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
('010839544', 'TX0124799', 'TX0124799', 'TXSATSTD', 'Texas Center for Medical and Surgical Weight Loss', 'Ramiro', 'D', 'Cavazos', 'MD', 'General Surgery', '', '', NULL, 'B', 'PO Box 928', 'San Antonio', 'Bexar', 'TX', '78249', '2106510303', NULL, '8811 Village Dr', 'San Antonio', 'Bexar', 'TX', '78217', NULL, NULL, 'TXSURGF', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, NULL, 0, 0, 'North East Baptist Hospital', NULL, '', '', 'HCFA|UB|', '1619977055', 0, 'y', 0, '2012-08-20', NULL, NULL, 0, 0, NULL, NULL),
('010839544', 'TX0124800', 'TX0124800', 'TXSATSTD', 'Texas Center for Medical and Surgical Weight Loss', 'Linda', '', 'Golden', 'NP', 'General Surgery', '', '', NULL, 'B', 'PO Box 928', 'San Antonio', 'Bexar', 'TX', '78249', '2106510303', NULL, 'PO Box 928', 'San Antonio', 'Bexar', 'TX', '78249', '2106510303', '', 'TXSURGF', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1578735692', 0, 'y', 0, '2014-06-30', NULL, NULL, 0, 0, NULL, NULL),
('010839544', 'TX0124801', 'TX0124801', 'TXSATSTD', 'Texas Center for Medical and Surgical Weight Loss', 'John', 'J', 'Gonzalez', 'MD', 'General Surgery', '', '', NULL, 'B', 'PO Box 928', 'San Antonio', 'Bexar', 'TX', '78249', '2106510303', NULL, 'PO Box 928', 'San Antonio', 'Bexar', 'TX', '78249', '2106510303', '', 'TXSURGF', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'South East Baptist Hospital', '', '', '', 'HCFA|UB|', '1700857927', 0, 'y', 0, '2014-06-16', NULL, NULL, 0, 0, NULL, NULL),
('010839544', 'TX0124802', 'TX0124802', 'TXSATSTD', 'Texas Center for Medical and Surgical Weight Loss', 'Carlos', 'G', 'Martinez', 'MD', 'General Surgery', '', '', NULL, 'B', 'PO Box 928', 'San Antonio', 'Bexar', 'TX', '78249', '2106510303', NULL, 'PO Box 928', 'San Antonio', 'Bexar', 'TX', '78249', '2106510303', '          ', 'TXSURGF', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2012-08-20', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1780894113', 0, 'N', 0, '2013-02-22', NULL, NULL, 0, 0, NULL, NULL),
('205977241', 'TX0124904', 'TX0124904', 'TXSATSTD', 'Toyota Family Health Center', 'Lillian', 'E', 'Perez', 'DO', 'Family Practice', '', '', NULL, 'O', '1 Lone Star Pass Bldg 46', 'San Antonio', 'Bexar', 'TX', '78264', '2102635700', NULL, '1 Lone Star Pass Bldg 46', 'San Antonio', 'Bexar', 'TX', '78264', '2102635700', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2012-08-22', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1710925805', 0, 'Y', 0, '2013-07-25', NULL, NULL, 0, 0, NULL, NULL),
('742047021', 'TX0125003', 'TX0125003', 'TXSATSTD', 'Central Texas Allergy and Asthma', 'Priyanka', '', 'Gupta', 'MD', 'Allergy and Immunology', '', '', NULL, 'O', '705  Landa St Ste F', 'New Braunfels', 'Comal', 'TX', '78130', '8306257612', NULL, '705  Landa St', 'New Braunfels', 'Comal', 'TX', '78130', '8306257612', '', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, NULL, 0, 0, 'North East Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1346281839', 0, 'N', 0, '2012-08-20', NULL, NULL, 29.7015, -98.1438, NULL, NULL),
('742047021', 'TX0125004', 'TX0125004', 'TXSATSTD', 'Central Texas Allergy and Asthma', 'Priyanka', '', 'Gupta', 'MD', 'Allergy and Immunology', '', '', NULL, 'O', '12501 Judson Rd Ste 202', 'San Antonio', 'Bexar', 'TX', '78233', '2106540944', NULL, '12501 Judson Rd Ste 202', 'San Antonio', 'Bexar', 'TX', '78233', '2106540944', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-01-29', 0, 0, 0, 'North East Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1346281839', 0, 'N', 0, '2013-01-31', NULL, NULL, 0, 0, NULL, NULL),
('264333033', 'TX0125007', 'TX0125007', 'TXSATSTD', 'Institute for Womens Health', 'Adrienne', 'W', 'Askew', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '1210 Arion Pkwy', 'San Antonio', 'Bexar', 'TX', '78216', '2103499300', NULL, '1210 Arion Pkwy', 'San Antonio', 'Bexar', 'TX', '78216', '2103499300', '          ', 'TXOBG', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'North Central Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1861699456', 0, 'N', 0, '2013-08-28', NULL, NULL, 0, 0, NULL, NULL),
('264333033', 'TX0125008', 'TX0125008', 'TXSATSTD', 'Institute for Womens Health', 'Adrienne', 'W', 'Askew', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1303 McCullough Ave Ste GL70', 'San Antonio', 'Bexar', 'TX', '78212', '2102269705', NULL, '1303 McCullough Ave Ste GL70', 'San Antonio', 'Bexar', 'TX', '78212', '2102269705', '', 'TXOBG', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'North Central Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1861699456', 0, 'N', 0, '2013-08-27', NULL, NULL, 29.4407, -98.4918, NULL, NULL),
('264333033', 'TX0125009', 'TX0125009', 'TXSATSTD', 'Consultants in Womens Health', 'Adrienne', 'W', 'Askew', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '540 Madison Oak Dr Ste 450', 'San Antonio', 'Bexar', 'TX', '78258', '2104942000', NULL, '540 Madison Oak Dr Ste 450', 'San Antonio', 'Bexar', 'TX', '78258', '2104942000', '          ', 'TXOBG', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-04-24', 0, 0, 0, 'North Central Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1861699456', 0, 'N', 0, '2013-08-27', NULL, NULL, 29.6203, -98.4928, NULL, NULL),
('820471484', 'ID0125048', 'ID0125048', 'IDBOISTD', 'Kuna Family Medical Clinic', 'Annie', '', 'Johnson', 'PA-C', 'Family Practice', '', '', NULL, 'O', '190 W Main St', 'Kuna', 'Ada', 'ID', '83634', '2089225130', NULL, '190 W Main St', 'Kuna', 'Ada', 'ID', '83634', '2089225130', '          ', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-08-20', '2013-06-25', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1003067984', 0, 'N', 0, '2013-07-01', NULL, NULL, 43.4909, -116.415, NULL, NULL),
('820471484', 'ID0125049', 'ID0125049', 'IDBOISTD', 'Kuna Family Medical Clinic', 'Annie', '', 'Johnson', 'PA-C', 'Family Practice', '', '', NULL, 'B', 'PO Box 68', 'Kuna', 'Ada', 'ID', '83634', '2089225130', NULL, 'PO Box 68', 'Kuna', 'Ada', 'ID', '83634', '2089225130', '          ', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-08-20', '2013-06-25', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1003067984', 0, 'N', 0, '2013-07-01', NULL, NULL, 0, 0, NULL, NULL),
('742503534', 'TX0125062', 'TX0125062', 'TXSATSTD', 'South Texas Spinal Clinic', 'Gregg', 'S', 'Gurwitz', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', 'PO Box 120037', 'San Antonio', 'Bexar', 'TX', '78212', '2106146432', NULL, 'PO Box 120037', 'San Antonio', 'Bexar', 'TX', '78212', '2106146432', '', 'TXNEURO', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'North Central Baptist Hospital', '', '', '', 'HCFA|UB|', '1598764813', 0, 'Y', 0, '2014-06-16', NULL, NULL, 0, 0, NULL, NULL),
('742503534', 'TX0125063', 'TX0125063', 'TXSATSTD', 'South Texas Spinal Clinic', 'Gregg', 'S', 'Gurwitz', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '18626 Hardy Oak Blvd Ste 300', 'San Antonio', 'Bexar', 'TX', '78258', '8002807977', NULL, '18626 Hardy Oak Blvd Ste 300', 'San Antonio', 'Bexar', 'TX', '78258', '8002807977', '', 'TXNEURO', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'North Central Baptist Hospital', '', '', '', 'HCFA|UB|', '1598764813', 0, 'N', 0, '2014-06-16', NULL, NULL, 29.6137, -98.4785, NULL, NULL),
('742503534', 'TX0125072', 'TX0125072', 'TXSATSTD', 'South Texas Spinal Clinic', 'Brent', 'M', 'Adcox', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', 'PO Box 120037', 'San Antonio', 'Bexar', 'TX', '78212', '2104959047', NULL, 'PO Box 120037', 'San Antonio', 'Bexar', 'TX', '78212', '2104959047', '', 'TXNEURO', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-04-24', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1437339454', 0, 'Y', 0, '2014-03-26', NULL, NULL, 0, 0, NULL, NULL),
('742503534', 'TX0125073', 'TX0125073', 'TXSATSTD', 'South Texas Spinal Clinic', 'Brent', 'M', 'Adcox', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '18626 Hardy Oak Blvd Ste 300', 'San Antonio', 'Bexar', 'TX', '78258', '8002807977', NULL, '18626 Hardy Oak Blvd Ste 300', 'San Antonio', 'Bexar', 'TX', '78258', '8002807977', '', 'TXNEURO', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-04-24', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1437339454', 0, 'N', 0, '2014-03-26', NULL, NULL, 29.6139, -98.4774, NULL, NULL),
('742503534', 'TX0125074', 'TX0125074', 'TXSATSTD', 'South Texas Spinal Clinic', 'Brent', 'M', 'Adcox', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '861 Landa St', 'New Braunfels', 'Comal', 'TX', '78130', '8306093800', NULL, '861 Landa St', 'New Braunfels', 'Comal', 'TX', '78130', '8306093800', '', 'TXNEURO', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-04-24', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1437339454', 0, 'N', 0, '2014-03-26', NULL, NULL, 29.6996, -98.1475, NULL, NULL),
('942854057', 'ID0114940', 'ID0114940', 'IDBOISTD', 'Primary Childrens Medical Center', 'James', 'F', 'Bale', 'MD', 'Neurology', 'Pediatric Neurology', '', NULL, 'B', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8015882000', NULL, '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8015882000', '          ', '', '', '', '0.00', '0.00', '0.00', 8, '2012-08-20', '2012-08-20', 0, 0, 0, 'Primary Childrens Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1750460226', 0, 'Y', 0, '2012-10-16', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'ID0114993', 'ID0114993', 'IDBOISTD', 'Safe and Healthy Families', 'Karen', 'K', 'Hansen', 'MD', 'Pediatrics', 'Child Protection and Family Health', '', NULL, 'B', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8015882000', NULL, '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8015882000', '          ', '', '', '', '0.00', '0.00', '0.00', 8, '2012-08-20', '2012-08-20', 0, 0, 0, 'University Health Care University Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1093805699', 0, 'Y', 0, '2012-10-16', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'ID0115000', 'ID0115000', 'IDBOISTD', 'Ophthalmology', 'Robert', 'O', 'Hoffman', 'MD', 'Ophthalmology', 'Pediatric Ophthalmology', '', NULL, 'B', '100 N Mario Capecchi Dr Ste 3650', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8015814955', NULL, '100 N Mario Capecchi Dr Ste 3650', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8015814955', '          ', '', '', '', '0.00', '0.00', '0.00', 8, '2012-08-20', '2012-08-20', 0, 0, 0, 'University Health Care University Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1992895593', 0, 'Y', 0, '2012-10-16', NULL, NULL, 0, 0, NULL, NULL),
('264333033', 'TX0101218', 'TX0101218', 'TXSATSTD', 'Northeast OB-GYN Associates', 'Joy', 'T', 'Aden', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '1210 Arion', 'San Antonio', 'Bexar', 'TX', '78216', '2106509978', NULL, '1210 Arion', 'San Antonio', 'Bexar', 'TX', '78216', '2106509978', '          ', 'TXOBG', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'North Central Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1114936408', 0, 'Y', 0, '2013-04-24', NULL, NULL, 0, 0, NULL, NULL),
('264333033', 'TX0101219', 'TX0101219', 'TXSATSTD', 'Northeast OB-GYN Associates', 'Bruce', 'D', 'Akright', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '1210 Arion Pkwy', 'San Antonio', 'Bexar', 'TX', '78216', '2106509978', NULL, '1210 Arion Pkwy', 'San Antonio', 'Bexar', 'TX', '78216', '2106509978', '          ', 'TXOBG', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'North Central Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1679515373', 0, 'Y', 0, '2013-08-22', NULL, NULL, 0, 0, NULL, NULL),
('264333033', 'TX0101230', 'TX0101230', 'TXSATSTD', 'Institute for Womens Health', 'Valentin', '', 'Almendarez', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '1210 Arion Pkwy', 'San Antonio', 'Bexar', 'TX', '78216', '2106563040', NULL, '1210 Arion Pkwy  ', 'San Antonio', 'Bexar', 'TX', '78216', '2106563040', '          ', 'TXOBG', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'St Lukes Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1326037615', 0, 'Y', 0, '2013-12-09', NULL, NULL, 0, 0, NULL, NULL),
('264333033', 'TX0101232', 'TX0101232', 'TXSATSTD', 'Institute for Womens Health', 'Daniel', 'A', 'Calderon', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '1210 Arion Pkwy', 'San Antonio', 'Bexar', 'TX', '78216', '2106563040', NULL, '1210 Arion Pkwy  ', 'San Antonio', 'Bexar', 'TX', '78216', '2106563040', '          ', 'TXOBG', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'North Central Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1083603252', 0, 'Y', 0, '2013-04-24', NULL, NULL, 0, 0, NULL, NULL),
('264333033', 'TX0101233', 'TX0101233', 'TXSATSTD', 'Institute for Womens Health', 'Karen', 'M', 'Carcamo', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '1210 Arion Pkwy', 'San Antonio', 'Bexar', 'TX', '78216', '2106563040', NULL, '1210 Arion Pkwy   ', 'San Antonio', 'Bexar', 'TX', '78216', '2106563040', '          ', 'TXOBG', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'St Lukes Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1235129271', 0, 'Y', 0, '2013-08-07', NULL, NULL, 0, 0, NULL, NULL),
('264333033', 'TX0101234', 'TX0101234', 'TXSATSTD', 'Institute for Womens Health', 'Carlos', 'A', 'Cardenas', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '1210 Arion Pkwy', 'San Antonio', 'Bexar', 'TX', '78216', '2106563040', NULL, '1210 Arion Pkwy    ', 'San Antonio', 'Bexar', 'TX', '78216', '2106563040', '          ', 'TXOBG', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'North Central Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1487643664', 0, 'Y', 0, '2014-03-18', NULL, NULL, 0, 0, NULL, NULL),
('264333033', 'TX0101236', 'TX0101236', 'TXSATSTD', 'Institute for Womens Health', 'Victor', 'L', 'Casiano', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '1210 Arion Pkwy', 'San Antonio', 'Bexar', 'TX', '78216', '2106563040', NULL, '1210 Arion Pkwy     ', 'San Antonio', 'Bexar', 'TX', '78216', '2106563040', '          ', 'TXOBG', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'North Central Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1679562862', 0, 'Y', 0, '2013-04-24', NULL, NULL, 0, 0, NULL, NULL),
('264333033', 'TX0101237', 'TX0101237', 'TXSATSTD', 'Institute for Womens Health', 'Luis', 'L', 'Castellanos', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '1210 Arion Pkwy', 'San Antonio', 'Bexar', 'TX', '78216', '2106563040', NULL, '1210 Arion Pkwy      ', 'San Antonio', 'Bexar', 'TX', '78216', '2106563040', '          ', 'TXOBG', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2012-12-31', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1538158720', 0, 'Y', 0, '2012-12-04', NULL, NULL, 0, 0, NULL, NULL),
('264333033', 'TX0101238', 'TX0101238', 'TXSATSTD', 'Institute for Womens Health', 'Anna', 'L', 'Chavana', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '1210 Arion Pkwy', 'San Antonio', 'Bexar', 'TX', '78216', '2106563040', NULL, '1210 Arion Pkwy       ', 'San Antonio', 'Bexar', 'TX', '78216', '2106563040', '', 'TXOBG', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'North Central Baptist Hospital', '', '', '', 'HCFA|UB|', '1689683039', 0, 'Y', 0, '2014-05-01', NULL, NULL, 0, 0, NULL, NULL),
('264333033', 'TX0101239', 'TX0101239', 'TXSATSTD', 'Institute for Womens Health', 'Joe', 'R', 'Childress', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '1210 Arion Pkwy', 'San Antonio', 'Bexar', 'TX', '78216', '2106563040', NULL, '1210 Arion Pkwy       ', 'San Antonio', 'Bexar', 'TX', '78216', '2106563040', '', 'TXOBG', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'North East Baptist Hospital', '', '', '', 'HCFA|UB|', '1063401271', 0, 'Y', 0, '2014-04-11', NULL, NULL, 0, 0, NULL, NULL),
('264333033', 'TX0101240', 'TX0101240', 'TXSATSTD', 'Institute for Womens Health', 'Celyna', 'D', 'Delgado', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '1210 Arion Pkwy', 'San Antonio', 'Bexar', 'TX', '78216', '2106563040', NULL, '1210 Arion Pkwy       ', 'San Antonio', 'Bexar', 'TX', '78216', '2106563040', '          ', 'TXOBG', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'St Lukes Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1417946625', 0, 'Y', 0, '2012-08-23', NULL, NULL, 0, 0, NULL, NULL),
('264333033', 'TX0101241', 'TX0101241', 'TXSATSTD', 'Institute for Womens Health', 'David', 'R', 'Dooley', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '1210 Arion Pkwy', 'San Antonio', 'Bexar', 'TX', '78216', '2106563040', NULL, '1210 Arion Pkwy       ', 'San Antonio', 'Bexar', 'TX', '78216', '2106563040', '          ', 'TXOBG', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'St Lukes Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1518947902', 0, 'Y', 0, '2013-03-12', NULL, NULL, 0, 0, NULL, NULL),
('264333033', 'TX0101242', 'TX0101242', 'TXSATSTD', 'Institute for Womens Health', 'Scott', 'A', 'Farhart', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '1210 Arion Pkwy', 'San Antonio', 'Bexar', 'TX', '78216', '2106563040', NULL, '1210 Arion Pkwy       ', 'San Antonio', 'Bexar', 'TX', '78216', '2106563040', '          ', 'TXOBG', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'North Central Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1467470021', 0, 'Y', 0, '2013-05-01', NULL, NULL, 0, 0, NULL, NULL),
('264333033', 'TX0101243', 'TX0101243', 'TXSATSTD', 'Institute for Womens Health', 'Jenatta', '', 'Freeman', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '1210 Arion Pkwy', 'San Antonio', 'Bexar', 'TX', '78216', '2106563040', NULL, '1210 Arion Pkwy        ', 'San Antonio', 'Bexar', 'TX', '78216', '2106563040', '          ', 'TXOBG', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-08-01', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1538102918', 0, 'Y', 0, '2013-09-25', NULL, NULL, 0, 0, NULL, NULL),
('264333033', 'TX0101245', 'TX0101245', 'TXSATSTD', 'Institute for Womens Health', 'Joseph', 'R', 'Garza', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '1210 Arion Pkwy', 'San Antonio', 'Bexar', 'TX', '78216', '2106563040', NULL, '1210 Arion Pkwy       ', 'San Antonio', 'Bexar', 'TX', '78216', '2106563040', '          ', 'TXOBG', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'North Central Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1144210121', 0, 'Y', 0, '2013-05-01', NULL, NULL, 0, 0, NULL, NULL),
('264333033', 'TX0101248', 'TX0101248', 'TXSATSTD', 'Northeast OB-GYN Associates', 'Elizabeth', 'A', 'King', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '1210 Arion Pkwy', 'San Antonio', 'Bexar', 'TX', '78216', '2106563040', NULL, '1210 Arion Pkwy         ', 'San Antonio', 'Bexar', 'TX', '78216', '2106563040', '          ', 'TXOBG', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'North Central Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1184643769', 0, 'Y', 0, '2013-05-06', NULL, NULL, 0, 0, NULL, NULL),
('264333033', 'TX0101250', 'TX0101250', 'TXSATSTD', 'Institute for Womens Health', 'Cameron', '', 'Powell', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '1210 Arion Pkwy', 'San Antonio', 'Bexar', 'TX', '78216', '2106563040', NULL, '1210 Arion Pkwy         ', 'San Antonio', 'Bexar', 'TX', '78216', '2106563040', '          ', 'TXOBG', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-04-24', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000008243', 0, 'Y', 0, '2013-04-24', NULL, NULL, 0, 0, NULL, NULL),
('264333033', 'TX0101251', 'TX0101251', 'TXSATSTD', 'Institute for Womens Health', 'Eduardo', '', 'Raez', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '1210 Arion Pkwy', 'San Antonio', 'Bexar', 'TX', '78216', '2106563040', NULL, '1210 Arion Pkwy         ', 'San Antonio', 'Bexar', 'TX', '78216', '2106563040', '', 'TXOBG', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'North East Baptist Hospital', '', '', '', 'HCFA|UB|', '1255320404', 0, 'Y', 0, '2014-04-11', NULL, NULL, 0, 0, NULL, NULL),
('264333033', 'TX0101252', 'TX0101252', 'TXSATSTD', 'Institute for Womens Health', 'Evangeline', '', 'Ramos-Gonzales', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '1210 Arion Pkwy', 'San Antonio', 'Bexar', 'TX', '78216', '2106563040', NULL, '1210 Arion Pkwy        ', 'San Antonio', 'Bexar', 'TX', '78216', '2106563040', '          ', 'TXOBG', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'North Central Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1922097070', 0, 'Y', 0, '2013-04-24', NULL, NULL, 0, 0, NULL, NULL),
('264333033', 'TX0101253', 'TX0101253', 'TXSATSTD', 'Institute for Womens Health', 'Cesar', '', 'Reyes', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '1210 Arion Pkwy', 'San Antonio', 'Bexar', 'TX', '78216', '2106563040', NULL, '1210 Arion Pkwy         ', 'San Antonio', 'Bexar', 'TX', '78216', '2106563040', '          ', 'TXOBG', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'St Lukes Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1801885959', 0, 'Y', 0, '2013-04-11', NULL, NULL, 0, 0, NULL, NULL),
('264333033', 'TX0101254', 'TX0101254', 'TXSATSTD', 'Institute for Womens Health', 'Jose', 'M', 'Ruiz III', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '1210 Arion Pkwy', 'San Antonio', 'Bexar', 'TX', '78216', '2106563040', NULL, '1210 Arion Pkwy         ', 'San Antonio', 'Bexar', 'TX', '78216', '2106563040', '          ', 'TXOBG', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'St Lukes Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1093705089', 0, 'Y', 0, '2013-03-12', NULL, NULL, 0, 0, NULL, NULL),
('264333033', 'TX0101255', 'TX0101255', 'TXSATSTD', 'Institute for Womens Health', 'Vincenzo', '', 'Sabella', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '1210 Arion Pkwy', 'San Antonio', 'Bexar', 'TX', '78216', '2106563040', NULL, '1210 Arion Pkwy         ', 'San Antonio', 'Bexar', 'TX', '78216', '2106563040', '          ', 'TXOBG', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'St Lukes Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1780601773', 0, 'Y', 0, '2013-08-28', NULL, NULL, 0, 0, NULL, NULL),
('264333033', 'TX0101256', 'TX0101256', 'TXSATSTD', 'Institute for Womens Health', 'Randall', 'K', 'Sadler', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '1210 Arion Pkwy', 'San Antonio', 'Bexar', 'TX', '78216', '2106563040', '          ', '1210 Arion Pkwy         ', 'San Antonio', 'Bexar', 'TX', '78216', '2106563040', '          ', 'TXOBG', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2014-04-08', 0, 0, 0, 'North Central Baptist Hospital', '', '', '', 'HCFA|UB|', '1720017601', 0, 'Y', 0, '2014-05-01', NULL, NULL, 0, 0, NULL, NULL),
('264333033', 'TX0101257', 'TX0101257', 'TXSATSTD', 'Institute for Womens Health', 'Ingrid', 'P', 'Skop', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '1210 Arion Pkwy', 'San Antonio', 'Bexar', 'TX', '78216', '2106563040', NULL, '1210 Arion Pkwy         ', 'San Antonio', 'Bexar', 'TX', '78216', '2106563040', '          ', 'TXOBG', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'North Central Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1275542698', 0, 'Y', 0, '2013-05-24', NULL, NULL, 0, 0, NULL, NULL),
('264333033', 'TX0101258', 'TX0101258', 'TXSATSTD', 'Institute for Womens Health', 'Orlando', 'J', 'Suris', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '1210 Arion Pkwy', 'San Antonio', 'Bexar', 'TX', '78216', '2106563040', NULL, '1210 Arion Pkwy         ', 'San Antonio', 'Bexar', 'TX', '78216', '2106563040', '          ', 'TXOBG', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'North Central Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1760471825', 0, 'Y', 0, '2013-08-26', NULL, NULL, 0, 0, NULL, NULL),
('264333033', 'TX0101259', 'TX0101259', 'TXSATSTD', 'Institute for Womens Health', 'Vernon', '', 'Theis', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '1210 Arion Pkwy', 'San Antonio', 'Bexar', 'TX', '78216', '2106563040', '          ', '1210 Arion Pkwy         ', 'San Antonio', 'Bexar', 'TX', '78216', '2106563040', '          ', 'TXOBG', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2014-04-08', 0, 0, 0, 'North Central Baptist Hospital', '', '', '', 'HCFA|UB|', '1952333213', 0, 'Y', 0, '2014-04-08', NULL, NULL, 0, 0, NULL, NULL),
('264333033', 'TX0101261', 'TX0101261', 'TXSATSTD', 'Institute for Womens Health', 'Mark', 'E', 'Thompson', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '1210 Arion Pkwy', 'San Antonio', 'Bexar', 'TX', '78216', '2106563040', NULL, '1210 Arion Pkwy         ', 'San Antonio', 'Bexar', 'TX', '78216', '2106563040', '          ', 'TXOBG', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'North Central Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1821017484', 0, 'Y', 0, '2013-05-24', NULL, NULL, 0, 0, NULL, NULL),
('264333033', 'TX0101262', 'TX0101262', 'TXSATSTD', 'Institute for Womens Health', 'Michael', '', 'Troy', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '1210 Arion Pkwy', 'San Antonio', 'Bexar', 'TX', '78216', '2106563040', NULL, '1210 Arion Pkwy        ', 'San Antonio', 'Bexar', 'TX', '78216', '2106563040', '          ', 'TXOBG', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'North Central Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1184613242', 0, 'Y', 0, '2013-04-24', NULL, NULL, 0, 0, NULL, NULL),
('264333033', 'TX0101263', 'TX0101263', 'TXSATSTD', 'Institute for Womens Health', 'Ronald', 'A', 'Valdez', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '1210 Arion Pkwy', 'San Antonio', 'Bexar', 'TX', '78216', '2106563040', NULL, '1210 Arion Pkwy        ', 'San Antonio', 'Bexar', 'TX', '78216', '2106563040', '          ', 'TXOBG', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'St Lukes Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1841280849', 0, 'Y', 0, '2013-09-27', NULL, NULL, 0, 0, NULL, NULL),
('264333033', 'TX0101264', 'TX0101264', 'TXSATSTD', 'Institute for Womens Health', 'Robin', 'L', 'Womack', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '1210 Arion Pkwy', 'San Antonio', 'Bexar', 'TX', '78216', '2106563040', NULL, '1210 Arion Pkwy         ', 'San Antonio', 'Bexar', 'TX', '78216', '2106563040', '          ', 'TXOBG', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'North Central Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1750370821', 0, 'Y', 0, '2013-04-24', NULL, NULL, 0, 0, NULL, NULL),
('264333033', 'TX0101247', 'TX0101247', 'TXSATSTD', 'Northeast Pediatric Associates, PA', '', '', 'Institute for Womens Health', 'GROUP', 'Obstetrics and Gynecology', '', '', NULL, 'B', '1210 Arion Pkwy         ', 'San Antonio', 'Bexar', 'TX', '78216', '2106563040', '', '1210 Arion Pkwy         ', 'San Antonio', 'Bexar', 'TX', '78216', '2106563040', '', 'TXOBG', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000006854', 0, 'Y', 0, '2014-07-24', NULL, NULL, 0, 0, NULL, NULL),
('820470163', 'ID0101183', 'ID0101183', 'IDBOISTD', 'Firstline Medical', 'Deb', '', 'Mabbutt', 'PA', 'Family Practice', 'Sports Medicine', 'Obstetrics and Gynecology', NULL, 'O', '6000 W Overland Rd', 'Boise', 'Ada', 'ID', '83709', '2083237588', '2085153468', ' 6000 W Overland Rd', 'Boise', 'Ada', 'ID', '83709', '2083237588', '2085153468', 'IDSTD', '', '', '0.00', '30.00', '0.00', 3, '2012-08-20', '2012-10-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1760581490', 0, 'N', 0, '2012-10-23', NULL, NULL, 0, 0, NULL, NULL),
('260553931', 'ID0101890', 'ID0101890', 'IDBOISTD', 'Saint Alponsus Medical Group Heart Care Boise', 'Beth', '', 'Malasky', 'MD', 'Cardiology', '', '', NULL, 'O', '6140 Curtisian Ste 200', 'Boise', 'Ada', 'ID', '83704', '2083674278', '2083675200', '6140 Curtisian Ste 200', 'Boise', 'Ada', 'ID', '83704', '2083674278', '2083675200', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1730285719', 0, 'N', 0, '2014-01-24', NULL, NULL, 43.6146, -116.258, NULL, NULL),
('202148889', 'TX0101526', 'TX0101526', 'TXSATSTD', 'Health Texas Medical Group', 'Michael', 'J', 'Dominguez', 'MD', 'Family Practice', '', '', NULL, 'B', ' 590 N General McMullen Ste 1', 'San Antonio', 'Bexar', 'TX', '78228', '2102490212', NULL, ' 590 N General McMullen Ste 1', 'San Antonio', 'Bexar', 'TX', '78228', '2102490212', '          ', 'TXINT', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2012-08-20', 0, 0, 0, 'Baptist Medical Center', NULL, NULL, NULL, 'HCFA|UB|DEN|', '1689674509', 0, 'Y', 0, '2013-05-10', NULL, NULL, 0, 0, NULL, NULL),
('202148889', 'TX0101527', 'TX0101527', 'TXSATSTD', 'Health Texas Medical Group', 'Michael', 'J', 'Dominguez', 'MD', 'Family Practice', '', '', NULL, 'M', '6243 IH 10 W Ste 480', 'San Antonio', 'Bexar', 'TX', '78201', '2102490212', NULL, '6243 IH 10 W Ste 480', 'San Antonio', 'Bexar', 'TX', '78201', '2102490212', '          ', 'TXINT', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'Baptist Medical Center', NULL, NULL, NULL, 'HCFA|UB|DEN|', '1689674509', 0, 'N', 0, '2012-12-18', NULL, NULL, 29.487, -98.5422, NULL, NULL),
('202148889', 'TX0101528', 'TX0101528', 'TXSATSTD', 'Health Texas Medical Group', 'Michael', 'J', 'Dominguez', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 100026', 'San Antonio', 'Bexar', 'TX', '78201', '2102490212', NULL, 'PO Box 100026', 'San Antonio', 'Bexar', 'TX', '78201', '2102490212', '          ', 'TXINT', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'Baptist Medical Center', NULL, NULL, NULL, 'HCFA|UB|DEN|', '1689674509', 0, 'N', 0, '2012-12-18', NULL, NULL, 0, 0, NULL, NULL),
