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', '2013-04-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1861440893', 0, 'N', 0, '2013-07-25', NULL, NULL, 42.0041, -88.0175, NULL, NULL),
('363374001', 'ELEL00023', 'ELEL00023', 'ILCHIGSTD', 'Midwest Pulmonary Associates', 'Carl', '', 'Barsanti', 'MD', 'Pulmonary', '', '', NULL, 'O', '2340 S Highland Ave Ste 230', 'Lombard', 'Dupage', 'IL', '60148', '6309322040', '9669321513', '2340 S Highland Ave Ste 230', 'Lombard', 'Dupage', 'IL', '60148', '6309322040', '9669321513', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1861450637', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.8429, -88.0115, NULL, NULL),
('208572306', 'ELEL00140', 'ELEL00140', 'ILCHIGSTD', 'Spine and Sports Physiatrists', 'Lawrence', 'W', 'Frank', 'MD', 'Physical Medicine and Rehabilitation', '', '', NULL, 'O', '183 N Addison Ave Ste 210', 'Elmhurst', 'Dupage', 'IL', '60126', '6308344540', '6308349990', '183 N Addison Ave Ste 210', 'Elmhurst', 'Dupage', 'IL', '60126', '6308344540', '6308349990', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1861468811', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.9029, -87.9416, NULL, NULL),
('362667448', 'ELEL00454', 'ELEL00454', 'ILCHIGSTD', 'Oak Brook Allergists', 'Ami', 'T', 'Hannam', 'MD', 'Allergy and Immunology', '', '', NULL, 'O', '120 Oak Brook Ctr Mall Ste 424', 'Oak Brook', 'Dupage', 'IL', '60523', '6305740460', '6305740470', '120 Oak Brook Ctr Mall Ste 424', 'Oak Brook', 'Dupage', 'IL', '60523', '6305740460', '6305740470', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', '2013-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1861699530', 0, 'N', 0, '2014-03-25', NULL, NULL, 41.8477, -87.9519, NULL, NULL),
('362667448', 'ELEL00455', 'ELEL00455', 'ILCHIGSTD', 'Oak Brook Allergists', 'Ami', 'T', 'Hannam', 'MD', 'Allergy and Immunology', '', '', NULL, 'O', '1220 Hobson Rd Ste 136', 'Naperville', 'Dupage', 'IL', '60540', '6309612960', '6309613296', '1220 Hobson Rd Ste 136', 'Naperville', 'Dupage', 'IL', '60540', '6309612960', '6309613296', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', '2013-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1861699530', 0, 'N', 0, '2014-03-25', NULL, NULL, 41.7528, -88.1191, NULL, NULL),
('800607953', 'ELEL00236', 'ELEL00236', 'ILCHIGSTD', 'Illinois Heart and Vascular', 'Selva', '', 'Kunchithapatham', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '11 Salt Creek Ln', 'Hinsdale', 'Dupage', 'IL', '60521', '6307893422', '6307899093', '11 Salt Creek Ln', 'Hinsdale', 'Dupage', 'IL', '60521', '6307893422', '6307899093', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, '', '', 'HCFA|UB|', '1871514810', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.8204, -87.9214, NULL, NULL),
('341981409', 'ELEL00369', 'ELEL00369', 'ILCHIGSTD', 'Dorothy Prusek', 'Dorothy', 'T', 'Prusek', 'MD', 'Internal Medicine', '', '', NULL, 'O', '363 N York Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '6302798200', '6302798236', '363 N York Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '6302798200', '6302798236', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1871592378', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.909, -87.9398, NULL, NULL),
('362704738', 'ELEL00315', 'ELEL00315', 'ILCHIGSTD', 'Nuclear Oncology', 'Anantha', 'K', 'Murthy', 'MD', 'Radiation Oncology', '', '', NULL, 'O', '200 Berteau Ave', 'Elmhurst', 'Dupage', 'IL', '60126', '6307827900', '6307827910', '200 Berteau Ave', 'Elmhurst', 'Dupage', 'IL', '60126', '6307827900', '6307827910', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 6, '2013-04-01', '2013-04-01', 0, 0, 0, 'Presence Mercy Medical Center', NULL, '', '', 'HCFA|UB|', '1871594945', 0, 'N', 0, '2014-04-25', NULL, NULL, 41.9023, -87.9304, NULL, NULL),
('346422786', 'ELEL00024', 'ELEL00024', 'ILCHIGSTD', 'Great West Cosmetic Surgery', 'Gary', 'J', 'Barsky', 'MD', 'Dermatology', '', '', NULL, 'O', '122 Schiller', 'Elmhurst', 'Dupage', 'IL', '60126', '6308328111', '6308328145', '122 Schiller', 'Elmhurst', 'Dupage', 'IL', '60126', '6308328111', '6308328145', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '1881756633', 0, 'N', 0, '2014-04-25', NULL, NULL, 41.9011, -87.9389, NULL, NULL),
('362657245', 'ELEL00027', 'ELEL00027', 'ILCHIGSTD', 'Ad Park Pediatric Associates', 'Paula', 'A', 'Bebej', 'DO', 'Pediatrics', '', '', NULL, 'O', '1640 W Lake St Ste 200', 'Addison', 'Dupage', 'IL', '60101', '6305433020', '6305431551', '1640 W Lake St Ste 200', 'Addison', 'Dupage', 'IL', '60101', '6305433020', '6305431551', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1881771459', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.9488, -88.0276, NULL, NULL),
