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
('820161600', 'W11023862', 'W11023862', 'IDREC', 'Pediatric Neurology of Idaho', 'David', 'B', 'Bettis', 'MD (Recognized PPO but not contracted pre-aut', 'Pediatric Neurology', '', '', NULL, 'O', '100 E Idaho St Ste 201', 'Boise', 'Ada', 'ID', '83712', '2083815180', NULL, '100 E Idaho St Ste 201', 'Boise', 'Ada', 'ID', '83712', '2083815180', '', '', NULL, NULL, '0.00', '0.00', '0.00', 8, '2010-01-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1053425603', 0, 'n', 0, '2011-11-15', NULL, NULL, 43.6123, -116.194, NULL, NULL),
('205934739', 'W11023863', 'W11023863', 'ID02', 'Family Medicine Health Center', 'Amber', 'M', 'Vickers', 'PA-C', 'Family Practice', 'Physician Assistant', '', NULL, 'O', '2321 E Gala St Ste 2', 'Meridian', 'Ada', 'ID', '83642', '2085142500', NULL, '2321 E Gala St Ste 2', 'Meridian', 'Ada', 'ID', '83642', '2085142500', '', 'IDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2010-01-29', '2010-05-07', 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1114964616', 0, 'N', 0, '2014-04-14', NULL, NULL, 0, 0, NULL, NULL),
('205934739', 'W11023864', 'W11023864', 'ID02', 'Family Medicine Health Center', 'Charles', 'T', 'Sherwood', 'PA-C', 'Family Practice', 'Physician Assistant', '', NULL, 'O', '2321 E Gala St Ste 2', 'Meridian', 'Ada', 'ID', '83642', '2085142500', NULL, '2321 E Gala St Ste 2', 'Meridian', 'Ada', 'ID', '83642', '2085142500', '', 'IDPPO', 'WUSTDHCPC5', NULL, '0.00', '30.00', '0.00', 3, '2010-01-29', NULL, 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1215979000', 0, 'n', 0, '2013-07-11', NULL, NULL, 0, 0, NULL, NULL),
('585528806', 'W11023865', 'W11023865', 'Sinclair', '(Sinclair Health Services\rProvider) Wood River Counseling Center', 'Terri', 'S', 'James', 'LCPC', 'Mental Health', 'Counseling', '', NULL, 'O', '220 S 2nd Ave', 'Hailey', 'Blaine', 'ID', '83333', '2087885625', NULL, '220 S 2nd Ave', 'Hailey', 'Blaine', 'ID', '83333', '2087885625', '', '', NULL, NULL, '0.00', '20.00', '0.00', 3, '2010-01-25', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1043305253', 0, 'n', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('820399684', 'W11023866', 'W11023866', 'ID02', 'Idaho Eyecare', 'Amber', 'L', 'Simonson', 'OD', 'Optometry', '', '', NULL, 'O', '1175 W Boise Ave', 'Boise', 'Ada', 'ID', '83706', '2083849194', NULL, '1175 W Boise Ave', 'Boise', 'Ada', 'ID', '83706', '2083849194', '          ', 'IDOPTOMETRY', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-01-25', '2010-09-10', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1386689156', 0, 'Y', 0, '2010-01-29', NULL, NULL, 0, 0, NULL, NULL),
('742467878', 'W11023867', 'W11023867', 'TX01', '', 'Leonard', 'R', 'Kajs', 'LCSW LPC', 'Mental Health', 'Counseling', 'Social Worker', NULL, 'O', '8207 Callaghan Rd Ste 425', 'San Antonio', 'Bexar', 'TX', '78230', '2109797100', NULL, '8207 Callaghan Rd Ste 425', 'San Antonio', 'Bexar', 'TX', '78230', '2109797100', '', 'TXMHMA10', '', '', '0.00', '45.00', '0.00', 3, '2010-02-01', '2010-03-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1477642593', 0, 'N', 0, '2013-09-10', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'W11023868', 'W11023868', 'UT01', NULL, 'Nathan', 'W', 'Elmore', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '1842 S 2000 W', 'Syracuse', 'Davis', 'UT', '84075', '8017747540', '8017747542', '867 E 9400 S', 'Sandy', 'Davis', 'UT', '84094', NULL, NULL, 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', '0.00', '55.46', 3, '2010-01-22', '2010-10-31', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0167979902', 0, 'N', 0, '2010-02-02', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11023869', 'W11023869', 'UTIHCPHY', 'Southwest Spine & Pain Center', 'Rick', 'W', 'Obray', 'MD', 'Radiology', '', '', NULL, 'o', '652 S Medical Ctr Dr Ste 110', 'St George', 'Washington', 'UT', '84790', '4352513700', NULL, '652 S Medical Center Dr Ste 110', 'St George', 'Washington', 'UT', '84790', '4352513700', '          ', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2010-01-14', '2011-09-10', 0, 0, 0, 'Dixie Regional Medical Center', '', '', '', 'HCFA|UB|', '1316087372', 0, 'N', 0, '2011-12-27', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11023870', 'W11023870', 'UTIHCPHY', 'Logan Hospitalists', 'Rob', 'K', 'Perkins', 'MD', '', 'Hospitalists', '', NULL, 'o', '1400 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357161000', NULL, '1400 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357161000', '          ', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2009-12-01', '2013-08-04', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1326087867', 0, 'N', 0, '2013-09-05', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11023871', 'W11023871', 'UTIHCPHY', 'Park City Specialty Clinic', 'LaReine', 'S', 'Sabella', 'MD', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'o', '900 Round Valley Dr Ste 200', 'Park City', 'Summit', 'UT', '84060', '4356574400', NULL, NULL, NULL, 'Summit', NULL, NULL, NULL, NULL, 'USTDMULT', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 8, '2010-01-14', NULL, NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1992716211', 0, 'n', 0, '2010-02-02', NULL, NULL, 40.6876, -111.468, NULL, NULL),
('942854057', 'W11023872', 'W11023872', 'UTIHCPHY', 'Heber Valley Clinic', 'Terry', 'L', 'Schoenwald', 'APRN', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'o', '1473 S Hwy 40 Ste E', 'Heber City', 'Wasatch', 'UT', '84032', '4356574400', NULL, NULL, NULL, 'Wasatch', NULL, NULL, NULL, NULL, 'USTDMULT', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 8, '2009-04-01', '2009-12-31', NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1871587121', 0, 'n', 0, '2010-02-02', NULL, NULL, 0, 0, NULL, NULL),
('237268471', 'W11024298', 'W11024298', 'UT01', 'University Health Care', 'Matt', 'T', 'Moore', 'MD', 'Diagnostic Radiology', '', '', NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015817553', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015817553', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2010-01-01', '2012-08-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1598939613', 0, 'N', 0, '2012-08-02', NULL, NULL, 0, 0, NULL, NULL),
('237268471', 'W11024297', 'W11024297', 'UT01', 'University Radiology Associates', 'Matt', 'T', 'Moore', 'MD', 'Diagnostic Radiology', '', '', NULL, 'B', 'PO Box 413025', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413025', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2010-01-01', '2012-08-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1598939613', 0, 'N', 0, '2012-08-02', NULL, NULL, 0, 0, NULL, NULL),
('942938348', 'W11023873', 'W11023873', 'UTMH1', 'Valley Mental Health  Inc', 'Alex', 'C', 'Gonzalez', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'B', '5965 S 900 E Ste 430', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012637100', NULL, '5965 S 900 E Ste 430', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012637100', '', 'UTVMHMA', NULL, NULL, '0.00', '35.00', '0.00', 6, '2008-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1740423078', 0, 'Y', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('942938348', 'W11023874', 'W11023874', 'UTMH1', 'Valley Mental Health  Inc', 'Travis', 'K', 'Labrum', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', '5965 S 900 E Ste 430', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012637100', NULL, '5965 S 900 E Ste 430', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012637100', '', 'UTVMHMA', NULL, NULL, '0.00', '35.00', '0.00', 6, '2010-02-01', '2013-02-14', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000007172', 0, 'Y', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('942938348', 'W11023875', 'W11023875', 'UTMH1', 'Valley Mental Health  Inc', 'Celeste', NULL, 'Bennett', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', '5965 S 900 E Ste 430', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012637100', NULL, '5965 S 900 E Ste 430', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012637100', '', 'UTVMHMA', NULL, NULL, '0.00', '35.00', '0.00', 6, '2010-02-01', '2013-02-14', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1932309804', 0, 'Y', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('263045510', 'W11023876', 'W11023876', 'ID01', NULL, 'Sheila', 'E', 'Sturgeon Freitas', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '3709 N Locust Grove Rd Ste 150', 'Meridian', 'Ada', 'ID', '83646', '2084754690', NULL, '3709 N Locust Grove Rd Ste 150', 'Meridian', 'Ada', 'ID', '83646', '2084754690', '', 'IDPHD', NULL, NULL, '0.00', '35.00', '0.00', 3, '2010-02-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1134248750', 0, 'n', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('820399684', 'W11023877', 'W11023877', 'ID02', 'Idaho Eyecare', 'John', 'H', 'Muto', 'OD', 'Optometry', '', '', NULL, 'O', '1175 W Boise Ave', 'Boise', 'Ada', 'ID', '83706', '2083849194', NULL, '1175 W Boise Ave', 'Boise', 'Ada', 'ID', '83706', '2083849194', '          ', 'IDOPTOMETRY', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-01-27', '2010-09-10', 0, 0, 1, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1912091174', 0, 'Y', 0, '2010-02-04', NULL, NULL, 0, 0, NULL, NULL),
('870710584', 'W11023878', 'W11023878', 'UTMH1', 'Jordan West Family Counseling', 'Marie', '', 'Snow', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '9263 B Redwood Rd', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015660749', NULL, '9263 B Redwood Rd', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015660749', '', 'MA', NULL, NULL, '0.00', '35.00', '0.00', 6, '2010-02-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1265443865', 0, 'n', 0, '2013-09-10', NULL, NULL, 0, 0, NULL, NULL),
('545311492', 'W11023879', 'W11023879', 'Sinclair', '(Sinclair Health Services\rProvider) Wood River Counseling Center', 'Heidi', '', 'Jorgensen', 'LPC LMFT', 'Mental Health', 'Counseling', 'Marriage & Family Therapy', NULL, 'O', '220 2nd Ave S', 'Hailey', 'Blaine', 'ID', '83333', '2087885625', NULL, '220 2nd Ave S', 'Hailey', 'Blaine', 'ID', '83333', '2087885625', '', '', '', '', '0.00', '20.00', '0.00', 3, '2010-02-01', '2013-04-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1952451734', 0, 'Y', 0, '2014-07-17', NULL, NULL, 0, 0, NULL, NULL),
('820399684', 'W11023880', 'W11023880', 'ID02', 'Idaho Eyecare', 'Jeffrey', 'P', 'Graviet', 'OD', 'Optometry', '', '', NULL, 'O', '1175 W Boise Ave', 'Boise', 'Ada', 'ID', '83706', '2083849194', NULL, '1175 W Boise Ave', 'Boise', 'Ada', 'ID', '83706', '2083849194', '          ', 'IDOPTOMETRY', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-01-27', '2010-09-10', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1831148105', 0, 'Y', 0, '2013-12-10', NULL, NULL, 0, 0, NULL, NULL),
('820399684', 'W11023881', 'W11023881', 'ID02', 'Idaho Eyecare Center', 'Zackary', 'N', 'Hall', 'OD', 'Optometry', '', '', NULL, 'O', '1175 W Boise Ave', 'Boise', 'Ada', 'ID', '83706', '2083849194', NULL, '1175 W Boise Ave', 'Boise', 'Ada', 'ID', '83706', '2083849194', '          ', 'IDOPTOMETRY', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-01-27', '2010-09-10', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1588759229', 0, 'Y', 0, '2013-09-12', NULL, NULL, 0, 0, NULL, NULL),
