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
('371625746', 'W12020567', 'W12020567', 'UT01', 'MountainStar Cardiology St Marks', 'Steven', 'A', 'Rokeach', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '3584 W 9000 S Ste 209', 'West Jordan', 'Salt Lake', 'UT', '84088', '8016763776', '8016760987', '3584 W 9000 S Ste 209', 'West Jordan', 'Salt Lake', 'UT', '84088', '8016763776', '8016760987', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1740290212', 0, 'N', 0, '2012-06-28', NULL, NULL, 40.5879, -111.976, NULL, NULL),
('371625746', 'W12020568', 'W12020568', 'UT01', 'MountainStar Cardiology St Marks', 'Steven', 'A', 'Rokeach', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '3725 W 4100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8016763776', '8016760987', '3725 W 4100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8016763776', '8016760987', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1740290212', 0, 'N', 0, '2012-06-28', NULL, NULL, 40.682, -111.979, NULL, NULL),
('371625746', 'W12020569', 'W12020569', 'UT01', 'MountainStar Cardiology St Marks', 'Steven', 'A', 'Rokeach', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '74 E Kimballs Ln Ste 260', 'Draper', 'Salt Lake', 'UT', '84020', '8015716100', '8015720505', '74 E Kimballs Ln Ste 260', 'Draper', 'Salt Lake', 'UT', '84020', '8015716100', '8015720505', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1740290212', 0, 'N', 0, '2012-06-28', NULL, NULL, 40.537, -111.889, NULL, NULL),
('371625746', 'W12020570', 'W12020570', 'UT01', 'MountainStar Cardiology St Marks', 'Steven', 'A', 'Rokeach', 'MD', 'Cardiovascular Disease', '', '', NULL, 'B', 'PO Box 741729', 'Atlanta', 'Fulton', 'GA', '30384', '8012663418', '8012664174', 'PO Box 741729', 'Atlanta', 'Fulton', 'GA', '30384', '8012663418', '8012664174', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1740290212', 0, 'N', 0, '2012-06-28', NULL, NULL, 0, 0, NULL, NULL),
('770701557', 'W12020571', 'W12020571', 'UT01', 'MountainStar Jordan Family Health', 'James', 'T', 'Roth', 'MD', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'O', '8846 S Redwood Rd Ste E-121', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015691999', '8015692001', '8846 S Redwood Rd Ste E-121', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015691999', '8015692001', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1104895705', 0, 'N', 0, '2012-06-28', NULL, NULL, 40.5911, -111.939, NULL, NULL),
('770701557', 'W12020572', 'W12020572', 'UT01', 'MountainStar Jordan Family Health', 'James', 'T', 'Roth', 'MD', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'B', 'PO Box 198560', 'Atlanta', 'Fulton', 'GA', '30384', '8015691999', '8015692001', 'PO Box 198560', 'Atlanta', 'Fulton', 'GA', '30384', '8015691999', '8015692001', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1104895705', 0, 'N', 0, '2012-06-28', NULL, NULL, 0, 0, NULL, NULL),
('800236802', 'W12020573', 'W12020573', 'UT01', 'Farr West Family Medicine', 'Julia', 'A', 'Rothgery', 'MD', 'Family Practice', '', '', NULL, 'O', '2850 N 2000 W Ste 101', 'Ogden', 'Weber', 'UT', '84404', '8017311222', '8017311666', '2850 N 2000 W Ste 101', 'Ogden', 'Weber', 'UT', '84404', '8017311222', '8017311666', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1609020072', 0, 'N', 0, '2012-06-28', NULL, NULL, 41.3105, -112.028, NULL, NULL),
('800236802', 'W12020574', 'W12020574', 'UT01', 'Farr West Family Medicine', 'Julia', 'A', 'Rothgery', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 405600', 'Atlanta', 'Fulton', 'GA', '30384', '8017311222', '8017311666', 'PO Box 405600', 'Atlanta', 'Fulton', 'GA', '30384', '8017311222', '8017311666', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1609020072', 0, 'N', 0, '2012-06-28', NULL, NULL, 0, 0, NULL, NULL),
('770701557', 'W12020575', 'W12020575', 'UT01', 'Lone Peak Family Medicine', 'Timothy', 'J', 'Schaat', 'MD', 'Family Practice', '', '', NULL, 'O', '11760 S 700 E Ste 111', 'Draper', 'Salt Lake', 'UT', '84020', '8019964384', '8015769800', '11760 S 700 E Ste 111', 'Draper', 'Salt Lake', 'UT', '84020', '8019964384', '8015769800', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1912032640', 0, 'N', 0, '2012-06-28', NULL, NULL, 40.5377, -111.871, NULL, NULL),
('770701557', 'W12020576', 'W12020576', 'UT01', 'Lone Peak Family Medicine', 'Timothy', 'J', 'Schaat', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 198560', 'Atlanta', 'Fulton', 'GA', '30384', '8006613365', '8015769800', 'PO Box 198560', 'Atlanta', 'Fulton', 'GA', '30384', '8006613365', '8015769800', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1912032640', 0, 'Y', 0, '2012-06-28', NULL, NULL, 0, 0, NULL, NULL),
('770701557', 'W12020577', 'W12020577', 'UT01', 'MountainStar Jordan Family Health', 'Todd', 'N', 'Schauers', 'PA-C', 'Family Practice', '', '', NULL, 'O', '8846 S Redwood Rd Ste E-121', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015691999', '8015692001', '8846 S Redwood Rd Ste E-121', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015691999', '8015692001', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1053344937', 0, 'N', 0, '2013-09-19', NULL, NULL, 40.5911, -111.939, NULL, NULL),
('770701557', 'W12020578', 'W12020578', 'UT01', 'MountainStar Jordan Family Health', 'Todd', 'N', 'Schauers', 'PA-C', 'Family Practice', '', '', NULL, 'B', 'PO Box 198560', 'Atlanta', 'Fulton', 'GA', '30384', '8015691999', '8015692001', 'PO Box 198560', 'Atlanta', 'Fulton', 'GA', '30384', '8015691999', '8015692001', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1053344937', 0, 'N', 0, '2013-09-19', NULL, NULL, 0, 0, NULL, NULL),
('770701557', 'W12020579', 'W12020579', 'UT01', 'South Jordan Family Medicine', 'Matthew', 'M', 'Schellenberg', 'DO', 'Family Practice', '', '', NULL, 'O', '10623 S Redwood Rd Ste 101', 'South Jordan', 'Salt Lake', 'UT', '84095', '8013020899', '8013020892', '10623 S Redwood Rd Ste 101', 'South Jordan', 'Salt Lake', 'UT', '84095', '8013020899', '8013020892', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1386855021', 0, 'N', 0, '2012-07-10', NULL, NULL, 40.5582, -111.939, NULL, NULL),
('770701557', 'W12020580', 'W12020580', 'UT01', 'South Jordan Family Medicine', 'Matthew', 'M', 'Schellenberg', 'DO', 'Family Practice', '', '', NULL, 'B', 'PO Box 198560', 'Atlanta', 'Fulton', 'GA', '30384', '8013020899', '8013020892', 'PO Box 198560', 'Atlanta', 'Fulton', 'GA', '30384', '8013020899', '8013020892', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1386855021', 0, 'N', 0, '2012-07-10', NULL, NULL, 0, 0, NULL, NULL),
('134332141', 'W12020581', 'W12020581', 'UT01', 'MountainStar Cardiovascular Surgery', 'Gilbert', 'R', 'Schorlemmer', 'MD', 'Cardiovascular Disease', 'Thoracic Surgery', '', NULL, 'O', '1160 E 3900 S Ste 3500', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8017434750', NULL, '1160 E 3900 S Ste 3500', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8017434750', '          ', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1629060553', 0, 'N', 0, '2012-06-28', NULL, NULL, 40.6871, -111.858, NULL, NULL),
('134332141', 'W12020582', 'W12020582', 'UT01', 'MountainStar Cardiovascular Surgery', 'Gilbert', 'R', 'Schorlemmer', 'MD', 'Cardiovascular Disease', 'Thoracic Surgery', '', NULL, 'O', '698 W 800 N Ste 210', 'Orem', 'Utah', 'UT', '84057', '8017146412', NULL, '698 W 800 N Ste 210', 'Orem', 'Utah', 'UT', '84057', '8017146412', '          ', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1629060553', 0, 'N', 0, '2012-06-28', NULL, NULL, 40.3121, -111.713, NULL, NULL),
('800701770', 'W12020583', 'W12020583', 'UT01', 'Mountainstar Medical Group Neurosurgery', 'Richard', 'H', 'Schwartz', 'MD', 'Neurosurgery', '', '', NULL, 'O', '1220 E 3900 S Ste 4E', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012618507', '8012618511', '1220 E 3900 S Ste 4E', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012618507', '8012618511', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', '2013-01-01', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1336148063', 0, 'N', 0, '2013-01-16', NULL, NULL, 0, 0, NULL, NULL),
('800701770', 'W12020584', 'W12020584', 'UT01', 'Mountainstar Medical Group Neurosurgery', 'Richard', 'H', 'Schwartz', 'MD', 'Neurosurgery', '', '', NULL, 'B', 'PO Box 741648', 'Atlanta', 'Fulton', 'GA', '30374', '6153737490', '8012618511', 'PO Box 741648', 'Atlanta', 'Fulton', 'GA', '30374', '6153737490', '8012618511', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', '2013-01-01', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1336148063', 0, 'N', 0, '2013-01-16', NULL, NULL, 0, 0, NULL, NULL),
('611572907', 'W12020585', 'W12020585', 'UT01', 'South Ogden Center for Family Medicine', 'Michael', 'E', 'Severance', 'PA', 'Family Practice', '', '', NULL, 'O', '5740 Crestwood Dr', 'Ogden', 'Weber', 'UT', '84405', '8014797771', NULL, '5740 Crestwood Dr', 'Ogden', 'Weber', 'UT', '84405', '8014797771', '          ', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1942273149', 0, 'N', 0, '2012-06-28', NULL, NULL, 41.1583, -111.947, NULL, NULL),
('371625746', 'W12020586', 'W12020586', 'UT01', 'MountainStar Cardiology St Marks', 'Pawan', 'K', 'Sharma', 'MD', 'Cardiovascular Disease', NULL, NULL, NULL, 'O', '1160 E 3900 S Ste 2000', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012663418', '8012664174', '1160 E 3900 S Ste 2000', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012663418', '8012664174', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1114919073', 0, 'N', 0, '2012-06-28', NULL, NULL, 40.6871, -111.858, NULL, NULL),
('371625746', 'W12020587', 'W12020587', 'UT01', 'MountainStar Cardiology St Marks', 'Pawan', 'K', 'Sharma', 'MD', 'Cardiovascular Disease', NULL, NULL, NULL, 'O', '3584 W 9000 S Ste 209', 'West Jordan', 'Salt Lake', 'UT', '84088', '8016763776', '8016760987', '3584 W 9000 S Ste 209', 'West Jordan', 'Salt Lake', 'UT', '84088', '8016763776', '8016760987', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1114919073', 0, 'N', 0, '2012-06-28', NULL, NULL, 40.5879, -111.976, NULL, NULL),
('371625746', 'W12020588', 'W12020588', 'UT01', 'MountainStar Cardiology St Marks', 'Pawan', 'K', 'Sharma', 'MD', 'Cardiovascular Disease', NULL, NULL, NULL, 'O', '3725 W 4100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8016763776', '8016760987', '3725 W 4100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8016763776', '8016760987', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1114919073', 0, 'N', 0, '2012-06-28', NULL, NULL, 40.682, -111.979, NULL, NULL),
('371625746', 'W12020589', 'W12020589', 'UT01', 'MountainStar Cardiology St Marks', 'Pawan', 'K', 'Sharma', 'MD', 'Cardiovascular Disease', NULL, NULL, NULL, 'O', '74 E Kimballs Ln Ste 260', 'Draper', 'Salt Lake', 'UT', '84020', '8015716100', '8015720505', '74 E Kimballs Ln Ste 260', 'Draper', 'Salt Lake', 'UT', '84020', '8015716100', '8015720505', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1114919073', 0, 'N', 0, '2012-06-28', NULL, NULL, 40.537, -111.889, NULL, NULL),
('371625746', 'W12020590', 'W12020590', 'UT01', 'MountainStar Cardiology St Marks', 'Pawan', 'K', 'Sharma', 'MD', 'Cardiovascular Disease', NULL, NULL, NULL, 'B', 'PO Box 741729', 'Atlanta', 'Fulton', 'GA', '30384', '8012663418', '8012664174', 'PO Box 741729', 'Atlanta', 'Fulton', 'GA', '30384', '8012663418', '8012664174', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1114919073', 0, 'N', 0, '2012-06-28', NULL, NULL, 0, 0, NULL, NULL),
('371625746', 'W12020591', 'W12020591', 'UT01', 'MountainStar Cardiology St Marks', 'Sally', 'D', 'Sharp', 'MD', 'Cardiovascular Disease', NULL, NULL, NULL, 'O', '1160 E 3900 S Ste 2000', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012663418', '8012664174', '1160 E 3900 S Ste 2000', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012663418', '8012664174', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1841282787', 0, 'N', 0, '2012-06-28', NULL, NULL, 40.6871, -111.858, NULL, NULL),
('371625746', 'W12020592', 'W12020592', 'UT01', 'MountainStar Cardiology St Marks', 'Sally', 'D', 'Sharp', 'MD', 'Cardiovascular Disease', NULL, NULL, NULL, 'O', '3584 W 9000 S Ste 209', 'West Jordan', 'Salt Lake', 'UT', '84088', '8016763776', '8016760987', '3584 W 9000 S Ste 209', 'West Jordan', 'Salt Lake', 'UT', '84088', '8016763776', '8016760987', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1841282787', 0, 'N', 0, '2012-06-28', NULL, NULL, 40.5879, -111.976, NULL, NULL),
('371625746', 'W12020593', 'W12020593', 'UT01', 'MountainStar Cardiology St Marks', 'Sally', 'D', 'Sharp', 'MD', 'Cardiovascular Disease', NULL, NULL, NULL, 'O', '3725 W 4100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8016763776', '8016760987', '3725 W 4100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8016763776', '8016760987', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1841282787', 0, 'N', 0, '2012-06-28', NULL, NULL, 40.682, -111.979, NULL, NULL),
('371625746', 'W12020594', 'W12020594', 'UT01', 'MountainStar Cardiology St Marks', 'Sally', 'D', 'Sharp', 'MD', 'Cardiovascular Disease', NULL, NULL, NULL, 'O', '74 E Kimballs Ln Ste 260', 'Draper', 'Salt Lake', 'UT', '84020', '8015716100', '8015720505', '74 E Kimballs Ln Ste 260', 'Draper', 'Salt Lake', 'UT', '84020', '8015716100', '8015720505', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1841282787', 0, 'N', 0, '2012-06-28', NULL, NULL, 40.537, -111.889, NULL, NULL),
('371625746', 'W12020595', 'W12020595', 'UT01', 'MountainStar Cardiology St Marks', 'Sally', 'D', 'Sharp', 'MD', 'Cardiovascular Disease', NULL, NULL, NULL, 'B', 'PO Box 741729', 'Atlanta', 'Fulton', 'GA', '30384', '8012663418', '8012664174', 'PO Box 741729', 'Atlanta', 'Fulton', 'GA', '30384', '8012663418', '8012664174', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1841282787', 0, 'N', 0, '2012-06-28', NULL, NULL, 0, 0, NULL, NULL),
('770701557', 'W12020596', 'W12020596', 'UT01', 'MountainStar Jordan Family Health', 'Caryn', 'M', 'Slack', 'MD', 'Family Practice', '', '', NULL, 'O', '8846 S Redwood Rd Ste E-121', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015691999', '8015692001', '8846 S Redwood Rd Ste E-121', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015691999', '8015692001', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1689619124', 0, 'N', 0, '2014-04-10', NULL, NULL, 40.5911, -111.939, NULL, NULL),
('770701557', 'W12020597', 'W12020597', 'UT01', 'MountainStar Jordan Family Health', 'Caryn', 'M', 'Slack', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 198560', 'Atlanta', 'Fulton', 'GA', '30384', '8015691999', '8015692001', 'PO Box 198560', 'Atlanta', 'Fulton', 'GA', '30384', '8015691999', '8015692001', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1689619124', 0, 'N', 0, '2014-04-10', NULL, NULL, 0, 0, NULL, NULL),
('770701557', 'W12020598', 'W12020598', 'UT01', 'Alta Internal Medicine', 'Barbara', 'E', 'Smith-Holmen', 'NP', 'Family Practice', '', '', NULL, 'O', '74 Kimballs Ln Ste 300', 'Draper', 'Salt Lake', 'UT', '84020', '8015720311', '8015711369', '74 Kimballs Ln Ste 300', 'Draper', 'Salt Lake', 'UT', '84020', '8015720311', '8015711369', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1568665784', 0, 'N', 0, '2013-07-25', NULL, NULL, 40.537, -111.889, NULL, NULL),
('770701557', 'W12020599', 'W12020599', 'UT01', 'Alta Internal Medicine', 'Barbara', 'E', 'Smith-Holmen', 'NP', 'Family Practice', '', '', NULL, 'B', 'PO Box 198560', 'Atlanta', 'Fulton', 'GA', '30384', '6153737600', '8015711369', 'PO Box 198560', 'Atlanta', 'Fulton', 'GA', '30384', '6153737600', '8015711369', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1568665784', 0, 'N', 0, '2013-07-25', NULL, NULL, 0, 0, NULL, NULL),
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('161767581', 'W12020601', 'W12020601', 'UT01', 'Far West Family Medicine', 'Casey', 'L', 'Stelter', 'MD', 'Family Practice', '', '', NULL, 'O', '2850 N 2000 W Ste 101', 'Ogden', 'Weber', 'UT', '84404', '8017311222', '8017311666', '2850 N 2000 W Ste 101', 'Ogden', 'Weber', 'UT', '84404', '8017311222', '8017311666', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1073607222', 0, 'N', 0, '2013-08-19', NULL, NULL, 41.3105, -112.028, NULL, NULL),
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('770701557', 'W12020606', 'W12020606', 'UT01', 'Lone Peak Family Medicine', 'Breony', '', 'Stoddard', 'PA', 'Family Practice', '', '', NULL, 'B', 'PO Box 198560', 'Atlanta', 'Fulton', 'GA', '30384', '8006613365', '8015769800', 'PO Box 198560', 'Atlanta', 'Fulton', 'GA', '30384', '8006613365', '8015769800', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1578711057', 0, 'N', 0, '2013-07-09', NULL, NULL, 0, 0, NULL, NULL),
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('200133012', 'W12020625', 'W12020625', 'UT01', 'Lakeview OB/GYN Clinic', 'Nathan', 'C', 'Ward', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 409836', 'Atlanta', 'Fulton', 'GA', '30384', '8006613365', NULL, 'PO Box 409836', 'Atlanta', 'Fulton', 'GA', '30384', '8006613365', '          ', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'Lakeview Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1134114473', 0, 'Y', 0, '2013-11-11', NULL, NULL, 0, 0, NULL, NULL),
('611572907', 'W12020626', 'W12020626', 'UT01', 'Mountain Star Medical Group', 'Nadya', 'P', 'Wayment', 'MD', 'Family Practice', '', '', NULL, 'O', '5405 S 500 E Ste 100', 'Ogden', 'Weber', 'UT', '84405', '8014757966', '', '5405 S 500 E Ste 100', 'Ogden', 'Weber', 'UT', '84405', '8014757966', '', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1821274655', 0, 'N', 0, '2014-07-25', NULL, NULL, 41.1655, -111.969, NULL, NULL),
('611572907', 'W12020627', 'W12020627', 'UT01', 'Mountain Star Medical Group', 'Nadya', 'P', 'Wayment', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 405714', 'Atlanta', 'Fulton', 'GA', '30384', '8014757966', '', 'PO Box 405714', 'Atlanta', 'Fulton', 'GA', '30384', '8014757966', '', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1821274655', 0, 'N', 0, '2014-07-25', NULL, NULL, 0, 0, NULL, NULL),
('161767581', 'W12020628', 'W12020628', 'UT01', 'MountainStar Urgent Care at Layton Family Medicine', 'Jonathan', 'A', 'Weeks', 'MD', 'Family Practice', '', '', NULL, 'O', '2950 N Church St Ste 200', 'Layton', 'Davis', 'UT', '84040', '8015469441', NULL, '2950 N Church St Ste 200', 'Layton', 'Davis', 'UT', '84040', '8015469441', '          ', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1649364803', 0, 'N', 0, '2014-02-26', NULL, NULL, 41.1009, -111.939, NULL, NULL),
('770701557', 'W12020629', 'W12020629', 'UT01', 'MountainStar Jordan Family Health', 'Garett', 'R', 'Williams', 'MD', 'Family Medicine', '', '', NULL, 'O', '8846 S Redwood Rd Ste E-121', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015691999', '8015692001', '8846 S Redwood Rd Ste E-121', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015691999', '8015692001', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1982866687', 0, 'N', 0, '2014-05-30', NULL, NULL, 40.5911, -111.939, NULL, NULL),
('770701557', 'W12020630', 'W12020630', 'UT01', 'MountainStar Jordan Family Health', 'Garett', 'R', 'Williams', 'MD', 'Family Medicine', '', '', NULL, 'B', 'PO Box 198560', 'Atlanta', 'Fulton', 'GA', '30384', '8015691999', '8015692001', 'PO Box 198560', 'Atlanta', 'Fulton', 'GA', '30384', '8015691999', '8015692001', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1982866687', 0, 'N', 0, '2014-05-30', NULL, NULL, 0, 0, NULL, NULL),
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('200133012', 'W12020632', 'W12020632', 'UT01', 'Lakeview OB/GYN Clinic', 'Laura', 'M', 'Zaugg', 'CNM', 'Family Practice', '', '', NULL, 'O', '620 E Medical Dr Ste 340', 'Bountiful', 'Davis', 'UT', '84010', '8012992229', NULL, '620 E Medical Dr Ste 340', 'Bountiful', 'Davis', 'UT', '84010', '8012992229', '          ', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'Lakeview Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1598831604', 0, 'N', 0, '2012-06-28', NULL, NULL, 40.8869, -111.869, NULL, NULL),
('200133012', 'W12020633', 'W12020633', 'UT01', 'Lakeview OB/GYN Clinic', 'Laura', 'M', 'Zaugg', 'CNM', 'Family Practice', '', '', NULL, 'B', 'PO Box 281721', 'Atlanta', 'Fulton', 'GA', '30384', '8012992229', NULL, 'PO Box 281721', 'Atlanta', 'Fulton', 'GA', '30384', '8012992229', '          ', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'Lakeview Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1598831604', 0, 'N', 0, '2012-06-28', NULL, NULL, 0, 0, NULL, NULL),
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('870767026', 'W12020650', 'W12020650', 'ID01', 'West Valley Medical Group', 'Kimberly', 'E', 'Drewrey', 'NP', 'Family Practice', '', '', NULL, 'B', 'PO Box 277976', 'Atlanta', 'Fulton', 'GA', '30384', '2087955075', '2084426520', 'PO Box 277976', 'Atlanta', 'Fulton', 'GA', '30384', '2087955075', '2084426520', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-07-01', '2012-08-19', 0, 0, 0, 'West Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1922388727', 0, 'N', 0, '2013-11-12', NULL, NULL, 0, 0, NULL, NULL),
('870767026', 'W12020651', 'W12020651', 'ID01', 'Caldwell Internal Medicine Group', 'Steven', 'T', 'Koga', 'MD', 'Internal Medicine', '', '', NULL, 'O', '211 E Logan St Ste 201', 'Caldwell', 'Canyon', 'ID', '83605', '2084594667', NULL, '211 E Logan St Ste 201', 'Caldwell', 'Canyon', 'ID', '83605', '2084594667', '          ', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-07-01', '2012-08-19', 0, 0, 0, 'West Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1144275512', 0, 'N', 0, '2013-08-16', NULL, NULL, 43.6554, -116.697, NULL, NULL),
('870767026', 'W12020652', 'W12020652', 'ID01', 'Caldwell Internal Medicine Group', 'Steven', 'T', 'Koga', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 277976', 'Atlanta', 'Fulton', 'GA', '30384', '2084594667', NULL, 'PO Box 277976', 'Atlanta', 'Fulton', 'GA', '30384', '2084594667', '          ', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-07-01', '2012-08-19', 0, 0, 0, 'West Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1144275512', 0, 'N', 0, '2013-08-16', NULL, NULL, 0, 0, NULL, NULL),
('870767026', 'W12020653', 'W12020653', 'ID01', 'Caldwell Medical Clinics', 'Joe', 'M', 'Llenos', 'MD', 'Family Practice', '', '', NULL, 'O', '211 E Logan St Ste 303', 'Caldwell', 'Canyon', 'ID', '83605', '2084594667', NULL, '211 E Logan St Ste 303', 'Caldwell', 'Canyon', 'ID', '83605', '2084594667', '', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-07-01', '2012-08-19', 0, 0, 0, 'West Valley Medical Center', '', '', '', 'HCFA|UB|', '1003073560', 0, 'N', 0, '2014-06-16', NULL, NULL, 43.6554, -116.697, NULL, NULL),
('870767026', 'W12020654', 'W12020654', 'ID01', 'Caldwell Medical Clinics', 'Joe', 'M', 'Llenos', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 277976', 'Atlanta', 'Fulton', 'GA', '30384', '2084594667', NULL, 'PO Box 277976', 'Atlanta', 'Fulton', 'GA', '30384', '2084594667', '', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-07-01', '2012-08-19', 0, 0, 0, 'West Valley Medical Center', '', '', '', 'HCFA|UB|', '1003073560', 0, 'N', 0, '2014-06-16', NULL, NULL, 0, 0, NULL, NULL),
('870767026', 'W12020655', 'W12020655', 'ID01', 'West Valley Medical Group', 'Suzanne ', 'F', 'McConnaughey', 'DO', 'Internal Medicine', '', '', NULL, 'O', '211 E Logan St Ste 203 and 303', 'Caldwell', 'Canyon', 'ID', '83605', '2084594667', '2084593372', '211 E Logan St Ste 203 and 303', 'Caldwell', 'Canyon', 'ID', '83605', '2084594667', '2084593372', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-07-01', '2012-08-19', 0, 0, 0, 'West Valley Medical Center', '', '', '', 'HCFA|UB|', '1538142609', 0, 'N', 0, '2014-04-04', NULL, NULL, 43.6554, -116.697, 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
('870767026', 'W12020656', 'W12020656', 'ID01', 'West Valley Medical Group', 'Suzanne ', 'F', 'McConnaughey', 'DO', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 277976', 'Atlanta', 'Fulton', 'GA', '30384', '2084594667', '2084593372', 'PO Box 277976', 'Atlanta', 'Fulton', 'GA', '30384', '2084594667', '2084593372', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-07-01', '2012-08-19', 0, 0, 0, 'West Valley Medical Center', '', '', '', 'HCFA|UB|', '1538142609', 0, 'N', 0, '2014-04-04', NULL, NULL, 0, 0, NULL, NULL),
('870767026', 'W12020657', 'W12020657', 'ID01', 'Caldwell Internal Medicine Group', 'Steven', 'B', 'Ollie', 'MD', 'Family Practice', '', '', NULL, 'O', '211 E Logan St Ste 303', 'Caldwell', 'Canyon', 'ID', '83605', '2084594667', NULL, '211 E Logan St Ste 303', 'Caldwell', 'Canyon', 'ID', '83605', '2084594667', '          ', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-07-01', '2012-08-19', 0, 0, 0, 'West Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1568432888', 0, 'N', 0, '2013-11-12', NULL, NULL, 43.6554, -116.697, NULL, NULL),
('870767026', 'W12020658', 'W12020658', 'ID01', 'Caldwell Internal Medicine Group', 'Steven', 'B', 'Ollie', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 277976', 'Atlanta', 'Fulton', 'GA', '30384', '2084594667', NULL, 'PO Box 277976', 'Atlanta', 'Fulton', 'GA', '30384', '2084594667', '          ', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-07-01', '2012-08-19', 0, 0, 0, 'West Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1568432888', 0, 'N', 0, '2013-11-12', NULL, NULL, 0, 0, NULL, NULL),
('870767026', 'W12020659', 'W12020659', 'ID01', 'Caldwell Medical Clinics', 'Melissa', 'L', 'Park', 'MD', 'Internal Medicine', '', '', NULL, 'O', '211 E Logan St Ste 303', 'Caldwell', 'Canyon', 'ID', '83605', '2084594667', NULL, '211 E Logan St Ste 303', 'Caldwell', 'Canyon', 'ID', '83605', '2084594667', '', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-07-01', '2012-08-19', 0, 0, 0, 'West Valley Medical Center', '', '', '', 'HCFA|UB|', '1386676039', 0, 'N', 0, '2014-06-26', NULL, NULL, 43.6554, -116.697, NULL, NULL),
('870767026', 'W12020660', 'W12020660', 'ID01', 'Caldwell Medical Clinics', 'Melissa', 'L', 'Park', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 277976', 'Atlanta', 'Fulton', 'GA', '30384', '2084594667', NULL, 'PO Box 277976', 'Atlanta', 'Fulton', 'GA', '30384', '2084594667', '', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-07-01', '2012-08-19', 0, 0, 0, 'West Valley Medical Center', '', '', '', 'HCFA|UB|', '1386676039', 0, 'N', 0, '2014-06-26', NULL, NULL, 0, 0, NULL, NULL),
('870767026', 'W12006742', 'W12006742', 'ID01', 'Caldwell Internal Medicine Group', 'John', '', 'Pearce', 'DO', 'Family Practice', '', '', NULL, 'O', '16459 M Midland Blvd', 'Nampa', 'Canyon', 'ID', '83687', '2087955075', NULL, '16459 M Midland Blvd', 'Nampa', 'Canyon', 'ID', '83687', '2087955075', '          ', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2010-09-01', '2012-06-30', 0, 0, 0, 'West Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1306880844', 0, 'N', 0, '2014-03-20', NULL, NULL, 43.6116, -116.593, NULL, NULL),
('870767026', 'W12020661', 'W12020661', 'ID01', 'Caldwell Internal Medicine Group', 'John', '', 'Pearce', 'DO', 'Family Practice', '', '', NULL, 'O', '16459 M Midland Blvd', 'Nampa', 'Canyon', 'ID', '83687', '2087955075', NULL, '16459 M Midland Blvd', 'Nampa', 'Canyon', 'ID', '83687', '2087955075', '          ', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-07-01', '2012-08-19', 0, 0, 0, 'West Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1306880844', 0, 'N', 0, '2014-03-20', NULL, NULL, 43.6116, -116.593, NULL, NULL),
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('870767026', 'W12020663', 'W12020663', 'ID01', 'Caldwell Internal Medicine Group', 'Carolyn', '', 'Rees', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 277976', 'Atlanta', 'Fulton', 'GA', '30384', '2084594667', NULL, 'PO Box 277976', 'Atlanta', 'Fulton', 'GA', '30384', '2084594667', '', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-07-01', '2012-08-19', 0, 0, 0, 'West Valley Medical Center', '', '', '', 'HCFA|UB|', '1386683431', 0, 'N', 0, '2014-04-04', NULL, NULL, 0, 0, NULL, NULL),
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('870767026', 'W12020668', 'W12020668', 'ID01', 'West Valley Medical Group', 'Robert', 'S', 'Thacker', 'NP', 'Family Practice', '', '', NULL, 'B', 'PO Box 277976', 'Atlanta', 'Fulton', 'GA', '30384', '2087955075', '2084426520', 'PO Box 277976', 'Atlanta', 'Fulton', 'GA', '30384', '2087955075', '2084426520', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-07-01', '2012-08-19', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1124309224', 0, 'N', 0, '2012-06-28', NULL, NULL, 0, 0, NULL, NULL),
('870675415', 'W12001708', 'W12001708', 'UT01', 'University Health Care', 'Amy', 'G', 'Frame', '', 'Physical Therapy', '', '', NULL, 'o', '520 Wakara Way Ste 302', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8017567200', NULL, '520 Wakara Way Ste 302', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8017567200', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2010-03-23', '2012-06-15', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1518297746', 0, 'N', 0, '2012-06-28', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12020671', 'W12020671', 'UTIHCPHY', 'North Canyon Family Practice', 'Cathie', 'R', 'Fox', 'PhD', 'Mental Health', 'Psychology', '', NULL, 'O', '3200 N Canyon Rd Ste D', 'Provo', 'Utah', 'UT', '84604', '8013733300', '8013547900', '3200 N Canyon Rd Ste D', 'Provo', 'Utah', 'UT', '84604', '8013733300', '8013547900', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2012-06-11', '2012-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1124166582', 0, 'N', 0, '2012-07-06', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12020673', 'W12020673', 'UTIHCPHY', 'Dixie Maternal Fetal Medicine', 'Kurt', 'A', 'Hales', 'MD', 'Obstetrics and Gynecology', 'Maternal Fetal Medicine', '', NULL, 'O', '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356884770', '4356884835', '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356884770', '4356884835', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2012-06-11', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1811952617', 0, 'N', 0, '2012-06-28', NULL, NULL, 37.0989, -113.575, NULL, NULL),
