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
('870476269', 'W12005751', 'W12005751', 'UT01', 'Department of Pediatrics University of Utah', 'Michele', 'A', 'Bennett', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '8015853655', 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '8015853655', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2010-07-01', '2012-08-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1316125859', 0, 'N', 0, '2012-08-02', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12005753', 'W12005753', 'UTPEHP', 'American Fork Surgical Associates', 'William', 'Noel', 'Peugh', 'MD', 'General Surgery', '', '', NULL, 'O', '1159 E 200 N', 'American Fork', 'Utah', 'UT', '84003', '8018552941', NULL, '1159 E 200 N', 'American Fork', 'Utah', 'UT', '84003', '8018552941', '          ', 'IHCPEHP', '', '', '0.00', '30.00', '0.00', 8, '2008-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1730147711', 0, 'N', 0, '2011-11-17', NULL, NULL, 0, 0, NULL, NULL),
('874446523', 'W12005765', 'W12005765', 'UT01', 'Knight Chiropractic Clinic', 'James', 'D', 'Knight', 'DC', 'Chiropractic', '', '', NULL, 'O', '513 W 2600 S', 'Bountiful', 'Davis', 'UT', '84010', '8012929857', '8012991131', '513 W 2600 S', 'Bountiful', 'Davis', 'UT', '84010', '8012929857', '8012991131', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2010-11-01', '2010-11-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1942201124', 0, 'N', 0, '2013-01-09', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12005783', 'W12005783', 'UTIHCPHY', 'Salt Lake Clinic - Laboratory', '', '', 'Salt Lake Clinic - Laboratory', 'GROUP', 'Laboratory', '', '', NULL, 'O', '333 S 900 E', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015358336', NULL, '333 S 900 E', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015358336', '          ', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2010-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1457481939', 0, 'Y', 0, '2010-10-27', NULL, NULL, 40.7622, -111.865, NULL, NULL),
('942854057', 'W12005785', 'W12005785', 'UTIHCPHY', 'Bryner Clinic Independent Lab', '', '', 'Bryner Clinic Independent Lab', 'GROUP', 'Laboratory', '', '', NULL, 'O', '525 E 100 S Ste 500L', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015197100', NULL, '525 E 100 S Ste 500L', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015197100', '          ', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2010-05-01', '2012-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1215109665', 0, 'Y', 0, '2012-12-31', NULL, NULL, 0, 0, NULL, NULL),
('731649834', 'W12005791', 'W12005791', 'UT01', 'Amon Chiropractic Center', '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', '55.46', 3, '2010-11-01', '2012-07-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1265407282', 0, 'N', 0, '2012-10-15', NULL, NULL, 0, 0, NULL, NULL),
('470904864', 'W12005792', 'W12005792', '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', '55.46', 3, '2010-11-01', '2012-07-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1598722928', 0, 'N', 0, '2012-07-09', NULL, NULL, 0, 0, NULL, NULL),
('528656859', 'W12005793', 'W12005793', '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', '55.46', 3, '2010-11-01', '2012-07-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1013020213', 0, 'N', 0, '2012-07-10', NULL, NULL, 0, 0, NULL, NULL),
('529571010', 'W12005798', 'W12005798', 'UT01', 'Collard Chiropractic', 'Chad', 'L', 'Collard', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '9103 S 1300 W Ste 101', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015691141', '8015691171', '9103 S 1300 W Ste 101', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015691141', '8015691171', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2010-11-01', '2010-11-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1184707036', 0, 'N', 0, '2012-02-15', NULL, NULL, 0, 0, NULL, NULL),
('870533440', 'W12005800', 'W12005800', 'UT01', 'Integrated Chiropractic', 'Gary', 'B', 'Davis', 'DC CCEP', 'Chiropractic', '', '', NULL, 'O', '716 E 4500 S Ste  N250', 'Murray', 'Salt Lake', 'UT', '84107', '8012628400', '8012625570', '716 E 4500 S Ste  N250', 'Murray', 'Salt Lake', 'UT', '84107', '8012628400', '8012625570', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2010-11-01', '2012-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1831255736', 0, 'N', 0, '2012-02-15', NULL, NULL, 0, 0, NULL, NULL),
('134259986', 'W12005801', 'W12005801', 'UT01', 'Dudley Chiropractic and Wellness', 'Mark', '', 'Dudley', 'DC', 'Mental Health', 'Chiropractic', NULL, NULL, 'O', '77 S 700 E Ste 230', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013593995', '8013598489', '77 S 700 E Ste 230', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013593995', '8013598489', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2010-11-01', '2012-07-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1689784019', 0, 'N', 0, '2012-07-09', NULL, NULL, 0, 0, NULL, NULL),
('870674742', 'W12005802', 'W12005802', 'UT01', 'Sports and Family Chiropractic Group PC', 'Roger', 'M', 'Ellis', 'DC', 'Chiropractic', '', '', NULL, 'O', '990 Medical Dr Ste UL-1', 'Brigham City', 'Box Elder', 'UT', '84302', '4357232311', '4357239706', '990 Medical Dr Ste UL-1', 'Brigham City', 'Box Elder', 'UT', '84302', '4357232311', '4357239706', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2010-11-01', '2012-07-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1740361435', 0, 'N', 0, '2012-07-10', NULL, NULL, 0, 0, NULL, NULL),
('870333664', 'W12005803', 'W12005803', 'UT01', '', 'Daryl', '', 'Hales', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '360 S State St Ste A', 'Clearfield', 'Davis', 'UT', '84015', '8017731821', '8018255276', '360 S State St Ste A', 'Clearfield', 'Davis', 'UT', '84015', '8017731821', '8018255276', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '35.00', '55.46', 3, '2010-11-01', '2012-07-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1972504892', 0, 'N', 0, '2012-07-09', NULL, NULL, 0, 0, NULL, NULL),
('204005480', 'W12005804', 'W12005804', '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', '55.46', 3, '2010-11-01', '2012-07-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1881652535', 0, 'N', 0, '2012-07-09', NULL, NULL, 0, 0, NULL, NULL),
('870674742', 'W12005805', 'W12005805', 'UT01', 'Sports and Family Chiropractic Group PC', 'Kyle', 'D', 'Klein', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '990 Medical Dr Ste UL-1', 'Brigham City', 'Box Elder', 'UT', '84302', '4357232311', '4357239706', '990 Medical Dr Ste UL-1', 'Brigham City', 'Box Elder', 'UT', '84302', '4357232311', '4357239706', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2010-11-01', '2012-07-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1104911130', 0, 'N', 0, '2012-07-10', NULL, NULL, 0, 0, NULL, NULL),
('330995596', 'W12005806', 'W12005806', 'UT01', 'Chiropractic Health Center Inc', 'Gailen', 'E', 'Lundell', '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', '55.46', 3, '2010-11-01', '2012-01-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1093765364', 0, 'N', 0, '2012-02-15', NULL, NULL, 0, 0, NULL, NULL),
('743079413', 'W12004840', 'W12004840', 'UT01', 'Miller Family Chiropractic', 'Jared', 'A', 'Miller', 'DC', 'Chiropractic', '', '', NULL, 'O', '12569 S 2700 W 202', 'Riverton', 'Salt Lake', 'UT', '84065', '8016419898', '8017683237', '12569 S 2700 W 202', 'Riverton', 'Salt Lake', 'UT', '84065', '8016419898', '8017683237', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2010-11-01', '2010-11-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1609825835', 0, 'N', 0, '2012-07-19', NULL, NULL, 0, 0, NULL, NULL),
('743079413', 'W12005808', 'W12005808', 'UT01', 'Miller Family Chiropractic', 'Jared', 'A', 'Miller', 'DC', 'Chiropractic', '', '', NULL, 'O', '3688 Campus Dr Ste 110', 'Eagle Mountain', 'Utah', 'UT', '84005', '8017895416', '8017822550', '3688 Campus Dr Ste 110', 'Eagle Mountain', 'Utah', 'UT', '84005', '8017895416', '8017822550', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2010-11-01', '2012-07-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1609825835', 0, 'Y', 0, '2012-07-19', NULL, NULL, 0, 0, NULL, NULL),
('810656595', 'W12005809', 'W12005809', 'UT01', 'Able Accident Chiropractic', 'Gregory', 'C', 'Molis', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '3378 W 3500 S', 'West Valley', 'Salt Lake', 'UT', '84119', '8019660342', '8019660360', '3378 W 3500 S', 'West Valley', 'Salt Lake', 'UT', '84119', '8019660342', '8019660360', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2010-11-01', '2012-07-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1730194523', 0, 'N', 0, '2012-07-09', NULL, NULL, 0, 0, NULL, NULL),
('870547455', 'W12005810', 'W12005810', 'UT01', 'Monson Chiropractic', 'Danny', '', 'Monson', 'DC', 'Chiropractic', '', '', NULL, 'O', '3378 W 3500 S', 'West Valley City', 'Salt Lake', 'UT', '84119', '8019665200', '8019660360', '3378 W 3500 S', 'West Valley City', 'Salt Lake', 'UT', '84119', '8019665200', '8019660360', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2010-11-01', '2012-07-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1518989763', 0, 'N', 0, '2012-07-10', NULL, NULL, 0, 0, NULL, NULL),
('870547455', 'W12005811', 'W12005811', 'UT01', 'Monson Chiropractic', 'Danny', '', 'Monson', 'DC', 'Chiropractic', '', '', NULL, 'O', '3684 S State St Ste 2', 'Salt Lake City', 'Salt Lake', 'UT', '84115', '8012682901', '8012665621', '3684 S State St Ste 2', 'Salt Lake City', 'Salt Lake', 'UT', '84115', '8012682901', '8012665621', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2010-11-01', '2012-01-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1518989763', 0, 'N', 0, '2012-02-27', NULL, NULL, 0, 0, NULL, NULL),
('030576981', 'W12005812', 'W12005812', 'UT01', 'Coral Canyon Chiropractic', 'Kelly', 'E', 'Murie', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '83 S 2600 Ste 102', 'Hurricane', 'Washington', 'UT', '84737', '4356357771', '4356357701', '83 S 2600 Ste 102', 'Hurricane', 'Washington', 'UT', '84737', '4356357771', '4356357701', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2010-11-01', '2011-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1306912969', 0, 'N', 0, '2012-01-23', NULL, NULL, 0, 0, NULL, NULL),
('522007508', 'W12005813', 'W12005813', 'UT01', 'Panah Chiropractic and Rehab', 'Timothy', '', 'Panah', 'DC', 'Chiropractic', '', '', NULL, 'O', '2002 N Main St Ste 7', 'Cedar City', 'Iron', 'UT', '84721', '4358674505', '4358651783', '2002 N Main St Ste 7', 'Cedar City', 'Iron', 'UT', '84721', '4358674505', '4358651783', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2010-11-01', '2012-07-11', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1538232301', 0, 'N', 0, '2012-06-26', NULL, NULL, 0, 0, NULL, NULL),
('205692514', 'W12005814', 'W12005814', 'UT01', 'Advanced Technology Spinal Center', 'Robert', 'E', 'Park', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '174 W Parrish Ln', 'Centerville', 'Davis', 'UT', '84014', '8012987330', '8012955434', '174 W Parrish Ln', 'Centerville', 'Davis', 'UT', '84014', '8012987330', '8012955434', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2010-11-01', '2011-06-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1255471579', 0, 'N', 0, '2012-02-14', NULL, NULL, 0, 0, NULL, NULL),
('870675662', 'W12005815', 'W12005815', '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', '55.46', 3, '2010-11-01', '2012-07-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1447381223', 0, 'N', 0, '2012-07-10', NULL, NULL, 0, 0, NULL, NULL),
('870674742', 'W12005816', 'W12005816', 'UT01', 'Sports and Family Chiropractic Group PC', 'Brian', 'C', 'Vranes', 'DC', 'Chiropractic', '', '', NULL, 'O', '990 Medical Dr Ste UL-1', 'Brigham City', 'Box Elder', 'UT', '84302', '4357232311', '4357239706', '990 Medical Dr Ste UL-1', 'Brigham City', 'Box Elder', 'UT', '84302', '4357232311', '4357239706', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2010-11-01', '2012-07-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1790939312', 0, 'N', 0, '2012-07-10', NULL, NULL, 0, 0, NULL, NULL),
('204574521', 'W12005817', 'W12005817', 'UT01', 'Health Source Chiropractic of South Ogden 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', '55.46', 3, '2010-11-01', '2012-07-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1619953254', 0, 'N', 0, '2013-12-06', NULL, NULL, 0, 0, NULL, NULL),
('870418269', 'W12005818', 'W12005818', 'UT01', '', 'Lew', 'A', 'Wheelwright', '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', '55.46', 3, '2010-11-01', '2011-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1194732933', 0, 'N', 0, '2012-01-23', NULL, NULL, 0, 0, NULL, NULL),
('870479469', 'W12005823', 'W12005823', 'UT01', 'Oakwood Chiropractic Offices Inc', 'Stuart', '', 'Yeager', 'DC', 'Chiropractic', '', '', NULL, 'O', '7086 S Highland Dr Ste 50', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019433355', '8019435719', '7086 S Highland Dr Ste 50', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019433355', '8019435719', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2010-11-01', '2011-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1356422828', 0, 'N', 0, '2012-01-09', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12005824', 'W12005824', 'UTIHCPHY', 'North Sevier Medical Clinic', 'Justin', 'D', 'Abbott', 'DO', 'Family Practice', '', '', NULL, 'O', '530 N 250 W', 'Salina', 'Sevier', 'UT', '84654', '4355297411', NULL, '530 N 250 W', 'Salina', 'Sevier', 'UT', '84654', '4355297411', '          ', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2010-07-20', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1184814436', 0, 'N', 0, '2012-12-31', NULL, NULL, 38.9534, -111.863, NULL, NULL),
('942854057', 'W12005825', 'W12005825', 'UTIHCPHY', 'Southwest Regional Cancer Clinic', 'Magid', 'H', 'Amer', 'MD', 'Oncology', 'Internal Medicine', '', NULL, 'O', '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356884900', NULL, '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356884900', '          ', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2010-05-13', '2010-11-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1316947849', 0, 'N', 0, '2011-09-23', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12005826', 'W12005826', 'UTIHCPHY', 'Cedar City Clinic', 'Travis', 'J', 'Bilanzich', 'DO', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1303 N Main Ste 3C', 'Cedar City', 'Iron', 'UT', '84720', '4358685500', NULL, '1303 N Main Ste 3C', 'Cedar City', 'Iron', 'UT', '84720', '4358685500', '          ', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2010-07-12', NULL, 0, 0, 0, 'Valley View Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1336331958', 0, 'N', 0, '2010-10-27', NULL, NULL, 37.6711, -113.103, NULL, NULL),
('942854057', 'W12005828', 'W12005828', 'UTIHCPHY', 'Logan Hospitalists', 'Karl', 'L', 'Brown', 'MD', '', 'Hospitalist', '', NULL, 'O', '1400 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357161000', NULL, '1400 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357161000', '          ', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2010-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1649497702', 0, 'Y', 0, '2013-12-30', NULL, NULL, 41.7569, -111.821, NULL, NULL),
('942854057', 'W12005829', 'W12005829', 'UTIHCPHY', 'Hillcrest Pediatrics', 'Neal', 'R', 'Davis', 'MD', 'Pediatrics', 'Internal Medicine', '', NULL, 'O', '5063 S Cottonwood St Ste 160', 'Murray', 'Salt Lake', 'UT', '84107', '8015071850', NULL, '5063 S Cottonwood St Ste 160', 'Murray', 'Salt Lake', 'UT', '84107', '8015071850', '          ', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2010-07-12', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1760691166', 0, 'N', 0, '2012-01-24', NULL, NULL, 40.6615, -111.893, NULL, NULL),
('942854057', 'W12005830', 'W12005830', 'UTIHCPHY', 'Logan Clinic', 'Brad', 'M', 'Goates', 'MD', 'Family Practice', '', '', NULL, 'O', '412 N 200 E', 'Logan', 'Cache', 'UT', '84321', '4357132800', NULL, '412 N 200 E', 'Logan', 'Cache', 'UT', '84321', '4357132800', '          ', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2010-07-14', NULL, 0, 0, 0, 'Logan Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1396942785', 0, 'N', 0, '2013-08-27', NULL, NULL, 41.7393, -111.83, NULL, NULL),
('942854057', 'W12005831', 'W12005831', 'UTIHCPHY', 'Pulmonary Medicine Clinic - St George', 'Melissa', 'J', 'Hinton', 'APRN', 'Family Practice', NULL, NULL, NULL, 'O', '1380 E Medical Ctr Dr Ste 2200', 'St George', 'Washington', 'UT', '84790', '4352512600', NULL, '1380 E Medical Ctr Dr Ste 2200', 'St George', 'Washington', 'UT', '84790', '4352512600', '          ', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2009-12-16', '2013-08-31', 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1043545536', 0, 'N', 0, '2013-09-05', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12005832', 'W12005832', 'UTIHCPHY', 'Pulmonary St George-Cedar City', 'Melissa', 'J', 'Hinton', 'APRN', 'Family Practice', NULL, NULL, NULL, 'O', '110 W 1325 N Ste 100', 'Cedar City', 'Iron', 'UT', '84721', '4352512600', NULL, '110 W 1325 N Ste 100', 'Cedar City', 'Iron', 'UT', '84721', '4352512600', '          ', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2010-06-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1043545536', 0, 'N', 0, '2013-09-05', NULL, NULL, 37.7011, -113.064, NULL, NULL),
('942854057', 'W12005833', 'W12005833', 'UTIHCPHY', 'Pulmonary St George-Cedar City', 'Michael', 'R', 'Kline', 'MD', 'Pulmonary', 'Family Practice', 'Internal Medicine', NULL, 'O', '110 W 1325 N Ste 100', 'Cedar City', 'Iron', 'UT', '84721', '4352512600', NULL, '110 W 1325 N Ste 100', 'Cedar City', 'Iron', 'UT', '84721', '4352512600', '', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2008-01-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', '', '', '', 'HCFA|UB|', '1073531331', 0, 'N', 0, '2014-06-17', NULL, NULL, 37.7011, -113.064, NULL, NULL),
('942854057', 'W12006014', 'W12006014', 'UTIHC04', 'Dixie Wound and Hyperbaric', 'Diedre', 'D', 'Bacon', 'APRN', 'Family Practice', '', '', NULL, 'O', '544 E 400 E', 'St George', 'Washington', 'UT', '84770', '4356884293', NULL, '544 E 400 E', 'St George', 'Washington', 'UT', '84770', '4356884293', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2010-10-04', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1700020369', 0, 'N', 0, '2013-03-11', NULL, NULL, 0, 0, NULL, NULL),
('200552841', 'W12005977', 'W12005977', 'Sinclair', '(Sinclair Health Services\rProvider) Central Wyoming Neurosurgery', 'Gina', '', 'Duel', 'PA-C', 'Neurosurgery', '', '', NULL, 'O', '6600 E 2nd St', 'Casper', 'Natrona', 'WY', '82609', '3072664000', NULL, '6600 E 2nd St', 'Casper', 'Natrona', 'WY', '82609', '3072664000', '          ', '', '', '', '0.00', '30.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, 'Mountain View Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1912985979', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12005835', 'W12005835', 'UTIHCPHY', 'Valley View Heart Clinic', 'Aarush', '', 'Manchanda', 'MD', 'Cardiovascular Disease', 'Internal Medicine', '', NULL, 'O', '1303 N Main Ste D', 'Cedar City', 'Iron', 'UT', '84720', '4358685500', NULL, '1303 N Main Ste D', 'Cedar City', 'Iron', 'UT', '84720', '4358685500', '          ', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2010-07-15', NULL, 0, 0, 0, 'Valley View Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1609027986', 0, 'N', 0, '2011-12-01', NULL, NULL, 37.6711, -113.103, NULL, NULL),
('942854057', 'W12005837', 'W12005837', 'UTIHCPHY', 'River Road Internal Medicine', 'Cathleen', 'F', 'Obray', 'MD', 'Internal Medicine', '', '', NULL, 'O', '577 S River Rd', 'St George', 'Washington', 'UT', '84790', '4356886200', NULL, '577 S River Rd', 'Saint George', 'Washington', 'UT', '84790', '4356886200', '          ', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2010-06-16', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1225191539', 0, 'N', 0, '2010-10-27', NULL, NULL, 37.0986, -113.557, NULL, NULL),
('942854057', 'W12005838', 'W12005838', 'UTIHCPHY', 'Utah Heart', 'Kelly', 'R', 'O Neal', 'MD', 'Cardiovascular Disease', 'Internal Medicine', '', NULL, 'O', '5169 S Cottonwood Dr Ste 520', 'Murray', 'Salt Lake', 'UT', '84107', '8015073500', NULL, '5169 S Cottonwood Dr Ste 520', 'Murray', 'Salt Lake', 'UT', '84107', '8015073500', '          ', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2010-08-16', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1053401240', 0, 'N', 0, '2013-12-30', NULL, NULL, 40.659, -111.894, NULL, NULL),
('942854057', 'W12005840', 'W12005840', 'UTIHCPHY', 'River Road Internal Medicine', 'Richard', 'R', 'Patilano', 'MD', 'Internal Medicine', '', '', NULL, 'O', '577 S River Rd', 'St George', 'Washington', 'UT', '84790', '4356886200', NULL, '577 S River Rd', 'St George', 'Washington', 'UT', '84790', '4356886200', '          ', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2010-07-20', '2011-01-26', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1417157876', 0, 'N', 0, '2013-09-05', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12005842', 'W12005842', 'UTIHC04', 'Bountiful KidsCare', 'Enrique', 'P', 'Baires', 'MD', 'Family Practice', '', '', NULL, 'O', '390 N Main St', 'Bountiful', 'Davis', 'UT', '84010', '8012949933', NULL, '390 N Main St', 'Bountiful', 'Davis', 'UT', '84010', '8012949933', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2009-10-09', '2009-10-09', 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1548373400', 0, 'Y', 0, '2013-03-27', NULL, NULL, 0, 0, NULL, NULL),
('860744315', 'W12005950', 'W12005950', 'Sinclair', 'A Womans Place', 'Holly', 'K', 'Vigil', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '3100 N W St Ste 300', 'Flagstaff', 'Coconino', 'AZ', '86004', '9287799250', NULL, '3100 N W St Ste 300', 'Flagstaff', 'Coconino', 'AZ', '86004', '9287799250', '          ', 'AZSINCLAIRd', 'AZSINCLAIRe', '', '0.00', '35.00', '0.00', 3, '2010-11-01', '2011-07-21', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1891783197', 0, 'N', 0, '2012-03-15', NULL, NULL, 0, 0, NULL, NULL),
('170409406', 'W12005843', 'W12005843', 'ID02', '', 'Jane', 'E', 'Henley', 'LMFT', 'Mental Health', 'Marriage and Family Therapy', '', NULL, 'O', '333 S Main St Ste 212', 'Ketchum', 'Blaine', 'ID', '83340', '2087254049', NULL, '333 S Main St Ste 212', 'Ketchum', 'Blaine', 'ID', '83340', '2087254049', '', 'IDMA', '', '', '0.00', '35.00', '0.00', 3, '2010-05-21', '2013-02-14', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1912072307', 0, 'N', 0, '2014-06-04', NULL, NULL, 0, 0, NULL, NULL),
('170409406', 'W12005844', 'W12005844', 'ID02', '', 'Jane', 'E', 'Henley', 'LMFT', 'Mental Health', 'Marriage and Family Therapy', '', NULL, 'B', 'PO Box 2141', 'Ketchum', 'Blaine', 'ID', '83340', '2087254049', NULL, 'PO Box 2141', 'Ketchum', 'Blaine', 'ID', '83340', '2087254049', '', 'IDMA', '', '', '0.00', '35.00', '0.00', 3, '2010-05-21', '2013-02-14', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1912072307', 0, 'Y', 0, '2014-06-04', NULL, NULL, 0, 0, NULL, NULL),
('870490866', 'W12005934', 'W12005934', 'UT01', 'University of Utah Surgical Associates', 'Toby', 'M', 'Enniss', 'MD', 'General Surgery', '', '', NULL, 'B', 'PO Box 413035', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8015812121', NULL, 'PO Box 413035', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8015812121', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2010-07-01', '2012-09-16', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1295915536', 0, 'N', 0, '2012-10-16', NULL, NULL, 0, 0, NULL, NULL),
('870490866', 'W12005935', 'W12005935', 'UT01', 'University Health Care', 'Toby', 'M', 'Enniss', 'MD', 'General Surgery', '', '', NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015851618', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015851618', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2010-07-01', '2012-09-16', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1295915536', 0, 'N', 0, '2012-10-16', NULL, NULL, 0, 0, NULL, NULL),
('830239998', 'W12005938', 'W12005938', 'Sinclair', '', 'Johnny', '', 'Tooke', 'MD', 'Family Practice', '', '', NULL, 'O', '2241  Farnum St Ste 105', 'Casper', 'Natrona', 'WY', '82609', '3072661263', NULL, '2241  Farnum St Ste 105', 'Casper', 'Natrona', 'WY', '82609', '3072661263', '          ', '', '', '', '0.00', '12.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1053426759', 0, 'N', 0, '2013-06-28', NULL, NULL, 0, 0, NULL, NULL),
('201328719', 'W12005926', 'W12005926', 'Sinclair', '(Sinclair Health Services\rProvider) Urgent Care Now', '', '', 'Urgent Care Now', 'GROUP', 'Urgent Care', '', '', NULL, 'O', '2546 E 2nd St Ste 200', 'Casper', 'Natrona', 'WY', '82609', '3072651110', NULL, '2546 E 2nd St Ste 200', 'Casper', 'Natrona', 'WY', '82609', '3072651110', '          ', '', '', '', '0.00', '8.00', '0.00', 3, '2010-11-01', '2013-02-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1932396199', 0, 'N', 0, '2013-02-05', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12005849', 'W12005849', 'UTIHCPHY', 'Budge Clinic Internal Medicine', 'Patrick', 'B', 'Shepherd', 'RD', 'Dietician', '', '', NULL, '', '1350 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357921980', NULL, '1350 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357921980', '          ', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2009-11-01', NULL, 0, 0, 0, 'Logan Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1164757100', 0, 'N', 0, '2010-10-28', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12005850', 'W12005850', 'UTIHCPHY', 'Park City Specialty Clinic', 'Danielle', '', 'Adams', 'MD', 'General Surgery', '', '', NULL, 'O', '900 Round Valley Dr Ste 200', 'Park City', 'Summit', 'UT', '84060', '4356587400', NULL, '900 Round Valley Dr Ste 200', 'Park City', 'Summit', 'UT', '84060', '4356587400', '', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2010-08-06', NULL, 0, 0, 0, 'Heber Valley Medical Center', 'Park City Medical Center', '', '', 'HCFA|UB|', '1699957886', 0, 'N', 0, '2014-06-27', NULL, NULL, 40.6876, -111.468, NULL, NULL),
('942854057', 'W12005851', 'W12005851', 'UTIHCPHY', 'Cedar City Clinic', 'Nupur', '', 'Aggarwal', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1303 N Main Ste 3C', 'Cedar City', 'Iron', 'UT', '84720', '4358685500', NULL, '1303 N Main Ste 3C', 'Cedar City', 'Iron', 'UT', '84720', '4358685500', '          ', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2010-08-12', NULL, 0, 0, 0, 'Valley View Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1164680336', 0, 'N', 0, '2010-10-28', NULL, NULL, 37.6711, -113.103, NULL, NULL),
('942854057', 'W12005852', 'W12005852', 'UTIHCPHY', 'Southridge Pediatrics', 'Marcus', '', 'Blackburn', 'MD', 'Pediatrics', '', '', NULL, 'O', '3723 W 12600 S Ste 450', 'Riverton', 'Salt Lake', 'UT', '84065', '8012854543', NULL, '3723 W 12600 S Ste 450', 'Riverton', 'Salt Lake', 'UT', '84065', '8012854543', '          ', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2010-10-01', NULL, 0, 0, 0, 'Riverton Childrens Unit Operated by Primary Childrens Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1598919409', 0, 'N', 0, '2013-05-17', NULL, NULL, 40.5222, -111.98, NULL, NULL),
('942854057', 'W12005854', 'W12005854', 'UTIHCPHY', 'Utah Heart', 'Anne', 'E', 'Boulter', 'APRN', 'Cardiovascular Disease', '', '', NULL, 'O', '5169 S Cottonwood St Ste 520', 'Murray', 'Salt Lake', 'UT', '84107', '8015073500', NULL, '5169 S Cottonwood St Ste 520', 'Murray', 'Salt Lake', 'UT', '84107', '8015073500', '          ', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2010-08-30', '2011-10-07', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1932395951', 0, 'N', 0, '2011-11-02', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12005855', 'W12005855', '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', '          ', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2010-09-01', '2012-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1255482097', 0, 'N', 0, '2012-07-02', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12005856', 'W12005856', 'UTIHCPHY', 'Provo Radiation Oncology', 'Robert', 'J', 'Lee', 'MD', 'Radiation Oncology', '', '', NULL, 'O', '1034 N 500 W', 'Provo', 'Utah', 'UT', '84601', '8013572480', '8012662074', '1034 N 500 W', 'Provo', 'Utah', 'UT', '84601', '8013572480', '8012662074', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2010-07-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1548219991', 0, 'N', 0, '2014-01-17', NULL, NULL, 40.2469, -111.667, NULL, NULL),
('942854057', 'W12005857', 'W12005857', 'UTIHCPHY', 'Heber Valley Clinic', 'Brian', 'C', 'Lofgran', 'MD', 'Family Practice', '', '', NULL, 'O', '1473 S Hwy 40 Ste E', 'Heber City', 'Wasatch', 'UT', '84032', '4356542500', NULL, '1473 S Hwy 40 Ste E', 'Heber City', 'Wasatch', 'UT', '84032', '4356542500', '          ', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2010-08-04', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1558518845', 0, 'N', 0, '2010-10-28', NULL, NULL, 40.4893, -111.409, NULL, NULL),