('362657245', 'ELEL00028', 'ELEL00028', 'ILCHIGSTD', 'Ad Park Pediatric Associates', 'Paula', 'A', 'Bebej', 'DO', 'Pediatrics', '', '', NULL, 'O', '610 S Maple Ste 3150', 'Oak Park', 'Cook', 'IL', '60304', '7083833853', '7083837498', '610 S Maple Ste 3150', 'Oak Park', 'Cook', 'IL', '60304', '7083833853', '7083837498', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1881771459', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.878, -87.8038, NULL, NULL),
('363163610', 'ELEL00246', 'ELEL00246', 'ILCHIGSTD', 'M and M Orthopaedics', 'Bryan', '', 'Lapinski', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '15900 W 127th St Ste 111', 'Lemont', 'Cook', 'IL', '60439', '6302437385', '6302438302', '15900 W 127th St Ste 111', 'Lemont', 'Cook', 'IL', '60439', '6302437385', '6302438302', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', '2013-06-30', 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '1891734935', 0, 'N', 0, '2014-06-13', NULL, NULL, 41.655, -88.0075, NULL, NULL),
('363163610', 'ELEL00247', 'ELEL00247', 'ILCHIGSTD', 'M and M Orthopaedics', 'Bryan', '', 'Lapinski', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '4115 Fairview Ave', 'Downers Grove', 'Dupage', 'IL', '60515', '6309681881', '6309683762', '4115 Fairview Ave', 'Downers Grove', 'Dupage', 'IL', '60515', '6309681881', '6309683762', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', '2013-06-30', 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '1891734935', 0, 'N', 0, '2014-06-13', NULL, NULL, 41.8109, -87.9947, NULL, NULL),
('364037473', 'ELEL00264', 'ELEL00264', 'ILCHIGSTD', 'Elmhurst Clinic', 'Julie', 'M', 'Lopatka', 'MD', 'Pediatrics', '', '', NULL, 'O', '1200 S York Rd Ste 2000', 'Elmhurst', 'Dupage', 'IL', '60126', '6309414710', '6307588481', '1200 S York Rd Ste 2000', 'Elmhurst', 'Dupage', 'IL', '60126', '6309414710', '6307588481', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1891746954', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.865, -87.9322, NULL, NULL),
('364037473', 'ELEL00263', 'ELEL00263', 'ILCHIGSTD', 'Elmhurst Clinic', 'Julie', 'M', 'Lopatka', 'MD', 'Pediatrics', '', '', NULL, 'O', '471 W Army Trail Ste 103', 'Bloomingdale', 'Dupage', 'IL', '60108', '6306916720', '6306916721', '471 W Army Trail Ste 103', 'Bloomingdale', 'Dupage', 'IL', '60108', '6306916720', '6306916721', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1891746954', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.9396, -88.1216, NULL, NULL),
('362907660', 'ELEL00313', 'ELEL00313', 'ILCHIGSTD', 'Nephrology Associates of Northern Illinois', 'Rukhsana', '', 'Muneer', 'MD', 'Nephrology', '', '', NULL, 'O', '183 Addison Ave', 'Elmhurst', 'Dupage', 'IL', '60126', '6308322183', '6308322184', '183 Addison Ave', 'Elmhurst', 'Dupage', 'IL', '60126', '6308322183', '6308322184', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1891754362', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.9029, -87.9416, NULL, NULL),
('364037473', 'ELEL00084', 'ELEL00084', 'ILCHIGSTD', 'Elmhurst Memorial Primary Care Associates', 'Brian', 'A', 'Couri', 'MD', 'Physical Medicine and Rehabilitation', '', '', NULL, 'O', '1200 S York Rd Ste 3160', 'Elmhurst', 'Dupage', 'IL', '60126', '3312219095', '3312219095', '1200 S York Rd Ste 3160', 'Elmhurst', 'Dupage', 'IL', '60126', '3312219095', '3312219095', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1891761284', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.865, -87.9322, NULL, NULL),
('362667448', 'ELEL00076', 'ELEL00076', 'ILCHIGSTD', 'Oak Brook Allergists', 'Ann', '', 'Collier', 'MD', 'Allergy and Immunology', '', '', NULL, 'O', '120 Oak Brook Ctr Mall Ste 424', 'Oak Brook', 'Dupage', 'IL', '60523', '6305740460', '6305740470', '120 Oak Brook Ctr Mall Ste 424', 'Oak Brook', 'Dupage', 'IL', '60523', '6305740460', '6305740470', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Edward Hospital', 'Elmhurst Memorial Hospital', NULL, NULL, 'HCFA|UB|', '1891863411', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.8477, -87.9519, NULL, NULL),
('362667448', 'ELEL00077', 'ELEL00077', 'ILCHIGSTD', 'Oak Brook Allergists', 'Ann', '', 'Collier', 'MD', 'Allergy and Immunology', '', '', NULL, 'O', '1220 Hobson Rd Ste 136', 'Naperville', 'Dupage', 'IL', '60540', '6309612960', '6309613296', '1220 Hobson Rd Ste 136', 'Naperville', 'Dupage', 'IL', '60540', '6309612960', '6309613296', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Edward Hospital', 'Elmhurst Memorial Hospital', NULL, NULL, 'HCFA|UB|', '1891863411', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.7528, -88.1191, NULL, NULL),