('942854057', 'W12020675', 'W12020675', 'UTIHCPHY', 'Park City Allergy Clinic', 'Richard', 'W', 'Hendershot', 'MD', 'Internal Medicine', 'Allergy and Immunology', '', NULL, 'O', '750 Round Valley Dr Ste 101A', 'Park City', 'Summit', 'UT', '84060', '4356586622', '8013553746', '750 Round Valley Dr Ste 101A', 'Park City', 'Summit', 'UT', '84060', '4356586622', '8013553746', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2012-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1518916782', 0, 'N', 0, '2012-06-28', NULL, NULL, 40.6855, -111.466, NULL, NULL),
('942854057', 'W12020780', 'W12020780', 'UTIHCPHY', 'Holladay Pediatrics', 'Jodi', '', 'Groot', 'APRN', 'Obstetrics and Gynecology', 'Mental Health', '', NULL, 'O', '2180 E 4500 S Ste 210', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8019474242', '8012728579', '2180 E 4500 S Ste 210', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8019474242', '8012728579', 'IHCAPRN', '', '', '0.00', '100.00', '0.00', 8, '2012-07-01', '2012-12-29', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1942488002', 0, 'N', 0, '2013-05-23', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12020678', 'W12020678', 'UTIHCPHY', 'Park City Sleep Disorders Clinic', 'Howard', 'M', 'Leaman', 'MD', 'Sleep Medicine', '', '', NULL, 'O', '750 Round Valley Dr Ste 101A', 'Park City', 'Summit', 'UT', '84060', '4356586621', '8014123160', '750 Round Valley Dr Ste 101A', 'Park City', 'Summit', 'UT', '84060', '4356586621', '8014123160', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2012-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1043316102', 0, 'N', 0, '2012-06-28', NULL, NULL, 40.6855, -111.466, NULL, NULL),
('942854057', 'W12020680', 'W12020680', 'UTIHCPHY', 'Utah Heart-Riverton', 'Jaime', 'D', 'Luna', 'PA-C', 'Cardiovascular Disease', '', '', NULL, 'O', '3741 W 12600 S Ste 160A', 'Riverton', 'Salt Lake', 'UT', '84065', '8015073500', '8018173503', '3741 W 12600 S Ste 160A', 'Riverton', 'Salt Lake', 'UT', '84065', '8015073500', '8018173503', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2011-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1790094357', 0, 'N', 0, '2012-06-28', NULL, NULL, 40.5222, -111.98, NULL, NULL),
('942854057', 'W12020684', 'W12020684', 'UTIHCPHY', 'Utah Heart', 'Jaime', 'D', 'Luna', 'PA-C', 'Cardiovascular Disease', '', '', NULL, 'O', '5169 Cottonwood St Ste 520', 'Murray', 'Salt Lake', 'UT', '84107', '8015073500', '8015073505', '5169 Cottonwood St Ste 520', 'Murray', 'Salt Lake', 'UT', '84107', '8015073500', '8015073505', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2011-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1790094357', 0, 'N', 0, '2012-06-28', NULL, NULL, 40.659, -111.894, NULL, NULL),
('942854057', 'W12020681', 'W12020681', 'UTIHCPHY', 'Utah Heart-LDSH', 'Jaime', 'D', 'Luna', 'PA-C', 'Cardiovascular Disease', '', '', NULL, 'O', '8th Ave And C St', 'Salt Lake City', 'Salt Lake', 'UT', '84143', '8015073500', '8014083909', '8th Ave And C St', 'Salt Lake City', 'Salt Lake', 'UT', '84143', '8015073500', '8014083909', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2011-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1790094357', 0, 'N', 0, '2012-06-28', NULL, NULL, 40.7785, -111.881, NULL, NULL),
('942854057', 'W12020683', 'W12020683', 'UTIHCPHY', 'Utah Heart-AVH', 'Jaime', 'D', 'Luna', 'PA-C', 'Cardiovascular Disease', '', '', NULL, 'O', '9690 S 1300 E Ste 200', 'Sandy', 'Salt Lake', 'UT', '84094', '8015073500', '8015013599', '9690 S 1300 E Ste 200', 'Sandy', 'Salt Lake', 'UT', '84094', '8015073500', '8015013599', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2011-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1790094357', 0, 'N', 0, '2012-06-28', NULL, NULL, 40.5743, -111.853, NULL, NULL),
('942854057', 'W12020685', 'W12020685', 'UTIHCPHY', 'Park City Sleep Disorders Clinic', 'Robert', 'L', 'Mazzola', 'MD', 'Sleep Medicine', 'Pulmonary', '', NULL, 'O', '750 Round Valley Dr Ste 101A', 'Park City', 'Summit', 'UT', '84060', '4356586621', '8014123160', '750 Round Valley Dr Ste 101A', 'Park City', 'Summit', 'UT', '84060', '4356586621', '8014123160', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2012-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1629142898', 0, 'N', 0, '2014-05-12', NULL, NULL, 40.6855, -111.466, NULL, NULL),
('942854057', 'W12020686', 'W12020686', 'UTIHCPHY', 'Cedar City Clinic', 'Wade', 'O', 'Milne', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '1303 N Main St Ste 3C', 'Cedar City', 'Iron', 'UT', '84720', '4358685500', '4358685504', '1303 N Main St Ste 3C', 'Cedar City', 'Iron', 'UT', '84720', '4358685500', '4358685504', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2012-06-29', '2012-06-30', 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1508843467', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12020688', 'W12020688', 'UTIHCPHY', 'Redrock Pediatrics', 'Mary', 'C', 'Murdock', 'PA-C', 'Pediatrics', '', '', NULL, 'O', '1380 E Medical Ctr Dr Ste 3100', 'St George', 'Washington', 'UT', '84790', '4352512740', '4352512741', '1380 E Medical Ctr Dr Ste 3100', 'St George', 'Washington', 'UT', '84790', '4352512740', '4352512741', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2012-06-26', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1023026192', 0, 'N', 0, '2012-06-28', NULL, NULL, 37.0998, -113.554, NULL, NULL),
('942854057', 'W12020691', 'W12020691', 'UTIHCPHY', 'Bountiful Clinic', 'Lori', '', 'Neeleman', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '390 N Main St', 'Bountiful', 'Davis', 'UT', '84010', '8012941000', '8012928369', '390 N Main St', 'Bountiful', 'Davis', 'UT', '84010', '8012941000', '8012928369', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2012-06-08', '2012-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1992000145', 0, 'N', 0, '2013-05-30', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12020690', 'W12020690', 'UTIHCPHY', 'Bryner Clinic', 'Lori', '', 'Neeleman', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '525 E 100 S Ste 500', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015197100', '8015213091', '525 E 100 S Ste 500', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015197100', '8015213091', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2012-06-08', '2012-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1992000145', 0, 'N', 0, '2013-05-30', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12020692', 'W12020692', 'UTIHCPHY', 'Saratoga Springs Family Practice', 'Robert', '', 'Patterson', 'MD', 'General Surgery', '', '', NULL, 'O', '354 W State Rd 73', 'Lehi', 'Utah', 'UT', '84043', '8017664567', '8017669734', '354 W State Rd 73', 'Lehi', 'Utah', 'UT', '84043', '8017664567', '8017669734', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2012-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1285723114', 0, 'N', 0, '2012-06-28', NULL, NULL, 40.4071, -111.921, NULL, NULL),
('942854057', 'W12020693', 'W12020693', 'UTIHCPHY', 'Redrock Spine & Neurosurgery Clinic', 'Judith', 'A', 'Sampson', 'APRN', 'Family Practice', '', '', NULL, 'O', '652 S Medical Ctr Dr Ste 115', 'St George', 'Washington', 'UT', '84790', '4352513700', '4352513701', '652 S Medical Ctr Dr Ste 115', 'St George', 'Washington', 'UT', '84790', '4352513700', '4352513701', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2012-05-30', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1538112214', 0, 'N', 0, '2012-06-28', NULL, NULL, 37.0498, -113.574, NULL, NULL),
('942854057', 'W12020694', 'W12020694', 'UTIHCPHY', 'Park City Sleep Disorders Clinic', 'Kevin', 'C', 'Shilling', 'MD', 'Pulmonary', 'Sleep Medicine', '', NULL, 'O', '750 Round Valley Dr Ste 101A', 'Park City', 'Summit', 'UT', '84060', '4356586621', '8014123160', '750 Round Valley Dr Ste 101A', 'Park City', 'Summit', 'UT', '84060', '4356586621', '8014123160', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2012-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1144233214', 0, 'N', 0, '2012-06-28', NULL, NULL, 40.6855, -111.466, NULL, NULL),
('942854057', 'W12020696', 'W12020696', 'UTIHCPHY', 'Heber Valley Clinic', 'Maureen', 'B', 'Smith', 'APRN', 'Family Practice', '', '', NULL, 'O', '1473 S Hwy 40 Ste E', 'Heber City', 'Wasatch', 'UT', '84032', '4356574400', '4356574460', '1473 S Hwy 40 Ste E', 'Heber City', 'Wasatch', 'UT', '84032', '4356574400', '4356574460', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2012-06-01', '2013-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1730111311', 0, 'N', 0, '2013-04-15', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12020698', 'W12020698', 'UTIHCPHY', 'Sunset Family Practice', 'Steven', 'J', 'Temple', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1739 W Sunset Blvd', 'St George', 'Washington', 'UT', '84770', '4356346000', '4356346033', '1739 W Sunset Blvd', 'St George', 'Washington', 'UT', '84770', '4356346000', '4356346033', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2012-06-11', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1841238987', 0, 'N', 0, '2013-05-23', NULL, NULL, 37.1227, -113.62, NULL, NULL),
('942854057', 'W12020700', 'W12020700', 'UTIHCPHY', 'Budge Clinic Internal Medicine', 'Lori', 'S', 'Trauntvein', 'APRN', 'Family Practice', '', '', NULL, 'O', '1350 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357921980', '4357530401', '1350 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357921980', '4357530401', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2012-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1790795102', 0, 'N', 0, '2012-06-28', NULL, NULL, 41.7565, -111.821, NULL, NULL),
('942854057', 'W12020701', 'W12020701', 'UTIHCPHY', 'Sevier Valley Clinic', 'Gary', 'R', 'Zeluff', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '70 E 1000 N', 'Richfield', 'Sevier', 'UT', '84701', '4358930580', '4358968420', '70 E 1000 N', 'Richfield', 'Sevier', 'UT', '84701', '4358930580', '4358968420', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2012-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1861557688', 0, 'N', 0, '2012-06-28', NULL, NULL, 38.8608, -111.967, NULL, NULL),
('870636554', 'W12020702', 'W12020702', 'UTDT01', '', 'Walter', '', 'Meden', 'DDS', 'Dentist', '', '', NULL, 'O', '11762 S State St Ste 300', 'Draper', 'Salt Lake', 'UT', '84020', '8015726262', NULL, '11762 S State St Ste 300', 'Draper', 'Salt Lake', 'UT', '84020', '8015726262', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2012-05-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000007542', 0, 'N', 0, '2012-06-28', NULL, NULL, 0, 0, NULL, NULL),
('201939139', 'W12020704', 'W12020704', 'ID01', 'Micron Family Health Center', 'Stefanie', 'J', 'Magee', 'PA', 'Orthopedic Surgery', '', '', NULL, 'O', '8000 S Federal Way', 'Boise', 'Ada', 'ID', '83716', '2083685656', NULL, '8000 S Federal Way', 'Boise', 'Ada', 'ID', '83716', '2083685656', '          ', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-07-25', '2012-08-10', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1639403041', 0, 'Y', 0, '2013-11-22', NULL, NULL, 43.5301, -116.149, NULL, NULL),
('830258707', 'W12020705', 'W12020705', 'WY01', 'Wyoming Surgical Associates', 'Lane ', '', 'Smothers', 'MD', 'General Surgery', '', '', NULL, 'O', '419 S Washington St Ste 102', 'Casper', 'Natrona', 'WY', '82601', '3075774220', '3072350931', '419 S Washington St Ste 102', 'Casper', 'Natrona', 'WY', '82601', '3075774220', '3072350931', '', '', '', '0.00', '12.00', '0.00', 3, '2012-06-15', NULL, 0, 0, 0, 'Wyoming Medical Center ', NULL, NULL, NULL, 'HCFA|UB|', '1043206485', 0, 'N', 0, '2012-10-09', NULL, NULL, 42.8464, -106.31, NULL, NULL),
('830258707', 'W12020706', 'W12020706', 'WYT2', 'Wyoming Surgical Associates', 'Lane ', '', 'Smothers', 'MD', 'General Surgery', '', '', NULL, 'O', '419 S Washington St Ste 102', 'Casper', 'Natrona', 'WY', '82601', '3075774220', '3072350931', '419 S Washington St Ste 102', 'Casper', 'Natrona', 'WY', '82601', '3075774220', '3072350931', '', '', '', '0.00', '12.00', '0.00', 3, '2012-06-15', NULL, 0, 0, 1, 'Wyoming Medical Center ', NULL, NULL, NULL, 'HCFA|UB|', '1043206485', 0, 'N', 0, '2012-10-09', NULL, NULL, 0, 0, NULL, NULL),
('870470026', 'W12020708', 'W12020708', 'UT01', '', 'Joanne', 'S', 'Hinson', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '4465 S 900 E Ste 275', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012726100', '8012726101', '4465 S 900 E Ste 275', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012726100', '8012726101', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', '2012-07-01', 0, 0, 0, 'Salt Lake Regional Medical Center', '', '', '', 'HCFA|UB|', '1881789212', 0, 'N', 0, '2012-12-11', NULL, NULL, 0, 0, NULL, NULL),
('201797321', 'W12020711', 'W12020711', 'UTDT01', 'Easton Dental Care', 'Robert Jeff', '', 'Easton', 'DMD', 'Dentist', '', '', NULL, 'O', '850 E 9400 S', 'Sandy', 'Salt Lake', 'UT', '84094', '8015713400', NULL, '850 E 9400 S', 'Sandy', 'Salt Lake', 'UT', '84094', '8015713400', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2012-06-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000009890', 0, 'N', 0, '2012-06-28', NULL, NULL, 0, 0, NULL, NULL),
('870678993', 'W12020712', 'W12020712', 'UT01', 'Families First Pediatrics', 'Barbara', 'E', 'Bean', 'MD', 'Pediatrics', '', '', NULL, 'O', '1268 W S Jordan Pkwy Ste 201', 'South Jordan', 'Salt Lake', 'UT', '84095', '8012549700', '8012549755', '1268 W S Jordan Pkwy Ste 201', 'South Jordan', 'Salt Lake', 'UT', '84095', '8012549700', '8012549755', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-08-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1659353472', 0, 'N', 0, '2014-01-06', NULL, NULL, 40.5622, -111.928, NULL, NULL),
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('870678993', 'W12020714', 'W12020714', 'UT01', 'Families First Pediatrics', 'Barbara', 'E', 'Bean', 'MD', 'Pediatrics', '', '', NULL, 'B', 'PO Box 95868', 'South Jordan', 'Salt Lake', 'UT', '84095', '          ', NULL, 'PO Box 95868', 'South Jordan', 'Salt Lake', 'UT', '84095', '          ', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-08-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1659353472', 0, 'N', 0, '2014-01-06', NULL, NULL, 0, 0, NULL, NULL),
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('861078690', 'W12020716', 'W12020716', 'WYT1', 'Absaroka Orthopedics', 'Gregory', '', 'Clark', 'PA', 'Orthopedic Surgery', '', '', NULL, 'O', '424 Yellowstone Ave', 'Cody', 'Park', 'WY', '82414', '3075277100', '3075277145', '424 Yellowstone Ave', 'Cody', 'Park', 'WY', '82414', '3075277100', '3075277145', '', '', '', '0.00', '25.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1760471726', 0, 'N', 0, '2012-12-28', NULL, NULL, 0, 0, NULL, NULL),
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('272853029', 'W12020720', 'W12020720', 'UTDT01', 'Kids Town Pediatric Dentistry', 'Renn', '', 'Veater', 'DMD', 'Pedodontist', '', '', NULL, 'O', '3540 W 6000 S Ste 200', 'Roy', 'Weber', 'UT', '84067', '8012173359', NULL, '3540 W 6000 S Ste 200', 'Roy', 'Weber', 'UT', '84067', '8012173359', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2012-06-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1548411598', 0, 'N', 0, '2013-09-25', NULL, NULL, 0, 0, NULL, NULL),
('841394139', 'W12020721', 'W12020721', 'ID01', 'Southwest Idaho ENT ', 'DelRay', '', 'Maughan', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '900 N Liberty St Ste 400', 'Boise', 'Ada', 'ID', '83704', '2083673320', '2083677474', '900 N Liberty St Ste 400', 'Boise', 'Ada', 'ID', '83704', '2083673320', '2083677474', 'IDSWIENT', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-10-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1649253188', 0, 'N', 0, '2014-01-24', NULL, NULL, 43.6133, -116.259, NULL, NULL),
('820470652', 'W12020722', 'W12020722', 'ID02', 'Riverside Rehab', 'Sandra', 'E', 'Phillips', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '7711 W Riverside Dr', 'Garden City', 'Ada', 'ID', '83714', '2088538536', '2088532929', '7711 W Riverside Dr', 'Garden City', 'Ada', 'ID', '83714', '2088538536', '2088532929', 'IDMA', '', '', '0.00', '35.00', '0.00', 3, '2012-08-01', '2013-02-14', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1922312776', 0, 'N', 0, '2014-03-19', NULL, NULL, 0, 0, NULL, NULL),
('452676603', 'W12020726', 'W12020726', 'UTDT01', 'Noble Family Dental', 'Andrew', '', 'Noble', 'DDS', 'Dentist', '', '', NULL, 'O', '321 E 300 N Ste A', 'American Fork', 'Utah', 'UT', '84003', '8017637655', NULL, '321 E 300 N Ste A', 'American Fork', 'Utah', 'UT', '84003', '8017637655', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2012-06-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000009892', 0, 'N', 0, '2012-11-28', NULL, NULL, 0, 0, NULL, NULL),
('820484941', 'W12020725', 'W12020725', 'ID01', 'Sane Solutions', 'Wendi', 'L', 'McCutchen', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '408 N Allumbaugh', 'Boise', 'Ada', 'ID', '83704', '2083239600', '2083434993', '408 N Allumbaugh', 'Boise', 'Ada', 'ID', '83704', '2083239600', '2083434993', 'IDMA', '', '', '0.00', '35.00', '0.00', 8, '2012-08-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1174768345', 0, 'N', 0, '2013-10-18', NULL, NULL, 0, 0, NULL, NULL),
('820484941', 'W12020727', 'W12020727', 'ID01', 'Center for Hope and Healing', 'Wendi', 'L', 'McCutchen', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'M', '4801 Callister', 'Boise', 'Ada', 'ID', '83703', '2083430441', '2083434993', '4801 Callister', 'Boise', 'Ada', 'ID', '83703', '2083430441', '2083434993', 'IDMA', '', '', '0.00', '35.00', '0.00', 8, '2012-08-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1174768345', 0, 'N', 0, '2013-10-18', NULL, NULL, 0, 0, NULL, NULL),
('820484941', 'W12020723', 'W12020723', 'ID01', 'Center for Hope and Healing', 'Wendi', 'L', 'McCutchen', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '660 E Franklin Rd Ste 260', 'Meridian', 'Ada', 'ID', '83646', '2083430441', '2083434993', '660 E Franklin Rd Ste 260', 'Meridian', 'Ada', 'ID', '83646', '2083430441', '2083434993', 'IDMA', '', '', '0.00', '35.00', '0.00', 8, '2012-08-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1174768345', 0, 'N', 0, '2013-10-18', NULL, NULL, 0, 0, NULL, NULL),
('820484941', 'W12020728', 'W12020728', 'ID01', 'Center for Hope and Healing', 'Wendi', 'L', 'McCutchen', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'B', 'PO Box 16820', 'Boise', 'Ada', 'ID', '83715', '2083430441', '2083434993', 'PO Box 16820', 'Boise', 'Ada', 'ID', '83715', '2083430441', '2083434993', 'IDMA', '', '', '0.00', '35.00', '0.00', 8, '2012-08-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1174768345', 0, 'N', 0, '2013-10-18', NULL, NULL, 0, 0, NULL, NULL),
('453617566', 'W12020729', 'W12020729', 'UT01', 'Davis Endocrinology and Diabeties ', 'Brett', 'M', 'Rawlins', 'NP', 'Nurse Practitioner', '', '', NULL, 'O', '1492 W Antelope Dr Ste 115', 'Layton', 'Davis', 'UT', '84041', '8017768080', '8017762888', '1492 W Antelope Dr Ste 115', 'Layton', 'Davis', 'UT', '84041', '8017768080', '8017762888', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-08-01', NULL, 0, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1295983831', 0, 'N', 0, '2012-08-03', NULL, NULL, 41.0893, -111.993, NULL, NULL),
('453617566', 'W12020730', 'W12020730', 'UT01', 'Davis Endocrinology and Diabeties ', 'Brett', 'M', 'Rawlins', 'NP', 'Nurse Practitioner', '', '', NULL, 'B', 'PO Box 268', 'Bountiful', 'Davis', 'UT', '84011', '8012962113', '8012961715', 'PO Box 268', 'Bountiful', 'Davis', 'UT', '84011', '8012962113', '8012961715', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-08-01', NULL, 0, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1295983831', 0, 'N', 0, '2012-08-03', NULL, NULL, 0, 0, NULL, NULL),
('870577952', 'W12020731', 'W12020731', 'UT01', 'Western Newborn Specialists', 'Cameron', 'H', 'Swinton', 'MD', 'Pediatrics', '', '', NULL, 'O', '1200 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012962113', '8012961715', '1200 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012962113', '8012961715', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-11-01', NULL, 0, 0, 0, 'St Marks Hospital', 'Jordan Valley Medical Center', '', '', 'HCFA|UB|', '1780856500', 0, 'N', 0, '2012-10-12', NULL, NULL, 40.6871, -111.856, NULL, NULL),
('870577952', 'W12020732', 'W12020732', 'UT01', 'Western Newborn Specialists', 'Cameron', 'H', 'Swinton', 'MD', 'Pediatrics', '', '', NULL, 'B', 'PO Box 520691', 'Salt Lake City', 'Salt Lake', 'UT', '84152', '8012962113', '8012961715', 'PO Box 520691', 'Salt Lake City', 'Salt Lake', 'UT', '84152', '8012962113', '8012961715', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-11-01', NULL, 0, 0, 0, 'St Marks Hospital', 'Jordan Valley Medical Center', '', '', 'HCFA|UB|', '1780856500', 0, 'N', 0, '2012-10-12', NULL, NULL, 0, 0, NULL, NULL),
('820511905', 'W12020733', 'W12020733', 'ID01', 'Treasure Valley Psychological Services', 'William', 'M', 'Tandy', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '6003 Overland Rd Ste 301', 'Boise', 'Ada', 'ID', '83709', '2086728699', '2086729308', '6003 Overland Rd Ste 301', 'Boise', 'Ada', 'ID', '83709', '2086728699', '2086729308', 'IDPHD', '', '', '0.00', '35.00', '0.00', 6, '2012-08-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1407081516', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('870299862', 'W12020735', 'W12020735', 'UTMH1', 'LDS Family Services', 'Alisha', '', 'Thomas', 'LCSW', 'Mental Health', '', '', NULL, 'B', '120 N 200 W', 'Salt Lake City', 'Salt Lake', 'UT', '84103', '8012940578', NULL, '120 N 200 W', 'Salt Lake City', 'Salt Lake', 'UT', '84103', '8012940578', '          ', 'ma', '', '', '0.00', '35.00', '0.00', 8, '2012-08-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|DEN|', '1730393471', 0, 'N', 0, '2013-03-25', NULL, NULL, 0, 0, NULL, NULL),
('870299862', 'W12020734', 'W12020734', 'UTMH1', 'LDS Family Services', 'Alisha', '', 'Thomas', 'LCSW', 'Mental Health', '', '', NULL, 'O', '94 E Pages Ln Ste A', 'Centerville', 'Davis', 'UT', '84014', '8012940578', NULL, '94 E Pages Ln Ste A', 'Centerville', 'Davis', 'UT', '84014', '8012940578', '          ', 'MA', '', '', '0.00', '35.00', '0.00', 8, '2012-08-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1730393471', 0, 'N', 0, '2013-03-25', NULL, NULL, 0, 0, NULL, NULL),
('870179340', 'W12020737', 'W12020737', 'UT01', 'Standard Optical', 'Ian', 'G', 'Whipple', 'OD', 'Optometry', '', '', NULL, 'O', '1901 Pkwy Blvd', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8019720203', NULL, '1901 Pkwy Blvd', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8019720203', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-08-01', '2012-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1487940466', 0, 'N', 0, '2013-05-08', NULL, NULL, 0, 0, NULL, NULL),
('870179340', 'W12020736', 'W12020736', 'UT01', 'Standard Optical', 'Ian', 'G', 'Whipple', 'OD', 'Optometry', '', '', NULL, 'O', '460 N 325 E', 'Ogden', 'Weber', 'UT', '84404', '8018279000', NULL, '460 N 325 E', 'Ogden', 'Weber', 'UT', '84404', '8018279000', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-08-01', '2012-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1487940466', 0, 'N', 0, '2013-05-08', NULL, NULL, 0, 0, NULL, NULL),
('861078690', 'W12020738', 'W12020738', 'WY01', 'Absaroka Orthopedics', 'Jay', '', 'Winzenried', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '424 Yellowstone Ave', 'Cody', 'Park', 'WY', '82414', '3075277100', '3075277145', '424 Yellowstone Ave', 'Cody', 'Park', 'WY', '82414', '3075277100', '3075277145', '', '', '', '0.00', '25.00', '0.00', 3, '2012-08-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1083603047', 0, 'N', 0, '2013-03-11', NULL, NULL, 44.517, -109.083, NULL, NULL),
('861078690', 'W12020739', 'W12020739', 'WYT1', 'Absaroka Orthopedics', 'Jay', '', 'Winzenried', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '424 Yellowstone Ave', 'Cody', 'Park', 'WY', '82414', '3075277100', '3075277145', '424 Yellowstone Ave', 'Cody', 'Park', 'WY', '82414', '3075277100', '3075277145', '', '', '', '0.00', '25.00', '0.00', 3, '2012-08-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1083603047', 0, 'N', 0, '2013-03-11', NULL, NULL, 0, 0, NULL, NULL),
('800239738', 'W12004645', 'W12004645', 'UT01', 'Jordan Specialty Services', 'John', 'Edward', 'Butler', 'MD', 'Ear, Nose and Throat', NULL, NULL, NULL, 'O', '8846 S Redwood Rd Ste E121', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015691999', '8015692001', '8846 S Redwood Rd Ste E121', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015691999', '8015692001', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-09-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1598725350', 0, 'N', 0, '2012-07-02', NULL, NULL, 40.5911, -111.939, NULL, NULL),
('770701557', 'W12020740', 'W12020740', 'UT01', 'MountainStar Jordan Family Health', 'Bari', 'M', 'King', 'FNP', 'Family Practice', '', '', NULL, 'O', '8846 S Redwood Rd Ste E-121', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015691999', '8015692001', '8846 S Redwood Rd Ste E-121', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015691999', '8015692001', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1063445948', 0, 'N', 0, '2012-06-29', NULL, NULL, 40.5911, -111.939, NULL, NULL),
('770701557', 'W12020741', 'W12020741', 'UT01', 'MountainStar Jordan Family Health', 'Bari', 'M', 'King', 'FNP', 'Family Practice', '', '', NULL, 'B', 'PO Box 198560', 'Atlanta', 'Fulton', 'GA', '30384', '8015691999', '8015692001', 'PO Box 198560', 'Atlanta', 'Fulton', 'GA', '30384', '8015691999', '8015692001', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1063445948', 0, 'N', 0, '2012-06-29', NULL, NULL, 0, 0, NULL, NULL),
('770701557', 'W12020742', 'W12020742', 'UT01', 'MountainStar Jordan Family Health', 'Judith', 'L', 'Kirstein', 'MD', 'Family Practice', '', '', NULL, 'O', '8846 S Redwood Rd Ste E-121', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015691999', '8015692001', '8846 S Redwood Rd Ste E-121', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015691999', '8015692001', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', '2014-04-04', 0, 0, 0, 'St Marks Hospital', 'Jordan Valley Medical Center', 'Pioneer Valley Hospital', '', 'HCFA|UB|', '1275576027', 0, 'N', 0, '2014-04-09', NULL, NULL, 40.5911, -111.939, NULL, NULL),
('770701557', 'W12020743', 'W12020743', 'UT01', 'MountainStar Jordan Family Health', 'Judith', 'L', 'Kirstein', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 198560', 'Atlanta', 'Fulton', 'GA', '30384', '8015691999', '8015692001', 'PO Box 198560', 'Atlanta', 'Fulton', 'GA', '30384', '8015691999', '8015692001', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', '2014-04-04', 0, 0, 0, 'St Marks Hospital', 'Jordan Valley Medical Center', 'Pioneer Valley Hospital', '', 'HCFA|UB|', '1275576027', 0, 'N', 0, '2014-04-09', NULL, NULL, 0, 0, NULL, NULL),
('861064757', 'W12020744', 'W12020744', 'TX01', 'Hill Country Psycho Therapy Associates', 'Michelle', '', 'Gunnin', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '4230 Gardendale Bldg 601', 'San Antonio', 'Bexar', 'TX', '78229', '2105580409', '2105580410', '4230 Gardendale Bldg 601', 'San Antonio', 'Bexar', 'TX', '78229', '2105580409', '2105580410', 'TXMA', '', '', '0.00', '100.00', '0.00', 6, '2012-06-29', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1124195763', 0, 'N', 0, '2012-07-02', NULL, NULL, 29.5238, -98.5675, NULL, NULL),
('800236802', 'W12004709', 'W12004709', 'UT01', 'Mountainstar Farr West Family Medicine', 'John', 'M', 'Hemmersmeier', 'MD', 'Family Practice', '', '', NULL, 'O', '2850 N 2000 W Ste 101', 'Ogden', 'Weber', 'UT', '84404', '8017311222', '8017311666', '2850 N 2000 W Ste 101', 'Ogden', 'Weber', 'UT', '84404', '8017311222', '8017311666', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-09-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1073582995', 0, 'N', 0, '2014-06-24', NULL, NULL, 41.3105, -112.028, NULL, NULL),
('870337363', 'W12019655', 'W12019655', 'UT01', 'Gastroenterology Associates', 'Christopher', '', 'Maxwell', 'MD', 'Gastroenterology', '', '', NULL, 'O', '1250 E 3900 S Ste 360', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012633041', '8012638485', '1250 E 3900 S Ste 360', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012633041', '8012638485', 'WiseSTD20', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-08-01', '2013-12-31', 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1114107026', 0, 'N', 0, '2013-12-18', NULL, NULL, 0, 0, NULL, NULL),
('271211810', 'W12020746', 'W12020746', 'UT01', 'Wasatch Infusion', 'R', 'C', 'Halversen', 'MD', 'General Surgery', '', '', NULL, 'O', '348 E 4500 S Ste 220', 'Murray', 'Salt Lake', 'UT', '84107', '8015777055', '8887177578', '348 E 4500 S Ste 220', 'Murray', 'Salt Lake', 'UT', '84107', '8015777055', '8887177578', 'WCSTRMAP5', 'WUSTDSURG5', '', '0.00', '35.00', '0.00', 3, '2012-06-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1275540585', 0, 'N', 0, '2013-10-04', NULL, NULL, 40.6743, -111.881, NULL, NULL),
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('942938348', 'W40006860', 'W40006860', 'UTMH1', 'Valley Mental Health  Inc', 'C RENEE', NULL, 'ROTTLER', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', '5965 S 900 E Ste 430', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012637100', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'UTVMHMA', NULL, NULL, '0.00', '40.00', '0.00', 6, '2013-02-15', NULL, NULL, 0, NULL, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1689658858', 0, 'Y', 0, '2013-02-28', NULL, NULL, 0, 0, NULL, NULL),
