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
('820299231', 'W12011291', 'W12011291', 'ID02', 'Saltzer Medical Group', 'Jon', 'L', 'Hlavinka', 'MD', 'Family Practice', '', '', NULL, 'O', '215 E Hawaii Ave', 'Nampa', 'Canyon', 'ID', '83686', '2084685910', '2084633032', '215 E Hawaii Ave', 'Nampa', 'Canyon', 'ID', '83686', '2084685910', '2084633032', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-05-13', '2012-12-31', 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1194715136', 0, 'N', 0, '2013-02-21', NULL, NULL, 0, 0, NULL, NULL),
('820299231', 'W12011292', 'W12011292', 'ID02', 'Saltzer Medical Group', 'Jon', 'L', 'Hlavinka', 'MD', 'Family Practice', '', '', NULL, 'B', '217 W Georgia Ave Ste 115', 'Nampa', 'Canyon', 'ID', '83686', '2084633280', '2082884987', '217 W Georgia Ave Ste 115', 'Nampa', 'Canyon', 'ID', '83686', '2084633280', '2082884987', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-05-13', '2012-12-31', 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1194715136', 0, 'N', 0, '2013-02-21', NULL, NULL, 0, 0, NULL, NULL),
('820299231', 'W12011294', 'W12011294', 'ID02', 'Saltzer Medical Group', 'Arthur', 'C', 'Jones', 'MD', 'Family Practice', '', '', NULL, 'B', '217 W Georgia Ave Ste 115', 'Nampa', 'Canyon', 'ID', '83686', '2084633280', '2082884987', '217 W Georgia Ave Ste 115', 'Nampa', 'Canyon', 'ID', '83686', '2084633280', '2082884987', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-05-13', '2011-08-18', 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1063402097', 0, 'N', 0, '2013-02-21', NULL, NULL, 0, 0, NULL, NULL),
('820299231', 'W12011295', 'W12011295', 'ID02', 'Saltzer Medical Group Portico', 'Arthur', 'C', 'Jones', 'MD', 'Family Practice', '', '', NULL, 'O', '3277 E Louise Dr', 'Meridian', 'Ada', 'ID', '83642', '2088842920', '2088842979', '3277 E Louise Dr', 'Meridian', 'Ada', 'ID', '83642', '2088842920', '2088842979', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-05-13', '2011-08-18', 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1063402097', 0, 'N', 0, '2013-02-21', NULL, NULL, 0, 0, NULL, NULL),
('820299231', 'W12011297', 'W12011297', 'ID02', 'Saltzer Medical Group', 'Kristyn', 'A', 'Schelhaas', 'DO', 'Family Practice', '', '', NULL, 'O', '215 E Hawaii Ave', 'Nampa', 'Canyon', 'ID', '83686', '2084685910', '2084633032', '215 E Hawaii Ave', 'Nampa', 'Canyon', 'ID', '83686', '2084685910', '2084633032', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-05-13', '2012-12-31', 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1366453524', 0, 'N', 0, '2013-02-21', NULL, NULL, 0, 0, NULL, NULL),
('820299231', 'W12011298', 'W12011298', 'ID02', 'Saltzer Medical Group', 'Kristyn', 'A', 'Schelhaas', 'DO', 'Family Practice', '', '', NULL, 'B', '217 W Georgia Ave Ste 115', 'Nampa', 'Canyon', 'ID', '83686', '2084633280', '2084633032', '217 W Georgia Ave Ste 115', 'Nampa', 'Canyon', 'ID', '83686', '2084633280', '2084633032', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-05-13', '2012-12-31', 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1366453524', 0, 'N', 0, '2013-02-21', NULL, NULL, 0, 0, NULL, NULL),
('820299231', 'W12011301', 'W12011301', 'ID02', 'Saltzer Medical Group Portico ', 'Steven', 'W', 'Williams', 'MD', 'General Surgery', '', '', NULL, 'B', '217 W Georgia Ave Ste 115', 'Nampa', 'Canyon', 'ID', '83686', '2084633280', '2088842979', '217 W Georgia Ave Ste 115', 'Nampa', 'Canyon', 'ID', '83686', '2084633280', '2088842979', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-05-13', '2012-12-31', 0, 0, 1, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1568451581', 0, 'N', 0, '2014-03-20', NULL, NULL, 0, 0, NULL, NULL),
('820299231', 'W12011300', 'W12011300', 'ID02', 'Saltzer Medical Group Portico ', 'Steven', 'W', 'Williams', 'MD', 'General Surgery', '', '', NULL, 'O', '3277 E Louise Dr Ste 200', 'Meridian', 'Ada', 'ID', '83642', '2088842920', '2088842979', '3277 E Louise Dr Ste 200', 'Meridian', 'Ada', 'ID', '83642', '2088842920', '2088842979', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-05-13', '2012-12-31', 0, 0, 1, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1568451581', 0, 'N', 0, '2014-03-20', NULL, NULL, 0, 0, NULL, NULL),
('820299231', 'W12011303', 'W12011303', 'ID02', 'Saltzer Medical Group', 'Patricia', 'M', 'Buersmeyer', 'MD', 'Internal Medicine', '', '', NULL, 'O', '215 E Hawaii Ave', 'Nampa', 'Canyon', 'ID', '83686', '2084685920', '2084685920', '215 E Hawaii Ave', 'Nampa', 'Canyon', 'ID', '83686', '2084685920', '2084685920', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-05-13', '2012-12-31', 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1104816198', 0, 'N', 0, '2013-02-21', NULL, NULL, 0, 0, NULL, NULL),
('820299231', 'W12011304', 'W12011304', 'ID02', 'Saltzer Medical Group', 'Patricia', 'M', 'Buersmeyer', 'MD', 'Internal Medicine', '', '', NULL, 'B', '217 W Georgia Ave Ste 115', 'Nampa', 'Canyon', 'ID', '83686', '2084633280', '2082884987', '217 W Georgia Ave Ste 115', 'Nampa', 'Canyon', 'ID', '83686', '2084633280', '2082884987', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-05-13', '2012-12-31', 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1104816198', 0, 'N', 0, '2013-02-21', NULL, NULL, 0, 0, NULL, NULL),
('820299231', 'W12011306', 'W12011306', 'ID02', 'Saltzer Medical Group', 'Michael', 'M', 'Dee', 'MD', 'Internal Medicine', '', '', NULL, 'O', '215 E Hawaii Ave', 'Nampa', 'Canyon', 'ID', '83686', '2084685920', '2084685920', '215 E Hawaii Ave', 'Nampa', 'Canyon', 'ID', '83686', '2084685920', '2084685920', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-05-13', '2012-12-31', 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1053302182', 0, 'N', 0, '2013-02-21', NULL, NULL, 0, 0, NULL, NULL),
('820299231', 'W12011307', 'W12011307', 'ID02', 'Saltzer Medical Group', 'Michael', 'M', 'Dee', 'MD', 'Internal Medicine', '', '', NULL, 'B', '217 W Georgia Ave Ste 115', 'Nampa', 'Canyon', 'ID', '83686', '2084633280', '2082884987', '217 W Georgia Ave Ste 115', 'Nampa', 'Canyon', 'ID', '83686', '2084633280', '2082884987', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-05-13', '2012-12-31', 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1053302182', 0, 'N', 0, '2013-02-21', NULL, NULL, 0, 0, NULL, NULL),
('820299231', 'W12011309', 'W12011309', 'ID02', 'Saltzer Medical Group', 'Michael', 'R', 'Djernes', 'MD', 'Neurology', '', '', NULL, 'O', '215 E Hawaii Ave', 'Nampa', 'Canyon', 'ID', '83686', '2084685920', '2084685920', '215 E Hawaii Ave', 'Nampa', 'Canyon', 'ID', '83686', '2084685920', '2084685920', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-05-13', '2012-12-31', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1346230356', 0, 'N', 0, '2014-03-26', NULL, NULL, 0, 0, NULL, NULL),
('820299231', 'W12011310', 'W12011310', 'ID02', 'Saltzer Medical Group', 'Michael', 'R', 'Djernes', 'MD', 'Neurology', '', '', NULL, 'B', '217 W Georgia Ave Ste 115', 'Nampa', 'Canyon', 'ID', '83686', '2084633280', '2082884987', '217 W Georgia Ave Ste 115', 'Nampa', 'Canyon', 'ID', '83686', '2084633280', '2082884987', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-05-13', '2012-12-31', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1346230356', 0, 'N', 0, '2014-03-26', NULL, NULL, 0, 0, NULL, NULL),
('820299231', 'W12011312', 'W12011312', 'ID02', 'Saltzer Medical Group', 'Charlotte', 'G', 'Eshelman', 'NPC', 'Family Practice', 'Nurse Practitioner', '', NULL, 'O', '215 E Hawaii Ave', 'Nampa', 'Canyon', 'ID', '83686', '2084685910', '2084633046', '215 E Hawaii Ave', 'Nampa', 'Canyon', 'ID', '83686', '2084685910', '2084633046', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-05-13', '2012-12-31', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1366432395', 0, 'N', 0, '2013-02-21', NULL, NULL, 0, 0, NULL, NULL),
('820299231', 'W12011313', 'W12011313', 'ID02', 'Saltzer Medical Group', 'Charlotte', 'G', 'Eshelman', 'NPC', 'Family Practice', 'Nurse Practitioner', '', NULL, 'B', '217 W Georgia Ave Ste 115', 'Nampa', 'Canyon', 'ID', '83686', '2084633280', '2082884987', '217 W Georgia Ave Ste 115', 'Nampa', 'Canyon', 'ID', '83686', '2084633280', '2082884987', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-05-13', '2012-12-31', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1366432395', 0, 'N', 0, '2013-02-21', NULL, NULL, 0, 0, NULL, NULL),
('820299231', 'W12011316', 'W12011316', 'ID02', 'Saltzer Medical Group', 'Stacy', 'A', 'Harmon', 'OT', 'Occupational Therapy', '', '', NULL, 'B', '217 W Georgia Ave Ste 115', 'Nampa', 'Canyon', 'ID', '83686', '2084633280', '2082884987', '217 W Georgia Ave Ste 115', 'Nampa', 'Canyon', 'ID', '83686', '2084633280', '2082884987', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-05-13', '2012-12-31', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1831189869', 0, 'N', 0, '2013-02-21', NULL, NULL, 0, 0, NULL, NULL),
('820299231', 'W12011315', 'W12011315', 'ID02', 'Saltzer Medical Group North', 'Stacy', 'A', 'Harmon', 'OT', 'Occupational Therapy', '', '', NULL, 'O', '4400 E Flamingo Ave', 'Nampa', 'Canyon', 'ID', '83687', '2084685970', '2082884991', '4400 E Flamingo Ave', 'Nampa', 'Canyon', 'ID', '83687', '2084685970', '2082884991', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-05-13', '2012-12-31', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1831189869', 0, 'N', 0, '2013-02-21', NULL, NULL, 43.5976, -116.517, NULL, NULL),
('820299231', 'W12011318', 'W12011318', 'ID02', 'Saltzer Medical Group', 'Shane', 'A', 'Andrew', 'DO', 'Orthopedic Surgery', '', '', NULL, 'O', '215 E Hawaii Ave', 'Nampa', 'Canyon', 'ID', '83686', '2084685940', '2084633055', '215 E Hawaii Ave', 'Nampa', 'Canyon', 'ID', '83686', '2084685940', '2084633055', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-05-13', '2012-11-11', 0, 0, 1, 'Saint Alphonsus Regional Medical Center', 'Saint Alphonsus Medical Center Nampa', '', '', 'HCFA|UB|', '1356308316', 0, 'N', 0, '2014-03-20', NULL, NULL, 0, 0, NULL, NULL),
('820299231', 'W12011319', 'W12011319', 'ID02', 'Saltzer Medical Group', 'Shane', 'A', 'Andrew', 'DO', 'Orthopedic Surgery', '', '', NULL, 'B', '217 W Georgia Ave Ste 115', 'Nampa', 'Canyon', 'ID', '83686', '2084633280', '2082884987', '217 W Georgia Ave Ste 115', 'Nampa', 'Canyon', 'ID', '83686', '2084633280', '2082884987', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-05-13', '2012-11-11', 0, 0, 1, 'Saint Alphonsus Regional Medical Center', 'Saint Alphonsus Medical Center Nampa', '', '', 'HCFA|UB|', '1356308316', 0, 'N', 0, '2014-03-20', NULL, NULL, 0, 0, NULL, NULL),
('820299231', 'W12011321', 'W12011321', 'ID02', 'Saltzer Medical Group', 'Andrew', 'R', 'Curran', 'DO', 'Orthopedic Surgery', '', '', NULL, 'O', '215 E Hawaii Ave', 'Nampa', 'Canyon', 'ID', '83686', '2084685940', '2084633055', '215 E Hawaii Ave', 'Nampa', 'Canyon', 'ID', '83686', '2084685940', '2084633055', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-05-13', '2012-11-11', 0, 0, 1, 'Saint Alphonsus Regional Medical Center', 'Saint Alphonsus Medical Center Nampa', '', '', 'HCFA|UB|', '1093705071', 0, 'N', 0, '2014-03-20', NULL, NULL, 0, 0, NULL, NULL),
('820299231', 'W12011322', 'W12011322', 'ID02', 'Saltzer Medical Group', 'Andrew', 'R', 'Curran', 'DO', 'Orthopedic Surgery', '', '', NULL, 'B', '217 W Georgia Ave Ste 115', 'Nampa', 'Canyon', 'ID', '83686', '2084633280', '2082884987', '217 W Georgia Ave Ste 115', 'Nampa', 'Canyon', 'ID', '83686', '2084633280', '2082884987', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-05-13', '2012-11-11', 0, 0, 1, 'Saint Alphonsus Regional Medical Center', 'Saint Alphonsus Medical Center Nampa', '', '', 'HCFA|UB|', '1093705071', 0, 'N', 0, '2014-03-20', NULL, NULL, 0, 0, NULL, NULL),
('820299231', 'W12011324', 'W12011324', 'ID02', 'Saltzer Medical Group', 'Michael', 'B', 'Aldous', 'MD', 'Pediatrics', '', '', NULL, 'O', '215 E Hawaii Ave', 'Nampa', 'Canyon', 'ID', '83686', '2084685930', '2084633351', '215 E Hawaii Ave', 'Nampa', 'Canyon', 'ID', '83686', '2084685930', '2084633351', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-05-13', '2012-12-31', 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1386616431', 0, 'N', 0, '2013-02-21', NULL, NULL, 0, 0, NULL, NULL),
('820299231', 'W12011325', 'W12011325', 'ID02', 'Saltzer Medical Group', 'Michael', 'B', 'Aldous', 'MD', 'Pediatrics', '', '', NULL, 'B', '217 W Georgia Ave Ste 115', 'Nampa', 'Canyon', 'ID', '83686', '2084633280', '2082884987', '217 W Georgia Ave Ste 115', 'Nampa', 'Canyon', 'ID', '83686', '2084633280', '2082884987', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-05-13', '2012-12-31', 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1386616431', 0, 'N', 0, '2013-02-21', NULL, NULL, 0, 0, NULL, NULL),
('820299231', 'W12011328', 'W12011328', 'ID02', 'Saltzer Medical Group', 'Kathy', 'A', 'Dufur', 'PT', 'Physical Therapy', '', '', NULL, 'B', '217 W Georgia Ave Ste 115', 'Nampa', 'Canyon', 'ID', '83686', '2084633280', '2082884987', '217 W Georgia Ave Ste 115', 'Nampa', 'Canyon', 'ID', '83686', '2084633280', '2082884987', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-05-13', '2012-12-31', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1265421291', 0, 'N', 0, '2013-02-21', NULL, NULL, 0, 0, NULL, NULL),
('820299231', 'W12011327', 'W12011327', 'ID02', 'Saltzer Medical Group North', 'Kathy', 'A', 'Dufur', 'PT', 'Physical Therapy', '', '', NULL, 'O', '4400 E Flamingo Ave', 'Nampa', 'Canyon', 'ID', '83687', '2084685970', '2082884987', '4400 E Flamingo Ave', 'Nampa', 'Canyon', 'ID', '83687', '2084685970', '2082884987', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-05-13', '2012-12-31', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1265421291', 0, 'N', 0, '2013-02-21', NULL, NULL, 43.5976, -116.517, NULL, NULL),
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('820299231', 'W12011330', 'W12011330', 'ID02', 'Saltzer Medical Group', 'Sarah', 'C', 'Maddux', 'PA-C', 'Physician Assistant', '', '', NULL, 'B', '217 W Georgia Ave Ste 115', 'Nampa', 'Canyon', 'ID', '83686', '2084633280', '2082884987', '217 W Georgia Ave Ste 115', 'Nampa', 'Canyon', 'ID', '83686', '2084633280', '2082884987', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-05-13', '2012-12-31', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1518155662', 0, 'N', 0, '2013-02-21', NULL, NULL, 0, 0, NULL, NULL),
('820299231', 'W12011333', 'W12011333', 'ID02', 'Saltzer Medical Group', 'Todd', 'M', 'Otstot', 'PAC', 'Physician Assistant', '', '', NULL, 'B', '217 W Georgia Ave Ste 115', 'Nampa', 'Canyon', 'ID', '83686', '2084633280', '2082884987', '217 W Georgia Ave Ste 115', 'Nampa', 'Canyon', 'ID', '83686', '2084633280', '2082884987', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-05-13', '2012-12-31', 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', NULL, NULL, NULL, 'HCFA|UB|', '1275523276', 0, 'N', 0, '2013-02-21', NULL, NULL, 0, 0, NULL, NULL),
('820299231', 'W12011332', 'W12011332', 'ID02', 'Saltzer Medical Group North', 'Todd', 'M', 'Otstot', 'PAC', 'Physician Assistant', '', '', NULL, 'O', '4400 E Flamingo Ave', 'Meridian', 'Ada', 'ID', '83642', '2084633000', '2084633044', '4400 E Flamingo Ave', 'Meridian', 'Ada', 'ID', '83642', '2084633000', '2084633044', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-05-13', '2012-12-31', 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', NULL, NULL, NULL, 'HCFA|UB|', '1275523276', 0, 'N', 0, '2013-02-21', NULL, NULL, 0, 0, NULL, NULL),
('820299231', 'W12011335', 'W12011335', 'ID02', 'Saltzer Medical Group', 'Eric', 'N', 'Wells', 'PAC', 'Physician Assistant', '', '', NULL, 'O', '215 E Hawaii Ave', 'Nampa', 'Canyon', 'ID', '83686', '2084633309', '2084633308', '215 E Hawaii Ave', 'Nampa', 'Canyon', 'ID', '83686', '2084633309', '2084633308', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-05-13', '2011-06-23', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1609943935', 0, 'N', 0, '2013-02-21', NULL, NULL, 0, 0, NULL, NULL),
('820299231', 'W12011336', 'W12011336', 'ID02', 'Saltzer Medical Group', 'Eric', 'N', 'Wells', 'PAC', 'Physician Assistant', '', '', NULL, 'B', '217 W Georgia Ave Ste 115', 'Nampa', 'Canyon', 'ID', '83686', '2084633280', '2082884987', '217 W Georgia Ave Ste 115', 'Nampa', 'Canyon', 'ID', '83686', '2084633280', '2082884987', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-05-13', '2011-06-23', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1609943935', 0, 'N', 0, '2013-02-21', NULL, NULL, 0, 0, NULL, NULL),
('800703995', 'W12011341', 'W12011341', 'UT01', 'Neurostimulation Services', '', '', 'Neurostimulation Services', 'Group', 'Mental Health Facility', '', '', NULL, 'B', 'PO Box 413076', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8015876688', NULL, 'PO Box 413076', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8015876688', '          ', '', '', '1', '0.00', '0.00', '0.00', 3, '2011-05-01', '2012-09-19', 1, 0, 0, '', '', '', '', 'HCFA|UB|', '1083913792', 0, 'N', 0, '2012-10-09', NULL, NULL, 0, 0, NULL, NULL),
('800703995', 'W12011342', 'W12011342', 'UT01', 'University Health Care', '', '', 'Neurostimulation Services', 'Group', 'Mental Health Facility', '', '', NULL, 'O', '501 Chipeta Way', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015851575', NULL, '501 Chipeta Way', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015851575', '          ', '', '', '1', '0.00', '0.00', '0.00', 3, '2011-05-01', '2012-09-19', 1, 0, 0, '', '', '', '', 'HCFA|UB|', '1083913792', 0, 'N', 0, '2012-10-09', NULL, NULL, 0, 0, NULL, NULL),
('870282100', 'W12011343', 'W12011343', 'UT01', 'Medical Arts Center Clinic', 'Lance', '', 'Barker', 'MD', 'Family Practice', '', '', NULL, 'O', '984 Medical Dr Ste 1', 'Brigham City', 'Box Elder', 'UT', '84302', '4357235248', '4357235240', '984 Medical Dr Ste 1', 'Brigham City', 'Box Elder', 'UT', '84302', '4357235248', '4357235240', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-07-01', NULL, 0, 0, 0, 'Brigham City Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1801089214', 0, 'N', 0, '2013-04-10', NULL, NULL, 41.4888, -112.026, NULL, NULL),
('529563804', 'W12011344', 'W12011344', 'UTMH1', 'Medical Towers Family Therapy', 'Shelia', '', 'Bittle', 'APRN', 'Mental Health', 'Psychiatry', '', NULL, 'O', '1060 E 100 S Ste 105', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015327414', '8015322381', '1060 E 100 S Ste 105', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015327414', '8015322381', 'ARNP', '', '', '0.00', '35.00', '0.00', 3, '2011-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1730143934', 0, 'N', 0, '2011-06-27', NULL, NULL, 0, 0, NULL, NULL),
('870710584', 'W12011345', 'W12011345', 'UTMH1', 'Jordan West Family Counseling', 'Debra', 'L', 'Bowman', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '9263 Redwood Rd Bldg 8 Ste B', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015660749', '8015667108', '9263 Redwood Rd Bldg 8 Ste B', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015660749', '8015667108', 'UTMA', '', '', '0.00', '35.00', '0.00', 6, '2011-06-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1992814164', 0, 'N', 0, '2012-12-11', NULL, NULL, 0, 0, NULL, NULL),
('010885716', 'W12011346', 'W12011346', 'UTMH1', 'Riley Individual Family and Marriage Counseling', 'Laura', 'P', 'Brown', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '406 W S Jordan Pkwy Ste 440', 'South Jordan', 'Salt Lake', 'UT', '84095', '8016570163', '8015687856', '406 W S Jordan Pkwy Ste 440', 'South Jordan', 'Salt Lake', 'UT', '84095', '8016570163', '8015687856', 'UTMA', '', '', '0.00', '35.00', '0.00', 3, '2011-09-01', '2012-06-23', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1144469727', 0, 'N', 0, '2014-05-21', NULL, NULL, 0, 0, NULL, NULL),
('010885716', 'W12011347', 'W12011347', 'UTMH1', 'Riley Individual Family and Marriage Counseling', 'Laura', 'P', 'Brown', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', 'PO Box 708458', 'Sandy', 'Salt Lake', 'UT', '84070', '8016570163', '8015687856', 'PO Box 708458', 'Sandy', 'Salt Lake', 'UT', '84070', '8016570163', '8015687856', 'UTMA', '', '', '0.00', '35.00', '0.00', 3, '2011-09-01', '2012-06-23', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1144469727', 0, 'N', 0, '2014-05-21', NULL, NULL, 0, 0, NULL, NULL),
('860735726', 'W12011348', 'W12011348', 'Sinclair', '(Sinclair Health Services\rProvider) Flagstaff Bone and Joint', 'Kirk', 'A', 'Butler', 'PA', 'Orthopedic Surgery', '', '', NULL, 'O', '77 W Forest Ave Ste 301', 'Flagstaff', 'Coconino', 'AZ', '86001', '9287732280', NULL, '77 W Forest Ave Ste 301', 'Flagstaff', 'Coconino', 'AZ', '86001', '9287732280', '          ', '', '', '', '0.00', '40.00', '0.00', 3, '2011-07-01', NULL, 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1760507065', 0, 'N', 0, '2012-07-18', NULL, NULL, 0, 0, NULL, NULL),
('870710584', 'W12011349', 'W12011349', 'UTMH1', 'Jordan West Family Counseling', 'Michelle', '', 'Carroll', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '9263 Redwood Rd Bldg 8 Ste B', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015660749', '8015667108', '9263 Redwood Rd Bldg 8 Ste B', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015660749', '8015667108', 'UTMA', '', '', '0.00', '35.00', '0.00', 6, '2012-08-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1801122411', 0, 'N', 0, '2012-08-03', NULL, NULL, 0, 0, NULL, NULL),
('320211919', 'W12011350', 'W12011350', 'UT01', 'Advanced Wound Care System', 'Linda', 'C', 'Cox', 'APRN', 'Wound Care', '', '', NULL, 'O', '2520 W 4700 S Ste 2A', 'Taylorsville', 'Salt Lake', 'UT', '84118', '8019642008', '8019642435', '2520 W 4700 S Ste 2A', 'Taylorsville', 'Salt Lake', 'UT', '84118', '8019642008', '8019642435', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2030-02-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1255353587', 0, 'N', 0, '2012-08-16', NULL, NULL, 0, 0, NULL, NULL),
('320211919', 'W12011351', 'W12011351', 'UT01', 'Advanced Wound Care System', 'Linda', 'C', 'Cox', 'APRN', 'Wound Care', '', '', NULL, 'B', '596 W 750 S Ste 300', 'Bountiful', 'Davis', 'UT', '84010', '8019642008', '8019642435', '596 W 750 S Ste 300', 'Bountiful', 'Davis', 'UT', '84010', '8019642008', '8019642435', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2030-01-01', '2030-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1255353587', 0, 'N', 0, '2012-08-16', NULL, NULL, 0, 0, NULL, NULL),
('870669961', 'W12011352', 'W12011352', 'UT01', 'Med One Medical Sleep Laboratory', 'Brydon', '', 'Grant', 'MD', 'Internal Medicine', '', '', NULL, 'O', '10712 S 1300 E', 'Sandy', 'Salt Lake', 'UT', '84094', '8019385362', '8885030041', '10712 S 1300 E', 'Sandy', 'Salt Lake', 'UT', '84094', '8019385362', '8885030041', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-07-01', '2012-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1962490128', 0, 'Y', 0, '2013-01-21', NULL, NULL, 0, 0, NULL, NULL),
('486923334', 'W12011353', 'W12011353', 'ID02', 'Molly and Me Counseling and Training Center', 'Molly', 'D', 'Gratton', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '1273 River Ste 110', 'Boise', 'Ada', 'ID', '83705', '2088600790', '2083921378', '1273 River Ste 110', 'Boise', 'Ada', 'ID', '83705', '2088600790', '2083921378', 'IDMA', '', '', '0.00', '35.00', '0.00', 3, '2011-07-01', '2011-07-01', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1730197138', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('486923334', 'W12011354', 'W12011354', 'ID02', 'Molly and Me Counseling and Training Center', 'Molly', 'D', 'Gratton', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', '7323 Swift Ln', 'Boise', 'Ada', 'ID', '83704', '2088600790', '2083921378', '7323 Swift Ln', 'Boise', 'Ada', 'ID', '83704', '2088600790', '2083921378', 'IDMA', '', '', '0.00', '35.00', '0.00', 3, '2011-07-01', '2013-02-14', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1730197138', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('870710584', 'W12011355', 'W12011355', 'UTMH1', 'Jordan West Family Counseling', 'Gloria', '', 'Jensen', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '9263 Redwood Rd Bldg 8 Ste B', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015660749', '8015667108', '9263 Redwood Rd Bldg 8 Ste B', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015660749', '8015667108', 'UTMA', '', '', '0.00', '35.00', '0.00', 6, '2011-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1942592282', 0, 'N', 0, '2011-06-29', NULL, NULL, 0, 0, NULL, NULL),
('320211919', 'W12011356', 'W12011356', 'UT01', 'Advanced Wound Care System', 'Sherman', 'B', 'Johnson', 'MD', 'Wound Care', '', '', NULL, 'O', '2520 W 4700 S Ste 2A', 'Taylorsville', 'Salt Lake', 'UT', '84118', '8019642008', '8019642435', '2520 W 4700 S Ste 2A', 'Taylorsville', 'Salt Lake', 'UT', '84118', '8019642008', '8019642435', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2030-01-01', '2030-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1376510800', 0, 'N', 0, '2012-09-04', NULL, NULL, 0, 0, NULL, NULL),
('320211919', 'W12011357', 'W12011357', 'UT01', 'Advanced Wound Care System', 'Sherman', 'B', 'Johnson', 'MD', 'Wound Care', '', '', NULL, 'B', '596 W 750 S Ste 300', 'Bountiful', 'Davis', 'UT', '84010', '8019642008', '8019642435', '596 W 750 S Ste 300', 'Bountiful', 'Davis', 'UT', '84010', '8019642008', '8019642435', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2030-01-01', '2030-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1376510800', 0, 'N', 0, '2012-09-04', NULL, NULL, 0, 0, NULL, NULL),
('870710584', 'W12011358', 'W12011358', 'UTMH1', 'Jordan West Family Counseling', 'Nancy', '', 'Julia', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '9263 Redwood Rd Bldg 8 Ste B', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015660749', '8015667108', '9263 Redwood Rd Bldg 8 Ste B', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015660749', '8015667108', 'UTMA', '', '', '0.00', '35.00', '0.00', 6, '2011-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1043360795', 0, 'N', 0, '2014-07-18', NULL, NULL, 0, 0, NULL, NULL),
('273382634', 'W12011360', 'W12011360', 'WY01', 'New Frontier Imaging', 'James', 'S', 'McEvoy', 'DO', 'Diagnostic Radiology', '', '', NULL, 'O', '2620 Commercial Way Ste 10', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073824282', NULL, '2620 Commercial Way Ste 10', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073824282', '          ', '', '', '', '0.00', '15.00', '0.00', 3, '2011-05-13', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1093795809', 0, 'Y', 0, '2011-06-29', NULL, NULL, 41.5823, -109.257, NULL, NULL),
('273382634', 'W12011361', 'W12011361', 'WY01', 'New Frontier Imaging', 'James', 'S', 'McEvoy', 'DO', 'Diagnostic Radiology', '', '', NULL, 'B', 'PO Box 2148', 'Rock Springs', 'Sweetwater', 'WY', '82902', '3073824282', NULL, 'PO Box 2148', 'Rock Springs', 'Sweetwater', 'WY', '82902', '3073824282', '          ', '', '', '', '0.00', '15.00', '0.00', 3, '2011-05-13', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1093795809', 0, 'Y', 0, '2011-06-29', NULL, NULL, 0, 0, NULL, NULL),
('262227009', 'W12011362', 'W12011362', 'ID02', 'Olsen Chiropractic Clinic', 'Nathan', 'E', 'Olsen', 'DC', 'Chiropractic', '', '', NULL, 'O', '2058 E Franklin Rd Ste 110', 'Meridian', 'Ada', 'ID', '83642', '2082862124', '2088555915', '2058 E Franklin Rd Ste 110', 'Meridian', 'Ada', 'ID', '83642', '2082862124', '2088555915', 'IDCHIRO1', '', '', '0.00', '35.00', '0.00', 3, '2011-06-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1417089442', 0, 'N', 0, '2011-05-26', NULL, NULL, 0, 0, NULL, NULL),
('262227009', 'W12011363', 'W12011363', 'ID02', 'Olsen Chiropractic Clinic', 'Nathan', 'E', 'Olsen', 'DC', 'Chiropractic', '', '', NULL, 'B', '4909 N Chimney Peak Ave', 'Meridian', 'Ada', 'ID', '83646', '2082862124', '2088555915', '4909 N Chimney Peak Ave', 'Meridian', 'Ada', 'ID', '83646', '2082862124', '2088555915', 'IDCHIRO1', '', '', '0.00', '35.00', '0.00', 3, '2011-06-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1417089442', 0, 'N', 0, '2011-05-26', NULL, NULL, 0, 0, NULL, NULL),
('870710584', 'W12011364', 'W12011364', 'UTMH1', 'Jordan West Family Counseling', 'Stan', '', 'Roberts', 'LMFT', 'Mental Health', '', '', NULL, 'O', '9263 Redwood Rd Bldg 8 Ste B', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015660749', '8015667108', '9263 Redwood Rd Bldg 8 Ste B', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015660749', '8015667108', 'UTMA', '', '', '0.00', '35.00', '0.00', 6, '2011-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1225337835', 0, 'N', 0, '2014-07-18', NULL, NULL, 0, 0, NULL, NULL),
('870710584', 'W12011365', 'W12011365', 'UTMH1', 'Jordan West Family Counseling', 'Scott', '', 'Smid', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '9263 Redwood Rd Bldg 8 Ste B', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015660749', '8015667108', '9263 Redwood Rd Bldg 8 Ste B', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015660749', '8015667108', 'UTMA', '', '', '0.00', '35.00', '0.00', 6, '2011-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1780799973', 0, 'N', 0, '2014-07-18', NULL, NULL, 0, 0, NULL, NULL),
('841401924', 'W12011366', 'W12011366', 'UT01', 'Alpine Medical Group', 'Shane ', 'R', 'Taufer', 'DO', 'Anesthesia', '', '', NULL, 'B', 'PO Box 3810', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8017272060', '8014322668', 'PO Box 3810', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8017272060', '8014322668', '', '', '1000', '47.25', '0.00', '0.00', 6, '2011-07-01', NULL, 1, 12, 0, '', '', '', '', 'HCFA|UB|', '1386826378', 0, 'Y', 0, '2012-03-16', NULL, NULL, 0, 0, NULL, NULL),
('870669961', 'W12011367', 'W12011367', 'UT01', 'Med One Medical Sleep Laboratory', '', '', 'Universal Diagnostic Testing', 'Group', 'Sleep Medicine', '', '', NULL, 'O', '10712 S 1300 E', 'Sandy', 'Salt Lake', 'UT', '84094', '8019385362', '8885030041', '10712 S 1300 E', 'Sandy', 'Salt Lake', 'UT', '84094', '8019385362', '8885030041', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-07-01', '2012-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1083702450', 0, 'N', 0, '2013-01-21', NULL, NULL, 0, 0, NULL, NULL),
('870628514', 'W12011369', 'W12011369', 'UT01', 'Avec Eye Associates', 'Barbara', '', 'Wirostko', 'MD', 'Ophthalmology', '', '', NULL, 'O', '8789 S Highland Dr Ste 100', 'Sandy', 'Salt Lake', 'UT', '84093', '8019434999', '8019433876', '8789 S Highland Dr Ste 100', 'Sandy', 'Salt Lake', 'UT', '84093', '8019434999', '8019433876', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-08-01', NULL, 0, 0, 0, 'University Health Care University Hospital', '', '', '', 'HCFA|UB|', '1326045261', 0, 'N', 0, '2014-04-16', NULL, NULL, 40.59, -111.834, NULL, NULL),
('870628514', 'W12011370', 'W12011370', 'UT01', 'Avec Eye Associates', 'Barbara', '', 'Wirostko', 'MD', 'Ophthalmology', '', '', NULL, 'M', 'PO Box 708757', 'Sandy', 'Salt Lake', 'UT', '84070', '8019434999', '8019433876', 'PO Box 708757', 'Sandy', 'Salt Lake', 'UT', '84070', '8019434999', '8019433876', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-08-01', NULL, 0, 0, 0, 'University Health Care University Hospital', '', '', '', 'HCFA|UB|', '1326045261', 0, 'N', 0, '2014-04-16', NULL, NULL, 0, 0, NULL, NULL),
('870628514', 'W12011371', 'W12011371', 'UT01', 'Avec Eye Associates', 'Barbara', '', 'Wirostko', 'MD', 'Ophthalmology', '', '', NULL, 'B', 'PO Box 95970', 'South Jordan', 'Salt Lake', 'UT', '84095', '8019434999', '8019433876', 'PO Box 95970', 'South Jordan', 'Salt Lake', 'UT', '84095', '8019434999', '8019433876', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-08-01', NULL, 0, 0, 0, 'University Health Care University Hospital', '', '', '', 'HCFA|UB|', '1326045261', 0, 'N', 0, '2014-04-16', NULL, NULL, 0, 0, NULL, NULL),
('870526286', 'W12009854', 'W12009854', 'UT01', 'Wasatch Internal Medicine and Family Practice', 'Paula', 'J', 'Cook', 'MD', 'Family Practice', '', '', NULL, 'O', '1160 E 3900 S Ste 1000', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012621771', '8012889101', '1160 E 3900 S Ste 1000', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012621771', '8012889101', 'WUWASIM5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-04-05', NULL, 0, 0, 0, 'Davis Hospital', '', '', '', 'HCFA|UB|', '1922209386', 0, 'N', 0, '2013-10-23', NULL, NULL, 40.6871, -111.858, NULL, NULL),
('263903795', 'W12011376', 'W12011376', 'UT01', 'Oral & Maxillofacial Surgeons of Utah', 'Michael', '', 'Broadbent', 'DMD MS', 'Oral/Maxillofacial Surgery', 'Oral Surgeon', '', NULL, 'O', '2711 N Hwy 89 Ste 200', 'Ogden', 'Weber', 'UT', '84414', '8017827175', NULL, '2711 N Hwy 89 Ste 200', 'Ogden', 'Weber', 'UT', '84414', '8017827175', '', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2011-06-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1205049459', 0, 'N', 0, '2014-05-14', NULL, NULL, 41.3075, -112.006, NULL, NULL),
('870281028', 'W12011380', 'W12011380', 'UT01', 'Central Utah Clinic PC', 'Edward', '', 'Corbett', 'MD', 'Internal Medicine', '', '', NULL, 'O', '700 W 800 N Ste 400', 'Orem', 'Utah', 'UT', '84057', '8012218811', '8018818805', '700 W 800 N Ste 400', 'Orem', 'Utah', 'UT', '84057', '8012218811', '8018818805', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-10-01', '2011-10-01', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1487724753', 0, 'N', 0, '2013-10-25', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W12011382', 'W12011382', 'UT01', 'Central Utah Clinic PC', 'Edward', '', 'Corbett', 'MD', 'Internal Medicine', '', '', NULL, 'M', '1055 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013548225', '8014298150', '1055 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013548225', '8014298150', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-10-01', '2011-10-01', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1487724753', 0, 'N', 0, '2013-10-25', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W12011381', 'W12011381', 'UT01', 'Central Utah Clinic PC', 'Edward', '', 'Corbett', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', '8014298180', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', '8014298180', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-10-01', '2011-10-01', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1487724753', 0, 'N', 0, '2013-10-25', NULL, NULL, 0, 0, NULL, NULL),
('770701557', 'W12011383', 'W12011383', 'UT01', 'St Marks Millcreek Primary Care', 'An', 'T', 'Dinh', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '4465 S 900 E Ste 200', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012662777', '8012661377', '4465 S 900 E Ste 200', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012662777', '8012661377', 'wise+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-05-01', '2012-06-30', 0, 0, 0, 'Mountain West Medical Center', '', '', '', 'HCFA|UB|', '1144319997', 0, 'N', 0, '2012-06-25', NULL, NULL, 0, 0, NULL, NULL),
('770701557', 'W12011384', 'W12011384', 'UT01', 'St Marks Millcreek Primary Care', 'An', 'T', 'Dinh', 'MD', 'Family Practice', NULL, NULL, NULL, 'B', 'PO Box 198560', 'Atlanta', 'Fulton', 'GA', '30384', '8006613365', '8012661377', 'PO Box 198560', 'Atlanta', 'Fulton', 'GA', '30384', '8006613365', '8012661377', 'wise+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-05-01', '2012-06-30', 0, 0, 0, 'Mountain West Medical Center', '', '', '', 'HCFA|UB|', '1144319997', 0, 'N', 0, '2012-06-25', NULL, NULL, 0, 0, NULL, NULL),
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('741967809', 'W12009314', 'W12009314', 'TX01', 'Gastroenterology Consultants of San Antonio', 'Sunil', 'K', 'Dwivedi', 'MD', 'Gastroenterology', '', '', NULL, 'B', 'PO Box 2778', 'San Antonio', 'Bexar', 'TX', '78229', '2106141234', NULL, 'PO Box 2778', 'San Antonio', 'Bexar', 'TX', '78229', '2106141234', '          ', 'TXSURGA', 'TXHCPCS', '', '0.00', '50.00', '0.00', 6, '2011-07-01', '2012-08-19', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1003854076', 0, 'N', 0, '2011-05-27', NULL, NULL, 0, 0, NULL, NULL),
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('742072186', 'W12009320', 'W12009320', 'TX01', 'San Antonio Infectious Diseases Consultants', 'Nicolas', 'A', 'Melgarejo', 'MD', 'Infectious Disease', '', '', NULL, 'O', '343 W Houston St Ste 808', 'San Antonio', 'Bexar', 'TX', '78205', '2102249616', NULL, '343 W Houston Ste 808', 'San Antonio', 'Bexar', 'TX', '78205', '2102249616', '          ', 'TXSURGE', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2010-04-01', NULL, 0, 0, 0, 'Baptist Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1386882520', 0, 'N', 0, '2011-05-27', NULL, NULL, 29.4264, -98.4967, NULL, NULL),
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('870218917', 'W12011401', 'W12011401', 'UT01', 'Tanner Memorial Clinic', 'Jonathan ', 'A', 'Donigan', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', 'PO Box 337', 'Layton', 'Davis', 'UT', '84041', '8017734840', NULL, 'PO Box 337', 'Layton', 'Davis', 'UT', '84041', '8017734840', '          ', 'WUTANNER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-10-01', NULL, 0, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1750599171', 0, 'Y', 0, '2012-11-02', NULL, NULL, 41.0763, -111.983, 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
('742423446', 'W12011405', 'W12011405', 'TX01', '', 'Patrick', 'M', 'Palmer', 'MD', 'Orthopedic Surgery', 'Pediatric Orthopedic Surgery', '', NULL, 'O', '7703 Floyd Curl Dr', 'San Antonio', 'Bexar', 'TX', '78229', '2105675125', NULL, '7703 Floyd Curl Dr', 'San Antonio', 'Bexar', 'TX', '78229', '2105675125', '          ', 'TXORTHO', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2011-06-01', '2012-08-19', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1487623567', 0, 'N', 0, '2013-05-06', NULL, NULL, 0, 0, NULL, NULL),
('742423446', 'W12011406', 'W12011406', 'TX01', '', 'Patrick', 'M', 'Palmer', 'MD', 'Orthopedic Surgery', 'Pediatric Orthopedic Surgery', '', NULL, 'O', '8300 Floyd Curl Dr FL 3', 'San Antonio', 'Bexar', 'TX', '78229', '2104509300', NULL, '8300 Floyd Curl Dr FL 3', 'San Antonio', 'Bexar', 'TX', '78229', '2104509300', '          ', 'TXORTHO', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2011-06-01', '2012-08-19', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1487623567', 0, 'N', 0, '2013-05-06', NULL, NULL, 0, 0, NULL, NULL),
('205537931', 'W12011407', 'W12011407', 'UT01', '', 'Nameer', 'T', 'Qader', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '5275 Adam Ave Ste A', 'Ogden', 'Weber', 'UT', '84405', '8014755335', '8014755558', '5275 Adam Ave Ste A', 'Ogden', 'Weber', 'UT', '84405', '8014755335', '8014755558', 'WUSTDFAM5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-02-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1336289610', 0, 'N', 0, '2013-09-09', NULL, NULL, 41.168, -111.969, NULL, NULL),