('942854057', 'W12005858', 'W12005858', 'UTIHCPHY', 'Heber Valley Clinic', 'Erin', 'M', 'Merryweather', 'APRN', 'Family Practice', '', '', NULL, 'O', '1473 S Hwy 40 Ste E', 'Heber City', 'Wasatch', 'UT', '84032', '4356574400', NULL, '1473 S Hwy 40 Ste E', 'Heber City', 'Wasatch', 'UT', '84032', '4356574400', '          ', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2009-11-13', '2010-07-31', 0, 0, 0, 'Heber Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1548278658', 0, 'N', 0, '2010-10-28', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12005859', 'W12005859', 'UTIHCPHY', 'Southern Utah Behavioral Health', 'Bradley', 'D', 'Workman', 'APRN', 'Mental Health', 'Psychiatry', '', 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', '          ', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2009-12-14', '2010-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1881764835', 0, 'N', 0, '2011-03-01', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12005860', 'W12005860', 'UTIHCPHY', 'Mt Pleasant Clinic', 'Mark', 'Lee', 'Wardle', 'DO', 'Family Practice', '', '', NULL, 'o', '1100 S Medical Dr', 'Mount Pleasant', 'Sanpete', 'UT', '84647', '4354623471', NULL, '1100 S Medical Dr', 'Mount Pleasant', 'Sanpete', 'UT', '84647', '4354623471', '          ', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2010-07-01', '2013-06-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1639274574', 0, 'N', 0, '2013-08-27', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12005862', 'W12005862', 'UTIHCPHY', 'Heber Valley Clinic', 'Danielle', '', 'Adams', 'MD', 'General Surgery', '', '', NULL, 'O', '1473 S Hwy 40 Ste E', 'Heber City', 'Wasatch', 'UT', '84032', '4356542500', '          ', '1473 S Hwy 40 Ste E', 'Heber City', 'Wasatch', 'UT', '84032', '4356542500', '          ', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2010-08-06', '2014-06-16', 0, 0, 0, 'Heber Valley Medical Center', 'Park City Medical Center', '', '', 'HCFA|UB|', '1699957886', 0, 'N', 0, '2014-06-27', NULL, NULL, 40.4893, -111.409, NULL, NULL),
('942854057', 'W12005863', 'W12005863', 'UTIHCPHY', 'Southwest Regional Cancer Clinic', 'Karim', '', 'Anwar', 'MD', 'Oncology', '', '', NULL, 'O', '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356884900', NULL, '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356884900', '          ', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2010-09-13', '2012-05-25', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1053350140', 0, 'N', 0, '2012-06-01', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12005864', 'W12005864', 'UTIHCPHY', 'Medical Center Radiation Oncology', 'Vilija', '', 'Avizonis', 'MD', 'Radiation Oncology', '', '', NULL, 'O', '5131 S Cottonwood St', 'Murray', 'Salt Lake', 'UT', '84107', '8015073888', '8012662074', '5131 S Cottonwood St', 'Murray', 'Salt Lake', 'UT', '84107', '8015073888', '8012662074', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2008-07-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1003865932', 0, 'Y', 0, '2013-12-10', NULL, NULL, 40.6594, -111.894, NULL, NULL),
('942854057', 'W12005865', 'W12005865', 'UTIHCPHY', 'Medical Center Radiation Oncology', 'A Jennifer', '', 'Fischbach', 'MD', 'Radiation Oncology', '', '', NULL, 'O', '5131 S Cottonwood St', 'Murray', 'Salt Lake', 'UT', '84107', '8015073888', '8012662074', '5131 S Cottonwood St', 'Murray', 'Salt Lake', 'UT', '84107', '8015073888', '8012662074', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2008-04-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1528017456', 0, 'N', 0, '2014-06-04', NULL, NULL, 40.6594, -111.894, NULL, NULL),
('942854057', 'W12005866', 'W12005866', 'UTIHCPHY', 'Southwest Neurology Associates', 'Barry', 'R', 'Fleischer', 'DO', 'Neurology', NULL, NULL, NULL, 'O', '652 S Medical Ctr Dr Ste 320', 'St George', 'Washington', 'UT', '84790', '4352513950', '4356563850', '652 S Medical Ctr Dr Ste 320', 'Saint George', 'Washington', 'UT', '84790', '4352513950', '4356563850', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2010-11-08', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1578520409', 0, 'N', 0, '2010-10-28', NULL, NULL, 37.0498, -113.574, NULL, NULL),
('942854057', 'W12005867', 'W12005867', 'UTIHCPHY', 'Heber Valley Clinic', 'Wayne', 'Richard', 'Graham', 'DO', 'Family Practice', '', '', NULL, 'O', '1473 S Hwy 40 Ste E', 'Heber City', 'Wasatch', 'UT', '84032', '4356542500', NULL, '1473 S Hwy 40 Ste E', 'Heber City', 'Wasatch', 'UT', '84032', '4356542500', '          ', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2008-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1699781054', 0, 'N', 0, '2013-02-06', NULL, NULL, 40.4893, -111.409, NULL, NULL),
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('942854057', 'W12005871', 'W12005871', 'UTIHCPHY', 'Holladay Pediatrics', 'Kristin', 'A', 'Lynch', 'MD', 'Pediatrics', '', '', NULL, 'O', '2180 E 4500 S Ste 210', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8019474242', NULL, '2180 E 4500 S Ste 210', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8019474242', '          ', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2010-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1588602320', 0, 'N', 0, '2010-10-28', NULL, NULL, 40.6742, -111.829, NULL, NULL),
('942854057', 'W12005872', 'W12005872', 'UTIHCPHY', 'Southwest Cardiology - St. George', 'Jaime', 'J', 'Molden', 'MD', 'Cardiovascular Disease', 'Internal Medicine', '', NULL, 'O', '1380 E Medical Ctr Dr Ste 1500', 'St George', 'Washington', 'UT', '84790', '4352512500', NULL, '1380 E Medical Ctr Dr Ste 1500', 'St George', 'Washington', 'UT', '84790', '4352512500', '          ', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2010-09-13', '2014-02-10', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1356540272', 0, 'N', 0, '2014-03-13', NULL, NULL, 37.0998, -113.554, NULL, NULL),
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('942854057', 'W12005877', 'W12005877', 'UTIHCPHY', 'Medical Center Radiation Oncology', 'Gordon', 'A', 'Watson', 'MD', 'Radiation Oncology', '', '', NULL, 'O', '5131 S Cottonwood St', 'Murray', 'Salt Lake', 'UT', '84107', '8015073888', NULL, '5131 S Cottonwood St', 'Murray', 'Salt Lake', 'UT', '84107', '8015073888', '          ', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2008-07-01', '2012-04-26', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1588682629', 0, 'N', 0, '2012-06-01', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12001613', 'W12001613', 'UTPEHP', 'Heber Valley Clinic', 'S Wesley', '', 'Webster', 'PA-C', 'Family Practice', '', '', NULL, 'O', '1473 S Hwy 40 Ste E', 'Heber City', 'Wasatch', 'UT', '84032', '4356574400', NULL, '1473 S Hwy 40 Ste E', 'Heber City', 'Wasatch', 'UT', '84032', '4356574400', '          ', 'PEHPMID', '', '', '0.00', '30.00', '0.00', 8, '2010-01-27', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1306033774', 0, 'N', 0, '2012-07-31', NULL, NULL, 0, 0, NULL, NULL),
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('942854057', 'W12005882', 'W12005882', 'UTIHCPHY', 'River Road InstaCare', 'Robert', 'A', 'Pepper', 'DO', 'Family Medicine', 'Urgent Care', '', NULL, 'O', '577 S River Rd', 'St George', 'Washington', 'UT', '84790', '4356886300', NULL, '577 S River Rd', 'St George', 'Washington', 'UT', '84790', '4356886300', '          ', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2010-09-01', '2013-09-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1306853163', 0, 'Y', 0, '2013-11-18', NULL, NULL, 0, 0, NULL, NULL),
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('942854057', 'W12005885', 'W12005885', 'UTIHCPHY', 'Utah Heart-LDSH', 'Kelly', 'R', 'O Neal', 'MD', 'Cardiovascular Disease', 'Internal Medicine', '', NULL, 'O', '8th Ave & C St Floor 7', 'Salt Lake City', 'Salt Lake', 'UT', '84143', '8014083900', NULL, '8th Ave & C St Floor 7', 'Salt Lake City', 'Salt Lake', 'UT', '84143', '8014083900', '          ', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2010-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1053401240', 0, 'N', 0, '2013-12-30', NULL, NULL, 40.7785, -111.881, NULL, NULL),
('942854057', 'W12005886', 'W12005886', 'UTIHCPHY', 'Utah Heart-AVH', 'Kelly', 'R', 'O Neal', 'MD', 'Cardiovascular Disease', 'Internal Medicine', '', NULL, 'O', '9844 S 1300 E Ste 350', 'Sandy', 'Salt Lake', 'UT', '84094', '8015073587', NULL, '9844 S 1300 E Ste 350', 'Sandy', 'Salt Lake', 'UT', '84094', '8015073587', '          ', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2010-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1053401240', 0, 'N', 0, '2013-12-30', NULL, NULL, 40.5721, -111.853, NULL, NULL),
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('263132634', 'W12005896', 'W12005896', 'UTDT01', '', 'Amira', NULL, 'Hassan', 'DDS', 'Dentist', NULL, NULL, NULL, 'O', '290 W Ctr St', 'Spanish Fork', 'Utah', 'UT', '84660', '8017987464', NULL, '290 W Center St', 'Spanish Fork', 'Utah', 'UT', '84660', '8017987464', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2010-09-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'DEN|', '0000006610', 0, 'N', 0, '2009-01-01', NULL, NULL, 0, 0, NULL, NULL),
('205103691', 'W12005902', 'W12005902', 'UTDT01', '', 'Tyson', '', 'Perrero', 'DMD', 'Dentist', '', '', NULL, 'O', '312 N Main', 'Spanish Fork', 'Utah', 'UT', '84660', '8017949684', NULL, '312 N Main', 'Spanish Fork', 'Utah', 'UT', '84660', '8017949684', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2010-09-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000004095', 0, 'N', 0, '2010-10-28', NULL, NULL, 0, 0, NULL, NULL),
('261603887', 'W12005903', 'W12005903', 'UTDT01', 'Alpenglow Dental', 'Cabot', '', 'Curtis', 'DMD', 'Dentist', '', '', NULL, 'O', '425 S Medical Dr Ste 211', 'Salt Lake City', 'Salt Lake', 'UT', '84101', '8017871700', NULL, '425 S Medical Dr Ste 211', 'Salt Lake City', 'Salt Lake', 'UT', '84101', '8017871700', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2010-09-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000005862', 0, 'N', 0, '2012-11-28', NULL, NULL, 0, 0, NULL, NULL),
('770640930', 'W12005906', 'W12005906', 'UTDT01', 'Professional Dental', 'John', '', 'Myers', 'DDS', 'Dentist', '', '', NULL, 'O', '32 Red Pine Dr Ste 14', 'Alpine', 'Utah', 'UT', '84004', '8017567633', NULL, '32 Red Pine Dr Ste 14', 'Alpine', 'Utah', 'UT', '84004', '8017567633', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2010-09-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000007780', 0, 'N', 0, '2012-03-06', NULL, NULL, 0, 0, NULL, NULL),
('770640930', 'W12005907', 'W12005907', 'UTDT01', 'Professional Dental', 'John', '', 'Myers', 'DDS', 'Dentist', '', '', NULL, 'O', '6351 W 13400 S', 'Herriman', 'Salt Lake', 'UT', '84096', '8013027808', NULL, '6351 W 13400 S', 'Herriman', 'Salt Lake', 'UT', '84096', '8013027808', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2010-09-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000007780', 0, 'N', 0, '2012-03-06', 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
('770640930', 'W12005908', 'W12005908', 'UTDT01', 'Professional Dental', 'John', '', 'Myers', 'DDS', 'Dentist', '', '', NULL, 'O', '503 E 770 N', 'Orem', 'Utah', 'UT', '84057', '8012251402', NULL, '503 E 770 N', 'Orem', 'Utah', 'UT', '84057', '8012251402', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2010-09-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000007780', 0, 'N', 0, '2012-03-06', NULL, NULL, 0, 0, NULL, NULL),
('770640930', 'W12005909', 'W12005909', 'UTDT01', 'Professional Dental', 'John', '', 'Myers', 'DDS', 'Dentist', '', '', NULL, 'O', '78 E 100 S', 'Payson', 'Utah', 'UT', '84651', '8014650550', NULL, '78 E 100 S', 'Payson', 'Utah', 'UT', '84651', '8014650550', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2010-09-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000007780', 0, 'N', 0, '2012-03-06', NULL, NULL, 0, 0, NULL, NULL),
('770640930', 'W12005910', 'W12005910', 'UTDT01', 'Professional Dental', 'John', '', 'Myers', 'DDS', 'Dentist', '', '', NULL, 'O', '465 E 1000 S', 'Pleasant Grove', 'Utah', 'UT', '84062', '8017856000', NULL, '465 E 1000 S', 'Pleasant Grove', 'Utah', 'UT', '84062', '8017856000', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2010-09-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000007780', 0, 'N', 0, '2012-03-06', NULL, NULL, 0, 0, NULL, NULL),
('770640930', 'W12005911', 'W12005911', 'UTDT01', 'Professional Dental', 'John', '', 'Myers', 'DDS', 'Dentist', '', '', NULL, 'O', '1314 N Redwood Rd Ste 102', 'Lehi', 'Utah', 'UT', '84043', '8017680440', NULL, '1314 N Redwood Rd Ste 102', 'Lehi', 'Utah', 'UT', '84043', '8017680440', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2010-09-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000007780', 0, 'N', 0, '2012-03-06', NULL, NULL, 0, 0, NULL, NULL),
('870623385', 'W12005912', 'W12005912', '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', '55.46', 3, '2010-11-01', '2012-07-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1487862843', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('870623599', 'W12004842', 'W12004842', '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', '55.46', 3, '2010-11-01', '2012-07-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1841241338', 0, 'N', 0, '2012-07-09', NULL, NULL, 0, 0, NULL, NULL),
('870481699', 'W12004845', 'W12004845', 'UT01', '', 'Terry', '', 'Martin', 'DC', 'Chiropractic', '', '', NULL, 'O', '1951 W 4700 S Ste 1', 'Taylorsville', 'Salt Lake', 'UT', '84129', '8019698197', '8019698192', '1951 W 4700 S Ste 1', 'Taylorsville', 'Salt Lake', 'UT', '84129', '8019698197', '8019698192', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2010-11-01', '2012-07-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1447224720', 0, 'N', 0, '2012-12-19', NULL, NULL, 0, 0, NULL, NULL),
('870493499', 'W12004849', 'W12004849', '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', '55.46', 3, '2010-11-01', '2012-07-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1780757526', 0, 'N', 0, '2012-07-10', NULL, NULL, 0, 0, NULL, NULL),
('870665661', 'W12004837', 'W12004837', 'UT01', 'Pioneer Comprehensive Medical', 'Gary', 'D', 'Olsen', 'DC', 'Chiropractic', '', '', NULL, 'O', '12433 S Fort St', 'Draper', 'Salt Lake', 'UT', '84020', '8015761086', '8015679796', '12433 S Fort St', 'Draper', 'Salt Lake', 'UT', '84020', '8015761086', '8015679796', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2010-11-01', '2010-11-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1023092293', 0, 'N', 0, '2010-10-29', NULL, NULL, 0, 0, NULL, NULL),
('841391385', 'W12005767', 'W12005767', 'UT01', 'Southwest Chiropractic Inc', 'Brad', 'N', 'Peterson', 'DC', 'Chiropractic', '', '', NULL, 'O', '10358 S 1700 W', 'South Jordan', 'Salt Lake', 'UT', '84095', '8012549400', '8012545739', '10358 S 1700 W', 'South Jordan', 'Salt Lake', 'UT', '84095', '8012549400', '8012545739', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2010-11-01', '2012-07-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1659390417', 0, 'N', 0, '2012-07-10', NULL, NULL, 0, 0, NULL, NULL),
('870653096', 'W12005921', 'W12005921', 'UT01', 'Spine and Posture Rehab', 'Matthew', 'W', 'Peterson', 'DC', 'Chiropractic', '', '', NULL, 'O', '134 W 1180 N Ste 5', 'Tooele', 'Tooele', 'UT', '84074', '4358821621', '4358828267', '134 W 1180 N Ste 5', 'Tooele', 'Tooele', 'UT', '84074', '4358821621', '4358828267', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2010-11-01', '2012-07-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1326011891', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
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('870410451', 'W12005923', 'W12005923', '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', '55.46', 3, '2010-11-01', '2012-07-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1336164466', 0, 'N', 0, '2012-07-10', NULL, NULL, 0, 0, NULL, NULL),
('522374006', 'W12005795', 'W12005795', 'UT01', 'South Ogden Chiropractic Health', 'Christopher', '', 'Bunn', 'DC', 'Chiropractic', '', '', NULL, 'O', '1893 Skyline Dr 110', 'Ogden', 'Weber', 'UT', '84403', '8016755600', NULL, '1893 Skyline Dr 110', 'Ogden', 'Weber', 'UT', '84403', '8016755600', '          ', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2010-11-01', '2010-11-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1376651950', 0, 'N', 0, '2012-06-29', NULL, NULL, 0, 0, NULL, NULL),
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('870679104', 'W12005742', 'W12005742', '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', '55.46', 3, '2010-11-01', '2012-07-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1215979133', 0, 'N', 0, '2012-07-09', NULL, NULL, 0, 0, NULL, NULL),
('262578815', 'W12005755', 'W12005755', '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', '55.46', 3, '2010-11-01', '2012-07-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1497922835', 0, 'N', 0, '2013-12-30', NULL, NULL, 0, 0, NULL, NULL),
('271277601', 'W12005757', 'W12005757', 'UT01', 'Wasatch Back Wellness', 'Stephen', '', 'Frogley', 'DC', 'Chiropractic', '', '', NULL, 'O', '906 S Main St', 'Heber City', 'Wasatch', 'UT', '84032', '4356543032', '4356543035', '906 S Main St', 'Heber City', 'Wasatch', 'UT', '84032', '4356543032', '4356543035', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2010-11-01', '2012-07-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1992032270', 0, 'N', 0, '2012-07-10', NULL, NULL, 0, 0, NULL, NULL),
('205804335', 'W12005758', 'W12005758', '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', '55.46', 3, '2010-11-01', '2012-07-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1306927991', 0, 'N', 0, '2012-07-10', NULL, NULL, 0, 0, NULL, NULL),
('870624013', 'W12005914', 'W12005914', 'UT01', 'Alpine Spinal Rehabilitation Inc', 'Jerry', 'S', 'Clark', 'DC', 'Chiropractic', '', '', NULL, 'O', '3325 N University Ave Ste 125', 'Provo', 'Utah', 'UT', '84604', '8013742774', '8013742775', '3325 N University Ave Ste 125', 'Provo', 'Utah', 'UT', '84604', '8013742774', '8013742775', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2010-11-01', '2012-07-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1114082872', 0, 'N', 0, '2012-07-09', NULL, NULL, 0, 0, NULL, NULL),
('870653332', 'W12004833', 'W12004833', 'UT01', '', 'Brian', 'H', 'Ewell', 'DC', 'Chiropractic', '', '', NULL, 'O', '2964 W 4700 S Ste 102', 'West Valley', 'Salt Lake', 'UT', '84129', '8019669100', '8019660084', '2964 W 4700 S Ste 102', 'West Valley', 'Salt Lake', 'UT', '84129', '8019669100', '8019660084', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2010-11-01', '2012-07-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1760459135', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('870624013', 'W12005916', 'W12005916', 'UT01', 'Alpine Spinal Rehabilitation Inc', 'Evan', '', 'Gwilliam', 'DC', 'Chiropractic', '', '', NULL, 'O', '3325 N University Ave Ste 125', 'Provo', 'Utah', 'UT', '84604', '8013742774', '8013742775', '3325 N University Ave Ste 125', 'Provo', 'Utah', 'UT', '84604', '8013742774', '8013742775', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2010-11-01', '2011-12-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1073587424', 0, 'N', 0, '2012-06-29', NULL, NULL, 0, 0, NULL, NULL),
('203470254', 'W12005759', 'W12005759', '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', '55.46', 3, '2010-11-01', '2012-07-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1417037920', 0, 'N', 0, '2013-12-31', NULL, NULL, 0, 0, NULL, NULL),
('205492223', 'W12005760', 'W12005760', 'UT01', 'Lonestar Chiropractic Center LLC', 'Benjamin', 'Carl', 'Higbee', 'DC', 'Chiropractic', '', '', NULL, 'O', '309 N State St', 'Orem', 'Utah', 'UT', '84057', '8014344555', '8014348333', '309 N State St', 'Orem', 'Utah', 'UT', '84057', '8014344555', '8014348333', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '35.00', '55.46', 3, '2010-11-01', '2012-09-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1831257500', 0, 'Y', 0, '2012-07-19', NULL, NULL, 0, 0, NULL, NULL),
('870637442', 'W12005761', 'W12005761', 'UT01', 'Alpine Chiropractic Inc', 'Karson', '', 'Johnson', 'DC', 'Chiropractic', '', '', NULL, 'O', '1472 N Main St', 'Logan', 'Cache', 'UT', '84341', '4357506236', '4357506290', '1472 N Main St', 'Logan', 'Cache', 'UT', '84341', '4357506236', '4357506290', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2010-11-01', '2010-11-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1659406858', 0, 'N', 0, '2012-04-10', NULL, NULL, 0, 0, NULL, NULL),
('870574355', 'W12005763', 'W12005763', 'UT01', 'Johnson Chiropractic', 'Wayne', 'T', 'Johnson', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '70 S Fairfield Rd Ste 7', 'Layton', 'Davis', 'UT', '84041', '8014441002', '8014440170', '70 S Fairfield Rd Ste 7', 'Layton', 'Davis', 'UT', '84041', '8014441002', '8014440170', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2010-11-01', '2012-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1558342105', 0, 'N', 0, '2012-04-10', NULL, NULL, 0, 0, NULL, NULL),
('200692301', 'W12005764', 'W12005764', 'UT01', 'Sports & Family Chiropractic Group of Clearfield', 'Mark', 'A', 'Jolley', 'DC', 'Chiropractic', '', '', NULL, 'O', '2071 N Main St Ste 202', 'Layton', 'Davis', 'UT', '84041', '8018257338', '8018251902', '2071 N Main St Ste 202', 'Layton', 'Davis', 'UT', '84041', '8018257338', '8018251902', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2010-11-01', '2011-03-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1801986310', 0, 'N', 0, '2012-04-10', NULL, NULL, 0, 0, NULL, NULL),
('870621716', 'W12005918', 'W12005918', 'UT01', 'Layton Hills Chiropractic', 'Michael', '', 'Kunzler', 'DC', 'Chiropractic', '', '', NULL, 'O', '471 W Heritage Park Blvd Ste 3', 'Layton', 'Davis', 'UT', '84041', '8015251471', '8015251473', '471 W Heritage Park Blvd Ste 3', 'Layton', 'Davis', 'UT', '84041', '8015251471', '8015251473', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2010-11-01', '2011-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1144374059', 0, 'N', 0, '2012-06-29', NULL, NULL, 0, 0, NULL, NULL),
('870548935', 'W12005920', 'W12005920', 'UT01', 'Spinal Rehab Specialists', 'Daniel', 'Thomas', 'LaFontaine', 'DC', 'Chiropractic', '', '', NULL, 'O', '1704 S State St', 'Orem', 'Utah', 'UT', '84097', '8012212999', '8012243235', '1704 S State St', 'Orem', 'Utah', 'UT', '84097', '8012212999', '8012243235', 'WLABRAD', 'WUSTDHCPC', '', '0.00', '0.00', '55.46', 3, '2010-11-01', '2012-07-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1295729473', 0, 'N', 0, '2012-07-10', NULL, NULL, 0, 0, NULL, NULL),
('841378055', 'W12005766', 'W12005766', 'UT01', 'Elite Chiropractic and Performance Center', 'Monte', 'J', 'Layton', 'DC', 'Chiropractic', '', '', 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', '55.46', 3, '2010-11-01', '2012-07-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1598773863', 0, 'N', 0, '2012-12-19', NULL, NULL, 0, 0, NULL, NULL),
('529672003', 'W12005807', 'W12005807', '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', '55.46', 3, '2010-11-01', '2012-07-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1992036180', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('870479797', 'W12005771', 'W12005771', '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', '55.46', 3, '2010-11-01', '2012-07-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1316001225', 0, 'N', 0, '2012-07-10', NULL, NULL, 0, 0, NULL, NULL),
('870479797', 'W12005772', 'W12005772', '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', '55.46', 3, '2010-11-01', '2012-07-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1316001225', 0, 'Y', 0, '2012-07-10', NULL, NULL, 0, 0, NULL, NULL),
('262014209', 'W12005925', 'W12005925', 'UT01', 'Shearman Chiropractic Inc', 'Thomas', '', 'Shearman', 'DC', 'Chiropractic', '', '', NULL, 'O', '1035 W 5370 S Ste 175', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8019676000', '8012615260', '1035 W 5370 S Ste 175', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8019676000', '8012615260', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2010-11-01', '2012-08-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1447349428', 0, 'Y', 0, '2012-07-03', NULL, NULL, 0, 0, NULL, NULL),
('262128007', 'W12005776', 'W12005776', 'UT01', 'Sorenson Chiropractic LLC', 'John', 'Robert', 'Sorenson', 'DC', 'Chiropractic', '', '', NULL, 'O', '1495 S Blackridge Dr Ste A210', 'St George', 'Washington', 'UT', '84770', '4356881415', '4356881204', '1495 S Blackridge Dr Ste A210', 'St George', 'Washington', 'UT', '84770', '4356881415', '4356881204', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2010-11-01', '2012-07-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1396918686', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('870620238', 'W12005777', 'W12005777', 'UT01', 'Stevens Chiropractic PC', 'Dee', 'Scott', 'Stevens', 'DC', 'Chiropractic', '', '', NULL, 'O', '1300 N 200 E Ste 110', 'Logan', 'Cache', 'UT', '84341', '4357557654', '4357537654', '1300 N 200 E Ste 110', 'Logan', 'Cache', 'UT', '84341', '4357557654', '4357537654', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2010-11-01', '2010-11-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1962456681', 0, 'N', 0, '2012-10-23', NULL, NULL, 0, 0, NULL, NULL),
('870678645', 'W12004843', 'W12004843', 'UT01', 'Southeast Chiropractic', 'Kelly', 'D', 'Terry', 'DC', 'Chiropractic', '', '', NULL, 'O', '55 N 600 E', 'Price', 'Carbon', 'UT', '84501', '4356374621', '4356375339', '55 N 600 E', 'Price', 'Carbon', 'UT', '84501', '4356374621', '4356375339', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2010-11-01', '2012-07-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1255343752', 0, 'N', 0, '2012-09-18', NULL, NULL, 0, 0, NULL, NULL),
('870637630', 'W12005821', 'W12005821', 'UT01', 'Wimmer Chiropractic Center', 'Michael', 'W', 'Wimmer', 'DC', 'Chiropractic', '', '', NULL, 'O', '413 Washington Blvd', 'Ogden', 'Weber', 'UT', '84404', '8013995697', '8013995699', '413 Washington Blvd', 'Ogden', 'Weber', 'UT', '84404', '8013995697', '8013995699', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2010-11-01', '2012-01-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1770769507', 0, 'N', 0, '2012-04-03', NULL, NULL, 0, 0, NULL, NULL),
('871378055', 'W12005781', 'W12005781', 'UT01', 'Elite Chiropractic and Performance Center', 'Kenneth', '', 'Wood', 'DC', 'Chiropractic', '', '', NULL, 'O', '6717 S 900 E Ste 101', 'Midvale', 'Salt Lake', 'UT', '84047', '8014327511', '8014327576', '6717 S 900 E Ste 101', 'Midvale', 'Salt Lake', 'UT', '84047', '8014327511', '8014327576', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2010-11-01', '2012-07-15', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1770801490', 0, 'Y', 0, '2013-07-09', NULL, NULL, 0, 0, NULL, NULL),
('364598541', 'W12005937', 'W12005937', 'ID01', 'University of Utah Surgical Intensive Care Unit', 'Toby', 'M', 'Enniss', 'MD', 'General Surgery', '', '', NULL, 'B', 'PO Box 413035', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '8015856336', 'PO Box 413035', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '8015856336', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2010-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1295915536', 0, 'N', 0, '2012-10-16', NULL, NULL, 0, 0, NULL, NULL),
('364598541', 'W12005936', 'W12005936', 'UT01', 'University Health Care', 'Toby', 'M', 'Enniss', 'MD', 'General Surgery', '', '', NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015812121', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015812121', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2010-07-01', '2012-09-16', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1295915536', 0, 'N', 0, '2012-10-16', NULL, NULL, 0, 0, NULL, NULL),
('830331130', 'W12005942', 'W12005942', 'Sinclair', '(Sinclair Health Services\rProvider) Casper Surgical Center', '', '', 'Casper Surgical Center', 'Group', 'Ambulatory Surgery Center', '', '', NULL, 'O', '1201 E 3rd St', 'Casper', 'Natrona', 'WY', '82601', '3075772950', NULL, '1201 E 3rd St', 'Casper', 'Natrona', 'WY', '82601', '3075772950', '          ', '', '', 'CASPSURG', '0.00', '100.00', '0.00', 3, '2010-11-01', NULL, 1, 0, 0, '', '', '', '', 'HCFA|UB|', '1174520993', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('870657911', 'W12005769', 'W12005769', 'UT01', 'Zion Chiropractic Neurology Associates LLC', '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', '55.46', 3, '2010-11-01', '2011-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1730165606', 0, 'N', 0, '2013-09-25', NULL, NULL, 0, 0, NULL, NULL),
('870679104', 'W12005774', 'W12005774', 'UT01', 'Center for Team Healthcare', 'Scott', '', 'Sato', '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', '55.46', 3, '2010-11-01', '2012-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1144428152', 0, 'N', 0, '2012-06-29', NULL, NULL, 0, 0, NULL, NULL),
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('200552841', 'W12005978', 'W12005978', 'Sinclair', '(Sinclair Health Services\rProvider) Central Wyoming Neurosurgery', 'Todd', '', 'Hammond', 'MD', 'Pain Management', '', '', NULL, 'O', '6600 E 2nd St', 'Casper', 'Natrona', 'WY', '82609', '3072664000', NULL, '6600 E 2nd St', 'Casper', 'Natrona', 'WY', '82609', '3072664000', '          ', '', '', '', '0.00', '30.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, 'Mountain View Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1659359610', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('200552841', 'W12005980', 'W12005980', 'Sinclair', 'Central Wyoming Neurosurgery', 'Tuenis', '', 'Zondag', 'MD', 'Pain Management', '', '', NULL, 'O', '6600 E 2nd St', 'Casper', 'Natrona', 'WY', '82609', '3072664000', NULL, '6600 E 2nd St', 'Casper', 'Natrona', 'WY', '82609', '3072664000', '          ', '', '', '', '0.00', '30.00', '0.00', 3, '2010-11-01', '2011-12-12', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1942288931', 0, 'N', 0, '2012-04-03', NULL, NULL, 0, 0, NULL, NULL),
