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
('201435671', 'W12026797', 'W12026797', 'TXHOUSTD', 'Diabetes America', 'Shreya', '', 'Parikh', 'MD', 'Endocrinology', '', '', NULL, 'B', '13171 Misty Willow Dr', 'Houston', 'Harris', 'TX', '77070', '8322373500', '8882377954', '13171 Misty Willow Dr', 'Houston', 'Harris', 'TX', '77070', '8322373500', '8882377954', 'HOUSTON4', 'TXHCPC13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-05-05', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1437488806', 0, 'N', 0, '2013-04-18', NULL, NULL, 0, 0, NULL, NULL),
('201435671', 'W12026798', 'W12026798', 'TXHOUSTD', 'Diabetes America', 'Shreya', '', 'Parikh', 'MD', 'Endocrinology', '', '', NULL, 'O', '15200 S US 59 Hwy Ste 360', 'Sugar Land', 'Fort Bend', 'TX', '77478', '8322373500', '8882377954', '15200 S US 59 Hwy Ste 360', 'Sugar Land', 'Fort Bend', 'TX', '77478', '8322373500', '8882377954', 'HOUSTON4', 'TXHCPC13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1437488806', 0, 'N', 0, '2012-12-14', NULL, NULL, 29.622, -95.6055, NULL, NULL),
('201435671', 'W12026801', 'W12026801', 'TXHOUSTD', 'Diabetes America', 'Samir', '', 'Ouais', 'MD', 'Endocrinology', '', '', NULL, 'B', '13171 Misty Willow Dr', 'Houston', 'Harris', 'TX', '77070', '8322373500', '8882377954', '13171 Misty Willow Dr', 'Houston', 'Harris', 'TX', '77070', '8322373500', '8882377954', 'HOUSTON4', 'TXHCPC13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-05-05', 0, 0, 0, 'Kingwood Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1861559213', 0, 'N', 0, '2013-04-18', NULL, NULL, 0, 0, NULL, NULL),
('201435671', 'W12026802', 'W12026802', 'TXHOUSTD', 'Diabetes America', 'Samir', '', 'Ouais', 'MD', 'Endocrinology', '', '', NULL, 'O', '3333 Bayshore Blvd Ste 240', 'Pasadena', 'Harris', 'TX', '77504', '8322373500', '8882377954', '3333 Bayshore Blvd Ste 240', 'Pasadena', 'Harris', 'TX', '77504', '8322373500', '8882377954', 'HOUSTON4', 'TXHCPC13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Kingwood Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1861559213', 0, 'N', 0, '2012-12-14', NULL, NULL, 29.663, -95.1837, NULL, NULL),
('201435671', 'W12026805', 'W12026805', 'TXHOUSTD', 'Diabetes America', 'Claudia', '', 'Makhoul', 'MD', 'Endocrinology', '', '', NULL, 'O', '10970 Shadow Creek Pkwy Ste 270', 'Pearland', 'Brazoria', 'TX', '77584', '8322373500', '8882377954', '10970 Shadow Creek Pkwy Ste 270', 'Pearland', 'Brazoria', 'TX', '77584', '8322373500', '8882377954', 'HOUSTON4', 'TXHCPC13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1619028198', 0, 'N', 0, '2013-04-18', NULL, NULL, 29.5802, -95.3886, NULL, NULL),
('201435671', 'W12026804', 'W12026804', 'TXHOUSTD', 'Diabetes America', 'Claudia', '', 'Makhoul', 'MD', 'Endocrinology', '', '', NULL, 'B', '13171 Misty Willow Dr', 'Houston', 'Harris', 'TX', '77070', '8322373500', '8882377954', '13171 Misty Willow Dr', 'Houston', 'Harris', 'TX', '77070', '8322373500', '8882377954', 'HOUSTON4', 'TXHCPC13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-05-05', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1619028198', 0, 'N', 0, '2013-04-18', NULL, NULL, 0, 0, NULL, NULL),
('201435671', 'W12026807', 'W12026807', 'TXDALSTD', 'Diabetes America', 'Paul', '', 'Lyde', 'MD', 'Endocrinology', '', '', NULL, 'B', '13171 Misty Willow Dr', 'Houston', 'Harris', 'TX', '77070', '8322373500', '8882377954', '13171 Misty Willow Dr', 'Houston', 'Harris', 'TX', '77070', '8322373500', '8882377954', 'HOUSTON4', 'TXHCPC13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-05-05', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1336321207', 0, 'N', 0, '2013-04-18', NULL, NULL, 0, 0, NULL, NULL),
('201435671', 'W12026808', 'W12026808', 'TXDALSTD', 'Diabetes America', 'Paul', '', 'Lyde', 'MD', 'Endocrinology', '', '', NULL, 'O', '6420 N MacArthur Blvd Ste 130 ', 'Irving', 'Dallas', 'TX', '75039', '8322373500', '8882377954', '6420 N MacArthur Blvd Ste 130 ', 'Irving', 'Dallas', 'TX', '75039', '8322373500', '8882377954', 'HOUSTON4', 'TXHCPC13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1336321207', 0, 'N', 0, '2013-02-13', NULL, NULL, 32.8961, -96.9587, NULL, NULL),
('201435671', 'W12026810', 'W12026810', 'TXHOUSTD', 'Diabetes America', 'Celia', '', 'Levesque', 'FNP', 'Endocrinology', '', '', NULL, 'B', '13171 Misty Willow Dr', 'Houston', 'Harris', 'TX', '77070', '8322373500', '8882377954', '13171 Misty Willow Dr', 'Houston', 'Harris', 'TX', '77070', '8322373500', '8882377954', 'HOUSTON4', 'TXHCPC13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-05-05', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1316120363', 0, 'N', 0, '2013-04-18', NULL, NULL, 0, 0, NULL, NULL),
('201435671', 'W12026811', 'W12026811', 'TXHOUSTD', 'Diabetes America', 'Celia', '', 'Levesque', 'FNP', 'Endocrinology', '', '', NULL, 'O', '3333 Bayshore Blvd Ste 240', 'Pasadena', 'Harris', 'TX', '77504', '8322373500', '8882377954', '3333 Bayshore Blvd Ste 240', 'Pasadena', 'Harris', 'TX', '77504', '8322373500', '8882377954', 'HOUSTON4', 'TXHCPC13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1316120363', 0, 'Y', 0, '2013-03-27', NULL, NULL, 29.663, -95.1837, NULL, NULL),
('201435671', 'W12026813', 'W12026813', 'TXDALSTD', 'Diabetes America', 'Rosemarie', '', 'Lajara', 'MD', 'Endocrinology', '', '', NULL, 'B', '13171 Misty Willow Dr', 'Houston', 'Harris', 'TX', '77070', '8322373500', '8882377954', '13171 Misty Willow Dr', 'Houston', 'Harris', 'TX', '77070', '8322373500', '8882377954', 'HOUSTON4', 'TXHCPC13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-05-05', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1780862102', 0, 'N', 0, '2013-04-18', NULL, NULL, 0, 0, NULL, NULL),
('201435671', 'W12026814', 'W12026814', 'TXDALSTD', 'Diabetes America', 'Rosemarie', '', 'Lajara', 'MD', 'Endocrinology', '', '', NULL, 'O', '1708 Coit Rd Ste 100', 'Plano', 'Collin', 'TX', '75075', '8882373500', '8882377954', '1708 Coit Rd Ste 100', 'Plano', 'Collin', 'TX', '75075', '8882373500', '8882377954', 'HOUSTON4', 'TXHCPC13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1780862102', 0, 'N', 0, '2013-02-13', NULL, NULL, 33.0228, -96.7691, NULL, NULL),