('202148889', 'TX0101272', 'TX0101272', 'TXSATSTD', 'Health Texas Medical Group', 'Stanley', 'L', 'Culotta', 'MD', 'Family Practice', '', '', NULL, 'B', ' 590 N General McMullen Ste 1', 'San Antonio', 'Bexar', 'TX', '78228', '2102490212', NULL, ' 590 N General McMullen Ste 1', 'San Antonio', 'Bexar', 'TX', '78228', '2102490212', '          ', 'TXINT', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-11-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|DEN|', '1255451779', 0, 'Y', 0, '2013-12-19', NULL, NULL, 0, 0, NULL, NULL),
('202148889', 'TX0101535', 'TX0101535', 'TXSATSTD', 'Health Texas Medical Group', 'Stanley', 'L', 'Culotta', 'MD', 'Family Practice', '', '', NULL, 'M', ' 6243 IH 10 W Ste 480', 'San Antonio', 'Bexar', 'TX', '78201', '          ', NULL, ' 6243 IH 10 W Ste 480', 'San Antonio', 'Bexar', 'TX', '78201', '          ', '          ', 'TXINT', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-11-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|DEN|', '1255451779', 0, 'N', 0, '2013-12-19', NULL, NULL, 0, 0, NULL, NULL),
('202148889', 'TX0101536', 'TX0101536', 'TXSATSTD', 'Health Texas Medical Group', 'Stanley', 'L', 'Culotta', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 100026', 'San Antonio', 'Bexar', 'TX', '78201', '          ', NULL, 'PO Box 100026', 'San Antonio', 'Bexar', 'TX', '78201', '          ', '          ', 'TXINT', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-11-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|DEN|', '1255451779', 0, 'N', 0, '2013-12-19', NULL, NULL, 0, 0, NULL, NULL),
('743003947', 'TX0101571', 'TX0101571', 'TXSATSTD', 'The San Antonio Orthopaedic Group', 'Randall', 'C', 'Marx', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '2829 Babcock Rd Ste 700', 'San Antonio', 'Bexar', 'TX', '78229', '2105931480', '2105931483', '2829 Babcock Rd Ste 700', 'San Antonio', 'Bexar', 'TX', '78229', '2105931480', '2105931483', 'TXORTHO', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'Baptist Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1790980068', 0, 'N', 0, '2012-08-20', NULL, NULL, 29.5129, -98.5916, NULL, NULL),
('743003947', 'TX0101573', 'TX0101573', 'TXSATSTD', 'The San Antonio Orthopaedic Group', 'Randall', 'C', 'Marx', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '400 Concord Plaza Dr Ste 300', 'San Antonio', 'Bexar', 'TX', '78216', '2105931480', '2105931483', '400 Concord Plaza Dr Ste 300', 'San Antonio', 'Bexar', 'TX', '78216', '2105931480', '2105931483', 'TXORTHO', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'Baptist Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1790980068', 0, 'N', 0, '2012-08-20', NULL, NULL, 29.5058, -98.4803, NULL, NULL),
('743003947', 'TX0101572', 'TX0101572', 'TXSATSTD', 'The San Antonio Orthopaedic Group', 'Randall', 'C', 'Marx', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', 'PO Box 2516', 'San Antonio', 'Bexar', 'TX', '78299', '8004454263', NULL, 'PO Box 2516', 'San Antonio', 'Bexar', 'TX', '78299', '8004454263', '          ', 'TXORTHO', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'Baptist Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1790980068', 0, 'N', 0, '2012-08-20', NULL, NULL, 0, 0, NULL, NULL),
('741967809', 'TX0101644', 'TX0101644', 'TXSATSTD', 'Gastroenterology Consultants of San Antonio', 'Oscar', 'G', 'Ramirez', 'MD', 'Gastroenterology', '', '', NULL, 'O', '8214 Wurzbach Rd', 'San Antonio', 'Bexar', 'TX', '78229', '2106141234', NULL, '8214 Wurzbach Rd', 'San Antonio', 'Bexar', 'TX', '78229', '2106141234', '', 'TXSURGA', 'TXHCPCS', '', '0.00', '50.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'North East Baptist Hospital', '', '', '', 'HCFA|UB|', '1962497420', 0, 'N', 0, '2014-05-21', NULL, NULL, 29.5161, -98.5763, NULL, NULL),
('741967809', 'TX0101645', 'TX0101645', 'TXSATSTD', 'Gastroenterology Consultants of San Antonio', 'Oscar', 'G', 'Ramirez', 'MD', 'Gastroenterology', '', '', NULL, 'M', '8415 Datapoint Dr Ste 1000', 'San Antonio', 'Bexar', 'TX', '78229', '2106141234', NULL, '8415 Datapoint Dr Ste 1000', 'San Antonio', 'Bexar', 'TX', '78229', '2106141234', '', 'TXSURGA', 'TXHCPCS', '', '0.00', '50.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'North East Baptist Hospital', '', '', '', 'HCFA|UB|', '1962497420', 0, 'N', 0, '2014-05-21', NULL, NULL, 0, 0, NULL, NULL),
('741967809', 'TX0101646', 'TX0101646', 'TXSATSTD', 'Gastroenterology Consultants of San Antonio', 'Oscar', 'G', 'Ramirez', 'MD', 'Gastroenterology', '', '', NULL, 'B', 'PO Box 2778', 'San Antonio', 'Bexar', 'TX', '78229', '2106141234', NULL, 'PO Box 2778', 'San Antonio', 'Bexar', 'TX', '78229', '2106141234', '', 'TXSURGA', 'TXHCPCS', '', '0.00', '50.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'North East Baptist Hospital', '', '', '', 'HCFA|UB|', '1962497420', 0, 'N', 0, '2014-05-21', NULL, NULL, 0, 0, NULL, NULL),
('202148889', 'TX0101850', 'TX0101850', 'TXSATSTD', 'Health Texas Medical Group of San Antonio', 'Iveth', '', 'Soza', 'DO', 'Family Practice', '', '', NULL, 'M', '6243 IH 10 W Ste 780', 'San Antonio', 'Bexar', 'TX', '78201', '2105320891', '2105320717', '6243 IH 10 W Ste 780', 'San Antonio', 'Bexar', 'TX', '78201', '2105320891', '2105320717', 'TXINT', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|DEN|', '1467421875', 0, 'N', 0, '2013-04-05', NULL, NULL, 29.487, -98.5422, NULL, NULL),
('202148889', 'TX0101851', 'TX0101851', 'TXSATSTD', 'Health Texas Medical Group of San Antonio', 'Iveth', '', 'Soza', 'DO', 'Family Practice', '', '', NULL, 'B', 'PO Box 100026', 'San Antonio', 'Bexar', 'TX', '78201', '2105320891', '2105320717', 'PO Box 100026', 'San Antonio', 'Bexar', 'TX', '78201', '2105320891', '2105320717', 'TXINT', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|DEN|', '1467421875', 0, 'N', 0, '2013-04-05', NULL, NULL, 0, 0, NULL, NULL),
('260553931', 'ID0101893', 'ID0101893', 'IDBOISTD', 'Saint Alphonsus Medical Group Heart Care Fruitland ', 'Mark', 'G', 'Parent', 'MD', 'Cardiology', '', '', NULL, 'O', '1118 NW 16th Ste A', 'Fruitland', 'Payette', 'ID', '83619', '2087278240', '2084522140', '1118 NW 16th Ste A', 'Fruitland', 'Payette', 'ID', '83619', '2087278240', '2084522140', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', '2012-10-14', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1558301515', 0, 'N', 0, '2013-01-10', NULL, NULL, 0, 0, NULL, NULL),
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('820200895', 'ID0101895', 'ID0101895', 'IDBOISTD', 'Dominican Health Services', 'James', 'W', 'Gardner', 'MD', 'Family Practice', '', '', NULL, 'O', '1118 NW 16th St Ste A', 'Fruitland', 'Payette', 'ID', '83619', '2084526851', '2084522140', '1118 NW 16th St Ste A', 'Fruitland', 'Payette', 'ID', '83619', '2084526851', '2084522140', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', '2012-10-14', 0, 0, 0, 'West Valley Medical Center', NULL, NULL, NULL, 'HCFA|', '1730275876', 0, 'N', 0, '2014-03-24', NULL, NULL, 44.025, -116.928, NULL, NULL),
('820200895', 'ID0101896', 'ID0101896', 'IDBOISTD', 'Saint Alphonsus Medical Group Family Medicine Dominican ', 'Mylynda', 'B', 'Massart', 'MD', 'Family Practice', '', '', NULL, 'O', '1118 NW 16th St Ste A', 'Fruitland', 'Payette', 'ID', '83619', '2084526851', '2084522140', '1118 NW 16th St Ste A', 'Fruitland', 'Payette', 'ID', '83619', '2084526851', '2084522140', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', '2012-10-14', 0, 0, 0, 'West Valley Medical Center', NULL, NULL, NULL, 'HCFA|', '1497936587', 0, 'Y', 0, '2013-09-05', NULL, NULL, 44.025, -116.928, NULL, NULL),
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('260553931', 'ID0101900', 'ID0101900', 'IDBOISTD', 'Saint Alphonsus Medical Group Coughlin Clinic Iowa', 'Christopher', 'B', 'Hirose', 'MD; Foot/Ankle', 'Orthopedic Surgery', NULL, NULL, NULL, 'O', '211 W Iowa Ave', 'Nampa', 'Canyon', 'ID', '83686', '2084657377', '2084657397', '211 W Iowa Ave', 'Nampa', 'Canyon', 'ID', '83686', '2084657377', '2084657397', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', '2013-09-17', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1437111267', 0, 'Y', 0, '2013-09-17', NULL, NULL, 43.5539, -116.575, NULL, NULL),
('260553931', 'ID0101901', 'ID0101901', 'IDBOISTD', 'Saint Alphonsus Medical Group Coughlin Clinic Iowa', 'Travis', 'J', 'Kemp', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '211 W Iowa Ave', 'Boise', 'Ada', 'ID', '83686', '2084657377', '2084657397', '211 W Iowa Ave', 'Boise', 'Ada', 'ID', '83686', '2084657377', '2084657397', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', '2013-10-01', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1669607172', 0, 'Y', 0, '2014-01-06', NULL, NULL, 0, 0, NULL, NULL),
('260553931', 'ID0101928', 'ID0101928', 'IDBOISTD', 'Saint Alphonsus Medical Group Heart Care Caldwell', 'Michael', 'A', 'Codina', 'MD', 'Cardiology', '', '', NULL, 'O', '1818 S 10th Ave Ste 200', 'Caldwell', 'Canyon', 'ID', '83605', '2083675734', '2083675744', '1818 S 10th Ave Ste 200', 'Caldwell', 'Canyon', 'ID', '83605', '2083675734', '2083675744', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', 'Saint Alphonsus Regional Medical Center', '', '', 'HCFA|UB|', '1871540708', 0, 'N', 0, '2014-07-09', NULL, NULL, 43.6541, -116.693, NULL, NULL),
('260553931', 'ID0101931', 'ID0101931', 'IDBOISTD', 'Saint Alponsus Medical Group Heart Care Caldwell', 'Rakesh', 'K', 'Pai', 'MD', 'Cardiology', '', '', NULL, 'O', '1818 S 10th Ave Ste 200', 'Caldwell', 'Canyon', 'ID', '83605', '2083676450', '2083675744', '1818 S 10th Ave Ste 200', 'Caldwell', 'Canyon', 'ID', '83605', '2083676450', '2083675744', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', '2014-01-17', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1710190665', 0, 'N', 0, '2013-12-11', NULL, NULL, 43.6538, -116.693, NULL, NULL),
('260553931', 'ID0101930', 'ID0101930', 'IDBOISTD', 'Saint Alphonsus Medical Group Heart Care Caldwell', 'Walter', 'L', 'Seale', 'MD', 'Cardiology', '', '', NULL, 'O', '1818 S 10th Ave Ste 200', 'Caldwell', 'Canyon', 'ID', '83605', '2083675734', '2083675744', '1818 S 10th Ave Ste 200', 'Caldwell', 'Canyon', 'ID', '83605', '2083675734', '2083675744', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', '2013-11-01', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1720033459', 0, 'Y', 0, '2014-01-24', NULL, NULL, 43.6538, -116.693, NULL, NULL),
('820200895', 'ID0101932', 'ID0101932', 'IDBOISTD', 'Saint Alphonsus Medical Group Family Medicine Dominican ', 'Sheila', 'M', 'Giffen', 'MD', 'Family Practice', '', '', NULL, 'O', '1118 NW 16th St Ste A', 'Fruitland', 'Payette', 'ID', '83619', '2084526851', '2083676170', '1118 NW 16th St Ste A', 'Fruitland', 'Payette', 'ID', '83619', '2084526851', '2083676170', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', '2012-10-14', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|', '1013957802', 0, 'N', 0, '2013-07-31', NULL, NULL, 44.025, -116.928, NULL, NULL),
('260553931', 'ID0101934', 'ID0101934', 'IDBOISTD', 'Saint Alphonsus Medical Group Heart Care Caldwell', 'Beth', '', 'Malasky', 'MD', 'Cardiology', '', '', NULL, 'O', '1818 S 10th Ave Ste 200', 'Caldwell', 'Canyon', 'ID', '83605', '2083676450', '2083675744', '1818 S 10th Ave Ste 200', 'Caldwell', 'Canyon', 'ID', '83605', '2083676450', '2083675744', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1730285719', 0, 'N', 0, '2013-10-07', NULL, NULL, 43.6541, -116.693, NULL, NULL),
('820200895', 'ID0101937', 'ID0101937', 'IDBOISTD', 'Idaho Neurology Saint Alphonsus', 'Mary', 'E', 'River', 'MD', 'Neurology', '', '', NULL, 'O', '1818 S 10th Ave Ste 200', 'Caldwell', 'Canyon', 'ID', '83605', '2083677272', '2083677111', '1818 S 10th Ave Ste 200', 'Caldwell', 'Canyon', 'ID', '83605', '2083677272', '2083677111', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1205882743', 0, 'Y', 0, '2014-05-20', NULL, NULL, 43.6541, -116.693, NULL, NULL),
('820200895', 'ID0103462', 'ID0103462', 'IDBOISTD', 'Saint Alphonsus Medical Group McMillan Family Medicine', 'David', '', 'Lee', 'MD', 'Internal Medicine', '', '', NULL, 'O', '12273 W McMillan Rd', 'Boise', 'Ada', 'ID', '83713', '2083676330', '2083674765', '12273 W McMillan Rd', 'Boise', 'Ada', 'ID', '83713', '2083676330', '2083674765', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1962501890', 0, 'Y', 0, '2014-06-20', NULL, NULL, 43.6484, -116.337, NULL, NULL),
('752806777', 'TX0102340', 'TX0102340', 'TXSATSTD', 'Toyota Family Health Center', 'Stephen', 'Anthony', 'Carter', 'MD', 'Family Practice', '', '', NULL, 'O', '1 Lone Star Pass Bldg 46', 'San Antonio', 'Bexar', 'TX', '78264', '2102635700', NULL, '1 Lone Star Pass Bldg 46', 'San Antonio', 'Bexar', 'TX', '78264', '2102635700', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2012-08-22', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1518083062', 0, 'N', 0, '2012-08-22', NULL, NULL, 0, 0, NULL, NULL),
('752806777', 'TX0102439', 'TX0102439', 'TXSATSTD', 'Toyota Family Health Center', 'Lillian', 'E', 'Perez', 'DO', 'Family Practice', '', '', NULL, 'O', '1 Lone Star Pass Bldg 46', 'San Antonio', 'Bexar', 'TX', '78264', '2102635700', NULL, '1 Lone Star Pass Bldg 46', 'San Antonio', 'Bexar', 'TX', '78264', '2102635700', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2012-08-20', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1710925805', 0, 'N', 0, '2013-07-25', NULL, NULL, 0, 0, NULL, NULL),
('743003947', 'TX0102448', 'TX0102448', 'TXSATSTD', 'The San Antonio Orthopaedic Group', '', '', 'The San Antonio Orthopedic Group LLP', 'GROUP', 'Orthopedic Surgery', 'Physical Therapy', '', NULL, 'O', '12602 Toepperwein Rd Ste 210', 'San Antonio', 'Bexar', 'TX', '78233', '2108045400', NULL, '12602 Toepperwein Rd Ste 210', 'San Antonio', 'Bexar', 'TX', '78233', '2108045400', '', 'TXORTHO', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-04-04', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009051', 0, 'N', 0, '2014-07-18', NULL, NULL, 0, 0, NULL, NULL),
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('743003947', 'TX0103119', 'TX0103119', 'TXSATSTD', 'The San Antonio Orthopaedic Group', 'Patrick', 'J', 'Denard', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '400 Concord Plaza Dr Ste 300', 'San Antonio', 'Bexar', 'TX', '78216', '2104897220', '2104026257', '400 Concord Plaza Dr Ste 300', 'San Antonio', 'Bexar', 'TX', '78216', '2104897220', '2104026257', 'TXORTHO', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2012-08-20', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1578684627', 0, 'N', 0, '2013-03-28', NULL, NULL, 29.5058, -98.4805, NULL, NULL),
('743003947', 'TX0103120', 'TX0103120', 'TXSATSTD', 'The San Antonio Orthopaedic Group', 'Patrick', 'J', 'Denard', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', 'PO Box 2516', 'San Antonio', 'Bexar', 'TX', '78299', '8004454263', NULL, 'PO Box 2516', 'San Antonio', 'Bexar', 'TX', '78299', '8004454263', '          ', 'TXORTHO', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2012-08-20', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1578684627', 0, 'Y', 0, '2013-03-28', NULL, NULL, 0, 0, NULL, NULL),
('203059260', 'TX0103548', 'TX0103548', 'TXSATSTD', 'BHS Physicians Network', 'Gretchen ', '', 'Bures', 'MD', 'Hospitalist', '', '', NULL, 'B', 'PO Box 840081', 'Dallas', 'Dallas', 'TX', '75284', '2102974000', NULL, 'PO Box 840081', 'Dallas', 'Dallas', 'TX', '75284', '2102974000', '          ', 'TXHSP', 'TXHCPCS', '', '0.00', '50.00', '0.00', 8, '2012-08-20', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB||', '1003098815', 0, 'Y', 0, '2013-07-11', NULL, NULL, 0, 0, NULL, NULL),
('742246239', 'TX0103418', 'TX0103418', 'TXSATSTD', 'San Antonio Gastroenterology Associates', 'Kevin', 'J', 'Franklin', 'MD', 'Gastroenterology', '', '', NULL, 'O', '215 E Quincy Ste 317', 'San Antonio', 'Bexar', 'TX', '78215', '2102710606', '2102228414', '215 E Quincy Ste 317', 'San Antonio', 'Bexar', 'TX', '78215', '2102710606', '2102228414', 'TXSURGA', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'Baptist Medical Center', 'North Central Baptist Hospital', 'Mission Trail Baptist Hospital', NULL, 'HCFA|UB|', '1699700583', 0, 'N', 0, '2013-04-24', NULL, NULL, 29.4354, -98.493, 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
('742246239', 'TX0103417', 'TX0103417', 'TXSATSTD', 'San Antonio Gastroenterology Associates', 'Kevin', 'J', 'Franklin', 'MD', 'Gastroenterology', '', '', NULL, 'O', '520 E Euclid Ave', 'San Antonio', 'Bexar', 'TX', '78212', '2105911409', '2102228414', '520 E Euclid Ave', 'San Antonio', 'Bexar', 'TX', '78212', '2105911409', '2102228414', 'TXSURGA', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'Baptist Medical Center', 'North Central Baptist Hospital', 'Mission Trail Baptist Hospital', NULL, 'HCFA|UB|', '1699700583', 0, 'N', 0, '2013-04-24', NULL, NULL, 29.4396, -98.4902, NULL, NULL),
('742246239', 'TX0103419', 'TX0103419', 'TXSATSTD', 'San Antonio Gastroenterology Associates', 'Kevin', 'J', 'Franklin', 'MD', 'Gastroenterology', '', '', NULL, 'M', 'PO Box 840390', 'Dallas', 'Dallas', 'TX', '75284', '2102710606', NULL, 'PO Box 840390', 'Dallas', 'Dallas', 'TX', '75284', '2102710606', '          ', 'TXSURGA', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'Baptist Medical Center', 'North Central Baptist Hospital', 'Mission Trail Baptist Hospital', NULL, 'HCFA|UB|', '1699700583', 0, 'N', 0, '2013-04-24', NULL, NULL, 0, 0, NULL, NULL),
('752806777', 'TX0103443', 'TX0103443', 'TXSATSTD', 'Toyota Family Health Center', 'Ann-Marie', 'R', 'Mora', 'OD', 'Ophthalmology', '', '', NULL, 'B', '205 Miller Spring Ct', 'Franklin', 'Williamson', 'TN', '37064', '2102635700', '', '205 Miller Spring Ct', 'Franklin', 'Williamson', 'TN', '37064', '2102635700', '', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1568563344', 0, 'Y', 0, '2014-07-23', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'ID0103463', 'ID0103463', 'IDBOISTD', 'Saint Alphonsus Medical Group Occupational Medicine Associat', 'David', '', 'Lee', 'MD', 'Internal Medicine', '', '', NULL, 'B', '3340 E Goldstone', 'Meridian', 'Ada', 'ID', '83642', '2083675170', NULL, '3340 E Goldstone', 'Meridian', 'Ada', 'ID', '83642', '2083675170', '', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1962501890', 0, 'N', 0, '2014-06-20', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'ID0103461', 'ID0103461', 'IDBOISTD', 'Lee, David ', 'David', '', 'Lee', 'MD', 'Internal Medicine', '', '', NULL, 'O', '6140 Curtisian Ste 300', 'Boise', 'Ada', 'ID', '83704', '2083676575', '2083676597', '6140 Curtisian Ste 300', 'Boise', 'Ada', 'ID', '83704', '2083676575', '2083676597', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1962501890', 0, 'N', 0, '2014-06-20', NULL, NULL, 43.6146, -116.258, NULL, NULL),
('820200895', 'ID0103464', 'ID0103464', 'IDBOISTD', 'Saint Alphonsus Medical Group Neurology Boise', 'Jackie', 'J', 'Whitesell', 'MD', 'Neurology', '', '', NULL, 'O', '901 N Curtis Ste 403', 'Boise', 'Ada', 'ID', '83706', '2083677272', '2083677111', '901 N Curtis Ste 403', 'Boise', 'Ada', 'ID', '83706', '2083677272', '2083677111', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', '2014-05-26', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1346367984', 0, 'N', 0, '2014-06-20', NULL, NULL, 43.6126, -116.254, NULL, NULL),
('820200895', 'ID0103465', 'ID0103465', 'IDBOISTD', 'Saint Alphonsus Caldwell Multi-Specialty', 'Jackie', 'J', 'Whitesell', 'MD', 'Neurology', '', '', NULL, 'O', '1818 S 10th Ave Ste 200', 'Caldwell', 'Canyon', 'ID', '83605', '2083677272', '2083677111', '1818 S 10th Ave Ste 200', 'Caldwell', 'Canyon', 'ID', '83605', '2083677272', '2083677111', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1346367984', 0, 'Y', 0, '2014-06-20', NULL, NULL, 43.6541, -116.693, NULL, NULL),
('820200895', 'ID0103466', 'ID0103466', 'IDBOISTD', 'Saint Alphonsus Regional Medical Center - Reading Only', 'Jackie', 'J', 'Whitesell', 'MD', 'Neurology', '', '', NULL, 'O', '1055 N Curtis', 'Boise', 'Ada', 'ID', '83706', '2083673722', '2083677111', '1055 N Curtis', 'Boise', 'Ada', 'ID', '83706', '2083673722', '2083677111', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1346367984', 0, 'Y', 0, '2014-06-20', NULL, NULL, 43.6145, -116.254, NULL, NULL),
('820200895', 'ID0103468', 'ID0103468', 'IDBOISTD', 'Saint Alphonsus Regional Medical Center - Reading Only', 'Jackie', 'J', 'Whitesell', 'MD', 'Neurology', '', '', NULL, 'B', '3340 E Goldstone', 'Meridian', 'Ada', 'ID', '83642', '2083675170', '2083677111', '3340 E Goldstone', 'Meridian', 'Ada', 'ID', '83642', '2083675170', '2083677111', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1346367984', 0, 'N', 0, '2014-06-20', NULL, NULL, 0, 0, NULL, NULL),
('260553931', 'ID0103487', 'ID0103487', 'IDBOISTD', 'Saint Alphonsus Specialty Services Inc', 'Christopher', '', 'Alessi', 'MD', 'Vascular Surgery', 'Cardiovascular Disease', '', NULL, 'B', '3340 E Goldstone', 'Meridian', 'Ada', 'ID', '83642', '2083675170', '2083677798', '3340 E Goldstone', 'Meridian', 'Ada', 'ID', '83642', '2083675170', '2083677798', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', '2012-11-13', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1598726960', 0, 'N', 0, '2013-05-07', NULL, NULL, 0, 0, NULL, NULL),
('260553931', 'ID0103486', 'ID0103486', 'IDBOISTD', 'Saint Alphonsus Medical Group Vascular Services', 'Christopher', '', 'Alessi', 'MD', 'Vascular Surgery', 'Cardiovascular Disease', '', NULL, 'O', '6140 W Curtisian Ave Ste 102', 'Boise', 'Ada', 'ID', '83704', '2083677787', '2083677798', '6140 W Curtisian Ave Ste 102', 'Boise', 'Ada', 'ID', '83704', '2083677787', '2083677798', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1598726960', 0, 'N', 0, '2013-05-07', NULL, NULL, 43.6146, -116.258, NULL, NULL),
('752806777', 'TX0103536', 'TX0103536', 'TXSATSTD', 'Toyota Family Health Center', 'Russell', 'T', 'Zepeda', 'PA-C', 'Family Practice', '', '', NULL, 'B', '1 Lone Star Pass Ste 46', 'San Antonio', 'Bexar', 'TX', '78264', '2102635700', '2102635701', '1 Lone Star Pass Ste 46', 'San Antonio', 'Bexar', 'TX', '78264', '2102635700', '2102635701', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2012-08-22', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1518162122', 0, 'Y', 0, '2012-08-22', NULL, NULL, 0, 0, NULL, NULL),
('752806777', 'TX0103537', 'TX0103537', 'TXSATSTD', 'Toyota Family Health Center', 'Russell', 'T', 'Zepeda', 'PA-C', 'Family Practice', '', '', NULL, 'B', '205 Miller Spring Ct', 'Franklin', 'Williamson', 'TN', '37064', '2102635700', NULL, '205 Miller Spring Ct', 'Franklin', 'Williamson', 'TN', '37064', '2102635700', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2012-08-22', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1518162122', 0, 'Y', 0, '2012-08-22', NULL, NULL, 0, 0, NULL, NULL),
('203059260', 'TX0103540', 'TX0103540', 'TXSATSTD', 'BHS Physicians Network', 'Bryan', '', 'Alexander', 'MD', 'Hospitalist', '', '', NULL, 'B', 'PO Box 840081', 'Dallas', 'Dallas', 'TX', '75284', '2102974000', NULL, 'PO Box 840081', 'Dallas', 'Dallas', 'TX', '75284', '2102974000', '          ', 'TXHSP', 'TXHCPCS', '', '0.00', '50.00', '0.00', 8, '2012-08-20', '2013-05-01', 0, 0, 0, '', '', '', '', 'HCFA|UB||', '1588824387', 0, 'Y', 0, '2013-07-11', NULL, NULL, 0, 0, NULL, NULL),
('203059260', 'TX0103541', 'TX0103541', 'TXSATSTD', 'BHS Physicians Network', 'Freddy', '', 'Angulo', 'MD', 'Hospitalist', '', '', NULL, 'B', 'PO Box 840081', 'Dallas', 'Dallas', 'TX', '75284', '2102974000', NULL, 'PO Box 840081', 'Dallas', 'Dallas', 'TX', '75284', '2102974000', '          ', 'TXHSP', 'TXHCPCS', '', '0.00', '50.00', '0.00', 8, '2012-08-20', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1255472205', 0, 'Y', 0, '2013-07-11', NULL, NULL, 0, 0, NULL, NULL),
('203059260', 'TX0103542', 'TX0103542', 'TXSATSTD', 'BHS Physicians Network', 'Felicia', '', 'Armstrong', 'MD', 'Hospitalist', '', '', NULL, 'B', 'PO Box 840081', 'Dallas', 'Dallas', 'TX', '75284', '2102974000', NULL, 'PO Box 840081', 'Dallas', 'Dallas', 'TX', '75284', '2102974000', '          ', 'TXHSP', 'TXHCPCS', '', '0.00', '50.00', '0.00', 8, '2012-08-20', NULL, 0, 0, 0, 'North Central Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB||', '1669652632', 0, 'Y', 0, '2013-07-11', NULL, NULL, 0, 0, NULL, NULL),
('203059260', 'TX0103549', 'TX0103549', 'TXSATSTD', 'BHS Physicians Network', 'Cristo', '', 'Calle', 'MD', 'Hospitalist', '', '', NULL, 'B', 'PO Box 840081', 'Dallas', 'Dallas', 'TX', '75284', '2102974000', NULL, 'PO Box 840081', 'Dallas', 'Dallas', 'TX', '75284', '2102974000', '          ', 'TXHSP', 'TXHCPCS', '', '0.00', '50.00', '0.00', 8, '2012-08-20', NULL, 0, 0, 0, 'Baptist Medical Center', NULL, NULL, NULL, 'HCFA|UB||', '1134398902', 0, 'Y', 0, '2013-07-11', NULL, NULL, 0, 0, NULL, NULL),
('203059260', 'TX0103550', 'TX0103550', 'TXSATSTD', 'BHS Physicians Network', 'Robert', '', 'Ching', 'MD', 'Hospitalist', '', '', NULL, 'B', 'PO Box 840081', 'Dallas', 'Dallas', 'TX', '75284', '2102974000', NULL, 'PO Box 840081', 'Dallas', 'Dallas', 'TX', '75284', '2102974000', '          ', 'TXHSP', 'TXHCPCS', '', '0.00', '50.00', '0.00', 8, '2012-08-20', NULL, 0, 0, 0, 'Mission Trail Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB||', '1770565707', 0, 'Y', 0, '2013-07-11', NULL, NULL, 0, 0, NULL, NULL),
('203059260', 'TX0103551', 'TX0103551', 'TXSATSTD', 'BHS Physicians Network', 'Minh', '', 'Do', 'MD', 'Hospitalist', '', '', NULL, 'B', 'PO Box 840081', 'Dallas', 'Dallas', 'TX', '75284', '2102974000', NULL, 'PO Box 840081', 'Dallas', 'Dallas', 'TX', '75284', '2102974000', '          ', 'TXHSP', 'TXHCPCS', '', '0.00', '50.00', '0.00', 8, '2012-08-20', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB||', '1740387695', 0, 'Y', 0, '2013-07-11', NULL, NULL, 0, 0, NULL, NULL),
('203059260', 'TX0103552', 'TX0103552', 'TXSATSTD', 'BHS Physicians Network', 'Renee ', '', 'Dunn', 'MD', 'Hospitalist', '', '', NULL, 'B', 'PO Box 840081', 'Dallas', 'Dallas', 'TX', '75284', '2102974000', NULL, 'PO Box 840081', 'Dallas', 'Dallas', 'TX', '75284', '2102974000', '          ', 'TXHSP', 'TXHCPCS', '', '0.00', '50.00', '0.00', 8, '2012-08-20', '2013-08-01', 0, 0, 0, '', '', '', '', 'HCFA|UB||', '1841387677', 0, 'Y', 0, '2013-08-14', NULL, NULL, 0, 0, NULL, NULL),
('203059260', 'TX0103553', 'TX0103553', 'TXSATSTD', 'BHS Physicians Network', 'Janice ', '', 'Ford', 'MD', 'Hospitalist', '', '', NULL, 'B', 'PO Box 840081', 'Dallas', 'Dallas', 'TX', '75284', '2102974000', NULL, 'PO Box 840081', 'Dallas', 'Dallas', 'TX', '75284', '2102974000', '          ', 'TXHSP', 'TXHCPCS', '', '0.00', '50.00', '0.00', 8, '2012-08-20', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB||', '1003857236', 0, 'Y', 0, '2013-07-11', NULL, NULL, 0, 0, NULL, NULL),
('203059260', 'TX0103555', 'TX0103555', 'TXSATSTD', 'BHS Physicians Network', 'Adi ', '', 'Klein', 'MD', 'Hospitalist', '', '', NULL, 'B', 'PO Box 840081', 'Dallas', 'Dallas', 'TX', '75284', '2102974000', NULL, 'PO Box 840081', 'Dallas', 'Dallas', 'TX', '75284', '2102974000', '          ', 'TXHSP', 'TXHCPCS', '', '0.00', '50.00', '0.00', 8, '2012-08-20', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB||', '1912929423', 0, 'Y', 0, '2013-07-11', NULL, NULL, 0, 0, NULL, NULL),
('203059260', 'TX0103556', 'TX0103556', 'TXSATSTD', 'BHS Physicians Network', 'Yiching', '', 'Liu', 'MD', 'Hospitalist', '', '', NULL, 'B', 'PO Box 840081', 'Dallas', 'Dallas', 'TX', '75284', '2102974000', NULL, 'PO Box 840081', 'Dallas', 'Dallas', 'TX', '75284', '2102974000', '          ', 'TXHSP', 'TXHCPCS', '', '0.00', '50.00', '0.00', 8, '2012-08-20', NULL, 0, 0, 0, 'Baptist Medical Center', NULL, NULL, NULL, 'HCFA|UB||', '1508902479', 0, 'Y', 0, '2013-07-11', NULL, NULL, 0, 0, NULL, NULL),
('203059260', 'TX0103557', 'TX0103557', 'TXSATSTD', 'BHS Physicians Network', 'Richa', '', 'Mahajan', 'MD', 'Hospitalist', '', '', NULL, 'B', 'PO Box 840081', 'Dallas', 'Dallas', 'TX', '75284', '2102974000', NULL, 'PO Box 840081', 'Dallas', 'Dallas', 'TX', '75284', '2102974000', '          ', 'TXHSP', 'TXHCPCS', '', '0.00', '50.00', '0.00', 8, '2012-08-20', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB||', '1730396656', 0, 'Y', 0, '2013-07-11', NULL, NULL, 0, 0, NULL, NULL),
('203059260', 'TX0103558', 'TX0103558', 'TXSATSTD', 'BHS Physicians Network', 'William', '', 'Mallott', 'MD', 'Hospitalist', '', '', NULL, 'B', 'PO Box 840081', 'Dallas', 'Dallas', 'TX', '75284', '2102974000', NULL, 'PO Box 840081', 'Dallas', 'Dallas', 'TX', '75284', '2102974000', '          ', 'TXHSP', 'TXHCPCS', '', '0.00', '50.00', '0.00', 8, '2012-08-20', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB||', '1679670624', 0, 'Y', 0, '2013-07-11', NULL, NULL, 0, 0, NULL, NULL),
('203059260', 'TX0103559', 'TX0103559', 'TXSATSTD', 'BHS Physicians Network', 'Thilina ', '', 'Marasinghe', 'MD', 'Hospitalist', '', '', NULL, 'B', 'PO Box 840081', 'Dallas', 'Dallas', 'TX', '75284', '2102974000', NULL, 'PO Box 840081', 'Dallas', 'Dallas', 'TX', '75284', '2102974000', '          ', 'TXHSP', 'TXHCPCS', '', '0.00', '50.00', '0.00', 8, '2012-08-20', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB||', '1821160938', 0, 'Y', 0, '2013-07-11', NULL, NULL, 0, 0, NULL, NULL),
