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
('453279299', 'W12047678', 'W12047678', 'ILCHIGSTD', 'Cardiovascular Care Consultants SC', '', '', 'Cardiovascular Care Consultants SC', '', 'Cardiovascular Disease', '', '', NULL, 'O', '14741 S Ravinia', 'Orland Park', 'Cook', 'IL', '60462', '7085768150', '7085768831', '14741 S Ravinia', 'Orland Park', 'Cook', 'IL', '60462', '7085768150', '7085768831', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-06-20', NULL, 0, 0, 0, 'Little Company of Mary', '', '', '', 'HCFA|UB|DEN|', '1164704805', 0, 'Y', 0, '2014-05-15', NULL, NULL, 0, 0, NULL, NULL),
('453279299', 'W12047677', 'W12047677', 'ILCHIGSTD', 'Cardiovascular Care Consultants SC', '', '', 'Cardiovascular Care Consultants SC', '', 'Cardiovascular Disease', '', '', NULL, 'O', '4950 W 95th St', 'Oak Lawn', 'Cook', 'IL', '60453', '7085768150', '7085768831', '4950 W 95th St', 'Oak Lawn', 'Cook', 'IL', '60453', '7085768150', '7085768831', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-06-20', NULL, 0, 0, 0, 'Little Company of Mary', '', '', '', 'HCFA|UB|', '1164704805', 0, 'Y', 0, '2014-05-15', NULL, NULL, 0, 0, NULL, NULL),
('453279299', 'W12047768', 'W12047768', 'ILCHIGSTD', 'Cardiovascular Care Consultants SC', 'Surendra', '', 'Avula', 'MD', 'Cardiology', '', '', NULL, 'O', '4950 W 95th St', 'Oak Lawn', 'Cook', 'IL', '60453', '7085768150', '7085768831', '4950 W 95th St', 'Oak Lawn', 'Cook', 'IL', '60453', '7085768150', '7085768831', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-06-20', NULL, 0, 0, 0, 'Little Company of Mary Hospital', '', '', '', 'HCFA|UB|', '1275526071', 0, 'N', 0, '2014-05-22', NULL, NULL, 0, 0, NULL, NULL),
('453279299', 'W12045672', 'W12045672', 'ILCHIGSTD', 'Cardiovascular Care Consultants SC', 'Gautam', '', 'Patel', 'MD', 'Cardiology', '', '', NULL, 'O', '14741 S Ravinia', 'Orland Park', 'Cook', 'IL', '60462', '7085768150', '7085768831', '14741 S Ravinia', 'Orland Park', 'Cook', 'IL', '60462', '7085768150', '7085768831', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-06-20', NULL, 0, 0, 0, 'Little Company of Mary Hospital', '', '', '', 'HCFA|UB|', '1699768432', 0, 'N', 0, '2014-05-22', NULL, NULL, 0, 0, NULL, NULL),
('453279299', 'LCOMSP109', 'LCOMSP109', 'ILCHIGSTD', 'Cardiovascular Care Consultants SC', 'Gautam', '', 'Patel', 'MD', 'Cardiology', '', '', NULL, 'O', '4950 W 95th St', 'Oak Lawn', 'Cook', 'IL', '60453', '7085768150', '7085768831', '4950 W 95th St', 'Oak Lawn', 'Cook', 'IL', '60453', '7085768150', '7085768831', '', '', '', '0.00', '0.00', '0.00', 3, '2014-06-20', NULL, 0, 0, 0, 'Little Company of Mary Hospital', '', '', '', 'HCFA|UB|', '1699768432', 0, 'N', 0, '2014-05-22', NULL, NULL, 0, 0, NULL, NULL),
('453279299', 'W12047771', 'W12047771', 'ILCHIGSTD', 'Cardiovascular Care Consultants SC', 'Jeffrey', '', 'Neiger', 'MD', 'Cardiology', '', '', NULL, 'O', '14741 S Ravinia', 'Orland Park', 'Cook', 'IL', '60462', '7085768150', '7085768831', '14741 S Ravinia', 'Orland Park', 'Cook', 'IL', '60462', '7085768150', '7085768831', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-06-20', NULL, 0, 0, 0, 'Little Company of Mary Hospital', '', '', '', 'HCFA|UB|DEN|', '1275719072', 0, 'N', 0, '2014-05-22', NULL, NULL, 0, 0, NULL, NULL),
('453279299', 'W12047770', 'W12047770', 'ILCHIGSTD', 'Cardiovascular Care Consultants SC', 'Jeffrey', '', 'Neiger', 'MD', 'Cardiology', '', '', NULL, 'O', '4950 W 95th St', 'Oak Lawn', 'Cook', 'IL', '60453', '7085768150', '7085768831', '4950 W 95th St', 'Oak Lawn', 'Cook', 'IL', '60453', '7085768150', '7085768831', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-06-20', NULL, 0, 0, 0, 'Little Company of Mary Hospital', '', '', '', 'HCFA|UB|', '1275719072', 0, 'N', 0, '2014-05-22', NULL, NULL, 0, 0, NULL, NULL),
('453279299', 'W12047773', 'W12047773', 'ILCHIGSTD', 'Cardiovascular Care Consultants SC', 'Maitrayee', '', 'Vadali', 'MD', 'Cardiology', '', '', NULL, 'O', '4950 W 95th St', 'Oak Lawn', 'Cook', 'IL', '60453', '7085768150', '7085768831', '4950 W 95th St', 'Oak Lawn', 'Cook', 'IL', '60453', '7085768150', '7085768831', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-06-20', NULL, 0, 0, 0, 'Little Company of Mary Hospital', '', '', '', 'HCFA|UB|', '1013900851', 0, 'N', 0, '2014-05-22', NULL, NULL, 0, 0, NULL, NULL),
('263608752', 'W12047779', 'W12047779', 'TXDALSTD', 'Sawroop Sandhu MD PA', 'Sawroop', 'K', 'Sandhu', 'MD', 'Family Practice', '', '', NULL, 'O', '350 Westpark Way Ste 111', 'Euless', 'Tarrant', 'TX', '76040', '8778448939', '8175105719', '350 Westpark Way Ste 111', 'Euless', 'Tarrant', 'TX', '76040', '8778448939', '8175105719', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1477706745', 0, 'N', 0, '2014-05-15', NULL, NULL, 0, 0, NULL, NULL),
('465196492', 'W12047783', 'W12047783', 'TXDALSTD', 'SB Nephrology', 'Adeel', '', 'Ijaz', 'MD', 'Nephrology', '', '', NULL, 'B', '15455 N Dallas Pkwy Ste 600', 'Addison', 'Dallas', 'TX', '75001', '8886343575', '8886343575', '15455 N Dallas Pkwy Ste 600', 'Addison', 'Dallas', 'TX', '75001', '8886343575', '8886343575', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-06-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1386695724', 0, 'N', 0, '2014-05-15', NULL, NULL, 0, 0, NULL, NULL),
('263608752', 'W12047781', 'W12047781', 'TXDALSTD', 'Sawroop Sandhu MD PA', 'Sawroop', 'K', 'Sandhu', 'MD', 'Family Practice', '', '', NULL, 'O', '1650 College St', 'Grapevine', 'Tarrant', 'TX', '76051', '8778448939', '8175105719', '1650 College St', 'Grapevine', 'Tarrant', 'TX', '76051', '8778448939', '8175105719', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1477706745', 0, 'N', 0, '2014-05-15', NULL, NULL, 0, 0, NULL, NULL),
('043692740', 'W12047775', 'W12047775', 'TXDALSTD', 'Surgical Group of North Texas', 'Shahid', '', 'Shafi', 'MD', 'General Surgery', '', '', NULL, 'O', '2001 N MacArthur Blvd Ste 530', 'Irving', 'Dallas', 'TX', '75061', '9722549399', '9722592040', '2001 N MacArthur Blvd Ste 530', 'Irving', 'Dallas', 'TX', '75061', '9722549399', '9722592040', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-06-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1538128889', 0, 'N', 0, '2014-05-15', NULL, NULL, 0, 0, NULL, NULL),
('043692740', 'W12047777', 'W12047777', 'TXDALSTD', 'Surgical Group of North Texas', 'Shahid', '', 'Shafi', 'MD', 'General Surgery', '', '', NULL, 'O', '1600 W College', 'Grapevine', 'Tarrant', 'TX', '76051', '8172510070', '8172592040', '1600 W College', 'Grapevine', 'Tarrant', 'TX', '76051', '8172510070', '8172592040', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-06-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1538128889', 0, 'N', 0, '2014-05-15', NULL, NULL, 0, 0, NULL, NULL),
('043692740', 'W12047776', 'W12047776', 'TXDALSTD', 'Surgical Group of North Texas', 'Shahid', '', 'Shafi', 'MD', 'General Surgery', '', '', NULL, 'B', 'PO Box 204803', 'Dallas', 'Dallas', 'TX', '75230', '9722549399', '9722592040', 'PO Box 204803', 'Dallas', 'Dallas', 'TX', '75230', '9722549399', '9722592040', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-06-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1538128889', 0, 'N', 0, '2014-05-15', NULL, NULL, 0, 0, NULL, NULL),
('263608752', 'W12047780', 'W12047780', 'TXDALSTD', 'Sawroop Sandhu MD PA', 'Sawroop', 'K', 'Sandhu', 'MD', 'Family Practice', '', '', NULL, 'B', '532 Coyote Rd', 'Southlake', 'Tarrant', 'TX', '76092', '8778448939', '8175105719', '532 Coyote Rd', 'Southlake', 'Tarrant', 'TX', '76092', '8778448939', '8175105719', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1477706745', 0, 'N', 0, '2014-05-15', NULL, NULL, 0, 0, NULL, NULL),
('465196492', 'W12047784', 'W12047784', 'TXDALSTD', 'SB Nephrology', 'Adeel', '', 'Ijaz', 'MD', 'Nephrology', '', '', NULL, 'O', '4201 Medical Ctr Dr Ste 260', 'Mckinney', 'Collin', 'TX', '75069', '9725476969', '9722935151', '4201 Medical Ctr Dr Ste 260', 'Mckinney', 'Collin', 'TX', '75069', '9725476969', '9722935151', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-06-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1386695724', 0, 'N', 0, '2014-05-15', NULL, NULL, 0, 0, NULL, NULL),
('465196492', 'W12047782', 'W12047782', 'TXDALSTD', 'SB Nephrology', 'Adeel', '', 'Ijaz', 'MD', 'Nephrology', '', '', NULL, 'O', '4309 Ridgecrest Ste 150', 'Greenville', 'Hunt', 'TX', '75402', '8886343575', '8886343575', '4309 Ridgecrest Ste 150', 'Greenville', 'Hunt', 'TX', '75402', '8886343575', '8886343575', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-06-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1386695724', 0, 'N', 0, '2014-05-15', NULL, NULL, 0, 0, NULL, NULL),
('465196492', 'W12047787', 'W12047787', 'TXDALSTD', 'SB Nephrology', 'Salman', 'S', 'Butt', 'MD', 'Nephrology', '', '', NULL, 'O', '4201 Medical Ctr Dr Ste 260', 'Mckinney', 'Collin', 'TX', '75069', '9725476969', '9722935151', '4201 Medical Ctr Dr Ste 260', 'Mckinney', 'Collin', 'TX', '75069', '9725476969', '9722935151', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-06-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1760664585', 0, 'N', 0, '2014-05-15', NULL, NULL, 0, 0, NULL, NULL),
('465196492', 'W12047786', 'W12047786', 'TXDALSTD', 'SB Nephrology', 'Salman', 'S', 'Butt', 'MD', 'Nephrology', '', '', NULL, 'O', '4309 Ridgecrest Ste 150', 'Greenville', 'Hunt', 'TX', '75402', '8886343575', '8886343575', '4309 Ridgecrest Ste 150', 'Greenville', 'Hunt', 'TX', '75402', '8886343575', '8886343575', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-06-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1760664585', 0, 'N', 0, '2014-05-15', NULL, NULL, 0, 0, NULL, NULL),
('450579013', 'W12047789', 'W12047789', 'UT01', 'St Marks Obstetrics & Gynecology Associates', 'Jason', 'L', 'Johnson', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1140 E 3900 S Ste 400', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012686811', '0000000000', '1140 E 3900 S Ste 400', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012686811', '0000000000', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-07-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', '', '', '', 'HCFA|UB|', '1376638718', 0, 'N', 0, '2014-06-13', NULL, NULL, 0, 0, NULL, NULL),
('450579013', 'W12047790', 'W12047790', 'UT01', 'St Marks Obstetrics & Gynecology Associates', 'Jason', 'L', 'Johnson', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 198546', 'Atlanta', 'Fulton', 'GA', '30384', '6153737600', '          ', 'PO Box 198546', 'Atlanta', 'Fulton', 'GA', '30384', '6153737600', '          ', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-07-01', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', '', '', '', 'HCFA|UB|', '1376638718', 0, 'N', 0, '2014-06-13', NULL, NULL, 0, 0, NULL, NULL),
('841033419', 'W12047791', 'W12047791', 'UT01', 'A-Med Supply', '', '', 'A-Med Supply', 'Group', 'Durable Medical Equipment', '', '', NULL, 'O', '27 N Harrison', 'Cortez', 'Montezuma', 'CO', '81321', '9705657699', '9705657861', '27 N Harrison', 'Cortez', 'Montezuma', 'CO', '81321', '9705657699', '9705657861', 'ROTECH', 'DMECURRENT', '', '0.00', '35.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1144200957', 0, 'N', 0, '2014-05-15', NULL, NULL, 0, 0, NULL, NULL),
('593344115', 'W12047792', 'W12047792', 'TX01', 'A-Plus Medical Equipment', '', '', 'A-Plus Medical Equipment', 'Group', 'Durable Medical Equipment', '', '', NULL, 'B', '5828 Ashleyanne Circle Ste 500', 'Wichita Falls', 'Wichita', 'TX', '76310', '9407612292', '9407612295', '5828 Ashleyanne Circle Ste 500', 'Wichita Falls', 'Wichita', 'TX', '76310', '9407612292', '9407612295', 'ROTECH', 'DMECURRENT', '', '0.00', '35.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1831179456', 0, 'Y', 0, '2014-05-15', NULL, NULL, 0, 0, NULL, NULL),
('593344115', 'W12047793', 'W12047793', 'TX01', 'A-Plus Medical Equipment', '', '', 'A-Plus Medical Equipment', 'Group', 'Durable Medical Equipment', '', '', NULL, 'B', 'PO Box 2080', 'Texarkana', 'Bowie', 'TX', '75504', '8006789796', '9037925395', 'PO Box 2080', 'Texarkana', 'Bowie', 'TX', '75504', '8006789796', '9037925395', 'ROTECH', 'DMECURRENT', '', '0.00', '35.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1831179456', 0, 'N', 0, '2014-05-15', NULL, NULL, 0, 0, NULL, NULL),
('593344111', 'W12047794', 'W12047794', 'TX01', 'Aaa Medical & Oxygen Supply', '', '', 'Aaa Medical & Oxygen Supply', 'Group', 'Durable Medical Equipment', '', '', NULL, 'B', '1218 Hwy 123', 'San Marcos', 'Hays', 'TX', '78666', '5123963372', '5123963479', '1218 Hwy 123', 'San Marcos', 'Hays', 'TX', '78666', '5123963372', '5123963479', 'ROTECH', 'DMECURRENT', '', '0.00', '35.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1508836404', 0, 'Y', 0, '2014-05-15', NULL, NULL, 0, 0, NULL, NULL),
('592973784', 'W12047795', 'W12047795', 'TX01', 'Aaa Medical & Oxygen Supply', '', '', 'Aaa Medical & Oxygen Supply', 'Group', 'Durable Medical Equipment', '', '', NULL, 'O', '11913 Starcrest Dr', 'San Antonio', 'Bexar', 'TX', '78247', '2104969770', '2104961405', '11913 Starcrest Dr', 'San Antonio', 'Bexar', 'TX', '78247', '2104969770', '2104961405', 'ROTECH', 'DMECURRENT', '', '0.00', '35.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1073583159', 0, 'N', 0, '2014-05-15', NULL, NULL, 0, 0, NULL, NULL),
('592973784', 'W12047796', 'W12047796', 'TX01', 'Aaa Medical & Oxygen Supply', '', '', 'Aaa Medical & Oxygen Supply', 'Group', 'Durable Medical Equipment', '', '', NULL, 'B', 'PO Box 2080', 'Texarkana', 'Bowie', 'TX', '75504', '8006789796', '9037925395', 'PO Box 2080', 'Texarkana', 'Bowie', 'TX', '75504', '8006789796', '9037925395', 'ROTECH', 'DMECURRENT', '', '0.00', '35.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1073583159', 0, 'Y', 0, '2014-05-15', NULL, NULL, 0, 0, NULL, NULL),
('593344111', 'W12047797', 'W12047797', 'TX01', 'Aaa Medical & Oxygen Supply', '', '', 'Aaa Medical & Oxygen Supply ', 'Group', 'Durable Medical Equipment', '', '', NULL, 'B', '102 S Commerce', 'Lockhart', 'Caldwell', 'TX', '78644', '5123983372', '5123769774', '102 S Commerce', 'Lockhart', 'Caldwell', 'TX', '78644', '5123983372', '5123769774', 'ROTECH', 'DMECURRENT', '', '0.00', '35.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1811967755', 0, 'Y', 0, '2014-05-15', NULL, NULL, 0, 0, NULL, NULL),
('593344117', 'W12047798', 'W12047798', 'TX01', 'Aaa Medical & Oxygen Supply', '', '', 'Aaa Medical & Oxygen Supply', 'Group', 'Durable Medical Equipment', '', '', NULL, 'B', '740 S Amy Ln Ste 102', 'Harker Heights', 'Bell', 'TX', '76548', '2545547585', '2546608009', '740 S Amy Ln Ste 102', 'Harker Heights', 'Bell', 'TX', '76548', '2545547585', '2546608009', 'ROTECH', 'DMECURRENT', '', '0.00', '35.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1841260437', 0, 'Y', 0, '2014-05-15', NULL, NULL, 0, 0, NULL, NULL),
('593344111', 'W12047799', 'W12047799', 'TX01', 'Aaa Medical & Oxygen Supply', '', '', 'Aaa Medical & Oxygen Supply ', 'Group', 'Durable Medical Equipment', '', '', NULL, 'B', '1800 S Main St Ste 105 & 115', 'Mcallen', 'Hidalgo', 'TX', '78503', '9566311153', '9566312091', '1800 S Main St Ste 105 & 115', 'Mcallen', 'Hidalgo', 'TX', '78503', '9566311153', '9566312091', 'ROTECH', 'DMECURRENT', '', '0.00', '35.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1932179926', 0, 'Y', 0, '2014-05-15', NULL, NULL, 0, 0, NULL, NULL),
('593344111', 'W12047800', 'W12047800', 'TX01', 'Aaa Medical & Oxygen Supply', '', '', 'Aaa Medical & Oxygen Supply  ', 'Group', 'Durable Medical Equipment', '', '', NULL, 'B', '5210 N Lamar', 'Austin', 'Travis', 'TX', '78751', '5124519999', '5124515413', '5210 N Lamar', 'Austin', 'Travis', 'TX', '78751', '5124519999', '5124515413', 'ROTECH', 'DMECURRENT', '', '0.00', '35.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1992775829', 0, 'Y', 0, '2014-05-15', NULL, NULL, 0, 0, NULL, NULL),
('593344111', 'W12047801', 'W12047801', 'TX01', 'Aaa Medical & Oxygen Supply', '', '', 'Aaa Medical & Oxygen Supply  ', 'Group', 'Durable Medical Equipment', '', '', NULL, 'B', 'PO Box 2080', 'Texarkana', 'Bowie', 'TX', '75504', '8006789796', '9037925395', 'PO Box 2080', 'Texarkana', 'Bowie', 'TX', '75504', '8006789796', '9037925395', 'ROTECH', 'DMECURRENT', '', '0.00', '35.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1992775829', 0, 'Y', 0, '2014-05-15', NULL, NULL, 0, 0, NULL, NULL),
('593344111', 'W12047802', 'W12047802', 'TX01', 'Aaa Medical/Oxygen', '', '', 'Aaa Medical/Oxygen', 'Group', 'Durable Medical Equipment', '', '', NULL, 'B', '2801 Oakmont Dr Ste 1400', 'Round Rock', 'Williamson', 'TX', '78665', '5122482888', '5122482999', '2801 Oakmont Dr Ste 1400', 'Round Rock', 'Williamson', 'TX', '78665', '5122482888', '5122482999', 'ROTECH', 'DMECURRENT', '', '0.00', '35.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1609846104', 0, 'Y', 0, '2014-05-15', NULL, NULL, 0, 0, NULL, NULL),
('593344111', 'W12047803', 'W12047803', 'TX01', 'Aaa Medical/Oxygen Supply', '', '', 'Aaa Medical/Oxygen Supply', 'Group', 'Durable Medical Equipment', '', '', NULL, 'B', '117 E Cameron Ave', 'Rockdale', 'Milam', 'TX', '76567', '5124462533', '5124460291', '117 E Cameron Ave', 'Rockdale', 'Milam', 'TX', '76567', '5124462533', '5124460291', 'ROTECH', 'DMECURRENT', '', '0.00', '35.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1023088028', 0, 'Y', 0, '2014-05-15', NULL, NULL, 0, 0, NULL, NULL),
('593344111', 'W12047804', 'W12047804', 'TX01', 'Aaa Medical/Oxygen Supply', '', '', 'Aaa Medical/Oxygen Supply', 'Group', 'Durable Medical Equipment', '', '', NULL, 'B', '2112 Hwy 1431 Ste 7', 'Kingsland', 'Llano', 'TX', '78639', '3253883588', '3253884652', '2112 Hwy 1431 Ste 7', 'Kingsland', 'Llano', 'TX', '78639', '3253883588', '3253884652', 'ROTECH', 'DMECURRENT', '', '0.00', '35.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1790755221', 0, 'Y', 0, '2014-05-15', NULL, NULL, 0, 0, NULL, NULL),
('593344111', 'W12047805', 'W12047805', 'TX01', 'Aaa Oxygen & Medical Supply', '', '', 'Aaa Oxygen & Medical Supply', 'Group', 'Durable Medical Equipment', '', '', NULL, 'B', '2209 N Padre Island Dr Ste D', 'Corpus Christi', 'Nueces', 'TX', '78408', '3612992293', '3612891127', '2209 N Padre Island Dr Ste D', 'Corpus Christi', 'Nueces', 'TX', '78408', '3612992293', '3612891127', 'ROTECH', 'DMECURRENT', '', '0.00', '35.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1376513820', 0, 'Y', 0, '2014-05-15', NULL, NULL, 0, 0, NULL, NULL),
('593344117', 'W12047806', 'W12047806', 'TX01', 'Abba Medical Equipment', '', '', 'Abba Medical Equipment', 'Group', 'Durable Medical Equipment', '', '', NULL, 'B', '8300 Central Park Dr Ste E', 'Woodway', 'Mclennan', 'TX', '76712', '2543998626', '2543996498', '8300 Central Park Dr Ste E', 'Woodway', 'Mclennan', 'TX', '76712', '2543998626', '2543996498', 'ROTECH', 'DMECURRENT', '', '0.00', '35.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1316927940', 0, 'Y', 0, '2014-05-15', NULL, NULL, 0, 0, NULL, NULL),
('593344117', 'W12047807', 'W12047807', 'TX01', 'Abba Medical Equipment', '', '', 'Abba Medical Equipment', 'Group', 'Durable Medical Equipment', '', '', NULL, 'B', 'PO Box 2080', 'Texarkana', 'Bowie', 'TX', '75504', '8006789796', '9037925395', 'PO Box 2080', 'Texarkana', 'Bowie', 'TX', '75504', '8006789796', '9037925395', 'ROTECH', 'DMECURRENT', '', '0.00', '35.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1316927940', 0, 'Y', 0, '2014-05-15', NULL, NULL, 0, 0, NULL, NULL),
('593387515', 'W12047808', 'W12047808', 'UT01', 'All Care Respiratory Services', '', '', 'All Care Respiratory Services  ', 'Group', 'Durable Medical Equipment', '', '', NULL, 'O', '6901 E 1St St Ste A', 'Prescott Valley', 'Yavapai', 'AZ', '86314', '9287752202', '9287750843', '6901 E 1St St Ste A', 'Prescott Valley', 'Yavapai', 'AZ', '86314', '9287752202', '9287750843', 'ROTECH', 'DMECURRENT', '', '0.00', '35.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1578522140', 0, 'N', 0, '2014-05-15', NULL, NULL, 0, 0, NULL, NULL),
('860423257', 'W12047809', 'W12047809', 'UT01', 'Allied Medical Supply', '', '', 'Allied Medical Supply', 'Group', 'Durable Medical Equipment', '', '', NULL, 'O', '611 W Desmond St', 'Winslow', 'Navajo', 'AZ', '86047', '9282895137', '9282895746', '611 W Desmond St', 'Winslow', 'Navajo', 'AZ', '86047', '9282895137', '9282895746', 'ROTECH', 'DMECURRENT', '', '0.00', '35.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1356321269', 0, 'N', 0, '2014-05-15', NULL, NULL, 0, 0, NULL, NULL),
('860423257', 'W12047810', 'W12047810', 'UT01', 'Allied Medical Supply', '', '', 'Allied Medical Supply', 'Group', 'Durable Medical Equipment', '', '', NULL, 'B', 'PO Box 9901', 'Clearfield', 'Davis', 'UT', '84089', '8008451378', '8019261335', 'PO Box 9901', 'Clearfield', 'Davis', 'UT', '84089', '8008451378', '8019261335', 'ROTECH', 'DMECURRENT', '', '0.00', '35.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1356321269', 0, 'Y', 0, '2014-05-15', NULL, NULL, 0, 0, NULL, NULL),
('841177602', 'W12047811', 'W12047811', 'UT01', 'Brighton Oxygen & Home Medical', '', '', 'Brighton Oxygen & Home Medical  ', 'Group', 'Durable Medical Equipment', '', '', NULL, 'O', '975 Platte River Blvd bldg 2 Ste A', 'Brighton', 'Adams', 'CO', '80601', '3036551515', '3036370195', '975 Platte River Blvd bldg 2 Ste A', 'Brighton', 'Adams', 'CO', '80601', '3036551515', '3036370195', 'ROTECH', 'DMECURRENT', '', '0.00', '35.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1184604886', 0, 'N', 0, '2014-05-15', NULL, NULL, 0, 0, NULL, NULL),