('205452085', 'W12005987', 'W12005987', 'Sinclair', '(Sinclair Health Services\rProvider) Flagstaff Foot Doctors', 'Anthony', '', 'Rosales', 'DPM', 'Podiatry', '', '', NULL, 'O', '421 N Humphreys St', 'Flagstaff', 'Coconino', 'AZ', '86001', '9287744825', NULL, '421 N Humphreys St', 'Flagstaff', 'Coconino', 'AZ', '86001', '9287744825', '          ', 'AZSINCLAIRd', 'AZSINCLAIRe', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1861453953', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('200552841', 'W12005979', 'W12005979', 'Sinclair', '(Sinclair Health Services\rProvider) Central Wyoming Neurosurgery', 'Thomas', 'A', 'Kopitnik', 'MD', 'Neurosurgery', '', '', NULL, 'O', '6600 E 2nd St', 'Casper', 'Natrona', 'WY', '82609', '3072664000', NULL, '6600 E 2nd St', 'Casper', 'Natrona', 'WY', '82609', '3072664000', '          ', '', '', '', '0.00', '30.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, 'Mountain View Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1669450656', 0, 'N', 0, '2012-10-09', NULL, NULL, 0, 0, NULL, NULL),
('200775852', 'W12005955', 'W12005955', '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', '55.46', 3, '2010-11-01', '2012-07-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1437126372', 0, 'N', 0, '2012-07-09', NULL, NULL, 0, 0, NULL, NULL),
('200552841', 'W12005983', 'W12005983', 'Sinclair', 'Central Wyoming Neurosurgery', 'Robert', '', 'Narotzky', 'MD', 'Neurosurgery', '', '', NULL, 'O', '6600 E 2nd St', 'Casper', 'Natrona', 'WY', '82609', '3072664000', NULL, '6600 E 2nd St', 'Casper', 'Natrona', 'WY', '82609', '3072664000', '          ', '', '', '', '0.00', '30.00', '0.00', 3, '2010-11-01', '2011-12-12', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1568436822', 0, 'N', 0, '2012-04-10', NULL, NULL, 0, 0, NULL, NULL),
('860691140', 'W12005984', 'W12005984', 'Sinclair', '(Sinclair Health Services\rProvider) Northern Arizona Cardiology Clinic', 'Robert', 'A', 'Mackin', 'MD', 'Cardiovascular Disease', 'Internal Medicine', '', NULL, 'O', '77 W Forest Ave Ste 205', 'Flagstaff', 'Coconino', 'AZ', '86001', '9287731638', NULL, '77 W Forest Ave Ste 205', 'Flagstaff', 'Coconino', 'AZ', '86001', '9287731638', '          ', 'AZSINCLAIRd', 'AZSINCLAIRe', '', '0.00', '35.00', '0.00', 3, '2010-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1447334784', 0, 'Y', 0, '2014-03-06', NULL, NULL, 0, 0, NULL, NULL),
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('860959327', 'W12005989', 'W12005989', 'Sinclair', '(Sinclair Health Services\rProvider) Flagstaff Family Physicians', 'Robert', 'S', 'Yee', 'MD', 'Family Practice', '', '', NULL, 'O', '710 N Beaver St Ste 3', 'Flagstaff', 'Coconino', 'AZ', '86001', '9282261454', NULL, '710 N Beaver St Ste 3', 'Flagstaff', 'Coconino', 'AZ', '86001', '9282261454', '          ', 'AZSINCLAIRd', 'AZSINCLAIRe', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1497743116', 0, 'N', 0, '2010-11-04', NULL, NULL, 0, 0, NULL, NULL),
('870627754', 'W12005957', 'W12005957', 'UT01', 'Natural Health and Wellness', 'Brandon', '', 'Allred', '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', '55.46', 3, '2010-11-01', '2012-07-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1245307701', 0, 'N', 0, '2012-12-19', NULL, NULL, 0, 0, NULL, NULL),
('203971513', 'W12005961', 'W12005961', 'UT01', 'Align Rehab', 'Lincoln', 'Olsen', 'Clifford', 'DC', 'Chiropractic', '', '', NULL, 'O', '2230 N University Pkwy Ste 6B', 'Provo', 'Utah', 'UT', '84604', '8012359944', '8012359955', '2230 N University Pkwy Ste 6B', 'Provo', 'Utah', 'UT', '84604', '8012359944', '8012359955', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2010-11-01', '2012-01-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1730187675', 0, 'N', 0, '2012-06-29', NULL, NULL, 0, 0, NULL, NULL),
('841410972', 'W12005990', 'W12005990', 'Sinclair', '(Sinclair Health Services\rProvider) ', 'Wayne', '', 'Couch', 'MD', 'Family Practice', 'Obstetrics and Gynecology', '', NULL, 'O', '606 23rd St', 'Rawlins', 'Carbon', 'WY', '82301', '3073246002', NULL, '606 23rd St', 'Rawlins', 'Carbon', 'WY', '82301', '3073246002', '', 'COUCH', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1023031861', 0, 'N', 0, '2014-04-14', NULL, NULL, 0, 0, NULL, NULL),
('201984976', 'W12005991', 'W12005991', 'Sinclair', '(Sinclair Health Services\rProvider) Rawlins Urgent Care', '', '', 'Rawlins Urgent Care', 'Group', 'Urgent Care', '', '', NULL, 'O', '606 23rd St', 'Rawlins', 'Carbon', 'WY', '82301', '3073246603', NULL, '606 23rd St', 'Rawlins', 'Carbon', 'WY', '82301', '3073246603', '          ', 'COUCHURGENT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-11-01', '2013-01-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1841210333', 0, 'N', 0, '2013-01-21', NULL, NULL, 0, 0, NULL, NULL),
('870576626', 'W12005965', 'W12005965', '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', '55.46', 3, '2010-11-01', '2012-07-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1417118498', 0, 'N', 0, '2012-07-10', NULL, NULL, 0, 0, NULL, NULL),
('870576626', 'W12005966', 'W12005966', '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', '55.46', 3, '2010-11-01', '2012-07-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1417118498', 0, 'N', 0, '2012-07-10', NULL, NULL, 0, 0, NULL, NULL),
('203971513', 'W12005968', 'W12005968', 'UT01', 'Align Rehab', 'Kimberly', '', 'Glasgow', 'DC', 'Chiropractic', '', '', NULL, 'O', '2230 N University Pkwy Ste 6B', 'Provo', 'Utah', 'UT', '84604', '8012359944', '8012359955', '2230 N University Pkwy Ste 6B', 'Provo', 'Utah', 'UT', '84604', '8012359944', '8012359955', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2010-11-01', '2011-03-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1508192311', 0, 'N', 0, '2014-02-06', NULL, NULL, 0, 0, NULL, NULL),
('200552841', 'W12005988', 'W12005988', 'Sinclair', 'Central Wyoming Neurosurgery', 'Jo', 'A', 'Ramsey', 'PA-C', 'Oncology', '', '', NULL, 'O', '6600 E 2nd St', 'Casper', 'Natrona', 'WY', '82609', '3072664000', NULL, '6600 E 2nd St', 'Casper', 'Natrona', 'WY', '82609', '3072664000', '          ', '', '', '', '0.00', '30.00', '0.00', 3, '2011-11-01', '2011-12-12', 0, 0, 0, 'Wyoming Medical Center ', NULL, NULL, NULL, 'HCFA|UB|', '1598792368', 0, 'N', 0, '2013-06-25', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12005992', 'W12005992', 'WYBILLINGS', 'Billings Clinic - Cardiology', 'Eric', 'M', 'Schallock', 'PA-C', 'Cardiovascular Disease', '', '', NULL, 'O', '1020 N 27th St', 'Billings', 'Yellowstone', 'MT', '59101', '4062382000', '4062382066', '1020 N 27th St', 'Billings', 'Yellowstone', 'MT', '59101', '4062382000', '4062382066', '', '', '', '0.00', '17.00', '0.00', 3, '2010-06-22', '2010-06-22', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1477874600', 0, 'N', 0, '2010-11-02', NULL, NULL, 0, 0, NULL, NULL),
('820464330', 'W12005996', 'W12005996', 'Sinclair', 'Pediatric Cardiology of Idaho', 'Eloisa', 'S', 'Walker', '(accepting newborn pediatric patients only)', 'Pediatric Cardiology', '', '', NULL, 'O', '100 E Idaho Ste 304', 'Boise', 'Ada', 'ID', '83712', '2083369188', NULL, '100 E Idaho Ste 304', 'Boise', 'Ada', 'ID', '83712', '2083369188', '', 'IDSINCLAIRL', '', '', '0.00', '15.00', '0.00', 3, '2010-11-01', '2010-11-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1760433601', 0, 'Y', 0, '2014-06-20', NULL, NULL, 43.6123, -116.194, NULL, NULL),
('466122122', 'W12005969', 'W12005969', 'UT01', 'Mecham Chiropractic Inc', 'Allan', 'L', 'Mecham', 'DC', 'Chiropractic', '', '', NULL, 'O', '1186 E 4600 S Ste 220', 'Ogden', 'Weber', 'UT', '84403', '8014751800', '8014750071', '1186 E 4600 S Ste 220', 'Ogden', 'Weber', 'UT', '84403', '8014751800', '8014750071', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2010-11-01', '2012-07-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1528003688', 0, 'N', 0, '2012-07-10', NULL, NULL, 0, 0, NULL, NULL),
('466122122', 'W12005970', 'W12005970', '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', '55.46', 3, '2010-11-01', '2012-07-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1528003688', 0, 'N', 0, '2012-07-10', NULL, NULL, 0, 0, NULL, NULL),
('352246962', 'W12005972', 'W12005972', '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', '55.46', 3, '2010-11-01', '2012-07-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1770691370', 0, 'N', 0, '2012-07-10', NULL, NULL, 0, 0, NULL, NULL),
('203971513', 'W12005974', 'W12005974', 'UT01', 'Align Rehab', 'Jonathan', '', 'Snow', '', 'Chiropractic', '', '', NULL, 'O', '2230 N University Pkwy Ste 6B', 'Provo', 'Utah', 'UT', '84604', '8012359944', '8012359955', '2230 N University Pkwy Ste 6B', 'Provo', 'Utah', 'UT', '84604', '8012359944', '8012359955', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2010-11-01', '2011-03-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1336295781', 0, 'N', 0, '2012-04-10', NULL, NULL, 0, 0, NULL, NULL),
('260144535', 'W12005976', 'W12005976', 'UT01', 'Spine and Posture Rehabilitation of Tooele', 'Thomas', '', 'Snyder', 'DC', 'Chiropractic', '', '', NULL, 'O', '134 W 1180 N Ste 5', 'Tooele', 'Tooele', 'UT', '84074', '4358821621', '4358828267', '134 W 1180 N Ste 5', 'Tooele', 'Tooele', 'UT', '84074', '4358821621', '4358828267', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2010-11-01', '2011-03-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1982894499', 0, 'N', 0, '2012-06-29', NULL, NULL, 0, 0, NULL, NULL),
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('942854057', 'W12006007', 'W12006007', 'UTIHC01', 'Audiology', 'Meghan', 'M', 'Anthony', 'AUD', 'Audiology', '', '', NULL, 'O', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016624949', NULL, '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016624949', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2010-09-20', '2013-08-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1154523538', 0, 'N', 0, '2013-09-12', NULL, NULL, 0, 0, NULL, NULL),
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('942854057', 'W12006025', 'W12006025', 'UTIHC04', 'Maternal Fetal Medicine', 'Michael', 'L', 'Draper', 'MD', 'Maternal Fetal Medicine', 'Obstetrics and Gynecology', '', NULL, 'O', '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356884770', NULL, '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356884770', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2010-10-01', NULL, 0, 0, 0, 'University Health Care University Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1992769368', 0, 'N', 0, '2011-06-23', NULL, NULL, 37.0989, -113.575, NULL, NULL),
('942854057', 'W12006027', 'W12006027', 'UTIHC04', 'Radiology', 'Cameron', 'J', 'Evans', 'MD', 'Radiology', '', '', NULL, 'O', '1485 S Hwy 40', 'Heber City', 'Wasatch', 'UT', '84032', '4356542500', NULL, '1485 S Hwy 40', 'Heber City', 'Wasatch', 'UT', '84032', '4356542500', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2010-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1477733574', 0, 'N', 0, '2010-11-04', NULL, NULL, 40.489, -111.409, 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
('942854057', 'W12006029', 'W12006029', 'UTIHC04', 'Emergency Room', 'R', 'Mark', 'Firth', 'MD', 'Family Practice', 'Emergency Medicine', '', 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, '2010-10-01', NULL, 0, 0, 0, 'Logan Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1477562767', 0, 'N', 0, '2010-11-04', NULL, NULL, 39.3506, -112.56, NULL, NULL),
('942854057', 'W12006032', 'W12006032', 'UTIHC04', 'Emergency Room', 'Gary', 'F', 'Holland', 'MD', 'Family Practice', '', '', 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, '2010-10-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1780780189', 0, 'N', 0, '2012-08-03', NULL, NULL, 39.3506, -112.56, NULL, NULL),
('942854057', 'W12006030', 'W12006030', 'UTIHC04', 'Emergency Room', 'R', 'Mark', 'Firth', 'MD', 'Family Practice', 'Emergency Medicine', '', 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, '2010-10-01', NULL, 0, 0, 0, 'Logan Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1477562767', 0, 'N', 0, '2010-11-04', NULL, NULL, 38.9534, -112.34, NULL, NULL),
('942854057', 'W12006033', 'W12006033', 'UTIHC04', 'Emergency Room', 'Gary', 'F', 'Holland', 'MD', 'Family Practice', '', '', 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, '2010-10-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1780780189', 0, 'N', 0, '2012-08-03', NULL, NULL, 38.9534, -112.34, NULL, NULL),
('942854057', 'W12006035', 'W12006035', 'UTIHC01', 'Physical Therapy', 'Megan', 'K', 'Reinhart', 'PT', 'Physical Therapy', '', '', NULL, 'O', '3845 W 4700 S', 'Taylorsville', 'Salt Lake', 'UT', '84118', '8018404360', NULL, '3845 W 4700 S', 'Taylorsville', 'Salt Lake', 'UT', '84118', '8018404360', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2010-10-06', '2013-07-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1629381694', 0, 'N', 0, '2013-08-30', NULL, NULL, 0, 0, NULL, NULL),
('271341374', 'W12030705', 'W12030705', 'UT01', '', 'Lance', '', 'Barker', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 5', 'Millville', 'Cache', 'UT', '84326', '0000000000', '0000000000', 'PO Box 5', 'Millville', 'Cache', 'UT', '84326', '0000000000', '0000000000', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-03-01', NULL, 0, 0, 0, 'Brigham City Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1801089214', 0, 'N', 0, '2013-04-10', NULL, NULL, 0, 0, NULL, NULL),
('271341374', 'W12030703', 'W12030703', 'UT01', '', 'Lance', '', 'Barker', 'MD', 'Family Practice', '', '', NULL, 'O', '984 Medical Dr Ste 1', 'Brigham City', 'Box Elder', 'UT', '84302', '4357235248', '4357235240', '984 Medical Dr Ste 1', 'Brigham City', 'Box Elder', 'UT', '84302', '4357235248', '4357235240', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-03-01', NULL, 0, 0, 0, 'Brigham City Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1801089214', 0, 'N', 0, '2013-04-10', NULL, NULL, 41.4888, -112.026, NULL, NULL),
('942854057', 'W12006048', 'W12006048', 'UTIHC01', 'EKG', 'Chuanchau', 'Jerry', 'Jou', 'DO', 'Pediatric Cardiology', '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', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2010-07-26', NULL, 0, 0, 0, 'Primary Childrens Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1104011998', 0, 'N', 0, '2012-05-03', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12006043', 'W12006043', 'UTIHC01', 'EKG', 'Chuanchau', 'Jerry', 'Jou', 'DO', 'Pediatric Cardiology', 'Pediatrics', '', NULL, 'O', '1380 E Medical Ctr Dr', 'St George', 'Washington', 'UT', '84790', '4352511000', NULL, '1380 E Medical Center Dr', 'St George', 'Washington', 'UT', '84790', '4352511000', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2010-07-26', NULL, 0, 0, 0, 'Primary Childrens Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1104011998', 0, 'N', 0, '2012-05-03', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12006045', 'W12006045', 'UTIHC01', 'EKG', 'Chuanchau', 'Jerry', 'Jou', 'DO', 'Pediatric Cardiology', 'Pediatrics', '', NULL, 'O', '500 E 1400 N', 'Logan', 'Cache', 'UT', '84341', '4357162050', NULL, '500 E 1400 N', 'Logan', 'Cache', 'UT', '84341', '4357162050', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2010-07-26', NULL, 0, 0, 0, 'Primary Childrens Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1104011998', 0, 'N', 0, '2012-05-03', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12006049', 'W12006049', 'UTIHC02', 'EKG', 'Chuanchau', 'Jerry', 'Jou', 'DO', 'Pediatric Cardiology', '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', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2010-07-26', NULL, 0, 0, 0, 'Primary Childrens Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1104011998', 0, 'N', 0, '2012-05-03', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12006050', 'W12006050', 'UTIHC03', 'EKG', 'Chuanchau', 'Jerry', 'Jou', 'DO', 'Pediatric Cardiology', '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', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2010-07-26', NULL, 0, 0, 0, 'Primary Childrens Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1104011998', 0, 'N', 0, '2012-05-03', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12006044', 'W12006044', 'UTIHC03', 'EKG', 'Chuanchau', 'Jerry', 'Jou', 'DO', 'Pediatric Cardiology', 'Pediatrics', '', NULL, 'O', '1380 E Medical Ctr Dr', 'St George', 'Washington', 'UT', '84790', '4352511000', NULL, '1380 E Medical Center Dr', 'St George', 'Washington', 'UT', '84790', '4352511000', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2010-07-26', NULL, 0, 0, 0, 'Primary Childrens Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1104011998', 0, 'N', 0, '2012-05-03', NULL, NULL, 0, 0, NULL, NULL),
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('942854057', 'W12006091', 'W12006091', 'UTIHC04', 'Emergency Room', 'Drew', '', 'Polson', 'MD', 'Family Practice', '', '', 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, '2010-10-01', NULL, 0, 0, 0, 'Valley View Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1700084829', 0, 'N', 0, '2012-03-10', NULL, NULL, 38.9534, -112.34, NULL, NULL),
('942854057', 'W12006092', 'W12006092', 'UTIHC04', 'Maternal Fetal Medicine', 'Glenn', 'K', 'Schemmer', 'MD', 'Maternal Fetal Medicine', 'Obstetrics and Gynecology', '', NULL, 'O', '544 E 400 E', 'St George', 'Washington', 'UT', '84770', '4356884000', NULL, '544 E 400 E', 'Saint George', 'Washington', 'UT', '84770', '4356884000', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2010-09-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1689628992', 0, 'N', 0, '2009-08-13', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12006093', 'W12006093', 'UTIHC03', 'Maternal Fetal Medicine', 'Glenn', 'K', 'Schemmer', 'MD', 'Maternal Fetal Medicine', 'Obstetrics and Gynecology', '', NULL, 'O', '544 E 400 E', 'St George', 'Washington', 'UT', '84770', '4356884000', NULL, '544 E 400 E', 'Saint George', 'Washington', 'UT', '84770', '4356884000', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2010-09-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1689628992', 0, 'N', 0, '2009-08-13', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12006094', 'W12006094', 'UTIHC01', 'Maternal Fetal Medicine', 'Glenn', 'K', 'Schemmer', 'MD', 'Maternal Fetal Medicine', 'Obstetrics and Gynecology', '', NULL, 'O', '544 E 400 E', 'St George', 'Washington', 'UT', '84770', '4356884000', NULL, '544 E 400 E', 'Saint George', 'Washington', 'UT', '84770', '4356884000', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2010-09-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1689628992', 0, 'N', 0, '2009-08-13', NULL, NULL, 0, 0, NULL, NULL),
('830240950', 'W12006095', 'W12006095', 'Sinclair', '(Sinclair Health Services\rProvider) Castle Rock Hospital District (Sinclair Health Services Provider', '', '', 'Castle Rock Hospital District', 'Group', 'Family Practice', '', '', NULL, 'O', '1400 Uinta Dr', 'Green River', 'Sweetwater', 'WY', '82935', '3078724500', NULL, '1400 Uinta Dr', 'Green River', 'Sweetwater', 'WY', '82935', '3078724500', '          ', '', '', '', '0.00', '5.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1740206382', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('870413860', 'W12006096', 'W12006096', 'UT01', 'Now Care Clinic', 'Charles', 'A', 'Caton', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '1937 W 5700 S', 'Roy', 'Weber', 'UT', '84067', '8017739380', '8016218811', '1937 W 5700 S', 'Roy', 'Weber', 'UT', '84067', '8017739380', '8016218811', 'NOWCARE', '', '', '0.00', '35.00', '0.00', 3, '2010-11-15', '2013-08-31', 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1750341210', 0, 'N', 0, '2013-11-26', NULL, NULL, 0, 0, NULL, NULL),
('870413860', 'W12006097', 'W12006097', 'UT01', 'Now Care Clinic', 'Charles', 'A', 'Caton', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '698 12th St', 'Ogden', 'Weber', 'UT', '84404', '8016213466', '8016218811', '698 12th St', 'Ogden', 'Weber', 'UT', '84404', '8016213466', '8016218811', 'NOWCARE', '', '', '0.00', '35.00', '0.00', 3, '2010-11-15', '2013-08-31', 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1750341210', 0, 'N', 0, '2013-11-26', NULL, NULL, 0, 0, NULL, NULL),
('870413860', 'W12006098', 'W12006098', 'UT01', 'Now Care Clinic', 'Charles', 'A', 'Caton', 'MD', 'Family Practice', NULL, NULL, NULL, 'B', 'PO Box 241', 'Roy', 'Weber', 'UT', '84067', '8016213466', '8016218811', 'PO Box 241', 'Roy', 'Weber', 'UT', '84067', '8016213466', '8016218811', 'NOWCARE', '', '', '0.00', '35.00', '0.00', 3, '2010-11-15', '2013-08-31', 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1750341210', 0, 'N', 0, '2013-11-26', NULL, NULL, 0, 0, NULL, NULL),
('820515881', 'W12006099', 'W12006099', 'Sinclair', '(Sinclair Health Services\rProvider) ', 'Nancy', '', 'Parry', 'MD', 'Family Practice', '', '', NULL, 'O', '431 Walnut Ave', 'Ketchum', 'Blaine', 'ID', '83340', '2086223180', NULL, '431 Walnut Ave', 'Ketchum', 'Blaine', 'ID', '83340', '2086223180', '          ', 'IDSINCLAIRA', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|UB|', '1033288865', 0, 'N', 0, '2013-07-15', NULL, NULL, 0, 0, NULL, NULL),
('820515881', 'W12006100', 'W12006100', 'Sinclair', '(Sinclair Health Services\rProvider) ', 'Nancy', '', 'Parry', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 2359', 'Ketchum', 'Blaine', 'ID', '83340', '2086223180', NULL, 'PO Box 2359', 'Ketchum', 'Blaine', 'ID', '83340', '2086223180', '          ', 'IDSINCLAIRA', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|UB|', '1033288865', 0, 'N', 0, '2013-07-15', NULL, NULL, 0, 0, NULL, NULL),
('527839931', 'W12006101', 'W12006101', 'Sinclair', '(Sinclair Health Services\rProvider) Northern Arizona Congenital Heart Center', 'Jeffrey', 'P', 'Rockow', 'MD', 'Pediatric Cardiology', '', '', NULL, 'O', '1330 N Rim Dr Ste A', 'Flagstaff', 'Coconino', 'AZ', '86001', '9287797014', NULL, '1330 N Rim Dr Ste A', 'Flagstaff', 'Coconino', 'AZ', '86001', '9287797014', '          ', 'AZSINCLAIRd', 'AZSINCLAIRe', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1982603494', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('860559827', 'W12006103', 'W12006103', 'Sinclair', '(Sinclair Health Services\rProvider) Womens Clinic of Northern Arizona', 'Jann', '', 'Shiels', 'MD', 'Gynecology', '', '', NULL, 'O', '1024 N San Francisco Ste 105', 'Flagstaff', 'Coconino', 'AZ', '86001', '9287790341', NULL, '1024 N San Francisco Ste 105', 'Flagstaff', 'Coconino', 'AZ', '86001', '9287790341', '          ', 'AZSINCLAIRd', 'AZSINCLAIRe', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1235158395', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('200749372', 'W12006102', 'W12006102', 'Sinclair', '(Sinclair Health Services\rProvider) Sleep Disorders Center of Flagstaff', 'Robert', 'S', 'Rosenberg', 'DO', 'Sleep Medicine', '', '', NULL, 'O', '1110 E Rt 66 Ste 202', 'Flagstaff', 'Coconino', 'AZ', '86001', '9282147400', '9282147400', '1110 E Rt 66 Ste 202', 'Flagstaff', 'Coconino', 'AZ', '86001', '9282147400', '9282147400', 'AZSINCLAIRd', 'AZSINCLAIRe', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1902808884', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('562570686', 'W12006104', 'W12006104', 'Sinclair', '(Sinclair Health Services\rProvider) St Lukes Magic Valley Regional Hospital (Sinclair Health Service', '', '', 'St Lukes Magic Valley Regional Hospital', 'Group', 'Hospital', '', '', NULL, 'O', '650 Addison Ave W', 'Twin Falls', 'Twin Falls', 'ID', '83301', '2087372000', NULL, '650 Addison Ave W', 'Twin Falls', 'Twin Falls', 'ID', '83301', '2087372000', '          ', '', '', '', '0.00', '7.50', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1932154705', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('841421665', 'W12006105', 'W12006105', 'Sinclair', 'St Lukes Wood River Medical Center (Sinclair Health Services Provider)', '', '', 'St Lukes Wood River Medical Center', 'Group', 'Hospital', '', '', NULL, 'O', '100 Hospital Dr', 'Ketchum', 'Blaine', 'ID', '83340', '2087278800', NULL, '100 Hospital Dr', 'Ketchum', 'Blaine', 'ID', '83340', '2087278800', '          ', '', '', '', '0.00', '7.50', '0.00', 6, '2010-11-01', '2011-02-28', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1508869470', 0, 'N', 0, '2014-03-11', NULL, NULL, 43.6485, -114.35, NULL, NULL),
('870286381', 'W12006107', 'W12006107', 'UT01', 'Ogden Clinic', 'Sherman', 'D', 'Stanley', 'OT', 'Physical Therapy', 'Occupational Therapy', '', NULL, 'O', '4650 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014753870', '8014753876', '4650 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014753870', '8014753876', '', '', '', '0.00', '0.00', '74.69', 6, '2010-11-04', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1285685420', 0, 'N', 0, '2010-11-09', NULL, NULL, 41.1787, -111.949, NULL, NULL),
('870286381', 'W12006106', 'W12006106', 'UT01', 'Ogden Clinic', 'Sherman', 'D', 'Stanley', 'OT', 'Physical Therapy', 'Occupational Therapy', '', NULL, 'O', '6112 S 1550 E', 'Ogden', 'Weber', 'UT', '84405', '8014753800', '8014753801', '6112 S 1550 E', 'Ogden', 'Weber', 'UT', '84405', '8014753800', '8014753801', '', '', '', '0.00', '0.00', '74.69', 6, '2010-11-04', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1285685420', 0, 'N', 0, '2010-11-09', NULL, NULL, 41.1523, -111.94, NULL, NULL),
('020475625', 'W12005931', 'W12005931', 'Sinclair', 'Hailey Orthopedic and Sports Medicine', 'Glen', 'D', 'Shapiro', 'MD', 'Orthopedic Surgery', 'Sports Medicine', '', NULL, 'M', '1420 N 2nd Ave', 'Hailey', 'Blaine', 'ID', '83333', '8777546330', '2083246778', '1420 N 2nd Ave', 'Hailey', 'Blaine', 'ID', '83333', '8777546330', '2083246778', 'IDSINCLAIRD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-11-01', '2011-11-30', 0, 0, 1, NULL, '', '', '', 'HCFA|UB|', '1336283779', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('020475625', 'W12005930', 'W12005930', 'Sinclair', '(Sinclair Health Services\rProvider) Hailey Orthopedic and Sports Medicine', 'Glen', 'D', 'Shapiro', 'MD', 'Orthopedic Surgery', 'Sports Medicine', '', NULL, 'O', '21 E Maple Ave', 'Hailey', 'Blaine', 'ID', '83333', '8777546330', '2083246778', '21 E Maple Ave', 'Hailey', 'Blaine', 'ID', '83333', '8777546330', '2083246778', 'IDSINCLAIRD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 1, NULL, '', '', '', 'HCFA|UB|', '1336283779', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('020475625', 'W12005928', 'W12005928', 'Sinclair', '(Sinclair Health Services\rProvider) Hailey Orthopedic and Sports Medicine', 'Glen', 'D', 'Shapiro', 'MD', 'Orthopedic Surgery', 'Sports Medicine', '', NULL, 'O', '431 Walnut Ave Ste N', 'Ketchum', 'Blaine', 'ID', '83340', '8777546330', '2083246778', '431 Walnut Ave Ste N', 'Ketchum', 'Blaine', 'ID', '83340', '8777546330', '2083246778', 'IDSINCLAIRD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 1, NULL, '', '', '', 'HCFA|UB|', '1336283779', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('020475625', 'W12005932', 'W12005932', 'Sinclair', '(Sinclair Health Services\rProvider) Hailey Orthopedic and Sports Medicine', 'Glen', 'D', 'Shapiro', 'MD', 'Orthopedic Surgery', 'Sports Medicine', '', NULL, 'B', 'PO Box 2200', 'Amherst', 'Hillsborough', 'NH', '03031', '8777546330', '2083246778', 'PO Box 2200', 'Amherst', 'Hillsborough', 'NH', '03031', '8777546330', '2083246778', 'IDSINCLAIRD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 1, NULL, '', '', '', 'HCFA|UB|', '1336283779', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('202630141', 'W12006108', 'W12006108', 'ID02', 'Primary Health Medical Group', '', '', 'Primary Health Medical Group', 'GROUP', 'Urgent Care', NULL, '', NULL, 'O', '125 E Idaho St Ste 201', 'Boise', 'Ada', 'ID', '83712', '2083859330', '2083810607', '125 E Idaho St Ste 201', 'Boise', 'Ada', 'ID', '83712', '2083859330', '2083810607', 'IDSTDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2010-09-27', '2013-02-28', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1568413920', 0, 'Y', 0, '2014-04-24', NULL, NULL, 43.6114, -116.194, NULL, NULL),
('810231784', 'W12006109', 'W12006109', 'WYBILLINGS', 'Billings Clinic - OB/GYN', 'Camille', 'S', 'Osborn', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '2675 C Ave', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062382978', '2675 C Ave', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062382978', '', '', '', '0.00', '17.00', '0.00', 3, '2010-09-07', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1245338292', 0, 'N', 0, '2010-01-15', NULL, NULL, 0, 0, NULL, NULL),
('742915297', 'W12006110', 'W12006110', 'TX01', 'South Texas Oncology and Hematology', 'Drew', 'W', 'Rasco', 'MD', 'Hematology and Oncology', '', '', NULL, 'O', '315 N San Saba Ste 1160', 'San Antonio', 'Bexar', 'TX', '78207', '2105935700', '2103543870', '315 N San Saba Ste 1160', 'San Antonio', 'Bexar', 'TX', '78207', '2105935700', '2103543870', 'TXONCOL', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2010-08-25', '2012-08-19', 0, 0, 0, 'North East Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1558311225', 0, 'N', 0, '2013-04-04', NULL, NULL, 29.4279, -98.5002, NULL, NULL),
