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
('830326365', 'WYT200271', 'WYT200271', 'WYT2', 'Rocky Mt Infections Disease', 'Mark (Recognized PPO but not contracted)', '', 'Dowell', '', 'Infectious Disease', '', '', NULL, 'O', '5810  E  2nd St', 'Casper', '', 'WY', '82601', '3072348700', NULL, '5810  E  2nd St', 'Casper', '', 'WY', '82601', '3072348700', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2009-12-15', '2012-12-01', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '0000006019', 0, 'Y', 0, '2012-10-19', NULL, NULL, 0, 0, NULL, NULL),
('836000295', 'WYT200520', 'WYT200520', 'WYT2', 'Memorial Hospital of Sweetwater County', 'Sigsbee', 'W', 'Duck', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '1204 Hilltop Dr Ste 109', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073528192', '3073528126', '1204 Hilltop Dr Ste 109', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073528192', '3073528126', '', '', '', '0.00', '5.00', '0.00', 3, '2011-01-01', '2014-02-09', 0, 0, 0, 'Memorial Hospital of Sweetwater County', '', '', '', 'HCFA|UB|', '1235228164', 0, 'N', 0, '2014-03-27', NULL, NULL, 0, 0, NULL, NULL),
('830251081', 'WYT200698', 'WYT200698', 'WYT2', 'Powder River Orthopedics & Spine PC', 'John', 'P', 'Dunn', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '508 Stocktrail Ste A', 'Gillette', 'Campbell', 'WY', '82716', '3076861413', NULL, '508 Stocktrail Ste A', 'Gillette', 'Campbell', 'WY', '82716', '3076861413', '          ', '', '', '', '0.00', '23.00', '0.00', 3, '2008-09-15', '2011-11-06', 0, 0, 0, 'Campbell County Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1639163702', 0, 'N', 0, '2013-09-17', NULL, NULL, 0, 0, NULL, NULL),
('521262870', 'WYT200272', 'WYT200272', 'WYT2', 'Dynasplint Systems Inc  (Custom Braces)', '', '', 'Dynasplint Systems Inc  (Custom Braces)', 'GROUP', 'Durable Medical Equipment', 'Custom Splints', '', NULL, 'O', '770 Ritchie Hwy Ste W 21', 'Severna Park', NULL, 'MD', NULL, '8006386771', NULL, '770 Ritchie Hwy Ste W 21', 'Severna Park', '', 'MD', '', '8006386771', '', 'WCSTDSS5', NULL, NULL, '0.00', '100.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1386643856', 0, 'Y', 0, '2012-09-24', NULL, NULL, 0, 0, NULL, NULL),
('311651314', 'WYT200554', 'WYT200554', 'WYT2', 'EBI LLC (Bone Stimulators)', '', '', 'EBI LLC (Bone Stimulators)', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'B', '100 Interpace Pkwy', 'Parsippany', 'Morris', 'NJ', '07054', '9732999300', '          ', '100 Interpace Pkwy', 'Parsippany', 'Morris', 'NJ', '07054', '9732999300', '          ', 'DME80', '', '', '0.00', '35.00', '0.00', 3, '2009-08-01', '2014-03-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1366423220', 0, 'Y', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('311651314', 'WYT200555', 'WYT200555', 'WYT2', 'EBI LLC (Bone Stimulators)', '', '', 'EBI LLC (Bone Stimulators)', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', 'Phone Number Only', '', '', '', '', '8005262579', '          ', 'Phone Number Only', '', '', '', '', '8005262579', '          ', 'DME80', '', '', '0.00', '35.00', '0.00', 3, '2009-05-21', '2014-03-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1366423220', 0, 'N', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('770644336', 'WYT200446', 'WYT200446', 'WYT2', '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, '2008-04-01', '2012-04-19', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1063414258', 0, 'N', 0, '2012-09-24', NULL, NULL, 0, 0, NULL, NULL),
('770644336', 'WYT200447', 'WYT200447', 'WYT2', 'eCardio Diagnostics ', '', '', 'eCardio Diagnostics LLC', 'GROUP', 'Cardiac Monitoring', '', '', NULL, 'O', 'Phone Number Only', NULL, NULL, NULL, NULL, '8884003522', NULL, 'Phone Number Only', '', '', '', '', '8884003522', '', 'wisecardio', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-04-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1063414258', 0, 'n', 0, '2012-09-24', NULL, NULL, 0, 0, NULL, NULL),
('341650951', 'WYT200273', 'WYT200273', 'WYT2', 'Edgepark', '', '', 'Edgepark', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'B', '1810 Summit Commerce', 'Twinsburg', 'Lorain', 'OH', '44039', '8003075930', NULL, '1810 Summit Commerce', 'Twinsburg', 'Lorain', 'OH', '44039', '8003075930', '          ', 'WCSTEPSI5', 'DME80', '', '0.00', '35.00', '0.00', 3, '2006-12-01', '2012-03-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1609858729', 0, 'Y', 0, '2014-01-27', NULL, NULL, 0, 0, NULL, NULL),
('830234097', 'WYT200629', 'WYT200629', 'WYT2', 'Campbell County Memorial Hospital', 'Robin', '', 'Eicher', 'MD', 'Mental Health', 'Psychiatry', '', NULL, 'O', '501 S Burma Ave', 'Gillette', 'Campbell', 'WY', '82717', '3076885000', '', '501 S Burma Ave', 'Gillette', 'Campbell', 'WY', '82717', '3076885000', '', '', '', '5001', '0.00', '0.00', '0.00', 3, '2008-09-15', '2008-09-15', 0, 0, 0, 'Campbell County Memorial Hospital', '', '', '', 'HCFA|UB|', '1518074442', 0, 'N', 0, '2014-07-22', NULL, NULL, 0, 0, NULL, NULL),
('520629656', 'WYT200274', 'WYT200274', 'WYT2', 'David Elbogen', 'David (Recognized PPO but not contracted)', '', 'Elbogen', '', 'Pediatrics', '', '', NULL, 'O', '1720 Poplar Dr Ste 1', 'Casper', '', 'WY', '82601', '3074731427', NULL, '1720 Poplar Dr Ste 1', 'Casper', '', 'WY', '82601', '3074731427', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2009-12-15', '2012-12-01', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '0000006102', 0, 'Y', 0, '2012-10-19', NULL, NULL, 0, 0, NULL, NULL),
('411310335', 'WYT200275', 'WYT200275', 'WYT2', 'Empi Inc (Neuromuscular Stimulator)', '', '', 'Empi Inc (Neuromuscular Stimulator)', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', '599 Cardigan Rd', 'St Paul', 'Ramsey', 'MN', '55126', '8003282536', NULL, '599 Cardigan Rd', 'Saint Paul', 'Ramsey', 'MN', '55126', '8003282536', '', 'WCSTEMPIWY', 'DME90', NULL, '0.00', '15.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1174574032', 0, 'y', 0, '2012-09-24', NULL, NULL, 0, 0, NULL, NULL),
('202765815', 'WYT200276', 'WYT200276', 'WYT2', 'Sage Medical Group', 'David ', '', 'Erk', 'MD', 'Internal Medicine', '', '', NULL, 'O', '419 S Washington St', 'Casper', '', 'WY', '82601', '3072658300', NULL, '419 S Washington St', 'Casper', '', 'WY', '82601', '3072658300', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2009-12-15', '2012-12-01', 0, 0, 1, 'Wyoming Medical Center ', NULL, NULL, NULL, 'HCFA|UB|', '1396713046', 0, 'Y', 0, '2013-06-27', NULL, NULL, 0, 0, NULL, NULL),
('830236761', 'WYT200766', 'WYT200766', 'WYT2', 'Fremont Orthopedics', 'Chris', '', 'Erschen', 'PA', 'Physician Assistant', '', '', NULL, 'O', '815 E Main St', 'Lander', 'Fremont', 'WY', '82520', '3073329720', NULL, '815 E Main St', 'Lander', 'Fremont', 'WY', '82520', '3073329720', '          ', 'WYORTHO2', 'wyhcpcs', '', '0.00', '35.00', '0.00', 3, '2010-07-15', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1811099450', 0, 'N', 0, '2012-06-08', NULL, NULL, 0, 0, NULL, NULL),
('830306180', 'WYT200797', 'WYT200797', 'WYT2', 'College Hill Womens Center', 'Amr', '', 'Etman', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '3000 College Dr Ste A', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073621861', NULL, '3000 College Dr Ste A', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073621861', '          ', '', '', '', '0.00', '10.00', '0.00', 3, '2009-03-09', NULL, 0, 0, 0, 'Memorial Hospital of Sweetwater County', NULL, NULL, NULL, 'HCFA|UB|', '1932362985', 0, 'N', 0, '2013-08-06', NULL, NULL, 0, 0, NULL, NULL),
('830327475', 'WYT200697', 'WYT200697', 'WYT2', 'Evanston Regional Hospital', '', '', 'Evanston Regional Hospital', 'GROUP', 'Hospital', '', '', NULL, 'O', '190 Arrowead Dr', 'Evanston', 'Uinta', 'WY', '82930', '3077893636', NULL, '190 Arrowead Dr', 'Evanston', 'Uinta', 'WY', '82930', '3077893636', '', '', NULL, NULL, '0.00', '20.00', '0.00', 6, '2006-12-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1639140015', 0, 'N', 0, '2012-03-26', NULL, NULL, 0, 0, NULL, NULL),
('830327475', 'WYT200277', 'WYT200277', 'WYT2', 'Evanston Regional Hospital - Anesthesia', '', '', 'Evanston Regional Hospital - Anesthesia', 'GROUP', '', '', '', NULL, 'O', '190 Arrowead Dr', 'Evanston', 'Uinta', 'WY', '82930', '3077893636', NULL, '190 Arrowead Dr', 'Evanston', 'Uinta', 'WY', '82930', '3077893636', '          ', '', '', '1000', '40.00', '0.00', '0.00', 6, '2006-12-01', NULL, 0, 12, 1, '', '', '', '', 'HCFA|UB|', '0000006169', 0, 'Y', 0, '2013-06-28', NULL, NULL, 0, 0, NULL, NULL),
('830327475', 'WYT200278', 'WYT200278', 'WYT2', 'Evanston Regional Hospital - PT', '', '', 'Evanston Regional Hospital - PT', 'GROUP', 'Physical Therapy', '', '', NULL, 'O', '190 Arrowead Dr', 'Evanston', 'Uinta', 'WY', '82930', '3077893636', NULL, '190 Arrowead Dr', 'Evanston', 'Uinta', 'WY', '82930', '3077893636', '', '', NULL, NULL, '0.00', '100.00', '58.00', 6, '2006-12-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '0000006170', 0, 'y', 0, '2011-09-20', NULL, NULL, 0, 0, NULL, NULL),
('830306207', 'WYT200677', 'WYT200677', 'WYT2', 'Big Horn Pediatrics', 'David', 'R', 'Fall', 'MD', 'Pediatrics', '', '', NULL, 'O', '1308 W Fourth St', 'Gillette', 'Campbell', 'WY', '82716', '3076871300', NULL, '1308 W Fourth St', 'Gillette', 'Campbell', 'WY', '82716', '3076871300', '          ', '', '', '', '0.00', '12.00', '0.00', 3, '2008-10-03', '2011-06-28', 0, 0, 1, 'Campbell County Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1578676490', 0, 'N', 0, '2012-04-12', NULL, NULL, 0, 0, NULL, NULL),
('830306207', 'WYT200539', 'WYT200539', 'WYT2', 'Big Horn Pediatrics', 'Julie', 'S', 'Fall', 'MD', 'Pediatrics', '', '', NULL, 'O', '1308 W Fourth St', 'Gillette', 'Campbell', 'WY', '82716', '3076871300', NULL, '1308 W Fourth St', 'Gillette', 'Campbell', 'WY', '82716', '3076871300', '          ', '', '', '', '0.00', '12.00', '0.00', 3, '2008-09-10', '2011-06-28', 0, 0, 1, 'Campbell County Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1306959267', 0, 'N', 0, '2012-04-12', NULL, NULL, 0, 0, NULL, NULL),
('830317319', 'WYT200727', 'WYT200727', 'WYT2', 'Fremont Pediatrics', 'Cheryl', '', 'Fallin', 'MD', 'Pediatrics', '', '', NULL, 'O', '115 Wyoming St', 'Lander', 'Fremont', 'WY', '82501', '3073322185', NULL, '115 Wyoming St', 'Lander', 'Fremont', 'WY', '82501', '3073322185', '', '', '', '', '0.00', '10.00', '0.00', 3, '2009-03-30', '2011-06-28', 0, 0, 0, 'SageWest Health Care', '', '', '', 'HCFA|UB|', '1720189368', 0, 'N', 0, '2014-06-17', NULL, NULL, 0, 0, NULL, NULL),
('911434381', 'WYT200531', 'WYT200531', 'WYT2', 'Family Medical Center', '', '', 'Family Medical Center', 'GROUP', 'Family Practice', '', '', NULL, 'O', '497 W Lott St', 'Buffalo', 'Johnson', 'WY', '82834', '3076842228', NULL, '497 W Lott St', 'Buffalo', 'Johnson', 'WY', '82834', '3076842228', '', '', NULL, NULL, '0.00', '5.00', '0.00', 3, '2009-08-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1285612317', 0, 'n', 0, '2011-06-10', NULL, NULL, 0, 0, NULL, NULL),
('830234097', 'WYT200454', 'WYT200454', 'WYT2', 'Cottonwood Clinic', 'Sameera', '', 'Fareed', 'MD', 'Internal Medicine', '', '', NULL, 'O', '407 Medical Arts Ct Ste F', 'Gillette', 'Campbell', 'WY', '82716', '3076821441', NULL, '407 Medical Arts Ct Ste F', 'Gillette', 'Campbell', 'WY', '82716', '3076821441', '          ', '', '', '5001', '0.00', '0.00', '0.00', 3, '2008-09-15', '2008-09-15', 0, 0, 0, 'Campbell County Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1083600183', 0, 'N', 0, '2013-10-30', NULL, NULL, 0, 0, NULL, NULL),
('223887117', 'WYT200713', 'WYT200713', 'WYT2', 'Mountain Valley Eye Institute', 'John', 'B', 'Fassio', 'MD', 'Ophthalmology', NULL, NULL, NULL, 'O', '196 Arrowhead Dr Ste 5', 'Evanston', 'Uinta', 'WY', '82930', '8774232020', NULL, '196 Arrowhead Dr Ste 5', 'Evanston', 'Uinta', 'WY', '82930', '8774232020', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-12-01', '2011-06-28', 0, 0, 0, 'Evanston Regional Hospital', 'Heber Valley Medical Center', NULL, NULL, 'HCFA|UB|', '1689671638', 0, 'N', 0, '2013-07-11', NULL, NULL, 0, 0, NULL, NULL),
('830219655', 'WYT200694', 'WYT200694', 'WYT2', 'Gem City Bone and Joint', 'Cindy', '', 'Faulkner', 'PA', 'Orthopedic Surgery', '', '', NULL, 'O', '1909 Vista Dr', 'Laramie', 'Albany', 'WY', '82070', '3077458851', NULL, '1909 Vista Dr', 'Laramie', 'Albany', 'WY', '82070', '3077458851', '          ', '', '', '', '0.00', '10.00', '0.00', 3, '2009-07-01', '2013-01-01', 0, 0, 1, 'Memorial Hospital of Carbon County', '', '', '', 'HCFA|UB|', '1619957685', 0, 'N', 0, '2013-05-08', NULL, NULL, 0, 0, NULL, NULL),
('836000891', 'WYT200451', 'WYT200451', 'WYT2', 'North Big Horn Hospital Clinic', 'Ken', '', 'Ferbrache', 'PAC', 'Family Practice', '', '', NULL, 'O', '1115 Lane 12', 'Lovell', 'Big Horn', 'WY', '82431', '3075485201', NULL, '1115 Lane 12', 'Lovell', 'Big Horn', 'WY', '82431', '3075485201', '          ', '', '', '', '0.00', '10.00', '0.00', 3, '2008-02-01', '2011-06-16', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1073625406', 0, 'N', 0, '2013-12-04', NULL, NULL, 0, 0, NULL, NULL),
('830218549', 'WYT200568', 'WYT200568', 'WYT2', 'Sheridan Orthopaedic Assoc', 'James', 'S', 'Ferries', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1050 Mydland Rd', 'Sheridan', 'Sheridan', 'WY', '82801', '3076747469', NULL, '1050 Mydland Rd', 'Sheridan', 'Sheridan', 'WY', '82801', '3076747469', '          ', '', '', '', '0.00', '15.00', '0.00', 3, '2009-07-15', '2012-02-12', 0, 0, 1, 'Sheridan Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1407879414', 0, 'N', 0, '2012-07-17', NULL, NULL, 0, 0, NULL, NULL),
('830317319', 'WYT200715', 'WYT200715', 'WYT2', 'Fremont County Pediatrics', 'Ryan', '', 'Firth', 'MD', 'Pediatrics', '', '', NULL, 'O', '115 Wyoming St', 'Lander', 'Fremont', 'WY', '82501', '3073322185', NULL, '115 Wyoming St', 'Lander', 'Fremont', 'WY', '82501', '3073322185', '', '', '', '', '0.00', '10.00', '0.00', 3, '2009-10-09', '2011-06-28', 0, 0, 0, 'SageWest Health Care', '', '', '', 'HCFA|UB|', '1689847485', 0, 'N', 0, '2014-03-27', NULL, NULL, 0, 0, NULL, NULL),
('836000295', 'WYT200456', 'WYT200456', 'WYT2', 'Sweetwater Medical Group', 'Ryan Karl', 'C', 'Fontanilla', 'MD', 'Mental Health', 'Psychiatry', '', NULL, 'O', '1204 Hilltop Dr Ste 108', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073528125', '3073528126', '1204 Hilltop Dr Ste 108', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073528125', '3073528126', '', '', '', '0.00', '5.00', '0.00', 3, '2011-07-01', NULL, 0, 0, 0, 'Memorial Hospital of Sweetwater County', '', '', '', 'HCFA|UB|', '1083821110', 0, 'N', 0, '2014-07-23', NULL, NULL, 0, 0, NULL, NULL),
('830234097', 'WYT200279', 'WYT200279', 'WYT2', 'Campbell County Memorial Hospital', 'Dennis', '', 'Ford', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '501 S Burma Ave', 'Gillette', 'Campbell', 'WY', '82717', '3076881000', NULL, '501 S Burma Ave', 'Gillette', 'Campbell', 'WY', '82717', '3076881000', '          ', '', '', '5001', '0.00', '0.00', '0.00', 3, '2008-09-15', '2008-09-15', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000006280', 0, 'Y', 0, '2013-09-17', NULL, NULL, 0, 0, NULL, NULL),
('203360654', 'WYT200478', 'WYT200478', 'WYT2', 'Western Medical Associates', 'Sherrill', '', 'Fox', 'MD', 'Family Practice', '', '', NULL, 'O', '3230 Cy Ave', 'Casper', 'Natrona', 'WY', '82604', '3075775100', NULL, '3230 Cy Ave', 'Casper', 'Natrona', 'WY', '82604', '3075775100', '', '', '', '', '0.00', '10.00', '0.00', 3, '2010-09-30', NULL, 0, 0, 0, 'Mountain View Regional Hospital', '', '', '', 'HCFA|UB|', '1124034566', 0, 'N', 0, '2014-04-03', NULL, NULL, 0, 0, NULL, NULL),
('203360654', 'WYT200479', 'WYT200479', 'WYT2', 'Western Medical Associates', 'Sherrill', '', 'Fox', 'MD', 'Family Practice', '', '', NULL, 'O', '6500 E 2nd St Ste 200', 'Casper', 'Natrona', 'WY', '82609', '3075775100', NULL, '6500 E 2nd St Ste 200', 'Casper', 'Natrona', 'WY', '82609', '3075775100', '', '', '', '', '0.00', '10.00', '0.00', 3, '2010-09-30', NULL, 0, 0, 0, 'Mountain View Regional Hospital', '', '', '', 'HCFA|UB|', '1124034566', 0, 'N', 0, '2014-04-03', NULL, NULL, 0, 0, NULL, NULL),
('752943993', 'W12046215', 'W12046215', 'TXDALSTD', 'North Texas Kidney Disease Associates', 'Kannaeganti', '', 'Prasad', 'MD', 'Nephrology', '', '', NULL, 'M', '1600 Waters Ridge Ste A', 'Lewisville', 'Denton', 'TX', '75057', '9722190558', '9724369273', '1600 Waters Ridge Ste A', 'Lewisville', 'Denton', 'TX', '75057', '9722190558', '9724369273', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1114922630', 0, 'N', 0, '2014-04-07', NULL, NULL, 0, 0, NULL, NULL),
('830219655', 'WYT200530', 'WYT200530', 'WYT2', 'Premier Bone and Joint Centers', 'Lori', '', 'Franc', 'PT', 'Physical Therapy', '', '', NULL, 'O', '1909 Vista Dr', 'Laramie', 'Albany', 'WY', '82070', '3077458851', NULL, '1909 Vista Dr', 'Laramie', 'Albany', 'WY', '82070', '3077458851', '          ', '', '', '', '0.00', '10.00', '0.00', 3, '2009-07-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1275513673', 0, 'N', 0, '2013-03-13', NULL, NULL, 0, 0, NULL, NULL),
('836000295', 'WYT200807', 'WYT200807', 'WYT2', 'Sweetwater Medical Group', 'Chad', 'K', 'Franks', 'MD', 'General Surgery', '', '', NULL, 'O', '1204 Hilltop Dr Ste 107', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073528193', NULL, '1204 Hilltop Dr Ste 107', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073528193', '          ', '', '', '', '0.00', '5.00', '0.00', 3, '2009-04-15', '2014-02-09', 0, 0, 0, 'Memorial Hospital of Sweetwater County', NULL, NULL, NULL, 'HCFA|UB|', '1982825675', 0, 'N', 0, '2014-03-04', NULL, NULL, 0, 0, NULL, NULL),
('203360654', 'WYT200683', 'WYT200683', 'WYT2', 'Western Medical Associates', 'Jennifer', 'L', 'Frary', 'PA-C', 'Family Practice', '', '', NULL, 'O', '3230 Cy Ave', 'Casper', 'Natrona', 'WY', '82604', '3075775100', NULL, '3230 Cy Ave', 'Casper', 'Natrona', 'WY', '82604', '3075775100', '', '', '', '', '0.00', '10.00', '0.00', 3, '2010-09-30', NULL, 0, 0, 0, 'Mountain View Regional Hospital', '', '', '', 'HCFA|UB|', '1609862580', 0, 'N', 0, '2014-07-14', NULL, NULL, 0, 0, NULL, NULL),
('203360654', 'WYT200684', 'WYT200684', 'WYT2', 'Western Medical Associates', 'Jennifer', 'L', 'Frary', 'PA-C', 'Family Practice', '', '', NULL, 'O', '6500 E 2nd St Ste 200', 'Casper', 'Natrona', 'WY', '82609', '3075775100', NULL, '6500 E 2nd St Ste 200', 'Casper', 'Natrona', 'WY', '82609', '3075775100', '', '', '', '', '0.00', '10.00', '0.00', 3, '2010-09-30', NULL, 0, 0, 0, 'Mountain View Regional Hospital', '', '', '', 'HCFA|UB|', '1609862580', 0, 'N', 0, '2014-07-14', NULL, NULL, 0, 0, NULL, NULL),
('203360654', 'WYT200481', 'WYT200481', 'WYT2', 'Western Medical Associates', 'Timothy', 'N', 'Frary', 'PA-C', 'Family Practice', '', '', NULL, 'O', '3230 Cy Ave', 'Casper', 'Natrona', 'WY', '82604', '3075775100', NULL, '3230 Cy Ave', 'Casper', 'Natrona', 'WY', '82604', '3075775100', '', '', '', '', '0.00', '10.00', '0.00', 3, '2010-09-30', NULL, 0, 0, 0, 'Mountain View Regional Hospital', '', '', '', 'HCFA|UB|', '1134110513', 0, 'N', 0, '2014-07-14', NULL, NULL, 0, 0, NULL, NULL),
('203360654', 'WYT200482', 'WYT200482', 'WYT2', 'Western Medical Associates', 'Timothy', 'N', 'Frary', 'PA-C', 'Family Practice', '', '', NULL, 'O', '6500 E 2nd St Ste 200', 'Casper', 'Natrona', 'WY', '82609', '3075775100', NULL, '6500 E 2nd St Ste 200', 'Casper', 'Natrona', 'WY', '82609', '3075775100', '', '', '', '', '0.00', '10.00', '0.00', 3, '2010-09-30', NULL, 0, 0, 0, 'Mountain View Regional Hospital', '', '', '', 'HCFA|UB|', '1134110513', 0, 'N', 0, '2014-07-14', NULL, NULL, 0, 0, NULL, NULL),
('930765801', 'WYT200476', 'WYT200476', 'WYT2', 'Big Horn Foot Clinic', 'D', 'H', 'Fraser', 'DPM', 'Podiatry', '', '', NULL, 'O', '424 Yellowstone Ste 140', 'Cody', 'Park', 'WY', '82414', '3075279191', '3077541291', '424 Yellowstone Ste 140', 'Cody', 'Park', 'WY', '82414', '3075279191', '3077541291', '', '', '', '0.00', '10.00', '0.00', 3, '2011-01-01', '2011-06-28', 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1114923463', 0, 'N', 0, '2014-02-10', NULL, NULL, 0, 0, NULL, NULL),
('930765801', 'WYT200477', 'WYT200477', 'WYT2', 'Big Horn Foot Clinic', 'D', 'H', 'Fraser', 'DPM', 'Podiatry', '', '', NULL, 'O', '777 Ave H', 'Powell', 'Park', 'WY', '82435', '3077549191', '3077541291', '777 Ave H', 'Powell', 'Park', 'WY', '82435', '3077549191', '3077541291', '', '', '', '0.00', '10.00', '0.00', 3, '2011-01-01', '2011-06-28', 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1114923463', 0, 'N', 0, '2014-02-10', NULL, NULL, 0, 0, NULL, NULL),
('836000891', 'WYT200488', 'WYT200488', 'WYT2', 'North Big Horn Hospital Clinic', 'Mary', '', 'Freund', 'NP', 'Family Practice', '', '', NULL, 'O', '1115 Lane 12', 'Lovell', 'Big Horn', 'WY', '82431', '3075485201', NULL, '1115 Lane 12', 'Lovell', 'Big Horn', 'WY', '82431', '3075485201', '          ', '', '', '', '0.00', '10.00', '0.00', 3, '2008-02-01', '2011-06-16', 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1134231558', 0, 'N', 0, '2013-12-04', NULL, NULL, 0, 0, NULL, NULL),
('272904966', 'WYT200508', 'WYT200508', 'WYT2', 'The Eye Institute of Utah', 'Randy', 'L', 'Fuja', 'OD', 'Optometry', '', '', NULL, 'O', '2631 Foothill Blvd Ste A', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073624202', NULL, '2631 Foothill Blvd Ste A', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073624202', '          ', 'WYSTD', '', '', '0.00', '35.00', '0.00', 8, '2010-07-01', '2011-06-28', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1215979976', 0, 'N', 0, '2012-06-28', NULL, NULL, 0, 0, NULL, NULL),
('870450251', 'WYT200509', 'WYT200509', 'WYT2', 'The Eye Institute of Utah', 'Randy', 'L', 'Fuja', 'OD', 'Optometry', '', '', NULL, 'O', '2631 Foothill Blvd Ste A', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073624202', NULL, '2631 Foothill Blvd Ste A', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073624202', '          ', 'WYSTD', '', '', '0.00', '35.00', '0.00', 8, '2007-03-01', '2011-06-28', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1215979976', 0, 'N', 0, '2012-06-28', NULL, NULL, 0, 0, NULL, NULL),
('870450251', 'WYT200510', 'WYT200510', 'WYT2', 'The Eye Institute of Utah', 'Randy', 'L', 'Fuja', 'OD', 'Optometry', '', '', NULL, 'B', '755 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '3073624202', NULL, '755 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '3073624202', '          ', 'WYSTD', '', '', '0.00', '35.00', '0.00', 8, '2007-03-01', '2011-06-28', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1215979976', 0, 'Y', 0, '2012-06-28', NULL, NULL, 0, 0, NULL, NULL),
('830182821', 'WYT200433', 'WYT200433', 'WYT2', 'Gottsche Rehabilitation Center', 'Troy', 'M', 'Fulton', 'PT', 'Physical Therapy', '', '', NULL, 'O', '639 W Coulter Ave', 'Powell', 'Park', 'WY', '82435', '3077549262', '          ', '639 W Coulter Ave', 'Powell', 'Park', 'WY', '82435', '3077549262', '          ', '', '', '', '0.00', '10.00', '0.00', 3, '2011-03-15', '2011-07-09', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1013009786', 0, 'N', 0, '2014-04-02', NULL, NULL, 0, 0, NULL, NULL),
('830216112', 'WYT200535', 'WYT200535', 'WYT2', 'Lander Medical Clinic', 'Kacie', '', 'Gallo', 'MD', 'Family Practice', '', '', NULL, 'O', '745 Buena Vista Dr', 'Lander', 'Fremont', 'WY', '82520', '3073322941', NULL, '745 Buena Vista Dr', 'Lander', 'Fremont', 'WY', '82520', '3073322941', '', '', NULL, NULL, '0.00', '10.00', '0.00', 3, '2009-12-15', NULL, 0, 0, 0, 'SageWest Health Care', NULL, NULL, NULL, 'HCFA|UB|', '1285853622', 0, 'n', 0, '2013-08-27', NULL, NULL, 0, 0, NULL, NULL),
('830332771', 'WYT200673', 'WYT200673', 'WYT2', 'ABC Pediatrics', 'Deborah', 'Kim', 'Gardner', 'FNP', 'Pediatrics', 'Infectious Disease', '', NULL, 'O', '1300 W 4th St', 'Gillette', 'Campbell', 'WY', '82716', '3076864900', NULL, '1300 W 4th St', 'Gillette', 'Campbell', 'WY', '82716', '3076864900', '          ', '', '', '', '0.00', '6.50', '0.00', 3, '2008-10-17', '2011-06-28', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1568669489', 0, 'N', 0, '2011-06-30', NULL, NULL, 0, 0, NULL, NULL),
('830217795', 'WYT200280', 'WYT200280', 'WYT2', 'Int Med Group (Cheyenne)', 'Geraldine (Recognized PPO but not contracted)', '', 'Gardner', '', 'Cardiovascular Disease', '', 'Internal Medicine', NULL, 'O', '2301  House Ave', 'Cheyenne', '', 'WY', '82001', '3076354141', NULL, '2301  House Ave', 'Cheyenne', '', 'WY', '82001', '3076354141', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2009-12-15', '2012-12-01', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '0000006361', 0, 'Y', 0, '2012-10-19', NULL, NULL, 0, 0, NULL, NULL),
('830248812', 'WYT200281', 'WYT200281', 'WYT2', '', 'Michael (Recognized PPO but not contracted)', '', 'Garnum', '', 'Pediatrics', '', '', NULL, 'O', '940 E  3rd ST Ste 205', 'Casper', '', 'WY', '82601', '3075774260', NULL, '940 E  3rd ST Ste 205', 'Casper', '', 'WY', '82601', '3075774260', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2009-12-15', '2012-12-01', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '0000006372', 0, 'Y', 0, '2012-10-19', NULL, NULL, 0, 0, NULL, NULL),
('830219655', 'WYT200632', 'WYT200632', 'WYT2', 'Premier Bone and Joint Centers', '', '', 'Premier Bone and Joint Centers', 'GROUP', 'Ambulatory Surgery Center', '', '', NULL, 'B', '111 S 5th St', 'Douglas', 'Converse', 'WY', '82633', '8004465684', NULL, '111 S 5th St', 'Douglas', 'Converse', 'WY', '82633', '8004465684', '          ', '', '', '', '0.00', '10.00', '0.00', 3, '2009-07-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1518947589', 0, 'Y', 0, '2013-03-07', NULL, NULL, 0, 0, NULL, NULL),
('830219655', 'WYT200633', 'WYT200633', 'WYT2', 'Premier Bone and Joint Centers', '', '', 'Premier Bone and Joint Centers', 'GROUP', 'Ambulatory Surgery Center', '', '', NULL, 'B', '1400 Uinta Dr', 'Green River', 'Sweetwater', 'WY', '82935', '8004465684', NULL, '1400 Uinta Dr', 'Green River', 'Sweetwater', 'WY', '82935', '8004465684', '          ', '', '', '', '0.00', '10.00', '0.00', 3, '2009-07-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1518947589', 0, 'Y', 0, '2013-03-07', NULL, NULL, 0, 0, NULL, NULL),
('830219655', 'WYT200634', 'WYT200634', 'WYT2', 'Premier Bone and Joint Centers', '', '', 'Premier Bone and Joint Centers', 'GROUP', 'Ambulatory Surgery Center', '', '', NULL, 'B', '1458 W 5th', 'Sheridan', 'Sheridan', 'WY', '82801', '8004465684', NULL, '1458 W 5th', 'Sheridan', 'Sheridan', 'WY', '82801', '8004465684', '          ', '', '', '', '0.00', '10.00', '0.00', 3, '2009-07-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1518947589', 0, 'Y', 0, '2013-03-07', NULL, NULL, 0, 0, NULL, NULL),
('830219655', 'WYT200635', 'WYT200635', 'WYT2', 'Premier Bone and Joint Centers', '', '', 'Premier Bone and Joint Centers', 'GROUP', 'Ambulatory Surgery Center', '', '', NULL, 'B', '167 S Conwell', 'Casper', 'Natrona', 'WY', '82601', '8004465684', NULL, '167 S Conwell', 'Casper', 'Natrona', 'WY', '82601', '8004465684', '          ', '', '', '', '0.00', '10.00', '0.00', 3, '2009-07-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1518947589', 0, 'Y', 0, '2013-03-07', NULL, NULL, 0, 0, NULL, NULL),
('830219655', 'WYT200636', 'WYT200636', 'WYT2', 'Premier Bone and Joint Centers', '', '', 'Premier Bone and Joint Centers', 'GROUP', 'Ambulatory Surgery Center', '', '', NULL, 'O', '1909 Vista Dr', 'Laramie', 'Albany', 'WY', '82070', '8004465684', NULL, '1909 Vista Dr', 'Laramie', 'Albany', 'WY', '82070', '8004465684', '          ', '', '', '', '0.00', '10.00', '0.00', 3, '2009-07-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1518947589', 0, 'Y', 0, '2013-03-13', NULL, NULL, 0, 0, NULL, NULL),
('830219655', 'WYT200637', 'WYT200637', 'WYT2', 'Premier Bone and Joint Centers', '', '', 'Premier Bone and Joint Centers', 'GROUP', 'Ambulatory Surgery Center', '', '', NULL, 'B', '1950 Bluegrass Cir', 'Cheyenne', 'Laramie', 'WY', '82009', '8004465684', NULL, '1950 Bluegrass Cir', 'Cheyenne', 'Laramie', 'WY', '82009', '8004465684', '          ', '', '', '', '0.00', '10.00', '0.00', 3, '2009-07-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1518947589', 0, 'Y', 0, '2013-03-07', NULL, NULL, 0, 0, NULL, NULL),
('830219655', 'WYT200638', 'WYT200638', 'WYT2', 'Premier Bone and Joint Centers', '', '', 'Premier Bone and Joint Centers', 'GROUP', 'Ambulatory Surgery Center', '', '', NULL, 'B', '2000 Campbell Dr', 'Torrington', 'Goshen', 'WY', '82240', '8004465684', NULL, '2000 Campbell Dr', 'Torrington', 'Goshen', 'WY', '82240', '8004465684', '          ', '', '', '', '0.00', '10.00', '0.00', 3, '2009-07-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1518947589', 0, 'Y', 0, '2013-03-07', NULL, NULL, 0, 0, NULL, NULL),
('830219655', 'WYT200639', 'WYT200639', 'WYT2', 'Premier Bone and Joint Centers', '', '', 'Premier Bone and Joint Centers', 'GROUP', 'Ambulatory Surgery Center', '', '', NULL, 'B', '2002 W Sunset Dr', 'Riverton', 'Fremont', 'WY', '82501', '8004465684', NULL, '2002 W Sunset Dr', 'Riverton', 'Fremont', 'WY', '82501', '8004465684', '          ', '', '', '', '0.00', '10.00', '0.00', 3, '2009-07-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1518947589', 0, 'Y', 0, '2013-03-07', NULL, NULL, 0, 0, NULL, NULL),
('830219655', 'WYT200640', 'WYT200640', 'WYT2', 'Premier Bone and Joint Centers', '', '', 'Premier Bone and Joint Centers', 'GROUP', 'Ambulatory Surgery Center', '', '', NULL, 'B', '201 14th St', 'Wheatland', 'Platte', 'WY', '82201', '8004465684', NULL, '201 14th St', 'Wheatland', 'Platte', 'WY', '82201', '8004465684', '          ', '', '', '', '0.00', '10.00', '0.00', 3, '2009-07-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1518947589', 0, 'Y', 0, '2013-03-07', NULL, NULL, 0, 0, NULL, NULL),
('830219655', 'WYT200641', 'WYT200641', 'WYT2', 'Premier Bone and Joint Centers', '', '', 'Premier Bone and Joint Centers', 'GROUP', 'Ambulatory Surgery Center', '', '', NULL, 'B', '2950 College Dr', 'Rock Springs', 'Sweetwater', 'WY', '82901', '8004465684', NULL, '2950 College Dr', 'Rock Springs', 'Sweetwater', 'WY', '82901', '8004465684', '          ', '', '', '', '0.00', '10.00', '0.00', 3, '2009-07-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1518947589', 0, 'Y', 0, '2013-03-07', NULL, NULL, 0, 0, NULL, NULL),
('830219655', 'WYT200642', 'WYT200642', 'WYT2', 'Premier Bone and Joint Centers', '', '', 'Premier Bone and Joint Centers', 'GROUP', 'Ambulatory Surgery Center', '', '', NULL, 'B', '606 23rd St', 'Rawlins', 'Carbon', 'WY', '82301', '8004465684', NULL, '606 23rd St', 'Rawlins', 'Carbon', 'WY', '82301', '8004465684', '          ', '', '', '', '0.00', '10.00', '0.00', 3, '2009-07-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1518947589', 0, 'Y', 0, '2013-03-07', NULL, NULL, 0, 0, NULL, NULL),
('830219655', 'WYT200643', 'WYT200643', 'WYT2', 'Gem City Bone and Joint', '', '', 'Premier Bone and Joint Centers', 'GROUP', 'Ambulatory Surgery Center', '', '', NULL, 'B', '620 4-J Rd', 'Gillette', 'Campbell', 'WY', '82716', '3076828899', NULL, '620 4-J Rd', 'Gillette', 'Campbell', 'WY', '82716', '3076828899', '          ', '', '', '', '0.00', '10.00', '0.00', 3, '2009-07-01', '2012-12-31', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1518947589', 0, 'Y', 0, '2013-03-07', NULL, NULL, 0, 0, NULL, NULL),
('830234097', 'WYT200282', 'WYT200282', 'WYT2', 'Campbell County Memorial Hospital', 'Daniel', '', 'Gerard', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '501 S Burma Ave', 'Gillette', 'Campbell', 'WY', '82717', '3076881000', NULL, '501 S Burma Ave', 'Gillette', 'Campbell', 'WY', '82717', '3076881000', '          ', '', '', '5001', '0.00', '0.00', '0.00', 3, '2008-09-15', '2008-09-15', 0, 0, 0, 'Campbell County Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '0000006398', 0, 'Y', 0, '2013-09-17', NULL, NULL, 0, 0, NULL, NULL),
('836000891', 'WYT200603', 'WYT200603', 'WYT2', 'North Big Horn Hospital Clinic', 'Derek', '', 'Gilbert', 'MD', 'Family Practice', '', '', NULL, 'O', '1115 Lane 12', 'Lovell', 'Big Horn', 'WY', '82431', '3075485201', NULL, '1115 Lane 12', 'Lovell', 'Big Horn', 'WY', '82431', '3075485201', '          ', '', '', '', '0.00', '10.00', '0.00', 3, '2008-02-01', '2011-06-16', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1477665925', 0, 'N', 0, '2012-04-27', NULL, NULL, 0, 0, NULL, NULL),
('830234097', 'WYT200571', 'WYT200571', 'WYT2', 'Orthopaedic Specialists of Wyoming', 'Jeffrey', 'A', 'Gilles', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '500 Latigo Dr', 'Wright', 'Campbell', 'WY', '82732', '3074640413', NULL, '500 Latigo Dr', 'Wright', 'Campbell', 'WY', '82732', '3074640413', '          ', '', '', '5001', '0.00', '0.00', '0.00', 3, '2010-06-11', '2010-06-11', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1417004334', 0, 'N', 0, '2013-09-19', NULL, NULL, 0, 0, NULL, NULL),
('830234097', 'WYT200572', 'WYT200572', 'WYT2', 'Campbell County Memorial Hospital', 'Jeffrey', 'A', 'Gilles', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '501 S Burma Ave Ste 3500', 'Gillette', 'Campbell', 'WY', '82717', '3076883510', NULL, '501 S Burma Ave Ste 3500', 'Gillette', 'Campbell', 'WY', '82717', '3076883510', '          ', '', '', '5001', '0.00', '0.00', '0.00', 3, '2010-04-14', '2010-04-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1417004334', 0, 'N', 0, '2013-09-19', NULL, NULL, 0, 0, NULL, NULL),
('830234097', 'WYT200573', 'WYT200573', 'WYT2', 'Orthopaedic Specialists of Wyoming', 'Jeffrey', 'A', 'Gilles', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', 'PO Box 3011', 'Gillette', 'Campbell', 'WY', '82717', '3074640413', NULL, 'PO Box 3011', 'Gillette', 'Campbell', 'WY', '82717', '3074640413', '          ', '', '', '5001', '0.00', '0.00', '0.00', 3, '2010-06-11', '2010-06-11', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1417004334', 0, 'N', 0, '2013-09-19', NULL, NULL, 0, 0, NULL, NULL),
('830270913', 'WYT200569', 'WYT200569', 'WYT2', 'Gillette Medical Imaging', '', '', 'Gillette Medical Imaging', '', 'Imaging Center', '', '', NULL, 'O', '501 S Burma Ave', 'Gillette', 'Campbell', 'WY', '82716', '3076881600', NULL, '501 S Burma Ave', 'Gillette', 'Campbell', 'WY', '82716', '3076881600', '          ', '', '', '', '0.00', '7.00', '0.00', 3, '2010-04-30', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1407956246', 0, 'N', 0, '2013-06-28', NULL, NULL, 0, 0, NULL, NULL),
('830270913', 'WYT200570', 'WYT200570', 'WYT2', 'Gillette Medical Imaging', '', '', 'Gillette Medical Imaging', '', 'Imaging Center', '', '', NULL, 'B', 'PO Box 638', 'Gillette', 'Campbell', 'WY', '82717', '3076881600', NULL, 'PO Box 638', 'Gillette', 'Campbell', 'WY', '82717', '3076881600', '          ', '', '', '', '0.00', '7.00', '0.00', 3, '2010-04-30', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1407956246', 0, 'Y', 0, '2013-06-28', NULL, NULL, 0, 0, NULL, NULL),
('331065329', 'WYT200685', 'WYT200685', 'WYT2', 'Gillette Urgent Care', '', '', 'Gillette Urgent Care', 'GROUP', 'Urgent Care', '', '', NULL, 'O', '2007 S Douglas Hwy Ste E2', 'Gillette', 'Campbell', 'WY', '82718', '3076865750', NULL, '2007 S Douglas Hwy Ste E2', 'Gillette', 'Campbell', 'WY', '82718', '3076865750', '', '', NULL, NULL, '0.00', '10.00', '0.00', 3, '2007-09-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1609896455', 0, 'n', 0, '2012-03-20', NULL, NULL, 0, 0, NULL, NULL),
('270104373', 'WYT200585', 'WYT200585', 'WYT2', 'Yellowstone Radiology', 'Travis', 'S', 'Graham', '', 'Diagnostic Radiology', '', '', NULL, 'O', '707 Sheridan Ave', 'Cody', 'Park', 'WY', '82414', '3075782372', NULL, '707 Sheridan Ave', 'Cody', 'Park', 'WY', '82414', '3075782372', '          ', 'WYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-07-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1417926528', 0, 'Y', 0, '2011-06-29', NULL, NULL, 0, 0, NULL, NULL),
('270104373', 'WYT200586', 'WYT200586', 'WYT2', 'Yellowstone Radiology', 'Travis', 'S', 'Graham', '', 'Diagnostic Radiology', '', '', NULL, 'B', 'PO Box 1829', 'Coeur D Alene', 'Kootenai', 'ID', '83816', '2086679334', NULL, 'PO Box 1829', 'Coeur D Alene', 'Kootenai', 'ID', '83816', '2086679334', '          ', 'WYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-07-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1417926528', 0, 'N', 0, '2011-06-29', NULL, NULL, 0, 0, NULL, NULL),
('830216112', 'WYT200612', 'WYT200612', 'WYT2', 'Lander Medical Clinic', 'Donald', '', 'Gullickson', 'MD', 'Internal Medicine', '', '', NULL, 'O', '745 Buena Vista Dr', 'Lander', 'Fremont', 'WY', '82520', '3073322941', NULL, '745 Buena Vista Dr', 'Lander', 'Fremont', 'WY', '82520', '3073322941', '', '', NULL, NULL, '0.00', '10.00', '0.00', 3, '2009-08-15', NULL, 0, 0, 1, 'SageWest Health Care', NULL, NULL, NULL, 'HCFA|UB|', '1497840110', 0, 'n', 0, '2012-07-18', NULL, NULL, 0, 0, NULL, NULL),
('830234097', 'WYT200283', 'WYT200283', 'WYT2', 'Campbell County Memorial Hospital', 'Landi', '', 'Halloran', 'MD', 'Hospitalist', '', '', NULL, 'O', '501 S Burma Ave', 'Gillette', 'Campbell', 'WY', '82717', '3076881000', NULL, '501 S Burma Ave', 'Gillette', 'Campbell', 'WY', '82717', '3076881000', '          ', '', '', '5001', '0.00', '0.00', '0.00', 3, '2008-09-15', '2008-09-15', 0, 0, 0, 'Campbell County Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '0000006540', 0, 'Y', 0, '2013-09-17', NULL, NULL, 0, 0, NULL, NULL),