('522762784', 'W11023882', 'W11023882', 'TX01', NULL, 'Randall', 'R', 'Lyle', 'PHD', 'Mental Health', 'Marriage & Family Therapy', '', NULL, 'O', '4230 Gradendale St Ste 502', 'San Antonio', 'Bexar', 'TX', '78224', '2105939725', NULL, '4230 Gradendale St Ste 502', 'San Antonio', 'Bexar', 'TX', '78224', '2105939725', '', 'TXMHPHD10', NULL, NULL, '0.00', '35.00', '0.00', 3, '2010-02-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1235216599', 0, 'n', 0, '2013-09-09', NULL, NULL, 29.5238, -98.5675, NULL, NULL),
('742246239', 'W11023883', 'W11023883', 'TX01', 'San Antonio Gastroenterology Associates', 'Jeffery', 'S', 'Bullock', 'MD', 'Gastroenterology', '', '', NULL, 'O', '150 E Sonterra Blvd Ste 100', 'San Antonio', 'Bexar', 'TX', '78258', '2102710606', NULL, '150 E Sonterra Blvd Ste 100', 'San Antonio', 'Bexar', 'TX', '78258', '2102710606', '', 'TXSURGA', 'TXHCPCS', NULL, '0.00', '50.00', '0.00', 3, '2010-01-29', '2012-08-19', 0, 0, 0, 'Baptist Medical Center', 'Mission Trail Baptist Hospital', 'St Lukes Baptist Hospital', NULL, 'HCFA|UB|', '1528062288', 0, 'N', 0, '2013-09-24', NULL, NULL, 29.6152, -98.4924, NULL, NULL),
('742246239', 'W11023884', 'W11023884', 'TX01', 'San Antonio Gastroenterology Associates', 'Michael', 'S', 'Lindner', 'MD', 'Gastroenterology', '', '', NULL, 'O', '150 E Sonterra Blvd Ste 100', 'San Antonio', 'Bexar', 'TX', '78258', '2102710606', NULL, '150 E Sonterra Blvd Ste 100', 'San Antonio', 'Bexar', 'TX', '78258', '2102710606', '', 'TXSURGA', 'TXHCPCS', NULL, '0.00', '50.00', '0.00', 3, '2010-01-29', '2012-08-19', 0, 0, 0, 'Baptist Medical Center', 'St Lukes Baptist Hospital', 'Mission Trail Baptist Hospital', NULL, 'HCFA|UB|', '1649274309', 0, 'N', 0, '2013-04-24', NULL, NULL, 29.6152, -98.4924, NULL, NULL),
('270976784', 'W11023885', 'W11023885', 'ID01', 'Green Leaves Counseling', 'Dana', 'H', 'Unruh', 'LCPC', 'Mental Health', 'Counseling', '', NULL, 'B', 'PO Box 1217', 'Meridian', 'Ada', 'ID', '83680', '2088552295', NULL, 'PO Box 1217', 'Meridian', 'Ada', 'ID', '83680', '2088552295', '', 'IDMA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2009-10-21', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1851306500', 0, 'y', 0, '2011-09-29', NULL, NULL, 0, 0, NULL, NULL),
('270976784', 'W11023886', 'W11023886', 'ID01', 'Green Leaves Counseling', 'Dana', 'H', 'Unruh', 'LCPC', 'Mental Health', 'Counseling', '', NULL, 'O', '3709 N Locust Grove Rd Ste 100', 'Meridian', 'Ada', 'ID', '83646', '2088552295', NULL, '3709 N Locust Grove Rd Ste 100', 'Meridian', 'Ada', 'ID', '83646', '2088552295', '', 'IDMA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2009-10-21', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1851306500', 0, 'n', 0, '2011-09-29', NULL, NULL, 0, 0, NULL, NULL),
('731672377', 'W11023887', 'W11023887', 'UT01', 'Mountain West Family Medicine', 'Holly', 'J', 'Green', 'APRN', 'Internal Medicine', 'Family Practice', '', NULL, 'O', '440 S Medical Dr Ste 2', 'Bountiful', 'Davis', 'UT', '84010', '8012940191', NULL, '440 S Medical Dr Ste 2', 'Bountiful', 'Davis', 'UT', '84010', '8012940191', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-02-04', NULL, 0, 0, 0, 'Lakeview Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1205000718', 0, 'N', 0, '2013-12-23', NULL, NULL, 40.8873, -111.872, NULL, NULL),
('942854057', 'W11023890', 'W11023890', 'UTIHC04', 'Pediatrics', 'Faizi', 'A', 'Siddiqi', 'MD', 'Plastic Surgery', 'Pediatrics', '', NULL, 'O', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621000', NULL, '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621000', '', '', NULL, NULL, '0.00', '10.00', '0.00', 8, '2008-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1982794517', 0, 'N', 0, '2013-09-03', NULL, NULL, 40.7663, -111.837, NULL, NULL),
('942854057', 'W11023888', 'W11023888', 'UTIHC04', 'Emergency Room', 'Zachary', 'Max', 'Bailey', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '440 W 600 N', 'Tremonton', 'Box Elder', 'UT', '84337', '4352577441', NULL, '440 W 600 N', 'Tremonton', 'Box Elder', 'UT', '84337', '4352577441', '', '', NULL, NULL, '0.00', '15.00', '0.00', 8, '2008-11-01', '2010-01-22', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1942492426', 0, 'Y', 0, '2013-10-14', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11023889', 'W11023889', 'UTIHC04', 'Emergency Room', 'Zachary', 'Max', 'Bailey', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '905 N 1000 W', 'Tremonton', 'Box Elder', 'UT', '84337', '4352577441', NULL, '905 N 1000 W', 'Tremonton', 'Box Elder', 'UT', '84337', '4352577441', '          ', '', '', '', '0.00', '15.00', '0.00', 8, '2010-01-22', '2012-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1942492426', 0, 'Y', 0, '2013-10-14', NULL, NULL, 0, 0, NULL, NULL),
('870619420', 'W11024293', 'W11024293', 'UT01', 'College of Nursing, University of Utah', 'Tiffany', 'B', 'Lundeen', 'CNM', 'Obstetrics and Gynecology', 'Certified Nurse Midwife', '', NULL, 'B', 'PO Box 413036', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413036', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2010-01-04', '2012-09-18', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1942257324', 0, 'N', 0, '2012-09-19', NULL, NULL, 0, 0, NULL, NULL),
('237268471', 'W11024292', 'W11024292', 'UT01', 'University Health Care', 'Thomas', 'J', 'Druzgal', 'MD', 'Diagnostic Radiology', '', '', NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015817553', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015817553', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2010-01-01', '2010-06-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1043345762', 0, 'N', 0, '2010-03-01', NULL, NULL, 0, 0, NULL, NULL),
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('203373192', 'W11023949', 'W11023949', 'UT01', 'Ashley Valley Family Practice', 'Justin', 'L', 'Brinkerhoff', 'PA-C', 'Family Practice', '', '', NULL, 'B', 'PO Box 150610', 'Ogden', 'Weber', 'UT', '84415', '4357818899', NULL, 'PO Box 150610', 'Ogden', 'Weber', 'UT', '84415', '4357818899', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2010-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1568532125', 0, 'Y', 0, '2013-05-17', NULL, NULL, 0, 0, NULL, NULL),
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('202292256', 'W11023952', 'W11023952', 'UT01', 'The NeuroDevelopment Center', 'Parth', 'V', 'Gandhi', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '722 W Shepard Ln', 'Farmington', 'Davis', 'UT', '84025', '8016495300', NULL, '722 W Shepard Ln', 'Farmington', 'Davis', 'UT', '84025', '8016495300', '', 'PHD', NULL, NULL, '0.00', '35.00', '0.00', 3, '2010-02-15', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1396980603', 0, 'n', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
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('742796322', 'W11023954', 'W11023954', 'TX01', 'Southwest Allergy & Asthma Clinic', 'Roberto', '', 'Rodriguez', 'MD', 'Allergy and Immunology', '', '', NULL, 'O', '3903 Wiseman Blvd Ste 202', 'San Antonio', 'Bexar', 'TX', '78251', '2107670690', NULL, '3903 Wiseman Blvd Ste 202', 'San Antonio', 'Bexar', 'TX', '78251', '2107670690', '', 'TXSTD', 'TXHCPCS', NULL, '0.00', '50.00', '0.00', 3, '2010-02-15', '2012-08-19', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1821069550', 0, 'n', 0, '2013-11-18', NULL, NULL, 29.4776, -98.695, NULL, NULL),
('900120192', 'W11023955', 'W11023955', 'TX01', 'Sports Medicine Associates of San Antonio', 'Eliot', 'J', 'Young', 'MD', 'Sports Medicine', 'Family Practice', '', NULL, 'B', 'PO Box 196', 'San Antonio', 'Bexar', 'TX', '78291', '2106998326', NULL, 'PO Box 196', 'San Antonio', 'Bexar', 'TX', '78291', '2106998326', '', 'TXORTHO', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2010-02-15', '2012-08-19', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1942206008', 0, 'y', 0, '2014-07-18', NULL, NULL, 0, 0, NULL, NULL),
('900120192', 'W11023956', 'W11023956', 'TX01', 'Sports Medicine Associates of San Antonio', 'Eliot', 'J', 'Young', 'MD', 'Sports Medicine', 'Family Practice', '', NULL, 'O', '21 Spurs Ln Ste 300', 'San Antonio', 'Bexar', 'TX', '78240', '2106998326', NULL, '21 Spurs Ln Ste 300', 'San Antonio', 'Bexar', 'TX', '78240', '2106998326', '', 'TXORTHO', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2010-02-15', '2012-08-19', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1942206008', 0, 'N', 0, '2014-07-18', NULL, NULL, 29.5271, -98.5917, NULL, NULL),
('900120192', 'W11023957', 'W11023957', 'TX01', 'Sports Medicine Associates of San Antonio', 'Eliot', 'J', 'Young', 'MD', 'Sports Medicine', 'Family Practice', '', NULL, 'O', '5921 Broadway Ste 300', 'San Antonio', 'Bexar', 'TX', '78209', '2108268326', NULL, '5921 Broadway Ste 300', 'San Antonio', 'Bexar', 'TX', '78209', '2108268326', '', 'TXORTHO', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2010-02-15', '2012-08-19', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1942206008', 0, 'N', 0, '2014-07-18', NULL, NULL, 29.4805, -98.465, NULL, NULL),
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('870572252', 'W11023975', 'W11023975', 'UT01', 'Hidden Valley Family Medicine', 'Hazen', 'T', 'Herzog', 'PA', 'Family Practice', '', '', NULL, 'B', 'PO Box 150610', 'Ogden', 'Weber', 'UT', '84415', '8015723750', NULL, 'PO Box 150610', 'Ogden', 'Weber', 'UT', '84415', '8015723750', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-02-15', '2011-11-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1932433190', 0, 'N', 0, '2011-11-17', NULL, NULL, 0, 0, NULL, NULL),
('870572252', 'W11023976', 'W11023976', 'UT01', 'Hidden Valley Family Medicine', 'Hazen', 'T', 'Herzog', 'PA', 'Family Practice', '', '', NULL, 'O', '12176 S 1000 E', 'Draper', 'Salt Lake', 'UT', '84020', '8015723750', NULL, '12176 S 1000 E', 'Draper', 'Salt Lake', 'UT', '84020', '8015723750', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-02-15', '2011-11-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1932433190', 0, 'N', 0, '2011-11-17', NULL, NULL, 0, 0, NULL, NULL),
('911394965', 'W11023977', 'W11023977', 'ID02', 'Pacific Cataract & Laser', '', '', 'Pacific Cataract & Laser', 'GROUP', 'Ambulatory Surgery Center', '', '', NULL, 'O', '2822 S Vista Ave', 'Boise', 'Ada', 'ID', '83705', '2083857576', NULL, NULL, NULL, 'Ada', NULL, NULL, NULL, NULL, '', NULL, 'OPID02', '0.00', '0.00', '0.00', 6, '2010-02-01', NULL, 1, 0, 1, '', '', '', '', 'HCFA|UB|', '1275700957', 0, 'N', 0, '2010-02-11', NULL, NULL, 43.5768, -116.213, NULL, NULL),
('263749619', 'W11023978', 'W11023978', 'TX01', 'Texas Medical and Sleep Specialists', 'Kelly', 'J', 'Smith', 'MD', 'Sleep Medicine', 'Pediatric Pulmonology', NULL, NULL, 'O', '525 Oak Ctr Dr Ste 440', 'San Antonio', 'Bexar', 'TX', '78258', '2102495020', NULL, '525 Oak Center Dr', 'San Antonio', 'Bexar', 'TX', '78258', NULL, NULL, 'TXSURGC', 'TXHCPCS', NULL, '0.00', '50.00', '0.00', 3, '2010-02-15', NULL, 0, 0, 0, 'North Central Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1528198405', 0, 'N', 0, '2010-02-11', NULL, NULL, 29.6189, -98.4917, NULL, NULL),
