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
('205934739', 'W12043584', 'W12043584', 'ID02', 'Family Medicine Health Center', '', '', 'Family Medicine Health Center', 'GROUP', 'Family Practice', '', '', NULL, 'O', '925 NW 1st St', 'Meridian', 'Ada', 'ID', '83642', '2085142527', '2085142517', '925 NW 1st St', 'Meridian', 'Ada', 'ID', '83642', '2085142527', '2085142517', 'IDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2014-02-18', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '0000006197', 0, 'N', 0, '2014-01-24', NULL, NULL, 0, 0, NULL, NULL),
('463397455', 'W12043582', 'W12043582', 'ILCHIGSTD', 'Center for Brain and Nerve Disorders', 'Sreepathy', '', 'Kannan', 'MD', 'Neurology', '', '', NULL, 'O', '1051 Essington Rd', 'Joliet', 'Will', 'IL', '60435', '8157682210', '7083103430', '1051 Essington Rd', 'Joliet', 'Will', 'IL', '60435', '8157682210', '7083103430', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-01-13', NULL, 0, 0, 0, 'Presence Saint Joseph Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1295793529', 0, 'N', 0, '2014-01-24', NULL, NULL, 41.5408, -88.1608, NULL, NULL),
('742943662', 'W12043579', 'W12043579', 'TXSATSTD', 'James Edward Garrison', 'James', 'E', 'Garrison', 'MD', 'Neurology', '', '', NULL, 'O', '5430 Fredericksburg Rd Ste 400', 'San Antonio', 'Bexar', 'TX', '78229', '2106923362', '2106163558', '5430 Fredericksburg Rd Ste 400', 'San Antonio', 'Bexar', 'TX', '78229', '2106923362', '2106163558', 'TXSTD', 'TXHCPC13', '', '50.00', '0.00', '0.00', 3, '2014-03-10', NULL, 0, 0, 0, 'St Lukes Baptist Hospital', NULL, '', '', 'HCFA|UB|', '1205927605', 0, 'N', 0, '2014-02-10', NULL, NULL, 0, 0, NULL, NULL),
('800809946', 'W12043581', 'W12043581', 'UT01', '', 'Bruce', 'A', 'Isaacson', 'MD', 'Family Practice', '', '', NULL, 'O', '550 E 1400 N Ste Z', 'Logan', 'Cache', 'UT', '84341', '4357555799', '4357555839', '550 E 1400 N Ste Z', 'Logan', 'Cache', 'UT', '84341', '4357555799', '4357555839', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, 'Logan Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1881762649', 0, 'N', 0, '2014-01-24', NULL, NULL, 41.7574, -111.82, NULL, NULL),
('464177791', 'W12043578', 'W12043578', 'ID01', 'Kestrel Counseling and Wellness', 'Lindsey', 'M', 'McConnell-Soong', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'B', '2421 Fairview Ave', 'Caldwell', 'Canyon', 'ID', '83605', '2086494049', '2089658388', '2421 Fairview Ave', 'Caldwell', 'Canyon', 'ID', '83605', '2086494049', '2089658388', 'IDMA', '', '', '0.00', '40.00', '0.00', 3, '2014-03-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1336474196', 0, 'N', 0, '2014-02-18', NULL, NULL, 0, 0, NULL, NULL),
('330057155', 'W12043573', 'W12043573', 'UT01', 'Apria Healthcare LLC', '', '', 'Apria Healthcare LLC', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', '987 N Main St Ste 5', 'Cedar City', 'Iron', 'UT', '84721', '4355860379', '4355869021', '987 N Main St Ste 5', 'Cedar City', 'Iron', 'UT', '84721', '4355860379', '4355869021', 'Wpraxair', '', '', '0.00', '20.00', '0.00', 3, '2014-01-23', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000008248', 0, 'Y', 0, '2014-01-24', NULL, NULL, 0, 0, NULL, NULL),
('330057155', 'W12043572', 'W12043572', 'UT01', 'Apria Healthcare LLC', '', '', 'Apria Healthcare LLC', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', '6952 High Tech Dr Ste A', 'Midvale', 'Salt Lake', 'UT', '84047', '8012615100', '8019757453', '6952 High Tech Dr Ste A', 'Midvale', 'Salt Lake', 'UT', '84047', '8012615100', '8019757453', 'Wpraxair', '', '', '0.00', '20.00', '0.00', 3, '2014-01-23', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000008248', 0, 'Y', 0, '2014-01-24', NULL, NULL, 0, 0, NULL, NULL),
('330057155', 'W12043571', 'W12043571', 'UT01', 'Apria Healthcare LLC', '', '', 'Apria Healthcare LLC', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', '60 S 700 E Ste 1', 'Price', 'Carbon', 'UT', '84501', '4356379500', '4356379501', '60 S 700 E Ste 1', 'Price', 'Carbon', 'UT', '84501', '4356379500', '4356379501', 'Wpraxair', '', '', '0.00', '20.00', '0.00', 3, '2014-01-23', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000008248', 0, 'Y', 0, '2014-01-24', NULL, NULL, 0, 0, NULL, NULL),
('330057155', 'W12043570', 'W12043570', 'UT01', 'Apria Healthcare LLC', '', '', 'Apria Healthcare LLC', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', '400 N Geneva Rd Ste F', 'Lindon', 'Utah', 'UT', '84042', '8017851000', '8017851001', '400 N Geneva Rd Ste F', 'Lindon', 'Utah', 'UT', '84042', '8017851000', '8017851001', 'Wpraxair', '', '', '0.00', '20.00', '0.00', 3, '2014-01-23', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000008248', 0, 'Y', 0, '2014-01-24', NULL, NULL, 0, 0, NULL, NULL),
('330057155', 'W12043569', 'W12043569', 'UT01', 'Apria Healthcare LLC', '', '', 'Apria Healthcare LLC', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', '36 N Main St Ste 4', 'Tooele', 'Tooele', 'UT', '84074', '4358824334', '4358824663', '36 N Main St Ste 4', 'Tooele', 'Tooele', 'UT', '84074', '4358824334', '4358824663', 'Wpraxair', '', '', '0.00', '20.00', '0.00', 3, '2014-01-23', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000008248', 0, 'Y', 0, '2014-01-24', NULL, NULL, 40.5313, -112.299, NULL, NULL),
('330057155', 'W12043568', 'W12043568', 'UT01', 'Apria Healthcare LLC', '', '', 'Apria Healthcare LLC', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', '206 W 36th St', 'Ogden', 'Weber', 'UT', '84405', '8013944000', '8013946853', '206 W 36th St', 'Ogden', 'Weber', 'UT', '84405', '8013944000', '8013946853', 'Wpraxair', '', '', '0.00', '20.00', '0.00', 3, '2014-01-23', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000008248', 0, 'Y', 0, '2014-01-24', NULL, NULL, 0, 0, NULL, NULL),
('330057155', 'W12043567', 'W12043567', 'UT01', 'Apria Healthcare LLC', '', '', 'Apria Healthcare LLC', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', '165 E 1400 N Ste D', 'Logan', 'Cache', 'UT', '84341', '4357522100', '4357526055', '165 E 1400 N Ste D', 'Logan', 'Cache', 'UT', '84341', '4357522100', '4357526055', 'Wpraxair', '', '', '0.00', '20.00', '0.00', 3, '2014-01-23', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000008248', 0, 'Y', 0, '2014-01-24', NULL, NULL, 0, 0, NULL, NULL),
('330057155', 'W12043566', 'W12043566', 'UT01', 'Apria Healthcare LLC', '', '', 'Apria Healthcare LLC', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', '1509 S 270 E Ste 9', 'Twin Falls', 'Twin Falls', 'ID', '847902', '4356285222', '4356733750', '1509 S 270 E Ste 9', 'Twin Falls', 'Twin Falls', 'ID', '847902', '4356285222', '4356733750', 'Wpraxair', '', '', '0.00', '20.00', '0.00', 3, '2014-01-23', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000008248', 0, 'Y', 0, '2014-01-24', NULL, NULL, 0, 0, NULL, NULL),
('202695346', 'W12043564', 'W12043564', 'UT01', 'North Valley Anesthesia', 'Thomas', 'S', 'Wood', 'DO', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 3810', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8014322609', '          ', 'PO Box 3810', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8014322609', '          ', '', '', '', '57.00', '25.00', '0.00', 6, '2015-07-01', NULL, 0, 12, 0, '', '', '', '', 'HCFA|UB|', '1720128564', 0, 'Y', 0, '2014-06-23', NULL, NULL, 0, 0, NULL, NULL),
('202695346', 'W12043562', 'W12043562', 'UT01', 'North Valley Anesthesia', 'Thomas', 'S', 'Wood', 'DO', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 3810', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8014322609', NULL, 'PO Box 3810', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8014322609', '          ', '', '', '', '55.00', '25.00', '0.00', 6, '2013-08-01', '2014-06-30', 0, 12, 0, '', '', '', '', 'HCFA|UB|', '1720128564', 0, 'Y', 0, '2014-01-23', NULL, NULL, 0, 0, NULL, NULL),
('202695346', 'W12043560', 'W12043560', 'UT01', 'North Valley Anesthesia', 'Stuart', 'A', 'Weichers', 'MD', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 3810', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8014322609', '          ', 'PO Box 3810', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8014322609', '          ', '', '', '', '57.00', '25.00', '0.00', 6, '2015-07-01', NULL, 0, 12, 0, '', '', '', '', 'HCFA|UB|', '1285714170', 0, 'Y', 0, '2014-06-23', NULL, NULL, 0, 0, NULL, NULL),
('202695346', 'W12043563', 'W12043563', 'UT01', 'North Valley Anesthesia', 'Thomas', 'S', 'Wood', 'DO', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 3810', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8014322609', NULL, 'PO Box 3810', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8014322609', '          ', '', '', '', '56.00', '25.00', '0.00', 6, '2014-07-01', '2015-06-30', 0, 12, 0, '', '', '', '', 'HCFA|UB|', '1720128564', 0, 'Y', 0, '2014-01-23', NULL, NULL, 0, 0, NULL, NULL),
('202695346', 'W12043559', 'W12043559', 'UT01', 'North Valley Anesthesia', 'Stuart', 'A', 'Weichers', 'MD', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 3810', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8014322609', NULL, 'PO Box 3810', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8014322609', '          ', '', '', '', '56.00', '25.00', '0.00', 6, '2014-07-01', '2015-06-30', 0, 12, 0, '', '', '', '', 'HCFA|UB|', '1285714170', 0, 'Y', 0, '2014-01-23', NULL, NULL, 0, 0, NULL, NULL),
('202695346', 'W12043555', 'W12043555', 'UT01', 'North Valley Anesthesia', 'Norman', 'C', 'Ritchie', 'MD', 'Anesthesia', '', '', NULL, 'B', 'PO Box 3810', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8014322609', NULL, 'PO Box 3810', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8014322609', '          ', '', '', '', '56.00', '25.00', '0.00', 6, '2014-07-01', '2015-06-30', 0, 12, 0, '', '', '', '', 'HCFA|UB|', '1316081532', 0, 'Y', 0, '2014-01-23', NULL, NULL, 0, 0, NULL, NULL),
('202695346', 'W12043556', 'W12043556', 'UT01', 'North Valley Anesthesia', 'Norman', 'C', 'Ritchie', 'MD', 'Anesthesia', '', '', NULL, 'B', 'PO Box 3810', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8014322609', '          ', 'PO Box 3810', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8014322609', '          ', '', '', '', '57.00', '25.00', '0.00', 6, '2015-07-01', NULL, 0, 12, 0, '', '', '', '', 'HCFA|UB|', '1316081532', 0, 'Y', 0, '2014-06-23', NULL, NULL, 0, 0, NULL, NULL),
('202695346', 'W12043553', 'W12043553', 'UT01', 'North Valley Anesthesia', 'Norman', 'C', 'Ritchie', 'MD', 'Anesthesia', '', '', NULL, 'B', 'PO Box 3810', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8014322609', NULL, 'PO Box 3810', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8014322609', '          ', '', '', '', '55.00', '25.00', '0.00', 6, '2013-08-01', '2014-06-30', 0, 12, 0, '', '', '', '', 'HCFA|UB|', '1316081532', 0, 'Y', 0, '2014-01-23', NULL, NULL, 0, 0, NULL, NULL),
('202695346', 'W12043552', 'W12043552', 'UT01', 'North Valley Anesthesia', 'Michael', 'R', 'Thygerson', 'CRNA', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 3810', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8014322609', '          ', 'PO Box 3810', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8014322609', '          ', '', '', '', '47.00', '25.00', '0.00', 6, '2015-07-01', NULL, 0, 12, 0, '', '', '', '', 'HCFA|UB|', '1144319849', 0, 'Y', 0, '2014-06-23', NULL, NULL, 0, 0, NULL, NULL),
('202695346', 'W12043551', 'W12043551', 'UT01', 'North Valley Anesthesia', 'Michael', 'R', 'Thygerson', 'CRNA', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 3810', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8014322609', NULL, 'PO Box 3810', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8014322609', '          ', '', '', '', '46.00', '25.00', '0.00', 6, '2014-07-01', '2015-06-30', 0, 12, 0, '', '', '', '', 'HCFA|UB|', '1144319849', 0, 'Y', 0, '2014-01-23', NULL, NULL, 0, 0, NULL, NULL),
('202695346', 'W12043550', 'W12043550', 'UT01', 'North Valley Anesthesia', 'Michael', 'R', 'Thygerson', 'CRNA', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 3810', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8014322609', NULL, 'PO Box 3810', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8014322609', '          ', '', '', '', '45.00', '25.00', '0.00', 6, '2013-08-01', '2014-06-30', 0, 12, 0, '', '', '', '', 'HCFA|UB|', '1144319849', 0, 'Y', 0, '2014-01-23', NULL, NULL, 0, 0, NULL, NULL),
('202695346', 'W12043548', 'W12043548', 'UT01', 'North Valley Anesthesia', 'Graham', 'B', 'Prime', 'CRNA', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 3810', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8014322609', '          ', 'PO Box 3810', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8014322609', '          ', '', '', '', '47.00', '25.00', '0.00', 6, '2015-07-01', NULL, 0, 12, 0, '', '', '', '', 'HCFA|UB|', '1255686259', 0, 'Y', 0, '2014-06-23', NULL, NULL, 0, 0, NULL, NULL),
('202695346', 'W12043547', 'W12043547', 'UT01', 'North Valley Anesthesia', 'Graham', 'B', 'Prime', 'CRNA', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 3810', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8014322609', NULL, 'PO Box 3810', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8014322609', '          ', '', '', '', '46.00', '25.00', '0.00', 6, '2014-07-01', '2015-06-30', 0, 12, 0, '', '', '', '', 'HCFA|UB|', '1255686259', 0, 'Y', 0, '2014-01-23', NULL, NULL, 0, 0, NULL, NULL),
('202695346', 'W12043546', 'W12043546', 'UT01', 'North Valley Anesthesia', 'Graham', 'B', 'Prime', 'CRNA', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 3810', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8014322609', NULL, 'PO Box 3810', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8014322609', '          ', '', '', '', '45.00', '25.00', '0.00', 6, '2013-08-01', '2014-06-30', 0, 12, 0, '', '', '', '', 'HCFA|UB|', '1255686259', 0, 'Y', 0, '2014-01-23', NULL, NULL, 0, 0, NULL, NULL),
('202695346', 'W12043544', 'W12043544', 'UT01', 'North Valley Anesthesia', 'Brian', 'M', 'Matthews', 'CRNA', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 3810', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8014322609', '          ', 'PO Box 3810', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8014322609', '          ', '', '', '', '47.00', '25.00', '0.00', 6, '2015-07-01', NULL, 0, 12, 0, '', '', '', '', 'HCFA|UB|', '1750619052', 0, 'Y', 0, '2014-06-23', NULL, NULL, 0, 0, NULL, NULL),
('202695346', 'W12043542', 'W12043542', 'UT01', 'North Valley Anesthesia', 'Brian', 'M', 'Matthews', 'CRNA', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 3810', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8014322609', NULL, 'PO Box 3810', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8014322609', '          ', '', '', '', '45.00', '25.00', '0.00', 6, '2013-08-01', '2014-06-30', 0, 12, 0, '', '', '', '', 'HCFA|UB|', '1750619052', 0, 'Y', 0, '2014-01-23', NULL, NULL, 0, 0, NULL, NULL),
('202695346', 'W12043540', 'W12043540', 'UT01', 'North Valley Anesthesia', 'Tyler', '', 'Leifson', 'CRNA', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 3810', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8014322609', '          ', 'PO Box 3810', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8014322609', '          ', '', '', '', '47.00', '25.00', '0.00', 6, '2015-07-01', NULL, 0, 12, 0, '', '', '', '', 'HCFA|UB|', '1912202003', 0, 'Y', 0, '2014-06-23', NULL, NULL, 0, 0, NULL, NULL),
('202695346', 'W12043543', 'W12043543', 'UT01', 'North Valley Anesthesia', 'Brian', 'M', 'Matthews', 'CRNA', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 3810', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8014322609', NULL, 'PO Box 3810', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8014322609', '          ', '', '', '', '46.00', '25.00', '0.00', 6, '2014-07-01', '2015-06-30', 0, 12, 0, '', '', '', '', 'HCFA|UB|', '1750619052', 0, 'Y', 0, '2014-01-23', NULL, NULL, 0, 0, NULL, NULL),
('202695346', 'W12043539', 'W12043539', 'UT01', 'North Valley Anesthesia', 'Tyler', '', 'Leifson', 'CRNA', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 3810', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8014322609', NULL, 'PO Box 3810', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8014322609', '          ', '', '', '', '46.00', '25.00', '0.00', 6, '2014-07-01', '2015-06-30', 0, 12, 0, '', '', '', '', 'HCFA|UB|', '1912202003', 0, 'Y', 0, '2014-01-23', NULL, NULL, 0, 0, NULL, NULL),
('202695346', 'W12043538', 'W12043538', 'UT01', 'North Valley Anesthesia', 'Tyler', '', 'Leifson', 'CRNA', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 3810', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8014322609', NULL, 'PO Box 3810', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8014322609', '          ', '', '', '', '45.00', '25.00', '0.00', 6, '2013-08-01', '2014-06-30', 0, 12, 0, '', '', '', '', 'HCFA|UB|', '1912202003', 0, 'Y', 0, '2014-01-23', NULL, NULL, 0, 0, NULL, NULL),
('202695346', 'W12043535', 'W12043535', 'UT01', 'North Valley Anesthesia', 'Michael', 'R', 'Blaney', 'CRNA', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 3810', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8014322609', '          ', 'PO Box 3810', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8014322609', '          ', '', '', '', '47.00', '25.00', '0.00', 6, '2015-07-01', NULL, 0, 12, 0, '', '', '', '', 'HCFA|UB|', '1225302938', 0, 'Y', 0, '2014-06-23', NULL, NULL, 0, 0, NULL, NULL),
('202695346', 'W12043534', 'W12043534', 'UT01', 'North Valley Anesthesia', 'Michael', 'R', 'Blaney', 'CRNA', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 3810', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8014322609', NULL, 'PO Box 3810', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8014322609', '          ', '', '', '', '46.00', '25.00', '0.00', 6, '2014-07-01', '2015-06-30', 0, 12, 0, '', '', '', '', 'HCFA|UB|', '1225302938', 0, 'Y', 0, '2014-01-23', NULL, NULL, 0, 0, NULL, NULL),
('202695346', 'W12043533', 'W12043533', 'UT01', 'North Valley Anesthesia', 'Michael', 'R', 'Blaney', 'CRNA', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 3810', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8014322609', NULL, 'PO Box 3810', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8014322609', '          ', '', '', '', '45.00', '25.00', '0.00', 6, '2013-08-01', '2014-06-30', 0, 12, 0, '', '', '', '', 'HCFA|UB|', '1225302938', 0, 'Y', 0, '2014-01-23', NULL, NULL, 0, 0, NULL, NULL),
('020752585', 'W12043531', 'W12043531', 'TXSATSTD', 'Steven Hillburn', 'Steven', '', 'Hillburn', 'MD', 'Pulmonary', '', '', NULL, 'M', 'PO Box 65140', 'San Antonio', 'Bexar', 'TX', '78265', '2106563600', '2106563603', 'PO Box 65140', 'San Antonio', 'Bexar', 'TX', '78265', '2106563600', '2106563603', 'TXSTD', 'TXHCPC13', '', '50.00', '0.00', '0.00', 3, '2014-03-10', NULL, 0, 0, 0, 'North East Baptist Hospital', NULL, '', '', 'HCFA|', '1013199512', 0, 'N', 0, '2014-02-10', NULL, NULL, 0, 0, NULL, NULL),
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('743003947', 'W12045305', 'W12045305', 'TXSATSTD', 'The San Antonio Orthopaedic Group', 'Scott', 'R', 'Seidel', 'DC', 'Chiropractic', '', '', NULL, 'O', '150 E Sonterra Blvd Ste 300', 'San Antonio', 'Bexar', 'TX', '78258', '2103965310', '          ', '150 E Sonterra Blvd Ste 300', 'San Antonio', 'Bexar', 'TX', '78258', '2103965310', '          ', 'TXORTHO', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2014-03-07', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1316097819', 0, 'Y', 0, '2014-04-01', NULL, NULL, 0, 0, NULL, NULL),
('204543044', 'W12045302', 'W12045302', 'TXSATSTD', 'John Mastrovich MD PA', 'John', 'D', 'Mastrovich', 'MD', 'Allergy and Immunology', '', '', NULL, 'O', '20650 Stone Oak Pkwy Ste 106', 'San Antonio', 'Bexar', 'TX', '78258', '2103426200', '2103426201', '20650 Stone Oak Pkwy Ste 106', 'San Antonio', 'Bexar', 'TX', '78258', '2103426200', '2103426201', 'TXSTD', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2014-04-18', NULL, 0, 0, 0, 'North Central Baptist Hospital', NULL, '', '', 'HCFA|UB|', '1740205418', 0, 'N', 0, '2014-03-18', NULL, NULL, 0, 0, NULL, NULL),
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('741880422', 'W12045297', 'W12045297', 'TXSATSTD', 'Colon and Rectal Surgical Associates of San Antonio', 'Clark', 'M', 'Kardys', 'MD', 'Colon and Rectal Surgery', '', '', NULL, 'O', '7950 Floyd Curl Dr Ste 101', 'San Antonio', 'Bexar', 'TX', '78229', '2106140880', '2106150258', '7950 Floyd Curl Dr Ste 101', 'San Antonio', 'Bexar', 'TX', '78229', '2106140880', '2106150258', 'TXSTD', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2014-04-18', NULL, 0, 0, 0, 'Baptist Medical Center', NULL, '', '', 'HCFA|UB|', '1578763009', 0, 'N', 0, '2014-03-18', NULL, NULL, 0, 0, NULL, NULL),
('741880422', 'W12045290', 'W12045290', 'TXSATSTD', 'Colon and Rectal Surgical Associates of San Antonio', '', '', 'Colon and Rectal Surgical Associates of San Antonio', '', 'Colon and Rectal Surgery', '', '', NULL, 'O', '7950 Floyd Curl Dr Ste 101', 'San Antonio', 'Bexar', 'TX', '78229', '2106140880', '2106150258', '7950 Floyd Curl Dr Ste 101', 'San Antonio', 'Bexar', 'TX', '78229', '2106140880', '2106150258', 'TXSTD', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2014-04-18', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000010160', 0, 'Y', 0, '2014-03-18', NULL, NULL, 0, 0, NULL, NULL),
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('201635551', 'W12045288', 'W12045288', 'Test', '', 'Test', 'Test', 'Testing', 'TEST', 'Test', 'Test', 'Test', NULL, 'B', 'Test @123 Test St Ste Test', 'West Jordan', 'Salt Lake', 'UT', '84084', '800434TEST', '', 'Test @123 Test St Ste Test', 'West Jordan', 'Salt Lake', 'UT', '84084', '800434TEST', '', '', '', '5005', '0.00', '15.00', '0.00', 8, '2014-03-01', NULL, 0, 0, 0, 'San Juan Hospital', '', '', '', 'HCFA|UB|', '0000000001', 0, 'N', 0, '2014-07-23', NULL, NULL, 0, 0, NULL, NULL),
('161767581', 'W12045285', 'W12045285', 'UT01', 'Layton Family Practice', '', '', 'Layton Family Practice', 'GROUP', 'Family Practice', '', '', NULL, 'B', 'PO Box 281221', 'Brentwood', 'Williamson', 'TN', '37027', '8015469441', NULL, 'PO Box 281221', 'Brentwood', 'Williamson', 'TN', '37027', '8015469441', '          ', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1538220306', 0, 'N', 0, '2014-03-06', NULL, NULL, 0, 0, NULL, NULL),
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('262345602', 'W12045217', 'W12045217', 'TXDALSTD', 'James Gallant ', 'James', 'F', 'Gallant', 'MD', 'Family Practice', '', '', NULL, 'O', '2351 S FM 51 Ste 100', 'Decatur', 'Wise', 'TX', '76234', '9406262110', '9406262113', '2351 S FM 51 Ste 100', 'Decatur', 'Wise', 'TX', '76234', '9406262110', '9406262113', 'DALLAS1', 'TXHCPC13', '', '0.00', '50.00', '0.00', 6, '2014-04-18', NULL, 0, 0, 0, NULL, NULL, '', '', 'HCFA|UB|DEN|', '1295712974', 0, 'N', 0, '2014-03-26', NULL, NULL, 0, 0, NULL, NULL),
('742910790', 'W12045280', 'W12045280', 'TXSATSTD', '', 'Mario', '', 'Bustamante', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '12770 Cimarron Path Ste 132', 'San Antonio', 'Bexar', 'TX', '78249', '2106143900', '2106147270', '12770 Cimarron Path Ste 132', 'San Antonio', 'Bexar', 'TX', '78249', '2106143900', '2106147270', 'TXSTD', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2014-04-18', NULL, 0, 0, 0, 'Baptist Medical Center', NULL, '', '', 'HCAFA|UB|', '1972546109', 0, 'N', 0, '2014-03-18', NULL, NULL, 0, 0, NULL, NULL),
('462016704', 'W12045281', 'W12045281', 'TXSATSTD', '', 'Juan', 'C', 'Garza', 'MD', 'Family Practice', '', '', NULL, 'O', '4318 Moonlight', 'San Antonio', 'Bexar', 'TX', '78230', '2105588878', '2105589389', '4318 Moonlight', 'San Antonio', 'Bexar', 'TX', '78230', '2105588878', '2105589389', 'TXSTD', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2014-04-18', NULL, 0, 0, 0, 'Baptist Medical Center', NULL, '', '', 'HCFA|UB|', '1639419153', 0, 'N', 0, '2014-03-18', NULL, NULL, 0, 0, NULL, NULL),
