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', 'S77001670', 'S77001670', 'UT01', 'Granger Medical Clinic', 'Dean', 'N', 'Walker', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '3725 W 4100 S', 'West Valley', 'Salt Lake', 'UT', '84120', '8019653424', '8019683605', '3725 W 4100 S', 'West Valley', 'Salt Lake', 'UT', '84120', '8019653424', '8019683605', 'WUGRANGER5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-08-01', NULL, 0, 0, 0, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1861424012', 0, 'N', 0, '2013-10-25', NULL, NULL, 40.682, -111.979, NULL, NULL),
('870284475', 'S77001671', 'S77001671', 'UT01', 'Granger Medical Clinic', 'Julie', 'I', 'Wilkerson', 'MD', 'Pediatrics', NULL, NULL, NULL, 'O', '3725 W 4100 S', 'West Valley', 'Salt Lake', 'UT', '84120', '8019653448', '8019683605', '3725 W 4100 S', 'West Valley', 'Salt Lake', 'UT', '84120', '8019653448', '8019683605', 'WUGRANGER5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-08-01', NULL, 0, 0, 0, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1447283932', 0, 'N', 0, '2012-05-08', NULL, NULL, 40.682, -111.979, NULL, NULL),
('870285509', 'S77001673', 'S77001673', 'UT01', 'Provo OBGYN Clinic', 'Scott', 'S', 'Rees', 'DO', 'Obstetrics and Gynecology', '', '', NULL, 'O', '920 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013741801', '8013750369', '920 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013741801', '8013750369', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-06-01', '2008-06-01', 0, 0, 0, 'Timpanogos Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1952427031', 0, 'N', 0, '2012-02-27', NULL, NULL, 0, 0, NULL, NULL),
('870286381', 'S77001677', 'S77001677', 'UT01', 'Ogden Clinic', 'C', 'Mark', 'Alder', 'MD', 'Radiologist', '', '', NULL, 'O', '4650 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014794621', '8014762670', '4650 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014794621', '8014762670', 'WUOGDCLIN5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2006-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1386631927', 0, 'Y', 0, '2012-07-03', NULL, NULL, 41.1787, -111.949, NULL, NULL),
('870286381', 'S77001678', 'S77001678', 'UT01', 'Ogden Clinic', 'John', 'G', 'Allred', 'DO', 'Pediatrics', '', '', NULL, 'B', '4650 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014794621', '8014762670', '4650 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014794621', '8014762670', 'WUOGDCLIN5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2006-08-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1336136977', 0, 'y', 0, '2013-07-08', NULL, NULL, 0, 0, NULL, NULL),
('870286381', 'S77001679', 'S77001679', 'UT01', 'Ogden Clinic', 'John', 'G', 'Allred', 'DO', 'Pediatrics', '', '', NULL, 'O', '5430 S 1900 W Ste G1', 'Roy', 'Weber', 'UT', '84067', '8017799975', NULL, '5430 S 1900 W Ste G1', 'Roy', 'Weber', 'UT', '84067', '8017799975', '', 'WUOGDCLIN5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2006-08-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1336136977', 0, 'N', 0, '2013-07-08', NULL, NULL, 41.1651, -112.026, NULL, NULL),
('870283576', 'S77001680', 'S77001680', 'UT01', 'Excel Eye Center', 'Matthew', 'R', 'Parsons', 'MD', 'Ophthalmology', NULL, NULL, NULL, 'O', '1735 N State St', 'Provo', 'Utah', 'UT', '84604', '8013741818', '8013740163', NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1063483071', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870283830', 'S77001682', 'S77001682', 'UT01', 'Intermountain Allergy', 'David', 'S', 'Gourley', 'MD', 'Allergy and Immunology', '', '', NULL, 'O', '6065 Fashion Blvd Ste 255', 'Murray', 'Salt Lake', 'UT', '84107', '8012664115', NULL, '6065 Fashion Blvd Ste 255', 'Murray', 'Salt Lake', 'UT', '84107', '8012664115', '', 'WiseSTD6A', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-09-01', '2010-12-31', 0, 0, 0, 'Davis Hospital', '', '', '', 'HCFA|UB|', '1477555712', 0, 'N', 0, '2014-05-29', NULL, NULL, 0, 0, NULL, NULL),
('870284475', 'S77001688', 'S77001688', 'UT01', 'Granger Medical Clinic', 'Robyn', 'E', 'Boehmer', 'PA-C', 'Orthopedic Surgery', 'General Surgery', '', NULL, 'O', '3725 W 4100 S', 'West Valley', 'Salt Lake', 'UT', '84120', '8019653425', '8019683605', '3725 W 4100 S', 'West Valley', '', 'UT', '84120', '', '', 'WUGRANGER5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-08-01', '2009-05-03', NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1619908092', 0, 'N', 0, '2009-07-17', NULL, NULL, 0, 0, NULL, NULL),
('870284475', 'S77001689', 'S77001689', 'UT01', 'Granger Medical Clinic', 'Robyn', 'E', 'Boehmer', 'PA-C', 'Orthopedic Surgery', 'General Surgery', '', NULL, 'B', 'PO Box 70658', 'West Valley', 'Salt Lake', 'UT', '84170', '8019653720', '8019653740', '3725 W 4100 S', 'West Valley', '', 'UT', '84120', '', '', 'WUGRANGER5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-08-01', '2009-05-03', NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1619908092', 0, 'Y', 0, '2009-07-17', NULL, NULL, 0, 0, NULL, NULL),
('870284475', 'S77001690', 'S77001690', 'UT01', 'Granger Medical Clinic', 'Craig', 'A', 'Brasher', 'MD', 'Pediatrics', '', '', NULL, 'B', 'PO Box 70658', 'West Valley', 'Salt Lake', 'UT', '84170', NULL, NULL, '3725 W 4100 S', 'West Valley', 'Salt Lake', 'UT', '84120', '', '', 'WUGRANGER5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-08-01', NULL, NULL, 0, 0, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1760410666', 0, 'Y', 0, '2011-07-01', NULL, NULL, 0, 0, NULL, NULL),
('870284475', 'S77001691', 'S77001691', 'UT01', 'Granger Medical Clinic', 'Alton', 'D', 'Burgett', 'MD', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'O', '3725 W 4100 S', 'West Valley', 'Salt Lake', 'UT', '84120', '8019653444', '8019683605', '3725 W 4100 S', 'West Valley', 'Salt Lake', 'UT', '84120', '8019653444', '8019683605', 'WUGRANGER5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-08-01', NULL, 0, 0, 0, 'Riverton Childrens Unit Operated by Primary Childrens Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1124059514', 0, 'N', 0, '2012-05-15', NULL, NULL, 40.682, -111.979, NULL, NULL),
('870284475', 'S77001692', 'S77001692', 'UT01', 'Granger Medical Clinic', 'William', 'H', 'Burleigh', 'DPM', 'Podiatry', NULL, NULL, NULL, 'B', 'PO Box 70658', 'West Valley', 'Salt Lake', 'UT', '84170', NULL, NULL, '3725 W 4100 S', 'West Valley', 'Salt Lake', 'UT', '84120', '', '', 'WUGRANGER5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-08-01', NULL, NULL, 0, 0, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1023040276', 0, 'Y', 0, '2011-07-01', NULL, NULL, 0, 0, NULL, NULL),
('870284475', 'S77001693', 'S77001693', 'UT01', 'Granger Medical Clinic', 'Dale', 'L', 'Chapman', 'MD', 'Pediatrics', '', '', NULL, 'B', 'PO Box 70658', 'West Valley', 'Salt Lake', 'UT', '84170', '          ', NULL, 'PO Box 70658', 'West Valley', 'Salt Lake', 'UT', '84170', '          ', '          ', 'WUGRANGER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-08-01', '2011-08-31', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1114959368', 0, 'Y', 0, '2012-05-23', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'S77001695', 'S77001695', 'UT01', 'Central Utah Clinic', 'Jerry', 'Dale', 'Walker, Jr', 'MD', 'Cardiovascular Disease', NULL, NULL, NULL, 'O', '700 W 800 N Ste 220', 'Orem', 'Utah', 'UT', '84057', '8013734366', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2007-03-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1649238866', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'S77001697', 'S77001697', 'UT01', 'Central Utah Clinic', 'Jeffrey', 'M', 'Wallentine', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '50 S Medical Dr', 'Payson', 'Utah', 'UT', '84651', '8014652527', NULL, '50 S Medical Dr', 'Payson', 'Utah', 'UT', '84651', '8014652527', '          ', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-06-01', '2010-07-14', 0, 0, 0, 'Mountain View Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1124121934', 0, 'N', 0, '2013-10-21', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'S77001698', 'S77001698', 'UT01', 'Central Utah Clinic', 'John', 'T', 'Wells', 'MD', 'Orthopedic Surgery', NULL, NULL, NULL, 'O', '680 E Main St', 'Lehi', 'Utah', 'UT', '84043', '8017633885', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1740371376', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870281299', 'S77001699', 'S77001699', 'UT01', 'American Fork Clinic', 'Michael', 'L', 'Cosgrave', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '226 N 1100 E Ste A', 'American Fork', 'Utah', 'UT', '84003', '8018553841', '8018553847', NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, 'Salt Lake Regional Medical Center', 'St Marks Hospital', NULL, NULL, 'HCFA|UB|', '1023127214', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870281299', 'S77001701', 'S77001701', 'UT01', 'American Fork Clinic', 'Douglas', 'R', 'Jones', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '226 N 1100 E Ste A', 'American Fork', 'Utah', 'UT', '84003', '8018553843', '8018553847', '226 N 1100 E', 'American Fork', '', 'UT', '84003', '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2007-08-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '6988', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870281299', 'S77001702', 'S77001702', 'UT01', 'Lehi Clinic', 'Toran', 'J', 'MacArthur', 'MD', 'Family Practice', '', '', NULL, 'O', '680 E Main St Ste 100', 'Lehi', 'Utah', 'UT', '84043', '8017681699', '8017684526', '680 E Main St Ste 100', 'Lehi', 'Utah', 'UT', '84043', '8017681699', '8017684526', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', '2010-07-14', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1063521177', 0, 'N', 0, '2013-10-25', NULL, NULL, 0, 0, NULL, NULL),
('870281299', 'S77001703', 'S77001703', 'UT01', 'American Fork Clinic', 'Peter', 'V', 'Sundwall', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '226 N 1100 E Ste A', 'American Fork', 'Utah', 'UT', '84003', '8018553841', '8018553847', NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1558470641', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870281942', 'S77001705', 'S77001705', 'UT01', 'Brigham Medical Clinic', 'Bruce', 'W', 'Keller', 'MD', 'Family Practice', '', '', NULL, 'O', '600 W Hospital Rd', 'Brigham City', 'Box Elder', 'UT', '84302', '4357342041', '4357238028', '600 W Hospital Rd', 'Brigham City', 'Box Elder', 'UT', '84302', '4357342041', '4357238028', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 0, 'Brigham City Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1427169036', 0, 'N', 0, '2013-12-10', NULL, NULL, 41.4905, -112.025, NULL, NULL),
('870281942', 'S77001706', 'S77001706', 'UT01', 'Brigham Medical Clinic', 'John', 'R', 'Markeson', 'MD', 'Internal Medicine', '', '', NULL, 'O', '600 W Hospital Rd', 'Brigham City', 'Box Elder', 'UT', '84302', '4357342041', '4357238028', '600 W Hospital Rd', 'Brigham City', 'Box Elder', 'UT', '84302', '4357342041', '4357238028', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 0, 'Brigham City Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1861503419', 0, 'N', 0, '2013-12-12', NULL, NULL, 41.4905, -112.025, NULL, NULL),
('870281942', 'S77001707', 'S77001707', 'UT01', 'Brigham Medical Clinic', 'John', 'R', 'Markeson', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 719', 'Brigham City', 'Box Elder', 'UT', '84302', '4357342041', '4357238028', 'PO Box 719', 'Brigham City', 'Box Elder', 'UT', '84302', '4357342041', '4357238028', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 0, 'Brigham City Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1861503419', 0, 'Y', 0, '2013-12-12', NULL, NULL, 0, 0, NULL, NULL),
('870286381', 'S77001708', 'S77001708', 'UT01', 'Ogden Clinic', 'Kelly', 'R', 'Amann', 'DO', 'Family Practice', NULL, NULL, NULL, 'O', '4650 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014794621', '8014762670', NULL, NULL, '', NULL, NULL, '', '', 'WUOGDCLIN5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-08-01', '2006-08-01', 0, NULL, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1134116783', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870286381', 'S77001712', 'S77001712', 'UT01', 'Ogden Clinic', 'Nadim', 'B', 'Bikhazi', 'MD', 'Ear, Nose and Throat', NULL, NULL, NULL, 'O', '4650 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014794621', '8014762670', '4650 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014794621', '8014762670', 'WUOGDCLIN5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2006-08-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1588651152', 0, 'N', 0, '2013-07-09', NULL, NULL, 41.1787, -111.949, NULL, NULL),
('870286381', 'S77001713', 'S77001713', 'UT01', 'Ogden Clinic', 'Mindy', 'M', 'Boehm', 'MD', 'Pediatrics', '', '', NULL, 'B', '4650 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014794621', '8014762670', '4650 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014794621', '8014762670', 'WUOGDCLIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-08-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1710974381', 0, 'y', 0, '2014-07-21', NULL, NULL, 0, 0, NULL, NULL),
('870286381', 'S77001714', 'S77001714', 'UT01', 'Ogden Clinic', 'Kimberly', 'A', 'Boyer', 'PA', 'Family Practice', '', '', NULL, 'B', '4650 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014794621', '8014762670', '4650 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014794621', '8014762670', 'WUOGDCLIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-08-01', '2010-04-30', NULL, 0, NULL, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1982692000', 0, 'N', 0, '2011-02-15', NULL, NULL, 0, 0, NULL, NULL),
('870286381', 'S77001715', 'S77001715', 'UT01', 'Ogden Clinic', 'Laurel', 'C', 'Brewer', 'AUD', 'Audiology', '', '', NULL, 'O', '4650 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014794621', '8014762670', '4650 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014794621', '8014762670', 'WUOGDCLIN5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2006-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1578551693', 0, 'N', 0, '2010-08-03', NULL, NULL, 41.1787, -111.949, NULL, NULL),
('870286381', 'S77001716', 'S77001716', 'UT01', 'Ogden Clinic', 'Tanya', NULL, 'Chesley', 'PA', 'Family Practice', NULL, NULL, NULL, 'O', '4650 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014794621', '8014762670', NULL, NULL, '', NULL, NULL, '', '', 'WUOGDCLIN5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-08-01', '2007-02-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1477541506', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870286381', 'S77001717', 'S77001717', 'UT01', 'Ogden Clinic', 'Laura', 'A', 'Colvin', 'PA', 'Family Practice', '', '', NULL, 'O', '1159 12th St', 'Ogden', 'Weber', 'UT', '84404', '8013343000', '8014762670', '1159 12th St', 'Ogden', 'Weber', 'UT', '84404', '8013343000', '8014762670', 'WUOGDCLIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-08-01', '2012-04-02', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1447248596', 0, 'N', 0, '2012-04-24', NULL, NULL, 0, 0, NULL, NULL),
('870286381', 'S77001718', 'S77001718', 'UT01', 'Ogden Clinic', 'Laura', 'A', 'Colvin', 'PA', 'Family Practice', NULL, NULL, NULL, 'O', '4650 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014794621', '8014762670', NULL, NULL, '', NULL, NULL, '', '', 'WUOGDCLIN5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-08-01', '2006-08-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1447248596', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870286381', 'S77001722', 'S77001722', 'UT01', 'Ogden Clinic Physical Therapy', 'Nathan', 'S', 'Goff', 'PT', 'Physical Therapy', '', '', NULL, 'O', '4700 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014757010', '8014762670', '4700 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014757010', '8014762670', '1838', '', '', '0.00', '0.00', '70.00', 6, '2006-08-01', '2009-04-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1629066675', 0, 'N', 0, '2014-07-14', NULL, NULL, 0, 0, NULL, NULL),
('870284475', 'S77001723', 'S77001723', 'UT01', 'Granger Medical Clinic', 'Peter', 'L', 'Christensen', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '2751 W 9000 S', 'West Jordan', 'Salt Lake', 'UT', '84088', '8013525900', NULL, '3725 W 4100 S', 'West Valley', 'Salt Lake', 'UT', '84120', '8013525900', '', 'WUGRANGER5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-08-01', NULL, NULL, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1992737159', 0, 'N', 0, '2011-07-01', NULL, NULL, 40.5878, -111.959, NULL, NULL),
('870284475', 'S77001724', 'S77001724', 'UT01', 'Granger Medical Clinic', 'James', 'S', 'Coy', 'MD', 'Family Practice', 'Urgent Care', NULL, NULL, 'O', '3725 W 4100 S', 'West Valley', 'Salt Lake', 'UT', '84120', '8019653479', '8019683605', '3725 W 4100 S', 'West Valley', '', 'UT', '84120', '', '', 'WUGRANGER5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-08-01', '2008-09-19', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1174555320', 0, 'N', 0, '2008-05-14', NULL, NULL, 0, 0, NULL, NULL),
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('870284475', 'S77001767', 'S77001767', 'UT01', 'Granger Medical Clinic', 'Mary', 'J', 'Pennington', 'MD', 'Pediatrics', NULL, NULL, NULL, 'O', '3725 W 4100 S', 'West Valley', 'Salt Lake', 'UT', '84120', '8019653448', '8019683605', '3725 W 4100 S', 'West Valley', 'Salt Lake', 'UT', '84120', '8019653448', '8019683605', 'WUGRANGER5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-08-01', NULL, NULL, 0, 0, 'Pioneer Valley Hospital', 'Riverton Childrens Unit Operated by Primary Childrens Medical Center', NULL, NULL, 'HCFA|UB|', '1205868452', 0, 'N', 0, '2011-06-29', NULL, NULL, 40.682, -111.979, NULL, NULL),
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('870284475', 'S77001772', 'S77001772', 'UT01', 'Granger Medical Clinic', 'Saurabh', 'B', 'Shah', 'MD', 'Ear, Nose and Throat', NULL, NULL, NULL, 'O', '3725 W 4100 S', 'West Valley', 'Salt Lake', 'UT', '84120', '8019653484', '8019683605', '3725 W 4100 S', 'West Valley', 'Salt Lake', 'UT', '84120', '8019653484', '8019683605', 'WUGRANGER5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-08-01', NULL, NULL, 0, 0, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1790717957', 0, 'N', 0, '2011-07-21', NULL, NULL, 40.682, -111.979, NULL, NULL),
('870284475', 'S77001773', 'S77001773', 'UT01', 'Granger Medical Clinic', 'Scott', 'D', 'Sheridan', 'MD', 'Family Practice', NULL, NULL, NULL, 'B', 'PO Box 70658', 'West Valley', 'Salt Lake', 'UT', '84170', NULL, NULL, '3725 W 4100 S', 'West Valley', 'Salt Lake', 'UT', '84120', '', '', 'WUGRANGER5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-08-01', NULL, NULL, 0, 0, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1578594925', 0, 'Y', 0, '2011-07-21', NULL, NULL, 0, 0, NULL, NULL),
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('870284475', 'S77001775', 'S77001775', 'UT01', 'Granger Medical Clinic', 'Paula', 'G', 'Thacker', 'CNM', 'Obstetrics and Gynecology', 'Nurse Midwife', '', NULL, 'O', '3725 W 4100 S', 'West Valley', 'Salt Lake', 'UT', '84120', '8019653444', '8019683605', '3725 W 4100 S', 'West Valley', 'Salt Lake', 'UT', '84120', '8019653444', '8019683605', 'WUGRANGER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-08-01', '2012-08-13', 0, 0, 0, 'Jordan Valley Medical Center', '', '', '', 'HCFA|UB|', '1205867553', 0, 'N', 0, '2012-08-20', NULL, NULL, 0, 0, NULL, NULL),
('870284475', 'S77001776', 'S77001776', 'UT01', 'Granger Medical Clinic', 'Eric', 'M', 'Thompson', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '3725 W 4100 S', 'West Valley', 'Salt Lake', 'UT', '84120', '8019653479', '8019683605', '3725 W 4100 S', 'West Valley', '', 'UT', '84120', '', '', 'WUGRANGER5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-08-01', '2008-08-28', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1043242290', 0, 'N', 0, '2006-10-19', NULL, NULL, 0, 0, NULL, NULL),
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('870285509', 'S77001778', 'S77001778', 'UT01', 'Provo Ob/Gyn Clinic', 'Steven', NULL, 'Bigler', 'MD', 'Gynecology', NULL, NULL, NULL, 'O', '920 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013741801', '8013750369', '920 N 500 W', 'Provo', '', 'UT', '84604', '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2007-03-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '833831', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
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('870284475', 'S77001790', 'S77001790', 'UT01', 'Granger Medical Clinic', 'Sandeep', 'L', 'Chowdhary', 'MD', 'Pulmonary', 'Sleep Studies', '', NULL, 'O', '3725 W 4100 S', 'West Valley', 'Salt Lake', 'UT', '84120', '8019653419', '8019683605', '3725 W 4100 S', 'West Valley', 'Salt Lake', 'UT', '84120', '8019653419', '8019683605', 'WUGRANGER5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-08-01', '2008-08-28', 0, 0, 0, 'Jordan Valley Medical Center', '', '', '', 'HCFA|UB|', '1891726162', 0, 'N', 0, '2013-03-19', NULL, NULL, 0, 0, NULL, NULL),
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('870286381', 'S77001795', 'S77001795', 'UT01', 'Ogden Clinic', 'J', 'David', 'Schmitz', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '1159 12th St', 'Ogden', 'Weber', 'UT', '84404', '8013343000', '8014762670', '4650 Harrison Blvd', 'Ogden', '', 'UT', '84403', '', '', 'WUOGDCLIN5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2006-08-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1891782819', 0, 'N', 0, '2006-07-31', NULL, NULL, 41.244, -111.95, NULL, NULL),
('870286381', 'S77001796', 'S77001796', 'UT01', 'Ogden Clinic', 'Jeffery', 'T', 'Sorensen', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '4650 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014794621', '8014762670', '4650 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014794621', '8014762670', 'WUOGDCLIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-08-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1508853425', 0, 'N', 0, '2012-09-07', NULL, NULL, 41.1787, -111.949, 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
('870286381', 'S77001797', 'S77001797', 'UT01', 'Ogden Clinic', 'Kelly', 'S', 'Stagg', 'DPM', 'Podiatry', NULL, NULL, NULL, 'B', '4650 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014794621', '8014762670', '4650 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014794621', '8014762670', 'WUOGDCLIN5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2006-08-01', NULL, NULL, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1316935117', 0, 'y', 0, '2012-01-16', NULL, NULL, 0, 0, NULL, NULL),
('870286381', 'S77001798', 'S77001798', 'UT01', 'Ogden Clinic', 'Kevin', 'G', 'Walker', 'DPM', 'Podiatry', '', '', NULL, 'O', '4650 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014794621', '8014762670', '4650 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014794621', '8014762670', 'WUOGDCLIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-08-01', '2011-12-31', 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1013905819', 0, 'N', 0, '2013-11-11', NULL, NULL, 0, 0, NULL, NULL),
