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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('830326578', 'W12017600', 'W12017600', 'WY01', 'Sheridan Physical Therapy', 'Kent', 'A', 'Sherwood', 'PT', 'Physical Therapy', '', '', NULL, 'O', '50 W 3rd St', 'Sheridan', 'Sheridan', 'WY', '82801', '3076722092', '3076731969', '50 W 3rd St', 'Sheridan', 'Sheridan', 'WY', '82801', '3076722092', '3076731969', '', '', '', '0.00', '18.00', '0.00', 3, '2012-03-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1770598658', 0, 'N', 0, '2012-03-10', NULL, NULL, 44.8048, -106.956, NULL, NULL),
('830326578', 'W12017601', 'W12017601', 'WYT1', 'Buffalo Physical Therapy', 'Kent', 'A', 'Sherwood', 'PT', 'Physical Therapy', '', '', NULL, 'O', '164 W Hart St', 'Buffalo', 'Johnson', 'WY', '82834', '3076848623', '3076849964', '164 W Hart St', 'Buffalo', 'Johnson', 'WY', '82834', '3076848623', '3076849964', '', '', '', '0.00', '18.00', '0.00', 3, '2012-03-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1770598658', 0, 'N', 0, '2012-03-10', NULL, NULL, 0, 0, NULL, NULL),
('830326578', 'W12017602', 'W12017602', 'WYT1', 'Sheridan Physical Therapy', 'Kent', 'A', 'Sherwood', 'PT', 'Physical Therapy', '', '', NULL, 'O', '50 W 3rd St', 'Sheridan', 'Sheridan', 'WY', '82801', '3076722092', '3076731969', '50 W 3rd St', 'Sheridan', 'Sheridan', 'WY', '82801', '3076722092', '3076731969', '', '', '', '0.00', '18.00', '0.00', 3, '2012-03-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1770598658', 0, 'N', 0, '2012-03-10', NULL, NULL, 0, 0, NULL, NULL),
('830326578', 'W12017603', 'W12017603', 'WY01', 'Buffalo Physical Therapy', 'Kress', 'T', 'Sherwood', 'SLP', 'Speech Therapy', '', '', NULL, 'O', '164 W Hart St', 'Buffalo', 'Johnson', 'WY', '82834', '3076848623', '3076849964', '164 W Hart St', 'Buffalo', 'Johnson', 'WY', '82834', '3076848623', '3076849964', '', '', '', '0.00', '18.00', '0.00', 3, '2012-03-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1518972397', 0, 'N', 0, '2012-03-10', NULL, NULL, 44.3548, -106.7, NULL, NULL),
('830326578', 'W12017604', 'W12017604', 'WY01', 'Sheridan Physical Therapy', 'Kress', 'T', 'Sherwood', 'SLP', 'Speech Therapy', '', '', NULL, 'O', '50 W 3rd St', 'Sheridan', 'Sheridan', 'WY', '82801', '3076722092', '3076731969', '50 W 3rd St', 'Sheridan', 'Sheridan', 'WY', '82801', '3076722092', '3076731969', '', '', '', '0.00', '18.00', '0.00', 3, '2012-03-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1518972397', 0, 'N', 0, '2012-03-10', NULL, NULL, 44.8048, -106.956, NULL, NULL),
('830326578', 'W12017606', 'W12017606', 'WYT1', 'Buffalo Physical Therapy', 'Kress', 'T', 'Sherwood', 'SLP', 'Speech Therapy', '', '', NULL, 'O', '164 W Hart St', 'Buffalo', 'Johnson', 'WY', '82834', '3076848623', '3076849964', '164 W Hart St', 'Buffalo', 'Johnson', 'WY', '82834', '3076848623', '3076849964', '', '', '', '0.00', '18.00', '0.00', 3, '2012-03-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1518972397', 0, 'N', 0, '2012-03-10', NULL, NULL, 0, 0, NULL, NULL),
('830326578', 'W12017605', 'W12017605', 'WYT1', 'Sheridan Physical Therapy', 'Kress', 'T', 'Sherwood', 'SLP', 'Speech Therapy', '', '', NULL, 'O', '50 W 3rd St', 'Sheridan', 'Sheridan', 'WY', '82801', '3076722092', '3076731969', '50 W 3rd St', 'Sheridan', 'Sheridan', 'WY', '82801', '3076722092', '3076731969', '', '', '', '0.00', '18.00', '0.00', 3, '2012-03-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1518972397', 0, 'N', 0, '2012-03-10', NULL, NULL, 0, 0, NULL, NULL),
('830326578', 'W12017608', 'W12017608', 'WY01', 'Buffalo Physical Therapy', 'Angelita', 'B', 'Siojo-Allen', 'OTR', 'Occupational Therapy', '', '', NULL, 'O', '164 W Hart St', 'Buffalo', 'Johnson', 'WY', '82834', '3076848623', '3076849964', '164 W Hart St', 'Buffalo', 'Johnson', 'WY', '82834', '3076848623', '3076849964', '', '', '', '0.00', '18.00', '0.00', 3, '2012-03-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1750396545', 0, 'N', 0, '2012-03-10', NULL, NULL, 44.3548, -106.7, NULL, NULL),
('830326578', 'W12017607', 'W12017607', 'WY01', 'Sheridan Physical Therapy', 'Angelita', 'B', 'Siojo-Allen', 'OTR', 'Occupational Therapy', '', '', NULL, 'O', '50 W 3rd St', 'Sheridan', 'Sheridan', 'WY', '82801', '3076722092', '3076731969', '50 W 3rd St', 'Sheridan', 'Sheridan', 'WY', '82801', '3076722092', '3076731969', '', '', '', '0.00', '18.00', '0.00', 3, '2012-03-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1750396545', 0, 'N', 0, '2012-03-10', NULL, NULL, 44.8048, -106.956, NULL, NULL),
('830326578', 'W12017609', 'W12017609', 'WYT1', 'Buffalo Physical Therapy', 'Angelita', 'B', 'Siojo-Allen', 'OTR', 'Occupational Therapy', '', '', NULL, 'O', '164 W Hart St', 'Buffalo', 'Johnson', 'WY', '82834', '3076848623', '3076849964', '164 W Hart St', 'Buffalo', 'Johnson', 'WY', '82834', '3076848623', '3076849964', '', '', '', '0.00', '18.00', '0.00', 3, '2012-03-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1750396545', 0, 'N', 0, '2012-03-10', NULL, NULL, 0, 0, NULL, NULL),
('830326578', 'W12017610', 'W12017610', 'WYT1', 'Sheridan Physical Therapy', 'Angelita', 'B', 'Siojo-Allen', 'OTR', 'Occupational Therapy', '', '', NULL, 'O', '50 W 3rd St', 'Sheridan', 'Sheridan', 'WY', '82801', '3076722092', '3076731969', '50 W 3rd St', 'Sheridan', 'Sheridan', 'WY', '82801', '3076722092', '3076731969', '', '', '', '0.00', '18.00', '0.00', 3, '2012-03-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1750396545', 0, 'N', 0, '2012-03-10', NULL, NULL, 0, 0, NULL, NULL),
('830326578', 'W12017611', 'W12017611', 'WY01', 'Buffalo Physical Therapy', 'Terry', 'C', 'Winnop', 'PT', 'Physical Therapy', '', '', NULL, 'O', '164 W Hart St', 'Buffalo', 'Johnson', 'WY', '82834', '3076848623', '3076849964', '164 W Hart St', 'Buffalo', 'Johnson', 'WY', '82834', '3076848623', '3076849964', '', '', '', '0.00', '18.00', '0.00', 3, '2012-03-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1780699561', 0, 'N', 0, '2012-03-10', NULL, NULL, 44.3548, -106.7, NULL, NULL),
('830326578', 'W12017614', 'W12017614', 'WY01', 'Sheridan Physical Therapy', 'Terry', 'C', 'Winnop', 'PT', 'Physical Therapy', '', '', NULL, 'O', '50 W 3rd St', 'Sheridan', 'Sheridan', 'WY', '82801', '3076722092', '3076731969', '50 W 3rd St', 'Sheridan', 'Sheridan', 'WY', '82801', '3076722092', '3076731969', '', '', '', '0.00', '18.00', '0.00', 3, '2012-03-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1780699561', 0, 'N', 0, '2012-03-10', NULL, NULL, 44.8048, -106.956, NULL, NULL),
('830326578', 'W12017613', 'W12017613', 'WYT1', 'Buffalo Physical Therapy', 'Terry', 'C', 'Winnop', 'PT', 'Physical Therapy', '', '', NULL, 'O', '164 W Hart St', 'Buffalo', 'Johnson', 'WY', '82834', '3076848623', '3076849964', '164 W Hart St', 'Buffalo', 'Johnson', 'WY', '82834', '3076848623', '3076849964', '', '', '', '0.00', '18.00', '0.00', 3, '2012-03-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1780699561', 0, 'N', 0, '2012-03-10', NULL, NULL, 0, 0, NULL, NULL),
('830326578', 'W12017612', 'W12017612', 'WYT1', 'Sheridan Physical Therapy', 'Terry', 'C', 'Winnop', 'PT', 'Physical Therapy', '', '', NULL, 'O', '50 W 3rd St', 'Sheridan', 'Sheridan', 'WY', '82801', '3076722092', '3076731969', '50 W 3rd St', 'Sheridan', 'Sheridan', 'WY', '82801', '3076722092', '3076731969', '', '', '', '0.00', '18.00', '0.00', 3, '2012-03-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1780699561', 0, 'N', 0, '2012-03-10', NULL, NULL, 0, 0, NULL, NULL),
('876157946', 'W12017620', 'W12017620', 'UT01', 'University Health Care', 'Preston', 'D', 'Ward', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '5126 W Daybreak Pkwy', 'South Jordan', 'Salt Lake', 'UT', '84095', '8015817514', NULL, '5126 W Daybreak Pkwy', 'South Jordan', 'Salt Lake', 'UT', '84095', '8015817514', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2010-07-01', '2012-09-17', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1649396185', 0, 'N', 0, '2012-09-18', NULL, NULL, 0, 0, NULL, NULL),
('876157946', 'W12017618', 'W12017618', 'UT01', 'University Ear, Nose, and Throat Associates', 'Preston', 'D', 'Ward', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'B', 'PO Box 413035', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', '8015853655', 'PO Box 413035', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', '8015853655', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2010-07-01', '2012-09-17', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1649396185', 0, 'N', 0, '2012-09-18', NULL, NULL, 0, 0, NULL, NULL),
('870413860', 'W12017621', 'W12017621', 'UT01', 'Now Care Clinic', '', '', 'Now Care Clinic', 'GROUP', 'Primary Care with Extended Hours', 'Urgent Care', '', 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, '2011-11-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000834785', 0, 'Y', 0, '2012-01-30', NULL, NULL, 0, 0, NULL, NULL),
('452732517', 'W12017883', 'W12017883', 'UT01', 'Encompass Home Health of the West ', '', '', 'Encompass Home Health of the West LLC', 'Group', 'Home Health Agency', '', '', NULL, 'O', '1172 E 100 N Ste 7A', 'Payson', 'Utah', 'UT', '84651', '8014654401', '8014654366', '1172 E 100 N Ste 7A', 'Payson', 'Utah', 'UT', '84651', '8014654401', '8014654366', '', '', '4', '0.00', '100.00', '0.00', 3, '2011-11-01', '2013-09-12', 1, 0, 0, '', '', '', '', 'HCFA|UB|', '1114208550', 0, 'N', 0, '2014-02-04', NULL, NULL, 0, 0, NULL, NULL),
('820312175', 'W12017623', 'W12017623', 'ID01', 'Idaho Emergency Physicians PA', 'Michael', 'J', 'Lamers', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '1512 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2083221730', '2083221731', '1512 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2083221730', '2083221731', 'IDSAMG3', '', '', '0.00', '10.00', '0.00', 3, '2011-12-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1629091491', 0, 'N', 0, '2012-01-30', NULL, NULL, 43.5537, -116.573, NULL, NULL),
('820161600', 'W12017624', 'W12017624', 'ID02', 'St Lukes Clinic - General Surgery', 'Roberto', 'V', 'Barresi', 'MD', 'General Surgery', '', '', NULL, 'O', '3399 E Louise Ave Ste 400', 'Meridian', 'Ada', 'ID', '83642', '2083643000', '2083643191', '3399 E Louise Ave Ste 400', 'Meridian', 'Ada', 'ID', '83642', '2083643000', '2083643191', 'IDACN', '', '', '0.00', '15.00', '0.00', 8, '2012-01-01', '2012-09-10', 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|UB|', '1740231620', 0, 'N', 0, '2012-09-24', NULL, NULL, 0, 0, NULL, NULL),
('820161600', 'W12017625', 'W12017625', 'ID02', 'St Lukes Clinic - General Surgery', 'Jon', 'B', 'Getz', 'MD', 'General Surgery', NULL, NULL, NULL, 'O', '3399 E Louise Ave Ste 400', 'Meridian', 'Ada', 'ID', '83642', '2083643000', '2083643191', '3399 E Louise Ave Ste 400', 'Meridian', 'Ada', 'ID', '83642', '2083643000', '2083643191', 'IDACN', '', '', '0.00', '15.00', '0.00', 8, '2012-01-01', '2012-09-10', 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|UB|', '1174575138', 0, 'N', 0, '2012-09-24', NULL, NULL, 0, 0, NULL, NULL),
('820161600', 'W12017626', 'W12017626', 'ID02', 'St Lukes Clinic - General Surgery', 'Jonathan', 'V', 'Giles', 'MD', 'General Surgery', '', '', NULL, 'O', '3399 E Louise Ave Ste 400', 'Meridian', 'Ada', 'ID', '83642', '2083643000', '2083643191', '3399 E Louise Ave Ste 400', 'Meridian', 'Ada', 'ID', '83642', '2083643000', '2083643191', 'IDACN', '', '', '0.00', '15.00', '0.00', 8, '2012-01-01', '2012-09-10', 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|UB|', '1457382723', 0, 'N', 0, '2012-09-24', NULL, NULL, 0, 0, NULL, NULL),
('820161600', 'W12017627', 'W12017627', 'ID02', 'St Lukes Clinic - General Surgery', 'Scott', 'A', 'Henson', 'MD', 'General Surgery', '', '', NULL, 'O', '3399 E Louise Ave Ste 400', 'Meridian', 'Ada', 'ID', '83642', '2083643000', '2083643191', '3399 E Louise Ave Ste 400', 'Meridian', 'Ada', 'ID', '83642', '2083643000', '2083643191', 'IDACN', '', '', '0.00', '15.00', '0.00', 8, '2012-01-01', '2012-09-10', 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|UB|', '1023060258', 0, 'N', 0, '2012-09-24', NULL, NULL, 0, 0, NULL, NULL),
('820161600', 'W12017628', 'W12017628', 'ID02', 'St Lukes Clinic - General Surgery', 'Reese', 'A', 'Verner', 'MD', 'General Surgery', '', '', NULL, 'O', '3399 E Louise Ave Ste 400', 'Meridian', 'Ada', 'ID', '83642', '2083643000', '2083643191', '3399 E Louise Ave Ste 400', 'Meridian', 'Ada', 'ID', '83642', '2083643000', '2083643191', 'IDACN', '', '', '0.00', '15.00', '0.00', 8, '2012-01-01', '2012-09-10', 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1427085281', 0, 'N', 0, '2014-07-09', NULL, NULL, 0, 0, NULL, NULL),
('820161600', 'W12017630', 'W12017630', 'ID02', 'St Lukes Clinic- GYN/Oncology', 'Amy', 'L', 'Cooper', 'MD', 'Gynecologic Oncology', '', '', NULL, 'O', '100 E Idaho St', 'Boise', 'Ada', 'ID', '83712', '2083814471', '2083814172', '100 E Idaho St', 'Boise', 'Ada', 'ID', '83712', '2083814471', '2083814172', 'IDACN', '', '', '0.00', '15.00', '0.00', 8, '2011-10-24', '2013-05-28', 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|UB|', '1306880398', 0, 'N', 0, '2013-06-24', NULL, NULL, 43.6123, -116.194, NULL, NULL),
('820161600', 'W12017631', 'W12017631', 'ID02', 'St Lukes Clinic- GYN/Oncology', 'Amy', 'L', 'Cooper', 'MD', 'Gynecologic Oncology', '', '', NULL, 'B', 'PO Box 550', 'Boise', 'Ada', 'ID', '83712', '2083814171', '2083814172', 'PO Box 550', 'Boise', 'Ada', 'ID', '83712', '2083814171', '2083814172', 'IDACN', '', '', '0.00', '15.00', '0.00', 8, '2011-10-24', '2013-05-28', 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|UB|', '1306880398', 0, 'N', 0, '2013-06-24', NULL, NULL, 0, 0, NULL, NULL),
('820161600', 'W12017632', 'W12017632', 'ID02', 'St Lukes Clinic- GYN/Oncology', 'Gerardo', 'M', 'Perez', 'MD', 'Gynecologic Oncology', '', '', NULL, 'O', '100 E Idaho St', 'Boise', 'Ada', 'ID', '83712', '2083814171', '2083814172', '100 E Idaho St', 'Boise', 'Ada', 'ID', '83712', '2083814171', '2083814172', 'IDACN', '', '', '0.00', '15.00', '0.00', 8, '2011-10-24', '2013-05-28', 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|UB|', '1730103995', 0, 'N', 0, '2013-09-04', NULL, NULL, 43.6123, -116.194, NULL, NULL),
('820161600', 'W12017633', 'W12017633', 'ID02', 'St Lukes Clinic- GYN/Oncology', 'Gerardo', 'M', 'Perez', 'MD', 'Gynecologic Oncology', '', '', NULL, 'B', 'PO Box 550', 'Boise', 'Ada', 'ID', '83712', '2083814171', '2083814172', 'PO Box 550', 'Boise', 'Ada', 'ID', '83712', '2083814171', '2083814172', 'IDACN', '', '', '0.00', '15.00', '0.00', 8, '2011-10-24', '2013-05-28', 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|UB|', '1730103995', 0, 'N', 0, '2013-09-04', NULL, NULL, 0, 0, NULL, NULL),
('452716222', 'W12017643', 'W12017643', 'ID02', 'St Lukes Clinic- Family Medicine', 'Amy', 'M', 'Ambrosier', 'PA-C', 'Family Practice', '', '', NULL, 'O', '1520 W State St Ste 100', 'Boise', 'Ada', 'ID', '83702', '2089477700', '2089477711', '1520 W State St Ste 100', 'Boise', 'Ada', 'ID', '83702', '2089477700', '2089477711', 'IDACN', '', '', '0.00', '15.00', '0.00', 8, '2011-01-23', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1073898821', 0, 'N', 0, '2013-10-16', NULL, NULL, 0, 0, NULL, NULL),
('452716222', 'W12017644', 'W12017644', 'ID02', 'St Lukes Clinic- Family Medicine', 'Amy', 'M', 'Ambrosier', 'PA-C', 'Family Practice', '', '', NULL, 'B', 'PO Box 640', 'Boise', 'Ada', 'ID', '83701', '2089477700', '2089477711', 'PO Box 640', 'Boise', 'Ada', 'ID', '83701', '2089477700', '2089477711', 'IDACN', '', '', '0.00', '15.00', '0.00', 8, '2011-01-23', '2012-03-29', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1073898821', 0, 'N', 0, '2013-10-16', NULL, NULL, 0, 0, NULL, NULL),
('820161600', 'W12017646', 'W12017646', 'ID02', 'St Lukes Clinic - General Surgery', 'Wendy', 'M', 'Jones', 'PA-C', 'Physician Assistant', '', '', NULL, 'O', '3399 E Louise Ave Ste 400', 'Meridian', 'Ada', 'ID', '83642', '2083643000', '2083643191', '3399 E Louise Ave Ste 400', 'Meridian', 'Ada', 'ID', '83642', '2083643000', '2083643191', 'IDACN', '', '', '0.00', '15.00', '0.00', 8, '2012-01-01', '2012-09-10', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1902188147', 0, 'N', 0, '2012-09-24', NULL, NULL, 0, 0, NULL, NULL),
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('820312175', 'W12017684', 'W12017684', 'ID01', 'Idaho Emergency Physicians PA', 'Christopher', 'E', 'Tobe', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '1512 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2083221730', '2083221731', '1512 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2083221730', '2083221731', 'IDSAMG3', '', '', '0.00', '10.00', '0.00', 3, '2011-12-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', 'West Valley Medical Center', NULL, NULL, 'HCFA|UB|', '1205889136', 0, 'N', 0, '2012-01-31', NULL, NULL, 43.5537, -116.573, NULL, NULL),
('820312175', 'W12017687', 'W12017687', 'ID01', 'Idaho Emergency Physicians PA', 'Andrew', '', 'Southard', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '1512 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2083221730', '2083221731', '1512 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2083221730', '2083221731', 'IDSAMG3', '', '', '0.00', '10.00', '0.00', 3, '2011-12-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', 'West Valley Medical Center', NULL, NULL, 'HCFA|UB|', '1154527547', 0, 'N', 0, '2012-02-23', NULL, NULL, 43.5537, -116.573, NULL, NULL),
('820312175', 'W12017686', 'W12017686', 'ID01', 'Idaho Emergency Physicians PA', 'Andrew', '', 'Southard', 'MD', 'Emergency Medicine', '', '', NULL, 'B', '2963 E Copper Point Dr', 'Meridian', 'Ada', 'ID', '83642', '2083221730', NULL, '2963 E Copper Point Dr', 'Meridian', 'Ada', 'ID', '83642', '2083221730', '          ', 'IDSAMG3', '', '', '0.00', '10.00', '0.00', 3, '2011-12-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', 'West Valley Medical Center', NULL, NULL, 'HCFA|UB|', '1154527547', 0, 'N', 0, '2012-02-23', NULL, NULL, 0, 0, NULL, NULL),
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('820312175', 'W12017689', 'W12017689', 'ID01', 'Idaho Emergency Physicians PA', 'Jason', 'M', 'Quinn', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '1512 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2083221730', '2083221731', '1512 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2083221730', '2083221731', 'IDSAMG3', '', '', '0.00', '10.00', '0.00', 3, '2011-12-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', 'West Valley Medical Center', NULL, NULL, 'HCFA|UB|', '1710978036', 0, 'N', 0, '2012-01-31', NULL, NULL, 43.5537, -116.573, NULL, NULL),