('521486235', 'WYT200284', 'WYT200284', 'WYT2', 'Hanger Prosthetics & Orthotics Inc', '', '', 'Hanger Prosthetics & Orthotics Inc', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'o', '148 E Arapaho Box 168', 'Thermopolis', 'Hot Springs', 'WY', '82443', '3078645530', '3078643281', '148 E Arapaho Box 168', 'Thermopolis', 'Hot Springs', 'WY', '82443', '3078645530', '3078643281', 'WUDME5', '', '', '0.00', '35.00', '0.00', 3, '2006-10-01', '2012-03-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000006560', 0, 'N', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('521486235', 'WYT200285', 'WYT200285', 'WYT2', 'Hanger Prosthetics & Orthotics Inc', '', '', 'Hanger Prosthetics & Orthotics Inc', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'o', '557 Broadway', 'Sheridan', 'Sheridan', 'WY', '82801', '3076720497', '3076720480', '557 Broadway', 'Sheridan', 'Sheridan', 'WY', '82801', '3076720497', '3076720480', 'WUDME5', '', '', '0.00', '35.00', '0.00', 3, '2006-10-01', '2012-03-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000006560', 0, 'N', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('841271328', 'WYT200625', 'WYT200625', 'WYT2', '', 'Robert', 'S', 'Hanna', 'MD', 'Ophthalmology', '', '', NULL, 'O', '340 W Dow', 'Sheridan', 'Sheridan', 'WY', '82801', '3076731704', NULL, '340 W Dow', 'Sheridan', 'Sheridan', 'WY', '82801', '3076731704', '', 'WiseWYSTD', 'Wyhcpcs', '', '0.00', '35.00', '0.00', 3, '2007-07-01', '2011-06-28', 0, 0, 0, 'Sheridan Memorial Hospital', '', '', '', 'HCFA|UB|', '1508908799', 0, 'N', 0, '2014-05-12', NULL, NULL, 0, 0, NULL, NULL),
('200070263', 'WYT200611', 'WYT200611', 'WYT2', 'Wind River OB/GYN', 'Maryanne', 'A', 'Hannaney', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1005 College View Dr', 'Riverton', 'Fremont', 'WY', '82501', '3078575217', NULL, '1005 College View Dr', 'Riverton', 'Fremont', 'WY', '82501', '3078575217', '          ', '', '', '', '0.00', '20.00', '0.00', 3, '2008-03-01', '2011-06-28', 0, 0, 1, 'SageWest Health Care', NULL, NULL, NULL, 'HCFA|UB|', '1497797260', 0, 'N', 0, '2012-01-17', NULL, NULL, 0, 0, NULL, NULL),
('204528561', 'WYT200471', 'WYT200471', 'WYT2', 'Family Vision Clinic', 'Mike', 'E', 'Harris', 'OD', 'Optometry', '', '', NULL, 'O', '2510 E 15th St Ste 1', 'Casper', 'Natrona', 'WY', '82609', '3072378713', NULL, '2510 E 15th St Ste 1', 'Casper', 'Natrona', 'WY', '82609', '3072378713', '          ', 'WISEWYSTD', 'wyhcpcs', '', '0.00', '35.00', '0.00', 3, '2007-09-01', '2011-06-28', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1104819333', 0, 'N', 0, '2011-06-29', NULL, NULL, 0, 0, NULL, NULL),
('830234097', 'WYT200286', 'WYT200286', 'WYT2', 'Campbell County Memorial Hospital', 'Suzanne', '', 'Harris', 'MD', 'Hospitalist', '', '', NULL, 'O', '501 S Burma Ave', 'Gillette', 'Campbell', 'WY', '82717', '3076881000', NULL, '501 S Burma Ave', 'Gillette', 'Campbell', 'WY', '82717', '3076881000', '          ', '', '', '5001', '0.00', '0.00', '0.00', 3, '2008-09-15', '2008-09-15', 0, 0, 0, 'Campbell County Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '0000006598', 0, 'Y', 0, '2013-09-17', NULL, NULL, 0, 0, NULL, NULL),
('203360654', 'WYT200789', 'WYT200789', 'WYT2', 'Western Medical Associates', 'Brehan', 'A', 'Newell', 'FNP', 'Family Practice', '', '', NULL, 'O', '3230 Cy Ave', 'Casper', 'Natrona', 'WY', '82604', '3075775100', NULL, '3230 Cy Ave', 'Casper', 'Natrona', 'WY', '82604', '3075775100', '', '', '', '', '0.00', '10.00', '0.00', 3, '2010-09-30', NULL, 0, 0, 0, 'Mountain View Regional Hospital', '', '', '', 'HCFA|UB|', '1922335579', 0, 'N', 0, '2014-04-02', NULL, NULL, 0, 0, NULL, NULL),
('203360654', 'WYT200790', 'WYT200790', 'WYT2', 'Western Medical Associates', 'Brehan', 'A', 'Newell', 'FNP', 'Family Practice', '', '', NULL, 'O', '6500 E 2nd St Ste 200', 'Casper', 'Natrona', 'WY', '82609', '3075775100', NULL, '6500 E 2nd St Ste 200', 'Casper', 'Natrona', 'WY', '82609', '3075775100', '', '', '', '', '0.00', '10.00', '0.00', 3, '2010-09-30', NULL, 0, NULL, 0, 'Mountain View Regional Hospital', '', '', '', 'HCFA|UB|', '1922335579', 0, 'N', 0, '2014-04-02', NULL, NULL, 0, 0, NULL, NULL),
('830207671', 'WYT200601', 'WYT200601', 'WYT2', 'West Park Hospital Disctrict ', 'Lisa', 'E', 'Harvey', 'MD', 'Family Practice', '', '', NULL, 'O', '424 Yellowstone Ave Ste 120', 'Cody', 'Park', 'WY', '82414', '3075787207', '3075782937', '424 Yellowstone Ave Ste 120', 'Cody', 'Park', 'WY', '82414', '3075787207', '3075782937', '', '', '', '0.00', '10.00', '0.00', 3, '2011-07-01', '2011-07-01', 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1477527299', 0, 'N', 0, '2014-04-10', NULL, NULL, 0, 0, NULL, NULL),
('830207671', 'WYT200602', 'WYT200602', 'WYT2', 'West Park Hospital Disctrict ', 'Lisa', 'E', 'Harvey', 'MD', 'Family Practice', '', '', NULL, 'B', '707 Sheridan Ave', 'Cody', 'Park', 'WY', '82414', '3075787207', '3075782937', '707 Sheridan Ave', 'Cody', 'Park', 'WY', '82414', '3075787207', '3075782937', '', '', '', '0.00', '10.00', '0.00', 3, '2011-07-01', '2011-07-01', 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1477527299', 0, 'N', 0, '2014-04-10', NULL, NULL, 0, 0, NULL, NULL),
('870393111', 'WYT200686', 'WYT200686', 'WYT2', 'Sweetwater Audiology', 'Stephen', 'B', 'Harward', 'AUD', 'Audiology', '', '', NULL, 'B', '425 E 5350 S Ste 120', 'Ogden', 'Weber', 'UT', '84405', '8014793346', NULL, '425 E 5350 S Ste 120', 'Ogden', 'Weber', 'UT', '84405', '8014793346', '', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-12-01', '2011-06-28', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1609899459', 0, 'Y', 0, '2014-06-04', NULL, NULL, 0, 0, NULL, NULL),
('870393111', 'WYT200687', 'WYT200687', 'WYT2', 'Sweetwater Audiology', 'Stephen', 'B', 'Harward', 'AUD', 'Audiology', '', '', NULL, 'O', '430 Broadway St 2nd Fl', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073628221', NULL, '430 Broadway St 2nd Fl', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073628221', '', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-12-01', '2011-06-28', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1609899459', 0, 'N', 0, '2014-06-04', NULL, NULL, 0, 0, NULL, NULL),
('830234097', 'WYT200287', 'WYT200287', 'WYT2', 'Campbell County Memorial Hospital', 'Jonathan', '', 'Hayden', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '501 S Burma Ave', 'Gillette', 'Campbell', 'WY', '82717', '3076881000', NULL, '501 S Burma Ave', 'Gillette', 'Campbell', 'WY', '82717', '3076881000', '          ', '', '', '5001', '0.00', '0.00', '0.00', 3, '2008-09-15', '2008-09-15', 0, 0, 0, 'Campbell County Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '0000006620', 0, 'Y', 0, '2013-09-17', NULL, NULL, 0, 0, NULL, NULL),
('830326307', 'WYT200288', 'WYT200288', 'WYT2', 'Community Health Ctr', 'Coleen (Recognized PPO but not contracted)', '', 'Haynes', '', 'Family Practice', '', '', NULL, 'O', '1522 E  A  St', 'Casper', '', 'WY', '82601', '3072336035', NULL, '1522 E  A  St', 'Casper', '', 'WY', '82601', '3072336035', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2009-12-15', '2012-09-30', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '0000006622', 0, 'Y', 0, '2012-10-11', NULL, NULL, 0, 0, NULL, NULL),
('742909001', 'WYT200289', 'WYT200289', 'WYT2', 'Healthtronics Memorial Hospital of Sweetwater Co', '', '', 'Healthtronics Inc', 'GROUP', 'Lithotriptor', '', '', NULL, 'O', '1200 Colledge Dr', 'Rock Springs', 'Sweetwater', 'WY', '82901', '8663144242', NULL, '1200 Colledge Dr', 'Rock Springs', 'Sweetwater', 'WY', '82901', '8663144242', '          ', '', '', '6', '0.00', '100.00', '0.00', 3, '2006-10-01', '2011-06-24', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '0000006635', 0, 'Y', 0, '2011-06-24', NULL, NULL, 0, 0, NULL, NULL),
('742909001', 'WYT200290', 'WYT200290', 'WYT2', 'Healthtronics Memorial Hospital of Sweetwater County', '', '', 'Healthtronics Inc', 'GROUP', 'Lithotriptor', '', '', NULL, 'O', '1200 Colledge Dr', 'ROCK SPRINGS', 'Sweetwater', 'WY', '82901', '8663144242', NULL, '1200 Colledge Dr', 'ROCK SPRINGS', 'Sweetwater', 'WY', '82901', '8663144242', '          ', '', '', '6', '0.00', '100.00', '0.00', 3, '2006-12-01', '2011-06-24', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '0000006635', 0, 'Y', 0, '2011-06-24', NULL, NULL, 0, 0, NULL, NULL),
('742909001', 'WYT200291', 'WYT200291', 'WYT2', 'Healthtronics Wyoming Medical Center', '', '', 'Healthtronics Inc', 'GROUP', 'Lithotriptor', '', '', NULL, 'O', '1233 E 2nd St', 'CASPER', 'Natrona', 'WY', '82601', '8663144242', NULL, '1233 E 2nd St', 'CASPER', 'Natrona', 'WY', '82601', '8663144242', '          ', '', '', '6', '0.00', '100.00', '0.00', 3, '2006-10-01', '2011-06-24', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '0000006635', 0, 'Y', 0, '2011-06-24', NULL, NULL, 0, 0, NULL, NULL),
('742909001', 'WYT200292', 'WYT200292', 'WYT2', 'Healthtronics Memorial Hospital of Sheridan Co', '', '', 'Healthtronics Inc', 'GROUP', 'Lithotriptor', '', '', NULL, 'O', '1401 W 5th St', 'Sheridan', 'Sheridan', 'WY', '82801', '8663144242', NULL, '1401 W 5th St', 'Sheridan', 'Sheridan', 'WY', '82801', '8663144242', '          ', '', '', '6', '0.00', '100.00', '0.00', 3, '2006-10-01', '2011-06-24', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '0000006635', 0, 'Y', 0, '2011-06-24', NULL, NULL, 0, 0, NULL, NULL),
('742909001', 'WYT200293', 'WYT200293', 'WYT2', 'Healthtronics Memorial Hospital of Sheridan County', '', '', 'Healthtronics Inc', 'GROUP', 'Lithotriptor', '', '', NULL, 'O', '1401 W 5th St', 'SHERIDAN', 'Sheridan', 'WY', '82801', '8663144242', NULL, '1401 W 5th St', 'SHERIDAN', 'Sheridan', 'WY', '82801', '8663144242', '          ', '', '', '6', '0.00', '100.00', '0.00', 3, '2006-12-01', '2011-06-24', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '0000006635', 0, 'Y', 0, '2011-06-24', NULL, NULL, 0, 0, NULL, NULL),
('742909001', 'WYT200294', 'WYT200294', 'WYT2', 'Healthtronics Riverton Memorial Hospital', '', '', 'Healthtronics Inc', 'GROUP', 'Lithotriptor', '', '', NULL, 'O', '2100 W Sunset', 'Riverton', 'Fremont', 'WY', '82501', '8663144242', NULL, '2100 W Sunset', 'Riverton', 'Fremont', 'WY', '82501', '8663144242', '          ', '', '', '6', '0.00', '100.00', '0.00', 3, '2006-10-01', '2011-06-24', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '0000006635', 0, 'Y', 0, '2011-06-24', NULL, NULL, 0, 0, NULL, NULL),
('742909001', 'WYT200295', 'WYT200295', 'WYT2', 'Healthtronics Riverton Memorial Hospital', '', '', 'Healthtronics Inc', 'GROUP', 'Lithotriptor', '', '', NULL, 'O', '2100 W Sunset', 'RIVERTON', 'Fremont', 'WY', '82501', '8663144242', NULL, '2100 W Sunset', 'RIVERTON', 'Fremont', 'WY', '82501', '8663144242', '          ', '', '', '6', '0.00', '100.00', '0.00', 3, '2006-12-01', '2011-06-24', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '0000006635', 0, 'Y', 0, '2011-06-24', NULL, NULL, 0, 0, NULL, NULL),
('742909001', 'WYT200296', 'WYT200296', 'WYT2', 'Healthtronics Ivinson Memorial Hospital', '', '', 'Healthtronics Inc', 'GROUP', 'Lithotriptor', '', '', NULL, 'O', '255 N 30th St', 'Laramie', 'Albany', 'WY', '82070', '8663144242', NULL, '255 N 30th St', 'Laramie', 'Albany', 'WY', '82070', '8663144242', '          ', '', '', '6', '0.00', '100.00', '0.00', 3, '2006-10-01', '2011-06-24', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '0000006635', 0, 'Y', 0, '2011-06-24', 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
('742909001', 'WYT200297', 'WYT200297', 'WYT2', 'Healthtronics United Medical Center', '', '', 'Healthtronics Inc', 'GROUP', 'Lithotriptor', '', '', NULL, 'O', '2600 E 18th St', 'CHEYENNE', 'Laramie', 'WY', '82001', '8663144242', NULL, '2600 E 18th St', 'CHEYENNE', 'Laramie', 'WY', '82001', '8663144242', '          ', '', '', '6', '0.00', '100.00', '0.00', 3, '2006-10-01', '2011-06-24', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '0000006635', 0, 'Y', 0, '2011-06-24', NULL, NULL, 0, 0, NULL, NULL),
('742909001', 'WYT200298', 'WYT200298', 'WYT2', 'Healthtronics United Medical Center', '', '', 'Healthtronics Inc', 'GROUP', 'Lithotriptor', '', '', NULL, 'O', '2600 E 18th St', 'CHEYENNE', 'Laramie', 'WY', '82001', '8663144242', NULL, '2600 E 18th St', 'CHEYENNE', 'Laramie', 'WY', '82001', '8663144242', '          ', '', '', '6', '0.00', '100.00', '0.00', 3, '2006-12-01', '2011-06-24', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '0000006635', 0, 'Y', 0, '2011-06-24', NULL, NULL, 0, 0, NULL, NULL),
('742909001', 'WYT200299', 'WYT200299', 'WYT2', 'Healthtronics Sheridan Surgical Center', '', '', 'Healthtronics Inc', 'GROUP', 'Lithotriptor', '', '', NULL, 'O', '425 W 5th St', 'SHERIDAN', 'Sheridan', 'WY', '82801', '8663144242', NULL, '425 W 5th St', 'SHERIDAN', 'Sheridan', 'WY', '82801', '8663144242', '          ', '', '', '6', '0.00', '100.00', '0.00', 3, '2006-10-01', '2011-06-24', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '0000006635', 0, 'Y', 0, '2011-06-24', NULL, NULL, 0, 0, NULL, NULL),
('742909001', 'WYT200300', 'WYT200300', 'WYT2', 'Healthtronics St Johns Hospital', '', '', 'Healthtronics Inc', 'GROUP', 'Lithotriptor', '', '', NULL, 'O', '625 E Broadway St', 'JACKSON', 'Teton', 'WY', '83001', '8663144242', NULL, '625 E Broadway St', 'JACKSON', 'Teton', 'WY', '83001', '8663144242', '          ', '', '', '6', '0.00', '100.00', '0.00', 3, '2006-10-01', '2011-06-24', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '0000006635', 0, 'Y', 0, '2011-06-24', NULL, NULL, 0, 0, NULL, NULL),
('742909001', 'WYT200301', 'WYT200301', 'WYT2', 'Healthtronics St Johns Hospital', '', '', 'Healthtronics Inc', 'GROUP', 'Lithotriptor', '', '', NULL, 'O', '625 E Broadway St', 'JACKSON', 'Teton', 'WY', '83001', '8663144242', NULL, '625 E Broadway St', 'JACKSON', 'Teton', 'WY', '83001', '8663144242', '          ', '', '', '6', '0.00', '100.00', '0.00', 3, '2006-12-01', '2011-06-24', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '0000006635', 0, 'Y', 0, '2011-06-24', NULL, NULL, 0, 0, NULL, NULL),
('742909001', 'WYT200302', 'WYT200302', 'WYT2', 'Healthtronics West Park Hospital', '', '', 'Healthtronics Inc', 'GROUP', 'Lithotriptor', '', '', NULL, 'O', '707 Sheridan Ave', 'CODY', 'Park', 'WY', '82414', '8663144242', NULL, '707 Sheridan Ave', 'CODY', 'Park', 'WY', '82414', '8663144242', '          ', '', '', '6', '0.00', '100.00', '0.00', 3, '2006-10-01', '2011-06-24', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '0000006635', 0, 'Y', 0, '2011-06-24', NULL, NULL, 0, 0, NULL, NULL),
('770254359', 'WYT200303', 'WYT200303', 'WYT2', 'Healthtronics Wyoming Medical Center', '', '', 'Healthtronics Inc', 'GROUP', 'Lithotriptor', '', '', NULL, 'O', '1233 E 2nd St', 'Casper', 'Natrona', 'WY', '82601', '8663144242', NULL, '1233 E 2nd St', 'Casper', 'Natrona', 'WY', '82601', '8663144242', '          ', '', '', '6', '0.00', '100.00', '0.00', 3, '2006-10-01', '2011-06-24', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '0000006635', 0, 'Y', 0, '2011-06-24', NULL, NULL, 0, 0, NULL, NULL),
('770254359', 'WYT200304', 'WYT200304', 'WYT2', 'Healthtronics Wyoming Medical Center', '', '', 'Healthtronics Inc', 'GROUP', 'Lithotriptor', '', '', NULL, 'O', '1233 E 2nd St', 'CASPER', 'Natrona', 'WY', '82601', '8663144242', NULL, '1233 E 2nd St', 'CASPER', 'Natrona', 'WY', '82601', '8663144242', '          ', '', '', '6', '0.00', '100.00', '0.00', 3, '2006-12-01', '2011-06-24', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '0000006635', 0, 'Y', 0, '2011-06-24', NULL, NULL, 0, 0, NULL, NULL),
('770254359', 'WYT200305', 'WYT200305', 'WYT2', 'Healthtronics Sheridan Memorial Hospital', '', '', 'Healthtronics Inc', 'GROUP', 'Lithotriptor', '', '', NULL, 'O', '1401 W 5th St', 'Sheridan', 'Sheridan', 'WY', '82801', '8663144242', NULL, '1401 W 5th St', 'Sheridan', 'Sheridan', 'WY', '82801', '8663144242', '          ', '', '', '6', '0.00', '100.00', '0.00', 3, '2006-10-01', '2011-06-24', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '0000006635', 0, 'Y', 0, '2011-06-24', NULL, NULL, 0, 0, NULL, NULL),
('770254359', 'WYT200306', 'WYT200306', 'WYT2', 'Healthtronics Sheridan Memorial Hospital', '', '', 'Healthtronics Inc', 'GROUP', 'Lithotriptor', '', '', NULL, 'O', '1401 W 5th St', 'SHERIDAN', 'Sheridan', 'WY', '82801', '8663144242', NULL, '1401 W 5th St', 'SHERIDAN', 'Sheridan', 'WY', '82801', '8663144242', '          ', '', '', '6', '0.00', '100.00', '0.00', 3, '2006-12-01', '2011-06-24', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '0000006635', 0, 'Y', 0, '2011-06-24', NULL, NULL, 0, 0, NULL, NULL),
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('770254359', 'WYT200308', 'WYT200308', 'WYT2', 'Healthtronics Riverton Memorial Hospital', '', '', 'Healthtronics Inc', 'GROUP', 'Lithotriptor', '', '', NULL, 'O', '2100 W Sunset', 'RIVERTON', 'Fremont', 'WY', '82501', '8663144242', NULL, '2100 W Sunset', 'RIVERTON', 'Fremont', 'WY', '82501', '8663144242', '          ', '', '', '6', '0.00', '100.00', '0.00', 3, '2006-12-01', '2011-06-24', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '0000006635', 0, 'Y', 0, '2011-06-24', NULL, NULL, 0, 0, NULL, NULL),
('770254359', 'WYT200309', 'WYT200309', 'WYT2', 'Healthtronics Ivinson Memorial Hospital', '', '', 'Healthtronics Inc', 'GROUP', 'Lithotriptor', '', '', NULL, 'O', '255 N 30th St', 'Laramie', 'Albany', 'WY', '82070', '8663144242', NULL, '255 N 30th St', 'Laramie', 'Albany', 'WY', '82070', '8663144242', '          ', '', '', '6', '0.00', '100.00', '0.00', 3, '2006-10-01', '2011-06-24', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '0000006635', 0, 'Y', 0, '2011-06-24', NULL, NULL, 0, 0, NULL, NULL),
('770254359', 'WYT200310', 'WYT200310', 'WYT2', 'Healthtronics Ivinson Memorial Hospital', '', '', 'Healthtronics Inc', 'GROUP', 'Lithotriptor', '', '', NULL, 'O', '255 N 30th St', 'LARAMIE', 'Albany', 'WY', '82070', '8663144242', NULL, '255 N 30th St', 'LARAMIE', 'Albany', 'WY', '82070', '8663144242', '          ', '', '', '6', '0.00', '100.00', '0.00', 3, '2006-12-01', '2011-06-24', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '0000006635', 0, 'Y', 0, '2011-06-24', NULL, NULL, 0, 0, NULL, NULL),
('770254359', 'WYT200311', 'WYT200311', 'WYT2', 'Healthtronics Sheridan Surgical Center', '', '', 'Healthtronics Inc', 'GROUP', 'Lithotriptor', '', '', NULL, 'O', '425 W 5th St', 'Sheridan', 'Sheridan', 'WY', '82801', '8663144242', NULL, '425 W 5th St', 'Sheridan', 'Sheridan', 'WY', '82801', '8663144242', '          ', '', '', '6', '0.00', '100.00', '0.00', 3, '2006-10-01', '2011-06-24', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '0000006635', 0, 'Y', 0, '2011-06-24', NULL, NULL, 0, 0, NULL, NULL),
('770254359', 'WYT200312', 'WYT200312', 'WYT2', 'Healthtronics Sheridan Surgical Center', '', '', 'Healthtronics Inc', 'GROUP', 'Lithotriptor', '', '', NULL, 'O', '425 W 5th St', 'SHERIDAN', 'Sheridan', 'WY', '82801', '8663144242', NULL, '425 W 5th St', 'SHERIDAN', 'Sheridan', 'WY', '82801', '8663144242', '          ', '', '', '6', '0.00', '100.00', '0.00', 3, '2006-12-01', '2011-06-24', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '0000006635', 0, 'Y', 0, '2011-06-24', NULL, NULL, 0, 0, NULL, NULL),
('770254359', 'WYT200313', 'WYT200313', 'WYT2', 'Healthtronics Inc Ivinson Memorial Hospital', '', '', 'Healthtronics Inc Ivinson Memorial Hospital', 'GROUP', 'Lithotriptor', '', '', NULL, 'O', '255 N 30th St', 'LARAMIE', 'Albany', 'WY', '82070', '8663144242', NULL, '255 N 30th St', 'LARAMIE', 'Albany', 'WY', '82070', '8663144242', '          ', '', '', '6', '0.00', '100.00', '0.00', 3, '2006-12-01', '2011-06-27', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '0000006636', 0, 'Y', 0, '2011-06-28', NULL, NULL, 0, 0, NULL, NULL),
('770254359', 'WYT200314', 'WYT200314', 'WYT2', 'Healthtronics Inc Riverton Memorial Hospital', '', '', 'Healthtronics Inc Riverton Memorial Hospital', 'GROUP', 'Lithotriptor', '', '', NULL, 'O', '2100 W Sunset', 'RIVERTON', 'Fremont', 'WY', '82501', '8663144242', NULL, '2100 W Sunset', 'RIVERTON', 'Fremont', 'WY', '82501', '8663144242', '          ', '', '', '6', '0.00', '100.00', '0.00', 3, '2006-12-01', '2011-06-27', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '0000006637', 0, 'Y', 0, '2011-06-28', NULL, NULL, 0, 0, NULL, NULL),
('770254359', 'WYT200315', 'WYT200315', 'WYT2', 'Healthtronics Inc Sheridan Memorial Hospital', '', '', 'Healthtronics Inc Sheridan Memorial Hospital', 'GROUP', 'Lithotriptor', '', '', NULL, 'O', '1401 W 5th St', 'SHERIDAN', 'Sheridan', 'WY', '82801', '8663144242', NULL, '1401 W 5th St', 'SHERIDAN', 'Sheridan', 'WY', '82801', '8663144242', '          ', '', '', '6', '0.00', '100.00', '0.00', 3, '2006-12-01', '2011-06-27', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '0000006638', 0, 'Y', 0, '2011-06-28', NULL, NULL, 0, 0, NULL, NULL),
('770254359', 'WYT200316', 'WYT200316', 'WYT2', 'Healthtronics Inc Sheridan Surgical Center', '', '', 'Healthtronics Inc Sheridan Surgical Center', 'GROUP', 'Lithotriptor', '', '', NULL, 'O', '425 W 5th St', 'SHERIDAN', 'Sheridan', 'WY', '82801', '8663144242', NULL, '425 W 5th St', 'SHERIDAN', 'Sheridan', 'WY', '82801', '8663144242', '          ', '', '', '6', '0.00', '100.00', '0.00', 3, '2006-12-01', '2011-06-27', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '0000006639', 0, 'Y', 0, '2011-06-28', NULL, NULL, 0, 0, NULL, NULL),
('770254359', 'WYT200317', 'WYT200317', 'WYT2', 'Healthtronics Inc Wyoming Medical Center', '', '', 'Healthtronics Inc Wyoming Medical Center', 'GROUP', 'Lithotriptor', '', '', NULL, 'O', '1233 E 2nd St', 'CASPER', 'Natrona', 'WY', '82601', '8663144242', NULL, '1233 E 2nd St', 'CASPER', 'Natrona', 'WY', '82601', '8663144242', '          ', '', '', '6', '0.00', '100.00', '0.00', 3, '2006-12-01', '2011-06-27', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '0000006640', 0, 'Y', 0, '2011-06-28', NULL, NULL, 0, 0, NULL, NULL),
('203360654', 'WYT200648', 'WYT200648', 'WYT2', 'Western Medical Associates', 'Stefanie', '', 'Garcia', 'PA-C', 'Family Practice', '', '', NULL, 'O', '3230 Cy Ave', 'Casper', 'Natrona', 'WY', '82604', '3075775100', NULL, '3230 Cy Ave', 'Casper', 'Natrona', 'WY', '82604', '3075775100', '          ', '', '', '', '0.00', '10.00', '0.00', 3, '2010-09-30', NULL, 0, 0, 0, 'Mountain View Regional Hospital', '', '', '', 'HCFA|UB|', '1528210523', 0, 'N', 0, '2014-03-24', NULL, NULL, 0, 0, NULL, NULL),
('203360654', 'WYT200649', 'WYT200649', 'WYT2', 'Western Medical Associates', 'Stefanie', '', 'Garcia', 'PA-C', 'Family Practice', '', '', NULL, 'O', '6500 E 2nd St Ste 200', 'Casper', 'Natrona', 'WY', '82609', '3075775100', NULL, '6500 E 2nd St Ste 200', 'Casper', 'Natrona', 'WY', '82609', '3075775100', '          ', '', '', '', '0.00', '10.00', '0.00', 3, '2010-09-30', NULL, 0, 0, 0, 'Mountain View Regional Hospital', '', '', '', 'HCFA|UB|', '1528210523', 0, 'N', 0, '2014-03-24', NULL, NULL, 0, 0, NULL, NULL),
('830327251', 'WYT200663', 'WYT200663', 'WYT2', 'Star Valley Medical Center', 'Gary ', '', 'Hess', 'APRN', 'Anesthesia', '', '', NULL, 'O', '901 Adams St', 'Afton', 'Lincoln', 'WY', '83110', '3078855817', NULL, '901 Adams St', 'Afton', 'Lincoln', 'WY', '83110', '3078855817', '          ', 'WSTARV', 'wyhcpcs', '', '0.00', '10.00', '0.00', 6, '2010-09-08', '2011-06-27', 0, 0, 1, 'Star Valley Medical Center', '', '', '', 'HCFA|UB|', '1558396911', 0, 'Y', 0, '2013-06-28', NULL, NULL, 0, 0, NULL, NULL),
('830327251', 'WYT200664', 'WYT200664', 'WYT2', 'Star Valley Medical Center', 'Gary ', '', 'Hess', 'APRN', 'Anesthesia', '', '', NULL, 'B', 'PO Box 579', 'Afton', 'Lincoln', 'WY', '83110', '3078855817', NULL, 'PO Box 579', 'Afton', 'Lincoln', 'WY', '83110', '3078855817', '          ', 'WSTARV', 'wyhcpcs', '', '0.00', '10.00', '0.00', 6, '2010-09-08', '2011-06-27', 0, 0, 1, 'Star Valley Medical Center', '', '', '', 'HCFA|UB|', '1558396911', 0, 'Y', 0, '2013-06-28', NULL, NULL, 0, 0, NULL, NULL),
('830291130', 'WYT200767', 'WYT200767', 'WYT2', 'Gillette Chiropractic Center', 'Todd', 'A', 'Hildebrand', 'DC', 'Chiropractic', '', '', NULL, 'O', '1001 4-J Rd', 'Gillette', 'Campbell', 'WY', '82716', '3076862327', '3076871106', '1001 4-J Rd', 'Gillette', 'Campbell', 'WY', '82716', '3076862327', '3076871106', '', '', '5004', '0.00', '100.00', '0.00', 3, '2007-10-01', '2011-06-27', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1811906845', 0, 'N', 0, '2014-04-21', NULL, NULL, 0, 0, NULL, NULL),
('830326307', 'WYT200318', 'WYT200318', 'WYT2', 'Community Health Ctr', 'Vincent (Recognized PPO but not contracted)', '', 'Hinshaw', '', 'Family Practice', '', '', NULL, 'O', '1522 E  A  St', 'Casper', '', 'WY', '82601', '3072336035', NULL, '1522 E  A  St', 'Casper', '', 'WY', '82601', '3072336035', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2009-12-15', '2012-09-30', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '0000006726', 0, 'Y', 0, '2012-10-11', NULL, NULL, 0, 0, NULL, NULL),
('836000891', 'WYT200491', 'WYT200491', 'WYT2', 'North Big Horn Hospital Clinic', 'David', '', 'Hoffman', 'MD', 'Family Practice', 'General Surgery', '', NULL, 'O', '1115 Lane 12', 'Lovell', 'Big Horn', 'WY', '82431', '3075485201', NULL, '1115 Lane 12', 'Lovell', 'Big Horn', 'WY', '82431', '3075485201', '          ', '', '', '', '0.00', '10.00', '0.00', 3, '2008-02-01', '2011-06-16', 0, 0, 1, NULL, '', '', '', 'HCFA|UB|', '1144332552', 0, 'N', 0, '2013-06-18', NULL, NULL, 0, 0, NULL, NULL),
('810422536', 'WYT200775', 'WYT200775', 'WYT2', 'Yellowstone Pathologists PC', 'Paul', 'W', 'Holley', 'MD', 'Pathology', '', '', NULL, 'O', '1008 Cody Ave', 'Cody', 'Park', 'WY', '82414', '4062386363', NULL, '1008 Cody Ave', 'Cody', 'Park', 'WY', '82414', '4062386363', '          ', 'WYSTD', 'Wyhcpcs', '', '0.00', '35.00', '0.00', 3, '2007-12-01', '2011-06-28', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1881696011', 0, 'N', 0, '2013-06-27', NULL, NULL, 0, 0, NULL, NULL),
('810422536', 'WYT200776', 'WYT200776', 'WYT2', 'Yellowstone Pathologists PC', 'Paul', 'W', 'Holley', 'MD', 'Pathology', '', '', NULL, 'O', '2900 12th Ave N Ste 295W', 'Billings', 'Yellowstone', 'MT', '59101', '4062386363', NULL, '2900 12th Ave N Ste 295W', 'Billings', 'Yellowstone', 'MT', '59101', '4062386363', '          ', 'WYSTD', 'Wyhcpcs', '', '0.00', '35.00', '0.00', 3, '2007-12-01', '2011-06-28', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1881696011', 0, 'N', 0, '2013-06-27', NULL, NULL, 0, 0, NULL, NULL),
('830283425', 'WYT200728', 'WYT200728', 'WYT2', 'North Platte Physical Therapy', 'Abby', 'L', 'Holwegner', 'OT', 'Occupational Therapy', '', '', NULL, 'O', '311 Thelma Dr', 'Casper', 'Natrona', 'WY', '82609', '3072342662', '3072348810', '311 Thelma Dr', 'Casper', 'Natrona', 'WY', '82609', '3072342662', '3072348810', 'WYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2011-07-01', '2011-07-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1720216294', 0, 'N', 0, '2013-11-13', NULL, NULL, 0, 0, NULL, NULL),
('830283425', 'WYT200729', 'WYT200729', 'WYT2', 'North Platte Physical Therapy', 'Abby', 'L', 'Holwegner', 'OT', 'Occupational Therapy', '', '', NULL, 'O', '3831 Denis Dr', 'Casper', 'Natrona', 'WY', '82604', '3072349067', '3072349074', '3831 Denis Dr', 'Casper', 'Natrona', 'WY', '82604', '3072349067', '3072349074', 'WYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2011-07-01', '2011-07-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1720216294', 0, 'N', 0, '2013-11-13', NULL, NULL, 0, 0, NULL, NULL),
('830283425', 'WYT200730', 'WYT200730', 'WYT2', 'North Platte Physical Therapy', 'Abby', 'L', 'Holwegner', 'OT', 'Occupational Therapy', '', '', NULL, 'B', 'PO Box 1790', 'Douglas', 'Converse', 'WY', '82633', '3072342662', '3072348810', 'PO Box 1790', 'Douglas', 'Converse', 'WY', '82633', '3072342662', '3072348810', 'WYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2011-07-01', '2011-07-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1720216294', 0, 'N', 0, '2013-11-13', NULL, NULL, 0, 0, NULL, NULL),
('830234097', 'WYT200319', 'WYT200319', 'WYT2', 'Home Health / Hospice', '', '', 'Home Health / Hospice', 'GROUP', 'Home Health Agency', 'Hospice', '', NULL, 'O', '710 W 12th St', 'Gillette', 'Campbell', 'WY', '82717', '3076886230', NULL, '710 W 12th St', 'Gillette', 'Campbell', 'WY', '82717', '3076886230', '          ', '', '', '5001', '0.00', '0.00', '0.00', 3, '2008-09-15', '2011-06-27', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000006762', 0, 'N', 0, '2013-09-17', NULL, NULL, 0, 0, NULL, NULL),
('830234097', 'WYT200320', 'WYT200320', 'WYT2', 'Home Medical Resources', '', '', 'Home Medical Resources', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', '1708 W Highway 15-16', 'Gillette', 'Campbell', 'WY', '82716', '3076886260', NULL, '1708 W Highway 15-16', 'Gillette', 'Campbell', 'WY', '82716', '3076886260', '          ', '', '', '5001', '0.00', '0.00', '0.00', 3, '2008-09-15', '2011-06-27', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000006763', 0, 'N', 0, '2013-09-17', NULL, NULL, 0, 0, NULL, NULL),
('830216112', 'WYT200806', 'WYT200806', 'WYT2', 'Lander Medical Clinic', 'Justin', '', 'Hopkin', 'MD', 'Internal Medicine', '', '', NULL, 'O', '745 Buena Vista Dr', 'Lander', 'Fremont', 'WY', '82520', '3073322941', NULL, '745 Buena Vista Dr', 'Lander', 'Fremont', 'WY', '82520', '3073322941', '', '', NULL, NULL, '0.00', '10.00', '0.00', 3, '2009-02-06', NULL, 0, 0, 1, 'SageWest Health Care', NULL, NULL, NULL, 'HCFA|UB|', '1972640225', 0, 'n', 0, '2013-01-17', NULL, NULL, 0, 0, NULL, NULL),
('830207671', 'WYT200500', 'WYT200500', 'WYT2', 'West Park Hospital District', 'Matthew', '', 'Hopkins', 'MD', 'Mental Health', 'Psychiatry', '', NULL, 'O', '707 Sheridan Ave', 'Cody', 'Park', 'WY', '82414', '3075277501', NULL, '707 Sheridan Ave', 'Cody', 'Park', 'WY', '82414', '3075277501', '          ', '', '', '', '0.00', '10.00', '0.00', 3, '2008-05-01', '2011-06-30', 0, 0, 1, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1194816439', 0, 'N', 0, '2011-07-20', NULL, NULL, 0, 0, NULL, NULL),
('830245718', 'WYT200810', 'WYT200810', 'WYT2', 'Northeast Wyoming Pediatric Associates PC', 'Marilyn', 'K', 'Horsley', 'PA-C', 'Pediatrics', '', '', NULL, 'O', '916 Jackson Ave', 'Sheridan', 'Sheridan', 'WY', '82801', '3076726451', NULL, '916 Jackson Ave', 'Sheridan', 'Sheridan', 'WY', '82801', '3076726451', '          ', '', '', '', '0.00', '15.00', '0.00', 3, '2008-11-01', '2011-06-28', 0, 0, 1, 'Sheridan Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1992782619', 0, 'N', 0, '2013-06-28', NULL, NULL, 0, 0, NULL, NULL),
('710952415', 'WYT200321', 'WYT200321', 'WYT2', 'Hospice Alliance of Wyoming', '', '', 'Hospice Alliance of Wyoming', 'GROUP', 'Hospice', '', '', NULL, 'O', '102293 US Hwy 89 Ste 1001', 'Thayne', 'Lincoln', 'WY', '83127', '3078837583', NULL, '102293 US Hwy 89 Ste 1001', 'Thayne', 'Lincoln', 'WY', '83127', '3078837583', '          ', '', '', '3', '0.00', '0.00', '0.00', 3, '2007-01-01', '2011-06-27', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '0000006781', 0, 'N', 0, '2013-06-06', NULL, NULL, 0, 0, NULL, NULL),
('710952415', 'WYT200322', 'WYT200322', 'WYT2', 'Hospice Alliance of Wyoming', '', '', 'Hospice Alliance of Wyoming', 'GROUP', 'Hospice', '', '', NULL, 'B', 'PO Box 1001', 'Thayne', 'Lincoln', 'WY', '83127', '3078837583', NULL, 'PO Box 1001', 'Thayne', 'Lincoln', 'WY', '83127', '3078837583', '          ', '', '', '3', '0.00', '0.00', '0.00', 3, '2007-01-01', '2011-06-27', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '0000006781', 0, 'N', 0, '2013-06-06', NULL, NULL, 0, 0, NULL, NULL),
('836000182', 'WYT200323', 'WYT200323', 'WYT2', 'Hot Springs County Memorial Hospital', '', '', 'Hot Springs County Memorial Hospital', 'GROUP', 'Hospital', '', '', NULL, 'O', '150 E Arapahoe', 'Thermopolis', 'Hot Springs', 'WY', '82443', '3078643121', NULL, '150 E Arapahoe', 'Thermopolis', 'Hot Springs', 'WY', '82443', '3078643121', '          ', '', '', '', '0.00', '10.00', '0.00', 3, '2008-11-01', '2011-06-30', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '0000006783', 0, 'N', 0, '2012-04-04', NULL, NULL, 0, 0, NULL, NULL),
('830320408', 'WYT200662', 'WYT200662', 'WYT2', 'The Family Clinic', 'Dana', 'R', 'Ideen', 'MD', 'Family Practice', '', '', NULL, 'O', '1315 East A St', 'Casper', 'Natrona', 'WY', '82601', '3072358552', '3072354656', '1315 East A Street', 'Casper', 'Natrona', 'WY', '82601', '3072358552', '3072354656', '', '', '', '0.00', '10.00', '0.00', 3, '2007-10-15', NULL, 0, 0, 1, 'Wyoming Medical Center ', NULL, NULL, NULL, 'HCFA|UB|', '1558375477', 0, 'N', 0, '2012-06-01', NULL, NULL, 0, 0, NULL, NULL),
('830326307', 'WYT200324', 'WYT200324', 'WYT2', 'Community Health Ctr', 'Brandon (Recognized PPO but not contracted)', '', 'Isaacs', '', 'Family Practice', '', '', NULL, 'O', '1522 E  A  St', 'Casper', '', 'WY', '82601', '3072336035', NULL, '1522 E  A  St', 'Casper', '', 'WY', '82601', '3072336035', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2009-12-15', '2012-09-30', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '0000006873', 0, 'Y', 0, '2012-10-11', NULL, NULL, 0, 0, NULL, NULL),
('836000295', 'WYT200717', 'WYT200717', 'WYT2', 'Sweetwater Medical Group', 'Augusto', 'G', 'Jamias', 'MD', 'General Surgery', '', '', NULL, 'O', '1204 Hilltop Dr Ste 109', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073528192', '3073528126', '1204 Hilltop Dr Ste 109', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073528192', '3073528126', '', '', '', '0.00', '5.00', '0.00', 3, '2010-10-01', '2014-02-09', 0, 0, 0, 'Memorial Hospital of Sweetwater County', NULL, NULL, NULL, 'HCFA|UB|', '1700045358', 0, 'N', 0, '2014-03-04', NULL, NULL, 0, 0, NULL, NULL),
('830234097', 'WYT200788', 'WYT200788', 'WYT2', 'Cottonwood Clinic', 'Farrukh', '', 'Javaid', 'MD', 'Internal Medicine', '', '', NULL, 'O', '407 Medical Arts Ct Ste F', 'Gillette', 'Campbell', 'WY', '82716', '3076821441', NULL, '407 Medical Arts Ct Ste F', 'Gillette', 'Campbell', 'WY', '82716', '3076821441', '          ', '', '', '5001', '0.00', '0.00', '0.00', 3, '2008-09-15', '2008-09-15', 0, 0, 0, 'Campbell County Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1922094036', 0, 'N', 0, '2013-09-17', NULL, NULL, 0, 0, NULL, NULL),
('830219655', 'WYT200458', 'WYT200458', 'WYT2', 'Premier Bone and Joint Centers', 'Lawrence', '', 'Jenkins', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', '111 S 5th St', 'Douglas', 'Converse', 'WY', '82633', '3073586200', NULL, '111 S 5th St', 'Douglas', 'Converse', 'WY', '82633', '3073586200', '', '', '', '', '0.00', '10.00', '0.00', 3, '2009-07-01', NULL, 0, 0, 0, 'Ivinson Memorial Hospital', '', '', '', 'HCFA|UB|', '1093795056', 0, 'N', 0, '2014-07-21', NULL, NULL, 0, 0, NULL, NULL),
('830219655', 'WYT200459', 'WYT200459', 'WYT2', 'Premier Bone and Joint Centers', 'Lawrence', '', 'Jenkins', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1400 Uinta Dr', 'Green River', 'Sweetwater', 'WY', '82935', '3078757576', NULL, '1400 Uinta Dr', 'Green River', 'Sweetwater', 'WY', '82935', '3078757576', '', '', '', '', '0.00', '10.00', '0.00', 3, '2009-07-01', NULL, 0, 0, 0, 'Ivinson Memorial Hospital', '', '', '', 'HCFA|UB|', '1093795056', 0, 'N', 0, '2014-07-21', NULL, NULL, 0, 0, NULL, NULL),
('830219655', 'WYT200460', 'WYT200460', 'WYT2', 'Premier Bone and Joint Centers', 'Lawrence', '', 'Jenkins', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', '167 S Conwell', 'Casper', 'Natrona', 'WY', '82601', '3072370304', NULL, '167 S Conwell', 'Casper', 'Natrona', 'WY', '82601', '3072370304', '', '', '', '', '0.00', '10.00', '0.00', 3, '2009-07-01', NULL, 0, 0, 0, 'Ivinson Memorial Hospital', '', '', '', 'HCFA|UB|', '1093795056', 0, 'N', 0, '2014-07-21', NULL, NULL, 0, 0, NULL, NULL),
('830219655', 'WYT200461', 'WYT200461', 'WYT2', 'Premier Bone and Joint Centers', 'Lawrence', '', 'Jenkins', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1909 Vista Dr', 'Laramie', 'Albany', 'WY', '82070', '3077458851', NULL, '1909 Vista Dr', 'Laramie', 'Albany', 'WY', '82070', '3077458851', '', '', '', '', '0.00', '10.00', '0.00', 3, '2009-07-01', NULL, 0, 0, 0, 'Ivinson Memorial Hospital', '', '', '', 'HCFA|UB|', '1093795056', 0, 'N', 0, '2014-07-21', NULL, NULL, 0, 0, NULL, NULL),
('830219655', 'WYT200462', 'WYT200462', 'WYT2', 'Premier Bone and Joint Centers', 'Lawrence', '', 'Jenkins', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', '2002 W Sunset Dr', 'Riverton', 'Fremont', 'WY', '82501', '3078564053', NULL, '2002 W Sunset Dr', 'Riverton', 'Fremont', 'WY', '82501', '3078564053', '', '', '', '', '0.00', '10.00', '0.00', 3, '2009-07-01', NULL, 0, 0, 0, 'Ivinson Memorial Hospital', '', '', '', 'HCFA|UB|', '1093795056', 0, 'N', 0, '2014-07-21', NULL, NULL, 0, 0, NULL, NULL),
('830219655', 'WYT200463', 'WYT200463', 'WYT2', 'Premier Bone and Joint Centers', 'Lawrence', '', 'Jenkins', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', '2950 College Dr', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073825112', NULL, '2950 College Dr', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073825112', '', '', '', '', '0.00', '10.00', '0.00', 3, '2009-07-01', NULL, 0, 0, 0, 'Ivinson Memorial Hospital', '', '', '', 'HCFA|UB|', '1093795056', 0, 'N', 0, '2014-07-21', NULL, NULL, 0, 0, NULL, NULL),