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('454898005', 'W12020752', 'W12020752', 'UTDT01', 'Lambourne Family Dental ', 'Steven', '', 'Lambourne', 'DDS', 'Dentist', '', '', NULL, 'O', '3500 Harrison Blvd Ste 104', 'Ogden', 'Weber', 'UT', '84403', '8016211912', NULL, '3500 Harrison Blvd Ste 104', 'Ogden', 'Weber', 'UT', '84403', '8016211912', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2012-06-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000009826', 0, 'N', 0, '2013-04-09', NULL, NULL, 0, 0, NULL, NULL),
('800137585', 'W12020754', 'W12020754', 'UTDT01', '', 'Courtney', '', 'Jackson', 'DDS', 'Dentist', '', '', NULL, 'O', '1747 S Heritage Ln Ste B-203', 'Syracuse', 'Davis', 'UT', '84075', '8015251725', NULL, '1747 S Heritage Ln Ste B-203', 'Syracuse', 'Davis', 'UT', '84075', '8015251725', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2012-06-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000009894', 0, 'N', 0, '2012-06-29', NULL, NULL, 0, 0, NULL, NULL),
('271534643', 'W12020756', 'W12020756', 'UT01', 'Horizon Home Health', '', '', 'Home Health Specialists', 'Group', 'Home Health Agency', '', '', NULL, 'O', '2069 N Main St Ste 106', 'Cedar City', 'Iron', 'UT', '84721', '8014740000', '4358659319', '2069 N Main St Ste 106', 'Cedar City', 'Iron', 'UT', '84721', '8014740000', '4358659319', '', '', '4', '0.00', '40.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1811226772', 0, 'N', 0, '2012-07-02', 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
('830327475', 'W12020758', 'W12020758', 'WY01', 'Evanston Regional Hospital', 'Weston', 'M', 'Swindlehurst', '', 'anesthesia', '', '', NULL, 'O', '190 Arrowhead Dr', 'Evanston', 'Uinta', 'WY', '82930', '3077893636', '3077898237', '190 Arrowhead Dr', 'Evanston', 'Uinta', 'WY', '82930', '3077893636', '3077898237', '', '', '', '40.00', '100.00', '58.00', 6, '2012-07-01', NULL, 0, 12, 0, '', '', '', '', 'HCFA|UB|', '1952628505', 0, 'N', 0, '2012-07-05', NULL, NULL, 41.2433, -110.998, NULL, NULL),
('830327475', 'W12020760', 'W12020760', 'WY01', 'Evanston Regional Hospital', 'Weston', 'M', 'Swindlehurst', '', 'anesthesia', '', '', NULL, 'B', 'PO Box 5897', 'Belfast', 'Waldo', 'ME', '04915', '3077893636', '3077898237', 'PO Box 5897', 'Belfast', 'Waldo', 'ME', '04915', '3077893636', '3077898237', '', '', '', '40.00', '100.00', '58.00', 6, '2012-07-01', NULL, 0, 12, 0, '', '', '', '', 'HCFA|UB|', '1952628505', 0, 'N', 0, '2012-07-05', NULL, NULL, 0, 0, NULL, NULL),
('830327475', 'W12020759', 'W12020759', 'WYT2', 'Evanston Regional Hospital', 'Weston', 'M', 'Swindlehurst', '', 'anesthesia', '', '', NULL, 'O', '190 Arrowhead Dr', 'Evanston', 'Uinta', 'WY', '82930', '3077893636', '3077898237', '190 Arrowhead Dr', 'Evanston', 'Uinta', 'WY', '82930', '3077893636', '3077898237', '', '', '', '40.00', '100.00', '58.00', 6, '2012-07-01', NULL, 0, 12, 1, '', '', '', '', 'HCFA|UB|', '1952628505', 0, 'N', 0, '2012-07-05', NULL, NULL, 0, 0, NULL, NULL),
('830327475', 'W12020761', 'W12020761', 'WYT2', 'Evanston Regional Hospital', 'Weston', 'M', 'Swindlehurst', '', 'anesthesia', '', '', NULL, 'B', 'PO Box 5897', 'Belfast', 'Waldo', 'ME', '04915', '3077893636', '3077898237', 'PO Box 5897', 'Belfast', 'Waldo', 'ME', '04915', '3077893636', '3077898237', '', '', '', '40.00', '100.00', '58.00', 6, '2012-07-01', NULL, 0, 12, 1, '', '', '', '', 'HCFA|UB|', '1952628505', 0, 'N', 0, '2012-07-05', NULL, NULL, 0, 0, NULL, NULL),
('820200896', 'W12020763', 'W12020763', 'ID01', 'Saint Alphonsus Medical Group Inpatient Pain Boise', 'Teresa', '', 'Morgan', 'CNS', 'Nurse SpecialistCertified', '', '', NULL, 'O', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83707', '2083672121', '2083674051', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83707', '2083672121', '2083674051', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-07-02', '2012-09-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1225336118', 0, 'Y', 0, '2012-09-20', NULL, NULL, 0, 0, NULL, NULL),
('870286381', 'W12020764', 'W12020764', 'UT01', 'Ogden Clinic', 'Chase', 'D', 'Bailey', 'NP', 'Family Practice', '', '', NULL, '', '3485 W 5200 S', 'Roy', 'Weber', 'UT', '84067', '8014753900', '8014753901', '3485 W 5200 S', 'Roy', 'Weber', 'UT', '84067', '8014753900', '8014753901', 'WUOGDCLIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2012-08-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1790047157', 0, 'N', 0, '2013-07-25', NULL, NULL, 0, 0, NULL, NULL),
('870286381', 'W12020765', 'W12020765', 'UT01', 'Ogden Clinic', 'Chase', 'D', 'Bailey', 'NP', 'Family Practice', '', '', NULL, 'O', '4650 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014753000', '8014753001', '4650 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014753000', '8014753001', 'WUOGDCLIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2012-08-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1790047157', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.1787, -111.949, NULL, NULL),
('201939139', 'W12020766', 'W12020766', 'ID01', 'Micron Family Health Center', 'Ralph', '', 'Heckard', 'MD', 'Family Practice', '', '', NULL, 'O', '8000 S Federal Way', 'Boise', 'Ada', 'ID', '83716', '2083685656', NULL, '8000 S Federal Way', 'Boise', 'Ada', 'ID', '83716', '2083685656', '          ', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-07-25', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1619032687', 0, 'Y', 0, '2013-04-26', NULL, NULL, 43.5301, -116.149, NULL, NULL),
('621801973', 'W12020767', 'W12020767', 'UT01', 'Jordan Valley Internal Medicine', 'Lora', '', 'Slabodkina', '', 'Internal Medicine', '', '', NULL, 'O', '3570 W 9000 S Ste 100', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015692384', '8015698643', '3570 W 9000 S Ste 100', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015692384', '8015698643', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2012-07-01', '2014-04-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1881646149', 0, 'N', 0, '2013-07-25', NULL, NULL, 40.588, -111.975, NULL, NULL),
('201939139', 'W12020769', 'W12020769', 'ID01', 'Micron Family Health Clinic', 'Brenda', '', 'Shaw', 'PA', 'Family Practice', '', '', NULL, 'O', '8000 S Federal Way', 'Boise', 'Ada', 'ID', '83716', '2083685656', NULL, '8000 S Federal Way', 'Boise', 'Ada', 'ID', '83716', '2083685656', '          ', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-07-25', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1679642037', 0, 'Y', 0, '2013-04-26', NULL, NULL, 43.5301, -116.149, NULL, NULL),
('621801973', 'W12020768', 'W12020768', 'UT01', 'Jordan Valley Internal Medicine', 'Lora', '', 'Slabodkina', '', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2012-07-01', '2014-04-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1881646149', 0, 'N', 0, '2013-07-25', NULL, NULL, 0, 0, NULL, NULL),
('201939139', 'W12020770', 'W12020770', 'ID01', 'Micron Family Health Center', 'Timothy', '', 'Phillips', 'MD', 'Family Practice', '', '', NULL, 'O', '8000 S Federal Way', 'Boise', 'Ada', 'ID', '83716', '2083685656', NULL, '8000 S Federal Way', 'Boise', 'Ada', 'ID', '83716', '2083685656', '          ', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-07-25', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1558349241', 0, 'Y', 0, '2013-04-26', NULL, NULL, 43.5301, -116.149, NULL, NULL),
('860735726', 'W12020774', 'W12020774', 'Sinclair', 'Flagstaff Bone and Joint', 'Jennifer', 'M', 'Starkey', 'PA', 'Orthopedic Surgery', '', '', NULL, 'O', '77 W Forest Ave Ste 301', 'Flagstaff', 'Coconino', 'AZ', '86001', '9287732280', '9287732281', '77 W Forest Ave Ste 301', 'Flagstaff', 'Coconino', 'AZ', '86001', '9287732280', '9287732281', '', '', '', '0.00', '40.00', '0.00', 3, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1457589061', 0, 'N', 0, '2012-11-27', NULL, NULL, 0, 0, NULL, NULL),
('453562721', 'W12020778', 'W12020778', 'UT01', 'Alpine Foot and Ankle', 'Scott', 'S', 'Shelton', 'DPM', 'Podiatry', '', '', NULL, 'O', '1434 E 9400 S  Ste 203', 'Sandy', 'Salt Lake', 'UT', '84093', '8015717911', '8015717912', '1434 E 9400 S  Ste 203', 'Sandy', 'Salt Lake', 'UT', '84093', '8015717911', '8015717912', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-08-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', 'Jordan Valley Medical Center', '', '', 'HCFA|UB|', '1710114962', 0, 'N', 0, '2012-12-05', NULL, NULL, 40.5804, -111.849, NULL, NULL),
('453562721', 'W12020779', 'W12020779', 'UT01', 'Alpine Foot and Ankle', 'Scott', 'S', 'Shelton', 'DPM', 'Podiatry', '', '', NULL, 'B', '16046 Fielding Hill Ln', 'Draper', 'Salt Lake', 'UT', '84020', '8015717911', '8015717912', '16046 Fielding Hill Ln', 'Draper', 'Salt Lake', 'UT', '84020', '8015717911', '8015717912', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-08-01', '2013-09-30', 0, 0, 0, 'Timpanogos Regional Hospital', 'Jordan Valley Medical Center', '', '', 'HCFA|UB|', '1710114962', 0, 'N', 0, '2013-09-30', NULL, NULL, 0, 0, NULL, NULL),
('453562721', 'W12020777', 'W12020777', 'UT01', 'Alpine Foot and Ankle', 'Scott', 'S', 'Shelton', 'DPM', 'Podiatry', '', '', NULL, 'O', '5455 W 11000 N Ste 203', 'American Fork', 'Utah', 'UT', '84003', '8017561800', '8017639225', '5455 W 11000 N Ste 203', 'American Fork', 'Utah', 'UT', '84003', '8017561800', '8017639225', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-08-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', 'Jordan Valley Medical Center', '', '', 'HCFA|UB|', '1710114962', 0, 'N', 0, '2013-09-30', NULL, NULL, 40.4319, -111.789, NULL, NULL),
('942854057', 'W12020676', 'W12020676', 'UTIHCPHY', 'Dixie High Risk OB', 'Tracy', '', 'Kvarfordt', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356884770', '4356884835', '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356884770', '4356884835', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2012-04-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1053313676', 0, 'N', 0, '2013-07-29', NULL, NULL, 37.0989, -113.575, NULL, NULL),
('942854057', 'W12020782', 'W12020782', 'UTIHCPHY', 'Bountiful Clinic', 'Brenda', '', 'Reiss-Brennan', 'APRN', 'Mental Health', '', '', NULL, 'O', '390 N Main St', 'Bountiful', 'Davis', 'UT', '84010', '8012941000', '8012928369', '390 N Main St', 'Bountiful', 'Davis', 'UT', '84010', '8012941000', '8012928369', 'IHCAPRN', '', '', '0.00', '100.00', '0.00', 8, '2012-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1467523621', 0, 'N', 0, '2012-07-02', NULL, NULL, 40.8935, -111.881, NULL, NULL),
('942854057', 'W12020783', 'W12020783', 'UTIHCPHY', 'Budge Clinic Obstetrics & Gynecology', 'Deborah', 'Ruth', 'Flansburg', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1400 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357161920', '4357921677', '1400 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357161920', '4357921677', 'IHCCNM', '', '', '0.00', '100.00', '0.00', 8, '2012-07-01', NULL, 0, 0, 0, 'Logan Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1538231808', 0, 'N', 0, '2012-07-02', NULL, NULL, 41.7569, -111.821, NULL, NULL),
('942854057', 'W12020784', 'W12020784', 'UTIHCPHY', 'Southern Utah Behavioral Health', 'Jaime', 'L', 'Bacon', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '1054 E Riverside Dr Ste 202', 'St George', 'Washington', 'UT', '84790', '4356346100', '4356346129', '1054 E Riverside Dr Ste 202', 'St George', 'Washington', 'UT', '84790', '4356346100', '4356346129', 'IHCMA', '', '', '0.00', '100.00', '0.00', 8, '2012-07-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1376758342', 0, 'N', 0, '2014-02-05', NULL, NULL, 37.0881, -113.561, NULL, NULL),
('942854057', 'W12020785', 'W12020785', 'UTIHCPHY', 'Cedar City Clinic', 'Jaime', 'L', 'Bacon', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '1303 N Main St Ste 3C', 'Cedar City', 'Iron', 'UT', '84720', '4358685500', '4358685504', '1303 N Main St Ste 3C', 'Cedar City', 'Iron', 'UT', '84720', '4358685500', '4358685504', 'IHCMA', '', '', '0.00', '100.00', '0.00', 8, '2012-07-01', '2013-04-30', 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1376758342', 0, 'N', 0, '2014-01-08', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12020786', 'W12020786', 'UTIHCPHY', 'Southern Utah Behavioral Health', 'Wade', 'O', 'Milne', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '1054 E Riverside Dr Ste 202', 'St George', 'Washington', 'UT', '84790', '4356346100', NULL, '1054 E Riverside Dr Ste 202', 'St George', 'Washington', 'UT', '84790', '4356346100', '          ', 'IHCMA', '', '', '0.00', '100.00', '0.00', 8, '2012-07-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1508843467', 0, 'N', 0, '2013-02-27', NULL, NULL, 37.0881, -113.561, NULL, NULL),
('942854057', 'W12020787', 'W12020787', 'UTIHCPHY', 'Cedar City Clinic', 'Wade', 'O', 'Milne', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '1303 N Main St Ste 3C', 'Cedar City', 'Iron', 'UT', '84720', '4358685500', '4358685504', '1303 N Main St Ste 3C', 'Cedar City', 'Iron', 'UT', '84720', '4358685500', '4358685504', 'IHCMA', '', '', '0.00', '100.00', '0.00', 8, '2012-07-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1508843467', 0, 'N', 0, '2013-02-27', NULL, NULL, 37.7003, -113.064, NULL, NULL),
('942854057', 'W12020788', 'W12020788', 'UTIHCPHY', 'Bountiful Clinic', 'Karen', 'Kay', 'Christian', 'MD', 'Mental Health', 'Pediatric Psychiatry', 'Psychiatry', NULL, 'O', '390 N Main St', 'Bountiful', 'Davis', 'UT', '84010', '8012941000', NULL, '390 N Main St', 'Bountiful', 'Davis', 'UT', '84010', '8012941000', '          ', 'IHCMD', '', '', '0.00', '100.00', '0.00', 8, '2012-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1255482097', 0, 'N', 0, '2012-07-02', NULL, NULL, 40.8935, -111.881, NULL, NULL),
('942854057', 'W12020789', 'W12020789', 'UTIHCPHY', 'Mountain View Pediatrics', 'Karen', 'Kay', 'Christian', 'MD', 'Mental Health', 'Pediatric Psychiatry', 'Psychiatry', NULL, 'O', '9720 S 1300 E Ste 100', 'Sandy', 'Salt Lake', 'UT', '84094', '8015718550', '8015711689', '9720 S 1300 E Ste 100', 'Sandy', 'Salt Lake', 'UT', '84094', '8015718550', '8015711689', 'IHCMD', '', '', '0.00', '100.00', '0.00', 8, '2012-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1255482097', 0, 'N', 0, '2012-07-02', NULL, NULL, 40.5739, -111.853, NULL, NULL),
('942854057', 'W12020790', 'W12020790', 'UTIHCPHY', 'Southern Utah Behavioral Health', 'David', 'A', 'Tomb', 'MD', 'Mental Health', 'Psychiatry', 'Pediatric Psychiatry', NULL, 'O', '1054 E Riverside Dr Ste 202', 'St George', 'Washington', 'UT', '84790', '4356346100', '4356346129', '1054 E Riverside Dr Ste 202', 'St George', 'Washington', 'UT', '84790', '4356346100', '4356346129', 'IHCMD', '', '', '0.00', '100.00', '0.00', 8, '2012-07-01', '2013-01-18', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1639269269', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12020791', 'W12020791', 'UTIHCPHY', 'Southern Utah Behavioral Health', 'Gloria', '', 'Tong', 'MD', 'Psychiatry', 'Mental Health', '', NULL, 'O', '1054 E Riverside Dr Ste 202', 'St George', 'Washington', 'UT', '84790', '4356346100', '4356346129', '1054 E Riverside Dr Ste 202', 'St George', 'Washington', 'UT', '84790', '4356346100', '4356346129', 'IHCMD', '', '', '0.00', '100.00', '0.00', 8, '2012-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1043354095', 0, 'N', 0, '2013-05-17', NULL, NULL, 37.0881, -113.561, NULL, NULL),
('942854057', 'W12020792', 'W12020792', 'UTIHCPHY', 'Dixie Inpatient Psychiatry', 'Chauncey', 'S', 'Adams', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356884343', '4356885331', '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356884343', '4356885331', 'IHCPSYD', '', '', '0.00', '100.00', '0.00', 8, '2012-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1437251170', 0, 'N', 0, '2012-07-02', NULL, NULL, 37.0989, -113.575, NULL, NULL),
('942854057', 'W12020793', 'W12020793', 'UTIHCPHY', 'Bountiful Clinic', 'Quincey', 'G', 'Atkin', 'PhD', 'Mental Health', '', '', NULL, 'O', '390 N Main', 'Bountiful', 'Davis', 'UT', '84010', '8012941000', '8012928369', '390 N Main', 'Bountiful', 'Davis', 'UT', '84010', '8012941000', '8012928369', 'IHCPSYD', '', '', '0.00', '100.00', '0.00', 8, '2012-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1255445672', 0, 'N', 0, '2012-07-02', NULL, NULL, 40.8935, -111.881, NULL, NULL),
('942854057', 'W12020794', 'W12020794', 'UTIHCPHY', 'Hillcrest Pediatrics', 'Kirk', 'R', 'Dansie', 'PhD', 'Mental Health', 'Psychology', '', NULL, 'O', '5063 S Cottonwood St Ste 610', 'Murray', 'Salt Lake', 'UT', '84107', '8015071850', '8015871875', '5063 S Cottonwood St Ste 610', 'Murray', 'Salt Lake', 'UT', '84107', '8015071850', '8015871875', 'IHCPSYD', '', '', '0.00', '100.00', '0.00', 8, '2012-07-01', '2013-11-15', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1821273772', 0, 'Y', 0, '2013-10-18', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12020795', 'W12020795', 'UTIHCPHY', 'Budge Clinic Pediatrics', 'Clinton', 'E', 'Field', 'PhD', 'Mental Health', 'Psychology', '', NULL, 'O', '1350 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357921940', '4357921692', '1350 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357921940', '4357921692', 'IHCPSYD', '', '', '0.00', '100.00', '0.00', 8, '2012-07-01', NULL, 0, 0, 0, 'Logan Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1467656900', 0, 'N', 0, '2012-07-02', NULL, NULL, 41.7565, -111.821, NULL, NULL),
('942854057', 'W12020796', 'W12020796', 'UTIHCPHY', 'North Canyon Family Practice', 'Cathie', 'R', 'Fox', 'PhD', 'Mental Health', 'Psychology', '', NULL, 'O', '3200 N Canyon Rd Ste D', 'Provo', 'Utah', 'UT', '84604', '8013733300', '8013547900', '3200 N Canyon Rd Ste D', 'Provo', 'Utah', 'UT', '84604', '8013733300', '8013547900', 'IHCPSYD', '', '', '0.00', '100.00', '0.00', 8, '2012-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1124166582', 0, 'N', 0, '2012-07-06', NULL, NULL, 40.276, -111.651, NULL, NULL),
('942854057', 'W12020797', 'W12020797', 'UTIHCPHY', 'Bountiful Clinic', 'Kelly', 'D', 'Garrett', 'PhD', 'Mental Health', 'Psychology', '', NULL, 'O', '390 N Main St', 'Bountiful', 'Davis', 'UT', '84010', '8012941000', '8012928369', '390 N Main St', 'Bountiful', 'Davis', 'UT', '84010', '8012941000', '8012928369', 'IHCPSYD', '', '', '0.00', '100.00', '0.00', 8, '2012-07-01', '2012-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1245251776', 0, 'N', 0, '2012-12-11', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12020798', 'W12020798', 'UTIHCPHY', 'Mountain View Pediatrics', 'W', 'Craig', 'Hall', 'PHD', 'Psychology', 'Mental Health', '', NULL, 'O', '9720 S 1300 E Ste 100', 'Sandy', 'Salt Lake', 'UT', '84094', '8015718550', '8015711689', '9720 S 1300 E Ste 100', 'Sandy', 'Salt Lake', 'UT', '84094', '8015718550', '8015711689', 'IHCPSYD', '', '', '0.00', '100.00', '0.00', 8, '2012-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1760486211', 0, 'N', 0, '2012-07-02', NULL, NULL, 40.5739, -111.853, NULL, NULL),
('942854057', 'W12020799', 'W12020799', 'UTIHCPHY', 'Bountiful Clinic', 'Lori', '', 'Neeleman', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '390 N Main St', 'Bountiful', 'Davis', 'UT', '84010', '8012941000', '8012928369', '390 N Main St', 'Bountiful', 'Davis', 'UT', '84010', '8012941000', '8012928369', 'IHCPSYD', '', '', '0.00', '100.00', '0.00', 8, '2012-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1992000145', 0, 'N', 0, '2013-05-30', NULL, NULL, 40.8935, -111.881, NULL, NULL),
('942854057', 'W12020800', 'W12020800', 'UTIHCPHY', 'Bryner Clinic', 'Lori', '', 'Neeleman', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '525 E 100 S Ste 500', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015197100', '8015213091', '525 E 100 S Ste 500', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015197100', '8015213091', 'IHCPSYD', '', '', '0.00', '100.00', '0.00', 8, '2012-07-01', '2012-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1992000145', 0, 'N', 0, '2013-05-30', NULL, NULL, 0, 0, NULL, NULL),
('870452315', 'W12020802', 'W12020802', 'UTDT01', 'The Tooth Doctor', 'Erika', '', 'Vekter', 'DMD', 'Dentist', '', '', NULL, 'O', '3060 S Redwood Rd', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8019720555', NULL, '3060 S Redwood Rd', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8019720555', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2012-06-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000009895', 0, 'N', 0, '2012-07-03', NULL, NULL, 0, 0, NULL, NULL),
('870617336', 'W12020805', 'W12020805', 'UTDT01', 'Monarch Dental', 'Andrew', '', 'Vernon', 'DMD', 'Dentist', '', '', NULL, 'O', '24 S 500 W Ste D', 'Bountiful', 'Davis', 'UT', '84010', '8012961606', NULL, '24 S 500 W Ste D', 'Bountiful', 'Davis', 'UT', '84010', '8012961606', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2012-06-01', '2014-03-20', 0, 0, 0, '', '', '', '', 'DEN|', '1831350289', 0, 'N', 0, '2014-03-20', NULL, NULL, 0, 0, NULL, NULL),
('870617336', 'W12020804', 'W12020804', 'UTDT01', 'Monarch Dental', 'Andrew', '', 'Vernon', 'DMD', 'Dentist', '', '', NULL, 'O', '476 N 900 W Ste A', 'American Fork', 'Utah', 'UT', '84003', '8017565522', NULL, '476 N 900 W Ste A', 'American Fork', 'Utah', 'UT', '84003', '8017565522', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2012-06-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1831350289', 0, 'N', 0, '2014-03-20', NULL, NULL, 0, 0, NULL, NULL),
('870617336', 'W12020806', 'W12020806', 'UTDT01', 'Monarch Dental', 'Andrew', '', 'Vernon', 'DMD', 'Dentist', '', '', NULL, 'O', '1492 W Antelope Dr Ste 201', 'Layton', 'Davis', 'UT', '84041', '8017766566', NULL, '1492 W Antelope Dr Ste 201', 'Layton', 'Davis', 'UT', '84041', '8017766566', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2012-06-01', '2014-03-20', 0, 0, 0, '', '', '', '', 'DEN|', '1831350289', 0, 'N', 0, '2014-03-20', NULL, NULL, 0, 0, NULL, NULL),
('870617336', 'W12020808', 'W12020808', 'UTDT01', 'Monarch Dental', 'Andrew', '', 'Vernon', 'DMD', 'Dentist', '', '', NULL, 'O', '10011 S Centennial Pkwy Ste 330', 'Sandy', 'Salt Lake', 'UT', '84070', '8012563700', NULL, '10011 S Centennial Pkwy Ste 330', 'Sandy', 'Salt Lake', 'UT', '84070', '8012563700', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2012-06-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1831350289', 0, 'N', 0, '2014-03-20', NULL, NULL, 0, 0, NULL, NULL),
('870617336', 'W12020809', 'W12020809', 'UTDT01', 'Monarch Dental', 'Andrew', '', 'Vernon', 'DMD', 'Dentist', '', '', NULL, 'O', '575 E University Pkwy Ste A-24', 'Orem', 'Utah', 'UT', '84097', '8012253300', NULL, '575 E University Pkwy Ste A-24', 'Orem', 'Utah', 'UT', '84097', '8012253300', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2012-06-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1831350289', 0, 'N', 0, '2014-03-20', NULL, NULL, 0, 0, NULL, NULL),
('870617336', 'W12020810', 'W12020810', 'UTDT01', 'Monarch Dental', 'Andrew', '', 'Vernon', 'DMD', 'Dentist', '', '', NULL, 'O', '370 E S Temple Ste 350', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8013209810', NULL, '370 E S Temple Ste 350', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8013209810', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2012-06-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1831350289', 0, 'N', 0, '2014-03-20', NULL, NULL, 0, 0, NULL, NULL),
('870617336', 'W12020811', 'W12020811', 'UTDT01', 'Monarch Dental', 'Andrew', '', 'Vernon', 'DMD', 'Dentist', '', '', NULL, 'O', '3730 W 4700 S', 'Taylorsville', 'Salt Lake', 'UT', '84118', '8019551900', NULL, '3730 W 4700 S', 'Taylorsville', 'Salt Lake', 'UT', '84118', '8019551900', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2012-06-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1831350289', 0, 'N', 0, '2014-03-20', NULL, NULL, 0, 0, NULL, NULL),
('870617336', 'W12020812', 'W12020812', 'UTDT01', 'Monarch Dental', 'Andrew', '', 'Vernon', 'DMD', 'Dentist', '', '', NULL, 'O', '5419 S Redwood Rd Ste 2', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8012636400', NULL, '5419 S Redwood Rd Ste 2', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8012636400', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2012-06-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1831350289', 0, 'N', 0, '2014-03-20', NULL, NULL, 0, 0, NULL, NULL),
('870617336', 'W12020813', 'W12020813', 'UTDT01', 'Monarch Dental', 'Andrew', '', 'Vernon', 'DMD', 'Dentist', '', '', NULL, 'O', '5974 S Fashion Pointe Dr Ste 210', 'Ogden', 'Weber', 'UT', '84403', '8014756121', NULL, '5974 S Fashion Pointe Dr Ste 210', 'Ogden', 'Weber', 'UT', '84403', '8014756121', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2012-06-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1831350289', 0, 'N', 0, '2014-03-20', NULL, NULL, 0, 0, NULL, NULL),
('770640930', 'W12020817', 'W12020817', 'UTDT01', 'Professional Dental ', 'Randy', '', 'Downing', 'DDS', 'Dentist', '', '', NULL, 'O', '1314 N Redwood Rd', 'Orem', 'Utah', 'UT', '84057', '8017680440', '          ', '1314 N Redwood Rd', 'Orem', 'Utah', 'UT', '84057', '8017680440', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2012-05-01', '2014-07-24', 0, 0, 0, '', '', '', '', 'DEN|', '1235234287', 0, 'N', 0, '2014-07-24', NULL, NULL, 0, 0, NULL, NULL),
('770640930', 'W12020815', 'W12020815', 'UTDT01', 'Professional Dental ', 'Randy', '', 'Downing', 'DDS', 'Dentist', '', '', NULL, 'O', '32 Red Pine Dr Ste 14', 'Alpine', 'Utah', 'UT', '84004', '8017567633', '          ', '32 Red Pine Dr Ste 14', 'Alpine', 'Utah', 'UT', '84004', '8017567633', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2012-05-01', '2014-07-24', 0, 0, 0, '', '', '', '', 'DEN|', '1235234287', 0, 'N', 0, '2014-07-24', NULL, NULL, 0, 0, NULL, NULL),
('770640930', 'W12020818', 'W12020818', 'UTDT01', 'Professional Dental ', 'Randy', '', 'Downing', 'DDS', 'Dentist', '', '', NULL, 'O', '3648 W 9800 S', 'South Jordan', 'Salt Lake', 'UT', '84095', '8012600700', '          ', '3648 W 9800 S', 'South Jordan', 'Salt Lake', 'UT', '84095', '8012600700', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2012-05-01', '2014-07-24', 0, 0, 0, '', '', '', '', 'DEN|', '1235234287', 0, 'N', 0, '2014-07-24', NULL, NULL, 0, 0, NULL, NULL),
('770640930', 'W12020820', 'W12020820', 'UTDT01', 'Professional Dental ', 'Randy', '', 'Downing', 'DDS', 'Dentist', '', '', NULL, 'O', '503 E 770 N', 'Orem', 'Utah', 'UT', '84097', '8012251402', '          ', '503 E 770 N', 'Orem', 'Utah', 'UT', '84097', '8012251402', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2012-05-01', '2014-07-24', 0, 0, 0, '', '', '', '', 'DEN|', '1235234287', 0, 'N', 0, '2014-07-24', NULL, NULL, 0, 0, NULL, NULL),
('770640930', 'W12020816', 'W12020816', 'UTDT01', 'Professional Dental ', 'Randy', '', 'Downing', 'DDS', 'Dentist', '', '', NULL, 'O', '537 W 550 N Ste E', 'Lindon', 'Utah', 'UT', '84042', '8017856000', '          ', '537 W 550 N Ste E', 'Lindon', 'Utah', 'UT', '84042', '8017856000', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2012-05-01', '2014-07-24', 0, 0, 0, '', '', '', '', 'DEN|', '1235234287', 0, 'N', 0, '2014-07-24', NULL, NULL, 0, 0, NULL, NULL),
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('870668894', 'W12020827', 'W12020827', 'UTDT01', 'Tooele Dental Associates', 'Brett', '', 'Wells', 'DMD', 'Dentist', '', '', NULL, 'O', '668 N Garden St', 'Tooele', 'Tooele', 'UT', '84074', '4358821381', NULL, '668 N Garden St', 'Tooele', 'Tooele', 'UT', '84074', '4358821381', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2012-06-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000009899', 0, 'N', 0, '2012-07-02', NULL, NULL, 0, 0, NULL, NULL),
('870668894', 'W12020829', 'W12020829', 'UTDT01', 'Tooele Dental Associates', 'Michael', '', 'Wells', 'DMD', 'Dentist', '', '', NULL, 'O', '668 N Garden St', 'Tooele', 'Tooele', 'UT', '84074', '4358821381', NULL, '668 N Garden St', 'Tooele', 'Tooele', 'UT', '84074', '4358821381', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2012-06-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000009900', 0, 'N', 0, '2012-07-02', NULL, NULL, 0, 0, NULL, NULL),
('870681986', 'W12020830', 'W12020830', 'UTDT01', 'Logan Dental Associates', 'Jake', '', 'Sorensen', 'DDS', 'Dentist', '', '', NULL, 'O', '40 W Cache Valley Blvd Ste 2A', 'Logan', 'Cache', 'UT', '84341', '4357878207', NULL, '40 W Cache Valley Blvd Ste 2A', 'Logan', 'Cache', 'UT', '84341', '4357878207', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2012-06-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000009830', 0, 'N', 0, '2012-07-02', NULL, NULL, 0, 0, NULL, NULL),
('611651071', 'W12020831', 'W12020831', 'UTDT01', 'Oquirrh Park Pediatric Dentistry', 'Jeff', '', 'Burg', 'DDS', 'Pedodontist', '', '', NULL, 'O', '6973 S 4800 W', 'West Jordan', 'Salt Lake', 'UT', '84084', '8018404833', NULL, '6973 S 4800 W', 'West Jordan', 'Salt Lake', 'UT', '84084', '8018404833', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2012-06-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000005484', 0, 'N', 0, '2013-06-27', NULL, NULL, 0, 0, NULL, NULL),
('611651071', 'W12020832', 'W12020832', 'UTDT01', 'Oquirrh Park Pediatric Dentistry', 'Darin', '', 'Knudson', 'DDS', 'Dentist', 'Pedodontist', '', NULL, 'O', '6973 S 4800 W', 'West Jordan', 'Salt Lake', 'UT', '84084', '8018404833', NULL, '6973 S 4800 W', 'West Jordan', 'Salt Lake', 'UT', '84084', '8018404833', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2012-06-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000007122', 0, 'N', 0, '2013-06-27', NULL, NULL, 0, 0, NULL, NULL),
('274352844', 'W12020835', 'W12020835', 'UTDT01', '', 'Troy', '', 'DeDecker', 'DDS', 'Dentist', '', '', NULL, 'O', '1480 S Orchard Dr Ste 110', 'Bountiful', 'Davis', 'UT', '84010', '8012959500', NULL, '1480 S Orchard Dr Ste 110', 'Bountiful', 'Davis', 'UT', '84010', '8012959500', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2012-07-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000004131', 0, 'N', 0, '2012-07-02', NULL, NULL, 0, 0, NULL, NULL),