('470905811', 'W12011408', 'W12011408', 'UT01', 'Asthma & Allergy Clinic of Utah', 'Amit', 'J', 'Shah', 'MD', 'Allergy and Immunology', '', '', NULL, 'O', '74 E Kimballs Ln Ste 360', 'Draper', 'Salt Lake', 'UT', '84020', '8012811300', '8012865973', '74 E Kimballs Ln Ste 360', 'Draper', 'Salt Lake', 'UT', '84020', '8012811300', '8012865973', 'WiseSTD8', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-05-26', '2011-05-26', 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1134246770', 0, 'N', 0, '2011-10-10', NULL, NULL, 0, 0, NULL, NULL),
('841401924', 'W12008090', 'W12008090', 'UT01', 'Alpine Medical Group', 'N', 'L', 'Smith', 'MD', 'Pain Management', '', '', NULL, 'O', '3838 S 700 E Ste 200', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8012614988', '8012699425', '3838 S 700 E Ste 200', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8012614988', '8012699425', 'WUSTDMULT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-02-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1124067236', 0, 'N', 0, '2013-05-20', NULL, NULL, 40.6874, -111.871, NULL, NULL),
('841401924', 'W12008091', 'W12008091', 'UT01', 'Alpine Medical Group', 'N', 'L', 'Smith', 'MD', 'Pain Management', '', '', NULL, 'B', 'PO Box 57068', 'Salt Lake City', 'Salt Lake', 'UT', '84157', '8012614988', '8012699425', 'PO Box 57068', 'Salt Lake City', 'Salt Lake', 'UT', '84157', '8012614988', '8012699425', 'WUSTDMULT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-02-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1124067236', 0, 'N', 0, '2013-05-20', NULL, NULL, 0, 0, NULL, NULL),
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('061506129', 'W12011494', 'W12011494', 'UT01', 'Wee Care Pediatrics', 'Davin', 'B', 'Hansen', 'PAC', 'Pediatrics', '', '', NULL, 'O', '2084 N 1700 W Ste A', 'Layton', 'Davis', 'UT', '84041', '8017738644', '8019271591', '2084 N 1700 W Ste A', 'Layton', 'Davis', 'UT', '84041', '8017738644', '8019271591', 'WUSTDPEDE5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1770562878', 0, 'N', 0, '2014-06-17', NULL, NULL, 41.0897, -111.997, NULL, NULL),
('061506129', 'W12011495', 'W12011495', 'UT01', 'Wee Care Pediatrics', 'Cody', 'J', 'Hawkes', 'DO', 'Pediatrics', '', '', NULL, 'O', '2084 N 1700 W Ste A', 'Layton', 'Davis', 'UT', '84041', '8017738644', '8019271591', '2084 N 1700 W Ste A', 'Layton', 'Davis', 'UT', '84041', '8017738644', '8019271591', 'WUSTDPEDE5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-07-01', NULL, 0, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1457535114', 0, 'N', 0, '2012-01-04', NULL, NULL, 41.0897, -111.997, 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
('061506129', 'W12011496', 'W12011496', 'UT01', 'Wee Care Pediatrics', 'Michael', 'P', 'Husseman', 'MD', 'Pediatrics', '', '', NULL, 'O', '2084 N 1700 W Ste A', 'Layton', 'Davis', 'UT', '84041', '8017738644', '8019271591', '2084 N 1700 W Ste A', 'Layton', 'Davis', 'UT', '84041', '8017738644', '8019271591', 'WUSTDPEDE5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-07-01', NULL, 0, 0, 0, 'Davis Hospital', '', '', '', 'HCFA|UB|', '1053319186', 0, 'N', 0, '2014-04-16', NULL, NULL, 41.0897, -111.997, NULL, NULL),
('061506129', 'W12011497', 'W12011497', 'UT01', 'Wee Care Pediatrics', 'Elenor', '', 'MacGregor', 'DO', 'Pediatrics', '', '', NULL, 'O', '2084 N 1700 W Ste A', 'Layton', 'Davis', 'UT', '84041', '8017738644', '8019271591', '2084 N 1700 W Ste A', 'Layton', 'Davis', 'UT', '84041', '8017738644', '8019271591', 'WUSTDPEDE5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-07-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', 'Davis Hospital', '', '', 'HCFA|UB|', '1740509223', 0, 'N', 0, '2014-07-21', NULL, NULL, 41.0897, -111.997, NULL, NULL),
('061506129', 'W12011498', 'W12011498', 'UT01', 'Wee Care Pediatrics', 'Anthony', 'G', 'Pruitt', 'MD', 'Pediatrics', '', '', NULL, 'O', '2084 N 1700 W Ste A', 'Layton', 'Davis', 'UT', '84041', '8017738644', '8019271591', '2084 N 1700 W Ste A', 'Layton', 'Davis', 'UT', '84041', '8017738644', '8019271591', 'WUSTDPEDE5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-07-01', NULL, 0, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1700884848', 0, 'N', 0, '2013-04-15', NULL, NULL, 41.0897, -111.997, NULL, NULL),
('061506129', 'W12011499', 'W12011499', 'UT01', 'Wee Care Pediatrics', 'Laurent', 'C', 'Sigg', 'MD', 'Pediatrics', '', '', NULL, 'O', '2084 N 1700 W Ste A', 'Layton', 'Davis', 'UT', '84041', '8017738644', '8019271591', '2084 N 1700 W Ste A', 'Layton', 'Davis', 'UT', '84041', '8017738644', '8019271591', 'WUSTDPEDE5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-07-01', NULL, 0, 0, 0, 'Davis Hospital', '', '', '', 'HCFA|UB|', '1750389805', 0, 'N', 0, '2014-03-27', NULL, NULL, 41.0897, -111.997, NULL, NULL),
('061506129', 'W12011500', 'W12011500', 'UT01', 'Wee Care Pediatrics', 'Peter', 'E', 'Silas', 'MD', 'Pediatrics', '', '', NULL, 'O', '2084 N 1700 W Ste A', 'Layton', 'Davis', 'UT', '84041', '8017738644', '8019271591', '2084 N 1700 W Ste A', 'Layton', 'Davis', 'UT', '84041', '8017738644', '8019271591', 'WUSTDPEDE5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-07-01', NULL, 0, 0, 0, 'Davis Hospital', '', '', '', 'HCFA|UB|', '1295733343', 0, 'N', 0, '2014-03-25', NULL, NULL, 41.0897, -111.997, NULL, NULL),
('061506129', 'W12011501', 'W12011501', 'UT01', 'Wee Care Pediatrics', 'Carmen', 'M', 'Taveras Espinal', 'MD', 'Pediatrics', '', '', NULL, 'O', '2084 N 1700 W Ste A', 'Layton', 'Davis', 'UT', '84041', '8017738644', '8019271591', '2084 N 1700 W Ste A', 'Layton', 'Davis', 'UT', '84041', '8017738644', '8019271591', 'WUSTDPEDE5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-07-01', '2011-09-30', 0, 0, 0, 'Primary Childrens Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1831400589', 0, 'N', 0, '2012-01-24', NULL, NULL, 0, 0, NULL, NULL),
('061506129', 'W12011502', 'W12011502', 'UT01', 'Wee Care Pediatrics 24 hrs 7 days a week', '', '', 'Wee Care Pediatrics', 'GROUP', 'Pediatrics', '', '', NULL, 'O', '2084 N 1700 W Ste A', 'Layton', 'Davis', 'UT', '84041', '8017738644', '8019271591', '2084 N 1700 W Ste A', 'Layton', 'Davis', 'UT', '84041', '8017738644', '8019271591', 'WUSTDPEDE5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009555', 0, 'N', 0, '2013-06-26', NULL, NULL, 41.0897, -111.997, NULL, NULL),
('271700729', 'W12011503', 'W12011503', 'UT01', 'Coalville Health Center', 'Gregory', 'D', 'Iverson', 'MD', 'Family Practice', '', '', NULL, 'O', '142 S 50 E', 'Coalville', 'Summit', 'UT', '84017', '4353364403', '4353365570', '142 S 50 E', 'Coalville', 'Summit', 'UT', '84017', '4353364403', '4353365570', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-07-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1962469395', 0, 'N', 0, '2011-12-06', NULL, NULL, 40.9141, -111.395, NULL, NULL),
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('271700729', 'W12011505', 'W12011505', 'UT01', 'Coalville Health Center', 'Gregory', 'D', 'Iverson', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 865', 'Coalville', 'Summit', 'UT', '84017', '4353364403', '4353365570', 'PO Box 865', 'Coalville', 'Summit', 'UT', '84017', '4353364403', '4353365570', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-07-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1962469395', 0, 'N', 0, '2011-12-06', NULL, NULL, 0, 0, NULL, NULL),
('200324983', 'W12011512', 'W12011512', 'ID02', 'Idaho Sports Medicine Institute', 'Kelly', 'C', 'Jorschumb', 'PT', 'Physical Therapy', '', '', NULL, 'O', '1188 University Dr', 'Boise', 'Ada', 'ID', '83706', '2083368250', '2083459514', '1188 University Dr', 'Boise', 'Ada', 'ID', '83706', '2083368250', '2083459514', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2011-05-20', '2012-06-30', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1790080687', 0, 'N', 0, '2012-07-03', NULL, NULL, 43.601, -116.196, NULL, NULL),
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('870281028', 'W12011516', 'W12011516', 'UT01', 'Central Utah Clinic PC', 'Gordon', 'H', 'Stock', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8017633885', NULL, 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8017633885', '          ', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-11-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1932149895', 0, 'N', 0, '2013-04-10', NULL, NULL, 0, 0, NULL, NULL),
('262257669', 'W12011517', 'W12011517', 'UT01', 'Rocky Mountain Allergy', 'Douglas', 'H', 'Jones', 'MD', 'Allergy and Immunology', 'Internal Medicine', '', NULL, 'O', '620 E Medical Dr Ste 150', 'Bountiful', 'Davis', 'UT', '84010', '8017759800', NULL, '620 E Medical Dr Ste 150', 'Bountiful', 'Davis', 'UT', '84010', '8017759800', '', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-05-02', '2012-12-31', 0, 0, 0, 'Davis Hospital', 'Lakeview Hospital', '', '', 'HCFA|UB|', '1346324761', 0, 'N', 0, '2014-05-29', NULL, NULL, 0, 0, NULL, NULL),
('262257669', 'W12011518', 'W12011518', 'UT01', 'Rocky Mountain Allergy', 'Douglas', 'H', 'Jones', 'MD', 'Allergy and Immunology', 'Internal Medicine', '', NULL, 'O', '380 E 1500 S Ste 201', 'Heber City', 'Wasatch', 'UT', '84032', '8017759800', NULL, '380 E 1500 S Ste 201', 'Heber City', 'Wasatch', 'UT', '84032', '8017759800', '', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-05-02', '2012-12-31', 0, 0, 0, 'Davis Hospital', 'Lakeview Hospital', '', '', 'HCFA|UB|', '1346324761', 0, 'N', 0, '2014-05-29', NULL, NULL, 0, 0, NULL, NULL),
('262257669', 'W12011519', 'W12011519', 'UT01', 'Rocky Mountain Allergy', 'Douglas', 'H', 'Jones', 'MD', 'Allergy and Immunology', 'Internal Medicine', '', NULL, 'B', 'PO Box 30015 Dept 124', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8017759800', NULL, 'PO Box 30015 Dept 124', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8017759800', '', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-05-02', '2012-12-31', 0, 0, 0, 'Davis Hospital', 'Lakeview Hospital', '', '', 'HCFA|UB|', '1346324761', 0, 'N', 0, '2014-05-29', NULL, NULL, 0, 0, NULL, NULL),
('830283425', 'W12011521', 'W12011521', 'WY01', 'North Platte Physical Therapy', 'Jeremy', 'E', 'Bieber', 'PT', 'Physical Therapy', '', '', NULL, 'O', '311 Thelma Dr', 'Casper', 'Natrona', 'WY', '82609', '3072342662', '3072348810', '311 Thelma Dr', 'Casper', 'Natrona', 'WY', '82609', '3072342662', '3072348810', 'WYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2011-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1619931102', 0, 'N', 0, '2011-06-30', NULL, NULL, 42.8482, -106.274, NULL, NULL),
('830283425', 'W12011520', 'W12011520', 'WY01', 'North Platte Physical Therapy', 'Jeremy', 'E', 'Bieber', 'PT', 'Physical Therapy', '', '', NULL, 'O', '3831 Denis Dr', 'Casper', 'Natrona', 'WY', '82604', '3072349067', '3072349074', '3831 Denis Dr', 'Casper', 'Natrona', 'WY', '82604', '3072349067', '3072349074', 'WYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2011-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1619931102', 0, 'N', 0, '2011-06-30', NULL, NULL, 42.822, -106.367, NULL, NULL),
('830283425', 'W12011522', 'W12011522', 'WY01', 'North Platte Physical Therapy', 'Jeremy', 'E', 'Bieber', 'PT', 'Physical Therapy', '', '', NULL, 'B', 'PO Box 1790', 'Douglas', 'Converse', 'WY', '82633', '3072342662', '3072348810', 'PO Box 1790', 'Douglas', 'Converse', 'WY', '82633', '3072342662', '3072348810', 'WYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2011-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1619931102', 0, 'N', 0, '2011-06-30', NULL, NULL, 0, 0, NULL, NULL),
('830283425', 'W12011523', 'W12011523', 'WY01', 'North Platte Physical Therapy', 'Michael', 'R', 'Boulter', 'PT', 'Physical Therapy', '', '', NULL, 'O', '311 Thelma Dr', 'Casper', 'Natrona', 'WY', '82609', '3072342662', '3072348810', '311 Thelma Dr', 'Casper', 'Natrona', 'WY', '82609', '3072342662', '3072348810', 'WYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2011-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1265663587', 0, 'N', 0, '2014-07-21', NULL, NULL, 42.8482, -106.274, NULL, NULL),
('830283425', 'W12011524', 'W12011524', 'WY01', 'North Platte Physical Therapy', 'Michael', 'R', 'Boulter', 'PT', 'Physical Therapy', '', '', NULL, 'O', '3831 Denis Dr', 'Casper', 'Natrona', 'WY', '82604', '3072342662', '3072349074', '3831 Denis Dr', 'Casper', 'Natrona', 'WY', '82604', '3072342662', '3072349074', 'WYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2011-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1265663587', 0, 'N', 0, '2014-07-21', NULL, NULL, 42.822, -106.367, NULL, NULL),
('830283425', 'W12011525', 'W12011525', 'WY01', 'North Platte Physical Therapy', 'Michael', 'R', 'Boulter', 'PT', 'Physical Therapy', '', '', NULL, 'B', 'PO Box 1790', 'Douglas', 'Converse', 'WY', '82633', '3072342662', '3072348810', 'PO Box 1790', 'Douglas', 'Converse', 'WY', '82633', '3072342662', '3072348810', 'WYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2011-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1265663587', 0, 'N', 0, '2014-07-21', NULL, NULL, 0, 0, NULL, NULL),
('830283425', 'W12011526', 'W12011526', 'WY01', 'North Platte Physical Therapy', 'Deidra', 'N', 'Cottenoir', 'PT', 'Physical Therapy', '', '', NULL, 'O', '311 Thelma Dr', 'Casper', 'Natrona', 'WY', '82609', '3072342662', '3072348810', '311 Thelma Dr', 'Casper', 'Natrona', 'WY', '82609', '3072342662', '3072348810', 'WYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2011-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1225215635', 0, 'N', 0, '2014-07-24', NULL, NULL, 42.8482, -106.274, NULL, NULL),
('830283425', 'W12011527', 'W12011527', 'WY01', 'North Platte Physical Therapy', 'Deidra', 'N', 'Cottenoir', 'PT', 'Physical Therapy', '', '', NULL, 'O', '3831 Denis Dr', 'Casper', 'Natrona', 'WY', '82604', '3072349067', '3072349074', '3831 Denis Dr', 'Casper', 'Natrona', 'WY', '82604', '3072349067', '3072349074', 'WYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2011-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1225215635', 0, 'N', 0, '2014-07-24', NULL, NULL, 42.822, -106.367, NULL, NULL),
('830283425', 'W12011528', 'W12011528', 'WY01', 'North Platte Physical Therapy', 'Deidra', 'N', 'Cottenoir', 'PT', 'Physical Therapy', '', '', NULL, 'B', 'PO Box 1790', 'Douglas', 'Converse', 'WY', '82633', '3072342662', '3072348810', 'PO Box 1790', 'Douglas', 'Converse', 'WY', '82633', '3072342662', '3072348810', 'WYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2011-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1225215635', 0, 'N', 0, '2014-07-24', NULL, NULL, 0, 0, NULL, NULL),
('263981143', 'W12011529', 'W12011529', 'UT01', 'Peak ENT Associates', 'David ', 'S', 'Darley', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '1055 N 300 W Ste 401', 'Provo', 'Utah', 'UT', '84604', '8013577499', NULL, '1055 N 300 W Ste 401', 'Provo', 'Utah', 'UT', '84604', '8013577499', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-11-10', '2011-11-30', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1811151558', 0, 'N', 0, '2011-12-20', NULL, NULL, 0, 0, NULL, NULL),
('870481325', 'W12011530', 'W12011530', 'UT01', 'Westside Medical', 'Tyler', 'C', 'Dixon', 'DO', 'Family Practice', '', '', NULL, 'O', '1477 N 2000 W Ste C', 'Clearfield', 'Davis', 'UT', '84015', '8017748888', '8018258519', '1477 N 2000 W Ste C', 'Clearfield', 'Davis', 'UT', '84015', '8017748888', '8018258519', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-11-10', NULL, 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1144339904', 0, 'N', 0, '2014-04-08', NULL, NULL, 41.1353, -112.064, NULL, NULL),
('870481325', 'W12011531', 'W12011531', 'UT01', 'Westside Medical', 'Tyler', 'C', 'Dixon', 'DO', 'Family Practice', '', '', NULL, 'M', 'PO Box 708757', 'Sandy', 'Salt Lake', 'UT', '84070', '8017748888', '8018258519', 'PO Box 708757', 'Sandy', 'Salt Lake', 'UT', '84070', '8017748888', '8018258519', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-11-10', NULL, 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1144339904', 0, 'N', 0, '2014-04-08', NULL, NULL, 0, 0, NULL, NULL),
('830283425', 'W12011533', 'W12011533', 'WY01', 'North Platte Physical Therapy', 'Abby', 'L', 'Holwegner', 'OT', 'Occupational Therapy', '', '', NULL, 'O', '311 Thelma Dr', 'Casper', 'Natrona', 'WY', '82609', '3072342662', '3072348810', '311 Thelma Dr', 'Casper', 'Natrona', 'WY', '82609', '3072342662', '3072348810', 'WYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2011-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1720216294', 0, 'N', 0, '2013-11-13', NULL, NULL, 42.8482, -106.274, NULL, NULL),
('830283425', 'W12011532', 'W12011532', 'WY01', 'North Platte Physical Therapy', 'Abby', 'L', 'Holwegner', 'OT', 'Occupational Therapy', '', '', NULL, 'O', '3831 Denis Dr', 'Casper', 'Natrona', 'WY', '82604', '3072349067', '3072349074', '3831 Denis Dr', 'Casper', 'Natrona', 'WY', '82604', '3072349067', '3072349074', 'WYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2011-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1720216294', 0, 'N', 0, '2013-11-13', NULL, NULL, 42.822, -106.367, NULL, NULL),
('830283425', 'W12011534', 'W12011534', 'WY01', 'North Platte Physical Therapy', 'Abby', 'L', 'Holwegner', 'OT', 'Occupational Therapy', '', '', NULL, 'B', 'PO Box 1790', 'Douglas', 'Converse', 'WY', '82633', '3072342662', '3072348810', 'PO Box 1790', 'Douglas', 'Converse', 'WY', '82633', '3072342662', '3072348810', 'WYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2011-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1720216294', 0, 'N', 0, '2013-11-13', NULL, NULL, 0, 0, NULL, NULL),
('870571510', 'W12011535', 'W12011535', 'UT01', 'Layton Ambulatory Anesthesia', 'William', 'R', 'Lowe', 'MD', 'Anesthesia', '', '', NULL, 'B', 'PO Box 160354', 'Clearfield', 'Davis', 'UT', '84016', '8017748992', '8015250347', 'PO Box 160354', 'Clearfield', 'Davis', 'UT', '84016', '8017748992', '8015250347', '', '', '1000', '49.50', '0.00', '0.00', 3, '2011-07-01', '2012-06-30', 1, 12, 0, '', '', '', '', 'HCFA|UB|', '1114110608', 0, 'N', 0, '2012-06-22', NULL, NULL, 0, 0, NULL, NULL),
('830283425', 'W12011536', 'W12011536', 'WY01', 'North Platte Physical Therapy', 'Robert ', 'A', 'Royse', 'PT', 'Physical Therapy', '', '', NULL, 'O', '311 Thelma Dr', 'Casper', 'Natrona', 'WY', '82609', '3072342662', '3072348810', '311 Thelma Dr', 'Casper', 'Natrona', 'WY', '82609', '3072342662', '3072348810', 'WYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2011-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1285698795', 0, 'N', 0, '2014-07-11', NULL, NULL, 42.8482, -106.274, NULL, NULL),
('830283425', 'W12011537', 'W12011537', 'WY01', 'North Platte Physical Therapy', 'Robert ', 'A', 'Royse', 'PT', 'Physical Therapy', '', '', NULL, 'O', '3831 Denis Dr Ste 200', 'Casper', 'Natrona', 'WY', '82604', '3072349067', '3072349074', '3831 Denis Dr Ste 200', 'Casper', 'Natrona', 'WY', '82604', '3072349067', '3072349074', 'WYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2011-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1285698795', 0, 'N', 0, '2014-07-11', NULL, NULL, 42.822, -106.367, NULL, NULL),
('830283425', 'W12011538', 'W12011538', 'WY01', 'North Platte Physical Therapy', 'Robert ', 'A', 'Royse', 'PT', 'Physical Therapy', '', '', NULL, 'B', 'PO Box 1790', 'Douglas', 'Converse', 'WY', '82633', '3072342662', '3072348810', 'PO Box 1790', 'Douglas', 'Converse', 'WY', '82633', '3072342662', '3072348810', 'WYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2011-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1285698795', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('830283425', 'W12011539', 'W12011539', 'WY01', 'North Platte Physical Therapy', 'Reagan ', '', 'Scott', 'OT', 'Occupational Therapy', '', '', NULL, 'O', '311 Thelma Dr', 'Casper', 'Natrona', 'WY', '82609', '3072342662', '3072348810', '311 Thelma Dr', 'Casper', 'Natrona', 'WY', '82609', '3072342662', '3072348810', 'WYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2011-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1154385748', 0, 'N', 0, '2014-07-16', NULL, NULL, 42.8482, -106.274, NULL, NULL),
('830283425', 'W12011540', 'W12011540', 'WY01', 'North Platte Physical Therapy', 'Reagan ', '', 'Scott', 'OT', 'Occupational Therapy', '', '', NULL, 'O', '3831 Denis Dr', 'Casper', 'Natrona', 'WY', '82604', '3072349067', '3072349074', '3831 Denis Dr', 'Casper', 'Natrona', 'WY', '82604', '3072349067', '3072349074', 'WYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2011-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1154385748', 0, 'N', 0, '2014-07-16', NULL, NULL, 42.822, -106.367, NULL, NULL),
('830283425', 'W12011541', 'W12011541', 'WY01', 'North Platte Physical Therapy', 'Reagan ', '', 'Scott', 'OT', 'Occupational Therapy', '', '', NULL, 'B', 'PO Box 1790', 'Douglas', 'Converse', 'WY', '82633', '3072342662', '3072348810', 'PO Box 1790', 'Douglas', 'Converse', 'WY', '82633', '3072342662', '3072348810', 'WYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2011-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1154385748', 0, 'N', 0, '2014-07-16', NULL, NULL, 0, 0, NULL, NULL),
('830199236', 'W12011542', 'W12011542', 'WY01', 'Yellowstone Behavioral Health Center', 'Sadie', '', 'Smith', 'LMFT', 'Mental Health', 'Counseling', '', NULL, 'O', '2538 Big Horn Ave', 'Cody', 'Park', 'WY', '82414', '3075872197', NULL, '2538 Big Horn Ave', 'Cody', 'Park', 'WY', '82414', '3075872197', '          ', 'MA', '', '', '0.00', '35.00', '0.00', 3, '2012-03-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1134458904', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('203787601', 'W12011543', 'W12011543', 'WY01', 'Urological Services of Northern Wyoming', 'Gregory', 'S', 'Stewart', 'MD', 'Urology', '', '', NULL, 'O', '225 W Yellowstone Ave Ste 9', 'Powell', 'Park', 'WY', '82435', '3075875131', '3075875132', '225 W Yellowstone Ave Ste 9', 'Powell', 'Park', 'WY', '82435', '3075875131', '3075875132', '', '', '', '0.00', '15.00', '0.00', 3, '2011-07-01', '2014-02-25', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1508832080', 0, 'N', 0, '2014-03-05', NULL, NULL, 0, 0, NULL, NULL),
('203787601', 'W12011544', 'W12011544', 'WY01', 'Urological Services of Northern Wyoming', 'Gregory', 'S', 'Stewart', 'MD', 'Urology', '', '', NULL, 'B', 'PO Box 1330', 'Powell', 'Park', 'WY', '82435', '3075875131', '3075875132', 'PO Box 1330', 'Powell', 'Park', 'WY', '82435', '3075875131', '3075875132', '', '', '', '0.00', '15.00', '0.00', 3, '2011-07-01', '2014-02-25', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1508832080', 0, 'N', 0, '2014-03-03', NULL, NULL, 0, 0, NULL, NULL),
('870550275', 'W12007720', 'W12007720', 'UT01', 'Wasatch Pediatrics at St Marks', 'Catherine', 'D', 'Jolma', 'MD', 'Pediatric Internal Medicine', 'Pediatrics', '', NULL, 'O', '1140 E 3900 S Ste 360', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012648686', '8012648962', '1140 E 3900 S Ste 360', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012648686', '8012648962', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-01-27', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1679507354', 0, 'N', 0, '2014-01-16', NULL, NULL, 40.6871, -111.859, NULL, NULL),
('870550275', 'W12007721', 'W12007721', 'UT01', 'Wasatch Pediatrics', 'Catherine', 'D', 'Jolma', 'MD', 'Pediatric Internal Medicine', 'Pediatrics', '', NULL, 'B', 'PO Box 71550', 'Salt Lake City', 'Salt Lake', 'UT', '84171', '8019470830', '8019470864', 'PO Box 71550', 'Salt Lake City', 'Salt Lake', 'UT', '84171', '8019470830', '8019470864', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-01-27', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1679507354', 0, 'N', 0, '2014-01-16', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12011545', 'W12011545', 'UTIHCPHY', 'Southridge InstaCare', 'Marcus', '', 'Blackburn', 'MD', 'Pediatrics', '', '', NULL, 'O', '3723 W 12600 S Ste 150', 'Riverton', 'Salt Lake', 'UT', '84065', '8012854560', '8012854565', '3723 W 12600 S Ste 150', 'Riverton', 'Salt Lake', 'UT', '84065', '8012854560', '8012854565', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2011-03-01', NULL, 0, 0, 0, 'Riverton Childrens Unit Operated by Primary Childrens Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1598919409', 0, 'N', 0, '2013-05-17', NULL, NULL, 40.5222, -111.98, NULL, NULL),
('942854057', 'W12011547', 'W12011547', 'UTIHCPHY', 'Mountain View Pediatrics', 'Paula', 'B', 'Bowers', 'MD', 'Pediatrics', '', '', NULL, 'O', '9720 S 1300 E Ste 100', 'Sandy', 'Salt Lake', 'UT', '84094', '          ', '8015711689', '9720 S 1300 E Ste 100', 'Sandy', 'Salt Lake', 'UT', '84094', '          ', '8015711689', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2003-06-22', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1538270343', 0, 'N', 0, '2011-05-24', NULL, NULL, 40.5739, -111.853, NULL, NULL),
('942854057', 'W12011548', 'W12011548', 'UT01', 'American Fork Surgical Associates', 'Scott', '', 'Bramble', 'PA-C', 'General Surgery', '', '', NULL, 'O', '1159 E 200 N Ste 350', 'American Fork', 'Utah', 'UT', '84003', '8018552941', '8017565091', '1159 E 200 N Ste 350', 'American Fork', 'Utah', 'UT', '84003', '8018552941', '8017565091', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2011-04-18', '2012-04-07', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1598913022', 0, 'N', 0, '2013-05-06', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12011549', 'W12011549', 'UTIHCPHY', 'Mt PleasantDelta', 'J', 'B', 'Butte', 'DO', 'General Surgery', '', '', NULL, 'o', '126 White Sage Ave', 'Delta', 'Millard', 'UT', '84624', '4358645591', '4354623354', '126 White Sage Ave', 'Delta', 'Millard', 'UT', '84624', '4358645591', '4354623354', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2011-04-01', '2012-09-30', 0, 0, 0, 'Sanpete Valley Hospital', '', '', '', 'HCFA|UB|', '1033174198', 0, 'N', 0, '2013-06-03', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12011551', 'W12011551', 'UTIHCPHY', 'Budge Clinic Surgical Specialists', 'Teryl', 'R', 'Hunsaker', 'PA', 'Urology', '', '', NULL, 'O', '1350 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357921950', '4357530401', '1350 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357921950', '4357530401', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2011-05-23', NULL, 0, 0, 0, 'Logan Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1376553834', 0, 'N', 0, '2011-05-24', NULL, NULL, 41.7565, -111.821, NULL, NULL),
('942854057', 'W12011552', 'W12011552', 'UTIHCPHY', 'Bear River Specialists', 'Teryl', 'R', 'Hunsaker', 'PA', 'Urology', '', '', NULL, 'O', '935 N 1000 W', 'Tremonton', 'Box Elder', 'UT', '84337', '4352074800', '4352074808', '935 N 1000 W', 'Tremonton', 'Box Elder', 'UT', '84337', '4352074800', '4352074808', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2011-05-23', NULL, 0, 0, 0, 'Logan Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1376553834', 0, 'N', 0, '2011-05-24', NULL, NULL, 41.7162, -112.201, NULL, NULL),
('942854057', 'W12011556', 'W12011556', 'UTIHCPHY', 'Redrock Digestive Health', '', '', 'Redrock Digestive Health', 'Group', 'Clinic', '', '', NULL, 'O', '652 S Medical Ctr Dr Ste 330', 'St George', 'Washington', 'UT', '84790', '4352513800', '4352513801', '652 S Medical Ctr Dr Ste 330', 'St George', 'Washington', 'UT', '84790', '4352513800', '4352513801', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2011-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1679865182', 0, 'N', 0, '2011-05-24', NULL, NULL, 37.0498, -113.574, NULL, NULL),
('870629019', 'W12011557', 'W12011557', 'UT01', '', 'Robert', 'D', 'Pearson', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '1251 N Northfield Rd Ste 200', 'Cedar City', 'Iron', 'UT', '84721', '4358678719', '4358675763', '1251 N Northfield Rd Ste 200', 'Cedar City', 'Iron', 'UT', '84721', '4358678719', '4358675763', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-05-24', NULL, 0, 0, 0, 'Valley View Medical Center', '', '', '', 'HCFA|UB|', '1295793834', 0, 'N', 0, '2014-06-17', NULL, NULL, 37.6996, -113.068, NULL, NULL),
('870306646', 'W12009024', 'W12009024', 'UT01', 'Emergency Physicians Group', 'Laurie', 'C', 'Raborn', 'DO', 'Emergency Medicine', '', '', NULL, 'O', '1200 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012687975', '8012703324', '1200 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012687975', '8012703324', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1497915839', 0, 'Y', 0, '2011-05-24', NULL, NULL, 40.6871, -111.856, NULL, NULL),
('870306646', 'W12009025', 'W12009025', 'UT01', 'Emergency Physicians Group', 'Laurie', 'C', 'Raborn', 'DO', 'Emergency Medicine', '', '', NULL, 'B', 'PO Box 95970', 'South Jordan', 'Salt Lake', 'UT', '84095', '8013529500', '8012703324', 'PO Box 95970', 'South Jordan', 'Salt Lake', 'UT', '84095', '8013529500', '8012703324', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1497915839', 0, 'Y', 0, '2011-05-24', NULL, NULL, 0, 0, NULL, NULL),
('870306646', 'W12011558', 'W12011558', 'UT01', 'Lone Peak Emergency', 'Laurie', 'C', 'Raborn', 'DO', 'Emergency Medicine', '', '', NULL, 'O', '11800 S State St', 'Draper', 'Salt Lake', 'UT', '84020', '8015458100', '8012703324', '11800 S State St', 'Draper', 'Salt Lake', 'UT', '84020', '8015458100', '8012703324', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1497915839', 0, 'N', 0, '2011-05-24', NULL, NULL, 40.5384, -111.891, NULL, NULL),
('870661331', 'W12008273', 'W12008273', 'UT01', 'Syracuse Chiropractic and Health Center', 'Tyler', 'R', 'Elmore', 'DC', 'Chiropractic', '', '', NULL, 'O', '1842 S 2000 W Ste 2', 'Syracuse', 'Davis', 'UT', '84075', '8017747540', '8017747542', '1842 S 2000 W Ste 2', 'Syracuse', 'Davis', 'UT', '84075', '8017747540', '8017747542', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2011-01-01', '2012-07-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1811081771', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('876000525', 'W12011563', 'W12011563', 'UT01', 'University Health Care', 'Jacob', 'Daniel', 'Erekson', 'DPT', 'Physical Therapy', '', '', NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015812121', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015812121', '          ', '', '', '1', '0.00', '0.00', '0.00', 6, '2011-05-25', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1407187867', 0, 'N', 0, '2011-05-25', NULL, NULL, 40.7685, -111.837, NULL, NULL),
('876000525', 'W12011562', 'W12011562', 'UT01', 'University of Utah Hospital', 'Jacob', 'Daniel', 'Erekson', 'DPT', 'Physical Therapy', '', '', NULL, 'B', 'PO Box 510721', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8015812121', NULL, 'PO Box 510721', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8015812121', '          ', '', '', '1', '0.00', '0.00', '0.00', 6, '2011-05-25', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1407187867', 0, 'N', 0, '2011-05-25', NULL, NULL, 0, 0, NULL, NULL),
('876000525', 'W12011565', 'W12011565', 'UT01', 'University Health Care', 'Emily', 'Jeanne', 'Hansen', 'RT', 'Physical Therapy', '', '', NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015812121', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015812121', '          ', '', '', '1', '0.00', '0.00', '0.00', 6, '2011-05-25', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1174825640', 0, 'N', 0, '2011-05-25', NULL, NULL, 40.7685, -111.837, NULL, NULL),
('876000525', 'W12011566', 'W12011566', 'UT01', 'University of Utah Hospital', 'Emily', 'Jeanne', 'Hansen', 'RT', 'Physical Therapy', '', '', NULL, 'B', 'PO Box 510721', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8015812121', NULL, 'PO Box 510721', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8015812121', '          ', '', '', '1', '0.00', '0.00', '0.00', 6, '2011-05-25', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1174825640', 0, 'N', 0, '2011-05-25', NULL, NULL, 0, 0, NULL, NULL),
('876000525', 'W12011568', 'W12011568', 'UT01', 'University of Utah Hospital', 'Patrick', 'M', 'Kelly', 'PT', 'Physical Therapy', '', '', NULL, 'B', 'PO Box 510721', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8015812121', NULL, 'PO Box 510721', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8015812121', '          ', '', '', '1', '0.00', '0.00', '0.00', 6, '2011-05-25', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1750386702', 0, 'N', 0, '2011-05-25', NULL, NULL, 0, 0, NULL, NULL),
('876000525', 'W12011569', 'W12011569', 'UT01', 'University of Utah Hospital', 'Patrick', 'M', 'Kelly', 'PT', 'Physical Therapy', '', '', NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015812121', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015812121', '          ', '', '', '1', '0.00', '0.00', '0.00', 6, '2011-05-25', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1750386702', 0, 'N', 0, '2011-05-25', NULL, NULL, 40.7685, -111.837, NULL, NULL),
('876000525', 'W12011571', 'W12011571', 'UT01', 'University of Utah Hospital', 'Michelle', '', 'Clark', 'OT', 'Occupational Medicine', '', '', NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015812121', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015812121', '          ', '', '', '1', '0.00', '0.00', '0.00', 6, '2011-05-25', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1922302967', 0, 'N', 0, '2011-05-25', NULL, NULL, 40.7685, -111.837, NULL, NULL),
('876000525', 'W12011572', 'W12011572', 'UT01', 'University of Utah', 'Michelle', '', 'Clark', 'OT', 'Occupational Medicine', '', '', NULL, 'B', 'PO Box 510721', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8015812121', NULL, 'PO Box 510721', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8015812121', '          ', '', '', '1', '0.00', '0.00', '0.00', 6, '2011-05-25', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1922302967', 0, 'N', 0, '2011-05-25', NULL, NULL, 0, 0, NULL, NULL),
('876000525', 'W12011575', 'W12011575', 'UT01', 'University Hospital Physicians', 'Jennifer', 'E', 'Penn', 'DPT', 'Physical Therapy', '', '', NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015812121', '8015816243', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015812121', '8015816243', '', '', '1', '0.00', '0.00', '0.00', 6, '2011-05-25', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1053615443', 0, 'N', 0, '2011-05-25', NULL, NULL, 40.7685, -111.837, NULL, NULL),
('876000525', 'W12011574', 'W12011574', 'UT01', 'University of Utah Hospital', 'Jennifer', 'E', 'Penn', 'DPT', 'Physical Therapy', '', '', NULL, 'B', 'PO Box 510721', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8015812121', NULL, 'PO Box 510721', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8015812121', '          ', '', '', '1', '0.00', '0.00', '0.00', 6, '2011-05-25', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1053615443', 0, 'N', 0, '2011-05-25', NULL, NULL, 0, 0, NULL, NULL),
('876000525', 'W12011577', 'W12011577', 'UT01', 'University Health Care', 'Thomas', 'N', 'Riche', 'OT', 'Occupational Therapy', '', '', NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015812121', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015812121', '          ', '', '', '1', '0.00', '0.00', '0.00', 6, '2011-02-09', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1336443068', 0, 'N', 0, '2011-05-25', NULL, NULL, 40.7685, -111.837, NULL, NULL),
('876000525', 'W12011578', 'W12011578', 'UT01', 'University of Utah Hospital', 'Thomas', 'N', 'Riche', 'OT', 'Occupational Therapy', '', '', NULL, 'B', 'PO Box 510721', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8015812121', NULL, 'PO Box 510721', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8015812121', '          ', '', '', '1', '0.00', '0.00', '0.00', 6, '2011-02-09', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1336443068', 0, 'N', 0, '2011-05-25', NULL, NULL, 0, 0, NULL, NULL),
('200791511', 'W12011739', 'W12011739', 'UT01', '', 'Stacie', 'R', 'Pearce', 'NP', 'Family Practice', '', '', NULL, 'O', '602 E Fort Union Blvd 2nd Floor', 'Midvale', 'Salt Lake', 'UT', '84047', '8013131010', '8017472116', '602 E Fort Union Blvd 2nd Floor', 'Midvale', 'Salt Lake', 'UT', '84047', '8013131010', '8017472116', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1912207226', 0, 'N', 0, '2011-07-19', NULL, NULL, 40.6207, -111.874, NULL, NULL),
('870442845', 'W12011581', 'W12011581', 'UT01', 'University Health Care', 'Marsha', 'Y', 'Thomas-Robertson', 'APRN', 'Internal Medicine', 'Oncology', '', NULL, 'O', '1950 Cir Of Hope Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84112', '8015850100', NULL, '1950 Cir Of Hope Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84112', '8015850100', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2011-02-11', '2012-08-27', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1275834319', 0, 'N', 0, '2012-08-28', NULL, NULL, 0, 0, NULL, NULL),
('870442845', 'W12011580', 'W12011580', 'UT01', 'U-U Hematology / Oncology Division', 'Marsha', 'Y', 'Thomas-Robertson', 'APRN', 'Internal Medicine', 'Oncology', '', NULL, 'B', 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2011-02-11', '2012-08-27', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1275834319', 0, 'N', 0, '2012-08-28', NULL, NULL, 0, 0, NULL, NULL),
('870616107', 'W12011584', 'W12011584', 'UT01', 'University Health Care', 'Christopher', 'A', 'Vis', 'PA', 'Family Practice', '', '', NULL, 'O', '1525 W 2100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8012139900', '8012139910', '1525 W 2100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8012139900', '8012139910', 'WISESTDU', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-03-31', '2012-09-16', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1568763159', 0, 'N', 0, '2012-09-18', NULL, NULL, 0, 0, NULL, NULL),
('870616107', 'W12011583', 'W12011583', 'UT01', 'U of U Hospitals and Clinics', 'Christopher', 'A', 'Vis', 'PA', 'Family Practice', '', '', NULL, 'B', 'PO Box 510708', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8015876303', NULL, 'PO Box 510708', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8015876303', '          ', 'WISESTDU', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-03-31', '2012-09-16', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1568763159', 0, 'N', 0, '2012-09-18', NULL, NULL, 0, 0, NULL, NULL),
('330057155', 'W12011585', 'W12011585', 'TX01', 'Apria Healthcare LLC', '', '', 'Apria Healthcare LLC', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'B', 'PO Box 676269', 'Dallas', 'Dallas', 'TX', '75267', '9496392000', NULL, 'PO Box 676269', 'Dallas', 'Dallas', 'TX', '75267', '9496392000', '          ', 'Wpraxair', '', '', '0.00', '20.00', '0.00', 3, '2011-03-04', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000008248', 0, 'Y', 0, '2014-01-24', NULL, NULL, 0, 0, NULL, NULL),