('830219655', 'WYT200464', 'WYT200464', 'WYT2', 'Gem City Bone and Joint', 'Lawrence', '', 'Jenkins', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '606 23rd St', 'Rawlins', 'Carbon', 'WY', '82301', '3073242104', NULL, '606 23rd St', 'Rawlins', 'Carbon', 'WY', '82301', '3073242104', '', '', '', '', '0.00', '10.00', '0.00', 3, '2009-07-01', '2013-01-01', 0, 0, 0, 'Ivinson Memorial Hospital', '', '', '', 'HCFA|UB|', '1093795056', 0, 'N', 0, '2014-07-21', NULL, NULL, 0, 0, NULL, NULL),
('830219655', 'WYT200465', 'WYT200465', 'WYT2', 'Gem City Bone and Joint', 'Lawrence', '', 'Jenkins', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', '620 4-J Rd', 'Gillette', 'Campbell', 'WY', '82716', '3076828899', NULL, '620 4-J Rd', 'Gillette', 'Campbell', 'WY', '82716', '3076828899', '', '', '', '', '0.00', '10.00', '0.00', 3, '2009-07-01', '2012-12-31', 0, 0, 0, 'Ivinson Memorial Hospital', '', '', '', 'HCFA|UB|', '1093795056', 0, 'N', 0, '2014-07-21', NULL, NULL, 0, 0, NULL, NULL),
('742423017', 'WYT200610', 'WYT200610', 'WYT2', 'Big Horn Bone & Joint Clinic', 'Beth', 'A', 'Johnsey', 'PT', 'Physical Therapy', '', '', NULL, 'O', '151 S 6th St', 'Worland', 'Washakie', 'WY', '82401', '3073478262', NULL, '151 S 6th St', 'Worland', 'Washakie', 'WY', '82401', '3073478262', '', '', '', '', '0.00', '15.00', '0.00', 3, '2008-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1497734248', 0, 'Y', 0, '2014-06-25', NULL, NULL, 0, 0, NULL, NULL),
('204974140', 'WYT200544', 'WYT200544', 'WYT2', 'Rocky Mountain Vein Clinic', 'James', 'L', 'Johnson', 'MD', 'Vascular Surgery', 'General Surgery', '', NULL, 'O', '125 W Yellowstone Ave', 'Cody', 'Park', 'WY', '82414', '3075277129', NULL, '125 W Yellowstone Ave', 'Cody', 'Park', 'WY', '82414', '3075277129', '          ', '', '', '', '0.00', '7.00', '0.00', 3, '2010-04-20', NULL, 0, 0, 1, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1326089137', 0, 'N', 0, '2013-06-17', NULL, NULL, 0, 0, NULL, NULL),
('204974140', 'WYT200545', 'WYT200545', 'WYT2', 'Rocky Mountain Vein Clinic', 'James', 'L', 'Johnson', 'MD', 'Vascular Surgery', 'General Surgery', '', NULL, 'O', '2800 Central Ave Ste A', 'Billings', 'Yellowstone', 'MT', '59102', '4062528346', NULL, '2800 Central Ave Ste A', 'Billings', 'Yellowstone', 'MT', '59102', '4062528346', '          ', '', '', '', '0.00', '7.00', '0.00', 3, '2010-04-20', NULL, 0, 0, 1, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1326089137', 0, 'N', 0, '2013-06-17', NULL, NULL, 0, 0, NULL, NULL),
('204974140', 'WYT200546', 'WYT200546', 'WYT2', 'Rocky Mountain Vein Clinic', 'James', 'L', 'Johnson', 'MD', 'Vascular Surgery', 'General Surgery', '', NULL, 'B', '449 Mountain View St', 'Powell', 'Park', 'WY', '82435', '3075277129', NULL, '449 Mountain View St', 'Powell', 'Park', 'WY', '82435', '3075277129', '          ', '', '', '', '0.00', '7.00', '0.00', 3, '2010-04-20', NULL, 0, 0, 1, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1326089137', 0, 'N', 0, '2013-06-17', NULL, NULL, 0, 0, NULL, NULL),
('841379990', 'WYT200326', 'WYT200326', 'WYT2', 'Johnson County Hospital District', '', '', 'Johnson County Hospital District', 'GROUP', 'Hospital', '', '', NULL, 'O', '497 W Lott', 'Buffalo', 'Johnson', 'WY', '82834', '3076846188', NULL, '497 W Lott', 'Buffalo', 'Johnson', 'WY', '82834', '3076846188', '          ', '', '', '', '0.00', '5.00', '0.00', 3, '2009-08-15', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '0000006978', 0, 'N', 0, '2011-08-23', NULL, NULL, 0, 0, NULL, NULL),
('201391282', 'WYT200795', 'WYT200795', 'WYT2', 'Thunder Basin Orthopedics and Sports Medicine', 'Terri', '', 'Joy', 'PA-C', 'Orthopedic Surgery', '', '', NULL, 'O', '111 S 5th St', 'Douglas', 'Converse', 'WY', '82633', '3073586200', NULL, '111 S 5th St', 'Douglas', 'Converse', 'WY', '82633', '3073586200', '          ', 'WYORTHO10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-11-15', '2013-12-31', 0, 0, 0, 'Memorial Hospital of Converse County', NULL, NULL, NULL, 'HCFA|UB|', '1932271343', 0, 'N', 0, '2014-01-03', NULL, NULL, 0, 0, NULL, NULL),
('201391282', 'WYT200796', 'WYT200796', 'WYT2', 'Thunder Basin Orthopedics and Sports Medicine', 'Terri', '', 'Joy', 'PA-C', 'Orthopedic Surgery', '', '', NULL, 'O', '6550 E 2nd St', 'Casper', 'Natrona', 'WY', '82609', '3073586200', NULL, '6550 E 2nd St', 'Casper', 'Natrona', 'WY', '82609', '3073586200', '          ', 'WYORTHO10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-01-22', NULL, 0, 0, 1, 'Memorial Hospital of Converse County', NULL, NULL, NULL, 'HCFA|UB|', '1932271343', 0, 'N', 0, '2013-06-28', NULL, NULL, 0, 0, NULL, NULL),
('830327475', 'WYT200327', 'WYT200327', 'WYT2', 'Evanston Regional Hospital', 'Victor', 'R', 'Judd', 'PT', '', '', '', NULL, 'O', '196 Arrowhead Dr', 'Evanston', 'Uinta', 'WY', '82930', '3077838220', NULL, '196 Arrowhead Dr', 'Evanston', 'Uinta', 'WY', '82930', '3077838220', '          ', '', '', '', '0.00', '0.00', '100.00', 6, '2006-12-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '0000007010', 0, 'N', 0, '2011-06-10', NULL, NULL, 0, 0, NULL, NULL),
('830306180', 'WYT200450', 'WYT200450', 'WYT2', 'College Hill Womens Center', 'Daryl', '', 'Kaan', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '3000 College Dr Ste 8', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073621861', NULL, '3000 College Dr Ste 8', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073621861', '          ', '', '', '', '0.00', '10.00', '0.00', 3, '2009-05-15', '2012-07-11', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1073618203', 0, 'N', 0, '2012-07-12', NULL, NULL, 0, 0, NULL, NULL),
('830219655', 'WYT200777', 'WYT200777', 'WYT2', 'Premier Bone and Joint Centers', 'Stephen', '', 'Kaiser', 'PT', 'Physical Therapy', '', '', NULL, 'O', '1909 Vista Dr', 'Laramie', 'Albany', 'WY', '82070', '3077458851', NULL, '1909 Vista Dr', 'Laramie', 'Albany', 'WY', '82070', '3077458851', '          ', '', '', '', '0.00', '10.00', '0.00', 3, '2009-07-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1891775862', 0, 'N', 0, '2013-03-13', NULL, NULL, 0, 0, NULL, NULL),
('830326307', 'WYT200328', 'WYT200328', 'WYT2', 'Community Health Ctr', 'Sharon (Recognized PPO but not contracted)', '', 'Kames', '', 'Family Practice', '', '', NULL, 'O', '1522 E  A  St', 'Casper', '', 'WY', '82601', '3072336035', NULL, '1522 E  A  St', 'Casper', '', 'WY', '82601', '3072336035', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2009-12-15', '2012-09-30', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '0000007032', 0, 'Y', 0, '2012-10-11', NULL, NULL, 0, 0, NULL, NULL),
('830219655', 'WYT200735', 'WYT200735', 'WYT2', 'Gem City Bone and Joint', 'Michael', 'C', 'Kaplan', 'MD', 'Physical Medicine and Rehabilitation', 'Pain Management', '', NULL, 'O', '1400 Uinta Dr', 'Green River', 'Sweetwater', 'WY', '82935', '3078757576', NULL, '1400 Uinta Dr', 'Green River', 'Sweetwater', 'WY', '82935', '3078757576', '', '', '', '', '0.00', '10.00', '0.00', 3, '2009-07-01', '2013-01-01', 0, 0, 0, 'Ivinson Memorial Hospital', '', '', '', 'HCFA|UB|', '1750361606', 0, 'N', 0, '2014-07-21', NULL, NULL, 0, 0, NULL, NULL),
('830219655', 'WYT200736', 'WYT200736', 'WYT2', 'Premier Bone and Joint Centers', 'Michael', 'C', 'Kaplan', 'MD', 'Physical Medicine and Rehabilitation', 'Pain Management', '', NULL, 'B', '167 S Conwell', 'Casper', 'Natrona', 'WY', '82601', '3072370304', NULL, '167 S Conwell', 'Casper', 'Natrona', 'WY', '82601', '3072370304', '', '', '', '', '0.00', '10.00', '0.00', 3, '2009-07-01', NULL, 0, 0, 0, 'Ivinson Memorial Hospital', '', '', '', 'HCFA|UB|', '1750361606', 0, 'N', 0, '2014-07-21', NULL, NULL, 0, 0, NULL, NULL),
('830219655', 'WYT200737', 'WYT200737', 'WYT2', 'Premier Bone and Joint Centers', 'Michael', 'C', 'Kaplan', 'MD', 'Physical Medicine and Rehabilitation', 'Pain Management', '', NULL, 'O', '1909 Vista Dr', 'Laramie', 'Albany', 'WY', '82070', '3077458851', NULL, '1909 Vista Dr', 'Laramie', 'Albany', 'WY', '82070', '3077458851', '', '', '', '', '0.00', '10.00', '0.00', 3, '2009-07-01', NULL, 0, 0, 0, 'Ivinson Memorial Hospital', '', '', '', 'HCFA|UB|', '1750361606', 0, 'N', 0, '2014-07-21', NULL, NULL, 0, 0, NULL, NULL),
('830219655', 'WYT200738', 'WYT200738', 'WYT2', 'Gem City Bone and Joint', 'Michael', 'C', 'Kaplan', 'MD', 'Physical Medicine and Rehabilitation', 'Pain Management', '', NULL, 'O', '1950 Bluegrass Cir', 'Cheyenne', 'Laramie', 'WY', '82009', '3076325889', NULL, '1950 Bluegrass Cir', 'Cheyenne', 'Laramie', 'WY', '82009', '3076325889', '', '', '', '', '0.00', '10.00', '0.00', 3, '2009-07-01', '2013-01-01', 0, 0, 0, 'Ivinson Memorial Hospital', '', '', '', 'HCFA|UB|', '1750361606', 0, 'N', 0, '2014-07-21', NULL, NULL, 0, 0, NULL, NULL),
('830306180', 'WYT200741', 'WYT200741', 'WYT2', 'College Hill Womens Center', 'Samer', '', 'Kattan', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '3000 College Dr Ste A', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073621861', NULL, '3000 College Dr Ste A', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073621861', '', '', '', '', '0.00', '10.00', '0.00', 3, '2009-03-09', NULL, 0, 0, 0, 'Memorial Hospital of Sweetwater County', '', '', '', 'HCFA|UB|', '1750502753', 0, 'N', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
('830182821', 'WYT200614', 'WYT200614', 'WYT2', 'Gottsche Rehabilitation Center', 'Kerry', 'A', 'Breen', 'PT', 'Physical Therapy', '', '', NULL, 'O', '720 Lindsay Ln', 'Cody', 'Park', 'WY', '82414', '3075781971', '          ', '720 Lindsay Ln', 'Cody', 'Park', 'WY', '82414', '3075781971', '          ', '', '', '', '0.00', '10.00', '0.00', 3, '2011-03-15', '2014-06-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1497847164', 0, 'N', 0, '2014-07-21', NULL, NULL, 0, 0, NULL, NULL),
('742152396', 'WYT200556', 'WYT200556', 'WYT2', 'KCI USA Inc (Wound Vac Only)', '', '', 'KCI USA Inc. ', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', 'Phone Number Only', '', '', '', '', '8002754524', NULL, 'Phone Number Only', '', '', '', '', '8002754524', '          ', 'KCI', '', '', '0.00', '100.00', '0.00', 3, '2011-03-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1366439507', 0, 'N', 0, '2013-03-12', NULL, NULL, 0, 0, NULL, NULL),
('836000025', 'WYT200761', 'WYT200761', 'WYT2', 'Kinbrook Clinic of Interal Medicine and Pediatrics', 'Michelle', '', 'Kinbrook', 'MD', 'Pediatrics', '', '', NULL, 'O', '2221 W Elm St', 'Rawlins', 'Carbon', 'WY', '82301', '3073248255', '3073248236', '2221 W Elm St', 'Rawlins', 'Carbon', 'WY', '82301', '3073248255', '3073248236', 'WISEWYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-07-01', '2011-07-01', 0, 0, 1, 'Memorial Hospital of Carbon County', '', '', '', 'HCFA|UB|', '1801983523', 0, 'N', 0, '2011-12-22', NULL, NULL, 0, 0, NULL, NULL),
('836000025', 'WYT200762', 'WYT200762', 'WYT2', 'Kinbrook Clinic of Interal Medicine and Pediatrics', 'Michelle', '', 'Kinbrook', 'MD', 'Pediatrics', '', '', NULL, 'B', 'PO Box 460', 'Rawlins', 'Carbon', 'WY', '82301', '3073248255', '3073248236', 'PO Box 460', 'Rawlins', 'Carbon', 'WY', '82301', '3073248255', '3073248236', 'WISEWYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-07-01', '2011-07-01', 0, 0, 1, 'Memorial Hospital of Carbon County', '', '', '', 'HCFA|UB|', '1801983523', 0, 'N', 0, '2011-12-22', NULL, NULL, 0, 0, NULL, NULL),
('830251081', 'WYT200734', 'WYT200734', 'WYT2', 'Powder River Orthopedics & Spine PC', 'Hans', 'C', 'Kioschos', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '508 Stocktrail Ste A', 'Gillette', 'Campbell', 'WY', '82716', '3076861413', NULL, '508 Stocktrail Ste A', 'Gillette', 'Campbell', 'WY', '82716', '3076861413', '          ', '', '', '', '0.00', '23.00', '0.00', 3, '2008-09-15', '2011-11-06', 0, 0, 0, 'Campbell County Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1740274265', 0, 'N', 0, '2013-09-17', NULL, NULL, 0, 0, NULL, NULL),
('830182821', 'WYT200615', 'WYT200615', 'WYT2', 'Gottsche Rehabilitation Center', 'Amanda', 'M', 'Kolstad', 'DPT', 'Physical Therapy', '', '', NULL, 'O', '639 W Coulter Ave', 'Powell', 'Park', 'WY', '82435', '3077549262', '          ', '639 W Coulter Ave', 'Powell', 'Park', 'WY', '82435', '3077549262', '          ', '', '', '', '0.00', '10.00', '0.00', 3, '2011-03-01', '2012-03-29', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1497868673', 0, 'N', 0, '2014-04-02', NULL, NULL, 0, 0, NULL, NULL),
('830182821', 'WYT200616', 'WYT200616', 'WYT2', 'Gottsche Rehabilitation Center', 'Amanda', 'M', 'Kolstad', 'DPT', 'Physical Therapy', '', '', NULL, 'O', '720 Lindsay Ln', 'Cody', 'Park', 'WY', '82414', '3075781970', '          ', '720 Lindsay Ln', 'Cody', 'Park', 'WY', '82414', '3075781970', '          ', '', '', '', '0.00', '10.00', '0.00', 3, '2011-03-01', '2012-03-29', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1497868673', 0, 'N', 0, '2014-04-02', NULL, NULL, 0, 0, NULL, NULL),
('830326307', 'WYT200329', 'WYT200329', 'WYT2', 'Community Health Ctr', 'Michael (Recognized PPO but not contracted)', '', 'Kooiker-Brostoski', '', 'Family Practice', '', '', NULL, 'O', '1522 E  A  St', 'Casper', '', 'WY', '82601', '3072336035', NULL, '1522 E  A  St', 'Casper', '', 'WY', '82601', '3072336035', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2009-12-15', '2012-09-30', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '0000007140', 0, 'Y', 0, '2012-10-11', NULL, NULL, 0, 0, NULL, NULL),
('840611484', 'WYT200472', 'WYT200472', 'WYT2', 'LabCorp of America Holdings', '', '', 'LabCorp of America Holdings', 'GROUP', 'Laboratory', '', '', NULL, 'B', 'PO Box 2270', 'Burlington', 'Alamance', 'NC', '27216', '          ', NULL, 'PO Box 2270', 'Burlington', 'Alamance', 'NC', '27216', '          ', '          ', 'WULABCORP5', '', '', '0.00', '35.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1104829159', 0, 'Y', 0, '2013-10-30', NULL, NULL, 0, 0, NULL, NULL),
('840611484', 'WYT200473', 'WYT200473', 'WYT2', 'LabCorp of America Holdings', '', '', 'LabCorp of America Holdings', 'GROUP', 'Laboratory', '', '', NULL, 'B', 'PO Box 8018', 'Burlington', 'Alamance', 'NC', '27216', '          ', NULL, 'PO Box 8018', 'Burlington', 'Alamance', 'NC', '27216', '          ', '          ', 'WULABCORP5', '', '', '0.00', '35.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1104829159', 0, 'Y', 0, '2013-10-30', NULL, NULL, 0, 0, NULL, NULL),
('133757370', 'WYT200778', 'WYT200778', 'WYT2', 'LabCorp of America Holdings', '', '', 'LabCorp of America Holdings', 'GROUP', 'Laboratory', '', '', NULL, 'B', 'PO Box 2270', 'BURLINGTON', 'Alamance', 'NC', '27216', '8002227566', NULL, 'PO Box 2270', 'BURLINGTON', 'Alamance', 'NC', '27216', '8002227566', '', 'WULABCORP5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1902809940', 0, 'Y', 0, '2014-03-21', NULL, NULL, 0, 0, NULL, NULL),
('830218549', 'WYT200563', 'WYT200563', 'WYT2', 'Sheridan Orthopaedic Assoc', 'Brian', '', 'Laman', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1050 Mydland Rd', 'Sheridan', 'Sheridan', 'WY', '82801', '3076747469', NULL, '1050 Mydland Rd', 'Sheridan', 'Sheridan', 'WY', '82801', '3076747469', '          ', '', '', '', '0.00', '15.00', '0.00', 3, '2009-08-15', '2012-02-12', 0, 0, 1, 'Sheridan Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1396794152', 0, 'N', 0, '2013-01-24', NULL, NULL, 0, 0, NULL, NULL),
('203730352', 'WYT200330', 'WYT200330', 'WYT2', 'Lander Outpatient Surgical Center', '', '', 'Lander Outpatient Surgical Center', 'GROUP', 'Ambulatory Surgery Center', '', '', NULL, 'B', '1340 Bishop Randall Dr', 'Lander', 'Fremont', 'WY', '82520', '3073356565', NULL, '1340 Bishop Randall Dr', 'Lander', 'Fremont', 'WY', '82520', '3073356565', '          ', '', '', '', '0.00', '5.00', '0.00', 3, '2009-06-15', '2009-06-15', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '0000007188', 0, 'N', 0, '2011-07-15', NULL, NULL, 0, 0, NULL, NULL),
('621823043', 'WYT200331', 'WYT200331', 'WYT2', 'Lander Valley Medical Center', '', '', 'Riverton Memorial Hospital, LLC', 'GROUP', 'Hospital', '', '', NULL, 'O', '1320 Bishop Randall Dr', 'Lander', 'Fremont', 'WY', '82520', '3073324420', NULL, '1320 Bishop Randall Dr', 'Lander', 'Fremont', 'WY', '82520', '3073324420', '', '', '', '', '0.00', '5.00', '0.00', 3, '2010-07-01', '2010-07-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1245337286', 0, 'N', 0, '2014-05-01', NULL, NULL, 0, 0, NULL, NULL),
('830326307', 'WYT200332', 'WYT200332', 'WYT2', 'Community Health Ctr', 'Paul (Recognized PPO but not contracted)', '', 'Langevin', '', 'Family Practice', '', '', NULL, 'O', '1522 E  A  St', 'Casper', '', 'WY', '82601', '3072336035', NULL, '1522 E  A  St', 'Casper', '', 'WY', '82601', '3072336035', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2009-12-15', '2012-09-30', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '0000007191', 0, 'Y', 0, '2012-10-11', NULL, NULL, 0, 0, NULL, NULL),
('830332882', 'WYT200333', 'WYT200333', 'WYT2', '', 'Steve (Recognized PPO but not contracted)', '', 'Larson', '', 'Optometrist', '', '', NULL, 'O', '204  S Durbin St', 'Casper', '', 'Wy', '82601', '3072350505', NULL, '204  S Durbin St', 'Casper', '', 'Wy', '82601', '3072350505', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2009-12-15', '2012-12-01', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '0000007207', 0, 'Y', 0, '2012-10-19', NULL, NULL, 0, 0, NULL, NULL),
('830326307', 'WYT200334', 'WYT200334', 'WYT2', 'Community Health Ctr', 'Eric (Recognized PPO but not contracted)', '', 'Lawrence', '', 'Family Practice', '', '', NULL, 'O', '1522 E  A  St', 'Casper', '', 'WY', '82601', '3072336035', NULL, '1522 E  A  St', 'Casper', '', 'WY', '82601', '3072336035', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2009-12-15', '2012-09-30', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '0000007218', 0, 'Y', 0, '2012-10-11', NULL, NULL, 0, 0, NULL, NULL),
('830234097', 'WYT200335', 'WYT200335', 'WYT2', 'Campbell County Memorial Hospital', 'Stanley', '', 'Lawson', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '501 S Burma Ave', 'Gillette', 'Campbell', 'WY', '82717', '3076881000', NULL, '501 S Burma Ave', 'Gillette', 'Campbell', 'WY', '82717', '3076881000', '          ', '', '', '5001', '0.00', '0.00', '0.00', 3, '2008-09-15', '2008-09-15', 0, 0, 0, 'Campbell County Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '0000007220', 0, 'Y', 0, '2013-09-17', NULL, NULL, 0, 0, NULL, NULL),
('830234097', 'WYT200336', 'WYT200336', 'WYT2', 'Campbell County Memorial Hospital', 'Ted', '', 'Lawson', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '501 S Burma Ave', 'Gillette', 'Campbell', 'WY', '82717', '3076881000', NULL, '501 S Burma Ave', 'Gillette', 'Campbell', 'WY', '82717', '3076881000', '          ', '', '', '5001', '0.00', '0.00', '0.00', 3, '2008-09-15', '2008-09-15', 0, 0, 0, 'Campbell County Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '0000007221', 0, 'Y', 0, '2013-09-17', NULL, NULL, 0, 0, NULL, NULL),
('202711377', 'WYT200711', 'WYT200711', 'WYT2', 'Dubois Chiropractic', 'Dean', 'J', 'Lehmkuhler', 'DC', 'Chiropractic', 'Acupuncture', '', NULL, 'O', '116 E Ramshorn Ave', 'Dubois', 'Fremont', 'WY', '82513', '3074552719', NULL, '116 E Ramshorn Ave', 'Dubois', 'Fremont', 'WY', '82513', '3074552719', '          ', '', '', '5004', '0.00', '100.00', '0.00', 3, '2008-10-08', '2011-06-27', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1689605040', 0, 'N', 0, '2012-05-10', NULL, NULL, 0, 0, NULL, NULL),
('202711377', 'WYT200712', 'WYT200712', 'WYT2', 'Lander Valley Chiropractic Inc', 'Dean', 'J', 'Lehmkuhler', 'DC', 'Chiropractic', 'Acupuncture', '', NULL, 'O', '160 S 4th St', 'Lander', 'Fremont', 'WY', '82520', '3073326148', NULL, '160 S 4th St', 'Lander', 'Fremont', 'WY', '82520', '3073326148', '          ', '', '', '5004', '0.00', '100.00', '0.00', 3, '2008-10-08', '2011-06-27', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1689605040', 0, 'N', 0, '2012-05-10', NULL, NULL, 0, 0, NULL, NULL),
('830182821', 'WYT200780', 'WYT200780', 'WYT2', 'Gottsche Rehabilitation Center', 'William', '', 'Lemke', 'PT', 'Physical Therapy', '', '', NULL, 'B', 'PO Box 790', 'Thermopolis', 'Hot Springs', 'WY', '82443', '3078642146', '3078642857', 'PO Box 790', 'Thermopolis', 'Hot Springs', 'WY', '82443', '3078642146', '3078642857', '', '', '', '0.00', '10.00', '0.00', 3, '2011-11-10', '2012-12-15', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1912145376', 0, 'N', 0, '2014-05-01', NULL, NULL, 0, 0, NULL, NULL),
('830219655', 'WYT200657', 'WYT200657', 'WYT2', 'Gem City Bone and Joint', 'Daniel', '', 'Levene', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1400 Uinta Dr', 'Green River', 'Sweetwater', 'WY', '82935', '3078757576', NULL, '1400 Uinta Dr', 'Green River', 'Sweetwater', 'WY', '82935', '3078757576', '', '', '', '', '0.00', '10.00', '0.00', 3, '2009-07-01', '2013-01-01', 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1558341412', 0, 'N', 0, '2014-07-18', NULL, NULL, 0, 0, NULL, NULL),
('830219655', 'WYT200658', 'WYT200658', 'WYT2', 'Premier Bone and Joint Centers', 'Daniel', '', 'Levene', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1909 Vista Dr', 'Laramie', 'Albany', 'WY', '82070', '3077458851', NULL, '1909 Vista Dr', 'Laramie', 'Albany', 'WY', '82070', '3077458851', '', '', '', '', '0.00', '10.00', '0.00', 3, '2009-07-01', NULL, 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1558341412', 0, 'N', 0, '2014-07-18', NULL, NULL, 0, 0, NULL, NULL),
('830219655', 'WYT200659', 'WYT200659', 'WYT2', 'Premier Bone and Joint Centers', 'Daniel', '', 'Levene', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '2000 Campbell Dr', 'Torrington', 'Goshen', 'WY', '82240', '3075322001', NULL, '2000 Campbell Dr', 'Torrington', 'Goshen', 'WY', '82240', '3075322001', '', '', '', '', '0.00', '10.00', '0.00', 3, '2009-07-01', NULL, 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1558341412', 0, 'N', 0, '2014-07-18', NULL, NULL, 0, 0, NULL, NULL),
('830219655', 'WYT200660', 'WYT200660', 'WYT2', 'Premier Bone and Joint Centers', 'Daniel', '', 'Levene', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', '2002 W Sunset Dr', 'Riverton', 'Fremont', 'WY', '82501', '3078564053', NULL, '2002 W Sunset Dr', 'Riverton', 'Fremont', 'WY', '82501', '3078564053', '', '', '', '', '0.00', '10.00', '0.00', 3, '2009-07-01', NULL, 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1558341412', 0, 'N', 0, '2014-07-18', NULL, NULL, 0, 0, NULL, NULL),
('830219655', 'WYT200661', 'WYT200661', 'WYT2', 'Premier Bone and Joint Centers', 'Daniel', '', 'Levene', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', '2950 College Dr', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073825112', NULL, '2950 College Dr', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073825112', '', '', '', '', '0.00', '10.00', '0.00', 3, '2009-07-01', NULL, 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1558341412', 0, 'N', 0, '2014-07-18', 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
('593504952', 'WYT200716', 'WYT200716', 'WYT2', 'Wind River Clinic', 'Dennis', 'M', 'Lewis', 'MD', 'General Surgery', '', '', NULL, 'O', '1005 College View Dr', 'Riverton', 'Fremont', 'WY', '82501', '3078575220', NULL, '1005 College View Dr', 'Riverton', 'Fremont', 'WY', '82501', '3078575220', '', '', NULL, NULL, '0.00', '20.00', '0.00', 3, '2008-03-01', NULL, 0, 0, 1, 'SageWest Health Care', '', '', '', 'HCFA|UB|', '1699701524', 0, 'n', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('522212112', 'WYT200522', 'WYT200522', 'WYT2', 'LifeWatch', '', '', '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, '2006-12-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1255367843', 0, 'N', 0, '2013-06-18', NULL, NULL, 0, 0, NULL, NULL),
('522212112', 'WYT200337', 'WYT200337', 'WYT2', 'Lifewatch Incorporated', '', '', 'Lifewatch Incorporated', 'GROUP', 'Cardiac Monitoring', '', '', NULL, 'B', '1161 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8777202100', NULL, '1161 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8777202100', '', 'WCSTLWI5', NULL, NULL, '0.00', '100.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '0000007278', 0, 'Y', 0, '2011-06-10', NULL, NULL, 0, 0, NULL, NULL),
('592852900', 'WYT200339', 'WYT200339', 'WYT2', 'Lincare', '', '', 'Lincare', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', '100 Brownfield Rd', 'Douglas', 'Converse', 'WY', '82633', '3073585805', NULL, '100 Brownfield Rd', 'Douglas', 'Converse', 'WY', '82633', '3073585805', '          ', 'LINCAREWY', '', '', '0.00', '20.00', '0.00', 8, '2007-01-01', '2011-06-27', 1, 0, 1, '', '', '', '', 'HCFA|UB|', '0000007285', 0, 'N', 0, '2013-06-18', NULL, NULL, 0, 0, NULL, NULL),
('592852900', 'WYT200340', 'WYT200340', 'WYT2', 'Lincare Inc', '', '', 'Lincare', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', '1121 Washington Ste 2', 'Newcastle', 'Weston', 'WY', '82701', '3077462281', NULL, '1121 Washington Ste 2', 'Newcastle', 'Weston', 'WY', '82701', '3077462281', '          ', 'LINCAREWY', '', '', '0.00', '20.00', '0.00', 8, '2007-01-01', '2011-06-27', 1, 0, 1, '', '', '', '', 'HCFA|UB|', '0000007285', 0, 'N', 0, '2013-06-18', NULL, NULL, 0, 0, NULL, NULL),
('592852900', 'WYT200341', 'WYT200341', 'WYT2', 'Lincare Inc', '', '', 'Lincare', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', '1221 E Pershing', 'Cheyenne', 'Laramie', 'WY', '82001', '3076378267', NULL, '1221 E Pershing', 'Cheyenne', 'Laramie', 'WY', '82001', '3076378267', '          ', 'LINCAREWY', '', '', '0.00', '20.00', '0.00', 8, '2007-01-01', '2011-06-27', 1, 0, 1, '', '', '', '', 'HCFA|UB|', '0000007285', 0, 'N', 0, '2013-06-18', NULL, NULL, 0, 0, NULL, NULL),
('592852900', 'WYT200342', 'WYT200342', 'WYT2', 'Lincare Inc', '', '', 'Lincare', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', '1363 N 4th St Ste B', 'Laramie', 'Albany', 'WY', '82072', '3077214992', NULL, '1363 N 4th St Ste B', 'Laramie', 'Albany', 'WY', '82072', '3077214992', '          ', 'LINCAREWY', '', '', '0.00', '20.00', '0.00', 8, '2007-01-01', '2011-06-27', 1, 0, 1, '', '', '', '', 'HCFA|UB|', '0000007285', 0, 'N', 0, '2013-06-18', NULL, NULL, 0, 0, NULL, NULL),
('592852900', 'WYT200343', 'WYT200343', 'WYT2', 'Lincare Inc', '', '', 'Lincare', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', '1408 E Murray St', 'Rawlins', 'Carbon', 'WY', '82301', '3073242117', NULL, '1408 E Murray St', 'Rawlins', 'Carbon', 'WY', '82301', '3073242117', '          ', 'LINCAREWY', '', '', '0.00', '20.00', '0.00', 8, '2007-01-01', '2011-06-27', 1, 0, 1, '', '', '', '', 'HCFA|UB|', '0000007285', 0, 'N', 0, '2013-06-18', NULL, NULL, 0, 0, NULL, NULL),
('592852900', 'WYT200344', 'WYT200344', 'WYT2', 'Lincare Inc', '', '', 'Lincare', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', '228 N 10th St', 'Worland', 'Washakie', 'WY', '82401', '3073472674', NULL, '228 N 10th St', 'Worland', 'Washakie', 'WY', '82401', '3073472674', '          ', 'LINCAREWY', '', '', '0.00', '20.00', '0.00', 8, '2007-01-01', '2011-06-27', 1, 0, 1, '', '', '', '', 'HCFA|UB|', '0000007285', 0, 'N', 0, '2013-06-18', NULL, NULL, 0, 0, NULL, NULL),
('592852900', 'WYT200345', 'WYT200345', 'WYT2', 'Lincare Inc', '', '', 'Lincare', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', '2546 E 2nd St Ste 602', 'Casper', 'Natrona', 'WY', '82609', '3072378000', NULL, '2546 E 2nd St Ste 602', 'Casper', 'Natrona', 'WY', '82609', '3072378000', '          ', 'LINCAREWY', '', '', '0.00', '20.00', '0.00', 8, '2007-01-01', '2011-06-27', 1, 0, 1, '', '', '', '', 'HCFA|UB|', '0000007285', 0, 'N', 0, '2013-06-18', NULL, NULL, 0, 0, NULL, NULL),
('592852900', 'WYT200346', 'WYT200346', 'WYT2', 'Lincare Inc', '', '', 'Lincare', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', '2734 Commercial Way', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073827703', NULL, '2734 Commercial Way', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073827703', '          ', 'LINCAREWY', '', '', '0.00', '20.00', '0.00', 8, '2007-01-01', '2011-06-27', 1, 0, 1, '', '', '', '', 'HCFA|UB|', '0000007285', 0, 'N', 0, '2013-06-18', NULL, NULL, 0, 0, NULL, NULL),
('592852900', 'WYT200347', 'WYT200347', 'WYT2', 'Lincare Inc', '', '', 'Lincare', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', '3317 W C St', 'Torrington', 'Goshen', 'WY', '82240', '3075323283', NULL, '3317 W C St', 'Torrington', 'Goshen', 'WY', '82240', '3075323283', '          ', 'LINCAREWY', '', '', '0.00', '20.00', '0.00', 8, '2007-01-01', '2011-06-27', 1, 0, 1, '', '', '', '', 'HCFA|UB|', '0000007285', 0, 'N', 0, '2013-06-18', NULL, NULL, 0, 0, NULL, NULL),
('592852900', 'WYT200348', 'WYT200348', 'WYT2', 'Lincare Inc', '', '', 'Lincare', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', '545 Budd Ave', 'Big Piney', 'Sublette', 'WY', '83113', '3072765744', NULL, '545 Budd Ave', 'Big Piney', 'Sublette', 'WY', '83113', '3072765744', '          ', 'LINCAREWY', '', '', '0.00', '20.00', '0.00', 8, '2007-01-01', '2011-06-27', 1, 0, 1, '', '', '', '', 'HCFA|UB|', '0000007285', 0, 'N', 0, '2013-06-18', NULL, NULL, 0, 0, NULL, NULL),
('592852900', 'WYT200349', 'WYT200349', 'WYT2', 'Lincare Inc', '', '', 'Lincare', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', '555 E Broadway Ste 108', 'Jackson', 'Teton', 'WY', '83001', '3077339737', NULL, '555 E Broadway Ste 108', 'Jackson', 'Teton', 'WY', '83001', '3077339737', '          ', 'LINCAREWY', '', '', '0.00', '20.00', '0.00', 8, '2007-01-01', '2011-06-27', 1, 0, 1, '', '', '', '', 'HCFA|UB|', '0000007285', 0, 'N', 0, '2013-06-18', NULL, NULL, 0, 0, NULL, NULL),
('592852900', 'WYT200350', 'WYT200350', 'WYT2', 'Lincare Inc', '', '', 'Lincare', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', '655 Broadway St', 'Sheridan', 'Sheridan', 'WY', '82801', '3076720073', NULL, '655 Broadway St', 'Sheridan', 'Sheridan', 'WY', '82801', '3076720073', '          ', 'LINCAREWY', '', '', '0.00', '20.00', '0.00', 8, '2007-01-01', '2011-06-27', 1, 0, 1, '', '', '', '', 'HCFA|UB|', '0000007285', 0, 'N', 0, '2013-06-18', NULL, NULL, 0, 0, NULL, NULL),
('592852900', 'WYT200351', 'WYT200351', 'WYT2', 'Lincare Inc', '', '', 'Lincare', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', '702 E Monroe', 'Riverton', 'Fremont', 'WY', '82501', '3078567562', NULL, '702 E Monroe', 'Riverton', 'Fremont', 'WY', '82501', '3078567562', '          ', 'LINCAREWY', '', '', '0.00', '20.00', '0.00', 8, '2007-01-01', '2011-06-27', 1, 0, 1, '', '', '', '', 'HCFA|UB|', '0000007285', 0, 'N', 0, '2013-06-18', NULL, NULL, 0, 0, NULL, NULL),
('592852900', 'WYT200352', 'WYT200352', 'WYT2', 'Lincare Inc', '', '', 'Lincare', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', '709 W 8th St Ste 2', 'Gillette', 'Campbell', 'WY', '82716', '3076870501', NULL, '709 W 8th St Ste 2', 'Gillette', 'Campbell', 'WY', '82716', '3076870501', '          ', 'LINCAREWY', '', '', '0.00', '20.00', '0.00', 8, '2007-01-01', '2011-06-27', 1, 0, 1, '', '', '', '', 'HCFA|UB|', '0000007285', 0, 'N', 0, '2013-06-18', NULL, NULL, 0, 0, NULL, NULL),
('592852900', 'WYT200353', 'WYT200353', 'WYT2', 'Lincare Inc', '', '', 'Lincare', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', '80 Yellow Creek Rd', 'Evanston', 'Uinta', 'WY', '82930', '3077896621', NULL, '80 Yellow Creek Rd', 'Evanston', 'Uinta', 'WY', '82930', '3077896621', '          ', 'LINCAREWY', '', '', '0.00', '20.00', '0.00', 8, '2007-01-01', '2011-06-27', 1, 0, 1, '', '', '', '', 'HCFA|UB|', '0000007285', 0, 'N', 0, '2013-06-18', NULL, NULL, 0, 0, NULL, NULL),
('592852900', 'WYT200354', 'WYT200354', 'WYT2', 'Lincare Inc', '', '', 'Lincare', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'B', 'PO Box 4598', 'Casper', 'NATRONA', 'WY', '82606', '8003590240', NULL, 'PO Box 4598', 'Casper', 'NATRONA', 'WY', '82606', '8003590240', '          ', 'LINCAREWY', '', '', '0.00', '20.00', '0.00', 8, '2007-01-01', '2011-06-27', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '0000007285', 0, 'Y', 0, '2013-06-18', NULL, NULL, 0, 0, NULL, NULL),
('592852900', 'WYT200338', 'WYT200338', 'WYT2', 'Lincare Wyoming', '', '', 'Lincare Wyoming', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'B', 'PO Box 2908', 'Spokane', 'Spokane', 'WA', '99220', '8002180777', NULL, 'PO Box 2908', 'Spokane', 'Spokane', 'WA', '99220', '8002180777', '          ', 'LINCAREWY', '', '', '0.00', '20.00', '0.00', 8, '2007-01-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '0000007284', 0, 'Y', 0, '2012-09-28', NULL, NULL, 0, 0, NULL, NULL),
('202765815', 'WYT200355', 'WYT200355', 'WYT2', 'Sage Medical Group', 'Jason', '', 'Lloyd', 'MD', 'Family Practice', '', '', NULL, 'O', '419 S Washington St', 'Casper', '', 'WY', '82601', '3072658300', NULL, '419 S Washington St', 'Casper', '', 'WY', '82601', '3072658300', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2009-12-15', '2012-12-01', 0, 0, 1, 'Wyoming Medical Center ', NULL, NULL, NULL, 'HCFA|UB|', '1841298536', 0, 'Y', 0, '2013-06-27', NULL, NULL, 0, 0, NULL, NULL),
('208380921', 'WYT200524', 'WYT200524', 'WYT2', 'Lowham Surgery and Endoscopy', 'Anthony', 'S', 'Lowham', 'MD', 'General Surgery', '', '', NULL, 'B', '1005 College View Dr', 'Riverton', 'Fremont', 'WY', '82501', '3073326222', NULL, '1005 College View Dr', 'Riverton', 'Fremont', 'WY', '82501', '3073326222', '          ', '', '', '', '0.00', '20.00', '0.00', 3, '2008-03-01', NULL, 0, 0, 1, 'SageWest Health Care', NULL, NULL, NULL, 'HCFA|UB|', '1255427985', 0, 'Y', 0, '2013-06-17', NULL, NULL, 0, 0, NULL, NULL),
('208380921', 'WYT200525', 'WYT200525', 'WYT2', 'Lowham Surgery and Endoscopy', 'Anthony', 'S', 'Lowham', 'MD', 'General Surgery', '', '', NULL, 'O', '195 Capitol', 'Lander', 'Fremont', 'WY', '82520', '3073326222', NULL, '195 Capitol', 'Lander', 'Fremont', 'WY', '82520', '3073326222', '          ', '', '', '', '0.00', '20.00', '0.00', 3, '2008-03-01', NULL, 0, 0, 1, 'SageWest Health Care', NULL, NULL, NULL, 'HCFA|UB|', '1255427985', 0, 'N', 0, '2013-06-17', NULL, NULL, 0, 0, NULL, NULL),
('830274249', 'WYT200356', 'WYT200356', 'WYT2', '', 'Anne (Recognized PPO but not contracted)', '', 'MacGuire', '', 'Rheumatology', '', '', NULL, 'O', '940 E 3rd St', 'Casper', '', 'WY', '82601', '3075770445', NULL, '940 E 3rd St', 'Casper', '', 'WY', '82601', '3075770445', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2009-12-15', '2012-12-01', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '0000007377', 0, 'Y', 0, '2012-10-19', NULL, NULL, 0, 0, NULL, NULL),
('836000295', 'WYT200680', 'WYT200680', 'WYT2', 'Memorial Hospital of Sweetwater County', 'Mohammad', '', 'Majeed', 'MD', 'Hospitalist', '', '', NULL, 'O', '1204 Hilltop Dr Ste 108', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073528125', NULL, '1204 Hilltop Dr Ste 108', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073528125', '          ', '', '', '', '0.00', '5.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 1, 'Campbell County Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1598854671', 0, 'Y', 0, '2011-06-10', NULL, NULL, 0, 0, NULL, NULL),
('201943877', 'WYT200469', 'WYT200469', 'WYT2', 'Sheridan Neurology PC', 'Thomas', 'O', 'Mayer', 'MD', 'Neurology', '', '', NULL, 'O', '1050 Mydland Rd', 'Sheridan', 'Sheridan', 'WY', '82801', '3076736300', NULL, '1050 Mydland Rd', 'Sheridan', 'Sheridan', 'WY', '82801', '3076736300', '          ', '', '', '', '0.00', '12.00', '0.00', 3, '2009-02-13', '2011-06-28', 0, 0, 1, 'Sheridan Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1104813930', 0, 'N', 0, '2012-07-18', NULL, NULL, 0, 0, NULL, NULL),
('201943877', 'WYT200470', 'WYT200470', 'WYT2', 'Sheridan Neurology PC', 'Thomas', 'O', 'Mayer', 'MD', 'Neurology', '', '', NULL, 'O', '497 W Lott', 'Buffalo', 'Johnson', 'WY', '82834', '3076736300', NULL, '497 W Lott', 'Buffalo', 'Johnson', 'WY', '82834', '3076736300', '          ', '', '', '', '0.00', '12.00', '0.00', 3, '2009-02-13', '2011-06-28', 0, 0, 1, 'Sheridan Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1104813930', 0, 'N', 0, '2012-07-18', NULL, NULL, 0, 0, NULL, NULL),
('830307192', 'WYT200441', 'WYT200441', 'WYT2', 'Powell Vision Clinic', 'Kim', 'A', 'Mcdowell', 'OD', 'Optometry', '', '', NULL, 'O', '106 S Absaroka', 'Powell', 'Park', 'WY', '82435', '3077542020', NULL, '106 S Absaroka', 'Powell', 'Park', 'WY', '82435', '3077542020', '          ', 'WiseWYSTD', 'Wyhcpcs', '', '0.00', '35.00', '0.00', 3, '2007-07-01', '2011-06-28', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1043385594', 0, 'N', 0, '2011-09-19', NULL, NULL, 0, 0, NULL, NULL),
('273382634', 'WYT200466', 'WYT200466', 'WYT2', 'New Frontier Imaging', 'James', 'S', 'McEvoy', 'DO', 'Diagnostic Radiology', '', '', NULL, 'O', '2620 Commercial Way Ste 10', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073824282', NULL, '2620 Commercial Way Ste 10', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073824282', '          ', '', '', '', '0.00', '15.00', '0.00', 3, '2011-05-13', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1093795809', 0, 'Y', 0, '2011-06-29', NULL, NULL, 0, 0, NULL, NULL),
('273382634', 'WYT200467', 'WYT200467', 'WYT2', 'New Frontier Imaging', 'James', 'S', 'McEvoy', 'DO', 'Diagnostic Radiology', '', '', NULL, 'B', 'PO Box 2148', 'Rock Springs', 'Sweetwater', 'WY', '82902', '3073824282', NULL, 'PO Box 2148', 'Rock Springs', 'Sweetwater', 'WY', '82902', '3073824282', '          ', '', '', '', '0.00', '15.00', '0.00', 3, '2011-05-13', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1093795809', 0, 'Y', 0, '2011-06-29', NULL, NULL, 0, 0, NULL, NULL),
