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
('112659192', 'W12030618', 'W12030618', 'NA01', 'PerkinElmer Laboratories Inc', '', '', 'PerkinElmer Laboratories Inc', '', 'Laboratory', '', '', NULL, 'O', '80 Ruland Rd Ste 1', 'Melville', 'Suffolk', 'NY', '11747', '6314250800', '6314250811', '80 Ruland Rd Ste 1', 'Melville', 'Suffolk', 'NY', '11747', '6314250800', '6314250811', 'PERKELABS', '', '', '0.00', '0.00', '0.00', 3, '2012-12-20', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1992779664', 0, 'N', 0, '2013-02-26', NULL, NULL, 0, 0, NULL, NULL),
('760509654', 'W12030617', 'W12030617', 'TXBEAUSTD', 'Endocrine Clinic of Southeast Texas', 'Jose', 'M', 'Ortiz', 'MD', 'Endocrinology', '', '', NULL, 'O', '3030 N St Ste 560', 'Beaumont', 'Jefferson', 'TX', '77702', '4098359834', '4098357623', '3030 N St Ste 560', 'Beaumont', 'Jefferson', 'TX', '77702', '4098359834', '4098357623', 'BEAUMONT4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1487667127', 0, 'N', 0, '2013-03-04', NULL, NULL, 30.0875, -94.1344, NULL, NULL),
('760509654', 'W12030615', 'W12030615', 'TXBEAUSTD', 'Endocrine Clinic of Southeast Texas', 'Robert', 'C', 'Hood', 'MD', 'Endocrinology', '', '', NULL, 'O', '3030 N St Ste 560', 'Beaumont', 'Jefferson', 'TX', '77702', '4098359834', '4098357623', '3030 N St Ste 560', 'Beaumont', 'Jefferson', 'TX', '77702', '4098359834', '4098357623', 'BEAUMONT4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1053321539', 0, 'N', 0, '2013-03-04', NULL, NULL, 30.0875, -94.1344, NULL, NULL),
('760509654', 'W12030613', 'W12030613', 'TXBEAUSTD', 'Endocrine Clinic of Southeast Texas', '', '', 'Endocrine Clinic of Southeast Texas', '', 'Endocrinology', '', '', NULL, 'O', '3030 N St Ste 560', 'Beaumont', 'Jefferson', 'TX', '77702', '4098359834', '4098357623', '3030 N St Ste 560', 'Beaumont', 'Jefferson', 'TX', '77702', '4098359834', '4098357623', 'BEAUMONT4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1336159847', 0, 'Y', 0, '2013-03-01', NULL, NULL, 30.0875, -94.1344, NULL, NULL),
('450483177', 'W12030612', 'W12030612', 'TXBEAUSTD', 'Minish Patel MD', 'Minish', '', 'Patel', 'MD', 'Family Practice', '', '', NULL, 'O', '3091 College St', 'Beaumont', 'Jefferson', 'TX', '77701', '4098333535', '4098334640', '3091 College St', 'Beaumont', 'Jefferson', 'TX', '77701', '4098333535', '4098334640', 'BEAUMONT1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Baptist Beaumont Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1457360083', 0, 'N', 0, '2013-05-31', NULL, NULL, 30.0685, -94.1206, NULL, NULL),
('760664336', 'W12030610', 'W12030610', 'TXHOUSTD', 'Dipsu Patel MD', 'Dipsu', '', 'Patel', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '6807 Emmett F Lowry Ste 108', 'Texas City', 'Galveston', 'TX', '77591', '4099455444', '4099454133', '6807 Emmett F Lowry Ste 108', 'Texas City', 'Galveston', 'TX', '77591', '4099455444', '4099454133', 'HOUSTON2', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB', '1760624951', 0, 'N', 0, '2013-06-05', NULL, NULL, 29.3953, -94.9874, NULL, NULL),
('942938348', 'W40006853', 'W40006853', 'UTMH1', 'Valley Mental Health  Inc', 'Kathleen', 'R', 'Reimherr', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', '5965 S 900 E Ste 430', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012637100', NULL, '5965 S 900 E Ste 430', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012637100', '', 'UTVMHMA', NULL, NULL, '0.00', '40.00', '0.00', 6, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1871564112', 0, 'Y', 0, '2013-06-04', NULL, NULL, 0, 0, NULL, NULL),
('364314354', 'ELPPA0491', 'ELPPA0491', 'ILCHIGSTD', 'Provena Medical Group - Behavioral Health', 'Paul', '', 'Hannah', 'MD', 'Psychiatry', '', '', NULL, 'O', '333 N Madison St', 'Joliet', 'Will', 'IL', '60435', '8157417530', '6309142499', '333 N Madison St', 'Joliet', 'Will', 'IL', '60435', '8157417530', '6309142499', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-10-01', 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1992920169', 0, 'Y', 0, '2013-10-31', NULL, NULL, 41.5279, -88.1354, NULL, NULL),
('264260933', 'ELHCA0063', 'ELHCA0063', 'TXHOUSTD', 'Houston  Women''s Care Associates', 'Laura', NULL, 'Hanson', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '7400 Fannin St Ste 1050', 'Houston', 'Harris', 'TX', '77054', '7137951000', '7137961087', '7400 Fannin St Ste 1050', 'Houston', 'Harris', 'TX', '77054', '7137951000', '7137961087', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'The Womans Hospital of Texas', NULL, NULL, NULL, 'HCFA|UB|', '1053677716', 0, 'N', 0, '2014-01-14', NULL, NULL, 29.6956, -95.4009, NULL, NULL),
('743200478', 'W12030609', 'W12030609', 'UT01', 'Draper Family Practice', 'Carlie', '', 'Hamilton', 'NP', 'Family Practice', '', '', NULL, 'B', 'PO Box 572528', 'Salt Lake City', 'Salt Lake', 'UT', '84157', '8017477237', '8017481601', 'PO Box 572528', 'Salt Lake City', 'Salt Lake', 'UT', '84157', '8017477237', '8017481601', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', '2012-02-29', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1104978873', 0, 'Y', 0, '2013-08-21', NULL, NULL, 0, 0, NULL, NULL),
('743200478', 'W12030608', 'W12030608', 'UT01', 'Draper Family Practice', 'Carlie', '', 'Hamilton', 'NP', 'Family Practice', '', '', NULL, 'O', '12422 S 450 E Ste A', 'Draper', 'Salt Lake', 'UT', '84020', '8017481600', '8017481601', '12422 S 450 E Ste A', 'Draper', 'Salt Lake', 'UT', '84020', '8017481600', '8017481601', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', '2012-02-29', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1104978873', 0, 'N', 0, '2013-08-21', NULL, NULL, 0, 0, NULL, NULL),
('352332742', 'W12030606', 'W12030606', 'ID01', 'Healthy Habits Wellness Center', 'Mari', '', 'Aitken', 'NP-C', 'Family Practice', '', '', NULL, 'O', '14 S Baltic Pl', 'Meridian', 'Ada', 'ID', '83642', '2088874872', '2088876331', '14 S Baltic Pl', 'Meridian', 'Ada', 'ID', '83642', '2088874872', '2088876331', 'IDSTD', '', '', '0.00', '30.00', '0.00', 6, '2011-12-20', '2012-08-19', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1063703682', 0, 'N', 1, '2013-02-25', NULL, NULL, 0, 0, NULL, NULL),
('760664336', 'W12030611', 'W12030611', 'TXHOUSTD', 'Dipsu Patel MD', 'Dipsu', '', 'Patel', 'MD', 'Cardiovascular Disease', '', '', NULL, 'B', 'PO Box 890089', 'Houston', 'Harris', 'TX', '77289', '4099455444', '4099454133', 'PO Box 890089', 'Houston', 'Harris', 'TX', '77289', '4099455444', '4099454133', 'HOUSTON2', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB', '1760624951', 0, 'N', 0, '2013-06-05', NULL, NULL, 0, 0, NULL, NULL),
('450579013', 'W12030620', 'W12030620', 'UT01', 'St Marks Gynecology Oncology Care LLC', 'Krista', 'J', 'Anders', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 198546', 'Atlanta', 'Fulton', 'GA', '30384', '6153737600', '0000000000', 'PO Box 198546', 'Atlanta', 'Fulton', 'GA', '30384', '6153737600', '0000000000', 'UTHCAPS', 'WUSTDCARD5', '', '0.00', '35.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1841353349', 0, 'N', 0, '2013-02-26', NULL, NULL, 0, 0, NULL, NULL),
('450579013', 'W12030621', 'W12030621', 'UT01', 'MountainStar Jordan Family Health', 'Krista', 'J', 'Anders', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '8846 S Redwood Ste E121', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015691999', '8015692001', '8846 S Redwood Ste E121', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015691999', '8015692001', 'UTHCAPS', 'WUSTDCARD5', '', '0.00', '35.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1841353349', 0, 'N', 0, '2013-02-26', NULL, NULL, 40.5911, -111.939, NULL, NULL),
('621801973', 'W12030623', 'W12030623', 'UT01', 'Oval Sports Medicine', 'Michael', 'L', 'Cosgrave', 'DO', 'Family Practice', 'Sports Medicine', '', NULL, 'O', '5662 S Cougar Ln Ste 311', 'Taylorsville', 'Salt Lake', 'UT', '84118', '8019128210', '0000000000', '5662 S Cougar Ln Ste 311', 'Taylorsville', 'Salt Lake', 'UT', '84118', '8019128210', '0000000000', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2012-12-01', '2014-04-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1720252117', 0, 'N', 0, '2013-07-25', NULL, NULL, 40.6466, -112.006, NULL, NULL),
('621801973', 'W12030624', 'W12030624', 'UT01', 'Davis Internal Medicine', 'Catherine', '', 'Coles', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1492 W Antelope Dr Ste 203', 'Layton', 'Davis', 'UT', '84041', '8017737500', '8017737800', '1492 W Antelope Dr Ste 203', 'Layton', 'Davis', 'UT', '84041', '8017737500', '8017737800', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2012-03-01', '2014-04-30', 0, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1679782031', 0, 'N', 0, '2013-02-26', NULL, NULL, 41.0893, -111.993, NULL, NULL),
