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
('522229954', 'W11020126', 'W11020126', 'UT01', 'Aspen Ridge Physical Therapy', 'Rick', NULL, 'Bowser', 'PT', 'Physical Therapy', '', '', NULL, 'O', '2121 N 1700 W Ste A', 'Layton', 'Davis', 'UT', '84041', '8017731350', '8017731351', NULL, NULL, 'Davis', NULL, NULL, NULL, NULL, 'WestRehab', 'WUSTDHCPC5', NULL, '0.00', '0.00', '65.00', 3, '2009-09-01', '2009-10-31', NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1386748846', 0, 'N', 0, '2009-11-30', NULL, NULL, 0, 0, NULL, NULL),
('522229954', 'W11020127', 'W11020127', 'UT01', 'Aspen Ridge Physical Therapy', 'David', '', 'Meads', 'PT', 'Physical Therapy', NULL, NULL, NULL, 'O', '2121 N 1700 W Ste A', 'Layton', 'Davis', 'UT', '84041', '8017731350', '8017731351', '2121 N 1700 W Ste A', 'Layton', 'Davis', 'UT', '84041', '8017731350', '8017731351', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '65.00', 3, '2009-09-01', '2009-10-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1942304589', 0, 'N', 0, '2011-04-19', NULL, NULL, 0, 0, NULL, NULL),
('522229954', 'W11020128', 'W11020128', 'UT01', 'Mountain Top Physical Therapy', 'Stacy', '', 'McCooey', 'DPT', 'Physical Therapy', '', '', NULL, 'O', '2080 Gold Dust Lane', 'Park City', 'Summit', 'UT', '84068', '4355751345', '4356470464', '2080 Gold Dust Lane', 'Park City', 'Summit', 'UT', '84068', '4355751345', '4356470464', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '65.00', 3, '2009-09-01', '2009-10-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1841393295', 0, 'N', 0, '2012-08-03', NULL, NULL, 0, 0, NULL, NULL),
('522229954', 'W11020129', 'W11020129', 'ID02', 'Mountain Land Nampa', 'Ryan', '', 'Myhre', 'DPT', 'Physical Therapy', '', '', NULL, 'O', '5251 E Exchange Way', 'Nampa', 'Canyon', 'ID', '83687', '2084669642', '2084669104', '5251 E Exchange Way', 'Nampa', 'Canyon', 'ID', '83687', '2084669642', '2084669104', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '65.00', 3, '2009-10-01', '2009-10-31', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1851494637', 0, 'N', 0, '2011-04-20', NULL, NULL, 0, 0, NULL, NULL),
('522229954', 'W11020130', 'W11020130', 'UT01', 'Hand & Orthopedic Rehabilitation Specialists', 'Seth', 'M', 'Riley', 'DPT', 'Physical Therapy', NULL, NULL, NULL, 'O', '5151 S 900 E', 'Murray', 'Salt Lake', 'UT', '84117', '8012613321', '8019425955', '5151 S 900 E', 'Murray', 'Salt Lake', 'UT', '84117', '8012613321', '8019425955', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '65.00', 3, '2009-09-01', '2009-10-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1427033109', 0, 'N', 0, '2011-11-29', NULL, NULL, 0, 0, NULL, NULL),
('522229954', 'W11020131', 'W11020131', 'UT01', 'Mountain Land Rehabilitation Home', 'David', 'D', 'Woodbury', 'PT', 'Physical Therapy', '', '', NULL, 'O', '736 S 900 E Ste B101', 'St George', 'Washington', 'UT', '84790', '4358678871', '8019425955', '736 S 900 E Ste B101', 'St George', 'Washington', 'UT', '84790', '4358678871', '8019425955', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '65.00', 3, '2008-08-27', '2009-10-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1407942253', 0, 'N', 0, '2011-10-26', NULL, NULL, 0, 0, NULL, NULL),
('522229954', 'W11020132', 'W11020132', 'UT01', 'Rocky Mountain Therapy Services @ First Med', 'Traivs', NULL, 'Booth', 'MPT', 'Physical Therapy', NULL, NULL, NULL, 'O', '8822 S Redwood Rd Ste E122', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015667080', '8012561133', NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, 'WestRehab', 'WUSTDHCPC5', NULL, '0.00', '0.00', '65.00', 3, '2009-06-01', '2009-10-31', NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0122229954', 0, 'N', 0, '2009-09-22', NULL, NULL, 0, 0, NULL, NULL),
('522229954', 'W11020133', 'W11020133', 'UT01', 'Mountain Land Rehabilitation Home', 'Kimberly', 'Ann', 'Hoth', 'MPT', 'Physical Therapy', NULL, NULL, NULL, 'O', '2055 N Main St', 'Tooele', 'Tooele', 'UT', '84074', '8019423311', '8019425955', '2055 N Main St', 'Tooele', 'Tooele', 'UT', '84074', '8019423311', '8019425955', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '65.00', 3, '2005-01-01', '2009-10-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1790888394', 0, 'N', 0, '2013-06-21', NULL, NULL, 0, 0, NULL, NULL),
('522229954', 'W11020134', 'W11020134', 'UT01', 'Rocky Mountain Salt Lake Industrial Clinic ', 'Ryan', NULL, 'Perron', 'MPT', 'Physical Therapy', NULL, NULL, NULL, 'O', '441 S Redwood Rd', 'Salt Lake City', 'Salt Lake', 'UT', '84104', '8019751403', '8019730391', NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, 'WestRehab', 'WUSTDHCPC5', NULL, '0.00', '0.00', '65.00', 3, '2009-06-24', '2009-10-31', NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1871740514', 0, 'N', 0, '2009-09-22', NULL, NULL, 0, 0, NULL, NULL),
('522229954', 'W11020135', 'W11020135', 'UT01', 'Mountain Land Rehabilitation West Layton', 'Nylin', 'J', 'Johnson', 'PT', 'Physical Therapy', '', '', NULL, 'O', '3225 W Gordon Ave Ste 3', 'Layton', 'Davis', 'UT', '84041', '8014970800', '8019425955', '3225 W Gordon Ave Ste 3', 'Layton', 'Davis', 'UT', '84041', '8014970800', '8019425955', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '65.00', 3, '2006-12-01', '2009-10-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1013010727', 0, 'N', 0, '2013-12-06', NULL, NULL, 0, 0, NULL, NULL),
('522229954', 'W11020136', 'W11020136', 'UT01', 'Peak Physical Therapy - Human Performance', 'Von', 'O', 'Hill', 'PT', 'Physical Therapy', '', '', NULL, 'O', '12198 S Factory Outlet Dr Ste 3', 'Draper', 'Salt Lake', 'UT', '84020', '8015716600', '8015716601', '12198 S Factory Outlet Dr Ste 3', 'Draper', 'Salt Lake', 'UT', '84020', '8015716600', '8015716601', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '65.00', 3, '2009-02-24', '2009-10-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1669472684', 0, 'N', 0, '2013-06-21', NULL, NULL, 0, 0, NULL, NULL),
('522229954', 'W11020137', 'W11020137', 'UT01', 'Prorehab Physical Therapy', 'David', NULL, 'Hume', 'MPT', 'Physical Therapy', NULL, NULL, NULL, 'O', '425 S Vernal Ave', 'Vernal ', 'Uintah', 'UT', '84078', '4357811502', '4357811505', NULL, NULL, 'Uintah', NULL, NULL, NULL, NULL, 'WestRehab', 'WUSTDHCPC5', NULL, '0.00', NULL, '68.00', 3, '2000-01-01', '2000-01-01', NULL, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1184686404', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('522229954', 'W11020138', 'W11020138', 'UT01', 'Mountain Land Mendenhall', 'Michael', NULL, 'Palmieri', 'PT', 'Physical Therapy', NULL, NULL, NULL, 'O', '754 S Main Ste 4', 'St George', 'Washington', 'UT', '84770', '4356730191', '4356730192', NULL, NULL, 'Washington', NULL, NULL, NULL, NULL, 'WestRehab', 'WUSTDHCPC5', NULL, '0.00', '0.00', '68.00', 3, '2009-11-01', '2009-12-31', NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0222229954', 0, 'N', 0, '2009-09-22', NULL, NULL, 0, 0, NULL, NULL),
('522229954', 'W11020139', 'W11020139', 'UT01', 'Mountain Land South Valley', 'Benjamin', NULL, 'Gubler', 'DPT', 'Physical Therapy', '', '', NULL, 'O', '11333 S 1000 E Ste 101', 'Sandy', 'Salt Lake', 'UT', '84094', '8015713318', '8015713319', NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, 'WestRehab', 'WUSTDHCPC5', NULL, '0.00', '0.00', '68.00', 3, '2009-11-01', '2009-12-31', NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1942435730', 0, 'N', 0, '2009-11-30', NULL, NULL, 0, 0, NULL, NULL),
('522229954', 'W11020140', 'W11020140', 'UT01', 'Hand & Orthopedic Rehabilitation Specialists', 'Todd', '', 'Schwartz', 'DPT', 'Physical Therapy', '', '', NULL, 'O', '5151 S 900 E Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8012613321', '8012615942', '5151 S 900 E Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8012613321', '8012615942', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '68.00', 3, '2009-11-01', '2009-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1124291570', 0, 'N', 0, '2011-04-20', NULL, NULL, 0, 0, NULL, NULL),
('522229954', 'W11020141', 'W11020141', 'UT01', 'Aspen Ridge Physical Therapy', 'Rick', NULL, 'Bowser', 'PT', 'Physical Therapy', '', '', NULL, 'O', '2121 N 1700 W Ste A', 'Layton', 'Davis', 'UT', '84041', '8017731350', '8017731351', NULL, NULL, 'Davis', NULL, NULL, NULL, NULL, 'WestRehab', 'WUSTDHCPC5', NULL, '0.00', '0.00', '68.00', 3, '2009-11-01', '2009-12-31', NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1386748846', 0, 'N', 0, '2009-11-30', NULL, NULL, 0, 0, NULL, NULL),
('522229954', 'W11020142', 'W11020142', 'UT01', 'Aspen Ridge Physical Therapy', 'David', '', 'Meads', 'PT', 'Physical Therapy', NULL, NULL, NULL, 'O', '2121 N 1700 W Ste A', 'Layton', 'Davis', 'UT', '84041', '8017731350', '8017731351', '2121 N 1700 W Ste A', 'Layton', 'Davis', 'UT', '84041', '8017731350', '8017731351', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '68.00', 3, '2009-11-01', '2009-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1942304589', 0, 'N', 0, '2011-04-19', NULL, NULL, 0, 0, NULL, NULL),
('522229954', 'W11020143', 'W11020143', 'UT01', 'Mountain Top Physical Therapy', 'Stacy', '', 'McCooey', 'DPT', 'Physical Therapy', '', '', NULL, 'O', '2080 Gold Dust Lane', 'Park City', 'Summit', 'UT', '84068', '4355751345', '4356470464', '2080 Gold Dust Lane', 'Park City', 'Summit', 'UT', '84068', '4355751345', '4356470464', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '68.00', 3, '2009-11-01', '2009-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1841393295', 0, 'N', 0, '2012-08-03', NULL, NULL, 0, 0, NULL, NULL),
('522229954', 'W11020144', 'W11020144', 'ID02', 'Mountain Land Nampa', 'Ryan', '', 'Myhre', 'DPT', 'Physical Therapy', '', '', NULL, 'O', '5251 E Exchange Way', 'Nampa', 'Canyon', 'ID', '83687', '2084669642', '2084669104', '5251 E Exchange Way', 'Nampa', 'Canyon', 'ID', '83687', '2084669642', '2084669104', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '68.00', 3, '2009-11-01', '2009-12-31', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1851494637', 0, 'N', 0, '2011-04-20', NULL, NULL, 0, 0, NULL, NULL),
('522229954', 'W11020145', 'W11020145', 'UT01', 'Hand & Orthopedic Rehabilitation Specialists', 'Seth', 'M', 'Riley', 'DPT', 'Physical Therapy', NULL, NULL, NULL, 'O', '5151 S 900 E', 'Murray', 'Salt Lake', 'UT', '84117', '8012613321', '8019425955', '5151 S 900 E', 'Murray', 'Salt Lake', 'UT', '84117', '8012613321', '8019425955', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '68.00', 3, '2009-11-01', '2009-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1427033109', 0, 'N', 0, '2011-11-29', NULL, NULL, 0, 0, NULL, NULL),
('522229954', 'W11020146', 'W11020146', 'UT01', 'Mountain Land Rehabilitation Home', 'David', 'D', 'Woodbury', 'PT', 'Physical Therapy', '', '', NULL, 'O', '736 S 900 E Ste B101', 'St George', 'Washington', 'UT', '84790', '4358678871', '8019425955', '736 S 900 E Ste B101', 'St George', 'Washington', 'UT', '84790', '4358678871', '8019425955', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '68.00', 3, '2009-11-01', '2009-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1407942253', 0, 'N', 0, '2011-10-26', NULL, NULL, 0, 0, NULL, NULL),
('522229954', 'W11020147', 'W11020147', 'UT01', 'Rocky Mountain Therapy Services @ First Med', 'Traivs', NULL, 'Booth', 'MPT', 'Physical Therapy', NULL, NULL, NULL, 'O', '8822 S Redwood Rd Ste E122', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015667080', '8012561133', NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, 'WestRehab', 'WUSTDHCPC5', NULL, '0.00', '0.00', '68.00', 3, '2009-11-01', '2009-12-31', NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0122229954', 0, 'N', 0, '2009-09-22', NULL, NULL, 0, 0, NULL, NULL),
('522229954', 'W11020148', 'W11020148', 'UT01', 'Mountain Land Rehabilitation Home', 'Kimberly', 'Ann', 'Hoth', 'MPT', 'Physical Therapy', NULL, NULL, NULL, 'O', '2055 N Main St', 'Tooele', 'Tooele', 'UT', '84074', '8019423311', '8019425955', '2055 N Main St', 'Tooele', 'Tooele', 'UT', '84074', '8019423311', '8019425955', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '68.00', 3, '2009-11-01', '2009-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1790888394', 0, 'N', 0, '2013-06-21', NULL, NULL, 0, 0, NULL, NULL),