('820312175', 'W12017690', 'W12017690', 'ID01', 'Idaho Emergency Physicians PA', 'Kari', '', 'Peterson', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '1512 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2083221730', '2083221731', '1512 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2083221730', '2083221731', 'IDSAMG3', '', '', '0.00', '10.00', '0.00', 3, '2011-12-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', 'West Valley Medical Center', NULL, NULL, 'HCFA|UB|', '1346363694', 0, 'N', 0, '2012-01-31', NULL, NULL, 43.5537, -116.573, NULL, NULL),
('820312175', 'W12017691', 'W12017691', 'ID01', 'Idaho Emergency Physicians PA', 'Andrew', '', 'Nelson', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '1512 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2083221730', '2083221731', '1512 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2083221730', '2083221731', 'IDSAMG3', '', '', '0.00', '10.00', '0.00', 3, '2011-12-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', 'West Valley Medical Center', NULL, NULL, 'HCFA|UB|', '1841493665', 0, 'N', 0, '2012-08-13', NULL, NULL, 43.5537, -116.573, NULL, NULL),
('820312175', 'W12017693', 'W12017693', 'ID01', 'Idaho Emergency Physicians PA', 'Jill', '', 'Vessey', 'MD', 'Emergency Medicine', '', '', NULL, 'B', '2963 E Copper Point Dr', 'Meridian', 'Ada', 'ID', '83642', '2083221730', NULL, '2963 E Copper Point Dr', 'Meridian', 'Ada', 'ID', '83642', '2083221730', '', 'IDSAMG3', '', '', '0.00', '10.00', '0.00', 3, '2011-12-01', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', 'West Valley Medical Center', 'Saint Alphonsus Regional Medical Center', '', 'HCFA|UB|', '1649204934', 0, 'N', 0, '2014-06-13', NULL, NULL, 0, 0, NULL, NULL),
('820312175', 'W12017694', 'W12017694', 'ID01', 'Idaho Emergency Physicians PA', 'Jill', '', 'Vessey', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '1717 Arlington', 'Caldwell', 'Canyon', 'ID', '83605', '2083221730', '2083221731', '1717 Arlington', 'Caldwell', 'Canyon', 'ID', '83605', '2083221730', '2083221731', 'IDSAMG3', '', '', '0.00', '10.00', '0.00', 3, '2011-12-01', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', 'West Valley Medical Center', 'Saint Alphonsus Regional Medical Center', '', 'HCFA|UB|', '1649204934', 0, 'N', 0, '2014-06-13', NULL, NULL, 43.6542, -116.696, NULL, NULL),
('820312175', 'W12017695', 'W12017695', 'ID01', 'Idaho Emergency Physicians PA', 'Jill', '', 'Vessey', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '323 E Riverside Dr', 'Eagle', 'Ada', 'ID', '83616', '2083221730', '2083221731', '323 E Riverside Dr', 'Eagle', 'Ada', 'ID', '83616', '2083221730', '2083221731', 'IDSAMG3', '', '', '0.00', '10.00', '0.00', 3, '2011-12-01', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', 'West Valley Medical Center', 'Saint Alphonsus Regional Medical Center', '', 'HCFA|UB|', '1649204934', 0, 'N', 0, '2014-06-13', NULL, NULL, 43.6896, -116.35, NULL, NULL),
('820312175', 'W12017696', 'W12017696', 'ID01', 'Idaho Emergency Physicians PA', 'Jill', '', 'Vessey', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083221730', '2083221731', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083221730', '2083221731', 'IDSAMG3', '', '', '0.00', '10.00', '0.00', 3, '2011-12-01', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', 'West Valley Medical Center', 'Saint Alphonsus Regional Medical Center', '', 'HCFA|UB|', '1649204934', 0, 'N', 0, '2014-06-13', NULL, NULL, 43.6145, -116.254, NULL, NULL),
('820312175', 'W12017697', 'W12017697', 'ID01', 'Idaho Emergency Physicians PA', 'Jill', '', 'Vessey', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '1512 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2083221730', '2083221731', '1512 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2083221730', '2083221731', 'IDSAMG3', '', '', '0.00', '10.00', '0.00', 3, '2011-12-01', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', 'West Valley Medical Center', 'Saint Alphonsus Regional Medical Center', '', 'HCFA|UB|', '1649204934', 0, 'N', 0, '2014-06-13', NULL, NULL, 43.5537, -116.573, NULL, NULL),
('820312175', 'W12017698', 'W12017698', 'ID01', 'Idaho Emergency Physicians PA', 'Michael', 'A', 'Watts', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '1512 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2083221730', '2083221731', '1512 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2083221730', '2083221731', 'IDSAMG3', '', '', '0.00', '10.00', '0.00', 3, '2011-12-01', '2013-11-29', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1265500938', 0, 'N', 0, '2013-12-10', NULL, NULL, 43.5537, -116.573, NULL, NULL),
('820312175', 'W12017699', 'W12017699', 'ID01', 'Idaho Emergency Physicians PA', 'Jessica', 'N', 'Wasielewski', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '1512 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2083221730', '2083221731', '1512 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2083221730', '2083221731', 'IDSAMG3', '', '', '0.00', '10.00', '0.00', 3, '2011-12-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', 'West Valley Medical Center', NULL, NULL, 'HCFA|UB|', '1427126127', 0, 'N', 0, '2012-01-31', NULL, NULL, 43.5537, -116.573, NULL, NULL),
('820312175', 'W12017700', 'W12017700', 'ID01', 'Idaho Emergency Physicians PA', 'Christopher', 'C', 'Wyatt', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '1512 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2083221730', '2083221731', '1512 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2083221730', '2083221731', 'IDSAMG3', '', '', '0.00', '10.00', '0.00', 3, '2011-12-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', 'West Valley Medical Center', NULL, NULL, 'HCFA|UB|', '1649487430', 0, 'N', 0, '2012-01-31', NULL, NULL, 43.5537, -116.573, NULL, NULL),
('260553931', 'W12017701', 'W12017701', 'ID01', 'St Alphonsus Medical Group General Sugery Nampa', 'Reese', 'A', 'Verner', 'MD', 'General Surgery', '', '', NULL, 'O', '1603 12th Ave Rd Ste E', 'Nampa', 'Canyon', 'ID', '83686', '2084656940', '2084656961', '1603 12th Ave Rd Ste E', 'Nampa', 'Canyon', 'ID', '83686', '2084656940', '2084656961', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2011-11-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1427085281', 0, 'Y', 0, '2014-07-09', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12017703', 'W12017703', 'ID01', 'Saint Alphonsus Medical Group Hosptialist Boise', 'Ryan', 'J', 'Williams', 'MD', 'Internal Medicine', 'Hospitalist', '', NULL, 'B', '3340 E Goldstone', 'Meridian', 'Ada', 'ID', '83642', '2083675170', '2083675180', '3340 E Goldstone', 'Meridian', 'Ada', 'ID', '83642', '2083675170', '2083675180', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2011-12-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1114053014', 0, 'N', 0, '2014-07-23', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12017704', 'W12017704', 'ID01', 'St Alphonsus Medical Group Nuerosurgery Boise 201', 'Bruce', 'J', 'Andersen', 'MD', 'Neurosurgery', '', '', NULL, 'O', '1075 N Curtis Rd Ste 201', 'Boise', 'Ada', 'ID', '83706', '2083674000', '2083678983', '1075 N Curtis Rd Ste 201', 'Boise', 'Ada', 'ID', '83706', '2083674000', '2083678983', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2011-12-31', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1063420792', 0, 'N', 0, '2014-07-09', NULL, NULL, 43.6143, -116.258, NULL, NULL),
('820425454', 'W12017706', 'W12017706', 'ID01', 'Boise Anesthesia PA', 'Phillip', '', 'Roylance', 'CRNA', 'Nurse Anesthetist', '', '', NULL, 'B', 'PO Box 4268', 'Portland', 'Multnomah', 'OR', '97208', '8002758752', '2083759530', 'PO Box 4268', 'Portland', 'Multnomah', 'OR', '97208', '8002758752', '2083759530', 'IDSAMG3', '', '', '59.20', '10.00', '0.00', 3, '2011-12-01', '2011-12-01', 1, 15, 0, '', '', '', '', 'HCFA|UB|', '1306170907', 0, 'N', 0, '2012-11-01', NULL, NULL, 0, 0, NULL, NULL),
('820425454', 'W12017708', 'W12017708', 'ID01', 'Boise Anesthesia PA', 'Joseph', '', 'Stover', 'CRNA', 'Nurse Anesthetist', '', '', NULL, 'B', 'PO Box 4268', 'Portland', 'Multnomah', 'OR', '97208', '8002758752', NULL, 'PO Box 4268', 'Portland', 'Multnomah', 'OR', '97208', '8002758752', '0         ', 'IDSAMG3', '', '', '59.20', '10.00', '0.00', 3, '2012-01-23', '2012-01-23', 1, 15, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1720064306', 0, 'N', 0, '2012-11-01', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12017709', 'W12017709', 'ID01', 'Saint Alphonsus Medical Group Pediatric Boise', 'Keri', 'J', 'Barnes', 'NP-C', 'Family Practice', 'Nurse Practitioner', '', NULL, 'O', '999 N Curtis Rds Ste 407', 'Boise', 'Ada', 'ID', '83706', '2084669092', '2083672968', '999 N Curtis Rds Ste 407', 'Boise', 'Ada', 'ID', '83706', '2084669092', '2083672968', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-02-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1407001852', 0, 'Y', 0, '2014-06-20', 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
('820200895', 'W12017712', 'W12017712', 'ID01', 'Saint Alphonsus Medical Group NHP Family Medicine ', 'Travis', '', 'Smith', 'PA-C', 'Family Practice', '', '', NULL, 'O', '1200 Garrity Blvd', 'Nampa', 'Canyon', 'ID', '83687', '2084669092', '2084665322', '1200 Garrity Blvd', 'Nampa', 'Canyon', 'ID', '83687', '2084669092', '2084665322', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-01-02', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1376810689', 0, 'N', 0, '2014-05-20', NULL, NULL, 43.587, -116.549, NULL, NULL),
('820200895', 'W12017711', 'W12017711', 'ID01', 'Saint Alphonsus Medical Group NHP Family Medicine ', 'Travis', '', 'Smith', 'PA-C', 'Family Practice', '', '', NULL, 'O', '4400 E Flamingo Ave Ste 301', 'Nampa', 'Canyon', 'ID', '83687', '2084656900', '2084656910', '4400 E Flamingo Ave Ste 301', 'Nampa', 'Canyon', 'ID', '83687', '2084656900', '2084656910', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-01-02', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1376810689', 0, 'N', 0, '2014-05-20', NULL, NULL, 43.5976, -116.517, NULL, NULL),
('260553931', 'W12017715', 'W12017715', 'ID01', 'SAMG General Surgery Nampa', 'Anne', '', 'Furrow', 'MD', 'General Surgery', '', '', NULL, 'O', '1603 E 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2084656940', '2084656949', '1603 E 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2084656940', '2084656949', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-01-23', '2012-03-29', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1720268667', 0, 'N', 0, '2013-10-07', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12017717', 'W12017717', 'ID01', 'StAlphonsus Regional Medical Center', 'Steven', '', 'Brown', 'MD', 'Internal Medicine', '', '', NULL, 'B', '3340 E Goldstone', 'Boise', 'Ada', 'ID', '83704', '2083675170', NULL, '3340 E Goldstone', 'Boise', 'Ada', 'ID', '83704', '2083675170', '', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-01-23', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1700874682', 0, 'N', 0, '2014-06-20', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12017718', 'W12017718', 'ID01', 'Saint Alphonsus Medical Group Pediatric Boise', 'Erin', '', 'Proctor', 'PA-C', 'Obstetrics and Gynecology', 'Physician Assistant', 'Family Practice', NULL, 'O', '999 N Cutis Rd Ste 407', 'Boise', 'Ada', 'ID', '83706', '2084669092', '2084665322', '999 N Cutis Rd Ste 407', 'Boise', 'Ada', 'ID', '83706', '2084669092', '2084665322', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-02-01', '2013-06-24', 0, 0, 0, 'West Valley Medical Center', NULL, NULL, NULL, 'HCFA|', '1811987076', 0, 'Y', 0, '2013-08-21', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12017719', 'W12017719', 'ID01', 'Saint Alphonsus Medical Group NHP Family Medicine  ', 'Kevin', '', 'Chicoine', 'MD', 'Occupational Medicine', 'Family Practice', 'Urgent Care', NULL, 'O', '4400 E Flamingo Ave Ste 301', 'Nampa', 'Canyon', 'ID', '83687', '2084656900', '2084656910', '4400 E Flamingo Ave Ste 301', 'Nampa', 'Canyon', 'ID', '83687', '2084656900', '2084656910', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-01-23', '2012-12-26', 0, 0, 0, 'West Valley Medical Center', '', '', '', 'HCFA|', '1730121740', 0, 'N', 0, '2014-06-20', NULL, NULL, 43.5976, -116.517, NULL, NULL),
('820200895', 'W12017720', 'W12017720', 'ID01', 'Saint Alphonsus Medical Group NHP Family Medicine  ', 'Charles', '', 'Frost', 'PA-C', 'Occupational Medicine', '', '', NULL, 'O', '4400 E Flamingo Ave Ste 301', 'Nampa', 'Canyon', 'ID', '83687', '2084656900', '2084656910', '4400 E Flamingo Ave Ste 301', 'Nampa', 'Canyon', 'ID', '83687', '2084656900', '2084656910', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-01-23', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1760425730', 0, 'N', 0, '2014-06-20', NULL, NULL, 43.5976, -116.517, NULL, NULL),
('820200895', 'W12017723', 'W12017723', 'ID01', 'Saint Alphonsus Medical Group Neurosurgery Boise 201', 'Bryan', '', 'Hart ', 'PAC', 'Neurosurgery', '', '', NULL, 'B', '3340 E Goldstone', 'Meridian', 'Ada', 'ID', '83642', '2083675170', '2084656910', '3340 E Goldstone', 'Meridian', 'Ada', 'ID', '83642', '2083675170', '2084656910', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2011-12-31', '2014-05-26', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1518977826', 0, 'N', 0, '2014-06-20', NULL, NULL, 0, 0, NULL, NULL),
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('770701557', 'W12017842', 'W12017842', 'UT01', 'MountainStar Jordan Family Health', 'Judith', 'L', 'Kirstein', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 198560', 'Atlanta', 'Fulton', 'GA', '30384', '8015691999', '8015692001', 'PO Box 198560', 'Atlanta', 'Fulton', 'GA', '30384', '8015691999', '8015692001', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', '2012-06-30', 0, 0, 0, 'St Marks Hospital', 'Jordan Valley Medical Center', 'Pioneer Valley Hospital', '', 'HCFA|UB|', '1275576027', 0, 'N', 0, '2014-04-09', NULL, NULL, 0, 0, NULL, NULL),
('770701557', 'W12017844', 'W12017844', 'UT01', 'MountainStar Jordan Family Health', 'Amelia', 'S', 'Maass', 'FNP', 'Family Practice', '', '', NULL, 'O', '8846 S Redwood Rd Ste E-121', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015691999', '8015692001', '8846 S Redwood Rd Ste E-121', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015691999', '8015692001', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', '2012-06-30', 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1366488348', 0, 'N', 0, '2013-08-14', NULL, NULL, 0, 0, NULL, NULL),
('770701557', 'W12017843', 'W12017843', 'UT01', 'MountainStar Jordan Family Health', 'Amelia', 'S', 'Maass', 'FNP', 'Family Practice', '', '', NULL, 'B', 'PO Box 198560', 'Atlanta', 'Fulton', 'GA', '30384', '8015691999', '8015692001', 'PO Box 198560', 'Atlanta', 'Fulton', 'GA', '30384', '8015691999', '8015692001', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', '2012-06-30', 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1366488348', 0, 'N', 0, '2013-08-14', NULL, NULL, 0, 0, NULL, NULL),
('770701557', 'W12017846', 'W12017846', 'UT01', 'MountainStar Jordan Family Health', 'David', 'K', 'Palmer', 'MD', 'Ear, Nose and Throat', NULL, NULL, NULL, 'B', 'PO Box 198560', 'Atlanta', 'Fulton', 'GA', '30384', '8015691999', '8015692001', 'PO Box 198560', 'Atlanta', 'Fulton', 'GA', '30384', '8015691999', '8015692001', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', '2012-06-30', 0, 0, 0, 'Mountain West Medical Center', 'St Marks Hospital', NULL, NULL, 'HCFA|UB|', '1427018191', 0, 'N', 0, '2012-06-27', NULL, NULL, 0, 0, NULL, NULL),
('770701557', 'W12017848', 'W12017848', 'UT01', 'MountainStar Jordan Family Health', 'Annliza', '', 'Piacitelli', 'MD', 'Family Practice', '', '', NULL, 'O', '8846 S Redwood Rd Ste E-121', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015691999', '8015692001', '8846 S Redwood Rd Ste E-121', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015691999', '8015692001', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', '2012-06-30', 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1205034113', 0, 'N', 0, '2012-06-27', NULL, NULL, 0, 0, NULL, NULL),
('770701557', 'W12017847', 'W12017847', 'UT01', 'MountainStar Jordan Family Health', 'Annliza', '', 'Piacitelli', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 198560', 'Atlanta', 'Fulton', 'GA', '30384', '8015691999', '8015692001', 'PO Box 198560', 'Atlanta', 'Fulton', 'GA', '30384', '8015691999', '8015692001', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', '2012-06-30', 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1205034113', 0, 'N', 0, '2012-06-27', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W12017849', 'W12017849', 'UT01', 'Salt Lake Senior Clinic - Jordan Commons', 'Robert', '', 'Powell', 'MD', 'Geriatrics', 'Internal Medicine', '', NULL, 'O', '9350 S 150 E Ste 150', 'Sandy', 'Salt Lake', 'UT', '84070', '8019035666', '8019848281', '9350 S 150 E Ste 150', 'Sandy', 'Salt Lake', 'UT', '84070', '8019035666', '8019848281', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2012-02-06', '2014-04-30', 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1700988656', 0, 'N', 0, '2014-04-04', NULL, NULL, 40.5814, -111.887, NULL, NULL),
('621801973', 'W12017850', 'W12017850', 'UT01', 'Salt Lake Senior Clinic - Jordan Commons', 'Robert', '', 'Powell', 'MD', 'Geriatrics', 'Internal Medicine', '', NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2012-02-06', '2014-04-30', 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1700988656', 0, 'N', 0, '2014-04-04', NULL, NULL, 0, 0, NULL, NULL),
('770701557', 'W12017851', 'W12017851', 'UT01', 'MountainStar Jordan Family Health', 'James', 'T', 'Roth', 'MD', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'B', 'PO Box 198560', 'Atlanta', 'Fulton', 'GA', '30384', '8015691999', '8015692001', 'PO Box 198560', 'Atlanta', 'Fulton', 'GA', '30384', '8015691999', '8015692001', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', '2012-06-30', 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1104895705', 0, 'N', 0, '2012-06-28', NULL, NULL, 0, 0, NULL, NULL),
('770701557', 'W12017853', 'W12017853', 'UT01', 'MountainStar Jordan Family Health', 'Todd', 'N', 'Schauers', 'PA-C', 'Family Practice', '', '', NULL, 'O', '8846 S Redwood Rd Ste E-121', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015691999', '8015692001', '8846 S Redwood Rd Ste E-121', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015691999', '8015692001', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', '2012-06-30', 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1053344937', 0, 'N', 0, '2013-09-19', NULL, NULL, 0, 0, NULL, NULL),