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('202220792', 'W12045277', 'W12045277', 'UT01', 'Precision EMG PLLC', 'Bryan', 'F', 'Child', 'PT', 'Physical Therapy', '', '', NULL, 'O', '3225 W Gordon Ave', 'Layton', 'Davis', 'UT', '84041', '8017252380', '8016755103', '3225 W Gordon Ave', 'Layton', 'Davis', 'UT', '84041', '8017252380', '8016755103', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1639360050', 0, 'N', 0, '2014-03-14', NULL, NULL, 0, 0, NULL, NULL),
('820472975', 'W12045276', 'W12045276', 'ID02', 'Elmore County Eyecare', 'Nathan', 'C', 'Price', 'OD', 'Optometry', '', '', NULL, 'O', '855 W 6th S', 'Mountain Home', 'Elmore', 'ID', '83647', '2085872020', NULL, '855 W 6th S', 'Mountain Home', 'Elmore', 'ID', '83647', '2085872020', '          ', 'IDOPTOMETRY', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-02-27', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1316038409', 0, 'N', 0, '2014-03-05', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12045275', 'W12045275', 'WYBILLINGS', 'Billings Clinic', 'Kacie', 'T', 'Robertus', 'NP', 'Family Practice', '', '', NULL, 'M', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', '0000000000', '0000000000', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', '0000000000', '0000000000', '', '', '', '0.00', '17.00', '0.00', 3, '2014-03-31', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1952615387', 0, 'N', 0, '2014-03-05', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12045273', 'W12045273', 'WYBILLINGS', 'Billings Clinic - Heights Clinic', 'Kacie', 'T', 'Robertus', 'NP', 'Family Practice', '', '', NULL, 'O', '760 Wicks Ln', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062382586', '760 Wicks Ln', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062382586', '', '', '', '0.00', '17.00', '0.00', 3, '2014-03-31', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1952615387', 0, 'N', 0, '2014-03-05', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12045274', 'W12045274', 'WYBILLINGS', 'Billings Clinic', 'Kacie', 'T', 'Robertus', 'NP', 'Family Practice', '', '', NULL, 'B', 'PO Box 31315', 'Billings', 'Yellowstone', 'MT', '59107', '4062382617', '0000000000', 'PO Box 31315', 'Billings', 'Yellowstone', 'MT', '59107', '4062382617', '0000000000', '', '', '', '0.00', '17.00', '0.00', 3, '2014-03-31', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1952615387', 0, 'N', 0, '2014-03-05', NULL, NULL, 0, 0, NULL, NULL),
('205934739', 'W12045270', 'W12045270', 'ID02', 'Family Medicine Health Center', 'Christine', 'G', 'Hahn', 'MD', 'Family Practice', '', '', NULL, 'O', '6094 W Emerald St', 'Boise', 'Ada', 'ID', '83704', '2085142505', '2085142504', '6094 W Emerald St', 'Boise', 'Ada', 'ID', '83704', '2085142505', '2085142504', 'IDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1174781959', 0, 'N', 1, '2014-03-05', NULL, NULL, 0, 0, NULL, NULL),
('205934739', 'W12045271', 'W12045271', 'ID02', 'Family Medicine Health Center', 'Christine', 'G', 'Hahn', 'MD', 'Family Practice', '', '', NULL, 'B', '777 N Raymond St', 'Boise', 'Ada', 'ID', '83704', '2085142505', '2085142504', '777 N Raymond St', 'Boise', 'Ada', 'ID', '83704', '2085142505', '2085142504', 'IDPPO', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1174781959', 0, 'N', 1, '2014-03-05', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W12045262', 'W12045262', 'UT01', '', 'Zoe', '', 'Robbins', 'APRN', 'Neurology', '', '', NULL, 'O', '3460 S Pioneer Pkwy 5th Fl', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019643100', NULL, '3460 S Pioneer Pkwy 5th Fl', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019643100', '          ', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-08-19', '2014-04-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1134321508', 0, 'N', 0, '2014-03-13', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W12045263', 'W12045263', 'UT01', 'Pioneer Valley Hospital Outpatient Behavioral Health Unit', 'Zoe', '', 'Robbins', 'APRN', 'Neurology', '', '', NULL, 'B', 'PO Box 281201', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', 'PO Box 281201', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-08-19', '2014-04-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1134321508', 0, 'N', 0, '2014-03-13', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W12045264', 'W12045264', 'UT01', 'Jordan Valley Neurology Associates', 'Thomas ', 'M', 'Buchanan', 'MD', 'Neurology', '', '', NULL, 'O', '3665 S 8400 W Ste 206', 'Magna', 'Salt Lake', 'UT', '84044', '8013528373', '8013528459', '3665 S 8400 W Ste 206', 'Magna', 'Salt Lake', 'UT', '84044', '8013528373', '8013528459', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2014-04-01', '2014-04-30', 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1710162227', 0, 'N', 0, '2014-03-13', NULL, NULL, 0, 0, NULL, NULL),
('836000295', 'W12045266', 'W12045266', 'WY01', 'Memorial Hospital of Sweetwater County', 'David', 'R', 'Dansie', 'DO', 'Family Practice', '', '', NULL, 'O', '1180 College Dr', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073528125', '3073528126', '1180 College Dr', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073528125', '3073528126', '', '', '', '0.00', '5.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1184889982', 0, 'N', 0, '2014-04-21', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W12045261', 'W12045261', 'UT01', 'Pioneer Valley Hospital Outpatient Behavioral Health Unit', 'Zoe', '', 'Robbins', 'APRN', 'Neurology', '', '', NULL, 'O', '4052 W Pioneer Pkwy Ste 105', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019643111', '8019643752', '4052 W Pioneer Pkwy Ste 105', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019643111', '8019643752', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-08-19', '2014-04-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1134321508', 0, 'N', 0, '2014-03-13', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W12045265', 'W12045265', 'UT01', 'Jordan Valley Neurology Associates', 'Rebecca', 'H', 'Reiser', 'MD', 'Neurology', '', '', NULL, 'O', '3665 S 8400 W Ste 206', 'Magna', 'Salt Lake', 'UT', '84044', '8013528373', '8013528459', '3665 S 8400 W Ste 206', 'Magna', 'Salt Lake', 'UT', '84044', '8013528373', '8013528459', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2014-04-01', '2014-04-30', 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1639336795', 0, 'N', 0, '2014-03-05', NULL, NULL, 0, 0, NULL, NULL),
('810587644', 'W12045258', 'W12045258', 'UT01', 'Cache Valley Community Health Ctr', 'Colby', '', 'Martin', 'PA', 'Family Practice', '', '', NULL, 'O', '26 W Main St Ste 3A', 'Hyrum', 'Cache', 'UT', '84319', '4352456988', '4352456987', '26 W Main St Ste 3A', 'Hyrum', 'Cache', 'UT', '84319', '4352456988', '4352456987', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-02-27', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1982033098', 0, 'N', 0, '2014-05-15', NULL, NULL, 0, 0, NULL, NULL),
('810587644', 'W12045259', 'W12045259', 'UT01', 'Bear Lake Community Health Center', 'Colby', '', 'Martin', 'PA', 'Family Practice', '', '', NULL, 'O', '325 W Logan Hwy', 'Garden City', 'Rich', 'UT', '84028', '4359463660', '4359468215', '325 W Logan Hwy', 'Garden City', 'Rich', 'UT', '84028', '4359463660', '4359468215', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-02-27', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1982033098', 0, 'N', 0, '2014-05-15', NULL, NULL, 0, 0, NULL, NULL),
('550896484', 'W12045250', 'W12045250', 'TXDALSTD', 'Donald Ozumba MD PA', 'Donald', '', 'Ozumba', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '8080 State Hwy 121 Ste 320', 'Mckinney', 'Collin', 'TX', '75070', '2147070034', '2147053640', '8080 State Hwy 121 Ste 320', 'Mckinney', 'Collin', 'TX', '75070', '2147070034', '2147053640', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, 'Baylor Medical Center at McKinney', NULL, '', '', 'HCFA|UB|', '1083615223', 0, 'N', 0, '2014-04-25', NULL, NULL, 0, 0, NULL, NULL),
('550896484', 'W12045251', 'W12045251', 'TXDALSTD', 'Donald Ozumba MD PA', 'Donald', '', 'Ozumba', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', 'PO Box 678388', 'Dallas', 'Dallas', 'TX', '75267', '2147070034', '2147053640', 'PO Box 678388', 'Dallas', 'Dallas', 'TX', '75267', '2147070034', '2147053640', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, 'Baylor Medical Center at McKinney', NULL, '', '', 'HCFA|UB|', '1083615223', 0, 'N', 0, '2014-04-25', NULL, NULL, 0, 0, NULL, NULL),
('205497151', 'W12045253', 'W12045253', 'TXDALSTD', 'The Orthopedic and Sports Medicine Institute', 'Richard', 'P', 'Wilson', 'MD', 'Sports Medicine', '', '', NULL, 'O', '6049 S Hulen St Ste 101', 'Fort Worth', 'Tarrant', 'TX', '76132', '8175291900', '8175291910', '6049 S Hulen St Ste 101', 'Fort Worth', 'Tarrant', 'TX', '76132', '8175291900', '8175291910', 'TIOPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 6, '2014-04-01', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', NULL, '', '', 'HCFA|UB', '1497923536', 0, 'N', 0, '2014-03-05', NULL, NULL, 0, 0, NULL, NULL),
('752312767', 'W12045255', 'W12045255', 'TXDALSTD', 'Gregory Phillips MD', 'Gregory', '', 'Phillips', 'MD', 'Internal Medicine', '', '', NULL, 'O', '724 Pennsylvania Ave', 'Fort Worth', 'Tarrant', 'TX', '76104', '8173361200', '8173384707', '724 Pennsylvania Ave', 'Fort Worth', 'Tarrant', 'TX', '76104', '8173361200', '8173384707', 'TIOPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', NULL, '', '', 'HCFA|UB|', '1699705152', 0, 'N', 0, '2014-03-05', NULL, NULL, 0, 0, NULL, NULL),
('752312767', 'W12045256', 'W12045256', 'TXDALSTD', 'Gregory Phillips MD', 'Gregory', '', 'Phillips', 'MD', 'Internal Medicine', '', '', NULL, 'B', '1050 Fifth Ave Ste J', 'Fort Worth', 'Tarrant', 'TX', '76104', '8173361200', '8173384707', '1050 Fifth Ave Ste J', 'Fort Worth', 'Tarrant', 'TX', '76104', '8173361200', '8173384707', 'TIOPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', NULL, '', '', 'HCFA|UB|', '1699705152', 0, 'N', 0, '2014-03-05', NULL, NULL, 0, 0, NULL, NULL),
('810587644', 'W12045260', 'W12045260', 'UT01', 'Cache Valley Community Health Ctr', 'Colby', '', 'Martin', 'PA', 'Family Practice', '', '', NULL, 'B', '1515 N 400 E Ste 104', 'Logan', 'Cache', 'UT', '84341', '0000000000', '          ', '1515 N 400 E Ste 104', 'Logan', 'Cache', 'UT', '84341', '0000000000', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-02-27', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1982033098', 0, 'N', 0, '2014-05-15', NULL, NULL, 0, 0, NULL, NULL),
('463233444', 'W12045246', 'W12045246', 'TXDALSTD', 'Questcare Medical Clinics', 'Matthew', 'S', 'Opalach', 'DO', 'Family Practice', '', '', NULL, 'O', '3215 Omega Dr', 'Arlington', 'Tarrant', 'TX', '76014', '2142171911', '2142171912', '3215 Omega Dr', 'Arlington', 'Tarrant', 'TX', '76014', '2142171911', '2142171912', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1316164403', 0, 'N', 0, '2014-03-05', NULL, NULL, 0, 0, NULL, NULL),
('463233444', 'W12045248', 'W12045248', 'TXDALSTD', 'Questcare Medical Clinics', 'Matthew', 'S', 'Opalach', 'DO', 'Family Practice', '', '', NULL, 'M', '12221 Merit Dr Ste 1610', 'Dallas', 'Dallas', 'TX', '75251', '2142171911', '2142171912', '12221 Merit Dr Ste 1610', 'Dallas', 'Dallas', 'TX', '75251', '2142171911', '2142171912', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1316164403', 0, 'N', 0, '2014-03-05', NULL, NULL, 0, 0, NULL, NULL),
('752943993', 'W12045242', 'W12045242', 'TXDALSTD', 'North Texas Kidney Disease Associates', 'Nandana', '', 'Mapakshi', 'MD', 'Nephrology', '', '', NULL, 'B', 'PO Box 650097', 'Dallas', 'Dallas', 'TX', '75265', '9722190558', '9724369273', 'PO Box 650097', 'Dallas', 'Dallas', 'TX', '75265', '9722190558', '9724369273', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, 'Baylor Medical Center at Carrollton', NULL, '', '', 'HCFA|UB|', '1710187125', 0, 'N', 0, '2014-03-05', NULL, NULL, 0, 0, NULL, NULL),
('300685412', 'W12045244', 'W12045244', 'TXDALSTD', 'Premium Choice Health Care', 'R Greg', '', 'Maul', 'DO', 'Family Practice', '', '', NULL, 'O', '5700 Rowlett Rd Ste 140', 'Rowlett', 'Dallas', 'TX', '75089', '2145011410', '2145011411', '5700 Rowlett Rd Ste 140', 'Rowlett', 'Dallas', 'TX', '75089', '2145011410', '2145011411', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, NULL, NULL, '', '', 'HCFA|UB|', '1285671891', 0, 'N', 0, '2014-03-05', NULL, NULL, 0, 0, NULL, NULL),
('463233444', 'W12045247', 'W12045247', 'TXDALSTD', 'Questcare Medical Clinics', 'Matthew', 'S', 'Opalach', 'DO', 'Family Practice', '', '', NULL, 'B', '2929 N Central Expy Ste 300', 'Richardson', 'Dallas', 'TX', '75080', '9727583598', '9725999604', '2929 N Central Expy Ste 300', 'Richardson', 'Dallas', 'TX', '75080', '9727583598', '9725999604', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1316164403', 0, 'N', 0, '2014-03-05', NULL, NULL, 0, 0, NULL, NULL),
('752943993', 'W12045243', 'W12045243', 'TXDALSTD', 'North Texas Kidney Disease Associates', 'Nandana', '', 'Mapakshi', 'MD', 'Nephrology', '', '', NULL, 'M', '1600 Waters Ridge Ste A', 'Lewisville', 'Denton', 'TX', '75057', '9722190558', '9724369273', '1600 Waters Ridge Ste A', 'Lewisville', 'Denton', 'TX', '75057', '9722190558', '9724369273', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, 'Baylor Medical Center at Carrollton', NULL, '', '', 'HCFA|UB|', '1710187125', 0, 'N', 0, '2014-03-05', NULL, NULL, 0, 0, NULL, NULL),
('463971151', 'W12045238', 'W12045238', 'TXDALSTD', 'DFW Premier Healthcare PA', 'Pierre', 'E', 'Laughton', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1650 W College St', 'Grapevine', 'Tarrant', 'TX', '76051', '8174811588', '0000000000', '1650 W College St', 'Grapevine', 'Tarrant', 'TX', '76051', '8174811588', '0000000000', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Grapevine', NULL, NULL, NULL, 'HCFA|UB', '1578523999', 0, 'N', 0, '2014-03-05', NULL, NULL, 0, 0, NULL, NULL),
('752943993', 'W12045241', 'W12045241', 'TXDALSTD', 'North Texas Kidney Disease Associates', 'Nandana', '', 'Mapakshi', 'MD', 'Nephrology', '', '', NULL, 'O', '4240 International Pkwy Ste 154', 'Carrollton', 'Denton', 'TX', '75007', '4695740464', '4695740471', '4240 International Pkwy Ste 154', 'Carrollton', 'Denton', 'TX', '75007', '4695740464', '4695740471', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, 'Baylor Medical Center at Carrollton', NULL, '', '', 'HCFA|UB|', '1710187125', 0, 'N', 0, '2014-03-05', NULL, NULL, 0, 0, NULL, NULL),
('463971151', 'W12045239', 'W12045239', 'TXDALSTD', 'DFW Premier Healthcare PA', 'Pierre', 'E', 'Laughton', 'MD', 'Internal Medicine', '', '', NULL, 'B', '4844 Sangers Ct', 'Keller', 'Tarrant', 'TX', '76244', '8174811588', '0000000000', '4844 Sangers Ct', 'Keller', 'Tarrant', 'TX', '76244', '8174811588', '0000000000', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Grapevine', NULL, NULL, NULL, 'HCFA|UB', '1578523999', 0, 'N', 0, '2014-03-05', NULL, NULL, 0, 0, NULL, NULL),
('463402552', 'W12045237', 'W12045237', 'TXDALSTD', 'melanie B Kinchen MD PA', 'Melanie', 'B', 'Kinchen', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '651 S Main St Ste 100', 'Keller', 'Tarrant', 'TX', '76248', '8175890393', '8174884493', '651 S Main St Ste 100', 'Keller', 'Tarrant', 'TX', '76248', '8175890393', '8174884493', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, 'Baylor Medical Center at Trophy Club', NULL, '', '', 'HCFA|UB|', '1134142029', 0, 'N', 0, '2014-04-25', NULL, NULL, 0, 0, NULL, NULL),
('463402552', 'W12045236', 'W12045236', 'TXDALSTD', 'melanie B Kinchen MD PA', 'Melanie', 'B', 'Kinchen', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1600 W College St Ste 685', 'Grapevine', 'Tarrant', 'TX', '76051', '6822231406', '6822231346', '1600 W College St Ste 685', 'Grapevine', 'Tarrant', 'TX', '76051', '6822231406', '6822231346', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, 'Baylor Medical Center at Trophy Club', NULL, '', '', 'HCFA|UB|', '1134142029', 0, 'N', 0, '2014-04-25', NULL, NULL, 0, 0, NULL, NULL),
('463401227', 'W12045233', 'W12045233', 'TXDALSTD', 'Covenant Surgery Associates', 'Franchell', 'R', 'Hamilton', 'MD', 'General Surgery', '', '', NULL, 'O', '306 E Randall Mill Rd Ste 136', 'Arlington', 'Tarrant', 'TX', '76011', '8172242292', '8009584717', '306 E Randall Mill Rd Ste 136', 'Arlington', 'Tarrant', 'TX', '76011', '8172242292', '8009584717', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, 'Baylor Medical Center at Trophy Club', NULL, '', '', 'HCFA|UB|', '1649431453', 0, 'N', 0, '2014-04-25', NULL, NULL, 0, 0, NULL, NULL),
('463401227', 'W12045234', 'W12045234', 'TXDALSTD', 'Covenant Surgery Associates', 'Franchell', 'R', 'Hamilton', 'MD', 'General Surgery', '', '', NULL, 'B', 'PO Box 201698', 'Arlington', 'Tarrant', 'TX', '76006', '8172242292', '8009584717', 'PO Box 201698', 'Arlington', 'Tarrant', 'TX', '76006', '8172242292', '8009584717', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, 'Baylor Medical Center at Trophy Club', NULL, '', '', 'HCFA|UB|', '1649431453', 0, 'N', 0, '2014-04-25', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'W12045229', 'W12045229', 'TXDALSTD', 'Baylor Internal Medicine Associates at Baylor', 'Joel', 'M', 'Brown', 'MD', 'Internal Medicine', '', '', NULL, 'O', '3608 Preston Rd Ste 105', 'Plano', 'Collin', 'TX', '75093', '9725963201', '9728673325', '3608 Preston Rd Ste 105', 'Plano', 'Collin', 'TX', '75093', '9725963201', '9728673325', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1134294457', 0, 'Y', 0, '2014-03-05', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'W12045223', 'W12045223', 'TXDALSTD', '', 'Krishna', 'C', 'Tatineni', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1336300631', 0, 'Y', 0, '2014-03-05', NULL, NULL, 0, 0, NULL, NULL),
('911947573', 'W12045225', 'W12045225', 'TXDALSTD', 'MedProvider Inpatient Care Unit', 'Hema', '', 'Atluri', 'MD', 'Internal Medicine', '', '', NULL, 'O', '3500 Gaston Ave Roberts Tower 4th Fl', 'Dallas', 'Dallas', 'TX', '75246', '2148203000', '2148203022', '3500 Gaston Ave Roberts Tower 4th Fl', 'Dallas', 'Dallas', 'TX', '75246', '2148203000', '2148203022', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1548450786', 0, 'Y', 0, '2014-03-05', NULL, NULL, 0, 0, NULL, NULL),
('911947573', 'W12045226', 'W12045226', 'TXDALSTD', 'MedProvider Inpatient Care Unit', 'Hema', '', 'Atluri', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 842001', 'Dallas', 'Dallas', 'TX', '75284', '2148203000', '2148203022', 'PO Box 842001', 'Dallas', 'Dallas', 'TX', '75284', '2148203000', '2148203022', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1548450786', 0, 'Y', 0, '2014-03-05', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'W12045228', 'W12045228', 'TXDALSTD', 'Baylor Internal Medicine Associates at Baylor', 'Joel', 'M', 'Brown', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1134294457', 0, 'N', 0, '2014-03-11', NULL, NULL, 0, 0, NULL, NULL),
('464201408', 'W12045231', 'W12045231', 'TXDALSTD', 'Noushin A Firouzbakht MD PA', 'Noushin', 'A', 'Firouzbakht', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1325 Pennsylvania Ave Ste 350', 'Fort Worth', 'Tarrant', 'TX', '76104', '8179242216', '8179245602', '1325 Pennsylvania Ave Ste 350', 'Fort Worth', 'Tarrant', 'TX', '76104', '8179242216', '8179245602', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', NULL, '', '', 'HCFA|UB|', '1417154634', 0, 'N', 0, '2014-04-25', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'W12045222', 'W12045222', 'TXDALSTD', '', 'Krishna', 'C', 'Tatineni', 'MD', 'Internal Medicine', '', '', NULL, 'O', '700 Walter Reed Blvd Ste 301B', 'Garland', 'Dallas', 'TX', '75042', '9724875462', '9724875277', '700 Walter Reed Blvd Ste 301B', 'Garland', 'Dallas', 'TX', '75042', '9724875462', '9724875277', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1336300631', 0, 'Y', 0, '2014-03-05', NULL, NULL, 0, 0, NULL, NULL),
('911947573', 'W12045219', 'W12045219', 'TXDALSTD', '', 'Muzakeer', '', 'Shaik', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1405 W Jefferson St', 'Waxahachie', 'Ellis', 'TX', '75165', '9729237144', '9729237145', '1405 W Jefferson St', 'Waxahachie', 'Ellis', 'TX', '75165', '9729237144', '9729237145', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1114969300', 0, 'Y', 0, '2014-03-05', NULL, NULL, 0, 0, NULL, NULL),
('611632192', 'W12045216', 'W12045216', 'WYT1', 'Cloud Peak Chiropractic', 'Sarah', 'E', 'Radabaugh', 'DC', 'Chiropractic', '', '', NULL, 'O', '1511 Charles Ave', 'Worland', 'Washakie', 'WY', '82401', '3073473500', '3073474893', '1511 Charles Ave', 'Worland', 'Washakie', 'WY', '82401', '3073473500', '3073474893', 'WYCHIRO13', '', '', '0.00', '40.00', '0.00', 3, '2014-03-04', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1144349598', 0, 'N', 0, '2014-06-11', NULL, NULL, 0, 0, NULL, NULL),
('911947573', 'W12045220', 'W12045220', 'TXDALSTD', '', 'Muzakeer', '', 'Shaik', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 842001', 'Dallas', 'Dallas', 'TX', '75284', '9729237144', '9729237145', 'PO Box 842001', 'Dallas', 'Dallas', 'TX', '75284', '9729237144', '9729237145', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1114969300', 0, 'Y', 0, '2014-03-05', NULL, NULL, 0, 0, NULL, NULL),
('611632192', 'W12045215', 'W12045215', 'WY01', 'Cloud Peak Chiropractic', 'Sarah', 'E', 'Radabaugh', 'DC', 'Chiropractic', '', '', NULL, 'O', '1511 Charles Ave', 'Worland', 'Washakie', 'WY', '82401', '3073473500', '3073474893', '1511 Charles Ave', 'Worland', 'Washakie', 'WY', '82401', '3073473500', '3073474893', 'WYCHIRO13', '', '', '0.00', '40.00', '0.00', 3, '2014-03-04', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1144349598', 0, 'N', 0, '2014-06-11', NULL, NULL, 0, 0, NULL, NULL),
('274676667', 'W12045207', 'W12045207', 'UT01', 'Sleep Institute Med Clinic', 'Seth', 'B', 'Wallace', 'MD', 'Family Practice', '', '', NULL, 'O', '2376 N 400 E Ste 201', 'Tooele', 'Tooele', 'UT', '84074', '8662275337', '8667166117', '2376 N 400 E Ste 201', 'Tooele', 'Tooele', 'UT', '84074', '8662275337', '8667166117', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2014-03-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', '', '', '', 'HCFA|UB|', '1245441971', 0, 'N', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('274676667', 'W12045206', 'W12045206', 'UT01', 'Sleep Institute Med Clinic', 'Seth', 'B', 'Wallace', 'MD', 'Family Practice', '', '', NULL, 'O', '5319 S Adams Ave Ste C', 'Ogden', 'Weber', 'UT', '84405', '8662275337', '8667166117', '5319 S Adams Ave Ste C', 'Ogden', 'Weber', 'UT', '84405', '8662275337', '8667166117', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2014-03-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', '', '', '', 'HCFA|UB|', '1245441971', 0, 'N', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('274676667', 'W12045205', 'W12045205', 'UT01', 'Sleep Institute Med Clinic', 'Seth', 'B', 'Wallace', 'MD', 'Family Practice', '', '', NULL, 'M', '8819 S Redwood Rd Ste B1', 'West Jordan', 'Salt Lake', 'UT', '84088', '0000000000', '0000000000', '8819 S Redwood Rd Ste B1', 'West Jordan', 'Salt Lake', 'UT', '84088', '0000000000', '0000000000', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2014-03-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', '', '', '', 'HCFA|UB|', '1245441971', 0, 'N', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('274676667', 'W12045203', 'W12045203', 'UT01', 'Sleep Institute Med Clinic', 'Seth', 'B', 'Wallace', 'MD', 'Family Practice', '', '', NULL, 'O', '5323 S Woodrow St Ste 205', 'Murray', 'Salt Lake', 'UT', '84107', '8662275337', '8667166117', '5323 S Woodrow St Ste 205', 'Murray', 'Salt Lake', 'UT', '84107', '8662275337', '8667166117', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2014-03-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', '', '', '', 'HCFA|UB|', '1245441971', 0, 'N', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('364037473', 'W12045199', 'W12045199', 'ILCHIGSTD', 'Elmhurst Memorial Hematology Oncology Services', 'Lucio', '', 'Di Nunno', 'MD', 'Oncology', '', '', NULL, 'B', 'Dept 4585', 'Carol Stream', 'Dupage', 'IL', '60122', '6307588640', '6307588642', 'Dept 4585', 'Carol Stream', 'Dupage', 'IL', '60122', '6307588640', '6307588642', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2014-02-25', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1639132343', 0, 'N', 0, '2014-03-11', NULL, NULL, 0, 0, NULL, NULL),