('263749619', 'W11023979', 'W11023979', 'TX01', 'Texas Medical and Sleep Specialists PLLC', 'Kelly', 'J', 'Smith', 'MD', 'Sleep Medicine', 'Pediatric Pulmonology', NULL, NULL, 'B', 'PO Box 230', 'San Antonio', 'Bexar', 'TX', '78291', '2102495020', NULL, '525 Oak Center Dr', 'San Antonio', 'Bexar', 'TX', '78258', NULL, NULL, 'TXSURGC', 'TXHCPCS', NULL, '0.00', '50.00', '0.00', 3, '2010-02-15', NULL, 0, 0, 0, 'North Central Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1528198405', 0, 'y', 0, '2010-02-11', NULL, NULL, 0, 0, NULL, NULL),
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('263749619', 'W11023981', 'W11023981', 'TX01', 'Texas Medical and Sleep Specialists', 'Avie', 'A', 'Grunspan', 'MD', 'Sleep Medicine', 'Internal Medicine', '', NULL, 'O', '525 Oak Ctr Dr Ste 440', 'San Antonio', 'Bexar', 'TX', '78258', '2102495020', NULL, '525 Oak Ctr Dr Ste 440', 'San Antonio', 'Bexar', 'TX', '78258', '2102495020', '          ', 'TXSURGC', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2010-02-15', '2013-10-07', 0, 0, 0, 'North Central Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1881695542', 0, 'N', 0, '2013-12-10', NULL, NULL, 29.6193, -98.4926, NULL, NULL),
('841616246', 'W11023982', 'W11023982', 'UT01', NULL, 'Edith', 'A', 'Shepherd', 'APRN', 'Adult Nurse Practitioner', NULL, NULL, NULL, 'B', '125 E Main St Ste 135', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8016542568', NULL, '125 E Main St', 'Salt Lake City', 'Salt Lake', 'UT', '84107', NULL, NULL, 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2010-02-15', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1134457682', 0, 'y', 0, '2010-02-11', NULL, NULL, 0, 0, NULL, NULL),
('870636424', 'W11023983', 'W11023983', 'UT01', 'Grantsville Medical Clinic', 'Rebekah', '', 'Aldridge', 'PA', 'Family Practice', '', '', NULL, 'O', '822 E Main St Ste 7', 'Grantsville', 'Tooele', 'UT', '84029', '4358843578', NULL, '822 E Main St Ste 7', 'Grantsville', 'Tooele', 'UT', '84029', '4358843578', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2010-02-15', NULL, 0, 0, 0, 'Mountain West Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1427386770', 0, 'N', 0, '2013-12-02', NULL, NULL, 40.5996, -112.426, NULL, NULL),
('870636424', 'W11023984', 'W11023984', 'UT01', 'Grantsville Medical Clinic', 'Rebekah', '', 'Aldridge', 'PA', 'Family Practice', '', '', NULL, 'B', 'PO Box 1060', 'Grantsville', 'Tooele', 'UT', '84029', '4358843578', NULL, 'PO Box 1060', 'Grantsville', 'Tooele', 'UT', '84029', '4358843578', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2010-02-15', NULL, 0, 0, 0, 'Mountain West Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1427386770', 0, 'y', 0, '2013-12-02', NULL, NULL, 0, 0, NULL, NULL),
('161767581', 'W11023985', 'W11023985', 'UT01', 'Layton Family Practice', 'Mont', 'C', 'Robins', 'PA', 'Family Practice', '', '', NULL, 'B', 'PO Box 281221', 'Atlanta', 'Fulton', 'GA', '30384', '8015469441', NULL, 'PO Box 281221', 'Atlanta', 'Fulton', 'GA', '30384', '8015469441', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2010-02-15', '2010-08-31', 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1467440701', 0, 'y', 0, '2014-04-09', NULL, NULL, 0, 0, NULL, NULL),
('161767581', 'W11023986', 'W11023986', 'UT01', 'Layton Family Practice', 'Mont', 'C', 'Robins', 'PA', 'Family Practice', '', '', NULL, 'O', '124 S Fairfield Rd', 'Layton', 'Davis', 'UT', '84041', '8015469441', NULL, '124 S Fairfield Rd', 'Layton', 'Davis', 'UT', '84041', '8015469441', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2010-02-15', '2010-08-31', 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1467440701', 0, 'N', 0, '2014-04-09', NULL, NULL, 0, 0, NULL, NULL),
('528692286', 'W11023987', 'W11023987', 'UT01', 'Holladay Family Practice', 'Timothy', 'P', 'Young', 'MD', 'Family Practice', '', '', NULL, 'O', '3920 S 1100 E Ste 220', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012682584', NULL, '3920 S 1100 E Ste 220', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012682584', '          ', 'WUSTDMULT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-02-15', '2010-11-01', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1558520189', 0, 'N', 0, '2013-11-25', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W11023988', 'W11023988', 'UT01', 'Central Utah Clinic', 'Jim', 'D', 'Crowley', 'MD', 'Urology', '', '', NULL, 'B', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013577327', NULL, 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013577327', '          ', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-02-15', '2010-07-14', 0, 0, 0, 'Timpanogos Regional Hospital', 'Mountain View Hospital', '', '', 'HCFA|UB|', '1083697957', 0, 'Y', 0, '2013-10-24', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W11023989', 'W11023989', 'UT01', 'Central Utah Clinic', 'Jim', 'D', 'Crowley', 'MD', 'Urology', '', '', NULL, 'O', '1055 N 500 W Ste 211', 'Provo', 'Utah', 'UT', '84604', '8013577327', NULL, '1055 N 500 W Ste 211', 'Provo', 'Utah', 'UT', '84604', '8013577327', '          ', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-02-15', '2010-07-14', 0, 0, 0, 'Timpanogos Regional Hospital', 'Mountain View Hospital', '', '', 'HCFA|UB|', '1083697957', 0, 'N', 0, '2013-10-24', NULL, NULL, 0, 0, NULL, NULL),
('870560763', 'W11023990', 'W11023990', 'UT01', 'Blanding Family Practice', 'Joshua', '', 'Nielson', 'DO', 'Family Practice', '', '', NULL, 'B', 'PO Box 130', 'Montezuma Creek', 'San Juan', 'UT', '84534', '4356783601', NULL, 'PO Box 130', 'Montezuma Creek', 'San Juan', 'UT', '84534', '4356783601', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2010-02-15', NULL, 0, 0, 0, 'Blue mountain hospital', '', '', '', 'HCFA|UB|', '1699776922', 0, 'Y', 0, '2013-11-06', NULL, NULL, 0, 0, NULL, NULL),
('870560763', 'W11023991', 'W11023991', 'UT01', 'Blanding Family Practice', 'Joshua', '', 'Nielson', 'DO', 'Family Practice', '', '', NULL, 'O', '802 S 200 W', 'Blanding', 'San Juan', 'UT', '84511', '4356783601', NULL, '802 S 200 W', 'Blanding', 'San Juan', 'UT', '84511', '4356783601', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2010-02-15', NULL, 0, 0, 0, 'Blue mountain hospital', '', '', '', 'HCFA|UB|', '1699776922', 0, 'N', 0, '2013-11-06', NULL, NULL, 37.6098, -109.479, NULL, NULL),
('870631360', 'W11023992', 'W11023992', 'UT01', 'Brigham Pediatrics', 'Marcus', 'P', 'Buchanan', 'MD', 'Pediatrics', '', '', NULL, 'B', 'PO Box 12173', 'Harrisville', 'Weber', 'UT', '84412', '4357342433', NULL, 'PO Box 12173', 'Harrisville', 'Weber', 'UT', '84412', '4357342433', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2010-02-15', NULL, 0, 0, 0, 'Brigham City Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1407025794', 0, 'Y', 0, '2014-01-17', NULL, NULL, 0, 0, NULL, NULL),
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('742688457', 'W11024026', 'W11024026', 'TX01', 'Heart and Vascular Institute of Texas', 'Christopher', 'W', 'Casey', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '908 E Court St Ste 3', 'Seguin', 'Guadalupe', 'TX', '78155', '8303791666', NULL, '908 E Court St Ste 3', 'Seguin', 'Guadalupe', 'TX', '78155', '8303791666', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2010-02-01', '2012-08-19', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1932129806', 0, 'N', 0, '2014-01-15', NULL, NULL, 0, 0, NULL, NULL),
('742688457', 'W11024027', 'W11024027', 'TX01', 'Heart and Vascular Institute of Texas', 'Stephen', 'M', 'Sokolyk', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '908 E Court St Ste 3', 'Seguin', 'Guadalupe', 'TX', '78155', '8303791666', NULL, '908 E Court St Ste 3', 'Seguin', 'Guadalupe', 'TX', '78155', '8303791666', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2010-02-01', '2012-08-19', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1659462826', 0, 'N', 0, '2014-01-15', NULL, NULL, 0, 0, NULL, NULL),
('742763430', 'W11024028', 'W11024028', 'TX01', 'Allergy Asthma & Immunology Associates of South Texas', 'William', 'T', 'Kniker', 'MD', 'Allergy and Immunology', 'Pediatric Allergy and Immunology', '', NULL, 'O', '19016 Stone Oak Pkwy Ste 250', 'San Antonio', 'Bexar', 'TX', '78258', '2106160882', NULL, '19016 Stone Oak Pkwy Ste 250', 'San Antonio', 'Bexar', 'TX', '78258', '2106160882', '', 'TXSTD', 'TXHCPCS', NULL, '0.00', '50.00', '0.00', 3, '2010-02-08', '2012-08-19', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1710978663', 0, 'N', 0, '2013-09-04', NULL, NULL, 29.6185, -98.4935, NULL, NULL),
('742763430', 'W11024029', 'W11024029', 'TX01', 'Allergy Asthma & Immunology Associates of South Texas', 'Melissa', 'E', 'Garcia', 'PA-C', 'Allergy and Immunology', '', '', NULL, 'O', '19016 Stone Oak Pkwy Ste 250', 'San Antonio', 'Bexar', 'TX', '78258', '2106160882', NULL, '19016 Stone Oak Pkwy Ste 250', 'San Antonio', 'Bexar', 'TX', '78258', '2106160882', '', 'TXSTD', 'TXHCPCS', NULL, '0.00', '50.00', '0.00', 3, '2010-02-08', '2012-08-19', 0, 0, 0, 'North Central Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1205801230', 0, 'N', 0, '2012-05-18', NULL, NULL, 29.6185, -98.4935, NULL, NULL),
('742763430', 'W11024030', 'W11024030', 'TX01', 'Allergy Asthma & Immunology Associates of South Texas', 'Joseph', 'D', 'Diaz', 'MD', 'Allergy and Immunology', 'Pediatric Allergy and Immunology', '', NULL, 'O', '19016 Stone Oak Pkwy Ste 250', 'San Antonio', 'Bexar', 'TX', '78258', '2106160882', NULL, '19016 Stone Oak Pkwy Ste 250', 'San Antonio', 'Bexar', 'TX', '78258', '2106160882', '', 'TXSTD', 'TXHCPCS', NULL, '0.00', '50.00', '0.00', 3, '2010-02-08', '2012-08-19', 0, 0, 0, 'North Central Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1417948241', 0, 'N', 0, '2013-04-04', NULL, NULL, 29.6185, -98.4935, NULL, NULL),
('742763430', 'W11024031', 'W11024031', 'TX01', 'Allergy Asthma & Immunology Associates of South Texas', 'Joseph', 'D', 'Diaz', 'MD', 'Allergy and Immunology', 'Pediatric Allergy and Immunology', '', NULL, 'O', '7500 Barlite Blvd Ste 106', 'San Antonio', 'Bexar', 'TX', '78224', '2106160882', NULL, '7500 Barlite Blvd Ste 106', 'San Antonio', 'Bexar', 'TX', '78224', '2106160882', '', 'TXSTD', 'TXHCPCS', NULL, '0.00', '50.00', '0.00', 3, '2010-02-08', '2012-08-19', 0, 0, 0, 'North Central Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1417948241', 0, 'N', 0, '2013-04-04', NULL, NULL, 29.3515, -98.5457, NULL, NULL),
('742763430', 'W11024032', 'W11024032', 'TX01', 'Allergy Asthma & Immunology Associates of South Texas', 'Melissa', 'E', 'Garcia', 'PA-C', 'Allergy and Immunology', '', '', NULL, 'O', '7500 Barlite Blvd Ste 106', 'San Antonio', 'Bexar', 'TX', '78224', '2106160882', NULL, '7500 Barlite Ste 106', 'San Antonio', 'Bexar', 'TX', '78224', '2106160882', '', 'TXSTD', 'TXHCPCS', NULL, '0.00', '50.00', '0.00', 3, '2010-02-08', '2012-08-19', 0, 0, 0, 'North Central Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1205801230', 0, 'N', 0, '2012-05-18', NULL, NULL, 29.3515, -98.5457, NULL, NULL),
('943485580', 'W11024033', 'W11024033', 'UT01', 'Advanced Pain Management', 'Alexey', 'A', 'Ryskin', 'MD', 'Pain Management', 'Anesthesiology', NULL, NULL, 'O', '620 S 400 E Ste 201', 'St George', 'Washington', 'UT', '84770', '4356560029', NULL, '620 S 400 E', 'St George', 'Washington', 'UT', '84770', NULL, NULL, 'WUSTDPAIN5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2010-02-15', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1366457236', 0, 'N', 0, '2010-02-12', NULL, NULL, 37.0978, -113.575, NULL, NULL),