('201435671', 'W12026816', 'W12026816', 'TXDALSTD', 'Diabetes America', 'Aysha', '', 'Kunju', 'MD', 'Endocrinology', '', '', NULL, 'B', '13171 Misty Willow Dr', 'Houston', 'Harris', 'TX', '77070', '8322373500', '8882377954', '13171 Misty Willow Dr', 'Houston', 'Harris', 'TX', '77070', '8322373500', '8882377954', 'HOUSTON4', 'TXHCPC13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-05-05', 0, 0, 0, 'Baylor Medical Center at Uptown', NULL, NULL, NULL, 'HCFA|UB|', '1831114669', 0, 'N', 0, '2013-04-18', NULL, NULL, 0, 0, NULL, NULL),
('201435671', 'W12026817', 'W12026817', 'TXDALSTD', 'Diabetes America', 'Aysha', '', 'Kunju', 'MD', 'Endocrinology', '', '', NULL, 'O', '6420 N MacArthur Blvd Ste 130 ', 'Irving', 'Dallas', 'TX', '75039', '8322373500', '8882377954', '6420 N MacArthur Blvd Ste 130 ', 'Irving', 'Dallas', 'TX', '75039', '8322373500', '8882377954', 'HOUSTON4', 'TXHCPC13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Medical Center at Uptown', NULL, NULL, NULL, 'HCFA|UB|', '1831114669', 0, 'N', 0, '2013-04-04', NULL, NULL, 32.8961, -96.9587, NULL, NULL),
('201435671', 'W12026819', 'W12026819', 'TXHOUSTD', 'Diabetes America', 'Kateryna', '', 'Komarovskiy', 'MD', 'Endocrinology', '', '', NULL, 'B', '13171 Misty Willow Dr', 'Houston', 'Harris', 'TX', '77070', '8322373500', '8882377954', '13171 Misty Willow Dr', 'Houston', 'Harris', 'TX', '77070', '8322373500', '8882377954', 'HOUSTON4', 'TXHCPC13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-05-05', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1265694285', 0, 'N', 0, '2013-04-18', NULL, NULL, 0, 0, NULL, NULL),
('201435671', 'W12026820', 'W12026820', 'TXHOUSTD', 'Diabetes America', 'Kateryna', '', 'Komarovskiy', 'MD', 'Endocrinology', '', '', NULL, 'O', '17937 I-45 Ste 115', 'Shenanhoah', 'Montgomery', 'TX', '77385', '8322373500', '8882377954', '17937 I-45 Ste 115', 'Shenanhoah', 'Montgomery', 'TX', '77385', '8322373500', '8882377954', 'HOUSTON4', 'TXHCPC13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1265694285', 0, 'N', 0, '2012-12-14', NULL, NULL, 30.1963, -95.4539, NULL, NULL),
('201435671', 'W12026822', 'W12026822', 'TXDALSTD', 'Diabetes America', 'Jane', '', 'Ko', 'MD', 'Endocrinology', '', '', NULL, 'B', '13171 Misty Willow Dr', 'Houston', 'Harris', 'TX', '77070', '8322373500', '8882377954', '13171 Misty Willow Dr', 'Houston', 'Harris', 'TX', '77070', '8322373500', '8882377954', 'HOUSTON4', 'TXHCPC13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-05-05', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1780892729', 0, 'N', 0, '2013-04-18', NULL, NULL, 0, 0, NULL, NULL),
('201435671', 'W12026823', 'W12026823', 'TXDALSTD', 'Diabetes America', 'Jane', '', 'Ko', 'MD', 'Endocrinology', '', '', NULL, 'O', '4519 Matlock Rd Ste 135', 'Arlington', 'Tarrant', 'TX', '76018', '8322373500', '8882377954', '4519 Matlock Rd Ste 135', 'Arlington', 'Tarrant', 'TX', '76018', '8322373500', '8882377954', 'HOUSTON4', 'TXHCPC13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1780892729', 0, 'N', 0, '2013-02-13', NULL, NULL, 32.6736, -97.1148, NULL, NULL),
('201435671', 'W12026825', 'W12026825', 'TXDALSTD', 'Diabetes America', 'Leo', '', 'Jeng', 'MD', 'Endocrinology', '', '', NULL, 'B', '13171 Misty Willow Dr', 'Houston', 'Harris', 'TX', '77070', '8322373500', '8882377954', '13171 Misty Willow Dr', 'Houston', 'Harris', 'TX', '77070', '8322373500', '8882377954', 'HOUSTON4', 'TXHCPC13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-05-05', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1821275959', 0, 'N', 0, '2013-04-18', NULL, NULL, 0, 0, NULL, NULL),
('201435671', 'W12026826', 'W12026826', 'TXDALSTD', 'Diabetes America', 'Leo', '', 'Jeng', 'MD', 'Endocrinology', '', '', NULL, 'O', '4519 Matlock Rd Ste 135', 'Arlington', 'Tarrant', 'TX', '76018', '8322373500', '8882377954', '4519 Matlock Rd Ste 135', 'Arlington', 'Tarrant', 'TX', '76018', '8322373500', '8882377954', 'HOUSTON4', 'TXHCPC13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1821275959', 0, 'N', 0, '2013-02-13', NULL, NULL, 32.6736, -97.1148, NULL, NULL),
('201435671', 'W12026829', 'W12026829', 'TXHOUSTD', 'Diabetes America', 'Erica', '', 'Hightower', 'MD', 'Endocrinology', '', '', NULL, 'O', '11301 Fallbrook Dr Ste 304', 'Houston', 'Harris', 'TX', '77065', '8322373500', '8882377954', '11301 Fallbrook Dr Ste 304', 'Houston', 'Harris', 'TX', '77065', '8322373500', '8882377954', 'HOUSTON4', 'TXHCPC13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1629198726', 0, 'N', 0, '2013-05-28', NULL, NULL, 29.9256, -95.589, NULL, NULL),
('201435671', 'W12026828', 'W12026828', 'TXHOUSTD', 'Diabetes America', 'Erica', '', 'Hightower', 'MD', 'Endocrinology', '', '', NULL, 'B', '13171 Misty Willow Dr', 'Houston', 'Harris', 'TX', '77070', '8322373500', '8882377954', '13171 Misty Willow Dr', 'Houston', 'Harris', 'TX', '77070', '8322373500', '8882377954', 'HOUSTON4', 'TXHCPC13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-05-05', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1629198726', 0, 'N', 0, '2013-05-28', NULL, NULL, 0, 0, NULL, NULL),
('201435671', 'W12026831', 'W12026831', 'TXHOUSTD', 'Diabetes America', 'Wendy', '', 'Hawkins', 'MD', 'Endocrinology', '', '', NULL, 'B', '13171 Misty Willow Dr', 'Houston', 'Harris', 'TX', '77070', '8322373500', '8882377954', '13171 Misty Willow Dr', 'Houston', 'Harris', 'TX', '77070', '8322373500', '8882377954', 'HOUSTON4', 'TXHCPC13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-05-05', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1104887033', 0, 'N', 0, '2013-04-18', NULL, NULL, 0, 0, NULL, NULL),
('201435671', 'W12026832', 'W12026832', 'TXHOUSTD', 'Diabetes America', 'Wendy', '', 'Hawkins', 'MD', 'Endocrinology', '', '', NULL, 'O', '2495 S Braeswood', 'Houston', 'Harris', 'TX', '77030', '8322373500', '8882377954', '2495 S Braeswood', 'Houston', 'Harris', 'TX', '77030', '8322373500', '8882377954', 'HOUSTON4', 'TXHCPC13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1104887033', 0, 'N', 0, '2012-12-14', NULL, NULL, 29.697, -95.4177, NULL, NULL),
('201435671', 'W12026834', 'W12026834', 'TXHOUSTD', 'Diabetes America', 'Rocio', '', 'Harbison', 'MD', 'Endocrinology', '', '', NULL, 'B', '13171 Misty Willow Dr', 'Houston', 'Harris', 'TX', '77070', '8322373500', '8882377954', '13171 Misty Willow Dr', 'Houston', 'Harris', 'TX', '77070', '8322373500', '8882377954', 'HOUSTON4', 'TXHCPC13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-05-05', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1881710499', 0, 'N', 0, '2013-04-18', NULL, NULL, 0, 0, NULL, NULL),