('522229954', 'W11020149', 'W11020149', 'UT01', 'Rocky Mountain Salt Lake Industrial Clinic ', 'Ryan', NULL, 'Perron', 'MPT', 'Physical Therapy', NULL, NULL, NULL, 'O', '441 S Redwood Rd', 'Salt Lake City', 'Salt Lake', 'UT', '84104', '8019751403', '8019730391', NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, 'WestRehab', 'WUSTDHCPC5', NULL, '0.00', '0.00', '68.00', 3, '2009-11-01', '2009-12-31', NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1871740514', 0, 'N', 0, '2009-09-22', NULL, NULL, 0, 0, NULL, NULL),
('522229954', 'W11020150', 'W11020150', 'UT01', 'Mountain Land Rehabilitation West Layton', 'Nylin', 'J', 'Johnson', 'PT', 'Physical Therapy', '', '', NULL, 'O', '3225 W Gordon Ave Ste 3', 'Layton', 'Davis', 'UT', '84041', '8014970800', '8019425955', '3225 W Gordon Ave Ste 3', 'Layton', 'Davis', 'UT', '84041', '8014970800', '8019425955', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '68.00', 3, '2009-11-01', '2009-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1013010727', 0, 'N', 0, '2013-12-06', NULL, NULL, 0, 0, NULL, NULL),
('522229954', 'W11020151', 'W11020151', 'UT01', 'Peak Physical Therapy - Human Performance', 'Von', 'O', 'Hill', 'PT', 'Physical Therapy', NULL, NULL, NULL, 'O', '12198 S Factory Outlet Dr Ste 3', 'Draper', 'Salt Lake', 'UT', '84020', '8015716600', '8015716601', NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, 'WestRehab', 'WUSTDHCPC5', NULL, '0.00', NULL, '68.00', 3, '2000-01-01', '2000-01-01', NULL, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1669472684', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('820477852', 'W11020152', 'W11020152', 'ID01', 'Saint Alphonsus Medical Group Emerald Family Medicine', 'John', 'C', 'Brosa', 'MD', 'Family Practice', '', '', NULL, 'O', '6533 Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083674170', '2083674765', '6533 Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083674170', '2083674765', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2009-09-15', '2012-03-29', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1275559080', 0, 'N', 0, '2014-01-23', NULL, NULL, 43.6119, -116.268, NULL, NULL),
('820477852', 'W11020153', 'W11020153', 'ID01', 'Saint Alphonsus Medical Group Cherry Lane', 'John', 'C', 'Brosa', 'MD', 'Family Practice', '', '', NULL, 'O', '3025 W Cherry Ln Ste B', 'Meridian', 'Ada', 'ID', '83642', '2083678550', '2083674765', '3025 W Cherry Ln Ste B', 'Meridian', 'Ada', 'ID', '83642', '2083678550', '2083674765', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2009-09-15', '2012-03-29', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1275559080', 0, 'N', 0, '2013-02-28', NULL, NULL, 43.6188, -116.431, NULL, NULL),
('331078261', 'W11020156', 'W11020156', 'ID01', 'Saint Alphonsus Coughlin Clinic', 'Michael', 'J', 'Coughlin', 'MD; Foot/Ankle', 'Orthopedic Surgery', '', '', NULL, 'O', '901 N Curtis Rd Ste 503', 'Boise', 'Ada', 'ID', '83706', '2083673330', '2083673331', '901 N Curtis Rd Ste 503', 'Boise', 'Ada', 'ID', '83706', '2083673330', '2083673331', 'IDSAMG1', NULL, '', '0.00', '10.00', '0.00', 3, '2009-08-18', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1023010824', 0, 'N', 0, '2014-07-09', NULL, NULL, 43.6126, -116.255, NULL, NULL),
('820477852', 'W11020154', 'W11020154', 'ID01', 'Saint Alphonsus Medical Group Garrity', 'John', 'C', 'Brosa', 'MD', 'Family Practice', '', '', NULL, 'O', '1200 Garrity Blvd', 'Nampa', 'Canyon', 'ID', '83687', '2084669092', '2083674765', '1200 Garrity Blvd', 'Nampa', 'Canyon', 'ID', '83687', '2084669092', '2083674765', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2009-09-15', '2012-03-29', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1275559080', 0, 'N', 0, '2013-02-28', NULL, NULL, 43.587, -116.549, NULL, NULL),
('820477852', 'W11020155', 'W11020155', 'ID01', 'Saint Alphonsus Medical Group Elm Family Medicine', 'John', 'C', 'Brosa', 'MD', 'Family Practice', '', '', NULL, 'O', '315 E Elm St Ste 100', 'Caldwell', 'Canyon', 'ID', '83605', '2084597415', '2083674765', '315 E Elm St Ste 100', 'Caldwell', 'Canyon', 'ID', '83605', '2084597415', '2083674765', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2009-09-15', '2012-03-29', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1275559080', 0, 'N', 0, '2014-01-23', NULL, NULL, 43.6539, -116.695, NULL, NULL),
('331078261', 'W11020157', 'W11020157', 'ID01', 'Saint Alphonsus Coughlin Clinic', 'Michael', 'J', 'Coughlin', 'MD; Foot/Ankle', 'Orthopedic Surgery', '', '', NULL, 'O', '100 Hospital Dr Ste 107', 'Ketchum', 'Blaine', 'ID', '83340', '2083673330', '2083673331', '100 Hospital Dr Ste 107', 'Ketchum', 'Blaine', 'ID', '83340', '2083673330', '2083673331', 'IDSAMG1', NULL, '', '0.00', '10.00', '0.00', 3, '2009-08-18', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1023010824', 0, 'N', 0, '2014-07-09', NULL, NULL, 43.6485, -114.35, NULL, NULL),
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('954893928', 'W11020196', 'W11020196', 'UT01', 'Exodus Healthcare Network', 'Juanita', '', 'Allen', 'APRN', 'Family Practice', '', '', NULL, 'O', '3336 S Pioneer Parkway Ste 201', 'West Valley', 'Salt Lake', 'UT', '84120', '8012509638', '          ', '3336 S Pioneer Parkway Ste 201', 'West Valley', 'Salt Lake', 'UT', '84120', '8012509638', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-09-15', '2014-05-30', 0, 0, 0, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1821125295', 0, 'N', 0, '2014-05-30', NULL, NULL, 40.6991, -111.99, NULL, NULL),
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('870479370', 'W11020198', 'W11020198', 'UT01', 'Mountain West Cardiovascular Associates', 'Kelly', 'R', 'O Neal', 'MD', 'Cardiovascular Disease', 'Internal Medicine', '', NULL, 'O', '5169 S Cottonwood Dr Ste B620', 'Murray', 'Salt Lake', 'UT', '84157', '8015078600', NULL, '5169 S Cottonwood Dr Ste B620', 'Murray', 'Salt Lake', 'UT', '84157', '8015078600', '          ', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-09-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1053401240', 0, 'N', 0, '2013-12-30', NULL, NULL, 40.659, -111.894, NULL, NULL),
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('810587644', 'W11020200', 'W11020200', 'UT01', 'Bear Lake Community Health Center', 'Brian', '', 'Jensen', 'PSYD', 'Psychology', '', '', NULL, 'O', '325 W Logan Hwy', 'Garden City', 'Rich', 'UT', '84028', '4359463660', NULL, '325 W Logan Hwy', 'Garden City', 'Rich', 'UT', '84028', '4359463660', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-09-15', '2014-01-15', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1518138049', 0, 'N', 0, '2014-03-11', NULL, NULL, 41.9363, -111.394, NULL, NULL),
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('820529971', 'W11020207', 'W11020207', 'ID02', 'Childrens Therapy Place Inc', 'Kimberly', 'A', 'Barbee', 'DPT', 'Physical Therapy', '', '', NULL, 'O', '6855 W Fairview Ave Ste 120', 'Boise', 'Ada', 'ID', '83704', '2083238888', NULL, '6855 W Fairview Ave Ste 120', 'Boise', 'Ada', 'ID', '83704', '2083238888', '          ', 'WestRehab', '', '', '0.00', '0.00', '65.00', 3, '2009-09-15', '2010-01-01', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1780814483', 0, 'N', 0, '2012-04-26', NULL, NULL, 0, 0, NULL, NULL),
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('202148889', 'W11020209', 'W11020209', 'TX01', 'Health Texas Medical Group of San Antonio', 'John', 'H', 'Choe', 'MD', 'Family Practice', '', '', NULL, 'B', '624 W Sunset Blvd', 'San Antonio', 'Bexar', 'TX', '78216', '2108282531', NULL, '624 W Sunset Blvd', 'San Antonio', 'Bexar', 'TX', '78216', '2108282531', '          ', 'TXINT', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2009-09-15', '2011-09-12', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1588614416', 0, 'Y', 0, '2011-09-09', NULL, NULL, 29.5077, -98.4807, NULL, NULL),
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('202630141', 'W11020214', 'W11020214', 'ID02', 'Primary Health Medical Group', 'John', 'P', 'Mullins', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 191050', 'Boise', 'Ada', 'ID', '83719', '2084666567', NULL, 'PO Box 191050', 'Boise', 'Ada', 'ID', '83719', '2084666567', '', 'IDSTDPPO', 'WUSTDHCPC5', NULL, '0.00', '30.00', '0.00', 3, '2009-09-15', '2013-02-28', 0, 0, 1, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1558307280', 0, 'Y', 0, '2013-02-28', NULL, NULL, 0, 0, NULL, NULL),
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('202148889', 'W11020216', 'W11020216', 'TX01', 'Health Texas Medical Group of San Antonio', 'Robert', 'G', 'Jakubowski', 'MD', 'Internal Medicine', '', '', NULL, 'O', '8542 Wurzbach Rd', 'San Antonio', 'Bexar', 'TX', '78240', '2106167300', NULL, '8542 Wurzbach Rd', 'San Antonio', 'Bexar', 'TX', '78240', '2106167300', '', 'TXINT', 'TXHCPCS', NULL, '0.00', '50.00', '0.00', 3, '2009-09-15', '2012-08-19', 0, 0, 0, 'St Lukes Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1786654475', 0, 'N', 0, '2013-09-11', NULL, NULL, 29.5212, -98.5714, NULL, NULL),
('202148889', 'W11020217', 'W11020217', 'TX01', 'Health Texas Medical Group of San Antonio', 'Robert', 'G', 'Jakubowski', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 100026', 'San Antonio', 'Bexar', 'TX', '78201', '2106167300', NULL, 'PO Box 100026', 'San Antonio', 'Bexar', 'TX', '78201', '2106167300', '', 'TXINT', 'TXHCPCS', NULL, '0.00', '50.00', '0.00', 3, '2009-09-15', '2012-08-19', 0, 0, 0, 'St Lukes Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1786654475', 0, 'y', 0, '2013-09-11', 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
('202148889', 'W11020218', 'W11020218', 'TX01', 'Health Texas Medical Group of San Antonio', 'Terry', '', 'Grover', 'DO', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 10006', 'San Antonio', 'Bexar', 'TX', '78201', '8302493800', NULL, 'PO Box 10006', 'San Antonio', 'Bexar', 'TX', '78201', '8302493800', '', 'TXINT', 'TXHCPCS', NULL, '0.00', '50.00', '0.00', 3, '2009-09-15', '2012-08-19', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1548263759', 0, 'y', 0, '2013-07-11', NULL, NULL, 0, 0, NULL, NULL),
('202148889', 'W11020219', 'W11020219', 'TX01', 'Health Texas Medical Group of San Antonio', 'Terry', '', 'Grover', 'DO', 'Internal Medicine', '', '', NULL, 'O', '105 Falls Ct Ste 100', 'Boerne', 'Kendall', 'TX', '78006', '8302493800', NULL, '105 Falls Ct Ste 100', 'Boerne', 'Kendall', 'TX', '78006', '8302493800', '', 'TXINT', 'TXHCPCS', NULL, '0.00', '50.00', '0.00', 3, '2009-09-15', '2012-08-19', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1548263759', 0, 'N', 0, '2013-07-11', NULL, NULL, 29.7799, -98.724, NULL, NULL),
('870632875', 'W11020220', 'W11020220', 'UTMH1', NULL, 'Stuart', 'D', 'Harper', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', 'PO Box 1077', 'Springville', 'Utah', 'UT', '84663', '8012291181', NULL, 'PO Box 1077', 'Springville', 'Utah', 'UT', '84663', '8012291181', '', 'MA', NULL, NULL, '0.00', '35.00', '0.00', 6, '2009-09-20', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1225097900', 0, 'y', 0, '2014-05-06', NULL, NULL, 0, 0, NULL, NULL),
('870632875', 'W11020221', 'W11020221', 'UTMH1', '', 'Stuart', 'D', 'Harper', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '315 S 100 E', 'Provo', 'Utah', 'UT', '84606', '8012291181', NULL, '315 S 100 E', 'Provo', 'Utah', 'UT', '84606', '8012291181', '', 'MA', '', '', '0.00', '35.00', '0.00', 6, '2009-09-20', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1225097900', 1, 'N', 0, '2014-05-06', NULL, NULL, 0, 0, NULL, NULL),
('203350494', 'W11020222', 'W11020222', 'UT01', 'Oasis Family Medicine', 'Jay', 'M', 'Spector', 'MD', 'Family Practice', '', '', NULL, 'O', '196 E 2000 N Ste 100', 'Tooele', 'Tooele', 'UT', '84074', '4358330229', '4358330231', '196 E 2000 N Ste 100', 'Tooele', 'Tooele', 'UT', '84074', '4358330229', '4358330231', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-09-01', '2009-09-30', 0, 0, 0, 'Mountain West Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1386630259', 0, 'N', 0, '2013-09-13', NULL, NULL, 0, 0, NULL, NULL),
('870299862', 'W11020223', 'W11020223', 'UTMH1', 'LDS Family Services', 'Paul', 'J', 'Peterson', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'o', '94 E Pages Ln Ste A', 'Centerville', 'Davis', 'UT', '84014', '8012940578', '8013363041', '94 E Pages Ln Ste A', 'Centerville', 'Davis', 'UT', '84014', '8012940578', '8013363041', 'MA', NULL, NULL, '0.00', '35.00', '0.00', 8, '2008-09-10', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1528114667', 0, 'n', 0, '2013-09-23', NULL, NULL, 0, 0, NULL, NULL),
('836000025', 'W11020224', 'W11020224', 'WY01', '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', '25.00', '0.00', 6, '2009-10-01', '2011-01-09', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1417031311', 0, 'N', 0, '2013-04-26', NULL, NULL, 0, 0, NULL, NULL),