('742915297', 'W12006111', 'W12006111', 'TX01', 'South Texas Oncology and Hematology', 'Drew', 'W', 'Rasco', 'MD', 'Hematology and Oncology', '', '', NULL, 'O', '134 Menger Springs Ste 1120', 'Boerne', 'Kendall', 'TX', '78006', '2105935700', '8302495439', '134 Menger Springs Ste 1120', 'Boerne', 'Kendall', 'TX', '78006', '2105935700', '8302495439', 'TXONCOL', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2010-08-25', '2012-08-19', 0, 0, 0, 'North East Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1558311225', 0, 'N', 0, '2013-04-04', NULL, NULL, 29.772, -98.7306, NULL, NULL),
('742915297', 'W12006112', 'W12006112', 'TX01', 'South Texas Oncology and Hematology', 'Drew', 'W', 'Rasco', 'MD', 'Hematology and Oncology', '', '', NULL, 'O', '8715 Village Dr Ste 116', 'San Antonio', 'Bexar', 'TX', '78217', '2105935700', '2105902019', '8715 Village Dr Ste 116', 'San Antonio', 'Bexar', 'TX', '78217', '2105935700', '2105902019', 'TXONCOL', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2010-08-25', '2012-08-19', 0, 0, 0, 'North East Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1558311225', 0, 'N', 0, '2013-04-04', NULL, NULL, 29.5187, -98.4281, NULL, NULL),
('742915297', 'W12006113', 'W12006113', 'TX01', 'South Texas Oncology and Hematology', 'Drew', 'W', 'Rasco', 'MD', 'Hematology and Oncology', '', '', NULL, 'O', '502 Madison Oak Dr Ste 120', 'San Antonio', 'Bexar', 'TX', '78258', '2105935700', '2104494782', '502 Madison Oak Dr Ste 120', 'San Antonio', 'Bexar', 'TX', '78258', '2105935700', '2104494782', 'TXONCOL', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2010-08-25', '2012-08-19', 0, 0, 0, 'North East Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1558311225', 0, 'N', 0, '2013-04-04', NULL, NULL, 29.6202, -98.49, NULL, NULL),
('742915297', 'W12006114', 'W12006114', 'TX01', 'South Texas Oncology and Hematology', 'Drew', 'W', 'Rasco', 'MD', 'Hematology and Oncology', '', '', NULL, 'O', '11212 St Hwy 151 Ste 290', 'San Antonio', 'Bexar', 'TX', '78251', '2105935700', '2105935992', '11212 St Hwy 151 Ste 290', 'San Antonio', 'Bexar', 'TX', '78251', '2105935700', '2105935992', 'TXONCOL', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2010-08-25', '2012-08-19', 0, 0, 0, 'North East Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1558311225', 0, 'N', 0, '2013-04-04', NULL, NULL, 0, 0, NULL, NULL),
('742915297', 'W12006115', 'W12006115', 'TX01', 'South Texas Oncology and Hematology', 'Drew', 'W', 'Rasco', 'MD', 'Hematology and Oncology', '', '', NULL, 'O', '8215 Ewing Halsell', 'San Antonio', 'Bexar', 'TX', '78229', '2105935700', '2105935899', '8215 Ewing Halsell', 'San Antonio', 'Bexar', 'TX', '78229', '2105935700', '2105935899', 'TXONCOL', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2010-08-25', '2012-08-19', 0, 0, 0, 'North East Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1558311225', 0, 'N', 0, '2013-04-04', NULL, NULL, 0, 0, NULL, NULL),
('742915297', 'W12006116', 'W12006116', 'TX01', 'South Texas Oncology and Hematology', 'Drew', 'W', 'Rasco', 'MD', 'Hematology and Oncology', '', '', NULL, 'O', '1050 Hwy 16 S', 'Bandera', 'Bandera', 'TX', '78003', '2105935700', '2105935899', '1050 Hwy 16 S', 'Bandera', 'Bandera', 'TX', '78003', '2105935700', '2105935899', 'TXONCOL', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2010-08-25', '2012-08-19', 0, 0, 0, 'North East Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1558311225', 0, 'N', 0, '2013-04-04', NULL, NULL, 29.7305, -99.0578, NULL, NULL),
('820484941', 'W12006117', 'W12006117', 'ID01', 'Center for Hope and Healing', 'Terri', 'L', 'Theriot', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '660 E Franklin Rd Ste 260', 'Meridian', 'Ada', 'ID', '83642', '2083430441', '2083434993', '660 E Franklin Rd Ste 260', 'Meridian', 'Ada', 'ID', '83642', '2083430441', '2083434993', 'IDMA', '', '', '0.00', '35.00', '0.00', 8, '2010-10-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1508074998', 0, 'N', 0, '2014-05-21', NULL, NULL, 0, 0, NULL, NULL),
('820484941', 'W12006118', 'W12006118', 'ID01', 'Center for Hope and Healing', 'Terri', 'L', 'Theriot', 'LCSW', 'Mental Health', 'Social Worker', '', 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, '2010-10-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1508074998', 0, 'N', 0, '2014-05-21', NULL, NULL, 0, 0, NULL, NULL),
('841367175', 'W12006119', 'W12006119', 'UT01', 'Canyon View Womens Care', 'W', 'L', 'Warner', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '15 S 1000 E Ste 125', 'Payson', 'Utah', 'UT', '84651', '8014652559', NULL, '15 S 1000 E Ste 125', 'Payson', 'Utah', 'UT', '84651', '8014652559', '          ', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-10-25', '2010-12-31', 0, 0, 0, 'Mountain View Hospital', '', '', '', 'HCFA|UB|', '1508954348', 0, 'N', 0, '2013-07-31', NULL, NULL, 0, 0, NULL, NULL),
('841367175', 'W12006121', 'W12006121', 'UT01', 'Canyon View Womens Care', 'Reed', 'J', 'Skinner', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '15 S 1000 E Ste 125', 'Payson', 'Utah', 'UT', '84651', '8014652559', NULL, '15 S 1000 E Ste 125', 'Payson', 'Utah', 'UT', '84651', '8014652559', '          ', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-11-01', '2011-03-08', 0, 0, 0, 'Mountain View Hospital', '', '', '', 'HCFA|UB|', '1427259415', 0, 'N', 0, '2013-07-31', NULL, NULL, 0, 0, NULL, NULL),
('820484941', 'W12006123', 'W12006123', 'ID01', 'Center for Hope and Healing', 'Cathie', 'D', 'Wick', 'LCSW', 'Mental Health', 'Social Worker', 'Counseling', NULL, 'O', '660 E Franklin Rd Ste 260', 'Meridian', 'Ada', 'ID', '83642', '2083430441', '2083434993', '660 E Franklin Rd Ste 260', 'Meridian', 'Ada', 'ID', '83642', '2083430441', '2083434993', 'IDMA', '', '', '0.00', '35.00', '0.00', 8, '2010-10-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1497961460', 0, 'N', 0, '2014-05-21', NULL, NULL, 0, 0, NULL, NULL),
('820484941', 'W12006124', 'W12006124', 'ID01', 'Center for Hope and Healing', 'Cathie', 'D', 'Wick', 'LCSW', 'Mental Health', 'Social Worker', '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, '2010-10-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1497961460', 0, 'N', 0, '2014-05-21', NULL, NULL, 0, 0, NULL, NULL),
('841367175', 'W12006129', 'W12006129', 'UT01', 'Canyon View Womens Care', 'David', 'E', 'Ludlow', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '15 S 1000 E Ste 125', 'Payson', 'Utah', 'UT', '84651', '8014652559', NULL, '15 S 1000 E Ste 125', 'Payson', 'Utah', 'UT', '84651', '8014652559', '          ', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-10-25', '2010-12-31', 0, 0, 0, 'Mountain View Hospital', '', '', '', 'HCFA|UB|', '1104864412', 0, 'N', 0, '2013-07-31', NULL, NULL, 0, 0, NULL, NULL),
('155670596', 'W12006142', 'W12006142', 'Sinclair', 'Allpaps Respiratory Services (Sinclair Health Services Provider)', '', '', 'Allpaps Respiratory Services', 'Group', 'Durable Medical Equipment', '', '', NULL, 'O', '401 E Collins Dr', 'Casper', 'Natrona', 'WY', '82601', '3075778796', NULL, '401 E Collins Dr', 'Casper', 'Natrona', 'WY', '82601', '3075778796', '          ', 'SINCLAIRALLPAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|UB|', '1912901638', 0, 'N', 0, '2010-11-10', NULL, NULL, 0, 0, NULL, NULL),
('830216782', 'W12006144', 'W12006144', 'Sinclair', '(Sinclair Health Services\rProvider) Laramie Physicians for Children', 'Debra', 'M', 'Anderson', 'MD', 'Pediatrics', '', '', NULL, 'O', '2710 E Harney St Ste 100', 'Laramie', 'Albany', 'WY', '82072', '3077213118', NULL, '2710 E Harney St Ste 100', 'Laramie', 'Albany', 'WY', '82072', '3077213118', '          ', '', '', '', '0.00', '10.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1346284320', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('621762357', 'W12006145', 'W12006145', 'UT01', 'Emery Medical Center', 'Mike', 'E', 'Bovos', 'MD', 'Family Practice', '', '', NULL, 'O', '90 W Main St', 'Castle Dale', 'Emery', 'UT', '84513', '4353812305', '4353815010', '90 W Main St', 'Castle Dale', 'Emery', 'UT', '84513', '4353812305', '4353815010', 'WURURAL5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-01-01', '2011-07-31', 0, 0, 0, 'Castleview Hosp', '', '', '', 'HCFA|', '1386855708', 0, 'N', 0, '2010-12-16', 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
('621762357', 'W12006146', 'W12006146', 'UT01', 'Emery Medical Center', 'Mike', 'E', 'Bovos', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 607', 'Castle Dale', 'Emery', 'UT', '84513', '4353812305', '4353815010', 'PO Box 607', 'Castle Dale', 'Emery', 'UT', '84513', '4353812305', '4353815010', 'WURURAL5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-01-01', '2011-07-31', 0, 0, 0, 'Castleview Hosp', '', '', '', 'HCFA|', '1386855708', 0, 'N', 0, '2010-12-16', NULL, NULL, 0, 0, NULL, NULL),
('830216782', 'W12006147', 'W12006147', 'Sinclair', '(Sinclair Health Services\rProvider) Laramie Physicians for Children', 'John', 'D', 'Bragg', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '2710 E Harney St Ste 100', 'Laramie', 'Albany', 'WY', '82072', '3077458991', NULL, '2710 E Harney St Ste 100', 'Laramie', 'Albany', 'WY', '82072', '3077458991', '          ', '', '', '', '0.00', '10.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1081877972', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('830216782', 'W12006148', 'W12006148', 'Sinclair', '(Sinclair Health Services\rProvider) Laramie Physicians for Children', 'John', 'D', 'Bragg', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '519 8th St', 'Rawlins', 'Carbon', 'WY', '82301', '3077458991', NULL, '519 8th St', 'Rawlins', 'Carbon', 'WY', '82301', '3077458991', '          ', '', '', '', '0.00', '10.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1081877972', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('820385013', 'W12006150', 'W12006150', 'Sinclair', '(Sinclair Health Services\rProvider) ', 'Peter', '', 'Doble', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '1330 Filer Ave E', 'Twin Falls', 'Twin Falls', 'ID', '83301', '2087344555', NULL, '1330 Filer Ave E', 'Twin Falls', 'Twin Falls', 'ID', '83301', '2087344555', '          ', 'IDSINCLAIRA', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1881620680', 0, 'N', 0, '2012-08-30', NULL, NULL, 42.5701, -114.457, NULL, NULL),
('830283425', 'W12006153', 'W12006153', 'WY01', 'North Platte Physical Therapy', 'Todd', 'L', 'Gentzler', 'PT', 'Physical Therapy', '', '', NULL, 'O', '777 Ave H', 'Powell', 'Park', 'WY', '82435', '3077541235', '3077543792', '777 Ave H', 'Powell', 'Park', 'WY', '82435', '3077541235', '3077543792', 'WYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2010-12-01', '2010-12-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1548224140', 0, 'N', 0, '2014-07-24', NULL, NULL, 0, 0, NULL, NULL),
('830216782', 'W12006151', 'W12006151', 'Sinclair', 'Laramie Physicians for Children', 'Julie', '', 'Duncan', 'FNP', 'Obstetrics and Gynecology', '', '', NULL, 'O', '2710 E Harney St Ste 100', 'Laramie', 'Albany', 'WY', '82072', '3077458991', NULL, '2710 E Harney St Ste 100', 'Laramie', 'Albany', 'WY', '82072', '3077458991', '          ', '', '', '', '0.00', '10.00', '0.00', 3, '2010-11-01', '2011-10-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1083655302', 0, 'N', 0, '2012-07-03', NULL, NULL, 0, 0, NULL, NULL),
('830283425', 'W12006154', 'W12006154', 'WY01', 'North Platte Physical Therapy', 'Todd', 'L', 'Gentzler', 'PT', 'Physical Therapy', '', '', NULL, 'B', 'PO Box 1790', 'Douglas', 'Converse', 'WY', '82633', '3077541235', '3077543792', 'PO Box 1790', 'Douglas', 'Converse', 'WY', '82633', '3077541235', '3077543792', 'WYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2010-12-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1548224140', 0, 'N', 0, '2014-07-24', NULL, NULL, 0, 0, NULL, NULL),
('830283425', 'W12006152', 'W12006152', 'wy01', 'North Platte Physical Therapy', 'Todd', 'L', 'Gentzler', 'PT', 'Physical Therapy', '', '', NULL, 'O', 'PO Box 928', 'Sundance', 'Crook', 'WY', '82729', '3072833516', '3072833515', 'PO Box 928', 'Sundance', 'Crook', 'WY', '82729', '3072833516', '3072833515', 'WYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2010-12-01', '2010-12-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1548224140', 0, 'N', 0, '2014-07-24', NULL, NULL, 0, 0, NULL, NULL),
('830216782', 'W12006155', 'W12006155', 'Sinclair', '(Sinclair Health Services\rProvider) Laramie Physicians for Children', 'Kathleen ', 'A', 'Hannifan', 'MD', 'Pediatrics', '', '', NULL, 'O', '2710 E Harney St Ste 100', 'Laramie', 'Albany', 'WY', '82072', '3077213118', NULL, '2710 E Harney St Ste 100', 'Laramie', 'Albany', 'WY', '82072', '3077213118', '          ', '', '', '', '0.00', '10.00', '0.00', 3, '2010-11-01', '2012-09-27', 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1114037389', 0, 'N', 0, '2012-10-05', NULL, NULL, 0, 0, NULL, NULL),
('830216782', 'W12006156', 'W12006156', 'Sinclair', 'Laramie Physicians for Children', 'Esther', '', 'Kehrer', 'APRN', 'Obstetrics and Gynecology', '', '', NULL, 'O', '2710 E Harney St Ste 100', 'Laramie', 'Albany', 'WY', '82072', '3077458991', NULL, '2710 E Harney St Ste 100', 'Laramie', 'Albany', 'WY', '82072', '3077458991', '          ', '', '', '', '0.00', '10.00', '0.00', 3, '2010-11-01', '2011-06-09', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1770521726', 0, 'N', 0, '2010-11-12', NULL, NULL, 0, 0, NULL, NULL),
('830216782', 'W12006157', 'W12006157', 'Sinclair', '(Sinclair Health Services\rProvider) Laramie Physicians for Children', 'Travis ', '', 'Klingler', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '2710 E Harney St Ste 100', 'Laramie', 'Albany', 'WY', '82072', '3077458991', NULL, '2710 E Harney St Ste 100', 'Laramie', 'Albany', 'WY', '82072', '3077458991', '          ', '', '', '', '0.00', '10.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1679560387', 0, 'N', 0, '2012-10-25', NULL, NULL, 0, 0, NULL, NULL),
('830216782', 'W12006158', 'W12006158', 'Sinclair', '(Sinclair Health Services\rProvider) Laramie Physicians for Children', 'Travis ', '', 'Klingler', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '519 8th St', 'Rawlins', 'Carbon', 'WY', '82301', '3077458991', NULL, '519 8th St', 'Rawlins', 'Carbon', 'WY', '82301', '3077458991', '          ', '', '', '', '0.00', '10.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1679560387', 0, 'N', 0, '2012-10-25', NULL, NULL, 0, 0, NULL, NULL),
('830216782', 'W12006159', 'W12006159', 'Sinclair', '(Sinclair Health Services\rProvider) Laramie Physicians for Children', 'Paula', 'S', 'Vasek', 'FNP', 'Pediatrics', '', '', NULL, 'O', '2710 E Harney St Ste 100', 'Laramie', 'Albany', 'WY', '82072', '3077213118', NULL, '2710 E Harney St Ste 100', 'Laramie', 'Albany', 'WY', '82072', '3077213118', '          ', '', '', '', '0.00', '10.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1073712279', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('836000188', 'W12006161', 'W12006161', 'Sinclair', 'Ivinson Memorial Hospital (Sinclair Health Services Provider)  (Recognized But Not Contracted)', '', '', 'Ivinson Memorial Hospital', 'Group', 'Hospital', '', '', NULL, 'O', '255 N 30th St', 'Laramie', 'Albany', 'WY', '82072', '3077422141', NULL, '255 N 30th St', 'Laramie', 'Albany', 'WY', '82072', '3077422141', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1265616171', 0, 'N', 0, '2011-01-03', NULL, NULL, 0, 0, NULL, NULL),
('820227163', 'W12006162', 'W12006162', 'Sinclair', 'St. Luke''s Jerome', '', '', 'St. Lukes Jerome', 'Group', 'Multi Specialty Clinic', '', '', NULL, 'O', '709 N Lincoln Ave', 'Jerome', 'Jerome', 'ID', '83338', '2083244301', '', '709 N Lincoln Ave', 'Jerome', 'Jerome', 'ID', '83338', '2083244301', '', '', '', '', '0.00', '5.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1902856727', 0, 'N', 0, '2014-07-25', NULL, NULL, 0, 0, NULL, NULL),
('820227163', 'W12023682', 'W12023682', 'Sinclair', 'St. Lukes Jerome', '', '', 'St. Lukes Jerome', 'Group', 'Multi Specialty Clinic', '', '', NULL, 'O', 'PO Box 586 ', 'Jerome', 'Jerome', 'ID', '83338', '2083241122', '', 'PO Box 586 ', 'Jerome', 'Jerome', 'ID', '83338', '2083241122', '', '', '', '', '0.00', '5.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1902856727', 0, 'N', 0, '2014-07-25', NULL, NULL, 0, 0, NULL, NULL),
('830321519', 'W12006163', 'W12006163', 'Sinclair', 'Professional Oxygen Supplies (Sinclair Health Services Provider)', '', '', 'Professional Oxygen Supplies', 'Group', 'Durable Medical Equipment', '', '', NULL, 'O', '417 W Buffalo St', 'Rawlins', 'Carbon', 'WY', '82301', '3073281357', NULL, '417 W Buffalo St', 'Rawlins', 'Carbon', 'WY', '82301', '3073281357', '', 'SINCLAIRALLPAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1215934161', 0, 'N', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('850335622', 'W12006164', 'W12006164', 'Sinclair', '(Sinclair Health Services\rProvider) ', 'Charles', 'C', 'Young', 'MD', 'Family Practice', '', '', NULL, 'O', '2213 E Cedar St', 'Rawlins', 'Carbon', 'WY', '82301', '3073246711', NULL, '2213 E Cedar St', 'Rawlins', 'Carbon', 'WY', '82301', '3073246711', '          ', 'WYSTDSINCLAIR', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-11-01', '2013-04-25', 0, 0, 0, 'Memorial Hospital of Carbon County', NULL, NULL, NULL, 'HCFA|UB|', '1538252077', 0, 'Y', 0, '2014-01-08', NULL, NULL, 0, 0, NULL, NULL),
('841377595', 'W12006137', 'W12006137', 'UT01', 'Murray Chiropractic Office', 'R', 'Scott', 'Binkerd', 'DC', 'Chiropractic', '', '', NULL, 'O', '431 E 5600 S', 'Murray', 'Salt Lake', 'UT', '84107', '8012622651', '8012622651', '431 E 5600 S', 'Murray', 'Salt Lake', 'UT', '84107', '8012622651', '8012622651', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2010-11-01', '2011-03-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1366509168', 0, 'N', 0, '2014-02-06', NULL, NULL, 0, 0, NULL, NULL),
('357544129', 'W12006139', 'W12006139', 'UT01', 'Smuin Chiropractic Clinic', 'Bryan', 'Dean', 'Smuin', 'DC', 'Chiropractic', '', '', NULL, 'O', '319 W 100 S Ste B', 'Vernal', 'Uintah', 'UT', '84078', '4357897290', '4357897291', '319 W 100 S Ste B', 'Vernal', 'Uintah', 'UT', '84078', '4357897290', '4357897291', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2010-11-01', '2012-07-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1467589069', 0, 'N', 0, '2012-07-10', NULL, NULL, 0, 0, NULL, NULL),
('870624638', 'W12006141', 'W12006141', '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', '55.46', 3, '2010-11-01', '2012-07-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1356417612', 0, 'N', 0, '2012-07-10', NULL, NULL, 0, 0, NULL, NULL),
('870482477', 'W12006138', 'W12006138', 'UT01', 'Chiropractic Associates Inc', 'Harold', 'W', 'Gunn', 'DC', 'Chiropractic', '', '', NULL, 'O', '7669 Redwood Rd', 'West Jordan', 'Salt Lake', 'UT', '84084', '8015662465', '8015665435', '7669 Redwood Rd', 'West Jordan', 'Salt Lake', 'UT', '84084', '8015662465', '8015665435', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2010-11-01', '2010-11-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1497744692', 0, 'N', 0, '2011-02-11', NULL, NULL, 0, 0, NULL, NULL),
('860663432', 'W12006193', 'W12006193', 'Sinclair', '(Sinclair Health Services\rProvider) North Country Health Care', 'Elaine', '', 'Accomando', 'PA-C', 'Family Practice', '', '', NULL, 'O', '2920 N 4th St', 'Flagstaff', 'Coconino', 'AZ', '86004', '9282136100', NULL, '2920 N 4th St', 'Flagstaff', 'Coconino', 'AZ', '86004', '9282136100', '          ', 'AZSINCLAIRc', 'AZSINCLAIRe', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1033189444', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('860663432', 'W12006194', 'W12006194', 'Sinclair', '(Sinclair Health Services\rProvider) North Country Health Care', 'Elaine', '', 'Accomando', 'PA-C', 'Family Practice', '', '', NULL, 'B', 'PO Box 3630', 'Flagstaff', 'Coconino', 'AZ', '86003', '9282136100', NULL, 'PO Box 3630', 'Flagstaff', 'Coconino', 'AZ', '86003', '9282136100', '          ', 'AZSINCLAIRc', 'AZSINCLAIRe', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1033189444', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('860663432', 'W12006195', 'W12006195', 'Sinclair', '(Sinclair Health Services\rProvider) North Country Health Care', 'Shipra', '', 'Bansal', 'MD', 'Family Practice', '', '', NULL, 'O', '2920 N 4th St', 'Flagstaff', 'Coconino', 'AZ', '86004', '9282136100', NULL, '2920 N 4th St', 'Flagstaff', 'Coconino', 'AZ', '86004', '9282136100', '          ', 'AZSINCLAIRc', 'AZSINCLAIRe', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1578755781', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('860663432', 'W12006196', 'W12006196', 'Sinclair', '(Sinclair Health Services\rProvider) North Country Health Care', 'Shipra', '', 'Bansal', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 3630', 'Flagstaff', 'Coconino', 'AZ', '86003', '9282136100', NULL, 'PO Box 3630', 'Flagstaff', 'Coconino', 'AZ', '86003', '9282136100', '          ', 'AZSINCLAIRc', 'AZSINCLAIRe', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1578755781', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('860663432', 'W12006197', 'W12006197', 'Sinclair', '(Sinclair Health Services\rProvider) North Country Health Care', 'Mary Lou', '', 'Brubaker', 'PA-C', 'Family Practice', '', '', NULL, 'O', '2920 N 4th St', 'Flagstaff', 'Coconino', 'AZ', '86004', '9282136100', NULL, '2920 N 4th St', 'Flagstaff', 'Coconino', 'AZ', '86004', '9282136100', '          ', 'AZSINCLAIRc', 'AZSINCLAIRe', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1336117134', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('860663432', 'W12006198', 'W12006198', 'Sinclair', '(Sinclair Health Services\rProvider) North Country Health Care', 'Mary Lou', '', 'Brubaker', 'PA-C', 'Family Practice', '', '', NULL, 'B', 'PO Box 3630', 'Flagstaff', 'Coconino', 'AZ', '86003', '9282136100', NULL, 'PO Box 3630', 'Flagstaff', 'Coconino', 'AZ', '86003', '9282136100', '          ', 'AZSINCLAIRc', 'AZSINCLAIRe', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1336117134', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('860663432', 'W12006199', 'W12006199', 'Sinclair', '(Sinclair Health Services\rProvider) North Country Health Care', 'Tisha', '', 'Cazel', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '2920 N 4th St', 'Flagstaff', 'Coconino', 'AZ', '86004', '9282136100', NULL, '2920 N 4th St', 'Flagstaff', 'Coconino', 'AZ', '86004', '9282136100', '          ', 'AZSINCLAIRc', 'AZSINCLAIRe', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1184816456', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('860663432', 'W12006200', 'W12006200', 'Sinclair', '(Sinclair Health Services\rProvider) North Country Health Care', 'Tisha', '', 'Cazel', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 3630', 'Flagstaff', 'Coconino', 'AZ', '86003', '9282136100', NULL, 'PO Box 3630', 'Flagstaff', 'Coconino', 'AZ', '86003', '9282136100', '          ', 'AZSINCLAIRc', 'AZSINCLAIRe', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1184816456', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('860663432', 'W12006201', 'W12006201', 'Sinclair', '(Sinclair Health Services\rProvider) North Country Health Care', 'Beth', '', 'Claxton', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '2920 N 4th St', 'Flagstaff', 'Coconino', 'AZ', '86004', '9282136100', NULL, '2920 N 4th St', 'Flagstaff', 'Coconino', 'AZ', '86004', '9282136100', '          ', 'AZSINCLAIRc', 'AZSINCLAIRe', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1306839840', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('860663432', 'W12006202', 'W12006202', 'Sinclair', '(Sinclair Health Services\rProvider) North Country Health Care', 'Beth', '', 'Claxton', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 3630', 'Flagstaff', 'Coconino', 'AZ', '86003', '9282136100', NULL, 'PO Box 3630', 'Flagstaff', 'Coconino', 'AZ', '86003', '9282136100', '          ', 'AZSINCLAIRc', 'AZSINCLAIRe', '', '0.00', '35.00', '0.00', 3, '2011-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1306839840', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('860663432', 'W12006204', 'W12006204', 'Sinclair', '(Sinclair Health Services\rProvider) North Country Health Care', 'Sue ', '', 'Collins', 'FNP', 'Family Practice', '', '', NULL, 'O', '2920 N 4th St', 'Flagstaff', 'Coconino', 'AZ', '86004', '9282136100', NULL, '2920 N 4th St', 'Flagstaff', 'Coconino', 'AZ', '86004', '9282136100', '          ', 'AZSINCLAIRc', 'AZSINCLAIRe', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1497726657', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('860663432', 'W12006203', 'W12006203', 'Sinclair', '(Sinclair Health Services\rProvider) North Country Health Care', 'Sue ', '', 'Collins', 'FNP', 'Family Practice', '', '', NULL, 'B', 'PO Box 3630', 'Flagstaff', 'Coconino', 'AZ', '86003', '9282136100', NULL, 'PO Box 3630', 'Flagstaff', 'Coconino', 'AZ', '86003', '9282136100', '          ', 'AZSINCLAIRc', 'AZSINCLAIRe', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1497726657', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('860663432', 'W12006205', 'W12006205', 'Sinclair', '(Sinclair Health Services\rProvider) North Country Health Care', 'Karen ', '', 'Damgaard', 'PA-C', 'Family Practice', '', '', NULL, 'O', '2920 N 4th St', 'Flagstaff', 'Coconino', 'AZ', '86004', '9282136100', NULL, '2920 N 4th St', 'Flagstaff', 'Coconino', 'AZ', '86004', '9282136100', '          ', 'AZSINCLAIRc', 'AZSINCLAIRe', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1376600171', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('860663432', 'W12006206', 'W12006206', 'Sinclair', '(Sinclair Health Services\rProvider) North Country Health Care', 'Karen ', '', 'Damgaard', 'PA-C', 'Family Practice', '', '', NULL, 'B', 'PO Box 3630', 'Flagstaff', 'Coconino', 'AZ', '86003', '9282136100', NULL, 'PO Box 3630', 'Flagstaff', 'Coconino', 'AZ', '86003', '9282136100', '          ', 'AZSINCLAIRc', 'AZSINCLAIRe', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1376600171', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('860663432', 'W12006207', 'W12006207', 'Sinclair', '(Sinclair Health Services\rProvider) North Country Health Care', 'Kathy', '', 'Deasy', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '2920 N 4th St', 'Flagstaff', 'Coconino', 'AZ', '86004', '9282136100', NULL, '2920 N 4th St', 'Flagstaff', 'Coconino', 'AZ', '86004', '9282136100', '          ', 'AZSINCLAIRc', 'AZSINCLAIRe', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1770638827', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('860663432', 'W12006208', 'W12006208', 'Sinclair', '(Sinclair Health Services\rProvider) North Country Health Care', 'Kathy', '', 'Deasy', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 3630', 'Flagstaff', 'Coconino', 'AZ', '86003', '9282136100', NULL, 'PO Box 3630', 'Flagstaff', 'Coconino', 'AZ', '86003', '9282136100', '          ', 'AZSINCLAIRc', 'AZSINCLAIRe', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1770638827', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('860663432', 'W12006209', 'W12006209', 'Sinclair', '(Sinclair Health Services\rProvider) North Country Health Care', 'Scott', '', 'Deasy', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '2920 N 4th St', 'Flagstaff', 'Coconino', 'AZ', '86004', '9282136100', NULL, '2920 N 4th St', 'Flagstaff', 'Coconino', 'AZ', '86004', '9282136100', '          ', 'AZSINCLAIRc', 'AZSINCLAIRe', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1275569154', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('860663432', 'W12006210', 'W12006210', 'Sinclair', '(Sinclair Health Services\rProvider) North Country Health Care', 'Scott', '', 'Deasy', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 3630', 'Flagstaff', 'Coconino', 'AZ', '86003', '9282136100', NULL, 'PO Box 3630', 'Flagstaff', 'Coconino', 'AZ', '86003', '9282136100', '          ', 'AZSINCLAIRc', 'AZSINCLAIRe', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1275569154', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('860663432', 'W12006211', 'W12006211', 'Sinclair', '(Sinclair Health Services\rProvider) North Country Health Care', 'Ruth', '', 'DeBoard', 'FNP', 'Family Practice', '', '', NULL, 'O', '2920 N 4th St', 'Flagstaff', 'Coconino', 'AZ', '86004', '9282136100', NULL, '2920 N 4th St', 'Flagstaff', 'Coconino', 'AZ', '86004', '9282136100', '          ', 'AZSINCLAIRc', 'AZSINCLAIRe', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1245419100', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('860663432', 'W12006212', 'W12006212', 'Sinclair', '(Sinclair Health Services\rProvider) North Country Health Care', 'Ruth', '', 'DeBoard', 'FNP', 'Family Practice', '', '', NULL, 'B', 'PO Box 3630', 'Flagstaff', 'Coconino', 'AZ', '86003', '9282136100', NULL, 'PO Box 3630', 'Flagstaff', 'Coconino', 'AZ', '86003', '9282136100', '          ', 'AZSINCLAIRc', 'AZSINCLAIRe', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1245419100', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('860663432', 'W12006214', 'W12006214', 'Sinclair', '(Sinclair Health Services\rProvider) North Country Health Care', 'Teri ', '', 'Dunn', 'MSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '2920 N 4th St', 'Flagstaff', 'Coconino', 'AZ', '86004', '9282136100', NULL, '2920 N 4th St', 'Flagstaff', 'Coconino', 'AZ', '86004', '9282136100', '          ', 'AZSINCLAIRc', 'AZSINCLAIRe', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1336110675', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('860663432', 'W12006213', 'W12006213', 'Sinclair', '(Sinclair Health Services\rProvider) North Country Health Care', 'Teri ', '', 'Dunn', 'MSW', 'Mental Health', 'Social Worker', '', NULL, 'B', 'PO Box 3630', 'Flagstaff', 'Coconino', 