('870286381', 'S77001799', 'S77001799', 'UT01', 'Ogden Clinic', 'Michelle', NULL, 'Wasden', 'PA', 'Family Practice', NULL, NULL, NULL, 'B', '5430 S 1900 W Ste G1', 'Roy', 'Weber', 'UT', '84067', '8017799975', NULL, '4650 Harrison Blvd', 'Ogden', '', 'UT', '84403', '', '', 'WUOGDCLIN5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2006-08-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1700875333', 0, 'N', 0, '2006-07-31', NULL, NULL, 0, 0, NULL, NULL),
('870286381', 'S77001800', 'S77001800', 'UT01', 'Ogden Clinic', 'Renee', '', 'West', 'MD', 'Family Practice', '', '', NULL, 'O', '4650 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014794621', '8014762670', '4650 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014794621', '8014762670', 'WUOGDCLIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-08-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1609864412', 0, 'N', 0, '2014-07-25', NULL, NULL, 41.1787, -111.949, NULL, NULL),
('870286381', 'S77001801', 'S77001801', 'UT01', 'Ogden Clinic', 'Debra', 'M', 'Whipple', 'FNP', 'Family Practice', NULL, NULL, NULL, 'B', '4650 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014794621', '8014762670', '4650 Harrison Blvd', 'Ogden', '', 'UT', '84403', '', '', 'WUOGDCLIN5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-08-01', '2007-03-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1235128877', 0, 'y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870286381', 'S77001802', 'S77001802', 'UT01', 'Ogden Clinic', 'Robert', 'D', 'Whipple', 'MD', 'General Surgery', '', '', NULL, 'O', '4650 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014794621', '8014762670', '4650 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014794621', '8014762670', 'WUOGDCLIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-08-01', '2012-06-30', 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1306834114', 0, 'N', 0, '2012-07-18', NULL, NULL, 0, 0, NULL, NULL),
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('870286937', 'S77001805', 'S77001805', 'UT01', '', 'Ronald', 'W', 'Ward', 'MD', 'Internal Medicine', 'Cardiovascular Disease', '', NULL, 'O', '24 S 1100 E Ste 305', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013598787', NULL, '24 S 1100 E', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013598787', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', '2011-02-23', NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1295816320', 0, 'N', 0, '2011-03-01', NULL, NULL, 0, 0, NULL, NULL),
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('870308023', 'S77001923', 'S77001923', 'UT01', 'Middleton Urological Associates', 'Gary', 'Blake', 'Johnson', 'MD', 'Urology', NULL, NULL, NULL, 'O', '181 E 5600 S Ste 130', 'Murray', 'Salt Lake', 'UT', '84107', '8012668664', '8012649031', NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2006-11-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '932032', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
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('870308023', 'S77001925', 'S77001925', 'UT01', 'Middleton Urological Associates', 'Lisa', NULL, 'Stout', 'MD', 'Urology', NULL, NULL, NULL, 'O', '181 E 5600 S Ste 130', 'Murray', 'Salt Lake', 'UT', '84107', '8012668664', '8015319467', NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2006-11-01', 0, NULL, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1548263213', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
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('870326862', 'S77001934', 'S77001934', 'UT01', 'Ogden Womens Clinic', 'John', 'D', 'Lesser', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '4403 Harrison Blvd Ste 4650', 'Ogden', 'Weber', 'UT', '84403', '8013874400', NULL, '4403 Harrison Bvld', 'Ogden', 'Weber', 'UT', '84403', '8013874400', '', 'Wise+', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-10-01', NULL, NULL, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1164403812', 0, 'N', 0, '2011-01-06', NULL, NULL, 41.1828, -111.949, NULL, NULL),
('870288620', 'S77001936', 'S77001936', 'UT01', 'Utah Orthopaedic Associates', 'Robert', 'P', 'Hansen', 'MD', 'Orthopedic Surgery', NULL, NULL, NULL, 'O', '1561 W 7000 S Ste 100', 'West Jordan', 'Salt Lake', 'UT', '84084', '8012800905', NULL, '1250 E 3900 S', 'Salt Lake City', '', 'UT', '84124', '', '', 'WUSTDORTH5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1598808503', 0, 'N', 0, '2006-12-21', NULL, NULL, 40.6241, -111.935, NULL, NULL),
('870288620', 'S77001937', 'S77001937', 'UT01', 'Utah Orthopaedic Associates', 'Leslie', 'J', 'Harris', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1250 E 3900 S Ste 440', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012612232', NULL, '1250 E 3900 S Ste 440', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012612232', '', 'WUSTDORTH5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2007-01-01', '2009-01-26', 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1679587687', 0, 'N', 0, '2012-07-19', NULL, NULL, 0, 0, NULL, NULL),
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('870293594', 'S77001944', 'S77001944', 'UT01', 'Fit Quest Therapy', 'Therapy', NULL, 'Fit Quest', 'GROUP', 'Physical Therapy', 'Occupational Therapy', 'Speech Therapy', NULL, 'B', 'PO Box 150173', 'Ogden', 'Weber', 'UT', '84415', '8014764141', '8017861926', NULL, NULL, '', NULL, NULL, '', '', 'UDME', 'USTDHCPC', '2298', '0.00', '35.00', NULL, 3, '2006-04-01', '2006-04-01', 1, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '834838', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870286381', 'S77001945', 'S77001945', 'UT01', 'Ogden Clinic', 'Van', 'G', 'Christiansen', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '4650 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014794621', '8014762670', NULL, NULL, '', NULL, NULL, '', '', 'WUOGDCLIN5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-08-01', '2006-08-01', 0, NULL, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1093702672', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870286381', 'S77001949', 'S77001949', 'UT01', 'Ogden Clinic', 'Roxina', NULL, 'Fischer', 'NP', 'Family Practice', NULL, NULL, NULL, 'O', '4650 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014794621', '8014762670', '4650 Harrison Blvd', 'Ogden', '', 'UT', '84403', '', '', 'WUOGDCLIN5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2006-08-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1932197084', 0, 'N', 0, '2006-07-31', NULL, NULL, 41.1787, -111.949, 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
('870286381', 'S77001951', 'S77001951', 'UT01', 'Ogden Clinic Physical Therapy', 'Nathan', 'S', 'Goff', 'PT', 'Physical Therapy', '', '', NULL, 'B', '4650 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014794621', '8014762670', '4650 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014794621', '8014762670', '1838', '', '', '0.00', '0.00', '70.00', 6, '2006-08-01', '2009-04-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1629066675', 0, 'Y', 0, '2014-07-14', NULL, NULL, 0, 0, NULL, NULL),
('870286381', 'S77001952', 'S77001952', 'UT01', 'Ogden Clinic', 'Michael', 'J', 'Hall', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '4350 Washington Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014765100', NULL, '4650 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014765100', '          ', 'WUOGDCLIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-08-01', '2012-01-04', NULL, 0, NULL, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1720075047', 0, 'N', 0, '2012-01-04', NULL, NULL, 0, 0, NULL, NULL),
('870286381', 'S77001953', 'S77001953', 'UT01', 'Ogden Clinic', 'Philip', 'H', 'Hassrick', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '4350 Washington Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014765100', NULL, '4650 Harrison Blvd', 'Ogden', '', 'UT', '84403', '', '', 'WUOGDCLIN5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-08-01', '2006-04-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1043207509', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870286381', 'S77001956', 'S77001956', 'UT01', 'Ogden Clinic', 'Eric', NULL, 'Johnson', 'PA', 'Family Practice', NULL, NULL, NULL, 'O', '5430 S 1900 W Ste G1', 'Roy', 'Weber', 'UT', '84067', '8017799975', NULL, '4650 Harrison Blvd', 'Ogden', '', 'UT', '84403', '', '', 'WUOGDCLIN5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2006-08-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1841289600', 0, 'N', 0, '2006-07-31', NULL, NULL, 41.1651, -112.026, NULL, NULL),
('870286381', 'S77001957', 'S77001957', 'UT01', 'Ogden Clinic', 'Edward', 'A', 'Jordan', 'MD', 'General Surgery', NULL, NULL, NULL, 'o', '4650 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014794621', '8014762670', '4650 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014794621', '8014762670', 'WUOGDCLIN5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2006-08-01', NULL, NULL, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1740277599', 0, 'n', 0, '2012-01-04', NULL, NULL, 41.1787, -111.949, NULL, NULL),
('870286381', 'S77001958', 'S77001958', 'UT01', 'Ogden Clinic', 'Dallen', NULL, 'Larson', 'PA', 'Family Practice', NULL, NULL, NULL, 'O', '4650 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014794621', '8014762670', '4650 Harrison Blvd', 'Ogden', '', 'UT', '84403', '', '', 'WUOGDCLIN5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2006-08-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1609865203', 0, 'N', 0, '2006-07-31', NULL, NULL, 41.1787, -111.949, NULL, NULL),
('870333759', 'S77001961', 'S77001961', 'UT01', NULL, 'Richard', 'H', 'Odell', 'MD', 'Dermatology', '', '', NULL, 'O', '1345 E 3900 S Ste 110', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012724219', NULL, '1345 E 3900 S Ste 110', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012724219', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1215999875', 0, 'N', 0, '2013-01-31', NULL, NULL, 40.6871, -111.853, NULL, NULL),
('870342259', 'S77001963', 'S77001963', 'UT01', 'Wayne Community Health Centers', 'Jeffrey', 'J', 'Brown', 'DO', 'Family Practice', '', '', NULL, 'O', '128 S 300 W', 'Bicknell', 'Wayne', 'UT', '84715', '4354253744', '4354253785', '128 S 300 W', 'Bicknell', 'Wayne', 'UT', '84715', '4354253744', '4354253785', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2006-10-01', '2011-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1205840642', 0, 'N', 0, '2013-12-18', NULL, NULL, 0, 0, NULL, NULL),
('870342259', 'S77001964', 'S77001964', 'UT01', 'Wayne Community Health Centers', 'Leland', 'J', 'Chappell', 'MD', 'Family Practice', '', '', NULL, 'O', '128 S 300 W', 'Bicknell', 'Wayne', 'UT', '84715', '4354253744', '4354253785', '128 S 300 W', 'Bicknell', 'Wayne', 'UT', '84715', '4354253744', '4354253785', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 8, '2006-10-01', NULL, 0, 0, 0, 'Sevier Valley Hospital', '', '', '', 'HCFA|UB|', '1447351424', 0, 'N', 0, '2010-09-03', NULL, NULL, 38.2989, -111.421, NULL, NULL),
('870342259', 'S77001965', 'S77001965', 'UT01', 'Wayne Community Health Centers', 'Joanna', '', 'Masi-Lynch', 'PA', 'Family Practice', '', '', NULL, 'B', 'PO Box 303', 'Bicknell', 'Wayne', 'UT', '84715', '4354253744', '4354253785', 'PO Box 303', 'Bicknell', 'Wayne', 'UT', '84715', '4354253744', '4354253785', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2006-10-01', '2011-11-07', NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '0000925126', 0, 'Y', 0, '2011-11-21', NULL, NULL, 0, 0, NULL, NULL),
('870342259', 'S77001966', 'S77001966', 'UT01', 'Wayne Community Health Centers', 'Anthony', 'F', 'Millward', 'PA', 'Family Practice', NULL, NULL, NULL, 'B', 'PO Box 303', 'Bicknell', 'Wayne', 'UT', '84715', '4354253744', '4354253785', NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-10-01', '2007-03-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '924549', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870344424', 'S77001967', 'S77001967', 'UT01', NULL, 'Ivan', 'W', 'Nelson', 'MD', 'Ear, Nose and Throat', NULL, NULL, NULL, 'O', '750 W 800 N', 'Orem', 'Utah', 'UT', '84057', '8017146000', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2007-04-08', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '833396', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870344927', 'S77001968', 'S77001968', 'UT01', 'Arbon, Robert A', 'Robert', 'A', 'Arbon', 'MD', 'Ear, Nose and Throat', NULL, NULL, NULL, 'O', '777 N 500 W Ste 105', 'Provo', 'Utah', 'UT', '84601', '8013754433', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '833397', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870346198', 'S77001969', 'S77001969', 'UT01', 'Rocky Mountain Associated Physicians', 'R', 'C', 'Halversen', 'MD', 'General Surgery', '', '', NULL, 'O', '1160 E 3900 S Ste 4100', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012683800', '8012683997', '1160 E 3900 S Ste 4100', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012683800', '8012683997', 'WCSTRMAP5', 'WUSTDSURG5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1275540585', 0, 'N', 0, '2013-10-04', NULL, NULL, 40.6871, -111.858, NULL, NULL),
('870347187', 'S77001970', 'S77001970', 'UT01', 'Utah Valley Eye Center', 'L Todd', NULL, 'Cook', 'MD', 'Ophthalmology', NULL, NULL, NULL, 'O', '1055 N 300 W Ste 204', 'Provo', 'Utah', 'UT', '84604', '8013577373', '8013577217', NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1801893375', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870351714', 'S77001972', 'S77001972', 'UT01', '', 'J', 'Barry', 'Nielsen', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '5770 S 250 E Ste 285', 'Murray', 'Salt Lake', 'UT', '84107', '8012682822', '8012682832', '5770 S 250 E', 'Murray', 'Salt Lake', 'UT', '84107', '8012682822', '8012682832', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', '2011-09-20', NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '0000833393', 0, 'N', 0, '2011-09-21', NULL, NULL, 0, 0, NULL, NULL),
('870354382', 'S77001973', 'S77001973', 'UT01', 'Berman and Siggard', 'John', 'F', 'Bermen', 'MD', 'Orthopedic Surgery', NULL, NULL, NULL, 'B', '3465 Pioneer Pkwy Ste 5', 'West Valley', 'Salt Lake', 'UT', '84120', '8019670282', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUSTDORTH5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2000-01-01', '2000-01-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1548351364', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870293594', 'S77001977', 'S77001977', 'UT01', 'Fit Quest Therapy', 'Sydney', 'D', 'Hicks', 'SPT', 'Speech Therapy', NULL, NULL, NULL, 'B', 'PO Box 150173', 'Ogden', 'Weber', 'UT', '84415', '8017823500', '8017861926', NULL, NULL, '', NULL, NULL, '', '', 'UDME', 'USTDHCPC', '2298', '0.00', '35.00', NULL, 3, '2006-04-01', '2006-04-01', 1, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '937295', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870293594', 'S77001979', 'S77001979', 'UT01', 'Fit Quest Therapy', 'David', NULL, 'Osteyee', 'PT', 'Physical Therapy', NULL, NULL, NULL, 'O', '275 N 300 W Ste 403', 'Kaysville', 'Davis', 'UT', '84037', '8015466868', '8015468225', NULL, NULL, '', NULL, NULL, '', '', 'UDME', 'USTDHCPC', '2298', '0.00', '35.00', NULL, 3, '2006-04-01', '2006-04-01', 1, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '834586', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870293594', 'S77001980', 'S77001980', 'UT01', 'Fit Quest Therapy', 'David', NULL, 'Osteyee', 'PT', 'Physical Therapy', NULL, NULL, NULL, 'B', 'PO Box 150173', 'Ogden', 'Weber', 'UT', '84415', '8017823500', '8017861926', NULL, NULL, '', NULL, NULL, '', '', 'UDME', 'USTDHCPC', '2298', '0.00', '35.00', NULL, 3, '2006-04-01', '2006-04-01', 1, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '834586', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870293873', 'S77001981', 'S77001981', 'UT01', 'Tri City Medical Clinic', 'Elwood', 'J', 'Corry', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '830 N 2000 W', 'Pleasant Grove', 'Utah', 'UT', '84062', '8017563511', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2007-03-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1609984988', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870302621', 'S77001983', 'S77001983', 'UT01', NULL, 'Douglas', 'S', 'Mehr', 'MD', 'Ophthalmology', NULL, NULL, NULL, 'O', '4400 S 700 E Ste 200', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8012644444', '8012812383', '4400 S 700 E', 'Salt Lake City', '', 'UT', '84107', '', '', 'WKRETINA', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2007-01-01', '2007-06-05', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1720070899', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870306625', 'S77001986', 'S77001986', 'UT01', 'H Ronald Brown DPM', 'H Ronald', NULL, 'Brown', 'DPM', 'Podiatry', NULL, NULL, NULL, 'B', '4370 S Redwood Rd', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8019673338', '8019670722', NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2000-01-01', '2000-01-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1619965225', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870286381', 'S77001987', 'S77001987', 'UT01', 'Ogden Clinic', 'David', 'W', 'Nemetz', 'MD', 'Family Practice', '', '', NULL, 'O', '5430 S 1900 W Ste G1', 'Roy', 'Weber', 'UT', '84067', '8017799975', NULL, '4650 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8017799975', '', 'WUOGDCLIN5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2006-08-01', NULL, NULL, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1811984800', 0, 'N', 0, '2011-07-15', NULL, NULL, 41.1651, -112.026, NULL, NULL),
('870286381', 'S77001988', 'S77001988', 'UT01', 'Ogden Clinic', 'Catherine', '', 'Ortega', 'PA', 'Family Practice', '', '', NULL, 'O', '1159 12th St', 'Ogden', 'Weber', 'UT', '84404', '8013343000', '8014762670', '1159 12th St', 'Ogden', 'Weber', 'UT', '84404', '8013343000', '8014762670', 'WUOGDCLIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-08-01', '2013-04-19', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1396734919', 0, 'N', 0, '2014-05-08', NULL, NULL, 0, 0, NULL, NULL),
('870286381', 'S77001989', 'S77001989', 'UT01', 'Ogden Clinic', 'Winston', 'N', 'Petersen', 'PA', 'Family Practice', NULL, NULL, NULL, 'O', '5430 S 1900 W Ste G1', 'Roy', 'Weber', 'UT', '84067', '8017799975', NULL, '4650 Harrison Blvd', 'Ogden', '', 'UT', '84403', '', '', 'WUOGDCLIN5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 6, '2006-08-01', '2007-07-11', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1194714717', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870286381', 'S77001990', 'S77001990', 'UT01', 'Ogden Clinic Physical Therapy', 'Jonathon', 'P', 'Rhodes', 'PT', 'Physical Therapy', '', '', NULL, 'B', '4650 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014794621', '8014762670', '4650 Harrison Blvd', 'Ogden', '', 'UT', '84403', '', '', '1838', NULL, NULL, '0.00', '0.00', '70.00', 6, '2006-08-01', '2009-04-30', NULL, 0, 0, '', '', '', '', 'HCFA|UB|', '1437148053', 0, 'Y', 0, '2010-03-29', NULL, NULL, 0, 0, NULL, NULL),
('870286381', 'S77001991', 'S77001991', 'UT01', 'Ogden Clinic', 'J', 'David', 'Schmitz', 'MD', 'Family Practice', NULL, NULL, NULL, 'B', '4650 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014794621', '8014762670', '4650 Harrison Blvd', 'Ogden', '', 'UT', '84403', '', '', 'WUOGDCLIN5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2006-08-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1891782819', 0, 'y', 0, '2006-07-31', NULL, NULL, 0, 0, NULL, NULL),
('870286381', 'S77001995', 'S77001995', 'UT01', 'Ogden Clinic', 'Larry', 'O', 'Smithing', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '4650 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014794621', '8014762670', '4650 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014794621', '8014762670', 'WUOGDCLIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-08-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1609864461', 0, 'N', 0, '2014-07-25', NULL, NULL, 41.1787, -111.949, NULL, NULL),
('870286381', 'S77001996', 'S77001996', 'UT01', 'Ogden Clinic', 'Jeffery', 'T', 'Sorensen', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '4350 Washington Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014765100', NULL, '4350 Washington Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014765100', '          ', 'WUOGDCLIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-08-01', '2012-01-01', 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1508853425', 0, 'N', 0, '2012-09-07', NULL, NULL, 0, 0, NULL, NULL),
('870286381', 'S77001997', 'S77001997', 'UT01', 'Ogden Clinic', 'Karen', NULL, 'Vastardis', 'FNP', 'Family Practice', NULL, NULL, NULL, 'O', '1159 12th St', 'Ogden', 'Weber', 'UT', '84404', '8013343000', '8014762670', '1159 12th St', 'Ogden', 'Weber', 'UT', '84404', '8013343000', '8014762670', 'WUOGDCLIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-08-01', '2013-08-28', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1487643011', 0, 'N', 0, '2013-09-20', NULL, NULL, 0, 0, NULL, NULL),
('870286381', 'S77001999', 'S77001999', 'UT01', 'Ogden Clinic', 'Michelle', NULL, 'Wasden', 'PA', 'Family Practice', NULL, NULL, NULL, 'O', '1159 12th St', 'Ogden', 'Weber', 'UT', '84404', '8013343000', '8014762670', '4650 Harrison Blvd', 'Ogden', '', 'UT', '84403', '', '', 'WUOGDCLIN5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2006-08-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1700875333', 0, 'N', 0, '2006-07-31', NULL, NULL, 41.244, -111.95, NULL, NULL),
('870286381', 'S77002001', 'S77002001', 'UT01', 'Ogden Clinic', 'John', 'S', 'Wolthuis', 'MD', 'Urology', '', '', NULL, 'O', '4650 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014794621', '8014762670', '4650 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014794621', '8014762670', 'WUOGDCLIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-08-01', '2011-12-31', 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1093703811', 0, 'N', 0, '2013-12-30', NULL, NULL, 0, 0, NULL, NULL),
('870354442', 'S77002002', 'S77002002', 'UT01', 'Rocky Mountain Womens Health Center', 'Teresa', 'V', 'Durbin', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1580 W Antelope Dr Ste 290', 'Layton', 'Davis', 'UT', '84041', '8017760880', NULL, '1580 W Antelope Dr Ste 290', 'Layton', 'Davis', 'UT', '84041', '8017760880', '', 'WRYMTWOM', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2007-01-01', '2014-04-30', 0, 0, 0, 'Davis Hospital', '', '', '', 'HCFA|UB|', '1609987791', 0, 'N', 0, '2014-04-02', NULL, NULL, 41.0893, -111.994, NULL, NULL),