('841177602', 'W12047812', 'W12047812', 'UT01', 'Brighton Oxygen & Home Medical', '', '', 'Brighton Oxygen & Home Medical  ', 'Group', 'Durable Medical Equipment', '', '', NULL, 'B', 'PO Box 6209', 'Lafayette', 'Tippecanoe', 'IN', '47903', '7654486685', '7654464287', 'PO Box 6209', 'Lafayette', 'Tippecanoe', 'IN', '47903', '7654486685', '7654464287', 'ROTECH', 'DMECURRENT', '', '0.00', '35.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1184604886', 0, 'Y', 0, '2014-05-15', NULL, NULL, 0, 0, NULL, NULL),
('201746792', 'W12047813', 'W12047813', 'ID01', 'Idaho Orthotic and Prosthetic Services', '', '', 'Idaho Orthotic and Prosthetic Services', '', 'Durable Medical Equipment', '', '', NULL, 'O', '1859 S Topaz Way Ste 100', 'Meridian', 'Ada', 'ID', '83642', '2088841294', '          ', '1859 S Topaz Way Ste 100', 'Meridian', 'Ada', 'ID', '83642', '2088841294', '          ', 'ID100DMECUR', '', '', '0.00', '35.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1801942354', 0, 'N', 0, '2014-05-15', NULL, NULL, 0, 0, NULL, NULL),
('465062444', 'W12047814', 'W12047814', 'UT01', 'West Valley OBGYN', 'Michael', '', 'Robinson', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 742941', 'Atlanta', 'Fulton', 'GA', '30374', '6153737600', '0000000000', 'PO Box 742941', 'Atlanta', 'Fulton', 'GA', '30374', '6153737600', '0000000000', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-07-01', NULL, 0, 0, 0, 'West Valley Medical Center', '', '', '', 'HCFA|UB|', '1275533184', 0, 'N', 0, '2014-07-09', NULL, NULL, 0, 0, NULL, NULL),
('270041325', 'W12047815', 'W12047815', 'UT01', 'Pinnacle Anesthesia Associates', 'Malcolm', 'S', 'Allen', 'CRNA', 'Anesthesiology', '', '', NULL, 'O', '300 N Hospital Dr', 'Price', 'Carbon', 'UT', '84501', '4356374800', '8014322670', '300 N Hospital Dr', 'Price', 'Carbon', 'UT', '84501', '4356374800', '8014322670', '', '', '', '0.00', '20.00', '0.00', 3, '2014-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1992809529', 0, 'Y', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
('270041325', 'W12047816', 'W12047816', 'UT01', 'Pinnacle Anesthesia Associates', 'Malcolm', 'S', 'Allen', 'CRNA', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 3750', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8007484868', '8014322670', 'PO Box 3750', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8007484868', '8014322670', '', '', '', '0.00', '20.00', '0.00', 3, '2014-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1992809529', 0, 'N', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
('270041325', 'W12047817', 'W12047817', 'UT01', 'Pinnacle Anesthesia Associates', 'Malcolm', 'S', 'Allen', 'CRNA', 'Anesthesiology', '', '', NULL, 'M', '10150 S Centennial Pkwy Ste 230', 'Sandy', 'Salt Lake', 'UT', '84070', '0000000000', '0000000000', '10150 S Centennial Pkwy Ste 230', 'Sandy', 'Salt Lake', 'UT', '84070', '0000000000', '0000000000', '', '', '', '0.00', '20.00', '0.00', 3, '2014-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1992809529', 0, 'Y', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
('611684739', 'W12047818', 'W12047818', 'TXHOUSTD', 'Conroe Physician Associates', 'Karen ', 'J', 'Brock', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '508 Medical Ctr Blvd Ste 320', 'Conroe', 'Montgomery', 'TX', '77304', '9367604600', '9367604601', '508 Medical Ctr Blvd Ste 320', 'Conroe', 'Montgomery', 'TX', '77304', '9367604600', '9367604601', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-04-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1033123781', 0, 'N', 0, '2014-05-15', NULL, NULL, 0, 0, NULL, NULL),
('611684739', 'W12047819', 'W12047819', 'TXHOUSTD', 'Conroe Physician Associates', 'Karen ', 'J', 'Brock', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'M', 'Three Maryland Farms Ste 250', 'Brentwood', 'Williamson', 'TN', '37027', '9367604600', '9367604601', 'Three Maryland Farms Ste 250', 'Brentwood', 'Williamson', 'TN', '37027', '9367604600', '9367604601', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-04-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1033123781', 0, 'N', 0, '2014-05-15', NULL, NULL, 0, 0, NULL, NULL),
('611684739', 'W12047820', 'W12047820', 'TXHOUSTD', 'Conroe Physician Associates', 'Karen ', 'J', 'Brock', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 742183', 'Atlanta', 'Fulton', 'GA', '30374', '          ', '          ', 'PO Box 742183', 'Atlanta', 'Fulton', 'GA', '30374', '          ', '          ', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-04-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1033123781', 0, 'N', 0, '2014-05-15', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W12047821', 'W12047821', 'UT01', 'Central Utah Clinic PC', 'James', '', 'Macdonald', 'MD', 'Dermatology', '', '', NULL, 'M', '1055 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013548225', '8014180941', '1055 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013548225', '8014180941', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2030-01-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1750517736', 0, 'N', 1, '2014-07-22', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W12047823', 'W12047823', 'UT01', 'Central Utah Clinic PC', 'James', '', 'Macdonald', 'MD', 'Dermatology', '', '', NULL, 'O', '220 N 1200 E Ste 203', 'Lehi', 'Utah', 'UT', '84043', '8014180920', '8014180921', '220 N 1200 E Ste 203', 'Lehi', 'Utah', 'UT', '84043', '8014180920', '8014180921', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2030-01-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1750517736', 0, 'N', 1, '2014-07-22', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W12047822', 'W12047822', 'UT01', 'Central Utah Clinic PC', 'James', '', 'Macdonald', 'MD', 'Dermatology', '', '', NULL, 'B', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', '8014298180', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', '8014298180', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2030-01-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1750517736', 0, 'N', 1, '2014-07-22', NULL, NULL, 0, 0, NULL, NULL),
('820277763', 'W12047824', 'W12047824', 'ID01', 'Norco', '', '', 'Norco', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', '2324 Caldwell Blvd', 'Nampa', 'Canyon', 'ID', '83651', '2084673070', '2084673317', '2324 Caldwell Blvd', 'Nampa', 'Canyon', 'ID', '83651', '2084673070', '2084673317', 'DMECURRENT', '', '', '0.00', '35.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1326109059', 0, 'N', 0, '2014-05-15', NULL, NULL, 0, 0, NULL, NULL),
('820277763', 'W12047825', 'W12047825', 'ID01', 'Norco', '', '', 'Norco', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', '2882 N Eagle Rd', 'Meridian', 'Ada', 'ID', '83646', '2088980202', '2088882266', '2882 N Eagle Rd', 'Meridian', 'Ada', 'ID', '83646', '2088980202', '2088882266', 'DMECURRENT', '', '', '0.00', '35.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1326109059', 0, 'N', 0, '2014-05-15', NULL, NULL, 0, 0, NULL, NULL),
('820277763', 'W12047826', 'W12047826', 'ID01', 'Norco', '', '', 'Norco', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', '315 E Elm St', 'Caldwell', 'Canyon', 'ID', '83605', '2084020100', '2084020103', '315 E Elm St', 'Caldwell', 'Canyon', 'ID', '83605', '2084020100', '2084020103', 'DMECURRENT', '', '', '0.00', '35.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1326109059', 0, 'N', 0, '2014-05-15', NULL, NULL, 0, 0, NULL, NULL),
('820277763', 'W12047827', 'W12047827', 'ID01', 'Norco', '', '', 'Norco', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', '340 S Main', 'Mountain Home', 'Elmore', 'ID', '83647', '2085871177', '2085872277', '340 S Main', 'Mountain Home', 'Elmore', 'ID', '83647', '2085871177', '2085872277', 'DMECURRENT', '', '', '0.00', '35.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1326109059', 0, 'N', 0, '2014-05-15', NULL, NULL, 0, 0, NULL, NULL),
('820277763', 'W12047828', 'W12047828', 'ID01', 'Norco', '', '', 'Norco', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', '400 Main St', 'Boise', 'Ada', 'ID', '83702', '2083440299', '2083444327', '400 Main St', 'Boise', 'Ada', 'ID', '83702', '2083440299', '2083444327', 'DMECURRENT', '', '', '0.00', '35.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1326109059', 0, 'N', 0, '2014-05-15', NULL, NULL, 0, 0, NULL, NULL),
('820277763', 'W12047829', 'W12047829', 'ID01', 'Norco', '', '', 'Norco', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'B', 'PO Box 15299', 'Boise', 'Ada', 'ID', '83715', '2084673070', '2084673317', 'PO Box 15299', 'Boise', 'Ada', 'ID', '83715', '2084673070', '2084673317', 'DMECURRENT', '', '', '0.00', '35.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1326109059', 0, 'N', 0, '2014-05-15', NULL, NULL, 0, 0, NULL, NULL),
('820277763', 'W12047830', 'W12047830', 'Sinclair', 'Norco', '', '', 'Norco', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', '198 N Overland', 'Burley', 'Cassia', 'ID', '83318', '2086788558', '2086789344', '198 N Overland', 'Burley', 'Cassia', 'ID', '83318', '2086788558', '2086789344', 'DMECURRENT', '', '', '0.00', '35.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1326109059', 0, 'N', 0, '2014-05-15', NULL, NULL, 0, 0, NULL, NULL),
('820277763', 'W12047831', 'W12047831', 'Sinclair', 'Norco', '', '', 'Norco', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', '203 S Park', 'Twin Falls', 'Twin Falls', 'ID', '83301', '2087338171', '2087338177', '203 S Park', 'Twin Falls', 'Twin Falls', 'ID', '83301', '2087338171', '2087338177', 'DMECURRENT', '', '', '0.00', '35.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1326109059', 0, 'N', 0, '2014-05-15', NULL, NULL, 0, 0, NULL, NULL),
('820277763', 'W12047832', 'W12047832', 'Sinclair', 'Norco', '', '', 'Norco', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', '2076 Century Way', 'Boise', 'Ada', 'ID', '83709', '2083754150', '2083223971', '2076 Century Way', 'Boise', 'Ada', 'ID', '83709', '2083754150', '2083223971', 'DMECURRENT', '', '', '0.00', '35.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1326109059', 0, 'N', 0, '2014-05-15', NULL, NULL, 0, 0, NULL, NULL),
('820277763', 'W12047833', 'W12047833', 'Sinclair', 'Norco', '', '', 'Norco', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', '2150 E Fairview Ave', 'Lake Montezuma', 'Yavapai', 'AZ', '86342', '2088980202', '2088882266', '2150 E Fairview Ave', 'Lake Montezuma', 'Yavapai', 'AZ', '86342', '2088980202', '2088882266', 'DMECURRENT', '', '', '0.00', '35.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1326109059', 0, 'N', 0, '2014-05-15', NULL, NULL, 0, 0, NULL, NULL),
('820277763', 'W12047834', 'W12047834', 'Sinclair', 'Norco', '', '', 'Norco', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', '400 Main St', 'Boise', 'Ada', 'ID', '83702', '2083440299', '2083444327', '400 Main St', 'Boise', 'Ada', 'ID', '83702', '2083440299', '2083444327', 'DMECURRENT', '', '', '0.00', '35.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1326109059', 0, 'N', 0, '2014-05-15', NULL, NULL, 0, 0, NULL, NULL),
('820277763', 'W12047835', 'W12047835', 'Sinclair', 'Norco', '', '', 'Norco', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', '573 Addison Ave', 'Twin Falls', 'Twin Falls', 'ID', '83301', '2087349330', '2087349014', '573 Addison Ave', 'Twin Falls', 'Twin Falls', 'ID', '83301', '2087349330', '2087349014', 'DMECURRENT', '', '', '0.00', '35.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1326109059', 0, 'N', 0, '2014-05-15', NULL, NULL, 0, 0, NULL, NULL),
('820277763', 'W12047836', 'W12047836', 'ID01', 'Norco', '', '', 'Norco', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', '400 Main St', 'Boise', 'Ada', 'ID', '83702', '2083440299', '2083444327', '400 Main St', 'Boise', 'Ada', 'ID', '83702', '2083440299', '2083444327', 'DMECURRENT', '', '', '0.00', '35.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1902960396', 0, 'N', 0, '2014-05-15', NULL, NULL, 0, 0, NULL, NULL),
('820277763', 'W12047837', 'W12047837', 'ID01', 'Norco', '', '', 'Norco', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', '400 SE 10th St', 'Ontario', 'Malheur', 'OR', '97914', '5418899327', '5418892669', '400 SE 10th St', 'Ontario', 'Malheur', 'OR', '97914', '5418899327', '5418892669', 'DMECURRENT', '', '', '0.00', '35.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1902960396', 0, 'N', 0, '2014-05-15', NULL, NULL, 0, 0, NULL, NULL),
('820277763', 'W12047838', 'W12047838', 'ID01', 'Norco', '', '', 'Norco', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', '315 E Elm St', 'Caldwell', 'Canyon', 'ID', '83605', '2084020100', '2084020103', '315 E Elm St', 'Caldwell', 'Canyon', 'ID', '83605', '2084020100', '2084020103', 'DMECURRENT', '', '', '0.00', '35.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1932263597', 0, 'N', 0, '2014-05-15', NULL, NULL, 0, 0, NULL, NULL),
('870443046', 'W12047840', 'W12047840', 'UT01', 'Universtiy of Utah Health Care Girls Transition Center', '', '', 'Universtiy of Utah Health Care Girls Transition Center', '', 'Psychiatry', '', '', NULL, 'O', '51 W 3900 S', 'Murray', 'Salt Lake', 'UT', '84107', '8015832500', '          ', '51 W 3900 S', 'Murray', 'Salt Lake', 'UT', '84107', '8015832500', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2014-05-13', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000010169', 0, 'N', 0, '2014-05-15', NULL, NULL, 0, 0, NULL, NULL),
('870443046', 'W12047841', 'W12047841', 'UT01', 'Universtiy of Utah Health Care Girls Transition Center', '', '', 'Universtiy of Utah Health Care Girls Transition Center', '', 'Psychiatry', '', '', NULL, 'B', 'PO Box 413029', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8015832500', '          ', 'PO Box 413029', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8015832500', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2014-05-13', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000010169', 0, 'N', 0, '2014-05-15', NULL, NULL, 0, 0, NULL, NULL),
('820254234', 'W12047842', 'W12047842', 'ID02', 'Brownfields Prosthetic and Orthotics Technologies', '', '', 'Brownfields Prosthetic and Orthotics Technologies', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', '122 N 5th St', 'Boise', 'Ada', 'ID', '83702', '2083424659', '          ', '122 N 5th St', 'Boise', 'Ada', 'ID', '83702', '2083424659', '          ', 'ID100DMECUR', '', '', '0.00', '25.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1932166212', 0, 'N', 0, '2014-05-15', NULL, NULL, 0, 0, NULL, NULL),
('061787631', 'W12047845', 'W12047845', 'UT01', 'MountainStar General Surgery', 'Ian', 'R', 'Cavin', 'DO', 'General Surgery', '', '', NULL, 'O', '4000 S 700 E Ste 9', 'Murray', 'Salt Lake', 'UT', '84107', '8012623564', '8012623613', '4000 S 700 E Ste 9', 'Murray', 'Salt Lake', 'UT', '84107', '8012623564', '8012623613', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-07-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1184647315', 0, 'N', 0, '2014-05-15', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12047844', 'W12047844', 'IDBOISTD', 'Saint Alphonsus Medical Group OBGYN Mulvaney', 'Shashi', '', 'Ajmani', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1072 N Liberty Ste 100', 'Boise', 'Ada', 'ID', '83704', '2083674224', '2083677806', '1072 N Liberty Ste 100', 'Boise', 'Ada', 'ID', '83704', '2083674224', '2083677806', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2014-05-15', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1740255504', 0, 'N', 0, '2014-05-19', NULL, NULL, 0, 0, NULL, NULL),
('061787631', 'W12047846', 'W12047846', 'UT01', 'MountainStar General Surgery', 'Ian', 'R', 'Cavin', 'DO', 'General Surgery', '', '', NULL, 'O', '74 Kimballs Ln Ste 210', 'Draper', 'Salt Lake', 'UT', '84020', '8015663062', '8015018219', '74 Kimballs Ln Ste 210', 'Draper', 'Salt Lake', 'UT', '84020', '8015663062', '8015018219', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-07-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1184647315', 0, 'N', 0, '2014-05-15', NULL, NULL, 0, 0, NULL, NULL),
('061787631', 'W12047847', 'W12047847', 'UT01', 'MountainStar General Surgery', 'Ian', 'R', 'Cavin', 'DO', 'General Surgery', '', '', NULL, 'O', '8846 S Redwood Rd Ste E121', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015691999', '          ', '8846 S Redwood Rd Ste E121', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015691999', '          ', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-07-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1184647315', 0, 'N', 0, '2014-05-15', NULL, NULL, 0, 0, NULL, NULL),
('061787631', 'W12047848', 'W12047848', 'UT01', 'MountainStar General Surgery', 'Ian', 'R', 'Cavin', 'DO', 'General Surgery', '', '', NULL, 'B', 'PO Box 100253', 'Atlanta', 'Fulton', 'GA', '30384', '8006613365', '          ', 'PO Box 100253', 'Atlanta', 'Fulton', 'GA', '30384', '8006613365', '          ', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-07-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1184647315', 0, 'Y', 0, '2014-05-15', NULL, NULL, 0, 0, NULL, NULL),
('061787631', 'W12047849', 'W12047849', 'UT01', 'MountainStar General Surgery', 'Charles', 'R', 'Davis', 'MD', 'General Surgery', '', '', NULL, 'O', '4000 S 700 E Ste 9', 'Murray', 'Salt Lake', 'UT', '84107', '8012623564', '8012623613', '4000 S 700 E Ste 9', 'Murray', 'Salt Lake', 'UT', '84107', '8012623564', '8012623613', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-07-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1326136565', 0, 'N', 0, '2014-05-15', NULL, NULL, 0, 0, NULL, NULL),
('061787631', 'W12047850', 'W12047850', 'UT01', 'MountainStar General Surgery', 'Charles', 'R', 'Davis', 'MD', 'General Surgery', '', '', NULL, 'O', '74 Kimballs Ln', 'Draper', 'Salt Lake', 'UT', '84020', '8015663062', '8015018219', '74 Kimballs Ln', 'Draper', 'Salt Lake', 'UT', '84020', '8015663062', '8015018219', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-07-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1326136565', 0, 'N', 0, '2014-05-15', NULL, NULL, 0, 0, NULL, NULL),
('061787631', 'W12047851', 'W12047851', 'UT01', 'MountainStar General Surgery', 'Charles', 'R', 'Davis', 'MD', 'General Surgery', '', '', NULL, 'O', '8846 S Redwood Rd Ste E121', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015691999', '          ', '8846 S Redwood Rd Ste E121', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015691999', '          ', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-07-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1326136565', 0, 'N', 0, '2014-05-15', NULL, NULL, 0, 0, NULL, NULL),
('061787631', 'W12047852', 'W12047852', 'UT01', 'MountainStar General Surgery', 'Charles', 'R', 'Davis', 'MD', 'General Surgery', '', '', NULL, 'B', 'PO Box 100253', 'Atlanta', 'Fulton', 'GA', '30384', '8015663062', '          ', 'PO Box 100253', 'Atlanta', 'Fulton', 'GA', '30384', '8015663062', '          ', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-07-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1326136565', 0, 'N', 0, '2014-05-15', NULL, NULL, 0, 0, NULL, NULL),
('061787631', 'W12047853', 'W12047853', 'UT01', 'MountainStar General Surgery', 'Alfonso', '', 'Preciado', 'MD', 'General Surgery', '', '', NULL, 'O', '4000 S 700 E Ste 9', 'Murray', 'Salt Lake', 'UT', '84107', '8012623564', '8669581297', '4000 S 700 E Ste 9', 'Murray', 'Salt Lake', 'UT', '84107', '8012623564', '8669581297', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-07-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', '', '', '', 'HCFA|UB|', '1962401315', 0, 'N', 0, '2014-05-15', NULL, NULL, 0, 0, NULL, NULL),
('061787631', 'W12047854', 'W12047854', 'UT01', 'MountainStar General Surgery', 'Alfonso', '', 'Preciado', 'MD', 'General Surgery', '', '', NULL, 'O', '74 Kimballs Ln Ste 210', 'Draper', 'Salt Lake', 'UT', '84020', '8015663062', '8015018219', '74 Kimballs Ln Ste 210', 'Draper', 'Salt Lake', 'UT', '84020', '8015663062', '8015018219', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-07-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', '', '', '', 'HCFA|UB|', '1962401315', 0, 'N', 0, '2014-05-15', NULL, NULL, 0, 0, NULL, NULL),
('061787631', 'W12047855', 'W12047855', 'UT01', 'MountainStar General Surgery', 'Alfonso', '', 'Preciado', 'MD', 'General Surgery', '', '', NULL, 'B', 'PO Box 100253', 'Atlanta', 'Fulton', 'GA', '30384', '8006613365', '          ', 'PO Box 100253', 'Atlanta', 'Fulton', 'GA', '30384', '8006613365', '          ', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-07-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', '', '', '', 'HCFA|UB|', '1962401315', 0, 'N', 0, '2014-05-15', NULL, NULL, 0, 0, NULL, NULL),
('061787631', 'W12047856', 'W12047856', 'UT01', 'MountainStar General Surgery', 'Hugh', 'D', 'Voorhees', 'MD', 'General Surgery', '', '', NULL, 'O', '4000 S 700 E Ste 9', 'Murray', 'Salt Lake', 'UT', '84107', '8012623564', '8012623613', '4000 S 700 E Ste 9', 'Murray', 'Salt Lake', 'UT', '84107', '8012623564', '8012623613', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-07-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1346354537', 0, 'N', 0, '2014-05-15', NULL, NULL, 0, 0, NULL, NULL),