('836000295', 'WYT200809', 'WYT200809', 'WYT2', 'Sweetwater Medical Group', 'Michael', '', 'McInnis', 'MD', 'Family Practice', '', '', NULL, 'O', '1204 Hilltop Ste 108', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073528193', '3073528126', '1204 Hilltop Ste 108', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073528193', '3073528126', '', '', '', '0.00', '5.00', '0.00', 3, '2030-01-01', '2030-01-01', 0, 0, 1, 'Memorial Hospital of Sweetwater County', '', '', '', 'HCFA|UB|', '1992037667', 0, 'N', 0, '2013-03-27', NULL, NULL, 0, 0, NULL, NULL),
('830234097', 'WYT200357', 'WYT200357', 'WYT2', 'Cottonwood Clinic', 'Phillip', '', 'McMahill', 'MD', 'Internal Medicine', '', '', NULL, 'O', '407 Medical Arts Ct Ste F', 'Gillette', 'Campbell', 'WY', '82716', '3076821441', NULL, '407 Medical Arts Ct Ste F', 'Gillette', 'Campbell', 'WY', '82716', '3076821441', '', '', '', '5001', '0.00', '0.00', '0.00', 3, '2008-09-15', '2008-09-15', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000007529', 0, 'Y', 0, '2014-06-23', NULL, NULL, 0, 0, NULL, NULL),
('830216112', 'WYT200681', 'WYT200681', 'WYT2', 'Lander Medical Clinic', 'Michael', 'C', 'McManus', 'MD', 'Urology', '', '', NULL, 'O', '745 Buena Vista Dr', 'Lander', 'Fremont', 'WY', '82520', '3073322941', '3073321920', '745 Buena Vista Dr', 'Lander', 'Fremont', 'WY', '82520', '3073322941', '3073321920', '', '', '', '0.00', '10.00', '0.00', 3, '2011-02-01', '2012-05-01', 0, 0, 1, 'SageWest Health Care', '', '', '', 'HCFA|UB|', '1609085612', 0, 'N', 0, '2012-04-30', NULL, NULL, 0, 0, NULL, NULL),
('830216112', 'WYT200682', 'WYT200682', 'WYT2', 'Lander Medical Clinic', 'Michael', 'C', 'McManus', 'MD', 'Urology', '', '', NULL, 'B', 'PO Box 9432', 'Belfast', 'Waldo', 'ME', '04915', '3073322941', '3073321920', 'PO Box 9432', 'Belfast', 'Waldo', 'ME', '04915', '3073322941', '3073321920', '', '', '', '0.00', '10.00', '0.00', 3, '2011-02-01', '2012-05-01', 0, 0, 1, 'SageWest Health Care', '', '', '', 'HCFA|UB|', '1609085612', 0, 'N', 0, '2012-04-30', NULL, NULL, 0, 0, NULL, NULL),
('836000295', 'WYT200701', 'WYT200701', 'WYT2', 'Sweetwater Medical Group', 'Brandon', '', 'Meck', 'MD', 'Anesthesiology', '', '', NULL, 'O', '1200 College Dr', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073623711', NULL, '1200 College Dr', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073623711', '          ', '', '', '', '0.00', '5.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1639203664', 0, 'Y', 0, '2013-06-28', NULL, NULL, 0, 0, NULL, NULL),
('836000295', 'WYT200702', 'WYT200702', 'WYT2', 'Sweetwater Medical Group', 'Brandon', '', 'Meck', 'MD', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 1359', 'Rock Springs', 'Sweetwater', 'WY', '82902', '3073623711', NULL, 'PO Box 1359', 'Rock Springs', 'Sweetwater', 'WY', '82902', '3073623711', '          ', '', '', '', '0.00', '5.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1639203664', 0, 'N', 0, '2013-06-28', NULL, NULL, 0, 0, NULL, NULL),
('836000025', 'WYT200574', 'WYT200574', 'WYT2', 'Memorial Hospital of Carbon County', '', '', 'Memorial Hospital of Carbon County', 'GROUP', 'Hospital', '', '', NULL, 'O', '2221 W Elm St', 'Rawlins', 'Carbon', 'WY', '82301', '3073248252', NULL, '2221 W Elm St', 'Rawlins', 'Carbon', 'WY', '82301', '3073248252', '          ', '', '', '', '0.00', '27.00', '0.00', 6, '2011-01-10', '2011-06-27', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1417031311', 0, 'N', 0, '2013-04-26', NULL, NULL, 0, 0, NULL, NULL),
('836000295', 'WYT200358', 'WYT200358', 'WYT2', 'Memorial Hospital of Sweetwater County', '', '', 'Memorial Hospital of Sweetwater County', 'GROUP', 'Hospital', '', '', NULL, 'O', '1200 College Dr', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073623711', NULL, '1200 College Dr', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073623711', '', '', '', '', '0.00', '5.00', '0.00', 3, '2006-12-01', '2014-02-09', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000007562', 0, 'N', 0, '2014-05-02', NULL, NULL, 0, 0, NULL, NULL),
('836000295', 'WYT200359', 'WYT200359', 'WYT2', 'Memorial Hospital of Sweetwater County', '', '', 'Memorial Hospital of Sweetwater County', 'GROUP', 'Hospital', '', '', NULL, 'B', 'PO Box 1359', 'Rock Springs', 'Sweetwater', 'WY', '82902', '3073623711', NULL, 'PO Box 1359', 'Rock Springs', 'Sweetwater', 'WY', '82902', '3073623711', '', '', NULL, NULL, '0.00', '5.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000007562', 0, 'y', 0, '2014-05-02', NULL, NULL, 0, 0, NULL, NULL),
('760738698', 'WYT200505', 'WYT200505', 'WYT2', 'Rose Lane Medical Arts', 'John', 'W', 'Mercer', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '1005 College View Dr', 'Riverton', 'Fremont', 'WY', '82501', '3078560382', NULL, '1005 College View Dr', 'Riverton', 'Fremont', 'WY', '82501', '3078560382', '          ', '', '', '', '0.00', '20.00', '0.00', 3, '2008-11-01', '2012-06-30', 0, 0, 1, 'SageWest Health Care', NULL, NULL, NULL, 'HCFA|UB|', '1205988540', 0, 'N', 0, '2012-08-06', NULL, NULL, 0, 0, NULL, NULL),
('760738698', 'WYT200506', 'WYT200506', 'WYT2', 'Rose Lane Medical Arts', 'John', 'W', 'Mercer', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1035 Rose Ln Ste B', 'Riverton', 'Fremont', 'WY', '82501', '3078560382', NULL, '1035 Rose Ln Ste B', 'Riverton', 'Fremont', 'WY', '82501', '3078560382', '          ', '', '', '', '0.00', '20.00', '0.00', 3, '2008-11-01', '2012-06-30', 0, 0, 1, 'SageWest Health Care', NULL, NULL, NULL, 'HCFA|UB|', '1205988540', 0, 'N', 0, '2012-08-06', NULL, NULL, 0, 0, NULL, NULL),
('330363116', 'WYT200360', 'WYT200360', 'WYT2', 'Metwest Inc dba Quest Diagnostics', '', '', 'Metwest Inc dba Quest Diagnostic', 'GROUP', 'Laboratory', '', '', NULL, 'B', '2032 Collection Ctr Dr', 'CHICAGO', '', 'IL', '', '          ', '          ', '2032 Collection Ctr Dr', 'CHICAGO', '', 'IL', '', '          ', '          ', 'WUQUEST5', '', '', '0.00', '20.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000831976', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('203360654', 'WYT200597', 'WYT200597', 'WYT2', 'Western Medical Associates', 'Joseph', '', 'Mickelson', 'MD', 'Family Practice', '', '', NULL, 'O', '3230 Cy Ave', 'Casper', 'Natrona', 'WY', '82604', '3075775100', NULL, '3230 Cy Ave', 'Casper', 'Natrona', 'WY', '82604', '3075775100', '', '', '', '', '0.00', '10.00', '0.00', 3, '2010-09-30', NULL, 0, 0, 0, 'Mountain View Regional Hospital', 'Wyoming Medical Center ', '', '', 'HCFA|UB|', '1467448043', 0, 'N', 0, '2014-04-02', NULL, NULL, 0, 0, NULL, NULL),
('203360654', 'WYT200598', 'WYT200598', 'WYT2', 'Western Medical Associates', 'Joseph', '', 'Mickelson', 'MD', 'Family Practice', '', '', NULL, 'O', '6500 E 2nd St Ste 200', 'Casper', 'Natrona', 'WY', '82609', '3075775100', NULL, '6500 E 2nd St Ste 200', 'Casper', 'Natrona', 'WY', '82609', '3075775100', '', '', '', '', '0.00', '10.00', '0.00', 3, '2010-09-30', NULL, 0, 0, 0, 'Mountain View Regional Hospital', 'Wyoming Medical Center ', '', '', 'HCFA|UB|', '1467448043', 0, 'N', 0, '2014-04-02', NULL, NULL, 0, 0, NULL, NULL),
('830216112', 'WYT200731', 'WYT200731', 'WYT2', 'Lander Medical Clinic', 'Malachi', '', 'Miller', 'MD', 'Family Practice', '', '', NULL, 'O', '745 Buena Vista Dr', 'Lander', 'Fremont', 'WY', '82520', '3073322941', NULL, '745 Buena Vista Dr', 'Lander', 'Fremont', 'WY', '82520', '3073322941', '          ', '', '', '', '0.00', '10.00', '0.00', 3, '2009-08-15', '2012-05-01', 0, 0, 1, 'SageWest Health Care', '', '', '', 'HCFA|UB|', '1730275421', 0, 'N', 0, '2013-02-01', NULL, NULL, 0, 0, NULL, NULL),
('830326307', 'WYT200361', 'WYT200361', 'WYT2', 'Community Health Ctr', 'Michael (Recognized PPO but not contracted)', '', 'Miller', '', 'Family Practice', '', '', NULL, 'O', '1522 E  A  St', 'Casper', '', 'WY', '82601', '3072336035', NULL, '1522 E  A  St', 'Casper', '', 'WY', '82601', '3072336035', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2009-12-15', '2012-09-30', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '0000007622', 0, 'Y', 0, '2012-10-11', NULL, NULL, 0, 0, NULL, NULL),
('742423017', 'WYT200487', 'WYT200487', 'WYT2', 'Big Horn Bone & Joint Clinic', 'Rachel', 'E', 'Miller', 'PT', 'Physical Therapy', '', '', NULL, 'O', '151 S 6th St', 'Worland', 'Washakie', 'WY', '82401', '3073478262', '', '151 S 6th St', 'Worland', 'Washakie', 'WY', '82401', '3073478262', '', '', '', '', '0.00', '15.00', '0.00', 3, '2008-10-06', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1134205743', 0, 'Y', 0, '2014-07-23', NULL, NULL, 0, 0, NULL, NULL),
('830260066', 'WYT200595', 'WYT200595', 'WYT2', NULL, 'Vernon', 'W', 'Miller', 'MD', 'General Surgery', '', '', NULL, 'O', '112 E Arapahoe St', 'Thermopolis', 'Hot Springs', 'WY', '82443', '3078642141', NULL, '112 E Arapahoe St', 'Thermopolis', 'Hot Springs', 'WY', '82443', '3078642141', '', '', NULL, NULL, '0.00', '15.00', '0.00', 3, '2009-03-01', NULL, 0, 0, 1, 'Hot Springs County Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1447256888', 0, 'n', 0, '2012-02-14', NULL, NULL, 0, 0, NULL, NULL),
('830218549', 'WYT200751', 'WYT200751', 'WYT2', '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', '15.00', '0.00', 3, '2009-07-15', '2012-02-12', 0, 0, 1, 'Sheridan Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1780644393', 0, 'N', 0, '2012-08-01', NULL, NULL, 0, 0, NULL, NULL),
('830326307', 'WYT200362', 'WYT200362', 'WYT2', 'Community Health Ctr', 'Michele (Recognized PPO but not contracted)', '', 'Mohr', '', 'Family Practice', '', '', NULL, 'O', '1522 E  A  St', 'Casper', '', 'WY', '82601', '3072336035', NULL, '1522 E  A  St', 'Casper', '', 'WY', '82601', '3072336035', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2009-12-15', '2012-09-30', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '0000007660', 0, 'Y', 0, '2012-10-11', NULL, NULL, 0, 0, NULL, NULL),
('203360654', 'WYT200758', 'WYT200758', 'WYT2', 'Western Medical Associates', 'Matthew', 'R', 'Moore', 'MD', 'Family Practice', '', '', NULL, 'O', '3230 Cy Ave', 'Casper', 'Natrona', 'WY', '82604', '3075775100', NULL, '3230 Cy Ave', 'Casper', 'Natrona', 'WY', '82604', '3075775100', '          ', '', '', '', '0.00', '10.00', '0.00', 3, '2010-11-01', '2011-12-12', 0, 0, 1, 'Mountain View Regional Hospital', '', '', '', 'HCFA|UB|', '1780912246', 0, 'N', 0, '2011-12-22', NULL, NULL, 0, 0, NULL, NULL),
('203360654', 'WYT200759', 'WYT200759', 'WYT2', 'Western Medical Associates', 'Matthew', 'R', 'Moore', 'MD', 'Family Practice', '', '', NULL, 'O', '6500 E 2nd St Ste 200', 'Casper', 'Natrona', 'WY', '82609', '3075775100', NULL, '6500 E 2nd St Ste 200', 'Casper', 'Natrona', 'WY', '82609', '3075775100', '          ', '', '', '', '0.00', '10.00', '0.00', 3, '2010-11-01', '2011-12-12', 0, 0, 1, 'Mountain View Regional Hospital', '', '', '', 'HCFA|UB|', '1780912246', 0, 'N', 0, '2011-12-22', NULL, NULL, 0, 0, NULL, NULL),
('830218549', 'WYT200782', 'WYT200782', 'WYT2', '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', '15.00', '0.00', 3, '2009-07-15', '2012-02-12', 0, 0, 1, 'Sheridan Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1912960667', 0, 'N', 0, '2012-06-28', NULL, NULL, 0, 0, NULL, NULL),
('830326307', 'WYT200363', 'WYT200363', 'WYT2', 'Dubois Med ical Clinic', 'Vaughn (Recognized PPO but not contracted)', '', 'Morgan', '', 'Family Practice', '', '', NULL, 'O', '5647 US Hwy  26', 'Dubois', '', 'WY', '82513', '3074552516', NULL, '5647 US Hwy  26', 'Dubois', '', 'WY', '82513', '3074552516', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2009-12-15', '2012-09-30', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '0000007698', 0, 'Y', 0, '2012-10-11', NULL, NULL, 0, 0, NULL, NULL),
('836000295', 'WYT200803', 'WYT200803', 'WYT2', 'Sweetwater Medical Group', 'Chris', '', 'Moser', 'MD', 'Family Practice', '', '', NULL, 'O', '1204 Hilltop Dr Ste 108', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073528125', '3073528126', '1204 Hilltop Dr Ste 108', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073528125', '3073528126', '', '', '', '0.00', '5.00', '0.00', 3, '2011-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1962441618', 0, 'N', 0, '2013-11-07', NULL, NULL, 0, 0, NULL, NULL),
('830320408', 'WYT200707', 'WYT200707', 'WYT2', 'The Family Clinic', 'Dorothy', 'E', 'Mosher', 'CFNP', 'Family Practice', '', '', NULL, 'O', '1315 East A Street', 'Casper', 'Natrona', 'WY', '82601', '3072358552', '3072354656', '1315 East A Street', 'Casper', 'Natrona', 'WY', '82601', '3072358552', '3072354656', '', '', '', '0.00', '10.00', '0.00', 3, '2007-10-15', '2012-05-29', 0, 0, 1, 'Wyoming Medical Center', '', '', '', 'HCFA|UB|', '1669486502', 0, 'N', 0, '2013-02-13', NULL, NULL, 0, 0, NULL, NULL),
('522085558', 'WYT200507', 'WYT200507', 'WYT2', 'Mountain Towers HC & Rehab Ctr', '', '', 'Mountain Towers HC & Rehab Ctr', 'GROUP', 'Skilled Nursing Facility', '', '', NULL, 'O', '3128 Boxelder Dr', 'Cheyenne', 'Laramie', 'WY', '82001', '3076347901', NULL, '3128 Boxelder Dr', 'Cheyenne', 'Laramie', 'WY', '82001', '3076347901', '          ', '', '', '7', '0.00', '100.00', '0.00', 3, '2009-05-01', '2011-06-27', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1215946546', 0, 'N', 0, '2012-04-25', NULL, NULL, 0, 0, NULL, NULL),
('205067728', 'WYT200429', 'WYT200429', 'WYT2', 'Mountain View Regional Hospital', '', '', 'Mountain View Regional Hospital', 'GROUP', 'Hospital', '', '', NULL, 'O', '6550 E 2nd St', 'Casper', 'Natrona', 'WY', '82609', '3074738499', NULL, '6550 E 2nd St', 'Casper', 'Natrona', 'WY', '82609', '3074738499', '', '', NULL, NULL, '0.00', '15.00', '0.00', 3, '2010-04-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '0000013030', 0, 'n', 0, '2012-11-19', NULL, NULL, 0, 0, NULL, NULL),
('205067728', 'WYT200430', 'WYT200430', 'WYT2', 'Mountain View Regional Hospital', '', '', 'Mountain View Regional Hospital', 'GROUP', 'Hospital', '', '', NULL, 'B', 'PO Box 51888', 'Casper', 'Natrona', 'WY', '82609', '3079958105', NULL, 'PO Box 51888', 'Casper', 'Natrona', 'WY', '82609', '3079958105', '', '', NULL, NULL, '0.00', '15.00', '0.00', 3, '2010-04-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '0000013030', 0, 'y', 0, '2012-11-19', NULL, NULL, 0, 0, NULL, NULL),
('830245718', 'WYT200768', 'WYT200768', 'WYT2', 'Northeast Wyoming Pediatric Associates PC', 'Deborah', 'L', 'Mullinax', 'PA-C', 'Pediatrics', '', '', NULL, 'O', '916 Jackson Ave', 'Sheridan', 'Sheridan', 'WY', '82801', '3076726451', NULL, '916 Jackson Ave', 'Sheridan', 'Sheridan', 'WY', '82801', '3076726451', '          ', '', '', '', '0.00', '15.00', '0.00', 3, '2008-10-03', '2010-06-04', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1821069964', 0, 'N', 0, '2012-01-16', NULL, NULL, 0, 0, NULL, NULL),
('201391282', 'WYT200484', 'WYT200484', 'WYT2', 'Thunder Basin Orthopedics and Sports Medicine', 'Mark', 'G', 'Murphy', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '111 S 5th St', 'Douglas', 'Converse', 'WY', '82633', '3073586200', NULL, '111 S 5th St', 'Douglas', 'Converse', 'WY', '82633', '3073586200', '          ', 'WYORTHO10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-12-15', '2013-12-31', 0, 0, 0, 'Memorial Hospital of Converse County', NULL, NULL, NULL, 'HCFA|UB|', '1134187008', 0, 'N', 0, '2014-01-03', NULL, NULL, 0, 0, NULL, NULL),
('201391282', 'WYT200485', 'WYT200485', 'WYT2', 'Thunder Basin Orthopedics and Sports Medicine', 'Mark', 'G', 'Murphy', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '201 14th St', 'Wheatland', 'Platte', 'WY', '82201', '3073586200', NULL, '201 14th St', 'Wheatland', 'Platte', 'WY', '82201', '3073586200', '          ', 'WYORTHO10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-01-22', NULL, 0, 0, 0, 'Memorial Hospital of Converse County', NULL, NULL, NULL, 'HCFA|UB|', '1134187008', 0, 'N', 0, '2013-09-09', NULL, NULL, 0, 0, NULL, NULL),
('201391282', 'WYT200486', 'WYT200486', 'WYT2', 'Thunder Basin Orthopedics and Sports Medicine', 'Mark', 'G', 'Murphy', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '6550 E 2nd St', 'Casper', 'Natrona', 'WY', '82609', '3073586200', NULL, '6550 E 2nd St', 'Casper', 'Natrona', 'WY', '82609', '3073586200', '          ', 'WYORTHO10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-01-22', NULL, 0, 0, 0, 'Memorial Hospital of Converse County', NULL, NULL, NULL, 'HCFA|UB|', '1134187008', 0, 'N', 0, '2013-09-09', NULL, NULL, 0, 0, NULL, NULL),
('383119546', 'WYT200619', 'WYT200619', 'WYT2', NULL, 'Dale', 'R', 'Myers', 'MD', 'Obstetrics and Gynecology', 'Gynecology', '', NULL, 'O', '1613 Stampede Ave Ste A', 'Cody', 'Park', 'WY', '82414', '3075871155', '3075871166', '1613 Stampede Ave Ste A', 'Cody', 'Park', 'WY', '82414', '3075871155', '3075871166', '', NULL, NULL, '0.00', '20.00', '0.00', 3, '2007-09-01', NULL, 0, 0, 1, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1053312827', 0, 'n', 0, '2013-07-09', NULL, NULL, 0, 0, NULL, NULL),
('760739677', 'WYT200364', 'WYT200364', 'WYT2', 'Myers Chiropractic', 'Jeffrey', 'T', 'Myers', 'DC', 'Chiropractic', '', '', NULL, 'O', '716 Big Horn Ave', 'Worland', 'Washakie', 'WY', '82401', '3079219890', NULL, '716 Big Horn Ave', 'Worland', 'Washakie', 'WY', '82401', '3079219890', '          ', '', '', '5004', '0.00', '100.00', '0.00', 3, '2007-11-01', '2011-06-27', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1598921801', 0, 'N', 0, '2012-10-25', NULL, NULL, 0, 0, NULL, NULL),
('760739677', 'WYT200365', 'WYT200365', 'WYT2', 'Myers Chiropractic', 'Jeffrey', 'T', 'Myers', 'DC', 'Chiropractic', '', '', NULL, 'B', 'PO Box 891', 'Thermopolis', 'Hot Springs', 'WY', '82443', '3073476457', NULL, 'PO Box 891', 'Thermopolis', 'Hot Springs', 'WY', '82443', '3073476457', '          ', '', '', '5004', '0.00', '100.00', '0.00', 3, '2007-11-01', '2011-06-27', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1598921801', 0, 'Y', 0, '2012-10-25', NULL, NULL, 0, 0, NULL, NULL),
('201523220', 'WYT200756', 'WYT200756', 'WYT2', 'Rawlins Eye Care', 'Scott', 'C', 'Neuman', 'OD', 'Optometry', '', '', NULL, 'O', '819 W Maple', 'Rawlins', 'Carbon', 'WY', '82301', '3073242219', NULL, '819 W Maple', 'Rawlins', 'Carbon', 'WY', '82301', '3073242219', '', 'WISEWYSTD', 'wyhcpcs', '', '0.00', '35.00', '0.00', 3, '2007-09-01', '2011-06-28', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1780776369', 0, 'N', 0, '2014-07-15', NULL, NULL, 0, 0, NULL, NULL),
('201523220', 'WYT200757', 'WYT200757', 'WYT2', 'Rawlins Eye Care', 'Scott', 'C', 'Neuman', 'OD', 'Optometry', '', '', NULL, 'B', 'PO Box 1001', 'Rawlins', 'Carbon', 'WY', '82301', '3073242219', NULL, 'PO Box 1001', 'Rawlins', 'Carbon', 'WY', '82301', '3073242219', '', 'WISEWYSTD', 'wyhcpcs', '', '0.00', '35.00', '0.00', 3, '2007-09-01', '2011-06-28', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1780776369', 0, 'Y', 0, '2014-07-15', NULL, NULL, 0, 0, NULL, NULL),
('830234097', 'WYT200366', 'WYT200366', 'WYT2', 'Campbell County Memorial Hospital', 'Robert', '', 'Neuwirth', 'MD', 'Nephrology', 'Hospitalist', '', NULL, 'O', '501 S Burma Ave', 'Gillette', 'Campbell', 'WY', '82717', '3076881000', NULL, '501 S Burma Ave', 'Gillette', 'Campbell', 'WY', '82717', '3076881000', '          ', '', '', '5001', '0.00', '0.00', '0.00', 3, '2008-09-15', '2008-09-15', 0, 0, 0, 'Campbell County Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '0000007826', 0, 'Y', 0, '2013-09-17', NULL, NULL, 0, 0, NULL, NULL),
('273382634', 'WYT200576', 'WYT200576', 'WYT2', 'New Frontier Imaging', '', '', 'New Frontier Imaging', 'Group', 'Diagnostic Radiology', '', '', NULL, 'O', '2620 Commercial Way Ste 10', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073824282', NULL, '2620 Commercial Way Ste 10', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073824282', '          ', '', '', '', '0.00', '15.00', '0.00', 3, '2011-05-13', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1417257114', 0, 'N', 0, '2011-06-10', NULL, NULL, 0, 0, NULL, NULL),
('273382634', 'WYT200577', 'WYT200577', 'WYT2', 'New Frontier Imaging', '', '', 'New Frontier Imaging', 'Group', 'Diagnostic Radiology', '', '', NULL, 'B', 'PO Box 2148', 'Rock Springs', 'Sweetwater', 'WY', '84902', '3073824282', NULL, 'PO Box 2148', 'Rock Springs', 'Sweetwater', 'WY', '84902', '3073824282', '          ', '', '', '', '0.00', '15.00', '0.00', 3, '2011-05-13', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1417257114', 0, 'N', 0, '2011-06-10', NULL, NULL, 0, 0, NULL, NULL),
('830228210', 'WYT200367', 'WYT200367', 'WYT2', 'WY  OtolaryngologyJoseph Vigneri MD', 'Cope (Recognized PPO but not contracted)', '', 'Norcross', '', 'Ear, Nose and Throat', '', '', NULL, 'O', '6500  E 2nd St', 'Casper', '', 'WY', '82609', '3075774240', NULL, '6500  E 2nd St', 'Casper', '', 'WY', '82609', '3075774240', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2009-12-15', '2012-12-01', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '0000007892', 0, 'Y', 0, '2012-10-19', NULL, NULL, 0, 0, NULL, NULL),
('836000891', 'WYT200368', 'WYT200368', 'WYT2', 'North Big Horn Hospital', '', '', 'North Big Horn Hospital', 'GROUP', 'Hospital', '', '', NULL, 'O', '1115 Lane 12', 'Lovell', 'Big Horn', 'WY', '82431', '3075485201', NULL, '1115 Lane 12', 'Lovell', 'Big Horn', 'WY', '82431', '3075485201', '          ', '', '', '', '0.00', '10.00', '0.00', 3, '2008-02-01', '2011-06-16', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000007899', 0, 'N', 0, '2013-08-07', NULL, NULL, 0, 0, NULL, NULL),
('870623138', 'WYT200369', 'WYT200369', 'WYT2', 'Northern Wyoming Surgical Center', '', '', 'Northern Wyoming Surgical Center', 'GROUP', 'Ambulatory Surgery Center', '', '', NULL, 'O', '732 Lindsay Ln', 'Cody', 'Park', 'WY', '82414', '3075872139', '3075872365', '732 Lindsay Ln', 'Cody', 'Park', 'WY', '82414', '3075872139', '3075872365', '', '', '5005', '0.00', '15.00', '0.00', 3, '2008-08-01', '2011-06-13', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '0000007910', 0, 'N', 0, '2011-06-29', NULL, NULL, 0, 0, NULL, NULL),
('260051437', 'WYT200725', 'WYT200725', 'WYT2', 'Nuclear Diagnosis ', '', '', 'Nuclear Diagnosis LLC', 'GROUP', 'Nuclear Medicine', '', '', NULL, 'B', '3103 E Fairground Loop Ste 4', 'Spearfish', 'Lawrence', 'SD', '57783', '          ', NULL, '3103 E Fairground Loop Ste 4', 'Spearfish', 'Lawrence', 'SD', '57783', '          ', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2008-08-21', '2013-03-01', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1710937685', 0, 'Y', 0, '2013-02-26', NULL, NULL, 0, 0, NULL, NULL),
('330892907', 'WYT200771', 'WYT200771', 'WYT2', 'Nufactor Inc', '', '', 'Nufactor', 'GROUP', 'Infusion Agency', '', '', NULL, 'B', '41093 County Ctr Dr', 'Temecula', 'Riverside', 'CA', '92591', '8003236832', NULL, '41093 County Ctr Dr', 'Temecula', 'Riverside', 'CA', '92591', '8003236832', '          ', '', '', '1001', '0.00', '0.00', '0.00', 3, '2006-12-01', '2013-02-28', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1861599540', 0, 'N', 0, '2013-06-18', NULL, NULL, 0, 0, NULL, NULL),
('830182821', 'WYT200630', 'WYT200630', 'WYT2', 'Gottsche Rehabilitation Center', 'Gary', '', 'Olheiser', 'OT', 'Occupational Therapy', '', '', NULL, 'O', '148 E Arapahoe', 'Thermopolis', 'Hot Springs', 'WY', '82443', '3078642146', '3078642857', '148 E Arapahoe', 'Thermopolis', 'Hot Springs', 'WY', '82443', '3078642146', '3078642857', '', '', '', '0.00', '10.00', '0.00', 3, '2011-01-01', '2014-06-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1518163203', 0, 'N', 0, '2014-06-16', NULL, NULL, 0, 0, NULL, NULL),
('830182821', 'WYT200631', 'WYT200631', 'WYT2', 'Gottsche Rehabilitation Center', 'Gary', '', 'Olheiser', 'OT', 'Occupational Therapy', '', '', NULL, 'B', 'PO Box 790', 'Thermopolis', 'Hot Springs', 'WY', '82443', '3078642146', '3078642857', 'PO Box 790', 'Thermopolis', 'Hot Springs', 'WY', '82443', '3078642146', '3078642857', '', '', '', '0.00', '10.00', '0.00', 3, '2011-01-01', '2014-06-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1518163203', 0, 'N', 0, '2014-06-16', NULL, NULL, 0, 0, NULL, NULL),
('830327251', 'WYT200745', 'WYT200745', 'WYT2', 'Star Valley Medical Center', 'David ', '', 'Olsen', 'CRNA', 'Anesthesia', '', '', NULL, 'O', '901 Adams St', 'Afton', 'Lincoln', 'WY', '83110', '3078855817', NULL, '901 Adams St', 'Afton', 'Lincoln', 'WY', '83110', '3078855817', '          ', 'WSTARV', 'wyhcpcs', '', '0.00', '10.00', '0.00', 6, '2010-09-08', '2011-06-28', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1770517344', 0, 'Y', 0, '2011-06-29', NULL, NULL, 0, 0, NULL, NULL),
('830327251', 'WYT200746', 'WYT200746', 'WYT2', 'Star Valley Medical Center', 'David ', '', 'Olsen', 'CRNA', 'Anesthesia', '', '', NULL, 'B', 'PO Box 579', 'Afton', 'Lincoln', 'WY', '83110', '3078855817', NULL, 'PO Box 579', 'Afton', 'Lincoln', 'WY', '83110', '3078855817', '          ', 'WSTARV', 'wyhcpcs', '', '0.00', '10.00', '0.00', 6, '2010-09-08', '2011-06-28', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1770517344', 0, 'Y', 0, '2011-06-29', NULL, NULL, 0, 0, NULL, NULL),
('830234097', 'WYT200370', 'WYT200370', 'WYT2', 'Oncology-Cancer Care', '', '', 'Oncology-Cancer Care', 'GROUP', 'Oncology', 'Hematology and Oncology', '', NULL, 'O', '501 S Burma Ave', 'Gillette', 'Campbell', 'WY', '82717', '3076881900', NULL, '501 S Burma Ave', 'Gillette', 'Campbell', 'WY', '82717', '3076881900', '          ', '', '', '5001', '0.00', '0.00', '0.00', 3, '2008-09-15', '2008-09-15', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000007970', 0, 'N', 0, '2013-09-17', NULL, NULL, 0, 0, NULL, NULL),
('752608036', 'WYT200371', 'WYT200371', 'WYT2', 'Orthofix (Bone Growth Stimulators Physicians Only)', '', '', 'Orthofix', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'B', 'PO Box 849806', 'Dallas', '', 'TX', '', '8005270404', '          ', 'PO Box 849806', 'Dallas', '', 'TX', '', '8005270404', '          ', 'WCSTORFIX5', '', '', '0.00', '100.00', '0.00', 3, '2006-12-01', '2014-06-18', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000007988', 0, 'Y', 0, '2014-06-19', NULL, NULL, 0, 0, NULL, NULL),
('752608036', 'WYT200372', 'WYT200372', 'TXDALSTD', 'Orthofix Inc (Bone Growth Stimulators Physicians Only)', '', '', 'Orthofix Inc (Bone Growth Stimulators Physicians Only)', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', '3451 Plano Pkwy', 'Lewisville', 'Dallas', 'TX', '75284', '8005354492', '          ', '3451 Plano Pkwy', 'Lewisville', 'Dallas', 'TX', '75284', '8005354492', '          ', 'ORTHOFIX14', '', '', '0.00', '50.00', '0.00', 3, '2014-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1235136060', 0, 'Y', 1, '2014-07-23', NULL, NULL, 0, 0, NULL, NULL),
('810422536', 'WYT200373', 'WYT200373', 'WYT2', 'Yellowstone Pathologists PC', '', '', 'Pathology Consultants PC', 'GROUP', 'Pathology', '', '', NULL, 'O', '1008 Cody Ave', 'Cody', 'Park', 'WY', '82414', '4062386363', NULL, '1008 Cody Ave', 'Cody', 'Park', 'WY', '82414', '4062386363', '          ', 'WYSTD', 'Wyhcpcs', '', '0.00', '35.00', '0.00', 3, '2007-12-01', '2011-06-28', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '0000008086', 0, 'N', 0, '2013-06-27', NULL, NULL, 0, 0, NULL, NULL),
('810422536', 'WYT200374', 'WYT200374', 'WYT2', 'Yellowstone Pathologists PC', '', '', 'Pathology Consultants PC', 'GROUP', 'Pathology', '', '', NULL, 'O', '2900 12th Ave N Ste 295W', 'Billings', 'Yellowstone', 'MT', '59101', '4062386363', NULL, '2900 12th Ave N Ste 295W', 'Billings', 'Yellowstone', 'MT', '59101', '4062386363', '          ', 'WYSTD', 'Wyhcpcs', '', '0.00', '35.00', '0.00', 3, '2007-12-01', '2011-06-28', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '0000008086', 0, 'N', 0, '2013-06-27', NULL, NULL, 0, 0, NULL, NULL),
('836000295', 'WYT200587', 'WYT200587', 'WYT2', 'Memorial Hospital of Sweetwater County', 'James', 'E', 'Pearl', 'MD', 'Internal Medicine', 'Pulmonary', 'Emergency Medicine', NULL, 'O', '1204 Hilltop Dr Ste 108', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073528125', NULL, '1204 Hilltop Dr Ste 108', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073528125', '', '', NULL, NULL, '0.00', '5.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 1, 'Memorial Hospital of Sweetwater County', '', '', '', 'HCFA|UB|', '1417959206', 0, 'N', 0, '2011-12-19', NULL, NULL, 0, 0, NULL, NULL),
('205050083', 'WYT200674', 'WYT200674', 'WYT2', 'Wyoming Vision Center', 'F', 'John', 'Pembroke', 'OD', 'Optometry', '', '', NULL, 'O', '2820 Foothill Blvd', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073824444', NULL, '2820 Foothill Blvd', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073824444', '          ', 'WYSTD', 'wyhcpcs', '', '0.00', '35.00', '0.00', 3, '2007-05-01', '2011-06-28', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1578582573', 0, 'N', 0, '2014-01-08', NULL, NULL, 0, 0, NULL, NULL),
('205050083', 'WYT200675', 'WYT200675', 'WYT2', 'Wyoming Vision Center', 'F', 'John', 'Pembroke', 'OD', 'Optometry', '', '', NULL, 'B', 'PO Box 2250', 'Rock Springs', 'Sweetwater', 'WY', '82902', '3073824444', NULL, 'PO Box 2250', 'Rock Springs', 'Sweetwater', 'WY', '82902', '3073824444', '          ', 'WYSTD', 'wyhcpcs', '', '0.00', '35.00', '0.00', 3, '2007-05-01', '2011-06-28', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1578582573', 0, 'Y', 0, '2014-01-08', NULL, NULL, 0, 0, NULL, NULL),
('830234097', 'WYT200802', 'WYT200802', 'WYT2', 'Sagebrush ENT', 'Brian', '', 'Peshek', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '1405 W 4th St', 'Gillette', 'Campbell', 'WY', '82716', '3076851442', NULL, '1405 W 4th St', 'Gillette', 'Campbell', 'WY', '82716', '3076851442', '          ', '', '', '5001', '0.00', '0.00', '0.00', 3, '2008-09-15', '2008-09-15', 0, 0, 0, 'Campbell County Memorial Hospital', '', '', '', 'HCFA|UB|', '1952528572', 0, 'N', 0, '2013-09-17', NULL, NULL, 0, 0, NULL, NULL),
('830251081', 'WYT200666', 'WYT200666', 'WYT2', 'Powder River Orthopedics & Spine PC', 'Roxanne', 'L', 'Peters', 'PAC', 'Orthopedic Surgery', '', '', NULL, 'O', '508 Stocktrail Ste A', 'Gillette', 'Campbell', 'WY', '82716', '3076861413', NULL, '508 Stocktrail Ste A', 'Gillette', 'Campbell', 'WY', '82716', '3076861413', '          ', '', '', '', '0.00', '23.00', '0.00', 3, '2009-11-15', '2011-11-06', 0, 0, 0, 'Campbell County Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1558593731', 0, 'N', 0, '2013-09-17', NULL, NULL, 0, 0, NULL, NULL),
('830306207', 'WYT200492', 'WYT200492', 'WYT2', 'Big Horn Pediatrics', 'Jennifer', 'M', 'Peterson', 'MD', 'Pediatrics', '', '', NULL, 'O', '1308 W Fourth St', 'Gillette', 'Campbell', 'WY', '82716', '3076871300', NULL, '1308 W Fourth St', 'Gillette', 'Campbell', 'WY', '82716', '3076871300', '          ', '', '', '', '0.00', '12.00', '0.00', 3, '2008-09-10', '2011-06-28', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1144333022', 0, 'N', 0, '2012-07-23', NULL, NULL, 0, 0, NULL, NULL),
('870716858', 'WYT200703', 'WYT200703', 'WYT2', 'Yellowstone Sports Medicine And Bone & Joint Clinic', 'Mary', 'L', 'Phillips', 'CFNP', 'Orthopedic Surgery', '', '', NULL, 'O', '720 Lindsay Ln Ste B', 'Cody', 'Park', 'WY', '82414', '3075781992', NULL, '720 Lindsay Ln Ste B', 'Cody', 'Park', 'WY', '82414', '3075781992', '          ', '', '', '', '0.00', '25.00', '0.00', 3, '2009-03-15', '2011-11-14', 0, 0, 1, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1639263650', 0, 'N', 0, '2011-11-15', NULL, NULL, 0, 0, NULL, NULL),
('870716858', 'WYT200704', 'WYT200704', 'WYT2', 'Yellowstone Sports Medicine And Bone & Joint Clinic LLC', 'Mary', 'L', 'Phillips', 'CFNP', 'Orthopedic Surgery', '', '', NULL, 'B', 'PO Box 457', 'Cody', 'Park', 'WY', '82414', '3075781992', NULL, 'PO Box 457', 'Cody', 'Park', 'WY', '82414', '3075781992', '          ', '', '', '', '0.00', '25.00', '0.00', 3, '2009-03-15', '2011-11-14', 0, 0, 1, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1639263650', 0, 'Y', 0, '2011-11-15', NULL, NULL, 0, 0, NULL, NULL),
('830216112', 'WYT200626', 'WYT200626', 'WYT2', 'Lander Medical Clinic', 'Douglas', '', 'Phipps', 'MD', 'Family Practice', '', '', NULL, 'O', '745 Buena Vista Dr', 'Lander', 'Fremont', 'WY', '82520', '3073322941', NULL, '745 Buena Vista Dr', 'Lander', 'Fremont', 'WY', '82520', '3073322941', '', '', '', '', '0.00', '10.00', '0.00', 3, '2009-03-06', NULL, 0, 0, 0, 'SageWest Health Care', '', '', '', 'HCFA|UB|', '1508952276', 0, 'N', 0, '2014-04-11', NULL, NULL, 0, 0, NULL, NULL),
('830234097', 'WYT200375', 'WYT200375', 'WYT2', 'Pioneer Manor', '', '', 'Pioneer Manor', 'GROUP', 'Skilled Nursing Facility', '', '', NULL, 'O', '900 W 8th St', 'Gillette', 'Campbell', 'WY', '82716', '3076824709', NULL, '900 W 8th St', 'Gillette', 'Campbell', 'WY', '82716', '3076824709', '          ', '', '', '5001', '0.00', '0.00', '0.00', 3, '2008-09-15', '2011-06-27', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000008208', 0, 'N', 0, '2013-09-17', NULL, NULL, 0, 0, NULL, NULL),
('830228210', 'WYT200376', 'WYT200376', 'WYT2', 'WY  OtolaryngologyJoseph Vigneri MD', 'Eugene (Recognized PPO but not contracted)', '', 'Podrazik', '', 'Ear, Nose and Throat', '', '', NULL, 'O', '6500  E 2nd St', 'Casper', '', 'WY', '82609', '3075774240', NULL, '6500  E 2nd St', 'Casper', '', 'WY', '82609', '3075774240', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2009-12-15', '2012-12-01', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '0000008226', 0, 'Y', 0, '2012-10-19', NULL, NULL, 0, 0, NULL, NULL),
('010685479', 'WYT200755', 'WYT200755', 'WYT2', 'Powder River Surgery Center', '', '', 'Powder River Surgery Center', 'GROUP', 'Ambulatory Surgery Center', '', '', NULL, 'O', '906 W 6th St Ste C', 'Gillette', 'Campbell', 'WY', '82716', '3076888600', NULL, '906 W 6th St Ste C', 'Gillette', 'Campbell', 'WY', '82716', '3076888600', '          ', '', '', '', '0.00', '10.00', '0.00', 3, '2009-01-01', '2011-11-06', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1780738153', 0, 'N', 0, '2011-12-22', 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
('830234097', 'WYT200377', 'WYT200377', 'WYT2', 'Campbell County Memorial Hospital', 'Mark', 'D', 'Prince', 'MD', 'Hospitalist', '', '', NULL, 'O', '501 S Burma Ave', 'Gillette', 'Campbell', 'WY', '82717', '3076881000', NULL, '501 S Burma Ave', 'Gillette', 'Campbell', 'WY', '82717', '3076881000', '          ', '', '', '5001', '0.00', '0.00', '0.00', 3, '2008-09-15', '2008-09-15', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000008265', 0, 'Y', 0, '2013-09-17', NULL, NULL, 0, 0, NULL, NULL),
('460360287', 'WYT200502', 'WYT200502', 'WYT2', 'Psi Health Care', '', '', 'Psi Health Care', 'Group', 'Durable Medical Equipment', '', '', NULL, 'O', '609 4-J Ct Ste B', 'Gillette', 'Campbell', 'WY', '82718', '3076861102', '3076862789', '609 4-J Ct Ste B', 'Gillette', 'Campbell', 'WY', '82718', '3076861102', '3076862789', 'ROTECH', 'DME80', '', '0.00', '35.00', '0.00', 3, '2008-10-01', '2011-06-28', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1205816980', 0, 'N', 0, '2011-06-30', NULL, NULL, 0, 0, NULL, NULL),
('460360287', 'WYT200503', 'WYT200503', 'WYT2', 'Psi Health Care', '', '', 'Psi Health Care', 'Group', 'Durable Medical Equipment', '', '', NULL, 'B', 'PO Box 9901', 'Clearfield', 'Davis', 'UT', '84089', '8008451378', '8019261335', 'PO Box 9901', 'Clearfield', 'Davis', 'UT', '84089', '8008451378', '8019261335', 'ROTECH', 'DME80', '', '0.00', '35.00', '0.00', 3, '2008-10-01', '2011-06-28', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1205816980', 0, 'Y', 0, '2011-06-30', NULL, NULL, 0, 0, NULL, NULL),
('830218549', 'WYT200455', 'WYT200455', 'WYT2', 'Sheridan Orthopaedic Assoc', 'Anthony', 'B', 'Quinn', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1050 Mydland Rd', 'Sheridan', 'Sheridan', 'WY', '82801', '3076747469', NULL, '1050 Mydland Rd', 'Sheridan', 'Sheridan', 'WY', '82801', '3076747469', '          ', '', '', '', '0.00', '15.00', '0.00', 3, '2009-07-15', '2012-02-12', 0, 0, 1, 'Sheridan Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1083637920', 0, 'N', 0, '2012-06-25', NULL, NULL, 0, 0, NULL, NULL),
('830218549', 'WYT200442', 'WYT200442', 'WYT2', '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', '15.00', '0.00', 3, '2009-07-15', '2012-02-12', 0, 0, 1, 'Sheridan Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1053331504', 0, 'N', 0, '2012-06-25', NULL, NULL, 0, 0, NULL, NULL),
('830326307', 'WYT200378', 'WYT200378', 'WYT2', 'Community Health Ctr', 'Thomas (Recognized PPO but not contracted)', '', 'Radosevich', '', 'Family Practice', '', '', NULL, 'O', '1522 E  A  St', 'Casper', '', 'WY', '82601', '3072336035', NULL, '1522 E  A  St', 'Casper', '', 'WY', '82601', '3072336035', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2009-12-15', '2012-09-30', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '0000008303', 0, 'Y', 0, '2012-10-11', NULL, NULL, 0, 0, NULL, NULL),
('061287427', 'WYT200379', 'WYT200379', 'WYT2', 'Raytel Cardiac Services Inc', '', '', 'Raytel Cardiac Services Inc', 'GROUP', 'Cardiac Monitoring', '', '', NULL, 'O', '7 Waterside Crossing', 'Windsor', NULL, 'CT', NULL, '8003670300', NULL, '7 Waterside Crossing', 'Windsor', '', 'CT', '', '8003670300', '', 'WCSTRCS5', NULL, NULL, '0.00', '100.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1194776518', 0, 'y', 0, '2011-12-19', NULL, NULL, 0, 0, NULL, NULL),