('870354442', 'S77002004', 'S77002004', 'UT01', 'Rocky Mountain Womens Health Center', 'Charles', 'W', 'Joseph', 'MD', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'B', '1580 W Antelope Dr Ste 280', 'Layton', 'Davis', 'UT', '84041', '8017730925', NULL, '1580 W Antelope Dr', 'Layton', '', 'UT', '84041', '', '', 'WRYMTWOM', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2000-01-01', '2000-01-01', 0, NULL, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1609978238', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870354442', 'S77002005', 'S77002005', 'UT01', 'Rocky Mountain Womens Health Center', 'Kristine', 'M', 'Zelenkov', 'MD', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'B', '1580 W Antelope Dr Ste 280', 'Layton', 'Davis', 'UT', '84041', '8017730925', NULL, '1580 W Antelope Dr', 'Layton', '', 'UT', '84041', '', '', 'WRYMTWOM', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2000-01-01', '2000-01-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1326159427', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870354511', 'S77002006', 'S77002006', 'UT01', '', 'H Gary', '', 'Morley', 'DPM', 'Podiatry', NULL, NULL, NULL, 'O', '1275 N University Ave Ste 12', 'Provo', 'Utah', 'UT', '84604', '8013746900', NULL, '1275 N University Ave', 'Provo', 'Utah', 'UT', '84604', '8013746900', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-09-01', '2011-10-27', NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1790726487', 0, 'N', 0, '2011-10-27', NULL, NULL, 0, 0, NULL, NULL),
('870354511', 'S77002007', 'S77002007', 'UT01', 'Morley, H Gary', 'H', 'Gary', 'Morley', 'DPM', 'Podiatry', NULL, NULL, NULL, 'O', '830 N 2000 W', 'Pleasant Grove', 'Utah', 'UT', '84062', '8013746900', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-09-01', '2006-09-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1790726487', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870354540', 'S77002008', 'S77002008', 'UT01', 'ENT Specialists', 'David', 'K', 'Palmer', 'MD', 'Ear, Nose and Throat', NULL, NULL, NULL, 'O', '196 W 2000 N Ste A-100', 'Tooele', 'Tooele', 'UT', '84074', '4358826448', NULL, '4000 S 700 E', 'Salt Lake City', 'Tooele', 'UT', '84107', '4358826448', '', 'WUSTDENT5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-12-01', NULL, NULL, 0, 0, 'Mountain West Medical Center', 'St Marks Hospital', NULL, NULL, 'HCFA|UB|', '1427018191', 0, 'N', 0, '2012-02-06', NULL, NULL, 40.5655, -112.302, NULL, NULL),
('870354540', 'S77002009', 'S77002009', 'UT01', 'ENT Specialists', 'David', 'K', 'Palmer', 'MD', 'Ear, Nose and Throat', NULL, NULL, NULL, 'O', '4000 S 700 E Ste 10', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8012684141', '8012618609', '4000 S 700 E', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8012684141', '8012618609', 'WUSTDENT5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-12-01', NULL, NULL, 0, 0, 'Mountain West Medical Center', 'St Marks Hospital', NULL, NULL, 'HCFA|UB|', '1427018191', 0, 'N', 0, '2012-02-06', NULL, NULL, 40.6857, -111.871, NULL, NULL),
('870354960', 'S77002010', 'S77002010', 'UT01', NULL, 'John', 'R', 'Shakula', 'MD', 'Pediatrics', NULL, NULL, NULL, 'O', '9720 S 1300 E Ste W120', 'Sandy', 'Salt Lake', 'UT', '84094', '8015710423', '8015710081', '9720 S 1300 E Ste W120', 'Sandy', 'Salt Lake', 'UT', '84094', '8015710423', '8015710081', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'Primary Childrens Medical Center', '', '', '', 'HCFA|UB|', '1235179375', 0, 'N', 0, '2012-05-25', NULL, NULL, 40.5739, -111.853, NULL, NULL),
('870355239', 'S77002011', 'S77002011', 'UT01', 'Advanced Eye Care', 'Francis', 'J', 'Wapner', 'MD', 'Ophthalmology', '', '', NULL, 'O', '1250 E 3900 S Ste 310', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012632020', NULL, '1250 E 3900 S Ste 310', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012632020', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-10-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1023110681', 0, 'N', 0, '2013-08-23', NULL, NULL, 40.6871, -111.856, NULL, NULL),
('870355879', 'S77002012', 'S77002012', 'UT01', 'Insight Eye Specialists', 'Christian', 'L', 'Hess', 'MD', 'Ophthalmology', '', '', NULL, 'O', '2255 N 1700 W Ste 100', 'Layton', 'Davis', 'UT', '84041', '8017730690', NULL, '1660 W Antelope Dr', 'Layton', 'Davis', 'UT', '84041', '8017730690', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, NULL, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1073505319', 0, 'N', 0, '2010-12-21', NULL, NULL, 41.0887, -111.997, NULL, NULL),
('870355954', 'S77002013', 'S77002013', 'UT01', 'Rocky Mountain Eye Center', 'O Claron', '', 'Alldredge', 'MD', 'Ophthalmology', '', '', NULL, 'O', '4400 S 700 E Ste 140', 'Murray', 'Salt Lake', 'UT', '84107', '8012880067', '8012880091', '4400 S 700 E', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8012880067', '8012880091', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-10-01', '2010-10-01', NULL, 0, NULL, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1780685412', 0, 'N', 0, '2011-10-05', NULL, NULL, 0, 0, NULL, NULL),
('870357016', 'S77002015', 'S77002015', 'UT01', 'Hughes, Dennis C', 'Dennis', 'C', 'Hughes', 'MD', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'B', '3970 S 700 E Ste 14', 'Murray', 'Salt Lake', 'UT', '84107', '8012613605', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-10-01', '2006-10-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1427027051', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870306646', 'S77002016', 'S77002016', 'UT01', 'Emergency Physicians Group', 'Julie', 'A', 'Fox', 'DO', 'Emergency Medicine', '', '', NULL, 'O', '1200 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012687129', NULL, '1200 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012687129', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, NULL, 0, 0, '', '', '', '', 'HCFA|UB|', '1659380624', 0, 'Y', 0, '2011-07-19', NULL, NULL, 40.6871, -111.856, NULL, NULL),
('870306646', 'S77002018', 'S77002018', 'UT01', 'Emergency Physicians Group', 'Debra', 'Sue', 'Martin', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '1200 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012687129', NULL, '1200 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012687129', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', '2010-12-31', NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1972543684', 0, 'Y', 0, '2011-07-19', NULL, NULL, 0, 0, NULL, NULL),
('870306646', 'S77002019', 'S77002019', 'UT01', 'Emergency Physicians Group', 'Robert', 'J', 'Munson', 'MD', 'Emergency Medicine', NULL, NULL, NULL, 'O', '425 Medical Dr Ste 101', 'Bountiful', 'Davis', 'UT', '84010', '8012961700', NULL, '1200 E 3900 S', 'Salt Lake City', '', 'UT', '84124', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2006-11-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1518908805', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870306646', 'S77002020', 'S77002020', 'UT01', 'Emergency Physicians Group', 'Robert', 'J', 'Munson', 'MD', 'Emergency Medicine', '', '', NULL, 'B', 'PO Box 95970', 'South Jordan', 'Salt Lake', 'UT', '84095', NULL, NULL, '1200 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, NULL, 0, 0, '', '', '', '', 'HCFA|UB|', '1518908805', 0, 'Y', 0, '2011-07-19', NULL, NULL, 0, 0, NULL, NULL),
('870306646', 'S77002022', 'S77002022', 'UT01', 'Emergency Physicians Group', 'Amie', '', 'Nielsen', 'MD', 'Emergency Medicine', '', '', NULL, 'B', 'PO Box 95970', 'South Jordan', 'Salt Lake', 'UT', '84095', '8012687975', '8013529502', '1200 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012687975', '8013529502', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, NULL, 0, 0, '', '', '', '', 'HCFA|UB|', '1891718656', 0, 'Y', 0, '2011-07-19', NULL, NULL, 0, 0, NULL, NULL),
('870306646', 'S77002023', 'S77002023', 'UT01', 'Emergency Physicians Group', 'Tammy', '', 'Park', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '1200 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012687975', NULL, '1200 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012687975', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, NULL, 0, 0, '', '', '', '', 'HCFA|UB|', '1043246036', 0, 'Y', 0, '2011-07-19', NULL, NULL, 40.6871, -111.856, NULL, NULL),
('870306646', 'S77002024', 'S77002024', 'UT01', 'Emergency Physicians Group', 'Tammy', '', 'Park', 'MD', 'Emergency Medicine', '', '', NULL, 'B', 'PO Box 95970', 'South Jordan', 'Salt Lake', 'UT', '84095', NULL, NULL, '1200 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, NULL, 0, 0, '', '', '', '', 'HCFA|UB|', '1043246036', 0, 'Y', 0, '2011-07-19', NULL, NULL, 0, 0, NULL, NULL),
('870306646', 'S77002025', 'S77002025', 'UT01', 'Emergency Physicians Group', 'Celeste', 'E', 'Raffin', 'MD', 'Emergency Medicine', NULL, NULL, NULL, 'O', '1200 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012687129', NULL, '1200 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012687129', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1174552863', 0, 'Y', 0, '2013-09-12', NULL, NULL, 40.6871, -111.856, NULL, NULL),
('870306646', 'S77002027', 'S77002027', 'UT01', 'Emergency Physicians Group', 'Mark', 'E', 'Stevens', 'MD', 'Emergency Medicine', '', '', NULL, 'B', 'PO Box 95970', 'South Jordan', 'Salt Lake', 'UT', '84095', NULL, NULL, '1200 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, NULL, 0, 0, '', '', '', '', 'HCFA|UB|', '1861433880', 0, 'Y', 0, '2011-07-19', NULL, NULL, 0, 0, NULL, NULL),
('870306646', 'S77002028', 'S77002028', 'UT01', 'Emergency Physicians Group', 'Karl', NULL, 'Vizmeg', 'MD', 'Emergency Medicine', NULL, NULL, NULL, 'B', 'PO Box 95970', 'South Jordan', 'Salt Lake', 'UT', '84095', NULL, NULL, '1200 E 3900 S', 'Salt Lake City', '', 'UT', '84124', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2007-01-01', 0, NULL, 0, 'Mountain View Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1427161363', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870306646', 'S77002029', 'S77002029', 'UT01', 'Emergency Physicians Group', 'Richard', 'D', 'Wallin', 'MD', 'Emergency Medicine', NULL, NULL, NULL, 'O', '1200 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012687129', NULL, '1200 E 3900 S', 'Salt Lake City', '', 'UT', '84124', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2007-01-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '833269', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870286381', 'S77002030', 'S77002030', 'UT01', 'Ogden Clinic Physical Therapy', 'Dorian', 'M', 'Wood', 'PT', 'Physical Therapy', '', '', NULL, 'O', '4700 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014757010', '8014762670', '4700 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014757010', '8014762670', '1838', '', '', '0.00', '0.00', '70.00', 6, '2006-08-01', '2009-04-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1376532911', 0, 'N', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('870286381', 'S77002031', 'S77002031', 'UT01', 'Ogden Clinic', 'Robert', 'H', 'Ziegler', 'MD', 'Gastroenterology', '', '', NULL, 'O', '4650 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014794621', '8014762670', '4650 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014794621', '8014762670', 'WUOGDCLIN5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2006-08-01', NULL, NULL, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1972591790', 0, 'N', 0, '2011-09-12', NULL, NULL, 41.1787, -111.949, NULL, NULL),
('870288569', 'S77002032', 'S77002032', 'UT01', 'CJ Graham, MD', 'C James', '', 'Graham', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box K', 'Hyrum', 'Cache', 'UT', '84319', '8012456451', NULL, 'PO Box K', 'Hyrum', 'Cache', 'UT', '84319', '8012456451', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-10-01', NULL, 0, 0, 0, 'Logan Regional Hospital', '', '', '', 'HCFA|UB|', '1346313046', 0, 'Y', 0, '2014-03-20', NULL, NULL, 0, 0, NULL, NULL),
('870288620', 'S77002033', 'S77002033', 'UT01', 'Utah Orthopaedic Associates', 'David', 'E', 'Curtis', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1250 E 3900 S Ste 440', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012612232', NULL, '1250 E 3900 S Ste 440', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012612232', '', 'WUSTDORTH5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1730222720', 0, 'N', 0, '2012-06-25', NULL, NULL, 40.6871, -111.856, NULL, NULL),
('870292535', 'S77002036', 'S77002036', 'UT01', '', 'Mark', 'A', 'Fullmer', 'MD', 'General Surgery', '', '', NULL, 'O', '1055 N 300 W Ste 304', 'Provo', 'Utah', 'UT', '84604', '8013577171', NULL, '1055 N 300 W Ste 304', 'Provo', 'Utah', 'UT', '84604', '8013577171', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-10-01', '2013-02-20', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1457420853', 0, 'N', 0, '2013-02-20', NULL, NULL, 0, 0, NULL, NULL),
('870293534', 'S77002037', 'S77002037', 'UT01', 'Neurosurgical Clinic Of Utah', 'Robert', 'S', 'Hood', 'MD', 'Neurosurgery', '', '', NULL, 'O', '24 S 1100 E Ste 302', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015317806', NULL, '24 S 1100 E', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015317806', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-10-01', '2011-11-01', NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1518973767', 0, 'N', 0, '2011-10-04', NULL, NULL, 0, 0, NULL, NULL),
('870358327', 'S77002040', 'S77002040', 'UT01', 'Olympus Clinic', 'Jon', 'T', 'Wall', 'MD', 'Family Practice', '', '', NULL, 'O', '4624 Holladay Blvd', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8012772682', '8012772980', '4624 Holladay Blvd', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8012772682', '8012772980', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-06-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1528006491', 0, 'N', 0, '2014-01-22', NULL, NULL, 40.6703, -111.826, NULL, NULL),
('870359334', 'S77002041', 'S77002041', 'UT01', '', 'A Patrick', '', 'Rose', 'MD', 'Pediatric Cardiology', 'Pediatrics', '', NULL, 'O', '5495 S 500 E Ste 330', 'Ogden', 'Weber', 'UT', '84405', '8014762717', NULL, '5495 S 500 E Ste 330', 'Ogden', 'Weber', 'UT', '84405', '8014762717', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', '2012-03-31', 0, 0, 0, 'Ogden Regional Medical Center', 'Brigham City Community Hospital ', '', '', 'HCFA|UB|', '1326002973', 0, 'N', 0, '2012-03-15', NULL, NULL, 0, 0, NULL, NULL),
('870362338', 'S77002043', 'S77002043', 'UT01', NULL, 'Dwight', 'H', 'Inouye', 'MD', 'Family Practice', '', '', NULL, 'O', '85 N 100 E', 'Gunnison', 'Sanpete', 'UT', '84634', '4355287202', '4355283624', '85 N 100 E', 'Gunnison', 'Sanpete', 'UT', '84634', '4355287202', '4355283624', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'Gunnison Valley Hospital', '', '', '', 'HCFA|UB|', '1497871099', 0, 'N', 0, '2014-06-04', NULL, NULL, 39.1564, -111.815, NULL, NULL),
('870364697', 'S77002046', 'S77002046', 'UT01', 'Mountain View Womens Care', 'W', 'L', 'Warner', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1120 E 100 N Ste 3', 'Payson', 'Utah', 'UT', '84651', '8014652559', NULL, '1120 E 100 N Ste 3', 'Payson', 'Utah', 'UT', '84651', '8014652559', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-06-01', '2008-09-30', 0, 0, 0, 'Mountain View Hospital', '', '', '', 'HCFA|UB|', '1508954348', 0, 'N', 0, '2013-07-31', NULL, NULL, 0, 0, NULL, NULL),
('870364697', 'S77002047', 'S77002047', 'UT01', 'Mountain View Womens Care', 'W', 'Lawrence', 'Warner', 'MD', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'B', '1120 E 100 N', 'Payson', 'Utah', 'UT', '84651', '8014652559', NULL, '1120 E 100 N', 'Payson', '', 'UT', '84651', '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2007-03-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1508954348', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870364964', 'S77002048', 'S77002048', 'UT01', '', 'Stewart', 'L', 'Ellington', 'MD', 'Gastroenterology', 'Internal Medicine', '', NULL, 'O', '24 S 1100 E Ste 103', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013645767', NULL, '24 S 1100 E Ste 103', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013645767', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-12-01', '2013-10-08', 0, 0, 0, 'Salt Lake Regional Medical Center', '', '', '', 'HCFA|UB|', '1437179041', 0, 'N', 0, '2013-10-11', NULL, NULL, 0, 0, NULL, NULL),
('870365762', 'S77002049', 'S77002049', 'UT01', 'Crestwood Medical Group', 'John', 'B', 'Taylor', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 347', 'Kaysville', 'Davis', 'UT', '84037', '8015461273', NULL, '47 Crestwood Rd', 'Kaysville', 'Davis', 'UT', '84037', '8015461273', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-12-01', '2008-09-01', NULL, 0, 0, '', '', '', '', 'HCFA|UB|', '1730270760', 0, 'Y', 0, '2011-01-19', NULL, NULL, 0, 0, NULL, NULL),
('870306646', 'S77002050', 'S77002050', 'UT01', 'Emergency Physicians Group', 'Shari', 'J', 'Welch', 'MD', 'Emergency Medicine', NULL, NULL, NULL, 'B', 'PO Box 95970', 'South Jordan', 'Salt Lake', 'UT', '84095', NULL, NULL, '1200 E 3900 S', 'Salt Lake City', '', 'UT', '84124', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2007-01-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '832952', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870308023', 'S77002051', 'S77002051', 'UT01', 'Middleton Urological Assoc', 'Gary', 'Blake', 'Johnson', 'MD', 'Urology', '', '', NULL, 'O', '1060 E 100 S Ste 110', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015319453', '8015319453', '1060 E 100 S Ste 110', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015319453', '8015319453', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', '', '', '', 'HCFA|UB|', '1144223827', 0, 'N', 0, '2014-06-17', NULL, NULL, 40.7672, -111.861, NULL, NULL),
('870308867', 'S77002053', 'S77002053', 'UT01', NULL, 'Lee', 'J', 'Malan', 'MD', 'Plastic Surgery', NULL, NULL, NULL, 'O', '3955 Harrison Blvd Ste U1', 'Ogden', 'Weber', 'UT', '84403', '8016213591', '8013930836', '3955 Harrison Blvd', 'Ogden', '', 'UT', '84403', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1033126271', 0, 'N', 0, '2006-12-11', NULL, NULL, 41.191, -111.949, NULL, NULL),
('870310259', 'S77002054', 'S77002054', 'UT01', NULL, 'Colin', 'K', 'Kelly', 'MD', 'Pediatrics', '', '', NULL, 'O', '1250 E 3900 S Ste 250', 'Salt Lake City', 'Salt Lake', 'UT', '84125', '8012686283', NULL, '1250 E 3900 S Ste 250', 'Salt Lake City', 'Salt Lake', 'UT', '84125', '8012686283', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-10-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1093862088', 0, 'N', 0, '2014-01-17', NULL, NULL, 40.6871, -111.856, NULL, NULL),
('870319604', 'S77002055', 'S77002055', 'UT01', NULL, 'Steven', 'J', 'Anderson', 'MD', 'Rheumatology', '', '', NULL, 'O', '1151 E 3900 S Ste 275', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012622452', NULL, '1151 E 3900 S Ste 275', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012622452', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1275528986', 0, 'N', 0, '2013-10-24', NULL, NULL, 40.6871, -111.858, NULL, NULL),
('870323929', 'S77002062', 'S77002062', 'UT01', '', 'G', 'S', 'Jessen', 'DDS', 'Oral/Maxillofacial Surgery', 'Oral Surgeon', '', NULL, 'O', '30 E 700 S', 'Brigham City', 'Box Elder', 'UT', '84302', '8008606260', NULL, '30 E 700 S', 'Brigham City', 'Box Elder', 'UT', '84302', '8008606260', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-11-01', '2011-12-31', 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|DEN|', '1548349251', 0, 'N', 0, '2012-08-23', NULL, NULL, 0, 0, NULL, NULL),
('870324719', 'S77002063', 'S77002063', 'UT01', 'Utah Neurological Clinic', 'Lynn', 'M', 'Gaufin', 'MD', 'Neurosurgery', '', '', NULL, 'O', '1055 N 300 W Ste 400', 'Provo', 'Utah', 'UT', '84604', '8013577404', '8013577587', '1055 N 300 W Ste 400', 'Provo', 'Utah', 'UT', '84604', '8013577404', '8013577587', 'WUSTDNEUR5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-06-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1205857158', 0, 'N', 0, '2014-04-23', NULL, NULL, 40.2476, -111.664, NULL, NULL),
('870293534', 'S77002064', 'S77002064', 'UT01', 'Neurosurgical Clinic of Utah', 'Jodie', 'K', 'Levitt', 'MD', 'Neurosurgery', NULL, NULL, NULL, 'O', '24 S 1100 E Ste 302', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015317806', NULL, '24 S 1100 E Ste 302', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015317806', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-10-01', '2008-08-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1053325365', 0, 'N', 0, '2012-05-07', NULL, NULL, 0, 0, NULL, NULL),
('870293594', 'S77002065', 'S77002065', 'UT01', 'Fit Quest Therapy', 'Therapy', NULL, 'Fit Quest', 'GROUP', 'Physical Therapy', 'Occupational Therapy', 'Speech Therapy', NULL, 'O', '1885 Skyline Dr', 'South Ogden', 'Weber', 'UT', '84403', '8014764141', NULL, NULL, NULL, '', NULL, NULL, '', '', 'UDME', 'USTDHCPC', '2298', '0.00', '35.00', NULL, 3, '2006-04-01', '2006-04-01', 1, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '834838', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870293594', 'S77002066', 'S77002066', 'UT01', 'Fit Quest Therapy', 'Therapy', NULL, 'Fit Quest', 'GROUP', 'Physical Therapy', 'Occupational Therapy', 'Speech Therapy', NULL, 'O', '275 N 300 W Ste 403', 'Kaysville', 'Davis', 'UT', '84037', '8015466868', NULL, NULL, NULL, '', NULL, NULL, '', '', 'UDME', 'USTDHCPC', '2298', '0.00', '35.00', NULL, 3, '2006-04-01', '2006-04-01', 1, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '834838', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870293594', 'S77002068', 'S77002068', 'UT01', 'Fit Quest Therapy', 'Ken', NULL, 'Colledge', 'PT', 'Physical Therapy', NULL, NULL, NULL, 'O', '2120 N 400 E', 'North Ogden', 'Weber', 'UT', '84414', '8017823500', '8017861926', NULL, NULL, '', NULL, NULL, '', '', 'UDME', 'USTDHCPC', '2298', '0.00', '35.00', NULL, 3, '2006-04-01', '2006-04-01', 1, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '833745', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870293594', 'S77002069', 'S77002069', 'UT01', 'Fit Quest Therapy', 'Ken', NULL, 'Colledge', 'PT', 'Physical Therapy', NULL, NULL, NULL, 'B', 'PO Box 150173', 'Ogden', 'Weber', 'UT', '84415', '8017823500', '8017861926', NULL, NULL, '', NULL, NULL, '', '', 'UDME', 'USTDHCPC', '2298', '0.00', '35.00', NULL, 3, '2006-04-01', '2006-04-01', 1, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '833745', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870293594', 'S77002072', 'S77002072', 'UT01', 'Fit Quest Therapy', 'Monte', 'R', 'Zundel', 'PT', 'Physical Therapy', NULL, NULL, NULL, 'O', '2120 N 400 E', 'North Ogden', 'Weber', 'UT', '84414', '8017823500', '8017861926', NULL, NULL, '', NULL, NULL, '', '', 'UDME', 'USTDHCPC', '2298', '0.00', '35.00', NULL, 3, '2006-04-01', '2006-04-01', 1, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '832129', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870293873', 'S77002073', 'S77002073', 'UT01', 'Tri City Medical Clinic', 'Ruth', 'A', 'Hooper', 'FNP', 'Family Practice', NULL, NULL, NULL, 'O', '830 N 2000 W', 'Pleasant Grove', 'Utah', 'UT', '84062', '8017563511', NULL, '830 N 2000 W', 'Pleasant Grove', '', 'UT', '84062', '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-06-01', '2008-04-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000831074', 0, 'N', 0, '2006-10-17', NULL, NULL, 0, 0, NULL, NULL),