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('942854057', 'W11020302', 'W11020302', 'UTPEHP', 'Salt Lake Clinic', 'Bryce', 'Gardner', 'Barker', 'MD', 'Ophthalmology', NULL, NULL, NULL, 'O', '333 S 900 E', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8019336000', NULL, NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-01-01', NULL, NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1447285242', 0, 'N', 0, '2009-09-28', NULL, NULL, 0, 0, NULL, NULL),
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('876000299', 'W11020303', 'W11020303', 'UTPEHP', 'Wasatch County Health Department', NULL, NULL, 'Wasatch County Health Department', 'GROUP', 'Health Department', NULL, NULL, NULL, 'O', '55 S 500 E', 'Heber City', 'Wasatch', 'UT', '84032', '4356542700', NULL, '55 S 500 E', 'Heber City', 'Wasatch', 'UT', '84032', NULL, NULL, 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2009-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1891721577', 0, 'n', 0, '2009-09-29', NULL, NULL, 0, 0, NULL, NULL),
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('870179340', 'W11020307', 'W11020307', 'UT01', 'Standard Optical', 'Michael', 'L', 'Cohen', 'OD', 'Optometry', '', '', NULL, 'B', '1901 W Parkway Blvd', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8019649911', NULL, '1901 W Parkway Blvd', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8019649911', '          ', 'WUTALBERT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2009-10-01', '2013-09-10', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1962521468', 0, 'N', 0, '2013-09-11', NULL, NULL, 0, 0, NULL, NULL),
('262949943', 'W11020308', 'W11020308', 'WY01', 'Phoenix Rising Counseling PC', 'Leyla', 'U', 'Dim', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '1001 14th St', 'Cody', 'Park', 'WY', '82414', '3075876288', NULL, '1001 14th St', 'Cody', 'Park', 'WY', '82414', '3075876288', '          ', 'WYMA', '', '', '0.00', '35.00', '0.00', 3, '2009-10-01', '2009-10-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1568612380', 0, 'N', 0, '2010-07-16', NULL, NULL, 0, 0, NULL, NULL);
INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
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('205934739', 'W11020310', 'W11020310', 'ID02', 'Family Medicine Health Center', '', '', 'Family Medicine Health Center', 'GROUP', 'Family Practice', '', '', NULL, 'O', '777 N Raymond St', 'Boise', 'Ada', 'ID', '83704', '2085142500', NULL, '777 N Raymond St', 'Boise', 'Ada', 'ID', '83704', '2085142500', '          ', 'IDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '0000006197', 0, 'N', 0, '2013-06-18', NULL, NULL, 0, 0, NULL, NULL),
('205934739', 'W11020311', 'W11020311', 'ID02', 'Family Medicine Health Center', '', '', 'Family Medicine Health Center', 'GROUP', 'Family Practice', '', '', NULL, 'O', '121 E Fort St', 'Boise', 'Ada', 'ID', '83712', '2083811775', NULL, '121 E Fort St', 'Boise', 'Ada', 'ID', '83712', '2083811775', '          ', 'IDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '0000006197', 0, 'N', 0, '2014-02-18', NULL, NULL, 0, 0, NULL, NULL),
('205934739', 'W11020312', 'W11020312', 'ID02', 'Family Medicine Health Center', '', '', 'Family Medicine Health Center', 'GROUP', 'Family Practice', '', '', NULL, 'O', '2321 W Gala St Ste 2', 'Meridian', 'Ada', 'ID', '83642', '2085142500', NULL, '2321 W Gala St Ste 2', 'Meridian', 'Ada', 'ID', '83642', '2085142500', '          ', 'IDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2009-10-15', '2012-12-25', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '0000006197', 0, 'N', 0, '2013-06-18', NULL, NULL, 0, 0, NULL, NULL),
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('331177233', 'W11020314', 'W11020314', 'UT01', 'Ogden Internal Medicine, LLC', 'Kathleen', 'R', 'DeRemer', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 100925', 'Atlanta', 'Fulton', 'GA', '30384', '8014758600', NULL, 'PO Box 100925', 'Atlanta', 'Fulton', 'GA', '30384', '8014758600', '', 'WISESTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2009-11-01', '2010-08-31', 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1437267192', 0, 'y', 0, '2013-08-21', NULL, NULL, 0, 0, NULL, NULL),
('820328732', 'W11020315', 'W11020315', 'ID01', 'Boise Pathology Group', NULL, NULL, 'Boise Pathology Group', 'GROUP', 'Pathology', NULL, NULL, NULL, 'O', '190 E Bannock St', 'Boise', 'Ada', 'ID', '83712', '2083812367', NULL, '190 E Bannock St', 'Boise', 'Ada', 'ID', '83712', NULL, NULL, 'IDSTD', NULL, NULL, '0.00', '30.00', '0.00', 3, '2009-10-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000005345', 0, 'n', 0, '2009-09-29', NULL, NULL, 43.6119, -116.192, NULL, NULL),
('820328732', 'W11020316', 'W11020316', 'ID01', 'Boise Pathology Group', NULL, NULL, 'Boise Pathology Group', 'GROUP', 'Pathology', NULL, NULL, NULL, 'B', 'PO Box 9589', 'Boise', 'Ada', 'ID', '83712', '2083812367', NULL, '190 E Bannock St', 'Boise', 'Ada', 'ID', '83712', NULL, NULL, 'IDSTD', NULL, NULL, '0.00', '30.00', '0.00', 3, '2009-10-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000005345', 0, 'y', 0, '2009-09-29', NULL, NULL, 0, 0, NULL, NULL),
('800147425', 'W11020329', 'W11020329', 'UT01', 'Pediatric Behavioral Health', 'Kimberlee', 'M', 'Roy', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'B', 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2009-09-01', '2012-07-31', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1346314408', 0, 'N', 0, '2012-08-01', NULL, NULL, 0, 0, NULL, NULL),
('870480520', 'W11020332', 'W11020332', 'UT01', 'Dept of Neurology School of Medicine U of U', 'Michael', 'J', 'Wilder', 'MD', 'Neurology', '', '', NULL, 'B', 'PO Box 413027', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413027', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2009-09-01', '2012-08-09', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1982861191', 0, 'N', 0, '2012-08-13', NULL, NULL, 0, 0, NULL, NULL),
('518505437', 'W11020317', 'W11020317', 'UTMH1', NULL, 'Gary', 'L', 'Groom', 'PHD', 'Mental Health', 'Psychology', NULL, NULL, 'O', '1424 E Foremaster Dr', 'St George', 'Washington', 'UT', '84790', '4356568800', NULL, 'PO Box 727', 'Brigham City', 'Washington', 'UT', '84302', NULL, NULL, 'PHD', NULL, NULL, '0.00', '35.00', '0.00', 3, '2009-09-30', '2013-02-14', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1467404202', 0, 'n', 0, '2009-09-30', NULL, NULL, 0, 0, NULL, NULL),
('518505437', 'W11020318', 'W11020318', 'UTMH1', NULL, 'Gary', 'L', 'Groom', 'PHD', 'Mental Health', 'Psychology', NULL, NULL, 'B', 'PO Box 727', 'Brigham City', 'Box Elder', 'UT', '84302', '4356568800', NULL, 'PO Box 727', 'Brigham City', 'Box Elder', 'UT', '84302', NULL, NULL, 'PHD', NULL, NULL, '0.00', '35.00', '0.00', 3, '2009-09-30', '2013-02-14', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1467404202', 0, 'y', 0, '2009-09-30', NULL, NULL, 0, 0, NULL, NULL),
('820529971', 'W11020319', 'W11020319', 'ID02', 'Childrens Therapy Place', 'Kristine', 'M', 'Lefferts', 'SLP', 'Speech Therapy', '', '', NULL, 'O', '6855 W Fairview Ave Ste 120', 'Boise', 'Ada', 'ID', '83704', '2083238888', NULL, '6855 W Fairview Ave Ste 120', 'Boise', 'Ada', 'ID', '83704', '2083238888', '          ', 'WestRehab', '', '', '0.00', '0.00', '65.00', 3, '2009-10-05', '2010-10-01', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1245463892', 0, 'N', 0, '2012-04-24', NULL, NULL, 0, 0, NULL, NULL),
('493442757', 'W11020320', 'W11020320', 'UTMH1', NULL, 'Anthony', 'B', 'Hanebrink', 'LMFT', 'Mental Health', 'Marriage & Family Therapy', '', NULL, 'O', '5583 S 925 E', 'South Ogden', 'Weber', 'UT', '84405', '8017251733', NULL, '5583 S 925 E', 'South Ogden', 'Weber', 'UT', '84405', '8017251733', '', 'UTMA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2009-10-05', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1528128139', 0, 'n', 0, '2014-02-27', NULL, NULL, 0, 0, NULL, NULL),
('870632875', 'W11020321', 'W11020321', 'UTMH1', NULL, 'Jill', 'S', 'Smart', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '315 S 100 E', 'Provo', 'Utah', 'UT', '84606', '8013584082', NULL, '315 S 100 E', 'Provo', 'Utah', 'UT', '84606', '8013584082', '', 'UTMA', NULL, NULL, '0.00', '35.00', '0.00', 6, '2009-10-05', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1245436179', 0, 'N', 0, '2013-04-16', NULL, NULL, 0, 0, NULL, NULL),
('870632875', 'W11020322', 'W11020322', 'UTMH1', NULL, 'Jill', 'S', 'Smart', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', 'PO Box 1077', 'Springville', 'Utah', 'UT', '84663', '8013584082', NULL, 'PO Box 1077', 'Springville', 'Utah', 'UT', '84663', '8013584082', '', 'UTMA', NULL, NULL, '0.00', '35.00', '0.00', 6, '2009-10-05', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1245436179', 0, 'y', 0, '2013-04-16', NULL, NULL, 0, 0, NULL, NULL),
('870442845', 'W11020323', 'W11020323', 'UT01', 'U-U Hematology / Oncology Division', 'Cynthia', NULL, 'Davidson', 'APRN', 'Hematology and Oncology', 'Oncology', '', NULL, 'B', 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2009-09-02', '2012-08-27', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1265549745', 0, 'N', 0, '2012-08-28', NULL, NULL, 0, 0, NULL, NULL),
('870442845', 'W11020324', 'W11020324', 'UT01', 'University Health Care', 'Cynthia', NULL, 'Davidson', 'APRN', 'Hematology and Oncology', 'Oncology', '', NULL, 'O', '1950 Circle of Hope Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84112', '8015850100', NULL, '1950 Circle of Hope Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84112', '8015850100', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2009-09-02', '2012-08-27', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1265549745', 0, 'N', 0, '2012-08-28', NULL, NULL, 0, 0, NULL, NULL),
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('611593123', 'W11020401', 'W11020401', 'UT01', 'University Health Care', NULL, NULL, 'University Health Care', 'GROUP', 'Hematology and Oncology', NULL, NULL, NULL, 'O', '1950 Circle of Hope Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84112', '8015852626', NULL, NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, 'WUUUMG5', 'WUSTDHCPC5', NULL, '0.00', '25.00', '0.00', 3, '2009-08-01', '2009-08-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000004786', 0, 'N', 0, '2009-10-05', 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
('611593123', 'W11020403', 'W11020403', 'UT01', 'BMT Division Department of University of Utah', '', '', 'BMT Division Department of University of Utah', 'GROUP', 'Hematology and Oncology', 'Oncology', NULL, NULL, 'B', 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, 'WUUUMG5', 'WUSTDHCPC5', NULL, '0.00', '25.00', '0.00', 3, '2009-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000005340', 0, 'Y', 0, '2009-10-05', NULL, NULL, 0, 0, NULL, NULL),
('262211423', 'W11020412', 'W11020412', 'UT01', 'St George Urology', 'Dennis', '', 'Mitchell', 'PA-C', 'Urology', '', '', NULL, 'O', '1490 E Foremaster Dr Ste 300', 'St George', 'Washington', 'UT', '84790', '4356882104', '4356285308', '1490 E Foremaster Dr Ste 300', 'St George', 'Washington', 'UT', '84790', '4356882104', '4356285308', 'WiseSTD10A', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2009-01-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', '', '', '', 'HCFA|UB|', '1629005715', 0, 'N', 0, '2014-04-22', NULL, NULL, 37.0959, -113.551, NULL, NULL),
('841428630', 'W11020410', 'W11020410', 'UT01', 'Kings Medical Imaging', NULL, NULL, 'Kings Medical Imaging', 'GROUP', 'Imaging Center', 'Radiology', NULL, NULL, 'O', '2071 N Main St Ste 100', 'Layton', 'Davis', 'UT', '84041', '8018254040', NULL, 'Dept 1384', 'Denver', 'Davis', 'CO', '80256', NULL, NULL, 'WUSTDRAD5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000833920', 0, 'N', 0, '2009-10-05', NULL, NULL, 41.0906, -112.003, NULL, NULL),
('870179340', 'W11020406', 'W11020406', 'UT01', 'Standard Optical', 'Curtis', 'W', 'Millet', 'OD', 'Optometry', '', '', NULL, 'O', '4878 S Highland Dr', 'Holladay', 'Salt Lake', 'UT', '84121', '8012728861', NULL, '4878 S Highland Dr', 'Holladay', 'Salt Lake', 'UT', '84121', '8012728861', '', 'WUTALBERT5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2009-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1497844690', 0, 'N', 0, '2012-05-03', NULL, NULL, 40.6633, -111.838, NULL, NULL),