('454340509', 'W12020836', 'W12020836', 'UTDT01', 'Wasatch Endodontics', 'Brady', '', 'Olsen', 'DMD', 'Endodontist', '', '', NULL, 'O', '185 S 400 E Ste 201', 'Bountiful', 'Davis', 'UT', '84010', '8012981101', NULL, '185 S 400 E Ste 201', 'Bountiful', 'Davis', 'UT', '84010', '8012981101', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2012-07-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1609971043', 0, 'N', 0, '2012-07-02', NULL, NULL, 0, 0, NULL, NULL),
('202630141', 'W40027987', 'W40027987', 'IDBOISTD', 'Primary Health Medical Group', 'Tara', 'C', 'Rothwell', 'PA', 'Family Practice', '', '', NULL, 'O', '435 S Eagle Rd', 'Eagle', 'Ada', 'ID', '83616', '2089398200', '2089398222', '435 S Eagle Rd', 'Eagle', 'Ada', 'ID', '83616', '2089398200', '2089398222', 'IDPRIMARY', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2013-03-01', '2014-03-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1912087438', 0, 'N', 0, '2014-07-08', NULL, NULL, 43.6918, -116.354, NULL, NULL),
('364100874', 'W12020837', 'W12020837', 'TX01', 'Walgreens Home Care Inc.', '', '', 'Walgreens Home Care Inc', 'GROUP', 'Infusion Agency', 'Infusion Agency', NULL, NULL, 'O', '14220 Northbrook Dr Ste 100B', 'San Antonio', 'Bexar', 'TX', '78232', '2106157211', NULL, '14220 Northbrook Dr Ste 100B', 'San Antonio', 'Bexar', 'TX', '78232', '2106157211', '          ', '', '', 'TX2', '0.00', '50.00', '0.00', 8, '2012-07-01', NULL, 1, 0, 0, '', '', '', '', 'HCFA|UB|', '1124033196', 0, 'N', 0, '2012-07-03', NULL, NULL, 29.5688, -98.4784, NULL, NULL),
('364100874', 'W12020838', 'W12020838', 'TX01', 'Walgreens Home Care Inc.', '', '', 'Walgreens Home Care Inc', 'GROUP', 'Infusion Agency', 'Infusion Agency', NULL, NULL, 'B', '16358 Collections Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '2104049259', NULL, '16358 Collections Center Dr', 'Chicago', 'Cook', 'IL', '60693', '2104049259', '          ', '', '', 'TX2', '0.00', '50.00', '0.00', 8, '2012-07-01', NULL, 1, 0, 0, '', '', '', '', 'HCFA|UB|', '1124033196', 0, 'N', 0, '2012-07-03', NULL, NULL, 0, 0, NULL, NULL),
('364100874', 'W12020839', 'W12020839', 'TX01', 'Walgreens Home Care Inc.', '', '', 'Walgreens Home Care Inc', 'GROUP', 'Infusion Agency', 'Infusion Agency', NULL, NULL, 'B', '9361 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '2104049259', NULL, '9361 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '2104049259', '          ', '', '', 'TX2', '0.00', '50.00', '0.00', 8, '2012-07-01', NULL, 1, 0, 0, '', '', '', '', 'HCFA|UB|', '1124033196', 0, 'N', 0, '2012-07-03', NULL, NULL, 0, 0, NULL, NULL),
('528748014', 'W12020843', 'W12020843', 'UTMH1', '', 'James ', 'G', 'Johnson', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', '10429 Zinnia Way', 'Sandy', 'Salt Lake', 'UT', '84094', '8015712691', '8015712691', '10429 Zinnia Way', 'Sandy', 'Salt Lake', 'UT', '84094', '8015712691', '8015712691', 'UTMA', '', '', '0.00', '35.00', '0.00', 6, '2012-05-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1336317650', 0, 'N', 0, '2013-07-24', NULL, NULL, 0, 0, NULL, NULL),
('870284475', 'W12020845', 'W12020845', 'UT01', 'Granger Medical Clinic', 'Sheetal', 'R', 'Shah', 'MD', 'Nephrology', '', '', NULL, 'O', '11724 S State St', 'Draper', 'Salt Lake', 'UT', '84020', '8019653600', '8019653740', '11724 S State St', 'Draper', 'Salt Lake', 'UT', '84020', '8019653600', '8019653740', 'WUGRANGER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-09-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', 'St Marks Hospital', '', '', 'HCFA|UB|', '1841271491', 0, 'N', 0, '2014-07-25', NULL, NULL, 40.5394, -111.891, NULL, NULL),
('870284475', 'W12020846', 'W12020846', 'UT01', 'Granger Medical Clinic', 'Sheetal', 'R', 'Shah', 'MD', 'Nephrology', '', '', NULL, 'B', 'PO Box 70658', 'Salt Lake City', 'Salt Lake', 'UT', '84170', '8019653720', '8019653740', 'PO Box 70658', 'Salt Lake City', 'Salt Lake', 'UT', '84170', '8019653720', '8019653740', 'WUGRANGER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-09-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', 'St Marks Hospital', '', '', 'HCFA|UB|', '1841271491', 0, 'N', 0, '2014-07-25', NULL, NULL, 0, 0, NULL, NULL),
('870284475', 'W12020848', 'W12020848', 'UT01', 'Granger Medical Clinic', 'Clare', 'D', 'Eggett', 'NP', 'Internal Medicine', '', '', NULL, 'O', '3181 W 9000 S', 'West Jordan', 'Salt Lake', 'UT', '84088', '8013525900', '8013525914', '3181 W 9000 S', 'West Jordan', 'Salt Lake', 'UT', '84088', '8013525900', '8013525914', 'WUGRANGER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-10-01', NULL, 0, 0, 0, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1568725760', 0, 'N', 0, '2012-10-09', NULL, NULL, 40.5877, -111.967, NULL, NULL),
('870284475', 'W12020847', 'W12020847', 'UT01', 'Granger Medical Clinic', 'Clare', 'D', 'Eggett', 'NP', 'Internal Medicine', '', '', NULL, 'O', '3725 W 4100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019656300', '8019683605', '3725 W 4100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019656300', '8019683605', 'WUGRANGER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-10-01', NULL, 0, 0, 0, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1568725760', 0, 'N', 0, '2012-10-09', NULL, NULL, 40.682, -111.979, NULL, NULL),
('870284475', 'W12020849', 'W12020849', 'UT01', 'Granger Medical Clinic', 'Clare', 'D', 'Eggett', 'NP', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 70658', 'Salt Lake City', 'Salt Lake', 'UT', '84170', '          ', NULL, 'PO Box 70658', 'Salt Lake City', 'Salt Lake', 'UT', '84170', '          ', '          ', 'WUGRANGER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-10-01', NULL, 0, 0, 0, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1568725760', 0, 'N', 0, '2012-10-09', NULL, NULL, 0, 0, NULL, NULL),
('264333033', 'W12019539', 'W12019539', 'TX01', 'Consultants in Womens Health', 'Henry', '', 'Garza', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '1210 Arion Pkwy', 'San Antonio', 'Bexar', 'TX', '78216', '2103499300', '2103662558', '1210 Arion Pkwy', 'San Antonio', 'Bexar', 'TX', '78216', '2103499300', '2103662558', 'TXOBG', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-07-01', '2012-08-19', 0, 0, 0, 'North East Baptist Hospital', '', '', '', 'HCFA|UB|', '1962491175', 0, 'N', 0, '2014-04-11', NULL, NULL, 0, 0, NULL, NULL),
('264333033', 'W12019538', 'W12019538', 'TX01', 'Consultants in Womens Health', 'Henry', '', 'Garza', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '8715 Village Dr Ste 418', 'San Antonio', 'Bexar', 'TX', '78217', '2106563040', '2106566419', '8715 Village Dr Ste 418', 'San Antonio', 'Bexar', 'TX', '78217', '2106563040', '2106566419', 'TXOBG', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-07-01', '2012-08-19', 0, 0, 0, 'North East Baptist Hospital', '', '', '', 'HCFA|UB|', '1962491175', 0, 'N', 0, '2014-04-11', NULL, NULL, 29.5187, -98.4281, NULL, NULL),
('742143569', 'W12019302', 'W12019302', 'TX01', 'Medical Center Ophthalmology', 'Noemi', '', 'Lozano', 'OD', 'Optometry', '', '', NULL, 'O', '109 Gallery Cir Ste 139', 'San Antonio', 'Bexar', 'TX', '78240', '2106972020', '2105587679', '109 Gallery Cir Ste 139', 'San Antonio', 'Bexar', 'TX', '78240', '2106972020', '2105587679', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-04-01', '2013-04-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1356572903', 0, 'N', 0, '2014-01-31', NULL, NULL, 0, 0, NULL, NULL),
('742143569', 'W12019301', 'W12019301', 'TX01', 'Medical Center Ophthalmology', 'Noemi', '', 'Lozano', 'OD', 'Optometry', '', '', NULL, 'O', '9157 Huebner Rd', 'San Antonio', 'Bexar', 'TX', '78240', '2106972020', '2105587679', '9157 Huebner Rd', 'San Antonio', 'Bexar', 'TX', '78240', '2106972020', '2105587679', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-04-01', '2013-04-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1356572903', 0, 'N', 0, '2014-01-31', NULL, NULL, 29.5286, -98.5961, NULL, NULL),
('742143569', 'W12019303', 'W12019303', 'TX01', 'Medical Center Ophthalmology', 'Noemi', '', 'Lozano', 'OD', 'Optometry', '', '', NULL, 'B', 'PO Box 1358', 'San Antonio', 'Bexar', 'TX', '78295', '2106972020', NULL, 'PO Box 1358', 'San Antonio', 'Bexar', 'TX', '78295', '2106972020', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-04-01', '2013-04-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1356572903', 0, 'N', 0, '2014-01-31', NULL, NULL, 0, 0, NULL, NULL),
('205067728', 'W12019650', 'W12019650', 'WY01', 'Mountain View Clinic', 'Karl', 'H', 'Radke', 'MD', 'Family Practice', '', '', NULL, 'O', '6600 E 2nd St', 'Casper', 'Natrona', 'WY', '82609', '3072664000', NULL, '6600 E 2nd St', 'Casper', 'Natrona', 'WY', '82609', '3072664000', '          ', '', '', '', '0.00', '15.00', '0.00', 3, '2012-05-23', NULL, 0, 0, 0, 'Mountain View Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1720188972', 0, 'N', 0, '2012-07-05', NULL, NULL, 42.8444, -106.244, NULL, NULL),
('205067728', 'W12019651', 'W12019651', 'WYT2', 'Mountain View Clinic', 'Karl', 'H', 'Radke', 'MD', 'Family Practice', '', '', NULL, 'O', '6600 E 2nd St', 'Casper', 'Natrona', 'WY', '82609', '3072664000', NULL, '6600 E 2nd St', 'Casper', 'Natrona', 'WY', '82609', '3072664000', '          ', '', '', '', '0.00', '15.00', '0.00', 3, '2012-05-23', NULL, 0, 0, 1, 'Mountain View Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1720188972', 0, 'N', 0, '2012-07-05', NULL, NULL, 0, 0, NULL, NULL),
('205294327', 'W12019547', 'W12019547', 'ID01', 'Digestive Health Clinic', 'June', 'M', 'Reiling', 'NP', 'Gastroenterology', '', '', NULL, 'O', '6259 W Emerald St', 'Boise', 'Ada', 'ID', '83704', '2084891900', '2083755286', '6259 W Emerald St', 'Boise', 'Ada', 'ID', '83704', '2084891900', '2083755286', 'IDDIGEST', 'WUSTDHCPC5', '', '0.00', '20.00', '0.00', 6, '2012-07-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1730182205', 0, 'N', 0, '2012-07-03', NULL, NULL, 43.6114, -116.259, NULL, NULL),
('260893115', 'W12020854', 'W12020854', 'WY01', 'Elkhorn Valley Rehabilitation  Hospital', '', '', 'Elkhorn Valley Rehabilitation  Hospital', '', 'Rehabilitation Hospital', '', '', NULL, 'O', '5715 E Second St', 'Casper', 'Natrona', 'WY', '82609', '3072687611', '3072652860', '5715 E Second St', 'Casper', 'Natrona', 'WY', '82609', '3072687611', '3072652860', '', '', '', '0.00', '30.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1326233586', 0, 'N', 0, '2012-07-09', NULL, NULL, 0, 0, NULL, NULL),
('260893115', 'W12020855', 'W12020855', 'WY01', 'Elkhorn Valley Rehabilitation  Hospital', '', '', 'Elkhorn Valley Rehabilitation  Hospital', '', 'Rehabilitation Hospital', '', '', NULL, 'B', 'PO Box 911981', 'Denver', 'Denver', 'CO', '80291', '3072687611', '3072652860', 'PO Box 911981', 'Denver', 'Denver', 'CO', '80291', '3072687611', '3072652860', '', '', '', '0.00', '30.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1326233586', 0, 'N', 0, '2012-07-09', NULL, NULL, 0, 0, NULL, NULL),
('260893115', 'W12020856', 'W12020856', 'WYT1', 'Elkhorn Valley Rehabilitation  Hospital', '', '', 'Elkhorn Valley Rehabilitation  Hospital', '', 'Rehabilitation Hospital', '', '', NULL, 'O', '5715 E Second St', 'Casper', 'Natrona', 'WY', '82609', '3072687611', '3072652860', '5715 E Second St', 'Casper', 'Natrona', 'WY', '82609', '3072687611', '3072652860', '', '', '', '0.00', '30.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1326233586', 0, 'N', 0, '2012-07-09', NULL, NULL, 0, 0, NULL, NULL),
('260893115', 'W12020857', 'W12020857', 'WYT1', 'Elkhorn Valley Rehabilitation  Hospital', '', '', 'Elkhorn Valley Rehabilitation  Hospital', '', 'Rehabilitation Hospital', '', '', NULL, 'B', 'PO Box 911981', 'Denver', 'Denver', 'CO', '80291', '3072687611', '3072652860', 'PO Box 911981', 'Denver', 'Denver', 'CO', '80291', '3072687611', '3072652860', '', '', '', '0.00', '30.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1326233586', 0, 'N', 0, '2012-07-09', NULL, NULL, 0, 0, NULL, NULL),
('364100874', 'W12020841', 'W12020841', 'NM01', 'Walgreens Infusion Services', '', '', 'Walgreens Home Care, Inc', '', 'Infusion Agency', '', '', NULL, 'B', '16358 Collections Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '2104049259', NULL, '16358 Collections Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '2104049259', '          ', '', '', 'TX2', '0.00', '0.00', '0.00', 8, '2012-07-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1235300609', 0, 'N', 0, '2013-07-25', NULL, NULL, 0, 0, NULL, NULL),
('364100874', 'W12020840', 'W12020840', 'NM01', 'Walgreens Infusion Services', '', '', 'Walgreens Home Care, Inc', '', 'Infusion Agency', '', '', NULL, 'O', '4374 Alexander Blvd NE Ste A-C', 'Albuquerque', 'Bernalillo', 'NM', '87107', '5058884325', '5053451521', '4374 Alexander Blvd NE Ste A-C', 'Albuquerque', 'Bernalillo', 'NM', '87107', '5058884325', '5053451521', '', '', 'TX2', '0.00', '0.00', '0.00', 8, '2012-07-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1235300609', 0, 'N', 0, '2013-07-25', NULL, NULL, 0, 0, NULL, NULL),
('364100874', 'W12020842', 'W12020842', 'NM01', 'Walgreens Home Care Inc.', '', '', 'Walgreens Home Care, Inc', '', 'Infusion Agency', '', '', NULL, 'B', '9361 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '2104049259', NULL, '9361 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '2104049259', '          ', '', '', 'TX2', '0.00', '0.00', '0.00', 8, '2012-07-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1235300609', 0, 'N', 0, '2013-07-25', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12020859', 'W12020859', 'UTIHC04', '', 'Jeffrey', 'L', 'Bell', 'CRNA', 'Certified Nurse Anesthetist', '', '', NULL, 'O', '126 S White Sage Ave', 'Delta', 'Millard', 'UT', '84624', '4358645591', NULL, '126 S White Sage Ave', 'Delta', 'Millard', 'UT', '84624', '4358645591', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2012-06-01', NULL, 0, 0, 0, 'Sanpete Valley Hospital', '', '', '', 'HCFA|UB|', '1992869598', 0, 'N', 0, '2012-08-14', NULL, NULL, 39.3506, -112.56, NULL, NULL),
('942854057', 'W12020860', 'W12020860', 'UTIHC04', '', 'Jeffrey', 'L', 'Bell', 'CRNA', 'Certified Nurse Anesthetist', '', '', NULL, 'O', '674 S Hwy 99', 'Fillmore', 'Millard', 'UT', '84631', '4357435591', NULL, '674 S Hwy 99', 'Fillmore', 'Millard', 'UT', '84631', '4357435591', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2012-06-01', NULL, 0, 0, 0, 'Sanpete Valley Hospital', '', '', '', 'HCFA|UB|', '1992869598', 0, 'N', 0, '2012-08-14', NULL, NULL, 38.9534, -112.34, NULL, NULL),
('742719352', 'W12009830', 'W12009830', 'TX01', 'Urology of San Antonio', 'Christopher', 'H', 'Cantrill', 'MD', 'Urology', '', '', NULL, 'O', '255 E Sonterra Ste 203', 'San Antonio', 'Bexar', 'TX', '78258', '2104995158', '2104995259', '255 E Sonterra Ste 203', 'San Antonio', 'Bexar', 'TX', '78258', '2104995158', '2104995259', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2011-10-01', '2012-08-19', 0, 0, 0, 'St Lukes Baptist Hospital', '', '', '', 'HCFA|UB|', '1568642296', 0, 'N', 0, '2014-04-11', NULL, NULL, 29.6171, -98.4906, NULL, NULL),
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('742719352', 'W12009829', 'W12009829', 'TX01', 'Urology of San Antonio', 'Christopher', 'H', 'Cantrill', 'MD', 'Urology', '', '', NULL, 'O', '12709 Toepperwein Ste 206', 'San Antonio', 'Bexar', 'TX', '78233', '2105648000', '2105907945', '12709 Toepperwein Ste 206', 'San Antonio', 'Bexar', 'TX', '78233', '2105648000', '2105907945', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2011-10-01', '2012-08-19', 0, 0, 0, 'St Lukes Baptist Hospital', '', '', '', 'HCFA|UB|', '1568642296', 0, 'N', 0, '2014-04-11', NULL, NULL, 29.5532, -98.3483, NULL, NULL),
('870767026', 'W12020864', 'W12020864', 'ID01', 'West Valley Medical Group Caldwell', 'Daniel', 'J', 'Allen', 'DO', 'Family Practice', 'Sports Medicine', '', NULL, 'O', '16459 N Midland Blvd', 'Nampa', 'Canyon', 'ID', '83687', '2087955075', '2084593372', '16459 N Midland Blvd', 'Nampa', 'Canyon', 'ID', '83687', '2087955075', '2084593372', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', '2012-08-19', 0, 0, 0, 'West Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1720017247', 0, 'N', 0, '2013-10-14', NULL, NULL, 43.6116, -116.593, 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
('870767026', 'W12020865', 'W12020865', 'ID01', 'West Valley Medical Group Caldwell', 'Daniel', 'J', 'Allen', 'DO', 'Family Practice', 'Sports Medicine', '', NULL, 'O', '211 E Logan St Ste 203', 'Caldwell', 'Canyon', 'ID', '83605', '2084594667', '2084593372', '211 E Logan St Ste 203', 'Caldwell', 'Canyon', 'ID', '83605', '2084594667', '2084593372', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', '2012-07-01', 0, 0, 0, 'West Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1720017247', 0, 'N', 0, '2013-10-14', NULL, NULL, 43.6554, -116.697, NULL, NULL),
('870767026', 'W12020866', 'W12020866', 'ID01', 'West Valley Medical Group Caldwell', 'Daniel', 'J', 'Allen', 'DO', 'Family Practice', 'Sports Medicine', '', NULL, 'B', 'PO Box 277976', 'Atlanta', 'Fulton', 'GA', '30384', '8015470747', '2084593372', 'PO Box 277976', 'Atlanta', 'Fulton', 'GA', '30384', '8015470747', '2084593372', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', '2012-08-19', 0, 0, 0, 'West Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1720017247', 0, 'N', 0, '2013-10-14', NULL, NULL, 0, 0, NULL, NULL),
('271456616', 'W12020851', 'W12020851', 'UTMH1', '', 'Laura', 'P', 'Brown', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', 'PO Box 58572', 'Salt Lake City', 'Salt Lake', 'UT', '84158', '8019970939', '8013592665', 'PO Box 58572', 'Salt Lake City', 'Salt Lake', 'UT', '84158', '8019970939', '8013592665', 'UTMA', '', '', '0.00', '35.00', '0.00', 3, '2012-06-26', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1144469727', 0, 'N', 0, '2014-05-21', NULL, NULL, 0, 0, NULL, NULL),
('820503498', 'W12020867', 'W12020867', 'ID02', 'Craniofacial Pain Center of Idaho', 'Cameron', 'A', 'Kuehne', 'DMD', 'Dentist', 'Sleep Apnea Device', '', NULL, 'O', '1436 S Edgewater Cir', 'Nampa', 'Canyon', 'ID', '83686', '2083763600', NULL, '1436 S Edgewater Cir', 'Nampa', 'Canyon', 'ID', '83686', '2083763600', '', '', '', '', '0.00', '20.00', '0.00', 3, '2012-07-05', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1013145754', 0, 'N', 0, '2014-05-08', NULL, NULL, 0, 0, NULL, NULL),
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('621801973', 'W12020853', 'W12020853', 'UT01', 'Physicians Group of Utah', 'Andrea', 'N', 'Smith', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2012-06-01', '2014-04-30', 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1831155746', 0, 'N', 0, '2013-07-25', NULL, NULL, 0, 0, NULL, NULL),
('820503498', 'W12020869', 'W12020869', 'ID02', 'Craniofacial Pain Center of Idaho', 'Jamison', 'R', 'Spencer', 'DMD', 'Dentist', 'Sleep Apnea Device', '', NULL, 'O', '1436 S Edgewater Cir', 'Nampa', 'Canyon', 'ID', '83686', '2083763600', NULL, '1436 S Edgewater Cir', 'Nampa', 'Canyon', 'ID', '83686', '2083763600', '          ', '', '', '', '0.00', '20.00', '0.00', 3, '2012-07-05', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1285654848', 0, 'N', 0, '2012-07-10', NULL, NULL, 0, 0, NULL, NULL),
('820161600', 'W12020873', 'W12020873', 'ID02', 'St Lukes Neurosurgical Associates', 'W', 'Bruce', 'Cherny', 'MD', 'Neurosurgery', 'Pediatric Neurosurgery', '', NULL, 'O', '100 E Idaho St Ste 202', 'Boise', 'Ada', 'ID', '83712', '2083817360', '2083817361', '100 E Idaho St Ste 202', 'Boise', 'Ada', 'ID', '83712', '2083817360', '2083817361', 'IDACN', '', '', '0.00', '15.00', '0.00', 8, '2012-03-01', '2013-02-04', 0, 0, 1, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1275575839', 0, 'N', 0, '2013-10-16', NULL, NULL, 43.6123, -116.194, NULL, NULL),
('455033857', 'W12020874', 'W12020874', 'WY01', 'Resonance Therapy', 'Diana', 'M', 'Cline', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '601 S Gillette Ave', 'Gillette', 'Campbell', 'WY', '82716', '3076858182', '3076858183', '601 S Gillette Ave', 'Gillette', 'Campbell', 'WY', '82716', '3076858182', '3076858183', 'WYMA', '', '', '0.00', '35.00', '0.00', 3, '2012-08-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1245474253', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('455033857', 'W12020875', 'W12020875', 'WYT1', 'Resonance Therapy', 'Diana', 'M', 'Cline', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '601 S Gillette Ave', 'Gillette', 'Campbell', 'WY', '82716', '3076858182', '3076858183', '601 S Gillette Ave', 'Gillette', 'Campbell', 'WY', '82716', '3076858182', '3076858183', 'WYMA', '', '', '0.00', '35.00', '0.00', 3, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1245474253', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('900120192', 'W12020879', 'W12020879', 'TX01', 'Sports Medicine Associates of San Antonio', '', '', 'Sports Medicine Associates of San Antonio', '', 'Orthopedic Surgery', 'Physical Therapy', '', NULL, 'O', '21 Spurs Ln Ste 300', 'San Antonio', 'Bexar', 'TX', '78240', '2106998326', '2105617121', '21 Spurs Ln Ste 300', 'San Antonio', 'Bexar', 'TX', '78240', '2106998326', '2105617121', 'TXORTHO', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-07-12', '2012-08-19', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1861549503', 0, 'N', 0, '2014-07-18', NULL, NULL, 29.5271, -98.5917, NULL, NULL),
('900120192', 'W12020880', 'W12020880', 'TX01', 'Sports Medicine Associates of San Antonio', '', '', 'Sports Medicine Associates of San Antonio', '', 'Orthopedic Surgery', 'Physical Therapy', '', NULL, 'O', '5921 Broadway', 'San Antonio', 'Bexar', 'TX', '78209', '2106998326', '2105617121', '5921 Broadway', 'San Antonio', 'Bexar', 'TX', '78209', '2106998326', '2105617121', 'TXORTHO', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-07-12', '2012-08-19', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1861549503', 0, 'N', 0, '2014-07-18', NULL, NULL, 29.4805, -98.465, NULL, NULL),
('900120192', 'W12020882', 'W12020882', 'TX01', 'Sports Medicine Associates of San Antonio', '', '', 'Sports Medicine Associates of San Antonio', '', 'Orthopedic Surgery', 'Physical Therapy', '', NULL, 'B', 'PO Box 196', 'San Antonio', 'Bexar', 'TX', '78291', '2106998326', '2105617121', 'PO Box 196', 'San Antonio', 'Bexar', 'TX', '78291', '2106998326', '2105617121', 'TXORTHO', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-07-12', '2012-08-19', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1861549503', 0, 'N', 0, '2014-07-18', NULL, NULL, 0, 0, NULL, NULL),
('263452005', 'W12020884', 'W12020884', 'WY01', '', 'Douglass', 'W', 'Forsha', 'MD', 'Dermatology', NULL, NULL, NULL, 'O', '1001 S Douglas Hwy Ste B5', 'Gillette', 'Campbell', 'WY', '82716', '3072652936', NULL, '1001 S Douglas Hwy Ste B5', 'Gillette', 'Campbell', 'WY', '82716', '3072652936', '          ', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-06-01', '2013-10-21', 0, 0, 0, 'Evanston Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1285674671', 0, 'N', 0, '2013-10-31', NULL, NULL, 0, 0, NULL, NULL),
('263452005', 'W12020885', 'W12020885', 'WY01', '', 'Douglass', 'W', 'Forsha', 'MD', 'Dermatology', NULL, NULL, NULL, 'O', '196 Arrowhead Dr Ste 5', 'Evanston', 'Uinta', 'WY', '82930', '3072652936', NULL, '196 Arrowhead Dr Ste 5', 'Evanston', 'Uinta', 'WY', '82930', '3072652936', '          ', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-06-01', NULL, 0, 0, 0, 'Evanston Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1285674671', 0, 'N', 0, '2013-10-23', NULL, NULL, 41.2435, -110.998, NULL, NULL),
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('263452005', 'W12020887', 'W12020887', 'WY01', '', 'Douglass', 'W', 'Forsha', 'MD', 'Dermatology', NULL, NULL, NULL, 'O', '511 N 12th St Ste EB', 'Riverton', 'Fremont', 'WY', '82501', '3072652936', NULL, '511 N 12th St Ste EB', 'Riverton', 'Fremont', 'WY', '82501', '3072652936', '          ', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-06-01', '2013-10-21', 0, 0, 0, 'Evanston Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1285674671', 0, 'N', 0, '2013-10-31', NULL, NULL, 0, 0, NULL, NULL),
('263452005', 'W12020888', 'W12020888', 'WY01', '', 'Douglass', 'W', 'Forsha', 'MD', 'Dermatology', NULL, NULL, NULL, 'O', '940 E 3rd St Ste 307', 'Casper', 'Natrona', 'WY', '82601', '3072652936', NULL, '940 E 3rd St Ste 307', 'Casper', 'Natrona', 'WY', '82601', '3072652936', '          ', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-06-01', NULL, 0, 0, 0, 'Evanston Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1285674671', 0, 'N', 0, '2013-10-23', NULL, NULL, 42.8477, -106.313, NULL, NULL),
('263452005', 'W12020889', 'W12020889', 'WYT1', '', 'Douglass', 'W', 'Forsha', 'MD', 'Dermatology', NULL, NULL, NULL, 'O', '1001 S Douglas Hwy Ste B5', 'Gillette', 'Campbell', 'WY', '82716', '3072652936', NULL, '1001 S Douglas Hwy Ste B5', 'Gillette', 'Campbell', 'WY', '82716', '3072652936', '          ', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-06-01', '2013-10-21', 0, 0, 0, 'Evanston Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1285674671', 0, 'N', 0, '2013-10-31', NULL, NULL, 0, 0, NULL, NULL),
('263452005', 'W12020890', 'W12020890', 'WYT1', '', 'Douglass', 'W', 'Forsha', 'MD', 'Dermatology', NULL, NULL, NULL, 'O', '196 Arrowhead Dr Ste 5', 'Evanston', 'Uinta', 'WY', '82930', '3072652936', NULL, '196 Arrowhead Dr Ste 5', 'Evanston', 'Uinta', 'WY', '82930', '3072652936', '          ', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-06-01', NULL, 0, 0, 0, 'Evanston Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1285674671', 0, 'N', 0, '2013-10-23', NULL, NULL, 0, 0, NULL, NULL),
('263452005', 'W12020891', 'W12020891', 'WYT1', '', 'Douglass', 'W', 'Forsha', 'MD', 'Dermatology', NULL, NULL, NULL, 'O', '430 Broadway', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3072652936', NULL, '430 Broadway', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3072652936', '          ', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-06-01', '2013-10-21', 0, 0, 0, 'Evanston Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1285674671', 0, 'N', 0, '2013-10-31', NULL, NULL, 0, 0, NULL, NULL),
('263452005', 'W12020892', 'W12020892', 'WYT1', '', 'Douglass', 'W', 'Forsha', 'MD', 'Dermatology', NULL, NULL, NULL, 'O', '511 N 12th St Ste EB', 'Riverton', 'Fremont', 'WY', '82501', '3072652936', NULL, '511 N 12th St Ste EB', 'Riverton', 'Fremont', 'WY', '82501', '3072652936', '          ', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-06-01', '2013-10-21', 0, 0, 0, 'Evanston Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1285674671', 0, 'N', 0, '2013-10-31', NULL, NULL, 0, 0, NULL, NULL),
('263452005', 'W12020893', 'W12020893', 'WYT1', '', 'Douglass', 'W', 'Forsha', 'MD', 'Dermatology', NULL, NULL, NULL, 'O', '940 E 3rd St Ste 307', 'Casper', 'Natrona', 'WY', '82601', '3072652936', NULL, '940 E 3rd St Ste 307', 'Casper', 'Natrona', 'WY', '82601', '3072652936', '          ', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-06-01', NULL, 0, 0, 0, 'Evanston Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1285674671', 0, 'N', 0, '2013-10-23', NULL, NULL, 0, 0, NULL, NULL),
('820161600', 'W12020909', 'W12020909', 'SACN', 'St Lukes Neurosurgical Associates', 'W', 'Bruce', 'Cherny', 'MD', 'Neurosurgery', 'Pediatric Neurosurgery', '', NULL, 'O', '100 E Idaho St Ste 200', 'Boise', 'Ada', 'ID', '83712', '2083817360', NULL, '100 E Idaho St Ste 200', 'Boise', 'Ada', 'ID', '83712', '2083817360', '          ', 'IDSINCLAIRL', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 8, '2011-01-01', '2013-02-04', 0, 0, 1, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1275575839', 0, 'N', 0, '2013-10-16', NULL, NULL, 43.6123, -116.194, NULL, NULL),
('200324983', 'W12020913', 'W12020913', 'ID01', 'Idaho Sports Medicine Institute', 'Jay', 'R', 'Armstrong', 'PT', 'Physical Therapy', NULL, NULL, NULL, 'O', '1188 University Dr', 'Boise', 'Ada', 'ID', '83706', '2083368250', '2083459514', '1188 University Dr', 'Boise', 'Ada', 'ID', '83706', '2083368250', '2083459514', 'WestRehab', '', '', '0.00', '0.00', '73.00', 3, '2012-07-01', '2013-01-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1447256086', 0, 'N', 0, '2013-01-28', NULL, NULL, 43.601, -116.196, NULL, NULL),
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('261686506', 'W12020931', 'W12020931', 'UT01', 'Advanced Spinal Rehabilitation', 'Corey', '', 'Bowden', 'DC', 'Chiropractic', '', '', NULL, 'O', '67 S Main Ste 150', 'Layton', 'Davis', 'UT', '84041', '8014441230', '8014441228', '67 S Main Ste 150', 'Layton', 'Davis', 'UT', '84041', '8014441230', '8014441228', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '57.12', 3, '2012-08-01', '2014-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1063639359', 0, 'N', 0, '2014-06-24', NULL, NULL, 41.059, -111.966, NULL, NULL),
('262578815', 'W12020932', 'W12020932', 'UT01', 'Advanced Spine and Health Center of Cache Valley', 'Steven', 'Delmont', 'Fisher', 'DC', 'Chiropractic', '', '', NULL, 'O', '1652 S Hwy 165', 'Providence', 'Cache', 'UT', '84332', '4357525522', '4357523075', '1652 S Hwy 165', 'Providence', 'Cache', 'UT', '84332', '4357525522', '4357523075', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '57.12', 3, '2012-08-01', '2013-11-26', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1497922835', 0, 'N', 0, '2013-12-30', NULL, NULL, 0, 0, NULL, NULL),
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('200775852', 'W12020934', 'W12020934', 'UT01', 'Alta Vista Chiropractic', 'Stephanie', '', 'Allen', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '1781 W 9000 S', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015625600', '8012557104', '1781 W 9000 S', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015625600', '8012557104', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '57.12', 3, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1437126372', 0, 'N', 0, '2012-07-09', NULL, NULL, 40.5877, -111.94, NULL, NULL),