('943485580', 'W11024034', 'W11024034', 'UT01', 'Advanced Pain Management', 'Alexey', 'A', 'Ryskin', 'MD', 'Pain Management', 'Anesthesiology', NULL, NULL, 'O', '110 W 1325 N Ste 175', 'Cedar City', 'Iron', 'UT', '84721', '4356560029', NULL, '620 S 400 E', 'St George', 'Iron', 'UT', '84770', NULL, NULL, 'WUSTDPAIN5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2010-02-15', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1366457236', 0, 'N', 0, '2010-02-12', NULL, NULL, 37.7011, -113.064, NULL, NULL),
('870281028', 'W11024035', 'W11024035', 'UT01', '', 'Jason', '', 'Hendrix', 'MD', 'Ophthalmology', '', '', NULL, 'O', '676 S Bluff St Ste 208', 'St George', 'Washington', 'UT', '84770', '4352884507', NULL, '676 S Bluff St Ste 208', 'St George', 'Washington', 'UT', '84770', '4352884507', '          ', 'WUUVPN10', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2009-12-08', '2010-07-14', 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1831117167', 0, 'N', 0, '2013-12-12', NULL, NULL, 0, 0, NULL, NULL),
('870649642', 'W11024036', 'W11024036', 'UT01', 'Eartech Audiology', 'Kerry', 'S', 'Braunberger', 'AUD', 'Audiology', '', '', NULL, 'O', '2850 N 2000 W', 'Farr West', 'Weber', 'UT', '84404', '8013999955', '8013993144', '2850 N 2000 W', 'Farr West', 'Weber', 'UT', '84404', '8013999955', '8013993144', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2010-02-12', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1710985965', 0, 'N', 0, '2010-11-29', NULL, NULL, 41.3105, -112.028, NULL, NULL),
('870649642', 'W11024037', 'W11024037', 'UT01', 'Eartech Audiology', 'Kerry', 'S', 'Braunberger', 'AUD', 'Audiology', '', '', NULL, 'O', '950 S Medical Dr Ste 103', 'Brigham City', 'Box Elder', 'UT', '84302', '8013999955', '8013993144', '950 S Medical Dr Ste 103', 'Brigham City', 'Box Elder', 'UT', '84302', '8013999955', '8013993144', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2010-02-12', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1710985965', 0, 'N', 0, '2010-11-29', NULL, NULL, 41.4894, -112.026, NULL, NULL),
('554159753', 'W11024038', 'W11024038', 'Sinclair', '(Sinclair Health Services\rProvider) Center for Conscious Living', 'Ellen', '', 'Tracy', 'LMFT', 'Mental Health', 'Marriage & Family Therapy', '', NULL, 'O', '110 Fifth St Ste 101', 'Ketchum', 'Blaine', 'ID', '83340', '2087207868', NULL, '110 Fifth St Ste 101', 'Ketchum', 'Blaine', 'ID', '83340', '2087207868', '', '', NULL, NULL, '0.00', '20.00', '0.00', 3, '2010-02-16', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1627292531', 0, 'n', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('554159753', 'W11024039', 'W11024039', 'Sinclair', '(Sinclair Health Services\rProvider) Center for Conscious Living', 'Ellen', '', 'Tracy', 'LMFT', 'Mental Health', 'Marriage & Family Therapy', '', NULL, 'B', 'PO Box 1335', 'Ketchum', 'Blaine', 'ID', '83340', '2087207868', NULL, 'PO Box 1335', 'Ketchum', 'Blaine', 'ID', '83340', '2087207868', '', '', NULL, NULL, '0.00', '20.00', '0.00', 3, '2010-02-16', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1627292531', 0, 'y', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('202800071', 'W11024040', 'W11024040', 'UTMH1', 'Alpine Center for Personal Growth', 'Jocelyn', 'E', 'Holbrook', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '5689 S Redwood Rd Ste 30', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8012681715', NULL, '5689 S Redwood Rd Ste 30', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8012681715', '', 'UTMA', NULL, NULL, '0.00', '35.00', '0.00', 6, '2010-02-16', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1437386547', 0, 'n', 0, '2014-02-27', NULL, NULL, 0, 0, NULL, NULL),
('942938348', 'W11024041', 'W11024041', 'UTMH1', 'Valley Mental Health  Inc', 'Gary', 'J', 'Klein', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', '5965 S 900 E Ste 430', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012637100', NULL, '5965 S 900 E Ste 430', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012637100', '', 'UTVMHMA', NULL, NULL, '0.00', '35.00', '0.00', 6, '2010-02-10', '2013-02-14', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1861613853', 0, 'Y', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL);
INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
('742964747', 'W11024042', 'W11024042', 'TX01', '', 'Johnnie', 'M', 'Staggs', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '3030 Macogdoches', 'San Antonio', 'Bexar', 'TX', '78217', '2108269599', NULL, '3030 Macogdoches', 'San Antonio', 'Bexar', 'TX', '78217', '2108269599', '          ', 'TXMHPHD10', '', '', '0.00', '35.00', '0.00', 3, '2010-02-17', '2013-09-08', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1407931124', 0, 'N', 0, '2013-09-30', NULL, NULL, 0, 0, NULL, NULL),
('496385129', 'W11024043', 'W11024043', 'TX01', NULL, 'Margaret', 'E', 'Wesner', 'PSYD', 'Mental Health', 'Psychology', '', NULL, 'O', '7950 Floyd Curl Dr Ste 1001', 'San Antonio', 'Bexar', 'TX', '78229', '2106142600', NULL, '7950 Floyd Curl Dr Ste 1001', 'San Antonio', 'Bexar', 'TX', '78229', '2106142600', '', 'TXMHPHD10', NULL, NULL, '0.00', '35.00', '0.00', 3, '2010-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1578669958', 0, 'n', 0, '2014-01-17', NULL, NULL, 29.5123, -98.5764, NULL, NULL),
('496385129', 'W11024044', 'W11024044', 'TX01', NULL, 'Margaret', 'E', 'Wesner', 'PSYD', 'Mental Health', 'Psychology', '', NULL, 'O', 'Medical Ctr Tower I', 'San Antonio', 'Bexar', 'TX', '78229', '2106142600', NULL, 'Medical Ctr Tower I', 'San Antonio', 'Bexar', 'TX', '78229', '2106142600', '', 'TXMHPHD10', NULL, NULL, '0.00', '35.00', '0.00', 3, '2010-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1578669958', 0, 'n', 0, '2014-01-17', NULL, NULL, 0, 0, NULL, NULL),
('841394394', 'W11024045', 'W11024045', 'UT01', 'Eye Care for You', 'Jeffrey', 'L', 'Cromwell', 'OD', 'Optometry', '', '', NULL, 'O', '43 E 400 N', 'Logan', 'Cache', 'UT', '84321', '4357526453', NULL, '43 E 400 N', 'Logan', 'Cache', 'UT', '84321', '4357526453', '', 'WUTALBERT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-02-15', '2011-09-12', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1801902333', 0, 'N', 0, '2014-03-28', NULL, NULL, 0, 0, NULL, NULL),
('841394394', 'W11024046', 'W11024046', 'UT01', 'Eye Care for You', 'Jeffrey', 'L', 'Cromwell', 'OD', 'Optometry', '', '', NULL, 'O', '134 N State St Ste A', 'Preston', 'Franklin', 'ID', '83263', '2088523030', NULL, '134 N State St Ste A', 'Preston', 'Franklin', 'ID', '83263', '2088523030', '', 'WUTALBERT5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2010-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1801902333', 0, 'N', 0, '2014-03-28', NULL, NULL, 42.099, -111.877, NULL, NULL),
('942854057', 'W11024047', 'W11024047', 'UTPEHP', 'Bryner Clinic', 'Sierra', 'E', 'Pardey', 'MD', 'Pediatrics', '', '', NULL, 'O', '525 E 100 S Ste 500', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015197100', NULL, '525 E 100 S Ste 500', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015197100', '', 'IHCPEHP', NULL, NULL, '0.00', '30.00', '0.00', 8, '2009-08-31', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1982885471', 0, 'N', 0, '2013-05-30', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11024048', 'W11024048', 'UTPEHP', 'Pulmonary Medicine Clinic - St George', 'Melissa', 'J', 'Hinton', 'APRN', 'Family Practice', NULL, NULL, NULL, 'O', '1380 E Medical Ctr Dr Ste 2200', 'St George', 'Washington', 'UT', '84790', '4352512600', NULL, '1380 E Medical Ctr Dr Ste 2200', 'St George', 'Washington', 'UT', '84790', '4352512600', '', 'PEHPMID', NULL, NULL, '0.00', '30.00', '0.00', 8, '2009-12-16', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1043545536', 0, 'N', 0, '2013-09-05', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11024049', 'W11024049', 'UTPEHP', 'Heber Valley Clinic', 'Troy', 'S', 'Johnson', 'PA-C', 'Orthopedic Surgery', 'Family Practice', '', NULL, 'O', '1473 S Hwy 40 Ste E', 'Heber City', 'Wasatch', 'UT', '84032', '4356574400', NULL, '1473 S Hwy 40 Ste E', 'Heber City', 'Wasatch', 'UT', '84032', '4356574400', '          ', 'PEHPMID', '', '', '0.00', '30.00', '0.00', 8, '2009-12-01', '2012-01-12', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1730197252', 0, 'N', 0, '2013-10-16', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11024050', 'W11024050', 'UTPEHP', 'Southern Utah Behavioral Health', 'Bradley', 'D', 'Workman', 'APRN', 'Mental Health', 'Psychiatry', '', NULL, 'O', '1054 E Riverside Dr Ste 202', 'St George', 'Washington', 'UT', '84790', '4356346100', NULL, '1054 E Riverside Dr Ste 202', 'St George', 'Washington', 'UT', '84790', '4356346100', '', 'PEHPMID', NULL, NULL, '0.00', '30.00', '0.00', 8, '2009-12-14', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1881764835', 0, 'N', 0, '2011-03-01', NULL, NULL, 0, 0, NULL, NULL),
('261938641', 'W11024051', 'W11024051', 'Sinclair', '(Sinclair Health Services\rProvider) North Canyon Medical Center (Sinclair Health Services Provider)', '', '', 'Partners in Healthcare Inc', 'GROUP', 'Hospital', '', '', NULL, 'O', '267 N Canyon Dr', 'Gooding', 'Gooding', 'ID', '83330', '2089344433', NULL, '267 N Canyon Dr', 'Gooding', 'Gooding', 'ID', '83330', '2089344433', '          ', '', '', '', '0.00', '5.00', '0.00', 3, '2010-02-16', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1609046671', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('261938641', 'W11024052', 'W11024052', 'Sinclair', '(Sinclair Health Services\rProvider) Gooding Fitness & Rehabilitation (Sinclair Health Services Provi', '', '', 'Partners in Healthcare Inc', 'GROUP', 'Hospital', '', '', NULL, 'O', '245 Main St', 'Gooding', 'Gooding', 'ID', '83330', '2089348766', NULL, '245 Main St', 'Gooding', 'Gooding', 'ID', '83330', '2089348766', '          ', '', '', '', '0.00', '5.00', '0.00', 3, '2010-02-16', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1609046671', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('870659348', 'W11024053', 'W11024053', 'UT01', 'University Pathology Associates', 'Rachel', 'E', 'Factor', 'MD', 'Pathology', '', '', NULL, 'B', 'PO Box 413037', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413037', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2009-10-14', '2011-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1831301241', 0, 'N', 0, '2012-03-06', NULL, NULL, 0, 0, NULL, NULL),
('870659348', 'W11024054', 'W11024054', 'UT01', 'University Pathology Associates', 'Rachel', 'E', 'Factor', 'MD', 'Pathology', '', '', NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015857376', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015857376', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2009-10-14', '2011-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1831301241', 0, 'N', 0, '2012-03-06', NULL, NULL, 0, 0, NULL, NULL),
('412144134', 'W11024055', 'W11024055', 'UT01', 'ARUP Pathology Associates', 'Rachel', 'E', 'Factor', 'MD', 'Pathology', '', '', NULL, 'B', 'PO Box 413037', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413037', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2009-10-14', '2011-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1831301241', 0, 'N', 0, '2012-03-06', NULL, NULL, 0, 0, NULL, NULL),