('870446925', 'W12011589', 'W12011589', 'UT01', 'University Health Care', 'John', 'H', 'Bowers', 'MD', 'Gastroenterology', '', '', NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015817802', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015817802', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2011-04-06', '2012-08-29', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1649283318', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('870446925', 'W12011588', 'W12011588', 'UT01', 'U-U Gastroenterology Division', 'John', 'H', 'Bowers', 'MD', 'Gastroenterology', '', '', NULL, 'B', 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012386615', NULL, 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012386615', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2011-04-06', '2012-08-29', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1649283318', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('870446925', 'W12011592', 'W12011592', 'UT01', 'University Health Care', 'Keisa', 'M', 'Lynch', 'APRN', 'Internal Medicine', '', '', NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015817802', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015817802', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2011-03-31', '2012-08-29', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1972768539', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('870446925', 'W12011591', 'W12011591', 'UT01', 'U-U Gastroenterology Division', 'Keisa', 'M', 'Lynch', 'APRN', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012386615', NULL, 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012386615', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2011-03-31', '2012-08-29', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1972768539', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('870619420', 'W12011599', 'W12011599', 'UT01', 'University Health Care', 'Honey', 'M', 'Newton', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015814014', '8015859345', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015814014', '8015859345', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2009-11-02', '2012-09-18', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1437386299', 0, 'N', 0, '2012-09-19', NULL, NULL, 0, 0, NULL, NULL),
('870619420', 'W12011598', 'W12011598', 'UT01', 'College of Nursing University of Utah', 'Honey', 'M', 'Newton', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 413036', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '8015853655', 'PO Box 413036', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '8015853655', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2009-11-02', '2012-09-18', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1437386299', 0, 'N', 0, '2012-09-19', NULL, NULL, 0, 0, NULL, NULL),
('870480520', 'W12011602', 'W12011602', 'UT01', 'University Health Care', 'Shawn', 'M', 'Smith', 'MD', 'Neurology', '', '', NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015856387', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015856387', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2011-04-07', '2012-08-09', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1720126154', 0, 'N', 0, '2012-08-13', NULL, NULL, 0, 0, NULL, NULL),
('870480520', 'W12011601', 'W12011601', 'UT01', 'University of Utah Dept of Neurology', 'Shawn', 'M', 'Smith', 'MD', 'Neurology', '', '', NULL, 'B', 'PO Box 413027', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413027', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2011-04-07', '2012-08-09', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1720126154', 0, 'N', 0, '2012-08-13', NULL, NULL, 0, 0, NULL, NULL),
('870616107', 'W12011605', 'W12011605', 'UT01', 'U of U Hospitals and Clinics', 'Paula', 'E', 'Stockman', 'PA', 'Family Practice', '', '', NULL, 'O', '1525 W 2100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8012139900', '8012139910', '1525 W 2100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8012139900', '8012139910', 'WISESTDU', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-03-30', '2012-09-16', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1932366887', 0, 'N', 0, '2012-09-18', NULL, NULL, 0, 0, NULL, NULL),
('870616107', 'W12011604', 'W12011604', 'UT01', 'U of U Hospitals and Clinics', 'Paula', 'E', 'Stockman', 'PA', 'Family Practice', '', '', NULL, 'B', 'PO Box 510708', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8015876303', NULL, 'PO Box 510708', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8015876303', '          ', 'WISESTDU', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-03-30', '2012-09-16', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1932366887', 0, 'N', 0, '2012-09-18', NULL, NULL, 0, 0, NULL, NULL),
('800236802', 'W12006967', 'W12006967', 'UT01', 'Farr West Family Medicine', 'Julia', 'A', 'Rothgery', 'MD', 'Family Practice', '', '', NULL, 'O', '2850 N 2000 W Ste 101', 'Ogden', 'Weber', 'UT', '84404', '8017311222', '8017311666', '2850 N 2000 W Ste 101', 'Ogden', 'Weber', 'UT', '84404', '8017311222', '8017311666', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-12-15', '2012-06-30', 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1609020072', 0, 'N', 0, '2012-06-28', NULL, NULL, 0, 0, NULL, NULL),
('800236802', 'W12006968', 'W12006968', 'UT01', 'Farr West Family Medicine', 'Julia', 'A', 'Rothgery', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 405600', 'Atlanta', 'Fulton', 'GA', '30384', '8017311222', '8017311666', 'PO Box 405600', 'Atlanta', 'Fulton', 'GA', '30384', '8017311222', '8017311666', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-12-15', '2012-06-30', 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1609020072', 0, 'N', 0, '2012-06-28', NULL, NULL, 0, 0, NULL, NULL),
('870638577', 'W12011607', 'W12011607', 'UT01', 'University Health Care', 'Norman', 'A', 'Zabriskie', 'MD', 'Ophthalmology', NULL, NULL, NULL, 'O', '100 N Mario Capecchi Dr Ste 3650', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8015812352', '8015851295', '100 N Mario Capecchi Dr Ste 3650', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8015812352', '8015851295', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2007-07-01', '2012-08-09', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1063502656', 0, 'N', 0, '2012-08-10', NULL, NULL, 0, 0, NULL, NULL),
('870638577', 'W12011606', 'W12011606', 'UT01', 'University of Utah Pediatric Ophthalmology', 'Norman', 'A', 'Zabriskie', 'MD', 'Ophthalmology', NULL, NULL, NULL, 'B', '65 Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015813195', NULL, '65 Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015813195', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2007-07-01', '2012-08-09', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1063502656', 0, 'N', 0, '2012-08-10', NULL, NULL, 0, 0, NULL, NULL),
('742152396', 'W12011611', 'W12011611', 'TX01', 'KCI USA Inc (Wound Vac Only)', '', '', 'KCI USA Inc. ', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', 'Phone Number Only', '', '', '', '', '8002754524', NULL, 'Phone Number Only', '', '', '', '', '8002754524', '          ', 'KCI', '', '', '0.00', '100.00', '0.00', 3, '2011-03-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1366439507', 0, 'N', 0, '2013-03-12', NULL, NULL, 0, 0, NULL, NULL),
('742152396', 'W12011612', 'W12011612', 'WY01', 'KCI USA Inc (Wound Vac Only)', '', '', 'KCI USA Inc. ', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', 'Phone Number Only', '', '', '', '', '8002754524', NULL, 'Phone Number Only', '', '', '', '', '8002754524', '          ', 'KCI', '', '', '0.00', '100.00', '0.00', 3, '2011-03-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1366439507', 0, 'N', 0, '2013-03-12', NULL, NULL, 0, 0, NULL, NULL),
('742152396', 'W12011614', 'W12011614', 'NA01', 'KCI USA Inc (Wound Vac Only)', '', '', 'KCI USA Inc. ', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', 'Phone Number Only', '', '', '', '', '8002754524', NULL, 'Phone Number Only', '', '', '', '', '8002754524', '          ', 'KCI', '', '', '0.00', '100.00', '0.00', 3, '2011-03-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1366439507', 0, 'N', 0, '2013-03-12', NULL, NULL, 0, 0, NULL, NULL),
('742152396', 'W12011613', 'W12011613', 'ID01', 'KCI USA Inc (Wound Vac Only)', '', '', 'KCI USA Inc. ', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', 'Phone Number Only', '', '', '', '', '8002754524', NULL, 'Phone Number Only', '', '', '', '', '8002754524', '          ', 'KCI', '', '', '0.00', '100.00', '0.00', 3, '2011-03-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1366439507', 0, 'N', 0, '2013-03-12', NULL, NULL, 0, 0, NULL, NULL),
('870574059', 'W12011621', 'W12011621', 'UT01', 'Mountain Land Layton', 'Tiffany', 'R', 'Vendela', 'PT', 'Physical Therapy', '', '', NULL, 'O', '124 S Fairfield Rd Ste Lower A', 'Layton', 'Davis', 'UT', '84041', '8015479462', '8045479116', '124 S Fairfield Rd Ste Lower A', 'Layton', 'Davis', 'UT', '84041', '8015479462', '8045479116', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '70.50', 3, '2011-04-01', '2011-11-15', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1932438249', 0, 'N', 0, '2012-01-10', 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
('870574059', 'W12011622', 'W12011622', 'UT01', 'Mountain Land Layton', 'Tiffany', 'R', 'Vendela', 'PT', 'Physical Therapy', '', '', NULL, 'O', '124 S Fairfield Rd Ste Lower A', 'Layton', 'Davis', 'UT', '84041', '8015479462', '8045479116', '124 S Fairfield Rd Ste Lower A', 'Layton', 'Davis', 'UT', '84041', '8015479462', '8045479116', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2012-04-01', '2012-04-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1932438249', 0, 'N', 0, '2012-01-10', NULL, NULL, 0, 0, NULL, NULL),
('870574059', 'W12011623', 'W12011623', 'UT01', 'Mountain Land Layton', 'Tiffany', 'R', 'Vendela', 'PT', 'Physical Therapy', '', '', NULL, 'B', 'PO Box 711185', 'Salt Lake City', 'Salt Lake', 'UT', '84171', '8015479462', '8045479116', 'PO Box 711185', 'Salt Lake City', 'Salt Lake', 'UT', '84171', '8015479462', '8045479116', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '70.50', 3, '2011-04-01', '2012-03-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1932438249', 0, 'N', 0, '2012-01-10', NULL, NULL, 0, 0, NULL, NULL),
('870574059', 'W12011624', 'W12011624', 'UT01', 'Mountain Land Layton', 'Tiffany', 'R', 'Vendela', 'PT', 'Physical Therapy', '', '', NULL, 'B', 'PO Box 711185', 'Salt Lake City', 'Salt Lake', 'UT', '84171', '8015479462', '8045479116', 'PO Box 711185', 'Salt Lake City', 'Salt Lake', 'UT', '84171', '8015479462', '8045479116', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2012-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1932438249', 0, 'N', 0, '2012-01-10', NULL, NULL, 0, 0, NULL, NULL),
('200405981', 'W12011626', 'W12011626', 'UT01', 'Morgan Valley Physical Therapy', 'Willis', '', 'Clyde', 'PT', 'Physical Therapy', '', '', NULL, 'O', '103 N Commercial St', 'Morgan', 'Morgan', 'UT', '84050', '8018451403', '8018451404', '103 N Commercial St', 'Morgan', 'Morgan', 'UT', '84050', '8018451403', '8018451404', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '68.00', 3, '2011-03-30', '2011-03-31', 0, 0, 0, '', '', '', '', 'HCFA|', '1033293865', 0, 'N', 0, '2012-10-22', NULL, NULL, 0, 0, NULL, NULL),
('200405981', 'W12011625', 'W12011625', 'UT01', 'Morgan Valley Physical Therapy', 'Willis', '', 'Clyde', 'PT', 'Physical Therapy', '', '', NULL, 'O', '103 N Commercial St', 'Morgan', 'Morgan', 'UT', '84050', '8018451403', '8018451404', '103 N Commercial St', 'Morgan', 'Morgan', 'UT', '84050', '8018451403', '8018451404', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '70.50', 3, '2011-04-01', '2012-03-31', 0, 0, 0, '', '', '', '', 'HCFA|', '1033293865', 0, 'N', 0, '2012-10-22', NULL, NULL, 0, 0, NULL, NULL),
('200405981', 'W12011627', 'W12011627', 'UT01', 'Morgan Valley Physical Therapy', 'Willis', '', 'Clyde', 'PT', 'Physical Therapy', '', '', NULL, 'O', '103 N Commercial St', 'Morgan', 'Morgan', 'UT', '84050', '8018451403', '8018451404', '103 N Commercial St', 'Morgan', 'Morgan', 'UT', '84050', '8018451403', '8018451404', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2012-04-01', '2012-10-18', 0, 0, 0, '', '', '', '', 'HCFA|', '1033293865', 0, 'N', 0, '2012-10-22', NULL, NULL, 0, 0, NULL, NULL),
('200405981', 'W12011628', 'W12011628', 'UT01', 'Morgan Valley Physical Therapy', 'Willis', '', 'Clyde', 'PT', 'Physical Therapy', '', '', NULL, 'B', 'PO Box 13', 'Heber City', 'Wasatch', 'UT', '84032', '8018451403', '8018451404', 'PO Box 13', 'Heber City', 'Wasatch', 'UT', '84032', '8018451403', '8018451404', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '70.50', 3, '2011-04-01', '2012-03-31', 0, 0, 0, '', '', '', '', 'HCFA|', '1033293865', 0, 'N', 0, '2012-10-22', NULL, NULL, 0, 0, NULL, NULL),
('200405981', 'W12011629', 'W12011629', 'UT01', 'Morgan Valley Physical Therapy', 'Willis', '', 'Clyde', 'PT', 'Physical Therapy', '', '', NULL, 'B', 'PO Box 13', 'Heber City', 'Wasatch', 'UT', '84032', '8018451403', '8018451404', 'PO Box 13', 'Heber City', 'Wasatch', 'UT', '84032', '8018451403', '8018451404', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2012-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1033293865', 0, 'N', 0, '2012-10-22', NULL, NULL, 0, 0, NULL, NULL),
('273381465', 'W12011630', 'W12011630', 'ID01', 'Action Health Studio', 'William', 'Parker', 'Lamm', 'DC', 'Chiropractic', '', '', NULL, 'O', '1542 S Timesquare Ln', 'Boise', 'Ada', 'ID', '83709', '2083760660', '2083760350', '1542 S Timesquare Ln', 'Boise', 'Ada', 'ID', '83709', '2083760660', '2083760350', 'IDCHIRO1', '', '', '0.00', '35.00', '0.00', 3, '2011-07-01', '2014-07-15', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1144539966', 0, 'N', 0, '2014-07-24', NULL, NULL, 43.5908, -116.301, NULL, NULL),
('836000295', 'W12011633', 'W12011633', 'WY01', 'Sweetwater Medical Group', 'Brianne', '', 'Crofts', 'MD', 'General Surgery', '', '', NULL, 'O', '1204 Hilltop Dr Ste 109', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073528192', '3073528593', '1204 Hilltop Dr Ste 109', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073528192', '3073528593', '', '', '', '0.00', '5.00', '0.00', 3, '2011-07-01', '2014-02-09', 0, 0, 0, 'Memorial Hospital of Sweetwater County', NULL, NULL, NULL, 'HCFA|UB|', '1457475451', 0, 'N', 0, '2014-03-04', NULL, NULL, 41.584, -109.232, NULL, NULL),
('870373083', 'W12011635', 'W12011635', 'UT01', 'Heart and Lung Institute', 'Amanda', '', 'Donohue', 'DO', 'Cardiovascular Disease', '', '', NULL, 'O', '3570 W 9000 S Ste 110', 'West Jordan', 'Salt Lake', 'UT', '84088', '8012632370', '8012651200', '3570 W 9000 S Ste 110', 'West Jordan', 'Salt Lake', 'UT', '84088', '8012632370', '8012651200', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-11-10', '2014-04-30', 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1750587143', 0, 'N', 0, '2011-12-20', NULL, NULL, 40.588, -111.975, NULL, NULL),
('870373083', 'W12011634', 'W12011634', 'UT01', 'Heart and Lung Institute', 'Amanda', '', 'Donohue', 'DO', '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', '', '0.00', '35.00', '0.00', 3, '2011-11-10', '2014-04-30', 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1750587143', 0, 'N', 0, '2011-12-20', NULL, NULL, 40.6415, -111.883, NULL, NULL),
('870373083', 'W12011636', 'W12011636', 'UT01', 'Heart and Lung Institute', 'Amanda', '', 'Donohue', 'DO', 'Cardiovascular Disease', '', '', NULL, 'B', 'PO Box 847112', 'Dallas', 'Dallas', 'TX', '75284', '8012632370', '8012651200', 'PO Box 847112', 'Dallas', 'Dallas', 'TX', '75284', '8012632370', '8012651200', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-12-01', '2014-04-30', 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1750587143', 0, 'N', 0, '2011-12-20', NULL, NULL, 0, 0, NULL, NULL),
('830207671', 'W12011637', 'W12011637', 'WY01', 'West Park Hospital District ', 'Lisa', 'E', 'Harvey', 'MD', 'Family Practice', '', '', NULL, 'O', '424 Yellowstone Ave Ste 120', 'Cody', 'Park', 'WY', '82414', '3075787207', '3075782937', '424 Yellowstone Ave Ste 120', 'Cody', 'Park', 'WY', '82414', '3075787207', '3075782937', '', '', '', '0.00', '12.00', '0.00', 3, '2011-07-01', NULL, 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1477527299', 0, 'N', 0, '2014-04-10', NULL, NULL, 44.517, -109.083, NULL, NULL),
('830207671', 'W12011638', 'W12011638', 'WY01', 'West Park Hospital Disctrict ', 'Lisa', 'E', 'Harvey', 'MD', 'Family Practice', '', '', NULL, 'B', '707 Sheridan Ave', 'Cody', 'Park', 'WY', '82414', '3075787207', '3075782937', '707 Sheridan Ave', 'Cody', 'Park', 'WY', '82414', '3075787207', '3075782937', '', '', '', '0.00', '12.00', '0.00', 3, '2011-07-01', NULL, 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1477527299', 0, 'N', 0, '2014-04-10', NULL, NULL, 0, 0, NULL, NULL),
('830182821', 'W12011736', 'W12011736', 'WY01', 'Gottsche Rehabilitation Center', 'William', '', 'Lemke', 'PT', 'Physical Therapy', '', '', NULL, 'B', 'PO Box 790', 'Thermopolis', 'Hot Springs', 'WY', '82443', '3078642146', '3078642857', 'PO Box 790', 'Thermopolis', 'Hot Springs', 'WY', '82443', '3078642146', '3078642857', '', '', '', '0.00', '10.00', '0.00', 3, '2011-11-10', '2012-12-15', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1912145376', 0, 'N', 0, '2014-05-01', NULL, NULL, 0, 0, NULL, NULL),
('412057748', 'W12011640', 'W12011640', 'UT01', 'Utah Pain and Rehab', 'Ryan', 'G', 'Michaud', 'MD', 'Pain Management', 'Anesthesia', '', NULL, 'O', '1276 S Wall Ave', 'Ogden', 'Weber', 'UT', '84404', '8013374000', '8013374002', '1276 S Wall Ave', 'Ogden', 'Weber', 'UT', '84404', '8013374000', '8013374002', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-08-01', '2014-01-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1801935895', 0, 'N', 0, '2014-06-19', NULL, NULL, 41.2433, -111.978, NULL, NULL),
('273299726', 'W12011643', 'W12011643', 'UT01', 'OBHG Utah', '', '', 'OBHG Utah', '', 'Obstetrics and Gynecology', '', '', NULL, 'M', '10 Centimeter Dr', 'Mauldin', 'Greenville', 'SC', '29662', '8009672289', '8646279920', '10 Centimeter Dr', 'Mauldin', 'Greenville', 'SC', '29662', '8009672289', '8646279920', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1457667727', 0, 'Y', 0, '2011-06-01', NULL, NULL, 0, 0, NULL, NULL),
('273299726', 'W12011642', 'W12011642', 'UT01', 'OBHG Utah', '', '', 'OBHG Utah', '', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1200 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8009672289', '8646279920', '1200 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8009672289', '8646279920', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1457667727', 0, 'Y', 0, '2011-06-01', NULL, NULL, 40.6871, -111.856, NULL, NULL),
('273299726', 'W12011644', 'W12011644', 'UT01', 'OBHG Utah', '', '', 'OBHG Utah', '', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 6803', 'Greenville', 'Greenville', 'SC', '29606', '8009672289', '8646279920', 'PO Box 6803', 'Greenville', 'Greenville', 'SC', '29606', '8009672289', '8646279920', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1457667727', 0, 'N', 0, '2011-06-01', NULL, NULL, 0, 0, NULL, NULL),
('820511905', 'W12011645', 'W12011645', 'ID01', 'Treasure Valley Psychological Services', 'Rachel', 'A', 'Root', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '6003 Overland Rd Ste 301', 'Boise', 'Ada', 'ID', '83709', '2086728699', NULL, '6003 Overland Rd Ste 301', 'Boise', 'Ada', 'ID', '83709', '2086728699', '', 'IDMA', '', '', '0.00', '35.00', '0.00', 6, '2011-07-01', '2012-10-11', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1710279807', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('870662816', 'W12011646', 'W12011646', 'UT01', 'Vascular Care Center', 'Kenneth', 'B', 'Seifert', 'MD', 'Vascular Surgery', '', '', NULL, 'O', '1250 E 3900 S Ste 301', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8016852900', '8016850440', '1250 E 3900 S Ste 301', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8016852900', '8016850440', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-07-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1134220882', 0, 'N', 0, '2011-06-29', NULL, NULL, 40.6871, -111.856, NULL, NULL),
('870662816', 'W12011647', 'W12011647', 'UT01', 'Vascular Care Center', 'Kenneth', 'B', 'Seifert', 'MD', 'Vascular Surgery', '', '', NULL, 'O', '2200 N Park Ave Ste D', 'Park City', 'Summit', 'UT', '84060', '4356591571', '8016850440', '2200 N Park Ave Ste D', 'Park City', 'Summit', 'UT', '84060', '4356591571', '8016850440', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-07-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1134220882', 0, 'N', 0, '2011-06-29', NULL, NULL, 40.6643, -111.513, NULL, NULL),
('275385307', 'W12011649', 'W12011649', 'ID01', 'Idaho Gastro', 'Matthew', 'R', 'Sericati', 'MD', 'Gastroenterology', '', '', NULL, 'O', '2235 E Gala St', 'Meridian', 'Ada', 'ID', '83642', '2088873724', '2088871682', '2235 E Gala St', 'Meridian', 'Ada', 'ID', '83642', '2088873724', '2088871682', 'IDPPONONFAC', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2011-06-15', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1194871871', 0, 'N', 0, '2013-02-01', NULL, NULL, 0, 0, NULL, NULL),
('275385307', 'W12011648', 'W12011648', 'ID01', 'Idaho Gastro', 'Matthew', 'R', 'Sericati', 'MD', 'Gastroenterology', '', '', NULL, 'O', '425 W Bannock St', 'Boise', 'Ada', 'ID', '83702', '2083436458', '2083435031', '425 W Bannock St', 'Boise', 'Ada', 'ID', '83702', '2083436458', '2083435031', 'IDPPONONFAC', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2011-06-15', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1194871871', 0, 'N', 0, '2013-02-01', NULL, NULL, 0, 0, NULL, NULL),
('562326691', 'W12011654', 'W12011654', 'UT01', 'Jordan Valley Family Health', 'Dennis', 'R', 'Hamp', 'DO', 'Family Practice', '', '', NULL, 'O', '3895 W 7800 S Ste 100', 'West Jordan', 'Salt Lake', 'UT', '84088', '8012807774', '8017432790', '3895 W 7800 S Ste 100', 'West Jordan', 'Salt Lake', 'UT', '84088', '8012807774', '8017432790', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-06-15', NULL, 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1568405397', 0, 'N', 0, '2011-09-28', NULL, NULL, 40.6094, -111.985, NULL, NULL),
('562326691', 'W12011663', 'W12011663', 'UT01', 'Jordan Landing Clinic', 'Brenten', 'C', 'Pugh', 'MD', 'Family Practice', '', '', NULL, 'O', '3895 W 7800 S Ste 100', 'West Jordan', 'Salt Lake', 'UT', '84088', '8012807774', '8017432790', '3895 W 7800 S Ste 100', 'West Jordan', 'Salt Lake', 'UT', '84088', '8012807774', '8017432790', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-06-15', NULL, 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1235158304', 0, 'N', 0, '2011-05-31', NULL, NULL, 40.6094, -111.985, NULL, NULL),
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('870281028', 'W12009856', 'W12009856', 'UT01', 'Central Utah Clinic PC', 'Walter', 'M', 'Snihurowych', 'MD', 'Urology', '', '', NULL, 'B', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', '8014298180', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', '8014298180', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-06-01', NULL, 0, 0, 0, 'Castleview Hospital', 'Castleview Hospital', 'Uintah Basin Medical Center', NULL, 'HCFA|UB|', '1669428736', 0, 'N', 0, '2014-01-20', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W12010727', 'W12010727', 'UT01', 'Central Utah Clinic PC', 'J.', 'K', 'McEwan', 'PT', 'Physical Therapy', '', '', NULL, 'O', '1055 N 500 W Ste 122 Bldg C', 'Provo', 'Utah', 'UT', '84604', '8014290610', '8014290629', '1055 N 500 W Ste 122 Bldg C', 'Provo', 'Utah', 'UT', '84604', '8014290610', '8014290629', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1750301081', 0, 'N', 0, '2014-07-17', NULL, NULL, 40.248, -111.667, NULL, NULL),
('870281028', 'W12010728', 'W12010728', 'UT01', 'Central Utah Clinic PC', 'J.', 'K', 'McEwan', 'PT', 'Physical Therapy', '', '', NULL, 'B', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8014290610', '8014290629', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8014290610', '8014290629', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2011-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1750301081', 0, 'N', 0, '2014-07-17', NULL, NULL, 0, 0, NULL, NULL),
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('942854057', 'W12011695', 'W12011695', 'UTPEHP', 'Maternal Fetal Medicine', 'Calla', 'M', 'Holmgren', 'MD', 'Maternal Fetal Medicine', '', '', NULL, 'O', '544 E 400 E', 'St George', 'Washington', 'UT', '84770', '4352511000', NULL, '544 E 400 E', 'St George', 'Washington', 'UT', '84770', '4352511000', '          ', 'IHCPEHP', '', '', '0.00', '30.00', '0.00', 8, '2010-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1194805002', 0, 'N', 0, '2011-06-23', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12011696', 'W12011696', 'UTPEHP', '', 'Shauna', 'M', 'Desai', 'MD', 'Mental Health', 'Psychiatry', '', NULL, 'O', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621000', NULL, '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621000', '          ', 'IHCPEHP', '', '', '0.00', '30.00', '0.00', 8, '2011-01-01', NULL, 0, 0, 0, 'Primary Childrens Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1063536381', 0, 'N', 0, '2013-08-28', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12011697', 'W12011697', 'UTPEHP', '', 'Shauna', 'M', 'Desai', 'MD', 'Mental Health', 'Psychiatry', '', NULL, 'O', '5770 S 1500 W', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8013137770', NULL, '5770 S 1500 W', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8013137770', '          ', 'IHCPEHP', '', '', '0.00', '30.00', '0.00', 8, '2010-09-01', NULL, 0, 0, 0, 'Primary Childrens Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1063536381', 0, 'N', 0, '2013-08-28', NULL, NULL, 0, 0, NULL, NULL),
('800522450', 'W12011664', 'W12011664', 'UT01', 'Omega Interventional Pain', 'Steven ', 'C', 'Pulley', 'MD', 'Pain Management', '', '', NULL, 'O', '3838 S 700 E Ste 300', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8012614988', '8012699425', '3838 S 700 E Ste 300', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8012614988', '8012699425', 'WUSTDPAIN5', '', '', '45.00', '35.00', '0.00', 6, '2011-01-01', NULL, 1, 12, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1104037878', 0, 'N', 0, '2013-05-16', NULL, NULL, 40.6874, -111.871, NULL, NULL),
('800522450', 'W12011665', 'W12011665', 'UT01', 'Omega Interventional Pain', 'Steven ', 'C', 'Pulley', 'MD', 'Pain Management', '', '', NULL, 'B', 'PO Box 27688', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '8012614988', '8012699425', 'PO Box 27688', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '8012614988', '8012699425', 'WUSTDPAIN5', '', '', '45.00', '35.00', '0.00', 6, '2011-01-01', NULL, 1, 12, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1104037878', 0, 'N', 0, '2013-05-16', NULL, NULL, 0, 0, NULL, NULL),
('800522450', 'W12011666', 'W12011666', 'UT01', 'Omega Interventional Pain', 'Steven ', 'C', 'Pulley', 'MD', 'Pain Management', '', '', NULL, 'M', 'PO Box 57068', 'Salt Lake City', 'Salt Lake', 'UT', '84157', '8012614988', '8012699425', 'PO Box 57068', 'Salt Lake City', 'Salt Lake', 'UT', '84157', '8012614988', '8012699425', 'WUSTDPAIN5', '', '', '45.00', '35.00', '0.00', 6, '2011-01-01', NULL, 1, 12, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1104037878', 0, 'N', 0, '2013-05-16', NULL, NULL, 0, 0, NULL, NULL),
('800522450', 'W12011657', 'W12011657', 'UT01', 'Omega Interventional Pain', 'Troy', '', 'Hunter', 'APRN', 'Pain Management', NULL, NULL, NULL, 'B', 'PO Box 27688', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '8012614988', '8012699425', 'PO Box 27688', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '8012614988', '8012699425', 'WUSTDPAIN5', '', '', '45.00', '35.00', '0.00', 6, '2011-01-01', NULL, 1, 12, 0, '', '', '', '', 'HCFA|UB|', '1164416848', 0, 'N', 0, '2012-07-17', NULL, NULL, 0, 0, NULL, NULL),
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('800522450', 'W12011668', 'W12011668', 'UT01', 'Omega Interventional Pain', 'N', 'L', 'Smith', 'MD', 'Pain Management', '', '', NULL, 'O', '3838 S 700 E Ste 300', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8012614988', '8012699425', '3838 S 700 E Ste 300', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8012614988', '8012699425', 'WUSTDPAIN5', '', '', '45.00', '35.00', '0.00', 6, '2011-01-01', NULL, 1, 12, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1124067236', 0, 'N', 0, '2013-05-20', NULL, NULL, 40.6874, -111.871, NULL, NULL),
('800522450', 'W12011669', 'W12011669', 'UT01', 'Omega Interventional Pain', 'N', 'L', 'Smith', 'MD', 'Pain Management', '', '', NULL, 'B', 'PO Box 27688', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '8012614988', '8012699425', 'PO Box 27688', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '8012614988', '8012699425', 'WUSTDPAIN5', '', '', '45.00', '35.00', '0.00', 6, '2011-01-01', NULL, 1, 12, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1124067236', 0, 'N', 0, '2013-05-20', NULL, NULL, 0, 0, NULL, NULL),
('800522450', 'W12011670', 'W12011670', 'UT01', 'Omega Interventional Pain', 'N', 'L', 'Smith', 'MD', 'Pain Management', '', '', NULL, 'M', 'PO Box 57068', 'Salt Lake City', 'Salt Lake', 'UT', '84157', '8012614988', '8012699425', 'PO Box 57068', 'Salt Lake City', 'Salt Lake', 'UT', '84157', '8012614988', '8012699425', 'WUSTDPAIN5', '', '', '45.00', '35.00', '0.00', 6, '2011-01-01', NULL, 1, 12, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1124067236', 0, 'N', 0, '2013-05-20', NULL, NULL, 0, 0, NULL, NULL),
('800522450', 'W12011656', 'W12011656', 'UT01', 'Omega Interventional Pain', 'Troy', '', 'Hunter', 'APRN', 'Pain Management', NULL, NULL, NULL, 'M', 'PO Box 57068', 'Salt Lake City', 'Salt Lake', 'UT', '84157', '8012614988', '8012699425', 'PO Box 57068', 'Salt Lake City', 'Salt Lake', 'UT', '84157', '8012614988', '8012699425', 'WUSTDPAIN5', '', '', '45.00', '35.00', '0.00', 6, '2011-01-01', NULL, 1, 12, 0, '', '', '', '', 'HCFA|UB|', '1164416848', 0, 'N', 0, '2012-07-17', NULL, NULL, 0, 0, NULL, NULL),
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('273299726', 'W12011651', 'W12011651', 'UT01', 'OB Hospitalist Group', 'Alisa', '', 'Carlton', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 6803', 'Greenville', 'Greenville', 'SC', '29606', '8009672289', '8646279920', 'PO Box 6803', 'Greenville', 'Greenville', 'SC', '29606', '8009672289', '8646279920', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1497766083', 0, 'N', 0, '2012-07-05', NULL, NULL, 0, 0, NULL, NULL),
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('743003947', 'W12011705', 'W12011705', 'TX01', 'The San Antonio Orthopaedic Group', 'Richard', 'E', 'Duey', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '400 Concord Plaza Dr Ste 300', 'San Antonio', 'Bexar', 'TX', '78212', '2104897220', '2104026257', '400 Concord Plaza Dr Ste 300', 'San Antonio', 'Bexar', 'TX', '78212', '2104897220', '2104026257', 'TXORTHO', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2011-10-01', '2012-08-19', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1235355587', 0, 'N', 0, '2013-05-23', NULL, NULL, 0, 0, NULL, NULL),
('743003947', 'W12011706', 'W12011706', 'TX01', 'The San Antonio Orthopaedic Group', 'Richard', 'E', 'Duey', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', 'PO Box 9585', 'Belfast', 'Waldo', 'ME', '04915', '2104897220', '2104026257', 'PO Box 9585', 'Belfast', 'Waldo', 'ME', '04915', '2104897220', '2104026257', 'TXORTHO', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2011-10-01', '2012-08-19', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1235355587', 0, 'N', 0, '2013-05-23', NULL, NULL, 0, 0, NULL, NULL),
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('942854057', 'W12011712', 'W12011712', 'UTIHC02', 'Neurology', 'Helen', '', 'Barkan', 'MD', 'Neurology', '', '', NULL, 'O', '100 Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8015877575', NULL, '100 Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8015877575', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2011-05-27', NULL, 0, 0, 0, 'Primary Childrens Medical Center', 'University Health Care University Hospital', NULL, NULL, 'HCFA|UB|', '1093898918', 0, 'N', 0, '2012-07-17', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12011713', 'W12011713', 'UTIHC03', 'Neurology', 'Helen', '', 'Barkan', 'MD', 'Neurology', '', '', NULL, 'O', '100 Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8015877575', NULL, '100 Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8015877575', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2011-05-27', NULL, 0, 0, 0, 'Primary Childrens Medical Center', 'University Health Care University Hospital', NULL, NULL, 'HCFA|UB|', '1093898918', 0, 'N', 0, '2012-07-17', NULL, NULL, 0, 0, NULL, NULL),
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('710926549', 'W12011716', 'W12011716', 'UT01', 'Pediatric PM & R', '', '', 'Pediatric PM & R', 'Group', 'Clinic', 'Pediatrics', '', NULL, 'B', 'PO Box 413032', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', NULL, 'PO Box 413032', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2011-06-01', '2012-07-26', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1760776223', 0, 'N', 0, '2012-07-27', NULL, NULL, 0, 0, NULL, NULL),
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('870373083', 'W12011719', 'W12011719', 'UT01', 'Heart and Lung Institute', 'Amanda', '', 'Donohue', 'DO', 'Cardiovascular Disease', '', '', NULL, 'O', '3336 S 4155 W  Ste 203', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8012632370', '8012651200', '3336 S 4155 W  Ste 203', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8012632370', '8012651200', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-11-10', '2014-04-30', 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1750587143', 0, 'N', 0, '2011-12-20', NULL, NULL, 40.6991, -111.99, NULL, NULL),
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('450823297', 'W12011721', 'W12011721', 'UTMH1', 'Synergism Counseling', 'Michelle', '', 'Greene', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', '3318 Canyon Meadow Dr', 'South Jordan', 'Salt Lake', 'UT', '84095', '8013501671', '8014466511', '3318 Canyon Meadow Dr', 'South Jordan', 'Salt Lake', 'UT', '84095', '8013501671', '8014466511', 'UTMA', '', '', '0.00', '35.00', '0.00', 3, '2011-08-01', '2011-08-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1508971276', 0, 'N', 0, '2014-06-11', NULL, NULL, 0, 0, NULL, NULL),
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('870308023', 'W12011723', 'W12011723', 'UT01', 'Middleton Urological Assoc', 'Justin', 'P', 'Parkinson', 'MD', 'Urology', '', '', NULL, 'O', '181 E 5600 S Ste 130', 'Murray', 'Salt Lake', 'UT', '84107', '8012668664', '8012649031', '181 E 5600 S Ste 130', 'Murray', 'Salt Lake', 'UT', '84107', '8012668664', '8012649031', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-08-01', '2011-10-17', 0, 0, 0, 'Jordan Valley Medical Center', 'Salt Lake Regional Medical Center', 'Pioneer Valley Hospital', '', 'HCFA|UB|', '1851314066', 0, 'N', 0, '2014-06-17', NULL, NULL, 0, 0, NULL, NULL),
('721528517', 'W12011724', 'W12011724', 'ID02', 'Pioneer Family Medicine', 'Julie', '', 'Franden', 'NP', 'Family Practice', '', '', NULL, 'O', '13150 W Persimmon Ln', 'Boise', 'Ada', 'ID', '83713', '2089383663', NULL, '13150 W Persimmon Ln', 'Boise', 'Ada', 'ID', '83713', '2089383663', '          ', 'IDPPO', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-08-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1457652661', 0, 'N', 0, '2011-07-19', NULL, NULL, 0, 0, NULL, NULL),
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('870635889', 'W12011726', 'W12011726', 'UT01', 'Tooele Clinic Corp', 'Fatima', 'G', 'Gangotena', 'MD', 'Internal Medicine', '', '', NULL, 'M', 'PO Box 689022', 'Franklin', 'Williamson', 'TN', '37068', '4358433647', '4358821275', 'PO Box 689022', 'Franklin', 'Williamson', 'TN', '37068', '4358433647', '4358821275', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-11-10', NULL, 0, 0, 0, 'Mountain West Medical Center', '', '', '', 'HCFA|UB|', '1467605147', 0, 'N', 0, '2014-04-17', NULL, NULL, 0, 0, NULL, NULL),
('870635889', 'W12011727', 'W12011727', 'UT01', 'Tooele Clinic Corp', 'Fatima', 'G', 'Gangotena', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 848416', 'Boston', 'Suffolk', 'MA', '02284', '6174021000', '6174021099', 'PO Box 848416', 'Boston', 'Suffolk', 'MA', '02284', '6174021000', '6174021099', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-11-10', NULL, 0, 0, 0, 'Mountain West Medical Center', '', '', '', 'HCFA|UB|', '1467605147', 0, 'N', 0, '2014-04-17', NULL, NULL, 0, 0, NULL, NULL),
('830216782', 'W12011728', 'W12011728', 'Sinclair', 'Laramie Physicians for Women', 'Joel', 'E', 'Higgins', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '2710 E Harney St Ste 100', 'Laramie', 'Albany', 'WY', '82072', '3077458991', '3077458167', '2710 E Harney St Ste 100', 'Laramie', 'Albany', 'WY', '82072', '3077458991', '3077458167', '', '', '', '0.00', '10.00', '0.00', 3, '2011-06-01', NULL, 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1336189414', 0, 'N', 0, '2012-07-10', NULL, NULL, 0, 0, NULL, NULL),
('770701557', 'W12003528', 'W12003528', 'UT01', 'St Marks Millcreek Primary Care LLC', 'Camille', '', 'Collett', 'MD', 'Family Practice', '', '', NULL, 'O', '4465 S 900 E Ste 200', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012662777', '8012661377', '4465 S 900 E Ste 200', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012662777', '8012661377', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-08-31', '2011-08-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1275530305', 0, 'N', 0, '2014-04-17', NULL, NULL, 0, 0, NULL, NULL),
('770701557', 'W12003527', 'W12003527', 'UT01', 'St Marks Millcreek Primary Care LLC', 'Camille', '', 'Collett', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 198560', 'Atlanta', 'Fulton', 'GA', '30384', '8006613365', '8015769800', 'PO Box 198560', 'Atlanta', 'Fulton', 'GA', '30384', '8006613365', '8015769800', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-08-31', '2011-08-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1275530305', 0, 'N', 0, '2014-04-17', NULL, NULL, 0, 0, NULL, NULL),
('841409176', 'W12011732', 'W12011732', 'UTMH1', 'Northeastern Counseling Center', 'Leon', 'H', 'Butler', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'B', '1140 W 500 S Ste 9', 'Vernal', 'Uintah', 'UT', '84078', '4357256300', NULL, '1140 W 500 S Ste 9', 'Vernal', 'Uintah', 'UT', '84078', '4357256300', '', 'UTPHD', '', '', '0.00', '35.00', '0.00', 6, '2011-08-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1245549773', 0, 'N', 0, '2014-04-24', NULL, NULL, 0, 0, NULL, NULL),