('770701557', 'W12017854', 'W12017854', 'UT01', 'MountainStar Jordan Family Health', 'Todd', 'N', 'Schauers', 'PA-C', 'Family Practice', '', '', NULL, 'B', 'PO Box 198560', 'Atlanta', 'Fulton', 'GA', '30384', '8015691999', '8015692001', 'PO Box 198560', 'Atlanta', 'Fulton', 'GA', '30384', '8015691999', '8015692001', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', '2012-06-30', 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1053344937', 0, 'N', 0, '2013-09-19', NULL, NULL, 0, 0, NULL, NULL),
('770701557', 'W12017856', 'W12017856', 'UT01', 'MountainStar Jordan Family Health', 'Caryn', 'M', 'Slack', 'MD', 'Family Practice', '', '', NULL, 'O', '8846 S Redwood Rd Ste E-121', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015691999', '8015692001', '8846 S Redwood Rd Ste E-121', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015691999', '8015692001', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', '2012-06-30', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1689619124', 0, 'N', 0, '2014-04-10', NULL, NULL, 0, 0, NULL, NULL),
('770701557', 'W12017855', 'W12017855', 'UT01', 'MountainStar Jordan Family Health', 'Caryn', 'M', 'Slack', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 198560', 'Atlanta', 'Fulton', 'GA', '30384', '8015691999', '8015692001', 'PO Box 198560', 'Atlanta', 'Fulton', 'GA', '30384', '8015691999', '8015692001', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', '2012-06-30', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1689619124', 0, 'N', 0, '2014-04-10', 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
('870413860', 'W12017858', 'W12017858', 'UT01', 'Now Care Clinic', 'Micah', '', 'Stansfield', 'NP', 'Family Practice', '', '', NULL, 'O', '1937 W 5700 S', 'Roy', 'Weber', 'UT', '84067', '8017739380', '8017739990', '1937 W 5700 S', 'Roy', 'Weber', 'UT', '84067', '8017739380', '8017739990', 'NOWCARE', '', '', '0.00', '35.00', '0.00', 3, '2012-02-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1730465873', 0, 'N', 0, '2012-02-21', NULL, NULL, 41.1596, -112.027, NULL, NULL),
('870413860', 'W12017857', 'W12017857', 'UT01', 'Now Care Clinic', 'Micah', '', 'Stansfield', 'NP', 'Family Practice', '', '', 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, '2012-02-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1730465873', 0, 'N', 0, '2012-02-21', NULL, NULL, 41.2442, -111.961, NULL, NULL),
('870413860', 'W12017859', 'W12017859', 'UT01', 'Now Care Clinic', 'Micah', '', 'Stansfield', 'NP', 'Family Practice', '', '', NULL, 'B', 'PO Box 241', 'Roy', 'Weber', 'UT', '84067', '8016214600', '8016221505', 'PO Box 241', 'Roy', 'Weber', 'UT', '84067', '8016214600', '8016221505', 'NOWCARE', '', '', '0.00', '35.00', '0.00', 3, '2012-02-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1730465873', 0, 'N', 0, '2012-02-21', NULL, NULL, 0, 0, NULL, NULL),
('770701557', 'W12017862', 'W12017862', 'UT01', 'MountainStar Jordan Family Health', 'Garett', 'R', 'Williams', 'MD', 'Family Medicine', '', '', NULL, 'O', '8846 S Redwood Rd Ste E-121', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015691999', '8015692001', '8846 S Redwood Rd Ste E-121', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015691999', '8015692001', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', '2012-06-30', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1982866687', 0, 'N', 0, '2014-05-30', NULL, NULL, 0, 0, NULL, NULL),
('770701557', 'W12017861', 'W12017861', 'UT01', 'MountainStar Jordan Family Health', 'Garett', 'R', 'Williams', 'MD', 'Family Medicine', '', '', NULL, 'B', 'PO Box 198560', 'Atlanta', 'Fulton', 'GA', '30384', '8015691999', '8015692001', 'PO Box 198560', 'Atlanta', 'Fulton', 'GA', '30384', '8015691999', '8015692001', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', '2012-06-30', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1982866687', 0, 'N', 0, '2014-05-30', NULL, NULL, 0, 0, NULL, NULL),
('383828080', 'W12017866', 'W12017866', 'UTDT01', 'Orem Family Dental', 'Paxton', '', 'Bartholomew', '', 'Dentist', '', '', NULL, 'O', '675 East 800 South', 'Orem', 'Utah', 'UT', '84097', '8012252210', NULL, '675 East 800 South', 'Orem', 'Utah', 'UT', '84097', '8012252210', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000009875', 0, 'N', 0, '2012-02-06', NULL, NULL, 0, 0, NULL, NULL),
('273424060', 'W12017868', 'W12017868', 'UTDT01', 'Salt Lake Dental ', 'David', '', 'Stohl', 'DMD', 'Dentist', '', '', NULL, 'O', '2120 S 700 E Ste 1', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8015825787', NULL, '2120 S 700 E Ste 1', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8015825787', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1457369415', 0, 'N', 0, '2014-03-20', NULL, NULL, 0, 0, NULL, NULL),
('261314723', 'W12017869', 'W12017869', 'UTDT01', '', 'Jon C', '', 'Fairbanks', 'DDS', 'Dentist', '', '', NULL, 'O', '83 W 900 N', 'Salem', 'Utah', 'UT', '84653', '8017941834', NULL, '83 W 900 N', 'Salem', 'Utah', 'UT', '84653', '8017941834', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000009869', 0, 'N', 0, '2012-09-10', NULL, NULL, 0, 0, NULL, NULL),
('273629873', 'W12017871', 'W12017871', 'UTDT01', 'Mountain Ridge Dental', 'John', '', 'Green', '', 'Dentist', '', '', NULL, 'O', '134 S Main St', 'Centerville', 'Davis', 'UT', '84014', '8019923221', NULL, '134 S Main St', 'Centerville', 'Davis', 'UT', '84014', '8019923221', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000009876', 0, 'N', 0, '2012-02-07', NULL, NULL, 0, 0, NULL, NULL),
('352202717', 'W12017873', 'W12017873', 'UTDT01', 'The Center for Dental Professionals', 'Luke', '', 'Petersen', '', 'Dentist', '', '', NULL, 'O', '530 E 500 S', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8017478019', NULL, '530 E 500 S', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8017478019', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000009877', 0, 'N', 0, '2013-06-11', NULL, NULL, 0, 0, NULL, NULL),
('273424060', 'W12017874', 'W12017874', 'UTDT01', 'Salt Lake Dental ', 'Matthew', '', 'Stohl', 'DMD', 'Dentist', '', '', NULL, 'O', '2120 S 700 E Ste 1', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8015825787', NULL, '2120 S 700 E Ste 1', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8015825787', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1205002292', 0, 'N', 0, '2014-03-20', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12017875', 'W12017875', 'UTPEHP', 'Dixie EndoDiabetes Clinic', 'Diedre', 'D', 'Bacon', 'APRN', 'Family Practice', '', '', NULL, 'O', '348 E 600 S', 'St George', 'Washington', 'UT', '84770', '4352512888', '4359866873', '348 E 600 S', 'St George', 'Washington', 'UT', '84770', '4352512888', '4359866873', 'PEHPMID', '', '', '0.00', '30.00', '0.00', 8, '2011-11-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1700020369', 0, 'N', 0, '2012-02-06', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12017876', 'W12017876', 'UTPEHP', 'Dixie Wound and Hyperbaric', 'Diedre', 'D', 'Bacon', 'APRN', 'Family Practice', '', '', NULL, 'O', '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356884293', '4356885524', '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356884293', '4356885524', 'PEHPMID', '', '', '0.00', '30.00', '0.00', 8, '2012-01-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1700020369', 0, 'N', 0, '2012-02-06', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12017877', 'W12017877', 'UTPEHP', 'Zion Orthopaedics & Sports Medicine', 'Colton', 'J', 'Bennett', 'PA', 'Orthopedic Surgery', '', '', NULL, 'O', '652 S Medical Ctr Dr Ste 400', 'St George', 'Washington', 'UT', '84790', '4352512650', '4352512668', '652 S Medical Ctr Dr Ste 400', 'St George', 'Washington', 'UT', '84790', '4352512650', '4352512668', 'PEHPMID', '', '', '0.00', '30.00', '0.00', 8, '2011-10-03', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1831472679', 0, 'N', 0, '2012-02-07', NULL, NULL, 0, 0, NULL, NULL),
('460703284', 'W12029075', 'W12029075', 'ID01', 'JC Hospitalists', 'Julie', '', 'Lyon', 'MD', 'Internal Medicine', '', '', NULL, 'O', '2131 S Bonito Way', 'Meridian', 'Ada', 'ID', '83642', '2084899500', '2084899599', '2131 S Bonito Way', 'Meridian', 'Ada', 'ID', '83642', '2084899500', '2084899599', 'IDSAMG1', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2013-03-01', NULL, 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1285685891', 0, 'N', 0, '2013-09-23', NULL, NULL, 43.5852, -116.358, NULL, NULL),
('454820915', 'W12018922', 'W12018922', 'ID02', 'Cottonwood Family Medicine ', 'Alessa', '', 'LopezCastor', 'NPC', 'Nurse Practitioner', '', '', NULL, 'O', '100 N Cottonwood Ct Ste 150', 'Eagle', 'Ada', 'ID', '83616', '2089952875', '2089952874', '100 N Cottonwood Ct Ste 150', 'Eagle', 'Ada', 'ID', '83616', '2089952875', '2089952874', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2012-04-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1285661744', 0, 'N', 0, '2012-05-17', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12017961', 'W12017961', 'UTPEHP', 'Medical Tower Family Practice', 'Carlos', 'A', 'Guerra', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '5770 S 250 E Ste 170', 'Murray', 'Salt Lake', 'UT', '84107', '8013144266', '8013144268', '5770 S 250 E Ste 170', 'Murray', 'Salt Lake', 'UT', '84107', '8013144266', '8013144268', 'IHCPEHP', '', '', '0.00', '30.00', '0.00', 8, '2012-01-01', NULL, 0, 0, 0, 'Primary Childrens Medical Center', '', '', '', 'HCFA|UB|', '1891772612', 0, 'Y', 0, '2012-04-17', NULL, NULL, 0, 0, NULL, NULL),
('770701557', 'W12004639', 'W12004639', 'UT01', 'Lone Peak Family Medicine', 'Matthew', 'T', 'Andersen', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 198560', 'Atlanta', 'Fulton', 'GA', '30384', '8006613365', '8015769800', 'PO Box 198560', 'Atlanta', 'Fulton', 'GA', '30384', '8006613365', '8015769800', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-09-01', '2014-04-04', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1922070093', 0, 'N', 0, '2014-04-09', NULL, NULL, 0, 0, NULL, NULL),
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('942854057', 'W12017915', 'W12017915', 'UTPEHP', 'Redrock Pediatrics', 'Johan', 'N', 'Leeflang', 'PAC', 'Pediatrics', '', '', NULL, 'O', '1380 E Medical Ctr Dr Ste 3100', 'St George', 'Washington', 'UT', '84790', '4352512740', '4352512741', '1380 E Medical Ctr Dr Ste 3100', 'St George', 'Washington', 'UT', '84790', '4352512740', '4352512741', 'PEHPMID', '', '', '0.00', '30.00', '0.00', 8, '2011-10-18', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1508149634', 0, 'N', 0, '2013-10-25', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12017917', 'W12017917', 'UTPEHP', 'Orthopedic Specialty Group - LDS Campus', 'Nathan', 'C', 'Littlefield', 'APRN', 'Family Practice', '', '', NULL, 'O', '324 10th Ave Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84103', '8014088700', '8014088732', '324 10th Ave Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84103', '8014088700', '8014088732', 'PEHPMID', '', '', '0.00', '30.00', '0.00', 8, '2011-11-10', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1568747707', 0, 'N', 0, '2012-02-07', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12017918', 'W12017918', 'UTPEHP', 'Heart Rhythm Specialists', 'Tavia', '', 'Mathers', 'APRN', 'General Surgery', '', '', NULL, 'O', '5169 Cottonwood St Ste 510', 'Murray', 'Salt Lake', 'UT', '84107', '8015073513', '8015073584', '5169 Cottonwood St Ste 510', 'Murray', 'Salt Lake', 'UT', '84107', '8015073513', '8015073584', 'PEHPMID', '', '', '0.00', '30.00', '0.00', 8, '2011-10-31', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1487802914', 0, 'N', 0, '2012-03-26', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12017921', 'W12017921', 'UTPEHP', 'LDS Campus Sleep Program', 'Amanda', '', 'McDonald', 'APRN', 'Family Practice', '', '', NULL, 'O', '325 8th Ave', 'Salt Lake City', 'Salt Lake', 'UT', '84143', '8014083617', '8014085110', '325 8th Ave', 'Salt Lake City', 'Salt Lake', 'UT', '84143', '8014083617', '8014085110', 'PEHPMID', '', '', '0.00', '30.00', '0.00', 8, '2011-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1558535930', 0, 'N', 0, '2012-02-07', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12017922', 'W12017922', 'UTPEHP', 'Riverton Campus Sleep Program', 'Amanda', '', 'McDonald', 'APRN', 'Family Practice', '', '', NULL, 'O', '3723 W 12600 S Ste 480', 'Riverton', 'Salt Lake', 'UT', '84065', '8012854870', '8014123160', '3723 W 12600 S Ste 480', 'Riverton', 'Salt Lake', 'UT', '84065', '8012854870', '8014123160', 'PEHPMID', '', '', '0.00', '30.00', '0.00', 8, '2011-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1558535930', 0, 'N', 0, '2012-02-07', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12017920', 'W12017920', 'UTPEHP', 'Intermountain Sleep Program TOSH', 'Amanda', '', 'McDonald', 'APRN', 'Family Practice', '', '', NULL, 'O', '5770 S 250 E Ste 340', 'Murray', 'Salt Lake', 'UT', '84107', '8013142400', '8013142385', '5770 S 250 E Ste 340', 'Murray', 'Salt Lake', 'UT', '84107', '8013142400', '8013142385', 'PEHPMID', '', '', '0.00', '30.00', '0.00', 8, '2011-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1558535930', 0, 'N', 0, '2012-02-07', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12017923', 'W12017923', 'UTPEHP', 'Dixie Plastic & Reconstructive Surgery', 'Kristina', '', 'McMahon', 'APRN', 'Family Practice', '', '', NULL, 'O', '652 S Medical Ctr Dr Ste 300', 'St George', 'Washington', 'UT', '84790', '4352513670', '4352513671', '652 S Medical Ctr Dr Ste 300', 'St George', 'Washington', 'UT', '84790', '4352513670', '4352513671', 'PEHPMID', '', '', '0.00', '30.00', '0.00', 8, '2011-12-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1053600171', 0, 'N', 0, '2012-02-07', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12017925', 'W12017925', 'UTPEHP', 'Intermountain Senior Clinic', 'Sandra', 'L', 'McNicoll', 'ARPN', 'Family Practice', '', '', NULL, 'O', '5770 S 250 E Ste 210', 'Murray', 'Salt Lake', 'UT', '84107', '8013144565', '8013144565', '5770 S 250 E Ste 210', 'Murray', 'Salt Lake', 'UT', '84107', '8013144565', '8013144565', 'PEHPMID', '', '', '0.00', '30.00', '0.00', 8, '2011-12-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1073533188', 0, 'N', 0, '2012-02-07', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12017928', 'W12017928', 'UTPEHP', 'LDS Campus Sleep Program', 'Kimberly', 'D', 'Megwalu', 'APRN', 'Family Practice', '', '', NULL, 'O', '325 8th Ave', 'Salt Lake City', 'Salt Lake', 'UT', '84143', '8014083617', '8014085110', '325 8th Ave', 'Salt Lake City', 'Salt Lake', 'UT', '84143', '8014083617', '8014085110', 'PEHPMID', '', '', '0.00', '30.00', '0.00', 8, '2011-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1356508857', 0, 'N', 0, '2012-02-07', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12017929', 'W12017929', 'UTPEHP', 'Riverton Campus Sleep Program', 'Kimberly', 'D', 'Megwalu', 'APRN', 'Family Practice', '', '', NULL, 'O', '3723 W 12600 S Ste 480', 'Riverton', 'Salt Lake', 'UT', '84065', '8012854870', '8014123160', '3723 W 12600 S Ste 480', 'Riverton', 'Salt Lake', 'UT', '84065', '8012854870', '8014123160', 'PEHPMID', '', '', '0.00', '30.00', '0.00', 8, '2011-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1356508857', 0, 'N', 0, '2012-02-07', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12017927', 'W12017927', 'UTPEHP', 'Intermountain Sleep Program TOSH', 'Kimberly', 'D', 'Megwalu', 'APRN', 'Family Practice', '', '', NULL, 'O', '5770 S 250 E Ste 340', 'Murray', 'Salt Lake', 'UT', '84107', '8013142400', '8013142385', '5770 S 250 E Ste 340', 'Murray', 'Salt Lake', 'UT', '84107', '8013142400', '8013142385', 'PEHPMID', '', '', '0.00', '30.00', '0.00', 8, '2011-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1356508857', 0, 'N', 0, '2012-02-07', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12017932', 'W12017932', 'UTPEHP', 'Intermountain Nurse Midwives-Rose Park', 'Martha', 'S', 'Nightingale', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1105 W 1000 N', 'Salt Lake City', 'Salt Lake', 'UT', '84116', '8013642434', '8013642436', '1105 W 1000 N', 'Salt Lake City', 'Salt Lake', 'UT', '84116', '8013642434', '8013642436', 'PEHPMID', '', '', '0.00', '30.00', '0.00', 8, '2011-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1588617229', 0, 'N', 0, '2012-02-08', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12017931', 'W12017931', 'UTPEHP', 'Intermountain Nurse Midwives', 'Martha', 'S', 'Nightingale', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '5063 Cottonwood St Ste 130', 'Murray', 'Salt Lake', 'UT', '84107', '8015077070', '8015077089', '5063 Cottonwood St Ste 130', 'Murray', 'Salt Lake', 'UT', '84107', '8015077070', '8015077089', 'PEHPMID', '', '', '0.00', '30.00', '0.00', 8, '2011-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1588617229', 0, 'N', 0, '2012-02-08', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12017933', 'W12017933', 'UTPEHP', 'Intermountain Nurse Midwives-Sorenson', 'Martha', 'S', 'Nightingale', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '855 California Ave', 'Salt Lake City', 'Salt Lake', 'UT', '84104', '8019770502', '8019770514', '855 California Ave', 'Salt Lake City', 'Salt Lake', 'UT', '84104', '8019770502', '8019770514', 'PEHPMID', '', '', '0.00', '30.00', '0.00', 8, '2011-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1588617229', 0, 'N', 0, '2012-02-08', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12017934', 'W12017934', 'UTPEHP', 'Heart Rhythm Specialists', 'Elizabeth', 'A', 'Pritt', 'PAC', 'Family Practice', '', '', NULL, 'O', '5169 Cottonwood St Ste 510', 'Murray', 'Salt Lake', 'UT', '84107', '8015073513', '8015073584', '5169 Cottonwood St Ste 510', 'Murray', 'Salt Lake', 'UT', '84107', '8015073513', '8015073584', 'PEHPMID', '', '', '0.00', '30.00', '0.00', 8, '2011-10-26', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1760763411', 0, 'N', 0, '2012-02-08', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12017936', 'W12017936', 'UTPEHP', 'Dixie EndoDiabetes Clinic', 'Lucinda', 'L', 'Ross', 'APRN', 'Endocrinology', 'Diabetes', '', NULL, 'O', '348 E 600 S', 'St George', 'Washington', 'UT', '84770', '4352512888', '4359866873', '348 E 600 S', 'St George', 'Washington', 'UT', '84770', '4352512888', '4359866873', 'PEHPMID', '', '', '0.00', '30.00', '0.00', 8, '2011-11-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1831340389', 0, 'N', 0, '2012-02-08', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12017937', 'W12017937', 'UTPEHP', 'Park City Specialty