('364037473', 'W12045202', 'W12045202', 'ILCHIGSTD', 'Elmhurst Memorial Hematology Oncology Services', 'Marilyn', 'L', 'Evrard', 'MD', 'Oncology', '', '', NULL, 'O', '177 Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '3312215900', '3312213857', '177 Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '3312215900', '3312213857', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2014-02-25', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1760471031', 0, 'N', 0, '2014-03-04', NULL, NULL, 0, 0, NULL, NULL),
('364037473', 'W12045201', 'W12045201', 'ILCHIGSTD', 'Elmhurst Memorial Hematology Oncology Services', 'Marilyn', 'L', 'Evrard', 'MD', 'Oncology', '', '', NULL, 'B', 'Dept 4585', 'Carol Stream', 'Dupage', 'IL', '60122', '6307588640', '6307588642', 'Dept 4585', 'Carol Stream', 'Dupage', 'IL', '60122', '6307588640', '6307588642', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2014-02-25', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1760471031', 0, 'N', 0, '2014-03-04', NULL, NULL, 0, 0, NULL, NULL),
('274676667', 'W12045204', 'W12045204', 'UT01', 'Sleep Institute Med Clinic', 'Seth', 'B', 'Wallace', 'MD', 'Family Practice', '', '', NULL, 'O', '275 W 200 N Ste 202', 'Lindon', 'Utah', 'UT', '84042', '8662275337', '8667166117', '275 W 200 N Ste 202', 'Lindon', 'Utah', 'UT', '84042', '8662275337', '8667166117', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2014-03-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', '', '', '', 'HCFA|UB|', '1245441971', 0, 'N', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('364037473', 'W12045198', 'W12045198', 'ILCHIGSTD', 'Elmhurst Memorial Hematology Oncology Services', 'Amaryllis', '', 'Gil', 'MD', 'Oncology', '', '', NULL, 'B', 'Dept 4585', 'Carol Stream', 'Dupage', 'IL', '60122', '3312219099', '6309935661', 'Dept 4585', 'Carol Stream', 'Dupage', 'IL', '60122', '3312219099', '6309935661', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2014-02-25', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1235116591', 0, 'N', 0, '2014-03-04', NULL, NULL, 0, 0, NULL, NULL),
('364037473', 'W12045197', 'W12045197', 'ILCHIGSTD', 'Elmhurst Memorial Hematology Oncology Services', 'Amaryllis', '', 'Gil', 'MD', 'Oncology', '', '', NULL, 'O', '177 Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '3312215900', '3312213857', '177 Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '3312215900', '3312213857', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2014-02-25', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1235116591', 0, 'N', 0, '2014-03-04', NULL, NULL, 0, 0, NULL, NULL),
('364037473', 'W12045195', 'W12045195', 'ILCHIGSTD', 'Elmhurst Memorial Hematology Oncology Services', 'Lucio', '', 'Di Nunno', 'MD', 'Oncology', '', '', NULL, 'O', '177 Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '6307588640', '6307588642', '177 Brush Hill Rd', 'Elmhurst', 'Dupage', 'IL', '60126', '6307588640', '6307588642', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 3, '2014-02-25', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1639132343', 0, 'N', 0, '2014-03-04', NULL, NULL, 0, 0, NULL, NULL),
('836000295', 'W12045193', 'W12045193', 'WY01', 'Memorial Hospital General Surgery', 'Brianne', '', 'Crofts', 'MD', 'General Surgery', '', '', NULL, 'O', '1180 College Dr', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073528125', NULL, '1180 College Dr', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073528125', '          ', '', '', '', '0.00', '5.00', '0.00', 3, '2014-02-10', NULL, 0, 0, 0, 'Memorial Hospital of Sweetwater County', NULL, NULL, NULL, 'HCFA|UB|', '1457475451', 0, 'N', 0, '2014-03-11', NULL, NULL, 0, 0, NULL, NULL),
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('260553931', 'W12046048', 'W12046048', 'IDBOISTD', 'Saint Alphonsus Medical Group Heart Care', 'Steven', 'J', 'Fonken', 'MD', 'Cardiology', '', '', NULL, 'O', '1024 E Locust', 'Emmett', 'Gem', 'ID', '83617', '2083678484', '2083678456', '1024 E Locust', 'Emmett', 'Gem', 'ID', '83617', '2083678484', '2083678456', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2014-03-03', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1063437630', 0, 'Y', 0, '2014-07-09', NULL, NULL, 0, 0, NULL, NULL),
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('836000295', 'W12045184', 'W12045184', 'WY01', 'Memorial Hospital ENT Otolaryngology', 'Sigsbee', 'W', 'Duck', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '1180 College Dr', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073528192', NULL, '1180 College Dr', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073528192', '', '', '', '', '0.00', '5.00', '0.00', 3, '2014-02-10', NULL, 0, 0, 0, 'Memorial Hospital of Sweetwater County', '', '', '', 'HCFA|UB|', '1235228164', 0, 'N', 0, '2014-03-27', NULL, NULL, 0, 0, NULL, NULL),
('836000295', 'W12045179', 'W12045179', 'WYT2', 'Memorial Hospital of Sweetwater County', 'Joan', '', 'Magill', 'APRN', 'Mental Health', 'Counseling', '', NULL, 'O', '2620 Commercial Way Ste 051', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073822080', '3073825099', '2620 Commercial Way Ste 051', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073822080', '3073825099', '', '', '', '0.00', '5.00', '0.00', 3, '2014-02-27', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1477520252', 0, 'N', 0, '2014-03-04', NULL, NULL, 0, 0, NULL, NULL),
('463092122', 'W12045183', 'W12045183', 'WYT1', 'Elevate Rehab- Shoulder to Hand', 'Michelle', '', 'Mazur', 'OTR', 'Occupational Therapy', '', '', NULL, 'O', '155 S 6th St', 'Lander', 'Fremont', 'WY', '82520', '3073353471', '3073325388', '155 S 6th St', 'Lander', 'Fremont', 'WY', '82520', '3073353471', '3073325388', 'WISEWYSTD', 'WYHCPCS', '', '0.00', '0.00', '0.00', 3, '2014-02-20', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1114061611', 0, 'N', 0, '2014-05-23', 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
('836000295', 'W12045181', 'W12045181', 'WYT2', 'Memorial Hospital of Sweetwater County', 'Joan', '', 'Magill', 'APRN', 'Mental Health', 'Counseling', '', NULL, 'B', 'PO Box 1359', 'Rock Springs', 'Sweetwater', 'WY', '82902', '3073623711', NULL, 'PO Box 1359', 'Rock Springs', 'Sweetwater', 'WY', '82902', '3073623711', '          ', '', '', '', '0.00', '5.00', '0.00', 3, '2014-02-27', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1477520252', 0, 'N', 0, '2014-03-04', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12045176', 'W12045176', 'UTIHC04', '', 'Craig', 'S', 'Nielson', 'DO', 'Pediatrics', '', '', NULL, 'O', '1303 N Main St ', 'Cedar City', 'Iron', 'UT', '84721', '4358685000', NULL, '1303 N Main St ', 'Cedar City', 'Iron', 'UT', '84721', '4358685000', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2013-04-01', NULL, 0, 0, 0, 'Valley View Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1316063084', 0, 'N', 0, '2014-03-04', NULL, NULL, 0, 0, NULL, NULL),
('836000295', 'W12045178', 'W12045178', 'WY01', 'Memorial Hospital of Sweetwater County', 'Joan', '', 'Magill', 'APRN', 'Mental Health', 'Counseling', '', NULL, 'O', '2620 Commercial Way Ste 051', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073528125', '3013528126', '2620 Commercial Way Ste 051', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073528125', '3013528126', '', '', '', '0.00', '5.00', '0.00', 3, '2014-02-27', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1477520252', 0, 'N', 0, '2014-06-04', NULL, NULL, 0, 0, NULL, NULL),
('836000295', 'W12045180', 'W12045180', 'WY01', 'Memorial Hospital of Sweetwater County', 'Joan', '', 'Magill', 'APRN', 'Mental Health', 'Counseling', '', NULL, 'B', 'PO Box 1359', 'Rock Springs', 'Sweetwater', 'WY', '82902', '3073623711', NULL, 'PO Box 1359', 'Rock Springs', 'Sweetwater', 'WY', '82902', '3073623711', '          ', '', '', '', '0.00', '5.00', '0.00', 3, '2014-02-27', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1477520252', 0, 'N', 0, '2014-03-04', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12045174', 'W12045174', 'UTIHC04', '', 'Rodney', 'W', 'Merrell', 'MD', 'Family Practice', '', '', NULL, 'O', '905 N 1000 W', 'Tremonton', 'Box Elder', 'UT', '84337', '4352074500', NULL, '905 N 1000 W  ', 'Tremonton', 'Box Elder', 'UT', '84337', '4352074500', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2013-04-01', NULL, 0, 0, 0, 'Bear River Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1932196771', 0, 'N', 0, '2014-03-04', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12045175', 'W12045175', 'UTIHC04', '', 'Cody', 'B', 'Nielson', 'PA', 'Physician Assistant', '', '', NULL, 'O', '126 S White Sage Ave', 'Delta', 'Millard', 'UT', '84624', '4358645591', NULL, '126 S White Sage Ave', 'Delta', 'Millard', 'UT', '84624', '4358645591', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2013-10-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1609127885', 0, 'N', 0, '2014-03-04', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12045173', 'W12045173', 'UTIHC04', '', 'Katherine', 'R', 'May', 'PT', 'Physical Therapy', '', '', NULL, 'O', '900 Round Valley Dr ', 'Park City', 'Summit', 'UT', '84060', '4356587350', NULL, '900 Round Valley Dr ', 'Park City', 'Summit', 'UT', '84060', '4356587350', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1760792584', 0, 'N', 0, '2014-03-04', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12045168', 'W12045168', 'UTIHC04', '', 'Michael', 'M', 'Green', 'DO', 'Physical Medicine and Rehabilitation', '', '', NULL, 'O', '100 Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016624949', NULL, '100 Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016624949', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2013-09-18', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1063665719', 0, 'N', 0, '2014-03-04', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12045167', 'W12045167', 'UTIHC04', '', 'Michael', 'M', 'Green', 'DO', 'Physical Medicine and Rehabilitation', '', '', NULL, 'O', '3773 W 12600 S ', 'Riverton', 'Salt Lake', 'UT', '84065', '8016624900', NULL, '3773 W 12600 S ', 'Riverton', 'Salt Lake', 'UT', '84065', '8016624900', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2013-09-18', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1063665719', 0, 'N', 0, '2014-03-04', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12045165', 'W12045165', 'UTIHC04', '', 'Kevin', 'F', 'O Meara', 'MD', 'Family Practice', '', '', NULL, 'O', '1485 S Hwy 40', 'Heber City', 'Wasatch', 'UT', '84032', '4356587000', NULL, '1485 S Hwy 40', 'Heber City', 'Wasatch', 'UT', '84032', '4356587000', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2013-12-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1063529568', 0, 'N', 0, '2014-03-04', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12045166', 'W12045166', 'UTIHC04', '', 'Kevin', 'F', 'O Meara', 'MD', 'Family Practice', '', '', NULL, 'O', '900 Round Valley Dr ', 'Park City', 'Summit', 'UT', '84060', '4356587000', NULL, '900 Round Valley Dr ', 'Park City', 'Summit', 'UT', '84060', '4356587000', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2013-12-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1063529568', 0, 'N', 0, '2014-03-04', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12045163', 'W12045163', 'UTIHC04', 'Safe and Healthy Families', 'Tracie', '', 'Penunuri', 'LCSW', 'Social Worker', '', '', NULL, 'O', '675 E 500 S Ste 300', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8016623600', NULL, '675 E 500 S Ste 300', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8016623600', '', '', '', '', '0.00', '10.00', '0.00', 8, '2013-09-16', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1245666106', 0, 'N', 0, '2014-05-22', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12045164', 'W12045164', 'UTIHC04', '', 'Rudolf', '', 'Otrusinik', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1400 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357161000', NULL, '1400 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357161000', '', '', '', '', '0.00', '15.00', '0.00', 8, '2014-01-01', NULL, 0, 0, 0, 'Logan Regional Hospital', '', '', '', 'HCFA|UB|', '1003922394', 0, 'N', 0, '2014-05-22', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12045162', 'W12045162', 'UTIHC04', '', 'Stephanie', 'C', 'Thomas', 'MD', 'Urgent Care', 'Family Practice', '', NULL, 'O', '905 N 1000 W', 'Tremonton', 'Box Elder', 'UT', '84337', '4352577441', NULL, '905 N 1000 W', 'Tremonton', 'Box Elder', 'UT', '84337', '4352577441', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2014-01-01', NULL, 0, 0, 0, 'Logan Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1043520489', 0, 'N', 0, '2014-03-04', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12045155', 'W12045155', 'UTIHC04', '', 'Heather', 'A', 'Darling', 'APRN', 'Advanced Practice Registered Nurse', '', '', NULL, 'O', '900 Round Valley Dr ', 'Park City', 'Summit', 'UT', '84060', '4356586703', NULL, '900 Round Valley Dr ', 'Park City', 'Summit', 'UT', '84060', '4356586703', '', '', '', '', '0.00', '15.00', '0.00', 8, '2013-12-13', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1043561368', 0, 'N', 0, '2014-05-22', NULL, NULL, 0, 0, NULL, NULL),
('830335677', 'W12047415', 'W12047415', 'WY01', 'Big Country Rehab', 'Meghann', '', 'Boggs', 'PT', 'Physical Therapy', '', '', NULL, 'O', '111 S 5th St', 'Douglas', 'Converse', 'WY', '82633', '3073589464', '3073589330', '111 S 5th St', 'Douglas', 'Converse', 'WY', '82633', '3073589464', '3073589330', '', '', '', '0.00', '0.00', '120.00', 3, '2014-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1265669287', 0, 'N', 0, '2014-05-28', NULL, NULL, 0, 0, NULL, NULL),
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('830335677', 'W12047421', 'W12047421', 'WYT1', 'Big Country Rehab', 'Meghann', '', 'Boggs', 'PT', 'Physical Therapy', '', '', NULL, 'O', '525 E Birch', 'Glenrock', 'Converse', 'WY', '82637', '3073589464', '3073589330', '525 E Birch', 'Glenrock', 'Converse', 'WY', '82637', '3073589464', '3073589330', '', '', '', '0.00', '0.00', '120.00', 3, '2014-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1265669287', 0, 'N', 0, '2014-05-28', NULL, NULL, 0, 0, NULL, NULL),
('830335677', 'W12047425', 'W12047425', 'WY01', 'Big Country Rehab', 'Emily', '', 'Cook', 'PT', 'Physical Therapy', '', '', NULL, 'O', '521 E 10th St', 'Lusk', 'Niobrara', 'WY', '82225', '3073589464', '3073589330', '521 E 10th St', 'Lusk', 'Niobrara', 'WY', '82225', '3073589464', '3073589330', '', '', '', '0.00', '0.00', '120.00', 3, '2014-05-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1437113552', 0, 'N', 0, '2014-05-28', NULL, NULL, 0, 0, NULL, NULL),
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('752894111', 'TCM000005', 'TCM000005', 'TXDALSTD', 'Clinicas Mi Doctor', 'Wendy', '', 'Rourke', 'PAC', 'Pediatrics', NULL, NULL, NULL, 'O', '916 W Illinois Ave', 'Dallas', 'Dallas', 'TX', '75224', '2149417611', '2149417818', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'DALLAS1', 'TXHCPC13', NULL, '0.00', '50.00', '0.00', 3, '2014-04-18', NULL, 0, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1992094767', 0, 'Y', 0, '2014-03-25', NULL, NULL, 0, 0, NULL, NULL),
('752894111', 'TCM000006', 'TCM000006', 'TXDALSTD', 'Top Care Medical PA', 'Wendy', '', 'Rourke', 'PAC', 'Pediatrics', NULL, NULL, NULL, 'B', '222 W Las Colinas Blvd Ste 2000', 'Irving', 'Dallas', 'TX', '75039', '9729573000', '9729573005', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'DALLAS1', 'TXHCPC13', NULL, '0.00', '50.00', '0.00', 3, '2014-04-18', NULL, 0, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1992094767', 0, 'Y', 0, '2014-03-25', NULL, NULL, 0, 0, NULL, NULL),
('752894111', 'TCM000077', 'TCM000077', 'TXHOUSTD', 'Clinicas Mi Doctor', 'Ana', '', 'Rodriguez', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '8225 Broadway St', 'Houston', 'Harris', 'TX', '77061', '7134694735', '7134694740', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'DALLAS1', 'TXHCPC13', NULL, '0.00', '50.00', '0.00', 3, '2014-04-18', NULL, 0, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1780962100', 0, 'N', 0, '2014-03-25', NULL, NULL, 0, 0, NULL, NULL),
('752894111', 'TCM000024', 'TCM000024', 'TXDALSTD', 'Top Care Medical PA', 'Rafael', '', 'Pomales', 'PAC', 'Pediatrics', NULL, NULL, NULL, 'B', '222 W Las Colinas Blvd Ste 2000', 'Irving', 'Dallas', 'TX', '75039', '9729573000', '9729573005', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'DALLAS1', 'TXHCPC13', NULL, '0.00', '50.00', '0.00', 3, '2014-04-18', NULL, 0, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1770507493', 0, 'Y', 0, '2014-03-25', NULL, NULL, 0, 0, NULL, NULL),
('752894111', 'TCM000023', 'TCM000023', 'TXDALSTD', 'Clinicas Mi Doctor', 'Rafael', '', 'Pomales', 'PAC', 'Pediatrics', NULL, NULL, NULL, 'O', '8112 Springvalley Rd', 'Dallas', 'Dallas', 'TX', '75240', '2148841705', '2148841711', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'DALLAS1', 'TXHCPC13', NULL, '0.00', '50.00', '0.00', 3, '2014-04-18', NULL, 0, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1770507493', 0, 'Y', 0, '2014-03-25', NULL, NULL, 0, 0, NULL, NULL),
('752894111', 'TCM000038', 'TCM000038', 'TXDALSTD', 'Top Care Medical PA', 'Ernesto', '', 'Pruna', 'MD', 'Family Practice', NULL, NULL, NULL, 'B', '222 W Las Colinas Blvd Ste 2000', 'Irving', 'Dallas', 'TX', '75039', '9729573000', '9729573005', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'DALLAS1', 'TXHCPC13', NULL, '0.00', '50.00', '0.00', 3, '2014-04-18', NULL, 0, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1932305828', 0, 'Y', 0, '2014-03-25', NULL, NULL, 0, 0, NULL, NULL),
('752894111', 'TCM000037', 'TCM000037', 'TXDALSTD', 'Clinicas Mi Doctor', 'Ernesto', '', 'Pruna', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '9753 Webb Chapel Rd Ste 900', 'Dallas', 'Dallas', 'TX', '75220', '2146226048', '2146226051', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'DALLAS1', 'TXHCPC13', NULL, '0.00', '50.00', '0.00', 3, '2014-04-18', NULL, 0, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1932305828', 0, 'N', 0, '2014-03-25', NULL, NULL, 0, 0, NULL, NULL),
('752894111', 'TCM000004', 'TCM000004', 'TXDALSTD', 'Top Care Medical PA', 'Nohemo', '', 'Randle', 'PAC', 'Pediatrics', NULL, NULL, NULL, 'B', '222 W Las Colinas Blvd Ste 2000', 'Irving', 'Dallas', 'TX', '75039', '9729573000', '9729573005', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'DALLAS1', 'TXHCPC13', NULL, '0.00', '50.00', '0.00', 3, '2014-04-18', NULL, 0, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1518108851', 0, 'Y', 0, '2014-03-25', NULL, NULL, 0, 0, NULL, NULL),
('752894111', 'TCM000003', 'TCM000003', 'TXDALSTD', 'Clinicas Mi Doctor', 'Nohemo', '', 'Randle', 'PAC', 'Pediatrics', NULL, NULL, NULL, 'O', '916 W Illinois Ave', 'Dallas', 'Dallas', 'TX', '75224', '2149417611', '2149417818', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'DALLAS1', 'TXHCPC13', NULL, '0.00', '50.00', '0.00', 3, '2014-04-18', NULL, 0, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1518108851', 0, 'Y', 0, '2014-03-25', NULL, NULL, 0, 0, NULL, NULL),
('752894111', 'TCM000078', 'TCM000078', 'TXHOUSTD', 'Top Care Medical PA', 'Ana', '', 'Rodriguez', 'MD', 'Family Practice', NULL, NULL, NULL, 'B', '222 W Las Colinas Blvd Ste 2000', 'Irving', 'Dallas', 'TX', '75039', '9729573000', '9729573005', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'DALLAS1', 'TXHCPC13', NULL, '0.00', '50.00', '0.00', 3, '2014-04-18', NULL, 0, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1780962100', 0, 'N', 0, '2014-03-25', NULL, NULL, 0, 0, NULL, NULL),
('752894111', 'TCM000035', 'TCM000035', 'TXDALSTD', 'Clinicas Mi Doctor', 'Victor', '', 'Peralta', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '941 E Park Row', 'Arlington', 'Tarrant', 'TX', '76010', '8175220221', '8175220401', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'DALLAS1', 'TXHCPC13', NULL, '0.00', '50.00', '0.00', 3, '2014-04-18', NULL, 0, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1902925795', 0, 'N', 0, '2014-03-25', NULL, NULL, 0, 0, NULL, NULL),
('752894111', 'TCM000036', 'TCM000036', 'TXDALSTD', 'Top Care Medical PA', 'Victor', '', 'Peralta', 'MD', 'Family Practice', NULL, NULL, NULL, 'B', '222 W Las Colinas Blvd Ste 2000', 'Irving', 'Dallas', 'TX', '75039', '9729573000', '9729573005', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'DALLAS1', 'TXHCPC13', NULL, '0.00', '50.00', '0.00', 3, '2014-04-18', NULL, 0, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1902925795', 0, 'Y', 0, '2014-03-25', NULL, NULL, 0, 0, NULL, NULL),
('752894111', 'TCM000072', 'TCM000072', 'TXHOUSTD', 'Top Care Medical PA', 'Euglis', '', 'Pena', 'FNP', 'Family Practice', NULL, NULL, NULL, 'B', '222 W Las Colinas Blvd Ste 2000', 'Irving', 'Dallas', 'TX', '75039', '9729573000', '9729573005', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'DALLAS1', 'TXHCPC13', NULL, '0.00', '50.00', '0.00', 3, '2014-04-18', NULL, 0, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1023216389', 0, 'Y', 0, '2014-03-25', NULL, NULL, 0, 0, NULL, NULL),
('752894111', 'TCM000071', 'TCM000071', 'TXHOUSTD', 'Clinicas Mi Doctor', 'Euglis', '', 'Pena', 'FNP', 'Family Practice', NULL, NULL, NULL, 'O', '6812 Harrisburg Blvd', 'Houston', 'Harris', 'TX', '77011', '7137154460', '7137154465', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'DALLAS1', 'TXHCPC13', NULL, '0.00', '50.00', '0.00', 3, '2014-04-18', NULL, 0, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1023216389', 0, 'Y', 0, '2014-03-25', NULL, NULL, 0, 0, NULL, NULL),
('752894111', 'TCM000081', 'TCM000081', 'TXHOUSTD', 'Clinicas Mi Doctor', 'Valeria', '', 'Orue Quintana', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '2982 Fulton St', 'Houston', 'Harris', 'TX', '77099', '7132311346', '2816570011', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'DALLAS1', 'TXHCPC13', NULL, '0.00', '50.00', '0.00', 3, '2014-04-18', NULL, 0, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1346539020', 0, 'N', 0, '2014-03-25', NULL, NULL, 0, 0, NULL, NULL),
('752894111', 'TCM000082', 'TCM000082', 'TXHOUSTD', 'Top Care Medical PA', 'Valeria', '', 'Orue Quintana', 'MD', 'Family Practice', NULL, NULL, NULL, 'B', '222 W Las Colinas Blvd Ste 2000', 'Irving', 'Dallas', 'TX', '75039', '9729573000', '9729573005', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'DALLAS1', 'TXHCPC13', NULL, '0.00', '50.00', '0.00', 3, '2014-04-18', NULL, 0, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1346539020', 0, 'N', 0, '2014-03-25', NULL, NULL, 0, 0, NULL, NULL),
('752894111', 'TCM000063', 'TCM000063', 'TXHOUSTD', 'Clinicas Mi Doctor', 'Adolfo', '', 'Ordonez', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '4230 Aldine Mail Rte', 'Houston', 'Harris', 'TX', '77039', '2815983300', '2815983305', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'DALLAS1', 'TXHCPC13', NULL, '0.00', '50.00', '0.00', 3, '2014-04-18', NULL, 0, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1437457660', 0, 'N', 0, '2014-03-25', NULL, NULL, 0, 0, NULL, NULL),
('752894111', 'TCM000041', 'TCM000041', 'TXDALSTD', 'Clinicas Mi Doctor', 'Alejandra', '', 'Moscoso', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '1120 E Parker Rd', 'Plano', 'Collin', 'TX', '75074', '4692981216', '4692981219', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'DALLAS1', 'TXHCPC13', NULL, '0.00', '50.00', '0.00', 3, '2014-04-18', NULL, 0, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1821253311', 0, 'N', 0, '2014-03-25', NULL, NULL, 0, 0, NULL, NULL),
('752894111', 'TCM000042', 'TCM000042', 'TXDALSTD', 'Top Care Medical PA', 'Alejandra', '', 'Moscoso', 'MD', 'Family Practice', NULL, NULL, NULL, 'B', '222 W Las Colinas Blvd Ste 2000', 'Irving', 'Dallas', 'TX', '75039', '9729573000', '9729573005', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'DALLAS1', 'TXHCPC13', NULL, '0.00', '50.00', '0.00', 3, '2014-04-18', NULL, 0, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1821253311', 0, 'Y', 0, '2014-03-25', NULL, NULL, 0, 0, NULL, NULL),
('752894111', 'TCM000040', 'TCM000040', 'TXDALSTD', 'Top Care Medical PA', 'Isabel', '', 'Munoz', 'FNP', 'Family Practice', NULL, NULL, NULL, 'B', '222 W Las Colinas Blvd Ste 2000', 'Irving', 'Dallas', 'TX', '75039', '9729573000', '9729573005', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'DALLAS1', 'TXHCPC13', NULL, '0.00', '50.00', '0.00', 3, '2014-04-18', NULL, 0, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1427218809', 0, 'Y', 0, '2014-03-25', NULL, NULL, 0, 0, NULL, NULL),
('752894111', 'TCM000039', 'TCM000039', 'TXDALSTD', 'Clinicas Mi Doctor', 'Isabel', '', 'Munoz', 'FNP', 'Family Practice', NULL, NULL, NULL, 'O', '9753 Webb Chapel Rd Ste 900', 'Dallas', 'Dallas', 'TX', '75220', '2146226048', '2146226051', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'DALLAS1', 'TXHCPC13', NULL, '0.00', '50.00', '0.00', 3, '2014-04-18', NULL, 0, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1427218809', 0, 'Y', 0, '2014-03-25', NULL, NULL, 0, 0, NULL, NULL),
('752894111', 'TCM000064', 'TCM000064', 'TXHOUSTD', 'Top Care Medical PA', 'Adolfo', '', 'Ordonez', 'MD', 'Family Practice', NULL, NULL, NULL, 'B', '222 W Las Colinas Blvd Ste 2000', 'Irving', 'Dallas', 'TX', '75039', '9729573000', '9729573005', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'DALLAS1', 'TXHCPC13', NULL, '0.00', '50.00', '0.00', 3, '2014-04-18', NULL, 0, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1437457660', 0, 'Y', 0, '2014-03-25', NULL, NULL, 0, 0, NULL, NULL),
('752894111', 'TCM000009', 'TCM000009', 'TXDALSTD', 'Clinicas Mi Doctor', 'Mazaffar', '', 'Mehdi', 'MD', 'Pediatrics', NULL, NULL, NULL, 'O', '916 W Illinois Ave', 'Dallas', 'Dallas', 'TX', '75224', '2149417611', '2149417818', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'DALLAS1', 'TXHCPC13', NULL, '0.00', '50.00', '0.00', 3, '2014-04-18', NULL, 0, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1891767513', 0, 'N', 0, '2014-03-25', NULL, NULL, 0, 0, NULL, NULL),
('752894111', 'TCM000013', 'TCM000013', 'TXDALSTD', 'Clinicas Mi Doctor', 'Santos', '', 'Martinez', 'PAC', 'Family Practice', NULL, NULL, NULL, 'O', '3247 Dawes Dr', 'Dallas', 'Dallas', 'TX', '75211', '2143307767', '2143307780', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'DALLAS1', 'TXHCPC13', NULL, '0.00', '50.00', '0.00', 3, '2014-04-18', NULL, 0, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1861422909', 0, 'Y', 0, '2014-03-25', NULL, NULL, 0, 0, NULL, NULL),
('752894111', 'TCM000016', 'TCM000016', 'TXDALSTD', 'Top Care Medical PA', 'Wesly', '', 'Mayr', 'PAC', 'Family Practice', NULL, NULL, NULL, 'B', '222 W Las Colinas Blvd Ste 2000', 'Irving', 'Dallas', 'TX', '75039', '9729573000', '9729573005', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'DALLAS1', 'TXHCPC13', NULL, '0.00', '50.00', '0.00', 3, '2014-04-18', NULL, 0, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1790820991', 0, 'Y', 0, '2014-03-25', NULL, NULL, 0, 0, NULL, NULL),
('752894111', 'TCM000015', 'TCM000015', 'TXDALSTD', 'Clinicas Mi Doctor', 'Wesly', '', 'Mayr', 'PAC', 'Family Practice', NULL, NULL, NULL, 'O', '3247 Dawes Dr', 'Dallas', 'Dallas', 'TX', '75211', '2143307767', '2143307780', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'DALLAS1', 'TXHCPC13', NULL, '0.00', '50.00', '0.00', 3, '2014-04-18', NULL, 0, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1790820991', 0, 'Y', 0, '2014-03-25', NULL, NULL, 0, 0, NULL, NULL),
('752894111', 'TCM000010', 'TCM000010', 'TXDALSTD', 'Top Care Medical PA', 'Mazaffar', '', 'Mehdi', 'MD', 'Pediatrics', NULL, NULL, NULL, 'B', '222 W Las Colinas Blvd Ste 2000', 'Irving', 'Dallas', 'TX', '75039', '9729573000', '9729573005', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'DALLAS1', 'TXHCPC13', NULL, '0.00', '50.00', '0.00', 3, '2014-04-18', NULL, 0, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1891767513', 0, 'Y', 0, '2014-03-25', NULL, NULL, 0, 0, NULL, NULL),
('752894111', 'TCM000060', 'TCM000060', 'TXDALSTD', 'Top Care Medical PA', 'Jess', '', 'Martinez', 'PAC', 'Pediatrics', NULL, NULL, NULL, 'B', '222 W Las Colinas Blvd Ste 2000', 'Irving', 'Dallas', 'TX', '75039', '9729573000', '9729573005', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'DALLAS1', 'TXHCPC13', NULL, '0.00', '50.00', '0.00', 3, '2014-04-18', NULL, 0, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1023234341', 0, 'Y', 0, '2014-03-25', NULL, NULL, 0, 0, NULL, NULL),
('752894111', 'TCM000059', 'TCM000059', 'TXDALSTD', 'Clinicas Mi Doctor', 'Jess', '', 'Martinez', 'PAC', 'Pediatrics', NULL, NULL, NULL, 'O', '4438 W Jefferson Blvd', 'Dallas', 'Dallas', 'TX', '75211', '9724981925', '9724981929', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'DALLAS1', 'TXHCPC13', NULL, '0.00', '50.00', '0.00', 3, '2014-04-18', NULL, 0, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1023234341', 0, 'Y', 0, '2014-03-25', NULL, NULL, 0, 0, NULL, NULL),
('752894111', 'TCM000014', 'TCM000014', 'TXDALSTD', 'Top Care Medical PA', 'Santos', '', 'Martinez', 'PAC', 'Family Practice', NULL, NULL, NULL, 'B', '222 W Las Colinas Blvd Ste 2000', 'Irving', 'Dallas', 'TX', '75039', '9729573000', '9729573005', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'DALLAS1', 'TXHCPC13', NULL, '0.00', '50.00', '0.00', 3, '2014-04-18', NULL, 0, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1861422909', 0, 'Y', 0, '2014-03-25', NULL, NULL, 0, 0, NULL, NULL),
('752894111', 'TCM000069', 'TCM000069', 'TXHOUSTD', 'Clinicas Mi Doctor', 'Maria', '', 'La Cruz Rondon', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '6812 Harrisburg Blvd', 'Houston', 'Harris', 'TX', '77011', '7137154460', '7137154465', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'DALLAS1', 'TXHCPC13', NULL, '0.00', '50.00', '0.00', 3, '2014-04-18', NULL, 0, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1255596342', 0, 'N', 0, '2014-03-25', NULL, NULL, 0, 0, NULL, NULL),
('752894111', 'TCM000028', 'TCM000028', 'TXDALSTD', 'Top Care Medical PA', 'Sarah', '', 'Levy', 'PAC', 'Pediatrics', NULL, NULL, NULL, 'B', '222 W Las Colinas Blvd Ste 2000', 'Irving', 'Dallas', 'TX', '75039', '9729573000', '9729573005', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'DALLAS1', 'TXHCPC13', NULL, '0.00', '50.00', '0.00', 3, '2014-04-18', NULL, 0, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1790846764', 0, 'Y', 0, '2014-03-25', NULL, NULL, 0, 0, NULL, NULL),
('752894111', 'TCM000027', 'TCM000027', 'TXDALSTD', 'Clinicas Mi Doctor', 'Sarah', '', 'Levy', 'PAC', 'Pediatrics', NULL, NULL, NULL, 'O', '8112 Springvalley Rd', 'Dallas', 'Dallas', 'TX', '75240', '2148841705', '2148841711', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'DALLAS1', 'TXHCPC13', NULL, '0.00', '50.00', '0.00', 3, '2014-04-18', NULL, 0, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1790846764', 0, 'Y', 0, '2014-03-25', NULL, NULL, 0, 0, NULL, NULL),
('752894111', 'TCM000070', 'TCM000070', 'TXHOUSTD', 'Top Care Medical PA', 'Maria', '', 'La Cruz Rondon', 'MD', 'Family Practice', NULL, NULL, NULL, 'B', '222 W Las Colinas Blvd Ste 2000', 'Irving', 'Dallas', 'TX', '75039', '9729573000', '9729573005', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'DALLAS1', 'TXHCPC13', NULL, '0.00', '50.00', '0.00', 3, '2014-04-18', NULL, 0, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1255596342', 0, 'Y', 0, '2014-03-25', NULL, NULL, 0, 0, NULL, NULL),
('752894111', 'TCM000055', 'TCM000055', 'TXDALSTD', 'Clinicas Mi Doctor', 'Michelle', '', 'Jasper', 'PAC', 'Family Practice', NULL, NULL, NULL, 'O', '6751 Abrams Rd Ste 108', 'Dallas', 'Dallas', 'TX', '75231', '2144666376', '2144666381', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'DALLAS1', 'TXHCPC13', NULL, '0.00', '50.00', '0.00', 3, '2014-04-18', NULL, 0, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1164786237', 0, 'Y', 0, '2014-03-25', NULL, NULL, 0, 0, NULL, NULL),
('752894111', 'TCM000043', 'TCM000043', 'TXDALSTD', 'Clinicas Mi Doctor', 'Judy', '', 'Humphries', 'FNP', 'Family Practice', NULL, NULL, NULL, 'O', '702 S Stemmons Fwy', 'Lewisville', 'Denton', 'TX', '75067', '9723166495', '9723166500', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'DALLAS1', 'TXHCPC13', NULL, '0.00', '50.00', '0.00', 3, '2014-04-18', NULL, 0, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1003960295', 0, 'Y', 0, '2014-03-25', NULL, NULL, 0, 0, NULL, NULL),
('752894111', 'TCM000056', 'TCM000056', 'TXDALSTD', 'Top Care Medical PA', 'Michelle', '', 'Jasper', 'PAC', 'Family Practice', NULL, NULL, NULL, 'B', '222 W Las Colinas Blvd Ste 2000', 'Irving', 'Dallas', 'TX', '75039', '9729573000', '9729573005', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'DALLAS1', 'TXHCPC13', NULL, '0.00', '50.00', '0.00', 3, '2014-04-18', NULL, 0, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1164786237', 0, 'Y', 0, '2014-03-25', NULL, NULL, 0, 0, NULL, NULL),
('752894111', 'TCM000044', 'TCM000044', 'TXDALSTD', 'Top Care Medical PA', 'Judy', '', 'Humphries', 'FNP', 'Family Practice', NULL, NULL, NULL, 'B', '222 W Las Colinas Blvd Ste 2000', 'Irving', 'Dallas', 'TX', '75039', '9729573000', '9729573005', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'DALLAS1', 'TXHCPC13', NULL, '0.00', '50.00', '0.00', 3, '2014-04-18', NULL, 0, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1003960295', 0, 'Y', 0, '2014-03-25', NULL, NULL, 0, 0, NULL, NULL),
('752894111', 'TCM000025', 'TCM000025', 'TXDALSTD', 'Clinicas Mi Doctor', 'Andrea', '', 'Hudson', 'FNP', 'Pediatrics', NULL, NULL, NULL, 'O', '8112 Springvalley Rd', 'Dallas', 'Dallas', 'TX', '75240', '2148841705', '2148841711', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'DALLAS1', 'TXHCPC13', NULL, '0.00', '50.00', '0.00', 3, '2014-04-18', NULL, 0, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1043591779', 0, 'Y', 0, '2014-03-25', NULL, NULL, 0, 0, NULL, NULL),
('752894111', 'TCM000026', 'TCM000026', 'TXDALSTD', 'Top Care Medical PA', 'Andrea', '', 'Hudson', 'FNP', 'Pediatrics', NULL, NULL, NULL, 'B', '222 W Las Colinas Blvd Ste 2000', 'Irving', 'Dallas', 'TX', '75039', '9729573000', '9729573005', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'DALLAS1', 'TXHCPC13', NULL, '0.00', '50.00', '0.00', 3, '2014-04-18', NULL, 0, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1043591779', 0, 'Y', 0, '2014-03-25', NULL, NULL, 0, 0, NULL, NULL),
('752894111', 'TCM000033', 'TCM000033', 'TXDALSTD', 'Clinicas Mi Doctor', 'Yesenia', '', 'Gutierrez', 'DO', 'Pediatrics', NULL, NULL, NULL, 'O', '4200 S Fwy Ste 106', 'Fort Worth', 'Tarrant', 'TX', '76115', '8175660505', '8175660509', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'DALLAS1', 'TXHCPC13', NULL, '0.00', '50.00', '0.00', 3, '2014-04-18', NULL, 0, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1205000809', 0, 'N', 0, '2014-03-25', NULL, NULL, 0, 0, NULL, NULL),
('752894111', 'TCM000022', 'TCM000022', 'TXDALSTD', 'Top Care Medical PA', 'Maria Lizette', '', 'Harris', 'MD', 'Pediatrics', NULL, NULL, NULL, 'B', '222 W Las Colinas Blvd Ste 2000', 'Irving', 'Dallas', 'TX', '75039', '9729573000', '9729573005', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'DALLAS1', 'TXHCPC13', NULL, '0.00', '50.00', '0.00', 3, '2014-04-18', NULL, 0, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1265663074', 0, 'Y', 0, '2014-03-25', 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
('752894111', 'TCM000021', 'TCM000021', 'TXDALSTD', 'Clinicas Mi Doctor', 'Maria Lizette', '', 'Harris', 'MD', 'Pediatrics', NULL, NULL, NULL, 'O', '8112 Springvalley Rd', 'Dallas', 'Dallas', 'TX', '75240', '2148841705', '2148841711', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'DALLAS1', 'TXHCPC13', NULL, '0.00', '50.00', '0.00', 3, '2014-04-18', NULL, 0, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1265663074', 0, 'N', 0, '2014-03-25', NULL, NULL, 0, 0, NULL, NULL),
('752894111', 'TCM000073', 'TCM000073', 'TXHOUSTD', 'Clinicas Mi Doctor', 'Carlos', '', 'Gutierrez', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '10058 A Long Point', 'Houston', 'Harris', 'TX', '77055', '8323803980', '8323803985', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'DALLAS1', 'TXHCPC13', NULL, '0.00', '50.00', '0.00', 3, '2014-04-18', NULL, 0, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1639330699', 0, 'N', 0, '2014-03-25', NULL, NULL, 0, 0, NULL, NULL),
('752894111', 'TCM000074', 'TCM000074', 'TXHOUSTD', 'Top Care Medical PA', 'Carlos', '', 'Gutierrez', 'MD', 'Family Practice', NULL, NULL, NULL, 'B', '222 W Las Colinas Blvd Ste 2000', 'Irving', 'Dallas', 'TX', '75039', '9729573000', '9729573005', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'DALLAS1', 'TXHCPC13', NULL, '0.00', '50.00', '0.00', 3, '2014-04-18', NULL, 0, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1639330699', 0, 'Y', 0, '2014-03-25', NULL, NULL, 0, 0, NULL, NULL),
('752894111', 'TCM000034', 'TCM000034', 'TXDALSTD', 'Top Care Medical PA', 'Yesenia', '', 'Gutierrez', 'DO', 'Pediatrics', NULL, NULL, NULL, 'B', '222 W Las Colinas Blvd Ste 2000', 'Irving', 'Dallas', 'TX', '75039', '9729573000', '9729573005', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'DALLAS1', 'TXHCPC13', NULL, '0.00', '50.00', '0.00', 3, '2014-04-18', NULL, 0, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1205000809', 0, 'Y', 0, '2014-03-25', NULL, NULL, 0, 0, NULL, NULL),
('752894111', 'TCM000049', 'TCM000049', 'TXDALSTD', 'Clinicas Mi Doctor', 'Milydas', '', 'Friesen', 'FNP', 'Family Practice', NULL, NULL, NULL, 'O', '410 E Pioneer Pkwy Ste 300', 'Grand Prairie', 'Dallas', 'TX', '75051', '4697331890', '4697331894', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'DALLAS1', 'TXHCPC13', NULL, '0.00', '50.00', '0.00', 3, '2014-04-18', NULL, 0, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1851698948', 0, 'Y', 0, '2014-03-25', NULL, NULL, 0, 0, NULL, NULL),
('752894111', 'TCM000007', 'TCM000007', 'TXDALSTD', 'Clinicas Mi Doctor', 'Jessica', '', 'Espinosa', 'PAC', 'Pediatrics', NULL, NULL, NULL, 'O', '916 W Illinois Ave', 'Dallas', 'Dallas', 'TX', '75224', '2149417611', '2149417818', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'DALLAS1', 'TXHCPC13', NULL, '0.00', '50.00', '0.00', 3, '2014-04-18', NULL, 0, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1598037855', 0, 'Y', 0, '2014-03-25', NULL, NULL, 0, 0, NULL, NULL),
('752894111', 'TCM000050', 'TCM000050', 'TXDALSTD', 'Top Care Medical PA', 'Milydas', '', 'Friesen', 'FNP', 'Family Practice', NULL, NULL, NULL, 'B', '222 W Las Colinas Blvd Ste 2000', 'Irving', 'Dallas', 'TX', '75039', '9729573000', '9729573005', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'DALLAS1', 'TXHCPC13', NULL, '0.00', '50.00', '0.00', 3, '2014-04-18', NULL, 0, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1851698948', 0, 'Y', 0, '2014-03-25', NULL, NULL, 0, 0, NULL, NULL),
('752894111', 'TCM000008', 'TCM000008', 'TXDALSTD', 'Top Care Medical PA', 'Jessica', '', 'Espinosa', 'PAC', 'Pediatrics', NULL, NULL, NULL, 'B', '222 W Las Colinas Blvd Ste 2000', 'Irving', 'Dallas', 'TX', '75039', '9729573000', '9729573005', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'DALLAS1', 'TXHCPC13', NULL, '0.00', '50.00', '0.00', 3, '2014-04-18', NULL, 0, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1598037855', 0, 'Y', 0, '2014-03-25', NULL, NULL, 0, 0, NULL, NULL),
('752894111', 'TCM000079', 'TCM000079', 'TXHOUSTD', 'Clinicas Mi Doctor', 'Javier', '', 'Diago', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '5402 Airline', 'Houston', 'Harris', 'TX', '77076', '7132391572', '7132391577', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'DALLAS1', 'TXHCPC13', NULL, '0.00', '50.00', '0.00', 3, '2014-04-18', NULL, 0, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1740587211', 0, 'N', 0, '2014-03-25', NULL, NULL, 0, 0, NULL, NULL),
('752894111', 'TCM000029', 'TCM000029', 'TXDALSTD', 'Clinicas Mi Doctor', 'Sanjeev', '', 'Chaturvedi', 'PAC', 'Family Practice', NULL, NULL, NULL, 'O', '229 NE 28th St', 'Fort Worth', 'Tarrant', 'TX', '76164', '8175660483', '8175660484', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'DALLAS1', 'TXHCPC13', NULL, '0.00', '50.00', '0.00', 3, '2014-04-18', NULL, 0, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1548584071', 0, 'Y', 0, '2014-03-25', NULL, NULL, 0, 0, NULL, NULL),
('752894111', 'TCM000080', 'TCM000080', 'TXHOUSTD', 'Top Care Medical PA', 'Javier', '', 'Diago', 'MD', 'Family Practice', NULL, NULL, NULL, 'B', '222 W Las Colinas Blvd Ste 2000', 'Irving', 'Dallas', 'TX', '75039', '9729573000', '9729573005', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'DALLAS1', 'TXHCPC13', NULL, '0.00', '50.00', '0.00', 3, '2014-04-18', NULL, 0, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1740587211', 0, 'N', 0, '2014-03-25', NULL, NULL, 0, 0, NULL, NULL),
('752894111', 'TCM000011', 'TCM000011', 'TXDALSTD', 'Clinicas Mi Doctor', 'Edgar', '', 'Cardenas', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '3247 Dawes Dr', 'Dallas', 'Dallas', 'TX', '75211', '2143307767', '2143307780', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'DALLAS1', 'TXHCPC13', NULL, '0.00', '50.00', '0.00', 3, '2014-04-18', NULL, 0, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1609075829', 0, 'N', 0, '2014-03-25', NULL, NULL, 0, 0, NULL, NULL),
('752894111', 'TCM000030', 'TCM000030', 'TXDALSTD', 'Top Care Medical PA', 'Sanjeev', '', 'Chaturvedi', 'PAC', 'Family Practice', NULL, NULL, NULL, 'B', '222 W Las Colinas Blvd Ste 2000', 'Irving', 'Dallas', 'TX', '75039', '9729573000', '9729573005', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'DALLAS1', 'TXHCPC13', NULL, '0.00', '50.00', '0.00', 3, '2014-04-18', NULL, 0, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1548584071', 0, 'Y', 0, '2014-03-25', NULL, NULL, 0, 0, NULL, NULL),
('752894111', 'TCM000012', 'TCM000012', 'TXDALSTD', 'Top Care Medical PA', 'Edgar', '', 'Cardenas', 'MD', 'Family Practice', NULL, NULL, NULL, 'B', '222 W Las Colinas Blvd Ste 2000', 'Irving', 'Dallas', 'TX', '75039', '9729573000', '9729573005', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'DALLAS1', 'TXHCPC13', NULL, '0.00', '50.00', '0.00', 3, '2014-04-18', NULL, 0, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1609075829', 0, 'Y', 0, '2014-03-25', NULL, NULL, 0, 0, NULL, NULL),
('752894111', 'TCM000019', 'TCM000019', 'TXDALSTD', 'Clinicas Mi Doctor', 'Rebecca', '', 'Brown', 'NP', 'Family Practice', NULL, NULL, NULL, 'O', '5334 Ross Ave Ste 900a', 'Dallas', 'Dallas', 'TX', '75206', '2148841584', '2148841590', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'DALLAS1', 'TXHCPC13', NULL, '0.00', '50.00', '0.00', 3, '2014-04-18', NULL, 0, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1740577311', 0, 'Y', 0, '2014-03-25', NULL, NULL, 0, 0, NULL, NULL),
('752894111', 'TCM000045', 'TCM000045', 'TXDALSTD', 'Clinicas Mi Doctor', 'Silvio', '', 'Azzolini', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '702 S Stemmons Fwy', 'Lewisville', 'Denton', 'TX', '75067', '9723166495', '9723166500', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'DALLAS1', 'TXHCPC13', NULL, '0.00', '50.00', '0.00', 3, '2014-04-18', NULL, 0, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1821003591', 0, 'N', 0, '2014-03-25', NULL, NULL, 0, 0, NULL, NULL),
('752894111', 'TCM000020', 'TCM000020', 'TXDALSTD', 'Top Care Medical PA', 'Rebecca', '', 'Brown', 'NP', 'Family Practice', NULL, NULL, NULL, 'B', '222 W Las Colinas Blvd Ste 2000', 'Irving', 'Dallas', 'TX', '75039', '9729573000', '9729573005', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'DALLAS1', 'TXHCPC13', NULL, '0.00', '50.00', '0.00', 3, '2014-04-18', NULL, 0, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1740577311', 0, 'Y', 0, '2014-03-25', NULL, NULL, 0, 0, NULL, NULL),
('752894111', 'TCM000046', 'TCM000046', 'TXDALSTD', 'Top Care Medical PA', 'Silvio', '', 'Azzolini', 'MD', 'Family Practice', NULL, NULL, NULL, 'B', '222 W Las Colinas Blvd Ste 2000', 'Irving', 'Dallas', 'TX', '75039', '9729573000', '9729573005', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'DALLAS1', 'TXHCPC13', NULL, '0.00', '50.00', '0.00', 3, '2014-04-18', NULL, 0, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1821003591', 0, 'Y', 0, '2014-03-25', NULL, NULL, 0, 0, NULL, NULL),
('752894111', 'TCM000001', 'TCM000001', 'TXDALSTD', 'Clinicas Mi Doctor', 'Pablo', '', 'Anglas', 'MD', 'Pediatrics', NULL, NULL, NULL, 'O', '916 W Illinois Ave', 'Dallas', 'Dallas', 'TX', '75224', '2149417611', '2149417818', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'DALLAS1', 'TXHCPC13', NULL, '0.00', '50.00', '0.00', 3, '2014-04-18', NULL, 0, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1033139738', 0, 'N', 0, '2014-03-25', NULL, NULL, 0, 0, NULL, NULL),
('752894111', 'TCM000002', 'TCM000002', 'TXDALSTD', 'Top Care Medical PA', 'Pablo', '', 'Anglas', 'MD', 'Pediatrics', NULL, NULL, NULL, 'B', '222 W Las Colinas Blvd Ste 2000', 'Irving', 'Dallas', 'TX', '75039', '9729573000', '9729573005', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'DALLAS1', 'TXHCPC13', NULL, '0.00', '50.00', '0.00', 3, '2014-04-18', NULL, 0, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1033139738', 0, 'Y', 0, '2014-03-25', NULL, NULL, 0, 0, NULL, NULL),
('752894111', 'TCM000075', 'TCM000075', 'TXHOUSTD', 'Clinicas Mi Doctor', 'Maribel', '', 'Anaya', 'PAC', 'Family Practice', NULL, NULL, NULL, 'O', '10058 A Long Point', 'Houston', 'Harris', 'TX', '77055', '8323803980', '8323803985', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'DALLAS1', 'TXHCPC13', NULL, '0.00', '50.00', '0.00', 3, '2014-04-18', NULL, 0, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1093144560', 0, 'Y', 0, '2014-03-25', NULL, NULL, 0, 0, NULL, NULL),
('752894111', 'TCM000076', 'TCM000076', 'TXHOUSTD', 'Top Care Medical PA', 'Maribel', '', 'Anaya', 'PAC', 'Family Practice', NULL, NULL, NULL, 'B', '222 W Las Colinas Blvd Ste 2000', 'Irving', 'Dallas', 'TX', '75039', '9729573000', '9729573005', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'DALLAS1', 'TXHCPC13', NULL, '0.00', '50.00', '0.00', 3, '2014-04-18', NULL, 0, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1093144560', 0, 'Y', 0, '2014-03-25', NULL, NULL, 0, 0, NULL, NULL),
('752894111', 'TCM000017', 'TCM000017', 'TXDALSTD', 'Clinicas Mi Doctor', 'Atilio', '', 'Abreu', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '5334 Ross Ave Ste 900a', 'Dallas', 'Dallas', 'TX', '75206', '2148841584', '2148841590', NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'DALLAS1', 'TXHCPC13', NULL, '0.00', '50.00', '0.00', 3, '2014-04-18', NULL, 0, 0, 0, '', NULL, NULL, NULL, 'HCFA|UB|', '1407087323', 0, 'N', 0, '2014-03-25', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12045926', 'W12045926', 'WYBILLINGS', 'Billings Clinic', 'Jill', 'H', 'Cranford', 'OT', 'Occupational Therapy', '', '', NULL, 'B', 'PO Box 31315', 'Billings', 'Yellowstone', 'MT', '59107', '4062382617', '0000000000', 'PO Box 31315', 'Billings', 'Yellowstone', 'MT', '59107', '4062382617', '0000000000', '', '', '', '0.00', '17.00', '0.00', 3, '2014-03-21', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1265627285', 0, 'N', 0, '2014-04-09', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12045925', 'W12045925', 'WYBILLINGS', 'Billings Clinic', 'Jill', 'H', 'Cranford', 'OT', 'Occupational Therapy', '', '', NULL, 'M', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', '0000000000', '0000000000', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', '0000000000', '0000000000', '', '', '', '0.00', '17.00', '0.00', 3, '2014-03-21', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1265627285', 0, 'N', 0, '2014-04-09', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12045923', 'W12045923', 'WYBILLINGS', 'Billings Clinic', 'Catherine', '', 'Heggem', 'SLP', 'Speech Therapy', '', '', NULL, 'M', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', '0000000000', '0000000000', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', '0000000000', '0000000000', '', '', '', '0.00', '17.00', '0.00', 3, '2014-03-12', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1245657022', 0, 'N', 0, '2014-03-24', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12045922', 'W12045922', 'WYBILLINGS', 'Billings Clinic', 'Catherine', '', 'Heggem', 'SLP', 'Speech Therapy', '', '', NULL, 'B', 'PO Box 31315', 'Billings', 'Yellowstone', 'MT', '59107', '4062382617', '0000000000', 'PO Box 31315', 'Billings', 'Yellowstone', 'MT', '59107', '4062382617', '0000000000', '', '', '', '0.00', '17.00', '0.00', 3, '2014-03-12', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1245657022', 0, 'N', 0, '2014-03-24', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12045921', 'W12045921', 'WYBILLINGS', 'Billings Clinic - Speech Therapy', 'Catherine', '', 'Heggem', 'SLP', 'Speech Therapy', '', '', NULL, 'O', '801 N 29th St', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062382469', '801 N 29th St', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062382469', '', '', '', '0.00', '17.00', '0.00', 3, '2014-03-12', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1245657022', 0, 'N', 0, '2014-03-24', NULL, NULL, 0, 0, NULL, NULL),
('452298151', 'W12045918', 'W12045918', 'TXHOUSTD', 'Columbus Prof Clinic', 'Sangeeta', NULL, 'Saikia', 'MD', 'Cardiology', '', '', NULL, 'O', '109 Shult Dr Ste 200', 'Columbus', 'Colorado', 'TX', '78934', '7138521538', '8665904336', '109 Shult Dr Ste 200', 'Columbus', 'Colorado', 'TX', '78934', '7138521538', '8665904336', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-02-17', NULL, 0, 0, 0, 'Houston Methodist Sugar Land Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1174605497', 0, 'N', 0, '2014-03-24', NULL, NULL, 0, 0, NULL, NULL),
('452298151', 'W12045919', 'W12045919', 'TXHOUSTD', 'Houston Heart Associates', 'Sangeeta', NULL, 'Saikia', 'MD', 'Cardiology', '', '', NULL, 'O', '12121 Richmond Ave Ste 116', 'Houston', 'Harris', 'TX', '77082', '2812658855', '2812654627', '12121 Richmond Ave Ste 116', 'Houston', 'Harris', 'TX', '77082', '2812658855', '2812654627', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-02-17', NULL, 0, 0, 0, 'Houston Methodist Sugar Land Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1174605497', 0, 'N', 0, '2014-03-24', NULL, NULL, 0, 0, NULL, NULL),
('465089299', 'W12045917', 'W12045917', 'UTMH1', 'Doug Nielsen Coaching and Counseling', 'Doug', 'E', 'Nielsen', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '2363 N Hillfield Rd Ste 5', 'Layton', 'Davis', 'UT', '84041', '8013914356', '8017797808', '2363 N Hillfield Rd Ste 5', 'Layton', 'Davis', 'UT', '84041', '8013914356', '8017797808', 'MA', '', '', '0.00', '40.00', '0.00', 3, '2014-03-12', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1003034240', 0, 'N', 0, '2014-03-24', NULL, NULL, 0, 0, NULL, NULL),
('830333437', 'W12045916', 'W12045916', 'WYT1', 'Teton Therapy', 'Ryan', '', 'Flatt', 'DPT', 'Physical Therapy', '', '', NULL, 'O', '820 W Main', 'Riverton', 'Fremont', 'WY', '82501', '3078577044', '3078566459', '820 W Main', 'Riverton', 'Fremont', 'WY', '82501', '3078577044', '3078566459', 'WISEWYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1689015448', 0, 'N', 0, '2014-04-21', NULL, NULL, 0, 0, NULL, NULL),
('830333437', 'W12045915', 'W12045915', 'WY01', 'Teton Therapy', 'Ryan', '', 'Flatt', 'DPT', 'Physical Therapy', '', '', NULL, 'O', '820 W Main', 'Riverton', 'Fremont', 'WY', '82501', '3078577044', '3078566459', '820 W Main', 'Riverton', 'Fremont', 'WY', '82501', '3078577044', '3078566459', 'WISEWYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1689015448', 0, 'N', 0, '2014-04-21', NULL, NULL, 0, 0, NULL, NULL),
('263090885', 'W12045912', 'W12045912', 'TXHOUSTD', 'S Faro MD & C Faro MD PLLC', 'Sebastian', '', 'Faro', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'M', 'Three Maryland Farms Ste 250', 'Brentwood', 'Williamson', 'TN', '37027', '7133839579', '7133839369', 'Three Maryland Farms Ste 250', 'Brentwood', 'Williamson', 'TN', '37027', '7133839579', '7133839369', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, 'The Womans Hospital of Texas', '', '', '', 'HCFA|UB|', '1356342315', 0, 'N', 0, '2014-04-25', NULL, NULL, 0, 0, NULL, NULL),
('263090885', 'W12045913', 'W12045913', 'TXHOUSTD', 'S Faro MD & C Faro MD PLLC', 'Sebastian', '', 'Faro', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 402087', 'Atlanta', 'Fulton', 'GA', '30384', '7133839579', '7133839369', 'PO Box 402087', 'Atlanta', 'Fulton', 'GA', '30384', '7133839579', '7133839369', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, 'The Womans Hospital of Texas', '', '', '', 'HCFA|UB|', '1356342315', 0, 'N', 0, '2014-04-25', NULL, NULL, 0, 0, NULL, NULL),
('261736078', 'W12045914', 'W12045914', 'TXHOUSTD', 'Womens Associates', 'Bassem', NULL, 'Tawadrous', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '2231 Ctr St Ste D', 'Deer Park', 'Harris', 'TX', '77536', '2814872371', '2814873689', '2231 Ctr St Ste D', 'Deer Park', 'Harris', 'TX', '77536', '2814872371', '2814873689', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-02-16', NULL, 0, 0, 0, 'Bayshore Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1730105925', 0, 'N', 0, '2014-03-24', NULL, NULL, 0, 0, NULL, NULL),
('263090885', 'W12045911', 'W12045911', 'TXHOUSTD', 'S Faro MD & C Faro MD PLLC', 'Sebastian', '', 'Faro', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '7400 Fannin St Ste 930', 'Houston', 'Harris', 'TX', '77054', '7133839579', '7133839369', '7400 Fannin St Ste 930', 'Houston', 'Harris', 'TX', '77054', '7133839579', '7133839369', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, 'The Womans Hospital of Texas', '', '', '', 'HCFA|UB|', '1356342315', 0, 'N', 0, '2014-04-25', NULL, NULL, 0, 0, NULL, NULL),
('200933683', 'W12045910', 'W12045910', 'UT01', 'Utah Hospice Specialists', '', '', 'Utah Hospice Specialists', 'GROUP', 'Hospice', '', '', NULL, 'O', '493 S Orem Blvd', 'Orem', 'Utah', 'UT', '84058', '4356744744', NULL, '493 S Orem Blvd', 'Orem', 'Utah', 'UT', '84058', '4356744744', '          ', '', '', '3', '0.00', '30.00', '0.00', 3, '2014-01-10', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009353', 0, 'N', 0, '2014-03-25', NULL, NULL, 0, 0, NULL, NULL),
('200933683', 'W12045909', 'W12045909', 'UT01', 'Utah Hospice Specialists', '', '', 'Utah Hospice Specialists', 'GROUP', 'Hospice', '', '', NULL, 'O', '292 S 1470 E Ste 101', 'St George', 'Washington', 'UT', '84790', '4356744744', NULL, '292 S 1470 E Ste 101', 'St George', 'Washington', 'UT', '84790', '4356744744', '          ', '', '', '3', '0.00', '30.00', '0.00', 3, '2014-01-10', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009353', 0, 'N', 0, '2014-03-25', NULL, NULL, 0, 0, NULL, NULL),
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('450579013', 'W12045907', 'W12045907', 'UT01', 'St Marks Gynecology Oncology Care', 'Jessica', 'R', 'Hunn', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '3100 Channing Way', 'Idaho Falls', 'Bonneville', 'ID', '83404', '2085296111', '2085297021', '3100 Channing Way', 'Idaho Falls', 'Bonneville', 'ID', '83404', '2085296111', '2085297021', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1992978712', 0, 'N', 1, '2014-07-08', NULL, NULL, 0, 0, NULL, NULL),
('562567385', 'W12045904', 'W12045904', 'TXSATSTD', 'Dowtown Dermatology Clinic', '', '', 'Bexar County Management Dermatology', '', 'Dermatology', '', '', NULL, 'O', '343 W Houston St Ste 903', 'San Antonio', 'Bexar', 'TX', '78205', '2102220376', '2102229198', '343 W Houston St Ste 903', 'San Antonio', 'Bexar', 'TX', '78205', '2102220376', '2102229198', 'TXSTD', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2014-05-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1639251838', 0, 'Y', 0, '2014-04-15', NULL, NULL, 0, 0, NULL, NULL),
('450579013', 'W12045906', 'W12045906', 'UT01', 'St Marks Gynecology Oncology Care', 'Jessica', 'R', 'Hunn', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1140 E 3900 S Ste 340', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8017434730', '8017434736', '1140 E 3900 S Ste 340', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8017434730', '8017434736', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1992978712', 0, 'N', 1, '2014-07-08', NULL, NULL, 0, 0, NULL, NULL),
('562567385', 'W12045903', 'W12045903', 'TXSATSTD', 'Castle Hills Dermatology Clinic', '', '', 'Bexar County Management Dermatology', '', 'Dermatology', '', '', NULL, 'O', '1842 Lockhill-Selma Rd Ste 101', 'San Antonio', 'Bexar', 'TX', '78213', '2103490011', '2103490666', '1842 Lockhill-Selma Rd Ste 101', 'San Antonio', 'Bexar', 'TX', '78213', '2103490011', '2103490666', 'TXSTD', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2014-05-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1639251838', 0, 'Y', 0, '2014-04-15', NULL, NULL, 0, 0, NULL, NULL),
('900419033', 'W12045900', 'W12045900', 'TXSATSTD', 'Bariatric Medical Institute of Texas', '', '', 'Bariatric Medical Institute of Texas', '', 'Family Practice', '', '', NULL, 'O', '9910 Huebner Rd Ste 250', 'San Antonio', 'Bexar', 'TX', '78240', '2106158500', '2105583345', '9910 Huebner Rd Ste 250', 'San Antonio', 'Bexar', 'TX', '78240', '2106158500', '2105583345', 'TXSTD', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2014-05-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1912151432', 0, 'Y', 0, '2014-04-15', NULL, NULL, 0, 0, NULL, NULL),
('900419033', 'W12045902', 'W12045902', 'TXSATSTD', 'Bariatric Medical Institute of Texas', 'Frank', '', 'Duperier', 'MD', 'Family Practice', '', '', NULL, 'O', '9910 Huebner Rd Ste 250', 'San Antonio', 'Bexar', 'TX', '78240', '2106158500', '2105583345', '9910 Huebner Rd Ste 250', 'San Antonio', 'Bexar', 'TX', '78240', '2106158500', '2105583345', 'TXSTD', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2014-05-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1609864909', 0, 'N', 0, '2014-04-15', NULL, NULL, 0, 0, NULL, NULL),
('460620389', 'W12045898', 'W12045898', 'TXSATSTD', '', 'Chun', 'Y', 'Wang', 'MD', 'Cardiology', '', '', NULL, 'O', '1540 W Goodwin St', 'Pleasanton', 'Atascosa', 'TX', '78064', '8305694003', '8305694001', '1540 W Goodwin St', 'Pleasanton', 'Atascosa', 'TX', '78064', '8305694003', '8305694001', 'TXSTD', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2014-05-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1104825785', 0, 'N', 0, '2014-04-15', NULL, NULL, 0, 0, NULL, NULL),
('275555297', 'W12045899', 'W12045899', 'TXHOUSTD', 'Gentle Pediatrics', 'Shahid', '', 'Hasnain', 'MD', 'Pediatrics', '', '', NULL, 'O', '22001 SW Fwy Ste 115', 'Richmond', 'Fort Bend', 'TX', '77469', '8322225437', '8322225438', '22001 SW Fwy Ste 115', 'Richmond', 'Fort Bend', 'TX', '77469', '8322225437', '8322225438', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1437249430', 0, 'N', 0, '2014-04-18', NULL, NULL, 0, 0, NULL, NULL),
('930765801', 'W12045897', 'W12045897', 'WYT1', 'Big Horn Foot Clinic', 'Lael', 'J', 'Beachler', 'DPM', 'Podiatry', '', '', NULL, 'O', '424 Yellowstone Ste 140', 'Cody', 'Park', 'WY', '82414', '3075279191', '3077541291', '424 Yellowstone Ste 140', 'Cody', 'Park', 'WY', '82414', '3075279191', '3077541291', '', '', '', '0.00', '10.00', '0.00', 3, '2014-04-15', NULL, 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1922241181', 0, 'N', 0, '2014-04-18', NULL, NULL, 0, 0, NULL, NULL),
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('870492265', 'W12045893', 'W12045893', 'UTDT01', 'Rocky Mountain Endodontics', 'Richard J', '', 'Pulsipher', 'DDS', 'Endodontist', '', '', NULL, 'O', '181 W Vine St Ste B', 'Tooele', 'Tooele', 'UT', '84074', '4358828800', NULL, '181 W Vine St Ste B', 'Tooele', 'Tooele', 'UT', '84074', '4358828800', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2014-03-24', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1295894186', 0, 'N', 0, '2014-03-24', NULL, NULL, 0, 0, NULL, NULL),
('930765801', 'W12045896', 'W12045896', 'WY01', 'Big Horn Foot Clinic', 'Lael', 'J', 'Beachler', 'DPM', 'Podiatry', '', '', NULL, 'O', '424 Yellowstone Ste 140', 'Cody', 'Park', 'WY', '82414', '3075279191', '3077541291', '424 Yellowstone Ste 140', 'Cody', 'Park', 'WY', '82414', '3075279191', '3077541291', '', '', '', '0.00', '10.00', '0.00', 3, '2014-04-15', NULL, 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1922241181', 0, 'N', 0, '2014-04-18', NULL, NULL, 0, 0, NULL, NULL),
('930765801', 'W12045894', 'W12045894', 'WY01', 'Big Horn Foot Clinic', 'Lael', 'J', 'Beachler', 'DPM', 'Podiatry', '', '', NULL, 'O', '777 Ave H', 'Powell', 'Park', 'WY', '82435', '3077549191', '3077541291', '777 Ave H', 'Powell', 'Park', 'WY', '82435', '3077549191', '3077541291', '', '', '', '0.00', '10.00', '0.00', 3, '2014-04-15', NULL, 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1922241181', 0, 'N', 0, '2014-04-18', NULL, NULL, 0, 0, NULL, NULL),
('275252289', 'W12035936', 'W12035936', 'ID01', 'Bridge Way Health Svc', 'Grant', 'B', 'Belnap', 'MD', 'Mental Health', 'Psychiatry', '', NULL, 'O', '1032 S Bridgeway Pl Ste 110', 'Eagle', 'Ada', 'ID', '83616', '2082460123', '          ', '1032 S Bridgeway Pl Ste 110', 'Eagle', 'Ada', 'ID', '83616', '2082460123', '          ', 'IDMD', '', '', '0.00', '40.00', '0.00', 6, '2013-03-20', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1356481790', 0, 'N', 0, '2014-05-15', NULL, NULL, 0, 0, NULL, NULL),
('275252289', 'W12035937', 'W12035937', 'ID01', 'Bridge Way Health Svc', 'Kellee', 'J', 'Crockett', 'PAC', 'Mental Health', '', '', NULL, 'O', '1032 S Bridgeway Pl Ste 110', 'Eagle', 'Ada', 'ID', '83616', '2082460123', '          ', '1032 S Bridgeway Pl Ste 110', 'Eagle', 'Ada', 'ID', '83616', '2082460123', '          ', 'IDMD', '', '', '0.00', '40.00', '0.00', 6, '2013-03-20', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1952441305', 0, 'N', 0, '2014-05-15', NULL, NULL, 0, 0, NULL, NULL),
('836000295', 'W12045883', 'W12045883', 'WY01', 'Memorial Hospital of Sweetwater County', 'Michael', 'D', 'Sutphin', 'MD', 'Urology', '', '', NULL, 'O', '1208 Hilltop Dr Ste 204', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073624200', '3073625406', '1208 Hilltop Dr Ste 204', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073624200', '3073625406', '', '', '', '0.00', '5.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'Memorial Hospital of Sweetwater County', '', '', '', 'HCFA|UB|', '1871693838', 0, 'N', 0, '2014-04-18', NULL, NULL, 0, 0, NULL, NULL),
('836000295', 'W12045884', 'W12045884', 'WYT2', 'Memorial Hospital of Sweetwater County', 'Michael', 'D', 'Sutphin', 'MD', 'Urology', '', '', NULL, 'O', '1208 Hilltop Dr Ste 204', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073624200', '3073625406', '1208 Hilltop Dr Ste 204', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073624200', '3073625406', '', '', '', '0.00', '5.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'Memorial Hospital of Sweetwater County', '', '', '', 'HCFA|UB|', '1871693838', 0, 'N', 0, '2014-04-18', NULL, NULL, 0, 0, NULL, NULL),
('261736078', 'W12045885', 'W12045885', 'TXHOUSTD', 'Womens Associates', 'Subha', NULL, 'Sundaram', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '2231 Ctr St Ste D', 'Deer Park', 'Harris', 'TX', '77536', '2814872371', '2814873689', '2231 Ctr St Ste D', 'Deer Park', 'Harris', 'TX', '77536', '2814872371', '2814873689', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-02-16', NULL, 0, 0, 0, 'Bayshore Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1912117151', 0, 'N', 0, '2014-03-21', NULL, NULL, 0, 0, NULL, NULL),
('452298151', 'W12045881', 'W12045881', 'TXHOUSTD', 'Specialty Associates of West Houston', 'Gregory', NULL, 'Pepper', 'MD', 'Cardiology', ' ', '', NULL, 'O', '146 E Hospital Dr Ste 201', 'Angleton', 'Brazoria', 'TX', '77515', '7138521538', '8665904336', '146 E Hospital Dr Ste 201', 'Angleton', 'Brazoria', 'TX', '77515', '7138521538', '8665904336', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-02-17', NULL, 0, 0, 0, 'Houston Methodist Sugar Land Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1386674901', 0, 'N', 0, '2014-03-21', NULL, NULL, 0, 0, NULL, NULL),
('810587644', 'W12045878', 'W12045878', 'UT01', 'Bear Lake Community Health Center', 'David', '', 'Robinson', 'LMFT', 'Mental Health', 'Counseling', '', NULL, 'O', '325 W Logan Hwy', 'Garden City', 'Rich', 'UT', '84028', '4359463660', '4359468215', '325 W Logan Hwy', 'Garden City', 'Rich', 'UT', '84028', '4359463660', '4359468215', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-04-24', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1114978269', 0, 'N', 0, '2014-03-25', NULL, NULL, 0, 0, NULL, NULL),
('954893928', 'W12045879', 'W12045879', 'UT01', 'Exodus Healthcare Network', 'Mark', 'W', 'Peterson', 'DO', 'Family Practice', 'Sports Medicine', '', NULL, 'O', '3665 S 8400 W Ste 110', 'Magna', 'Salt Lake', 'UT', '84044', '8012509638', '8012503204', '3665 S 8400 W Ste 110', 'Magna', 'Salt Lake', 'UT', '84044', '8012509638', '8012503204', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-06-01', NULL, 0, 0, 0, 'Pioneer Valley Hospital', '', '', '', 'HCFA|UB|', '1326374562', 0, 'N', 0, '2014-05-28', NULL, NULL, 0, 0, NULL, NULL),
('460706062', 'W12045882', 'W12045882', 'ID02', 'State Avenue Counseling', 'Sandra', 'E', 'Phillips', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '39 E State Ave', 'Meridian', 'Ada', 'ID', '83642', '2089943599', '2084732206', '39 E State Ave', 'Meridian', 'Ada', 'ID', '83642', '2089943599', '2084732206', 'IDMA', '', '', '0.00', '40.00', '0.00', 6, '2014-03-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1922312776', 0, 'N', 0, '2014-03-21', NULL, NULL, 0, 0, NULL, NULL),
('275252289', 'W12035938', 'W12035938', 'ID01', 'Bridge Way Health Svc', 'Jody', 'L', 'Jenson', 'NP', 'Mental Health', 'Psychiatry', '', NULL, 'O', '1032 S Bridgeway Pl Ste 110', 'Eagle', 'Ada', 'ID', '83616', '2082460123', '          ', '1032 S Bridgeway Pl Ste 110', 'Eagle', 'Ada', 'ID', '83616', '2082460123', '          ', 'IDARNP', '', '', '0.00', '40.00', '0.00', 6, '2013-03-20', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1669737300', 0, 'N', 0, '2014-05-15', NULL, NULL, 0, 0, NULL, NULL),
('810587644', 'W12045876', 'W12045876', 'UT01', 'Cache Valley Community Health Ctr', 'David', '', 'Robinson', 'LMFT', 'Mental Health', 'Counseling', '', NULL, 'B', '1515 N 400 E Ste 104', 'Logan', 'Cache', 'UT', '84341', '4357556061', '4357556091', '1515 N 400 E Ste 104', 'Logan', 'Cache', 'UT', '84341', '4357556061', '4357556091', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-04-24', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1114978269', 0, 'N', 0, '2014-03-25', NULL, NULL, 0, 0, NULL, NULL),
('810587644', 'W12045877', 'W12045877', 'UT01', 'Cache Valley Community Health Ctr', 'David', '', 'Robinson', 'LMFT', 'Mental Health', 'Counseling', '', NULL, 'O', '26 W Main St Ste 3A', 'Hyrum', 'Cache', 'UT', '84319', '4352456988', '4352456987', '26 W Main St Ste 3A', 'Hyrum', 'Cache', 'UT', '84319', '4352456988', '4352456987', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-04-24', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1114978269', 0, 'N', 0, '2014-03-25', NULL, NULL, 0, 0, NULL, NULL),
('452298151', 'W12045880', 'W12045880', 'TXHOUSTD', 'Columbus Prof Clinic', 'Gregory', NULL, 'Pepper', 'MD', 'Cardiology', ' ', '', NULL, 'O', '109 Shult Dr Ste 200', 'Columbus', 'Colorado', 'TX', '78934', '7138521538', '8665904336', '109 Shult Dr Ste 200', 'Columbus', 'Colorado', 'TX', '78934', '7138521538', '8665904336', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-02-17', NULL, 0, 0, 0, 'Houston Methodist Sugar Land Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1386674901', 0, 'N', 0, '2014-03-21', NULL, NULL, 0, 0, NULL, NULL),
('850232628', 'W12045875', 'W12045875', 'NM01', 'Womens Specialists of NM', 'Alicia', 'C', 'Castillo', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '6320 Riverside Plaza Ln NW Ste A', 'Albuquerque', 'Bernalillo', 'NM', '87120', '5058436168', '5058905933', '6320 Riverside Plaza Ln NW Ste A', 'Albuquerque', 'Bernalillo', 'NM', '87120', '5058436168', '5058905933', 'NMWOMENS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-06-01', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1053573600', 0, 'N', 0, '2014-05-28', NULL, NULL, 0, 0, NULL, NULL),
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('581955423', 'APC000037', 'APC000037', 'APCTEST', 'Southern Regional Medical Center', NULL, NULL, 'Southern Regional Medical Center', NULL, 'Hospital', NULL, NULL, NULL, 'B', 'Change', NULL, NULL, NULL, '00000', NULL, NULL, 'Change', '', '', '', '00000', '', '', NULL, NULL, 'APCTEST', '0.00', '0.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1831190958', 0, 'Y', 0, '2014-03-20', '110165', NULL, 0, 0, NULL, NULL),
('581529366', 'APC000041', 'APC000041', 'APCTEST', 'Wesley Woods Hospital', NULL, NULL, 'Wesley Woods Hospital', NULL, 'Hospital', NULL, NULL, NULL, 'B', 'Change', NULL, NULL, NULL, '00000', NULL, NULL, 'Change', '', '', '', '00000', '', '', NULL, NULL, 'APCTEST', '0.00', '0.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1770560294', 0, 'Y', 0, '2014-03-20', '110203', NULL, 0, 0, NULL, NULL),
('582433438', 'APC000028', 'APC000028', 'APCTEST', 'Cartersville Medical Center  HCA Affili', NULL, NULL, 'Cartersville Medical Center  HCA Affili', NULL, 'Hospital', NULL, NULL, NULL, 'B', 'Change', NULL, NULL, NULL, '00000', NULL, NULL, 'Change', '', '', '', '00000', '', '', NULL, NULL, 'APCTEST', '0.00', '0.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1780638833', 0, 'Y', 0, '2014-03-20', '110030', NULL, 0, 0, NULL, NULL),
('582155150', 'APC000032', 'APC000032', 'APCTEST', 'Newton Health System Inc', NULL, NULL, 'Newton Health System Inc', NULL, 'Hospital', NULL, NULL, NULL, 'B', 'Change', NULL, NULL, NULL, '00000', NULL, NULL, 'Change', '', '', '', '00000', '', '', NULL, NULL, 'APCTEST', '0.00', '0.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1750408167', 0, 'Y', 0, '2014-03-20', '110018', NULL, 0, 0, NULL, NULL),
('581123037', 'APC000034', 'APC000034', 'APCTEST', 'Redmond Regional Medical Center  HCA Af', NULL, NULL, 'Redmond Regional Medical Center  HCA Af', NULL, 'Hospital', NULL, NULL, NULL, 'B', 'Change', NULL, NULL, NULL, '00000', NULL, NULL, 'Change', '', '', '', '00000', '', '', NULL, NULL, 'APCTEST', '0.00', '0.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1508810565', 0, 'Y', 0, '2014-03-20', '110168', NULL, 0, 0, NULL, NULL),
('752919505', 'APC000036', 'APC000036', 'APCTEST', 'South Fulton Medical Center', NULL, NULL, 'South Fulton Medical Center', NULL, 'Hospital', NULL, NULL, NULL, 'B', 'Change', NULL, NULL, NULL, '00000', NULL, NULL, 'Change', '', '', '', '00000', '', '', NULL, NULL, 'APCTEST', '0.00', '0.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1598781635', 0, 'Y', 0, '2014-03-20', '110219', NULL, 0, 0, NULL, NULL),
('200141568', 'APC000029', 'APC000029', 'APCTEST', 'Clearview Regional Medical Center', NULL, NULL, 'Clearview Regional Medical Center', NULL, 'Hospital', NULL, NULL, NULL, 'B', 'Change', NULL, NULL, NULL, '00000', NULL, NULL, 'Change', '', '', '', '00000', '', '', NULL, NULL, 'APCTEST', '0.00', '0.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1043265564', 0, 'Y', 0, '2014-03-20', '110046', NULL, 0, 0, NULL, NULL),
('205077249', 'APC000033', 'APC000033', 'APCTEST', 'Piedmont Newnan Hospital', NULL, NULL, 'Piedmont Newnan Hospital', NULL, 'Hospital', NULL, NULL, NULL, 'B', 'Change', NULL, NULL, NULL, '00000', NULL, NULL, 'Change', '', '', '', '00000', '', '', NULL, NULL, 'APCTEST', '0.00', '0.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1134133002', 0, 'Y', 0, '2014-03-20', '110229', NULL, 0, 0, NULL, NULL),
('582200195', 'APC000031', 'APC000031', 'APCTEST', 'Henry Medical Center', NULL, NULL, 'Henry Medical Center', NULL, 'Hospital', NULL, NULL, NULL, 'B', 'Change', NULL, NULL, NULL, '00000', NULL, NULL, 'Change', '', '', '', '00000', '', '', NULL, NULL, 'APCTEST', '0.00', '0.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1220534333', 0, 'Y', 0, '2014-03-20', '110191', NULL, 0, 0, NULL, NULL),
('263202930', 'APC000035', 'APC000035', 'APCTEST', 'Rockdale Medical Center Inc', NULL, NULL, 'Rockdale Medical Center Inc', NULL, 'Hospital', NULL, NULL, NULL, 'B', 'Change', NULL, NULL, NULL, '00000', NULL, NULL, 'Change', '', '', '', '00000', '', '', NULL, NULL, 'APCTEST', '0.00', '0.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1275788762', 0, 'Y', 0, '2014-03-20', '110091', NULL, 0, 0, NULL, NULL),
('870550021', 'W12045868', 'W12045868', 'UT01', 'Utah Physicians Care Center', 'Margi', '', 'Bhatt', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1160 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012619651', '          ', '1160 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012619651', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'St Marks Hospital', 'Mountain View Hospital', 'Timpanogos Regional Hospital', '', 'HCFA|UB|', '1174594485', 0, 'N', 1, '2014-04-21', NULL, NULL, 0, 0, NULL, NULL),
('870550021', 'W12045867', 'W12045867', 'UT01', 'Utah Physicians Care Center', 'Margi', '', 'Bhatt', 'MD', 'Internal Medicine', '', '', NULL, 'B', '5630 S Waterbury Way Ste B102', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012619651', '          ', '5630 S Waterbury Way Ste B102', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012619651', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'St Marks Hospital', 'Mountain View Hospital', 'Timpanogos Regional Hospital', '', 'HCFA|UB|', '1174594485', 0, 'N', 1, '2014-04-21', NULL, NULL, 0, 0, NULL, NULL),
('870550021', 'W12045864', 'W12045864', 'UT01', 'Utah Physicians Care Center', 'James', 'J', 'Chamberlain', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1160 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012619651', '          ', '1160 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012619651', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1093805681', 0, 'N', 0, '2014-05-01', NULL, NULL, 0, 0, NULL, NULL),
('870550021', 'W12045865', 'W12045865', 'UT01', 'Utah Physicians Care Center', 'James', 'J', 'Chamberlain', 'MD', 'Internal Medicine', '', '', NULL, 'B', '5630 S Waterbury Way Ste B102', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012619651', '          ', '5630 S Waterbury Way Ste B102', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012619651', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1093805681', 0, 'N', 0, '2014-05-01', NULL, NULL, 0, 0, NULL, NULL),
('204043287', 'W12045863', 'W12045863', 'NM01', 'ABQ Health Partners', 'Ju Yung', '', 'Kim', 'CNP', 'Nurse Practitioner ', '', '', NULL, 'B', 'PO Box 27829           ', 'Albuquerque', 'Bernalillo', 'NM', '87125', '5052627600', '0000000000', 'PO Box 27829           ', 'Albuquerque', 'Bernalillo', 'NM', '87125', '5052627600', '0000000000', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2014-03-10', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1487076220', 0, 'N', 0, '2014-03-20', NULL, NULL, 0, 0, NULL, NULL),
('204043287', 'W12045862', 'W12045862', 'NM01', 'ABQ Health Partners', 'Ju Yung', '', 'Kim', 'CNP', 'Nurse Practitioner ', '', '', NULL, 'O', '5400 Gibson Blvd SE', 'Albuquerque', 'Bernalillo', 'NM', '87108', '5052627960', '5052321368', '5400 Gibson Blvd SE', 'Albuquerque', 'Bernalillo', 'NM', '87108', '5052627960', '5052321368', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2014-03-10', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1487076220', 0, 'N', 0, '2014-03-20', NULL, NULL, 0, 0, NULL, NULL),
('204043287', 'W12045859', 'W12045859', 'NM01', 'ABQ Health Partners', 'Ludmila', '', 'Tsigelnitska', 'CNP', 'Nurse Practitioner ', '', '', NULL, 'O', '5400 Gibson Blvd SE', 'Albuquerque', 'Bernalillo', 'NM', '87108', '5052627960', '5052321368', '5400 Gibson Blvd SE', 'Albuquerque', 'Bernalillo', 'NM', '87108', '5052627960', '5052321368', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2014-03-10', '2014-06-26', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1770826810', 0, 'N', 0, '2014-07-14', NULL, NULL, 0, 0, NULL, NULL),
('204043287', 'W12045861', 'W12045861', 'NM01', 'ABQ Health Partners', 'Ju Yung', '', 'Kim', 'CNP', 'Nurse Practitioner ', '', '', NULL, 'O', '2121 Juan Tabo Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87112', '5052378800', '5052378817', '2121 Juan Tabo Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87112', '5052378800', '5052378817', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2014-03-10', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1487076220', 0, 'N', 0, '2014-03-20', NULL, NULL, 0, 0, NULL, NULL),
('204043287', 'W12045858', 'W12045858', 'NM01', 'ABQ Health Partners', 'Ludmila', '', 'Tsigelnitska', 'CNP', 'Nurse Practitioner ', '', '', NULL, 'B', 'PO Box 27829', 'Albuquerque', 'Bernalillo', 'NM', '87125', '5052627600', '0000000000', 'PO Box 27829', 'Albuquerque', 'Bernalillo', 'NM', '87125', '5052627600', '0000000000', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2014-03-10', '2014-06-26', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1770826810', 0, 'N', 0, '2014-07-14', NULL, NULL, 0, 0, NULL, NULL),
('204043287', 'W12045857', 'W12045857', 'NM01', 'ABQ Health Partners', 'Ludmila', '', 'Tsigelnitska', 'CNP', 'Nurse Practitioner ', '', '', NULL, 'O', '500 Walter St NE Ste 401', 'Albuquerque', 'Bernalillo', 'NM', '87102', '5052623542', '5052627394', '500 Walter St NE Ste 401', 'Albuquerque', 'Bernalillo', 'NM', '87102', '5052623542', '5052627394', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2014-03-10', '2014-06-26', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1770826810', 0, 'N', 0, '2014-07-14', NULL, NULL, 0, 0, NULL, NULL),
('528596484', 'W12045855', 'W12045855', 'UTMH1', '', 'Gary', 'L', 'Anderson', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '520 E Topaz Blvd Ste 208', 'Delta', 'Millard', 'UT', '84624', '4358647072', NULL, '520 E Topaz Blvd Ste 208', 'Delta', 'Millard', 'UT', '84624', '4358647072', '          ', 'UTMA', '', '', '0.00', '40.00', '0.00', 3, '2014-03-17', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1013123553', 0, 'N', 0, '2014-03-20', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12045853', 'W12045853', 'WYBILLINGS', 'Billings Clinic', 'Naomi', 'K', 'Atkins', 'DO', 'Hospitalist', '', '', NULL, 'B', 'PO Box 31315', 'Billings', 'Yellowstone', 'MT', '59107', '4062382617', '0000000000', 'PO Box 31315', 'Billings', 'Yellowstone', 'MT', '59107', '4062382617', '0000000000', '', '', '', '0.00', '17.00', '0.00', 3, '2014-03-12', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1225308844', 0, 'N', 0, '2014-03-20', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12045854', 'W12045854', 'WYBILLINGS', 'Billings Clinic', 'Naomi', 'K', 'Atkins', 'DO', 'Hospitalist', '', '', NULL, 'M', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', '0000000000', '0000000000', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', '0000000000', '0000000000', '', '', '', '0.00', '17.00', '0.00', 3, '2014-03-12', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1225308844', 0, 'N', 0, '2014-03-20', NULL, NULL, 0, 0, NULL, NULL),
('464249891', 'W12045848', 'W12045848', 'UTDT01', 'Starley Family Dental', 'Nathan', '', 'Starley', 'DDS', 'Dentist', '', '', NULL, 'O', '3590 Harrison Blvd Ste 6', 'Ogden', 'Weber', 'UT', '84403', '8016213553', NULL, '3590 Harrison Blvd Ste 6', 'Ogden', 'Weber', 'UT', '84403', '8016213553', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1619118791', 0, 'N', 0, '2014-03-20', NULL, NULL, 0, 0, NULL, NULL);
INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
('464488723', 'W12045846', 'W12045846', 'UTDT01', 'Clark Dental Care', 'Richard', '', 'Smart', 'DDS', 'Dentist', '', '', NULL, 'O', '2180 E 4500 S Ste 250', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8012728609', NULL, '2180 E 4500 S Ste 250', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8012728609', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1861538126', 0, 'N', 0, '2014-03-24', NULL, NULL, 0, 0, NULL, NULL),
('461412682', 'W12045845', 'W12045845', 'UTDT01', 'Half Dental', 'Brady', '', 'Powell', 'DDS', 'Dentist', '', '', NULL, 'O', '2274 N Washington Blvd Ste 202', 'Ogden', 'Weber', 'UT', '84414', '8018525252', NULL, '2274 N Washington Blvd Ste 202', 'Ogden', 'Weber', 'UT', '84414', '8018525252', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1275859985', 0, 'N', 0, '2014-03-20', NULL, NULL, 0, 0, NULL, NULL),
('463067541', 'W12045843', 'W12045843', 'UTDT01', 'South Jordan Dental', 'Robert', '', 'Paxton', 'DMD', 'Dentist', '', '', NULL, 'O', '1268 W S Jordan Pkwy Ste 302', 'South Jordan', 'Salt Lake', 'UT', '84095', '8012533900', NULL, '1268 W S Jordan Pkwy Ste 302', 'South Jordan', 'Salt Lake', 'UT', '84095', '8012533900', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1275634743', 0, 'N', 0, '2014-03-20', NULL, NULL, 0, 0, NULL, NULL),
('461412682', 'W12045844', 'W12045844', 'UTDT01', 'Half Dental', 'Travis', '', 'Perkins', 'DMD', 'Dentist', '', '', NULL, 'O', '2274 N Washington Blvd Ste 202', 'Ogden', 'Weber', 'UT', '84414', '8018525252', NULL, '2274 N Washington Blvd Ste 202', 'Ogden', 'Weber', 'UT', '84414', '8018525252', '', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1982840203', 0, 'N', 0, '2014-07-18', NULL, NULL, 0, 0, NULL, NULL),
('461412682', 'W12045842', 'W12045842', 'UTDT01', 'Half Dental', 'Bryan', '', 'Larson', 'DDS', 'Dentist', '', '', NULL, 'O', '2274 N Washington Blvd Ste 202', 'Ogden', 'Weber', 'UT', '84414', '8018525252', NULL, '2274 N Washington Blvd Ste 202', 'Ogden', 'Weber', 'UT', '84414', '8018525252', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1225260037', 0, 'N', 0, '2014-03-20', NULL, NULL, 0, 0, NULL, NULL),
('870429596', 'W12045839', 'W12045839', 'UTDT01', 'Barton Gleave DDS', 'Barton', '', 'Gleave', 'DDS', 'Dentist', '', '', NULL, 'O', '5872 S 900 E Ste 200', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '4352881818', NULL, '5872 S 900 E Ste 200', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '4352881818', '          ', 'UT000B', '', '', '0.00', '100.00', '0.00', 8, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1346453438', 0, 'N', 0, '2014-03-20', NULL, NULL, 0, 0, NULL, NULL),
('464292504', 'W12045838', 'W12045838', 'UTDT01', 'Olympus View Dental', 'Jacob', '', 'Froerer', 'DDS', 'Dentist', '', '', NULL, 'O', '4110 S Highland Dr Ste 200', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012781164', NULL, '4110 S Highland Dr Ste 200', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012781164', '          ', 'UT000B', '', '', '0.00', '100.00', '0.00', 8, '2014-03-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1356511794', 0, 'N', 0, '2014-03-20', NULL, NULL, 0, 0, NULL, NULL),
('464393280', 'W12045841', 'W12045841', 'UTDT01', 'Happy Valley Endodontics', 'Richard J', '', 'Pulsipher', 'DDS', 'Endodontist', '', '', NULL, 'O', '3355 University Ave Ste 100', 'Provo', 'Utah', 'UT', '84604', '8013563636', NULL, '3355 University Ave Ste 100', 'Provo', 'Utah', 'UT', '84604', '8013563636', '          ', '', '', '', '0.00', '20.00', '0.00', 8, '2014-03-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1295894186', 0, 'N', 0, '2014-03-24', NULL, NULL, 0, 0, NULL, NULL),
('464489695', 'W12045840', 'W12045840', 'UTDT01', 'Goodman Dental', 'Christopher', '', 'Goodman', 'DMD', 'Dentist', '', '', NULL, 'O', '11576 S State St Ste 1203', 'Draper', 'Salt Lake', 'UT', '84020', '8018427993', NULL, '11576 S State St Ste 1203', 'Draper', 'Salt Lake', 'UT', '84020', '8018427993', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2014-02-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1518174259', 0, 'N', 0, '2014-03-20', NULL, NULL, 0, 0, NULL, NULL),
('870517486', 'W12045836', 'W12045836', 'UTDT01', 'Gentle Dental Arts', 'Larsen', '', 'Alexander', 'DDS', 'Dentist', '', '', NULL, 'O', '385 W Ctr St', 'Orem', 'Utah', 'UT', '84057', '8012241117', NULL, '385 W Ctr St', 'Orem', 'Utah', 'UT', '84057', '8012241117', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2014-03-01', NULL, 0, 0, 0, '', '', '', '', '|DEN|', '1396838181', 0, 'N', 0, '2014-03-20', NULL, NULL, 0, 0, NULL, NULL),
('464488723', 'W12045837', 'W12045837', 'UTDT01', 'Clark Dental Care', 'David M', '', 'Clark', 'DDS', 'Dentist', '', '', NULL, 'O', '2180 E 4500 S Ste 250', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8012728609', NULL, '2180 E 4500 S Ste 250', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8012728609', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1902193253', 0, 'N', 0, '2014-03-20', NULL, NULL, 0, 0, NULL, NULL),
('261494084', 'W12045834', 'W12045834', 'UTDT01', 'Hyde Park Dental', 'Brandon', '', 'Priebe', 'DDS', 'Dentist', '', '', NULL, 'O', '3125 N Main Ste 104', 'Logan', 'Cache', 'UT', '84321', '4357874444', NULL, '3125 N Main Ste 104', 'Logan', 'Cache', 'UT', '84321', '4357874444', '          ', 'UT000B', '', '', '0.00', '100.00', '0.00', 8, '2014-03-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1427213594', 0, 'N', 0, '2014-03-20', NULL, NULL, 0, 0, NULL, NULL),
('901009910', 'W12045829', 'W12045829', 'UTDT01', 'Corner Canyon Dentistry', 'Nathan', '', 'Holt', 'DMD', 'Dentist', '', '', NULL, 'O', '308 E Crossroads Blvd', 'Lehi', 'Utah', 'UT', '84043', '8014954440', NULL, '308 E Crossroads Blvd', 'Lehi', 'Utah', 'UT', '84043', '8014954440', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2014-03-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1437384500', 0, 'N', 0, '2014-03-20', NULL, NULL, 0, 0, NULL, NULL),
('870627380', 'W12045831', 'W12045831', 'UTDT01', 'Koelliker Endodontics', 'Koelliker', '', 'David', 'DDS', 'Endodontist', '', '', NULL, 'O', '6364 S Highland Dr Ste 200', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012789505', NULL, '6364 S Highland Dr Ste 200', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012789505', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2014-03-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1245243542', 0, 'N', 0, '2014-03-20', NULL, NULL, 0, 0, NULL, NULL),
('464314958', 'W12045832', 'W12045832', 'UTDT01', 'Naisbitt Family Dentistry', 'Sarah', '', 'Naisbitt', 'DDS', 'Dentist', '', '', NULL, 'O', '2860 W 4700 S Ste A', 'Salt Lake City', 'Salt Lake', 'UT', '84129', '8019681142', NULL, '2860 W 4700 S Ste A', 'Salt Lake City', 'Salt Lake', 'UT', '84129', '8019681142', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2014-03-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1497730022', 0, 'N', 0, '2014-03-20', NULL, NULL, 0, 0, NULL, NULL),
('320422239', 'W12045833', 'W12045833', 'UTDT01', 'Platinum Dental Care', 'Daniel', '', 'Poelman', 'DDS', 'Dentist', '', '', NULL, 'O', '1530 N State St Ste A', 'Lehi', 'Utah', 'UT', '84043', '8013318545', NULL, '1530 N State St Ste A', 'Lehi', 'Utah', 'UT', '84043', '8013318545', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 3, '2014-03-01', NULL, 0, 0, 0, '', '', '', '', '|DEN|', '1891048823', 0, 'N', 0, '2014-03-20', NULL, NULL, 0, 0, NULL, NULL),
('261508946', 'W12045828', 'W12045828', 'UTDT01', 'Genesis Dental of Orem', 'Devin', '', 'Davidson', 'DMD', 'Dentist', '', '', NULL, 'O', '320 E 800 S', 'Orem', 'Utah', 'UT', '84097', '8012249555', NULL, '320 E 800 S', 'Orem', 'Utah', 'UT', '84097', '8012249555', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2014-03-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1861755571', 0, 'N', 0, '2014-03-20', NULL, NULL, 0, 0, NULL, NULL),
('870617336', 'W12045827', 'W12045827', 'UTDT01', 'Monarch Dental', 'Kent', '', 'Dastrup', 'DDS', 'Dentist', '', '', NULL, 'O', '1140 W Riverdale Rd Ste D', 'Ogden', 'Weber', 'UT', '84405', '8019171502', NULL, '1140 W Riverdale Rd Ste D', 'Ogden', 'Weber', 'UT', '84405', '8019171502', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2014-03-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1689725137', 0, 'N', 0, '2014-03-20', NULL, NULL, 0, 0, NULL, NULL),
('870680242', 'W12045825', 'W12045825', 'UTDT01', 'East Mountain Dental', 'Ryan G', '', 'Hamilton', 'DDS', 'Dentist', '', '', NULL, 'O', '2211 E Valley Vista Way', 'Provo', 'Utah', 'UT', '84606', '8013770037', NULL, '2211 E Valley Vista Way', 'Provo', 'Utah', 'UT', '84606', '8013770037', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2014-02-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1881725273', 0, 'N', 0, '2014-03-20', NULL, NULL, 0, 0, NULL, NULL),
('721543665', 'W12045826', 'W12045826', 'UTDT01', 'Baer Canyon Dental', 'Brian', '', 'Miles', 'DMD', 'Dentist', '', '', NULL, 'O', '275 N 300 W Ste 404', 'Kaysville', 'Davis', 'UT', '84037', '8015449444', NULL, '275 N 300 W Ste 404', 'Kaysville', 'Davis', 'UT', '84037', '8015449444', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1639357254', 0, 'N', 0, '2014-03-20', NULL, NULL, 0, 0, NULL, NULL),
('900272250', 'W12045824', 'W12045824', 'UTDT01', 'Strong Family Dentistry', 'Brad ', '', 'Strong', 'DDS', 'Dentist', '', '', NULL, 'O', '128 W 900 S', 'Spanish Fork', 'Utah', 'UT', '84660', '8017942254', NULL, '128 W 900 S', 'Spanish Fork', 'Utah', 'UT', '84660', '8017942254', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1326189846', 0, 'N', 0, '2014-03-20', NULL, NULL, 0, 0, NULL, NULL),
('262972579', 'W12045823', 'W12045823', 'UTDT01', 'Andrew Vernon DDS', 'Andrew', '', 'Vernon', 'DMD', 'Dentist', '', '', NULL, 'O', '715 E 3900 S Ste 211', 'Murray', 'Salt Lake', 'UT', '84107', '8012630417', NULL, '715 E 3900 S Ste 211', 'Murray', 'Salt Lake', 'UT', '84107', '8012630417', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2014-03-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1831350289', 0, 'N', 0, '2014-03-20', NULL, NULL, 0, 0, NULL, NULL),
('870617336', 'W12045821', 'W12045821', 'UTDT01', 'Monarch Dental', 'Scott', '', 'Cardall', 'DMD', 'Orthodontist', '', '', NULL, 'O', '4645 S 4000 W Ste B', 'Taylorsville', 'Salt Lake', 'UT', '84118', '8019551900', NULL, '4645 S 4000 W Ste B', 'Taylorsville', 'Salt Lake', 'UT', '84118', '8019551900', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2014-03-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1114269289', 0, 'N', 0, '2014-03-20', NULL, NULL, 0, 0, NULL, NULL),
('463877047', 'W12045822', 'W12045822', 'UTDT01', 'David D Stubbs DDS', 'David', '', 'Stubbs', 'DDS', 'Dentist', '', '', NULL, 'O', '3383 N Orchard Dr', 'Bountiful', 'Davis', 'UT', '84010', '8018130044', NULL, '3383 N Orchard Dr', 'Bountiful', 'Davis', 'UT', '84010', '8018130044', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2014-03-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1588995377', 0, 'N', 0, '2014-03-20', NULL, NULL, 0, 0, NULL, NULL),
('870617336', 'W12045819', 'W12045819', 'UTDT01', 'Monarch Dental', 'Scott', '', 'Cardall', 'DMD', 'Orthodontist', '', '', NULL, 'O', '1140 W Riverdale Rd Ste D', 'Ogden', 'Weber', 'UT', '84405', '8019171502', NULL, '1140 W Riverdale Rd Ste D', 'Ogden', 'Weber', 'UT', '84405', '8019171502', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2014-03-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1114269289', 0, 'N', 0, '2014-03-20', NULL, NULL, 0, 0, NULL, NULL),
('870617336', 'W12045820', 'W12045820', 'UTDT01', 'Monarch Dental', 'Scott', '', 'Cardall', 'DMD', 'Orthodontist', '', '', NULL, 'O', '24 S 500 W Ste A', 'Bountiful', 'Davis', 'UT', '84010', '8012961606', NULL, '24 S 500 W Ste A', 'Bountiful', 'Davis', 'UT', '84010', '8012961606', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2014-03-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1114269289', 0, 'N', 0, '2014-03-20', NULL, NULL, 0, 0, NULL, NULL),
('870617336', 'W12045818', 'W12045818', 'UTDT01', 'Monarch Dental', 'Scott', '', 'Cardall', 'DMD', 'Orthodontist', '', '', NULL, 'O', '1492 W Antelope Dr Ste 201', 'Layton', 'Davis', 'UT', '84041', '8017766566', NULL, '1492 W Antelope Dr Ste 201', 'Layton', 'Davis', 'UT', '84041', '8017766566', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2014-03-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1114269289', 0, 'N', 0, '2014-03-20', NULL, NULL, 0, 0, NULL, NULL),
('870617336', 'W12045817', 'W12045817', 'UTDT01', 'Monarch Dental', 'Scott', '', 'Cardall', 'DMD', 'Orthodontist', '', '', NULL, 'O', '280 N Union Ave Ste L110', 'Farmington', 'Davis', 'UT', '84025', '8019343181', NULL, '280 N Union Ave Ste L110', 'Farmington', 'Davis', 'UT', '84025', '8019343181', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2014-03-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1114269289', 0, 'N', 0, '2014-03-20', NULL, NULL, 0, 0, NULL, NULL),
('870617336', 'W12045816', 'W12045816', 'UTDT01', 'Monarch Dental', 'Scott', '', 'Cardall', 'DMD', 'Orthodontist', '', '', NULL, 'O', '5974 S Fashion Pointe Dr Ste 210', 'Ogden', 'Weber', 'UT', '84403', '8014754797', NULL, '5974 S Fashion Pointe Dr Ste 210', 'Ogden', 'Weber', 'UT', '84403', '8014754797', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2014-03-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1114269289', 0, 'N', 0, '2014-03-20', NULL, NULL, 0, 0, NULL, NULL),
('870617336', 'W12045815', 'W12045815', 'UTDT01', 'Monarch Dental', 'Scott', '', 'Cardall', 'DMD', 'Orthodontist', '', '', NULL, 'O', '575 E University Pkwy Ste A-24', 'Orem', 'Utah', 'UT', '84057', '8012253300', NULL, '575 E University Pkwy Ste A-24', 'Orem', 'Utah', 'UT', '84057', '8012253300', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2014-03-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1114269289', 0, 'N', 0, '2014-03-20', NULL, NULL, 0, 0, NULL, NULL),
('870617336', 'W12045813', 'W12045813', 'UTDT01', 'Monarch Dental', 'Scott', '', 'Cardall', 'DMD', 'Orthodontist', '', '', NULL, 'O', '5419 S Redwood Rd Ste 2', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8012636400', NULL, '5419 S Redwood Rd Ste 2', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8012636400', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2014-03-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1114269289', 0, 'N', 0, '2014-03-20', NULL, NULL, 0, 0, NULL, NULL),
('870617336', 'W12045814', 'W12045814', 'UTDT01', 'Monarch Dental', 'Scott', '', 'Cardall', 'DMD', 'Orthodontist', '', '', NULL, 'O', '476 N 900 W Ste A', 'American Fork', 'Utah', 'UT', '84003', '8017565522', NULL, '476 N 900 W Ste A', 'American Fork', 'Utah', 'UT', '84003', '8017565522', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2014-03-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1114269289', 0, 'N', 0, '2014-03-20', NULL, NULL, 0, 0, NULL, NULL),
('870617336', 'W12045811', 'W12045811', 'UTDT01', 'Monarch Dental', 'Scott', '', 'Cardall', 'DMD', 'Orthodontist', '', '', NULL, 'O', '10011 S Centennial Pkwy Ste 330', 'Sandy', 'Salt Lake', 'UT', '84070', '8012563700', NULL, '10011 S Centennial Pkwy Ste 330', 'Sandy', 'Salt Lake', 'UT', '84070', '8012563700', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2014-03-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1114269289', 0, 'N', 0, '2014-03-20', NULL, NULL, 0, 0, NULL, NULL),
('870617336', 'W12045812', 'W12045812', 'UTDT01', 'Monarch Dental', 'Scott', '', 'Cardall', 'DMD', 'Orthodontist', '', '', NULL, 'O', '370 E S Temple Ste 350', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8013209810', NULL, '370 E S Temple Ste 350', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8013209810', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2014-03-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1114269289', 0, 'N', 0, '2014-03-20', NULL, NULL, 0, 0, NULL, NULL),
('262854549', 'W12045809', 'W12045809', 'UTDT01', 'Stonehaven Dental', 'David', '', 'Cameron', 'DMD', 'Orthodontist', '', '', NULL, 'O', '181 N 1200 E', 'Lehi', 'Utah', 'UT', '84043', '8017663600', NULL, '181 N 1200 E', 'Lehi', 'Utah', 'UT', '84043', '8017663600', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2014-03-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1255661039', 0, 'N', 0, '2014-03-20', NULL, NULL, 0, 0, NULL, NULL),
('452403034', 'W12045810', 'W12045810', 'UTDT01', 'Stonehaven Dental', 'David', '', 'Cameron', 'DMD', 'Orthodontist', '', '', NULL, 'O', '3785 W 10400 S Ste 103', 'South Jordan', 'Salt Lake', 'UT', '84095', '8017663600', NULL, '3785 W 10400 S Ste 103', 'South Jordan', 'Salt Lake', 'UT', '84095', '8017663600', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2014-03-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1255661039', 0, 'N', 0, '2014-03-20', NULL, NULL, 0, 0, NULL, NULL),
('452323070', 'W12045808', 'W12045808', 'UTDT01', 'Stonehaven Dental Orem', 'David', '', 'Cameron', 'DMD', 'Orthodontist', '', '', NULL, 'O', '1802 N State St', 'Salem', 'Utah', 'UT', '84653', '8017663600', NULL, '1802 N State St', 'Salem', 'Utah', 'UT', '84653', '8017663600', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2014-03-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1255661039', 0, 'N', 0, '2014-03-20', NULL, NULL, 0, 0, NULL, NULL),
('452067635', 'W12045807', 'W12045807', 'UTDT01', 'Stonehaven Dental Draper', 'David', '', 'Cameron', 'DMD', 'Orthodontist', '', '', NULL, 'O', '177 W 12300 S', 'Draper', 'Salt Lake', 'UT', '84020', '8017663600', NULL, '177 W 12300 S', 'Draper', 'Salt Lake', 'UT', '84020', '8017663600', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2014-03-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1255661039', 0, 'N', 0, '2014-03-20', NULL, NULL, 0, 0, NULL, NULL),
('870617336', 'W12045805', 'W12045805', 'UTDT01', 'Monarch Dental', 'Ashley', '', 'Brown', 'DDS', 'Dentist', '', '', NULL, 'O', '10011 S Centennial Pkwy Ste 330', 'Sandy', 'Salt Lake', 'UT', '84070', '8012563700', NULL, '10011 S Centennial Pkwy Ste 330', 'Sandy', 'Salt Lake', 'UT', '84070', '8012563700', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2014-03-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1780017723', 0, 'N', 0, '2014-03-20', NULL, NULL, 0, 0, NULL, NULL),
('870617336', 'W12045806', 'W12045806', 'UTDT01', 'Monarch Dental', 'Ashley', '', 'Brown', 'DDS', 'Dentist', '', '', NULL, 'O', '280 N Union Ave Ste L-110', 'Farmington', 'Davis', 'UT', '84025', '8019343181', NULL, '280 N Union Ave Ste L-110', 'Farmington', 'Davis', 'UT', '84025', '8019343181', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2014-03-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1780017723', 0, 'N', 0, '2014-03-20', NULL, NULL, 0, 0, NULL, NULL),
('870617336', 'W12045804', 'W12045804', 'UTDT01', 'Monarch Dental', 'Ashley', '', 'Brown', 'DDS', 'Dentist', '', '', NULL, 'O', '575 E University Pkwy Ste A-24', 'Orem', 'Utah', 'UT', '84097', '8012253300', NULL, '575 E University Pkwy Ste A-24', 'Orem', 'Utah', 'UT', '84097', '8012253300', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2014-03-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1780017723', 0, 'N', 0, '2014-03-20', NULL, NULL, 0, 0, NULL, NULL),
('462770472', 'W12045800', 'W12045800', 'UTDT01', 'Premier Dental', 'Mark', '', 'Baker', 'DMD', 'Dentist', '', '', NULL, 'O', '352 E Riverside Dr Ste C-1', 'St George', 'Washington', 'UT', '84790', '4356280621', NULL, '352 E Riverside Dr Ste C-1', 'St George', 'Washington', 'UT', '84790', '4356280621', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2014-03-01', NULL, 0, 0, 0, '', '', '', '', '|DEN|', '1811242340', 0, 'N', 0, '2014-03-20', 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
('271790052', 'W12045716', 'W12045716', 'IDBOISTD', 'Saint Alphonsus Medical Group Baker City Express Care', 'Charles', 'E', 'Hofmann', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1120 Campbell St', 'Baker City', 'Baker', 'OR', '97814', '5415232100', '5415232108', '1120 Campbell St', 'Baker City', 'Baker', 'OR', '97814', '5415232100', '5415232108', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2013-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1750381224', 0, 'N', 0, '2014-07-15', NULL, NULL, 0, 0, NULL, NULL),
('271790052', 'W12045717', 'W12045717', 'IDBOISTD', 'Saint Alphonsus Medical Group Baker City Express Care', 'Brandon', 'G', 'Isaacs', 'DO', 'Family Practice', '', '', NULL, 'O', '1120 Campbell St', 'Baker City', 'Baker', 'OR', '97814', '5415232100', '5415232108', '1120 Campbell St', 'Baker City', 'Baker', 'OR', '97814', '5415232100', '5415232108', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2013-11-01', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1801833645', 0, 'N', 0, '2014-07-09', NULL, NULL, 0, 0, NULL, NULL),
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('271790052', 'W12045720', 'W12045720', 'IDBOISTD', 'Saint Alphonsus Medical Group Baker City Express Care', 'Bud', '', 'Zunino', 'NP-C', 'Nurse Practitioner', '', '', NULL, 'O', '1120 Campbell St', 'Baker City', 'Baker', 'OR', '97814', '5415232100', '5415232108', '1120 Campbell St', 'Baker City', 'Baker', 'OR', '97814', '5415232100', '5415232108', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2013-11-01', '2014-03-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1841253408', 0, 'Y', 0, '2014-07-09', NULL, NULL, 0, 0, NULL, NULL),
('271790052', 'W12045714', 'W12045714', 'IDBOISTD', 'Saint Alphonsus Medical Group Baker City Express Care', 'Kathryn', '', 'Grace', 'PA-C', 'Family Practice', '', '', NULL, 'O', '1120 Campbell St', 'Baker City', 'Baker', 'OR', '97814', '5415232100', '5415232108', '1120 Campbell St', 'Baker City', 'Baker', 'OR', '97814', '5415232100', '5415232108', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2013-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1467575639', 0, 'N', 0, '2014-07-09', NULL, NULL, 0, 0, NULL, NULL),
('271790052', 'W12045712', 'W12045712', 'IDBOISTD', 'Saint Alphonsus Medical Group Baker City Express Care', 'Elizabeth', 'A', 'DeMille', 'PA-C', 'Physician Assistant', '', '', NULL, 'O', '1120 Campbell St', 'Baker City', 'Baker', 'OR', '97814', '5415232100', '5415232108', '1120 Campbell St', 'Baker City', 'Baker', 'OR', '97814', '5415232100', '5415232108', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2013-11-01', '2014-06-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1245501501', 0, 'N', 0, '2014-06-10', NULL, NULL, 0, 0, NULL, NULL),
('271790052', 'W12045709', 'W12045709', 'IDBOISTD', 'Saint Alphonsus Medical Group Baker City Express Care', 'Elizabeth', '', 'Chattin', 'PA-C', 'Physician Assistant', '', '', NULL, 'O', '1120 Campbell St', 'Baker City', 'Baker', 'OR', '97814', '5415232100', '5415232108', '1120 Campbell St', 'Baker City', 'Baker', 'OR', '97814', '5415232100', '5415232108', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2013-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1821211277', 0, 'N', 0, '2014-03-18', NULL, NULL, 0, 0, NULL, NULL),
('271790052', 'W12045710', 'W12045710', 'IDBOISTD', 'Saint Alphonsus Medical Group Baker City Express Care', 'Mary', '', 'Colvin', 'MD', 'General Surgery', '', '', NULL, 'O', '1120 Campbell St', 'Baker City', 'Baker', 'OR', '97814', '5415232100', '5415232108', '1120 Campbell St', 'Baker City', 'Baker', 'OR', '97814', '5415232100', '5415232108', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2013-11-01', '2014-07-09', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1588838353', 0, 'N', 0, '2014-07-09', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12045706', 'W12045706', 'IDBOISTD', 'Saint Alphonsus Medical Group Orthopedics Emerald', 'James', 'F', 'Young', 'PA-C', 'Physician Assistant', '', '', NULL, 'O', '6500 Emerald', 'Boise', 'Ada', 'ID', '83704', '2083770777', '2083771070', '6500 Emerald', 'Boise', 'Ada', 'ID', '83704', '2083770777', '2083771070', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2014-03-03', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1740557420', 0, 'N', 0, '2014-03-18', NULL, NULL, 0, 0, NULL, NULL),
('271790052', 'W12045708', 'W12045708', 'IDBOISTD', 'Saint Alphonsus Medical Group Baker City Express Care', 'Bryan', 'L', 'Braun', 'PA-C', 'Physician Assistant', '', '', NULL, 'O', '1120 Campbell St', 'Baker City', 'Baker', 'OR', '97814', '5415232100', '5415232108', '1120 Campbell St', 'Baker City', 'Baker', 'OR', '97814', '5415232100', '5415232108', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2013-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1063505444', 0, 'N', 0, '2014-07-15', NULL, NULL, 0, 0, NULL, NULL),
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('870546501', 'W12045617', 'W12045617', 'UT01', 'Alpine Pediatrics', 'Mark', 'B', 'Rowan', 'MD', 'Pediatrics', '', '', NULL, 'O', '3231 N 1120 E', 'Lehi', 'Utah', 'UT', '84043', '8017682800', '8017665938', '3231 N 1120 E', 'Lehi', 'Utah', 'UT', '84043', '8017682800', '8017665938', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1437449055', 0, 'N', 1, '2014-07-14', NULL, NULL, 0, 0, NULL, NULL),
('461588608', 'W12045682', 'W12045682', 'WYT1', 'Frontier Family Medicine', 'Julie', 'M', 'Kovacich', 'PA-C', 'Family Practice', '', '', NULL, 'M', 'PO Box 637', 'Gillette', 'Campbell', 'WY', '82717', '3076823333', '3076826723', 'PO Box 637', 'Gillette', 'Campbell', 'WY', '82717', '3076823333', '3076826723', '', '', '', '0.00', '10.00', '0.00', 3, '2014-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1528482254', 0, 'N', 0, '2014-06-25', NULL, NULL, 0, 0, NULL, NULL),
('202630141', 'W12045515', 'W12045515', 'IDBOISTD', 'Primary Health Medical Group', 'Amber', 'M', 'Vickers', 'PA-C', 'Family Practice', 'Physician Assistant', '', NULL, 'B', 'PO Box 191050', 'Boise', 'Ada', 'ID', '83719', '2088958670', '          ', 'PO Box 191050', 'Boise', 'Ada', 'ID', '83719', '2088958670', '          ', 'IDPRIMARY', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1114964616', 0, 'N', 0, '2014-04-18', NULL, NULL, 0, 0, NULL, NULL),
('461588608', 'W12045680', 'W12045680', 'WYT1', 'Frontier Family Medicine', 'Julie', 'M', 'Kovacich', 'PA-C', 'Family Practice', '', '', NULL, 'O', '709 W 8th Ste 4', 'Gillette', 'Campbell', 'WY', '82716', '3076823333', '3076826723', '709 W 8th Ste 4', 'Gillette', 'Campbell', 'WY', '82716', '3076823333', '3076826723', '', '', '', '0.00', '10.00', '0.00', 3, '2014-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1528482254', 0, 'N', 0, '2014-06-25', NULL, NULL, 0, 0, NULL, NULL),
('461588608', 'W12045681', 'W12045681', 'WY01', 'Frontier Family Medicine', 'Julie', 'M', 'Kovacich', 'PA-C', 'Family Practice', '', '', NULL, 'M', 'PO Box 637', 'Gillette', 'Campbell', 'WY', '82717', '3076823333', '3076826723', 'PO Box 637', 'Gillette', 'Campbell', 'WY', '82717', '3076823333', '3076826723', '', '', '', '0.00', '10.00', '0.00', 3, '2014-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1528482254', 0, 'N', 0, '2014-06-25', NULL, NULL, 0, 0, NULL, NULL),
('461588608', 'W12045679', 'W12045679', 'WY01', 'Frontier Family Medicine', 'Julie', 'M', 'Kovacich', 'PA-C', 'Family Practice', '', '', NULL, 'O', '709 W 8th Ste 4', 'Gillette', 'Campbell', 'WY', '82716', '3076823333', '3076826723', '709 W 8th Ste 4', 'Gillette', 'Campbell', 'WY', '82716', '3076823333', '3076826723', '', '', '', '0.00', '10.00', '0.00', 3, '2014-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1528482254', 0, 'N', 0, '2014-06-25', NULL, NULL, 0, 0, NULL, NULL),
('760550696', 'OBA000002', 'OBA000002', 'TXHOUSTD', 'Obstetrical and Gynecological Associates', 'Katie', 'Loky', 'Fung Yip', 'MD', 'Obstetrics and Gynecology', '', NULL, NULL, 'B', '1213 Hermann Dr Ste 800', 'Houston', 'Harris', 'TX', '77004', '7135127001', NULL, '1213 Hermann Dr Ste 800', 'Houston', 'Harris', 'TX', '77004', '7135127001', '', 'OGA', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, 'The Womans Hospital of Texas', '', NULL, NULL, 'HCFA|UB|', '1003074881', 0, 'Y', 0, '2014-03-20', NULL, NULL, 0, 0, NULL, NULL),
('870288620', 'W12045678', 'W12045678', 'UT01', 'Utah Orthopaedic Associates', 'Benjamin', 'D', 'Curtis', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1250 E 3900 S Ste 440', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012612232', '8012641138', '1250 E 3900 S Ste 440', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012612232', '8012641138', 'WUSTDORTH5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'St Marks Hospital', 'Lone Peak Hospital', '', '', 'HCFA|UB|', '1124299714', 0, 'N', 0, '2014-04-21', NULL, NULL, 0, 0, NULL, NULL),
('830282780', 'W12045465', 'W12045465', 'WYT1', 'Marbleton Big Piney Clinic', 'Deborah', 'S', 'Brackett', 'MD', 'Family Practice', '', '', NULL, 'O', '103 W 3rd St', 'Big Piney', 'Sublette', 'WY', '83113', '3072763306', '3072763024', '103 W 3rd St', 'Big Piney', 'Sublette', 'WY', '83113', '3072763306', '3072763024', 'SCRHCD13', '', '', '0.00', '20.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, NULL, '', '', '', 'HCFA|', '1306978580', 0, 'N', 0, '2014-03-17', NULL, NULL, 0, 0, NULL, NULL),
('454510252', 'W12045667', 'W12045667', 'TXDALSTD', 'Baylor Medical Center at Carrollton', '', '', 'Baylor Medical Center at Carrollton ', '', 'Hospital', '', '', NULL, 'B', 'PO Box 844309', 'Dallas', 'Dallas', 'TX', '75284', '9724921010', NULL, 'PO Box 844309', 'Dallas', 'Dallas', 'TX', '75284', '9724921010', '          ', '', '', 'BAYHEALTHD', '0.00', '0.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1952509465', 0, 'N', 0, '2014-03-14', NULL, NULL, 0, 0, NULL, NULL),
('454510252', 'W12045668', 'W12045668', 'TXDALSTD', 'Baylor Medical Center at Carrollton', '', '', 'Baylor Medical Center at Carrollton ', '', 'Hospital', '', '', NULL, 'O', '4343 N Josey Ln', 'Carrollton', 'Denton', 'TX', '75010', '9724921010', NULL, '4343 N Josey Ln', 'Carrollton', 'Denton', 'TX', '75010', '9724921010', '          ', '', '', 'BAYHEALTHD', '0.00', '0.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1952509465', 0, 'N', 0, '2014-03-14', NULL, NULL, 0, 0, NULL, NULL),
('320395164', 'W12045666', 'W12045666', 'UTMH1', 'Wasatch Pediatric Neuropsychology', 'Julien', 'T', 'Smith', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '231 E 400 S Ste 335', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8013631189', '8013631196', '231 E 400 S Ste 335', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8013631189', '8013631196', 'UTPHD', '', '', '0.00', '40.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1326069022', 0, 'N', 0, '2014-03-14', NULL, NULL, 0, 0, NULL, NULL),
('061787631', 'W12045663', 'W12045663', 'UT01', 'Lone Peak General Surgery', 'Alfonso', '', 'Preciado', 'MD', 'General Surgery', '', '', NULL, 'O', '74 Kimballs Ln Ste 210', 'Draper', 'Salt Lake', 'UT', '84020', '8015663062', '8015018219', '74 Kimballs Ln Ste 210', 'Draper', 'Salt Lake', 'UT', '84020', '8015663062', '8015018219', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-05-01', '2014-06-30', 0, 0, 0, 'Jordan Valley Medical Center', '', '', '', 'HCFA|UB|', '1962401315', 0, 'N', 0, '2014-05-15', NULL, NULL, 0, 0, NULL, NULL),
('061787631', 'W12045664', 'W12045664', 'UT01', 'Lone Peak General Surgery', 'Alfonso', '', 'Preciado', 'MD', 'General Surgery', '', '', NULL, 'O', '4000 S 700 E Ste 9', 'Murray', 'Salt Lake', 'UT', '84107', '8012623564', '8669581297', '4000 S 700 E Ste 9', 'Murray', 'Salt Lake', 'UT', '84107', '8012623564', '8669581297', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-05-01', '2014-06-30', 0, 0, 0, 'Jordan Valley Medical Center', '', '', '', 'HCFA|UB|', '1962401315', 0, 'N', 0, '2014-05-15', NULL, NULL, 0, 0, NULL, NULL),
('870540039', 'W12045665', 'W12045665', 'UT01', 'Davis County Medical Clinic', 'Eileen', '', 'Torpy', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '22 S State St Ste 1007', 'Clearfield', 'Davis', 'UT', '84015', '8014513711', NULL, '22 S State St Ste 1007', 'Clearfield', 'Davis', 'UT', '84015', '8014513711', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-03-12', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1447365184', 0, 'N', 0, '2014-03-14', NULL, NULL, 0, 0, NULL, NULL),
('061787631', 'W12045662', 'W12045662', 'UT01', 'Lone Peak General Surgery', 'Alfonso', '', 'Preciado', 'MD', 'General Surgery', '', '', NULL, 'B', 'PO Box 100253', 'Atlanta', 'Fulton', 'GA', '30384', '8006613365', '          ', 'PO Box 100253', 'Atlanta', 'Fulton', 'GA', '30384', '8006613365', '          ', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-05-01', '2014-06-30', 0, 0, 0, 'Jordan Valley Medical Center', '', '', '', 'HCFA|UB|', '1962401315', 0, 'N', 0, '2014-05-15', NULL, NULL, 0, 0, NULL, NULL),
('260859911', 'W12045660', 'W12045660', 'TXHOUSTD', 'Surgical Specialists of Clear Lake ', 'Kelly', 'K', 'Gilmore-Lynch', 'MD', 'Colon and Rectal Surgery', '', '', NULL, 'B', 'PO Box 100559 ', 'Atlanta', 'Fulton', 'GA', '30384', '          ', NULL, 'PO Box 100559 ', 'Atlanta', 'Fulton', 'GA', '30384', '          ', '', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', '', '', '', 'HCFA|UB|', '1962697417', 0, 'N', 0, '2014-04-24', NULL, NULL, 0, 0, NULL, NULL),
('260859911', 'W12045661', 'W12045661', 'TXHOUSTD', 'Surgical Specialists of Clear Lake ', 'Kelly', 'K', 'Gilmore-Lynch', 'MD', 'Colon and Rectal Surgery', '', '', NULL, 'M', 'Three Maryland Farms Ste 250', 'Brentwood', 'Williamson', 'TN', '37027', '0000000000', '0000000000', 'Three Maryland Farms Ste 250', 'Brentwood', 'Williamson', 'TN', '37027', '0000000000', '0000000000', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', '', '', '', 'HCFA|UB|', '1962697417', 0, 'N', 0, '2014-04-24', NULL, NULL, 0, 0, NULL, NULL),
('260859911', 'W12045659', 'W12045659', 'TXHOUSTD', 'Surgical Specialists of Clear Lake ', 'Kelly', 'K', 'Gilmore-Lynch', 'MD', 'Colon and Rectal Surgery', '', '', NULL, 'O', '450 Medical Ctr Blvd Ste 600', 'Webster', 'Harris', 'TX', '77598', '2813324596', '2813329610', '450 Medical Ctr Blvd Ste 600', 'Webster', 'Harris', 'TX', '77598', '2813324596', '2813329610', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', '', '', '', 'HCFA|UB|', '1962697417', 0, 'N', 0, '2014-04-24', NULL, NULL, 0, 0, NULL, NULL),
('830234097', 'W12045658', 'W12045658', 'WYT1', 'Campbell County Memorial Hospital', 'Dawn', 'D', 'Fiedler', 'APRN', 'Geriatrics', '', '', NULL, 'B', 'PO Box 3046', 'Gillette', 'Campbell', 'WY', '82717', '3076881000', '          ', 'PO Box 3046', 'Gillette', 'Campbell', 'WY', '82717', '3076881000', '          ', '', '', '5001', '0.00', '0.00', '0.00', 6, '2014-06-01', NULL, 0, 0, 0, 'Campbell County Memorial Hospital', '', '', '', 'HCFA|UB|', '1992127401', 0, 'N', 0, '2014-05-28', NULL, NULL, 0, 0, NULL, NULL),
('830234097', 'W12045656', 'W12045656', 'WYT1', 'Pioneer Manor', 'Dawn', 'D', 'Fiedler', 'APRN', 'Geriatrics', '', '', NULL, 'O', '900 W 8th St', 'Gillette', 'Campbell', 'WY', '82716', '3076824709', '          ', '900 W 8th St', 'Gillette', 'Campbell', 'WY', '82716', '3076824709', '          ', '', '', '5001', '0.00', '0.00', '0.00', 6, '2014-06-01', NULL, 0, 0, 0, 'Campbell County Memorial Hospital', '', '', '', 'HCFA|UB|', '1992127401', 0, 'N', 0, '2014-05-28', NULL, NULL, 0, 0, NULL, NULL),
('830234097', 'W12045654', 'W12045654', 'WYT1', 'Campbell County Memorial Hospital', 'Dawn', 'D', 'Fiedler', 'APRN', 'Geriatrics', '', '', NULL, 'O', '501 S Burma Ave', 'Gillette', 'Campbell', 'WY', '82717', '3076885000', '          ', '501 S Burma Ave', 'Gillette', 'Campbell', 'WY', '82717', '3076885000', '          ', '', '', '5001', '0.00', '0.00', '0.00', 6, '2014-06-01', NULL, 0, 0, 0, 'Campbell County Memorial Hospital', '', '', '', 'HCFA|UB|', '1992127401', 0, 'N', 0, '2014-05-28', NULL, NULL, 0, 0, NULL, NULL),
('830234097', 'W12045655', 'W12045655', 'WY01', 'Pioneer Manor', 'Dawn', 'D', 'Fiedler', 'APRN', 'Geriatrics', '', '', NULL, 'O', '900 W 8th St', 'Gillette', 'Campbell', 'WY', '82716', '3076824709', '          ', '900 W 8th St', 'Gillette', 'Campbell', 'WY', '82716', '3076824709', '          ', '', '', '5001', '0.00', '0.00', '0.00', 6, '2014-06-01', NULL, 0, 0, 0, 'Campbell County Memorial Hospital', '', '', '', 'HCFA|UB|', '1992127401', 0, 'N', 0, '2014-05-28', NULL, NULL, 0, 0, NULL, NULL),
('830234097', 'W12045653', 'W12045653', 'WY01', 'Campbell County Memorial Hospital', 'Dawn', 'D', 'Fiedler', 'APRN', 'Geriatrics', '', '', NULL, 'O', '501 S Burma Ave', 'Gillette', 'Campbell', 'WY', '82717', '3076883636', '          ', '501 S Burma Ave', 'Gillette', 'Campbell', 'WY', '82717', '3076883636', '          ', '', '', '5001', '0.00', '0.00', '0.00', 6, '2014-06-01', NULL, 0, 0, 0, 'Campbell County Memorial Hospital', '', '', '', 'HCFA|UB|', '1992127401', 0, 'N', 0, '2014-06-13', NULL, NULL, 0, 0, NULL, NULL),
('830234097', 'W12045657', 'W12045657', 'WY01', 'Campbell County Memorial Hospital', 'Dawn', 'D', 'Fiedler', 'APRN', 'Geriatrics', '', '', NULL, 'B', 'PO Box 3046', 'Gillette', 'Campbell', 'WY', '82717', '3076881000', '          ', 'PO Box 3046', 'Gillette', 'Campbell', 'WY', '82717', '3076881000', '          ', '', '', '5001', '0.00', '0.00', '0.00', 6, '2014-06-01', NULL, 0, 0, 0, 'Campbell County Memorial Hospital', '', '', '', 'HCFA|UB|', '1992127401', 0, 'N', 0, '2014-05-28', NULL, NULL, 0, 0, NULL, NULL),
('461544956', 'W12045650', 'W12045650', 'UTDT01', 'Bonneville Preventive Dentistry', 'Matthew', '', 'Wolpert', 'DMD', 'Dentist', '', '', NULL, 'O', '3860 Jackson Ave Ste 6', 'Ogden', 'Weber', 'UT', '84403', '8016270420', NULL, '3860 Jackson Ave Ste 6', 'Ogden', 'Weber', 'UT', '84403', '8016270420', '          ', 'UT000B', '', '', '0.00', '100.00', '0.00', 8, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1093087629', 0, 'N', 0, '2014-03-14', NULL, NULL, 0, 0, NULL, NULL),
('870514745', 'W12045652', 'W12045652', 'UTDT01', 'Creekstone Dental', 'Daniel', '', 'Poelman', 'DDS', 'Dentist', '', '', NULL, 'O', '714 E Fort Union Blvd', 'Midvale', 'Salt Lake', 'UT', '84047', '8015670343', NULL, '714 E Fort Union Blvd', 'Midvale', 'Salt Lake', 'UT', '84047', '8015670343', '          ', 'UT000C', '', '', '0.00', '100.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', '|DEN|', '1891048823', 0, 'N', 0, '2014-03-20', NULL, NULL, 0, 0, NULL, NULL),
('870617336', 'W12045648', 'W12045648', 'UTDT01', 'Monarch Dental', 'Devin', '', 'Orvin', 'DDS', 'Dentist', '', '', NULL, 'O', '280 N Union Ave Ste L110', 'Farmington', 'Davis', 'UT', '84025', '8019343181', NULL, '280 N Union Ave Ste L110', 'Farmington', 'Davis', 'UT', '84025', '8019343181', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1487913869', 0, 'N', 0, '2014-03-14', NULL, NULL, 0, 0, NULL, NULL),
('870617336', 'W12045649', 'W12045649', 'UTDT01', 'Monarch Dental', 'Devin', '', 'Orvin', 'DDS', 'Dentist', '', '', NULL, 'O', '24 S 500 W Ste A', 'Bountiful', 'Davis', 'UT', '84010', '8012961606', NULL, '24 S 500 W Ste A', 'Bountiful', 'Davis', 'UT', '84010', '8012961606', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1487913869', 0, 'N', 0, '2014-03-14', NULL, NULL, 0, 0, NULL, NULL),
('870617336', 'W12045647', 'W12045647', 'UTDT01', 'Monarch Dental', 'Devin', '', 'Orvin', 'DDS', 'Dentist', '', '', NULL, 'O', '1140 W Riverdale Rd Ste D', 'Ogden', 'Weber', 'UT', '84405', '8019171502', NULL, '1140 W Riverdale Rd Ste D', 'Ogden', 'Weber', 'UT', '84405', '8019171502', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1487913869', 0, 'N', 0, '2014-03-14', NULL, NULL, 0, 0, NULL, NULL),
('274549671', 'W12045645', 'W12045645', 'UTDT01', 'Aloha Dental', 'Mark', 'S', 'Naisbitt', 'MD', 'Anesthesiology', '', '', NULL, 'O', '2792 S 5600 W', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019699669', NULL, '2792 S 5600 W', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019699669', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000833937', 0, 'N', 0, '2014-03-14', NULL, NULL, 0, 0, NULL, NULL),
('463805588', 'W12045643', 'W12045643', 'UTDT01', 'All Valley Dental', 'Steven', '', 'Pinegar', 'DDS', 'Dentist', '', '', NULL, 'O', '1377 E 3900 S Ste 105', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012778222', NULL, '1377 E 3900 S Ste 105', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012778222', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1598999427', 0, 'N', 0, '2014-03-14', NULL, NULL, 0, 0, NULL, NULL),
('463805588', 'W12045644', 'W12045644', 'UTDT01', 'All Valley Dental', 'Darin', '', 'Hartvigsen', 'DDS', 'Dentist', '', '', NULL, 'O', '1377 E 3900 S Ste 105', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012778222', NULL, '1377 E 3900 S Ste 105', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012778222', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1003983297', 0, 'N', 0, '2014-03-14', NULL, NULL, 0, 0, NULL, NULL),