'AZ', '86003', '9282136100', NULL, 'PO Box 3630', 'Flagstaff', 'Coconino', 'AZ', '86003', '9282136100', '          ', 'AZSINCLAIRc', 'AZSINCLAIRe', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1336110675', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('860663432', 'W12006216', 'W12006216', 'Sinclair', '(Sinclair Health Services\rProvider) North Country Health Care', 'Kathryn', 'N', 'Feuquay', 'MD', 'Family Practice', '', '', NULL, 'O', '2920 N 4th St', 'Flagstaff', 'Coconino', 'AZ', '86004', '9282136100', NULL, '2920 N 4th St', 'Flagstaff', 'Coconino', 'AZ', '86004', '9282136100', '          ', 'AZSINCLAIRc', 'AZSINCLAIRe', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1689878530', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('860663432', 'W12006215', 'W12006215', 'Sinclair', '(Sinclair Health Services\rProvider) North Country Health Care', 'Kathryn', 'N', 'Feuquay', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 3630', 'Flagstaff', 'Coconino', 'AZ', '86003', '9282136100', NULL, 'PO Box 3630', 'Flagstaff', 'Coconino', 'AZ', '86003', '9282136100', '          ', 'AZSINCLAIRc', 'AZSINCLAIRe', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1689878530', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('860663432', 'W12006217', 'W12006217', 'Sinclair', '(Sinclair Health Services\rProvider) North Country Health Care', 'Jessica', '', 'Gaylord', 'FNP', 'Family Practice', '', '', NULL, 'O', '2920 N 4th St', 'Flagstaff', 'Coconino', 'AZ', '86004', '9282136100', NULL, '2920 N 4th St', 'Flagstaff', 'Coconino', 'AZ', '86004', '9282136100', '          ', 'AZSINCLAIRc', 'AZSINCLAIRe', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1861546384', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('860663432', 'W12006218', 'W12006218', 'Sinclair', '(Sinclair Health Services\rProvider) North Country Health Care', 'Jessica', '', 'Gaylord', 'FNP', 'Family Practice', '', '', NULL, 'B', 'PO Box 3630', 'Flagstaff', 'Coconino', 'AZ', '86003', '9282136100', NULL, 'PO Box 3630', 'Flagstaff', 'Coconino', 'AZ', '86003', '9282136100', '          ', 'AZSINCLAIRc', 'AZSINCLAIRe', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1861546384', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('860663432', 'W12006219', 'W12006219', 'Sinclair', '(Sinclair Health Services\rProvider) North Country Health Care', 'Elizabeth', '', 'Harding', 'MD', 'Family Practice', '', '', NULL, 'O', '2920 N 4th St', 'Flagstaff', 'Coconino', 'AZ', '86004', '9282136100', NULL, '2920 N 4th St', 'Flagstaff', 'Coconino', 'AZ', '86004', '9282136100', '          ', 'AZSINCLAIRc', 'AZSINCLAIRe', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1700871688', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('860663432', 'W12006220', 'W12006220', 'Sinclair', '(Sinclair Health Services\rProvider) North Country Health Care', 'Elizabeth', '', 'Harding', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 3630', 'Flagstaff', 'Coconino', 'AZ', '86003', '9282136100', NULL, 'PO Box 3630', 'Flagstaff', 'Coconino', 'AZ', '86003', '9282136100', '          ', 'AZSINCLAIRc', 'AZSINCLAIRe', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1700871688', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('860663432', 'W12006221', 'W12006221', 'Sinclair', '(Sinclair Health Services\rProvider) North Country Health Care', 'Karen ', '', 'Holder', 'FNP', 'Family Practice', '', '', NULL, 'O', '2920 N 4th St', 'Flagstaff', 'Coconino', 'AZ', '86004', '9282136100', NULL, '2920 N 4th St', 'Flagstaff', 'Coconino', 'AZ', '86004', '9282136100', '          ', 'AZSINCLAIRc', 'AZSINCLAIRe', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1831192913', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('860663432', 'W12006222', 'W12006222', 'Sinclair', '(Sinclair Health Services\rProvider) North Country Health Care', 'Karen ', '', 'Holder', 'FNP', 'Family Practice', '', '', NULL, 'B', 'PO Box 3630', 'Flagstaff', 'Coconino', 'AZ', '86003', '9282136100', NULL, 'PO Box 3630', 'Flagstaff', 'Coconino', 'AZ', '86003', '9282136100', '          ', 'AZSINCLAIRc', 'AZSINCLAIRe', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1831192913', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('860663432', 'W12006224', 'W12006224', 'Sinclair', '(Sinclair Health Services\rProvider) North Country Health Care', 'Michele', '', 'Inge', 'FNP', 'Family Practice', '', '', NULL, 'O', '2920 N 4th St', 'Flagstaff', 'Coconino', 'AZ', '86004', '9282136100', NULL, '2920 N 4th St', 'Flagstaff', 'Coconino', 'AZ', '86004', '9282136100', '          ', 'AZSINCLAIRc', 'AZSINCLAIRe', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1558339259', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('860663432', 'W12006223', 'W12006223', 'Sinclair', '(Sinclair Health Services\rProvider) North Country Health Care', 'Michele', '', 'Inge', 'FNP', 'Family Practice', '', '', NULL, 'B', 'PO Box 3630', 'Flagstaff', 'Coconino', 'AZ', '86003', '9282136100', NULL, 'PO Box 3630', 'Flagstaff', 'Coconino', 'AZ', '86003', '9282136100', '          ', 'AZSINCLAIRc', 'AZSINCLAIRe', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1558339259', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('860663432', 'W12006226', 'W12006226', 'Sinclair', '(Sinclair Health Services\rProvider) North Country Health Care', 'Marcy', '', 'Krueger', 'MD', 'Family Practice', '', '', NULL, 'O', '2920 N 4th St', 'Flagstaff', 'Coconino', 'AZ', '86004', '9282136100', NULL, '2920 N 4th St', 'Flagstaff', 'Coconino', 'AZ', '86004', '9282136100', '          ', 'AZSINCLAIRc', 'AZSINCLAIRe', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1871666578', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('860663432', 'W12006225', 'W12006225', 'Sinclair', '(Sinclair Health Services\rProvider) North Country Health Care', 'Marcy', '', 'Krueger', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 3630', 'Flagstaff', 'Coconino', 'AZ', '86003', '9282136100', NULL, 'PO Box 3630', 'Flagstaff', 'Coconino', 'AZ', '86003', '9282136100', '          ', 'AZSINCLAIRc', 'AZSINCLAIRe', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1871666578', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('860663432', 'W12006227', 'W12006227', 'Sinclair', '(Sinclair Health Services\rProvider) North Country Health Care', 'Bettina', '', 'Martin', 'MD', 'Family Practice', '', '', NULL, 'O', '2920 N 4th St', 'Flagstaff', 'Coconino', 'AZ', '86004', '9282136100', NULL, '2920 N 4th St', 'Flagstaff', 'Coconino', 'AZ', '86004', '9282136100', '          ', 'AZSINCLAIRc', 'AZSINCLAIRe', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1972692150', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('860663432', 'W12006229', 'W12006229', 'Sinclair', '(Sinclair Health Services\rProvider) North Country Health Care', 'Bettina', '', 'Martin', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 3630', 'Flagstaff', 'Coconino', 'AZ', '86003', '9282136100', NULL, 'PO Box 3630', 'Flagstaff', 'Coconino', 'AZ', '86003', '9282136100', '          ', 'AZSINCLAIRc', 'AZSINCLAIRe', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1972692150', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('860663432', 'W12006231', 'W12006231', 'Sinclair', '(Sinclair Health Services\rProvider) North Country Health Care', 'Barbara', '', 'Polstein', 'DO', 'Family Practice', '', '', NULL, 'O', '2920 N 4th St', 'Flagstaff', 'Coconino', 'AZ', '86004', '9282136100', NULL, '2920 N 4th St', 'Flagstaff', 'Coconino', 'AZ', '86004', '9282136100', '          ', 'AZSINCLAIRc', 'AZSINCLAIRe', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1316915069', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('860663432', 'W12006230', 'W12006230', 'Sinclair', '(Sinclair Health Services\rProvider) North Country Health Care', 'Barbara', '', 'Polstein', 'DO', 'Family Practice', '', '', NULL, 'B', 'PO Box 3630', 'Flagstaff', 'Coconino', 'AZ', '86003', '9282136100', NULL, 'PO Box 3630', 'Flagstaff', 'Coconino', 'AZ', '86003', '9282136100', '          ', 'AZSINCLAIRc', 'AZSINCLAIRe', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1316915069', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('860663432', 'W12006233', 'W12006233', 'Sinclair', '(Sinclair Health Services\rProvider) North Country Health Care', 'Bidisha', '', 'Ray', 'MD', 'Family Practice', '', '', NULL, 'O', '2920 N 4th St', 'Flagstaff', 'Coconino', 'AZ', '86004', '9282136100', NULL, '2920 N 4th St', 'Flagstaff', 'Coconino', 'AZ', '86004', '9282136100', '          ', 'AZSINCLAIRc', 'AZSINCLAIRe', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1881878429', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('860663432', 'W12006232', 'W12006232', 'Sinclair', '(Sinclair Health Services\rProvider) North Country Health Care', 'Bidisha', '', 'Ray', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 3630', 'Flagstaff', 'Coconino', 'AZ', '86003', '9282136100', NULL, 'PO Box 3630', 'Flagstaff', 'Coconino', 'AZ', '86003', '9282136100', '          ', 'AZSINCLAIRc', 'AZSINCLAIRe', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1881878429', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('860663432', 'W12006235', 'W12006235', 'Sinclair', '(Sinclair Health Services\rProvider) North Country Health Care', 'Andrew', '', 'Saal', 'MD', 'Family Practice', '', '', NULL, 'O', '2920 N 4th St', 'Flagstaff', 'Coconino', 'AZ', '86004', '9282136100', NULL, '2920 N 4th St', 'Flagstaff', 'Coconino', 'AZ', '86004', '9282136100', '          ', 'AZSINCLAIRc', 'AZSINCLAIRe', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1326013913', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('860663432', 'W12006234', 'W12006234', 'Sinclair', '(Sinclair Health Services\rProvider) North Country Health Care', 'Andrew', '', 'Saal', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 3630', 'Flagstaff', 'Coconino', 'AZ', '86003', '9282136100', NULL, 'PO Box 3630', 'Flagstaff', 'Coconino', 'AZ', '86003', '9282136100', '          ', 'AZSINCLAIRc', 'AZSINCLAIRe', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1326013913', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
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('860663432', 'W12006236', 'W12006236', 'Sinclair', '(Sinclair Health Services\rProvider) North Country Health Care', 'Scott', '', 'Sadler', 'PA-C', 'Family Practice', '', '', NULL, 'B', 'PO Box 3630', 'Flagstaff', 'Coconino', 'AZ', '86003', '9282136100', NULL, 'PO Box 3630', 'Flagstaff', 'Coconino', 'AZ', '86003', '9282136100', '          ', 'AZSINCLAIRc', 'AZSINCLAIRe', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1386612265', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('860663432', 'W12006239', 'W12006239', 'Sinclair', '(Sinclair Health Services\rProvider) North Country Health Care', 'Charles', '', 'Smith', 'MD', 'Family Practice', '', '', NULL, 'O', '2920 N 4th St', 'Flagstaff', 'Coconino', 'AZ', '86004', '9282136100', NULL, '2920 N 4th St', 'Flagstaff', 'Coconino', 'AZ', '86004', '9282136100', '          ', 'AZSINCLAIRc', 'AZSINCLAIRe', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1053383950', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('860663432', 'W12006238', 'W12006238', 'Sinclair', '(Sinclair Health Services\rProvider) North Country Health Care', 'Charles', '', 'Smith', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 3630', 'Flagstaff', 'Coconino', 'AZ', '86003', '9282136100', NULL, 'PO Box 3630', 'Flagstaff', 'Coconino', 'AZ', '86003', '9282136100', '          ', 'AZSINCLAIRc', 'AZSINCLAIRe', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1053383950', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('860663432', 'W12006241', 'W12006241', 'Sinclair', '(Sinclair Health Services\rProvider) North Country Health Care', 'Nina', '', 'Souders', 'MD', 'Family Practice', '', '', NULL, 'O', '2920 N 4th St', 'Flagstaff', 'Coconino', 'AZ', '86004', '9282136100', NULL, '2920 N 4th St', 'Flagstaff', 'Coconino', 'AZ', '86004', '9282136100', '          ', 'AZSINCLAIRc', 'AZSINCLAIRe', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1023086758', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('860663432', 'W12006240', 'W12006240', 'Sinclair', '(Sinclair Health Services\rProvider) North Country Health Care', 'Nina', '', 'Souders', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 3630', 'Flagstaff', 'Coconino', 'AZ', '86003', '9282136100', NULL, 'PO Box 3630', 'Flagstaff', 'Coconino', 'AZ', '86003', '9282136100', '          ', 'AZSINCLAIRc', 'AZSINCLAIRe', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1023086758', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('860663432', 'W12006243', 'W12006243', 'Sinclair', '(Sinclair Health Services\rProvider) North Country Health Care', 'Jill', '', 'Zurawski', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '2920 N 4th St', 'Flagstaff', 'Coconino', 'AZ', '86004', '9282136100', NULL, '2920 N 4th St', 'Flagstaff', 'Coconino', 'AZ', '86004', '9282136100', '          ', 'AZSINCLAIRc', 'AZSINCLAIRe', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1013981513', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('860663432', 'W12006242', 'W12006242', 'Sinclair', '(Sinclair Health Services\rProvider) North Country Health Care', 'Jill', '', 'Zurawski', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 3630', 'Flagstaff', 'Coconino', 'AZ', '86003', '9282136100', NULL, 'PO Box 3630', 'Flagstaff', 'Coconino', 'AZ', '86003', '9282136100', '          ', 'AZSINCLAIRc', 'AZSINCLAIRe', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1013981513', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('820447136', 'W12006244', 'W12006244', 'Sinclair', '(Sinclair Health Services\rProvider) Sun Valley Sports Therapy', 'Colleen', 'A', 'Coyne', 'PT', 'Physical Therapy', '', '', NULL, 'O', '245 Raven Rd', 'Ketchum', 'Blaine', 'ID', '83340', '2087267246', NULL, '245 Raven Rd', 'Ketchum', 'Blaine', 'ID', '83340', '2087267246', '          ', 'IDSINCLAIRA', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1780779280', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('860780167', 'W12006245', 'W12006245', 'Sinclair', '(Sinclair Health Services\rProvider) ', 'Michael', 'J', 'Flores', 'MD', 'Family Practice', '', '', NULL, 'O', '1100 N San Francisco St Ste E', 'Flagstaff', 'Coconino', 'AZ', '86001', '9287743318', '9287743847', '1100 N San Francisco St Ste E', 'Flagstaff', 'Coconino', 'AZ', '86001', '9287743318', '9287743847', 'AZSINCLAIRd', 'AZSINCLAIRe', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1588748875', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('860904481', 'W12006246', 'W12006246', 'Sinclair', '(Sinclair Health Services\rProvider) North Arizona Kidney Care', 'Harnath', '', 'Singh', 'MD', 'Nephrology', '', '', NULL, 'O', '823 N Beaver St Ste A', 'Flagstaff', 'Coconino', 'AZ', '86001', '9282131443', NULL, '823 N Beaver St Ste A', 'Flagstaff', 'Coconino', 'AZ', '86001', '9282131443', '          ', 'AZSINCLAIRd', 'AZSINCLAIRe', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1538133236', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('820518815', 'W12006247', 'W12006247', 'ID02', 'Meridian Family Chiropractic', 'Robert', 'E', 'Gentry', 'DC', 'Chiropractic', '', '', NULL, 'O', '1565 E Leighfield Dr Ste 150', 'Meridian', 'Ada', 'ID', '83646', '2088842142', '2088842142', '1565 E Leighfield Dr Ste 150', 'Meridian', 'Ada', 'ID', '83646', '2088842142', '2088842142', 'IDCHIRO1', '', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1598820128', 0, 'N', 0, '2010-11-15', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W12006248', 'W12006248', 'UT01', 'Central Utah Clinic Rheumatology', 'Malgorzata', '', 'Hanczyc', 'MD', 'Rheumatology', '', '', NULL, 'O', '1055 N 500 W Ste 205', 'Provo', 'Utah', 'UT', '84604', '8014298095', NULL, '1055 N 500 W Ste 205', 'Provo', 'Utah', 'UT', '84604', '8014298095', '          ', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-11-01', '2011-02-28', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1467765735', 0, 'N', 0, '2013-04-16', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W12006249', 'W12006249', 'UT01', 'Central Utah Clinic', 'Malgorzata', '', 'Hanczyc', 'MD', 'Rheumatology', '', '', NULL, 'B', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', '8014290629', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', '8014290629', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-11-01', '2011-02-28', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1467765735', 0, 'N', 0, '2013-04-16', NULL, NULL, 0, 0, NULL, NULL),
('870639098', 'W12006252', 'W12006252', 'UT01', 'After Hours Medical Company', 'Garth', '', 'Reid', 'PA', 'Family Practice', '', '', NULL, 'O', '10433 S Redwood Rd', 'South Jordan', 'Salt Lake', 'UT', '84095', '8015010500', '8012530696', '10433 S Redwood Rd', 'South Jordan', 'Salt Lake', 'UT', '84095', '8015010500', '8012530696', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1912072570', 0, 'Y', 0, '2013-11-18', NULL, NULL, 40.5602, -111.939, NULL, NULL),
('870639098', 'W12006256', 'W12006256', 'UT01', 'After Hours Draper Clinic', 'Garth', '', 'Reid', 'PA', 'Family Practice', '', '', NULL, 'O', '1126 E 126300 S', 'Draper', 'Salt Lake', 'UT', '84020', '8015450600', '8015450626', '1126 E 126300 S', 'Draper', 'Salt Lake', 'UT', '84020', '8015450600', '8015450626', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1912072570', 0, 'Y', 0, '2013-11-18', NULL, NULL, 0, 0, NULL, NULL),
('870639098', 'W12006251', 'W12006251', 'UT01', 'After Hours Medical Company - Latyon', 'Garth', '', 'Reid', 'PA', 'Family Practice', '', '', NULL, 'O', '1550 N Main St Ste E', 'Layton', 'Davis', 'UT', '84041', '8016149030', '8016149040', '1550 N Main St Ste E', 'Layton', 'Davis', 'UT', '84041', '8016149030', '8016149040', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1912072570', 0, 'Y', 0, '2013-11-18', NULL, NULL, 41.0825, -111.993, NULL, NULL),
('870639098', 'W12006253', 'W12006253', 'UT01', 'After Hours Medical Company', 'Garth', '', 'Reid', 'PA', 'Family Practice', '', '', NULL, 'O', '3451 S 5600 W Ste F', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019570900', '8019664384', '3451 S 5600 W Ste F', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019570900', '8019664384', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1912072570', 0, 'Y', 0, '2013-11-18', NULL, NULL, 40.6977, -112.025, NULL, NULL),
('870639098', 'W12006255', 'W12006255', 'UT01', 'After Hours Medical American Fork', 'Garth', '', 'Reid', 'PA', 'Family Practice', '', '', NULL, 'O', '476 N 900 W Ste C', 'American Fork', 'Utah', 'UT', '84003', '8014921611', '8014921480', '476 N 900 W Ste C', 'American Fork', 'Utah', 'UT', '84003', '8014921611', '8014921480', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1912072570', 0, 'Y', 0, '2013-11-18', NULL, NULL, 40.3961, -111.815, NULL, NULL),
('870639098', 'W12006254', 'W12006254', 'UT01', 'After Hours Medical Company -Sandy', 'Garth', '', 'Reid', 'PA', 'Family Practice', '', '', NULL, 'O', '7998 S 1300 E', 'Sandy', 'Salt Lake', 'UT', '84094', '8012552000', '8013257185', '7998 S 1300 E', 'Sandy', 'Salt Lake', 'UT', '84094', '8012552000', '8013257185', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1912072570', 0, 'Y', 0, '2013-11-18', NULL, NULL, 40.6056, -111.853, NULL, NULL),
('870639098', 'W12006258', 'W12006258', 'UT01', 'After Hours Medical Company', 'Garth', '', 'Reid', 'PA', 'Family Practice', '', '', NULL, 'B', 'PO Box 8476', 'Belfast', 'Waldo', 'ME', '04915', '8015428222', NULL, 'PO Box 8476', 'Belfast', 'Waldo', 'ME', '04915', '8015428222', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1912072570', 0, 'Y', 0, '2013-11-18', NULL, NULL, 0, 0, NULL, NULL),
('870639098', 'W12006259', 'W12006259', 'UT01', 'After Hours Medical Company', 'Garth', '', 'Reid', 'PA', 'Family Practice', '', '', NULL, 'M', 'PO Box 708757', 'Sandy', 'Salt Lake', 'UT', '84070', '8014921611', NULL, 'PO Box 708757', 'Sandy', 'Salt Lake', 'UT', '84070', '8014921611', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1912072570', 0, 'Y', 0, '2013-11-18', NULL, NULL, 0, 0, NULL, NULL),
('870414075', 'W12006369', 'W12006369', 'UT01', 'Cherry Tree Family Practice', 'William', 'D', 'Preston', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '155 N 400 W Ste B6', 'Orem', 'Utah', 'UT', '84057', '8012241300', '8012253236', '155 N 400 W Ste B6', 'Orem', 'Utah', 'UT', '84057', '8012241300', '8012253236', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-01-01', '2010-07-14', 0, 0, 0, 'Timpanogos Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1396709903', 0, 'N', 0, '2010-12-16', NULL, NULL, 0, 0, NULL, NULL),
('870467991', 'W12006263', 'W12006263', 'UT01', 'Salt Lake Endoscopy Center', '', '', 'Salt Lake Endoscopy Center', 'GROUP', 'Endoscopy Center', '', '', NULL, 'O', '24 S 1100 E Ste 103', 'Salt Lake City', 'Salt Lake', 'UT', '84101', '8013552988', NULL, '24 S 1100 E Ste 103', 'Salt Lake City', 'Salt Lake', 'UT', '84101', '8013552988', '          ', 'SLENDO', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-10-20', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1609896216', 0, 'N', 0, '2012-06-29', NULL, NULL, 40.7689, -111.86, NULL, NULL),
('870521827', 'W12006419', 'W12006419', 'UT01', 'University Health Care Neuropsychiatric Institute', 'Jeffrey', 'M', 'Watabe', 'MD', 'Mental Health', 'Psychiatry', '', NULL, 'O', '501 Chipeta Way', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015814636', NULL, '501 Chipeta Way', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015814636', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-01-01', '2013-06-12', 0, 0, 0, '', '', '', '', 'HCFA|', '1407945710', 0, 'N', 0, '2013-08-14', NULL, NULL, 0, 0, NULL, NULL),
('452098247', 'W12012481', 'W12012481', 'UT01', 'University Health Care', '', '', 'University of Utah Neuro-Ophthalmology', 'Group', 'Clinics', '', '', NULL, 'O', '65 Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015813195', NULL, '65 Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015813195', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2011-08-01', '2012-08-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1821380759', 0, 'N', 0, '2012-08-02', NULL, NULL, 0, 0, NULL, NULL),
('300655165', 'W12012484', 'W12012484', 'UT01', 'Pediatrics 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, '2011-08-01', '2012-07-26', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1245524651', 0, 'N', 0, '2012-07-27', NULL, NULL, 0, 0, NULL, NULL),
('841414140', 'W12006273', 'W12006273', 'UT01', 'Wasatch Chiropractic Clinic', 'Sidney', '', 'Hendricks', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '352 S 200 W Ste 2', 'Farmington', 'Davis', 'UT', '84025', '8014517900', '8014517211', '352 S 200 W Ste 2', 'Farmington', 'Davis', 'UT', '84025', '8014517900', '8014517211', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2010-11-01', '2012-07-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1831196633', 0, 'N', 0, '2012-07-10', 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
('841414140', 'W12006274', 'W12006274', 'UT01', 'Wasatch Chiropractic Clinic', 'Sidney', '', 'Hendricks', 'DC', 'Chiropractic', NULL, NULL, NULL, 'B', 'PO Box 304', 'Farmington', 'Davis', 'UT', '84025', '8014517900', '8014517211', 'PO Box 304', 'Farmington', 'Davis', 'UT', '84025', '8014517900', '8014517211', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2010-11-01', '2012-07-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1831196633', 0, 'N', 0, '2012-07-10', NULL, NULL, 0, 0, NULL, NULL),
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('870524473', 'W12006277', 'W12006277', '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', '55.46', 3, '2010-11-01', '2012-07-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1275542284', 0, 'N', 0, '2013-06-14', NULL, NULL, 0, 0, NULL, NULL),
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('870653551', 'W12006394', 'W12006394', 'UT01', 'Canyons Clinic', 'Lisa', 'M', 'Saturnino', 'MD', 'Family Practice', '', '', NULL, 'O', '4000 Canyons Resort Dr', 'Park City', 'Summit', 'UT', '84098', '4356497640', '4356491365', '4000 Canyons Resort Dr', 'Park City', 'Summit', 'UT', '84098', '4356497640', '4356491365', 'WURURAL10', 'wUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-12-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1336362490', 0, 'N', 0, '2013-05-23', NULL, NULL, 40.6839, -111.553, 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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('870653551', 'W12006396', 'W12006396', 'UT01', 'Canyons Clinic', 'Robert', 'T', 'Winn', 'MD', 'Family Practice', 'Pediatrics', 'Urgent Care', NULL, 'O', '4000 Canyons Resort Dr', 'Park City', 'Summit', 'UT', '84098', '4356497640', '4356491365', '4000 Canyons Resort Dr', 'Park City', 'Summit', 'UT', '84098', '4356497640', '4356491365', 'WURURAL10', 'wUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-12-01', NULL, 0, 0, 0, 'Park City Medical Center', '', '', '', 'HCFA|UB|', '1912951393', 0, 'N', 0, '2014-04-08', NULL, NULL, 40.6839, -111.553, NULL, NULL),
('572588753', 'W12006398', 'W12006398', 'ID02', '', 'Victor', 'H', 'Horch', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '13176 W Persimmon Ln Ste 110', 'Boise', 'Ada', 'ID', '83713', '2083210044', '2089389807', '13176 W Persimmon Ln Ste 110', 'Boise', 'Ada', 'ID', '83713', '2083210044', '2089389807', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '55.46', '0.00', 3, '2010-11-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1750504163', 0, 'N', 0, '2013-11-01', NULL, NULL, 0, 0, NULL, NULL),
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('820511819', 'W12006401', 'W12006401', 'ID01', 'Treasure Valley Laboratory', '', '', 'Treasure Valley Laboratory', 'GROUP', 'Laboratory', '', '', NULL, 'O', '333 N 1st Ste 250', 'Boise', 'Ada', 'ID', '83702', '2083849296', '2083457270', '333 N 1st Ste 250', 'Boise', 'Ada', 'ID', '83702', '2083849296', '2083457270', 'TVLAB', '', '', '0.00', '25.00', '0.00', 3, '2010-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1730165838', 0, 'N', 0, '2011-05-23', NULL, NULL, 43.6132, -116.194, NULL, NULL),
('820511819', 'W12006402', 'W12006402', 'ID01', 'Treasure Valley Laboratory', '', '', 'Treasure Valley Laboratory', 'GROUP', 'Laboratory', '', '', NULL, 'O', '1520 W State St Ste 100', 'Boise', 'Ada', 'ID', '83702', '2083431584', '2083453322', '1520 W State St Ste 100', 'Boise', 'Ada', 'ID', '83702', '2083431584', '2083453322', 'TVLAB', '', '', '0.00', '25.00', '0.00', 3, '2010-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1730165838', 0, 'N', 0, '2011-05-23', NULL, NULL, 0, 0, NULL, NULL),
('820511819', 'W12006403', 'W12006403', 'ID01', 'Treasure Valley Laboratory', '', '', 'Treasure Valley Laboratory', 'GROUP', 'Laboratory', '', '', NULL, 'O', '211 E Logan St Ste B102', 'Caldwell', 'Canyon', 'ID', '83605', '2084541200', '2084547922', '211 E Logan St Ste B102', 'Caldwell', 'Canyon', 'ID', '83605', '2084541200', '2084547922', 'TVLAB', '', '', '0.00', '25.00', '0.00', 3, '2010-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1730165838', 0, 'N', 0, '2011-05-23', NULL, NULL, 43.6552, -116.697, NULL, NULL),
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('270430145', 'W12006406', 'W12006406', 'UTMH1', '', 'Jocelyn', 'E', 'Holbrook', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '5796 S 900 E Ste 206', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8018790252', '8019835258', '5796 S 900 E Ste 206', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8018790252', '8019835258', 'UTMA', '', '', '0.00', '35.00', '0.00', 6, '2010-11-11', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1437386547', 0, 'N', 0, '2014-01-17', NULL, NULL, 0, 0, NULL, NULL),
('270430145', 'W12006407', 'W12006407', 'UTMH1', '', 'Jocelyn', 'E', 'Holbrook', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', 'PO Box 57162', 'Salt Lake City', 'Salt Lake', 'UT', '84157', '8018790252', '8019835258', 'PO Box 57162', 'Salt Lake City', 'Salt Lake', 'UT', '84157', '8018790252', '8019835258', 'UTMA', '', '', '0.00', '35.00', '0.00', 6, '2010-11-11', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1437386547', 0, 'N', 0, '2014-01-17', NULL, NULL, 0, 0, NULL, NULL),
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('203298020', 'W12006411', 'W12006411', 'UT01', 'Tucker Medical Group', 'Stephen', '', 'Tucker', 'MD', 'Pediatric Internal Medicine', 'Family Practice', '', NULL, 'O', '1054 E Millbrook Way', 'Bountiful', 'Davis', 'UT', '84010', '8016608687', '8663328067', '1054 E Millbrook Way', 'Bountiful', 'Davis', 'UT', '84010', '8016608687', '8663328067', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-11-01', '2011-09-21', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1538179247', 0, 'N', 0, '2014-06-30', NULL, NULL, 0, 0, NULL, NULL),
('203298020', 'W12006412', 'W12006412', 'UT01', 'Tucker Medical Group', 'Stephen', '', 'Tucker', 'MD', 'Pediatric Internal Medicine', 'Family Practice', '', NULL, 'B', 'PO Box 14', 'Bountiful', 'Davis', 'UT', '84010', '8016608687', '8663328067', 'PO Box 14', 'Bountiful', 'Davis', 'UT', '84010', '8016608687', '8663328067', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1538179247', 0, 'Y', 0, '2014-06-30', NULL, NULL, 0, 0, NULL, NULL),
('830219655', 'W12006413', 'W12006413', 'Sinclair', 'Premier Bone and Joint Centers', 'Ryan', '', 'Aukerman', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '167 S Conwell', 'Casper', 'Natrona', 'WY', '82601', '8004465684', NULL, '167 S Conwell', 'Casper', 'Natrona', 'WY', '82601', '8004465684', '          ', '', '', '', '0.00', '15.00', '0.00', 3, '2010-04-19', NULL, 0, 0, 0, 'Wyoming Medical Center ', NULL, NULL, NULL, 'HCFA|UB|', '1417912858', 0, 'N', 0, '2013-03-07', NULL, NULL, 0, 0, NULL, NULL),