East', 'Eva', 'L', 'Rowles', 'APRN', 'Family Practice', '', '', NULL, 'O', '750 Round Valley Dr Ste 101', 'Park City', 'Summit', 'UT', '84060', '4356587246', '4356587456', '750 Round Valley Dr Ste 101', 'Park City', 'Summit', 'UT', '84060', '4356587246', '4356587456', 'PEHPMID', '', '', '0.00', '30.00', '0.00', 8, '2011-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1811035421', 0, 'N', 0, '2014-07-09', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12017938', 'W12017938', 'UTPEHP', 'Heber Valley Clinic', 'Eva', 'L', 'Rowles', 'APRN', 'Family Practice', '', '', NULL, 'O', '1473 S Hwy 40 Ste E', 'Heber City', 'Wasatch', 'UT', '84032', '4356542500', '4356574460', '1473 S Hwy 40 Ste E', 'Heber City', 'Wasatch', 'UT', '84032', '4356542500', '4356574460', 'PEHPMID', '', '', '0.00', '30.00', '0.00', 8, '2011-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1811035421', 0, 'N', 0, '2014-07-09', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12017939', 'W12017939', 'UTPEHP', 'Sevier Valley Clinic', 'Brent', 'J', 'Allen', 'MD', 'General Surgery', '', '', NULL, 'O', '70 E 1000 N', 'Richfield', 'Sevier', 'UT', '84701', '4358930580', '4358968420', '70 E 1000 N', 'Richfield', 'Sevier', 'UT', '84701', '4358930580', '4358968420', 'IHCPEHP', '', '', '0.00', '30.00', '0.00', 8, '2011-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1477660389', 0, 'N', 0, '2012-02-07', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12017940', 'W12017940', 'UTPEHP', 'Sevier Valley FP SVMC', 'Brent', 'J', 'Allen', 'MD', 'General Surgery', '', '', NULL, 'O', '1000 N Main St', 'Richfield', 'Sevier', 'UT', '84701', '4358966496', '4358930214', '1000 N Main St', 'Richfield', 'Sevier', 'UT', '84701', '4358966496', '4358930214', 'IHCPEHP', '', '', '0.00', '30.00', '0.00', 8, '2011-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1477660389', 0, 'N', 0, '2012-02-07', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12017941', 'W12017941', 'UTPEHP', 'Utah Heart', 'Nestor', 'E', 'Almeida', 'MD', 'Hospitalist', '', '', NULL, 'O', '5169 Cottonwood St Ste 520', 'Murray', 'Salt Lake', 'UT', '84107', '8015073500', '8015073505', '5169 Cottonwood St Ste 520', 'Murray', 'Salt Lake', 'UT', '84107', '8015073500', '8015073505', 'IHCPEHP', '', '', '0.00', '0.00', '0.00', 8, '2011-12-16', NULL, 0, 30, 0, '', '', '', '', 'HCFA|UB|', '1891089926', 0, 'N', 0, '2012-02-08', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12017942', 'W12017942', 'UTPEHP', 'Dixie Wound and Hyperbaric', 'Craig', 'L', 'Booth', 'MD', 'Family Practice', '', '', NULL, 'O', '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356884293', '4356885524', '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356884293', '4356885524', 'IHCPEHP', '', '', '0.00', '30.00', '0.00', 8, '2012-01-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1225146392', 0, 'N', 0, '2012-02-07', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12017944', 'W12017944', 'UTPEHP', 'Sandy Clinic', 'Richard', 'B', 'Cannon', 'MD', 'Endocrinology', '', '', NULL, 'O', '9500 S 1300 E', 'Sandy', 'Salt Lake', 'UT', '84094', '8015012100', '8015012107', '9500 S 1300 E', 'Sandy', 'Salt Lake', 'UT', '84094', '8015012100', '8015012107', 'IHCPEHP', '', '', '0.00', '30.00', '0.00', 8, '2011-11-01', '2012-07-09', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1366722746', 0, 'Y', 0, '2012-07-09', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12017945', 'W12017945', 'UTPEHP', 'Intermountain Sleep Program TOSH', 'Tom', 'V', 'Cloward', '', 'Pulmonary', '', '', NULL, 'O', '5770 S 250 E Ste 340', 'Murray', 'Salt Lake', 'UT', '84107', '8013142400', '8013142385', '5770 S 250 E Ste 340', 'Murray', 'Salt Lake', 'UT', '84107', '8013142400', '8013142385', 'IHCPEHP', '', '', '0.00', '30.00', '0.00', 8, '2011-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1053407726', 0, 'N', 0, '2012-06-26', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12017946', 'W12017946', 'UTPEHP', 'LDS Campus Sleep Program', 'Tom', 'V', 'Cloward', '', 'Pulmonary', '', '', NULL, 'O', '325 8th Ave', 'Salt Lake City', 'Salt Lake', 'UT', '84143', '8014083617', '8014085110', '325 8th Ave', 'Salt Lake City', 'Salt Lake', 'UT', '84143', '8014083617', '8014085110', 'IHCPEHP', '', '', '0.00', '30.00', '0.00', 8, '2011-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1053407726', 0, 'N', 0, '2012-06-26', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12017947', 'W12017947', 'UTPEHP', 'Riverton Campus Sleep Program', 'Tom', 'V', 'Cloward', '', 'Pulmonary', '', '', NULL, 'O', '3723 W 12600 S Ste 480', 'Riverton', 'Salt Lake', 'UT', '84065', '8012854870', '8014123160', '3723 W 12600 S Ste 480', 'Riverton', 'Salt Lake', 'UT', '84065', '8012854870', '8014123160', 'IHCPEHP', '', '', '0.00', '30.00', '0.00', 8, '2011-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1053407726', 0, 'N', 0, '2012-06-26', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12017948', 'W12017948', 'UTPEHP', 'Redrock Spine & Neurosurgery Clinic', 'Richard', 'A', 'Day', 'MD', 'Neurosurgery', '', '', NULL, 'O', '652 S Medical Ctr Dr Ste 115', 'St George', 'Washington', 'UT', '84790', '4352513700', '4352513701', '652 S Medical Ctr Dr Ste 115', 'St George', 'Washington', 'UT', '84790', '4352513700', '4352513701', 'IHCPEHP', '', '', '0.00', '30.00', '0.00', 8, '2011-12-08', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1447275854', 0, 'N', 0, '2013-05-30', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12017949', 'W12017949', 'UTPEHP', 'Dixie Wound and Hyperbaric', 'Joan', 'V', 'Eggert', 'MD', 'Obstetrics and Gynecology', 'Gynecology', 'Hyperbaric Medicine', NULL, 'O', '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356884293', '4356885524', '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356884293', '4356885524', 'IHCPEHP', '', '', '0.00', '30.00', '0.00', 8, '2012-01-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', '', '', '', 'HCFA|UB|', '1093715542', 0, 'N', 0, '2014-06-16', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12017950', 'W12017950', 'UTPEHP', 'Intermountain Sleep Program TOSH', 'Robert', 'V', 'Farney', '', 'Pulmonary', 'Sleep Medicine', '', NULL, 'O', '5770 S 250 E Ste 340', 'Murray', 'Salt Lake', 'UT', '84107', '8013142400', '8013142385', '5770 S 250 E Ste 340', 'Murray', 'Salt Lake', 'UT', '84107', '8013142400', '8013142385', 'IHCPEHP', '', '', '0.00', '30.00', '0.00', 8, '2011-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1841386513', 0, 'N', 0, '2012-02-08', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12017951', 'W12017951', 'UTPEHP', 'LDS Campus Sleep Program', 'Robert', 'V', 'Farney', '', 'Pulmonary', 'Sleep Medicine', '', NULL, 'O', '325 8th Ave', 'Salt Lake City', 'Salt Lake', 'UT', '84143', '8014083617', '8014085110', '325 8th Ave', 'Salt Lake City', 'Salt Lake', 'UT', '84143', '8014083617', '8014085110', 'IHCPEHP', '', '', '0.00', '30.00', '0.00', 8, '2011-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1841386513', 0, 'N', 0, '2012-02-08', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12017952', 'W12017952', 'UTPEHP', 'Riverton Campus Sleep Program', 'Robert', 'V', 'Farney', '', 'Pulmonary', 'Sleep Medicine', '', NULL, 'O', '3723 W 12600 S Ste 480', 'Riverton', 'Salt Lake', 'UT', '84065', '8012854870', '8014123160', '3723 W 12600 S Ste 480', 'Riverton', 'Salt Lake', 'UT', '84065', '8012854870', '8014123160', 'IHCPEHP', '', '', '0.00', '30.00', '0.00', 8, '2011-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1841386513', 0, 'N', 0, '2012-02-08', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12017954', 'W12017954', 'UTPEHP', 'McKay Dee Internal Medicine Clinic', 'Laurel', 'A', 'Fedor', 'MD', 'Internal Medicine', '', '', NULL, 'O', '4403 Harrison Blvd Ste 3875', 'Ogden', 'Weber', 'UT', '84403', '8013877950', '8013877955', '4403 Harrison Blvd Ste 3875', 'Ogden', 'Weber', 'UT', '84403', '8013877950', '8013877955', 'IHCPEHP', '', '', '0.00', '30.00', '0.00', 8, '2011-10-06', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1245442086', 0, 'N', 0, '2012-02-08', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12017956', 'W12017956', 'UTPEHP', 'Intermountain Senior Clinic', 'E', 'Dennis', 'Genebach', 'MD', 'Internal Medicine', '', '', NULL, 'O', '5770 S 250 E Ste 210', 'Murray', 'Salt Lake', 'UT', '84107', '8013144544', '8013144565', '5770 S 250 E Ste 210', 'Murray', 'Salt Lake', 'UT', '84107', '8013144544', '8013144565', 'IHCPEHP', '', '', '0.00', '30.00', '0.00', 8, '2011-12-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1003833468', 0, 'N', 0, '2012-02-08', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12017957', 'W12017957', 'UTPEHP', 'Southwest Regional Cancer Clinic', 'Michelle', 'H', 'Gilbert', 'MD', 'Hematology and Oncology', 'Internal Medicine', '', NULL, 'O', '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356884900', '4356884901', '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356884900', '4356884901', 'IHCPEHP', '', '', '0.00', '30.00', '0.00', 8, '2012-01-16', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1992876452', 0, 'N', 0, '2012-07-31', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12017960', 'W12017960', 'UTPEHP', 'Memorial Clinic', 'Darcie', 'R', 'Gorman', 'MD', 'Gastroenterology', '', '', NULL, 'O', '2000 S 900 E', 'Salt Lake City', 'Salt Lake', 'UT', '84105', '8014647500', '8014647876', '2000 S 900 E', 'Salt Lake City', 'Salt Lake', 'UT', '84105', '8014647500', '8014647876', 'IHCPEHP', '', '', '0.00', '30.00', '0.00', 8, '2011-11-28', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1063637353', 0, 'N', 0, '2012-02-07', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12017959', 'W12017959', 'UTPEHP', 'Avenues Specialty Clinic', 'Darcie', 'R', 'Gorman', 'MD', 'Gastroenterology', '', '', NULL, 'O', '324 10th Ave Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84103', '8014087500', '8014082886', '324 10th Ave Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84103', '8014087500', '8014082886', 'IHCPEHP', '', '', '0.00', '30.00', '0.00', 8, '2011-11-28', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1063637353', 0, 'N', 0, '2012-02-07', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12017962', 'W12017962', 'UTPEHP', 'Kearns Clinic', 'Paula', 'A', 'Guerra', 'MD', 'Family Practice', '', '', NULL, 'O', '4946 W 6200 S', 'Taylorsville', 'Salt Lake', 'UT', '84118', '8018714444', '8018714494', '4946 W 6200 S', 'Taylorsville', 'Salt Lake', 'UT', '84118', '8018714444', '8018714494', 'IHCPEHP', '', '', '0.00', '30.00', '0.00', 8, '2011-10-01', '2011-07-31', 0, 0, 0, 'Riverton Childrens Unit Operated by Primary Childrens Medical Center', '', '', '', 'HCFA|UB|', '1902883721', 0, 'N', 0, '2014-04-11', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12017963', 'W12017963', 'UTPEHP', 'LDS Campus Sleep Program', 'Howard', 'M', 'Leaman', 'MD', 'Sleep Medicine', '', '', NULL, 'O', '325 8th Ave', 'Salt Lake City', 'Salt Lake', 'UT', '84143', '8014083617', '8014085110', '325 8th Ave', 'Salt Lake City', 'Salt Lake', 'UT', '84143', '8014083617', '8014085110', 'IHCPEHP', '', '', '0.00', '30.00', '0.00', 8, '2011-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1043316102', 0, 'N', 0, '2012-06-28', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12017964', 'W12017964', 'UTPEHP', 'Intermountain Sleep Program TOSH', 'Howard', 'M', 'Leaman', 'MD', 'Sleep Medicine', '', '', NULL, 'O', '5770 S 250 E Ste 340', 'Murray', 'Salt Lake', 'UT', '84107', '8013142400', '8013142385', '5770 S 250 E Ste 340', 'Murray', 'Salt Lake', 'UT', '84107', '8013142400', '8013142385', 'IHCPEHP', '', '', '0.00', '30.00', '0.00', 8, '2011-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1043316102', 0, 'N', 0, '2012-06-28', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12017965', 'W12017965', 'UTPEHP', 'Riverton Campus Sleep Program', 'Howard', 'M', 'Leaman', 'MD', 'Sleep Medicine', '', '', NULL, 'O', '3723 W 12600 S Ste 480', 'Riverton', 'Salt Lake', 'UT', '84065', '8012854870', '8014123160', '3723 W 12600 S Ste 480', 'Riverton', 'Salt Lake', 'UT', '84065', '8012854870', '8014123160', 'IHCPEHP', '', '', '0.00', '30.00', '0.00', 8, '2011-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1043316102', 0, 'N', 0, '2012-06-28', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12017966', 'W12017966', 'UTPEHP', 'Heart Rhythm Specialists', 'Charles', 'D', 'Mallender', 'MD', 'Internal Medicine', '', '', NULL, 'O', '5169 Cottonwood St Ste 510', 'Murray', 'Salt Lake', 'UT', '84107', '8015073513', '8015073584', '5169 Cottonwood St Ste 510', 'Murray', 'Salt Lake', 'UT', '84107', '8015073513', '8015073584', 'IHCPEHP', '', '', '0.00', '30.00', '0.00', 8, '2011-11-14', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1942261037', 0, 'N', 0, '2013-06-12', 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
('942854057', 'W12017967', 'W12017967', 'UTPEHP', 'LDS Campus Sleep Program', 'Robert', 'L', 'Mazzola', 'MD', 'Sleep Medicine', 'Pulmonary', '', NULL, 'O', '325 8th Ave', 'Salt Lake City', 'Salt Lake', 'UT', '84143', '8014083617', '8014085110', '325 8th Ave', 'Salt Lake City', 'Salt Lake', 'UT', '84143', '8014083617', '8014085110', 'IHCPEHP', '', '', '0.00', '30.00', '0.00', 8, '2011-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1629142898', 0, 'N', 0, '2014-05-12', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12017968', 'W12017968', 'UTPEHP', 'Intermountain Sleep Program TOSH', 'Robert', 'L', 'Mazzola', 'MD', 'Sleep Medicine', 'Pulmonary', '', NULL, 'O', '5770 S 250 E Ste 340', 'Murray', 'Salt Lake', 'UT', '84107', '8013142400', '8013142385', '5770 S 250 E Ste 340', 'Murray', 'Salt Lake', 'UT', '84107', '8013142400', '8013142385', 'IHCPEHP', '', '', '0.00', '30.00', '0.00', 8, '2011-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1629142898', 0, 'N', 0, '2014-05-12', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12017969', 'W12017969', 'UTPEHP', 'Riverton Campus Sleep Program', 'Robert', 'L', 'Mazzola', 'MD', 'Sleep Medicine', 'Pulmonary', '', NULL, 'O', '3723 W 12600 S Ste 480', 'Riverton', 'Salt Lake', 'UT', '84065', '8012854870', '8014123160', '3723 W 12600 S Ste 480', 'Riverton', 'Salt Lake', 'UT', '84065', '8012854870', '8014123160', 'IHCPEHP', '', '', '0.00', '30.00', '0.00', 8, '2011-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1629142898', 0, 'N', 0, '2014-05-12', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12017971', 'W12017971', 'UTPEHP', 'Utah Valley Internal Medicine', 'Matthew', 'K', 'Money', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '1134 N 500 W Ste 101', 'Provo', 'Utah', 'UT', '84604', '8013577323', '8013577071', '1134 N 500 W Ste 101', 'Provo', 'Utah', 'UT', '84604', '8013577323', '8013577071', 'IHCPEHP', '', '', '0.00', '0.00', '0.00', 8, '2012-01-02', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1326115403', 0, 'N', 0, '2012-02-08', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12017972', 'W12017972', 'UTPEHP', 'Dixie EndoDiabetes Clinic', 'Monica', 'P', 'Moreno', 'MD', 'Endocrinology', '', '', NULL, 'O', '348 E 600 S', 'St George', 'Washington', 'UT', '84770', '4352512888', '4359866873', '348 E 600 S', 'St George', 'Washington', 'UT', '84770', '4352512888', '4359866873', 'IHCPEHP', '', '', '0.00', '30.00', '0.00', 8, '2011-11-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1669679379', 0, 'N', 0, '2012-02-08', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12017974', 'W12017974', 'UTPEHP', 'Alta View Senior Clinic', 'Crystal', 'D', 'Owens', 'MD', 'Geriatrics', '', '', NULL, 'O', '9660 S 1300 E', 'Sandy', 'Salt Lake', 'UT', '84094', '8015012025', '8015014099', '9660 S 1300 E', 'Sandy', 'Salt Lake', 'UT', '84094', '8015012025', '8015014099', 'IHCPEHP', '', '', '0.00', '30.00', '0.00', 8, '2011-12-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1477676427', 0, 'N', 0, '2012-02-08', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12017975', 'W12017975', 'UTPEHP', 'Utah Valley Womens Center', 'Margaret', 'L', 'Rodgers', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1034 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013577009', '8013578132', '1034 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013577009', '8013578132', 'IHCPEHP', '', '', '0.00', '30.00', '0.00', 8, '2011-12-08', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1013063163', 0, 'N', 0, '2012-02-08', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12017977', 'W12017977', 'UTPEHP', 'LDS Campus Sleep Program', 'Kevin', 'C', 'Shilling', 'MD', 'Pulmonary', 'Sleep Medicine', '', NULL, 'O', '325 8th Ave', 'Salt Lake City', 'Salt Lake', 'UT', '84143', '8014083617', '8014085110', '325 8th Ave', 'Salt Lake City', 'Salt Lake', 'UT', '84143', '8014083617', '8014085110', 'IHCPEHP', '', '', '0.00', '30.00', '0.00', 8, '2011-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1144233214', 0, 'N', 0, '2012-06-28', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12017978', 'W12017978', 'UTPEHP', 'Intermountain Sleep Program TOSH', 'Kevin', 'C', 'Shilling', 'MD', 'Pulmonary', 'Sleep Medicine', '', NULL, 'O', '5770 S 250 E Ste 340', 'Murray', 'Salt Lake', 'UT', '84107', '8013142400', '8013142385', '5770 S 250 E Ste 340', 'Murray', 'Salt Lake', 'UT', '84107', '8013142400', '8013142385', 'IHCPEHP', '', '', '0.00', '30.00', '0.00', 8, '2011-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1144233214', 0, 'N', 0, '2012-06-28', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12017979', 'W12017979', 'UTPEHP', 'Riverton Campus Sleep Program', 'Kevin', 'C', 'Shilling', 'MD', 'Pulmonary', 'Sleep Medicine', '', NULL, 'O', '3723 W 12600 S Ste 480', 'Riverton', 'Salt Lake', 'UT', '84065', '8012854870', '8014123160', '3723 W 12600 S Ste 480', 'Riverton', 'Salt Lake', 'UT', '84065', '8012854870', '8014123160', 'IHCPEHP', '', '', '0.00', '30.00', '0.00', 8, '2011-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1144233214', 0, 'N', 0, '2012-06-28', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12017980', 'W12017980', 'UTPEHP', 'Utah Valley Vascular Surgery', 'Robert', 'Paul', 'Smilanich', 'MD', 'Vascular Surgery', NULL, NULL, NULL, 'O', '1055 N 300 W Ste 205', 'Provo', 'Utah', 'UT', '84604', '8013749100', '8013749117', '1055 N 300 W Ste 205', 'Provo', 'Utah', 'UT', '84604', '8013749100', '8013749117', 'IHCPEHP', '', '', '0.00', '30.00', '0.00', 8, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1730187600', 0, 'N', 0, '2012-02-07', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12017983', 'W12017983', 'UTPEHP', 'Dixie Wound and Hyperbaric', 'Steven', 'A', 