('201435671', 'W12026835', 'W12026835', 'TXHOUSTD', 'Diabetes America', 'Rocio', '', 'Harbison', 'MD', 'Endocrinology', '', '', NULL, 'O', '3333 Bayshore Blvd Ste 240', 'Pasadena', 'Harris', 'TX', '77504', '8322373500', '8882377954', '3333 Bayshore Blvd Ste 240', 'Pasadena', 'Harris', 'TX', '77504', '8322373500', '8882377954', 'HOUSTON4', 'TXHCPC13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2014-02-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1881710499', 0, 'N', 0, '2014-02-05', NULL, NULL, 29.6632, -95.1833, NULL, NULL),
('201435671', 'W12026837', 'W12026837', 'TXHOUSTD', 'Diabetes America', 'Liliana', '', 'Garcia', 'PA', 'Endocrinology', '', '', NULL, 'B', '13171 Misty Willow Dr', 'Houston', 'Harris', 'TX', '77070', '8322373500', '8882377954', '13171 Misty Willow Dr', 'Houston', 'Harris', 'TX', '77070', '8322373500', '8882377954', 'HOUSTON4', 'TXHCPC13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-05-05', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1467647669', 0, 'N', 0, '2013-04-23', NULL, NULL, 0, 0, NULL, NULL),
('201435671', 'W12026838', 'W12026838', 'TXHOUSTD', 'Diabetes America', 'Liliana', '', 'Garcia', 'PA', 'Endocrinology', '', '', NULL, 'O', '707 S Fry Rd Ste 290', 'Katy', 'Harris', 'TX', '77450', '8322373500', '8882377954', '707 S Fry Rd Ste 290', 'Katy', 'Harris', 'TX', '77450', '8322373500', '8882377954', 'HOUSTON4', 'TXHCPC13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-03-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1467647669', 0, 'N', 0, '2013-04-23', NULL, NULL, 29.7778, -95.719, NULL, NULL),
('201435671', 'W12026840', 'W12026840', 'TXHOUSTD', 'Diabetes America', 'Dianne', 'A', 'Fetchick', 'MD', 'Endocrinology', '', '', NULL, 'B', '13171 Misty Willow Dr', 'Houston', 'Harris', 'TX', '77070', '8322373500', '8882377954', '13171 Misty Willow Dr', 'Houston', 'Harris', 'TX', '77070', '8322373500', '8882377954', 'HOUSTON4', 'TXHCPC13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-05-05', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1770665465', 0, 'N', 0, '2013-04-18', NULL, NULL, 0, 0, NULL, NULL),
('201435671', 'W12026839', 'W12026839', 'TXHOUSTD', 'Diabetes America', 'Dianne', 'A', 'Fetchick', 'MD', 'Endocrinology', '', '', NULL, 'O', '7863 Callaghan Rd Ste 206', 'San Antonio', 'Bexar', 'TX', '78258', '8322373500', '8882377954', '7863 Callaghan Rd Ste 206', 'San Antonio', 'Bexar', 'TX', '78258', '8322373500', '8882377954', 'HOUSTON4', 'TXHCPC13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1770665465', 0, 'Y', 0, '2013-03-21', NULL, NULL, 29.5092, -98.5544, NULL, NULL),
('201435671', 'W12026843', 'W12026843', 'TXHOUSTD', 'Diabetes America', 'Timothy', '', 'Daniel', 'MD', 'Endocrinology', '', '', NULL, 'O', '10970 Shadow Creek Pkwy Ste 270', 'Pearland', 'Brazoria', 'TX', '77584', '8322373500', '8882377954', '10970 Shadow Creek Pkwy Ste 270', 'Pearland', 'Brazoria', 'TX', '77584', '8322373500', '8882377954', 'HOUSTON4', 'TXHCPC13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1770679573', 0, 'N', 0, '2013-04-18', NULL, NULL, 29.5802, -95.3886, NULL, NULL),
('201435671', 'W12026842', 'W12026842', 'TXHOUSTD', 'Diabetes America', 'Timothy', '', 'Daniel', 'MD', 'Endocrinology', '', '', NULL, 'B', '13171 Misty Willow Dr', 'Houston', 'Harris', 'TX', '77070', '8322373500', '8882377954', '13171 Misty Willow Dr', 'Houston', 'Harris', 'TX', '77070', '8322373500', '8882377954', 'HOUSTON4', 'TXHCPC13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-05-05', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1770679573', 0, 'N', 0, '2013-04-18', NULL, NULL, 0, 0, NULL, NULL),
('201435671', 'W12026845', 'W12026845', 'TXHOUSTD', 'Diabetes America', 'Bernadette', '', 'Collazo', 'FNP', 'Endocrinology', '', '', NULL, 'B', '13171 Misty Willow Dr', 'Houston', 'Harris', 'TX', '77070', '8322373500', '8882377954', '13171 Misty Willow Dr', 'Houston', 'Harris', 'TX', '77070', '8322373500', '8882377954', 'HOUSTON4', 'TXHCPC13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-05-05', 0, 0, 0, 'Baptist Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1316126162', 0, 'Y', 0, '2013-05-10', NULL, NULL, 0, 0, NULL, NULL),
('201435671', 'W12026846', 'W12026846', 'TXHOUSTD', 'Diabetes America', 'Bernadette', '', 'Collazo', 'FNP', 'Endocrinology', '', '', NULL, 'O', '20330 S Huebner Rd Ste 104', 'San Antonio', 'Bexar', 'TX', '78258', '8322373500', '8882377954', '20330 S Huebner Rd Ste 104', 'San Antonio', 'Bexar', 'TX', '78258', '8322373500', '8882377954', 'HOUSTON4', 'TXHCPC13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baptist Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1316126162', 0, 'N', 0, '2013-05-10', NULL, NULL, 29.6121, -98.491, NULL, NULL),
('201435671', 'W12026848', 'W12026848', 'TXDALSTD', 'Diabetes America', 'Christina', '', 'Bratcher', 'MD', 'Endocrinology', '', '', NULL, 'B', '13171 Misty Willow Dr', 'Houston', 'Harris', 'TX', '77070', '8322373500', '8882377954', '13171 Misty Willow Dr', 'Houston', 'Harris', 'TX', '77070', '8322373500', '8882377954', 'HOUSTON4', 'TXHCPC13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-02-28', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1255384756', 0, 'N', 0, '2013-03-26', NULL, NULL, 0, 0, NULL, NULL),
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('201435671', 'W12026854', 'W12026854', 'TXHOUSTD', 'Diabetes America', 'Nuzha', '', 'Amjad', 'MD', 'Endocrinology', '', '', NULL, 'B', '13171 Misty Willow Dr', 'Houston', 'Harris', 'TX', '77070', '8322373500', '8882377954', '13171 Misty Willow Dr', 'Houston', 'Harris', 'TX', '77070', '8322373500', '8882377954', 'HOUSTON4', 'TXHCPC13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-05-05', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1336159920', 0, 'N', 0, '2013-04-23', NULL, NULL, 0, 0, NULL, NULL),
('201435671', 'W12026855', 'W12026855', 'TXHOUSTD', 'Diabetes America', 'Nuzha', '', 'Amjad', 'MD', 'Endocrinology', '', '', NULL, 'O', '707 S Fry Rd Ste 290', 'Katy', 'Harris', 'TX', '77450', '8322373500', '8882377954', '707 S Fry Rd Ste 290', 'Katy', 'Harris', 'TX', '77450', '8322373500', '8882377954', 'HOUSTON4', 'TXHCPC13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-03-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1336159920', 0, 'N', 0, '2013-04-23', NULL, NULL, 29.7778, -95.719, NULL, NULL),