('272295237', 'ELEL00127', 'ELEL00127', 'ILCHIGSTD', 'Midwest Hand Surgery', 'Ramsey', 'A', 'Ellis', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1200 S York Rd Ste 3200', 'Elmhurst', 'Dupage', 'IL', '60126', '6303596888', '6303596889', '1200 S York Rd Ste 3200', 'Elmhurst', 'Dupage', 'IL', '60126', '6303596888', '6303596889', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Presence Saint Joseph Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1902010192', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.865, -87.9322, NULL, NULL),
('272295237', 'ELEL00128', 'ELEL00128', 'ILCHIGSTD', 'Midwest Hand Surgery', 'Ramsey', 'A', 'Ellis', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '16618 W 159th St Ste 400', 'Lockport', 'Will', 'IL', '60441', '8153062888', '8153062889', '16618 W 159th St Ste 400', 'Lockport', 'Will', 'IL', '60441', '8153062888', '8153062889', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Presence Saint Joseph Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1902010192', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.5979, -88.022, NULL, NULL),
('205146678', 'ELEL00185', 'ELEL00185', 'ILCHIGSTD', 'Dental Sleep Center', 'James', '', 'Hogg', 'DDS', 'Dentist', '', '', NULL, 'O', '120 Oakbrook Ctr Ste 726', 'Oak Brook', 'Dupage', 'IL', '60523', '6302181920', '8157447059', '120 Oakbrook Ctr Ste 726', 'Oak Brook', 'Dupage', 'IL', '60523', '6302181920', '8157447059', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1902981780', 0, 'Y', 0, '2013-07-25', NULL, NULL, 41.8477, -87.9519, NULL, NULL),
('364028323', 'ELEL00125', 'ELEL00125', 'ILCHIGSTD', 'Oakbrook Behavioral Health', 'Osama', 'A', 'El Shafie', 'MD', 'Psychiatry', '', '', NULL, 'O', '18W100 22nd St Ste 132', 'Oakbrook Terrace', 'Dupage', 'IL', '60181', '6304249204', '6304249208', '18W100 22nd St Ste 132', 'Oakbrook Terrace', 'Dupage', 'IL', '60181', '6304249204', '6304249208', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1912004623', 0, 'Y', 0, '2013-07-25', NULL, NULL, 41.8461, -87.9795, NULL, NULL),
('363236791', 'ELEL00111', 'ELEL00111', 'ILCHIGSTD', 'Marianjoy Medical Group', 'Dolly', '', 'Devara', 'MD', 'Physical Medicine and Rehabilitation', '', '', NULL, 'O', '26W171 Roosevelt Rd', 'Wheaton', 'Dupage', 'IL', '60187', '6309097005', '6309097000', '26W171 Roosevelt Rd', 'Wheaton', 'Dupage', 'IL', '60187', '6309097005', '6309097000', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', '2013-04-15', 0, 0, 0, 'Edward Hospital', 'Elmhurst Memorial Hospital', '', '', 'HCFA|UB|', '1912096108', 0, 'N', 0, '2014-04-25', NULL, NULL, 0, 0, NULL, NULL),
('364079642', 'ELEL00110', 'ELEL00110', 'ILCHIGSTD', 'Elmhurst Orthopaedics', 'Dolly', '', 'Devara', 'MD', 'Physical Medicine and Rehabilitation', '', '', NULL, 'O', '300 W Butterfield Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '6308340491', '6309097001', '300 W Butterfield Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '6308340491', '6309097001', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Edward Hospital', 'Elmhurst Memorial Hospital', '', '', 'HCFA|UB|', '1912096108', 0, 'N', 0, '2014-04-25', NULL, NULL, 41.8661, -87.9484, NULL, NULL),
('364037473', 'ELEL00019', 'ELEL00019', 'ILCHIGSTD', 'Elmhurst Clinic', 'Khalid', 'H', 'Badwan', 'MD', 'Urology', '', '', NULL, 'O', '1200 S York Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '6309412609', '6307588575', '1200 S York Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '6309412609', '6307588575', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1912923236', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.865, -87.9322, NULL, NULL),
('362670634', 'ELEL00176', 'ELEL00176', 'ILCHIGSTD', 'Oak Park Eye Center', 'Michael', 'J', 'Hennessey', 'MD', 'Ophthalmology', '', '', NULL, 'O', '1200 S York Rd Ste 3230', 'Elmhurst', 'Dupage', 'IL', '60126', '6302793673', '6302793843', '1200 S York Rd Ste 3230', 'Elmhurst', 'Dupage', 'IL', '60126', '6302793673', '6302793843', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1912994393', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.865, -87.9322, NULL, NULL),
('362670634', 'ELEL00177', 'ELEL00177', 'ILCHIGSTD', 'Oak Park Eye Center', 'Michael', 'J', 'Hennessey', 'MD', 'Ophthalmology', '', '', NULL, 'O', '7638 W North Ave', 'Elmwood Park', 'Cook', 'IL', '60707', '7084524257', '7084524283', '7638 W North Ave', 'Elmwood Park', 'Cook', 'IL', '60707', '7084524257', '7084524283', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1912994393', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.9087, -87.8171, NULL, NULL),