'VanNorman', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356884293', '4356885524', '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356884293', '4356885524', 'IHCPEHP', '', '', '0.00', '30.00', '0.00', 8, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1780671107', 0, 'N', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12017982', 'W12017982', 'UTPEHP', 'Kearns Clinic', 'Orlando', 'R', 'Valdez', 'MD', 'Pediatrics', '', '', NULL, 'O', '4946 W 6200 S', 'Taylorsville', 'Salt Lake', 'UT', '84118', '8018714444', '8018714494', '4946 W 6200 S', 'Taylorsville', 'Salt Lake', 'UT', '84118', '8018714444', '8018714494', 'IHCPEHP', '', '', '0.00', '30.00', '0.00', 8, '2011-10-01', NULL, 0, 0, 0, 'Riverton Childrens Unit Operated by Primary Childrens Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1912945239', 0, 'N', 0, '2012-06-01', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12017985', 'W12017985', 'UTPEHP', 'Intermountain Senior Clinic', 'Edward', 'C', 'Wyne', 'MD', 'Geriatrics', '', '', NULL, 'O', '5770 S 250 E Ste 210', 'Murray', 'Salt Lake', 'UT', '84107', '8013144544', '8013144565', '5770 S 250 E Ste 210', 'Murray', 'Salt Lake', 'UT', '84107', '8013144544', '8013144565', 'IHCPEHP', '', '', '0.00', '30.00', '0.00', 8, '2011-12-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1114947223', 0, 'N', 0, '2012-02-08', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12017987', 'W12017987', 'UTIHC01', '', 'Melanie', 'J', 'Ray', 'SLP', 'Speech Therapy', '', '', NULL, 'O', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016624971', NULL, '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016624971', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2010-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1194924191', 0, 'Y', 0, '2012-02-08', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12017988', 'W12017988', 'UTIHC02', '', 'Melanie', 'J', 'Ray', 'SLP', 'Speech Therapy', '', '', NULL, 'O', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016624971', NULL, '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016624971', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2010-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1194924191', 0, 'Y', 0, '2012-02-08', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12017989', 'W12017989', 'UTIHC03', '', 'Melanie', 'J', 'Ray', 'SLP', 'Speech Therapy', '', '', NULL, 'O', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016624971', NULL, '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016624971', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2010-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1194924191', 0, 'Y', 0, '2012-02-08', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12017990', 'W12017990', 'UTIHC04', '', 'Melanie', 'J', 'Ray', 'SLP', 'Speech Therapy', '', '', NULL, 'O', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016624971', NULL, '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016624971', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2010-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1194924191', 0, 'Y', 0, '2012-02-08', NULL, NULL, 40.7663, -111.837, NULL, NULL),
('942854057', 'W12017992', 'W12017992', 'UTIHC01', 'Rehab', 'Kimberly', 'Eve', 'Desautels', 'OT', 'Occupational Therapy', '', '', NULL, 'O', '100 Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621000', NULL, '100 Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621000', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2011-04-26', '2012-02-23', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1790063931', 0, 'Y', 0, '2012-09-13', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12017993', 'W12017993', 'UTIHC02', 'Rehab', 'Kimberly', 'Eve', 'Desautels', 'OT', 'Occupational Therapy', '', '', NULL, 'O', '100 Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621000', NULL, '100 Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621000', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2011-04-26', '2012-02-23', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1790063931', 0, 'Y', 0, '2012-09-13', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12017994', 'W12017994', 'UTIHC03', 'Rehab', 'Kimberly', 'Eve', 'Desautels', 'OT', 'Occupational Therapy', '', '', NULL, 'O', '100 Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621000', NULL, '100 Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621000', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2011-04-26', '2012-02-23', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1790063931', 0, 'Y', 0, '2012-09-13', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12017995', 'W12017995', 'UTIHC04', 'Rehab', 'Kimberly', 'Eve', 'Desautels', 'OT', 'Occupational Therapy', '', '', NULL, 'O', '100 Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621000', NULL, '100 Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621000', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2011-04-26', '2012-02-23', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1790063931', 0, 'Y', 0, '2012-09-13', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12017996', 'W12017996', 'UTIHC04', '', 'Tricia', '', 'Petzold', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', NULL, '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2011-12-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1043300668', 0, 'N', 0, '2012-02-08', NULL, NULL, 40.6876, -111.468, NULL, NULL),
('942854057', 'W12017998', 'W12017998', 'UTIHC01', '', 'Tina', 'M', 'Sauer', 'SLP', 'Speech Therapy', '', '', NULL, 'O', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016624971', NULL, '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016624971', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2010-09-20', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1750475885', 0, 'Y', 0, '2012-02-08', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12017999', 'W12017999', 'UTIHC02', '', 'Tina', 'M', 'Sauer', 'SLP', 'Speech Therapy', '', '', NULL, 'O', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016624971', NULL, '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016624971', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2010-09-20', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1750475885', 0, 'Y', 0, '2012-02-08', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12018000', 'W12018000', 'UTIHC03', '', 'Tina', 'M', 'Sauer', 'SLP', 'Speech Therapy', '', '', NULL, 'O', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016624971', NULL, '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016624971', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2010-09-20', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1750475885', 0, 'Y', 0, '2012-02-08', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12018001', 'W12018001', 'UTIHC04', '', 'Tina', 'M', 'Sauer', 'SLP', 'Speech Therapy', '', '', NULL, 'O', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016624971', NULL, '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016624971', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2010-09-20', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1750475885', 0, 'Y', 0, '2012-02-08', NULL, NULL, 40.7663, -111.837, NULL, NULL),
('942854057', 'W12018003', 'W12018003', 'UTIHC01', '', 'Amy', 'L', 'Walton', 'SLP', 'Speech Therapy', '', '', NULL, 'O', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016624971', NULL, '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016624971', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2011-01-01', '2013-07-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1649462631', 0, 'Y', 0, '2013-09-03', NULL, NULL, 0, 0, NULL, NULL),
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('850444170', 'W12018085', 'W12018085', 'NM01', 'TriCore Reference Laboratories', '', '', 'TriCore Reference Laboratories', 'Group', 'Laboratory', '', '', NULL, 'O', '3901 Altisco NW', 'Albuquerque', 'Bernalillo', 'NM', '87120', '5054627549', '5058391043', '3901 Altisco NW', 'Albuquerque', 'Bernalillo', 'NM', '87120', '5054627549', '5058391043', 'NMLAB', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1033285044', 0, 'N', 0, '2012-09-05', NULL, NULL, 35.1278, -106.707, NULL, NULL),
('850444170', 'W12018094', 'W12018094', 'NM01', 'TriCore Reference Laboratories', '', '', 'TriCore Reference Laboratories', 'Group', 'Laboratory', '', '', NULL, 'O', '4005 High Resort Blvd', 'Rio Rancho', 'Sandoval', 'NM', '87124', '5054628500', '5054628463', '4005 High Resort Blvd', 'Rio Rancho', 'Sandoval', 'NM', '87124', '5054628500', '5054628463', 'NMLAB', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1033285044', 0, 'N', 0, '2012-09-05', NULL, NULL, 35.2508, -106.657, NULL, NULL),
('850444170', 'W12018083', 'W12018083', 'NM01', 'TriCore Reference Laboratories', '', '', 'TriCore Reference Laboratories', 'Group', 'Laboratory', '', '', NULL, 'O', '401 San Mateo SE', 'Albuquerque', 'Bernalillo', 'NM', '87108', '5054627492', '5052601584', '401 San Mateo SE', 'Albuquerque', 'Bernalillo', 'NM', '87108', '5054627492', '5052601584', 'NMLAB', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1033285044', 0, 'N', 0, '2012-09-05', NULL, NULL, 35.075, -106.586, NULL, NULL),
('850444170', 'W12018086', 'W12018086', 'NM01', 'TriCore Reference Laboratories', '', '', 'TriCore Reference Laboratories', 'Group', 'Laboratory', '', '', NULL, 'O', '5901 Harper NE', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058238755', '5058238764', '5901 Harper NE', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058238755', '5058238764', 'NMLAB', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1033285044', 0, 'N', 0, '2012-09-05', NULL, NULL, 35.1532, -106.586, NULL, NULL),
('850444170', 'W12018092', 'W12018092', 'NM01', 'TriCore Reference Laboratories', '', '', 'TriCore Reference Laboratories', 'Group', 'Laboratory', '', '', NULL, 'O', '608 S Christopher Rd', 'Belen', 'Valencia', 'NM', '87002', '5058645484', '5058645493', '608 S Christopher Rd', 'Belen', 'Valencia', 'NM', '87002', '5058645484', '5058645493', 'NMLAB', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1033285044', 0, 'N', 0, '2012-09-05', NULL, NULL, 0, 0, NULL, NULL),
('850444170', 'W12018091', 'W12018091', 'NM01', 'TriCore Reference Laboratories', '', '', 'TriCore Reference Laboratories', 'Group', 'Laboratory', '', '', NULL, 'O', '6410 Coors NW Ste 200', 'Albuquerque', 'Bernalillo', 'NM', '87120', '5059246900', '5057928329', '6410 Coors NW Ste 200', 'Albuquerque', 'Bernalillo', 'NM', '87120', '5059246900', '5057928329', 'NMLAB', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1033285044', 0, 'N', 0, '2012-09-05', NULL, NULL, 0, 0, NULL, NULL),
('850444170', 'W12018087', 'W12018087', 'NM01', 'TriCore Reference Laboratories', '', '', 'TriCore Reference Laboratories', 'Group', 'Laboratory', '', '', NULL, 'O', '6800 Montgomery Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87111', '5054626414', '5054626501', '6800 Montgomery Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87111', '5054626414', '5054626501', 'NMLAB', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-02-15', '2012-09-04', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1033285044', 0, 'N', 0, '2012-09-05', NULL, NULL, 0, 0, NULL, NULL),
('850444170', 'W12018088', 'W12018088', 'NM01', 'TriCore Reference Laboratories', '', '', 'TriCore Reference Laboratories', 'Group', 'Laboratory', '', '', NULL, 'O', '8300 Constitution Ave NE', 'Albuquerque', 'Bernalillo', 'NM', '87110', '5052912761', '5052912386', '8300 Constitution Ave NE', 'Albuquerque', 'Bernalillo', 'NM', '87110', '5052912761', '5052912386', 'NMLAB', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1033285044', 0, 'N', 0, '2012-09-05', NULL, NULL, 35.0946, -106.553, NULL, NULL),
('850444170', 'W12018082', 'W12018082', 'NM01', 'TriCore Reference Laboratories', '', '', 'TriCore Reference Laboratories', 'Group', 'Laboratory', '', '', NULL, 'B', 'PO Box 27935', 'Albuquerque', 'Bernalillo', 'NM', '87125', '5059388888', NULL, 'PO Box 27935', 'Albuquerque', 'Bernalillo', 'NM', '87125', '5059388888', '          ', 'NMLAB', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1033285044', 0, 'N', 0, '2012-09-05', NULL, NULL, 0, 0, NULL, NULL),
('820299231', 'W12018098', 'W12018098', 'ID02', 'Saltzer Medical Group- Caldwell', 'Erik', '', 'Richardson', 'DO', 'Family Practice', '', '', NULL, 'O', '1818 S 10th Ave Ste 120 or Ste 220', 'Caldwell', 'Canyon', 'ID', '83605', '2084685940', '2084633055', '1818 S 10th Ave Ste 120 or Ste 220', 'Caldwell', 'Canyon', 'ID', '83605', '2084685940', '2084633055', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-07-01', '2012-12-31', 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1942307640', 0, 'N', 0, '2013-02-21', NULL, NULL, 43.6538, -116.693, NULL, NULL),
('820299231', 'W12018097', 'W12018097', 'ID02', 'Saltzer Medical Group', 'Erik', '', 'Richardson', 'DO', 'Family Practice', '', '', NULL, 'B', '217 W Georgia Ave Ste 115', 'Nampa', 'Canyon', 'ID', '83686', '2084633280', '2082884987', '217 W Georgia Ave Ste 115', 'Nampa', 'Canyon', 'ID', '83686', '2084633280', '2082884987', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-07-01', '2012-12-31', 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1942307640', 0, 'N', 0, '2013-02-21', NULL, NULL, 0, 0, NULL, NULL),
('820299231', 'W12018100', 'W12018100', 'ID02', 'Saltzer Medical Group-Portico', 'Erik', '', 'Richardson', 'DO', 'Family Practice', '', '', NULL, 'O', '3277 E Louise Dr Ste 200', 'Meridian', 'Ada', 'ID', '83642', '2084633000', '2084633044', '3277 E Louise Dr Ste 200', 'Meridian', 'Ada', 'ID', '83642', '2084633000', '2084633044', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-07-01', '2012-12-31', 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1942307640', 0, 'N', 0, '2013-02-21', NULL, NULL, 0, 0, NULL, NULL),
('820299231', 'W12018099', 'W12018099', 'ID02', 'Saltzer Medical Group North', 'Erik', '', 'Richardson', 'DO', 'Family Practice', '', '', NULL, 'O', '4400 E Flamingo Ave', 'Nampa', 'Canyon', 'ID', '83687', '2084633000', '2084633044', '4400 E Flamingo Ave', 'Nampa', 'Canyon', 'ID', '83687', '2084633000', '2084633044', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-07-01', '2012-12-31', 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1942307640', 0, 'N', 0, '2013-02-21', NULL, NULL, 43.5976, -116.517, NULL, NULL),
('820299231', 'W12018101', 'W12018101', 'ID02', 'Saltzer Medical Group-Sleep', 'Erik', '', 'Richardson', 'DO', 'Family Practice', '', '', NULL, 'O', '7272 W Potomac Dr', 'Boise', 'Ada', 'ID', '83704', '2084633000', '2084633044', '7272 W Potomac Dr', 'Boise', 'Ada', 'ID', '83704', '2084633000', '2084633044', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-07-01', '2012-12-31', 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1942307640', 0, 'N', 0, '2013-02-21', NULL, NULL, 0, 0, NULL, NULL),
('850444170', 'W12018102', 'W12018102', 'NM01', 'TriCore Reference Laboratories', '', '', 'TriCore Reference Laboratories', 'Group', 'Laboratory', '', '', NULL, 'O', '801 Encino Pl NE Ste B4', 'Albuquerque', 'Bernalillo', 'NM', '87102', '5059246910', '5052449477', '801 Encino Pl NE Ste B4', 'Albuquerque', 'Bernalillo', 'NM', '87102', '5059246910', '5052449477', 'NMLAB', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1033285044', 0, 'N', 0, '2012-09-05', NULL, NULL, 35.0888, -106.632, NULL, NULL),
('262594249', 'W12018107', 'W12018107', 'ID02', 'Northwest Physical Medicine and Rehabilitation', 'Kevin', 'R', 'Krafft', 'MD', 'Physical Medicine and Rehabilitation', NULL, NULL, NULL, 'O', '190 E Bannock St', 'Boise', 'Ada', 'ID', '83712', '2083275650', '2086376545', '190 E Bannock St', 'Boise', 'Ada', 'ID', '83712', '2083275650', '2086376545', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-12-28', NULL, 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|UB|', '1447253232', 0, 'N', 0, '2012-02-22', NULL, NULL, 0, 0, NULL, NULL),
('820161600', 'W12018109', 'W12018109', 'ID02', 'St Lukes Clinic General Surgery', 'Vera', '', 'Thomas', 'CFA', 'Surgical Assist', '', '', NULL, 'O', '3399 E Louise Ave Ste 400', 'Meridian', 'Ada', 'ID', '83642', '2083643000', '2083643191', '3399 E Louise Ave Ste 400', 'Meridian', 'Ada', 'ID', '83642', '2083643000', '2083643191', 'IDACN', '', '', '0.00', '15.00', '0.00', 8, '2012-01-01', '2012-09-10', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1740346188', 0, 'N', 0, '2012-09-24', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12018111', 'W12018111', 'ID01', 'Saint Alphonsus Regional Medical Center', 'Ted', '', 'Burgess', 'LCSW', 'Mental Health', 'Counseling', '', NULL, 'O', '1055 N Curtis', 'Boise', 'Ada', 'ID', '83706', '2083676238', '2083670285', '1055 N Curtis', 'Boise', 'Ada', 'ID', '83706', '2083676238', '2083670285', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2011-01-23', '2013-11-27', 0, 0, 0, '', '', '', '', 'HCFA|', '1770618712', 0, 'Y', 0, '2013-12-23', NULL, NULL, 43.6127, -116.254, NULL, NULL),
('820200895', 'W12018113', 'W12018113', 'ID01', 'Saint Alphonsus Regional Medical Center', 'Margaret', 'N', 'Callens', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '1055 N Curtis', 'Boise', 'Ada', 'ID', '83706', '2083676238', '2083670285', '1055 N Curtis', 'Boise', 'Ada', 'ID', '83706', '2083676238', '2083670285', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2011-12-01', '2012-01-18', 0, 0, 0, '', '', '', '', 'HCFA|', '1750418844', 0, 'Y', 0, '2012-03-29', NULL, NULL, 43.6127, -116.254, NULL, NULL),
('204043287', 'W12018123', 'W12018123', 'NM01', 'ABQ Health Partners', 'Christina', '', 'Lopez', 'MD', 'Cardiology', '', '', NULL, 'O', '500 Walter St NE Ste 401', 'Albuquerque', 'Bernalillo', 'NM', '87102', '5052627451', '5052627870', '500 Walter St NE Ste 401', 'Albuquerque', 'Bernalillo', 'NM', '87102', '5052627451', '5052627870', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2012-02-09', NULL, 0, 0, 0, 'Lovelace Medical Center', 'Lovelace Womens Hospital', 'Lovelace Westside Hospital ', NULL, 'HCFA|UB|', '1821110289', 0, 'N', 0, '2012-02-16', NULL, NULL, 35.0863, -106.64, NULL, NULL),
('204043287', 'W12018125', 'W12018125', 'NM01', 'ABQ Health Partners', 'Christina', '', 'Lopez', 'MD', 'Cardiology', '', '', NULL, 'M', '5400 Gibson Blvd SE', 'Albuquerque', 'Bernalillo', 'NM', '87108', '5058968604', '5058968697', '5400 Gibson Blvd SE', 'Albuquerque', 'Bernalillo', 'NM', '87108', '5058968604', '5058968697', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2012-02-09', NULL, 0, 0, 0, 'Lovelace Medical Center', 'Lovelace Womens Hospital', 'Lovelace Westside Hospital ', NULL, 'HCFA|UB|', '1821110289', 0, 'N', 0, '2012-02-16', NULL, NULL, 0, 0, NULL, NULL),
