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
('364088232', 'ELDR00550', 'ELDR00550', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Corpia', 'C', 'Keyes', 'MD', 'Internal Medicine', '', '', NULL, 'O', '2500 W Fabyan Pkwy', 'Batavia', 'Kane', 'IL', '60510', '6308792110', '6307624779', '2500 W Fabyan Pkwy', 'Batavia', 'Kane', 'IL', '60510', '6308792110', '6307624779', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, '', NULL, 'HCFA|UB|', '1831322965', 0, 'N', 0, '2012-12-19', NULL, NULL, 41.8633, -88.269, NULL, NULL),
('364088232', 'ELDR00551', 'ELDR00551', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Corpia', 'C', 'Keyes', 'MD', 'Internal Medicine', '', '', NULL, 'B', '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', NULL, '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', '', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, '', NULL, 'HCFA|UB|', '1831322965', 0, 'Y', 0, '2012-12-19', NULL, NULL, 0, 0, NULL, NULL),
('364088232', 'ELDR00552', 'ELDR00552', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Kuljit', 'S', 'Kapur', 'DO', 'Hospitalist', '', '', NULL, 'O', '1870 W Galena Blvd', 'Aurora', 'Kane', 'IL', '60506', '6308596700', '6309065941', '1870 W Galena Blvd', 'Aurora', 'Kane', 'IL', '60506', '6308596700', '6309065941', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1831399518', 0, 'Y', 0, '2013-12-03', NULL, NULL, 41.7642, -88.3626, NULL, NULL),
('364088232', 'ELDR00553', 'ELDR00553', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Kuljit', 'S', 'Kapur', 'DO', 'Hospitalist', '', '', NULL, 'B', '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', NULL, '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', '', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1831399518', 0, 'Y', 0, '2013-12-03', NULL, NULL, 0, 0, NULL, NULL),
('364088232', 'ELDR00554', 'ELDR00554', 'ILCHIGSTD', 'Dreyer Clinic', 'Margaret', 'A', 'Silberman', 'PhD', 'Mental Health', 'Psychology', '', NULL, 'O', '1877 W Downer Pl', 'Aurora', 'Kane', 'IL', '60506', '6309065120', '6309065093', '1877 W Downer Pl', 'Aurora', 'Kane', 'IL', '60506', '6309065120', '6309065093', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-01-01', '2013-08-27', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1841304532', 0, 'Y', 0, '2013-09-16', NULL, NULL, 41.7623, -88.3603, NULL, NULL),
('364088232', 'ELDR00555', 'ELDR00555', 'ILCHIGSTD', 'Dreyer Clinic', 'Margaret', 'A', 'Silberman', 'PhD', 'Mental Health', 'Psychology', '', NULL, 'B', '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', NULL, '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', '          ', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-01-01', '2013-08-27', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1841304532', 0, 'Y', 0, '2013-09-16', NULL, NULL, 0, 0, NULL, NULL),
('364088232', 'ELDR00556', 'ELDR00556', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Kristie', 'K', 'Vogel', 'PAC', 'Family Practice', '', '', NULL, 'O', '24508 W Village Ctr Dr', 'Plainfield', 'Will', 'IL', '60544', '8154399400', '8154394959', '24508 W Village Ctr Dr', 'Plainfield', 'Will', 'IL', '60544', '8154399400', '8154394959', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1841309069', 0, 'Y', 0, '2013-04-17', NULL, NULL, 41.6073, -88.2148, NULL, NULL),
('364088232', 'ELDR00557', 'ELDR00557', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Kristie', 'K', 'Vogel', 'PAC', 'Family Practice', '', '', NULL, 'B', '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', NULL, '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', '', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1841309069', 0, 'Y', 0, '2013-04-17', NULL, NULL, 0, 0, NULL, NULL),
('364088232', 'ELDR00558', 'ELDR00558', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Joni', 'R', 'Cave', 'APN', 'Family Practice', '', '', NULL, 'O', '1500 Sycamore Rd Ste 1000', 'Yorkville', 'Kendall', 'IL', '60560', '6305534470', '6303017616', '1500 Sycamore Rd Ste 1000', 'Yorkville', 'Kendall', 'IL', '60560', '6305534470', '6303017616', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1841343001', 0, 'Y', 0, '2012-12-19', NULL, NULL, 41.6572, -88.4372, NULL, NULL),
('364088232', 'ELDR00559', 'ELDR00559', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Joni', 'R', 'Cave', 'APN', 'Family Practice', '', '', NULL, 'O', '1870 W Galena Blvd', 'Aurora', 'Kane', 'IL', '60506', '6308596700', '6308596744', '1870 W Galena Blvd', 'Aurora', 'Kane', 'IL', '60506', '6308596700', '6308596744', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1841343001', 0, 'Y', 0, '2012-12-19', NULL, NULL, 41.7642, -88.3626, NULL, NULL),
('364088232', 'ELDR00560', 'ELDR00560', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Joni', 'R', 'Cave', 'APN', 'Family Practice', '', '', NULL, 'B', '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', NULL, '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', '', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1841343001', 0, 'Y', 0, '2012-12-19', NULL, NULL, 0, 0, NULL, NULL),
('364088232', 'ELDR00561', 'ELDR00561', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Padmaja', '', 'Gutti', 'MD', 'Neurology', '', '', NULL, 'O', '1870 W Galena Blvd', 'Aurora', 'Kane', 'IL', '60506', '6308596700', '6309065099', '1870 W Galena Blvd', 'Aurora', 'Kane', 'IL', '60506', '6308596700', '6309065099', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1841449451', 0, 'N', 0, '2012-12-19', NULL, NULL, 41.7642, -88.3626, NULL, NULL),
('364088232', 'ELDR00562', 'ELDR00562', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Padmaja', '', 'Gutti', 'MD', 'Neurology', '', '', NULL, 'O', '4100 Healthway Dr', 'Aurora', 'Dupage', 'IL', '60504', '6308513105', '6309786669', '4100 Healthway Dr', 'Aurora', 'Dupage', 'IL', '60504', '6308513105', '6309786669', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1841449451', 0, 'N', 0, '2012-12-19', NULL, NULL, 41.7522, -88.2131, NULL, NULL),
('364088232', 'ELDR00563', 'ELDR00563', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Padmaja', '', 'Gutti', 'MD', 'Neurology', '', '', NULL, 'B', '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', NULL, '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', '', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1841449451', 0, 'Y', 0, '2012-12-19', NULL, NULL, 0, 0, NULL, NULL),
('364088232', 'ELDR00564', 'ELDR00564', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'HungnaShing', '', 'Tsang', 'MD', 'Anesthesiology', '', '', NULL, 'O', '1221 N Highland Ave', 'Aurora', 'Kane', 'IL', '60506', '6302648400', '6302648402', '1221 N Highland Ave', 'Aurora', 'Kane', 'IL', '60506', '6302648400', '6302648402', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1841479284', 0, 'Y', 0, '2012-12-19', NULL, NULL, 41.7821, -88.3293, NULL, NULL),
('364088232', 'ELDR00565', 'ELDR00565', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'HungnaShing', '', 'Tsang', 'MD', 'Anesthesiology', '', '', NULL, 'B', '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', NULL, '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', '', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1841479284', 0, 'Y', 0, '2012-12-19', NULL, NULL, 0, 0, NULL, NULL),
('364088232', 'ELDR00566', 'ELDR00566', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Kiranjit', 'K', 'Deol', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1870 W Galena Blvd', 'Aurora', 'Kane', 'IL', '60506', '6308596700', '6309065941', '1870 W Galena Blvd', 'Aurora', 'Kane', 'IL', '60506', '6308596700', '6309065941', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, '', NULL, 'HCFA|UB|', '1841486198', 0, 'N', 0, '2012-12-19', NULL, NULL, 41.7642, -88.3626, NULL, NULL),
('364088232', 'ELDR00567', 'ELDR00567', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Kiranjit', 'K', 'Deol', 'MD', 'Internal Medicine', '', '', NULL, 'B', '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', NULL, '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', '', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, '', NULL, 'HCFA|UB|', '1841486198', 0, 'Y', 0, '2012-12-19', NULL, NULL, 0, 0, NULL, NULL),
('364088232', 'ELDR00568', 'ELDR00568', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Michelle', 'K', 'Venhuizen', 'PT', 'Physical Therapy', '', '', NULL, 'O', '1221 N Highland Ave', 'Aurora', 'Kane', 'IL', '60506', '6308598700', '6302648444', '1221 N Highland Ave', 'Aurora', 'Kane', 'IL', '60506', '6308598700', '6302648444', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1851493654', 0, 'Y', 0, '2012-12-19', NULL, NULL, 41.7821, -88.3293, NULL, NULL),
('364088232', 'ELDR00570', 'ELDR00570', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Michelle', 'K', 'Venhuizen', 'PT', 'Physical Therapy', '', '', NULL, 'B', '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', NULL, '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', '', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1851493654', 0, 'Y', 0, '2012-12-19', NULL, NULL, 0, 0, NULL, NULL),
('364088232', 'ELDR00569', 'ELDR00569', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Michelle', 'K', 'Venhuizen', 'PT', 'Physical Therapy', '', '', NULL, 'O', '80 Templeton Dr', 'Oswego', 'Kendall', 'IL', '60543', '6305543456', '6305512764', '80 Templeton Dr', 'Oswego', 'Kendall', 'IL', '60543', '6305543456', '6305512764', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1851493654', 0, 'Y', 0, '2012-12-19', NULL, NULL, 41.6724, -88.3381, NULL, NULL),
('364088232', 'ELDR00571', 'ELDR00571', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Sandra', 'L', 'Harris', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1221 N Highland Ave', 'Aurora', 'Kane', 'IL', '60506', '6308598700', '6302648864', '1221 N Highland Ave', 'Aurora', 'Kane', 'IL', '60506', '6308598700', '6302648864', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1861410268', 0, 'Y', 0, '2012-12-19', NULL, NULL, 41.7821, -88.3293, NULL, NULL),
('364088232', 'ELDR00572', 'ELDR00572', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Sandra', 'L', 'Harris', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '2040 Ogden Ave', 'Aurora', 'Dupage', 'IL', '60504', '6305857100', '6306924080', '2040 Ogden Ave', 'Aurora', 'Dupage', 'IL', '60504', '6305857100', '6306924080', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1861410268', 0, 'Y', 0, '2012-12-19', NULL, NULL, 41.7282, -88.2677, NULL, NULL),
('364088232', 'ELDR00573', 'ELDR00573', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Sandra', 'L', 'Harris', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', NULL, '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', '', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1861410268', 0, 'Y', 0, '2012-12-19', NULL, NULL, 0, 0, NULL, NULL),
('364088232', 'ELDR00574', 'ELDR00574', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Ramon', '', 'Alvarezna Leonardo', 'MD', 'Mental Health', 'Psychiatry', '', NULL, 'O', '1877 W Downer Pl', 'Aurora', 'Kane', 'IL', '60506', '6309065120', '6309065093', '1877 W Downer Pl', 'Aurora', 'Kane', 'IL', '60506', '6309065120', '6309065093', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1861425365', 0, 'Y', 0, '2012-12-19', NULL, NULL, 41.7618, -88.3621, NULL, NULL),
('364088232', 'ELDR00575', 'ELDR00575', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Ramon', '', 'Alvarezna Leonardo', 'MD', 'Mental Health', 'Psychiatry', '', NULL, 'B', '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', NULL, '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', '', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1861425365', 0, 'Y', 0, '2012-12-19', NULL, NULL, 0, 0, NULL, NULL),
('364088232', 'ELDR00576', 'ELDR00576', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Roy', 'G', 'Henderson', 'MD', 'Sports Medicine', '', '', NULL, 'O', '1221 N Highland Ave', 'Aurora', 'Kane', 'IL', '60506', '6308598700', '6302648423', '1221 N Highland Ave', 'Aurora', 'Kane', 'IL', '60506', '6308598700', '6302648423', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1861426694', 0, 'N', 0, '2012-12-19', NULL, NULL, 41.7821, -88.3293, NULL, NULL),
('364088232', 'ELDR00577', 'ELDR00577', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Roy', 'G', 'Henderson', 'MD', 'Sports Medicine', '', '', NULL, 'O', '2040 Ogden Ave Ste 605', 'Aurora', 'Dupage', 'IL', '60504', '6305857100', '6306924129', '2040 Ogden Ave Ste 605', 'Aurora', 'Dupage', 'IL', '60504', '6305857100', '6306924129', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1861426694', 0, 'N', 0, '2013-04-04', NULL, NULL, 41.7282, -88.2677, NULL, NULL),
('364088232', 'ELDR00578', 'ELDR00578', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Roy', 'G', 'Henderson', 'MD', 'Sports Medicine', '', '', NULL, 'B', '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', NULL, '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', '', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1861426694', 0, 'Y', 0, '2012-12-19', NULL, NULL, 0, 0, NULL, NULL),
('364088232', 'ELDR00579', 'ELDR00579', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Andrea', 'A', 'Silver', 'MD', 'General Surgery', '', '', NULL, 'O', '1221 N Highland Ave', 'Aurora', 'Kane', 'IL', '60506', '6308598700', '6302648858', '1221 N Highland Ave', 'Aurora', 'Kane', 'IL', '60506', '6308598700', '6302648858', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1861436453', 0, 'N', 0, '2012-12-19', NULL, NULL, 41.7821, -88.3293, NULL, NULL),
('364088232', 'ELDR00580', 'ELDR00580', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Andrea', 'A', 'Silver', 'MD', 'General Surgery', '', '', NULL, 'O', '2040 Ogden Ave Ste 605', 'Aurora', 'Dupage', 'IL', '60504', '6305857100', '6306924110', '2040 Ogden Ave Ste 605', 'Aurora', 'Dupage', 'IL', '60504', '6305857100', '6306924110', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1861436453', 0, 'N', 0, '2013-04-04', NULL, NULL, 41.7282, -88.2677, NULL, NULL),
('364088232', 'ELDR00581', 'ELDR00581', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Andrea', 'A', 'Silver', 'MD', 'General Surgery', '', '', NULL, 'B', '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', NULL, '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', '', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1861436453', 0, 'Y', 0, '2012-12-19', NULL, NULL, 0, 0, NULL, NULL),
('364088232', 'ELDR00582', 'ELDR00582', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Katherine', 'F', 'Kouvelis', 'MD', 'General Surgery', '', '', NULL, 'O', '1221 N Highland Ave', 'Aurora', 'Kane', 'IL', '60506', '6308598700', '6302648858', '1221 N Highland Ave', 'Aurora', 'Kane', 'IL', '60506', '6308598700', '6302648858', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1861493165', 0, 'N', 0, '2012-12-19', NULL, NULL, 41.7821, -88.3293, NULL, NULL),
('364088232', 'ELDR00583', 'ELDR00583', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Katherine', 'F', 'Kouvelis', 'MD', 'General Surgery', '', '', NULL, 'O', '2040 Ogden Ave Ste 605', 'Aurora', 'Dupage', 'IL', '60504', '6305857100', '6306924110', '2040 Ogden Ave Ste 605', 'Aurora', 'Dupage', 'IL', '60504', '6305857100', '6306924110', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1861493165', 0, 'N', 0, '2013-04-04', NULL, NULL, 41.7282, -88.2677, NULL, NULL),
('364088232', 'ELDR00584', 'ELDR00584', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Katherine', 'F', 'Kouvelis', 'MD', 'General Surgery', '', '', NULL, 'B', '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', NULL, '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', '', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1861493165', 0, 'Y', 0, '2012-12-19', NULL, NULL, 0, 0, NULL, NULL),
('364088232', 'ELDR00585', 'ELDR00585', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Karen', 'L', 'Rittgarn', 'PT', 'Physical Therapy', '', '', NULL, 'O', '1221 N Highland Ave', 'Aurora', 'Kane', 'IL', '60506', '6308598700', '6302648444', '1221 N Highland Ave', 'Aurora', 'Kane', 'IL', '60506', '6308598700', '6302648444', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1861584872', 0, 'Y', 0, '2012-12-19', NULL, NULL, 41.7821, -88.3293, NULL, NULL),
('364088232', 'ELDR00587', 'ELDR00587', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Karen', 'L', 'Rittgarn', 'PT', 'Physical Therapy', '', '', NULL, 'B', '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', NULL, '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', '', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1861584872', 0, 'Y', 0, '2012-12-19', NULL, NULL, 0, 0, NULL, NULL),
('364088232', 'ELDR00586', 'ELDR00586', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Karen', 'L', 'Rittgarn', 'PT', 'Physical Therapy', '', '', NULL, 'O', '80 Templeton Dr', 'Oswego', 'Kendall', 'IL', '60543', '6305543456', '6305512764', '80 Templeton Dr', 'Oswego', 'Kendall', 'IL', '60543', '6305543456', '6305512764', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1861584872', 0, 'Y', 0, '2012-12-19', NULL, NULL, 41.6724, -88.3381, NULL, NULL),
('364088232', 'ELDR00588', 'ELDR00588', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Andrea', 'L', 'Naugle', 'PAC', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1221 N Highland Ave', 'Aurora', 'Kane', 'IL', '60506', '6308598700', '6302648864', '1221 N Highland Ave', 'Aurora', 'Kane', 'IL', '60506', '6308598700', '6302648864', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1871531392', 0, 'Y', 0, '2013-04-17', NULL, NULL, 41.7821, -88.3293, NULL, NULL),
('364088232', 'ELDR00589', 'ELDR00589', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Andrea', 'L', 'Naugle', 'PAC', 'Obstetrics and Gynecology', '', '', NULL, 'O', '2040 Ogden Ave', 'Aurora', 'Dupage', 'IL', '60504', '6305857100', '6306924080', '2040 Ogden Ave', 'Aurora', 'Dupage', 'IL', '60504', '6305857100', '6306924080', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1871531392', 0, 'Y', 0, '2013-04-17', NULL, NULL, 41.7282, -88.2677, NULL, NULL),
('364088232', 'ELDR00590', 'ELDR00590', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Andrea', 'L', 'Naugle', 'PAC', 'Obstetrics and Gynecology', '', '', NULL, 'B', '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', NULL, '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', '', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1871531392', 0, 'Y', 0, '2013-04-17', NULL, NULL, 0, 0, NULL, NULL),
('364088232', 'ELDR00592', 'ELDR00592', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Jerome', 'J', 'Skurka', 'MD', 'Pediatrics', '', '', NULL, 'B', '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', NULL, '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', '', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, '', NULL, 'HCFA|UB|', '1871609016', 0, 'Y', 0, '2012-12-19', NULL, NULL, 0, 0, NULL, NULL),
('364088232', 'ELDR00591', 'ELDR00591', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Jerome', 'J', 'Skurka', 'MD', 'Pediatrics', '', '', NULL, 'O', '80 Templeton Dr', 'Oswego', 'Kendall', 'IL', '60543', '6305543456', '6305512810', '80 Templeton Dr', 'Oswego', 'Kendall', 'IL', '60543', '6305543456', '6305512810', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, '', NULL, 'HCFA|UB|', '1871609016', 0, 'N', 0, '2012-12-19', NULL, NULL, 41.6724, -88.3381, NULL, NULL),
('364088232', 'ELDR00593', 'ELDR00593', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Julie', 'A', 'Overcash', 'MD', 'Pediatrics', '', '', NULL, 'O', '4100 Healthway Dr', 'Aurora', 'Dupage', 'IL', '60504', '6308513105', '6309786605', '4100 Healthway Dr', 'Aurora', 'Dupage', 'IL', '60504', '6308513105', '6309786605', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, '', NULL, 'HCFA|UB|', '1881607992', 0, 'N', 0, '2012-12-19', NULL, NULL, 41.7522, -88.2131, NULL, NULL),
('364088232', 'ELDR00594', 'ELDR00594', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Julie', 'A', 'Overcash', 'MD', 'Pediatrics', '', '', NULL, 'B', '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', NULL, '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', '', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, '', NULL, 'HCFA|UB|', '1881607992', 0, 'Y', 0, '2012-12-19', NULL, NULL, 0, 0, NULL, NULL),
('364088232', 'ELDR00595', 'ELDR00595', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Shilpa', 'S', 'Davé', 'DO', 'Internal Medicine', '', '', NULL, 'O', '1870 W Galena Blvd', 'Aurora', 'Kane', 'IL', '60506', '6308596700', '6309065941', '1870 W Galena Blvd', 'Aurora', 'Kane', 'IL', '60506', '6308596700', '6309065941', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1881624245', 0, 'N', 0, '2012-12-19', NULL, NULL, 41.7642, -88.3626, NULL, NULL),
('364088232', 'ELDR00597', 'ELDR00597', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Shilpa', 'S', 'Davé', 'DO', 'Internal Medicine', '', '', NULL, 'B', '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', NULL, '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', '', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1881624245', 0, 'Y', 0, '2012-12-19', NULL, NULL, 0, 0, NULL, NULL),
('364088232', 'ELDR00596', 'ELDR00596', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Shilpa', 'S', 'Davé', 'DO', 'Internal Medicine', '', '', NULL, 'O', '80 Templeton Dr', 'Oswego', 'Kendall', 'IL', '60543', '6305543456', '6305512970', '80 Templeton Dr', 'Oswego', 'Kendall', 'IL', '60543', '6305543456', '6305512970', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1881624245', 0, 'N', 0, '2012-12-19', NULL, NULL, 41.6724, -88.3381, NULL, NULL),
('364088232', 'ELDR00598', 'ELDR00598', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Bienvenido', 'V', 'Castillo', 'MD', 'Ophthalmology', '', '', NULL, 'O', '1221 N Highland Ave', 'Aurora', 'Kane', 'IL', '60506', '6308598700', '6302648809', '1221 N Highland Ave', 'Aurora', 'Kane', 'IL', '60506', '6308598700', '6302648809', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1891710257', 0, 'N', 0, '2012-12-19', NULL, NULL, 41.7821, -88.3293, NULL, NULL),
('364088232', 'ELDR00599', 'ELDR00599', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Bienvenido', 'V', 'Castillo', 'MD', 'Ophthalmology', '', '', NULL, 'B', '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', NULL, '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', '', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1891710257', 0, 'Y', 0, '2012-12-19', NULL, NULL, 0, 0, NULL, NULL),
('364088232', 'ELDR00600', 'ELDR00600', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Douglas', 'G', 'Dorman', 'MD', 'Family Practice', '', '', NULL, 'O', '1500 Sycamore Rd', 'Yorkville', 'Kendall', 'IL', '60560', '6305534470', '6303017616', '1500 Sycamore Rd', 'Yorkville', 'Kendall', 'IL', '60560', '6305534470', '6303017616', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1891711958', 0, 'N', 0, '2012-12-19', NULL, NULL, 41.6572, -88.4372, NULL, NULL),
('364088232', 'ELDR00601', 'ELDR00601', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Douglas', 'G', 'Dorman', 'MD', 'Family Practice', '', '', NULL, 'B', '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', NULL, '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', '', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1891711958', 0, 'Y', 0, '2012-12-19', NULL, NULL, 0, 0, NULL, NULL),
('364088232', 'ELDR00602', 'ELDR00602', 'ILCHIGSTD', 'Dreyer Clinic', 'Jodi', 'A', 'Pelegrin', 'DO', 'Sports Medicine', '', '', NULL, 'O', '1221 N Highland Ave', 'Aurora', 'Kane', 'IL', '60506', '6308598700', '6302648423', '1221 N Highland Ave', 'Aurora', 'Kane', 'IL', '60506', '6308598700', '6302648423', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-01-01', '2014-02-01', 0, 0, 0, 'Presence Mercy Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1891802286', 0, 'Y', 0, '2014-03-13', NULL, NULL, 41.7821, -88.3293, NULL, NULL),
('364088232', 'ELDR00603', 'ELDR00603', 'ILCHIGSTD', 'Dreyer Clinic', 'Jodi', 'A', 'Pelegrin', 'DO', 'Sports Medicine', '', '', NULL, 'B', '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', NULL, '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', '          ', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-01-01', '2014-02-01', 0, 0, 0, 'Presence Mercy Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1891802286', 0, 'Y', 0, '2014-03-13', NULL, NULL, 0, 0, NULL, NULL),
('364088232', 'ELDR00604', 'ELDR00604', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Wendy', 'A', 'Beseda', 'AUD', 'Audiology', '', '', NULL, 'O', '1221 N Highland Ave', 'Aurora', 'Kane', 'IL', '60506', '6308598700', '6302648484', '1221 N Highland Ave', 'Aurora', 'Kane', 'IL', '60506', '6308598700', '6302648484', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1891892360', 0, 'Y', 0, '2013-04-22', NULL, NULL, 41.7821, -88.3293, NULL, NULL),
('364088232', 'ELDR00605', 'ELDR00605', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Wendy', 'A', 'Beseda', 'AUD', 'Audiology', '', '', NULL, 'O', '2040 Ogden Ave', 'Aurora', 'Dupage', 'IL', '60504', '6305857100', '6306924057', '2040 Ogden Ave', 'Aurora', 'Dupage', 'IL', '60504', '6305857100', '6306924057', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1891892360', 0, 'Y', 0, '2013-04-22', NULL, NULL, 41.7282, -88.2677, NULL, NULL),
('364088232', 'ELDR00606', 'ELDR00606', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Wendy', 'A', 'Beseda', 'AUD', 'Audiology', '', '', NULL, 'B', '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', NULL, '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', '', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1891892360', 0, 'Y', 0, '2013-04-22', NULL, NULL, 0, 0, NULL, NULL),
('364088232', 'ELDR00607', 'ELDR00607', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Amita', '', 'Heaser', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1870 W Galena Blvd', 'Aurora', 'Kane', 'IL', '60506', '6308596700', '6308596811', '1870 W Galena Blvd', 'Aurora', 'Kane', 'IL', '60506', '6308596700', '6308596811', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1902062219', 0, 'N', 0, '2014-01-16', NULL, NULL, 41.7642, -88.3626, NULL, NULL),
('364088232', 'ELDR00608', 'ELDR00608', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Amita', '', 'Heaser', 'MD', 'Internal Medicine', '', '', NULL, 'B', '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', NULL, '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', '', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1902062219', 0, 'Y', 0, '2014-01-16', NULL, NULL, 0, 0, NULL, NULL),
('364088232', 'ELDR00609', 'ELDR00609', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Bharti', 'K', 'Patel', 'MD', 'Family Practice', '', '', NULL, 'O', '1870 W Galena Blvd', 'Aurora', 'Kane', 'IL', '60506', '6308596700', '6308596785', '1870 W Galena Blvd', 'Aurora', 'Kane', 'IL', '60506', '6308596700', '6308596785', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1902819139', 0, 'N', 0, '2012-12-19', NULL, NULL, 41.7642, -88.3626, NULL, NULL),
('364088232', 'ELDR00610', 'ELDR00610', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Bharti', 'K', 'Patel', 'MD', 'Family Practice', '', '', NULL, 'O', '2500 W Fabyan Pkwy', 'Batavia', 'Kane', 'IL', '60510', '6308792110', '6307624877', '2500 W Fabyan Pkwy', 'Batavia', 'Kane', 'IL', '60510', '6308792110', '6307624877', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1902819139', 0, 'N', 0, '2012-12-19', NULL, NULL, 41.8633, -88.269, NULL, NULL),
('364088232', 'ELDR00611', 'ELDR00611', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Bharti', 'K', 'Patel', 'MD', 'Family Practice', '', '', NULL, 'O', '4100 Healthway Dr', 'Aurora', 'Dupage', 'IL', '60504', '6308513105', '6309786690', '4100 Healthway Dr', 'Aurora', 'Dupage', 'IL', '60504', '6308513105', '6309786690', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1902819139', 0, 'N', 0, '2012-12-19', NULL, NULL, 41.7522, -88.2131, NULL, NULL),
('364088232', 'ELDR00612', 'ELDR00612', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Bharti', 'K', 'Patel', 'MD', 'Family Practice', '', '', NULL, 'B', '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', NULL, '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', '', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1902819139', 0, 'Y', 0, '2012-12-19', NULL, NULL, 0, 0, NULL, NULL),
('364088232', 'ELDR00613', 'ELDR00613', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'John', 'R', 'Tauscher', 'MD', 'Diagnostic Radiology', '', '', NULL, 'O', '1221 N Highland Ave', 'Aurora', 'Kane', 'IL', '60506', '6308598700', '6302648522', '1221 N Highland Ave', 'Aurora', 'Kane', 'IL', '60506', '6308598700', '6302648522', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', '', '', '', 'HCFA|UB|', '1902894231', 0, 'Y', 0, '2014-04-07', NULL, NULL, 41.7821, -88.3293, NULL, NULL),
('364088232', 'ELDR00614', 'ELDR00614', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'John', 'R', 'Tauscher', 'MD', 'Diagnostic Radiology', '', '', NULL, 'O', '1870 W Galena Blvd', 'Aurora', 'Kane', 'IL', '60506', '6308596700', '6309065962', '1870 W Galena Blvd', 'Aurora', 'Kane', 'IL', '60506', '6308596700', '6309065962', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', '', '', '', 'HCFA|UB|', '1902894231', 0, 'Y', 0, '2014-04-07', NULL, NULL, 41.7642, -88.3626, NULL, NULL),
('364088232', 'ELDR00615', 'ELDR00615', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'John', 'R', 'Tauscher', 'MD', 'Diagnostic Radiology', '', '', NULL, 'B', '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', NULL, '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', '', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', '', '', '', 'HCFA|UB|', '1902894231', 0, 'Y', 0, '2014-04-07', NULL, NULL, 0, 0, NULL, NULL),
('364088232', 'ELDR00616', 'ELDR00616', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Sheryl', 'P', 'Snyder', 'MD', 'Pathology', '', '', NULL, 'O', '1221 N Highland Ave', 'Aurora', 'Kane', 'IL', '60506', '6308598700', '6302648478', '1221 N Highland Ave', 'Aurora', 'Kane', 'IL', '60506', '6308598700', '6302648478', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-01-01', '2014-07-02', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1902915739', 0, 'Y', 0, '2014-07-09', NULL, NULL, 41.7821, -88.3293, NULL, NULL),
('364088232', 'ELDR00617', 'ELDR00617', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Sheryl', 'P', 'Snyder', 'MD', 'Pathology', '', '', NULL, 'B', '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', '          ', '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', '          ', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-01-01', '2014-07-02', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1902915739', 0, 'Y', 0, '2014-07-09', NULL, NULL, 0, 0, NULL, NULL),
('364088232', 'ELDR00618', 'ELDR00618', 'ILCHIGSTD', 'Dreyer Clinic', 'Christina', 'M', 'DeVormer', 'PT DPT', 'Physical Therapy', '', '', NULL, 'O', '1870 W Galena Blvd', 'Aurora', 'Kane', 'IL', '60506', '6308596700', '6309065099', '1870 W Galena Blvd', 'Aurora', 'Kane', 'IL', '60506', '6308596700', '6309065099', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-01-01', '2013-06-28', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1912207515', 0, 'Y', 0, '2013-07-09', NULL, NULL, 41.7625, -88.3623, NULL, NULL),
('364088232', 'ELDR00619', 'ELDR00619', 'ILCHIGSTD', 'Dreyer Clinic', 'Christina', 'M', 'DeVormer', 'PT DPT', 'Physical Therapy', '', '', NULL, 'O', '2500 W Fabyan Pkwy', 'Batavia', 'Kane', 'IL', '60510', '6304829200', '6307624774', '2500 W Fabyan Pkwy', 'Batavia', 'Kane', 'IL', '60510', '6304829200', '6307624774', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-01-01', '2013-06-28', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1912207515', 0, 'Y', 0, '2013-07-09', NULL, NULL, 41.8641, -88.3512, NULL, NULL),
('364088232', 'ELDR00621', 'ELDR00621', 'ILCHIGSTD', 'Dreyer Clinic', 'Christina', 'M', 'DeVormer', 'PT DPT', 'Physical Therapy', '', '', NULL, 'B', '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', NULL, '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', '          ', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-01-01', '2013-06-28', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1912207515', 0, 'Y', 0, '2013-07-09', NULL, NULL, 0, 0, NULL, NULL),