('621801973', 'W12030625', 'W12030625', 'UT01', 'Davis Internal Medicine', 'Catherine', '', 'Coles', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2012-03-01', '2014-04-30', 0, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1679782031', 0, 'N', 0, '2013-02-26', NULL, NULL, 0, 0, NULL, NULL),
('870299862', 'W40013239', 'W40013239', 'UTMH1', 'LDS Family Services', 'Sandra', '', 'Everett', 'LMFT', 'Mental Health', 'Counseling', '', NULL, 'B', '50 E N Temple', 'Salt Lake City', 'Salt Lake', 'UT', '84150', '8013363040', '8013363041', '50 E N Temple', 'Salt Lake City', 'Salt Lake', 'UT', '84150', '8013363040', '8013363041', 'MA', '', '', '0.00', '40.00', '0.00', 8, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1619098811', 0, 'N', 0, '2014-04-21', NULL, NULL, 0, 0, NULL, NULL),
('870299862', 'W40015847', 'W40015847', 'UTMH1', 'LDS Family Services', 'Melanie', '', 'Jackson', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', '125 N State St', 'Salt Lake City', 'Salt Lake', 'UT', '84150', '8013363040', '8013363041', '125 N State St', 'Salt Lake City', 'Salt Lake', 'UT', '84150', '8013363040', '8013363041', 'MA', '', '', '0.00', '40.00', '0.00', 8, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1639229131', 0, 'N', 0, '2014-06-16', NULL, NULL, 0, 0, NULL, NULL),
('870299862', 'W40001787', 'W40001787', 'UTMH1', 'Resilient Solutions Inc', 'Melanie', '', 'Jackson', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '1355 N Main Ste I', 'Bountiful', 'Davis', 'UT', '84010', '8017211013', '8013363041', '1355 N Main Ste I', 'Bountiful', 'Davis', 'UT', '84010', '8017211013', '8013363041', 'MA', '', '', '0.00', '40.00', '0.00', 8, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1639229131', 0, 'N', 0, '2014-06-16', NULL, NULL, 40.9035, -111.879, NULL, NULL),
('870299862', 'W40001786', 'W40001786', 'UTMH1', 'LDS Family Services', 'Melanie', '', 'Jackson', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '930 W Hillfield Rd Ste A', 'Layton', 'Davis', 'UT', '84041', '8013363040', '8013363041', '930 W Hillfield Rd Ste A', 'Layton', 'Davis', 'UT', '84041', '8013363040', '8013363041', 'MA', '', '', '0.00', '40.00', '0.00', 8, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1639229131', 0, 'N', 0, '2014-06-16', NULL, NULL, 41.072, -111.981, NULL, NULL),
('743212651', 'W40007446', 'W40007446', 'UTMH1', 'JWH Thrive Inc', 'John', 'W', 'Howard', 'LMFT', 'Mental Health', 'Marriage and Family Therapy', '', NULL, 'O', '2363 N Hillfield Ste 5', 'Layton', 'Davis', 'UT', '84041', '8016283512', '8017797808', '2363 N Hillfield Ste 5', 'Layton', 'Davis', 'UT', '84041', '8016283512', '8017797808', 'MA', '', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1689738130', 0, 'N', 0, '2013-02-27', NULL, NULL, 41.0944, -111.974, NULL, NULL),
('870299862', 'W40015842', 'W40015842', 'UTMH1', 'LDS Family Services', 'John', 'W', 'Howard', 'LMFT', 'Mental Health', 'Marriage and Family Therapy', '', NULL, 'B', '125 N State St', 'Salt Lake City', 'Salt Lake', 'UT', '84150', '8013363040', '8013363041', '125 N State St', 'Salt Lake City', 'Salt Lake', 'UT', '84150', '8013363040', '8013363041', 'MA', '', '', '0.00', '40.00', '0.00', 8, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1689738130', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('870299862', 'W40006972', 'W40006972', 'UTMH1', 'LDS Family Services', 'John', 'W', 'Howard', 'LMFT', 'Mental Health', 'Marriage and Family Therapy', '', NULL, 'O', '930 W Hillfield Rd Ste A', 'Layton', 'Davis', 'UT', '84041', '8013363040', '8013363041', '930 W Hillfield Rd Ste A', 'Layton', 'Davis', 'UT', '84041', '8013363040', '8013363041', 'MA', NULL, NULL, '0.00', '40.00', '0.00', 8, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1689738130', 0, 'N', 0, '2013-02-27', NULL, NULL, 41.072, -111.981, NULL, NULL),
('870299862', 'W40015869', 'W40015869', 'UTMH1', 'LDS Family Services', 'Debra', 'E', 'Smith', 'CMHC', 'Mental Health', 'Counseling', '', NULL, 'B', '125 N State St', 'Salt Lake City', 'Salt Lake', 'UT', '84150', '8012940578', NULL, '125 N State St', 'Salt Lake City', 'Salt Lake', 'UT', '84150', '8012940578', '', 'MA', '', '', '0.00', '40.00', '0.00', 8, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1689865974', 0, 'N', 0, '2014-07-16', NULL, NULL, 0, 0, NULL, NULL),
('870299862', 'W40004614', 'W40004614', 'UTMH1', 'LDS Family Services', 'Debra', 'E', 'Smith', 'CMHC', 'Mental Health', 'Counseling', '', NULL, 'O', '94 E Pages Ln Ste A', 'Centerville', 'Davis', 'UT', '84014', '8012940578', NULL, '94 E Pages Ln Ste A', 'Centerville', 'Davis', 'UT', '84014', '8012940578', '', 'MA', '', '', '0.00', '40.00', '0.00', 8, '2013-02-15', NULL, 0, NULL, 0, '', '', '', '', 'HCFA|UB|', '1689865974', 0, 'N', 0, '2014-07-16', NULL, NULL, 40.9066, -111.877, NULL, NULL),
('529865884', 'W40005665', 'W40005665', 'UTMH1', 'Titensor Enterprises', 'Steven', 'D', 'Titensor', 'LMFT', 'Mental Health', 'Marriage and Family Therapy', '', NULL, 'O', '2205 S 800 W', 'Wood Cross', 'Davis', 'UT', '84087', '8012980336', NULL, '2205 S 800 W', 'Wood Cross', 'Davis', 'UT', '84087', '8012980336', '', 'UTMA', NULL, NULL, '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1720120710', 0, 'n', 0, '2013-02-27', NULL, NULL, 40.8671, -111.902, NULL, NULL),
('204203827', 'W40018876', 'W40018876', 'UTMH1', 'Resilient Solutions Inc', 'Becky', 'P', 'Andrews', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '1355 N Main St Ste 1', 'Bountiful', 'Davis', 'UT', '84010', '8012593883', NULL, '1355 N Main St Ste 1', 'Bountiful', 'Davis', 'UT', '84010', '8012593883', '', 'MA', NULL, NULL, '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1730239534', 0, 'n', 0, '2013-02-27', NULL, NULL, 40.9035, -111.879, NULL, NULL),
('870299862', 'W40020735', 'W40020735', 'UTMH1', 'LDS Family Services', 'Alisha', '', 'Thomas', 'LCSW', 'Mental Health', '', '', NULL, 'B', '120 N 200 W', 'Salt Lake City', 'Salt Lake', 'UT', '84103', '8012940578', NULL, '120 N 200 W', 'Salt Lake City', 'Salt Lake', 'UT', '84103', '8012940578', '          ', 'ma', '', '', '0.00', '40.00', '0.00', 8, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|DEN|', '1730393471', 0, 'N', 0, '2013-03-25', NULL, NULL, 0, 0, NULL, NULL),
('870299862', 'W40020734', 'W40020734', 'UTMH1', 'LDS Family Services', 'Alisha', '', 'Thomas', 'LCSW', 'Mental Health', '', '', NULL, 'O', '94 E Pages Ln Ste A', 'Centerville', 'Davis', 'UT', '84014', '8012940578', NULL, '94 E Pages Ln Ste A', 'Centerville', 'Davis', 'UT', '84014', '8012940578', '          ', 'MA', '', '', '0.00', '40.00', '0.00', 8, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1730393471', 0, 'N', 0, '2013-03-25', NULL, NULL, 40.9066, -111.877, NULL, NULL),
('125422121', 'W40005180', 'W40005180', 'UTMH1', 'FBC Counseling', 'Faline', 'B', 'Christensen', 'LMFT', 'Mental Health', 'Marriage and Family Therapy', '', NULL, 'O', '475 N 350 W Ste 14', 'Kaysville', 'Davis', 'UT', '84037', '8016986701', NULL, '475 N 350 W Ste 14', 'Kaysville', 'Davis', 'UT', '84037', '8016986701', '', 'UTPHD', NULL, '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1770543746', 0, 'N', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('125422121', 'W40005181', 'W40005181', 'UTMH1', 'LDS Family Services', 'Faline', 'B', 'Christensen', 'LMFT', 'Mental Health', 'Marriage and Family Therapy', '', NULL, 'B', '930 W Hillfield Rd Ste A', 'Layton', 'Davis', 'UT', '84041', '8013363040', NULL, '930 W Hillfield Rd Ste A', 'Layton', 'Davis', 'UT', '84041', '8013363040', '', 'UTPHD', NULL, '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1770543746', 0, 'Y', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('125422121', 'W40005182', 'W40005182', 'UTMH1', NULL, 'Faline', 'B', 'Christensen', 'LMFT', 'Mental Health', 'Marriage and Family Therapy', '', NULL, 'B', 'PO Box 235', 'Layton', 'Davis', 'UT', '84041', '8016986701', NULL, 'PO Box 235', 'Layton', 'Davis', 'UT', '84041', '8016986701', '', 'UTPHD', NULL, '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1770543746', 0, 'Y', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
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('205934739', 'SACN00290', 'SACN00290', 'SACN', 'Family Medicine Health Center', 'Christopher', 'D', 'Gunderson', 'PA', 'Family Practice', '', '', NULL, 'O', '777 N Raymond St', 'Boise', 'Ada', 'ID', '83704', '2085142500', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'IDSINCLAIRL', 'WUSTDHCPC5', NULL, '0.00', '15.00', '0.00', 3, '2011-01-01', NULL, 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1417066143', 0, 'n', 0, '2013-02-28', NULL, NULL, 0, 0, NULL, NULL),
('205934739', 'SACN00289', 'SACN00289', 'SACN', 'Family Medicine Health Center', 'Christopher', 'D', 'Gunderson', 'PA', 'Family Practice', '', '', NULL, 'O', '2321 W Gala St Ste 2', 'Meridian', 'Ada', 'ID', '83642', '2085142500', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'IDSINCLAIRL', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2011-01-01', NULL, NULL, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1417066143', 0, 'N', 0, '2013-02-28', NULL, NULL, 0, 0, NULL, NULL),