('412144134', 'W11024056', 'W11024056', 'UT01', 'University Health Care', 'Rachel', 'E', 'Factor', 'MD', 'Pathology', '', '', NULL, 'O', '500 Chipeta Wy', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015832787', NULL, '500 Chipeta Wy', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015832787', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2009-10-14', '2011-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1831301241', 0, 'N', 0, '2012-03-06', NULL, NULL, 0, 0, NULL, NULL),
('876151902', 'W11024057', 'W11024057', 'UT01', 'University Health Care', 'Michael', 'R', 'Feilmeier', 'MD', 'Ophthalmology', '', '', NULL, 'o', '65 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015812352', NULL, '65 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015812352', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 6, '2009-10-13', '2012-08-09', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1245440437', 0, 'N', 0, '2012-08-10', NULL, NULL, 0, 0, NULL, NULL),
('870442845', 'W11024058', 'W11024058', 'UT01', 'U-U Hematology / Oncology Division', 'Esther', 'L', 'Kannapel', 'APRN', 'Hematology and Oncology', 'Oncology', NULL, NULL, 'B', 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, 'WUUUMG5', 'WUSTDHCPC5', NULL, '0.00', '25.00', '0.00', 3, '2009-11-04', '2010-03-01', NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1679523831', 0, 'y', 0, '2010-02-16', NULL, NULL, 0, 0, NULL, NULL),
('870442845', 'W11024059', 'W11024059', 'UT01', 'University Health Care', 'Esther', 'L', 'Kannapel', 'APRN', 'Hematology and Oncology', 'Oncology', NULL, NULL, 'O', '1950 Circle of Hope Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84112', '8015850100', NULL, NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, 'WUUUMG5', 'WUSTDHCPC5', NULL, '0.00', '25.00', '0.00', 3, '2009-11-04', '2010-03-01', NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1679523831', 0, 'N', 0, '2010-02-16', NULL, NULL, 0, 0, NULL, NULL),
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('820425454', 'W11024129', 'W11024129', 'ID01', 'Boise Anesthesia, PA', 'James', 'L', 'Ward', 'MD', 'Anesthesiology', '', '', NULL, 'o', '1717 Arlington Ave', 'Caldwell', 'Canyon', 'ID', '83605', '2084594641', '0', '1717 Arlington Ave', 'Caldwell', 'Canyon', 'ID', '83605', '2084594641', '0', 'IDSAMG3', NULL, NULL, '57.48', '10.00', '0.00', 3, '2010-02-01', '2010-06-30', 0, 15, 0, '', '', 'West Valley Medical Center', '', 'HCFA|UB|', '1720133085', 0, 'n', 0, '2013-07-18', NULL, NULL, 0, 0, NULL, NULL),
('820425454', 'W12024569', 'W12024569', 'ID01', 'Boise Anesthesia, PA', 'Brad', '', 'Foss', 'CRNA', 'Nurse Anesthetist', '', '', NULL, 'B', 'PO Box 4268', 'Portland', 'Multnomah', 'OR', '97208', '8002758752', NULL, 'PO Box 4268  ', 'Portland', 'Multnomah', 'OR', '97208', '8002758752', '          ', 'IDSAMG3', '', '', '60.97', '10.00', '0.00', 3, '2011-07-01', '2012-06-30', 1, 15, 0, '', '', '', '', 'HCFA|UB|', '1831339068', 0, 'N', 0, '2012-10-30', NULL, NULL, 0, 0, NULL, NULL),
('820425454', 'W12024497', 'W12024497', 'ID01', 'Boise Anesthesia, PA', 'Marilyn', 'S', 'Armayor', 'CRNA', 'Nurse Anesthetist', '', '', NULL, 'B', 'PO Box 4268', 'Portland', 'Multnomah', 'OR', '97208', '8002758752', NULL, 'PO Box 4268     ', 'Portland', 'Multnomah', 'OR', '97208', '8002758752', '0         ', 'IDSAMG3', '', '', '57.48', '10.00', '0.00', 3, '2010-02-01', '2010-06-30', 0, 15, 0, '', '', '', '', 'HCFA|UB|', '1124079785', 0, 'N', 0, '2012-10-29', NULL, NULL, 0, 0, NULL, NULL),
('742592013', 'W12024564', 'W12024564', 'TXSATSTD', 'Dermatology Associates of San Antonio', '', '', 'Dermatology Associates of San Antonio', '', '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, '', '', '', '', 'HCFA|UB|', '0000009777', 0, 'Y', 0, '2012-10-30', NULL, NULL, 29.6121, -98.4831, 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
('820425454', 'W12024504', 'W12024504', 'ID01', 'Boise Anesthesia, PA', 'Gary', 'D', 'Bevan', 'CRNA', 'Nurse Anesthetist', '', '', NULL, 'B', 'PO Box 4268', 'Portland', 'Multnomah', 'OR', '97208', '2084594641', NULL, 'PO Box 4268      ', 'Portland', 'Multnomah', 'OR', '97208', '2084594641', '0         ', 'IDSAMG3', '', '', '59.20', '10.00', '0.00', 3, '2010-07-01', '2011-06-30', 1, 15, 0, '', '', '', '', 'HCFA|UB|', '1174579742', 0, 'N', 0, '2013-04-19', NULL, NULL, 0, 0, NULL, NULL),
('820425454', 'W12024515', 'W12024515', 'ID01', 'Boise Anesthesia, PA', 'Jeffery', '', 'Borders', 'CRNA', 'Nurse Anesthetist', '', '', NULL, 'B', 'PO Box 4268', 'Portland', 'Multnomah', 'OR', '97208', '8002758752', NULL, 'PO Box 4268      ', 'Portland', 'Multnomah', 'OR', '97208', '8002758752', '0         ', 'IDSAMG3', '', '', '59.20', '10.00', '0.00', 3, '2010-07-01', '2011-06-30', 1, 15, 0, '', '', '', '', 'HCFA|UB|', '1942288964', 0, 'N', 0, '2012-10-29', NULL, NULL, 0, 0, NULL, NULL),
('820425454', 'W12024528', 'W12024528', 'ID01', 'Boise Anesthesia, PA', 'Clara', '', 'Cohen', 'CRNA', 'Nurse Anesthetist', '', '', NULL, 'B', 'PO Box 4268', 'Portland', 'Multnomah', 'OR', '97208', '8002758752', NULL, 'PO Box 4268     ', 'Portland', 'Multnomah', 'OR', '97208', '8002758752', '0         ', 'IDSAMG3', '', '', '60.97', '10.00', '0.00', 3, '2011-07-01', '2012-06-30', 1, 15, 0, '', '', '', '', 'HCFA|UB|', '1841246360', 0, 'N', 0, '2012-10-29', NULL, NULL, 0, 0, NULL, NULL),
('820425454', 'W12024525', 'W12024525', 'ID01', 'Boise Anesthesia, PA', 'Clara', '', 'Cohen', 'CRNA', 'Nurse Anesthetist', '', '', NULL, 'B', 'PO Box 4008', 'Portland', 'Multnomah', 'OR', '97208', '8002758752', NULL, 'PO Box 4008  ', 'Portland', 'Multnomah', 'OR', '97208', '8002758752', '0         ', 'IDSAMG3', '', '', '55.81', '10.00', '0.00', 3, '2008-07-01', '2010-01-30', 0, 15, 0, '', '', '', '', 'HCFA|UB|', '1841246360', 0, 'N', 0, '2012-10-29', NULL, NULL, 0, 0, NULL, NULL),
('820425454', 'W12024533', 'W12024533', 'ID01', 'Boise Anesthesia, PA', 'Karen', 'K', 'Coscia', 'CRNA', 'Nurse Anesthetist', '', '', NULL, 'B', 'PO Box 4268', 'Portland', 'Multnomah', 'OR', '97208', '8002758752', NULL, 'PO Box 4268     ', 'Portland', 'Multnomah', 'OR', '97208', '8002758752', '0         ', 'IDSAMG3', '', '', '60.97', '10.00', '0.00', 3, '2011-07-01', '2012-06-30', 1, 15, 0, '', '', '', '', 'HCFA|UB|', '1033164454', 0, 'N', 0, '2012-10-29', NULL, NULL, 0, 0, NULL, NULL),
('820425454', 'W12024530', 'W12024530', 'ID01', 'Boise Anesthesia, PA', 'Karen', 'K', 'Coscia', 'CRNA', 'Nurse Anesthetist', '', '', NULL, 'B', 'PO Box 4008', 'Portland', 'Multnomah', 'OR', '97208', '8002758752', NULL, 'PO Box 4008  ', 'Portland', 'Multnomah', 'OR', '97208', '8002758752', '0         ', 'IDSAMG3', '', '', '55.81', '10.00', '0.00', 3, '2008-07-01', '2010-01-30', 0, 15, 0, '', '', '', '', 'HCFA|UB|', '1033164454', 0, 'N', 1, '2012-10-29', NULL, NULL, 0, 0, NULL, NULL),
('820425454', 'W12024538', 'W12024538', 'ID01', 'Boise Anesthesia, PA', 'Brett', 'E', 'Curley', 'CRNA', 'Nurse Anesthetist', '', '', NULL, 'B', 'PO Box 4268', 'Portland', 'Multnomah', 'OR', '97208', '8002758752', NULL, 'PO Box 4268     ', 'Portland', 'Multnomah', 'OR', '97208', '8002758752', '0         ', 'IDSAMG3', '', '', '60.97', '10.00', '0.00', 3, '2011-07-01', '2012-06-30', 1, 15, 0, '', '', '', '', 'HCFA|UB|', '1063467637', 0, 'N', 0, '2012-10-29', NULL, NULL, 0, 0, NULL, NULL),
('820425454', 'W12024535', 'W12024535', 'ID01', 'Boise Anesthesia, PA', 'Brett', 'E', 'Curley', 'CRNA', 'Nurse Anesthetist', '', '', NULL, 'B', 'PO Box 4008', 'Portland', 'Multnomah', 'OR', '97208', '8002758752', NULL, 'PO Box 4008  ', 'Portland', 'Multnomah', 'OR', '97208', '8002758752', '0         ', 'IDSAMG3', '', '', '55.81', '10.00', '0.00', 3, '2008-07-01', '2010-01-30', 0, 15, 0, '', '', '', '', 'HCFA|UB|', '1063467637', 0, 'N', 0, '2012-10-29', NULL, NULL, 0, 0, NULL, NULL),
('820425454', 'W12024544', 'W12024544', 'ID01', 'Boise Anesthesia, PA', 'Amber', '', 'Davidson', 'CRNA', 'Nurse Anesthetist', '', '', NULL, 'B', 'PO Box 4268', 'Portland', 'Multnomah', 'OR', '97208', '8002758752', NULL, 'PO Box 4268     ', 'Portland', 'Multnomah', 'OR', '97208', '8002758752', '0         ', 'IDSAMG3', '', '', '60.97', '10.00', '0.00', 3, '2011-07-01', '2012-06-30', 1, 15, 0, '', '', '', '', 'HCFA|UB|', '1649453028', 0, 'N', 0, '2012-10-29', NULL, NULL, 0, 0, NULL, NULL),
('820425454', 'W12024542', 'W12024542', 'ID01', 'Boise Anesthesia, PA', 'Amber', '', 'Davidson', 'CRNA', 'Nurse Anesthetist', '', '', NULL, 'B', 'PO Box 4268', 'Portland', 'Multnomah', 'OR', '97208', '8002758752', NULL, 'PO Box 4268   ', 'Portland', 'Multnomah', 'OR', '97208', '8002758752', '0         ', 'IDSAMG3', '', '', '57.48', '10.00', '0.00', 3, '2010-02-01', '2010-06-30', 0, 15, 0, '', '', '', '', 'HCFA|UB|', '1649453028', 0, 'N', 0, '2012-10-29', NULL, NULL, 0, 0, NULL, NULL),
('820425454', 'W11024144', 'W11024144', 'ID01', 'Boise Anesthesia, PA', 'Amy', 'L', 'Engelmann', 'CRNA', 'Nurse Anesthetist', '', '', NULL, 'o', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083676416', '2083759530', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083676416', '2083759530', 'IDSAMG3', NULL, NULL, '57.48', '10.00', '0.00', 3, '2010-02-01', '2010-06-30', 0, 15, 0, '', '', '', '', 'HCFA|UB|', '1275625238', 0, 'n', 0, '2012-10-30', NULL, NULL, 43.6127, -116.254, NULL, NULL),
('820425454', 'W11024145', 'W11024145', 'ID01', 'Boise Anesthesia, PA', 'Amy', 'L', 'Engelmann', 'CRNA', 'Nurse Anesthetist', '', '', NULL, 'o', '1717 Arlington Ave', 'Caldwell', 'Canyon', 'ID', '83605', '2084594641', '0', '1717 Arlington Ave', 'Caldwell', 'Canyon', 'ID', '83605', '2084594641', '0', 'IDSAMG3', NULL, NULL, '57.48', '10.00', '0.00', 3, '2010-02-01', '2010-06-30', 0, 15, 0, '', '', '', '', 'HCFA|UB|', '1275625238', 0, 'n', 0, '2012-10-30', NULL, NULL, 0, 0, NULL, NULL),
('820425454', 'W11024146', 'W11024146', 'ID01', 'Boise Anesthesia, PA', 'Darron', 'D', 'Funk', 'CRNA', 'Nurse Anesthetist', '', '', NULL, 'o', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083676416', '2083759530', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083676416', '2083759530', 'IDSAMG3', NULL, NULL, '57.48', '10.00', '0.00', 3, '2010-02-01', '2010-06-30', 0, 15, 0, '', '', '', '', 'HCFA|UB|', '1174560759', 0, 'n', 0, '2012-10-30', NULL, NULL, 43.6127, -116.254, NULL, NULL),
('820425454', 'W11024147', 'W11024147', 'ID01', 'Boise Anesthesia, PA', 'Darron', 'D', 'Funk', 'CRNA', 'Nurse Anesthetist', '', '', NULL, 'o', '1717 Arlington Ave', 'Caldwell', 'Canyon', 'ID', '83605', '2084594641', '0', '1717 Arlington Ave', 'Caldwell', 'Canyon', 'ID', '83605', '2084594641', '0', 'IDSAMG3', NULL, NULL, '57.48', '10.00', '0.00', 3, '2010-02-01', '2010-06-30', 0, 15, 0, '', '', '', '', 'HCFA|UB|', '1174560759', 0, 'n', 0, '2012-10-30', NULL, NULL, 0, 0, NULL, NULL),
('820425454', 'W11024148', 'W11024148', 'ID01', 'Boise Anesthesia, PA', 'Michael', 'P', 'Garrett', 'CRNA', 'Nurse Anesthetist', '', '', NULL, 'o', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083676416', '2083759530', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083676416', '2083759530', 'IDSAMG3', NULL, NULL, '57.48', '10.00', '0.00', 3, '2010-02-01', '2010-06-30', 0, 15, 0, '', '', '', '', 'HCFA|UB|', '1083651665', 0, 'n', 0, '2013-04-02', NULL, NULL, 43.6127, -116.254, NULL, NULL),