('061787631', 'W12047857', 'W12047857', 'UT01', 'MountainStar General Surgery', 'Hugh', 'D', 'Voorhees', 'MD', 'General Surgery', '', '', NULL, 'O', '8846 S Redwood Rd Ste E121', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015691999', '          ', '8846 S Redwood Rd Ste E121', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015691999', '          ', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-07-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1346354537', 0, 'N', 0, '2014-05-15', NULL, NULL, 0, 0, NULL, NULL),
('061787631', 'W12047858', 'W12047858', 'UT01', 'MountainStar General Surgery', 'Hugh', 'D', 'Voorhees', 'MD', 'General Surgery', '', '', NULL, 'B', 'PO Box 100253', 'Atlanta', 'Fulton', 'GA', '30384', '8015663062', '          ', 'PO Box 100253', 'Atlanta', 'Fulton', 'GA', '30384', '8015663062', '          ', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-07-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1346354537', 0, 'N', 0, '2014-05-15', NULL, NULL, 0, 0, NULL, NULL),
('870618816', 'W12047861', 'W12047861', 'UT01', 'Petersen Medical', '', '', 'Orem Branch Location', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', '325 E University Pkwy', 'Orem', 'Utah', 'UT', '84058', '8013748101', '          ', '325 E University Pkwy', 'Orem', 'Utah', 'UT', '84058', '8013748101', '          ', 'DME75CURR', '', '', '0.00', '40.00', '0.00', 3, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1164519856', 0, 'N', 0, '2014-05-16', NULL, NULL, 0, 0, NULL, NULL),
('870354442', 'W12047865', 'W12047865', 'UT01', 'Rocky Mountain Womens Health Center ', 'Jared ', 'C', 'Martin', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1580 W Antelope Dr Ste 290', 'Layton', 'Davis', 'UT', '84041', '8017760880', '8017737399', '1580 W Antelope Dr Ste 290', 'Layton', 'Davis', 'UT', '84041', '8017760880', '8017737399', 'WUSTDSURG5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-06-01', NULL, 0, 0, 0, 'Davis Hospital', '', '', '', 'HCFA|UB|', '1639499783', 0, 'N', 0, '2014-06-17', NULL, NULL, 0, 0, NULL, NULL),
('870354442', 'W12047866', 'W12047866', 'UT01', 'Rocky Mountain Womens Health Center ', 'Jared ', 'C', 'Martin', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 844839', 'Dallas', 'Dallas', 'TX', '75284', '8016145271', '          ', 'PO Box 844839', 'Dallas', 'Dallas', 'TX', '75284', '8016145271', '          ', 'WUSTDSURG5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-06-01', NULL, 0, 0, 0, 'Davis Hospital', '', '', '', 'HCFA|UB|', '1639499783', 0, 'N', 0, '2014-06-17', NULL, NULL, 0, 0, NULL, NULL),
('272752875', 'W12048116', 'W12048116', 'UT01', 'Hofmann Arthritis Institute PLLC', 'John', '', 'Lewis', '', 'Physical Therapy', '', '', NULL, 'O', '24 S 1100 E Ste 101', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013556468', '8013553450', '24 S 1100 E Ste 101', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013556468', '8013553450', 'WestRehab', '', '', '0.00', '0.00', '73.00', 6, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1194913491', 0, 'N', 1, '2014-05-28', NULL, NULL, 0, 0, NULL, NULL),
('260553931', 'W12047874', 'W12047874', 'IDBOISTD', 'Saint Alphonsus Medical Group Trauma Services Boise', 'Carlos', 'E', 'Justiniano', 'MD', 'General Surgery', 'Critical Care', '', NULL, 'O', '999 N Curtis Rd Ste 407', 'Boise', 'Ada', 'ID', '83706', '2083677676', '2083676849', '999 N Curtis Rd Ste 407', 'Boise', 'Ada', 'ID', '83706', '2083677676', '2083676849', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2014-05-19', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1265629554', 0, 'N', 0, '2014-06-11', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12047876', 'W12047876', 'IDBOISTD', 'Saint Alphonsus Medical Group Neurology Mulvaney', 'Catherine', 'H', 'Wuthrich', 'MD', 'Neurology', '', '', NULL, 'O', '1072 N Liberty St Ste 303', 'Boise', 'Ada', 'ID', '83706', '2083672800', '2083677111', '1072 N Liberty St Ste 303', 'Boise', 'Ada', 'ID', '83706', '2083672800', '2083677111', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2014-05-19', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1477745842', 0, 'N', 0, '2014-06-11', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12047878', 'W12047878', 'IDBOISTD', 'Saint Alphonsus Medical Group Boise Pediatrics Mulvaney', 'Jakeb', 'K', 'Searle', 'PA-C', 'Family Practice', '', '', NULL, 'O', '1072 N Liberty Ste 203', 'Boise', 'Ada', 'ID', '83704', '2083674321', '2083674525', '1072 N Liberty Ste 203', 'Boise', 'Ada', 'ID', '83704', '2083674321', '2083674525', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2014-05-19', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1801142146', 0, 'N', 0, '2014-05-19', 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
('820200895', 'W12047879', 'W12047879', 'IDBOISTD', 'Saint Alphonsus Medical Group Express Care Carrington', 'Jakeb', 'K', 'Searle', 'PA-C', 'Family Practice', '', '', NULL, 'O', '1122 N Liberty Rd', 'Boise', 'Ada', 'ID', '83704', '2083672032', '2083672033', '1122 N Liberty Rd', 'Boise', 'Ada', 'ID', '83704', '2083672032', '2083672033', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2014-05-19', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1801142146', 0, 'N', 0, '2014-05-19', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12047881', 'W12047881', 'IDBOISTD', 'Saint Alphonsus Medical Group Express Clinics', 'Jakeb', 'K', 'Searle', 'PA-C', 'Family Practice', '', '', NULL, 'O', '1515 W State St', 'Boise', 'Ada', 'ID', '83702', '2083456768', '          ', '1515 W State St', 'Boise', 'Ada', 'ID', '83702', '2083456768', '          ', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2014-05-19', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1801142146', 0, 'N', 0, '2014-05-19', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12047882', 'W12047882', 'IDBOISTD', 'Saint Alphonsus Medical Group MHP Family Medicine', 'Jakeb', 'K', 'Searle', 'PA-C', 'Family Practice', '', '', NULL, 'O', '3025 W Cherry Ln Ste B', 'Meridian', 'Ada', 'ID', '83642', '2083678550', '2083678555', '3025 W Cherry Ln Ste B', 'Meridian', 'Ada', 'ID', '83642', '2083678550', '2083678555', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2014-05-19', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1801142146', 0, 'N', 0, '2014-05-19', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12047883', 'W12047883', 'IDBOISTD', 'Saint Alphonsus Medical Group Elm Family Medicine', 'Jakeb', 'K', 'Searle', 'PA-C', 'Family Practice', '', '', NULL, 'O', '315 E Elm St Ste 100', 'Caldwell', 'Canyon', 'ID', '83605', '2084597415', '2084533307', '315 E Elm St Ste 100', 'Caldwell', 'Canyon', 'ID', '83605', '2084597415', '2084533307', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2014-05-19', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1801142146', 0, 'N', 0, '2014-05-19', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12047884', 'W12047884', 'IDBOISTD', 'Saint Alphonsus Medical Group Oasis Medical Clinic', 'Jakeb', 'K', 'Searle', 'PA-C', 'Family Practice', '', '', NULL, 'O', '3217 W Bavaria St', 'Eagle', 'Ada', 'ID', '83616', '2082866676', '2089473419', '3217 W Bavaria St', 'Eagle', 'Ada', 'ID', '83616', '2082866676', '2089473419', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2014-05-19', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1801142146', 0, 'N', 0, '2014-05-19', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12047885', 'W12047885', 'IDBOISTD', 'Saint Alphonsus Medical Group NHP Family Medicine  ', 'Jakeb', 'K', 'Searle', 'PA-C', 'Family Practice', '', '', NULL, 'O', '4400 E Flamingo Ave', 'Nampa', 'Canyon', 'ID', '83687', '2084656970', '2084656910', '4400 E Flamingo Ave', 'Nampa', 'Canyon', 'ID', '83687', '2084656970', '2084656910', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2014-05-19', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1801142146', 0, 'N', 0, '2014-05-19', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12047886', 'W12047886', 'IDBOISTD', 'Saint Alphonsus Express Care Inc', 'Jakeb', 'K', 'Searle', 'PA-C', 'Family Practice', '', '', NULL, 'O', '4700 N Eagle Rd', 'Boise', 'Ada', 'ID', '83713', '2089384797', '2083674765', '4700 N Eagle Rd', 'Boise', 'Ada', 'ID', '83713', '2089384797', '2083674765', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2014-05-19', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1801142146', 0, 'N', 0, '2014-05-19', NULL, NULL, 0, 0, NULL, NULL),
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('521486235', 'W12047990', 'W12047990', 'UT01', 'Hanger Clinic', '', '', 'Hanger Clinic', '', 'Durable Medical Equipment', '', '', NULL, 'O', '1660 W Antelope Dr Ste 120', 'Layton', 'Davis', 'UT', '84041', '8019172870', '8017766573', '1660 W Antelope Dr Ste 120', 'Layton', 'Davis', 'UT', '84041', '8019172870', '8017766573', 'DMECURRENT', '', '', '0.00', '35.00', '0.00', 3, '2014-05-21', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1942630686', 0, 'N', 0, '2014-05-22', NULL, NULL, 0, 0, NULL, NULL),
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('521486235', 'W12047997', 'W12047997', 'UT01', 'Hanger Clinic', '', '', 'Hanger Clinic', '', 'Durable Medical Equipment', '', '', NULL, 'O', '5292 S College Dr Ste 103', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8012667768', '8012669570', '5292 S College Dr Ste 103', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8012667768', '8012669570', 'DMECURRENT', '', '', '0.00', '35.00', '0.00', 3, '2014-05-21', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1417066333', 0, 'N', 0, '2014-05-22', NULL, NULL, 0, 0, NULL, NULL),
('521486235', 'W12047999', 'W12047999', 'UT01', 'Hanger Clinic', '', '', 'Hanger Clinic', '', 'Durable Medical Equipment', '', '', NULL, 'O', '887 E Vine St', 'Murray', 'Salt Lake', 'UT', '84107', '8012938777', '8012930231', '887 E Vine St', 'Murray', 'Salt Lake', 'UT', '84107', '8012938777', '8012930231', 'DMECURRENT', '', '', '0.00', '35.00', '0.00', 3, '2014-05-21', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1255608501', 0, 'N', 0, '2014-05-22', NULL, NULL, 0, 0, NULL, NULL),
('521486235', 'W12048001', 'W12048001', 'UT01', 'Hanger Clinic', '', '', 'Hanger Clinic', '', 'Durable Medical Equipment', '', '', NULL, 'O', '630 S 400 E Ste 102', 'St George', 'Washington', 'UT', '84770', '4356736449', '4356732619', '630 S 400 E Ste 102', 'St George', 'Washington', 'UT', '84770', '4356736449', '4356732619', 'DMECURRENT', '', '', '0.00', '35.00', '0.00', 3, '2014-05-21', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1841214210', 0, 'N', 0, '2014-05-22', NULL, NULL, 0, 0, NULL, NULL),
('464124474', 'W12047988', 'W12047988', 'UTMH1', 'Northern Utah Counseling', '', '', 'Northern Utah Counseling', '', 'Mental Health Facility', '', '', NULL, 'O', '1387 W 1800 N', 'Clearfield', 'Davis', 'UT', '84015', '8017790095', '8017790255', '1387 W 1800 N', 'Clearfield', 'Davis', 'UT', '84015', '8017790095', '8017790255', 'NOUTCSLG', '', '', '0.00', '100.00', '0.00', 3, '2013-12-02', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1073640322', 0, 'N', 0, '2014-05-22', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12048003', 'W12048003', 'UTIHC04', 'Cleft Palate Clinic', 'Jeremy', 'D', 'Meier', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '100 N Mario Capecchi Dr Ste 4500', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621742', '          ', '100 N Mario Capecchi Dr Ste 4500', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621742', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2013-06-19', NULL, 0, 0, 0, 'Primary Childrens Medical Center', '', '', '', 'HCFA|UB|', '1225012610', 0, 'N', 0, '2014-05-22', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12048004', 'W12048004', 'UTIHC04', 'Cleft Palate Clinic', 'Jeremy', 'D', 'Meier', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '736 S 900 E Ste 107', 'St George', 'Washington', 'UT', '84790', '4352512888', '          ', '736 S 900 E Ste 107', 'St George', 'Washington', 'UT', '84790', '4352512888', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2013-06-19', NULL, 0, 0, 0, 'Primary Childrens Medical Center', '', '', '', 'HCFA|UB|', '1225012610', 0, 'N', 0, '2014-05-22', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12048005', 'W12048005', 'UTIHC04', '', 'Creekpaum', 'M', 'Stephanie', 'PSYD', 'Psychology', '', '', NULL, 'O', '675 E 500 S Ste 300', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8016625592', '          ', '675 E 500 S Ste 300', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8016625592', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2014-04-28', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1114237765', 0, 'N', 0, '2014-05-22', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12048006', 'W12048006', 'UTIHC04', '', 'Heather', 'A', 'Darling', 'APRN', 'Advanced Practice Registered Nurse', '', '', NULL, 'O', '5445 S Highland Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '4356587880', '          ', '5445 S Highland Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '4356587880', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2014-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1043561368', 0, 'N', 0, '2014-05-22', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12048007', 'W12048007', 'UTIHC04', 'Cleft Palate Clinic', 'Barbu', 'R', 'Gociman', 'MD', 'Plastic Surgery', '', '', NULL, 'O', '736 S 900 E Ste 107', 'St George', 'Washington', 'UT', '84790', '4352512888', '          ', '736 S 900 E Ste 107', 'St George', 'Washington', 'UT', '84790', '4352512888', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1396900841', 0, 'N', 0, '2014-05-22', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12048008', 'W12048008', 'UTIHC04', '', 'Rudolf', '', 'Otrusinik', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '905 N 1000 W', 'Tremonton', 'Box Elder', 'UT', '84337', '4352577441', '          ', '905 N 1000 W  ', 'Tremonton', 'Box Elder', 'UT', '84337', '4352577441', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2014-01-01', NULL, 0, 0, 0, 'Logan Regional Hospital', '', '', '', 'HCFA|UB|', '1003922394', 0, 'N', 0, '2014-05-22', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12048010', 'W12048010', 'UTIHC04', '', 'Gerald', 'Ira', 'Polukoff', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '905 N 1000 W', 'Tremonton', 'Box Elder', 'UT', '84337', '4352577441', '0000000000', '905 N 1000 W', 'Tremonton', 'Box Elder', 'UT', '84337', '4352577441', '0000000000', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2014-01-01', NULL, 0, 0, 0, 'Logan Regional Hospital', '', '', '', 'HCFA|UB|', '1215020045', 0, 'N', 0, '2014-05-22', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12048011', 'W12048011', 'UTIHC04', '', 'William', 'L', 'Saul', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '905 N 1000 W', 'Tremonton', 'Box Elder', 'UT', '84337', '4352577441', '          ', '905 N 1000 W  ', 'Tremonton', 'Box Elder', 'UT', '84337', '4352577441', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2014-01-01', NULL, 0, 0, 0, 'Logan Regional Hospital', '', '', '', 'HCFA|UB|', '1255447538', 0, 'N', 0, '2014-05-22', NULL, NULL, 0, 0, NULL, NULL),
('841617523', 'W12048118', 'W12048118', 'NM01', 'Northside Family Medicine', 'Rebecca ', 'L', 'Wittenburg', 'CFNP', 'Family Practice', '', '', NULL, 'O', '6100 Pan American Fwy NE Ste 390', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058231805', '5058231844', '6100 Pan American Fwy NE Ste 390', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058231805', '5058231844', 'NMSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1417000878', 0, 'N', 1, '2014-06-18', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12048012', 'W12048012', 'UTIHC04', 'Kidney Transplant', 'Joseph', 'R', 'Sherbotie', 'MD', 'Pediatrics', 'Pediatric Nephrology', '', NULL, 'O', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016626801', '          ', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016626801', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2014-05-01', NULL, 0, 0, 0, 'University Health Care University Hospital', '', '', '', 'HCFA|UB|', '1205915873', 0, 'N', 0, '2014-05-22', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12048013', 'W12048013', 'UTIHC04', '', 'Kirk', 'A', 'Simon', 'MD', 'Mental Health', 'Psychiatry', '', NULL, 'O', '5770 S 1500 W Ste C', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8013137954', '          ', '5770 S 1500 W Ste C', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8013137954', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1043399611', 0, 'N', 0, '2014-06-18', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12048016', 'W12048016', 'WYBILLINGS', 'Billings Clinic', 'Michael', 'B', 'Hill', 'MD', 'General Surgery', '', '', NULL, 'B', 'PO Box 31315', 'Billings', 'Yellowstone', 'MT', '59107', '4062382617', '0000000000', 'PO Box 31315', 'Billings', 'Yellowstone', 'MT', '59107', '4062382617', '0000000000', '', '', '', '0.00', '17.00', '0.00', 3, '2014-05-07', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1962636167', 0, 'N', 0, '2014-05-22', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12048018', 'W12048018', 'WYBILLINGS', 'Billings Clinic - General Surgery', 'Michael', 'B', 'Hill', 'MD', 'General Surgery', '', '', NULL, 'O', '801 N 29th St', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062382848', '801 N 29th St', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062382848', '', '', '', '0.00', '17.00', '0.00', 3, '2014-05-07', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1962636167', 0, 'N', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12048017', 'W12048017', 'WYBILLINGS', 'Billings Clinic', 'Michael', 'B', 'Hill', 'MD', 'General Surgery', '', '', NULL, 'M', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', '0000000000', '0000000000', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', '0000000000', '0000000000', '', '', '', '0.00', '17.00', '0.00', 3, '2014-05-07', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1962636167', 0, 'N', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12048020', 'W12048020', 'WYBILLINGS', 'Billings Clinic - Dietary', 'Taryn', 'A', 'Palmer', 'RD', 'Dietician', '', '', NULL, 'B', '2800 10th Ave N', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4066574349', '2800 10th Ave N', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4066574349', '', '', '', '0.00', '17.00', '0.00', 3, '2014-05-12', '2014-05-12', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1669817482', 0, 'N', 0, '2014-06-18', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12048021', 'W12048021', 'WYBILLINGS', 'Billings Clinic', 'Taryn', 'A', 'Palmer', 'RD', 'Dietician', '', '', NULL, 'B', 'PO Box 31315', 'Billings', 'Yellowstone', 'MT', '59107', '4062382617', '0000000000', 'PO Box 31315', 'Billings', 'Yellowstone', 'MT', '59107', '4062382617', '0000000000', '', '', '', '0.00', '17.00', '0.00', 3, '2014-05-12', '2014-05-12', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1669817482', 0, 'N', 0, '2014-06-18', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12048022', 'W12048022', 'WYBILLINGS', 'Billings Clinic', 'Taryn', 'A', 'Palmer', 'RD', 'Dietician', '', '', NULL, 'M', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', '0000000000', '0000000000', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', '0000000000', '0000000000', '', '', '', '0.00', '17.00', '0.00', 3, '2014-05-12', '2014-05-12', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1669817482', 0, 'N', 0, '2014-06-18', NULL, NULL, 0, 0, NULL, NULL),
('203125761', 'W12048023', 'W12048023', 'WY01', 'Blair Investments', 'Lewis', '', 'Benedict', 'PT', 'Physical Therapy', '', '', NULL, 'O', '1331 Prairie Ave Ste 6', 'Cheyenne', 'Laramie', 'WY', '82001', '3076374617', '3076373568', '1331 Prairie Ave Ste 6', 'Cheyenne', 'Laramie', 'WY', '82001', '3076374617', '3076373568', '', '', '', '0.00', '0.00', '125.00', 3, '2014-05-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1417269457', 0, 'N', 0, '2014-05-22', 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
('203125761', 'W12048024', 'W12048024', 'WY01', 'Blair Investments', 'Lewis', '', 'Benedict', 'PT', 'Physical Therapy', '', '', NULL, 'O', '4016 Laramie St', 'Cheyenne', 'Laramie', 'WY', '82009', '3076374617', '3076373568', '4016 Laramie St', 'Cheyenne', 'Laramie', 'WY', '82009', '3076374617', '3076373568', '', '', '', '0.00', '0.00', '125.00', 3, '2014-05-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1417269457', 0, 'N', 0, '2014-05-22', NULL, NULL, 0, 0, NULL, NULL),
('203125761', 'W12048025', 'W12048025', 'WYT1', 'Blair Investments', 'Lewis', '', 'Benedict', 'PT', 'Physical Therapy', '', '', NULL, 'O', '1331 Prairie Ave Ste 6', 'Cheyenne', 'Laramie', 'WY', '82001', '3076374617', '3076373568', '1331 Prairie Ave Ste 6', 'Cheyenne', 'Laramie', 'WY', '82001', '3076374617', '3076373568', '', '', '', '0.00', '0.00', '125.00', 3, '2014-05-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1417269457', 0, 'N', 0, '2014-05-22', NULL, NULL, 0, 0, NULL, NULL),