('841409176', 'W12011731', 'W12011731', 'UTMH1', 'Northeastern Counseling Center', 'Leon', 'H', 'Butler', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '285 W 800 S', 'Roosevelt', 'Duchesne', 'UT', '84066', '4357256300', NULL, '285 W 800 S', 'Roosevelt', 'Duchesne', 'UT', '84066', '4357256300', '', 'UTPHD', '', '', '0.00', '35.00', '0.00', 6, '2011-08-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1245549773', 0, 'N', 0, '2014-04-24', NULL, NULL, 0, 0, NULL, NULL),
('870577591', 'W12011734', 'W12011734', 'UTMH1', 'Psychological Assessment and Treatment Specialists', 'Lynn', 'A', 'Jarreau-Wihongi', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '814 E Bamberger Dr Ste B', 'American Fork', 'Utah', 'UT', '84003', '8017720202', NULL, '814 E Bamberger Dr Ste B', 'American Fork', 'Utah', 'UT', '84003', '8017720202', '', 'MA', '', '', '0.00', '35.00', '0.00', 3, '2011-08-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1144256686', 0, 'N', 0, '2014-05-16', NULL, NULL, 0, 0, NULL, NULL),
('841383395', 'W12011735', 'W12011735', 'UTMH1', '', 'Kathryn', 'M', 'Kair', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '6925 S Union Park Ctr Ste 490', 'Midvale', 'Salt Lake', 'UT', '84047', '8015662622', '8015660536', '6925 S Union Park Ctr Ste 490', 'Midvale', 'Salt Lake', 'UT', '84047', '8015662622', '8015660536', 'PHD', '', '', '0.00', '35.00', '0.00', 3, '2011-11-10', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1508960063', 0, 'N', 0, '2014-05-01', 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
('731714968', 'W12011737', 'W12011737', 'UT01', 'Rocky Mountain Anesthesiology', 'Christopher', 'B', 'Lloyd', 'CRNA', 'Anesthesia', '', '', NULL, 'B', 'PO Box 3750', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8017272080', '8014322668', 'PO Box 3750', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8017272080', '8014322668', '', '', '', '0.00', '19.00', '0.00', 3, '2011-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1851538615', 0, 'N', 0, '2011-06-29', NULL, NULL, 0, 0, NULL, NULL),
('870520042', 'W12011738', 'W12011738', 'UT01', 'Nephrology Associates', 'Rebecca', 'H', 'Moore', 'MD', 'Nephrology', '', '', NULL, 'O', '650 E 4500 S', 'Murray', 'Salt Lake', 'UT', '84107', '8012882634', '8012881186', '650 E 4500 S', 'Murray', 'Salt Lake', 'UT', '84107', '8012882634', '8012881186', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-08-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1477609089', 0, 'N', 0, '2014-04-16', NULL, NULL, 40.6743, -111.874, NULL, NULL),
('200791511', 'W12011740', 'W12011740', 'UT01', '', 'Stacie', 'R', 'Pearce', 'NP', 'Family Practice', '', '', NULL, 'M', 'PO Box 708757', 'Sandy', 'Salt Lake', 'UT', '84070', '8013131010', '8017472116', 'PO Box 708757', 'Sandy', 'Salt Lake', 'UT', '84070', '8013131010', '8017472116', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1912207226', 0, 'N', 0, '2011-07-19', NULL, NULL, 0, 0, NULL, NULL),
('202800071', 'W12011741', 'W12011741', 'UTMH1', 'Alpine Center for Personal Growth', 'Wendy', '', 'Seeley', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '5689 S Redwood Rd Ste 30', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8012681715', '8012681783', '5689 S Redwood Rd Ste 30', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8012681715', '8012681783', 'UTMA', '', '', '0.00', '35.00', '0.00', 6, '2011-08-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1205129772', 0, 'N', 0, '2014-06-02', NULL, NULL, 0, 0, NULL, NULL),
('870326862', 'W12011742', 'W12011742', 'UT01', 'Ogden Womens Clinic', 'Kristine', 'M', 'Zelenkov', '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, '2011-07-01', '2012-12-31', 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1326159427', 0, 'N', 0, '2014-04-10', NULL, NULL, 0, 0, NULL, NULL),
('870635889', 'W12011743', 'W12011743', 'UT01', 'Mountain West Orthopedic & Sports Medicine', 'Christopher', 'G', 'Belton', 'DO', 'Orthopedic Surgery', '', '', NULL, 'O', '1929 N Aaron Dr Ste L', 'Tooele', 'Tooele', 'UT', '84074', '4358433859', '4352280130', '1929 N Aaron Dr Ste L', 'Tooele', 'Tooele', 'UT', '84074', '4358433859', '4352280130', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-01-01', '2012-10-31', 0, 0, 0, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1710920590', 0, 'N', 0, '2013-11-14', NULL, NULL, 0, 0, NULL, NULL),
('204011364', 'WY0200115', 'WY0200115', 'WYT1', 'Independent Family Practice', 'Donald', 'J', 'Kirk', 'MD', 'Family Practice', '', '', NULL, 'O', '110 Hospital Ln Bldg 2 Ste 1', 'Afton', 'Lincoln', 'WY', '83110', '3078854437', '', '110 Hospital Ln Bldg 2 Ste 1', 'Afton', 'Lincoln', 'WY', '83110', '3078854437', '', 'wystd', 'wyhcpcs', '', '0.00', '35.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 0, 'Star Valley Medical Center', '', '', '', 'HCFA|UB|', '1861447971', 0, 'N', 0, '2014-07-25', NULL, NULL, 0, 0, NULL, NULL),
('204011364', 'WY0200116', 'WY0200116', 'WYT1', 'Independent Family Practice', 'Donald', 'J', 'Kirk', 'MD', 'Family Practice', '', '', NULL, 'O', '122 Peterson Pkwy', 'Thayne', 'Lincoln', 'WY', '83127', '3078834437', '', '122 Peterson Pkwy', 'Thayne', 'Lincoln', 'WY', '83127', '3078834437', '', 'wystd', 'wyhcpcs', '', '0.00', '35.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 0, 'Star Valley Medical Center', '', '', '', 'HCFA|UB|', '1861447971', 0, 'N', 0, '2014-07-25', NULL, NULL, 0, 0, NULL, NULL),
('830327251', 'WY0200117', 'WY0200117', 'WYT1', 'Star Valley Medical Center', 'Donald', 'J', 'Kirk', 'MD', 'Family Practice', '', '', NULL, 'O', '901 Adams St', 'Afton', 'Lincoln', 'WY', '83110', '3078855817', '', '901 Adams St', 'Afton', 'Lincoln', 'WY', '83110', '3078855817', '', 'WSTARV', 'wyhcpcs', '', '0.00', '10.00', '0.00', 6, '2010-09-08', NULL, 0, 0, 0, 'Star Valley Medical Center', '', '', '', 'HCFA|UB|', '1861447971', 0, 'N', 0, '2014-07-25', NULL, NULL, 0, 0, NULL, NULL),
('830182821', 'WYT200695', 'WYT200695', 'WYT2', 'Gottsche Rehabilitation Center', 'Susan', '', 'Abbott', 'PT', 'Physical Therapy', '', '', NULL, 'O', '148 E Arapahoe', 'Thermopolis', 'Hot Springs', 'WY', '82443', '3078642146', '3078642857', '148 E Arapahoe', 'Thermopolis', 'Hot Springs', 'WY', '82443', '3078642146', '3078642857', '', '', '', '0.00', '10.00', '0.00', 3, '2011-01-01', '2014-06-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1629274303', 0, 'N', 0, '2014-07-22', NULL, NULL, 0, 0, NULL, NULL),
('830182821', 'WYT200696', 'WYT200696', 'WYT2', 'Gottsche Rehabilitation Center', 'Susan', '', 'Abbott', 'PT', 'Physical Therapy', '', '', NULL, 'B', 'PO Box 790', 'Thermopolis', 'Hot Springs', 'WY', '82443', '3078642146', '3078642857', 'PO Box 790', 'Thermopolis', 'Hot Springs', 'WY', '82443', '3078642146', '3078642857', '', '', '', '0.00', '10.00', '0.00', 3, '2011-01-01', '2014-06-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1629274303', 0, 'N', 0, '2014-07-22', NULL, NULL, 0, 0, NULL, NULL),
('830234097', 'WYT200259', 'WYT200259', 'WYT2', 'Campbell County Memorial Hospital', 'Charles', '', 'Barnett', 'MD', 'Hospitalist', '', '', NULL, 'O', '501 S Burma Ave', 'Gillette', 'Campbell', 'WY', '82717', '3076881000', NULL, '501 S Burma Ave', 'Gillette', 'Campbell', 'WY', '82717', '3076881000', '          ', '', '', '5001', '0.00', '0.00', '0.00', 3, '2008-09-15', '2008-09-15', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000005199', 0, 'Y', 0, '2013-09-17', NULL, NULL, 0, 0, NULL, NULL),
('830234097', 'WYT200805', 'WYT200805', 'WYT2', 'Campbell County Memorial Hospital', 'Monica', '', 'Morman', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '501 S Burma Ave', 'Gillette', 'Campbell', 'WY', '82716', '3076881000', NULL, '501 S Burma Ave', 'Gillette', 'Campbell', 'WY', '82716', '3076881000', '          ', '', '', '5001', '0.00', '0.00', '0.00', 3, '2009-11-15', '2009-11-15', 0, 0, 0, 'Campbell County Memorial Hospital', '', '', '', 'HCFA|UB|', '1962497958', 0, 'N', 0, '2013-09-17', NULL, NULL, 0, 0, NULL, NULL),
('836000025', 'WY0200002', 'WY0200002', 'WYT1', 'Energy Basin Clinic', 'Duane', 'E', 'Abels', 'MD', 'Urgent Care', '', '', NULL, 'O', '1008 Feldspar Ct', 'Hanna', 'Carbon', 'WY', '82327', '3073256596', NULL, '1008 Feldspar Ct', 'Hanna', 'Carbon', 'WY', '82327', '3073256596', '          ', 'WISEWYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 6, '2009-12-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1700945789', 0, 'Y', 0, '2013-06-28', NULL, NULL, 0, 0, NULL, NULL),
('836000025', 'WY0200001', 'WY0200001', 'WYT1', '', 'Duane', 'E', 'Abels', 'MD', 'Urgent Care', '', '', NULL, 'O', '2221 W Elm St', 'Rawlins', 'Carbon', 'WY', '82301', '3073248225', NULL, '2221 W Elm St', 'Rawlins', 'Carbon', 'WY', '82301', '3073248225', '          ', 'WISEWYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 6, '2009-12-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1700945789', 0, 'Y', 0, '2013-06-28', NULL, NULL, 0, 0, NULL, NULL),
('810587644', 'WY0200004', 'WY0200004', 'WYT1', '', 'Michael', 'D', 'Adams', 'MD', 'Family Practice', '', '', NULL, 'O', '75 Yellow Creek Rd', 'Evanston', 'Uinta', 'WY', '82930', '3077898290', NULL, '75 Yellow Creek Rd', 'Evanston', 'Uinta', 'WY', '82930', '3077898290', '          ', 'wystd', 'wyhcpcs', '', '0.00', '35.00', '0.00', 3, '2011-02-24', NULL, 0, 0, 0, 'Evanston Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1922005347', 0, 'N', 0, '2013-03-07', NULL, NULL, 0, 0, NULL, NULL),
('830291722', 'WY0200003', 'WY0200003', 'WYT1', '', 'Michael', 'D', 'Adams', 'MD', 'Family Practice', '', '', NULL, 'O', '75 Yellow Creek Rd Ste 102', 'Evanston', 'Uinta', 'WY', '82930', '3077898290', NULL, '75 Yellow Creek Rd Ste 102', 'Evanston', 'Uinta', 'WY', '82930', '3077898290', '          ', 'wystd', 'wyhcpcs', '', '0.00', '35.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 0, 'Evanston Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1922005347', 0, 'N', 0, '2013-03-07', NULL, NULL, 0, 0, NULL, NULL),
('770636659', 'W41008391', 'W41008391', 'ID01', '', 'Diane', '', 'Barnhill', 'PSYD MED', 'Mental Health', 'Counseling', '', NULL, 'O', '2309 N Mountain View Dr Ste 185', 'Boise', 'Ada', 'ID', '83706', '2086028867', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'IDPHD', '', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1770596249', 0, 'N', 0, '2013-03-01', NULL, NULL, 43.6258, -116.249, NULL, NULL),
('870625250', 'W41005671', 'W41005671', 'UTMH1', 'Sundance Behavioral Resources ', 'Trudy', '', 'Bach-Whitehead', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '845 E 4800 S Ste 200', 'Murray', 'Salt Lake', 'UT', '84107', '8012649522', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'MA', NULL, NULL, '0.00', '40.00', '0.00', 6, '2013-02-15', NULL, 0, 0, NULL, '', '', '', '', 'HCFA|UB|', '1265529267', 0, 'N', 0, '2013-03-01', NULL, NULL, 40.6651, -111.867, NULL, NULL),
('330239910', 'WY0200007', 'WY0200007', 'WYT1', 'Alliance Healthcare Services', '', '', 'Alliance Healthcare Services ', 'GROUP', 'Imaging Center', '', '', NULL, 'O', '1401 W 5th St', 'Sheridan', 'Sheridan', 'WY', '82801', '8005300912', NULL, '1401 W 5th St', 'Sheridan', 'Sheridan', 'WY', '82801', '8005300912', '          ', 'WYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2008-11-01', '2012-02-29', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1134303845', 0, 'N', 0, '2013-06-18', NULL, NULL, 0, 0, NULL, NULL),
('330239910', 'WY0200008', 'WY0200008', 'WYT1', 'Alliance Healthcare Services', '', '', 'Alliance Healthcare Services ', 'GROUP', 'Imaging Center', '', '', NULL, 'O', '625 E Broadway St', 'Jackson', 'Teton', 'WY', '83001', '8005300912', NULL, '625 E Broadway St', 'Jackson', 'Teton', 'WY', '83001', '8005300912', '          ', 'WYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2008-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1134303845', 0, 'N', 0, '2013-06-18', NULL, NULL, 0, 0, NULL, NULL),
('830317012', 'WY0200217', 'WY0200217', 'WYT1', 'Fremont Therapy Group ', 'Kim', '', 'Asbell', 'PT', 'Physical Therapy', '', '', NULL, 'O', '2002 W Sunset Dr Ste 1', 'Riverton', 'Fremont', 'WY', '82501', '3078567021', NULL, '2002 W Sunset Dr Ste 1', 'Riverton', 'Fremont', 'WY', '82501', '3078567021', '', 'WYFREEM', 'wyhcpcs', '', '0.00', '35.00', '0.00', 3, '2007-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1043232952', 0, 'n', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('830317012', 'WY0200218', 'WY0200218', 'WYT1', 'Fremont Therapy Group ', 'Kim', '', 'Asbell', 'PT', 'Physical Therapy', '', '', NULL, 'O', '8168 Hwy 789', 'Lander', 'Fremont', 'WY', '82520', '3073325240', NULL, '8168 Hwy 789', 'Lander', 'Fremont', 'WY', '82520', '3073325240', '', 'WYFREEM', 'wyhcpcs', '', '0.00', '35.00', '0.00', 3, '2007-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1043232952', 0, 'n', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('830267172', 'WY0200010', 'WY0200010', 'WYT1', 'South Lincoln Medical Clinic', 'Fred', 'A', 'Baldwin', 'PA', 'Family Practice', 'Emergency Medicine', '', NULL, 'O', '711 Onyx St', 'Kemmerer', 'Lincoln', 'WY', '83101', '3078774401', NULL, '711 Onyx St', 'Kemmerer', 'Lincoln', 'WY', '83101', '3078774401', '', 'wystd', 'wyhcpcs', NULL, '0.00', '35.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 0, 'Evanston Regional Hospital', 'South Lincoln Medical Center', NULL, NULL, 'HCFA|UB|', '1033290978', 0, 'N', 0, '2011-06-15', NULL, NULL, 0, 0, NULL, NULL),
('830330554', 'WY0200012', 'WY0200012', 'WYT1', 'Mountain View Medical Clinic', 'Amanda', 'M', 'Barnes', 'PA', 'General Surgery', '', '', NULL, 'O', '831 Parkway Dr', 'Mountain View', 'Uinta', 'WY', '82939', '3077891390', '          ', '831 Parkway Dr', 'Mountain View', 'Uinta', 'WY', '82939', '3077891390', '          ', 'WYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2009-08-01', '2014-04-23', 0, 0, 0, 'Evanston Regional Hospital', '', '', '', 'HCFA|UB|', '1841435385', 0, 'N', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('900347306', 'WY0200011', 'WY0200011', 'WYT1', 'Evanston Surgical Center', 'Amanda', 'M', 'Barnes', 'PA', 'General Surgery', '', '', NULL, 'O', '196 Arrowhead Dr Ste 8', 'Evanston', 'Uinta', 'WY', '82930', '3077891390', '          ', '196 Arrowhead Dr Ste 8', 'Evanston', 'Uinta', 'WY', '82930', '3077891390', '          ', 'WYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2009-08-01', NULL, 0, 0, 0, 'Evanston Regional Hospital', '', '', '', 'HCFA|UB|', '1841435385', 0, 'N', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('830199236', 'WY0200013', 'WY0200013', 'WYT1', 'Yellowstone Behavioral Health Center', 'Laci', 'L', 'Morgan', 'PSYD', 'Mental Health', 'Psychology', '', NULL, 'O', '2538 Bighorn Ave', 'Cody', 'Park', 'WY', '82414', '3075872197', NULL, '2538 Bighorn Ave', 'Cody', 'Park', 'WY', '82414', '3075872197', '', 'PHD', NULL, NULL, '0.00', '35.00', '0.00', 6, '2009-03-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1720227648', 0, 'n', 0, '2012-05-14', NULL, NULL, 0, 0, NULL, NULL),
('270266601', 'WY0200014', 'WY0200014', 'WYT1', 'Platte Valley Medical Clinic PC', 'Dean', 'W', 'Bartholomew', 'MD', 'Family Practice', '', '', NULL, 'O', '1208 S River St', 'Saratoga', 'Carbon', 'WY', '82331', '3073268381', NULL, '1208 S River St', 'Saratoga', 'Carbon', 'WY', '82331', '3073268381', '', 'WISEWYSTD', 'wyhcpcs', NULL, '0.00', '35.00', '0.00', 3, '2009-07-01', NULL, 0, 0, 0, 'Memorial Hospital of Carbon County', NULL, NULL, NULL, 'HCFA|UB|', '1053306662', 0, 'n', 0, '2012-07-11', NULL, NULL, 0, 0, NULL, NULL),
('270624464', 'WY0200015', 'WY0200015', 'WYT1', 'Unitah General Surgery', 'Jared', 'B', 'Barton', 'MD', 'General Surgery', '', '', NULL, 'O', '196 Arrowhead Dr Ste 4', 'Evanston', 'Uinta', 'WY', '82930', '3077898721', '3077898664', '196 Arrowhead Dr Ste 4', 'Evanston', 'Uinta', 'WY', '82930', '3077898721', '3077898664', 'WISEWYSTD', 'WYSTD', '', '0.00', '35.00', '0.00', 3, '2010-06-02', '2012-08-19', 0, 0, 0, 'Evanston Regional Hospital', '', '', '', 'HCFA|UB|DEN|', '1144328949', 0, 'N', 0, '2014-06-04', NULL, NULL, 0, 0, NULL, NULL),
('830333437', 'WY0200016', 'WY0200016', 'WYT1', 'Teton Therapy', 'Grant', 'A', 'Basko', 'OT', 'Occupational Therapy', '', '', NULL, 'O', '820 W Main', 'Riverton', 'Fremont', 'WY', '82501', '3078577074', '3078566459', '820 W Main', 'Riverton', 'Fremont', 'WY', '82501', '3078577074', '3078566459', 'WISEWYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2011-01-26', '2011-01-26', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1255666137', 0, 'N', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
('830327251', 'WY0200017', 'WY0200017', 'WYT1', 'Star Valley Medical Center', 'David', 'S', 'Bender', 'MD', 'General Surgery', '', '', NULL, 'O', '901 Adams St', 'Afton', 'Lincoln', 'WY', '83110', '3078855890', '          ', '901 Adams St', 'Afton', 'Lincoln', 'WY', '83110', '3078855890', '          ', 'WSTARV', 'wyhcpcs', '', '0.00', '10.00', '0.00', 6, '2007-01-01', '2014-03-24', 0, 0, 0, 'Star Valley Medical Center', '', '', '', 'HCFA|UB|', '1649208943', 0, 'N', 0, '2014-03-31', NULL, NULL, 0, 0, NULL, NULL),
('830317012', 'WY0200220', 'WY0200220', 'WYT1', 'Fremont Therapy Group', 'Chantel', '', 'Bowen', 'PT', 'Physical Therapy', '', '', NULL, 'O', '2002 W Sunset Dr Ste 1', 'Riverton', 'Fremont', 'WY', '82501', '3078567021', NULL, '2002 W Sunset Dr Ste 1', 'Riverton', 'Fremont', 'WY', '82501', '3078567021', '          ', 'WYFREEM', 'wyhcpcs', '', '0.00', '35.00', '0.00', 3, '2007-07-01', '2011-06-03', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1114949021', 0, 'N', 0, '2012-01-26', NULL, NULL, 0, 0, NULL, NULL),
('830317012', 'WY0200221', 'WY0200221', 'WYT1', 'Fremont Therapy Group', 'Chantel', '', 'Bowen', 'PT', 'Physical Therapy', '', '', NULL, 'O', '8168 Highway 789', 'Lander', 'Fremont', 'WY', '82520', '3073325240', NULL, '8168 Highway 789', 'Lander', 'Fremont', 'WY', '82520', '3073325240', '          ', 'WYFREEM', 'wyhcpcs', '', '0.00', '35.00', '0.00', 3, '2007-07-01', '2011-06-03', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1114949021', 0, 'N', 0, '2012-01-26', NULL, NULL, 0, 0, NULL, NULL),
('204028167', 'WY0200018', 'WY0200018', 'WYT1', 'Goose Creek Pediatrics', 'Mary', 'I', 'Bowers', 'MD', 'Pediatrics', '', '', NULL, 'O', '1701 W 5th St Ste A', 'Sheridan', 'Sheridan', 'WY', '82801', '3076727700', NULL, '1701 W 5th St Ste A', 'Sheridan', 'Sheridan', 'WY', '82801', '3076727700', '', 'WiseWYSTD', 'Wyhcpcs', NULL, '0.00', '35.00', '0.00', 3, '2007-07-01', NULL, 0, 0, 0, 'Sheridan Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1023047339', 0, 'N', 0, '2011-06-10', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'WY0200019', 'WY0200019', 'WYT1', 'Cardiovascular Consultants of Utah', 'William', 'M', 'Brann', 'MD', 'Internal Medicine', '', '', NULL, 'O', '150 Arrowhead Dr', 'Evanston', 'Uinta', 'WY', '82930', '8017464440', '', '150 Arrowhead Dr', 'Evanston', 'Uinta', 'WY', '82930', '8017464440', '', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2008-07-21', '2014-04-30', 0, 0, 0, 'Jordan Valley Medical Center', 'University Health Care University Hospital', 'Salt Lake Regional Medical Center', '', 'HCFA|UB|', '1912087826', 0, 'N', 0, '2014-07-25', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'WY0200020', 'WY0200020', 'WYT1', 'Cardiovascular Consultants of Utah', 'William', 'M', 'Brann', 'MD', 'Internal Medicine', '', '', NULL, 'O', '2751 Commercial Way', 'Rock Springs', 'Sweetwater', 'WY', '82901', '8017464440', '', '2751 Commercial Way', 'Rock Springs', 'Sweetwater', 'WY', '82901', '8017464440', '', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2008-07-21', '2014-04-30', 0, 0, 0, 'Jordan Valley Medical Center', 'University Health Care University Hospital', 'Salt Lake Regional Medical Center', '', 'HCFA|UB|', '1912087826', 0, 'N', 0, '2014-07-25', NULL, NULL, 0, 0, NULL, NULL),
('830327251', 'WY0200021', 'WY0200021', 'WYT1', 'Star Valley Medical Center', 'Roger', '', 'Brecheen', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '901 Adams St', 'Afton', 'Lincoln', 'WY', '83110', '3078855817', '          ', '901 Adams St', 'Afton', 'Lincoln', 'WY', '83110', '3078855817', '          ', 'WSTARV', 'wyhcpcs', '', '0.00', '10.00', '0.00', 6, '2010-09-08', '2014-03-24', 0, 0, 0, 'SageWest Health Care', '', '', '', 'HCFA|UB|', '1720039357', 0, 'N', 0, '2014-03-31', NULL, NULL, 0, 0, NULL, NULL),
('830317012', 'WY0200222', 'WY0200222', 'WYT1', 'Fremont Therapy Group', 'Aileen', '', 'Brew', 'MS', 'Physical Therapy', '', '', NULL, 'O', '2002 W Sunset Dr Ste 1', 'Riverton', 'Fremont', 'WY', '82501', '3078567021', NULL, '2002 W Sunset Dr Ste 1', 'Riverton', 'Fremont', 'WY', '82501', '3078567021', '          ', 'WYFREEM', 'wyhcpcs', '', '0.00', '35.00', '0.00', 3, '2007-07-01', '2011-06-03', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1376557827', 0, 'N', 0, '2011-06-10', NULL, NULL, 0, 0, NULL, NULL),
('830317012', 'WY0200223', 'WY0200223', 'WYT1', 'Fremont Therapy Group', 'Aileen', '', 'Brew', 'MS', 'Physical Therapy', '', '', NULL, 'O', '8168 Highway 789', 'Lander', 'Fremont', 'WY', '82520', '3073325240', NULL, '8168 Highway 789', 'Lander', 'Fremont', 'WY', '82520', '3073325240', '          ', 'WYFREEM', 'wyhcpcs', '', '0.00', '35.00', '0.00', 3, '2007-07-01', '2011-06-03', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1376557827', 0, 'N', 0, '2011-06-10', NULL, NULL, 0, 0, NULL, NULL),
('830324911', 'WY0200022', 'WY0200022', 'WYT1', 'Uinta Physical Therapy', 'Mark', 'Z', 'Brinkerhoff', 'PT', 'Physical Therapy', '', '', NULL, 'O', '170 Yellow Creek Rd Ste D', 'Evanston', 'Uinta', 'WY', '82930', '3077838068', NULL, '170 Yellow Creek Rd Ste D', 'Evanston', 'Uinta', 'WY', '82930', '3077838068', '', 'wystd', 'wyhcpcs', NULL, '0.00', '35.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1750433918', 0, 'N', 0, '2011-06-10', NULL, NULL, 0, 0, NULL, NULL),
('431417869', 'WY0200224', 'WY0200224', 'WYT1', 'Fremont Orthopedics', 'Cornelius', 'L', 'Britt', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '815 E Main St', 'Lander', 'Fremont', 'WY', '82520', '8004437173', NULL, '815 E Main St', 'Lander', 'Fremont', 'WY', '82520', '8004437173', '', 'WYORTHO2', 'wyhcpcs', NULL, '0.00', '35.00', '0.00', 3, '2009-07-02', NULL, 0, 0, 0, 'SageWest Health Care', NULL, NULL, NULL, 'HCFA|UB|', '1366547994', 0, 'n', 0, '2012-10-12', NULL, NULL, 0, 0, NULL, NULL),
('830267172', 'WY0200023', 'WY0200023', 'WYT1', 'South Lincoln Medical Clinic', 'Cornelius', 'L', 'Britt', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '711 Onyx St', 'Kemmerer', 'Lincoln', 'WY', '83101', '3078774401', NULL, '711 Onyx St', 'Kemmerer', 'Lincoln', 'WY', '83101', '3078774401', '', 'wystd', 'wyhcpcs', NULL, '0.00', '35.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 0, 'SageWest Health Care', NULL, NULL, NULL, 'HCFA|UB|', '1366547994', 0, 'N', 0, '2012-10-12', NULL, NULL, 0, 0, NULL, NULL),
('274279163', 'WY0200024', 'WY0200024', 'WYT1', '', 'Christopher ', 'C', 'Brown', 'MD', 'Internal Medicine', 'Infectious Disease', '', NULL, 'O', '1458 W 5th St', 'Sheridan', 'Sheridan', 'WY', '82801', '3076744633', '3076720348', '1458 W 5th St', 'Sheridan', 'Sheridan', 'WY', '82801', '3076744633', '3076720348', 'WISEWYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2011-04-01', NULL, 0, 0, 0, 'Campbell County Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1376569202', 0, 'N', 0, '2011-06-10', NULL, NULL, 0, 0, NULL, NULL),
('870519172', 'WY0200025', 'WY0200025', 'WYT1', 'Utah Heart Clinic', 'James', 'Lee', 'Burke', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '702 Onyx St', 'Kemmerer', 'Lincoln', 'WY', '83101', '3078774496', NULL, '702 Onyx St', 'Kemmerer', 'Lincoln', 'WY', '83101', '3078774496', '', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-12-01', '2008-05-04', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1154399459', 0, 'N', 0, '2014-05-19', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'WY0200028', 'WY0200028', 'WYT1', 'Intermountain Utah Heart Group', 'James', 'Lee', 'Burke', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '110 Hospital Ln', 'Afton', 'Lincoln', 'WY', '83110', '3078855800', NULL, '110 Hospital Ln', 'Afton', 'Lincoln', 'WY', '83110', '3078855800', '', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2009-01-29', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1154399459', 0, 'N', 0, '2014-05-19', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'WY0200026', 'WY0200026', 'WYT1', 'Intermountain Utah Heart Group', 'James', 'Lee', 'Burke', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1400 Uinta Dr', 'Green River', 'Sweetwater', 'WY', '82935', '3078724500', NULL, '1400 Uinta Dr', 'Green River', 'Sweetwater', 'WY', '82935', '3078724500', '', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2009-01-29', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1154399459', 0, 'N', 0, '2014-05-19', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'WY0200027', 'WY0200027', 'WYT1', 'Intermountain Utah Heart Group', 'James', 'Lee', 'Burke', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '150 Arrowhead Dr', 'Evanston', 'Uinta', 'WY', '82930', '3077890524', '          ', '150 Arrowhead Dr', 'Evanston', 'Uinta', 'WY', '82930', '3077890524', '          ', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2009-01-29', '2014-05-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1154399459', 0, 'N', 0, '2014-05-22', NULL, NULL, 0, 0, NULL, NULL),
('830317012', 'WY0200225', 'WY0200225', 'WYT1', 'Fremont Therapy Group', 'Tamara', '', 'Bushmeyer', 'MS', 'Physical Therapy', '', '', NULL, 'O', '2002 W Sunset Dr Ste 1', 'Riverton', 'Fremont', 'WY', '82501', '3078567021', NULL, '2002 W Sunset Dr Ste 1', 'Riverton', 'Fremont', 'WY', '82501', '3078567021', '          ', 'WYFREEM', 'wyhcpcs', '', '0.00', '35.00', '0.00', 3, '2007-07-01', '2011-06-03', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1679595581', 0, 'N', 0, '2011-06-10', NULL, NULL, 0, 0, NULL, NULL),
('830317012', 'WY0200226', 'WY0200226', 'WYT1', 'Fremont Therapy Group', 'Tamara', '', 'Bushmeyer', 'MS', 'Physical Therapy', '', '', NULL, 'O', '8168 Highway 789', 'Lander', 'Fremont', 'WY', '82520', '3073325240', NULL, '8168 Highway 789', 'Lander', 'Fremont', 'WY', '82520', '3073325240', '          ', 'WYFREEM', 'wyhcpcs', '', '0.00', '35.00', '0.00', 3, '2007-07-01', '2011-06-03', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1679595581', 0, 'N', 0, '2011-06-10', NULL, NULL, 0, 0, NULL, NULL),
('272612740', 'WY0200029', 'WY0200029', 'WYT1', '', 'Kris', 'A', 'Canfield', 'MD', 'General Surgery', '', '', NULL, 'O', '1001 S Douglas Hwy Ste B5', 'Gillette', 'Campbell', 'WY', '82716', '3076827500', '3076827585', '1001 S Douglas Hwy Ste B5', 'Gillette', 'Campbell', 'WY', '82716', '3076827500', '3076827585', 'WISEWYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-02-01', '2012-02-12', 0, 0, 0, 'Campbell County Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1366441131', 0, 'N', 0, '2014-01-28', NULL, NULL, 0, 0, NULL, NULL),
('810284764', 'WY0200030', 'WY0200030', 'WYT1', 'Arapahoe Health Center', 'Mark', 'S', 'Cardinal', 'MD', 'Family Practice', '', '', NULL, 'O', '14 Great Plains Rd', 'Arapahoe', 'Fremont', 'WY', '82510', '3078569281', '3078577063', '14 Great Plains Rd', 'Arapahoe', 'Fremont', 'WY', '82510', '3078569281', '3078577063', 'WYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, 'SageWest Health Care', NULL, NULL, NULL, 'HCFA|UB|', '1508931981', 0, 'N', 0, '2011-06-10', NULL, NULL, 0, 0, NULL, NULL),
('810284764', 'WY0200031', 'WY0200031', 'WYT1', 'Fort Washakie Health Center', 'Mark', 'S', 'Cardinal', 'MD', 'Family Practice', '', '', NULL, 'O', '29 Black Coal Dr', 'Fort Washakie', 'Fremont', 'WY', '82514', '3073320446', '3073320131', '29 Black Coal Dr', 'Fort Washakie', 'Fremont', 'WY', '82514', '3073320446', '3073320131', 'WYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, 'SageWest Health Care', NULL, NULL, NULL, 'HCFA|UB|', '1508931981', 0, 'N', 0, '2011-06-10', NULL, NULL, 0, 0, NULL, NULL),
('481200844', 'WY0200032', 'WY0200032', 'WYT1', 'Christian Counseling Center', 'Kay', '', 'Cartee', 'LMFT', 'Mental Health', 'Marriage & Family Therapy', '', NULL, 'O', '829 Belinda Dr', 'Riverton', 'Fremont', 'WY', '82501', '3076900661', NULL, '829 Belinda Dr', 'Riverton', 'Fremont', 'WY', '82501', '3076900661', '          ', 'WYPHD', '', '', '0.00', '35.00', '0.00', 3, '2009-03-23', '2014-01-20', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1508020553', 0, 'Y', 0, '2014-02-27', NULL, NULL, 0, 0, NULL, NULL),
('830327251', 'WY0200033', 'WY0200033', 'WYT1', 'Star Valley Medical Center', 'Allen', 'D', 'Carter', 'MD', 'Family Practice', '', '', NULL, 'O', '901 Adams St', 'Afton', 'Lincoln', 'WY', '83110', '3078855852', NULL, '901 Adams St', 'Afton', 'Lincoln', 'WY', '83110', '3078855852', '', 'WSTARV', 'wyhcpcs', NULL, '0.00', '10.00', '0.00', 6, '2007-01-01', NULL, 0, 0, 0, 'Star Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1073549952', 0, 'N', 0, '2011-06-10', NULL, NULL, 0, 0, NULL, NULL),
('830210617', 'WY0200035', 'WY0200035', 'WYT1', 'Moorcroft Clinic', 'Cynthia', 'M', 'Casey', 'MD', 'Family Practice', '', '', NULL, 'O', '107 W Crook', 'Moorcroft', 'Crook', 'WY', '82721', '3077563414', NULL, '107 W Crook', 'Moorcroft', 'Crook', 'WY', '82721', '3077563414', '', 'WISEWYSTD', 'Wyhcpcs', '', '0.00', '35.00', '0.00', 6, '2007-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1497861652', 0, 'N', 0, '2014-06-20', NULL, NULL, 0, 0, NULL, NULL),
('830210617', 'WY0200034', 'WY0200034', 'WYT1', 'Halett Clinic', 'Cynthia', 'M', 'Casey', 'MD', 'Family Practice', '', '', NULL, 'O', '122 Main St', 'Hulett', 'Crook', 'WY', '82720', '3074675281', NULL, '122 Main St', 'Hulett', 'Crook', 'WY', '82720', '3074675281', '', 'WISEWYSTD', 'Wyhcpcs', '', '0.00', '35.00', '0.00', 6, '2007-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1497861652', 0, 'N', 0, '2014-06-20', NULL, NULL, 0, 0, NULL, NULL),
('830210617', 'WY0200036', 'WY0200036', 'WYT1', 'Sundance Clinic', 'Cynthia', 'M', 'Casey', 'MD', 'Family Practice', '', '', NULL, 'O', '713 Oak St', 'Sundance', 'Crook', 'WY', '82729', '3072832476', NULL, '713 Oak St', 'Sundance', 'Crook', 'WY', '82729', '3072832476', '', 'WISEWYSTD', 'Wyhcpcs', '', '0.00', '35.00', '0.00', 6, '2007-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1497861652', 0, 'N', 0, '2014-06-20', NULL, NULL, 0, 0, NULL, NULL),
('201192861', 'WY0200037', 'WY0200037', 'WYT1', 'Cesko Family Medicine', 'David', 'R', 'Cesko', 'MD', 'Family Practice', 'Obstetrics and Gynecology', '', NULL, 'O', '819 W Maple', 'Rawlins', 'Carbon', 'WY', '82301', '3073243667', '3073245591', '819 W Maple', 'Rawlins', 'Carbon', 'WY', '82301', '3073243667', '3073245591', 'WY125', 'wyhcpcs', NULL, '0.00', '35.00', '0.00', 3, '2007-09-01', NULL, 0, 0, 0, 'Memorial Hospital of Carbon County', NULL, NULL, NULL, 'HCFA|UB|', '1497756118', 0, 'n', 0, '2011-06-10', NULL, NULL, 0, 0, NULL, NULL),
('203082047', 'WY0200038', 'WY0200038', 'WYT1', 'Pediatric and Adolescent Clinic', 'Rebecca', '', 'Ching', 'MD', 'Pediatrics', '', '', NULL, 'O', '170 Arrowhead Dr Ste 2', 'Evanston', 'Uinta', 'WY', '82930', '3077896048', NULL, '170 Arrowhead Dr Ste 2', 'Evanston', 'Uinta', 'WY', '82930', '3077896048', '', 'wystd', 'wyhcpcs', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'Evanston Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1730195546', 0, 'N', 0, '2012-10-25', NULL, NULL, 0, 0, NULL, NULL),
('836000025', 'WY0200039', 'WY0200039', 'WYT1', 'Wagon Circle Surgery Clinic', 'Gary', 'E', 'Chizever', 'MD', 'General Surgery', '', '', NULL, 'O', '2012 W Elm St', 'Rawlins', 'Carbon', 'WY', '82301', '3073246022', '3073248232', '2012 W Elm St', 'Rawlins', 'Carbon', 'WY', '82301', '3073246022', '3073248232', 'WISEWYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 6, '2011-04-01', '2011-10-01', 0, 0, 0, 'Memorial Hospital of Carbon County', '', '', '', 'HCFA|', '1295752988', 0, 'N', 0, '2012-04-27', NULL, NULL, 0, 0, NULL, NULL),
('300481005', 'WY0200040', 'WY0200040', 'WYT1', 'Achieve Sports Medicine Physical Therapy', 'Randall', 'C', 'Christopherson', 'PT', 'Physical Therapy', '', '', NULL, 'O', '109 S Main St Ste D', 'Lyman', 'Uinta', 'WY', '82937', '3077474627', '3077876212', '109 S Main St Ste D', 'Lyman', 'Uinta', 'WY', '82937', '3077474627', '3077876212', 'WISEWYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2011-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1639184096', 0, 'N', 0, '2014-07-11', NULL, NULL, 0, 0, NULL, NULL),
('201909762', 'WY0200041', 'WY0200041', 'WYT1', 'Pro Physical Therapy ', 'Dallas', 'L', 'Clark', 'PT', 'Physical Therapy', '', '', NULL, 'O', '20 Adaville Dr Ste 10', 'Diamondville', 'Lincoln', 'WY', '83116', '3078771000', NULL, '20 Adaville Dr Ste 10', 'Diamondville', 'Lincoln', 'WY', '83116', '3078771000', '', 'WISEWYSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2008-10-03', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1972693497', 0, 'n', 0, '2011-10-04', NULL, NULL, 0, 0, NULL, NULL),
('830255515', 'WY0200042', 'WY0200042', 'WYT1', '', 'Stephen', 'B', 'Cook', 'PHD', 'Mental Health', '', '', NULL, 'O', '350 City View Dr', 'Evanston', 'Uinta', 'WY', '82930', '3077897915', NULL, '350 City View Dr', 'Evanston', 'Uinta', 'WY', '82930', '3077897915', '          ', 'PHD', '', '', '0.00', '100.00', '0.00', 3, '2007-11-01', '2012-06-15', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1821194580', 0, 'N', 0, '2012-06-08', NULL, NULL, 0, 0, NULL, NULL),
('830199236', 'WY0200043', 'WY0200043', 'WYT1', 'Yellowstone Behavioral Health Center', 'Daniel', '', 'Cossuboon', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '2538 Bighorn Ave', 'Cody', 'Park', 'WY', '82414', '3075872197', NULL, '2538 Bighorn Ave', 'Cody', 'Park', 'WY', '82414', '3075872197', '          ', 'PHD', '', '', '0.00', '35.00', '0.00', 6, '2009-03-06', '2012-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1578727855', 0, 'N', 0, '2012-01-09', NULL, NULL, 0, 0, NULL, NULL),
('830210617', 'WY0200045', 'WY0200045', 'WYT1', 'Moorcroft Clinic', 'Robert', '', 'Cummings', 'PAC', 'Family Practice', '', '', NULL, 'O', '107 W Crook', 'Moorcroft', 'Crook', 'WY', '82721', '3077563414', NULL, '107 W Crook', 'Moorcroft', 'Crook', 'WY', '82721', '3077563414', '', 'WISEWYSTD', 'Wyhcpcs', NULL, '0.00', '35.00', '0.00', 6, '2007-09-01', NULL, 0, 0, 0, 'Crook County Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1831205095', 0, 'N', 0, '2013-09-04', NULL, NULL, 0, 0, NULL, NULL),
('830210617', 'WY0200044', 'WY0200044', 'WYT1', 'Halett Clinic', 'Robert', '', 'Cummings', 'PAC', 'Family Practice', '', '', NULL, 'O', '122 Main St', 'Hulett', 'Crook', 'WY', '82720', '3074675281', NULL, '122 Main St', 'Hulett', 'Crook', 'WY', '82720', '3074675281', '', 'WISEWYSTD', 'Wyhcpcs', NULL, '0.00', '35.00', '0.00', 6, '2007-09-01', NULL, 0, 0, 0, 'Crook County Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1831205095', 0, 'N', 0, '2013-09-04', NULL, NULL, 0, 0, NULL, NULL),
('830210617', 'WY0200046', 'WY0200046', 'WYT1', 'Sundance Clinic', 'Robert', '', 'Cummings', 'PAC', 'Family Practice', '', '', NULL, 'O', '713 Oak St', 'Sundance', 'Crook', 'WY', '82729', '3072832476', NULL, '713 Oak St', 'Sundance', 'Crook', 'WY', '82729', '3072832476', '', 'WISEWYSTD', 'Wyhcpcs', NULL, '0.00', '35.00', '0.00', 6, '2007-09-01', NULL, 0, 0, 0, 'Crook County Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1831205095', 0, 'N', 0, '2013-09-04', NULL, NULL, 0, 0, NULL, NULL),
('810284764', 'WY0200047', 'WY0200047', 'WYT1', 'Arapahoe Health Center', 'Corey', '', 'Dahl', 'PT', 'Physical Therapy', '', '', NULL, 'O', '17 Great Plains Rd', 'Arapahoe', 'Fremont', 'WY', '82510', '3078569281', '3078547063', '17 Great Plains Rd', 'Arapahoe', 'Fremont', 'WY', '82510', '3078569281', '3078547063', 'WYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2010-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1366578106', 0, 'N', 0, '2011-06-10', NULL, NULL, 0, 0, NULL, NULL),
('810284764', 'WY0200048', 'WY0200048', 'WYT1', 'Fort Washakie Health Center', 'Corey', '', 'Dahl', 'PT', 'Physical Therapy', '', '', NULL, 'O', '29 Black Coal Dr', 'Fort Washakie', 'Fremont', 'WY', '82514', '3073320446', '3073320131', '29 Black Coal Dr', 'Fort Washakie', 'Fremont', 'WY', '82514', '3073320446', '3073320131', 'WYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2010-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1366578106', 0, 'N', 0, '2011-06-10', NULL, NULL, 0, 0, NULL, NULL),
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('810284764', 'WY0200053', 'WY0200053', 'WYT1', 'Fort Washakie Health Center', 'Connie', 'L', 'Day', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '29 Black Coal Dr', 'Fort Washakie', 'Fremont', 'WY', '82514', '3073320446', '3073320131', '29 Black Coal Dr', 'Fort Washakie', 'Fremont', 'WY', '82514', '3073320446', '3073320131', 'WYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, 'SageWest Health Care', NULL, NULL, NULL, 'HCFA|UB|', '1154459303', 0, 'N', 0, '2011-06-10', NULL, NULL, 0, 0, NULL, NULL),
('202837708', 'WY0200054', 'WY0200054', 'WYT1', 'Evanston Pediatrics', 'Catherine', 'M', 'Depalma', 'MD', 'Pediatrics', '', '', NULL, 'O', '195 Featherway Ste 2', 'Evanston', 'Uinta', 'WY', '82930', '3077891102', NULL, '195 Featherway Ste 2', 'Evanston', 'Uinta', 'WY', '82930', '3077891102', '', 'wystd', 'wyhcpcs', NULL, '0.00', '35.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 0, 'Evanston Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1144272394', 0, 'N', 0, '2011-06-10', NULL, NULL, 0, 0, NULL, NULL),
('810284764', 'WY0200055', 'WY0200055', 'WYT1', 'Arapahoe Health Center', 'Kimberly', 'R', 'Donohue', 'MD', 'Family Practice', '', '', NULL, 'O', '14 Great Plains Rd', 'Arapahoe', 'Fremont', 'WY', '82510', '3078569281', '3078577063', '14 Great Plains Rd', 'Arapahoe', 'Fremont', 'WY', '82510', '3078569281', '3078577063', 'WYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2011-02-01', NULL, 0, 0, 0, 'SageWest Health Care', NULL, NULL, NULL, 'HCFA|UB|', '1457548760', 0, 'N', 0, '2011-06-10', NULL, NULL, 0, 0, NULL, NULL),
('810284764', 'WY0200056', 'WY0200056', 'WYT1', 'Fort Washakie Health Center', 'Kimberly', 'R', 'Donohue', 'MD', 'Family Practice', '', '', NULL, 'O', '29 Black Coal Dr', 'Fort Washakie', 'Fremont', 'WY', '82514', '3073320446', '3073320131', '29 Black Coal Dr', 'Fort Washakie', 'Fremont', 'WY', '82514', '3073320446', '3073320131', 'WYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2011-02-01', NULL, 0, 0, 0, 'SageWest Health Care', NULL, NULL, NULL, 'HCFA|UB|', '1457548760', 0, 'N', 0, '2011-06-10', NULL, NULL, 0, 0, NULL, NULL),
('481269523', 'WY0200057', 'WY0200057', 'WYT1', 'Sweetwater Foot Care', 'David', 'A', 'Duckwitz', 'DPM', 'Podiatry', '', '', NULL, 'O', '2631 Foothill Blvd Ste C', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073629545', NULL, '2631 Foothill Blvd Ste C', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073629545', '', 'wystd', 'wyhcpcs', NULL, '0.00', '35.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 0, 'Memorial Hospital of Sweetwater County', '', '', '', 'HCFA|UB|', '1447421904', 0, 'N', 0, '2014-03-24', NULL, NULL, 0, 0, NULL, NULL),