('061287427', 'WYT200380', 'WYT200380', 'WYT2', 'Raytel Cardiac Services Inc', '', '', 'Raytel Cardiac Services Inc', 'GROUP', 'Cardiac Monitoring', '', '', NULL, 'B', 'PO Box 727', 'Windsor', NULL, 'CT', NULL, '8003670300', NULL, 'PO Box 727', 'Windsor', '', 'CT', '', '8003670300', '', 'WCSTRCS5', NULL, NULL, '0.00', '100.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '0000008335', 0, 'Y', 0, '2011-06-10', NULL, NULL, 0, 0, NULL, NULL),
('202299593', 'WYT200381', 'WYT200381', 'WYT2', 'Red Desert InstaCare', '', '', 'Red Desert InstaCare', 'GROUP', 'Urgent Care', '', '', NULL, 'O', '2761 Commercial Way', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073823064', NULL, '2761 Commercial Way', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073823064', '          ', '', '', '', '0.00', '7.50', '0.00', 3, '2007-01-01', '2011-06-28', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '0000008342', 0, 'N', 0, '2012-03-20', NULL, NULL, 0, 0, NULL, NULL),
('830234097', 'WYT200382', 'WYT200382', 'WYT2', 'Campbell County Memorial Hospital', '', '', 'Rehabilitation Services', 'GROUP', 'Speech Therapy', 'Occupational Medicine', 'Physical Therapy', NULL, 'O', '508 Stocktrail Ste B', 'Gillette', 'Campbell', 'WY', '82716', '3076888000', NULL, '508 Stocktrail Ste B', 'Gillette', 'Campbell', 'WY', '82716', '3076888000', '          ', '', '', '5001', '0.00', '0.00', '0.00', 3, '2008-09-15', '2008-09-15', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000008349', 0, 'N', 0, '2013-09-17', NULL, NULL, 0, 0, NULL, NULL),
('830218549', 'WYT200760', 'WYT200760', 'WYT2', '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', '15.00', '0.00', 3, '2009-07-15', '2012-02-12', 0, 0, 1, 'Sheridan Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1801819750', 0, 'N', 0, '2012-06-25', NULL, NULL, 0, 0, NULL, NULL),
('621762468', 'WYT200383', 'WYT200383', 'WYT2', 'Riverton Memorial Hospital', '', '', 'Riverton Memorial Hospital, LLC', 'GROUP', 'Rehabilitation Hospital', '', '', NULL, 'B', '1320 Bishop Randall Dr', 'Lander', 'Fremont', 'WY', '82520', '3073324420', NULL, '1320 Bishop Randall Dr', 'Lander', 'Fremont', 'WY', '82520', '3073324420', '', '', '', '', '0.00', '5.00', '0.00', 3, '2010-07-01', '2010-07-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1295153591', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('621762468', 'WYT200384', 'WYT200384', 'WYT2', 'Riverton Memorial Hospital', '', '', 'Riverton Memorial Hospital, LLC', 'GROUP', 'Rehabilitation Hospital', '', '', NULL, 'O', '2100 W Sunset Dr', 'Riverton', 'Fremont', 'WY', '82501', '3078564161', NULL, '2100 W Sunset Dr', 'Riverton', 'Fremont', 'WY', '82501', '3078564161', '', '', '', '', '0.00', '5.00', '0.00', 3, '2010-07-01', '2010-07-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1295153591', 0, 'N', 0, '2014-04-29', NULL, NULL, 0, 0, NULL, NULL),
('262011935', 'WYT200808', 'WYT200808', 'WYT2', '', 'Amber', 'C', 'Robbins', 'MD', 'Dermatology', '', '', NULL, 'O', '206 N Brooks St', 'Sheridan', 'Sheridan', 'WY', '82801', '3076728941', NULL, '206 N Brooks St', 'Sheridan', 'Sheridan', 'WY', '82801', '3076728941', '          ', '', '', '', '0.00', '10.00', '0.00', 3, '2009-05-15', '2011-06-28', 0, 0, 1, 'Sheridan Memorial Hospital', '', '', '', 'HCFA|UB|', '1982870697', 0, 'N', 0, '2012-05-10', NULL, NULL, 0, 0, NULL, NULL),
('830326307', 'WYT200385', 'WYT200385', 'WYT2', 'Community Health Ctr', 'Andrew (Recognized PPO but not contracted)', '', 'Roberts', '', 'Family Practice', '', '', NULL, 'O', '1522 E  A  St', 'Casper', '', 'WY', '82601', '3072336035', NULL, '1522 E  A  St', 'Casper', '', 'WY', '82601', '3072336035', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2009-12-15', '2012-09-30', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '0000008421', 0, 'Y', 0, '2012-10-11', NULL, NULL, 0, 0, NULL, NULL),
('201391282', 'WYT200499', 'WYT200499', 'WYT2', 'Thunder Basin Orthopedics and Sports Medicine', 'Patrick', 'C', 'Robertson', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '111 S 5th St', 'Douglas', 'Converse', 'WY', '82633', '3073586200', NULL, '111 S 5th St', 'Douglas', 'Converse', 'WY', '82633', '3073586200', '          ', 'WYORTHO10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-04-09', '2013-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1194715037', 0, 'N', 0, '2014-01-03', NULL, NULL, 0, 0, NULL, NULL),
('830326307', 'WYT200386', 'WYT200386', 'WYT2', 'Community Health Ctr', 'Beth (Recognized PPO but not contracted)', '', 'Robitaille', '', 'Family Practice', '', '', NULL, 'O', '1522 E  A  St', 'Casper', '', 'WY', '82601', '3072336035', NULL, '1522 E  A  St', 'Casper', '', 'WY', '82601', '3072336035', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2009-12-15', '2012-09-30', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '0000008433', 0, 'Y', 0, '2012-10-11', NULL, NULL, 0, 0, NULL, NULL),
('830301302', 'WYT200387', 'WYT200387', 'WYT2', 'Rocky Mountain Care', '', '', 'Rocky Mountain Care', 'GROUP', 'Skilled Nursing Facility', '', '', NULL, 'O', '475 Yellow Creek Rd', 'Evanston', 'Uinta', 'WY', '82930', '3077890726', NULL, '475 Yellow Creek Rd', 'Evanston', 'Uinta', 'WY', '82930', '3077890726', '          ', '', '', '7', '0.00', '100.00', '0.00', 3, '2006-12-01', '2011-06-27', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '0000008437', 0, 'N', 0, '2011-06-28', NULL, NULL, 0, 0, NULL, NULL),
('870468543', 'WYT200560', 'WYT200560', 'WYT2', 'Rocky Mountain Home Care', '', '', 'Rocky Mountain Home Care', 'GROUP', 'Home Health Agency', 'Hospice', '', NULL, 'O', '535 Uinta Dr', 'Green River', 'Sweetwater', 'WY', '82935', '3078758990', NULL, '535 Uinta Dr', 'Green River', 'Sweetwater', 'WY', '82935', '3078758990', '          ', '', '', '4', '0.00', '100.00', '0.00', 3, '2006-12-01', '2011-06-27', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1386642965', 0, 'N', 0, '2011-06-28', NULL, NULL, 0, 0, NULL, NULL),
('810422536', 'WYT200786', 'WYT200786', 'WYT2', 'Yellowstone Pathologists PC', 'Pamela', 'R', 'Root', 'MD', 'Pathology', '', '', NULL, 'O', '1008 Cody Ave', 'Cody', 'Park', 'WY', '82414', '4062386363', NULL, '1008 Cody Ave', 'Cody', 'Park', 'WY', '82414', '4062386363', '          ', 'WYSTD', 'Wyhcpcs', '', '0.00', '35.00', '0.00', 3, '2007-12-01', '2011-06-28', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1922091859', 0, 'Y', 0, '2013-06-27', NULL, NULL, 0, 0, NULL, NULL),
('810422536', 'WYT200787', 'WYT200787', 'WYT2', 'Yellowstone Pathologists PC', 'Pamela', 'R', 'Root', 'MD', 'Pathology', '', '', NULL, 'O', '2900 12th Ave N Ste 295W', 'Billings', 'Yellowstone', 'MT', '59101', '4062386363', NULL, '2900 12th Ave N Ste 295W', 'Billings', 'Yellowstone', 'MT', '59101', '4062386363', '          ', 'WYSTD', 'Wyhcpcs', '', '0.00', '35.00', '0.00', 3, '2007-12-01', '2011-06-28', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1922091859', 0, 'N', 0, '2013-06-27', NULL, NULL, 0, 0, NULL, NULL),
('830326307', 'WYT200388', 'WYT200388', 'WYT2', 'Community Health Ctr', 'Dale (Recognized PPO but not contracted)', '', 'Ross', '', 'Family Practice', '', '', NULL, 'O', '1522 E  A  St', 'Casper', '', 'WY', '82601', '3072336035', NULL, '1522 E  A  St', 'Casper', '', 'WY', '82601', '3072336035', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2009-12-15', '2012-09-30', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '0000008486', 0, 'Y', 0, '2012-10-11', NULL, NULL, 0, 0, NULL, NULL),
('760738698', 'WYT200747', 'WYT200747', 'WYT2', 'Rose Lane Medical Arts', 'Stephen', 'S', 'Rotholz', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '1005 College View Dr', 'Riverton', 'Fremont', 'WY', '82501', '3078560382', NULL, '1005 College View Dr', 'Riverton', 'Fremont', 'WY', '82501', '3078560382', '', '', NULL, NULL, '0.00', '20.00', '0.00', 3, '2008-10-03', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1770519605', 0, 'y', 0, '2012-07-02', NULL, NULL, 0, 0, NULL, NULL),
('760738698', 'WYT200748', 'WYT200748', 'WYT2', 'Rose Lane Medical Arts', 'Stephen', 'S', 'Rotholz', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1035 Rose Ln Ste B', 'Riverton', 'Fremont', 'WY', '82501', '3078560382', NULL, '1035 Rose Ln Ste B', 'Riverton', 'Fremont', 'WY', '82501', '3078560382', '', '', NULL, NULL, '0.00', '20.00', '0.00', 3, '2008-10-03', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1770519605', 0, 'n', 0, '2012-07-02', NULL, NULL, 0, 0, NULL, NULL),
('830283425', 'WYT200532', 'WYT200532', 'WYT2', 'North Platte Physical Therapy', 'Robert ', 'A', 'Royse', 'PT', 'Physical Therapy', '', '', NULL, 'O', '311 Thelma Dr', 'Casper', 'Natrona', 'WY', '82609', '3072342662', '3072348810', '311 Thelma Dr', 'Casper', 'Natrona', 'WY', '82609', '3072342662', '3072348810', 'WYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2011-07-01', '2011-07-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1285698795', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('830283425', 'WYT200533', 'WYT200533', 'WYT2', 'North Platte Physical Therapy', 'Robert ', 'A', 'Royse', 'PT', 'Physical Therapy', '', '', NULL, 'O', '3831 Denis Dr Ste 200', 'Casper', 'Natrona', 'WY', '82604', '3072349067', '3072349074', '3831 Denis Dr Ste 200', 'Casper', 'Natrona', 'WY', '82604', '3072349067', '3072349074', 'WYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2011-07-01', '2011-07-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1285698795', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('830283425', 'WYT200534', 'WYT200534', 'WYT2', 'North Platte Physical Therapy', 'Robert ', 'A', 'Royse', 'PT', 'Physical Therapy', '', '', NULL, 'B', 'PO Box 1790', 'Douglas', 'Converse', 'WY', '82633', '3072342662', '3072348810', 'PO Box 1790', 'Douglas', 'Converse', 'WY', '82633', '3072342662', '3072348810', 'WYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2011-07-01', '2011-07-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1285698795', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('911490213', 'WYT200389', 'WYT200389', 'WYT2', 'RS Medical', '', '', 'RS Medical', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'B', 'PO Box 872650', 'Vancouver', 'Clark', 'WA', '98687', '8006830353', NULL, 'PO Box 872650', 'Vancouver', 'Clark', 'WA', '98687', '8006830353', '', 'WCSTRSMED5', NULL, NULL, '0.00', '25.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '0000008499', 0, 'Y', 0, '2011-08-25', NULL, NULL, 0, 0, NULL, NULL),
('911490213', 'WYT200390', 'WYT200390', 'WYT2', 'RS Medical (Muscle Stimulators)', '', '', 'RS Medical (Muscle Stimulators)', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', '14401 SE 1st St', 'Vancouver', 'Clark', 'WA', '98684', '8006830353', NULL, '14401 SE 1st St', 'Vancouver', 'Clark', 'WA', '98684', '8006830353', '', 'WCSTRSMED5', NULL, NULL, '0.00', '25.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1992791230', 0, 'Y', 0, '2012-09-24', NULL, NULL, 0, 0, NULL, NULL),
('161722609', 'WYT200818', 'WYT200818', 'WYT2', 'Accurate Eye Care Clinic', 'David', 'R', 'Russell', 'OD', 'Ophthalmology', '', '', NULL, 'O', '916 Main St', 'Evanston', 'Uinta', 'WY', '82930', '3077891500', NULL, '916 Main St', 'Evanston', 'Uinta', 'WY', '82930', '3077891500', '          ', 'wystd', 'wyhcpcs', '', '0.00', '35.00', '0.00', 3, '2006-12-01', '2011-06-28', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1992898894', 0, 'N', 0, '2011-12-19', NULL, NULL, 0, 0, NULL, NULL),
('830234097', 'WYT200391', 'WYT200391', 'WYT2', 'Walk in Clinic', 'Laine', '', 'Russell', 'DO', 'Family Practice', '', '', NULL, 'O', '407 Medical Arts Ct Ste C', 'Gillette', 'Campbell', 'WY', '82716', '3076821441', NULL, '407 Medical Arts Ct Ste C', 'Gillette', 'Campbell', 'WY', '82716', '3076821441', '          ', '', '', '5001', '0.00', '0.00', '0.00', 3, '2008-09-15', '2008-09-15', 0, 0, 0, 'Campbell County Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1578552444', 0, 'N', 0, '2013-09-17', NULL, NULL, 0, 0, NULL, NULL),
('522085558', 'WYT200392', 'WYT200392', 'WYT2', 'Sage View Care Center', '', '', 'Sage View Care Center', 'GROUP', 'Skilled Nursing Facility', '', '', NULL, 'O', '1325 Sage St', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073623780', NULL, '1325 Sage St', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073623780', '          ', '', '', '7', '0.00', '100.00', '0.00', 3, '2006-12-01', '2011-06-28', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '0000008530', 0, 'N', 0, '2012-04-25', NULL, NULL, 0, 0, NULL, NULL),
('202299593', 'WYT200393', 'WYT200393', 'WYT2', 'Red Desert InstaCare', 'Jonathan', '', 'Said', 'PA-C', 'Family Practice', '', '', NULL, 'O', '2761 Commercial Way', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073823064', NULL, '2761 Commercial Way', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073823064', '          ', '', '', '', '0.00', '7.50', '0.00', 3, '2007-01-01', '2011-06-28', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '0000008532', 0, 'N', 0, '2011-06-30', NULL, NULL, 0, 0, NULL, NULL),
('202299593', 'WYT200394', 'WYT200394', 'WYT2', 'Wyoming Range Medical', 'Jonathan', '', 'Said', 'PA-C', 'Family Practice', '', '', NULL, 'B', 'PO Box 130', 'Big Piney', 'Sublette', 'WY', '83113', '3073823064', NULL, 'PO Box 130', 'Big Piney', 'Sublette', 'WY', '83113', '3073823064', '          ', '', '', '', '0.00', '7.50', '0.00', 3, '2007-01-01', '2011-06-28', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '0000008532', 0, 'Y', 0, '2011-06-30', NULL, NULL, 0, 0, NULL, NULL),
('435707144', 'WYT200519', 'WYT200519', 'WYT2', '', 'Robert', 'D', 'Schaffarzick', 'OD', 'Optometry', '', '', NULL, 'O', '816 Klondyke St', 'Kemmerer', 'Lincoln', 'WY', '83101', '3078779250', '', '816 Klondyke St', 'Kemmerer', 'Lincoln', 'WY', '83101', '3078779250', '', 'WisewySTD', 'wyhcpcs', '', '0.00', '35.00', '0.00', 3, '2007-07-01', '2011-06-28', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1235107954', 0, 'N', 0, '2014-07-21', NULL, NULL, 0, 0, NULL, NULL),
('830216112', 'WYT200779', 'WYT200779', 'WYT2', 'Lander Medical Clinic', 'Gentian', '', 'Scheer', 'MD', 'Internal Medicine', '', '', NULL, 'O', '745 Buena Vista Dr', 'Lander', 'Fremont', 'WY', '82520', '3073322941', NULL, '745 Buena Vista Dr', 'Lander', 'Fremont', 'WY', '82520', '3073322941', '          ', '', '', '', '0.00', '10.00', '0.00', 3, '2009-08-15', '2012-05-01', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1912093667', 0, 'N', 0, '2012-04-30', NULL, NULL, 0, 0, NULL, NULL),
('203360654', 'WYT200732', 'WYT200732', 'WYT2', 'Western Medical Associates', 'Joe', '', 'Schoeber', 'MD', 'Family Practice', '', '', NULL, 'O', '3230 Cy Ave', 'Casper', 'Natrona', 'WY', '82604', '3075775100', '', '3230 Cy Ave', 'Casper', 'Natrona', 'WY', '82604', '3075775100', '', '', '', '', '0.00', '10.00', '0.00', 3, '2010-09-30', NULL, 0, 0, 0, 'Mountain View Regional Hospital', 'Wyoming Medical Center ', '', '', 'HCFA|UB|', '1740233071', 0, 'N', 0, '2014-07-21', NULL, NULL, 0, 0, NULL, NULL),
('203360654', 'WYT200733', 'WYT200733', 'WYT2', 'Western Medical Associates', 'Joe', '', 'Schoeber', 'MD', 'Family Practice', '', '', NULL, 'O', '6500 E 2nd St Ste 200', 'Casper', 'Natrona', 'WY', '82609', '3075775100', '', '6500 E 2nd St Ste 200', 'Casper', 'Natrona', 'WY', '82609', '3075775100', '', '', '', '', '0.00', '10.00', '0.00', 3, '2010-09-30', NULL, 0, 0, 0, 'Mountain View Regional Hospital', 'Wyoming Medical Center ', '', '', 'HCFA|UB|', '1740233071', 0, 'N', 0, '2014-07-21', NULL, NULL, 0, 0, NULL, NULL),
('810422536', 'WYT200749', 'WYT200749', 'WYT2', 'Yellowstone Pathologists PC', 'Duane', 'A', 'Schultz', 'MD', 'Pathology', '', '', NULL, 'O', '1008 Cody Ave', 'Cody', 'Park', 'WY', '82414', '4062386363', NULL, '1008 Cody Ave', 'Cody', 'Park', 'WY', '82414', '4062386363', '          ', 'WYSTD', 'Wyhcpcs', '', '0.00', '35.00', '0.00', 3, '2007-12-01', '2011-06-28', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1770585903', 0, 'Y', 0, '2013-06-27', NULL, NULL, 0, 0, NULL, NULL),
('810422536', 'WYT200750', 'WYT200750', 'WYT2', 'Yellowstone Pathologists PC', 'Duane', 'A', 'Schultz', 'MD', 'Pathology', '', '', NULL, 'O', '2900 12th Ave N Ste 295W', 'Billings', 'Yellowstone', 'MT', '59101', '4062386363', NULL, '2900 12th Ave N Ste 295W', 'Billings', 'Yellowstone', 'MT', '59101', '4062386363', '          ', 'WYSTD', 'Wyhcpcs', '', '0.00', '35.00', '0.00', 3, '2007-12-01', '2011-06-28', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1770585903', 0, 'N', 0, '2013-06-27', NULL, NULL, 0, 0, NULL, NULL),
('836000025', 'WYT200655', 'WYT200655', 'WYT2', 'Wagon Circle Ortho Clinic', 'Kenneth', '', 'Schulze', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', '2221 W Elm St', 'Rawlins', 'Carbon', 'WY', '82301', '3073246022', '3073248232', '2221 W Elm St', 'Rawlins', 'Carbon', 'WY', '82301', '3073246022', '3073248232', 'WISEWYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 6, '2030-01-01', NULL, 0, 0, 0, 'Memorial Hospital of Carbon County', '', '', '', 'HCFA|', '1538239454', 0, 'N', 1, '2014-05-12', NULL, NULL, 0, 0, NULL, NULL),
('830283425', 'WYT200493', 'WYT200493', 'WYT2', 'North Platte Physical Therapy', 'Reagan ', '', 'Scott', 'OT', 'Occupational Therapy', '', '', NULL, 'O', '311 Thelma Dr', 'Casper', 'Natrona', 'WY', '82609', '3072342662', '3072348810', '311 Thelma Dr', 'Casper', 'Natrona', 'WY', '82609', '3072342662', '3072348810', 'WYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2011-07-01', '2011-07-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1154385748', 0, 'N', 0, '2014-07-16', NULL, NULL, 0, 0, NULL, NULL),
('830283425', 'WYT200494', 'WYT200494', 'WYT2', 'North Platte Physical Therapy', 'Reagan ', '', 'Scott', 'OT', 'Occupational Therapy', '', '', NULL, 'O', '3831 Denis Dr', 'Casper', 'Natrona', 'WY', '82604', '3072349067', '3072349074', '3831 Denis Dr', 'Casper', 'Natrona', 'WY', '82604', '3072349067', '3072349074', 'WYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2011-07-01', '2011-07-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1154385748', 0, 'N', 0, '2014-07-16', NULL, NULL, 0, 0, NULL, NULL),
('830283425', 'WYT200495', 'WYT200495', 'WYT2', 'North Platte Physical Therapy', 'Reagan ', '', 'Scott', 'OT', 'Occupational Therapy', '', '', NULL, 'B', 'PO Box 1790', 'Douglas', 'Converse', 'WY', '82633', '3072342662', '3072348810', 'PO Box 1790', 'Douglas', 'Converse', 'WY', '82633', '3072342662', '3072348810', 'WYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2011-07-01', '2011-07-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1154385748', 0, 'N', 0, '2014-07-16', NULL, NULL, 0, 0, NULL, NULL),
('810422536', 'WYT200436', 'WYT200436', 'WYT2', 'Yellowstone Pathologists PC', 'Hoyle', 'E', 'Setzer', 'MD', 'Pathology', '', '', NULL, 'O', '1008 Cody Ave', 'Cody', 'Park', 'WY', '82414', '4062386363', NULL, '1008 Cody Ave', 'Cody', 'Park', 'WY', '82414', '4062386363', '          ', 'WYSTD', 'Wyhcpcs', '', '0.00', '35.00', '0.00', 3, '2007-12-01', '2011-06-28', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1023010253', 0, 'N', 0, '2013-06-27', NULL, NULL, 0, 0, NULL, NULL),
('810422536', 'WYT200437', 'WYT200437', 'WYT2', 'Yellowstone Pathologists PC', 'Hoyle', 'E', 'Setzer', 'MD', 'Pathology', '', '', NULL, 'O', '2900 12th Ave N Ste 295W', 'Billings', 'Yellowstone', 'MT', '59101', '4062386363', NULL, '2900 12th Ave N Ste 295W', 'Billings', 'Yellowstone', 'MT', '59101', '4062386363', '          ', 'WYSTD', 'Wyhcpcs', '', '0.00', '35.00', '0.00', 3, '2007-12-01', '2011-06-28', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1023010253', 0, 'N', 0, '2013-06-27', NULL, NULL, 0, 0, NULL, NULL),
('830322385', 'WYT200709', 'WYT200709', 'WYT2', 'Sharons Home Health', '', '', 'Sharons Home Health', 'GROUP', 'Home Health Agency', '', '', NULL, 'O', '116 D Little Horn', 'Moorcroft', 'Crook', 'WY', '82721', '3077563344', NULL, '116 D Little Horn', 'Moorcroft', 'Crook', 'WY', '82721', '3077563344', '          ', '', '', '', '0.00', '30.00', '0.00', 3, '2010-03-11', '2011-06-14', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1679712384', 0, 'N', 0, '2011-06-15', NULL, NULL, 0, 0, NULL, NULL),
('830322385', 'WYT200710', 'WYT200710', 'WYT2', 'Sharons Home Health', '', '', 'Sharons Home Health', 'GROUP', 'Home Health Agency', '', '', NULL, 'O', '1737 E 2nd St', 'Casper', 'Natrona', 'WY', '82601', '3074736889', NULL, '1737 E 2nd St', 'Casper', 'Natrona', 'WY', '82601', '3074736889', '          ', '', '', '', '0.00', '30.00', '0.00', 3, '2010-03-11', '2011-06-14', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1679712384', 0, 'N', 0, '2011-06-15', NULL, NULL, 0, 0, NULL, NULL),
('061666516', 'WYT200395', 'WYT200395', 'WYT2', 'Allergy & Asthma', 'Karmish (Recognized PPO but not contracted)', '', 'Shaw', '', 'Allergy and Immunology', '', '', NULL, 'O', '2222 E  2nd St', 'Casper', '', 'WY', '82609', '3075775222', NULL, '2222 E  2nd St', 'Casper', '', 'WY', '82609', '3075775222', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2009-12-15', '2012-12-01', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '0000008686', 0, 'Y', 0, '2012-10-19', NULL, NULL, 0, 0, NULL, NULL),
('836000241', 'WYT200396', 'WYT200396', 'WYT2', 'Sheridan Memorial Hospital', '', '', 'Sheridan Memorial Hospital', 'GROUP', 'Hospital', '', '', NULL, 'O', '1401 W 5th St', 'Sheridan', 'Sheridan', 'WY', '82801', '3076721014', NULL, '1401 W 5th St', 'Sheridan', 'Sheridan', 'WY', '82801', '3076721014', '          ', '', '', '5001', '0.00', '0.00', '0.00', 3, '2009-12-15', '2012-02-29', 0, 0, 1, '', '', '', '', 'UB|HCFA|', '0000008695', 0, 'N', 0, '2012-03-06', NULL, NULL, 0, 0, NULL, NULL),
('850300232', 'W12014666', 'W12014666', 'NM01', 'Southwest Gastroenterology Associates', '', '', 'Southwest Gastroenterology Associates', '', 'Gastroenterology', '', '', NULL, '', 'Change', 'Albuquerque', 'Bernalillo', 'NM', '87109', '          ', '5059991650', 'Change', 'Albuquerque', 'Bernalillo', 'NM', '87109', '          ', '5059991650', '', '', '', '0.00', '0.00', '0.00', 3, '2012-01-01', '2012-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|DEN|', '0000009784', 0, 'Y', 0, '2012-02-01', NULL, NULL, 0, 0, NULL, NULL),
('830216112', 'WYT200800', 'WYT200800', 'WYT2', 'Lander Medical Clinic', 'Jan', '', 'Siebersma', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '745 Buena Vista Dr', 'Lander', 'Fremont', 'WY', '82520', '3073322941', NULL, '745 Buena Vista Dr', 'Lander', 'Fremont', 'WY', '82520', '3073322941', '', '', NULL, NULL, '0.00', '10.00', '0.00', 3, '2009-03-06', NULL, 0, 0, 1, 'SageWest Health Care', NULL, NULL, NULL, 'HCFA|UB|', '1952303216', 0, 'n', 0, '2012-02-08', NULL, NULL, 0, 0, NULL, NULL),
('271448325', 'WYT200501', 'WYT200501', 'WYT2', 'Bone & Joint Radiology LLC', 'Nathan', 'S', 'Simpson', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', '508 Stocktrail Ste A', 'Gillette', 'Campbell', 'WY', '82716', '3076861413', NULL, '508 Stocktrail Ste A', 'Gillette', 'Campbell', 'WY', '82716', '3076861413', '          ', '', '', '', '0.00', '23.00', '0.00', 3, '2010-01-01', '2011-11-06', 0, 0, 1, 'Campbell County Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1205165727', 0, 'Y', 0, '2012-01-16', NULL, NULL, 0, 0, NULL, NULL),
('830251081', 'WYT200592', 'WYT200592', 'WYT2', 'Powder River Orthopedics & Spine PC', 'Nathan', 'S', 'Simpson', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '508 Stocktrail Ste A', 'Gillette', 'Campbell', 'WY', '82716', '3076861413', NULL, '508 Stocktrail Ste A', 'Gillette', 'Campbell', 'WY', '82716', '3076861413', '          ', '', '', '', '0.00', '23.00', '0.00', 3, '2008-09-15', '2011-11-06', 0, 0, 0, 'Campbell County Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1427042936', 0, 'N', 0, '2013-09-17', NULL, NULL, 0, 0, NULL, NULL),
('760738698', 'WYT200552', 'WYT200552', 'WYT2', 'Rose Lane Medical Arts', 'Linda', 'B', 'Sims', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'B', '1005 College View Dr', 'Riverton', 'Fremont', 'WY', '82501', '3078560382', NULL, '1005 College View Dr', 'Riverton', 'Fremont', 'WY', '82501', '3078560382', '', '', NULL, NULL, '0.00', '20.00', '0.00', 3, '2008-11-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1356360002', 0, 'y', 0, '2011-06-10', NULL, NULL, 0, 0, NULL, NULL),
('760738698', 'WYT200553', 'WYT200553', 'WYT2', 'Rose Lane Medical Arts', 'Linda', 'B', 'Sims', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1035 Rose Lane Ste B', 'Riverton', 'Fremont', 'WY', '82501', '3078560382', NULL, '1035 Rose Lane Ste B', 'Riverton', 'Fremont', 'WY', '82501', '3078560382', '', '', NULL, NULL, '0.00', '20.00', '0.00', 3, '2008-11-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1356360002', 0, 'N', 0, '2011-06-10', NULL, NULL, 0, 0, NULL, NULL),
('830234097', 'WYT200397', 'WYT200397', 'WYT2', 'Campbell County Memorial Hospital', 'Shailendra', '', 'Singh', 'MD', 'Hospitalist', '', '', NULL, 'O', '501 S Burma Ave', 'Gillette', 'Campbell', 'WY', '82717', '3076881000', NULL, '501 S Burma Ave', 'Gillette', 'Campbell', 'WY', '82717', '3076881000', '          ', '', '', '5001', '0.00', '0.00', '0.00', 3, '2008-09-15', '2008-09-15', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000008728', 0, 'Y', 0, '2013-09-17', NULL, NULL, 0, 0, NULL, NULL),
('830199236', 'WYT200489', 'WYT200489', 'WYT2', 'Yellowstone Behavioral Health Center', 'Sadie', '', 'Smith', 'LMFT', 'Mental Health', 'Counseling', '', NULL, 'O', '2538 Big Horn Ave', 'Cody', 'Park', 'WY', '82414', '3075872197', NULL, '2538 Big Horn Ave', 'Cody', 'Park', 'WY', '82414', '3075872197', '          ', 'MA', '', '', '0.00', '35.00', '0.00', 6, '2012-03-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1134458904', 0, 'N', 0, '2013-07-25', NULL, NULL, 0, 0, NULL, NULL),
('223887117', 'WYT200705', 'WYT200705', 'WYT2', 'Mountain Valley Eye Institute', 'Stacy', 'R', 'Smith', 'MD', 'Ophthalmology', '', '', NULL, 'O', '196 Arrowhead Dr Ste 5', 'Evanston', 'Uinta', 'WY', '82930', '8774232020', NULL, '196 Arrowhead Dr Ste 5', 'Evanston', 'Uinta', 'WY', '82930', '8774232020', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2008-08-08', '2011-06-28', 0, 0, 1, 'Evanston Regional Hospital', 'Heber Valley Medical Center', NULL, NULL, 'HCFA|UB|', '1639348899', 0, 'N', 0, '2012-10-09', NULL, NULL, 0, 0, NULL, NULL),
('510123924', 'WYT200398', 'WYT200398', 'WYT2', 'Smith Nephew Inc (Muscle Stimulators)', '', '', 'Smith Nephew Inc (Muscle Stimulators)', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', '1450 Brooks Road', 'Memphis', 'Shelby', 'TN', '38116', '8006374391', NULL, '1450 Brooks Road', 'Memphis', 'Shelby', 'TN', '38116', '8006374391', '', '', NULL, '1002', '0.00', '30.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1568532901', 0, 'Y', 0, '2012-09-24', NULL, NULL, 0, 0, NULL, NULL),
('830306207', 'WYT200724', 'WYT200724', 'WYT2', 'Big Horn Pediatrics', 'Ambrose', '', 'Soler', 'MD', 'Pediatrics', '', '', NULL, 'O', '1308 W Fourth St', 'Gillette', 'Campbell', 'WY', '82716', '3076874300', NULL, '1308 W Fourth St', 'Gillette', 'Campbell', 'WY', '82716', '3076874300', '          ', '', '', '', '0.00', '12.00', '0.00', 3, '2010-04-20', '2011-06-28', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1710915525', 0, 'N', 0, '2013-07-08', NULL, NULL, 0, 0, NULL, NULL),
('830181409', 'WYT200399', 'WYT200399', 'WYT2', 'South Big Horn County Hospital District', '', '', 'South Big Horn County Hospital District', 'GROUP', 'Hospital', '', '', NULL, 'O', '388 Hwy 20 S', 'Basin', 'Big Horn', 'WY', '82410', '3075683311', NULL, '388 Hwy 20 S', 'Basin', 'Big Horn', 'WY', '82410', '3075683311', '', '', NULL, NULL, '0.00', '10.00', '0.00', 6, '2008-07-18', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '0000008826', 0, 'n', 0, '2011-06-10', NULL, NULL, 0, 0, NULL, NULL),
('522085558', 'WYT200400', 'WYT200400', 'WYT2', 'South Central Wyoming Health Care', '', '', 'South Central Wyoming Health Care', 'GROUP', 'Skilled Nursing Facility', '', '', NULL, 'O', '542 16th St', 'Rawlins', 'Fremont', 'WY', '82501', '3073242759', NULL, '542 16th St', 'Rawlins', 'Fremont', 'WY', '82501', '3073242759', '          ', '', '', '7', '0.00', '100.00', '0.00', 3, '2006-12-01', '2011-06-27', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '0000008827', 0, 'N', 0, '2012-04-25', NULL, NULL, 0, 0, NULL, NULL),
('830128950', 'WYT200401', 'WYT200401', 'WYT2', 'South Lincoln Medical Center', '', '', 'South Lincoln Medical Center', 'GROUP', 'Hospital', '', '', NULL, 'O', '711 Onyx St', 'Kemmerer', 'Lincoln', 'WY', '83101', '3078774401', NULL, '711 Onyx St', 'Kemmerer', 'Lincoln', 'WY', '83101', '3078774401', '          ', '', '', '1', '0.00', '10.00', '0.00', 3, '2006-12-01', '2011-06-30', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '0000008830', 0, 'N', 0, '2011-07-20', NULL, NULL, 0, 0, NULL, NULL),
('830128950', 'WYT200402', 'WYT200402', 'WYT2', 'South Lincoln Medical Center Home Oxygen/Swing Bed', '', '', 'South Lincoln Medical Center Home Oxygen/Swing Bed', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', '711 Onyx St', 'Kemmerer', 'Lincoln', 'WY', '83101', '3078774401', NULL, '711 Onyx St', 'Kemmerer', 'Lincoln', 'WY', '83101', '3078774401', '          ', '', '', '1', '0.00', '10.00', '0.00', 3, '2006-12-01', '2011-06-30', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '0000008831', 0, 'Y', 0, '2011-07-20', NULL, NULL, 0, 0, NULL, NULL),
('830128950', 'WYT200403', 'WYT200403', 'WYT2', 'South Lincoln Medical Center Swing Bed', '', '', 'South Lincoln Medical Center Swing Bed', 'GROUP', '', '', '', NULL, 'O', '711 Onyx St', 'Kemmerer', 'Lincoln', 'WY', '83101', '3078774401', NULL, '711 Onyx St', 'Kemmerer', 'Lincoln', 'WY', '83101', '3078774401', '          ', '', '', '1', '0.00', '10.00', '0.00', 3, '2006-12-01', '2011-06-30', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '0000008832', 0, 'Y', 0, '2011-07-20', NULL, NULL, 0, 0, NULL, NULL),
('830128950', 'WYT200404', 'WYT200404', 'WYT2', 'South Lincoln Nursing Center', '', '', 'South Lincoln Nursing Center', 'GROUP', '', '', '', NULL, 'O', '711 Onyx St', 'Kemmerer', 'Lincoln', 'WY', '83101', '3078774401', NULL, '711 Onyx St', 'Kemmerer', 'Lincoln', 'WY', '83101', '3078774401', '          ', '', '', '1', '0.00', '10.00', '0.00', 3, '2006-12-01', '2011-06-30', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '0000008834', 0, 'N', 0, '2011-07-20', NULL, NULL, 0, 0, NULL, NULL),
('104448620', 'WYT200513', 'WYT200513', 'WYT2', 'Welch Cancer Center', 'John', 'P', 'Stamato', 'MD', 'Radiation Oncology', '', '', NULL, 'O', '1585 W 5th St', 'Sheridan', 'Sheridan', 'WY', '82801', '3076746022', NULL, '1585 W 5th St', 'Sheridan', 'Sheridan', 'WY', '82801', '3076746022', '', '', NULL, NULL, '0.00', '15.00', '0.00', 3, '2009-06-05', NULL, 0, 0, 1, 'Campbell County Memorial Hospital', 'Sheridan Memorial Hospital', NULL, NULL, 'HCFA|UB|', '1225080831', 0, 'n', 0, '2012-05-16', NULL, NULL, 0, 0, NULL, NULL),
('104448620', 'WYT200514', 'WYT200514', 'WYT2', 'Welch Cancer Center', 'John', 'P', 'Stamato', 'MD', 'Radiation Oncology', '', '', NULL, 'B', 'PO Box 6607', 'Sheridan', 'Sheridan', 'WY', '82801', '3076746022', NULL, 'PO Box 6607', 'Sheridan', 'Sheridan', 'WY', '82801', '3076746022', '', '', NULL, NULL, '0.00', '15.00', '0.00', 3, '2009-06-05', NULL, 0, 0, 1, 'Campbell County Memorial Hospital', 'Sheridan Memorial Hospital', NULL, NULL, 'HCFA|UB|', '1225080831', 0, 'y', 0, '2012-05-16', NULL, NULL, 0, 0, NULL, NULL),
('830317319', 'WYT200511', 'WYT200511', 'WYT2', 'Fremont County Pediatrics', 'Thomas', '', 'Stamps', 'MD', 'Pediatrics', '', '', NULL, 'O', '115 Wyoming St', 'Lander', 'Fremont', 'WY', '82501', '3073322185', NULL, '115 Wyoming St', 'Lander', 'Fremont', 'WY', '82501', '3073322185', '          ', '', '', '', '0.00', '10.00', '0.00', 3, '2009-10-09', '2011-06-28', 0, 0, 0, 'SageWest Health Care', NULL, NULL, NULL, 'HCFA|UB|', '1215980370', 0, 'N', 0, '2013-07-16', NULL, NULL, 0, 0, NULL, NULL),
('830327251', 'WYT200523', 'WYT200523', 'WYT2', 'Star Valley Medical Center', '', '', 'Star Valley Medical Center', 'GROUP', 'Hospital', '', '', NULL, 'O', '901 Adams St', 'Afton', 'Lincoln', 'WY', '83110', '3078855800', NULL, '901 Adams St', 'Afton', 'Lincoln', 'WY', '83110', '3078855800', '          ', '', '', '', '0.00', '5.00', '0.00', 6, '2007-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1255376406', 0, 'N', 0, '2014-03-25', NULL, NULL, 0, 0, NULL, NULL),
('830182821', 'WYT200537', 'WYT200537', 'WYT2', 'Gottsche Rehabilitation Center', 'Timothy', 'P', 'Stecker', 'PT', 'Orthopedic Surgery', '', '', NULL, 'O', '639 W Coulter Ave', 'Powell', 'Park', 'WY', '82435', '3077549262', '          ', '639 W Coulter Ave', 'Powell', 'Park', 'WY', '82435', '3077549262', '          ', '', '', '', '0.00', '10.00', '0.00', 3, '2011-02-01', '2012-08-17', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1306938097', 0, 'N', 0, '2014-04-02', NULL, NULL, 0, 0, NULL, NULL),
('830182821', 'WYT200538', 'WYT200538', 'WYT2', 'Gottsche Rehabilitation Center', 'Timothy', 'P', 'Stecker', 'PT', 'Orthopedic Surgery', '', '', NULL, 'O', '720 Lindsay Ln', 'Cody', 'Park', 'WY', '82414', '3075781970', '          ', '720 Lindsay Ln', 'Cody', 'Park', 'WY', '82414', '3075781970', '          ', '', '', '', '0.00', '10.00', '0.00', 3, '2011-02-01', '2012-08-17', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1306938097', 0, 'N', 0, '2014-04-02', NULL, NULL, 0, 0, NULL, NULL),
('203787601', 'WYT200623', 'WYT200623', 'WYT2', 'Urological Services of Northern Wyoming', 'Gregory', 'S', 'Stewart', 'MD', 'Urology', '', '', NULL, 'O', '225 W Yellowstone Ave Ste 9', 'Powell', 'Park', 'WY', '82435', '3075875131', '3075875132', '225 W Yellowstone Ave Ste 9', 'Powell', 'Park', 'WY', '82435', '3075875131', '3075875132', '', '', '', '0.00', '15.00', '0.00', 3, '2011-07-01', '2014-02-25', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1508832080', 0, 'N', 0, '2014-03-03', NULL, NULL, 0, 0, NULL, NULL),
('203787601', 'WYT200624', 'WYT200624', 'WYT2', 'Urological Services of Northern Wyoming', 'Gregory', 'S', 'Stewart', 'MD', 'Urology', '', '', NULL, 'B', 'PO Box 1330', 'Powell', 'Park', 'WY', '82435', '3075875131', '3075875132', 'PO Box 1330', 'Powell', 'Park', 'WY', '82435', '3075875131', '3075875132', '', '', '', '0.00', '15.00', '0.00', 3, '2011-07-01', '2014-02-25', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1508832080', 0, 'N', 0, '2014-03-03', NULL, NULL, 0, 0, NULL, NULL),
('830234097', 'WYT200405', 'WYT200405', 'WYT2', 'Campbell County Memorial Hospital', 'Michael', '', 'Stolpe', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '501 S Burma Ave', 'Gillette', 'Campbell', 'WY', '82717', '3076881000', NULL, '501 S Burma Ave', 'Gillette', 'Campbell', 'WY', '82717', '3076881000', '          ', '', '', '5001', '0.00', '0.00', '0.00', 3, '2008-09-15', '2008-09-15', 0, 0, 0, 'Campbell County Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '0000008930', 0, 'Y', 0, '2013-09-17', NULL, NULL, 0, 0, NULL, NULL),
('201207626', 'WYT200644', 'WYT200644', 'WYT2', 'Fremont Family Practice', 'Gerald', '', 'Stopczynski', 'DO', 'Family Practice', '', '', NULL, 'O', '1130 Major Ave', 'Riverton', 'Fremont', 'WY', '82501', '3078577071', '3078577071', '1130 Major Ave', 'Riverton', 'Fremont', 'WY', '82501', '3078577071', '3078577071', '', '', '', '0.00', '10.00', '0.00', 3, '2030-01-01', '2030-01-01', 0, 0, 1, '', '', '', '', 'HCFA|UB|DEN|', '1528025780', 0, 'N', 1, '2012-07-31', NULL, NULL, 0, 0, NULL, NULL),
('203360654', 'WYT200599', 'WYT200599', 'WYT2', 'Western Medical Associates', 'Jay', '', 'Swedberg', 'MD', 'Family Practice', '', '', NULL, 'O', '3230 Cy Ave', 'Casper', 'Natrona', 'WY', '82604', '3075775100', '', '3230 Cy Ave', 'Casper', 'Natrona', 'WY', '82604', '3075775100', '', '', '', '', '0.00', '10.00', '0.00', 3, '2010-09-30', NULL, 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1467450163', 0, 'N', 0, '2014-07-21', NULL, NULL, 0, 0, NULL, NULL),
('203360654', 'WYT200600', 'WYT200600', 'WYT2', 'Western Medical Associates', 'Jay', '', 'Swedberg', 'MD', 'Family Practice', '', '', NULL, 'O', '6500 E 2nd St Ste 200', 'Casper', 'Natrona', 'WY', '82609', '3075775100', '', '6500 E 2nd St Ste 200', 'Casper', 'Natrona', 'WY', '82609', '3075775100', '', '', '', '', '0.00', '10.00', '0.00', 3, '2010-09-30', NULL, 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1467450163', 0, 'N', 0, '2014-07-21', NULL, NULL, 0, 0, NULL, NULL),
('830333324', 'WYT200406', 'WYT200406', 'WYT2', 'Sweetwater Surgery Center', '', '', 'Sweetwater Surgery Center', 'GROUP', 'Ambulatory Surgery Center', '', '', NULL, 'O', '2761 Commercial Way', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073826873', NULL, '2761 Commercial Way', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073826873', '', '', NULL, NULL, '0.00', '25.00', '0.00', 3, '2008-10-31', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '0000008972', 0, 'n', 0, '2011-06-10', NULL, NULL, 0, 0, NULL, NULL),