('841488548', 'W12006414', 'W12006414', 'UTPEHP', 'Western Colorado Lung Center', 'Garry', '', 'Lambert', 'DO', 'Pulmonary', 'Critical Care', '', NULL, 'O', '1050 Wellington Ave', 'Grand Junction', 'Mesa', 'CO', '81501', '9702454810', '', '1050 Wellington Ave', 'Grand Junction', 'Mesa', 'CO', '81501', '9702454810', '', 'WISESTD', '', '', '0.00', '35.00', '0.00', 3, '2010-11-15', NULL, 0, 0, 0, 'Community Hospital', '', '', '', 'HCFA|UB|', '1942303904', 0, 'N', 0, '2014-07-22', NULL, NULL, 0, 0, NULL, NULL),
('870521827', 'W12006415', 'W12006415', 'UT01', 'University Health Care Neuropsychiatric Institute', 'Michael', 'J', 'Voss', 'MD', 'Mental Health', 'Psychiatry', '', NULL, 'B', 'PO Box 30294', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8015876688', NULL, 'PO Box 30294', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8015876688', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, 'University Health Care University Hospital', NULL, NULL, NULL, 'HCFA|', '1790985992', 0, 'N', 0, '2012-01-26', NULL, NULL, 0, 0, NULL, NULL),
('205067728', 'W12006416', 'W12006416', 'Sinclair', 'Mountain View Regional Hospital', '', '', 'Mountain View Regional Hospital', 'GROUP', 'Hospital', '', '', NULL, 'O', '6550 E 2nd St', 'Casper', 'Natrona', 'WY', '82609', '3074738499', NULL, '6550 E 2nd St', 'Casper', 'Natrona', 'WY', '82609', '3074738499', '          ', '', '', '', '0.00', '15.00', '0.00', 3, '2010-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000013030', 0, 'N', 0, '2012-11-19', NULL, NULL, 0, 0, NULL, NULL),
('870521827', 'W12006418', 'W12006418', 'UT01', 'University Health Care Neuropsychiatric Institute', 'Jeffrey', 'M', 'Watabe', 'MD', 'Mental Health', 'Psychiatry', '', NULL, 'B', 'PO Box 30294', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8015876688', NULL, 'PO Box 30294', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8015876688', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-01-01', '2013-06-12', 0, 0, 0, '', '', '', '', 'HCFA|', '1407945710', 0, 'N', 0, '2013-08-14', NULL, NULL, 0, 0, NULL, NULL),
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('870521827', 'W12006421', 'W12006421', 'UT01', 'University Health Care Neuropsychiatric Institute', 'Amanda', 'M', 'Weeks', 'PSYD', 'Mental Health', 'Psychology', '', NULL, 'B', 'PO Box 30294', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8015876688', NULL, 'PO Box 30294', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8015876688', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1295791234', 0, 'N', 0, '2012-01-26', NULL, NULL, 0, 0, NULL, NULL),
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('870521827', 'W12006427', 'W12006427', 'UT01', 'University Health Care Neuropsychiatric Institute', 'Arden', 'L', 'Weintraub', 'MD', 'Mental Health', 'Psychiatry', 'Pediatric Psychiatry', NULL, 'B', 'PO Box 30294', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8015876688', NULL, 'PO Box 30294', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8015876688', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1811961279', 0, 'N', 0, '2012-01-26', NULL, NULL, 0, 0, NULL, NULL),
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('870521827', 'W12006429', 'W12006429', 'UT01', 'University Health Care Neuropsychiatric Institute', 'Sandra', 'L', 'Whitehouse', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'B', 'PO Box 30294', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8015876688', NULL, 'PO Box 30294', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8015876688', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1821055377', 0, 'N', 0, '2012-01-26', NULL, NULL, 0, 0, NULL, NULL),
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('870467746', 'W12006433', 'W12006433', 'UT01', 'U-U Human Development Division', 'Katherine', 'A', 'Anderson', 'MD', 'Geriatrics', '', '', NULL, 'B', 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8015812121', NULL, 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8015812121', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2010-07-01', '2012-08-29', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1326221540', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('830279242', 'W12006435', 'W12006435', 'Sinclair', 'Wyoming Medical Center (Recognized but not Contracted)', '', '', 'Wyoming Medical Center', 'Group', 'Hospital', '', '', NULL, 'O', '1233 E 2nd St', 'Casper', 'Natrona', 'WY', '82601', '3075777201', NULL, '1233 E 2nd St', 'Casper', 'Natrona', 'WY', '82601', '3075777201', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2010-11-01', '2012-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1346332954', 0, 'N', 0, '2013-09-26', NULL, NULL, 0, 0, NULL, NULL),
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('237268471', 'W12006460', 'W12006460', 'UT01', 'University Radiology Associates', 'Richard', 'P', 'Nguyen', 'MD', 'Radiology', '', '', NULL, 'o', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015812121', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015812121', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2010-07-01', '2011-01-07', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1861655284', 0, 'N', 0, '2011-05-26', NULL, NULL, 0, 0, NULL, NULL),
('237268471', 'W12006459', 'W12006459', 'UT01', 'University Radiology Associates', 'Richard', 'P', 'Nguyen', 'MD', 'Radiology', '', '', NULL, 'B', 'PO Box 413025', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '8015850520', 'PO Box 413025', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '8015850520', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2010-07-01', '2011-01-07', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1861655284', 0, 'N', 0, '2011-05-26', NULL, NULL, 0, 0, NULL, NULL),
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('870532788', 'W12006461', 'W12006461', 'UT01', 'Physical Medicine Clinic', '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', '55.46', 3, '2010-11-01', '2012-07-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1750388765', 0, 'N', 0, '2012-12-19', NULL, NULL, 0, 0, NULL, NULL),
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('870366259', 'W12006463', 'W12006463', 'UT01', 'Downtown Chiropractic & Message Therapy', 'Michael', '', 'Lane', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '525 E 100 S Ste 420', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013223067', '8013224054', '525 E 100 S Ste 420', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013223067', '8013224054', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2010-11-01', '2010-11-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1376637116', 0, 'N', 0, '2011-12-19', NULL, NULL, 0, 0, NULL, NULL),
('870630609', 'W12006448', 'W12006448', 'UT01', 'Barrus Chiropractic LLC', 'J Scott', '', 'Barrus', 'DC', 'Chiropractic', '', '', NULL, 'O', '894 N 2000 W', 'Pleasant Grove', 'Utah', 'UT', '84062', '8017562861', '8014921882', '894 N 2000 W', 'Pleasant Grove', 'Utah', 'UT', '84062', '8017562861', '8014921882', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2010-11-01', '2012-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1538242714', 0, 'N', 0, '2012-01-17', NULL, NULL, 0, 0, NULL, NULL),
('870526252', 'W12006449', 'W12006449', 'UT01', 'Courtney Chiropractic Clinic', 'David', '', 'Courtney', 'DC', 'Chiropractic', '', '', NULL, 'O', '800 N 100 E', 'Spanish Fork', 'Utah', 'UT', '84660', '8017982482', '8017986607', '800 N 100 E', 'Spanish Fork', 'Utah', 'UT', '84660', '8017982482', '8017986607', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2010-11-01', '2012-07-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1356358758', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('651305121', 'W12006450', 'W12006450', 'UT01', '1st Choice Chiropractic PLLC', 'Michael', 'Loren', 'Massengale', 'DC', 'Chiropractic', '', '', NULL, 'O', '1951 W 4700 S Ste 2', 'Taylorsville', 'Salt Lake', 'UT', '84129', '8019694700', '8019697217', '1951 W 4700 S Ste 2', 'Taylorsville', 'Salt Lake', 'UT', '84129', '8019694700', '8019697217', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2010-11-01', '2012-01-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1962507848', 0, 'N', 0, '2013-12-30', NULL, NULL, 0, 0, NULL, NULL),
('800341115', 'W12006451', 'W12006451', 'UT01', 'Ulibarri Chiropractic and Rehab', 'Isaiah', '', 'Ulibarri', 'DC', 'Chiropractic', '', '', NULL, 'O', '1951 W 4700 S Ste 2', 'Taylorsville', 'Salt Lake', 'UT', '84129', '8016743314', '8019697217', '1951 W 4700 S Ste 2', 'Taylorsville', 'Salt Lake', 'UT', '84129', '8016743314', '8019697217', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2010-11-01', '2012-07-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1194962621', 0, 'N', 0, '2013-12-06', NULL, NULL, 0, 0, NULL, NULL),
('460439999', 'W12006453', 'W12006453', 'UT01', 'Innova Pain Clinic', 'Andrew', '', 'White', 'DC', 'Chiropractic', '', '', NULL, 'O', '435 N 1680 E Ste 6', 'St George', 'Washington', 'UT', '84790', '4356524322', '4356272510', '435 N 1680 E Ste 6', 'St George', 'Washington', 'UT', '84790', '4356524322', '4356272510', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2010-11-01', '2011-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1194705384', 0, 'N', 0, '2012-01-09', NULL, NULL, 0, 0, NULL, NULL),
('529511010', 'W12006464', 'W12006464', 'UT01', 'Collard Chiropractic', 'Chad', 'L', 'Collard', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '9103 S 1300 W Ste 101', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015691141', '8015691171', '9103 S 1300 W Ste 101', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015691141', '8015691171', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2010-11-01', '2012-01-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1184707036', 0, 'N', 0, '2012-02-15', NULL, NULL, 0, 0, NULL, NULL),
('203360654', 'W12006469', 'W12006469', 'Sinclair', 'Western Medical Associates', 'Matthew', 'R', 'Moore', 'MD', 'Family Practice', '', '', NULL, 'O', '3230 Cy Ave', 'Casper', 'Natrona', 'WY', '82604', '3075775100', NULL, '3230 Cy Ave', 'Casper', 'Natrona', 'WY', '82604', '3075775100', '          ', '', '', '', '0.00', '10.00', '0.00', 3, '2010-11-01', '2011-12-12', 0, 0, 0, 'Mountain View Regional Hospital', '', '', '', 'HCFA|UB|', '1780912246', 0, 'N', 0, '2011-12-22', NULL, NULL, 0, 0, NULL, NULL),
('203360654', 'W12006470', 'W12006470', 'Sinclair', 'Western Medical Associates', 'Matthew', 'R', 'Moore', 'MD', 'Family Practice', '', '', NULL, 'O', '6500 E 2nd St Ste 200', 'Casper', 'Natrona', 'WY', '82609', '3075775100', NULL, '6500 E 2nd St Ste 200', 'Casper', 'Natrona', 'WY', '82609', '3075775100', '          ', '', '', '', '0.00', '10.00', '0.00', 3, '2010-11-01', '2011-12-12', 0, 0, 0, 'Mountain View Regional Hospital', '', '', '', 'HCFA|UB|', '1780912246', 0, 'N', 0, '2011-12-22', NULL, NULL, 0, 0, NULL, NULL),
('870710584', 'W12006471', 'W12006471', 'UTMH1', 'Jordan West Family Counseling', 'Shauntele', '', 'Curry Smid', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '9263 S Redwood Rd Bldg 8 Ste B', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015660749', '8015667108', '9263 S Redwood Rd Bldg 8 Ste B', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015660749', '8015667108', 'MA', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-02-01', '2013-02-14', 0, NULL, 0, '', '', '', '', 'HCFA|UB|', '1528088986', 0, 'N', 0, '2014-03-07', NULL, NULL, 0, 0, NULL, NULL),
('270627913', 'W12006472', 'W12006472', 'UT01', 'Hobble Creek Medical Center', 'David', 'S', 'Devenport', 'MD', 'Pediatrics', '', '', NULL, 'O', '269 E 400 S Ste 2', 'Springville', 'Utah', 'UT', '84663', '8014919883', '8014893141', '269 E 400 S Ste 2', 'Springville', 'Utah', 'UT', '84663', '8014919883', '8014893141', 'WUTCTY', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-02-01', NULL, 0, 0, 0, 'Mountain View Hospital', '', '', '', 'HCFA|UB|', '1245258425', 0, 'N', 0, '2013-06-19', NULL, NULL, 40.1611, -111.606, NULL, NULL),
('270627913', 'W12006473', 'W12006473', 'UT01', 'Hobble Creek Medical Center', 'David', 'S', 'Devenport', 'MD', 'Pediatrics', '', '', NULL, 'B', 'PO Box 9117 Ste 2', 'Belfast', 'Waldo', 'ME', '04915', '8014919883', '8014893141', 'PO Box 9117 Ste 2', 'Belfast', 'Waldo', 'ME', '04915', '8014919883', '8014893141', 'WUTCTY', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-02-01', NULL, 0, 0, 0, 'Mountain View Hospital', '', '', '', 'HCFA|UB|', '1245258425', 0, 'N', 0, '2013-06-19', NULL, NULL, 0, 0, NULL, NULL),
('270627913', 'W12006474', 'W12006474', 'UT01', 'Hobble Creek Medical Clinic', 'Mark', 'J', 'Devenport', 'MD', 'Pediatrics', '', '', NULL, 'O', '269 E 400 S Ste 2', 'Springville', 'Utah', 'UT', '84663', '8014919883', '8014893141', '269 E 400 S Ste 2', 'Springville', 'Utah', 'UT', '84663', '8014919883', '8014893141', 'WUTCTY', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-12-15', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|UB|', '1962453688', 0, 'N', 0, '2010-12-16', NULL, NULL, 40.1611, -111.606, NULL, NULL),
('270627913', 'W12006475', 'W12006475', 'UT01', 'Hobble Creek Medical Clinic', 'Mark', 'J', 'Devenport', 'MD', 'Pediatrics', '', '', NULL, 'B', 'PO Box 9117', 'Belfast', 'Waldo', 'ME', '04915', '8014919883', '8014893141', 'PO Box 9117', 'Belfast', 'Waldo', 'ME', '04915', '8014919883', '8014893141', 'WUTCTY', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-12-15', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|UB|', '1962453688', 0, 'N', 0, '2010-12-16', NULL, NULL, 0, 0, NULL, NULL),
('930765801', 'W12006478', 'W12006478', 'WY01', 'Big Horn Foot Clinic', 'D', 'H', 'Fraser', 'DPM', 'Podiatry', '', '', NULL, 'O', '424 Yellowstone Ste 140', 'Cody', 'Park', 'WY', '82414', '3075279191', '3077541291', '424 Yellowstone Ste 140', 'Cody', 'Park', 'WY', '82414', '3075279191', '3077541291', '', '', '', '0.00', '10.00', '0.00', 3, '2011-01-01', NULL, 0, NULL, 0, NULL, '', '', '', 'HCFA|UB|', '1114923463', 0, 'N', 0, '2014-02-10', NULL, NULL, 44.517, -109.083, NULL, NULL),
('930765801', 'W12006477', 'W12006477', 'WY01', 'Big Horn Foot Clinic', 'D', 'H', 'Fraser', 'DPM', 'Podiatry', '', '', NULL, 'O', '777 Ave H', 'Powell', 'Park', 'WY', '82435', '3077549191', '3077541291', '777 Ave H', 'Powell', 'Park', 'WY', '82435', '3077549191', '3077541291', '', '', '', '0.00', '10.00', '0.00', 3, '2011-01-01', NULL, 0, NULL, 0, NULL, '', '', '', 'HCFA|UB|', '1114923463', 0, 'N', 0, '2014-02-10', NULL, NULL, 44.7567, -108.769, NULL, NULL),
('273611370', 'W12006479', 'W12006479', 'ID01', '', 'Ninon', '', 'Germain', 'MD', 'Mental Health', 'Psychiatry', '', NULL, 'O', '413 N Allumbaugh Ste 101', 'Boise', 'Ada', 'ID', '83704', '2083231125', '2083231905', '413 N Allumbaugh Ste 101', 'Boise', 'Ada', 'ID', '83704', '2083231125', '2083231905', 'IDMD', '', '', '0.00', '35.00', '0.00', 3, '2011-02-01', '2013-02-14', 0, NULL, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1588705560', 0, 'N', 0, '2014-01-29', NULL, NULL, 0, 0, NULL, NULL),
('870469392', 'W12006480', 'W12006480', 'UT01', '', 'George', 'C', 'Gourley', 'DO', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1055 N 300 W Ste 305', 'Provo', 'Utah', 'UT', '84604', '8013577190', '8013563107', '1055 N 300 W Ste 305', 'Provo', 'Utah', 'UT', '84604', '8013577190', '8013563107', 'WUTCTY', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-02-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1457469249', 0, 'N', 0, '2012-05-29', NULL, NULL, 40.2476, -111.664, NULL, NULL),
('870635889', 'W12006481', 'W12006481', 'UT01', 'Oquirrh Anesthesia and Pain Services', 'Jacob', 'E', 'Jessop', 'DO', 'Pain Management', '', '', NULL, 'O', '196 E 2000 N Ste 110', 'Tooele', 'Tooele', 'UT', '84074', '4358433643', NULL, '196 E 2000 N Ste 110', 'Tooele', 'Tooele', 'UT', '84074', '4358433643', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-02-01', '2011-10-21', 0, 0, 0, 'Mountain West Medical Center', '', '', '', 'HCFA|UB|', '1164644944', 0, 'N', 0, '2011-10-24', NULL, NULL, 0, 0, NULL, NULL),
('870635889', 'W12006482', 'W12006482', 'UT01', 'Oquirrh Anesthesia and Pain Services', 'Jacob', 'E', 'Jessop', 'DO', 'Pain Management', '', '', NULL, 'M', '7100 Commerce Way Ste 180', 'Brentwood', 'Williamson', 'TN', '37027', '4358433643', '4358821275', '7100 Commerce Way Ste 180', 'Brentwood', 'Williamson', 'TN', '37027', '4358433643', '4358821275', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-02-01', '2011-10-21', 0, 0, 0, 'Mountain West Medical Center', '', '', '', 'HCFA|UB|', '1164644944', 0, 'N', 0, '2011-10-24', NULL, NULL, 0, 0, NULL, NULL),
('870635889', 'W12006483', 'W12006483', 'UT01', 'Oquirrh Anesthesia and Pain Services', 'Jacob', 'E', 'Jessop', 'DO', 'Pain Management', '', '', NULL, 'B', 'PO Box 848416', 'Boston', 'Suffolk', 'MA', '02284', '4358434930', '4358439997', 'PO Box 848416', 'Boston', 'Suffolk', 'MA', '02284', '4358434930', '4358439997', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-02-01', '2011-10-21', 0, 0, 0, 'Mountain West Medical Center', '', '', '', 'HCFA|UB|', '1164644944', 0, 'N', 0, '2011-10-24', NULL, NULL, 0, 0, NULL, NULL),
('270627913', 'W12006484', 'W12006484', 'UT01', 'Hobble Creek Medical Center', 'Ian', 'B', 'McMaster', 'MD', 'Family Practice', '', '', NULL, 'O', '269 E 400 S Ste 2', 'Springville', 'Utah', 'UT', '84663', '8014919883', '8014893141', '269 E 400 S Ste 2', 'Springville', 'Utah', 'UT', '84663', '8014919883', '8014893141', 'WUTCTY', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1598799462', 0, 'N', 0, '2011-02-03', NULL, NULL, 40.1611, -111.606, NULL, NULL),
('270627913', 'W12006485', 'W12006485', 'UT01', 'Hobble Creek Medical Center', 'Ian', 'B', 'McMaster', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 9117', 'Belfast', 'Waldo', 'ME', '04915', '8014919883', NULL, 'PO Box 9117', 'Belfast', 'Waldo', 'ME', '04915', '8014919883', '          ', 'WUTCTY', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1598799462', 0, 'N', 0, '2011-02-03', NULL, NULL, 0, 0, NULL, NULL),
('270627913', 'W12006486', 'W12006486', 'UT01', 'Hobble Creek Medical Center', 'George', 'H', 'Michalek', 'MD', 'Pediatrics', '', '', NULL, 'O', '269 E 400 S Ste 2', 'Springville', 'Utah', 'UT', '84663', '8014919883', '8014893141', '269 E 400 S Ste 2', 'Springville', 'Utah', 'UT', '84663', '8014919883', '8014893141', 'WUTCTY', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1225062904', 0, 'N', 0, '2011-02-03', NULL, NULL, 40.1611, -111.606, NULL, NULL),
('270627913', 'W12006487', 'W12006487', 'UT01', 'Hobble Creek Medical Center', 'George', 'H', 'Michalek', 'MD', 'Pediatrics', '', '', NULL, 'B', 'PO Box 9117', 'Belfast', 'Waldo', 'ME', '04915', '8014919883', '8014893141', 'PO Box 9117', 'Belfast', 'Waldo', 'ME', '04915', '8014919883', '8014893141', 'WUTCTY', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1225062904', 0, 'N', 0, '2011-02-03', NULL, NULL, 0, 0, NULL, NULL),
('547769846', 'W12006489', 'W12006489', 'UT01', '', 'Val', 'G', 'Mullinax', 'DPM', 'Podiatry', '', '', NULL, 'O', '1275 N University Ave Ste 12', 'Provo', 'Utah', 'UT', '84604', '8013746900', '8013746901', '1275 N University Ave Ste 12', 'Provo', 'Utah', 'UT', '84604', '8013746900', '8013746901', 'WUTCTY', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', '2013-02-15', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1528179256', 0, 'N', 0, '2014-06-04', NULL, NULL, 0, 0, NULL, NULL),
('547769846', 'W12006488', 'W12006488', 'UT01', '', 'Val', 'G', 'Mullinax', 'DPM', 'Podiatry', '', '', NULL, 'O', '1928 N 1120 W Ste 6', 'Provo', 'Utah', 'UT', '84604', '8013743010', '8013772426', '1928 N 1120 W Ste 6', 'Provo', 'Utah', 'UT', '84604', '8013743010', '8013772426', 'WUTCTY', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-15', '2013-02-15', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1528179256', 0, 'N', 0, '2014-06-04', NULL, NULL, 0, 0, NULL, NULL),
('528518241', 'W12005993', 'W12005993', 'UTMH1', 'Preferred Family Clinic', 'Nancy', 'L', 'Belliston', 'LCSW', 'Mental Health', 'Social Worker', 'Counseling', NULL, 'O', '1355 N University Ave Ste 200', 'Provo', 'Utah', 'UT', '84604', '8012210223', '8012210291', '1355 N University Ave Ste 200', 'Provo', 'Utah', 'UT', '84604', '8012210223', '8012210291', 'UTMA', '', '', '0.00', '35.00', '0.00', 3, '2010-11-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1841468147', 0, 'N', 0, '2014-05-16', NULL, NULL, 0, 0, NULL, NULL),
('270354831', 'W12006491', 'W12006491', 'UT01', 'Integrative Medical Associates', 'Stuart', 'B', 'Porter', 'DO', 'Family Practice', '', '', NULL, 'O', '3650 N University Ave Ste 200', 'Provo', 'Utah', 'UT', '84604', '8013757100', '8013757102', '3650 N University Ave Ste 200', 'Provo', 'Utah', 'UT', '84604', '8013757100', '8013757102', 'WUTCTY', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-01-01', NULL, 0, NULL, 0, 'Timpanogos Regional Hospital', 'Mountain View Hospital', '', '', 'HCFA|UB|', '1689612996', 0, 'N', 0, '2013-04-11', NULL, NULL, 40.2823, -111.658, NULL, NULL),
('841699386', 'W12006492', 'W12006492', 'ID02', 'Rausch Chiropractic', 'Jeremy', 'H', 'Rausch', 'DC', 'Chiropractic', '', '', NULL, 'O', '1390 S Maple Grove Rd Ste 200', 'Boise', 'Ada', 'ID', '83709', '2086720100', '2086720200', '1390 S Maple Grove Rd Ste 200', 'Boise', 'Ada', 'ID', '83709', '2086720100', '2086720200', 'IDCHIRO1', '', '', '0.00', '35.00', '0.00', 3, '2010-11-01', '2011-01-23', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1679648679', 0, 'N', 0, '2012-03-23', NULL, NULL, 0, 0, NULL, NULL),
('460516456', 'W12006493', 'W12006493', 'ID02', 'Modern Dental', 'Chad', 'W', 'Roskelley', 'DDS', 'Sleep Apnea Device', 'Durable Medical Equipment', '', NULL, 'O', '2031 E Hospitality Ln Ste 100', 'Boise', 'Ada', 'ID', '83716', '2083339999', '2083435889', '2031 E Hospitality Ln Ste 100', 'Boise', 'Ada', 'ID', '83716', '2083339999', '2083435889', 'MODERNDENT', '', '', '0.00', '100.00', '0.00', 3, '2010-11-15', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1508979766', 0, 'N', 0, '2014-07-23', NULL, NULL, 0, 0, NULL, NULL),
('460516456', 'W12006494', 'W12006494', 'ID02', 'Modern Dental', 'Edward (Ted)', 'C', 'Wagner', 'DMD', 'Sleep Apnea Device', 'Durable Medical Equipment', '', NULL, 'O', '2031 E Hospitality Ln Ste 100', 'Boise', 'Ada', 'ID', '83716', '2083339999', '2083435889', '2031 E Hospitality Ln Ste 100', 'Boise', 'Ada', 'ID', '83716', '2083339999', '2083435889', 'MODERNDENT', '', '', '0.00', '100.00', '0.00', 3, '2010-11-15', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1740393917', 0, 'N', 0, '2014-07-23', NULL, NULL, 0, 0, NULL, NULL),
('680548602', 'W12006495', 'W12006495', 'Sinclair', '(Sinclair Health Services\rProvider) Verst Spine and Orthopedic Care', 'David', 'B', 'Verst', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '15 W Galena St', 'Hailey', 'Blaine', 'ID', '83333', '2087887779', NULL, '15 W Galena St', 'Hailey', 'Blaine', 'ID', '83333', '2087887779', '          ', 'IDSINCLAIRD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|UB|', '1164465977', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('830283425', 'W12006496', 'W12006496', 'WY01', 'North Platte Physical Therapy', 'Todd', 'L', 'Gentzler', 'PT', 'Physical Therapy', '', '', NULL, 'O', '620 4J Ct Ste B', 'Gillette', 'Campbell', 'WY', '82716', '3076862569', '3076862615', '620 4J Ct Ste B', 'Gillette', 'Campbell', 'WY', '82716', '3076862569', '3076862615', 'WYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2010-12-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1548224140', 0, 'N', 0, '2014-07-24', NULL, NULL, 44.2835, -105.51, NULL, NULL),
('272825194', 'W12006497', 'W12006497', 'UT01', 'Lakeside Audiology', 'Marilyn', 'K', 'Howe', 'ST', 'Speech Therapy', NULL, NULL, NULL, 'O', '70 S Fairfield Rd Ste 10', 'Layton', 'Davis', 'UT', '84041', '8014440300', NULL, '70 S Fairfield Rd Ste 10', 'Layton', 'Davis', 'UT', '84041', '8014440300', '          ', 'WUDME5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-11-01', '2011-09-30', 0, 0, 0, 'Primary Childrens Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1508941543', 0, 'N', 0, '2011-10-26', NULL, NULL, 0, 0, NULL, NULL),
('272789328', 'W12006498', 'W12006498', 'UTMH1', 'All Ages & LIfe Stages Counseling', 'Dwight', 'D', 'Hurst', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '2363 N Hillfield Rd Ste 5', 'Layton', 'Davis', 'UT', '84041', '8014253628', NULL, '2363 N Hillfield Rd Ste 5', 'Layton', 'Davis', 'UT', '84041', '8014253628', '          ', 'MA', '', '', '0.00', '35.00', '0.00', 3, '2010-11-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1043474620', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('870528056', 'W12006500', 'W12006500', 'UT01', '', 'Christopher', 'J', 'Jolles', 'MD', 'Gynecologic Oncology', NULL, NULL, NULL, 'O', '12391 S 4000 W Ste 208', 'Riverton', 'Salt Lake', 'UT', '84065', '8013025360', '8013027898', '12391 S 4000 W Ste 208', 'Riverton', 'Salt Lake', 'UT', '84065', '8013025360', '8013027898', 'WiseSTD10A', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-07-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1841346756', 0, 'N', 0, '2012-08-20', NULL, NULL, 40.5226, -111.987, NULL, NULL),
('870528056', 'W12006501', 'W12006501', 'UT01', '', 'Christopher', 'J', 'Jolles', 'MD', 'Gynecologic Oncology', NULL, NULL, NULL, 'B', 'PO Box 29675 Dept 2078', 'Phoenix', 'Maricopa', 'AZ', '85038', '8012660878', '8012662074', 'PO Box 29675 Dept 2078', 'Phoenix', 'Maricopa', 'AZ', '85038', '8012660878', '8012662074', 'WiseSTD10A', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-07-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1841346756', 0, 'N', 0, '2012-08-20', NULL, NULL, 0, 0, NULL, NULL),
('272825194', 'W12006502', 'W12006502', 'UT01', 'Lakeside Audiology', 'Jennie', '', 'Mollerup', 'AUD', 'Audiology', '', '', NULL, 'O', '70 S Fairfield Rd Ste 10', 'Layton', 'Davis', 'UT', '84041', '8014440300', NULL, '70 S Fairfield Rd Ste 10', 'Layton', 'Davis', 'UT', '84041', '8014440300', '          ', 'WUDME5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-11-01', '2011-09-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1376662791', 0, 'N', 0, '2011-10-26', NULL, NULL, 0, 0, NULL, NULL),
('272825194', 'W12006503', 'W12006503', 'UT01', 'Lakeside Audiology', 'Jennie', '', 'Mollerup', 'AUD', 'Audiology', '', '', NULL, 'O', '74 E 500 S Ste 112', 'Bountiful', 'Davis', 'UT', '84010', '8012946200', NULL, '74 E 500 S Ste 112', 'Bountiful', 'Davis', 'UT', '84010', '8012946200', '          ', 'WUDME5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-11-01', '2011-09-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1376662791', 0, 'N', 0, '2011-10-26', NULL, NULL, 0, 0, NULL, NULL),
('272825194', 'W12006505', 'W12006505', 'UT01', 'Lakeside Audiology', 'Kent', 'J', 'Nielsen', 'AUD', 'Audiology', NULL, NULL, NULL, 'O', '3651 Wall Ave Ste 1127', 'Ogden', 'Weber', 'UT', '84405', '8016120202', NULL, '3651 Wall Ave Ste 1127', 'Ogden', 'Weber', 'UT', '84405', '8016120202', '          ', 'WUDME5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-11-01', '2011-01-17', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1689744138', 0, 'N', 0, '2011-10-26', NULL, NULL, 0, 0, NULL, NULL),
('272825194', 'W12006504', 'W12006504', 'UT01', 'Lakeside Audiology', 'Kent', 'J', 'Nielsen', 'AUD', 'Audiology', NULL, NULL, NULL, 'O', '70 S Fairfield Rd Ste 10', 'Layton', 'Davis', 'UT', '84041', '8014440300', NULL, '70 S Fairfield Rd Ste 10', 'Layton', 'Davis', 'UT', '84041', '8014440300', '          ', 'WUDME5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-11-01', '2011-01-17', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1689744138', 0, 'N', 0, '2011-10-26', NULL, NULL, 0, 0, NULL, NULL),
('870304200', 'W12006466', 'W12006466', 'UT01', '', 'Curtis', 'Emil', 'Cook', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '10358 S 1700 W', 'South Jordan', 'Salt Lake', 'UT', '84095', '8015614257', '8012545739', '10358 S 1700 W', 'South Jordan', 'Salt Lake', 'UT', '84095', '8015614257', '8012545739', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2010-11-01', '2012-07-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1972640555', 0, 'N', 0, '2012-07-09', NULL, NULL, 0, 0, NULL, NULL),
('470918269', 'W12006467', 'W12006467', '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', '55.46', 3, '2010-11-01', '2012-05-11', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1114977105', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('260519219', 'W12006468', 'W12006468', 'UT01', 'Swenson Chiropractic', 'Joseph', 'Woodruff', 'Swenson', 'DC', 'Chiropractic', '', '', NULL, 'O', '3564 S 7200 W Ste D', 'Magna', 'Salt Lake', 'UT', '84044', '8015087246', '8015081902', '3564 S 7200 W Ste D', 'Magna', 'Salt Lake', 'UT', '84044', '8015087246', '8015081902', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2010-11-01', '2012-01-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1194843698', 0, 'N', 0, '2012-06-26', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W12006508', 'W12006508', 'UT01', 'Jordan Valley Neurology', 'Rebecca', 'H', 'Reiser', 'MD', 'Neurology', '', '', NULL, 'O', '3590 W 9000 S Ste 240', 'West Jordan', 'Salt Lake', 'UT', '84088', '8013528373', '8013528459', '3590 W 9000 S Ste 240', 'West Jordan', 'Salt Lake', 'UT', '84088', '8013528373', '8013528459', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-12-01', '2014-04-30', 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1639336795', 0, 'N', 0, '2014-03-05', NULL, NULL, 40.5879, -111.976, NULL, NULL),