('364088232', 'ELDR00620', 'ELDR00620', 'ILCHIGSTD', 'Dreyer Clinic', 'Christina', 'M', 'DeVormer', 'PT DPT', 'Physical Therapy', '', '', NULL, 'O', '80 Templeton Dr', 'Oswego', 'Kendall', 'IL', '60543', '6305543456', '6305512764', '80 Templeton Dr', 'Oswego', 'Kendall', 'IL', '60543', '6305543456', '6305512764', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-01-01', '2013-06-28', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1912207515', 0, 'Y', 0, '2013-07-09', NULL, NULL, 41.6735, -88.343, NULL, NULL),
('364088232', 'ELDR00622', 'ELDR00622', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Catherine', 'M', 'Dudley', 'MD', 'Dermatology', '', '', NULL, 'O', '24508 W Village Ctr Dr', 'Plainfield', 'Will', 'IL', '60544', '8154399400', '8154394959', '24508 W Village Ctr Dr', 'Plainfield', 'Will', 'IL', '60544', '8154399400', '8154394959', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1912923095', 0, 'N', 0, '2012-12-19', NULL, NULL, 41.6073, -88.2148, NULL, NULL),
('364088232', 'ELDR00623', 'ELDR00623', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Catherine', 'M', 'Dudley', 'MD', 'Dermatology', '', '', NULL, 'O', '4100 Healthway Dr', 'Aurora', 'Dupage', 'IL', '60504', '6308513105', '6309786694', '4100 Healthway Dr', 'Aurora', 'Dupage', 'IL', '60504', '6308513105', '6309786694', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1912923095', 0, 'N', 0, '2012-12-19', NULL, NULL, 41.7522, -88.2131, NULL, NULL),
('364088232', 'ELDR00624', 'ELDR00624', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Catherine', 'M', 'Dudley', 'MD', 'Dermatology', '', '', NULL, 'B', '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', NULL, '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', '', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1912923095', 0, 'Y', 0, '2012-12-19', NULL, NULL, 0, 0, NULL, NULL),
('364088232', 'ELDR00625', 'ELDR00625', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Jamil', '', 'JacobsnaEl', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1221 N Highland Ave', 'Aurora', 'Kane', 'IL', '60506', '6308598700', '6302648423', '1221 N Highland Ave', 'Aurora', 'Kane', 'IL', '60506', '6308598700', '6302648423', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1912931932', 0, 'N', 0, '2012-12-19', NULL, NULL, 41.7821, -88.3293, NULL, NULL),
('364088232', 'ELDR00626', 'ELDR00626', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Jamil', '', 'JacobsnaEl', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '2040 Ogden Ave Ste 605', 'Aurora', 'Dupage', 'IL', '60504', '6305857100', '6306924129', '2040 Ogden Ave Ste 605', 'Aurora', 'Dupage', 'IL', '60504', '6305857100', '6306924129', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1912931932', 0, 'N', 0, '2013-04-04', NULL, NULL, 41.7282, -88.2677, NULL, NULL),
('364088232', 'ELDR00627', 'ELDR00627', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Jamil', '', 'JacobsnaEl', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', NULL, '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', '', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1912931932', 0, 'Y', 0, '2012-12-19', NULL, NULL, 0, 0, NULL, NULL),
('364088232', 'ELDR00628', 'ELDR00628', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Tehmina', 'A', 'Bajwa', 'MD', 'Family Practice', '', '', NULL, 'O', '2424 W Indian Trail Ste B', 'Aurora', 'Kane', 'IL', '60506', '6309072424', '6309072444', '2424 W Indian Trail Ste B', 'Aurora', 'Kane', 'IL', '60506', '6309072424', '6309072444', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-01-01', '2014-05-31', 0, 0, 0, 'Presence Mercy Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1922083476', 0, 'N', 0, '2014-06-04', NULL, NULL, 41.7809, -88.3766, NULL, NULL),
('364088232', 'ELDR00629', 'ELDR00629', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Tehmina', 'A', 'Bajwa', 'MD', 'Family Practice', '', '', NULL, 'B', '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', '          ', '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', '          ', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-01-01', '2014-05-31', 0, 0, 0, 'Presence Mercy Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1922083476', 0, 'Y', 0, '2014-06-04', NULL, NULL, 0, 0, NULL, NULL),
('364088232', 'ELDR00631', 'ELDR00631', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Bridget', 'A', 'Kampman', 'MD', 'Family Practice', '', '', NULL, 'B', '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', NULL, '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', '', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1922237023', 0, 'Y', 0, '2012-12-19', NULL, NULL, 0, 0, NULL, NULL),
('364088232', 'ELDR00630', 'ELDR00630', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Bridget', 'A', 'Kampman', 'MD', 'Family Practice', '', '', NULL, 'O', '80 Templeton Dr', 'Oswego', 'Kendall', 'IL', '60543', '6305543456', '6305512970', '80 Templeton Dr', 'Oswego', 'Kendall', 'IL', '60543', '6305543456', '6305512970', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1922237023', 0, 'N', 0, '2012-12-19', NULL, NULL, 41.6724, -88.3381, NULL, NULL),
('364088232', 'ELDR00633', 'ELDR00633', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'John', 'W', 'Karesh', 'MD', 'Internal Medicine', '', '', NULL, 'B', '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', NULL, '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', '', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, '', NULL, 'HCFA|UB|', '1932127917', 0, 'Y', 0, '2012-12-19', NULL, NULL, 0, 0, NULL, NULL),
('364088232', 'ELDR00632', 'ELDR00632', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'John', 'W', 'Karesh', 'MD', 'Internal Medicine', '', '', NULL, 'O', '80 Templeton Dr', 'Oswego', 'Kendall', 'IL', '60543', '6305543456', '6305512970', '80 Templeton Dr', 'Oswego', 'Kendall', 'IL', '60543', '6305543456', '6305512970', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, '', NULL, 'HCFA|UB|', '1932127917', 0, 'N', 0, '2012-12-19', NULL, NULL, 41.6724, -88.3381, NULL, NULL),
('364088232', 'ELDR00634', 'ELDR00634', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Melissa', 'C', 'Mahon', 'PsyD', 'Mental Health', 'Psychology', '', NULL, 'O', '1877 W Downer Pl', 'Aurora', 'Kane', 'IL', '60506', '6309065120', '6309065093', '1877 W Downer Pl', 'Aurora', 'Kane', 'IL', '60506', '6309065120', '6309065093', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1932304102', 0, 'Y', 0, '2013-04-22', NULL, NULL, 41.7618, -88.3621, NULL, NULL),
('364088232', 'ELDR00635', 'ELDR00635', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Melissa', 'C', 'Mahon', 'PsyD', 'Mental Health', 'Psychology', '', NULL, 'B', '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', NULL, '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', '', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1932304102', 0, 'Y', 0, '2013-04-22', NULL, NULL, 0, 0, NULL, NULL),
('364088232', 'ELDR00636', 'ELDR00636', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Marcia', 'J', 'Huston', 'MD', 'Infectious Disease', '', '', NULL, 'O', '1870 W Galena Blvd', 'Aurora', 'Kane', 'IL', '60506', '6308596700', '6308596811', '1870 W Galena Blvd', 'Aurora', 'Kane', 'IL', '60506', '6308596700', '6308596811', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1942234984', 0, 'N', 0, '2012-12-19', NULL, NULL, 41.7642, -88.3626, NULL, NULL),
('364088232', 'ELDR00637', 'ELDR00637', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Marcia', 'J', 'Huston', 'MD', 'Infectious Disease', '', '', NULL, 'B', '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', NULL, '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', '', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1942234984', 0, 'Y', 0, '2012-12-19', NULL, NULL, 0, 0, NULL, NULL),
('364088232', 'ELDR00638', 'ELDR00638', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Christina', 'L', 'Willis', 'APN', 'Pediatrics', '', '', NULL, 'O', '1870 W Galena Blvd', 'Aurora', 'Kane', 'IL', '60506', '6308596700', '6308596744', '1870 W Galena Blvd', 'Aurora', 'Kane', 'IL', '60506', '6308596700', '6308596744', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1942241492', 0, 'Y', 0, '2013-09-16', NULL, NULL, 41.7642, -88.3626, NULL, NULL),
('364088232', 'ELDR00639', 'ELDR00639', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Christina', 'L', 'Willis', 'APN', 'Pediatrics', '', '', NULL, 'B', '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', NULL, '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', '', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1942241492', 0, 'Y', 0, '2013-09-16', NULL, NULL, 0, 0, NULL, NULL),
('364088232', 'ELDR00640', 'ELDR00640', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'John', '', 'Siegfried', 'MD', 'Gastroenterology', '', '', NULL, 'O', '1221 N Highland Ave', 'Aurora', 'Kane', 'IL', '60506', '6308598700', '6302648828', '1221 N Highland Ave', 'Aurora', 'Kane', 'IL', '60506', '6308598700', '6302648828', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1942314612', 0, 'N', 0, '2013-04-03', NULL, NULL, 41.7821, -88.3293, 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
('364088232', 'ELDR00641', 'ELDR00641', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'John', '', 'Siegfried', 'MD', 'Gastroenterology', '', '', NULL, 'B', '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', NULL, '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', '', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1942314612', 0, 'Y', 0, '2013-04-03', NULL, NULL, 0, 0, NULL, NULL),
('364088232', 'ELDR00642', 'ELDR00642', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Joseph', 'A', 'Kmiecik', 'MD', 'Radiology', '', '', NULL, 'O', '1221 N Highland Ave', 'Aurora', 'Kane', 'IL', '60506', '6308598700', '6302648522', '1221 N Highland Ave', 'Aurora', 'Kane', 'IL', '60506', '6308598700', '6302648522', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', '', '', '', 'HCFA|UB|', '1942317839', 0, 'Y', 0, '2014-04-07', NULL, NULL, 41.7821, -88.3293, NULL, NULL),
('364088232', 'ELDR00643', 'ELDR00643', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Joseph', 'A', 'Kmiecik', 'MD', 'Radiology', '', '', NULL, 'O', '1870 W Galena Blvd', 'Aurora', 'Kane', 'IL', '60506', '6308596700', '6309065962', '1870 W Galena Blvd', 'Aurora', 'Kane', 'IL', '60506', '6308596700', '6309065962', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', '', '', '', 'HCFA|UB|', '1942317839', 0, 'Y', 0, '2014-04-07', NULL, NULL, 41.7642, -88.3626, NULL, NULL),
('364088232', 'ELDR00644', 'ELDR00644', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Joseph', 'A', 'Kmiecik', 'MD', 'Radiology', '', '', NULL, 'B', '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', NULL, '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', '', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', '', '', '', 'HCFA|UB|', '1942317839', 0, 'Y', 0, '2014-04-07', NULL, NULL, 0, 0, NULL, NULL),
('364088232', 'ELDR00645', 'ELDR00645', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Mayur', 'M', 'Saujani', 'MD', 'Hospitalist', '', '', NULL, 'O', '1221 N Highland Ave', 'Aurora', 'Kane', 'IL', '60506', '6308593248', NULL, '1221 N Highland Ave', 'Aurora', 'Kane', 'IL', '60506', '6308593248', '', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1942462106', 0, 'Y', 0, '2012-12-19', NULL, NULL, 41.7821, -88.3293, NULL, NULL),
('364088232', 'ELDR00646', 'ELDR00646', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Mayur', 'M', 'Saujani', 'MD', 'Hospitalist', '', '', NULL, 'B', '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', NULL, '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', '', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1942462106', 0, 'Y', 0, '2012-12-19', NULL, NULL, 0, 0, NULL, NULL),
('364088232', 'ELDR00647', 'ELDR00647', 'ILCHIGSTD', 'Dreyer Clinic', 'Mark', 'R', 'Fister', 'MD', 'Diagnostic Radiology', '', '', NULL, 'O', '1221 N Highland Ave', 'Aurora', 'Kane', 'IL', '60506', '6308598700', '6302648522', '1221 N Highland Ave', 'Aurora', 'Kane', 'IL', '60506', '6308598700', '6302648522', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-01-01', '2014-02-20', 0, 0, 0, 'Presence Mercy Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1952303653', 0, 'Y', 0, '2014-03-13', NULL, NULL, 41.7821, -88.3293, NULL, NULL),
('364088232', 'ELDR00648', 'ELDR00648', 'ILCHIGSTD', 'Dreyer Clinic', 'Mark', 'R', 'Fister', 'MD', 'Diagnostic Radiology', '', '', NULL, 'O', '1870 W Galena Blvd', 'Aurora', 'Kane', 'IL', '60506', '6308596700', '6309065962', '1870 W Galena Blvd', 'Aurora', 'Kane', 'IL', '60506', '6308596700', '6309065962', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-01-01', '2014-02-20', 0, 0, 0, 'Presence Mercy Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1952303653', 0, 'Y', 0, '2014-03-13', NULL, NULL, 41.7642, -88.3626, NULL, NULL),
('364088232', 'ELDR00649', 'ELDR00649', 'ILCHIGSTD', 'Dreyer Clinic', 'Mark', 'R', 'Fister', 'MD', 'Diagnostic Radiology', '', '', NULL, 'B', '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', NULL, '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', '          ', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-01-01', '2014-02-20', 0, 0, 0, 'Presence Mercy Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1952303653', 0, 'Y', 0, '2014-03-13', NULL, NULL, 0, 0, NULL, NULL),
('364088232', 'ELDR00650', 'ELDR00650', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Atif', '', 'Fakhruddin', 'MD', 'Nephrology', '', '', NULL, 'O', '1500 Sycamore Rd', 'Yorkville', 'Kendall', 'IL', '60560', '6305534470', '6303017616', '1500 Sycamore Rd', 'Yorkville', 'Kendall', 'IL', '60560', '6305534470', '6303017616', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1952349516', 0, 'N', 0, '2012-12-19', NULL, NULL, 41.6572, -88.4372, NULL, NULL),
('364088232', 'ELDR00652', 'ELDR00652', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Atif', '', 'Fakhruddin', 'MD', 'Nephrology', '', '', NULL, 'B', '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', NULL, '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', '', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1952349516', 0, 'Y', 0, '2012-12-19', NULL, NULL, 0, 0, NULL, NULL),
('364088232', 'ELDR00651', 'ELDR00651', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Atif', '', 'Fakhruddin', 'MD', 'Nephrology', '', '', NULL, 'O', '80 Templeton Dr', 'Oswego', 'Kendall', 'IL', '60543', '6305543456', '6305512933', '80 Templeton Dr', 'Oswego', 'Kendall', 'IL', '60543', '6305543456', '6305512933', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1952349516', 0, 'N', 0, '2012-12-19', NULL, NULL, 41.6724, -88.3381, NULL, NULL),
('364088232', 'ELDR00653', 'ELDR00653', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Joseph', 'E', 'Lisac', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1221 N Highland Ave', 'Aurora', 'Kane', 'IL', '60506', '6308598700', '6302648864', '1221 N Highland Ave', 'Aurora', 'Kane', 'IL', '60506', '6308598700', '6302648864', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1962413344', 0, 'Y', 0, '2012-12-19', NULL, NULL, 41.7821, -88.3293, NULL, NULL),
('364088232', 'ELDR00654', 'ELDR00654', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Joseph', 'E', 'Lisac', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '2040 Ogden Ave', 'Aurora', 'Dupage', 'IL', '60504', '6305857100', '6306924080', '2040 Ogden Ave', 'Aurora', 'Dupage', 'IL', '60504', '6305857100', '6306924080', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1962413344', 0, 'Y', 0, '2012-12-19', NULL, NULL, 41.7282, -88.2677, NULL, NULL),
('364088232', 'ELDR00655', 'ELDR00655', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Joseph', 'E', 'Lisac', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', NULL, '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', '', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1962413344', 0, 'Y', 0, '2012-12-19', NULL, NULL, 0, 0, NULL, NULL),
('364088232', 'ELDR00656', 'ELDR00656', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Ramon', '', 'Sotolongona Veras', 'PAC', 'Ear, Nose and Throat', '', '', NULL, 'O', '1221 N Highland Ave', 'Aurora', 'Kane', 'IL', '60506', '6308598700', '6302648484', '1221 N Highland Ave', 'Aurora', 'Kane', 'IL', '60506', '6308598700', '6302648484', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1962419002', 0, 'Y', 0, '2012-12-19', NULL, NULL, 41.7821, -88.3293, NULL, NULL),
('364088232', 'ELDR00657', 'ELDR00657', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Ramon', '', 'Sotolongona Veras', 'PAC', 'Ear, Nose and Throat', '', '', NULL, 'O', '2040 Ogden Ave', 'Aurora', 'Dupage', 'IL', '60504', '6305857100', '6306924057', '2040 Ogden Ave', 'Aurora', 'Dupage', 'IL', '60504', '6305857100', '6306924057', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1962419002', 0, 'Y', 0, '2012-12-19', NULL, NULL, 41.7282, -88.2677, NULL, NULL),
('364088232', 'ELDR00658', 'ELDR00658', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Ramon', '', 'Sotolongona Veras', 'PAC', 'Ear, Nose and Throat', '', '', NULL, 'B', '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', NULL, '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', '', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1962419002', 0, 'Y', 0, '2012-12-19', NULL, NULL, 0, 0, NULL, NULL),
('364088232', 'ELDR00659', 'ELDR00659', 'ILCHIGSTD', 'Dreyer Clinic', 'Parthiv', 'S', 'Mehta', 'MD', 'Radiation Oncology', '', '', NULL, 'O', '1221 N Highland Ave', 'Aurora', 'Kane', 'IL', '60506', '6308598700', '6302648653', '1221 N Highland Ave', 'Aurora', 'Kane', 'IL', '60506', '6308598700', '6302648653', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-01-01', '2013-04-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1962539759', 0, 'N', 0, '2013-04-05', NULL, NULL, 41.7828, -88.3276, NULL, NULL),
('364088232', 'ELDR00660', 'ELDR00660', 'ILCHIGSTD', 'Dreyer Clinic', 'Parthiv', 'S', 'Mehta', 'MD', 'Radiation Oncology', '', '', NULL, 'B', '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', NULL, '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', '          ', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-01-01', '2013-04-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1962539759', 0, 'Y', 0, '2013-04-05', NULL, NULL, 0, 0, NULL, NULL),
('364088232', 'ELDR00661', 'ELDR00661', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Layne', 'A', 'Rousseau', 'DO', 'Urology', '', '', NULL, 'O', '1221 N Highland Ave', 'Aurora', 'Kane', 'IL', '60506', '6308598700', '6302648828', '1221 N Highland Ave', 'Aurora', 'Kane', 'IL', '60506', '6308598700', '6302648828', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1962645630', 0, 'N', 0, '2012-12-19', NULL, NULL, 41.7821, -88.3293, NULL, NULL),
('364088232', 'ELDR00662', 'ELDR00662', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Layne', 'A', 'Rousseau', 'DO', 'Urology', '', '', NULL, 'O', '2040 Ogden Ave Ste 605', 'Aurora', 'Dupage', 'IL', '60504', '6305857100', '6306924110', '2040 Ogden Ave Ste 605', 'Aurora', 'Dupage', 'IL', '60504', '6305857100', '6306924110', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1962645630', 0, 'N', 0, '2013-04-04', NULL, NULL, 41.7282, -88.2677, NULL, NULL),
('364088232', 'ELDR00663', 'ELDR00663', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Layne', 'A', 'Rousseau', 'DO', 'Urology', '', '', NULL, 'B', '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', NULL, '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', '', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1962645630', 0, 'Y', 0, '2012-12-19', NULL, NULL, 0, 0, NULL, NULL),
('364088232', 'ELDR00664', 'ELDR00664', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'William', 'P', 'Dagiantis', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1870 W Galena Blvd', 'Aurora', 'Kane', 'IL', '60506', '6308596700', '6308596811', '1870 W Galena Blvd', 'Aurora', 'Kane', 'IL', '60506', '6308596700', '6308596811', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1972511822', 0, 'N', 0, '2012-12-19', NULL, NULL, 41.7642, -88.3626, NULL, NULL),
('364088232', 'ELDR00665', 'ELDR00665', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'William', 'P', 'Dagiantis', 'MD', 'Internal Medicine', '', '', NULL, 'O', '2500 W Fabyan Pkwy', 'Batavia', 'Kane', 'IL', '60510', '6308792110', '6307624779', '2500 W Fabyan Pkwy', 'Batavia', 'Kane', 'IL', '60510', '6308792110', '6307624779', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1972511822', 0, 'N', 0, '2012-12-19', NULL, NULL, 41.8633, -88.269, NULL, NULL),
('364088232', 'ELDR00666', 'ELDR00666', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'William', 'P', 'Dagiantis', 'MD', 'Internal Medicine', '', '', NULL, 'B', '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', NULL, '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', '', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1972511822', 0, 'Y', 0, '2012-12-19', NULL, NULL, 0, 0, NULL, NULL),
('364088232', 'ELDR00667', 'ELDR00667', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Reena', 'R', 'Shah', 'DO', 'Internal Medicine', '', '', NULL, 'O', '2320 Dean St Ste 201', 'St.Charles', 'Kane', 'IL', '60175', '6303774048', '6303778305', '2320 Dean St Ste 201', 'St.Charles', 'Kane', 'IL', '60175', '6303774048', '6303778305', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, '', NULL, 'HCFA|UB|', '1972597524', 0, 'N', 0, '2012-12-19', NULL, NULL, 41.9201, -88.3443, NULL, NULL),
('364088232', 'ELDR00668', 'ELDR00668', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Reena', 'R', 'Shah', 'DO', 'Internal Medicine', '', '', NULL, 'O', '2500 W Fabyan Pkwy', 'Batavia', 'Kane', 'IL', '60510', '6308792110', '6307624779', '2500 W Fabyan Pkwy', 'Batavia', 'Kane', 'IL', '60510', '6308792110', '6307624779', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, '', NULL, 'HCFA|UB|', '1972597524', 0, 'N', 0, '2012-12-19', NULL, NULL, 41.8633, -88.269, NULL, NULL),
('364088232', 'ELDR00669', 'ELDR00669', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Reena', 'R', 'Shah', 'DO', 'Internal Medicine', '', '', NULL, 'B', '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', NULL, '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', '', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, '', NULL, 'HCFA|UB|', '1972597524', 0, 'Y', 0, '2012-12-19', NULL, NULL, 0, 0, NULL, NULL),
('364088232', 'ELDR00670', 'ELDR00670', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Steven', 'C', 'Harnack', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1870 W Galena Blvd', 'Aurora', 'Kane', 'IL', '60506', '6308596700', '6308596811', '1870 W Galena Blvd', 'Aurora', 'Kane', 'IL', '60506', '6308596700', '6308596811', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1982622387', 0, 'N', 0, '2012-12-19', NULL, NULL, 41.7642, -88.3626, NULL, NULL),
('364088232', 'ELDR00671', 'ELDR00671', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Steven', 'C', 'Harnack', 'MD', 'Internal Medicine', '', '', NULL, 'B', '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', NULL, '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', '', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1982622387', 0, 'Y', 0, '2012-12-19', NULL, NULL, 0, 0, NULL, NULL),
('364088232', 'ELDR00672', 'ELDR00672', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Neena', 'S', 'Szuch', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1221 N Highland Ave', 'Aurora', 'Kane', 'IL', '60506', '6308598700', '6302648423', '1221 N Highland Ave', 'Aurora', 'Kane', 'IL', '60506', '6308598700', '6302648423', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1992842116', 0, 'N', 0, '2012-12-19', NULL, NULL, 41.7821, -88.3293, NULL, NULL),
('364088232', 'ELDR00673', 'ELDR00673', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Neena', 'S', 'Szuch', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', NULL, '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', '', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1992842116', 0, 'Y', 0, '2012-12-19', NULL, NULL, 0, 0, NULL, NULL),
('364088232', 'ELDR00674', 'ELDR00674', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Parag', 'G', 'Merai', 'MD', 'Mental Health', 'Pediatric Psychiatry', '', NULL, 'O', '1877 W Downer Pl', 'Aurora', 'Kane', 'IL', '60506', '6309065120', '6309065093', '1877 W Downer Pl', 'Aurora', 'Kane', 'IL', '60506', '6309065120', '6309065093', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1992905335', 0, 'Y', 0, '2012-12-19', NULL, NULL, 41.7618, -88.3621, NULL, NULL),
('364088232', 'ELDR00675', 'ELDR00675', 'ILCHIGSTD', 'Dreyer Medical Clinic', 'Parag', 'G', 'Merai', 'MD', 'Mental Health', 'Pediatric Psychiatry', '', NULL, 'B', '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', NULL, '62199 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '6308596800', '', 'CHIG17', 'CHIHCPCSMA', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1992905335', 0, 'Y', 0, '2012-12-19', NULL, NULL, 0, 0, NULL, NULL),
('362811504', 'ELRHC0419', 'ELRHC0419', 'ILCHIGSTD', 'Treister Orthopaedic Services', 'Michael', 'R', 'Treister', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1431 N Western Ave Ste 510', 'Chicago', 'Cook', 'IL', '60622', '3126335866', '3126335867', '1431 N Western Ave Ste 510', 'Chicago', 'Cook', 'IL', '60622', '3126335866', '3126335867', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', NULL, NULL, NULL, 'HCFA|UB|', '1003888389', 0, 'N', 0, '2013-12-09', NULL, NULL, 41.9073, -87.6871, NULL, NULL),
('362663241', 'ELRHC0214', 'ELRHC0214', 'ILCHIGSTD', 'Chicago Orthopaedics and Sports Medicine', 'David', 'R', 'Guelich', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '3000 N Halsted St Ste 525', 'Chicago', 'Cook', 'IL', '60657', '7734333130', '7734333125', '3000 N Halsted St Ste 525', 'Chicago', 'Cook', 'IL', '60657', '7734333130', '7734333125', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, NULL, NULL, 'HCFA|UB|', '1003863077', 0, 'N', 0, '2012-12-20', NULL, NULL, 41.9369, -87.6491, NULL, NULL),
('363600851', 'ELRHC0121', 'ELRHC0121', 'ILCHIGSTD', 'Advanced Vision Specialists', 'John', 'B', 'Bello', 'MD', 'Ophthalmology', '', '', NULL, 'O', '7447 W Talcott Ave Ste 406', 'Chicago', 'Cook', 'IL', '60631', '7737759755', '7737754306', '7447 W Talcott Ave Ste 406', 'Chicago', 'Cook', 'IL', '60631', '7737759755', '7737754306', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1003813973', 0, 'N', 0, '2013-04-16', NULL, NULL, 41.9887, -87.8131, NULL, NULL),
('364419620', 'ELRHC0387', 'ELRHC0387', 'ILCHIGSTD', 'Omni Health Clinic', 'Juwaria', 'O', 'Siddiqui', 'MD', 'Family Practice', '', '', NULL, 'O', '2501 W Lawrence Ave Unit C', 'Chicago', 'Cook', 'IL', '60625', '7739893344', '7739898458', '2501 W Lawrence Ave Unit C', 'Chicago', 'Cook', 'IL', '60625', '7739893344', '7739898458', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1003063264', 0, 'N', 0, '2014-06-11', '', NULL, 0, 0, NULL, NULL),
('362975765', 'ELRHC0396', 'ELRHC0396', 'ILCHIGSTD', 'SpindelBuckman Eye Associates', 'David', '', 'Spindel', 'MD', 'Ophthalmology', '', '', NULL, 'O', '800 Austin St East Tower Ste 360', 'Evanston', 'Cook', 'IL', '60202', '8474750694', '8474750697', '800 Austin St East Tower Ste 360', 'Evanston', 'Cook', 'IL', '60202', '8474750694', '8474750697', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Francis Hospital', NULL, '', NULL, 'HCFA|UB|', '1003892985', 0, 'N', 0, '2012-12-20', NULL, NULL, 42.0255, -87.6819, NULL, NULL),
('470956170', 'ELRHC0146', 'ELRHC0146', 'ILCHIGSTD', 'Center for Neurological Disorders', 'Prasad', 'V', 'Chappidi', 'MD', 'Neurology', '', '', NULL, 'O', '5600 W Addison St Ste 406', 'Chicago', 'Cook', 'IL', '60634', '7732059800', '7732059801', '5600 W Addison St Ste 406', 'Chicago', 'Cook', 'IL', '60634', '7732059800', '7732059801', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Our Lady Of The Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1013032499', 0, 'N', 0, '2012-12-20', NULL, NULL, 41.9459, -87.7667, NULL, NULL),
('470956170', 'ELRHC0145', 'ELRHC0145', 'ILCHIGSTD', 'Center for Neurological Disorders', 'Prasad', 'V', 'Chappidi', 'MD', 'Neurology', '', '', NULL, 'B', 'PO Box 320', 'Glenview', 'Cook', 'IL', '60025', '7732059800', '7732059801', 'PO Box 320', 'Glenview', 'Cook', 'IL', '60025', '7732059800', '7732059801', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Our Lady Of The Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1013032499', 0, 'Y', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('364207350', 'ELRHC0221', 'ELRHC0221', 'ILCHIGSTD', 'Fadi Habib MD', 'Fadi', 'A', 'Habib', 'MD', 'Urology', '', '', NULL, 'O', '5600 W Addison St Ste 305', 'Chicago', 'Cook', 'IL', '60634', '7737250760', '7737253499', '5600 W Addison St Ste 305', 'Chicago', 'Cook', 'IL', '60634', '7737250760', '7737253499', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', NULL, NULL, NULL, 'HCFA|UB|', '1013963164', 0, 'N', 0, '2013-05-31', NULL, NULL, 41.9459, -87.7667, NULL, NULL),
('364370485', 'ELRHC0438', 'ELRHC0438', 'ILCHIGSTD', 'Northwest ENT Associates', 'Daniel', 'D', 'Vukas', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '7447 W Talcott Ave Ste 316', 'Chicago', 'Cook', 'IL', '60631', '7734671285', '7734671465', '7447 W Talcott Ave Ste 316', 'Chicago', 'Cook', 'IL', '60631', '7734671285', '7734671465', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1013993005', 0, 'N', 0, '2012-12-20', NULL, NULL, 41.9887, -87.8131, NULL, NULL),
('364370485', 'ELRHC0437', 'ELRHC0437', 'ILCHIGSTD', 'Northwest ENT Associates', 'Daniel', 'D', 'Vukas', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'B', 'PO Box 8710', 'Belfast', 'Waldo', 'ME', '04915', '7734671285', '7734671465', 'PO Box 8710', 'Belfast', 'Waldo', 'ME', '04915', '7734671285', '7734671465', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1013993005', 0, 'Y', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('364827648', 'ELRHC0165', 'ELRHC0165', 'ILCHIGSTD', 'Bruno Delahaye MD', 'Bruno', '', 'Delahaye', 'MD', 'Internal Medicine', '', '', NULL, 'O', '5025 N Paulina St Ste 101', 'Chicago', 'Cook', 'IL', '60640', '7733346578', '7733349009', '5025 N Paulina St Ste 101', 'Chicago', 'Cook', 'IL', '60640', '7733346578', '7733349009', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, '', NULL, 'HCFA|UB|', '1023062551', 0, 'N', 0, '2013-05-31', NULL, NULL, 41.9728, -87.6712, NULL, NULL),
('363835507', 'ELRHC0155', 'ELRHC0155', 'ILCHIGSTD', 'CDN Surgical Associates', 'Mark', 'M', 'Connolly', 'MD', 'General Surgery', '', '', NULL, 'O', '2913 N Commonwealth Ave 5th Fl', 'Chicago', 'Cook', 'IL', '60657', '7734723427', '7734728561', '2913 N Commonwealth Ave 5th Fl', 'Chicago', 'Cook', 'IL', '60657', '7734723427', '7734728561', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, NULL, NULL, 'HCFA|UB|', '1033162839', 0, 'N', 0, '2013-04-03', NULL, NULL, 41.9346, -87.638, NULL, NULL),
('363835507', 'ELRHC0154', 'ELRHC0154', 'ILCHIGSTD', 'CDN Surgical Associates', 'Mark', 'M', 'Connolly', 'MD', 'General Surgery', '', '', NULL, 'B', 'PO Box 597995', 'Chicago', 'Cook', 'IL', '60659', '7734723427', '7734728561', 'PO Box 597995', 'Chicago', 'Cook', 'IL', '60659', '7734723427', '7734728561', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, NULL, NULL, 'HCFA|UB|', '1033162839', 0, 'Y', 0, '2013-04-03', NULL, NULL, 0, 0, NULL, NULL),
('326940400', 'ELRHC0255', 'ELRHC0255', 'ILCHIGSTD', 'Consultants in Kidney Disease', 'Ajit', 'K', 'Kesani', 'MD', 'Nephrology', '', '', NULL, 'O', '800 Austin St Ste 269', 'Evanston', 'Cook', 'IL', '60202', '7734897979', '8478645551', '800 Austin St Ste 269', 'Evanston', 'Cook', 'IL', '60202', '7734897979', '8478645551', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Francis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1043269210', 0, 'N', 0, '2013-07-02', NULL, NULL, 42.0255, -87.6819, NULL, NULL),
('363200170', 'ELRHC0417', 'ELRHC0417', 'ILCHIGSTD', 'Seton Family Health Center', 'Cezar', 'Batongbacal', 'Tolentino', 'MD', 'Family Practice', '', '', NULL, 'O', '711 W N Ave', 'Chicago', 'Cook', 'IL', '60610', '3123371982', '3126423847', '711 W N Ave', 'Chicago', 'Cook', 'IL', '60610', '3123371982', '3126423847', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 8, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, '', '', 'HCFA|UB|', '1043415771', 0, 'N', 0, '2013-08-01', NULL, NULL, 41.911, -87.6461, NULL, NULL),