('364037473', 'ELEL00256', 'ELEL00256', 'ILCHIGSTD', 'Elmhurst Memorial Primary Care Associates', 'Emmanuel', 'C', 'Linchangco', 'MD', 'Internal Medicine', '', '', NULL, 'O', '303 W Lake St Ste 301', 'Addison', 'Dupage', 'IL', '60101', '3312214300', '3312214037', '303 W Lake St Ste 301', 'Addison', 'Dupage', 'IL', '60101', '3312214300', '3312214037', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1922095546', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.9356, -87.9965, NULL, NULL),
('362907660', 'ELEL00158', 'ELEL00158', 'ILCHIGSTD', 'Nephrology Associates of Northern Illinois', 'Nayan', 'S', 'Gowda', 'MD', 'Nephrology', '', '', NULL, 'O', '329 Remington Blvd Ste 105', 'Bolingbrook', 'Will', 'IL', '60440', '6306855699', '6302269750', '329 Remington Blvd Ste 105', 'Bolingbrook', 'Will', 'IL', '60440', '6306855699', '6302269750', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, '', '', 'HCFA|UB|', '1922294388', 0, 'N', 0, '2014-04-25', NULL, NULL, 41.6837, -88.0774, NULL, NULL),
('362907660', 'ELEL00159', 'ELEL00159', 'ILCHIGSTD', 'Nephrology Associates of Northern Illinois', 'Nayan', 'S', 'Gowda', 'MD', 'Nephrology', '', '', NULL, 'O', '3825 Highland Ave Ste 4C', 'Downers Grove', 'Dupage', 'IL', '60515', '6309681595', '6309681590', '3825 Highland Ave Ste 4C', 'Downers Grove', 'Dupage', 'IL', '60515', '6309681595', '6309681590', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, '', '', 'HCFA|UB|', '1922294388', 0, 'N', 0, '2014-04-25', NULL, NULL, 41.8181, -88.0102, NULL, NULL),
('364037473', 'ELEL00290', 'ELEL00290', 'ILCHIGSTD', 'Elmhurst Clinic', 'Brian', 'E', 'McCann', 'MD', 'General Surgery', '', '', NULL, 'O', '1200 S York Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '6309412633', '6307588578', '1200 S York Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '6309412633', '6307588578', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1932101722', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.865, -87.9322, NULL, NULL),
('364037473', 'ELEL00291', 'ELEL00291', 'ILCHIGSTD', 'Elmhurst Clinic', 'Brian', 'E', 'McCann', 'MD', 'General Surgery', '', '', NULL, 'O', '375 W North Ave Ste 416', 'Melrose Park', 'Cook', 'IL', '60160', '7084500462', '7084501591', '375 W North Ave Ste 416', 'Melrose Park', 'Cook', 'IL', '60160', '7084500462', '7084501591', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1932101722', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.9084, -87.8383, NULL, NULL),
('364037473', 'ELEL00484', 'ELEL00484', 'ILCHIGSTD', 'Elmhurst Clinic', 'Emela', '', 'Vukomanovic', 'MD', 'Internal Medicine', '', '', NULL, 'O', '130 S Main St', 'Lombard', 'Dupage', 'IL', '60148', '6306524200', '6306524222', '130 S Main St', 'Lombard', 'Dupage', 'IL', '60148', '6306524200', '6306524222', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1932112067', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.8856, -88.0184, NULL, NULL),
('364037473', 'ELEL00483', 'ELEL00483', 'ILCHIGSTD', 'Elmhurst Clinic', 'Emela', '', 'Vukomanovic', 'MD', 'Internal Medicine', '', '', NULL, 'O', '172 Schiller', 'Elmhurst', 'Dupage', 'IL', '60126', '6309412600', '6307588480', '172 Schiller', 'Elmhurst', 'Dupage', 'IL', '60126', '6309412600', '6307588480', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1932112067', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.9011, -87.9371, NULL, NULL),
('362120183', 'ELEL00302', 'ELEL00302', 'ILCHIGSTD', 'Villa Medical Arts', 'Inna', '', 'Milgram', 'MD', 'Internal Medicine', '', '', NULL, 'O', '10 E Central Blvd', 'Villa Park', 'Dupage', 'IL', '60181', '6308329000', '6308329049', '10 E Central Blvd', 'Villa Park', 'Dupage', 'IL', '60181', '6308329000', '6308329049', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1932197597', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.8839, -87.9787, NULL, NULL),
('364079642', 'ELEL00025', 'ELEL00025', 'ILCHIGSTD', 'Elmhurst Orthopaedics', 'Eugene', '', 'Bartucci', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '300 W Butterfield Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '6308340491', '6308340735', '300 W Butterfield Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '6308340491', '6308340735', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1932213469', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.8661, -87.9484, NULL, NULL),