('452715973', 'W12027745', 'W12027745', 'Sinclair', 'St Lukes Clinic Wood River', 'Daniel', 'B', 'Judd', '(Sinclair Health Service Provider)', 'Orthopedic Surgery', '', '', NULL, 'O', '191 W 5th St', 'Ketchum', 'Blaine', 'ID', '83340', '2087265027', '2087268948', '191 W 5th St', 'Ketchum', 'Blaine', 'ID', '83340', '2087265027', '2087268948', 'IDSINCLAIRD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-10-29', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1073670360', 0, 'N', 0, '2014-02-19', NULL, NULL, 0, 0, NULL, NULL),
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('383868128', 'W12026857', 'W12026857', 'WYT1', 'West Park Hospital District', '', '', 'West Park Hospital District', '', 'Home Health Agency', '', '', NULL, 'O', '707 Sheridan Ave', 'Cody', 'Park', 'WY', '82414', '3075782291', '3075782294', '707 Sheridan Ave', 'Cody', 'Park', 'WY', '82414', '3075782291', '3075782294', '', '', '', '0.00', '12.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009968', 0, 'N', 0, '2012-12-11', NULL, NULL, 0, 0, NULL, NULL),
('204043287', 'W12026860', 'W12026860', 'NM01', 'ABQ Health Partners', 'Ruben', 'P', 'Franco', 'PA-C', 'Pain Management', '', '', NULL, 'B', 'PO Box 27829', 'Albuquerque', 'Bernalillo', 'NM', '87125', '5052627600', '0000000000', 'PO Box 27829', 'Albuquerque', 'Bernalillo', 'NM', '87125', '5052627600', '0000000000', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2012-11-14', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1104908839', 0, 'N', 0, '2013-11-15', NULL, NULL, 0, 0, NULL, NULL),
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('204043287', 'W12026865', 'W12026865', 'NM01', 'ABQ Health Partners', 'Kristen', '', 'Bushnell', 'PA-C', 'General Surgery', '', '', NULL, 'O', '9101 Montgomery Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87111', '5052754259', '5052754223', '9101 Montgomery Blvd NE', 'Albuquerque', 'Bernalillo', 'NM', '87111', '5052754259', '5052754223', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2012-11-14', NULL, 0, 0, 0, 'Lovelace Westside Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1982818860', 0, 'N', 0, '2013-10-03', NULL, NULL, 35.1307, -106.542, NULL, NULL),
('204043287', 'W12026866', 'W12026866', 'NM01', 'ABQ Health Partners', 'Kristen', '', 'Bushnell', 'PA-C', 'General Surgery', '', '', NULL, 'O', '1721 Rio Rancho Blvd SE', 'Rio Rancho', 'Sandoval', 'NM', '87144', '5058968604', '5058968697', '1721 Rio Rancho Blvd SE', 'Rio Rancho', 'Sandoval', 'NM', '87144', '5058968604', '5058968697', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2012-11-14', NULL, 0, 0, 0, 'Lovelace Westside Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1982818860', 0, 'N', 0, '2013-10-03', NULL, NULL, 35.2284, -106.66, NULL, NULL),
('942854057', 'W12026868', 'W12026868', 'UTIHCPHY', 'Heber Valley Clinic', 'Chad', 'N', 'Wood', 'MD', 'Urgent Care', '', '', NULL, 'O', '1473 S Hwy 40 Ste E', 'Heber City', 'Wasatch', 'UT', '84032', '4356574400', '4356574460', '1473 S Highway 40 Ste E', 'Heber City', 'Wasatch', 'UT', '84032', '4356574400', '4356574460', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2012-09-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1477646875', 0, 'Y', 0, '2012-12-11', NULL, NULL, 40.4893, -111.409, NULL, NULL),
('942854057', 'W12026870', 'W12026870', 'UTIHCPHY', 'River Road InstaCare', 'Jordan', 'V', 'Blanchard', 'MD', 'Urgent Care', '', '', NULL, 'O', '577 S River Rd', 'St George', 'Washington', 'UT', '84790', '4356886300', '4356886333', '577 S River Rd', 'St George', 'Washington', 'UT', '84790', '4356886300', '4356886333', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2012-10-20', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1356630941', 0, 'Y', 0, '2013-05-30', NULL, NULL, 37.0986, -113.557, NULL, NULL),
('942854057', 'W12026871', 'W12026871', 'UTIHCPHY', 'Salt Lake Clinic', 'Kelly', 'D', 'Garrett', 'PhD', 'Mental Health', 'Psychology', '', NULL, 'O', '389 S 900 E', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '3852822000', '3852822201', '389 S 900 E', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '3852822000', '3852822201', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HHCFA|UB|', '1245251776', 0, 'Y', 0, '2012-12-11', NULL, NULL, 40.761, -111.865, NULL, NULL),
('942854057', 'W12026872', 'W12026872', 'UTIHCPHY', 'Southridge KidsCare', 'Marcus', '', 'Blackburn', 'MD', 'Pediatrics', '', '', NULL, 'O', '3723 W 12600 S Ste 150', 'Riverton', 'Salt Lake', 'UT', '84065', '8012854561', '8012854565', '3723 W 12600 S Ste 150', 'Riverton', 'Salt Lake', 'UT', '84065', '8012854561', '8012854565', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2012-12-01', NULL, 0, 0, 0, 'Riverton Childrens Unit Operated by Primary Childrens Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1598919409', 0, 'Y', 0, '2013-05-17', NULL, NULL, 40.5222, -111.98, NULL, NULL),
('942854057', 'W12026874', 'W12026874', 'UTIHCPHY', 'Southwest Neurology Associates', 'Cindy', 'M', 'Duke', 'PhD', 'Neurology', '', '', NULL, 'O', '652 S Medical Ctr Dr Ste 320', 'St George', 'Washington', 'UT', '84790', '4352513950', '4352513951', '652 S Medical Center Dr Ste 320', 'St George', 'Washington', 'UT', '84790', '4352513950', '4352513951', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2012-10-08', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1518151331', 0, 'Y', 0, '2012-12-11', NULL, NULL, 37.0498, -113.574, NULL, NULL),
('942854057', 'W12026875', 'W12026875', 'UTIHCPHY', 'Redrock Spine & Neurosurgery Clinic', 'Cindy', 'M', 'Duke', 'PhD', 'Neurology', '', '', NULL, 'O', '652 S Medical Ctr Dr Ste 420', 'St George', 'Washington', 'UT', '84790', '4352516800', '4352513701', '652 S Medical Center Dr Ste 420', 'St George', 'Washington', 'UT', '84790', '4352516800', '4352513701', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2012-10-09', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1518151331', 0, 'Y', 0, '2012-12-11', NULL, NULL, 37.0498, -113.574, NULL, NULL),