('205934739', 'SACN00288', 'SACN00288', 'SACN', 'Family Medicine Health Center', 'Christopher', 'D', 'Gunderson', 'PA', 'Family Practice', '', '', NULL, 'O', '215 W 35th St', 'Boise', 'Ada', 'ID', '83714', '2083676030', '2083227018', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'IDSINCLAIRL', 'WUSTDHCPC5', NULL, '0.00', '15.00', '0.00', 3, '2011-01-01', NULL, 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1417066143', 0, 'n', 0, '2013-02-28', NULL, NULL, 0, 0, NULL, NULL),
('205934739', 'SACN00287', 'SACN00287', 'SACN', 'Family Medicine Health Center', 'Christopher', 'D', 'Gunderson', 'PA', 'Family Practice', '', '', NULL, 'O', '121 E Fort St', 'Boise', 'Ada', 'ID', '83712', '2083811775', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'IDSINCLAIRL', 'WUSTDHCPC5', NULL, '0.00', '15.00', '0.00', 3, '2011-01-01', NULL, 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1417066143', 0, 'n', 0, '2013-02-28', NULL, NULL, 0, 0, NULL, NULL),
('942938348', 'W40006910', 'W40006910', 'UTMH1', 'Valley Mental Health  Inc', 'Shannon', '', 'Gullett', 'MD', 'Mental Health', 'Psychiatry', '', NULL, 'B', '5965 S 900 E Ste 430', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012637100', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'UTMD-2', NULL, NULL, '0.00', '40.00', '0.00', 6, '2013-02-15', NULL, NULL, 0, NULL, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1669559118', 0, 'Y', 0, '2013-02-28', NULL, NULL, 0, 0, NULL, NULL),
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('942938348', 'W40006790', 'W40006790', 'UTMH1', 'Valley Mental Health  Inc', 'CANDICE', 'ELIZABETH', 'GONZALEZ', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', '5965 S 900 E Ste 430', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012637100', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'UTVMHMA', NULL, NULL, '0.00', '40.00', '0.00', 6, '2013-02-15', NULL, NULL, 0, NULL, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1801830252', 0, 'Y', 0, '2013-02-28', NULL, NULL, 0, 0, NULL, NULL);
INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
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('263079603', 'W12003697', 'W12003697', 'UTDT01', 'Falling Creek Dental', 'Chad', NULL, 'Goeckeritz', 'DDS', 'Dentist', '', '', NULL, 'O', '112 E 12450 S Ste 101', 'Draper', 'Salt Lake', 'UT', '84020', '8014953567', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2010-05-01', NULL, NULL, 0, NULL, NULL, NULL, NULL, NULL, 'DEN|', '0000006428', 0, 'N', 0, '2013-02-28', NULL, NULL, 0, 0, NULL, NULL),
('201773062', 'W40016011', 'W40016011', 'ID01', 'Access Behavioral Health Services Inc', 'Christopher "Skip"', '', 'Goddard', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '3307 Caldwell Blvd Ste 104', 'Nampa', 'Canyon', 'ID', '83651', '2084654833', '2083384699', '3307 Caldwell Blvd Ste 104', 'Nampa', 'Canyon', 'ID', '83651', '2084654833', '2083384699', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2013-02-15', '2014-06-23', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1952689317', 0, 'N', 0, '2014-04-24', NULL, NULL, 43.6156, -116.618, NULL, NULL),
('201773062', 'W40016010', 'W40016010', 'ID01', 'Access Behavioral Health Services Inc', 'Christopher "Skip"', '', 'Goddard', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '1276 River St Ste 100', 'Boise', 'Ada', 'ID', '83704', '2083384699', '2083384699', '1276 River St Ste 100', 'Boise', 'Ada', 'ID', '83704', '2083384699', '2083384699', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2013-02-15', '2014-06-23', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1952689317', 0, 'N', 0, '2014-04-24', NULL, NULL, 43.6149, -116.215, NULL, NULL),
('205934739', 'SACN00197', 'SACN00197', 'SACN', 'Family Medicine Health Center', 'Justin', 'A', 'Glass', 'MD', 'Family Practice', '', '', NULL, 'O', '777 N Raymond St', 'Boise', 'Ada', 'ID', '83704', '2085142500', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'IDSINCLAIRL', 'WUSTDHCPC5', NULL, '0.00', '15.00', '0.00', 3, '2011-01-01', NULL, 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1194820852', 0, 'n', 0, '2013-02-28', NULL, NULL, 0, 0, NULL, NULL),
('205934739', 'SACN00196', 'SACN00196', 'SACN', 'Family Medicine Health Center', 'Justin', 'A', 'Glass', 'MD', 'Family Practice', '', '', NULL, 'O', '121 E Fort St', 'Boise', 'Ada', 'ID', '83712', '2083811775', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'IDSINCLAIRL', 'WUSTDHCPC5', NULL, '0.00', '15.00', '0.00', 3, '2011-01-01', NULL, 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1194820852', 0, 'n', 0, '2013-02-28', NULL, NULL, 0, 0, NULL, NULL),
('202075388', 'SACN00227', 'SACN00227', 'SACN', 'Boise Advanced Imaging PLLC', 'David', 'J', 'Giles', 'MD', 'Radiologist', '', '', NULL, 'B', 'PO Box 9649', 'Boise', 'Ada', 'ID', '83707', '2084728126', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'IDSINCLAIRL', NULL, NULL, '0.00', '15.00', '0.00', 3, '2011-01-01', NULL, 0, 0, 1, '', '', '', 'Saint Alphonsus Medical Center Nampa', 'HCFA|UB|', '1295787935', 0, 'Y', 0, '2013-02-28', NULL, NULL, 0, 0, NULL, NULL),
('271524083', 'W12019391', 'W12019391', 'WYT1', 'Big Horn Health Network', 'Derek', '', 'Gilbert', 'MD', 'Family Practice', '', '', NULL, 'B', '1435 Burton St', 'Sheridan', 'Sheridan', 'WY', '82801', '3076752650', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'BHHN3', '', '', '0.00', '0.00', '0.00', 3, '2012-03-01', NULL, NULL, 0, NULL, '', '', '', '', 'HCFA|', '1477665925', 0, 'N', 0, '2013-02-28', NULL, NULL, 0, 0, NULL, NULL),
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('201773062', 'W40018035', 'W40018035', 'ID01', 'Access Behavioral Health', 'Gretchen', 'R', 'Finley', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'B', '2808 Pleasanton Ave', 'Boise', 'Ada', 'ID', '83702', '2083384699', '2083224722', '2808 Pleasanton Ave', 'Boise', 'Ada', 'ID', '83702', '2083384699', '2083224722', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2013-02-15', '2014-06-23', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1629345020', 0, 'N', 0, '2014-04-24', NULL, NULL, 0, 0, NULL, NULL),
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('271524083', 'W12019410', 'W12019410', 'WYT1', 'Big Horn Health Network', 'Laura', '', 'Ferries', 'MD', 'Endocrinology', '', '', NULL, 'B', '1435 Burton St', 'Sheridan', 'Sheridan', 'WY', '82801', '3076752650', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'BHHN6', '', '', '0.00', '0.00', '0.00', 3, '2012-03-01', NULL, NULL, 0, NULL, 'Sheridan Memorial Hospital', NULL, NULL, NULL, 'HCFA|', '1700827557', 0, 'N', 0, '2013-02-28', NULL, NULL, 0, 0, NULL, NULL),
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('204186533', 'SACN01131', 'SACN01131', 'SACN', NULL, 'Frank', 'J', 'Fazzio', 'MD', 'General Surgery', '', '', NULL, 'O', '7301 W Emerald St Ste 102', 'Boise', 'Ada', 'ID', '83704', '2083218600', '2083218626', '7301 W Emerald St Ste 102', 'Boise', 'Ada', 'ID', '83704', '2083218600', '2083218626', 'IDSINCLAIRL', NULL, NULL, '0.00', '15.00', '0.00', 3, '2011-01-01', NULL, 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1528035276', 0, 'N', 0, '2013-09-13', NULL, NULL, 0, 0, NULL, NULL),
('263090885', 'ELHCA0055', 'ELHCA0055', 'TXHOUSTD', 'Faro, Constance', 'Constance', 'J', 'Faro', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '7400 Fannin St Ste 840', 'Houston', 'Harris', 'TX', '77054', '7137999900', '7137999923', '7400 Fannin St Ste 840', 'Houston', 'Harris', 'TX', '77054', '7137999900', '7137999923', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'The Womans Hospital of Texas', NULL, NULL, NULL, 'HCFA|UB|', '1306899612', 0, 'N', 0, '2013-05-01', NULL, NULL, 29.6956, -95.4009, NULL, NULL),
('841401924', 'W12008019', 'W12008019', 'UT01', 'Alpine Medical Group', 'Keri ', '', 'Fakata', 'PharmD', 'Pain Management', '', '', NULL, 'B', 'PO Box 57068', 'Salt Lake City', 'Salt Lake', 'UT', '84157', '8012614988', '8012699425', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDMULT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-02-03', '2011-02-03', NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1164666327', 0, 'N', 0, '2013-02-28', NULL, NULL, 0, 0, NULL, NULL),
('841401924', 'W12008018', 'W12008018', 'UT01', 'Alpine Medical Group', 'Keri ', '', 'Fakata', 'PharmD', 'Pain Management', '', '', NULL, 'O', '3838 S 700 E Ste 200', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8012614988', '8012699425', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'WUSTDMULT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-02-03', '2011-02-03', NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1164666327', 0, 'N', 0, '2013-02-28', NULL, NULL, 0, 0, NULL, NULL),