('621801973', 'W12006510', 'W12006510', 'UT01', 'Neurology Associates in Assoc with JVMC', 'Rebecca', 'H', 'Reiser', 'MD', 'Neurology', '', '', NULL, 'M', '406 W S Jordan Pkwy Ste 450', 'South Jordan', 'Salt Lake', 'UT', '84095', '8013528373', '8013528459', '406 W S Jordan Pkwy Ste 450', 'South Jordan', 'Salt Lake', 'UT', '84095', '8013528373', '8013528459', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-12-01', '2014-04-30', 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1639336795', 0, 'N', 0, '2013-09-20', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W12006509', 'W12006509', 'UT01', 'Neurology Associates in Assoc with JVMC', 'Rebecca', 'H', 'Reiser', 'MD', 'Neurology', '', '', 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, '2010-12-01', '2014-04-30', 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1639336795', 0, 'N', 0, '2013-09-20', NULL, NULL, 0, 0, NULL, NULL),
('270613074', 'W12006511', 'W12006511', 'Sinclair', 'LS Educational and Psychoeducational Services', 'Liza', 'D', 'Sanderson', 'LPC', 'Mental Health', '', '', NULL, 'O', '2980 Shetland Dr', 'Rawlins', 'Carbon', 'WY', '82301', '3077603611', NULL, '2980 Shetland Dr', 'Rawlins', 'Carbon', 'WY', '82301', '3077603611', '          ', 'WYMA', '', '', '0.00', '35.00', '0.00', 3, '2010-06-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1447584511', 0, 'N', 0, '2013-07-15', NULL, NULL, 0, 0, NULL, NULL),
('270613074', 'W12006512', 'W12006512', 'WY01', 'LS Educational and Psychoeducational Services', 'Liza', 'D', 'Sanderson', 'LPC', 'Mental Health', '', '', NULL, 'O', '2980 Shetland Dr', 'Rawlins', 'Carbon', 'WY', '82301', '3077603611', NULL, '2980 Shetland Dr', 'Rawlins', 'Carbon', 'WY', '82301', '3077603611', '          ', 'WYMA', '', '', '0.00', '35.00', '0.00', 3, '2010-06-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1447584511', 0, 'N', 0, '2013-07-15', NULL, NULL, 0, 0, NULL, NULL),
('770701557', 'W12003170', 'W12003170', 'UT01', 'Lone Peak Family Medicine', 'Matthew', 'T', 'Andersen', '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', 'WUSTDFAM5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-07-01', '2010-09-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1922070093', 0, 'N', 1, '2014-04-09', NULL, NULL, 0, 0, NULL, NULL),
('870366239', 'W12006514', 'W12006514', 'UT01', 'Downtown Chiropractic & Message Therapy', 'Michael', '', 'Lane', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '525 E 100 S Ste 420', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013223067', '8013224054', '525 E 100 S Ste 420', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013223067', '8013224054', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2010-11-01', '2012-07-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1376637116', 0, 'N', 0, '2012-07-09', NULL, NULL, 0, 0, NULL, NULL),
('362844357', 'W12024049', 'W12024049', 'ILCHIGSTD', 'Kundan Giri MD', 'Kundan', '', 'Giri', 'MD', 'Pediatrics', '', '', NULL, 'O', '8319 W North Ave', 'Melrose Park', 'Cook', 'IL', '60160', '7084509700', '7084509978', '8319 W North Ave', 'Melrose Park', 'Cook', 'IL', '60160', '7084509700', '7084509978', 'CHIG11', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, '', '', 'HCFA|UB|', '1265481659', 0, 'N', 0, '2013-04-26', NULL, NULL, 41.9085, -87.8264, NULL, NULL),
('870478993', 'W12006518', 'W12006518', 'UT01', 'University Health Care', 'Joseph', 'T', 'Krezowski', 'MD', 'Internal Medicine', '', '', NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015817818', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015817818', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2010-07-01', '2012-08-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1811149818', 0, 'N', 0, '2012-08-31', 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
('870478993', 'W12006517', 'W12006517', 'UT01', 'U-U General Medicine Division', 'Joseph', 'T', 'Krezowski', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '8414', '8012133800', NULL, 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '8414', '8012133800', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2010-07-01', '2012-08-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1811149818', 0, 'N', 0, '2012-08-31', NULL, NULL, 0, 0, NULL, NULL),
('870442755', 'W12006521', 'W12006521', 'UT01', 'University Health Care', 'Mir-Mustafa', '', 'Mir-Kasimov', 'MD', 'Internal Medicine', 'Pulmonary', '', NULL, 'o', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015817806', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015817806', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2010-07-01', '2012-08-26', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1841401155', 0, 'N', 0, '2012-08-27', NULL, NULL, 0, 0, NULL, NULL),
('870442755', 'W12006520', 'W12006520', 'UT01', 'U-U Pulmonary Division', 'Mir-Mustafa', '', 'Mir-Kasimov', 'MD', 'Internal Medicine', 'Pulmonary', '', NULL, 'B', 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2010-07-01', '2012-08-26', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1841401155', 0, 'N', 0, '2012-08-27', NULL, NULL, 0, 0, NULL, NULL),
('237268471', 'W12006523', 'W12006523', 'UT01', 'University Radiology Associates', 'Lauren', 'V', 'Zollinger', 'MD', 'Radiology', '', '', NULL, 'o', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015812121', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015812121', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2010-07-01', '2012-08-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1548443716', 0, 'N', 0, '2013-04-12', NULL, NULL, 0, 0, NULL, NULL),
('237268471', 'W12006524', 'W12006524', 'UT01', 'University Radiology Associates', 'Lauren', 'V', 'Zollinger', 'MD', 'Radiology', '', '', NULL, 'B', 'PO Box 413025', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413025', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2010-07-01', '2012-08-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1548443716', 0, 'N', 0, '2013-04-12', NULL, NULL, 0, 0, NULL, NULL),
('743134253', 'W12006526', 'W12006526', 'UT01', 'University Health Care', 'Holly', 'L', 'Spraker-Perlman', 'MD', 'Pediatric Hematology - Oncology', '', '', NULL, 'O', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016624700', '8016624705', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016624700', '8016624705', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2010-06-14', '2012-07-30', 0, 0, 0, 'Primary Childrens Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1235385832', 0, 'N', 0, '2013-09-12', NULL, NULL, 0, 0, NULL, NULL),
('743134253', 'W12006527', 'W12006527', 'UT01', 'University Health Care', 'Holly', 'L', 'Spraker-Perlman', 'MD', 'Pediatric Hematology - Oncology', '', '', NULL, 'B', 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '8015853655', 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '8015853655', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2010-06-14', '2012-07-30', 0, 0, 0, 'Primary Childrens Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1235385832', 0, 'N', 0, '2013-09-12', NULL, NULL, 0, 0, NULL, NULL),
('710885968', 'W12006529', 'W12006529', 'ID01', 'U of U Pain Management Physicians Group', 'Eric', 'A', 'Yelsa', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'B', 'PO Box 413034', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413034', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2010-05-01', '2012-08-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1093775298', 0, 'N', 0, '2012-08-31', NULL, NULL, 0, 0, NULL, NULL),
('710885968', 'W12006530', 'W12006530', 'UT01', 'University Health Care', 'Eric', 'A', 'Yelsa', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '546 Chipeta Way', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015816393', NULL, '546 Chipeta Way', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015816393', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2010-05-01', '2012-08-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1093775298', 0, 'N', 0, '2012-08-31', NULL, NULL, 0, 0, NULL, NULL),
('870567427', 'W12006533', 'W12006533', 'UT01', 'University Health Care', 'James', 'M', 'Wilson', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015812292', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015812292', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2010-07-01', '2011-05-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1023269172', 0, 'N', 0, '2010-11-18', NULL, NULL, 0, 0, NULL, NULL),
('870567427', 'W12006532', 'W12006532', 'UT01', 'U of U Emergency Physicians', 'James', 'M', 'Wilson', 'MD', 'Emergency Medicine', '', '', NULL, 'B', 'PO Box 510726', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8012133800', NULL, 'PO Box 510726', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8012133800', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2010-07-01', '2011-05-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1023269172', 0, 'N', 0, '2010-11-18', NULL, NULL, 0, 0, NULL, NULL),
('870648457', 'W12006536', 'W12006536', 'UT01', 'University Health Care', 'Shani', '', 'Allred', 'APRN', 'Obstetrics and Gynecology', '', '', NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015879500', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015879500', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2010-07-15', '2012-08-21', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1700104445', 0, 'N', 0, '2012-08-22', NULL, NULL, 0, 0, NULL, NULL),
('870648457', 'W12006535', 'W12006535', 'UT01', 'University Health Care', 'Shani', '', 'Allred', 'APRN', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 1674', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8015876303', NULL, 'PO Box 1674', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8015876303', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2010-07-15', '2012-08-21', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1700104445', 0, 'N', 0, '2012-08-22', NULL, NULL, 0, 0, NULL, NULL),
('743134258', 'W12006539', 'W12006539', 'UT01', 'University Health Care', 'Ryann', '', 'Bierer', 'MD', 'Pediatrics', '', '', 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, '2010-07-27', '2012-07-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1518180397', 0, 'N', 0, '2012-07-31', NULL, NULL, 0, 0, NULL, NULL),
('743134258', 'W12006538', 'W12006538', 'UT01', 'Pediatric Neonatology-Department of University of Utah', 'Ryann', '', 'Bierer', 'MD', 'Pediatrics', '', '', NULL, 'B', 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '8015853655', 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '8015853655', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2010-07-27', '2012-07-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1518180397', 0, 'N', 0, '2012-07-31', NULL, NULL, 0, 0, NULL, NULL),
('942764098', 'W12006540', 'W12006540', 'UT01', 'University Health Care', 'Erica', 'F', 'Bisson', 'MD', 'Neurosurgery', '', '', NULL, 'O', '145 W University Pkwy', 'Orem', 'Utah', 'UT', '84058', '6571234120', NULL, '145 W University Pkwy', 'Orem', 'Utah', 'UT', '84058', '6571234120', '          ', 'WUUNEURO', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2009-09-01', '2012-08-20', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1750409520', 0, 'N', 0, '2012-08-21', NULL, NULL, 0, 0, NULL, NULL),
('870480520', 'W12006542', 'W12006542', 'UT01', 'University Health Care', 'Elizabeth', 'J', 'Burlew', 'APRN', 'Cardiovascular Disease', '', '', NULL, 'o', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015856387', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015856387', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2007-01-01', '2012-08-09', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1023219490', 0, 'N', 0, '2012-08-10', NULL, NULL, 0, 0, NULL, NULL),
('870480520', 'W12006541', 'W12006541', 'UT01', 'Dept of Neurology School of Medicine U of U', 'Elizabeth', 'J', 'Burlew', 'APRN', 'Cardiovascular Disease', '', '', NULL, 'B', 'PO Box 413027', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413027', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2007-01-01', '2012-08-09', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1023219490', 0, 'N', 0, '2012-08-10', NULL, NULL, 0, 0, NULL, NULL),
('743134254', 'W12006544', 'W12006544', 'ID01', 'University of Utah Dept of Pediatric Immunology', 'Karin', '', 'Chen', 'MD', 'Allergy and Immunology', 'Pediatrics', '', NULL, 'O', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016624500', NULL, '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016624500', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2010-07-06', '2010-07-06', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1477877611', 0, 'N', 0, '2012-07-17', NULL, NULL, 0, 0, NULL, NULL),
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('237268471', 'W12006548', 'W12006548', 'UT01', 'University Radiology Associates', 'Brian', 'M', 'Chin', 'MD', 'Radiology', '', '', NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015812121', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015812121', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2010-07-01', '2012-08-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1558576157', 0, 'N', 0, '2012-08-02', NULL, NULL, 0, 0, NULL, NULL),
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('200489062', 'W12006589', 'W12006589', 'ID02', 'Sandoval Advanced Vein Care', 'Jesse', '', 'Sandoval', 'DO', 'Internal Medicine', '', '', NULL, 'O', '1199 Shoreline Ln Ste 310', 'Boise', 'Ada', 'ID', '83702', '2083331472', '2083337757', '1199 Shoreline Ln Ste 310', 'Boise', 'Ada', 'ID', '83702', '2083331472', '2083337757', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2010-12-01', NULL, 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1972552271', 0, 'N', 0, '2014-07-25', NULL, NULL, 0, 0, NULL, NULL),
('200489062', 'W12006590', 'W12006590', 'ID02', 'Sandoval Advanced Vein Care', 'Jesse', '', 'Sandoval', 'DO', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 7130', 'Boise', 'Ada', 'ID', '83707', '2083331472', '2083337757', 'PO Box 7130', 'Boise', 'Ada', 'ID', '83707', '2083331472', '2083337757', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2010-12-01', NULL, 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1972552271', 0, 'N', 0, '2014-07-25', NULL, NULL, 0, 0, NULL, NULL),
('200525828', 'W12006591', 'W12006591', 'UTMH1', 'Wasatch Psychological Services', 'Kay', '', 'Koellner', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '505 E 200 S Ste 303', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '          ', NULL, '505 E 200 S Ste 303', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '          ', '          ', 'PHD', '', '', '0.00', '35.00', '0.00', 3, '2011-02-01', '2013-02-14', 0, NULL, 0, '', '', '', '', 'HCFA|UB|', '1790896132', 0, 'N', 0, '2011-01-28', NULL, NULL, 0, 0, NULL, NULL),
('205529469', 'W12006595', 'W12006595', 'UT01', 'University Health Care', 'Carly', 'E', 'Day', 'MD', 'Physical Medicine and Rehabilitation', '', '', NULL, 'O', '1493 Lowell Ave', 'Park City', 'Summit', 'UT', '84060', '4356557079', NULL, '1493 Lowell Ave', 'Park City', 'Summit', 'UT', '84060', '4356557079', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2010-08-03', '2012-08-21', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1215149810', 0, 'N', 0, '2012-08-22', NULL, NULL, 0, 0, NULL, NULL),
('870515631', 'W12006594', 'W12006594', 'UT01', 'University Health Care', 'Carly', 'E', 'Day', 'MD', 'Physical Medicine and Rehabilitation', '', '', NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015812267', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015812267', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2010-08-03', '2012-08-22', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1215149810', 0, 'N', 0, '2012-08-23', NULL, NULL, 0, 0, NULL, NULL),
('205529469', 'W12006596', 'W12006596', 'UT01', 'University Health Care Park City Mountain Resort Urgent Care', 'Carly', 'E', 'Day', 'MD', 'Physical Medicine and Rehabilitation', '', '', NULL, 'B', 'PO Box 58108', 'Salt Lake City', 'Salt Lake', 'UT', '84158', '8015813998', NULL, 'PO Box 58108', 'Salt Lake City', 'Salt Lake', 'UT', '84158', '8015813998', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2010-08-03', '2012-08-21', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1215149810', 0, 'N', 0, '2012-08-22', NULL, NULL, 0, 0, NULL, NULL),
('870515631', 'W12006593', 'W12006593', 'UT01', 'UUMC Rehab Medicine', 'Carly', 'E', 'Day', 'MD', 'Physical Medicine and Rehabilitation', '', '', NULL, 'B', 'PO Box 413032', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413032', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2010-08-03', '2012-08-22', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1215149810', 0, 'N', 0, '2012-08-23', NULL, NULL, 0, 0, NULL, NULL),
('870442845', 'W12006599', 'W12006599', 'UT01', 'University Health Care', 'Michael', 'W', 'Deininger', 'MD', 'Hematology', '', '', NULL, 'O', '1950 Circle of Hope Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84112', '8015850100', NULL, '1950 Circle of Hope Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84112', '8015850100', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2010-09-01', '2012-08-27', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1932115524', 0, 'N', 0, '2012-08-28', NULL, NULL, 0, 0, NULL, NULL),
('870442845', 'W12006598', 'W12006598', 'UT01', 'Huntsman Cancer Institute', 'Michael', 'W', 'Deininger', 'MD', 'Hematology', '', '', NULL, 'B', 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2010-09-01', '2012-08-27', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1932115524', 0, 'N', 0, '2012-08-28', NULL, NULL, 0, 0, NULL, NULL),
('870443152', 'W12006600', 'W12006600', 'UT01', 'University Health Care', 'Sara', 'D', 'Feltz', 'PA', 'Family Practice', '', '', NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015817763', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015817763', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2009-11-09', '2012-08-27', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1821323742', 0, 'N', 0, '2012-08-28', NULL, NULL, 0, 0, NULL, NULL),
('870443152', 'W12006601', 'W12006601', 'UT01', 'U-U Endocrinology Division', 'Sara', 'D', 'Feltz', 'PA', 'Family Practice', '', '', NULL, 'B', 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2009-11-09', '2012-08-27', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1821323742', 0, 'N', 0, '2012-08-28', NULL, NULL, 0, 0, NULL, NULL),
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('870443687', 'W12006603', 'W12006603', 'UT01', 'U-U Cardiology Division', 'Bradford', 'A', 'Gale', 'PA', 'Family Practice', '', '', NULL, 'B', 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2010-08-18', '2012-08-29', 0, 0, 0, 'Jordan Valley Medical Center', 'Salt Lake Regional Medical Center', NULL, NULL, 'HCFA|UB|', '1932126976', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('300655165', 'W12012483', 'W12012483', 'UT01', 'Pediatric Emergency Sedation Service', '', '', 'Pediatric Emergency Sedation Service', 'Group', 'Clinics', '', '', NULL, 'B', 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8015853655', NULL, 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8015853655', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2011-08-01', '2012-07-26', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1245524651', 0, 'N', 0, '2012-07-27', NULL, NULL, 0, 0, NULL, NULL),
('760215922', 'W12006617', 'W12006617', 'ID01', 'Coram Specialty Infusion Services', '', '', 'Coram, Inc', '', 'Infusion Agency', '', '', NULL, 'O', '11660 W Executive Dr', 'Boise', 'Ada', 'ID', '83713', '8008288149', NULL, '11660 W Executive Dr', 'Boise', 'Ada', 'ID', '83713', '8008288149', '          ', '', '', '1001', '0.00', '60.00', '0.00', 3, '2010-11-29', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1912953431', 0, 'N', 0, '2010-11-29', NULL, NULL, 0, 0, NULL, NULL),
('760215922', 'W12006618', 'W12006618', 'ID01', 'Coram Specialty Infusion Services', '', '', 'Coram, Inc', '', 'Infusion Agency', '', '', NULL, 'B', 'PO Box 74798', 'Chicago', 'Cook', 'IL', '60694', '8008288149', NULL, 'PO Box 74798', 'Chicago', 'Cook', 'IL', '60694', '8008288149', '          ', '', '', '1001', '0.00', '60.00', '0.00', 3, '2010-11-29', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1912953431', 0, 'Y', 0, '2010-11-29', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12006619', 'W12006619', 'UTIHCPHY', 'Southwest Regional Cancer Clinic', 'Karim', '', 'Anwar', 'MD', 'Oncology', '', '', NULL, 'O', '1303 N Main St', 'Cedar City', 'Iron', 'UT', '84720', '4358685690', NULL, '1303 N Main St', 'Cedar City', 'Iron', 'UT', '84720', '4358685690', '          ', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2010-09-13', '2012-05-25', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1053350140', 0, 'N', 0, '2012-06-01', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12006621', 'W12006621', 'UTIHCPHY', 'Southwest Cardiology - St George', 'Robert', '', 'Hurst', 'APRN', 'Cardiovascular Disease', '', '', NULL, 'O', '1380 E Medical Ctr Dr Ste 1500', 'St George', 'Washington', 'UT', '84790', '4352512500', NULL, '1380 E Medical Ctr Dr Ste 1500', 'St George', 'Washington', 'UT', '84790', '4352512500', '          ', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2010-11-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1639488950', 0, 'N', 0, '2013-06-03', NULL, NULL, 37.0998, -113.554, NULL, NULL),
('942854057', 'W12006623', 'W12006623', 'UTIHCPHY', 'Redrock Pediatrics', 'Cara', 'C', 'Smith', 'PA', 'Pediatrics', '', '', NULL, 'O', '1380 E Medical Ctr Dr Ste 3100', 'St George', 'Washington', 'UT', '84790', '4352512740', NULL, '1380 E Medical Ctr Dr Ste 3100', 'Saint George', 'Washington', 'UT', '84790', '4352512740', '          ', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2010-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1124166053', 0, 'N', 0, '2010-11-29', NULL, NULL, 37.0998, -113.554, NULL, NULL),
('942854057', 'W12006625', 'W12006625', 'UTIHCPHY', 'Budge Clinic Surgical Specialists', 'Kathleen', 'M', 'Stahl', 'APRN', 'Family Practice', '', '', NULL, 'O', '1350 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357921950', NULL, '1350 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357921950', '          ', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2010-11-01', NULL, 0, 0, 0, 'Logan Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1053625541', 0, 'N', 0, '2010-11-29', NULL, NULL, 41.7565, -111.821, NULL, NULL),
('870299862', 'W12006490', 'W12006490', 'UTMH1', 'LDS Family Services', 'Kevin', 'D', 'Broderick', 'LMFT', 'Mental Health', 'Counseling', '', NULL, 'O', '94 E Pages Ln Ste A', 'Centerville', 'Davis', 'UT', '84014', '8012940578', '8012982147', '94 E Pages Ln Ste A', 'Centerville', 'Davis', 'UT', '84014', '8012940578', '8012982147', 'MA', '', '', '0.00', '35.00', '0.00', 8, '2011-01-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1255485793', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('870299862', 'W12006626', 'W12006626', 'UTMH1', 'LDS Family Services', 'Stephanie', '', 'Farnes', 'LMFT', 'Mental Health', 'Counseling', '', NULL, 'O', '930 W Hill Field Rd Ste A', 'Layton', 'Davis', 'UT', '84041', '8013363040', '8013363041', '930 W Hill Field Rd Ste A', 'Layton', 'Davis', 'UT', '84041', '8013363040', '8013363041', 'ma', '', '', '0.00', '35.00', '0.00', 8, '2011-01-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1114186202', 0, 'N', 0, '2014-07-22', NULL, NULL, 0, 0, NULL, NULL),
('201312583', 'W12006627', 'W12006627', 'ID01', 'Life Counseling Center', 'Matthew', 'C', 'Genuchi', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '112 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2084655433', NULL, '112 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2084655433', '', 'IDPHD', '', '', '0.00', '35.00', '0.00', 6, '2011-02-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1477875631', 0, 'N', 0, '2014-04-02', NULL, NULL, 0, 0, NULL, NULL),
('841429983', 'W12006628', 'W12006628', 'UT01', 'Cotton Tree Medical', 'Richard', 'J', 'Holmes', 'MD', 'Family Practice', 'Obstetrics and Gynecology', '', NULL, 'O', '2230 N University Pkwy Ste 1A', 'Provo', 'Utah', 'UT', '84604', '8013773413', '8016551890', '2230 N University Pkwy Ste 1A', 'Provo', 'Utah', 'UT', '84604', '8013773413', '8016551890', 'WUTCTY', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-02-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1083601942', 0, 'N', 0, '2011-01-28', NULL, NULL, 40.2621, -111.666, NULL, NULL),
('820527710', 'W12006629', 'W12006629', 'Sinclair', 'St Lukes Sun Valley Sport Medicine', 'Daniel', 'B', 'Judd', '(Sinclair Health Service Provider)', 'Orthopedic Surgery', '', '', NULL, 'O', '191 5th St W', 'Ketchum', 'Blaine', 'ID', '83340', '2087265027', '2087268948', '191 5th St W', 'Ketchum', 'Blaine', 'ID', '83340', '2087265027', '2087268948', 'IDSINCLAIRE', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1073670360', 0, 'N', 0, '2012-12-27', NULL, NULL, 0, 0, NULL, NULL),
('273470943', 'W12006630', 'W12006630', 'UT01', '', 'Alma', 'L', 'Parker', 'MD', 'Family Practice', '', '', NULL, 'O', '175 N 100 W Ste 205C', 'Vernal', 'Uintah', 'UT', '84078', '4357816300', '4357816301', '175 N 100 W Ste 205C', 'Vernal', 'Uintah', 'UT', '84078', '4357816300', '4357816301', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-06-01', NULL, 0, 0, 0, 'Ashley Valley Regional Medical', '', '', '', 'HCFA|UB|', '1164474037', 0, 'N', 0, '2014-07-22', NULL, NULL, 40.4582, -109.53, NULL, NULL),
('273470943', 'W12006631', 'W12006631', 'UT01', '', 'Alma', 'L', 'Parker', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 150610', 'Ogden', 'Weber', 'UT', '84415', '4357816300', '4357816301', 'PO Box 150610', 'Ogden', 'Weber', 'UT', '84415', '4357816300', '4357816301', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-06-01', NULL, 0, 0, 0, 'Ashley Valley Regional Medical', '', '', '', 'HCFA|UB|', '1164474037', 0, 'N', 0, '2014-07-22', NULL, NULL, 0, 0, NULL, NULL),
('870235759', 'W12006632', 'W12006632', 'UT01', 'Central Utah Foot & Ankle Clinic', 'Scott', '', 'Rogers', 'DPM', 'Podiatry', '', '', NULL, 'O', '120 N 1220 E Ste 12', 'American Fork', 'Utah', 'UT', '84003', '8017564200', '8017568252', '120 N 1220 E Ste 12', 'American Fork', 'Utah', 'UT', '84003', '8017564200', '8017568252', 'WUTCTY', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-11-29', NULL, 0, 0, 0, 'Mountain West Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1821046418', 0, 'N', 0, '2011-10-24', NULL, NULL, 40.379, -111.765, NULL, NULL),
('870235759', 'W12006633', 'W12006633', 'UT01', 'Central Utah Foot & Ankle Clinic', 'Scott', '', 'Rogers', 'DPM', 'Podiatry', '', '', NULL, 'O', '150 W 800 N', 'Provo', 'Utah', 'UT', '84601', '8013755353', '8013755395', '150 W 800 N', 'Provo', 'Utah', 'UT', '84601', '8013755353', '8013755395', 'WUTCTY', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-11-29', NULL, 0, 0, 0, 'Mountain West Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1821046418', 0, 'N', 0, '2011-10-24', NULL, NULL, 40.2443, -111.661, NULL, NULL),
('841626016', 'W12006640', 'W12006640', 'UT01', 'UpZen Health', 'Matthew', 'Scott', 'Bailey', 'DC', 'Chiropractic', '', '', NULL, 'O', '9055 S 255 W', 'Sandy', 'Salt Lake', 'UT', '84070', '8015722272', '8015458744', '9055 S 255 W', 'Sandy', 'Salt Lake', 'UT', '84070', '8015722272', '8015458744', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2010-11-01', '2012-07-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1902036189', 0, 'N', 0, '2013-12-06', NULL, NULL, 0, 0, NULL, NULL),
('870560087', 'W12006635', 'W12006635', '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', '55.46', 3, '2010-11-01', '2012-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1790739324', 0, 'N', 0, '2012-05-08', NULL, NULL, 0, 0, NULL, NULL),
('870493137', 'W12006641', 'W12006641', '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', '55.46', 3, '2010-11-01', '2012-07-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1447206586', 0, 'N', 0, '2012-07-10', NULL, NULL, 0, 0, NULL, NULL),
('352371911', 'W12006637', 'W12006637', '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', '55.46', 3, '2010-11-01', '2012-07-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1639281421', 0, 'N', 0, '2012-07-10', NULL, NULL, 0, 0, NULL, NULL),
('840837536', 'W12006638', 'W12006638', 'UT01', 'Scott Chiropractic and Wellness', 'Theodore', '', 'Scott', 'DC', 'Chiropractic', '', '', NULL, 'O', '180 W Gordon Ave', 'Layton', 'Davis', 'UT', '84041', '8015444213', '8015444715', '180 W Gordon Ave', 'Layton', 'Davis', 'UT', '84041', '8015444213', '8015444715', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2010-11-01', '2012-01-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1417940891', 0, 'N', 0, '2012-02-15', NULL, NULL, 0, 0, NULL, NULL),
('113676182', 'W12006642', 'W12006642', 'TX01', '', 'Michael', 'L', 'Dempsey', 'DPM', 'Podiatry', '', '', NULL, 'O', '2115 Pleasanton Rd', 'San Antonio', 'Bexar', 'TX', '78221', '2109244999', NULL, '2115 Pleasanton Rd', 'San Antonio', 'Bexar', 'TX', '78221', '2109244999', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2010-12-01', '2012-08-19', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1003886789', 0, 'N', 0, '2013-05-23', NULL, NULL, 0, 0, NULL, NULL),