('362540456', 'ELRHC0323', 'ELRHC0323', 'ILCHIGSTD', 'Nora Medical Group', 'Maryannette', '', 'Nora', 'MD', 'Internal Medicine', '', '', NULL, 'O', '6969 N Lincoln Ave', 'Lincolnwood', 'Cook', 'IL', '60712', '8476741200', '8476741332', '6969 N Lincoln Ave', 'Lincolnwood', 'Cook', 'IL', '60712', '8476741200', '8476741332', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, NULL, NULL, 'HCFA|UB|', '1053339499', 0, 'N', 0, '2013-04-03', NULL, NULL, 42.0075, -87.7339, NULL, NULL),
('364242200', 'ELRHC0411', 'ELRHC0411', 'ILCHIGSTD', 'Ghabra and Tarsha Medical', 'Thana', '', 'Tarsha', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '2222 W Division St Ste 330', 'Chicago', 'Cook', 'IL', '60622', '7732270111', '7732270006', '2222 W Division St Ste 330', 'Chicago', 'Cook', 'IL', '60622', '7732270111', '7732270006', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1063432375', 0, 'N', 0, '2013-03-28', NULL, NULL, 41.9032, -87.6826, NULL, NULL),
('364242200', 'ELRHC0410', 'ELRHC0410', 'ILCHIGSTD', 'Ghabra and Tarsha Medical', 'Thana', '', 'Tarsha', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 967', 'Tinley Park', 'Cook', 'IL', '60477', '7732270111', '7732270006', 'PO Box 967', 'Tinley Park', 'Cook', 'IL', '60477', '7732270111', '7732270006', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1063432375', 0, 'Y', 0, '2013-03-28', NULL, NULL, 0, 0, NULL, NULL),
('363145256', 'ELRHC0443', 'ELRHC0443', 'ILCHIGSTD', 'Chest Medicine Consultants', 'Julia', 'R', 'Weinberger', 'MD', 'Pulmonary', '', '', NULL, 'O', '2800 N Sheridan Rd Ste 301', 'Chicago', 'Cook', 'IL', '60657', '7739355556', '7739352724', '2800 N Sheridan Rd Ste 301', 'Chicago', 'Cook', 'IL', '60657', '7739355556', '7739352724', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, NULL, NULL, 'HCFA|UB|', '1063445195', 0, 'N', 0, '2012-12-20', NULL, NULL, 41.9329, -87.6393, NULL, NULL),
('364453677', 'ELRHC0308', 'ELRHC0308', 'ILCHIGSTD', 'Advanced Dermatology Center', 'Belmina', 'N', 'Michael', 'MD', 'Dermatology', '', '', NULL, 'O', '2735 N Harlem Ave', 'Chicago', 'Cook', 'IL', '60707', '7733856069', '7733856281', '2735 N Harlem Ave', 'Chicago', 'Cook', 'IL', '60707', '7733856069', '7733856281', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-07-23', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1063451458', 0, 'N', 0, '2013-07-23', NULL, NULL, 0, 0, NULL, NULL),
('363033120', 'ELRHC0227', 'ELRHC0227', 'ILCHIGSTD', 'Carl Hill MD', 'Carl', 'E', 'Hill', 'MD', 'Family Practice', '', '', NULL, 'O', '841 Dodge Ave', 'Evanston', 'Cook', 'IL', '60202', '8474911150', '8474910008', '841 Dodge Ave', 'Evanston', 'Cook', 'IL', '60202', '8474911150', '8474910008', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Francis Hospital', NULL, '', NULL, 'HCFA|UB|', '1063528255', 0, 'N', 0, '2013-04-16', NULL, NULL, 42.033, -87.6993, NULL, NULL),
('363920118', 'ELRHC0301', 'ELRHC0301', 'ILCHIGSTD', 'Mayuga Medical Practice', 'Ruperto', 'D', 'Mayuga', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '2800 N Sheridan Rd Ste 303', 'Chicago', 'Cook', 'IL', '60657', '7732817660', '7732810841', '2800 N Sheridan Rd Ste 303', 'Chicago', 'Cook', 'IL', '60657', '7732817660', '7732810841', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwestern Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1073557740', 0, 'N', 0, '2012-12-20', NULL, NULL, 41.9329, -87.6393, NULL, NULL),
('274478152', 'ELRHC0242', 'ELRHC0242', 'ILCHIGSTD', 'Consultants in Gynecology', 'Marko', '', 'Jachtorowycz', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '3201 Old Glenview Rd', 'Wilmette', 'Cook', 'IL', '60091', '8476631030', '8476631039', '3201 Old Glenview Rd', 'Wilmette', 'Cook', 'IL', '60091', '8476631030', '8476631039', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Francis Hospital', '', '', '', 'HCFA|UB|', '1073597894', 0, 'Y', 0, '2014-01-10', NULL, NULL, 0, 0, NULL, NULL),
('274478152', 'ELRHC0243', 'ELRHC0243', 'ILCHIGSTD', 'Metro Chicago Surgical Oncology', 'Marko', '', 'Jachtorowycz', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '5747 W Dempster St Ste 100', 'Morton Grove', 'Cook', 'IL', '60053', '8476631030', '8476631039', '5747 W Dempster St Ste 100', 'Morton Grove', 'Cook', 'IL', '60053', '8476631030', '8476631039', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Francis Hospital', '', '', '', 'HCFA|UB|', '1073597894', 0, 'N', 0, '2014-01-10', NULL, NULL, 42.0409, -87.7702, NULL, NULL),
('364296301', 'ELRHC0188', 'ELRHC0188', 'ILCHIGSTD', 'Manuel Franco MD', 'Manuel', 'A', 'Franco', 'MD', 'Family Practice', '', '', NULL, 'O', '1431 N Western Ave Ste 508', 'Chicago', 'Cook', 'IL', '60622', '7734897648', '7734892078', '1431 N Western Ave Ste 508', 'Chicago', 'Cook', 'IL', '60622', '7734897648', '7734892078', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', NULL, NULL, NULL, 'HCFA|UB|', '1083671341', 0, 'N', 0, '2013-05-31', NULL, NULL, 41.9073, -87.6871, NULL, NULL),
('364296301', 'ELRHC0187', 'ELRHC0187', 'ILCHIGSTD', 'Manuel Franco MD', 'Manuel', 'A', 'Franco', 'MD', 'Family Practice', '', '', NULL, 'B', '909 Norge Pkwy', 'Fox River Grove', 'McHenry', 'IL', '60021', '7734897648', '7734892078', '909 Norge Pkwy', 'Fox River Grove', 'McHenry', 'IL', '60021', '7734897648', '7734892078', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', NULL, NULL, NULL, 'HCFA|UB|', '1083671341', 0, 'Y', 0, '2013-05-31', NULL, NULL, 0, 0, NULL, NULL),
('364336222', 'ELRHC0127', 'ELRHC0127', 'ILCHIGSTD', 'Fabian Carbonell MD', 'Sachin', 'J', 'Bhalerao', 'DO', 'Psychiatry', '', '', NULL, 'O', '2913 N Commonwealth Ave 5th Fl', 'Chicago', 'Cook', 'IL', '60657', '7736653024', '7736653408', '2913 N Commonwealth Ave 5th Fl', 'Chicago', 'Cook', 'IL', '60657', '7736653024', '7736653408', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1083759344', 0, 'Y', 0, '2013-05-31', NULL, NULL, 41.9346, -87.638, NULL, NULL),
('363612758', 'ELRHC0149', 'ELRHC0149', 'ILCHIGSTD', 'Chicago N Medical Partnership', 'Peter', 'E', 'Chou', 'MD', 'Internal Medicine', '', '', NULL, 'O', '5308 N Broadway', 'Chicago', 'Cook', 'IL', '60640', '7737842822', '7737843931', '5308 N Broadway', 'Chicago', 'Cook', 'IL', '60640', '7737842822', '7737843931', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Francis Hospital', NULL, '', NULL, 'HCFA|UB|', '1093723868', 0, 'N', 0, '2012-12-20', NULL, NULL, 41.9783, -87.66, NULL, NULL),
('800090759', 'ELRHC0226', 'ELRHC0226', 'ILCHIGSTD', 'Lakeshore Gastroenterology and Liver Disease Institute', 'Kamran', '', 'Heydarpour', 'MD', 'Gastroenterology', '', '', NULL, 'O', '1 Erie Ct Ste 3100', 'Oak Park', 'Cook', 'IL', '60302', '7087638248', '7083837875', '1 Erie Ct Ste 3100', 'Oak Park', 'Cook', 'IL', '60302', '7087638248', '7083837875', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Holy Family Medical Center', NULL, '', NULL, 'HCFA|UB|', '1093764193', 0, 'N', 0, '2012-12-20', NULL, NULL, 41.8919, -87.775, NULL, NULL),
('363200170', 'ELRHC0420', 'ELRHC0420', 'ILCHIGSTD', 'Seton Family Health Center', 'Sharyl', 'J', 'Truty', 'MD', 'Family Practice', '', '', NULL, 'O', '711 W N Ave 1st Fl', 'Chicago', 'Cook', 'IL', '60610', '3123371982', '0000000000', '711 W N Ave 1st Fl', 'Chicago', 'Cook', 'IL', '60610', '3123371982', '0000000000', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 8, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, '', '', 'HCFA|UB|', '1093767147', 0, 'N', 0, '2013-05-28', NULL, NULL, 41.911, -87.6461, NULL, NULL),
('362605281', 'ELRHC0212', 'ELRHC0212', 'ILCHIGSTD', 'Surgical Associates', 'Charles', 'R', 'Gruner', 'MD', 'General Surgery', '', '', NULL, 'O', '800 Austin St East Tower Ste 563', 'Evanston', 'Cook', 'IL', '60202', '8478690522', '8478690652', '800 Austin St East Tower Ste 563', 'Evanston', 'Cook', 'IL', '60202', '8478690522', '8478690652', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Francis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1093980872', 0, 'N', 0, '2012-12-20', NULL, NULL, 42.0255, -87.6819, NULL, NULL),
('362720130', 'ELRHC0434', 'ELRHC0434', 'ILCHIGSTD', 'Clniical Neurosciences', 'Jonathan', 'E', 'Vogel', 'MD', 'Neurology', '', '', NULL, 'O', '8 S Michigan Ave Ste 1505', 'Chicago', 'Cook', 'IL', '60603', '3122632828', '3122632759', '8 S Michigan Ave Ste 1505', 'Chicago', 'Cook', 'IL', '60603', '3122632828', '3122632759', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, '', NULL, 'HCFA|UB|', '1104007533', 0, 'N', 0, '2012-12-20', NULL, NULL, 41.882, -87.6245, NULL, NULL),
('363612758', 'ELRHC0450', 'ELRHC0450', 'ILCHIGSTD', 'Chicago N Medical Partnership', 'Ming', 'S', 'Wu', 'MD', 'Internal Medicine', '', '', NULL, 'O', '5308 N Broadway', 'Chicago', 'Cook', 'IL', '60640', '7737842822', '7737843931', '5308 N Broadway', 'Chicago', 'Cook', 'IL', '60640', '7737842822', '7737843931', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Francis Hospital', NULL, '', NULL, 'HCFA|UB|', '1104834043', 0, 'N', 0, '2012-12-20', NULL, NULL, 41.9783, -87.66, NULL, NULL),
('363325093', 'ELRHC0185', 'ELRHC0185', 'ILCHIGSTD', 'North Shore Cardiology Consultants', 'Raymond', 'L', 'Fisher', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '7447 W Talcott Ave Ste 200', 'Chicago', 'Cook', 'IL', '60631', '7737745020', '7737744967', '7447 W Talcott Ave Ste 200', 'Chicago', 'Cook', 'IL', '60631', '7737745020', '7737744967', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1104886779', 0, 'N', 0, '2012-12-20', NULL, NULL, 41.9887, -87.8131, NULL, NULL),
('363200170', 'ELRHC0179', 'ELRHC0179', 'ILCHIGSTD', 'Seton Family Health Center', 'Jean', 'M', 'Engelkemeir', 'MD', 'Family Practice', '', '', NULL, 'O', '711 W N Ave', 'Chicago', 'Cook', 'IL', '60610', '3123371982', '3126423847', '711 W N Ave', 'Chicago', 'Cook', 'IL', '60610', '3123371982', '3126423847', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 8, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, '', '', 'HCFA|UB|', '1104996115', 0, 'N', 0, '2013-05-28', NULL, NULL, 41.911, -87.6461, NULL, NULL),
('820558911', 'ELRHC0423', 'ELRHC0423', 'ILCHIGSTD', 'Kidney and Hypertension Consultants', 'Daiva', 'K', 'Valaitis', 'MD', 'Nephrology', '', '', NULL, 'O', '7447 W Talcott Ave Ste 463', 'Chicago', 'Cook', 'IL', '60631', '7737638400', '7737748085', '7447 W Talcott Ave Ste 463', 'Chicago', 'Cook', 'IL', '60631', '7737638400', '7737748085', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', NULL, NULL, 'HCFA|UB|', '1114905544', 0, 'N', 0, '2012-12-20', NULL, NULL, 41.9887, -87.8131, NULL, NULL),
('363553539', 'ELRHC0350', 'ELRHC0350', 'ILCHIGSTD', 'Barry A Rapaport MD', 'Barry', 'A', 'Rapaport', 'MD', 'Internal Medicine', '', '', NULL, 'O', '3048 W Peterson Ave', 'Chicago', 'Cook', 'IL', '60659', '7734653443', '7734653160', '3048 W Peterson Ave', 'Chicago', 'Cook', 'IL', '60659', '7734653443', '7734653160', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Francis Hospital', NULL, '', NULL, 'HCFA|UB|', '1114988417', 0, 'N', 0, '2013-05-30', NULL, NULL, 41.9904, -87.7062, NULL, NULL),
('363553539', 'ELRHC0349', 'ELRHC0349', 'ILCHIGSTD', 'Barry A Rapaport MD', 'Barry', 'A', 'Rapaport', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 2548', 'Northbrook', 'Cook', 'IL', '60065', '7734653443', '7734653160', 'PO Box 2548', 'Northbrook', 'Cook', 'IL', '60065', '7734653443', '7734653160', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Francis Hospital', NULL, '', NULL, 'HCFA|UB|', '1114988417', 0, 'Y', 0, '2013-05-30', NULL, NULL, 0, 0, NULL, NULL),
('363113918', 'ELRHC0148', 'ELRHC0148', 'ILCHIGSTD', 'Sheridan Cardiac Consultants', 'Kamal', 'K', 'Chawla', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '2800 N Sheridan Rd Ste 510', 'Chicago', 'Cook', 'IL', '60657', '7733487555', '7733487585', '2800 N Sheridan Rd Ste 510', 'Chicago', 'Cook', 'IL', '60657', '7733487555', '7733487585', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, '', NULL, 'HCFA|UB|', '1124009691', 0, 'N', 0, '2012-12-20', NULL, NULL, 41.9329, -87.6393, NULL, NULL),
('364288034', 'ELRHC0312', 'ELRHC0312', 'ILCHIGSTD', 'Young Family Health Center', 'Young', 'H', 'Mok', 'MD', 'Pediatrics', '', '', NULL, 'O', '1431 N Western Ave Ste 101', 'Chicago', 'Cook', 'IL', '60622', '7732762272', '7732762399', '1431 N Wern Ave Ste 101', 'Chicago', 'Cook', 'IL', '60622', '7732762272', '7732762399', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', NULL, NULL, NULL, 'HCFA|UB|', '1124029277', 0, 'N', 0, '2012-12-20', NULL, NULL, 41.9073, -87.6871, NULL, NULL),
('363434158', 'ELRHC0395', 'ELRHC0395', 'ILCHIGSTD', 'Neal A Spero MD', 'Neal', 'A', 'Spero', 'MD', 'Dermatology', '', '', NULL, 'O', '800 Austin St West Tower Ste 301', 'Evanston', 'Cook', 'IL', '60202', '8478649500', '8478643926', '800 Austin St West Tower Ste 301', 'Evanston', 'Cook', 'IL', '60202', '8478649500', '8478643926', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Francis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1124189071', 0, 'N', 0, '2013-05-30', NULL, NULL, 42.0255, -87.6819, NULL, NULL),
('364370485', 'ELRHC0194', 'ELRHC0194', 'ILCHIGSTD', 'Northwest ENT Associates', 'Thomas', 'E', 'Garrity', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '7447 W Talcott Ave Ste 316', 'Chicago', 'Cook', 'IL', '60631', '7734671285', '7734671465', '7447 W Talcott Ave Ste 316', 'Chicago', 'Cook', 'IL', '60631', '7734671285', '7734671465', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1134105125', 0, 'N', 0, '2012-12-20', NULL, NULL, 41.9887, -87.8131, NULL, NULL),
('364370485', 'ELRHC0193', 'ELRHC0193', 'ILCHIGSTD', 'Northwest ENT Associates', 'Thomas', 'E', 'Garrity', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'B', 'PO Box 8710', 'Belfast', 'Waldo', 'ME', '04915', '7734671285', '7734671465', 'PO Box 8710', 'Belfast', 'Waldo', 'ME', '04915', '7734671285', '7734671465', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1134105125', 0, 'Y', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('363399399', 'ELRHC0334', 'ELRHC0334', 'ILCHIGSTD', 'Amritbhail P Patel MD', 'Amritbhai', 'P', 'Patel', 'MD', 'Gastroenterology', '', '', NULL, 'B', '2222 W Division St Ste 225', 'Chicago', 'Cook', 'IL', '60622', '7738830800', '7735254022', '2222 W Division St Ste 225', 'Chicago', 'Cook', 'IL', '60622', '7738830800', '7735254022', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Our Lady Of The Resurrection Medical Center', 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', NULL, NULL, 'HCFA|UB|', '1134294853', 0, 'Y', 0, '2013-05-30', NULL, NULL, 41.9033, -87.6834, NULL, NULL),
('363399399', 'ELRHC0333', 'ELRHC0333', 'ILCHIGSTD', 'Amritbhail P Patel MD', 'Amritbhai', 'P', 'Patel', 'MD', 'Gastroenterology', '', '', NULL, 'O', '2800 N Sheridan Rd Ste 107', 'Chicago', 'Cook', 'IL', '60657', '7738830800', '7735254022', '2800 N Sheridan Rd Ste 107', 'Chicago', 'Cook', 'IL', '60657', '7738830800', '7735254022', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Our Lady Of The Resurrection Medical Center', 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', NULL, NULL, 'HCFA|UB|', '1134294853', 0, 'N', 0, '2013-05-30', NULL, NULL, 41.9329, -87.6393, NULL, NULL),
('364370485', 'ELRHC0314', 'ELRHC0314', 'ILCHIGSTD', 'Northwest ENT Associates', 'Victor', 'P', 'Mokarry', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '7447 W Talcott Ave Ste 316', 'Chicago', 'Cook', 'IL', '60631', '7734671285', '7734671465', '7447 W Talcott Ave Ste 316', 'Chicago', 'Cook', 'IL', '60631', '7734671285', '7734671465', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1144206129', 0, 'N', 0, '2012-12-20', NULL, NULL, 41.9887, -87.8131, NULL, NULL),
('364370485', 'ELRHC0313', 'ELRHC0313', 'ILCHIGSTD', 'Northwest ENT Associates', 'Victor', 'P', 'Mokarry', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'B', 'PO Box 8710', 'Belfast', 'Waldo', 'ME', '04915', '7734671285', '7734671465', 'PO Box 8710', 'Belfast', 'Waldo', 'ME', '04915', '7734671285', '7734671465', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1144206129', 0, 'Y', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('363963241', 'ELRHC0427', 'ELRHC0427', 'ILCHIGSTD', 'Chicago Hamlin Family Practice Specialist', 'Donna', 'I', 'Vasquez', 'MD', 'Family Practice', '', '', NULL, 'O', '3758 W Chicago Ave', 'Chicago', 'Cook', 'IL', '60651', '7732350626', '7732355834', '3758 W Chicago Ave', 'Chicago', 'Cook', 'IL', '60651', '7732350626', '7732355834', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', NULL, NULL, NULL, 'HCFA|UB|', '1154333169', 0, 'N', 0, '2013-10-03', NULL, NULL, 41.8955, -87.7205, NULL, NULL),
('363963241', 'ELRHC0425', 'ELRHC0425', 'ILCHIGSTD', 'Chicago Hamlin Family Practice Specialist', 'Donna', 'I', 'Vasquez', 'MD', 'Family Practice', '', '', NULL, 'B', '520 E 22nd St', 'Lombard', 'Dupage', 'IL', '60148', '7732350626', '7732355834', '520 E 22nd St', 'Lombard', 'Dupage', 'IL', '60148', '7732350626', '7732355834', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', NULL, NULL, NULL, 'HCFA|UB|', '1154333169', 0, 'Y', 0, '2013-10-03', NULL, NULL, 0, 0, NULL, NULL),
('870299862', 'W12030677', 'W12030677', 'UTMH1', 'Life Changing Services', 'Mindy', 'R', 'Lundgreen', 'MSW', 'Mental Health', '', '', NULL, 'O', '722 Shepard Ln', 'Farmington', 'Davis', 'UT', '84025', '8016412252', NULL, '722 Shepard Ln', 'Farmington', 'Davis', 'UT', '84025', '8016412252', '          ', 'UTMA', '', '', '0.00', '40.00', '0.00', 8, '2030-01-01', '2014-02-25', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1629209247', 0, 'Y', 1, '2014-02-25', NULL, NULL, 0, 0, NULL, NULL),
('363145256', 'ELRHC0373', 'ELRHC0373', 'ILCHIGSTD', 'Chest Medicine Consultants', 'William', 'M', 'Sanders', 'MD', 'Pulmonary', '', '', NULL, 'O', '2800 N Sheridan Rd Ste 301', 'Chicago', 'Cook', 'IL', '60657', '7739355556', '7739352724', '2800 N Sheridan Rd Ste 301', 'Chicago', 'Cook', 'IL', '60657', '7739355556', '7739352724', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, NULL, NULL, 'HCFA|UB|', '1164426599', 0, 'N', 0, '2012-12-20', NULL, NULL, 41.9329, -87.6393, NULL, NULL),
('363416185', 'ELRHC0274', 'ELRHC0274', 'ILCHIGSTD', 'Elizabeth J Lavoo MD', 'Elizabeth', 'J', 'Lavoo', 'MD', 'Dermatology', '', '', NULL, 'O', '201 E Huron St Galter 11230', 'Chicago', 'Cook', 'IL', '60611', '3126426868', '3126422902', '201 E Huron St Galter 11230', 'Chicago', 'Cook', 'IL', '60611', '3126426868', '3126422902', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwestern Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1164491858', 0, 'N', 0, '2013-05-30', NULL, NULL, 41.895, -87.6227, NULL, NULL),
('363416185', 'ELRHC0273', 'ELRHC0273', 'ILCHIGSTD', '363416185', 'Elizabeth', 'J', 'Lavoo', 'MD', 'Dermatology', '', '', NULL, 'B', 'PO Box 249', 'Wilmette', 'Cook', 'IL', '60091', '3126426868', '3126422902', 'PO Box 249', 'Wilmette', 'Cook', 'IL', '60091', '3126426868', '3126422902', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwestern Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1164491858', 0, 'Y', 0, '2013-05-30', 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
('200797489', 'ELRHC0220', 'ELRHC0220', 'ILCHIGSTD', 'Salvador Gutierrez MD', 'Salvador', 'R', 'Gutierrez', 'MD', 'Family Practice', '', '', NULL, 'O', '2655 N Milwaukee Ave', 'Chicago', 'Cook', 'IL', '60647', '7734890133', '7738626380', '2655 N Milwaukee Ave', 'Chicago', 'Cook', 'IL', '60647', '7734890133', '7738626380', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', NULL, '', NULL, 'HCFA|UB|', '1164522769', 0, 'N', 0, '2013-05-24', NULL, NULL, 41.9298, -87.7086, NULL, NULL),
('331441930', 'ELRHC0298', 'ELRHC0298', 'ILCHIGSTD', 'Mann Stewart R', 'Stewart', 'R', 'Mann', 'MD', 'Pulmonary', '', '', NULL, 'B', '1730 Park St  Ste 101', 'Naperville', 'Dupage', 'IL', '60563', '7739072650', '7736653384', '1730 Park St  Ste 101', 'Naperville', 'Dupage', 'IL', '60563', '7739072650', '7736653384', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, '', NULL, 'HCFA|UB|', '1174533442', 0, 'Y', 0, '2013-05-31', NULL, NULL, 0, 0, NULL, NULL),
('331441930', 'ELRHC0297', 'ELRHC0297', 'ILCHIGSTD', 'Mann Stewart R', 'Stewart', 'R', 'Mann', 'MD', 'Pulmonary', '', '', NULL, 'O', '2900 N Lake Shore Dr', 'Chicago', 'Cook', 'IL', '60657', '7739072650', '7736653384', '2900 N Lake Shore Dr', 'Chicago', 'Cook', 'IL', '60657', '7739072650', '7736653384', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, '', NULL, 'HCFA|UB|', '1174533442', 0, 'N', 0, '2013-05-31', NULL, NULL, 41.9349, -87.6367, NULL, NULL),
('363304645', 'ELRHC0303', 'ELRHC0303', 'ILCHIGSTD', 'Kris G McGrath MD', 'Kris', 'G', 'McGrath', 'MD', 'Allergy and Immunology', '', '', NULL, 'O', '500 N Michigan Ave Ste 1640', 'Chicago', 'Cook', 'IL', '60611', '3122229500', '3122229589', '500 N Michigan Ave Ste 1640', 'Chicago', 'Cook', 'IL', '60611', '3122229500', '3122229589', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwestern Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1174563811', 0, 'N', 0, '2013-05-24', NULL, NULL, 41.8909, -87.6243, NULL, NULL),
('364301250', 'ELRHC0100', 'ELRHC0100', 'ILCHIGSTD', 'Yousef Darwish MD', 'Suhair', 'S', 'Abdel Jalil', 'MD', 'Rheumatology', '', '', NULL, 'O', '800 Austin St East Tower Ste 163', 'Evanston', 'Cook', 'IL', '60202', '8473163880', '8473163883', '800 Austin St East Tower Ste 163', 'Evanston', 'Cook', 'IL', '60202', '8473163880', '8473163883', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Francis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1174572929', 0, 'N', 0, '2013-05-31', NULL, NULL, 42.0255, -87.6819, NULL, NULL),
('362700193', 'ELRHC0133', 'ELRHC0133', 'ILCHIGSTD', 'Associates in Urology', 'James', 'L', 'Brown', 'MD', 'Urology', '', '', NULL, 'O', '7447 W Talcott Ave Ste 522', 'Chicago', 'Cook', 'IL', '60631', '7737631314', '7737634739', '7447 W Talcott Ave Ste 522', 'Chicago', 'Cook', 'IL', '60631', '7737631314', '7737634739', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1174599153', 0, 'N', 0, '2012-12-20', NULL, NULL, 41.9887, -87.8131, NULL, NULL),
('270907956', 'ELRHC0169', 'ELRHC0169', 'ILCHIGSTD', 'University Dermatology', 'Vassilios', 'A', 'Dimitropoulos', 'MD', 'Dermatology', '', '', NULL, 'O', '4605 W Golf Rd', 'Skokie', 'Cook', 'IL', '60076', '2694285199', '8476795490', '4605 W Golf Rd', 'Skokie', 'Cook', 'IL', '60076', '2694285199', '8476795490', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', NULL, '', '', 'HCFA|UB|', '1194838045', 0, 'N', 0, '2013-07-02', NULL, NULL, 42.0552, -87.7402, NULL, NULL),
('270907956', 'ELRHC0168', 'ELRHC0168', 'ILCHIGSTD', 'University Dermatology', 'Vassilios', 'A', 'Dimitropoulos', 'MD', 'Dermatology', '', '', NULL, 'B', 'PO Box 6029', 'Chicago', 'Cook', 'IL', '60680', '8476795199', '8476795490', 'PO Box 6029', 'Chicago', 'Cook', 'IL', '60680', '8476795199', '8476795490', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', NULL, '', '', 'HCFA|UB|', '1194838045', 0, 'Y', 0, '2013-07-02', NULL, NULL, 0, 0, NULL, NULL),
('362984914', 'ELRHC0261', 'ELRHC0261', 'ILCHIGSTD', 'Ashay Kparker MD', 'Ashay', '', 'Kparker', 'MD', 'Urology', '', '', NULL, 'O', '6084 S Archer Ave Ste 202', 'Chicago', 'Cook', 'IL', '60638', '7735815888', '7735815895', '6084 S Archer Ave Ste 202', 'Chicago', 'Cook', 'IL', '60638', '7735815888', '7735815895', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', NULL, '', NULL, 'HCFA|UB|', '1205037785', 0, 'N', 0, '2013-05-24', NULL, NULL, 41.7947, -87.7696, NULL, NULL),
('455498993', 'ELRHC0143', 'ELRHC0143', 'ILCHIGSTD', 'Lakeview Digestive Disease and Liver Center', 'Samuel', 'F', 'Castillo', 'MD', 'Gastroenterology', '', '', NULL, 'O', '5744 N Broadway', 'Chicago', 'Cook', 'IL', '60657', '3123350181', '8477138160', '5744 N Broadway', 'Chicago', 'Cook', 'IL', '60657', '3123350181', '8477138160', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', '', '', '', 'HCFA|UB|', '1205801313', 0, 'N', 0, '2013-04-16', NULL, NULL, 41.9862, -87.6602, NULL, NULL),
('455498993', 'ELRHC0142', 'ELRHC0142', 'ILCHIGSTD', 'Chicago GI Specialist', 'Samuel', 'F', 'Castillo', 'MD', 'Gastroenterology', '', '', NULL, 'O', 'Saint Elizabeth Professional Bldg 1431 N Wern Ave Ste 133', 'Chicago', 'Cook', 'IL', '60622', '7733426800', '7733426332', 'Saint Elizabeth Professional Bldg 1431 N Wern Ave Ste 133', 'Chicago', 'Cook', 'IL', '60622', '7733426800', '7733426332', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', '', '', '', 'HCFA|UB|', '1205801313', 0, 'N', 0, '2013-04-16', NULL, NULL, 41.9013, -87.6828, NULL, NULL),
('134212397', 'ELRHC0362', 'ELRHC0362', 'ILCHIGSTD', 'Garcia Rosenberg and Associates', 'Sharon', 'B', 'Rosenberg', 'MD', 'Internal Medicine', '', '', NULL, 'O', '7126 N Lincoln Ave', 'Lincolnwood', 'Cook', 'IL', '60712', '8475839189', '8475839196', '7126 N Lincoln Ave', 'Lincolnwood', 'Cook', 'IL', '60712', '8475839189', '8475839196', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-01-01', 0, 0, 0, 'Presence Saint Francis Hospital', NULL, '', '', 'HCFA|UB|', '1205876893', 0, 'N', 0, '2013-08-01', NULL, NULL, 42.0108, -87.7386, NULL, NULL),
('134212397', 'ELRHC0361', 'ELRHC0361', 'ILCHIGSTD', 'Garcia Rosenberg and Associates', 'Sharon', 'B', 'Rosenberg', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'Springfield Service Corp PO', 'Springfield', 'Sangamon', 'IL', '62708', '8475839189', '8475839196', 'Springfield Service Corp PO', 'Springfield', 'Sangamon', 'IL', '62708', '8475839189', '8475839196', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Francis Hospital', NULL, '', '', 'HCFA|UB|', '1205876893', 0, 'Y', 0, '2013-08-01', NULL, NULL, 0, 0, NULL, NULL),
('362716083', 'ELRHC0158', 'ELRHC0158', 'ILCHIGSTD', 'Womens Health Associates', 'Joseph', 'J', 'Coughlin', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '7447 W Talcott Ave Ste 454', 'Chicago', 'Cook', 'IL', '60631', '7736315767', '7736310828', '7447 W Talcott Ave Ste 454', 'Chicago', 'Cook', 'IL', '60631', '7736315767', '7736310828', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1215022637', 0, 'N', 0, '2012-12-20', NULL, NULL, 41.9887, -87.8131, NULL, NULL),
('364362710', 'ELRHC0156', 'ELRHC0156', 'ILCHIGSTD', 'Retina Institute of Illinois PC', 'Stephen', 'M', 'Conti', 'MD', 'Ophthalmology', '', '', NULL, 'O', '8780 W Golf Rd Ste 304', 'Niles', 'Cook', 'IL', '60714', '8472978900', '8472978926', '8780 W Golf Rd Ste 304', 'Niles', 'Cook', 'IL', '60714', '8472978900', '8472978926', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Francis Hospital', NULL, '', NULL, 'HCFA|UB|', '1215027115', 0, 'N', 0, '2012-12-20', NULL, NULL, 42.0485, -87.84, NULL, NULL),
('362720130', 'ELRHC0393', 'ELRHC0393', 'ILCHIGSTD', 'Clinical Neurosciences', 'Hilliard', 'E', 'Slavick', 'MD', 'Neurology', '', '', NULL, 'O', '8 S Michigan Ave Ste 1505', 'Chicago', 'Cook', 'IL', '60603', '3122632828', '3122632759', '8 S Michigan Ave Ste 1505', 'Chicago', 'Cook', 'IL', '60603', '3122632828', '3122632759', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, '', NULL, 'HCFA|UB|', '1215935523', 0, 'N', 0, '2012-12-20', NULL, NULL, 41.882, -87.6245, NULL, NULL),
('363094662', 'ELRHC0456', 'ELRHC0456', 'ILCHIGSTD', 'Merrill Zahtz MD', 'Merrill', 'J', 'Zahtz', 'MD', 'Internal Medicine', '', '', NULL, 'B', '3525 W Granville', 'Chicago', 'Cook', 'IL', '60659', '8473164744', '8883168010', '3525 W Granville', 'Chicago', 'Cook', 'IL', '60659', '8473164744', '8883168010', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Francis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1225097819', 0, 'Y', 0, '2013-05-24', NULL, NULL, 0, 0, NULL, NULL),
('363094662', 'ELRHC0455', 'ELRHC0455', 'ILCHIGSTD', 'Merrill Zahtz MD', 'Merrill', 'J', 'Zahtz', 'MD', 'Internal Medicine', '', '', NULL, 'O', '800 Austin St West Tower Ste 508', 'Evanston', 'Cook', 'IL', '60202', '8473164744', '8883168010', '800 Austin St West Tower Ste 508', 'Evanston', 'Cook', 'IL', '60202', '8473164744', '8883168010', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Francis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1225097819', 0, 'N', 0, '2013-05-24', NULL, NULL, 42.0255, -87.6819, NULL, NULL),
('363018460', 'ELRHC0386', 'ELRHC0386', 'ILCHIGSTD', 'Alia Siddiqi MD', 'Alia', 'N', 'Siddiqi', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '4646 N Marine Dr Ste 5500A', 'Chicago', 'Cook', 'IL', '60640', '7735611574', '7737696201', '4646 N Marine Dr Ste 5500A', 'Chicago', 'Cook', 'IL', '60640', '7735611574', '7737696201', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, NULL, NULL, 'HCFA|UB|', '1225148000', 0, 'N', 0, '2013-05-30', NULL, NULL, 41.9669, -87.649, NULL, NULL),
('363018460', 'ELRHC0385', 'ELRHC0385', 'ILCHIGSTD', 'Alia Siddiqi MD', 'Alia', 'N', 'Siddiqi', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '7017 N Kilbourn Ave', 'Lincolnwood', 'Cook', 'IL', '60712', '7735611574', '7737696201', '7017 N Kilbourn Ave', 'Lincolnwood', 'Cook', 'IL', '60712', '7735611574', '7737696201', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, NULL, NULL, 'HCFA|UB|', '1225148000', 0, 'Y', 0, '2013-05-30', NULL, NULL, 0, 0, NULL, NULL),
('362822963', 'ELRHC0198', 'ELRHC0198', 'ILCHIGSTD', 'Lawrence Gluskin MD', 'Lawrence', 'E', 'Gluskin', 'MD', 'Gastroenterology', '', '', NULL, 'O', '2800 N Sheridan Rd Ste 510', 'Chicago', 'Cook', 'IL', '60657', '7732481616', '7732484343', '2800 N Sheridan Rd Ste 510', 'Chicago', 'Cook', 'IL', '60657', '7732481616', '7732484343', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, NULL, NULL, 'HCFA|UB|', '1235109711', 0, 'N', 0, '2013-05-24', NULL, NULL, 41.9329, -87.6393, NULL, NULL),
('362704297', 'ELRHC0352', 'ELRHC0352', 'ILCHIGSTD', 'Tiesenga Surgical Associates', 'Scott', 'A', 'Reishus', 'DO', 'Vascular Surgery', '', '', NULL, 'O', '1950 N Harlem Ave', 'Elmwood Park', 'Cook', 'IL', '60707', '7084536800', '7084533985', '1950 N Harlem Ave', 'Elmwood Park', 'Cook', 'IL', '60707', '7084536800', '7084533985', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Our Lady Of The Resurrection Medical Center', NULL, '', NULL, 'HCFA|UB|', '1245210160', 0, 'N', 0, '2012-12-20', NULL, NULL, 41.9158, -87.806, NULL, NULL),
('362704297', 'ELRHC0377', 'ELRHC0377', 'ILCHIGSTD', 'Tiesenga Surgical Associates', 'Charles', 'B', 'Schubert', 'MD', 'Vascular Surgery', '', '', NULL, 'O', '1950 N Harlem Ave', 'Elmwood Park', 'Cook', 'IL', '60707', '7084536800', '7084533985', '1950 N Harlem Ave', 'Elmwood Park', 'Cook', 'IL', '60707', '7084536800', '7084533985', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Our Lady Of The Resurrection Medical Center', NULL, '', NULL, 'HCFA|UB|', '1245219641', 0, 'N', 0, '2012-12-20', NULL, NULL, 41.9158, -87.806, NULL, NULL),
('363114403', 'ELRHC0400', 'ELRHC0400', 'ILCHIGSTD', 'Eye Associates', 'Kevin', 'L', 'Sullivan', 'MD', 'Ophthalmology', '', '', NULL, 'O', '7447 W Talcott Ave Ste 300', 'Chicago', 'Cook', 'IL', '60631', '7737750811', '7737750818', '7447 W Talcott Ave Ste 300', 'Chicago', 'Cook', 'IL', '60631', '7737750811', '7737750818', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1245390897', 0, 'N', 0, '2012-12-20', NULL, NULL, 41.9887, -87.8131, NULL, NULL),
('363145256', 'ELRHC0363', 'ELRHC0363', 'ILCHIGSTD', 'Chest Medicine Consultants', 'Neil', '', 'Rosenberg', 'MD', 'Pulmonary', '', '', NULL, 'O', '2800 N Sheridan Rd Ste 301', 'Chicago', 'Cook', 'IL', '60657', '7739355556', '7739352724', '2800 N Sheridan Rd Ste 301', 'Chicago', 'Cook', 'IL', '60657', '7739355556', '7739352724', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', 'Presence Saint Joseph Hospital Chicago', NULL, NULL, 'HCFA|UB|', '1265436695', 0, 'N', 0, '2012-12-20', NULL, NULL, 41.9329, -87.6393, NULL, NULL),
('364288034', 'ELRHC0442', 'ELRHC0442', 'ILCHIGSTD', 'Young Family Health Center', 'Roohi', 'U', 'Wasiuddin', 'MD', 'Pediatrics', '', '', NULL, 'O', '1431 N Western Ave Ste 101', 'Chicago', 'Cook', 'IL', '60622', '7732762272', '7733843605', '1431 N Wern Ave Ste 101', 'Chicago', 'Cook', 'IL', '60622', '7732762272', '7733843605', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', NULL, NULL, NULL, 'HCFA|UB|', '1265629786', 0, 'N', 0, '2012-12-20', NULL, NULL, 41.9073, -87.6871, NULL, NULL),
('363744019', 'ELRHC0177', 'ELRHC0177', 'ILCHIGSTD', 'Eye Specialists of Chicago', 'Steven', 'C', 'Eidt', 'MD', 'Ophthalmology', '', '', NULL, 'O', '5600 W Addison St Ste 102', 'Chicago', 'Cook', 'IL', '60634', '7737361717', '7737367538', '5600 W Addison St Ste 102', 'Chicago', 'Cook', 'IL', '60634', '7737361717', '7737367538', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Our Lady Of The Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1275561557', 0, 'N', 0, '2012-12-20', NULL, NULL, 41.9459, -87.7667, NULL, NULL),