('731649834', 'W12020935', 'W12020935', 'UT01', 'Amon Chiropractic Center PC', 'Richard', 'P', 'Amon', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '3996 S 1900 W', 'Roy', 'Weber', 'UT', '84067', '8017312200', '8017312228', '3996 S 1900 W', 'Roy', 'Weber', 'UT', '84067', '8017312200', '8017312228', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '57.12', 3, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1265407282', 0, 'N', 0, '2012-10-15', NULL, NULL, 41.1908, -112.026, NULL, NULL),
('263003358', 'W12020936', 'W12020936', 'UT01', 'Aspen Falls Spinal Care Center', 'Dustin', 'James', 'Hedstrom', 'DC', 'Chiropractic', '', '', NULL, 'O', '505 E 200 S Ste 425', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013630060', '8013633926', '505 E 200 S Ste 425', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013630060', '8013633926', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '57.12', 3, '2012-08-01', '2013-07-22', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1831383298', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('870684664', 'W12020937', 'W12020937', 'UT01', 'Astle Chiropractic Clinic Inc', 'Joseph', 'Todd', 'Astle', 'DC', 'Chiropractic', '', '', NULL, 'O', '112 E 100 N', 'Logan', 'Cache', 'UT', '84321', '4357534744', '4357521249', '112 E 100 N', 'Logan', 'Cache', 'UT', '84321', '4357534744', '4357521249', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '57.12', 3, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1871582080', 0, 'N', 0, '2012-07-09', NULL, NULL, 41.7332, -111.832, NULL, NULL),
('470904864', 'W12020938', 'W12020938', 'UT01', 'Awerkamp Chiropractic PC', 'Blaine', 'A', 'Awerkamp', 'DC', 'Chiropractic', '', '', NULL, 'O', '8394 S 700 E', 'Sandy', 'Salt Lake', 'UT', '84070', '8015620135', '8015620174', '8394 S 700 E', 'Sandy', 'Salt Lake', 'UT', '84070', '8015620135', '8015620174', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '57.12', 3, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1598722928', 0, 'N', 0, '2012-07-09', NULL, NULL, 40.5988, -111.872, NULL, NULL),
('870623599', 'W12020939', 'W12020939', 'UT01', 'Bach Chiropractic', 'John', '', 'Bach', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '1473 S 600 E', 'Salt Lake City', 'Salt Lake', 'UT', '84105', '8014871010', '8014871015', '1473 S 600 E', 'Salt Lake City', 'Salt Lake', 'UT', '84105', '8014871010', '8014871015', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '57.12', 3, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1841241338', 0, 'N', 0, '2012-07-09', NULL, NULL, 40.7377, -111.874, NULL, NULL),
('450514240', 'W12020940', 'W12020940', 'UT01', 'Basic Health Chiropractic', 'Milton', 'L', 'Carroll', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '675 S 100 W Ste 4', 'Payson', 'Utah', 'UT', '84651', '8014658177', '8014658266', '675 S 100 W Ste 4', 'Payson', 'Utah', 'UT', '84651', '8014658177', '8014658266', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '57.12', 3, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1982704177', 0, 'N', 0, '2012-07-09', NULL, NULL, 40.0327, -111.734, NULL, NULL),
('870623385', 'W12020941', 'W12020941', 'UT01', 'Berlin Chiropractic Inc', 'Daniel', '', 'Berlin', 'DC', 'Chiropractic', '', '', NULL, 'O', '4360 S Redwood Rd Ste 3', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8019638750', '8019672494', '4360 S Redwood Rd Ste 3', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8019638750', '8019672494', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '57.12', 3, '2012-08-01', '2014-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1487862843', 0, 'N', 0, '2014-06-24', NULL, NULL, 40.6761, -111.939, NULL, NULL),
('800386273', 'W12020942', 'W12020942', 'UT01', 'Best Life Chiropractic PLLC', 'Blaine', 'A', 'Ford', 'DC', 'Chiropractic', '', '', NULL, 'O', '96 N Main St Ste 103', 'Cedar City', 'Iron', 'UT', '84720', '4358678986', '4358676233', '96 N Main St Ste 103', 'Cedar City', 'Iron', 'UT', '84720', '4358678986', '4358676233', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '57.12', 3, '2012-08-01', '2013-09-16', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1457582694', 0, 'N', 0, '2013-10-08', NULL, NULL, 0, 0, NULL, NULL),
('870524473', 'W12020943', 'W12020943', 'UT01', 'Blue Mountain Chiropractic PC', 'Thomas', 'Rhett', 'Maughan', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '225 S Main', 'Monticello', 'San Juan', 'UT', '84535', '4355873255', '4355873442', '225 S Main', 'Monticello', 'San Juan', 'UT', '84535', '4355873255', '4355873442', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '57.12', 3, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1275542284', 0, 'N', 0, '2013-06-14', NULL, NULL, 37.8698, -109.343, NULL, NULL),
('870524473', 'W12020944', 'W12020944', 'UT01', 'Blue Mountain Chiropractic', 'Thomas', 'Rhett', 'Maughan', 'DC', 'Chiropractic', NULL, NULL, NULL, 'B', 'PO Box 783', 'Monticello', 'San Juan', 'UT', '84535', '4355873255', '4355873442', 'PO Box 783', 'Monticello', 'San Juan', 'UT', '84535', '4355873255', '4355873442', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '57.12', 3, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1275542284', 0, 'N', 0, '2013-06-14', NULL, NULL, 0, 0, NULL, NULL),
('204005480', 'W12020945', 'W12020945', 'UT01', 'Body Needs', 'Jeremiah', '', 'Hoopes', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '770 S 200 E', 'Brigham City', 'Box Elder', 'UT', '84302', '4357230517', '4357230587', '770 S 200 E', 'Brigham City', 'Box Elder', 'UT', '84302', '4357230517', '4357230587', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '57.12', 3, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1881652535', 0, 'N', 0, '2012-07-09', NULL, NULL, 41.4948, -112.013, NULL, NULL),
('261087273', 'W12020946', 'W12020946', 'UT01', '', 'James Bradley', '', 'Young', 'DC', 'Chiropractic', '', '', NULL, 'O', '1410 N Hill Field Rd Ste 4', 'Layton', 'Davis', 'UT', '84041', '8015441401', '8015441404', '1410 N Hill Field Rd Ste 4', 'Layton', 'Davis', 'UT', '84041', '8015441401', '8015441404', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '57.12', 3, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1861580888', 0, 'N', 0, '2012-07-09', NULL, NULL, 41.0805, -111.973, NULL, NULL),
('870653332', 'W12020947', 'W12020947', 'UT01', '', 'Brian', 'H', 'Ewell', 'DC', 'Chiropractic', '', '', NULL, 'O', '2964 W 4700 S Ste 102', 'Salt Lake City', 'Salt Lake', 'UT', '84129', '8019669100', '8019660094', '2964 W 4700 S Ste 102', 'Salt Lake City', 'Salt Lake', 'UT', '84129', '8019669100', '8019660094', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '57.12', 3, '2012-08-01', '2014-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1760459135', 0, 'N', 0, '2014-06-24', NULL, NULL, 40.6676, -111.962, NULL, NULL),
('528942300', 'W12020948', 'W12020948', 'UT01', 'Brian N Hardy', 'Brian', 'N', 'Hardy', 'DC', 'Chiropractic', '', '', NULL, 'O', '75 S 100 E Ste 1A', 'St George', 'Washington', 'UT', '84770', '4356888830', '4356882240', '75 S 100 E Ste 1A', 'St George', 'Washington', 'UT', '84770', '4356888830', '4356882240', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '57.12', 3, '2012-08-01', '2013-01-15', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1831255033', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('273777950', 'W12020949', 'W12020949', 'UT01', 'Brigham City Chiropractic and Accident Rehabilitation', 'Craig', '', 'Johnson', 'DC', 'Chiropractic', '', '', NULL, 'O', '75 E 600 S', 'Brigham City', 'Box Elder', 'UT', '84302', '4357342095', '4357340731', '75 E 600 S', 'Brigham City', 'Box Elder', 'UT', '84302', '4357342095', '4357340731', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '57.12', 3, '2012-08-01', '2012-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1437239696', 0, 'N', 0, '2013-01-09', NULL, NULL, 0, 0, NULL, NULL),
('870559629', 'W12020950', 'W12020950', 'UT01', '', 'Bryon', '', 'Rosquist', 'DC', 'Chiropractic', '', '', NULL, 'O', '405 S 100 E Ste 104', 'Pleasant Grove', 'Utah', 'UT', '84062', '8017859411', '8884312763', '405 S 100 E Ste 104', 'Pleasant Grove', 'Utah', 'UT', '84062', '8017859411', '8884312763', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '57.12', 3, '2012-08-01', '2014-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1730221706', 0, 'N', 0, '2014-06-24', NULL, NULL, 40.3593, -111.739, NULL, NULL),
('412110107', 'W12020951', 'W12020951', 'UT01', 'Bullough Chiropractic', 'Jerry', '', 'Bullough', 'DC', 'Chiropractic', '', '', NULL, 'O', '360 S Fort Ln Ste 102', 'Layton', 'Davis', 'UT', '84041', '8015463731', '8015463777', '360 S Fort Ln Ste 102', 'Layton', 'Davis', 'UT', '84041', '8015463731', '8015463777', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '57.12', 3, '2012-08-01', '2014-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1558360198', 0, 'N', 0, '2014-02-06', NULL, NULL, 0, 0, NULL, NULL),
('870424894', 'W12020952', 'W12020952', 'UT01', 'Campbell Chiropractic', 'Craig', 'D', 'Campbell', 'DC', 'Chiropractic', '', '', NULL, 'O', '115 E 7200 S', 'Midvale', 'Salt Lake', 'UT', '84047', '8015664357', '8015664476', '115 E 7200 S', 'Midvale', 'Salt Lake', 'UT', '84047', '8015664357', '8015664476', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '57.12', 3, '2012-08-01', '2014-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1013023282', 0, 'N', 0, '2014-06-24', NULL, NULL, 40.6208, -111.888, NULL, NULL),
('870627188', 'W12020953', 'W12020953', 'UT01', 'Canyon Ridge Chiropractic Inc', 'Jason', 'L', 'Smith', 'DC', 'Chiropractic', '', '', NULL, 'O', '425 S Medical Dr Ste 216', 'Bountiful', 'Davis', 'UT', '84010', '8012924400', '8013353209', '425 S Medical Dr Ste 216', 'Bountiful', 'Davis', 'UT', '84010', '8012924400', '8013353209', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '57.12', 3, '2012-08-01', '2014-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1558391169', 0, 'N', 0, '2014-06-24', NULL, NULL, 40.8873, -111.872, NULL, NULL),
('870304778', 'W12020954', 'W12020954', 'UT01', 'Carbon Chiropractic Center', 'Milton', 'K', 'Thayn', 'DC', 'Chiropractic', '', '', NULL, 'O', '39 N 600 E', 'Price', 'Carbon', 'UT', '84501', '4356370450', '4356376341', '39 N 600 E', 'Price', 'Carbon', 'UT', '84501', '4356370450', '4356376341', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '57.12', 3, '2012-08-01', '2014-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1720112980', 0, 'N', 0, '2014-06-24', NULL, NULL, 39.6001, -110.8, NULL, NULL),
('607075915', 'W12020956', 'W12020956', 'UT01', 'Carter Chiropractic Center', 'Brandon', '', 'Carter', 'DC', 'Chiropractic', '', '', NULL, 'O', '10684 S River Front Pkwy', 'South Jordan', 'Salt Lake', 'UT', '84095', '8018160332', '8018160331', '10684 S River Front Pkwy', 'South Jordan', 'Salt Lake', 'UT', '84095', '8018160332', '8018160331', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '57.12', 3, '2012-08-01', '2012-09-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1093996373', 0, 'N', 0, '2012-10-15', NULL, NULL, 0, 0, NULL, NULL),
('870679104', 'W12020958', 'W12020958', 'UT01', 'Center for Team Healthcare', 'Donald', 'A', 'Cofer', 'DC', 'Chiropractic', '', '', NULL, 'O', '1260 B Iron Horse Dr', 'Park City', 'Summit', 'UT', '84060', '4356491542', '4356584909', '1260 B Iron Horse Dr', 'Park City', 'Summit', 'UT', '84060', '4356491542', '4356584909', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '57.12', 3, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1215979133', 0, 'N', 0, '2012-07-09', NULL, NULL, 40.6593, -111.502, NULL, NULL),
('870679104', 'W12020959', 'W12020959', 'UT01', 'Center for Team Healthcare', 'Donald', 'A', 'Cofer', 'DC', 'Chiropractic', '', '', NULL, 'B', 'PO Box 680638', 'Park City', 'Summit', 'UT', '84068', '4356491542', '4356584909', 'PO Box 680638', 'Park City', 'Summit', 'UT', '84068', '4356491542', '4356584909', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '57.12', 3, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1215979133', 0, 'N', 0, '2012-07-09', NULL, NULL, 0, 0, NULL, NULL),
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INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
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('200022831', 'W12020998', 'W12020998', 'ID02', 'Foothills Physical Therapy', 'James', 'D', 'Hammer', 'DPT', 'Physical Therapy', '', '', NULL, 'O', '1618 S Millennium Way Ste 210', 'Meridian', 'Ada', 'ID', '83642', '2088844647', NULL, '1618 S Millennium Way Ste 210', 'Meridian', 'Ada', 'ID', '83642', '2088844647', '          ', 'WestRehab', '', '', '0.00', '0.00', '73.00', 3, '2012-07-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1245494269', 0, 'N', 0, '2013-12-30', NULL, NULL, 43.5903, -116.368, NULL, NULL),
('200022831', 'W12020999', 'W12020999', 'ID02', 'Foothills Physical Therapy', 'James', 'D', 'Hammer', 'DPT', 'Physical Therapy', '', '', NULL, 'O', '1673 W Shoreline Dr Ste 230', 'Boise', 'Ada', 'ID', '83702', '2083434700', NULL, '1673 W Shoreline Dr Ste 230', 'Boise', 'Ada', 'ID', '83702', '2083434700', '          ', 'WestRehab', '', '', '0.00', '0.00', '73.00', 3, '2012-07-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1245494269', 0, 'N', 0, '2013-12-30', NULL, NULL, 43.6171, -116.222, NULL, NULL),
('200022831', 'W12021000', 'W12021000', 'ID02', 'Foothills Physical Therapy', 'Jerret', 'K', 'Hopstad', 'PT', 'Physical Therapy', '', '', NULL, 'O', '1618 S Millennium Way Ste 210', 'Meridian', 'Ada', 'ID', '83642', '2088844647', NULL, '1618 S Millennium Way Ste 210', 'Meridian', 'Ada', 'ID', '83642', '2088844647', '          ', 'WestRehab', '', '', '0.00', '0.00', '73.00', 3, '2012-07-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1083620553', 0, 'N', 0, '2013-12-30', NULL, NULL, 43.5903, -116.368, NULL, NULL),
('200022831', 'W12021001', 'W12021001', 'ID02', 'Foothills Physical Therapy', 'Jerret', 'K', 'Hopstad', 'PT', 'Physical Therapy', '', '', NULL, 'O', '1673 W Shoreline Dr Ste 230', 'Boise', 'Ada', 'ID', '83702', '2083434700', NULL, '1673 W Shoreline Dr Ste 230', 'Boise', 'Ada', 'ID', '83702', '2083434700', '          ', 'WestRehab', '', '', '0.00', '0.00', '73.00', 3, '2012-07-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1083620553', 0, 'N', 0, '2013-12-30', NULL, NULL, 43.6171, -116.222, NULL, NULL),
('200022831', 'W12021002', 'W12021002', 'ID02', 'Foothills Physical Therapy', 'Anthony (Toby)', 'E', 'Kinney', 'PT', 'Physical Therapy', '', '', NULL, 'O', '1618 S Millennium Way Ste 210', 'Meridian', 'Ada', 'ID', '83642', '2088844647', NULL, '1618 S Millennium Way Ste 210', 'Meridian', 'Ada', 'ID', '83642', '2088844647', '          ', 'WestRehab', '', '', '0.00', '0.00', '73.00', 3, '2012-07-01', '2013-09-03', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1508958224', 0, 'N', 0, '2013-09-06', NULL, NULL, 43.5903, -116.368, NULL, NULL),
('200022831', 'W12021003', 'W12021003', 'ID02', 'Foothills Physical Therapy', 'Anthony (Toby)', 'E', 'Kinney', 'PT', 'Physical Therapy', '', '', NULL, 'O', '1673 W Shoreline Dr Ste 230', 'Boise', 'Ada', 'ID', '83702', '2083434700', NULL, '1673 W Shoreline Dr Ste 230', 'Boise', 'Ada', 'ID', '83702', '2083434700', '          ', 'WestRehab', '', '', '0.00', '0.00', '73.00', 3, '2012-07-01', '2013-09-03', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1508958224', 0, 'N', 0, '2013-09-06', NULL, NULL, 43.6171, -116.222, NULL, NULL),
('200022831', 'W12021004', 'W12021004', 'ID02', 'Foothills Physical Therapy', 'Debra', 'F', 'Marquez', 'PT', 'Physical Therapy', '', '', NULL, 'O', '1618 S Millennium Way Ste 210', 'Meridian', 'Ada', 'ID', '83642', '2088844647', NULL, '1618 S Millennium Way Ste 210', 'Meridian', 'Ada', 'ID', '83642', '2088844647', '          ', 'WestRehab', '', '', '0.00', '0.00', '73.00', 3, '2012-07-01', '2013-09-03', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1811066558', 0, 'N', 0, '2013-09-06', NULL, NULL, 43.5903, -116.368, NULL, NULL),
('200022831', 'W12021005', 'W12021005', 'ID02', 'Foothills Physical Therapy', 'Debra', 'F', 'Marquez', 'PT', 'Physical Therapy', '', '', NULL, 'O', '1673 W Shoreline Dr Ste 230', 'Boise', 'Ada', 'ID', '83702', '2083434700', NULL, '1673 W Shoreline Dr Ste 230', 'Boise', 'Ada', 'ID', '83702', '2083434700', '          ', 'WestRehab', '', '', '0.00', '0.00', '73.00', 3, '2012-07-01', '2013-09-03', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1811066558', 0, 'N', 0, '2013-09-06', NULL, NULL, 43.6171, -116.222, NULL, NULL),
('200022831', 'W12021007', 'W12021007', 'ID02', 'Foothills Physical Therapy', 'Pamela', 'A', 'Martin', 'PT', 'Physical Therapy', '', '', NULL, 'O', '1673 W Shoreline Dr Ste 230', 'Boise', 'Ada', 'ID', '83702', '2083434700', NULL, '1673 W Shoreline Dr Ste 230', 'Boise', 'Ada', 'ID', '83702', '2083434700', '          ', 'WestRehab', '', '', '0.00', '0.00', '73.00', 3, '2012-07-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1154380293', 0, 'N', 0, '2013-12-30', NULL, NULL, 43.6171, -116.222, NULL, NULL),
('200022831', 'W12021008', 'W12021008', 'ID02', 'Foothills Physical Therapy', 'Brian', 'C', 'O Neal', 'PT', 'Physical Therapy', '', '', NULL, 'O', '1618 S Millennium Way Ste 210', 'Meridian', 'Ada', 'ID', '83642', '2088844647', NULL, '1618 S Millennium Way Ste 210', 'Meridian', 'Ada', 'ID', '83642', '2088844647', '          ', 'WestRehab', '', '', '0.00', '0.00', '73.00', 3, '2012-07-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1093970675', 0, 'N', 0, '2013-12-30', NULL, NULL, 43.5903, -116.368, NULL, NULL),
('200022831', 'W12021009', 'W12021009', 'ID02', 'Foothills Physical Therapy', 'Brian', 'C', 'O Neal', 'PT', 'Physical Therapy', '', '', NULL, 'O', '1673 W Shoreline Dr Ste 230', 'Boise', 'Ada', 'ID', '83702', '2083434700', NULL, '1673 W Shoreline Dr Ste 230', 'Boise', 'Ada', 'ID', '83702', '2083434700', '          ', 'WestRehab', '', '', '0.00', '0.00', '73.00', 3, '2012-07-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1093970675', 0, 'N', 0, '2013-12-30', NULL, NULL, 43.6171, -116.222, NULL, NULL),
('200022831', 'W12021010', 'W12021010', 'ID02', 'Foothills Physical Therapy', 'Linda', 'M', 'Owen', 'PT', 'Physical Therapy', '', '', NULL, 'O', '1618 S Millennium Way Ste 210', 'Meridian', 'Ada', 'ID', '83642', '2088844647', '2088848984', '1618 S Millennium Way Ste 210', 'Meridian', 'Ada', 'ID', '83642', '2088844647', '2088848984', 'WestRehab', '', '', '0.00', '0.00', '73.00', 3, '2012-07-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1558677021', 0, 'N', 0, '2013-09-10', NULL, NULL, 43.5903, -116.368, NULL, NULL),
('200022831', 'W12021011', 'W12021011', 'ID02', 'Foothills Physical Therapy', 'Linda', 'M', 'Owen', 'PT', 'Physical Therapy', '', '', NULL, 'O', '1673 W Shoreline Dr Ste 230', 'Boise', 'Ada', 'ID', '83702', '2083434700', '2083434706', '1673 W Shoreline Dr Ste 230', 'Boise', 'Ada', 'ID', '83702', '2083434700', '2083434706', 'WestRehab', '', '', '0.00', '0.00', '73.00', 3, '2012-07-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1558677021', 0, 'N', 0, '2013-09-10', NULL, NULL, 43.6171, -116.222, NULL, NULL),
('200022831', 'W12021012', 'W12021012', 'ID02', 'Foothills Physical Therapy', 'Lisa', 'M', 'Swan', 'PT', 'Physical Therapy', '', '', NULL, 'O', '1618 S Millennium Way Ste 210', 'Meridian', 'Ada', 'ID', '83642', '2088844647', '2088848984', '1618 S Millennium Way Ste 210', 'Meridian', 'Ada', 'ID', '83642', '2088844647', '2088848984', 'WestRehab', '', '', '0.00', '0.00', '73.00', 3, '2012-07-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1275603086', 0, 'N', 0, '2013-12-30', NULL, NULL, 43.5903, -116.368, NULL, NULL),
('200022831', 'W12021013', 'W12021013', 'ID02', 'Foothills Physical Therapy', 'Lisa', 'M', 'Swan', 'PT', 'Physical Therapy', '', '', NULL, 'O', '1673 W Shoreline Dr Ste 230', 'Boise', 'Ada', 'ID', '83702', '2083434700', '2083434706', '1673 W Shoreline Dr Ste 230', 'Boise', 'Ada', 'ID', '83702', '2083434700', '2083434706', 'WestRehab', '', '', '0.00', '0.00', '73.00', 3, '2012-07-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1275603086', 0, 'N', 0, '2013-12-30', NULL, NULL, 43.6171, -116.222, NULL, NULL),
('200022831', 'W12021014', 'W12021014', 'ID02', 'Foothills Physical Therapy', 'Nick', 'L', 'Woods', 'PT', 'Physical Therapy', '', '', NULL, 'O', '1618 S Millennium Way Ste 210', 'Meridian', 'Ada', 'ID', '83642', '2088844647', NULL, '1618 S Millennium Way Ste 210', 'Meridian', 'Ada', 'ID', '83642', '2088844647', '          ', 'WestRehab', '', '', '0.00', '0.00', '73.00', 3, '2012-07-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1790792646', 0, 'N', 0, '2012-07-18', NULL, NULL, 43.5903, -116.368, NULL, NULL),
('200022831', 'W12021015', 'W12021015', 'ID02', 'Foothills Physical Therapy', 'Nick', 'L', 'Woods', 'PT', 'Physical Therapy', '', '', NULL, 'O', '1673 W Shoreline Dr Ste 230', 'Boise', 'Ada', 'ID', '83702', '2083434700', NULL, '1673 W Shoreline Dr Ste 230', 'Boise', 'Ada', 'ID', '83702', '2083434700', '          ', 'WestRehab', '', '', '0.00', '0.00', '73.00', 3, '2012-07-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1790792646', 0, 'N', 0, '2012-07-18', NULL, NULL, 43.6171, -116.222, NULL, NULL),
('841424660', 'W12021019', 'W12021019', 'UT01', '', 'Evan', 'J', 'LeFevre', 'DC', 'Chiropractic', '', '', NULL, 'O', '186 E 1800 N Ste 2', 'Logan', 'Cache', 'UT', '84341', '4357524747', '4357524747', '186 E 1800 N Ste 2', 'Logan', 'Cache', 'UT', '84341', '4357524747', '4357524747', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '57.12', 3, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1386725190', 0, 'N', 0, '2012-07-10', NULL, NULL, 41.7648, -111.829, NULL, NULL),
('261712543', 'W12021020', 'W12021020', 'UT01', 'Family First Chiropractic & Wellness Center', 'Kimberly', '', 'Glasgow', 'DC', 'Chiropractic', '', '', NULL, 'O', '495 E 4500 S Ste 104', 'Murray', 'Salt Lake', 'UT', '84107', '8012811688', '8012815544', '495 E 4500 S Ste 104', 'Murray', 'Salt Lake', 'UT', '84107', '8012811688', '8012815544', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '57.12', 3, '2012-08-01', '2013-09-15', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1508192311', 0, 'N', 0, '2014-02-06', NULL, NULL, 0, 0, NULL, NULL),
('261712543', 'W12021021', 'W12021021', 'UT01', 'Family First Chiropractic & Wellness Center', 'Kristina', 'A', 'Stitcher', 'DC', 'Chiropractic', '', '', NULL, 'O', '495 E 4500 S Ste 104', 'Murray', 'Salt Lake', 'UT', '84107', '8012811688', '8012815544', '495 E 4500 S Ste 104', 'Murray', 'Salt Lake', 'UT', '84107', '8012811688', '8012815544', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '57.12', 3, '2012-08-01', '2013-09-15', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1922039650', 0, 'N', 0, '2014-02-06', NULL, NULL, 0, 0, NULL, NULL),
('870664764', 'W12021022', 'W12021022', 'UT01', 'First Physicians ', 'Stephen', 'Cope', 'Taylor', 'DC', 'Chiropractic', '', '', NULL, 'O', '298 24th St Ste 435C', 'Ogden', 'Weber', 'UT', '84401', '8017823060', '8016058031', '298 24th St Ste 435C', 'Ogden', 'Weber', 'UT', '84401', '8017823060', '8016058031', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '57.12', 3, '2012-08-01', '2014-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1750478723', 0, 'N', 0, '2014-06-24', NULL, NULL, 41.2228, -111.973, NULL, NULL),
('870664764', 'W12021023', 'W12021023', 'UT01', 'First Physicians ', 'Stephen', 'Cope', 'Taylor', 'DC', 'Chiropractic', '', '', NULL, 'M', 'PO Box 1005', 'Eden', 'Weber', 'UT', '84310', '8017823060', '8013348499', 'PO Box 1005', 'Eden', 'Weber', 'UT', '84310', '8017823060', '8013348499', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '57.12', 3, '2012-08-01', '2013-10-17', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1750478723', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('454788597', 'W12021024', 'W12021024', 'UT01', 'Genesis Chiropractic', 'Tiffani', '', 'Fries', 'DC', 'Chiropractic', '', '', NULL, 'O', '1200 E 3300 S', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8014852580', '8014852587', '1200 E 3300 S', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8014852580', '8014852587', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '57.12', 3, '2012-08-01', '2012-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1114977105', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('205804335', 'W12021025', 'W12021025', 'UT01', 'Gibbons Chiropractic', 'Jeremy', 'D', 'Gibbons', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '1177 S Main St', 'Smithfield', 'Cache', 'UT', '84335', '4355632514', '4355350769', '1177 S Main St', 'Smithfield', 'Cache', 'UT', '84335', '4355632514', '4355350769', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '57.12', 3, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1306927991', 0, 'N', 0, '2012-07-10', NULL, NULL, 41.8359, -111.844, NULL, NULL),
('202823178', 'W12021026', 'W12021026', 'UT01', 'Goodman Chiropractic', 'Kenneth', 'Michael', 'Goodman', 'DC', 'Chiropractic', '', '', NULL, 'O', '85 E SR 73', 'Saratoga Springs', 'Utah', 'UT', '84045', '8017660507', '8017660838', '85 E SR 73', 'Saratoga Springs', 'Utah', 'UT', '84045', '8017660507', '8017660838', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '57.12', 3, '2012-08-01', '2013-10-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1700971587', 0, 'N', 0, '2013-12-06', NULL, NULL, 0, 0, NULL, NULL),
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('203470254', 'W12021028', 'W12021028', 'UT01', 'Harrison Chiropractic', 'Eric', 'J', 'Harrison', 'DC', 'Chiropractic', '', '', NULL, 'O', '2828 W 4700 S Ste A', 'Salt Lake City', 'Salt Lake', 'UT', '84129', '8019663101', '8019660161', '2828 W 4700 S Ste A', 'Salt Lake City', 'Salt Lake', 'UT', '84129', '8019663101', '8019660161', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '57.12', 3, '2012-08-01', '2014-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1417037920', 0, 'N', 0, '2013-12-31', NULL, NULL, 0, 0, NULL, NULL),
('870662138', 'W12021029', 'W12021029', 'UT01', 'Hartle Chiropractic Clinic Inc', 'George', 'A', 'Hartle', 'DC', 'Chiropractic', '', '', NULL, 'O', '383 E Lagoon St', 'Roosevelt', 'Duchesne', 'UT', '84066', '4357223370', '4357223384', '383 E Lagoon St', 'Roosevelt', 'Duchesne', 'UT', '84066', '4357223370', '4357223384', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '57.12', 3, '2012-08-01', '2013-04-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1306885967', 0, 'N', 0, '2013-03-30', NULL, NULL, 0, 0, NULL, NULL),
('870560087', 'W12021030', 'W12021030', 'UT01', 'Harward Chiropractic', 'Russell', '', 'Harward', 'DC', 'Chiropractic', '', '', NULL, 'O', '11616 S State St Ste 1502', 'Draper', 'Salt Lake', 'UT', '84020', '8015712200', '8018161048', '11616 S State St Ste 1502', 'Draper', 'Salt Lake', 'UT', '84020', '8015712200', '8018161048', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '57.12', 3, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1790739324', 0, 'N', 0, '2012-07-10', NULL, NULL, 40.541, -111.891, NULL, NULL),
('204574521', 'W12021031', 'W12021031', 'UT01', 'Health Solutions Chiropractic, LLC', 'Stephen', 'Mark', 'Wheeler', 'DC', 'Chiropractic', '', '', NULL, 'O', '5974 Fashion Point Dr Ste 110', 'Ogden', 'Weber', 'UT', '84403', '8016211667', '8016053807', '5974 Fashion Point Dr Ste 110', 'Ogden', 'Weber', 'UT', '84403', '8016211667', '8016053807', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '57.12', 3, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1619953254', 0, 'N', 0, '2013-12-06', NULL, NULL, 41.1541, -111.937, NULL, NULL),
('204574521', 'W12021032', 'W12021032', 'UT01', 'Health Solutions Chiropractic, LLC', 'Wesley', 'V', 'Wooden', 'DC', 'Chiropractic', '', '', NULL, 'O', '5974 Fashion Point Dr Ste 110', 'Ogden', 'Weber', 'UT', '84403', '8016211667', '8016053807', '5974 Fashion Point Dr Ste 110', 'Ogden', 'Weber', 'UT', '84403', '8016211667', '8016053807', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '57.12', 3, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1912984725', 0, 'N', 0, '2013-12-06', NULL, NULL, 41.1541, -111.937, NULL, NULL),
('204890438', 'W12021033', 'W12021033', 'UT01', 'Horsley Chiropractic', 'Erik', 'Spence', 'Horsley', 'DC', 'Chiropractic', '', '', NULL, 'O', '3855 W 7800 S Ste 125', 'West Jordan', 'Salt Lake', 'UT', '84088', '8012807777', '8012807797', '3855 W 7800 S Ste 125', 'West Jordan', 'Salt Lake', 'UT', '84088', '8012807777', '8012807797', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '57.12', 3, '2012-08-01', '2014-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1952341802', 0, 'N', 0, '2014-06-24', NULL, NULL, 40.6094, -111.983, NULL, NULL),
('271898282', 'W12021034', 'W12021034', 'UT01', 'Integrated Wellness South Jordan', 'Jon', '', 'McDonald', 'DC', 'Chiropractic', '', '', NULL, 'O', '10684 S River Front Pkwy', 'South Jordan', 'Salt Lake', 'UT', '84095', '8018160332', '8018160331', '10684 S River Front Pkwy', 'South Jordan', 'Salt Lake', 'UT', '84095', '8018160332', '8018160331', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '57.12', 3, '2012-08-01', '2012-08-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1265749774', 0, 'N', 0, '2012-08-29', NULL, NULL, 0, 0, NULL, NULL),
('870445422', 'W12021035', 'W12021035', 'UT01', '', 'John', 'C', 'Romney', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '965 S Main St Ste A', 'Cedar City', 'Iron', 'UT', '84720', '4355869904', '4355869648', '965 S Main St Ste A', 'Cedar City', 'Iron', 'UT', '84720', '4355869904', '4355869648', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '57.12', 3, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1982640454', 0, 'N', 0, '2012-07-10', NULL, NULL, 37.6611, -113.07, NULL, NULL),
('271642541', 'W12021036', 'W12021036', 'UT01', 'Jeremy P. Wimmer Chiropractic, LLC', 'Jeremy', 'P', 'Wimmer', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '6717 S 900 E Ste 101', 'Midvale', 'Salt Lake', 'UT', '84047', '8014327511', '8014327516', '6717 S 900 E Ste 101', 'Midvale', 'Salt Lake', 'UT', '84047', '8014327511', '8014327516', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '57.12', 3, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1659318632', 0, 'N', 0, '2012-12-19', NULL, NULL, 40.6294, -111.866, NULL, NULL),