('830326307', 'WYT200407', 'WYT200407', 'WYT2', 'Community Health Ctr', 'Lonnie (Recognized PPO but not contracted)', '', 'Teague', '', 'Family Practice', '', '', NULL, 'O', '1522 E  A  St', 'Casper', '', 'WY', '82601', '3072336035', NULL, '1522 E  A  St', 'Casper', '', 'WY', '82601', '3072336035', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2009-12-15', '2012-09-30', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '0000009026', 0, 'Y', 0, '2012-10-11', NULL, NULL, 0, 0, NULL, NULL),
('830326904', 'WYT200490', 'WYT200490', 'WYT2', 'Thurston Medical Clinic', 'John', 'E', 'Thurston', 'MD', 'Family Practice', '', '', NULL, 'O', '401 S 15th St', 'Worland', 'Washakie', 'WY', '82401', '3073472525', NULL, '401 S 15th St', 'Worland', 'Washakie', 'WY', '82401', '3073472525', '', '', NULL, NULL, '0.00', '10.00', '0.00', 3, '2008-09-08', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1144296245', 0, 'n', 0, '2011-06-10', NULL, NULL, 0, 0, NULL, NULL),
('830207671', 'WYT200408', 'WYT200408', 'WYT2', 'West Park Hospital District', 'Kyle', '', 'Tilden', 'MD', 'Urgent Care', '', '', NULL, 'O', '707 Sheridan Ave', 'Cody', 'Park', 'WY', '82414', '3075277501', NULL, '707 Sheridan Ave', 'Cody', 'Park', 'WY', '82414', '3075277501', '          ', '', '', '', '0.00', '10.00', '0.00', 3, '2008-05-01', '2011-06-30', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '0000009101', 0, 'Y', 0, '2011-07-21', NULL, NULL, 0, 0, NULL, NULL),
('830182821', 'WYT200772', 'WYT200772', 'WYT2', 'Gottsche Rehabilitation Center', 'Allison', 'A', 'Tipton', 'OTR', 'Occupational Therapy', '', '', NULL, 'O', '720 Lindsay Ln', 'Cody', 'Park', 'WY', '82414', '3075781971', '3075781973', '720 Lindsay Ln', 'Cody', 'Park', 'WY', '82414', '3075781971', '3075781973', '', '', '', '0.00', '10.00', '0.00', 3, '2011-05-01', '2011-01-24', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1871685560', 0, 'N', 0, '2014-04-02', NULL, NULL, 0, 0, NULL, NULL),
('760758992', 'WYT200409', 'WYT200409', 'WYT2', 'Heart Mountain Eyecare Group', 'J', 'G', 'Toland', 'OD', 'Optometry', '', '', NULL, 'O', '255 W 3rd St', 'Powell', 'Park', 'WY', '82435', '3077547151', NULL, '255 W 3rd St', 'Powell', 'Park', 'WY', '82435', '3077547151', '          ', 'WiseWYSTD', 'wyhcpcs', '', '0.00', '35.00', '0.00', 3, '2007-08-01', '2011-06-28', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1427050343', 0, 'N', 0, '2013-11-20', NULL, NULL, 0, 0, NULL, NULL),
('760758992', 'WYT200410', 'WYT200410', 'WYT2', 'Heart Mountain Eyecare Group', 'J', 'G', 'Toland', 'OD', 'Optometry', '', '', NULL, 'B', 'PO Box 231', 'Powell', 'Park', 'WY', '82435', '3077547151', NULL, 'PO Box 231', 'Powell', 'Park', 'WY', '82435', '3077547151', '          ', 'WiseWYSTD', 'wyhcpcs', '', '0.00', '35.00', '0.00', 3, '2007-08-01', '2011-06-28', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1427050343', 0, 'Y', 0, '2013-11-20', NULL, NULL, 0, 0, NULL, NULL),
('830239998', 'WYT200443', 'WYT200443', 'WYT2', '(Recognized PPO but not Contracted)', 'Johnny', '', 'Tooke', 'MD', 'Family Practice', '', '', NULL, 'O', '2241  Farnum St', 'Casper', '', 'WY', '82609', '3072661263', NULL, '2241  Farnum St', 'Casper', '', 'WY', '82609', '3072661263', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2009-12-15', '2013-06-28', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1053426759', 0, 'Y', 0, '2013-06-28', NULL, NULL, 0, 0, NULL, NULL),
('753031794', 'WYT200561', 'WYT200561', 'WYT2', 'Clear Image Vision Care PC', 'Kirby', 'T', 'Treat', 'OD', 'Optometry', '', '', NULL, 'O', '610 S 12 th St', 'Worland', 'Washakie', 'WY', '82401', '3073474157', NULL, '610 S 12 th St', 'Worland', 'Washakie', 'WY', '82401', '3073474157', '          ', 'WISEWYSTD', 'wyhcpcs', '', '0.00', '35.00', '0.00', 3, '2010-05-14', '2011-06-28', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1386836302', 0, 'N', 0, '2014-02-06', NULL, NULL, 0, 0, NULL, NULL),
('753031794', 'WYT200562', 'WYT200562', 'WYT2', 'Clear Image Vision Care PC', 'Kirby', 'T', 'Treat', 'OD', 'Optometry', '', '', NULL, 'B', 'PO Box 846', 'Worland', 'Washakie', 'WY', '82401', '3073474157', NULL, 'PO Box 846', 'Worland', 'Washakie', 'WY', '82401', '3073474157', '          ', 'WISEWYSTD', 'wyhcpcs', '', '0.00', '35.00', '0.00', 3, '2007-08-01', '2011-06-28', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1386836302', 0, 'Y', 0, '2014-02-06', NULL, NULL, 0, 0, NULL, NULL),
('830219655', 'WYT200706', 'WYT200706', 'WYT2', 'Premier Bone and Joint Centers', 'Michael', '', 'Trenam', 'PA', 'Orthopedic Surgery', '', '', NULL, 'O', '1909 Vista Dr', 'Laramie', 'Albany', 'WY', '82070', '3077458851', NULL, '1909 Vista Dr', 'Laramie', 'Albany', 'WY', '82070', '3077458851', '', '', '', '', '0.00', '10.00', '0.00', 3, '2009-07-01', NULL, 0, 0, 0, 'Ivinson Memorial Hospital', '', '', '', 'HCFA|UB|', '1649250051', 0, 'N', 0, '2014-07-21', NULL, NULL, 0, 0, NULL, NULL),
('830326307', 'WYT200411', 'WYT200411', 'WYT2', 'Community Health Ctr', 'Stephan (Recognized PPO but not contracted)', '', 'Trent', '', 'Family Practice', '', '', NULL, 'O', '1522 E  A  St', 'Casper', '', 'WY', '82601', '3072336035', NULL, '1522 E  A  St', 'Casper', '', 'WY', '82601', '3072336035', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2009-12-15', '2012-09-30', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '0000009174', 0, 'Y', 0, '2012-10-11', NULL, NULL, 0, 0, NULL, NULL),
('202299593', 'WYT200604', 'WYT200604', 'WYT2', 'Red Desert InstaCare', 'Darcy', '', 'Turner', 'MD', 'Family Practice', '', '', NULL, 'O', '2761 Commercial Way', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073823064', NULL, '2761 Commercial Way', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073823064', '', '', '', '', '0.00', '7.50', '0.00', 3, '2007-01-01', '2011-06-28', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1487741658', 0, 'N', 0, '2014-06-25', NULL, NULL, 0, 0, NULL, NULL),
('202299593', 'WYT200605', 'WYT200605', 'WYT2', 'Wyoming Range Medical', 'Darcy', '', 'Turner', 'MD', 'Family Practice', '', '', NULL, 'O', '630 Piney Drive', 'Big Piney', 'Sublette', 'WY', '83113', '3072764700', NULL, '630 Piney Drive', 'Big Piney', 'Sublette', 'WY', '83113', '3072764700', '', '', '', '', '0.00', '7.50', '0.00', 3, '2007-01-01', '2011-06-28', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1487741658', 0, 'N', 0, '2014-06-25', NULL, NULL, 0, 0, NULL, NULL),
('202299593', 'WYT200606', 'WYT200606', 'WYT2', 'Wyoming Range Medical', 'Darcy', '', 'Turner', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 130', 'Big Piney', 'Sublette', 'WY', '83113', '3073823064', NULL, 'PO Box 130', 'Big Piney', 'Sublette', 'WY', '83113', '3073823064', '', '', '', '', '0.00', '7.50', '0.00', 3, '2007-01-01', '2011-06-28', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1487741658', 0, 'Y', 0, '2014-06-25', NULL, NULL, 0, 0, NULL, NULL),
('202299593', 'WYT200627', 'WYT200627', 'WYT2', 'Wyoming Range Medical', 'Lorri', '', 'Turner', 'FNP', 'Family Practice', '', '', NULL, 'O', '630 Piney Dr', 'Big Piney', 'Sublette', 'WY', '83113', '3072764700', NULL, '630 Piney Dr', 'Big Piney', 'Sublette', 'WY', '83113', '3072764700', '          ', '', '', '', '0.00', '7.50', '0.00', 3, '2007-01-01', '2011-06-28', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1518054782', 0, 'N', 0, '2011-09-20', NULL, NULL, 0, 0, NULL, NULL),
('202299593', 'WYT200628', 'WYT200628', 'WYT2', 'Wyoming Range Medical', 'Lorri', '', 'Turner', 'FNP', 'Family Practice', '', '', NULL, 'B', 'PO Box 130', 'Big Piney', 'Sublette', 'WY', '83113', '3073823064', NULL, 'PO Box 130', 'Big Piney', 'Sublette', 'WY', '83113', '3073823064', '          ', '', '', '', '0.00', '7.50', '0.00', 3, '2007-01-01', '2011-06-28', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1518054782', 0, 'Y', 0, '2011-09-20', NULL, NULL, 0, 0, NULL, NULL),
('830215583', 'WYT200412', 'WYT200412', 'WYT2', 'Uinta Home Health & Hospice', '', '', 'Uinta Home Health & Hospice', 'GROUP', 'Hospice', 'Home Health Agency', '', NULL, 'O', '1229 Uinta St', 'Evanston', 'Uinta', 'WY', '82930', '3077897712', NULL, '1229 Uinta St', 'Evanston', 'Uinta', 'WY', '82930', '3077897712', '          ', '', '', '3', '0.00', '100.00', '0.00', 6, '2006-12-01', '2011-06-27', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '0000009264', 0, 'N', 0, '2011-06-28', NULL, NULL, 0, 0, NULL, NULL),
('830215583', 'WYT200413', 'WYT200413', 'WYT2', 'Uinta Home Health & Hospice', '', '', 'Uinta Home Health & Hospice', 'GROUP', 'Hospice', 'Home Health Agency', '', NULL, 'O', '216 W Sage', 'Lyman', 'Uinta', 'WY', '82937', '3077873872', NULL, '216 W Sage', 'Lyman', 'Uinta', 'WY', '82937', '3077873872', '          ', '', '', '3', '0.00', '100.00', '0.00', 6, '2006-12-01', '2011-06-27', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '0000009264', 0, 'N', 0, '2011-06-28', NULL, NULL, 0, 0, NULL, NULL);
INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
('830215583', 'WYT200414', 'WYT200414', 'WYT2', 'Uinta Home Health & Hospice', '', '', 'Uinta Home Health & Hospice', 'GROUP', 'Hospice', 'Home Health Agency', '', NULL, 'B', 'PO Box 728', 'Evanston', 'Uinta', 'WY', '82930', '3077897712', NULL, 'PO Box 728', 'Evanston', 'Uinta', 'WY', '82930', '3077897712', '          ', '', '', '4', '0.00', '100.00', '0.00', 6, '2006-12-01', '2011-06-27', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '0000009264', 0, 'Y', 0, '2011-06-28', NULL, NULL, 0, 0, NULL, NULL),
('830215583', 'WYT200415', 'WYT200415', 'WYT2', 'Uinta Home Health & Hospice', '', '', 'Uinta Home Health & Hospice', 'GROUP', 'Hospice', 'Home Health Agency', '', NULL, 'B', 'PO Box 9', 'Lyman', 'Uinta', 'WY', '82937', '3077873872', NULL, 'PO Box 9', 'Lyman', 'Uinta', 'WY', '82937', '3077873872', '          ', '', '', '4', '0.00', '100.00', '0.00', 6, '2006-12-01', '2011-06-27', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '0000009264', 0, 'Y', 0, '2011-06-28', NULL, NULL, 0, 0, NULL, NULL),
('830218549', 'WYT200676', 'WYT200676', 'WYT2', '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', '15.00', '0.00', 3, '2009-07-15', '2012-02-12', 0, 0, 1, 'Sheridan Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1578586269', 0, 'N', 0, '2012-06-25', NULL, NULL, 0, 0, NULL, NULL),
('201328719', 'WYT200798', 'WYT200798', 'WYT2', 'Urgent Care Now (Recognized PPO but not contracted)', '', '', 'Urgent Care Now', 'GROUP', 'Urgent Care', '', '', NULL, 'O', '2546 E 2nd St', 'Casper', 'Natrona', 'WY', '82609', '3072651110', NULL, '2546 E 2nd St', 'Casper', 'Natrona', 'WY', '82609', '3072651110', '          ', '', '', '', '0.00', '8.00', '0.00', 3, '2009-12-15', '2013-02-01', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1932396199', 0, 'Y', 0, '2013-02-05', NULL, NULL, 0, 0, NULL, NULL),
('830326307', 'WYT200416', 'WYT200416', 'WYT2', 'Community Health Ctr', 'Biran (Recognized PPO but not contracted)', '', 'Veauthier', '', 'Family Practice', '', '', NULL, 'O', '1522 E  A  St', 'Casper', '', 'WY', '82601', '3072336035', NULL, '1522 E  A  St', 'Casper', '', 'WY', '82601', '3072336035', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2009-12-15', '2012-09-30', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '0000009433', 0, 'Y', 0, '2012-10-11', NULL, NULL, 0, 0, NULL, NULL),
('830228210', 'WYT200417', 'WYT200417', 'WYT2', 'WY  OtolaryngologyJoseph Vigneri MD', 'Joseph (Recognized PPO but not contracted)', '', 'Vigneri', '', 'Ear, Nose and Throat', '', '', NULL, 'O', '6500  E 2nd St', 'Casper', '', 'WY', '82609', '3075774240', NULL, '6500  E 2nd St', 'Casper', '', 'WY', '82609', '3075774240', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2009-12-15', '2012-12-01', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '0000009446', 0, 'Y', 0, '2012-10-19', NULL, NULL, 0, 0, NULL, NULL),
('810490456', 'WYT200547', 'WYT200547', 'WYT2', 'Vital Air Medical', '', '', 'Vital Air Medical', 'Group', 'Durable Medical Equipment', '', '', NULL, 'O', '460 W Big Horn Ave', 'Worland', 'Washakie', 'WY', '82401', '3073476475', '3073472126', '460 W Big Horn Ave', 'Worland', 'Washakie', 'WY', '82401', '3073476475', '3073472126', 'ROTECH', 'DME80', '', '0.00', '35.00', '0.00', 3, '2008-10-01', '2011-06-28', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1336129006', 0, 'N', 0, '2011-06-30', NULL, NULL, 0, 0, NULL, NULL),
('810490456', 'WYT200548', 'WYT200548', 'WYT2', 'Vital Air Medical', '', '', 'Vital Air Medical', 'Group', 'Durable Medical Equipment', '', '', NULL, 'B', 'PO Box 9901', 'Clearfield', 'Davis', 'UT', '84089', '8008451378', '8019261335', 'PO Box 9901', 'Clearfield', 'Davis', 'UT', '84089', '8008451378', '8019261335', 'ROTECH', 'DME80', '', '0.00', '35.00', '0.00', 3, '2008-10-01', '2011-06-28', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1336129006', 0, 'Y', 0, '2011-06-30', NULL, NULL, 0, 0, NULL, NULL),
('810490456', 'WYT200774', 'WYT200774', 'WYT2', 'Vital Air Medical', '', '', 'Vital Air Medical', 'Group', 'Durable Medical Equipment', '', '', NULL, 'O', '233 E 2Nd St', 'Powell', 'Park', 'WY', '82435', '3077544524', '3077544536', '233 E 2Nd St', 'Powell', 'Park', 'WY', '82435', '3077544524', '3077544536', 'ROTECH', 'DME80', '', '0.00', '35.00', '0.00', 3, '2008-10-01', '2011-06-28', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1881674562', 0, 'N', 0, '2011-06-30', NULL, NULL, 0, 0, NULL, NULL),
('810490456', 'WYT200785', 'WYT200785', 'WYT2', 'Vital Air Medical', '', '', 'Vital Air Medical', 'Group', 'Durable Medical Equipment', '', '', NULL, 'O', '538 Yellowstone Ave', 'Cody', 'Park', 'WY', '82414', '3075874953', '3075277841', '538 Yellowstone Ave', 'Cody', 'Park', 'WY', '82414', '3075874953', '3075277841', 'ROTECH', 'DME80', '', '0.00', '35.00', '0.00', 3, '2008-10-01', '2011-06-28', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1922088509', 0, 'N', 0, '2011-06-29', NULL, NULL, 0, 0, NULL, NULL),
('830216112', 'WYT200799', 'WYT200799', 'WYT2', 'Lander Medical Clinic', 'Karla', '', 'Wagner', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '745 Buena Vista Dr', 'Lander', 'Fremont', 'WY', '82520', '3073322941', NULL, '745 Buena Vista Dr', 'Lander', 'Fremont', 'WY', '82520', '3073322941', '          ', '', '', '', '0.00', '10.00', '0.00', 3, '2009-08-15', '2012-05-01', 0, 0, 0, 'SageWest Health Care', '', '', '', 'HCFA|UB|', '1942395652', 0, 'N', 0, '2014-01-28', NULL, NULL, 0, 0, NULL, NULL),
('830234097', 'WYT200418', 'WYT200418', 'WYT2', 'Walk in Clinic', '', '', 'Campbell County Clinics Walk in Clinic', 'GROUP', 'Urgent Care', '', '', NULL, 'O', '407 Medical Arts Ct Ste C', 'Gillette', 'Campbell', 'WY', '82716', '3076889258', NULL, '407 Medical Arts Ct Ste C', 'Gillette', 'Campbell', 'WY', '82716', '3076889258', '          ', '', '', '5001', '0.00', '0.00', '0.00', 3, '2008-09-15', '2008-09-15', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1922271386', 0, 'N', 0, '2013-10-22', NULL, NULL, 0, 0, NULL, NULL),
('201391282', 'WYT200783', 'WYT200783', 'WYT2', 'Thunder Basin Orthopedics and Sports Medicine', 'Debra', 'L', 'Walker', 'PA', 'Orthopaedic Surgery', '', '', NULL, 'O', '111 S 5th St', 'Douglas', 'Converse', 'WY', '82633', '3073586200', NULL, '111 S 5th St', 'Douglas', 'Converse', 'WY', '82633', '3073586200', '          ', 'WYORTHO10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-12-15', '2013-12-31', 0, 0, 0, 'Wyoming Medical Center ', NULL, NULL, NULL, 'HCFA|UB|', '1912993015', 0, 'N', 0, '2014-01-03', NULL, NULL, 0, 0, NULL, NULL),
('830251081', 'WYT200720', 'WYT200720', 'WYT2', 'Powder River Orthopedics & Spine PC', 'Grant', 'E', 'Walker', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '508 Stocktrail Ste A', 'Gillette', 'Campbell', 'WY', '82716', '3076861413', NULL, '508 Stocktrail Ste A', 'Gillette', 'Campbell', 'WY', '82716', '3076861413', '          ', '', '', '', '0.00', '23.00', '0.00', 3, '2010-02-15', '2011-09-01', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1700923018', 0, 'N', 0, '2011-08-29', NULL, NULL, 0, 0, NULL, NULL),
('830219655', 'WYT200791', 'WYT200791', 'WYT2', 'Premier Bone and Joint Centers', 'Michael', '', 'Wasser', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', '167 S Conwell', 'Casper', 'Natrona', 'WY', '82601', '3072370304', '', '167 S Conwell', 'Casper', 'Natrona', 'WY', '82601', '3072370304', '', '', '', '', '0.00', '10.00', '0.00', 3, '2009-07-01', NULL, 0, 0, 0, 'Ivinson Memorial Hospital', '', '', '', 'HCFA|UB|', '1932189339', 0, 'Y', 0, '2014-07-21', NULL, NULL, 0, 0, NULL, NULL),
('830219655', 'WYT200792', 'WYT200792', 'WYT2', 'Premier Bone and Joint Centers', 'Michael', '', 'Wasser', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1909 Vista Dr', 'Laramie', 'Albany', 'WY', '82070', '3077458851', '', '1909 Vista Dr', 'Laramie', 'Albany', 'WY', '82070', '3077458851', '', '', '', '', '0.00', '10.00', '0.00', 3, '2009-07-01', NULL, 0, 0, 0, 'Ivinson Memorial Hospital', '', '', '', 'HCFA|UB|', '1932189339', 0, 'N', 0, '2014-07-21', NULL, NULL, 0, 0, NULL, NULL),
('830219655', 'WYT200793', 'WYT200793', 'WYT2', 'Premier Bone and Joint Centers', 'Michael', '', 'Wasser', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1950 Bluegrass Cir', 'Cheyenne', 'Laramie', 'WY', '82009', '3076325889', '', '1950 Bluegrass Cir', 'Cheyenne', 'Laramie', 'WY', '82009', '3076325889', '', '', '', '', '0.00', '10.00', '0.00', 3, '2009-07-01', NULL, 0, 0, 0, 'Ivinson Memorial Hospital', '', '', '', 'HCFA|UB|', '1932189339', 0, 'N', 0, '2014-07-21', NULL, NULL, 0, 0, NULL, NULL),
('830219655', 'WYT200794', 'WYT200794', 'WYT2', 'Gem City Bone and Joint', 'Michael', '', 'Wasser', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', '620 4-J Rd', 'Gillette', 'Campbell', 'WY', '82716', '3076828899', '', '620 4-J Rd', 'Gillette', 'Campbell', 'WY', '82716', '3076828899', '', '', '', '', '0.00', '10.00', '0.00', 3, '2009-07-01', '2012-12-31', 0, 0, 0, 'Ivinson Memorial Hospital', '', '', '', 'HCFA|UB|', '1932189339', 0, 'Y', 0, '2014-07-21', NULL, NULL, 0, 0, NULL, NULL),
('202099145', 'WYT200801', 'WYT200801', 'WYT2', 'Worland Surgery Clinic', 'Gerald', 'E', 'Weaver', 'MD', 'General Surgery', 'Vascular Surgery', '', NULL, 'O', '1511 Charles Ave', 'Worland', 'Washakie', 'WY', '82401', '3073472405', NULL, '1511 Charles Ave', 'Worland', 'Washakie', 'WY', '82401', '3073472405', '          ', '', '', '', '0.00', '15.00', '0.00', 3, '2009-03-31', '2012-11-30', 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1952333221', 0, 'N', 0, '2013-12-18', NULL, NULL, 0, 0, NULL, NULL),
('830327475', 'WYT200419', 'WYT200419', 'WYT2', 'Evanston Regional Hospital', 'Ann', 'K', 'Webb', 'PT', '', '', '', NULL, 'O', '196 Arrowhead Dr', 'Evanston', 'Uinta', 'WY', '82930', '3077838220', '', '196 Arrowhead Dr', 'Evanston', 'Uinta', 'WY', '82930', '3077838220', '', '', '', '', '0.00', '0.00', '100.00', 6, '2006-12-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009543', 0, 'N', 0, '2014-07-23', NULL, NULL, 0, 0, NULL, NULL),
('204077312', 'WYT200557', 'WYT200557', 'WYT2', NULL, 'Charles', 'G', 'Welch', 'MD', 'General Surgery', '', '', NULL, 'O', '1613 Stampede Ave Ste A', 'Cody', 'Park', 'WY', '82414', '3075879800', NULL, '1613 Stampede Ave Ste A', 'Cody', 'Park', 'WY', '82414', '3075879800', '', '', NULL, '', '0.00', '10.00', '0.00', 3, '2010-04-20', NULL, 0, 0, 0, 'West Park Hospital District', '', '', '', 'HCFA|UB|', '1366631285', 0, 'n', 0, '2014-05-20', NULL, NULL, 0, 0, NULL, NULL),
('204077312', 'WYT200558', 'WYT200558', 'WYT2', NULL, 'Charles', 'G', 'Welch', 'MD', 'General Surgery', '', '', NULL, 'B', '449 Mountain View St', 'Powell', 'Park', 'WY', '82435', '3075879800', NULL, '449 Mountain View St', 'Powell', 'Park', 'WY', '82435', '3075879800', '', '', NULL, '', '0.00', '10.00', '0.00', 3, '2010-04-20', NULL, 0, 0, 0, 'West Park Hospital District', '', '', '', 'HCFA|UB|', '1366631285', 0, 'y', 0, '2014-05-20', NULL, NULL, 0, 0, NULL, NULL),
('830234097', 'WYT200420', 'WYT200420', 'WYT2', 'Wellness Health Works', '', '', 'Wellness Health Works', 'GROUP', 'Clinic', '', '', NULL, 'O', '508 Stocktrail Ste B', 'Gillette', 'Campbell', 'WY', '82716', '3076888000', NULL, '508 Stocktrail Ste B', 'Gillette', 'Campbell', 'WY', '82716', '3076888000', '          ', '', '', '5001', '0.00', '0.00', '0.00', 3, '2008-09-15', '2008-09-15', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009566', 0, 'N', 0, '2013-09-17', NULL, NULL, 0, 0, NULL, NULL),
('830320408', 'WYT200754', 'WYT200754', 'WYT2', 'The Family Clinic', 'Marjorie', 'L', 'Wells', 'MD', 'Family Practice', '', '', NULL, 'O', '1315 East A Street', 'Casper', 'Natrona', 'WY', '82601', '3072358552', '3072354656', '1315 East A Street', 'Casper', 'Natrona', 'WY', '82601', '3072358552', '3072354656', '', '', '', '0.00', '10.00', '0.00', 3, '2007-10-15', '2010-12-31', 0, 0, 1, 'Wyoming Medical Center ', NULL, NULL, NULL, 'HCFA|UB|', '1780698431', 0, 'N', 0, '2013-06-27', NULL, NULL, 0, 0, NULL, NULL),
('830207671', 'WYT200421', 'WYT200421', 'WYT2', 'West Park Hospital District', '', '', 'West Park Hospital District', 'GROUP', 'Hospital', '', '', NULL, 'O', '707 Sheridan Ave', 'Cody', 'Park', 'WY', '82414', '3075277501', NULL, '707 Sheridan Ave', 'Cody', 'Park', 'WY', '82414', '3075277501', '          ', '', '', '', '0.00', '10.00', '0.00', 3, '2008-05-01', '2011-06-30', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '0000009575', 0, 'Y', 0, '2013-06-28', NULL, NULL, 0, 0, NULL, NULL),
('203360654', 'WYT200422', 'WYT200422', 'WYT2', 'Western Medical Associates', '', '', 'Western Medical Associates', '', 'Family Practice', '', '', NULL, 'O', '3230 Cy Ave', 'Casper', 'Natrona', 'WY', '82604', '3075775100', NULL, '3230 Cy Ave', 'Casper', 'Natrona', 'WY', '82604', '3075775100', '          ', '', '', '', '0.00', '10.00', '0.00', 3, '2010-09-30', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '0000009580', 0, 'Y', 0, '2012-10-18', NULL, NULL, 0, 0, NULL, NULL),
('203360654', 'WYT200423', 'WYT200423', 'WYT2', 'Western Medical Associates', '', '', 'Western Medical Associates', '', 'Family Practice', '', '', NULL, 'O', '6500 E 2nd St Ste 200', 'Casper', 'Natrona', 'WY', '82609', '3075775100', NULL, '6500 E 2nd St Ste 200', 'Casper', 'Natrona', 'WY', '82609', '3075775100', '          ', '', '', '', '0.00', '10.00', '0.00', 3, '2010-09-30', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '0000009580', 0, 'Y', 0, '2012-10-18', NULL, NULL, 0, 0, NULL, NULL),
('204511600', 'WYT200645', 'WYT200645', 'WYT2', 'Wind River Clinic', 'James', 'R', 'White', 'DO', 'General Surgery', '', '', NULL, 'O', '1005 College View Dr', 'Riverton', 'Fremont', 'WY', '82501', '3078573488', NULL, '1005 College View Dr', 'Riverton', 'Fremont', 'WY', '82501', '3078573488', '', '', NULL, NULL, '0.00', '20.00', '0.00', 3, '2008-11-12', NULL, 0, 0, 1, 'SageWest Health Care', NULL, NULL, NULL, 'HCFA|UB|', '1528045614', 0, 'n', 0, '2012-01-04', NULL, NULL, 0, 0, NULL, NULL),
('830326307', 'WYT200424', 'WYT200424', 'WYT2', 'Community Health Ctr', 'Karen (Recognized PPO but not contracted)', '', 'Wildman', '', 'Family Practice', '', '', NULL, 'O', '1522 E  A  St', 'Casper', '', 'WY', '82601', '3072336035', NULL, '1522 E  A  St', 'Casper', '', 'WY', '82601', '3072336035', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2009-12-15', '2012-09-30', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '0000009619', 0, 'Y', 0, '2012-10-11', NULL, NULL, 0, 0, NULL, NULL),
('830182821', 'WYT200541', 'WYT200541', 'WYT2', 'Gottsche Rehabilitation Center', 'Laura', '', 'Williams', 'DPT', 'Physical Therapy', '', '', NULL, 'O', '148 E Arapahoe', 'Thermopolis', 'Hot Springs', 'WY', '82443', '3078642146', '3078642857', '148 E Arapahoe', 'Thermopolis', 'Hot Springs', 'WY', '82443', '3078642146', '3078642857', '', '', '', '0.00', '10.00', '0.00', 3, '2011-01-01', '2011-06-03', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1316176100', 0, 'N', 0, '2014-04-02', NULL, NULL, 0, 0, NULL, NULL),
('830182821', 'WYT200542', 'WYT200542', 'WYT2', 'Gottsche Rehabilitation Center', 'Laura', '', 'Williams', 'DPT', 'Physical Therapy', '', '', NULL, 'B', 'PO Box 790', 'Thermopolis', 'Hot Springs', 'WY', '82443', '3078642146', '3078642857', 'PO Box 790', 'Thermopolis', 'Hot Springs', 'WY', '82443', '3078642146', '3078642857', '', '', '', '0.00', '10.00', '0.00', 3, '2011-01-01', '2011-06-03', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1316176100', 0, 'N', 0, '2014-04-02', NULL, NULL, 0, 0, NULL, NULL),
('270002825', 'WYT200739', 'WYT200739', 'WYT2', 'A Womans Place', 'Lisa', '', 'Williams', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1443 Beck Ave', 'Cody', 'Park', 'WY', '82414', '3075277811', NULL, '1443 Beck Ave', 'Cody', 'Park', 'WY', '82414', '3075277811', '          ', '', '', '', '0.00', '20.00', '0.00', 3, '2008-07-01', '2011-06-13', 0, 0, 1, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1750376083', 0, 'N', 0, '2012-05-07', NULL, NULL, 0, 0, NULL, NULL),
('270002825', 'WYT200740', 'WYT200740', 'WYT2', 'A Womans Place', 'Lisa', '', 'Williams', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 1000', 'Cody', 'Park', 'WY', '82414', '3075277811', NULL, 'PO Box 1000', 'Cody', 'Park', 'WY', '82414', '3075277811', '          ', '', '', '', '0.00', '20.00', '0.00', 3, '2008-07-01', '2011-06-13', 0, 0, 1, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1750376083', 0, 'Y', 0, '2012-05-07', NULL, NULL, 0, 0, NULL, NULL),
('830182821', 'WYT200564', 'WYT200564', 'WYT2', 'Gottsche Rehabilitation Center', 'Ryan', '', 'Williams', 'DPT', 'Physical Therapy', '', '', NULL, 'O', '148 E Arapahoe', 'Thermopolis', 'Hot Springs', 'WY', '82443', '3078642146', '3078642857', '148 E Arapahoe', 'Thermopolis', 'Hot Springs', 'WY', '82443', '3078642146', '3078642857', '', '', '', '0.00', '10.00', '0.00', 3, '2011-01-01', '2014-06-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1396941076', 0, 'N', 0, '2014-06-16', NULL, NULL, 0, 0, NULL, NULL),
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INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
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('870510192', 'W12011829', 'W12011829', 'UT01', 'Performance West Physical Therapy', 'Alexander', 'James', 'Bravo', 'DPT', 'Physical Therapy', '', '', NULL, 'O', '1551 Renaissance Town Dr Ste 350', 'Bountiful', 'Davis', 'UT', '84010', '8012953553', '8012953599', '1551 Renaissance Town Dr Ste 350', 'Bountiful', 'Davis', 'UT', '84010', '8012953553', '8012953599', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2012-04-01', '2012-11-15', 0, 0, 0, '', '', '', '', 'HCFA|', '1548552300', 0, 'N', 0, '2012-12-19', NULL, NULL, 0, 0, NULL, NULL),
('870285547', 'W12011830', 'W12011830', 'UT01', 'Registered Physical Therapists', 'Greg', 'Jonathon', 'Baker', 'PT', 'Physical Therapy', '', '', NULL, 'O', '1577 W 7000 S Ste 100', 'West Jordan', 'Salt Lake', 'UT', '84084', '8015666301', '8015664739', '1577 W 7000 S Ste 100', 'West Jordan', 'Salt Lake', 'UT', '84084', '8015666301', '8015664739', 'WESTREHAB', '', '', '0.00', '0.00', '70.50', 3, '2011-06-01', '2012-03-31', 0, 0, 0, '', '', '', '', 'HCFA|', '1558348516', 0, 'N', 0, '2011-10-20', NULL, NULL, 0, 0, NULL, NULL),
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('870623138', 'W12011832', 'W12011832', 'WYT1', 'Northern Wyoming Surgical Center', '', '', 'Northern Wyoming Surgical Center', 'GROUP', 'Ambulatory Surgery Center', '', '', NULL, 'O', '732 Lindsay Ln', 'Cody', 'Park', 'WY', '82414', '3075872139', '3075872365', '732 Lindsay Ln', 'Cody', 'Park', 'WY', '82414', '3075872139', '3075872365', '', '', '5005', '0.00', '15.00', '0.00', 3, '2011-06-14', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000007910', 0, 'N', 0, '2011-06-29', NULL, NULL, 0, 0, NULL, NULL),
('528819353', 'W12011840', 'W12011840', 'UTMH1', '', 'Kelly', '', 'Morse', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '386 N Main St', 'Centerville', 'Davis', 'UT', '84014', '8012982000', '8019511490', '386 N Main St', 'Centerville', 'Davis', 'UT', '84014', '8012982000', '8019511490', 'MA', '', '', '0.00', '35.00', '0.00', 3, '2011-05-31', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1871774596', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('710905316', 'W12011842', 'W12011842', 'UT01', 'Surgical Care Associate', 'Bhupendra', 'C', 'Patel', 'MD', 'Ophthalmology', 'Oculoplastic Surgery', '', NULL, 'O', '1025 E 3300 S', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '          ', '8015939626', '1025 E 3300 S', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '          ', '8015939626', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-06-01', '2011-10-05', 0, 0, 0, 'University Health Care University Hospital', '', '', '', 'HCFA|UB|', '1366436412', 0, 'N', 0, '2014-06-23', NULL, NULL, 0, 0, NULL, NULL),
('710905316', 'W12011843', 'W12011843', 'UT01', 'Davis Surgical Center', 'Bhupendra', 'C', 'Patel', 'MD', 'Ophthalmology', 'Oculoplastic Surgery', '', NULL, 'O', '1544 W Antelope', 'Layton', 'Davis', 'UT', '84041', '8017730690', '8015939626', '1544 W Antelope', 'Layton', 'Davis', 'UT', '84041', '8017730690', '8015939626', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-06-01', NULL, 0, 0, 0, 'University Health Care University Hospital', '', '', '', 'HCFA|UB|', '1366436412', 0, 'N', 0, '2014-06-23', NULL, NULL, 41.0893, -111.994, NULL, NULL),
('710905316', 'W12011841', 'W12011841', 'UT01', 'Cataract and Lasik Center of Utah', 'Bhupendra', 'C', 'Patel', 'MD', 'Ophthalmology', 'Oculoplastic Surgery', '', NULL, 'O', '175 N 400 W Ste C-10', 'Orem', 'Utah', 'UT', '84057', '8012246767', '8015939626', '175 N 400 W Ste C-10', 'Orem', 'Utah', 'UT', '84057', '8012246767', '8015939626', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-06-01', NULL, 0, 0, 0, 'University Health Care University Hospital', '', '', '', 'HCFA|UB|', '1366436412', 0, 'N', 0, '2014-06-23', NULL, NULL, 40.3004, -111.705, NULL, NULL),
('710905316', 'W12011844', 'W12011844', 'UT01', 'Insight Laser & Cataract Eye Spec', 'Bhupendra', 'C', 'Patel', 'MD', 'Ophthalmology', 'Oculoplastic Surgery', '', NULL, 'O', '2255 N 1700 W', 'Layton', 'Davis', 'UT', '84041', '8017730690', '8015939626', '2255 N 1700 W', 'Layton', 'Davis', 'UT', '84041', '8017730690', '8015939626', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-06-01', NULL, 0, 0, 0, 'University Health Care University Hospital', '', '', '', 'HCFA|UB|', '1366436412', 0, 'N', 0, '2014-06-23', NULL, NULL, 41.0887, -111.997, NULL, NULL),
('710905316', 'W12011845', 'W12011845', 'UT01', 'Surgical Care Associate', 'Bhupendra', 'C', 'Patel', 'MD', 'Ophthalmology', 'Oculoplastic Surgery', '', NULL, 'B', 'PO Box 1512', 'Layton', 'Davis', 'UT', '84041', '8015939923', '8015939626', 'PO Box 1512', 'Layton', 'Davis', 'UT', '84041', '8015939923', '8015939626', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-06-01', NULL, 0, 0, 0, 'University Health Care University Hospital', '', '', '', 'HCFA|UB|', '1366436412', 0, 'N', 0, '2014-06-23', NULL, NULL, 0, 0, NULL, NULL),
('870622942', 'W12011846', 'W12011846', 'UT01', 'Utah Imaging Associates', 'Aaron', 'E', 'Frodsham', 'MD', 'Radiology', '', '', NULL, 'B', 'PO Box 1369', 'Bountiful', 'Davis', 'UT', '84011', '8012962113', '8012961715', 'PO Box 1369', 'Bountiful', 'Davis', 'UT', '84011', '8012962113', '8012961715', 'WUUTIMAGE5', '', '', '0.00', '35.00', '0.00', 3, '2011-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1184807208', 0, 'N', 0, '2012-10-12', NULL, NULL, 0, 0, NULL, NULL),
('202630141', 'W12011847', 'W12011847', 'ID02', 'Primary Health Medical Group', 'Kirk', 'D', 'Prodzinski', 'DO', 'Family Practice', '', '', NULL, 'O', '8971 W Overland Rd', 'Boise', 'Ada', 'ID', '83709', '2083784288', '2083784297', '8971 W Overland Rd', 'Boise', 'Ada', 'ID', '83709', '2083784288', '2083784297', 'IDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2011-07-01', '2013-02-28', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1245206648', 0, 'N', 0, '2013-07-29', NULL, NULL, 43.5898, -116.294, NULL, NULL),
('202630141', 'W12011848', 'W12011848', 'ID02', 'Primary Health Medical Group', 'Kirk', 'D', 'Prodzinski', 'DO', 'Family Practice', '', '', NULL, 'B', 'PO Box 191050', 'Boise', 'Ada', 'ID', '83719', '2083784288', '2083784297', 'PO Box 191050', 'Boise', 'Ada', 'ID', '83719', '2083784288', '2083784297', 'IDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2011-07-01', '2013-02-28', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1245206648', 0, 'N', 0, '2013-07-29', NULL, NULL, 0, 0, NULL, NULL),
('870208619', 'W12011849', 'W12011849', 'UT01', 'Sunshine Terrace Foundation', '', '', 'Sunshine Terrace Foundation', 'GROUP', 'Skilled Nursing Facility', 'Hospice', 'Home Health Agency', NULL, 'O', '248 W 300 N', 'Logan', 'Cache', 'UT', '84321', '4357520411', '4357521318', '248 W 300 N', 'Logan', 'Cache', 'UT', '84321', '4357520411', '4357521318', '', '', '7', '0.00', '100.00', '0.00', 8, '2011-06-14', NULL, 0, 0, 0, '', '', '', '', '|UB|', '1609879493', 0, 'N', 0, '2013-01-24', NULL, NULL, 41.7373, -111.841, NULL, NULL),
('205506855', 'W12011851', 'W12011851', 'ID01', 'Northwest Radiation Oncology', 'Joseph', 'P', 'Brooks', 'MD', 'Radiation Oncology', '', '', NULL, 'O', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083673131', '2083677942', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083673131', '2083677942', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2011-08-01', '2012-09-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1457323693', 0, 'N', 0, '2014-04-17', NULL, NULL, 43.6127, -116.254, NULL, NULL),
('205506855', 'W12011853', 'W12011853', 'ID01', 'Northwest Radiation Oncology', 'Joseph', 'P', 'Brooks', 'MD', 'Radiation Oncology', '', '', NULL, 'O', '2855 E Magic View Dr', 'Meridian', 'Ada', 'ID', '83642', '2086394900', '2086344919', '2855 E Magic View Dr', 'Meridian', 'Ada', 'ID', '83642', '2086394900', '2086344919', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2011-08-01', '2012-09-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1457323693', 0, 'N', 0, '2014-04-17', NULL, NULL, 43.599, -116.36, NULL, NULL),
('205506855', 'W12011852', 'W12011852', 'ID01', 'Northwest Radiation Oncology', 'Joseph', 'P', 'Brooks', 'MD', 'Radiation Oncology', '', '', NULL, 'O', '3123 Medical Way', 'Caldwell', 'Canyon', 'ID', '83605', '2084532033', '2083674817', '3123 Medical Way', 'Caldwell', 'Canyon', 'ID', '83605', '2084532033', '2083674817', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2011-08-01', '2012-09-18', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1457323693', 0, 'N', 0, '2014-04-17', NULL, NULL, 43.6596, -116.658, NULL, NULL),
('205506855', 'W12011854', 'W12011854', 'ID01', 'Northwest Radiation Oncology', 'Joseph', 'P', 'Brooks', 'MD', 'Radiation Oncology', '', '', NULL, 'B', 'PO Box 5145', 'Boise', 'Ada', 'ID', '83705', '2084532033', '2083674817', 'PO Box 5145', 'Boise', 'Ada', 'ID', '83705', '2084532033', '2083674817', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2011-08-01', '2012-09-12', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1457323693', 0, 'N', 0, '2014-04-17', NULL, NULL, 0, 0, NULL, NULL),
('742383489', 'W12011856', 'W12011856', 'UT01', 'Chase Plastic Surgery', 'Lawrence', 'J', 'Chase', 'MD', 'Plastic Surgery', 'Hand Surgery', '', NULL, 'O', '321 N Mall Dr Bldg N', 'St George', 'Washington', 'UT', '84790', '4356340358', '4356742520', '321 N Mall Dr Bldg N', 'St George', 'Washington', 'UT', '84790', '4356340358', '4356742520', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-08-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', '', '', '', 'HCFA|UB|', '1538232863', 0, 'N', 0, '2014-04-16', NULL, NULL, 37.1139, -113.543, NULL, NULL),
('870322019', 'W12011857', 'W12011857', 'UTMH1', 'Lakeview Hospital', 'Carl', '', 'Rasmusen', 'MD', 'Mental Health', 'Psychiatry', '', NULL, 'O', '630 E Medical Dr', 'Bountiful', 'Davis', 'UT', '84010', '8012993780', '8012996119', '630 E Medical Dr', 'Bountiful', 'Davis', 'UT', '84010', '8012993780', '8012996119', 'MD', '', '', '0.00', '35.00', '0.00', 6, '2013-03-01', NULL, 0, 0, 0, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|', '1619048964', 0, 'Y', 0, '2013-11-19', NULL, NULL, 40.8869, -111.869, NULL, NULL),
('830216782', 'W12011858', 'W12011858', 'Sinclair', 'Laramie Physicians for Women', 'Helen ', 'M', 'Coates', '', 'Obstetrics and Gynecology', '', '', NULL, 'O', '2710 E Harney St Ste 100', 'Laramie', 'Albany', 'WY', '82072', '3077458991', '3077458167', '2710 E Harney St Ste 100', 'Laramie', 'Albany', 'WY', '82072', '3077458991', '3077458167', '', '', '', '0.00', '10.00', '0.00', 3, '2011-07-01', '2012-07-06', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1092959588', 0, 'N', 0, '2012-07-09', NULL, NULL, 0, 0, NULL, NULL),
('870179340', 'W12011861', 'W12011861', 'UT01', 'Standard Optical', 'James', 'R', 'David', 'OD', 'Optometry', '', '', NULL, 'B', '1901 W Parkway Blvd', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8018259703', NULL, '1901 W Parkway Blvd', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8018259703', '', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1932289691', 0, 'N', 0, '2014-05-16', NULL, NULL, 0, 0, NULL, NULL),
('870179340', 'W12011860', 'W12011860', 'UT01', 'Standard Optical', 'James', 'R', 'David', 'OD', 'Optometry', '', '', NULL, 'O', '5421 S 19th W', 'Roy', 'Weber', 'UT', '84067', '8018259703', NULL, '5421 S 19th W', 'Roy', 'Weber', 'UT', '84067', '8018259703', '', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1932289691', 0, 'N', 0, '2014-05-16', NULL, NULL, 41.1734, -112.042, NULL, NULL),