('942854057', 'W12026876', 'W12026876', 'UTIHCPHY', 'Dixie Acute Rehab', 'Cindy', 'M', 'Duke', 'PhD', 'Neurology', '', '', NULL, 'O', '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356884700', '4356884326', '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356884700', '4356884326', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2012-10-08', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1518151331', 0, 'Y', 0, '2012-12-11', NULL, NULL, 37.0989, -113.575, NULL, NULL),
('942854057', 'W12026878', 'W12026878', 'UTIHCPHY', 'Int Heart Cardiology-Riverton', 'Hannah', 'E', 'Raasch', 'MD', 'Cardiology', '', '', NULL, 'O', '3741 W 12600 S Ste 160 A', 'Riverton', 'Salt Lake', 'UT', '84065', '8015073500', '8015073505', '3741 W 12600 S Ste 160 A', 'Riverton', 'Salt Lake', 'UT', '84065', '8015073500', '8015073505', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2012-11-05', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1326249657', 0, 'N', 0, '2012-12-11', NULL, NULL, 40.5222, -111.98, NULL, NULL),
('942854057', 'W12026879', 'W12026879', 'UTIHCPHY', 'Int Heart Cardiology-AVH', 'Hannah', 'E', 'Raasch', 'MD', 'Cardiology', '', '', NULL, 'O', '9690 S 1300 E Ste 200', 'Sandy', 'Salt Lake', 'UT', '84094', '8015073500', '8015073505', '9690 S 1300 E Ste 200', 'Sandy', 'Salt Lake', 'UT', '84094', '8015073500', '8015073505', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2012-11-05', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1326249657', 0, 'N', 0, '2012-12-11', NULL, NULL, 40.5743, -111.853, NULL, NULL),
('942854057', 'W12026880', 'W12026880', 'UTIHCPHY', 'Int Heart Cardiology-LDSH', 'Hannah', 'E', 'Raasch', 'MD', 'Cardiology', '', '', NULL, 'O', '8th Ave and C St 7th Floor', 'Salt Lake City', 'Salt Lake', 'UT', '84143', '8015073500', '8015073505', '8th Ave and C St 7th Floor', 'Salt Lake City', 'Salt Lake', 'UT', '84143', '8015073500', '8015073505', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2012-11-05', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1326249657', 0, 'N', 0, '2012-12-11', NULL, NULL, 40.7785, -111.881, NULL, NULL),
('942854057', 'W12026882', 'W12026882', 'UTIHCPHY', 'Southwest Regional Cancer Clinic', 'Karen', 'Y', 'Lin', 'MD', 'Hematology and Oncology', '', '', NULL, 'O', '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356884900', '4356884901', '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356884900', '4356884901', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2012-11-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1437361185', 0, 'N', 0, '2012-12-11', NULL, NULL, 37.0989, -113.575, NULL, NULL),
('942854057', 'W12026883', 'W12026883', 'UTIHCPHY', 'Southwest Regional Cancer-Cedar City', 'Karen', 'Y', 'Lin', 'MD', 'Hematology and Oncology', '', '', NULL, 'O', '1303 N Main St', 'Cedar City', 'Iron', 'UT', '84720', '4358685690', '4356349852', '1303 N Main St', 'Cedar City', 'Iron', 'UT', '84720', '4358685690', '4356349852', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2012-11-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1437361185', 0, 'N', 0, '2012-12-11', NULL, NULL, 37.7003, -113.064, NULL, NULL),
('770364810', 'W12026884', 'W12026884', 'TXHOUSTD', 'Robert W Jackson MD', 'Robert ', 'W', 'Jackson', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '17070 Red Oak Dr Ste 409', 'Houston', 'Harris', 'TX', '77090', '2814408090', '2814409959', '17070 Red Oak Dr Ste 409', 'Houston', 'Harris', 'TX', '77090', '2814408090', '2814409959', 'HOUSTON3', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1689630196', 0, 'Y', 0, '2014-04-29', NULL, NULL, 30.0181, -95.4445, NULL, NULL),
('522419748', 'W12026885', 'W12026885', 'TXHOUSTD', 'Bich Nguyen MD', 'Khoa', 'T', 'Cao', 'MD', 'Family Practice', '', '', NULL, 'O', '11034 Scarsdale Ste B', 'Houston', 'Harris', 'TX', '77089', '2814840449', '2814847210', '11034 Scarsdale Ste B', 'Houston', 'Harris', 'TX', '77089', '2814840449', '2814847210', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1982702031', 0, 'N', 0, '2013-06-05', NULL, NULL, 29.5873, -95.2105, NULL, NULL),
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('030385803', 'W12026887', 'W12026887', 'TXHOUSTD', 'Northwest Pediatric Clinic', 'Thirty', '', 'Desai', 'MD', 'Pediatrics', '', '', NULL, 'B', '7306 Dayhill Dr', 'Spring', 'Harris', 'TX', '77379', '2814440000', '2814446158', '7306 Dayhill Dr', 'Spring', 'Harris', 'TX', '77379', '2814440000', '2814446158', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Houston Methodist Willowbrook Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1922056183', 0, 'N', 0, '2013-05-24', NULL, NULL, 0, 0, NULL, NULL),
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('741471627', 'W12026922', 'W12026922', 'TXHOUSTD', 'Orthopaedic Associates', '', '', 'Orthopaedic Associates LLP', '', 'Orthopedic Surgery', '', '', NULL, 'O', '707 S Fry Rd Ste 255', 'Katy', 'Harris', 'TX', '77450', '7136506900', '7136504900', '707 S Fry Rd Ste 255', 'Katy', 'Harris', 'TX', '77450', '7136506900', '7136504900', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1841276631', 0, 'Y', 0, '2013-01-09', NULL, NULL, 29.7765, -95.7189, NULL, NULL),
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('741471627', 'W12026924', 'W12026924', 'TXHOUSTD', 'Orthopaedic Associates', '', '', 'Orthopaedic Associates LLP', '', 'Orthopedic Surgery', '', '', NULL, 'O', '22751 Professional Dr Ste 250', 'Kingwood', 'Harris', 'TX', '77339', '7136506900', '7136504900', '22751 Professional Dr Ste 250', 'Kingwood', 'Harris', 'TX', '77339', '7136506900', '7136504900', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1841276631', 0, 'Y', 0, '2013-01-09', NULL, NULL, 30.0479, -95.258, NULL, NULL),
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('820200895', 'W12027009', 'W12027009', 'IDBOISTD', 'Saint Alphonsus Medical Group Pulmonary & Sleep Nampa ', 'Cary', '', 'Jackson', 'MD', 'Pulmonary', 'Sleep Medicine', 'Sleep Disorders', NULL, 'O', '401 E Hawaii Ave', 'Nampa', 'Canyon', 'ID', '83686', '2084656952', '2084656449', '401 E Hawaii Ave', 'Nampa', 'Canyon', 'ID', '83686', '2084656952', '2084656449', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-11-30', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|', '1932169042', 0, 'N', 0, '2014-06-20', NULL, NULL, 43.5551, -116.569, NULL, NULL),