('942938348', 'W40006881', 'W40006881', 'UTMH1', 'Valley Mental Health  Inc', 'CHERYL', 'DAWN', 'EVANS', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'B', '5965 S 900 E Ste 430', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012637100', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'UTVMHMA', NULL, NULL, '0.00', '40.00', '0.00', 6, '2013-02-15', NULL, NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1881864007', 0, 'Y', 0, '2013-02-28', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12006028', 'W12006028', 'UTIHC04', 'Radiology', 'Cameron', 'J', 'Evans', 'MD', 'Radiology', '', '', NULL, 'O', '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '', '', '', '0.00', '15.00', '0.00', 8, '2010-10-01', NULL, NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1477733574', 0, 'N', 0, '2013-02-28', NULL, NULL, 40.6876, -111.468, NULL, NULL),
('263091340', 'ELHCA0054', 'ELHCA0054', 'TXHOUSTD', 'Internist Associates of Houston ', 'Nancy', '', 'Esper', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 405880                                     ', 'Atlanta', 'Fulton', 'GA', '30384', '          ', NULL, 'PO Box 405880                                     ', 'Atlanta', 'Fulton', 'GA', '30384', '          ', '          ', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1013006063', 0, 'Y', 0, '2013-05-01', NULL, NULL, 0, 0, NULL, NULL),
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('880166804', 'W12002113', 'W12002113', 'UTDT01', '', 'James', '', 'Ence', 'DDS', 'Dentist', '', '', NULL, 'O', '754 S Main St Ste 1', 'St George', 'Washington', 'UT', '84770', '4356282667', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2010-05-01', NULL, NULL, 0, NULL, '', '', '', '', 'DEN|', '0001000024', 0, 'N', 0, '2013-02-28', NULL, NULL, 0, 0, NULL, NULL),
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('272276391', 'W12003694', 'W12003694', 'UTDT01', 'Doman Dental', 'Cliff', NULL, 'Doman', 'DMD', 'Dentist', '', '', NULL, 'O', '3300 N Running Creek Way', 'Lehi', 'Utah', 'UT', '84043', '8017680404', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2010-05-01', NULL, NULL, 0, NULL, NULL, NULL, NULL, NULL, 'DEN|', '0000006003', 0, 'N', 0, '2013-02-28', NULL, NULL, 0, 0, NULL, NULL),
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('271712522', 'ELHCA0040', 'ELHCA0040', 'TXHOUSTD', 'Plus Care', 'Claire', '', 'DeVore', 'PA', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 741115', 'Atlanta', 'Fulton', 'GA', '30374', '          ', NULL, 'PO Box 741115', 'Atlanta', 'Fulton', 'GA', '30374', '          ', '          ', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', '2013-03-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1245314632', 0, 'Y', 0, '2013-09-10', NULL, NULL, 0, 0, NULL, NULL),
('264260933', 'ELHCA0043', 'ELHCA0043', 'TXHOUSTD', 'Houston  Women''s Care Associates', 'Rahki', '', 'Dimino', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '7400 Fannin St Ste 1050', 'Houston', 'Harris', 'TX', '77054', '7137951000', '7137961087', '7400 Fannin St Ste 1050', 'Houston', 'Harris', 'TX', '77054', '7137951000', '7137961087', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'The Womans Hospital of Texas', '', '', '', 'HCFA|UB|', '1972518744', 0, 'N', 0, '2014-04-25', NULL, NULL, 29.6956, -95.4009, NULL, NULL),
('271712522', 'ELHCA0039', 'ELHCA0039', 'TXHOUSTD', 'Plus Care', 'Claire', '', 'DeVore', 'PA', 'Internal Medicine', '', '', NULL, 'O', '119 D Medical Park Ln ', 'Huntsville', 'Walker', 'TX', '77340', '9364361786', '9364351109', '119 D Medical Park Ln ', 'Huntsville', 'Walker', 'TX', '77340', '9364361786', '9364351109', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', '2013-03-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1245314632', 0, 'Y', 0, '2013-09-10', 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
('942938348', 'W40017444', 'W40017444', 'UTMH1', ' Valley Mental Health Inc', 'Michael', 'C', 'Desjardins', 'APRN', 'Mental Health', 'Adult Psychiatric Nurse Practitioner', 'Psychiatry', NULL, 'B', '5965 S 900 E Ste 430', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012637100', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'UTVMHARNP', NULL, NULL, '0.00', '40.00', '0.00', 6, '2013-02-15', NULL, NULL, 0, NULL, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1801924766', 0, 'Y', 0, '2013-02-28', NULL, NULL, 0, 0, NULL, NULL),
('202800071', 'W40019706', 'W40019706', 'UTMH1', 'Alpine Center for Personal Growth', 'Michael', 'C', 'Desjardins', 'APRN', 'Mental Health', 'Adult Psychiatric Nurse Practitioner', 'Psychiatry', NULL, 'O', '5689 S Redwood Rd Ste 30', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8012681715', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'UTARNP', '', '', '0.00', '40.00', '0.00', 6, '2013-02-15', NULL, NULL, 0, NULL, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1801924766', 0, 'N', 0, '2013-02-28', NULL, NULL, 40.6479, -111.939, NULL, NULL),
('263510730', 'W40021390', 'W40021390', 'UTMH1', 'Autism Assessment and Treatment Center', 'Laraine', '', 'Miner', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '4505 Wasatch Blvd Ste 190', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8013868069', NULL, '4505 Wasatch Blvd Ste 190', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8013868069', '', 'UTMA', '', '', '0.00', '40.00', '0.00', 6, '2013-02-15', '2014-03-13', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1871571638', 0, 'N', 0, '2014-05-06', NULL, NULL, 40.6739, -111.802, NULL, NULL),
('548700079', 'W40012873', 'W40012873', 'UTMH1', 'Holistic Balance', 'Laraine', '', 'Miner', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '865 E 4800 S Ste 222', 'Murray', 'Salt Lake', 'UT', '84107', '8016568827', '8012663358', '865 E 4800 S Ste 222', 'Murray', 'Salt Lake', 'UT', '84107', '8016568827', '8012663358', 'UTMA', '', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1871571638', 0, 'N', 0, '2014-05-06', NULL, NULL, 40.6654, -111.867, NULL, NULL),
('548700079', 'W40012874', 'W40012874', 'UTMH1', 'Holistic Balance', 'Laraine', '', 'Miner', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'B', 'PO Box 18415', 'Taylorsville', 'Salt Lake', 'UT', '84118', '8016568827', '8012663358', 'PO Box 18415', 'Taylorsville', 'Salt Lake', 'UT', '84118', '8016568827', '8012663358', 'UTMA', '', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1871571638', 0, 'N', 0, '2014-05-06', NULL, NULL, 0, 0, NULL, NULL),
('876114073', 'W40011877', 'W40011877', 'UTMH1', 'The Childrens Center', 'Laraine', '', 'Miner', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'B', '350 S 400 E', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8019664251', '8019664289', '350 S 400 E', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8019664251', '8019664289', 'UTMA', '', '', '0.00', '40.00', '0.00', 6, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1871571638', 0, 'N', 0, '2014-05-06', NULL, NULL, 0, 0, NULL, NULL),
('876114073', 'W40005644', 'W40005644', 'UTMH1', 'The Childrens Center', 'Laraine', '', 'Miner', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '5242 S 4820 W', 'Kearns', 'Salt Lake', 'UT', '84118', '8019664251', NULL, '5242 S 4820 W', 'Kearns', 'Salt Lake', 'UT', '84118', '8019664251', '', 'UTMA', NULL, NULL, '0.00', '40.00', '0.00', 6, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1871571638', 0, 'n', 0, '2014-05-06', NULL, NULL, 40.6558, -112.006, NULL, NULL),
('942938348', 'W40006889', 'W40006889', 'UTMH1', 'Valley Mental Health  Inc', 'Laraine', '', 'Miner', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'B', '5965 S 900 E Ste 430', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012637100', NULL, '5965 S 900 E Ste 430', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012637100', '', 'UTVMHMA', NULL, NULL, '0.00', '40.00', '0.00', 6, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1871571638', 0, 'Y', 0, '2014-05-06', NULL, NULL, 0, 0, NULL, NULL),
('201657769', 'ELHCA0037', 'ELHCA0037', 'TXHOUSTD', 'North Pines General Surgery', 'Charlie', '', 'Dendy', 'DO', 'General Surgery', '', '', NULL, 'O', '500 Medical Ctr Blvd Ste 340', 'Conroe', 'Montgomery', 'TX', '77304', '9364942201', '9364942217', '500 Medical Ctr Blvd Ste 340', 'Conroe', 'Montgomery', 'TX', '77304', '9364942201', '9364942217', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Conroe Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1508087438', 0, 'N', 0, '2013-05-01', NULL, NULL, 30.2831, -95.4693, NULL, NULL),
('201657769', 'ELHCA0038', 'ELHCA0038', 'TXHOUSTD', 'North Pines General Surgery', 'Charlie', '', 'Dendy', 'DO', 'General Surgery', '', '', NULL, 'B', 'PO Box 404554   ', 'Atlanta', 'Fulton', 'GA', '30384', NULL, NULL, 'PO Box 404554   ', 'Atlanta', 'Fulton', 'GA', '30384', '', '', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Conroe Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1508087438', 0, 'Y', 0, '2013-05-01', NULL, NULL, 0, 0, NULL, NULL),