('364037473', 'ELEL00161', 'ELEL00161', 'ILCHIGSTD', 'Elmhurst Clinic', 'Therese', 'M', 'Gracey', 'MD', 'Pediatrics', '', '', NULL, 'O', '1200 S York Rd Ste 2000', 'Elmhurst', 'Dupage', 'IL', '60126', '6309414710', '6309412642', '1200 S York Rd Ste 2000', 'Elmhurst', 'Dupage', 'IL', '60126', '6309414710', '6309412642', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1932263605', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.865, -87.9322, NULL, NULL),
('364037473', 'ELEL00160', 'ELEL00160', 'ILCHIGSTD', 'Elmhurst Clinic', 'Therese', 'M', 'Gracey', 'MD', 'Pediatrics', '', '', NULL, 'O', '303 W Lake St Ste 200', 'Addison', 'Dupage', 'IL', '60101', '3312219002', '3312213973', '303 W Lake St Ste 200', 'Addison', 'Dupage', 'IL', '60101', '3312219002', '3312213973', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1932263605', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.9356, -87.9965, NULL, NULL),
('362704738', 'ELEL00182', 'ELEL00182', 'ILCHIGSTD', 'Nuclear Oncology', 'Ommar', 'Tin', 'Hla', 'MD', 'Radiation Oncology', '', '', NULL, 'O', '200 Berteau Ave', 'Elmhurst', 'Dupage', 'IL', '60126', '6307827900', '6307827910', '200 Berteau Ave', 'Elmhurst', 'Dupage', 'IL', '60126', '6307827900', '6307827910', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 6, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1942225511', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.9022, -87.9293, NULL, NULL),
('364037473', 'ELEL00400', 'ELEL00400', 'ILCHIGSTD', 'Elmhurst Clinic', 'Elizabeth', 'M', 'Sack', 'MD', 'Gastroenterology', '', '', NULL, 'O', '133 E Brush Hill Rd Ste 310', 'Elmhurst', 'Dupage', 'IL', '60126', '6309412608', '6309412642', '133 E Brush Hill Rd Ste 310', 'Elmhurst', 'Dupage', 'IL', '60126', '6309412608', '6309412642', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1942250071', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.8616, -87.9371, NULL, NULL),
('362667448', 'ELEL00463', 'ELEL00463', 'ILCHIGSTD', 'Oak Brook Allergists', 'Jyothi', '', 'Tirumalasetty', 'MD', 'Allergy and Immunology', '', '', NULL, 'O', '120 Oak Brook Ctr Mall Ste 424', 'Oak Brook', 'Dupage', 'IL', '60523', '6305740460', '6305740470', '120 Oak Brook Ctr Mall Ste 424', 'Oak Brook', 'Dupage', 'IL', '60523', '6305740460', '6305740470', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '1942257605', 0, 'N', 0, '2014-04-25', NULL, NULL, 41.8477, -87.9519, NULL, NULL),
('362667448', 'ELEL00462', 'ELEL00462', 'ILCHIGSTD', 'Oak Brook Allergists', 'Jyothi', '', 'Tirumalasetty', 'MD', 'Allergy and Immunology', '', '', NULL, 'O', '282 W Loop Rd', 'Wheaton', 'Dupage', 'IL', '60187', '6306538890', '6306538919', '282 W Loop Rd', 'Wheaton', 'Dupage', 'IL', '60187', '6306538890', '6306538919', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '1942257605', 0, 'N', 0, '2014-04-25', NULL, NULL, 41.8294, -88.11, NULL, NULL),
('364037473', 'ELEL00099', 'ELEL00099', 'ILCHIGSTD', 'Elmhurst Clinic', 'Kimberley', 'Michelle', 'Darey', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1200 S York Rd Ste 2000', 'Elmhurst', 'Dupage', 'IL', '60126', '6308341120', '6307588480', '1200 S York Rd Ste 2000', 'Elmhurst', 'Dupage', 'IL', '60126', '6308341120', '6307588480', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1942478441', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.865, -87.9322, NULL, NULL),
('364037473', 'ELEL00098', 'ELEL00098', 'ILCHIGSTD', 'Elmhurst Clinic', 'Kimberley', 'Michelle', 'Darey', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '303 W Lake St Ste 200', 'Addison', 'Dupage', 'IL', '60101', '3312219002', '3312213973', '303 W Lake St Ste 200', 'Addison', 'Dupage', 'IL', '60101', '3312219002', '3312213973', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1942478441', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.9356, -87.9965, NULL, NULL),
('270310134', 'ELEL00241', 'ELEL00241', 'ILCHIGSTD', 'Illinois Cardiothoracic Surgeons', 'Stephen', 'F', 'Laga', 'MD', 'Thoracic Surgery', '', '', NULL, 'O', '1111 W Superior St Ste 405', 'Melrose Park', 'Cook', 'IL', '60160', '7083445242', '8474550411', '1111 W Superior St Ste 405', 'Melrose Park', 'Cook', 'IL', '60160', '7083445242', '8474550411', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '1952361818', 0, 'N', 0, '2014-04-25', NULL, NULL, 41.8925, -87.8471, NULL, NULL),
('710870653', 'ELEL00175', 'ELEL00175', 'ILCHIGSTD', 'Family Medical Care', 'Colleen', '', 'Heniff', 'MD', 'Family Practice', '', '', NULL, 'O', '965 Lake St', 'Oak Park', 'Cook', 'IL', '60301', '7083830400', '7083834314', '965 Lake St', 'Oak Park', 'Cook', 'IL', '60301', '7083830400', '7083834314', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', '2013-04-01', 0, 0, 0, 'Little Company of Mary Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1972509594', 0, 'N', 0, '2013-08-01', NULL, NULL, 41.8887, -87.7975, NULL, NULL),