('830199236', 'WY0200058', 'WY0200058', 'WYT1', 'Yellowstone Behavioral Health Center', 'Jessica', 'L', 'Erickson', 'LPC', 'Mental Health', '', '', NULL, 'O', '2538 Bighorn Ave', 'Cody', 'Park', 'WY', '82414', '3075872197', NULL, '2538 Bighorn Ave', 'Cody', 'Park', 'WY', '82414', '3075872197', '          ', 'MA', '', '', '0.00', '35.00', '0.00', 6, '2010-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1689853491', 0, 'N', 0, '2011-06-10', NULL, NULL, 0, 0, NULL, NULL),
('830199236', 'WY0200059', 'WY0200059', 'WYT1', 'Yellowstone Behavioral Health Center', 'Christine', '', 'Esposito', 'LMFT', 'Mental Health', 'Marriage & Family Therapy', '', NULL, 'O', '2538 Bighorn Ave', 'Cody', 'Park', 'WY', '82414', '3075872197', NULL, '2538 Bighorn Ave', 'Cody', 'Park', 'WY', '82414', '3075872197', '', 'MA', NULL, NULL, '0.00', '35.00', '0.00', 6, '2009-02-06', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1013157197', 0, 'n', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('900347306', 'WY0200060', 'WY0200060', 'WYT1', 'Evanston Surgical Center', '', '', 'Evanston Surgical Center', 'GROUP', 'General Surgery', '', '', NULL, 'O', '196 Arrowhead Dr Ste 8', 'Evanston', 'Uinta', 'WY', '82930', '3077891390', NULL, '196 Arrowhead Dr Ste 8', 'Evanston', 'Uinta', 'WY', '82930', '3077891390', '', 'wystd', 'wyhcpcs', NULL, '0.00', '35.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000004777', 0, 'n', 0, '2011-06-10', NULL, NULL, 0, 0, NULL, NULL),
('830181409', 'WY0200061', 'WY0200061', 'WYT1', 'Midway Clinic', 'Brendan', 'H', 'Fitzsimmons', 'MD', 'Family Practice', '', '', NULL, 'O', '388 S US Hwy 20', 'Basin', 'Big Horn', 'WY', '82410', '3075683311', NULL, '388 S US Hwy 20', 'Basin', 'Big Horn', 'WY', '82410', '3075683311', '          ', 'WISEWYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2008-07-18', '2014-01-31', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1912102989', 0, 'N', 0, '2014-02-03', NULL, NULL, 0, 0, NULL, NULL),
('263452005', 'WY0200063', 'WY0200063', 'WYT1', '', 'Douglass', 'W', 'Forsha', 'MD', 'Dermatology', NULL, NULL, NULL, 'O', '1001 S Douglas Hwy Ste B5', 'Gillette', 'Campbell', 'WY', '82716', '3072652936', NULL, '1001 S Douglas Hwy Ste B5', 'Gillette', 'Campbell', 'WY', '82716', '3072652936', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-01-01', '2012-05-31', 0, 0, 0, 'Evanston Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1285674671', 0, 'N', 0, '2013-10-23', NULL, NULL, 0, 0, NULL, NULL),
('263452005', 'WY0200064', 'WY0200064', 'WYT1', '', 'Douglass', 'W', 'Forsha', 'MD', 'Dermatology', NULL, NULL, NULL, 'O', '196 Arrowhead Dr Ste 5', 'Evanston', 'Uinta', 'WY', '82930', '3072652936', NULL, '196 Arrowhead Dr Ste 5', 'Evanston', 'Uinta', 'WY', '82930', '3072652936', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-01-01', '2012-05-31', 0, 0, 0, 'Evanston Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1285674671', 0, 'N', 0, '2013-10-23', NULL, NULL, 0, 0, NULL, NULL),
('263452005', 'WY0200065', 'WY0200065', 'WYT1', '', 'Douglass', 'W', 'Forsha', 'MD', 'Dermatology', NULL, NULL, NULL, 'O', '430 Broadway', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3072652936', NULL, '430 Broadway', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3072652936', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-01-01', '2012-05-31', 0, 0, 0, 'Evanston Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1285674671', 0, 'N', 0, '2013-10-23', NULL, NULL, 0, 0, NULL, NULL),
('263452005', 'WY0200066', 'WY0200066', 'WYT1', '', 'Douglass', 'W', 'Forsha', 'MD', 'Dermatology', NULL, NULL, NULL, 'O', '511 N 12th St Ste EB', 'Riverton', 'Fremont', 'WY', '82501', '3072652936', NULL, '511 N 12th St Ste EB', 'Riverton', 'Fremont', 'WY', '82501', '3072652936', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-01-01', '2012-05-31', 0, 0, 0, 'Evanston Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1285674671', 0, 'N', 0, '2013-10-23', NULL, NULL, 0, 0, NULL, NULL),
('263452005', 'WY0200067', 'WY0200067', 'WYT1', '', 'Douglass', 'W', 'Forsha', 'MD', 'Dermatology', NULL, NULL, NULL, 'O', '940 E 3rd St Ste 307', 'Casper', 'Natrona', 'WY', '82601', '3072652936', NULL, '940 E 3rd St Ste 307', 'Casper', 'Natrona', 'WY', '82601', '3072652936', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-01-01', '2012-05-31', 0, 0, 0, 'Evanston Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1285674671', 0, 'N', 0, '2013-10-23', NULL, NULL, 0, 0, NULL, NULL),
('870487560', 'WY0200062', 'WY0200062', 'WYT1', '', 'Douglass', 'W', 'Forsha', 'MD', 'Dermatology', NULL, NULL, NULL, 'O', '940 E 3rd St Ste 207', 'Casper', 'Natrona', 'WY', '82601', '3072652936', NULL, '940 E 3rd St Ste 207', 'Casper', 'Natrona', 'WY', '82601', '3072652936', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-08-06', '2012-05-31', 0, 0, 0, 'Evanston Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1285674671', 0, 'N', 0, '2013-10-23', NULL, NULL, 0, 0, NULL, NULL),
('830267172', 'WY0200068', 'WY0200068', 'WYT1', 'South Lincoln Medical Clinic', 'Melissa', 'A', 'Foster', 'FNP', 'Family Practice', '', '', NULL, 'O', '711 Onyx St', 'Kemmerer', 'Lincoln', 'WY', '83101', '3078774401', NULL, '711 Onyx St', 'Kemmerer', 'Lincoln', 'WY', '83101', '3078774401', '          ', 'wystd', 'wyhcpcs', '', '0.00', '35.00', '0.00', 3, '2006-12-01', '2012-04-01', 0, 0, 0, 'Evanston Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1205928108', 0, 'N', 0, '2012-04-02', NULL, NULL, 0, 0, NULL, NULL),
('830283425', 'WY0200069', 'WY0200069', 'WYT1', 'North Platte Physical Therapy', 'Todd', 'L', 'Gentzler', 'PT', 'Physical Therapy', '', '', NULL, 'O', '620 4J Ct Ste B', 'Gillette', 'Campbell', 'WY', '82716', '3076862569', '3076862615', '620 4J Ct Ste B', 'Gillette', 'Campbell', 'WY', '82716', '3076862569', '3076862615', 'WYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2010-12-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1548224140', 0, 'N', 0, '2014-07-24', NULL, NULL, 0, 0, NULL, NULL),
('830267172', 'WY0200070', 'WY0200070', 'WYT1', 'South Lincoln Medical Clinic', 'S', 'D', 'George', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '711 Onyx St', 'Kemmerer', 'Lincoln', 'WY', '83101', '3078774401', NULL, '711 Onyx St', 'Kemmerer', 'Lincoln', 'WY', '83101', '3078774401', '', 'wystd', 'wyhcpcs', NULL, '0.00', '35.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 0, 'South Lincoln Medical Center', '', '', '', 'HCFA|UB|', '1043392863', 0, 'N', 0, '2012-08-14', NULL, NULL, 0, 0, NULL, NULL),
('830235231', 'WY0200071', 'WY0200071', 'WYT1', 'Cloud Peak Counseling Center', 'Lonnie', 'G', 'Gerharter', 'LAT', 'Mental Health', 'Counseling', '', NULL, 'O', '206 S 7th St', 'Worland', 'Washakie', 'WY', '82401', '3073476165', '          ', '206 S 7th St', 'Worland', 'Washakie', 'WY', '82401', '3073476165', '          ', 'MA', '', '', '0.00', '35.00', '0.00', 3, '2008-11-21', '2014-02-28', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1538283809', 0, 'N', 0, '2014-03-26', NULL, NULL, 0, 0, NULL, NULL),
('261359020', 'WY0200072', 'WY0200072', 'WYT1', 'Southwest Comfort Counseling', 'Wendy', 'S', 'Gersing', 'PSYD', 'Mental Health', '', '', NULL, 'O', '214 W Maple St', 'Rawlins', 'Carbon', 'WY', '82301', '3073244826', '3073244826', '214 W Maple St', 'Rawlins', 'Carbon', 'WY', '82301', '3073244826', '3073244826', 'RAWINSPHD', '', '', '0.00', '35.00', '0.00', 3, '2011-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1164549234', 0, 'N', 0, '2011-06-10', NULL, NULL, 0, 0, NULL, NULL),
('270248138', 'WY0200073', 'WY0200073', 'WYT1', 'Big Horn Urgent Care', 'Paula', 'S', 'Giovanini-Morris', 'NP', 'Family Practice', '', '', NULL, 'O', '4620 Grandview Ave Ste 104', 'Sheridan', 'Sheridan', 'WY', '82801', '          ', NULL, '4620 Grandview Ave Ste 104', 'Sheridan', 'Sheridan', 'WY', '82801', '          ', '          ', 'WISEWYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-02-01', '2012-04-23', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1932116803', 0, 'N', 0, '2012-04-23', NULL, NULL, 0, 0, NULL, NULL),
('830327251', 'WY0200074', 'WY0200074', 'WYT1', 'Star Valley Medical Center', 'E Marlowe', '', 'Goble', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '901 Adams St', 'Afton', 'Lincoln', 'WY', '83110', '3078855817', NULL, '901 Adams St', 'Afton', 'Lincoln', 'WY', '83110', '3078855817', '', 'WSTARV', 'wyhcpcs', '', '0.00', '10.00', '0.00', 6, '2010-09-08', NULL, 0, 0, 0, 'Logan Regional Hospital', '', '', '', 'HCFA|UB|', '1235232646', 0, 'N', 0, '2014-05-08', NULL, NULL, 0, 0, NULL, NULL),
('810284764', 'WY0200075', 'WY0200075', 'WYT1', 'Arapahoe Health Center', 'Mary', 'A', 'Gookin', 'FNP', 'Family Practice', '', '', NULL, 'O', '17 Great Plains Rd', 'Arapahoe', 'Fremont', 'WY', '82510', '3078569281', '3078577063', '17 Great Plains Rd', 'Arapahoe', 'Fremont', 'WY', '82510', '3078569281', '3078577063', 'WYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2010-10-01', NULL, 0, 0, 0, 'SageWest Health Care', NULL, NULL, NULL, 'HCFA|UB|', '1104000827', 0, 'N', 0, '2011-06-10', NULL, NULL, 0, 0, NULL, NULL);
INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
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('204303175', 'WY0200227', 'WY0200227', 'WYT1', 'Summit Physical Therapy', 'Darrin', '', 'Goyn', 'PT', 'Physical Therapy', '', '', NULL, 'O', '541 A E Flaming Gorge Way', 'Green River', 'Sweetwater', 'WY', '82935', '3078754654', NULL, '541 A E Flaming Gorge Way', 'Green River', 'Sweetwater', 'WY', '82935', '3078754654', '', 'GOYNPT', '', '', '0.00', '40.00', '0.00', 3, '2010-04-26', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1891883203', 0, 'N', 0, '2014-06-04', NULL, NULL, 0, 0, NULL, NULL),
('830235231', 'WY0200077', 'WY0200077', 'WYT1', 'Cloud Peak Counseling Center', 'Brock', '', 'Greek', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '206 S 7th St', 'Worland', 'Washakie', 'WY', '82401', '3073476165', NULL, '206 S 7th St', 'Worland', 'Washakie', 'WY', '82401', '3073476165', '', 'MA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2009-01-09', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1750406153', 0, 'n', 0, '2011-12-29', NULL, NULL, 0, 0, NULL, NULL),
('830323501', 'WY0200228', 'WY0200228', 'WYT1', 'Therapy Solutions', 'Heather', 'A', 'Grigg', 'OT', 'Occupational Therapy', '', '', NULL, 'O', '6631 E 2nd St', 'Casper', 'Natrona', 'WY', '82609', '3072689904', '3072689907', '6631 E 2nd St', 'Casper', 'Natrona', 'WY', '82609', '3072689904', '3072689907', 'THERAPY', '', '', '0.00', '35.00', '0.00', 3, '2010-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1841447232', 0, 'N', 0, '2011-06-10', NULL, NULL, 0, 0, NULL, NULL),
('450541117', 'WY0200078', 'WY0200078', 'WYT1', 'Valley X-ray', 'Donald', 'H', 'Guear', 'AART', 'Diagnostic Radiology', '', '', NULL, 'O', '124 Peterson Pwky Ste 2', 'Thayne', 'Lincoln', 'WY', '83127', '3078839729', NULL, '124 Peterson Pwky Ste 2', 'Thayne', 'Lincoln', 'WY', '83127', '3078839729', '          ', 'WISEWYSTD', 'wyhcpcs', '', '0.00', '35.00', '0.00', 3, '2009-07-22', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1710097647', 0, 'Y', 0, '2012-07-19', NULL, NULL, 0, 0, NULL, NULL),
('830330554', 'WY0200009', 'WY0200009', 'WYT1', 'Evanston Regional Hospital', 'Paul', '', 'Gustafson', 'DO', 'General Surgery', '', '', NULL, 'O', '196 Arrowhead Dr Ste 9', 'Evanston', 'Uinta', 'WY', '82930', '3077894710', NULL, '196 Arrowhead Dr Ste 9', 'Evanston', 'Uinta', 'WY', '82930', '3077894710', '          ', 'wystd', 'wyhcpcs', '', '0.00', '35.00', '0.00', 3, '2006-12-01', '2010-09-21', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1528033644', 0, 'N', 0, '2011-06-10', NULL, NULL, 0, 0, NULL, NULL),
('263042851', 'WY0200079', 'WY0200079', 'WYT1', 'Southwest Wyoming ENT', 'Jason', 'P', 'Haack', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '196 Arrowhead Dr Ste 4', 'Evanston', 'Uinta', 'WY', '82930', '3077898721', NULL, '196 Arrowhead Dr Ste 4', 'Evanston', 'Uinta', 'WY', '82930', '3077898721', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-05-01', '2012-08-19', 0, 0, 0, 'Evanston Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1407832728', 0, 'N', 0, '2012-08-21', NULL, NULL, 0, 0, NULL, NULL),
('830327251', 'WY0200080', 'WY0200080', 'WYT1', 'Star Valley Medical Center', 'Martha ', 'S', 'Hageman', 'MD', 'Family Practice', '', '', NULL, 'O', '901 Adams St', 'Afton', 'Lincoln', 'WY', '83110', '3078855817', NULL, '901 Adams St', 'Afton', 'Lincoln', 'WY', '83110', '3078855817', '', 'WSTARV', 'wyhcpcs', '', '0.00', '10.00', '0.00', 6, '2010-09-08', NULL, 0, 0, 0, 'Star Valley Medical Center', '', '', '', 'HCFA|UB|', '1033395561', 0, 'N', 0, '2014-03-31', NULL, NULL, 0, 0, NULL, NULL),
('830319938', 'WY0200081', 'WY0200081', 'WYT1', 'Health Services', 'Shirley', 'L', 'Haley', 'NP', 'Family Practice', '', '', NULL, 'O', '201 W Lakeway Ste 414', 'Gillette', 'Campbell', 'WY', '82716', '3076828110', NULL, '201 W Lakeway Ste 414', 'Gillette', 'Campbell', 'WY', '82716', '3076828110', '', 'WiseWYStd', 'wyhcpcs', '', '0.00', '35.00', '0.00', 3, '2007-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1962524504', 0, 'n', 0, '2014-06-25', NULL, NULL, 0, 0, NULL, NULL),
('520707341', 'WY0200082', 'WY0200082', 'WYT1', '', 'Glenn', 'L', 'Hammer', 'LPC', 'Mental Health', '', '', NULL, 'O', '1465 N 4th St Ste 119', 'Laramie', 'Albany', 'WY', '82072', '3077218207', NULL, '1465 N 4th St Ste 119', 'Laramie', 'Albany', 'WY', '82072', '3077218207', '          ', 'MA', '', '', '0.00', '100.00', '0.00', 3, '2007-11-01', '2013-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1396846879', 0, 'N', 0, '2013-06-26', NULL, NULL, 0, 0, NULL, NULL),
('810284764', 'WY0200083', 'WY0200083', 'WYT1', 'Arapahoe Health Center', 'Jenaneta ', 'S', 'Hampton', 'NP', 'Family Practice', '', '', NULL, 'O', '17 Great Plains Rd', 'Arapahoe', 'Fremont', 'WY', '82510', '3078569281', '3078577063', '17 Great Plains Rd', 'Arapahoe', 'Fremont', 'WY', '82510', '3078569281', '3078577063', 'WYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2010-10-01', NULL, 0, 0, 0, 'SageWest Health Care', NULL, NULL, NULL, 'HCFA|UB|', '1396817516', 0, 'N', 0, '2011-06-10', NULL, NULL, 0, 0, NULL, NULL),
('810284764', 'WY0200084', 'WY0200084', 'WYT1', 'Fort Washakie Health Center', 'Jenaneta ', 'S', 'Hampton', 'NP', 'Family Practice', '', '', NULL, 'O', '29 Black Coal Dr', 'Fort Washakie', 'Fremont', 'WY', '82514', '3073320446', '3073320131', '29 Black Coal Dr', 'Fort Washakie', 'Fremont', 'WY', '82514', '3073320446', '3073320131', 'WYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2010-10-01', NULL, 0, 0, 0, 'SageWest Health Care', NULL, NULL, NULL, 'HCFA|UB|', '1396817516', 0, 'N', 0, '2011-06-10', NULL, NULL, 0, 0, NULL, NULL),
('830317012', 'WY0200229', 'WY0200229', 'WYT1', 'Fremont Therapy Group ', 'Courtney', '', 'Hansen', 'PT', 'Physical Therapy', '', '', NULL, 'O', '2002 W Sunset Dr Ste 1', 'Riverton', 'Fremont', 'WY', '82501', '3078567021', NULL, '2002 W Sunset Dr Ste 1', 'Riverton', 'Fremont', 'WY', '82501', '3078567021', '', 'WYFREEM', 'wyhcpcs', NULL, '0.00', '35.00', '0.00', 3, '2007-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1003838640', 0, 'n', 0, '2014-05-01', NULL, NULL, 0, 0, NULL, NULL),
('830317012', 'WY0200230', 'WY0200230', 'WYT1', 'Fremont Therapy Group ', 'Courtney', '', 'Hansen', 'PT', 'Physical Therapy', '', '', NULL, 'O', '8168 Hwy 789', 'Lander', 'Fremont', 'WY', '82520', '3073325240', NULL, '8168 Hwy 789', 'Lander', 'Fremont', 'WY', '82520', '3073325240', '', 'WYFREEM', 'wyhcpcs', NULL, '0.00', '35.00', '0.00', 3, '2007-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1003838640', 0, 'n', 0, '2014-05-01', NULL, NULL, 0, 0, NULL, NULL),
('470940489', 'WY0200085', 'WY0200085', 'WYT1', NULL, 'Eric', 'C', 'Hansen', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '150 Arrowhead Dr Ste 2', 'Evanston', 'Uinta', 'WY', '82930', '3077898881', NULL, '150 Arrowhead Dr Ste 2', 'Evanston', 'Uinta', 'WY', '82930', '3077898881', '', 'wystd', 'wyhcpcs', NULL, '0.00', '35.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 0, 'Evanston Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1366500449', 0, 'N', 0, '2011-06-10', NULL, NULL, 0, 0, NULL, NULL),
('205701046', 'WY0200086', 'WY0200086', 'WYT1', NULL, 'David', 'J', 'Harbrecht', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '196 Arrowhead Ste 5', 'Evanston', 'Uinta', 'WY', '82930', '3077838364', NULL, '196 Arrowhead Ste 5', 'Evanston', 'Uinta', 'WY', '82930', '3077838364', '', 'wystd', 'wyhcpcs', NULL, '0.00', '35.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 0, 'Lakeview Hospital', '', '', '', 'HCFA|UB|', '1245312784', 0, 'N', 0, '2013-11-11', NULL, NULL, 0, 0, NULL, NULL),
('273723626', 'WY0200087', 'WY0200087', 'WYT1', 'Family Circle Counseling', 'Janae', 'B', 'Harman', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '801 Robertson Ave', 'Worland', 'Washakie', 'WY', '82401', '3079212360', NULL, '801 Robertson Ave', 'Worland', 'Washakie', 'WY', '82401', '3079212360', '          ', 'WYMA', '', '', '0.00', '35.00', '0.00', 3, '2011-03-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1851627210', 0, 'N', 0, '2014-02-03', NULL, NULL, 0, 0, NULL, NULL),
('271124756', 'WY0200088', 'WY0200088', 'WYT1', '', 'Rose', 'M', 'Harriet', 'MFT', 'Mental Health', 'Counseling', '', NULL, 'O', ' 140 S Main St', 'Buffalo', 'Johnson', 'WY', '82834', '3072172161', NULL, ' 140 S Main St', 'Buffalo', 'Johnson', 'WY', '82834', '3072172161', '          ', 'WYMA', '', '', '0.00', '35.00', '0.00', 3, '2010-04-18', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1124268354', 0, 'N', 0, '2013-12-13', NULL, NULL, 0, 0, NULL, NULL),
('830323501', 'WY0200231', 'WY0200231', 'WYT1', 'Therapy Solutions', 'Kacey', 'M', 'Hawkins', 'PT', 'Physical Therapy', '', '', NULL, 'O', '6631 E 2nd St', 'Casper', 'Natrona', 'WY', '82609', '3072689904', '3072689907', '6631 E 2nd St', 'Casper', 'Natrona', 'WY', '82609', '3072689904', '3072689907', 'THERAPY', '', '', '0.00', '35.00', '0.00', 3, '2010-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1427065069', 0, 'N', 0, '2011-06-10', NULL, NULL, 0, 0, NULL, NULL),
('830327251', 'WY0200089', 'WY0200089', 'WYT1', 'Star Valley Medical Center', 'K', 'P', 'Head', 'MD', 'Family Practice', '', '', NULL, 'O', '901 Adams St', 'Afton', 'Lincoln', 'WY', '83110', '3078855852', NULL, '901 Adams St', 'Afton', 'Lincoln', 'WY', '83110', '3078855852', '', 'WSTARV', 'wyhcpcs', NULL, '0.00', '10.00', '0.00', 6, '2007-01-01', NULL, 0, 0, 0, 'Star Valley Medical Center', '', '', '', 'HCFA|UB|', '1538195417', 0, 'N', 0, '2014-03-31', NULL, NULL, 0, 0, NULL, NULL),
('830303520', 'WY0200091', 'WY0200091', 'WYT1', 'Northwest Wyoming Family Planning', 'Sonja', 'M', 'Hein', 'PA', 'Family Practice', '', '', NULL, 'O', '1231 Rumsey Ave', 'Cody', 'Park', 'WY', '82414', '3075275174', '3075275286', '1231 Rumsey Ave', 'Cody', 'Park', 'WY', '82414', '3075275174', '3075275286', 'WYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1902959265', 0, 'N', 0, '2014-06-04', NULL, NULL, 0, 0, NULL, NULL),
('830303520', 'WY0200090', 'WY0200090', 'WYT1', 'Northwest Wyoming Family Planning', 'Sonja', 'M', 'Hein', 'PA', 'Family Practice', '', '', NULL, 'O', '246 N Hamilton', 'Powell', 'Park', 'WY', '82435', '3077545023', '3075275286', '246 N Hamilton', 'Powell', 'Park', 'WY', '82435', '3077545023', '3075275286', 'WYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1902959265', 0, 'N', 0, '2014-06-04', NULL, NULL, 0, 0, NULL, NULL),
('260064367', 'WY0200092', 'WY0200092', 'WYT1', 'Total Family Health', 'Laura', 'J', 'Heitz', 'FNP', 'Family Practice', '', '', NULL, 'O', '1208 Hilltop Dr Ste 100', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073822080', NULL, '1208 Hilltop Dr Ste 100', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073822080', '', 'wystd', 'wyhcpcs', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1013090554', 0, 'N', 0, '2014-04-02', NULL, NULL, 0, 0, NULL, NULL),
('836000025', 'WY0200093', 'WY0200093', 'WYT1', 'Memorial Hospital of Carbon County', 'Michael ', '', 'Higginbotham', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '2221 W Elm St', 'Rawlins', 'Carbon', 'WY', '82301', '3073248252', '3073248368', '2221 W Elm St', 'Rawlins', 'Carbon', 'WY', '82301', '3073248252', '3073248368', 'WISEWYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 6, '2011-06-01', NULL, 0, 0, 0, 'Memorial Hospital of Carbon County', '', '', '', 'HCFA|', '1336188150', 0, 'N', 0, '2011-06-10', NULL, NULL, 0, 0, NULL, NULL),
('830181409', 'WY0200094', 'WY0200094', 'WYT1', 'Midway Clinic', 'Demar', 'D', 'Hill', 'MD', 'Family Practice', '', '', NULL, 'O', '388 S US Hwy 20', 'Basin', 'Big Horn', 'WY', '82410', '3075683311', NULL, '388 S US Hwy 20', 'Basin', 'Big Horn', 'WY', '82410', '3075683311', '', 'WISEWYSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2008-07-18', NULL, 0, 0, 0, 'South Big Horn County Hospital District', '', '', '', 'HCFA|UB|', '1043415987', 0, 'n', 0, '2012-04-24', NULL, NULL, 0, 0, NULL, NULL),
('830267172', 'WY0200095', 'WY0200095', 'WYT1', 'South Lincoln Medical Clinic', 'Vince', 'H', 'Hinshaw', 'MD', 'Family Practice', '', '', NULL, 'O', '711 Onyx St', 'Kemmerer', 'Lincoln', 'WY', '83101', '3078774401', NULL, '711 Onyx St', 'Kemmerer', 'Lincoln', 'WY', '83101', '3078774401', '', 'wystd', 'wyhcpcs', NULL, '0.00', '35.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 0, 'South Lincoln Medical Center', '', '', '', 'HCFA|UB|', '1346286671', 0, 'N', 0, '2014-04-16', NULL, NULL, 0, 0, NULL, NULL),
('830327251', 'WY0200096', 'WY0200096', 'WYT1', 'Star Valley Medical Center', 'Kyle', '', 'Hirschi', 'PA', 'Orthopedic Surgery', '', '', NULL, 'O', '901 Adams St', 'Afton', 'Lincoln', 'WY', '83110', '3078855817', NULL, '901 Adams St', 'Afton', 'Lincoln', 'WY', '83110', '3078855817', '', 'WSTARV', 'wyhcpcs', '', '0.00', '10.00', '0.00', 6, '2010-09-08', NULL, 0, 0, 0, 'Star Valley Medical Center', '', '', '', 'HCFA|UB|', '1881841898', 0, 'N', 0, '2014-07-21', NULL, NULL, 0, 0, NULL, NULL),
('830333437', 'WY0200097', 'WY0200097', 'WYT1', 'Teton Therapy', 'Virginia', 'J', 'Holcomb', 'OT', 'Occupational Therapy', '', '', NULL, 'O', '820 W Main', 'Riverton', 'Fremont', 'WY', '82501', '3078577074', '3078566549', '820 W Main', 'Riverton', 'Fremont', 'WY', '82501', '3078577074', '3078566549', 'WISEWYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2011-01-26', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1932432101', 0, 'N', 0, '2014-03-18', NULL, NULL, 0, 0, NULL, NULL),
('830199236', 'WY0200098', 'WY0200098', 'WYT1', 'Yellowstone Behavioral Health Center', 'Sandra', '', 'Holland', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '2538 Bighorn Ave', 'Cody', 'Park', 'WY', '82414', '3075872197', NULL, '2538 Bighorn Ave', 'Cody', 'Park', 'WY', '82414', '3075872197', '          ', 'MA', '', '', '0.00', '35.00', '0.00', 6, '2009-05-15', '2012-05-25', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1437398716', 0, 'N', 0, '2013-04-23', NULL, NULL, 0, 0, NULL, NULL),
('412060533', 'WY0200099', 'WY0200099', 'WYT1', '', 'Derek', '', 'Hoopes', 'PA', 'Orthopedic Surgery', '', '', NULL, 'O', '170 Arrowhead Dr Ste 3', 'Evanston', 'Uinta', 'WY', '82930', '3077890098', NULL, '170 Arrowhead Dr Ste 3', 'Evanston', 'Uinta', 'WY', '82930', '3077890098', '', 'WUSTDORTH5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 0, 'Evanston Regional Hospital', 'Heber Valley Medical Center', '', '', 'HCFA|UB|', '0000009763', 0, 'N', 0, '2014-06-23', NULL, NULL, 0, 0, NULL, NULL),
('830327251', 'WY0200100', 'WY0200100', 'WYT1', 'Star Valley Medical Center', 'Anne', '', 'Horsley', 'FNP', 'Family Practice', '', '', NULL, 'O', '901 Adams St', 'Afton', 'Lincoln', 'WY', '83110', '3076547138', NULL, '901 Adams St', 'Afton', 'Lincoln', 'WY', '83110', '3076547138', '', 'WSTARV', 'wyhcpcs', NULL, '0.00', '10.00', '0.00', 6, '2007-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000006775', 0, 'N', 0, '2011-06-10', NULL, NULL, 0, 0, NULL, NULL),
('870519172', 'WY0200101', 'WY0200101', 'WYT1', 'Utah Heart Clinic', 'Steven', 'Curtis', 'Horton', 'MD', 'Cardiovascular Disease', 'Internal Medicine', '', NULL, 'O', '110 Hospital Ln', 'Afton', 'Lincoln', 'WY', '83110', '3078855800', NULL, '110 Hospital Ln', 'Afton', 'Lincoln', 'WY', '83110', '3078855800', '', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-12-01', '2008-05-04', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1043288640', 0, 'N', 0, '2014-05-19', NULL, NULL, 0, 0, NULL, NULL),
('870519172', 'WY0200102', 'WY0200102', 'WYT1', 'Utah Heart Clinic', 'Steven', 'Curtis', 'Horton', 'MD', 'Cardiovascular Disease', 'Internal Medicine', '', NULL, 'O', '702 Onyx St', 'Kemmerer', 'Lincoln', 'WY', '83101', '3078774496', NULL, '702 Onyx St', 'Kemmerer', 'Lincoln', 'WY', '83101', '3078774496', '', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-12-01', '2008-05-04', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1043288640', 0, 'N', 0, '2014-05-19', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'WY0200103', 'WY0200103', 'WYT1', 'Intermountain Utah Heart Group', 'Steven', 'Curtis', 'Horton', 'MD', 'Cardiovascular Disease', 'Internal Medicine', '', NULL, 'O', '1400 Uinta Dr', 'Green River', 'Sweetwater', 'WY', '82935', '3078724500', NULL, '1400 Uinta Dr', 'Green River', 'Sweetwater', 'WY', '82935', '3078724500', '', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2009-01-29', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1043288640', 0, 'N', 0, '2014-05-19', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'WY0200104', 'WY0200104', 'WYT1', 'Intermountain Utah Heart Group', 'Steven', 'Curtis', 'Horton', 'MD', 'Cardiovascular Disease', 'Internal Medicine', '', NULL, 'O', '150 Arrowhead Dr', 'Evanston', 'Uinta', 'WY', '82930', '3077890524', '          ', '150 Arrowhead Dr', 'Evanston', 'Uinta', 'WY', '82930', '3077890524', '          ', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2009-01-29', '2014-05-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1043288640', 0, 'N', 0, '2014-05-22', NULL, NULL, 0, 0, NULL, NULL),
('830199236', 'WY0200105', 'WY0200105', 'WYT1', 'Yellowstone Behavioral Health Center', 'Steve', '', 'Humphries-Wadsworth', 'LMFT', 'Mental Health', 'Marriage & Family Therapy', '', NULL, 'O', '2538 Bighorn Ave', 'Cody', 'Park', 'WY', '82414', '3075872197', NULL, '2538 Bighorn Ave', 'Cody', 'Park', 'WY', '82414', '3075872197', '          ', 'PHD', '', '', '0.00', '35.00', '0.00', 6, '2008-12-05', '2013-03-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1700026903', 0, 'N', 0, '2013-05-08', NULL, NULL, 0, 0, NULL, NULL),
('830199236', 'WY0200106', 'WY0200106', 'WYT1', 'Yellowstone Behavioral Health Center', 'Terresa', '', 'Humphries-Wadsworth', 'PHD', 'Mental Health', 'Marriage & Family Therapy', '', NULL, 'O', '2538 Bighorn Ave', 'Cody', 'Park', 'WY', '82414', '3075872197', NULL, '2538 Bighorn Ave', 'Cody', 'Park', 'WY', '82414', '3075872197', '          ', 'PHD', '', '', '0.00', '35.00', '0.00', 6, '2009-01-15', '2012-09-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1811155880', 0, 'N', 0, '2013-04-23', NULL, NULL, 0, 0, NULL, NULL),
('300051569', 'WY0200107', 'WY0200107', 'WYT1', 'Wyoming Specialized Physical Therapy', 'Michael', 'G', 'Jacketta', 'PT', 'Physical Therapy', '', '', NULL, 'O', '1595 S Hwy 150 Ste D', 'Evanston', 'Uinta', 'WY', '82930', '3077898860', NULL, '1595 S Hwy 150 Ste D', 'Evanston', 'Uinta', 'WY', '82930', '3077898860', '', 'wystd', 'wyhcpcs', NULL, '0.00', '35.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1134131055', 0, 'N', 0, '2011-12-19', NULL, NULL, 0, 0, NULL, NULL),
('300051569', 'WY0200109', 'WY0200109', 'WYT1', 'Wyoming Specialized Physical Therapy', 'Michael', 'G', 'Jacketta', 'PT', 'Physical Therapy', '', '', NULL, 'O', '620 W Cheyenne Dr', 'Evanston', 'Uinta', 'WY', '82930', '3077864460', NULL, '620 W Cheyenne Dr', 'Evanston', 'Uinta', 'WY', '82930', '3077864460', '          ', 'wystd', 'wyhcpcs', '', '0.00', '35.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1134131055', 0, 'N', 0, '2011-12-19', NULL, NULL, 0, 0, NULL, NULL),
('300051569', 'WY0200108', 'WY0200108', 'WYT1', 'Wyoming Specialized Physical Therapy', 'Michael', 'G', 'Jacketta', 'PT', 'Physical Therapy', '', '', NULL, 'O', '64 Meadow St', 'Urie', 'Uinta', 'WY', '82937', '3077864460', NULL, '64 Meadow St', 'Urie', 'Uinta', 'WY', '82937', '3077864460', '', 'wystd', 'wyhcpcs', NULL, '0.00', '35.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1134131055', 0, 'N', 0, '2011-12-19', NULL, NULL, 0, 0, NULL, NULL),
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('830317012', 'WY0200233', 'WY0200233', 'WYT1', 'Fremont Therapy Group ', 'Mitchell', '', 'Johnson', 'PT', 'Physical Therapy', '', '', NULL, 'O', '8168 Hwy 789', 'Lander', 'Fremont', 'WY', '82520', '3073325240', NULL, '8168 Hwy 789', 'Lander', 'Fremont', 'WY', '82520', '3073325240', '', 'WYFREEM', 'wyhcpcs', '', '0.00', '35.00', '0.00', 3, '2007-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1013945120', 0, 'n', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('270980493', 'WY0200110', 'WY0200110', 'WYT1', 'Uplift Counseling ', 'Charles', 'E', 'Junkin', 'LPC', 'Mental Health', '', '', NULL, 'O', '501 W Buffalo', 'Rawlins', 'Carbon', 'WY', '82301', '3073245899', NULL, '501 W Buffalo', 'Rawlins', 'Carbon', 'WY', '82301', '3073245899', '          ', 'WYMA', '', '', '0.00', '35.00', '0.00', 3, '2010-07-15', '2013-02-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|DEN|', '1811070782', 0, 'Y', 0, '2013-03-15', NULL, NULL, 0, 0, NULL, NULL),
('830317012', 'WY0200234', 'WY0200234', 'WYT1', 'Fremont Therapy Group ', 'Lorin', 'B', 'Kaufman', 'PT', 'Physical Therapy', '', '', NULL, 'O', '2002 W Sunset Dr Ste 1', 'Riverton', 'Fremont', 'WY', '82501', '3078567021', NULL, '2002 W Sunset Dr Ste 1', 'Riverton', 'Fremont', 'WY', '82501', '3078567021', '', 'WYFREEM', 'wyhcpcs', '', '0.00', '35.00', '0.00', 3, '2007-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1093729543', 0, 'n', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('830317012', 'WY0200235', 'WY0200235', 'WYT1', 'Fremont Therapy Group ', 'Lorin', 'B', 'Kaufman', 'PT', 'Physical Therapy', '', '', NULL, 'O', '8168 Hwy 789', 'Lander', 'Fremont', 'WY', '82520', '3073325240', NULL, '8168 Hwy 789', 'Lander', 'Fremont', 'WY', '82520', '3073325240', '', 'WYFREEM', 'wyhcpcs', '', '0.00', '35.00', '0.00', 3, '2007-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1093729543', 0, 'n', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('830267172', 'WY0200111', 'WY0200111', 'WYT1', 'South Lincoln Medical Clinic', 'Laurie', 'A', 'Keetch', 'FNP', 'Family Practice', '', '', NULL, 'O', '711 Onyx St', 'Kemmerer', 'Lincoln', 'WY', '83101', '3078774496', NULL, '711 Onyx St', 'Kemmerer', 'Lincoln', 'WY', '83101', '3078774496', '', 'wystd', 'wyhcpcs', NULL, '0.00', '35.00', '0.00', 3, '2009-01-14', NULL, 0, 0, 0, 'South Lincoln Medical Center', '', '', '', 'HCFA|UB|', '1851581524', 0, 'N', 0, '2012-03-10', NULL, NULL, 0, 0, NULL, NULL),
('260231993', 'WY0200112', 'WY0200112', 'WYT1', 'Central Wyoming Therapy', 'Cheryl', 'A', 'Keffeler', 'OT', 'Occupational Therapy', '', '', NULL, 'O', '201 E Second St Ste 12', 'Casper', 'Natrona', 'WY', '82601', '3074723327', NULL, '201 E Second St Ste 12', 'Casper', 'Natrona', 'WY', '82601', '3074723327', '          ', 'WISEWYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2010-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|DEN|', '1649328873', 0, 'N', 0, '2011-06-10', NULL, NULL, 0, 0, NULL, NULL),
('830324512', 'WY0200113', 'WY0200113', 'WYT1', 'Evanston Internal Medicine', 'Ardella', 'M', 'Kemmler', 'MD', 'Internal Medicine', 'Rheumatology', '', NULL, 'O', '150 Arrowhead Dr', 'Evanston', 'Uinta', 'WY', '82930', '3077890524', NULL, '150 Arrowhead Dr', 'Evanston', 'Uinta', 'WY', '82930', '3077890524', '', 'WYSTD8', 'wyhcpcs', NULL, '0.00', '35.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, 'Evanston Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1346316221', 0, 'N', 0, '2012-01-03', NULL, NULL, 0, 0, NULL, NULL),
('830235231', 'WY0200114', 'WY0200114', 'WYT1', 'Cloud Peak Counseling Center', 'Kerri', 'D', 'Kinzell', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '206 S 7th St', 'Worland', 'Washakie', 'WY', '82401', '3073476165', NULL, '206 S 7th St', 'Worland', 'Washakie', 'WY', '82401', '3073476165', '', 'MA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2009-03-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1437341310', 0, 'n', 0, '2013-02-22', NULL, NULL, 0, 0, NULL, NULL),
('830330554', 'WY0200118', 'WY0200118', 'WYT1', 'Evanston Clinic', 'Karrie', '', 'Knopf', 'PAC', 'Family Practice', '', '', NULL, 'O', '196 Arrowhead Dr Ste 1', 'Evanston', 'Uinta', 'WY', '82930', '3077838136', '3077838254', '196 Arrowhead Dr Ste 1', 'Evanston', 'Uinta', 'WY', '82930', '3077838136', '3077838254', 'wystd', 'wyhcpcs', '', '0.00', '35.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 0, 'Evanston Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1487659371', 0, 'N', 0, '2013-06-28', NULL, NULL, 0, 0, NULL, NULL),
('830267172', 'WY0200119', 'WY0200119', 'WYT1', 'South Lincoln Medical Clinic', 'George', 'C', 'Krell', 'MD', 'Family Practice', '', '', NULL, 'O', '711 Onyx St', 'Kemmerer', 'Lincoln', 'WY', '83101', '3078774401', NULL, '711 Onyx St', 'Kemmerer', 'Lincoln', 'WY', '83101', '3078774401', '', 'wystd', 'wyhcpcs', NULL, '0.00', '35.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 0, 'South Lincoln Medical Center', '', '', '', 'HCFA|UB|', '1750482527', 0, 'N', 0, '2014-04-16', NULL, NULL, 0, 0, NULL, NULL),
('830254184', 'WY0200236', 'WY0200236', 'WYT1', NULL, 'Ludwig', 'F', 'Kroner', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1204 Hilltop Dr Ste 102', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073825646', NULL, '1204 Hilltop Dr Ste 102', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073825646', '', 'WYORTHO', 'wyhcpcs', NULL, '0.00', '35.00', '0.00', 3, '2009-06-05', NULL, 0, 0, 0, 'Memorial Hospital of Sweetwater County', '', '', '', 'HCFA|UB|', '1093709404', 0, 'n', 0, '2012-05-16', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'WY0200120', 'WY0200120', 'WYT1', 'Intermountain Utah Heart Group', 'Donald', 'Lewis', 'Lappe', 'MD', 'Cardiovascular Disease', 'Internal Medicine', '', NULL, 'O', '110 Hospital Ln', 'Afton', 'Lincoln', 'WY', '83110', '3078855800', NULL, '110 Hospital Ln', 'Afton', 'Lincoln', 'WY', '83110', '3078855800', '', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2009-01-29', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1669440277', 0, 'N', 0, '2014-05-22', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'WY0200122', 'WY0200122', 'WYT1', 'Intermountain Utah Heart Group', 'Donald', 'Lewis', 'Lappe', 'MD', 'Cardiovascular Disease', 'Internal Medicine', '', NULL, 'O', '1400 Uinta Dr', 'Green River', 'Sweetwater', 'WY', '82935', '3078724500', NULL, '1400 Uinta Dr', 'Green River', 'Sweetwater', 'WY', '82935', '3078724500', '', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2009-01-29', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1669440277', 0, 'N', 0, '2014-05-22', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'WY0200123', 'WY0200123', 'WYT1', 'Intermountain Utah Heart Group', 'Donald', 'Lewis', 'Lappe', 'MD', 'Cardiovascular Disease', 'Internal Medicine', '', NULL, 'O', '150 Arrowhead Dr', 'Evanston', 'Uinta', 'WY', '82930', '3077890524', '          ', '150 Arrowhead Dr', 'Evanston', 'Uinta', 'WY', '82930', '3077890524', '          ', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2009-01-29', '2014-05-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1669440277', 0, 'N', 0, '2014-05-22', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'WY0200121', 'WY0200121', 'WYT1', 'Intermountain Utah Heart Group', 'Donald', 'Lewis', 'Lappe', 'MD', 'Cardiovascular Disease', 'Internal Medicine', '', NULL, 'O', '702 Onyx St', 'Kemmerer', 'Lincoln', 'WY', '83101', '3078774496', NULL, '702 Onyx St', 'Kemmerer', 'Lincoln', 'WY', '83101', '3078774496', '', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2009-01-29', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1669440277', 0, 'N', 0, '2014-05-22', NULL, NULL, 0, 0, NULL, NULL),
('830333437', 'WY0200124', 'WY0200124', 'WYT1', 'Teton Therapy', 'Benjamin', 'R', 'Larsen', 'DPT', 'Physical Therapy', '', '', NULL, 'O', '820 W Main', 'Riverton', 'Fremont', 'WY', '82501', '3078577074', '3078566549', '820 W Main', 'Riverton', 'Fremont', 'WY', '82501', '3078577074', '3078566549', 'WISEWYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2011-03-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1487974887', 0, 'N', 0, '2014-03-18', NULL, NULL, 0, 0, NULL, NULL),
('542172261', 'WY0200125', 'WY0200125', 'WYT1', NULL, 'Jason', 'C', 'Levitre', 'DPM', 'Podiatry', '', '', NULL, 'O', '1565 S Hwy 150 Ste C', 'Evanston', 'Uinta', 'WY', '82930', '3072898997', NULL, '1565 S Hwy 150 Ste C', 'Evanston', 'Uinta', 'WY', '82930', '3072898997', '', 'wystd', 'wyhcpcs', NULL, '0.00', '35.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 0, 'Evanston Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1326017179', 0, 'N', 0, '2014-01-24', NULL, NULL, 0, 0, NULL, NULL),
('303724312', 'WY0200126', 'WY0200126', 'WYT1', '', 'Ann', '', 'Lindsey', 'LCSW', 'Mental Health', '', '', NULL, 'O', '501 W Buffalo Basement', 'Rawlins', 'Carbon', 'WY', '82301', '3073245899', '3073242695', '501 W Buffalo Basement', 'Rawlins', 'Carbon', 'WY', '82301', '3073245899', '3073242695', 'WYMA', '', '', '0.00', '35.00', '0.00', 3, '2010-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1114051927', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('830317012', 'WY0200237', 'WY0200237', 'WYT1', 'Fremont Therapy Group ', 'Lisa', '', 'Lowham', 'MS', 'Physical Therapy', '', '', NULL, 'O', '2002 W Sunset Dr Ste 1', 'Riverton', 'Fremont', 'WY', '82501', '3078567021', NULL, '2002 W Sunset Dr Ste 1', 'Riverton', 'Fremont', 'WY', '82501', '3078567021', '          ', 'WYFREEM', 'wyhcpcs', '', '0.00', '35.00', '0.00', 3, '2007-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1467466912', 0, 'Y', 0, '2012-11-12', NULL, NULL, 0, 0, NULL, NULL),
('830317012', 'WY0200238', 'WY0200238', 'WYT1', 'Fremont Therapy Group ', 'Lisa', '', 'Lowham', 'MS', 'Physical Therapy', '', '', NULL, 'O', '8168 Hwy 789', 'Lander', 'Fremont', 'WY', '82520', '3073325240', NULL, '8168 Highway 789', 'Lander', 'Fremont', 'WY', '82520', '3073325240', '          ', 'WYFREEM', 'wyhcpcs', '', '0.00', '35.00', '0.00', 3, '2007-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1467466912', 0, 'Y', 0, '2012-11-12', NULL, NULL, 0, 0, NULL, NULL),
('208741495', 'WY0200239', 'WY0200239', 'WYT1', 'Alliance Physical Therapy', 'Daren', 'L', 'Martin', 'PT', 'Physical Therapy', '', '', NULL, 'O', '1977 Dewar Dr Ste J', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073823228', NULL, '1977 Dewar Dr Ste J', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073823228', '', 'WYALLIANCE', 'wyhcpcs', NULL, '0.00', '35.00', '0.00', 3, '2007-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1750593703', 0, 'n', 0, '2011-09-21', NULL, NULL, 0, 0, NULL, NULL),
('261286085', 'WY0200127', 'WY0200127', 'WYT1', 'Rehab Solutions', 'Dustin', 'D', 'Martinson', 'DPT', 'Physical Therapy', '', '', NULL, 'O', '1103 E Box Elder Rd Ste 4KA', 'Gillette', 'Campbell', 'WY', '82718', '3076868177', '3076869484', '1103 E Box Elder Rd Ste 4KA', 'Gillette', 'Campbell', 'WY', '82718', '3076868177', '3076869484', 'WISEWYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-02-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1073701116', 0, 'N', 0, '2011-07-11', NULL, NULL, 0, 0, NULL, NULL),
('261286085', 'WY0200128', 'WY0200128', 'WYT1', 'Rehab Solutions', 'Heather', 'J', 'Martinson', 'DPT', 'Physical Therapy', '', '', NULL, 'O', '1103 E Box Elder Rd Ste 4KA', 'Gillette', 'Campbell', 'WY', '82718', '3076868177', '3076869484', '1103 E Box Elder Rd Ste 4KA', 'Gillette', 'Campbell', 'WY', '82718', '3076868177', '3076869484', 'WISEWYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-02-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1366630402', 0, 'N', 0, '2013-03-12', NULL, NULL, 0, 0, NULL, NULL),
('830236761', 'WY0200240', 'WY0200240', 'WYT1', 'Fremont Orthopedics', 'Michelle', '', 'Mazur', 'OTR', 'Occupational Therapy', '', '', NULL, 'O', '815 E Main St', 'Lander', 'Fremont', 'WY', '82520', '3073329720', NULL, '815 E Main St', 'Lander', 'Fremont', 'WY', '82520', '3073329720', '', 'WYORTHO2', 'wyhcpcs', '', '0.00', '35.00', '0.00', 3, '2010-03-15', '2013-11-18', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1114061611', 0, 'Y', 0, '2014-05-23', NULL, NULL, 0, 0, NULL, NULL),
('830235231', 'WY0200129', 'WY0200129', 'WYT1', 'Cloud Peak Counseling Center', 'Jacqueline', '', 'McCoughlan', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '206 S 7th St', 'Worland', 'Washakie', 'WY', '82401', '3073476165', '          ', '206 S 7th St', 'Worland', 'Washakie', 'WY', '82401', '3073476165', '          ', 'MA', '', '', '0.00', '35.00', '0.00', 3, '2009-01-09', '2014-07-18', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1588788822', 0, 'N', 0, '2014-04-16', NULL, NULL, 0, 0, NULL, NULL),
('518519218', 'WY0200130', 'WY0200130', 'WYT1', '', 'Denese', 'H', 'McDonald', 'LCSW', 'Mental Health', '', '', NULL, 'O', '2300 Foothill Blvd', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073526677', NULL, '2300 Foothill Blvd', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073526677', '          ', 'MA', '', '', '0.00', '100.00', '0.00', 3, '2007-12-01', '2011-08-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1831269364', 0, 'Y', 0, '2013-01-14', NULL, NULL, 0, 0, NULL, NULL),
('273351051', 'WY0200131', 'WY0200131', 'WYT1', 'Camel Country Clinic', 'Lori', 'E', 'McKinsey', 'FNP', 'Family Practice', '', '', NULL, 'O', '620 4-J Ct Ste C', 'Gillette', 'Campbell', 'WY', '82716', '3076853733', '3076854126', '620 4-J Ct Ste C', 'Gillette', 'Campbell', 'WY', '82716', '3076853733', '3076854126', 'WISEWYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-09-27', '2012-04-17', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1730186255', 0, 'Y', 0, '2012-03-19', NULL, NULL, 0, 0, NULL, NULL),
('431957473', 'WY0200132', 'WY0200132', 'WYT1', 'The Foot Care Center', 'Craig', 'J', 'Mclaws', 'DPM', 'Podiatry', '', '', NULL, 'O', '132 N Gould St', 'Sheridan', 'Sheridan', 'WY', '82801', '3076723457', NULL, '132 N Gould St', 'Sheridan', 'Sheridan', 'WY', '82801', '3076723457', '', 'WisewySTD', 'wyhcpcs', NULL, '0.00', '35.00', '0.00', 3, '2007-08-01', NULL, 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1295744647', 0, 'n', 0, '2011-06-10', NULL, NULL, 0, 0, NULL, NULL),
('431957473', 'WY0200133', 'WY0200133', 'WYT1', 'The Foot Care Center', 'Craig', 'J', 'Mclaws', 'DPM', 'Podiatry', '', '', NULL, 'O', '1401 W 4th St', 'Gillette', 'Campbell', 'WY', '82716', '3076823338', NULL, '1401 W 4th St', 'Gillette', 'Campbell', 'WY', '82716', '3076823338', '', 'WisewySTD', 'wyhcpcs', NULL, '0.00', '35.00', '0.00', 3, '2007-08-01', NULL, 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1295744647', 0, 'n', 0, '2011-06-10', NULL, NULL, 0, 0, NULL, NULL),
('830333437', 'WY0200134', 'WY0200134', 'WYT1', 'Teton Therapy', 'Jeffrey ', 'L', 'McMenamy', 'OT', 'Occupational Therapy', '', '', NULL, 'O', '820 W Main', 'Riverton', 'Fremont', 'WY', '82501', '3078577074', '3078566459', '820 W Main', 'Riverton', 'Fremont', 'WY', '82501', '3078577074', '3078566459', 'WISEWYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2011-01-26', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1740215227', 0, 'N', 0, '2014-03-18', NULL, NULL, 0, 0, NULL, NULL),
('830323501', 'WY0200241', 'WY0200241', 'WYT1', 'Therapy Solutions', 'Connie', 'J', 'Mcmillan', 'PT', 'Physical Therapy', '', '', NULL, 'O', '6631 E 2nd St', 'Casper', 'Natrona', 'WY', '82609', '3072689904', '3072689907', '6631 E 2nd St', 'Casper', 'Natrona', 'WY', '82609', '3072689904', '3072689907', 'THERAPY', '', '', '0.00', '35.00', '0.00', 3, '2010-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1558380774', 0, 'N', 0, '2011-06-10', NULL, NULL, 0, 0, NULL, NULL),
('841555965', 'WY0200135', 'WY0200135', 'WYT1', NULL, 'Eric', 'F', 'Meyer', 'MD', 'Anesthesiology', '', '', NULL, 'O', '6550 E 2nd St', 'Casper', 'Natrona', 'WY', '82609', '3079958100', NULL, '6550 E 2nd St', 'Casper', 'Natrona', 'WY', '82609', '3079958100', '', 'WYSTD', 'WUSTDHCPC5', NULL, '41.00', '35.00', '0.00', 3, '2009-06-15', NULL, 0, 15, 0, '', '', '', '', 'HCFA|UB|', '1982719589', 0, 'n', 0, '2012-05-22', NULL, NULL, 0, 0, NULL, NULL),
('830327251', 'WY0200136', 'WY0200136', 'WYT1', 'Star Valley Medical Center', 'Niki', '', 'Milleson', 'DO', 'Family Practice', '', '', NULL, 'O', '110 Hospital Ln', 'Afton', 'Lincoln', 'WY', '83110', '3078855852', '', '110 Hospital Ln', 'Afton', 'Lincoln', 'WY', '83110', '3078855852', '', 'WSTARV', 'wyhcpcs', '', '0.00', '10.00', '0.00', 6, '2010-11-01', NULL, 0, 0, 0, 'Star Valley Medical Center', '', '', '', 'HCFA|UB|', '1225155997', 0, 'N', 0, '2014-07-25', NULL, NULL, 0, 0, NULL, NULL),
('830327251', 'WY0200137', 'WY0200137', 'WYT1', 'Star Valley Medical Center', 'Christian', 'M', 'Morgan', 'MD', 'Family Practice', '', '', NULL, 'O', '110 Hospital Ln', 'Afton', 'Lincoln', 'WY', '83110', '3078855852', '', '110 Hospital Ln', 'Afton', 'Lincoln', 'WY', '83110', '3078855852', '', 'WSTARV', 'wyhcpcs', '', '0.00', '10.00', '0.00', 6, '2010-03-19', NULL, 0, 0, 0, 'Star Valley Medical Center', '', '', '', 'HCFA|UB|', '1457358962', 0, 'N', 0, '2014-07-24', NULL, NULL, 0, 0, NULL, NULL),
('810284764', 'WY0200138', 'WY0200138', 'WYT1', 'Arapahoe Health Center', 'Jacqueline', '', 'Nelson', 'MD', 'Pediatrics', '', '', NULL, 'O', '17 Great Plains Rd', 'Arapahoe', 'Fremont', 'WY', '82510', '3078569281', '3078577063', '17 Great Plains Rd', 'Arapahoe', 'Fremont', 'WY', '82510', '3078569281', '3078577063', 'WYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2010-10-01', NULL, 0, 0, 0, 'SageWest Health Care', NULL, NULL, NULL, 'HCFA|UB|', '1548333206', 0, 'N', 0, '2011-06-10', NULL, NULL, 0, 0, NULL, NULL),
('810284764', 'WY0200139', 'WY0200139', 'WYT1', 'Fort Washakie Health Center', 'Jacqueline', '', 'Nelson', 'MD', 'Pediatrics', '', '', NULL, 'O', '29 Black Coal Dr', 'Fort Washakie', 'Fremont', 'WY', '82514', '3073320446', '3073320131', '29 Black Coal Dr', 'Fort Washakie', 'Fremont', 'WY', '82514', '3073320446', '3073320131', 'WYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2010-10-01', NULL, 0, 0, 0, 'SageWest Health Care', NULL, NULL, NULL, 'HCFA|UB|', '1548333206', 0, 'N', 0, '2011-06-10', NULL, NULL, 0, 0, NULL, NULL),
('830317012', 'WY0200242', 'WY0200242', 'WYT1', 'Fremont Therapy Group', 'Kristopher', '', 'Nelson', 'PT', 'Physical Therapy', '', '', NULL, 'O', '2002 W Sunset Dr Ste 1', 'Riverton', 'Fremont', 'WY', '82501', '3078567021', NULL, '2002 W Sunset Dr Ste 1', 'Riverton', 'Fremont', 'WY', '82501', '3078567021', '          ', 'WYFREEM', 'wyhcpcs', '', '0.00', '35.00', '0.00', 3, '2007-07-01', '2011-06-08', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1558375006', 0, 'N', 0, '2011-06-10', NULL, NULL, 0, 0, NULL, NULL),
('830317012', 'WY0200243', 'WY0200243', 'WYT1', 'Fremont Therapy Group', 'Kristopher', '', 'Nelson', 'PT', 'Physical Therapy', '', '', NULL, 'O', '8168 Highway 789', 'Lander', 'Fremont', 'WY', '82520', '3073325240', NULL, '8168 Highway 789', 'Lander', 'Fremont', 'WY', '82520', '3073325240', '          ', 'WYFREEM', 'wyhcpcs', '', '0.00', '35.00', '0.00', 3, '2007-07-01', '2011-06-08', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1558375006', 0, 'N', 0, '2011-06-10', NULL, NULL, 0, 0, NULL, NULL),
('830210617', 'WY0200141', 'WY0200141', 'WYT1', 'Moorcroft Clinic', 'Keith', 'A', 'Noback', 'MD', 'Family Practice', '', '', NULL, 'O', '107 W Crook', 'Moorcroft', 'Crook', 'WY', '82721', '3077563414', NULL, '107 W Crook', 'Moorcroft', 'Crook', 'WY', '82721', '3077563414', '', 'WISEWYSTD', 'Wyhcpcs', NULL, '0.00', '35.00', '0.00', 6, '2007-09-01', NULL, 0, 0, 0, 'Crook County Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1154437317', 0, 'N', 0, '2013-09-25', NULL, NULL, 0, 0, NULL, NULL),
('830210617', 'WY0200140', 'WY0200140', 'WYT1', 'Halett Clinic', 'Keith', 'A', 'Noback', 'MD', 'Family Practice', '', '', NULL, 'O', '122 Main St', 'Hulett', 'Crook', 'WY', '82720', '3074675281', NULL, '122 Main St', 'Hulett', 'Crook', 'WY', '82720', '3074675281', '', 'WISEWYSTD', 'Wyhcpcs', NULL, '0.00', '35.00', '0.00', 6, '2007-09-01', NULL, 0, 0, 0, 'Crook County Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1154437317', 0, 'N', 0, '2013-09-25', NULL, NULL, 0, 0, NULL, NULL),
('830210617', 'WY0200142', 'WY0200142', 'WYT1', 'Sundance Clinic', 'Keith', 'A', 'Noback', 'MD', 'Family Practice', '', '', NULL, 'O', '713 Oak St', 'Sundance', 'Crook', 'WY', '82729', '3072832476', NULL, '713 Oak St', 'Sundance', 'Crook', 'WY', '82729', '3072832476', '', 'WISEWYSTD', 'Wyhcpcs', NULL, '0.00', '35.00', '0.00', 6, '2007-09-01', NULL, 0, 0, 0, 'Crook County Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1154437317', 0, 'N', 0, '2013-09-25', NULL, NULL, 0, 0, NULL, NULL),
('830330554', 'WY0200143', 'WY0200143', 'WYT1', 'Evanston Clinic', 'Gary', '', 'Noe', 'MD', 'Family Practice', '', '', NULL, 'O', '107 N Main St', 'Lyman', 'Uinta', 'WY', '82937', '3077873313', NULL, '107 N Main St', 'Lyman', 'Uinta', 'WY', '82937', '3077873313', '', 'wystd', 'wyhcpcs', '', '0.00', '35.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 0, 'Evanston Regional Hospital', '', '', '', 'HCFA|UB|', '1417952391', 0, 'N', 0, '2014-04-16', NULL, NULL, 0, 0, NULL, NULL),
('830330554', 'WY0200144', 'WY0200144', 'WYT1', 'Mountain View Medical Clinic', 'Gary', '', 'Noe', 'MD', 'Family Practice', '', '', NULL, 'O', '831 Parkway Dr', 'Mountain View', 'Uinta', 'WY', '82939', '3077891390', NULL, '831 Parkway Dr', 'Mountain View', 'Uinta', 'WY', '82939', '3077891390', '', 'wystd', 'wyhcpcs', '', '0.00', '35.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 0, 'Evanston Regional Hospital', '', '', '', 'HCFA|UB|', '1417952391', 0, 'N', 0, '2014-04-16', NULL, NULL, 0, 0, NULL, NULL),
('830330554', 'WY0200145', 'WY0200145', 'WYT1', 'Evanston Clinic', 'Edmund', '', 'Nowicki', 'MD', 'Family Practice', '', '', NULL, 'O', '196 Arrowhead Dr Ste 1', 'Evanston', 'Uinta', 'WY', '82930', '3077838200', NULL, '196 Arrowhead Dr Ste 1', 'Evanston', 'Uinta', 'WY', '82930', '3077838200', '          ', 'wystd', 'wyhcpcs', '', '0.00', '35.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 0, 'Evanston Regional Hospital', '', '', '', 'HCFA|UB|', '1902801897', 0, 'N', 0, '2013-06-28', NULL, NULL, 0, 0, NULL, NULL),
('870333759', 'WY0200146', 'WY0200146', 'WYT1', NULL, 'Richard', 'H', 'Odell', 'MD', 'Dermatology', '', '', NULL, 'O', '150 Arrowhead Dr', 'Evanston', 'Uinta', 'WY', '82930', '3077890524', NULL, '150 Arrowhead Dr', 'Evanston', 'Uinta', 'WY', '82930', '3077890524', '', 'WiseStd', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1215999875', 0, 'N', 0, '2013-01-31', NULL, NULL, 0, 0, NULL, NULL),
('830237418', 'WY0200147', 'WY0200147', 'WYT1', NULL, 'Joseph', 'J', 'Oliver', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1204 Hilltop Dr Ste 103', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073627745', NULL, '1204 Hilltop Dr Ste 103', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073627745', '', 'wystd', 'wyhcpcs', NULL, '0.00', '35.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, 'Memorial Hospital of Sweetwater County', NULL, NULL, NULL, 'HCFA|UB|', '1477564656', 0, 'N', 0, '2011-06-10', NULL, NULL, 0, 0, NULL, NULL),
('412060533', 'WY0200249', 'WY0200249', 'WYT1', '', 'Gordon', 'S', 'Olsen', 'DO', 'Orthopedic Surgery', '', '', NULL, 'O', '170 Arrowhead Dr Ste 3', 'Evanston', 'Uinta', 'WY', '82930', '3077890098', NULL, '170 Arrowhead Dr Ste 3', 'Evanston', 'Uinta', 'WY', '82930', '3077890098', '          ', 'WUSTDORTH5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 0, 'Evanston Regional Hospital', 'Heber Valley Medical Center', NULL, NULL, 'HCFA|UB|', '1235237744', 0, 'N', 0, '2014-01-21', NULL, NULL, 0, 0, NULL, NULL),
('204028167', 'WY0200148', 'WY0200148', 'WYT1', 'Goose Creek Pediatrics', 'Suzanne', 'E', 'Oss', 'MD', 'Pediatrics', '', '', NULL, 'O', '1701 W 5th St Ste A', 'Sheridan', 'Sheridan', 'WY', '82801', '3076727700', NULL, '1701 W 5th St Ste A', 'Sheridan', 'Sheridan', 'WY', '82801', '3076727700', '', 'WiseWYSTD', 'Wyhcpcs', NULL, '0.00', '35.00', '0.00', 3, '2007-07-01', NULL, 0, 0, 0, 'Sheridan Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1316973613', 0, 'N', 0, '2013-06-28', NULL, NULL, 0, 0, NULL, NULL),
('721537787', 'WY0200149', 'WY0200149', 'WYT1', 'Lander Family Medicine', 'Susan', 'M', 'Pearson', 'MD', 'Family Practice', '', '', NULL, 'O', '8185 S Hwy 789', 'Lander', 'Fremont', 'WY', '82520', '3073321551', NULL, '8185 S Hwy 789', 'Lander', 'Fremont', 'WY', '82520', '3073321551', '          ', 'WisewySTD', 'wyhcpcs', '', '0.00', '35.00', '0.00', 3, '2007-08-01', '2011-06-30', 0, 0, 0, 'SageWest Health Care', NULL, NULL, NULL, 'HCFA|UB|', '1245289511', 0, 'N', 0, '2012-05-07', NULL, NULL, 0, 0, NULL, NULL),
('830199236', 'WY0200150', 'WY0200150', 'WYT1', 'Yellowstone Behavioral Health Center', 'Jan', '', 'Pedro', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '2538 Bighorn Ave', 'Cody', 'Park', 'WY', '82414', '3075872197', NULL, '2538 Bighorn Ave', 'Cody', 'Park', 'WY', '82414', '3075872197', '          ', 'MA', '', '', '0.00', '35.00', '0.00', 6, '2009-02-06', '2011-11-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1104064195', 0, 'N', 0, '2013-04-23', NULL, NULL, 0, 0, NULL, NULL),
('830183531', 'WY0200151', 'WY0200151', 'WYT1', '', 'Orson', 'D', 'Perkes', 'MD', 'Family Practice', '', '', NULL, 'O', '110 Hospital Ln', 'Afton', 'Lincoln', 'WY', '83110', '3078855837', NULL, '110 Hospital Ln', 'Afton', 'Lincoln', 'WY', '83110', '3078855837', '          ', 'wystd', 'wyhcpcs', '', '0.00', '35.00', '0.00', 3, '2006-12-01', '2012-11-15', 0, 0, 0, 'Star Valley Medical Center', '', '', '', 'HCFA|UB|', '0000008137', 0, 'N', 0, '2012-11-20', NULL, NULL, 0, 0, NULL, NULL),
('710972884', 'WY0200152', 'WY0200152', 'WYT1', 'Timeless Touch Skin Professionals', 'Lynn', '', 'Perlenfein', 'PA-C', 'Dermatology', '', '', NULL, 'O', '3805 S Douglas Hwy Ste 2', 'Gillette', 'Campbell', 'WY', '82718', '3076858111', NULL, '3805 S Douglas Hwy Ste 2', 'Gillette', 'Campbell', 'WY', '82718', '3076858111', '          ', 'WiseWYSTD', 'wyhcpcs', '', '0.00', '35.00', '0.00', 3, '2007-08-01', '2011-06-21', 0, 0, 0, 'Campbell County Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1881641553', 0, 'N', 0, '2013-10-29', NULL, NULL, 0, 0, NULL, NULL),
('830327251', 'WY0200153', 'WY0200153', 'WYT1', 'Star Valley Medical Center', 'Lance', '', 'Petersen', 'MD', 'Family Practice', '', '', NULL, 'O', '901 Adams St', 'Afton', 'Lincoln', 'WY', '83110', '3078855817', '', '901 Adams St', 'Afton', 'Lincoln', 'WY', '83110', '3078855817', '', 'WSTARV', 'wyhcpcs', '', '0.00', '10.00', '0.00', 6, '2010-09-08', NULL, 0, 0, 0, 'Star Valley Medical Center', '', '', '', 'HCFA|UB|', '1245303429', 0, 'N', 0, '2014-07-25', NULL, NULL, 0, 0, NULL, NULL),
('830317012', 'WY0200244', 'WY0200244', 'WYT1', 'Fremont Therapy Group ', 'Scott', '', 'Phister', 'PT', 'Physical Therapy', '', '', NULL, 'O', '2002 W Sunset Dr Ste 1', 'Riverton', 'Fremont', 'WY', '82501', '3078567021', NULL, '2002 W Sunset Dr Ste 1', 'Riverton', 'Fremont', 'WY', '82501', '3078567021', '', 'WYFREEM', 'wyhcpcs', NULL, '0.00', '35.00', '0.00', 3, '2007-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1568484475', 0, 'n', 0, '2011-06-10', NULL, NULL, 0, 0, NULL, NULL),
('830317012', 'WY0200245', 'WY0200245', 'WYT1', 'Fremont Therapy Group ', 'Scott', '', 'Phister', 'PT', 'Physical Therapy', '', '', NULL, 'O', '8168 Hwy 789', 'Lander', 'Fremont', 'WY', '82520', '3073325240', NULL, '8168 Highway 789', 'Lander', 'Fremont', 'WY', '82520', '3073325240', '', 'WYFREEM', 'wyhcpcs', NULL, '0.00', '35.00', '0.00', 3, '2007-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1568484475', 0, 'n', 0, '2011-06-10', NULL, NULL, 0, 0, NULL, NULL),
('830327251', 'WY0200154', 'WY0200154', 'WYT1', 'Star Valley Medical Center', 'Michael ', 'Ross', 'Pieper', 'DO', 'Family Practice', '', '', NULL, 'O', '901 Adams St', 'Afton', 'Lincoln', 'WY', '83110', '3078855817', '', '901 Adams St', 'Afton', 'Lincoln', 'WY', '83110', '3078855817', '', 'WSTARV', 'wyhcpcs', '', '0.00', '10.00', '0.00', 6, '2010-09-08', NULL, 0, 0, 0, 'Star Valley Medical Center', '', '', '', 'HCFA|UB|', '1174717128', 0, 'N', 0, '2014-07-25', NULL, NULL, 0, 0, NULL, NULL);
INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
('721537787', 'WY0200155', 'WY0200155', 'WYT1', 'Lander Family Medicine', 'Steve', '', 'Platz', 'PA', 'Family Practice', '', '', NULL, 'O', '8160 S Hwy 789', 'Lander', 'Fremont', 'WY', '82520', '3073321551', NULL, '8160 S Hwy 789', 'Lander', 'Fremont', 'WY', '82520', '3073321551', '          ', 'WisewySTD', 'wyhcpcs', '', '0.00', '35.00', '0.00', 3, '2009-03-30', '2011-06-30', 0, 0, 0, 'SageWest Health Care', NULL, NULL, NULL, 'HCFA|UB|', '1376638338', 0, 'N', 0, '2011-07-13', NULL, NULL, 0, 0, NULL, NULL),
('830323501', 'WY0200246', 'WY0200246', 'WYT1', 'Therapy Solutions', 'Mark', 'S', 'Plessman', 'OT', 'Occupational Therapy', '', '', NULL, 'O', '6631 E 2nd St', 'Casper', 'Natrona', 'WY', '82609', '3072689904', '3072689907', '6631 E 2nd St', 'Casper', 'Natrona', 'WY', '82609', '3072689904', '3072689907', 'THERAPY', '', '', '0.00', '35.00', '0.00', 3, '2010-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1326060658', 0, 'N', 0, '2011-06-10', NULL, NULL, 0, 0, NULL, NULL),
('520582578', 'WY0200156', 'WY0200156', 'WYT1', 'Alternative Counseling Associates', 'Cheryl', 'C', 'Portwood', 'MD', 'Mental Health', 'Pediatric Psychiatry', 'Psychiatry', NULL, 'O', '315 Main St Ste 6', 'Lander', 'Fremont', 'WY', '82520', '3073324515', NULL, '315 Main St Ste 6', 'Lander', 'Fremont', 'WY', '82520', '3073324515', '', 'WYMD', NULL, NULL, '0.00', '35.00', '0.00', 3, '2009-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1639246044', 0, 'n', 0, '2013-03-18', NULL, NULL, 0, 0, NULL, NULL),
('205760783', 'WY0200250', 'WY0200250', 'WYT1', 'Rock Springs Family Practice', 'Melinda', 'J', 'Poyer', 'DO', 'Family Practice', '', '', NULL, 'O', '1208 Hilltop Dr Ste 205', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073620083', NULL, '1208 Hilltop Dr Ste 205', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073620083', '', 'WYRSFP', 'wyhcpcs', NULL, '0.00', '25.00', '0.00', 3, '2007-12-15', NULL, 0, 0, 0, 'Memorial Hospital of Sweetwater County', '', '', '', 'HCFA|UB|', '1033175831', 0, 'n', 0, '2011-06-10', NULL, NULL, 0, 0, NULL, NULL),
('270248138', 'WY0200157', 'WY0200157', 'WYT1', 'Big Horn Urgent Care', 'Travis', 'M', 'Preszler', 'PA-C', 'Urgent Care', '', '', NULL, 'O', '813 Highland Ave', 'Sheridan', 'Sheridan', 'WY', '82801', '3076735501', NULL, '813 Highland Ave', 'Sheridan', 'Sheridan', 'WY', '82801', '3076735501', '', 'WYSTD', 'wyhcpcs', NULL, '0.00', '35.00', '0.00', 3, '2010-03-10', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1770565764', 0, 'n', 0, '2013-06-18', NULL, NULL, 0, 0, NULL, NULL),
('810284761', 'WY0200158', 'WY0200158', 'WYT1', 'Arapahoe Health Center', 'Garth ', 'E', 'Reber', 'DO', 'Family Practice', '', '', NULL, 'O', '17 Great Plains Rd', 'Arapahoe', 'Fremont', 'WY', '82510', '3078569281', '3073320131', '17 Great Plains Rd', 'Arapahoe', 'Fremont', 'WY', '82510', '3078569281', '3073320131', 'WYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2010-10-01', NULL, 0, 0, 0, 'SageWest Health Care', '', '', '', 'HCFA|UB|', '1417029950', 0, 'N', 0, '2011-06-10', NULL, NULL, 0, 0, NULL, NULL),
('810284761', 'WY0200159', 'WY0200159', 'WYT1', 'Wind River Fort Washakie Health Center', 'Garth ', 'E', 'Reber', 'DO', 'Family Practice', '', '', NULL, 'O', '29 Black Coal Dr', 'Fort Washakie', 'Fremont', 'WY', '82514', '3073320446', '3073320131', '29 Black Coal Dr', 'Fort Washakie', 'Fremont', 'WY', '82514', '3073320446', '3073320131', 'WYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2010-10-01', NULL, 0, 0, 0, 'SageWest Health Care', '', '', '', 'HCFA|UB|', '1417029950', 0, 'N', 0, '2011-06-10', NULL, NULL, 0, 0, NULL, NULL),
('810284764', 'WY0200160', 'WY0200160', 'WYT1', 'Arapahoe Health Center', 'Phillip', 'K', 'Rector', '', 'Mental Health', '', '', NULL, 'O', '17 Great Plains Rd', 'Arapahoe', 'Fremont', 'WY', '82510', '3078569281', '3078577063', '17 Great Plains Rd', 'Arapahoe', 'Fremont', 'WY', '82510', '3078569281', '3078577063', 'WYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2010-10-01', NULL, 0, 0, 0, 'SageWest Health Care', NULL, NULL, NULL, 'HCFA|UB|', '1952468043', 0, 'N', 0, '2011-06-10', NULL, NULL, 0, 0, NULL, NULL),
('810284764', 'WY0200161', 'WY0200161', 'WYT1', 'Fort Washakie Health Center', 'Phillip', 'K', 'Rector', '', 'Mental Health', '', '', NULL, 'O', '29 Black Coal Dr', 'Fort Washakie', 'Fremont', 'WY', '82514', '3073320446', '3073320131', '29 Black Coal Dr', 'Fort Washakie', 'Fremont', 'WY', '82514', '3073320446', '3073320131', 'WYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2010-10-01', NULL, 0, 0, 0, 'SageWest Health Care', NULL, NULL, NULL, 'HCFA|UB|', '1952468043', 0, 'N', 0, '2011-06-10', NULL, NULL, 0, 0, NULL, NULL),
('810284764', 'WY0200162', 'WY0200162', 'WYT1', 'Arapahoe Health Center', 'Joni', 'D', 'Renbarger', 'PSYD', 'Mental Health', 'Psychology', '', NULL, 'O', '17 Great Plains Rd', 'Arapahoe', 'Fremont', 'WY', '82510', '3078569281', '3078577063', '17 Great Plains Rd', 'Arapahoe', 'Fremont', 'WY', '82510', '3078569281', '3078577063', 'WYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, 'SageWest Health Care', '', '', '', 'HCFA|UB|', '1629238365', 0, 'N', 0, '2014-07-21', NULL, NULL, 0, 0, NULL, NULL),
('810284764', 'WY0200163', 'WY0200163', 'WYT1', 'Fort Washakie Health Center', 'Joni', 'D', 'Renbarger', 'PSYD', 'Mental Health', 'Psychology', '', NULL, 'O', '29 Black Coal Dr', 'Fort Washakie', 'Fremont', 'WY', '82514', '3073320446', '3073320131', '29 Black Coal Dr', 'Fort Washakie', 'Fremont', 'WY', '82514', '3073320446', '3073320131', 'WYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2010-11-01', NULL, 0, 0, 0, 'SageWest Health Care', '', '', '', 'HCFA|UB|', '1629238365', 0, 'N', 0, '2014-07-21', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'WY0200164', 'WY0200164', 'WYT1', 'Intermountain Utah Heart Group', 'James', 'R', 'Revenaugh', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '110 Hospital Ln', 'Afton', 'Lincoln', 'WY', '83110', '3078855800', NULL, '110 Hospital Ln', 'Afton', 'Lincoln', 'WY', '83110', '3078855800', '', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2009-01-29', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1316915952', 0, 'N', 0, '2014-05-19', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'WY0200166', 'WY0200166', 'WYT1', 'Intermountain Utah Heart Group', 'James', 'R', 'Revenaugh', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1400 Uinta Dr', 'Green River', 'Sweetwater', 'WY', '82935', '3078724500', NULL, '1400 Uinta Dr', 'Green River', 'Sweetwater', 'WY', '82935', '3078724500', '', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2009-01-29', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1316915952', 0, 'N', 0, '2014-05-19', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'WY0200167', 'WY0200167', 'WYT1', 'Intermountain Utah Heart Group', 'James', 'R', 'Revenaugh', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '150 Arrowhead Dr', 'Evanston', 'Uinta', 'WY', '82930', '3077890524', '          ', '150 Arrowhead Dr', 'Evanston', 'Uinta', 'WY', '82930', '3077890524', '          ', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2009-01-29', '2014-05-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1316915952', 0, 'N', 0, '2014-05-22', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'WY0200165', 'WY0200165', 'WYT1', 'Intermountain Utah Heart Group', 'James', 'R', 'Revenaugh', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '702 Onyx St', 'Kemmerer', 'Lincoln', 'WY', '83101', '3078774496', NULL, '702 Onyx St', 'Kemmerer', 'Lincoln', 'WY', '83101', '3078774496', '', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2009-01-29', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1316915952', 0, 'N', 0, '2014-05-19', NULL, NULL, 0, 0, NULL, NULL),
('870507858', 'WY0200168', 'WY0200168', 'WYT1', 'Neurological Associates', 'Christopher', 'J', 'Reynolds', 'MD', 'Neurology', 'Sleep Medicine', '', NULL, 'O', '196 Arrowhead Dr Ste 5', 'Evanston', 'Uinta', 'WY', '82930', '8662909881', NULL, '196 Arrowhead Dr Ste 5', 'Evanston', 'Uinta', 'WY', '82930', '8662909881', '          ', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-07-15', NULL, 0, 0, 0, 'Evanston Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1700843695', 0, 'N', 0, '2013-12-10', NULL, NULL, 0, 0, NULL, NULL),
('270248138', 'WY0200169', 'WY0200169', 'WYT1', 'Big Horn Urgent Care', 'Sylvia', 'A', 'Rife', 'ARNP', 'Urgent Care', '', '', NULL, 'O', '813 Highland Ave', 'Sheridan', 'Sheridan', 'WY', '82801', '3076735501', '3076735434', '813 Highland Ave', 'Sheridan', 'Sheridan', 'WY', '82801', '3076735501', '3076735434', 'WISEWYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-02-01', '2014-07-15', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1245292242', 0, 'N', 0, '2014-07-22', NULL, NULL, 0, 0, NULL, NULL),
('830210617', 'WY0200171', 'WY0200171', 'WYT1', 'Moorcroft Clinic', 'Erin', 'L', 'Rogers', 'MD', 'Family Practice', '', '', NULL, 'O', '107 W Crook', 'Moorcroft', 'Crook', 'WY', '82721', '3077563414', '          ', '107 W Crook', 'Moorcroft', 'Crook', 'WY', '82721', '3077563414', '          ', 'WISEWYSTD', 'Wyhcpcs', '', '0.00', '35.00', '0.00', 6, '2007-09-01', '2014-05-13', 0, 0, 0, 'Crook County Memorial Hospital', '', '', '', 'HCFA|UB|', '1104932359', 0, 'N', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('830210617', 'WY0200170', 'WY0200170', 'WYT1', 'Halett Clinic', 'Erin', 'L', 'Rogers', 'MD', 'Family Practice', '', '', NULL, 'O', '122 Main St', 'Hulett', 'Crook', 'WY', '82720', '3074675281', '          ', '122 Main St', 'Hulett', 'Crook', 'WY', '82720', '3074675281', '          ', 'WISEWYSTD', 'Wyhcpcs', '', '0.00', '35.00', '0.00', 6, '2007-09-01', '2014-05-13', 0, 0, 0, 'Crook County Memorial Hospital', '', '', '', 'HCFA|UB|', '1104932359', 0, 'N', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('830210617', 'WY0200172', 'WY0200172', 'WYT1', 'Sundance Clinic', 'Erin', 'L', 'Rogers', 'MD', 'Family Practice', '', '', NULL, 'O', '713 Oak St', 'Sundance', 'Crook', 'WY', '82729', '3072832476', '          ', '713 Oak St', 'Sundance', 'Crook', 'WY', '82729', '3072832476', '          ', 'WISEWYSTD', 'Wyhcpcs', '', '0.00', '35.00', '0.00', 6, '2007-09-01', '2014-05-13', 0, 0, 0, 'Crook County Memorial Hospital', '', '', '', 'HCFA|UB|', '1104932359', 0, 'N', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('830235231', 'WY0200173', 'WY0200173', 'WYT1', 'Cloud Peak Counseling Center', 'Mark', 'C', 'Russler', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '206 S 7th St', 'Worland', 'Washakie', 'WY', '82401', '3073476165', NULL, '206 S 7th St', 'Worland', 'Washakie', 'WY', '82401', '3073476165', '', 'MA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2009-01-09', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1962526228', 0, 'n', 0, '2012-01-19', NULL, NULL, 0, 0, NULL, NULL),
('270613074', 'WY0200174', 'WY0200174', 'WYT1', 'LS Educational and Psychoeducational Services', 'Liza', 'D', 'Sanderson', 'LPC', 'Mental Health', '', '', NULL, 'O', '2980 Shetland Dr', 'Rawlins', 'Carbon', 'WY', '82301', '3077603611', NULL, '2980 Shetland Dr', 'Rawlins', 'Carbon', 'WY', '82301', '3077603611', '          ', 'WYMA', '', '', '0.00', '35.00', '0.00', 3, '2010-06-01', '2013-10-12', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1447584511', 0, 'Y', 0, '2013-07-15', NULL, NULL, 0, 0, NULL, NULL),
('261112301', 'WY0200175', 'WY0200175', 'WYT1', 'Hope Counseling', 'Heather', '', 'Sanford', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '15 S 6th St', 'Greybull', 'Big Horn', 'WY', '82426', '3077652060', NULL, '15 S 6th St', 'Greybull', 'Big Horn', 'WY', '82426', '3077652060', '', 'WYMA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2010-03-08', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1851515431', 0, 'n', 0, '2011-06-10', NULL, NULL, 0, 0, NULL, NULL),
('810284764', 'WY0200176', 'WY0200176', 'WYT1', 'Arapahoe Health Center', 'Marilyn', 'R', 'Scott', 'NP', 'Family Practice', '', '', NULL, 'O', '17 Great Plains Rd', 'Arapahoe', 'Fremont', 'WY', '82510', '3078569281', '3078577063', '17 Great Plains Rd', 'Arapahoe', 'Fremont', 'WY', '82510', '3078569281', '3078577063', 'WYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2010-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1740264993', 0, 'N', 0, '2011-06-10', NULL, NULL, 0, 0, NULL, NULL),
('810284764', 'WY0200177', 'WY0200177', 'WYT1', 'Fort Washakie Health Center', 'Marilyn', 'R', 'Scott', 'NP', 'Family Practice', '', '', NULL, 'O', '29 Black Coal Dr', 'Fort Washakie', 'Fremont', 'WY', '82514', '3073320446', '3073320131', '29 Black Coal Dr', 'Fort Washakie', 'Fremont', 'WY', '82514', '3073320446', '3073320131', 'WYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2010-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1740264993', 0, 'N', 0, '2011-06-10', NULL, NULL, 0, 0, NULL, NULL),
('830327251', 'WY0200178', 'WY0200178', 'WYT1', 'Star Valley Medical Center', 'David ', '', 'Shrader', 'MD', 'Internal Medicine', '', '', NULL, 'O', '901 Adams St', 'Afton', 'Lincoln', 'WY', '83110', '3078855817', NULL, '901 Adams St', 'Afton', 'Lincoln', 'WY', '83110', '3078855817', '', 'WSTARV', 'wyhcpcs', '', '0.00', '10.00', '0.00', 6, '2010-09-08', '2013-12-31', 0, 0, 0, 'Star Valley Medical Center', '', '', '', 'HCFA|UB|', '1275615494', 0, 'N', 0, '2014-04-03', NULL, NULL, 0, 0, NULL, NULL),
('460482972', 'WY0200179', 'WY0200179', 'WYT1', '', 'Eric', 'H', 'Siiteri', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '903 A S Greeley Hwy', 'Cheyenne', 'Laramie', 'WY', '82007', '8887969217', NULL, '903 A S Greeley Hwy', 'Cheyenne', 'Laramie', 'WY', '82007', '8887969217', '          ', 'UTPHD', '', '', '0.00', '35.00', '0.00', 3, '2008-11-07', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1235108994', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('830324512', 'WY0200180', 'WY0200180', 'WYT1', 'Evanston Internal Medicine', 'Thomas', 'J', 'Simon', 'MD', 'Internal Medicine', '', '', NULL, 'O', '150 Arrowhead Dr Ste 1', 'Evanston', 'Uinta', 'WY', '82930', '3077890524', NULL, '150 Arrowhead Dr Ste 1', 'Evanston', 'Uinta', 'WY', '82930', '3077890524', '', 'WYSTD8', 'wyhcpcs', '', '0.00', '35.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, 'Evanston Regional Hospital', '', '', '', 'HCFA|UB|', '1609883453', 0, 'N', 0, '2014-06-23', NULL, NULL, 0, 0, NULL, NULL),
('270248138', 'WY0200181', 'WY0200181', 'WYT1', 'Big Horn Urgent Care', 'Michel', 'W', 'Skaf', 'MD', 'Internal Medicine', 'Cardiovascular Disease', '', NULL, 'O', '813 Highland Ave', 'Sheridan', 'Sheridan', 'WY', '82801', '3076735501', '3076735434', '813 Highland Ave', 'Sheridan', 'Sheridan', 'WY', '82801', '3076735501', '3076735434', 'WYSTD', 'wyhcpcs', '', '0.00', '35.00', '0.00', 3, '2010-02-15', NULL, 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1821041740', 0, 'Y', 0, '2014-04-01', NULL, NULL, 0, 0, NULL, NULL),
('870503202', 'WY0200182', 'WY0200182', 'WYT1', 'South Lincoln Medical Clinic', 'Demetrios', 'G', 'Skedros', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '711 Onyx St', 'Kemmerer', 'Lincoln', 'WY', '83101', '3078774496', NULL, '711 Onyx St', 'Kemmerer', 'Lincoln', 'WY', '83101', '3078774496', '', 'WiseStd', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 0, 'Davis Hospital', 'Lakeview Hospital', NULL, NULL, 'HCFA|UB|', '1821146242', 0, 'N', 0, '2013-08-19', NULL, NULL, 0, 0, NULL, NULL),
('830267172', 'WY0200183', 'WY0200183', 'WYT1', 'South Lincoln Medical Clinic', '', '', 'South Lincoln Medical Clinic', 'GROUP', 'Clinic', '', '', NULL, 'O', '711 Onyx St', 'Kemmerer', 'Lincoln', 'WY', '83101', '3078774401', NULL, '711 Onyx St', 'Kemmerer', 'Lincoln', 'WY', '83101', '3078774401', '', 'wystd', 'wyhcpcs', NULL, '0.00', '35.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000008833', 0, 'Y', 0, '2014-02-07', NULL, NULL, 0, 0, NULL, NULL),
('830249025', 'WY0200247', 'WY0200247', 'WYT1', NULL, 'Palur', 'V', 'Sridharan', 'MD', 'General Surgery', '', '', NULL, 'O', '519 8th St', 'Rawlins', 'Carbon', 'WY', '82301', '3073242705', NULL, '519 8th St', 'Rawlins', 'Carbon', 'WY', '82301', '3073242705', '', 'WYSINCLAIR', 'wyhcpcs', NULL, '0.00', '35.00', '0.00', 3, '2007-10-01', NULL, 0, 0, 0, 'Memorial Hospital of Carbon County', NULL, NULL, NULL, 'HCFA|UB|', '1881672897', 0, 'n', 0, '2013-05-08', NULL, NULL, 0, 0, NULL, NULL),
('830267172', 'WY0200184', 'WY0200184', 'WYT1', 'South Lincoln Medical Clinic', 'Jeremy', 'C', 'Starr', 'DO', 'Family Practice', '', '', NULL, 'O', '711 Onyx St', 'Kemmerer', 'Lincoln', 'WY', '83101', '3078774401', NULL, '711 Onyx St', 'Kemmerer', 'Lincoln', 'WY', '83101', '3078774401', '', 'wystd', 'wyhcpcs', NULL, '0.00', '35.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 0, 'South Lincoln Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1699876987', 0, 'N', 0, '2011-12-29', NULL, NULL, 0, 0, NULL, NULL),
('830327251', 'WY0200185', 'WY0200185', 'WYT1', 'Star Valley Medical Center', 'Noel', 'B', 'Stibor', 'MD', 'Family Practice', '', '', NULL, 'O', '901 Adams St', 'Afton', 'Lincoln', 'WY', '83110', '3078855852', NULL, '901 Adams St', 'Afton', 'Lincoln', 'WY', '83110', '3078855852', '', 'WSTARV', 'wyhcpcs', NULL, '0.00', '10.00', '0.00', 6, '2007-01-01', NULL, 0, 0, 0, 'Star Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1750327979', 0, 'N', 0, '2011-06-10', NULL, NULL, 0, 0, NULL, NULL),
('870503202', 'WY0200186', 'WY0200186', 'WYT1', 'Mountain West Ear Nose and Throat', 'Curt', 'R', 'Stock', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '901 Adams St', 'Afton', 'Lincoln', 'WY', '83110', '3078855800', NULL, '901 Adams St', 'Afton', 'Lincoln', 'WY', '83110', '3078855800', '', 'WiseStd', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 0, 'Davis Hospital', 'Lakeview Hospital', 'Primary Childrens Medical Center', 'Star Valley Medical Center', 'HCFA|UB|', '1275681686', 0, 'N', 0, '2013-08-16', NULL, NULL, 0, 0, NULL, NULL),
('830327251', 'WY0200187', 'WY0200187', 'WYT1', 'Star Valley Medical Center', 'Curt', 'R', 'Stock', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '901 Adams St', 'Afton', 'Lincoln', 'WY', '83110', '3078855817', NULL, '901 Adams St', 'Afton', 'Lincoln', 'WY', '83110', '3078855817', '', 'WSTARV', 'wyhcpcs', NULL, '0.00', '10.00', '0.00', 6, '2007-01-01', NULL, 0, 0, 0, 'Davis Hospital', 'Lakeview Hospital', 'Primary Childrens Medical Center', 'Star Valley Medical Center', 'HCFA|UB|', '1275681686', 0, 'N', 0, '2013-08-16', NULL, NULL, 0, 0, NULL, NULL),
('830199236', 'WY0200188', 'WY0200188', 'WYT1', 'Yellowstone Behavioral Health Center', 'Kristin', 'R', 'Sween', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '2538 Bighorn Ave', 'Cody', 'Park', 'WY', '82414', '3075872197', NULL, '2538 Bighorn Ave', 'Cody', 'Park', 'WY', '82414', '3075872197', '', 'MA', NULL, NULL, '0.00', '35.00', '0.00', 6, '2009-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1225205867', 0, 'n', 0, '2013-11-21', NULL, NULL, 0, 0, NULL, NULL),
('870507858', 'WY0200189', 'WY0200189', 'WYT1', 'Neurological Associates', 'Mohammad', 'E', 'Taher', 'MD', 'Neurology', NULL, NULL, NULL, 'O', '196 Arrowhead Dr Ste 5', 'Evanston', 'Uinta', 'WY', '82930', '8662909881', NULL, '196 Arrowhead Dr Ste 5', 'Evanston', 'Uinta', 'WY', '82930', '8662909881', '          ', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-07-15', NULL, 0, 0, 0, 'Evanston Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1992762918', 0, 'N', 0, '2011-06-10', NULL, NULL, 0, 0, NULL, NULL),
('830327251', 'WY0200190', 'WY0200190', 'WYT1', 'Star Valley Medical Center', 'Brian', 'D', 'Tallerico', 'DO', 'Orthopedic Surgery', '', '', NULL, 'O', '901 Adams St', 'Afton', 'Lincoln', 'WY', '83110', '3078855870', NULL, '901 Adams St', 'Afton', 'Lincoln', 'WY', '83110', '3078855870', '', 'WSTARV', 'wyhcpcs', NULL, '0.00', '10.00', '0.00', 6, '2007-01-01', NULL, 0, 0, 0, 'Star Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1538137724', 0, 'N', 0, '2011-06-10', NULL, NULL, 0, 0, NULL, NULL),
('830327251', 'WY0200191', 'WY0200191', 'WYT1', 'Star Valley Medical Center', 'Ruthanne ', '', 'Taylor', 'APRN', 'Family Practice', '', '', NULL, 'O', '901 Adams St', 'Afton', 'Lincoln', 'WY', '83110', '3078855817', '          ', '901 Adams St', 'Afton', 'Lincoln', 'WY', '83110', '3078855817', '          ', 'WSTARV', 'wyhcpcs', '', '0.00', '10.00', '0.00', 6, '2010-09-08', '2014-03-24', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1538278171', 0, 'N', 0, '2014-03-31', NULL, NULL, 0, 0, NULL, NULL),
('830333437', 'WY0200192', 'WY0200192', 'WYT1', 'Teton Therapy', '', '', 'Teton Therapy', 'Group', 'Physical Therapy', 'Occupational Therapy', '', NULL, 'O', '820 W Main', 'Riverton', 'Fremont', 'WY', '82501', '3078577044', '3078566459', '820 W Main', 'Riverton', 'Fremont', 'WY', '82501', '3078577044', '3078566459', 'WISEWYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2011-01-25', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1275564122', 0, 'N', 0, '2014-03-20', NULL, NULL, 0, 0, NULL, NULL),
('836000025', 'WY0200193', 'WY0200193', 'WYT1', 'Wagon Circle Family Practice', 'James', 'A', 'Trent', 'MD', 'Family Practice', '', '', NULL, 'B', '2221 W Elm St', 'Rawlins', 'Carbon', 'WY', '82301', '3073242221', '3073248232', '2221 W Elm St', 'Rawlins', 'Carbon', 'WY', '82301', '3073242221', '3073248232', 'WISEWYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 6, '2010-09-30', NULL, 0, 0, 0, 'Memorial Hospital of Carbon County', '', '', '', 'HCFA|', '1285756007', 0, 'N', 0, '2013-09-12', NULL, NULL, 0, 0, NULL, NULL),
('352293133', 'WY0200194', 'WY0200194', 'WYT1', 'Alternative Counseling Associates', 'Patricia', 'J', 'Vazquez', 'LMFT', 'Mental Health', 'Marriage & Family Therapy', '', NULL, 'O', '315 Main St', 'Lander', 'Fremont', 'WY', '82520', '3073324515', NULL, '315 Main St', 'Lander', 'Fremont', 'WY', '82520', '3073324515', '', 'WYMA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2009-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1669594958', 0, 'n', 0, '2013-03-14', NULL, NULL, 0, 0, NULL, NULL),
('830210617', 'WY0200196', 'WY0200196', 'WYT1', 'Moorcroft Clinic', 'Jeremi', '', 'Villano', 'MD', 'Family Practice', '', '', NULL, 'O', '107 W Crook', 'Moorcroft', 'Crook', 'WY', '82721', '3077563414', NULL, '107 W Crook', 'Moorcroft', 'Crook', 'WY', '82721', '3077563414', '', 'WISEWYSTD', 'Wyhcpcs', NULL, '0.00', '35.00', '0.00', 6, '2007-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1265548424', 0, 'N', 0, '2011-06-10', NULL, NULL, 0, 0, NULL, NULL),
('830210617', 'WY0200195', 'WY0200195', 'WYT1', 'Halett Clinic', 'Jeremi', '', 'Villano', 'MD', 'Family Practice', '', '', NULL, 'O', '122 Main St', 'Hulett', 'Crook', 'WY', '82720', '3074675281', NULL, '122 Main St', 'Hulett', 'Crook', 'WY', '82720', '3074675281', '', 'WISEWYSTD', 'Wyhcpcs', NULL, '0.00', '35.00', '0.00', 6, '2007-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1265548424', 0, 'N', 0, '2011-06-10', NULL, NULL, 0, 0, NULL, NULL),
('830210617', 'WY0200197', 'WY0200197', 'WYT1', 'Sundance Clinic', 'Jeremi', '', 'Villano', 'MD', 'Family Practice', '', '', NULL, 'O', '713 Oak St', 'Sundance', 'Crook', 'WY', '82729', '3072832476', NULL, '713 Oak St', 'Sundance', 'Crook', 'WY', '82729', '3072832476', '', 'WISEWYSTD', 'Wyhcpcs', NULL, '0.00', '35.00', '0.00', 6, '2007-09-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1265548424', 0, 'N', 0, '2011-06-10', NULL, NULL, 0, 0, NULL, NULL),
('830210617', 'WY0200199', 'WY0200199', 'WYT1', 'Moorcroft Clinic', 'Patricia', '', 'Voll', 'FNP', 'Family Practice', '', '', NULL, 'O', '107 W Crook', 'Moorcroft', 'Crook', 'WY', '82721', '3077563414', NULL, '107 W Crook', 'Moorcroft', 'Crook', 'WY', '82721', '3077563414', '', 'WISEWYSTD', 'Wyhcpcs', NULL, '0.00', '35.00', '0.00', 6, '2007-09-01', NULL, 0, 0, 0, 'Crook County Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1457467607', 0, 'N', 0, '2013-09-25', NULL, NULL, 0, 0, NULL, NULL),
('830210617', 'WY0200198', 'WY0200198', 'WYT1', 'Halett Clinic', 'Patricia', '', 'Voll', 'FNP', 'Family Practice', '', '', NULL, 'O', '122 Main St', 'Hulett', 'Crook', 'WY', '82720', '3074675281', NULL, '122 Main St', 'Hulett', 'Crook', 'WY', '82720', '3074675281', '', 'WISEWYSTD', 'Wyhcpcs', NULL, '0.00', '35.00', '0.00', 6, '2007-09-01', NULL, 0, 0, 0, 'Crook County Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1457467607', 0, 'N', 0, '2013-09-25', NULL, NULL, 0, 0, NULL, NULL),
('830210617', 'WY0200200', 'WY0200200', 'WYT1', 'Sundance Clinic', 'Patricia', '', 'Voll', 'FNP', 'Family Practice', '', '', NULL, 'O', '713 Oak St', 'Sundance', 'Crook', 'WY', '82729', '3072832476', NULL, '713 Oak St', 'Sundance', 'Crook', 'WY', '82729', '3072832476', '', 'WISEWYSTD', 'Wyhcpcs', NULL, '0.00', '35.00', '0.00', 6, '2007-09-01', NULL, 0, 0, 0, 'Crook County Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1457467607', 0, 'N', 0, '2013-09-25', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'WY0200201', 'WY0200201', 'WYT1', 'Intermountain Utah Heart Group', 'Kevin', 'J', 'Walsh', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '110 Hospital Ln', 'Afton', 'Lincoln', 'WY', '83110', '3078855800', NULL, '110 Hospital Ln', 'Afton', 'Lincoln', 'WY', '83110', '3078855800', '', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2009-01-29', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1609845734', 0, 'N', 0, '2014-05-19', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'WY0200203', 'WY0200203', 'WYT1', 'Intermountain Utah Heart Group', 'Kevin', 'J', 'Walsh', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1400 Uinta Dr', 'Green River', 'Sweetwater', 'WY', '82935', '3078724500', NULL, '1400 Uinta Dr', 'Green River', 'Sweetwater', 'WY', '82935', '3078724500', '', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2009-01-29', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1609845734', 0, 'N', 0, '2014-05-19', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'WY0200204', 'WY0200204', 'WYT1', 'Intermountain Utah Heart Group', 'Kevin', 'J', 'Walsh', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '150 Arrowhead Dr', 'Evanston', 'Uinta', 'WY', '82930', '3077890524', '          ', '150 Arrowhead Dr', 'Evanston', 'Uinta', 'WY', '82930', '3077890524', '          ', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2009-01-29', '2014-05-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1609845734', 0, 'N', 0, '2014-05-22', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'WY0200202', 'WY0200202', 'WYT1', 'Intermountain Utah Heart Group', 'Kevin', 'J', 'Walsh', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '702 Onyx St', 'Kemmerer', 'Lincoln', 'WY', '83101', '3078774496', NULL, '702 Onyx St', 'Kemmerer', 'Lincoln', 'WY', '83101', '3078774496', '', 'WUSTDCARD5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2009-01-29', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1609845734', 0, 'N', 0, '2014-05-19', NULL, NULL, 0, 0, NULL, NULL),
('830199236', 'WY0200205', 'WY0200205', 'WYT1', 'Yellowstone Behavioral Health Center', 'Randalene', '', 'Washburn', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '2538 Bighorn Ave', 'Cody', 'Park', 'WY', '82414', '3075872197', NULL, '2538 Bighorn Ave', 'Cody', 'Park', 'WY', '82414', '3075872197', '          ', 'MA', '', '', '0.00', '35.00', '0.00', 6, '2009-05-15', '2012-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1073753893', 0, 'N', 0, '2012-01-09', NULL, NULL, 0, 0, NULL, NULL),
('830237580', 'WY0200208', 'WY0200208', 'WYT1', 'Western Wyoming Family Planning', '', '', 'Western Wyoming Family Planning', 'GROUP', 'Obstetrics and Gynecology', '', '', NULL, 'O', '325 W Main', 'Riverton', 'Fremont', 'WY', '82501', '3078567212', NULL, '325 W Main', 'Riverton', 'Fremont', 'WY', '82501', '3078567212', '', 'WYSTD', 'wyhcpcs', NULL, '0.00', '35.00', '0.00', 3, '2007-03-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009585', 0, 'n', 0, '2011-06-10', NULL, NULL, 0, 0, NULL, NULL),
('830237580', 'WY0200207', 'WY0200207', 'WYT1', 'Western Wyoming Family Planning', '', '', 'Western Wyoming Family Planning', 'GROUP', 'Obstetrics and Gynecology', '', '', NULL, 'O', '350 City View Dr', 'Evanston', 'Uinta', 'WY', '82930', '3077899520', NULL, '350 City View Dr', 'Evanston', 'Uinta', 'WY', '82930', '3077899520', '', 'WYSTD', 'wyhcpcs', NULL, '0.00', '35.00', '0.00', 3, '2007-03-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009585', 0, 'n', 0, '2011-06-10', NULL, NULL, 0, 0, NULL, NULL),
('830237580', 'WY0200206', 'WY0200206', 'WYT1', 'Western Wyoming Family Planning', '', '', 'Western Wyoming Family Planning', 'GROUP', 'Obstetrics and Gynecology', '', '', NULL, 'O', '809 Rhode Island Ste 12A', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073626813', NULL, '809 Rhode Island Ste 12A', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073626813', '', 'WYSTD', 'wyhcpcs', NULL, '0.00', '35.00', '0.00', 3, '2007-03-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009585', 0, 'n', 0, '2011-06-10', NULL, NULL, 0, 0, NULL, NULL),
('830236761', 'WY0200248', 'WY0200248', 'WYT1', 'Fremont Orthopedics', 'John', '', 'Whipp', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '815 E Main St', 'Lander', 'Fremont', 'WY', '82520', '8004437173', NULL, '815 E Main St', 'Lander', 'Fremont', 'WY', '82520', '8004437173', '          ', 'WYORTHO2', 'wyhcpcs', '', '0.00', '35.00', '0.00', 3, '2009-09-11', NULL, 0, 0, 0, 'SageWest Health Care', NULL, NULL, NULL, 'HCFA|UB|', '1649375502', 0, 'N', 0, '2013-09-27', NULL, NULL, 0, 0, NULL, NULL),
('830235231', 'WY0200209', 'WY0200209', 'WYT1', 'Cloud Peak Counseling Center', 'Wendy', 'K', 'Wiecki', 'CMHW', 'Mental Health', 'Social Worker', '', NULL, 'O', '206 S 7th St', 'Worland', 'Washakie', 'WY', '82401', '3073476165', NULL, '206 S 7th St', 'Worland', 'Washakie', 'WY', '82401', '3073476165', '', 'MA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2009-01-09', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1760506067', 0, 'n', 0, '2012-01-11', NULL, NULL, 0, 0, NULL, NULL),
('487621499', 'WY0200210', 'WY0200210', 'WYT1', 'Coffeen Clinic', 'Edward', 'A', 'Wilson', 'DO', 'Family Practice', '', '', NULL, 'O', '1955 Coffen Ave Ste A', 'Sheridan', 'Sheridan', 'WY', '82801', '3076720773', NULL, '1955 Coffen Ave Ste A', 'Sheridan', 'Sheridan', 'WY', '82801', '3076720773', '          ', 'WiseWYSTD', 'Wyhcpcs', '', '0.00', '35.00', '0.00', 3, '2007-07-01', '2013-11-02', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1447336680', 0, 'N', 0, '2013-11-14', NULL, NULL, 0, 0, NULL, NULL),
('830235231', 'WY0200211', 'WY0200211', 'WYT1', 'Cloud Peak Counseling Center', 'Darcie', '', 'Wisehart', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '206 S 7th St', 'Worland', 'Washakie', 'WY', '82401', '3073476165', NULL, '206 S 7th St', 'Worland', 'Washakie', 'WY', '82401', '3073476165', '', 'MA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-12-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1558486621', 0, 'n', 0, '2011-10-07', NULL, NULL, 0, 0, NULL, NULL),
('262668995', 'WY0200212', 'WY0200212', 'WYT1', 'Wyoming Healthy Option & Alternatives', 'Medea', '', 'Woods', '', 'Mental Health', 'Psychology', '', NULL, 'O', ' 214 1/2 Maple', 'Rawlins', 'Carbon', 'WY', '82301', '3073240092', NULL, ' 214 1/2 Maple', 'Rawlins', 'Carbon', 'WY', '82301', '3073240092', '          ', 'RAWLINSPHD', '', '', '0.00', '35.00', '0.00', 3, '2010-04-20', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1881890291', 0, 'N', 0, '2011-06-10', NULL, NULL, 0, 0, NULL, NULL),
('830267172', 'WY0200214', 'WY0200214', 'WYT1', 'South Lincoln Medical Clinic', 'Gregory', 'M', 'Yasuda', 'MD', 'General Surgery', '', '', NULL, 'O', '711 Onyx St', 'Kemmerer', 'Lincoln', 'WY', '83101', '3078774401', NULL, '711 Onyx St', 'Kemmerer', 'Lincoln', 'WY', '83101', '3078774401', '', 'wystd', 'wyhcpcs', NULL, '0.00', '35.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 0, 'South Lincoln Medical Center', '', '', '', 'HCFA|UB|', '1841391349', 0, 'N', 0, '2014-04-17', NULL, NULL, 0, 0, NULL, NULL),
('830267172', 'WY0200213', 'WY0200213', 'WYT1', 'Evanston Medical Clinic', 'Gregory', 'M', 'Yasuda', 'MD', 'General Surgery', '', '', NULL, 'O', '75 Yellow Creek Rd Ste 101', 'Evanston', 'Uinta', 'WY', '82930', '3077897777', NULL, '75 Yellow Creek Rd Ste 101', 'Evanston', 'Uinta', 'WY', '82930', '3077897777', '', 'wystd', 'wyhcpcs', NULL, '0.00', '35.00', '0.00', 3, '2008-11-05', NULL, 0, 0, 0, 'South Lincoln Medical Center', '', '', '', 'HCFA|UB|', '1841391349', 0, 'N', 0, '2014-04-17', NULL, NULL, 0, 0, NULL, NULL),
('830333437', 'WY0200215', 'WY0200215', 'WYT1', 'Teton Therapy', 'Margaret', 'A', 'Zeiss', 'PT', 'Physical Therapy', '', '', NULL, 'O', '820 W Main', 'Riverton', 'Fremont', 'WY', '82501', '3078577074', '3078566549', '820 W Main', 'Riverton', 'Fremont', 'WY', '82501', '3078577074', '3078566549', 'WISEWYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2011-03-01', '2014-01-02', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1386663813', 0, 'N', 0, '2014-02-04', NULL, NULL, 0, 0, NULL, NULL),
('264241796', 'WY0200216', 'WY0200216', 'WYT1', 'Big Horn Family Medicine', 'Edward', 'D', 'Zimmerman', 'MD', 'Family Practice', '', '', NULL, 'O', ' 316 N 10th St', 'Worland', 'Washakie', 'WY', '82401', '3073478885', '3073472428', ' 316 N 10th St', 'Worland', 'Washakie', 'WY', '82401', '3073478885', '3073472428', 'WISEWYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-07-09', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|DEN|', '1386646669', 0, 'N', 0, '2014-05-22', NULL, NULL, 0, 0, NULL, NULL),
('201391282', 'WYT200620', 'WYT200620', 'WYT2', 'Thunder Basin Orthopedics and Sports Medicine', 'Joseph', 'F', 'Allegretto', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '109 W Lakeway', 'Gillette', 'Campbell', 'WY', '82718', '3076826222', NULL, '109 W Lakeway', 'Gillette', 'Campbell', 'WY', '82718', '3076826222', '', 'WYORTHO10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-12-15', NULL, 0, 0, 0, 'Memorial Hospital of Converse County', '', '', '', 'HCFA|UB|', '1508823964', 0, 'N', 0, '2014-04-28', NULL, NULL, 0, 0, NULL, NULL),
('830259403', 'WYT200252', 'WYT200252', 'WYT2', 'High Country Audiology', 'Michael', 'B', 'Alley', 'AUD', 'Audiology', '', '', NULL, 'O', '125 Main St', 'Lander', 'Fremont', 'WY', '82520', '3073325088', NULL, '125 Main St', 'Lander', 'Fremont', 'WY', '82520', '3073325088', '          ', 'WISEWYSTD', 'wyhcpcs', '', '0.00', '35.00', '0.00', 3, '2007-10-01', '2011-06-28', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1801999826', 0, 'N', 0, '2013-04-17', NULL, NULL, 0, 0, NULL, NULL),
('830259403', 'WYT200253', 'WYT200253', 'WYT2', 'High Country Audiology', 'Michael', 'B', 'Alley', 'AUD', 'Audiology', '', '', NULL, 'O', '514 Broadway', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073620055', NULL, '514 Broadway', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073620055', '          ', 'WISEWYSTD', 'wyhcpcs', '', '0.00', '35.00', '0.00', 3, '2007-10-01', '2011-06-28', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1801999826', 0, 'N', 0, '2013-04-17', NULL, NULL, 0, 0, NULL, NULL),
('204746599', 'WYT200254', 'WYT200254', 'WYT2', 'Alliance Home Health of Wyoming', '', '', 'Alliance Home Health of Wyoming', 'GROUP', 'Home Health Agency', '', '', NULL, 'O', '102293 US Hwy 89', 'Thayne', 'Lincoln', 'WY', '83127', '3078837583', NULL, '102293 US Hwy 89', 'Thayne', 'Lincoln', 'WY', '83127', '3078837583', '          ', '', '', '4', '0.00', '100.00', '0.00', 3, '2007-01-01', '2011-06-27', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '0000004979', 0, 'N', 0, '2011-07-18', NULL, NULL, 0, 0, NULL, NULL),
('204746599', 'WYT200255', 'WYT200255', 'WYT2', 'Alliance Home Health of Wyoming', '', '', 'Alliance Home Health of Wyoming', 'GROUP', 'Home Health Agency', '', '', NULL, 'B', 'PO Box 1001', 'Thayne', 'Lincoln', 'WY', '83127', '3078837583', NULL, 'PO Box 1001', 'Thayne', 'Lincoln', 'WY', '83127', '3078837583', '          ', '', '', '4', '0.00', '100.00', '0.00', 3, '2007-01-01', '2011-06-27', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '0000004979', 0, 'N', 0, '2011-07-18', NULL, NULL, 0, 0, NULL, NULL),
('830306180', 'WYT200763', 'WYT200763', 'WYT2', 'College Hill Womens Center', 'Peter', 'G', 'Allyn', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '3000 College Dr Ste A', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073621861', NULL, '3000 College Dr Ste A', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073621861', '          ', '', '', '', '0.00', '10.00', '0.00', 3, '2009-03-09', NULL, 0, 0, 0, 'Memorial Hospital of Sweetwater County', '', '', '', 'HCFA|UB|', '1801991013', 0, 'N', 0, '2013-08-21', NULL, NULL, 0, 0, NULL, NULL),
('203147173', 'WYT200665', 'WYT200665', 'WYT2', 'Altitude Analysis Inc', '', '', 'Altitude Analysis Inc', 'GROUP', 'Laboratory', '', '', NULL, 'O', '2328 Foothill Blvd', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073624552', NULL, '2328 Foothill Blvd', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073624552', '          ', 'WISEWYSTD', 'wyhcpcs', '', '0.00', '35.00', '0.00', 3, '2007-09-01', '2011-06-28', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1558554113', 0, 'N', 0, '2011-06-30', NULL, NULL, 0, 0, NULL, NULL),
('830332771', 'WYT200480', 'WYT200480', 'WYT2', 'ABC Pediatrics', 'Linda', 'K', 'Ammari', 'MD', 'Pediatrics', 'Infectious Disease', '', NULL, 'O', '1300 W 4th St', 'Gillette', 'Campbell', 'WY', '82716', '3076864900', NULL, '1300 W 4th St', 'Gillette', 'Campbell', 'WY', '82716', '3076864900', '          ', '', '', '', '0.00', '6.50', '0.00', 3, '2008-10-17', '2011-06-28', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1124190277', 0, 'N', 0, '2013-11-19', NULL, NULL, 0, 0, NULL, NULL),
('830258707', 'WYT200504', 'WYT200504', 'WYT2', 'Wyoming Surgical Associates', 'James', '', 'Anderson', 'MD', 'Colon and Rectal Surgery', 'General Surgery', 'Vascular Surgery', NULL, 'O', '419 S Washington St Ste 102', 'Casper', 'Natrona', 'WY', '82601', '3075774220', '3072350931', '419 S Washington St Ste 102', 'Casper', 'Natrona', 'WY', '82601', '3075774220', '3072350931', '', '', '', '0.00', '0.00', '0.00', 3, '2009-12-15', '2012-06-14', 0, 0, 1, 'Wyoming Medical Center ', NULL, NULL, NULL, 'HCFA|UB|', '1205822442', 0, 'Y', 0, '2012-06-27', NULL, NULL, 0, 0, NULL, NULL),
('202299593', 'WYT200764', 'WYT200764', 'WYT2', 'Red Desert InstaCare', 'Rich', '', 'Anderson', 'PA-C', 'Family Practice', '', '', NULL, 'O', '2761 Commercial Way', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073823064', NULL, '2761 Commercial Way', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073823064', '          ', '', '', '', '0.00', '7.50', '0.00', 3, '2007-01-01', '2011-06-28', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1811084080', 0, 'N', 0, '2011-10-11', NULL, NULL, 0, 0, NULL, NULL),
('202299593', 'WYT200765', 'WYT200765', 'WYT2', 'Wyoming Range Medical', 'Rich', '', 'Anderson', 'PA-C', 'Family Practice', '', '', NULL, 'B', 'PO Box 130', 'Big Piney', 'Sublette', 'WY', '83113', '3072764700', NULL, 'PO Box 130', 'Big Piney', 'Sublette', 'WY', '83113', '3072764700', '          ', '', '', '', '0.00', '7.50', '0.00', 3, '2007-01-01', '2011-06-28', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1811084080', 0, 'Y', 0, '2011-10-11', NULL, NULL, 0, 0, NULL, NULL),
('830330554', 'WYT200457', 'WYT200457', 'WYT2', 'Evanston Regional Hospital', 'Frank', 'J', 'Archer', 'MD', 'Family Practice', '', '', NULL, 'O', '196 Arrowhead Dr Ste 1', 'Evanston', 'Uinta', 'WY', '82930', '3077878200', NULL, '196 Arrowhead Dr Ste 1', 'Evanston', 'Uinta', 'WY', '82930', '3077878200', '          ', 'wystd', 'wyhcpcs', '', '0.00', '35.00', '0.00', 3, '2006-12-01', '2011-06-15', 0, 0, 0, 'Mountain View Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1093710998', 0, 'N', 0, '2013-10-15', NULL, NULL, 0, 0, NULL, NULL),
('841399721', 'WYT200721', 'WYT200721', 'WYT2', 'Frontier Audiology', 'Lori', 'L', 'Archie', 'AUD', 'Audiology', '', '', NULL, 'O', '222 S 5th St', 'Douglas', 'Converse', 'WY', '82633', '3073388300', NULL, '222 S 5th St', 'Douglas', 'Converse', 'WY', '82633', '3073388300', '', 'WISEWYSTD', 'wyhcpcs', '', '0.00', '35.00', '0.00', 3, '2007-07-01', '2011-06-28', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1710072681', 0, 'N', 0, '2014-04-24', NULL, NULL, 0, 0, NULL, NULL),
('841399721', 'WYT200722', 'WYT200722', 'WYT2', 'Frontier Audiology', 'Lori', 'L', 'Archie', 'AUD', 'Audiology', '', '', NULL, 'O', '407 S Medical Arts Ct Ste F', 'Gillette', 'Campbell', 'WY', '82716', '3076823399', NULL, '407 S Medical Arts Ct Ste F', 'Gillette', 'Campbell', 'WY', '82716', '3076823399', '', 'WISEWYSTD', 'wyhcpcs', '', '0.00', '35.00', '0.00', 3, '2007-07-01', '2011-06-28', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1710072681', 0, 'N', 0, '2014-04-24', NULL, NULL, 0, 0, NULL, NULL),
('841399721', 'WYT200723', 'WYT200723', 'WYT2', 'Frontier Audiology', 'Lori', 'L', 'Archie', 'AUD', 'Audiology', '', '', NULL, 'B', '968 Gilchirst', 'Wheatland', 'Platte', 'WY', '82201', '3076823399', NULL, '968 Gilchirst', 'Wheatland', 'Platte', 'WY', '82201', '3076823399', '', 'WISEWYSTD', 'wyhcpcs', '', '0.00', '35.00', '0.00', 3, '2007-07-01', '2011-06-28', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1710072681', 0, 'Y', 0, '2014-04-24', NULL, NULL, 0, 0, NULL, NULL),
('205050083', 'WYT200256', 'WYT200256', 'WYT2', 'Wyoming Vision Center', 'Alison', 'A', 'Arrants', 'OD', 'Optometry', '', '', NULL, 'O', '2820 Foothill Blvd', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073824444', NULL, '2820 Foothill Blvd', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073824444', '', 'WYSTD', 'wyhcpcs', '', '0.00', '35.00', '0.00', 3, '2007-05-01', '2011-06-28', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1144270091', 0, 'N', 0, '2014-05-07', NULL, NULL, 0, 0, NULL, NULL),
('205050083', 'WYT200257', 'WYT200257', 'WYT2', 'Wyoming Vision Center', 'Alison', 'A', 'Arrants', 'OD', 'Optometry', '', '', NULL, 'B', 'PO Box 2250', 'Rock Springs', 'Sweetwater', 'WY', '82902', '3073824444', NULL, 'PO Box 2250', 'Rock Springs', 'Sweetwater', 'WY', '82902', '3073824444', '', 'WYSTD', 'wyhcpcs', '', '0.00', '35.00', '0.00', 3, '2007-05-01', '2011-06-28', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1144270091', 0, 'Y', 0, '2014-05-07', NULL, NULL, 0, 0, NULL, NULL),
('200425381', 'WYT200258', 'WYT200258', 'WYT2', 'Advanced Eyecare Center', 'William', 'F', 'Atkinson', 'OD', 'Optometry', '', '', NULL, 'O', '547 Cheyenne Dr', 'Evanston', 'Uinta', 'WY', '82930', '3077893937', NULL, '547 Cheyenne Dr', 'Evanston', 'Uinta', 'WY', '82930', '3077893937', '          ', 'wystd', 'wyhcpcs', '', '0.00', '35.00', '0.00', 3, '2006-12-01', '2011-06-27', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1518007517', 0, 'N', 0, '2011-06-29', NULL, NULL, 0, 0, NULL, NULL),
('830219655', 'WYT200579', 'WYT200579', 'WYT2', 'Premier Bone and Joint Centers', 'Ryan', '', 'Aukerman', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1400 Uinta Dr', 'Green River', 'Sweetwater', 'WY', '82935', '3078757576', NULL, '1400 Uinta Dr', 'Green River', 'Sweetwater', 'WY', '82935', '3078757576', '          ', '', '', '', '0.00', '10.00', '0.00', 3, '2009-07-01', NULL, 0, 0, 1, 'Wyoming Medical Center ', NULL, NULL, NULL, 'HCFA|UB|', '1417912858', 0, 'N', 0, '2013-03-13', NULL, NULL, 0, 0, NULL, NULL),
('830219655', 'WYT200580', 'WYT200580', 'WYT2', 'Premier Bone and Joint Centers', 'Ryan', '', 'Aukerman', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', '1458 W 5th', 'Sheridan', 'Sheridan', 'WY', '82801', '3076730623', NULL, '1458 W 5th', 'Sheridan', 'Sheridan', 'WY', '82801', '3076730623', '          ', '', '', '', '0.00', '10.00', '0.00', 3, '2009-07-01', NULL, 0, 0, 1, 'Wyoming Medical Center ', NULL, NULL, NULL, 'HCFA|UB|', '1417912858', 0, 'N', 0, '2013-03-13', NULL, NULL, 0, 0, NULL, NULL),
('830219655', 'WYT200581', 'WYT200581', 'WYT2', 'Premier Bone and Joint Centers', 'Ryan', '', 'Aukerman', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', '1909 Vista Dr', 'Laramie', 'Albany', 'WY', '82070', '3077458851', NULL, '1909 Vista Dr', 'Laramie', 'Albany', 'WY', '82070', '3077458851', '          ', '', '', '', '0.00', '10.00', '0.00', 3, '2009-07-01', NULL, 0, 0, 1, 'Wyoming Medical Center ', NULL, NULL, NULL, 'HCFA|UB|', '1417912858', 0, 'N', 0, '2013-03-13', NULL, NULL, 0, 0, NULL, NULL),
('830219655', 'WYT200582', 'WYT200582', 'WYT2', 'Premier Bone and Joint Centers', 'Ryan', '', 'Aukerman', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', '2950 College Dr', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073825112', NULL, '2950 College Dr', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073825112', '          ', '', '', '', '0.00', '10.00', '0.00', 3, '2009-07-01', NULL, 0, 0, 1, 'Wyoming Medical Center ', NULL, NULL, NULL, 'HCFA|UB|', '1417912858', 0, 'N', 0, '2013-03-13', NULL, NULL, 0, 0, NULL, NULL),
('830219655', 'WYT200583', 'WYT200583', 'WYT2', 'Gem City Bone and Joint', 'Ryan', '', 'Aukerman', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', '620 4-J Rd', 'Gillette', 'Campbell', 'WY', '82716', '3076828899', NULL, '620 4-J Rd', 'Gillette', 'Campbell', 'WY', '82716', '3076828899', '          ', '', '', '', '0.00', '10.00', '0.00', 3, '2009-07-01', '2012-12-31', 0, 0, 1, 'Wyoming Medical Center ', NULL, NULL, NULL, 'HCFA|UB|', '1417912858', 0, 'N', 0, '2013-03-13', NULL, NULL, 0, 0, NULL, NULL),
('830219655', 'WYT200584', 'WYT200584', 'WYT2', 'Premier Bone and Joint Centers', 'Ryan', '', 'Aukerman', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', 'Box 3414 16th & Gibbon St', 'Laramie', 'Albany', 'WY', '82071', '3077662305', NULL, 'Box 3414 16th & Gibbon St', 'Laramie', 'Albany', 'WY', '82071', '3077662305', '          ', '', '', '', '0.00', '10.00', '0.00', 3, '2009-07-01', NULL, 0, 0, 1, 'Wyoming Medical Center ', NULL, NULL, NULL, 'HCFA|UB|', '1417912858', 0, 'Y', 0, '2013-03-13', NULL, NULL, 0, 0, NULL, NULL),
('260726474', 'WYT200526', 'WYT200526', 'WYT2', 'Wind River Clinic', 'Ricardo', 'A', 'Aviles', 'MD', 'Ophthalmology', '', '', NULL, 'O', '1005 College View Dr', 'Riverton', 'Fremont', 'WY', '82501', '3078573488', NULL, '1005 College View Dr', 'Riverton', 'Fremont', 'WY', '82501', '3078573488', '          ', '', '', '', '0.00', '20.00', '0.00', 3, '2008-03-01', '2011-06-17', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1265625297', 0, 'N', 0, '2011-06-24', NULL, NULL, 0, 0, NULL, NULL),
('830216112', 'WYT200594', 'WYT200594', 'WYT2', 'Lander Medical Clinic', 'Todd', '', 'Bainter', 'DO', 'Internal Medicine', '', '', NULL, 'O', '745 Buena Vista Dr', 'Lander', 'Fremont', 'WY', '82520', '3073322941', NULL, '745 Buena Vista Dr', 'Lander', 'Fremont', 'WY', '82520', '3073322941', '', '', NULL, NULL, '0.00', '10.00', '0.00', 3, '2009-10-09', NULL, 0, 0, 0, 'SageWest Health Care', NULL, NULL, NULL, 'HCFA|UB|', '1427226034', 0, 'n', 0, '2013-08-30', NULL, NULL, 0, 0, NULL, NULL),
('830251081', 'WYT200543', 'WYT200543', 'WYT2', 'Powder River Orthopedics & Spine PC', 'Gerald', 'L', 'Baker', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '508 Stocktrail Ste A', 'Gillette', 'Campbell', 'WY', '82716', '3076861413', NULL, '508 Stocktrail Ste A', 'Gillette', 'Campbell', 'WY', '82716', '3076861413', '          ', '', '', '', '0.00', '23.00', '0.00', 3, '2008-09-15', '2011-11-06', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1316932783', 0, 'N', 0, '2013-01-07', NULL, NULL, 0, 0, NULL, NULL),
('830317319', 'WYT200708', 'WYT200708', 'WYT2', 'Fremont Pediatrics', 'Mary', '', 'Barnes', 'MD', 'Pediatrics', '', '', NULL, 'O', '115 Wyoming St', 'Lander', 'Fremont', 'WY', '82501', '3073322185', NULL, '115 Wyoming St', 'Lander', 'Fremont', 'WY', '82501', '3073322185', '', '', '', '', '0.00', '10.00', '0.00', 3, '2009-03-31', '2011-06-28', 0, 0, 0, 'SageWest Health Care', '', '', '', 'HCFA|UB|', '1679674246', 0, 'N', 0, '2014-05-14', NULL, NULL, 0, 0, NULL, NULL),
('830317319', 'WYT200498', 'WYT200498', 'WYT2', 'Fremont Pediatrics', 'Richard', '', 'Barnes', 'MD', 'Pediatrics', '', '', NULL, 'O', '115 Wyoming St', 'Lander', 'Fremont', 'WY', '82501', '3073322185', NULL, '115 Wyoming St', 'Lander', 'Fremont', 'WY', '82501', '3073322185', '          ', '', '', '', '0.00', '10.00', '0.00', 3, '2009-03-06', '2011-06-28', 0, 0, 1, 'SageWest Health Care', NULL, NULL, NULL, 'HCFA|UB|', '1174616122', 0, 'N', 0, '2012-06-04', NULL, NULL, 0, 0, NULL, NULL),
('830326307', 'WYT200260', 'WYT200260', 'WYT2', 'Community Health Ctr', 'Trent (Recognized PPO but not contracted)', '', 'Batty', '', 'Family Practice', '', '', NULL, 'O', '1522 E  A  St', 'Casper', '', 'WY', '82601', '3072336035', NULL, '1522 E  A  St', 'Casper', '', 'WY', '82601', '3072336035', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2009-12-15', '2012-09-30', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '0000005222', 0, 'Y', 0, '2012-10-11', NULL, NULL, 0, 0, NULL, NULL);
INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
('830335926', 'WYT200496', 'WYT200496', 'WYT2', 'Uinta Urgent Care', 'Kimberly', 'A', 'Begalla', 'NP', 'Family Practice', 'Urgent Care', '', NULL, 'O', '75 Yellow Creek Rd Ste 202', 'Evanston', 'Uinta', 'WY', '82931', '3077896111', NULL, '75 Yellow Creek Rd Ste 202', 'Evanston', 'Uinta', 'WY', '82931', '3077896111', '', '', NULL, NULL, '0.00', '15.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1174563241', 0, 'N', 0, '2011-12-19', NULL, NULL, 0, 0, NULL, NULL),
('830335926', 'WYT200497', 'WYT200497', 'WYT2', 'Uinta Urgent Care', 'Kimberly', 'A', 'Begalla', 'NP', 'Family Practice', 'Urgent Care', '', NULL, 'B', 'PO Box 1382', 'Evanston', 'Uinta', 'WY', '82931', '3077896111', NULL, 'PO Box 1382', 'Evanston', 'Uinta', 'WY', '82931', '3077896111', '', '', NULL, NULL, '0.00', '15.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1174563241', 0, 'y', 0, '2011-12-19', NULL, NULL, 0, 0, NULL, NULL),
('870716858', 'WYT200439', 'WYT200439', 'WYT2', 'Yellowstone Sports Medicine And Bone & Joint Clinic', 'Kevin', '', 'Bell', 'PA-C', 'Orthopedic Surgery', '', '', NULL, 'O', '720 Lindsay Ln Ste B', 'Cody', 'Park', 'WY', '82414', '3075781992', NULL, '720 Lindsay Ln Ste B', 'Cody', 'Park', 'WY', '82414', '3075781992', '          ', '', '', '', '0.00', '25.00', '0.00', 3, '2009-03-01', '2009-05-01', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1033146402', 0, 'N', 0, '2011-09-16', NULL, NULL, 0, 0, NULL, NULL),
('840835036', 'WYT200444', 'WYT200444', 'WYT2', 'Heart Mountain Chiropractic', 'Paul', 'W', 'Bergamini', 'DC', 'Chiropractic', '', '', NULL, 'O', '1543 Bleistein Ave', 'Cody', 'Park', 'WY', '82414', '3075874600', NULL, '1543 Bleistein Ave', 'Cody', 'Park', 'WY', '82414', '3075874600', '          ', '', '', '5004', '0.00', '100.00', '0.00', 3, '2007-11-01', '2011-06-27', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1053486480', 0, 'N', 0, '2012-06-25', NULL, NULL, 0, 0, NULL, NULL),
('830323501', 'WYT200672', 'WYT200672', 'WYT2', 'Therapy Solutions', 'Michael ', 'J', 'Bernd', 'PT', 'Physical Therapy', '', '', NULL, 'O', '6631 E 2nd St', 'Casper', 'Natrona', 'WY', '82609', '3072689904', '3072689907', '6631 E 2nd St', 'Casper', 'Natrona', 'WY', '82609', '3072689904', '3072689907', 'THERAPY', '', '', '0.00', '35.00', '0.00', 3, '2010-10-01', '2011-06-28', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1568484897', 0, 'N', 0, '2011-06-29', NULL, NULL, 0, 0, NULL, NULL),
('830283425', 'WYT200688', 'WYT200688', 'WYT2', 'North Platte Physical Therapy', 'Jeremy', 'E', 'Bieber', 'PT', 'Physical Therapy', '', '', NULL, 'O', '311 Thelma Dr', 'Casper', 'Natrona', 'WY', '82609', '3072342662', '3072348810', '311 Thelma Dr', 'Casper', 'Natrona', 'WY', '82609', '3072342662', '3072348810', 'WYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2011-07-01', '2011-07-01', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1619931102', 0, 'N', 0, '2011-06-30', NULL, NULL, 0, 0, NULL, NULL),
('830283425', 'WYT200689', 'WYT200689', 'WYT2', 'North Platte Physical Therapy', 'Jeremy', 'E', 'Bieber', 'PT', 'Physical Therapy', '', '', NULL, 'O', '3831 Denis Dr', 'Casper', 'Natrona', 'WY', '82604', '3072349067', '3072349074', '3831 Denis Dr', 'Casper', 'Natrona', 'WY', '82604', '3072349067', '3072349074', 'WYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2011-07-01', '2011-07-01', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1619931102', 0, 'N', 0, '2011-06-30', NULL, NULL, 0, 0, NULL, NULL),
('830283425', 'WYT200690', 'WYT200690', 'WYT2', 'North Platte Physical Therapy', 'Jeremy', 'E', 'Bieber', 'PT', 'Physical Therapy', '', '', NULL, 'B', 'PO Box 1790', 'Douglas', 'Converse', 'WY', '82633', '3072342662', '3072348810', 'PO Box 1790', 'Douglas', 'Converse', 'WY', '82633', '3072342662', '3072348810', 'WYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2011-07-01', '2011-07-01', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1619931102', 0, 'N', 0, '2011-06-30', NULL, NULL, 0, 0, NULL, NULL),
('830219655', 'WYT200811', 'WYT200811', 'WYT2', 'Premier Bone and Joint Centers', 'Thomas', '', 'Bienz', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', '1400 Uinta Dr', 'Green River', 'Sweetwater', 'WY', '82935', '3078757576', NULL, '1400 Uinta Dr', 'Green River', 'Sweetwater', 'WY', '82935', '3078757576', '', '', '', '', '0.00', '10.00', '0.00', 3, '2009-07-01', NULL, 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1992785976', 0, 'N', 0, '2014-07-18', NULL, NULL, 0, 0, NULL, NULL),
('830219655', 'WYT200812', 'WYT200812', 'WYT2', 'Premier Bone and Joint Centers', 'Thomas', '', 'Bienz', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', '167 S Conwell', 'Casper', 'Natrona', 'WY', '82601', '3072370304', NULL, '167 S Conwell', 'Casper', 'Natrona', 'WY', '82601', '3072370304', '', '', '', '', '0.00', '10.00', '0.00', 3, '2009-07-01', NULL, 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1992785976', 0, 'N', 0, '2014-07-18', NULL, NULL, 0, 0, NULL, NULL),
('830219655', 'WYT200813', 'WYT200813', 'WYT2', 'Premier Bone and Joint Centers', 'Thomas', '', 'Bienz', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1909 Vista Dr', 'Laramie', 'Albany', 'WY', '82070', '3077458851', NULL, '1909 Vista Dr', 'Laramie', 'Albany', 'WY', '82070', '3077458851', '', '', '', '', '0.00', '10.00', '0.00', 3, '2009-07-01', NULL, 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1992785976', 0, 'N', 0, '2014-07-18', NULL, NULL, 0, 0, NULL, NULL),
('830219655', 'WYT200814', 'WYT200814', 'WYT2', 'Gem City Bone and Joint', 'Thomas', '', 'Bienz', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1950 Bluegrass Cir', 'Cheyenne', 'Laramie', 'WY', '82009', '3076325889', NULL, '1950 Bluegrass Cir', 'Cheyenne', 'Laramie', 'WY', '82009', '3076325889', '', '', '', '', '0.00', '10.00', '0.00', 3, '2009-07-01', '2013-01-01', 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1992785976', 0, 'N', 0, '2014-07-18', NULL, NULL, 0, 0, NULL, NULL),
('830219655', 'WYT200815', 'WYT200815', 'WYT2', 'Premier Bone and Joint Centers', 'Thomas', '', 'Bienz', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', '201 14th St', 'Wheatland', 'Platte', 'WY', '82201', '3073223636', NULL, '201 14th St', 'Wheatland', 'Platte', 'WY', '82201', '3073223636', '', '', '', '', '0.00', '10.00', '0.00', 3, '2009-07-01', NULL, 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1992785976', 0, 'N', 0, '2014-07-18', NULL, NULL, 0, 0, NULL, NULL),
('830219655', 'WYT200816', 'WYT200816', 'WYT2', 'Premier Bone and Joint Centers', 'Thomas', '', 'Bienz', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', '2950 College Dr', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073825112', NULL, '2950 College Dr', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073825112', '', '', '', '', '0.00', '10.00', '0.00', 3, '2009-07-01', NULL, 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1992785976', 0, 'N', 0, '2014-07-18', NULL, NULL, 0, 0, NULL, NULL),
('830234097', 'WYT200714', 'WYT200714', 'WYT2', 'OB/Gyn Clinic', 'Angela', '', 'Biggs', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1414 W 4th St', 'Gillette', 'Campbell', 'WY', '82716', '3076863855', NULL, '1414 W 4th St', 'Gillette', 'Campbell', 'WY', '82716', '3076863855', '          ', '', '', '5001', '0.00', '0.00', '0.00', 3, '2008-09-15', '2008-09-15', 0, 0, 0, 'Campbell County Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1689787814', 0, 'N', 0, '2013-09-17', NULL, NULL, 0, 0, NULL, NULL),
('870716858', 'WYT200474', 'WYT200474', 'WYT2', 'Yellowstone Sports Medicine And Bone & Joint Clinic', 'Jimmie', 'G', 'Biles', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '720 Lindsay Ln Ste B', 'Cody', 'Park', 'WY', '82414', '3075781992', NULL, '720 Lindsay Ln Ste B', 'Cody', 'Park', 'WY', '82414', '3075781992', '          ', '', '', '', '0.00', '25.00', '0.00', 3, '2009-03-01', '2011-11-14', 0, 0, 1, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1114018728', 0, 'N', 0, '2012-03-01', NULL, NULL, 0, 0, NULL, NULL),
('830219655', 'WYT200607', 'WYT200607', 'WYT2', 'Gem City Bone and Joint', 'William', 'S', 'Bodemer', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', '1909 Vista Dr', 'Laramie', 'Albany', 'WY', '82070', '3076325889', NULL, '1909 Vista Dr', 'Laramie', 'Albany', 'WY', '82070', '3076325889', '          ', '', '', '', '0.00', '10.00', '0.00', 3, '2009-07-01', '2012-04-23', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1497705370', 0, 'N', 0, '2013-01-07', NULL, NULL, 0, 0, NULL, NULL),
('830219655', 'WYT200608', 'WYT200608', 'WYT2', 'Gem City Bone and Joint', 'William', 'S', 'Bodemer', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1950 Bluegrass Cir Ste 100', 'Cheyenne', 'Laramie', 'WY', '82009', '3076325889', NULL, '1950 Bluegrass Cir Ste 100', 'Cheyenne', 'Laramie', 'WY', '82009', '3076325889', '          ', '', '', '', '0.00', '10.00', '0.00', 3, '2009-07-01', '2012-04-23', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1497705370', 0, 'N', 0, '2013-01-07', NULL, NULL, 0, 0, NULL, NULL),
('830219655', 'WYT200609', 'WYT200609', 'WYT2', 'Gem City Bone and Joint', 'William', 'S', 'Bodemer', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', '301 S Fenway Ste 203', 'Casper', 'Natrona', 'WY', '82601', '3072370304', NULL, '301 S Fenway Ste 203', 'Casper', 'Natrona', 'WY', '82601', '3072370304', '          ', '', '', '', '0.00', '10.00', '0.00', 3, '2009-07-01', '2012-04-23', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1497705370', 0, 'Y', 0, '2013-01-07', NULL, NULL, 0, 0, NULL, NULL),
('830219655', 'WYT200656', 'WYT200656', 'WYT2', 'Premier Bone and Joint Centers', 'Roberta', '', 'Boltz', 'PT', 'Physical Therapy', '', '', NULL, 'O', '1909 Vista Dr', 'Laramie', 'Albany', 'WY', '82070', '3077458851', NULL, '1909 Vista Dr', 'Laramie', 'Albany', 'WY', '82070', '3077458851', '          ', '', '', '', '0.00', '10.00', '0.00', 3, '2009-07-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1548240500', 0, 'N', 0, '2013-03-13', NULL, NULL, 0, 0, NULL, NULL),
('830283425', 'WYT200527', 'WYT200527', 'WYT2', 'North Platte Physical Therapy', 'Michael', 'R', 'Boulter', 'PT', 'Physical Therapy', '', '', NULL, 'O', '311 Thelma Dr', 'Casper', 'Natrona', 'WY', '82609', '3072342662', '3072348810', '311 Thelma Dr', 'Casper', 'Natrona', 'WY', '82609', '3072342662', '3072348810', 'WYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2011-07-01', '2011-07-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1265663587', 0, 'N', 0, '2014-07-21', NULL, NULL, 0, 0, NULL, NULL),
('830283425', 'WYT200528', 'WYT200528', 'WYT2', 'North Platte Physical Therapy', 'Michael', 'R', 'Boulter', 'PT', 'Physical Therapy', '', '', NULL, 'O', '3831 Denis Dr', 'Casper', 'Natrona', 'WY', '82604', '3072342662', '3072349074', '3831 Denis Dr', 'Casper', 'Natrona', 'WY', '82604', '3072342662', '3072349074', 'WYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2011-07-01', '2011-07-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1265663587', 0, 'N', 0, '2014-07-21', NULL, NULL, 0, 0, NULL, NULL),
('830283425', 'WYT200529', 'WYT200529', 'WYT2', 'North Platte Physical Therapy', 'Michael', 'R', 'Boulter', 'PT', 'Physical Therapy', '', '', NULL, 'B', 'PO Box 1790', 'Douglas', 'Converse', 'WY', '82633', '3072342662', '3072348810', 'PO Box 1790', 'Douglas', 'Converse', 'WY', '82633', '3072342662', '3072348810', 'WYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2011-07-01', '2011-07-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1265663587', 0, 'N', 0, '2014-07-21', NULL, NULL, 0, 0, NULL, NULL),
('830336991', 'WYT200445', 'WYT200445', 'WYT2', 'Optique 20/20 of Evanston', 'William', 'B', 'Bourland', 'OD', 'Optometry', '', '', NULL, 'O', '701 Front St', 'Evanston', 'Uinta', 'WY', '82930', '3077898820', NULL, '701 Front St', 'Evanston', 'Uinta', 'WY', '82930', '3077898820', '', 'wystd', 'wyhcpcs', '', '0.00', '35.00', '0.00', 3, '2006-12-01', '2011-06-28', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1063413318', 0, 'N', 0, '2014-07-15', NULL, NULL, 0, 0, NULL, NULL),
('830234097', 'WYT200262', 'WYT200262', 'WYT2', 'Campbell County Memorial Hospital', 'Judith', '', 'Boyle', 'MD', 'Hospitalist', '', '', NULL, 'O', '501 S Burma Ave', 'Gillette', 'Campbell', 'WY', '82717', '3076881000', NULL, '501 S Burma Ave', 'Gillette', 'Campbell', 'WY', '82717', '3076881000', '          ', '', '', '5001', '0.00', '0.00', '0.00', 3, '2008-09-15', '2008-09-15', 0, 0, 0, 'Campbell County Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '0000005387', 0, 'Y', 0, '2013-09-17', NULL, NULL, 0, 0, NULL, NULL),
('810422536', 'WYT200699', 'WYT200699', 'WYT2', 'Yellowstone Pathologists PC', 'Michael', 'S', 'Brown', 'MD', 'Pathology', '', '', NULL, 'O', '1008 Cody Ave', 'Cody', 'Park', 'WY', '82414', '4062386363', NULL, '1008 Cody Ave', 'Cody', 'Park', 'WY', '82414', '4062386363', '          ', 'WYSTD', 'Wyhcpcs', '', '0.00', '35.00', '0.00', 3, '2007-12-01', '2011-06-27', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1639171713', 0, 'N', 0, '2013-06-27', NULL, NULL, 0, 0, NULL, NULL),
('810422536', 'WYT200700', 'WYT200700', 'WYT2', 'Yellowstone Pathologists PC', 'Michael', 'S', 'Brown', 'MD', 'Pathology', '', '', NULL, 'O', '2900 12th Ave N Ste 295W', 'Billings', 'Yellowstone', 'MT', '59101', '4062386363', NULL, '2900 12th Ave N Ste 295W', 'Billings', 'Yellowstone', 'MT', '59101', '4062386363', '          ', 'WYSTD', 'Wyhcpcs', '', '0.00', '35.00', '0.00', 3, '2007-12-01', '2011-06-27', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1639171713', 0, 'Y', 0, '2013-06-27', NULL, NULL, 0, 0, NULL, NULL),
('830216112', 'WYT200521', 'WYT200521', 'WYT2', 'Lander Medical Clinic', 'James', '', 'Brubaker', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '745 Buena Vista Dr', 'Lander', 'Fremont', 'WY', '82520', '3073322941', NULL, '745 Buena Vista Dr', 'Lander', 'Fremont', 'WY', '82520', '3073322941', '          ', '', '', '', '0.00', '10.00', '0.00', 3, '2009-08-01', '2012-05-01', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1245326867', 0, 'N', 0, '2012-04-30', NULL, NULL, 0, 0, NULL, NULL),
('830219655', 'WYT200475', 'WYT200475', 'WYT2', 'Premier Bone and Joint Centers', 'David', '', 'Brumbaugh', 'PA', 'Orthopedic Surgery', '', '', NULL, 'O', '1909 Vista Dr', 'Laramie', 'Albany', 'WY', '82070', '3077458851', NULL, '1909 Vista Dr', 'Laramie', 'Albany', 'WY', '82070', '3077458851', '          ', '', '', '', '0.00', '10.00', '0.00', 3, '2009-07-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1114907722', 0, 'N', 0, '2013-03-13', NULL, NULL, 0, 0, NULL, NULL),
('202299593', 'WYT200742', 'WYT200742', 'WYT2', 'Red Desert InstaCare', 'William', 'D', 'Burnett', 'MD', 'Family Practice', '', '', NULL, 'O', '2761 Commercial Way', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073823064', NULL, '2761 Commercial Way', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073823064', '', '', '', '', '0.00', '7.50', '0.00', 3, '2007-01-01', '2011-06-27', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1760579023', 0, 'N', 0, '2014-04-01', NULL, NULL, 0, 0, NULL, NULL),
('202299593', 'WYT200743', 'WYT200743', 'WYT2', 'Wyoming Range Medical', 'William', 'D', 'Burnett', 'MD', 'Family Practice', '', '', NULL, 'O', '630 Piney Dr', 'Big Piney', 'Sublette', 'WY', '83113', '3072764700', NULL, '630 Piney Dr', 'Big Piney', 'Sublette', 'WY', '83113', '3072764700', '', '', '', '', '0.00', '7.50', '0.00', 3, '2007-01-01', '2011-06-27', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1760579023', 0, 'N', 0, '2014-04-01', NULL, NULL, 0, 0, NULL, NULL),
('202299593', 'WYT200744', 'WYT200744', 'WYT2', 'Wyoming Range Medical', 'William', 'D', 'Burnett', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 130', 'Big Piney', 'Sublette', 'WY', '83113', '3073823064', NULL, 'PO Box 130', 'Big Piney', 'Sublette', 'WY', '83113', '3073823064', '', '', '', '', '0.00', '7.50', '0.00', 3, '2007-01-01', '2011-06-27', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1760579023', 0, 'Y', 0, '2014-04-01', NULL, NULL, 0, 0, NULL, NULL),
('711001763', 'WYT200483', 'WYT200483', 'WYT2', 'Desert View Eyecare', 'Jeffery', 'A', 'Wilson', 'OD', 'Optometry', '', '', NULL, 'O', '520 Wilkes Dr Ste 12', 'Green River', 'Sweetwater', 'WY', '82935', '3078753399', NULL, '520 Wilkes Dr Ste 12', 'Green River', 'Sweetwater', 'WY', '82935', '3078753399', '          ', 'WISEWYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2007-10-01', '2011-06-28', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1134163272', 0, 'N', 0, '2011-12-20', NULL, NULL, 0, 0, NULL, NULL),
('202765815', 'WYT200263', 'WYT200263', 'WYT2', 'Sage Medical Group', 'Marian (Recognized PPO but not contracted)', '', 'Bursten', '', 'Family Practice', '', '', NULL, 'O', '419 S Washington St', 'Casper', '', 'WY', '82601', '3072658300', NULL, '419 S Washington St', 'Casper', '', 'WY', '82601', '3072658300', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2009-12-15', '2012-12-01', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '0000005496', 0, 'Y', 0, '2012-10-19', NULL, NULL, 0, 0, NULL, NULL),
('830326307', 'WYT200264', 'WYT200264', 'WYT2', 'Community Health Ctr', 'David (Recognized PPO but not contracted)', '', 'Butters', '', 'Family Practice', '', '', NULL, 'O', '1522 E  A  St', 'Casper', '', 'WY', '82601', '3072336035', NULL, '1522 E  A  St', 'Casper', '', 'WY', '82601', '3072336035', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2009-12-15', '2012-09-30', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '0000005504', 0, 'Y', 0, '2012-10-11', NULL, NULL, 0, 0, NULL, NULL),
('810284764', 'WYT200588', 'WYT200588', 'WYT2', 'Arapahoe Health Center', 'Shelly ', '', 'Cadman', 'OD', 'Optometry', '', '', NULL, 'O', '17 Great Plains Rd', 'Arapahoe', 'Fremont', 'WY', '82510', '3078569281', '3078577063', '17 Great Plains Rd', 'Arapahoe', 'Fremont', 'WY', '82510', '3078569281', '3078577063', 'WYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2010-12-01', '2011-06-27', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1417969718', 0, 'N', 0, '2014-07-21', NULL, NULL, 0, 0, NULL, NULL),
('810284764', 'WYT200589', 'WYT200589', 'WYT2', 'Fort Washakie Health Center', 'Shelly ', '', 'Cadman', 'OD', 'Optometry', '', '', NULL, 'O', '29 Black Coal Dr', 'Fort Washakie', 'Fremont', 'WY', '82514', '3073320446', '3073320131', '29 Black Coal Dr', 'Fort Washakie', 'Fremont', 'WY', '82514', '3073320446', '3073320131', 'WYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2010-12-01', '2011-06-27', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1417969718', 0, 'N', 0, '2014-07-21', NULL, NULL, 0, 0, NULL, NULL),
('810284764', 'WYT200590', 'WYT200590', 'WYT2', 'Fort Washakie Health Center', 'Shelly ', '', 'Cadman', 'OD', 'Optometry', '', '', NULL, 'B', 'PO Box 128', 'Fort Washakie', 'Fremont', 'WY', '82514', '3073320446', '3073320131', 'PO Box 128', 'Fort Washakie', 'Fremont', 'WY', '82514', '3073320446', '3073320131', 'WYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2010-12-01', '2011-06-27', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1417969718', 0, 'N', 0, '2014-07-21', NULL, NULL, 0, 0, NULL, NULL),
('810284764', 'WYT200591', 'WYT200591', 'WYT2', 'Arapahoe Health Center', 'Shelly ', '', 'Cadman', 'OD', 'Optometry', '', '', NULL, 'M', 'PO Box 31001', 'Pasadena', 'Los Angeles', 'CA', '91110', '3078569281', '3078577063', 'PO Box 31001', 'Pasadena', 'Los Angeles', 'CA', '91110', '3078569281', '3078577063', 'WYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2010-12-01', '2011-06-27', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1417969718', 0, 'N', 0, '2014-07-21', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'WYT200650', 'WYT200650', 'WYBILLINGS', 'Billings Clinic - PMR', 'Terrence', 'J', 'Cahill', 'MD', 'Physical Medicine and Rehabilitation', '', '', NULL, 'O', '801 N 29th St', 'Billings', 'Yellowstone', 'Mt', '59101', '4062382501', '4062382723', '801 N 29th St', 'Billings', 'Yellowstone', 'Mt', '59101', '4062382501', '4062382723', '', '', '', '0.00', '17.00', '0.00', 3, '2010-06-12', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1528382603', 0, 'N', 0, '2014-05-22', NULL, NULL, 0, 0, NULL, NULL),
('836000891', 'WYT200817', 'WYT200817', 'WYT2', 'North Big Horn Hospital Clinic', 'Troy', '', 'Caldwell', 'MD', 'Family Practice', '', '', NULL, 'O', '1115 Lane 12', 'Lovell', 'Big Horn', 'WY', '82431', '3075485201', NULL, '1115 Lane 12', 'Lovell', 'Big Horn', 'WY', '82431', '3075485201', '          ', '', '', '', '0.00', '10.00', '0.00', 3, '2008-02-01', '2011-06-16', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1992817381', 0, 'N', 0, '2013-12-04', NULL, NULL, 0, 0, NULL, NULL),
('830234097', 'WYT200265', 'WYT200265', 'WYT2', 'Campbell County Memorial Hospital', '', '', 'Campbell County Memorial Hospital', 'GROUP', 'Hospital', '', '', NULL, 'O', '501 S Burma Ave', 'Gillette', 'Campbell', 'WY', '82716', '3076881000', NULL, '501 S Burma Ave', 'Gillette', 'Campbell', 'WY', '82716', '3076881000', '          ', '', '', '5001', '0.00', '0.00', '0.00', 3, '2007-11-15', '2007-11-15', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000005551', 0, 'N', 0, '2013-10-23', NULL, NULL, 0, 0, NULL, NULL),
('830234097', 'WYT200266', 'WYT200266', 'WYT2', 'Campbell County Memorial Hospital', '', '', 'Campbell County Memorial Hospital', 'GROUP', 'Hospital', '', '', NULL, 'B', 'PO Box 3011', 'Gillette', 'Campbell', 'WY', '82717', '3076881000', NULL, 'PO Box 3011', 'Gillette', 'Campbell', 'WY', '82717', '3076881000', '          ', '', '', '5001', '0.00', '0.00', '0.00', 3, '2007-11-15', '2007-11-15', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000005551', 0, 'Y', 0, '2013-10-23', NULL, NULL, 0, 0, NULL, NULL),
('541707322', 'WYT200267', 'WYT200267', 'WYT2', 'Care Rehab and Orthopedic Products  (Muscle Stimulators)', '', '', 'Care Rehab and Orthopedic Products  (Muscle Stimulators)', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'B', 'PO Box 716', 'Keysville', 'Charlotte', 'VA', '23947', '8004879644', NULL, 'PO Box 716', 'Keysville', 'Charlotte', 'VA', '23947', '8004879644', '', 'WCSTCROP5', NULL, NULL, '0.00', '20.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1578562468', 0, 'y', 0, '2012-09-24', NULL, NULL, 0, 0, NULL, NULL),
('836000891', 'WYT200781', 'WYT200781', 'WYT2', 'North Big Horn Hospital Clinic', 'Jack', '', 'Carpenter', 'PA', 'Family Practice', '', '', NULL, 'O', '1115 Lane 12', 'Lovell', 'Big Horn', 'WY', '82431', '3075485201', NULL, '1115 Lane 12', 'Lovell', 'Big Horn', 'WY', '82431', '3075485201', '          ', '', '', '', '0.00', '10.00', '0.00', 3, '2008-02-01', '2011-06-16', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1912957028', 0, 'N', 0, '2013-12-04', NULL, NULL, 0, 0, NULL, NULL),
('830219655', 'WYT200667', 'WYT200667', 'WYT2', 'Gem City Bone and Joint', 'Jay', '', 'Carson', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1400 Uinta Dr', 'Green River', 'Sweetwater', 'WY', '82935', '3078757576', NULL, '1400 Uinta Dr', 'Green River', 'Sweetwater', 'WY', '82935', '3078757576', '', '', '', '', '0.00', '10.00', '0.00', 3, '2009-07-01', '2013-01-01', 0, 0, 0, 'Ivinson Memorial Hospital', '', '', '', 'HCFA|UB|', '1568442523', 0, 'N', 0, '2014-07-18', NULL, NULL, 0, 0, NULL, NULL),
('830219655', 'WYT200668', 'WYT200668', 'WYT2', 'Premier Bone and Joint Centers', 'Jay', '', 'Carson', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', '1909 Vista Dr', 'Laramie', 'Albany', 'WY', '82070', '3077458851', NULL, '1909 Vista Dr', 'Laramie', 'Albany', 'WY', '82070', '3077458851', '', '', '', '', '0.00', '10.00', '0.00', 3, '2009-07-01', NULL, 0, 0, 0, 'Ivinson Memorial Hospital', '', '', '', 'HCFA|UB|', '1568442523', 0, 'N', 0, '2014-07-18', NULL, NULL, 0, 0, NULL, NULL),
('830219655', 'WYT200669', 'WYT200669', 'WYT2', 'Premier Bone and Joint Centers', 'Jay', '', 'Carson', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1950 Bluegrass Cir', 'Cheyenne', 'Laramie', 'WY', '82009', '3076325889', NULL, '1950 Bluegrass Cir', 'Cheyenne', 'Laramie', 'WY', '82009', '3076325889', '', '', '', '', '0.00', '10.00', '0.00', 3, '2009-07-01', NULL, 0, 0, 0, 'Ivinson Memorial Hospital', '', '', '', 'HCFA|UB|', '1568442523', 0, 'N', 0, '2014-07-18', NULL, NULL, 0, 0, NULL, NULL),
('830219655', 'WYT200670', 'WYT200670', 'WYT2', 'Premier Bone and Joint Centers', 'Jay', '', 'Carson', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', '2002 W Sunset Dr', 'Riverton', 'Fremont', 'WY', '82501', '3078564053', NULL, '2002 W Sunset Dr', 'Riverton', 'Fremont', 'WY', '82501', '3078564053', '', '', '', '', '0.00', '10.00', '0.00', 3, '2009-07-01', NULL, 0, 0, 0, 'Ivinson Memorial Hospital', '', '', '', 'HCFA|UB|', '1568442523', 0, 'N', 0, '2014-07-18', NULL, NULL, 0, 0, NULL, NULL),
('830219655', 'WYT200671', 'WYT200671', 'WYT2', 'Premier Bone and Joint Centers', 'Jay', '', 'Carson', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', '2950 College Dr', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073825112', NULL, '2950 College Dr', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073825112', '', '', '', '', '0.00', '10.00', '0.00', 3, '2009-07-01', NULL, 0, 0, 0, 'Ivinson Memorial Hospital', '', '', '', 'HCFA|UB|', '1568442523', 0, 'N', 0, '2014-07-18', NULL, NULL, 0, 0, NULL, NULL),
('810422536', 'WYT200653', 'WYT200653', 'WYT2', 'Yellowstone Pathologists PC', 'Samuel', 'K', 'Caughron', 'MD', 'Pathology', '', '', NULL, 'O', '1008 Cody Ave', 'Cody', 'Park', 'WY', '82414', '4062386363', NULL, '1008 Cody Ave', 'Cody', 'Park', 'WY', '82414', '4062386363', '          ', 'WYSTD', 'Wyhcpcs', '', '0.00', '35.00', '0.00', 3, '2007-12-01', '2011-06-28', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1538216353', 0, 'N', 0, '2013-06-27', NULL, NULL, 0, 0, NULL, NULL),
('810422536', 'WYT200654', 'WYT200654', 'WYT2', 'Yellowstone Pathologists PC', 'Samuel', 'K', 'Caughron', 'MD', 'Pathology', '', '', NULL, 'O', '2900 12th Ave N Ste 295W', 'Billings', 'Yellowstone', 'MT', '59101', '4062386363', NULL, '2900 12th Ave N Ste 295W', 'Billings', 'Yellowstone', 'MT', '59101', '4062386363', '          ', 'WYSTD', 'Wyhcpcs', '', '0.00', '35.00', '0.00', 3, '2007-12-01', '2011-06-28', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1538216353', 0, 'N', 0, '2013-06-27', NULL, NULL, 0, 0, NULL, NULL),
('870716858', 'WYT200617', 'WYT200617', 'WYT2', 'Yellowstone Sports Medicine And Bone & Joint Clinic', 'Sheri', 'L', 'Chacon', 'PA-C', 'Orthopedic Surgery', '', '', NULL, 'O', '720 Lindsay Ln Ste B', 'Cody', 'Park', 'WY', '82414', '3075781992', NULL, '720 Lindsay Ln Ste B', 'Cody', 'Park', 'WY', '82414', '3075781992', '          ', '', '', '', '0.00', '25.00', '0.00', 3, '2009-08-01', '2011-11-14', 0, 0, 1, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1497925424', 0, 'N', 0, '2012-07-30', NULL, NULL, 0, 0, NULL, NULL),
('870716858', 'WYT200618', 'WYT200618', 'WYT2', 'Yellowstone Sports Medicine And Bone & Joint Clinic LLC', 'Sheri', 'L', 'Chacon', 'PA-C', 'Orthopedic Surgery', '', '', NULL, 'B', 'PO Box 457', 'Cody', 'Park', 'WY', '82414', '3075781992', NULL, 'PO Box 457', 'Cody', 'Park', 'WY', '82414', '3075781992', '          ', '', '', '', '0.00', '25.00', '0.00', 3, '2009-08-01', '2011-11-14', 0, 0, 1, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1497925424', 0, 'Y', 0, '2012-07-30', NULL, NULL, 0, 0, NULL, NULL),
('830246056', 'WYT200452', 'WYT200452', 'WYT2', '', 'V', 'Raja', 'Chandra', 'MD', 'Family Practice', 'Urgent Care', '', NULL, 'O', '519 8th St', 'Rawlins', 'Carbon', 'WY', '82301', '3073242294', NULL, '519 8th St', 'Rawlins', 'Carbon', 'WY', '82301', '3073242294', '          ', 'WYSINCLAIR', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2007-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1073667317', 0, 'Y', 0, '2013-08-30', NULL, NULL, 0, 0, NULL, NULL),
('830246056', 'WYT200453', 'WYT200453', 'WYT2', '', 'V', 'Raja', 'Chandra', 'MD', 'Family Practice', 'Urgent Care', '', NULL, 'B', 'PO Box 1768', 'Rawlins', 'Carbon', 'WY', '82301', '3073242294', NULL, 'PO Box 1768', 'Rawlins', 'Carbon', 'WY', '82301', '3073242294', '          ', 'WYSINCLAIR', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2007-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1073667317', 0, 'Y', 0, '2013-08-30', NULL, NULL, 0, 0, NULL, NULL),
('261739588', 'WYT200251', 'WYT200251', 'WYT2', 'Cloud Peak Sleep Specialist ', '', '', 'Cloud Peak Sleep Specialist LLC', 'MD', 'Sleep Medicine', '', '', NULL, 'O', '1050 Mydland Rd', 'Sheridan', 'Sheridan', 'WY', '82801', '3076736300', NULL, '1050 Mydland Rd', 'Sheridan', 'Sheridan', 'WY', '82801', '3076736300', '', '', NULL, NULL, '0.00', '12.00', '0.00', 3, '2009-02-13', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '0000003029', 0, 'n', 0, '2011-06-10', NULL, NULL, 0, 0, NULL, NULL),
('830336456', 'WYT200718', 'WYT200718', 'WYT2', 'Western Wyoming Neurological Surgery', 'Brent', 'Lee', 'Clyde', 'MD', 'Neurosurgery', '', '', NULL, 'O', '110 Hospital Ln', 'Afton', 'Lincoln', 'WY', '83110', '8005581912', NULL, '110 Hospital Ln', 'Afton', 'Lincoln', 'WY', '83110', '8005581912', '          ', '', '', '', '0.00', '20.00', '0.00', 3, '2007-01-01', '2011-06-27', 0, 0, 0, 'Davis Hospital', 'Star Valley Medical Center', NULL, NULL, 'HCFA|UB|', '1700896552', 0, 'N', 0, '2013-12-10', NULL, NULL, 0, 0, NULL, NULL),
('830336456', 'WYT200719', 'WYT200719', 'WYT2', 'Western Wyoming Neurological Surgery', 'Brent', 'Lee', 'Clyde', 'MD', 'Neurosurgery', '', '', NULL, 'o', '190 Arrowead Dr', 'Evanston', 'Uinta', 'WY', '82930', '8005581912', NULL, '190 Arrowead Dr', 'Evanston', 'Uinta', 'WY', '82930', '8005581912', '          ', '', '', '', '0.00', '20.00', '0.00', 3, '2007-01-01', '2011-06-27', 0, 0, 0, 'Davis Hospital', 'Star Valley Medical Center', NULL, NULL, 'HCFA|UB|', '1700896552', 0, 'N', 0, '2013-12-10', NULL, NULL, 0, 0, NULL, NULL),
('810490456', 'WYT200440', 'WYT200440', 'WYT2', 'Community Home Oxygen', '', '', 'Community Home Oxygen', 'Group', 'Durable Medical Equipment', '', '', NULL, 'O', '2240 Coffeen Ave Ste F', 'Sheridan', 'Sheridan', 'WY', '82801', '3076729021', '3076728367', '2240 Coffeen Ave Ste F', 'Sheridan', 'Sheridan', 'WY', '82801', '3076729021', '3076728367', 'ROTECH', 'DME80', '', '0.00', '35.00', '0.00', 3, '2008-10-01', '2011-06-28', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1033189261', 0, 'N', 0, '2011-06-30', NULL, NULL, 0, 0, NULL, NULL),
('830310603', 'WYT200512', 'WYT200512', 'WYT2', 'Community Home Oxygen', '', '', 'Community Home Oxygen ', 'Group', 'Durable Medical Equipment', '', '', NULL, 'O', '1012 W Bridge St Ste B', 'Saratoga', 'Carbon', 'WY', '82331', '3073265592', '3073265114', '1012 W Bridge St Ste B', 'Saratoga', 'Carbon', 'WY', '82331', '3073265592', '3073265114', 'ROTECH', 'DME80', '', '0.00', '35.00', '0.00', 3, '2008-10-01', '2011-06-28', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1215997382', 0, 'N', 0, '2011-06-30', NULL, NULL, 0, 0, NULL, NULL),
('830310603', 'WYT200515', 'WYT200515', 'WYT2', 'Community Home Oxygen', '', '', 'Community Home Oxygen', 'Group', 'Durable Medical Equipment', '', '', NULL, 'O', '2900 Grand Ave Ste 106', 'Laramie', 'Albany', 'WY', '82070', '3077455716', '3077457859', '2900 Grand Ave Ste 106', 'Laramie', 'Albany', 'WY', '82070', '3077455716', '3077457859', 'ROTECH', 'DME80', '', '0.00', '35.00', '0.00', 3, '2008-10-01', '2011-06-28', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1225098585', 0, 'N', 0, '2011-06-30', NULL, NULL, 0, 0, NULL, NULL),
('830310603', 'WYT200551', 'WYT200551', 'WYT2', 'Community Home Oxygen', '', '', 'Community Home Oxygen', 'Group', 'Durable Medical Equipment', '', '', NULL, 'O', '1993 Dewar Dr Ste 4', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073621419', '3073627439', '1993 Dewar Dr Ste 4', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073621419', '3073627439', 'ROTECH', 'DME80', '', '0.00', '35.00', '0.00', 3, '2008-10-01', '2011-06-28', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1356300602', 0, 'N', 0, '2011-06-30', NULL, NULL, 0, 0, NULL, NULL),
('810490456', 'WYT200559', 'WYT200559', 'WYT2', 'Community Home Oxygen', '', '', 'Community Home Oxygen', 'Group', 'Durable Medical Equipment', '', '', NULL, 'O', '810 S Federal Blvd', 'Riverton', 'Fremont', 'WY', '82501', '3078569415', '3078568616', '810 S Federal Blvd', 'Riverton', 'Fremont', 'WY', '82501', '3078569415', '3078568616', 'ROTECH', 'DME80', '', '0.00', '35.00', '0.00', 3, '2008-10-01', '2011-06-28', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1376523050', 0, 'N', 0, '2011-06-30', NULL, NULL, 0, 0, NULL, NULL),
('830310603', 'WYT200621', 'WYT200621', 'WYT2', 'Community Home Oxygen', '', '', 'Community Home Oxygen', 'Group', 'Durable Medical Equipment', '', '', NULL, 'O', '240 N Elk St', 'Casper', 'Natrona', 'WY', '82601', '3072377350', '3074723977', '240 N Elk St', 'Casper', 'Natrona', 'WY', '82601', '3072377350', '3074723977', 'ROTECH', 'DME80', '', '0.00', '35.00', '0.00', 3, '2008-10-01', '2011-06-28', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1508825845', 0, 'N', 0, '2011-06-29', NULL, NULL, 0, 0, NULL, NULL),
('830310603', 'WYT200622', 'WYT200622', 'WYT2', 'Community Home Oxygen', '', '', 'Community Home Oxygen', 'Group', 'Durable Medical Equipment', '', '', NULL, 'B', 'PO Box 9901', 'Clearfield', 'Davis', 'UT', '84089', '8008451378', '8019261335', 'PO Box 9901', 'Clearfield', 'Davis', 'UT', '84089', '8008451378', '8019261335', 'ROTECH', 'DME80', '', '0.00', '35.00', '0.00', 3, '2008-10-01', '2011-06-28', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1508825845', 0, 'Y', 0, '2011-06-29', NULL, NULL, 0, 0, NULL, NULL),
('830310603', 'WYT200773', 'WYT200773', 'WYT2', 'Community Home Oxygen', '', '', 'Community Home Oxygen', 'Group', 'Durable Medical Equipment', '', '', NULL, 'O', '6002 Us Hwy 30 Bldg 1', 'Cheyenne', 'Laramie', 'WY', '82001', '3076358866', '3076355685', '6002 Us Hwy 30 Bldg 1', 'Cheyenne', 'Laramie', 'WY', '82001', '3076358866', '3076355685', 'ROTECH', 'DME80', '', '0.00', '35.00', '0.00', 3, '2008-10-01', '2011-06-28', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1881653145', 0, 'N', 0, '2011-06-30', NULL, NULL, 0, 0, NULL, NULL),
('830310603', 'WYT200784', 'WYT200784', 'WYT2', 'Community Home Oxygen', '', '', 'Community Home Oxygen', 'Group', 'Durable Medical Equipment', '', '', NULL, 'O', '115 W 22Nd Ave', 'Torrington', 'Goshen', 'WY', '82240', '3075328907', '3075328905', '115 W 22Nd Ave', 'Torrington', 'Goshen', 'WY', '82240', '3075328907', '3075328905', 'ROTECH', 'DME80', '', '0.00', '35.00', '0.00', 3, '2008-10-01', '2011-06-28', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1922068287', 0, 'N', 0, '2011-06-30', NULL, NULL, 0, 0, NULL, NULL),
('830310603', 'WYT200804', 'WYT200804', 'WYT2', 'Community Home Oxygen', '', '', 'Community Home Oxygen', 'Group', 'Durable Medical Equipment', '', '', NULL, 'O', '604 9Th St', 'Wheatland', 'Platte', 'WY', '82201', '307 322471', NULL, '604 9Th St', 'Wheatland', 'Platte', 'WY', '82201', '307 322471', '307 322311', 'ROTECH', 'DME80', '', '0.00', '35.00', '0.00', 3, '2008-10-01', '2011-06-28', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1962462218', 0, 'N', 0, '2011-06-30', NULL, NULL, 0, 0, NULL, NULL),
('830234097', 'WYT200651', 'WYT200651', 'WYT2', 'Orthopedic Specialists of Wyoming', 'Patricia ', 'A', 'Connally', 'DO', 'Family Practice', '', '', NULL, 'O', '501 S Burma Ave', 'Gillette', 'Campbell', 'WY', '82717', '3076883500', '3076883510', '501 S Burma Ave', 'Gillette', 'Campbell', 'WY', '82717', '3076883500', '3076883510', '', '', '5001', '0.00', '0.00', '0.00', 3, '2011-02-03', '2011-02-03', 0, 0, 0, 'Campbell County Memorial Hospital', '', '', '', 'HCFA|UB|', '1538142930', 0, 'N', 0, '2014-07-21', NULL, NULL, 0, 0, NULL, NULL),
('830234097', 'WYT200652', 'WYT200652', 'WYT2', 'Orthopedic Specialists of Wyoming', 'Patricia ', 'A', 'Connally', 'DO', 'Family Practice', '', '', NULL, 'B', 'PO Box 3011', 'Gillette', 'Campbell', 'WY', '82717', '3076883500', '3076883510', 'PO Box 3011', 'Gillette', 'Campbell', 'WY', '82717', '3076883500', '3076883510', '', '', '5001', '0.00', '0.00', '0.00', 3, '2011-02-03', '2011-02-03', 0, 0, 0, 'Campbell County Memorial Hospital', '', '', '', 'HCFA|UB|', '1538142930', 0, 'N', 0, '2014-07-21', NULL, NULL, 0, 0, NULL, NULL),
('830283425', 'WYT200516', 'WYT200516', 'WYT2', 'North Platte Physical Therapy', 'Deidra', 'N', 'Cottenoir', 'PT', 'Physical Therapy', '', '', NULL, 'O', '311 Thelma Dr', 'Casper', 'Natrona', 'WY', '82609', '3072342662', '3072348810', '311 Thelma Dr', 'Casper', 'Natrona', 'WY', '82609', '3072342662', '3072348810', 'WYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2011-07-01', '2011-07-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1225215635', 0, 'N', 0, '2014-07-24', NULL, NULL, 0, 0, NULL, NULL),
('830283425', 'WYT200517', 'WYT200517', 'WYT2', 'North Platte Physical Therapy', 'Deidra', 'N', 'Cottenoir', 'PT', 'Physical Therapy', '', '', NULL, 'O', '3831 Denis Dr', 'Casper', 'Natrona', 'WY', '82604', '3072349067', '3072349074', '3831 Denis Dr', 'Casper', 'Natrona', 'WY', '82604', '3072349067', '3072349074', 'WYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2011-07-01', '2011-07-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1225215635', 0, 'N', 0, '2014-07-24', NULL, NULL, 0, 0, NULL, NULL),
('830283425', 'WYT200518', 'WYT200518', 'WYT2', 'North Platte Physical Therapy', 'Deidra', 'N', 'Cottenoir', 'PT', 'Physical Therapy', '', '', NULL, 'B', 'PO Box 1790', 'Douglas', 'Converse', 'WY', '82633', '3072342662', '3072348810', 'PO Box 1790', 'Douglas', 'Converse', 'WY', '82633', '3072342662', '3072348810', 'WYSTD', 'WYHCPCS', '', '0.00', '35.00', '0.00', 3, '2011-07-01', '2011-07-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1225215635', 0, 'N', 0, '2014-07-24', NULL, NULL, 0, 0, NULL, NULL),
('201391282', 'WYT200691', 'WYT200691', 'WYT2', 'Thunder Basin Orthopedics and Sports Medicine', 'Scott', 'T', 'Croft', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '111 S 5th St', 'Douglas', 'Converse', 'WY', '82633', '3073586200', '3073583748', '111 S 5th St', 'Douglas', 'Converse', 'WY', '82633', '3073586200', '3073583748', 'WYORTHO10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-04-01', '2013-12-31', 0, 0, 0, 'Memorial Hospital of Converse County', '', '', '', 'HCFA|UB|', '1619934163', 0, 'N', 0, '2014-01-03', NULL, NULL, 0, 0, NULL, NULL),
('201391282', 'WYT200692', 'WYT200692', 'WYT2', 'Thunder Basin Orthopedics and Sports Medicine', 'Scott', 'T', 'Croft', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '6500 E 2nd St', 'Casper', 'Natrona', 'WY', '82601', '3073586200', '3073583748', '6500 E 2nd St', 'Casper', 'Natrona', 'WY', '82601', '3073586200', '3073583748', 'WYORTHO10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-04-01', NULL, 0, 0, 1, 'Memorial Hospital of Converse County', '', '', '', 'HCFA|UB|', '1619934163', 0, 'N', 0, '2013-06-28', NULL, NULL, 0, 0, NULL, NULL),
('201391282', 'WYT200693', 'WYT200693', 'WYT2', 'Thunder Basin Orthopedics and Sports Medicine', 'Scott', 'T', 'Croft', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', 'PO Box 688', 'Douglas', 'Converse', 'WY', '82633', '3073586200', '3073583748', 'PO Box 688', 'Douglas', 'Converse', 'WY', '82633', '3073586200', '3073583748', 'WYORTHO10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-04-01', NULL, 0, 0, 1, 'Memorial Hospital of Converse County', '', '', '', 'HCFA|UB|', '1619934163', 0, 'N', 0, '2013-06-28', NULL, NULL, 0, 0, NULL, NULL),
('836000295', 'WYT200596', 'WYT200596', 'WYT2', 'Sweetwater Medical Group', 'Brianne', '', 'Crofts', 'MD', 'General Surgery', '', '', NULL, 'O', '1204 Hilltop Dr Ste 109', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073528192', '3073528593', '1204 Hilltop Dr Ste 109', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073528192', '3073528593', '', '', '', '0.00', '5.00', '0.00', 3, '2011-07-01', '2014-02-09', 0, 0, 0, 'Memorial Hospital of Sweetwater County', NULL, NULL, NULL, 'HCFA|UB|', '1457475451', 0, 'N', 0, '2014-03-04', NULL, NULL, 0, 0, NULL, NULL),
('830210617', 'WYT200268', 'WYT200268', 'WYT2', 'Crook County Memorial Hospital', '', '', 'Crook County Memorial Hospital', 'GROUP', 'Hospital', '', '', NULL, 'O', '713 Oak St', 'Sundance', 'Crook', 'WY', '82729', '3072832476', NULL, '713 Oak St', 'Sundance', 'Crook', 'WY', '82729', '3072832476', '', '', NULL, NULL, '0.00', '5.00', '0.00', 6, '2007-09-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '0000005840', 0, 'N', 0, '2012-06-12', NULL, NULL, 0, 0, NULL, NULL),
('830210617', 'WYT200269', 'WYT200269', 'WYT2', 'Crook County Memorial Hospital', '', '', 'Crook County Memorial Hospital', 'GROUP', 'Hospital', '', '', NULL, 'B', 'PO Box 517', 'Sundance', 'Crook', 'WY', '82729', '3072833501', NULL, 'PO Box 517', 'Sundance', 'Crook', 'WY', '82729', '3072833501', '', '', NULL, NULL, '0.00', '5.00', '0.00', 6, '2007-09-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '0000005840', 0, 'Y', 0, '2012-06-12', NULL, NULL, 0, 0, NULL, NULL),
('830327251', 'WYT200678', 'WYT200678', 'WYT2', 'Star Valley Medical Center', 'Jacob ', '', 'Crosby', 'CRNA', 'Anesthesia', '', '', NULL, 'O', '901 Adams St', 'Afton', 'Lincoln', 'WY', '83110', '3078855817', NULL, '901 Adams St', 'Afton', 'Lincoln', 'WY', '83110', '3078855817', '          ', 'WSTARV', 'wyhcpcs', '', '0.00', '10.00', '0.00', 6, '2010-09-08', '2011-06-27', 0, 0, 1, 'Star Valley Medical Center', '', '', '', 'HCFA|UB|', '1578721544', 0, 'Y', 0, '2011-06-10', NULL, NULL, 0, 0, NULL, NULL),
('830327251', 'WYT200679', 'WYT200679', 'WYT2', 'Star Valley Medical Center', 'Jacob ', '', 'Crosby', 'CRNA', 'Anesthesia', '', '', NULL, 'B', 'PO Box 579', 'Afton', 'Lincoln', 'WY', '83110', '3078855817', NULL, 'PO Box 579', 'Afton', 'Lincoln', 'WY', '83110', '3078855817', '          ', 'WSTARV', 'wyhcpcs', '', '0.00', '10.00', '0.00', 6, '2010-09-08', '2011-06-27', 0, 0, 1, 'Star Valley Medical Center', '', '', '', 'HCFA|UB|', '1578721544', 0, 'Y', 0, '2011-06-10', NULL, NULL, 0, 0, NULL, NULL),
('270104373', 'WYT200434', 'WYT200434', 'WYT2', 'Yellowstone Radiology', 'Gregory', 'H', 'Cross', '', 'Diagnostic Radiology', '', '', NULL, 'O', '707 Sheridan Ave', 'Cody', 'Park', 'WY', '82414', '3075782372', NULL, '707 Sheridan Ave', 'Cody', 'Park', 'WY', '82414', '3075782372', '          ', 'WYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-07-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1013900547', 0, 'Y', 0, '2011-06-29', NULL, NULL, 0, 0, NULL, NULL),
('270104373', 'WYT200435', 'WYT200435', 'WYT2', 'Yellowstone Radiology', 'Gregory', 'H', 'Cross', '', 'Diagnostic Radiology', '', '', NULL, 'B', 'PO Box 1829', 'Coeur D Alene', 'Kootenai', 'ID', '83816', '2086679334', NULL, 'PO Box 1829', 'Coeur D Alene', 'Kootenai', 'ID', '83816', '2086679334', '          ', 'WYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-07-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1013900547', 0, 'Y', 0, '2011-06-29', NULL, NULL, 0, 0, NULL, NULL),
('208460446', 'WYT200593', 'WYT200593', 'WYT2', NULL, 'Rodni', '', 'Cruz', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '721 Sheridan Ave Ste 260', 'Cody', 'Park', 'WY', '82414', '3075873133', NULL, '721 Sheridan Ave Ste 260', 'Cody', 'Park', 'WY', '82414', '3075873133', '', '', NULL, NULL, '0.00', '10.00', '0.00', 3, '2009-03-30', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1427144088', 0, 'n', 0, '2011-06-10', NULL, NULL, 0, 0, NULL, NULL),
('830234097', 'WYT200270', 'WYT200270', 'WYT2', 'Campbell County Memorial Hospital', 'Brian', '', 'Cullison', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '501 S Burma Ave', 'Gillette', 'Campbell', 'WY', '82717', '3076881000', NULL, '501 S Burma Ave', 'Gillette', 'Campbell', 'WY', '82717', '3076881000', '          ', '', '', '5001', '0.00', '0.00', '0.00', 3, '2008-09-15', '2008-09-15', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000005851', 0, 'Y', 0, '2013-09-17', NULL, NULL, 0, 0, NULL, NULL),
('830182821', 'WYT200646', 'WYT200646', 'WYT2', 'Gottsche Rehabilitation Center', 'Brian', 'E', 'Dalton', 'PT', 'Physical Therapy', '', '', NULL, 'O', '639 W Coulter Ave', 'Powell', 'Park', 'WY', '82435', '3077549262', '          ', '639 W Coulter Ave', 'Powell', 'Park', 'WY', '82435', '3077549262', '          ', '', '', '', '0.00', '10.00', '0.00', 3, '2011-02-03', '2014-06-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1528150380', 0, 'N', 0, '2014-07-21', NULL, NULL, 0, 0, NULL, NULL),
('830182821', 'WYT200647', 'WYT200647', 'WYT2', 'Gottsche Rehabilitation Center', 'Brian', 'E', 'Dalton', 'PT', 'Physical Therapy', '', '', NULL, 'O', '720 Lindsay Ln', 'Cody', 'Park', 'WY', '82414', '3075781970', '          ', '720 Lindsay Ln', 'Cody', 'Park', 'WY', '82414', '3075781970', '          ', '', '', '', '0.00', '10.00', '0.00', 3, '2011-02-03', '2014-06-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1528150380', 0, 'N', 0, '2014-07-21', NULL, NULL, 0, 0, NULL, NULL),
('274409223', 'WYT200549', 'WYT200549', 'WYT2', 'Davis ENT Specialists', 'Thomas', '', 'Davis', 'MD', 'Ear, Nose and Throat', 'Pediatric Ear, Nose and Throat', 'Sleep Medicine', NULL, 'O', '407 S Medical Arts Ct Ste C', 'Gillette', 'Campbell', 'WY', '82716', '3076867346', '3076821485', '407 S Medical Arts Ct Ste C', 'Gillette', 'Campbell', 'WY', '82716', '3076867346', '3076821485', '', '', '', '0.00', '18.00', '0.00', 3, '2011-03-04', '2011-11-06', 0, 0, 0, 'Campbell County Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1336139120', 0, 'N', 0, '2013-11-08', NULL, NULL, 0, 0, NULL, NULL),
('200284506', 'WYT200752', 'WYT200752', 'WYT2', 'The Eye Institute of Wyoming', 'Dana', 'L', 'Day', 'OD', 'Optometry', '', '', NULL, 'O', '112 N 2nd St', 'Douglas', 'Converse', 'WY', '82633', '3073582900', NULL, '112 N 2nd St', 'Douglas', 'Converse', 'WY', '82633', '3073582900', '          ', 'WiseWyStd', 'wyhcpcs', '', '0.00', '35.00', '0.00', 3, '2007-08-01', '2011-06-28', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1780689067', 0, 'N', 0, '2013-04-16', NULL, NULL, 0, 0, NULL, NULL),
('200284506', 'WYT200753', 'WYT200753', 'WYT2', 'The Eye Institute of Wyoming', 'Dana', 'L', 'Day', 'OD', 'Optometry', '', '', NULL, 'O', '301 S Fenway Ste 102', 'Casper', 'Natrona', 'WY', '82601', '3072355384', NULL, '301 S Fenway Ste 102', 'Casper', 'Natrona', 'WY', '82601', '3072355384', '          ', 'WiseWyStd', 'wyhcpcs', '', '0.00', '35.00', '0.00', 3, '2007-08-01', '2011-06-28', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1780689067', 0, 'N', 0, '2013-04-16', NULL, NULL, 0, 0, NULL, NULL),
('830219655', 'WYT200726', 'WYT200726', 'WYT2', 'Gem City Bone and Joint', 'Martha', 'C', 'Martinez del Rio', 'PT', 'Physical Therapy', '', '', NULL, 'O', '1909 Vista Dr', 'Laramie', 'Albany', 'WY', '82070', '3077458851', NULL, '1909 Vista Dr', 'Laramie', 'Albany', 'WY', '82070', '3077458851', '', '', NULL, NULL, '0.00', '10.00', '0.00', 3, '2009-07-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1710967666', 0, 'n', 0, '2012-06-04', NULL, NULL, 0, 0, NULL, NULL),
('870656518', 'WYT200769', 'WYT200769', 'WYT2', 'Diabetes Specialty Center', '', '', 'Diabetes Specialty Center', 'GROUP', 'Durable Medical Equipment', 'Diabetic Supplies', '', NULL, 'O', 'Phone Number Only', '', '', 'WY', '', '8007754372', NULL, 'Phone Number Only', '', '', 'WY', '', '8007754372', '          ', 'WCSTDSC', '', '', '0.00', '35.00', '0.00', 3, '2007-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1841279155', 0, 'N', 0, '2013-10-28', NULL, NULL, 0, 0, NULL, NULL),
('061128081', 'WYT200431', 'WYT200431', 'WYT2', 'Dianon Systems Inc', '', '', 'Dianon Systems Inc', 'GROUP', 'Laboratory', '', '', NULL, 'B', '840 Research Pkwy', 'Oklahoma', 'Oklahoma', 'OK', '73104', '8003282666', NULL, '840 Research Pkwy', 'Oklahoma', 'Oklahoma', 'OK', '73104', '8003282666', '', 'WDIANON', NULL, NULL, '0.00', '35.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1003819020', 0, 'y', 0, '2012-02-27', NULL, NULL, 0, 0, NULL, NULL),
('061128081', 'WYT200432', 'WYT200432', 'WYT2', 'Dianon Systems Inc', '', '', 'Dianon Systems Inc', 'GROUP', 'Laboratory', '', '', NULL, 'B', 'PO Box 8005', 'Burlington', 'Alamance', 'NC', '27216', '8003282666', NULL, 'PO Box 8005', 'Burlington', 'Alamance', 'NC', '27216', '8003282666', '', 'WDIANON', NULL, NULL, '0.00', '35.00', '0.00', 3, '2006-12-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1003819020', 0, 'Y', 0, '2012-02-27', NULL, NULL, 0, 0, NULL, NULL),
('522165554', 'WYT200438', 'WYT200438', 'WYT2', 'DJO (Orthopedic Supplies)', '', '', 'DJO (Orthopedic Supplies for Provider Use Only)', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'B', 'PO Box 515471', 'Los Angeles', 'Los Angeles', 'CA', '90051', '8008638010', NULL, 'PO Box 515471', 'Los Angeles', 'Los Angeles', 'CA', '90051', '8008638010', '', 'DME80', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1023296035', 0, 'y', 0, '2012-09-24', NULL, NULL, 0, 0, NULL, NULL),
('836000295', 'WYT200578', 'WYT200578', 'WYT2', 'Memorial Hospital of Sweetwater County', 'Terry', '', 'Donaldson', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1204 Hilltop Dr Ste 108', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073528125', NULL, '1204 Hilltop Dr Ste 108', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073528125', '          ', '', '', '', '0.00', '5.00', '0.00', 3, '2006-12-01', '2011-09-30', 0, 0, 1, 'Memorial Hospital of Sweetwater County', '', '', '', 'HCFA|UB|', '1417903709', 0, 'N', 0, '2012-04-27', NULL, NULL, 0, 0, NULL, NULL);