('205934739', 'SACN00176', 'SACN00176', 'SACN', 'Family Medicine Health Center', 'Timothy', '', 'DeBlieck', 'MD', 'Family Practice', '', '', NULL, 'O', '777 N Raymond St', 'Boise', 'Ada', 'ID', '83704', '2085142500', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'IDSINCLAIRL', 'WUSTDHCPC5', NULL, '0.00', '15.00', '0.00', 3, '2011-01-01', NULL, 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1114961042', 0, 'n', 0, '2013-02-28', NULL, NULL, 0, 0, NULL, NULL),
('205934739', 'SACN00175', 'SACN00175', 'SACN', 'Family Medicine Health Center', 'Timothy', '', 'DeBlieck', 'MD', 'Family Practice', '', '', NULL, 'O', '121 E Fort St', 'Boise', 'Ada', 'ID', '83712', '2083811775', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'IDSINCLAIRL', 'WUSTDHCPC5', NULL, '0.00', '15.00', '0.00', 3, '2011-01-01', NULL, 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1114961042', 0, 'n', 0, '2013-02-28', NULL, NULL, 0, 0, NULL, NULL),
('942938348', 'W40006739', 'W40006739', 'UTMH1', 'Valley Mental Health  Inc', 'KAREN', NULL, 'DEARING', 'APRN', 'Mental Health', '', '', NULL, 'B', '5965 S 900 E Ste 430', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012637100', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'UTVMHARNP', NULL, NULL, '0.00', '40.00', '0.00', 6, '2013-02-15', NULL, NULL, 0, NULL, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1740267665', 0, 'Y', 0, '2013-02-28', NULL, NULL, 0, 0, NULL, NULL),
('942938348', 'W40006777', 'W40006777', 'UTMH1', 'Valley Mental Health  Inc', 'JAMIE', NULL, 'DAYBELL', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', '5965 S 900 E Ste 430', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012637100', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'UTVMHMA', NULL, NULL, '0.00', '40.00', '0.00', 6, '2013-02-15', NULL, NULL, 0, NULL, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1649221771', 0, 'Y', 0, '2013-02-28', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12002281', 'W12002281', 'UTIHCPHY', 'Bountiful KidsCare', 'Bessann', '', 'Dawson', 'MD', 'Urgent Care', '', '', NULL, 'O', '390 N Main St', 'Bountiful', 'Davis', 'UT', '84010', '8012949933', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2008-07-01', NULL, NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1427071265', 0, 'Y', 0, '2013-02-28', NULL, NULL, 40.8935, -111.881, NULL, NULL),
('942854057', 'W12003241', 'W12003241', 'UTIHC04', 'Radiology', 'Steven', 'B', 'Davis', 'MD', 'Radiologist', '', '', NULL, 'O', '1380 E Medical Ctr Dr', 'St George', 'Washington', 'UT', '84790', '4352511715', '4356563850', NULL, NULL, NULL, NULL, NULL, NULL, NULL, '', '', '', '0.00', '15.00', '0.00', 8, '2010-06-30', NULL, NULL, 0, NULL, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1467471284', 0, 'N', 0, '2013-02-28', NULL, NULL, 37.0998, -113.554, NULL, NULL),
('942854057', 'W12003239', 'W12003239', 'UTIHC01', 'Radiology', 'Steven', 'B', 'Davis', 'MD', 'Radiologist', '', '', NULL, 'O', '1380 E Medical Ctr Dr', 'St George', 'Washington', 'UT', '84790', '4352511715', '4356563850', '1380 E Medical Ctr Dr', 'St George', 'Washington', 'UT', '84790', '4352511715', '4356563850', '', '', '', '0.00', '15.00', '0.00', 8, '2010-06-30', '2013-07-01', 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1467471284', 0, 'N', 0, '2013-08-28', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12003240', 'W12003240', 'UTIHC03', 'Radiology', 'Steven', 'B', 'Davis', 'MD', 'Radiologist', '', '', NULL, 'O', '1380 E Medical Ctr Dr', 'St George', 'Washington', 'UT', '84790', '4352511715', '4356563850', '1380 E Medical Ctr Dr', 'St George', 'Washington', 'UT', '84790', '4352511715', '4356563850', '', '', '', '0.00', '15.00', '0.00', 8, '2010-06-30', '2013-07-01', 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1467471284', 0, 'N', 0, '2013-08-28', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12003233', 'W12003233', 'UTIHC04', 'Radiology', 'John', 'A', 'Davis', 'MD', 'Radiologist', '', '', NULL, 'O', '1380 E Medical Ctr Dr', 'St George', 'Washington', 'UT', '84790', '4352511715', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '', '', '', '0.00', '15.00', '0.00', 8, '2010-01-01', NULL, NULL, 0, NULL, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1326093998', 0, 'N', 0, '2013-02-28', NULL, NULL, 37.0998, -113.554, NULL, NULL),
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('271524083', 'W12019392', 'W12019392', 'WYT1', 'Big Horn Health Network', 'Nicole', 'L', 'Caldwell', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1435 Burton St', 'Sheridan', 'Sheridan', 'WY', '82801', '3076752650', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'BHHN3', 'BHHN1', '', '0.00', '0.00', '0.00', 3, '2012-03-01', NULL, NULL, 0, NULL, '', '', '', '', 'HCFA|', '1053499426', 0, 'N', 0, '2013-02-28', NULL, NULL, 0, 0, NULL, NULL),
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('263091562', 'ELHCA0026', 'ELHCA0026', 'TXHOUSTD', 'Mainland PCP', 'Yohmarie', NULL, 'Cajigas', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 405470      ', 'Atlanta', 'Fulton', 'GA', '30384', NULL, NULL, 'PO Box 405470      ', 'Atlanta', 'Fulton', 'GA', '30384', '', '', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', NULL, '', NULL, 'HCFA|UB|', '1811972862', 0, 'Y', 0, '2013-05-01', NULL, NULL, 0, 0, NULL, NULL),
('263091562', 'ELHCA0025', 'ELHCA0025', 'TXHOUSTD', 'Mainland PCP', 'Yohmarie', NULL, 'Cajigas', 'MD', 'Family Practice', '', '', NULL, 'O', '6807 Emmett F Lowry Expwy Ste 103', 'Texas City', 'Galveston', 'TX', '77591', '4099381770', '4099380701', '6807 Emmett F Lowry Expwy Ste 103', 'Texas City', 'Galveston', 'TX', '77591', '4099381770', '4099380701', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', NULL, '', NULL, 'HCFA|UB|', '1811972862', 0, 'N', 0, '2013-05-01', NULL, NULL, 29.3953, -94.9874, NULL, NULL),
('205934739', 'SACN00387', 'SACN00387', 'SACN', 'Family Medicine Health Center', 'Kara', 'L', 'Cadwallader', 'MD', 'Family Practice', '', '', NULL, 'O', '777 N Raymond St', 'Boise', 'Ada', 'ID', '83704', '2085142500', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'IDSINCLAIRL', 'WUSTDHCPC5', NULL, '0.00', '15.00', '0.00', 3, '2011-01-01', NULL, 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1669414728', 0, 'n', 0, '2013-02-28', NULL, NULL, 0, 0, NULL, NULL),
('205934739', 'SACN00386', 'SACN00386', 'SACN', 'Family Medicine Health Center', 'Kara', 'L', 'Cadwallader', 'MD', 'Family Practice', '', '', NULL, 'O', '121 E Fort St', 'Boise', 'Ada', 'ID', '83712', '2083811775', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'IDSINCLAIRL', 'WUSTDHCPC5', NULL, '0.00', '15.00', '0.00', 3, '2011-01-01', NULL, 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1669414728', 0, 'n', 0, '2013-02-28', NULL, NULL, 0, 0, NULL, NULL),
('942938348', 'W40006764', 'W40006764', 'UTMH1', 'Valley Mental Health  Inc', 'JOHN', NULL, 'BYRNE', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', '5965 S 900 E Ste 430', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012637100', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'UTVMHMA', NULL, NULL, '0.00', '40.00', '0.00', 6, '2013-02-15', NULL, NULL, 0, NULL, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1982674495', 0, 'Y', 0, '2013-02-28', NULL, NULL, 0, 0, NULL, NULL),
('200192377', 'SACN01640', 'SACN01640', 'SACN', 'Meridian Family Medicine', 'David', 'J', 'Butuk', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 44440', 'Boise', 'Ada', 'ID', '83711', '2083239130', '2083239070', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'IDSINCLAIRL', NULL, NULL, '0.00', '15.00', '0.00', 3, '2011-01-01', NULL, 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|UB|', '1942250972', 0, 'Y', 0, '2013-02-28', NULL, NULL, 0, 0, NULL, NULL),
('202630141', 'W40010664', 'W40010664', 'IDBOISTD', 'Primary Health Medical Group', 'Ann', 'M', 'Weiss', 'MD', 'Family Practice', '', '', NULL, 'O', '700 Caldwell Blvd', 'Nampa', 'Canyon', 'ID', '83651', '2084666567', '2084667922', '700 Caldwell Blvd', 'Nampa', 'Canyon', 'ID', '83651', '2084666567', '2084667922', 'IDPRIMARY', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2013-03-01', NULL, 0, 0, 0, 'West Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1013094820', 0, 'N', 0, '2013-07-02', NULL, NULL, 43.5963, -116.59, NULL, NULL),
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('202630141', 'W40015520', 'W40015520', 'IDBOISTD', 'Primary Health Medical Group', 'April', 'L', 'Dillion', 'DO', 'Family Practice', '', '', NULL, 'O', '11197 W Fairview Ave', 'Boise', 'Ada', 'ID', '83713', '2083788011', NULL, '11197 W Fairview Ave', 'Boise', 'Ada', 'ID', '83713', '2083788011', '          ', 'IDPRIMARY', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2013-03-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1033329842', 0, 'N', 0, '2013-07-02', NULL, NULL, 43.6195, -116.322, NULL, NULL),