('270627913', 'W11020405', 'W11020405', 'UT01', 'Hobble Creek Med Center', NULL, NULL, 'Hobble Creek Med Center', 'GROUP', 'Clinic', '', '', NULL, 'B', 'PO Box 9117', 'Belfast', '', 'ME', '04915', '8014919883', NULL, 'PO Box 9117', 'Belfast', '', 'ME', '04915', '8014919883', '          ', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-12-01', '2010-07-14', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000006737', 0, 'N', 0, '2009-10-05', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'W11020404', 'W11020404', 'ID03', NULL, 'Jeffery', NULL, 'Olaveson', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '3854 E 300 N', 'Rigby', 'Jefferson', 'ID', '83442', '2087451109', '2083236508', '867 E 9400 S', 'Sandy', 'Jefferson', 'UT', '84094', NULL, NULL, 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', '0.00', '55.46', 3, '2009-09-30', '2010-10-31', 0, 0, 1, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000007949', 0, 'N', 0, '2009-10-05', NULL, NULL, 0, 0, NULL, NULL),
('870179340', 'W11020407', 'W11020407', 'UT01', 'Standard Optical', 'Curtis', 'W', 'Millet', 'OD', 'Optometry', '', '', NULL, 'B', '1901 W Parkway Blvd', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8012728861', NULL, '1901 W Parkway Blvd', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8012728861', '', 'WUTALBERT5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2009-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1497844690', 0, 'y', 0, '2012-05-03', NULL, NULL, 0, 0, NULL, NULL),
('870609595', 'W11020408', 'W11020408', 'UT01', 'Utah County Medical Associates', 'Gale', 'J', 'Skousen', 'MD', 'Family Practice', '', '', NULL, 'O', '97 S Professional Way Ste 2', 'Payson', 'Utah', 'UT', '84651', '8014654896', NULL, '97 S Professional Way Ste 2', 'Payson', 'Utah', 'UT', '84651', '8014654896', '          ', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-10-02', '2010-07-14', 0, 0, 0, 'Mountain View Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1053305391', 0, 'Y', 0, '2013-06-19', NULL, NULL, 0, 0, NULL, NULL),
('742768427', 'W11020409', 'W11020409', 'TX01', 'Institute for Womens Health', 'Jenatta', '', 'Freeman', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '8715 Village Dr Ste 418', 'San Antonio', 'Bexar', 'TX', '78217', '2106563040', NULL, '8715 Village Dr Ste 418', 'San Antonio', 'Bexar', 'TX', '78217', '2106563040', '', 'TXOBG', 'TXHCPCS', NULL, '0.00', '50.00', '0.00', 3, '2009-10-02', '2010-01-01', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1538102918', 0, 'N', 0, '2013-09-25', NULL, NULL, 29.5187, -98.4281, NULL, NULL),
('841428630', 'W11020411', 'W11020411', 'UT01', 'Kings Medical Imaging', 'Gary', 'L', 'Halversen', 'MD', 'Diagnostic Radiology', 'Radiology', '', NULL, 'B', 'Dept 1384', 'Denver', 'Denver', 'CO', '80256', '8012889671', NULL, 'Dept 1384', 'Denver', 'Denver', 'CO', '80256', '8012889671', '', 'WUSTDRAD5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2009-10-02', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1740286970', 0, 'Y', 0, '2013-11-14', NULL, NULL, 0, 0, NULL, NULL),
('262211423', 'W11020413', 'W11020413', 'UT01', 'St George Urology', 'Robert', 'M', 'Cope', 'MD', 'Urology', '', '', NULL, 'O', '1490 E Foremaster Dr Ste 300', 'St George', 'Washington', 'UT', '84790', '4356882104', '4356285308', '1490 E Foremaster Dr Ste 300', 'St George', 'Washington', 'UT', '84790', '4356882104', '4356285308', 'WiseSTD10A', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2009-01-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1891722245', 0, 'N', 0, '2010-09-08', NULL, NULL, 37.0959, -113.551, NULL, NULL),
('200133012', 'W11020414', 'W11020414', 'UT01', 'Lakeview OB/GYN Clinic', 'Gina', 'M', 'Muscolino', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '620 E Medical Dr Ste 340', 'Bountiful', 'Davis', 'UT', '84010', '8012992229', NULL, '620 E Medical Dr Ste 340', 'Bountiful', 'Davis', 'UT', '84010', '8012992229', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2009-10-02', '2010-08-31', 0, 0, 0, 'Lakeview Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1194825117', 0, 'N', 0, '2013-06-19', NULL, NULL, 0, 0, NULL, NULL),
('200133012', 'W11020415', 'W11020415', 'UT01', 'Lakeview OB/GYN Clinic', 'Gina', 'M', 'Muscolino', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 409836', 'Atlanta', 'Fulton', 'GA', '30384', '8012992229', NULL, 'PO Box 409836', 'Atlanta', 'Fulton', 'GA', '30384', '8012992229', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2009-10-02', '2010-08-31', 0, 0, 0, 'Lakeview Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1194825117', 0, 'y', 0, '2013-06-19', NULL, NULL, 0, 0, NULL, NULL),
('810587644', 'W11020416', 'W11020416', 'UT01', 'Cache Valley Community Health Ctr', 'Ben', '', 'Boyer', 'FNP', 'Family Practice', '', '', NULL, 'O', '550 E 1400 N Ste K', 'Logan', 'Cache', 'UT', '84341', '4357556061', NULL, '550 E 1400 N Ste K', 'Logan', 'Cache', 'UT', '84341', '4357556061', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2009-10-09', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1477703338', 0, 'N', 0, '2013-12-06', NULL, NULL, 41.7574, -111.82, NULL, NULL),
('841417752', 'W11020417', 'W11020417', 'UTMH1', 'Willow Creek Psychological Service Inc', 'Kirk', 'B', 'Thorn', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '1111 E Draper Pkwy Ste 102', 'Draper', 'Salt Lake', 'UT', '84020', '8016760333', NULL, '1111 E Draper Pkwy Ste 102', 'Draper', 'Salt Lake', 'UT', '84020', '8016760333', '', 'PHD', NULL, NULL, '0.00', '35.00', '0.00', 3, '2009-10-09', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1568478741', 0, 'n', 0, '2013-06-21', NULL, NULL, 0, 0, NULL, NULL),
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('270687506', 'W11020420', 'W11020420', 'UT01', 'Athena Womens Clinic', 'Wendy', 'A', 'Johnson', 'PMHNP-BC', 'Family Practice', 'Mental Health', 'Psychiatry', NULL, 'O', '1407 N State St Ste A', 'Orem', 'Utah', 'UT', '84057', '8012255323', NULL, '1407 N State St Ste A', 'Orem', 'Utah', 'UT', '84057', '8012255323', '          ', '', '', '', '0.00', '20.00', '0.00', 3, '2009-10-09', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1245422617', 0, 'N', 0, '2013-12-20', NULL, NULL, 40.323, -111.706, NULL, NULL),
('836000025', 'W11020421', 'W11020421', 'WY01', 'Xpress Care', 'Calvin', NULL, 'Garrison', 'PA', 'Urgent Care', NULL, NULL, NULL, 'O', '2221 W Elm St', 'Rawlins', 'Carbon', 'WY', '82301', '3073248252', NULL, '2221 W Elm St', 'Rawlins', 'Carbon', 'WY', '82301', '3073248252', '          ', '', '', 'WYURGENT', '0.00', '100.00', '0.00', 6, '2009-10-09', '2010-04-20', NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000006377', 0, 'N', 0, '2009-10-06', NULL, NULL, 0, 0, NULL, NULL),
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('270687506', 'W11020423', 'W11020423', 'UT01', 'Athena Womens Clinic', 'Sandra', '', 'Miller', 'NP', 'Gynecologic Oncology', '', '', NULL, 'O', '1407 N State St Ste A', 'Orem', 'Utah', 'UT', '84057', '8012255323', NULL, '1407 N State St Ste A', 'Orem', 'Utah', 'UT', '84057', '8012255323', '', '', '', '', '0.00', '20.00', '0.00', 3, '2009-10-09', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1699776930', 0, 'N', 0, '2014-06-23', NULL, NULL, 40.323, -111.706, NULL, NULL),
('954893928', 'W11020424', 'W11020424', 'UT01', 'Exodus Healthcare Network', 'Cecilia', 'N I', 'Ahanonu', 'MPAS', 'Family Practice', '', '', NULL, 'O', '8211 W 3500 S', 'Magna', 'Salt Lake', 'UT', '84044', '8012509638', NULL, '8211 W 3500 S', 'Magna', 'Salt Lake', 'UT', '84044', '8012509638', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-10-09', '2011-09-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1720231368', 0, 'N', 0, '2011-09-29', NULL, NULL, 0, 0, NULL, NULL),
('954893928', 'W11020425', 'W11020425', 'UT01', 'Exodus Healthcare Network', 'Cecilia', 'N I', 'Ahanonu', 'MPAS', 'Family Practice', '', '', NULL, 'O', '3336 S Pioneer Parkway Ste 201', 'West Valley', 'Salt Lake', 'UT', '84120', '8012509638', '          ', '3336 S Pioneer Parkway Ste 201', 'West Valley', 'Salt Lake', 'UT', '84120', '8012509638', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-10-09', '2014-05-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1720231368', 0, 'N', 0, '2014-05-30', NULL, NULL, 40.6991, -111.99, NULL, NULL),
('810587644', 'W11020426', 'W11020426', 'UT01', 'Rocky Mountain Dermatology', 'Heather', '', 'Allred', 'PA', 'Family Practice', '', '', NULL, 'O', '550 E 1400 N Ste K', 'Logan', 'Cache', 'UT', '84341', '4357556061', NULL, '550 E 1400 N Ste K', 'Logan', 'Cache', 'UT', '84341', '4357556061', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-10-09', '2013-06-12', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1104859149', 0, 'N', 0, '2013-06-19', NULL, NULL, 0, 0, NULL, NULL),
('743003947', 'W11020427', 'W11020427', 'TX01', 'The San Antonio Orthopaedic Group', 'Luis', 'D', 'Perez', 'PA', 'Orthopedic Surgery', '', '', NULL, 'B', 'PO Box 2516', 'San Antonio', 'Bexar', 'TX', '78299', '8004454263', NULL, 'PO Box 2516', 'San Antonio', 'Bexar', 'TX', '78299', '8004454263', '', 'TXORTHO', 'TXHCPCS', NULL, '0.00', '50.00', '0.00', 3, '2009-10-09', '2012-08-19', 0, 0, 0, 'Baptist Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1629011085', 0, 'Y', 0, '2013-06-20', NULL, NULL, 0, 0, NULL, NULL),
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('742592013', 'W11020442', 'W11020442', 'TX01', 'Dermatology Associates of San Antonio', 'Julian', 'A', 'Garcia', 'MD', 'Dermatology', '', '', NULL, 'B', '7832 Pat Booker Rd', 'San Antonio', 'Bexar', 'TX', '78233', '2104904661', NULL, '7832 Pat Booker Rd', 'San Antonio', 'Bexar', 'TX', '78233', '2104904661', '', 'TXSTD', 'TXHCPCS', NULL, '0.00', '50.00', '0.00', 3, '2009-10-09', '2012-08-19', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1790818201', 0, 'y', 0, '2013-05-23', NULL, NULL, 29.5623, -98.3334, NULL, NULL),
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('870609622', 'W11020451', 'W11020451', 'UT01', 'Snow Canyon Clinic', 'Laura', 'J', 'Schlagel', 'MD', 'Neurology', '', '', NULL, 'O', '272 E Ctr St', 'Ivins', 'Washington', 'UT', '84738', '4359862300', '          ', '272 E Ctr St', 'Ivins', 'Washington', 'UT', '84738', '4359862300', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-10-09', '2014-03-31', 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1306803226', 0, 'N', 0, '2014-05-21', NULL, NULL, 37.1684, -113.673, NULL, NULL),
('830317319', 'W11020452', 'W11020452', 'WY01', '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', '', '', NULL, NULL, '0.00', '10.00', '0.00', 3, '2009-10-09', NULL, 0, 0, 0, 'SageWest Health Care', NULL, NULL, NULL, 'HCFA|UB|', '1215980370', 0, 'n', 0, '2013-07-16', NULL, NULL, 42.8233, -108.73, NULL, NULL),
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('270534038', 'W11020454', 'W11020454', 'UT01', NULL, 'Jill', 'E', 'Waldron', 'MD', 'Colon and Rectal Surgery', '', '', NULL, 'B', 'PO Box 150610', 'Ogden', 'Salt Lake', 'UT', '84115', '8012631621', NULL, 'PO Box 150610', 'Ogden', 'Salt Lake', 'UT', '84115', '8012631621', '', 'WISESTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2009-10-09', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1295922052', 0, 'y', 0, '2013-06-19', NULL, NULL, 0, 0, NULL, NULL),
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('331177233', 'W11020456', 'W11020456', 'UT01', 'Ogden Internal Medicine & Urology', 'Samuel', 'J', 'Otto', 'MD', 'Urology', '', '', NULL, 'B', 'PO Box 100925', 'Atlanta', 'Fulton', 'GA', '30384', '8014758600', NULL, 'PO Box 100925', 'Atlanta', 'Fulton', 'GA', '30384', '8014758600', '', 'WISESTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2009-10-09', '2010-08-31', 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1154565273', 0, 'y', 0, '2014-04-09', NULL, NULL, 0, 0, NULL, NULL),
('820201128', 'W11020457', 'W11020457', 'ID02', 'Warm Springs Counseling Center', 'Carolyn', 'S', 'Golden', 'PSYD', 'Mental Health', 'Psychology', '', NULL, 'O', '740 Warm Springs Ave', 'Boise', 'Ada', 'ID', '83712', '2083437797', NULL, '740 Warm Springs Ave', 'Boise', 'Ada', 'ID', '83712', '2083437797', '          ', 'IDPHD', '', '', '0.00', '35.00', '0.00', 3, '2009-10-09', '2011-08-31', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1740314228', 0, 'N', 0, '2012-10-12', NULL, NULL, 0, 0, NULL, NULL),