('820487790', 'W12006645', 'W12006645', 'ID01', 'Selah Medical Center', 'Janet', 'G', 'Robinson', 'DO', 'Family Practice', '', '', NULL, 'O', '1618 S Millennium Way Ste 220', 'Meridian', 'Ada', 'ID', '83642', '2082881717', '2083775335', '1618 S Millennium Way Ste 220', 'Meridian', 'Ada', 'ID', '83642', '2082881717', '2083775335', 'IDPCPSELAH', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2011-03-01', '2011-12-15', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1083688576', 0, 'N', 0, '2012-01-04', NULL, NULL, 43.5903, -116.368, NULL, NULL),
('820487790', 'W12006644', 'W12006644', 'ID01', 'Selah Medical Center', 'Janet', 'G', 'Robinson', 'DO', 'Family Practice', '', '', NULL, 'O', '6565 W Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083775055', '2083775335', '6565 W Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083775055', '2083775335', 'IDPCPSELAH', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2011-03-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1083688576', 0, 'N', 0, '2012-01-04', NULL, NULL, 43.6119, -116.268, 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
('870441813', 'W12006646', 'W12006646', 'UT01', '', 'Steven', 'D', 'Rowley', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '48 N 1100 E Ste B', 'American Fork', 'Utah', 'UT', '84003', '8017563788', '8017566364', '48 N 1100 E Ste B', 'American Fork', 'Utah', 'UT', '84003', '8017563788', '8017566364', 'WUTCTY', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-02-01', NULL, 0, 0, 0, 'Central Valley Medical Center', '', '', '', 'HCFA|UB|', '1124121538', 0, 'N', 0, '2014-07-23', NULL, NULL, 40.3774, -111.769, NULL, NULL),
('841433992', 'W12006647', 'W12006647', 'RCM01', 'Rosenberg Cooley Metcalf Clinic', 'Robert', 'M', 'Stirling', 'PA', 'Family Practice', '', '', 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, '2011-04-01', '2011-07-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1295049971', 0, 'N', 0, '2014-07-22', NULL, NULL, 0, 0, NULL, NULL),
('870479370', 'W12006648', 'W12006648', 'UT01', 'Mountain West Cardiovascular Associates', 'Charles', 'W', 'Tate', 'MD', 'Cardiovascular Disease', 'Electrophysiology', '', NULL, 'O', '1160 E 3900 S Ste 2000', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012663418', '8012884456', '1160 E 3900 S Ste 2000', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012663418', '8012884456', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-03-01', NULL, 0, 0, 0, 'St Marks Hospital', 'Valley View Medical Center', '', '', 'HCFA|UB|', '1376583526', 0, 'N', 0, '2014-05-27', NULL, NULL, 40.6871, -111.858, NULL, NULL),
('870479370', 'W12006649', 'W12006649', 'UT01', 'Mountain West Cardiovascular Associates', 'Charles', 'W', 'Tate', 'MD', 'Cardiovascular Disease', 'Electrophysiology', '', 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', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-03-01', NULL, 0, 0, 0, 'St Marks Hospital', 'Valley View Medical Center', '', '', 'HCFA|UB|', '1376583526', 0, 'N', 0, '2014-05-27', NULL, NULL, 40.5879, -111.976, NULL, NULL),
('841429983', 'W12006650', 'W12006650', 'UT01', 'Cotton Tree Medical', 'James', '', 'Woodmansee', 'MD', 'Family Practice', 'Obstetrics and Gynecology', '', NULL, 'O', '2230 N University Pkwy Ste 1A', 'Provo', 'Utah', 'UT', '84604', '8013773413', '8016551890', '2230 N University Pkwy Ste 1A', 'Provo', 'Utah', 'UT', '84604', '8013773413', '8016551890', 'WUTCTY', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-02-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1093703530', 0, 'N', 0, '2014-04-10', NULL, NULL, 40.2621, -111.666, NULL, NULL),
('942854057', 'W12006651', 'W12006651', 'UTIHC04', 'Anesthesia', 'Patrick', 'J', 'Knight', 'CRNA', 'Anesthesiologist', '', '', NULL, 'O', '126 S White Sage Ave', 'Delta', 'Millard', 'UT', '84624', '4352511000', '8014322670', '126 S White Sage Ave', 'Delta', 'Millard', 'UT', '84624', '4352511000', '8014322670', '', '', '', '0.00', '15.00', '0.00', 8, '2010-08-01', '2013-02-11', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1982922928', 0, 'Y', 0, '2013-09-12', NULL, NULL, 0, 0, NULL, NULL),
('942938348', 'W12006643', 'W12006643', 'UTMH1', 'Valley Mental Health  Inc', 'Kristine', '', 'Kokol', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', '5965 S 900 E Ste 430', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012637100', NULL, '5965 S 900 E Ste 430', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012637100', '          ', 'UTVMHMA', '', '', '0.00', '35.00', '0.00', 6, '2010-12-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1134370067', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12006653', 'W12006653', 'UTIHC01', 'Southwest Cardiology - St George', 'Alberto', 'A', 'Brizolara', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1380 E Medical Ctr Dr Ste 1500', 'St George', 'Washington', 'UT', '84790', '4352511000', NULL, '1380 E Medical Ctr Dr Ste 1500', 'St George', 'Washington', 'UT', '84790', '4352511000', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2010-11-15', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1164488961', 0, 'N', 0, '2013-03-11', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12006654', 'W12006654', 'UTIHC03', 'Southwest Cardiology - St George', 'Alberto', 'A', 'Brizolara', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1380 E Medical Ctr Dr Ste 1500', 'St George', 'Washington', 'UT', '84790', '4352511000', NULL, '1380 E Medical Ctr Dr Ste 1500', 'St George', 'Washington', 'UT', '84790', '4352511000', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2010-11-15', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1164488961', 0, 'N', 0, '2013-03-11', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12006655', 'W12006655', 'UTIHC04', 'Southwest Cardiology - St George', 'Alberto', 'A', 'Brizolara', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1380 E Medical Ctr Dr Ste 1500', 'St George', 'Washington', 'UT', '84790', '4352511000', NULL, '1380 E Medical Ctr Dr Ste 1500', 'St George', 'Washington', 'UT', '84790', '4352511000', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2010-11-15', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1164488961', 0, 'N', 0, '2013-03-11', NULL, NULL, 37.0998, -113.554, NULL, NULL),
('942854057', 'W12006656', 'W12006656', 'UTIHC01', '', 'Jaime', 'J', 'Molden', 'MD', 'Cardiovascular Disease', 'Internal Medicine', '', NULL, 'O', '1380 E Medical Ctr Dr', 'St George', 'Washington', 'UT', '84790', '4352511000', NULL, '1380 E Medical Ctr Dr', 'St George', 'Washington', 'UT', '84790', '4352511000', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2010-11-15', '2013-10-16', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1356540272', 0, 'N', 0, '2013-11-18', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12006657', 'W12006657', 'UTIHC03', '', 'Jaime', 'J', 'Molden', 'MD', 'Cardiovascular Disease', 'Internal Medicine', '', NULL, 'O', '1380 E Medical Ctr Dr', 'St George', 'Washington', 'UT', '84790', '4352511000', NULL, '1380 E Medical Ctr Dr', 'St George', 'Washington', 'UT', '84790', '4352511000', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2010-11-15', '2013-10-16', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1356540272', 0, 'N', 0, '2013-11-18', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12006658', 'W12006658', 'UTIHC04', '', 'Jaime', 'J', 'Molden', 'MD', 'Cardiovascular Disease', 'Internal Medicine', '', NULL, 'O', '1380 E Medical Ctr Dr', 'St George', 'Washington', 'UT', '84790', '4352511000', NULL, '1380 E Medical Ctr Dr', 'St George', 'Washington', 'UT', '84790', '4352511000', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2010-11-15', '2013-10-16', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1356540272', 0, 'N', 0, '2013-11-18', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12006659', 'W12006659', 'UTIHC01', 'Radiology', 'John', 'H', 'Jentzer', 'MD', 'Cardiovascular Disease', '', '', NULL, 'o', '1380 E Medical Ctr Dr', 'St George', 'Washington', 'UT', '84790', '4352511000', NULL, '1380 E Medical Ctr Dr', 'St George', 'Washington', 'UT', '84790', '4352511000', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2010-11-15', '2011-11-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1366413924', 0, 'N', 0, '2012-04-10', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12006660', 'W12006660', 'UTIHC03', 'Radiology', 'John', 'H', 'Jentzer', 'MD', 'Cardiovascular Disease', '', '', NULL, 'o', '1380 E Medical Ctr Dr', 'St George', 'Washington', 'UT', '84790', '4352511000', NULL, '1380 E Medical Ctr Dr', 'St George', 'Washington', 'UT', '84790', '4352511000', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2010-11-15', '2011-11-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1366413924', 0, 'N', 0, '2012-04-10', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12006661', 'W12006661', 'UTIHC04', 'Radiology', 'John', 'H', 'Jentzer', 'MD', 'Cardiovascular Disease', '', '', NULL, 'o', '1380 E Medical Ctr Dr', 'St George', 'Washington', 'UT', '84790', '4352511000', NULL, '1380 E Medical Ctr Dr', 'St George', 'Washington', 'UT', '84790', '4352511000', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2010-11-15', '2011-11-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1366413924', 0, 'N', 0, '2012-04-10', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12006662', 'W12006662', 'UTIHC04', 'Emergency Room', 'Randy', 'R', 'Lundell', 'DO', 'Family Practice', '', '', NULL, 'O', '1100 S Medical Dr', 'Mount Pleasant', 'Sanpete', 'UT', '84647', '4354622441', NULL, '1100 S Medical Dr', 'Mount Pleasant', 'Sanpete', 'UT', '84647', '4354622441', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2010-10-01', '2013-05-31', 0, 0, 0, 'Mountain View Hospital', '', '', '', 'HCFA|UB|', '1336239888', 0, 'N', 0, '2013-11-18', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12006682', 'W12006682', 'UTIHC04', 'Emergency Room', 'Gary', 'F', 'Holland', 'MD', 'Family Practice', '', '', NULL, 'O', '905 N 1000 W', 'Tremonton', 'Box Elder', 'UT', '84337', '8012074515', NULL, '905 N 1000 W', 'Tremonton', 'Box Elder', 'UT', '84337', '8012074515', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2010-10-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1780780189', 0, 'N', 0, '2012-08-03', NULL, NULL, 41.7162, -112.201, NULL, NULL),
('942854057', 'W12006688', 'W12006688', 'UTIHC01', 'Neurology', 'Barry', 'R', 'Fleischer', 'DO', 'Neurology', NULL, NULL, NULL, 'O', '1380 E Medical Ctr Dr', 'St George', 'Washington', 'UT', '84790', '4352511000', '4356563850', '1380 E Medical Ctr Dr', 'Saint George', 'Washington', 'UT', '84790', '4352511000', '4356563850', '', '', '', '0.00', '15.00', '0.00', 8, '2010-06-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1578520409', 0, 'N', 0, '2010-10-28', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12006689', 'W12006689', 'UTIHC03', 'Neurology', 'Barry', 'R', 'Fleischer', 'DO', 'Neurology', NULL, NULL, NULL, 'O', '1380 E Medical Ctr Dr', 'St George', 'Washington', 'UT', '84790', '4352511000', '4356563850', '1380 E Medical Ctr Dr', 'Saint George', 'Washington', 'UT', '84790', '4352511000', '4356563850', '', '', '', '0.00', '15.00', '0.00', 8, '2010-06-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1578520409', 0, 'N', 0, '2010-10-28', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12006690', 'W12006690', 'UTIHC04', 'Neurology', 'Barry', 'R', 'Fleischer', 'DO', 'Neurology', NULL, NULL, NULL, 'O', '1380 E Medical Ctr Dr', 'St George', 'Washington', 'UT', '84790', '4352511000', '4356563850', '1380 E Medical Ctr Dr', 'Saint George', 'Washington', 'UT', '84790', '4352511000', '4356563850', '', '', '', '0.00', '15.00', '0.00', 8, '2010-06-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1578520409', 0, 'N', 0, '2010-10-28', NULL, NULL, 37.0998, -113.554, NULL, NULL),
('942854057', 'W12006705', 'W12006705', 'UTIHC01', 'Neuropsychology', 'Dana', 'R', 'Schmidt', 'APRN', 'Mental Health', 'Psychology', '', NULL, 'O', '675 E 500 S Ste 300', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8016655592', NULL, '675 E 500 S Ste 300', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8016655592', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2011-01-01', '2013-07-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1760451538', 0, 'N', 0, '2013-08-30', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12006706', 'W12006706', 'UTIHC02', 'Neuropsychology', 'Dana', 'R', 'Schmidt', 'APRN', 'Mental Health', 'Psychology', '', NULL, 'O', '675 E 500 S Ste 300', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8016655592', NULL, '675 E 500 S Ste 300', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8016655592', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2011-01-01', '2013-07-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1760451538', 0, 'N', 0, '2013-08-30', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12006707', 'W12006707', 'UTIHC03', 'Neuropsychology', 'Dana', 'R', 'Schmidt', 'APRN', 'Mental Health', 'Psychology', '', NULL, 'O', '675 E 500 S Ste 300', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8016655592', NULL, '675 E 500 S Ste 300', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8016655592', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2011-01-01', '2013-07-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1760451538', 0, 'N', 0, '2013-08-30', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12006708', 'W12006708', 'UTIHC04', 'Neuropsychology', 'Dana', 'R', 'Schmidt', 'APRN', 'Mental Health', 'Psychology', '', NULL, 'O', '675 E 500 S Ste 300', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8016655592', NULL, '675 E 500 S Ste 300', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8016655592', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2011-01-01', '2013-08-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1760451538', 0, 'N', 0, '2013-08-30', NULL, NULL, 0, 0, NULL, NULL),
('272553261', 'W12006728', 'W12006728', 'UT01', 'Integrated Dermatology of Bountiful', 'Amy', 'V', 'Curtis', 'MD', 'Dermatology', '', '', NULL, 'O', '425 Medical Dr', 'Bountiful', 'Davis', 'UT', '84010', '8012983802', '8013988371', '425 Medical Dr', 'Bountiful', 'Davis', 'UT', '84010', '8012983802', '8013988371', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-01-01', NULL, 0, 0, 0, 'Lakeview Hospital', '', '', '', 'HCFA|UB|', '1841499084', 0, 'N', 0, '2014-07-14', NULL, NULL, 40.8873, -111.872, NULL, NULL),
('272553261', 'W12006730', 'W12006730', 'UT01', 'Integrated Dermatology of Bountiful', 'Amy', 'V', 'Curtis', 'MD', 'Dermatology', '', '', NULL, 'B', '902 Clint Moore Rd', 'Boca Raton', 'Palm Beach', 'FL', '33487', '8012983802', '8013988371', '902 Clint Moore Rd', 'Boca Raton', 'Palm Beach', 'FL', '33487', '8012983802', '8013988371', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-01-01', NULL, 0, 0, 0, 'Lakeview Hospital', '', '', '', 'HCFA|UB|', '1841499084', 0, 'N', 0, '2014-07-14', NULL, NULL, 0, 0, NULL, NULL),
('870767026', 'W12006738', 'W12006738', 'ID01', 'Caldwell Internal Medicine Group', 'David', 'J', 'Kelly', 'MD', 'Family & Sports Medicine', '', '', NULL, 'O', '211 E Logan St Ste 201', 'Caldwell', 'Canyon', 'ID', '83605', '2087955201', '2084593372', '211 E Logan St Ste 201', 'Caldwell', 'Canyon', 'ID', '83605', '2087955201', '2084593372', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2010-09-01', '2013-03-22', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1194862417', 0, 'N', 0, '2013-03-25', NULL, NULL, 43.6554, -116.697, NULL, NULL),
('870767026', 'W12006739', 'W12006739', 'ID01', 'Caldwell Internal Medicine Group', 'David', 'J', 'Kelly', 'MD', 'Family & Sports Medicine', '', '', NULL, 'B', 'PO Box 277976', 'Atlanta', 'Fulton', 'GA', '30384', '2084594667', NULL, 'PO Box 277976', 'Atlanta', 'Fulton', 'GA', '30384', '2084594667', '          ', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2010-09-01', '2013-03-22', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1194862417', 0, 'N', 0, '2013-03-25', NULL, NULL, 0, 0, NULL, NULL),
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('870767026', 'W12006741', 'W12006741', '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', '          ', '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|', '1568432888', 0, 'N', 0, '2013-11-12', NULL, NULL, 0, 0, NULL, NULL),
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('820442659', 'W12006768', 'W12006768', 'ID02', 'Idaho Foot & Ankle Associates', 'Stewart', 'O', 'Jones', 'DPM', 'Podiatry', '', '', NULL, 'O', '2635 Caldwell Blvd Ste 101', 'Nampa', 'Canyon', 'ID', '83651', '2084550655', '2084550654', '2635 Caldwell Blvd Ste 101', 'Nampa', 'Canyon', 'ID', '83651', '2084550655', '2084550654', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2009-03-31', NULL, 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|UB|', '1083643464', 0, 'N', 0, '2014-03-26', NULL, NULL, 0, 0, NULL, NULL),
('820442659', 'W12006769', 'W12006769', 'ID02', 'Idaho Foot & Ankle Associates', 'Stanley', 'B', 'Leis', 'DPM', 'Podiatry', '', '', NULL, 'O', '2635 Caldwell Blvd Ste 101', 'Nampa', 'Canyon', 'ID', '83651', '2084550655', '2084550654', '2635 Caldwell Blvd Ste 101', 'Nampa', 'Canyon', 'ID', '83651', '2084550655', '2084550654', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2009-03-31', NULL, 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|UB|', '1194779066', 0, 'N', 0, '2014-03-26', NULL, NULL, 0, 0, NULL, NULL),
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('260553931', 'W12006775', 'W12006775', 'ID01', 'Saint Alphonsus Medical Group Cardiology Nampa', 'Rakesh', 'K', 'Pai', 'MD', 'Cardiology', '', '', NULL, 'O', '1524 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2084635050', '2084635040', '1524 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2084635050', '2084635040', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2010-11-15', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1710190665', 0, 'N', 0, '2013-12-11', NULL, NULL, 43.5533, -116.573, NULL, NULL),
('751365258', 'W12024181', 'W12024181', 'TXDALSTD', 'The Medical and Surgical Clinic of Irvin', 'Visalakshi', '', 'Vallury', 'MD', 'Family Practice', '', '', NULL, 'O', '2021 N MacArthur Blvd Ste 325', 'Irving', 'Dallas', 'TX', '75061', '9722534200', '9722534218', '2021 N MacArthur Blvd Ste 325', 'Irving', 'Dallas', 'TX', '75061', '9722534200', '9722534218', '', '', '', '0.00', '100.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1174528061', 0, 'N', 1, '2012-10-24', NULL, NULL, 32.8355, -96.9602, NULL, NULL),
('942854057', 'W12006782', 'W12006782', 'UTIHCPHY', 'Southwest Rheumatology Associates', 'Sara', 'Jane', 'Andersen', 'MD', 'Rheumatology', '', '', NULL, 'O', '577 S River Rd', 'St George', 'Washington', 'UT', '84790', '4356886262', NULL, '577 S River Rd', 'St George', 'Washington', 'UT', '84790', '4356886262', '          ', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2009-06-01', '2013-06-19', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1164512786', 0, 'N', 0, '2013-07-12', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12006783', 'W12006783', 'ID01', 'Northwest Pulmonary Saint Alphonsus', 'Linda', '', 'Gould', 'NP-C', 'Nurse Practitioner', '', '', NULL, 'O', '6140 W Curtisian Ste B10', 'Boise', 'Ada', 'ID', '83704', '2083678333', '2083672003', '6140 W Curtisian Ste B10', 'Boise', 'Ada', 'ID', '83704', '2083678333', '2083672003', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2010-11-22', '2011-08-31', 0, 0, 0, '', '', '', '', 'HCFA|', '1457499261', 0, 'N', 0, '2011-09-19', NULL, NULL, 43.6151, -116.256, NULL, NULL),
('820200895', 'W12006784', 'W12006784', 'ID01', 'Northwest Pulmonary Saint Alphonsus ', 'Brekk', '', 'Macpherson', 'NP-C', 'Nurse Practitioner', '', '', NULL, 'O', '6140 W Curtisian Ste B10', 'Boise', 'Ada', 'ID', '83704', '2083678333', '2083672003', '6140 W Curtisian Ste B10', 'Boise', 'Ada', 'ID', '83704', '2083678333', '2083672003', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2010-11-22', '2011-05-01', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|', '1669798286', 0, 'N', 0, '2011-09-19', NULL, NULL, 43.6151, -116.256, NULL, NULL),
('820200895', 'W12006785', 'W12006785', 'ID01', 'Saint Alphonsus Medical Group Polumnary & Sleep Boise ', 'Nancy', '', 'Nadolski', 'NP-C', 'Nurse Practitioner', '', '', NULL, 'O', '6140 W Curtisian Ste B10', 'Boise', 'Ada', 'ID', '83704', '2083678333', '2083672003', '6140 W Curtisian Ste B10', 'Boise', 'Ada', 'ID', '83704', '2083678333', '2083672003', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2010-11-22', '2012-11-30', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|', '1881755023', 0, 'N', 0, '2013-02-19', NULL, NULL, 43.6151, -116.256, NULL, NULL),
('260553931', 'W12006724', 'W12006724', 'ID02', 'Saint Alphonsus Medical Group Cardiology Nampa', 'Randolph', 'C', 'Byrd', 'MD', 'Cardiology', '', '', NULL, 'O', '1524 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2084635050', '2084635040', '1524 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2084635050', '2084635040', 'IDACN', '', '', '0.00', '15.00', '0.00', 6, '2010-12-06', '2010-12-06', 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1356339618', 0, 'N', 0, '2014-07-09', NULL, NULL, 43.5533, -116.573, NULL, NULL),
('260553931', 'W12006725', 'W12006725', 'ID02', 'Saint Alphonsus Medical Group Cardiology Nampa', 'Randolph', 'C', 'Byrd', 'MD', 'Cardiology', '', '', NULL, 'B', '3340 E Goldstone', 'Meridian', 'Ada', 'ID', '83642', '2083675170', '2084635040', '3340 E Goldstone', 'Meridian', 'Ada', 'ID', '83642', '2083675170', '2084635040', 'IDACN', '', '', '0.00', '15.00', '0.00', 6, '2010-12-06', '2010-12-06', 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1356339618', 0, 'N', 0, '2014-07-09', NULL, NULL, 0, 0, NULL, NULL),
('260553931', 'W12006726', 'W12006726', 'ID02', 'Saint Alphonsus Medical Group Heart Care Nampa', 'Peter', 'G', 'Roan', 'MD', 'Cardiology', '', '', NULL, 'O', '1524 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2084635050', '2084635040', '1524 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2084635050', '2084635040', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2010-12-06', '2010-12-06', 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1326037342', 0, 'N', 0, '2014-07-09', NULL, NULL, 43.5533, -116.573, NULL, NULL),
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('820200895', 'W12006734', 'W12006734', 'ID01', 'Saint Alphonsus Medical Group Dallan Woods Family Medicine', 'Jaiyeola', '', 'Ashaye', 'MD', 'Family Practice', '', '', NULL, 'O', '214 S Midland Blvd', 'Nampa', 'Canyon', 'ID', '83686', '2084656970', '2084656990', '214 S Midland Blvd', 'Nampa', 'Canyon', 'ID', '83686', '2084656970', '2084656990', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2010-12-06', '2011-07-15', 0, 0, 0, '', '', '', '', 'HCFA|', '1952488561', 0, 'N', 0, '2014-04-01', NULL, NULL, 43.5678, -116.593, NULL, NULL),
('820200895', 'W12006735', 'W12006735', 'ID01', 'Saint Alphonsus Regional Medical Center', 'Jaiyeola', '', 'Ashaye', 'MD', 'Family Practice', '', '', NULL, 'B', '3340 E Goldstone', 'Meridian', 'Ada', 'ID', '83642', '2083675170', '2084656990', '3340 E Goldstone', 'Meridian', 'Ada', 'ID', '83642', '2083675170', '2084656990', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2010-12-06', '2012-03-29', 0, 0, 0, '', '', '', '', 'HCFA|', '1952488561', 0, 'N', 0, '2014-04-01', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12006736', 'W12006736', 'ID01', 'Saint Alphonsus Medical Group Family Practice Nampa Health Plaza', 'Jaiyeola', '', 'Ashaye', 'MD', 'Family Practice', '', '', NULL, 'O', '4400 Flamingo Ave E Ste 301', 'Nampa', 'Canyon', 'ID', '83687', '2084656970', '2084656990', '4400 Flamingo Ave E Ste 301', 'Nampa', 'Canyon', 'ID', '83687', '2084656970', '2084656990', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2010-12-06', '2012-03-29', 0, 0, 0, '', '', '', '', 'HCFA|', '1952488561', 0, 'N', 0, '2014-04-01', NULL, NULL, 0, 0, NULL, NULL),
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('870767026', 'W12006746', 'W12006746', 'ID01', 'West Valley Medical Group Nampa', 'Richard', 'A', 'Augustus', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 277976', 'Atlanta', 'Fulton', 'GA', '30384', '8015470747', '2084593372', 'PO Box 277976', 'Atlanta', 'Fulton', 'GA', '30384', '8015470747', '2084593372', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2010-09-15', '2012-06-30', 0, 0, 0, 'West Valley Medical Center', '', '', '', 'HCFA|UB|', '1699717793', 0, 'N', 0, '2013-08-16', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12006747', 'W12006747', 'ID01', 'Saint Alphonsus Medical Group Dallan Woods Family Medicine ', 'Brian', 'E', 'Cothern', 'MD', 'Family Practice', 'Hospitalist', '', NULL, 'O', '214 S Midland Blvd', 'Nampa', 'Canyon', 'ID', '83687', '2084656900', '2084656910', '214 S Midland Blvd', 'Nampa', 'Canyon', 'ID', '83687', '2084656900', '2084656910', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2010-12-06', '2012-03-29', 0, 0, 0, '', '', '', 'Saint Alphonsus Medical Center Nampa', 'HCFA|', '1295774149', 0, 'N', 0, '2012-03-29', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12006749', 'W12006749', 'ID01', 'Saint Alphonsus Medical Group Dallan Woods Family Medicine ', 'Bayo', 'O', 'Crownson', 'MD', 'Family Practice', 'Hospitalist', '', NULL, 'O', '214 S Midland Blvd', 'Nampa', 'Canyon', 'ID', '83687', '2084656900', '2084656910', '214 S Midland Blvd', 'Nampa', 'Canyon', 'ID', '83687', '2084656900', '2084656910', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2010-12-06', '2012-03-29', 0, 0, 0, '', '', '', 'Saint Alphonsus Medical Center Nampa', 'HCFA|', '1376589689', 0, 'N', 0, '2012-03-29', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12006750', 'W12006750', 'ID01', 'Saint Alphonsus Medical Group Dallan Woods Family Medicine', 'Austin', 'J', 'Graham', 'MD', 'Family Practice', '', '', NULL, 'O', '214 S Midland Blvd', 'Nampa', 'Canyon', 'ID', '83686', '2084656970', '2084656990', '214 S Midland Blvd', 'Nampa', 'Canyon', 'ID', '83686', '2084656970', '2084656990', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2010-12-06', '2011-07-31', 0, 0, 0, '', '', '', 'Saint Alphonsus Medical Center Nampa', 'HCFA|', '1548228844', 0, 'N', 0, '2011-09-19', NULL, NULL, 43.5678, -116.593, NULL, NULL),
('820200895', 'W12006753', 'W12006753', 'ID01', 'Saint Alphonsus Medical Group Dallan Woods Family Medicine', 'Jay', 'H', 'Hansen', 'MD', 'Family Practice', '', '', NULL, 'O', '214 S Midland Blvd', 'Nampa', 'Canyon', 'ID', '83686', '2084656970', '2084656990', '214 S Midland Blvd', 'Nampa', 'Canyon', 'ID', '83686', '2084656970', '2084656990', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2010-12-06', '2011-07-31', 0, 0, 0, '', '', '', '', 'HCFA|', '1710084363', 0, 'N', 0, '2011-09-19', NULL, NULL, 43.5678, -116.593, NULL, NULL),
('820200895', 'W12006752', 'W12006752', 'ID01', 'Saint Alphonsus Medical Group NHP Family Medicine Practice ', 'Jay', 'H', 'Hansen', 'MD', 'Family Practice', '', '', NULL, 'O', '4400 Flamingo Ave E Ste 301', 'Nampa', 'Canyon', 'ID', '83687', '2084656970', '2084656990', '4400 Flamingo Ave E Ste 301', 'Nampa', 'Canyon', 'ID', '83687', '2084656970', '2084656990', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2010-12-06', '2011-07-31', 0, 0, 0, '', '', '', '', 'HCFA|', '1710084363', 0, 'N', 0, '2011-09-19', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12006754', 'W12006754', 'ID01', 'Saint Alphonsus Medical Group Dallan Woods Family Medicine', 'Tricia', 'L', 'Keefe', 'DO', 'Family Practice', '', '', NULL, 'O', '214 S Midland Blvd', 'Nampa', 'Canyon', 'ID', '83687', '2084656900', '2084656910', '214 S Midland Blvd', 'Nampa', 'Canyon', 'ID', '83687', '2084656900', '2084656910', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2010-12-06', '2012-03-30', 0, 0, 0, '', '', '', 'Saint Alphonsus Medical Center Nampa', 'HCFA|', '1730123043', 0, 'N', 0, '2012-03-30', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12006755', 'W12006755', 'ID01', 'Saint Alphonsus Medical Group Dallan Woods Family Medicine ', 'John', '', 'Johnson', 'MD', 'Family Practice', 'Sports Medicine', '', NULL, 'O', '214 S Midland Blvd', 'Nampa', 'Canyon', 'ID', '83686', '2084656970', '2084656990', '214 S Midland Blvd', 'Nampa', 'Canyon', 'ID', '83686', '2084656970', '2084656990', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2010-12-06', '2012-03-29', 0, 0, 0, '', '', '', '', 'HCFA|', '1164402681', 0, 'N', 0, '2012-03-29', NULL, NULL, 43.5678, -116.593, NULL, NULL),
('260553931', 'W12006756', 'W12006756', 'ID01', 'Saint Alphonsus Medical Group General Surgery Nampa', 'Richard', '', 'Ballantyne', 'DO', 'General Surgery', '', '', NULL, 'O', '1603 E 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2084656940', '2084656961', '1603 E 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2084656940', '2084656961', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2010-12-06', '2012-03-03', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1174745582', 0, 'N', 0, '2013-11-21', NULL, NULL, 0, 0, NULL, NULL),
('260553931', 'W12006786', 'W12006786', 'ID01', 'Saint Alphonsus Medical Group Cardiology Nampa', 'Tosha', 'J', 'Johnson', 'NP-C', 'Cardiovascular Disease', '', '', NULL, 'O', '1524 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2084635050', '2084635040', '1524 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2084635050', '2084635040', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2010-12-06', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, NULL, NULL, 'HCFA|UB|', '0163921426', 0, 'N', 0, '2012-07-19', NULL, NULL, 43.5533, -116.573, NULL, NULL),
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