('202630141', 'W40020386', 'W40020386', 'IDBOISTD', 'Primary Health Medical Group', 'April', 'L', 'Dillion', 'DO', 'Family Practice', '', '', NULL, 'O', '300 W Myrtle St Ste 100', 'Boise', 'Ada', 'ID', '83702', '2084729082', '2084729083', '300 W Myrtle St Ste 100', 'Boise', 'Ada', 'ID', '83702', '2084729082', '2084729083', 'IDPRIMARY', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2013-03-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1033329842', 0, 'N', 0, '2013-07-02', NULL, NULL, 43.6096, -116.201, NULL, NULL),
('202630141', 'W40015521', 'W40015521', 'IDBOISTD', 'Primary Health Medical Group', 'April', 'L', 'Dillion', 'DO', 'Family Practice', '', '', NULL, 'B', 'PO Box 191050', 'Boise', 'Ada', 'ID', '83719', '2088788011', '2089556501', 'PO Box 191050', 'Boise', 'Ada', 'ID', '83719', '2088788011', '2089556501', 'IDPRIMARY', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2013-03-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1033329842', 0, 'N', 0, '2013-07-02', NULL, NULL, 0, 0, NULL, NULL),
('461870451', 'W12030634', 'W12030634', 'UT01', 'Eye Site of Utah', 'Alan', 'B', 'Gummow', 'OD', 'Optometry', '', '', NULL, 'O', '307 N 300 W Ste 302', 'Kaysville', 'Davis', 'UT', '84037', '8014449977', '0000000000', '307 N 300 W Ste 302', 'Kaysville', 'Davis', 'UT', '84037', '8014449977', '0000000000', 'WUTALBERT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-03-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1558550913', 0, 'N', 0, '2014-04-23', NULL, NULL, 41.0399, -111.944, NULL, NULL),
('262518076', 'W12030635', 'W12030635', 'ID01', 'Journey Mental Health', 'Michael', 'A', 'Grigg', 'LMFT', 'Mental Health', 'Counseling', '', NULL, 'O', '3288 E Pine Ave', 'Meridian', 'Ada', 'ID', '83642', '2088888886', '2086580153', '3288 E Pine Ave', 'Meridian', 'Ada', 'ID', '83642', '2088888886', '2086580153', 'IDMA', '', '', '0.00', '40.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1851599252', 0, 'N', 0, '2013-03-18', NULL, NULL, 43.6122, -116.35, NULL, NULL),
('271368925', 'W12030636', 'W12030636', 'WY01', 'Bear Lodge Rehabilitation', 'Lana', 'M', 'Dacar', 'PT', 'Physical Therapy', '', '', NULL, 'O', '226 State Hwy 585', 'Sundance', 'Crook', 'WY', '82729', '3072833516', '3072833515', '226 State Hwy 585', 'Sundance', 'Crook', 'WY', '82729', '3072833516', '3072833515', 'WISEWYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1912077991', 0, 'N', 0, '2013-03-18', NULL, NULL, 44.4052, -104.374, NULL, NULL),
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('271368925', 'W12030638', 'W12030638', 'WYT1', 'Bear Lodge Rehabilitation', 'Lana', 'M', 'Dacar', 'PT', 'Physical Therapy', '', '', NULL, 'M', 'PO Box 928', 'Sundance', 'Crook', 'WY', '82729', '3072833516', '3072833515', 'PO Box 928', 'Sundance', 'Crook', 'WY', '82729', '3072833516', '3072833515', 'WISEWYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1912077991', 0, 'N', 0, '2013-03-18', NULL, NULL, 0, 0, NULL, NULL),
('271368925', 'W12030639', 'W12030639', 'WY01', 'Bear Lodge Rehabilitation', 'Lana', 'M', 'Dacar', 'PT', 'Physical Therapy', '', '', NULL, 'M', 'PO Box 928', 'Sundance', 'Crook', 'WY', '82729', '3072833516', '3072833515', 'PO Box 928', 'Sundance', 'Crook', 'WY', '82729', '3072833516', '3072833515', 'WISEWYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1912077991', 0, 'N', 0, '2013-03-18', NULL, NULL, 0, 0, NULL, NULL),
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('271368925', 'W12030641', 'W12030641', 'WY01', 'Bear Lodge Rehabilitation', 'Lana', 'M', 'Dacar', 'PT', 'Physical Therapy', '', '', NULL, 'B', 'PO Box 1790', 'Douglas', 'Converse', 'WY', '82633', '3072833516', '3072833515', 'PO Box 1790', 'Douglas', 'Converse', 'WY', '82633', '3072833516', '3072833515', 'WISEWYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1912077991', 0, 'N', 0, '2013-03-18', NULL, NULL, 0, 0, NULL, NULL),
('364343066', 'W12030644', 'W12030644', 'ILCHIGSTD', 'Northwest Medical Clinic SC', 'Daniela', '', 'Huerta de Hathaway', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1614 W Central Rd Ste 209', 'Arlington Heights', 'Cook', 'IL', '60005', '8472598777', '8472599994', '1614 W Central Rd Ste 209', 'Arlington Heights', 'Cook', 'IL', '60005', '8472598777', '8472599994', 'CHIG1', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-03-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1235390154', 0, 'N', 0, '2013-03-05', NULL, NULL, 42.0667, -88.0017, NULL, NULL),
('364343066', 'W12030645', 'W12030645', 'ILCHIGSTD', 'Northwest Medical Clinic SC', 'Daniela', '', 'Huerta de Hathaway', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 967', 'Tinley Park', 'Cook', 'IL', '60477', '8472598777', '8472599994', 'PO Box 967  ', 'Tinley Park', 'Cook', 'IL', '60477', '8472598777', '8472599994', 'CHIG1', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-03-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1235390154', 0, 'N', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('263133757', 'W12029468', 'W12029468', 'TXBEAUSTD', 'Rodonaia Family Medicine and Aesthetics', 'Grigoriy', 'T', 'Rodonaia', 'MD', 'Family Practice', '', '', NULL, 'O', '2955 Harrison Ste 200 & 301', 'Beaumont', 'Jefferson', 'TX', '77702', '4099231617', '4099231618', '2955 Harrison Ste 200 & 301', 'Beaumont', 'Jefferson', 'TX', '77702', '4099231617', '4099231618', 'BEAUMONT1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-04-03', NULL, 0, 0, 0, 'Baptist Beaumont Hospital', NULL, '', '', 'HCFA|UB|', '1023210317', 0, 'N', 0, '2013-05-24', NULL, NULL, 30.0895, -94.1329, NULL, NULL),
('742915297', 'W12030648', 'W12030648', 'TXSATSTD', 'South Texas Oncology and Hematology', 'Luis', 'C', 'Rodriguez', 'MD', 'Hematology and Oncology', 'Oncology', '', NULL, 'B', 'PO Box 268', 'San Antonio', 'Bexar', 'TX', '78291', '2105935200', '2103543870', 'PO Box 268', 'San Antonio', 'Bexar', 'TX', '78291', '2105935200', '2103543870', 'TXONCOL', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-11-05', NULL, 0, 0, 0, 'Baptist Medical Center', 'North East Baptist Hospital', NULL, NULL, 'HCFA|UB|', '1942234216', 0, 'N', 0, '2013-04-24', NULL, NULL, 0, 0, NULL, NULL),
('742915297', 'W12030647', 'W12030647', 'TXSATSTD', 'South Texas Oncology and Hematology', 'Luis', 'C', 'Rodriguez', 'MD', 'Hematology and Oncology', 'Oncology', '', NULL, 'O', '1200 Brooklyn Ave Ste 350', 'San Antonio', 'Bexar', 'TX', '78212', '2105935200', '2103543870', '1200 Brooklyn Ave Ste 350', 'San Antonio', 'Bexar', 'TX', '78212', '2105935200', '2103543870', 'TXONCOL', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-11-05', '2013-04-24', 0, 0, 0, 'Baptist Medical Center', 'North East Baptist Hospital', NULL, NULL, 'HCFA|UB|', '1942234216', 0, 'N', 0, '2013-04-24', NULL, NULL, 29.4403, -98.4903, NULL, NULL),
('260421988', 'W12030649', 'W12030649', 'UT01', 'Salt Lake Retina ', 'Christopher', 'J', 'Gee', 'MD', 'Ophthalmology', '', '', NULL, 'O', '3855 W 7800 S Ste 100', 'West Jordan', 'Salt Lake', 'UT', '84088', '8012600034', '8012600035', '3855 W 7800 S Ste 100', 'West Jordan', 'Salt Lake', 'UT', '84088', '8012600034', '8012600035', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-03-01', NULL, 0, 0, 0, 'University Health Care University Hospital', '', '', '', 'HCFA|UB|', '1831372499', 0, 'N', 0, '2013-03-19', NULL, NULL, 40.6094, -111.983, NULL, NULL),
('260421988', 'W12030650', 'W12030650', 'UT01', 'Salt Lake Retina', 'Douglas', 'S', 'Mehr', 'MD', 'Ophthalmology', '', '', NULL, 'O', '3855 W 7800 S Ste 100', 'West Jordan', 'Salt Lake', 'UT', '84088', '8012600034', '8012600035', '3855 W 7800 S Ste 100', 'West Jordan', 'Salt Lake', 'UT', '84088', '8012600034', '8012600035', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-03-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1720070899', 0, 'N', 0, '2013-03-19', NULL, NULL, 40.6094, -111.983, NULL, NULL),
('870284475', 'W12030651', 'W12030651', 'UT01', 'Granger Medical Clinic', 'Craig', 'H', 'Yerke', 'PA', 'Physician Assistant', '', '', NULL, 'O', '3725 W 4100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019653600', '8019653740', '3725 W 4100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019653600', '8019653740', 'WUGRANGER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Pioneer Valley Hospital', '', '', '', 'HCFA|UB|', '1275861619', 0, 'N', 0, '2013-03-27', NULL, NULL, 40.682, -111.979, NULL, NULL),
('870284475', 'W12030652', 'W12030652', 'UT01', 'Granger Medical Clinic', 'Craig', 'H', 'Yerke', 'PA', 'Physician Assistant', '', '', NULL, 'B', 'PO Box 70658', 'Salt Lake City', 'Salt Lake', 'UT', '84170', '          ', NULL, 'PO Box 70658', 'Salt Lake City', 'Salt Lake', 'UT', '84170', '          ', '          ', 'WUGRANGER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-04-01', NULL, 0, 0, 0, 'Pioneer Valley Hospital', '', '', '', 'HCFA|UB|', '1275861619', 0, 'N', 0, '2013-03-27', NULL, NULL, 0, 0, NULL, NULL),