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('201909749', 'W11020459', 'W11020459', 'UT01', 'Mesquite Medical Equipment', '', '', 'Mesquite Medical Equipment', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', '1301 Bertha Howe Ave Ste 7', 'Mesquite', 'Clark', 'NV', '89027', '7023454625', '          ', '1301 Bertha Howe Ave Ste 7', 'Mesquite', 'Clark', 'NV', '89027', '7023454625', '          ', 'DME80', '', '', '0.00', '40.00', '0.00', 3, '2009-10-02', '2014-03-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1316010432', 0, 'N', 0, '2014-05-13', NULL, NULL, 36.8087, -114.115, NULL, NULL),
('201909749', 'W11020460', 'W11020460', 'UT01', 'Mesquite Medical Equipment', '', '', 'Mesquite Medical Equipment', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'B', 'PO Box 2885', 'Mesquite', 'Clark', 'NV', '89024', '7023454625', '          ', 'PO Box 2885', 'Mesquite', 'Clark', 'NV', '89024', '7023454625', '          ', 'DME80', '', '', '0.00', '40.00', '0.00', 3, '2009-10-02', '2014-03-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1316010432', 0, 'N', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('261906096', 'W11020461', 'W11020461', 'UT01', 'Gut  Whisperer', 'Umaprasanna', 'S', 'Karnam', 'MD', 'Gastroenterology', 'Internal Medicine', '', NULL, 'O', '1665 Bonanza Dr', 'Park City', 'Summit', 'UT', '84068', '4357763499', NULL, '1665 Bonanza Dr', 'Park City', 'Summit', 'UT', '84068', '4357763499', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-10-12', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1689623852', 0, 'N', 0, '2013-04-09', NULL, NULL, 40.6623, -111.5, NULL, NULL),
('742412898', 'W11020462', 'W11020462', 'UT01', 'Stephen D Ratcliffe Clinic', 'Amy', 'K', 'Ford Nguyen', 'MD', 'Family Practice', '', '', NULL, 'O', '1365 W 1000 N', 'Salt Lake City', 'Salt Lake', 'UT', '84116', '8013285750', '          ', '1365 W 1000 N', 'Salt Lake City', 'Salt Lake', 'UT', '84116', '8013285750', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-09-15', '2011-01-04', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1679654412', 0, 'N', 0, '2014-04-25', NULL, NULL, 40.791, -111.931, NULL, NULL),
('742412898', 'W11020463', 'W11020463', 'UT01', 'Central City Clinic Medical', 'Amy', 'K', 'Ford Nguyen', 'MD', 'Family Practice', '', '', NULL, 'O', '461 S 400 E', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8015398634', '8015377238', '461 S 400 E', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8015398634', '8015377238', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-09-15', '2011-01-04', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1679654412', 0, 'N', 0, '2014-04-25', NULL, NULL, 40.7593, -111.88, NULL, NULL),
('742412898', 'W11020464', 'W11020464', 'UT01', 'Oquirrh View Clinic', 'Amy', 'K', 'Ford Nguyen', 'MD', 'Family Practice', '', '', NULL, 'O', '4745 S 3200 W', 'Salt Lake City', 'Salt Lake', 'UT', '84118', '8019646214', '          ', '4745 S 3200 W', 'Salt Lake City', 'Salt Lake', 'UT', '84118', '8019646214', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-09-15', '2011-01-04', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1679654412', 0, 'N', 0, '2014-04-25', NULL, NULL, 40.6664, -111.967, NULL, NULL),
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('870543318', 'W11020471', 'W11020471', 'UT01', 'Mountain West Gastroenterology', 'Brett', 'W', 'Doxey', 'MD', 'Gastroenterology', '', '', NULL, 'O', '3723 W 12600 S Ste 470', 'Riverton', 'Salt Lake', 'UT', '84065', '8017274280', NULL, '3723 W 12600 S Ste 470', 'Riverton', 'Salt Lake', 'UT', '84065', '8017274280', '          ', 'WCSTMTWEST5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-10-01', '2013-12-31', 0, 0, 0, 'Lakeview Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1386775682', 0, 'N', 0, '2013-12-18', NULL, NULL, 0, 0, NULL, NULL),
('870543318', 'W11020472', 'W11020472', 'UT01', 'Mountain West Gastroenterology', 'Peter', 'C', 'Fenton', 'MD', 'Gastroenterology', '', '', NULL, 'O', '3723 W 12600 S Ste 470', 'Riverton', 'Salt Lake', 'UT', '84065', '8019443144', NULL, '3723 W 12600 S Ste 470', 'Riverton', 'Salt Lake', 'UT', '84065', '8019443144', '          ', 'WCSTMTWEST5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-10-01', '2013-12-31', 0, 0, 0, 'Lakeview Hospital', '', '', '', 'HCFA|UB|', '1952311797', 0, 'N', 0, '2013-12-18', NULL, NULL, 0, 0, NULL, NULL),
('870543318', 'W11020473', 'W11020473', 'UT01', 'Mountain West Gastroenterology', 'Gordon', 'E', 'Harmston', 'MD', 'Gastroenterology', '', '', NULL, 'O', '3723 W 12600 S Ste 470', 'Riverton', 'Salt Lake', 'UT', '84065', '8019443144', NULL, '3723 W 12600 S Ste 470', 'Riverton', 'Salt Lake', 'UT', '84065', '8019443144', '          ', 'WCSTMTWEST5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-10-01', '2013-12-31', 0, 0, 0, 'Lakeview Hospital', '', '', '', 'HCFA|UB|', '1972516748', 0, 'N', 0, '2014-01-17', NULL, NULL, 0, 0, NULL, NULL),
('870543318', 'W11020474', 'W11020474', 'UT01', 'Mountain West Gastroenterology', 'Clarke', 'A', 'Hilbig', 'MD', 'Gastroenterology', 'Internal Medicine', '', NULL, 'O', '3723 W 12600 S Ste 470', 'Riverton', 'Salt Lake', 'UT', '84065', '8017274280', NULL, '3723 W 12600 S Ste 470', 'Riverton', 'Salt Lake', 'UT', '84065', '8017274280', '          ', 'WCSTMTWEST5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-10-01', '2013-12-31', 0, 0, 0, 'Lakeview Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1861404758', 0, 'N', 0, '2013-12-18', NULL, NULL, 0, 0, NULL, NULL),
('870543318', 'W11020475', 'W11020475', 'UT01', 'Mountain West Gastroenterology', 'Robert', 'G', 'Jones', 'MD', 'Gastroenterology', '', '', NULL, 'O', '3723 W 12600 S Ste 470', 'Riverton', 'Salt Lake', 'UT', '84065', '8017274280', NULL, '3723 W 12600 S Ste 470', 'Riverton', 'Salt Lake', 'UT', '84065', '8017274280', '          ', 'WCSTMTWEST5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-10-01', '2013-12-31', 0, 0, 0, 'Lakeview Hospital', '', '', '', 'HCFA|UB|', '1164465647', 0, 'N', 0, '2013-12-18', NULL, NULL, 0, 0, NULL, NULL),
('870543318', 'W11020476', 'W11020476', 'UT01', 'Mountain West Gastroenterology', 'Gladys', 'K', 'Meidinger', 'NP', 'Gastroenterology', '', '', NULL, 'O', '3723 W 12600 S Ste 470', 'Riverton', 'Salt Lake', 'UT', '84065', '8019443144', NULL, '3723 W 12600 S Ste 470', 'Riverton', 'Salt Lake', 'UT', '84065', '8019443144', '          ', 'WCSTMTWEST5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-10-01', '2011-11-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1457517369', 0, 'N', 0, '2013-12-12', NULL, NULL, 0, 0, NULL, NULL),
('870543318', 'W11020477', 'W11020477', 'UT01', 'Mountain West Gastroenterology', 'Randall', 'J', 'Ryser', 'MD', 'Gastroenterology', '', '', NULL, 'O', '3723 W 12600 S Ste 470', 'Riverton', 'Salt Lake', 'UT', '84065', '8017274280', NULL, '3723 W 12600 S Ste 470', 'Riverton', 'Salt Lake', 'UT', '84065', '8017274280', '          ', 'WCSTMTWEST5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-10-01', '2013-12-31', 0, 0, 0, 'Lakeview Hospital', '', '', '', 'HCFA|UB|', '1528071156', 0, 'N', 0, '2014-01-17', NULL, NULL, 0, 0, NULL, NULL),
('870543318', 'W11020478', 'W11020478', 'UT01', 'Mountain West Gastroenterology', 'Michael', 'J', 'Sossenheimer', 'MD', 'Gastroenterology', 'Internal Medicine', '', NULL, 'O', '3723 W 12600 S Ste 470', 'Riverton', 'Salt Lake', 'UT', '84065', '8017274280', NULL, '3723 W 12600 S Ste 470', 'Riverton', 'Salt Lake', 'UT', '84065', '8017274280', '          ', 'WCSTMTWEST5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-10-01', '2013-12-31', 0, 0, 0, 'Lakeview Hospital', '', '', '', 'HCFA|UB|', '1508876350', 0, 'N', 0, '2013-12-18', NULL, NULL, 0, 0, NULL, NULL),
('870543318', 'W11020479', 'W11020479', 'UT01', 'Mountain West Gastroenterology', 'I', 'R', 'Thomason', 'MD', 'Gastroenterology', '', '', NULL, 'O', '3723 W 12600 S Ste 470', 'Riverton', 'Salt Lake', 'UT', '84065', '8019443144', NULL, '3723 W 12600 S Ste 470', 'Riverton', 'Salt Lake', 'UT', '84065', '8019443144', '', 'WCSTMTWEST5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-10-01', '2012-12-31', 0, 0, 0, 'Lakeview Hospital', '', '', '', 'HCFA|UB|', '1649282542', 0, 'N', 0, '2014-04-17', NULL, NULL, 0, 0, NULL, NULL),
('870543318', 'W11020480', 'W11020480', 'UT01', 'Mountain West Gastroenterology', 'Edward', 'J', 'Frech', 'MD', 'Gastroenterology', '', '', NULL, 'O', '3723 W 12600 S Ste 470', 'Riverton', 'Salt Lake', 'UT', '84065', '8017274280', NULL, '3723 W 12600 S Ste 470', 'Riverton', 'Salt Lake', 'UT', '84065', '8017274280', '          ', 'WCSTMTWEST5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-10-01', '2013-12-31', 0, 0, 0, 'Lakeview Hospital', '', '', '', 'HCFA|UB|', '1942496757', 0, 'N', 0, '2013-12-18', NULL, NULL, 0, 0, NULL, NULL),
('870543318', 'W11020481', 'W11020481', 'UT01', 'Mountain West Gastroenterology', 'Christopher', 'C', 'Canale', 'MD', 'Gastroenterology', '', '', NULL, 'O', '3723 W 12600 S Ste 470', 'Riverton', 'Salt Lake', 'UT', '84065', '8017274280', NULL, '3723 W 12600 S Ste 470', 'Riverton', 'Salt Lake', 'UT', '84065', '8017274280', '          ', 'WCSTMTWEST5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-10-01', '2013-12-31', 0, 0, 0, 'Lakeview Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1598952145', 0, 'N', 0, '2013-12-18', NULL, NULL, 0, 0, NULL, NULL),
('621762570', 'W11020482', 'W11020482', 'UT01', 'Ashley Valley Physician Practice', 'Ghanshyam', 'P', 'Massand', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '175 N 100 W Ste 204', 'Vernal', 'Uintah', 'UT', '84078', '4357891522', NULL, '175 N 100 W Ste 204', 'Vernal', 'Uintah', 'UT', '84078', '4357891522', '', 'WURURAL5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-10-05', '2012-05-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1740245604', 0, 'N', 0, '2014-06-02', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11020483', 'W11020483', 'UTPEHP', NULL, 'Brady', 'P', 'Barker', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1157 N 300 W Ste 201', 'Provo', 'Utah', 'UT', '84604', '8013578898', NULL, '1157 N 300 W Ste 201', 'Provo', 'Utah', 'UT', '84604', '8013578898', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2008-11-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1588863880', 0, 'N', 0, '2014-04-16', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W11020486', 'W11020486', 'WYBILLINGS', 'Billings Clinic - Hospitalist', 'Kathie', '', 'Kadri', 'MD', 'Hospitalist', '', '', NULL, 'O', '2800 10th Ave N', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4066574349', '2800 10th Ave N', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4066574349', '', NULL, NULL, '0.00', '17.00', '0.00', 3, '2009-04-10', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1235176173', 0, 'N', 0, '2014-02-04', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W11020484', 'W11020484', 'WYBILLINGS', 'Billings Clinic - West End Clinic', 'Angela', NULL, 'Goodman', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '2675 Central Ave', 'Billings', 'Yellowstone', 'MT', '59102', '4062382501', '4062382978', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', NULL, NULL, '', NULL, NULL, '0.00', '17.00', '0.00', 3, '2009-05-14', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1225188212', 0, 'N', 0, '2009-10-09', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W11020485', 'W11020485', 'WYBILLINGS', 'Billings Clinic - Miles City Clinic', 'William', NULL, 'Peters', 'MD', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'O', '620 S Haynes', 'Miles City', 'Custer', 'MT', '59301', '4062337000', '4062337070', 'PO Box 37000', 'Billings', 'Custer', 'MT', '59107', NULL, NULL, '', NULL, NULL, '0.00', '17.00', '0.00', 3, '2009-05-11', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1649370222', 0, 'N', 0, '2009-10-09', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W11020487', 'W11020487', 'WYBILLINGS', 'Billings Clinic - Hospitalist', 'Abdulmajeed', '', 'Kadri', 'MD', 'Hospitalist', '', '', NULL, 'O', '2800 10th Ave N', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062382572', '2800 10th Ave N', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062382572', '', NULL, NULL, '0.00', '17.00', '0.00', 3, '2009-04-10', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1336186261', 0, 'N', 0, '2014-02-04', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W11020488', 'W11020488', 'WYBILLINGS', 'Billings Clinic - Neurology', 'Steven', 'D', 'Arbogast', 'OD', 'Neurology', NULL, NULL, NULL, 'O', '2825 8th Ave N', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062382805', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', NULL, NULL, '', NULL, NULL, '0.00', '17.00', '0.00', 