('262529124', 'ELRHC0397', 'ELRHC0397', 'ILCHIGSTD', 'Total Care Medical Clinic', 'Leonard', 'M', 'Spishakoff', 'MD', 'Family Practice', '', '', NULL, 'O', '6929 W Ogden Ave', 'Berwyn', 'Cook', 'IL', '60402', '7084849472', '7084849473', '6929 W Ogden Ave', 'Berwyn', 'Cook', 'IL', '60402', '7084849472', '7084849473', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Our Lady Of The Resurrection Medical Center', NULL, '', NULL, 'HCFA|UB|', '1275597098', 0, 'N', 0, '2012-12-20', NULL, NULL, 41.826, -87.7963, NULL, NULL),
('363322419', 'ELRHC0129', 'ELRHC0129', 'ILCHIGSTD', 'Retina Consultants', 'Michael', 'P', 'Blair', 'MD', 'Ophthalmology', '', '', NULL, 'O', '2454 E Dempster Ave Ste 400', 'Des Plaines', 'Cook', 'IL', '60016', '8472990700', '8473900616', '2454 E Dempster Ave Ste 400', 'Des Plaines', 'Cook', 'IL', '60016', '8472990700', '8473900616', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Holy Family Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1285645549', 0, 'N', 0, '2012-12-20', NULL, NULL, 42.0393, -87.8632, NULL, NULL),
('271714769', 'ELRHC0364', 'ELRHC0364', 'ILCHIGSTD', 'Illinois Allergy and Asthma Center', 'Brian', 'D', 'Rotskoff', 'MD', 'Allergy and Immunology', '', '', NULL, 'O', '4801 W Peterson Ave Ste 306', 'Chicago', 'Cook', 'IL', '60646', '7738773500', '8882282622', '4801 W Peterson Ave Ste 306', 'Chicago', 'Cook', 'IL', '60646', '7738773500', '8882282622', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', NULL, '', NULL, 'HCFA|UB|', '1285662304', 0, 'N', 0, '2012-12-20', NULL, NULL, 41.9898, -87.7483, NULL, NULL),
('364336222', 'ELRHC0140', 'ELRHC0140', 'ILCHIGSTD', 'Fabian Carbonell MD', 'Fabian', 'E', 'Carbonell', 'MD', 'Psychiatry', '', '', NULL, 'B', '2900 N Lake Shore Dr Mailbox 48', 'Chicago', 'Cook', 'IL', '60657', '7736653203', '8477280058', '2900 N Lake Shore Dr Mailbox 48', 'Chicago', 'Cook', 'IL', '60657', '7736653203', '8477280058', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1295705119', 0, 'Y', 0, '2013-05-31', NULL, NULL, 41.9338, -87.6372, NULL, NULL),
('364336222', 'ELRHC0139', 'ELRHC0139', 'ILCHIGSTD', 'Fabian Carbonell MD', 'Fabian', 'E', 'Carbonell', 'MD', 'Psychiatry', '', '', NULL, 'O', '2913 N Commonwealth Ave 5th Fl', 'Chicago', 'Cook', 'IL', '60657', '7736653203', '8477280058', '2913 N Commonwealth Ave 5th Fl', 'Chicago', 'Cook', 'IL', '60657', '7736653203', '8477280058', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1295705119', 0, 'Y', 0, '2013-05-31', NULL, NULL, 41.9346, -87.638, NULL, NULL),
('300435300', 'ELRHC0326', 'ELRHC0326', 'ILCHIGSTD', 'Olivo Wellness Medical Center', 'Jacqueline', '', 'Olivo', 'MD', 'Family Practice', '', '', NULL, 'O', '2412 W Fullerton Ave', 'Chicago', 'Cook', 'IL', '60647', '7733847977', '7739047169', '2412 W Fullerton Ave', 'Chicago', 'Cook', 'IL', '60647', '7733847977', '7739047169', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', NULL, '', '', 'HCFA|UB|', '1295767366', 0, 'N', 0, '2013-01-23', NULL, NULL, 41.9249, -87.6883, NULL, NULL),
('363819436', 'ELRHC0161', 'ELRHC0161', 'ILCHIGSTD', 'Cardiac Surgery Associates', 'David', 'J', 'Cziperle', 'MD', 'Cardiothoracic Surgery', '', '', NULL, 'O', '7447 W Talcott Ave Ste 512', 'Chicago', 'Cook', 'IL', '60631', '7735946460', '7735946473', '7447 W Talcott Ave Ste 512', 'Chicago', 'Cook', 'IL', '60631', '7735946460', '7735946473', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, 'Edward Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1295797900', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.9887, -87.8131, NULL, NULL),
('363819436', 'ELRHC0160', 'ELRHC0160', 'ILCHIGSTD', 'Cardiac Surgery Associates', 'David', 'J', 'Cziperle', 'MD', 'Cardiothoracic Surgery', '', '', NULL, 'B', '900 S Frontage Rd 110', 'Woodridge', 'Dupage', 'IL', '60517', '7735946460', '7735946473', '900 S Frontage Rd 110', 'Woodridge', 'Dupage', 'IL', '60517', '7735946460', '7735946473', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, 'Edward Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1295797900', 0, 'Y', 0, '2013-07-25', NULL, NULL, 0, 0, NULL, NULL),
('363843619', 'ELRHC0225', 'ELRHC0225', 'ILCHIGSTD', 'Eye Physicians and Surgeons of Chicago', 'Barry', 'S', 'Herst', 'MD', 'Ophthalmology', '', '', NULL, 'O', '2800 N Sheridan Rd  Ste 103', 'Chicago', 'Cook', 'IL', '60657', '7735258700', '7735258699', '2800 N Sheridan Rd  Ste 103', 'Chicago', 'Cook', 'IL', '60657', '7735258700', '7735258699', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, NULL, NULL, 'HCFA|UB|', '1295809259', 0, 'N', 0, '2012-12-20', NULL, NULL, 41.9329, -87.6393, NULL, NULL),
('364466307', 'ELRHC0372', 'ELRHC0372', 'ILCHIGSTD', 'University Surgical Consultants', 'George', 'I', 'Salti', 'MD', 'General Surgery', '', '', NULL, 'O', '5011 N Lincoln Ave', 'Chicago', 'Cook', 'IL', '60625', '7735617710', '7735617760', '5011 N Lincoln Ave', 'Chicago', 'Cook', 'IL', '60625', '7735617710', '7735617760', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-08-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1306847702', 0, 'N', 0, '2014-04-02', NULL, NULL, 0, 0, NULL, NULL),
('316683206', 'ELRHC0107', 'ELRHC0107', 'ILCHIGSTD', 'Emmanuel Alzona  MD', 'Emmanuel', 'L', 'Alzona', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1431 N Claremont', 'Chicago', 'Cook', 'IL', '60622', '7738523085', '8476746883', '1431 N Claremont', 'Chicago', 'Cook', 'IL', '60622', '7738523085', '8476746883', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', NULL, NULL, NULL, 'HCFA|UB|', '1306876594', 0, 'N', 0, '2013-05-31', NULL, NULL, 41.9073, -87.6859, NULL, NULL),
('316683206', 'ELRHC0106', 'ELRHC0106', 'ILCHIGSTD', 'Emmanuel Alzona  MD', 'Emmanuel', 'L', 'Alzona', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 148', 'Glenview', 'Cook', 'IL', '60025', '7738523085', '8476746883', 'PO Box 148', 'Glenview', 'Cook', 'IL', '60025', '7738523085', '8476746883', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', NULL, NULL, NULL, 'HCFA|UB|', '1306876594', 0, 'Y', 0, '2013-05-31', NULL, NULL, 0, 0, NULL, NULL),
('363843619', 'ELRHC0190', 'ELRHC0190', 'ILCHIGSTD', 'Eye Physicians and Surgeons of Chicago', 'Joseph', 'B', 'Garber', 'MD', 'Ophthalmology', '', '', NULL, 'O', '2800 N Sheridan Rd Ste 103', 'Chicago', 'Cook', 'IL', '60657', '7735258700', '7735258699', '2800 N Sheridan Rd Ste 103', 'Chicago', 'Cook', 'IL', '60657', '7735258700', '7735258699', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, NULL, NULL, 'HCFA|UB|', '1306910542', 0, 'N', 0, '2012-12-20', NULL, NULL, 41.9329, -87.6393, NULL, NULL),
('363155305', 'ELRHC0404', 'ELRHC0404', 'ILCHIGSTD', 'Metro Chicago', 'Balakrishna', '', 'Sundar', 'MD', 'Urology', '', '', NULL, 'O', '2400 N Ashland Ave 2nd Fl', 'Chicago', 'Cook', 'IL', '60614', '7738681800', '7738684072', '2400 N Ashland Ave 2nd Fl', 'Chicago', 'Cook', 'IL', '60614', '7738681800', '7738684072', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-01-01', 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, '', '', 'HCFA|UB|', '1316049166', 0, 'N', 0, '2013-02-07', NULL, NULL, 41.9252, -87.6682, NULL, NULL),
('363155305', 'ELRHC0403', 'ELRHC0403', 'ILCHIGSTD', 'Metro Chicago', 'Balakrishna', '', 'Sundar', 'MD', 'Urology', '', '', NULL, 'B', 'PO Box 798', 'Park Ridge', 'Cook', 'IL', '60068', '7738681800', '7738684072', 'PO Box 798', 'Park Ridge', 'Cook', 'IL', '60068', '7738681800', '7738684072', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-01-01', 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, '', '', 'HCFA|UB|', '1316049166', 0, 'Y', 0, '2013-02-07', NULL, NULL, 0, 0, NULL, NULL),
('362663241', 'ELRHC0319', 'ELRHC0319', 'ILCHIGSTD', 'Chicago Orthopaedics and Sports Medicine', 'Ellis', 'K', 'Nam', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', '13728 Collections Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '7734333130', '7734333125', '13728 Collections Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '7734333130', '7734333125', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, NULL, NULL, 'HCFA|UB|', '1316916190', 0, 'Y', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('362663241', 'ELRHC0318', 'ELRHC0318', 'ILCHIGSTD', 'Chicago Orthopaedics and Sports Medicine', 'Ellis', 'K', 'Nam', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '3000 N Halsted St Ste 525', 'Chicago', 'Cook', 'IL', '60657', '7734333130', '7734333125', '3000 N Halsted St Ste 525', 'Chicago', 'Cook', 'IL', '60657', '7734333130', '7734333125', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, NULL, NULL, 'HCFA|UB|', '1316916190', 0, 'N', 0, '2012-12-20', NULL, NULL, 41.9369, -87.6491, NULL, NULL),
('270837740', 'ELRHC0269', 'ELRHC0269', 'ILCHIGSTD', 'California Devon Medical Center', 'Olga', '', 'Lansky', 'MD', 'Internal Medicine', '', '', NULL, 'O', '6420 N California Ave', 'Chicago', 'Cook', 'IL', '60645', '7739736100', '7732624882', '6420 N California Ave', 'Chicago', 'Cook', 'IL', '60645', '7739736100', '7732624882', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Francis Hospital', NULL, '', NULL, 'HCFA|UB|', '1326019407', 0, 'N', 0, '2012-12-20', NULL, NULL, 41.998, -87.6997, NULL, NULL),
('274478152', 'ELRHC0258', 'ELRHC0258', 'ILCHIGSTD', 'Consultants in Gynecology', 'John', 'V', 'Knaus', 'DO', 'Gynecologic Oncology', '', '', NULL, 'B', '3201 Old Glenview Rd', 'Wilmette', 'Cook', 'IL', '60091', '8476631030', '8476631039', '3201 Old Glenview Rd', 'Wilmette', 'Cook', 'IL', '60091', '8476631030', '8476631039', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1326023714', 0, 'Y', 0, '2013-04-05', NULL, NULL, 0, 0, NULL, NULL),
('274478152', 'ELRHC0259', 'ELRHC0259', 'ILCHIGSTD', 'Consultants in Gynecology', 'John', 'V', 'Knaus', 'DO', 'Gynecologic Oncology', '', '', NULL, 'O', '5747 W Dempster St 100', 'Morton Grove', 'Cook', 'IL', '60053', '8476631030', '8476631039', '5747 W Dempster St 100', 'Morton Grove', 'Cook', 'IL', '60053', '8476631030', '8476631039', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1326023714', 0, 'Y', 0, '2013-04-05', NULL, NULL, 42.0409, -87.7702, NULL, NULL),
('363855726', 'ELRHC0282', 'ELRHC0282', 'ILCHIGSTD', 'Joan M Leya MD', 'Joan', 'M', 'Leya', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '800 Austin St West Tower Ste 310', 'Evanston', 'Cook', 'IL', '60202', '8474755188', '8474758778', '800 Austin St West Tower Ste 310', 'Evanston', 'Cook', 'IL', '60202', '8474755188', '8474758778', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Francis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1326037912', 0, 'N', 0, '2013-05-30', NULL, NULL, 42.0255, -87.6819, NULL, NULL),
('364380509', 'ELRHC0430', 'ELRHC0430', 'ILCHIGSTD', 'Lake Shore Adult and Geriatric Medicine', 'Mark', '', 'Vexelman', 'MD', 'Internal Medicine', '', '', NULL, 'B', '2115 Pioneer Ln', 'Wilmette', 'Cook', 'IL', '60091', '7736652966', '7736652625', '2115 Pioneer Ln', 'Wilmette', 'Cook', 'IL', '60091', '7736652966', '7736652625', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwestern Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1326056276', 0, 'Y', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('364380509', 'ELRHC0429', 'ELRHC0429', 'ILCHIGSTD', 'Lake Shore Adult and Geriatric Medicine', 'Mark', '', 'Vexelman', 'MD', 'Internal Medicine', '', '', NULL, 'O', '2900 N Lake Shore Dr  Ste 1202', 'Chicago', 'Cook', 'IL', '60657', '7736652966', '7736652625', '2900 N Lake Shore Dr  Ste 1202', 'Chicago', 'Cook', 'IL', '60657', '7736652966', '7736652625', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwestern Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1326056276', 0, 'N', 0, '2012-12-20', NULL, NULL, 41.9349, -87.6367, NULL, NULL),
('364169066', 'ELRHC0402', 'ELRHC0402', 'ILCHIGSTD', 'Northside Surgical Care', 'Barry', '', 'Summers', 'MD', 'General Surgery', '', '', NULL, 'O', '3000 N Halsted St Ste 823', 'Chicago', 'Cook', 'IL', '60657', '7739355985', '7739355478', '3000 N Halsted St Ste 823', 'Chicago', 'Cook', 'IL', '60657', '7739355985', '7739355478', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Holy Family Medical Center', NULL, '', '', 'HCFA|UB|', '1326117383', 0, 'N', 0, '2013-04-03', NULL, NULL, 41.9369, -87.6491, NULL, NULL),
('364380509', 'ELRHC0433', 'ELRHC0433', 'ILCHIGSTD', 'Lake Shore Adult and Geriatric Medicine', 'Natalya', '', 'Vladimirskiy', 'MD', 'Internal Medicine', '', '', NULL, 'B', '2115 Pioneer Ln', 'Wilmette', 'Cook', 'IL', '60091', '7736652966', '7736652625', '2115 Pioneer Ln', 'Wilmette', 'Cook', 'IL', '60091', '7736652966', '7736652625', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, '', NULL, 'HCFA|UB|', '1326246356', 0, 'Y', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('364380509', 'ELRHC0432', 'ELRHC0432', 'ILCHIGSTD', 'Lake Shore Adult and Geriatric Medicine', 'Natalya', '', 'Vladimirskiy', 'MD', 'Internal Medicine', '', '', NULL, 'O', '2900 N Lake Shore Dr  Ste 1215', 'Chicago', 'Cook', 'IL', '60657', '7736652966', '7736652625', '2900 N Lake Shore Dr  Ste 1215', 'Chicago', 'Cook', 'IL', '60657', '7736652966', '7736652625', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, '', NULL, 'HCFA|UB|', '1326246356', 0, 'N', 0, '2013-04-04', NULL, NULL, 41.9349, -87.6367, NULL, NULL),
('203493835', 'ELRHC0331', 'ELRHC0331', 'ILCHIGSTD', 'Optimum Kidney Care', 'Vedvati', 'M', 'Patel', 'MD', 'Nephrology', '', '', NULL, 'O', '3023 N Ashland Ave Ste 1S', 'Chicago', 'Cook', 'IL', '60657', '7735254701', '7733263539', '3023 N Ashland Ave Ste 1S', 'Chicago', 'Cook', 'IL', '60657', '7735254701', '7733263539', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', '', '', '', 'HCFA|UB|', '1326247966', 0, 'N', 0, '2014-04-25', NULL, NULL, 41.9369, -87.6685, NULL, NULL),
('363815402', 'ELRHC0449', 'ELRHC0449', 'ILCHIGSTD', 'Center for Athletic Medicine', 'Preston', 'M', 'Wolin', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '830 W Diversey Ave Ste 300', 'Chicago', 'Cook', 'IL', '60614', '7732484150', '7732484291', '830 W Diversey Ave Ste 300', 'Chicago', 'Cook', 'IL', '60614', '7732484150', '7732484291', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, '', NULL, 'HCFA|UB|', '1336145036', 0, 'N', 0, '2012-12-20', NULL, NULL, 41.9327, -87.6502, NULL, NULL),
('362605281', 'ELRHC0239', 'ELRHC0239', 'ILCHIGSTD', 'Surgical Associates', 'Matthew', 'J', 'Hyser', 'MD', 'General Surgery', '', '', NULL, 'O', '800 Austin St East Tower Ste 563', 'Evanston', 'Cook', 'IL', '60202', '8478690522', '8478690652', '800 Austin St East Tower Ste 563', 'Evanston', 'Cook', 'IL', '60202', '8478690522', '8478690652', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Francis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1336155092', 0, 'N', 0, '2012-12-20', NULL, NULL, 42.0255, -87.6819, NULL, NULL),
('363843619', 'ELRHC0418', 'ELRHC0418', 'ILCHIGSTD', 'Eye Physicians and Surgeons of Chicago', 'Bryan', 'S', 'Traubert', 'MD', 'Ophthalmology', '', '', NULL, 'O', '2800 N Sheridan Rd Ste 103', 'Chicago', 'Cook', 'IL', '60657', '7735258700', '7735258699', '2800 N Sheridan Rd Ste 103', 'Chicago', 'Cook', 'IL', '60657', '7735258700', '7735258699', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, NULL, NULL, 'HCFA|UB|', '1336213495', 0, 'N', 0, '2012-12-20', NULL, NULL, 41.9329, -87.6393, NULL, NULL),
('362685781', 'ELRHC0454', 'ELRHC0454', 'ILCHIGSTD', 'Steven Yellen MD', 'Steven', 'F', 'Yellen', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '2222 W Division St Ste 300', 'Chicago', 'Cook', 'IL', '60622', '7733421119', '7732929792', '2222 W Division St Ste 300', 'Chicago', 'Cook', 'IL', '60622', '7733421119', '7732929792', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', NULL, '', NULL, 'HCFA|UB|', '1336245380', 0, 'N', 0, '2013-05-24', NULL, NULL, 41.9032, -87.6826, NULL, NULL),
('362685781', 'ELRHC0453', 'ELRHC0453', 'ILCHIGSTD', 'Steven Yellen MD', 'Steven', 'F', 'Yellen', 'MD', 'Cardiovascular Disease', '', '', NULL, 'B', 'PO Box 1185', 'Indianapolis', 'Marion', 'IN', '46206', '7733421119', '7732929792', 'PO Box 1185', 'Indianapolis', 'Marion', 'IN', '46206', '7733421119', '7732929792', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', NULL, '', NULL, 'HCFA|UB|', '1336245380', 0, 'Y', 0, '2013-05-30', NULL, NULL, 0, 0, NULL, NULL),
('363102948', 'ELRHC0384', 'ELRHC0384', 'ILCHIGSTD', 'Suad Shuber MD', 'Suad', 'A', 'Shuber', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '7237 W Irving Park Rd', 'Chicago', 'Cook', 'IL', '60634', '7735892600', '7736254460', '7237 W Irving Park Rd', 'Chicago', 'Cook', 'IL', '60634', '7735892600', '7736254460', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1346214483', 0, 'N', 0, '2013-05-24', NULL, NULL, 41.9528, -87.8085, NULL, NULL),
('363719474', 'ELRHC0401', 'ELRHC0401', 'ILCHIGSTD', 'Lakeshore Infectious Disease Associates', 'James', 'F', 'Sullivan', 'MD', 'Infectious Disease', '', '', NULL, 'O', '2900 N Lake Shore Dr Ste 1231', 'Chicago', 'Cook', 'IL', '60657', '7736653261', '7736659435', '2900 N Lake Shore Dr Ste 1231', 'Chicago', 'Cook', 'IL', '60657', '7736653261', '7736659435', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, NULL, NULL, 'HCFA|UB|', '1346236379', 0, 'N', 0, '2012-12-20', NULL, NULL, 41.9349, -87.6367, NULL, NULL),
('363719474', 'ELRHC0399', 'ELRHC0399', 'ILCHIGSTD', 'Lakeshore Infectious Disease Associates', 'James', 'F', 'Sullivan', 'MD', 'Infectious Disease', '', '', NULL, 'B', '777 Oakmont Ln Ste 1600', 'Westmont', 'Dupage', 'IL', '60559', '7736653261', '7736659435', '777 Oakmont Ln Ste 1600', 'Westmont', 'Dupage', 'IL', '60559', '7736653261', '7736659435', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, NULL, NULL, 'HCFA|UB|', '1346236379', 0, 'Y', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('161659897', 'ELRHC0460', 'ELRHC0460', 'ILCHIGSTD', 'Eduard Zinger MD', 'Eduard', 'A', 'Zinger', 'MD', 'Internal Medicine', '', '', NULL, 'B', '2800 N Lake Shore Dr Ste 3609', 'Chicago', 'Cook', 'IL', '60657', '7734126123', '8129615829', '2800 N Lake Shore Dr Ste 3609', 'Chicago', 'Cook', 'IL', '60657', '7734126123', '8129615829', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, '', '', 'HCFA|UB|', '1346276656', 0, 'Y', 0, '2013-05-30', NULL, NULL, 0, 0, NULL, NULL),
('161659897', 'ELRHC0459', 'ELRHC0459', 'ILCHIGSTD', 'Eduard Zinger MD', 'Eduard', 'A', 'Zinger', 'MD', 'Internal Medicine', '', '', NULL, 'O', '4656 W Touhy Ave', 'Lincolnwood', 'Dupage', 'IL', '60172', '7734126123', '8129615829', '4656 W Touhy Ave', 'Lincolnwood', 'Dupage', 'IL', '60172', '7734126123', '8129615829', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, '', '', 'HCFA|UB|', '1346276656', 0, 'N', 0, '2013-05-24', NULL, NULL, 42.0118, -87.7448, NULL, NULL),
('362716083', 'ELRHC0268', 'ELRHC0268', 'ILCHIGSTD', 'Womens Health Associates', 'Robert', 'T', 'Kus', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '7447 W Talcott Ave Ste 454', 'Chicago', 'Cook', 'IL', '60631', '7736315767', '7736310828', '7447 W Talcott Ave Ste 454', 'Chicago', 'Cook', 'IL', '60631', '7736315767', '7736310828', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1346386984', 0, 'N', 0, '2012-12-20', NULL, NULL, 41.9887, -87.8131, NULL, NULL),
('363200170', 'ELRHC0440', 'ELRHC0440', 'ILCHIGSTD', 'Seton Family Health Center', 'Laura', 'L', 'Wally', 'MD', 'Family Practice', '', '', NULL, 'O', '711 W N Ave', 'Chicago', 'Cook', 'IL', '60610', '3123371982', '3126423847', '711 W N Ave', 'Chicago', 'Cook', 'IL', '60610', '3123371982', '3126423847', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 8, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, '', '', 'HCFA|UB|', '1356352710', 0, 'N', 0, '2013-05-28', NULL, NULL, 41.911, -87.6461, NULL, NULL),
('364301250', 'ELRHC0164', 'ELRHC0164', 'ILCHIGSTD', 'Yousef Darwish MD', 'Yousef', 'Husein', 'Darwish', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '800 Austin St East Tower Ste 163', 'Evanston', 'Cook', 'IL', '60202', '8473163880', '8473163883', '800 Austin St East Tower Ste 163', 'Evanston', 'Cook', 'IL', '60202', '8473163880', '8473163883', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Francis Hospital', NULL, '', '', 'HCFA|UB|', '1356390926', 0, 'N', 0, '2013-05-31', NULL, NULL, 42.0255, -87.6819, NULL, NULL),
('363088987', 'ELRHC0452', 'ELRHC0452', 'ILCHIGSTD', 'Northwestern Neurosurgical Associates', 'Wesley', 'Y', 'Yapor', 'MD', 'Neurosurgery', '', '', NULL, 'O', '7447 W Talcott Ave Ste 340', 'Chicago', 'Cook', 'IL', '60631', '7735940200', '7735949082', '7447 W Talcott Ave Ste 340', 'Chicago', 'Cook', 'IL', '60631', '7735940200', '7735949082', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Our Lady Of The Resurrection Medical Center', NULL, '', NULL, 'HCFA|UB|', '1356450167', 0, 'N', 0, '2012-12-20', NULL, NULL, 41.9887, -87.8131, NULL, NULL),
('363088987', 'ELRHC0451', 'ELRHC0451', 'ILCHIGSTD', 'Northwestern Neurosurgical Associates', 'Wesley', 'Y', 'Yapor', 'MD', 'Neurosurgery', '', '', NULL, 'B', '75 Remittance Dr Ste 1244', 'Chicago', 'Cook', 'IL', '60675', '7735940200', '7735949082', '75 Remittance Dr Ste 1244', 'Chicago', 'Cook', 'IL', '60675', '7735940200', '7735949082', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Our Lady Of The Resurrection Medical Center', NULL, '', NULL, 'HCFA|UB|', '1356450167', 0, 'Y', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('363200170', 'ELRHC0230', 'ELRHC0230', 'ILCHIGSTD', 'Seton Family Health Center', 'Valerie', 'C', 'Hines', 'MD', 'Pediatrics', '', '', NULL, 'O', '711 W N Ave', 'Chicago', 'Cook', 'IL', '60610', '3123371982', '3126423847', '711 W N Ave', 'Chicago', 'Cook', 'IL', '60610', '3123371982', '3126423847', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 8, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, '', NULL, 'HCFA|UB|', '1356516942', 0, 'N', 0, '2013-05-28', NULL, NULL, 41.911, -87.6461, NULL, NULL),
('363145256', 'ELRHC0357', 'ELRHC0357', 'ILCHIGSTD', 'Chest Medicine Consultants', 'Michael', 'H', 'Ries', 'MD', 'Pulmonary', '', '', NULL, 'O', '2800 N Sheridan Rd Ste 301', 'Chicago', 'Cook', 'IL', '60657', '7739355556', '7739352724', '2800 N Sheridan Rd Ste 301', 'Chicago', 'Cook', 'IL', '60657', '7739355556', '7739352724', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, NULL, NULL, 'HCFA|UB|', '1366446791', 0, 'N', 0, '2012-12-20', NULL, NULL, 41.9329, -87.6393, NULL, NULL),
('362540456', 'ELRHC0197', 'ELRHC0197', 'ILCHIGSTD', 'Nora Medical Group', 'Andres', 'A', 'Giraldo', 'MD', 'Internal Medicine', '', '', NULL, 'O', '6969 N Lincoln Ave', 'Lincolnwood', 'Cook', 'IL', '60712', '8476741200', '8476741332', '6969 N Lincoln Ave', 'Lincolnwood', 'Cook', 'IL', '60712', '8476741200', '8476741332', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, NULL, NULL, 'HCFA|UB|', '1366460933', 0, 'N', 0, '2013-05-24', NULL, NULL, 42.0075, -87.7339, NULL, NULL),
('363441544', 'ELRHC0218', 'ELRHC0218', 'ILCHIGSTD', 'Christoper M Guerrero MD', 'Christopher', 'M', 'Guerrero', 'MD', 'Family Practice', '', '', NULL, 'O', '1431 N Western Ave Ste 302', 'Chicago', 'Cook', 'IL', '60622', '7737727922', '7737727982', '1431 N Western Ave Ste 302', 'Chicago', 'Cook', 'IL', '60622', '7737727922', '7737727982', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', '', '', '', 'HCFA|UB|', '1376511345', 0, 'N', 0, '2014-06-25', NULL, NULL, 41.9073, -87.6871, NULL, NULL),
('363441544', 'ELRHC0216', 'ELRHC0216', 'ILCHIGSTD', 'Christoper M Guerrero MD', 'Christopher', 'M', 'Guerrero', 'MD', 'Family Practice', '', '', NULL, 'B', '2922 N 73rd Ct', 'Elmwood Park', 'Cook', 'IL', '60707', '7737727922', '7737727982', '2922 N 73rd Ct', 'Elmwood Park', 'Cook', 'IL', '60707', '7737727922', '7737727982', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', '', '', '', 'HCFA|UB|', '1376511345', 0, 'Y', 0, '2014-06-25', NULL, NULL, 0, 0, NULL, NULL),
('363843619', 'ELRHC0315', 'ELRHC0315', 'ILCHIGSTD', 'Eye Physicians and Surgeons of Chicago', 'Gary', 'B', 'Morris', 'MD', 'Ophthalmology', '', '', NULL, 'O', '64 Old Orchard Ctr Ste 430', 'Skokie', 'Cook', 'IL', '60076', '8476748400', '8476748465', '64 Old Orchard Ctr Ste 430', 'Skokie', 'Cook', 'IL', '60076', '8476748400', '8476748465', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-01-01', 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, NULL, NULL, 'HCFA|UB|', '1376528463', 0, 'N', 0, '2013-04-03', NULL, NULL, 0, 0, NULL, NULL),
('363719474', 'ELRHC0322', 'ELRHC0322', 'ILCHIGSTD', 'Lakeshore Infectious Disease Associates', 'Judith', 'L', 'Nerad', 'MD', 'Infectious Disease', '', '', NULL, 'O', '2900 N Lake Shore Dr Ste 1231', 'Chicago', 'Cook', 'IL', '60657', '7736653261', '7736659435', '2900 N Lake Shore Dr Ste 1231', 'Chicago', 'Cook', 'IL', '60657', '7736653261', '7736659435', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-05-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1376567560', 0, 'N', 0, '2013-06-06', NULL, NULL, 41.9338, -87.6372, NULL, NULL),
('363719474', 'ELRHC0321', 'ELRHC0321', 'ILCHIGSTD', 'Lakeshore Infectious Disease Associates', 'Judith', 'L', 'Nerad', 'MD', 'Infectious Disease', '', '', NULL, 'B', '777 Oakmont Ln Ste 1600', 'Westmont', 'Dupage', 'IL', '60559', '7736653261', '7736659435', '777 Oakmont Ln Ste 1600', 'Westmont', 'Dupage', 'IL', '60559', '7736653261', '7736659435', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-05-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1376567560', 0, 'Y', 0, '2013-06-06', NULL, NULL, 0, 0, NULL, NULL),
('432017006', 'ELRHC0240', 'ELRHC0240', 'ILCHIGSTD', 'The Geldner Center', 'Lawrence', 'H', 'Iteld', 'MD', 'Plastic Surgery', '', '', NULL, 'O', '680 N Lake Shore Dr Ste 1325', 'Chicago', 'Cook', 'IL', '60611', '3129814440', '3129814441', '680 N Lake Shore Dr Lake Shore Place Ste 1325', 'Chicago', 'Cook', 'IL', '60611', '3129814440', '3129814441', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, '', NULL, 'HCFA|UB|', '1386600203', 0, 'N', 0, '2012-12-20', NULL, NULL, 41.8947, -87.6156, NULL, NULL),
('362751683', 'ELRHC0196', 'ELRHC0196', 'ILCHIGSTD', 'Edward Ghislandi, MD', 'Edward', 'V', 'Ghislandi', 'MD', 'Family Practice', '', '', NULL, 'O', '5641 W Irving Park Rd', 'Chicago', 'Cook', 'IL', '60634', '7732822520', '7732827970', '5641 W Irving Park Rd', 'Chicago', 'Cook', 'IL', '60634', '7732822520', '7732827970', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Our Lady Of The Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1386623460', 0, 'N', 0, '2013-04-16', NULL, NULL, 41.9532, -87.7684, NULL, NULL),
('363963241', 'ELRHC0271', 'ELRHC0271', 'ILCHIGSTD', 'Chicago Hamlin Medical Center', 'Noel', 'E', 'Lasala', 'MD', 'Family Practice', '', '', NULL, 'O', '3758 W Chicago Ave', 'Chicago', 'Cook', 'IL', '60651', '7732350626', '7732355834', '3758 W Chicago Ave', 'Chicago', 'Cook', 'IL', '60651', '7732350626', '7732355834', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', NULL, NULL, NULL, 'HCFA|UB|', '1386646172', 0, 'N', 0, '2012-12-20', NULL, NULL, 41.8955, -87.7205, NULL, NULL),
('363963241', 'ELRHC0270', 'ELRHC0270', 'ILCHIGSTD', 'Chicago Hamlin Medical Center', 'Noel', 'E', 'Lasala', 'MD', 'Family Practice', '', '', NULL, 'B', '520 E 22nd St', 'Lombard', 'Dupage', 'IL', '60148', '7732350626', '7732355834', '520 E 22nd St', 'Lombard', 'Dupage', 'IL', '60148', '7732350626', '7732355834', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', NULL, NULL, NULL, 'HCFA|UB|', '1386646172', 0, 'Y', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('270907956', 'ELRHC0134', 'ELRHC0134', 'ILCHIGSTD', 'University Dermatology', 'Clarence', 'W', 'Brown', 'MD', 'Dermatology', '', '', NULL, 'O', '4605 W Golf Rd', 'Skokie', 'Cook', 'IL', '60076', '8476795199', '8476795490', '4605 W Golf Rd', 'Skokie', 'Cook', 'IL', '60076', '8476795199', '8476795490', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1386654390', 0, 'N', 0, '2012-12-20', NULL, NULL, 42.0552, -87.7402, NULL, NULL),
('270907956', 'ELRHC0132', 'ELRHC0132', 'ILCHIGSTD', 'University Dermatology', 'Clarence', 'W', 'Brown', 'MD', 'Dermatology', '', '', NULL, 'B', 'PO Box 6029', 'Chicago', 'Cook', 'IL', '60680', '8476795199', '8476795490', 'PO Box 6029', 'Chicago', 'Cook', 'IL', '60680', '8476795199', '8476795490', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1386654390', 0, 'Y', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('362898466', 'ELRHC0338', 'ELRHC0338', 'ILCHIGSTD', 'Dimitris Perros MD', 'Dimitris', 'G', 'Perros', 'MD', 'Ophthalmology', '', '', NULL, 'O', '800 Austin St West Tower Ste 507', 'Evanston', 'Cook', 'IL', '60202', '8478647760', '8478640984', '800 Austin St West Tower Ste 507', 'Evanston', 'Cook', 'IL', '60202', '8478647760', '8478640984', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Francis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1386659886', 0, 'N', 0, '2013-05-24', NULL, NULL, 42.0255, -87.6819, NULL, NULL),
('348883433', 'ELRHC0296', 'ELRHC0296', 'ILCHIGSTD', 'Malko Marek MD', 'Marek', 'A', 'Malko', 'MD', 'Family Practice', '', '', NULL, 'O', '5600 W Addison St Ste LL001', 'Chicago', 'Cook', 'IL', '60634', '7732029622', '7732830901', '5600 W Addison St Ste LL001', 'Chicago', 'Cook', 'IL', '60634', '7732029622', '7732830901', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1386757581', 0, 'N', 0, '2013-05-31', NULL, NULL, 41.9459, -87.7667, NULL, NULL),
('260557363', 'ELRHC0356', 'ELRHC0356', 'ILCHIGSTD', 'Presence Medical Group', 'Hernan', 'S', 'Reyes', 'MD', 'Family Practice', '', '', NULL, 'O', '5610 W Cermak Rd Ste 2', 'Cicero', 'Cook', 'IL', '60804', '7086569247', '7086569358', '5610 W Cermak Rd Ste 2', 'Cicero', 'Cook', 'IL', '60804', '7086569247', '7086569358', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', NULL, NULL, NULL, 'HCFA|UB|', '1386868826', 0, 'N', 0, '2013-05-24', NULL, NULL, 41.851, -87.7644, 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
('260557363', 'ELRHC0355', 'ELRHC0355', 'ILCHIGSTD', 'Presence Medical Group', 'Hernan', 'S', 'Reyes', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 129', 'Plainfield', 'Will', 'IL', '60544', '7086569247', '7086569358', 'PO Box 129', 'Plainfield', 'Will', 'IL', '60544', '7086569247', '7086569358', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', NULL, NULL, NULL, 'HCFA|UB|', '1386868826', 0, 'Y', 0, '2013-05-24', NULL, NULL, 0, 0, NULL, NULL),
('364090322', 'ELRHC0104', 'ELRHC0104', 'ILCHIGSTD', 'AugustaDamen Medical Center', 'Safia', 'S', 'Ahmed', 'MD', 'Family Practice', '', '', NULL, 'O', '948 N Damen Ave', 'Chicago', 'Cook', 'IL', '60622', '7732762655', '7732762726', '948 N Damen Ave', 'Chicago', 'Cook', 'IL', '60622', '7732762655', '7732762726', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', NULL, '', NULL, 'HCFA|UB|', '1396760831', 0, 'N', 0, '2012-12-20', NULL, NULL, 41.8989, -87.6772, NULL, NULL),
('742074876', 'W12027414', 'W12027414', 'TXHOUSTD', 'Rosewood ENT ', 'John', 'W', 'Craddock', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '2500 Tanglewilde Ste 160', 'Houston', 'Harris', 'TX', '77063', '7137819660', '7139743672', '2500 Tanglewilde Ste 160', 'Houston', 'Harris', 'TX', '77063', '7137819660', '7139743672', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1699752857', 0, 'N', 0, '2012-12-20', NULL, NULL, 29.7399, -95.5348, NULL, NULL),
('263553949', 'W12024238', 'W12024238', 'TXDALSTD', 'Gene G Reister DPM div of PMPT', 'Gene', 'G', 'Reister', 'DPM', 'Podiatry', '', '', NULL, 'O', '2001 N Collins Blvd Ste 103', 'Richardson', 'Dallas', 'TX', '75080', '9726905374', '9726906446', '2001 N Collins Blvd Ste 103', 'Richardson', 'Dallas', 'TX', '75080', '9726905374', '9726906446', 'DALLAS4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1659470896', 0, 'N', 0, '2013-02-21', NULL, NULL, 32.9755, -96.7237, NULL, NULL),
('741903407', 'W12027556', 'W12027556', 'TXBEAUSTD', 'Beaumont Internal Medicine and Geriatric Associates', '', '', 'Beaumont Internal Medicine and Geriatric Associates', '', 'Clinics', '', '', NULL, 'O', '755 N 11th St Ste P-5200', 'Beaumont', 'Jefferson', 'TX', '77702', '4098982994', '4098995542', '755 N 11th St Ste P-5200', 'Beaumont', 'Jefferson', 'TX', '77702', '4098982994', '4098995542', 'BEAUMONT1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1164430906', 0, 'Y', 0, '2013-09-27', NULL, NULL, 30.0882, -94.1299, NULL, NULL),