('203125761', 'W12048026', 'W12048026', 'WYT1', 'Blair Investments', 'Lewis', '', 'Benedict', 'PT', 'Physical Therapy', '', '', NULL, 'O', '4016 Laramie St', 'Cheyenne', 'Laramie', 'WY', '82009', '3076374617', '3076373568', '4016 Laramie St', 'Cheyenne', 'Laramie', 'WY', '82009', '3076374617', '3076373568', '', '', '', '0.00', '0.00', '125.00', 3, '2014-05-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1417269457', 0, 'N', 0, '2014-05-22', NULL, NULL, 0, 0, NULL, NULL),
('203125761', 'W12048027', 'W12048027', 'WY01', 'Blair Investments', 'Jonathan', 'R', 'Claude', 'PT', 'Physical Therapy', '', '', NULL, 'M', '1347 S Wisconsin Ave', 'Casper', 'Natrona', 'WY', '82609', '0000000000', '0000000000', '1347 S Wisconsin Ave', 'Casper', 'Natrona', 'WY', '82609', '0000000000', '0000000000', '', '', '', '0.00', '0.00', '125.00', 3, '2014-05-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1891946299', 0, 'N', 0, '2014-05-22', NULL, NULL, 0, 0, NULL, NULL),
('203125761', 'W12048028', 'W12048028', 'WY01', 'Blair Investments', 'Jonathan', 'R', 'Claude', 'PT', 'Physical Therapy', '', '', NULL, 'O', '3125 E Grand Ave', 'Laramie', 'Albany', 'WY', '82070', '3077423110', '3077214785', '3125 E Grand Ave', 'Laramie', 'Albany', 'WY', '82070', '3077423110', '3077214785', '', '', '', '0.00', '0.00', '125.00', 3, '2014-05-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1891946299', 0, 'N', 0, '2014-05-22', NULL, NULL, 0, 0, NULL, NULL),
('203125761', 'W12048029', 'W12048029', 'WYT1', 'Blair Investments', 'Jonathan', 'R', 'Claude', 'PT', 'Physical Therapy', '', '', NULL, 'M', '1347 S Wisconsin Ave', 'Casper', 'Natrona', 'WY', '82609', '0000000000', '0000000000', '1347 S Wisconsin Ave', 'Casper', 'Natrona', 'WY', '82609', '0000000000', '0000000000', '', '', '', '0.00', '0.00', '125.00', 3, '2014-05-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1891946299', 0, 'N', 0, '2014-05-22', NULL, NULL, 0, 0, NULL, NULL),
('203125761', 'W12048030', 'W12048030', 'WYT1', 'Blair Investments', 'Jonathan', 'R', 'Claude', 'PT', 'Physical Therapy', '', '', NULL, 'O', '3125 E Grand Ave', 'Laramie', 'Albany', 'WY', '82070', '3077423110', '3077214785', '3125 E Grand Ave', 'Laramie', 'Albany', 'WY', '82070', '3077423110', '3077214785', '', '', '', '0.00', '0.00', '125.00', 3, '2014-05-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1891946299', 0, 'N', 0, '2014-05-22', NULL, NULL, 0, 0, NULL, NULL),
('203125761', 'W12048031', 'W12048031', 'WY01', 'Blair Investments', 'Ken', '', 'Abbott', 'PT', 'Physical Therapy', '', '', NULL, 'O', '1331 Prairie Ave Ste 6', 'Cheyenne', 'Laramie', 'WY', '82001', '3076374617', '3076373568', '1331 Prairie Ave Ste 6', 'Cheyenne', 'Laramie', 'WY', '82001', '3076374617', '3076373568', '', '', '', '0.00', '0.00', '125.00', 3, '2014-05-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1609028844', 0, 'N', 0, '2014-05-22', NULL, NULL, 0, 0, NULL, NULL),
('203125761', 'W12048032', 'W12048032', 'WY01', 'Blair Investments', 'Ken', '', 'Abbott', 'PT', 'Physical Therapy', '', '', NULL, 'O', '4016 Laramie St', 'Cheyenne', 'Laramie', 'WY', '82009', '3076374617', '3076373568', '4016 Laramie St', 'Cheyenne', 'Laramie', 'WY', '82009', '3076374617', '3076373568', '', '', '', '0.00', '0.00', '125.00', 3, '2014-05-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1609028844', 0, 'N', 0, '2014-05-22', NULL, NULL, 0, 0, NULL, NULL),
('203125761', 'W12048033', 'W12048033', 'WYT1', 'Blair Investments', 'Ken', '', 'Abbott', 'PT', 'Physical Therapy', '', '', NULL, 'O', '1331 Prairie Ave Ste 6', 'Cheyenne', 'Laramie', 'WY', '82001', '3076374617', '3076373568', '1331 Prairie Ave Ste 6', 'Cheyenne', 'Laramie', 'WY', '82001', '3076374617', '3076373568', '', '', '', '0.00', '0.00', '125.00', 3, '2014-05-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1609028844', 0, 'N', 0, '2014-05-22', NULL, NULL, 0, 0, NULL, NULL),
('203125761', 'W12048034', 'W12048034', 'WYT1', 'Blair Investments', 'Ken', '', 'Abbott', 'PT', 'Physical Therapy', '', '', NULL, 'O', '4016 Laramie St', 'Cheyenne', 'Laramie', 'WY', '82009', '3076374617', '3076373568', '4016 Laramie St', 'Cheyenne', 'Laramie', 'WY', '82009', '3076374617', '3076373568', '', '', '', '0.00', '0.00', '125.00', 3, '2014-05-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1609028844', 0, 'N', 0, '2014-05-22', NULL, NULL, 0, 0, NULL, NULL),
('203125761', 'W12048035', 'W12048035', 'WY01', 'Blair Investments', 'Erin', '', 'Ver Burg', 'PT', 'Physical Therapy', '', '', NULL, 'O', '1331 Prairie Ave Ste 6', 'Cheyenne', 'Laramie', 'WY', '82001', '3076374617', '3076373568', '1331 Prairie Ave Ste 6', 'Cheyenne', 'Laramie', 'WY', '82001', '3076374617', '3076373568', '', '', '', '0.00', '0.00', '125.00', 3, '2014-05-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1366706830', 0, 'N', 0, '2014-05-22', NULL, NULL, 0, 0, NULL, NULL),
('203125761', 'W12048036', 'W12048036', 'WY01', 'Blair Investments', 'Erin', '', 'Ver Burg', 'PT', 'Physical Therapy', '', '', NULL, 'M', '1347 S Wisconsin Ave', 'Casper', 'Natrona', 'WY', '82609', '0000000000', '0000000000', '1347 S Wisconsin Ave', 'Casper', 'Natrona', 'WY', '82609', '0000000000', '0000000000', '', '', '', '0.00', '0.00', '125.00', 3, '2014-05-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1366706830', 0, 'N', 0, '2014-05-22', NULL, NULL, 0, 0, NULL, NULL),
('203125761', 'W12048037', 'W12048037', 'WY01', 'Blair Investments', 'Erin', '', 'Ver Burg', 'PT', 'Physical Therapy', '', '', NULL, 'O', '4016 Laramie St', 'Cheyenne', 'Laramie', 'WY', '82009', '3076374617', '3076373568', '4016 Laramie St', 'Cheyenne', 'Laramie', 'WY', '82009', '3076374617', '3076373568', '', '', '', '0.00', '0.00', '125.00', 3, '2014-05-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1366706830', 0, 'N', 0, '2014-05-22', NULL, NULL, 0, 0, NULL, NULL),
('203125761', 'W12048038', 'W12048038', 'WYT1', 'Blair Investments', 'Erin', '', 'Ver Burg', 'PT', 'Physical Therapy', '', '', NULL, 'O', '1331 Prairie Ave Ste 6', 'Cheyenne', 'Laramie', 'WY', '82001', '3076374617', '3076373568', '1331 Prairie Ave Ste 6', 'Cheyenne', 'Laramie', 'WY', '82001', '3076374617', '3076373568', '', '', '', '0.00', '0.00', '125.00', 3, '2014-05-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1366706830', 0, 'N', 0, '2014-05-22', NULL, NULL, 0, 0, NULL, NULL),
('203125761', 'W12048039', 'W12048039', 'WYT1', 'Blair Investments', 'Erin', '', 'Ver Burg', 'PT', 'Physical Therapy', '', '', NULL, 'M', '1347 S Wisconsin Ave', 'Casper', 'Natrona', 'WY', '82609', '0000000000', '0000000000', '1347 S Wisconsin Ave', 'Casper', 'Natrona', 'WY', '82609', '0000000000', '0000000000', '', '', '', '0.00', '0.00', '125.00', 3, '2014-05-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1366706830', 0, 'N', 0, '2014-05-22', NULL, NULL, 0, 0, NULL, NULL),
('203125761', 'W12048040', 'W12048040', 'WYT1', 'Blair Investments', 'Erin', '', 'Ver Burg', 'PT', 'Physical Therapy', '', '', NULL, 'O', '4016 Laramie St', 'Cheyenne', 'Laramie', 'WY', '82009', '3076374617', '3076373568', '4016 Laramie St', 'Cheyenne', 'Laramie', 'WY', '82009', '3076374617', '3076373568', '', '', '', '0.00', '0.00', '125.00', 3, '2014-05-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1366706830', 0, 'N', 0, '2014-05-22', NULL, NULL, 0, 0, NULL, NULL),
('800307419', 'W12048043', 'W12048043', 'WYT1', 'Wyoming Health Medical Group', 'Norman', '', 'Macleod', 'MD', 'Family Practice', '', '', NULL, 'O', '1020 S Conwell St', 'Casper', 'Natrona', 'WY', '82601', '3072658300', '3072338230', '1020 S Conwell St', 'Casper', 'Natrona', 'WY', '82601', '3072658300', '3072338230', '', '', '', '0.00', '18.00', '0.00', 3, '2014-07-01', NULL, 0, 0, 0, 'Wyoming Medical Center ', '', '', '', 'HCFA|UB|', '1275521015', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
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('820510794', 'W12048068', 'W12048068', 'ID02', 'CT Derm PC', 'Tiffany', 'A', 'McCray', 'PA-C', 'Physician Assistant', '', '', NULL, 'O', '811 NW 12th St', 'Fruitland', 'Payette', 'ID', '83619', '2084527450', '2084527550', '811 NW 12th St', 'Fruitland', 'Payette', 'ID', '83619', '2084527450', '2084527550', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1417999657', 0, 'N', 0, '2014-05-22', 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
('452716222', 'W12048070', 'W12048070', 'ID02', 'St Lukes Clinic Pediatric Cardiology', 'Diana', '', 'Alexander', '', 'Pediatric Cardiology', '', '', NULL, 'O', '100 E Idaho St Ste 200', 'Boise', 'Ada', 'ID', '83712', '2083817384', '2083817387', '100 E Idaho St Ste 200', 'Boise', 'Ada', 'ID', '83712', '2083817384', '2083817387', 'IDACN', '', '', '0.00', '15.00', '0.00', 8, '2014-05-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1528004702', 0, 'N', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
('452716222', 'W12048069', 'W12048069', 'ID02', 'St Lukes Clinic Pediatric Cardiology', 'Diana', '', 'Alexander', '', 'Pediatric Cardiology', '', '', NULL, 'O', '3525 E Louise Ste 250', 'Meridian', 'Ada', 'ID', '83642', '2085878401', '2085809807', '3525 E Louise Ste 250', 'Meridian', 'Ada', 'ID', '83642', '2085878401', '2085809807', 'IDACN', '', '', '0.00', '15.00', '0.00', 8, '2014-05-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1528004702', 0, 'N', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
('820466781', 'W12048071', 'W12048071', 'ID02', 'Mountain States Counseling & Psychological Services', 'Jason', '', 'Gage', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '311 N Allumbaugh St', 'Boise', 'Ada', 'ID', '83704', '2083756402', '2083231850', '311 N Allumbaugh St', 'Boise', 'Ada', 'ID', '83704', '2083756402', '2083231850', 'IDPHD', '', '', '0.00', '40.00', '0.00', 8, '2014-05-01', NULL, 0, 0, 1, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1548280699', 0, 'N', 0, '2014-05-22', NULL, NULL, 0, 0, NULL, NULL),
('464355723', 'W12048072', 'W12048072', 'UTDT01', 'Little Mountain Dental', 'Michael', '', 'Eggett', 'DDS', 'Dentist', '', '', NULL, 'O', '394 S Main St', 'Tooele', 'Tooele', 'UT', '84074', '4358822331', '          ', '394 S Main St', 'Tooele', 'Tooele', 'UT', '84074', '4358822331', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1316108772', 0, 'N', 0, '2014-05-23', NULL, NULL, 0, 0, NULL, NULL),
('464355723', 'W12048073', 'W12048073', 'UTDT01', 'Little Mountain Dental                  ', 'Aaron J', '', 'Stobbe', 'DMD', 'Dentist', '', '', NULL, 'O', '349 S Main St', 'Tooele', 'Tooele', 'UT', '84074', '4358822331', '          ', '349 S Main St', 'Tooele', 'Tooele', 'UT', '84074', '4358822331', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1689716045', 0, 'N', 0, '2014-05-23', NULL, NULL, 0, 0, NULL, NULL),
('272231329', 'W12048074', 'W12048074', 'UTDT01', 'Park City Dental Spa', 'Ashley', '', 'Bailey', 'DDS', 'Dentist', '', '', NULL, 'O', '1526 Ute Blvd Ste 212', 'Park City', 'Summit', 'UT', '84098', '4356158500', '          ', '1526 Ute Blvd Ste 212', 'Park City', 'Summit', 'UT', '84098', '4356158500', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1043478217', 0, 'N', 0, '2014-05-23', NULL, NULL, 0, 0, NULL, NULL),
('263441716', 'W12048076', 'W12048076', 'UTDT01', 'Reve Chaston DDS                        ', 'Reve', '', 'Chaston', 'DDS', 'Periodontist', '', '', NULL, 'O', '2185 N 1700 W Ste 201', 'Layton', 'Davis', 'UT', '84041', '8017283388', '          ', '2185 N 1700 W Ste 201', 'Layton', 'Davis', 'UT', '84041', '8017283388', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', '|DEN|', '1417968678', 0, 'N', 0, '2014-05-23', NULL, NULL, 0, 0, NULL, NULL),
('274519439', 'W12048077', 'W12048077', 'UTDT01', 'Cottonwood Pediatric Dentistry', 'Robert', '', 'Nielson', 'DDS', 'Dentist', '', '', NULL, 'O', '7050 S 2000 E Ste 110', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019433233', '          ', '7050 S 2000 E Ste 110', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019433233', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1821381666', 0, 'N', 0, '2014-05-23', NULL, NULL, 0, 0, NULL, NULL),
('201745440', 'W12048079', 'W12048079', 'UTDT01', 'Cloward Dental                          ', 'Jacob', '', 'Haslem', 'DDS', 'Dentist', '', '', NULL, 'O', '83 W 90 N', 'Spanish Fork', 'Utah', 'UT', '84660', '8017941834', '          ', '83 W 90 N', 'Spanish Fork', 'Utah', 'UT', '84660', '8017941834', '          ', 'UT000A', '', '', '0.00', '20.00', '8.00', 8, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', '|DEN|', '1922237379', 0, 'N', 0, '2014-05-23', NULL, NULL, 0, 0, NULL, NULL),
('201972242', 'W12048081', 'W12048081', 'UTDT01', 'Gary L Wilson DM', 'Gary', '', 'Wilson', 'DMD', 'Dentist', '', '', NULL, 'O', '1355 N University Ave Ste 310', 'Provo', 'Utah', 'UT', '84604', '8013704040', '          ', '1355 N University Ave Ste 310', 'Provo', 'Utah', 'UT', '84604', '8013704040', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', '|DEN|', '1164589743', 0, 'N', 0, '2014-05-23', NULL, NULL, 0, 0, NULL, NULL),
('870332707', 'W12048082', 'W12048082', 'UTDT01', 'Young Family Dental', 'Michael', '', 'Boyack', 'DDS', 'Dentist', '', '', NULL, 'O', '1416 N Commerce Dr Unit 1', 'Saratoga Springs', 'Utah', 'UT', '84045', '8017662112', '          ', '1416 N Commerce Dr Unit 1', 'Saratoga Springs', 'Utah', 'UT', '84045', '8017662112', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1649424029', 0, 'N', 0, '2014-05-23', NULL, NULL, 0, 0, NULL, NULL),
('870332707', 'W12048083', 'W12048083', 'UTDT01', 'Young Family Dental', 'William', '', 'Cerny', 'DDS', 'Dentist', '', '', NULL, 'O', '1416 N Commerce Dr Unit 1', 'Saratoga Springs', 'Utah', 'UT', '84045', '8017662112', '          ', '1416 N Commerce Dr Unit 1', 'Saratoga Springs', 'Utah', 'UT', '84045', '8017662112', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1346381498', 0, 'N', 0, '2014-05-23', NULL, NULL, 0, 0, NULL, NULL),
('870332707', 'W12048084', 'W12048084', 'UTDT01', 'Young Family Dental', 'Michael', '', 'Loeser', 'DMD', 'Dentist', '', '', NULL, 'O', '1416 N Commerce Dr Unit 1', 'Saratoga Springs', 'Utah', 'UT', '84045', '8017662112', '          ', '1416 N Commerce Dr Unit 1', 'Saratoga Springs', 'Utah', 'UT', '84045', '8017662112', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1467595157', 0, 'N', 0, '2014-05-23', NULL, NULL, 0, 0, NULL, NULL),
('870332707', 'W12048085', 'W12048085', 'UTDT01', 'Young Family Dental', 'Michael', '', 'Young', 'DDS', 'Dentist', '', '', NULL, 'O', '1416 N Commerce Dr Unit 1', 'Saratoga Springs', 'Utah', 'UT', '84045', '8017662112', '          ', '1416 N Commerce Dr Unit 1', 'Saratoga Springs', 'Utah', 'UT', '84045', '8017662112', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1831235167', 0, 'N', 0, '2014-05-23', NULL, NULL, 0, 0, NULL, NULL),
('870332707', 'W12048086', 'W12048086', 'UTDT01', 'Young Family Dental', 'Christopner', '', 'Young', 'DDS', 'Dentist', '', '', NULL, 'O', '1416 N Commerce Dr Unit 1', 'Saratoga Springs', 'Utah', 'UT', '84045', '8017662112', '          ', '1416 N Commerce Dr Unit 1', 'Saratoga Springs', 'Utah', 'UT', '84045', '8017662112', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1093887374', 0, 'N', 0, '2014-05-23', NULL, NULL, 0, 0, NULL, NULL),
('870332707', 'W12048087', 'W12048087', 'UTDT01', 'Young Family Dental', 'Paige', '', 'White', 'DDS', 'Dentist', '', '', NULL, 'O', '1416 N Commerce Dr Unit 1', 'Saratoga Springs', 'Utah', 'UT', '84045', '8017662112', '          ', '1416 N Commerce Dr Unit 1', 'Saratoga Springs', 'Utah', 'UT', '84045', '8017662112', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1396046702', 0, 'N', 0, '2014-05-23', NULL, NULL, 0, 0, NULL, NULL),
('870332707', 'W12048088', 'W12048088', 'UTDT01', 'Young Family Dental', 'Kwang', '', 'Park', 'DDS', 'Dentist', '', '', NULL, 'O', '1416 N Commerce Dr Unit 1', 'Saratoga Springs', 'Utah', 'UT', '84045', '8017662112', '          ', '1416 N Commerce Dr Unit 1', 'Saratoga Springs', 'Utah', 'UT', '84045', '8017662112', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1215078365', 0, 'N', 0, '2014-05-23', NULL, NULL, 0, 0, NULL, NULL),
('463861075', 'W12048089', 'W12048089', 'UTDT01', 'Advanced Family Dental', 'Brian', '', 'Glazier', 'DDS', 'Dentist', '', '', NULL, 'O', '1760 N Main St Ste 106', 'Sandy', 'Salt Lake', 'UT', '84070', '4358670644', '          ', '1760 N Main St Ste 106', 'Sandy', 'Salt Lake', 'UT', '84070', '4358670644', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1033430111', 0, 'N', 0, '2014-05-23', NULL, NULL, 0, 0, NULL, NULL),
('452706192', 'W12048090', 'W12048090', 'UTDT01', 'iSmile Dental Designs of Salt Lake', 'David', '', 'Duke', 'DDS', 'Dentist', '', '', NULL, 'O', '420 E S Temple Ste 410', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013552202', '          ', '420 E S Temple Ste 410', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013552202', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1467543421', 0, 'N', 0, '2014-05-23', NULL, NULL, 0, 0, NULL, NULL),
('464411090', 'W12048092', 'W12048092', 'UTDT01', 'Scott Folkman DMD PC', 'Scott', '', 'Folkman', 'dmd', 'Pedodontist', '', '', NULL, 'O', '3225 W Gordon Ave Ste G', 'Layton', 'Davis', 'UT', '84041', '8015443400', '          ', '3225 W Gordon Ave Ste G', 'Layton', 'Davis', 'UT', '84041', '8015443400', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2014-04-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1144533266', 0, 'N', 0, '2014-05-23', NULL, NULL, 0, 0, NULL, NULL),
('202946486', 'W12048093', 'W12048093', 'UTDT01', 'Bishop Dental                           ', 'John L', '', 'Bishop', 'DMD', 'Dentist', '', '', NULL, 'O', '102 W 1180 N Ste 1', 'Tooele', 'Tooele', 'UT', '84074', '4358828600', '          ', '102 W 1180 N Ste 1', 'Tooele', 'Tooele', 'UT', '84074', '4358828600', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1538103544', 0, 'N', 0, '2014-05-23', NULL, NULL, 0, 0, NULL, NULL),
('611733276', 'W12048094', 'W12048094', 'UTDT01', 'Platinum Dental Care', 'Jared', '', 'Weaver', 'DDS', 'Dentist', '', '', NULL, 'O', '2011 S 1300 E', 'Salt Lake City', 'Salt Lake', 'UT', '84105', '8014840792', '          ', '2011 S 1300 E', 'Salt Lake City', 'Salt Lake', 'UT', '84105', '8014840792', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1851555650', 0, 'N', 0, '2014-05-23', NULL, NULL, 0, 0, NULL, NULL),
('383923245', 'W12048096', 'W12048096', 'UTDT01', 'iSmile at Alta View Dental Care', 'Richard', '', 'Hughes', 'dmd', 'Dentist', '', '', NULL, 'O', '9844 S 1300 E Ste 340', 'Sandy', 'Salt Lake', 'UT', '84094', '8015724261', '          ', '9844 S 1300 E Ste 340', 'Sandy', 'Salt Lake', 'UT', '84094', '8015724261', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1881645745', 0, 'N', 0, '2014-05-23', NULL, NULL, 0, 0, NULL, NULL),
('202946486', 'W12048098', 'W12048098', 'UTDT01', 'Bishop Dental                           ', 'Joseph', '', 'Checchio', 'DDS', 'Dentist', '', '', NULL, 'O', '102 W 1180 N Ste 1', 'Tooele', 'Tooele', 'UT', '84074', '4358828600', '          ', '102 W 1180 N Ste 1', 'Tooele', 'Tooele', 'UT', '84074', '4358828600', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1962597559', 0, 'N', 0, '2014-05-23', NULL, NULL, 0, 0, NULL, NULL),
('452706192', 'W12048099', 'W12048099', 'UTDT01', 'iSmile Dental Designs of Salt Lake', 'Jason G', '', 'Barton', 'DDS', 'Dentist', '', '', NULL, 'O', '420 E S Temple Ste 410', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8013552202', '          ', '420 E S Temple Ste 410', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8013552202', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1801998794', 0, 'N', 0, '2014-05-23', NULL, NULL, 0, 0, NULL, NULL),
('383923245', 'W12048100', 'W12048100', 'UTDT01', 'iSmile at Alta View Dental Care', 'Jason G', '', 'Barton', 'DDS', 'Dentist', '', '', NULL, 'O', '9844 S 1300 E Ste 340', 'Sandy', 'Salt Lake', 'UT', '84094', '8015724261', '          ', '9844 S 1300 E Ste 340', 'Sandy', 'Salt Lake', 'UT', '84094', '8015724261', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1801998794', 0, 'N', 0, '2014-05-23', NULL, NULL, 0, 0, NULL, NULL),
('260816943', 'W12048101', 'W12048101', 'UTDT01', 'iSmile at Murray Family Dental          ', 'Jason G', '', 'Barton', 'DDS', 'Dentist', '', '', NULL, 'O', '164 E 5900 S Ste A-111', 'Murray', 'Salt Lake', 'UT', '84107', '8012621181', '          ', '164 E 5900 S Ste A-111', 'Murray', 'Salt Lake', 'UT', '84107', '8012621181', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1801998794', 0, 'N', 0, '2014-05-23', NULL, NULL, 0, 0, NULL, NULL),
('453730194', 'W12048102', 'W12048102', 'UTDT01', 'iSmile at Crossroads Dental Group       ', 'Jason G', '', 'Barton', 'DDS', 'Dentist', '', '', NULL, 'O', '3409 W 12600 S Ste 100', 'Riverton', 'Salt Lake', 'UT', '84065', '8015611559', '          ', '3409 W 12600 S Ste 100', 'Riverton', 'Salt Lake', 'UT', '84065', '8015611559', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1801998794', 0, 'N', 0, '2014-05-23', NULL, NULL, 0, 0, NULL, NULL),
('464857672', 'W12048103', 'W12048103', 'UTDT01', 'Genesis Dental of Granger               ', 'David', 'B', 'Petersen', 'MD', 'Dentist', '', '', NULL, 'O', '3725 W 4100 S Ste 240', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019652700', '          ', '3725 W 4100 S Ste 240', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019652700', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1598846867', 0, 'N', 0, '2014-05-23', NULL, NULL, 0, 0, NULL, NULL),