('820425454', 'W11024149', 'W11024149', 'ID01', 'Boise Anesthesia, PA', 'Michael', 'P', 'Garrett', 'CRNA', 'Nurse Anesthetist', '', '', NULL, 'o', '1717 Arlington Ave', 'Caldwell', 'Canyon', 'ID', '83605', '2084594641', '0', '1717 Arlington Ave', 'Caldwell', 'Canyon', 'ID', '83605', '2084594641', '0', 'IDSAMG3', NULL, NULL, '57.48', '10.00', '0.00', 3, '2010-02-01', '2010-06-30', 0, 15, 0, '', '', '', '', 'HCFA|UB|', '1083651665', 0, 'n', 0, '2013-04-02', NULL, NULL, 0, 0, NULL, NULL),
('820425454', 'W11024150', 'W11024150', 'ID01', 'Boise Anesthesia, PA', 'David', 'R', 'Haymore', 'CRNA', 'Nurse Anesthetist', '', '', NULL, 'o', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083676416', '2083759530', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083676416', '2083759530', 'IDSAMG3', NULL, NULL, '57.48', '10.00', '0.00', 3, '2010-02-01', '2010-06-30', 0, 15, 0, '', '', '', '', 'HCFA|UB|', '1790968634', 0, 'n', 0, '2012-10-30', NULL, NULL, 43.6127, -116.254, NULL, NULL),
('820425454', 'W11024151', 'W11024151', 'ID01', 'Boise Anesthesia, PA', 'David', 'R', 'Haymore', 'CRNA', 'Nurse Anesthetist', '', '', NULL, 'o', '1717 Arlington Ave', 'Caldwell', 'Canyon', 'ID', '83605', '2084594641', '0', '1717 Arlington Ave', 'Caldwell', 'Canyon', 'ID', '83605', '2084594641', '0', 'IDSAMG3', NULL, NULL, '57.48', '10.00', '0.00', 3, '2010-02-01', '2010-06-30', 0, 15, 0, '', '', '', '', 'HCFA|UB|', '1790968634', 0, 'n', 0, '2012-10-30', NULL, NULL, 0, 0, NULL, NULL),
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('820425454', 'W11024153', 'W11024153', 'ID01', 'Boise Anesthesia, PA', 'Sheri', 'L', 'Hirai', 'CRNA', 'Nurse Anesthetist', '', '', NULL, 'o', '1717 Arlington Ave', 'Caldwell', 'Canyon', 'ID', '83605', '2084594641', '0', '1717 Arlington Ave', 'Caldwell', 'Canyon', 'ID', '83605', '2084594641', '0', 'IDSAMG3', NULL, NULL, '57.48', '10.00', '0.00', 3, '2010-02-01', '2010-06-30', 0, 15, 0, '', '', '', '', 'HCFA|UB|', '1609821099', 0, 'n', 0, '2012-10-30', NULL, NULL, 0, 0, NULL, NULL),
('820425454', 'W11024154', 'W11024154', 'ID01', 'Boise Anesthesia, PA', 'Denise', 'L', 'Janicek', 'CRNA', 'Nurse Anesthetist', '', '', NULL, 'o', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083676416', '2083759530', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083676416', '2083759530', 'IDSAMG3', NULL, NULL, '57.48', '10.00', '0.00', 3, '2010-02-01', '2010-06-30', 0, 15, 0, '', '', '', '', 'HCFA|UB|', '1477509057', 0, 'n', 0, '2012-11-01', NULL, NULL, 43.6127, -116.254, NULL, NULL),
('820425454', 'W11024155', 'W11024155', 'ID01', 'Boise Anesthesia, PA', 'Denise', 'L', 'Janicek', 'CRNA', 'Nurse Anesthetist', '', '', NULL, 'o', '1717 Arlington Ave', 'Caldwell', 'Canyon', 'ID', '83605', '2084594641', '0', '1717 Arlington Ave', 'Caldwell', 'Canyon', 'ID', '83605', '2084594641', '0', 'IDSAMG3', NULL, NULL, '57.48', '10.00', '0.00', 3, '2010-02-01', '2010-06-30', 0, 15, 0, '', '', '', '', 'HCFA|UB|', '1477509057', 0, 'n', 0, '2012-11-01', NULL, NULL, 0, 0, NULL, NULL),
('820425454', 'W11024156', 'W11024156', 'ID01', 'Boise Anesthesia, PA', 'Richard', '', 'Kannenberg', 'CRNA', 'Nurse Anesthetist', '', '', NULL, 'o', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083676416', '2083759530', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083676416', '2083759530', 'IDSAMG3', NULL, NULL, '57.48', '10.00', '0.00', 3, '2010-02-01', '2010-06-30', 0, 15, 0, '', '', '', '', 'HCFA|UB|', '1174579692', 0, 'n', 0, '2012-02-23', NULL, NULL, 43.6127, -116.254, NULL, NULL),
('820425454', 'W11024157', 'W11024157', 'ID01', 'Boise Anesthesia, PA', 'Richard', '', 'Kannenberg', 'CRNA', 'Nurse Anesthetist', '', '', NULL, 'o', '1717 Arlington Ave', 'Caldwell', 'Canyon', 'ID', '83605', '2084594641', '0', '1717 Arlington Ave', 'Caldwell', 'Canyon', 'ID', '83605', '2084594641', '0', 'IDSAMG3', NULL, NULL, '57.48', '10.00', '0.00', 3, '2010-02-01', '2010-06-30', 0, 15, 0, '', '', '', '', 'HCFA|UB|', '1174579692', 0, 'n', 0, '2012-02-23', NULL, NULL, 0, 0, NULL, NULL),
('820425454', 'W11024158', 'W11024158', 'ID01', 'Boise Anesthesia, PA', 'Darin', '', 'Lee', 'CRNA', 'Nurse Anesthetist', '', '', NULL, 'o', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083676416', '2083759530', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083676416', '2083759530', 'IDSAMG3', NULL, NULL, '57.48', '10.00', '0.00', 3, '2010-02-01', '2010-06-30', 0, 15, 0, '', '', '', '', 'HCFA|UB|', '1578519542', 0, 'n', 0, '2012-11-01', NULL, NULL, 43.6127, -116.254, NULL, NULL),
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('200582039', 'W11024231', 'W11024231', 'UT01', 'Sundance Physical Therapy Farr West', 'Sherri', '', 'Duft', 'PT', 'Physical Therapy', '', '', NULL, 'O', '2850 N 2000 W Ste 204', 'Ogden', 'Weber', 'UT', '84404', '8017315421', '8017320303', '2850 N 2000 W Ste 204', 'Ogden', 'Weber', 'UT', '84404', '8017315421', '8017320303', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '68.00', 3, '2010-01-01', '2010-01-01', 0, 0, 0, '', '', '', '', 'HCFA|', '1780676569', 0, 'N', 0, '2014-07-18', NULL, NULL, 0, 0, NULL, NULL),
('261211429', 'W11024232', 'W11024232', 'UT01', 'Utah Physical Therapy Specialists', 'Erinlee', '', 'Boden', 'MPT', 'Physical Therapy', NULL, NULL, NULL, 'O', '2751 W 9000 S Ste 150', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015611061', '8015611570', '2751 W 9000 S Ste 150', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015611061', '8015611570', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '68.00', 3, '2010-01-01', '2011-03-31', 0, 0, 0, '', '', '', '', 'HCFA|', '1932182243', 0, 'N', 0, '2011-10-17', NULL, NULL, 0, 0, NULL, NULL);
INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
('261211429', 'W11024233', 'W11024233', 'UT01', 'Utah Physical Therapy Specialists', 'Brian', '', 'Rodriguez', 'MPT', 'Physical Therapy', '', '', NULL, 'O', '2751 W 9000 S Ste 150', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015611061', '8015611570', '2751 W 9000 S Ste 150', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015611061', '8015611570', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '68.00', 3, '2010-01-01', '2011-03-31', 0, 0, 0, '', '', '', '', 'HCFA|', '0000003100', 0, 'N', 0, '2011-10-17', NULL, NULL, 0, 0, NULL, NULL),
('200582039', 'W11024234', 'W11024234', 'UT01', 'Sundance Physical Therapy', 'Pamela', NULL, 'Frinkman', 'PT', 'Physical Therapy', NULL, NULL, NULL, 'O', '2701 University Cir', 'Ogden', 'Weber', 'UT', '84408', '8016267712', '8016267264', NULL, NULL, 'Weber', NULL, NULL, NULL, NULL, 'WESTREHAB', 'WUSTDHCPC5', NULL, '0.00', NULL, '68.00', 3, '2000-01-01', '2000-01-01', NULL, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1699873364', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('200291769', 'W11024235', 'W11024235', 'UT01', 'Neuroworx', 'Jan', 'R', 'Black', 'PT', 'Physical Therapy', '', '', NULL, 'B', 'PO Box 150173', 'Ogden', 'Weber', 'UT', '84415', '8016193670', '8016193679', 'PO Box 150173', 'Ogden', 'Weber', 'UT', '84415', '8016193670', '8016193679', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '68.00', 3, '2010-01-01', '2011-03-31', 0, 0, 0, '', '', '', '', 'HCFA|', '1568429967', 0, 'Y', 0, '2014-01-31', NULL, NULL, 0, 0, NULL, NULL),
('200582039', 'W11024236', 'W11024236', 'UT01', 'Sundance Physical Therapy Farr West', 'Pamela', '', 'Frinkman', 'PT', 'Physical Therapy', '', '', NULL, 'B', 'PO Box 886', 'Bountiful', 'Davis', 'UT', '84011', '8017315421', '8017320303', 'PO Box 886', 'Bountiful', 'Davis', 'UT', '84011', '8017315421', '8017320303', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '68.00', 3, '2010-01-01', '2011-03-31', 0, 0, 0, '', '', '', '', 'HCFA|', '1699873364', 0, 'Y', 0, '2013-12-04', NULL, NULL, 0, 0, NULL, NULL),
('200582039', 'W11024237', 'W11024237', 'UT01', 'Sundance Physical Therapy Farr West', 'Clay', '', 'Sniteman', 'PT', 'Physical Therapy', '', '', NULL, 'B', 'PO Box 886', 'Bountiful', 'Davis', 'UT', '84011', '8017315421', '8017320303', 'PO Box 886', 'Bountiful', 'Davis', 'UT', '84011', '8017315421', '8017320303', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '68.00', 3, '2010-01-01', '2011-03-31', 0, 0, 0, '', '', '', '', 'HCFA|', '1235295049', 0, 'Y', 0, '2014-07-18', NULL, NULL, 0, 0, NULL, NULL),
('200582039', 'W11024238', 'W11024238', 'UT01', 'Sundance Physical Therapy Farr West', 'Sherri', '', 'Duft', 'PT', 'Physical Therapy', '', '', NULL, 'B', 'PO Box 886', 'Bountiful', 'Davis', 'UT', '84011', '8017315421', '8017320303', 'PO Box 886', 'Bountiful', 'Davis', 'UT', '84011', '8017315421', '8017320303', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '68.00', 3, '2010-01-01', '2011-03-31', 0, 0, 0, '', '', '', '', 'HCFA|', '1780676569', 0, 'Y', 0, '2014-07-18', NULL, NULL, 0, 0, NULL, NULL),
('261211429', 'W11024239', 'W11024239', 'UT01', 'Utah Physical Therapy Specialists', 'Erinlee', '', 'Boden', 'MPT', 'Physical Therapy', NULL, NULL, NULL, 'B', '8969 S 2700 W', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015611061', '8015611570', '8969 S 2700 W', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015611061', '8015611570', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '68.00', 3, '2010-01-01', '2011-03-31', 0, 0, 0, '', '', '', '', 'HCFA|', '1932182243', 0, 'Y', 0, '2011-10-17', NULL, NULL, 0, 0, NULL, NULL),
('261211429', 'W11024240', 'W11024240', 'UT01', 'Utah Physical Therapy Specialists', 'Brian', '', 'Rodriguez', 'MPT', 'Physical Therapy', '', '', NULL, 'B', '8969 S 2700 W', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015611061', '8015611570', '8969 S 2700 W', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015611061', '8015611570', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '68.00', 3, '2010-01-01', '2011-03-31', 0, 0, 0, '', '', '', '', 'HCFA|', '0000003100', 0, 'Y', 0, '2011-10-17', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11024241', 'W11024241', 'UTIHCPHY', 'Heber Valley Clinic', 'Heather', 'H', 'Christensen', 'PA-C', 'Family Practice', '', '', NULL, 'o', '1473 S Hwy 40 Ste E', 'Heber City', 'Wasatch', 'UT', '84032', '4356574400', NULL, '1473 S Hwy 40 Ste E', 'Heber City', 'Wasatch', 'UT', '84032', '4356574400', '', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2009-12-01', '2010-03-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1447325055', 0, 'N', 0, '2014-06-20', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11024242', 'W11024242', 'UTIHCPHY', 'McKay Dee Rheumatology Clinic', 'Jean', NULL, 'Hollis', 'PA-C', 'Rheumatology', NULL, NULL, NULL, 'O', '4403 Harrison Blvd Ste 3650', 'Ogden', 'Weber', 'UT', '84403', '8013877125', NULL, NULL, NULL, 'Weber', NULL, NULL, '8013877125', '          ', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2009-12-28', '2010-03-23', NULL, 0, NULL, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1740394972', 0, 'N', 0, '2010-02-23', NULL, NULL, 0, 0, NULL, NULL),
('271637237', 'W11024243', 'W11024243', 'UT01', 'Davis Vision Center Associates PLLC', 'David', 'B', 'Petersen', 'MD', 'Ophthalmology', '', '', NULL, 'O', '1325 W S Jordan Pkwy Ste 103', 'South Jordan', 'Salt Lake', 'UT', '84095', '8012533080', '8012530772', '1325 W S Jordan Pkwy Ste 103', 'South Jordan', 'Salt Lake', 'UT', '84095', '8012533080', '8012530772', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2010-03-31', '2010-03-31', 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1851482202', 0, 'N', 0, '2012-04-23', NULL, NULL, 0, 0, NULL, NULL),