('364037473', 'ELEL00364', 'ELEL00364', 'ILCHIGSTD', 'Elmhurst Clinic', 'Anita', 'P', 'Pillai', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1200 S York Rd Ste 2000', 'Elmhurst', 'Dupage', 'IL', '60126', '6309412609', '6307588574', '1200 S York Rd Ste 2000', 'Elmhurst', 'Dupage', 'IL', '60126', '6309412609', '6307588574', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1972554038', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.865, -87.9322, NULL, NULL),
('364037473', 'ELEL00365', 'ELEL00365', 'ILCHIGSTD', 'Elmhurst Clinic', 'Anita', 'P', 'Pillai', 'MD', 'Internal Medicine', '', '', NULL, 'O', '172 Schiller', 'Elmhurst', 'Dupage', 'IL', '60126', '6309412600', '6307588480', '172 Schiller', 'Elmhurst', 'Dupage', 'IL', '60126', '6309412600', '6307588480', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1972554038', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.9011, -87.9371, NULL, NULL),
('363933846', 'ELEL00395', 'ELEL00395', 'ILCHIGSTD', 'Mark Ros MD', 'Mark', '', 'Ros', 'MD', 'Ophthalmology', '', '', NULL, 'O', '130 S Main St Ste 305', 'Lombard', 'Dupage', 'IL', '60148', '6304260505', '6304260506', '130 S Main St Ste 305', 'Lombard', 'Dupage', 'IL', '60148', '6304260505', '6304260506', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1972593549', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.8856, -88.0184, NULL, NULL),
('363709775', 'ELEL00344', 'ELEL00344', 'ILCHIGSTD', 'Diane L Ozog MD', 'Diane', 'L', 'Ozog', 'MD', 'Allergy and Immunology', '', '', NULL, 'O', '1288 Rickert Dr Ste 100', 'Naperville', 'Dupage', 'IL', '60540', '6306520606', '6306529900', '1288 Rickert Dr Ste 100', 'Naperville', 'Dupage', 'IL', '60540', '6306520606', '6306529900', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1972647154', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.7484, -88.1673, NULL, NULL),
('363709775', 'ELEL00343', 'ELEL00343', 'ILCHIGSTD', 'Diane L Ozog MD', 'Diane', 'L', 'Ozog', 'MD', 'Allergy and Immunology', '', '', NULL, 'O', '130 S Main St Ste 202', 'Lombard', 'Dupage', 'IL', '60148', '6306520606', '6306529900', '130 S Main St Ste 202', 'Lombard', 'Dupage', 'IL', '60148', '6306520606', '6306529900', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1972647154', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.8856, -88.0184, NULL, NULL),
('562601102', 'ELEL00512', 'ELEL00512', 'ILCHIGSTD', 'Karim Yunez MD', 'Karim', 'S', 'Yunez', 'MD', 'Internal Medicine', '', '', NULL, 'O', '130 S Main St Ste 203', 'Lombard', 'Dupage', 'IL', '60148', '6306273700', '6306273711', '130 S Main St Ste 203', 'Lombard', 'Dupage', 'IL', '60148', '6306273700', '6306273711', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1972662781', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.8856, -88.0184, NULL, NULL),
('362818636', 'ELEL00403', 'ELEL00403', 'ILCHIGSTD', 'MZ Sait MD', 'Mohamed', 'Z', 'Sait', 'MD', 'Gastroenterology', '', '', NULL, 'O', '2340 S Highland Ave Ste 120', 'Lombard', 'Dupage', 'IL', '60148', '6309322010', '6309530261', '2340 S Highland Ave Ste 120', 'Lombard', 'Dupage', 'IL', '60148', '6309322010', '6309530261', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1972690651', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.8429, -88.0115, NULL, NULL),
('362818636', 'ELEL00404', 'ELEL00404', 'ILCHIGSTD', 'MZ Sait MD', 'Mohamed', 'Z', 'Sait', 'MD', 'Gastroenterology', '', '', NULL, 'O', '675 W North Ave Ste 601', 'Melrose Park', 'Cook', 'IL', '60160', '6309322010', '6309530261', '675 W North Ave Ste 601', 'Melrose Park', 'Cook', 'IL', '60160', '6309322010', '6309530261', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1972690651', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.9083, -87.8421, NULL, NULL),
('364037473', 'ELEL00311', 'ELEL00311', 'ILCHIGSTD', 'Elmhurst Memorial Professional Services', 'Joseph', 'William', 'Mullen', 'DO', 'Psychiatry', '', '', NULL, 'O', '200 Berteau Ave', 'Elmhurst', 'Dupage', 'IL', '60126', '6309414577', '6307585024', '200 Berteau Ave', 'Elmhurst', 'Dupage', 'IL', '60126', '6309414577', '6307585024', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1972778801', 0, 'Y', 0, '2013-07-25', NULL, NULL, 41.9022, -87.9293, NULL, NULL),