('203059260', 'TX0103560', 'TX0103560', 'TXSATSTD', 'BHS Physicians Network', 'Haritha', '', 'Mikkilineni', 'MD', 'Hospitalist', '', '', NULL, 'B', 'PO Box 840081', 'Dallas', 'Dallas', 'TX', '75284', '2102974000', NULL, 'PO Box 840081', 'Dallas', 'Dallas', 'TX', '75284', '2102974000', '          ', 'TXHSP', 'TXHCPCS', '', '0.00', '50.00', '0.00', 8, '2012-08-20', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB||', '1891947438', 0, 'Y', 0, '2013-07-11', NULL, NULL, 0, 0, NULL, NULL),
('203059260', 'TX0103561', 'TX0103561', 'TXSATSTD', 'BHS Physicians Network', 'Sowjanya', '', 'Mohan', 'MD', 'Hospitalist', '', '', NULL, 'B', 'PO Box 840081', 'Dallas', 'Dallas', 'TX', '75284', '2102974000', NULL, 'PO Box 840081', 'Dallas', 'Dallas', 'TX', '75284', '2102974000', '          ', 'TXHSP', 'TXHCPCS', '', '0.00', '50.00', '0.00', 8, '2012-08-20', NULL, 0, 0, 0, 'Baptist Medical Center', NULL, NULL, NULL, 'HCFA|UB||', '1467488940', 0, 'Y', 0, '2013-07-11', NULL, NULL, 0, 0, NULL, NULL),
('203059260', 'TX0103562', 'TX0103562', 'TXSATSTD', 'BHS Physicians Network', 'Uma ', '', 'Nair', 'MD', 'Hospitalist', '', '', NULL, 'B', 'PO Box 840081', 'Dallas', 'Dallas', 'TX', '75284', '2102974000', NULL, 'PO Box 840081', 'Dallas', 'Dallas', 'TX', '75284', '2102974000', '          ', 'TXHSP', 'TXHCPCS', '', '0.00', '50.00', '0.00', 8, '2012-08-20', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB||', '1962475962', 0, 'Y', 0, '2013-07-11', NULL, NULL, 0, 0, NULL, NULL),
('203059260', 'TX0103563', 'TX0103563', 'TXSATSTD', 'BHS Physicians Network', 'Nhi', '', 'Pham', 'MD', 'Hospitalist', '', '', NULL, 'B', 'PO Box 840081', 'Dallas', 'Dallas', 'TX', '75284', '2102974000', NULL, 'PO Box 840081', 'Dallas', 'Dallas', 'TX', '75284', '2102974000', '          ', 'TXHSP', 'TXHCPCS', '', '0.00', '50.00', '0.00', 8, '2012-08-20', NULL, 0, 0, 0, 'Baptist Medical Center', NULL, NULL, NULL, 'HCFA|UB||', '1366638538', 0, 'Y', 0, '2013-07-11', NULL, NULL, 0, 0, NULL, NULL),
('203059260', 'TX0103565', 'TX0103565', 'TXSATSTD', 'BHS Physicians Network', 'Maher', '', 'Saloum', 'MD', 'Hospitalist', '', '', NULL, 'B', 'PO Box 840081', 'Dallas', 'Dallas', 'TX', '75284', '2102974000', NULL, 'PO Box 840081', 'Dallas', 'Dallas', 'TX', '75284', '2102974000', '          ', 'TXHSP', 'TXHCPCS', '', '0.00', '50.00', '0.00', 8, '2012-08-20', NULL, 0, 0, 0, 'Baptist Medical Center', NULL, NULL, NULL, 'HCFA|UB||', '1487650487', 0, 'Y', 0, '2013-07-11', NULL, NULL, 0, 0, NULL, NULL),
('203059260', 'TX0103566', 'TX0103566', 'TXSATSTD', 'BHS Physicians Network', 'Wayne', 'H', 'Gordon', 'MD', 'Hospitalist', '', '', NULL, 'B', 'PO Box 840081', 'Dallas', 'Dallas', 'TX', '75284', '2102974000', NULL, 'PO Box 840081', 'Dallas', 'Dallas', 'TX', '75284', '2102974000', '          ', 'TXHSP', 'TXHCPCS', '', '0.00', '50.00', '0.00', 8, '2012-08-20', '2012-08-20', 0, 0, 0, '', '', '', '', 'HCFA|UB||', '1750486858', 0, 'N', 0, '2013-07-11', NULL, NULL, 0, 0, NULL, NULL),
('203059260', 'TX0103567', 'TX0103567', 'TXSATSTD', 'BHS Physicians Network', 'Dicky ', '', 'Huey', 'MD', 'Hospitalist', '', '', NULL, 'B', 'PO Box 840081', 'Dallas', 'Dallas', 'TX', '75284', '2102974000', NULL, 'PO Box 840081', 'Dallas', 'Dallas', 'TX', '75284', '2102974000', '          ', 'TXHSP', 'TXHCPCS', '', '0.00', '50.00', '0.00', 8, '2012-08-20', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB||', '1255388609', 0, 'Y', 0, '2013-07-11', NULL, NULL, 0, 0, NULL, NULL),
('203059260', 'TX0103568', 'TX0103568', 'TXSATSTD', 'BHS Physicians Network', 'Claudia', '', 'Santos', 'MD', 'Hospitalist', '', '', NULL, 'B', 'PO Box 840081', 'Dallas', 'Dallas', 'TX', '75284', '2102974000', NULL, 'PO Box 840081', 'Dallas', 'Dallas', 'TX', '75284', '2102974000', '          ', 'TXHSP', 'TXHCPCS', '', '0.00', '50.00', '0.00', 8, '2012-08-20', '2013-03-21', 0, 0, 0, '', '', '', '', 'HCFA|UB||', '1013192970', 0, 'Y', 0, '2013-07-11', NULL, NULL, 0, 0, NULL, NULL),
('203059260', 'TX0103569', 'TX0103569', 'TXSATSTD', 'BHS Physicians Network', 'Michael', '', 'Seawell', 'MD', 'Hospitalist', '', '', NULL, 'B', 'PO Box 840081', 'Dallas', 'Dallas', 'TX', '75284', '2102974000', NULL, 'PO Box 840081', 'Dallas', 'Dallas', 'TX', '75284', '2102974000', '          ', 'TXHSP', 'TXHCPCS', '', '0.00', '50.00', '0.00', 8, '2012-08-20', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB||', '1306952296', 0, 'Y', 0, '2013-07-11', NULL, NULL, 0, 0, NULL, NULL),
('203059260', 'TX0103570', 'TX0103570', 'TXSATSTD', 'BHS Physicians Network', 'Ayham', 'F', 'Shneker', 'MD', 'Hospitalist', '', '', NULL, 'B', 'PO Box 840081', 'Dallas', 'Dallas', 'TX', '75284', '2102974000', NULL, 'PO Box 840081', 'Dallas', 'Dallas', 'TX', '75284', '2102974000', '          ', 'TXHSP', 'TXHCPCS', '', '0.00', '50.00', '0.00', 8, '2012-08-20', NULL, 0, 0, 0, 'Mission Trail Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB||', '1871557454', 0, 'Y', 0, '2013-07-11', NULL, NULL, 0, 0, NULL, NULL),
('203059260', 'TX0103571', 'TX0103571', 'TXSATSTD', 'BHS Physicians Network', 'Jeff', '', 'Sorrell', 'MD', 'Hospitalist', '', '', NULL, 'B', 'PO Box 840081', 'Dallas', 'Dallas', 'TX', '75284', '2102974000', NULL, 'PO Box 840081', 'Dallas', 'Dallas', 'TX', '75284', '2102974000', '          ', 'TXHSP', 'TXHCPCS', '', '0.00', '50.00', '0.00', 8, '2012-08-20', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB||', '1598949083', 0, 'Y', 0, '2013-07-11', NULL, NULL, 0, 0, NULL, NULL),
('203059260', 'TX0103572', 'TX0103572', 'TXSATSTD', 'BHS Physicians Network', 'Edward', '', 'Sternaman', 'MD', 'Hospitalist', '', '', NULL, 'B', 'PO Box 840081', 'Dallas', 'Dallas', 'TX', '75284', '2102974000', NULL, 'PO Box 840081', 'Dallas', 'Dallas', 'TX', '75284', '2102974000', '          ', 'TXHSP', 'TXHCPCS', '', '0.00', '50.00', '0.00', 8, '2012-08-20', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB||', '1801994462', 0, 'Y', 0, '2013-07-11', NULL, NULL, 0, 0, NULL, NULL),
('203059260', 'TX0103573', 'TX0103573', 'TXSATSTD', 'BHS Physicians Network', 'Brian ', '', 'Treuhaft', 'DO', 'Hospitalist', '', '', NULL, 'B', 'PO Box 840081', 'Dallas', 'Dallas', 'TX', '75284', '2102974000', NULL, 'PO Box 840081', 'Dallas', 'Dallas', 'TX', '75284', '2102974000', '          ', 'TXHSP', 'TXHCPCS', '', '0.00', '50.00', '0.00', 8, '2012-08-20', NULL, 0, 0, 0, 'North East Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB||', '1871690826', 0, 'Y', 0, '2013-07-11', NULL, NULL, 0, 0, NULL, NULL),
('203059260', 'TX0103574', 'TX0103574', 'TXSATSTD', 'BHS Physicians Network', 'Marek ', '', 'Walczak', 'MD', 'Hospitalist', '', '', NULL, 'B', 'PO Box 840081', 'Dallas', 'Dallas', 'TX', '75284', '2102974000', NULL, 'PO Box 840081', 'Dallas', 'Dallas', 'TX', '75284', '2102974000', '          ', 'TXHSP', 'TXHCPCS', '', '0.00', '50.00', '0.00', 8, '2012-08-20', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB||', '1083840375', 0, 'Y', 0, '2013-07-11', NULL, NULL, 0, 0, NULL, NULL),
('201657769', 'ELHCA0163', 'ELHCA0163', 'TXHOUSTD', 'North Pines General Surgery', 'Jeffrey', 'A', 'Przybyla', 'MD', 'General Surgery', '', '', NULL, 'O', '500 Medical Ctr Blvd Ste 340', 'Conroe', 'Montgomery', 'TX', '77304', '9364942201', '9364942217', '500 Medical Ctr Blvd Ste 340', 'Conroe', 'Montgomery', 'TX', '77304', '9364942201', '9364942217', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Conroe Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1942454137', 0, 'N', 0, '2013-05-01', NULL, NULL, 30.2831, -95.4693, NULL, NULL),
('202630141', 'W40011848', 'W40011848', 'IDBOISTD', 'Primary Health Medical Group', 'Kirk', 'D', 'Prodzinski', 'DO', 'Family Practice', '', '', NULL, 'B', 'PO Box 191050', 'Boise', 'Ada', 'ID', '83719', '2083784288', '2083784297', 'PO Box 191050', 'Boise', 'Ada', 'ID', '83719', '2083784288', '2083784297', 'IDPRIMARY', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2013-03-01', '2013-07-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1245206648', 0, 'N', 0, '2013-07-29', NULL, NULL, 0, 0, NULL, NULL),
('942938348', 'W40006847', 'W40006847', 'UTMH1', 'Valley Mental Health  Inc', 'PAMELA', NULL, 'PRUYT', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', '5965 S 900 E Ste 430', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012637100', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'UTVMHMA', NULL, NULL, '0.00', '40.00', '0.00', 6, '2013-02-15', NULL, NULL, 0, NULL, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1457331233', 0, 'Y', 0, '2013-02-28', NULL, NULL, 0, 0, NULL, NULL),
('202630141', 'W40011847', 'W40011847', 'IDBOISTD', 'Primary Health Medical Group', 'Kirk', 'D', 'Prodzinski', 'DO', 'Family Practice', '', '', NULL, 'O', '8971 W Overland Rd', 'Boise', 'Ada', 'ID', '83709', '2083784288', '2083784297', '8971 W Overland Rd', 'Boise', 'Ada', 'ID', '83709', '2083784288', '2083784297', 'IDPRIMARY', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2013-03-01', '2013-07-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1245206648', 0, 'N', 0, '2013-07-29', NULL, NULL, 43.5898, -116.294, NULL, NULL),
('273225359', 'ELHCA0162', 'ELHCA0162', 'TXHOUSTD', 'Calder Urgent Care and Family Practice', 'Kevin', NULL, 'Prince', 'ARNP', 'Family Practice', '', '', NULL, 'B', 'PO Box 741371', 'Atlanta', 'Fulton', 'GA', '30374', NULL, NULL, 'PO Box 741371', 'Atlanta', 'Fulton', 'GA', '30374', '', '', 'HCA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1558396465', 0, 'Y', 0, '2013-05-01', NULL, NULL, 0, 0, NULL, NULL),
('263329351', 'TX0103594', 'TX0103594', 'TXSATSTD', 'San Antonio Internal Medicine Physicians', 'Jennifer', '', 'Wallace', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1303 McCullough Ave Ste 560', 'San Antonio', 'Bexar', 'TX', '78212', '2102239617', '2102236115', '1303 McCullough Ave Ste 560', 'San Antonio', 'Bexar', 'TX', '78212', '2102239617', '2102236115', 'TXINT', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1699760934', 0, 'N', 0, '2013-08-28', NULL, NULL, 29.4407, -98.4918, NULL, NULL),
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('741967809', 'TX0104500', 'TX0104500', 'TXSATSTD', 'Gastroenterology Consultants of San Antonio', 'Hays', 'L', 'Arnold', 'MD', 'Gastroenterology', '', '', NULL, 'B', 'PO Box 2778', 'San Antonio', 'Bexar', 'TX', '78229', '2106141234', NULL, 'PO Box 2778', 'San Antonio', 'Bexar', 'TX', '78229', '2106141234', '          ', 'TXSURGA', 'TXHCPCS', '', '0.00', '50.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'North East Baptist Hospital', NULL, '', '', 'HCFA|UB|', '1699765461', 0, 'N', 0, '2012-08-20', NULL, NULL, 0, 0, NULL, NULL),
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('820200895', 'ID0104559', 'ID0104559', 'IDBOISTD', 'Saint Alphonsus Medical Group OB/GYN Boise BOGA Bldg', 'Rebecca', 'L', 'McCaffrey', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '5966 Curtisian', 'Boise', 'Ada', 'ID', '83704', '2083758100', '2083778163', '5966 Curtisian', 'Boise', 'Ada', 'ID', '83704', '2083758100', '2083778163', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', '2013-08-01', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1215193263', 0, 'N', 0, '2014-06-20', NULL, NULL, 43.6149, -116.256, NULL, NULL),
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('201300128', 'ID0204630', 'ID0204630', 'IDBOISTD', 'Idaho Urologic Institute', 'Helen', 'J', 'Kuo', 'MD', 'Urology', '', '', NULL, 'O', '2855 E Magic View Dr', 'Meridian', 'Ada', 'ID', '83642', '2086394900', '2086394901', '2855 E Magic View Dr', 'Meridian', 'Ada', 'ID', '83642', '2086394900', '2086394901', 'IDUROLOGY', 'WUSTDHCPC5', '', '0.00', '20.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, NULL, NULL, 'HCFA|UB|', '1346407921', 0, 'N', 0, '2013-06-25', NULL, NULL, 43.5999, -116.359, NULL, NULL),
('260553931', 'ID0104886', 'ID0104886', 'IDBOISTD', 'Saint Alphonsus Medical Group Heart Care Eagle', 'Frederick', 'E', 'Badke', 'MD', 'Cardiology', '', '', NULL, 'O', '323 E Riverside Dr Ste 224', 'Eagle', 'Ada', 'ID', '83616', '2083675750', '2083675765', '323 E Riverside Dr Ste 224', 'Eagle', 'Ada', 'ID', '83616', '2083675750', '2083675765', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1407814411', 0, 'N', 0, '2014-06-11', NULL, NULL, 43.6896, -116.35, NULL, NULL),
('820200895', 'ID0104887', 'ID0104887', 'IDBOISTD', 'Saint Alphonsus Medical Group Family Medicine Dominican ', 'Jennifer', '', 'Hale', 'DO', 'Sleep Medicine', '', '', NULL, 'O', '1118 NW 16th St Ste A', 'Fruitland', 'Payette', 'ID', '83619', '2084526851', '2084522140', '1118 NW 16th St Ste A', 'Fruitland', 'Payette', 'ID', '83619', '2084526851', '2084522140', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', '2012-10-14', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1831143338', 0, 'N', 0, '2014-05-06', NULL, NULL, 44.025, -116.928, NULL, NULL),
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('460500210', 'ID0105219', 'ID0105219', 'IDBOISTD', 'Saint Alphonsus Trauma Physician Services', 'Harry', 'K', 'Stinger', 'MD', 'General Surgery', '', '', NULL, 'O', '901 N Curtis Rd Ste 401', 'Boise', 'Ada', 'ID', '83706', '2083677676', '2083676849', '901 N Curtis Rd Ste 401', 'Boise', 'Ada', 'ID', '83706', '2083677676', '2083676849', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1518935055', 0, 'N', 0, '2013-11-22', NULL, NULL, 43.6126, -116.254, NULL, NULL),
('460500210', 'ID0105220', 'ID0105220', 'IDBOISTD', 'Saint Alphonsus Trauma Physician Services', 'Harry', 'K', 'Stinger', 'MD', 'General Surgery', '', '', NULL, 'B', 'PO Box 9589', 'Boise', 'Ada', 'ID', '83707', '2084728111', '2083673174', 'PO Box 9589', 'Boise', 'Ada', 'ID', '83707', '2084728111', '2083673174', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1518935055', 0, 'N', 0, '2013-11-22', NULL, NULL, 0, 0, NULL, NULL),
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('742915297', 'TX0106111', 'TX0106111', 'TXSATSTD', 'South Texas Oncology and Hematology', 'Drew', 'W', 'Rasco', 'MD', 'Hematology and Oncology', '', '', NULL, 'O', '134 Menger Springs Ste 1120', 'Boerne', 'Kendall', 'TX', '78006', '2105935700', '8302495439', '134 Menger Springs Ste 1120', 'Boerne', 'Kendall', 'TX', '78006', '2105935700', '8302495439', 'TXONCOL', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'North East Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1558311225', 0, 'N', 0, '2013-04-04', NULL, NULL, 30.0543, -98.7392, NULL, NULL),
('742915297', 'TX0106112', 'TX0106112', 'TXSATSTD', 'South Texas Oncology and Hematology', 'Drew', 'W', 'Rasco', 'MD', 'Hematology and Oncology', '', '', NULL, 'O', '8715 Village Dr Ste 116', 'San Antonio', 'Bexar', 'TX', '78217', '2105935700', '2105902019', '8715 Village Dr Ste 116', 'San Antonio', 'Bexar', 'TX', '78217', '2105935700', '2105902019', 'TXONCOL', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-04-04', 0, 0, 0, 'North East Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1558311225', 0, 'N', 0, '2013-04-04', NULL, NULL, 29.5187, -98.4281, NULL, NULL),
('742915297', 'TX0106113', 'TX0106113', 'TXSATSTD', 'South Texas Oncology and Hematology', 'Drew', 'W', 'Rasco', 'MD', 'Hematology and Oncology', '', '', NULL, 'O', '502 Madison Oak Dr Ste 120', 'San Antonio', 'Bexar', 'TX', '78258', '2105935700', '2104494782', '502 Madison Oak Dr Ste 120', 'San Antonio', 'Bexar', 'TX', '78258', '2105935700', '2104494782', 'TXONCOL', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-04-04', 0, 0, 0, 'North East Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1558311225', 0, 'N', 0, '2013-04-04', NULL, NULL, 29.6202, -98.49, 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
('742915297', 'TX0106114', 'TX0106114', 'TXSATSTD', 'South Texas Oncology and Hematology', 'Drew', 'W', 'Rasco', 'MD', 'Hematology and Oncology', '', '', NULL, 'O', '11212 St Hwy 151 Ste 290', 'San Antonio', 'Bexar', 'TX', '78251', '2105935700', '2105935992', '11212 St Hwy 151 Ste 290', 'San Antonio', 'Bexar', 'TX', '78251', '2105935700', '2105935992', 'TXONCOL', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-04-04', 0, 0, 0, 'North East Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1558311225', 0, 'N', 0, '2013-04-04', NULL, NULL, 0, 0, NULL, NULL),
('742915297', 'TX0106115', 'TX0106115', 'TXSATSTD', 'South Texas Oncology and Hematology', 'Drew', 'W', 'Rasco', 'MD', 'Hematology and Oncology', '', '', NULL, 'O', '8215 Ewing Halsell', 'San Antonio', 'Bexar', 'TX', '78229', '2105935700', '2105935899', '8215 Ewing Halsell', 'San Antonio', 'Bexar', 'TX', '78229', '2105935700', '2105935899', 'TXONCOL', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-04-04', 0, 0, 0, 'North East Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1558311225', 0, 'N', 0, '2013-04-04', NULL, NULL, 0, 0, NULL, NULL),
('742915297', 'TX0106116', 'TX0106116', 'TXSATSTD', 'South Texas Oncology and Hematology', 'Drew', 'W', 'Rasco', 'MD', 'Hematology and Oncology', '', '', NULL, 'O', '1050 Hwy 16 S', 'Bandera', 'Bandera', 'TX', '78003', '2105935700', '2105935899', '1050 Hwy 16 S', 'Bandera', 'Bandera', 'TX', '78003', '2105935700', '2105935899', 'TXONCOL', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'North East Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1558311225', 0, 'N', 0, '2013-04-04', NULL, NULL, 29.7301, -99.0773, NULL, NULL),
('113676182', 'TX0106642', 'TX0106642', 'TXSATSTD', '', 'Michael', 'L', 'Dempsey', 'DPM', 'Podiatry', '', '', NULL, 'O', '2115 Pleasanton Rd', 'San Antonio', 'Bexar', 'TX', '78221', '2109244999', NULL, '2115 Pleasanton Rd', 'San Antonio', 'Bexar', 'TX', '78221', '2109244999', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-04-24', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1003886789', 0, 'N', 0, '2013-05-23', NULL, NULL, 0, 0, NULL, NULL),
('820487790', 'ID0106644', 'ID0106644', 'IDBOISTD', 'Selah Medical Center', 'Janet', 'G', 'Robinson', 'DO', 'Family Practice', '', '', NULL, 'O', '6565 W Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083775055', '2083775335', '6565 W Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083775055', '2083775335', 'IDPCPSELAH', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1083688576', 0, 'N', 0, '2012-08-20', NULL, NULL, 43.612, -116.263, NULL, NULL),
('260553931', 'ID0106775', 'ID0106775', 'IDBOISTD', 'Saint Alphonsus Medical Group Cardiology Nampa', 'Rakesh', 'K', 'Pai', 'MD', 'Cardiology', '', '', NULL, 'O', '1524 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2084635050', '2084635040', '1524 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2084635050', '2084635040', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', '2014-01-17', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1710190665', 0, 'N', 0, '2013-12-11', NULL, NULL, 43.5533, -116.573, NULL, NULL),
('260553931', 'ID0106786', 'ID0106786', 'IDBOISTD', 'Saint Alphonsus Medical Group Cardiology Nampa', 'Tosha', 'J', 'Johnson', 'NPC', 'Cardiology', 'Nurse Practitioner', '', NULL, 'O', '1524 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2084635050', '2084635040', '1524 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2084635050', '2084635040', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1639214216', 0, 'N', 0, '2014-06-13', NULL, NULL, 43.5537, -116.573, NULL, NULL),
('820200895', 'ID0106778', 'ID0106778', 'IDBOISTD', 'Saint Alphonsus Medical Group Federal Way Family Medicine', 'Jennifer', '', 'Biggerstaff', 'MD', 'Family Practice', '', '', NULL, 'O', '1880 W Judith Ln', 'Boise', 'Ada', 'ID', '83705', '2083676910', '2083676170', '1880 W Judith Ln', 'Boise', 'Ada', 'ID', '83705', '2083676910', '2083676170', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1861690745', 0, 'N', 0, '2014-06-20', NULL, NULL, 43.5913, -116.204, NULL, NULL),
('953134847', 'ID0106960', 'ID0106960', 'IDBOISTD', 'West Dermatology of Idaho', 'Wade', 'R', 'Keller', 'DO', 'Dermatology', '', '', NULL, 'O', '868 E Riverside Dr Ste 200', 'Eagle', 'Ada', 'ID', '83616', '2089396227', '2089396442', '868 E Riverside Dr Ste 200', 'Eagle', 'Ada', 'ID', '83616', '2089396227', '2089396442', 'IDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1942402169', 0, 'N', 0, '2014-06-04', NULL, NULL, 43.6884, -116.339, NULL, NULL),
('953134847', 'ID0106961', 'ID0106961', 'IDBOISTD', 'West Dermatology of Idaho', 'Wade', 'R', 'Keller', 'DO', 'Dermatology', '', '', NULL, 'M', '101 E Redlands Blvd Ste 212', 'Redlands', 'San Bernardino', 'CA', '92373', '2089396227', '2089396442', '101 E Redlands Blvd Ste 212', 'Redlands', 'San Bernardino', 'CA', '92373', '2089396227', '2089396442', 'IDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1942402169', 0, 'N', 0, '2014-06-04', NULL, NULL, 0, 0, NULL, NULL),
('953134847', 'ID0106962', 'ID0106962', 'IDBOISTD', 'West Dermatology of Idaho', 'Wade', 'R', 'Keller', 'DO', 'Dermatology', '', '', NULL, 'B', 'PO Box 2150', 'Redlands', 'San Bernardino', 'CA', '92373', '2089396227', '2089396442', 'PO Box 2150', 'Redlands', 'San Bernardino', 'CA', '92373', '2089396227', '2089396442', 'IDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1942402169', 0, 'N', 0, '2014-06-04', NULL, NULL, 0, 0, NULL, NULL),
('742337161', 'TX0106963', 'TX0106963', 'TXSATSTD', 'Alamo Heart Associates', 'Fernando', '', 'Lopez', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '2829 Babcock Rd Ste 200', 'San Antonio', 'Bexar', 'TX', '78229', '2106163318', NULL, '2829 Babcock Rd Ste 200', 'San Antonio', 'Bexar', 'TX', '78229', '2106163318', '          ', 'TXALAMO', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-05-23', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1619974045', 0, 'N', 0, '2013-05-24', NULL, NULL, 29.5138, -98.5907, NULL, NULL),
('272713767', 'TX0107192', 'TX0107192', 'TXSATSTD', 'Cardiology Clinic of San Antonio', 'Jorge', 'A', 'Alvarez', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '4411 Medical Dr Ste 300', 'San Antonio', 'Bexar', 'TX', '78229', '2106145400', '2106142431', '4411 Medical Dr Ste 300', 'San Antonio', 'Bexar', 'TX', '78229', '2106145400', '2106142431', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2014-06-15', 0, 0, 0, 'St Lukes Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1821183559', 0, 'N', 0, '2014-05-06', NULL, NULL, 29.5103, -98.5717, NULL, NULL),
('272713767', 'TX0107193', 'TX0107193', 'TXSATSTD', 'Cardiology Clinic of San Antonio', 'Jorge', 'A', 'Alvarez', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '255 E Sonterra Blvd Ste 150', 'San Antonio', 'Bexar', 'TX', '78258', '2104906000', '2104904658', '255 E Sonterra Blvd Ste 150', 'San Antonio', 'Bexar', 'TX', '78258', '2104906000', '2104904658', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2014-06-15', 0, 0, 0, 'St Lukes Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1821183559', 0, 'Y', 0, '2014-05-06', NULL, NULL, 29.6164, -98.4911, NULL, NULL),
('272713767', 'TX0107194', 'TX0107194', 'TXSATSTD', 'Cardiology Clinic of San Antonio', 'Jorge', 'A', 'Alvarez', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '3903 Wiseman Blvd Ste 315', 'San Antonio', 'Bexar', 'TX', '78251', '2106145400', '2106142431', '3903 Wiseman Blvd Ste 315', 'San Antonio', 'Bexar', 'TX', '78251', '2106145400', '2106142431', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2014-06-15', 0, 0, 0, 'St Lukes Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1821183559', 0, 'N', 0, '2014-05-06', NULL, NULL, 29.4763, -98.6953, NULL, NULL),
('272713767', 'TX0107197', 'TX0107197', 'TXSATSTD', 'Cardiology Clinic of San Antonio', 'Richard', 'A', 'Baum', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '255 E Sonterra Blvd Ste 150', 'San Antonio', 'Bexar', 'TX', '78258', '2104906000', '2104904658', '255 E Sonterra Blvd Ste 150', 'San Antonio', 'Bexar', 'TX', '78258', '2104906000', '2104904658', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2014-06-15', 0, 0, 0, 'St Lukes Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1013994987', 0, 'N', 0, '2014-05-06', NULL, NULL, 29.6164, -98.4911, NULL, NULL),
('272713767', 'TX0107198', 'TX0107198', 'TXSATSTD', 'Cardiology Clinic of San Antonio', 'Richard', 'A', 'Baum', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '3903 Wiseman Blvd Ste 315', 'San Antonio', 'Bexar', 'TX', '78251', '2106145400', '2106142431', '3903 Wiseman Blvd Ste 315', 'San Antonio', 'Bexar', 'TX', '78251', '2106145400', '2106142431', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2014-06-15', 0, 0, 0, 'St Lukes Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1013994987', 0, 'N', 0, '2014-05-06', NULL, NULL, 29.4763, -98.6953, NULL, NULL),
('272713767', 'TX0107196', 'TX0107196', 'TXSATSTD', 'Cardiology Clinic of San Antonio', 'Richard', 'A', 'Baum', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '4411 Medical Dr Ste 300', 'San Antonio', 'Bexar', 'TX', '78229', '2106145400', '2106142431', '4411 Medical Dr Ste 300', 'San Antonio', 'Bexar', 'TX', '78229', '2106145400', '2106142431', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2014-06-15', 0, 0, 0, 'St Lukes Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1013994987', 0, 'N', 0, '2014-05-06', NULL, NULL, 29.5103, -98.5717, NULL, NULL),
('272713767', 'TX0107199', 'TX0107199', 'TXSATSTD', 'Cardiology Clinic of San Antonio', 'Moises', '', 'Bucay', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '255 E Sonterra Blvd Ste 150', 'San Antonio', 'Bexar', 'TX', '78258', '2104906000', '2104904658', '255 E Sonterra Blvd Ste 150', 'San Antonio', 'Bexar', 'TX', '78258', '2104906000', '2104904658', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2014-06-15', 0, 0, 0, 'St Lukes Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1285614529', 0, 'N', 0, '2014-05-06', NULL, NULL, 29.6164, -98.4911, NULL, NULL),
('272713767', 'TX0107201', 'TX0107201', 'TXSATSTD', 'Cardiology Clinic of San Antonio', 'Moises', '', 'Bucay', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '3903 Wiseman Blvd Ste 315', 'San Antonio', 'Bexar', 'TX', '78251', '2106145400', '2106142431', '3903 Wiseman Blvd Ste 315', 'San Antonio', 'Bexar', 'TX', '78251', '2106145400', '2106142431', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2014-06-15', 0, 0, 0, 'St Lukes Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1285614529', 0, 'N', 0, '2014-05-06', NULL, NULL, 29.4763, -98.6953, NULL, NULL),
('272713767', 'TX0107200', 'TX0107200', 'TXSATSTD', 'Cardiology Clinic of San Antonio', 'Moises', '', 'Bucay', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '4411 Medical Dr Ste 300', 'San Antonio', 'Bexar', 'TX', '78229', '2106145400', '2106142431', '4411 Medical Dr Ste 300', 'San Antonio', 'Bexar', 'TX', '78229', '2106145400', '2106142431', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2014-06-15', 0, 0, 0, 'St Lukes Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1285614529', 0, 'N', 0, '2014-05-06', NULL, NULL, 29.5103, -98.5717, NULL, NULL),
('272713767', 'TX0107202', 'TX0107202', 'TXSATSTD', 'Cardiology Clinic of San Antonio', 'James', 'C', 'Buell', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '255 E Sonterra Blvd Ste 150', 'San Antonio', 'Bexar', 'TX', '78258', '2104906000', '2104904658', '255 E Sonterra Blvd Ste 150', 'San Antonio', 'Bexar', 'TX', '78258', '2104906000', '2104904658', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2014-06-15', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1174594949', 0, 'N', 0, '2014-05-06', NULL, NULL, 29.6164, -98.4911, NULL, NULL),
('272713767', 'TX0107204', 'TX0107204', 'TXSATSTD', 'Cardiology Clinic of San Antonio', 'James', 'C', 'Buell', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '3903 Wiseman Blvd Ste 315', 'San Antonio', 'Bexar', 'TX', '78251', '2106145400', '2106142431', '3903 Wiseman Blvd Ste 315', 'San Antonio', 'Bexar', 'TX', '78251', '2106145400', '2106142431', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2014-06-15', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1174594949', 0, 'N', 0, '2014-05-06', NULL, NULL, 29.4763, -98.6953, NULL, NULL),
('272713767', 'TX0107203', 'TX0107203', 'TXSATSTD', 'Cardiology Clinic of San Antonio', 'James', 'C', 'Buell', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '4411 Medical Dr Ste 300', 'San Antonio', 'Bexar', 'TX', '78229', '2106145400', '2106142431', '4411 Medical Dr Ste 300', 'San Antonio', 'Bexar', 'TX', '78229', '2106145400', '2106142431', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2014-06-15', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1174594949', 0, 'N', 0, '2014-05-06', NULL, NULL, 29.5103, -98.5717, NULL, NULL),
('273225359', 'ELHCA0161', 'ELHCA0161', 'TXHOUSTD', 'Calder Urgent Care and Family Practice', 'Kevin', NULL, 'Prince', 'ARNP', 'Family Practice', '', '', NULL, 'O', '1108 S Gulf Fwy                  Ste 230', 'League City', 'Galveston', 'TX', '77573', '2815574404', '2715574443', '1108 S Gulf Fwy                  Ste 230', 'League City', 'Galveston', 'TX', '77573', '2815574404', '2715574443', 'HCA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1558396465', 0, 'Y', 0, '2013-05-01', NULL, NULL, 29.495, -95.1088, NULL, NULL),
('820485925', 'SACN01697', 'SACN01697', 'SACN', 'Price Chiropractic Center', 'David', 'N', 'Price', 'DC', 'Chiropractic', '', '', NULL, 'O', '9508 Fairview Ave', 'Boise', 'Ada', 'ID', '83704', '2083231313', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'IDSINCLAIRM', NULL, NULL, '0.00', '10.00', '0.00', 3, '2011-01-01', NULL, 0, 0, NULL, '', '', '', '', 'HCFA|UB|', '1699716365', 0, 'n', 0, '2013-02-28', NULL, NULL, 0, 0, NULL, NULL),
('364314354', 'ELPPA0013', 'ELPPA0013', 'ILCHIGSTD', 'Provena Medical Group', 'John', '', 'Pollastrini', 'MD', 'Family Practice', '', '', NULL, 'O', '410 E Lincoln Hwy', 'New Lenox', 'Will', 'IL', '60451', '8154852541', '6309142499', '410 E Lincoln Hwy', 'New Lenox', 'Will', 'IL', '60451', '8154852541', '6309142499', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1033131479', 0, 'N', 0, '2013-03-07', NULL, NULL, 41.5123, -87.957, NULL, NULL),