3, '2009-05-01', '2010-03-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1962615377', 0, 'N', 0, '2010-01-15', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W11020489', 'W11020489', 'WYBILLINGS', 'Billings Clinic - Pulmonary', 'Jerimiah', 'L', 'Lysinger', 'MD', 'Pediatric Pulmonary', '', '', NULL, 'O', '2825 8th Ave N', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062382813', '2825 8th Ave N', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062382813', '', NULL, NULL, '0.00', '17.00', '0.00', 3, '2009-03-16', '2010-03-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1164569448', 0, 'N', 0, '2014-02-04', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W11020490', 'W11020490', 'WYBILLINGS', 'Billings Clinic - OB/GYN', 'Michelle', '', 'Montville', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '2825 8th Ave N', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062382806', '2825 8th Ave N', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062382806', '', NULL, NULL, '0.00', '17.00', '0.00', 3, '2009-03-16', '2010-03-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1891987756', 0, 'N', 0, '2010-11-04', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W11020491', 'W11020491', 'WYBILLINGS', 'Billings Clinic - Nephrology', 'Kendrick', 'A', 'Trostel', 'MD', 'Nephrology', NULL, NULL, NULL, 'O', '2825 8th Ave N', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062382590', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', NULL, NULL, '', NULL, NULL, '0.00', '17.00', '0.00', 3, '2009-04-22', '2010-03-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1174537658', 0, 'N', 0, '2010-01-15', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W11020492', 'W11020492', 'WYBILLINGS', 'Billings Clinic - Rehab', 'Travis', 'E', 'Sherman', 'PT', 'Physical Therapy', NULL, NULL, NULL, 'O', '2825 8th Ave N', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062382590', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', NULL, NULL, '', NULL, NULL, '0.00', '17.00', '0.00', 3, '2009-03-16', '2010-03-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1972796258', 0, 'N', 0, '2010-01-15', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W11020493', 'W11020493', 'WYBILLINGS', 'Billings Clinic - Neurosurgery', 'Haring', 'J', 'Nauta', 'MD', 'Neurosurgery', '', '', NULL, 'O', '2825 8th Ave N', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062382590', '2825 8th Ave N', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062382590', '', NULL, NULL, '0.00', '17.00', '0.00', 3, '2009-04-01', '2010-03-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1518066539', 0, 'N', 0, '2014-03-24', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'W11020494', 'W11020494', 'ID02', NULL, 'Kevin', 'K', 'Lewis', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '4900 N Rosepoint Way Ste B', 'Boise', 'Ada', 'ID', '83713', '2083773335', NULL, NULL, NULL, 'Ada', NULL, NULL, NULL, NULL, 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', '0.00', '55.46', 3, '2009-03-23', '2010-10-31', NULL, 0, 1, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1033230958', 0, 'N', 0, '2009-10-09', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11020495', 'W11020495', 'UTPEHP', NULL, 'Melissa', 'L', 'McLane', 'MD', 'Sports Medicine', NULL, NULL, NULL, 'O', '1157 N 300 W Ste 201', 'Provo', 'Utah', 'UT', '84604', '8013571200', NULL, NULL, NULL, 'Utah', NULL, NULL, NULL, NULL, 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2006-06-01', NULL, NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1013017029', 0, 'N', 0, '2009-10-12', NULL, NULL, 0, 0, NULL, NULL);
INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
('133757370', 'W11020496', 'W11020496', 'UT01', 'LabCorp Draw Station', '', '', 'LabCorp of America Holdings', 'GROUP', 'Laboratory', '', '', NULL, 'O', '2356 N 400 E Ste 204', 'Tooele', 'Tooele', 'UT', '84074', '4358827106', NULL, '2356 N 400 E Ste 204', 'Tooele', 'Tooele', 'UT', '84074', '4358827106', '', 'WULABCORP5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1902809940', 0, 'N', 0, '2014-03-21', NULL, NULL, 40.5621, -112.293, 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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('270319363', 'W11021372', 'W11021372', 'UT01', 'Orthopedic Practice Associates', 'James', 'W', 'Roach', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', 'PO Box 413026', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, 'WUUPEDS', 'WUSTDHCPC5', NULL, '0.00', '15.00', '0.00', 3, '2009-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1598720898', 0, 'y', 0, '2009-11-04', NULL, NULL, 0, 0, NULL, NULL),
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('870645895', 'W11020605', 'W11020605', 'UT01', 'U of U Pediatric Orthopedics', 'Theresa', 'A', 'Hennessey', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', 'PO Box 413026', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413026', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2009-07-01', '2011-01-11', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1699826693', 0, 'N', 0, '2011-05-02', NULL, NULL, 0, 0, NULL, NULL),
('870645895', 'W11020606', 'W11020606', 'UT01', 'University Health Care', 'Theresa', 'A', 'Hennessey', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '100 Mario Capecchi Dr Ste 4550', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016625600', NULL, '100 Mario Capecchi Dr Ste 4550', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016625600', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2009-07-01', '2011-01-11', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1699826693', 0, 'N', 0, '2011-05-02', NULL, NULL, 0, 0, NULL, NULL),
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('870616107', 'W11020608', 'W11020608', 'UT01', 'University Health Care', 'Jeremy', 'J', 'Biggs', 'MD', 'Family Practice', '', '', NULL, 'O', '1525 W 2100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8012139900', NULL, '1525 W 2100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8012139900', '          ', 'WISESTDU', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2009-07-01', '2012-09-16', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1679758536', 0, 'N', 0, '2012-09-17', NULL, NULL, 0, 0, NULL, NULL),
('743134267', 'W11020609', 'W11020609', 'UT01', 'Pediatric Inpatient Services-Department of University of Uta', 'Elizabeth', 'S', 'Vukin', 'MD', 'Pediatrics', '', '', NULL, 'B', 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2008-07-01', '2012-07-31', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1942498035', 0, 'N', 0, '2013-01-22', NULL, NULL, 0, 0, NULL, NULL),
('743134267', 'W11020610', 'W11020610', 'UT01', 'University Health Care', 'Elizabeth', 'S', 'Vukin', 'MD', 'Pediatrics', '', '', NULL, 'O', '100 Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016623645', NULL, '100 Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016623645', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2008-07-01', '2012-07-31', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1942498035', 0, 'N', 0, '2013-01-22', NULL, NULL, 0, 0, NULL, NULL),
('870442845', 'W11020611', 'W11020611', 'UT01', 'University Health Care', 'Marc', 'T', 'Nuttall', 'MD', 'Internal Medicine', 'Hematolgy and Oncology', '', NULL, 'B', 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2009-07-01', '2010-06-30', 0, 0, 0, 'Mountain View Hospital', '', '', '', 'HCFA|UB|', '1144497322', 0, 'N', 0, '2013-10-31', NULL, NULL, 0, 0, NULL, NULL),
('870442845', 'W11020612', 'W11020612', 'UT01', 'University Health Care', 'Marc', 'T', 'Nuttall', 'MD', 'Internal Medicine', 'Hematolgy and Oncology', '', NULL, 'O', '1950 Circle of Hope Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84112', '8015850100', NULL, '1950 Circle of Hope Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84112', '8015850100', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2009-07-01', '2010-06-30', 0, 0, 0, 'Mountain View Hospital', '', '', '', 'HCFA|UB|', '1144497322', 0, 'N', 0, '2013-10-31', NULL, NULL, 0, 0, NULL, NULL),
('870542586', 'W11020613', 'W11020613', 'UT01', 'U-U Division of Nephrology', 'Kalani', 'L', 'Raphael', 'MD', 'Nephrology', 'Internal Medicine', '', NULL, 'B', 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2009-07-01', '2012-04-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1902982382', 0, 'N', 0, '2012-04-12', NULL, NULL, 0, 0, NULL, NULL),
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('237268471', 'W11020615', 'W11020615', 'UT01', 'University Radiology Associates', 'Sirisha', 'T', 'Komakula', 'MD', 'Radiologist', '', '', NULL, 'B', 'PO Box 413025', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413025', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2009-07-01', '2010-06-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1295872562', 0, 'N', 0, '2009-10-13', NULL, NULL, 0, 0, NULL, NULL),
('237268471', 'W11020616', 'W11020616', 'UT01', 'University Health Care', 'Sirisha', 'T', 'Komakula', 'MD', 'Radiologist', '', '', NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015817553', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015817553', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2009-07-01', '2010-06-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1295872562', 0, 'N', 0, '2009-10-13', NULL, NULL, 0, 0, NULL, NULL),
('743134258', 'W11020617', 'W11020617', 'UT01', 'Pediatric Neonatology-Department of University of Utah', 'Daniel', 'T', 'Malleske', 'MD', 'Neonatology', 'Pediatrics', 'Internal Medicine', NULL, 'B', 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2009-07-01', '2012-07-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1881635472', 0, 'N', 0, '2012-07-31', NULL, NULL, 0, 0, NULL, NULL),
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('870567427', 'W11020619', 'W11020619', 'UT01', 'University of Utah Emergency Physicians', 'Carl', 'J', 'Seger', 'MD', 'Emergency Medicine', '', '', NULL, 'B', 'PO Box 510726', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8012133800', NULL, 'PO Box 510726', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8012133800', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2009-07-01', '2010-06-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1699957308', 0, 'N', 0, '2009-10-13', NULL, NULL, 0, 0, NULL, NULL),
('870567427', 'W11020620', 'W11020620', 'UT01', 'University Health Care', 'Carl', 'J', 'Seger', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015812292', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015812292', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2009-07-01', '2010-06-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1699957308', 0, 'N', 0, '2009-10-13', NULL, NULL, 0, 0, NULL, NULL),
('870564069', 'W11020621', 'W11020621', 'UT01', 'U Dept of Family & Preventative Medicine', 'Susan', 'D', 'Pohl', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 510004', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8015876303', NULL, 'PO Box 510004', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8015876303', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2009-07-01', '2012-08-20', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1043271422', 0, 'N', 0, '2012-08-21', NULL, NULL, 0, 0, NULL, NULL),
('870564069', 'W11020622', 'W11020622', 'UT01', 'University Health Care', 'Susan', 'D', 'Pohl', 'MD', 'Family Practice', '', '', NULL, 'O', '555 Foothill Blvd', 'Salt Lake City', 'Salt Lake', 'UT', '84112', '8015818000', NULL, '555 Foothill Blvd', 'Salt Lake City', 'Salt Lake', 'UT', '84112', '8015818000', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2009-07-01', '2012-08-20', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1043271422', 0, 'N', 0, '2012-08-21', NULL, NULL, 0, 0, NULL, NULL),
('870480520', 'W11020623', 'W11020623', 'UT01', 'Dept of Neurology School of Medicine U of U', 'David', 'R', 'Shprecher', 'DO', 'Neurology', '', '', NULL, 'B', 'PO Box 413027', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413027', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2009-07-01', '2012-08-09', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1679692594', 0, 'N', 0, '2012-08-10', NULL, NULL, 0, 0, NULL, NULL),
('870480520', 'W11020624', 'W11020624', 'UT01', 'University Health Care', 'David', 'R', 'Shprecher', 'DO', 'Neurology', '', '', NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015856387', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015856387', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2009-07-01', '2012-08-09', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1679692594', 0, 'N', 0, '2012-08-10', NULL, NULL, 0, 0, NULL, NULL),