('870293873', 'S77002074', 'S77002074', 'UT01', 'Tri City Medical Clinic', 'Melinda', 'M', 'Midgley', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '830 N 2000 W', 'Pleasant Grove', 'Utah', 'UT', '84062', '8017563511', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1760587653', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870302621', 'S77002077', 'S77002077', 'UT01', 'Rocky Mountain Retina Consultants', 'David', 'W', 'Faber', 'MD', 'Ophthalmology', NULL, NULL, NULL, 'B', '4400 S 700 E Ste 200', 'Murray', 'Salt Lake', 'UT', '84107', '8012644444', '8012812383', NULL, NULL, '', NULL, NULL, '', '', 'WKRETINA', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2007-01-01', '2007-01-01', 0, NULL, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1811990450', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870371831', 'S77002078', 'S77002078', 'UT01', NULL, 'Grant', 'L', 'Christian', 'MD', 'Internal Medicine', '', '', NULL, 'O', '425 Medical Dr Ste 118', 'Bountiful', 'Davis', 'UT', '84010', '8012921422', NULL, '425 Medical Dr Ste 118', 'Bountiful', 'Davis', 'UT', '84010', '8012921422', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'Lakeview Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1073671442', 0, 'N', 0, '2013-11-04', NULL, NULL, 40.8873, -111.872, NULL, NULL),
('529661977', 'S77002079', 'S77002079', 'UT01', NULL, 'Paul', 'N', 'Daniels', 'DPM', 'Podiatry', '', '', NULL, 'O', '1449 E 3300 S', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8014831015', '8014842875', '1449 E 3300 S', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8014831015', '8014842875', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-10-01', NULL, 0, 0, 0, 'Evanston Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1760499180', 0, 'N', 0, '2013-07-10', NULL, NULL, 40.6999, -111.849, NULL, NULL),
('870372827', 'S77002081', 'S77002081', 'UT01', NULL, 'Sherry', '', 'Edon', 'CRNA', 'Anesthesiology', NULL, NULL, NULL, 'B', '1954 E Fort Union Blvd Ste 107', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019939506', NULL, '1954 E Fort Union Bvld', 'Salt Lake City', '', 'UT', '84121', '', '', NULL, NULL, '1000', '47.75', NULL, NULL, 3, '2007-01-01', '2007-03-01', 1, 12, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', NULL, 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870372827', 'S77002085', 'S77002085', 'UT01', NULL, 'Trevor', 'K', 'Tomlinson', 'CRNA', 'Anesthesiology', NULL, NULL, NULL, 'B', '1954 E Fort Union Blvd Ste 107', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019939506', NULL, '1954 E Fort Union Bvld', 'Salt Lake City', '', 'UT', '84121', '', '', NULL, NULL, '1000', '47.75', NULL, NULL, 3, '2007-01-01', '2007-03-01', 1, 12, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', NULL, 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870373083', 'S77002086', 'S77002086', 'UT01', 'Heart And Lung Institute', 'Ali', NULL, 'Ahmed', 'MD', 'Internal Medicine', 'Pulmonary', NULL, NULL, 'O', '3570 W 9000 S Ste 110', 'West Jordan', 'Salt Lake', 'UT', '84088', '8012330140', '8012633887', NULL, NULL, '', NULL, NULL, '', '', 'WUSTDCARD5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-10-01', '2006-10-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1013994813', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870373083', 'S77002087', 'S77002087', 'UT01', 'Heart and Lung Institute', 'David', 'G', 'Dienhart', 'MD', 'Pulmonary', 'Sleep Medicine', 'Critical Care', NULL, 'O', '5979 S Fashion Blvd', 'Murray', 'Salt Lake', 'UT', '84107', '8012632370', '8012651200', '5979 S Fashion Blvd', 'Murray', 'Salt Lake', 'UT', '84107', '8012632370', '8012651200', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-10-01', '2011-04-01', 0, 0, 0, 'Jordan Valley Medical Center', '', '', '', 'HCFA|UB|', '1184601940', 0, 'N', 0, '2013-12-10', NULL, NULL, 0, 0, NULL, NULL),
('870326862', 'S77002089', 'S77002089', 'UT01', 'Ogden Womens Clinic', 'Jeffrey', 'T', 'Arrington', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '4403 Harrison Blvd Ste 4650', 'Ogden', 'Weber', 'UT', '84403', '8013874400', NULL, '4403 Harrison Blvd Ste 4650', 'Ogden', 'Weber', 'UT', '84403', '8013874400', '', 'Wise+', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-10-01', '2012-12-31', 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1063472280', 0, 'N', 0, '2014-03-28', NULL, NULL, 0, 0, NULL, NULL),
('870326862', 'S77002090', 'S77002090', 'UT01', 'Ogden Womens Clinic', 'Rosemary', 'T', 'Lesser', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '4403 Harrison Blvd Ste 4650', 'Ogden', 'Weber', 'UT', '84403', '8013874400', NULL, '4403 Harrison Bvld', 'Ogden', 'Weber', 'UT', '84403', '8013874400', '', 'Wise+', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-10-01', NULL, NULL, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1407824667', 0, 'N', 0, '2010-10-18', NULL, NULL, 41.1828, -111.949, NULL, NULL),
('870326862', 'S77002091', 'S77002091', 'UT01', 'Ogden Womens Clinic', 'Heather', 'D', 'Major', 'MD', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'O', '4403 Harrison Blvd Ste 4650', 'Ogden', 'Weber', 'UT', '84403', '8013874400', NULL, '4403 Harrison Bvld', 'Ogden', '', 'UT', '84403', '', '', 'Wise+', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-10-01', '2007-06-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1700860350', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870326862', 'S77002092', 'S77002092', 'UT01', 'Ogden Womens Clinic', 'Fred', 'G', 'Seale', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '4403 Harrison Blvd Ste 4650', 'Ogden', 'Weber', 'UT', '84403', '8013874400', '8013874410', '4403 Harrison Blvd Ste 4650', 'Ogden', 'Weber', 'UT', '84403', '8013874400', '8013874410', 'Wise+', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-10-01', '2012-12-31', 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1518962794', 0, 'N', 0, '2012-12-06', NULL, NULL, 0, 0, NULL, NULL),
('870326862', 'S77002093', 'S77002093', 'UT01', 'Ogden Womens Clinic', 'Scott', 'D', 'Swift', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '4403 Harrison Blvd Ste 4650', 'Ogden', 'Weber', 'UT', '84403', '8013874400', '', '4403 Harrison Blvd Ste 4650', 'Ogden', 'Weber', 'UT', '84403', '8013874400', '', 'Wise+', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-10-01', '2012-12-31', 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1568445807', 0, 'N', 0, '2014-07-25', NULL, NULL, 0, 0, NULL, NULL),
('870328528', 'S77002094', 'S77002094', 'UT01', NULL, 'J Preston', '', 'Hughes', 'MD', 'Colon and Rectal Surgery', '', '', NULL, 'O', '1250 E 3900 S Ste 320', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012661409', NULL, '1250 E 3900 S Ste 320', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012661409', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-09-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1982631123', 0, 'N', 0, '2013-10-23', NULL, NULL, 40.6871, -111.856, 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
('870330589', 'S77002095', 'S77002095', 'UT01', 'American Fork Hospital', 'Val', 'D', 'Dunn', 'MD', 'Radiologist', '', '', NULL, 'O', '120 N 1100 E', 'American Fork', 'Utah', 'UT', '84003', NULL, NULL, '120 N 1100 E', 'American Fork', 'Utah', 'UT', '840032952', '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-06-01', NULL, NULL, 0, 0, '', '', '', '', 'HCFA|UB|', '1215975552', 0, 'Y', 0, '2010-12-28', NULL, NULL, 0, 0, NULL, NULL),
('870333048', 'S77002101', 'S77002101', 'UT01', 'Mountain View Hospital Pro Fees', NULL, NULL, 'Mountain View Hospit', 'GROUP', 'Multi Specialty (Clinic)', NULL, NULL, NULL, 'O', '1000 E 100 N', 'Payson', 'Utah', 'UT', '84651', '8014659201', NULL, NULL, NULL, '', NULL, NULL, '', '', NULL, NULL, NULL, '0.00', '40.00', NULL, 3, '2006-10-01', '2006-10-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '833270', 0, 'y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870333048', 'S77002102', 'S77002102', 'UT01', 'Physical & Sports Therapy', 'Brian', NULL, 'Lambert', 'PT', 'Physical Therapy', NULL, NULL, NULL, 'O', '1000 E 100 N', 'Payson', 'Utah', 'UT', '84651', '8014657070', NULL, NULL, NULL, '', NULL, NULL, '', '', NULL, NULL, NULL, '0.00', '0.00', NULL, 3, '2006-10-01', '2006-10-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '833488', 0, 'n', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870333610', 'S77002103', 'S77002103', 'UT01', NULL, 'E', 'Keith', 'Hansen', 'MD', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'O', '9600 S 1300 E Ste 305', 'Sandy', 'Salt Lake', 'UT', '84094', '8015725808', NULL, '9600 S 1300 E', 'Sandy', '', 'UT', '84094', '', '', 'Wise+', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-09-01', '2010-03-12', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1558471946', 0, 'N', 0, '2007-01-26', NULL, NULL, 0, 0, NULL, NULL),
('870305037', 'S77002105', 'S77002105', 'UT01', 'Nelson, John C', 'Russell', 'B', 'Jackson', 'OD', 'Optometry', NULL, NULL, NULL, 'O', '3465 Pioneer Pkwy Ste 4', 'West Valley', 'Salt Lake', 'UT', '84120', '8019660081', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUTALBERT5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-10-01', '2006-10-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1922008663', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870305037', 'S77002106', 'S77002106', 'UT01', '', 'Michael', 'F', 'Pingree', 'MD', 'Ophthalmology', '', '', NULL, 'O', '3465 Pioneer Pkwy Ste 5', 'West Valley', 'Salt Lake', 'UT', '84120', '8019660081', '8019660218', '3465 Pioneer Pkwy Ste 5', 'West Valley', 'Salt Lake', 'UT', '84120', '8019660081', '8019660218', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-10-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', '', '', '', 'HCFA|UB|', '1982716031', 0, 'N', 0, '2013-08-26', NULL, NULL, 40.6972, -111.99, NULL, NULL),
('870306646', 'S77002107', 'S77002107', 'UT01', 'Emergency Physicians Group', NULL, NULL, 'Emergency Physicians Group', 'GROUP', 'Emergency Medicine', NULL, NULL, NULL, 'B', 'PO Box 95970', 'South Jordan', 'Salt Lake', 'UT', '84095', '8013529500', '8013529502', '1200 E 3900 S', 'Salt Lake City', '', 'UT', '84124', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2006-11-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1588611016', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870306646', 'S77002108', 'S77002108', 'UT01', 'Emergency Physicians Group', 'Peter', 'J', 'Deweerd', 'MD', 'Family Practice', '', '', NULL, 'O', '1200 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012687975', NULL, '1200 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012687975', '', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1134166259', 0, 'Y', 0, '2014-04-17', NULL, NULL, 40.6871, -111.856, NULL, NULL),
('870306646', 'S77002109', 'S77002109', 'UT01', 'Emergency Physicians Group', 'Peter', 'J', 'Deweerd', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 95970', 'South Jordan', 'Salt Lake', 'UT', '84095', '8012687975', '8013529502', 'PO Box 95970', 'South Jordan', 'Salt Lake', 'UT', '84095', '8012687975', '8013529502', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1134166259', 0, 'Y', 0, '2014-04-17', NULL, NULL, 0, 0, NULL, NULL),
('870306646', 'S77002110', 'S77002110', 'UT01', 'Emergency Physicians Group', 'Lester', NULL, 'Dixon', 'MD', 'Emergency Medicine', NULL, NULL, NULL, 'O', '1200 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012687129', NULL, '1200 E 3900 S', 'Salt Lake City', '', 'UT', '84124', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2007-01-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '833260', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870306646', 'S77002111', 'S77002111', 'UT01', 'Emergency Physicians Group', 'Stephen', 'J', 'Hunt', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '1200 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012687975', NULL, '1200 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012687975', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, NULL, 0, 0, '', '', '', '', 'HCFA|UB|', '0000833282', 0, 'Y', 0, '2011-07-19', NULL, NULL, 40.6871, -111.856, NULL, NULL),
('870306646', 'S77002113', 'S77002113', 'UT01', 'Emergency Physicians Group', 'Robert', 'J', 'Munson', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '1200 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012687129', NULL, '1200 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012687129', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, NULL, 0, 0, '', '', '', '', 'HCFA|UB|', '1518908805', 0, 'Y', 0, '2011-07-19', NULL, NULL, 40.6871, -111.856, NULL, NULL),
('870306646', 'S77002114', 'S77002114', 'UT01', 'Emergency Physicians Group', 'Amie', '', 'Nielsen', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '1200 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012687975', NULL, '1200 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012687975', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, NULL, 0, 0, '', '', '', '', 'HCFA|UB|', '1891718656', 0, 'Y', 0, '2011-07-19', NULL, NULL, 40.6871, -111.856, NULL, NULL),
('870373083', 'S77002120', 'S77002120', 'UT01', 'Heart and Lung Institute', 'John', 'A', 'McHenry', 'MD', 'Cardiovascular Disease', NULL, NULL, NULL, 'O', '3570 W 9000 S Ste 110', 'West Jordan', 'Salt Lake', 'UT', '84088', '8012330140', '8012633887', '5979 S Fashion Blvd', 'Murray', '', 'UT', '84107', '', '', 'WUSTDCARD5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-10-01', '2008-09-15', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1750365193', 0, 'N', 0, '2007-11-06', NULL, NULL, 0, 0, NULL, NULL),
('870373083', 'S77002121', 'S77002121', 'UT01', 'Heart and Lung Institute', 'Gary', 'P', 'Symkoviak', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '5979 S Fashion Blvd', 'Murray', 'Salt Lake', 'UT', '84107', '8012632370', '8012651200', '5979 S Fashion Blvd', 'Murray', 'Salt Lake', 'UT', '84107', '8012632370', '8012651200', 'WUSTDCARD5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-10-01', '2008-04-24', 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1841273844', 0, 'N', 0, '2012-11-27', NULL, NULL, 0, 0, NULL, NULL),
('870373083', 'S77002123', 'S77002123', 'UT01', 'Heart and Lung Institute', 'George', 'K', 'Wong', 'MD', 'Cardiovascular Disease', NULL, NULL, NULL, 'O', '3570 W 9000 S Ste 110', 'West Jordan', 'Salt Lake', 'UT', '84088', '8012330140', '8012633887', '5979 S Fashion Blvd', 'Murray', '', 'UT', '84107', '', '', 'WUSTDCARD5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-10-01', '2009-06-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1316928903', 0, 'N', 0, '2007-11-06', NULL, NULL, 0, 0, NULL, NULL),
('870334372', 'S77002126', 'S77002126', 'UT01', 'Bountiful Family Physicians', 'Dennis', 'R', 'Peterson', 'MD', 'Family Practice', NULL, NULL, NULL, 'B', '415 Medical Dr Ste B 200', 'Bountiful', 'Davis', 'UT', '84010', '8012927254', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUSTDMULT5', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2007-01-01', '2007-01-01', 0, NULL, 0, 'Lakeview Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1164532073', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870334372', 'S77002127', 'S77002127', 'UT01', 'Bountiful Family Physicians', 'Dennis', 'R', 'Peterson', 'MD', 'Family Practice', '', '', NULL, 'O', '415 Medical Dr Ste B200', 'Bountiful', 'Davis', 'UT', '84010', '8012927254', NULL, '415 Medical Dr Ste B200', 'Bountiful', 'Davis', 'UT', '84010', '8012927254', '', 'WUSTDMULT5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, 'Lakeview Hospital', '', '', '', 'HCFA|UB|', '1164532073', 0, 'N', 0, '2014-04-16', NULL, NULL, 40.8873, -111.872, NULL, NULL),
('870336917', 'S77002128', 'S77002128', 'UT01', NULL, 'Edward', 'G', 'Southwick', 'MD', 'Dermatology', NULL, NULL, NULL, 'O', '3465 Pioneer Pkwy Ste 1', 'West Valley', 'Salt Lake', 'UT', '84120', '8019661403', '8019646478', '3465 Pioneer Pkwy Ste 1', 'West Valley', 'Salt Lake', 'UT', '84120', '8019661403', '8019646478', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-09-01', NULL, 0, 0, 0, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1619957156', 0, 'N', 0, '2013-10-15', NULL, NULL, 40.6972, -111.99, NULL, NULL),
('870337363', 'S77002129', 'S77002129', 'UT01', 'Gastroenterology Associates', 'Holly', 'B', 'Clark', 'MD', 'Gastroenterology', '', '', NULL, 'O', '1250 E 3900 S Ste 360', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012633041', '8012638485', '1250 E 3900 S Ste 360', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012633041', '8012638485', 'WiseSTD20', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', '2013-12-31', 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1376639047', 0, 'N', 0, '2014-01-17', NULL, NULL, 0, 0, NULL, NULL),
('870337363', 'S77002130', 'S77002130', 'UT01', 'Gastroenterology Associates', 'Suzanne', 'M', 'Daly', 'MD', 'Gastroenterology', '', '', NULL, 'O', '1250 E 3900 S Ste 360', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012633041', '8012638485', '1250 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '841241362', '8012633041', '8012638485', 'WiseSTD20', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', '2011-09-28', NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1780770446', 0, 'N', 0, '2011-09-28', NULL, NULL, 0, 0, NULL, NULL),
('870337363', 'S77002131', 'S77002131', 'UT01', 'Gastroenterology Associates', 'R Wesley', NULL, 'Keller', 'MD', 'Gastroenterology', NULL, NULL, NULL, 'O', '1250 E 3900 S Ste 360', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012633041', '8012638485', NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD20', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2007-01-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '832434', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870337363', 'S77002132', 'S77002132', 'UT01', 'Gastroenterology Associates', 'D', 'B', 'Trowbridge', 'MD', 'Gastroenterology', '', '', NULL, 'O', '1250 E 3900 S Ste 360', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012633041', '8012638485', '1250 E 3900 S Ste 360', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012633041', '8012638485', 'WiseSTD20', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', '2013-12-31', 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1134215809', 0, 'N', 0, '2013-12-18', NULL, NULL, 0, 0, NULL, NULL),
('870338238', 'S77002133', 'S77002133', 'UT01', '', 'Jan', 'F', 'Christensen', 'MD', 'Family Practice', '', '', NULL, 'O', '65 E 100 N', 'Gunnison', 'Sanpete', 'UT', '84634', '4355282130', '4355283844', 'PO Box 600', 'Gunnison', 'Sanpete', 'UT', '84634', '4355282130', '4355283844', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-09-01', '2011-10-13', NULL, 0, NULL, 'Gunnison Valley Hospital', '', '', '', 'HCFA|UB|', '1013969799', 0, 'N', 0, '2011-10-14', NULL, NULL, 0, 0, NULL, NULL),
('870338238', 'S77002134', 'S77002134', 'UT01', '', 'Jan', 'F', 'Christensen', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 600', 'Gunnison', 'Sanpete', 'UT', '84634', '4355287291', '4355283844', 'PO Box 600', 'Gunnison', 'Sanpete', 'UT', '84634', '4355287291', '4355283844', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-09-01', '2011-10-13', NULL, 0, NULL, 'Gunnison Valley Hospital', '', '', '', 'HCFA|UB|', '1013969799', 0, 'Y', 0, '2011-10-14', NULL, NULL, 0, 0, NULL, NULL),
('870340571', 'S77002135', 'S77002135', 'UT01', '', 'Robert', 'L', 'Moesinger', 'MD', 'Ear, Nose and Throat', 'Head and Neck Surgery', '', NULL, 'O', '3955 Harrison Blvd Ste U6', 'Ogden', 'Weber', 'UT', '84403', '8013935324', NULL, '3955 Harrison Blvd Ste U6', 'Ogden', 'Weber', 'UT', '84403', '8013935324', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-10-01', '2013-11-20', 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1154319473', 0, 'N', 0, '2013-11-04', NULL, NULL, 0, 0, NULL, NULL),
('870342259', 'S77002136', 'S77002136', 'UT01', 'Wayne Community Health Centers', 'Leland', 'J', 'Chappell', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 303', 'Bicknell', 'Wayne', 'UT', '84715', '4354253744', '4354253785', 'PO Box 303', 'Bicknell', 'Wayne', 'UT', '84715', '4354253744', '4354253785', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 8, '2006-10-01', NULL, 0, 0, 0, 'Sevier Valley Hospital', '', '', '', 'HCFA|UB|', '1447351424', 0, 'Y', 0, '2010-09-03', NULL, NULL, 0, 0, NULL, NULL),
('870306646', 'S77002138', 'S77002138', 'UT01', 'Emergency Physicians Group', 'Brian', 'E', 'Shiozawa', 'MD', 'Emergency Medicine', NULL, NULL, NULL, 'O', '1200 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012687129', NULL, '1200 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012687129', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, NULL, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1306887666', 0, 'Y', 0, '2011-07-19', NULL, NULL, 40.6871, -111.856, NULL, NULL),
('870306646', 'S77002140', 'S77002140', 'UT01', 'Emergency Physicians Group', 'Mark', 'E', 'Stevens', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '1200 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012687975', NULL, '1200 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012687975', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, NULL, 0, 0, '', '', '', '', 'HCFA|UB|', '1861433880', 0, 'Y', 0, '2011-07-19', NULL, NULL, 40.6871, -111.856, NULL, NULL),
('870306646', 'S77002141', 'S77002141', 'UT01', 'Emergency Physicians Group', 'Karl', NULL, 'Vizmeg', 'MD', 'Emergency Medicine', NULL, NULL, NULL, 'O', '1200 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012687975', NULL, '1200 E 3900 S', 'Salt Lake City', '', 'UT', '84124', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2007-01-01', 0, NULL, 0, 'Mountain View Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1427161363', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870306646', 'S77002142', 'S77002142', 'UT01', 'Emergency Physicians Group', 'Shari', 'J', 'Welch', 'MD', 'Emergency Medicine', NULL, NULL, NULL, 'O', '1200 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012687975', NULL, '1200 E 3900 S', 'Salt Lake City', '', 'UT', '84124', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2007-01-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '832952', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870308023', 'S77002143', 'S77002143', 'UT01', 'Middleton Urological Associates', 'Lisa', '', 'Stout', 'MD', 'Urology', NULL, NULL, NULL, 'O', '1060 E 100 S Ste 110', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015319453', '8015319453', '1060 E 100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015319453', '8015319453', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, NULL, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1548263213', 0, 'N', 0, '2011-08-23', NULL, NULL, 40.7672, -111.861, NULL, NULL),