('202946486', 'W12048105', 'W12048105', 'UTDT01', 'Bishop Dental                           ', 'Ken', '', 'Handy', 'DDS', 'Dentist', '', '', NULL, 'O', '102 W 1180 N Ste 1', 'Tooele', 'Tooele', 'UT', '84074', '4358828600', '          ', '102 W 1180 N Ste 1', 'Tooele', 'Tooele', 'UT', '84074', '4358828600', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1720249337', 0, 'N', 0, '2014-05-23', NULL, NULL, 0, 0, NULL, NULL),
('364740822', 'W12048107', 'W12048107', 'UTDT01', 'iSmile at Kaysville', 'Matthew', '', 'Harris', 'DDS', 'Dentist', '', '', NULL, 'O', '302 N Main St', 'Kaysville', 'Davis', 'UT', '84037', '8015443953', '          ', '302 N Main St', 'Kaysville', 'Davis', 'UT', '84037', '8015443953', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1972926111', 0, 'N', 0, '2014-05-23', NULL, NULL, 0, 0, NULL, NULL),
('452706192', 'W12048109', 'W12048109', 'UTDT01', 'iSmile Dental Designs of Salt Lake', 'Ryan', '', 'McAffee', 'DDS', 'Dentist', '', '', NULL, 'O', '420 E S Temple Ste 410', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013552202', '          ', '420 E S Temple Ste 410', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013552202', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1174880249', 0, 'N', 0, '2014-05-23', NULL, NULL, 0, 0, NULL, NULL),
('461412682', 'W12048111', 'W12048111', 'UTDT01', 'Half Dental', 'Stephen', '', 'Adam', 'DMD', 'Dentist', '', '', NULL, 'O', '350 E 600 S Ste 1', 'St George', 'Washington', 'UT', '84770', '4356563868', '          ', '350 E 600 S Ste 1', 'St George', 'Washington', 'UT', '84770', '4356563868', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1992060131', 0, 'N', 0, '2014-05-23', NULL, NULL, 0, 0, NULL, NULL),
('363948194', 'TNE000020', 'TNE000020', 'ILCHIGSTD', 'Ophthalmology Associates, Ltd', 'Evelyn', 'S', 'Ackermann', 'MD', 'Ophthalmology', NULL, NULL, NULL, 'O', '87 N Arlite St Ste G11-12', 'Elgin', 'Kane', 'IL', '60123', '8474681100', '8474681193', NULL, NULL, NULL, NULL, NULL, NULL, NULL, '', NULL, NULL, '0.00', '0.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1053308676', 0, 'N', 1, '2014-05-27', NULL, NULL, 0, 0, NULL, NULL),
('364402342', 'TNE000011', 'TNE000011', 'ILCHIGSTD', 'M. M. Ahsan S.C.', 'Azeem', 'M', 'Ahsan', 'DO', 'Family Practice', NULL, NULL, NULL, 'O', '1640 Willow Circle Dr Ste 100', 'Crest Hill', 'Will', 'IL', '60403', '8157412525', '8157412522', NULL, NULL, NULL, NULL, NULL, NULL, NULL, '', 'CHIHCPCS13', NULL, '0.00', '40.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Medical Center', '', '', '', 'HCFA|UB|', '1861543985', 0, 'N', 1, '2014-05-27', NULL, NULL, 0, 0, NULL, NULL),
('205114362', 'TNE000001', 'TNE000001', 'ILCHIGSTD', 'R&W Medical Llc', 'Syed', 'R', 'Akhter', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '3017 N Ashland Ave Ste 1N', 'Chicago', 'Cook', 'IL', '60657', '7739351199', '7739351219', NULL, NULL, NULL, NULL, NULL, NULL, NULL, '', NULL, NULL, '0.00', '0.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1295787422', 0, 'N', 1, '2014-05-27', NULL, NULL, 0, 0, NULL, NULL),
('363045859', 'TNE000029', 'TNE000029', 'ILCHIGSTD', 'Associates In Ear Nose & Throat And Head & Neck Surgery', 'Nikhil', NULL, 'Bhatt', 'MD', 'Otolaryngology', NULL, NULL, NULL, 'O', '2050 Larkin Ave Ste 102', 'Elgin', 'Kane', 'IL', '60123', '8477427458', '8477420191', NULL, NULL, NULL, NULL, NULL, NULL, NULL, '', NULL, NULL, '0.00', '0.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Elgin', NULL, NULL, NULL, 'HCFA|UB|', '1174574073', 0, 'N', 1, '2014-05-27', NULL, NULL, 0, 0, NULL, NULL),
('363780199', 'TNE000027', 'TNE000027', 'ILCHIGSTD', 'Elgin Family Physicians, SC', 'Sylvie', NULL, 'Chau', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '1435 N Randall Rd Ste 301', 'Elgin', 'Kane', 'Il', '60123', '8478417116', '8478888526', NULL, NULL, NULL, NULL, NULL, NULL, NULL, '', NULL, NULL, '0.00', '0.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1750541454', 0, 'N', 1, '2014-05-27', NULL, NULL, 0, 0, NULL, NULL),
('363780199', 'TNE000026', 'TNE000026', 'ILCHISTD', 'Elgin Family Physicians, SC', 'Sylvie', NULL, 'Chau', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '901 Center St Ste 3000', 'Elgin', 'Kane', 'IL', '60120', '8478883661', '8478889964', NULL, NULL, NULL, NULL, NULL, NULL, NULL, '', NULL, NULL, '0.00', '0.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1750541454', 0, 'N', 1, '2014-05-27', NULL, NULL, 0, 0, NULL, NULL),
('363780199', 'TNE000025', 'TNE000025', 'ILCHIGSTD', 'Elgin Family Physicians, SC', 'Victor', 'H', 'Colin', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '901 Center St Ste 3000', 'Elgin', 'Kane', 'IL', '60120', '8478883661', '8478889964', NULL, NULL, NULL, NULL, NULL, NULL, NULL, '', NULL, NULL, '0.00', '0.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Elgin', NULL, NULL, NULL, 'HCFA|UB|', '1659369163', 0, 'N', 1, '2014-05-27', NULL, NULL, 0, 0, NULL, NULL),
('530295423', 'W12048240', 'W12048240', 'WY01', 'CG Mental Health ', 'Christopher', 'D', 'Gauger', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '887 E North St', 'Powell', 'Park', 'WY', '82435', '3072541818', '          ', '887 E North St', 'Powell', 'Park', 'WY', '82435', '3072541818', '          ', 'WYMA', '', '', '0.00', '40.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1932163540', 0, 'N', 1, '2014-07-10', NULL, NULL, 0, 0, NULL, NULL),
('530295423', 'W12048242', 'W12048242', 'WY01', 'CG Mental Health ', 'Christopher', 'D', 'Gauger', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'M', 'PO Box 247', 'Powell', 'Park', 'WY', '82435', '3072541818', '          ', 'PO Box 247', 'Powell', 'Park', 'WY', '82435', '3072541818', '          ', 'WYMA', '', '', '0.00', '40.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1932163540', 0, 'N', 1, '2014-07-10', NULL, NULL, 0, 0, NULL, NULL),
('363650574', 'TNE000008', 'TNE000008', 'ILCHIGSTD', 'Eugenia Grochowska', 'Eugenia', NULL, 'Grochowska', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '3240 W Franklin Blvd', 'Chicago', 'Cook', 'IL', '60630', '7737223020', '7737220422', NULL, NULL, NULL, NULL, NULL, NULL, NULL, '', NULL, NULL, '0.00', '0.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1154302297', 0, 'N', 1, '2014-05-27', NULL, NULL, 0, 0, NULL, NULL),
('363650574', 'TNE000007', 'TNE000007', 'ILCHISTD', 'Eugenia Grochowska', 'Eugenia', NULL, 'Grochowska', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '5647 W Lawrence Ave 2nd Fl', 'Chicago', 'Cook', 'IL', '60630', '7735455252', '7735455671', NULL, NULL, NULL, NULL, NULL, NULL, NULL, '', NULL, NULL, '0.00', '0.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1154302297', 0, 'N', 1, '2014-05-27', NULL, NULL, 0, 0, NULL, NULL),
('363780199', 'TNE000028', 'TNE000028', 'ILCHIGSTD', 'Elgin Family Physicians, SC', 'Vanita', NULL, 'Gupta', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '901 Center St Ste 3000', 'Elgin', 'Kane', 'IL', '60120', '8478883661', '8478889964', NULL, NULL, NULL, NULL, NULL, NULL, NULL, '', NULL, NULL, '0.00', '0.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Elgin', NULL, NULL, NULL, 'HCFA|UB|', '1760583629', 0, 'N', 1, '2014-05-27', NULL, NULL, 0, 0, NULL, NULL),
('363045859', 'TNE000030', 'TNE000030', 'ILCHIGSTD', 'Associates In Ear Nose & Throat And Head & Neck Surgery', 'Jongwook', NULL, 'Ham', 'MD', 'Otolaryngology', NULL, NULL, NULL, 'O', '2050 Larkin Ave Ste 102', 'Elgin', 'Kane', 'IL', '60123', '8477427458', '8477420191', NULL, NULL, NULL, NULL, NULL, NULL, NULL, '', NULL, NULL, '0.00', '0.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Elgin', NULL, NULL, NULL, 'HCFA|UB|', '1700838992', 0, 'N', 1, '2014-05-27', NULL, NULL, 0, 0, NULL, NULL),
('363474729', 'TNE000015', 'TNE000015', 'ILCHIGSTD', 'Pulmonary & Critical Care Medicine Specialists SC', 'Matthew', 'A', 'Ivanovich', 'MD', 'Pulmonary Disease', NULL, NULL, NULL, 'O', '1710 N Randall Rd Ste 260', 'Elgin ', 'Kane', 'IL', '60123', '8479317900', '8479311562', NULL, NULL, NULL, NULL, NULL, NULL, NULL, '', NULL, NULL, '0.00', '0.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1174516314', 0, 'N', 1, '2014-05-27', NULL, NULL, 0, 0, NULL, NULL),
('363474729', 'TNE000016', 'TNE000016', 'ILCHISTD', 'Pulmonary & Critical Care Medicine Specialists SC', 'Matthew', 'A', 'Ivanovich', 'MD', 'Pulmonary Disease', NULL, NULL, NULL, 'O', '27750 W Highway 22 Ste 110', 'Barrington', 'Lake', 'IL', '60010', '8473814491', '8473814498', NULL, NULL, NULL, NULL, NULL, NULL, NULL, '', NULL, NULL, '0.00', '0.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1174516314', 0, 'N', 1, '2014-05-27', NULL, NULL, 0, 0, NULL, NULL),
('362697710', 'TNE000004', 'TNE000004', 'ILCHIGSTD', 'Will County Ob Gyn Ltd', 'Russell', NULL, 'Khater', 'MD', 'Obstetrics/Gynecology', NULL, NULL, NULL, 'O', '1106 N Larkin Ave', 'Joliet', 'Will', 'IL', '60435', '8157256188', '8157411541', NULL, NULL, NULL, NULL, NULL, NULL, NULL, '', NULL, NULL, '0.00', '0.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1306904131', 0, 'N', 1, '2014-05-27', NULL, NULL, 0, 0, NULL, NULL),
('364270833', 'TNE000019', 'TNE000019', 'ILCHIGSTD', 'Access Neuro Care Pc', 'Syed', 'M', 'Munzir', 'MD', 'Neurology', NULL, NULL, NULL, 'O', '1600 N Randall Rd Ste 220', 'Elgin', 'Kane', 'IL', '60123', '8476289977', '8476289955', NULL, NULL, NULL, NULL, NULL, NULL, NULL, '', NULL, NULL, '0.00', '0.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1255356762', 0, 'N', 1, '2014-05-27', NULL, NULL, 0, 0, NULL, NULL),
('522385354', 'TNE000014', 'TNE000014', 'ILCHIGSTD', 'Sanjay Pethkar, M.D., S. C.', 'Sanjay', NULL, 'Pethkar', 'MD', 'Internal Medicine', NULL, NULL, NULL, 'O', '13415 S Rt 59', 'Plainfield', 'Will', 'IL', '60585', '8156093627', '8156091328', NULL, NULL, NULL, NULL, NULL, NULL, NULL, '', NULL, NULL, '0.00', '0.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1134181829', 0, 'N', 1, '2014-05-27', NULL, NULL, 0, 0, NULL, NULL),
('363780199', 'TNE000024', 'TNE000024', 'ILCHIGSTD', 'Elgin Family Physicians, SC', 'Dorothea', NULL, 'Poulos', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '1435 N Randall Rd Ste 301', 'Elgin', 'Kane', 'Il', '60123', '8478417116', '8478888526', NULL, NULL, NULL, NULL, NULL, NULL, NULL, '', NULL, NULL, '0.00', '0.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1003804519', 0, 'N', 1, '2014-05-27', NULL, NULL, 0, 0, NULL, NULL),
('363780199', 'TNE000023', 'TNE000023', 'ILCHISTD', 'Elgin Family Physicians, SC', 'Dorothea', NULL, 'Poulos', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '901 Center St Ste 3000', 'Elgin', 'Kane', 'IL', '60120', '8478883661', '8478889964', NULL, NULL, NULL, NULL, NULL, NULL, NULL, '', NULL, NULL, '0.00', '0.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1003804519', 0, 'N', 1, '2014-05-27', NULL, NULL, 0, 0, NULL, NULL),
('363039368', 'TNE000005', 'TNE000005', 'ILCHIGSTD', 'Anthony Proske Md Ltd', 'Anthony', 'E', 'Proske', 'MD', 'Neurology', NULL, NULL, NULL, 'O', '2132 W Jefferson St #A', 'Joliet', 'Will', 'IL', '60435', '8157447762', '8157447861', NULL, NULL, NULL, NULL, NULL, NULL, NULL, '', NULL, NULL, '0.00', '0.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1114918547', 0, 'N', 1, '2014-05-27', NULL, NULL, 0, 0, NULL, NULL),
('363673789', 'TNE000009', 'TNE000009', 'ILCHIGSTD', 'Alan Reich', 'Alan', 'M', 'Reich', 'MD', 'Endocrinology', NULL, NULL, NULL, 'O', '7447 W Talcott Ave Ste 569', 'Chicago', 'Cook', 'IL', '60631', '7767759574', '7737759714', NULL, NULL, NULL, NULL, NULL, NULL, NULL, '', NULL, NULL, '0.00', '0.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1932207487', 0, 'N', 1, '2014-05-27', NULL, NULL, 0, 0, NULL, NULL),
('364438080', 'TNE000013', 'TNE000013', 'ILCHIGSTD', 'J Sadowski Md Pc', 'Joseph', NULL, 'Sadowski', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '6109 N Northwest Hwy', 'Chicago', 'Cook', 'IL', '60631', '7735941109', '7735941162', NULL, NULL, NULL, NULL, NULL, NULL, NULL, '', NULL, NULL, '0.00', '0.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1790737849', 0, 'N', 1, '2014-05-27', NULL, NULL, 0, 0, NULL, NULL),
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('363948194', 'TNE000022', 'TNE000022', 'ILCHISTD', 'Ophthalmology Associates, Ltd', 'Michael', 'L', 'Seigle', 'MD', 'Ophthalmology', NULL, NULL, NULL, 'O', '87 N Arlite St Ste G11-12', 'Elgin', 'Kane', 'IL', '60123', '8474681100', '8474681193', NULL, NULL, NULL, NULL, NULL, NULL, NULL, '', NULL, NULL, '0.00', '0.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1639166259', 0, 'N', 1, '2014-05-27', NULL, NULL, 0, 0, NULL, NULL),
('364374765', 'TNE000010', 'TNE000010', 'ILCHIGSTD', 'Joliet Diabetes & Endocrinology Associates Inc', 'Bhavani', NULL, 'Sivarajan', 'MD', 'Endocrinology', NULL, NULL, NULL, 'O', '1715 Glenwood Ave', 'Joliet', 'Will', 'IL', '60435', '8157441089', '8157440460', NULL, NULL, NULL, NULL, NULL, NULL, NULL, '', NULL, NULL, '0.00', '0.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1396711701', 0, 'N', 1, '2014-05-27', NULL, NULL, 0, 0, NULL, NULL),
('364369702', 'TNE000018', 'TNE000018', 'ILCHIGSTD', 'Elio M Vento Md & Associates SC', 'Elio', NULL, 'Vento', 'MD', 'Internal Medicine', NULL, NULL, NULL, 'O', '2350 Royal Blvd Ste 100', 'Elgin', 'Kane', 'IL', '60123', '8476958100', '8476956808', NULL, NULL, NULL, NULL, NULL, NULL, NULL, '', NULL, NULL, '0.00', '0.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1487717492', 0, 'N', 1, '2014-05-27', NULL, NULL, 0, 0, NULL, NULL),
('272752875', 'W12048114', 'W12048114', 'UT01', 'Hofmann Arthritis Institute PLLC', 'Ted', '', 'Sexton', 'PT', 'Physical Therapy', '', '', NULL, 'O', '24 S 1100 E Ste 101', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013556468', '8013553450', '24 S 1100 E Ste 101', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013556468', '8013553450', 'WestRehab', '', '', '0.00', '0.00', '73.00', 6, '2014-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1467705590', 0, 'N', 0, '2014-06-25', NULL, NULL, 0, 0, NULL, NULL),
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('272752875', 'W12048117', 'W12048117', 'UT01', 'Hofmann Arthritis Institute PLLC', 'John', '', 'Lewis', '', 'Physical Therapy', '', '', NULL, 'B', 'PO Box 572528', 'Salt Lake City', 'Salt Lake', 'UT', '84157', '8013556468', '8013553450', 'PO Box 572528', 'Salt Lake City', 'Salt Lake', 'UT', '84157', '8013556468', '8013553450', 'WestRehab', '', '', '0.00', '0.00', '73.00', 6, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1194913491', 0, 'N', 1, '2014-05-28', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12048120', 'W12048120', 'UTIHC04', 'Bear River Valley Hospital', 'Hayden', 'J', 'Behling', 'PA', 'Physician Assistant', '', '', NULL, 'O', '905 N 1000 W', 'Tremonton', 'Box Elder', 'UT', '84337', '4352577441', '          ', '905 N 1000 W', 'Tremonton', 'Box Elder', 'UT', '84337', '4352577441', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2014-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1235386152', 0, 'N', 0, '2014-05-27', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12048124', 'W12048124', 'UTIHC04', 'Cassia Regional Medical Center', 'Lindsey', 'E', 'Coats', 'APRN', 'Registered Nurse', '', '', NULL, 'O', '1501 Hiland Ave Ste A', 'Burley', 'Cassia', 'ID', '83318', '2088789432', '          ', '1501 Hiland Ave Ste A', 'Burley', 'Cassia', 'ID', '83318', '2088789432', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2013-12-01', '2013-12-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1801232392', 0, 'N', 0, '2014-05-27', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12048126', 'W12048126', 'UTIHC04', 'Bear River Valley Hospital', 'DeVon', 'E', 'Dahlke', 'PA', 'Physician Assistant', '', '', NULL, 'O', '905 N 1000 W', 'Tremonton', 'Box Elder', 'UT', '84337', '4352577441', '          ', '905 N 1000 W', 'Tremonton', 'Box Elder', 'UT', '84337', '4352577441', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2014-01-26', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1598866691', 0, 'N', 0, '2014-05-27', NULL, NULL, 0, 0, NULL, NULL),
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('942854057', 'W12048130', 'W12048130', 'UTIHC04', 'Bear River Valley Hospital', 'Michael', 'G', 'Henderson', 'PA-C', 'Emergency Medicine', 'Physician Assistant', 'Neurosurgery', NULL, 'O', '905 N 1000 W', 'Tremonton', 'Box Elder', 'UT', '84337', '4352577441', '          ', '905 N 1000 W', 'Tremonton', 'Box Elder', 'UT', '84337', '4352577441', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2014-02-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1265423594', 0, 'Y', 0, '2014-05-27', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12048132', 'W12048132', 'UTIHC04', 'Primary Childrens Medical Center', 'Bridgette', '', 'Higgins', 'SLP', 'Speech Therapy', '', '', NULL, 'O', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016624971', '          ', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016624971', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2013-12-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1770914467', 0, 'N', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12048134', 'W12048134', 'UTIHC04', 'Bear River Valley Hospital', 'Craig', 'S', 'Humes', 'PA', 'Physician Assistant', '', '', NULL, 'O', '905 N 1000 W', 'Tremonton', 'Box Elder', 'UT', '84337', '4352577441', '          ', '905 N 1000 W', 'Tremonton', 'Box Elder', 'UT', '84337', '4352577441', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2014-05-02', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1528013166', 0, 'N', 0, '2014-05-27', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12048136', 'W12048136', 'UTIHC04', 'Dixie Regional Medical Center', 'Ralph', 'E', 'Jensen', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1380 E Medical Ctr Dr Ste 1500', 'St George', 'Washington', 'UT', '84790', '4352512500', '          ', '1380 E Medical Ctr Dr Ste 1500', 'St George', 'Washington', 'UT', '84790', '4352512500', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2014-04-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', 'Valley View Medical Center', '', '', 'HCFA|UB|', '1750351029', 0, 'N', 0, '2014-06-27', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12048137', 'W12048137', 'UTIHC04', 'Valley View Medical Center', 'Ralph', 'E', 'Jensen', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1303 N Main', 'Cedar City', 'Iron', 'UT', '84720', '4358685000', '          ', '1303 N Main', 'Cedar City', 'Iron', 'UT', '84720', '4358685000', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2014-04-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', 'Valley View Medical Center', '', '', 'HCFA|UB|', '1750351029', 0, 'N', 0, '2014-06-27', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12048138', 'W12048138', 'UTIHC04', 'Valley View Medical Center', 'Charles', 'W', 'Tate', 'MD', 'Cardiovascular Disease', 'Electrophysiology', '', NULL, 'o', '1303 N Main', 'Cedar City', 'Iron', 'UT', '84720', '4358685000', '          ', '1303 N Main', 'Cedar City', 'Iron', 'UT', '84720', '4358685000', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2014-04-01', NULL, 0, 0, 0, 'St Marks Hospital', 'Valley View Medical Center', '', '', 'HCFA|UB|', '1376583526', 0, 'N', 0, '2014-05-27', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12048139', 'W12048139', 'UTIHC04', 'Dixie Regional Medical Center', 'Charles', 'W', 'Tate', 'MD', 'Cardiovascular Disease', 'Electrophysiology', '', NULL, 'M', '1380 E Medical Ctr Dr', 'St George', 'Washington', 'UT', '84790', '4352512500', '          ', '1380 E Medical Ctr Dr', 'St George', 'Washington', 'UT', '84790', '4352512500', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2014-04-01', NULL, 0, 0, 0, 'St Marks Hospital', 'Valley View Medical Center', '', '', 'HCFA|UB|', '1376583526', 0, 'N', 0, '2014-05-27', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12048141', 'W12048141', 'UTIHC04', 'Dixie Regional Medical Center', 'Carrie', 'A', 'Willis', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1380 E Medical Ctr Dr', 'St George', 'Washington', 'UT', '84790', '4352512500', '          ', '1380 E Medical Ctr Dr', 'St George', 'Washington', 'UT', '84790', '4352512500', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2014-04-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', '', '', '', 'HCFA|UB|', '1811151020', 0, 'N', 0, '2014-05-27', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12048142', 'W12048142', 'UTIHC04', '', 'Carrie', 'A', 'Willis', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1303 N Main St', 'Cedar City', 'Iron', 'UT', '84721', '4358685000', '          ', '1303 N Main St', 'Cedar City', 'Iron', 'UT', '84721', '4358685000', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2014-04-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', '', '', '', 'HCFA|UB|', '1811151020', 0, 'N', 0, '2014-05-27', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12048144', 'W12048144', 'UTIHC04', 'Park City Medical Center', 'Cortney', 'P', 'Jones', 'PT', 'Physical Therapy', '', '', NULL, 'O', '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587350', '          ', '900 Round Valley Dr', 'Park City', 'Summit', 'UT', '84060', '4356587350', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2013-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1801056593', 0, 'N', 0, '2014-05-27', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12048146', 'W12048146', 'UTIHC04', 'Bear River Valley Hospital', 'Roland', 'G', 'Ruegner', 'PA', 'Physician Assistant', '', '', NULL, 'O', '905 N 1000 W', 'Tremonton', 'Box Elder', 'UT', '84337', '4352577441', '          ', '905 N 1000 W', 'Tremonton', 'Box Elder', 'UT', '84337', '4352577441', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2014-02-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1871688267', 0, 'N', 0, '2014-05-27', NULL, NULL, 0, 0, NULL, NULL),