('870284475', 'W11020625', 'W11020625', 'UT01', 'Granger Medical Clinic', 'Dan', '', 'Richards', 'DO', 'Orthopedic Surgery', '', '', NULL, 'B', 'PO Box 70658', 'West Valley', 'Salt Lake', 'UT', '84170', '8019653720', NULL, 'PO Box 70658', 'West Valley', 'Salt Lake', 'UT', '84170', '8019653720', '', 'WUGRANGER5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2009-10-02', NULL, 0, 0, 0, 'Pioneer Valley Hospital', 'Riverton Childrens Unit Operated by Primary Childrens Medical Center', NULL, NULL, 'HCFA|UB|', '1649455403', 0, 'Y', 0, '2013-09-19', NULL, NULL, 0, 0, NULL, NULL),
('870284475', 'W11020626', 'W11020626', 'UT01', 'Granger Medical Clinic', 'Dan', '', 'Richards', 'DO', 'Orthopedic Surgery', '', '', NULL, 'O', '3725 W 4100 S', 'West Valley', 'Salt Lake', 'UT', '84120', '8019653424', NULL, '3725 W 4100 S', 'West Valley', 'Salt Lake', 'UT', '84120', '8019653424', '', 'WUGRANGER5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2009-10-02', NULL, 0, 0, 0, 'Pioneer Valley Hospital', 'Riverton Childrens Unit Operated by Primary Childrens Medical Center', NULL, NULL, 'HCFA|UB|', '1649455403', 0, 'N', 0, '2013-09-19', NULL, NULL, 40.682, -111.979, NULL, NULL),
('870284475', 'W11020627', 'W11020627', 'UT01', 'Granger Medical Clinic', 'Dan', '', 'Richards', 'DO', 'Orthopedic Surgery', '', '', NULL, 'O', '12391 S 4000 W', 'Riverton', 'Salt Lake', 'UT', '84065', '8013021700', NULL, '12391 S 4000 W', 'Riverton', 'Salt Lake', 'UT', '84065', '8013021700', '', 'WUGRANGER5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2009-10-02', NULL, 0, 0, 0, 'Pioneer Valley Hospital', 'Riverton Childrens Unit Operated by Primary Childrens Medical Center', NULL, NULL, 'HCFA|UB|', '1649455403', 0, 'N', 0, '2013-09-19', NULL, NULL, 40.5226, -111.987, NULL, NULL),
('810231784', 'W11020628', 'W11020628', 'WYBILLINGS', 'Billings Clinic - OB/GYN', 'Cynthia', 'M', 'Hermes', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '2825 8th Ave N', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062382806', '2825 8th Ave N', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062382806', '', NULL, '', '0.00', '17.00', '0.00', 3, '2009-12-14', '2010-03-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1336474048', 0, 'N', 0, '2014-06-23', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W11020629', 'W11020629', 'UT01', 'Institute for Specialty Surgery', 'Tadge', '', 'Kanjo', 'MD', 'General Surgery', '', '', NULL, 'O', '3336 S Pioneer Parkway Ste 306', 'West Valley', 'Salt Lake', 'UT', '84120', '8019653855', NULL, '3336 S Pioneer Parkway Ste 306', 'West Valley', 'Salt Lake', 'UT', '84120', '8019653855', '          ', 'WUSTDSURG5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2009-10-01', '2010-06-17', 0, 0, 0, 'Evanston Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1710970058', 0, 'N', 0, '2013-06-28', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W11020630', 'W11020630', 'UT01', 'Institute for Specialty Surgery', 'Tadge', '', 'Kanjo', 'MD', 'General Surgery', '', '', NULL, 'B', '406 W South Jordan Pkwy Ste 500', 'South Jordan', 'Salt Lake', 'UT', '84095', '8019653855', NULL, '406 W South Jordan Pkwy Ste 500', 'South Jordan', 'Salt Lake', 'UT', '84095', '8019653855', '          ', 'WUSTDSURG5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2009-10-01', '2010-06-17', 0, 0, 0, 'Evanston Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1710970058', 0, 'N', 0, '2013-06-28', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W11020631', 'W11020631', 'UT01', 'Davis Hospital (Hospitalist)', 'Rodney', '', 'Bates', 'DO', 'Internal Medicine', '', '', NULL, 'O', '1600 W Antelope Dr', 'Layton', 'Davis', 'UT', '84041', '8018077219', NULL, '1600 W Antelope Dr', 'Layton', 'Davis', 'UT', '84041', '8018077219', '          ', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2009-10-05', '2010-10-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1700822491', 0, 'Y', 0, '2011-09-19', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W11020632', 'W11020632', 'UT01', 'Salt Lake Regional Hospital (Hospitalist)', 'Rodney', '', 'Bates', 'DO', 'Internal Medicine', '', '', NULL, 'O', '1050 E S Temple', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013504111', NULL, '1050 E S Temple', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013504111', '          ', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2009-10-05', '2010-10-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1700822491', 0, 'Y', 0, '2011-09-19', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W11020633', 'W11020633', 'UT01', 'Salt Lake Regional Hospital (Hospitalist)', 'Rodney', '', 'Bates', 'DO', 'Internal Medicine', '', '', NULL, 'B', '406 W South Jordan Pkwy Ste 500', 'South Jordan', 'Salt Lake', 'UT', '84095', '8013504111', NULL, '406 W South Jordan Pkwy Ste 500', 'South Jordan', 'Salt Lake', 'UT', '84095', '8013504111', '          ', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2009-10-05', '2010-10-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1700822491', 0, 'Y', 0, '2011-09-19', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W11020634', 'W11020634', 'UT01', 'Jordan Valley Hospital (Hospitalist)', 'Rodney', '', 'Bates', 'DO', 'Internal Medicine', '', '', NULL, 'O', '3580 W 9000 S', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015618888', NULL, '3580 W 9000 S', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015618888', '          ', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2009-10-05', '2010-10-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1700822491', 0, 'Y', 0, '2011-09-19', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W11020635', 'W11020635', 'UT01', 'Pioneer Valley Hospital (Hospitalist)', 'Rodney', '', 'Bates', 'DO', 'Internal Medicine', '', '', NULL, 'O', '3460 S Pioneer Pkwy', 'West Valley', 'Salt Lake', 'UT', '84120', '8019643100', NULL, '3460 S Pioneer Pkwy', 'West Valley', 'Salt Lake', 'UT', '84120', '8019643100', '          ', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2009-10-05', '2010-10-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1700822491', 0, 'Y', 0, '2011-09-19', NULL, NULL, 0, 0, NULL, NULL),
('264333033', 'W11020636', 'W11020636', 'TX01', 'Institute for Womens Health', 'Jenatta', '', 'Freeman', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '8715 Village Dr Ste 418', 'San Antonio', 'Bexar', 'TX', '78217', '2106563040', NULL, '8715 Village Dr Ste 418', 'San Antonio', 'Bexar', 'TX', '78217', '2106563040', '', 'TXOBG', 'TXHCPCS', NULL, '0.00', '50.00', '0.00', 3, '2010-01-01', '2012-08-19', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1538102918', 0, 'N', 0, '2013-09-25', NULL, NULL, 29.5187, -98.4281, NULL, NULL),
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('260553931', 'W11020768', 'W11020768', 'ID01', 'Saint Alphonsu Medical Group Heart Care Elm  provides coverage as needed do not post on website', 'Laura', 'A', 'Morton', 'NP-C', 'Cardiology', 'Nurse Practitioner', '', NULL, 'O', '315 E Elm St 100 Ste 100', 'Caldwell', 'Canyon', 'ID', '83605', '2083674278', '2083675200', '315 E Elm St 100 Ste 100', 'Caldwell', 'Canyon', 'ID', '83605', '2083674278', '2083675200', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2009-12-21', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1477597573', 0, 'Y', 0, '2014-07-09', NULL, NULL, 0, 0, NULL, NULL),
('260553931', 'W11020769', 'W11020769', 'IDBOISTD', 'Saint Alphonsus Medical Group Neurosurgery Boise 102', 'Teresa', 'A', 'Weeks', 'NP-C', 'Neurosurgery', 'Nurse Practitioner', '', NULL, 'O', '1075 N Curtis 102 Ste 102 Ste 201', 'Boise', 'Ada', 'ID', '83706', '2083674000', '2083674052', '1075 N Curtis 102 Ste 102 Ste 201', 'Boise', 'Ada', 'ID', '83706', '2083674000', '2083674052', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2009-12-21', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1346259454', 0, 'N', 0, '2014-06-13', NULL, NULL, 43.6148, -116.254, NULL, NULL),
('260553931', 'W11020770', 'W11020770', 'IDBOISTD', 'Saint Alphonsus Specialty Services, Inc', 'Teresa', 'A', 'Weeks', 'NP-C', 'Neurosurgery', 'Nurse Practitioner', '', NULL, 'O', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083674000', '2083674052', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083674000', '2083674052', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2009-12-21', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1346259454', 0, 'Y', 0, '2014-06-13', NULL, NULL, 43.6145, -116.254, NULL, NULL),
('260553931', 'W11020771', 'W11020771', 'ID01', 'Saint Alphonsus Medical Group Neurosurgery Fruitland', 'Teresa', 'A', 'Weeks', 'NP-C', 'Neurosurgery', 'Nurse Practitioner', '', NULL, 'O', '1118 NW 16th St', 'Fruitland', 'Payette', 'ID', '83619', '2083674000', '2083674052', '1118 NW 16th St', 'Fruitland', 'Payette', 'ID', '83619', '2083674000', '2083674052', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2009-12-21', '2012-10-14', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1346259454', 0, 'Y', 0, '2013-04-30', NULL, NULL, 44.025, -116.928, NULL, NULL),
('260553931', 'W11020772', 'W11020772', 'ID01', 'Saint Alphonsus Medical Group Coughlin Clinic ', 'Michael', 'J', 'Coughlin', 'MD; Foot/Ankle', 'Orthopedic Surgery', '', '', NULL, 'O', '901 N Curtis Rd Ste 503', 'Boise', 'Ada', 'ID', '83706', '2083673330', '2083673331', '901 N Curtis Rd Ste 503', 'Boise', 'Ada', 'ID', '83706', '2083673330', '2083673331', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2009-12-21', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1023010824', 0, 'N', 0, '2014-07-09', NULL, NULL, 43.6126, -116.255, NULL, NULL),
('260553931', 'W11020773', 'W11020773', 'ID01', 'Saint Alphonsus Specialty Services, Inc', 'Michael', 'J', 'Coughlin', 'MD', 'Orthopedic Surgery', NULL, NULL, NULL, 'O', '100 Hospital Dr Ste 107', 'Ketchum', 'Blaine', 'ID', '83340', '2083673330', '2083673331', NULL, NULL, 'Blaine', NULL, NULL, NULL, NULL, 'IDSAMG1', NULL, NULL, '0.00', '10.00', NULL, 6, '2000-01-01', '2000-01-01', NULL, NULL, 0, 'St Alphonsus', NULL, NULL, NULL, 'HCFA|UB|', '1023010824', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('260553931', 'W11020774', 'W11020774', 'ID01', 'Saint Alphonsus Medical Group Coughlin Clinic ', 'Christopher', 'B', 'Hirose', 'MD; Foot/Ankle', 'Orthopedic Surgery', NULL, NULL, NULL, 'O', '901 N Curtis Rd Ste 503', 'Boise', 'Ada', 'ID', '83706', '2083673330', '2083673331', '901 N Curtis Rd Ste 503', 'Boise', 'Ada', 'ID', '83706', '2083673330', '2083673331', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2009-12-21', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1437111267', 0, 'N', 0, '2013-09-17', NULL, NULL, 43.6126, -116.255, NULL, NULL),
('260553931', 'W11020775', 'W11020775', 'ID01', 'Saint Alphonsus Specialty Services, Inc', 'Christopher', 'B', 'Hirose', 'MD; Foot/Ankle', 'Orthopedic Surgery', NULL, NULL, NULL, 'O', '100 Hospital Dr Ste 107', 'Boise', 'Ada', 'ID', '83706', '2083673330', '2083673331', '100 Hospital Dr Ste 107', 'Boise', 'Ada', 'ID', '83706', '2083673330', '2083673331', 'IDSAMG1', NULL, NULL, '0.00', '10.00', '0.00', 6, '2009-12-21', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1437111267', 0, 'Y', 0, '2013-09-17', NULL, NULL, 43.6335, -116.296, NULL, NULL),
('260553931', 'W11020776', 'W11020776', 'ID01', 'Saint Alphonsus Medical Group Coughlin Clinic ', 'Travis', 'J', 'Kemp', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '901 N Curtis Rd Ste 501', 'Boise', 'Ada', 'ID', '83706', '2083673330', '2083673331', '901 N Curtis Rd Ste 501', 'Boise', 'Ada', 'ID', '83706', '2083673330', '2083673331', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2009-12-21', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1669607172', 0, 'N', 0, '2014-01-06', NULL, NULL, 43.6126, -116.255, NULL, NULL),
('260553931', 'W11020777', 'W11020777', 'ID01', 'Saint Alphonsus Specialty Services, Inc', 'Travis', 'J', 'Kemp', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '100 Hospital Dr Ste 107', 'Boise', 'Ada', 'ID', '83706', '2083673330', '2083673331', '100 Hospital Dr Ste 107', 'Boise', 'Ada', 'ID', '83706', '2083673330', '2083673331', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2009-12-21', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1669607172', 0, 'Y', 0, '2014-01-06', NULL, NULL, 43.6335, -116.296, NULL, NULL),
('260553931', 'W11020778', 'W11020778', 'ID01', 'Saint Alphonsus Specialty Services, Inc', 'Jeffrey', NULL, 'Shilt', 'MD', 'Pediatric Orthopedic Surgery', NULL, NULL, NULL, 'O', '6500 Emerald', 'Boise', 'Ada', 'ID', '83704', '2083770777', '2083771070', NULL, NULL, 'Ada', NULL, NULL, NULL, NULL, 'IDSAMG1', NULL, NULL, '0.00', '10.00', NULL, 6, '2000-01-01', '2000-01-01', NULL, NULL, 0, 'St Alphonsus', NULL, NULL, NULL, 'HCFA|UB|', '1730165366', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('260553931', 'W11020779', 'W11020779', 'ID01', 'Saint Alphonsus Specialty Services, Inc', 'Jeffrey', NULL, 'Shilt', 'MD', 'Pediatric Orthopedic Surgery', NULL, NULL, NULL, 'O', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083770777', '2083771070', NULL, NULL, 'Ada', NULL, NULL, NULL, NULL, 'IDSAMG1', NULL, NULL, '0.00', '10.00', NULL, 6, '2000-01-01', '2000-01-01', NULL, NULL, 0, 'St Alphonsus', NULL, NULL, NULL, 'HCFA|UB|', '1730165366', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('260553931', 'W11020780', 'W11020780', 'ID01', 'Saint Alphonsus Specialty Services, Inc', 'Jeffrey', NULL, 'Shilt', 'MD', 'Pediatric Orthopedic Surgery', NULL, NULL, NULL, 'O', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083673000', '2083676200', NULL, NULL, 'Ada', NULL, NULL, NULL, NULL, 'IDSAMG1', NULL, NULL, '0.00', '10.00', NULL, 6, '2000-01-01', '2000-01-01', NULL, NULL, 0, 'St Alphonsus', NULL, NULL, NULL, 'HCFA|UB|', '1730165366', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('260553931', 'W11020781', 'W11020781', 'ID01', 'Saint Alphonsus Specialty Services, Inc', 'Vivek', NULL, 'Kadyan', 'MD', 'Physical Medicine and Rehabilitation', 'Rehabilitation Practitioner', NULL, NULL, 'O', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083673000', '2083676200', NULL, NULL, 'Ada', NULL, NULL, NULL, NULL, 'IDSAMG1', NULL, NULL, '0.00', '10.00', NULL, 6, '2000-01-01', '2000-01-01', NULL, NULL, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1417950205', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('260553931', 'W11020782', 'W11020782', 'ID01', 'Saint Alphonsus Specialty Services, Inc', 'Rebekah', 'E', 'Guy', 'MD', 'Pain Management', NULL, NULL, NULL, 'O', '1055 N Curtis Rd 6th Floor', 'Boise', 'Ada', 'ID', '83706', '2083674306', '2083677667', NULL, NULL, 'Ada', NULL, NULL, NULL, NULL, 'IDSAMG1', NULL, NULL, '0.00', '10.00', NULL, 6, '2000-01-01', '2000-01-01', NULL, NULL, 0, 'St Alphonsus', NULL, NULL, NULL, 'HCFA|UB|', '1154542355', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('260553931', 'W11020783', 'W11020783', 'ID01', 'Saint Alphonsus Medical Group Comprehensive Pain and Spine', 'Daniel', 'R', 'Marsh', 'MD', 'Pain Management', NULL, NULL, NULL, 'O', '1055 N Curtis Rd 6th Floor', 'Boise', 'Ada', 'ID', '83706', '2083674343', '2083677667', '1055 N Curtis Rd 6th Floor', 'Boise', 'Ada', 'ID', '83706', '2083674343', '2083677667', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2009-12-21', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1356377535', 0, 'N', 0, '2013-12-26', NULL, NULL, 43.6127, -116.254, NULL, NULL),
('260553931', 'W11020784', 'W11020784', 'ID01', 'Saint Alphonsus Specialty Services, Inc', 'Achini', 'P', 'Dingman', 'MD', 'Rheumatology', '', '', NULL, 'O', '1000 N Curtis Ste 305', 'Boise', 'Ada', 'ID', '83706', '2083677800', '2083678099', '1000 N Curtis Ste 305', 'Boise', 'Ada', 'ID', '83706', '2083677800', '2083678099', 'IDSAMG1', NULL, NULL, '0.00', '10.00', '0.00', 6, '2009-12-21', '2009-12-21', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1174594758', 0, 'N', 0, '2012-02-27', NULL, NULL, 0, 0, NULL, NULL),
('260553931', 'W11020785', 'W11020785', 'ID01', 'Saint Alphonsus Specialty Services, Inc', 'Ann', 'C', 'Agnew', 'MD', 'Hospitalist', '', '', NULL, 'O', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083676279', '2083675180', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083676279', '2083675180', 'IDSAMG1', NULL, NULL, '0.00', '10.00', '0.00', 6, '2009-12-21', '2009-12-21', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1497797302', 0, 'N', 0, '2013-09-30', NULL, NULL, 43.6127, -116.254, NULL, NULL),
('260553931', 'W11020786', 'W11020786', 'ID01', 'Saint Alphonsus Specialty Services, Inc', 'Debra', 'A', 'Bogossian', 'MD', 'Internal Medicine', NULL, NULL, NULL, 'O', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083676279', '2083675180', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083676279', '2083675180', 'IDSAMG1', NULL, NULL, '0.00', '10.00', '0.00', 6, '2009-12-21', '2009-12-21', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1437175064', 0, 'N', 0, '2011-12-19', NULL, NULL, 43.6127, -116.254, NULL, NULL),
('260553931', 'W11020787', 'W11020787', 'ID01', 'Saint Alphonsus Specialty Services, Inc', 'Clive', 'R', 'Cooper', 'MD', 'Hospitalist', NULL, NULL, NULL, 'O', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083676279', '2083675180', NULL, NULL, 'Ada', NULL, NULL, NULL, NULL, 'IDSAMG1', NULL, NULL, '0.00', '10.00', NULL, 6, '2000-01-01', '2000-01-01', NULL, NULL, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1962446104', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('260553931', 'W11020788', 'W11020788', 'ID01', 'Saint Alphonsus Specialty Services, Inc', 'Stephen', 'J', 'Focht', 'MD', 'Hospitalist', '', '', NULL, 'O', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083676279', '2083675180', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083676279', '2083675180', 'IDSAMG1', NULL, NULL, '0.00', '10.00', '0.00', 6, '2009-12-21', '2009-12-21', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1043288004', 0, 'N', 0, '2012-10-29', NULL, NULL, 43.6127, -116.254, NULL, NULL),
('260553931', 'W11020789', 'W11020789', 'ID01', 'Saint Alphonsus Medical Group Hospitalist Boise', 'Lisa', 'M', 'Hunt', 'MD', 'Hospitalist', '', '', NULL, 'O', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083676279', '2083675180', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083676279', '2083675180', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2009-12-21', '2009-12-21', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1225066103', 0, 'Y', 0, '2014-06-20', NULL, NULL, 43.6127, -116.254, NULL, NULL),
('260553931', 'W11020790', 'W11020790', 'ID01', 'Saint Alphonsus Specialty Services, Inc', 'Tanya', 'S', 'Krafft', 'MD', 'Hospitalist', NULL, NULL, NULL, 'O', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083676279', '2083675180', NULL, NULL, 'Ada', NULL, NULL, NULL, NULL, 'IDSAMG1', NULL, NULL, '0.00', '10.00', NULL, 6, '2000-01-01', '2000-01-01', NULL, NULL, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1356370563', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('260553931', 'W11020791', 'W11020791', 'ID01', 'Saint Alphonsus Specialty Services, Inc', 'Katherine', 'A', 'Mathews', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083676279', '2083675180', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083676279', '2083675180', 'IDSAMG1', NULL, '', '0.00', '10.00', '0.00', 6, '2009-12-21', '2009-12-21', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1841296902', 0, 'N', 0, '2014-06-20', NULL, NULL, 43.6127, -116.254, NULL, NULL),
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('260553931', 'W11020793', 'W11020793', 'ID01', 'Saint Alphonsus Specialty Services, Inc', 'Robert', 'L', 'Petersen', 'MD', 'Hospitalist', '', '', NULL, 'O', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083676279', '2083675180', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083676279', '2083675180', 'IDSAMG1', NULL, NULL, '0.00', '10.00', '0.00', 6, '2009-12-21', '2009-12-21', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1043229685', 0, 'N', 0, '2011-08-17', NULL, NULL, 43.6127, -116.254, NULL, NULL),
('260553931', 'W11020794', 'W11020794', 'ID01', 'Saint Alphonsus Specialty Services, Inc', 'Tarik', '', 'Qasim', 'MD', 'Internal Medicine', 'Hospitalist', '', NULL, 'O', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083676279', '2083675180', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083676279', '2083675180', 'IDSAMG1', NULL, NULL, '0.00', '10.00', '0.00', 6, '2009-12-21', '2009-12-21', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1962608646', 0, 'N', 0, '2012-04-03', NULL, NULL, 43.6127, -116.254, NULL, NULL),
('260553931', 'W11020795', 'W11020795', 'ID01', 'Saint Alphonsus Specialty Services, Inc', 'Joel', 'C', 'Swanson', 'MD', 'Internal Medicine', 'Hospitalist', '', NULL, 'O', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083676279', '2083675180', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083676279', '2083675180', 'IDSAMG1', NULL, '', '0.00', '10.00', '0.00', 6, '2009-12-21', '2009-12-21', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1013956705', 0, 'N', 0, '2014-06-20', NULL, NULL, 43.6127, -116.254, NULL, NULL),
('260553931', 'W11020796', 'W11020796', 'ID01', 'Saint Alphonsus Specialty Services, Inc', 'Gregory', 'T', 'Trapp', 'MD', 'Hospitalist', NULL, NULL, NULL, 'O', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083676279', '2083675180', NULL, NULL, 'Ada', NULL, NULL, NULL, NULL, 'IDSAMG1', NULL, NULL, '0.00', '10.00', NULL, 6, '2000-01-01', '2000-01-01', NULL, NULL, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1851407944', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
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('260553931', 'W11020798', 'W11020798', 'ID01', 'Saint Alphonsus Specialty Services, Inc', 'Martha', 'H', 'Lund', 'MD', 'Obstetrics and Gynecology', 'Hospitalist', NULL, NULL, 'O', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083672121', NULL, NULL, NULL, 'Ada', NULL, NULL, NULL, NULL, 'IDSAMG1', NULL, NULL, '0.00', '10.00', NULL, 6, '2000-01-01', '2000-01-01', NULL, NULL, 0, 'St Alphonsus', NULL, NULL, NULL, 'HCFA|UB|', '1053356923', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
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('942854057', 'W11021496', 'W11021496', 'UTIHC04', 'EKG', 'Marvin', 'R', 'Allen', 'MD', 'Cardiovascular Disease', '', '', NULL, 'o', '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', NULL, '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587000', '', '', NULL, NULL, '0.00', '15.00', '0.00', 8, '2009-10-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', 'Mountain View Regional Hospital', '', '', 'HCFA|UB|', '1831154566', 0, 'Y', 0, '2013-09-09', NULL, NULL, 40.6876, -111.468, NULL, NULL),
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('810231784', 'W11020846', 'W11020846', 'WYBILLINGS', 'West Park Hospital', 'Kim', NULL, 'Trostel', 'MD PHD', 'Nephrology', NULL, NULL, NULL, 'O', '707 Sheridan Ave', 'Cody', 'Park', 'WY', '82414', '3075277501', NULL, NULL, NULL, 'Park', NULL, NULL, NULL, NULL, '', NULL, NULL, '0.00', '17.00', '0.00', 3, '2009-05-01', NULL, NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000009184', 0, 'N', 0, '2009-10-19', NULL, NULL, 0, 0, NULL, NULL),
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('810231784', 'W11020850', 'W11020850', 'WYBILLINGS', 'Billings Clinic - Miles City Clinic', 'Richard', 'B', 'Melzer', 'MD', 'Urology', '', '', NULL, 'O', '620 S Haynes', 'Miles City', 'Custer', 'MT', '59301', '4062337000', NULL, '620 S Haynes', 'Miles City', 'Custer', 'MT', '59301', '4062337000', '', '', NULL, NULL, '0.00', '17.00', '0.00', 3, '2009-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1407953086', 0, 'N', 0, '2011-08-22', NULL, NULL, 0, 0, NULL, NULL),
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('611593123', 'W11020852', 'W11020852', 'UT01', 'BMT Division Department of University of Utah', 'Paul', 'J', 'Shami', 'MD', 'Internal Medicine', 'Hematolgy and Oncology', '', NULL, 'B', 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2009-07-30', '2012-08-23', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1992895510', 0, 'Y', 0, '2012-08-24', NULL, NULL, 0, 0, NULL, NULL),
('611593123', 'W11020853', 'W11020853', 'UT01', 'University Health Care', 'Paul', 'J', 'Shami', 'MD', 'Internal Medicine', 'Hematolgy and Oncology', '', NULL, 'O', '1950 Circle of Hope Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84112', '8015852626', NULL, '1950 Circle of Hope Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84112', '8015852626', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2009-07-30', '2012-08-23', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1992895510', 0, 'N', 0, '2012-08-24', NULL, NULL, 0, 0, NULL, NULL);