('942938348', 'W40024810', 'W40024810', 'UTMH1', 'Valley Mental Health  Inc', 'Angelique', 'M', 'Poncelet', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'B', '5965 S 900 E Ste 430', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012637100', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'UTVMHMA', NULL, NULL, '0.00', '40.00', '0.00', 6, '2013-02-15', NULL, NULL, 0, NULL, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1467775882', 0, 'Y', 0, '2013-02-28', NULL, NULL, 0, 0, NULL, NULL),
('272713767', 'TX0107208', 'TX0107208', 'TXSATSTD', 'Cardiology Clinic of San Antonio', 'Paul', 'V', 'Celio', 'MD', 'Cardiovascular Disease', '', '', NULL, 'B', 'PO Box 741248', 'Atlanta', 'Fulton', 'GA', '30374', '2104906000', '2104904658', 'PO Box 741248', 'Atlanta', 'Fulton', 'GA', '30374', '2104906000', '2104904658', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2014-06-15', 0, 0, 0, 'St Lukes Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1023095965', 0, 'Y', 0, '2014-05-06', NULL, NULL, 0, 0, NULL, NULL),
('272713767', 'TX0107210', 'TX0107210', 'TXSATSTD', 'Cardiology Clinic of San Antonio', 'Madhu', 'B', 'Challapalli', 'MD', 'Cardiovascular Disease', '', '', NULL, 'B', 'PO Box 741248', 'Atlanta', 'Fulton', 'GA', '30374', '2104906000', '2104904658', 'PO Box 741248', 'Atlanta', 'Fulton', 'GA', '30374', '2104906000', '2104904658', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2014-06-15', 0, 0, 0, 'North Central Baptist Hospital', 'St Lukes Baptist Hospital', NULL, NULL, 'HCFA|UB|', '1609847029', 0, 'Y', 0, '2014-05-06', NULL, NULL, 0, 0, NULL, NULL),
('272713767', 'TX0107209', 'TX0107209', 'TXSATSTD', 'Cardiology Clinic of San Antonio', 'Madhu', 'B', 'Challapalli', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '255 E Sonterra Blvd Ste 150', 'San Antonio', 'Bexar', 'TX', '78258', '2104906000', '2104904658', '255 E Sonterra Blvd Ste 150', 'San Antonio', 'Bexar', 'TX', '78258', '2104906000', '2104904658', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2014-06-15', 0, 0, 0, 'North Central Baptist Hospital', 'St Lukes Baptist Hospital', NULL, NULL, 'HCFA|UB|', '1609847029', 0, 'N', 0, '2014-05-06', NULL, NULL, 29.6164, -98.4911, NULL, NULL),
('272713767', 'TX0107211', 'TX0107211', 'TXSATSTD', 'Cardiology Clinic of San Antonio', 'Madhu', 'B', 'Challapalli', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '3903 Wiseman Blvd Ste 315', 'San Antonio', 'Bexar', 'TX', '78251', '2106145400', '2106142431', '3903 Wiseman Blvd Ste 315', 'San Antonio', 'Bexar', 'TX', '78251', '2106145400', '2106142431', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2014-06-15', 0, 0, 0, 'North Central Baptist Hospital', 'St Lukes Baptist Hospital', NULL, NULL, 'HCFA|UB|', '1609847029', 0, 'N', 0, '2014-05-06', NULL, NULL, 29.4763, -98.6953, NULL, NULL),
('272713767', 'TX0107212', 'TX0107212', 'TXSATSTD', 'Cardiology Clinic of San Antonio', 'Madhu', 'B', 'Challapalli', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '4411 Medical Dr Ste 300', 'San Antonio', 'Bexar', 'TX', '78229', '2106145400', '2106142431', '4411 Medical Dr Ste 300', 'San Antonio', 'Bexar', 'TX', '78229', '2106145400', '2106142431', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2014-06-15', 0, 0, 0, 'North Central Baptist Hospital', 'St Lukes Baptist Hospital', NULL, NULL, 'HCFA|UB|', '1609847029', 0, 'N', 0, '2014-05-06', NULL, NULL, 29.5103, -98.5717, NULL, NULL),
('272713767', 'TX0107222', 'TX0107222', 'TXSATSTD', 'Cardiology Clinic of San Antonio', 'Gregory', 'L', 'Freeman', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '255 E Sonterra Blvd Ste 150', 'San Antonio', 'Bexar', 'TX', '78258', '2104906000', '2104904658', '255 E Sonterra Blvd Ste 150', 'San Antonio', 'Bexar', 'TX', '78258', '2104906000', '2104904658', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2014-06-15', 0, 0, 0, 'St Lukes Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1871600866', 0, 'N', 0, '2014-05-06', NULL, NULL, 29.6164, -98.4911, NULL, NULL),
('272713767', 'TX0107223', 'TX0107223', 'TXSATSTD', 'Cardiology Clinic of San Antonio', 'Gregory', 'L', 'Freeman', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '3903 Wiseman Blvd Ste 315', 'San Antonio', 'Bexar', 'TX', '78251', '2106145400', '2106142431', '3903 Wiseman Blvd Ste 315', 'San Antonio', 'Bexar', 'TX', '78251', '2106145400', '2106142431', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2014-06-15', 0, 0, 0, 'St Lukes Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1871600866', 0, 'N', 0, '2014-05-06', NULL, NULL, 29.4763, -98.6953, NULL, NULL),
('272713767', 'TX0107224', 'TX0107224', 'TXSATSTD', 'Cardiology Clinic of San Antonio', 'Gregory', 'L', 'Freeman', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '4411 Medical Dr Ste 300', 'San Antonio', 'Bexar', 'TX', '78229', '2106145400', '2106142431', '4411 Medical Dr Ste 300', 'San Antonio', 'Bexar', 'TX', '78229', '2106145400', '2106142431', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2014-06-15', 0, 0, 0, 'St Lukes Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1871600866', 0, 'N', 0, '2014-05-06', NULL, NULL, 29.5103, -98.5717, NULL, NULL),
('272713767', 'TX0107225', 'TX0107225', 'TXSATSTD', 'Cardiology Clinic of San Antonio', 'Gregory', 'L', 'Freeman', 'MD', 'Cardiovascular Disease', '', '', NULL, 'B', 'PO Box 741248', 'Atlanta', 'Fulton', 'GA', '30374', '2104906000', '2104904658', 'PO Box 741248', 'Atlanta', 'Fulton', 'GA', '30374', '2104906000', '2104904658', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2014-06-15', 0, 0, 0, 'St Lukes Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1871600866', 0, 'Y', 0, '2014-05-06', NULL, NULL, 0, 0, NULL, NULL),
('942938348', 'W40006846', 'W40006846', 'UTMH1', 'Valley Mental Health  Inc', 'JANET', NULL, 'POHANKA', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', '5965 S 900 E Ste 430', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012637100', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'UTVMHMA', NULL, NULL, '0.00', '40.00', '0.00', 6, '2013-02-15', NULL, NULL, 0, NULL, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1861477556', 0, 'Y', 0, '2013-02-28', NULL, NULL, 0, 0, NULL, NULL),
('870560763', 'W40000322', 'W40000322', 'UT01', 'Montezuma Creek', 'Deirdre', '', 'Piotrowski', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', 'PO Box 130', 'Montezuma Creek', 'San Juan', 'UT', '84534', '4357273241', NULL, 'PO Box 130', 'Montezuma Creek', 'San Juan', 'UT', '84534', '4357273241', '', 'ma', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 6, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1609879998', 0, 'Y', 0, '2014-05-12', NULL, NULL, 0, 0, NULL, NULL),
('870560763', 'W40004826', 'W40004826', 'UT01', 'Monument Valley Community Health Center', 'Deirdre', '', 'Piotrowski', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', 'Four Rock Door Canyon Rd', 'Monument Valley', 'San Juan', 'UT', '84536', '4357273000', NULL, 'Four Rock Door Canyon Rd', 'Monument Valley', 'San Juan', 'UT', '84536', '4357273000', '', 'ma', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 6, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1609879998', 0, 'N', 0, '2014-05-12', NULL, NULL, 37.0992, -110.619, NULL, NULL),
('870560763', 'W40004821', 'W40004821', 'UT01', 'Blanding Family Practice', 'Deirdre', '', 'Piotrowski', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '799 S 200 W', 'Blanding', 'San Juan', 'UT', '84511', '4356783601', NULL, '799 S 200 W', 'Blanding', 'San Juan', 'UT', '84511', '4356783601', '', 'ma', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 6, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1609879998', 0, 'N', 0, '2014-05-12', NULL, NULL, 37.6135, -109.481, NULL, NULL),
('870560763', 'W40004816', 'W40004816', 'UT01', 'Montezuma Creek Community Health Center', 'Deirdre', '', 'Piotrowski', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', 'E Hwy 262', 'Montezuma Creek', 'San Juan', 'UT', '84534', '4356513291', NULL, 'E Hwy 262', 'Montezuma Creek', 'San Juan', 'UT', '84534', '4356513291', '', 'ma', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 6, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1609879998', 0, 'N', 0, '2014-05-12', NULL, NULL, 37.2619, -109.306, NULL, NULL),
('870560763', 'W40004828', 'W40004828', 'UT01', 'Navajo Mountain Community Health Center', 'Deirdre', '', 'Piotrowski', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '#2 Rainbow Rd', 'Tonalea', 'Coconino', 'AZ', '86044', '9286722498', NULL, '#2 Rainbow Rd', 'Tonalea', 'Coconino', 'AZ', '86044', '9286722498', '', 'ma', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 6, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1609879998', 0, 'N', 0, '2014-05-12', NULL, NULL, 35.9397, -110.866, NULL, NULL),
('263091124', 'ELHCA0160', 'ELHCA0160', 'TXHOUSTD', 'Complete Womens Care Center', 'Ferdinand', NULL, 'Plavidal', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 405477     ', 'Atlanta', 'Fulton', 'GA', '30384', '          ', NULL, 'PO Box 405477     ', 'Atlanta', 'Fulton', 'GA', '30384', '          ', '          ', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'The Womans Hospital of Texas', NULL, NULL, NULL, 'HCFA|UB|', '1649244039', 0, 'Y', 0, '2013-06-05', NULL, NULL, 0, 0, NULL, NULL),
('741833341', 'TX0107234', 'TX0107234', 'TXSATSTD', 'Peripheral Vascular Associates', 'Alfred', 'L', 'Laborde', 'MD', 'Vascular Surgery', '', '', NULL, 'O', '4330 Medical Dr Ste 100', 'San Antonio', 'Bexar', 'TX', '78229', '2106147467', NULL, '4330 Medical Dr Ste 100', 'San Antonio', 'Bexar', 'TX', '78229', '2106147467', '          ', 'TXSURGB', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'St Lukes Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1114924396', 0, 'N', 0, '2014-01-17', NULL, NULL, 29.5116, -98.5703, NULL, NULL),
('741833341', 'TX0107244', 'TX0107244', 'TXSATSTD', 'Peripheral Vascular Associates', 'David', 'J', 'Mozersky', 'MD', 'Vascular Surgery', '', '', NULL, 'O', '4330 Medical Dr Ste 100', 'San Antonio', 'Bexar', 'TX', '78229', '2106147467', NULL, '4330 Medical Dr Ste 100', 'San Antonio', 'Bexar', 'TX', '78229', '2106147467', '          ', 'TXSURGB', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1548246200', 0, 'N', 0, '2013-07-16', NULL, NULL, 29.5116, -98.5703, NULL, NULL),
('272713767', 'TX0107247', 'TX0107247', 'TXSATSTD', 'Cardiology Clinic of San Antonio', 'John', 'P', 'Mulrow', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '255 E Sonterra Blvd Ste 150', 'San Antonio', 'Bexar', 'TX', '78258', '2104906000', '2104904658', '255 E Sonterra Blvd Ste 150', 'San Antonio', 'Bexar', 'TX', '78258', '2104906000', '2104904658', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2014-06-15', 0, 0, 0, 'St Lukes Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1043297922', 0, 'N', 0, '2014-05-06', NULL, NULL, 29.6164, -98.4911, NULL, NULL),
('272713767', 'TX0107246', 'TX0107246', 'TXSATSTD', 'Cardiology Clinic of San Antonio', 'John', 'P', 'Mulrow', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '3903 Wiseman Blvd Ste 315', 'San Antonio', 'Bexar', 'TX', '78251', '2106145400', '2106142431', '3903 Wiseman Blvd Ste 315', 'San Antonio', 'Bexar', 'TX', '78251', '2106145400', '2106142431', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2014-06-15', 0, 0, 0, 'St Lukes Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1043297922', 0, 'N', 0, '2014-05-06', NULL, NULL, 29.4763, -98.6953, NULL, NULL),
('272713767', 'TX0107245', 'TX0107245', 'TXSATSTD', 'Cardiology Clinic of San Antonio', 'John', 'P', 'Mulrow', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '4411 Medical Dr Ste 300', 'San Antonio', 'Bexar', 'TX', '78229', '2106145400', '2106142431', '4411 Medical Dr Ste 300', 'San Antonio', 'Bexar', 'TX', '78229', '2106145400', '2106142431', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2014-06-15', 0, 0, 0, 'St Lukes Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1043297922', 0, 'N', 0, '2014-05-06', NULL, NULL, 29.5103, -98.5717, NULL, NULL),
('272713767', 'TX0107248', 'TX0107248', 'TXSATSTD', 'Cardiology Clinic of San Antonio', 'John', 'P', 'Mulrow', 'MD', 'Cardiovascular Disease', '', '', NULL, 'B', 'PO Box 741248', 'Atlanta', 'Fulton', 'GA', '30374', '2104906000', '2104904658', 'PO Box 741248', 'Atlanta', 'Fulton', 'GA', '30374', '2104906000', '2104904658', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2014-06-15', 0, 0, 0, 'St Lukes Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1043297922', 0, 'Y', 0, '2014-05-06', NULL, NULL, 0, 0, NULL, NULL),
('272713767', 'TX0107252', 'TX0107252', 'TXSATSTD', 'Cardiology Clinic of San Antonio', 'Mauro', '', 'Ortiz', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '3903 Wiseman Blvd Ste 315', 'San Antonio', 'Bexar', 'TX', '78251', '2106145400', '2106142431', '3903 Wiseman Blvd Ste 315', 'San Antonio', 'Bexar', 'TX', '78251', '2106145400', '2106142431', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2014-06-15', 0, 0, 0, 'St Lukes Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1699747790', 0, 'N', 0, '2014-05-06', NULL, NULL, 29.4763, -98.6953, NULL, NULL),
('272713767', 'TX0107253', 'TX0107253', 'TXSATSTD', 'Cardiology Clinic of San Antonio', 'Mauro', '', 'Ortiz', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '255 E Sonterra Blvd Ste 150', 'San Antonio', 'Bexar', 'TX', '78258', '2104906000', '2104904658', '255 E Sonterra Blvd Ste 150', 'San Antonio', 'Bexar', 'TX', '78258', '2104906000', '2104904658', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2014-06-15', 0, 0, 0, 'St Lukes Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1699747790', 0, 'N', 0, '2014-05-06', NULL, NULL, 29.6164, -98.4911, NULL, NULL),
('272713767', 'TX0107251', 'TX0107251', 'TXSATSTD', 'Cardiology Clinic of San Antonio', 'Mauro', '', 'Ortiz', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '4411 Medical Dr Ste 300', 'San Antonio', 'Bexar', 'TX', '78229', '2106145400', '2106142431', '4411 Medical Dr Ste 300', 'San Antonio', 'Bexar', 'TX', '78229', '2106145400', '2106142431', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2014-06-15', 0, 0, 0, 'St Lukes Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1699747790', 0, 'N', 0, '2014-05-06', NULL, NULL, 29.5103, -98.5717, NULL, NULL),
('272713767', 'TX0107254', 'TX0107254', 'TXSATSTD', 'Cardiology Clinic of San Antonio', 'Mauro', '', 'Ortiz', 'MD', 'Cardiovascular Disease', '', '', NULL, 'B', 'PO Box 741248', 'Atlanta', 'Fulton', 'GA', '30374', '2104906000', '2104904658', 'PO Box 741248', 'Atlanta', 'Fulton', 'GA', '30374', '2104906000', '2104904658', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2014-06-15', 0, 0, 0, 'St Lukes Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1699747790', 0, 'Y', 0, '2014-05-06', NULL, NULL, 0, 0, NULL, NULL),
('263091124', 'ELHCA0159', 'ELHCA0159', 'TXHOUSTD', '', 'Ferdinand', NULL, 'Plavidal', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '7400 Fannin St Ste 335', 'Houston', 'Harris', 'TX', '77054', '7137955450', '7137950250', '7400 Fannin St Ste 335', 'Houston', 'Harris', 'TX', '77054', '7137955450', '7137950250', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', '2013-03-21', 0, 0, 0, 'The Womans Hospital of Texas', NULL, NULL, NULL, 'HCFA|UB|', '1649244039', 0, 'N', 0, '2013-05-01', NULL, NULL, 29.6946, -95.4012, NULL, NULL),
('263091124', 'ELHCA0157', 'ELHCA0157', 'TXHOUSTD', 'Womans OB-GYN Specialists', 'Phillip', '', 'Pinell', 'MD', 'Obstetrics and Gynecology', 'Infectious Disease', '', NULL, 'O', '7900 Fannin St Ste 2650', 'Houston', 'Harris', 'TX', '77054', '7137971119', '7137969747', '7900 Fannin St Ste 2650', 'Houston', 'Harris', 'TX', '77054', '7137971119', '7137969747', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'The Womans Hospital of Texas', NULL, NULL, NULL, 'HCFA|UB|', '1922009463', 0, 'N', 0, '2013-05-01', NULL, NULL, 29.6896, -95.4034, NULL, NULL),
('263091124', 'ELHCA0158', 'ELHCA0158', 'TXHOUSTD', 'Womans OB-GYN Specialists', 'Phillip', '', 'Pinell', 'MD', 'Obstetrics and Gynecology', 'Infectious Disease', '', NULL, 'B', 'PO Box 405477     ', 'Atlanta', 'Fulton', 'GA', '30384', NULL, NULL, 'PO Box 405477     ', 'Atlanta', 'Fulton', 'GA', '30384', '', '', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'The Womans Hospital of Texas', NULL, NULL, NULL, 'HCFA|UB|', '1922009463', 0, 'Y', 0, '2013-05-01', NULL, NULL, 0, 0, NULL, NULL),
('260859911', 'ELHCA0154', 'ELHCA0154', 'TXHOUSTD', 'Surgical Specialists of Clear Lake ', 'Hoang', NULL, 'Pham', 'MD', 'General Surgery', '', '', NULL, 'B', 'PO Box 100559 ', 'Atlanta', 'Fulton', 'GA', '30384', NULL, NULL, 'PO Box 100559 ', 'Atlanta', 'Fulton', 'GA', '30384', '', '', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1073693495', 0, 'Y', 0, '2013-05-01', NULL, NULL, 0, 0, NULL, NULL),
('260859911', 'ELHCA0153', 'ELHCA0153', 'TXHOUSTD', 'Surgical Specialists of Clear Lake ', 'Hoang', NULL, 'Pham', 'MD', 'General Surgery', '', '', NULL, 'O', '450 Medical Ctr Blvd                         Ste 600', 'Webster', 'Harris', 'TX', '77598', '2813324596', '2815544501', '450 Medical Ctr Blvd                         Ste 600', 'Webster', 'Harris', 'TX', '77598', '2813324596', '2815544501', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1073693495', 0, 'N', 0, '2013-05-01', NULL, NULL, 29.5413, -95.126, NULL, NULL),
('272713767', 'TX0107261', 'TX0107261', 'TXSATSTD', 'Cardiology Clinic of San Antonio', 'David', 'N', 'Pederson', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '255 E Sonterra Blvd Ste 150', 'San Antonio', 'Bexar', 'TX', '78258', '2104906000', '2104904658', '255 E Sonterra Blvd Ste 150', 'San Antonio', 'Bexar', 'TX', '78258', '2104906000', '2104904658', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2014-06-15', 0, 0, 0, 'St Lukes Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1700857471', 0, 'N', 0, '2014-05-06', NULL, NULL, 29.6164, -98.4911, NULL, NULL),
('272713767', 'TX0107262', 'TX0107262', 'TXSATSTD', 'Cardiology Clinic of San Antonio', 'David', 'N', 'Pederson', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '3903 Wiseman Blvd Ste 315', 'San Antonio', 'Bexar', 'TX', '78251', '2106145400', '2106142431', '3903 Wiseman Blvd Ste 315', 'San Antonio', 'Bexar', 'TX', '78251', '2106145400', '2106142431', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2014-06-15', 0, 0, 0, 'St Lukes Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1700857471', 0, 'N', 0, '2014-05-06', NULL, NULL, 29.4763, -98.6953, NULL, NULL),
('272713767', 'TX0107259', 'TX0107259', 'TXSATSTD', 'Cardiology Clinic of San Antonio', 'David', 'N', 'Pederson', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '4411 Medical Dr Ste 300', 'San Antonio', 'Bexar', 'TX', '78229', '2106145400', '2106142431', '4411 Medical Dr Ste 300', 'San Antonio', 'Bexar', 'TX', '78229', '2106145400', '2106142431', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2014-06-15', 0, 0, 0, 'St Lukes Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1700857471', 0, 'N', 0, '2014-05-06', NULL, NULL, 29.5103, -98.5717, NULL, NULL),
('272713767', 'TX0107260', 'TX0107260', 'TXSATSTD', 'Cardiology Clinic of San Antonio', 'David', 'N', 'Pederson', 'MD', 'Cardiovascular Disease', '', '', NULL, 'B', 'PO Box 741248', 'Atlanta', 'Fulton', 'GA', '30374', '2104906000', '2104904658', 'PO Box 741248', 'Atlanta', 'Fulton', 'GA', '30374', '2104906000', '2104904658', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2014-06-15', 0, 0, 0, 'St Lukes Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1700857471', 0, 'Y', 0, '2014-05-06', NULL, NULL, 0, 0, NULL, NULL),
('272713767', 'TX0107267', 'TX0107267', 'TXSATSTD', 'Cardiology Clinic of San Antonio', 'Ananth', 'K', 'Prasad', 'MD', 'Cardiovascular Disease', '', '', NULL, 'B', 'PO Box 741248', 'Atlanta', 'Fulton', 'GA', '30374', '2104906000', '2104904658', 'PO Box 741248', 'Atlanta', 'Fulton', 'GA', '30374', '2104906000', '2104904658', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2014-06-15', 0, 0, 0, 'St Lukes Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1023089703', 0, 'Y', 0, '2014-05-06', NULL, NULL, 0, 0, NULL, NULL),
('272713767', 'TX0107266', 'TX0107266', 'TXSATSTD', 'Cardiology Clinic of San Antonio', 'Ananth', 'K', 'Prasad', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '255 E Sonterra Blvd Ste 150', 'San Antonio', 'Bexar', 'TX', '78258', '2104906000', '2104904658', '255 E Sonterra Blvd Ste 150', 'San Antonio', 'Bexar', 'TX', '78258', '2104906000', '2104904658', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2014-06-15', 0, 0, 0, 'St Lukes Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1023089703', 0, 'N', 0, '2014-05-06', NULL, NULL, 29.6164, -98.4911, NULL, NULL),
('272713767', 'TX0107264', 'TX0107264', 'TXSATSTD', 'Cardiology Clinic of San Antonio', 'Ananth', 'K', 'Prasad', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '4411 Medical Dr Ste 300', 'San Antonio', 'Bexar', 'TX', '78229', '2106145400', '2106142431', '4411 Medical Dr Ste 300', 'San Antonio', 'Bexar', 'TX', '78229', '2106145400', '2106142431', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2014-06-15', 0, 0, 0, 'St Lukes Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1023089703', 0, 'N', 0, '2014-05-06', NULL, NULL, 29.5103, -98.5717, NULL, NULL),
('272713767', 'TX0107265', 'TX0107265', 'TXSATSTD', 'Cardiology Clinic of San Antonio', 'Ananth', 'K', 'Prasad', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '3903 Wiseman Blvd Ste 315', 'San Antonio', 'Bexar', 'TX', '78251', '2106145400', '2106142431', '3903 Wiseman Blvd Ste 315', 'San Antonio', 'Bexar', 'TX', '78251', '2106145400', '2106142431', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2014-06-15', 0, 0, 0, 'St Lukes Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1023089703', 0, 'N', 0, '2014-05-06', NULL, NULL, 29.4763, -98.6953, NULL, NULL),
('272713767', 'TX0107270', 'TX0107270', 'TXSATSTD', 'Cardiology Clinic of San Antonio', 'Stephen', 'S', 'Reich', 'MD', 'Cardiac Electrophysiology Cardiology', '', '', NULL, 'O', '255 E Sonterra Blvd Ste 150', 'San Antonio', 'Bexar', 'TX', '78258', '2104906000', '2104904658', '255 E Sonterra Blvd Ste 150', 'San Antonio', 'Bexar', 'TX', '78258', '2104906000', '2104904658', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-04-24', 0, 0, 0, 'St Lukes Baptist Hospital', NULL, '', '', 'HCFA|UB|', '1992766935', 0, 'N', 0, '2014-03-25', NULL, NULL, 29.6171, -98.4906, NULL, NULL),
('272713767', 'TX0107269', 'TX0107269', 'TXSATSTD', 'Cardiology Clinic of San Antonio', 'Stephen', 'S', 'Reich', 'MD', 'Cardiac Electrophysiology Cardiology', '', '', NULL, 'O', '3903 Wiseman Blvd Ste 315', 'San Antonio', 'Bexar', 'TX', '78251', '2106145400', '2106142431', '3903 Wiseman Blvd Ste 315', 'San Antonio', 'Bexar', 'TX', '78251', '2106145400', '2106142431', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-04-24', 0, 0, 0, 'St Lukes Baptist Hospital', NULL, '', '', 'HCFA|UB|', '1992766935', 0, 'N', 0, '2014-03-25', NULL, NULL, 29.4776, -98.695, NULL, NULL),
('272713767', 'TX0107268', 'TX0107268', 'TXSATSTD', 'Cardiology Clinic of San Antonio', 'Stephen', 'S', 'Reich', 'MD', 'Cardiac Electrophysiology Cardiology', '', '', NULL, 'O', '4411 Medical Dr Ste 300', 'San Antonio', 'Bexar', 'TX', '78229', '2106145400', '2106142431', '4411 Medical Dr Ste 300', 'San Antonio', 'Bexar', 'TX', '78229', '2106145400', '2106142431', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-04-24', 0, 0, 0, 'St Lukes Baptist Hospital', NULL, '', '', 'HCFA|UB|', '1992766935', 0, 'N', 0, '2014-03-25', NULL, NULL, 29.5103, -98.5724, NULL, NULL),
('272713767', 'TX0107271', 'TX0107271', 'TXSATSTD', 'Cardiology Clinic of San Antonio', 'Stephen', 'S', 'Reich', 'MD', 'Cardiac Electrophysiology Cardiology', '', '', NULL, 'B', 'PO Box 741248', 'Atlanta', 'Fulton', 'GA', '30374', '2104906000', '2104904658', 'PO Box 741248', 'Atlanta', 'Fulton', 'GA', '30374', '2104906000', '2104904658', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-04-24', 0, 0, 0, 'St Lukes Baptist Hospital', NULL, '', '', 'HCFA|UB|', '1992766935', 0, 'Y', 0, '2014-03-25', NULL, NULL, 0, 0, NULL, NULL),
('272713767', 'TX0107275', 'TX0107275', 'TXSATSTD', 'Cardiology Clinic of San Antonio', 'Carlos', 'A', 'Roman', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '255 E Sonterra Blvd Ste 150', 'San Antonio', 'Bexar', 'TX', '78258', '2104906000', '2104904658', '255 E Sonterra Blvd Ste 150', 'San Antonio', 'Bexar', 'TX', '78258', '2104906000', '2104904658', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2014-06-15', 0, 0, 0, 'St Lukes Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1043297989', 0, 'N', 0, '2014-05-06', NULL, NULL, 29.6164, -98.4911, NULL, NULL),
('272713767', 'TX0107274', 'TX0107274', 'TXSATSTD', 'Cardiology Clinic of San Antonio', 'Carlos', 'A', 'Roman', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '3903 Wiseman Blvd Ste 315', 'San Antonio', 'Bexar', 'TX', '78251', '2106145400', '2106142431', '3903 Wiseman Blvd Ste 315', 'San Antonio', 'Bexar', 'TX', '78251', '2106145400', '2106142431', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2014-06-15', 0, 0, 0, 'St Lukes Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1043297989', 0, 'N', 0, '2014-05-06', NULL, NULL, 29.4763, -98.6953, NULL, NULL),
('272713767', 'TX0107272', 'TX0107272', 'TXSATSTD', 'Cardiology Clinic of San Antonio', 'Carlos', 'A', 'Roman', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '4411 Medical Dr Ste 300', 'San Antonio', 'Bexar', 'TX', '78229', '2106145400', '2106142431', '4411 Medical Dr Ste 300', 'San Antonio', 'Bexar', 'TX', '78229', '2106145400', '2106142431', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2014-06-15', 0, 0, 0, 'St Lukes Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1043297989', 0, 'N', 0, '2014-05-06', NULL, NULL, 29.5103, -98.5717, NULL, NULL),
('272713767', 'TX0107273', 'TX0107273', 'TXSATSTD', 'Cardiology Clinic of San Antonio', 'Carlos', 'A', 'Roman', 'MD', 'Cardiovascular Disease', '', '', NULL, 'B', 'PO Box 741248', 'Atlanta', 'Fulton', 'GA', '30374', '2104906000', '2104904658', 'PO Box 741248', 'Atlanta', 'Fulton', 'GA', '30374', '2104906000', '2104904658', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2014-06-15', 0, 0, 0, 'St Lukes Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1043297989', 0, 'Y', 0, '2014-05-06', NULL, NULL, 0, 0, NULL, NULL),
('272713767', 'TX0107276', 'TX0107276', 'TXSATSTD', 'Cardiology Clinic of San Antonio', 'Robert', 'M', 'Saad', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '4411 Medical Dr Ste 300', 'San Antonio', 'Bexar', 'TX', '78229', '2106145400', '2106142431', '4411 Medical Dr Ste 300', 'San Antonio', 'Bexar', 'TX', '78229', '2106145400', '2106142431', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2014-06-15', 0, 0, 0, 'St Lukes Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1528039393', 0, 'N', 0, '2014-05-06', NULL, NULL, 29.5103, -98.5717, NULL, NULL),
('272713767', 'TX0107278', 'TX0107278', 'TXSATSTD', 'Cardiology Clinic of San Antonio', 'Robert', 'M', 'Saad', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '255 E Sonterra Blvd Ste 150', 'San Antonio', 'Bexar', 'TX', '78258', '2104906000', '2104904658', '255 E Sonterra Blvd Ste 150', 'San Antonio', 'Bexar', 'TX', '78258', '2104906000', '2104904658', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2014-06-15', 0, 0, 0, 'St Lukes Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1528039393', 0, 'N', 0, '2014-05-06', NULL, NULL, 29.6164, -98.4911, NULL, NULL),
('272713767', 'TX0107277', 'TX0107277', 'TXSATSTD', 'Cardiology Clinic of San Antonio', 'Robert', 'M', 'Saad', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '3903 Wiseman Blvd Ste 315', 'San Antonio', 'Bexar', 'TX', '78251', '2106145400', '2106142431', '3903 Wiseman Blvd Ste 315', 'San Antonio', 'Bexar', 'TX', '78251', '2106145400', '2106142431', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2014-06-15', 0, 0, 0, 'St Lukes Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1528039393', 0, 'N', 0, '2014-05-06', NULL, NULL, 29.4763, -98.6953, NULL, NULL),
('272713767', 'TX0107279', 'TX0107279', 'TXSATSTD', 'Cardiology Clinic of San Antonio', 'Robert', 'M', 'Saad', 'MD', 'Cardiovascular Disease', '', '', NULL, 'B', 'PO Box 741248', 'Atlanta', 'Fulton', 'GA', '30374', '2104906000', '2104904658', 'PO Box 741248', 'Atlanta', 'Fulton', 'GA', '30374', '2104906000', '2104904658', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2014-06-15', 0, 0, 0, 'St Lukes Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1528039393', 0, 'Y', 0, '2014-05-06', NULL, NULL, 0, 0, NULL, NULL),
('272713767', 'TX0107451', 'TX0107451', 'TXSATSTD', 'Cardiology Clinic of San Antonio', 'Eric', 'H', 'Stocker', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '255 E Sonterra Blvd Ste 150', 'San Antonio', 'Bexar', 'TX', '78258', '2104906000', '2104904658', '255 E Sonterra Blvd Ste 150', 'San Antonio', 'Bexar', 'TX', '78258', '2104906000', '2104904658', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2014-06-15', 0, 0, 0, 'St Lukes Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1891765624', 0, 'N', 0, '2014-05-06', NULL, NULL, 29.6164, -98.4911, NULL, NULL),