('760478691', 'W12027140', 'W12027140', 'TXHOUSTD', 'The Kidney Institute', 'Christopher', '', 'Kwoh', 'MD', 'Nephrology', '', '', NULL, 'O', '1700 Romano Park Ln', 'Houston', 'Harris', 'TX', '77090', '2818669995', '2818667212', '1700 Romano Park Ln', 'Houston', 'Harris', 'TX', '77090', '2818669995', '2818667212', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1962427534', 0, 'N', 0, '2013-04-26', NULL, NULL, 30.014, -95.4557, NULL, NULL),
('260553931', 'W12027014', 'W12027014', 'IDBOISTD', 'Saint Alphonsus Medical Group Maternal Fetal Medicine Boise', 'Paul', 'W', 'Whitecar', 'MD', 'Maternal Fetal Medicine', '', '', NULL, 'O', '900 N Liberty Ste 206', 'Boise', 'Ada', 'ID', '83704', '2083675544', '2083675543', '900 N Liberty Ste 206', 'Boise', 'Ada', 'ID', '83704', '2083675544', '2083675543', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2012-08-20', '2012-10-11', 0, 0, 0, 'St Marks Hospital', 'Ogden Regional Medical Center', '', '', 'HCFA|UB|', '1639144934', 0, 'Y', 0, '2013-05-07', NULL, NULL, 43.6133, -116.259, NULL, NULL),
('362709982', 'W12026660', 'W12026660', 'ILCHIGSTD', 'Presence Medical Group', '', '', 'Presence Medical Group', '', 'Clinics', '', '', NULL, 'B', '25872 Network Place', 'Chicago', 'Cook', 'IL', '60673', '          ', NULL, '25872 Network Place', 'Chicago', 'Cook', 'IL', '60673', '          ', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000010017', 0, 'N', 0, '2013-10-28', NULL, NULL, 0, 0, NULL, NULL),
('362709982', 'W12026661', 'W12026661', 'ILCHIGSTD', 'Presence Medical Group', '', '', 'Presence Medical Group', '', 'Clinics', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '          ', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '          ', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000010017', 0, 'N', 0, '2013-10-28', NULL, NULL, 0, 0, NULL, NULL),
('363330929', 'W12026662', 'W12026662', 'ILCHIGSTD', 'Presence Medical Group', '', '', 'Presence Medical Group', '', 'Clinics', '', '', NULL, 'B', '25872 Network Place', 'Chicago', 'Cook', 'IL', '60673', '          ', NULL, '25872 Network Place', 'Chicago', 'Cook', 'IL', '60673', '          ', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000010017', 0, 'N', 0, '2013-10-28', NULL, NULL, 0, 0, NULL, NULL),
('363330929', 'W12026663', 'W12026663', 'ILCHIGSTD', 'Presence Medical Group', '', '', 'Presence Medical Group', '', 'Clinics', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '          ', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '          ', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000010017', 0, 'N', 0, '2013-10-28', NULL, NULL, 0, 0, NULL, NULL),
('364286236', 'W12026665', 'W12026665', 'ILCHIGSTD', 'Presence Medical Group', '', '', 'Presence Medical Group', '', 'Clinics', '', '', NULL, 'B', '25872 Network Place', 'Chicago', 'Cook', 'IL', '60673', '          ', NULL, '25872 Network Place', 'Chicago', 'Cook', 'IL', '60673', '          ', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000010017', 0, 'N', 0, '2013-10-28', NULL, NULL, 0, 0, NULL, NULL),
('364286236', 'W12026664', 'W12026664', 'ILCHIGSTD', 'Presence Medical Group', '', '', 'Presence Medical Group', '', 'Clinics', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '          ', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '          ', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000010017', 0, 'N', 0, '2013-10-28', NULL, NULL, 0, 0, NULL, NULL),
('364314354', 'W12026666', 'W12026666', 'ILCHIGSTD', 'Presence Medical Group', '', '', 'Presence Medical Group', '', 'Clinics', '', '', NULL, 'B', '25872 Network Place', 'Chicago', 'Cook', 'IL', '60673', '          ', NULL, '25872 Network Place', 'Chicago', 'Cook', 'IL', '60673', '          ', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000010017', 0, 'N', 0, '2013-10-28', NULL, NULL, 0, 0, NULL, NULL),
('364314354', 'W12026667', 'W12026667', 'ILCHIGSTD', 'Presence Medical Group', '', '', 'Presence Medical Group', '', 'Clinics', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '          ', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '          ', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2030-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000010017', 0, 'N', 0, '2013-10-28', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG018', 'EDMPMG018', 'ILCHIGSTD', 'St Joseph Hospital', 'Aaron', '', 'Kallsnick', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '5645 W Addison', 'Chicago', 'Cook', 'IL', '60634', '7732827000', NULL, '5645 W Addison', 'Chicago', 'Cook', 'IL', '60634', '7732827000', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1003011966', 0, 'Y', 0, '2013-03-05', NULL, NULL, 41.9459, -87.7678, NULL, NULL),
('363330928', 'EDMPMG561', 'EDMPMG561', 'ILCHIGSTD', 'St Joseph Hospital', 'Aaron', '', 'Kallsnick', 'MD', 'Emergency Medicine', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7732827000', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7732827000', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1003011966', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('364314354', 'EDMPMG281', 'EDMPMG281', 'ILCHIGSTD', 'PMG Kankakee Obstetrics', 'Jennifer', NULL, 'Klump', 'APN', 'Obstetrics and Gynecology', '', '', NULL, 'B', '25872 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '8159372141', NULL, '25872 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '8159372141', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1003199951', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('364314354', 'EDMPMG110', 'EDMPMG110', 'ILCHIGSTD', 'PMG Kankakee Obstetrics', 'Jennifer', NULL, 'Klump', 'APN', 'Obstetrics and Gynecology', '', '', NULL, 'O', '555 W Court St Ste 214', 'Kankakee', 'Kankakee', 'IL', '60901', '8159372141', NULL, '555 W Court St Ste 214', 'Kankakee', 'Kankakee', 'IL', '60901', '8159372141', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1003199951', 0, 'Y', 0, '2013-03-05', NULL, NULL, 41.1213, -87.8723, 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