('464760729', 'W12048147', 'W12048147', 'UT01', 'Salt City Chiropractic Wellness Center', 'Jason', 'R', 'Vance', 'DC', 'Chiropractic', '', '', NULL, 'O', '11762 S State St Ste 320', 'Draper', 'Salt Lake', 'UT', '84020', '8013129991', '8013129979', '11762 S State St Ste 320', 'Draper', 'Salt Lake', 'UT', '84020', '8013129991', '8013129979', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '57.12', 3, '2014-06-01', '2014-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1124369988', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('870710584', 'W12048148', 'W12048148', 'UTMH1', 'Jordan West Family Counseling', 'Heber', '', 'Tippetts', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '9263 Redwood Rd Bldg 8 Ste B', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015660749', '8015667108', '9263 Redwood Rd Bldg 8 Ste B', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015660749', '8015667108', 'UTMA', '', '', '0.00', '40.00', '0.00', 6, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1962827360', 0, 'N', 1, '2014-07-14', NULL, NULL, 0, 0, NULL, NULL),
('270985081', 'W12048149', 'W12048149', 'TXDALSTD', 'Warthan Dermatology Associates', 'Robert', 'E', 'Marinaro', 'MD', 'Dermatology', '', '', NULL, 'O', '5971 Virginia Pkwy Ste 100', 'Mckinney', 'Collin', 'TX', '75071', '9725424646', '9725420909', '5971 Virginia Pkwy Ste 100', 'Mckinney', 'Collin', 'TX', '75071', '9725424646', '9725420909', 'SPA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1790865970', 0, 'N', 0, '2014-05-27', NULL, NULL, 0, 0, NULL, NULL),
('870710584', 'W12048150', 'W12048150', 'UTMH1', 'Jordan West Family Counseling', 'Katherin', '', 'Galieti', '', 'Mental Health', '', '', NULL, 'O', '9263 Redwood Rd Bldg 8 Ste B', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015660749', '8015667108', '9263 Redwood Rd Bldg 8 Ste B', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015660749', '8015667108', 'UTMA', '', '', '0.00', '40.00', '0.00', 6, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1457794992', 0, 'N', 1, '2014-05-27', NULL, NULL, 0, 0, NULL, NULL),
('850275777', 'W12048151', 'W12048151', 'NM01', 'Southwest Medical Associates', 'Keri', '', 'Black', 'CNP', 'Family Practice', '', '', NULL, 'O', '6100 Pan American Fwy, NE Ste 100', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058231010', '          ', '6100 Pan American Fwy, NE Ste 100', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058231010', '          ', 'NMSWMED', '', '', '0.00', '10.00', '0.00', 3, '2014-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1538194550', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('850275777', 'W12048152', 'W12048152', 'NM01', 'Southwest Medical Associates', 'Keri', '', 'Black', 'CNP', 'Family Practice', '', '', NULL, 'O', '10511 Golf Course Rd Ste 205', 'Albuquerque', 'Bernalillo', 'NM', '87114', '5058231010', '5057974503', '10511 Golf Course Rd Ste 205', 'Albuquerque', 'Bernalillo', 'NM', '87114', '5058231010', '5057974503', 'NMSWMED', '', '', '0.00', '10.00', '0.00', 3, '2014-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1538194550', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('850275777', 'W12048153', 'W12048153', 'NM01', 'Southwest Medical Associates', 'Keri', '', 'Black', 'CNP', 'Family Practice', '', '', NULL, 'O', '4420 Irving Blvd NW', 'Albuquerque', 'Bernalillo', 'NM', '87114', '5058231010', '5057974503', '4420 Irving Blvd NW', 'Albuquerque', 'Bernalillo', 'NM', '87114', '5058231010', '5057974503', 'NMSWMED', '', '', '0.00', '10.00', '0.00', 3, '2014-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1538194550', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('850275777', 'W12048154', 'W12048154', 'NM01', 'Southwest Medical Associates', 'Keri', '', 'Black', 'CNP', 'Family Practice', '', '', NULL, 'O', '4705 Montgomery Blvd NE Ste 301-302', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058231010', '5057974503', '4705 Montgomery Blvd NE Ste 301-302', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5058231010', '5057974503', 'NMSWMED', '', '', '0.00', '10.00', '0.00', 3, '2014-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1538194550', 0, 'N', 0, '2014-06-30', NULL, NULL, 0, 0, NULL, NULL),
('850275777', 'W12048155', 'W12048155', 'NM01', 'Southwest Medical Associates', 'Keri', '', 'Black', 'CNP', 'Family Practice', '', '', NULL, 'O', '4801 McMahon Blvd Ste 110', 'Albuquerque', 'Bernalillo', 'NM', '87114', '5057274025', '5057274030', '4801 McMahon Blvd Ste 110', 'Albuquerque', 'Bernalillo', 'NM', '87114', '5057274025', '5057274030', 'NMSWMED', '', '', '0.00', '10.00', '0.00', 3, '2014-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1538194550', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('850275777', 'W12048156', 'W12048156', 'NM01', 'Southwest Medical Associates', 'Keri', '', 'Black', 'CNP', 'Family Practice', '', '', NULL, 'O', '8401 Constitution NE Ste 150', 'Albuquerque', 'Bernalillo', 'NM', '87110', '5058231010', '5057974503', '8401 Constitution NE Ste 150', 'Albuquerque', 'Bernalillo', 'NM', '87110', '5058231010', '5057974503', 'NMSWMED', '', '', '0.00', '10.00', '0.00', 3, '2014-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1538194550', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('850275777', 'W12048157', 'W12048157', 'NM01', 'Southwest Medical Associates', 'Keri', '', 'Black', 'CNP', 'Family Practice', '', '', NULL, 'O', '9501 Paseo del Norte Ste C & D', 'Albuquerque', 'Bernalillo', 'NM', '87122', '5057274000', '5057274014', '9501 Paseo del Norte Ste C & D', 'Albuquerque', 'Bernalillo', 'NM', '87122', '5057274000', '5057274014', 'NMSWMED', '', '', '0.00', '10.00', '0.00', 3, '2014-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1538194550', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('820161600', 'W12048158', 'W12048158', 'IDREC', 'Pediatric Neurology of Idaho', 'Edward', '', 'Jernigan', 'MD', 'Pediatric Neurology', '', '', NULL, 'O', '100 E Idaho St Ste 201', 'Boise', 'Ada', 'ID', '83712', '2083815180', '          ', '100 E Idaho St Ste 201', 'Boise', 'Ada', 'ID', '83712', '2083815180', '          ', '', '', '', '0.00', '0.00', '0.00', 8, '2014-06-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1982750659', 0, 'N', 0, '2014-05-30', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12048161', 'W12048161', 'WYBILLINGS', 'Billings Clinic', 'Whitney', '', 'Gum', 'MD', 'Emergency Medicine', '', '', NULL, 'M', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', '0000000000', '0000000000', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', '0000000000', '0000000000', '', '', '', '0.00', '17.00', '0.00', 3, '2014-05-19', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1215221841', 0, 'N', 0, '2014-05-27', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12048162', 'W12048162', 'WYBILLINGS', 'Billings Clinic - Emergency', 'Whitney', '', 'Gum', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '2800 10th Ave N', 'Billings', 'Yellowstone', 'MT', '59101', '4066574150', '4066574349', '2800 10th Ave N', 'Billings', 'Yellowstone', 'MT', '59101', '4066574150', '4066574349', '', '', '', '0.00', '17.00', '0.00', 3, '2014-05-19', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1215221841', 0, 'N', 0, '2014-05-27', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12048160', 'W12048160', 'WYBILLINGS', 'Billings Clinic', 'Whitney', '', 'Gum', 'MD', 'Emergency Medicine', '', '', NULL, 'B', 'PO Box 31315', 'Billings', 'Yellowstone', 'MT', '59107', '4062382617', '0000000000', 'PO Box 31315', 'Billings', 'Yellowstone', 'MT', '59107', '4062382617', '0000000000', '', '', '', '0.00', '17.00', '0.00', 3, '2014-05-19', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1215221841', 0, 'N', 0, '2014-05-27', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12048165', 'W12048165', 'WYBILLINGS', 'Billings Clinic', 'Nash', '', 'Maria', 'PT', 'Physical Therapy', '', '', NULL, 'B', 'PO Box 31315', 'Billings', 'Yellowstone', 'MT', '59107', '4062382617', '0000000000', 'PO Box 31315', 'Billings', 'Yellowstone', 'MT', '59107', '4062382617', '0000000000', '', '', '', '0.00', '17.00', '0.00', 3, '2014-05-28', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1891710224', 0, 'N', 0, '2014-05-27', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12048167', 'W12048167', 'WYBILLINGS', 'Billings Clinic - Miles City Clinic', 'Nash', '', 'Maria', 'PT', 'Physical Therapy', '', '', NULL, 'O', '620 S Haynes', 'Miles City', 'Custer', 'MT', '59301', '4062337000', '4062337070', '620 S Haynes', 'Miles City', 'Custer', 'MT', '59301', '4062337000', '4062337070', '', '', '', '0.00', '17.00', '0.00', 3, '2014-05-28', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1891710224', 0, 'N', 0, '2014-05-27', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12048166', 'W12048166', 'WYBILLINGS', 'Billings Clinic', 'Nash', '', 'Maria', 'PT', 'Physical Therapy', '', '', NULL, 'M', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', '0000000000', '0000000000', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', '0000000000', '0000000000', '', '', '', '0.00', '17.00', '0.00', 3, '2014-05-28', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1891710224', 0, 'N', 0, '2014-05-27', 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
('760540476', 'W12048168', 'W12048168', 'TXHOUSTD', 'Oakbend Medical Group', 'Wayne', '', 'Wang', 'NP', 'Family Practice', '', '', NULL, 'O', '30525 First St Ste C', 'Rosenberg', 'Fort Bend', 'TX', '77471', '2816334950', '2816334955', '30525 First St Ste C', 'Rosenberg', 'Fort Bend', 'TX', '77471', '2816334950', '2816334955', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-06-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1871927335', 0, 'N', 0, '2014-05-27', NULL, NULL, 0, 0, NULL, NULL),
('760540476', 'W12048169', 'W12048169', 'TXHOUSTD', 'Oakbend Medical Group', 'Wayne', '', 'Wang', 'NP', 'Family Practice', '', '', NULL, 'O', '4911 Sand Hill Dr', 'Sugar Land', 'Fort Bend', 'TX', '77479', '2812387870', '2816334985', '4911 Sand Hill Dr', 'Sugar Land', 'Fort Bend', 'TX', '77479', '2812387870', '2816334985', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-06-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1871927335', 0, 'N', 0, '2014-05-27', NULL, NULL, 0, 0, NULL, NULL),
('464128789', 'W12048170', 'W12048170', 'UT01', 'Alta View Sports Medicine Center ', 'Christian', 'L', 'Sybrowsky', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '9844 S 1300 E Ste 100', 'Sandy', 'Salt Lake', 'UT', '84094', '8015719433', '8015725607', '9844 S 1300 E Ste 100', 'Sandy', 'Salt Lake', 'UT', '84094', '8015719433', '8015725607', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1710099676', 0, 'N', 0, '2014-05-27', NULL, NULL, 0, 0, NULL, NULL),
('363819982', 'W12048171', 'W12048171', 'ILCHIGSTD', 'Accelerated Rehabilitation Centers', '', '', 'Accelerated Rehabilitation Centers', '', 'Physical Therapy', '', '', NULL, 'O', '13311 S Route 59', 'Plainfield', 'Will', 'IL', '60585', '8475491460', '8475491490', '13311 S Route 59', 'Plainfield', 'Will', 'IL', '60585', '8475491460', '8475491490', '', '', '', '0.00', '0.00', '95.00', 3, '2014-05-02', NULL, 0, 0, 0, '', '', '', '', 'HCFA| ', '1205875713', 0, 'N', 0, '2014-05-27', NULL, NULL, 0, 0, NULL, NULL),
('760585021', 'W12048173', 'W12048173', 'TXHOUSTD', '1960 Family Practice', 'Minh', 'Q', 'Mai', 'MD', 'Internal Medicine', '', '', NULL, 'O', '837 FM 1960 W Ste 105', 'Houston', 'Harris', 'TX', '77090', '2815863888', '2814402020', '837 FM 1960 W Ste 105', 'Houston', 'Harris', 'TX', '77090', '2815863888', '2814402020', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-06-21', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1427248970', 0, 'N', 0, '2014-05-29', NULL, NULL, 0, 0, NULL, NULL),
('870286381', 'W12048174', 'W12048174', 'UT01', 'Ogden Clinic Womens Center McKay', 'Marilyn', 'B', 'Wise', 'APRN', 'Family Practice', '', '', NULL, 'O', '4403 Harrison Blvd Ste 4650', 'Ogden', 'Weber', 'UT', '84403', '8014753240', '8014753241', '4403 Harrison Blvd Ste 4650', 'Ogden', 'Weber', 'UT', '84403', '8014753240', '8014753241', 'WUOGDCLIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2014-06-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1720098189', 0, 'N', 0, '2014-05-27', NULL, NULL, 0, 0, NULL, NULL),
('741660214', 'W12048176', 'W12048176', 'TXHOUSTD', 'Bone and Joint Clinic of Houston', 'Ronald', 'S', 'Lepow', 'DPM', 'Podiatry', '', '', NULL, 'O', '6624 Fannin Ste 2600', 'Houston', 'Harris', 'TX', '77030', '7137901818', '7137907500', '6624 Fannin Ste 2600', 'Houston', 'Harris', 'TX', '77030', '7137901818', '7137907500', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-06-21', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1346228442', 0, 'N', 0, '2014-05-27', NULL, NULL, 0, 0, NULL, NULL),
('741660214', 'W12048177', 'W12048177', 'TXHOUSTD', 'Bone and Joint Clinic of Houston', 'Ronald', 'S', 'Lepow', 'DPM', 'Podiatry', '', '', NULL, 'B', 'PO Box 9689', 'Belfast', 'Waldo', 'ME', '04915', '7137901818', '7137907500', 'PO Box 9689', 'Belfast', 'Waldo', 'ME', '04915', '7137901818', '7137907500', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-06-21', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1346228442', 0, 'N', 0, '2014-05-27', NULL, NULL, 0, 0, NULL, NULL),
('460796181', 'W12048179', 'W12048179', 'TXHOUSTD', 'Clear Lake Primary Care', 'Topiwala', '', 'Tasnim', 'MD', 'Internal Medicine', '', '', NULL, 'O', '500 N Kobayashi Rd Ste C', 'Webster', 'Harris', 'TX', '77598', '2817241860', '2817241861', '500 N Kobayashi Rd Ste C', 'Webster', 'Harris', 'TX', '77598', '2817241860', '2817241861', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-06-21', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1790945426', 0, 'N', 0, '2014-05-27', NULL, NULL, 0, 0, NULL, NULL),
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('204043287', 'W12048286', 'W12048286', 'NM01', 'ABQ Health Partners', 'Melissa', '', 'Moore', 'CNM', 'Certified Nurse Midwife', '', '', NULL, 'O', '4010 Montgomery Blvd', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5052546500', '5052546532', '4010 Montgomery Blvd', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5052546500', '5052546532', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2014-05-19', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1619392172', 0, 'N', 0, '2014-05-29', NULL, NULL, 0, 0, NULL, NULL),
('204043287', 'W12048287', 'W12048287', 'NM01', 'ABQ Health Partners', 'Melissa', '', 'Moore', 'CNM', 'Certified Nurse Midwife', '', '', NULL, 'O', '5400 Gibson Blvd SE ', 'Albuquerque', 'Bernalillo', 'NM', '87108', '5052627960', '0000000000', '5400 Gibson Blvd SE ', 'Albuquerque', 'Bernalillo', 'NM', '87108', '5052627960', '0000000000', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2014-05-19', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1619392172', 0, 'N', 0, '2014-05-29', NULL, NULL, 0, 0, NULL, NULL),
('204043287', 'W12048288', 'W12048288', 'NM01', 'ABQ Health Partners', 'Melissa', '', 'Moore', 'CNM', 'Certified Nurse Midwife', '', '', NULL, 'B', 'PO Box 27829', 'Albuquerque', 'Bernalillo', 'NM', '87125', '5052627600', '0000000000', 'PO Box 27829', 'Albuquerque', 'Bernalillo', 'NM', '87125', '5052627600', '0000000000', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2014-05-19', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1619392172', 0, 'N', 0, '2014-05-29', NULL, NULL, 0, 0, NULL, NULL),
('204043287', 'W12048290', 'W12048290', 'NM01', 'ABQ Health Partners', 'Tanya', 'T', 'Bryndzia', 'CNP', 'Family Practice', '', '', NULL, 'O', '5400 Gibson Blvd SE ', 'Albuquerque', 'Bernalillo', 'NM', '87108', '5052627960', '0000000000', '5400 Gibson Blvd SE ', 'Albuquerque', 'Bernalillo', 'NM', '87108', '5052627960', '0000000000', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2014-05-19', '2014-05-27', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1720064835', 0, 'N', 0, '2014-07-18', NULL, NULL, 0, 0, NULL, NULL),
('204043287', 'W12048291', 'W12048291', 'NM01', 'ABQ Health Partners', 'Tanya', 'T', 'Bryndzia', 'CNP', 'Family Practice', '', '', NULL, 'O', '5150 Journal Ctr Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5052623212', '0000000000', '5150 Journal Ctr Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87109', '5052623212', '0000000000', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2014-05-19', '2014-05-27', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1720064835', 0, 'N', 0, '2014-07-18', NULL, NULL, 0, 0, NULL, NULL),
('204043287', 'W12048292', 'W12048292', 'NM01', 'ABQ Health Partners', 'Tanya', 'T', 'Bryndzia', 'CNP', 'Family Practice', '', '', NULL, 'B', 'PO Box 27829           ', 'Albuquerque', 'Bernalillo', 'NM', '87125', '5052627600', '0000000000', 'PO Box 27829           ', 'Albuquerque', 'Bernalillo', 'NM', '87125', '5052627600', '0000000000', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2014-05-19', '2014-05-27', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1720064835', 0, 'N', 0, '2014-07-18', NULL, NULL, 0, 0, NULL, NULL),
('760585021', 'W12048293', 'W12048293', 'TXHOUSTD', '1960 Family Practice', 'Minh', 'Q', 'Mai', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 4356 Dept 667', 'Houston', 'Harris', 'TX', '77210', '2815863888', '2814402020', 'PO Box 4356 Dept 667', 'Houston', 'Harris', 'TX', '77210', '2815863888', '2814402020', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-06-21', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1427248970', 0, 'N', 0, '2014-05-29', NULL, NULL, 0, 0, NULL, NULL),
('760585021', 'W12048295', 'W12048295', 'TXHOUSTD', '1960 Family Practice', 'Lance', 'R', 'Pickard', 'MD', 'Family Practice', '', '', NULL, 'O', '837 FM 1960 W Ste 105', 'Houston', 'Harris', 'TX', '77090', '2815863888', '2814402020', '837 FM 1960 W Ste 105', 'Houston', 'Harris', 'TX', '77090', '2815863888', '2814402020', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-06-21', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1841511912', 0, 'N', 0, '2014-05-29', NULL, NULL, 0, 0, NULL, NULL),
('760585021', 'W12048296', 'W12048296', 'TXHOUSTD', '1960 Family Practice', 'Lance', 'R', 'Pickard', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 4356 Dept 667', 'Houston', 'Harris', 'TX', '77210', '2815863888', '2814402020', 'PO Box 4356 Dept 667', 'Houston', 'Harris', 'TX', '77210', '2815863888', '2814402020', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-06-21', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1841511912', 0, 'N', 0, '2014-05-29', NULL, NULL, 0, 0, NULL, NULL),
('760585021', 'W12048298', 'W12048298', 'TXHOUSTD', '1960 Family Practice', 'Minni', '', 'Malhotra', 'MD', 'Family Practice', '', '', NULL, 'O', '5039 FM 2920 Rd', 'Spring', 'Harris', 'TX', '77388', '2815863888', '2814402020', '5039 FM 2920 Rd', 'Spring', 'Harris', 'TX', '77388', '2815863888', '2814402020', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-06-21', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1528257508', 0, 'N', 0, '2014-05-29', NULL, NULL, 0, 0, NULL, NULL),
('760585021', 'W12048299', 'W12048299', 'TXHOUSTD', '1960 Family Practice', 'Minni', '', 'Malhotra', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 4356 Dept 667', 'Houston', 'Harris', 'TX', '77210', '2815863888', '2814402020', 'PO Box 4356 Dept 667', 'Houston', 'Harris', 'TX', '77210', '2815863888', '2814402020', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-06-21', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1528257508', 0, 'N', 0, '2014-05-29', NULL, NULL, 0, 0, NULL, NULL),
('760585021', 'W12048301', 'W12048301', 'TXHOUSTD', '1960 Family Practice', 'Olvia', 'P', 'Revelo', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 4356 Dept 667', 'Houston', 'Harris', 'TX', '77210', '2815863888', '2814402020', 'PO Box 4356 Dept 667', 'Houston', 'Harris', 'TX', '77210', '2815863888', '2814402020', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-06-21', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1356579304', 0, 'N', 0, '2014-05-29', NULL, NULL, 0, 0, NULL, NULL),
('760585021', 'W12048302', 'W12048302', 'TXHOUSTD', '1960 Family Practice', 'Olvia', 'P', 'Revelo', 'MD', 'Family Practice', '', '', NULL, 'O', '837 FM 1960 W Ste 105', 'Houston', 'Harris', 'TX', '77090', '2815863888', '2814402020', '837 FM 1960 W Ste 105', 'Houston', 'Harris', 'TX', '77090', '2815863888', '2814402020', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-06-21', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1356579304', 0, 'N', 0, '2014-05-29', NULL, NULL, 0, 0, NULL, NULL),
('760585021', 'W12048304', 'W12048304', 'TXHOUSTD', '1960 Family Practice', 'Pamela', 'L', 'Johnson', 'MD', 'Occupational Medicine', '', '', NULL, 'B', 'PO Box 4356 Dept 667', 'Houston', 'Harris', 'TX', '77210', '2815863888', '2814402020', 'PO Box 4356 Dept 667', 'Houston', 'Harris', 'TX', '77210', '2815863888', '2814402020', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-06-21', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1184764235', 0, 'N', 0, '2014-05-29', 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