('272713767', 'TX0107449', 'TX0107449', 'TXSATSTD', 'Cardiology Clinic of San Antonio', 'Eric', 'H', 'Stocker', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '3903 Wiseman Blvd Ste 315', 'San Antonio', 'Bexar', 'TX', '78251', '2106145400', '2106142431', '3903 Wiseman Blvd Ste 315', 'San Antonio', 'Bexar', 'TX', '78251', '2106145400', '2106142431', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2014-06-15', 0, 0, 0, 'St Lukes Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1891765624', 0, 'N', 0, '2014-05-06', NULL, NULL, 29.4763, -98.6953, NULL, NULL),
('272713767', 'TX0107448', 'TX0107448', 'TXSATSTD', 'Cardiology Clinic of San Antonio', 'Eric', 'H', 'Stocker', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '4411 Medical Dr Ste 300', 'San Antonio', 'Bexar', 'TX', '78229', '2106145400', '2106142431', '4411 Medical Dr Ste 300', 'San Antonio', 'Bexar', 'TX', '78229', '2106145400', '2106142431', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2014-06-15', 0, 0, 0, 'St Lukes Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1891765624', 0, 'N', 0, '2014-05-06', NULL, NULL, 29.5103, -98.5717, NULL, NULL),
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('272713767', 'TX0107456', 'TX0107456', 'TXSATSTD', 'Cardiology Clinic of San Antonio', 'Anatole', 'D', 'Trakhtenbroit', 'MD', 'Cardiovascular Disease', '', '', NULL, 'B', 'PO Box 741248', 'Atlanta', 'Fulton', 'GA', '30374', '2104906000', '2104904658', 'PO Box 741248', 'Atlanta', 'Fulton', 'GA', '30374', '2104906000', '2104904658', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2014-06-15', 0, 0, 0, 'St Lukes Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1972580967', 0, 'Y', 0, '2014-05-06', NULL, NULL, 0, 0, NULL, NULL),
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('272713767', 'TX0107459', 'TX0107459', 'TXSATSTD', 'Cardiology Clinic of San Antonio', 'Jose', 'F', 'Triana', 'MD', 'Cardiovascular Disease', NULL, NULL, NULL, 'O', '4411 Medical Dr Ste 300', 'San Antonio', 'Bexar', 'TX', '78229', '2106145400', '2106142431', '4411 Medical Dr Ste 300', 'San Antonio', 'Bexar', 'TX', '78229', '2106145400', '2106142431', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2014-06-15', 0, 0, 0, 'St Lukes Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1679550511', 0, 'N', 0, '2014-05-06', NULL, NULL, 29.5103, -98.5717, NULL, NULL),
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('272713767', 'TX0107464', 'TX0107464', 'TXSATSTD', 'Cardiology Clinic of San Antonio', 'Randal', 'W', 'White', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '255 E Sonterra Blvd Ste 150', 'San Antonio', 'Bexar', 'TX', '78258', '2104906000', '2104904658', '255 E Sonterra Blvd Ste 150', 'San Antonio', 'Bexar', 'TX', '78258', '2104906000', '2104904658', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2014-06-15', 0, 0, 0, 'St Lukes Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1851378889', 0, 'N', 0, '2014-05-06', NULL, NULL, 29.6164, -98.4911, NULL, NULL),
('272713767', 'TX0107463', 'TX0107463', 'TXSATSTD', 'Cardiology Clinic of San Antonio', 'Randal', 'W', 'White', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '3903 Wiseman Blvd Ste 315', 'San Antonio', 'Bexar', 'TX', '78251', '2106145400', '2106142431', '3903 Wiseman Blvd Ste 315', 'San Antonio', 'Bexar', 'TX', '78251', '2106145400', '2106142431', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2014-06-15', 0, 0, 0, 'St Lukes Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1851378889', 0, 'N', 0, '2014-05-06', NULL, NULL, 29.4763, -98.6953, NULL, NULL),
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('272713767', 'TX0107461', 'TX0107461', 'TXSATSTD', 'Cardiology Clinic of San Antonio', 'Randal', 'W', 'White', 'MD', 'Cardiovascular Disease', '', '', NULL, 'B', 'PO Box 741248', 'Atlanta', 'Fulton', 'GA', '30374', '2104906000', '2104904658', 'PO Box 741248', 'Atlanta', 'Fulton', 'GA', '30374', '2104906000', '2104904658', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2014-06-15', 0, 0, 0, 'St Lukes Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1851378889', 0, 'Y', 0, '2014-05-06', NULL, NULL, 0, 0, NULL, NULL),
('272713767', 'TX0107465', 'TX0107465', 'TXSATSTD', 'Cardiology Clinic of San Antonio', 'Phillip', 'D', 'Zinn', 'MD', 'Cardiovascular Disease', '', '', NULL, 'B', 'PO Box 741248', 'Atlanta', 'Fulton', 'GA', '30374', '2104906000', '2104904658', 'PO Box 741248', 'Atlanta', 'Fulton', 'GA', '30374', '2104906000', '2104904658', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2014-06-15', 0, 0, 0, 'St Lukes Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1982681961', 0, 'Y', 0, '2014-05-06', NULL, NULL, 0, 0, NULL, NULL),
('272713767', 'TX0107466', 'TX0107466', 'TXSATSTD', 'Cardiology Clinic of San Antonio', 'Phillip', 'D', 'Zinn', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '255 E Sonterra Blvd Ste 150', 'San Antonio', 'Bexar', 'TX', '78258', '2104906000', '2104904658', '255 E Sonterra Blvd Ste 150', 'San Antonio', 'Bexar', 'TX', '78258', '2104906000', '2104904658', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2014-06-15', 0, 0, 0, 'St Lukes Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1982681961', 0, 'N', 0, '2014-05-06', NULL, NULL, 29.6164, -98.4911, NULL, NULL),
('272713767', 'TX0107467', 'TX0107467', 'TXSATSTD', 'Cardiology Clinic of San Antonio', 'Phillip', 'D', 'Zinn', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '3903 Wiseman Blvd Ste 315', 'San Antonio', 'Bexar', 'TX', '78251', '2106145400', '2106142431', '3903 Wiseman Blvd Ste 315', 'San Antonio', 'Bexar', 'TX', '78251', '2106145400', '2106142431', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2014-06-15', 0, 0, 0, 'St Lukes Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1982681961', 0, 'N', 0, '2014-05-06', NULL, NULL, 29.4763, -98.6953, NULL, NULL),
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('260553931', 'ID0107518', 'ID0107518', 'IDBOISTD', 'Saint Alphonsus Medical Group Heart Care Boise ', 'Steven', 'J', 'Fonken', 'MD', 'Cardiology', '', '', NULL, 'O', '1070 N Curtis Ste 125', 'Boise', 'Ada', 'ID', '83706', '2083678880', '2083753451', '1070 N Curtis Ste 125', 'Boise', 'Ada', 'ID', '83706', '2083678880', '2083753451', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1063437630', 0, 'N', 0, '2014-07-09', NULL, NULL, 43.6142, -116.254, NULL, NULL),
('260553931', 'ID0107520', 'ID0107520', 'IDBOISTD', 'Saint Alphonsus Medical Group Heart Care Mountain Home', 'Steven', 'J', 'Fonken', 'MD', 'Cardiology', '', '', NULL, 'O', '890 N 6th E', 'Mountain Home', 'Elmore', 'ID', '83647', '2083771415', '2083753451', '890 N 6th E', 'Mountain Home', 'Elmore', 'ID', '83647', '2083771415', '2083753451', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1063437630', 0, 'N', 0, '2014-07-09', NULL, NULL, 43.1392, -115.693, NULL, NULL),
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('260553931', 'ID0107526', 'ID0107526', 'IDBOISTD', 'Saint Alphonsus Medical Group Heart Care Boise ', 'David', 'F', 'Oakes', 'MD', 'Cardiology', '', '', NULL, 'O', '1070 N Curtis Ste 125', 'Boise', 'Ada', 'ID', '83706', '2083678880', '2083753451', '1070 N Curtis Ste 125', 'Boise', 'Ada', 'ID', '83706', '2083678880', '2083753451', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1083642987', 0, 'Y', 0, '2014-02-07', NULL, NULL, 43.6142, -116.254, NULL, NULL),
('260553931', 'ID0107527', 'ID0107527', 'IDBOISTD', 'Saint Alphonsus Medical Group Heart Care Boise', 'Charles', 'M', 'Rasmussen', 'MD', 'Cardiology', '', '', NULL, 'O', '1070 N Curtis Ste 125', 'Boise', 'Ada', 'ID', '83706', '2083678880', '2083753451', '1070 N Curtis Ste 125', 'Boise', 'Ada', 'ID', '83706', '2083678880', '2083753451', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1881611424', 0, 'Y', 0, '2014-03-27', NULL, NULL, 43.6142, -116.254, NULL, NULL),
('260553931', 'ID0107529', 'ID0107529', 'IDBOISTD', 'Saint Alphonsus Medical Group Heart Care Emmett', 'Charles', 'M', 'Rasmussen', 'MD', 'Cardiology', '', '', NULL, 'O', '1202 E Locust St', 'Emmett', 'Gem', 'ID', '83617', '2083771415', '2083753451', '1202 E Locust St', 'Emmett', 'Gem', 'ID', '83617', '2083771415', '2083753451', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', '2014-03-03', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1881611424', 0, 'N', 0, '2014-03-27', NULL, NULL, 43.8791, -116.485, NULL, NULL),
('820200895', 'ID0107531', 'ID0107531', 'IDBOISTD', 'Saint Alphonsus Medical Group Family Medicine Dominican ', 'Marcel', 'A', 'Goldberg', 'MD', 'Family Practice', '', '', NULL, 'O', '1118 Nw 16th St Ste A', 'Fruitland', 'Payette', 'ID', '83619', '2084526851', '2084522140', '1118 Nw 16th St Ste A', 'Fruitland', 'Payette', 'ID', '83619', '2084526851', '2084522140', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', '2012-10-14', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|', '1801837141', 0, 'N', 0, '2013-09-05', NULL, NULL, 44.025, -116.928, NULL, NULL),
('820200895', 'ID0107534', 'ID0107534', 'IDBOISTD', 'Saint Alphonsus Medical Group Iowa Family Medicine', 'Brigitta', 'S', 'Lavergne', 'MD', 'Family Practice', '', '', NULL, 'O', '211 W Iowa Ave', 'Nampa', 'Canyon', 'ID', '83686', '2084657377', '2084657397', '211 W Iowa Ave', 'Nampa', 'Canyon', 'ID', '83686', '2084657377', '2084657397', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', '2012-11-30', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|', '1164596557', 0, 'N', 0, '2014-06-20', NULL, NULL, 43.5539, -116.575, NULL, NULL),
('742719352', 'TX0108040', 'TX0108040', 'TXSATSTD', 'Urology of San Antonio', 'Samuel', '', 'Hakim', 'MD', 'Urology', '', '', NULL, 'O', '11212 Hwy 151 Ste 180', 'San Antonio', 'Bexar', 'TX', '78251', '2105217333', '2106793725', '11212 Hwy 151 Ste 180', 'San Antonio', 'Bexar', 'TX', '78251', '2105217333', '2106793725', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1669509006', 0, 'N', 0, '2014-04-08', NULL, NULL, 29.4801, -98.7053, 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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('741849254', 'TX0112563', 'TX0112563', 'TXSATSTD', 'Southeast Surgical Associates', 'Oluwamayowa', 'F', 'Familua', 'MD', 'General Surgery', '', '', NULL, 'B', 'PO Box 23409', 'San Antonio', 'Bexar', 'TX', '78223', '2103337510', NULL, 'PO Box 23409', 'San Antonio', 'Bexar', 'TX', '78223', '2103337510', '          ', 'TXSURGB', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-05-01', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1063714970', 0, 'N', 0, '2013-05-22', NULL, NULL, 0, 0, NULL, NULL),
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('264333033', 'TX0112858', 'TX0112858', 'TXSATSTD', 'Institute for Womens Health', 'Paula', 'M', 'Bilica', 'DO', 'Obstetrics and Gynecology', '', '', NULL, 'O', '7940 Floyd Curl Dr Ste 900', 'San Antonio', 'Bexar', 'TX', '78229', '2106141000', '2106151236', '7940 Floyd Curl Dr Ste 900', 'San Antonio', 'Bexar', 'TX', '78229', '2106141000', '2106151236', 'TXOBG', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-04-24', 0, 0, 0, 'St Lukes Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1467620260', 0, 'N', 0, '2013-04-24', NULL, NULL, 29.5117, -98.5756, NULL, NULL),
('264333033', 'TX0113237', 'TX0113237', 'TXSATSTD', 'Institute for Womens Health', 'John', 'Q', 'Adams', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '1210 Arion Pkwy', 'San Antonio', 'Bexar', 'TX', '78216', '2106563040', NULL, '1210 Arion Pkwy', 'San Antonio', 'Bexar', 'TX', '78216', '2106563040', '          ', 'TXOBG', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'St Lukes Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1770524340', 0, 'N', 0, '2012-08-20', NULL, NULL, 0, 0, NULL, NULL),
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('260553931', 'ID0113435', 'ID0113435', 'IDBOISTD', 'Saint Alphonsus Medical Group Heart Care Boise ', 'Charles', 'M', 'Rasmussen', 'MD', 'Cardiology', '', '', NULL, 'O', '6140 W Curtisian Ste 200', 'Boise', 'Ada', 'ID', '83704', '2083674278', '2083675200', '6140 W Curtisian Ste 200', 'Boise', 'Ada', 'ID', '83704', '2083674278', '2083675200', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1881611424', 0, 'N', 0, '2014-03-27', NULL, NULL, 43.6146, -116.258, NULL, NULL),
('820200895', 'ID0113438', 'ID0113438', 'IDBOISTD', 'Saint Alphonsus Medical Group Hospitalist Boise', 'Jenifer', '', 'Barry', 'MD', 'Hospitalist', '', '', NULL, 'B', '3340 E Goldstone', 'Meridian', 'Ada', 'ID', '83642', '2083675170', '2083675180', '3340 E Goldstone', 'Meridian', 'Ada', 'ID', '83642', '2083675170', '2083675180', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1164673968', 0, 'N', 0, '2014-06-20', NULL, NULL, 0, 0, NULL, NULL),
('260553931', 'ID0113445', 'ID0113445', 'IDBOISTD', 'Saint Alphonsus Medical Group Maternal Fetal Medicine Boise', 'Patricia', '', 'Caplinger', 'MD', 'Hospitalist', '', '', NULL, 'O', '900 N Liberty Ste 206 and 204', 'Boise', 'Ada', 'ID', '83704', '2083672229', '2083674242', '900 N Liberty Ste 206 and 204', 'Boise', 'Ada', 'ID', '83704', '2083672229', '2083674242', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1588605364', 0, 'Y', 0, '2014-07-09', NULL, NULL, 43.6124, -116.261, NULL, NULL),
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('742083988', 'TX0113982', 'TX0113982', 'TXSATSTD', 'Renal Associates', 'Fadi', '', 'Abouzahr', 'MD', 'Nephrology', '', '', NULL, 'O', '4242 E Southcross Blvd Ste 10', 'San Antonio', 'Bexar', 'TX', '78222', '2103597888', NULL, '4242 E Southcross Blvd Ste 10', 'San Antonio', 'Bexar', 'TX', '78222', '2103597888', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1982695896', 0, 'N', 0, '2013-05-24', NULL, NULL, 29.3749, -98.4113, NULL, NULL),
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('113676182', 'TX0114065', 'TX0114065', 'TXSATSTD', 'The Podiatry Group of South Texas', '', '', 'The Podiatry Group of South Texas', '', 'Podiatry', '', '', NULL, '', 'Change', 'San Antonio', 'Bexar', 'TX', '78247', '          ', NULL, 'Change', 'San Antonio', 'Bexar', 'TX', '78247', '          ', '', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|DEN|', '0000009774', 0, 'Y', 0, '2014-04-16', NULL, NULL, 0, 0, NULL, NULL),
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('743003947', 'TX0114088', 'TX0114088', 'TXSATSTD', 'The San Antonio Orthopaedic Group', 'Michael', 'W', 'Hennessy', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', 'PO Box 9585', 'Belfast', 'Waldo', 'ME', '04915', '2103965265', '2103965268', 'PO Box 9585', 'Belfast', 'Waldo', 'ME', '04915', '2103965265', '2103965268', 'TXORTHO', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'Baptist Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1770795387', 0, 'Y', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('742083988', 'TX0114100', 'TX0114100', 'TXSATSTD', 'Renal Associates', 'Aashish', 'K', 'Pandey', 'MD', 'Nephrology', '', '', NULL, 'B', '16620 US Hwy 281 N Ste 300', 'San Antonio', 'Bexar', 'TX', '78232', '2103597888', NULL, '16620 US Hwy 281 Ste 300', 'San Antonio', 'Bexar', 'TX', '78232', '2103597888', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1790089134', 0, 'N', 0, '2012-08-20', NULL, NULL, 0, 0, NULL, NULL),
('742083988', 'TX0114099', 'TX0114099', 'TXSATSTD', 'Renal Associates', 'Aashish', 'K', 'Pandey', 'MD', 'Nephrology', '', '', NULL, 'O', '4242 E Southcross Blvd Ste 10', 'San Antonio', 'Bexar', 'TX', '78222', '2103597888', NULL, '4242 E Southcross Ste 10', 'San Antonio', 'Bexar', 'TX', '78222', '2103597888', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1790089134', 0, 'N', 0, '2012-08-20', NULL, NULL, 29.374, -98.4109, NULL, NULL),
('870767026', 'ID0111768', 'ID0111768', 'IDBOISTD', 'West Valley Medical Group', 'Steven', 'L', 'Fuller', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 277976', 'Atlanta', 'Fulton', 'GA', '30384', '2087955075', '2084426520', 'PO Box 277976', 'Atlanta', 'Fulton', 'GA', '30384', '2087955075', '2084426520', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-08-20', '2013-03-22', 0, 0, 0, 'West Valley Medical Center', '', '', '', 'HCFA|UB|', '1760423438', 0, 'N', 0, '2013-03-25', NULL, NULL, 0, 0, NULL, NULL),
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('820496280', 'ID0114200', 'ID0114200', 'IDBOISTD', 'Dermatology Clinic of ID', 'Naomi', '', 'Brooks', 'MD', 'Dermatology', '', '', NULL, 'O', '661 S Rivershore Ln Ste 130', 'Eagle', 'Ada', 'ID', '83616', '2089394599', '2083227370', '661 S Rivershore Ln Ste 130', 'Eagle', 'Ada', 'ID', '83616', '2089394599', '2083227370', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-08-20', '2014-05-05', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1972653566', 0, 'N', 0, '2014-03-12', NULL, NULL, 43.6892, -116.355, NULL, NULL),
('820496280', 'ID0114199', 'ID0114199', 'IDBOISTD', 'Dermatology Clinic of ID', 'Naomi', '', 'Brooks', 'MD', 'Dermatology', '', '', NULL, 'O', '7733 W Emerald', 'Boise', 'Ada', 'ID', '83704', '2083763220', '2083227370', '7733 W Emerald', 'Boise', 'Ada', 'ID', '83704', '2083763220', '2083227370', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1972653566', 0, 'N', 0, '2013-07-02', NULL, NULL, 43.6129, -116.278, NULL, NULL),
('260553931', 'ID0114202', 'ID0114202', 'IDBOISTD', 'Saint Alphonsus Medical Group Heart Care Garrity', 'Michael', 'A', 'Codina', 'MD', 'Cardiology', '', '', NULL, 'B', '3340 E Goldstone', 'Meridian', 'Ada', 'ID', '83642', '2083675170', NULL, '3340 E Goldstone', 'Meridian', 'Ada', 'ID', '83642', '2083675170', '', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', 'Saint Alphonsus Regional Medical Center', '', '', 'HCFA|UB|', '1871540708', 0, 'Y', 0, '2014-07-09', NULL, NULL, 0, 0, NULL, NULL),
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('460500210', 'ID0114210', 'ID0114210', 'IDBOISTD', 'Saint Alphonsus Oncology Physician Services ', 'Alan', 'B', 'Grossett', 'MD', 'Hematology and Oncology', '', '', NULL, 'O', '1512 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2082884679', '2083673174', '1512 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2082884679', '2083673174', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', '2012-10-31', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1689667263', 0, 'N', 0, '2013-05-07', NULL, NULL, 43.5537, -116.573, NULL, NULL),
('460500210', 'ID0114211', 'ID0114211', 'IDBOISTD', 'Saint Alphonsus Oncology Physician Services ', 'Alan', 'B', 'Grossett', 'MD', 'Hematology and Oncology', '', '', NULL, 'O', '1717 Arlington Ave', 'Caldwell', 'Canyon', 'ID', '83605', '2083673627', '2083673174', '1717 Arlington Ave', 'Caldwell', 'Canyon', 'ID', '83605', '2083673627', '2083673174', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', '2013-04-30', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1689667263', 0, 'Y', 0, '2013-05-07', NULL, NULL, 0, 0, NULL, NULL),
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('260553931', 'ID0114213', 'ID0114213', 'IDBOISTD', 'Saint Alphonsus Medical Group Coughlin Clinic Boise ', 'Christopher', 'B', 'Hirose', 'MD; Foot/Ankle', 'Orthopedic Surgery', NULL, NULL, NULL, 'O', '1075 N Curtis Rd Ste 300', 'Boise', 'Ada', 'ID', '83706', '2083673330', '2083673331', '1075 N Curtis Rd Ste 300', 'Boise', 'Ada', 'ID', '83706', '2083673330', '2083673331', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1437111267', 0, 'N', 0, '2013-09-17', NULL, NULL, 43.6148, -116.254, NULL, NULL),
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('460500210', 'ID0114215', 'ID0114215', 'IDBOISTD', 'Saint Alphonsus Oncology Physician Services ', 'Stephanie', 'B', 'Hodson', 'MD', 'Hematology and Oncology', 'Oncology', '', NULL, 'O', '1717 Arlington Ave', 'Caldwell', 'Canyon', 'ID', '83605', '2083673627', '2083673174', '1717 Arlington Ave', 'Caldwell', 'Canyon', 'ID', '83605', '2083673627', '2083673174', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', '2013-04-30', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', 'West Valley Medical Center', 'Saint Alphonsus Medical Center Nampa', 'HCFA|UB|', '1265478374', 0, 'Y', 0, '2014-05-28', NULL, NULL, 0, 0, NULL, NULL),
('260553931', 'ID0114216', 'ID0114216', 'IDBOISTD', 'Saint Alphonsus Medical Group Coughlin Clinic Boise ', 'Travis', 'J', 'Kemp', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1075 N Curtis Rd Ste 300', 'Boise', 'Ada', 'ID', '83706', '2083673330', '2083673331', '1075 N Curtis Rd Ste 300', 'Boise', 'Ada', 'ID', '83706', '2083673330', '2083673331', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', '2013-10-01', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1669607172', 0, 'N', 0, '2014-01-06', NULL, NULL, 43.6143, -116.258, NULL, NULL),
('460500210', 'ID0114218', 'ID0114218', 'IDBOISTD', 'Saint Alphonsus Oncology Physician Services ', 'Alan', 'D', 'Langerak', 'MD', 'Hematology and Oncology', 'Oncology', '', NULL, 'O', '1512 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2082884679', '2083673174', '1512 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2082884679', '2083673174', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', '2012-10-31', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1902853294', 0, 'N', 0, '2014-05-28', NULL, NULL, 43.5537, -116.573, NULL, NULL);
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('460500210', 'ID0114219', 'ID0114219', 'IDBOISTD', 'Saint Alphonsus Oncology Physician Services ', 'Alan', 'D', 'Langerak', 'MD', 'Hematology and Oncology', 'Oncology', '', NULL, 'O', '1717 Arlington Ave', 'Caldwell', 'Canyon', 'ID', '83605', '2083673627', '2083673174', '1717 Arlington Ave', 'Caldwell', 'Canyon', 'ID', '83605', '2083673627', '2083673174', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', '2013-04-30', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1902853294', 0, 'Y', 0, '2014-05-28', NULL, NULL, 0, 0, NULL, NULL),
('260553931', 'ID0114222', 'ID0114222', 'IDBOISTD', 'Saint Alphonsus Medical Group Hip & Knee Recon ', 'Dennis', '', 'McGee', 'MD; Jnt Replace/Reconst', 'Orthopedic Surgery', '', '', NULL, 'O', '1075 N Curtis Rd Ste 300', 'Boise', 'Ada', 'ID', '83706', '2083673330', '2083673331', '1075 N Curtis Rd Ste 300', 'Boise', 'Ada', 'ID', '83706', '2083673330', '2083673331', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1679584577', 0, 'N', 0, '2014-07-09', NULL, NULL, 43.6148, -116.254, NULL, NULL),
('820200895', 'ID0114226', 'ID0114226', 'IDBOISTD', 'Saint Alphonsus Medical Group Pulmonary & Sleep Boise ', 'Anil', '', 'Patel', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1075 N Curtis Ste 200 Bldg 6 Ste 201', 'Boise', 'Ada', 'ID', '83704', '2083678333', '2083672003', '1075 N Curtis Ste 200 Bldg 6 Ste 201', 'Boise', 'Ada', 'ID', '83704', '2083678333', '2083672003', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1356350664', 0, 'Y', 0, '2014-06-20', NULL, NULL, 43.6148, -116.254, NULL, NULL),
('820200895', 'ID0114228', 'ID0114228', 'IDBOISTD', 'Saint Alphonsus Medical Group Pulmonary & Sleep Nampa', 'Anil', '', 'Patel', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1512 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2084671171', '2084635050', '1512 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2084671171', '2084635050', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', '2013-01-08', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1356350664', 0, 'Y', 0, '2014-06-20', NULL, NULL, 43.5537, -116.573, NULL, NULL),
('820200895', 'ID0114229', 'ID0114229', 'IDBOISTD', 'Saint Alphonsus Medical Group Pulmonary & Sleep Boise ', 'Anil', '', 'Patel', 'MD', 'Internal Medicine', '', '', NULL, 'B', '3340 E Goldstone', 'Meridian', 'Ada', 'ID', '83642', '2083675170', '2083672003', '3340 E Goldstone', 'Meridian', 'Ada', 'ID', '83642', '2083675170', '2083672003', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1356350664', 0, 'N', 0, '2014-06-20', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'ID0114227', 'ID0114227', 'IDBOISTD', 'Saint Alphonsus Medical Group Pulmonary & Sleep Boise ', 'Anil', '', 'Patel', 'MD', 'Internal Medicine', '', '', NULL, 'O', '6140 W Curtisian Ste B10', 'Boise', 'Ada', 'ID', '83704', '2083678333', '2083672003', '6140 W Curtisian Ste B10', 'Boise', 'Ada', 'ID', '83704', '2083678333', '2083672003', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1356350664', 0, 'Y', 0, '2014-06-20', NULL, NULL, 43.6146, -116.258, NULL, NULL),
('460500210', 'ID0114237', 'ID0114237', 'IDBOISTD', 'Saint Alphonsus Oncology Physician Services ', 'Andrew', '', 'Pierson', 'MD', 'Hematology and Oncology', 'Oncology', '', NULL, 'O', '1512 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2082884679', '2082884679', '1512 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2082884679', '2082884679', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', '2012-10-31', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1992760664', 0, 'N', 0, '2014-05-28', NULL, NULL, 43.5537, -116.573, NULL, NULL),
('460500210', 'ID0114238', 'ID0114238', 'IDBOISTD', 'Saint Alphonsus Oncology Physician Services ', 'Andrew', '', 'Pierson', 'MD', 'Hematology and Oncology', 'Oncology', '', NULL, 'O', '1717 Arlington Ave', 'Caldwell', 'Canyon', 'ID', '83605', '2083673627', '2082884679', '1717 Arlington Ave', 'Caldwell', 'Canyon', 'ID', '83605', '2083673627', '2082884679', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', '2013-04-30', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1992760664', 0, 'Y', 0, '2014-05-28', NULL, NULL, 0, 0, NULL, NULL),
('460500210', 'ID0114239', 'ID0114239', 'IDBOISTD', 'Saint Alphonsus Oncology Physician Services ', 'Andrew', '', 'Pierson', 'MD', 'Hematology and Oncology', 'Oncology', '', NULL, 'B', 'PO Box 9589', 'Boise', 'Ada', 'ID', '83707', '2084728115', '2082884679', 'PO Box 9589', 'Boise', 'Ada', 'ID', '83707', '2084728115', '2082884679', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', '2013-04-30', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1992760664', 0, 'N', 0, '2014-05-28', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'ID0114240', 'ID0114240', 'IDBOISTD', 'Saint Alphonsus Medical Group Elm Family Medicine', 'Samantha', 'J', 'Portenier', 'MD', 'Family Practice', '', '', NULL, 'O', '4400 E Flamingo', 'Nampa', 'Canyon', 'ID', '83687', '2084656900', '2084656910', '4400 E Flamingo', 'Nampa', 'Canyon', 'ID', '83687', '2084656900', '2084656910', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'West Valley Medical Center', '', '', '', 'HCFA|', '1356385132', 0, 'N', 0, '2014-06-20', NULL, NULL, 43.5966, -116.519, NULL, NULL),
('460500210', 'ID0114241', 'ID0114241', 'IDBOISTD', 'Saint Alphonsus Oncology Physician Services', 'Kerry', 'P', 'Pulver', 'MD', 'Hematology and Oncology', 'Oncology', '', NULL, 'O', '1512 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2082884679', '2083673174', '1512 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2082884679', '2083673174', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', '2012-10-31', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', 'West Valley Medical Center', 'Saint Alphonsus Medical Center Nampa', 'HCFA|UB|', '1376596247', 0, 'N', 0, '2014-05-28', NULL, NULL, 43.5537, -116.573, NULL, NULL),
('460500210', 'ID0114242', 'ID0114242', 'IDBOISTD', 'Saint Alphonsus Oncology Physician Services', 'Kerry', 'P', 'Pulver', 'MD', 'Hematology and Oncology', 'Oncology', '', NULL, 'O', '1717 Arlington Ave', 'Caldwell', 'Canyon', 'ID', '83605', '2083673627', '2083673174', '1717 Arlington Ave', 'Caldwell', 'Canyon', 'ID', '83605', '2083673627', '2083673174', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', '2013-04-30', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', 'West Valley Medical Center', 'Saint Alphonsus Medical Center Nampa', 'HCFA|UB|', '1376596247', 0, 'Y', 0, '2014-05-28', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'ID0114243', 'ID0114243', 'IDBOISTD', 'Saint Alphonsus Medical Group NHP Family Medicine', 'Michael', 'L', 'Roach', 'MD', 'Family Practice', '', '', NULL, 'O', '4400 E Flamingo Ste 301', 'Nampa', 'Canyon', 'ID', '83687', '2084656900', '2084656910', '4400 E Flamingo Ste 301', 'Nampa', 'Canyon', 'ID', '83687', '2084656900', '2084656910', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', '2013-07-15', 0, 0, 0, 'West Valley Medical Center', NULL, NULL, NULL, 'HCFA|', '1528004389', 0, 'Y', 0, '2013-09-05', NULL, NULL, 43.5976, -116.517, NULL, NULL),
('460500210', 'ID0114244', 'ID0114244', 'IDBOISTD', 'Saint Alphonsus Oncology Physician Services ', 'Karl', 'J', 'Schultheiss', 'MD', 'Hematology and Oncology', 'Oncology', '', NULL, 'O', '1512 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2082884679', '2083673174', '1512 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2082884679', '2083673174', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', '2012-10-31', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', 'West Valley Medical Center', 'Saint Alphonsus Medical Center Nampa', 'HCFA|UB|', '1265478325', 0, 'N', 0, '2014-05-28', NULL, NULL, 43.5537, -116.573, NULL, NULL),
('460500210', 'ID0114245', 'ID0114245', 'IDBOISTD', 'Saint Alphonsus Oncology Physician Services', 'Karl', 'J', 'Schultheiss', 'MD', 'Hematology and Oncology', 'Oncology', '', NULL, 'O', '1717 Arlington Ave', 'Caldwell', 'Canyon', 'ID', '83605', '2083673627', '2083673174', '1717 Arlington Ave', 'Caldwell', 'Canyon', 'ID', '83605', '2083673627', '2083673174', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', '2013-04-30', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', 'West Valley Medical Center', 'Saint Alphonsus Medical Center Nampa', 'HCFA|UB|', '1265478325', 0, 'Y', 0, '2014-05-28', NULL, NULL, 0, 0, NULL, NULL),