('870316543', 'S77002144', 'S77002144', 'UT01', '', 'J', 'B', 'Robb', 'MD', 'General Surgery', '', '', NULL, 'O', '1220 E 3900 S Ste 3F', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012682531', '', '1220 E 3900 S Ste 3F', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012682531', '', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-10-01', '2011-09-28', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1740356328', 0, 'N', 0, '2014-07-21', NULL, NULL, 0, 0, NULL, NULL),
('870323929', 'S77002149', 'S77002149', 'UT01', '', 'G', 'S', 'Jessen', 'DDS', 'Oral/Maxillofacial Surgery', 'Oral Surgeon', '', NULL, 'O', '1230 N 200 E', 'Logan', 'Cache', 'UT', '84341', '8008606260', NULL, '1230 N 200 E', 'Logan', 'Cache', 'UT', '84341', '8008606260', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2006-11-01', '2006-11-01', 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|DEN|', '1548349251', 0, 'N', 0, '2012-08-23', NULL, NULL, 0, 0, NULL, NULL),
('870375015', 'S77002154', 'S77002154', 'UT01', 'Wasatch Medical Clinic', 'Neal', 'J', 'Burton', 'MD', 'Family Practice', '', '', NULL, 'O', '35 S 500 E', 'Heber City', 'Wasatch', 'UT', '84032', '4356541501', '4356542030', 'PO Box 247', 'Heber', 'Wasatch', 'UT', '84032', '4356541501', '4356542030', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-10-01', '2011-10-26', NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1033141924', 0, 'N', 0, '2011-10-27', NULL, NULL, 0, 0, NULL, NULL),
('870376403', 'S77002158', 'S77002158', 'UT01', NULL, 'Mathew', 'R', 'Tempest', 'MD', 'Ophthalmology', NULL, NULL, NULL, 'B', '9720 S 1300 E Ste E210', 'Sandy', 'Salt Lake', 'UT', '84094', '8015720631', '8015760670', NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-10-01', '2006-10-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1427020221', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870379037', 'S77002159', 'S77002159', 'UT01', NULL, 'Robert', 'C', 'Newman', 'MD', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'O', '4403 Harrison Blvd Ste 4440', 'Ogden', 'Weber', 'UT', '84403', '8013874485', '8013874499', '4403 Harrison Blvd', 'Ogden', '', 'UT', '84403', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-09-01', '2007-03-31', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1518928258', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870380540', 'S77002162', 'S77002162', 'UT01', 'Western Urological Clinic', 'Steven', 'N', 'Gange', 'MD', 'Urology', '', '', NULL, 'O', '4252 Highland Dr Ste 200', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8019931800', NULL, '4252 Highland Dr Ste 200', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8019931800', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1790825768', 0, 'N', 0, '2013-08-21', NULL, NULL, 40.6791, -111.843, NULL, NULL),
('870380540', 'S77002164', 'S77002164', 'UT01', 'Western Urological Clinic', 'Scott', 'A', 'Hopkins', 'MD', 'Urology', '', '', NULL, 'O', '4252 Highland Dr Ste 200', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8019931800', NULL, '4252 Highland Dr Ste 200', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8019931800', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1649310681', 0, 'N', 0, '2014-01-28', NULL, NULL, 40.6791, -111.843, NULL, NULL),
('870343122', 'S77002165', 'S77002165', 'UT01', 'Intermountain Dermatology', 'David', 'Edgar', 'Allen', 'MD', 'Dermatology', NULL, NULL, NULL, 'O', '3860 Jackson Ave Ste 2', 'Ogden', 'Weber', 'UT', '84403', '8016270515', NULL, '3860 Jackson Ave', 'Ogden', '', 'UT', '84403', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2000-01-01', '2000-01-01', 0, NULL, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1487672986', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870344078', 'S77002166', 'S77002166', 'UT01', NULL, 'Fred', 'E', 'Clayson', 'MD', 'Ophthalmology', '', '', NULL, 'O', '4403 Harrison Blvd Ste 3600', 'Ogden', 'Weber', 'UT', '84403', '8013873550', '8013873555', '4403 Harrison Blvd Ste 3600', 'Ogden', 'Weber', 'UT', '84403', '8013873550', '8013873555', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-10-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1194756718', 0, 'N', 0, '2014-01-27', NULL, NULL, 41.1828, -111.949, NULL, NULL),
('870344182', 'S77002167', 'S77002167', 'UT01', 'Pediatric Clinic', 'Edward', 'K', 'Madsen', 'MD', 'Pediatrics', '', '', NULL, 'O', '590 E 100 N Ste 4', 'Price', 'Carbon', 'UT', '84501', '4356377551', '4356360499', '590 E 100 N Ste 4', 'Price', 'Carbon', 'UT', '84501', '4356377551', '4356360499', 'WEUHP', 'WUSTDHCPC5', NULL, '0.00', '20.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 0, 'Castleview Hospital', 'Castleview Hospital', NULL, NULL, 'HCFA|UB|', '1689635914', 0, 'N', 0, '2013-08-21', NULL, NULL, 39.601, -110.8, NULL, NULL),
('870344182', 'S77002168', 'S77002168', 'UT01', 'Pediatric Clinic', 'Edward', 'K', 'Madsen', 'MD', 'Pediatrics', '', '', NULL, 'B', 'PO Box 958', 'Price', 'Carbon', 'UT', '84501', '4356377551', '4356360499', 'PO Box 958', 'Price', 'Carbon', 'UT', '84501', '4356377551', '4356360499', 'WEUHP', 'WUSTDHCPC5', NULL, '0.00', '20.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 0, 'Castleview Hospital', 'Castleview Hospital', NULL, NULL, 'HCFA|UB|', '1689635914', 0, 'Y', 0, '2013-08-21', NULL, NULL, 0, 0, NULL, NULL),
('870344399', 'S77002169', 'S77002169', 'UT01', '', 'Perry', 'T', 'Walters', 'MD', 'Urology', NULL, NULL, NULL, 'O', '255 S 100 E Ste 100', 'Tooele', 'Tooele', 'UT', '84074', '4358829622', NULL, '255 S 100 E Ste 100', 'Tooele', 'Tooele', 'UT', '84074', '4358829622', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', '2011-10-20', 0, 0, 0, 'Mountain West Medical Center', 'Lakeview Hospital', '', '', 'HCFA|UB|', '1790844165', 0, 'N', 0, '2012-06-08', NULL, NULL, 0, 0, NULL, NULL),
('870344927', 'S77002171', 'S77002171', 'UT01', 'Arbon, Robert A', 'Robert', 'A', 'Arbon', 'MD', 'Ear, Nose and Throat', NULL, NULL, NULL, 'B', '777 N 500 W Ste 106', 'Provo', 'Utah', 'UT', '84601', NULL, NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '833397', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870346222', 'S77002174', 'S77002174', 'UT01', '', 'William', 'D', 'Norris', 'DMD', 'Oral/Maxillofacial Surgery', 'Oral Surgeon', '', NULL, 'O', '3590 Harrison Blvd Ste 2', 'Ogden', 'Weber', 'UT', '84403', '8013927176', '8013929828', '3590 Harrison Bvld', 'Ogden', 'Weber', 'UT', '84403', '8013927176', '8013929828', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-10-01', '2010-11-08', NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1659336071', 0, 'N', 0, '2010-11-08', NULL, NULL, 0, 0, NULL, NULL),
('870346419', 'S77002175', 'S77002175', 'UT01', 'Murray Clinic', 'Peter', 'V', 'Sundwall', 'MD', 'Family Practice', '', '', NULL, 'O', '4815 Ctr St', 'Murray', 'Salt Lake', 'UT', '84107', '8012622443', NULL, '4815 Ctr St', 'Murray', 'Utah', 'UT', '84107', '8012622443', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1942200274', 0, 'N', 0, '2010-07-15', NULL, NULL, 40.6668, -111.886, NULL, NULL),
('870346694', 'S77002176', 'S77002176', 'UT01', '', 'B Grant', '', 'Bishop', 'MD', 'Dermatology', '', '', NULL, 'O', '425 Medical Dr Ste 218', 'Bountiful', 'Davis', 'UT', '84010', '8012983802', '          ', '425 Medical Dr Ste 218', 'Bountiful', 'Davis', 'UT', '84010', '8012983802', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-10-01', '2014-04-22', 0, 0, 0, 'Lakeview Hospital', '', '', '', 'HCFA|UB|', '1174693733', 0, 'N', 0, '2014-05-13', NULL, NULL, 40.8873, -111.872, NULL, NULL),
('870347187', 'S77002177', 'S77002177', 'UT01', 'Utah Valley Eye Center', 'Loran', 'D', 'Cook', 'MD', 'Ophthalmology', NULL, NULL, NULL, 'O', '1055 N 300 W Ste 204', 'Provo', 'Utah', 'UT', '84604', '8013577373', '8013577217', NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1396741948', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870350585', 'S77002179', 'S77002179', 'UT01', NULL, 'Gregory', 'C', 'Tanner', 'MD', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'O', '9600 S 1300 E Ste 305', 'Sandy', 'Salt Lake', 'UT', '84094', '8015725808', '8015722953', '9600 S 1300 E Ste 305', 'Sandy', 'Salt Lake', 'UT', '84094', '8015725808', '8015722953', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-09-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', 'Pioneer Valley Hospital', '', '', 'HCFA|UB|', '1598875973', 0, 'N', 0, '2012-07-13', NULL, NULL, 40.5756, -111.853, NULL, NULL),
('870324719', 'S77002180', 'S77002180', 'UT01', 'Utah Neurological Clinic', 'Howard', 'R', 'Reichman', 'MD', 'Neurosurgery', '', '', NULL, 'O', '1055 N 300 W Ste 400', 'Provo', 'Utah', 'UT', '84604', '8013577404', '8013577587', '1055 N 300 W Ste 400', 'Provo', 'Utah', 'UT', '84604', '8013577404', '8013577587', 'WUSTDNEUR5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-06-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1932123940', 0, 'N', 0, '2010-09-03', NULL, NULL, 40.2476, -111.664, NULL, NULL),
('870326862', 'S77002182', 'S77002182', 'UT01', 'Ogden Womens Clinic', 'Steven', 'E', 'Kammeyer', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '4403 Harrison Blvd Ste 4650', 'Ogden', 'Weber', 'UT', '84403', '8013874400', NULL, '4403 Harrison Blvd Ste 4650', 'Ogden', 'Weber', 'UT', '84403', '8013874400', '', 'Wise+', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-10-01', '2012-12-31', 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1851374920', 0, 'N', 0, '2014-07-21', NULL, NULL, 0, 0, NULL, NULL),
('870330589', 'S77002183', 'S77002183', 'UT01', 'American Fork Radiology', 'Val', 'D', 'Dunn', 'MD', 'Radiologist', '', '', NULL, 'B', 'PO Box 374', 'American Fork', 'Utah', 'UT', '84003', NULL, NULL, NULL, NULL, 'Utah', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-06-01', NULL, NULL, 0, 0, '', '', '', '', 'HCFA|UB|', '1215975552', 0, 'Y', 0, '2010-12-28', NULL, NULL, 0, 0, NULL, NULL),
('870330589', 'S77002184', 'S77002184', 'UT01', 'American Fork Radiology', 'Daniel', 'J', 'Hatch', 'MD', 'Vascular Surgery', 'Radiologist', '', NULL, 'O', '170 N 1100 E', 'American Fork', 'Utah', 'UT', '84003', '8017633300', NULL, '170 N 1100 E', 'American Fork', 'Utah', 'UT', '840032096', '8017633300', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-06-01', NULL, NULL, 0, 0, '', '', '', '', 'HCFA|UB|', '1588608582', 0, 'Y', 0, '2010-08-30', NULL, NULL, 40.3806, -111.769, NULL, NULL),
('870330589', 'S77002185', 'S77002185', 'UT01', 'American Fork Hospital', 'Kimball', 'Bruce', 'Taylor', 'MD', 'Radiologist', '', '', NULL, 'O', '120 N 1100 E', 'American Fork', 'Utah', 'UT', '84003', NULL, NULL, '120 N 1100 E', 'American Fork', 'Utah', 'UT', '840032952', '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-06-01', NULL, NULL, 0, 0, '', '', '', '', 'HCFA|UB|', '1760420996', 0, 'Y', 0, '2010-12-28', NULL, NULL, 0, 0, NULL, NULL),
('870330589', 'S77002186', 'S77002186', 'UT01', 'American Fork Radiology', 'Kimball', 'Bruce', 'Taylor', 'MD', 'Radiologist', '', '', NULL, 'B', 'PO Box 374', 'American Fork', 'Utah', 'UT', '84003', NULL, NULL, NULL, NULL, 'Utah', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-06-01', NULL, NULL, 0, 0, '', '', '', '', 'HCFA|UB|', '1760420996', 0, 'Y', 0, '2010-12-28', NULL, NULL, 0, 0, NULL, NULL),
('870331588', 'S77002188', 'S77002188', 'UT01', NULL, 'Joseph', 'D', 'Hillam', 'MD', 'General Surgery', 'Gastroenterology', '', NULL, 'O', '990 Medical Dr Ste U2', 'Brigham City', 'Box Elder', 'UT', '84302', '4357349439', '4357230267', '990 Medical Dr Ste U2', 'Brigham City', 'Box Elder', 'UT', '84302', '4357349439', '4357230267', 'WURURAL10', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 0, 'Brigham City Community Hospital', '', '', '', 'HCFA|UB|', '1154362747', 0, 'N', 0, '2014-04-17', NULL, NULL, 41.4887, -112.027, NULL, NULL),
('870386125', 'S77002196', 'S77002196', 'UT01', '', 'Michael', 'S', 'Kottler', 'MD', 'Ophthalmology', '', '', NULL, 'O', '4568 Highland Dr Ste 160', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8014243090', '8014243091', 'PO Box 27688', 'Salt Lake City', 'Salt Lake', 'UT', '841270688', '8014243090', '8014243091', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', '2011-10-05', NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1740287705', 0, 'N', 0, '2011-10-05', NULL, NULL, 0, 0, NULL, NULL),
('870391052', 'S77002202', 'S77002202', 'UT01', 'Audiology Associates', 'Audiology Associates', NULL, NULL, 'GROUP', 'Audiology', NULL, NULL, NULL, 'O', '1377 E 3900 S Ste 201', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012721232', NULL, '1377 E 3900 S', 'Salt Lake City', '', 'UT', '84124', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2006-11-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '834137', 0, 'y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870391052', 'S77002203', 'S77002203', 'UT01', 'Audiology Associates of Salt Lake City', 'C', 'B', 'Fox', 'CCCA', 'Audiology', '', '', NULL, 'O', '1377 E 3900 S Ste 201', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012721232', '8012721238', '1377 E 3900 S Ste 201', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012721232', '8012721238', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', '2010-07-05', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1811938939', 0, 'N', 0, '2014-04-14', NULL, NULL, 0, 0, NULL, NULL),
('870391052', 'S77002205', 'S77002205', 'UT01', 'Kings Peak CU Bldg', 'C Brent', NULL, 'Fox', 'AUD', 'Audiology', NULL, NULL, NULL, 'O', '57 N 100 E Ste 3', 'Roosevelt', 'Duchesne', 'UT', '84066', '8002449001', NULL, '1377 E 3900 S', 'Salt Lake City', '', 'UT', '84124', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2006-11-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1811938939', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870391052', 'S77002206', 'S77002206', 'UT01', 'Sanpete Valley Hospital', 'C Brent', NULL, 'Fox', 'AUD', 'Audiology', NULL, NULL, NULL, 'O', '1100 S Medical Dr', 'Mount Pleasant', 'Sanpete', 'UT', '84647', '8002449001', NULL, '1377 E 3900 S', 'Salt Lake City', '', 'UT', '84124', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2006-11-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1811938939', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870392925', 'S77002207', 'S77002207', 'UT01', NULL, 'David', '', 'Okubo', 'MD', 'Pediatrics', '', '', NULL, 'O', '1995 W 9000 S', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015669888', NULL, '1995 W 9000 S', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015669888', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-06-01', NULL, NULL, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1881656106', 0, 'N', 0, '2011-10-03', NULL, NULL, 40.5877, -111.945, NULL, NULL),
('870351941', 'S77002209', 'S77002209', 'UT01', NULL, 'Rolfe', 'P', 'Horsley', 'MD', 'Dermatology', '', '', NULL, 'O', '6040 Fashion Blvd Ste 203', 'Murray', 'Salt Lake', 'UT', '84107', '8012662353', NULL, '6040 Fashion Blvd Ste 203', 'Murray', 'Salt Lake', 'UT', '84107', '8012662353', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1518949411', 0, 'N', 0, '2013-11-20', NULL, NULL, 40.6397, -111.883, NULL, NULL),
('870354382', 'S77002210', 'S77002210', 'UT01', 'Bermen and Siggard', 'John', 'F', 'Bermen', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '3465 Pioneer Pkwy Ste 5', 'West Valley', 'Salt Lake', 'UT', '84120', '8019670282', NULL, '3465 S Pioneer Pkwy', 'West Valley', 'Salt Lake', 'UT', '84120', '8019670282', '          ', 'WUSTDORTH5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2007-01-01', '2011-10-06', NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1548351364', 0, 'N', 0, '2011-10-10', NULL, NULL, 0, 0, NULL, NULL),
('870354442', 'S77002211', 'S77002211', 'UT01', 'Rocky Mountain Womens Health Center', 'Gretchen', 'Thorn', 'Faucett', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1580 W Antelope Dr Ste 290', 'Layton', 'Davis', 'UT', '84041', '8017760880', '8017737399', '1580 W Antelope Dr Ste 290', 'Layton', 'Davis', 'UT', '84041', '8017760880', '8017737399', 'WRYMTWOM', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2007-01-01', '2013-03-20', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1477647741', 0, 'N', 0, '2014-03-21', NULL, NULL, 0, 0, NULL, NULL),
('870354442', 'S77002212', 'S77002212', 'UT01', 'Rocky Mountain Womens Health Center', 'William', 'G', 'Hughes', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1580 W Antelope Dr Ste 290', 'Layton', 'Davis', 'UT', '84041', '8017760880', NULL, '1580 W Antelope Dr Ste 290', 'Layton', 'Davis', 'UT', '84041', '8017760880', '', 'WRYMTWOM', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2007-01-01', '2014-04-30', 0, 0, 0, 'Davis Hospital', '', '', '', 'HCFA|UB|', '1881787885', 0, 'N', 0, '2014-03-25', NULL, NULL, 41.0893, -111.994, NULL, NULL),
('870354540', 'S77002214', 'S77002214', 'UT01', 'ENT Specialists', 'Jerry', 'W', 'Sonkens', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '4000 S 700 E Ste 10', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8012684141', '8012618609', '4000 S 700 E Ste 10', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8012684141', '8012618609', 'WUSTDENT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-12-01', '2011-11-16', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1699734079', 0, 'N', 0, '2012-03-15', NULL, NULL, 0, 0, NULL, NULL),
('870354540', 'S77002215', 'S77002215', 'UT01', 'ENT Specialists', 'Randal', 'W', 'Swenson', 'MD', 'Ear, Nose and Throat', NULL, NULL, NULL, 'O', '4000 S 700 E Ste 10', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8012684141', '8012618609', '4000 S 700 E Ste 10', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8012684141', '8012618609', 'WUSTDENT5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1578522959', 0, 'N', 0, '2013-12-11', NULL, NULL, 40.6857, -111.871, NULL, NULL),
('870354960', 'S77002216', 'S77002216', 'UT01', NULL, 'John', 'R', 'Shakula', 'MD', 'Pediatrics', NULL, NULL, NULL, 'B', '9720 S 1300 E Ste W-120', 'Sandy', 'Salt Lake', 'UT', '84094', '8015710423', '8015710081', NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2006-11-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1235179375', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870355239', 'S77002217', 'S77002217', 'UT01', 'Advanced Eye Care', 'Gary', 'B', 'Stanford', 'MD', 'Ophthalmology', '', '', NULL, 'O', '1250 E 3900 S Ste 310', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012632020', NULL, '1259 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012632020', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-10-01', '2011-10-05', NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1497866180', 0, 'N', 0, '2011-10-05', NULL, NULL, 0, 0, NULL, NULL),
('870355706', 'S77002219', 'S77002219', 'UT01', '', 'Leroy', 'C', 'Taylor', 'MD', 'Family Practice', '', '', NULL, 'O', '520 E Medical Dr Ste 210', 'Bountiful', 'Davis', 'UT', '84010', '8012965805', '8012989156', '520 E Medical Dr Ste 210', 'Bountiful', 'Davis', 'UT', '84010', '8012965805', '8012989156', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', '2013-01-01', 0, 0, 0, 'Lakeview Hospital', '', '', '', 'HCFA|UB|', '1083610141', 0, 'N', 0, '2013-10-31', NULL, NULL, 0, 0, NULL, NULL),
('870355879', 'S77002220', 'S77002220', 'UT01', 'Insight Eye Specialists', 'Michael', 'D', 'Washburn', 'MD', 'Ophthalmology', '', '', NULL, 'O', '2255 N 1700 W Ste 100', 'Layton', 'Davis', 'UT', '84041', '8017730690', NULL, '2255 N 1700 W Ste 100', 'Layton', 'Davis', 'UT', '84041', '8017730690', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1548252885', 0, 'N', 0, '2013-09-30', NULL, NULL, 41.0887, -111.997, NULL, NULL),
('870355954', 'S77002221', 'S77002221', 'UT01', 'Hoopes-Alldredge-Vision Institute', 'O Claron', '', 'Alldredge', 'MD', 'Ophthalmology', '', '', NULL, 'O', '10011 Centennial Pkwy Ste 400', 'Sandy', 'Salt Lake', 'UT', '84070', '8015680200', NULL, '4400 S 700 E', 'Salt Lake City', 'Salt Lake', 'UT', '84017', '8015680200', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-10-01', '2010-10-01', NULL, 0, NULL, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1780685412', 0, 'N', 0, '2011-10-05', NULL, NULL, 0, 0, NULL, NULL),
('870333048', 'S77002224', 'S77002224', 'UT01', 'Mountain View Hosp Prof Fees', NULL, NULL, 'Mountain View Hospit', 'GROUP', 'Multi Specialty (Clinic)', NULL, NULL, NULL, 'B', 'PO Box 409636', 'Atlanta', 'Fulton', 'GA', '30384', '7028552700', NULL, NULL, NULL, '', NULL, NULL, '', '', NULL, NULL, NULL, '0.00', '40.00', NULL, 3, '2006-10-01', '2006-10-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '833270', 0, 'y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870333048', 'S77002225', 'S77002225', 'UT01', 'Physical & Sports Therapy', 'William', 'G', 'Sumsion', 'PT', 'Physical Therapy', NULL, NULL, NULL, 'O', '1000 E 100 N', 'Payson', 'Utah', 'UT', '84651', '8014657070', NULL, NULL, NULL, '', NULL, NULL, '', '', NULL, NULL, NULL, '0.00', '0.00', NULL, 3, '2006-10-01', '2006-10-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '833489', 0, 'n', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870334072', 'S77002226', 'S77002226', 'UT01', NULL, 'Hugh', 'D', 'Voorhees', 'MD', 'General Surgery', NULL, NULL, NULL, 'B', '1954 E Fort Union Blvd Ste 101', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019939506', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-10-01', '2006-10-01', 0, NULL, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1346354537', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870334072', 'S77002227', 'S77002227', 'UT01', NULL, 'Hugh', 'D', 'Voorhees', 'MD', 'General Surgery', '', '', NULL, 'O', '4000 S 700 E Ste 9', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8012623564', NULL, '4000 S 700 E Ste 9', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8012623564', '', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-10-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1346354537', 0, 'N', 0, '2014-05-15', NULL, NULL, 40.6857, -111.871, NULL, NULL),
('870336917', 'S77002228', 'S77002228', 'UT01', NULL, 'Edward', 'G', 'Southwick', 'MD', 'Dermatology', NULL, NULL, NULL, 'B', '3465 Pioneer Pkwy Ste 1', 'West Valley', 'Salt Lake', 'UT', '84120', '8019661403', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-09-01', '2006-09-01', 0, NULL, 0, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1619957156', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870341157', 'S77002229', 'S77002229', 'UT01', NULL, 'Thomas', 'R', 'Austad', 'DPM', 'Podiatry', '', '', NULL, 'O', '1885 W 4400 S', 'Roy', 'Weber', 'UT', '84067', '8017313833', NULL, '1885 W 4000 S', 'Roy', 'Weber', 'UT', '84067', '8017313833', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-10-01', '2009-01-30', NULL, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1710085261', 0, 'N', 0, '2011-05-24', NULL, NULL, 0, 0, NULL, NULL),
('870342259', 'S77002230', 'S77002230', 'UT01', 'Wayne Community Health Centers', 'Jeffrey', 'J', 'Brown', 'DO', 'Family Practice', '', '', NULL, 'B', 'PO Box 303', 'Bicknell', 'Wayne', 'UT', '84715', '4354253744', '4354253785', 'PO Box 303', 'Bicknell', 'Wayne', 'UT', '84715', '4354253744', '4354253785', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2006-10-01', '2011-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1205840642', 0, 'Y', 0, '2013-12-18', NULL, NULL, 0, 0, NULL, NULL),