('841433620', 'W12021037', 'W12021037', 'UT01', 'Jordan Oaks Chiropractic', 'Alan', 'John', 'Adams', 'DC', 'Chiropractic', '', '', NULL, 'O', '7555 S Ctr View Ct Ste 102', 'West Jordan', 'Salt Lake', 'UT', '84084', '8015689222', '8015689559', '7555 S Ctr View Ct Ste 102', 'West Jordan', 'Salt Lake', 'UT', '84084', '8015689222', '8015689559', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '57.12', 3, '2012-08-01', '2014-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1598894685', 0, 'N', 0, '2014-06-24', NULL, NULL, 40.6147, -111.984, NULL, NULL),
('529672003', 'W12021038', 'W12021038', 'UT01', '', 'Kevin', '', 'Lundell', 'DC', 'Chiropractic', '', '', NULL, 'O', '3500 Harrison Blvd Ste 200', 'Ogden', 'Weber', 'UT', '84403', '8016272225', '8016272228', '3500 Harrison Blvd Ste 200', 'Ogden', 'Weber', 'UT', '84403', '8016272225', '8016272228', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '57.12', 3, '2012-08-01', '2012-09-19', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1992036180', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('870576626', 'W12021039', 'W12021039', 'UT01', '', 'Kris', 'Ivan', 'Davis', 'DC', 'Chiropractic', '', '', NULL, 'O', '1186 E 4600 S Ste 220', 'Ogden', 'Weber', 'UT', '84403', '8014751800', NULL, '1186 E 4600 S Ste 220', 'Ogden', 'Weber', 'UT', '84403', '8014751800', '          ', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '57.12', 3, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1417118498', 0, 'N', 0, '2012-07-10', NULL, NULL, 41.1796, -111.95, NULL, NULL),
('870576626', 'W12021040', 'W12021040', 'UT01', '', 'Kris', 'Ivan', 'Davis', 'DC', 'Chiropractic', '', '', NULL, 'B', 'PO Box 150342', 'Ogden', 'Weber', 'UT', '84415', '8014751800', NULL, 'PO Box 150342', 'Ogden', 'Weber', 'UT', '84415', '8014751800', '          ', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '57.12', 3, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1417118498', 0, 'N', 0, '2012-07-10', NULL, NULL, 0, 0, NULL, NULL),
('870517949', 'W12021041', 'W12021041', 'UT01', 'Layton Chiropractic Clinic', 'Daniel', 'Lee', 'Hendricks', 'DC', 'Chiropractic', '', '', NULL, 'O', '1025 N Main St', 'Layton', 'Davis', 'UT', '84041', '8015444333', '8015440063', '1025 N Main St', 'Layton', 'Davis', 'UT', '84041', '8015444333', '8015440063', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '57.12', 3, '2012-08-01', '2014-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1437123122', 0, 'N', 0, '2014-06-24', NULL, NULL, 41.0751, -111.981, NULL, NULL),
('466122122', 'W12021042', 'W12021042', 'UT01', 'Mecham Chiropractic Inc', 'Allan', 'L', 'Mecham', 'DC', 'Chiropractic', '', '', NULL, 'O', '1186 E 4600 S', 'Ogden', 'Weber', 'UT', '84403', '8014751800', '8014750071', '1186 E 4600 S', 'Ogden', 'Weber', 'UT', '84403', '8014751800', '8014750071', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '57.12', 3, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1528003688', 0, 'N', 0, '2012-07-10', NULL, NULL, 41.1796, -111.95, NULL, NULL),
('466122122', 'W12021043', 'W12021043', 'UT01', 'Mecham Chiropractic Inc', 'Allan', 'L', 'Mecham', 'DC', 'Chiropractic', '', '', NULL, 'B', 'PO Box 150321', 'Ogden', 'Weber', 'UT', '84415', '8014751800', '8014750071', 'PO Box 150321', 'Ogden', 'Weber', 'UT', '84415', '8014751800', '8014750071', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '57.12', 3, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1528003688', 0, 'N', 0, '2012-07-10', NULL, NULL, 0, 0, NULL, NULL),
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('870547455', 'W12021046', 'W12021046', 'UT01', 'Monson Chiropractic', 'Danny', '', 'Monson', 'DC', 'Chiropractic', '', '', NULL, 'O', '3378 W 3500 S', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8019665200', '8019660360', '3378 W 3500 S', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8019665200', '8019660360', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '57.12', 3, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1518989763', 0, 'N', 0, '2012-07-10', NULL, NULL, 40.6967, -111.972, NULL, NULL),
('870493499', 'W12021047', 'W12021047', 'UT01', '', 'Morgan', '', 'Carlson', 'DC', 'Chiropractic', '', '', NULL, 'O', '3935 N 75 W', 'Hyde Park', 'Cache', 'UT', '84318', '4355634141', '4355630293', '3935 N 75 W', 'Hyde Park', 'Cache', 'UT', '84318', '4355634141', '4355630293', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '57.12', 3, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1780757526', 0, 'N', 0, '2012-07-10', NULL, NULL, 41.802, -111.837, NULL, NULL),
('870624638', 'W12021048', 'W12021048', 'UT01', 'Mountain View Chiropractic', 'Lance', '', 'Tilley', 'DC', 'Chiropractic', '', '', NULL, 'O', '859 Washington Blvd Ste 1', 'Ogden', 'Weber', 'UT', '84404', '8016216155', '8016216158', '859 Washington Blvd Ste 1', 'Ogden', 'Weber', 'UT', '84404', '8016216155', '8016216158', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '57.12', 3, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1356417612', 0, 'N', 0, '2012-07-10', NULL, NULL, 41.2491, -111.97, NULL, NULL),
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('841377595', 'W12021051', 'W12021051', 'UT01', 'Murray Chiropractic Office', 'R', 'Scott', 'Binkerd', 'DC', 'Chiropractic', '', '', NULL, 'B', 'PO Box 348', 'Heber City', 'Wasatch', 'UT', '84032', '8012622651', '8012622651', 'PO Box 348', 'Heber City', 'Wasatch', 'UT', '84032', '8012622651', '8012622651', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '57.12', 3, '2012-08-01', '2014-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1366509168', 0, 'N', 0, '2014-02-06', NULL, NULL, 0, 0, NULL, NULL),
('870627754', 'W12021052', 'W12021052', 'UT01', 'Natural Health and Wellness', 'Brandon', '', 'Allred', 'DC', 'Chiropractic', '', '', NULL, 'O', '7840 S 700 E ', 'Sandy', 'Salt Lake', 'UT', '84070', '8012560006', '8012560007', '7840 S 700 E ', 'Sandy', 'Salt Lake', 'UT', '84070', '8012560006', '8012560007', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '57.12', 3, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1245307701', 0, 'N', 0, '2012-07-10', NULL, NULL, 40.6091, -111.872, NULL, NULL),
('203753738', 'W12021053', 'W12021053', 'UT01', 'Neff Family Chiropractic', 'Brandon', 'L', 'Neff', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '10358 S Redwood Rd', 'South Jordan', 'Salt Lake', 'UT', '84095', '8012546697', '8012545739', '10358 S Redwood Rd', 'South Jordan', 'Salt Lake', 'UT', '84095', '8012546697', '8012545739', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '57.12', 3, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1609839638', 0, 'N', 0, '2012-07-10', NULL, NULL, 40.5642, -111.939, NULL, NULL),
('870675662', 'W12021054', 'W12021054', 'UT01', 'Optimal Health Dynamics', 'Corey', 'J', 'Sondrup', 'DC', 'Chiropractic', '', '', NULL, 'O', '1117 Country Hills Dr Ste 2', 'Ogden', 'Weber', 'UT', '84403', '8014761752', '8014763075', '1117 Country Hills Dr Ste 2', 'Ogden', 'Weber', 'UT', '84403', '8014761752', '8014763075', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '57.12', 3, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1447381223', 0, 'N', 0, '2012-07-10', NULL, NULL, 41.1867, -111.952, NULL, NULL),
('270616354', 'W12021055', 'W12021055', 'UT01', 'Optimum Health and Spinal Care', 'John', 'Kurt', 'Olsen', 'DC', 'Chiropractic', '', '', NULL, 'O', '7840 S 700 E', 'Sandy', 'Salt Lake', 'UT', '84070', '8012560006', '8012560005', '7840 S 700 E', 'Sandy', 'Salt Lake', 'UT', '84070', '8012560006', '8012560005', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '57.12', 3, '2012-08-01', '2014-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1982836631', 0, 'N', 0, '2014-06-24', NULL, NULL, 40.6091, -111.872, NULL, NULL),
('870661615', 'W12021056', 'W12021056', 'UT01', 'Peterson Chiropractic', 'James', 'L', 'Misustin', 'DC', 'Chiropractic', '', '', NULL, 'O', '1415 N 400 E Ste A', 'Logan', 'Cache', 'UT', '84341', '4357532840', '4357879422', '1415 N 400 E Ste A', 'Logan', 'Cache', 'UT', '84341', '4357532840', '4357879422', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '57.12', 3, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1427115682', 0, 'N', 0, '2012-07-10', NULL, NULL, 41.7577, -111.824, NULL, NULL),
('870532788', 'W12021057', 'W12021057', 'UT01', 'Physical Medicine Clinic, Inc', 'Patrick', '', 'Egbert', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '7669 S Redwood Rd', 'West Jordan', 'Salt Lake', 'UT', '84084', '8015662449', '8015665435', '7669 S Redwood Rd', 'West Jordan', 'Salt Lake', 'UT', '84084', '8015662449', '8015665435', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '57.12', 3, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1750388765', 0, 'N', 0, '2012-12-19', NULL, NULL, 40.6117, -111.939, NULL, NULL),
('352246962', 'W12021058', 'W12021058', 'UT01', 'Porter Family Chiropractic', 'Kip', '', 'Porter', 'DC', 'Chiropractic', '', '', NULL, 'O', '275 S Main St', 'Tooele', 'Tooele', 'UT', '84074', '4358330977', '4358330978', '275 S Main St', 'Tooele', 'Tooele', 'UT', '84074', '4358330977', '4358330978', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '57.12', 3, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1770691370', 0, 'N', 0, '2012-07-10', NULL, NULL, 40.5253, -112.299, NULL, NULL),
('352371911', 'W12021059', 'W12021059', 'UT01', 'Rawlings Chiropractic Services Corp', 'Lance', 'S', 'Rawlings', 'DC', 'Chiropractic', '', '', NULL, 'O', '891 E 9400 S', 'Sandy', 'Salt Lake', 'UT', '84094', '8015698181', '8015698191', '891 E 9400 S', 'Sandy', 'Salt Lake', 'UT', '84094', '8015698181', '8015698191', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '57.12', 3, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1639281421', 0, 'N', 0, '2012-07-10', NULL, NULL, 40.5806, -111.866, NULL, NULL),
('200930035', 'W12021060', 'W12021060', 'UT01', 'Rigby Chiropractic', 'Micah', 'L', 'Rigby', 'DC', 'Chiropractic', '', '', NULL, 'O', '25 N 570 E', 'Tremonton', 'Box Elder', 'UT', '84337', '4352572131', '4352572132', '25 N 570 E', 'Tremonton', 'Box Elder', 'UT', '84337', '4352572131', '4352572132', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '57.12', 3, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1760495808', 0, 'N', 0, '2013-07-09', NULL, NULL, 41.7041, -112.179, NULL, NULL),
('870493137', 'W12021061', 'W12021061', 'UT01', '', 'Robert', 'K', 'Nelson', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '756 W Main', 'Vernal', 'Uintah', 'UT', '84078', '4357810048', '4357810002', '756 W Main', 'Vernal', 'Uintah', 'UT', '84078', '4357810048', '4357810002', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '57.12', 3, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1447206586', 0, 'N', 0, '2012-07-10', NULL, NULL, 40.4555, -109.542, NULL, NULL),
('272058546', 'W12021062', 'W12021062', 'UT01', 'Rocky Mountain Family Chiropractic ', 'William', 'Dalley', 'Green', 'DC', 'Chiropractic', '', '', NULL, 'O', '425 S Medical Dr Ste 216', 'Bountiful', 'Davis', 'UT', '84010', '8016839553', '8013353209', '425 S Medical Dr Ste 216', 'Bountiful', 'Davis', 'UT', '84010', '8016839553', '8013353209', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '57.12', 3, '2012-08-01', '2013-09-24', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1871730267', 0, 'N', 0, '2013-10-08', NULL, NULL, 0, 0, NULL, NULL),
('870479797', 'W12021063', 'W12021063', 'UT01', '', 'Ronald', '', 'Sanders', 'DC', 'Chiropractic', '', '', NULL, 'O', '46 E Main St', 'Castle Dale', 'Emery', 'UT', '84513', '4353815432', '4353815630', '46 E Main St', 'Castle Dale', 'Emery', 'UT', '84513', '4353815432', '4353815630', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '57.12', 3, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1316001225', 0, 'N', 0, '2012-07-10', NULL, NULL, 39.2109, -111.02, NULL, NULL),
('870479797', 'W12021064', 'W12021064', 'UT01', '', 'Ronald', '', 'Sanders', 'DC', 'Chiropractic', '', '', NULL, 'B', 'PO Box 495', 'Castle Dale', 'Emery', 'UT', '84513', '4353815630', '4353815630', 'PO Box 495', 'Castle Dale', 'Emery', 'UT', '84513', '4353815630', '4353815630', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '57.12', 3, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1316001225', 0, 'Y', 0, '2012-07-10', NULL, NULL, 0, 0, NULL, NULL),
('870410451', 'W12021065', 'W12021065', 'UT01', 'Rose Chiropractic', 'Thomas', 'D', 'Rose', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '489 N Main St', 'Richfield', 'Sevier', 'UT', '84701', '4358968820', '4358960334', '489 N Main St', 'Richfield', 'Sevier', 'UT', '84701', '4358968820', '4358960334', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '57.12', 3, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1336164466', 0, 'N', 0, '2012-07-10', NULL, NULL, 38.775, -112.085, NULL, NULL),
('870410451', 'W12021067', 'W12021067', 'UT01', 'Rose Chiropractic', 'Thomas', 'D', 'Rose', 'DC', 'Chiropractic', NULL, NULL, NULL, 'B', 'PO Box 146', 'Richfield', 'Sevier', 'UT', '84701', '4358968820', '4358960334', 'PO Box 146', 'Richfield', 'Sevier', 'UT', '84701', '4358968820', '4358960334', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '57.12', 3, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1336164466', 0, 'N', 0, '2012-07-10', NULL, NULL, 0, 0, NULL, NULL),
('528656859', 'W12021068', 'W12021068', 'UT01', '', 'Ryan', 'Benson', 'Bosley', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '3500 Harrison Blvd Ste 200', 'Ogden', 'Weber', 'UT', '84403', '8016272225', '8016272228', '3500 Harrison Blvd Ste 200', 'Ogden', 'Weber', 'UT', '84403', '8016272225', '8016272228', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '57.12', 3, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1013020213', 0, 'N', 0, '2012-07-10', NULL, NULL, 41.1995, -111.949, NULL, NULL),
('010891863', 'W12021069', 'W12021069', 'UT01', 'San Juan Chiropractic & Wellness Center', 'Sterling', 'P', 'Black', 'DC', 'Chiropractic', '', '', NULL, 'O', '792 S Main St', 'Blanding', 'San Juan', 'UT', '84511', '4356782795', '8885102690', '792 S Main St', 'Blanding', 'San Juan', 'UT', '84511', '4356782795', '8885102690', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '57.12', 3, '2012-08-01', '2014-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1699725747', 0, 'N', 0, '2014-06-24', NULL, NULL, 37.6136, -109.479, NULL, NULL),
('201030213', 'W12021070', 'W12021070', 'UT01', 'Sanders Chiropractic and Wellness', 'Ronald', 'Eric', 'Sanders', '', 'Chiropractic', '', '', NULL, 'O', '180 W Gordon Ave', 'Layton', 'Davis', 'UT', '84041', '8015464500', '8012560005', '180 W Gordon Ave', 'Layton', 'Davis', 'UT', '84041', '8015464500', '8012560005', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '57.12', 3, '2012-08-01', '2014-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1619044179', 0, 'N', 0, '2014-06-24', NULL, NULL, 41.0748, -111.969, NULL, NULL),
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('203921453', 'W12021097', 'W12021097', 'UT01', 'Wright Family Chiropractic ', 'Morris', 'Jimmie', 'Wright', 'DC', 'Chiropractic', '', '', NULL, 'O', '352 E Riverside Dr Ste A6', 'St George', 'Washington', 'UT', '84790', '4356521556', '8665697810', '352 E Riverside Dr Ste A6', 'St George', 'Washington', 'UT', '84790', '4356521556', '8665697810', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '57.12', 3, '2012-08-01', '2014-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1942363148', 0, 'N', 0, '2014-02-06', NULL, NULL, 0, 0, NULL, NULL),
('273945978', 'W12021098', 'W12021098', 'UT01', 'Zion Health Management Service', 'Carl', 'Kirk', 'Salmon', 'DC', 'Chiropractic', '', '', NULL, 'O', '301 N 200 E Ste 1B', 'St George', 'Washington', 'UT', '84770', '4356742626', '4356285999', '301 N 200 E Ste 1B', 'St George', 'Washington', 'UT', '84770', '4356742626', '4356285999', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '57.12', 3, '2012-08-01', '2012-09-17', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1730165606', 0, 'N', 0, '2013-09-25', 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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('200552841', 'W12021103', 'W12021103', 'WYT2', 'Central Wyoming Neurosurgery', 'Gina', '', 'Duel', 'PA-C', 'Neurosurgery', '', '', NULL, 'O', '6600 E 2nd St', 'Casper', 'Natrona', 'WY', '82609', '3072664000', '3072664545', '6600 E 2nd St', 'Casper', 'Natrona', 'WY', '82609', '3072664000', '3072664545', '', '', '', '0.00', '10.00', '0.00', 3, '2012-08-01', NULL, 0, 0, 1, 'Mountain View Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1912985979', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('043673591', 'W12021104', 'W12021104', 'ID01', 'Eagle River Psychiatry', 'Matthew', '', 'Geske', 'LCPC', 'Mental Health', 'Counseling', '', NULL, 'O', '1032 S Bridgeway Pl Ste 110', 'Eagle', 'Ada', 'ID', '83616', '2082460123', NULL, '1032 S Bridgeway Pl Ste 110', 'Eagle', 'Ada', 'ID', '83616', '2082460123', '          ', 'IDMA', '', '', '0.00', '35.00', '0.00', 3, '2012-10-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1982691069', 0, 'N', 0, '2012-10-12', NULL, NULL, 0, 0, NULL, NULL),
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('264557232', 'W12021108', 'W12021108', 'WYT2', 'Platte River Family Practice', 'Mary', '', 'Hager', 'NP', 'Family Practice', '', '', NULL, 'O', '1900 E 1st St', 'Casper', 'Natrona', 'WY', '82601', '3075777737', '3075770049', '1900 E 1st St', 'Casper', 'Natrona', 'WY', '82601', '3075777737', '3075770049', '', '', '', '0.00', '10.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1003994484', 0, 'N', 0, '2013-01-09', NULL, NULL, 0, 0, NULL, NULL),
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('264557232', 'W12021110', 'W12021110', 'WYT2', 'Platte River Family Practice', 'Velvet', 'M', 'Hiser', 'NP', 'Family Practice', '', '', NULL, 'O', '1900 E 1st St', 'Casper', 'Natrona', 'WY', '82601', '3075777737', '3075770049', '1900 E 1st St', 'Casper', 'Natrona', 'WY', '82601', '3075777737', '3075770049', '', '', '', '0.00', '10.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1669750394', 0, 'N', 0, '2013-01-09', NULL, NULL, 0, 0, NULL, NULL),
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('264557232', 'W12021112', 'W12021112', 'WYT2', 'Platte River Family Practice', 'Dorothy', 'E', 'Mosher', 'CFNP', 'Family Practice', '', '', NULL, 'O', '1900 E 1st St', 'Casper', 'Natrona', 'WY', '82601', '3075777737', '3075770049', '1900 E 1st St', 'Casper', 'Natrona', 'WY', '82601', '3075777737', '3075770049', '', '', '', '0.00', '10.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 1, 'Wyoming Medical Center', '', '', '', 'HCFA|UB|', '1669486502', 0, 'N', 0, '2013-02-13', NULL, NULL, 0, 0, NULL, NULL),
('830323423', 'W12021115', 'W12021115', 'WY01', 'Laramie Pediatrics', 'Kent', 'M', 'Kleppinger', 'MD', 'Pediatrics', '', '', NULL, 'O', '1252 N 22nd Ste B', 'Laramie', 'Albany', 'WY', '82072', '3077453704', NULL, '1252 N 22nd Ste B', 'Laramie', 'Albany', 'WY', '82072', '3077453704', '          ', 'WY130', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-06-01', NULL, 0, 0, 0, 'Memorial Hospital of Carbon County', '', '', '', 'HCFA|UB|', '1013012467', 0, 'N', 0, '2013-06-04', NULL, NULL, 41.3227, -105.567, NULL, NULL),
('830323423', 'W12021114', 'W12021114', 'WYT1', 'Laramie Pediatrics', 'Kent', 'M', 'Kleppinger', 'MD', 'Pediatrics', '', '', NULL, 'O', '1174 N 22nd', 'Laramie', 'Albany', 'WY', '82072', '3077453536', NULL, '1174 N 22nd', 'Laramie', 'Albany', 'WY', '82072', '3077453536', '          ', 'WY130', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-06-01', NULL, 0, 0, 0, 'Memorial Hospital of Carbon County', '', '', '', 'HCFA|UB|', '1013012467', 0, 'N', 0, '2013-06-04', NULL, NULL, 0, 0, NULL, NULL),
('841433992', 'W12021116', 'W12021116', 'UTPEHP', 'Rosenberg Cooley Metcalf', 'Patrick', 'R', 'Olson', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '900 Round Valley Dr Ste 100', 'Park City', 'Summit', 'UT', '84060', '4356556600', '4356552388', '900 Round Valley Dr Ste 100', 'Park City', 'Summit', 'UT', '84060', '4356556600', '4356552388', 'WMETCALF', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-10-01', NULL, 0, 0, 0, 'Park City Medical Center', '', '', '', 'HCFA|UB|', '1811095326', 0, 'N', 0, '2012-10-12', NULL, NULL, 0, 0, NULL, NULL),
('870639748', 'W12021117', 'W12021117', 'UT01', 'Hoopes Vision Correction Center', 'David', 'M', 'Parkinson', 'OD', 'Optometry', '', '', NULL, 'O', '10011 S Centennial Pkwy Ste 400', 'Sandy', 'Salt Lake', 'UT', '84070', '8015680200', '8015630200', '10011 S Centennial Pkwy Ste 400', 'Sandy', 'Salt Lake', 'UT', '84070', '8015680200', '8015630200', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-08-01', '2012-11-28', 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1568797652', 0, 'N', 0, '2013-08-07', NULL, NULL, 0, 0, NULL, NULL),
('261752159', 'W12021118', 'W12021118', 'UTMH1', 'Hope Haven Counseling', 'Cari', 'Y', 'Morphet', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '9140 S State St Ste 101', 'Sandy', 'Salt Lake', 'UT', '84070', '8016768796', '8016768797', '9140 S State St Ste 101', 'Sandy', 'Salt Lake', 'UT', '84070', '8016768796', '8016768797', 'UTMA', '', '', '0.00', '35.00', '0.00', 3, '2012-08-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1104081470', 0, 'N', 0, '2013-09-11', NULL, NULL, 0, 0, NULL, NULL),
('870569774', 'W12019683', 'W12019683', 'UT01', '', 'Scott', 'B', 'McKay', 'PA-C', 'Orthopedic Surgery', '', '', NULL, 'O', '4403 Harrison Blvd Ste 1815', 'Ogden', 'Weber', 'UT', '84403', '8013876520', '8013876525', '4403 Harrison Blvd Ste 1815', 'Ogden', 'Weber', 'UT', '84403', '8013876520', '8013876525', 'WUOGDEN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-05-24', NULL, 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1013008408', 0, 'N', 0, '2012-08-03', NULL, NULL, 41.1828, -111.949, NULL, NULL),
('870569774', 'W12021119', 'W12021119', 'UT01', '', 'Scott', 'B', 'McKay', 'PA-C', 'Orthopedic Surgery', '', '', NULL, 'O', '4403 Harrison Blvd Ste 1815', 'Ogden', 'Weber', 'UT', '84403', '8013876520', '8013876525', '4403 Harrison Blvd Ste 1815', 'Ogden', 'Weber', 'UT', '84403', '8013876520', '8013876525', 'WUOGDCLIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-08-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1013008408', 0, 'N', 0, '2012-08-03', NULL, NULL, 41.1828, -111.949, NULL, NULL),
('275415258', 'W12021120', 'W12021120', 'UTMH1', 'Utah Psychological Associates', 'Jennifer', 'A', 'Morrill', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '3325 N University Ave Ste 300D', 'Provo', 'Utah', 'UT', '84604', '8013772014', NULL, '3325 N University Ave Ste 300D', 'Provo', 'Utah', 'UT', '84604', '8013772014', '          ', 'UTPHD', '', '', '0.00', '35.00', '0.00', 3, '2012-03-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1881730604', 0, 'N', 0, '2012-07-11', NULL, NULL, 0, 0, NULL, NULL),
('383858989', 'W12021016', 'W12021016', 'UT01', 'Internal Med-Cardiology Advanced Heart Failure-Department of University of Utah', '', '', 'Internal Med-Cardiology Advanced Heart Failure-Department of University of Utah', '', 'Cardiovascular Disease', '', '', NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015850434', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015850434', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1154680247', 0, 'N', 0, '2013-12-12', NULL, NULL, 40.7685, -111.837, NULL, NULL),
('383858989', 'W12021017', 'W12021017', 'UT01', 'Internal Med-Cardiology Advanced Heart Failure-Department of University of Utah', '', '', 'Internal Med-Cardiology Advanced Heart Failure-Department of University of Utah', '', 'Cardiovascular Disease', '', '', NULL, 'B', 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', NULL, 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1154680247', 0, 'N', 0, '2013-12-12', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W12021128', 'W12021128', 'UT01', 'Internal Medicine of Salt Lake ', 'Anthony', 'G', 'Musci', '', 'Internal Medicine', '', '', NULL, 'O', '2645 E Parleys Way Ste 200', 'Salt Lake City', 'Salt Lake', 'UT', '84109', '8013844700', '8013844733', '2645 E Parleys Way Ste 200', 'Salt Lake City', 'Salt Lake', 'UT', '84109', '8013844700', '8013844733', 'WUSTDMULT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2012-07-01', '2014-04-30', 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1205853173', 0, 'N', 0, '2013-07-25', NULL, NULL, 40.7203, -111.816, NULL, NULL),
('621801973', 'W12021129', 'W12021129', 'UT01', 'Internal Medicine of Salt Lake ', 'Anthony', 'G', 'Musci', '', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', 'WUSTDMULT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2012-07-01', '2014-04-30', 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1205853173', 0, 'N', 0, '2013-07-25', NULL, NULL, 0, 0, NULL, NULL),
('820482736', 'W12021132', 'W12021132', 'ID01', '', 'Shawna', 'L', 'Kuehne', 'NP', 'Psychiatry', '', '', NULL, 'O', '1902 W Judith Ln Ste 110', 'Boise', 'Ada', 'ID', '83705', '2086580800', '2083231894', '1902 W Judith Ln Ste 110', 'Boise', 'Ada', 'ID', '83705', '2086580800', '2083231894', 'ARNP', '', '', '0.00', '35.00', '0.00', 6, '2012-11-01', '2013-12-01', 1, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1679898225', 0, 'N', 0, '2014-04-25', NULL, NULL, 43.5914, -116.205, NULL, NULL),
('820312070', 'W12021136', 'W12021136', 'ID01', 'Boise Valley Asthma and Allergy Clinic', 'Jennifer', '', 'Neumayer', 'NP', 'Allergy and Immunology', '', '', NULL, 'O', '16060 Idaho Ctr Blvd', 'Nampa', 'Canyon', 'ID', '83687', '2083780080', '2083780259', '16060 Idaho Ctr Blvd', 'Nampa', 'Canyon', 'ID', '83687', '2083780080', '2083780259', 'IDALLERGY', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-08-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1639432131', 0, 'N', 0, '2012-08-03', NULL, NULL, 0, 0, NULL, NULL),
('820312070', 'W12021134', 'W12021134', 'ID01', 'Boise Valley Asthma and Allergy Clinic', 'Jennifer', '', 'Neumayer', 'NP', 'Allergy and Immunology', '', '', NULL, 'O', '2320 E Gala Ste 500', 'Meridian', 'Ada', 'ID', '83642', '2083780080', '2083780259', '2320 E Gala Ste 500', 'Meridian', 'Ada', 'ID', '83642', '2083780080', '2083780259', 'IDALLERGY', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-08-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1639432131', 0, 'N', 0, '2012-08-03', NULL, NULL, 43.59, -116.365, NULL, NULL),
('820312070', 'W12021135', 'W12021135', 'ID01', 'Boise Valley Asthma and Allergy Clinic', 'Jennifer', '', 'Neumayer', 'NP', 'Allergy and Immunology', '', '', NULL, 'O', '323 E Riverside Dr Ste 204', 'Eagle', 'Ada', 'ID', '83616', '2083780080', '2083780259', '323 E Riverside Dr Ste 204', 'Eagle', 'Ada', 'ID', '83616', '2083780080', '2083780259', 'IDALLERGY', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-08-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1639432131', 0, 'N', 0, '2012-08-03', NULL, NULL, 43.6892, -116.351, NULL, NULL),
('820312070', 'W12021133', 'W12021133', 'ID01', 'Boise Valley Asthma and Allergy Clinic', 'Jennifer', '', 'Neumayer', 'NP', 'Allergy and Immunology', '', '', NULL, 'O', '901 N Curtis Rd Ste 100', 'Boise', 'Ada', 'ID', '83706', '2083780080', '2083780259', '901 N Curtis Rd Ste 100', 'Boise', 'Ada', 'ID', '83706', '2083780080', '2083780259', 'IDALLERGY', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-08-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1639432131', 0, 'N', 0, '2012-08-03', NULL, NULL, 43.6126, -116.255, NULL, NULL),
('870492272', 'W12021137', 'W12021137', 'UT01', 'Utah Cardiology', 'Bhavananda', 'T', 'Reddy', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '2132 N 1700 W Ste 200', 'Layton', 'Davis', 'UT', '84041', '8017760174', '8018253904', '2132 N 1700 W Ste 200', 'Layton', 'Davis', 'UT', '84041', '8017760174', '8018253904', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-10-01', NULL, 0, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1326130758', 0, 'N', 0, '2012-10-12', NULL, NULL, 41.0892, -111.997, NULL, NULL),
('870492272', 'W12021138', 'W12021138', 'UT01', 'Utah Cardiology', 'Bhavananda', 'T', 'Reddy', 'MD', 'Cardiovascular Disease', '', '', NULL, 'B', '520 E Medical Dr Ste 310', 'Layton', 'Davis', 'UT', '84040', '          ', '8018253904', '520 E Medical Dr Ste 310', 'Layton', 'Davis', 'UT', '84040', '          ', '8018253904', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-10-01', NULL, 0, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1326130758', 0, 'N', 0, '2012-10-12', NULL, NULL, 0, 0, NULL, NULL),
('860898663', 'W12021140', 'W12021140', 'NA01', 'Preferred Homecare', '', '', 'Founders Healthcare', '', 'Durable Medical Equipment', '', '', NULL, 'B', 'PO Box 40700', 'Mesa', 'Maricopa', 'AZ', '85274', '          ', '5056618352', 'PO Box 40700', 'Mesa', 'Maricopa', 'AZ', '85274', '          ', '5056618352', 'DME7012', '', '', '0.00', '35.00', '0.00', 3, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1538468574', 0, 'Y', 0, '2012-08-03', NULL, NULL, 0, 0, NULL, NULL),
('860898663', 'W12021139', 'W12021139', 'NM01', 'Preferred Homecare', '', '', 'Founders Healthcare', '', 'Durable Medical Equipment', '', '', NULL, 'O', '3917 W Rd Ste 191', 'Los Alamos', 'Los Alamos', 'NM', '87544', '5056618074', '5056618352', '3917 W Rd Ste 191', 'Los Alamos', 'Los Alamos', 'NM', '87544', '5056618074', '5056618352', 'DME7012', '', '', '0.00', '35.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1538468574', 0, 'N', 0, '2012-08-03', NULL, NULL, 35.8824, -106.319, NULL, NULL),
('860898663', 'W12021142', 'W12021142', 'NA01', 'Preferred Homecare', '', '', 'Founders Healthcare', '', 'Durable Medical Equipment', '', '', NULL, 'B', 'PO Box 40700', 'Mesa', 'Maricopa', 'AZ', '85274', '          ', '5058211699', 'PO Box 40700', 'Mesa', 'Maricopa', 'AZ', '85274', '          ', '5058211699', 'DME7012', '', '', '0.00', '35.00', '0.00', 3, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1619916632', 0, 'Y', 0, '2012-08-03', NULL, NULL, 0, 0, NULL, NULL),