('362704738', 'ELEL00145', 'ELEL00145', 'ILCHIGSTD', 'Nuclear Oncology', 'Dennis', 'Lee', 'Galinsky', 'MD', 'Radiation Oncology', '', '', NULL, 'O', '200 Berteau Ave', 'Elmhurst', 'Dupage', 'IL', '60126', '6307827900', '6307827910', '200 Berteau Ave', 'Elmhurst', 'Dupage', 'IL', '60126', '6307827900', '6307827910', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 6, '2013-04-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, NULL, NULL, 'HCFA|UB|', '1982605036', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.9022, -87.9293, NULL, NULL),
('362841646', 'ELEL00296', 'ELEL00296', 'ILCHIGSTD', 'Orthopedic Specialists', 'Jeffrey', 'S', 'Meisles', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '360 W Butterfield Rd Ste 160', 'Elmhurst', 'Dupage', 'IL', '60126', '6307829600', '6307821643', '360 W Butterfield Rd Ste 160', 'Elmhurst', 'Dupage', 'IL', '60126', '6307829600', '6307821643', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1982606372', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.8648, -87.9509, NULL, NULL),
('362841646', 'ELEL00297', 'ELEL00297', 'ILCHIGSTD', 'Orthopedic Specialists', 'Jeffrey', 'S', 'Meisles', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '675 W North Ave Ste 314', 'Melrose Park', 'Cook', 'IL', '60160', '7084505744', '7083380474', '675 W North Ave Ste 314', 'Melrose Park', 'Cook', 'IL', '60160', '7084505744', '7083380474', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1982606372', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.9083, -87.8421, NULL, NULL),
('364037473', 'ELEL00396', 'ELEL00396', 'ILCHIGSTD', 'Elmhurst Clinic', 'Gayle', '', 'Rosenthal', 'MD', 'Gastroenterology', '', '', NULL, 'O', '1100 Lake St Ste 230', 'Oak Park', 'Cook', 'IL', '60301', '7085241420', '7085241509', '1100 Lake St Ste 230', 'Oak Park', 'Cook', 'IL', '60301', '7085241420', '7085241509', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', '2014-07-09', 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1982627840', 0, 'N', 0, '2014-06-09', NULL, NULL, 41.8886, -87.8026, NULL, NULL),
('363236791', 'ELEL00443', 'ELEL00443', 'ILCHIGSTD', 'Marianjoy Medical Group', 'Vasilios', 'E', 'Stambolis', 'MD', 'Physical Medicine and Rehabilitation', '', '', NULL, 'O', '26W171 Roosevelt Rd', 'Wheaton', 'Dupage', 'IL', '60187', '6309097005', '6309097001', '26W171 Roosevelt Rd', 'Wheaton', 'Dupage', 'IL', '60187', '6309097005', '6309097001', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', '2013-04-15', 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '1982772471', 0, 'N', 0, '2014-04-25', NULL, NULL, 0, 0, NULL, NULL),
('364079642', 'ELEL00442', 'ELEL00442', 'ILCHIGSTD', 'Elmhurst Orthopaedics', 'Vasilios', 'E', 'Stambolis', 'MD', 'Physical Medicine and Rehabilitation', '', '', NULL, 'O', '300 W Butterfield Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '6309097005', '6309097001', '300 W Butterfield Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '6309097005', '6309097001', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '1982772471', 0, 'N', 0, '2014-04-25', NULL, NULL, 41.8661, -87.9484, NULL, NULL),
('205146678', 'ELEL00361', 'ELEL00361', 'ILCHIGSTD', 'Dental Sleep Center', 'Katherine', '', 'Phillips', 'DDS', 'Dentist', '', '', NULL, 'O', '120 Oakbrook Ctr Ste 726', 'Oak Brook', 'Dupage', 'IL', '60523', '6302181920', '8157447059', '120 Oakbrook Ctr Ste 726', 'Oak Brook', 'Dupage', 'IL', '60523', '6302181920', '8157447059', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1982869996', 0, 'Y', 0, '2013-07-25', NULL, NULL, 41.8477, -87.9519, NULL, NULL),
('272295237', 'ELEL00437', 'ELEL00437', 'ILCHIGSTD', 'Midwest Hand Surgery', 'Nicholas', 'J', 'Speziale', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1200 S York Rd Ste 3200', 'Elmhurst', 'Dupage', 'IL', '60126', '6303596888', '6303596889', '1200 S York Rd Ste 3200', 'Elmhurst', 'Dupage', 'IL', '60126', '6303596888', '6303596889', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Presence Saint Joseph Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1992721385', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.865, -87.9322, NULL, NULL),
('272295237', 'ELEL00438', 'ELEL00438', 'ILCHIGSTD', 'Midwest Hand Surgery', 'Nicholas', 'J', 'Speziale', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '16618 W 159th St Ste 400', 'Lockport', 'Will', 'IL', '60441', '8153062888', '8153062889', '16618 W 159th St Ste 400', 'Lockport', 'Will', 'IL', '60441', '8153062888', '8153062889', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Presence Saint Joseph Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1992721385', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.5979, -88.022, NULL, NULL),