('870343048', 'S77002231', 'S77002231', 'UT01', '', 'A', 'Creig', 'MacArthur', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1055 N 300 W Ste 212', 'Provo', 'Utah', 'UT', '84604', '8013577676', '8013577666', '1055 N 300 W Ste 212', 'Provo', 'Utah', 'UT', '84604', '8013577676', '8013577666', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', '2010-08-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1760464895', 0, 'N', 0, '2010-08-27', NULL, NULL, 0, 0, NULL, NULL),
('870393111', 'S77002232', 'S77002232', 'UT01', 'Ogden Audiology Services', 'Tel', 'S', 'Bowman', 'AUD', 'Audiology', NULL, NULL, NULL, 'O', '425 E 5350 S Ste 120', 'Ogden', 'Weber', 'UT', '84405', '8014793346', '8014790725', NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-08-01', '2006-08-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '834723', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870395257', 'S77002233', 'S77002233', 'UT01', NULL, 'Patricia', NULL, 'Legant', 'MD', 'Hematology and Oncology', NULL, NULL, NULL, 'B', '164 E 5900 S Ste 106', 'Murray', 'Salt Lake', 'UT', '84107', NULL, NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2006-11-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1851365050', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77002234', 'S77002234', 'UT01', 'Chiro Center', 'Travis', 'Ray', 'Allan', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '1781 W 1000 S', 'Vernal', 'Uintah', 'UT', '84078', '4357816035', '4357816040', '1781 W 1000 S', 'Vernal', 'Uintah', 'UT', '84078', '4357816035', '4357816040', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2006-04-01', '2010-10-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1225082118', 0, 'N', 0, '2013-01-28', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77002235', 'S77002235', 'UT01', 'Allen Chiropractic', 'Richard', 'C', 'Allen', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '11451 S 700 E Ste B', 'Draper', 'Salt Lake', 'UT', '84020', '8013070544', '8013070718', '867 E 9400 S', 'Sandy', '', 'UT', '84094', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', '0.00', '55.46', 3, '2006-04-01', '2009-05-01', NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1427035047', 0, 'N', 0, '2008-10-20', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77002236', 'S77002236', 'UT01', NULL, 'Richard', 'C', 'Allen', 'DC', 'Chiropractic', NULL, NULL, NULL, 'B', '9135 S Monroe St Ste B', 'Sandy', 'Salt Lake', 'UT', '84070', '8013527270', '8013527024', '9135 S Monroe', 'Sandy', '', 'UT', '84070', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', NULL, '55.46', 3, '2006-04-01', '2007-12-31', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1427035047', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77002237', 'S77002237', 'UT01', NULL, 'Kenneth', 'R', 'Andersen', 'DC', 'Chiropractic', NULL, NULL, NULL, 'B', '9135 S Monroe St Ste B', 'Sandy', 'Salt Lake', 'UT', '84070', NULL, NULL, '9135 S Monroe', 'Sandy', '', 'UT', '84070', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', NULL, '55.46', 3, '2006-04-01', '2007-12-31', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1760483986', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77002238', 'S77002238', 'UT01', 'Awerkamp Chiropractic', 'Blaine', 'A', 'Awerkamp', 'DC', 'Chiropractic', '', '', NULL, 'O', '8394 S 700 E', 'Sandy', 'Salt Lake', 'UT', '84070', '8015620135', '8015620174', '867 E 9400 S', 'Sandy', 'Salt Lake', 'UT', '84094', '8015620135', '8015620174', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2006-04-01', '2010-10-31', NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1598722928', 0, 'N', 0, '2010-11-02', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77002239', 'S77002239', 'UT01', '', 'John', '', 'Bach', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '1473 S 600 E', 'Salt Lake City', 'Salt Lake', 'UT', '84105', '8014871010', '8014871015', '867 E 9400 S', 'Sandy', 'Salt Lake', 'UT', '84094', '8014871010', '8014871015', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2006-04-01', '2010-10-31', NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1841241338', 0, 'N', 0, '2010-10-29', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77002240', 'S77002240', 'UT01', 'Valley View Chiropractic', 'Jennifer', 'L', 'Beck-Schmidt', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '9035 S 1300 E Ste 1', 'Sandy', 'Salt Lake', 'UT', '84094', '8015698787', '8015690376', '867 E 9400 S', 'Sandy', '', 'UT', '84094', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', '0.00', '55.46', 3, '2006-04-01', '2010-10-31', NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1073594438', 0, 'N', 0, '2006-08-31', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77002241', 'S77002241', 'UT01', NULL, 'Jennifer', 'L', 'Beck-Schmidt', 'DC', 'Chiropractic', NULL, NULL, NULL, 'B', '9135 S Monroe St Ste B', 'Sandy', 'Salt Lake', 'UT', '84070', '8013527270', '8013527024', '9135 S Monroe', 'Sandy', '', 'UT', '84070', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', NULL, '55.46', 3, '2006-04-01', '2007-12-31', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1073594438', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77002242', 'S77002242', 'UT01', NULL, 'Thomas', 'M', 'Benhard', 'DC', 'Chiropractic', NULL, NULL, NULL, 'B', '9135 S Monroe St Ste B', 'Sandy', 'Salt Lake', 'UT', '84070', NULL, NULL, '9135 S Monroe', 'Sandy', '', 'UT', '84070', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', NULL, '55.46', 3, '2006-04-01', '2007-12-31', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1851476428', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77002243', 'S77002243', 'UT01', 'Bond Chiropractic', 'Roger', 'A', 'Bond', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '1684 Reunion Ave Ste 250', 'South Jordan', 'Salt Lake', 'UT', '84095', '8015620363', NULL, '9135 S Monroe', 'Sandy', '', 'UT', '84070', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', NULL, '55.46', 3, '2006-04-01', '2007-04-28', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1750475810', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870355954', 'S77002244', 'S77002244', 'UT01', 'Hoopes-Alldredge-Vision Institute', 'Phillip', 'C', 'Hoopes', 'MD', 'Ophthalmology', NULL, NULL, NULL, 'O', '10011 Centennial Pkwy Ste 400', 'Sandy', 'Salt Lake', 'UT', '84070', '8015680200', NULL, '4400 S 700 E', 'Salt Lake City', '', ' UT', '84107', '', '', 'WISESTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2000-01-01', '2000-01-01', 0, NULL, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1629067921', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870355954', 'S77002245', 'S77002245', 'UT01', 'Hoopes-Alldredge-Vision Institute', 'Phillip', 'C', 'Hoopes', 'MD', 'Ophthalmology', '', '', NULL, 'O', '10011 Centennial Pkwy Ste 400', 'Sandy', 'Salt Lake', 'UT', '84070', '8015680200', '', '10011 Centennial Pkwy Ste 400', 'Sandy', 'Salt Lake', 'UT', '84070', '8015680200', '', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-10-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1629067921', 0, 'N', 0, '2014-07-24', NULL, NULL, 40.5696, -111.895, NULL, NULL),
('870357014', 'S77002246', 'S77002246', 'UT01', 'Brown, Bryant J', 'Bryant', 'J', 'Brown', 'MD', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'B', '3970 S 700 E Ste 14', 'Murray', 'Salt Lake', 'UT', '84107', NULL, NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-10-01', '2006-10-01', 0, NULL, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1629038963', 0, 'Y', 0, NULL, 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
('870357014', 'S77002247', 'S77002247', 'UT01', 'Old Farm OBGYN', 'Bryant', 'J', 'Brown', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '3970 S 700 E Ste 14', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8012613605', NULL, '3970 S 700 E Ste 14', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8012613605', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-10-01', '2011-04-30', 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1629038963', 0, 'N', 0, '2014-02-26', NULL, NULL, 0, 0, NULL, NULL),
('870357185', 'S77002248', 'S77002248', 'UT01', NULL, 'Robert', 'H', 'Horne', 'MD', 'Orthopedic Surgery', NULL, NULL, NULL, 'O', '9844 S 1300 E Ste 300', 'Sandy', 'Salt Lake', 'UT', '84094', '8015724433', '8015722271', '9844 S 1300 E', 'Sandy', '', 'UT', '84094', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-09-01', '2010-04-06', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1932261005', 0, 'N', 0, '2006-08-31', NULL, NULL, 0, 0, NULL, NULL),
('870358019', 'S77002249', 'S77002249', 'UT01', 'Cottonwood Eye & Laser Clinic', 'Alan', 'E', 'Jackson', 'MD', 'Ophthalmology', '', '', NULL, 'O', '201 E 5900 S Ste 101', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8012686600', NULL, '201 E 5900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8012686600', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-10-01', '2010-07-01', NULL, 0, NULL, NULL, '', '', '', 'HCFA|UB|', '1467411223', 0, 'N', 0, '2011-11-16', NULL, NULL, 0, 0, NULL, NULL),
('870358327', 'S77002250', 'S77002250', 'UT01', 'Olympus Clinic', 'Christopher', 'J', 'Gamble', 'MD', 'Family Practice', '', '', NULL, 'O', '4624 Holladay Blvd', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8012772682', '8012772980', '4624 Holladay Blvd', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8012772682', '8012772980', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1487609277', 0, 'N', 0, '2014-05-19', NULL, NULL, 40.6703, -111.826, NULL, NULL),
('870358327', 'S77002252', 'S77002252', 'UT01', 'Olympus Clinic', 'Steven', 'W', 'Heath', 'MD', 'Family Practice', '', '', NULL, 'O', '4624 Holladay Blvd', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8012772682', '8012772980', '4624 Holladay Blvd', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8012772682', '8012772980', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1366497166', 0, 'N', 0, '2014-04-17', NULL, NULL, 40.6703, -111.826, NULL, NULL),
('870358327', 'S77002253', 'S77002253', 'UT01', 'Olympus Clinic', 'Robert', 'C', 'Hill', 'MD', 'Family Practice', '', '', NULL, 'O', '4624 Holladay Blvd', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8012772682', '8012772980', '4624 Holladay Blvd', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8012772682', '8012772980', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1770521643', 0, 'N', 0, '2014-07-21', NULL, NULL, 40.6703, -111.826, NULL, NULL),
('870358327', 'S77002254', 'S77002254', 'UT01', 'Olympus Clinic', 'Jared', 'B', 'Probst', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '4624 Holladay Blvd', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8012772682', '8012772980', '4624 Holladay Blvd', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8012772682', '8012772980', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-06-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1346295177', 0, 'N', 0, '2012-05-17', NULL, NULL, 40.6703, -111.826, NULL, NULL),
('870358327', 'S77002255', 'S77002255', 'UT01', 'Olympus Clinic', 'Dana', 'M', 'Shaw', 'NP', 'Family Practice', NULL, NULL, NULL, 'B', '4624 Holladay Blvd', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8012772682', '8012772980', NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2007-03-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1871532101', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870358327', 'S77002256', 'S77002256', 'UT01', 'Olympus Clinic', 'Dana', 'M', 'Shaw', 'NP', 'Family Practice', '', '', NULL, 'O', '4624 Holladay Blvd', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8012772682', '8012772980', '4624 Holladay Blvd', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8012772682', '8012772980', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1871532101', 0, 'N', 0, '2013-10-10', NULL, NULL, 40.6703, -111.826, NULL, NULL),
('870343122', 'S77002257', 'S77002257', 'UT01', 'Intermountain skin cancer and Aesthetics Center  ', 'D', 'E', 'Allen', 'MD', 'Dermatology', '', '', NULL, 'O', '3860 Jackson Ave Ste 2', 'Ogden', 'Weber', 'UT', '84403', '8016270515', NULL, '3860 Jackson Ave', 'Ogden', 'Weber', 'UT', '84403', '8016270515', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-12-01', NULL, NULL, 0, NULL, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1619995107', 0, 'N', 0, '2011-11-03', NULL, NULL, 41.1918, -111.954, NULL, NULL),
('870344399', 'S77002259', 'S77002259', 'UT01', '', 'Perry', 'T', 'Walters', 'MD', 'Urology', NULL, NULL, NULL, 'O', '425 Medical Dr Ste 112', 'Bountiful', 'Davis', 'UT', '84010', '8012927249', '8012927251', '425 Medical Dr Ste 112', 'Bountiful', 'Davis', 'UT', '84010', '8012927249', '8012927251', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', '2013-02-15', 0, 0, 0, 'Mountain West Medical Center', 'Lakeview Hospital', '', '', 'HCFA|UB|', '1790844165', 0, 'N', 0, '2013-11-06', NULL, NULL, 0, 0, NULL, NULL),
('870344424', 'S77002260', 'S77002260', 'UT01', NULL, 'Ivan', 'W', 'Nelson', 'MD', 'Ear, Nose and Throat', NULL, NULL, NULL, 'B', '556 E 4020 N', 'Provo', 'Utah', 'UT', '84604', NULL, NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2007-04-08', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '833396', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870345762', 'S77002262', 'S77002262', 'UT01', NULL, 'Terry', 'P', 'Smith', 'DPM', 'Podiatry', '', '', NULL, 'O', '1060 E 100 S Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013632543', NULL, '1060 E 100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84012', '8013632543', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', '2008-11-17', NULL, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1013972157', 0, 'N', 0, '2012-01-05', NULL, NULL, 0, 0, NULL, NULL),
('870346419', 'S77002263', 'S77002263', 'UT01', 'Murray Clinic', 'David', 'S', 'Anderson', 'PA', 'Family Practice', '', '', NULL, 'O', '4815 Ctr St', 'Murray', 'Salt Lake', 'UT', '84107', '8012622443', NULL, '4815 Ctr St', 'Murray', 'Salt Lake', 'UT', '84107', '8012622443', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, NULL, 0, 0, '', '', '', '', 'HCFA|UB|', '1356342539', 0, 'N', 0, '2011-06-15', NULL, NULL, 40.6668, -111.886, NULL, NULL),
('870347187', 'S77002265', 'S77002265', 'UT01', 'Utah Valley Eye Center', 'Paul', 'F', 'Olson', 'MD', 'Ophthalmology', NULL, NULL, NULL, 'O', '1055 N 300 W Ste 204', 'Provo', 'Utah', 'UT', '84604', '8013577373', '8013577217', NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1851397491', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870353757', 'S77002268', 'S77002268', 'UT01', NULL, 'Don', 'R', 'Holdaway', 'MD', 'Dermatology', NULL, NULL, NULL, 'B', '2380 N 400 E Ste B', 'Logan', 'Cache', 'UT', '84341', '8017525741', '4357525746', '2380 N 400 E', 'N Logan', '', 'UT', '84341', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2000-01-01', '2000-01-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1790824100', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870353757', 'S77002269', 'S77002269', 'UT01', '', 'Don', 'R', 'Holdaway', 'MD', 'Dermatology', NULL, NULL, NULL, 'O', '2380 N 400 E Ste B', 'North Logan', 'Cache', 'UT', '84341', '4357525741', '4357525746', '2380 N 400 E', 'N Logan', 'Cache', 'UT', '84341', '4357525741', '4357525746', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-10-01', '2011-09-13', NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1790824100', 0, 'N', 0, '2011-09-20', NULL, NULL, 0, 0, NULL, NULL),
('870354442', 'S77002270', 'S77002270', 'UT01', 'Rocky Mountain Womens Health Center', 'Charles', 'W', 'Joseph', 'MD', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'O', '1580 W Antelope Dr Ste 290', 'Layton', 'Davis', 'UT', '84041', '8017760880', NULL, '1580 W Antelope Dr Ste 290', 'Layton', 'Davis', 'UT', '84041', '8017760880', '          ', 'WRYMTWOM', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2007-01-01', '2014-04-30', 0, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1609978238', 0, 'N', 0, '2013-07-22', NULL, NULL, 41.0893, -111.994, NULL, NULL),
('870354442', 'S77002271', 'S77002271', 'UT01', 'Rocky Mountain Womens Health Center', 'Vivian', '', 'Dearden', 'CNM', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'O', '1580 W Antelope Dr Ste 290', 'Layton', 'Davis', 'UT', '84041', '8017760880', NULL, '1580 W Antelope Dr', 'Layton', 'Davis', 'UT', '84041', '8017760880', '', 'WRYMTWOM', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2007-01-01', '2014-04-30', NULL, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1437260510', 0, 'N', 0, '2011-09-20', NULL, NULL, 41.0893, -111.994, NULL, NULL),
('870395551', 'S77002273', 'S77002273', 'UT01', NULL, 'James', 'A', 'Brown', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '7211 Plaza Ctr Dr Ste 120', 'West Jordan', 'Salt Lake', 'UT', '84084', '8012804629', '8012808495', '867 E 9400 S', 'Sandy', '', 'UT', '84094', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', '0.00', '55.46', 3, '2006-04-01', '2009-12-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1043300106', 0, 'N', 0, '2006-08-31', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77002274', 'S77002274', 'UT01', NULL, 'James', 'A', 'Brown', 'DC', 'Chiropractic', NULL, NULL, NULL, 'B', '9135 S Monroe St Ste B', 'Sandy', 'Salt Lake', 'UT', '84070', NULL, NULL, '9135 S Monroe', 'Sandy', '', 'UT', '84070', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', NULL, '55.46', 3, '2006-04-01', '2007-12-31', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1043300106', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77002275', 'S77002275', 'UT01', NULL, 'Joshua', 'W', 'Bryan', 'DC', 'Chiropractic', NULL, NULL, NULL, 'B', '9135 S Monroe St Ste B', 'Sandy', 'Salt Lake', 'UT', '84070', '8013527270', '8013527024', '9135 S Monroe', 'Sandy', '', 'UT', '84070', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', NULL, '55.46', 3, '2006-04-01', '2007-12-31', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1124196167', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77002276', 'S77002276', 'UT01', 'Canova  Chiropractic', 'Donald', 'R', 'Canova', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '610 N Main St Ste 5B', 'Clearfield', 'Davis', 'UT', '84015', '8017763389', '8017759393', '867 E 9400 S', 'Sandy', '', 'UT', '84094', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', '0.00', '55.46', 3, '2006-04-01', '2010-10-31', NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1770526394', 0, 'N', 0, '2006-08-31', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77002277', 'S77002277', 'UT01', '', 'Morgan', '', 'Carlson', 'DC', 'Chiropractic', '', '', NULL, 'O', '3935 N 75 W', 'Hyde Park', 'Cache', 'UT', '84318', '4355634141', '4355630293', '3935 N 75 W', 'Hyde Park', 'Cache', 'UT', '84318', '4355634141', '4355630293', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2006-04-01', '2010-10-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1780757526', 0, 'N', 0, '2012-06-25', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77002278', 'S77002278', 'UT01', NULL, 'Alan', 'C', 'Casey', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '903 N Washington Blvd', 'Ogden', 'Weber', 'UT', '84404', '8017821430', '8017827616', '867 E 9400 S', 'Sandy', '', 'UT', '84094', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', '0.00', '55.46', 3, '2006-04-01', '2010-10-31', NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1639277163', 0, 'N', 0, '2006-08-31', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77002279', 'S77002279', 'UT01', NULL, 'Donald', 'A', 'Cofer', 'DC', 'Chiropractic', NULL, NULL, NULL, 'B', '9135 S Monroe St Ste B', 'Sandy', 'Salt Lake', 'UT', '84070', NULL, NULL, '9135 S Monroe', 'Sandy', '', 'UT', '84070', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', NULL, '55.46', 3, '2006-04-01', '2007-12-31', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1215979133', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77002280', 'S77002280', 'UT01', '', 'Chad', 'L', 'Collard', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '9103 S 1300 W Ste 101', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015691141', '8015691171', '9103 S 1300 W Ste 101', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015691141', '8015691171', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2006-04-01', '2010-10-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1184707036', 0, 'N', 0, '2012-02-15', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77002281', 'S77002281', 'UT01', NULL, 'Terrance', 'M', 'Cooper', 'DC', 'Chiropractic', NULL, NULL, NULL, 'B', '9135 S Monroe St Ste B', 'Sandy', 'Salt Lake', 'UT', '84070', '8013527270', '8013527024', '9135 S Monroe', 'Sandy', '', 'UT', '84070', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', NULL, '55.46', 3, '2006-04-01', '2007-12-31', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1720183288', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77002282', 'S77002282', 'UT01', 'Doxey Chiropractic', 'Todd', 'T', 'Doxey', 'DC', 'Chiropractic', NULL, NULL, NULL, 'B', 'PO Box 3243', 'Ogden', 'Weber', 'UT', '84409', '8013949450', '8018660033', '867 E 9400 S', 'Sandy', '', 'UT', '84094', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', NULL, '55.46', 3, '2006-04-01', '2006-04-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1386714459', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77002283', 'S77002283', 'UT01', NULL, 'Tom', NULL, 'Doxey', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '876 12th St', 'Ogden', 'Weber', 'UT', '84404', '8013999802', '8013999807', '867 E 9400 S', 'Sandy', '', 'UT', '84094', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', '0.00', '55.46', 3, '2006-04-01', '2010-10-31', NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000833529', 0, 'N', 0, '2006-08-31', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77002284', 'S77002284', 'UT01', NULL, 'Elizabeth', 'C', 'Draney', 'DC', 'Chiropractic', NULL, NULL, NULL, 'B', '9135 S Monroe St Ste B', 'Sandy', 'Salt Lake', 'UT', '84070', NULL, NULL, '9135 S Monroe', 'Sandy', '', 'UT', '84070', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', NULL, '55.46', 3, '2006-04-01', '2007-12-31', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1063512580', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77002285', 'S77002285', 'UT01', NULL, 'Mark', NULL, 'Dudley', 'APRN', 'Mental Health', 'Chiropractic', NULL, NULL, 'B', '9135 S Monroe St Ste B', 'Sandy', 'Salt Lake', 'UT', '84070', '8013527270', '8013527024', '9135 S Monroe', 'Sandy', '', 'UT', '84070', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', NULL, '55.46', 3, '2006-04-01', '2007-12-31', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1689784019', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870358327', 'S77002286', 'S77002286', 'UT01', 'Olympus Clinic', 'Jon', 'T', 'Wall', 'MD', 'Family Practice', NULL, NULL, NULL, 'B', '4624 Holladay Blvd', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8012772682', '8012772980', NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2007-03-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1528006491', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870359334', 'S77002288', 'S77002288', 'UT01', NULL, 'A Patrick', NULL, 'Rose', 'MD', 'Pediatric Cardiology', 'Pediatrics', NULL, NULL, 'B', '5495 S 500 E Ste 330', 'Ogden', 'Weber', 'UT', '84405', '8014762717', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2006-11-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1326002973', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