('860898663', 'W12021141', 'W12021141', 'NM01', 'Preferred Homecare', '', '', 'Founders Healthcare', '', 'Durable Medical Equipment', '', '', NULL, 'O', '8401 Jefferson St NE', 'Albuquerque', 'Bernalillo', 'NM', '87113', '5057978126', '5058211699', '8401 Jefferson St NE', 'Albuquerque', 'Bernalillo', 'NM', '87113', '5057978126', '5058211699', 'DME7012', '', '', '0.00', '35.00', '0.00', 3, '2012-08-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1619916632', 0, 'N', 0, '2012-08-03', NULL, NULL, 0, 0, NULL, NULL),
('454651336', 'W12021147', 'W12021147', 'UT01', '', 'Brice', 'J', 'Williams', 'MD', 'Ophthalmology', '', '', NULL, 'O', '4403 Harrison Blvd Ste 3600', 'Ogden', 'Weber', 'UT', '84403', '8013873550', '8013873555', '4403 Harrison Blvd Ste 3600', 'Ogden', 'Weber', 'UT', '84403', '8013873550', '8013873555', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-11-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1154574390', 0, 'N', 0, '2012-10-12', NULL, NULL, 41.1828, -111.949, NULL, NULL),
('860898663', 'W12021148', 'W12021148', 'UT01', 'Preferred Home Care', '', '', 'Preferred Home Care', '', 'Durable Medical Equipment', '', '', NULL, 'O', '14549 S Ctr Point Way', 'Riverton', 'Salt Lake', 'UT', '84065', '8013164215', '8013164217', '14549 S Ctr Point Way', 'Riverton', 'Salt Lake', 'UT', '84065', '8013164215', '8013164217', 'DME7012', '', '', '0.00', '35.00', '0.00', 3, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1619280286', 0, 'N', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('860898663', 'W12021149', 'W12021149', 'UT01', 'Preferred Home Care', '', '', 'Preferred Home Care', '', 'Durable Medical Equipment', '', '', NULL, 'B', '2546 W Birchwood Ave Ste 101', 'Mesa', 'Maricopa', 'AZ', '85202', '8013164215', '8013164217', '2546 W Birchwood Ave Ste 101', 'Mesa', 'Maricopa', 'AZ', '85202', '8013164215', '8013164217', 'DME7012', '', '', '0.00', '35.00', '0.00', 3, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1619280286', 0, 'N', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('860898663', 'W12021151', 'W12021151', 'NA01', 'Preferred Home Care', '', '', 'Preferred Home Care', '', 'Durable Medical Equipment', '', '', NULL, 'M', 'PO Box 40700', 'Mesa', 'Maricopa', 'AZ', '85274', '8013164215', '8013164217', 'PO Box 40700', 'Mesa', 'Maricopa', 'AZ', '85274', '8013164215', '8013164217', 'DME7012', '', '', '0.00', '35.00', '0.00', 3, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1619280286', 0, 'Y', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
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('942938348', 'W40006894', 'W40006894', 'UTMH1', 'Valley Mental Health  Inc', 'DEBRA', 'ANITA', 'ROBERTS', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'B', '5965 S 900 E Ste 430', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012637100', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'UTVMHMA', NULL, NULL, '0.00', '40.00', '0.00', 6, '2013-02-15', NULL, NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1689645343', 0, 'Y', 0, '2013-02-28', NULL, NULL, 0, 0, NULL, NULL),
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('870286381', 'W12002455', 'W12002455', 'UT01', 'Ogden Clinic', 'Michael', 'E', 'Van Bibber', 'MD', 'Urology', '', '', NULL, 'O', '6112 S 1550 E', 'Ogden', 'Weber', 'UT', '84405', '8014753800', NULL, '6112 S 1550 E', 'Ogden', 'Weber', 'UT', '84405', '8014753800', '          ', 'WUOGDCLIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-09-10', '2013-08-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1598851503', 0, 'N', 0, '2013-09-05', NULL, NULL, 0, 0, NULL, NULL),
('202630141', 'W40020393', 'W40020393', 'IDBOISTD', 'Primary Health Medical Group', 'Jeffrey', '', 'Robbins', 'CFNP', 'Family Practice', '', '', NULL, 'O', '4815 Cleveland Blvd', 'Caldwell', 'Canyon', 'ID', '83605', '2084553545', '2084549690', '4815 Cleveland Blvd', 'Caldwell', 'Canyon', 'ID', '83605', '2084553545', '2084549690', 'IDPRIMARY', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2013-03-01', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, NULL, NULL, 'HCFA|UB|', '1669408514', 0, 'N', 0, '2013-06-11', NULL, NULL, 43.6351, -116.647, 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
('264260933', 'ELHCA0178', 'ELHCA0178', 'TXHOUSTD', 'Houston  Women''s Care Associates', 'Nancy', NULL, 'Rios', 'NP', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 281928', 'Atlanta', 'Fulton', 'GA', '30384', '          ', NULL, 'PO Box 281928', 'Atlanta', 'Fulton', 'GA', '30384', '          ', '          ', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'The Womans Hospital of Texas', NULL, NULL, NULL, 'HCFA|UB|', '1508850942', 0, 'Y', 0, '2014-01-14', NULL, NULL, 0, 0, NULL, NULL),
('202630141', 'W40004525', 'W40004525', 'IDBOISTD', 'Primary Health Medical Group', 'Shelley', 'R', 'Ringo', 'MD', 'Family Practice', 'Sports Medicine', '', NULL, 'B', 'PO Box 191050', 'Boise', 'Ada', 'ID', '83719', '2084553545', '', 'PO Box 191050', 'Boise', 'Ada', 'ID', '83719', '2084553545', '', 'IDPRIMARY', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2013-03-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1316143886', 0, 'N', 0, '2014-07-21', NULL, NULL, 0, 0, NULL, NULL),
('264260933', 'ELHCA0177', 'ELHCA0177', 'TXHOUSTD', 'Houston  Women''s Care Associates', 'Nancy', NULL, 'Rios', 'NP', 'Obstetrics and Gynecology', '', '', NULL, 'O', '7400 Fannin St Ste 1050', 'Houston', 'Harris', 'TX', '77054', '7137951000', '7137961087', '7400 Fannin St Ste 1050', 'Houston', 'Harris', 'TX', '77054', '7137951000', '7137961087', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'The Womans Hospital of Texas', NULL, NULL, NULL, 'HCFA|UB|', '1508850942', 0, 'Y', 0, '2014-01-14', NULL, NULL, 29.6956, -95.4009, NULL, NULL),
('202630141', 'W40004524', 'W40004524', 'IDBOISTD', 'Primary Health Medical Group', 'Shelley', 'R', 'Ringo', 'MD', 'Family Practice', 'Sports Medicine', '', NULL, 'O', '6052 W State St', 'Boise', 'Ada', 'ID', '83703', '2083447799', '2089471945', '6052 W State St', 'Boise', 'Ada', 'ID', '83703', '2083447799', '2089471945', 'IDPRIMARY', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2013-03-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1316143886', 0, 'N', 0, '2014-07-21', NULL, NULL, 43.6592, -116.264, NULL, NULL),
('942938348', 'W40006746', 'W40006746', 'UTMH1', 'Valley Mental Health  Inc', 'SCOTT', NULL, 'RICHINS', 'APRN', 'Mental Health', '', '', NULL, 'B', '5965 S 900 E Ste 430', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012637100', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'UTVMHARNP', NULL, NULL, '0.00', '40.00', '0.00', 6, '2013-02-15', NULL, NULL, 0, NULL, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1770563629', 0, 'Y', 0, '2013-02-28', NULL, NULL, 0, 0, NULL, NULL),
('205934739', 'SACN00500', 'SACN00500', 'SACN', 'Family Medicine Health Center', 'Kevin', 'T', 'Rich', 'MD', 'Family Practice', '', '', NULL, 'O', '777 N Raymond St', 'Boise', 'Ada', 'ID', '83704', '2085142500', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'IDSINCLAIRL', 'WUSTDHCPC5', NULL, '0.00', '15.00', '0.00', 3, '2011-01-01', NULL, 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1902833031', 0, 'n', 0, '2013-02-28', NULL, NULL, 0, 0, NULL, NULL),
('205934739', 'SACN00499', 'SACN00499', 'SACN', 'Family Medicine Health Center', 'Kevin', 'T', 'Rich', 'MD', 'Family Practice', '', '', NULL, 'O', '121 E Fort St', 'Boise', 'Ada', 'ID', '83712', '2083811775', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'IDSINCLAIRL', 'WUSTDHCPC5', NULL, '0.00', '15.00', '0.00', 3, '2011-01-01', NULL, 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1902833031', 0, 'n', 0, '2013-02-28', NULL, NULL, 0, 0, NULL, NULL),
('942938348', 'W40006945', 'W40006945', 'UTMH1', 'Valley Mental Health  Inc', 'JAMES D', NULL, 'RICCIARDI', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'B', '5965 S 900 E Ste 430', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012637100', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'UTVMHPHD', NULL, NULL, '0.00', '40.00', '0.00', 6, '2013-02-15', NULL, NULL, 0, NULL, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1659355790', 0, 'Y', 0, '2013-02-28', NULL, NULL, 0, 0, NULL, NULL),
('830216112', 'W12021680', 'W12021680', 'WYT2', 'Lander Medical Center ', 'Carolyn', '', 'Renner', '', 'Family Practice', '', '', NULL, 'O', '745 Buena Vista', 'Lander', 'Fremont', 'WY', '82520', '3073322941', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '', '', '', '0.00', '10.00', '0.00', 3, '2030-01-01', '2030-01-01', NULL, 0, 1, '', '', '', '', 'HCFA|UB|', '1962707687', 0, 'N', 0, '2013-02-28', NULL, NULL, 0, 0, NULL, NULL),
('830216112', 'W12021742', 'W12021742', 'WYT2', 'Lander Medical Center ', 'Carolyn', '', 'Renner', '', 'Family Practice', '', '', NULL, 'B', 'PO Box 9432', 'Belfast', 'Waldo', 'ME', '04915', '3073322941', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '', '', '', '0.00', '10.00', '0.00', 3, '2030-01-01', '2030-01-01', NULL, 0, 1, '', '', '', '', 'HCFA|UB|', '1962707687', 0, 'N', 0, '2013-02-28', NULL, NULL, 0, 0, NULL, NULL),
('830216112', 'W12021743', 'W12021743', 'WY01', 'Lander Medical Center ', 'Carolyn', '', 'Renner', '', 'Family Practice', '', '', NULL, 'B', 'PO Box 9432', 'Belfast', 'Waldo', 'ME', '04915', '3073322941', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '', '', '', '0.00', '10.00', '0.00', 3, '2030-01-01', '2030-01-01', NULL, 0, 1, '', '', '', '', 'HCFA|UB|', '1962707687', 0, 'N', 0, '2013-02-28', NULL, NULL, 0, 0, NULL, NULL),
('830216112', 'W12021679', 'W12021679', 'WY01', 'Lander Medical Center ', 'Carolyn', '', 'Renner', '', 'Family Practice', '', '', NULL, 'O', '745 Buena Vista', 'Lander', 'Fremont', 'WY', '82520', '3073322941', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '', '', '', '0.00', '10.00', '0.00', 3, '2030-01-01', '2030-01-01', NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1962707687', 0, 'N', 0, '2013-02-28', NULL, NULL, 0, 0, NULL, NULL),
('942938348', 'W40006924', 'W40006924', 'UTMH1', 'Valley Mental Health  Inc', 'Frederick', 'W', 'Reimherr', 'MD', 'Mental Health', 'Psychiatry', '', NULL, 'B', '5965 S 900 E Ste 430', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012637100', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'UTMD-2', NULL, NULL, '0.00', '40.00', '0.00', 6, '2013-02-15', NULL, NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1740259795', 0, 'Y', 0, '2013-02-28', NULL, NULL, 0, 0, NULL, NULL),
('202622667', 'ELHCA0174', 'ELHCA0174', 'TXHOUSTD', 'Sugarland Medical Assoc', 'Alan', NULL, 'Reichman', 'MD', 'Family Practice', ' ', '', NULL, 'B', 'PO Box 403856  ', 'Atlanta', 'Fulton', 'GA', '30384', NULL, NULL, 'PO Box 403856  ', 'Atlanta', 'Fulton', 'GA', '30384', '', '', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'West Houston Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1245328376', 0, 'Y', 0, '2013-05-01', NULL, NULL, 0, 0, NULL, NULL),
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('830238247', 'W12021155', 'W12021155', 'GROUP', 'Wyoming Cardiopulmonary Services', '', '', 'Wyoming Cardiopulmonary Services', '', 'Cardiovascular Disease', '', '', NULL, '', 'Change', 'Casper', 'Natrona', 'WY', '82601', '          ', '3072663177', 'Change', 'Casper', 'Natrona', 'WY', '82601', '          ', '3072663177', '', '', '', '0.00', '0.00', '0.00', 3, '2012-07-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|DEN|', '1992866560', 0, 'N', 0, '2013-06-28', NULL, NULL, 0, 0, NULL, NULL),
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('621801973', 'W12021234', 'W12021234', 'UT01', 'Jordan Parkway Medical Clinic ', 'Michelle ', 'L', 'Palmer', '', 'Family Practice', '', '', NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2012-05-01', '2013-09-06', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1194987875', 0, 'N', 0, '2013-08-26', NULL, NULL, 0, 0, NULL, NULL),
('112659192', 'W12021266', 'W12021266', 'NA01', 'NTD Laboratories Inc', '', '', 'PerkinElmer Laboratories Inc', '', 'Laboratory', '', '', NULL, 'O', '80 Ruland Rd Ste 1', 'Melville', 'Suffolk', 'NY', '11747', '6314250800', '6314250811', '80 Ruland Rd Ste 1', 'Melville', 'Suffolk', 'NY', '11747', '6314250800', '6314250811', 'PERKELABS', '', '', '0.00', '0.00', '0.00', 3, '2012-10-01', '2012-12-19', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1992779664', 0, 'N', 0, '2013-02-26', NULL, NULL, 0, 0, NULL, NULL),
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('870281028', 'W12021247', 'W12021247', 'UT01', 'Central Utah Clinic PC', 'Michael', '', 'Carlson', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1055 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013737350', '8012245337', '1055 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013737350', '8012245337', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2012-10-01', NULL, 0, 0, 0, 'Mountain View Hospital', 'Timpanogos Regional Hospital', '', '', 'HCFA|UB|', '1407076193', 0, 'N', 0, '2013-10-24', NULL, NULL, 40.248, -111.667, NULL, NULL),
('870284475', 'W12021251', 'W12021251', 'UT01', 'Granger Medical Clinic ', 'Casey', '', 'Henich', 'MD', 'Family Practice', '', '', NULL, 'O', '3725 W 4100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019653600', NULL, '3725 W 4100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019653600', '          ', 'WUGRANGER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-11-01', NULL, 0, 0, 0, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1003041740', 0, 'N', 0, '2012-10-09', NULL, NULL, 40.682, -111.979, NULL, NULL),
('870281028', 'W12021248', 'W12021248', 'UT01', 'Central Utah Clinic PC', 'Michael', '', 'Carlson', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', 'PO Box 30079 ', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', '8014298180', 'PO Box 30079 ', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', '8014298180', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2012-10-01', NULL, 0, 0, 0, 'Mountain View Hospital', 'Timpanogos Regional Hospital', '', '', 'HCFA|UB|', '1407076193', 0, 'N', 0, '2013-10-24', NULL, NULL, 0, 0, NULL, NULL),
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('870284475', 'W12021253', 'W12021253', 'UT01', 'Granger Medical Clinic ', 'Casey', '', 'Henich', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 70658', 'Salt Lake City', 'Salt Lake', 'UT', '84170', '8019653600', NULL, 'PO Box 70658', 'Salt Lake City', 'Salt Lake', 'UT', '84170', '8019653600', '          ', 'WUGRANGER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-11-01', NULL, 0, 0, 0, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1003041740', 0, 'N', 0, '2012-10-09', NULL, NULL, 0, 0, NULL, NULL),
('870542578', 'W12021263', 'W12021263', 'UT01', 'University of Utah Dialysis - Physicians', '', '', 'U Of U Dialysis Program', 'GROUP', 'Dialysis Center', '', '', NULL, 'O', '85 N Medical Dr Ste E201', 'Salt Lake City', 'Salt Lake', 'UT', '84112', '8015818578', NULL, '85 N Medical Dr Ste E201', 'Salt Lake City', 'Salt Lake', 'UT', '84112', '8015818578', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-07-25', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1689770356', 0, 'N', 0, '2012-07-25', NULL, NULL, 40.77, -111.839, NULL, NULL),
('861072115', 'W12021267', 'W12021267', 'NA01', 'Signature Genomic Laboratories', '', '', 'Signature Genomic Laboratories', '', 'Laboratory', '', '', NULL, 'O', '2820 N Astor St', 'Spokane', 'Spokane', 'WA', '99207', '5094746840', '5094746839', '2820 N Astor St', 'Spokane', 'Spokane', 'WA', '99207', '5094746840', '5094746839', 'PERKELABS', '', '', '0.00', '0.00', '0.00', 3, '2012-10-10', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1740248848', 0, 'N', 0, '2012-10-09', NULL, NULL, 0, 0, NULL, NULL),
('861072115', 'W12021268', 'W12021268', 'NA01', 'Signature Genomic Laboratories', '', '', 'Signature Genomic Laboratories', '', 'Laboratory', '', '', NULL, 'B', 'PO Box 4474', 'Spokane', 'Spokane', 'WA', '99220', '5094746840', '5094746839', 'PO Box 4474', 'Spokane', 'Spokane', 'WA', '99220', '5094746840', '5094746839', 'PERKELABS', '', '', '0.00', '0.00', '0.00', 3, '2012-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1740248848', 0, 'N', 0, '2012-10-09', NULL, NULL, 0, 0, NULL, NULL),
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('200100106', 'W12021275', 'W12021275', 'ID01', 'Hearts for Hospice', '', '', 'Hearts for Hospice', 'GROUP', 'Hospice', 'Home Health Agency', '', NULL, 'O', '3090 Gentry Way Ste 150', 'Meridian', 'Ada', 'ID', '83642', '2083892276', '8012880910', '3090 Gentry Way Ste 150', 'Meridian', 'Ada', 'ID', '83642', '2083892276', '8012880910', '', '', '4', '0.00', '30.00', '0.00', 3, '2012-07-25', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1750324927', 0, 'N', 0, '2012-10-09', NULL, NULL, 43.598, -116.355, NULL, NULL),
('264333033', 'W12021276', 'W12021276', 'TX01', 'Consultants in Womens Health', 'Katherine', 'E', 'Cornforth', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '7940 Floyd Curl Dr Ste 900', 'San Antonio', 'Bexar', 'TX', '78229', '2106141000', '2106151236', '7940 Floyd Curl Dr Ste 900', 'San Antonio', 'Bexar', 'TX', '78229', '2106141000', '2106151236', 'TXOBG', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2030-01-01', '2012-08-19', 0, 0, 0, 'St Lukes Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1366760548', 0, 'N', 0, '2013-05-01', NULL, NULL, 29.5117, -98.5756, 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
('264333033', 'W12021277', 'W12021277', 'TX01', 'Consultants in Womens Health', 'Katherine', 'E', 'Cornforth', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '1210 Arion Pkwy', 'San Antonio', 'Bexar', 'TX', '78216', '2103499300', '2103662558', '1210 Arion Pkwy', 'San Antonio', 'Bexar', 'TX', '78216', '2103499300', '2103662558', 'TXOBG', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2030-01-01', '2012-08-19', 0, 0, 0, 'St Lukes Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1366760548', 0, 'N', 0, '2013-05-01', NULL, NULL, 0, 0, NULL, NULL),
('205934739', 'W12021284', 'W12021284', 'ID02', 'Family Medicine Health Center', 'Judith', 'L', 'Chasin', 'MD', 'Family Practice', '', '', NULL, 'O', '777 N Raymond St', 'Boise', 'Ada', 'ID', '83704', '2085142500', '2083752217', '777 N Raymond St', 'Boise', 'Ada', 'ID', '83704', '2085142500', '2083752217', 'IDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-08-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1427256841', 0, 'N', 0, '2014-06-05', NULL, NULL, 0, 0, NULL, NULL),
('205934739', 'W12021285', 'W12021285', 'ID02', 'Family Medicine Health Center', 'Judith', 'L', 'Chasin', 'MD', 'Family Practice', '', '', NULL, 'O', '121 E Fort St', 'Boise', 'Ada', 'ID', '83712', '2083816102', '2083811776', '121 E Fort St', 'Boise', 'Ada', 'ID', '83712', '2083816102', '2083811776', 'IDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-08-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1427256841', 0, 'N', 0, '2014-06-05', NULL, NULL, 0, 0, NULL, NULL),
('205934739', 'W12021286', 'W12021286', 'ID02', 'Family Medicine Health Center ', 'Andrea ', 'M', 'Buckler', '', 'Sports Medicine', '', '', NULL, 'O', '777 N Raymond St', 'Boise', 'Ada', 'ID', '83704', '2085142500', '2083752217', '777 N Raymond St', 'Boise', 'Ada', 'ID', '83704', '2085142500', '2083752217', 'IDPPO', 'WUSTDHCPC5', '30', '0.00', '0.00', '0.00', 3, '2012-08-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1376868224', 0, 'N', 0, '2012-10-19', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W12021287', 'W12021287', 'UT01', 'Central Utah Clinic PC', 'David ', 'S', 'Slade', 'MD', 'Ophthalmology', '', '', NULL, 'O', '1054 E Riverside Dr', 'St George', 'Washington', 'UT', '84790', '8013548225', '8014180941', '1054 E Riverside Dr', 'St George', 'Washington', 'UT', '84790', '8013548225', '8014180941', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2012-07-30', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1598918666', 0, 'N', 0, '2013-12-12', NULL, NULL, 37.0881, -113.561, NULL, NULL),
('870281028', 'W12021288', 'W12021288', 'UT01', 'Central Utah Clinic PC', 'David ', 'S', 'Slade', 'MD', 'Ophthalmology', '', '', NULL, 'M', '1055 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013548225', '8014180941', '1055 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013548225', '8014180941', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2012-07-30', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1598918666', 0, 'N', 0, '2013-12-12', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W12021289', 'W12021289', 'UT01', 'Central Utah Clinic PC', 'David ', 'S', 'Slade', 'MD', 'Ophthalmology', '', '', NULL, 'B', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', '8014298180', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', '8014298180', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2012-07-30', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1598918666', 0, 'N', 0, '2013-12-12', NULL, NULL, 0, 0, NULL, NULL),
('300655165', 'W12021292', 'W12021292', 'UT01', 'Pediatric Emergency Sedation Services', '', '', 'Pediatric Emergency Sedation Service', 'Group', 'Clinics', '', '', NULL, 'O', '100 Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621262', NULL, '100 Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621262', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2012-07-27', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1245524651', 0, 'N', 0, '2012-07-27', NULL, NULL, 0, 0, NULL, NULL),
('300655165', 'W12021293', 'W12021293', 'UT01', 'Pediatric Emergency Sedation Service', '', '', 'Pediatric Emergency Sedation Service', 'Group', 'Clinics', '', '', NULL, 'B', 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', NULL, 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2012-07-27', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1245524651', 0, 'N', 0, '2012-07-27', NULL, NULL, 0, 0, NULL, NULL),
('320186101', 'W12021294', 'W12021294', 'UT01', 'Pediatric Diagnostic Cardiology', NULL, NULL, 'U of U Pediatric Diagnostic Cardiology', 'GROUP', 'Pediatrics', '', '', NULL, 'O', '3773 W 12600 S', 'Riverton', 'Salt Lake', 'UT', '84065', '8016625400', NULL, '3773 W 12600 S', 'Riverton', 'Salt Lake', 'UT', '84065', '8016625400', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2012-07-27', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1710016340', 0, 'N', 0, '2012-07-27', NULL, NULL, 40.5222, -111.981, NULL, NULL),
('320186101', 'W12021295', 'W12021295', 'UT01', 'Pediatric Diagnostic Cardiology', NULL, NULL, 'U of U Pediatric Diagnostic Cardiology', 'GROUP', 'Pediatrics', '', '', NULL, 'B', 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', NULL, 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2012-07-27', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1710016340', 0, 'N', 0, '2012-07-27', NULL, NULL, 0, 0, NULL, NULL),
('710926549', 'W12021297', 'W12021297', 'UT01', 'Pediatric PM&R', '', '', 'Pediatric PM & R', 'Group', 'Clinic', 'Pediatrics', '', NULL, 'O', '100 Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016624949', NULL, '100 Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016624949', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2012-07-27', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1760776223', 0, 'N', 0, '2012-08-23', NULL, NULL, 0, 0, NULL, NULL),
('320186101', 'W12021300', 'W12021300', 'UT01', 'Pediatric Diagnostic Cardiology', NULL, NULL, 'U of U Pediatric Diagnostic Cardiology', 'GROUP', 'Pediatrics', '', '', NULL, 'O', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016625400', NULL, '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016625400', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2012-07-27', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1710016340', 0, 'N', 0, '2012-07-27', NULL, NULL, 40.7663, -111.837, NULL, NULL),
('710926549', 'W12021299', 'W12021299', 'UT01', 'Pediatric PM & R', '', '', 'Pediatric PM & R', 'Group', 'Clinic', 'Pediatrics', '', NULL, 'B', 'PO Box 413032', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', NULL, 'PO Box 413032', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2012-07-27', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1760776223', 0, 'N', 0, '2012-07-27', NULL, NULL, 0, 0, NULL, NULL),
('743134250', 'W12021301', 'W12021301', 'UT01', 'Pediatric Critical Care-Department of University of Utah', '', '', 'University of Utah Dept of Pediatric Critical Care', 'GROUP', 'Pediatric Critical Care', '', '', NULL, 'o', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016622465', NULL, '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016622465', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2012-07-27', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009293', 0, 'N', 0, '2012-07-27', NULL, NULL, 40.7663, -111.837, NULL, NULL),
('743134250', 'W12021302', 'W12021302', 'UT01', 'Pediatric Critical Care-Department of University of Utah', '', '', 'University of Utah Dept of Pediatric Critical Care', 'GROUP', 'Pediatric Critical Care', '', '', NULL, 'B', 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', NULL, 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2012-07-27', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009293', 0, 'Y', 0, '2012-07-27', NULL, NULL, 0, 0, NULL, NULL),
('383725436', 'W12021303', 'W12021303', 'UT01', 'Pediatric Adolescent Medicine-Department of University of Utah', '', '', 'University of Utah Dept of Pediatrics and Adolescent Medicine', 'GROUP', 'Pediatrics', 'Internal Medicine', '', NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015813501', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015813501', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2012-07-27', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009307', 0, 'N', 0, '2012-10-16', NULL, NULL, 40.7685, -111.837, NULL, NULL),
('383725436', 'W12021304', 'W12021304', 'UT01', 'Pediatric Adolescent Medicine-Department of University of Utah', '', '', 'University of Utah Dept of Pediatrics and Adolescent Medicine', 'GROUP', 'Pediatrics', 'Internal Medicine', '', NULL, 'B', 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', NULL, 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2012-07-27', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009307', 0, 'N', 0, '2012-10-16', NULL, NULL, 0, 0, NULL, NULL),
('364586972', 'W12021305', 'W12021305', 'UT01', 'University of Utah Pediatric Rapid Treatment Unit', '', '', 'University of Utah Pediatric Rapid Treatment Unit', 'GROUP', 'Pediatric Emergency Medicine', '', '', NULL, 'O', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621234', NULL, '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621234', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2012-07-27', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009308', 0, 'N', 0, '2012-07-27', NULL, NULL, 40.7663, -111.837, NULL, NULL),
('364586972', 'W12021306', 'W12021306', 'UT01', 'Pediatric Rapid Treatment Unit-Department of University of Utah', '', '', 'University of Utah Pediatric Rapid Treatment Unit', 'GROUP', 'Pediatric Emergency Medicine', '', '', NULL, 'B', 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', NULL, 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2012-07-27', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009308', 0, 'Y', 0, '2012-07-27', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12021307', 'W12021307', 'UTIHCPHY', 'DRMC Radiation Oncology', 'Vilija', '', 'Avizonis', 'MD', 'Radiation Oncology', '', '', NULL, 'O', '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356884175', '8014423263', '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356884175', '8014423263', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2012-08-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1003865932', 0, 'Y', 0, '2013-12-10', NULL, NULL, 37.0989, -113.575, NULL, NULL),
('942854057', 'W12021309', 'W12021309', 'UTIHCPHY', 'Utah Heart', 'Mary', 'B', 'Blankenship', 'MD', 'Hospitalist', '', '', NULL, 'O', '5169 Cottonwood St Ste 520', 'Murray', 'Salt Lake', 'UT', '84107', '8015073500', '8015073505', '5169 Cottonwood St Ste 520', 'Murray', 'Salt Lake', 'UT', '84107', '8015073500', '8015073505', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2012-07-01', '2013-07-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1659513968', 0, 'N', 0, '2013-09-05', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12020077', 'W12020077', 'UTIHC01', '', 'Justin', 'L', 'Brinkerhoff', 'PA-C', 'Family Practice', '', '', NULL, 'O', '544 S 400 E', 'Ogden', 'Weber', 'UT', '847703', '4356884343', NULL, '544 S 400 E', 'Ogden', 'Weber', 'UT', '847703', '4356884343', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2010-09-27', '2013-03-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1568532125', 0, 'N', 0, '2013-05-17', NULL, NULL, 0, 0, NULL, NULL),
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('942854057', 'W12020079', 'W12020079', 'UTIHC04', '', 'Justin', 'L', 'Brinkerhoff', 'PA-C', 'Family Practice', '', '', NULL, 'O', '544 S 400 E', 'Ogden', 'Weber', 'UT', '847703', '4356884343', NULL, '544 S 400 E', 'Ogden', 'Weber', 'UT', '847703', '4356884343', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2010-09-27', '2013-03-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1568532125', 0, 'N', 0, '2013-05-17', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12021310', 'W12021310', 'UTIHCPHY', 'Dixie Inpatient Psychiatry', 'Justin', 'L', 'Brinkerhoff', 'PA-C', 'Family Practice', '', '', NULL, 'O', '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356884343', '4356885331', '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356884343', '4356885331', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2012-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1568532125', 0, 'N', 0, '2014-02-18', NULL, NULL, 37.0989, -113.575, NULL, NULL),
('942854057', 'W12021312', 'W12021312', 'UTIHCPHY', 'Dixie High Risk OB', 'Deborah', 'M', 'Chun', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356884770', '4356884835', '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356884770', '4356884835', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2012-06-28', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1760553663', 0, 'N', 0, '2012-09-05', NULL, NULL, 37.0989, -113.575, NULL, NULL),