('363163610', 'ELEL00237', 'ELEL00237', 'ILCHIGSTD', 'M and M Orthopaedics', 'Christina', '', 'Kuo', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '15900 W 127th St Ste 111', 'Lemont', 'Cook', 'IL', '60439', '6302437385', '6302438302', '15900 W 127th St Ste 111', 'Lemont', 'Cook', 'IL', '60439', '6302437385', '6302438302', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', '2013-06-30', 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '1992745681', 0, 'N', 0, '2014-06-13', NULL, NULL, 41.655, -88.0075, NULL, NULL),
('363163610', 'ELEL00238', 'ELEL00238', 'ILCHIGSTD', 'M and M Orthopaedics', 'Christina', '', 'Kuo', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '4115 Fairview Ave', 'Downers Grove', 'Dupage', 'IL', '60515', '6309681881', '6309683762', '4115 Fairview Ave', 'Downers Grove', 'Dupage', 'IL', '60515', '6309681881', '6309683762', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', '2013-06-30', 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '1992745681', 0, 'N', 0, '2014-06-13', NULL, NULL, 41.8109, -87.9947, NULL, NULL),
('204047031', 'ELEL00166', 'ELEL00166', 'ILCHIGSTD', 'DuPage Ophthalmology', 'Balaji', 'K', 'Gupta', 'MD', 'Ophthalmology', '', '', NULL, 'O', '2500 S Highland Ave Ste 110', 'Lombard', 'Dupage', 'IL', '60148', '6304952220', '6304952279', '2500 S Highland Ave Ste 110', 'Lombard', 'Dupage', 'IL', '60148', '6304952220', '6304952279', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1992767818', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.8412, -88.0115, NULL, NULL),
('204047031', 'ELEL00167', 'ELEL00167', 'ILCHIGSTD', 'DuPage Ophthalmology', 'Balaji', 'K', 'Gupta', 'MD', 'Ophthalmology', '', '', NULL, 'O', '2602 W 83rd St', 'Darien', 'Dupage', 'IL', '60561', '6304952220', '6304952279', '2602 W 83rd St', 'Darien', 'Dupage', 'IL', '60561', '6304952220', '6304952279', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1992767818', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.7366, -88.0083, NULL, NULL),
('272295237', 'ELEL00419', 'ELEL00419', 'ILCHIGSTD', 'Midwest Hand Surgery', 'Samir', '', 'Shah', 'MD', 'Plastic Surgery', '', '', NULL, 'O', '1200 S York Rd Ste 3200', 'Elmhurst', 'Dupage', 'IL', '60126', '6303596888', '6303596889', '1200 S York Rd Ste 3200', 'Elmhurst', 'Dupage', 'IL', '60126', '6303596888', '6303596889', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Presence Saint Joseph Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1992961494', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.865, -87.9322, NULL, NULL),
('272295237', 'ELEL00422', 'ELEL00422', 'ILCHIGSTD', 'Midwest Hand Surgery', 'Samir', '', 'Shah', 'MD', 'Plastic Surgery', '', '', NULL, 'O', '301 N Madison St Ste 307', 'Joliet', 'Will', 'IL', '60435', '8153062888', '8153062889', '301 N Madison St Ste 307', 'Joliet', 'Will', 'IL', '60435', '8153062888', '8153062889', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Presence Saint Joseph Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1992961494', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.5273, -88.1346, NULL, NULL),
('272295237', 'ELEL00424', 'ELEL00424', 'ILCHIGSTD', 'Midwest Hand Surgery', 'Samir', '', 'Shah', 'MD', 'Plastic Surgery', '', '', NULL, 'B', '62025 Collections Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '8153062888', '8153062889', '62025 Collections Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '8153062888', '8153062889', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Presence Saint Joseph Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1992961494', 0, 'Y', 0, '2013-07-25', NULL, NULL, 0, 0, NULL, NULL),
('272295237', 'ELEL00421', 'ELEL00421', 'ILCHIGSTD', 'Midwest Hand Surgery', 'Samir', '', 'Shah', 'MD', 'Plastic Surgery', '', '', NULL, 'O', '7460 W College Dr 2nd Fl', 'Palos Heights', 'Cook', 'IL', '60463', '7088272888', '7088272889', '7460 W College Dr 2nd Fl', 'Palos Heights', 'Cook', 'IL', '60463', '7088272888', '7088272889', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Presence Saint Joseph Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1992961494', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.6752, -87.8034, NULL, NULL),
('450579013', 'W12030619', 'W12030619', 'UT01', 'Lone Peak OBGYN', 'Krista', 'J', 'Anders', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '74 Kimballs Ln', 'Draper', 'Salt Lake', 'UT', '84020', '8015233053', '8015233059', '74 Kimballs Ln', 'Draper', 'Salt Lake', 'UT', '84020', '8015233053', '8015233059', 'UTHCAPS', 'WUSTDCARD5', '', '0.00', '35.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1841353349', 0, 'N', 0, '2013-02-26', NULL, NULL, 40.537, -111.889, NULL, NULL);