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('870358327', 'S77002304', 'S77002304', 'UT01', 'Olympus Clinic', 'Christopher', 'J', 'Gamble', 'MD', 'Family Practice', NULL, NULL, NULL, 'B', '4624 Holladay Blvd', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8012772682', '8012772980', NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2007-03-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1487609277', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
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('870395551', 'S77002325', 'S77002325', 'UT01', 'Grant Chiropractic', 'Jay', 'P', 'Grant', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '62 N Grant Ave Ste 200', 'American Fork', 'Utah', 'UT', '84003', '8017566868', NULL, '867 E 9400 S', 'Sandy', '', 'UT', '84094', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', '0.00', '55.46', 3, '2006-04-01', '2010-10-31', NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1588691570', 0, 'N', 0, '2006-08-31', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77002326', 'S77002326', 'UT01', NULL, 'Todd', 'N', 'Grant', 'DC', 'Chiropractic', NULL, NULL, NULL, 'B', '9135 S Monroe St Ste B', 'Sandy', 'Salt Lake', 'UT', '84070', NULL, NULL, '9135 S Monroe', 'Sandy', '', 'UT', '84070', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', NULL, '55.46', 3, '2006-04-01', '2007-12-31', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1265516165', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870370541', 'S77002327', 'S77002327', 'UT01', 'Ogden Speech & Hearing Center', 'Ogden Speech & Hearing Center', NULL, NULL, 'GROUP', 'Speech Therapy', NULL, NULL, NULL, 'O', '978 Chambers St Ste 1', 'Ogden', 'Weber', 'UT', '84403', '8013995601', '8013942230', NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-09-01', '2006-09-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '834782', 0, 'y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870371964', 'S77002328', 'S77002328', 'UT01', 'Cache Valley Ear Nose and Throat', 'Jeffrey', 'G', 'Bennion', 'MD', 'Ear, Nose and Throat', 'Head and Neck Surgery', 'Plastic Surgery', NULL, 'O', '2380 N 400 E Ste D', 'North Logan', 'Cache', 'UT', '84341', '4357537880', '4357535845', '2380 N 400 E Ste D', 'North Logan', 'Cache', 'UT', '84341', '4357537880', '4357535845', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-10-01', NULL, 0, 0, 0, 'Franklin County Medical Center ', 'Logan Regional Hospital', NULL, NULL, 'HCFA|UB|', '1396731469', 0, 'N', 0, '2012-10-23', NULL, NULL, 41.775, -111.823, NULL, NULL),
('870372827', 'S77002329', 'S77002329', 'UT01', NULL, 'Paul J', '', 'Diehl,', 'MD', 'Anesthesiology', NULL, NULL, NULL, 'B', '1954 E Fort Union Blvd Ste 107', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019939527', NULL, '1954 E Fort Union Bvld', 'Salt Lake City', '', 'UT', '84121', '', '', NULL, NULL, '1000', '47.75', NULL, NULL, 3, '2007-01-01', '2007-01-01', 1, 12, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', NULL, 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870372827', 'S77002330', 'S77002330', 'UT01', NULL, 'Dallan', NULL, 'Daniels', 'CRNA', 'Anesthesiology', NULL, NULL, NULL, 'O', '10011 Centennial Pkwy', 'Sandy', 'Salt Lake', 'UT', '84070', '8019939527', NULL, '1954 E Fort Union Bvld', 'Salt Lake City', '', 'UT', '84121', '', '', '', NULL, '1000', '47.75', '0.00', '0.00', 3, '2007-01-01', NULL, 1, 12, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1326066499', 0, 'Y', 0, '2007-01-10', NULL, NULL, 40.5696, -111.895, NULL, NULL),
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('870364077', 'S77002339', 'S77002339', 'UT01', 'Wasatch Neurological Clinic', 'Robert', 'A', 'Summerfield', 'MD', 'Neurology', '', '', NULL, 'O', '6040 Fashion Blvd Ste 201', 'Murray', 'Salt Lake', 'UT', '84107', '8012681888', NULL, '6040 Fashion Blvd Ste 201', 'Murray', 'Salt Lake', 'UT', '84107', '8012681888', '', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', '2011-10-03', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1215919659', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('870364697', 'S77002340', 'S77002340', 'UT01', 'Mountain View Womens Care', 'Stephen', 'M', 'Rees', 'MD', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'O', '1120 E 100 N Ste 3', 'Payson', 'Utah', 'UT', '84651', '8014652559', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1689750838', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870364697', 'S77002341', 'S77002341', 'UT01', 'Mountain View Womens Care', 'Stephen', 'M', 'Rees', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '777 N 500 W Ste 203', 'Provo', 'Utah', 'UT', '84601', '8013561113', '', '777 N 500 W Ste 203', 'Provo', 'Utah', 'UT', '84601', '8013561113', '', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-06-01', '2008-09-30', 0, 0, 0, 'Mountain View Hospital', '', '', '', 'HCFA|UB|', '1689750838', 0, 'N', 0, '2014-07-24', NULL, NULL, 0, 0, NULL, NULL),
('870365447', 'S77002343', 'S77002343', 'UT01', '', 'N Branson', '', 'Call', 'MD', 'Ophthalmology', '', '', NULL, 'O', '324 10th Ave Ste 185', 'Salt Lake City', 'Salt Lake', 'UT', '84103', '8014082015', '8014085190', '324 10th Ave', 'Salt Lake City', 'Salt Lake', 'UT', '84103', '8014082015', '8014085190', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', '2011-10-05', NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1710931191', 0, 'N', 0, '2011-10-05', NULL, NULL, 0, 0, NULL, NULL),
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('870371964', 'S77002347', 'S77002347', 'UT01', 'Cache Valley Ear Nose And Throat', 'Jeffrey', 'G', 'Bennion', 'MD', 'Ear, Nose and Throat', 'Head and Neck Surgery', 'Plastic Surgery', 'Plastic Surgery', 'B', '2380 N 400 E Ste D', 'Logan', 'Cache', 'UT', '84341', '4357537880', '4357535845', NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-10-01', '2006-10-01', 0, NULL, 0, 'Franklin County Medical Center ', 'Logan Regional Hospital', NULL, NULL, 'HCFA|UB|', '1396731469', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870371964', 'S77002348', 'S77002348', 'UT01', 'Cache Valley Ear Nose And Throat', 'James', 'W', 'Blotter', 'MD', 'Ear, Nose and Throat', 'Head and Neck Surgery', 'Plastic Surgery', 'Plastic Surgery', 'B', '2380 N 400 E Ste D', 'Logan', 'Cache', 'UT', '84341', '4357537880', '4357535845', NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-10-01', '2006-10-01', 0, NULL, 0, 'Logan Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1962499673', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870371964', 'S77002349', 'S77002349', 'UT01', 'Cache Valley Ear Nose and Throat', 'James', 'W', 'Blotter', 'MD', 'Ear, Nose and Throat', 'Head and Neck Surgery', 'Plastic Surgery', NULL, 'O', '2380 N 400 E Ste D', 'North Logan', 'Cache', 'UT', '84341', '4357537880', '4357535845', '2380 N 400 E Ste D', 'North Logan', 'Cache', 'UT', '84341', '4357537880', '4357535845', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-10-01', NULL, 0, 0, 0, 'Logan Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1962499673', 0, 'N', 0, '2013-08-27', NULL, NULL, 41.775, -111.823, NULL, NULL),
('870395551', 'S77002350', 'S77002350', 'UT01', '', 'Bruce', '', 'Gundersen', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '4211 Holladay Blvd', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012728471', '8012726941', '867 E 9400 S', 'Sandy', 'Salt Lake', 'UT', '84094', '8012728471', '8012726941', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2006-04-01', '2010-09-23', NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1952409476', 0, 'Y', 0, '2011-03-08', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77002351', 'S77002351', 'UT01', 'Chiropractic Associates', 'Harold', 'W', 'Gunn', 'DC', 'Chiropractic', '', '', NULL, 'O', '7669 S 1700 W', 'West Jordan', 'Salt Lake', 'UT', '84084', '8015662465', '8015660247', '867 E 9400 S', 'Sandy', 'Salt Lake', 'UT', '84094', '8015662465', '8015660247', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2006-04-01', '2010-10-31', NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1497744692', 0, 'N', 0, '2011-02-11', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77002352', 'S77002352', 'UT01', NULL, 'Charles', NULL, 'Hagan', 'DC', 'Chiropractic', NULL, NULL, NULL, 'B', '9135 S Monroe St Ste B', 'Sandy', 'Salt Lake', 'UT', '84070', NULL, NULL, '9135 S Monroe', 'Sandy', '', 'UT', '84070', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', NULL, '55.46', 3, '2006-04-01', '2007-12-31', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '833506', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77002353', 'S77002353', 'UT01', NULL, 'Gregory', 'K', 'Hansen', 'DC', 'Chiropractic', NULL, NULL, NULL, 'B', '9135 S Monroe St Ste B', 'Sandy', 'Salt Lake', 'UT', '84070', NULL, NULL, '9135 S Monroe', 'Sandy', '', 'UT', '84070', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', NULL, '55.46', 3, '2006-04-01', '2007-12-31', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1275602724', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77002354', 'S77002354', 'UT01', NULL, 'Randall', 'W', 'Hayes', 'DC', 'Chiropractic', NULL, NULL, NULL, 'B', '9135 S Monroe St Ste B', 'Sandy', 'Salt Lake', 'UT', '84070', NULL, NULL, '9135 S Monroe', 'Sandy', '', 'UT', '84070', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', NULL, '55.46', 3, '2006-04-01', '2007-12-31', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '834298', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77002356', 'S77002356', 'UT01', NULL, 'Wayne', NULL, 'Hunsaker', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '150 E 200 N', 'Logan', 'Cache', 'UT', '84321', '4357522962', '4357525173', '867 E 9400 S', 'Sandy', '', 'UT', '84094', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', '0.00', '55.46', 3, '2006-04-01', '2010-10-31', NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1205986148', 0, 'N', 0, '2006-08-31', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77002357', 'S77002357', 'UT01', NULL, 'Kelly', NULL, 'Jarvis', 'DC', 'Chiropractic', NULL, NULL, NULL, 'B', '9135 S Monroe St Ste B', 'Sandy', 'Salt Lake', 'UT', '84070', NULL, NULL, '9135 S Monroe', 'Sandy', '', 'UT', '84070', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', NULL, '55.46', 3, '2006-04-01', '2007-12-31', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1730138470', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77002358', 'S77002358', 'UT01', NULL, 'Ryan', 'C', 'Jeffery', 'DC', 'Chiropractic', NULL, NULL, NULL, 'B', '9135 S Monroe St Ste B', 'Sandy', 'Salt Lake', 'UT', '84070', NULL, NULL, '9135 S Monroe', 'Sandy', '', 'UT', '84070', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', NULL, '55.46', 3, '2006-04-01', '2007-01-26', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1336291012', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77002359', 'S77002359', 'UT01', NULL, 'Paul', NULL, 'Jensen', 'DC', 'Chiropractic', NULL, NULL, NULL, 'B', '9135 S Monroe St Ste B', 'Sandy', 'Salt Lake', 'UT', '84070', NULL, NULL, '9135 S Monroe', 'Sandy', '', 'UT', '84070', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', NULL, '55.46', 3, '2006-04-01', '2007-12-31', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1417013178', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77002360', 'S77002360', 'UT01', NULL, 'Karson', NULL, 'Johnson', 'DC', 'Chiropractic', NULL, NULL, NULL, 'B', '9135 S Monroe St Ste B', 'Sandy', 'Salt Lake', 'UT', '84070', NULL, NULL, '9135 S Monroe', 'Sandy', '', 'UT', '84070', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', NULL, '55.46', 3, '2006-04-01', '2007-12-31', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1659406858', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77002361', 'S77002361', 'UT01', NULL, 'Mark', 'A', 'Jolley', 'DC', 'Chiropractic', NULL, NULL, NULL, 'B', '9135 S Monroe St Ste B', 'Sandy', 'Salt Lake', 'UT', '84070', NULL, NULL, '9135 S Monroe', 'Sandy', '', 'UT', '84070', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', NULL, '55.46', 3, '2006-04-01', '2007-12-31', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1801986310', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870373084', 'S77002363', 'S77002363', 'UT01', 'Henderson, David J', 'David', 'J', 'Henderson', 'MD', 'Urology', NULL, NULL, NULL, 'B', '415 Medical Dr A202', 'Bountiful', 'Davis', 'UT', '84010', '8017734840', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-10-01', '2006-10-01', 0, NULL, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1417933284', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870373103', 'S77002364', 'S77002364', 'UT01', 'Goble, E Marlow', 'E Marlowe', NULL, 'Goble', 'MD', 'Orthopedic Surgery', NULL, NULL, NULL, 'B', '2380 N 400 E Ste G', 'Logan', 'Cache', 'UT', '84341', '4357878797', '4357871984', NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-12-01', '2006-12-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '832862', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870373103', 'S77002365', 'S77002365', 'UT01', '', 'E Marlowe', '', 'Goble', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '2380 N 400 E Ste G', 'North Logan', 'Cache', 'UT', '84341', '4357524665', '4357871984', '2380 N 400 E Ste G', 'North Logan', 'Cache', 'UT', '84341', '4357524665', '4357871984', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-12-01', '2010-09-27', 0, 0, 0, 'Logan Regional Hospital', '', '', '', 'HCFA|UB|', '1235232646', 0, 'N', 0, '2014-05-08', NULL, NULL, 0, 0, NULL, NULL),
('870373493', 'S77002366', 'S77002366', 'UT01', NULL, 'Bradd', '', 'Christensen', 'MD', 'Plastic Surgery', '', '', NULL, 'O', '1377 E 3900 S Ste 104', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012724249', '8012724262', '1377 E 3900 S Ste 104', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012724249', '8012724262', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-10-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1891840914', 0, 'N', 0, '2014-06-04', NULL, NULL, 40.6871, -111.852, NULL, NULL),
('870376403', 'S77002369', 'S77002369', 'UT01', '', 'John', 'F', 'Ramsey', 'MD', 'Ophthalmology', '', '', NULL, 'O', '9720 S 1300 E Ste E210', 'Sandy', 'Salt Lake', 'UT', '84094', '8015720631', '8015760670', '9720 S 1300 E', 'Sandy', 'Salt Lake', 'UT', '840943712', '8015720631', '8015760670', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-10-01', '2011-07-07', NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1114999224', 0, 'N', 0, '2011-07-07', NULL, NULL, 0, 0, NULL, NULL),
('870378499', 'S77002370', 'S77002370', 'UT01', NULL, 'Wayne', 'E', 'Cox', 'MD', 'General Surgery', '', '', NULL, 'B', 'PO Box 918', 'Price', 'Carbon', 'UT', '84501', '4356372970', '4356379158', 'PO Box 918', 'Price', 'Carbon', 'UT', '84501', '4356372970', '4356379158', 'WEUHP', 'WUSTDHCPC5', NULL, '0.00', '20.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, 'Castleview Hospital', 'Castleview Hospital', NULL, NULL, 'HCFA|UB|', '1821215997', 0, 'Y', 0, '2012-10-25', NULL, NULL, 0, 0, NULL, NULL),
('870380540', 'S77002371', 'S77002371', 'UT01', 'Western Urological Clinic', 'Regan', 'K', 'Brooks', 'PA', 'Urology', '', '', NULL, 'O', '4252 Highland Dr Ste 200', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8019931800', NULL, '4252 Highland Dr Ste 200', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8019931800', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1215077250', 0, 'N', 0, '2013-12-02', NULL, NULL, 40.6791, -111.843, NULL, NULL),
('870382132', 'S77002373', 'S77002373', 'UT01', 'Draper Vision Care Center', 'Howard', 'A', 'Katzman', 'MD', 'Ophthalmology', NULL, NULL, NULL, 'O', '12256 S 900 E Ste 401', 'Draper', 'Salt Lake', 'UT', '84020', '8016199494', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2006-11-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1760492912', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870385861', 'S77002374', 'S77002374', 'UT01', NULL, 'Russell', 'B', 'Shields', 'MD', 'Internal Medicine', '', '', NULL, 'O', '425 Medical Dr Ste 108', 'Bountiful', 'Davis', 'UT', '84010', '8012928444', NULL, '425 Medical Dr', 'Bountiful', 'Davis', 'UT', '84010', '8012928444', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, NULL, 0, 0, 'Lakeview Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1568451730', 0, 'N', 0, '2011-12-01', NULL, NULL, 40.8873, -111.872, 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
('870386970', 'S77002375', 'S77002375', 'UT01', NULL, 'Donald', 'A', 'Schmidt', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '9844 S 1300 E Ste 275', 'Sandy', 'Salt Lake', 'UT', '84094', '8015717061', '8015724564', '9844 S 1300 E Ste 275', 'Sandy', 'Salt Lake', 'UT', '84094', '8015717061', '8015724564', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-09-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', '', '', '', 'HCFA|UB|', '1811979255', 0, 'N', 0, '2012-05-18', NULL, NULL, 40.5721, -111.853, NULL, NULL),
('870372798', 'S77002376', 'S77002376', 'UT01', NULL, 'Robert', 'S', 'Kiyomura', 'MD', 'Gastroenterology', '', '', NULL, 'O', '2084 N 1700 W Ste B', 'Layton', 'Davis', 'UT', '84041', '8017739710', NULL, '2084 N 1700 W Ste B', 'Layton', 'Davis', 'UT', '84041', '8017739710', '', 'WiseSTD15', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1922113380', 0, 'N', 0, '2014-07-10', NULL, NULL, 41.0897, -111.997, NULL, NULL),
('870372827', 'S77002377', 'S77002377', 'UT01', NULL, 'Paul J', '', 'Diehl,', 'MD', 'Anesthesiology', NULL, NULL, NULL, 'O', '10011 Centennial Pkwy ', 'Sandy', 'Salt Lake', 'UT', '84070', '8019939527', NULL, '1954 E Fort Union Bvld', 'Salt Lake City', '', 'UT', '84121', '', '', NULL, NULL, '1000', '47.75', NULL, NULL, 3, '2007-01-01', '2007-01-01', 1, 12, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', NULL, 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870372827', 'S77002378', 'S77002378', 'UT01', NULL, 'Dallan', NULL, 'Daniels', 'CRNA', 'Anesthesiology', NULL, NULL, NULL, 'B', '1954 E Fort Union Blvd Ste 107', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019939506', NULL, '1954 E Fort Union Bvld', 'Salt Lake City', '', 'UT', '84121', '', '', '', NULL, '1000', '47.75', '0.00', '0.00', 3, '2007-01-01', NULL, 1, 12, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1326066499', 0, 'Y', 0, '2007-01-10', NULL, NULL, 0, 0, NULL, NULL),
('870372827', 'S77002379', 'S77002379', 'UT01', NULL, 'Gary', NULL, 'Wiscombe', 'CRNA', 'Anesthesiology', NULL, NULL, NULL, 'O', '10011 Centennial Pkwy', 'Sandy', 'Salt Lake', 'UT', '84070', '8019939527', NULL, '1954 E Fort Union Bvld', 'Salt Lake City', '', 'UT', '84121', '', '', '', NULL, '1000', '47.75', '0.00', '0.00', 3, '2007-01-01', NULL, 1, 12, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1790881761', 0, 'Y', 0, '2007-01-10', NULL, NULL, 40.5696, -111.895, NULL, NULL),
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('870395551', 'S77002490', 'S77002490', 'UT01', '', 'Tyler', 'R', 'Elmore', 'DC', 'Chiropractic', '', '', NULL, 'O', '1842 S 2000 W', 'Syracuse', 'Davis', 'UT', '84075', '8017747540', '8017747542', '1842 S 2000 W', 'Syracuse', 'Davis', 'UT', '84075', '8017747540', '8017747542', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2006-04-01', '2010-10-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1811081771', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('870386125', 'S77002491', 'S77002491', 'UT01', NULL, 'Michael', 'S', 'Kottler', 'MD', 'Ophthalmology', NULL, NULL, NULL, 'O', '1471 S Highway 40', 'Heber City', 'Wasatch', 'UT', '84032', '4356543090', '4356543091', NULL, NULL, '', NULL, NULL, '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2006-11-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1740287705', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870386125', 'S77002492', 'S77002492', 'UT01', '', 'Michael', 'S', 'Kottler', 'MD', 'Ophthalmology', '', '', NULL, 'B', 'PO Box 27688', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '8015341360', '8013669883', 'PO Box 27688', 'Salt Lake City', 'Salt Lake', 'UT', '841270688', '8015341360', '8013669883', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-11-01', '2011-10-05', NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1740287705', 0, 'Y', 0, '2011-10-05', NULL, NULL, 0, 0, NULL, NULL),
('870386904', 'S77002493', 'S77002493', 'UT01', 'Nuttall, David C', 'David', 'C', 'Nuttall', 'MD', 'Pediatrics', NULL, NULL, NULL, 'O', '120 N 1220 E Ste 2', 'American Fork', 'Utah', 'UT', '84003', '8017566092', NULL, NULL, NULL, '', NULL, NULL, '', '', 'WUUVPN10', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-06-01', '2006-06-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1780701862', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870387679', 'S77002494', 'S77002494', 'UT01', 'Lind Lamoreaux Melendez and Aagard', 'James', '', 'Lamoreaux', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '120 N 1220 E Ste 7', 'American Fork', 'Utah', 'UT', '84003', '8017569635', NULL, '120 N 1220 E Ste 7', 'American Fork', 'Utah', 'UT', '84003', '8017569635', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-09-01', '2008-04-01', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1932212503', 0, 'N', 0, '2012-03-14', NULL, NULL, 0, 0, NULL, NULL),
('870387679', 'S77002495', 'S77002495', 'UT01', 'Lind Lamoreaux Melendez and Aagard', 'Terry', '', 'Melendez', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '120 N 1220 E Ste 7', 'American Fork', 'Utah', 'UT', '84003', '8017569635', NULL, '120 N 1220 E Ste 7', 'American Fork', 'Utah', 'UT', '84003', '8017569635', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-09-01', '2008-04-01', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1316050081', 0, 'N', 0, '2012-03-08', NULL, NULL, 0, 0, NULL, NULL),
('870387994', 'S77002496', 'S77002496', 'UT01', '', 'Rich', 'H', 'Humpherys', 'OD', 'Optometry', '', '', NULL, 'O', '1055 N Washington Blvd', 'Ogden', 'Weber', 'UT', '84404', '8013945709', NULL, '1055 N Washington Blvd', 'Ogden', 'Weber', 'UT', '84404', '8013945709', '', 'WUTALBERT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-09-01', '2012-11-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1275569444', 0, 'N', 0, '2014-04-23', NULL, NULL, 0, 0, NULL, NULL),