('364314354', 'EDMPMG278', 'EDMPMG278', 'ILCHIGSTD', 'PMG Kankakee Family Practice', 'Shonna', NULL, 'Beckman', 'PA-C', 'Physician Assistant', '', '', NULL, 'B', '25872 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '8159372400', NULL, '25872 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '8159372400', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1003823188', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('364314354', 'EDMPMG277', 'EDMPMG277', 'ILCHIGSTD', 'PMG Kankakee Family Practice', 'Shonna', NULL, 'Beckman', 'PA-C', 'Physician Assistant', '', '', NULL, 'O', '500 W Court St', 'Kankakee', 'Kankakee', 'IL', '60901', '8159372400', NULL, '500 W Court St', 'Kankakee', 'Kankakee', 'IL', '60901', '8159372400', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1003823188', 0, 'Y', 0, '2013-03-05', NULL, NULL, 41.1211, -87.8718, NULL, NULL),
('363330928', 'EDMPMG480', 'EDMPMG480', 'ILCHIGSTD', '', 'Mario', NULL, 'Salazar', 'MD', 'Family Practice', '', '', NULL, 'O', '3048 N Harlem Ave', 'Chicago', 'Cook', 'IL', '60634', '7732377795', NULL, '3048 N Harlem Ave', 'Chicago', 'Cook', 'IL', '60634', '7732377795', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Our Lady Of The Resurrection Medical Center', NULL, '', NULL, 'HCFA|UB|', '1003915620', 0, 'N', 0, '2013-03-05', NULL, NULL, 41.9354, -87.8066, NULL, NULL),
('363330928', 'EDMPMG481', 'EDMPMG481', 'ILCHIGSTD', '', 'Mario', NULL, 'Salazar', 'MD', 'Family Practice', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7732377795', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7732377795', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Our Lady Of The Resurrection Medical Center', NULL, '', NULL, 'HCFA|UB|', '1003915620', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('752536818', 'W12030632', 'W12030632', 'TXDALSTD', 'Health Texas Provider Network', 'Anna', 'A', 'Nguyen', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'PO Box 844128', 'Dallas', 'Dallas', 'TX', '75284', '8663771650', '4694675905', 'HTPN', 'TXHCPCHTPN', '', '0.00', '45.00', '0.00', 3, '2013-03-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1154551752', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG415', 'EDMPMG415', 'ILCHIGSTD', 'Presence Center for Health', 'John', NULL, 'Evans', 'MD', 'Family Practice', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '8002732614', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '8002732614', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1003964156', 0, 'Y', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG250', 'EDMPMG250', 'ILCHIGSTD', 'PMG Endocrinology', 'Erin', '', 'Malone', 'MD', 'Endocrinology', 'Internal Medicine', 'Pediatrics', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7084561600', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7084561600', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', NULL, NULL, NULL, 'HCFA|UB|', '1013173376', 0, 'Y', 0, '2014-01-31', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG249', 'EDMPMG249', 'ILCHIGSTD', 'PMG Endocrinology', 'Erin', '', 'Malone', 'MD', 'Endocrinology', 'Internal Medicine', 'Pediatrics', NULL, 'O', '7435 W Talcott Ave', 'Chicago', 'Cook', 'IL', '60631', '7084561600', NULL, '7435 W Talcott Ave', 'Chicago', 'Cook', 'IL', '60631', '7084561600', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', NULL, NULL, NULL, 'HCFA|UB|', '1013173376', 0, 'Y', 0, '2014-01-31', NULL, NULL, 41.9884, -87.8124, NULL, NULL),
('363330928', 'EDMPMG006', 'EDMPMG006', 'ILCHIGSTD', 'St Mary and Elizabeth Medical Ctr Hospitalist Group', 'Brian', NULL, 'Field', 'MD', 'Hospitalist', '', '', NULL, 'O', '2233 W Division St', 'Chicago', 'Cook', 'IL', '60622', '3127702000', NULL, '2233 W Division St', 'Chicago', 'Cook', 'IL', '60622', '3127702000', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1013180090', 0, 'Y', 0, '2013-03-05', NULL, NULL, 41.9031, -87.6829, NULL, NULL),
('363330928', 'EDMPMG562', 'EDMPMG562', 'ILCHIGSTD', 'St Mary and Elizabeth Medical Ctr', 'Brian', NULL, 'Field', 'MD', 'Hospitalist', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '3127702000', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '3127702000', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1013180090', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG034', 'EDMPMG034', 'ILCHIGSTD', 'Our Lady of the Resurrection Medical Ctr', 'Robert', NULL, 'Rifenburg', 'DO', 'Emergency Medicine', '', '', NULL, 'O', '5645 W Addison St', 'Chicago', 'Cook', 'IL', '60634', '7737947601', NULL, '5645 W Addison St', 'Chicago', 'Cook', 'IL', '60634', '7737947601', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1013917574', 0, 'Y', 0, '2013-03-05', NULL, NULL, 41.9459, -87.7678, NULL, NULL),
('363330928', 'EDMPMG197', 'EDMPMG197', 'ILCHIGSTD', 'Our Lady of the Resurrection Medical Ctr', 'Robert', NULL, 'Rifenburg', 'DO', 'Emergency Medicine', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7737947601', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7737947601', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1013917574', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG049', 'EDMPMG049', 'ILCHIGSTD', 'Presence Emergency Medicine', 'Reena', NULL, 'Patel', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '5645 W Addison St', 'Chicago', 'Cook', 'IL', '60634', '7737947601', NULL, '5645 W Addison St', 'Chicago', 'Cook', 'IL', '60634', '7737947601', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1023259553', 0, 'Y', 0, '2013-03-05', NULL, NULL, 41.9459, -87.7678, NULL, NULL),
('363330928', 'EDMPMG358', 'EDMPMG358', 'ILCHIGSTD', 'Presence Emergency Medicine', 'Reena', NULL, 'Patel', 'MD', 'Emergency Medicine', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7737947601', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7737947601', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1023259553', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG052', 'EDMPMG052', 'ILCHIGSTD', 'Presence St Mary and Elizabeth Medical Ctr', 'Chad', '', 'Lucci', 'PA', 'Emergency Medicine', '', '', NULL, 'O', '1909 W Belle Plaine Ave', 'Chicago', 'Cook', 'IL', '60613', '7736653086', NULL, '1909 W Belle Plaine Ave', 'Chicago', 'Cook', 'IL', '60613', '7736653086', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1023261963', 0, 'Y', 0, '2013-10-15', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG379', 'EDMPMG379', 'ILCHIGSTD', 'Presence St Mary and Elizabeth Medical Ctr', 'Chad', '', 'Lucci', 'PA', 'Emergency Medicine', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7736653086', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7736653086', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1023261963', 0, 'Y', 0, '2013-10-15', NULL, NULL, 0, 0, NULL, NULL),