('460500210', 'ID0114250', 'ID0114250', 'IDBOISTD', 'Saint Alphonsus Trauma Physician Services', 'Harry', 'K', 'Stinger', 'MD', 'General Surgery', '', '', NULL, 'O', '1215 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2082884679', '2083673174', '1215 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2082884679', '2083673174', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', '2013-05-31', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1518935055', 0, 'Y', 0, '2013-11-22', NULL, NULL, 0, 0, NULL, NULL),
('460500210', 'ID0114253', 'ID0114253', 'IDBOISTD', 'Saint Alphonsus Oncology Physician Services', 'Holly', '', 'Swensen', 'NP', 'Hematology and Oncology', 'Oncology', '', NULL, 'O', '1512 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2082884679', '2083673174', '1512 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2082884679', '2083673174', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', '2012-10-31', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1386672012', 0, 'N', 0, '2014-06-20', NULL, NULL, 43.5537, -116.573, NULL, NULL),
('460500210', 'ID0114256', 'ID0114256', 'IDBOISTD', 'Saint Alphonsus Oncology Physician Services ', 'Bruce', 'H', 'Zietz', 'MD', 'Hematology and Oncology', '', '', NULL, 'O', '1512 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2082884679', '2083673174', '1512 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2082884679', '2083673174', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', '2012-10-31', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1184689002', 0, 'N', 0, '2012-11-16', NULL, NULL, 43.5537, -116.573, NULL, NULL),
('460500210', 'ID0114257', 'ID0114257', 'IDBOISTD', 'Saint Alphonsus Oncology Physician Services ', 'Bruce', 'H', 'Zietz', 'MD', 'Hematology and Oncology', '', '', NULL, 'O', '1717 Arlington Ave', 'Caldwell', 'Canyon', 'ID', '83605', '2082884679', '2083673174', '1717 Arlington Ave', 'Caldwell', 'Canyon', 'ID', '83605', '2082884679', '2083673174', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', '2012-11-01', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1184689002', 0, 'N', 0, '2012-11-19', NULL, NULL, 0, 0, NULL, NULL),
('460500210', 'ID0114258', 'ID0114258', 'IDBOISTD', 'Saint Alphonsus Oncology Physician Services ', 'Bruce', 'H', 'Zietz', 'MD', 'Hematology and Oncology', '', '', NULL, 'B', 'PO Box 9589', 'Boise', 'Ada', 'ID', '83708', '2084728115', '2083673174', 'PO Box 9589', 'Boise', 'Ada', 'ID', '83708', '2084728115', '2083673174', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', '2012-11-01', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1184689002', 0, 'N', 0, '2012-11-16', NULL, NULL, 0, 0, NULL, NULL),
('742719352', 'TX0114339', 'TX0114339', 'TXSATSTD', 'Urology of San Antonio', 'Michael', 'A', 'White', 'DO', 'Urology', '', '', NULL, 'O', '12709 Toepperwein Ste 206', 'San Antonio', 'Bexar', 'TX', '78233', '2105648000', '2106793732', '12709 Toepperwein Ste 206', 'San Antonio', 'Bexar', 'TX', '78233', '2105648000', '2106793732', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'North Central Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1295955086', 0, 'N', 0, '2013-05-24', NULL, NULL, 29.5535, -98.3472, NULL, NULL),
('742719352', 'TX0114338', 'TX0114338', 'TXSATSTD', 'Urology of San Antonio', 'Michael', 'A', 'White', 'DO', 'Urology', '', '', NULL, 'O', '414 Navarro Ste 900', 'San Antonio', 'Bexar', 'TX', '78205', '2104747020', '2106793733', '414 Navarro Ste 900', 'San Antonio', 'Bexar', 'TX', '78205', '2104747020', '2106793733', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'North Central Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1295955086', 0, 'N', 0, '2013-05-24', NULL, NULL, 29.4254, -98.4897, NULL, NULL),
('742719352', 'TX0114340', 'TX0114340', 'TXSATSTD', 'Urology of San Antonio', 'Michael', 'A', 'White', 'DO', 'Urology', '', '', NULL, 'M', '7909 Fredericksburg Rd Ste 110', 'San Antonio', 'Bexar', 'TX', '78229', '2106144544', '2105825655', '7909 Fredericksburg Rd Ste 110', 'San Antonio', 'Bexar', 'TX', '78229', '2106144544', '2105825655', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'North Central Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1295955086', 0, 'N', 0, '2014-01-24', NULL, NULL, 29.5113, -98.5683, NULL, NULL),
('742719352', 'TX0114341', 'TX0114341', 'TXSATSTD', 'Urology of San Antonio', 'Michael', 'A', 'White', 'DO', 'Urology', '', '', NULL, 'B', 'PO Box 2952', 'San Antonio', 'Bexar', 'TX', '78299', '2105648000', '2106793732', 'PO Box 2952', 'San Antonio', 'Bexar', 'TX', '78299', '2105648000', '2106793732', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'North Central Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1295955086', 0, 'N', 0, '2014-01-24', NULL, NULL, 0, 0, NULL, NULL),
('742592013', 'TX0113698', 'TX0113698', 'TXSATSTD', 'Dermatology Associates of San Antonio', 'Mary', 'D', 'Altmeyer', 'MD', 'Dermatology', '', '', NULL, 'O', '18540 Sigma Rd', 'San Antonio', 'Bexar', 'TX', '78258', '2104904661', NULL, '18540 Sigma Rd', 'San Antonio', 'Bexar', 'TX', '78258', '2104904661', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'North Central Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1144493024', 0, 'N', 0, '2012-08-20', NULL, NULL, 29.6121, -98.4831, NULL, NULL),
('742592013', 'TX0113699', 'TX0113699', 'TXSATSTD', 'Dermatology Associates of San Antonio', 'Mary', 'D', 'Altmeyer', 'MD', 'Dermatology', '', '', NULL, 'B', '7832 Pat Booker Rd', 'San Antonio', 'Bexar', 'TX', '78233', '2104904661', NULL, '7832 Pat Booker Rd', 'San Antonio', 'Bexar', 'TX', '78233', '2104904661', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'North Central Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1144493024', 0, 'N', 0, '2012-08-20', NULL, NULL, 29.5623, -98.3334, NULL, NULL),
('352332742', 'ID0115614', 'ID0115614', 'IDBOISTD', 'Healthy Habits Wellness Center', 'Mari', '', 'Aitken', 'NP-C', 'Family Practice', '', '', NULL, 'O', '14 S Baltic Place', 'Meridian', 'Ada', 'ID', '83642', '2088874872', '2088876331', '14 S Baltic Place', 'Meridian', 'Ada', 'ID', '83642', '2088874872', '2088876331', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 6, '2012-08-20', '2013-03-08', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1063703682', 0, 'N', 0, '2013-04-16', NULL, NULL, 43.6045, -116.38, NULL, NULL),
('352332742', 'ID0115615', 'ID0115615', 'IDBOISTD', 'Healthy Habits Wellness Center', 'Mari', '', 'Aitken', 'NP-C', 'Family Practice', '', '', NULL, 'O', '5216 E Cleveland Blvd Ste G', 'Caldwell', 'Canyon', 'ID', '83605', '2084548111', NULL, '5216 E Cleveland Blvd Ste G', 'Caldwell', 'Canyon', 'ID', '83605', '2084548111', '          ', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 6, '2012-08-20', '2013-03-08', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1063703682', 0, 'N', 0, '2013-04-16', NULL, NULL, 0, 0, NULL, NULL),
('260553931', 'ID0116249', 'ID0116249', 'IDBOISTD', 'Saint Alphonsus Medical Group Heart Care Nampa', 'Graham', 'K', 'Wetherley', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1524 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2084635050', '2084635040', '1524 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2084635050', '2084635040', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1821030586', 0, 'N', 0, '2014-07-09', NULL, NULL, 43.5537, -116.573, NULL, NULL),
('260553931', 'ID0116250', 'ID0116250', 'IDBOISTD', 'Saint Alphonsus Medical Group Heart Care Nampa', 'Graham', 'K', 'Wetherley', 'MD', 'Cardiovascular Disease', '', '', NULL, 'B', '3350 E Goldstone', 'Meridian', 'Ada', 'ID', '83642', '2083675170', NULL, '3350 E Goldstone', 'Meridian', 'Ada', 'ID', '83642', '2083675170', '', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1821030586', 0, 'N', 0, '2014-07-09', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'ID0116265', 'ID0116265', 'IDBOISTD', 'Saint Alphonsus Medical Group Garrity Family Medicine', 'Robert', 'B', 'Buxton', 'DO', 'Family Practice', '', '', NULL, 'O', '1200 Garrity Blvd', 'Nampa', 'Canyon', 'ID', '83687', '2084669092', '2084665322', '1200 Garrity Blvd', 'Nampa', 'Canyon', 'ID', '83687', '2084669092', '2084665322', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|', '1073778098', 0, 'Y', 0, '2014-06-20', NULL, NULL, 43.5867, -116.549, NULL, NULL),
('820200895', 'ID0116266', 'ID0116266', 'IDBOISTD', 'Saint Alphonsus Medical Group Iowa Family Medicine', 'Robert', 'B', 'Buxton', 'DO', 'Family Practice', '', '', NULL, 'O', '211 W Iowa Ave', 'Nampa', 'Canyon', 'ID', '83686', '2084657377', '2084657397', '211 W Iowa Ave', 'Nampa', 'Canyon', 'ID', '83686', '2084657377', '2084657397', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|', '1073778098', 0, 'N', 0, '2014-06-20', NULL, NULL, 43.5543, -116.574, NULL, NULL),
('820200895', 'ID0116270', 'ID0116270', 'IDBOISTD', 'Saint Alphonsus Medical Group Boise Pediatrics', 'Christie', 'A', 'Julian', 'MD', 'Pediatrics', '', '', NULL, 'O', '999 N Curtis Ste 407', 'Boise', 'Ada', 'ID', '83706', '2083674321', '2083674525', '999 N Curtis Ste 407', 'Boise', 'Ada', 'ID', '83706', '2083674321', '2083674525', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', '2013-06-24', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1801072129', 0, 'N', 0, '2014-06-20', NULL, NULL, 43.6132, -116.255, NULL, NULL),
('820200895', 'ID0116272', 'ID0116272', 'IDBOISTD', 'Saint Alphonsus Medical Group Dallan Woods Family Medicine', 'Linda', 'B', 'Kaczmarek', 'DO', 'Family Practice', '', '', NULL, 'O', '214 S Midland Blvd', 'Nampa', 'Canyon', 'ID', '83686', '2084656900', '2084656911', '214 S Midland Blvd', 'Nampa', 'Canyon', 'ID', '83686', '2084656900', '2084656911', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', '2013-11-01', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1104896000', 0, 'N', 0, '2014-06-10', NULL, NULL, 43.5706, -116.593, NULL, NULL),
('820200895', 'ID0116273', 'ID0116273', 'IDBOISTD', 'Saint Alphonsus Medical Group Elm Family Medicine', 'Merle', 'L', 'Keller', 'MD', 'Pediatrics', '', '', 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, '2012-08-20', NULL, 0, 0, 0, 'West Valley Medical Center', '', '', '', 'HCFA|', '1265609929', 0, 'N', 0, '2014-06-20', NULL, NULL, 43.6534, -116.695, NULL, NULL),
('820200895', 'ID0116275', 'ID0116275', 'IDBOISTD', 'Saint Alphonsus Medical Group Elm Family Medicine', 'Bridgette', 'M', 'Baker', 'MD', '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, '2012-08-20', '2013-10-14', 0, 0, 0, 'West Valley Medical Center', '', '', '', 'HCFA|', '1265693386', 0, 'N', 0, '2014-06-13', NULL, NULL, 43.6539, -116.695, NULL, NULL),
('460500210', 'ID0116276', 'ID0116276', 'IDBOISTD', 'Saint Alphonsus Trauma Physician Services', 'Billy', 'R', 'Morgan', 'MD', 'General Surgery', '', '', NULL, 'O', '1512 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2083677676', NULL, '1512 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2083677676', '', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1891747663', 0, 'Y', 0, '2014-07-09', NULL, NULL, 43.5537, -116.573, NULL, NULL),
('820200895', 'ID0116280', 'ID0116280', 'IDBOISTD', 'Saint Alphonsus Medical Group Neurology Boise', 'David', 'W', 'Tesar', 'MD', 'Neurology', '', '', NULL, 'O', '901 N Curtis Ste 403', 'Boise', 'Ada', 'ID', '83706', '2083677272', '2083677111', '901 N Curtis Ste 403', 'Boise', 'Ada', 'ID', '83706', '2083677272', '2083677111', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', '2012-11-01', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1205913746', 0, 'N', 0, '2013-07-12', NULL, NULL, 43.6126, -116.255, NULL, NULL),
('820200895', 'ID0116284', 'ID0116284', 'IDBOISTD', 'Saint Alphonsus Medical Group Neurology ALS  Clinic Idaho Elks Rehab', 'Jackie', 'J', 'Whitesell', 'MD', 'Neurology', '', '', NULL, 'O', '600 W Robbins Rd', 'Boise', 'Ada', 'ID', '83702', '2083677272', '2083677111', '600 W Robbins Rd', 'Boise', 'Ada', 'ID', '83702', '2083677272', '2083677111', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1346367984', 0, 'Y', 0, '2014-06-20', NULL, NULL, 43.6164, -116.192, NULL, NULL),
('820200895', 'ID0116285', 'ID0116285', 'IDBOISTD', 'Saint Alphonsus Medical Group Neurology MDA Clinic', 'Jackie', 'J', 'Whitesell', 'MD', 'Neurology', '', '', NULL, 'O', '3551 E Overland', 'Meridian', 'Ada', 'ID', '83642', '2083677272', '2083677111', '3551 E Overland', 'Meridian', 'Ada', 'ID', '83642', '2083677272', '2083677111', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', '2012-12-12', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1346367984', 0, 'Y', 0, '2014-06-20', NULL, NULL, 0, 0, NULL, NULL),
('260553931', 'ID0116286', 'ID0116286', 'IDBOISTD', 'Saint Alphonsus Medical Group Neurosurgery Boise 503', 'Christian', 'G', 'Zimmerman', 'MD', 'Neurosurgery', '', '', NULL, 'O', '901 N Curtis Rd Ste 503', 'Boise', 'Ada', 'ID', '83706', '2083674000', '2083674052', '901 N Curtis Rd Ste 503', 'Boise', 'Ada', 'ID', '83706', '2083674000', '2083674052', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1407874068', 0, 'N', 0, '2014-07-09', NULL, NULL, 43.6126, -116.254, NULL, NULL),
('113676182', 'TX0112579', 'TX0112579', 'TXSATSTD', 'The Podiatry Group of South Texas', 'Steven', 'P', 'Kissel', 'DPM', 'Podiatry', '', '', NULL, 'O', '414 Navarro Ste 811', 'San Antonio', 'Bexar', 'TX', '78205', '2102221077', '2102221215', '414 Navarro Ste 811', 'San Antonio', 'Bexar', 'TX', '78205', '2102221077', '2102221215', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1081052451', 0, 'N', 0, '2012-08-20', NULL, NULL, 29.4254, -98.4897, NULL, NULL),
('113676182', 'TX0112580', 'TX0112580', 'TXSATSTD', 'The Podiatry Group of South Texas', 'Steven', 'P', 'Kissel', 'DPM', 'Podiatry', '', '', NULL, 'M', '45 NE Loop 410 Ste 920', 'San Antonio', 'Bexar', 'TX', '78216', '2102221077', '2102221215', '45 NE Loop 410 Ste 920', 'San Antonio', 'Bexar', 'TX', '78216', '2102221077', '2102221215', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1081052451', 0, 'N', 0, '2012-08-20', NULL, NULL, 0, 0, NULL, NULL),
('113676182', 'TX0112581', 'TX0112581', 'TXSATSTD', 'The Podiatry Group of South Texas', 'Steven', 'P', 'Kissel', 'DPM', 'Podiatry', '', '', NULL, 'B', 'PO Box 1277', 'San Antonio', 'Bexar', 'TX', '78295', '2102221077', '2102221215', 'PO Box 1277', 'San Antonio', 'Bexar', 'TX', '78295', '2102221077', '2102221215', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1081052451', 0, 'N', 0, '2012-08-20', NULL, NULL, 0, 0, NULL, NULL),
('742915297', 'TX0116612', 'TX0116612', 'TXSATSTD', 'South Texas Oncology and Hematology', 'Mark', 'C', 'Rittenhouse', 'MD', 'General Surgery', '', '', NULL, 'O', '7940 Floyd Curl Ste 840', 'San Antonio', 'Bexar', 'TX', '78229', '2106143349', NULL, '7940 Floyd Curl Ste 840', 'San Antonio', 'Bexar', 'TX', '78229', '2106143349', '          ', 'TXONCOL', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-05-05', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1538155270', 0, 'N', 0, '2013-05-06', NULL, NULL, 0, 0, NULL, NULL),
('820312041', 'ID0116615', 'ID0116615', 'IDBOISTD', 'Podiatry Center of Idaho', 'Scott', 'A', 'Graviet', 'DPM', 'Podiatry', '', '', NULL, 'O', '520 S Eagle Rd Ste 1243', 'Meridian', 'Ada', 'ID', '83642', '2089384670', NULL, '520 S Eagle Rd Ste 1243', 'Meridian', 'Ada', 'ID', '83642', '2089384670', '          ', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-08-20', '2013-06-01', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|UB|', '1578514618', 0, 'Y', 0, '2013-09-11', NULL, NULL, 43.5995, -116.352, NULL, NULL),
('820312041', 'ID0116619', 'ID0116619', 'IDBOISTD', 'Podiatry Center of Idaho', 'Clinton', 'H', 'Clark', 'DPM', 'Podiatry', '', '', NULL, 'O', '520 S Eagle Rd Ste 1243', 'Meridian', 'Ada', 'ID', '83642', '2089384670', NULL, '520 S Eagle Rd Ste 1243', 'Meridian', 'Ada', 'ID', '83642', '2089384670', '          ', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-08-20', '2013-06-01', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|UB|', '1710924345', 0, 'N', 0, '2013-08-30', NULL, NULL, 43.5995, -116.352, NULL, NULL),
('820312041', 'ID0116620', 'ID0116620', 'IDBOISTD', 'Podiatry Center of Idaho', 'Gary', 'J', 'Millward', 'DPM', 'Podiatry', '', '', NULL, 'O', '520 S Eagle Rd Ste 1243', 'Meridian', 'Ada', 'ID', '83642', '2089384670', NULL, '520 S Eagle Rd Ste 1243', 'Meridian', 'Ada', 'ID', '83642', '2089384670', '          ', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-08-20', '2013-06-01', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|UB|', '1063462075', 0, 'N', 0, '2013-05-15', NULL, NULL, 43.5995, -116.352, NULL, NULL),
('260553931', 'ID0116736', 'ID0116736', 'IDBOISTD', 'Saint Alphonsus Medical Group Heart Care Moreau Bldg', 'Angelo', 'S', 'Ferraro', 'MD', 'Cardiovascular Disease', '', '', NULL, 'B', '3340 E Goldstone', 'Meridian', 'Ada', 'ID', '83642', '2083675170', '2083675200', '3340 E Goldstone', 'Meridian', 'Ada', 'ID', '83642', '2083675170', '2083675200', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1740236405', 0, 'N', 0, '2014-07-09', NULL, NULL, 0, 0, NULL, NULL),
('260553931', 'ID0116738', 'ID0116738', 'IDBOISTD', 'Saint Alphonsus Specialty Services Inc', 'Ronald', 'D', 'Jenkins', 'MD', 'Cardiovascular Disease', '', '', NULL, 'B', '3340 E Goldstone', 'Meridian', 'Ada', 'ID', '83642', '2083675170', '2083675180', '3340 E Goldstone', 'Meridian', 'Ada', 'ID', '83642', '2083675170', '2083675180', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1922751648', 0, 'N', 0, '2014-07-09', NULL, NULL, 0, 0, NULL, NULL),
('260553931', 'ID0116740', 'ID0116740', 'IDBOISTD', 'Saint Alphonsus Specialty Services Inc', 'Guy', 'E', 'Katz', 'MD', 'Cardiovascular Disease', '', '', NULL, 'B', '3340 E Goldstone', 'Meridian', 'Ada', 'ID', '83642', '2083675170', '2084635040', '3340 E Goldstone', 'Meridian', 'Ada', 'ID', '83642', '2083675170', '2084635040', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1346265881', 0, 'N', 0, '2014-07-09', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'ID0116741', 'ID0116741', 'IDBOISTD', 'Saint Alphonsus Medical Group NHP Family Medicine ', 'Marcel', 'A', 'Goldberg', 'MD', 'Family Practice', '', '', NULL, 'O', '4400 E Flamingo Ave', 'Nampa', 'Canyon', 'ID', '83687', '2084656900', '2084656910', '4400 E Flamingo Ave', 'Nampa', 'Canyon', 'ID', '83687', '2084656900', '2084656910', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|', '1801837141', 0, 'Y', 0, '2013-09-05', NULL, NULL, 43.5966, -116.519, NULL, NULL),
('820200895', 'ID0116750', 'ID0116750', 'IDBOISTD', 'Saint Alphonsus Medical Group OB/GYN Nampa', 'Steven', 'G', 'Moser', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '211 W Iowa', 'Nampa', 'Canyon', 'ID', '83686', '2084657377', '2084657397', '211 W Iowa', 'Nampa', 'Canyon', 'ID', '83686', '2084657377', '2084657397', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', '2012-12-13', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|', '1831396449', 0, 'N', 0, '2013-11-15', NULL, NULL, 0, 0, NULL, NULL),
('742915297', 'TX0116770', 'TX0116770', 'TXSATSTD', 'South Texas Oncology and Hematology', 'Damon', 'A', 'Mimari', 'MD', 'General Surgery', '', '', NULL, 'O', '8042 Wurzback Rd Ste 630', 'San Antonio', 'Bexar', 'TX', '78229', '2106145067', NULL, '8042 Wurzback Rd Ste 630', 'San Antonio', 'Bexar', 'TX', '78229', '2106145067', '          ', 'TXONCOL', 'TXHCPCS', '0', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-05-05', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|DEN|', '1972787745', 0, 'N', 0, '2013-07-19', NULL, NULL, 0, 0, NULL, NULL),
('742915297', 'TX0116771', 'TX0116771', 'TXSATSTD', 'South Texas Oncology and Hematology', 'George', 'E', 'Mimari', 'MD', 'General Surgery', '', '', NULL, 'O', '8042 Wurzbach Rd Ste 630', 'San Antonio', 'Bexar', 'TX', '78229', '2106145067', NULL, '8042 Wurzbach Rd Ste 630', 'San Antonio', 'Bexar', 'TX', '78229', '2106145067', '          ', 'TXONCOL', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-05-05', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|DEN|', '1982602546', 0, 'N', 0, '2013-07-19', NULL, NULL, 29.5151, -98.5765, NULL, NULL),
('201300128', 'ID0117071', 'ID0117071', 'IDBOISTD', 'Idaho Urologic', '', '', 'Idaho Urologic', '', 'Urology', '', '', NULL, '', 'Change', '', '', '', '123456', '          ', NULL, 'Change', '', '', '', '123456', '          ', '          ', '', '', '', '0.00', '0.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|DEN|', '0000009809', 0, 'Y', 1, '2012-08-20', NULL, NULL, 0, 0, NULL, NULL),
('741849254', 'TX0115805', 'TX0115805', 'TXSATSTD', 'Southeast Surgical Associates', 'Christopher', 'W', 'Salzman', 'MD', 'General Surgery', '', '', NULL, 'O', '4242 E Southcross Blvd Ste 1', 'San Antonio', 'Bexar', 'TX', '78222', '2103337510', '2103331912', '4242 E Southcross Blvd Ste 1', 'San Antonio', 'Bexar', 'TX', '78222', '2103337510', '2103331912', 'TXSURGB', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-04-24', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1679741524', 0, 'N', 0, '2013-05-23', NULL, NULL, 29.374, -98.4109, NULL, NULL),
('741849254', 'TX0115806', 'TX0115806', 'TXSATSTD', 'Southeast Surgical Associates', 'Christopher', 'W', 'Salzman', 'MD', 'General Surgery', '', '', NULL, 'B', 'PO Box 23409', 'San Antonio', 'Bexar', 'TX', '78223', '2103337510', '2103331912', 'PO Box 23409', 'San Antonio', 'Bexar', 'TX', '78223', '2103337510', '2103331912', 'TXSURGB', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-04-24', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1679741524', 0, 'N', 0, '2013-05-23', NULL, NULL, 0, 0, NULL, NULL),
('432043556', 'ID0117317', 'ID0117317', 'IDBOISTD', 'Rocky Mountain Health and Wellness', 'Colleen', 'M', 'Shackelford', 'NP', 'Family Practice', '', '', NULL, 'O', '951 E Plaza Dr Ste 110', 'Eagle', 'Ada', 'ID', '83616', '2089385680', '2089385679', '951 E Plaza Dr Ste 110', 'Eagle', 'Ada', 'ID', '83616', '2089385680', '2089385679', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1104107317', 0, 'N', 0, '2012-08-20', NULL, NULL, 43.6917, -116.342, NULL, NULL),
('202148889', 'TX0117337', 'TX0117337', 'TXSATSTD', 'Health Texas Medical Group of San Antonio', 'Dixie', 'P', 'McCrory', 'MD', 'Family Practice', '', '', NULL, 'M', '6243 IH 10 W Ste 480', 'San Antonio', 'Bexar', 'TX', '78201', '2106167300', '2106167359', '6243 IH 10 W Ste 480', 'San Antonio', 'Bexar', 'TX', '78201', '2106167300', '2106167359', 'TXINT', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2012-12-19', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1962499590', 0, 'N', 0, '2013-02-01', NULL, NULL, 29.487, -98.5422, NULL, NULL),
('202148889', 'TX0117336', 'TX0117336', 'TXSATSTD', 'Health Texas Medical Group of San Antonio', 'Dixie', 'P', 'McCrory', 'MD', 'Family Practice', '', '', NULL, 'O', '8542 Wurzbach Rd', 'San Antonio', 'Bexar', 'TX', '78240', '2106167300', '2106167359', '8542 Wurzbach Rd', 'San Antonio', 'Bexar', 'TX', '78240', '2106167300', '2106167359', 'TXINT', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2012-12-19', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1962499590', 0, 'N', 0, '2013-02-01', NULL, NULL, 29.5212, -98.5714, NULL, NULL),
('202148889', 'TX0117338', 'TX0117338', 'TXSATSTD', 'Health Texas Medical Group of San Antonio', 'Dixie', 'P', 'McCrory', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 10006', 'San Antonio', 'Bexar', 'TX', '78201', '2106167300', '2106167359', 'PO Box 10006', 'San Antonio', 'Bexar', 'TX', '78201', '2106167300', '2106167359', 'TXINT', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2012-12-19', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1962499590', 0, 'N', 0, '2013-02-01', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'ID0117498', 'ID0117498', 'IDBOISTD', 'Saint Alphonsus Medical Group Overland', 'Cynda', 'L', 'Tomlinson', 'MD', 'Family Practice', '', '', NULL, 'B', '471 E Baybrook Ct', 'Boise', 'Ada', 'ID', '83706', '2083675170', '2083677204', '471 E Baybrook Ct', 'Boise', 'Ada', 'ID', '83706', '2083675170', '2083677204', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1891703070', 0, 'N', 0, '2014-06-20', NULL, NULL, 0, 0, NULL, NULL),
('460500210', 'ID0117500', 'ID0117500', 'IDBOISTD', 'Saint Alphonsus Oncology Physician Services ', 'Alan', 'B', 'Grossett', 'MD', 'Hematology and Oncology', '', '', NULL, 'O', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083673627', '2083673174', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083673627', '2083673174', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', '2013-04-30', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1689667263', 0, 'Y', 0, '2013-05-07', NULL, NULL, 43.6127, -116.254, NULL, NULL),
('460500210', 'ID0117501', 'ID0117501', 'IDBOISTD', 'Saint Alphonsus Oncology Physician Services ', 'Alan', 'B', 'Grossett', 'MD', 'Hematology and Oncology', '', '', NULL, 'O', '3123 Medical Dr', 'Caldwell', 'Canyon', 'ID', '83605', '2083673627', '2083674817', '3123 Medical Dr', 'Caldwell', 'Canyon', 'ID', '83605', '2083673627', '2083674817', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', '2013-04-30', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1689667263', 0, 'N', 0, '2013-05-07', NULL, NULL, 43.6596, -116.658, NULL, NULL),
('460500210', 'ID0117502', 'ID0117502', 'IDBOISTD', 'Saint Alphonsus Oncology Physician Services ', 'Alan', 'B', 'Grossett', 'MD', 'Hematology and Oncology', '', '', NULL, 'O', '1202 E Locust', 'Emmett', 'Gem', 'ID', '83617', '2083653561', '2083673174', '1202 E Locust', 'Emmett', 'Gem', 'ID', '83617', '2083653561', '2083673174', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', '2013-04-30', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1689667263', 0, 'N', 0, '2013-05-07', NULL, NULL, 43.8791, -116.485, NULL, NULL),
('261900472', 'ID0117506', 'ID0117506', 'IDBOISTD', 'Idaho Skin Surgery Center', 'Jared', '', 'Scott', 'MD', 'Dermatology', '', '', NULL, 'O', '222 N 2nd St Ste 315', 'Boise', 'Ada', 'ID', '83702', '2084331114', NULL, '222 N 2nd St Ste 315', 'Boise', 'Ada', 'ID', '83702', '2084331114', '          ', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-08-20', '2013-07-25', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1992808893', 0, 'N', 0, '2013-08-16', NULL, NULL, 43.6131, -116.195, NULL, NULL),
('460500210', 'ID0117508', 'ID0117508', 'IDBOISTD', 'Saint Alphonsus Trauma Physician Services', 'Dale', '', 'Strawn', 'MD', 'General Surgery', '', '', NULL, 'O', '1512 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2084635029', '2083676849', '1512 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2084635029', '2083676849', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1518059427', 0, 'Y', 0, '2013-11-22', NULL, NULL, 43.5537, -116.573, NULL, NULL),
('352332742', 'ID0117510', 'ID0117510', 'IDBOISTD', 'Healthy Habits Wellness Clinic', 'Bryce', '', 'Aitken', 'NPC', 'Family Practice', '', '', NULL, 'O', '14 S Baltic Pl', 'Meridian', 'Ada', 'ID', '83642', '2088874872', NULL, '14 S Baltic Pl', 'Meridian', 'Ada', 'ID', '83642', '2088874872', '          ', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-08-20', '2013-02-01', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1730279407', 0, 'N', 0, '2013-04-15', NULL, NULL, 0, 0, NULL, NULL),
('800502084', 'ID0115764', 'ID0115764', 'IDBOISTD', 'Eagle Health and Wellness', 'Katherine', 'M', 'Elstun', 'MD', 'Family Practice', 'Obstetrics and Gynecology', '', NULL, 'O', '3771 N Eagle Rd', 'Boise', 'Ada', 'ID', '83713', '2089384040', NULL, '3771 N Eagle Rd', 'Boise', 'Ada', 'ID', '83713', '2089384040', '          ', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1114963717', 0, 'N', 0, '2013-07-31', NULL, NULL, 43.6394, -116.354, NULL, NULL),
('800502084', 'ID0115765', 'ID0115765', 'IDBOISTD', 'Advanced Family Medicine', 'Katherine', 'M', 'Elstun', 'MD', 'Family Practice', 'Obstetrics and Gynecology', '', NULL, 'O', '943 Linder Ste 103', 'Kuna', 'Ada', 'ID', '83634', '2089223355', NULL, '943 Linder Ste 103', 'Kuna', 'Ada', 'ID', '83634', '2089223355', '          ', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-08-20', '2013-07-29', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1114963717', 0, 'N', 0, '2013-07-31', NULL, NULL, 0, 0, NULL, NULL),
('743003947', 'TX0117579', 'TX0117579', 'TXSATSTD', 'The San Antonio Orthopaedic Group', 'John', 'T', 'Friedland', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '150 E Sonterra Blvd Ste 300', 'San Antonio', 'Bexar', 'TX', '78258', '2108045400', '2108045510', '150 E Sonterra Blvd Ste 300', 'San Antonio', 'Bexar', 'TX', '78258', '2108045400', '2108045510', 'TXORTHO', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-05-10', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1689654345', 0, 'N', 0, '2013-05-10', NULL, NULL, 29.6152, -98.4924, NULL, NULL),
('260553931', 'ID0117654', 'ID0117654', 'IDBOISTD', 'Saint Alphonsus Medical group Heart Care Nampa', 'Michael', 'A', 'Codina', 'MD', 'Cardiology', '', '', NULL, 'O', '1524 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2084635050', '2084635040', '1524 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2084635050', '2084635040', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', 'Saint Alphonsus Regional Medical Center', '', '', 'HCFA|UB|', '1871540708', 0, 'N', 0, '2014-07-09', NULL, NULL, 43.5537, -116.573, NULL, NULL),