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('820477852', 'SACN01090', 'SACN01090', 'SACN', 'Saint Alphonsus Medical Group Pediatrics', 'James', 'P', 'Baker', 'MD', 'Pediatrics', '', '', NULL, 'o', '999 N Curtis Ste 407', 'Boise', 'Ada', 'ID', '83706', '2083674321', '2083674525', '999 N Curtis Ste 407', 'Boise', 'Ada', 'ID', '83706', '2083674321', '2083674525', 'IDSINCLAIRL', '', '', '0.00', '15.00', '0.00', 6, '2011-01-01', '2014-03-31', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1497799670', 0, 'N', 0, '2014-02-19', NULL, NULL, 43.6132, -116.255, 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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('820200895', 'SACN01088', 'SACN01088', 'SACN', 'Saint Alphonsus Medical Group Pediatrics', 'James', 'P', 'Baker', 'MD', 'Pediatrics', '', '', NULL, 'O', '999 N Curtis Ste 407', 'Boise', 'Ada', 'ID', '83706', '2083674321', '2083674525', '999 N Curtis Ste 407', 'Boise', 'Ada', 'ID', '83706', '2083674321', '2083674525', 'IDSINCLAIRL', '', '', '0.00', '15.00', '0.00', 6, '2011-01-01', '2014-03-31', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|', '1497799670', 0, 'N', 0, '2014-02-19', NULL, NULL, 43.6132, -116.255, NULL, NULL),
('452298151', 'ELHCA0010', 'ELHCA0010', 'TXHOUSTD', 'Azimpoor, Ali', 'Ali', NULL, 'Azimpoor', 'MD', 'Neurosurgery', '', '', NULL, 'B', 'PO Box 741714', 'Atlanta', 'Fulton', 'GA', '30374', '          ', NULL, 'PO Box 741714', 'Atlanta', 'Fulton', 'GA', '30374', '          ', '          ', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'West Houston Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1134123862', 0, 'Y', 0, '2013-05-01', NULL, NULL, 0, 0, NULL, NULL),
('452298151', 'ELHCA0009', 'ELHCA0009', 'TXHOUSTD', 'Azimpoor, Ali', 'Ali', NULL, 'Azimpoor', 'MD', 'Neurosurgery', '', '', NULL, 'O', '1140 Business Ctr Dr Ste 490', 'Houston', 'Harris', 'TX', '77043', '7139321247', '7139321887', '1140 Business Ctr Dr Ste 490', 'Houston', 'Harris', 'TX', '77043', '7139321247', '7139321887', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'West Houston Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1134123862', 0, 'N', 0, '2013-05-01', NULL, NULL, 29.7894, -95.568, NULL, NULL),
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('043673591', 'W40021706', 'W40021706', 'ID01', 'Eagle River Psychiatry and Counseling', 'Jody', 'L', 'Jenson', 'NP', 'Mental Health', 'Psychiatry', '', NULL, 'O', '1032 S Bridgeway Pl Ste 100', 'Eagle', 'Ada', 'ID', '83616', '2082460123', '          ', '1032 S Bridgeway Pl Ste 100', 'Eagle', 'Ada', 'ID', '83616', '2082460123', '          ', 'IDARNP', '', '', '0.00', '40.00', '0.00', 6, '2013-02-15', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1669737300', 0, 'N', 0, '2014-05-15', NULL, NULL, 43.6872, -116.35, NULL, NULL),
('870621744', 'W40015409', 'W40015409', 'UTMH1', 'Mt Logan Clinic', 'Bruce', '', 'Johns', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '246 E 1260 N', 'Logan', 'Cache', 'UT', '84341', '4357506300', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'PHD', NULL, NULL, '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, NULL, '', '', '', '', 'HCFA|UB|', '1831102052', 0, 'n', 0, '2013-02-28', NULL, NULL, 41.7547, -111.827, 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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('542369340', 'W40005464', 'W40005464', 'UTMH1', NULL, 'Robert', 'B', 'Johnson', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'B', '3434 Brookview Ln', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8019499554', NULL, '3434 Brookview Ln', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8019499554', '', 'UTMA', NULL, NULL, '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1609946375', 0, 'Y', 0, '2014-05-01', NULL, NULL, 0, 0, NULL, NULL),
('542369340', 'W40015811', 'W40015811', 'UTMH1', '', 'Robert', 'B', 'Johnson', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '9035 S 700 E Ste 207', 'Sandy', 'Salt Lake', 'UT', '84070', '8019499554', NULL, '9035 S 700 E Ste 207', 'Sandy', 'Salt Lake', 'UT', '84070', '8019499554', '', 'UTMA', '', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1609946375', 0, 'N', 0, '2014-05-01', NULL, NULL, 40.5874, -111.872, NULL, NULL),
('870575977', 'W40014094', 'W40014094', 'UTMH1', '', 'Roderick', 'V', 'Johnson', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '40 S Main', 'Tooele', 'Tooele', 'UT', '84074', '8016859600', NULL, '40 S Main', 'Tooele', 'Tooele', 'UT', '84074', '8016859600', '', 'UTMA', '', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1780672915', 0, 'N', 0, '2014-05-08', NULL, NULL, 40.5298, -112.299, NULL, NULL),
('870575977', 'W40005321', 'W40005321', 'UTMH1', NULL, 'Roderick', 'V', 'Johnson', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '860 E 4500 S Ste 302', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8016859600', NULL, '860 E 4500 S Ste 302', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8016859600', '', 'UTMA', NULL, '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1780672915', 0, 'N', 0, '2014-05-08', NULL, NULL, 40.6743, -111.867, NULL, NULL),
('870575977', 'W40005322', 'W40005322', 'UTMH1', NULL, 'Roderick', 'V', 'Johnson', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', 'PO Box 955', 'Tooele', 'Tooele', 'UT', '84074', '4358822207', NULL, 'PO Box 955', 'Tooele', 'Tooele', 'UT', '84074', '4358822207', '', 'UTMA', NULL, '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1780672915', 0, 'Y', 0, '2014-05-08', NULL, NULL, 0, 0, NULL, NULL),
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('870710584', 'W40005693', 'W40005693', 'UTMH1', 'Jordan West Family Counseling', 'Tod', '', 'Johnson', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '9263 B Redwood Rd', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015660749', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'MA', NULL, NULL, '0.00', '40.00', '0.00', 6, '2013-02-15', NULL, 0, 0, NULL, '', '', '', '', 'HCFA|UB|', '1629089180', 0, 'n', 0, '2013-02-28', NULL, NULL, 40.583, -111.939, NULL, NULL),
('203117934', 'W40017416', 'W40017416', 'UTMH1', NULL, 'Cindy', 'A', 'Jones', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '965 S Main St Ste 5', 'Cedar City', 'Iron', 'UT', '84720', '4355864568', NULL, '965 S Main St Ste 5', 'Cedar City', 'Iron', 'UT', '84720', '4355864568', '', 'UTMA', NULL, NULL, '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1689704223', 0, 'n', 0, '2013-06-19', NULL, NULL, 37.6611, -113.07, NULL, NULL),
('524645160', 'W40005886', 'W40005886', 'UTMH1', '', 'Georgia', 'A', 'Jones', 'LCSW', 'Mental Health', 'Social Worker', NULL, NULL, 'O', '1348 S 1100 E', 'Salt Lake City', 'Salt Lake', 'UT', '84105', '8014676136', '8014676157', '1348 S 1100 E', 'Salt Lake City', 'Salt Lake', 'UT', '84105', '8014676136', '8014676157', 'MA', '', '', '0.00', '40.00', '0.00', 3, '2013-02-15', '2014-02-05', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1689627416', 0, 'N', 0, '2014-02-25', NULL, NULL, 0, 0, NULL, NULL),
('205934739', 'W40013531', 'W40013531', 'ID02', 'Family Medicine Health Center', 'Jeralyn', 'J', 'Jones', 'MD', 'Mental Health', 'Psychiatry', 'Family Practice', NULL, 'O', '121 E Fort St', 'Boise', 'Ada', 'ID', '83712', '2083811775', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'IDPPO', 'WUSTDHCPC5', NULL, '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1891731451', 0, 'n', 0, '2013-02-28', NULL, NULL, 0, 0, NULL, NULL),
('205934739', 'W40013530', 'W40013530', 'ID02', 'Family Medicine Health Center', 'Jeralyn', 'J', 'Jones', 'MD', 'Mental Health', 'Psychiatry', 'Family Practice', NULL, 'O', '777 N Raymond St', 'Boise', 'Ada', 'ID', '83704', '2085142500', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'IDPPO', 'WUSTDHCPC5', NULL, '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1891731451', 0, 'n', 0, '2013-02-28', NULL, NULL, 0, 0, NULL, NULL),
('263252282', 'W40019345', 'W40019345', 'UTMH1', 'SLC Body Mind Fitness', 'Leann', 'G', 'Jones', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '1615 S State', 'Salt Lake City', 'Salt Lake', 'UT', '84115', '8014672072', '          ', '1615 S State', 'Salt Lake City', 'Salt Lake', 'UT', '84115', '8014672072', '          ', 'MA', '', '', '0.00', '40.00', '0.00', 3, '2013-02-15', '2014-07-07', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1962569426', 0, 'Y', 0, '2014-04-11', NULL, NULL, 0, 0, NULL, NULL),
('270980493', 'W40001809', 'W40001809', 'Sinclair', '', 'Charles', 'E', 'Junkin', 'LPC', 'Mental Health', '', '', NULL, 'O', '501 W Buffalo', 'Rawlins', 'Carbon', 'WY', '82301', '3073245899', NULL, '501 W Buffalo', 'Rawlins', 'Carbon', 'WY', '82301', '3073245899', '          ', 'WYMA', '', '', '0.00', '40.00', '0.00', 3, '2013-02-15', '2013-02-15', 0, 0, 0, '', '', '', '', 'HCFA|UB|DEN|', '1811070782', 0, 'Y', 0, '2013-03-27', NULL, NULL, 0, 0, NULL, NULL),