('760585021', 'W12048305', 'W12048305', 'TXHOUSTD', '1960 Family Practice', 'Pamela', 'L', 'Johnson', 'MD', 'Occupational Medicine', '', '', NULL, 'O', '20320 NW Fwy', 'Houston', 'Harris', 'TX', '77065', '2815863888', '2814402020', '20320 NW Fwy', 'Houston', 'Harris', 'TX', '77065', '2815863888', '2814402020', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-06-21', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1184764235', 0, 'N', 0, '2014-05-29', NULL, NULL, 0, 0, NULL, NULL),
('760585021', 'W12048307', 'W12048307', 'TXHOUSTD', '1960 Family Practice', 'Smitha', '', 'Mantha', 'MD', 'Podiatry', '', '', NULL, 'B', 'PO Box 4356 Dept 667', 'Houston', 'Harris', 'TX', '77210', '2815863888', '2814402020', 'PO Box 4356 Dept 667', 'Houston', 'Harris', 'TX', '77210', '2815863888', '2814402020', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-06-21', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1689808479', 0, 'N', 0, '2014-05-29', NULL, NULL, 0, 0, NULL, NULL),
('760585021', 'W12048308', 'W12048308', 'TXHOUSTD', '1960 Family Practice', 'Smitha', '', 'Mantha', 'MD', 'Podiatry', '', '', NULL, 'O', '837 FM 1960 W Ste 105', 'Houston', 'Harris', 'TX', '77090', '2815863888', '2814402020', '837 FM 1960 W Ste 105', 'Houston', 'Harris', 'TX', '77090', '2815863888', '2814402020', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-06-21', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1689808479', 0, 'N', 0, '2014-05-29', NULL, NULL, 0, 0, NULL, NULL),
('461482835', 'W12048309', 'W12048309', 'UT01', 'Rocky Mountain Allergy Asthma and Immunology LL', 'Douglas', 'H', 'Jones', 'MD', 'Allergy and Immunology', 'Internal Medicine', '', NULL, 'B', 'PO Box 410008', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8017759800', '8017759806', 'PO Box 410008', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8017759800', '8017759806', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-07-01', NULL, 0, 0, 0, 'Davis Hospital', 'Lakeview Hospital', '', '', 'HCFA|UB|', '1346324761', 0, 'N', 0, '2014-05-29', NULL, NULL, 0, 0, NULL, NULL),
('870476172', 'W12048310', 'W12048310', 'UTMH1', 'Shepherds Staff Christian Counseling Center', 'James', 'T', 'Northrop', 'PHD', 'Mental Health', 'Counseling', NULL, NULL, 'O', '525 E 4500 S Ste F-125', 'Murray', 'Salt Lake', 'UT', '84107', '8012681564', '8012681565', '525 E 4500 S Ste F-125', 'Murray', 'Salt Lake', 'UT', '84107', '8012681564', '8012681565', 'MA', '', '', '0.00', '40.00', '0.00', 6, '2013-08-21', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1700842069', 0, 'N', 0, '2014-05-29', NULL, NULL, 0, 0, NULL, NULL),
('870476172', 'W12048311', 'W12048311', 'UTMH1', 'Shepherds Staff Christian Counseling Center', 'James', 'T', 'Northrop', 'PHD', 'Mental Health', 'Counseling', NULL, NULL, 'O', '3665 S 8400 W', 'Magna', 'Salt Lake', 'UT', '84044', '8012681564', '8012681565', '3665 S 8400 W', 'Magna', 'Salt Lake', 'UT', '84044', '8012681564', '8012681565', 'MA', '', '', '0.00', '40.00', '0.00', 6, '2013-08-21', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1700842069', 0, 'N', 0, '2014-05-29', NULL, NULL, 0, 0, NULL, NULL),
('870476172', 'W12048312', 'W12048312', 'UTMH1', 'Shepherds Staff Christian Counseling Center', 'James', 'T', 'Northrop', 'PHD', 'Mental Health', 'Counseling', NULL, NULL, 'O', '8575 S 700 E', 'Sandy', 'Salt Lake', 'UT', '84070', '8012681564', '8012681565', '8575 S 700 E', 'Sandy', 'Salt Lake', 'UT', '84070', '8012681564', '8012681565', 'MA', '', '', '0.00', '40.00', '0.00', 6, '2013-08-21', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1700842069', 0, 'N', 0, '2014-05-29', NULL, NULL, 0, 0, NULL, NULL),
('870476172', 'W12048313', 'W12048313', 'UTMH1', 'Shepherds Staff Christian Counseling Center', 'James', 'T', 'Northrop', 'PHD', 'Mental Health', 'Counseling', NULL, NULL, 'O', '575 23rd St', 'Ogden', 'Weber', 'UT', '84401', '8012681564', '8012681565', '575 23rd St', 'Ogden', 'Weber', 'UT', '84401', '8012681564', '8012681565', 'MA', '', '', '0.00', '40.00', '0.00', 6, '2013-08-21', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1700842069', 0, 'N', 0, '2014-05-29', NULL, NULL, 0, 0, NULL, NULL),
('870476172', 'W12048314', 'W12048314', 'UTMH1', 'Shepherds Staff Christian Counseling Center', 'Robert', 'F', 'Pramann', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '575 23rd St', 'Ogden', 'Weber', 'UT', '84401', '8012681564', '8012681565', '575 23rd St', 'Ogden', 'Weber', 'UT', '84401', '8012681564', '8012681565', 'PHD', '', '', '0.00', '40.00', '0.00', 6, '2013-08-21', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1487622908', 0, 'N', 0, '2014-05-29', NULL, NULL, 0, 0, NULL, NULL),
('870476172', 'W12048315', 'W12048315', 'UTMH1', 'Shepherds Staff Christian Counseling Center', 'Robert', 'F', 'Pramann', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '8575 S 700 E', 'Sandy', 'Salt Lake', 'UT', '84070', '8012681564', '8012681565', '8575 S 700 E', 'Sandy', 'Salt Lake', 'UT', '84070', '8012681564', '8012681565', 'PHD', '', '', '0.00', '40.00', '0.00', 6, '2013-08-21', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1487622908', 0, 'N', 0, '2014-05-29', NULL, NULL, 0, 0, NULL, NULL),
('870476172', 'W12048316', 'W12048316', 'UTMH1', 'Shepherds Staff Christian Counseling Center', 'Robert', 'F', 'Pramann', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '3665 S 8400 W', 'Magna', 'Salt Lake', 'UT', '84044', '8012681564', '8012681565', '3665 S 8400 W', 'Magna', 'Salt Lake', 'UT', '84044', '8012681564', '8012681565', 'PHD', '', '', '0.00', '40.00', '0.00', 6, '2013-08-21', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1487622908', 0, 'N', 0, '2014-05-29', NULL, NULL, 0, 0, NULL, NULL),
('870476172', 'W12048317', 'W12048317', 'UTMH1', 'Shepherds Staff Christian Counseling Center', 'Robert', 'F', 'Pramann', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '525 E 4500 S Ste F-125', 'Murray', 'Salt Lake', 'UT', '84107', '8012681564', '8012681565', '525 E 4500 S Ste F-125', 'Murray', 'Salt Lake', 'UT', '84107', '8012681564', '8012681565', 'PHD', '', '', '0.00', '40.00', '0.00', 6, '2013-08-21', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1487622908', 0, 'N', 0, '2014-05-29', NULL, NULL, 0, 0, NULL, NULL),
('464124474', 'W12048320', 'W12048320', 'UTMH1', 'Northern Utah Counseling', 'Brent', '', 'Eberhard', 'MD', 'Pediatrics', '', '', NULL, 'O', '1387 W 1800 N', 'Clearfield', 'Davis', 'UT', '84015', '8017790095', '8017790255', '1387 W 1800 N', 'Clearfield', 'Davis', 'UT', '84015', '8017790095', '8017790255', 'NOUTCSLG', '', '', '0.00', '100.00', '0.00', 3, '2014-01-29', NULL, 0, 0, 0, 'Davis Hospital', '', '', '', 'HCFA|UB|', '1679559629', 0, 'N', 0, '2014-05-29', NULL, NULL, 0, 0, NULL, NULL),
('870476172', 'W12048321', 'W12048321', 'UTMH1', 'Shepherds Staff Christian Counseling Center', 'Phyllis', 'M', 'Tronrud', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '8575 S 700 E', 'Sandy', 'Salt Lake', 'UT', '84070', '8012681564', '8012681565', '8575 S 700 E', 'Sandy', 'Salt Lake', 'UT', '84070', '8012681564', '8012681565', 'MA', '', '', '0.00', '40.00', '0.00', 6, '2013-08-21', '2011-11-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1871776146', 0, 'N', 0, '2014-06-04', NULL, NULL, 0, 0, NULL, NULL),
('870476172', 'W12048322', 'W12048322', 'UTMH1', 'Shepherds Staff Christian Counseling Center', 'Phyllis', 'M', 'Tronrud', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '525 E 4500 S Ste F-125', 'Murray', 'Salt Lake', 'UT', '84107', '8012681564', '8012681565', '525 E 4500 S Ste F-125', 'Murray', 'Salt Lake', 'UT', '84107', '8012681564', '8012681565', 'MA', '', '', '0.00', '40.00', '0.00', 6, '2013-08-21', '2011-11-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1871776146', 0, 'N', 0, '2014-06-04', NULL, NULL, 0, 0, NULL, NULL),
('870476172', 'W12048323', 'W12048323', 'UTMH1', 'Shepherds Staff Christian Counseling Center', 'Phyllis', 'M', 'Tronrud', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '575 23rd St', 'Ogden', 'Weber', 'UT', '84401', '8012681564', '8012681565', '575 23rd St', 'Ogden', 'Weber', 'UT', '84401', '8012681564', '8012681565', 'MA', '', '', '0.00', '40.00', '0.00', 6, '2013-08-21', '2011-11-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1871776146', 0, 'N', 0, '2014-06-04', NULL, NULL, 0, 0, NULL, NULL),
('870476172', 'W12048324', 'W12048324', 'UTMH1', 'Shepherds Staff Christian Counseling Center', 'Phyllis', 'M', 'Tronrud', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '3665 S 8400 W', 'Magna', 'Salt Lake', 'UT', '84044', '8012681564', '8012681565', '3665 S 8400 W', 'Magna', 'Salt Lake', 'UT', '84044', '8012681564', '8012681565', 'MA', '', '', '0.00', '40.00', '0.00', 6, '2013-08-21', '2011-11-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1871776146', 0, 'N', 0, '2014-06-04', NULL, NULL, 0, 0, NULL, NULL),
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('431922598', 'W12048343', 'W12048343', 'ID02', 'Numotion', '', '', 'Numotion', '', 'Durable Medical Equipment', '', '', NULL, 'B', 'PO Box 790051', 'Saint Louis', 'Saint Louis City', 'MO', '63179', '          ', '          ', 'PO Box 790051', 'Saint Louis', 'Saint Louis City', 'MO', '63179', '          ', '          ', 'IDNUMOT', '', '', '0.00', '45.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000008793', 0, 'N', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
('452715973', 'W12048345', 'W12048345', 'Sinclair', 'St Lukes Clinic Internal Medicine', 'Charles ', '', 'Mangham', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'B', 'PO Box 640', 'Boise', 'Ada', 'ID', '83701', '2087278888', '2087278889', 'PO Box 640', 'Boise', 'Ada', 'ID', '83701', '2087278888', '2087278889', 'IDSINCLAIRD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2030-01-01', NULL, 0, 0, 0, 'St Lukes Regional Medical Center', '', '', '', 'HCFA|UB|', '1972565224', 0, 'N', 1, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
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('364314354', 'W12048346', 'W12048346', 'ILCHIGSTD', 'Presence Service Corporation', 'Mahreen', '', 'Majid', 'MD', 'Hospitalist', '', '', NULL, 'O', '333 N Madison St', 'Joliet', 'Will', 'IL', '60435', '8157737827', '6309142499', '333 N Madison St', 'Joliet', 'Will', 'IL', '60435', '8157737827', '6309142499', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1912158882', 0, 'N', 0, '2014-06-11', NULL, NULL, 0, 0, NULL, NULL),
('364314354', 'W12048347', 'W12048347', 'ILCHIGSTD', 'Presence Service Corporation', 'Mahreen', '', 'Majid', 'MD', 'Hospitalist', '', '', NULL, 'B', '25872 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '8557647687', '6309142469', '25872 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '8557647687', '6309142469', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1912158882', 0, 'N', 0, '2014-06-11', NULL, NULL, 0, 0, NULL, NULL),
('201780406', 'W12048348', 'W12048348', 'ILCHIGSTD', 'UroPartners', 'Laurie', '', 'Bachrach', 'MD', 'Urology', '', '', NULL, 'O', '675 W North Ave Ste 605', 'Melrose Park', 'Cook', 'IL', '60160', '7084505055', '7083382474', '675 W North Ave Ste 605', 'Melrose Park', 'Cook', 'IL', '60160', '7084505055', '7083382474', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1184899775', 0, 'N', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
('201780406', 'W12048349', 'W12048349', 'ILCHIGSTD', 'UroPartners', 'Laurie', '', 'Bachrach', 'MD', 'Urology', '', '', NULL, 'B', '3183 Paysphere Cr', 'Chicago', 'Cook', 'IL', '60674', '2242603100', '8479988112', '3183 Paysphere Cr', 'Chicago', 'Cook', 'IL', '60674', '2242603100', '8479988112', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1184899775', 0, 'N', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
('202630141', 'W12048350', 'W12048350', 'IDBOISTD', 'Primary Health Medical Group', 'Carolyn', 'G', 'Barnhart', 'NP', 'Family Practice', '', '', NULL, 'O', '8971 W Overland', 'Boise', 'Ada', 'ID', '83709', '2083784288', '2083784297', '8971 W Overland', 'Boise', 'Ada', 'ID', '83709', '2083784288', '2083784297', 'IDPRIMARY', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2014-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1033190582', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('202630141', 'W12048351', 'W12048351', 'IDBOISTD', 'Primary Health Medical Group', 'Carolyn', 'G', 'Barnhart', 'NP', 'Family Practice', '', '', NULL, 'B', 'PO Box 191050', 'Boise', 'Ada', 'ID', '83719', '2088958670', '          ', 'PO Box 191050', 'Boise', 'Ada', 'ID', '83719', '2088958670', '          ', 'IDPRIMARY', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2014-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1033190582', 0, 'N', 0, '2014-06-24', NULL, NULL, 0, 0, NULL, NULL),
('954893928', 'W12048352', 'W12048352', 'UT01', 'Exodus Healthcare Network', 'Justin', '', 'Atherton', 'DO', 'General Surgery', '', '', NULL, 'O', '3665 S 8400 W Ste 110', 'Magna', 'Salt Lake', 'UT', '84044', '8012509638', '8012503204', '3665 S 8400 W Ste 110', 'Magna', 'Salt Lake', 'UT', '84044', '8012509638', '8012503204', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1386876167', 0, 'N', 1, '2014-05-30', NULL, NULL, 0, 0, NULL, NULL),
('954893928', 'W12048353', 'W12048353', 'UT01', 'Exodus Healthcare Network', 'Justin', '', 'Atherton', 'DO', 'General Surgery', '', '', NULL, 'O', '3336 S Pioneer Pkwy Ste 201', 'Magna', 'Salt Lake', 'UT', '84044', '8012509638', '8012503204', '3336 S Pioneer Pkwy Ste 201', 'Magna', 'Salt Lake', 'UT', '84044', '8012509638', '8012503204', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1386876167', 0, 'N', 1, '2014-05-30', NULL, NULL, 0, 0, NULL, NULL),
('954893928', 'W12048354', 'W12048354', 'UT01', 'Exodus Healthcare Network', 'Cecilia', 'N I', 'Ahanonu', 'MPAS', 'Family Practice', '', '', NULL, 'O', '3336 S Pioneer Pkwy Ste 201', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8012509638', '          ', '3336 S Pioneer Pkwy Ste 201', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8012509638', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-05-30', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1720231368', 0, 'N', 0, '2014-05-30', NULL, NULL, 0, 0, NULL, NULL),
('954893928', 'W12048355', 'W12048355', 'UT01', 'Exodus Healthcare Network', 'Juanita', '', 'Allen', 'APRN', 'Family Practice', '', '', NULL, 'O', '3336 S Pioneer Pkwy Ste 201', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8012509638', '          ', '3336 S Pioneer Pkwy Ste 201', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8012509638', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-05-30', NULL, 0, 0, 0, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1821125295', 0, 'N', 0, '2014-05-30', NULL, NULL, 0, 0, NULL, NULL),
('954893928', 'W12048356', 'W12048356', 'UT01', 'Exodus Healthcare Network', 'Pragati', '', 'Hooda', 'MD', 'Family Practice', '', '', NULL, 'O', '3336 S Pioneer Pkwy Ste 201', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8012509638', '8012503204', '3336 S Pioneer Pkwy Ste 201', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8012509638', '8012503204', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-05-30', NULL, 0, 0, 0, 'Pioneer Valley Hospital', '', '', '', 'HCFA|UB|', '1962735670', 0, 'N', 0, '2014-05-30', NULL, NULL, 0, 0, NULL, NULL),
('954893928', 'W12048357', 'W12048357', 'UT01', 'Exodus Healthcare Network', 'Aziza', 'O', 'Keval', 'MD', 'General Practice', NULL, NULL, NULL, 'O', '3336 S Pioneer Pkwy Ste 201', 'Magna', 'Salt Lake', 'UT', '84044', '8012509638', '8012503204', '3336 S Pioneer Pkwy Ste 201', 'Magna', 'Salt Lake', 'UT', '84044', '8012509638', '8012503204', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-05-30', NULL, 0, 0, 0, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1790716439', 0, 'Y', 0, '2014-05-30', NULL, NULL, 0, 0, NULL, NULL),
('954893928', 'W12048358', 'W12048358', 'UT01', 'Exodus Healthcare Network', 'Rodolfo', '', 'Martinez-Ferrate', 'MD', 'Family Practice', '', '', NULL, 'O', '3336 S Pioneer Pkwy Ste 201', 'Magna', 'Salt Lake', 'UT', '84044', '8012509638', '8012503204', '3336 S Pioneer Pkwy Ste 201', 'Magna', 'Salt Lake', 'UT', '84044', '8012509638', '8012503204', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-05-30', '2014-06-24', 0, 0, 0, 'Pioneer Valley Hospital', '', '', '', 'HCFA|UB|', '1598738270', 0, 'N', 0, '2014-06-30', NULL, NULL, 0, 0, NULL, NULL),
('954893928', 'W12048359', 'W12048359', 'UT01', 'Exodus Healthcare Network', 'Jill', 'D', 'McBride', 'MD', 'Family Practice', '', '', NULL, 'O', '3336 S Pioneer Pkwy Ste 201', 'Magna', 'Salt Lake', 'UT', '84044', '8012509638', '8012503204', '3336 S Pioneer Pkwy Ste 201', 'Magna', 'Salt Lake', 'UT', '84044', '8012509638', '8012503204', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-05-30', NULL, 0, 0, 0, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1992718902', 0, 'N', 0, '2014-05-30', NULL, NULL, 0, 0, NULL, NULL),
('954893928', 'W12048360', 'W12048360', 'UT01', 'Exodus Healthcare Network', 'Steven', 'J', 'Spencer', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '3336 S Pioneer Pkwy Ste 201', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8012509638', '          ', '3336 S Pioneer Pkwy Ste 201', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8012509638', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-05-30', NULL, 0, 0, 0, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1356369938', 0, 'N', 0, '2014-05-30', NULL, NULL, 0, 0, NULL, NULL),
('954893928', 'W12048361', 'W12048361', 'UT01', 'Exodus Healthcare Network', 'Brian', 'K', 'Zehnder', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '3336 S Pioneer Pkwy Ste 201', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8012509638', '8014170063', '3336 S Pioneer Pkwy Ste 201', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8012509638', '8014170063', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-05-30', NULL, 0, 0, 0, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1447278023', 0, 'N', 0, '2014-05-30', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'W12048364', 'W12048364', 'ILCHIGSTD', 'Presence Healthcare Services', 'Maria', '', 'Tuason', 'MD', 'Family Practice', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '8557647687', '6309142469', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60693', '8557647687', '6309142469', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-06-01', NULL, 0, 0, 0, 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', '', '', '', 'HCFA|UB|', '1013919893', 0, 'N', 0, '2014-05-30', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'W12048363', 'W12048363', 'ILCHIGSTD', '', 'Maria', '', 'Tuason', 'MD', 'Family Practice', '', '', NULL, 'O', '3224 W Armitage Ave', 'Chicago', 'Cook', 'IL', '60647', '7736450096', '6309142499', '3224 W Armitage Ave', 'Chicago', 'Cook', 'IL', '60647', '7736450096', '6309142499', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-06-01', NULL, 0, 0, 0, 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', '', '', '', 'HCFA|UB|', '1013919893', 0, 'N', 0, '2014-05-30', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'W12048362', 'W12048362', 'ILCHIGSTD', '', 'Maria', '', 'Tuason', 'MD', 'Family Practice', '', '', NULL, 'O', '3758 W Chicago Ave', 'Chicago', 'Cook', 'IL', '60651', '7732350626', '6309142499', '3758 W Chicago Ave', 'Chicago', 'Cook', 'IL', '60651', '7732350626', '6309142499', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2014-06-01', NULL, 0, 0, 0, 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', '', '', '', 'HCFA|UB|', '1013919893', 0, 'N', 0, '2014-05-30', NULL, NULL, 0, 0, NULL, NULL),
('870427760', 'W12048365', 'W12048365', 'NA01', 'Depot Drug (CPAP Services and Home Sleep Testing)', '', '', 'Depot Drug', '', 'Durable Medical Equipment', '', '', NULL, 'O', 'Phone Number Only', '', '', '', '', '8008770618', '0000000000', 'Phone Number Only', '', '', '', '', '8008770618', '0000000000', 'DEPOTDRUG', '', '', '0.00', '50.00', '0.00', 3, '2014-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1104987312', 0, 'N', 0, '2014-05-30', NULL, NULL, 0, 0, NULL, NULL),
('870427760', 'W12048366', 'W12048366', 'NA01', 'Depot Drug (CPAP Services and Home Sleep Testing)', '', '', 'Depot Drug', '', 'Durable Medical Equipment', '', '', NULL, 'B', 'PO Box 161020', 'Salt Lake City', 'Salt Lake', 'UT', '84116', '8008770618', '0000000000', 'PO Box 161020', 'Salt Lake City', 'Salt Lake', 'UT', '84116', '8008770618', '0000000000', 'DEPOTDRUG', '', '', '0.00', '50.00', '0.00', 3, '2014-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1104987312', 0, 'N', 0, '2014-05-30', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12048368', 'W12048368', 'WYBILLINGS', 'Billings Clinic', 'Katie', 'A', 'Germany', 'MD', 'Pediatrics', '', '', NULL, 'B', 'PO Box 31315', 'Billings', 'Yellowstone', 'MT', '59107', '4062382617', '0000000000', 'PO Box 31315', 'Billings', 'Yellowstone', 'MT', '59107', '4062382617', '0000000000', '', '', '', '0.00', '17.00', '0.00', 3, '2014-05-28', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1669791091', 0, 'N', 0, '2014-05-30', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12048371', 'W12048371', 'WYBILLINGS', 'Billings Clinic - Pediatrics', 'Katie', 'A', 'Germany', 'MD', 'Pediatrics', '', '', NULL, 'O', '2675 Central Ave', 'Billings', 'Yellowstone', 'MT', '59102', '4062382501', '4062382978', '2675 Central Ave', 'Billings', 'Yellowstone', 'MT', '59102', '4062382501', '4062382978', '', '', '', '0.00', '17.00', '0.00', 3, '2014-05-28', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1669791091', 0, 'N', 0, '2014-05-30', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12048370', 'W12048370', 'WYBILLINGS', 'Billings Clinic', 'Katie', 'A', 'Germany', 'MD', 'Pediatrics', '', '', NULL, 'M', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', '0000000000', '0000000000', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', '0000000000', '0000000000', '', '', '', '0.00', '17.00', '0.00', 3, '2014-05-28', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1669791091', 0, 'N', 0, '2014-05-30', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12048375', 'W12048375', 'WYBILLINGS', 'Billings Clinic - Pediatrics', 'John', 'M', 'Binder', 'MD', 'Pediatric Neurology', '', '', NULL, 'O', '2800 10th Ave N', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4066574349', '2800 10th Ave N', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4066574349', '', '', '', '0.00', '17.00', '0.00', 3, '2014-05-22', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1265667893', 0, 'N', 0, '2014-05-30', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12048373', 'W12048373', 'WYBILLINGS', 'Billings Clinic', 'John', 'M', 'Binder', 'MD', 'Pediatric Neurology', '', '', NULL, 'B', 'PO Box 31315', 'Billings', 'Yellowstone', 'MT', '59107', '4062382617', '0000000000', 'PO Box 31315', 'Billings', 'Yellowstone', 'MT', '59107', '4062382617', '0000000000', '', '', '', '0.00', '17.00', '0.00', 3, '2014-05-22', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1265667893', 0, 'N', 0, '2014-05-30', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12048374', 'W12048374', 'WYBILLINGS', 'Billings Clinic', 'John', 'M', 'Binder', 'MD', 'Pediatric Neurology', '', '', NULL, 'M', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', '0000000000', '0000000000', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', '0000000000', '0000000000', '', '', '', '0.00', '17.00', '0.00', 3, '2014-05-22', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1265667893', 0, 'N', 0, '2014-05-30', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12048377', 'W12048377', 'WYBILLINGS', 'Billings Clinic', 'Ronald', '', 'Handlos', 'PA-C', 'Occupational Medicine', '', '', NULL, 'B', 'PO Box 31315', 'Billings', 'Yellowstone', 'MT', '59107', '4062382617', '0000000000', 'PO Box 31315', 'Billings', 'Yellowstone', 'MT', '59107', '4062382617', '0000000000', '', '', '', '0.00', '17.00', '0.00', 3, '2014-05-23', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1679685192', 0, 'N', 0, '2014-05-30', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12048378', 'W12048378', 'WYBILLINGS', 'Billings Clinic', 'Ronald', '', 'Handlos', 'PA-C', 'Occupational Medicine', '', '', NULL, 'M', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', '0000000000', '0000000000', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', '0000000000', '0000000000', '', '', '', '0.00', '17.00', '0.00', 3, '2014-05-23', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1679685192', 0, 'N', 0, '2014-05-30', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12048379', 'W12048379', 'WYBILLINGS', 'Billings Clinic - Occupational Health & Wellness', 'Ronald', '', 'Handlos', 'PA-C', 'Occupational Medicine', '', '', NULL, 'O', '2675 Central Ave', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062382978', '2675 Central Ave', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062382978', '', '', '', '0.00', '17.00', '0.00', 3, '2014-05-23', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1679685192', 0, 'N', 0, '2014-05-30', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12048381', 'W12048381', 'WYBILLINGS', 'Billings Clinic -Family Practice', 'Leslie', 'R', 'Mutchler', 'NP', 'Family Practice', '', '', NULL, 'O', '801 N 29th St', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062382868', '801 N 29th St', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062382868', '', '', '', '0.00', '17.00', '0.00', 3, '2014-05-27', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1720272347', 0, 'N', 0, '2014-05-30', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12048382', 'W12048382', 'WYBILLINGS', 'Billings Clinic', 'Leslie', 'R', 'Mutchler', 'NP', 'Family Practice', '', '', NULL, 'B', 'PO Box 31315', 'Billings', 'Yellowstone', 'MT', '59107', '4062382617', '0000000000', 'PO Box 31315', 'Billings', 'Yellowstone', 'MT', '59107', '4062382617', '0000000000', '', '', '', '0.00', '17.00', '0.00', 3, '2014-05-27', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1720272347', 0, 'N', 0, '2014-05-30', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12048383', 'W12048383', 'WYBILLINGS', 'Billings Clinic', 'Leslie', 'R', 'Mutchler', 'NP', 'Family Practice', '', '', NULL, 'M', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', '0000000000', '0000000000', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', '0000000000', '0000000000', '', '', '', '0.00', '17.00', '0.00', 3, '2014-05-27', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1720272347', 0, 'N', 0, '2014-05-30', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12048385', 'W12048385', 'WYBILLINGS', 'Billings Clinic', 'Gordon', '', 'Herrald', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 31315', 'Billings', 'Yellowstone', 'MT', '59107', '4062382617', '0000000000', 'PO Box 31315', 'Billings', 'Yellowstone', 'MT', '59107', '4062382617', '0000000000', '', '', '', '0.00', '17.00', '0.00', 3, '2014-05-27', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1619965779', 0, 'N', 0, '2014-05-30', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12048387', 'W12048387', 'WYBILLINGS', 'Billings Clinic - Miles City Clinic', 'Gordon', '', 'Herrald', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '620 S Haynes', 'Miles City', 'Custer', 'MT', '59301', '4062337000', '4062337070', '620 S Haynes', 'Miles City', 'Custer', 'MT', '59301', '4062337000', '4062337070', '', '', '', '0.00', '17.00', '0.00', 3, '2014-05-27', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1619965779', 0, 'N', 0, '2014-05-30', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12048386', 'W12048386', 'WYBILLINGS', 'Billings Clinic', 'Gordon', '', 'Herrald', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'M', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', '0000000000', '0000000000', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', '0000000000', '0000000000', '', '', '', '0.00', '17.00', '0.00', 3, '2014-05-27', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1619965779', 0, 'N', 0, '2014-05-30', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12048388', 'W12048388', 'WYBILLINGS', 'Billings Clinic - Heights Clinic', 'Garett', 'R', 'Williams', 'MD', 'Family Medicine', '', '', NULL, 'O', '760 Wicks Ln', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062382586', '760 Wicks Ln', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062382586', '', '', '', '0.00', '17.00', '0.00', 3, '2014-05-05', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1982866687', 0, 'N', 0, '2014-05-30', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12048389', 'W12048389', 'WYBILLINGS', 'Billings Clinic', 'Garett', 'R', 'Williams', 'MD', 'Family Medicine', '', '', NULL, 'B', 'PO Box 31315', 'Billings', 'Yellowstone', 'MT', '59107', '4062382617', '0000000000', 'PO Box 31315', 'Billings', 'Yellowstone', 'MT', '59107', '4062382617', '0000000000', '', '', '', '0.00', '17.00', '0.00', 3, '2014-05-05', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1982866687', 0, 'N', 0, '2014-05-30', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W12048390', 'W12048390', 'WYBILLINGS', 'Billings Clinic', 'Garett', 'R', 'Williams', 'MD', 'Family Medicine', '', '', NULL, 'M', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', '0000000000', '0000000000', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', '0000000000', '0000000000', '', '', '', '0.00', '17.00', '0.00', 3, '2014-05-05', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1982866687', 0, 'N', 0, '2014-05-30', NULL, NULL, 0, 0, NULL, NULL),
('760512625', 'W12048185', 'W12048185', 'TXHOUSTD', 'Houston Eye Associates', 'John', 'J', 'Alappatt', 'MD', 'Ophthalmology', '', '', NULL, 'M', '7155 Old Katy Rd Ste N100', 'Houston', 'Harris', 'TX', '77024', '          ', '          ', '7155 Old Katy Rd Ste N100', 'Houston', 'Harris', 'TX', '77024', '          ', '          ', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1568409688', 0, 'N', 0, '2014-05-30', NULL, NULL, 0, 0, NULL, NULL),
('760512625', 'W12048391', 'W12048391', 'TXHOUSTD', 'Houston Eye Associates', 'John', 'J', 'Alappatt', 'MD', 'Ophthalmology', '', '', NULL, 'O', '2302 Ave P', 'Galveston', 'Galveston', 'TX', '77550', '4097656324', '4099388437', '2302 Ave P', 'Galveston', 'Galveston', 'TX', '77550', '4097656324', '4099388437', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1568409688', 0, 'N', 0, '2014-05-30', NULL, NULL, 0, 0, NULL, NULL),
('760512625', 'W12048189', 'W12048189', 'TXHOUSTD', 'Houston Eye Associates', 'John', 'J', 'Alappatt', 'MD', 'Ophthalmology', '', '', NULL, 'B', 'PO Box 4958', 'Houston', 'Harris', 'TX', '77210', '          ', '          ', 'PO Box 4958', 'Houston', 'Harris', 'TX', '77210', '          ', '          ', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1568409688', 0, 'N', 0, '2014-05-30', NULL, NULL, 0, 0, NULL, NULL),
('760512625', 'W12048392', 'W12048392', 'TXHOUSTD', 'Houston Eye Associates', 'John', 'J', 'Alappatt', 'MD', 'Ophthalmology', '', '', NULL, 'O', '1100 Gulf Fwy Ste 114', 'League City', 'Galveston', 'TX', '77573', '2813323937', '2813320807', '1100 Gulf Fwy Ste 114', 'League City', 'Galveston', 'TX', '77573', '2813323937', '2813320807', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1568409688', 0, 'N', 0, '2014-05-30', NULL, NULL, 0, 0, NULL, NULL),
('760512625', 'W12048393', 'W12048393', 'TXHOUSTD', 'Houston Eye Associates', 'John', 'J', 'Alappatt', 'MD', 'Ophthalmology', '', '', NULL, 'O', '7111 Medical Ctr Dr Ste 110', 'Texas City', 'Galveston', 'TX', '77591', '4099388437', '4099387687', '7111 Medical Ctr Dr Ste 110', 'Texas City', 'Galveston', 'TX', '77591', '4099388437', '4099387687', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1568409688', 0, 'N', 0, '2014-05-30', NULL, NULL, 0, 0, NULL, NULL),
('760512625', 'W12048395', 'W12048395', 'TXHOUSTD', 'Houston Eye Associates', 'Sol', '', 'Hamburg', 'MD', 'Ophthalmology', '', '', NULL, 'O', '1601 Main Ste 408', 'Richmond', 'Fort Bend', 'TX', '77469', '2813410405', '2813411000', '1601 Main Ste 408', 'Richmond', 'Fort Bend', 'TX', '77469', '2813410405', '2813411000', 'Houston4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1346295185', 0, 'N', 0, '2014-05-30', NULL, NULL, 0, 0, NULL, NULL),
('760512625', 'W12048396', 'W12048396', 'TXHOUSTD', 'Houston Eye Associates', 'Sol', '', 'Hamburg', 'MD', 'Ophthalmology', '', '', NULL, 'O', '2855 Gramercy', 'Houston', 'Harris', 'TX', '77025', '7136686828', '7136683823', '2855 Gramercy', 'Houston', 'Harris', 'TX', '77025', '7136686828', '7136683823', 'Houston4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1346295185', 0, 'N', 0, '2014-05-30', NULL, NULL, 0, 0, NULL, NULL),
('760512625', 'W12048397', 'W12048397', 'TXHOUSTD', 'Houston Eye Associates', 'Sol', '', 'Hamburg', 'MD', 'Ophthalmology', '', '', NULL, 'M', '7155 Old Katy Rd Ste N100', 'Houston', 'Harris', 'TX', '77024', '          ', '          ', '7155 Old Katy Rd Ste N100', 'Houston', 'Harris', 'TX', '77024', '          ', '          ', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1346295185', 0, 'N', 0, '2014-05-30', NULL, NULL, 0, 0, NULL, NULL),
('760512625', 'W12048398', 'W12048398', 'TXHOUSTD', 'Houston Eye Associates', 'Sol', '', 'Hamburg', 'MD', 'Ophthalmology', '', '', NULL, 'B', 'PO Box 4958', 'Houston', 'Harris', 'TX', '77210', '          ', '          ', 'PO Box 4958', 'Houston', 'Harris', 'TX', '77210', '          ', '          ', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1346295185', 0, 'N', 0, '2014-05-30', NULL, NULL, 0, 0, NULL, NULL),
('760512625', 'W12048399', 'W12048399', 'TXHOUSTD', 'Houston Eye Associates', 'Sol', '', 'Hamburg', 'MD', 'Ophthalmology', '', '', NULL, 'O', '12121 Richmond Ave Ste 220', 'Houston', 'Harris', 'TX', '77082', '2815565483', '2815565416', '12121 Richmond Ave Ste 220', 'Houston', 'Harris', 'TX', '77082', '2815565483', '2815565416', 'Houston4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1346295185', 0, 'N', 0, '2014-05-30', NULL, NULL, 0, 0, NULL, NULL),
('760512625', 'W12048400', 'W12048400', 'TXHOUSTD', 'Houston Eye Associates', 'Lindsey', 'D', 'Harris', 'MD', 'Ophthalmology', '', '', NULL, 'O', '12121 Richmond Ave Ste 220', 'Houston', 'Harris', 'TX', '77082', '2815565483', '2815565416', '12121 Richmond Ave Ste 220', 'Houston', 'Harris', 'TX', '77082', '2815565483', '2815565416', 'Houston4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-06-01', NULL, 0, 0, 0, 'Houston Methodist Hospital', '', '', '', 'HCFA|UB|', '1093729402', 0, 'N', 0, '2014-05-30', NULL, NULL, 0, 0, NULL, NULL),
('760512625', 'W12048402', 'W12048402', 'TXHOUSTD', 'Houston Eye Associates', 'Timmy', 'A', 'Kovoor', 'MD', 'Ophthalmology', '', '', NULL, 'M', '7155 Old Katy Rd Ste N100', 'Houston', 'Harris', 'TX', '77024', '          ', '          ', '7155 Old Katy Rd Ste N100', 'Houston', 'Harris', 'TX', '77024', '          ', '          ', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1679776512', 0, 'N', 0, '2014-05-30', NULL, NULL, 0, 0, NULL, NULL),
('760512625', 'W12048403', 'W12048403', 'TXHOUSTD', 'Houston Eye Associates', 'Timmy', 'A', 'Kovoor', 'MD', 'Ophthalmology', '', '', NULL, 'B', 'PO Box 4958', 'Houston', 'Harris', 'TX', '77210', '          ', '          ', 'PO Box 4958', 'Houston', 'Harris', 'TX', '77210', '          ', '          ', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1679776512', 0, 'N', 0, '2014-05-30', NULL, NULL, 0, 0, NULL, NULL),
('760512625', 'W12048404', 'W12048404', 'TXHOUSTD', 'Houston Eye Associates', 'Timmy', 'A', 'Kovoor', 'MD', 'Ophthalmology', '', '', NULL, 'O', '590 Chimney Rock', 'Houston', 'Harris', 'TX', '77056', '7137824406', '7137822554', '590 Chimney Rock', 'Houston', 'Harris', 'TX', '77056', '7137824406', '7137822554', 'Houston4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1679776512', 0, 'N', 0, '2014-05-30', NULL, NULL, 0, 0, NULL, NULL),
('760512625', 'W12048405', 'W12048405', 'TXHOUSTD', 'Houston Eye Associates', 'Timmy', 'A', 'Kovoor', 'MD', 'Ophthalmology', '', '', NULL, 'O', '1229 Campbell Rd', 'Houston', 'Harris', 'TX', '77055', '7134676600', '7134677914', '1229 Campbell Rd', 'Houston', 'Harris', 'TX', '77055', '7134676600', '7134677914', 'Houston4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1679776512', 0, 'N', 0, '2014-05-30', NULL, NULL, 0, 0, NULL, NULL),
('760512625', 'W12048406', 'W12048406', 'TXHOUSTD', 'Houston Eye Associates', 'Timmy', 'A', 'Kovoor', 'MD', 'Ophthalmology', '', '', NULL, 'O', '2855 Gramercy', 'Houston', 'Harris', 'TX', '77025', '7136686828', '7136683823', '2855 Gramercy', 'Houston', 'Harris', 'TX', '77025', '7136686828', '7136683823', 'Houston4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1679776512', 0, 'N', 0, '2014-05-30', NULL, NULL, 0, 0, NULL, NULL),
('760512625', 'W12048407', 'W12048407', 'TXHOUSTD', 'Houston Eye Associates', 'Timmy', 'A', 'Kovoor', 'MD', 'Ophthalmology', '', '', NULL, 'O', '5420 Dashwood Ste 101', 'Houston', 'Harris', 'TX', '77081', '7136689118', '7136631005', '5420 Dashwood Ste 101', 'Houston', 'Harris', 'TX', '77081', '7136689118', '7136631005', 'Houston4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1679776512', 0, 'N', 0, '2014-05-30', NULL, NULL, 0, 0, NULL, NULL),
('760512625', 'W12048409', 'W12048409', 'TXHOUSTD', 'Houston Eye Associates', 'Michael', 'K', 'Lam', 'MD', 'Ophthalmology', '', '', NULL, 'M', '7155 Old Katy Rd Ste N100', 'Houston', 'Harris', 'TX', '77024', '          ', '          ', '7155 Old Katy Rd Ste N100', 'Houston', 'Harris', 'TX', '77024', '          ', '          ', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1548200835', 0, 'N', 0, '2014-05-30', NULL, NULL, 0, 0, NULL, NULL),
('760512625', 'W12048410', 'W12048410', 'TXHOUSTD', 'Houston Eye Associates', 'Michael', 'K', 'Lam', 'MD', 'Ophthalmology', '', '', NULL, 'B', 'PO Box 4958', 'Houston', 'Harris', 'TX', '77210', '          ', '          ', 'PO Box 4958', 'Houston', 'Harris', 'TX', '77210', '          ', '          ', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1548200835', 0, 'N', 0, '2014-05-30', NULL, NULL, 0, 0, NULL, NULL),
('760512625', 'W12048411', 'W12048411', 'TXHOUSTD', 'Houston Eye Associates', 'Michael', 'K', 'Lam', 'MD', 'Ophthalmology', '', '', NULL, 'O', '2302 Ave P', 'Galveston', 'Galveston', 'TX', '77550', '4097656324', '4099388437', '2302 Ave P', 'Galveston', 'Galveston', 'TX', '77550', '4097656324', '4099388437', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2014-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1548200835', 0, 'N', 0, '2014-05-30', NULL, NULL, 0, 0, NULL, NULL),
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INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
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('820484605', 'W12048651', 'W12048651', 'ID02', 'Fisher Chiropractic', 'Christopher', 'W', 'Fisher', 'DC', 'Chiropractic', 'Acupuncture', '', NULL, 'O', '2523 S 10th Ave Ste 102', 'Caldwell', 'Canyon', 'ID', '83605', '2086494321', '2084591036', '2523 S 10th Ave Ste 102', 'Caldwell', 'Canyon', 'ID', '83605', '2086494321', '2084591036', 'IDCHIRO1', '', '', '0.00', '35.00', '0.00', 3, '2014-02-10', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1225175771', 0, 'N', 0, '2014-06-06', NULL, NULL, 0, 0, NULL, NULL),
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('742412898', 'W12048664', 'W12048664', 'UT01', 'Bear River Community Health Center', 'Suzanne', 'E', 'Lee', 'MD', 'Family Practice', '', '', NULL, 'O', '440 W 600 N', 'Tremonton', 'Box Elder', 'UT', '84337', '4357238276', '4357349761', '440 W 600 N', 'Tremonton', 'Box Elder', 'UT', '84337', '4357238276', '4357349761', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2014-05-01', NULL, 0, 0, 0, 'Pioneer Valley Hospital', '', '', '', 'HCFA|UB|', '1962660969', 0, 'N', 0, '2014-06-09', NULL, NULL, 0, 0, NULL, NULL),
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('460706062', 'W12048672', 'W12048672', 'ID02', 'State Avenue Counseling', 'Shane', 'M', 'Clubb', 'LCPC', 'Mental Health', 'Counseling', '', NULL, 'O', '39 E State Ave', 'Meridian', 'Ada', 'ID', '83642', '2089943599', '2084732206', '39 E State Ave', 'Meridian', 'Ada', 'ID', '83642', '2089943599', '2084732206', 'IDMA', '', '', '0.00', '40.00', '0.00', 6, '2014-07-15', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1871554584', 0, 'N', 1, '2014-07-21', NULL, NULL, 0, 0, NULL, NULL),
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('830182821', 'W12048539', 'W12048539', 'WY01', 'Gottsche Rehabilitation Center', 'Joan', '', 'Morgan', 'OT', 'Occupational Therapy', '', '', NULL, 'O', '148 E Arapahoe', 'Thermopolis', 'Hot Springs', 'WY', '82443', '3078642146', '3078642857', '148 E Arapahoe', 'Thermopolis', 'Hot Springs', 'WY', '82443', '3078642146', '3078642857', '', '', '', '0.00', '25.00', '0.00', 3, '2014-06-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1841549649', 0, 'N', 0, '2014-06-16', NULL, NULL, 0, 0, NULL, NULL),
('830182821', 'W12048541', 'W12048541', 'WY01', 'Gottsche Rehabilitation Center', 'Whitney', '', 'Neves', 'PT', 'Physical Therapy', '', '', NULL, 'O', '406 S 4th St', 'Basin', 'Big Horn', 'WY', '82410', '3075689399', '3075689396', '406 S 4th St', 'Basin', 'Big Horn', 'WY', '82410', '3075689399', '3075689396', '', '', '', '0.00', '25.00', '0.00', 3, '2014-06-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1417399775', 0, 'N', 1, '2014-06-18', NULL, NULL, 0, 0, NULL, NULL),
('830182821', 'W12048542', 'W12048542', 'WYT1', 'Gottsche Rehabilitation Center', 'Whitney', '', 'Neves', 'PT', 'Physical Therapy', '', '', NULL, 'O', '406 S 4th St', 'Basin', 'Big Horn', 'WY', '82410', '3075689399', '3075689396', '406 S 4th St', 'Basin', 'Big Horn', 'WY', '82410', '3075689399', '3075689396', '', '', '', '0.00', '25.00', '0.00', 3, '2014-06-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1417399775', 0, 'N', 1, '2014-06-18', NULL, NULL, 0, 0, NULL, NULL),
('830182821', 'W12048563', 'W12048563', 'WYT1', 'Gottsche Rehabilitation Center', 'Ryan', '', 'Vincent', 'PT', 'Physical Therapy', '', '', NULL, 'O', '720 Lindsay Ln', 'Cody', 'Park', 'WY', '82414', '3075781970', '3075781973', '720 Lindsay Ln', 'Cody', 'Park', 'WY', '82414', '3075781970', '3075781973', '', '', '', '0.00', '25.00', '0.00', 3, '2014-06-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1831445162', 0, 'N', 1, '2014-06-17', NULL, NULL, 0, 0, NULL, NULL);