('860735726', 'W12011862', 'W12011862', 'Sinclair', 'Flagstaff Bone and Joint', 'Dana', 'M', 'Hasten', 'C-FNP', 'Orthopedic Surgery', '', '', NULL, 'O', '77 W Forest Ave Ste 301', 'Flagstaff', 'Coconino', 'AZ', '86001', '9287732280', '9287732281', '77 W Forest Ave Ste 301', 'Flagstaff', 'Coconino', 'AZ', '86001', '9287732280', '9287732281', '', '', '', '0.00', '40.00', '0.00', 3, '2011-07-01', '2012-11-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1174653638', 0, 'N', 0, '2013-01-24', NULL, NULL, 0, 0, NULL, NULL),
('830251081', 'W12011863', 'W12011863', 'WY01', 'Powder River Orthopedics and Spine', 'Gary', 'I', 'Molk', 'DO', 'Orthopedic Surgery', '', '', NULL, 'O', '508 Stocktrail Ste A', 'Gillette', 'Campbell', 'WY', '82716', '3076861413', '3076821113', '508 Stocktrail Ste A', 'Gillette', 'Campbell', 'WY', '82716', '3076861413', '3076821113', '', '', '', '0.00', '23.00', '0.00', 3, '2011-08-01', '2011-11-06', 0, 0, 0, 'Campbell County Memorial Hospital', '', '', '', 'HCFA|UB|', '1629233895', 0, 'N', 0, '2012-06-13', NULL, NULL, 0, 0, NULL, NULL),
('830182821', 'W12011864', 'W12011864', 'WY01', 'Gottsche Rehabilitation Center', 'Jeri', '', 'Black-Farber', 'PT', 'Physical Therapy', '', '', NULL, 'O', '148 E Arapahoe', 'Thermopolis', 'Hot Springs', 'WY', '82443', '3078642146', '3078642857', '148 E Arapahoe', 'Thermopolis', 'Hot Springs', 'WY', '82443', '3078642146', '3078642857', '', '', '', '0.00', '10.00', '0.00', 3, '2011-08-01', '2014-06-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1083694483', 0, 'N', 0, '2014-06-09', NULL, NULL, 43.6474, -108.2, NULL, NULL),
('830182821', 'W12011865', 'W12011865', 'WY01', 'Gottsche Rehabilitation Center', 'Jeri', '', 'Black-Farber', 'PT', 'Physical Therapy', '', '', NULL, 'B', 'PO Box 790', 'Thermopolis', 'Hot Springs', 'WY', '82443', '3078642146', '3078642857', 'PO Box 790', 'Thermopolis', 'Hot Springs', 'WY', '82443', '3078642146', '3078642857', '', '', '', '0.00', '10.00', '0.00', 3, '2011-08-01', '2014-06-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1083694483', 0, 'N', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
('273291370', 'W12011866', 'W12011866', 'ID02', 'Northwest Neurobehavioral Health', 'Kimberly', 'L', 'Parks', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '2950 E Magic View Dr Ste 140', 'Meridian', 'Ada', 'ID', '83642', '2083239130', '2083239070', '2950 E Magic View Dr Ste 140', 'Meridian', 'Ada', 'ID', '83642', '2083239130', '2083239070', 'IDPHD', '', '', '0.00', '35.00', '0.00', 3, '2011-08-01', '2011-12-31', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1659528677', 0, 'N', 0, '2014-05-01', NULL, NULL, 0, 0, NULL, NULL),
('273291370', 'W12011867', 'W12011867', 'ID02', 'Northwest Neurobehavioral Health', 'Kimberly', 'L', 'Parks', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'B', 'POBox 16820', 'Boise', 'Ada', 'ID', '83715', '2083239130', '2083239070', 'POBox 16820', 'Boise', 'Ada', 'ID', '83715', '2083239130', '2083239070', 'IDPHD', '', '', '0.00', '35.00', '0.00', 3, '2011-08-01', '2013-02-14', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1659528677', 0, 'N', 0, '2014-05-01', NULL, NULL, 0, 0, NULL, NULL),
('200961076', 'W12011868', 'W12011868', 'UT01', 'Summit Pain Management', 'Tyson', '', 'Riesenberg', 'MD', 'Pain Management', '', '', NULL, 'O', '5250 Commerce Dr Ste 305', 'Murray', 'Salt Lake', 'UT', '84107', '8012627246', '8012623696', '5250 Commerce Dr Ste 305', 'Murray', 'Salt Lake', 'UT', '84107', '8012627246', '8012623696', 'WUSTDPAIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-11-10', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', '', '', '', 'HCFA|UB|', '1255590642', 0, 'N', 0, '2012-08-03', NULL, NULL, 40.6564, -111.899, NULL, NULL),
('200961076', 'W12011869', 'W12011869', 'UT01', 'Summit Pain Management', 'Tyson', '', 'Riesenberg', 'MD', 'Pain Management', '', '', NULL, 'B', 'POBox 572528', 'Salt Lake City', 'Salt Lake', 'UT', '84157', '8012627246', '8012623696', 'POBox 572528', 'Salt Lake City', 'Salt Lake', 'UT', '84157', '8012627246', '8012623696', 'WUSTDPAIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-11-10', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', '', '', '', 'HCFA|UB|', '1255590642', 0, 'N', 0, '2012-08-03', NULL, NULL, 0, 0, NULL, NULL),
('621762573', 'W12012539', 'W12012539', 'UT01', 'Eastern Utah Ear, Nose, and Throat', 'Erik ', 'M', 'Lyman', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'B', '280 N Hospital Dr Ste 4', 'Price', 'Carbon', 'UT', '84501', '4356374327', '4356139709', '280 N Hospital Dr Ste 4', 'Price', 'Carbon', 'UT', '84501', '4356374327', '4356139709', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-11-10', NULL, 0, 0, 0, 'Castleview Hospital', 'Castleview Hospital', NULL, NULL, 'HCFA|UB|', '1568680122', 0, 'N', 0, '2011-11-11', NULL, NULL, 0, 0, NULL, NULL),
('876114073', 'W12011870', 'W12011870', 'UTMH1', 'The Childrens Center', 'LeAnne', 'H', 'Beale', 'PHD', 'Mental Health', 'Psychology', '', 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', 'UTPHD', '', '', '0.00', '35.00', '0.00', 6, '2011-06-16', '2012-04-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1407028525', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('876114073', 'W12011871', 'W12011871', 'UTMH1', 'The Childrens Center', 'Nancy', '', 'Coyne', 'LCSW', 'Mental Health', 'Social Worker', '', 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, '2011-06-16', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1912179375', 0, 'N', 0, '2014-05-12', NULL, NULL, 0, 0, NULL, NULL),
('876114073', 'W12011872', 'W12011872', 'UTMH1', 'The Childrens Center', 'Suzanne', 'M', 'Fields', 'LCSW', 'Mental Health', 'Social Worker', '', 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, '2011-06-16', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1093790552', 0, 'N', 0, '2014-04-24', NULL, NULL, 0, 0, NULL, NULL),
('876114073', 'W12011873', 'W12011873', 'UTMH1', 'The Childrens Center', 'Katherine', '', 'Gardiner', 'LPC', 'Mental Health', '', '', NULL, 'O', '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, '2011-06-16', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1669408019', 0, 'N', 0, '2012-01-26', NULL, NULL, 0, 0, NULL, NULL),
('876114073', 'W12011874', 'W12011874', 'UTMH1', 'The Childrens Center', 'Douglas', '', 'Goldsmith', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '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', 'UTPHD', '', '', '0.00', '35.00', '0.00', 6, '2011-06-16', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1376570820', 0, 'N', 0, '2014-05-01', NULL, NULL, 0, 0, NULL, NULL),
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('263903795', 'W12011925', 'W12011925', 'UTDT01', 'Oral Maxillofacial Surgeons of Utah', 'Jason', 'G', 'Chandler', 'DMD', 'Oral/Maxillofacial Surgery', '', '', NULL, 'O', '2711 N Hwy89 Ste 200 Dental', 'Ogden', 'Weber', 'UT', '84414', '8017827175', NULL, '2711 N Highway89 Ste 200 Dental', 'Ogden', 'Weber', 'UT', '84414', '8017827175', '          ', '', '', '', '0.00', '20.00', '0.00', 8, '2011-06-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'DEN|', '1114134004', 0, 'N', 0, '2012-06-21', NULL, NULL, 0, 0, NULL, NULL),
('263903795', 'W12011926', 'W12011926', 'UTDT01', 'Oral & Maxillofacial Surgeons of Utah', 'Michael', '', 'Broadbent', 'DMD MS', 'Oral/Maxillofacial Surgery', 'Oral Surgeon', '', NULL, 'O', '2711 N Hwy89 Ste 200 Dental', 'Ogden', 'Weber', 'UT', '84414', '8017827175', NULL, '2711 N Hwy89 Ste 200 Dental', 'Ogden', 'Weber', 'UT', '84414', '8017827175', '', '', '', '', '0.00', '20.00', '0.00', 8, '2011-06-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'DEN|', '1205049459', 0, 'N', 0, '2014-05-14', NULL, NULL, 0, 0, NULL, NULL),
('680588382', 'W12011928', 'W12011928', 'UTDT01', 'Family Legacy Dental', 'Dan', '', 'Dansie', 'DDS', 'Dentist', '', '', NULL, 'O', '845 N 100 W Ste 100', 'Orem', 'Utah', 'UT', '84057', '8012275080', NULL, '845 N 100 W Ste 100', 'Orem', 'Utah', 'UT', '84057', '8012275080', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2011-06-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1720094733', 0, 'N', 0, '2013-09-09', NULL, NULL, 0, 0, NULL, NULL),
('261433331', 'W12011930', 'W12011930', 'UTDT01', 'Alpine Endodontics', 'Ryan', '', 'Van Moorlehem', 'DMD', 'Endodontist', '', '', NULL, 'O', '826 N 100 E Ste 3', 'Spanish Fork', 'Utah', 'UT', '84660', '8015046070', NULL, '826 N 100 E Ste 3', 'Spanish Fork', 'Utah', 'UT', '84660', '8015046070', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2011-06-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000004205', 0, 'N', 0, '2011-06-21', NULL, NULL, 0, 0, NULL, NULL),
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INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
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('770254359', 'W12011984', 'W12011984', 'WYT1', 'Healthtronics Sheridan Surgical Center', '', '', 'Healthtronics Inc', 'GROUP', 'Lithotriptor', '', '', NULL, 'B', 'PO Box 847324', 'Dallas', 'Dallas', 'TX', '75284', '8663144242', NULL, 'PO Box 847324', 'Dallas', 'Dallas', 'TX', '75284', '8663144242', '          ', '', '', '6', '0.00', '100.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000006635', 0, 'Y', 0, '2011-06-24', NULL, NULL, 0, 0, NULL, NULL),
('770254359', 'W12011985', 'W12011985', 'WY01', 'Healthtronics Sheridan Surgical Center', '', '', 'Healthtronics Inc', 'GROUP', 'Lithotriptor', '', '', NULL, 'B', 'PO Box 847324', 'Dallas', 'Dallas', 'TX', '75284', '8663144242', NULL, 'PO Box 847324', 'Dallas', 'Dallas', 'TX', '75284', '8663144242', '          ', '', '', '6', '0.00', '100.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000006635', 0, 'Y', 0, '2011-06-24', NULL, NULL, 0, 0, NULL, NULL),
('870372277', 'W12011986', 'W12011986', 'UT01', '', 'Paul', 'N', 'Daniels', 'DPM', 'Podiatry', '', '', NULL, 'O', '1449 E 3300 S', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8014831015', '8014842875', '1449 E 3300 S', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8014831015', '8014842875', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-08-01', NULL, 0, 0, 0, 'Evanston Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1760499180', 0, 'N', 0, '2013-07-10', NULL, NULL, 40.6999, -111.849, NULL, NULL),
('870372277', 'W12011987', 'W12011987', 'UT01', '', 'Paul', 'N', 'Daniels', 'DPM', 'Podiatry', '', '', NULL, 'B', 'PO Box 1529', 'Layton', 'Davis', 'UT', '84041', '8014831015', '8014842875', 'PO Box 1529', 'Layton', 'Davis', 'UT', '84041', '8014831015', '8014842875', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-08-01', NULL, 0, 0, 0, 'Evanston Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1760499180', 0, 'N', 0, '2013-07-10', NULL, NULL, 0, 0, NULL, NULL),
('010624198', 'W12011988', 'W12011988', 'TX01', 'Alamo Mental Health Group', 'Luis Manuel ', '', 'Baez-Cabrera', 'MD', 'Mental Health', 'Psychiatry', '', NULL, 'O', '4242 Medical Dr Ste 6300', 'San Antonio', 'Bexar', 'TX', '78229', '2106148400', NULL, '4242 Medical Dr Ste 6300', 'San Antonio', 'Bexar', 'TX', '78229', '2106148400', '', 'TXALAMOMD', '', '', '0.00', '35.00', '0.00', 6, '2011-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1770763666', 0, 'N', 0, '2014-07-16', NULL, NULL, 29.5146, -98.5673, NULL, NULL),
('010624198', 'W12011989', 'W12011989', 'TX01', 'Alamo Mental Health Group', 'Fermin', '', 'Briones', 'MD', 'Mental Health', 'Psychiatry', '', NULL, 'O', '4242 Medical Dr Ste 6300', 'San Antonio', 'Bexar', 'TX', '78229', '2106148400', NULL, '4242 Medical Dr Ste 6300', 'San Antonio', 'Bexar', 'TX', '78229', '2106148400', '', 'TXALAMOMD', '', '', '0.00', '35.00', '0.00', 6, '2011-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1508031733', 0, 'N', 0, '2014-04-16', NULL, NULL, 29.5146, -98.5673, NULL, NULL),
('836000891', 'W12011990', 'W12011990', 'WYT1', 'North Big Horn Hospital Clinic', 'Troy', '', 'Caldwell', 'MD', 'Family Practice', '', '', NULL, 'O', '1115 Ln 12', 'Lovell', 'Big Horn', 'WY', '82431', '3075485201', NULL, '1115 Ln 12', 'Lovell', 'Big Horn', 'WY', '82431', '3075485201', '          ', '', '', '', '0.00', '12.00', '0.00', 3, '2011-06-17', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1992817381', 0, 'N', 0, '2013-12-04', NULL, NULL, 0, 0, NULL, NULL),
('836000891', 'W12011991', 'W12011991', 'WYT1', 'North Big Horn Hospital Clinic', 'Jack', '', 'Carpenter', 'PA', 'Family Practice', '', '', NULL, 'O', '1115 Ln 12', 'Lovell', 'Big Horn', 'WY', '82431', '3075485201', NULL, '1115 Ln 12', 'Lovell', 'Big Horn', 'WY', '82431', '3075485201', '          ', '', '', '', '0.00', '12.00', '0.00', 3, '2011-06-17', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1912957028', 0, 'N', 0, '2013-12-04', NULL, NULL, 0, 0, NULL, NULL),
('010624198', 'W12011992', 'W12011992', 'TX01', 'Alamo Mental Health Group', 'Michael', '', 'Castillo', 'PHD', 'Mental Health', 'Psychology', NULL, NULL, 'O', ' 4242 Medical Dr Ste 6300', 'San Antonio', 'Bexar', 'TX', '78229', '2106148400', NULL, ' 4242 Medical Dr Ste 6300', 'San Antonio', 'Bexar', 'TX', '78229', '2106148400', '          ', 'TXALAMOPHD', '', '', '0.00', '35.00', '0.00', 6, '2011-06-24', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1992734479', 0, 'N', 0, '2013-10-23', NULL, NULL, 29.5146, -98.5673, NULL, NULL),
('010624198', 'W12011993', 'W12011993', 'TX01', 'Alamo Mental Health Group', 'Diane', 'B', 'Castillo', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '4242 Medical Dr Ste 6300', 'San Antonio', 'Bexar', 'TX', '78229', '2106148400', NULL, '4242 Medical Dr Ste 6300', 'San Antonio', 'Bexar', 'TX', '78229', '2106148400', '', 'TXALAMOMA', '', '', '0.00', '35.00', '0.00', 6, '2011-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1912943432', 0, 'N', 0, '2014-04-24', NULL, NULL, 29.5146, -98.5673, NULL, NULL),
('830506152', 'W12011994', 'W12011994', 'UT01', '', 'Jayne', 'E', 'Clark', 'MD', 'Physical Medicine and Rehabilitation', '', '', NULL, 'O', '1414 E 4500 S Ste 2', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8012726972', NULL, '1414 E 4500 S Ste 2', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8012726972', '', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-06-24', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1295735728', 0, 'N', 0, '2014-04-16', NULL, NULL, 40.6743, -111.851, NULL, NULL),
('836000891', 'W12011995', 'W12011995', 'WYT1', 'North Big Horn Hospital Clinic', 'Ken', '', 'Ferbrache', 'PAC', 'Family Practice', '', '', NULL, 'O', '1115 Ln 12', 'Lovell', 'Big Horn', 'WY', '82431', '3075485201', NULL, '1115 Ln 12', 'Lovell', 'Big Horn', 'WY', '82431', '3075485201', '          ', '', '', '', '0.00', '12.00', '0.00', 3, '2011-06-17', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1073625406', 0, 'N', 0, '2013-12-04', NULL, NULL, 0, 0, NULL, NULL),
('836000891', 'W12011996', 'W12011996', 'WYT1', 'North Big Horn Hospital Clinic', 'Mary', '', 'Freund', 'NP', 'Family Practice', '', '', NULL, 'O', '1115 Ln 12', 'Lovell', 'Big Horn', 'WY', '82431', '3075485201', NULL, '1115 Ln 12', 'Lovell', 'Big Horn', 'WY', '82431', '3075485201', '          ', '', '', '', '0.00', '12.00', '0.00', 3, '2011-06-17', NULL, 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1134231558', 0, 'N', 0, '2013-12-04', NULL, NULL, 0, 0, NULL, NULL),
('836000891', 'W12011997', 'W12011997', 'WYT1', 'North Big Horn Hospital Clinic', 'Derek', '', 'Gilbert', 'MD', 'Family Practice', '', '', NULL, 'O', '1115 Ln 12', 'Lovell', 'Big Horn', 'WY', '82431', '3075485201', NULL, '1115 Ln 12', 'Lovell', 'Big Horn', 'WY', '82431', '3075485201', '          ', '', '', '', '0.00', '12.00', '0.00', 3, '2011-06-17', '2012-03-19', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1477665925', 0, 'N', 0, '2012-04-27', NULL, NULL, 0, 0, NULL, NULL),
('450975585', 'W12012002', 'W12012002', 'UT01', '', 'Patrick', 'N', 'Green', 'MD', 'Family Practice', '', '', NULL, 'O', '210 Millpond', 'Tooele', 'Tooele', 'UT', '84074', '8018285857', '8015060296', '210 Millpond', 'Tooele', 'Tooele', 'UT', '84074', '8018285857', '8015060296', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-07-01', '2011-09-09', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1144431800', 0, 'N', 0, '2014-04-16', NULL, NULL, 0, 0, NULL, NULL),
('450975585', 'W12012003', 'W12012003', 'UT01', '', 'Patrick', 'N', 'Green', 'MD', 'Family Practice', '', '', NULL, 'B', '3578 E Summer Oaks Cir', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8018285857', '8015060296', '3578 E Summer Oaks Cir', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8018285857', '8015060296', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-07-01', '2011-09-09', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1144431800', 0, 'N', 0, '2014-04-16', NULL, NULL, 0, 0, NULL, NULL),
('274412746', 'W12012004', 'W12012004', 'UT01', 'Olympus Eye Associates', 'David', 'T', 'Brockbank', 'MD', 'Ophthalmology', '', '', NULL, 'O', '6065 S Fashion Blvd Ste 125', 'Murray', 'Salt Lake', 'UT', '84107', '8012610726', NULL, '6065 S Fashion Blvd Ste 125', 'Murray', 'Salt Lake', 'UT', '84107', '8012610726', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-07-18', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1093822561', 0, 'N', 0, '2011-12-15', NULL, NULL, 40.6391, -111.883, NULL, NULL),
('836000891', 'W12012011', 'W12012011', 'WYT1', 'North Big Horn Hospital Clinic', 'David', '', 'Hoffman', 'MD', 'Family Practice', 'General Surgery', '', NULL, 'O', '1115 Lane 12', 'Lovell', 'Big Horn', 'WY', '82431', '3075485201', NULL, '1115 Lane 12', 'Lovell', 'Big Horn', 'WY', '82431', '3075485201', '          ', '', '', '', '0.00', '12.00', '0.00', 3, '2011-06-17', NULL, 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1144332552', 0, 'N', 0, '2013-06-18', NULL, NULL, 0, 0, NULL, NULL),
('830330554', 'W12012013', 'W12012013', 'WY01', 'Evanston Clinic', 'Karrie', '', 'Knopf', 'PAC', 'Family Practice', '', '', NULL, 'B', 'PO Box 848407', 'Boston', 'Suffolk', 'MA', '02284', '3077838136', '3077838254', 'PO Box 848407', 'Boston', 'Suffolk', 'MA', '02284', '3077838136', '3077838254', 'wystd', 'wyhcpcs', '', '0.00', '35.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 0, 'Evanston Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1487659371', 0, 'N', 0, '2013-06-28', NULL, NULL, 0, 0, NULL, NULL),
('830330554', 'W12012014', 'W12012014', 'WYT1', 'Evanston Clinic', 'Karrie', '', 'Knopf', 'PAC', 'Family Practice', '', '', NULL, 'B', 'PO Box 848407', 'Boston', 'Suffolk', 'MA', '02284', '3077838136', '3077838254', 'PO Box 848407', 'Boston', 'Suffolk', 'MA', '02284', '3077838136', '3077838254', 'wystd', 'wyhcpcs', '', '0.00', '35.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 0, 'Evanston Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1487659371', 0, 'N', 0, '2013-06-28', NULL, NULL, 0, 0, NULL, NULL),
('452403057', 'W12012016', 'W12012016', 'UTMH1', 'St. George Children and Family Psychiatric Center', 'Cantril', '', 'Nielsen', 'MD', 'Mental Health', 'Psychiatry', '', NULL, 'O', '437 S Bluff St Ste 202', 'St George', 'Washington', 'UT', '84770', '4356521897', NULL, '437 S Bluff St Ste 202', 'St George', 'Washington', 'UT', '84770', '4356521897', '          ', 'MD-3', '', '', '0.00', '35.00', '0.00', 3, '2011-06-20', '2013-02-14', 0, 0, 0, 'Dixie Regional Medical Center', '', '', '', 'HCFA|UB|', '1942364435', 0, 'N', 0, '2013-08-27', NULL, NULL, 0, 0, NULL, NULL),
('836000891', 'W12012017', 'W12012017', 'WYT1', 'North Big Horn Hospital', '', '', 'North Big Horn Hospital', 'GROUP', 'Hospital', '', '', NULL, 'O', '1115 Ln 12', 'Lovell', 'Big Horn', 'WY', '82431', '3075485201', NULL, '1115 Ln 12', 'Lovell', 'Big Horn', 'WY', '82431', '3075485201', '          ', '', '', '', '0.00', '12.00', '0.00', 3, '2011-06-17', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000007899', 0, 'Y', 0, '2013-08-07', NULL, NULL, 0, 0, NULL, NULL),
('010624198', 'W12012018', 'W12012018', 'TX01', 'Alamo Mental Health Group', 'Jose', 'R', 'Odio', 'LMFT', 'Mental Health', 'Counseling', '', NULL, 'O', '4242 Medical Dr Ste 6300', 'San Antonio', 'Bexar', 'TX', '78229', '2106148400', NULL, '4242 Medical Dr Ste 6300', 'San Antonio', 'Bexar', 'TX', '78229', '2106148400', '', 'TXALAMOMA', '', '', '0.00', '35.00', '0.00', 6, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1801921309', 0, 'N', 0, '2014-06-24', NULL, NULL, 29.5146, -98.5673, NULL, NULL),
('010624198', 'W12012019', 'W12012019', 'TX01', 'Alamo Mental Health Group', 'John', 'W', 'Perry', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '4242 Medical Dr Ste 6300', 'San Antonio', 'Bexar', 'TX', '78229', '2106148400', NULL, '4242 Medical Dr Ste 6300', 'San Antonio', 'Bexar', 'TX', '78229', '2106148400', '          ', 'TXALAMOPHD', '', '', '0.00', '35.00', '0.00', 6, '2011-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1184635468', 0, 'N', 0, '2014-01-22', NULL, NULL, 29.5146, -98.5673, NULL, NULL),
('204203827', 'W12012020', 'W12012020', 'UTMH1', 'Pathways to Healing', 'Desiree', 'L', 'Porter', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '1325 N Main St Ste 3', 'Bountiful', 'Davis', 'UT', '84010', '8014997869', NULL, '1325 N Main St Ste 3', 'Bountiful', 'Davis', 'UT', '84010', '8014997869', '          ', 'MA', '', '', '0.00', '35.00', '0.00', 3, '2011-06-26', '2011-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1447568449', 0, 'N', 0, '2014-02-12', NULL, NULL, 0, 0, NULL, NULL),
('010624198', 'W12012021', 'W12012021', 'TX01', 'Alamo Mental Health Group', 'Faustina', '', 'Ramirez-Knoll', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', ' 4242 Medical Dr Ste 6300', 'San Antonio', 'Bexar', 'TX', '78229', '2106148400', NULL, ' 4242 Medical Dr Ste 6300', 'San Antonio', 'Bexar', 'TX', '78229', '2106148400', '', 'TXALAMOMA', '', '', '0.00', '35.00', '0.00', 6, '2011-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1174532816', 0, 'N', 0, '2014-05-08', NULL, NULL, 29.5146, -98.5673, NULL, NULL),
('621801973', 'W12012022', 'W12012022', 'UT01', 'Physician Group of Utah', 'Leslie', 'H', 'Rassner', 'MD', 'Family Practice', '', '', NULL, 'O', '82 S 1100 E Ste 303', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015332002', '8013239546', '82 S 1100 E Ste 303', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015332002', '8013239546', 'WUSTDSURG5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-07-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1427022938', 0, 'N', 0, '2011-11-03', NULL, NULL, 40.7676, -111.86, NULL, NULL),
('621801973', 'W12012023', 'W12012023', 'UT01', 'Physician Group of Utah', 'Leslie', 'H', 'Rassner', 'MD', 'Family Practice', '', '', NULL, 'O', '9350 S 150 E Ste 460', 'Sandy', 'Salt Lake', 'UT', '84070', '8015332002', '8013239546', '9350 S 150 E Ste 460', 'Sandy', 'Salt Lake', 'UT', '84070', '8015332002', '8013239546', 'WUSTDSURG5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-07-01', '2011-10-10', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1427022938', 0, 'N', 0, '2011-11-03', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W12012024', 'W12012024', 'UT01', 'Physician Group of Utah', 'Leslie', 'H', 'Rassner', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', 'WUSTDSURG5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-06-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1427022938', 0, 'N', 0, '2011-11-03', NULL, NULL, 0, 0, NULL, NULL),
('010624198', 'W12012027', 'W12012027', 'TX01', 'Alamo Mental Health Group', 'Italo', 'A', 'Samano', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '4242 Medical Dr Ste 6300', 'San Antonio', 'Bexar', 'TX', '78229', '2106148400', NULL, '4242 Medical Dr Ste 6300', 'San Antonio', 'Bexar', 'TX', '78229', '2106148400', '          ', 'TXALAMOPHD', '', '', '0.00', '35.00', '0.00', 6, '2011-06-24', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1770530974', 0, 'N', 0, '2014-01-17', NULL, NULL, 29.5146, -98.5673, NULL, NULL),
('010624198', 'W12012028', 'W12012028', 'TX01', 'Alamo Mental Health Group', 'Juan ', 'C', 'Urizar', 'MD', 'Mental Health', '', '', NULL, 'O', '4242 Medical Dr Ste 6300', 'San Antonio', 'Bexar', 'TX', '78229', '2106148400', NULL, '4242 Medical Dr Ste 6300', 'San Antonio', 'Bexar', 'TX', '78229', '2106148400', '', 'TXALAMOMD', '', '', '0.00', '35.00', '0.00', 6, '2011-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1114977634', 0, 'N', 0, '2014-04-16', NULL, NULL, 29.5146, -98.5673, NULL, NULL),
('841401924', 'W12012030', 'W12012030', 'UT01', 'Alpine Medical Group', 'Keith', '', 'Elliott', 'MD', 'Anesthesia', '', '', NULL, 'B', 'PO Box 3810', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8017272068', '8014322668', 'PO Box 3810', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8017272068', '8014322668', '', '', '1000', '47.25', '0.00', '0.00', 6, '2011-07-01', NULL, 1, 12, 0, '', '', '', '', 'HCFA|UB|', '1508011180', 0, 'N', 0, '2012-03-16', NULL, NULL, 0, 0, NULL, NULL),
('261527467', 'W12012031', 'W12012031', 'WY01', 'Evanston Anesthesia Associates', '', '', 'Evanston Anesthesia Associates', 'Group', 'Anesthesia', '', '', NULL, 'O', '1101 Ctr St', 'Evanston', 'Uinta', 'WY', '82931', '3077891219', '3077893460', '1101 Ctr St', 'Evanston', 'Uinta', 'WY', '82931', '3077891219', '3077893460', '', '', '', '0.00', '10.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1891979258', 0, 'Y', 0, '2011-06-29', NULL, NULL, 0, 0, NULL, NULL),
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('770254359', 'W12012073', 'W12012073', 'WYT1', 'Healthtronics Inc Riverton Memorial Hospital', '', '', 'Healthtronics Inc Riverton Memorial Hospital', 'GROUP', 'Lithotriptor', '', '', NULL, 'O', '2100 W Sunset', 'Riverton', 'Fremont', 'WY', '82501', '8663144242', NULL, '2100 W Sunset', 'Riverton', 'Fremont', 'WY', '82501', '8663144242', '          ', '', '', '6', '0.00', '100.00', '0.00', 3, '2011-06-28', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000006637', 0, 'Y', 0, '2011-06-28', NULL, NULL, 0, 0, NULL, NULL),
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('770254359', 'W12012075', 'W12012075', 'WYT1', 'Healthtronics Inc Sheridan Surgical Center', '', '', 'Healthtronics Inc Sheridan Surgical Center', 'GROUP', 'Lithotriptor', '', '', NULL, 'O', '425 W 5th St', 'Sheridan', 'Sheridan', 'WY', '82801', '8663144242', NULL, '425 W 5th St', 'Sheridan', 'Sheridan', 'WY', '82801', '8663144242', '          ', '', '', '6', '0.00', '100.00', '0.00', 3, '2011-06-28', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000006639', 0, 'Y', 0, '2011-06-28', NULL, NULL, 0, 0, NULL, NULL),
('770254359', 'W12012076', 'W12012076', 'WYT1', 'Healthtronics Inc Wyoming Medical Center', '', '', 'Healthtronics Inc Wyoming Medical Center', 'GROUP', 'Lithotriptor', '', '', NULL, 'O', '1233 E 2nd St', 'Casper', 'Natrona', 'WY', '82601', '8663144242', NULL, '1233 E 2nd St', 'Casper', 'Natrona', 'WY', '82601', '8663144242', '          ', '', '', '6', '0.00', '100.00', '0.00', 3, '2011-06-28', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000006640', 0, 'Y', 0, '2011-06-28', NULL, NULL, 0, 0, NULL, NULL),
('830291130', 'W12012077', 'W12012077', 'WYT1', 'Gillette Chiropractic Center', 'Todd', 'A', 'Hildebrand', 'DC', 'Chiropractic', '', '', NULL, 'O', '1001 4-J Rd', 'Gillette', 'Campbell', 'WY', '82716', '3076862327', '3076871106', '1001 4-J Rd', 'Gillette', 'Campbell', 'WY', '82716', '3076862327', '3076871106', '', '', '5004', '0.00', '100.00', '0.00', 3, '2011-06-28', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1811906845', 0, 'N', 0, '2014-04-21', NULL, NULL, 0, 0, NULL, NULL),
('830234097', 'W12012078', 'W12012078', 'WYT1', 'Home Health / Hospice', '', '', 'Home Health / Hospice', 'GROUP', 'Home Health Agency', 'Hospice', '', NULL, 'O', '710 W 12th St', 'Gillette', 'Campbell', 'WY', '82717', '3076886230', NULL, '710 W 12th St', 'Gillette', 'Campbell', 'WY', '82717', '3076886230', '          ', '', '', '', '0.00', '19.00', '0.00', 6, '2011-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000006762', 0, 'N', 0, '2013-09-17', NULL, NULL, 0, 0, NULL, NULL),
('010624198', 'W12012012', 'W12012012', 'TX01', 'Alamo Mental Health Group', 'Vikram', '', 'Kashyap', 'MD', 'Pediatric Psychiatry', '', '', NULL, 'O', '4242 Medical Dr Ste 6300', 'San Antonio', 'Bexar', 'TX', '78229', '2106148400', '          ', '4242 Medical Dr Ste 6300', 'San Antonio', 'Bexar', 'TX', '78229', '2106148400', '          ', 'TXALAMOMD', '', '', '0.00', '35.00', '0.00', 6, '2011-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1255324083', 0, 'N', 0, '2014-04-02', NULL, NULL, 29.5146, -98.5673, NULL, NULL),
('830234097', 'W12012079', 'W12012079', 'WYT1', 'Home Medical Resources', '', '', 'Home Medical Resources', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', '1708 W Hwy 15-16', 'Gillette', 'Campbell', 'WY', '82716', '3076886260', NULL, '1708 W Hwy 15-16', 'Gillette', 'Campbell', 'WY', '82716', '3076886260', '          ', '', '', '', '0.00', '19.00', '0.00', 6, '2011-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000006763', 0, 'N', 0, '2013-09-17', 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
('710952415', 'W12012080', 'W12012080', 'WYT1', 'Hospice Alliance of Wyoming', '', '', 'Hospice Alliance of Wyoming', 'GROUP', 'Hospice', '', '', NULL, 'O', '102293 US Hwy 89 Ste 1001', 'Thayne', 'Lincoln', 'WY', '83127', '3078837583', NULL, '102293 US Hwy 89 Ste 1001', 'Thayne', 'Lincoln', 'WY', '83127', '3078837583', '          ', '', '', '3', '0.00', '100.00', '0.00', 3, '2011-06-28', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000006781', 0, 'N', 0, '2013-06-06', NULL, NULL, 0, 0, NULL, NULL),
('710952415', 'W12012081', 'W12012081', 'WYT1', 'Hospice Alliance of Wyoming', '', '', 'Hospice Alliance of Wyoming', 'GROUP', 'Hospice', '', '', NULL, 'B', 'PO Box 1001', 'Thayne', 'Lincoln', 'WY', '83127', '3078837583', NULL, 'PO Box 1001', 'Thayne', 'Lincoln', 'WY', '83127', '3078837583', '          ', '', '', '3', '0.00', '100.00', '0.00', 3, '2011-06-28', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000006781', 0, 'N', 0, '2013-06-06', NULL, NULL, 0, 0, NULL, NULL),
('202711377', 'W12012083', 'W12012083', 'WYT1', 'Dubois Chiropractic', 'Dean', 'J', 'Lehmkuhler', 'DC', 'Chiropractic', 'Acupuncture', '', NULL, 'O', '116 E Ramshorn Ave', 'Dubois', 'Fremont', 'WY', '82513', '3074552719', NULL, '116 E Ramshorn Ave', 'Dubois', 'Fremont', 'WY', '82513', '3074552719', '          ', '', '', '5004', '0.00', '100.00', '0.00', 3, '2011-06-28', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1689605040', 0, 'N', 0, '2012-05-10', NULL, NULL, 0, 0, NULL, NULL),
('202711377', 'W12012084', 'W12012084', 'WYT1', 'Lander Valley Chiropractic', 'Dean', 'J', 'Lehmkuhler', 'DC', 'Chiropractic', 'Acupuncture', '', NULL, 'O', '160 S 4th St', 'Lander', 'Fremont', 'WY', '82520', '3073326143', NULL, '160 S 4th St', 'Lander', 'Fremont', 'WY', '82520', '3073326143', '          ', '', '', '5004', '0.00', '100.00', '0.00', 3, '2011-06-28', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1689605040', 0, 'N', 0, '2013-06-17', NULL, NULL, 0, 0, NULL, NULL),
('522085558', 'W12012085', 'W12012085', 'WYT1', 'Mountain Towers HC & Rehab Ctr', '', '', 'Mountain Towers HC & Rehab Ctr', 'GROUP', 'Skilled Nursing Facility', '', '', NULL, 'O', '3128 Boxelder Dr', 'Cheyenne', 'Laramie', 'WY', '82001', '3076347901', NULL, '3128 Boxelder Dr', 'Cheyenne', 'Laramie', 'WY', '82001', '3076347901', '          ', '', '', '7', '0.00', '100.00', '0.00', 3, '2011-06-28', NULL, 1, 0, 0, '', '', '', '', 'HCFA|UB|', '1215946546', 0, 'N', 0, '2012-04-25', NULL, NULL, 0, 0, NULL, NULL),
('760739677', 'W12012086', 'W12012086', 'WYT1', 'Myers Chiropractic', 'Jeffrey', 'T', 'Myers', 'DC', 'Chiropractic', '', '', NULL, 'O', '716 Big Horn Ave', 'Worland', 'Washakie', 'WY', '82401', '3079219890', NULL, '716 Big Horn Ave', 'Worland', 'Washakie', 'WY', '82401', '3079219890', '          ', '', '', '5004', '0.00', '100.00', '0.00', 3, '2011-06-28', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1598921801', 0, 'N', 0, '2012-10-25', NULL, NULL, 0, 0, NULL, NULL),
('760739677', 'W12012087', 'W12012087', 'WYT1', 'Myers Chiropractic', 'Jeffrey', 'T', 'Myers', 'DC', 'Chiropractic', '', '', NULL, 'B', 'PO Box 891', 'Thermopolis', 'Hot Springs', 'WY', '82443', '3073476457', NULL, 'PO Box 891', 'Thermopolis', 'Hot Springs', 'WY', '82443', '3073476457', '          ', '', '', '5004', '0.00', '100.00', '0.00', 3, '2011-06-28', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1598921801', 0, 'Y', 0, '2012-10-25', NULL, NULL, 0, 0, NULL, NULL),
('830234097', 'W12013036', 'W12013036', 'WYT1', 'Campbell County Memorial Hospital', 'Mark', 'D', 'Prince', 'MD', 'Hospitalist', '', '', NULL, 'O', '501 S Burma Ave', 'Gillette', 'Campbell', 'WY', '82717', '3076881000', NULL, '501 S Burma Ave', 'Gillette', 'Campbell', 'WY', '82717', '3076881000', '          ', '', '', '', '0.00', '19.00', '0.00', 6, '2011-07-01', '2011-09-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000008265', 0, 'Y', 0, '2013-09-17', NULL, NULL, 0, 0, NULL, NULL),
('331177233', 'W12012025', 'W12012025', 'UT01', 'Ogden Internal Medicine and Urolgy', 'John', 'K', 'Reis', 'MD', 'Internal Medicine', '', '', NULL, 'O', '5405 S 500 E Ste 203 and Ste 100', 'Ogden', 'Weber', 'UT', '84405', '8014758600', '8014758686', '5405 S 500 E Ste 203 and Ste 100', 'Ogden', 'Weber', 'UT', '84405', '8014758600', '8014758686', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-08-01', '2014-04-04', 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1588689095', 0, 'N', 0, '2014-04-16', NULL, NULL, 41.1655, -111.969, NULL, NULL),
('331177233', 'W12012026', 'W12012026', 'UT01', 'Ogden Internal Medicine and Urolgy', 'John', 'K', 'Reis', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 100925', 'Atlanta', 'Fulton', 'GA', '30384', '8006613365', '8014758686', 'PO Box 100925', 'Atlanta', 'Fulton', 'GA', '30384', '8006613365', '8014758686', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-08-01', '2014-04-04', 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1588689095', 0, 'N', 0, '2014-04-16', NULL, NULL, 0, 0, NULL, NULL),
('830301302', 'W12012089', 'W12012089', 'WYT1', 'Rocky Mountain Care', '', '', 'Rocky Mountain Care', 'GROUP', 'Skilled Nursing Facility', '', '', NULL, 'O', '475 Yellow Creek Rd', 'Evanston', 'Uinta', 'WY', '82930', '3077890726', NULL, '475 Yellow Creek Rd', 'Evanston', 'Uinta', 'WY', '82930', '3077890726', '          ', '', '', '7', '0.00', '100.00', '0.00', 3, '2011-06-28', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000008437', 0, 'N', 0, '2011-06-28', NULL, NULL, 0, 0, NULL, NULL),
('870468543', 'W12012090', 'W12012090', 'WYT1', 'Rocky Mountain Home Care', '', '', 'Rocky Mountain Home Care', 'GROUP', 'Home Health Agency', 'Hospice', '', NULL, 'O', '535 Uinta Dr', 'Green River', 'Sweetwater', 'WY', '82935', '3078758990', NULL, '535 Uinta Dr', 'Green River', 'Sweetwater', 'WY', '82935', '3078758990', '          ', '', '', '4', '0.00', '100.00', '0.00', 3, '2011-06-28', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1386642965', 0, 'N', 0, '2011-06-28', NULL, NULL, 0, 0, NULL, NULL),
('522085558', 'W12012091', 'W12012091', 'WYT1', 'South Central Wyoming Health Care', '', '', 'South Central Wyoming Health Care', 'GROUP', 'Skilled Nursing Facility', '', '', NULL, 'O', '542 16th St', 'Riverton', 'Fremont', 'WY', '82501', '3073242759', NULL, '542 16th St', 'Riverton', 'Fremont', 'WY', '82501', '3073242759', '          ', '', '', '7', '0.00', '100.00', '0.00', 3, '2011-06-28', NULL, 1, 0, 0, '', '', '', '', 'HCFA|UB|', '0000008827', 0, 'N', 0, '2012-04-25', NULL, NULL, 0, 0, NULL, NULL),
('830128950', 'W12012092', 'W12012092', 'WYT1', 'South Lincoln Medical Center', '', '', 'South Lincoln Medical Center', 'GROUP', 'Hospital', '', '', NULL, 'O', '711 Onyx St', 'Kemmerer', 'Lincoln', 'WY', '83101', '3078774401', NULL, '711 Onyx St', 'Kemmerer', 'Lincoln', 'WY', '83101', '3078774401', '          ', '', '', '1', '0.00', '12.00', '0.00', 3, '2011-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000008830', 0, 'N', 0, '2011-07-20', NULL, NULL, 0, 0, NULL, NULL),
('830128950', 'W12012093', 'W12012093', 'WYT1', 'South Lincoln Medical Center Home Oxygen/Swing Bed', '', '', 'South Lincoln Medical Center Home Oxygen/Swing Bed', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', '711 Onyx St', 'Kemmerer', 'Lincoln', 'WY', '83101', '3078774401', NULL, '711 Onyx St', 'Kemmerer', 'Lincoln', 'WY', '83101', '3078774401', '          ', '', '', '1', '0.00', '12.00', '0.00', 3, '2011-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000008831', 0, 'Y', 0, '2011-07-20', NULL, NULL, 0, 0, NULL, NULL),
('830215583', 'W12012094', 'W12012094', 'WYT1', 'Uinta Home Health & Hospice', '', '', 'Uinta Home Health & Hospice', 'GROUP', 'Hospice', 'Home Health Agency', '', NULL, 'O', '1229 Uinta St', 'Evanston', 'Uinta', 'WY', '82930', '3077897712', NULL, '1229 Uinta St', 'Evanston', 'Uinta', 'WY', '82930', '3077897712', '          ', '', '', '3', '0.00', '100.00', '0.00', 6, '2011-06-28', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009264', 0, 'N', 0, '2011-06-28', NULL, NULL, 0, 0, NULL, NULL),