('204043287', 'W12018124', 'W12018124', 'NM01', 'ABQ Health Partners', 'Christina', '', 'Lopez', 'MD', 'Cardiology', '', '', NULL, 'B', 'PO Box 27829           ', 'Albuquerque', 'Bernalillo', 'NM', '87125', '5052627600', '5058888503', 'PO Box 27829           ', 'Albuquerque', 'Bernalillo', 'NM', '87125', '5052627600', '5058888503', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2012-02-09', NULL, 0, 0, 0, 'Lovelace Medical Center', 'Lovelace Womens Hospital', 'Lovelace Westside Hospital ', NULL, 'HCFA|UB|', '1821110289', 0, 'N', 0, '2012-02-16', NULL, NULL, 0, 0, NULL, NULL),
('204043287', 'W12018129', 'W12018129', 'NM01', 'ABQ Health Partners', 'Galina', '', 'Batygina', 'PA', 'Orthopedic Surgery', '', '', NULL, 'O', '101 Hospital Loop NE Ste 201', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5052627375', '5052627776', '101 Hospital Loop NE Ste 201', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5052627375', '5052627776', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2012-02-14', '2013-10-01', 0, 0, 0, 'Lovelace Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1962525550', 0, 'N', 0, '2013-09-09', NULL, NULL, 0, 0, NULL, NULL),
('204043287', 'W12018128', 'W12018128', 'NM01', 'ABQ Health Partners', 'Galina', '', 'Batygina', 'PA', 'Orthopedic Surgery', '', '', NULL, 'M', '5400 Gibson Blvd SE', 'Albuquerque', 'Bernalillo', 'NM', '87108', '5052627375', '5052627776', '5400 Gibson Blvd SE', 'Albuquerque', 'Bernalillo', 'NM', '87108', '5052627375', '5052627776', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2012-02-14', NULL, 0, 0, 0, 'Lovelace Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1962525550', 0, 'N', 0, '2013-09-09', NULL, NULL, 0, 0, NULL, NULL),
('204043287', 'W12018127', 'W12018127', 'NM01', 'ABQ Health Partners', 'Galina', '', 'Batygina', 'PA', 'Orthopedic Surgery', '', '', NULL, 'B', 'PO Box 27829 ', 'Albuquerque', 'Bernalillo', 'NM', '87125', '5052627600', '5058888503', 'PO Box 27829 ', 'Albuquerque', 'Bernalillo', 'NM', '87125', '5052627600', '5058888503', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2012-02-14', NULL, 0, 0, 0, 'Lovelace Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1962525550', 0, 'N', 0, '2013-09-09', NULL, NULL, 0, 0, NULL, NULL),
('870566149', 'W12018132', 'W12018132', 'UT01', 'Pediatrix Medical Group', 'Lan Le', '', 'Adams', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1140 E 3900 S Ste 390', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8017434700', NULL, '1140 E 3900 S Ste 390', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8017434700', '          ', '', '', '', '0.00', '20.00', '0.00', 3, '2030-01-01', '2030-01-01', 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1750405601', 0, 'N', 0, '2012-07-05', NULL, NULL, 0, 0, NULL, NULL),
('870566149', 'W12018131', 'W12018131', 'UT01', 'Pediatrix Medical Group', 'Lan Le', '', 'Adams', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'M', '4722 N 24th St Ste 150', 'Phoenix', 'Maricopa', 'AZ', '85016', '8014764280', NULL, '4722 N 24th St Ste 150', 'Phoenix', 'Maricopa', 'AZ', '85016', '8014764280', '          ', '', '', '', '0.00', '20.00', '0.00', 3, '2030-01-01', '2030-01-01', 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1750405601', 0, 'N', 0, '2012-07-05', NULL, NULL, 0, 0, NULL, NULL),
('870566149', 'W12018130', 'W12018130', 'UT01', 'Pediatrix Medical Group', 'Lan Le', '', 'Adams', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 840532', 'Dallas', 'Dallas', 'TX', '75284', '8014764280', NULL, 'PO Box 840532', 'Dallas', 'Dallas', 'TX', '75284', '8014764280', '          ', '', '', '', '0.00', '20.00', '0.00', 3, '2030-01-01', '2030-01-01', 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1750405601', 0, 'N', 0, '2012-07-05', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W12018133', 'W12018133', 'UT01', 'Davis Internal Medicine', 'Andrew', 'E', '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, '', '', '', '', 'HCFA|UB|', '1982721106', 0, 'N', 0, '2013-07-10', NULL, NULL, 41.0893, -111.993, NULL, NULL),
('621801973', 'W12018134', 'W12018134', 'UT01', 'Davis Internal Medicine', 'Andrew', 'E', '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, '', '', '', '', 'HCFA|UB|', '1982721106', 0, 'N', 0, '2013-07-10', NULL, NULL, 0, 0, NULL, NULL),
('870550275', 'W12018136', 'W12018136', 'UT01', 'Wasatch Pediatrics Inc', 'Ryan', 'T', 'Donnelly', 'MD', 'Pediatrics', '', '', NULL, 'O', '7138 S 2000 E Ste 106', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019421800', '8019441865', '7138 S 2000 E Ste 106', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019421800', '8019441865', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-04-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1205089661', 0, 'N', 0, '2012-04-10', NULL, NULL, 40.6215, -111.834, NULL, NULL),
('870550275', 'W12018135', 'W12018135', 'UT01', 'Wasatch Pediatrics Inc', 'Ryan', 'T', 'Donnelly', 'MD', 'Pediatrics', '', '', NULL, 'B', 'PO Box 71550', 'Salt Lake City', 'Salt Lake', 'UT', '84171', '8019421800', '8019441865', 'PO Box 71550', 'Salt Lake City', 'Salt Lake', 'UT', '84171', '8019421800', '8019441865', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-04-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1205089661', 0, 'N', 0, '2012-04-10', NULL, NULL, 0, 0, NULL, NULL),
('841401924', 'W12018137', 'W12018137', 'UT01', 'Alpine Medical Group ', 'Wei', '', 'Peng', 'MD', 'Cardiovascular Disease', 'Hospitalist', 'Internal Medicine', NULL, 'O', '1060 E 100 S Ste L-10', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013281260', '8013504361', '1060 E 100 S Ste L-10', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013281260', '8013504361', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2012-02-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', '', '', '', 'HCFA|UB|', '1295831865', 0, 'N', 0, '2013-03-18', NULL, NULL, 40.7672, -111.861, NULL, NULL),
('870550275', 'W12018139', 'W12018139', 'UT01', 'Wasatch Pediatrics', 'Katherine', 'R', 'Lavender', 'MD', 'Pediatrics', 'Pediatric Emergency Medicine', '', NULL, 'M', '7138 S 2000 E Ste 103', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '4356550926', '4356493748', '7138 S 2000 E Ste 103', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '4356550926', '4356493748', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-05-01', NULL, 0, 0, 0, 'Primary Childrens Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1326229550', 0, 'N', 0, '2012-06-18', NULL, NULL, 0, 0, NULL, NULL),
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('870555165', 'W12018173', 'W12018173', 'UT01', 'Pediatric Care of Ogden', 'Suzanne', '', 'Ballingham', 'NP', 'Family Practice', '', '', NULL, 'O', '1740 E Combe Rd Ste 5', 'Ogden', 'Weber', 'UT', '84403', '8016211701', '8016217064', '1740 E Combe Rd Ste 5', 'Ogden', 'Weber', 'UT', '84403', '8016211701', '8016217064', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-04-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1962522573', 0, 'N', 0, '2012-04-02', NULL, NULL, 41.1613, -111.937, NULL, NULL),
('870555165', 'W12018174', 'W12018174', 'UT01', 'Pediatric Care of Ogden', 'Ann', '', 'Maruri', 'NP', 'Pediatrics', '', '', NULL, 'O', '1740 E Combe Rd Ste 5', 'Ogden', 'Weber', 'UT', '84403', '8016211701', '8016217064', '1740 E Combe Rd Ste 5', 'Ogden', 'Weber', 'UT', '84403', '8016211701', '8016217064', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1477673291', 0, 'N', 0, '2012-04-04', NULL, NULL, 41.1613, -111.937, NULL, NULL),
('870555165', 'W12018175', 'W12018175', 'UT01', 'Pediatric Care of Ogden', 'Robert', 'J', 'Nielsen', 'MD', 'Pediatrics', '', '', NULL, 'O', '1740 E Combe Rd Ste 5', 'Ogden', 'Weber', 'UT', '84403', '8016211701', '8016217064', '1740 E Combe Rd Ste 5', 'Ogden', 'Weber', 'UT', '84403', '8016211701', '8016217064', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-04-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1932307204', 0, 'N', 0, '2012-07-05', NULL, NULL, 41.1613, -111.937, NULL, NULL),
('870284475', 'W12011762', 'W12011762', 'UT01', 'Granger Medical Clinic', 'Craig', 'W', 'Davis', 'MD', 'Pain Management', '', '', NULL, 'O', '2376 N 400 E Ste 203', 'Tooele', 'Tooele', 'UT', '84074', '8019653634', NULL, '2376 N 400 E Ste 203', 'Tooele', 'Tooele', 'UT', '84074', '8019653634', '          ', 'WUGRANGER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1861643330', 0, 'N', 0, '2012-02-28', NULL, NULL, 40.5621, -112.293, NULL, NULL),
('870284475', 'W12011760', 'W12011760', 'UT01', 'Granger Medical Clinic', 'Craig', 'W', 'Davis', 'MD', 'Pain Management', '', '', NULL, 'O', '3181 W 9000 S', 'West Jordan', 'Salt Lake', 'UT', '84088', '8013525900', NULL, '3181 W 9000 S', 'West Jordan', 'Salt Lake', 'UT', '84088', '8013525900', '          ', 'WUGRANGER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1861643330', 0, 'N', 0, '2012-02-28', NULL, NULL, 40.5877, -111.967, NULL, NULL),
('870284475', 'W12011759', 'W12011759', 'UT01', 'Granger Medical Clinic', 'Craig', 'W', 'Davis', 'MD', 'Pain Management', '', '', NULL, 'O', '3725 W 4100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019653634', NULL, '3725 W 4100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019653634', '          ', 'WUGRANGER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1861643330', 0, 'N', 0, '2012-02-28', NULL, NULL, 40.682, -111.979, NULL, NULL),
('870284475', 'W12011763', 'W12011763', 'UT01', 'Granger Medical Clinic', 'Craig', 'W', 'Davis', 'MD', 'Pain Management', '', '', NULL, 'B', 'PO Box 70658', 'Salt Lake City', 'Salt Lake', 'UT', '84170', '8019653634', NULL, 'PO Box 70658', 'Salt Lake City', 'Salt Lake', 'UT', '84170', '8019653634', '          ', 'WUGRANGER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1861643330', 0, 'N', 0, '2012-02-28', NULL, NULL, 0, 0, NULL, NULL),
('870498345', 'W12018176', 'W12018176', 'UT01', 'Woseth Dermatology', 'Angela', 'K', 'Brimhall', 'DO', 'Dermatology', '', '', NULL, 'O', '1548 E 4500 S Ste 202', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8012668841', '8012660449', '1548 E 4500 S Ste 202', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8012668841', '8012660449', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-04-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1770773061', 0, 'N', 0, '2012-04-04', NULL, NULL, 40.6743, -111.846, NULL, NULL),
('876114073', 'W12018177', 'W12018177', 'UTMH1', 'The Childrens Center', 'Najmeh', '', 'Hourmanesh', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '350 S 400 E', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8015825334', '8015825546', '350 S 400 E', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8015825334', '8015825546', 'UTPHD', '', '', '0.00', '35.00', '0.00', 6, '2012-04-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1093955502', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('876114073', 'W12018179', 'W12018179', 'UTMH1', 'The Childrens Center', 'Christine', 'A', 'Pembroke', 'LCSW', 'Mental Health', '', '', 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', '35.00', '0.00', 6, '2012-04-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1114247467', 0, 'N', 0, '2013-10-24', NULL, NULL, 0, 0, NULL, NULL),
('876114073', 'W12018178', 'W12018178', 'UTMH1', 'The Childrens Center', 'Christine', 'A', 'Pembroke', 'LCSW', 'Mental Health', '', '', NULL, 'O', '5242 S 4820 W', 'Taylorsville', 'Salt Lake', 'UT', '84118', '8019664251', '8019664289', '5242 S 4820 W', 'Taylorsville', 'Salt Lake', 'UT', '84118', '8019664251', '8019664289', 'UTMA', '', '', '0.00', '35.00', '0.00', 6, '2012-04-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1114247467', 0, 'N', 0, '2013-10-24', NULL, NULL, 0, 0, NULL, NULL),
('876114073', 'W12018180', 'W12018180', 'UTMH1', 'The Childrens Center', 'Emily ', '', 'Smolin', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '350 S 400 E', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8015825534', '8015825540', '350 S 400 E', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8015825534', '8015825540', 'UTMA', '', '', '0.00', '35.00', '0.00', 6, '2012-04-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1881800209', 0, 'N', 0, '2012-04-04', NULL, NULL, 0, 0, NULL, NULL),
('870333664', 'W12018181', 'W12018181', 'UT01', '', 'Nathan', 'E', 'Hales', 'DC', 'Chiropractic', '', '', 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', '0.00', '55.46', 3, '2012-03-01', '2012-07-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1336398189', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('870395634', 'W12018182', 'W12018182', 'UT01', '', 'Loral', 'G', 'Linton', 'DC', 'Chiropractic', '', '', NULL, 'O', '662 S Hwy 89 Ste A', 'Kanab', 'Kane', 'UT', '84741', '4356445296', '4356445296', '662 S Hwy 89 Ste A', 'Kanab', 'Kane', 'UT', '84741', '4356445296', '4356445296', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2012-01-01', '2012-07-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1194894501', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('820299231', 'W12018186', 'W12018186', 'ID02', 'Saltzer Medical Group', 'KaLynne', '', 'Harris', 'MD', 'Dermatology', '', '', NULL, 'B', '217 W Georgia Ave', 'Nampa', 'Canyon', 'ID', '83686', '2084633280', '2084633046', '217 W Georgia Ave', 'Nampa', 'Canyon', 'ID', '83686', '2084633280', '2084633046', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2012-02-16', '2012-12-31', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1275786725', 0, 'N', 0, '2013-02-21', NULL, NULL, 0, 0, NULL, NULL),
('820299231', 'W12018187', 'W12018187', 'ID02', 'Saltzer Medical Group', 'KaLynne', '', 'Harris', 'MD', 'Dermatology', '', '', NULL, 'O', '9850 W St Lukes Dr Ste 129', 'Nampa', 'Canyon', 'ID', '83687', '2082884970', '2084633044', '9850 W St Lukes Dr Ste 129', 'Nampa', 'Canyon', 'ID', '83687', '2082884970', '2084633044', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2012-02-16', '2012-12-31', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1275786725', 0, 'N', 0, '2013-02-21', NULL, NULL, 0, 0, NULL, NULL),
('820368435', 'W12018188', 'W12018188', 'ID02', 'Troy Watkins MD', 'Troy', 'B', 'Watkins', 'MD; Hand', 'Orthopedic Surgery', 'Hand Surgery', NULL, NULL, 'O', '8854 W Emerald Ste 170', 'Boise', 'Ada', 'ID', '83704', '2083432555', '2083432558', '8854 W Emerald Ste 170', 'Boise', 'Ada', 'ID', '83704', '2083432555', '2083432558', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2012-02-13', NULL, 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|UB|', '1083654305', 0, 'N', 0, '2013-03-08', NULL, NULL, 43.6123, -116.292, NULL, NULL),
('820299231', 'W12018189', 'W12018189', 'ID02', 'Saltzer Medical Group-Sleep', 'Tom', 'F', 'Douthit', 'PAC', 'Physician Assistant', '', '', NULL, 'O', '9850 W St Lukes Dr Ste 129', 'Nampa', 'Canyon', 'ID', '83687', '2084633000', '2084633044', '9850 W St Lukes Dr Ste 129', 'Nampa', 'Canyon', 'ID', '83687', '2084633000', '2084633044', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2012-02-23', '2012-03-31', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1023008414', 0, 'N', 0, '2013-02-21', NULL, NULL, 0, 0, NULL, NULL),
('260553931', 'W12018190', 'W12018190', 'ID01', 'St Alphonsus Medical Group Nuerosurgery Boise 201', 'Bruce', 'J', 'Andersen', 'MD', 'Neurosurgery', '', '', NULL, 'O', '1075 N Curtis Rd Ste 201', 'Boise', 'Ada', 'ID', '83706', '2083674000', '2083678983', '1075 N Curtis Rd Ste 201', 'Boise', 'Ada', 'ID', '83706', '2083674000', '2083678983', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-01-23', '2012-01-23', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1063420792', 0, 'N', 0, '2014-07-09', NULL, NULL, 43.6143, -116.258, NULL, NULL),
('820312175', 'W12018199', 'W12018199', 'ID01', 'Idaho Emergency Physicians PA', 'Andrew', '', 'Southard', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '323 E Riverside Dr', 'Eagle', 'Ada', 'ID', '83616', '2083221730', '2083221731', '323 E Riverside Dr', 'Eagle', 'Ada', 'ID', '83616', '2083221730', '2083221731', 'IDSAMG3', '', '', '0.00', '10.00', '0.00', 3, '2011-12-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', 'West Valley Medical Center', NULL, NULL, 'HCFA|UB|', '1154527547', 0, 'N', 0, '2012-02-23', NULL, NULL, 43.6896, -116.35, NULL, NULL),
('820312175', 'W12018200', 'W12018200', 'ID01', 'Idaho Emergency Physicians PA', 'Andrew', '', 'Southard', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '1717 Arlington', 'Caldwell', 'Canyon', 'ID', '83605', '2083221730', '2083221731', '1717 Arlington', 'Caldwell', 'Canyon', 'ID', '83605', '2083221730', '2083221731', 'IDSAMG3', '', '', '0.00', '10.00', '0.00', 3, '2011-12-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', 'West Valley Medical Center', NULL, NULL, 'HCFA|UB|', '1154527547', 0, 'N', 0, '2012-02-23', NULL, NULL, 43.6542, -116.696, NULL, NULL),
('820312175', 'W12018198', 'W12018198', 'ID01', 'Idaho Emergency Physicians PA', 'Andrew', '', 'Southard', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83704', '2083221730', '2083221731', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83704', '2083221730', '2083221731', 'IDSAMG3', '', '', '0.00', '10.00', '0.00', 3, '2011-12-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', 'West Valley Medical Center', NULL, NULL, 'HCFA|UB|', '1154527547', 0, 'N', 0, '2012-02-23', NULL, NULL, 43.6145, -116.254, 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
('820200895', 'W12018201', 'W12018201', 'ID01', 'Saint Alphonsus Medical Group NHP  Family Medicine', 'Phillip', 'J', 'Redd', 'DO', 'Family Practice', 'Hospitalist', '', NULL, 'O', '4400  E Flamingo Ave Ste 301', 'Nampa', 'Canyon', 'ID', '83687', '2084656900', '2084656910', '4400  E Flamingo Ave Ste 301', 'Nampa', 'Canyon', 'ID', '83687', '2084656900', '2084656910', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2011-12-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|', '1134296106', 0, 'N', 0, '2014-06-20', NULL, NULL, 43.5976, -116.517, NULL, NULL),
('820200895', 'W12018202', 'W12018202', 'ID01', 'Saint Alphonsus Medical Group Iowa Family Medicine', 'Phillip', 'J', 'Redd', 'DO', 'Family Practice', 'Hospitalist', '', NULL, 'O', '211 W Iowa Ave', 'Nampa', 'Canyon', 'ID', '83686', '2084657377', '2084657397', '211 W Iowa Ave', 'Nampa', 'Canyon', 'ID', '83686', '2084657377', '2084657397', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2011-12-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|', '1134296106', 0, 'N', 0, '2014-06-20', NULL, NULL, 43.5539, -116.575, NULL, NULL),