('271637237', 'W11024244', 'W11024244', 'UT01', 'Davis Vision Center Associates PLLC', 'Kurt', 'P', 'Hepworth', 'OD', 'Optometry', '', '', NULL, 'B', '1325 W S Jordan Pkwy Ste 103', 'South Jordan', 'Salt Lake', 'UT', '84095', '8013529500', '8013529502', '1325 W S Jordan Pkwy Ste 103', 'South Jordan', 'Salt Lake', 'UT', '84095', '8013529500', '8013529502', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-04-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1457531428', 0, 'N', 0, '2012-07-31', NULL, NULL, 0, 0, NULL, NULL),
('271637237', 'W11024245', 'W11024245', 'UT01', 'Davis Vision Center Associates PLLC', 'Brian', 'R', 'Davis', 'MD', 'Ophthalmology', '', '', NULL, 'O', '1325 W S Jordan Pkwy Ste 103', 'South Jordan', 'Salt Lake', 'UT', '84095', '8012533080', '8012530772', '1325 W S Jordan Pkwy Ste 103', 'South Jordan', 'Salt Lake', 'UT', '84095', '8012533080', '8012530772', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2010-03-31', NULL, 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1679583470', 0, 'N', 0, '2014-01-17', NULL, NULL, 40.5621, -111.93, NULL, NULL),
('621801973', 'W11024246', 'W11024246', 'UT01', 'Jordan Valley Wound Care Specialists', 'Edward', 'D', 'Slawson', 'MD', 'General Surgery', NULL, NULL, NULL, 'O', '3590 W 9000 S Ste 105', 'West Jordan', 'Salt Lake', 'UT', '84088', '8016012322', NULL, '406 W S Jordan Pkwy', 'South Jordan', 'Salt Lake', 'UT', '84095', NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2010-02-23', NULL, NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1104802693', 0, 'N', 0, '2010-02-23', NULL, NULL, 40.5879, -111.976, NULL, NULL),
('621801973', 'W11024247', 'W11024247', 'UT01', 'Jordan Valley Wound Care Specialists', 'Edward', 'D', 'Slawson', 'MD', 'General Surgery', NULL, NULL, NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8016012322', NULL, '406 W S Jordan Pkwy', 'South Jordan', 'Fulton', 'UT', '84095', NULL, NULL, 'WUSTDSURG5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2010-02-23', NULL, NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1104802693', 0, 'y', 0, '2010-02-23', NULL, NULL, 0, 0, NULL, NULL),
('383809303', 'W11024248', 'W11024248', 'ID01', 'Treasure Valley Psychological Services', 'Melody', 'L', 'Snider', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '6003 Overland Rd Ste 301', 'Boise', 'Ada', 'ID', '83709', '2086728699', NULL, '6003 Overland Rd Ste 301', 'Boise', 'Ada', 'ID', '83709', '2086728699', '          ', 'IDPHD', '', '', '0.00', '35.00', '0.00', 3, '2010-02-11', '2012-07-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1982734984', 0, 'N', 0, '2012-08-17', NULL, NULL, 0, 0, NULL, NULL),
('870299862', 'W11024249', 'W11024249', 'UTMH1', 'LDS Family Services', 'Suzette', '', 'Fritinger', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '94 E Pages Ln Ste A', 'Centerville', 'Davis', 'UT', '84014', '8012940578', NULL, '94 E Pages Ln Ste A', 'Centerville', 'Davis', 'UT', '84014', '8012940578', '', 'MA', NULL, NULL, '0.00', '35.00', '0.00', 8, '2010-02-17', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1558401372', 0, 'N', 0, '2013-04-12', NULL, NULL, 0, 0, NULL, NULL),
('200123241', 'W11024250', 'W11024250', 'UTMH1', 'Aloha Behavioral Consultants Inc', 'Kenyon', '', 'Tew', 'LMFT', 'Mental Health', 'Marriage & Family Therapy', '', NULL, 'O', '707 24th St Ste D', 'Ogden', 'Weber', 'UT', '84401', '8013991818', NULL, '707 24th St Ste D', 'Ogden', 'Weber', 'UT', '84401', '8013991818', '', 'PHD', NULL, NULL, '0.00', '35.00', '0.00', 6, '2010-02-22', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1750371951', 0, 'n', 0, '2014-03-31', NULL, NULL, 0, 0, NULL, NULL),
('741117341', 'W11024251', 'W11024251', 'TX01', 'Family Service Association', 'Caren', '', 'Corkins', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '702 San Pedro', 'San Antonio', 'Bexar', 'TX', '78212', '2102992400', NULL, '702 San Pedro', 'San Antonio', 'Bexar', 'TX', '78212', '2102992400', '', 'TXMHMA10', NULL, NULL, '0.00', '35.00', '0.00', 3, '2010-02-22', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1699782540', 0, 'n', 0, '2014-01-17', NULL, NULL, 29.4396, -98.4986, NULL, NULL),
('810231784', 'W11024252', 'W11024252', 'WYBILLINGS', 'Billings Clinic - Heights Clinic', 'Jill', 'C', 'Powell', 'PA-C', 'Family Practice', NULL, NULL, NULL, 'O', '760 Wicks Ln', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062382586', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', NULL, NULL, '', NULL, NULL, '0.00', '17.00', '0.00', 3, '2010-02-22', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000003041', 0, 'N', 0, '2010-02-23', NULL, NULL, 0, 0, NULL, NULL),
('270176536', 'W11024253', 'W11024253', 'UT01', '', 'Edward', 'Joe', 'Eyring', 'MD', 'Colon and Rectal Surgery', 'General Surgery', '', NULL, 'O', '10011 S Centennial Pkwy Ste 150', 'Sandy', 'Salt Lake', 'UT', '84070', '8017272672', NULL, '10011 S Centennial Pkwy Ste 150', 'Sandy', 'Salt Lake', 'UT', '84070', '8017272672', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-03-01', '2011-09-19', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1427074582', 0, 'N', 0, '2012-06-04', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W11024254', 'W11024254', 'UT01', 'Pioneer Valley Hospital (Hospitalist)', 'Shadi', '', 'Karabsheh', 'MD', 'Internal Medicine', '', '', NULL, 'O', '3460 S Pioneer Pkwy', 'West Valley', 'Salt Lake', 'UT', '84120', '8019643100', NULL, '3460 S Pioneer Pkwy', 'West Valley', 'Salt Lake', 'UT', '84120', '8019643100', '          ', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-02-22', '2010-10-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1548212665', 0, 'Y', 0, '2011-09-20', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W11024255', 'W11024255', 'UT01', 'Pioneer Valley Hospital (Hospitalist)', 'Shadi', '', 'Karabsheh', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019643100', NULL, 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019643100', '          ', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-02-22', '2010-10-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1548212665', 0, 'N', 0, '2011-09-20', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W11024256', 'W11024256', 'WYBILLINGS', 'Billings Clinic - Endocrinology', 'Ruth', 'L', 'Sampson', 'MD', 'Endocrinology', '', '', NULL, 'O', '801 N 29th St', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062382413', '801 N 29th St', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062382413', '', '', '', '0.00', '17.00', '0.00', 3, '2010-02-25', '2010-08-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1851476287', 0, 'N', 0, '2010-02-25', NULL, NULL, 0, 0, NULL, NULL),
('205529469', 'W11024257', 'W11024257', 'UT01', 'University Health Care', 'Emily', 'J', 'Harold', 'MD', 'Family Practice', 'Internal Medicine', '', NULL, 'B', 'PO Box 58108', 'Salt Lake City', 'Salt Lake', 'UT', '84158', '8015883998', NULL, 'PO Box 58108', 'Salt Lake City', 'Salt Lake', 'UT', '84158', '8015883998', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2009-11-24', '2010-09-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1437287851', 0, 'N', 0, '2011-04-28', NULL, NULL, 0, 0, NULL, NULL),
('205529469', 'W11024258', 'W11024258', 'UT01', 'University Health Care', 'Emily', 'J', 'Harold', 'MD', 'Family Practice', 'Internal Medicine', '', NULL, 'O', '1493 Lowell Ave', 'Park City', 'Summit', 'UT', '84060', '4356557079', NULL, '1493 Lowell Ave', 'Park City', 'Summit', 'UT', '84060', '4356557079', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2009-11-24', '2012-08-21', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1437287851', 0, 'N', 0, '2012-08-22', NULL, NULL, 0, 0, NULL, NULL),
('870526462', 'W11024259', 'W11024259', 'UT01', 'University of Utah Plastic Surgery Associates', 'Sophia', 'H', 'Kwo', 'MD', 'Plastic Surgery', '', '', NULL, 'B', 'PO Box 58049', 'Salt Lake City', 'Salt Lake', 'UT', '84158', '8015817073', NULL, 'PO Box 58049', 'Salt Lake City', 'Salt Lake', 'UT', '84158', '8015817073', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2009-12-04', '2010-07-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1720112352', 0, 'N', 0, '2010-02-25', NULL, NULL, 0, 0, NULL, NULL),
('870526462', 'W11024260', 'W11024260', 'UT01', 'University Health Care', 'Sophia', 'H', 'Kwo', 'MD', 'Plastic Surgery', '', '', NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015856839', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015856839', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2009-12-04', '2010-07-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1720112352', 0, 'N', 0, '2010-02-25', NULL, NULL, 0, 0, NULL, NULL),
('870640775', 'W11024261', 'W11024261', 'UT01', 'U of U Hospitals and Clinics - FPO', 'Zach', 'M', 'Beresford', 'MD', 'Physical Medicine and Rehabilitation', '', '', NULL, 'B', 'PO Box 510708', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8015876303', NULL, 'PO Box 510708', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8015876303', '          ', 'WISESTDU', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-07-01', '2012-09-18', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1922282458', 0, 'N', 0, '2012-09-19', NULL, NULL, 0, 0, NULL, NULL),
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('205529469', 'W11024263', 'W11024263', 'UT01', 'University Health Care', 'Brock', NULL, 'Niceler', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 58108', 'Salt Lake City', 'Salt Lake', 'UT', '84158', '8015883998', NULL, 'PO Box 58108', 'Salt Lake City', 'Salt Lake', 'UT', '84158', '8015883998', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2009-11-20', '2010-09-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1164608113', 0, 'N', 0, '2010-02-25', NULL, NULL, 0, 0, NULL, NULL),
('205529469', 'W11024264', 'W11024264', 'UT01', 'University Health Care', 'Brock', NULL, 'Niceler', 'MD', 'Family Practice', '', '', NULL, 'O', '1493 Lowell Ave', 'Park City', 'Summit', 'UT', '84060', '4356557079', NULL, '1493 Lowell Ave', 'Park City', 'Summit', 'UT', '84060', '4356557079', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2009-11-20', '2012-08-21', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1164608113', 0, 'N', 0, '2012-08-22', NULL, NULL, 0, 0, NULL, NULL),
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('270676745', 'W11024597', 'W11024597', 'UTDT01', 'DeMille MacKay Dental', 'David', '', 'MacKay', 'DMD', 'Dentist', '', '', NULL, 'O', '386 N Redwood Rd Ste 106', 'North Salt Lake', 'Davis', 'UT', '84054', '8013975262', NULL, '386 N Redwood Rd Ste 106', 'North Salt Lake', 'Davis', 'UT', '84054', '8013975262', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2010-02-01', '2013-07-14', 0, 0, 0, '', '', '', '', 'DEN|', '1023213287', 0, 'N', 0, '2013-09-06', NULL, NULL, 0, 0, NULL, NULL),
('270676745', 'W11024598', 'W11024598', 'UTDT01', 'DeMille MacKay Dental', 'Lyndon C', '', 'MacKay', 'DDS', 'Dentist', '', '', NULL, 'O', '386 N Redwood Rd Ste 106', 'North Salt Lake', 'Davis', 'UT', '84054', '8013975262', NULL, '386 N Redwood Rd Ste 106', 'North Salt Lake', 'Davis', 'UT', '84054', '8013975262', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2010-02-01', '2013-07-01', 0, 0, 0, '', '', '', '', 'DEN|', '0000002044', 0, 'N', 1, '2013-09-06', NULL, NULL, 0, 0, NULL, NULL),