('529216375', 'W40005234', 'W40005234', 'UTMH1', 'LDS Family Services', 'Michele', 'W', 'Ashdown', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', '1525 Lincoln Ave', 'Ogden', 'Weber', 'UT', '84401', '8016216510', NULL, '1525 Lincoln Ave', 'Ogden', 'Weber', 'UT', '84401', '8016216510', '', 'UTMA', NULL, NULL, '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1497876346', 0, 'Y', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG515', 'EDMPMG515', 'ILCHIGSTD', 'RMG North Shore Physicians Group', 'David', NULL, 'Pike', 'MD', 'Internal Medicine', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '8475687400', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '8475687400', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Francis Hospital', NULL, '', NULL, 'HCFA|UB|', '1043257330', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG514', 'EDMPMG514', 'ILCHIGSTD', 'RMG North Shore Physicians Group', 'David', NULL, 'Pike', 'MD', 'Internal Medicine', '', '', NULL, 'O', '7380 N Lincoln Ave', 'Lincolnwood', 'Cook', 'IL', '60712', '8475687400', NULL, '7380 N Lincoln Ave', 'Lincolnwood', 'Cook', 'IL', '60712', '8475687400', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Francis Hospital', NULL, '', NULL, 'HCFA|UB|', '1043257330', 0, 'N', 0, '2013-03-05', NULL, NULL, 42.0146, -87.7432, NULL, NULL),
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('363330928', 'EDMPMG075', 'EDMPMG075', 'ILCHIGSTD', 'Seton Family Health Center', 'Cezar', 'Batongbacal', 'Tolentino', 'MD', 'Family Practice', '', '', NULL, 'O', '711 W North Ave 1st Fl', 'Chicago', 'Cook', 'IL', '60610', '3123371982', NULL, '711 W North Ave 1st Fl', 'Chicago', 'Cook', 'IL', '60610', '3123371982', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-08-01', 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, '', '', 'HCFA|UB|', '1043415771', 0, 'N', 0, '2013-08-02', NULL, NULL, 41.9108, -87.6464, NULL, NULL),
('363330928', 'EDMPMG181', 'EDMPMG181', 'ILCHIGSTD', 'Emergency', 'Irene', NULL, 'Yao', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '1411 Elmwoor', 'Evanston', 'Cook', 'IL', '60201', '7736615800', NULL, '1411 Elmwoor', 'Evanston', 'Cook', 'IL', '60201', '7736615800', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, NULL, NULL, 'HCFA|UB|', '1053368415', 0, 'Y', 0, '2013-03-05', NULL, NULL, 42.043, -87.6836, NULL, NULL),
('363330928', 'EDMPMG182', 'EDMPMG182', 'ILCHIGSTD', 'Emergency', 'Irene', NULL, 'Yao', 'MD', 'Emergency Medicine', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7736615800', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7736615800', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, NULL, NULL, 'HCFA|UB|', '1053368415', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('364314354', 'EDMPMG328', 'EDMPMG328', 'ILCHIGSTD', 'PMG Internal Medicine', 'Nidhi', NULL, 'Tiwari', 'MD', 'Internal Medicine', '', '', NULL, 'B', '25872 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '6304998758', NULL, '25872 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '6304998758', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1053415067', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('364314354', 'EDMPMG166', 'EDMPMG166', 'ILCHIGSTD', 'PMG Internal Medicine', 'Nidhi', NULL, 'Tiwari', 'MD', 'Internal Medicine', '', '', NULL, 'O', '444 N Eola Rd Ste Unit 110', 'Aurora', 'Dupage', 'IL', '60502', '6304998758', NULL, '444 N Eola Rd Ste Unit 110', 'Aurora', 'Dupage', 'IL', '60502', '6304998758', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1053415067', 0, 'N', 0, '2013-03-05', NULL, NULL, 41.7607, -88.2431, NULL, NULL),
('870299862', 'W40015870', 'W40015870', 'UTMH1', 'LDS Family Services', 'Sondra', 'J', 'Southers', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', '125 N State St', 'Salt Lake City', 'Salt Lake', 'UT', '84150', '8012940578', NULL, '125 N State St', 'Salt Lake City', 'Salt Lake', 'UT', '84150', '8012940578', '          ', 'MA', '', '', '0.00', '40.00', '0.00', 8, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1518008168', 0, 'N', 0, '2013-07-09', NULL, NULL, 0, 0, NULL, NULL),
('364314354', 'EDMPMG271', 'EDMPMG271', 'ILCHIGSTD', 'PMG Joliet Hospitalist', 'Pavana', '', 'Radhakrishna', 'MD', 'Hospitalist', '', '', NULL, 'O', '333 N Madison St', 'Joliet', 'Will', 'IL', '60435', '8157257133', NULL, '333 N Madison St', 'Joliet', 'Will', 'IL', '60435', '8157257133', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1053595934', 0, 'N', 0, '2013-04-24', NULL, NULL, 41.528, -88.1346, NULL, NULL),
('364314354', 'EDMPMG081', 'EDMPMG081', 'ILCHIGSTD', 'PMG Behavioral Health', 'Azra', NULL, 'Pappa', 'MD', 'Psychiatry', '', '', NULL, 'O', '21 Heritage Dr Ste 102', 'Bourbonnais', 'Kankakee', 'IL', '60914', '8159378204', NULL, '21 Heritage Dr Ste 102', 'Bourbonnais', 'Kankakee', 'IL', '60914', '8159378204', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1063423549', 0, 'Y', 0, '2013-03-05', NULL, NULL, 41.1645, -87.8758, NULL, NULL),
('364314354', 'EDMPMG205', 'EDMPMG205', 'ILCHIGSTD', 'PMG Behavioral Health', 'Azra', NULL, 'Pappa', 'MD', 'Psychiatry', '', '', NULL, 'B', '25872 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '8159378204', NULL, '25872 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '8159378204', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1063423549', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('364314354', 'EDMPMG263', 'EDMPMG263', 'ILCHIGSTD', 'PMG Internal Medicine Bourbonnais and Clifton', 'Abraham', NULL, 'Thomas', 'MD', 'Internal Medicine', '', '', NULL, 'B', '25872 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '8159365167', NULL, '25872 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '8159365167', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1063423655', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('364314354', 'EDMPMG161', 'EDMPMG161', 'ILCHIGSTD', 'PMG Internal Medicine Bourbonnais and Clifton', 'Abraham', NULL, 'Thomas', 'MD', 'Internal Medicine', '', '', NULL, 'O', '656 N Convent Ste B', 'Bourbonnais', 'Kankakee', 'IL', '60914', '8159365167', NULL, '656 N Convent Ste B', 'