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
('452700181', 'W12039665', 'W12039665', 'UTDT01', 'IDA Endodontics - Comfort Family Dental of South Ogden', 'Thomas', '', 'Vandenberghe', 'DDS', 'Endodontist', '', '', NULL, 'O', '5685 S 1475 E Ste 2A', 'Ogden', 'Weber', 'UT', '84403', '8014750509', NULL, '5685 S 1475 E Ste 2A', 'Ogden', 'Weber', 'UT', '84403', '8014750509', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1770506610', 0, 'N', 0, '2013-10-23', NULL, NULL, 0, 0, NULL, NULL),
('452700181', 'W12039666', 'W12039666', 'UTDT01', 'IDA Endodontics - Heritage Dental', 'Thomas', '', 'Vandenberghe', 'DDS', 'Endodontist', '', '', NULL, 'O', '1747 S Heritage Ln Ste A1', 'Syracuse', 'Davis', 'UT', '84075', '8015251415', NULL, '1747 S Heritage Ln Ste A1', 'Syracuse', 'Davis', 'UT', '84075', '8015251415', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1770506610', 0, 'N', 0, '2013-10-23', NULL, NULL, 0, 0, NULL, NULL),
('452700181', 'W12039667', 'W12039667', 'UTDT01', 'IDA Endodontics - Hillside Dental', 'Thomas', '', 'Vandenberghe', 'DDS', 'Endodontist', '', '', NULL, 'O', '466 N Main St Ste 101', 'Clearfield', 'Davis', 'UT', '84015', '8017768441', NULL, '466 N Main St Ste 101', 'Clearfield', 'Davis', 'UT', '84015', '8017768441', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1770506610', 0, 'N', 0, '2013-10-23', NULL, NULL, 0, 0, NULL, NULL),
('452700181', 'W12039668', 'W12039668', 'UTDT01', 'IDA Endodontics - Hyde Park Dental', 'Thomas', '', 'Vandenberghe', 'DDS', 'Endodontist', '', '', NULL, 'O', '3125 N Main St Ste 104', 'Logan', 'Cache', 'UT', '84341', '4357874444', NULL, '3125 N Main St Ste 104', 'Logan', 'Cache', 'UT', '84341', '4357874444', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1770506610', 0, 'N', 0, '2013-10-23', NULL, NULL, 0, 0, NULL, NULL),
('452700181', 'W12039669', 'W12039669', 'UTDT01', 'IDA Endodontics - Logan Dental', 'Thomas', '', 'Vandenberghe', 'DDS', 'Endodontist', '', '', NULL, 'O', '40 W Cache Valley Blvd Ste 2A', 'Logan', 'Cache', 'UT', '84341', '4357878207', NULL, '40 W Cache Valley Blvd Ste 2A', 'Logan', 'Cache', 'UT', '84341', '4357878207', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1770506610', 0, 'N', 0, '2013-10-23', NULL, NULL, 0, 0, NULL, NULL),
('452700181', 'W12039670', 'W12039670', 'UTDT01', 'IDA Endodontics - Lomond View Dental', 'Thomas', '', 'Vandenberghe', 'DDS', 'Endodontist', '', '', NULL, 'O', '2685 N 1000 W', 'Ogden', 'Weber', 'UT', '84414', '8017379442', NULL, '2685 N 1000 W', 'Ogden', 'Weber', 'UT', '84414', '8017379442', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1770506610', 0, 'N', 0, '2013-10-23', NULL, NULL, 0, 0, NULL, NULL),
('452700181', 'W12039671', 'W12039671', 'UTDT01', 'IDA Endodontics - Midland Dental', 'Thomas', '', 'Vandenberghe', 'DDS', 'Endodontist', '', '', NULL, 'O', '4040 S Midland Ste 1', 'Roy', 'Weber', 'UT', '84067', '8013174407', NULL, '4040 S Midland Ste 1', 'Roy', 'Weber', 'UT', '84067', '8013174407', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1770506610', 0, 'N', 0, '2013-10-23', NULL, NULL, 0, 0, NULL, NULL),
('452700181', 'W12039672', 'W12039672', 'UTDT01', 'IDA Endodontics - Mountain View Dental', 'Thomas', '', 'Vandenberghe', 'DDS', 'Endodontist', '', '', NULL, 'O', '2717 N Hwy 89 Ste 100', 'Ogden', 'Weber', 'UT', '84414', '8017372410', NULL, '2717 N Hwy 89 Ste 100', 'Ogden', 'Weber', 'UT', '84414', '8017372410', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1770506610', 0, 'N', 0, '2013-10-23', NULL, NULL, 0, 0, NULL, NULL),
('452700181', 'W12039674', 'W12039674', 'UTDT01', 'IDA Endodontics - Payson', 'Thomas', '', 'Vandenberghe', 'DDS', 'Endodontist', '', '', NULL, 'O', '107 S 500 W', 'Payson', 'Utah', 'UT', '84651', '8014657966', NULL, '107 S 500 W', 'Payson', 'Utah', 'UT', '84651', '8014657966', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1770506610', 0, 'N', 0, '2013-10-23', NULL, NULL, 0, 0, NULL, NULL),
('452700181', 'W12039675', 'W12039675', 'UTDT01', 'IDA Endodontics - Perry Dental', 'Thomas', '', 'Vandenberghe', 'DDS', 'Endodontist', '', '', NULL, 'O', '2535 S Hwy 89 Ste 1', 'Brigham City', 'Box Elder', 'UT', '84302', '4357234300', NULL, '2535 S Hwy 89 Ste 1', 'Brigham City', 'Box Elder', 'UT', '84302', '4357234300', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1770506610', 0, 'N', 0, '2013-10-23', NULL, NULL, 0, 0, NULL, NULL),
('452700181', 'W12039676', 'W12039676', 'UTDT01', 'IDA Endodontics - Spring Creek Dental', 'Thomas', '', 'Vandenberghe', 'DDS', 'Endodontist', '', '', NULL, 'O', '274 N Spring Creek Pkwy', 'Providence', 'Cache', 'UT', '84332', '4357130096', NULL, '274 N Spring Creek Pkwy', 'Providence', 'Cache', 'UT', '84332', '4357130096', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1770506610', 0, 'N', 0, '2013-10-23', NULL, NULL, 0, 0, NULL, NULL),
('452700181', 'W12039677', 'W12039677', 'UTDT01', 'IDA Endodontics - Ridge View Dental', 'Thomas', '', 'Vandenberghe', 'DDS', 'Endodontist', '', '', NULL, 'O', '1186 E 4600 S Ste 410', 'Ogden', 'Weber', 'UT', '84403', '8013349444', NULL, '1186 E 4600 S Ste 410', 'Ogden', 'Weber', 'UT', '84403', '8013349444', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1770506610', 0, 'N', 0, '2013-10-23', NULL, NULL, 0, 0, NULL, NULL),
('452700181', 'W12039679', 'W12039679', 'UTDT01', 'IDA Endodontics - Cherry Creek Dental', 'John', '', 'Vandenberghe', 'DDS', 'Endodontist', '', '', NULL, 'O', '105 S Hwy 91', 'Richmond', 'Cache', 'UT', '84333', '4352582301', NULL, '105 S Hwy 91', 'Richmond', 'Cache', 'UT', '84333', '4352582301', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1780607663', 0, 'N', 0, '2013-10-23', NULL, NULL, 0, 0, NULL, NULL),
('452700181', 'W12039680', 'W12039680', 'UTDT01', 'IDA Endodontics - Comfort Family Dental of South Ogden', 'John', '', 'Vandenberghe', 'DDS', 'Endodontist', '', '', NULL, 'O', '5685 S 1475 E Ste 2A', 'Ogden', 'Weber', 'UT', '84403', '8014750509', NULL, '5685 S 1475 E Ste 2A', 'Ogden', 'Weber', 'UT', '84403', '8014750509', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1780607663', 0, 'N', 0, '2013-10-23', NULL, NULL, 0, 0, NULL, NULL),
('452700181', 'W12039681', 'W12039681', 'UTDT01', 'IDA Endodontics - Hillside Dental', 'John', '', 'Vandenberghe', 'DDS', 'Endodontist', '', '', NULL, 'O', '466 N Main St Ste 101', 'Clearfield', 'Davis', 'UT', '84015', '8017768441', NULL, '466 N Main St Ste 101', 'Clearfield', 'Davis', 'UT', '84015', '8017768441', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1780607663', 0, 'N', 0, '2013-10-23', NULL, NULL, 0, 0, NULL, NULL),
('452700181', 'W12039682', 'W12039682', 'UTDT01', 'IDA Endodontics - Canyon Dental', 'John', '', 'Vandenberghe', 'DDS', 'Endodontist', '', '', NULL, 'O', '291 S Main Ste C', 'Smithfield', 'Cache', 'UT', '84335', '4355632553', NULL, '291 S Main Ste C', 'Smithfield', 'Cache', 'UT', '84335', '4355632553', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1780607663', 0, 'N', 0, '2013-10-23', NULL, NULL, 0, 0, NULL, NULL),
('452700181', 'W12039683', 'W12039683', 'UTDT01', 'IDA Endodontics - Logan Dental', 'John', '', 'Vandenberghe', 'DDS', 'Endodontist', '', '', NULL, 'O', '40 W Cache Valley Blvd Ste 2A', 'Logan', 'Cache', 'UT', '84341', '4357878207', NULL, '40 W Cache Valley Blvd Ste 2A', 'Logan', 'Cache', 'UT', '84341', '4357878207', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1780607663', 0, 'N', 0, '2013-10-23', NULL, NULL, 0, 0, NULL, NULL),
('452700181', 'W12039684', 'W12039684', 'UTDT01', 'IDA Endodontics - Hyde Park Dental', 'John', '', 'Vandenberghe', 'DDS', 'Endodontist', '', '', NULL, 'O', '3125 N Main St Ste 104', 'Logan', 'Cache', 'UT', '84341', '4357874444', NULL, '3125 N Main St Ste 104', 'Logan', 'Cache', 'UT', '84341', '4357874444', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1780607663', 0, 'N', 0, '2013-10-23', NULL, NULL, 0, 0, NULL, NULL),
('452700181', 'W12039685', 'W12039685', 'UTDT01', 'IDA Endodontics - Midland Dental', 'John', '', 'Vandenberghe', 'DDS', 'Endodontist', '', '', NULL, 'O', '4040 S Midland Ste 1', 'Roy', 'Weber', 'UT', '84067', '8013174407', NULL, '4040 S Midland Ste 1', 'Roy', 'Weber', 'UT', '84067', '8013174407', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1780607663', 0, 'N', 0, '2013-10-23', NULL, NULL, 0, 0, NULL, NULL),
('452700181', 'W12039686', 'W12039686', 'UTDT01', 'IDA Endodontics - Payson', 'John', '', 'Vandenberghe', 'DDS', 'Endodontist', '', '', NULL, 'O', '107 S 500 W', 'Payson', 'Utah', 'UT', '84651', '8014657966', NULL, '107 S 500 W', 'Payson', 'Utah', 'UT', '84651', '8014657966', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1780607663', 0, 'N', 0, '2013-10-23', NULL, NULL, 0, 0, NULL, NULL),
('452700181', 'W12039687', 'W12039687', 'UTDT01', 'IDA Endodontics - Ridge View Dental', 'John', '', 'Vandenberghe', 'DDS', 'Endodontist', '', '', NULL, 'O', '1186 E 4600 S Ste 410', 'Ogden', 'Weber', 'UT', '84403', '8013349444', NULL, '1186 E 4600 S Ste 410', 'Ogden', 'Weber', 'UT', '84403', '8013349444', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1780607663', 0, 'N', 0, '2013-10-23', NULL, NULL, 0, 0, NULL, NULL),
('452700181', 'W12039688', 'W12039688', 'UTDT01', 'IDA Endodontics - Aspen Dental', 'John', '', 'Vandenberghe', 'DDS', 'Endodontist', '', '', NULL, 'O', '1451 N 200 E Ste 200', 'Logan', 'Cache', 'UT', '84341', '4357534400', NULL, '1451 N 200 E Ste 200', 'Logan', 'Cache', 'UT', '84341', '4357534400', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1780607663', 0, 'N', 0, '2013-10-23', NULL, NULL, 0, 0, NULL, NULL),
('452700181', 'W12039689', 'W12039689', 'UTDT01', 'IDA Endodontics - Heritage Dental', 'John', '', 'Vandenberghe', 'DDS', 'Endodontist', '', '', NULL, 'O', '1747 S Heritage Ln Ste A1', 'Syracuse', 'Davis', 'UT', '84075', '8015251415', NULL, '1747 S Heritage Ln Ste A1', 'Syracuse', 'Davis', 'UT', '84075', '8015251415', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1780607663', 0, 'N', 0, '2013-10-23', NULL, NULL, 0, 0, NULL, NULL),
('452700181', 'W12039690', 'W12039690', 'UTDT01', 'IDA Endodontics - North View Dental', 'John', '', 'Vandenberghe', 'DDS', 'Endodontist', '', '', NULL, 'O', '2201 N 400 E', 'Ogden', 'Weber', 'UT', '84414', '8017826681', NULL, '2201 N 400 E', 'Ogden', 'Weber', 'UT', '84414', '8017826681', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1780607663', 0, 'N', 0, '2013-10-23', NULL, NULL, 0, 0, NULL, NULL),
('452700181', 'W12039691', 'W12039691', 'UTDT01', 'IDA Endodontics - Comfort Dental of Clinton', 'John', '', 'Vandenberghe', 'DDS', 'Endodontist', '', '', NULL, 'O', '2207 W 1800 N', 'Clearfield', 'Davis', 'UT', '84015', '8018253993', NULL, '2207 W 1800 N', 'Clearfield', 'Davis', 'UT', '84015', '8018253993', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1780607663', 0, 'N', 0, '2013-10-23', NULL, NULL, 0, 0, NULL, NULL),
('452700181', 'W12039692', 'W12039692', 'UTDT01', 'IDA Endodontics - Perry Dental', 'John', '', 'Vandenberghe', 'DDS', 'Endodontist', '', '', NULL, 'O', '2535 S Hwy 89 Ste 1', 'Brigham City', 'Box Elder', 'UT', '84302', '4357234300', NULL, '2535 S Hwy 89 Ste 1', 'Brigham City', 'Box Elder', 'UT', '84302', '4357234300', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1780607663', 0, 'N', 0, '2013-10-23', NULL, NULL, 0, 0, NULL, NULL),
('452700181', 'W12039693', 'W12039693', 'UTDT01', 'IDA Endodontics - Lomond View Dental', 'John', '', 'Vandenberghe', 'DDS', 'Endodontist', '', '', NULL, 'O', '2685 N 1000 W', 'Ogden', 'Weber', 'UT', '84414', '8017379442', NULL, '2685 N 1000 W', 'Ogden', 'Weber', 'UT', '84414', '8017379442', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1780607663', 0, 'N', 0, '2013-10-23', NULL, NULL, 0, 0, NULL, NULL),
('452700181', 'W12039694', 'W12039694', 'UTDT01', 'IDA Endodontics - Mountain View Dental', 'John', '', 'Vandenberghe', 'DDS', 'Endodontist', '', '', NULL, 'O', '2717 N Hwy 89 Ste 100', 'Ogden', 'Weber', 'UT', '84414', '8017372410', NULL, '2717 N Hwy 89 Ste 100', 'Ogden', 'Weber', 'UT', '84414', '8017372410', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1780607663', 0, 'N', 0, '2013-10-23', NULL, NULL, 0, 0, NULL, NULL),
('452700181', 'W12039695', 'W12039695', 'UTDT01', 'IDA Endodontics - Spring Creek Dental', 'John', '', 'Vandenberghe', 'DDS', 'Endodontist', '', '', NULL, 'O', '274 N Spring Creek Pkwy', 'Providence', 'Cache', 'UT', '84332', '4357130096', NULL, '274 N Spring Creek Pkwy', 'Providence', 'Cache', 'UT', '84332', '4357130096', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1780607663', 0, 'N', 0, '2013-10-23', NULL, NULL, 0, 0, NULL, NULL),
('452712822', 'W12039696', 'W12039696', 'UTDT01', 'IDA Surgical - Cherry Creek Dental', 'Jared', '', 'Rasmussen', 'DMD', 'Oral Surgeon', '', '', NULL, 'O', '105 S Hwy 91', 'Richmond', 'Cache', 'UT', '84333', '4352582301', NULL, '105 S Hwy 91', 'Richmond', 'Cache', 'UT', '84333', '4352582301', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1417157355', 0, 'N', 0, '2013-12-06', NULL, NULL, 0, 0, NULL, NULL),
('452712822', 'W12039697', 'W12039697', 'UTDT01', 'IDA Surgical - Payson ', 'Jared', '', 'Rasmussen', 'DMD', 'Oral Surgeon', '', '', NULL, 'O', '107 S 500 W', 'Payson', 'Utah', 'UT', '84651', '8014657966', NULL, '107 S 500 W', 'Payson', 'Utah', 'UT', '84651', '8014657966', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1417157355', 0, 'N', 0, '2013-12-06', NULL, NULL, 0, 0, NULL, NULL),
('452712822', 'W12039698', 'W12039698', 'UTDT01', 'IDA Surgical - Ridge View Dental', 'Jared', '', 'Rasmussen', 'DMD', 'Oral Surgeon', '', '', NULL, 'O', '1186 E 4600 S Ste 410', 'Ogden', 'Weber', 'UT', '84403', '8013349444', NULL, '1186 E 4600 S Ste 410', 'Ogden', 'Weber', 'UT', '84403', '8013349444', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1417157355', 0, 'N', 0, '2013-12-06', NULL, NULL, 0, 0, NULL, NULL),
('452712822', 'W12039699', 'W12039699', 'UTDT01', 'IDA Surgical - Aspen Dental', 'Jared', '', 'Rasmussen', 'DMD', 'Oral Surgeon', '', '', NULL, 'O', '1451 N 200 E Ste 200', 'Logan', 'Cache', 'UT', '84341', '4357534400', NULL, '1451 N 200 E Ste 200', 'Logan', 'Cache', 'UT', '84341', '4357534400', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1417157355', 0, 'N', 0, '2013-12-06', NULL, NULL, 0, 0, NULL, NULL),
('452712822', 'W12039701', 'W12039701', 'UTDT01', 'IDA Surgical - Heritage Dental', 'Jared', '', 'Rasmussen', 'DMD', 'Oral Surgeon', '', '', NULL, 'O', '1747 S Heritage Ln Ste A1', 'Syracuse', 'Davis', 'UT', '84075', '8015251415', NULL, '1747 S Heritage Ln Ste A1', 'Syracuse', 'Davis', 'UT', '84075', '8015251415', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1417157355', 0, 'N', 0, '2013-12-06', NULL, NULL, 0, 0, NULL, NULL),
('452712822', 'W12039702', 'W12039702', 'UTDT01', 'IDA Surgical - North View Dental', 'Jared', '', 'Rasmussen', 'DMD', 'Oral Surgeon', '', '', NULL, 'O', '2201 N 400 E', 'Ogden', 'Weber', 'UT', '84414', '8017826681', NULL, '2201 N 400 E', 'Ogden', 'Weber', 'UT', '84414', '8017826681', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1417157355', 0, 'N', 0, '2013-12-06', NULL, NULL, 0, 0, NULL, NULL),
('452712822', 'W12039703', 'W12039703', 'UTDT01', 'IDA Surgical - Comfort Dental of Clinton', 'Jared', '', 'Rasmussen', 'DMD', 'Oral Surgeon', '', '', NULL, 'O', '2207 W 1800 N', 'Clearfield', 'Davis', 'UT', '84015', '8018253993', NULL, '2207 W 1800 N', 'Clearfield', 'Davis', 'UT', '84015', '8018253993', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1417157355', 0, 'N', 0, '2013-12-06', NULL, NULL, 0, 0, NULL, NULL),
('452712822', 'W12039704', 'W12039704', 'UTDT01', 'IDA Surgical - Perry Dental', 'Jared', '', 'Rasmussen', 'DMD', 'Oral Surgeon', '', '', NULL, 'O', '2535 S Hwy 89 Ste 1', 'Brigham City', 'Box Elder', 'UT', '84302', '4357234300', NULL, '2535 S Hwy 89 Ste 1', 'Brigham City', 'Box Elder', 'UT', '84302', '4357234300', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1417157355', 0, 'N', 0, '2013-12-06', NULL, NULL, 0, 0, NULL, NULL),
('452712822', 'W12039705', 'W12039705', 'UTDT01', 'IDA Surgical - Lomond View Dental', 'Jared', '', 'Rasmussen', 'DMD', 'Oral Surgeon', '', '', NULL, 'O', '2685 N 1000 W', 'Ogden', 'Weber', 'UT', '84414', '8017379442', NULL, '2685 N 1000 W', 'Ogden', 'Weber', 'UT', '84414', '8017379442', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1417157355', 0, 'N', 0, '2013-12-06', NULL, NULL, 0, 0, NULL, NULL),
('452712822', 'W12039706', 'W12039706', 'UTDT01', 'IDA Surgical - Mountain View Dental', 'Jared', '', 'Rasmussen', 'DMD', 'Oral Surgeon', '', '', NULL, 'O', '2717 N Hwy 89 Ste 100', 'Ogden', 'Weber', 'UT', '84414', '8017372410', NULL, '2717 N Hwy 89 Ste 100', 'Ogden', 'Weber', 'UT', '84414', '8017372410', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1417157355', 0, 'N', 0, '2013-12-06', NULL, NULL, 0, 0, NULL, NULL),
('452712822', 'W12039707', 'W12039707', 'UTDT01', 'IDA Surgical - Spring Creek Dental', 'Jared', '', 'Rasmussen', 'DMD', 'Oral Surgeon', '', '', NULL, 'O', '274 N Spring Creek Pkwy', 'Providence', 'Cache', 'UT', '84332', '4357130096', NULL, '274 N Spring Creek Pkwy', 'Providence', 'Cache', 'UT', '84332', '4357130096', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1417157355', 0, 'N', 0, '2013-12-06', NULL, NULL, 0, 0, NULL, NULL),
('452712822', 'W12039708', 'W12039708', 'UTDT01', 'IDA Surgical - Canyon Dental', 'Jared', '', 'Rasmussen', 'DMD', 'Oral Surgeon', '', '', NULL, 'O', '291 S Main Ste C', 'Smithfield', 'Cache', 'UT', '84335', '4355632553', NULL, '291 S Main Ste C', 'Smithfield', 'Cache', 'UT', '84335', '4355632553', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1417157355', 0, 'N', 0, '2013-12-06', NULL, NULL, 0, 0, NULL, NULL),
('452712822', 'W12039709', 'W12039709', 'UTDT01', 'IDA Surgical - Hyde Park Dental', 'Jared', '', 'Rasmussen', 'DMD', 'Oral Surgeon', '', '', NULL, 'O', '3125 N Main St Ste 104', 'Logan', 'Cache', 'UT', '84341', '4357874444', NULL, '3125 N Main St Ste 104', 'Logan', 'Cache', 'UT', '84341', '4357874444', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1417157355', 0, 'N', 0, '2013-12-06', NULL, NULL, 0, 0, NULL, NULL),
('452712822', 'W12039710', 'W12039710', 'UTDT01', 'IDA Surgical - Logan Dental', 'Jared', '', 'Rasmussen', 'DMD', 'Oral Surgeon', '', '', NULL, 'O', '40 W Cache Valley Blvd Ste 2A', 'Logan', 'Cache', 'UT', '84341', '4357878207', NULL, '40 W Cache Valley Blvd Ste 2A', 'Logan', 'Cache', 'UT', '84341', '4357878207', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1417157355', 0, 'N', 0, '2013-12-06', NULL, NULL, 0, 0, NULL, NULL),
('452712822', 'W12039711', 'W12039711', 'UTDT01', 'IDA Surgical - Midland Dental', 'Jared', '', 'Rasmussen', 'DMD', 'Oral Surgeon', '', '', NULL, 'O', '4040 S Midland Dr Ste 1', 'Roy', 'Weber', 'UT', '84067', '8013174407', NULL, '4040 S Midland Dr Ste 1', 'Roy', 'Weber', 'UT', '84067', '8013174407', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1417157355', 0, 'N', 0, '2013-12-06', NULL, NULL, 0, 0, NULL, NULL),
('452712822', 'W12039712', 'W12039712', 'UTDT01', 'IDA Surgical - Hillside Dental', 'Jared', '', 'Rasmussen', 'DMD', 'Oral Surgeon', '', '', NULL, 'O', '466 N Main St Ste 101', 'Clearfield', 'Davis', 'UT', '84015', '8017768441', NULL, '466 N Main St Ste 101', 'Clearfield', 'Davis', 'UT', '84015', '8017768441', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1417157355', 0, 'N', 0, '2013-12-06', NULL, NULL, 0, 0, NULL, NULL),
('870687748', 'W12039714', 'W12039714', 'UTDT01', 'Kelly A Mangrum DDS', 'Kelly', '', 'Mangrum', 'DDS', 'Dentist', '', '', NULL, 'O', '7110 Highland Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019436880', NULL, '7110 Highland Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019436880', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000004164', 0, 'N', 0, '2013-10-23', NULL, NULL, 0, 0, NULL, NULL),
('452712822', 'W12039713', 'W12039713', 'UTDT01', 'IDA Surgical - Comfort Family Dental of South Ogden', 'Jared', '', 'Rasmussen', 'DMD', 'Oral Surgeon', '', '', NULL, 'O', '5685 S 1475 E Ste 2A', 'Ogden', 'Weber', 'UT', '84403', '8014750509', NULL, '5685 S 1475 E Ste 2A', 'Ogden', 'Weber', 'UT', '84403', '8014750509', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1417157355', 0, 'N', 0, '2013-12-06', NULL, NULL, 0, 0, NULL, NULL),
('900292080', 'W12039717', 'W12039717', 'UTDT01', 'Thanksgiving Point Dental', 'Blair', '', 'Losee', 'DMD', 'Dentist', '', '', NULL, 'O', '3098 Executive Pkwy Ste 250', 'Lehi', 'Utah', 'UT', '84043', '8017665300', NULL, '3098 Executive Pkwy Ste 250', 'Lehi', 'Utah', 'UT', '84043', '8017665300', '          ', 'UT000B', '', '', '0.00', '100.00', '0.00', 8, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1073654299', 0, 'N', 0, '2013-10-23', NULL, NULL, 0, 0, NULL, NULL),
('870618654', 'W12039718', 'W12039718', 'UTDT01', 'Century Dental West', 'Kelly', '', 'Egan', 'DMD', 'Dentist', '', '', NULL, 'O', '4445 W 3500 S', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019680798', NULL, '4445 W 3500 S', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019680798', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1538253349', 0, 'N', 0, '2013-10-23', NULL, NULL, 0, 0, NULL, NULL),
('870618654', 'W12039720', 'W12039720', 'UTDT01', 'Century Dental West', 'Gary', '', 'Shaw', 'DDS', 'Dentist', '', '', NULL, 'O', '4445 W 3500 S', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019680798', NULL, '4445 W 3500 S', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019680798', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1215026612', 0, 'N', 0, '2013-10-23', NULL, NULL, 0, 0, NULL, NULL),
('870618654', 'W12039721', 'W12039721', 'UTDT01', 'Century Dental West', 'Val', '', 'Cox', 'DDS MSD', 'Endodontist', '', '', NULL, 'O', '4445 W 3500 S', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019680798', NULL, '4445 W 3500 S', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019680798', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1316013964', 0, 'N', 0, '2013-10-23', NULL, NULL, 0, 0, NULL, NULL),
('900941378', 'W12039723', 'W12039723', 'UTDT01', 'Layton Smiles Dentistry and Orthodontics', 'Bryon', '', 'Talbot', 'DDS', 'Dentist', '', '', NULL, 'O', '820 N Main St Ste B', 'Layton', 'Davis', 'UT', '84041', '8017718000', NULL, '820 N Main St Ste B', 'Layton', 'Davis', 'UT', '84041', '8017718000', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1659386142', 0, 'N', 0, '2013-10-23', NULL, NULL, 0, 0, NULL, NULL),
('463300384', 'W12039726', 'W12039726', 'UTDT01', 'Mountain View Pediatric Dentistry', 'Samuel', '', 'Bailey', 'DMD', 'Pedodontist', '', '', NULL, 'O', '1401 N 1075 W Ste 200', 'Farmington', 'Davis', 'UT', '84025', '8014775437', NULL, '1401 N 1075 W Ste 200', 'Farmington', 'Davis', 'UT', '84025', '8014775437', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1285990978', 0, 'N', 0, '2013-10-23', NULL, NULL, 0, 0, NULL, NULL),
('463300384', 'W12039727', 'W12039727', 'UTDT01', 'Mountain View Pediatric Dentistry', 'Cameron', 'P', 'Quayle', 'DDS', 'Pedodontist', '', '', NULL, 'O', '1401 N 1075 W Ste 200', 'Farmington', 'Davis', 'UT', '84025', '8014775437', NULL, '1401 N 1075 W Ste 200', 'Farmington', 'Davis', 'UT', '84025', '8014775437', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1225194046', 0, 'N', 0, '2013-10-23', NULL, NULL, 0, 0, NULL, NULL),
('870561438', 'W12039731', 'W12039731', 'UTDT01', 'Greenwood Dental', 'Bryan', '', 'Greenwood', 'DDS', 'Dentist', '', '', NULL, 'O', '226 N 1100 E Ste D', 'American Fork', 'Utah', 'UT', '84003', '8017566037', NULL, '226 N 1100 E Ste D', 'American Fork', 'Utah', 'UT', '84003', '8017566037', '          ', 'UT000B', '', '', '0.00', '100.00', '0.00', 8, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1578901674', 0, 'N', 0, '2013-10-23', NULL, NULL, 0, 0, NULL, NULL),
('201995728', 'W12039729', 'W12039729', 'UTDT01', 'Greenwood Dental', 'Bryan', '', 'Greenwood', 'DDS', 'Dentist', '', '', NULL, 'O', '76 E Commerce Dr Ste 101', 'Saratoga Springs', 'Utah', 'UT', '84045', '8017663269', NULL, '76 E Commerce Dr Ste 101', 'Saratoga Springs', 'Utah', 'UT', '84045', '8017663269', '          ', 'UT000B', '', '', '0.00', '100.00', '0.00', 8, '2013-09-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1578901674', 0, 'N', 0, '2013-10-23', NULL, NULL, 0, 0, NULL, NULL),
('010624198', 'W12039735', 'W12039735', 'TX01', 'Alamo Mental Health Group', '', '', 'Alamo Mental Health Group', '', 'Mental Health', '', '', NULL, 'O', '4242 Medical Dr MA Ste 6300', 'San Antonio', 'Bexar', 'TX', '78229', '2106148400', '2106148165', '4242 Medical Dr MA Ste 6300', 'San Antonio', 'Bexar', 'TX', '78229', '2106148400', '2106148165', 'TXALAMOMA', '', '', '0.00', '35.00', '0.00', 6, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1336206275', 0, 'Y', 1, '2013-10-23', NULL, NULL, 0, 0, NULL, NULL),
('010624198', 'W12039733', 'W12039733', 'TX01', 'Alamo Mental Health Group', '', '', 'Alamo Mental Health Group', '', 'Mental Health', '', '', NULL, 'O', '4242 Medical Dr PHD Ste 6300', 'San Antonio', 'Bexar', 'TX', '78229', '2106148400', '2106148165', '4242 Medical Dr PHD Ste 6300', 'San Antonio', 'Bexar', 'TX', '78229', '2106148400', '2106148165', 'TXALAMOPHD', '', '', '0.00', '35.00', '0.00', 6, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1336206275', 0, 'Y', 1, '2013-10-23', NULL, NULL, 0, 0, NULL, NULL),
('010624198', 'W12039734', 'W12039734', 'TX01', 'Alamo Mental Health Group', '', '', 'Alamo Mental Health Group', '', 'Mental Health', '', '', NULL, 'O', '4242 Medical Dr MD Ste 6300', 'San Antonio', 'Bexar', 'TX', '78229', '2106148400', '2106148165', '4242 Medical Dr MD Ste 6300', 'San Antonio', 'Bexar', 'TX', '78229', '2106148400', '2106148165', 'TXALAMOMD', '', '', '0.00', '35.00', '0.00', 6, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1336206275', 0, 'Y', 1, '2013-10-23', NULL, NULL, 0, 0, NULL, NULL),
('870546501', 'W12039737', 'W12039737', 'UT01', 'Alpine Pediatrics', 'Julia', 'K', 'Gunther', 'MD', 'Pediatrics', '', '', NULL, 'O', '77 E Commerce Dr', 'Saratoga Springs', 'Utah', 'UT', '84045', '8019229222', '8017661758', '77 E Commerce Dr', 'Saratoga Springs', 'Utah', 'UT', '84045', '8019229222', '8017661758', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-10-23', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1528229101', 0, 'N', 0, '2013-10-23', NULL, NULL, 40.3848, -111.914, NULL, NULL),
('462726462', 'W12040581', 'W12040581', 'UT01', 'Mobley MD Facial Plastic and Reconstructive Surgery', 'Steven', 'R', 'Mobley', 'MD', 'Ear, Nose and Throat', 'Plastic Surgery', '', NULL, 'B', 'PO Box 15086', 'Scottsdale', 'Maricopa', 'AZ', '85267', '4809918100', '4809221028', 'PO Box 15086', 'Scottsdale', 'Maricopa', 'AZ', '85267', '4809918100', '4809221028', 'WUSTDPLAS5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-10-01', NULL, 0, 0, 0, 'University Health Care University Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1265522874', 0, 'N', 0, '2013-11-12', NULL, NULL, 0, 0, NULL, NULL),
('850275777', 'W12038902', 'W12038902', 'NM01', 'Southwest Medical Associates', 'Asit', 'N', 'Bhatt', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '8401 Constitution NE Ste 150', 'Albuquerque', 'Bernalillo', 'NM', '87110', '5058231010', '5057974503', '8401 Constitution NE Ste 150', 'Albuquerque', 'Bernalillo', 'NM', '87110', '5058231010', '5057974503', 'NMSWMED', '', '', '0.00', '10.00', '0.00', 3, '2013-11-01', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1184839854', 0, 'N', 0, '2013-10-30', NULL, NULL, 35.0946, -106.552, NULL, NULL),
('850275777', 'W12038901', 'W12038901', 'NM01', 'Southwest Medical Associates', 'Asit', 'N', 'Bhatt', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '4420 Irving Blvd NW', 'Albuquerque', 'Bernalillo', 'NM', '87114', '5058231010', '5057974503', '4420 Irving Blvd NW', 'Albuquerque', 'Bernalillo', 'NM', '87114', '5058231010', '5057974503', 'NMSWMED', '', '', '0.00', '10.00', '0.00', 3, '2013-11-01', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1184839854', 0, 'N', 0, '2013-10-30', NULL, NULL, 35.1902, -106.665, NULL, NULL),
('850275777', 'W12038899', 'W12038899', 'NM01', 'Southwest Medical Associates', 'Asit', 'N', 'Bhatt', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '4705 Montgomery Blvd NE Ste 301-302', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058231010', '5057974503', '4705 Montgomery Blvd NE Ste 301-302', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058231010', '5057974503', 'NMSWMED', '', '', '0.00', '10.00', '0.00', 3, '2013-11-01', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1184839854', 0, 'N', 0, '2013-10-30', NULL, NULL, 35.131, -106.591, NULL, NULL),
('850275777', 'W12038900', 'W12038900', 'NM01', 'Southwest Medical Associates', 'Asit', 'N', 'Bhatt', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '6100 Pan American Fwy, Ne Ste 100', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058231010', '5058231010', '6100 Pan American Fwy, Ne Ste 100', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058231010', '5058231010', 'NMSWMED', '', '', '0.00', '10.00', '0.00', 3, '2013-11-01', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1184839854', 0, 'N', 0, '2013-10-30', NULL, NULL, 0, 0, NULL, NULL),
('462503344', 'W12034114', 'W12034114', 'UTMH1', '', 'Christine', 'A', 'Pembroke', 'LCSW', 'Mental Health', '', '', NULL, 'O', '231 E 400 S Ste 360', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8018932530', '8019077662', '231 E 400 S Ste 360', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8018932530', '8019077662', 'UTMA', '', '', '0.00', '40.00', '0.00', 3, '2013-04-10', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1114247467', 0, 'N', 0, '2013-10-24', NULL, NULL, 40.7607, -111.884, NULL, NULL),
('208926544', 'W12039739', 'W12039739', 'TXDALSTD', 'The Internal Medicine Center of Fort Worth', 'Angelo', 'A', 'Khanh', 'DO', 'Internal Medicine', '', '', NULL, 'O', '12001 S Fwy Ste 307', 'Burleson', 'Johnson', 'TX', '76028', '8175688700', '8175688704', '12001 S Fwy Ste 307', 'Burleson', 'Johnson', 'TX', '76028', '8175688700', '8175688704', 'DALLAS1', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-11-30', NULL, 0, 0, 0, 'Baylor All Saints Medical Center', NULL, '', '', 'HCFA|', '1467675751', 0, 'N', 0, '2014-02-11', NULL, NULL, 32.5842, -97.3191, NULL, NULL),
('363819436', 'W12039740', 'W12039740', 'ILCHIGSTD', 'Cardiac Surgery Associates', '', '', 'Cardiac Surgery Associates', '', 'Cardiology', '', '', NULL, 'O', '2650 Warrenville Rd Ste 280', 'Downers Grove', 'Dupage', 'IL', '60515', '6303247900', '6302711813', '2650 Warrenville Rd Ste 280', 'Downers Grove', 'Dupage', 'IL', '60515', '6303247900', '6302711813', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 6, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1043269160', 0, 'Y', 0, '2014-02-25', NULL, NULL, 41.8082, -88.0496, NULL, NULL),
('363819436', 'W12039741', 'W12039741', 'ILCHIGSTD', 'Cardiac Surgery Associates', '', '', 'Cardiac Surgery Associates', '', 'Cardiology', '', '', NULL, 'B', 'PO Box 153', 'Channahon', 'Will', 'IL', '60410', '6303247900', '6302711813', 'PO Box 153', 'Channahon', 'Will', 'IL', '60410', '6303247900', '6302711813', 'CHIG13', 'CHIHCPCS02', '', '0.00', '40.00', '0.00', 6, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1043269160', 0, 'N', 0, '2014-02-25', NULL, NULL, 0, 0, NULL, NULL),
('621762357', 'W12039742', 'W12039742', 'UT01', 'Emery Medical Center', '', '', 'Castleview Hospital-Pro Fees', 'GROUP', 'Hospital', '', '', NULL, 'O', '90 W Main St', 'Castle Dale', 'Emery', 'UT', '84513', '4353812305', '4353815010', '90 W Main St', 'Castle Dale', 'Emery', 'UT', '84513', '4353812305', '4353815010', 'WURURAL5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '0000834088', 0, 'Y', 0, '2013-10-24', NULL, NULL, 39.2109, -111.02, NULL, NULL),
('621762357', 'W12039744', 'W12039744', 'UT01', 'Emery Medical Center', '', '', 'Castleview Hospital-Pro Fees', 'GROUP', 'Hospital', '', '', NULL, 'B', 'PO Box 607', 'Castle Dale', 'Emery', 'UT', '84513', '4353812305', '4353815010', 'PO Box 607', 'Castle Dale', 'Emery', 'UT', '84513', '4353812305', '4353815010', 'WURURAL5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '0000834088', 0, 'Y', 0, '2013-10-24', NULL, NULL, 0, 0, NULL, NULL),
('562302331', 'W12039753', 'W12039753', 'UT01', 'Central Utah Anesthesia', '', '', 'Central Utah Anesthesia', 'Group', 'Anesthesia', '', '', NULL, 'B', '1067 N 500 W PHYS Bldg B', 'Provo', 'Utah', 'UT', '84604', '8013740354', NULL, '1067 N 500 W PHYS Bldg B', 'Provo', 'Utah', 'UT', '84604', '8013740354', '          ', 'WCUANES', '', '1000', '50.91', '20.00', '0.00', 6, '2031-01-01', '2031-12-31', 0, 12, 0, '', '', '', '', 'HCFA|UB|', '1578765533', 0, 'Y', 1, '2013-10-24', NULL, NULL, 0, 0, NULL, NULL),
('562302331', 'W12039754', 'W12039754', 'UT01', 'Central Utah Anesthesia', '', '', 'Central Utah Anesthesia', 'Group', 'Anesthesia', '', '', NULL, 'B', '1067 N 500 W PHYS Bldg B', 'Provo', 'Utah', 'UT', '84604', '8013740354', NULL, '1067 N 500 W PHYS Bldg B', 'Provo', 'Utah', 'UT', '84604', '8013740354', '          ', 'WCUANES', '', '1000', '52.95', '20.00', '0.00', 6, '2032-01-01', '2032-12-31', 0, 12, 0, '', '', '', '', 'HCFA|UB|', '1578765533', 0, 'Y', 1, '2013-10-24', NULL, NULL, 0, 0, NULL, NULL),
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('562302331', 'W12039751', 'W12039751', 'UT01', 'Central Utah Anesthesia', '', '', 'Central Utah Anesthesia', 'Group', 'Anesthesia', '', '', NULL, 'B', '1067 N 500 W CRNA Bldg B', 'Provo', 'Utah', 'UT', '84604', '8013740354', NULL, '1067 N 500 W CRNA Bldg B', 'Provo', 'Utah', 'UT', '84604', '8013740354', '          ', 'WCUANES', '', '1000', '41.36', '20.00', '0.00', 6, '2031-01-01', '2031-12-31', 0, 12, 0, '', '', '', '', 'HCFA|UB|', '1578765533', 0, 'Y', 1, '2013-10-24', NULL, NULL, 0, 0, NULL, NULL),
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('870281028', 'W12039760', 'W12039760', 'UT01', 'Central Utah Clinic PC', 'Edward', '', 'Corbett', 'MD', 'Internal Medicine', '', '', NULL, 'M', '1055 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013548225', '8014298150', '1055 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013548225', '8014298150', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-10-02', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1487724753', 0, 'N', 0, '2013-10-25', NULL, NULL, 0, 0, NULL, NULL),
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('462252776', 'W12039767', 'W12039767', 'UT01', 'Premier Family Medical', 'Cheryl', 'A', 'Johnson', 'MD', 'Family Practice', '', '', NULL, 'O', '680 E Main St', 'Lehi', 'Utah', 'UT', '84043', '8017681699', '0000000000', '680 E Main St', 'Lehi', 'Utah', 'UT', '84043', '8017681699', '0000000000', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-07-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1417066671', 0, 'N', 0, '2013-10-25', NULL, NULL, 40.3882, -111.838, NULL, NULL),
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('870549057', 'W12039780', 'W12039780', 'UT01', 'Utah Valley Pediatrics', 'Jonathen', '', 'Bartholomew', 'DO', 'Pediatrics', '', '', NULL, 'B', '1355 N University Ave Ste 220', 'Provo', 'Utah', 'UT', '84604', '8013748863', NULL, '1355 N University Ave Ste 220', 'Provo', 'Utah', 'UT', '84604', '8013748863', '          ', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-11-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1073672135', 0, 'N', 0, '2013-12-10', NULL, NULL, 0, 0, NULL, NULL),
('870550275', 'W12039783', 'W12039783', 'UT01', 'Wasatch Pediatrics', 'Jennifer', '', 'Makosky', 'MD', 'Pediatrics', '', '', NULL, 'B', 'PO Box 71550', 'Salt Lake City', 'Salt Lake', 'UT', '84171', '8019470830', '8019470864', 'PO Box 71550', 'Salt Lake City', 'Salt Lake', 'UT', '84171', '8019470830', '8019470864', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, 'Primary Childrens Medical Center', 'Jordan Valley Medical Center', '', '', 'HCFA|UB|', '1073767463', 0, 'N', 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
('870550275', 'W12039781', 'W12039781', 'UT01', 'Wasatch Pediatrics', 'Jennifer', '', 'Makosky', 'MD', 'Pediatrics', '', '', NULL, 'O', '5770 S 250 E Ste 290', 'Murray', 'Salt Lake', 'UT', '84107', '8017478700', '8017478701', '5770 S 250 E Ste 290', 'Murray', 'Salt Lake', 'UT', '84107', '8017478700', '8017478701', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, 'Primary Childrens Medical Center', 'Jordan Valley Medical Center', '', '', 'HCFA|UB|', '1073767463', 0, 'N', 0, '2014-03-25', NULL, NULL, 0, 0, NULL, NULL),
('870550275', 'W12039782', 'W12039782', 'UT01', 'Wasatch Pediatrics', 'Jennifer', '', 'Makosky', 'MD', 'Pediatrics', '', '', NULL, 'M', '7138 S 2000 E Ste 103', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8014539625', '8019447347', '7138 S 2000 E Ste 103', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8014539625', '8019447347', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, 'Primary Childrens Medical Center', 'Jordan Valley Medical Center', '', '', 'HCFA|UB|', '1073767463', 0, 'N', 0, '2014-03-25', NULL, NULL, 0, 0, NULL, NULL),
('850246856', 'W12039788', 'W12039788', 'NM01', 'Eye Associates of New Mexico', 'Lauren', 'E', 'Bobick', 'OD', 'Optometry', '', '', NULL, 'O', '5757 Harper Dr NE', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058885757', '5058893589', '5757 Harper Dr NE', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058885757', '5058893589', 'NMEYE', '', '', '0.00', '10.00', '0.00', 3, '2014-02-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1124380738', 0, 'N', 0, '2014-01-22', NULL, NULL, 35.1517, -106.584, NULL, NULL),
('850246856', 'W12039786', 'W12039786', 'NM01', 'Eye Associates of New Mexico', 'Lauren', 'E', 'Bobick', 'OD', 'Optometry', '', '', NULL, 'O', '5200 Eubank Blvd NE A4', 'Albuquerque', 'Bernalillo', 'NM', '87111', '5052984419', '5052980878', '5200 Eubank Blvd NE A4', 'Albuquerque', 'Bernalillo', 'NM', '87111', '5052984419', '5052980878', 'NMEYE', '', '', '0.00', '10.00', '0.00', 3, '2014-02-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1124380738', 0, 'N', 0, '2014-01-22', NULL, NULL, 35.1381, -106.533, NULL, NULL),
('850246856', 'W12039787', 'W12039787', 'NM01', 'Eye Associates of New Mexico', 'Lauren', 'E', 'Bobick', 'OD', 'Optometry', '', '', NULL, 'B', 'PO Box 90550', 'Albuquerque', 'Bernalillo', 'NM', '87199', '5052462622', '5052469885', 'PO Box 90550', 'Albuquerque', 'Bernalillo', 'NM', '87199', '5052462622', '5052469885', 'NMEYE', '', '', '0.00', '10.00', '0.00', 3, '2014-02-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1124380738', 0, 'N', 0, '2014-01-22', NULL, NULL, 0, 0, NULL, NULL),
('850246856', 'W12039789', 'W12039789', 'NM01', 'Eye Associates of New Mexico', 'Lauren', 'E', 'Bobick', 'OD', 'Optometry', '', '', NULL, 'M', '8801 Horizon Blvd NE Ste 360', 'Albuquerque', 'Bernalillo', 'NM', '87113', '0000000000', '0000000000', '8801 Horizon Blvd NE Ste 360', 'Albuquerque', 'Bernalillo', 'NM', '87113', '0000000000', '0000000000', 'NMEYE', '', '', '0.00', '10.00', '0.00', 3, '2014-02-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1124380738', 0, 'N', 0, '2014-01-22', NULL, NULL, 0, 0, NULL, NULL),
('850246856', 'W12039790', 'W12039790', 'NM01', 'Eye Associates of New Mexico', 'Lauren', 'E', 'Bobick', 'OD', 'Optometry', '', '', NULL, 'O', '1603 Main St Ste B', 'Los Lunas', 'Valencia', 'NM', '87031', '5058660623', '5058665297', '1603 Main St Ste B', 'Los Lunas', 'Valencia', 'NM', '87031', '5058660623', '5058665297', 'NMEYE', '', '', '0.00', '10.00', '0.00', 3, '2014-02-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1124380738', 0, 'N', 0, '2014-01-22', NULL, NULL, 34.8147, -106.75, NULL, NULL),
('850246856', 'W12039792', 'W12039792', 'NM01', 'Eye Associates of New Mexico', 'Vanlin', '', 'Chan', 'OD', 'Optometry', '', '', NULL, 'B', 'PO Box 90550', 'Albuquerque', 'Bernalillo', 'NM', '87199', '5052462622', '5052469885', 'PO Box 90550', 'Albuquerque', 'Bernalillo', 'NM', '87199', '5052462622', '5052469885', 'NMEYE', '', '', '0.00', '10.00', '0.00', 3, '2014-02-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1851726533', 0, 'N', 0, '2014-01-22', NULL, NULL, 0, 0, NULL, NULL),
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('752694558', 'W12039867', 'W12039867', 'TXDALSTD', 'Advanced Heart Care', 'Jai', '', 'Varma', 'MD', 'Cardiology', '', '', NULL, 'O', '1425 Lincoln Rd E Ste A5', 'Idabel', 'Mccurtain', 'OK', '74745', '5802082700', '5802082900', '1425 Lincoln Rd E Ste A5', 'Idabel', 'Mccurtain', 'OK', '74745', '5802082700', '5802082900', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-11-22', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, NULL, NULL, 'HCFA|UB', '1952520488', 0, 'N', 0, '2013-10-28', NULL, NULL, 33.8809, -94.8155, NULL, NULL),
('752694558', 'W12039868', 'W12039868', 'TXDALSTD', 'Advanced Heart Care', 'Jai', '', 'Varma', 'MD', 'Cardiology', '', '', NULL, 'O', '2020 State Hwy 121 Ste 190, Medical Plaza II', 'Grapevine', 'Tarrant', 'TX', '76051', '9038853059', '9038858539', '2020 State Hwy 121 Ste 190, Medical Plaza II', 'Grapevine', 'Tarrant', 'TX', '76051', '9038853059', '9038858539', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-11-22', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, NULL, NULL, 'HCFA|UB', '1952520488', 0, 'N', 0, '2013-10-28', NULL, NULL, 32.9592, -97.0398, NULL, NULL),
('752694558', 'W12039869', 'W12039869', 'TXDALSTD', 'Advanced Heart Care', 'Jai', '', 'Varma', 'MD', 'Cardiology', '', '', NULL, 'O', '875 S Collegiate', 'Paris', 'Lamar', 'TX', '75460', '9037858857', '9037841942', '875 S Collegiate', 'Paris', 'Lamar', 'TX', '75460', '9037858857', '9037841942', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-11-22', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, NULL, NULL, 'HCFA|UB', '1952520488', 0, 'N', 0, '2013-10-28', NULL, NULL, 33.6543, -95.5267, NULL, NULL),
('752694558', 'W12039870', 'W12039870', 'TXDALSTD', 'Advanced Heart Care', 'Jai', '', 'Varma', 'MD', 'Cardiology', '', '', NULL, 'O', 'S FM 62 Ste 200 ', 'Decatur', 'Wise', 'TX', '76234', '9406270044', '9406270275', 'S FM 62 Ste 200 ', 'Decatur', 'Wise', 'TX', '76234', '9406270044', '9406270275', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-11-22', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Plano', NULL, NULL, NULL, 'HCFA|UB', '1952520488', 0, 'N', 0, '2013-10-28', NULL, NULL, 33.2342, -97.5937, NULL, NULL),
('271933345', 'W12039873', 'W12039873', 'TXDALSTD', 'Premier Care Physicians', 'Paul', 'J', 'Smelter', 'MD', 'Family Practice', '', '', NULL, 'O', '1102 N Galloway', 'Mesquite', 'Dallas', 'TX', '75149', '2143207199', '2143207129', '1102 N Galloway', 'Mesquite', 'Dallas', 'TX', '75149', '2143207199', '2143207129', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-11-22', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1528078714', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.778, -96.5997, NULL, NULL),
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('850275777', 'W12040015', 'W12040015', 'NM01', 'Southwest Medical Associates', 'Nicole', 'M', 'Dishong', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '4801 McMahon Blvd Ste 110', 'Albuquerque', 'Bernalillo', 'NM', '87114', '5057274025', '5057274030', '4801 McMahon Blvd Ste 110', 'Albuquerque', 'Bernalillo', 'NM', '87114', '5057274025', '5057274030', 'NMSWMED', '', '', '0.00', '10.00', '0.00', 3, '2013-11-27', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1205272481', 0, 'N', 0, '2013-10-30', NULL, NULL, 35.2069, -106.678, NULL, NULL),
('850275777', 'W12040016', 'W12040016', 'NM01', 'Southwest Medical Associates', 'Christina', 'C', 'Chaney', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '4801 McMahon Blvd Ste 110', 'Albuquerque', 'Bernalillo', 'NM', '87114', '5057274025', '5057274030', '4801 McMahon Blvd Ste 110', 'Albuquerque', 'Bernalillo', 'NM', '87114', '5057274025', '5057274030', 'NMSWMED', '', '', '0.00', '10.00', '0.00', 3, '2013-11-27', NULL, 0, 0, 0, 'Lovelace Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1487998639', 0, 'N', 0, '2013-10-30', NULL, NULL, 35.2069, -106.678, 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
('870284475', 'W12040017', 'W12040017', 'UT01', 'Granger Medical Clinic', 'Craig', 'H', 'Yerke', 'PA', 'Physician Assistant', '', '', NULL, 'O', '2356 N 400 E Ste 201', 'Tooele', 'Tooele', 'UT', '84074', '8019653600', '8019653740', '2356 N 400 E Ste 201', 'Tooele', 'Tooele', 'UT', '84074', '8019653600', '8019653740', 'WUGRANGER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-11-01', NULL, 0, 0, 0, 'Pioneer Valley Hospital', '', '', '', 'HCFA|UB|', '1275861619', 0, 'N', 0, '2013-10-30', NULL, NULL, 40.5621, -112.293, NULL, NULL),
('820200895', 'W12040020', 'W12040020', 'SACN', 'Saint Alphonsus Oncology Physician Services', 'Karl', 'J', 'Schultheiss', 'MD', 'Hematology and Oncology', 'Oncology', '', NULL, 'O', '3123 Medical Dr', 'Caldwell', 'Canyon', 'ID', '83605', '2083674810', '2083674817', '3123 Medical Dr', 'Caldwell', 'Canyon', 'ID', '83605', '2083674810', '2083674817', 'IDSINCLAIRL', '', '', '0.00', '15.00', '0.00', 6, '2013-10-22', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', 'West Valley Medical Center', 'Saint Alphonsus Medical Center Nampa', 'HCFA|', '1265478325', 0, 'N', 0, '2014-05-28', NULL, NULL, 43.6596, -116.658, NULL, NULL),
('820200895', 'W12040019', 'W12040019', 'SACN', 'Saint Alphonsus Oncology Physician Services', 'Karl', 'J', 'Schultheiss', 'MD', 'Hematology and Oncology', 'Oncology', '', NULL, 'O', '1202 E Locust', 'Emmett', 'Gem', 'ID', '83617', '2083653561', NULL, '1202 E Locust', 'Emmett', 'Gem', 'ID', '83617', '2083653561', '', 'IDSINCLAIRL', '', '', '0.00', '15.00', '0.00', 6, '2013-10-22', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', 'West Valley Medical Center', 'Saint Alphonsus Medical Center Nampa', 'HCFA|', '1265478325', 0, 'N', 0, '2014-05-28', NULL, NULL, 43.8791, -116.485, NULL, NULL),
('820200895', 'W12040018', 'W12040018', 'SACN', 'Saint Alphonsus Oncology Physician Services', 'Karl', 'J', 'Schultheiss', 'MD', 'Hematology and Oncology', 'Oncology', '', NULL, 'O', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083673131', '2083673174', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083673131', '2083673174', 'IDSINCLAIRL', '', '', '0.00', '15.00', '0.00', 6, '2013-10-22', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', 'West Valley Medical Center', 'Saint Alphonsus Medical Center Nampa', 'HCFA|', '1265478325', 0, 'N', 0, '2014-05-28', NULL, NULL, 43.6127, -116.254, NULL, NULL),
('363330928', 'W12040021', 'W12040021', 'ILCHIGSTD', '', 'Valerie', 'M', 'Roth', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '5645 W Addison St', 'Chicago', 'Cook', 'IL', '60634', '7732827000', '6309142499', '5645 W Addison St', 'Chicago', 'Cook', 'IL', '60634', '7732827000', '6309142499', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1124333984', 0, 'N', 0, '2014-01-23', NULL, NULL, 41.9459, -87.7678, NULL, NULL),
('870637304', 'W12040025', 'W12040025', 'UT01', 'Zion Pain Management', 'Wayne', 'M', 'Woodbury', 'MD', 'Physical Medicine and Rehabilitation', '', '', NULL, 'O', '301 N 200 E Ste 2A', 'St George', 'Washington', 'UT', '84770', '4356887246', '4356881363', '301 N 200 E Ste 2A', 'St George', 'Washington', 'UT', '84770', '4356887246', '4356881363', 'WUSTDPAIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-12-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', '', '', '', 'HCFA|UB|', '1770572893', 0, 'N', 0, '2013-11-26', NULL, NULL, 37.1081, -113.566, NULL, NULL),
('363330928', 'W12040023', 'W12040023', 'ILCHIGSTD', '', 'Valerie', 'M', 'Roth', 'MD', 'Emergency Medicine', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '          ', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '          ', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1124333984', 0, 'N', 0, '2014-01-23', NULL, NULL, 0, 0, NULL, NULL),
('611523524', 'W12040024', 'W12040024', 'TXDALSTD', 'McPremier Health Center', 'Michael', 'K', 'McFarland', 'DO', 'Internal Medicine', '', '', NULL, 'O', '236 Park Pl', 'Azle', 'Tarrant', 'TX', '76020', '8172703000', '8172703001', '236 Park Pl', 'Azle', 'Tarrant', 'TX', '76020', '8172703000', '8172703001', 'DALLAS1', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-11-30', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1881658714', 0, 'N', 0, '2013-10-31', NULL, NULL, 32.8962, -97.5332, NULL, NULL),
('461552029', 'W12040026', 'W12040026', 'UTMH1', 'Solstice Counseling & Wellness PC', 'Christian', 'H', 'Monson', 'PSYD', 'Mental Health', 'Psychology', '', NULL, 'O', '722 W 100 S Ste 1', 'Heber City', 'Wasatch', 'UT', '84032', '4356544037', '4356544077', '722 W 100 S Ste 1', 'Heber City', 'Wasatch', 'UT', '84032', '4356544037', '4356544077', 'UTPHD', '', '', '0.00', '40.00', '0.00', 3, '2013-12-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1649618307', 0, 'N', 0, '2013-12-09', NULL, NULL, 40.5068, -111.424, NULL, NULL),
('760578127', 'W12040027', 'W12040027', 'TXHOUSTD', 'Kerry D McCarroll', 'Kerry', 'D', 'McCarroll', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1100 Smith Dr', 'Alvin', 'Brazoria', 'TX', '77511', '2813310082', '2813312624', '1100 Smith Dr', 'Alvin', 'Brazoria', 'TX', '77511', '2813310082', '2813312624', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-11-30', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|', '1568448181', 0, 'N', 0, '2013-10-31', NULL, NULL, 29.4331, -95.2424, NULL, NULL),
('760578127', 'W12040028', 'W12040028', 'TXHOUSTD', 'Kerry D McCarroll', 'Kerry', 'D', 'McCarroll', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 1968', 'Alvin', 'Brazoria', 'TX', '77512', '2813310082', '2813312624', 'PO Box 1968', 'Alvin', 'Brazoria', 'TX', '77512', '2813310082', '2813312624', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-11-30', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|', '1568448181', 0, 'N', 0, '2013-10-31', NULL, NULL, 0, 0, NULL, NULL),
('900536546', 'W12040029', 'W12040029', 'TXHOUSTD', 'Fair Health Care', 'Syed', 'N', 'Ahmed', 'MD', 'Nephrology', 'Internal Medicine', '', NULL, 'O', '17115 Red Oak Dr Ste 114', 'Houston', 'Harris', 'TX', '77090', '8322864735', '8322864790', '17115 Red Oak Dr Ste 114', 'Houston', 'Harris', 'TX', '77090', '8322864735', '8322864790', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-11-30', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1255378352', 0, 'N', 0, '2013-10-31', NULL, NULL, 30.0187, -95.4449, NULL, NULL),
('830234097', 'W12040030', 'W12040030', 'WY01', 'Campbell County Clinics Internal Medicine', 'Sameera', '', 'Fareed', 'MD', 'Internal Medicine', '', '', NULL, 'O', '501 S Burma Ave 3 South', 'Gillette', 'Campbell', 'WY', '82716', '3076881000', NULL, '501 S Burma Ave 3 South', 'Gillette', 'Campbell', 'WY', '82716', '3076881000', '          ', '', '', '5001', '0.00', '0.00', '0.00', 6, '2013-10-01', NULL, 0, 0, 0, 'Campbell County Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1083600183', 0, 'N', 0, '2013-10-30', NULL, NULL, 0, 0, NULL, NULL),
('830234097', 'W12040031', 'W12040031', 'WYT1', 'Campbell County Clinics Internal Medicine', 'Sameera', '', 'Fareed', 'MD', 'Internal Medicine', '', '', NULL, 'O', '501 S Burma Ave 3 South', 'Gillette', 'Campbell', 'WY', '82716', '3076881000', NULL, '501 S Burma Ave 3 South', 'Gillette', 'Campbell', 'WY', '82716', '3076881000', '          ', '', '', '', '0.00', '21.00', '0.00', 6, '2013-10-01', NULL, 0, 0, 0, 'Campbell County Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1083600183', 0, 'N', 0, '2013-10-30', NULL, NULL, 0, 0, NULL, NULL),
('562294746', 'W12040032', 'W12040032', 'TXHOUSTD', 'Fernando Cuadra', 'Fernando', '', 'Cuadra', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1420 FM 1960 E Bypass Ste 103', 'Humble', 'Harris', 'TX', '77338', '2814463829', '2814463829', '1420 FM 1960 E Bypass Ste 103', 'Humble', 'Harris', 'TX', '77338', '2814463829', '2814463829', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-11-30', NULL, 0, 0, 0, 'Kingwood Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1861572208', 0, 'N', 0, '2013-10-31', NULL, NULL, 30.0041, -95.2527, NULL, NULL),
('273995478', 'W12040033', 'W12040033', 'UT01', 'Southwest Spine and Pain Care Specialists', 'David', 'T', 'Cowley', 'NP', 'Pain Management', '', '', NULL, 'O', '1303 N Main St', 'Cedar City', 'Iron', 'UT', '84720', '4355862229', '4355862022', '1303 N Main St', 'Cedar City', 'Iron', 'UT', '84720', '4355862229', '4355862022', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1720429491', 0, 'N', 0, '2014-04-08', NULL, NULL, 37.7003, -113.064, NULL, NULL),
('273995478', 'W12040035', 'W12040035', 'UT01', 'Southwest Spine and Pain Care Specialists', 'David', 'T', 'Cowley', 'NP', 'Pain Management', '', '', NULL, 'O', '652 S Medical Ctr Dr Ste 110', 'St George', 'Washington', 'UT', '84790', '0000000000', '0000000000', '652 S Medical Ctr Dr Ste 110', 'St George', 'Washington', 'UT', '84790', '0000000000', '0000000000', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1720429491', 0, 'N', 0, '2014-04-08', NULL, NULL, 37.0498, -113.574, NULL, NULL),
('273995478', 'W12040034', 'W12040034', 'UT01', 'Southwest Spine and Pain Care Specialists', 'David', 'T', 'Cowley', 'NP', 'Pain Management', '', '', NULL, 'O', '70 E 1000 N', 'Richfield', 'Sevier', 'UT', '84701', '4355862229', '4355862022', '70 E 1000 N', 'Richfield', 'Sevier', 'UT', '84701', '4355862229', '4355862022', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1720429491', 0, 'N', 0, '2014-04-08', NULL, NULL, 38.8608, -111.967, NULL, NULL),
('566998525', 'W12040036', 'W12040036', 'TXHOUSTD', 'Conroe Foot Specialists', 'Gurpreet', '', 'Mukker', 'DPM', 'Podiatry', '', '', NULL, 'O', '100 Medical Ctr Blvd Ste 216', 'Conroe', 'Montgomery', 'TX', '77304', '9367569191', '9367569197', '100 Medical Ctr Blvd Ste 216', 'Conroe', 'Montgomery', 'TX', '77304', '9367569191', '9367569197', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-11-30', NULL, 0, 0, 0, 'Conroe Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1518185719', 0, 'N', 0, '2013-10-31', NULL, NULL, 30.2879, -95.4628, NULL, NULL),
('566998525', 'W12040037', 'W12040037', 'TXHOUSTD', 'Woodlands Foot Specialists', 'Gurpreet', '', 'Mukker', 'DPM', 'Podiatry', '', '', NULL, 'O', '17198 St Lukes Way Ste 550', 'The Woodlands', 'Montgomery', 'TX', '77384', '9363211221', '9362710707', '17198 St Lukes Way Ste 550', 'The Woodlands', 'Montgomery', 'TX', '77384', '9363211221', '9362710707', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-11-30', NULL, 0, 0, 0, 'Conroe Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1518185719', 0, 'N', 0, '2013-10-31', NULL, NULL, 30.2057, -95.4608, NULL, NULL),
('463305617', 'W12040038', 'W12040038', 'UT01', 'Integrated Wellness', 'Anne', '', 'Bowden', 'NP', 'Pain Management', '', '', NULL, 'O', '10684 Riverfront Pkwy', 'South Jordan', 'Salt Lake', 'UT', '84095', '8018160332', '8018160331', '10684 Riverfront Pkwy', 'South Jordan', 'Salt Lake', 'UT', '84095', '8018160332', '8018160331', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-12-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1427485275', 0, 'N', 0, '2013-11-26', NULL, NULL, 40.5572, -111.911, NULL, NULL),
('760558595', 'W12040039', 'W12040039', 'TXHOUSTD', 'Dzung D Dang', 'Dzung', 'D', 'Dang', 'MD', 'Podiatry', '', '', NULL, '', '1111 Gessner Rd Ste A', 'Houston', 'Harris', 'TX', '77055', '7139350020', '7139350130', '1111 Gessner Rd Ste A', 'Houston', 'Harris', 'TX', '77055', '7139350020', '7139350130', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-11-30', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1346274099', 0, 'N', 0, '2013-10-31', NULL, NULL, 0, 0, NULL, NULL),
('743074746', 'W12040040', 'W12040040', 'TXDALSTD', 'Kwok Wai Chiu', 'Kwok ', 'Wai', 'Chiu', 'MD', 'Family Practice', '', '', NULL, 'O', '1220 Coit Rd Ste 105', 'Plano', 'Collin', 'TX', '75075', '9728898888', '9728899999', '1220 Coit Rd Ste 105', 'Plano', 'Collin', 'TX', '75075', '9728898888', '9728899999', 'DALLAS1', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-11-30', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1144325549', 0, 'N', 0, '2013-11-01', NULL, NULL, 33.0173, -96.7666, NULL, NULL),
('870284475', 'W12040041', 'W12040041', 'UT01', 'Granger Medical Clinic', 'Scott', 'L', 'Carpenter', 'PA', 'Orthopedic Surgery', NULL, NULL, NULL, 'O', '2356 N 400 E Ste 201', 'Tooele', 'Tooele', 'UT', '84074', '8019653600', '8019653740', '2356 N 400 E Ste 201', 'Tooele', 'Tooele', 'UT', '84074', '8019653600', '8019653740', 'WUGRANGER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-11-01', NULL, 0, 0, 0, 'Pioneer Valley Hospital', 'Riverton Childrens Unit Operated by Primary Childrens Medical Center', NULL, NULL, 'HCFA|UB|', '1346271715', 0, 'N', 0, '2013-10-31', NULL, NULL, 40.5621, -112.293, NULL, NULL),
('870284475', 'W12040042', 'W12040042', 'UT01', 'Granger Medical Clinic', 'Michael', 'S', 'Connolly', 'MD', 'Mental Health', 'Psychiatry', '', NULL, 'O', '11724 S State St', 'Draper', 'Salt Lake', 'UT', '84020', '8015762000', '8015762001', '11724 S State St', 'Draper', 'Salt Lake', 'UT', '84020', '8015762000', '8015762001', 'WUGRANGER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-11-01', NULL, 0, 0, 0, 'Pioneer Valley Hospital', 'Riverton Childrens Unit Operated by Primary Childrens Medical Center', NULL, NULL, 'HCFA|UB|', '1003014374', 0, 'N', 0, '2013-10-31', NULL, NULL, 40.5394, -111.891, NULL, NULL),
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('850275777', 'W12040236', 'W12040236', 'NM01', 'Southwest Medical Associates', 'Felipe', '', 'Zanghellini', 'MD', 'Pediatrics', '', '', NULL, 'O', '4420 Irving Blvd NW', 'Albuquerque', 'Bernalillo', 'NM', '87114', '5058231010', '5057974503', '4420 Irving Blvd NW', 'Albuquerque', 'Bernalillo', 'NM', '87114', '5058231010', '5057974503', 'NMSWMED', '', '', '0.00', '10.00', '0.00', 3, '2013-12-01', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1205919867', 0, 'N', 0, '2013-11-13', NULL, NULL, 35.1902, -106.665, NULL, NULL),
('850275777', 'W12040240', 'W12040240', 'NM01', 'Southwest Medical Associates', 'Felipe', '', 'Zanghellini', 'MD', 'Pediatrics', '', '', NULL, 'O', '4705 Montgomery Blvd NE Ste 301-302', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058231010', '5057974503', '4705 Montgomery Blvd NE Ste 301-302', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058231010', '5057974503', 'NMSWMED', '', '', '0.00', '10.00', '0.00', 3, '2013-12-01', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1205919867', 0, 'N', 0, '2013-11-13', NULL, NULL, 35.131, -106.591, NULL, NULL);
INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
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('850275777', 'W12040237', 'W12040237', 'NM01', 'Southwest Medical Associates', 'Felipe', '', 'Zanghellini', 'MD', 'Pediatrics', '', '', NULL, 'O', '6100 Pan American Fwy, NE Ste 100', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058231010', NULL, '6100 Pan American Fwy, NE Ste 100', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058231010', '          ', 'NMSWMED', '', '', '0.00', '10.00', '0.00', 3, '2013-12-01', NULL, 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1205919867', 0, 'N', 0, '2013-11-13', NULL, NULL, 35.1537, -106.587, NULL, NULL),
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('830231437', 'W12040259', 'W12040259', 'WYT1', 'Casper Orthopedic Associates', 'Jennifer', '', 'Frontiero', 'PT', 'Physical Therapy', '', '', NULL, 'O', '4140 Centennial Hills Blvd Ste A', 'Casper', 'Natrona', 'WY', '82609', '3072657205', '3072356262', '4140 Centennial Hills Blvd Ste A', 'Casper', 'Natrona', 'WY', '82609', '3072657205', '3072356262', '', '', '', '0.00', '15.00', '0.00', 3, '2013-11-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1558553339', 0, 'N', 0, '2013-11-13', NULL, NULL, 0, 0, NULL, NULL),
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('204276205', 'W12040362', 'W12040362', 'TXHOUSTD', 'Her Healthcare LLP', '', '', 'Her Healthcare', '', 'Obstetrics and Gynecology', '', '', NULL, 'O', '23802 Hwy 59 N', 'Kingwood', 'Harris', 'TX', '77339', '2813125400', '2813215440', '23802 Hwy 59 N', 'Kingwood', 'Harris', 'TX', '77339', '2813125400', '2813215440', 'HOUSTON3', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-13', NULL, 0, 0, 0, 'Kingwood Medical Center', NULL, '', '', 'HCFA|UB|', '1538177258', 0, 'N', 0, '2013-11-13', NULL, NULL, 30.0599, -95.2495, NULL, NULL),
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INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
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('204276205', 'W12040368', 'W12040368', 'TXHOUSTD', 'Her Healthcare LLP', 'Mary', '', 'Jackson', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '23802 Hwy 59 N', 'Kingwood', 'Harris', 'TX', '77339', '2813125400', '2813215440', '23802 Hwy 59 N', 'Kingwood', 'Harris', 'TX', '77339', '2813125400', '2813215440', 'HOUSTON3', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-13', NULL, 0, 0, 0, 'Kingwood Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1558595371', 0, 'N', 0, '2013-11-14', NULL, NULL, 30.0599, -95.2495, NULL, NULL),
('204276205', 'W12040370', 'W12040370', 'TXHOUSTD', 'Her Healthcare LLP', 'Patricia', '', 'Pinckert', 'NP', 'Obstetrics and Gynecology', '', '', NULL, 'O', '23802 Hwy 59 N', 'Kingwood', 'Harris', 'TX', '77339', '2813125400', '2813215440', '23802 Hwy 59 N', 'Kingwood', 'Harris', 'TX', '77339', '2813125400', '2813215440', 'HOUSTON3', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-13', NULL, 0, 0, 0, 'Kingwood Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1225047962', 0, 'N', 0, '2013-11-14', NULL, NULL, 30.0599, -95.2495, NULL, NULL),
('741996652', 'W12040371', 'W12040371', 'TXSATSTD', 'North San Antonio Healthcare Associates', '', '', 'North San Antonio Healthcare Associates', '', 'Family Practice', '', '', NULL, 'O', '3338 Oakwell Ct Ste 107', 'San Antonio', 'Bexar', 'TX', '78218', '2108223646', '2108225242', '3338 Oakwell Ct Ste 107', 'San Antonio', 'Bexar', 'TX', '78218', '2108223646', '2108225242', 'SANANTONIO1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-13', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1295880987', 0, 'N', 0, '2013-11-13', NULL, NULL, 29.507, -98.4311, NULL, NULL),
('741996652', 'W12040373', 'W12040373', 'TXSATSTD', 'North San Antonio Healthcare Associates', 'Gordon', '', 'Hill', 'MD', 'Family Practice', '', '', NULL, 'O', '3338 Oakwell Ct Ste 107', 'San Antonio', 'Bexar', 'TX', '78218', '2108223646', '2108225242', '3338 Oakwell Ct Ste 107', 'San Antonio', 'Bexar', 'TX', '78218', '2108223646', '2108225242', 'SANANTONIO1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-13', NULL, 0, 0, 0, 'North East Baptist Hospital', NULL, '', '', 'HCFA|UB|', '1972676831', 0, 'N', 0, '2013-11-14', NULL, NULL, 29.507, -98.4311, NULL, NULL),
('741996652', 'W12040375', 'W12040375', 'TXSATSTD', 'North San Antonio Healthcare Associates', 'David', '', 'Sandercock', 'DO', 'Family Practice', '', '', NULL, 'O', '3338 Oakwell Ct Ste 107', 'San Antonio', 'Bexar', 'TX', '78218', '2108223646', '2108225242', '3338 Oakwell Ct Ste 107', 'San Antonio', 'Bexar', 'TX', '78218', '2108223646', '2108225242', 'SANANTONIO1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-13', NULL, 0, 0, 0, 'North East Baptist Hospital', NULL, '', '', 'HCFA|UB|', '1871672436', 0, 'N', 0, '2013-11-14', NULL, NULL, 29.507, -98.4311, NULL, NULL),
('741996652', 'W12040377', 'W12040377', 'TXSATSTD', 'North San Antonio Healthcare Associates', 'Walter', '', 'Walthall', 'MD', 'Family Practice', '', '', NULL, 'O', '3338 Oakwell Ct Ste 107', 'San Antonio', 'Bexar', 'TX', '78218', '2108223646', '2108225242', '3338 Oakwell Ct Ste 107', 'San Antonio', 'Bexar', 'TX', '78218', '2108223646', '2108225242', 'SANANTONIO1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-13', NULL, 0, 0, 0, 'North East Baptist Hospital', NULL, '', '', 'HCFA|UB|', '1750460317', 0, 'N', 0, '2013-11-14', NULL, NULL, 29.507, -98.4311, NULL, NULL),
('741996652', 'W12040379', 'W12040379', 'TXSATSTD', 'North San Antonio Healthcare Associates', 'Clifford', '', 'Alprin', 'MD', 'Family Practice', '', '', NULL, 'O', '3338 Oakwell Ct Ste 107', 'San Antonio', 'Bexar', 'TX', '78218', '2108223646', '2108225242', '3338 Oakwell Ct Ste 107', 'San Antonio', 'Bexar', 'TX', '78218', '2108223646', '2108225242', 'SANANTONIO1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-13', NULL, 0, 0, 0, 'North East Baptist Hospital', NULL, '', '', 'HCFA|UB|', '1568504835', 0, 'N', 0, '2013-11-14', NULL, NULL, 29.507, -98.4311, NULL, NULL),
('741996652', 'W12040381', 'W12040381', 'TXSATSTD', 'North San Antonio Healthcare Associates', 'Joshua', '', 'Beck', 'MD', 'Family Practice', '', '', NULL, 'O', '3338 Oakwell Ct Ste 107', 'San Antonio', 'Bexar', 'TX', '78218', '2108223646', '2108225242', '3338 Oakwell Ct Ste 107', 'San Antonio', 'Bexar', 'TX', '78218', '2108223646', '2108225242', 'SANANTONIO1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-13', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1245495530', 0, 'N', 0, '2013-11-14', NULL, NULL, 29.507, -98.4311, NULL, NULL),
('742022877', 'W12040382', 'W12040382', 'TXHOUSTD', 'The Davis Clinic', '', '', 'The Davis Clinic', '', 'General Surgery', '', '', NULL, 'O', '929 B Gessner Rd Ste 106', 'Houston', 'Harris', 'TX', '77024', '7134646000', '7134646002', '929 B Gessner Rd Ste 106', 'Houston', 'Harris', 'TX', '77024', '7134646000', '7134646002', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-13', NULL, 0, 0, 0, 'Houston Methodist Hospital', NULL, '', '', 'HCFA|UB|', '1487663852', 0, 'N', 0, '2013-11-13', NULL, NULL, 29.7813, -95.5443, NULL, NULL),
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('742107965', 'W12040389', 'W12040389', 'TXHOUSTD', 'Houston Neurology Associates', '', '', 'Houston Neurology Associates', '', 'Neurology', '', '', NULL, 'O', '7500 Beechnut St Ste 135', 'Houston', 'Harris', 'TX', '77074', '7137774122', '7132707533', '7500 Beechnut St Ste 135', 'Houston', 'Harris', 'TX', '77074', '7137774122', '7132707533', 'HOUSTON5', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-13', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1952594251', 0, 'Y', 0, '2013-11-13', NULL, NULL, 29.6912, -95.5182, NULL, NULL),
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('760636396', 'W12040398', 'W12040398', 'TXHOUSTD', 'Subodh Bhuchar', 'Subodh', '', 'Bhuchar', 'MD', 'Family Practice', '', '', NULL, 'O', '3533 Town Ctr Blvd S Ste 100', 'Sugar Land', 'Fort Bend', 'TX', '77479', '2814912555', '2814912554', '3533 Town Ctr Blvd S Ste 100', 'Sugar Land', 'Fort Bend', 'TX', '77479', '2814912555', '2814912554', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 8, '2013-12-13', NULL, 0, 0, 0, 'Houston Methodist Sugar Land Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1629082417', 0, 'N', 0, '2013-11-13', NULL, NULL, 29.5873, -95.6306, NULL, NULL),
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('463869882', 'W12040405', 'W12040405', 'UT01', 'Interventional Spine & Pain Management', 'Devin', '', 'Despain', 'DO', 'Pain Management', 'Anesthesiology', '', NULL, 'B', '274 N Main St', 'Logan', 'Cache', 'UT', '84321', '4357139681', NULL, '274 N Main St', 'Logan', 'Cache', 'UT', '84321', '4357139681', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1144306176', 0, 'N', 0, '2013-12-23', NULL, NULL, 0, 0, NULL, NULL),
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('463869882', 'W12040406', 'W12040406', 'UT01', 'Interventional Spine & Pain Management', 'Devin', '', 'Despain', 'DO', 'Pain Management', 'Anesthesiology', '', NULL, 'O', '4624 S Holladay Blvd', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8012772682', NULL, '4624 S Holladay Blvd', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8012772682', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1144306176', 0, 'N', 0, '2013-12-23', NULL, NULL, 40.6703, -111.826, NULL, NULL),
('463869882', 'W12040407', 'W12040407', 'UT01', 'Interventional Spine & Pain Management', 'Devin', '', 'Despain', 'DO', 'Pain Management', 'Anesthesiology', '', NULL, 'O', '11800 S State Ste 350', 'Draper', 'Salt Lake', 'UT', '84020', '8012611391', NULL, '11800 S State Ste 350', 'Draper', 'Salt Lake', 'UT', '84020', '8012611391', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1144306176', 0, 'N', 0, '2013-12-23', NULL, NULL, 40.5384, -111.891, NULL, NULL),
('463869882', 'W12040408', 'W12040408', 'UT01', 'Interventional Spine & Pain Management', 'Devin', '', 'Despain', 'DO', 'Pain Management', 'Anesthesiology', '', NULL, 'O', '2295 S Foothill Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84109', '8014863021', NULL, '2295 S Foothill Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84109', '8014863021', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1144306176', 0, 'N', 0, '2013-12-23', NULL, NULL, 40.7206, -111.811, NULL, NULL),
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('201435671', 'W12040411', 'W12040411', 'TXHOUSTD', 'Diabetes America', 'Shazia', 'F', 'Sheikh', 'MD', 'Internal Medicine', '', '', NULL, 'B', '13100 NW Fwy Ste 400', 'Houston', 'Harris', 'TX', '77040', '8666934223', '8882377954', '13100 NW Fwy Ste 400', 'Houston', 'Harris', 'TX', '77040', '8666934223', '8882377954', 'HOUSTON4', 'TXHCPC13', '', '0.00', '40.00', '0.00', 3, '2013-11-07', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1033270806', 0, 'N', 0, '2013-11-11', NULL, NULL, 0, 0, NULL, NULL),
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('830207671', 'W12040414', 'W12040414', 'WY01', 'West Park Hospital District', 'Rebecca', 'L', 'Danforth', 'MD', 'Rheumatology', '', '', NULL, 'O', '707 Sheridan Ave', 'Cody', 'Park', 'WY', '82414', '3075782500', '3075782492', '707 Sheridan Ave', 'Cody', 'Park', 'WY', '82414', '3075782500', '3075782492', '', '', '', '0.00', '12.00', '0.00', 3, '2013-11-05', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1164570172', 0, 'N', 0, '2013-11-13', NULL, NULL, 44.526, -109.074, NULL, NULL),
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('830207671', 'W12040413', 'W12040413', 'WYT1', 'West Park Hospital District ', 'Rebecca', 'L', 'Danforth', 'MD', 'Rheumatology', '', '', NULL, 'O', '424 Yellowstone Ave Ste 220', 'Cody', 'Park', 'WY', '82414', '3075782975', '3075782979', '424 Yellowstone Ave Ste 220', 'Cody', 'Park', 'WY', '82414', '3075782975', '3075782979', '', '', '', '0.00', '12.00', '0.00', 3, '2013-11-05', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1164570172', 0, 'N', 0, '2013-11-13', NULL, NULL, 0, 0, NULL, NULL),
('830207671', 'W12040415', 'W12040415', 'WYT1', 'West Park Hospital District', 'Rebecca', 'L', 'Danforth', 'MD', 'Rheumatology', '', '', NULL, 'O', '707 Sheridan Ave', 'Cody', 'Park', 'WY', '82414', '3075782500', '3075782492', '707 Sheridan Ave', 'Cody', 'Park', 'WY', '82414', '3075782500', '3075782492', '', '', '', '0.00', '12.00', '0.00', 3, '2013-11-05', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1164570172', 0, 'N', 0, '2013-11-13', NULL, NULL, 0, 0, NULL, NULL),
('201435671', 'W12040417', 'W12040417', 'TXHOUSTD', 'Diabetes America', 'Min', '', 'Liang', 'MD,PHD', 'Internal Medicine', '', '', NULL, 'B', '13100 NW Fwy Ste 400', 'Houston', 'Harris', 'TX', '77040', '8666934223', '8882377954', '13100 NW Fwy Ste 400', 'Houston', 'Harris', 'TX', '77040', '8666934223', '8882377954', 'HOUSTON4', 'TXHCPC13', '', '0.00', '40.00', '0.00', 3, '2013-11-07', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1295053684', 0, 'N', 0, '2013-12-02', NULL, NULL, 0, 0, NULL, NULL),
('201435671', 'W12040418', 'W12040418', 'TXHOUSTD', 'Diabetes America', 'Min', '', 'Liang', 'MD,PHD', 'Internal Medicine', '', '', NULL, 'B', '5451 Loch Lomond Dr', 'Houston', 'Harris', 'TX', '77096', '8322373500', '8882377954', '5451 Loch Lomond Dr', 'Houston', 'Harris', 'TX', '77096', '8322373500', '8882377954', 'HOUSTON4', 'TXHCPC13', '', '0.00', '40.00', '0.00', 3, '2013-11-07', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1295053684', 0, 'N', 0, '2013-12-02', NULL, NULL, 0, 0, NULL, NULL),
('201435671', 'W12040416', 'W12040416', 'TXHOUSTD', 'Diabetes America', 'Min', '', 'Liang', 'MD,PHD', 'Internal Medicine', '', '', NULL, 'O', '9473 FM 1960 Bypass Ste 300', 'Humble', 'Harris', 'TX', '77338', '8322373500', '8882377954', '9473 FM 1960 Bypass Ste 300', 'Humble', 'Harris', 'TX', '77338', '8322373500', '8882377954', 'HOUSTON4', 'TXHCPC13', '', '0.00', '40.00', '0.00', 3, '2013-11-07', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1295053684', 0, 'N', 0, '2013-12-02', NULL, NULL, 30.005, -95.2823, NULL, NULL),
('201435671', 'W12040419', 'W12040419', 'TXHOUSTD', 'Diabetes America', 'Shazia', 'F', 'Sheikh', 'MD', 'Internal Medicine', '', '', NULL, 'O', '23015 S Warmstone Way', 'Katy', 'Fort Bend', 'TX', '77494', '8322373500', '2818979906', '23015 S Warmstone Way', 'Katy', 'Fort Bend', 'TX', '77494', '8322373500', '2818979906', 'HOUSTON4', 'TXHCPC13', '', '0.00', '40.00', '0.00', 3, '2013-11-07', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1033270806', 0, 'N', 0, '2013-11-11', NULL, NULL, 29.7614, -95.7686, NULL, NULL),
('870335974', 'W12040420', 'W12040420', 'UT01', 'Medical Hearing Clinic, Inc.', 'William', 'I', 'Owens', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '1100 Country Hill Dr Ste 200', 'Ogden', 'Weber', 'UT', '84403', '8013995014', '8013990830', '1100 Country Hill Dr Ste 200', 'Ogden', 'Weber', 'UT', '84403', '8013995014', '8013990830', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-10-29', NULL, 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1528095627', 0, 'N', 0, '2014-04-03', NULL, NULL, 41.1869, -111.952, NULL, NULL),
('800843551', 'W12040422', 'W12040422', 'UT01', 'Central Utah Veterans Home', '', '', 'Central Utah Veterans Home', '', 'Skilled Nursing Facility', '', '', NULL, 'O', '1551 N Main St', 'Payson', 'Utah', 'UT', '84651', '8014655400', '8014654872', '1551 N Main St', 'Payson', 'Utah', 'UT', '84651', '8014655400', '8014654872', '', '', '7', '0.00', '100.00', '0.00', 3, '2013-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1205177722', 0, 'N', 0, '2013-11-11', NULL, NULL, 0, 0, NULL, NULL),
('800843551', 'W12040423', 'W12040423', 'UT01', 'Central Utah Veterans Home', '', '', 'Central Utah Veterans Home', '', 'Skilled Nursing Facility', '', '', NULL, 'B', 'PO Box 2009', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8014655400', '8014654872', 'PO Box 2009', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8014655400', '8014654872', '', '', '7', '0.00', '100.00', '0.00', 3, '2013-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1205177722', 0, 'N', 0, '2013-11-11', NULL, NULL, 0, 0, NULL, NULL),
('432012505', 'W12040433', 'W12040433', 'TXHOUSTD', 'Berkeley Eye Institute', '', '', 'Berkeley Eye Institute', '', 'Ophthalmology', '', '', NULL, 'O', '10970 Shadow Creek Pkwy Ste 370', 'Pearland', 'Brazoria', 'TX', '77584', '7134361551', '7134367491', '10970 Shadow Creek Pkwy Ste 370', 'Pearland', 'Brazoria', 'TX', '77584', '7134361551', '7134367491', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-13', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1740286186', 0, 'Y', 0, '2013-11-13', NULL, NULL, 29.5802, -95.3886, NULL, NULL),
('432012505', 'W12040437', 'W12040437', 'TXHOUSTD', 'Berkeley Eye Institute', '', '', 'Berkeley Eye Institute', '', 'Ophthalmology', '', '', NULL, 'O', '1120 N Fulton', 'Wharton', 'Wharton', 'TX', '77488', '9795320805', '9795322084', '1120 N Fulton', 'Wharton', 'Wharton', 'TX', '77488', '9795320805', '9795322084', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-13', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1740286186', 0, 'Y', 0, '2013-11-13', NULL, NULL, 29.3194, -96.0967, NULL, NULL),
('432012505', 'W12040428', 'W12040428', 'TXHOUSTD', 'Berkeley Eye Institute', '', '', 'Berkeley Eye Institute', '', 'Ophthalmology', '', '', NULL, 'O', '1200 McKinney Ste 411', 'Houston', 'Harris', 'TX', '77010', '7137599449', '7137596915', '1200 McKinney Ste 411', 'Houston', 'Harris', 'TX', '77010', '7137599449', '7137596915', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-13', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1740286186', 0, 'Y', 0, '2013-11-13', NULL, NULL, 29.7559, -95.3632, NULL, NULL),
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('432012505', 'W12040434', 'W12040434', 'TXHOUSTD', 'Berkeley Eye Institute', '', '', 'Berkeley Eye Institute', '', 'Ophthalmology', '', '', NULL, 'O', '17450 St Lukes Way Ste 100', 'Conroe', 'Montgomery', 'TX', '77384', '2813633443', '9362711351', '17450 St Lukes Way Ste 100', 'Conroe', 'Montgomery', 'TX', '77384', '2813633443', '9362711351', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-13', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1740286186', 0, 'Y', 0, '2013-11-13', NULL, NULL, 30.1997, -95.458, NULL, NULL),
('432012505', 'W12040431', 'W12040431', 'TXHOUSTD', 'Berkeley Eye Institute', '', '', 'Berkeley Eye Institute', '', 'Ophthalmology', '', '', NULL, 'O', '2 Financial Plaza Ste 801', 'Huntsville', 'Walker', 'TX', '77340', '9362952020', '9362954171', '2 Financial Plaza Ste 801', 'Huntsville', 'Walker', 'TX', '77340', '9362952020', '9362954171', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-13', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1740286186', 0, 'Y', 0, '2013-11-13', NULL, NULL, 30.7152, -95.5699, NULL, NULL),
('432012505', 'W12040430', 'W12040430', 'TXHOUSTD', 'Berkeley Eye Institute', '', '', 'Berkeley Eye Institute', '', 'Ophthalmology', '', '', NULL, 'O', '2012 W Loop St', 'El Campo', 'Wharton', 'TX', '77437', '9795436821', '9795436817', '2012 W Loop St', 'El Campo', 'Wharton', 'TX', '77437', '9795436821', '9795436817', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-13', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1740286186', 0, 'Y', 0, '2013-11-13', NULL, NULL, 29.2031, -96.294, NULL, NULL),
('432012505', 'W12040429', 'W12040429', 'TXHOUSTD', 'Berkeley Eye Institute', '', '', 'Berkeley Eye Institute', '', 'Ophthalmology', '', '', NULL, 'O', '22741 Professional Dr', 'Kingwood', 'Harris', 'TX', '77339', '2813194334', '2813194855', '22741 Professional Dr', 'Kingwood', 'Harris', 'TX', '77339', '2813194334', '2813194855', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-13', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1740286186', 0, 'Y', 0, '2013-11-13', NULL, NULL, 30.0478, -95.2579, NULL, NULL),
('432012505', 'W12040424', 'W12040424', 'TXHOUSTD', 'Berkeley Eye Institute', '', '', 'Berkeley Eye Institute', '', 'Ophthalmology', '', '', NULL, 'O', '3100 Weslayan Ste 400', 'Houston', 'Harris', 'TX', '77027', '7135261600', '7135260679', '3100 Weslayan Ste 400', 'Houston', 'Harris', 'TX', '77027', '7135261600', '7135260679', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-13', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1740286186', 0, 'Y', 0, '2013-11-13', NULL, NULL, 29.7374, -95.4416, NULL, NULL),
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('432012505', 'W12040479', 'W12040479', 'TXHOUSTD', 'Berkeley Eye Institute', 'Regina', 'L', 'Sun', 'MD', 'Ophthalmology', '', '', NULL, 'O', '17450 St Lukes Way Ste 100', 'Conroe', 'Montgomery', 'TX', '77384', '2813633443', '9362711351', '17450 St Lukes Way Ste 100', 'Conroe', 'Montgomery', 'TX', '77384', '2813633443', '9362711351', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-13', NULL, 0, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1104852466', 0, 'N', 0, '2013-11-14', NULL, NULL, 30.1997, -95.458, NULL, NULL);
INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
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('432012505', 'W12040483', 'W12040483', 'TXHOUSTD', 'Berkeley Eye Institute', 'Kimberly ', 'C', 'Bertrand', 'OD', 'Optometry', '', '', NULL, 'O', '3100 Weslayan Ste 400', 'Houston', 'Harris', 'TX', '77027', '7135261600', '7135260679', '3100 Weslayan Ste 400', 'Houston', 'Harris', 'TX', '77027', '7135261600', '7135260679', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-13', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1497873038', 0, 'Y', 0, '2013-11-14', NULL, NULL, 29.7374, -95.4416, NULL, NULL),
('432012505', 'W12040488', 'W12040488', 'TXHOUSTD', 'Berkeley Eye Institute', 'Kimberly ', 'C', 'Bertrand', 'OD', 'Optometry', '', '', NULL, 'O', '10970 Shadow Creek Pkwy Ste 370', 'Pearland', 'Brazoria', 'TX', '77584', '7134361551', '7134367491', '10970 Shadow Creek Pkwy Ste 370', 'Pearland', 'Brazoria', 'TX', '77584', '7134361551', '7134367491', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-13', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1497873038', 0, 'Y', 0, '2013-11-14', NULL, NULL, 29.5802, -95.3886, NULL, NULL),
('432012505', 'W12040486', 'W12040486', 'TXHOUSTD', 'Berkeley Eye Institute', 'Kimberly ', 'C', 'Bertrand', 'OD', 'Optometry', '', '', NULL, 'O', '1200 McKinney Ste 411', 'Houston', 'Harris', 'TX', '77010', '7137599449', '7137596915', '1200 McKinney Ste 411', 'Houston', 'Harris', 'TX', '77010', '7137599449', '7137596915', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-13', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1497873038', 0, 'Y', 0, '2013-11-14', NULL, NULL, 29.7559, -95.3632, NULL, NULL),
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('432012505', 'W12040487', 'W12040487', 'TXHOUSTD', 'Berkeley Eye Institute', 'Kimberly ', 'C', 'Bertrand', 'OD', 'Optometry', '', '', NULL, 'O', '707 S Fry Rd Ste 480', 'Katy', 'Harris', 'TX', '77450', '2815796777', '2815786534', '707 S Fry Rd Ste 480', 'Katy', 'Harris', 'TX', '77450', '2815796777', '2815786534', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-13', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1497873038', 0, 'Y', 0, '2013-11-14', NULL, NULL, 29.7765, -95.7189, NULL, NULL),
('432012505', 'W12040489', 'W12040489', 'TXHOUSTD', 'Berkeley Eye Institute', 'Kimberly ', 'C', 'Bertrand', 'OD', 'Optometry', '', '', NULL, 'O', '8800 Katy Fwy Ste 107', 'Houston', 'Harris', 'TX', '77024', '7138278311', '7138277488', '8800 Katy Fwy Ste 107', 'Houston', 'Harris', 'TX', '77024', '7138278311', '7138277488', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-13', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1497873038', 0, 'Y', 0, '2013-11-14', NULL, NULL, 29.785, -95.5045, NULL, NULL),
('432012505', 'W12040484', 'W12040484', 'TXHOUSTD', 'Berkeley Eye Institute', 'Kimberly ', 'C', 'Bertrand', 'OD', 'Optometry', '', '', NULL, 'O', '902 Frostwood Ste 256', 'Houston', 'Harris', 'TX', '77024', '7139359485', '7139350326', '902 Frostwood Ste 256', 'Houston', 'Harris', 'TX', '77024', '7139359485', '7139350326', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-13', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1497873038', 0, 'Y', 0, '2013-11-14', NULL, NULL, 29.7795, -95.5478, NULL, NULL),
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('432012505', 'W12040493', 'W12040493', 'TXHOUSTD', 'Berkeley Eye Institute', 'Karl', 'M', 'Ermis', 'OD', 'Optometry', '', '', NULL, 'O', '2012 W Loop St', 'El Campo', 'Wharton', 'TX', '77437', '9795436821', '9795436817', '2012 W Loop St', 'El Campo', 'Wharton', 'TX', '77437', '9795436821', '9795436817', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-13', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1972509461', 0, 'Y', 0, '2013-11-14', NULL, NULL, 29.2031, -96.294, NULL, NULL),
('432012505', 'W12040495', 'W12040495', 'TXHOUSTD', 'Berkeley Eye Institute', 'Robert', 'E', 'Brumbelow', 'OD', 'Optometry', '', '', NULL, 'O', '2 Financial Plaza Ste 801', 'Huntsville', 'Walker', 'TX', '77340', '9362952020', '9362954171', '2 Financial Plaza Ste 801', 'Huntsville', 'Walker', 'TX', '77340', '9362952020', '9362954171', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-13', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1982600474', 0, 'Y', 0, '2013-11-14', NULL, NULL, 30.7152, -95.5699, NULL, NULL),
('432012505', 'W12040497', 'W12040497', 'TXHOUSTD', 'Berkeley Eye Institute', 'Gary', 'L', 'Buettner', 'OD', 'Optometry', '', '', NULL, 'O', '902 Frostwood Ste 256', 'Houston', 'Harris', 'TX', '77024', '7139359485', '7139350326', '902 Frostwood Ste 256', 'Houston', 'Harris', 'TX', '77024', '7139359485', '7139350326', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-13', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1922004415', 0, 'Y', 0, '2013-11-14', NULL, NULL, 29.7795, -95.5478, NULL, NULL),
('432012505', 'W12040498', 'W12040498', 'TXHOUSTD', 'Berkeley Eye Institute', 'Gary', 'L', 'Buettner', 'OD', 'Optometry', '', '', NULL, 'O', '707 S Fry Rd Ste 480', 'Katy', 'Harris', 'TX', '77450', '2815796777', '2815786534', '707 S Fry Rd Ste 480', 'Katy', 'Harris', 'TX', '77450', '2815796777', '2815786534', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-13', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1922004415', 0, 'Y', 0, '2013-11-14', NULL, NULL, 29.7765, -95.7189, NULL, NULL),
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('432012505', 'W12040502', 'W12040502', 'TXHOUSTD', 'Berkeley Eye Institute', 'Reza', 'D', 'Farahani', 'OD', 'Optometry', '', '', NULL, 'O', '5419 1960 W Ste E', 'Houston', 'Harris', 'TX', '77069', '2818942020', '2815377617', '5419 1960 W Ste E', 'Houston', 'Harris', 'TX', '77069', '2818942020', '2815377617', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-13', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1063419042', 0, 'Y', 0, '2013-11-14', NULL, NULL, 29.9806, -95.5115, NULL, NULL),
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('571201170', 'W12040506', 'W12040506', 'TXHOUSTD', 'TMHPO Neurosurgery Department', 'David', '', 'Baskin', 'MD', 'Neurosurgery', '', '', NULL, 'B', 'PO Box 4655', 'Houston', 'Harris', 'TX', '77210', '7134413800', '7137931015', 'PO Box 4655', 'Houston', 'Harris', 'TX', '77210', '7134413800', '7137931015', 'TMHPHOSPC', 'TXHCPCTMH', '', '0.00', '50.00', '0.00', 6, '2014-01-01', NULL, 0, 0, 0, 'Houston Methodist Hospital', NULL, '', '', 'HCFA|UB|', '1215962485', 0, 'N', 0, '2013-11-13', NULL, NULL, 0, 0, NULL, NULL),
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('432012505', 'W12040515', 'W12040515', 'TXHOUSTD', 'Berkeley Eye Institute', 'Jorge', 'E', 'Garrett', 'OD', 'Optometry', '', '', NULL, 'O', '707 S Fry Rd Ste 480', 'Katy', 'Harris', 'TX', '77450', '2815796777', '2815786534', '707 S Fry Rd Ste 480', 'Katy', 'Harris', 'TX', '77450', '2815796777', '2815786534', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-13', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1609898212', 0, 'Y', 0, '2013-11-14', NULL, NULL, 29.7765, -95.7189, NULL, NULL),
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('432012505', 'W12040560', 'W12040560', 'TXHOUSTD', 'Berkeley Eye Institute', 'Sriyuta', '', 'Thota', 'OD', 'Optometry', '', '', NULL, 'O', '902 Frostwood Ste 256', 'Houston', 'Harris', 'TX', '77024', '7139359485', '7139350326', '902 Frostwood Ste 256', 'Houston', 'Harris', 'TX', '77024', '7139359485', '7139350326', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-13', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1912909003', 0, 'Y', 0, '2013-11-14', NULL, NULL, 29.7795, -95.5478, NULL, NULL),
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('432012505', 'W12040562', 'W12040562', 'TXHOUSTD', 'Berkeley Eye Institute', 'Sriyuta', '', 'Thota', 'OD', 'Optometry', '', '', NULL, 'O', '707 S Fry Rd Ste 480', 'Katy', 'Harris', 'TX', '77450', '2815796777', '2815786534', '707 S Fry Rd Ste 480', 'Katy', 'Harris', 'TX', '77450', '2815796777', '2815786534', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-13', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1912909003', 0, 'Y', 0, '2013-11-14', NULL, NULL, 29.7765, -95.7189, NULL, NULL),
('432012505', 'W12040563', 'W12040563', 'TXHOUSTD', 'Berkeley Eye Institute', 'Sriyuta', '', 'Thota', 'OD', 'Optometry', '', '', NULL, 'O', '8800 Katy Fwy Ste 107', 'Houston', 'Harris', 'TX', '77024', '7138278311', '7138277488', '8800 Katy Fwy Ste 107', 'Houston', 'Harris', 'TX', '77024', '7138278311', '7138277488', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-13', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1912909003', 0, 'Y', 0, '2013-11-14', NULL, NULL, 29.785, -95.5045, NULL, NULL),
('432012505', 'W12040565', 'W12040565', 'TXHOUSTD', 'Berkeley Eye Institute', 'James', 'T', 'Varnell', 'OD', 'Optometry', '', '', NULL, 'O', '17450 St Lukes Way Ste 100', 'The Woodlands', 'Montgomery', 'TX', '77384', '2813633443', '9362711351', '17450 St Lukes Way Ste 100', 'The Woodlands', 'Montgomery', 'TX', '77384', '2813633443', '9362711351', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-13', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1174529655', 0, 'Y', 0, '2013-11-14', NULL, NULL, 30.1997, -95.458, NULL, NULL),
('760402623', 'W12040586', 'W12040586', 'TXHOUSTD', 'Pearland Diagnotstic Clinic PA', 'Joseph', 'H', 'Roosth', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1834 Broadway Ste 102', 'Pearland', 'Brazoria', 'TX', '77581', '2819978181', '2819978184', '1834 Broadway Ste 102', 'Pearland', 'Brazoria', 'TX', '77581', '2819978181', '2819978184', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-21', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1851308787', 0, 'N', 0, '2013-11-21', NULL, NULL, 29.5478, -95.2389, NULL, NULL),
('263350839', 'SPA500049', 'SPA500049', 'TXDALSTD', 'Sanjay Btel MD', 'Sanjay', '', 'Patel', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 848221', 'Boston', 'Suffolk', 'TX', '02284', '2145752663', '2145752664', 'PO Box 848221', 'Boston', 'Suffolk', 'TX', '02284', '2145752663', '2145752664', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-12-05', NULL, 0, 0, 0, 'Baylor Medical Center at McKinney', NULL, NULL, NULL, 'HCFA|UB|', '1043263833', 0, 'Y', 0, '2013-11-11', NULL, NULL, 0, 0, NULL, NULL),
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('800230400', 'SPA500054', 'SPA500054', 'TXDALSTD', 'Skin Specialists', 'Tanya', 'E', 'Rodgers', 'MD', 'Dermatology', '', '', NULL, 'O', '5304 Belt Line Rd', 'Addison', 'Dallas', 'TX', '75254', '9726496644', '9726496908', '5304 Belt Line Rd', 'Addison', 'Dallas', 'TX', '75254', '9726496644', '9726496908', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-12-05', NULL, 0, 0, 0, NULL, '', NULL, NULL, 'HCFA|UB|', '1790721421', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.9539, -96.8165, NULL, NULL),
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('752607861', 'SPA500055', 'SPA500055', 'TXDALSTD', 'Mid Cities Arthritis Clinic', 'Thuan', 'Q', 'Vu', 'MD', 'Rheumatology', '', '', NULL, 'O', '3200 Long Prairie Rd Ste 100', 'Flower Mound', 'Denton', 'TX', '75022', '972 350 0225', NULL, '3200 Long Prairie Rd Ste 100', 'Flower Mound', 'Denton', 'TX', '75022', '972 350 0225', '972 350 0228', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-12-05', NULL, 0, 0, 0, NULL, '', NULL, NULL, 'HCFA|UB|', '1366407918', 0, 'N', 0, '2013-11-11', NULL, NULL, 33.0281, -97.0707, NULL, NULL),
('274024724', 'SPA500052', 'SPA500052', 'TXDALSTD', 'Internal Medicine and Urgent Care Clinic of Frisco', 'SriVenkateswara', '', 'Yedlapalli', 'MD', 'Internal Medicine', '', '', NULL, 'O', '3520 Preston Rd Ste 108', 'Frisco', 'Denton', 'TX', '75034', '2144364949', NULL, '3520 Preston Rd Ste 108', 'Frisco', 'Denton', 'TX', '75034', '2144364949', '', 'SPA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-12-05', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1902842172', 0, 'N', 0, '2014-04-02', NULL, NULL, 33.1083, -96.8056, NULL, NULL),
('363330928', 'W12040754', 'W12040754', 'ILCHIGSTD', 'Presence Healthcare Services', 'Kochurani', 'J', 'Maliekel', 'MD', 'Internal Medicine', 'Hematology and Oncology', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '8557647687', '6309142469', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '8557647687', '6309142469', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-10-14', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, NULL, NULL, 'HCFA|UB|', '1699777813', 0, 'N', 0, '2013-11-14', NULL, NULL, 0, 0, NULL, NULL),
('462726462', 'W12040582', 'W12040582', 'UT01', 'Mobley MD Facial Plastic and Reconstructive Surgery', 'Steven', 'R', 'Mobley', 'MD', 'Ear, Nose and Throat', 'Plastic Surgery', '', NULL, 'O', '3715 W 4100 S Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8014499990', '8012938101', '3715 W 4100 S Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8014499990', '8012938101', 'WUSTDPLAS5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-10-01', NULL, 0, 0, 0, 'University Health Care University Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1265522874', 0, 'N', 0, '2013-11-12', NULL, NULL, 40.682, -111.979, NULL, NULL),
('462726462', 'W12040583', 'W12040583', 'UT01', 'Mobley MD Facial Plastic and Reconstructive Surgery', 'Steven', 'R', 'Mobley', 'MD', 'Ear, Nose and Throat', 'Plastic Surgery', '', NULL, 'O', '1200 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8014499990', '8012938101', '1200 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8014499990', '8012938101', 'WUSTDPLAS5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-10-01', NULL, 0, 0, 0, 'University Health Care University Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1265522874', 0, 'N', 0, '2013-11-12', NULL, NULL, 40.6871, -111.856, NULL, NULL),
('462726462', 'W12040584', 'W12040584', 'UT01', 'Mobley MD Facial Plastic and Reconstructive Surgery', 'Steven', 'R', 'Mobley', 'MD', 'Ear, Nose and Throat', 'Plastic Surgery', '', NULL, 'O', '8th Ave & C St', 'Salt Lake City', 'Salt Lake', 'UT', '84143', '8014499990', '8012938101', '8th Ave & C St', 'Salt Lake City', 'Salt Lake', 'UT', '84143', '8014499990', '8012938101', 'WUSTDPLAS5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-10-01', NULL, 0, 0, 0, 'University Health Care University Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1265522874', 0, 'N', 0, '2013-11-12', NULL, NULL, 40.7785, -111.881, NULL, NULL),
('320047747', 'W12040588', 'W12040588', 'TXHOUSTD', 'John Park', 'John', 'J', 'Park', 'MD', 'Neurosurgery', '', '', NULL, 'O', '16605 SW Fwy Ste 285', 'Sugar Land', 'Fort Bend', 'TX', '77479', '2813130031', '2813130032', '16605 SW Fwy Ste 285', 'Sugar Land', 'Fort Bend', 'TX', '77479', '2813130031', '2813130032', 'HOUSTON5', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-15', NULL, 0, 0, 0, 'Houston Methodist Sugar Land Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1063560597', 0, 'N', 0, '2013-11-15', NULL, NULL, 29.5919, -95.6298, NULL, NULL),
('320047747', 'W12040589', 'W12040589', 'TXHOUSTD', 'John Park', 'John', 'J', 'Park', 'MD', 'Neurosurgery', '', '', NULL, 'O', '23920 Katy Fwy Ste 300', 'Katy', 'Austin', 'TX', '77474', '2813130031', '2813130032', '23920 Katy Fwy Ste 300', 'Katy', 'Austin', 'TX', '77474', '2813130031', '2813130032', 'HOUSTON5', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-15', NULL, 0, 0, 0, 'Houston Methodist Sugar Land Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1063560597', 0, 'N', 0, '2013-11-15', NULL, NULL, 29.7859, -95.7858, NULL, NULL),
('320047747', 'W12040590', 'W12040590', 'TXHOUSTD', 'John Park', 'John', 'J', 'Park', 'MD', 'Neurosurgery', '', '', NULL, 'B', 'PO Box 67', 'Houston', 'Harris', 'TX', '77001', '2813130031', '2813130032', 'PO Box 67', 'Houston', 'Harris', 'TX', '77001', '2813130031', '2813130032', 'HOUSTON5', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-15', NULL, 0, 0, 0, 'Houston Methodist Sugar Land Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1063560597', 0, 'N', 0, '2014-05-08', NULL, NULL, 29.7581, -95.3614, NULL, NULL),
('742915791', 'W12040591', 'W12040591', 'TXHOUSTD', 'Southeast Houston Pulmonology', 'Louis', 'M', 'Hamer', 'MD', 'Pulmonary', '', '', NULL, 'O', '5010 Crenshaw Rd Ste 100', 'Pasadena', 'Harris', 'TX', '77505', '8323990399', '8323990398', '5010 Crenshaw Rd Ste 100', 'Pasadena', 'Harris', 'TX', '77505', '8323990399', '8323990398', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-21', NULL, 0, 0, 0, 'Bayshore Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1326083288', 0, 'N', 0, '2013-11-21', NULL, NULL, 29.6403, -95.165, NULL, NULL),
('383774459', 'W12040592', 'W12040592', 'TXHOUSTD', 'John I Dogan', 'John', 'I', 'Dogan', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '11302 Fallbrook Dr Ste 202B', 'Houston', 'Harris', 'TX', '77065', '2814779333', '2814779341', '11302 Fallbrook Dr Ste 202B', 'Houston', 'Harris', 'TX', '77065', '2814779333', '2814779341', 'HOUSTON3', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-12-21', NULL, 0, 0, 0, 'Houston Methodist Willowbrook Hospital', NULL, '', '', 'HCFA|UB|', '1497972913', 0, 'N', 0, '2014-04-25', NULL, NULL, 29.9256, -95.5888, NULL, NULL),
('208254478', 'W12040593', 'W12040593', 'TXDALSTD', 'Xiaohui Lu', 'Xiaohui', '', 'Lu', 'MD', 'Family Practice', '', '', NULL, 'O', '1220 Coit Rd Ste 105', 'Plano', 'Collin', 'TX', '75075', '9728898888', '9728899999', '1220 Coit Rd Ste 105', 'Plano', 'Collin', 'TX', '75075', '9728898888', '9728899999', 'DALLAS1', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-12-21', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1619022464', 0, 'N', 0, '2013-11-21', NULL, NULL, 33.0173, -96.7666, NULL, NULL),
('752674367', 'W12040594', 'W12040594', 'TXDALSTD', 'Healthcare Associates of Irving', '', '', 'Healthcare Associates of Irving ', '', 'Family Practice', '', '', NULL, 'O', '1110 Cottonwood Ln Ste L100', 'Irving', 'Dallas', 'TX', '75038', '9722587499', '9722558922', '1110 Cottonwood Ln Ste L100', 'Irving', 'Dallas', 'TX', '75038', '9722587499', '9722558922', 'DALLAS1', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-12-13', NULL, 0, 0, 0, 'Baylor Medical Center at Irving', NULL, '', '', 'HCFA|UB|', '1467413625', 0, 'N', 0, '2013-11-13', NULL, NULL, 32.8652, -96.9601, NULL, NULL),
('752674367', 'W12040596', 'W12040596', 'TXDALSTD', 'Healthcare Associates of Irving', '', '', 'Healthcare Associates of Irving ', '', 'Family Practice', '', '', NULL, 'B', 'PO Box 224968', 'Irving', 'Dallas', 'TX', '75038', '9722587499', '9722558922', 'PO Box 224968', 'Irving', 'Dallas', 'TX', '75038', '9722587499', '9722558922', 'DALLAS1', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-12-13', NULL, 0, 0, 0, 'Baylor Medical Center at Irving', NULL, '', '', 'HCFA|UB|', '1467413625', 0, 'N', 0, '2013-11-13', NULL, NULL, 0, 0, NULL, NULL),
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('752674367', 'W12040599', 'W12040599', 'TXDALSTD', 'Healthcare Associates of Irving', 'Maria', 'Nicola', 'Biard', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 224968', 'Irving', 'Dallas', 'TX', '75038', '9722587499', '9722558922', 'PO Box 224968', 'Irving', 'Dallas', 'TX', '75038', '9722587499', '9722558922', 'DALLAS1', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-12-13', NULL, 0, 0, 0, 'Baylor Medical Center at Irving', NULL, '', '', 'HCFA|UB|', '1073589586', 0, 'N', 0, '2013-11-14', NULL, NULL, 0, 0, NULL, NULL),
('752674367', 'W12040601', 'W12040601', 'TXDALSTD', 'Healthcare Associates of Irving', 'James', 'M', 'Anderson', 'MD', 'Family Practice', '', '', NULL, 'O', '1110 Cottonwood Ln Ste L100', 'Irving', 'Dallas', 'TX', '75038', '9722587499', '9722558922', '1110 Cottonwood Ln Ste L100', 'Irving', 'Dallas', 'TX', '75038', '9722587499', '9722558922', 'DALLAS1', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-12-13', NULL, 0, 0, 0, 'Baylor Medical Center at Irving', NULL, '', '', 'HCFA|UB|', '1225004351', 0, 'N', 0, '2013-11-14', NULL, NULL, 32.8652, -96.9601, NULL, NULL),
('752674367', 'W12040602', 'W12040602', 'TXDALSTD', 'Healthcare Associates of Irving', 'James', 'M', 'Anderson', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 224968', 'Irving', 'Dallas', 'TX', '75038', '9722587499', '9722558922', 'PO Box 224968', 'Irving', 'Dallas', 'TX', '75038', '9722587499', '9722558922', 'DALLAS1', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-12-13', NULL, 0, 0, 0, 'Baylor Medical Center at Irving', NULL, '', '', 'HCFA|UB|', '1225004351', 0, 'N', 0, '2013-11-14', NULL, NULL, 0, 0, NULL, NULL),
('752674367', 'W12040604', 'W12040604', 'TXDALSTD', 'Healthcare Associates of Irving', 'David', 'A', 'Deems', 'MD', 'Family Practice', '', '', NULL, 'O', '1110 Cottonwood Ln Ste L100', 'Irving', 'Dallas', 'TX', '75038', '9722587499', '9722558922', '1110 Cottonwood Ln Ste L100', 'Irving', 'Dallas', 'TX', '75038', '9722587499', '9722558922', 'DALLAS1', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-12-13', NULL, 0, 0, 0, 'Baylor Medical Center at Irving', NULL, '', '', 'HCFA|UB|', '1346216850', 0, 'N', 0, '2013-11-14', NULL, NULL, 32.8652, -96.9601, NULL, NULL),
('752674367', 'W12040605', 'W12040605', 'TXDALSTD', 'Healthcare Associates of Irving', 'David', 'A', 'Deems', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 224968', 'Irving', 'Dallas', 'TX', '75038', '9722587499', '9722558922', 'PO Box 224968', 'Irving', 'Dallas', 'TX', '75038', '9722587499', '9722558922', 'DALLAS1', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-12-13', NULL, 0, 0, 0, 'Baylor Medical Center at Irving', NULL, '', '', 'HCFA|UB|', '1346216850', 0, 'N', 0, '2013-11-14', NULL, NULL, 0, 0, NULL, NULL);