('942854057', 'W12021314', 'W12021314', 'UTIHCPHY', 'Northern Utah Pediatrics', 'Heath', 'A', 'Cobb', 'MD', 'Pediatrics', '', '', NULL, 'O', '4403 Harrison Blvd Ste 4875', 'Ogden', 'Weber', 'UT', '84403', '8013874500', '8013874712', '4403 Harrison Blvd Ste 4875', 'Ogden', 'Weber', 'UT', '84403', '8013874500', '8013874712', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2012-07-16', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1730322405', 0, 'N', 0, '2012-07-31', NULL, NULL, 41.1828, -111.949, NULL, NULL),
('942854057', 'W12021316', 'W12021316', 'UTIHCPHY', 'Redrock Spine & Neurosurgery Clinic', 'Chad', 'D', 'Cole', 'MD', 'Neurosurgery', '', '', NULL, 'O', '652 S Medical Ctr Dr Ste 115', 'St George', 'Washington', 'UT', '84790', '4352516800', '4352513701', '652 S Medical Ctr Dr Ste 115', 'St George', 'Washington', 'UT', '84790', '4352516800', '4352513701', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2012-07-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1386832970', 0, 'N', 0, '2013-08-15', NULL, NULL, 37.0498, -113.574, NULL, NULL),
('942854057', 'W12021317', 'W12021317', 'UTIHCPHY', 'Dixie Inpatient Psychiatry', 'Randall', 'E', 'Draper', 'MD', 'Psychiatry', '', '', NULL, 'O', '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356884343', '4356885331', '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356884343', '4356885331', 'IHCMD', '', '', '0.00', '100.00', '0.00', 8, '2012-07-12', '2013-12-15', 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1235175415', 0, 'N', 0, '2013-12-17', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12021318', 'W12021318', 'UTIHCPHY', 'Southwest Regional CancerCedar City', 'Michelle', 'H', 'Gilbert', 'MD', 'Hematology and Oncology', 'Internal Medicine', '', NULL, 'O', '1303 N Main St', 'Cedar City', 'Iron', 'UT', '84720', '4358685690', '4356349852', '1303 N Main St', 'Cedar City', 'Iron', 'UT', '84720', '4358685690', '4356349852', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2012-01-16', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1992876452', 0, 'N', 0, '2012-07-31', NULL, NULL, 37.7003, -113.064, NULL, NULL),
('942854057', 'W12021320', 'W12021320', 'UTIHCPHY', 'Canyon View Family Practice', 'Erik', 'E', 'Gulbrandsen', 'DO', 'Urgent Care', '', '', NULL, 'O', '15 E 400 N', 'Parowan', 'Iron', 'UT', '84761', '4354773317', '4354779805', '15 E 400 N', 'Parowan', 'Iron', 'UT', '84761', '4354773317', '4354779805', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2012-07-01', NULL, 0, 0, 0, 'Valley View Medical Center', '', '', '', 'HCFA|UB|', '1477822955', 0, 'N', 0, '2014-05-13', NULL, NULL, 37.8411, -112.83, NULL, NULL),
('942854057', 'W12021321', 'W12021321', 'UTIHCPHY', 'Dixie Infectious Disease Clinic', 'Jamal', '', 'Horani', 'MD', 'Internal Medicine', 'Infectious Disease', '', NULL, 'O', '1380 E Medical Ctr Dr Ste 2300', 'St George', 'Washington', 'UT', '84790', '4352512620', '4352512621', '1380 E Medical Ctr Dr Ste 2300', 'St George', 'Washington', 'UT', '84790', '4352512620', '4352512621', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2012-07-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', '', '', '', 'HCFA|UB|', '1770585564', 0, 'N', 0, '2012-07-31', NULL, NULL, 37.0998, -113.554, NULL, NULL),
('942854057', 'W12021323', 'W12021323', 'UTIHCPHY', 'McKay Dee Rheumatology Clinic', 'Daniel', 'P', 'Lupash', 'MD', 'Rheumatology', '', '', NULL, 'O', '4403 Harrison Blvd Ste 3650', 'Ogden', 'Weber', 'UT', '84403', '8013877125', '8013877130', '4403 Harrison Blvd Ste 3650', 'Ogden', 'Weber', 'UT', '84403', '8013877125', '8013877130', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2012-07-11', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1619154135', 0, 'N', 0, '2012-07-31', NULL, NULL, 41.1828, -111.949, NULL, NULL),
('942854057', 'W12021324', 'W12021324', 'UTIHCPHY', 'Bryner Clinic', 'Chelsi', 'E', 'MacMurray', 'APRN', 'Mental Health', '', '', NULL, 'O', '525 E 100 S Ste 500', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015197100', '8015213091', '525 E 100 S Ste 500', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015197100', '8015213091', 'IHCAPRN', '', '', '0.00', '100.00', '0.00', 8, '2012-07-22', '2012-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1629289699', 0, 'N', 0, '2013-05-23', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12021325', 'W12021325', 'UTIHCPHY', 'Bountiful Clinic', 'Chelsi', 'E', 'MacMurray', 'APRN', 'Mental Health', '', '', NULL, 'O', '390 N Main St', 'Bountiful', 'Davis', 'UT', '84010', '8012941000', '8012928369', '390 N Main St', 'Bountiful', 'Davis', 'UT', '84010', '8012941000', '8012928369', 'IHCAPRN', '', '', '0.00', '100.00', '0.00', 8, '2012-07-22', '2013-04-04', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1629289699', 0, 'N', 0, '2013-05-23', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12021327', 'W12021327', 'UTIHCPHY', 'Pulmonary St GeorgeCedar City', 'Theodore', 'H', 'Moon', 'MD', 'Pulmonary', '', '', NULL, 'O', '110 W 1325 N Ste 100', 'Cedar City', 'Iron', 'UT', '84721', '4352512600', '4352512610', '110 W 1325 N Ste 100', 'Cedar City', 'Iron', 'UT', '84721', '4352512600', '4352512610', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2012-08-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1568438455', 0, 'N', 0, '2012-12-31', NULL, NULL, 37.7011, -113.064, NULL, NULL),
('942854057', 'W12021328', 'W12021328', 'UTIHCPHY', 'St George Pulmonary Clinic', 'Theodore', 'H', 'Moon', 'MD', 'Pulmonary', '', '', NULL, 'O', '1380 E Medical Ctr Dr Ste 2200', 'St George', 'Washington', 'UT', '84790', '4352512600', '4352512610', '1380 E Medical Ctr Dr Ste 2200', 'St George', 'Washington', 'UT', '84790', '4352512600', '4352512610', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2012-08-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1568438455', 0, 'N', 0, '2012-12-31', NULL, NULL, 37.0998, -113.554, NULL, NULL),
('942854057', 'W12021330', 'W12021330', 'UTIHCPHY', 'Logan Hyperbaric and Wound Care', 'Douglas', 'P', 'Plowman', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '1400 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357162250', '4357162265', '1400 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357162250', '4357162265', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2012-06-01', '2013-01-31', 0, 0, 0, 'Brigham City Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1255362273', 0, 'N', 0, '2014-02-10', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12021333', 'W12021333', 'UTIHCPHY', 'Utah Valley Pulmonary Clinic', 'Ray', '', 'Shubhra', 'MD', 'Pulmonary', '', '', NULL, 'O', '1055 N 300 W Ste 500', 'Provo', 'Utah', 'UT', '84604', '8013577291', '8013577919', '1055 N 300 W Ste 500', 'Provo', 'Utah', 'UT', '84604', '8013577291', '8013577919', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2012-07-01', '2013-03-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1245278175', 0, 'N', 0, '2013-05-23', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12021335', 'W12021335', 'UTIHCPHY', 'Zion Orthopaedics & Sports Medicine', 'Dirk', 'L', 'Slade', 'MD', 'Hand Surgery', '', '', NULL, 'O', '652 S Medical Ctr Dr Ste 400', 'St George', 'Washington', 'UT', '84790', '4352512650', '4352512668', '652 S Medical Ctr Dr Ste 400', 'St George', 'Washington', 'UT', '84790', '4352512650', '4352512668', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2012-07-16', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1164564860', 0, 'N', 0, '2012-07-31', NULL, NULL, 37.0498, -113.574, NULL, NULL),
('942854057', 'W12021337', 'W12021337', 'UTIHCPHY', 'Budge Clinic Obstetrics & Gynecology', 'Erica', 'L', 'Smith', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1400 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357161920', '4357921677', '1400 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357161920', '4357921677', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2012-07-16', NULL, 0, 0, 0, 'Logan Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1932355468', 0, 'N', 0, '2012-07-31', NULL, NULL, 41.7569, -111.821, NULL, NULL),
('942854057', 'W12021338', 'W12021338', 'UTIHCPHY', 'Mt Pleasant Clinic', 'Brooks', '', 'Thompson', 'MD', 'Family Practice', '', '', NULL, 'O', '1100 S Medical Dr', 'Mount Pleasant', 'Sanpete', 'UT', '84647', '4354623471', '4354623354', '1100 S Medical Dr', 'Mount Pleasant', 'Sanpete', 'UT', '84647', '4354623471', '4354623354', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2012-07-01', NULL, 0, 0, 0, 'Sanpete Valley Hospital', '', '', '', 'HCFA|UB|', '1487657763', 0, 'N', 0, '2014-06-04', NULL, NULL, 39.5318, -111.461, NULL, NULL),
('942854057', 'W12021340', 'W12021340', 'UTIHCPHY', 'Southwest Urology', 'Bryant', 'M', 'Whiting', 'MD', 'Urology', '', '', NULL, 'O', '1380 E Medical Ctr Dr Ste 2100', 'St George', 'Washington', 'UT', '84790', '4352513250', '4352513251', '1380 E Medical Ctr Dr Ste 2100', 'St George', 'Washington', 'UT', '84790', '4352513250', '4352513251', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2012-07-10', NULL, 0, 0, 0, 'Dixie Regional Medical Center', 'Valley View Medical Center', NULL, NULL, 'HCFA|UB|', '1760687388', 0, 'N', 0, '2013-05-23', NULL, NULL, 37.0998, -113.554, NULL, NULL),
('942854057', 'W12021342', 'W12021342', 'UTIHCPHY', 'Logan InstaCare', 'Benjamin', 'G', 'Woods', 'MD', 'Urgent Care', '', '', NULL, 'O', '412 N 200 E', 'Logan', 'Cache', 'UT', '84321', '4357132710', '4357132746', '412 N 200 E', 'Logan', 'Cache', 'UT', '84321', '4357132710', '4357132746', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2012-07-05', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1225291487', 0, 'Y', 0, '2012-09-10', NULL, NULL, 41.7393, -111.83, NULL, NULL),
('942854057', 'W12021343', 'W12021343', 'UTIHCPHY', 'Dixie Wound and Hyperbaric', 'Eugene', 'R', 'Worth', 'MD', 'Hyperbaric Medicine', '', '', NULL, 'O', '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356884293', '4356885524', '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356884293', '4356885524', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2012-09-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1801816061', 0, 'N', 0, '2013-06-03', NULL, NULL, 37.0989, -113.575, NULL, NULL),
('942854057', 'W12021345', 'W12021345', 'UTIHCPHY', 'Park City Bonanza InstaCare', '', '', 'Park City Clinic-Bonanza', 'Group', 'Clinic', '', '', NULL, 'O', '1665 Bonanza Dr', 'Park City', 'Summit', 'UT', '84060', '8667432584', '4356457768', '1665 Bonanza Dr', 'Park City', 'Summit', 'UT', '84060', '8667432584', '4356457768', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1861757478', 0, 'N', 0, '2013-08-09', NULL, NULL, 40.6623, -111.5, NULL, NULL),
('942854057', 'W12021347', 'W12021347', 'UTIHCPHY', 'Park City Clinic-Round Valley', '', '', 'Park City Clinic-Round Valley', 'Group', 'Clinic', '', '', NULL, 'O', '1665 Bonanza Dr', 'Park City', 'Summit', 'UT', '84060', '8667432584', '4356457768', '1665 Bonanza Dr', 'Park City', 'Summit', 'UT', '84060', '8667432584', '4356457768', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1033474648', 0, 'N', 0, '2012-07-30', NULL, NULL, 40.6623, -111.5, NULL, NULL),
('942854057', 'W12021349', 'W12021349', 'UTIHCPHY', 'Park City Clinic-Canyons', '', '', 'Park City Clinic-Canyons', 'Group', 'Clinic', '', '', NULL, 'O', '4000 Canyons Resort Dr', 'Park City', 'Summit', 'UT', '84098', '4356456900', NULL, '4000 Canyons Resort Dr', 'Park City', 'Summit', 'UT', '84098', '4356456900', '          ', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1831454446', 0, 'N', 0, '2012-07-30', NULL, NULL, 40.6839, -111.553, NULL, NULL),
('538081436', 'W12021351', 'W12021351', 'UT01', '', 'Ryan', 'Lee', 'Emmett', 'DC', 'Chiropractic', '', '', NULL, 'O', '2002 N Main St Ste 7', 'Cedar City', 'Iron', 'UT', '84721', '4358674505', NULL, '2002 N Main St Ste 7', 'Cedar City', 'Iron', 'UT', '84721', '4358674505', '', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2012-07-01', '2012-07-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1083837934', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('538081436', 'W12021352', 'W12021352', 'UT01', 'Ryan L. Emmett, DC', 'Ryan', 'Lee', 'Emmett', 'DC', 'Chiropractic', '', '', NULL, 'O', '2002 N Main St Ste 7', 'Cedar City', 'Iron', 'UT', '84721', '4358674505', NULL, '2002 N Main St Ste 7', 'Cedar City', 'Iron', 'UT', '84721', '4358674505', '', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '57.12', 3, '2012-08-01', '2012-11-15', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1083837934', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('870574059', 'W12021354', 'W12021354', 'UT01', 'Mountain Land Clinton', 'Jennifer', 'Kristine', 'Harp', 'DPT', 'Physical Therapy', '', '', NULL, 'O', '1477 N 2000 W', 'Clearfield', 'Davis', 'UT', '84015', '8017734191', '8017734197', '1477 N 2000 W', 'Clearfield', 'Davis', 'UT', '84015', '8017734191', '8017734197', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1609135292', 0, 'N', 0, '2012-07-30', NULL, NULL, 41.1353, -112.064, NULL, NULL),
('870574059', 'W12021355', 'W12021355', 'UT01', 'Mountain Land Clinton', 'Jennifer', 'Kristine', 'Harp', 'DPT', 'Physical Therapy', '', '', NULL, 'B', 'PO Box 711185', 'Salt Lake City', 'Salt Lake', 'UT', '84171', '8017734191', '8017734197', 'PO Box 711185', 'Salt Lake City', 'Salt Lake', 'UT', '84171', '8017734191', '8017734197', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1609135292', 0, 'N', 0, '2012-07-30', NULL, NULL, 0, 0, NULL, NULL),
('743134264', 'W12021357', 'W12021357', 'UT01', 'Pediatric Pulmonology-Department of University of Utah', '', '', 'University of Utah Dept of Pediatric Pulmonolgy', 'GROUP', 'Pediatric Pulmonology', '', '', NULL, 'O', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621790', NULL, '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621790', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2012-07-31', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009304', 0, 'N', 0, '2012-07-31', NULL, NULL, 40.7663, -111.837, NULL, NULL),
('743134264', 'W12021358', 'W12021358', 'UT01', 'Pediatric Pulmonology-Department of University of Utah', '', '', 'University of Utah Dept of Pediatric Pulmonolgy', 'GROUP', 'Pediatric Pulmonology', '', '', NULL, 'B', 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', NULL, 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2012-07-31', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009304', 0, 'N', 0, '2012-07-31', NULL, NULL, 0, 0, NULL, NULL),
('743134266', 'W12021359', 'W12021359', 'UT01', 'Pediatric Emergency Medicine-Department of University of Utah', '', '', 'University of Utah Dept of  Pediatric Emergency Medicine', 'GROUP', 'Pediatric Emergency Medicine', '', '', NULL, 'O', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621234', NULL, '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621234', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2012-07-31', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009283', 0, 'N', 0, '2012-07-31', NULL, NULL, 40.7663, -111.837, NULL, NULL),
('743134266', 'W12021360', 'W12021360', 'UT01', 'Pediatric Emergency Medicine-Department of University of Utah', '', '', 'University of Utah Dept of  Pediatric Emergency Medicine', 'GROUP', 'Pediatric Emergency Medicine', '', '', NULL, 'B', 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', NULL, 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2012-07-31', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009283', 0, 'N', 0, '2012-07-31', NULL, NULL, 0, 0, NULL, NULL),
('743134262', 'W12021361', 'W12021361', 'UT01', 'Pediatric Neurology-Department of University of Utah', '', '', 'University of Utah Dept of Pediatric Neurology', 'GROUP', 'Pediatric Neurology', '', '', NULL, 'O', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8015877575', NULL, '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8015877575', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2012-07-31', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009303', 0, 'N', 0, '2012-07-31', NULL, NULL, 40.7663, -111.837, NULL, NULL),
('743134262', 'W12021363', 'W12021363', 'UT01', 'Pediatric Neurology-Department of University of Utah', '', '', 'University of Utah Dept of Pediatric Neurology', 'GROUP', 'Pediatric Neurology', '', '', NULL, 'B', 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', NULL, 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2012-07-31', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009303', 0, 'N', 0, '2012-07-31', NULL, NULL, 0, 0, NULL, NULL),
('743134260', 'W12021364', 'W12021364', 'UT01', 'Pediatric Nephrology-Department of University of Utah', '', '', 'University of Utah Dept of Pediatric Nephrology', 'GROUP', 'Pediatric Nephrology', '', '', NULL, 'O', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8015877575', NULL, '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8015877575', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2012-07-31', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009302', 0, 'N', 0, '2012-07-31', NULL, NULL, 40.7663, -111.837, NULL, NULL),
('743134260', 'W12021365', 'W12021365', 'UT01', 'Pediatric Nephrology-Department of University of Utah', '', '', 'University of Utah Dept of Pediatric Nephrology', 'GROUP', 'Pediatric Nephrology', '', '', NULL, 'B', 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', NULL, 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2012-07-31', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009302', 0, 'N', 0, '2012-07-31', NULL, NULL, 0, 0, NULL, NULL),
('743134258', 'W12021366', 'W12021366', 'UT01', 'Pediatric Neonatology-Department of University of Utah', '', '', 'University of Utah Dept of Pediatric Neonatology', 'GROUP', 'Neonatology', '', '', NULL, 'O', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016624183', NULL, '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016624183', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2012-07-31', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009301', 0, 'N', 0, '2012-07-31', NULL, NULL, 40.7663, -111.837, NULL, NULL),
('743134258', 'W12021367', 'W12021367', 'UT01', 'Pediatric Neonatology-Department of University of Utah', '', '', 'University of Utah Dept of Pediatric Neonatology', 'GROUP', 'Neonatology', '', '', NULL, 'B', 'Po Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', NULL, 'Po Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2012-07-31', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009301', 0, 'N', 0, '2012-07-31', NULL, NULL, 0, 0, NULL, NULL),
('743134257', 'W12021368', 'W12021368', 'UT01', 'Pediatric Infectious Disease-Department of University of Utah', '', '', 'University of Utah Dept of Pediatric Infectious Disease', 'GROUP', 'Pediatric Infectious Diseases', '', '', NULL, 'O', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8015816791', NULL, '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8015816791', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2012-07-31', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009299', 0, 'N', 0, '2012-07-31', NULL, NULL, 40.7663, -111.837, NULL, NULL),
('743134257', 'W12021369', 'W12021369', 'UT01', 'Pediatric Infectious Disease-Department of University of Utah', '', '', 'University of Utah Dept of Pediatric Infectious Disease', 'GROUP', 'Pediatric Infectious Diseases', '', '', NULL, 'B', 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', NULL, 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2012-07-31', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009299', 0, 'N', 0, '2012-07-31', NULL, NULL, 0, 0, NULL, NULL),
('743134254', 'W12021370', 'W12021370', 'UT01', 'Pediatric Immunology-Department of University of Utah', '', '', 'University of Utah Dept of Pediatric Immunology', 'GROUP', 'Pediatric Immunology and Rheumatology', '', '', NULL, 'O', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8012133599', NULL, '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8012133599', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2012-07-31', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009298', 0, 'N', 0, '2012-07-31', NULL, NULL, 40.7663, -111.837, NULL, NULL),
('743134254', 'W12021371', 'W12021371', 'UT01', 'Pediatric Immunology-Department of University of Utah', '', '', 'University of Utah Dept of Pediatric Immunology', 'GROUP', 'Pediatric Immunology and Rheumatology', '', '', NULL, 'B', 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', NULL, 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2012-07-31', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009298', 0, 'N', 0, '2012-07-31', NULL, NULL, 0, 0, NULL, NULL),
('743134253', 'W12021372', 'W12021372', 'UT01', 'Pediatric Hematology-Oncology-Department of University of Utah', '', '', 'University of Utah Dept of Pediatric Hematology Oncology', 'GROUP', 'Pediatric Hematology and Oncolocy', '', '', NULL, 'O', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016624700', NULL, '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016624700', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2012-07-31', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009297', 0, 'N', 0, '2012-07-31', NULL, NULL, 40.7663, -111.837, NULL, NULL),
('743134252', 'W12021375', 'W12021375', 'UT01', 'Pediatric Genetics-Department of University of Utah', '', '', 'University of Utah Dept of Pediatric Genetics', 'GROUP', 'Pediatric Genetics', '', '', NULL, 'O', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8015818943', NULL, '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8015818943', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2012-07-31', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009296', 0, 'N', 0, '2012-07-31', NULL, NULL, 40.7663, -111.837, NULL, NULL),
('743134253', 'W12021373', 'W12021373', 'UT01', 'Pediatric Hematology-Oncology-Department of University of Utah', '', '', 'University of Utah Dept of Pediatric Hematology Oncology', 'GROUP', 'Pediatric Hematology and Oncolocy', '', '', NULL, 'B', 'Po Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', NULL, 'Po Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2006-08-01', '2012-07-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009297', 0, 'N', 0, '2012-07-31', NULL, NULL, 0, 0, NULL, NULL),
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('743134251', 'W12021377', 'W12021377', 'UT01', 'Pediatric Gastroenterology-Department of University of Utah', '', '', 'University of Utah Dept of Pediatric Gastroenterology', 'GROUP', 'Pediatric Gastroenterology', '', '', NULL, 'O', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016622900', NULL, '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016622900', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2012-07-31', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009295', 0, 'N', 0, '2012-07-31', NULL, NULL, 40.7663, -111.837, NULL, NULL),
('743134251', 'W12021378', 'W12021378', 'UT01', 'Pediatric Gastroenterology-Department of University of Utah', '', '', 'University of Utah Dept of Pediatric Gastroenterology', 'GROUP', 'Pediatric Gastroenterology', '', '', NULL, 'B', 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', NULL, 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2012-07-31', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009295', 0, 'N', 0, '2012-07-31', NULL, NULL, 0, 0, NULL, NULL),
('743134267', 'W12021386', 'W12021386', 'UT01', 'University of Utah Dept of Pediatric Inpatient Services', '', '', 'University of Utah Dept of Pediatric Inpatient Services', 'GROUP', 'Pediatric Emergency Medicine', '', '', NULL, 'B', 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', '8016623446', 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', '8016623446', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009300', 0, 'N', 0, '2013-01-22', NULL, NULL, 0, 0, NULL, NULL),
('743134267', 'W12021385', 'W12021385', 'UT01', 'University of Utah Dept of Pediatric Inpatient Services', '', '', 'University of Utah Dept of Pediatric Inpatient Services', 'GROUP', 'Pediatric Emergency Medicine', '', '', NULL, 'O', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016623645', '8016623446', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016623645', '8016623446', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009300', 0, 'N', 0, '2013-01-22', NULL, NULL, 40.7663, -111.837, NULL, NULL),
('743134268', 'W12021387', 'W12021387', 'UT01', 'Pediatric Sleep Medicine-Department of University of Utah', '', '', 'University of Utah Dept of Pediatric Sleep Medicine', 'GROUP', 'Pediatric Pulmonology', 'Pediatric Sleep Medicine', 'Pediatrics', NULL, 'O', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '743134268 ', NULL, '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '743134268 ', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009305', 0, 'N', 0, '2012-08-01', NULL, NULL, 40.7663, -111.837, NULL, NULL),
('743134268', 'W12021388', 'W12021388', 'UT01', 'Pediatric Sleep Medicine-Department of University of Utah', '', '', 'University of Utah Dept of Pediatric Sleep Medicine', 'GROUP', 'Pediatric Pulmonology', 'Pediatric Sleep Medicine', 'Pediatrics', NULL, 'B', 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', NULL, 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009305', 0, 'N', 0, '2012-08-01', NULL, NULL, 0, 0, NULL, NULL),
('743134271', 'W12021389', 'W12021389', 'UT01', 'Pediatric Cardiology-Department of University of Utah', '', '', 'University of Utah Dept of Pediatric Cardiology', 'GROUP', 'Pediatric Cardiology', '', '', NULL, 'O', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016625400', NULL, '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016625400', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009292', 0, 'N', 0, '2012-08-01', NULL, NULL, 40.7663, -111.837, NULL, NULL),
('743134271', 'W12021390', 'W12021390', 'UT01', 'Pediatric Cardiology-Department of University of Utah', '', '', 'University of Utah Dept of Pediatric Cardiology', 'GROUP', 'Pediatric Cardiology', '', '', NULL, 'B', 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', NULL, 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009292', 0, 'N', 0, '2012-08-01', NULL, NULL, 0, 0, NULL, NULL),
('743134273', 'W12021392', 'W12021392', 'UT01', 'Pediatric Bone Marrow Transplant-Department of University of Utah', '', '', 'Pediatric Bone Marrow Transplant-Department of University of Utah', 'GROUP', 'Pediatric Hematology and Oncolocy', '', '', NULL, 'O', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016624700', NULL, '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016624700', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000008108', 0, 'N', 0, '2012-08-01', NULL, NULL, 40.7663, -111.837, NULL, NULL),
('743134273', 'W12021393', 'W12021393', 'UT01', 'Pediatric Bone Marrow Transplant-Department of University of', '', '', 'Pediatric Bone Marrow Transplant-Department of University of Utah', 'GROUP', 'Pediatric Hematology and Oncolocy', '', '', NULL, 'B', 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', NULL, 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000008108', 0, 'N', 0, '2012-08-01', NULL, NULL, 0, 0, NULL, NULL),
('743134291', 'W12021394', 'W12021394', 'UT01', 'Pediatric Endocrinology-Department of University of Utah', '', '', 'University of Utah Dept of Pediatric Endocrinology', 'GROUP', 'Pediatric Endocrinology', '', '', NULL, 'O', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016622830', NULL, '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016622830', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009294', 0, 'N', 0, '2012-08-01', NULL, NULL, 40.7663, -111.837, NULL, NULL),
('743134291', 'W12021395', 'W12021395', 'UT01', 'Pediatric Endocrinology-Department of University of Utah', '', '', 'University of Utah Dept of Pediatric Endocrinology', 'GROUP', 'Pediatric Endocrinology', '', '', NULL, 'B', 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', NULL, 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009294', 0, 'N', 0, '2012-08-01', NULL, NULL, 0, 0, NULL, NULL),
('800147425', 'W12021396', 'W12021396', 'UT01', 'Pediatric Behavioral Health', '', '', 'Pediatric Behavioral Health', 'GROUP', 'Mental Health', 'Pediatric Psychiatry', '', NULL, 'B', 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', '8015853655', 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', '8015853655', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000008106', 0, 'N', 0, '2012-08-01', NULL, NULL, 0, 0, NULL, NULL),
('800147425', 'W12021397', 'W12021397', 'UT01', 'Pediatric Behavioral Health', '', '', 'Pediatric Behavioral Health', 'GROUP', 'Mental Health', 'Pediatric Psychiatry', '', NULL, 'O', '100 Mario Cappechi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621000', '8015853655', '100 Mario Cappechi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621000', '8015853655', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000008106', 0, 'N', 0, '2012-08-01', NULL, NULL, 40.7663, -111.837, NULL, NULL),
('800147447', 'W12021399', 'W12021399', 'UT01', 'University Pediatric Allergy', '', '', 'University Pediatric Allergy', '', 'Pediatric Allergy and Immunology', '', '', NULL, 'O', '7495 S State St', 'Midvale', 'Salt Lake', 'UT', '84047', '8012139400', NULL, '7495 S State St', 'Midvale', 'Salt Lake', 'UT', '84047', '8012139400', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '0.00', '0.00', 3, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009901', 0, 'N', 0, '2012-08-01', NULL, NULL, 40.6152, -111.891, NULL, NULL),
('800147447', 'W12021400', 'W12021400', 'UT01', 'University Pediatric Allergy', '', '', 'University Pediatric Allergy', '', 'Pediatric Allergy and Immunology', '', '', NULL, 'B', 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', NULL, 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '0.00', '0.00', 3, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009901', 0, 'N', 0, '2012-08-01', NULL, NULL, 0, 0, NULL, NULL);