('452716222', 'W12018203', 'W12018203', 'ID02', 'Idaho Family Physicians Inc', 'Ann', 'E', 'Erwin', 'MD', 'Family Practice', '', '', NULL, 'O', '130 E Boise Ave', 'Boise', 'Ada', 'ID', '83706', '2083454066', NULL, '130 E Boise Ave', 'Boise', 'Ada', 'ID', '83706', '2083454066', '          ', 'IDACN', '', '', '0.00', '15.00', '0.00', 8, '2011-11-08', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1851494223', 0, 'N', 0, '2013-10-16', NULL, NULL, 0, 0, NULL, NULL),
('452716222', 'W12018204', 'W12018204', 'SACN', 'Idaho Family Physicians Inc', 'Ann', 'E', 'Erwin', 'MD', 'Family Practice', '', '', NULL, 'O', '130 E Boise Ave', 'Boise', 'Ada', 'ID', '83706', '2083454066', NULL, '130 E Boise Ave', 'Boise', 'Ada', 'ID', '83706', '2083454066', '          ', 'IDSINCLAIRL', '', '', '0.00', '15.00', '0.00', 8, '2011-11-08', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1851494223', 0, 'N', 0, '2013-10-16', NULL, NULL, 0, 0, NULL, NULL),
('061128081', 'W12018211', 'W12018211', 'NM01', 'Dianon Systems Inc', '', '', 'Dianon Systems Inc', 'GROUP', 'Laboratory', '', '', NULL, 'B', 'PO Box 8005', 'Burlington', 'Alamance', 'NC', '27216', '8003282666', NULL, 'PO Box 8005', 'Burlington', 'Alamance', 'NC', '27216', '8003282666', '', 'WDIANON', '', '', '0.00', '35.00', '0.00', 3, '2012-01-01', '2012-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1003819020', 0, 'Y', 0, '2014-06-03', '', NULL, 0, 0, NULL, NULL),
('061128081', 'W12018212', 'W12018212', 'NM01', 'Dianon Systems Inc', '', '', 'Dianon Systems Inc', 'GROUP', 'Laboratory', '', '', NULL, 'B', '840 Research Pkwy', 'Oklahoma City', 'Oklahoma', 'OK', '73104', '8003282666', NULL, '840 Research Pkwy', 'Oklahoma City', 'Oklahoma', 'OK', '73104', '8003282666', '', 'WDIANON', '', '', '0.00', '35.00', '0.00', 3, '2012-01-01', '2012-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1003819020', 0, 'N', 0, '2014-06-03', '', NULL, 0, 0, NULL, NULL),
('770644336', 'W12018213', 'W12018213', 'NM01', 'eCardio Diagnostics LLC', '', '', 'eCardio Diagnostics LLC', 'GROUP', 'Cardiac Monitoring', '', '', NULL, 'B', '411 Lantern Bend Dr Ste 220', 'Houston', 'Harris', 'TX', '77090', '2818955700', NULL, '411 Lantern Bend Dr Ste 220', 'Houston', 'Harris', 'TX', '77090', '2818955700', '          ', 'wisecardio', '', '', '0.00', '35.00', '0.00', 3, '2012-01-01', '2012-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1063414258', 0, 'N', 0, '2012-09-24', NULL, NULL, 0, 0, NULL, NULL),
('522212112', 'W12018214', 'W12018214', 'NM01', 'LifeWatch Inc', '', '', 'LifeWatch Inc', 'GROUP', 'Cardiac Monitoring', '', '', NULL, 'B', '1161 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8777202100', NULL, '1161 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8777202100', '          ', 'WCSTLWI5', '', '', '0.00', '100.00', '0.00', 3, '2012-01-01', '2012-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1255367843', 0, 'Y', 0, '2013-06-18', NULL, NULL, 0, 0, NULL, NULL),
('522212112', 'W12018215', 'W12018215', 'NM01', 'LifeWatch Inc', '', '', 'LifeWatch Inc', 'GROUP', 'Cardiac Monitoring', '', '', NULL, 'O', '1351 Abbott Ct', 'Buffalo Grove', 'Lake', 'IL', '60089', '8777749846', NULL, '1351 Abbott Ct', 'Buffalo Grove', 'Lake', 'IL', '60089', '8777749846', '          ', 'WCSTLWI5', '', '', '0.00', '100.00', '0.00', 3, '2012-01-01', '2012-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1255367843', 0, 'N', 0, '2013-06-18', NULL, NULL, 0, 0, NULL, NULL),
('411694999', 'W12018216', 'W12018216', 'NM01', 'Roche Insulin Delivery Systems Inc ', '', '', 'Roche Insulin Delivery Systems Inc', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'B', 'PO Box 86 SDS 12-2207', 'Minneapolis', 'Hennepin', 'MN', '55486', '8002807801', '8888100758', 'PO Box 86 SDS 12-2207', 'Minneapolis', 'Hennepin', 'MN', '55486', '8002807801', '8888100758', 'WDISETR', '', '', '0.00', '30.00', '0.00', 3, '2012-01-01', '2012-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1083880447', 0, 'Y', 0, '2012-09-24', NULL, NULL, 0, 0, NULL, NULL),
('200348433', 'W12018217', 'W12018217', 'UT01', 'Cedar Ridge Family Medicine', 'Daniel', 'J', 'Allen', 'DO', 'Family Practice', 'Sports Medicine', '', NULL, 'O', '110 W 1325 N Ste 200', 'Cedar City', 'Iron', 'UT', '84721', '4355867676', '4355862290', '110 W 1325 N Ste 200', 'Cedar City', 'Iron', 'UT', '84721', '4355867676', '4355862290', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-05-01', NULL, 0, 0, 0, 'West Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1720017247', 0, 'N', 0, '2014-04-02', NULL, NULL, 37.7011, -113.064, NULL, NULL),
('300170857', 'W12018218', 'W12018218', 'UTMH1', 'Center for Family Evaluation and Treatment', 'Lani', '', 'Ete', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '5691 S Redwood Rd Ste 16', 'Taylorsville', 'Salt Lake', 'UT', '84123', '8012653895', '8012631265', '5691 S Redwood Rd Ste 16', 'Taylorsville', 'Salt Lake', 'UT', '84123', '8012653895', '8012631265', 'UTMA', '', '', '0.00', '35.00', '0.00', 3, '2012-04-01', '2012-04-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1255518080', 0, 'N', 0, '2013-08-01', NULL, NULL, 0, 0, NULL, NULL),
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('820200895', 'W12018257', 'W12018257', 'ID01', 'Saint Alphonsus Wound Healing & Hyperbaric Medicine', 'Scott', 'D', 'Lossmann', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 190930', 'Boise', 'Ada', 'ID', '83719', '2083672130', '2083676022', 'PO Box 190930', 'Boise', 'Ada', 'ID', '83719', '2083672130', '2083676022', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2011-12-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1720032725', 0, 'N', 0, '2014-06-20', NULL, NULL, 0, 0, NULL, NULL),
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('460500210', 'W12018260', 'W12018260', 'ID01', 'Saint Alphonsus Oncology Physician Services ', 'Bruce', 'H', 'Zietz', 'MD', 'Hematology and Oncology', '', '', NULL, 'O', '3123 Medical Dr', 'Caldwell', 'Canyon', 'ID', '83605', '2083674810', '2083674817', '3123 Medical Dr', 'Caldwell', 'Canyon', 'ID', '83605', '2083674810', '2083674817', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2011-12-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1184689002', 0, 'N', 0, '2012-11-16', NULL, NULL, 43.6596, -116.658, NULL, NULL),
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('830218549', 'W12018322', 'W12018322', 'WYT1', 'Sheridan Orthopaedic Assoc', 'Brenton', 'F', 'Milner', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1050 Mydland Rd', 'Sheridan', 'Sheridan', 'WY', '82801', '3076747469', NULL, '1050 Mydland Rd', 'Sheridan', 'Sheridan', 'WY', '82801', '3076747469', '          ', '', '', '', '0.00', '20.00', '0.00', 3, '2012-02-13', NULL, 0, 0, 0, 'Sheridan Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1780644393', 0, 'N', 0, '2012-08-01', NULL, NULL, 0, 0, NULL, NULL),
('830218549', 'W12018323', 'W12018323', 'WYT1', 'Sheridan Orthopaedic Assoc', 'Scott', 'L', 'Morey', 'PA', 'Orthopedic Surgery', '', '', NULL, 'O', '1050 Mydland Rd', 'Sheridan', 'Sheridan', 'WY', '82801', '3076747469', NULL, '1050 Mydland Rd', 'Sheridan', 'Sheridan', 'WY', '82801', '3076747469', '          ', '', '', '', '0.00', '20.00', '0.00', 3, '2012-02-13', NULL, 0, 0, 0, 'Sheridan Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1912960667', 0, 'N', 0, '2012-06-28', NULL, NULL, 0, 0, NULL, NULL);
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('830218549', 'W12018325', 'W12018325', 'WYT1', 'Sheridan Orthopaedic Assoc', 'Steve', 'E', 'Rabon', 'DPM', 'Podiatry', '', '', NULL, 'O', '1050 Mydland Rd', 'Sheridan', 'Sheridan', 'WY', '82801', '3076747469', NULL, '1050 Mydland Rd', 'Sheridan', 'Sheridan', 'WY', '82801', '3076747469', '          ', '', '', '', '0.00', '20.00', '0.00', 3, '2012-02-13', NULL, 0, 0, 0, 'Sheridan Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1053331504', 0, 'N', 0, '2012-06-25', NULL, NULL, 0, 0, NULL, NULL),
('830218549', 'W12018326', 'W12018326', 'WYT1', 'Sheridan Orthopaedic Assoc', 'John', 'F', 'Ritterbusch', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1050 Mydland Rd', 'Sheridan', 'Sheridan', 'WY', '82801', '3076747469', NULL, '1050 Mydland Rd', 'Sheridan', 'Sheridan', 'WY', '82801', '3076747469', '          ', '', '', '', '0.00', '20.00', '0.00', 3, '2012-02-13', NULL, 0, 0, 0, 'Sheridan Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1801819750', 0, 'N', 0, '2012-06-25', NULL, NULL, 0, 0, NULL, NULL),
('830218549', 'W12018327', 'W12018327', 'WYT1', 'Sheridan Orthopaedic Assoc', 'James', 'A', 'Ulibarri', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1050 Mydland Rd', 'Sheridan', 'Sheridan', 'WY', '82801', '3076747469', NULL, '1050 Mydland Rd', 'Sheridan', 'Sheridan', 'WY', '82801', '3076747469', '          ', '', '', '', '0.00', '20.00', '0.00', 3, '2012-02-13', NULL, 0, 0, 0, 'Sheridan Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1578586269', 0, 'N', 0, '2012-06-25', NULL, NULL, 0, 0, NULL, NULL),
('830218549', 'W12018328', 'W12018328', 'WYT1', 'Sheridan Orthopaedic Assoc', 'Jeremy', 'P', 'Zebroski', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1050 Mydland Rd', 'Sheridan', 'Sheridan', 'WY', '82801', '3076747469', NULL, '1050 Mydland Rd', 'Sheridan', 'Sheridan', 'WY', '82801', '3076747469', '          ', '', '', '', '0.00', '20.00', '0.00', 3, '2012-02-13', NULL, 0, 0, 0, 'Sheridan Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1497840318', 0, 'N', 0, '2013-01-24', NULL, NULL, 0, 0, NULL, NULL),
('820476912', 'W12018330', 'W12018330', 'ID02', 'Two Rivers Medical Clinic', 'Deland', '', 'Barr', 'DO', 'Family Practice', '', '', NULL, 'O', '683 E 3rd St', 'Weiser', 'Washington', 'ID', '83672', '2085490211', '2085490104', '683 E 3rd St', 'Weiser', 'Washington', 'ID', '83672', '2085490211', '2085490104', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 1, NULL, '', '', '', 'HCFA|UB|', '1316032261', 0, 'N', 0, '2012-02-29', NULL, NULL, 0, 0, NULL, NULL),
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('820299231', 'W12018336', 'W12018336', 'ID02', 'Saltzer Medical Group-Hearing & Balance', 'Michael', 'A', 'Chenore', 'MD', 'Family Practice', '', '', NULL, 'O', '210 W Georgia Ave Ste 100', 'Nampa', 'Canyon', 'ID', '83686', '2084633000', '2084633044', '210 W Georgia Ave Ste 100', 'Nampa', 'Canyon', 'ID', '83686', '2084633000', '2084633044', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2012-01-01', '2012-12-31', 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1225028632', 0, 'N', 0, '2013-06-10', NULL, NULL, 43.5564, -116.575, NULL, NULL),
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('820299231', 'W12018341', 'W12018341', 'ID02', 'Saltzer Medical Group', 'Mark', '', 'Clinger', 'MD', 'Family Practice', '', '', NULL, 'B', '217 W Georgia Ave Ste 115', 'Nampa', 'Canyon', 'ID', '83686', '2084633280', '2082884987', '217 W Georgia Ave Ste 115', 'Nampa', 'Canyon', 'ID', '83686', '2084633280', '2082884987', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2012-01-01', '2012-12-31', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1699769471', 0, 'N', 0, '2014-03-26', NULL, NULL, 0, 0, NULL, NULL),
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('942854057', 'W12018375', 'W12018375', 'UTIHCPHY', 'Logan Hyperbaric and Wound Care', 'Curtis', 'Charles', 'Pedersen', 'DPM', 'Podiatry', '', '', NULL, 'O', '1400 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357162250', '4357162265', '1400 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357162250', '4357162265', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2012-01-01', NULL, 0, 0, 0, 'Logan Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1366452757', 0, 'N', 0, '2012-11-07', NULL, NULL, 41.7569, -111.821, NULL, NULL),
('942854057', 'W12018376', 'W12018376', 'UTIHCPHY', 'Budge Clinic Internal Medicine', 'Rob', 'K', 'Perkins', 'MD', '', 'Hospitalists', '', NULL, 'O', '1350 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357921980', '4357530401', '1350 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357921980', '4357530401', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2011-12-01', '2013-08-04', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1326087867', 0, 'Y', 0, '2013-09-05', NULL, NULL, 0, 0, NULL, NULL),
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('942854057', 'W12018378', 'W12018378', 'UTIHCPHY', 'Dixie Pulmonary Critical Care', 'Chakravarthy', 'B', 'Reddy', 'MD', 'Pulmonary', 'Critical Care Medicine', '', NULL, 'O', '1380 E Medical Ctr Dr', 'St George', 'Washington', 'UT', '84790', '4352512600', '4352512610', '1380 E Medical Ctr Dr', 'St George', 'Washington', 'UT', '84790', '4352512600', '4352512610', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2012-02-01', NULL, 0, 0, 0, 'University Health Care University Hospital', '', '', '', 'HCFA|UB|', '1508962176', 0, 'N', 0, '2013-06-27', NULL, NULL, 37.0998, -113.554, NULL, NULL),
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('942854057', 'W12018381', 'W12018381', 'UTIHCPHY', 'Utah Valley Pulmonary Clinic', 'Ronna', 'G', 'Schrenk', 'PA-C', 'Pulmonary', '', '', NULL, 'O', '1055 N 300 W Ste 500', 'Provo', 'Utah', 'UT', '84604', '8013577291', '8013577919', '1055 N 300 W Ste 500', 'Provo', 'Utah', 'UT', '84604', '8013577291', '8013577919', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2012-02-06', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1538439864', 0, 'N', 0, '2012-02-29', NULL, NULL, 40.2476, -111.664, NULL, NULL),
('942854057', 'W12018382', 'W12018382', 'UTIHCPHY', 'Heber Valley Clinic', 'Spencer', 'Lee', 'Scoville', 'DO', 'Family Practice', '', '', NULL, 'B', '1473 S Hwy 40 Ste E', 'Heber City', 'Wasatch', 'UT', '84032', '4356542500', '4356574460', '1473 S Hwy 40 Ste E', 'Heber City', 'Wasatch', 'UT', '84032', '4356542500', '4356574460', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2011-12-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1821192436', 0, 'Y', 0, '2012-05-04', NULL, NULL, 0, 0, NULL, NULL),
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('942854057', 'W12018387', 'W12018387', 'UTIHCPHY', 'Heber Valley Clinic', 'Mary Jean', '', 'Walker', 'APRN', 'Pain Management', NULL, NULL, NULL, 'O', '1473 S Hwy 40 Ste E', 'Heber City', 'Wasatch', 'UT', '84032', '4356542500', '4356574460', '1473 S Hwy 40 Ste E', 'Heber City', 'Wasatch', 'UT', '84032', '4356542500', '4356574460', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2012-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1508851890', 0, 'Y', 0, '2012-02-29', NULL, NULL, 40.4893, -111.409, NULL, NULL),
('942854057', 'W12018388', 'W12018388', 'UTIHCPHY', 'Logan Hyperbaric and Wound Care', 'Bartley', 'Myron', 'Weiss', 'MD', 'General Surgery', '', '', NULL, 'O', '1400 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357162250', '4357162265', '1400 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357162250', '4357162265', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2012-01-01', NULL, 0, 0, 0, 'Logan Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1942210364', 0, 'N', 0, '2012-02-29', NULL, NULL, 41.7569, -111.821, NULL, NULL),
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('830182821', 'W12018409', 'W12018409', 'WY01', 'Gottsche Rehabilitation Center', 'Grant', 'A', 'Basko', 'OT', 'Occupational Therapy', '', '', NULL, 'O', '148 E Arapahoe', 'Thermopolis', 'Hot Springs', 'WY', '82443', '3078642146', '3078643443', '148 E Arapahoe', 'Thermopolis', 'Hot Springs', 'WY', '82443', '3078642146', '3078643443', '', '', '', '0.00', '10.00', '0.00', 3, '2012-03-15', '2014-06-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1255666137', 0, 'N', 0, '2014-06-09', NULL, NULL, 43.6474, -108.2, NULL, NULL),
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('830316093', 'W12018416', 'W12018416', 'WY01', 'Frontier Access and Mobility', '', '', 'Frontier Access and Mobility', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', '1207 E Pershing Blvd', 'Cheyenne', 'Laramie', 'WY', '82001', '3076377663', '3076377745', '1207 E Pershing Blvd', 'Cheyenne', 'Laramie', 'WY', '82001', '3076377663', '3076377745', 'DME8012', '', '', '0.00', '35.00', '0.00', 3, '2012-03-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1710983838', 0, 'N', 0, '2012-03-10', NULL, NULL, 0, 0, NULL, NULL),
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('830316093', 'W12018419', 'W12018419', 'WYT1', 'Frontier Access and Mobility', '', '', 'Frontier Access and Mobility', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', '6540 S College Ave', 'Fort Collins', 'Larimer', 'CO', '80525', '9702238267', '9702233357', '6540 S College Ave', 'Fort Collins', 'Larimer', 'CO', '80525', '9702238267', '9702233357', 'DME8012', '', '', '0.00', '35.00', '0.00', 3, '2012-03-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1710983838', 0, 'Y', 0, '2012-03-10', NULL, NULL, 0, 0, NULL, NULL),
('453151464', 'W12018420', 'W12018420', 'UTMH1', '', 'Margaret', '', 'Tan', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '1960 Sidewinder Ste 211', 'Park City', 'Summit', 'UT', '84060', '4355134799', '8015624484', '1960 Sidewinder Ste 211', 'Park City', 'Summit', 'UT', '84060', '4355134799', '8015624484', 'UTMA', '', '', '0.00', '35.00', '0.00', 3, '2012-03-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1003062811', 0, 'N', 0, '2013-08-01', NULL, NULL, 0, 0, NULL, NULL),
('201300128', 'W12018423', 'W12018423', 'ID01', 'Idaho Urologic Institute', 'Melissa', 'B', 'Coblentz', 'PA', 'Urology', '', '', NULL, 'O', '2855 E Magic View Dr', 'Meridian', 'Ada', 'ID', '83642', '2086394900', '2086394901', '2855 E Magic View Dr', 'Meridian', 'Ada', 'ID', '83642', '2086394900', '2086394901', 'IDUROLOGY', 'WUSTDHCPC5', '', '0.00', '20.00', '0.00', 3, '2012-04-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, NULL, NULL, 'HCFA|UB|', '1053695676', 0, 'N', 0, '2012-04-11', NULL, NULL, 43.599, -116.36, NULL, NULL),
('820470652', 'W12018424', 'W12018424', 'ID02', 'Riverside Rehab', 'Gayle', 'J', 'Detweiler', 'PA', 'Mental Health', 'Psychiatry', '', NULL, 'O', '7711 W Riverside Dr', 'Garden City', 'Ada', 'ID', '83714', '2088538536', NULL, '7711 W Riverside Dr', 'Garden City', 'Ada', 'ID', '83714', '2088538536', '          ', 'IDMD', '', '', '0.00', '35.00', '0.00', 3, '2012-03-01', '2013-02-14', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1548339211', 0, 'N', 0, '2012-03-01', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W12018425', 'W12018425', 'UT01', 'Center for Orthopedic and Rehabilitation Excellence', 'Jeffrey', 'S', 'Devaney', 'APRN', 'Internal Medicine', '', '', NULL, 'O', '3584W 9000 S Ste 405', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015683480', '8015683482', '3584W 9000 S Ste 405', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015683480', '8015683482', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2012-03-01', '2014-04-30', 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1376716399', 0, 'N', 0, '2012-03-01', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W12018426', 'W12018426', 'UT01', 'Center for Orthopedic and Rehabilitation Excellence', 'Jeffrey', 'S', 'Devaney', 'APRN', '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, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1376716399', 0, 'N', 0, '2012-03-01', NULL, NULL, 0, 0, NULL, NULL),
('870562879', 'W12018427', 'W12018427', 'UT01', 'Urology Associates', 'J', 'B', 'Ellsworth', 'MD', 'Urology', NULL, NULL, NULL, 'O', '736 S 900 E Ste 108', 'St George', 'Washington', 'UT', '84790', '4356283606', NULL, '736 S 900 E Ste 108', 'St George', 'Washington', 'UT', '84790', '4356283606', '          ', 'WiseSTD10A', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-03-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1083619043', 0, 'N', 0, '2012-07-06', NULL, NULL, 37.0956, -113.564, NULL, NULL),
('270671464', 'W12018428', 'W12018428', 'UT01', 'Castle Valley Foot & Ankle PC', 'Brian', 'J', 'Griffeth', 'DPM', 'Podiatry', '', '', NULL, 'B', 'PO Box 268', 'Bountiful', 'Davis', 'UT', '84011', '8015050823', '8018330044', 'PO Box 268', 'Bountiful', 'Davis', 'UT', '84011', '8015050823', '8018330044', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-23', NULL, 0, 0, 0, 'Castleview Hospital', 'Castleview Hospital', NULL, NULL, 'HCFA|UB|', '1487833406', 0, 'N', 0, '2013-06-19', NULL, NULL, 0, 0, NULL, NULL),
('454342058', 'W12018422', 'W12018422', 'UTMH1', 'Aspire A Group of Professional', 'Adam ', 'B', 'Capel', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', '1771 Beaumont Dr', 'Kaysville', 'Davis', 'UT', '84037', '8016418569', '8017797808', '1771 Beaumont Dr', 'Kaysville', 'Davis', 'UT', '84037', '8016418569', '8017797808', 'ma', '', '', '0.00', '35.00', '0.00', 3, '2012-03-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1790761518', 0, 'N', 0, '2014-07-23', NULL, NULL, 0, 0, NULL, NULL),
('454342058', 'W12018421', 'W12018421', 'UTMH1', 'Aspire A Group of Professional', 'Adam ', 'B', 'Capel', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '2363 N Hillfield Rd Ste 5', 'Layton', 'Davis', 'UT', '84041', '8016418569', '8017797808', '2363 N Hillfield Rd Ste 5', 'Layton', 'Davis', 'UT', '84041', '8016418569', '8017797808', 'ma', '', '', '0.00', '35.00', '0.00', 3, '2012-03-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1790761518', 0, 'N', 0, '2014-07-23', NULL, NULL, 0, 0, NULL, NULL),
('820470652', 'W12018429', 'W12018429', 'ID02', 'Riverside Rehab', 'Evelynn', 'L', 'Horton', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '7711 W Riverside Dr', 'Garden City', 'Ada', 'ID', '83714', '2088538536', NULL, '7711 W Riverside Dr', 'Garden City', 'Ada', 'ID', '83714', '2088538536', '          ', 'IDMA', '', '', '0.00', '35.00', '0.00', 3, '2012-03-01', '2013-02-14', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1326368655', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('820470652', 'W12018430', 'W12018430', 'ID02', 'Riverside Rehab', 'Amy', 'R', 'Houser', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '7711 W Riverside Dr', 'Garden City', 'Ada', 'ID', '83714', '2088538536', NULL, '7711 W Riverside Dr', 'Garden City', 'Ada', 'ID', '83714', '2088538536', '          ', 'IDMA', '', '', '0.00', '35.00', '0.00', 3, '2012-03-01', '2013-02-14', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1386943744', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL);
INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
('611572907', 'W12018433', 'W12018433', 'UT01', 'MountainStar Primary Care', 'Hans', '', 'Jenkins', 'DO', 'Family Practice', '', '', NULL, 'O', '5405 S 500 E Ste 100', 'Ogden', 'Weber', 'UT', '84405', '8014757966', '8014797795', '5405 S 500 E Ste 100', 'Ogden', 'Weber', 'UT', '84405', '8014757966', '8014797795', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', '2012-06-30', 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1316932866', 0, 'N', 0, '2012-06-27', NULL, NULL, 0, 0, NULL, NULL),
('611572907', 'W12018434', 'W12018434', 'UT01', 'MountainStar Primary Care', 'Hans', '', 'Jenkins', 'DO', 'Family Practice', '', '', NULL, 'B', 'PO Box 405714', 'Atlanta', 'Fulton', 'GA', '30384', '8014757966', '8014797795', 'PO Box 405714', 'Atlanta', 'Fulton', 'GA', '30384', '8014757966', '8014797795', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-01-01', '2012-06-30', 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1316932866', 0, 'N', 0, '2012-06-27', NULL, NULL, 0, 0, NULL, NULL),
('452716222', 'W12018436', 'W12018436', 'ID02', 'St Lukes Clinic Family Medicine', 'Gregory', 'W', 'Johnson', 'MD', 'Family Practice', '', '', NULL, 'O', '130 E Boise Ave', 'Boise', 'Ada', 'ID', '83706', '2083454066', NULL, '130 E Boise Ave', 'Boise', 'Ada', 'ID', '83706', '2083454066', '          ', 'IDACN', '', '', '0.00', '15.00', '0.00', 8, '2011-11-08', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1508969973', 0, 'N', 0, '2013-10-16', NULL, NULL, 0, 0, NULL, NULL),
('452716222', 'W12018437', 'W12018437', 'SACN', 'Idaho Family Physicians Inc', 'Gregory', 'W', 'Johnson', 'MD', 'Family Practice', '', '', NULL, 'O', '130 E Boise Ave', 'Boise', 'Ada', 'ID', '83706', '2083454066', NULL, '130 E Boise Ave', 'Boise', 'Ada', 'ID', '83706', '2083454066', '          ', 'IDSINCLAIRL', '', '', '0.00', '15.00', '0.00', 8, '2011-11-08', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1508969973', 0, 'N', 0, '2013-10-16', NULL, NULL, 0, 0, NULL, NULL),
('202595845', 'W12018438', 'W12018438', 'ID01', 'Boise Kidney & Hypertension Institute', 'Christopher', 'R', 'Keller', 'MD', 'Nephrology', '', '', NULL, 'O', '4620 Enterprise Ste 100', 'Caldwell', 'Canyon', 'ID', '83605', '2088468335', NULL, '4620 Enterprise Ste 100', 'Caldwell', 'Canyon', 'ID', '83605', '2088468335', '', 'IDKIDNEY', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-03-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1255467312', 0, 'N', 0, '2014-04-04', NULL, NULL, 43.661, -116.641, NULL, NULL),
('272226361', 'W12018143', 'W12018143', 'ID02', 'Southern Idaho Surgery Center', 'Marlon', 'B', 'Michel', 'MD', 'Anesthesia', '', '', NULL, 'B', '1187 N 1100 E', 'Orem', 'Utah', 'UT', '84097', '2088951908', NULL, '1187 N 1100 E', 'Orem', 'Utah', 'UT', '84097', '2088951908', '          ', 'SISCDENT', '', '', '58.45', '100.00', '0.00', 3, '2012-02-01', NULL, 0, 15, 1, '', '', '', '', 'HCFA|UB|', '1528383924', 0, 'N', 0, '2012-07-26', NULL, NULL, 0, 0, NULL, NULL),
('272226361', 'W12018144', 'W12018144', 'ID02', 'Southern Idaho Surgery Center', 'Marlon', 'B', 'Michel', 'MD', 'Anesthesia', '', '', NULL, 'O', '3235 N Towerbridge Way Ste 100', 'Meridian', 'Ada', 'ID', '83646', '2088951908', NULL, '3235 N Towerbridge Way Ste 100', 'Meridian', 'Ada', 'ID', '83646', '2088951908', '          ', 'SISCDENT', '', '', '58.45', '100.00', '0.00', 3, '2012-02-01', NULL, 0, 15, 1, '', '', '', '', 'HCFA|UB|', '1528383924', 0, 'N', 0, '2012-07-26', NULL, NULL, 0, 0, NULL, NULL),
('710947638', 'W12018440', 'W12018440', 'UT01', '', 'Don', 'L', 'Reese', 'MD', 'Dermatology', '', '', NULL, 'O', '999 Murray Holladay Rd Ste 207', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8012682584', '8012621168', '999 Murray Holladay Rd Ste 207', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8012682584', '8012621168', 'HOLLADAYFP', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-03-01', '2013-12-31', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1659350049', 0, 'N', 0, '2013-12-03', NULL, NULL, 0, 0, NULL, NULL),
('202595845', 'W12018441', 'W12018441', 'ID01', 'Boise Kidney & Hypertension Institute', 'Arnold', 'L', 'Silva', 'MD', 'Nephrology', '', '', NULL, 'O', '4620 Enterprise Way Ste 100', 'Caldwell', 'Canyon', 'ID', '83605', '2088468335', NULL, '4620 Enterprise Way Ste 100', 'Caldwell', 'Canyon', 'ID', '83605', '2088468335', '', 'IDKIDNEY', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-03-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', 'West Valley Medical Center', NULL, '', 'HCFA|UB|', '1497790646', 0, 'N', 0, '2014-04-04', NULL, NULL, 43.661, -116.641, NULL, NULL),
('820471484', 'W12018442', 'W12018442', 'ID01', 'Kuna Family Medical Clinic', 'Myrna', '', 'Fisher', 'FNP', 'Internal Medicine', '', '', NULL, 'O', '708 E Wythe Creek Ct Ste 103', 'Kuna', 'Ada', 'ID', '83634', '2089225130', NULL, '708 E Wythe Creek Ct Ste 103', 'Kuna', 'Ada', 'ID', '83634', '2089225130', '          ', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-03-01', '2012-08-19', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1306839741', 0, 'N', 0, '2014-01-24', NULL, NULL, 43.488, -116.405, NULL, NULL),
('830300467', 'W12018444', 'W12018444', 'WY01', 'Powell Valley Healthcare', 'Angela', 'M', 'Redder', 'PA-C', 'Orthopedic Surgery', '', '', NULL, 'O', '777 Ave H', 'Powell', 'Park', 'WY', '82435', '3077547257', '3077547217', '777 Ave H', 'Powell', 'Park', 'WY', '82435', '3077547257', '3077547217', '', '', '', '0.00', '12.00', '0.00', 3, '2012-03-01', '2014-02-21', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1891070744', 0, 'Y', 0, '2014-02-21', NULL, NULL, 0, 0, NULL, NULL),
('830300467', 'W12018443', 'W12018443', 'WYT1', 'Powell Valley Healthcare', 'Angela', 'M', 'Redder', 'PA-C', 'Orthopedic Surgery', '', '', NULL, 'O', '777 Ave H', 'Powell', 'Park', 'WY', '82435', '3077547257', '3077547217', '777 Ave H', 'Powell', 'Park', 'WY', '82435', '3077547257', '3077547217', '', '', '', '0.00', '12.00', '0.00', 3, '2012-03-01', '2014-02-21', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1891070744', 0, 'Y', 0, '2014-02-21', NULL, NULL, 0, 0, NULL, NULL),
('870284475', 'W12018445', 'W12018445', 'UT01', 'Granger Medical Clinic', 'Pinky', '', 'Kotwal', 'MD', 'Internal Medicine', NULL, NULL, NULL, 'O', '3725 W 4100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019653600', '8019683605', '3725 W 4100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019653600', '8019683605', 'WUGRANGER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-05-01', NULL, 0, 0, 0, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1083645444', 0, 'N', 0, '2012-04-23', NULL, NULL, 40.682, -111.979, NULL, NULL),
('870284475', 'W12018446', 'W12018446', 'UT01', 'Granger Medical Clinic', 'Pinky', '', 'Kotwal', 'MD', 'Internal Medicine', NULL, NULL, NULL, 'B', 'PO Box 70658', 'Salt Lake City', 'Salt Lake', 'UT', '84170', '8019653600', '8019683605', 'PO Box 70658', 'Salt Lake City', 'Salt Lake', 'UT', '84170', '8019653600', '8019683605', 'WUGRANGER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-05-01', NULL, 0, 0, 0, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1083645444', 0, 'N', 0, '2012-04-23', NULL, NULL, 0, 0, NULL, NULL),
('452716222', 'W12018447', 'W12018447', 'ID02', 'Idaho Family Physicians Inc', 'Mark', 'A', 'Rutherford', 'MD', 'Family Practice', '', '', NULL, 'O', '130 E Boise Ave', 'Boise', 'Ada', 'ID', '83706', '2083454066', NULL, '130 E Boise Ave', 'Boise', 'Ada', 'ID', '83706', '2083454066', '          ', 'IDACN', '', '', '0.00', '15.00', '0.00', 8, '2011-11-08', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1972693786', 0, 'N', 0, '2013-10-16', NULL, NULL, 0, 0, NULL, NULL),
('452716222', 'W12018448', 'W12018448', 'SACN', 'Idaho Family Physicians Inc', 'Mark', 'A', 'Rutherford', 'MD', 'Family Practice', '', '', NULL, 'O', '130 E Boise Ave', 'Boise', 'Ada', 'ID', '83706', '2083454066', NULL, '130 E Boise Ave', 'Boise', 'Ada', 'ID', '83706', '2083454066', '          ', 'IDSINCLAIRL', '', '', '0.00', '15.00', '0.00', 8, '2011-11-08', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1972693786', 0, 'N', 0, '2013-10-16', NULL, NULL, 0, 0, NULL, NULL),
('270652429', 'W12018453', 'W12018453', 'UTDT01', 'Cobble Creek Dental', 'Kelly', '', 'Wilkins', 'DDS', 'Dentist', '', '', NULL, 'O', '2274 N 400 E Ste 204', 'Ogden', 'Weber', 'UT', '84414', '8013990458', NULL, '2274 N 400 E Ste 204', 'Ogden', 'Weber', 'UT', '84414', '8013990458', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2012-01-16', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000009834', 0, 'N', 0, '2012-03-01', NULL, NULL, 0, 0, NULL, NULL),
('432051652', 'W12018455', 'W12018455', 'ID02', 'Idaho Spine and Sports Chiropractic', 'Kendrick', 'L', 'Tweedt', 'DC', 'Chiropractic', '', '', NULL, 'O', '2399 S Orchard St Ste 204', 'Boise', 'Ada', 'ID', '83705', '2083232833', NULL, '2399 S Orchard St Ste 204', 'Boise', 'Ada', 'ID', '83705', '2083232833', '          ', 'IDCHIRO1', '', '', '0.00', '35.00', '0.00', 3, '2012-03-01', '2013-07-31', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1528142007', 0, 'N', 0, '2013-09-11', NULL, NULL, 0, 0, NULL, NULL),
('452716222', 'W12018456', 'W12018456', 'ID02', 'Idaho Family Physicians Inc', 'Irv', 'E', 'Sackman', 'MD', 'Family Practice', '', '', NULL, 'O', '130 E Boise Ave', 'Boise', 'Ada', 'ID', '83706', '2083454066', NULL, '130 E Boise Ave', 'Boise', 'Ada', 'ID', '83706', '2083454066', '          ', 'IDACN', '', '', '0.00', '15.00', '0.00', 8, '2011-11-08', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1003919473', 0, 'N', 0, '2013-10-16', NULL, NULL, 0, 0, NULL, NULL),
('452716222', 'W12018457', 'W12018457', 'SACN', 'Idaho Family Physicians Inc', 'Irv', 'E', 'Sackman', 'MD', 'Family Practice', '', '', NULL, 'O', '130 E Boise Ave', 'Boise', 'Ada', 'ID', '83706', '2083454066', NULL, '130 E Boise Ave', 'Boise', 'Ada', 'ID', '83706', '2083454066', '          ', 'IDSINCLAIRL', '', '', '0.00', '15.00', '0.00', 8, '2011-11-08', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1003919473', 0, 'N', 0, '2013-10-16', NULL, NULL, 0, 0, NULL, NULL),
('452716222', 'W12018459', 'W12018459', 'ID02', 'Idaho Family Physicians Inc', 'Mont', 'B', 'Tolman', 'DO', 'Family Practice', '', '', NULL, 'O', '130 E Boise Ave', 'Boise', 'Ada', 'ID', '83706', '2083454066', NULL, '130 E Boise Ave', 'Boise', 'Ada', 'ID', '83706', '2083454066', '          ', 'IDACN', '', '', '0.00', '15.00', '0.00', 8, '2011-11-08', '2013-04-01', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1124069828', 0, 'N', 0, '2013-04-16', NULL, NULL, 0, 0, NULL, NULL),
('452716222', 'W12018460', 'W12018460', 'SACN', 'Idaho Family Physicians Inc', 'Mont', 'B', 'Tolman', 'DO', 'Family Practice', '', '', NULL, 'O', '130 E Boise Ave', 'Boise', 'Ada', 'ID', '83706', '2083454066', NULL, '130 E Boise Ave', 'Boise', 'Ada', 'ID', '83706', '2083454066', '          ', 'IDSINCLAIRL', '', '', '0.00', '15.00', '0.00', 8, '2011-11-08', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1124069828', 0, 'N', 0, '2012-03-02', NULL, NULL, 0, 0, NULL, NULL),
('942938348', 'W12018462', 'W12018462', 'UTMH1', 'Valley Mental Health  Inc', 'Samuel', 'B', 'Vincent', 'APRN', 'Mental Health', '', '', 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, '2012-03-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1538350749', 0, 'N', 0, '2013-07-09', NULL, NULL, 0, 0, NULL, NULL),
('820512942', 'W12018463', 'W12018463', 'ID01', 'Alpine Cottage Chiropractic', 'John', 'E', 'Whalen', 'DC', 'Chiropractic', '', '', NULL, 'O', '1326 N Main St', 'Meridian', 'Ada', 'ID', '83642', '2088843368', NULL, '1326 N Main St', 'Meridian', 'Ada', 'ID', '83642', '2088843368', '          ', 'IDCHIRO1', '', '', '0.00', '35.00', '0.00', 3, '2012-03-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1144208281', 0, 'N', 0, '2012-03-02', NULL, NULL, 43.6155, -116.392, NULL, NULL),
('820470652', 'W12018464', 'W12018464', 'ID02', 'Riverside Rehab', 'Debra', 'L', 'Scholten', 'LPC LSW', 'Mental Health', 'Counseling', 'Social Worker', NULL, 'O', '7711 W Riverside Dr', 'Garden City', 'Ada', 'ID', '83714', '2088538536', NULL, '7711 W Riverside Dr', 'Garden City', 'Ada', 'ID', '83714', '2088538536', '', 'IDMA', '', '', '0.00', '35.00', '0.00', 3, '2012-03-01', '2013-02-14', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1972775351', 0, 'N', 0, '2014-05-19', NULL, NULL, 0, 0, NULL, NULL),
('870651302', 'W12018465', 'W12018465', 'UTMH1', 'Meccico Therapeuctic Services Inc', 'Carolie', '', 'Meccico', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '920 Chambers St Ste 17', 'Ogden', 'Weber', 'UT', '84403', '8015285054', '8014794212', '920 Chambers St Ste 17', 'Ogden', 'Weber', 'UT', '84403', '8015285054', '8014794212', 'UTMA', '', '', '0.00', '35.00', '0.00', 3, '2012-03-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1699730812', 0, 'N', 0, '2012-03-02', NULL, NULL, 0, 0, NULL, NULL),
('205934739', 'W12018468', 'W12018468', 'ID02', 'Family Medicine Health Center', 'Jennifer', '', 'Cook', 'MD', 'Family Practice', '', '', NULL, 'O', '121 E Fort', 'Boise', 'Ada', 'ID', '83712', '2083816102', '2083811776', '121 E Fort', 'Boise', 'Ada', 'ID', '83712', '2083816102', '2083811776', 'IDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-03-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1265680417', 0, 'N', 0, '2014-06-05', NULL, NULL, 0, 0, NULL, NULL),
('205934739', 'W12018471', 'W12018471', 'ID02', 'Family Medicine Health Center', 'Jennifer', '', 'Cook', 'MD', 'Family Practice', '', '', NULL, 'O', '215 W 35th St', 'Garden City', 'Ada', 'ID', '83714', '2083190037', '2083811776', '215 W 35th St', 'Garden City', 'Ada', 'ID', '83714', '2083190037', '2083811776', 'IDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-03-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1265680417', 0, 'N', 0, '2014-06-05', NULL, NULL, 0, 0, NULL, NULL),
('205934739', 'W12018470', 'W12018470', 'ID02', 'Family Medicine Health Center', 'Jennifer', '', 'Cook', 'MD', 'Family Practice', '', '', NULL, 'O', '2321 E Gala St', 'Meridian', 'Ada', 'ID', '83642', '2085142520', '2085142521', '2321 E Gala St', 'Meridian', 'Ada', 'ID', '83642', '2085142520', '2085142521', 'IDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-03-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1265680417', 0, 'N', 0, '2014-06-05', NULL, NULL, 0, 0, NULL, NULL),
('205934739', 'W12018469', 'W12018469', 'ID02', 'Family Medicine Health Center', 'Jennifer', '', 'Cook', 'MD', 'Family Practice', '', '', NULL, 'O', '6094 W Emerald St', 'Boise', 'Ada', 'ID', '83704', '2085142510', '2085142511', '6094 W Emerald St', 'Boise', 'Ada', 'ID', '83704', '2085142510', '2085142511', 'IDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-03-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1265680417', 0, 'N', 0, '2014-06-05', NULL, NULL, 0, 0, NULL, NULL),
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