('463805588', 'W12045641', 'W12045641', 'UTDT01', 'All Valley Dental', 'Richard', '', 'Clegg', 'DDS', 'Dentist', '', '', NULL, 'O', '1377 E 3900 S Ste 105', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012778222', NULL, '1377 E 3900 S Ste 105', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012778222', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1679586911', 0, 'N', 0, '2014-03-14', NULL, NULL, 0, 0, NULL, NULL),
('463805588', 'W12045642', 'W12045642', 'UTDT01', 'All Valley Dental', 'Daren', '', 'Cole', 'DMD', 'Dentist', '', '', NULL, 'O', '1377 E 3900 S Ste 105', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012778222', NULL, '1377 E 3900 S Ste 105', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012778222', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1356578926', 0, 'N', 0, '2014-03-14', NULL, NULL, 0, 0, NULL, NULL),
('274741628', 'W12045640', 'W12045640', 'UTDT01', 'Gardner Dental', 'Timothy A', '', 'Gardner', 'DMD', 'Dentist', '', '', NULL, 'O', '7001 S 900 E Ste 130', 'Midvale', 'Salt Lake', 'UT', '84047', '8012554421', NULL, '7001 S 900 E Ste 130', 'Midvale', 'Salt Lake', 'UT', '84047', '8012554421', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-12-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1245363100', 0, 'N', 0, '2014-03-14', NULL, NULL, 0, 0, NULL, NULL),
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('830282780', 'W12045493', 'W12045493', 'WYT1', 'Sublette County Rural Health Care', 'Stephen', 'W', 'Wallace', 'MD', 'Emergency Medicine', 'Family Practice', '', NULL, 'B', 'PO Box 627', 'Pinedale', 'Sublette', 'WY', '82941', '3072763306', '3072763024', 'PO Box 627', 'Pinedale', 'Sublette', 'WY', '82941', '3072763306', '3072763024', 'SCRHCD13', '', '', '0.00', '20.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1851379119', 0, 'N', 0, '2014-04-21', NULL, NULL, 0, 0, NULL, NULL),
('841617523', 'W12045628', 'W12045628', 'NM01', 'Northside Family Medicine', 'James', 'R', 'Blanton', 'MD', 'Family Practice', '', '', NULL, 'O', '6100 Pan American Fwy NE Ste 390', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058231805', '5058231844', '6100 Pan American Fwy NE Ste 390', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058231805', '5058231844', 'NMSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-04-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1912099169', 0, 'N', 0, '2014-04-18', NULL, NULL, 0, 0, NULL, NULL),
('830282780', 'W12045492', 'W12045492', 'WY01', 'Sublette County Rural Health Care', 'Stephen', 'W', 'Wallace', 'MD', 'Emergency Medicine', 'Family Practice', '', NULL, 'B', 'PO Box 627', 'Pinedale', 'Sublette', 'WY', '82941', '3072763306', '3072763024', 'PO Box 627', 'Pinedale', 'Sublette', 'WY', '82941', '3072763306', '3072763024', 'SCRHCD13', '', '', '0.00', '20.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1851379119', 0, 'N', 0, '2014-03-17', NULL, NULL, 0, 0, NULL, NULL),
('830282780', 'W12045498', 'W12045498', 'WY01', 'Pinedale Medical Clinic', 'Stephen', 'W', 'Wallace', 'MD', 'Emergency Medicine', 'Family Practice', '', NULL, 'O', '625 E Hennick', 'Pinedale', 'Sublette', 'WY', '82941', '3073674133', '3073676636', '625 E Hennick', 'Pinedale', 'Sublette', 'WY', '82941', '3073674133', '3073676636', 'SCRHCD13', '', '', '0.00', '20.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1851379119', 0, 'N', 0, '2014-03-17', NULL, NULL, 0, 0, NULL, NULL),
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('830282780', 'W12045481', 'W12045481', 'WYT1', 'Pinedale Medical Clinic', 'Rebecca', 'A', 'Stroklund', 'DO', 'Family Practice', '', '', NULL, 'O', '625 E Hennick', 'Pinedale', 'Sublette', 'WY', '82941', '3073674133', '3073676636', '625 E Hennick', 'Pinedale', 'Sublette', 'WY', '82941', '3073674133', '3073676636', 'SCRHCD13', '', '', '0.00', '20.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1700046927', 0, 'N', 0, '2014-03-17', NULL, NULL, 0, 0, NULL, NULL),
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('830282780', 'W12045480', 'W12045480', 'WY01', 'Pinedale Medical Clinic', 'Rebecca', 'A', 'Stroklund', 'DO', 'Family Practice', '', '', NULL, 'O', '625 E Hennick', 'Pinedale', 'Sublette', 'WY', '82941', '3073674133', '3073676636', '625 E Hennick', 'Pinedale', 'Sublette', 'WY', '82941', '3073674133', '3073676636', 'SCRHCD13', '', '', '0.00', '20.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1700046927', 0, 'N', 0, '2014-03-17', NULL, NULL, 0, 0, NULL, NULL),
('830282780', 'W12045508', 'W12045508', 'WYT1', 'Sublette County Rural Health Care', 'David', 'P', 'Kappenman', 'MD', 'Family Practice', '', '', NULL, 'M', 'PO Box 787', 'Big Piney', 'Sublette', 'WY', '83113', '0000000000', '0000000000', 'PO Box 787', 'Big Piney', 'Sublette', 'WY', '83113', '0000000000', '0000000000', 'SCRHCD13', '', '', '0.00', '20.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1134149958', 0, 'N', 0, '2014-03-17', NULL, NULL, 0, 0, NULL, NULL),
('830282780', 'W12045502', 'W12045502', 'WYT1', 'Pinedale Medical Clinic', 'David', 'P', 'Kappenman', 'MD', 'Family Practice', '', '', NULL, 'O', '625 E Hennick', 'Pinedale', 'Sublette', 'WY', '82941', '3073674133', '3073676636', '625 E Hennick', 'Pinedale', 'Sublette', 'WY', '82941', '3073674133', '3073676636', 'SCRHCD13', '', '', '0.00', '20.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1134149958', 0, 'N', 0, '2014-03-17', NULL, NULL, 0, 0, NULL, NULL),
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('830282780', 'W12045504', 'W12045504', 'WYT1', 'Marbleton Big Piney Clinic', 'David', 'P', 'Kappenman', 'MD', 'Family Practice', '', '', NULL, 'O', '103 W 3rd St', 'Big Piney', 'Sublette', 'WY', '83113', '3072763306', '3072763024', '103 W 3rd St', 'Big Piney', 'Sublette', 'WY', '83113', '3072763306', '3072763024', 'SCRHCD13', '', '', '0.00', '20.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1134149958', 0, 'N', 0, '2014-03-17', NULL, NULL, 0, 0, NULL, NULL),
('830282780', 'W12045438', 'W12045438', 'WYT1', 'Pinedale Medical Clinic', 'William', 'D', 'Burnett', 'MD', 'Family Practice', '', '', NULL, 'O', '625 E Hennick', 'Pinedale', 'Sublette', 'WY', '82941', '3073674133', '3073676636', '625 E Hennick', 'Pinedale', 'Sublette', 'WY', '82941', '3073674133', '3073676636', 'SCRHCD13', '', '', '0.00', '20.00', '0.00', 3, '2014-03-05', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1760579023', 0, 'N', 0, '2014-04-01', NULL, NULL, 0, 0, NULL, NULL),
('830282780', 'W12045501', 'W12045501', 'WY01', 'Pinedale Medical Clinic', 'David', 'P', 'Kappenman', 'MD', 'Family Practice', '', '', NULL, 'O', '625 E Hennick', 'Pinedale', 'Sublette', 'WY', '82941', '3073674133', '3073676636', '625 E Hennick', 'Pinedale', 'Sublette', 'WY', '82941', '3073674133', '3073676636', 'SCRHCD13', '', '', '0.00', '20.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1134149958', 0, 'N', 0, '2014-03-17', NULL, NULL, 0, 0, NULL, NULL);
INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
('830282780', 'W12045436', 'W12045436', 'WYT1', 'Marbleton Big Piney Clinic', 'William', 'D', 'Burnett', 'MD', 'Family Practice', '', '', NULL, 'O', '103 W 3rd St', 'Big Piney', 'Sublette', 'WY', '83113', '3072763306', '3072763024', '103 W 3rd St', 'Big Piney', 'Sublette', 'WY', '83113', '3072763306', '3072763024', 'SCRHCD13', '', '', '0.00', '20.00', '0.00', 3, '2014-03-05', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1760579023', 0, 'N', 0, '2014-04-01', NULL, NULL, 0, 0, NULL, NULL),
('830282780', 'W12045437', 'W12045437', 'WY01', 'Pinedale Medical Clinic', 'William', 'D', 'Burnett', 'MD', 'Family Practice', '', '', NULL, 'O', '625 E Hennick', 'Pinedale', 'Sublette', 'WY', '82941', '3073674133', '3073676636', '625 E Hennick', 'Pinedale', 'Sublette', 'WY', '82941', '3073674133', '3073676636', 'SCRHCD13', '', '', '0.00', '20.00', '0.00', 3, '2014-03-05', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1760579023', 0, 'N', 0, '2014-04-01', NULL, NULL, 0, 0, NULL, NULL),
('830282780', 'W12045486', 'W12045486', 'WYT1', 'Marbleton Big Piney Clinic', 'Kurt', 'E', 'Frauenpreis', 'MD', 'Family Practice', '', '', NULL, 'O', '103 W 3rd St', 'Big Piney', 'Sublette', 'WY', '83113', '3072763306', '3072763024', '103 W 3rd St', 'Big Piney', 'Sublette', 'WY', '83113', '3072763306', '3072763024', 'SCRHCD13', '', '', '0.00', '20.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1093722182', 0, 'N', 0, '2014-04-21', NULL, NULL, 0, 0, NULL, NULL),
('830282780', 'W12045484', 'W12045484', 'WYT1', 'Pinedale Medical Clinic', 'Kurt', 'E', 'Frauenpreis', 'MD', 'Family Practice', '', '', NULL, 'O', '625 E Hennick', 'Pinedale', 'Sublette', 'WY', '82941', '3073674133', '3073676636', '625 E Hennick', 'Pinedale', 'Sublette', 'WY', '82941', '3073674133', '3073676636', 'SCRHCD13', '', '', '0.00', '20.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1093722182', 0, 'N', 0, '2014-04-21', NULL, NULL, 0, 0, NULL, NULL),
('830282780', 'W12045435', 'W12045435', 'WY01', 'Marbleton Big Piney Clinic', 'William', 'D', 'Burnett', 'MD', 'Family Practice', '', '', NULL, 'O', '103 W 3rd St', 'Big Piney', 'Sublette', 'WY', '83113', '3072763306', '3072763024', '103 W 3rd St', 'Big Piney', 'Sublette', 'WY', '83113', '3072763306', '3072763024', 'SCRHCD13', '', '', '0.00', '20.00', '0.00', 3, '2014-03-05', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1760579023', 0, 'N', 0, '2014-04-01', NULL, NULL, 0, 0, NULL, NULL),
('830282780', 'W12045489', 'W12045489', 'WYT1', 'Sublette County Rural Health Care', 'Kurt', 'E', 'Frauenpreis', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 627', 'Pinedale', 'Sublette', 'WY', '82941', '3072763306', '3072763024', 'PO Box 627', 'Pinedale', 'Sublette', 'WY', '82941', '3072763306', '3072763024', 'SCRHCD13', '', '', '0.00', '20.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1093722182', 0, 'N', 0, '2014-04-21', NULL, NULL, 0, 0, NULL, NULL),
('830282780', 'W12045488', 'W12045488', 'WY01', 'Sublette County Rural Health Care', 'Kurt', 'E', 'Frauenpreis', 'MD', 'Family Practice', '', '', NULL, 'M', 'PO Box 787', 'Big Piney', 'Sublette', 'WY', '83113', '0000000000', '0000000000', 'PO Box 787', 'Big Piney', 'Sublette', 'WY', '83113', '0000000000', '0000000000', 'SCRHCD13', '', '', '0.00', '20.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1093722182', 0, 'N', 0, '2014-04-21', NULL, NULL, 0, 0, NULL, NULL),
('830282780', 'W12045487', 'W12045487', 'WY01', 'Sublette County Rural Health Care', 'Kurt', 'E', 'Frauenpreis', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 627', 'Pinedale', 'Sublette', 'WY', '82941', '3072763306', '3072763024', 'PO Box 627', 'Pinedale', 'Sublette', 'WY', '82941', '3072763306', '3072763024', 'SCRHCD13', '', '', '0.00', '20.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1093722182', 0, 'N', 0, '2014-03-17', NULL, NULL, 0, 0, NULL, NULL),
('830282780', 'W12045483', 'W12045483', 'WY01', 'Pinedale Medical Clinic', 'Kurt', 'E', 'Frauenpreis', 'MD', 'Family Practice', '', '', NULL, 'O', '625 E Hennick', 'Pinedale', 'Sublette', 'WY', '82941', '3073674133', '3073676636', '625 E Hennick', 'Pinedale', 'Sublette', 'WY', '82941', '3073674133', '3073676636', 'SCRHCD13', '', '', '0.00', '20.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1093722182', 0, 'N', 0, '2014-03-17', NULL, NULL, 0, 0, NULL, NULL),
('364088232', 'W12045624', 'W12045624', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Brian', 'D', 'Oostman', 'DO', 'Family Practice', '', '', NULL, 'O', '1221 N Highland Ave', 'Aurora', 'Kane', 'IL', '60506', '6308598700', '6302648444', '1221 N Highland Ave', 'Aurora', 'Kane', 'IL', '60506', '6308598700', '6302648444', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2014-02-28', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1316950496', 0, 'N', 0, '2014-03-13', NULL, NULL, 0, 0, NULL, NULL),
('460706062', 'W12045614', 'W12045614', 'ID02', 'State Avenue Counseling', 'Sandra', 'E', 'Phillips', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '7711 W Riverside Dr', 'Garden City', 'Ada', 'ID', '83714', '2089943599', '2084732206', '7711 W Riverside Dr', 'Garden City', 'Ada', 'ID', '83714', '2089943599', '2084732206', 'IDMA', '', '', '0.00', '40.00', '0.00', 6, '2014-03-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1922312776', 0, 'N', 0, '2014-03-19', NULL, NULL, 0, 0, NULL, NULL),
('870546501', 'W12045615', 'W12045615', 'UT01', 'Alpine Pediatrics', 'Mark', 'B', 'Rowan', 'MD', 'Pediatrics', '', '', NULL, 'O', '1912 W 930 N', 'Pleasant Grove', 'Utah', 'UT', '84062', '8014921999', '8014921991', '1912 W 930 N', 'Pleasant Grove', 'Utah', 'UT', '84062', '8014921999', '8014921991', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1437449055', 0, 'N', 1, '2014-07-14', NULL, NULL, 0, 0, NULL, NULL),
('363383867', 'W12045622', 'W12045622', 'ILCHIGSTD', 'Little Company of Mary Affiliated Services', 'Briana', '', 'Bloembergen', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'B', '2800 W 87th St', 'Chicago', 'Cook', 'IL', '60632', '7738637550', '7738637542', '2800 W 87th St', 'Chicago', 'Cook', 'IL', '60632', '7738637550', '7738637542', 'CHIG8', 'CHIHCPCS01', '', '0.00', '40.00', '0.00', 3, '2014-03-11', NULL, 0, 0, 0, 'Little Company of Mary Hospital', NULL, '', '', 'HCFA|UB|', '1790101459', 0, 'N', 0, '2014-04-18', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12045608', 'W12045608', 'UTIHCPHY', 'Cardiovascular & Thoracic Surgery - St George', 'Johanna', '', 'Rojas', 'PA-C', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1380 E Medical Ctr Dr Ste 2600', 'St George', 'Washington', 'UT', '84790', '4352512700', '4356564907', '1380 E Medical Ctr Dr Ste 2600', 'St George', 'Washington', 'UT', '84790', '4352512700', '4356564907', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2014-02-04', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1447416516', 0, 'Y', 0, '2014-03-13', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12045610', 'W12045610', 'UTIHCPHY', 'Southwest Cardiology - St George', 'John', 'D', 'Rozich', 'MD', 'Cardiology', '', '', NULL, 'O', '1380 E Medical Ctr Dr Ste 1500', 'St George', 'Washington', 'UT', '84790', '4352512500', '4356564907', '1380 E Medical Ctr Dr Ste 1500', 'St George', 'Washington', 'UT', '84790', '4352512500', '4356564907', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2014-02-10', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1063473684', 0, 'Y', 0, '2014-03-17', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12045607', 'W12045607', 'UTIHCPHY', 'Int Heart Rhythm', 'David', 'L', 'Johnson', 'PA', 'Cardiovascular Disease', '', '', NULL, 'O', '5169 S Cottonwood Dr Ste 510', 'Murray', 'Salt Lake', 'UT', '84107', '8015073513', '8015073584', '5169 S Cottonwood Dr Ste 510', 'Murray', 'Salt Lake', 'UT', '84107', '8015073513', '8015073584', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1326248022', 0, 'Y', 0, '2014-03-13', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12045612', 'W12045612', 'UTIHCPHY', 'Int Psychiatry & Counseling-St George', 'Lisa', '', 'Stoddard', 'APRN', 'Psychiatry', '', '', NULL, 'O', '1054 E Riverside Dr Ste 202', 'St George', 'Washington', 'UT', '84790', '4356346100', '4356346129', '1054 E Riverside Dr Ste 202', 'St George', 'Washington', 'UT', '84790', '4356346100', '4356346129', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2014-02-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1053645770', 0, 'N', 0, '2014-03-13', NULL, NULL, 0, 0, NULL, NULL),
('205026064', 'W12045613', 'W12045613', 'ID01', 'Emmett Family Chiropractic Center', 'Daniel', 'M', 'Pewe', 'DC', 'Chiropractic', '', '', NULL, 'O', '288 Hwy 16 Ste 101', 'Emmett', 'Gem', 'ID', '83617', '2083652225', NULL, '288 Hwy 16 Ste 101', 'Emmett', 'Gem', 'ID', '83617', '2083652225', '          ', 'IDCHIRO1', '', '', '0.00', '35.00', '0.00', 3, '2014-03-11', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1922012954', 0, 'N', 0, '2014-03-13', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12045605', 'W12045605', 'UTIHCPHY', 'Mt Pleasant Clinic', 'Stephen', 'J', 'Carter', 'MD', 'General Surgery', '', '', NULL, 'O', '1100 S Medical Dr', 'Mount Pleasant', 'Sanpete', 'UT', '84647', '4354623471', '4354623354', '1100 S Medical Dr', 'Mount Pleasant', 'Sanpete', 'UT', '84647', '4354623471', '4354623354', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1427051747', 0, 'N', 0, '2014-04-08', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12045606', 'W12045606', 'UTIHCPHY', 'Southwest Regional Cancer Clinic', 'David', 'T', 'Cowley', 'NP', 'Pain Management', '', '', NULL, 'O', '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356884900', '4356884901', '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356884900', '4356884901', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2014-02-02', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1720429491', 0, 'Y', 0, '2014-04-08', NULL, NULL, 0, 0, NULL, NULL),
('204043287', 'W12045604', 'W12045604', 'NM01', 'ABQ Health Partners', 'Kari', '', 'Thomas', 'PA-C', 'Orthopedic Surgery', '', '', NULL, 'O', '105011 Golf Course Rd Ste 203', 'Albuquerque', 'Bernalillo', 'NM', '87114', '5052321150', '5052321151', '105011 Golf Course Rd Ste 203', 'Albuquerque', 'Bernalillo', 'NM', '87114', '5052321150', '5052321151', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2014-03-03', NULL, 0, 0, 0, 'Lovelace Westside Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1114985660', 0, 'N', 0, '2014-03-13', NULL, NULL, 0, 0, NULL, NULL),
('204043287', 'W12045603', 'W12045603', 'NM01', 'ABQ Health Partners', 'Mark', '', 'Crawford', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '105011 Golf Course Rd Ste 203', 'Albuquerque', 'Bernalillo', 'NM', '87114', '5052321150', '5052321151', '105011 Golf Course Rd Ste 203', 'Albuquerque', 'Bernalillo', 'NM', '87114', '5052321150', '5052321151', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2014-03-03', NULL, 0, 0, 0, 'Lovelace Westside Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1619970654', 0, 'N', 0, '2014-03-13', NULL, NULL, 0, 0, NULL, NULL),
('452976742', 'W12045602', 'W12045602', 'ID02', 'Kaleidoscope Pediatric Therapy', 'Kamber', 'D', 'Spangler', 'OT', 'Occupational Therapy', '', '', NULL, 'O', '7211 W Franklin Rd', 'Boise', 'Ada', 'ID', '83709', '2083754200', '2083754201', '7211 W Franklin Rd', 'Boise', 'Ada', 'ID', '83709', '2083754200', '2083754201', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2014-02-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1285994194', 0, 'N', 0, '2014-03-13', NULL, NULL, 0, 0, NULL, NULL),
('452976742', 'W12045600', 'W12045600', 'ID02', 'Kaleidoscope Pediatric Therapy', 'Maureen', 'Ann', 'Page', 'OT', 'Occupational Therapy', '', '', NULL, 'O', '7211 W Franklin Rd', 'Boise', 'Ada', 'ID', '83709', '2083754200', '2083754201', '7211 W Franklin Rd', 'Boise', 'Ada', 'ID', '83709', '2083754200', '2083754201', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2014-03-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1083876916', 0, 'N', 0, '2014-03-13', NULL, NULL, 0, 0, NULL, NULL),
('452976742', 'W12045598', 'W12045598', 'ID02', 'Kaleidoscope Pediatric Therapy', 'Marcie', 'Anne', 'Ganier', 'OT', 'Occupational Therapy', '', '', NULL, 'O', '7211 W Franklin Rd', 'Boise', 'Ada', 'ID', '83709', '2083754200', '2083754201', '7211 W Franklin Rd', 'Boise', 'Ada', 'ID', '83709', '2083754200', '2083754201', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2014-02-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1972836351', 0, 'N', 0, '2014-03-13', NULL, NULL, 0, 0, NULL, NULL),
('870470821', 'W12045595', 'W12045595', 'UT01', 'Rocky Mountain Therapy Services', 'Tiffany', 'Ann', 'West', 'OT', 'Occupational Therapy', '', '', NULL, 'O', '3497 W 3500 S', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8014175017', '8014175016', '3497 W 3500 S', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8014175017', '8014175016', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2014-03-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1932521663', 0, 'N', 0, '2014-03-13', NULL, NULL, 0, 0, NULL, NULL),
('870470821', 'W12045596', 'W12045596', 'UT01', 'Rocky Mountain Therapy Services', 'Tiffany', 'Ann', 'West', 'OT', 'Occupational Therapy', '', '', NULL, 'B', 'PO Box 540640', 'North Salt Lake', 'Davis', 'UT', '84054', '8019431041', '8019438805', 'PO Box 540640', 'North Salt Lake', 'Davis', 'UT', '84054', '8019431041', '8019438805', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2014-03-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1932521663', 0, 'N', 0, '2014-03-13', NULL, NULL, 0, 0, NULL, NULL),
('201113815', 'W12045594', 'W12045594', 'UT01', 'Rocky Mountain Therapy Services', 'Tiffany', 'Ann', 'West', 'OT', 'Occupational Therapy', '', '', NULL, 'B', 'PO Box 540640', 'North Salt Lake', 'Davis', 'UT', '84054', '8019431041', '8019438805', 'PO Box 540640', 'North Salt Lake', 'Davis', 'UT', '84054', '8019431041', '8019438805', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2014-03-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1932521663', 0, 'N', 0, '2014-03-13', NULL, NULL, 0, 0, NULL, NULL),
('870638453', 'W12045589', 'W12045589', 'UT01', 'Alpine Sports Medicine', 'Adrianne', 'O', 'Musick', 'DPT', 'Physical Therapy', '', '', NULL, 'B', 'PO Box 682226', 'Park City', 'Summit', 'UT', '84068', '4356459095', '4356459092', 'PO Box 682226', 'Park City', 'Summit', 'UT', '84068', '4356459095', '4356459092', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 8, '2014-03-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1861831703', 0, 'N', 0, '2014-03-13', NULL, NULL, 0, 0, NULL, NULL),
('711048468', 'W12045591', 'W12045591', 'UT01', 'Cutting Edge Physical Therapy ', 'Laura', 'M', 'Nice', 'DPT', 'Physical Therapy', '', '', NULL, 'O', '1151 E 3900 S Ste B199', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8016859212', '8016859195', '1151 E 3900 S Ste B199', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8016859212', '8016859195', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2014-03-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1295160695', 0, 'N', 0, '2014-03-13', NULL, NULL, 0, 0, NULL, NULL),
('201113815', 'W12045593', 'W12045593', 'UT01', 'Rocky Mountain Therapy Services', 'Tiffany', 'Ann', 'West', 'OT', 'Occupational Therapy', '', '', NULL, 'O', '1950 E 7000 S', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019431041', '8019438805', '1950 E 7000 S', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019431041', '8019438805', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2014-03-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1932521663', 0, 'N', 0, '2014-03-13', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12045584', 'W12045584', 'WYBILLINGS', 'Billings Clinic - Cardiology', 'Amber', '', 'Zito', 'PA-C', 'Occupational Medicine', '', '', NULL, 'O', '801 N 29th St', 'Billings', 'Yellowstone', 'MT', '59101', '4062382000', '4062382066', '801 N 29th St', 'Billings', 'Yellowstone', 'MT', '59101', '4062382000', '4062382066', '', '', '', '0.00', '17.00', '0.00', 3, '2014-03-31', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1902033442', 0, 'N', 0, '2014-03-13', NULL, NULL, 0, 0, NULL, NULL),
('870638453', 'W12045588', 'W12045588', 'UT01', 'Alpine Sports Medicine', 'Adrianne', 'O', 'Musick', 'DPT', 'Physical Therapy', '', '', NULL, 'O', '2015 Sidewinder Dr', 'Park City', 'Summit', 'UT', '84060', '4356459095', '4356459092', '2015 Sidewinder Dr', 'Park City', 'Summit', 'UT', '84060', '4356459095', '4356459092', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 8, '2014-03-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1861831703', 0, 'N', 0, '2014-03-13', NULL, NULL, 0, 0, NULL, NULL),
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('810231784', 'W12045583', 'W12045583', 'WYBILLINGS', 'Billings Clinic', 'Amber', '', 'Zito', 'PA-C', 'Occupational Medicine', '', '', NULL, 'M', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', '0000000000', '0000000000', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', '0000000000', '0000000000', '', '', '', '0.00', '17.00', '0.00', 3, '2014-03-31', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1902033442', 0, 'N', 0, '2014-03-13', NULL, NULL, 0, 0, NULL, NULL),
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