('260553931', 'ID0117701', 'ID0117701', 'IDBOISTD', 'St Alphonsus Medical Group General Sugery Nampa', 'Reese', 'A', 'Verner', 'MD', 'General Surgery', '', '', NULL, 'O', '1603 12th Ave Rd Ste E', 'Nampa', 'Canyon', 'ID', '83686', '2084656940', '2084656961', '1603 12th Ave Rd Ste E', 'Nampa', 'Canyon', 'ID', '83686', '2084656940', '2084656961', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', '2012-11-29', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1427085281', 0, 'Y', 0, '2014-07-09', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'ID0117703', 'ID0117703', 'IDBOISTD', 'Saint Alphonsus Medical Group Hosptialist Boise', 'Ryan', 'J', 'Williams', 'MD', 'Internal Medicine', 'Hospitalist', '', NULL, 'B', '3340 E Goldstone', 'Meridian', 'Ada', 'ID', '83642', '2083675170', '2083675180', '3340 E Goldstone', 'Meridian', 'Ada', 'ID', '83642', '2083675170', '2083675180', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1114053014', 0, 'Y', 0, '2014-07-23', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'ID0117704', 'ID0117704', 'IDBOISTD', 'St Alphonsus Medical Group Nuerosurgery Boise 201', 'Bruce', 'J', 'Andersen', 'MD', 'Neurosurgery', '', '', NULL, 'O', '1075 N Curtis Rd Ste 201', 'Boise', 'Ada', 'ID', '83706', '2083674000', '2083678983', '1075 N Curtis Rd Ste 201', 'Boise', 'Ada', 'ID', '83706', '2083674000', '2083678983', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', '2013-09-25', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1063420792', 0, 'N', 0, '2014-07-09', NULL, NULL, 43.6143, -116.258, NULL, NULL),
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('820200895', 'ID0118201', 'ID0118201', 'IDBOISTD', 'Saint Alphonsus Medical Group NHP Family Medicine', 'Phillip', 'J', 'Redd', 'DO', 'Family Practice', 'Hospitalist', '', NULL, 'O', '4400  E Flamingo Ave', 'Nampa', 'Canyon', 'ID', '83687', '2084656900', '2084656910', '4400  E Flamingo Ave', 'Nampa', 'Canyon', 'ID', '83687', '2084656900', '2084656910', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|', '1134296106', 0, 'Y', 0, '2014-06-20', NULL, NULL, 43.5966, -116.519, NULL, NULL),
('820200895', 'ID0118202', 'ID0118202', 'IDBOISTD', 'Saint Alphonsus Medical Group Iowa Family Medicine', 'Phillip', 'J', 'Redd', 'DO', 'Family Practice', 'Hospitalist', '', NULL, 'O', '211 W Iowa Ave', 'Nampa', 'Canyon', 'ID', '83686', '2084657377', '2084657397', '211 W Iowa Ave', 'Nampa', 'Canyon', 'ID', '83686', '2084657377', '2084657397', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|', '1134296106', 0, 'Y', 0, '2014-06-20', NULL, NULL, 43.5543, -116.574, NULL, NULL);
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('820200895', 'ID0118241', 'ID0118241', 'IDBOISTD', 'Saint Alphonsus Medical Group Federal Way Family Medicine', 'Phillip', 'J', 'Redd', 'DO', 'Family Practice', 'Hospitalist', '', NULL, 'O', '1880 W Judith Ln', 'Boise', 'Ada', 'ID', '83705', '2083676910', '2083676170', '1880 W Judith Ln', 'Boise', 'Ada', 'ID', '83705', '2083676910', '2083676170', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|', '1134296106', 0, 'Y', 0, '2014-06-20', NULL, NULL, 43.5913, -116.204, NULL, NULL),
('820200895', 'ID0118242', 'ID0118242', 'IDBOISTD', 'Saint Alphonsus Medical Group  OB/GYN Boise Liberty Bldg', 'Phillip', 'J', 'Redd', 'DO', 'Family Practice', 'Hospitalist', '', NULL, 'O', '900 N Liberty Ste 204', 'Boise', 'Ada', 'ID', '83704', '2083672229', '2083674242', '900 N Liberty Ste 204', 'Boise', 'Ada', 'ID', '83704', '2083672229', '2083674242', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', '2013-12-01', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|', '1134296106', 0, 'Y', 0, '2014-06-20', NULL, NULL, 43.6133, -116.259, NULL, NULL),
('820200895', 'ID0118243', 'ID0118243', 'IDBOISTD', 'Saint Alphonsus Medical Group Occupational Med Emerald ', 'Phillip', 'J', 'Redd', 'DO', 'Family Practice', 'Hospitalist', '', NULL, 'O', '6533 Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083674170', '2083678136', '6533 Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083674170', '2083678136', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|', '1134296106', 0, 'Y', 0, '2014-06-20', NULL, NULL, 43.6119, -116.263, NULL, NULL),
('820200895', 'ID0118244', 'ID0118244', 'IDBOISTD', 'Saint Alphonsus Medical Group OB/GYN Boise Moreau Bldg', 'Phillip', 'J', 'Redd', 'DO', 'Family Practice', 'Hospitalist', '', NULL, 'O', '6140 W Curtisian Ste 100', 'Boise', 'Ada', 'ID', '83704', '2083674224', '2083677806', '6140 W Curtisian Ste 100', 'Boise', 'Ada', 'ID', '83704', '2083674224', '2083677806', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', '2013-08-01', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|', '1134296106', 0, 'Y', 0, '2014-06-20', NULL, NULL, 43.6151, -116.256, NULL, NULL),
('820200895', 'ID0118245', 'ID0118245', 'IDBOISTD', 'Saint Alphonsus Medical Group Shoreline Family Medicine', 'Phillip', 'J', 'Redd', 'DO', 'Family Practice', 'Hospitalist', '', NULL, 'O', '1673 W Shoreline Dr Ste 120', 'Boise', 'Ada', 'ID', '83702', '2084298311', '2084298310', '1673 W Shoreline Dr Ste 120', 'Boise', 'Ada', 'ID', '83702', '2084298311', '2084298310', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|', '1134296106', 0, 'Y', 0, '2014-06-20', NULL, NULL, 43.6174, -116.221, NULL, NULL),
('820200895', 'ID0118246', 'ID0118246', 'IDBOISTD', 'Saint Alphonsus Medical Group Internal Medicine ', 'Phillip', 'J', 'Redd', 'DO', 'Family Practice', 'Hospitalist', '', NULL, 'O', '6094 Emerald Ste 2', 'Boise', 'Ada', 'ID', '83704', '2083676575', '2083676597', '6094 Emerald Ste 2', 'Boise', 'Ada', 'ID', '83704', '2083676575', '2083676597', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|', '1134296106', 0, 'Y', 0, '2014-06-20', NULL, NULL, 43.6117, -116.257, NULL, NULL),
('820200895', 'ID0118247', 'ID0118247', 'IDBOISTD', 'Saint Alphonsus Medical Group Park Center', 'Phillip', 'J', 'Redd', 'DO', 'Family Practice', 'Hospitalist', '', NULL, 'O', '471 E Baybrook Ct', 'Boise', 'Ada', 'ID', '83706', '2083674250', '2083678158', '471 E Baybrook Ct', 'Boise', 'Ada', 'ID', '83706', '2083674250', '2083678158', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|', '1134296106', 0, 'Y', 0, '2014-06-20', NULL, NULL, 43.5974, -116.178, NULL, NULL),
('820200895', 'ID0118248', 'ID0118248', 'IDBOISTD', 'Saint Alphonsus Medical Group Emerald Family Medicine', 'Phillip', 'J', 'Redd', 'DO', 'Family Practice', 'Hospitalist', '', NULL, 'O', '6533 Emerald', 'Boise', 'Ada', 'ID', '83704', '2083674170', '2083678135', '6533 Emerald', 'Boise', 'Ada', 'ID', '83704', '2083674170', '2083678135', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|', '1134296106', 0, 'Y', 0, '2014-06-20', NULL, NULL, 43.6119, -116.263, NULL, NULL),
('820200895', 'ID0118249', 'ID0118249', 'IDBOISTD', 'Saint Alphonsus Medical Group EHP Family Medicine', 'Phillip', 'J', 'Redd', 'DO', 'Family Practice', 'Hospitalist', '', NULL, 'O', '323 E Riverside Dr Ste 224', 'Eagle', 'Ada', 'ID', '83616', '2083675750', '2083675765', '323 E Riverside Dr Ste 224', 'Eagle', 'Ada', 'ID', '83616', '2083675750', '2083675765', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', '2013-12-01', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|', '1134296106', 0, 'Y', 0, '2014-06-20', NULL, NULL, 43.6892, -116.351, NULL, NULL),
('820200895', 'ID0118250', 'ID0118250', 'IDBOISTD', 'Saint Alphonsus Medical Group MHP Family Medicine ', 'Phillip', 'J', 'Redd', 'DO', 'Family Practice', 'Hospitalist', '', 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, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|', '1134296106', 0, 'Y', 0, '2014-06-20', NULL, NULL, 43.6193, -116.431, NULL, NULL),
('820200895', 'ID0118251', 'ID0118251', 'IDBOISTD', 'Saint Alphonsus Medical Group Boise Pediatrics', 'Phillip', 'J', 'Redd', 'DO', 'Family Practice', 'Hospitalist', '', NULL, 'O', '999 N Curtis Ste 407', 'Boise', 'Ada', 'ID', '83706', '2083674321', '2083674525', '999 N Curtis Ste 407', 'Boise', 'Ada', 'ID', '83706', '2083674321', '2083674525', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', '2013-06-24', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|', '1134296106', 0, 'Y', 0, '2014-06-20', NULL, NULL, 43.6132, -116.255, NULL, NULL),
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('820200895', 'ID0118253', 'ID0118253', 'IDBOISTD', 'Saint Alphonsus Medical Group Garrity Family Medicine', 'Phillip', 'J', 'Redd', 'DO', 'Family Practice', 'Hospitalist', '', NULL, 'O', '1200 Garrity Blvd', 'Nampa', 'Canyon', 'ID', '83687', '2084669092', '2084665322', '1200 Garrity Blvd', 'Nampa', 'Canyon', 'ID', '83687', '2084669092', '2084665322', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|', '1134296106', 0, 'Y', 0, '2014-06-20', NULL, NULL, 43.5867, -116.549, NULL, NULL),
('820200895', 'ID0118256', 'ID0118256', 'IDBOISTD', 'Saint Alphonsus Wound Healing & Hyperbaric Medicine', 'Scott', 'D', 'Lossmann', 'MD', 'Family Practice', '', '', NULL, 'O', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083672121', '2083676022', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083672121', '2083676022', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1720032725', 0, 'Y', 0, '2014-06-20', NULL, NULL, 43.6145, -116.254, NULL, NULL),
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('820200896', 'ID0118313', 'ID0118313', 'IDBOISTD', 'Saint Alphonsus Medical Group Cardiology Nampa', 'Randolph', 'C', 'Byrd', 'MD', 'Cardiology', '', '', NULL, 'O', '1512 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2084635050', '2084635050', '1512 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2084635050', '2084635050', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1356339618', 0, 'Y', 0, '2014-07-09', NULL, NULL, 43.5537, -116.573, NULL, NULL),
('201300128', 'ID0118423', 'ID0118423', 'IDBOISTD', 'Idaho Urologic Institute', 'Melissa', 'B', 'Coblentz', 'PA', 'Urology', '', '', NULL, 'O', '2855 E Magic View Dr', 'Meridian', 'Ada', 'ID', '83642', '2086394900', '2086394901', '2855 E Magic View Dr', 'Meridian', 'Ada', 'ID', '83642', '2086394900', '2086394901', 'IDUROLOGY', 'WUSTDHCPC5', '', '0.00', '20.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, NULL, NULL, 'HCFA|UB|', '1053695676', 0, 'N', 0, '2012-08-20', NULL, NULL, 43.5999, -116.359, NULL, NULL),
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('820471484', 'ID0118442', 'ID0118442', 'IDBOISTD', 'Kuna Family Medical Clinic', 'Myrna', '', 'Fisher', 'FNP', 'Internal Medicine', '', '', NULL, 'O', '708 E Wythe Creek Ct Ste 103', 'Kuna', 'Ada', 'ID', '83634', '2089225130', NULL, '708 E Wythe Creek Ct Ste 103', 'Kuna', 'Ada', 'ID', '83634', '2089225130', '          ', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-08-20', '2014-01-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1306839741', 0, 'N', 0, '2014-01-24', NULL, NULL, 43.488, -116.405, NULL, NULL),
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('820200895', 'ID0118686', 'ID0118686', 'IDBOISTD', 'Saint Alphonsus Express Care Inc', 'Linda', 'B', 'Kaczmarek', 'DO', 'Family Practice', '', '', NULL, 'O', '4700 N Eagle Rd', 'Boise', 'Ada', 'ID', '83713', '2089384797', '2083672968', '4700 N Eagle Rd', 'Boise', 'Ada', 'ID', '83713', '2089384797', '2083672968', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', '2013-01-10', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1104896000', 0, 'N', 0, '2014-06-10', NULL, NULL, 43.6474, -116.352, NULL, NULL),
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('260553931', 'ID0118688', 'ID0118688', 'IDBOISTD', 'Saint Alphonsus Medical Group General Surgery Nampa', 'Richard', '', 'Ballantyne', 'DO', 'General Surgery', '', '', NULL, 'O', '401 E Hawaii Ave', 'Nampa', 'Canyon', 'ID', '83686', '2084656940', '2084656961', '401 E Hawaii Ave', 'Nampa', 'Canyon', 'ID', '83686', '2084656940', '2084656961', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', '2013-11-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1174745582', 0, 'N', 0, '2013-11-21', NULL, NULL, 43.5551, -116.569, NULL, NULL),
('260553931', 'ID0118689', 'ID0118689', 'IDBOISTD', 'St Alphonsus Medical Group General Sugery Nampa', 'Anne', '', 'Furrow', 'MD', 'General Surgery', '', '', NULL, 'O', '401 E Hawaii Ave', 'Nampa', 'Canyon', 'ID', '83686', '2084656940', '2084656961', '401 E Hawaii Ave', 'Nampa', 'Canyon', 'ID', '83686', '2084656940', '2084656961', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', '2013-09-09', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1720268667', 0, 'Y', 0, '2013-10-07', NULL, NULL, 43.5551, -116.569, NULL, NULL),
('260553931', 'ID0118691', 'ID0118691', 'IDBOISTD', 'St Alphonsus Medical Group General Sugery Nampa', 'Keith', 'K', 'Harmon', 'MD', 'General Surgery', '', '', NULL, 'O', '401 E Hawaii Ave', 'Nampa', 'Canyon', 'ID', '83686', '2084656940', '2084656949', '401 E Hawaii Ave', 'Nampa', 'Canyon', 'ID', '83686', '2084656940', '2084656949', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1730398165', 0, 'Y', 0, '2014-07-09', NULL, NULL, 43.5551, -116.569, NULL, NULL),
('260553931', 'ID0118692', 'ID0118692', 'IDBOISTD', 'St Alphonsus Medical Group General Sugery Nampa', 'Reese', 'A', 'Verner', 'MD', 'General Surgery', '', '', NULL, 'O', '401 E Hawaii', 'Nampa', 'Canyon', 'ID', '83686', '2084656940', '2084656961', '401 E Hawaii', 'Nampa', 'Canyon', 'ID', '83686', '2084656940', '2084656961', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1427085281', 0, 'Y', 0, '2014-07-09', NULL, NULL, 43.5551, -116.569, NULL, NULL),
('820200895', 'ID0118695', 'ID0118695', 'IDBOISTD', 'Saint Alphonsus Medical Group General Surgery Nampa', 'Derek', '', 'Derkacs', 'PA', 'Urology', 'General Surgery', '', NULL, 'O', '401 E Hawaii Ave', 'Nampa', 'Canyon', 'ID', '83686', '2084656940', '2084656949', '401 E Hawaii Ave', 'Nampa', 'Canyon', 'ID', '83686', '2084656940', '2084656949', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, '', '', 'HCFA|', '1720157720', 0, 'Y', 0, '2013-12-10', NULL, NULL, 43.5551, -116.569, NULL, NULL),
('820441031', 'ID0118831', 'ID0118831', 'IDBOISTD', 'Ada Orthopaedic Clinic', 'William', 'C', 'Lindner', 'MD; Shoulder, General', 'Orthopedic Surgery', '', '', NULL, 'O', '6500 W Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083770777', '2083771070', '6500 W Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083770777', '2083771070', 'IDORTHO2', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1982649927', 0, 'N', 0, '2014-03-27', NULL, NULL, 43.6119, -116.262, NULL, NULL),
('742915297', 'TX0118863', 'TX0118863', 'TXSATSTD', 'South Texas Oncology and Hematology', 'Kathy', 'D', 'Grove', 'MD', 'General Surgery', '', '', NULL, 'O', '1200 Brooklyn Ave Ste 120', 'San Antonio', 'Bexar', 'TX', '78212', '2102241971', '', '1200 Brooklyn Ave Ste 120', 'San Antonio', 'Bexar', 'TX', '78212', '2102241971', '', 'TXONCOL', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-05-06', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1710912860', 0, 'N', 0, '2014-07-25', NULL, NULL, 29.4403, -98.4903, NULL, NULL),
('820200895', 'ID0118890', 'ID0118890', 'IDBOISTD', 'StAlphonsus Regional Medical Center', 'Steven', '', 'Brown', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83704', '2083675170', '          ', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83704', '2083675170', '          ', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1700874682', 0, 'Y', 0, '2014-06-20', NULL, NULL, 43.6145, -116.254, NULL, NULL),
('202148889', 'TX0118899', 'TX0118899', 'TXSATSTD', 'Health Texas Medical Group of San Antonio', 'Christopher', 'Thomas', 'Caulfield', 'MD', 'Family Practice', '', '', NULL, 'M', '6243 IH 10 W Ste 480', 'San Antonio', 'Bexar', 'TX', '78201', '2103714800', NULL, '6243 IH 10 W Ste 480', 'San Antonio', 'Bexar', 'TX', '78201', '2103714800', '          ', 'TXINT', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1790710051', 0, 'N', 0, '2013-04-05', NULL, NULL, 29.487, -98.5422, NULL, NULL),
('202148889', 'TX0118898', 'TX0118898', 'TXSATSTD', 'Health Texas Medical Group of San Antonio', 'Christopher', 'Thomas', 'Caulfield', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 100026', 'San Antonio', 'Bexar', 'TX', '78201', '2105723306', '2012490125', 'PO Box 100026', 'San Antonio', 'Bexar', 'TX', '78201', '2105723306', '2012490125', 'TXINT', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1790710051', 0, 'N', 0, '2013-04-05', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'ID0119248', 'ID0119248', 'IDBOISTD', 'Saint Alphonsus Medical Group EHP Family Medicine ', 'Carla', '', 'Pharris', 'MD', 'Internal Medicine', '', '', NULL, 'O', '323 E Riverside Dr Ste 224', 'Eagle', 'Ada', 'ID', '83616', '2083675750', '2083675765', '323 E Riverside Dr Ste 224', 'Eagle', 'Ada', 'ID', '83616', '2083675750', '2083675765', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1134177744', 0, 'N', 0, '2014-06-20', NULL, NULL, 43.6896, -116.35, NULL, NULL),
('202148889', 'TX0119282', 'TX0119282', 'TXSATSTD', 'Health Texas Medical Group of San Antonio', 'Christopher', 'Thomas', 'Caulfield', 'MD', 'Family Practice', '', '', NULL, 'O', '2897 NE Loop 410 Ste 2', 'San Antonio', 'Bexar', 'TX', '78218', '2105723306', '2102490125', '2897 NE Loop 410 Ste 2', 'San Antonio', 'Bexar', 'TX', '78218', '2105723306', '2102490125', 'TXINT', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1790710051', 0, 'N', 0, '2013-04-05', NULL, NULL, 29.5166, -98.4053, NULL, NULL),
('820200895', 'ID0119508', 'ID0119508', 'IDBOISTD', 'Saint Alphonsus Express Care Inc', 'Kelly', 'R', 'Whitehead Price', 'NP-C', 'Family Practice', '', '', NULL, 'O', '4700 N Eagle Rd', 'Boise', 'Ada', 'ID', '83713', '2089384797', '2084522140', '4700 N Eagle Rd', 'Boise', 'Ada', 'ID', '83713', '2089384797', '2084522140', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|', '1710268099', 0, 'Y', 0, '2012-12-26', NULL, NULL, 43.6474, -116.354, NULL, NULL),
('820200895', 'ID0119509', 'ID0119509', 'IDBOISTD', 'Saint Alphonsus Express Care Inc', 'Kelly', 'R', 'Whitehead Price', 'NP-C', 'Family Practice', '', '', NULL, 'O', '1515 W State St', 'Boise', 'Ada', 'ID', '83702', '2083457684', '2084522140', '1515 W State St', 'Boise', 'Ada', 'ID', '83702', '2083457684', '2084522140', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|', '1710268099', 0, 'Y', 0, '2013-07-03', NULL, NULL, 43.6229, -116.209, NULL, NULL),
('273972429', 'ID0119563', 'ID0119563', 'IDBOISTD', 'Idaho Center for Regenerative Medicine', 'Robert', 'J', 'Haake', 'DO', 'Internal Medicine', '', '', NULL, 'O', '500 E Shore Dr', 'Eagle', 'Ada', 'ID', '83616', '2089952802', NULL, '500 E Shore Dr', 'Eagle', 'Ada', 'ID', '83616', '2089952802', '          ', 'IDSTDCRM', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1295747046', 0, 'N', 0, '2014-01-13', NULL, NULL, 43.6882, -116.347, NULL, NULL),
('870767026', 'ID0119676', 'ID0119676', 'IDBOISTD', 'West Valley Medical Group Nampa', 'Christy', '', 'Bayes', 'NP', 'Family Practice', '', '', NULL, 'O', '16459 M Midland Blvd', 'Nampa', 'Canyon', 'ID', '83687', '2087955075', '2084426520', '16459 M Midland Blvd', 'Nampa', 'Canyon', 'ID', '83687', '2087955075', '2084426520', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-08-20', '2013-03-01', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1760796296', 0, 'N', 0, '2013-11-12', NULL, NULL, 43.6116, -116.593, NULL, NULL),
('870767026', 'ID0119677', 'ID0119677', 'IDBOISTD', 'West Valley Medical Group Caldwell', 'Christy', '', 'Bayes', 'NP', 'Family Practice', '', '', NULL, 'O', '211 E Logan St Ste 203 and 303', 'Caldwell', 'Canyon', 'ID', '83605', '2084591667', '2084593372', '211 E Logan St Ste 203 and 303', 'Caldwell', 'Canyon', 'ID', '83605', '2084591667', '2084593372', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-08-20', '2013-03-01', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1760796296', 0, 'N', 0, '2013-11-12', NULL, NULL, 43.6554, -116.697, NULL, NULL),
('870767026', 'ID0119678', 'ID0119678', 'IDBOISTD', 'West Valley Medical Group', 'Christy', '', 'Bayes', 'NP', 'Family Practice', '', '', NULL, 'B', 'PO Box 277976', 'Atlanta', 'Fulton', 'GA', '30384', '2084594667', '2084593372', 'PO Box 277976', 'Atlanta', 'Fulton', 'GA', '30384', '2084594667', '2084593372', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-08-20', '2013-03-01', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1760796296', 0, 'N', 0, '2013-11-12', NULL, NULL, 0, 0, NULL, NULL),
('820392395', 'ID0119693', 'ID0119693', 'IDBOISTD', '', 'Kristina', 'M', 'Huffaker', 'PA', 'Family Practice', '', '', NULL, 'O', '2036 N Cole Rd', 'Boise', 'Ada', 'ID', '83704', '2083750722', '2083750015', '2036 N Cole Rd', 'Boise', 'Ada', 'ID', '83704', '2083750722', '2083750015', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-08-20', '2013-05-24', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1508142613', 0, 'N', 0, '2014-03-27', NULL, NULL, 43.6238, -116.273, NULL, NULL),
('260553931', 'ID0119744', 'ID0119744', 'IDBOISTD', 'Saint Alphonsus Medical Group Orthopedic Spine Surgery', 'Charles', 'T', 'Floyd', 'MD; Spine', 'Orthopedic Surgery', '', '', NULL, 'O', '1075 N Curtis Rd Ste 101', 'Boise', 'Ada', 'ID', '83706', '2083677463', '2083677507', '1075 N Curtis Rd Ste 101', 'Boise', 'Ada', 'ID', '83706', '2083677463', '2083677507', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1124039714', 0, 'N', 0, '2014-07-09', NULL, NULL, 43.6148, -116.254, NULL, NULL),
('260553931', 'ID0119753', 'ID0119753', 'IDBOISTD', 'St Alphonsus Medical Group General Sugery Nampa', 'George', '', 'Waterhouse', 'MD', 'General Surgery', '', '', NULL, 'O', '1603 12th Ave Rd Ste E', 'Nampa', 'Canyon', 'ID', '83686', '2084656940', '2084656961', '1603 12th Ave Rd Ste E', 'Nampa', 'Canyon', 'ID', '83686', '2084656940', '2084656961', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', '2012-11-30', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1811052020', 0, 'Y', 0, '2013-08-21', NULL, NULL, 0, 0, NULL, NULL),
('260553931', 'ID0119754', 'ID0119754', 'IDBOISTD', 'St Alphonsus Medical Group General Sugery Nampa', 'George', '', 'Waterhouse', 'MD', 'General Surgery', '', '', NULL, 'B', '3340 E Goldstone', 'Meridian', 'Ada', 'ID', '83642', '2083675180', '2084656961', '3340 E Goldstone', 'Meridian', 'Ada', 'ID', '83642', '2083675180', '2084656961', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', '2013-07-01', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1811052020', 0, 'Y', 0, '2013-09-20', NULL, NULL, 0, 0, NULL, NULL),
('113676182', 'TX0119927', 'TX0119927', 'TXSATSTD', 'The Podiatry Group of South Texas', 'Jeff', 'S', 'Henke', 'DPM', 'Podiatry', '', '', NULL, 'O', '135 Burton Creed Rd Ste 300', 'Kyle', 'Hays', 'TX', '78640', '5122683668', NULL, '135 Burton Creed Rd Ste 300', 'Kyle', 'Hays', 'TX', '78640', '5122683668', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1871539007', 0, 'Y', 0, '2014-03-20', NULL, NULL, 29.9966, -97.8448, NULL, NULL),
('741967809', 'TX0119936', 'TX0119936', 'TXSATSTD', 'Gastroenterology Consultants of San Antonio', 'David', 'P', 'Jones', 'DO', 'Gastroenterology', '', '', NULL, 'O', '11485 Topperwein Ste 2', 'San Antonio', 'Bexar', 'TX', '78233', '2106141234', '2106147749', '11485 Topperwein Ste 2', 'San Antonio', 'Bexar', 'TX', '78233', '2106141234', '2106147749', 'TXSURGA', 'TXHCPCS', '', '0.00', '50.00', '0.00', 6, '2012-08-20', '2013-04-04', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1265410914', 0, 'N', 0, '2013-04-24', NULL, NULL, 29.5423, -98.3402, NULL, NULL),
('741967809', 'TX0119937', 'TX0119937', 'TXSATSTD', 'Gastroenterology Consultants of San Antonio', 'David', 'P', 'Jones', 'DO', 'Gastroenterology', '', '', NULL, 'O', '855 Proton Rd', 'San Antonio', 'Bexar', 'TX', '78258', '2106141234', '2106147749', '855 Proton Rd', 'San Antonio', 'Bexar', 'TX', '78258', '2106141234', '2106147749', 'TXSURGA', 'TXHCPCS', '', '0.00', '50.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1265410914', 0, 'N', 0, '2013-04-24', NULL, NULL, 29.6121, -98.4806, NULL, NULL),
('741967809', 'TX0119938', 'TX0119938', 'TXSATSTD', 'Gastroenterology Consultants of San Antonio', 'David', 'P', 'Jones', 'DO', 'Gastroenterology', '', '', NULL, 'B', '8415 Datapoint Dr Ste 1000', 'San Antonio', 'Bexar', 'TX', '78229', '2106141234', NULL, '8415 Datapoint Dr Ste 1000', 'San Antonio', 'Bexar', 'TX', '78229', '2106141234', '          ', 'TXSURGA', 'TXHCPCS', '', '0.00', '50.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1265410914', 0, 'N', 0, '2013-04-24', NULL, NULL, 0, 0, NULL, NULL),
('223941333', 'ID0119945', 'ID0119945', 'IDBOISTD', 'Treasure Valley Eye Center', 'Mark ', 'R', 'Miller', 'MD', 'Ophthalmology', '', '', NULL, 'O', '3045 E St Lukes St Ste 100', 'Meridian', 'Ada', 'ID', '83642', '2082882020', '2082882015', '3045 E St Lukes St Ste 100', 'Meridian', 'Ada', 'ID', '83642', '2082882020', '2082882015', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1881629327', 0, 'N', 0, '2012-11-08', NULL, NULL, 43.6011, -116.356, NULL, NULL),
('742592013', 'TX0119950', 'TX0119950', 'TXSATSTD', 'Dermatology Associates of San Antonio', 'Liliana', 'J', 'Saap', 'MD', 'Dermatology', '', '', NULL, 'O', '18540 Sigma Rd', 'San Antonio', 'Bexar', 'TX', '78258', '2104904661', NULL, '18540 Sigma Rd', 'San Antonio', 'Bexar', 'TX', '78258', '2104904661', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'North Central Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1861460644', 0, 'N', 0, '2012-08-20', NULL, NULL, 29.6121, -98.4831, NULL, NULL),
('742592013', 'TX0119951', 'TX0119951', 'TXSATSTD', 'Dermatology Associates of San Antonio', 'Liliana', 'J', 'Saap', 'MD', 'Dermatology', '', '', NULL, 'B', '7832 Pat Booker Rd', 'San Antonio', 'Bexar', 'TX', '78233', '2106579338', NULL, '7832 Pat Booker Rd', 'San Antonio', 'Bexar', 'TX', '78233', '2106579338', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'North Central Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1861460644', 0, 'N', 0, '2012-08-20', NULL, NULL, 29.5623, -98.3334, NULL, NULL),
('202148889', 'TX0119981', 'TX0119981', 'TXSATSTD', 'Health Texas Medical Group of San Antonio', 'Eduardo', 'O', 'Caveda', 'MD', 'Family Practice', '', '', NULL, 'O', '803 Castroville Rd Ste 120', 'San Antonio', 'Bexar', 'TX', '78237', '2104367402', '2104367398', '803 Castroville Rd Ste 120', 'San Antonio', 'Bexar', 'TX', '78237', '2104367402', '2104367398', 'TXINT', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'Baptist Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1811947880', 0, 'N', 0, '2012-11-12', NULL, NULL, 29.4169, -98.5526, NULL, NULL),
('202148889', 'TX0119982', 'TX0119982', 'TXSATSTD', 'Health Texas Medical Group of San Antonio', 'Eduardo', 'O', 'Caveda', 'MD', 'Family Practice', '', '', NULL, 'M', '6243 IH 10 W Ste 480', 'San Antonio', 'Bexar', 'TX', '78201', '2103714800', NULL, '6243 IH 10 W Ste 480', 'San Antonio', 'Bexar', 'TX', '78201', '2103714800', '          ', 'TXINT', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'Baptist Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1811947880', 0, 'N', 0, '2012-11-12', NULL, NULL, 29.487, -98.5422, NULL, NULL),
('202148889', 'TX0119983', 'TX0119983', 'TXSATSTD', 'Health Texas Medical Group of San Antonio', 'Eduardo', 'O', 'Caveda', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 100026', 'San Antonio', 'Bexar', 'TX', '78201', '2108282531', NULL, 'PO Box 100026', 'San Antonio', 'Bexar', 'TX', '78201', '2108282531', '          ', 'TXINT', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'Baptist Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1811947880', 0, 'N', 0, '2012-11-12', NULL, NULL, 0, 0, NULL, NULL),
('742083988', 'TX0120132', 'TX0120132', 'TXSATSTD', 'Renal Associates', 'Michael', '', 'Wall', 'MD', 'Internal Medicine', '', '', NULL, 'O', '5131 Medical Dr Ste 120', 'San Antonio', 'Bexar', 'TX', '78229', '2106141515', '2106156904', '5131 Medical Dr Ste 120', 'San Antonio', 'Bexar', 'TX', '78229', '2106141515', '2106156904', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-10-01', NULL, 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1639118730', 0, 'N', 0, '2012-09-12', NULL, NULL, 29.5112, -98.5853, NULL, NULL),
('742083988', 'TX0120133', 'TX0120133', 'TXSATSTD', 'Renal Associates', 'Michael', '', 'Wall', 'MD', 'Internal Medicine', '', '', NULL, 'O', '134 Menger Springs Ste 1100', 'Boerne', 'Kendall', 'TX', '78006', '2106141515', '2106156904', '134 Menger Springs Ste 1100', 'Boerne', 'Kendall', 'TX', '78006', '2106141515', '2106156904', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-10-01', NULL, 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1639118730', 0, 'N', 0, '2012-09-12', NULL, NULL, 30.0543, -98.7392, NULL, NULL),
('742083988', 'TX0120134', 'TX0120134', 'TXSATSTD', 'Renal Associates', 'Michael', '', 'Wall', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1050 Hwy 16 N', 'Bandera', 'Bandera', 'TX', '78003', '2106141515', '2106156904', '1050 Hwy 16 N', 'Bandera', 'Bandera', 'TX', '78003', '2106141515', '2106156904', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-10-01', NULL, 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1639118730', 0, 'N', 0, '2012-09-12', NULL, NULL, 29.7333, -99.0728, NULL, NULL),