('263553949', 'W12027472', 'W12027472', 'TXDALSTD', 'Podiatric Medical Partners of Texas', 'Gene', 'G', 'Reister', 'DPM', 'Podiatry', '', '', NULL, 'B', 'PO Box 975517', 'Dallas', 'Dallas', 'TX', '75397', '3212072839', '3212562966', 'PO Box 975517', 'Dallas', 'Dallas', 'TX', '75397', '3212072839', '3212562966', 'DALLAS4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1659470896', 0, 'N', 0, '2013-01-09', NULL, NULL, 0, 0, NULL, NULL),
('260553931', 'W12027474', 'W12027474', 'IDBOISTD', 'Saint Alphonsus Medical Group Orthopedics Dallan Woods', 'Andrew', 'R', 'Curran', 'DO', 'Orthopedic Surgery', '', '', NULL, 'O', '214 S Midland Blvd', 'Nampa', 'Canyon', 'ID', '83686', '2082884700', '2082884720', '214 S Midland Blvd  ', 'Nampa', 'Canyon', 'ID', '83686', '2082884700', '2082884720', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-12-10', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', 'Saint Alphonsus Medical Center Nampa', '', '', 'HCFA|UB|', '1093705071', 0, 'N', 0, '2014-03-20', NULL, NULL, 43.5706, -116.593, NULL, NULL),
('260553931', 'W12027475', 'W12027475', 'IDBOISTD', 'Saint Alphonsus Medical Group Orthopedics Dallan Woods', 'Keith', 'G', 'Holley', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '214 S Midland Blvd', 'Nampa', 'Canyon', 'ID', '83686', '2082884700', '2082884720', '214 S Midland Blvd  ', 'Nampa', 'Canyon', 'ID', '83686', '2082884700', '2082884720', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-12-10', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', 'Saint Alphonsus Medical Center Nampa', '', '', 'HCFA|UB|', '1386616183', 0, 'N', 0, '2014-03-20', NULL, NULL, 43.5706, -116.593, NULL, NULL),
('260553931', 'W12027476', 'W12027476', 'IDBOISTD', 'Saint Alphonsus Medical Group Orthopedics ', 'Miers', 'C', 'Johnson', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '214 S Midland Blvd', 'Nampa', 'Canyon', 'ID', '83686', '2082884700', '2082884720', '214 S Midland Blvd  ', 'Nampa', 'Canyon', 'ID', '83686', '2082884700', '2082884720', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-12-10', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', 'Saint Alphonsus Medical Center Nampa', '', '', 'HCFA|UB|', '1942291521', 0, 'N', 0, '2014-03-20', NULL, NULL, 43.5706, -116.593, NULL, NULL),
('363672984', 'ELRHC0223', 'ELRHC0223', 'ILCHIGSTD', 'Lawrence M Kaufman MD', 'Katherine', 'A', 'Hare', 'MD', 'Ophthalmology', '', '', NULL, 'O', '2456 N Western Ave', 'Chicago', 'Cook', 'IL', '60647', '7732352020', '7732352037', '2456 N Western Ave', 'Chicago', 'Cook', 'IL', '60647', '7732352020', '7732352037', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, '', NULL, 'HCFA|UB|', '1407019524', 0, 'N', 0, '2013-05-30', NULL, NULL, 41.9265, -87.6877, NULL, NULL),
('331200950', 'ELRHC0159', 'ELRHC0159', 'ILCHIGSTD', 'Merlita C Cruzat  Blanco MD', 'Merlita', 'C', 'Cruzat Blanco', 'MD', 'Internal Medicine', '', '', NULL, 'O', '2800 N Sheridan Rd Ste 205S', 'Chicago', 'Cook', 'IL', '60657', '7739759957', '7739753930', '2800 N Sheridan Rd Ste 205S', 'Chicago', 'Cook', 'IL', '60657', '7739759957', '7739753930', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, NULL, NULL, 'HCFA|UB|', '1407092323', 0, 'N', 0, '2013-05-31', NULL, NULL, 41.9329, -87.6393, NULL, NULL),
('363325093', 'ELRHC0398', 'ELRHC0398', 'ILCHIGSTD', 'North Shore Cardiology Consultants', 'Otakar', '', 'Sroubek', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '7447 W Talcott Ave Ste 200', 'Chicago', 'Cook', 'IL', '60631', '7737745020', '7737744967', '7447 W Talcott Ave Ste 200', 'Chicago', 'Cook', 'IL', '60631', '7737745020', '7737744967', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1407816689', 0, 'N', 0, '2012-12-20', NULL, NULL, 41.9887, -87.8131, NULL, NULL),
('364288034', 'ELRHC0250', 'ELRHC0250', 'ILCHIGSTD', 'Young Family Health Center', 'Laura', 'A', 'Kauffman', 'MD', 'Pediatrics', '', '', NULL, 'O', '1431 N Western Ave Ste 101', 'Chicago', 'Cook', 'IL', '60622', '7732762272', '7732762399', '1431 N Wern Ave Ste 101', 'Chicago', 'Cook', 'IL', '60622', '7732762272', '7732762399', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', NULL, NULL, NULL, 'HCFA|UB|', '1407896020', 0, 'N', 0, '2012-12-20', NULL, NULL, 41.9073, -87.6871, NULL, NULL),
('362171079', 'ELRHC0413', 'ELRHC0413', 'ILCHIGSTD', 'Presence Sts Mary and Elizabeth Medical Center', 'Gabriela', '', 'Temneanu', 'MD', 'Family Practice', '', '', NULL, 'B', '62311 Collections Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '3127702040', '3127703270', '62311 Collections Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '3127702040', '3127703270', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 8, '2013-01-01', NULL, 0, 0, 0, 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', NULL, '', '', 'HCFA|UB|', '1407910516', 0, 'Y', 0, '2013-05-28', NULL, NULL, 0, 0, NULL, NULL),
('362171079', 'ELRHC0412', 'ELRHC0412', 'ILCHIGSTD', 'Presence Saints Mary and Elizabeth Medical Center', 'Gabriela', '', 'Temneanu', 'MD', 'Family Practice', '', '', NULL, 'O', 'Nazareth Family Ctr 1127 N Oakley Blvd 2nd Fl', 'Chicago', 'Cook', 'IL', '60622', '3127702040', '3127703270', 'Nazareth Family Ctr 1127 N Oakley Blvd 2nd Fl', 'Chicago', 'Cook', 'IL', '60622', '3127702040', '3127703270', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 8, '2013-01-01', '2013-04-02', 0, 0, 0, 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', NULL, '', '', 'HCFA|UB|', '1407910516', 0, 'N', 0, '2013-05-28', NULL, NULL, 0, 0, NULL, NULL),
('364405418', 'ELRHC0141', 'ELRHC0141', 'ILCHIGSTD', 'Vinac Medical Center', 'Vicente', 'E', 'Cardenas', 'MD', 'Family Practice', '', '', NULL, 'O', '2032 W Cermak Rd', 'Chicago', 'Cook', 'IL', '60608', '7732478855', '7732478896', '2032 W Cermak Rd', 'Chicago', 'Cook', 'IL', '60608', '7732478855', '7732478896', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', NULL, NULL, NULL, 'HCFA|UB|', '1417025842', 0, 'N', 0, '2013-05-31', NULL, NULL, 41.8522, -87.6766, NULL, NULL),
('363158845', 'ELRHC0381', 'ELRHC0381', 'ILCHIGSTD', 'Sudha Shah MD', 'Sudha', 'V', 'Shah', 'MD', 'Pediatrics', '', '', NULL, 'O', '1516 W Devon Ave', 'Chicago', 'Cook', 'IL', '60660', '7734657889', '7734657615', '1516 W Devon Ave', 'Chicago', 'Cook', 'IL', '60660', '7734657889', '7734657615', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, NULL, NULL, 'HCFA|UB|', '1417966789', 0, 'N', 0, '2013-05-24', NULL, NULL, 41.998, -87.6686, NULL, NULL),
('364210615', 'ELRHC0289', 'ELRHC0289', 'ILCHIGSTD', '', 'Marcos', 'A', 'Lopez', 'MD', 'Ophthalmology', '', '', NULL, 'O', '9005 W Cermak Rd', 'North Riverside', 'Cook', 'IL', '60546', '7084428010', '7084428009', '9005 W Cermak Rd', 'North Riverside', 'Cook', 'IL', '60546', '7084428010', '7084428009', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', NULL, NULL, NULL, 'HCFA|UB|', '1417967308', 0, 'N', 0, '2014-01-14', NULL, NULL, 41.8495, -87.8478, NULL, NULL),
('363145256', 'ELRHC0283', 'ELRHC0283', 'ILCHIGSTD', 'Chest Medicine Consultants', 'Vadim', '', 'Leyenson', 'MD', 'Pulmonary', '', '', NULL, 'O', '2800 N Sheridan Rd Ste 301', 'Chicago', 'Cook', 'IL', '60657', '7739355556', '7739352724', '2800 N Sheridan Rd Ste 301', 'Chicago', 'Cook', 'IL', '60657', '7739355556', '7739352724', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, NULL, NULL, 'HCFA|UB|', '1427052851', 0, 'N', 0, '2012-12-20', NULL, NULL, 41.9329, -87.6393, NULL, NULL),
('363330926', 'ELRHC0152', 'ELRHC0152', 'ILCHIGSTD', '', 'Dumitru', 'F', 'Cioata', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '7447 W Talcott Ave Ste 222', 'Chicago', 'Cook', 'IL', '60631', '7737745245', '7737748580', '7447 W Talcott Ave Ste 222', 'Chicago', 'Cook', 'IL', '60631', '7737745245', '7737748580', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', NULL, '', NULL, 'HCFA|UB|', '1427059294', 0, 'N', 0, '2013-02-15', NULL, NULL, 41.9887, -87.8131, NULL, NULL),
('260839930', 'ELRHC0344', 'ELRHC0344', 'ILCHIGSTD', 'SPS Family Care', 'Sorvein', '', 'Prieto', 'MD', 'Family Practice', '', '', NULL, 'O', '1810 W Chicago Ave', 'Chicago', 'Cook', 'IL', '60622', '7734896100', '7734896156', '1810 W Chicago Ave', 'Chicago', 'Cook', 'IL', '60622', '7734896100', '7734896156', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', NULL, '', NULL, 'HCFA|UB|', '1427231224', 0, 'N', 0, '2012-12-20', NULL, NULL, 41.896, -87.6725, NULL, NULL),
('260839930', 'ELRHC0343', 'ELRHC0343', 'ILCHIGSTD', 'SPS Family Care', 'Sorvein', '', 'Prieto', 'MD', 'Family Practice', '', '', NULL, 'B', '750 Pearson Ste 507', 'Des Plaines', 'Cook', 'IL', '60016', '7734896100', '7734896156', '750 Pearson Ste 507', 'Des Plaines', 'Cook', 'IL', '60016', '7734896100', '7734896156', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', NULL, '', NULL, 'HCFA|UB|', '1427231224', 0, 'Y', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('200772826', 'ELRHC0170', 'ELRHC0170', 'ILCHIGSTD', 'Manuel Dominguez MD', 'Manuel', 'G', 'Dominguez', 'MD', 'Family Practice', '', '', NULL, 'O', '1431 N Western Ave Ste 212', 'Chicago', 'Cook', 'IL', '60622', '7737703409', '7737703418', '1431 N Western Ave Ste 212', 'Chicago', 'Cook', 'IL', '60622', '7737703409', '7737703418', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', NULL, NULL, NULL, 'HCFA|UB|', '1437205671', 0, 'N', 0, '2013-05-24', NULL, NULL, 41.9073, -87.6871, NULL, NULL),
('363975172', 'ELRHC0448', 'ELRHC0448', 'ILCHIGSTD', 'Behavioral Health Care Associates', 'Blaise', 'J', 'Wolfrum', 'MD', 'Psychiatry', '', '', NULL, 'O', '1375 Ehaumburg Rd Ste 230', 'Schaumburg', 'Cook', 'IL', '60194', '8478954540', '8478954544', '1375 Ehaumburg Rd Ste 230', 'Schaumburg', 'Cook', 'IL', '60194', '8478954540', '8478954544', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1437231321', 0, 'Y', 0, '2012-12-20', NULL, NULL, 42.026, -88.1136, NULL, NULL),
('362708347', 'ELRHC0167', 'ELRHC0167', 'ILCHIGSTD', 'Associates in Nephrology', 'Bogdan', '', 'Derylo', 'MD', 'Nephrology', '', '', NULL, 'O', '1945 W Wilson Ave Ste 2113', 'Chicago', 'Cook', 'IL', '60640', '3126542701', '3126540118', '1945 W Wilson Ave Ste 2113', 'Chicago', 'Cook', 'IL', '60640', '3126542701', '3126540118', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-01-01', 0, 0, 0, 'Presence Our Lady Of The Resurrection Medical Center', NULL, '', NULL, 'HCFA|UB|', '1447211966', 0, 'N', 0, '2013-04-03', NULL, NULL, 0, 0, NULL, NULL),
('362708347', 'ELRHC0166', 'ELRHC0166', 'ILCHIGSTD', 'Associates in Nephrology', 'Bogdan', '', 'Derylo', 'MD', 'Nephrology', '', '', NULL, 'B', '4026 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '3126542701', '3126540118', '4026 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '3126542701', '3126540118', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Our Lady Of The Resurrection Medical Center', NULL, '', NULL, 'HCFA|UB|', '1447211966', 0, 'Y', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('363525632', 'ELRHC0293', 'ELRHC0293', 'ILCHIGSTD', 'Chicago Institute of Advanced Bariatrics', 'Rami', '', 'Lutfi', 'MD', 'General Surgery', '', '', NULL, 'O', '2913 N Commonwealth Ave 4th Fl', 'Chicago', 'Cook', 'IL', '60657', '7736653904', '7736656668', '2913 N Commonwealth Ave 4th Fl', 'Chicago', 'Cook', 'IL', '60657', '7736653904', '7736656668', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, '', '', 'HCFA|UB|', '1447237425', 0, 'N', 0, '2013-04-03', NULL, NULL, 41.9346, -87.638, NULL, NULL),
('363525632', 'ELRHC0292', 'ELRHC0292', 'ILCHIGSTD', 'Chicago Institute of Advanced Bariatrics', 'Rami', '', 'Lutfi', 'MD', 'General Surgery', '', '', NULL, 'B', '5011 N Lincoln Ave', 'Chicago', 'Cook', 'IL', '60625', '7736653904', '7736656668', '5011 N Lincoln Ave', 'Chicago', 'Cook', 'IL', '60625', '7736653904', '7736656668', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, '', '', 'HCFA|UB|', '1447237425', 0, 'Y', 0, '2013-04-03', NULL, NULL, 0, 0, NULL, NULL),
('363364374', 'ELRHC0206', 'ELRHC0206', 'ILCHIGSTD', 'Colette Gordon MD', 'Colette', 'B', 'Gordon', 'MD', 'Internal Medicine', '', '', NULL, 'O', '2800 N Sheridan Rd Ste 101', 'Chicago', 'Cook', 'IL', '60657', '7732817835', '7732818736', '2800 N Sheridan Rd Ste 101', 'Chicago', 'Cook', 'IL', '60657', '7732817835', '7732818736', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1447266176', 0, 'N', 0, '2013-05-24', NULL, NULL, 41.9329, -87.6393, NULL, NULL),
('363719474', 'ELRHC0445', 'ELRHC0445', 'ILCHIGSTD', 'Lakeshore Infectious Disease Associates', 'Mitchell', 'R', 'Weinstein', 'MD', 'Infectious Disease', '', '', NULL, 'O', '2900 N Lake Shore Dr Ste 1231', 'Chicago', 'Cook', 'IL', '60657', '7736653261', '7736659435', '2900 N Lake Shore Dr Ste 1231', 'Chicago', 'Cook', 'IL', '60657', '7736653261', '7736659435', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, NULL, NULL, 'HCFA|UB|', '1447270475', 0, 'N', 0, '2012-12-20', NULL, NULL, 41.9349, -87.6367, NULL, NULL),
('363719474', 'ELRHC0444', 'ELRHC0444', 'ILCHIGSTD', 'Lakeshore Infectious Disease Associates', 'Mitchell', 'R', 'Weinstein', 'MD', 'Infectious Disease', '', '', NULL, 'B', '777 Oakmont Ln Ste 1600', 'Westmont', 'Dupage', 'IL', '60559', '7736653261', '7736659435', '777 Oakmont Ln Ste 1600', 'Westmont', 'Dupage', 'IL', '60559', '7736653261', '7736659435', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, NULL, NULL, 'HCFA|UB|', '1447270475', 0, 'Y', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('362728940', 'ELRHC0409', 'ELRHC0409', 'ILCHIGSTD', 'Kimball Medical Center', 'Ely', 'R', 'Tandeter', 'MD', 'Internal Medicine', '', '', NULL, 'O', '2837 N Milwaukee Ave', 'Chicago', 'Cook', 'IL', '60618', '7732356266', '7732359054', '2837 N Milwaukee Ave', 'Chicago', 'Cook', 'IL', '60618', '7732356266', '7732359054', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Francis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1457306953', 0, 'N', 0, '2012-12-20', NULL, NULL, 41.9328, -87.7135, NULL, NULL),
('362663241', 'ELRHC0307', 'ELRHC0307', 'ILCHIGSTD', 'Chicago Orthopaedics and Sports Medicine', 'Charles', 'Waite', 'Mercier', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', '13728 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '7734333130', '7734333142', '13728 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '7734333130', '7734333142', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, NULL, NULL, 'HCFA|UB|', '1457320749', 0, 'Y', 0, '2013-04-03', NULL, NULL, 0, 0, NULL, NULL),
('362663241', 'ELRHC0306', 'ELRHC0306', 'ILCHIGSTD', 'Chicago Orthopaedics and Sports Medicine', 'Charles', 'Waite', 'Mercier', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '3000 N Halsted St Ste 525', 'Chicago', 'Cook', 'IL', '60657', '7734333130', '7734333142', '3000 N Halsted St Ste 525', 'Chicago', 'Cook', 'IL', '60657', '7734333130', '7734333142', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, NULL, NULL, 'HCFA|UB|', '1457320749', 0, 'N', 0, '2013-04-03', NULL, NULL, 41.9369, -87.6491, NULL, NULL),
('364463898', 'ELRHC0181', 'ELRHC0181', 'ILCHIGSTD', 'Espinosa Medical Services', 'Pilarita', 'G', 'Espinosa', 'MD', 'Family Practice', '', '', NULL, 'O', '2800 N Sheridan Rd Ste 602', 'Chicago', 'Cook', 'IL', '60657', '7732483911', '7732484937', '2800 N Sheridan Rd Ste 602', 'Chicago', 'Cook', 'IL', '60657', '7732483911', '7732484937', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, '', NULL, 'HCFA|UB|', '1467416313', 0, 'N', 0, '2012-12-20', NULL, NULL, 41.9329, -87.6393, NULL, NULL),
('341482988', 'ELRHC0189', 'ELRHC0189', 'ILCHIGSTD', 'Mark D Freedman MD', 'Mark', 'D', 'Freedman', 'MD', 'Family Practice', '', '', NULL, 'O', '800 Austin St West Tower Ste 303', 'Evanston', 'Cook', 'IL', '60202', '8473321066', '8473321067', '800 Austin St West Tower Ste 303', 'Evanston', 'Cook', 'IL', '60202', '8473321066', '8473321067', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Francis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1467493049', 0, 'N', 0, '2013-05-31', NULL, NULL, 42.0255, -87.6819, NULL, NULL),
('363275212', 'ELRHC0144', 'ELRHC0144', 'ILCHIGSTD', 'St Mary and Elizabeth Med Center', 'Samuel', '', 'Castillo', 'MD', 'Gastroenterology', '', '', NULL, 'O', '1431 N Western Ave Ste 133', 'Chicago', 'Cook', 'IL', '60622', '7733426800', '7733426332', '1431 N Western Ave Ste 133', 'Chicago', 'Cook', 'IL', '60622', '7733426800', '7733426332', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1467503672', 0, 'N', 0, '2013-05-24', NULL, NULL, 41.9073, -87.6871, NULL, NULL),
('363196629', 'ELRHC0264', 'ELRHC0264', 'ILCHIGSTD', 'Northside Neurosurgery', 'Leonard', '', 'Kranzler', 'MD', 'Neurosurgery', '', '', NULL, 'O', '3000 N Halsted St Ste 605', 'Chicago', 'Cook', 'IL', '60657', '7733484333', '7733482434', '3000 N Halsted St Ste 605', 'Chicago', 'Cook', 'IL', '60657', '7733484333', '7733482434', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', '', '', '', 'HCFA|UB|', '1467567693', 0, 'N', 0, '2014-05-23', NULL, NULL, 41.9369, -87.6491, NULL, NULL),
('363196629', 'ELRHC0263', 'ELRHC0263', 'ILCHIGSTD', 'Northside Neurosurgery', 'Leonard', '', 'Kranzler', 'MD', 'Neurosurgery', '', '', NULL, 'B', '75 Remittance Dr Ste 6994', 'Chicago', 'Cook', 'IL', '60675', '7733484333', '7733482434', '75 Remittance Dr Ste 6994', 'Chicago', 'Cook', 'IL', '60675', '7733484333', '7733482434', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', '', '', '', 'HCFA|UB|', '1467567693', 0, 'Y', 0, '2014-05-23', NULL, NULL, 0, 0, NULL, NULL),
('363114403', 'ELRHC0157', 'ELRHC0157', 'ILCHIGSTD', 'Eye Associates', 'Thomas', 'J', 'Conti', 'MD', 'Ophthalmology', '', '', NULL, 'O', '7447 W Talcott Ave Ste 300', 'Chicago', 'Cook', 'IL', '60631', '7737750811', '7737750818', '7447 W Talcott Ave Ste 300', 'Chicago', 'Cook', 'IL', '60631', '7737750811', '7737750818', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', 'Presence Resurrection Medical Center', NULL, NULL, 'HCFA|UB|', '1477648756', 0, 'N', 0, '2012-12-20', NULL, NULL, 41.9887, -87.8131, NULL, NULL),
('262219708', 'ELRHC0408', 'ELRHC0408', 'ILCHIGSTD', 'Siddharth Tambar MD', 'Siddharth', '', 'Tambar', 'MD', 'Rheumatology', '', '', NULL, 'O', '2800 N Sheridan Rd Ste 100A', 'Chicago', 'Cook', 'IL', '60657', '7736965855', '7736965861', '2800 N Sheridan Rd Ste 100A', 'Chicago', 'Cook', 'IL', '60657', '7736965855', '7736965861', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, '', NULL, 'HCFA|UB|', '1477655488', 0, 'N', 0, '2013-05-24', NULL, NULL, 41.9329, -87.6393, NULL, NULL),
('364137461', 'ELRHC0392', 'ELRHC0392', 'ILCHIGSTD', 'Marian Skolarz MD', 'Marian', 'J', 'Skolarz', 'MD', 'Family Practice', '', '', NULL, 'O', '7447 W Talcott Ave Ste 366', 'Chicago', 'Cook', 'IL', '60631', '7735941410', '7737741402', '7447 W Talcott Ave Ste 366', 'Chicago', 'Cook', 'IL', '60631', '7735941410', '7737741402', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1487764163', 0, 'N', 0, '2013-05-31', NULL, NULL, 41.9887, -87.8131, NULL, NULL),
('820558911', 'ELRHC0205', 'ELRHC0205', 'ILCHIGSTD', 'Kidney and Hypertension Consultants', 'Anna', 'B', 'Gopaniuk Folga', 'MD', 'Nephrology', '', '', NULL, 'O', '7447 W Talcott Ave Ste 463', 'Chicago', 'Cook', 'IL', '60631', '7737638400', '7737748085', '7447 W Talcott Ave Ste 463', 'Chicago', 'Cook', 'IL', '60631', '7737638400', '7737748085', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', NULL, NULL, 'HCFA|UB|', '1497733828', 0, 'N', 0, '2012-12-20', NULL, NULL, 41.9887, -87.8131, NULL, NULL),
('362171079', 'ELRHC0406', 'ELRHC0406', 'ILCHIGSTD', 'Presence Saints Mary and Elizabeth Medical Center', 'Frank', 'P', 'Szelag', 'MD', 'Family Practice', '', '', NULL, 'B', '62311 Collections Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '3127702040', '3127703270', '62311 Collections Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '3127702040', '3127703270', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 8, '2013-01-01', NULL, 0, 0, 0, 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', NULL, '', NULL, 'HCFA|UB|', '1497808604', 0, 'Y', 0, '2013-05-28', NULL, NULL, 0, 0, NULL, NULL),
('362171079', 'ELRHC0405', 'ELRHC0405', 'ILCHIGSTD', 'Presence Saints Mary and Elizabeth Medical Center', 'Frank', 'P', 'Szelag', 'MD', 'Family Practice', '', '', NULL, 'O', 'Nazareth Family Ctr 1127 N Oakley Blvd 2nd Fl', 'Chicago', 'Cook', 'IL', '60622', '3127702040', '3127703270', 'Nazareth Family Ctr 1127 N Oakley Blvd 2nd Fl', 'Chicago', 'Cook', 'IL', '60622', '3127702040', '3127703270', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 8, '2013-01-01', '2013-04-02', 0, 0, 0, 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', NULL, '', NULL, 'HCFA|UB|', '1497808604', 0, 'N', 0, '2013-05-28', NULL, NULL, 0, 0, NULL, NULL),
('320068076', 'ELRHC0276', 'ELRHC0276', 'ILCHIGSTD', 'MD Care Center', 'Milenko', 'B', 'Lazarevic', 'MD', 'Internal Medicine', '', '', NULL, 'O', '5067 N Lincoln Ave Unit 1 S', 'Chicago', 'Cook', 'IL', '60625', '7738786550', '7738786557', '5067 N Lincoln Ave Unit 1 S', 'Chicago', 'Cook', 'IL', '60625', '7738786550', '7738786557', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, '', NULL, 'HCFA|UB|', '1518158138', 0, 'N', 0, '2012-12-20', NULL, NULL, 41.9735, -87.6916, NULL, NULL),
('320068076', 'ELRHC0275', 'ELRHC0275', 'ILCHIGSTD', 'MD Care Center', 'Milenko', 'B', 'Lazarevic', 'MD', 'Internal Medicine', '', '', NULL, 'B', '6533 N Trumbull Ave', 'Lincolnwood', 'Cook', 'IL', '60712', '7738786550', '7738786557', '6533 N Trumbull Ave', 'Lincolnwood', 'Cook', 'IL', '60712', '7738786550', '7738786557', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, '', NULL, 'HCFA|UB|', '1518158138', 0, 'Y', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('363325093', 'ELRHC0414', 'ELRHC0414', 'ILCHIGSTD', 'North Shore Cardiology Consultants', 'Marc', 'L', 'Tenzer', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '7447 W Talcott Ave Ste 200', 'Chicago', 'Cook', 'IL', '60631', '7737745020', '7737744967', '7447 W Talcott Ave Ste 200', 'Chicago', 'Cook', 'IL', '60631', '7737745020', '7737744967', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1518927185', 0, 'N', 0, '2012-12-20', NULL, NULL, 41.9887, -87.8131, NULL, NULL),
('363835507', 'ELRHC0131', 'ELRHC0131', 'ILCHIGSTD', 'CDN Surgical Associates', 'Matthew', '', 'Blecha', 'MD', 'Vascular Surgery', '', '', NULL, 'O', '2913 N Commonwealth Ave 5th Fl', 'Chicago', 'Cook', 'IL', '60657', '7734723427', '7734728561', '2913 N Commonwealth Ave 5th Fl', 'Chicago', 'Cook', 'IL', '60657', '7734723427', '7734728561', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, NULL, NULL, 'HCFA|UB|', '1518990399', 0, 'N', 0, '2013-04-03', NULL, NULL, 41.9346, -87.638, NULL, NULL),
('363835507', 'ELRHC0130', 'ELRHC0130', 'ILCHIGSTD', 'CDN Surgical Associates', 'Matthew', '', 'Blecha', 'MD', 'Vascular Surgery', '', '', NULL, 'B', 'PO Box 597995', 'Chicago', 'Cook', 'IL', '60659', '7734723427', '7734728561', 'PO Box 597995', 'Chicago', 'Cook', 'IL', '60659', '7734723427', '7734728561', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, NULL, NULL, 'HCFA|UB|', '1518990399', 0, 'Y', 0, '2013-04-03', NULL, NULL, 0, 0, NULL, NULL),
('264573677', 'ELRHC0163', 'ELRHC0163', 'ILCHIGSTD', 'Joseph Danon Medical Services', 'Joseph', '', 'Danon', 'MD', 'Internal Medicine', '', '', NULL, 'O', '2222 W Division St Ste 205', 'Chicago', 'Cook', 'IL', '60622', '7733954505', '7733954504', '2222 W Division Ste 205', 'Chicago', 'Cook', 'IL', '60622', '7733954505', '7733954504', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', NULL, '', NULL, 'HCFA|UB|', '1528015104', 0, 'N', 0, '2012-12-20', NULL, NULL, 41.9032, -87.6826, NULL, NULL),
('455548173', 'ELRHC0265', 'ELRHC0265', 'ILCHIGSTD', 'Kroczek Surgical Associates', 'Bohdan', 'J', 'Kroczek', 'MD', 'General Surgery', '', '', NULL, 'O', '7447 W Talcott Ave Ste 221', 'Chicago', 'Cook', 'IL', '60631', '7737631234', '7736311650', '7447 W Talcott Ave Ste 221', 'Chicago', 'Cook', 'IL', '60631', '7737631234', '7736311650', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1528050598', 0, 'N', 0, '2012-12-20', NULL, NULL, 41.9887, -87.8131, NULL, NULL),
('362930116', 'ELRHC0260', 'ELRHC0260', 'ILCHIGSTD', 'Komutanon Kajorndej MD', 'Kajorndej', '', 'Komutanon', 'MD', 'Allergy and Immunology', '', '', NULL, 'O', '3218 W Lawrence Ave', 'Chicago', 'Cook', 'IL', '60625', '7735886846', '7735886847', '3218 W Lawrence Ave', 'Chicago', 'Cook', 'IL', '60625', '7735886846', '7735886847', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', NULL, NULL, NULL, 'HCFA|UB|', '1528069804', 0, 'N', 0, '2013-05-24', NULL, NULL, 41.9685, -87.7092, NULL, NULL),
('270837740', 'ELRHC0195', 'ELRHC0195', 'ILCHIGSTD', '', 'Inessa', 'M', 'Gelfand', 'MD', 'Endocrinology', '', '', NULL, 'O', '6420 N California Ave', 'Chicago', 'Cook', 'IL', '60645', '7739736100', '7732624882', '6420 N California Ave', 'Chicago', 'Cook', 'IL', '60645', '7739736100', '7732624882', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Francis Hospital', NULL, '', NULL, 'HCFA|UB|', '1528080637', 0, 'N', 0, '2012-12-20', NULL, NULL, 41.998, -87.6997, NULL, NULL),
('364210615', 'ELRHC0337', 'ELRHC0337', 'ILCHIGSTD', '', 'Julie', 'B', 'Pearlman', 'MD', 'Ophthalmology', '', '', NULL, 'O', '1431 N Western Ave Ste 301', 'Chicago', 'Cook', 'IL', '60622', '3123940400', '7733940404', '1431 N Western Ave Ste 301', 'Chicago', 'Cook', 'IL', '60622', '3123940400', '7733940404', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', NULL, NULL, NULL, 'HCFA|UB|', '1528097359', 0, 'N', 0, '2014-01-14', NULL, NULL, 41.9073, -87.6871, NULL, NULL),
('364210615', 'ELRHC0336', 'ELRHC0336', 'ILCHIGSTD', '', 'Julie', 'B', 'Pearlman', 'MD', 'Ophthalmology', '', '', NULL, 'B', '9005 W Cermak Rd', 'North Riverside', 'Cook', 'IL', '60546', '3123940400', '7733940404', '9005 W Cermak Rd', 'North Riverside', 'Cook', 'IL', '60546', '3123940400', '7733940404', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', NULL, NULL, NULL, 'HCFA|UB|', '1528097359', 0, 'N', 0, '2014-01-14', NULL, NULL, 41.8493, -87.8478, NULL, NULL),
('203493835', 'ELRHC0371', 'ELRHC0371', 'ILCHIGSTD', 'Optimum Kidney Care', 'Mohamed', 'M', 'Salem', 'MD', 'Nephrology', '', '', NULL, 'O', '3023 N Ashland Ave 1st Fl', 'Chicago', 'Cook', 'IL', '60657', '7735254701', '7734420046', '3023 N Ashland Ave 1st Fl', 'Chicago', 'Cook', 'IL', '60657', '7735254701', '7734420046', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, '', '', 'HCFA|UB|', '1538139316', 0, 'N', 0, '2014-04-25', NULL, NULL, 41.9369, -87.6685, NULL, NULL),
('203493835', 'ELRHC0370', 'ELRHC0370', 'ILCHIGSTD', 'Optinum Kidney Care', 'Mohamed', 'M', 'Salem', 'MD', 'Nephrology', '', '', NULL, 'B', '777 Oakmont Ln Ste 1600', 'Westmont', 'Dupage', 'IL', '60559', '7735254701', '7734420046', '777 Oakmont Ln Ste 1600', 'Westmont', 'Dupage', 'IL', '60559', '7735254701', '7734420046', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, '', '', 'HCFA|UB|', '1538139316', 0, 'Y', 0, '2014-04-25', NULL, NULL, 0, 0, NULL, NULL),
('593530456', 'ELRHC0376', 'ELRHC0376', 'ILCHIGSTD', 'Haresh Sawlani MD', 'Haresh', 'B', 'Sawlani', 'MD', 'Internal Medicine', '', '', NULL, 'O', '3445 N Central Ave Unit C', 'Chicago', 'Cook', 'IL', '60634', '7732050800', '7732051804', '3445 N Central Ave Unit C', 'Chicago', 'Cook', 'IL', '60634', '7732050800', '7732051804', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Holy Family Medical Center', NULL, '', NULL, 'HCFA|UB|', '1538157045', 0, 'N', 0, '2013-06-03', NULL, NULL, 41.9434, -87.7666, NULL, NULL),
('020767840', 'ELRHC0266', 'ELRHC0266', 'ILCHIGSTD', 'Women for Women OB-GYN', 'Kornelia', 'E', 'Krol', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '6438 N Central Ave', 'Chicago', 'Cook', 'IL', '60646', '7737757883', '7737757885', '6438 N Central Ave', 'Chicago', 'Cook', 'IL', '60646', '7737757883', '7737757885', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, NULL, NULL, 'HCFA|UB|', '1538192398', 0, 'N', 0, '2012-12-20', NULL, NULL, 41.9982, -87.7635, NULL, NULL),
('363999801', 'ELRHC0281', 'ELRHC0281', 'ILCHIGSTD', 'St Joseph Hospital', 'Bruce', 'E', 'Lewis', 'MD', 'Cardiovascular Disease', 'Internal Medicine', '', NULL, 'O', '2900 N Lake Shore Dr', 'Chicago', 'Cook', 'IL', '60657', '7736653391', '7736656027', '2900 N Lake Shore Dr', 'Chicago', 'Cook', 'IL', '60657', '7736653391', '7736656027', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1538238050', 0, 'N', 0, '2013-10-24', NULL, NULL, 41.9349, -87.6367, NULL, NULL),
('363635039', 'ELRHC0351', 'ELRHC0351', 'ILCHIGSTD', 'Jader D Reis MD', 'Jader', 'D', 'Reis', 'MD', 'Family Practice', '', '', NULL, 'O', '1431 N Western Ave Ste 208', 'Chicago', 'Cook', 'IL', '60622', '7733848823', '7733848811', '1431 N Western Ave Ste 208', 'Chicago', 'Cook', 'IL', '60622', '7733848823', '7733848811', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', NULL, NULL, NULL, 'HCFA|UB|', '1548311954', 0, 'N', 0, '2013-05-30', NULL, NULL, 41.9073, -87.6871, NULL, NULL),
('364312047', 'ELRHC0305', 'ELRHC0305', 'ILCHIGSTD', 'American Hispanic Wellness', 'Ramiro', 'D', 'Mercado', 'MD', 'Family Practice', '', '', NULL, 'O', '1431 N Western Ave Ste 201', 'Chicago', 'Cook', 'IL', '60622', '7732766443', '7732766448', '1431 N Western Ave Ste 201', 'Chicago', 'Cook', 'IL', '60622', '7732766443', '7732766448', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', NULL, NULL, NULL, 'HCFA|UB|', '1558329276', 0, 'N', 0, '2013-05-31', NULL, NULL, 41.9073, -87.6871, NULL, NULL),
('371424613', 'ELRHC0180', 'ELRHC0180', 'ILCHIGSTD', 'Chicago Behavioral Health Resources', 'Eric', 'E', 'Erickson', 'DO', 'Psychiatry', '', '', NULL, 'O', '2800 N Sheridan Rd Ste 610', 'Chicago', 'Cook', 'IL', '60657', '7734725424', '7734728903', '2800 N Sheridan Rd Ste 610', 'Chicago', 'Cook', 'IL', '60657', '7734725424', '7734728903', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, NULL, NULL, 'HCFA|UB|', '1558342220', 0, 'Y', 0, '2012-12-20', NULL, NULL, 41.9329, -87.6393, NULL, NULL),
('363966745', 'ELRHC0151', 'ELRHC0151', 'ILCHIGSTD', 'Metro Infectious Disease Consultants', 'Vishnu', 'V', 'Chundi', 'MD', 'Infectious Disease', '', '', NULL, 'O', '5600 W Addison St Ste 204', 'Chicago', 'Cook', 'IL', '60634', '7732054660', '7732057654', '5600 W Addison St Ste 204', 'Chicago', 'Cook', 'IL', '60634', '7732054660', '7732057654', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, 'Presence Our Lady Of The Resurrection Medical Center', NULL, '', '', 'HCFA|UB|', '1558357905', 0, 'N', 0, '2013-05-28', NULL, NULL, 41.9459, -87.7667, NULL, NULL),
('363966745', 'ELRHC0150', 'ELRHC0150', 'ILCHIGSTD', 'Metro Infectious Disease Consultants', 'Vishnu', 'V', 'Chundi', 'MD', 'Infectious Disease', '', '', NULL, 'B', '901 McClintock Dr Ste 202', 'Burr Ridge', 'Dupage', 'IL', '60527', '7732054660', '7732057654', '901 McClintock Dr Ste 202', 'Burr Ridge', 'Dupage', 'IL', '60527', '7732054660', '7732057654', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, 'Presence Our Lady Of The Resurrection Medical Center', NULL, '', '', 'HCFA|UB|', '1558357905', 0, 'Y', 0, '2013-05-28', NULL, NULL, 41.7544, -87.9071, NULL, NULL),
('200818616', 'ELRHC0348', 'ELRHC0348', 'ILCHIGSTD', 'Raghu Ramadurai MD', 'Raghu', '', 'Ramadurai', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '2222 W Division St Ste 300', 'Chicago', 'Cook', 'IL', '60622', '7733423333', '7733423334', '2222 W Division St Ste 300', 'Chicago', 'Cook', 'IL', '60622', '7733423333', '7733423334', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', NULL, '', NULL, 'HCFA|UB|', '1558378059', 0, 'N', 0, '2013-05-24', NULL, NULL, 41.9032, -87.6826, NULL, NULL),
('200818616', 'ELRHC0347', 'ELRHC0347', 'ILCHIGSTD', 'Raghu Ramadurai MD', 'Raghu', '', 'Ramadurai', 'MD', 'Cardiovascular Disease', '', '', NULL, 'B', 'PO Box 798', 'Park Ridge', 'Cook', 'IL', '60068', '7733423333', '7733423334', 'PO Box 798', 'Park Ridge', 'Cook', 'IL', '60068', '7733423333', '7733423334', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', NULL, '', NULL, 'HCFA|UB|', '1558378059', 0, 'Y', 0, '2013-05-24', NULL, NULL, 0, 0, NULL, NULL),
('363078753', 'ELRHC0295', 'ELRHC0295', 'ILCHIGSTD', 'Medical Office Building', 'Amalendu', '', 'Majumdar', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '2222 W Division St Ste 340', 'Chicago', 'Cook', 'IL', '60622', '7733421990', '7733421993', '2222 W Division St Ste 340', 'Chicago', 'Cook', 'IL', '60622', '7733421990', '7733421993', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', NULL, '', NULL, 'HCFA|UB|', '1558384081', 0, 'N', 0, '2013-04-03', NULL, NULL, 41.9032, -87.6826, NULL, NULL),
('363744019', 'ELRHC0135', 'ELRHC0135', 'ILCHIGSTD', 'Eye Specialists of Chicago', 'Mark', 'P', 'Buranosky', 'MD', 'Ophthalmology', '', '', NULL, 'O', '5600 W Addison St Ste 102', 'Chicago', 'Cook', 'IL', '60634', '7737361717', '7737367538', '5600 W Addison St Ste 102', 'Chicago', 'Cook', 'IL', '60634', '7737361717', '7737367538', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Our Lady Of The Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1558399949', 0, 'N', 0, '2012-12-20', NULL, NULL, 41.9459, -87.7667, NULL, NULL),
('363954552', 'ELRHC0447', 'ELRHC0447', 'ILCHIGSTD', 'Sage Medical Group', 'Paulette', 'C', 'Wilson', 'MD', 'Internal Medicine', 'Family Practice', '', NULL, 'O', '1150 W Fullerton Ave 2nd Fl', 'Chicago', 'Cook', 'IL', '60614', '7735497757', '7735491221', '1150 W Fullerton Ave 2nd Fl', 'Chicago', 'Cook', 'IL', '60614', '7735497757', '7735491221', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, '', '', 'HCFA|UB|', '1558475657', 0, 'N', 0, '2014-01-31', NULL, NULL, 41.9253, -87.6576, NULL, NULL),
('363708234', 'ELRHC0118', 'ELRHC0118', 'ILCHIGSTD', 'Midwest Medical Associates', 'Pandelis', '', 'Banias', 'MD', 'Internal Medicine', '', '', NULL, 'B', '501 N Hicks Rd', 'Palatine', 'McHenry', 'IL', '60072', '8473164455', '8473164456', '501 N Hicks Rd', 'Palatine', 'Mchenry', 'IL', '60072', '8473164455', '8473164456', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', 'Presence Saint Francis Hospital', NULL, NULL, 'HCFA|UB|', '1558477570', 0, 'Y', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('363708234', 'ELRHC0117', 'ELRHC0117', 'ILCHIGSTD', 'Midwest Medical Associates', 'Pandelis', '', 'Banias', 'MD', 'Internal Medicine', '', '', NULL, 'O', '800 Austin St East Tower Ste 369', 'Evanston', 'Cook', 'IL', '60202', '8473164455', '8473164456', '800 Austin St East Tower Ste 369', 'Evanston', 'Cook', 'IL', '60202', '8473164455', '8473164456', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', 'Presence Saint Francis Hospital', NULL, NULL, 'HCFA|UB|', '1558477570', 0, 'N', 0, '2012-12-20', NULL, NULL, 42.0255, -87.6819, NULL, NULL),
('452028348', 'ELRHC0238', 'ELRHC0238', 'ILCHIGSTD', 'Summit Digestive and Ulcer Disease Specialists', 'Afreen', 'A', 'Hyder', 'MD', 'Gastroenterology', '', '', NULL, 'O', '1 S 280 Summit Ave Court A', 'Oakbrook Terrice', 'Dupage', 'IL', '60181', '6308899889', '6308898977', '1 S 280 Summit Ave Court A', 'Oakbrook Terrice', 'Dupage', 'IL', '60181', '6308899889', '6308898977', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', NULL, NULL, NULL, 'HCFA|UB|', '1558563148', 0, 'N', 0, '2012-12-20', NULL, NULL, 41.8553, -87.9728, NULL, NULL),
('362605281', 'ELRHC0341', 'ELRHC0341', 'ILCHIGSTD', 'Surgical Associates', 'Michael', 'R', 'Prendergast', 'MD', 'General Surgery', '', '', NULL, 'O', '800 Austin St East Tower Ste 563', 'Evanston', 'Cook', 'IL', '60202', '8478690522', '8478690652', '800 Austin St East Tower Ste 563', 'Evanston', 'Cook', 'IL', '60202', '8478690522', '8478690652', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Francis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1568570158', 0, 'N', 0, '2012-12-20', NULL, NULL, 42.0255, -87.6819, NULL, NULL),
('364337000', 'ELRHC0211', 'ELRHC0211', 'ILCHIGSTD', 'Lisa S Greising MD', 'Lisa', 'S', 'Greising', 'MD', 'Internal Medicine', '', '', NULL, 'O', '2800 N Sheridan Rd  Ste 310 ', 'Chicago', 'Cook', 'IL', '60657', '7736657515', '7736657514', '2800 N Sheridan Rd  Ste 310 ', 'Chicago', 'Cook', 'IL', '60657', '7736657515', '7736657514', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, '', '', 'HCFA|UB|', '1578523155', 0, 'N', 0, '2013-08-01', NULL, NULL, 41.9329, -87.6393, NULL, NULL),
('820558911', 'ELRHC0108', 'ELRHC0108', 'ILCHIGSTD', 'Kidney and Hypertension Consultants', 'Lynn', 'M', 'Anderson', 'MD', 'Nephrology', '', '', NULL, 'O', '7447 W Talcott Ave Ste 463', 'Chicago', 'Cook', 'IL', '60631', '7737638400', '7737748085', '7447 W Talcott Ave Ste 463', 'Chicago', 'Cook', 'IL', '60631', '7737638400', '7737748085', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', NULL, NULL, 'HCFA|UB|', '1578541876', 0, 'N', 0, '2012-12-20', NULL, NULL, 41.9887, -87.8131, NULL, NULL),
('363980173', 'ELRHC0125', 'ELRHC0125', 'ILCHIGSTD', 'Michael Berkson MD', 'Michael', 'H', 'Berkson', 'MD', 'Dermatology', '', '', NULL, 'O', '2800 N Sheridan Rd Ste 508', 'Chicago', 'Cook', 'IL', '60657', '7735255550', '7735253084', '2800 N Sheridan Rd Ste 508', 'Chicago', 'Cook', 'IL', '60657', '7735255550', '7735253084', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, NULL, NULL, 'HCFA|UB|', '1588645741', 0, 'N', 0, '2013-05-31', NULL, NULL, 41.9329, -87.6393, NULL, NULL),
('363980173', 'ELRHC0124', 'ELRHC0124', 'ILCHIGSTD', 'Michael Berkson MD', 'Michael', 'H', 'Berkson', 'MD', 'Dermatology', '', '', NULL, 'B', '4250 N Marine Dr Ste 236', 'Chicago', 'Cook', 'IL', '60613', '7735255550', '7735253084', '4250 N Marine Dr Ste 236', 'Chicago', 'Cook', 'IL', '60613', '7735255550', '7735253084', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, NULL, NULL, 'HCFA|UB|', '1588645741', 0, 'Y', 0, '2013-05-31', NULL, NULL, 0, 0, NULL, NULL),
('364210615', 'ELRHC0346', 'ELRHC0346', 'ILCHIGSTD', 'Maleka Rahman MD', 'Maleka', 'P', 'Rahman', 'DO', 'Ophthalmology', '', '', NULL, 'O', '9005 W Cermak Rd', 'North Riverside', 'Cook', 'IL', '60546', '7084428010', '7084428009', '9005 W Cermak Rd', 'North Riverside', 'Cook', 'IL', '60546', '7084428010', '7084428009', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', NULL, NULL, NULL, 'HCFA|UB|', '1588976245', 0, 'N', 0, '2013-05-31', NULL, NULL, 41.8495, -87.8478, NULL, NULL),
('362708347', 'ELRHC0280', 'ELRHC0280', 'ILCHIGSTD', 'Associates in Nephrology', 'Mark', 'P', 'Leischner', 'MD', 'Nephrology', '', '', NULL, 'O', '2800 N Sheridan Rd Ste 304', 'Chicago', 'Cook', 'IL', '60657', '7735254501', '7735253416', '2800 N Sheridan Rd Ste 304', 'Chicago', 'Cook', 'IL', '60657', '7735254501', '7735253416', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, NULL, NULL, 'HCFA|UB|', '1598708877', 0, 'N', 0, '2012-12-20', NULL, NULL, 41.9329, -87.6393, NULL, NULL),
('362708347', 'ELRHC0279', 'ELRHC0279', 'ILCHIGSTD', 'Associates in Nephrology', 'Mark', 'P', 'Leischner', 'MD', 'Nephrology', '', '', NULL, 'B', '4026 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '7735254501', '7735253416', '4026 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '7735254501', '7735253416', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, NULL, NULL, 'HCFA|UB|', '1598708877', 0, 'Y', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('363200170', 'ELRHC0192', 'ELRHC0192', 'ILCHIGSTD', 'Seton Family Health Center', 'Luis', 'T', 'Garcia', 'MD', 'Family Practice', '', '', NULL, 'B', '62311 Collections Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '3123371982', '3126423847', '62311 Collections Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '3123371982', '3126423847', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 8, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, '', NULL, 'HCFA|UB|', '1598874398', 0, 'Y', 0, '2013-05-28', NULL, NULL, 0, 0, NULL, NULL),
('363200170', 'ELRHC0191', 'ELRHC0191', 'ILCHIGSTD', 'Seton Family Health Center', 'Luis', 'T', 'Garcia', 'MD', 'Family Practice', '', '', NULL, 'O', '711 W N Ave', 'Chicago', 'Cook', 'IL', '60610', '3123371982', '3126423847', '711 W N Ave', 'Chicago', 'Cook', 'IL', '60610', '3123371982', '3126423847', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 8, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, '', NULL, 'HCFA|UB|', '1598874398', 0, 'N', 0, '2013-05-28', NULL, NULL, 41.911, -87.6461, 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
('363843619', 'ELRHC0358', 'ELRHC0358', 'ILCHIGSTD', 'Eye Physicians and Surgeons of Chicago', 'Gina', 'M', 'Rogers', 'MD', 'Ophthalmology', '', '', NULL, 'O', '2800 N Sheridan Rd Ste 103', 'Chicago', 'Cook', 'IL', '60657', '7738838880', '7735258699', '2800 N Sheridan Rd Ste 103', 'Chicago', 'Cook', 'IL', '60657', '7738838880', '7735258699', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, NULL, NULL, 'HCFA|UB|', '1609042902', 0, 'N', 0, '2013-07-02', NULL, NULL, 41.9329, -87.6393, NULL, NULL),
('362171079', 'ELRHC0123', 'ELRHC0123', 'ILCHIGSTD', 'Presence Saints Mary and Elizabeth Medical Center', 'David', 'M', 'Berdy', 'MD', 'Family Practice', '', '', NULL, 'B', '62311 Collections Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '3127702040', '3127703204', '62311 Collections Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '3127702040', '3127703204', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 8, '2013-01-01', NULL, 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1609854942', 0, 'Y', 0, '2013-08-12', NULL, NULL, 0, 0, NULL, NULL),
('362171079', 'ELRHC0122', 'ELRHC0122', 'ILCHIGSTD', 'Presence Saints Mary and Elizabeth Medical Center', 'David', 'M', 'Berdy', 'MD', 'Family Practice', '', '', NULL, 'O', 'Nazareth Family Ctr 1127 N Oakley Blvd 2nd Fl', 'Chicago', 'Cook', 'IL', '60622', '3127702040', '3127703204', 'Nazareth Family Ctr 1127 N Oakley Blvd 2nd Fl', 'Chicago', 'Cook', 'IL', '60622', '3127702040', '3127703204', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 8, '2013-01-01', '2013-04-02', 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1609854942', 0, 'N', 0, '2013-08-12', NULL, NULL, 0, 0, NULL, NULL),
('362605281', 'ELRHC0222', 'ELRHC0222', 'ILCHIGSTD', 'Surgical Associates', 'Kevin', 'S', 'Halstuk', 'MD', 'Vascular Surgery', '', '', NULL, 'O', '800 Austin St East Tower Ste 563', 'Evanston', 'Cook', 'IL', '60202', '8478690522', '8478690652', '800 Austin St East Tower Ste 563', 'Evanston', 'Cook', 'IL', '60202', '8478690522', '8478690652', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Francis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1609984293', 0, 'N', 0, '2012-12-20', NULL, NULL, 42.0255, -87.6819, NULL, NULL),
('363336929', 'ELRHC0208', 'ELRHC0208', 'ILCHIGSTD', 'Suzanne Greider MD', 'Suzanne', 'M', 'Greider', 'MD', 'Internal Medicine', '', '', NULL, 'O', '800 Austin St West Tower Ste 311', 'Evanston', 'Cook', 'IL', '60202', '8478695480', '8478695487', '800 Austin St West Tower Ste 311', 'Evanston', 'Cook', 'IL', '60202', '8478695480', '8478695487', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Francis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1619017803', 0, 'N', 0, '2013-05-24', NULL, NULL, 42.0255, -87.6819, NULL, NULL),
('364399256', 'ELRHC0175', 'ELRHC0175', 'ILCHIGSTD', 'Godwin Herman DSouza MD', 'Godwin', 'H', 'DSouza', 'MD', 'Internal Medicine', '', '', NULL, 'O', '5600 W Addison St Ste LL001', 'Chicago', 'Cook', 'IL', '60634', '7732029622', '7732830901', '5600 W Addison St Ste LL001', 'Chicago', 'Cook', 'IL', '60634', '7732029622', '7732830901', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1619915295', 0, 'N', 0, '2013-05-31', NULL, NULL, 41.9459, -87.7667, NULL, NULL),
('364377052', 'ELRHC0416', 'ELRHC0416', 'ILCHIGSTD', 'Wicker Park Eye Center', 'Daniel', 'J', 'Tepper', 'MD', 'Ophthalmology', '', '', NULL, 'O', '2222 W Division St Ste 135', 'Chicago', 'Cook', 'Il', '60622', '7732769030', '7732769110', '2222 W Division St Ste 135', 'Chicago', 'Cook', 'Il', '60622', '7732769030', '7732769110', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', NULL, NULL, NULL, 'HCFA|UB|', '1629088604', 0, 'N', 0, '2012-12-20', NULL, NULL, 41.9032, -87.6826, NULL, NULL),
('364377052', 'ELRHC0415', 'ELRHC0415', 'ILCHIGSTD', 'Wicker Park Eye Center', 'Daniel', 'J', 'Tepper', 'MD', 'Ophthalmology', '', '', NULL, 'B', 'PO Box 777193 7193 Solution Ctr', 'Chicago', 'Cook', 'IL', '60677', '7732769030', '7732769110', 'PO Box 777193 7193 Solution Ctr', 'Chicago', 'Cook', 'IL', '60677', '7732769030', '7732769110', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', NULL, NULL, NULL, 'HCFA|UB|', '1629088604', 0, 'Y', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('363388772', 'ELRHC0272', 'ELRHC0272', 'ILCHIGSTD', 'Lewanzer Lassiter MD', 'Lewanzer', '', 'Lassiter', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '2555 S Martin Luther King Dr 2nd Fl', 'Chicago', 'Cook', 'IL', '60616', '7739478412', '3126744001', '2555 S Martin Luther King Dr 2nd Fl', 'Chicago', 'Cook', 'IL', '60616', '7739478412', '3126744001', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, NULL, NULL, 'HCFA|UB|', '1639115777', 0, 'N', 0, '2013-05-24', NULL, NULL, 41.8456, -87.6264, NULL, NULL),
('141942488', 'ELRHC0458', 'ELRHC0458', 'ILCHIGSTD', 'Carlos Zambrano MD', 'Carlos', 'H', 'Zambrano', 'MD', 'Infectious Disease', '', '', NULL, 'O', '2222 W Division St Ste 205', 'Chicago', 'Cook', 'IL', '60622', '7734868820', '7734868823', '2222 W Division St Ste 205', 'Chicago', 'Cook', 'IL', '60622', '7734868820', '7734868823', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, '', NULL, 'HCFA|UB|', '1639139272', 0, 'N', 0, '2013-05-24', NULL, NULL, 41.9032, -87.6826, NULL, NULL),
('141942488', 'ELRHC0457', 'ELRHC0457', 'ILCHIGSTD', 'Carlos Zambrano MD', 'Carlos', 'H', 'Zambrano', 'MD', 'Infectious Disease', '', '', NULL, 'B', 'PO Box 8088', 'Wilmette', 'Cook', 'IL', '60091', '7734868820', '7734868823', 'PO Box 8088', 'Wilmette', 'Cook', 'IL', '60091', '7734868820', '7734868823', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, '', NULL, 'HCFA|UB|', '1639139272', 0, 'Y', 0, '2013-05-30', NULL, NULL, 0, 0, NULL, NULL),
('270837740', 'ELRHC0204', 'ELRHC0204', 'ILCHIGSTD', 'East W Internal Medicine Associates', 'Jaroslav', 'I', 'Goldman', 'MD', 'Internal Medicine', '', '', NULL, 'O', '6420 N California Ave', 'Chicago', 'Cook', 'IL', '60645', '7739736100', '7732624882', '6420 N California Ave', 'Chicago', 'Cook', 'IL', '60645', '7739736100', '7732624882', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Francis Hospital', '', '', '', 'HCFA|UB|', '1639140403', 0, 'N', 0, '2013-03-26', NULL, NULL, 41.998, -87.6997, NULL, NULL),
('324385651', 'ELRHC0199', 'ELRHC0199', 'ILCHIGSTD', 'St Joseph Hospital', 'Bruce', 'A', 'Gober', 'MD', 'Psychiatry', '', '', NULL, 'O', '2900 N Lake Shore Dr  6th Fl', 'Chicago', 'Cook', 'IL', '60657', '7736653426', '7736653435', '2900 N Lake Shore Dr  6th Fl', 'Chicago', 'Cook', 'IL', '60657', '7736653426', '7736653435', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1639143373', 0, 'Y', 0, '2013-06-04', NULL, NULL, 41.9349, -87.6367, NULL, NULL),
('363145256', 'ELRHC0441', 'ELRHC0441', 'ILCHIGSTD', 'Chest Medicine Consultants', 'Kristin', 'L', 'Walter', 'MD', 'Pulmonary', '', '', NULL, 'O', '2800 N Sheridan Rd Ste 301', 'Chicago', 'Cook', 'IL', '60657', '7739355556', '7739352724', '2800 N Sheridan Rd Ste 301', 'Chicago', 'Cook', 'IL', '60657', '7739355556', '7739352724', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, NULL, NULL, 'HCFA|UB|', '1649214636', 0, 'N', 0, '2012-12-20', NULL, NULL, 41.9329, -87.6393, NULL, NULL),
('134212397', 'ELRHC0390', 'ELRHC0390', 'ILCHIGSTD', 'Garcia Rosenberg and Associates', 'Brenda', 'J', 'Sikorski', 'DO', 'Family Practice', '', '', NULL, 'O', '7126 N Lincoln Ave', 'Lincolnwood', 'Cook', 'IL', '60712', '8475839189', '8475839196', '7126 N Lincoln Ave', 'Lincolnwood', 'Cook', 'IL', '60712', '8475839189', '8475839196', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-01-01', 0, 0, 0, 'Presence Saint Francis Hospital', NULL, '', '', 'HCFA|UB|', '1649310905', 0, 'N', 0, '2013-08-01', NULL, NULL, 42.0108, -87.7386, NULL, NULL),
('363617129', 'ELRHC0311', 'ELRHC0311', 'ILCHIGSTD', 'Frank Minardi DO', 'Frank', '', 'Minardi', 'DO', 'Orthopedic Surgery', '', '', NULL, 'O', '7447 W Talcott Ave Ste 515', 'Chicago', 'Cook', 'IL', '60631', '7737922100', '7737928578', '7447 W Talcott Ave Ste 515', 'Chicago', 'Cook', 'IL', '60631', '7737922100', '7737928578', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1659300747', 0, 'N', 0, '2013-05-30', NULL, NULL, 41.9887, -87.8131, NULL, NULL),
('364467374', 'ELRHC0233', 'ELRHC0233', 'ILCHIGSTD', 'Allergy Partners of Chicago', 'Waheeda', 'M', 'Hirani', 'MD', 'Allergy and Immunology', '', '', NULL, 'O', '7447 W Talcott Ave Ste 422', 'Chicago', 'Cook', 'IL', '60631', '7737752600', '7737753115', '7447 W Talcott Ave Ste 422', 'Chicago', 'Cook', 'IL', '60631', '7737752600', '7737753115', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, 'Presence Resurrection Medical Center', '', '', '', 'HCFA|UB|', '1659350205', 0, 'N', 0, '2014-07-14', NULL, NULL, 41.9887, -87.8131, NULL, NULL),
('364467374', 'ELRHC0232', 'ELRHC0232', 'ILCHIGSTD', '', 'Waheeda', 'M', 'Hirani', 'MD', 'Allergy and Immunology', '', '', NULL, 'B', '9301 W Golf Rd Ste 301', 'Des Plaines', 'Cook', 'IL', '60016', '8476357300', '7737753115', '9301 W Golf Rd Ste 301', 'Des Plaines', 'Cook', 'IL', '60016', '8476357300', '7737753115', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, 'Presence Resurrection Medical Center', '', '', '', 'HCFA|UB|', '1659350205', 0, 'Y', 0, '2014-07-14', NULL, NULL, 42.0537, -87.8566, NULL, NULL),
('353689022', 'ELRHC0136', 'ELRHC0136', 'ILCHIGSTD', 'Austin Street Pediatrics', 'Ranulfo', 'P', 'Cabrera', 'MD', 'Pediatrics', '', '', NULL, 'O', '800 Austin St East Tower Ste 463', 'Evanston', 'Cook', 'IL', '60202', '8474758711', '8474752513', '800 Austin St East Tower Ste 463', 'Evanston', 'Cook', 'IL', '60202', '8474758711', '8474752513', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Francis Hospital', NULL, '', NULL, 'HCFA|UB|', '1669510145', 0, 'N', 0, '2012-12-20', NULL, NULL, 42.0255, -87.6819, NULL, NULL),
('363145256', 'ELRHC0247', 'ELRHC0247', 'ILCHIGSTD', 'Chest Medicine Consultants', 'Jyothi', '', 'Jolepalem', 'MD', 'Pulmonary', '', '', NULL, 'O', '2800 N Sheridan Rd Ste 301', 'Chicago', 'Cook', 'IL', '60657', '7739355556', '7739352724', '2800 N Sheridan Rd Ste 301', 'Chicago', 'Cook', 'IL', '60657', '7739355556', '7739352724', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Holy Family Medical Center', NULL, '', NULL, 'HCFA|UB|', '1669574299', 0, 'N', 0, '2012-12-20', NULL, NULL, 41.9329, -87.6393, NULL, NULL),
('364453650', 'ELRHC0367', 'ELRHC0367', 'ILCHIGSTD', 'Advanced Urology Center', 'Alan', 'Y', 'Sadah', 'MD', 'Urology', '', '', NULL, 'O', '2735 N Harlem Ave', 'Chicago', 'Cook', 'IL', '60707', '7733856069', '7733856281', '2735 N Harlem Ave', 'Chicago', 'Cook', 'IL', '60707', '7733856069', '7733856281', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-01-01', 0, 0, 0, 'Presence Our Lady Of The Resurrection Medical Center', NULL, '', '', 'HCFA|UB|', '1679510275', 0, 'N', 0, '2013-09-24', NULL, NULL, 0, 0, NULL, NULL),
('611432288', 'ELRHC0224', 'ELRHC0224', 'ILCHIGSTD', 'Chicago MaternalFetal Medicine', 'Nawar', '', 'Hatoum', 'MD', 'Maternal and Fetal Medicine', '', '', NULL, 'O', '2507 N Halsted St', 'Chicago', 'Cook', 'IL', '60614', '7733488032', '7733488042', '2507 N Halsted St', 'Chicago', 'Cook', 'IL', '60614', '7733488032', '7733488042', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Prentice Womens Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1679549299', 0, 'Y', 0, '2012-12-20', NULL, NULL, 41.9279, -87.6488, NULL, NULL),
('363201806', 'ELRHC0345', 'ELRHC0345', 'ILCHIGSTD', 'Zenaida Racho MD', 'Zenaida', 'E', 'Racho', 'MD', 'Family Practice', '', '', NULL, 'O', '1431 N Western Ave Ste 309', 'Chicago', 'Cook', 'IL', '60622', '7738621356', '7738621366', '1431 N Western Ave Ste 309', 'Chicago', 'Cook', 'IL', '60622', '7738621356', '7738621366', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Our Lady Of The Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1679670194', 0, 'N', 0, '2013-05-24', NULL, NULL, 41.9073, -87.6871, NULL, NULL),
('870299862', 'W40024249', 'W40024249', 'UTMH1', 'LDS Family Services', 'Suzette', '', 'Fritinger', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '94 E Pages Ln Ste A', 'Centerville', 'Davis', 'UT', '84014', '8012940578', NULL, '94 E Pages Ln Ste A', 'Centerville', 'Davis', 'UT', '84014', '8012940578', '', 'MA', NULL, NULL, '0.00', '40.00', '0.00', 8, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1558401372', 0, 'N', 0, '2013-04-12', NULL, NULL, 40.9066, -111.877, NULL, NULL),
('562504196', 'ELRHC0287', 'ELRHC0287', 'ILCHIGSTD', 'Acezr Leynes MD', 'Acezr', 'S', 'Leynes', 'MD', 'Family Practice', '', '', NULL, 'O', '3758 W Chicago Ave', 'Chicago', 'Cook', 'IL', '60651', '7732350626', '7732355834', '3758 W Chicago Ave', 'Chicago', 'Cook', 'IL', '60651', '7732350626', '7732355834', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', NULL, NULL, NULL, 'HCFA|UB|', '1689672537', 0, 'Y', 0, '2013-07-15', NULL, NULL, 41.8955, -87.7205, NULL, NULL),
('562504196', 'ELRHC0285', 'ELRHC0285', 'ILCHIGSTD', 'Acezr Leynes MD', 'Acezr', 'S', 'Leynes', 'MD', 'Family Practice', '', '', NULL, 'B', '520 E 22nd St', 'Lombard', 'Dupage', 'IL', '60148', '7732350626', '7732355834', '520 E 22nd St', 'Lombard', 'Dupage', 'IL', '60148', '7732350626', '7732355834', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', NULL, NULL, NULL, 'HCFA|UB|', '1689672537', 0, 'Y', 0, '2013-07-15', NULL, NULL, 0, 0, NULL, NULL),
('363114403', 'ELRHC0302', 'ELRHC0302', 'ILCHIGSTD', 'Eye Associates', 'Kevin', 'R', 'McClellan', 'MD', 'Ophthalmology', '', '', NULL, 'O', '7447 W Talcott Ave Ste 300', 'Chicago', 'Cook', 'IL', '60631', '7737750811', '7737750818', '7447 W Talcott Ave Ste 300', 'Chicago', 'Cook', 'IL', '60631', '7737750811', '7737750818', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1699835249', 0, 'N', 0, '2012-12-20', NULL, NULL, 41.9887, -87.8131, NULL, NULL),
('363458637', 'ELRHC0439', 'ELRHC0439', 'ILCHIGSTD', 'Uday I Vyas MD', 'Uday', 'I', 'Vyas', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '7101 W Higgins Rd', 'Chicago', 'Cook', 'IL', '60656', '7737929111', '7737929119', '7101 W Higgins Rd', 'Chicago', 'Cook', 'IL', '60656', '7737929111', '7737929119', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, NULL, NULL, 'HCFA|UB|', '1700851656', 0, 'N', 0, '2013-05-30', NULL, NULL, 41.9806, -87.8047, NULL, NULL),
('272306009', 'ELRHC0147', 'ELRHC0147', 'ILCHIGSTD', 'Presence Health Care', 'Milton', 'C', 'Chavez', 'MD', 'Family Practice', '', '', NULL, 'O', '2222 W Division St Ste 320', 'Chicago', 'Cook', 'IL', '60622', '7733421212', '7733421010', '2222 W Division St Ste 320', 'Chicago', 'Cook', 'IL', '60622', '7733421212', '7733421010', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', NULL, '', NULL, 'HCFA|UB|', '1700869450', 0, 'N', 0, '2013-05-28', NULL, NULL, 41.9032, -87.6826, NULL, NULL),
('363259841', 'ELRHC0186', 'ELRHC0186', 'ILCHIGSTD', 'David Fishman MD', 'David', 'L', 'Fishman', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '5600 W Addison St Ste 505', 'Chicago', 'Cook', 'IL', '60634', '7732823311', '7737947635', '5600 W Addison St Ste 505', 'Chicago', 'Cook', 'IL', '60634', '7732823311', '7737947635', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1700967684', 0, 'N', 0, '2013-05-24', NULL, NULL, 41.9459, -87.7667, NULL, NULL),
('363649758', 'ELRHC0317', 'ELRHC0317', 'ILCHIGSTD', 'Heart Specialist', 'Ashish', '', 'Mukherjee', 'MD', 'Cardiovascular Disease', '', '', NULL, 'B', '3724 Glenlake Dr', 'Glenview', 'Cook', 'IL', '60026', '7737678375', '7737678532', '3724 Glenlake Dr', 'Glenview', 'Cook', 'IL', '60026', '7737678375', '7737678532', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, '', NULL, 'HCFA|UB|', '1710997259', 0, 'Y', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('363649758', 'ELRHC0316', 'ELRHC0316', 'ILCHIGSTD', 'Heart Specialist', 'Ashish', '', 'Mukherjee', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '4900 S Archer Ave', 'Chicago', 'Cook', 'IL', '60632', '7737678375', '7737678532', '4900 S Archer Ave', 'Chicago', 'Cook', 'IL', '60632', '7737678375', '7737678532', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, '', NULL, 'HCFA|UB|', '1710997259', 0, 'N', 0, '2012-12-20', NULL, NULL, 41.8043, -87.7203, NULL, NULL),
('364288034', 'ELRHC0335', 'ELRHC0335', 'ILCHIGSTD', 'Young Family Health Center', 'Myrna', 'M', 'Patricio', 'MD', 'Family Practice', '', '', NULL, 'O', '1431 N Western Ave Ste 101', 'Chicago', 'Cook', 'IL', '60622', '7732762272', '7732762399', '1431 N Wern Ave Ste 101', 'Chicago', 'Cook', 'IL', '60622', '7732762272', '7732762399', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', NULL, NULL, NULL, 'HCFA|UB|', '1720080534', 0, 'N', 0, '2012-12-20', NULL, NULL, 41.9073, -87.6871, NULL, NULL),
('363108634', 'ELRHC0375', 'ELRHC0375', 'ILCHIGSTD', 'Wanchai Sangchantr MD', 'Wanchai', '', 'Sangchantr', 'MD', 'Gastroenterology', '', '', NULL, 'O', '2900 N Lake Shore Dr', 'Chicago', 'Cook', 'IL', '60657', '7736653084', '7736653728', '2900 N Lake Shore Dr', 'Chicago', 'Cook', 'IL', '60657', '7736653084', '7736653728', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, NULL, NULL, 'HCFA|UB|', '1720145386', 0, 'N', 0, '2013-05-24', NULL, NULL, 41.9349, -87.6367, NULL, NULL),
('363108634', 'ELRHC0374', 'ELRHC0374', 'ILCHIGSTD', 'Wanchai Sangchantr MD', 'Wanchai', '', 'Sangchantr', 'MD', 'Gastroenterology', '', '', NULL, 'B', '4207 Rutgers Ln', 'Northbrook', 'Cook', 'IL', '60062', '7736653084', '7736653728', '4207 Rutgers Ln', 'Northbrook', 'Cook', 'IL', '60062', '7736653084', '7736653728', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, NULL, NULL, 'HCFA|UB|', '1720145386', 0, 'Y', 0, '2013-05-24', NULL, NULL, 0, 0, NULL, NULL),
('363100914', 'ELRHC0203', 'ELRHC0203', 'ILCHIGSTD', 'Mitchell Goldflies, MD', 'Mitchell', '', 'Goldflies', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '6445 N Central Ave', 'Chicago', 'Cook', 'IL', '60646', '7737923311', '7737756212', '6445 N Central Ave', 'Chicago', 'Cook', 'IL', '60646', '7737923311', '7737756212', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, '', '', 'HCFA|UB|', '1730189598', 0, 'N', 0, '2013-04-16', NULL, NULL, 41.9983, -87.7634, NULL, NULL),
('363437517', 'ELRHC0249', 'ELRHC0249', 'ILCHIGSTD', 'Lincoln Park Dermatology', 'Jeffrey', 'E', 'Karaban', 'MD', 'Dermatology', '', '', NULL, 'O', '2800 N Sheridan Rd Ste 210', 'Chicago', 'Cook', 'IL', '60657', '7732810046', '7732810228', '2800 N Sheridan Rd Ste 210', 'Chicago', 'Cook', 'IL', '60657', '7732810046', '7732810228', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, NULL, NULL, 'HCFA|UB|', '1730272246', 0, 'N', 0, '2012-12-20', NULL, NULL, 41.9329, -87.6393, NULL, NULL),
('364402711', 'ELRHC0342', 'ELRHC0342', 'ILCHIGSTD', 'Jorge Prieto Orthopedics', 'Jorge', 'J', 'Prieto', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '800 Austin St East Tower Ste 254', 'Evanston', 'Cook', 'IL', '60202', '8474754550', '8474750482', '800 Austin St East Tower Ste 254', 'Evanston', 'Cook', 'IL', '60202', '8474754550', '8474750482', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Francis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1740273747', 0, 'N', 0, '2013-05-31', NULL, NULL, 42.0255, -87.6819, NULL, NULL),
('363114403', 'ELRHC0172', 'ELRHC0172', 'ILCHIGSTD', 'Eye Associates', 'Mary', 'A', 'Dougal', 'MD', 'Ophthalmology', '', '', NULL, 'O', '7447 W Talcott Ave Ste 300', 'Chicago', 'Cook', 'IL', '60631', '7737750811', '7737750818', '7447 W Talcott Ave Ste 300', 'Chicago', 'Cook', 'IL', '60631', '7737750811', '7737750818', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1740358886', 0, 'N', 0, '2012-12-20', NULL, NULL, 41.9887, -87.8131, NULL, NULL),
('362708347', 'ELRHC0436', 'ELRHC0436', 'ILCHIGSTD', 'Associates In Nephrology', 'Sudesh', '', 'Vohra', 'MD', 'Nephrology', '', '', NULL, 'O', '1945 W Wilson Ave Ste 2113', 'Chicago', 'Cook', 'IL', '60640', '3126542701', '3126540118', '1945 W Wilson Ave Ste 2113', 'Chicago', 'Cook', 'IL', '60640', '3126542701', '3126540118', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-01-01', 0, 0, 0, 'Presence Our Lady Of The Resurrection Medical Center', NULL, '', '', 'HCFA|UB|', '1750351680', 0, 'N', 0, '2013-04-03', NULL, NULL, 0, 0, NULL, NULL),
('362708347', 'ELRHC0435', 'ELRHC0435', 'ILCHIGSTD', 'Associates In Nephrology', 'Sudesh', '', 'Vohra', 'MD', 'Nephrology', '', '', NULL, 'B', '4026 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '3126542701', '3126540118', '4026 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '3126542701', '3126540118', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Our Lady Of The Resurrection Medical Center', NULL, '', '', 'HCFA|UB|', '1750351680', 0, 'Y', 0, '2013-04-03', NULL, NULL, 0, 0, NULL, NULL),
('364373392', 'ELRHC0200', 'ELRHC0200', 'ILCHIGSTD', 'Vision Surgeons and Consultants', 'Carrie', 'E', 'Golden Brenner', 'MD', 'Ophthalmology', '', '', NULL, 'O', '800 Austin St East Tower Ste 151', 'Evanston', 'Cook', 'IL', '60202', '8473282300', '8474921988', '800 Austin St East Tower Ste 151', 'Evanston', 'Cook', 'IL', '60202', '8473282300', '8474921988', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Francis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1750375572', 0, 'N', 0, '2012-12-20', NULL, NULL, 42.0255, -87.6819, NULL, NULL),
('346584983', 'ELRHC0369', 'ELRHC0369', 'ILCHIGSTD', 'Salcedo Medical Center', 'Hector', 'B', 'Salcedo', 'MD', 'Family Practice', '', '', NULL, 'O', '3132 W N Ave', 'Chicago', 'Cook', 'IL', '60647', '7732273132', '7732273309', '3132 W N Ave', 'Chicago', 'Cook', 'IL', '60647', '7732273132', '7732273309', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', NULL, NULL, NULL, 'HCFA|UB|', '1750458287', 0, 'N', 0, '2012-12-20', NULL, NULL, 41.9102, -87.7056, NULL, NULL),
('346584983', 'ELRHC0368', 'ELRHC0368', 'ILCHIGSTD', 'Salcedo Medical Center', 'Hector', 'B', 'Salcedo', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 565', 'Skokie', 'Cook', 'IL', '60076', '7732273132', '7732273309', 'PO Box 565', 'Skokie', 'Cook', 'IL', '60076', '7732273132', '7732273309', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', NULL, NULL, NULL, 'HCFA|UB|', '1750458287', 0, 'Y', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('364373392', 'ELRHC0234', 'ELRHC0234', 'ILCHIGSTD', 'Vision Surgeons and Consultants', 'Mary', 'K', 'Hoffman', 'MD', 'Ophthalmology', '', '', NULL, 'O', '800 Austin St East Tower Ste 151', 'Evanston', 'Cook', 'IL', '60202', '8473282300', '8474921988', '800 Austin St East Tower Ste 151', 'Evanston', 'Cook', 'IL', '60202', '8473282300', '8474921988', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Francis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1760477806', 0, 'N', 0, '2012-12-20', NULL, NULL, 42.0255, -87.6819, NULL, NULL),
('362171079', 'ELRHC0310', 'ELRHC0310', 'ILCHIGSTD', 'Nazareth Family Center', 'Socorro', 'A', 'Milan Flanigan', 'MD', 'Family Practice', '', '', NULL, 'O', '1127 N Oakley Blvd 2nd Fl', 'Chicago', 'Cook', 'IL', '60622', '3127702040', '3127703969', '1127 N Oakley Blvd 2nd Fl', 'Chicago', 'Cook', 'IL', '60622', '3127702040', '3127703969', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 8, '2013-01-01', NULL, 0, 0, 0, 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', NULL, NULL, NULL, 'HCFA|UB|', '1760695779', 0, 'N', 0, '2013-05-28', NULL, NULL, 41.9021, -87.6846, NULL, NULL),
('362171079', 'ELRHC0309', 'ELRHC0309', 'ILCHIGSTD', 'Nazareth Family Center', 'Socorro', 'A', 'Milan Flanigan', 'MD', 'Family Practice', '', '', NULL, 'B', '62311 Collections Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '3127702040', '3127703969', '62311 Collections Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '3127702040', '3127703969', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 8, '2013-01-01', NULL, 0, 0, 0, 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', NULL, NULL, NULL, 'HCFA|UB|', '1760695779', 0, 'Y', 0, '2013-05-28', NULL, NULL, 0, 0, NULL, NULL),
('364374686', 'ELRHC0360', 'ELRHC0360', 'ILCHIGSTD', 'RoquePonton Medical Group', 'David', 'L', 'Roque', 'MD', 'Family Practice', '', '', NULL, 'O', '2740 W Foster Ave Ste 313', 'Chicago', 'Cook', 'IL', '60625', '7732713344', '7732714540', '2740 W Foster Ave Ste 313', 'Chicago', 'Cook', 'IL', '60625', '7732713344', '7732714540', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Francis Hospital', NULL, '', NULL, 'HCFA|UB|', '1770502940', 0, 'N', 0, '2012-12-20', NULL, NULL, 41.9758, -87.6979, NULL, NULL),
('364374686', 'ELRHC0359', 'ELRHC0359', 'ILCHIGSTD', 'RoquePonton Medical Group', 'David', 'L', 'Roque', 'MD', 'Family Practice', '', '', NULL, 'B', '3861 W Pratt Ave', 'Lincolnwood', 'Cook', 'IL', '60712', '7732713344', '7732714540', '3861 W Pratt Ave', 'Lincolnwood', 'Cook', 'IL', '60712', '7732713344', '7732714540', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Francis Hospital', NULL, '', NULL, 'HCFA|UB|', '1770502940', 0, 'Y', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('362696328', 'ELRHC0461', 'ELRHC0461', 'ILCHIGSTD', 'Jack Zoldan MD', 'Jack', 'S', 'Zoldan', 'MD', 'Internal Medicine', '', '', NULL, 'O', '5015 N Paulina St Ste 315', 'Chicago', 'Cook', 'IL', '60640', '7735616573', '7735618323', '5015 N Paulina St Ste 315', 'Chicago', 'Cook', 'IL', '60640', '7735616573', '7735618323', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, '', NULL, 'HCFA|UB|', '1770544629', 0, 'N', 0, '2013-05-24', NULL, NULL, 41.9727, -87.6711, NULL, NULL),
('363980781', 'ELRHC0246', 'ELRHC0246', 'ILCHIGSTD', 'Ashland Clinic', 'Abelardo', 'J', 'Jarava', 'MD', 'Family Practice', '', '', NULL, 'O', '3336 N Ashland Ave', 'Chicago', 'Cook', 'IL', '60657', '7734722936', '7734725306', '3336 N Ashland Ave', 'Chicago', 'Cook', 'IL', '60657', '7734722936', '7734725306', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', NULL, NULL, NULL, 'HCFA|UB|', '1780690362', 0, 'N', 0, '2012-12-20', NULL, NULL, 41.9425, -87.6688, NULL, NULL),
('364015184', 'ELRHC0241', 'ELRHC0241', 'ILCHIGSTD', 'Midwest Pulmonary Sleep Consultants', 'Rada', 'I', 'Ivanov', 'MD', 'Pulmonary', '', '', NULL, 'O', '5600 W Addison St Ste 304', 'Chicago', 'Cook', 'IL', '60634', '7734811570', '7734810547', '5600 W Addison St Ste 304', 'Chicago', 'Cook', 'IL', '60634', '7734811570', '7734810547', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1790782613', 0, 'N', 0, '2012-12-20', NULL, NULL, 41.9459, -87.7667, NULL, NULL),
('362663241', 'ELRHC0431', 'ELRHC0431', 'ILCHIGSTD', 'Chicago Orthopaedics and Sports Medicine', 'William', 'A', 'Vitello', 'MD', 'Orthopedic Surgery', 'Hand Surgery', '', NULL, 'O', '3000 N Halsted St Ste 525', 'Chicago', 'Cook', 'IL', '60657', '7734333130', '7734333136', '3000 N Halsted St Ste 525', 'Chicago', 'Cook', 'IL', '60657', '7734333130', '7734333136', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, '', '', 'HCFA|UB|', '1790878981', 0, 'N', 0, '2013-05-01', NULL, NULL, 41.9369, -87.6491, NULL, NULL),
('362708347', 'ELRHC0330', 'ELRHC0330', 'ILCHIGSTD', 'Associates in Nephrology', 'Chirag', 'P', 'Patel', 'MD', 'Nephrology', '', '', NULL, 'B', '4026 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8472945160', '3126549930', '4026 Paysphere Cir', 'Chicago', 'Cook', 'IL', '60674', '8472945160', '3126549930', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Holy Family Medical Center', NULL, '', NULL, 'HCFA|UB|', '1801840699', 0, 'Y', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('362708347', 'ELRHC0328', 'ELRHC0328', 'ILCHIGSTD', 'Associates in Nephrology', 'Chirag', 'P', 'Patel', 'MD', 'Nephrology', '', '', NULL, 'O', '8901 W Golf Rd  Ste 203', 'Des Plaines', 'Cook', 'IL', '60016', '8472945160', '3126549930', '8901 W Golf Rd  Ste 203', 'Des Plaines', 'Cook', 'IL', '60016', '8472945160', '3126549930', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Holy Family Medical Center', NULL, '', NULL, 'HCFA|UB|', '1801840699', 0, 'N', 0, '2012-12-20', NULL, NULL, 42.0543, -87.8482, NULL, NULL),
('412158396', 'ELRHC0424', 'ELRHC0424', 'ILCHIGSTD', 'Margaret Van Dyk MD', 'Margaret', 'I', 'Van Dyk', 'MD', 'Internal Medicine', '', '', NULL, 'O', '111 N Wabash Ave Ste 1212', 'Chicago', 'Cook', 'IL', '60602', '3122010044', '3122019202', '111 N Wabash Ave Ste 1212', 'Chicago', 'Cook', 'IL', '60602', '3122010044', '3122019202', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, NULL, NULL, 'HCFA|UB|', '1801852926', 0, 'N', 0, '2013-05-31', NULL, NULL, 41.8835, -87.6263, NULL, NULL),
('362663241', 'ELRHC0236', 'ELRHC0236', 'ILCHIGSTD', 'Chicago Orthopaedics and Sports Medicine', 'David', '', 'Hoffman', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', '13728 Collections Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '7734333130', '7734333125', '13728 Collections Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '7734333130', '7734333125', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, NULL, NULL, 'HCFA|UB|', '1801865191', 0, 'Y', 0, '2013-04-03', NULL, NULL, 0, 0, NULL, NULL),
('362663241', 'ELRHC0235', 'ELRHC0235', 'ILCHIGSTD', 'Chicago Orthopaedics and Sports Medicine', 'David', '', 'Hoffman', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '3000 N Halsted St Ste 525', 'Chicago', 'Cook', 'IL', '60657', '7734333130', '7734333125', '3000 N Halsted St Ste 525', 'Chicago', 'Cook', 'IL', '60657', '7734333130', '7734333125', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, NULL, NULL, 'HCFA|UB|', '1801865191', 0, 'N', 0, '2013-04-03', NULL, NULL, 41.9369, -87.6491, NULL, NULL),
('342681528', 'ELRHC0120', 'ELRHC0120', 'ILCHIGSTD', 'Cielo Belingon Suerte MD', 'Cielo', 'C', 'Belingon Suerte', 'MD', 'Pediatrics', '', '', NULL, 'O', '840 W Irving Park Rd Ste 304', 'Chicago', 'Cook', 'IL', '60613', '7732448300', '7732449508', '840 W Irving Park Rd Ste 304', 'Chicago', 'Cook', 'IL', '60613', '7732448300', '7732449508', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, '', NULL, 'HCFA|UB|', '1811078694', 0, 'N', 0, '2013-05-31', NULL, NULL, 41.9546, -87.6511, NULL, NULL),
('363147338', 'ELRHC0178', 'ELRHC0178', 'ILCHIGSTD', 'Rodrigo Endara MD', 'Rodrigo', 'F', 'Endara', 'MD', 'Family Practice', '', '', NULL, 'O', '1417 N Ashland Ave', 'Chicago', 'Cook', 'IL', '60622', '7733421090', '7733425249', '1417 N Ashland Ave', 'Chicago', 'Cook', 'IL', '60622', '7733421090', '7733425249', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', NULL, '', '', 'HCFA|UB|', '1811909963', 0, 'N', 0, '2014-03-21', NULL, NULL, 41.9075, -87.6675, NULL, NULL),
('364129144', 'ELRHC0389', 'ELRHC0389', 'ILCHIGSTD', 'Carmen Sierra MD', 'Carmen', 'A', 'Sierra', 'MD', 'Family Practice', '', '', NULL, 'O', '1349 N Western Ave', 'Chicago', 'Cook', 'IL', '60622', '7733848584', '7733842801', '1349 N Western Ave', 'Chicago', 'Cook', 'IL', '60622', '7733848584', '7733842801', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', NULL, NULL, NULL, 'HCFA|UB|', '1811949415', 0, 'N', 0, '2013-05-31', NULL, NULL, 41.9058, -87.687, NULL, NULL),
('364129144', 'ELRHC0388', 'ELRHC0388', 'ILCHIGSTD', 'Carmen Sierra MD', 'Carmen', 'A', 'Sierra', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 221628', 'Chicago', 'Cook', 'Il', '60622', '7733848584', '7733842801', 'PO Box 221628', 'Chicago', 'Cook', 'Il', '60622', '7733848584', '7733842801', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', NULL, NULL, NULL, 'HCFA|UB|', '1811949415', 0, 'Y', 0, '2013-05-31', NULL, NULL, 0, 0, NULL, NULL),
('362984914', 'ELRHC0256', 'ELRHC0256', 'ILCHIGSTD', 'Vilas P Khandepacker MD', 'Vilas', 'P', 'Khandeparker', 'MD', 'Urology', '', '', NULL, 'O', '6084 S Archer Ave Ste 202', 'Chicago', 'Cook', 'IL', '60638', '7735815888', '7735815895', '6084 S Archer Ave Ste 202', 'Chicago', 'Cook', 'IL', '60638', '7735815888', '7735815895', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', NULL, '', NULL, 'HCFA|UB|', '1811951932', 0, 'N', 0, '2013-05-24', NULL, NULL, 41.7947, -87.7696, NULL, NULL),
('363141714', 'ELRHC0294', 'ELRHC0294', 'ILCHIGSTD', 'Eduardo N Madamba MD', 'Eduardo', 'N', 'Madamba', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1431 N Western Ave Ste 203', 'Chicago', 'Cook', 'IL', '60622', '7732781222', '7732784598', '1431 N Western Ave Ste 203', 'Chicago', 'Cook', 'IL', '60622', '7732781222', '7732784598', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', NULL, '', NULL, 'HCFA|UB|', '1821057795', 0, 'N', 0, '2013-05-24', NULL, NULL, 41.9073, -87.6871, NULL, NULL),
('362797976', 'ELRHC0153', 'ELRHC0153', 'ILCHIGSTD', 'CardioMedical Associates', 'Harry', 'M', 'Cohen', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '2800 N Sheridan Rd Ste 100', 'Chicago', 'Cook', 'IL', '60657', '7739291900', '7739294823', '2800 N Sheridan Rd Ste 100', 'Chicago', 'Cook', 'IL', '60657', '7739291900', '7739294823', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-05-29', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1821081480', 0, 'N', 0, '2013-05-29', NULL, NULL, 41.9329, -87.6394, NULL, NULL),
('364286090', 'ELRHC0446', 'ELRHC0446', 'ILCHIGSTD', 'Gary G Wiesman MD', 'Gary', 'G', 'Wiesman', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '712 N Dearborn St Ste 101', 'Chicago', 'Cook', 'IL', '60654', '3129811290', '3129811292', '712 N Dearborn St Ste 101', 'Chicago', 'Cook', 'IL', '60654', '3129811290', '3129811292', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', NULL, NULL, NULL, 'HCFA|UB|', '1821191404', 0, 'N', 0, '2013-06-05', NULL, NULL, 41.8952, -87.6297, NULL, NULL),
('363200170', 'ELRHC0391', 'ELRHC0391', 'ILCHIGSTD', 'Seton Family Health Center', 'Maria', 'V', 'SilveiraGalban', 'MD', 'Pediatrics', '', '', NULL, 'O', '711 W N Ave', 'Chicago', 'Cook', 'IL', '60610', '3123371982', '3123373847', '711 W N Ave', 'Chicago', 'Cook', 'IL', '60610', '3123371982', '3123373847', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 8, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, '', '', 'HCFA|UB|', '1821287657', 0, 'N', 0, '2013-05-28', NULL, NULL, 41.911, -87.6461, NULL, NULL),
('363672984', 'ELRHC0252', 'ELRHC0252', 'ILCHIGSTD', 'Lawrence M Kaufman MD', 'Lawrence', 'M', 'Kaufman', 'MD', 'Pediatric Ophthalmology', '', '', NULL, 'O', '2456 N Western Ave', 'Chicago', 'Cook', 'IL', '60647', '7732352020', '7732352037', '2456 N Western Ave', 'Chicago', 'Cook', 'IL', '60647', '7732352020', '7732352037', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1831147164', 0, 'Y', 0, '2013-05-30', NULL, NULL, 41.9265, -87.6877, NULL, NULL),
('363672984', 'ELRHC0251', 'ELRHC0251', 'ILCHIGSTD', 'Lawrence M Kaufman MD', 'Lawrence', 'M', 'Kaufman', 'MD', 'Pediatric Ophthalmology', '', '', NULL, 'B', 'PO Box 258024', 'Chicago', 'Cook', 'IL', '60625', '7732352020', '7732352037', 'PO Box 258024', 'Chicago', 'Cook', 'IL', '60625', '7732352020', '7732352037', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1831147164', 0, 'Y', 0, '2013-05-30', NULL, NULL, 0, 0, NULL, NULL),
('364467374', 'ELRHC0354', 'ELRHC0354', 'ILCHIGSTD', 'Allergy Partners of Chicago', 'Frederic', '', 'Renold', 'MD', 'Allergy and Immunology', '', '', NULL, 'O', '1029 W Howard St Ste 100', 'Evanston', 'Cook', 'IL', '60202', '7737752600', '7737753115', '1029 W Howard St Ste 100', 'Evanston', 'Cook', 'IL', '60202', '7737752600', '7737753115', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2014-04-01', 0, 0, 0, 'Presence Resurrection Medical Center', '', '', '', 'HCFA|UB|', '1841278173', 0, 'N', 0, '2014-04-29', NULL, NULL, 42.0195, -87.6866, NULL, NULL),
('364467374', 'ELRHC0353', 'ELRHC0353', 'ILCHIGSTD', 'Allergy Partners of Chicago', 'Frederic', '', 'Renold', 'MD', 'Allergy and Immunology', '', '', NULL, 'O', '9301 W Golf Rd Ste 301', 'Des Plaines', 'Cook', 'IL', '60016', '7737752600', '7737753115', '9301 W Golf Rd Ste 301', 'Des Plaines', 'Cook', 'IL', '60016', '7737752600', '7737753115', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2014-04-01', 0, 0, 0, 'Presence Resurrection Medical Center', '', '', '', 'HCFA|UB|', '1841278173', 0, 'N', 0, '2014-04-29', NULL, NULL, 42.0539, -87.8576, NULL, NULL),
('363966745', 'ELRHC0231', 'ELRHC0231', 'ILCHIGSTD', 'Metro Infectious Disease Consultants', 'David', 'W', 'Hines', 'MD', 'Infectious Disease', '', '', NULL, 'O', '5600 W Addison St Ste 204', 'Chicago', 'Cook', 'IL', '60634', '7732054660', '7732057654', '5600 W Addison St Ste 204', 'Chicago', 'Cook', 'IL', '60634', '7732054660', '7732057654', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, 'Presence Our Lady Of The Resurrection Medical Center', NULL, '', '', 'HCFA|UB|', '1851387955', 0, 'N', 0, '2013-05-28', NULL, NULL, 41.9459, -87.7667, NULL, NULL),
('363966745', 'ELRHC0229', 'ELRHC0229', 'ILCHIGSTD', 'Metro Infectious Disease Consultants', 'David', 'W', 'Hines', 'MD', 'Infectious Disease', '', '', NULL, 'B', '901 McClintock Dr Ste 202', 'Burr Ridge', 'Dupage', 'IL', '60527', '7732054660', '7732057654', '901 McClintock Dr Ste 202', 'Burr Ridge', 'Dupage', 'IL', '60527', '7732054660', '7732057654', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, 'Presence Our Lady Of The Resurrection Medical Center', NULL, '', '', 'HCFA|UB|', '1851387955', 0, 'Y', 0, '2013-05-28', NULL, NULL, 41.7544, -87.9071, NULL, NULL),
('363456649', 'ELRHC0383', 'ELRHC0383', 'ILCHIGSTD', 'North Town Medical Center', 'Jean', '', 'Shlyak', 'MD', 'Internal Medicine', '', '', NULL, 'B', '3492 Milwaukee Ave', 'Northbrook', 'Cook', 'IL', '60062', '7737646969', '7737641502', '3492 Milwaukee Ave', 'Northbrook', 'Cook', 'IL', '60062', '7737646969', '7737641502', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Francis Hospital', NULL, '', '', 'HCFA|UB|', '1851457717', 0, 'Y', 0, '2013-04-03', NULL, NULL, 0, 0, NULL, NULL),
('363456649', 'ELRHC0382', 'ELRHC0382', 'ILCHIGSTD', 'North Town Medical Center', 'Jean', '', 'Shlyak', 'MD', 'Internal Medicine', '', '', NULL, 'O', '6201 N California Ave Ste 105', 'Chicago', 'Cook', 'IL', '60659', '7737646969', '7737641502', '6201 N California Ave Ste 105', 'Chicago', 'Cook', 'IL', '60659', '7737646969', '7737641502', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-01-01', 0, 0, 0, 'Presence Saint Francis Hospital', NULL, '', '', 'HCFA|UB|', '1851457717', 0, 'N', 0, '2013-04-03', NULL, NULL, 0, 0, NULL, NULL),
('363707544', 'ELRHC0162', 'ELRHC0162', 'ILCHIGSTD', 'Northwest General Surgeons', 'Daniel', 'L', 'Dahlinghaus', 'MD', 'General Surgery', '', '', NULL, 'O', '7447 W Talcott Ave Ste 427', 'Chicago', 'Cook', 'IL', '60631', '7736319699', '7736314299', '7447 W Talcott Ave Ste 427', 'Chicago', 'Cook', 'IL', '60631', '7736319699', '7736314299', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1861400327', 0, 'N', 0, '2013-06-21', NULL, NULL, 41.9887, -87.8131, NULL, NULL),
('362939698', 'ELRHC0138', 'ELRHC0138', 'ILCHIGSTD', 'Elmer Carasig MD', 'Elmer', 'A', 'Carasig', 'MD', 'Internal Medicine', '', '', NULL, 'O', '2222 W Division St Ste 300', 'Chicago', 'Cook', 'IL', '60622', '7734863537', '7734865224', '2222 W Division St Ste 300', 'Chicago', 'Cook', 'IL', '60622', '7734863537', '7734865224', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', NULL, '', NULL, 'HCFA|UB|', '1871570960', 0, 'N', 0, '2013-05-24', NULL, NULL, 41.9032, -87.6826, NULL, NULL),
('455133880', 'ELRHC0217', 'ELRHC0217', 'ILCHIGSTD', 'Northwest Chicago Primary Care', 'Charlemagne', '', 'Guerrero', 'MD', 'Internal Medicine', '', '', NULL, 'B', '2900 N 76th Ct', 'Elmwood Park', 'Cook', 'IL', '60707', '7736355700', '7736355050', '2900 N 76th Ct', 'Elmwood Park', 'Cook', 'IL', '60707', '7736355700', '7736355050', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Our Lady Of The Resurrection Medical Center', NULL, '', '', 'HCFA|UB|', '1871715540', 0, 'Y', 0, '2013-05-31', NULL, NULL, 0, 0, NULL, NULL),
('455133880', 'ELRHC0215', 'ELRHC0215', 'ILCHIGSTD', 'Northwest Chicago Primary Care', 'Charlemagne', '', 'Guerrero', 'MD', 'Internal Medicine', '', '', NULL, 'O', '5600 W Addison St Ste 505', 'Chicago', 'Cook', 'IL', '60634', '7736355700', '7736355050', '5600 W Addison St Ste 505', 'Chicago', 'Cook', 'IL', '60634', '7736355700', '7736355050', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-05-23', 0, 0, 0, 'Presence Our Lady Of The Resurrection Medical Center', NULL, '', '', 'HCFA|UB|', '1871715540', 0, 'N', 0, '2013-05-31', NULL, NULL, 41.946, -87.7673, NULL, NULL),
('363963241', 'ELRHC0300', 'ELRHC0300', 'ILCHIGSTD', 'Chicago Hamlin Medical Center', 'Irma', 'E', 'Maravilla', 'MD', 'Family Practice', '', '', NULL, 'O', '3758 W Chicago Ave', 'Chicago', 'Cook', 'IL', '60651', '7732350626', '7732355834', '3758 W Chicago Ave', 'Chicago', 'Cook', 'IL', '60651', '7732350626', '7732355834', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', NULL, NULL, NULL, 'HCFA|UB|', '1881634061', 0, 'N', 0, '2012-12-20', NULL, NULL, 41.8955, -87.7205, NULL, NULL),
('363963241', 'ELRHC0299', 'ELRHC0299', 'ILCHIGSTD', 'Chicago Hamlin Medical Center', 'Irma', 'E', 'Maravilla', 'MD', 'Family Practice', '', '', NULL, 'B', '520 E 22nd St', 'Lombard', 'Dupage', 'IL', '60148', '7732350626', '7732355834', '520 E 22nd St', 'Lombard', 'Dupage', 'IL', '60148', '7732350626', '7732355834', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', NULL, NULL, NULL, 'HCFA|UB|', '1881634061', 0, 'Y', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('364492913', 'ELRHC0407', 'ELRHC0407', 'ILCHIGSTD', 'Chicago Womens Health', 'Eden', '', 'Takhsh', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '30 N Michigan Ave Ste 1410', 'Chicago', 'Cook', 'IL', '60602', '3127267272', '3128998382', '30 N Michigan Ave Ste 1410', 'Chicago', 'Cook', 'IL', '60602', '3127267272', '3128998382', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, NULL, NULL, 'HCFA|UB|', '1881677730', 0, 'N', 0, '2013-05-24', NULL, NULL, 41.8824, -87.6245, NULL, NULL),
('363283271', 'ELRHC0394', 'ELRHC0394', 'ILCHIGSTD', 'George Sosenko MD', 'George', 'R', 'Sosenko', 'MD', 'Urology', '', '', NULL, 'O', '3825 Highland Ave Tower 2 Ste 2A', 'Downers Grove', 'Dupage', 'IL', '60515', '6307259700', '6307259703', '3825 Highland Ave Tower 2 Ste 2A', 'Downers Grove', 'Dupage', 'IL', '60515', '6307259700', '6307259703', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', NULL, NULL, NULL, 'HCFA|UB|', '1881680411', 0, 'N', 0, '2013-05-24', NULL, NULL, 41.8181, -88.0102, NULL, NULL),
('870771370', 'ELRHC0267', 'ELRHC0267', 'ILCHIGSTD', 'Innovative Dermatology', 'Aleksandar', 'L', 'Krunic', 'MD', 'Dermatology', '', '', NULL, 'O', '5140 N California Ave Ste 660', 'Chicago', 'Cook', 'IL', '60625', '7739078454', '7739076336', '5140 N California Ave Ste 660', 'Chicago', 'Cook', 'IL', '60625', '7739078454', '7739076336', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, '', NULL, 'HCFA|UB|', '1891721965', 0, 'N', 0, '2012-12-20', NULL, NULL, 41.9752, -87.6989, NULL, NULL),
('363719474', 'ELRHC0332', 'ELRHC0332', 'ILCHIGSTD', 'Lakeshore Infectious Disease Associates', 'Toral', 'A', 'Patel', 'MD', 'Infectious Disease', '', '', NULL, 'O', '2900 N Lake Shore Dr Ste 1231', 'Chicago', 'Cook', 'IL', '60657', '7736653261', '7736659435', '2900 N Lake Shore Dr Ste 1231', 'Chicago', 'Cook', 'IL', '60657', '7736653261', '7736659435', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, NULL, NULL, 'HCFA|UB|', '1902008006', 0, 'N', 0, '2012-12-20', NULL, NULL, 41.9349, -87.6367, 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
('363719474', 'ELRHC0329', 'ELRHC0329', 'ILCHIGSTD', 'Lakeshore Infectious Disease Associates', 'Toral', 'A', 'Patel', 'MD', 'Infectious Disease', '', '', NULL, 'B', '777 Oakmont Ln Ste 1600', 'Westmont', 'Dupage', 'IL', '60559', '7736653261', '7736659435', '777 Oakmont Ln Ste 1600', 'Westmont', 'Dupage', 'IL', '60559', '7736653261', '7736659435', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, NULL, NULL, 'HCFA|UB|', '1902008006', 0, 'Y', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('455321824', 'ELRHC0237', 'ELRHC0237', 'ILCHIGSTD', 'Satyendra Humad, MD', 'Satyendra', 'K', 'Humad', 'MD', 'Rheumatology', '', '', NULL, 'O', '800 Austin St West Tower Ste 208', 'Evanston', 'Cook', 'IL', '60202', '8478668988', '8478668990', '800 Austin St West Tower Ste 208', 'Evanston', 'Cook', 'IL', '60202', '8478668988', '8478668990', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Francis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1902167398', 0, 'N', 0, '2013-04-16', NULL, NULL, 42.0255, -87.6819, NULL, NULL),
('270837740', 'ELRHC0219', 'ELRHC0219', 'ILCHIGSTD', 'California Devon Medical Center', 'Boris', '', 'Gurevich', 'MD', 'Internal Medicine', '', '', NULL, 'O', '6420 N California Ave Ste U7', 'Chicago', 'Cook', 'IL', '60645', '7739736100', '7732624882', '6420 N California Ave Ste U7', 'Chicago', 'Cook', 'IL', '60645', '7739736100', '7732624882', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Francis Hospital', NULL, '', NULL, 'HCFA|UB|', '1902877129', 0, 'N', 0, '2012-12-20', NULL, NULL, 41.998, -87.6997, NULL, NULL),
('363801926', 'ELRHC0137', 'ELRHC0137', 'ILCHIGSTD', 'Adalberto Campo MD', 'Adalberto', '', 'Campo', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1431 N Western Ave Ste 506', 'Chicago', 'Cook', 'IL', '60622', '7736451000', '7736451069', '1431 N Western Ave Ste 506', 'Chicago', 'Cook', 'IL', '60622', '7736451000', '7736451069', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', NULL, NULL, NULL, 'HCFA|UB|', '1902961006', 0, 'N', 0, '2013-05-30', NULL, NULL, 41.9073, -87.6871, NULL, NULL),
('363656783', 'ELRHC0103', 'ELRHC0103', 'ILCHIGSTD', 'Devon Family Health Center', 'Nalini', '', 'Ahluwalia', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1516 W Devon Ave', 'Chicago', 'Cook', 'IL', '60660', '7734657888', '7734657615', '1516 W Devon Ave', 'Chicago', 'Cook', 'IL', '60660', '7734657888', '7734657615', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, NULL, NULL, 'HCFA|UB|', '1912032780', 0, 'N', 0, '2012-12-20', NULL, NULL, 41.998, -87.6686, NULL, NULL),
('363656783', 'ELRHC0102', 'ELRHC0102', 'ILCHIGSTD', 'Devon Family Health Center', 'Nalini', '', 'Ahluwalia', 'MD', 'Internal Medicine', '', '', NULL, 'B', '6440 Hill Crest Dr', 'Hinsdale', 'Dupage', 'IL', '60521', '7734657888', '7734657615', '6440 Hill Crest Dr', 'Hinsdale', 'Dupage', 'IL', '60521', '7734657888', '7734657615', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, NULL, NULL, 'HCFA|UB|', '1912032780', 0, 'Y', 0, '2012-12-20', NULL, NULL, 0, 0, NULL, NULL),
('364015184', 'ELRHC0105', 'ELRHC0105', 'ILCHIGSTD', 'Midwest Pulmonary Sleep Consultants', 'Sarah', 'M', 'Alderman', 'MD', 'Pulmonary', '', '', NULL, 'O', '5600 W Addison St Ste 304', 'Chicago', 'Cook', 'IL', '60634', '7734811570', '7734810547', '5600 W Addison St Ste 304', 'Chicago', 'Cook', 'IL', '60634', '7734811570', '7734810547', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', 'Presence Our Lady Of The Resurrection Medical Center', NULL, NULL, 'HCFA|UB|', '1912904822', 0, 'N', 0, '2012-12-20', NULL, NULL, 41.9459, -87.7667, NULL, NULL),
('364467374', 'ELRHC0174', 'ELRHC0174', 'ILCHIGSTD', 'Allergy Partners of Chicago', 'Sol', '', 'Drapkin', 'MD', 'Allergy and Immunology', '', '', NULL, 'O', '1029 W Howard St Ste 100', 'Evanston', 'Cook', 'IL', '60202', '8473283737', '8473283738', '1029 W Howard St Ste 100', 'Evanston', 'Cook', 'IL', '60202', '8473283737', '8473283738', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1912986563', 0, 'N', 0, '2013-04-16', NULL, NULL, 42.0195, -87.6866, NULL, NULL),
('364467374', 'ELRHC0173', 'ELRHC0173', 'ILCHIGSTD', 'Allergy Partners of Chicago', 'Sol', '', 'Drapkin', 'MD', 'Allergy and Immunology', '', '', NULL, 'B', '9301 W Golf Rd Ste 301', 'Des Plaines', 'Cook', 'IL', '60016', '8473283737', '8473283738', '9301 W Golf Rd Ste 301', 'Des Plaines', 'Cook', 'IL', '60016', '8473283737', '8473283738', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1912986563', 0, 'Y', 0, '2013-04-16', NULL, NULL, 42.0537, -87.8566, NULL, NULL),
('364350007', 'ELRHC0304', 'ELRHC0304', 'ILCHIGSTD', 'Chicago Retina', 'Carol', 'A', 'Menner', 'MD', 'Ophthalmology', '', '', NULL, 'O', '1182 N Milwaukee Ave', 'Chicago', 'Cook', 'IL', '60622', '7733946990', '7733946993', '1182 N Milwaukee Ave', 'Chicago', 'Cook', 'IL', '60622', '7733946990', '7733946993', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', NULL, NULL, NULL, 'HCFA|UB|', '1922019181', 0, 'N', 0, '2012-12-20', NULL, NULL, 41.9031, -87.666, NULL, NULL),
('286567146', 'ELRHC0176', 'ELRHC0176', 'ILCHIGSTD', 'Michael W Earley MD', 'Michael', 'W', 'Earley', 'MD', 'Family Practice', '', '', NULL, 'O', '3623 W Chicago Ave', 'Chicago', 'Cook', 'IL', '60651', '7737226171', '7737227913', '3623 W Chicago Ave', 'Chicago', 'Cook', 'IL', '60651', '7737226171', '7737227913', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', NULL, NULL, NULL, 'HCFA|UB|', '1922107952', 0, 'N', 0, '2013-09-30', NULL, NULL, 41.8955, -87.7172, NULL, NULL),
('363200170', 'ELRHC0320', 'ELRHC0320', 'ILCHIGSTD', 'Seton Family Health Center', 'James', 'G', 'Nee', 'MD', 'Family Practice', '', '', NULL, 'O', '711 W N Ave', 'Chicago', 'Cook', 'IL', '60610', '3123371982', '3126423847', '711 W N Ave', 'Chicago', 'Cook', 'IL', '60610', '3123371982', '3126423847', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 8, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, '', NULL, 'HCFA|UB|', '1932159282', 0, 'N', 0, '2013-05-28', NULL, NULL, 41.911, -87.6461, NULL, NULL),
('362704297', 'ELRHC0128', 'ELRHC0128', 'ILCHIGSTD', 'Tiesenga Surgical Associates', 'Rabia', 'Z', 'Bhatti', 'MD', 'General Surgery', '', '', NULL, 'O', '1950 N Harlem Ave', 'Elmwood Park', 'Cook', 'IL', '60707', '7084536800', '7084533985', '1950 N Harlem Ave', 'Elmwood Park', 'Cook', 'IL', '60707', '7084536800', '7084533985', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Holy Family Medical Center', NULL, '', NULL, 'HCFA|UB|', '1932195039', 0, 'N', 0, '2013-04-03', NULL, NULL, 41.9158, -87.806, NULL, NULL),
('364375885', 'ELRHC0245', 'ELRHC0245', 'ILCHIGSTD', 'Janneth Jaramillo MD', 'Janneth', 'M', 'Jaramillo', 'MD', 'Family Practice', '', '', NULL, 'B', '2551 Chestnut', 'Glenview', 'Cook', 'IL', '60025', '7732273232', '7732272898', '2551 Chestnut', 'Glenview', 'Cook', 'IL', '60025', '7732273232', '7732272898', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', NULL, NULL, NULL, 'HCFA|UB|', '1932287315', 0, 'Y', 0, '2013-05-31', NULL, NULL, 0, 0, NULL, NULL),
('364375885', 'ELRHC0244', 'ELRHC0244', 'ILCHIGSTD', 'Janneth Jaramillo MD', 'Janneth', 'M', 'Jaramillo', 'MD', 'Family Practice', '', '', NULL, 'O', '2610 W Division St', 'Chicago', 'Cook', 'IL', '60622', '7732273232', '7732272898', '2610 W Division St', 'Chicago', 'Cook', 'IL', '60622', '7732273232', '7732272898', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', NULL, NULL, NULL, 'HCFA|UB|', '1932287315', 0, 'N', 0, '2013-05-31', NULL, NULL, 41.903, -87.6922, NULL, NULL),
('200107401', 'ELRHC0184', 'ELRHC0184', 'ILCHIGSTD', 'Ridge Medical Center', 'Shaheen', '', 'Fatima', 'MD', 'Internal Medicine', '', '', NULL, 'O', '7133 N Ridge Ave', 'Chicago', 'Cook', 'IL', '60645', '7733388343', '7733388349', '7133 N Ridge Ave', 'Chicago', 'Cook', 'IL', '60645', '7733388343', '7733388349', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Francis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1942242979', 0, 'N', 0, '2012-12-20', NULL, NULL, 42.0116, -87.6828, NULL, NULL),
('363707544', 'ELRHC0325', 'ELRHC0325', 'ILCHIGSTD', 'Northwest General Surgeons', 'Richard', 'N', 'Olen', 'MD', 'General Surgery', '', '', NULL, 'O', '7447 W Talcott Ave Ste 427', 'Chicago', 'Cook', 'IL', '60631', '7736319699', '7736314299', '7447 W Talcott Ave Ste 427', 'Chicago', 'Cook', 'IL', '60631', '7736319699', '7736314299', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1952319410', 0, 'N', 0, '2013-06-21', NULL, NULL, 41.9887, -87.8131, NULL, NULL),
('363800501', 'ELRHC0207', 'ELRHC0207', 'ILCHIGSTD', 'Daniel R Greenberg MD', 'Daniel', 'R', 'Greenberg', 'MD', 'Ophthalmology', '', '', NULL, 'O', '800 Austin St East Tower Ste 256', 'Evanston', 'Cook', 'IL', '60202', '8474928434', '8474920144', '800 Austin St East Tower Ste 256', 'Evanston', 'Cook', 'IL', '60202', '8474928434', '8474920144', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1952398919', 0, 'N', 0, '2013-05-30', NULL, NULL, 42.0255, -87.6819, NULL, NULL),
('274478152', 'ELRHC0126', 'ELRHC0126', 'ILCHIGSTD', 'Consultants in Gynecology', 'Lisa', 'B', 'Bhagan', 'MD', 'Gynecology', '', '', NULL, 'O', '5747 W Dempster St Ste 100', 'Morton Grove', 'Cook', 'IL', '60053', '8476631030', '8476631039', '5747 W Dempster St Ste 100', 'Morton Grove', 'Cook', 'IL', '60053', '8476631030', '8476631039', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', NULL, '', NULL, 'HCFA|UB|', '1952579328', 0, 'N', 0, '2012-12-20', NULL, NULL, 42.0409, -87.7702, NULL, NULL),
('363330926', 'ELRHC0379', 'ELRHC0379', 'ILCHIGSTD', 'Family Practice Center', 'Mayank', 'K', 'Shah', 'MD', 'Family Practice', '', '', NULL, 'B', '62311 Collections Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '7737925155', '7735947975', '62311 Collections Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '7737925155', '7735947975', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', NULL, '', NULL, 'HCFA|UB|', '1962430272', 0, 'Y', 0, '2013-02-15', NULL, NULL, 0, 0, NULL, NULL),
('363330926', 'ELRHC0378', 'ELRHC0378', 'ILCHIGSTD', 'Family Practice Center', 'Mayank', 'K', 'Shah', 'MD', 'Family Practice', '', '', NULL, 'O', '7447 W Talcott Ave Ste 182', 'Chicago', 'Cook', 'IL', '60631', '7737925155', '7735947975', '7447 W Talcott Ave Ste 182', 'Chicago', 'Cook', 'IL', '60631', '7737925155', '7735947975', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 6, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', NULL, '', NULL, 'HCFA|UB|', '1962430272', 0, 'N', 0, '2013-02-15', NULL, NULL, 41.9887, -87.8131, NULL, NULL),
('363200170', 'ELRHC0119', 'ELRHC0119', 'ILCHIGSTD', 'Seton Family Health Center', 'Tatiana', 'A', 'Batista', 'DO', 'Family Practice', '', '', NULL, 'O', '711 W N Ave', 'Chicago', 'Cook', 'IL', '60610', '3123371982', '3126423847', '711 W N Ave', 'Chicago', 'Cook', 'IL', '60610', '3123371982', '3126423847', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 8, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, '', '', 'HCFA|UB|', '1972612760', 0, 'N', 0, '2013-05-28', NULL, NULL, 41.911, -87.6461, NULL, NULL),
('363746418', 'ELRHC0380', 'ELRHC0380', 'ILCHIGSTD', 'Ashok Shah MD', 'Ashok', 'C', 'Shah', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1624 W Montrose Ave', 'Chicago', 'Cook', 'IL', '60613', '7737693338', '7737695568', '1624 W Montrose Ave', 'Chicago', 'Cook', 'IL', '60613', '7737693338', '7737695568', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', NULL, '', NULL, 'HCFA|UB|', '1972672715', 0, 'N', 0, '2013-04-16', NULL, NULL, 41.9616, -87.6701, NULL, NULL),
('363040294', 'ELRHC0422', 'ELRHC0422', 'ILCHIGSTD', 'Victor M Uribe MD', 'Victor', 'M', 'Uribe', 'MD', 'Psychiatry', '', '', NULL, 'O', '1431 N Western Ave Ste 504', 'Chicago', 'Cook', 'IL', '60622', '7736453449', '7736453453', '1431 N Western Ave Ste 504', 'Chicago', 'Cook', 'IL', '60622', '7736453449', '7736453453', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', NULL, NULL, 'HCFA|UB|', '1982630471', 0, 'Y', 0, '2013-05-24', NULL, NULL, 41.9073, -87.6871, NULL, NULL),
('363040294', 'ELRHC0421', 'ELRHC0421', 'ILCHIGSTD', 'Victor M Uribe MD', 'Victor', 'M', 'Uribe', 'MD', 'Psychiatry', '', '', NULL, 'B', '8 S Michigan Ave Ste 801', 'Chicago', 'Cook', 'IL', '60603', '7736453449', '7736453453', '8 S Michigan Ave Ste 801', 'Chicago', 'Cook', 'IL', '60603', '7736453449', '7736453453', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', NULL, NULL, 'HCFA|UB|', '1982630471', 0, 'Y', 0, '2013-05-24', NULL, NULL, 41.8818, -87.6249, NULL, NULL),
('362744019', 'ELRHC0228', 'ELRHC0228', 'ILCHIGSTD', 'Eye Specialists of Chicago', 'David', 'S', 'Hillman', 'MD', 'Ophthalmology', '', '', NULL, 'O', '5600 W Addison St Ste 102', 'Chicago', 'Cook', 'IL', '60634', '7737361717', '7737367538', '5600 W Addison St Ste 102', 'Chicago', 'Cook', 'IL', '60634', '7737361717', '7737367538', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Our Lady Of The Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1982632105', 0, 'N', 0, '2013-03-14', NULL, NULL, 41.9459, -87.7667, NULL, NULL),
('363166986', 'ELRHC0171', 'ELRHC0171', 'ILCHIGSTD', 'Ashok Doshi MD', 'Ashok', 'M', 'Doshi', 'MD', 'Thoracic Surgery', '', '', NULL, 'O', '7101 W Higgins Rd', 'Chicago', 'Cook', 'IL', '60656', '7737636260', '7737929119', '7101 W Higgins Rd', 'Chicago', 'Cook', 'IL', '60656', '7737636260', '7737929119', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', NULL, '', '', 'HCFA|UB|', '1982670709', 0, 'N', 0, '2013-05-24', NULL, NULL, 41.9806, -87.8047, NULL, NULL),
('363277544', 'ELRHC0291', 'ELRHC0291', 'ILCHIGSTD', 'Cole Lundquist MD', 'Cole', 'D', 'Lundquist', 'MD', 'Dermatology', '', '', NULL, 'B', '6547 Avondale  Ste 001', 'Chicago', 'Cook', 'IL', '60631', '7737747122', '7736317642', '6547 Avondale  Ste 001', 'Chicago', 'Cook', 'IL', '60631', '7737747122', '7736317642', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1982688891', 0, 'Y', 0, '2013-05-24', NULL, NULL, 0, 0, NULL, NULL),
('363277544', 'ELRHC0290', 'ELRHC0290', 'ILCHIGSTD', 'Cole Lundquist MD', 'Cole', 'D', 'Lundquist', 'MD', 'Dermatology', '', '', NULL, 'O', '7447 W Talcott Ave Ste 321', 'Chicago', 'Cook', 'IL', '60631', '7737747122', '7736317642', '7447 W Talcott Ave Ste 321', 'Chicago', 'Cook', 'IL', '60631', '7737747122', '7736317642', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1982688891', 0, 'N', 0, '2013-05-24', NULL, NULL, 41.9887, -87.8131, NULL, NULL),
('134212397', 'ELRHC0288', 'ELRHC0288', 'ILCHIGSTD', 'Garcia Rosenberg and Associates', 'Celia', 'M', 'Lipinski', 'DO', 'Family Practice', '', '', NULL, 'O', '7126 N Lincoln Ave', 'Lincolnwood', 'Cook', 'IL', '60712', '8475839189', '8475839196', '7126 N Lincoln Ave', 'Lincolnwood', 'Cook', 'IL', '60712', '8475839189', '8475839196', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-01-01', 0, 0, 0, 'Presence Saint Francis Hospital', NULL, '', '', 'HCFA|UB|', '1982808523', 0, 'N', 0, '2013-04-02', NULL, NULL, 42.0108, -87.7386, NULL, NULL),
('452403119', 'ELRHC0111', 'ELRHC0111', 'ILCHIGSTD', 'Swathi Arekapudi MD', 'Swathi', '', 'Arekapudi', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '2222 W Division St Ste 116', 'Chicago', 'Cook', 'IL', '60622', '7735257720', '7733429028', '2222 W Division St Ste 116', 'Chicago', 'Cook', 'IL', '60622', '7735257720', '7733429028', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', NULL, '', NULL, 'HCFA|UB|', '1982894762', 0, 'N', 0, '2013-05-31', NULL, NULL, 41.9032, -87.6826, NULL, NULL),
('452403119', 'ELRHC0110', 'ELRHC0110', 'ILCHIGSTD', 'Swathi Arekapudi MD', 'Swathi', '', 'Arekapudi', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '2734 N Lincoln Ave', 'Chicago', 'Cook', 'IL', '60614', '7735257720', '7733429028', '2734 N Lincoln Ave', 'Chicago', 'Cook', 'IL', '60614', '7735257720', '7733429028', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', NULL, '', NULL, 'HCFA|UB|', '1982894762', 0, 'Y', 0, '2013-05-31', NULL, NULL, 0, 0, NULL, NULL),
('363145256', 'ELRHC0248', 'ELRHC0248', 'ILCHIGSTD', 'Chest Medicine Consultants', 'Erika', 'S', 'Kahan', 'MD', 'Pulmonary', '', '', NULL, 'O', '2800 N Sheridan Rd Ste 301', 'Chicago', 'Cook', 'IL', '60657', '7739355556', '7739352724', '2800 N Sheridan Rd Ste 301', 'Chicago', 'Cook', 'IL', '60657', '7739355556', '7739352724', 'CHIGP1', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, NULL, NULL, 'HCFA|UB|', '1992756340', 0, 'N', 0, '2012-12-20', NULL, NULL, 41.9329, -87.6393, NULL, NULL),
('760454609', 'ELAFA0035', 'ELAFA0035', 'TXHOUSTD', 'Renal Specialists of Houston', 'Sibtain', 'H', 'Ali', 'MD', 'Nephrology', '', '', NULL, 'O', '10970 Shadow Creek Pkwy', 'Pearland', 'Brazoria', 'TX', '77584', '7137912648', '7137950717', '10970 Shadow Creek Pkwy', 'Pearland', 'Brazoria', 'TX', '77584', '7137912648', '7137950717', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', 'Houston Methodist San Jacinto Hospital', 'East Houston Regional Medical Center', NULL, 'HCFA|UB|', '1013933902', 0, 'N', 0, '2013-07-03', NULL, NULL, 29.5802, -95.3886, NULL, NULL),
('760454609', 'ELAFA0028', 'ELAFA0028', 'TXHOUSTD', 'Renal Specialists of Houston', 'Sibtain', 'H', 'Ali', 'MD', 'Nephrology', '', '', NULL, 'O', '11914 Astoria Blvd Ste 530', 'Houston', 'Harris', 'TX', '77089', '2814649681', '2814647593', '11914 Astoria Blvd Ste 530', 'Houston', 'Harris', 'TX', '77089', '2814649681', '2814647593', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', 'Houston Methodist San Jacinto Hospital', 'East Houston Regional Medical Center', NULL, 'HCFA|UB|', '1013933902', 0, 'N', 0, '2013-07-03', NULL, NULL, 29.5851, -95.2071, NULL, NULL),
('760454609', 'ELAFA0036', 'ELAFA0036', 'TXHOUSTD', 'Renal Specialists of Houston', 'Sibtain', 'H', 'Ali', 'MD', 'Nephrology', '', '', NULL, 'O', '16126 Southwest Fwy Ste 230', 'Sugar Land', 'Fort Bend', 'TX', '77479', '7139444660', '8323812444', '16126 Southwest Fwy Ste 230', 'Sugar Land', 'Fort Bend', 'TX', '77479', '7139444660', '8323812444', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', 'Houston Methodist San Jacinto Hospital', 'East Houston Regional Medical Center', NULL, 'HCFA|UB|', '1013933902', 0, 'N', 0, '2013-07-03', NULL, NULL, 29.5968, -95.6249, NULL, NULL),
('760454609', 'ELAFA0030', 'ELAFA0030', 'TXHOUSTD', 'Renal Specialists of Houston', 'Sibtain', 'H', 'Ali', 'MD', 'Nephrology', '', '', NULL, 'O', '250 Blossom Ste 275', 'Webster', 'Harris', 'TX', '77598', '2813322059', '2813160731', '250 Blossom Ste 275', 'Webster', 'Harris', 'TX', '77598', '2813322059', '2813160731', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', 'Houston Methodist San Jacinto Hospital', 'East Houston Regional Medical Center', NULL, 'HCFA|UB|', '1013933902', 0, 'N', 0, '2013-07-03', NULL, NULL, 29.5436, -95.126, NULL, NULL),
('760454609', 'ELAFA0026', 'ELAFA0026', 'TXHOUSTD', 'Renal Specialists of Houston', 'Sibtain', 'H', 'Ali', 'MD', 'Nephrology', '', '', NULL, 'O', '2825 S Loop 35 Ste 154', 'Alvin', 'Brazoria', 'TX', '77511', '7137912648', '7137950717', '2825 S Loop 35 Ste 154', 'Alvin', 'Brazoria', 'TX', '77511', '7137912648', '7137950717', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', '2013-07-02', 0, 0, 0, 'Clear Lake Regional Medical Center', 'Houston Methodist San Jacinto Hospital', 'East Houston Regional Medical Center', NULL, 'HCFA|UB|', '1013933902', 0, 'N', 0, '2013-07-03', NULL, NULL, 29.4028, -95.2374, NULL, NULL),
('760454609', 'ELAFA0034', 'ELAFA0034', 'TXHOUSTD', 'Renal Specialists of Houston', 'Sibtain', 'H', 'Ali', 'MD', 'Nephrology', '', '', NULL, 'O', '3333 Bayshore Blvd Ste 270', 'Pasadena', 'Harris', 'TX', '77504', '7139479507', '7139476286', '3333 Bayshore Blvd Ste 270', 'Pasadena', 'Harris', 'TX', '77504', '7139479507', '7139476286', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', 'Houston Methodist San Jacinto Hospital', 'East Houston Regional Medical Center', NULL, 'HCFA|UB|', '1013933902', 0, 'N', 0, '2013-07-03', NULL, NULL, 29.663, -95.1837, NULL, NULL),
('760454609', 'ELAFA0027', 'ELAFA0027', 'TXHOUSTD', 'Renal Specialists of Houston', 'Sibtain', 'H', 'Ali', 'MD', 'Nephrology', '', '', NULL, 'O', '4201 Garth Rd Ste 319', 'Baytown', 'Harris', 'TX', '77521', '2814282487', '2814282784', '4201 Garth Rd Ste 319', 'Baytown', 'Harris', 'TX', '77521', '2814282487', '2814282784', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', 'Houston Methodist San Jacinto Hospital', 'East Houston Regional Medical Center', NULL, 'HCFA|UB|', '1013933902', 0, 'N', 0, '2013-07-03', NULL, NULL, 29.7677, -94.9775, NULL, NULL),
('760454609', 'ELAFA0031', 'ELAFA0031', 'TXHOUSTD', 'Renal Specialists of Houston', 'Sibtain', 'H', 'Ali', 'MD', 'Nephrology', '', '', NULL, 'O', '4407 Yoakum', 'Houston', 'Harris', 'TX', '77006', '7135288111', '7135282276', '4407 Yoakum', 'Houston', 'Harris', 'TX', '77006', '7135288111', '7135282276', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', 'Houston Methodist San Jacinto Hospital', 'East Houston Regional Medical Center', NULL, 'HCFA|UB|', '1013933902', 0, 'N', 0, '2013-07-03', NULL, NULL, 29.7335, -95.3924, NULL, NULL),
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INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
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('760454609', 'ELAFA0204', 'ELAFA0204', 'TXHOUSTD', 'Renal Specialists of Houston', 'Vijay', '', 'Koka', 'MD', 'Nephrology', '', '', NULL, 'O', '16126 Southwest Fwy Ste 230', 'Sugar Land', 'Fort Bend', 'TX', '77479', '7139444660', '8323812444', '16126 Southwest Fwy Ste 230', 'Sugar Land', 'Fort Bend', 'TX', '77479', '7139444660', '8323812444', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', 'Houston Methodist San Jacinto Hospital', NULL, NULL, 'HCFA|UB|', '1144423922', 0, 'N', 0, '2013-07-03', NULL, NULL, 29.5968, -95.6249, NULL, NULL),
('760454609', 'ELAFA0198', 'ELAFA0198', 'TXHOUSTD', 'Renal Specialists of Houston', 'Vijay', '', 'Koka', 'MD', 'Nephrology', '', '', NULL, 'O', '250 Blossom Ste 275', 'Webster', 'Harris', 'TX', '77598', '2813322059', '2813160731', '250 Blossom Ste 275', 'Webster', 'Harris', 'TX', '77598', '2813322059', '2813160731', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', 'Houston Methodist San Jacinto Hospital', NULL, NULL, 'HCFA|UB|', '1144423922', 0, 'N', 0, '2013-07-03', NULL, NULL, 29.5436, -95.126, NULL, NULL),
('760454609', 'ELAFA0195', 'ELAFA0195', 'TXHOUSTD', 'Renal Specialists of Houston', 'Vijay', '', 'Koka', 'MD', 'Nephrology', '', '', NULL, 'O', '2825 S Loop 35 Ste 154', 'Alvin', 'Brazoria', 'TX', '77511', '7137912648', '7137950717', '2825 S Loop 35 Ste 154', 'Alvin', 'Brazoria', 'TX', '77511', '7137912648', '7137950717', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', '2013-07-02', 0, 0, 0, 'Clear Lake Regional Medical Center', 'Houston Methodist San Jacinto Hospital', NULL, NULL, 'HCFA|UB|', '1144423922', 0, 'N', 0, '2013-07-03', NULL, NULL, 29.4028, -95.2374, NULL, NULL),
('760454609', 'ELAFA0202', 'ELAFA0202', 'TXHOUSTD', 'Renal Specialists of Houston', 'Vijay', '', 'Koka', 'MD', 'Nephrology', '', '', NULL, 'O', '3333 Bayshore Blvd Ste 270', 'Pasadena', 'Harris', 'TX', '77504', '7139479507', '7139476286', '3333 Bayshore Blvd Ste 270', 'Pasadena', 'Harris', 'TX', '77504', '7139479507', '7139476286', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', 'Houston Methodist San Jacinto Hospital', NULL, NULL, 'HCFA|UB|', '1144423922', 0, 'N', 0, '2013-07-03', NULL, NULL, 29.663, -95.1837, NULL, NULL),
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('760454609', 'ELAFA0200', 'ELAFA0200', 'TXHOUSTD', 'Renal Specialists of Houston', 'Vijay', '', 'Koka', 'MD', 'Nephrology', '', '', NULL, 'O', '5435 Aldine Mail Rd', 'Houston', 'Harris', 'TX', '77039', '8323812441', '8323812443', '5435 Aldine Mail Rd', 'Houston', 'Harris', 'TX', '77039', '8323812441', '8323812443', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', 'Houston Methodist San Jacinto Hospital', NULL, NULL, 'HCFA|UB|', '1144423922', 0, 'N', 0, '2013-07-03', NULL, NULL, 29.9022, -95.3095, NULL, NULL),
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('760454609', 'ELAFA0201', 'ELAFA0201', 'TXHOUSTD', 'Renal Specialists of Houston', 'Vijay', '', 'Koka', 'MD', 'Nephrology', '', '', NULL, 'O', '8537 Gulf Fwy Ste C', 'Houston', 'Harris', 'TX', '77017', '8323860900', '8323860907', '8537 Gulf Fwy Ste C', 'Houston', 'Harris', 'TX', '77017', '8323860900', '8323860907', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', 'Houston Methodist San Jacinto Hospital', NULL, NULL, 'HCFA|UB|', '1144423922', 0, 'N', 0, '2013-07-03', NULL, NULL, 29.6682, -95.2613, NULL, NULL),
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('760454609', 'ELAFA0049', 'ELAFA0049', 'TXHOUSTD', 'Renal Specialists of Houston', 'Jesse', 'K', 'Uyeda', 'MD', 'Nephrology', '', '', NULL, 'O', '9449 Grogans Mill', 'The Woodlands', 'Montgomery', 'TX', '77380', '7137912648', '7137950717', '9449 Grogans Mill', 'The Woodlands', 'Montgomery', 'TX', '77380', '7137912648', '7137950717', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', 'Houston Methodist San Jacinto Hospital', NULL, NULL, 'HCFA|UB|', '1467478453', 0, 'N', 0, '2013-07-03', NULL, NULL, 30.1672, -95.4656, NULL, NULL),
('760454609', 'ELAFA0215', 'ELAFA0215', 'TXHOUSTD', 'Renal Specialists of Houston', 'Bilal', '', 'Moukaddem', 'MD', 'Nephrology', '', '', NULL, 'O', '10970 Shadow Creek Pkwy', 'Pearland', 'Brazoria', 'TX', '77584', '7137912648', '7137950717', '10970 Shadow Creek Pkwy', 'Pearland', 'Brazoria', 'TX', '77584', '7137912648', '7137950717', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', 'Houston Methodist San Jacinto Hospital', NULL, NULL, 'HCFA|UB|', '1497771489', 0, 'N', 0, '2013-07-31', NULL, NULL, 29.5802, -95.3886, NULL, NULL),
('760454609', 'ELAFA0209', 'ELAFA0209', 'TXHOUSTD', 'Renal Specialists of Houston', 'Bilal', '', 'Moukaddem', 'MD', 'Nephrology', '', '', NULL, 'O', '11914 Astoria Blvd Ste 530', 'Houston', 'Harris', 'TX', '77089', '2814649681', '2814647593', '11914 Astoria Blvd Ste 530', 'Houston', 'Harris', 'TX', '77089', '2814649681', '2814647593', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', 'Houston Methodist San Jacinto Hospital', NULL, NULL, 'HCFA|UB|', '1497771489', 0, 'N', 0, '2013-07-31', NULL, NULL, 29.5851, -95.2071, NULL, NULL),
('760454609', 'ELAFA0216', 'ELAFA0216', 'TXHOUSTD', 'Renal Specialists of Houston', 'Bilal', '', 'Moukaddem', 'MD', 'Nephrology', '', '', NULL, 'O', '16126 Southwest Fwy Ste 230', 'Sugar Land', 'Fort Bend', 'TX', '77479', '7139444660', '8323812444', '16126 Southwest Fwy Ste 230', 'Sugar Land', 'Fort Bend', 'TX', '77479', '7139444660', '8323812444', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', 'Houston Methodist San Jacinto Hospital', NULL, NULL, 'HCFA|UB|', '1497771489', 0, 'N', 0, '2013-07-31', NULL, NULL, 29.5968, -95.6249, NULL, NULL),
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('760454609', 'ELAFA0207', 'ELAFA0207', 'TXHOUSTD', 'Renal Specialists of Houston', 'Bilal', '', 'Moukaddem', 'MD', 'Nephrology', '', '', NULL, 'O', '2825 S Loop 35 Ste 154', 'Alvin', 'Brazoria', 'TX', '77511', '7137912648', '7137950717', '2825 S Loop 35 Ste 154', 'Alvin', 'Brazoria', 'TX', '77511', '7137912648', '7137950717', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', '2013-07-02', 0, 0, 0, 'Clear Lake Regional Medical Center', 'Houston Methodist San Jacinto Hospital', NULL, NULL, 'HCFA|UB|', '1497771489', 0, 'N', 0, '2013-07-31', NULL, NULL, 29.4028, -95.2374, NULL, NULL),
('760454609', 'ELAFA0214', 'ELAFA0214', 'TXHOUSTD', 'Renal Specialists of Houston', 'Bilal', '', 'Moukaddem', 'MD', 'Nephrology', '', '', NULL, 'O', '3333 Bayshore Blvd Ste 270', 'Pasadena', 'Harris', 'TX', '77504', '7139479507', '7139476286', '3333 Bayshore Blvd Ste 270', 'Pasadena', 'Harris', 'TX', '77504', '7139479507', '7139476286', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', 'Houston Methodist San Jacinto Hospital', NULL, NULL, 'HCFA|UB|', '1497771489', 0, 'N', 0, '2013-07-31', NULL, NULL, 29.663, -95.1837, NULL, NULL),
('760454609', 'ELAFA0208', 'ELAFA0208', 'TXHOUSTD', 'Renal Specialists of Houston', 'Bilal', '', 'Moukaddem', 'MD', 'Nephrology', '', '', NULL, 'O', '4201 Garth Rd Ste 319', 'Baytown', 'Harris', 'TX', '77521', '2814282487', '2814282784', '4201 Garth Rd Ste 319', 'Baytown', 'Harris', 'TX', '77521', '2814282487', '2814282784', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', '2013-07-29', 0, 0, 0, 'Clear Lake Regional Medical Center', 'Houston Methodist San Jacinto Hospital', NULL, NULL, 'HCFA|UB|', '1497771489', 0, 'N', 0, '2013-07-31', NULL, NULL, 29.7677, -94.9796, NULL, NULL),
('760454609', 'ELAFA0211', 'ELAFA0211', 'TXHOUSTD', 'Renal Specialists of Houston', 'Bilal', '', 'Moukaddem', 'MD', 'Nephrology', '', '', NULL, 'O', '4407 Yoakum', 'Houston', 'Harris', 'TX', '77006', '7135288111', '7135282276', '4407 Yoakum', 'Houston', 'Harris', 'TX', '77006', '7135288111', '7135282276', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', 'Houston Methodist San Jacinto Hospital', NULL, NULL, 'HCFA|UB|', '1497771489', 0, 'N', 0, '2013-07-31', NULL, NULL, 29.7335, -95.3924, NULL, NULL),
('760454609', 'ELAFA0212', 'ELAFA0212', 'TXHOUSTD', 'Renal Specialists of Houston', 'Bilal', '', 'Moukaddem', 'MD', 'Nephrology', '', '', NULL, 'O', '5435 Aldine Mail Rd', 'Houston', 'Harris', 'TX', '77039', '8323812441', '8323812443', '5435 Aldine Mail Rd', 'Houston', 'Harris', 'TX', '77039', '8323812441', '8323812443', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', 'Houston Methodist San Jacinto Hospital', NULL, NULL, 'HCFA|UB|', '1497771489', 0, 'N', 0, '2013-07-31', NULL, NULL, 29.9022, -95.3095, NULL, NULL),
('760454609', 'ELAFA0206', 'ELAFA0206', 'TXHOUSTD', 'Renal Specialists of Houston', 'Bilal', '', 'Moukaddem', 'MD', 'Nephrology', '', '', NULL, 'O', '6624 Fannin St Ste 2510', 'Houston', 'Harris', 'TX', '77030', '7137912648', '7137950717', '6624 Fannin St Ste 2510', 'Houston', 'Harris', 'TX', '77030', '7137912648', '7137950717', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', 'Houston Methodist San Jacinto Hospital', NULL, NULL, 'HCFA|UB|', '1497771489', 0, 'N', 0, '2013-07-31', NULL, NULL, 29.7096, -95.4011, NULL, NULL),
('760454609', 'ELAFA0213', 'ELAFA0213', 'TXHOUSTD', 'Renal Specialists of Houston', 'Bilal', '', 'Moukaddem', 'MD', 'Nephrology', '', '', NULL, 'O', '8537 Gulf Fwy Ste C', 'Houston', 'Harris', 'TX', '77017', '8323860900', '8323860907', '8537 Gulf Fwy Ste C', 'Houston', 'Harris', 'TX', '77017', '8323860900', '8323860907', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', 'Houston Methodist San Jacinto Hospital', NULL, NULL, 'HCFA|UB|', '1497771489', 0, 'N', 0, '2013-07-31', NULL, NULL, 29.6682, -95.2613, NULL, NULL),
('760454609', 'ELAFA0217', 'ELAFA0217', 'TXHOUSTD', 'Renal Specialists of Houston', 'Bilal', '', 'Moukaddem', 'MD', 'Nephrology', '', '', NULL, 'O', '9449 Grogans Mill', 'The Woodlands', 'Montgomery', 'TX', '77380', '7137912648', '7137950717', '9449 Grogans Mill', 'The Woodlands', 'Montgomery', 'TX', '77380', '7137912648', '7137950717', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', 'Houston Methodist San Jacinto Hospital', NULL, NULL, 'HCFA|UB|', '1497771489', 0, 'N', 0, '2013-07-31', NULL, NULL, 30.1672, -95.4656, NULL, NULL),
('760454609', 'ELAFA0107', 'ELAFA0107', 'TXHOUSTD', 'Renal Specialists of Houston', 'June', '', 'Yao', 'MD', 'Nephrology', '', '', NULL, 'O', '10970 Shadow Creek Pkwy', 'Pearland', 'Brazoria', 'TX', '77584', '7137912648', '7137950717', '10970 Shadow Creek Pkwy', 'Pearland', 'Brazoria', 'TX', '77584', '7137912648', '7137950717', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', 'Houston Methodist San Jacinto Hospital', NULL, NULL, 'HCFA|UB|', '1649243742', 0, 'N', 0, '2013-07-03', NULL, NULL, 29.5802, -95.3886, NULL, NULL),
('760454609', 'ELAFA0101', 'ELAFA0101', 'TXHOUSTD', 'Renal Specialists of Houston', 'June', '', 'Yao', 'MD', 'Nephrology', '', '', NULL, 'O', '11914 Astoria Blvd Ste 530', 'Houston', 'Harris', 'TX', '77089', '2814649681', '2814647593', '11914 Astoria Blvd Ste 530', 'Houston', 'Harris', 'TX', '77089', '2814649681', '2814647593', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', 'Houston Methodist San Jacinto Hospital', NULL, NULL, 'HCFA|UB|', '1649243742', 0, 'N', 0, '2013-07-03', NULL, NULL, 29.5851, -95.2071, NULL, NULL),
('760454609', 'ELAFA0108', 'ELAFA0108', 'TXHOUSTD', 'Renal Specialists of Houston', 'June', '', 'Yao', 'MD', 'Nephrology', '', '', NULL, 'O', '16126 Southwest Fwy Ste 230', 'Sugar Land', 'Fort Bend', 'TX', '77479', '7139444660', '8323812444', '16126 Southwest Fwy Ste 230', 'Sugar Land', 'Fort Bend', 'TX', '77479', '7139444660', '8323812444', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', 'Houston Methodist San Jacinto Hospital', NULL, NULL, 'HCFA|UB|', '1649243742', 0, 'N', 0, '2013-07-03', NULL, NULL, 29.5968, -95.6249, NULL, NULL),
('760454609', 'ELAFA0102', 'ELAFA0102', 'TXHOUSTD', 'Renal Specialists of Houston', 'June', '', 'Yao', 'MD', 'Nephrology', '', '', NULL, 'O', '250 Blossom Ste 275', 'Webster', 'Harris', 'TX', '77598', '2813322059', '2813160731', '250 Blossom Ste 275', 'Webster', 'Harris', 'TX', '77598', '2813322059', '2813160731', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', 'Houston Methodist San Jacinto Hospital', NULL, NULL, 'HCFA|UB|', '1649243742', 0, 'N', 0, '2013-07-03', NULL, NULL, 29.5436, -95.126, NULL, NULL),
('760454609', 'ELAFA0099', 'ELAFA0099', 'TXHOUSTD', 'Renal Specialists of Houston', 'June', '', 'Yao', 'MD', 'Nephrology', '', '', NULL, 'O', '2825 S Loop 35 Ste 154', 'Alvin', 'Brazoria', 'TX', '77511', '7137912648', '7137950717', '2825 S Loop 35 Ste 154', 'Alvin', 'Brazoria', 'TX', '77511', '7137912648', '7137950717', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', '2013-07-02', 0, 0, 0, 'Clear Lake Regional Medical Center', 'Houston Methodist San Jacinto Hospital', NULL, NULL, 'HCFA|UB|', '1649243742', 0, 'N', 0, '2013-07-03', NULL, NULL, 29.4028, -95.2374, NULL, NULL),
('760454609', 'ELAFA0106', 'ELAFA0106', 'TXHOUSTD', 'Renal Specialists of Houston', 'June', '', 'Yao', 'MD', 'Nephrology', '', '', NULL, 'O', '3333 Bayshore Blvd Ste 270', 'Pasadena', 'Harris', 'TX', '77504', '7139479507', '7139476286', '3333 Bayshore Blvd Ste 270', 'Pasadena', 'Harris', 'TX', '77504', '7139479507', '7139476286', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', 'Houston Methodist San Jacinto Hospital', NULL, NULL, 'HCFA|UB|', '1649243742', 0, 'N', 0, '2013-07-03', NULL, NULL, 29.663, -95.1837, NULL, NULL),
('760454609', 'ELAFA0100', 'ELAFA0100', 'TXHOUSTD', 'Renal Specialists of Houston', 'June', '', 'Yao', 'MD', 'Nephrology', '', '', NULL, 'O', '4201 Garth Rd Ste 319', 'Baytown', 'Harris', 'TX', '77521', '2814282487', '2814282784', '4201 Garth Rd Ste 319', 'Baytown', 'Harris', 'TX', '77521', '2814282487', '2814282784', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', 'Houston Methodist San Jacinto Hospital', NULL, NULL, 'HCFA|UB|', '1649243742', 0, 'N', 0, '2013-07-03', NULL, NULL, 29.7677, -94.9775, NULL, NULL),
('760454609', 'ELAFA0103', 'ELAFA0103', 'TXHOUSTD', 'Renal Specialists of Houston', 'June', '', 'Yao', 'MD', 'Nephrology', '', '', NULL, 'O', '4407 Yoakum Ste B', 'Houston', 'Harris', 'TX', '77006', '7135288111', '7135282276', '4407 Yoakum Ste B', 'Houston', 'Harris', 'TX', '77006', '7135288111', '7135282276', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', 'Houston Methodist San Jacinto Hospital', NULL, NULL, 'HCFA|UB|', '1649243742', 0, 'N', 0, '2013-07-03', NULL, NULL, 29.7335, -95.3924, NULL, NULL),
('760454609', 'ELAFA0104', 'ELAFA0104', 'TXHOUSTD', 'Renal Specialists of Houston', 'June', '', 'Yao', 'MD', 'Nephrology', '', '', NULL, 'O', '5435 Aldine Mail Rd', 'Houston', 'Harris', 'TX', '77039', '8323812441', '8323812443', '5435 Aldine Mail Rd', 'Houston', 'Harris', 'TX', '77039', '8323812441', '8323812443', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', 'Houston Methodist San Jacinto Hospital', NULL, NULL, 'HCFA|UB|', '1649243742', 0, 'N', 0, '2013-07-03', NULL, NULL, 29.9022, -95.3095, NULL, NULL),
('760454609', 'ELAFA0098', 'ELAFA0098', 'TXHOUSTD', 'Renal Specialists of Houston', 'June', '', 'Yao', 'MD', 'Nephrology', '', '', NULL, 'O', '6624 Fannin St Ste 2510', 'Houston', 'Harris', 'TX', '77030', '7134912648', '7137950717', '6624 Fannin St Ste 2510', 'Houston', 'Harris', 'TX', '77030', '7134912648', '7137950717', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', 'Houston Methodist San Jacinto Hospital', NULL, NULL, 'HCFA|UB|', '1649243742', 0, 'N', 0, '2013-07-03', NULL, NULL, 29.7096, -95.4011, NULL, NULL),
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('760454609', 'ELAFA0016', 'ELAFA0016', 'TXHOUSTD', 'Renal Specialists of Houston', 'Mohammed', 'A', 'Ahmed', 'MD', 'Nephrology', '', '', NULL, 'O', '11914 Astoria Blvd Ste 530', 'Houston', 'Harris', 'TX', '77089', '2814649681', '2814647593', '11914 Astoria Blvd Ste 530', 'Houston', 'Harris', 'TX', '77089', '2814649681', '2814647593', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Bayshore Medical Center', 'Houston Methodist San Jacinto Hospital', 'Clear Lake Regional Medical Center', NULL, 'HCFA|UB|', '1851545859', 0, 'N', 0, '2013-07-15', NULL, NULL, 29.5851, -95.2071, NULL, NULL),
('760454609', 'ELAFA0024', 'ELAFA0024', 'TXHOUSTD', 'Renal Specialists of Houston', 'Mohammed', 'A', 'Ahmed', 'MD', 'Nephrology', '', '', NULL, 'O', '16126 Southwest Fwy Ste 230', 'Sugar Land', 'Fort Bend', 'TX', '77479', '7139444660', '8323812444', '16126 Southwest Fwy Ste 230', 'Sugar Land', 'Fort Bend', 'TX', '77479', '7139444660', '8323812444', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Bayshore Medical Center', 'Houston Methodist San Jacinto Hospital', 'Clear Lake Regional Medical Center', NULL, 'HCFA|UB|', '1851545859', 0, 'N', 0, '2013-07-15', NULL, NULL, 29.5968, -95.6249, NULL, NULL),
('760454609', 'ELAFA0018', 'ELAFA0018', 'TXHOUSTD', 'Renal Specialists of Houston', 'Mohammed', 'A', 'Ahmed', 'MD', 'Nephrology', '', '', NULL, 'O', '250 Blossom Ste 275', 'Webster', 'Harris', 'TX', '77598', '2813322059', '2813160731', '250 Blossom Ste 275', 'Webster', 'Harris', 'TX', '77598', '2813322059', '2813160731', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Bayshore Medical Center', 'Houston Methodist San Jacinto Hospital', 'Clear Lake Regional Medical Center', NULL, 'HCFA|UB|', '1851545859', 0, 'N', 0, '2013-07-15', NULL, NULL, 29.5436, -95.126, NULL, NULL),
('760454609', 'ELAFA0015', 'ELAFA0015', 'TXHOUSTD', 'Renal Specialists of Houston', 'Mohammed', 'A', 'Ahmed', 'MD', 'Nephrology', '', '', NULL, 'O', '2825 S Loop 35 Ste 154', 'Alvin', 'Brazoria', 'TX', '77511', '7137912648', '7137950717', '2825 S Loop 35 Ste 154', 'Alvin', 'Brazoria', 'TX', '77511', '7137912648', '7137950717', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Bayshore Medical Center', 'Houston Methodist San Jacinto Hospital', 'Clear Lake Regional Medical Center', NULL, 'HCFA|UB|', '1851545859', 0, 'N', 0, '2013-07-15', NULL, NULL, 29.3988, -95.2459, NULL, NULL),
('760454609', 'ELAFA0022', 'ELAFA0022', 'TXHOUSTD', 'Renal Specialists of Houston', 'Mohammed', 'A', 'Ahmed', 'MD', 'Nephrology', '', '', NULL, 'O', '3333 Bayshore Blvd Ste 270', 'Pasadena', 'Harris', 'TX', '77504', '7139479507', '7139476286', '3333 Bayshore Blvd Ste 270', 'Pasadena', 'Harris', 'TX', '77504', '7139479507', '7139476286', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Bayshore Medical Center', 'Houston Methodist San Jacinto Hospital', 'Clear Lake Regional Medical Center', NULL, 'HCFA|UB|', '1851545859', 0, 'N', 0, '2013-07-15', NULL, NULL, 29.663, -95.1837, NULL, NULL),
('760454609', 'ELAFA0014', 'ELAFA0014', 'TXHOUSTD', 'Renal Specialists of Houston', 'Mohammed', 'A', 'Ahmed', 'MD', 'Nephrology', '', '', NULL, 'O', '4201 Garth Rd Ste 319', 'Baytown', 'Harris', 'TX', '77521', '2814282487', '2814282784', '4201 Garth Rd Ste 319', 'Baytown', 'Harris', 'TX', '77521', '2814282487', '2814282784', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Bayshore Medical Center', 'Houston Methodist San Jacinto Hospital', 'Clear Lake Regional Medical Center', NULL, 'HCFA|UB|', '1851545859', 0, 'N', 0, '2013-07-15', NULL, NULL, 29.7677, -94.9775, NULL, NULL),
('760454609', 'ELAFA0019', 'ELAFA0019', 'TXHOUSTD', 'Renal Specialists of Houston', 'Mohammed', 'A', 'Ahmed', 'MD', 'Nephrology', '', '', NULL, 'O', '4407 Yoakum', 'Houston', 'Harris', 'TX', '77006', '7135288111', '7135282276', '4407 Yoakum', 'Houston', 'Harris', 'TX', '77006', '7135288111', '7135282276', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Bayshore Medical Center', 'Houston Methodist San Jacinto Hospital', 'Clear Lake Regional Medical Center', NULL, 'HCFA|UB|', '1851545859', 0, 'N', 0, '2013-07-15', NULL, NULL, 29.7335, -95.3924, NULL, NULL),
('760454609', 'ELAFA0020', 'ELAFA0020', 'TXHOUSTD', 'Renal Specialists of Houston', 'Mohammed', 'A', 'Ahmed', 'MD', 'Nephrology', '', '', NULL, 'O', '5435 Aldine Mail Rd', 'Houston', 'Harris', 'TX', '77039', '8323812441', '8323812443', '5435 Aldine Mail Rd', 'Houston', 'Harris', 'TX', '77039', '8323812441', '8323812443', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Bayshore Medical Center', 'Houston Methodist San Jacinto Hospital', 'Clear Lake Regional Medical Center', NULL, 'HCFA|UB|', '1851545859', 0, 'N', 0, '2013-07-15', NULL, NULL, 29.9022, -95.3095, NULL, NULL),
('760454609', 'ELAFA0017', 'ELAFA0017', 'TXHOUSTD', 'Renal Specialists of Houston', 'Mohammed', 'A', 'Ahmed', 'MD', 'Nephrology', '', '', NULL, 'O', '6624 Fannin St Ste 2200', 'Houston', 'Harris', 'TX', '77030', '7137912648', '7137950717', '6624 Fannin St Ste 2200', 'Houston', 'Harris', 'TX', '77030', '7137912648', '7137950717', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Bayshore Medical Center', 'Houston Methodist San Jacinto Hospital', 'Clear Lake Regional Medical Center', NULL, 'HCFA|UB|', '1851545859', 0, 'N', 0, '2013-07-15', NULL, NULL, 29.7096, -95.4011, NULL, NULL),
('760454609', 'ELAFA0021', 'ELAFA0021', 'TXHOUSTD', 'Renal Specialists of Houston', 'Mohammed', 'A', 'Ahmed', 'MD', 'Nephrology', '', '', NULL, 'O', '8537 Gulf Fwy Ste C', 'Houston', 'Harris', 'TX', '77017', '8323860900', '8323860907', '8537 Gulf Fwy Ste C', 'Houston', 'Harris', 'TX', '77017', '8323860900', '8323860907', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Bayshore Medical Center', 'Houston Methodist San Jacinto Hospital', 'Clear Lake Regional Medical Center', NULL, 'HCFA|UB|', '1851545859', 0, 'N', 0, '2013-07-15', NULL, NULL, 29.6682, -95.2613, NULL, NULL),
('760454609', 'ELAFA0025', 'ELAFA0025', 'TXHOUSTD', 'Renal Specialists of Houston', 'Mohammed', 'A', 'Ahmed', 'MD', 'Nephrology', '', '', NULL, 'O', '9449 Grogans Mill', 'The Woodlands', 'Montgomery', 'TX', '77380', '7137912648', '7137950717', '9449 Grogans Mill', 'The Woodlands', 'Montgomery', 'TX', '77380', '7137912648', '7137950717', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Bayshore Medical Center', 'Houston Methodist San Jacinto Hospital', 'Clear Lake Regional Medical Center', NULL, 'HCFA|UB|', '1851545859', 0, 'N', 0, '2013-07-15', NULL, NULL, 30.1672, -95.4656, NULL, NULL),
('760454609', 'ELAFA0191', 'ELAFA0191', 'TXHOUSTD', 'Renal Specialists of Houston', 'Humaira', '', 'Chaudhary', 'MD', 'Nephrology', '', '', NULL, 'O', '10970 Shadow Creek Pkwy', 'Pearland', 'Brazoria', 'TX', '77584', '7137912648', '7137950717', '10970 Shadow Creek Pkwy', 'Pearland', 'Brazoria', 'TX', '77584', '7137912648', '7137950717', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', '2013-01-01', 0, 0, 0, 'Clear Lake Regional Medical Center', 'Houston Methodist San Jacinto Hospital', NULL, NULL, 'HCFA|UB|', '1912904996', 0, 'N', 0, '2013-03-21', NULL, NULL, 29.5771, -95.3886, NULL, NULL),
('760454609', 'ELAFA0185', 'ELAFA0185', 'TXHOUSTD', 'Renal Specialists of Houston', 'Humaira', '', 'Chaudhary', 'MD', 'Nephrology', '', '', NULL, 'O', '11914 Astoria Blvd Ste 530', 'Houston', 'Harris', 'TX', '77089', '2814649681', '2814647593', '11914 Astoria Blvd Ste 530', 'Houston', 'Harris', 'TX', '77089', '2814649681', '2814647593', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', '2013-01-01', 0, 0, 0, 'Clear Lake Regional Medical Center', 'Houston Methodist San Jacinto Hospital', NULL, NULL, 'HCFA|UB|', '1912904996', 0, 'N', 0, '2013-03-21', NULL, NULL, 29.5836, -95.2059, NULL, NULL),
('760454609', 'ELAFA0192', 'ELAFA0192', 'TXHOUSTD', 'Renal Specialists of Houston', 'Humaira', '', 'Chaudhary', 'MD', 'Nephrology', '', '', NULL, 'O', '16126 Southwest Fwy Ste 230', 'Sugar Land', 'Fort Bend', 'TX', '77479', '7139444660', '8323812444', '16126 Southwest Fwy Ste 230', 'Sugar Land', 'Fort Bend', 'TX', '77479', '7139444660', '8323812444', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', 'Houston Methodist San Jacinto Hospital', NULL, NULL, 'HCFA|UB|', '1912904996', 0, 'N', 0, '2013-03-21', NULL, NULL, 29.5968, -95.6249, NULL, NULL),
('760454609', 'ELAFA0186', 'ELAFA0186', 'TXHOUSTD', 'Renal Specialists of Houston', 'Humaira', '', 'Chaudhary', 'MD', 'Nephrology', '', '', NULL, 'O', '250 Blossom Ste 275', 'Webster', 'Harris', 'TX', '77598', '2813322059', '2813160731', '250 Blossom Ste 275', 'Webster', 'Harris', 'TX', '77598', '2813322059', '2813160731', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', '2013-01-01', 0, 0, 0, 'Clear Lake Regional Medical Center', 'Houston Methodist San Jacinto Hospital', NULL, NULL, 'HCFA|UB|', '1912904996', 0, 'N', 0, '2013-03-21', NULL, NULL, 29.5448, -95.1267, NULL, NULL),
('760454609', 'ELAFA0183', 'ELAFA0183', 'TXHOUSTD', 'Renal Specialists of Houston', 'Humaira', '', 'Chaudhary', 'MD', 'Nephrology', '', '', NULL, 'O', '2825 S Loop 35 Ste 154', 'Alvin', 'Brazoria', 'TX', '77511', '7137912648', '7137950717', '2825 S Loop 35 Ste 154', 'Alvin', 'Brazoria', 'TX', '77511', '7137912648', '7137950717', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', '2013-01-01', 0, 0, 0, 'Clear Lake Regional Medical Center', 'Houston Methodist San Jacinto Hospital', NULL, NULL, 'HCFA|UB|', '1912904996', 0, 'N', 0, '2013-03-21', NULL, NULL, 29.4028, -95.2374, NULL, NULL),
('760454609', 'ELAFA0190', 'ELAFA0190', 'TXHOUSTD', 'Renal Specialists of Houston', 'Humaira', '', 'Chaudhary', 'MD', 'Nephrology', '', '', NULL, 'O', '3333 Bayshore Blvd Ste 270', 'Pasadena', 'Harris', 'TX', '77504', '7139479507', '7139476286', '3333 Bayshore Blvd Ste 270', 'Pasadena', 'Harris', 'TX', '77504', '7139479507', '7139476286', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', '2013-01-01', 0, 0, 0, 'Clear Lake Regional Medical Center', 'Houston Methodist San Jacinto Hospital', NULL, NULL, 'HCFA|UB|', '1912904996', 0, 'N', 0, '2013-03-21', NULL, NULL, 29.6632, -95.1833, NULL, NULL);