('830215583', 'W12012095', 'W12012095', 'WYT1', 'Uinta Home Health & Hospice', '', '', 'Uinta Home Health & Hospice', 'GROUP', 'Hospice', 'Home Health Agency', '', NULL, 'O', '216 W Sage', 'Lyman', 'Uinta', 'WY', '82937', '3077873872', NULL, '216 W Sage', 'Lyman', 'Uinta', 'WY', '82937', '3077873872', '          ', '', '', '3', '0.00', '100.00', '0.00', 6, '2011-06-28', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009264', 0, 'N', 0, '2011-06-28', NULL, NULL, 0, 0, NULL, NULL),
('830215583', 'W12012096', 'W12012096', 'WYT1', 'Uinta Home Health & Hospice', '', '', 'Uinta Home Health & Hospice', 'GROUP', 'Hospice', 'Home Health Agency', '', NULL, 'B', 'PO Box 728', 'Evanston', 'Uinta', 'WY', '82930', '3077897712', NULL, 'PO Box 728', 'Evanston', 'Uinta', 'WY', '82930', '3077897712', '          ', '', '', '4', '0.00', '100.00', '0.00', 6, '2011-06-28', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009264', 0, 'Y', 0, '2011-06-28', NULL, NULL, 0, 0, NULL, NULL),
('830215583', 'W12012097', 'W12012097', 'WYT1', 'Uinta Home Health & Hospice', '', '', 'Uinta Home Health & Hospice', 'GROUP', 'Hospice', 'Home Health Agency', '', NULL, 'B', 'PO Box 9', 'Lyman', 'Uinta', 'WY', '82937', '3077873872', NULL, 'PO Box 9', 'Lyman', 'Uinta', 'WY', '82937', '3077873872', '          ', '', '', '4', '0.00', '100.00', '0.00', 6, '2011-06-28', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009264', 0, 'Y', 0, '2011-06-28', NULL, NULL, 0, 0, NULL, NULL),
('522085558', 'W12012098', 'W12012098', 'WYT1', 'Wind River Health Care & Rehab Center', '', '', 'Wind River Health Care & Rehab Center', 'GROUP', 'Skilled Nursing Facility', '', '', NULL, 'O', '1002 Forest Dr', 'Riverton', 'Fremont', 'WY', '82501', '3078569471', NULL, '1002 Forest Dr', 'Riverton', 'Fremont', 'WY', '82501', '3078569471', '          ', '', '', '7', '0.00', '100.00', '0.00', 3, '2011-06-28', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009642', 0, 'N', 0, '2012-04-25', NULL, NULL, 0, 0, NULL, NULL),
('830327251', 'W12012099', 'W12012099', 'WYT1', 'Star Valley Medical Center', 'Jacob ', '', 'Crosby', 'CRNA', 'Anesthesia', '', '', NULL, 'O', '901 Adams St', 'Afton', 'Lincoln', 'WY', '83110', '3078855817', NULL, '901 Adams St', 'Afton', 'Lincoln', 'WY', '83110', '3078855817', '          ', 'WSTARV', 'wyhcpcs', '', '0.00', '10.00', '0.00', 6, '2011-06-28', NULL, 0, 0, 0, 'Star Valley Medical Center', '', '', '', 'HCFA|UB|', '1578721544', 0, 'Y', 0, '2011-06-10', NULL, NULL, 0, 0, NULL, NULL),
('830327251', 'W12012100', 'W12012100', 'WYT1', 'Star Valley Medical Center', 'Jacob ', '', 'Crosby', 'CRNA', 'Anesthesia', '', '', NULL, 'B', 'PO Box 579', 'Afton', 'Lincoln', 'WY', '83110', '3078855817', NULL, 'PO Box 579', 'Afton', 'Lincoln', 'WY', '83110', '3078855817', '          ', 'WSTARV', 'wyhcpcs', '', '0.00', '10.00', '0.00', 6, '2011-06-28', NULL, 0, 0, 0, 'Star Valley Medical Center', '', '', '', 'HCFA|UB|', '1578721544', 0, 'Y', 0, '2011-06-10', NULL, NULL, 0, 0, NULL, NULL),
('830327251', 'W12012101', 'W12012101', 'WYT1', 'Star Valley Medical Center', 'Gary ', '', 'Hess', 'APRN', 'Anesthesia', '', '', NULL, 'B', 'PO Box 579', 'Afton', 'Lincoln', 'WY', '83110', '3078855817', NULL, 'PO Box 579', 'Afton', 'Lincoln', 'WY', '83110', '3078855817', '          ', 'WSTARV', 'wyhcpcs', '', '0.00', '10.00', '0.00', 6, '2011-06-28', NULL, 0, 0, 0, 'Star Valley Medical Center', '', '', '', 'HCFA|UB|', '1558396911', 0, 'Y', 0, '2013-06-28', NULL, NULL, 0, 0, NULL, NULL),
('202299593', 'W12012102', 'W12012102', 'WYT1', 'Red Desert InstaCare', 'William', 'D', 'Burnett', 'MD', 'Family Practice', '', '', NULL, 'O', '2761 Commercial Way', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073823064', NULL, '2761 Commercial Way', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073823064', '', '', '', '', '0.00', '7.50', '0.00', 3, '2011-06-28', '2011-09-22', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1760579023', 0, 'N', 0, '2014-04-01', NULL, NULL, 0, 0, NULL, NULL),
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('202299593', 'W12012104', 'W12012104', 'WYT1', 'Wyoming Range Medical', 'William', 'D', 'Burnett', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 130', 'Big Piney', 'Sublette', 'WY', '83113', '3073823064', NULL, 'PO Box 130', 'Big Piney', 'Sublette', 'WY', '83113', '3073823064', '', '', '', '', '0.00', '7.50', '0.00', 3, '2011-06-28', '2011-09-22', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1760579023', 0, 'Y', 0, '2014-04-01', NULL, NULL, 0, 0, NULL, NULL),
('810284764', 'W12012105', 'W12012105', 'WYT1', 'Arapahoe Health Center', 'Shelly ', '', 'Cadman', 'OD', 'Optometry', '', '', NULL, 'M', 'PO Box 31001', 'Pasadena', 'Los Angeles', 'CA', '91110', '3078569281', '3078577063', 'PO Box 31001', 'Pasadena', 'Los Angeles', 'CA', '91110', '3078569281', '3078577063', 'WYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2011-06-28', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1417969718', 0, 'N', 0, '2014-07-21', NULL, NULL, 0, 0, NULL, NULL),
('810284764', 'W12012106', 'W12012106', 'WYT1', 'Fort Washakie Health Center', 'Shelly ', '', 'Cadman', 'OD', 'Optometry', '', '', NULL, 'B', 'PO Box 128', 'Fort Washakie', 'Fremont', 'WY', '82514', '3073320446', '3073320131', 'PO Box 128', 'Fort Washakie', 'Fremont', 'WY', '82514', '3073320446', '3073320131', 'WYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2011-06-28', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1417969718', 0, 'N', 0, '2014-07-21', NULL, NULL, 0, 0, NULL, NULL),
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('810284764', 'W12012108', 'W12012108', 'WYT1', 'Arapahoe Health Center', 'Shelly ', '', 'Cadman', 'OD', 'Optometry', '', '', NULL, 'O', '17 Great Plains Rd', 'Arapahoe', 'Fremont', 'WY', '82510', '3078569281', '3078577063', '17 Great Plains Rd', 'Arapahoe', 'Fremont', 'WY', '82510', '3078569281', '3078577063', 'WYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2011-06-28', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1417969718', 0, 'N', 0, '2014-07-21', NULL, NULL, 0, 0, NULL, NULL),
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('830336456', 'W12012110', 'W12012110', 'WYT1', 'Western Wyoming Neurological Surgery', 'Brent', 'Lee', 'Clyde', 'MD', 'Neurosurgery', '', '', NULL, 'o', '190 Arrowead Dr', 'Evanston', 'Uinta', 'WY', '82930', '8005581912', NULL, '190 Arrowead Dr', 'Evanston', 'Uinta', 'WY', '82930', '8005581912', '          ', '', '', '', '0.00', '20.00', '0.00', 3, '2011-06-28', NULL, 0, 0, 0, 'Davis Hospital', 'Star Valley Medical Center', NULL, NULL, 'HCFA|UB|', '1700896552', 0, 'N', 0, '2013-12-10', NULL, NULL, 0, 0, NULL, NULL),
('592852900', 'W12012111', 'W12012111', 'WYT1', 'Lincare', '', '', 'Lincare', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', '100 Brownfield Rd', 'Douglas', 'Converse', 'WY', '82633', '3073585805', NULL, '100 Brownfield Rd', 'Douglas', 'Converse', 'WY', '82633', '3073585805', '          ', 'LINCAREWY', '', '', '0.00', '20.00', '0.00', 8, '2011-06-28', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000007285', 0, 'N', 0, '2013-06-18', NULL, NULL, 0, 0, NULL, NULL),
('592852900', 'W12012112', 'W12012112', 'WYT1', 'Lincare', '', '', 'Lincare', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', '1121 Washington Ste 2', 'Newcastle', 'Weston', 'WY', '82701', '3077462281', NULL, '1121 Washington Ste 2', 'Newcastle', 'Weston', 'WY', '82701', '3077462281', '          ', 'LINCAREWY', '', '', '0.00', '20.00', '0.00', 8, '2011-06-28', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000007285', 0, 'N', 0, '2013-06-18', NULL, NULL, 0, 0, NULL, NULL),
('592852900', 'W12012113', 'W12012113', 'WYT1', 'Lincare', '', '', 'Lincare', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', '1221 E Pershing', 'Cheyenne', 'Laramie', 'WY', '82001', '3076378267', NULL, '1221 E Pershing', 'Cheyenne', 'Laramie', 'WY', '82001', '3076378267', '          ', 'LINCAREWY', '', '', '0.00', '20.00', '0.00', 8, '2011-06-28', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000007285', 0, 'N', 0, '2013-06-18', NULL, NULL, 0, 0, NULL, NULL),
('592852900', 'W12012114', 'W12012114', 'WYT1', 'Lincare', '', '', 'Lincare', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', '1363 N 4th St Ste B', 'Laramie', 'Albany', 'WY', '82072', '3077214992', NULL, '1363 N 4th St Ste B', 'Laramie', 'Albany', 'WY', '82072', '3077214992', '          ', 'LINCAREWY', '', '', '0.00', '20.00', '0.00', 8, '2011-06-28', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000007285', 0, 'N', 0, '2013-06-18', NULL, NULL, 0, 0, NULL, NULL),
('592852900', 'W12012115', 'W12012115', 'WYT1', 'Lincare', '', '', 'Lincare', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', '1408 E Murray St', 'Rawlins', 'Carbon', 'WY', '82301', '3073242117', NULL, '1408 E Murray St', 'Rawlins', 'Carbon', 'WY', '82301', '3073242117', '          ', 'LINCAREWY', '', '', '0.00', '20.00', '0.00', 8, '2011-06-28', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000007285', 0, 'N', 0, '2013-06-18', NULL, NULL, 0, 0, NULL, NULL),
('592852900', 'W12012116', 'W12012116', 'WYT1', 'Lincare', '', '', 'Lincare', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', '228 N 10th St', 'Worland', 'Washakie', 'WY', '82401', '3073472674', NULL, '228 N 10th St', 'Worland', 'Washakie', 'WY', '82401', '3073472674', '          ', 'LINCAREWY', '', '', '0.00', '20.00', '0.00', 8, '2011-06-28', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000007285', 0, 'N', 0, '2013-06-18', NULL, NULL, 0, 0, NULL, NULL),
('592852900', 'W12012117', 'W12012117', 'WYT1', 'Lincare', '', '', 'Lincare', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', '2546 E 2nd St Ste 602', 'Casper', 'Natrona', 'WY', '82609', '3072378000', NULL, '2546 E 2nd St Ste 602', 'Casper', 'Natrona', 'WY', '82609', '3072378000', '          ', 'LINCAREWY', '', '', '0.00', '20.00', '0.00', 8, '2011-06-28', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000007285', 0, 'N', 0, '2013-06-18', NULL, NULL, 0, 0, NULL, NULL),
('592852900', 'W12012118', 'W12012118', 'WYT1', 'Lincare', '', '', 'Lincare', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', '2734 Commercial Way', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073827703', NULL, '2734 Commercial Way', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073827703', '          ', 'LINCAREWY', '', '', '0.00', '20.00', '0.00', 8, '2011-06-28', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000007285', 0, 'N', 0, '2013-06-18', NULL, NULL, 0, 0, NULL, NULL),
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('592852900', 'W12012120', 'W12012120', 'WYT1', 'Lincare', '', '', 'Lincare', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', '545 Budd Ave', 'Big Piney', 'Sublette', 'WY', '83113', '3072765744', NULL, '545 Budd Ave', 'Big Piney', 'Sublette', 'WY', '83113', '3072765744', '          ', 'LINCAREWY', '', '', '0.00', '20.00', '0.00', 8, '2011-06-28', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000007285', 0, 'N', 0, '2013-06-18', NULL, NULL, 0, 0, NULL, NULL),
('592852900', 'W12012121', 'W12012121', 'WYT1', 'Lincare', '', '', 'Lincare', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', '555 E Broadway Ste 108', 'Jackson', 'Teton', 'WY', '83001', '3077339737', NULL, '555 E Broadway Ste 108', 'Jackson', 'Teton', 'WY', '83001', '3077339737', '          ', 'LINCAREWY', '', '', '0.00', '20.00', '0.00', 8, '2011-06-28', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000007285', 0, 'N', 0, '2013-06-18', NULL, NULL, 0, 0, NULL, NULL),
('592852900', 'W12012122', 'W12012122', 'WYT1', 'Lincare', '', '', 'Lincare', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', '655 Broadway St', 'Sheridan', 'Sheridan', 'WY', '82801', '3076720073', NULL, '655 Broadway St', 'Sheridan', 'Sheridan', 'WY', '82801', '3076720073', '          ', 'LINCAREWY', '', '', '0.00', '20.00', '0.00', 8, '2011-06-28', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000007285', 0, 'N', 0, '2013-06-18', NULL, NULL, 0, 0, NULL, NULL),
('592852900', 'W12012123', 'W12012123', 'WYT1', 'Lincare', '', '', 'Lincare', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'B', 'PO Box 4598', 'Casper', 'NATRONA', 'WY', '82606', '8003590240', NULL, 'PO Box 4598', 'Casper', 'NATRONA', 'WY', '82606', '8003590240', '          ', 'LINCAREWY', '', '', '0.00', '20.00', '0.00', 8, '2011-06-28', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000007285', 0, 'Y', 0, '2013-06-18', NULL, NULL, 0, 0, NULL, NULL),
('592852900', 'W12012124', 'W12012124', 'WYT1', 'Lincare', '', '', 'Lincare', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', '80 Yellow Creek Rd', 'Evanston', 'Uinta', 'WY', '82930', '3077896621', NULL, '80 Yellow Creek Rd', 'Evanston', 'Uinta', 'WY', '82930', '3077896621', '          ', 'LINCAREWY', '', '', '0.00', '20.00', '0.00', 8, '2011-06-28', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000007285', 0, 'N', 0, '2013-06-18', NULL, NULL, 0, 0, NULL, NULL),
('592852900', 'W12012125', 'W12012125', 'WYT1', 'Lincare', '', '', 'Lincare', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', '709 W 8th St Ste 2', 'Gillette', 'Campbell', 'WY', '82716', '3076870501', NULL, '709 W 8th St Ste 2', 'Gillette', 'Campbell', 'WY', '82716', '3076870501', '          ', 'LINCAREWY', '', '', '0.00', '20.00', '0.00', 8, '2011-06-28', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000007285', 0, 'N', 0, '2013-06-18', NULL, NULL, 0, 0, NULL, NULL),
('592852900', 'W12012126', 'W12012126', 'WYT1', 'Lincare', '', '', 'Lincare', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', '702 E Monroe', 'Riverton', 'Fremont', 'WY', '82501', '3078567562', NULL, '702 E Monroe', 'Riverton', 'Fremont', 'WY', '82501', '3078567562', '          ', 'LINCAREWY', '', '', '0.00', '20.00', '0.00', 8, '2011-06-28', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000007285', 0, 'N', 0, '2013-06-18', NULL, NULL, 0, 0, NULL, NULL),
('860735726', 'W12029059', 'W12029059', 'Sinclair', 'Flagstaff Bone and Joint', 'Kevin ', '', 'ODonnell', 'DO', 'Sports Medicine', '', '', NULL, 'O', '1841 Morrow Ave', 'Kingman', 'Mohave', 'AZ', '86409', '9287732280', '9287732281', '1841 Morrow Ave', 'Kingman', 'Mohave', 'AZ', '86409', '9287732280', '9287732281', '', '', '', '0.00', '40.00', '0.00', 3, '2012-12-28', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1114911492', 0, 'N', 0, '2013-01-24', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'SACN01085', 'SACN01085', 'SACN', 'Saint Alphonsus Medical Group Hospitalist Boise', 'Ann', 'C', 'Agnew', 'MD', 'Hospitalist', '', '', NULL, 'o', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083672121', '2083675180', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083672121', '2083675180', 'IDSINCLAIRL', '', '', '0.00', '15.00', '0.00', 6, '2011-01-01', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|', '1497797302', 0, 'N', 0, '2013-09-30', NULL, NULL, 43.6127, -116.254, NULL, NULL),
('205934739', 'SACN00559', 'SACN00559', 'SACN', 'Family Medicine Health Center', 'Thomas', '', 'Ahlrichs', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '777 N Raymond St', 'Boise', 'Ada', 'ID', '83704', '2085142500', NULL, '777 N Raymond St', 'Boise', 'Ada', 'ID', '83704', '2085142500', '          ', 'IDSINCLAIRL', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2011-01-01', '2012-04-05', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1013135078', 0, 'N', 0, '2012-04-05', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'SACN00643', 'SACN00643', 'SACN', 'Saint Alphonsus  Medical Group OBGYN Boise BOGA Bldg ', 'Georgianna', '', 'Ainslie', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '5966 Curtisian', 'Boise', 'Ada', 'ID', '83704', '2083758100', '2083778163', '5966 Curtisian', 'Boise', 'Ada', 'ID', '83704', '2083758100', '2083778163', 'IDSINCLAIRL', '', '', '0.00', '15.00', '0.00', 6, '2011-01-01', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|', '1073566089', 0, 'N', 0, '2014-06-20', NULL, NULL, 43.6149, -116.256, NULL, NULL),
('455227009', 'W12030680', 'W12030680', 'UT01', 'UPRI Murray', 'Lynn', 'A', 'Morrison', 'APRN', 'Pain Management', '', '', NULL, 'O', '32 W Winchester St Ste 200', 'Murray', 'Salt Lake', 'UT', '84107', '8012810555', '8012810444', '32 W Winchester St Ste 200', 'Murray', 'Salt Lake', 'UT', '84107', '8012810555', '8012810444', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1467526855', 0, 'N', 0, '2013-06-04', NULL, NULL, 40.6332, -111.893, NULL, NULL),
('455227009', 'W12030681', 'W12030681', 'UT01', 'UPRI Taylorsville', 'Lynn', 'A', 'Morrison', 'APRN', 'Pain Management', '', '', NULL, 'O', '1972 W 5400 S Ste 100', 'Taylorsville', 'Salt Lake', 'UT', '84118', '8012810555', '8012810444', '1972 W 5400 S Ste 100', 'Taylorsville', 'Salt Lake', 'UT', '84118', '8012810555', '8012810444', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1467526855', 0, 'N', 0, '2013-06-04', NULL, NULL, 40.6531, -111.944, NULL, NULL),
('363977608', 'W12030689', 'W12030689', 'ILCHIGSTD', 'Northwest Pediatric Services', 'Yesha', 'N', 'Modi', 'MD', 'Pediatrics', '', '', NULL, 'O', '121 S Wilke Rd Ste 311 and 600', 'Arlington Heights', 'Cook', 'IL', '60005', '8472594122', '8472598209', '121 S Wilke Rd Ste 311 and 600', 'Arlington Heights', 'Cook', 'IL', '60005', '8472594122', '8472598209', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-03-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1053573972', 0, 'Y', 0, '2013-09-06', NULL, NULL, 42.0807, -88.0047, NULL, NULL),
('260553931', 'SACN01194', 'SACN01194', 'SACN', 'Saint Alphonsus Medical Group Vascular Services Boise 102', 'Christopher', '', 'Alessi', 'MD', 'Vascular Surgery', 'Cardiovascular Disease', '', NULL, 'O', '6140 W Curtisian Ave Ste 102', 'Boise', 'Ada', 'ID', '83704', '2083677787', '2083677798', '6140 W Curtisian Ave Ste 102', 'Boise', 'Ada', 'ID', '83704', '2083677787', '2083677798', 'IDSINCLAIRL', '', '', '0.00', '15.00', '0.00', 6, '2011-01-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1598726960', 0, 'N', 0, '2013-05-07', NULL, NULL, 43.6151, -116.256, NULL, NULL),
('820536340', 'SACN01221', 'SACN01221', 'SACN', 'The Clinic at Eagle', 'Katherine', 'T', 'Coate', 'NP-C', 'Family Practice', '', '', NULL, 'O', '600 E State St Ste 200', 'Eagle', 'Ada', 'ID', '83616', '2089392273', '2089395888', '600 E State St Ste 200', 'Eagle', 'Ada', 'ID', '83616', '2089392273', '2089395888', 'IDSINCLAIRL', '', '', '0.00', '15.00', '0.00', 3, '2011-01-01', '2013-10-21', 0, 0, 1, 'Saint Alphonsus Regional Medical Center', NULL, '', '', 'HCFA|UB|', '1619939451', 0, 'N', 0, '2013-11-15', NULL, NULL, 0, 0, NULL, NULL),
('820536340', 'SACN01222', 'SACN01222', 'SACN', 'The Clinic at Eagle', 'Katherine', 'T', 'Coate', 'NP-C', 'Family Practice', '', '', NULL, 'B', 'PO Box 9589', 'Boise', 'Ada', 'ID', '83707', '2084728112', '2084728112', 'PO Box 9589', 'Boise', 'Ada', 'ID', '83707', '2084728112', '2084728112', 'IDSINCLAIRL', '', '', '0.00', '15.00', '0.00', 3, '2011-01-01', '2013-10-21', 0, 0, 1, 'Saint Alphonsus Regional Medical Center', NULL, '', '', 'HCFA|UB|', '1619939451', 0, 'N', 0, '2013-11-15', NULL, NULL, 0, 0, NULL, NULL),
('203276415', 'SACN01429', 'SACN01429', 'SACN', 'Ada West Dermatology', 'Laura', 'B', 'Allen', 'PA-C', 'Dermatology', '', '', NULL, 'O', '1618 S Millennium Way Ste 100', 'Meridian', 'Ada', 'ID', '83642', '2088843376', NULL, '1618 S Millennium Way Ste 100', 'Meridian', 'Ada', 'ID', '83642', '2088843376', '', 'IDSINCLAIRL', 'WUSTDHCPC5', NULL, '0.00', '15.00', '0.00', 3, '2011-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1740476969', 0, 'n', 0, '2013-03-20', NULL, NULL, 43.5903, -116.368, NULL, NULL),
('201300128', 'SACN00747', 'SACN00747', 'SACN', 'Idaho Urologic Institute', 'Nicolas', '', 'Allen', 'PA-C', 'Physician Assistant', '', '', NULL, 'O', '2855 E Magic View Dr', 'Meridian', 'Ada', 'ID', '83642', '2086394900', NULL, '2855 E Magic View Dr', 'Meridian', 'Ada', 'ID', '83642', '2086394900', '', 'IDSINCLAIRL', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2011-01-01', '2011-08-30', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1205910551', 0, 'N', 0, '2014-04-15', NULL, NULL, 43.599, -116.36, NULL, NULL),
('621801973', 'W12030684', 'W12030684', 'UT01', 'Western Hills Medical Clinic', 'Randal', 'J', 'Lewis', 'MD', 'Family Practice', '', '', NULL, 'O', '5255 S 4015 W Ste 206', 'Salt Lake City', 'Salt Lake', 'UT', '84129', '8019129700', '8019129710', '5255 S 4015 W Ste 206', 'Salt Lake City', 'Salt Lake', 'UT', '84129', '8019129700', '8019129710', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-03-01', '2014-04-30', 0, 0, 0, 'Riverton Childrens Unit Operated by Primary Childrens Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1215964309', 0, 'N', 0, '2013-07-25', NULL, NULL, 40.6556, -111.987, NULL, NULL),
('820200895', 'SACN01348', 'SACN01348', 'SACN', 'Saint Alphonsus  Medical Group Comprehensive Pain and Spine', 'Nicole', 'M', 'Amideo', 'PA-C', 'Pain Management', 'Physician Assistant', '', NULL, 'o', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083677644', '2083673319', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083677644', '2083673319', 'IDSINCLAIRL', '', '', '0.00', '15.00', '0.00', 6, '2011-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1700813714', 0, 'N', 0, '2012-12-13', NULL, NULL, 43.6127, -116.254, NULL, NULL),
('820511746', 'SACN00623', 'SACN00623', 'SACN', '', 'Bruce', 'J', 'Andersen', 'MD', 'Neurosurgery', '', '', NULL, 'O', '6140 W Curtisian Ave Ste 400', 'Boise', 'Ada', 'ID', '83704', '2083673500', NULL, '6140 W Curtisian Ave Ste 400', 'Boise', 'Ada', 'ID', '83704', '2083673500', '', 'IDSINCLAIRL', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2011-01-01', '2012-01-03', 0, 0, 1, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1063420792', 0, 'N', 0, '2014-07-09', NULL, NULL, 43.6151, -116.256, NULL, NULL),
('820442659', 'SACN00375', 'SACN00375', 'SACN', 'Idaho Foot & Ankle Associates', 'Kerry', 'W', 'Anderson', 'DPM', 'Podiatry', '', '', NULL, 'O', '2635 Caldwell Blvd Ste 101', 'Nampa', 'Canyon', 'ID', '83651', '2084550655', '2084550654', '2635 Caldwell Blvd Ste 101', 'Nampa', 'Canyon', 'ID', '83651', '2084550655', '2084550654', 'IDSINCLAIRL', '', '', '0.00', '15.00', '0.00', 3, '2011-01-01', NULL, 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1659310829', 0, 'N', 0, '2014-03-26', NULL, NULL, 0, 0, NULL, NULL),
('820442659', 'SACN00376', 'SACN00376', 'SACN', 'Idaho Foot & Ankle Associates', 'Kerry', 'W', 'Anderson', 'DPM', 'Podiatry', '', '', NULL, 'O', '809 N Liberty', 'Boise', 'Ada', 'ID', '83704', '2083270627', '2083765258', '809 N Liberty', 'Boise', 'Ada', 'ID', '83704', '2083270627', '2083765258', 'IDSINCLAIRL', NULL, NULL, '0.00', '15.00', '0.00', 3, '2011-01-01', NULL, 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1659310829', 0, 'N', 0, '2014-03-26', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W12030685', 'W12030685', 'UT01', 'Physician Group of Utah', 'Randal', 'J', 'Lewis', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-03-01', '2014-04-30', 0, 0, 0, 'Riverton Childrens Unit Operated by Primary Childrens Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1215964309', 0, 'N', 0, '2013-07-25', NULL, NULL, 0, 0, NULL, NULL),
('820312175', 'SACN01525', 'SACN01525', 'SACN', 'Idaho Emergency Physicians PA', 'Peter', 'J', 'Angleton', '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', 'IDSINCLAIRL', '', '', '0.00', '15.00', '0.00', 3, '2011-01-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', 'West Valley Medical Center', NULL, NULL, 'HCFA|UB|', '1821042334', 0, 'N', 0, '2012-01-06', NULL, NULL, 43.6136, -116.256, NULL, NULL),
('820312175', 'SACN01526', 'SACN01526', 'SACN', 'Idaho Emergency Physicians PA', 'Peter', 'J', 'Angleton', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '1717 Arlington', 'Caldwell', 'Canyon', 'ID', '83605', '2083221730', '2083221731', '1717 Arlington', 'Caldwell', 'Canyon', 'ID', '83605', '2083221730', '2083221731', 'IDSINCLAIRL', NULL, NULL, '0.00', '15.00', '0.00', 3, '2011-01-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', 'West Valley Medical Center', NULL, NULL, 'HCFA|UB|', '1821042334', 0, 'N', 0, '2012-01-06', NULL, NULL, 0, 0, NULL, NULL),
('820312175', 'SACN01527', 'SACN01527', 'SACN', 'Idaho Emergency Physicians PA', 'Peter', 'J', 'Angleton', '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', '          ', 'IDSINCLAIRL', '', '', '0.00', '15.00', '0.00', 3, '2011-01-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', 'West Valley Medical Center', NULL, NULL, 'HCFA|UB|', '1821042334', 0, 'Y', 0, '2012-01-06', NULL, NULL, 0, 0, NULL, NULL),
('820312175', 'SACN01528', 'SACN01528', 'SACN', 'Idaho Emergency Physicians PA', 'Peter', 'J', 'Angleton', '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', 'IDSINCLAIRL', NULL, NULL, '0.00', '15.00', '0.00', 3, '2011-01-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', 'West Valley Medical Center', NULL, NULL, 'HCFA|UB|', '1821042334', 0, 'n', 0, '2012-01-06', NULL, NULL, 43.6892, -116.351, NULL, NULL),
('820200895', 'SACN01506', 'SACN01506', 'SACN', 'Saint Alphonsus Medical Group EHP Family Medicine', 'Naya', 'N', 'Antink', 'MD', 'Pediatrics', '', '', NULL, 'O', '323 E Riverside Dr Ste 224', 'Eagle', 'Ada', 'ID', '83616', '2083675750', '2083675765', '323 E Riverside Dr Ste 224', 'Eagle', 'Ada', 'ID', '83616', '2083675750', '2083675765', 'IDSINCLAIRL', '', '', '0.00', '15.00', '0.00', 6, '2011-01-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|', '1811942816', 0, 'Y', 0, '2013-06-10', NULL, NULL, 43.6892, -116.351, NULL, NULL),
('820200895', 'SACN01507', 'SACN01507', 'SACN', 'Saint Alphonsus Medical GroupCurtisian Internal Medicine Moreau Bldg ', 'Naya', 'N', 'Antink', 'MD', 'Pediatrics', '', '', NULL, 'O', '6140 Curtisian Ste 300', 'Boise', 'Ada', 'ID', '83704', '2083676575', '2083676597', '6140 Curtisian Ste 300', 'Boise', 'Ada', 'ID', '83704', '2083676575', '2083676597', 'IDSINCLAIRL', '', '', '0.00', '15.00', '0.00', 6, '2011-01-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|', '1811942816', 0, 'Y', 0, '2013-06-10', NULL, NULL, 43.615, -116.256, NULL, NULL),
('820200895', 'SACN01508', 'SACN01508', 'SACN', 'Saint Alphonsus Medical Group Boise Pediatrics', 'Naya', 'N', 'Antink', 'MD', 'Pediatrics', '', '', NULL, 'O', '999 N Curtis Ste 407', 'Boise', 'Ada', 'ID', '83706', '2083674321', '2083674525', '999 N Curtis Ste 407', 'Boise', 'Ada', 'ID', '83706', '2083674321', '2083674525', 'IDSINCLAIRL', '', '', '0.00', '15.00', '0.00', 6, '2011-01-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|', '1811942816', 0, 'N', 0, '2013-06-10', NULL, NULL, 43.6132, -116.255, NULL, NULL),
('820477852', 'SACN01509', 'SACN01509', 'SACN', 'Saint Alphonsus Medical Group Eagle Health Plaza', 'Naya', 'N', 'Antink', 'MD', 'Pediatrics', '', '', NULL, 'B', '323 E Riverside Dr Ste 224', 'Eagle', 'Ada', 'ID', '83616', '2083675750', '2083675765', '323 E Riverside Dr Ste 224', 'Eagle', 'Ada', 'ID', '83616', '2083675750', '2083675765', 'IDSINCLAIRL', NULL, NULL, '0.00', '15.00', '0.00', 6, '2011-01-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1811942816', 0, 'Y', 0, '2013-06-10', NULL, NULL, 43.6892, -116.351, NULL, NULL),
('820477852', 'SACN01510', 'SACN01510', 'SACN', 'Saint Alphonsus Medical Group Internal Medicine', 'Naya', 'N', 'Antink', 'MD', 'Pediatrics', '', '', NULL, 'O', '6140 Curtisian Ste 300', 'Boise', 'Ada', 'ID', '83704', '2083676575', '2083675765', '6140 Curtisian Ste 300', 'Boise', 'Ada', 'ID', '83704', '2083676575', '2083675765', 'IDSINCLAIRL', NULL, NULL, '0.00', '15.00', '0.00', 6, '2011-01-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1811942816', 0, 'Y', 0, '2013-06-10', NULL, NULL, 43.615, -116.256, NULL, NULL),
('820477852', 'SACN01511', 'SACN01511', 'SACN', 'Saint Alphonsus Medical Group Pediatrics', 'Naya', 'N', 'Antink', 'MD', 'Pediatrics', '', '', NULL, 'o', '999 N Curtis Ste 407', 'Boise', 'Ada', 'ID', '83706', '2083674321', '2083674525', '999 N Curtis Ste 407', 'Boise', 'Ada', 'ID', '83706', '2083674321', '2083674525', 'IDSINCLAIRL', NULL, NULL, '0.00', '15.00', '0.00', 6, '2011-01-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1811942816', 0, 'n', 0, '2013-06-10', NULL, NULL, 43.6132, -116.255, NULL, NULL),
('820496280', 'SACN00572', 'SACN00572', 'SACN', 'Dermatology Clinic of ID', 'Alexander', 'J', 'Arhets', 'PA', 'Dermatology', '', '', NULL, 'O', '271 Duffers Ln', 'Cascade', 'Valley', 'ID', '83611', '2083764777', NULL, '271 Duffers Ln', 'Cascade', 'Valley', 'ID', '83611', '2083764777', '          ', 'IDSINCLAIRL', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2011-01-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1013956853', 0, 'N', 0, '2013-07-02', NULL, NULL, 44.5085, -116.058, NULL, NULL),
('820496280', 'SACN00573', 'SACN00573', 'SACN', 'Dermatology Clinic of ID', 'Alexander', 'J', 'Arhets', 'PA', 'Dermatology', '', '', NULL, 'O', '661 S Rivershore Ln Ste 130', 'Eagle', 'Ada', 'ID', '83616', '2089394599', NULL, '661 S Rivershore Ln Ste 130', 'Eagle', 'Ada', 'ID', '83616', '2089394599', '          ', 'IDSINCLAIRL', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2011-01-01', '2014-05-05', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1013956853', 0, 'N', 0, '2014-03-12', NULL, NULL, 43.6886, -116.356, NULL, NULL),
('820496280', 'SACN00574', 'SACN00574', 'SACN', 'Dermatology Clinic of ID', 'Alexander', 'J', 'Arhets', 'PA', 'Dermatology', '', '', NULL, 'O', '7733 W Emerald', 'Boise', 'Ada', 'ID', '83704', '2083764776', NULL, '7733 W Emerald', 'Boise', 'Ada', 'ID', '83704', '2083764776', '', 'IDSINCLAIRL', 'WUSTDHCPC5', NULL, '0.00', '15.00', '0.00', 3, '2011-01-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1013956853', 0, 'n', 0, '2012-05-04', NULL, NULL, 43.6127, -116.278, NULL, NULL),
('820425454', 'SACN00012', 'SACN00012', 'SACN', 'Boise Anesthesia, PA', 'Marilyn', 'S', 'Armayor', 'CRNA', 'Nurse Anesthetist', '', '', NULL, 'o', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083676416', '2083759530', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083676416', '2083759530', '', '', '', '58.45', '10.00', '0.00', 3, '2011-01-01', NULL, 1, 15, 0, '', '', '', '', 'HCFA|UB|', '1124079785', 0, 'N', 0, '2012-10-29', NULL, NULL, 43.6127, -116.254, NULL, NULL),
('820425454', 'SACN00013', 'SACN00013', 'SACN', 'Boise Anesthesia, PA', 'Marilyn', 'S', 'Armayor', 'CRNA', 'Nurse Anesthetist', '', '', NULL, 'o', '1717 Arlington Ave', 'Caldwell', 'Canyon', 'ID', '83605', '2084594641', NULL, '1717 Arlington Ave', 'Caldwell', 'Canyon', 'ID', '83605', '2084594641', '0         ', '', '', '', '58.45', '10.00', '0.00', 3, '2011-01-01', NULL, 1, 15, 0, '', '', '', '', 'HCFA|UB|', '1124079785', 0, 'N', 0, '2012-10-29', NULL, NULL, 0, 0, NULL, NULL),
('201328487', 'SACN00651', 'SACN00651', 'SACN', 'Advance Family Medicine', 'Molly', 'B', 'Armijo', 'MD', 'Family Practice', '', '', NULL, 'O', '943 N Linder Rd Ste 103', 'Kuna', 'Ada', 'ID', '83634', '2089223355', '6785531263', '943 N Linder Rd Ste 103', 'Kuna', 'Ada', 'ID', '83634', '2089223355', '6785531263', 'IDSINCLAIRL', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2011-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1093750200', 0, 'N', 0, '2013-12-03', NULL, NULL, 43.4974, -116.414, NULL, NULL),
('200324983', 'SACN01002', 'SACN01002', 'SACN', 'Idaho Sports Medicine Institute', 'Jay', 'R', 'Armstrong', 'PT', 'Physical Therapy', NULL, NULL, NULL, 'O', '1188 University Dr', 'Boise', 'Ada', 'ID', '83706', '2083368250', '2083459514', '1188 University Dr', 'Boise', 'Ada', 'ID', '83706', '2083368250', '2083459514', 'IDSINCLAIRL', NULL, NULL, '0.00', '15.00', '0.00', 3, '2011-01-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1447256086', 0, 'N', 0, '2012-08-06', NULL, NULL, 43.601, -116.196, NULL, NULL),
('460500210', 'SACN00548', 'SACN00548', 'SACN', 'Saint Alphonsus Oncology Physician Services', 'Laura', 'L', 'Asaro', 'NP-C', 'Oncology', 'Hematology and Oncology', 'Orthopedic Surgery', NULL, 'B', '1055 N Curtis', 'Boise', 'Ada', 'ID', '83706', '2083673627', '2083673174', '1055 N Curtis', 'Boise', 'Ada', 'ID', '83706', '2083673627', '2083673174', 'IDSINCLAIRL', '', '', '0.00', '15.00', '0.00', 6, '2011-01-01', '2013-04-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1003916636', 0, 'Y', 0, '2014-05-28', NULL, NULL, 43.6127, -116.254, NULL, NULL),
('460500210', 'SACN00549', 'SACN00549', 'SACN', 'Saint Alphonsus Oncology Physician Services', 'Laura', 'L', 'Asaro', 'NP-C', 'Oncology', 'Hematology and Oncology', 'Orthopedic Surgery', NULL, 'B', '1202 E Locust', 'Emmett', 'Gem', 'ID', '83617', '2083653561', '0         ', '1202 E Locust', 'Emmett', 'Gem', 'ID', '83617', '2083653561', '0         ', 'IDSINCLAIRL', '', '', '0.00', '15.00', '0.00', 6, '2011-01-01', '2013-04-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1003916636', 0, 'Y', 0, '2014-05-28', NULL, NULL, 43.8791, -116.485, NULL, NULL),
('460500210', 'SACN00550', 'SACN00550', 'SACN', 'Saint Alphonsus Oncology Physician Services', 'Laura', 'L', 'Asaro', 'NP-C', 'Oncology', 'Hematology and Oncology', 'Orthopedic Surgery', NULL, 'B', '3123 Medical Dr', 'Caldwell', 'Canyon', 'ID', '83605', '2083674810', '0         ', '3123 Medical Dr', 'Caldwell', 'Canyon', 'ID', '83605', '2083674810', '0         ', 'IDSINCLAIRL', '', '', '0.00', '15.00', '0.00', 6, '2011-01-01', '2013-04-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1003916636', 0, 'Y', 0, '2014-05-28', NULL, NULL, 43.6596, -116.658, NULL, NULL),
('820312175', 'SACN01144', 'SACN01144', 'SACN', 'Idaho Emergency Physicians PA', 'Hansel', '', 'Ashby', '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', 'IDSINCLAIRL', NULL, NULL, '0.00', '15.00', '0.00', 3, '2011-01-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', 'West Valley Medical Center', NULL, NULL, 'HCFA|UB|', '1548213457', 0, 'n', 0, '2012-01-30', NULL, NULL, 43.6136, -116.256, NULL, NULL),
('820312175', 'SACN01145', 'SACN01145', 'SACN', 'Idaho Emergency Physicians PA', 'Hansel', '', 'Ashby', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '1717 Arlington', 'Caldwell', 'Canyon', 'ID', '83605', '2083221730', '2083221731', '1717 Arlington', 'Caldwell', 'Canyon', 'ID', '83605', '2083221730', '2083221731', 'IDSINCLAIRL', NULL, NULL, '0.00', '15.00', '0.00', 3, '2011-01-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', 'West Valley Medical Center', NULL, NULL, 'HCFA|UB|', '1548213457', 0, 'N', 0, '2012-01-30', NULL, NULL, 0, 0, NULL, NULL),
('820312175', 'SACN01146', 'SACN01146', 'SACN', 'Idaho Emergency Physicians PA', 'Hansel', '', 'Ashby', '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', '          ', 'IDSINCLAIRL', '', '', '0.00', '15.00', '0.00', 3, '2011-01-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', 'West Valley Medical Center', NULL, NULL, 'HCFA|UB|', '1548213457', 0, 'Y', 0, '2012-01-30', NULL, NULL, 0, 0, NULL, NULL),
('820312175', 'SACN01147', 'SACN01147', 'SACN', 'Idaho Emergency Physicians PA', 'Hansel', '', 'Ashby', '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', 'IDSINCLAIRL', NULL, NULL, '0.00', '15.00', '0.00', 3, '2011-01-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', 'West Valley Medical Center', NULL, NULL, 'HCFA|UB|', '1548213457', 0, 'n', 0, '2012-01-30', NULL, NULL, 43.6892, -116.351, NULL, NULL),
('820478504', 'SACN00934', 'SACN00934', 'SACN', 'Personal Solutions', 'Irma', 'C', 'Atkinson', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '2596 N Stokesberry Pl Ste 100', 'Meridian', 'Ada', 'ID', '83646', '2089383837', NULL, '2596 N Stokesberry Pl Ste 100', 'Meridian', 'Ada', 'ID', '83646', '2089383837', '          ', 'IDSINCLAIRL', '', '', '0.00', '15.00', '0.00', 3, '2011-01-01', '2010-07-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1396706396', 0, 'N', 0, '2012-11-01', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'SACN01571', 'SACN01571', 'SACN', 'Saint Alphonsus Medical Group Elm Family Medicine', 'David', 'G', 'Babbel', 'DO', 'Pediatrics', '', '', NULL, 'O', '315 E Elm St Ste 100', 'Caldwell', 'Canyon', 'ID', '83605', '2084597415', '2084533307', '315 E Elm St Ste 100', 'Caldwell', 'Canyon', 'ID', '83605', '2084597415', '2084533307', 'IDSINCLAIRL', '', '', '0.00', '15.00', '0.00', 6, '2011-01-01', NULL, 0, 0, 0, 'West Valley Medical Center', '', '', '', 'HCFA|', '1861434961', 0, 'N', 0, '2014-06-20', NULL, NULL, 43.6539, -116.695, NULL, NULL),
('820477852', 'SACN01572', 'SACN01572', 'SACN', 'Saint Alphonsus Medical Group Elm Family Medicine', 'David', 'G', 'Babbel', 'DO', 'Pediatrics', '', '', NULL, 'o', '315 E Elm St Ste 100', 'Caldwell', 'Canyon', 'ID', '83605', '2084597415', '2084545113', '315 E Elm St Ste 100', 'Caldwell', 'Canyon', 'ID', '83605', '2084597415', '2084545113', 'IDSINCLAIRL', '', '', '0.00', '15.00', '0.00', 6, '2011-01-01', NULL, 0, 0, 0, 'West Valley Medical Center', '', '', '', 'HCFA|UB|', '1861434961', 0, 'N', 0, '2014-06-20', NULL, NULL, 43.6539, -116.695, NULL, NULL),
('260553931', 'SACN00264', 'SACN00264', 'SACN', 'Saint Alphonsus Medical Group Heart Care Ketchum', 'Frederick', 'E', 'Badke', 'MD', 'Cardiology', '', '', NULL, 'O', '100 Hospital Dr', 'Ketchum', 'Blaine', 'ID', '83340', '2083674278', NULL, '100 Hospital Dr', 'Ketchum', 'Blaine', 'ID', '83340', '2083674278', '', 'IDSINCLAIRL', '', '', '0.00', '15.00', '0.00', 6, '2011-01-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1407814411', 0, 'Y', 0, '2014-06-11', NULL, NULL, 43.6485, -114.35, NULL, NULL);