('742083988', 'TX0120135', 'TX0120135', 'TXSATSTD', 'Renal Associates', 'Michael', '', 'Wall', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1561 IH 35 N', 'New Braunfels', 'Comal', 'TX', '78130', '8303038770', '8304010412', '1561 IH-35 N', 'New Braunfels', 'Comal', 'TX', '78130', '8303038770', '8304010412', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-10-01', NULL, 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1639118730', 0, 'N', 0, '2012-09-12', NULL, NULL, 29.6983, -98.0827, NULL, NULL),
('820200895', 'ID0120368', 'ID0120368', 'IDBOISTD', 'St Alphonsus Medical Group Iowa Family Medicine', 'Linda', '', 'Lam', 'DO', 'Family Practice', '', '', NULL, 'O', '211 W Iowa St', 'Nampa', 'Canyon', 'ID', '83686', '2084657377', '2084657397', '211 W Iowa St', 'Nampa', 'Canyon', 'ID', '83686', '2084657377', '2084657397', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', '2012-12-13', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, NULL, NULL, 'HCFA|', '1427099852', 0, 'N', 0, '2014-03-20', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'ID0120372', 'ID0120372', 'IDBOISTD', 'Saint Alphonsus Medical Group Inpatient Pain Boise', 'Holly', '', 'Swensen', 'NP', 'Hematology and Oncology', 'Oncology', '', NULL, 'O', '1055 N Curtis', 'Boise', 'Ada', 'ID', '83706', '2083673627', '2083673174', '1055 N Curtis', 'Boise', 'Ada', 'ID', '83706', '2083673627', '2083673174', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|', '1386672012', 0, 'Y', 0, '2014-06-20', NULL, NULL, 43.6145, -116.254, NULL, NULL),
('200324983', 'ID0120375', 'ID0120375', 'IDBOISTD', 'Idaho Sports Medicine Institute PA', 'Michael', 'J', 'Gustavel', 'MD; Shoulder, General, Sports Med', 'Orthopedic Surgery', '', '', NULL, 'O', '1188 University Dr', 'Boise', 'Ada', 'ID', '83706', '2083368250', '2083459514', '1188 University Dr', 'Boise', 'Ada', 'ID', '83706', '2083368250', '2083459514', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1306842182', 0, 'N', 0, '2012-10-17', NULL, NULL, 43.601, -116.196, NULL, NULL),
('200324983', 'ID0120376', 'ID0120376', 'IDBOISTD', 'Idaho Sports Medicine Institute', 'Kirk', 'J', 'Lewis', 'MD; Shoulder, General, Foot/Ankle, Sports Med', 'Orthopedic Surgery', '', '', NULL, 'O', '1188 University Dr', 'Boise', 'Ada', 'ID', '83706', '2083368250', '2083459514', '1188 University Dr', 'Boise', 'Ada', 'ID', '83706', '2083368250', '2083459514', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1033115803', 0, 'N', 0, '2012-10-17', NULL, NULL, 43.601, -116.196, NULL, NULL),
('200324983', 'ID0120377', 'ID0120377', 'IDBOISTD', 'Idaho Sports Medicine Institute PA', 'Jennifer', 'R', 'Miller', 'MD; Shoulder, General, Sports Med', 'Orthopedic Surgery', NULL, NULL, NULL, 'O', '1188 University Dr', 'Boise', 'Ada', 'ID', '83706', '2083368250', '2083459514', '1188 University Dr', 'Boise', 'Ada', 'ID', '83706', '2083368250', '2083459514', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1245236983', 0, 'N', 0, '2012-10-17', NULL, NULL, 43.601, -116.196, NULL, NULL),
('200324983', 'ID0120378', 'ID0120378', 'IDBOISTD', 'Idaho Sports Medicine Institute PA', 'Scot', 'B', 'Scheffel', 'MD; Sports Med', 'Orthopedic Surgery', NULL, NULL, NULL, 'O', '1188 University Dr', 'Boise', 'Ada', 'ID', '83706', '2083368250', '2083459514', '1188 University Dr', 'Boise', 'Ada', 'ID', '83706', '2083368250', '2083459514', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1043216823', 0, 'N', 0, '2012-10-17', NULL, NULL, 43.601, -116.196, NULL, NULL),
('841394139', 'ID0120396', 'ID0120396', 'IDBOISTD', 'Southwest Idaho ENT ', 'Arthur', 'C', 'Jones', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '4400 E Flamingo Ave Ste 220', 'Nampa', 'Canyon', 'ID', '83687', '2083673320', '          ', '4400 E Flamingo Ave Ste 220', 'Nampa', 'Canyon', 'ID', '83687', '2083673320', '          ', 'IDSWIENT', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|UB|', '1659354223', 0, 'N', 0, '2014-06-26', NULL, NULL, 43.5966, -116.519, NULL, NULL);
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('870767026', 'ID0120661', 'ID0120661', 'IDBOISTD', 'Caldwell Internal Medicine Group', 'John', '', 'Pearce', 'DO', 'Family Practice', '', '', NULL, 'O', '16459 M Midland Blvd', 'Nampa', 'Canyon', 'ID', '83687', '2087955075', NULL, '16459 M Midland Blvd', 'Nampa', 'Canyon', 'ID', '83687', '2087955075', '          ', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'West Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1306880844', 0, 'N', 0, '2014-03-20', NULL, NULL, 43.6116, -116.593, NULL, NULL),
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('870767026', 'ID0120665', 'ID0120665', 'IDBOISTD', 'Caldwell Internal Medicine Group', 'Cheryl', 'K', 'Sobba', 'NP', 'Family Practice', '', '', NULL, 'B', 'PO Box 277976', 'Atlanta', 'Fulton', 'GA', '30384', '2084594667', NULL, 'PO Box 277976', 'Atlanta', 'Fulton', 'GA', '30384', '2084594667', '          ', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'West Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1740235712', 0, 'N', 0, '2013-08-16', NULL, NULL, 0, 0, NULL, NULL),
('870767026', 'ID0120666', 'ID0120666', 'IDBOISTD', 'West Valley Medical Group', 'Robert', 'S', 'Thacker', 'NP', 'Family Practice', '', '', NULL, 'O', '16459 M Midland Blvd', 'Nampa', 'Canyon', 'ID', '83687', '2087955075', '2084426520', '16459 M Midland Blvd', 'Nampa', 'Canyon', 'ID', '83687', '2087955075', '2084426520', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-08-20', '2013-06-25', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1124309224', 0, 'N', 0, '2013-07-03', NULL, NULL, 43.6116, -116.593, NULL, NULL),
('870767026', 'ID0120667', 'ID0120667', 'IDBOISTD', 'West Valley Medical Group Nampa', 'Robert', 'S', 'Thacker', 'NP', 'Family Practice', '', '', NULL, 'O', '211 E Logan St Ste 203 and 303', 'Caldwell', 'Canyon', 'ID', '83605', '2084594667', '2084593372', '211 E Logan St Ste 203 and 303', 'Caldwell', 'Canyon', 'ID', '83605', '2084594667', '2084593372', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1124309224', 0, 'N', 0, '2013-03-21', NULL, NULL, 43.6552, -116.697, NULL, NULL),
('870767026', 'ID0120668', 'ID0120668', 'IDBOISTD', 'West Valley Medical Group', 'Robert', 'S', 'Thacker', 'NP', 'Family Practice', '', '', NULL, 'B', 'PO Box 277976', 'Atlanta', 'Fulton', 'GA', '30384', '2087955075', '2084426520', 'PO Box 277976', 'Atlanta', 'Fulton', 'GA', '30384', '2087955075', '2084426520', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1124309224', 0, 'N', 0, '2013-03-21', NULL, NULL, 0, 0, NULL, NULL),
('841394139', 'ID0120721', 'ID0120721', 'IDBOISTD', 'Southwest Idaho ENT ', 'DelRay', '', 'Maughan', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '900 N Liberty St Ste 400', 'Boise', 'Ada', 'ID', '83704', '2083673320', '2083677474', '900 N Liberty St Ste 400', 'Boise', 'Ada', 'ID', '83704', '2083673320', '2083677474', 'IDSWIENT', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 6, '2012-10-01', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1649253188', 0, 'N', 0, '2014-06-26', NULL, NULL, 43.6124, -116.261, NULL, NULL),
('201939139', 'ID0120766', 'ID0120766', 'IDBOISTD', 'Micron Family Health Center', 'Ralph', '', 'Heckard', 'MD', 'Family Practice', '', '', NULL, 'O', '8000 S Federal Way', 'Boise', 'Ada', 'ID', '83716', '2083685656', '          ', '8000 S Federal Way', 'Boise', 'Ada', 'ID', '83716', '2083685656', '          ', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-08-20', '2014-06-12', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1619032687', 0, 'Y', 0, '2014-06-13', NULL, NULL, 43.5285, -116.15, NULL, NULL),
('201939139', 'ID0120769', 'ID0120769', 'IDBOISTD', 'Micron Family Health Clinic', 'Brenda', '', 'Shaw', 'PA', 'Family Practice', '', '', NULL, 'O', '8000 S Federal Way', 'Boise', 'Ada', 'ID', '83716', '2083685656', NULL, '8000 S Federal Wy', 'Boise', 'Ada', 'ID', '83716', '2083685656', '          ', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1679642037', 0, 'Y', 0, '2013-04-26', NULL, NULL, 43.5285, -116.15, NULL, NULL),
('201939139', 'ID0120770', 'ID0120770', 'IDBOISTD', 'Micron Family Health Center', 'Timothy', '', 'Phillips', 'MD', 'Family Practice', '', '', NULL, 'O', '8000 S Federal Way', 'Boise', 'Ada', 'ID', '83716', '2083685656', NULL, '8000 S Federal Wy', 'Boise', 'Ada', 'ID', '83716', '2083685656', '          ', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1558349241', 0, 'Y', 0, '2013-04-26', NULL, NULL, 43.5285, -116.15, NULL, NULL),
('264333033', 'TX0119539', 'TX0119539', 'TXSATSTD', 'Consultants in Womens Health', 'Henry', '', 'Garza', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '1210 Arion Pkwy', 'San Antonio', 'Bexar', 'TX', '78216', '2103499300', '2103662558', '1210 Arion Pkwy', 'San Antonio', 'Bexar', 'TX', '78216', '2103499300', '2103662558', 'TXOBG', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'North East Baptist Hospital', '', '', '', 'HCFA|UB|', '1962491175', 0, 'N', 0, '2014-04-11', NULL, NULL, 0, 0, NULL, NULL),
('264333033', 'TX0219538', 'TX0219538', 'TXSATSTD', 'Institute for Womens Health', 'Henry', '', 'Garza', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '8715 Village Dr Ste 418', 'San Antonio', 'Bexar', 'TX', '78217', '2106563040', '2106566419', '8715 Village Dr Ste 418', 'San Antonio', 'Bexar', 'TX', '78217', '2106563040', '2106566419', 'TXOBG', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2014-04-13', 0, 0, 0, 'North East Baptist Hospital', '', '', '', 'HCFA|UB|', '1962491175', 0, 'N', 0, '2014-04-11', NULL, NULL, 29.519, -98.4275, NULL, NULL),
('205294327', 'ID0119547', 'ID0119547', 'IDBOISTD', 'Digestive Health Clinic ', 'June', 'M', 'Reiling', 'NP', 'Gastroenterology', '', '', NULL, 'O', '6259 W Emerald St', 'Boise', 'Ada', 'ID', '83704', '2084891900', '2083755286', '6259 W Emerald St', 'Boise', 'Ada', 'ID', '83704', '2084891900', '2083755286', 'IDDIGEST', 'WUSTDHCPC5', '', '0.00', '20.00', '0.00', 6, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1730182205', 0, 'N', 0, '2012-08-20', NULL, NULL, 43.6118, -116.258, NULL, NULL),
('742719352', 'TX0109830', 'TX0109830', 'TXSATSTD', 'Urology of San Antonio', 'Christopher', 'H', 'Cantrill', 'MD', 'Urology', '', '', NULL, 'O', '255 E Sonterra Ste 203', 'San Antonio', 'Bexar', 'TX', '78258', '2104995158', '2104995259', '255 E Sonterra Ste 203', 'San Antonio', 'Bexar', 'TX', '78258', '2104995158', '2104995259', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-05-24', 0, 0, 0, 'St Lukes Baptist Hospital', '', '', '', 'HCFA|UB|', '1568642296', 0, 'N', 0, '2014-04-11', NULL, NULL, 29.6171, -98.4906, NULL, NULL),
('742719352', 'TX0109831', 'TX0109831', 'TXSATSTD', 'Urology of San Antonio', 'Christopher', 'H', 'Cantrill', 'MD', 'Urology', '', '', NULL, 'O', '414 Navarro Ste 900', 'San Antonio', 'Bexar', 'TX', '78205', '2104747020', '2102262192', '414 Navarro Ste 900', 'San Antonio', 'Bexar', 'TX', '78205', '2104747020', '2102262192', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'St Lukes Baptist Hospital', '', '', '', 'HCFA|UB|', '1568642296', 0, 'N', 0, '2014-04-11', NULL, NULL, 29.4254, -98.4897, NULL, NULL),
('742719352', 'TX0109828', 'TX0109828', 'TXSATSTD', 'Urology of San Antonio', 'Christopher', 'H', 'Cantrill', 'MD', 'Urology', '', '', NULL, 'O', '4212 E Southcross Blvd Ste 125', 'San Antonio', 'Bexar', 'TX', '78222', '2103376228', '2103046476', '4212 E Southcross Blvd Ste 125', 'San Antonio', 'Bexar', 'TX', '78222', '2103376228', '2103046476', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2014-04-08', 0, 0, 0, 'St Lukes Baptist Hospital', '', '', '', 'HCFA|UB|', '1568642296', 0, 'N', 0, '2014-04-11', NULL, NULL, 29.3748, -98.412, NULL, NULL),
('742719352', 'TX0109827', 'TX0109827', 'TXSATSTD', 'Urology of San Antonio', 'Christopher', 'H', 'Cantrill', 'MD', 'Urology', '', '', NULL, 'O', '7909 Fredericksburg Rd Ste 120-210', 'San Antonio', 'Bexar', 'TX', '78229', '2106144544', '2105825655', '7909 Fredericksburg Rd Ste 120-210', 'San Antonio', 'Bexar', 'TX', '78229', '2106144544', '2105825655', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'St Lukes Baptist Hospital', '', '', '', 'HCFA|UB|', '1568642296', 0, 'N', 0, '2014-04-11', NULL, NULL, 29.511, -98.5673, NULL, NULL),
('742719352', 'TX0109829', 'TX0109829', 'TXSATSTD', 'Urology of San Antonio', 'Christopher', 'H', 'Cantrill', 'MD', 'Urology', '', '', NULL, 'O', '12709 Toepperwein Ste 206', 'San Antonio', 'Bexar', 'TX', '78233', '2105648000', '2105907945', '12709 Toepperwein Ste 206', 'San Antonio', 'Bexar', 'TX', '78233', '2105648000', '2105907945', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'St Lukes Baptist Hospital', '', '', '', 'HCFA|UB|', '1568642296', 0, 'N', 0, '2014-04-11', NULL, NULL, 29.5535, -98.3472, NULL, NULL),
('870767026', 'ID0120864', 'ID0120864', 'IDBOISTD', 'West Valley Medical Group Caldwell', 'Daniel', 'J', 'Allen', 'DO', 'Family Practice', 'Sports Medicine', '', NULL, 'O', '16459 N Midland Blvd', 'Nampa', 'Canyon', 'ID', '83687', '2087955075', '2084593372', '16459 N Midland Blvd', 'Nampa', 'Canyon', 'ID', '83687', '2087955075', '2084593372', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'West Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1720017247', 0, 'N', 0, '2013-10-14', NULL, NULL, 43.6125, -116.594, NULL, NULL),
('870767026', 'ID0120865', 'ID0120865', 'IDBOISTD', 'West Valley Medical Group Caldwell', 'Daniel', 'J', 'Allen', 'DO', 'Family Practice', 'Sports Medicine', '', NULL, 'O', '211 E Logan St Ste 203', 'Caldwell', 'Canyon', 'ID', '83605', '2084594667', '2084593372', '211 E Logan St Ste 203', 'Caldwell', 'Canyon', 'ID', '83605', '2084594667', '2084593372', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-08-20', '2012-08-20', 0, 0, 0, 'West Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1720017247', 0, 'N', 0, '2013-10-14', NULL, NULL, 43.6554, -116.697, NULL, NULL),
('870767026', 'ID0120866', 'ID0120866', 'IDBOISTD', 'West Valley Medical Group Caldwell', 'Daniel', 'J', 'Allen', 'DO', 'Family Practice', 'Sports Medicine', '', NULL, 'B', 'PO Box 277976', 'Atlanta', 'Fulton', 'GA', '30384', '8015470747', '2084593372', 'PO Box 277976', 'Atlanta', 'Fulton', 'GA', '30384', '8015470747', '2084593372', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'West Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1720017247', 0, 'N', 0, '2013-10-14', NULL, NULL, 0, 0, NULL, NULL),
('900120192', 'TX0120879', 'TX0120879', 'TXSATSTD', 'Sports Medicine Associates of San Antonio', '', '', 'Sports Medicine Associates of San Antonio', '', 'Orthopedic Surgery', 'Physical Therapy', '', NULL, 'O', '21 Spurs Ln Ste 300', 'San Antonio', 'Bexar', 'TX', '78240', '2106998326', '2105617121', '21 Spurs Ln Ste 300', 'San Antonio', 'Bexar', 'TX', '78240', '2106998326', '2105617121', 'TXORTHO', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-07-12', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1861549503', 0, 'N', 0, '2014-07-18', NULL, NULL, 29.5267, -98.5922, NULL, NULL),
('900120192', 'TX0120880', 'TX0120880', 'TXSATSTD', 'Sports Medicine Associates of San Antonio', '', '', 'Sports Medicine Associates of San Antonio', '', 'Orthopedic Surgery', 'Physical Therapy', '', NULL, 'O', '5921 Broadway', 'San Antonio', 'Bexar', 'TX', '78209', '2106998326', '2105617121', '5921 Broadway', 'San Antonio', 'Bexar', 'TX', '78209', '2106998326', '2105617121', 'TXORTHO', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-07-12', '2013-04-04', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1861549503', 0, 'N', 0, '2014-07-18', NULL, NULL, 29.4805, -98.465, NULL, NULL),
('900120192', 'TX0120882', 'TX0120882', 'TXSATSTD', 'Sports Medicine Associates of San Antonio', '', '', 'Sports Medicine Associates of San Antonio', '', 'Orthopedic Surgery', 'Physical Therapy', '', NULL, 'B', 'PO Box 196', 'San Antonio', 'Bexar', 'TX', '78291', '2106998326', '2105617121', 'PO Box 196', 'San Antonio', 'Bexar', 'TX', '78291', '2106998326', '2105617121', 'TXORTHO', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-07-12', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1861549503', 0, 'N', 0, '2014-07-18', NULL, NULL, 0, 0, NULL, NULL),
('820312070', 'ID0121136', 'ID0121136', 'IDBOISTD', 'Boise Valley Asthma and Allergy Clinic', 'Jennifer', '', 'Neumayer', 'NP', 'Allergy and Immunology', '', '', NULL, 'O', '16060 Idaho Ctr Blvd', 'Nampa', 'Canyon', 'ID', '83687', '2083780080', '2083780259', '16060 Idaho Ctr Blvd', 'Nampa', 'Canyon', 'ID', '83687', '2083780080', '2083780259', 'IDALLERGY', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1639432131', 0, 'N', 0, '2012-08-20', NULL, NULL, 43.6059, -116.513, NULL, NULL),
('820312070', 'ID0121134', 'ID0121134', 'IDBOISTD', 'Boise Valley Asthma and Allergy Clinic', 'Jennifer', '', 'Neumayer', 'NP', 'Allergy and Immunology', '', '', NULL, 'O', '2320 E Gala Ste 500', 'Meridian', 'Ada', 'ID', '83642', '2083780080', '2083780259', '2320 E Gala Ste 500', 'Meridian', 'Ada', 'ID', '83642', '2083780080', '2083780259', 'IDALLERGY', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1639432131', 0, 'N', 0, '2012-08-20', NULL, NULL, 43.5892, -116.365, NULL, NULL),
('820312070', 'ID0121135', 'ID0121135', 'IDBOISTD', 'Boise Valley Asthma and Allergy Clinic', 'Jennifer', '', 'Neumayer', 'NP', 'Allergy and Immunology', '', '', NULL, 'O', '323 E Riverside Dr Ste 204', 'Eagle', 'Ada', 'ID', '83616', '2083780080', '2083780259', '323 E Riverside Dr Ste 204', 'Eagle', 'Ada', 'ID', '83616', '2083780080', '2083780259', 'IDALLERGY', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1639432131', 0, 'N', 0, '2012-08-20', NULL, NULL, 43.6896, -116.35, NULL, NULL),
('820312070', 'ID0121133', 'ID0121133', 'IDBOISTD', 'Boise Valley Asthma and Allergy Clinic', 'Jennifer', '', 'Neumayer', 'NP', 'Allergy and Immunology', '', '', NULL, 'O', '901 N Curtis Rd Ste 100', 'Boise', 'Ada', 'ID', '83706', '2083780080', '2083780259', '901 N Curtis Rd Ste 100', 'Boise', 'Ada', 'ID', '83706', '2083780080', '2083780259', 'IDALLERGY', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1639432131', 0, 'N', 0, '2012-08-20', NULL, NULL, 43.6126, -116.254, NULL, NULL),
('200324983', 'ID0121168', 'ID0121168', 'IDBOISTD', 'Idaho Sports Medicine Institute PA', 'George', 'A', 'Wade', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1188 University Dr', 'Boise', 'Ada', 'ID', '83706', '2083368250', '2083459514', '1188 University Dr', 'Boise', 'Ada', 'ID', '83706', '2083368250', '2083459514', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|UB|', '1063418903', 0, 'N', 0, '2013-11-11', NULL, NULL, 43.601, -116.196, NULL, NULL),
('942938348', 'W40006842', 'W40006842', 'UTMH1', 'Valley Mental Health  Inc', 'PENNY', NULL, 'PETERSON', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', '5965 S 900 E Ste 430', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012637100', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'UTVMHMA', NULL, NULL, '0.00', '40.00', '0.00', 6, '2013-02-15', NULL, NULL, 0, NULL, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1609856053', 0, 'Y', 0, '2013-02-28', NULL, NULL, 0, 0, NULL, NULL),
('942938348', 'W40006892', 'W40006892', 'UTMH1', 'Valley Mental Health  Inc', 'CORA', 'MICHELLE', 'PETERSON', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'B', '5965 S 900 E Ste 430', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012637100', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'UTVMHMA', NULL, NULL, '0.00', '40.00', '0.00', 6, '2013-02-15', NULL, NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1447441464', 0, 'Y', 0, '2013-02-28', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'ELRHC0339', 'ELRHC0339', 'ILCHIGSTD', '', 'Mary', NULL, 'Peterson', 'DO', 'Family Practice', NULL, NULL, NULL, 'O', '205 S NW Hwy', 'Park Ridge', 'Cook', 'IL', '60068', '8472925200', '8476923884', '205 S NW Hwy', 'Park Ridge', 'Cook', 'IL', '60068', '8472925200', '8476923884', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1356508675', 0, 'N', 0, '2014-01-23', NULL, NULL, 42.0091, -87.8262, NULL, NULL),
('942938348', 'W40006841', 'W40006841', 'UTMH1', 'Valley Mental Health  Inc', 'LEE', 'LEGRAND', 'PERRY', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', '5965 S 900 E Ste 430', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012637100', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'UTVMHMA', NULL, NULL, '0.00', '40.00', '0.00', 6, '2013-02-15', NULL, NULL, 0, NULL, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1760588818', 0, 'Y', 0, '2013-02-28', NULL, NULL, 0, 0, NULL, NULL),
('202622667', 'ELHCA0152', 'ELHCA0152', 'TXHOUSTD', 'Sugarland Medical Associates', 'Abraham', NULL, 'Peringol', 'MD', 'Family Practice', ' ', '', NULL, 'B', 'PO Box 403856  ', 'Atlanta', 'Fulton', 'GA', '30384', '          ', NULL, 'PO Box 403856  ', 'Atlanta', 'Fulton', 'GA', '30384', '          ', '          ', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'West Houston Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1053445361', 0, 'Y', 0, '2013-05-01', NULL, NULL, 0, 0, NULL, NULL),
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('202622667', 'ELHCA0151', 'ELHCA0151', 'TXHOUSTD', 'Sugarland Medical Associates', 'Abraham', NULL, 'Peringol', 'MD', 'Family Practice', ' ', '', NULL, 'O', '14815 Southwest Fwy                    ', 'Sugar Land', 'Fort Bend', 'TX', '77478', '2815652140', '2815652174', '14815 Southwest Fwy                    ', 'Sugar Land', 'Fort Bend', 'TX', '77478', '2815652140', '2815652174', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'West Houston Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1053445361', 0, 'N', 0, '2013-05-01', NULL, NULL, 29.6121, -95.6084, NULL, NULL),
('452298151', 'ELHCA0149', 'ELHCA0149', 'TXHOUSTD', 'Houston Heart Associates  ', 'Gregory', NULL, 'Pepper', 'MD', 'Cardiology', ' ', '', NULL, 'O', '15200 Southwest Fwy  Ste 290', 'Sugar Land', 'Fort Bend', 'TX', '77478', '2819802010', '2819802321', '15200 Southwest Fwy  Ste 290', 'Sugar Land', 'Fort Bend', 'TX', '77478', '2819802010', '2819802321', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Houston Methodist Sugar Land Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1386674901', 0, 'N', 0, '2013-05-01', NULL, NULL, 29.6072, -95.6143, NULL, NULL),
('841409176', 'W40009562', 'W40009562', 'UTMH1', 'Northeastern Counseling Center', 'Jeremy', '', 'Patton', 'LCSW', 'Mental Health', '', '', NULL, 'O', '285 W 800 S', 'Roosevelt', 'Duchesne', 'UT', '84066', '4357256300', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'UTMA', '', '', '0.00', '40.00', '0.00', 6, '2013-02-15', NULL, NULL, 0, 0, '', '', '', '', 'HCFA|UB|', '1588867766', 0, 'N', 0, '2013-02-28', NULL, NULL, 40.292, -109.993, NULL, NULL),
('841409176', 'W40009563', 'W40009563', 'UTMH1', 'Northeastern Counseling Center', 'Jeremy', '', 'Patton', 'LCSW', 'Mental Health', '', '', NULL, 'B', '1140 W 500 S Ste 9', 'Vernal', 'Uintah', 'UT', '84078', '4357256300', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'UTMA', '', '', '0.00', '40.00', '0.00', 6, '2013-02-15', NULL, NULL, 0, 0, '', '', '', '', 'HCFA|UB|', '1588867766', 0, 'N', 0, '2013-02-28', NULL, NULL, 0, 0, NULL, NULL),
('942938348', 'W40006840', 'W40006840', 'UTMH1', 'Valley Mental Health  Inc', 'SHERIE LEE', NULL, 'PATON', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', '5965 S 900 E Ste 430', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012637100', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'UTVMHMA', NULL, NULL, '0.00', '40.00', '0.00', 6, '2013-02-15', NULL, NULL, 0, NULL, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1699745778', 0, 'Y', 0, '2013-02-28', NULL, NULL, 0, 0, NULL, NULL),
('364314354', 'ELPPA0350', 'ELPPA0350', 'ILCHIGSTD', 'Provena Medical Group - Lockport 9th St', 'Lee', 'V', 'Patterson', 'MD', 'Pediatrics', '', '', NULL, 'B', '25872 Network Place', 'Chicago', 'Cook', 'IL', '60673', '8158380694', '8158380705', '25872 Network Place', 'Chicago', 'Cook', 'IL', '60673', '8158380694', '8158380705', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1700905981', 0, 'Y', 0, '2013-04-03', NULL, NULL, 0, 0, NULL, NULL),
('272713767', 'TX0107256', 'TX0107256', 'TXSATSTD', 'Cardiology Clinic of San Antonio', 'Devang', 'N', 'Patel', 'MD', 'Cardiovascular Disease', '', '', NULL, 'B', 'PO Box 741248', 'Atlanta', 'Fulton', 'GA', '30374', '2104906000', '2104904658', 'PO Box 741248', 'Atlanta', 'Fulton', 'GA', '30374', '2104906000', '2104904658', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2014-06-15', 0, 0, 0, 'North Central Baptist Hospital', 'St Lukes Baptist Hospital', NULL, NULL, 'HCFA|UB|', '1306952627', 0, 'Y', 0, '2014-05-06', NULL, NULL, 0, 0, NULL, NULL),
('272713767', 'TX0107255', 'TX0107255', 'TXSATSTD', 'Cardiology Clinic of San Antonio', 'Devang', 'N', 'Patel', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '4411 Medical Dr Ste 300', 'San Antonio', 'Bexar', 'TX', '78229', '2106145400', '2106142431', '4411 Medical Dr Ste 300', 'San Antonio', 'Bexar', 'TX', '78229', '2106145400', '2106142431', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-04-24', 0, 0, 0, 'North Central Baptist Hospital', 'St Lukes Baptist Hospital', NULL, NULL, 'HCFA|UB|', '1306952627', 0, 'N', 0, '2013-10-28', NULL, NULL, 29.5103, -98.5724, NULL, NULL),
('272713767', 'TX0107257', 'TX0107257', 'TXSATSTD', 'Cardiology Clinic of San Antonio', 'Devang', 'N', 'Patel', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '3903 Wiseman Blvd Ste 315', 'San Antonio', 'Bexar', 'TX', '78251', '2106145400', '2106142431', '3903 Wiseman Blvd Ste 315', 'San Antonio', 'Bexar', 'TX', '78251', '2106145400', '2106142431', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2014-06-15', 0, 0, 0, 'North Central Baptist Hospital', 'St Lukes Baptist Hospital', NULL, NULL, 'HCFA|UB|', '1306952627', 0, 'N', 0, '2014-05-06', NULL, NULL, 29.4763, -98.6953, NULL, NULL),
('272713767', 'TX0107258', 'TX0107258', 'TXSATSTD', 'Cardiology Clinic of San Antonio', 'Devang', 'N', 'Patel', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '255 E Sonterra Blvd Ste 150', 'San Antonio', 'Bexar', 'TX', '78258', '2104906000', '2104904658', '255 E Sonterra Blvd Ste 150', 'San Antonio', 'Bexar', 'TX', '78258', '2104906000', '2104904658', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2014-06-15', 0, 0, 0, 'North Central Baptist Hospital', 'St Lukes Baptist Hospital', NULL, NULL, 'HCFA|UB|', '1306952627', 0, 'N', 0, '2014-05-06', NULL, NULL, 29.6164, -98.4911, NULL, NULL),
('272713767', 'W12007256', 'W12007256', 'TX01', 'Cardiology Clinic of San Antonio', 'Devang', 'N', 'Patel', 'MD', 'Cardiovascular Disease', '', '', NULL, 'B', 'PO Box 741248', 'Atlanta', 'Fulton', 'GA', '30374', '2104906000', '2104904658', 'PO Box 741248', 'Atlanta', 'Fulton', 'GA', '30374', '2104906000', '2104904658', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2010-09-01', '2012-08-19', 0, 0, 0, 'North Central Baptist Hospital', 'St Lukes Baptist Hospital', NULL, NULL, 'HCFA|UB|', '1306952627', 0, 'N', 0, '2013-10-28', NULL, NULL, 0, 0, NULL, NULL),
('272713767', 'W12007257', 'W12007257', 'TX01', 'Cardiology Clinic of San Antonio', 'Devang', 'N', 'Patel', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '3903 Wiseman Blvd Ste 315', 'San Antonio', 'Bexar', 'TX', '78251', '2106145400', '2106142431', '3903 Wiseman Blvd Ste 315', 'San Antonio', 'Bexar', 'TX', '78251', '2106145400', '2106142431', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2010-09-01', '2012-08-19', 0, 0, 0, 'North Central Baptist Hospital', 'St Lukes Baptist Hospital', NULL, NULL, 'HCFA|UB|', '1306952627', 0, 'N', 0, '2013-10-28', NULL, NULL, 29.4776, -98.695, NULL, NULL),
('272713767', 'W12007255', 'W12007255', 'TX01', 'Cardiology Clinic of San Antonio', 'Devang', 'N', 'Patel', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '4411 Medical Dr Ste 300', 'San Antonio', 'Bexar', 'TX', '78229', '2106145400', '2106142431', '4411 Medical Dr Ste 300', 'San Antonio', 'Bexar', 'TX', '78229', '2106145400', '2106142431', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2010-09-01', '2012-08-19', 0, 0, 0, 'North Central Baptist Hospital', 'St Lukes Baptist Hospital', NULL, NULL, 'HCFA|UB|', '1306952627', 0, 'N', 0, '2013-10-28', NULL, NULL, 29.5103, -98.5724, NULL, NULL),
('113676182', 'TX0121171', 'TX0121171', 'TXSATSTD', 'The Podiatry Group of South Texas', 'John', 'E', 'Konkol', 'DPM', 'Podiatry', '', '', NULL, 'O', '414 Navarro Ste 811', 'San Antonio', 'Bexar', 'TX', '78205', '2102221077', NULL, '414 Navarro Ste 811', 'San Antonio', 'Bexar', 'TX', '78205', '2102221077', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', '2013-05-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1588758791', 0, 'N', 0, '2013-05-01', NULL, NULL, 29.4256, -98.4895, NULL, NULL),
('113676182', 'TX0121198', 'TX0121198', 'TXSATSTD', 'The Podiatry Group of South Texas', 'John', 'E', 'Konkol', 'DPM', 'Podiatry', '', '', NULL, 'M', '45 NE Loop 410 Ste 920', 'San Antonio', 'Bexar', 'TX', '78296', '2102221077', NULL, '45 NE Loop 410 Ste 920', 'San Antonio', 'Bexar', 'TX', '78296', '2102221077', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1588758791', 0, 'N', 0, '2013-05-01', NULL, NULL, 0, 0, NULL, NULL),
('113676182', 'TX0121199', 'TX0121199', 'TXSATSTD', 'The Podiatry Group of South Texas', 'John', 'E', 'Konkol', 'DPM', 'Podiatry', '', '', NULL, 'B', 'PO Box 1277', 'San Antonio', 'Bexar', 'TX', '78295', '2102221077', NULL, 'PO Box 1277', 'San Antonio', 'Bexar', 'TX', '78295', '2102221077', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-20', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1588758791', 0, 'N', 0, '2013-05-01', NULL, NULL, 0, 0, NULL, NULL);