('870391052', 'S77002499', 'S77002499', 'UT01', 'Audiology Associates', 'C Brent', NULL, 'Fox', 'AUD', 'Audiology', NULL, NULL, NULL, 'O', '130 W Main St Ste E', 'Lehi', 'Utah', 'UT', '84043', '8002449001', NULL, '1377 E 3900 S', 'Salt Lake City', '', 'UT', '84124', '', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 3, '2006-11-01', '2006-11-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1811938939', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870393111', 'S77002503', 'S77002503', 'UT01', 'Ogden Audiology Services', 'Kody', '', 'Kennington', 'AUD', 'Audiology', '', '', NULL, 'O', '425 E 5350 S Ste 120', 'Ogden', 'Weber', 'UT', '84405', '8014793346', '8014790725', '425 E 5350 S Ste 120', 'Ogden', 'Weber', 'UT', '84405', '8014793346', '8014790725', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000007070', 0, 'Y', 0, '2013-02-21', NULL, NULL, 41.166, -111.97, NULL, NULL),
('870395551', 'S77002504', 'S77002504', 'UT01', NULL, 'Rodney', 'R', 'Scuderi', 'DC', 'Chiropractic', NULL, NULL, NULL, 'B', '9135 S Monroe St Ste B', 'Sandy', 'Salt Lake', 'UT', '84070', NULL, NULL, '9135 S Monroe', 'Sandy', '', 'UT', '84070', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', NULL, '55.46', 3, '2006-04-01', '2007-12-31', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1548271950', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77002505', 'S77002505', 'UT01', NULL, 'David', NULL, 'Sessions', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '279 E 5900 S Ste 100', 'Murray', 'Salt Lake', 'UT', '84157', '8012611700', '8012611800', '867 E 9400 S', 'Sandy', '', 'UT', '84094', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', '0.00', '55.46', 3, '2006-04-01', '2010-10-31', NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1144334707', 0, 'N', 0, '2006-08-31', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77002506', 'S77002506', 'UT01', NULL, 'Edward', 'F', 'Smith', 'DC', 'Chiropractic', NULL, NULL, NULL, 'B', '9135 S Monroe St Ste B', 'Sandy', 'Salt Lake', 'UT', '84070', '8013527270', '8013527024', '9135 S Monroe', 'Sandy', '', 'UT', '84070', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', NULL, '55.46', 3, '2006-04-01', '2007-12-31', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1578615761', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77002508', 'S77002508', 'UT01', 'Maple Ridge Chiropractic', 'Matthew', 'D', 'Smith', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '11483 S State St Ste F', 'Draper', 'Salt Lake', 'UT', '84020', '8015717670', '8015717674', '9135 S Monroe', 'Sandy', '', 'UT', '84070', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', NULL, '55.46', 3, '2006-04-01', '2007-01-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1770757569', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77002509', 'S77002509', 'UT01', '', 'Bryan', 'Dean', 'Smuin', 'DC', 'Chiropractic', '', '', NULL, 'O', '319 W 100 S Ste B', 'Vernal', 'Uintah', 'UT', '84078', '4357897290', '4357897251', '867 E 9400 S', 'Sandy', 'Uintah', 'UT', '84094', '4357897290', '4357897251', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2006-04-01', '2010-10-31', NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1467589069', 0, 'N', 0, '2011-03-01', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77002510', 'S77002510', 'UT01', NULL, 'Bryan', 'D', 'Smuin', 'DC', 'Chiropractic', NULL, NULL, NULL, 'B', '9135 S Monroe St Ste B', 'Sandy', 'Salt Lake', 'UT', '84070', NULL, NULL, '9135 S Monroe', 'Sandy', '', 'UT', '84070', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', NULL, '55.46', 3, '2006-04-01', '2007-12-31', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1467589069', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77002511', 'S77002511', 'UT01', NULL, 'Corey', 'J', 'Sondrup', 'DC', 'Chiropractic', NULL, NULL, NULL, 'B', '9135 S Monroe St Ste B', 'Sandy', 'Salt Lake', 'UT', '84070', '8013527270', '8013527024', '9135 S Monroe', 'Sandy', '', 'UT', '84070', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', NULL, '55.46', 3, '2006-04-01', '2007-12-31', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1447381223', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77002512', 'S77002512', 'UT01', '', 'Corey', 'J', 'Sondrup', 'DC', 'Chiropractic', '', '', NULL, 'O', '1117 Country Hills Dr Ste 2', 'Ogden', 'Weber', 'UT', '84403', '8014761752', '8014763075', '867 E 9400 S', 'Sandy', 'Weber', 'UT', '84094', '8014761752', '8014763075', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2006-04-01', '2010-10-31', NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1447381223', 0, 'N', 0, '2011-03-28', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77002513', 'S77002513', 'UT01', NULL, 'Randy', 'L', 'Stauffer', 'DC', 'Chiropractic', NULL, NULL, NULL, 'B', '9135 S Monroe St Ste B', 'Sandy', 'Salt Lake', 'UT', '84070', '8013527270', '8013527024', '9135 S Monroe', 'Sandy', '', 'UT', '84070', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', NULL, '55.46', 3, '2006-04-01', '2007-12-31', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '920827', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77002514', 'S77002514', 'UT01', NULL, 'Dee', 'Scott', 'Stevens', 'DC', 'Chiropractic', NULL, NULL, NULL, 'B', '9135 S Monroe St Ste B', 'Sandy', 'Salt Lake', 'UT', '84070', '8013527270', '8013527024', '9135 S Monroe', 'Sandy', '', 'UT', '84070', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', NULL, '55.46', 3, '2006-04-01', '2007-12-31', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1962456681', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77002515', 'S77002515', 'UT01', '', 'Joseph', 'Woodruff', 'Swenson', 'DC', 'Chiropractic', '', '', NULL, 'O', '3564 S 7200 W Ste D', 'Magna', 'Salt Lake', 'UT', '84044', '8015087246', '8015081902', '3564 S 7200 W Ste D', 'Magna', 'Salt Lake', 'UT', '84044', '8015087246', '8015081902', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2006-04-01', '2010-10-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1194843698', 0, 'N', 0, '2012-06-26', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77002516', 'S77002516', 'UT01', NULL, 'Kelly', 'D', 'Terry', 'DC', 'Chiropractic', NULL, NULL, NULL, 'B', '9135 S Monroe St Ste B', 'Sandy', 'Salt Lake', 'UT', '84070', NULL, NULL, '9135 S Monroe', 'Sandy', '', 'UT', '84070', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', NULL, '55.46', 3, '2006-04-01', '2007-12-31', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '834535', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77002517', 'S77002517', 'UT01', NULL, 'Glenn', 'H', 'Thompson', 'DC', 'Chiropractic', NULL, NULL, NULL, 'B', '9135 S Monroe St Ste B', 'Sandy', 'Salt Lake', 'UT', '84070', NULL, NULL, '9135 S Monroe', 'Sandy', '', 'UT', '84070', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', NULL, '55.46', 3, '2006-04-01', '2007-12-31', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1407830953', 0, 'Y', 0, NULL, 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
('870395551', 'S77002518', 'S77002518', 'UT01', NULL, 'Neil', 'L', 'Erickson', 'DC', 'Chiropractic', NULL, NULL, NULL, 'B', '9135 S Monroe St Ste B', 'Sandy', 'Salt Lake', 'UT', '84070', NULL, NULL, '9135 S Monroe', 'Sandy', '', 'UT', '84070', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', NULL, '55.46', 3, '2006-04-01', '2007-12-31', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1801832241', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77002519', 'S77002519', 'UT01', 'Chiropractic Health Plan', 'Randall', 'B', 'Forbes', 'DC', 'Chiropractic', NULL, NULL, NULL, 'B', '9135 S Monroe St Ste B', 'Sandy', 'Salt Lake', 'UT', '84070', NULL, NULL, '9135 S Monroe', 'Sandy', '', 'UT', '84070', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', NULL, '55.46', 3, '2006-04-01', '2007-04-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '833959', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77002520', 'S77002520', 'UT01', NULL, 'James', 'I', 'Grant', 'DC', 'Chiropractic', NULL, NULL, NULL, 'B', '9135 S Monroe St Ste B', 'Sandy', 'Salt Lake', 'UT', '84070', NULL, NULL, '9135 S Monroe', 'Sandy', '', 'UT', '84070', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', NULL, '55.46', 3, '2006-04-01', '2007-12-31', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1316057466', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77002521', 'S77002521', 'UT01', '', 'Todd', 'N', 'Grant', 'DC', 'Chiropractic', '', '', NULL, 'O', '280 W 200 N Ste A', 'Kaysville', 'Davis', 'UT', '84037', '8015462273', '8015464585', '280 W 200 N Ste A', 'Kaysville', 'Davis', 'UT', '84037', '8015462273', '8015464585', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2006-04-01', '2010-10-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1265516165', 0, 'N', 0, '2014-05-07', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77002522', 'S77002522', 'UT01', NULL, 'Jeff', NULL, 'Gray', 'DC', 'Chiropractic', NULL, NULL, NULL, 'B', '9135 S Monroe St Ste B', 'Sandy', 'Salt Lake', 'UT', '84070', NULL, NULL, '9135 S Monroe', 'Sandy', '', 'UT', '84070', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', NULL, '55.46', 3, '2006-04-01', '2007-12-31', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '832053', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77002523', 'S77002523', 'UT01', NULL, 'Harold', NULL, 'Gunn', 'DC', 'Chiropractic', NULL, NULL, NULL, 'B', '9135 S Monroe St Ste B', 'Sandy', 'Salt Lake', 'UT', '84070', NULL, NULL, '9135 S Monroe', 'Sandy', '', 'UT', '84070', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', NULL, '55.46', 3, '2006-04-01', '2007-12-31', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1497744692', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77002524', 'S77002524', 'UT01', NULL, 'Paul', NULL, 'Gurney', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '381 E 800 S Ste 101', 'Orem', 'Utah', 'UT', '84097', '8012346325', '8012211655', '867 E 9400 S', 'Sandy', '', 'UT', '84094', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', '0.00', '55.46', 3, '2006-04-01', '2010-10-31', NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1649328170', 0, 'N', 0, '2006-08-31', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77002525', 'S77002525', 'UT01', '', 'Daryl', '', 'Hales', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '360 S State St Ste A', 'Clearfield', 'Davis', 'UT', '84015', '8017731821', '8018255276', '867 E 9400 S', 'Sandy', 'Davis', 'UT', '84094', '8017731821', '8018255276', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '35.00', '55.46', 3, '2006-04-01', '2010-10-31', NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1972504892', 0, 'N', 0, '2011-02-15', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77002526', 'S77002526', 'UT01', NULL, 'Keith', 'S', 'Hansen', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '891 E 9400 S', 'Sandy', 'Salt Lake', 'UT', '84094', '8015698181', NULL, '867 E 9400 S', 'Sandy', '', 'UT', '84094', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', '0.00', '55.46', 3, '2006-04-01', '2008-05-10', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1497886246', 0, 'N', 0, '2006-08-31', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77002527', 'S77002527', 'UT01', NULL, 'Keith', 'S', 'Hansen', 'DC', 'Chiropractic', NULL, NULL, NULL, 'B', '9135 S Monroe St Ste B', 'Sandy', 'Salt Lake', 'UT', '84070', '8013527270', '8013527024', '9135 S Monroe', 'Sandy', '', 'UT', '84070', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', NULL, '55.46', 3, '2006-04-01', '2007-12-31', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1497886246', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77002528', 'S77002528', 'UT01', 'Harrison Chiropractic', 'Eric', 'J', 'Harrison', 'DC', 'Chiropractic', '', '', NULL, 'O', '2828 W 4700 S Ste A', 'Taylorsville', 'Salt Lake', 'UT', '84118', '8019663101', '8019660161', '2828 W 4700 S Ste A', 'Taylorsville', 'Salt Lake', 'UT', '84118', '8019663101', '8019660161', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2006-04-01', '2010-10-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1417037920', 0, 'N', 0, '2013-12-31', NULL, NULL, 0, 0, NULL, NULL),
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('870395551', 'S77002632', 'S77002632', 'UT01', '', 'James', 'L', 'Misustin', 'DC', 'Chiropractic', '', '', NULL, 'O', '1415 N 400 E Ste A', 'Logan', 'Cache', 'UT', '84341', '4357532840', '4357879422', '1415 N 400 E Ste A', 'Logan', 'Cache', 'UT', '84341', '4357532840', '4357879422', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2006-04-01', '2010-10-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1427115682', 0, 'N', 0, '2012-06-29', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77002633', 'S77002633', 'UT01', NULL, 'James', 'L', 'Misustin', 'DC', 'Chiropractic', NULL, NULL, NULL, 'B', '9135 S Monroe St Ste B', 'Sandy', 'Salt Lake', 'UT', '84070', NULL, NULL, '9135 S Monroe', 'Sandy', '', 'UT', '84070', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', NULL, '55.46', 3, '2006-04-01', '2007-12-31', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1427115682', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
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('870395551', 'S77002635', 'S77002635', 'UT01', '', 'Danny', '', 'Monson', 'DC', 'Chiropractic', '', '', NULL, 'O', '3684 S State St', 'Murray', 'Salt Lake', 'UT', '84115', '8019665200', NULL, '3684 S State St', 'Murray', 'Salt Lake', 'UT', '84115', '8019665200', '          ', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2006-04-01', '2010-10-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1518989763', 0, 'N', 0, '2012-02-27', NULL, NULL, 0, 0, NULL, NULL),
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('870395551', 'S77002640', 'S77002640', 'UT01', '', 'Robert', 'K', 'Nelson', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '756 W Main St', 'Vernal', 'Uintah', 'UT', '84078', '4357810048', '4357897241', '867 E 9400 S', 'Sandy', 'Uintah', 'UT', '84094', '4357810048', '4357897241', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2006-04-01', '2010-10-31', NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1447206586', 0, 'N', 0, '2011-06-29', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77002641', 'S77002641', 'UT01', NULL, 'Roger', NULL, 'Neuman', 'DC', 'Chiropractic', NULL, NULL, NULL, 'B', '9135 S Monroe St Ste B', 'Sandy', 'Salt Lake', 'UT', '84070', NULL, NULL, '9135 S Monroe', 'Sandy', '', 'UT', '84070', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', NULL, '55.46', 3, '2006-04-01', '2007-12-31', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '833552', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77002642', 'S77002642', 'UT01', NULL, 'Bruce', NULL, 'Nielson', 'DC', 'Chiropractic', NULL, NULL, NULL, 'B', '9135 S Monroe St Ste B', 'Sandy', 'Salt Lake', 'UT', '84070', NULL, NULL, '9135 S Monroe', 'Sandy', '', 'UT', '84070', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', '0.00', '55.46', 3, '2006-04-01', '2008-02-09', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000833867', 0, 'Y', 0, '2006-08-31', 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
('870395551', 'S77002643', 'S77002643', 'UT01', NULL, 'Gary', 'D', 'Olsen', 'DC', 'Chiropractic', NULL, NULL, NULL, 'B', '9135 S Monroe St Ste B', 'Sandy', 'Salt Lake', 'UT', '84070', NULL, NULL, '9135 S Monroe', 'Sandy', '', 'UT', '84070', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', NULL, '55.46', 3, '2006-04-01', '2007-12-31', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1023092293', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77002644', 'S77002644', 'UT01', NULL, 'James', 'R', 'Park', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '1096 36th St', 'Ogden', 'Weber', 'UT', '84403', '8013932424', '8013943451', '867 E 9400 S', 'Sandy', '', 'UT', '84094', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', '0.00', '55.46', 3, '2006-04-01', '2010-10-31', NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1922188754', 0, 'N', 0, '2006-08-31', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77002645', 'S77002645', 'UT01', NULL, 'James', 'R', 'Park', 'DC', 'Chiropractic', NULL, NULL, NULL, 'B', '9135 S Monroe St Ste B', 'Sandy', 'Salt Lake', 'UT', '84070', NULL, NULL, '9135 S Monroe', 'Sandy', '', 'UT', '84070', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', NULL, '55.46', 3, '2006-04-01', '2007-12-31', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1922188754', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77002646', 'S77002646', 'UT01', NULL, 'Robert', 'E', 'Park', 'DC', 'Chiropractic', NULL, NULL, NULL, 'B', '9135 S Monroe St Ste B', 'Sandy', 'Salt Lake', 'UT', '84070', '8013527270', '8013527024', '9135 S Monroe', 'Sandy', '', 'UT', '84070', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', NULL, '55.46', 3, '2006-04-01', '2007-12-31', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1255471579', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77002647', 'S77002647', 'UT01', NULL, 'Jeff', NULL, 'Gray', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '1227 W 9000 S Ste G', 'West Jordan', 'Salt Lake', 'UT', '84088', '8017480140', NULL, '9135 S Monroe', 'Sandy', '', 'UT', '84070', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', NULL, '55.46', 3, '2006-04-01', '2007-04-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '832053', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77002648', 'S77002648', 'UT01', NULL, 'Bruce', NULL, 'Gundersen', 'DC', 'Chiropractic', NULL, NULL, NULL, 'B', '9135 S Monroe St Ste B', 'Sandy', 'Salt Lake', 'UT', '84070', NULL, NULL, '9135 S Monroe', 'Sandy', '', 'UT', '84070', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', NULL, '55.46', 3, '2006-04-01', '2007-12-31', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1952409476', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77002649', 'S77002649', 'UT01', 'Zion Chiropractic Neurology Associates', 'Kris', NULL, 'Hansen', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '301 N 200 E  Ste 1B', 'St George', 'Washington', 'UT', '84770', '4356742626', '4356285999', '867 E 9400 S', 'Sandy', '', 'UT', '84094', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', '0.00', '55.46', 3, '2006-04-01', '2010-10-31', NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1457388555', 0, 'N', 0, '2006-08-31', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77002650', 'S77002650', 'UT01', NULL, 'Kris', NULL, 'Hansen', 'DC', 'Chiropractic', NULL, NULL, NULL, 'B', '9135 S Monroe St Ste B', 'Sandy', 'Salt Lake', 'UT', '84070', NULL, NULL, '9135 S Monroe', 'Sandy', '', 'UT', '84070', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', NULL, '55.46', 3, '2006-04-01', '2007-12-31', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1457388555', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77002651', 'S77002651', 'UT01', NULL, 'Eric', 'J', 'Harrison', 'DC', 'Chiropractic', NULL, NULL, NULL, 'B', '9135 S Monroe St Ste B', 'Sandy', 'Salt Lake', 'UT', '84070', NULL, NULL, '9135 S Monroe', 'Sandy', '', 'UT', '84070', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', NULL, '55.46', 3, '2006-04-01', '2007-12-31', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1417037920', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77002652', 'S77002652', 'UT01', 'Harrison Chiropractic', 'Trent', NULL, 'Harrison', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '2828 W 4700 S Ste A', 'Taylorsville', 'Salt Lake', 'UT', '84118', '8019663101', '8019660161', '867 E 9400 S', 'Sandy', '', 'UT', '84094', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', '0.00', '55.46', 3, '2006-04-01', '2010-10-31', NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1659401438', 0, 'N', 0, '2007-04-05', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77002653', 'S77002653', 'UT01', '', 'George', 'A', 'Hartle', 'DC', 'Chiropractic', '', '', NULL, 'O', '383 E Lagoon St', 'Roosevelt', 'Duchesne', 'UT', '84066', '4357223370', '4357223384', '867 E 9400 S', 'Sandy', 'Duchesne', 'UT', '84094', '4357223370', '4357223384', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2006-04-01', '2010-10-31', NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1306885967', 0, 'N', 0, '2011-06-29', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77002654', 'S77002654', 'UT01', NULL, 'George', 'A', 'Hartle', 'DC', 'Chiropractic', NULL, NULL, NULL, 'B', '9135 S Monroe St Ste B', 'Sandy', 'Salt Lake', 'UT', '84070', NULL, NULL, '9135 S Monroe', 'Sandy', '', 'UT', '84070', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', NULL, '55.46', 3, '2006-04-01', '2007-12-31', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1306885967', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77002656', 'S77002656', 'UT01', NULL, 'Eugene', NULL, 'Hawkins', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '705 E 900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84105', '8013638881', NULL, '9135 S Monroe', 'Sandy', '', 'UT', '84070', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', NULL, '55.46', 3, '2006-04-01', '2007-01-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '833507', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77002657', 'S77002657', 'UT01', NULL, 'Dale', NULL, 'Heath', 'DC', 'Chiropractic', NULL, NULL, NULL, 'B', '9135 S Monroe St Ste B', 'Sandy', 'Salt Lake', 'UT', '84070', NULL, NULL, '9135 S Monroe', 'Sandy', '', 'UT', '84070', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', NULL, '55.46', 3, '2006-04-01', '2007-12-31', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1124192042', 0, 'Y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77002658', 'S77002658', 'UT01', NULL, 'Jeffrey', 'J', 'Hebert', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '8706 S 700 E Ste 206', 'Sandy', 'Salt Lake', 'UT', '84070', '8019426000', '8017484069', '867 E 9400 S', 'Sandy', '', 'UT', '84094', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', '0.00', '55.46', 3, '2006-04-01', '2010-10-31', NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1457449290', 0, 'N', 0, '2008-01-07', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'S77002659', 'S77002659', 'UT01', 'Avicenna Spine & Joint Care', 'Jeffrey', 'J', 'Hebert', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '1960 Sidewinder Dr Ste 106', 'Park City', 'Summit', 'UT', '84060', '4356559800', '4356553268', '9135 S Monroe', 'Sandy', '', 'UT', '84070', '', '', 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', NULL, '55.46', 3, '2006-04-01', '2007-05-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1457449290', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
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('870413860', 'S77002821', 'S77002821', 'UT01', 'Now Care Clinic', 'Danette', '', 'Stuart', 'PA', 'Family Practice', '', '', NULL, 'B', 'PO Box 241', 'Roy', 'Weber', 'UT', '84067', '8016213466', '8016218811', 'PO Box 241', 'Roy', 'Weber', 'UT', '84067', '8016213466', '8016218811', 'WUSTDFAM5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-06-01', '2009-12-15', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1104888718', 0, 'Y', 0, '2013-11-26', NULL, NULL, 0, 0, NULL, NULL),
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