('270980493', 'W40001812', 'W40001812', 'Sinclair', '', 'Charles', 'E', 'Junkin', 'LPC', 'Mental Health', '', '', NULL, 'B', 'PO Box 911', 'Rawlins', 'Carbon', 'WY', '82301', '3073245899', NULL, 'PO Box 911', 'Rawlins', 'Carbon', 'WY', '82301', '3073245899', '          ', 'WYMA', '', '', '0.00', '40.00', '0.00', 3, '2013-02-15', '2013-02-15', 0, 0, 0, '', '', '', '', 'HCFA|UB|DEN|', '1811070782', 0, 'Y', 0, '2013-03-27', NULL, NULL, 0, 0, NULL, NULL),
('270980493', 'W40001808', 'W40001808', 'WY01', '', 'Charles', 'E', 'Junkin', 'LPC', 'Mental Health', '', '', NULL, 'O', '501 W Buffalo', 'Rawlins', 'Carbon', 'WY', '82301', '3073245899', NULL, '501 W Buffalo', 'Rawlins', 'Carbon', 'WY', '82301', '3073245899', '          ', 'WYMA', '', '', '0.00', '40.00', '0.00', 3, '2013-02-15', '2013-02-15', 0, 0, 0, '', '', '', '', 'HCFA|UB|DEN|', '1811070782', 0, 'N', 0, '2013-03-27', NULL, NULL, 0, 0, NULL, NULL),
('270980493', 'W40001813', 'W40001813', 'WY01', '', 'Charles', 'E', 'Junkin', 'LPC', 'Mental Health', '', '', NULL, 'B', 'PO Box 911', 'Rawlins', 'Carbon', 'WY', '82301', '3073245899', NULL, 'PO Box 911', 'Rawlins', 'Carbon', 'WY', '82301', '3073245899', '          ', 'WYMA', '', '', '0.00', '40.00', '0.00', 3, '2013-02-15', '2013-02-15', 0, 0, 0, '', '', '', '', 'HCFA|UB|DEN|', '1811070782', 0, 'Y', 0, '2013-03-27', NULL, NULL, 0, 0, NULL, NULL),
('841383395', 'W40011735', 'W40011735', 'UTMH1', '', 'Kathryn', 'M', 'Kair', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '6925 S Union Park Ctr Ste 490', 'Midvale', 'Salt Lake', 'UT', '84047', '8015662622', '8015660536', '6925 S Union Park Ctr Ste 490', 'Midvale', 'Salt Lake', 'UT', '84047', '8015662622', '8015660536', 'PHD', '', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1508960063', 0, 'N', 0, '2014-05-01', NULL, NULL, 40.6248, -111.856, NULL, NULL),
('900136549', 'W40012953', 'W40012953', 'UTMH1', '', 'Catharina', 'H', 'Kang', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '425 E 5350 S Ste 280', 'Ogden', 'Weber', 'UT', '84405', '8014750712', '          ', '425 E 5350 S Ste 280', 'Ogden', 'Weber', 'UT', '84405', '8014750712', '          ', 'PHD', '', '', '0.00', '40.00', '0.00', 3, '2013-02-15', '2014-04-24', 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1609927466', 0, 'N', 0, '2014-04-28', NULL, NULL, 41.166, -111.97, NULL, NULL),
('900136549', 'W40020029', 'W40020029', 'UTMH1', '', 'Catharina', 'H', 'Kang', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '4699 Harrison Blvd Ste 301', 'Ogden', 'Weber', 'UT', '84403', '8014757139', '8014757139', '4699 Harrison Blvd Ste 301', 'Ogden', 'Weber', 'UT', '84403', '8014757139', '8014757139', 'PHD', '', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1609927466', 0, 'N', 0, '2014-04-28', NULL, NULL, 41.1775, -111.949, NULL, NULL),
('010885716', 'W40024037', 'W40024037', 'UTMH1', 'Riley Individual, Family and Marriage Counseling', 'William', 'R', 'Kastner', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '873 Baxter Dr', 'South Jordan', 'Salt Lake', 'UT', '84095', '8016570163', '8015687856', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'UTMD', '', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1982906616', 0, 'N', 0, '2013-02-28', NULL, NULL, 40.5606, -111.915, NULL, NULL),
('010885716', 'W40024038', 'W40024038', 'UTMH1', 'Riley Individual, Family and Marriage Counseling', 'William', 'R', 'Kastner', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', 'PO Box 708458', 'Sandy', 'Salt Lake', 'UT', '84070', '8016570163', '8015687856', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'UTMD', '', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1982906616', 0, 'N', 0, '2013-02-28', NULL, NULL, 0, 0, NULL, NULL),
('542627466', 'W40019839', 'W40019839', 'ID02', 'Keeton Counseling Services', 'Nancy', 'E', 'Keeton', 'LCPC', 'Mental Health', 'Counseling', '', NULL, 'O', '10259 W Landmark Ct', 'Boise', 'Ada', 'ID', '83704', '2087945349', NULL, '10259 W Landmark Ct', 'Boise', 'Ada', 'ID', '83704', '2087945349', '', 'IDMA', NULL, NULL, '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1689884652', 0, 'n', 0, '2013-04-16', NULL, NULL, 0, 0, NULL, NULL),
('102403214', 'W40005592', 'W40005592', 'UTMH1', NULL, 'Joyce', 'A', 'Kelen', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '925 E 900 S Ste 26', 'Salt Lake City', 'Salt Lake', 'UT', '84105', '8015377523', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'UTMA', NULL, NULL, '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, NULL, '', '', '', '', 'HCFA|UB|', '1609947712', 0, 'n', 0, '2013-02-28', NULL, NULL, 40.7498, -111.864, NULL, NULL),
('208798561', 'W40013677', 'W40013677', 'UTMH1', '', 'Joyce', 'A', 'Kelen', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '925 E 900 S Ste 26', 'Salt Lake City', 'Salt Lake', 'UT', '84105', '8015377523', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'UTMA', '', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1609947712', 0, 'N', 0, '2013-02-28', NULL, NULL, 40.7498, -111.864, NULL, NULL),
('451154798', 'W40011385', 'W40011385', 'UT01', '', 'Cheryl', '', 'Kelstrom-Smith', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '5149 S 1500 W', 'Ogden', 'Weber', 'UT', '84405', '8014750402', NULL, '5149 S 1500 W', 'Ogden', 'Weber', 'UT', '84405', '8014750402', '', 'MA', '', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1740335850', 0, 'N', 0, '2014-05-08', NULL, NULL, 41.1716, -112.018, NULL, NULL),
('451154798', 'W40011386', 'W40011386', 'UT01', '', 'Cheryl', '', 'Kelstrom-Smith', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'M', 'PO Box 213', 'Roy', 'Weber', 'UT', '84067', '8014750402', '8014757464', 'PO Box 213', 'Roy', 'Weber', 'UT', '84067', '8014750402', '8014757464', 'MA', '', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1740335850', 0, 'N', 0, '2014-05-08', NULL, NULL, 0, 0, NULL, NULL),
('870559169', 'W40015280', 'W40015280', 'UTMH1', 'Aspen Therapy Inc', 'Ruth', 'M', 'Killpack', 'PHD', 'Mental Health', 'Marriage & Family Therapy', '', NULL, 'O', '3707 N Canyon Rd Ste 2C', 'Provo', 'Utah', 'UT', '84604', '8012253111', NULL, '3707 N Canyon Rd Ste 2C', 'Provo', 'Utah', 'UT', '84604', '8012253111', '', 'UTPHD', NULL, NULL, '0.00', '40.00', '0.00', 6, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1932281227', 0, 'n', 0, '2013-11-18', NULL, NULL, 40.282, -111.652, NULL, NULL),
('546963662', 'W40005325', 'W40005325', 'UTMH1', NULL, 'Lorraine', 'S', 'Kilpatrick', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '6925  Union Park Ctr Ste 490', 'Midvale', 'Salt Lake', 'UT', '84047', '8015662622', NULL, '6925  Union Park Ctr Ste 490', 'Midvale', 'Salt Lake', 'UT', '84047', '8015662622', '', 'MA', NULL, '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1528089711', 0, 'N', 0, '2014-05-12', NULL, NULL, 40.6248, -111.856, NULL, NULL),
('261703236', 'W40005774', 'W40005774', 'UTMH1', 'Clinical Consultants ', 'Frederick', 'T', 'King', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '2351 Grant Ave Ste 100', 'Ogden', 'Weber', 'UT', '84401', '8016218670', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'UTMA', NULL, NULL, '0.00', '40.00', '0.00', 6, '2013-02-15', NULL, 0, 0, NULL, '', '', '', '', 'HCFA|UB|', '1518131622', 0, 'n', 0, '2013-02-28', NULL, NULL, 41.2238, -111.973, NULL, NULL),
('261703236', 'W40016483', 'W40016483', 'UTMH1', 'Clinical Consultants ', 'Frederick', 'T', 'King', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '7601 S Redwood Rd Ste E', 'West Jordan', 'Salt Lake', 'UT', '84084', '8012338670', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'UTMA', '', '', '0.00', '40.00', '0.00', 6, '2013-02-15', NULL, NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1518131622', 0, 'N', 0, '2013-02-28', NULL, NULL, 40.6131, -111.939, NULL, NULL),
('160405127', 'W40005735', 'W40005735', 'UTMH1', NULL, 'Michael', 'A', 'Kligman', 'MD', 'Mental Health', 'Psychiatry', '', NULL, 'O', '650 S Komas Dr Ste 207E', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015857831', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'MD-2', NULL, NULL, '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, NULL, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1679615918', 0, 'n', 0, '2013-02-28', NULL, NULL, 40.7553, -111.83, NULL, NULL),
('270655418', 'W40013244', 'W40013244', 'UTMH1', 'Davis Mental Health', 'Jaclyn', 'K', 'Knapp', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '1492 W Antelope Dr Ste 205', 'Layton', 'Davis', 'UT', '84041', '8016435225', '8018232344', '1492 W Antelope Dr Ste 205', 'Layton', 'Davis', 'UT', '84041', '8016435225', '8018232344', 'UTMA', '', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1508152885', 0, 'N', 0, '2014-05-08', NULL, NULL, 41.0893, -111.993, NULL, NULL),
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