('770640930', 'W11024599', 'W11024599', 'UTDT01', 'Professional Dental', 'Matthew', '', 'McInnes', 'DDS', 'Dentist', '', '', NULL, 'O', '32 Red Pine Dr Ste 14', 'Alpine', 'Utah', 'UT', '84004', '8017569595', NULL, '32 Red Pine Dr Ste 14', 'Alpine', 'Utah', 'UT', '84004', '8017569595', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2010-02-01', '2013-03-25', 0, 0, 0, '', '', '', '', 'DEN|', '0000002045', 0, 'N', 0, '2013-03-26', NULL, NULL, 0, 0, NULL, NULL),
('770640930', 'W11024600', 'W11024600', 'UTDT01', 'Professional Dental', 'Matthew', '', 'McInnes', 'DDS', 'Dentist', '', '', NULL, 'O', '6351 W 13400 S', 'Herriman', 'Salt Lake', 'UT', '84096', '8013027808', NULL, '6351 W 13400 S', 'Herriman', 'Salt Lake', 'UT', '84096', '8013027808', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2010-02-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000002046', 0, 'N', 0, '2012-08-22', NULL, NULL, 0, 0, NULL, NULL),
('770640930', 'W11024601', 'W11024601', 'UTDT01', 'Professional Dental', 'Matthew', '', 'McInnes', 'DDS', 'Dentist', '', '', NULL, 'O', '503 E 770 N', 'Orem', 'Utah', 'UT', '84057', '8012251400', NULL, '503 E 770 N', 'Orem', 'Utah', 'UT', '84057', '8012251400', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2010-02-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000002047', 0, 'N', 0, '2012-08-22', NULL, NULL, 0, 0, NULL, NULL),
('770640930', 'W11024602', 'W11024602', 'UTDT01', 'Professional Dental', 'Matthew', '', 'McInnes', 'DDS', 'Dentist', '', '', NULL, 'O', '78 E 100 S', 'Payson', 'Utah', 'UT', '84651', '8014650550', NULL, '78 E 100 S', 'Payson', 'Utah', 'UT', '84651', '8014650550', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2010-02-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000002048', 0, 'N', 0, '2012-08-22', NULL, NULL, 0, 0, NULL, NULL),
('770640930', 'W11024603', 'W11024603', 'UTDT01', 'Professional Dental', 'Matthew', '', 'McInnes', 'DDS', 'Dentist', '', '', NULL, 'O', '465 E 1000 S', 'Pleasant Grove', 'Utah', 'UT', '84062', '8017856000', NULL, '465 E 1000 S', 'Pleasant Grove', 'Utah', 'UT', '84062', '8017856000', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2010-02-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000002049', 0, 'N', 0, '2012-08-22', NULL, NULL, 0, 0, NULL, NULL),
('770640930', 'W11024604', 'W11024604', 'UTDT01', 'Professional Dental', 'Matthew', '', 'McInnes', 'DDS', 'Dentist', '', '', NULL, 'O', '1314 N Redwood Rd', 'Lehi', 'Utah', 'UT', '84043', '8017680440', NULL, '1314 N Redwood Rd', 'Lehi', 'Utah', 'UT', '84043', '8017680440', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2010-02-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000002050', 0, 'N', 0, '2012-08-22', NULL, NULL, 0, 0, NULL, NULL),
('271606596', 'W11024605', 'W11024605', 'UTDT01', '', 'Aaron', '', 'Olson', 'DDS', 'Dentist', '', '', NULL, 'O', '105 Skyline Dr', 'Brigham City', 'Box Elder', 'UT', '84302', '4357238913', NULL, '105 Skyline Dr', 'Brigham City', 'Box Elder', 'UT', '84302', '4357238913', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2010-02-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000002051', 0, 'N', 0, '2012-08-22', NULL, NULL, 0, 0, NULL, NULL),
('141954877', 'W11024606', 'W11024606', 'UTDT01', 'Rosewood Dental Associates', 'Landon', '', 'Rockwell', 'DDS', 'Dentist', '', '', NULL, 'O', '181 W Vine St', 'Tooele', 'Tooele', 'UT', '84074', '4358820099', NULL, '181 W Vine St', 'Tooele', 'Tooele', 'UT', '84074', '4358820099', '          ', 'UT000B', '', '', '0.00', '100.00', '0.00', 8, '2010-02-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000002052', 0, 'N', 0, '2012-08-22', NULL, NULL, 0, 0, NULL, NULL),
('141954877', 'W11024607', 'W11024607', 'UTDT01', 'Rosewood Dental Associates', 'Michael', '', 'Rockwell', 'DDS', 'Dentist', '', '', NULL, 'O', '181 W Vine St', 'Tooele', 'Tooele', 'UT', '84074', '4358820099', NULL, '181 W Vine St', 'Tooele', 'Tooele', 'UT', '84074', '4358820099', '          ', 'UT000B', '', '', '0.00', '100.00', '0.00', 8, '2010-02-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000002053', 0, 'N', 0, '2012-08-22', NULL, NULL, 0, 0, NULL, NULL),
('271073173', 'W11024608', 'W11024608', 'UTDT01', 'Saratoga Springs Pediatric Dentistry', 'Jeffrey  ', '', 'Rupp', 'DMD', 'Pedodontist', '', '', NULL, 'O', '76 E Commerce Dr Ste 100', 'Saratoga Springs', 'Utah', 'UT', '84045', '8017664900', NULL, '76 E Commerce Dr Ste 100', 'Saratoga Springs', 'Utah', 'UT', '84045', '8017664900', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2010-02-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000002054', 0, 'N', 0, '2012-08-22', NULL, NULL, 0, 0, NULL, NULL),
('271681340', 'W11024609', 'W11024609', 'UTDT01', 'Saratoga Pediatric Dentistry', 'Nathan F', '', 'Smith', 'DDS', 'Pedodontist', '', '', NULL, 'O', '245 E SR73', 'Saratoga Springs', '', 'UT', '84045', '8017668410', NULL, '245 E SR73', 'Saratoga Springs', '', 'UT', '84045', '8017668410', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2010-02-01', '2011-07-01', 0, 0, 0, '', '', '', '', 'DEN|', '1811918329', 0, 'N', 0, '2014-03-14', NULL, NULL, 0, 0, NULL, NULL),
('770640930', 'W11024610', 'W11024610', 'UTDT01', 'Professional Dental', 'Steven', '', 'Sorensen', 'DDS', 'Dentist', '', '', NULL, 'O', '32 Red Pine Dr Ste 14', 'Alpine', 'Utah', 'UT', '84004', '8017569595', NULL, '32 Red Pine Dr Ste 14', 'Alpine', 'Utah', 'UT', '84004', '8017569595', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2010-02-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000002056', 0, 'N', 0, '2012-08-22', NULL, NULL, 0, 0, NULL, NULL),
('770640930', 'W11024611', 'W11024611', 'UTDT01', 'Professional Dental', 'Steven', '', 'Sorensen', 'DDS', 'Dentist', '', '', NULL, 'O', '6351 W 13400 S', 'Herriman', 'Salt Lake', 'UT', '84096', '8013027808', NULL, '6351 W 13400 S', 'Herriman', 'Salt Lake', 'UT', '84096', '8013027808', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2010-02-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000002057', 0, 'N', 0, '2012-08-22', NULL, NULL, 0, 0, NULL, NULL),
('770640930', 'W11024612', 'W11024612', 'UTDT01', 'Professional Dental', 'Steven', '', 'Sorensen', 'DDS', 'Dentist', '', '', NULL, 'O', '503 E 770 N', 'Orem', 'Utah', 'UT', '84057', '8012251400', NULL, '503 E 770 N', 'Orem', 'Utah', 'UT', '84057', '8012251400', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2010-02-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000002058', 0, 'N', 0, '2012-08-22', NULL, NULL, 0, 0, NULL, NULL),
('770640930', 'W11024613', 'W11024613', 'UTDT01', 'Professional Dental', 'Steven', '', 'Sorensen', 'DDS', 'Dentist', '', '', NULL, 'O', '78 E 100 S', 'Payson', 'Utah', 'UT', '84651', '8014650550', NULL, '78 E 100 S', 'Payson', 'Utah', 'UT', '84651', '8014650550', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2010-02-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000002059', 0, 'N', 0, '2012-08-22', NULL, NULL, 0, 0, NULL, NULL),
('770640930', 'W11024614', 'W11024614', 'UTDT01', 'Professional Dental', 'Steven', '', 'Sorensen', 'DDS', 'Dentist', '', '', NULL, 'O', '465 E 1000 S', 'Pleasant Grove', 'Utah', 'UT', '84062', '8017856000', NULL, '465 E 1000 S', 'Pleasant Grove', 'Utah', 'UT', '84062', '8017856000', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2010-02-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000002060', 0, 'N', 0, '2012-08-22', NULL, NULL, 0, 0, NULL, NULL),
('770640930', 'W11024615', 'W11024615', 'UTDT01', 'Professional Dental', 'Steven', '', 'Sorensen', 'DDS', 'Dentist', '', '', NULL, 'O', '1314 N Redwood Rd', 'Lehi', 'Utah', 'UT', '84043', '8017680440', NULL, '1314 N Redwood Rd', 'Lehi', 'Utah', 'UT', '84043', '8017680440', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2010-02-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000002061', 0, 'N', 0, '2012-08-21', NULL, NULL, 0, 0, NULL, NULL),
('271073173', 'W11024616', 'W11024616', 'UTDT01', 'Saratoga Springs Pediatric Dentistry', 'Michael', '', 'Tew', 'DDS', 'Pedodontist', '', '', NULL, 'O', '76 E Commerce Dr Ste 100', 'Saratoga Springs', 'Utah', 'UT', '84045', '8017664900', NULL, '76 E Commerce Dr Ste 100', 'Saratoga Springs', 'Utah', 'UT', '84045', '8017664900', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2010-02-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000002062', 0, 'N', 0, '2012-08-21', NULL, NULL, 0, 0, NULL, NULL),
('261433331', 'W11024617', 'W11024617', 'UTDT01', 'Alpine Endodontics', 'Ryan', '', 'VanMoorlehem', 'DMD', 'Pedodontist', '', '', NULL, 'O', '826 N 100 E Ste 3', 'Spanish Fork', '', 'UT', '84660', '8015046070', NULL, '826 N 100 E Ste 3', 'Spanish Fork', '', 'UT', '84660', '8015046070', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2010-02-01', '2011-06-01', 0, 0, 0, '', '', '', '', 'DEN|', '0000002063', 0, 'N', 0, '2011-06-21', NULL, NULL, 0, 0, NULL, NULL),
('870355648', 'W11024618', 'W11024618', 'UTDT01', '', 'James', '', 'Bailey', 'DDS', 'Dentist', '', '', NULL, 'O', '230 N Cedar Hills Dr', 'Price', 'Carbon', 'UT', '84501', '4356373186', '          ', '230 N Cedar Hills Dr', 'Price', 'Carbon', 'UT', '84501', '4356373186', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2010-03-01', '2014-05-01', 0, 0, 0, '', '', '', '', 'DEN|', '1407957723', 0, 'N', 0, '2014-05-23', NULL, NULL, 0, 0, NULL, NULL),
('861062924', 'W11024619', 'W11024619', 'Sinclair', NULL, 'Jane', '', 'Krumm', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '834 Falls Ave Ste 1180', 'Twin Falls', 'Twin Falls', 'ID', '83301', '2087350403', NULL, '834 Falls Ave Ste 1180', 'Twin Falls', 'Twin Falls', 'ID', '83301', '2087350403', '', 'IDMA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2010-03-08', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1578559308', 0, 'n', 0, '2013-09-25', NULL, NULL, 0, 0, NULL, NULL),
('860913157', 'W11024620', 'W11024620', 'Sinclair', '(Sinclair Health Services\rProvider) The Ambulatory Surgi Center at FMC', '', '', 'The Ambulatory Surgi Center at FMC', 'GROUP', 'Ambulatory Surgery Center', '', '', NULL, 'O', '1200 N Beaver St Ste B', 'Flagstaff', 'Coconino', 'AZ', '86001', '2982142700', NULL, '1200 N Beaver St Ste B', 'Flagstaff', 'Coconino', 'AZ', '86001', '2982142700', '', '', NULL, NULL, '0.00', '20.00', '0.00', 3, '2010-03-08', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1154378909', 0, 'n', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('743236052', 'W11024621', 'W11024621', 'UT01', 'Bountiful Diabetes Clinic', 'Charles', 'D', 'White', 'MD', 'Family Practice', '', '', NULL, 'O', '440 Medical Dr Ste 2', 'Bountiful', 'Davis', 'UT', '84010', '8012955185', NULL, '440 Medical Dr Ste 2', 'Bountiful', 'Davis', 'UT', '84010', '8012955185', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-03-05', NULL, 0, 0, 0, 'Lakeview Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1366486805', 0, 'N', 0, '2014-01-17', NULL, NULL, 40.8873, -111.872, NULL, NULL),
('743236052', 'W11024622', 'W11024622', 'UT01', 'Bountiful Diabetes Clinic', 'Charles', 'D', 'White', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 244', 'Bountiful', 'Davis', 'UT', '84011', '8012955185', NULL, 'PO Box 244', 'Bountiful', 'Davis', 'UT', '84011', '8012955185', '', 'WISESTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2010-03-05', NULL, 0, 0, 0, 'Lakeview Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1366486805', 0, 'y', 0, '2014-01-17', NULL, NULL, 0, 0, NULL, NULL);
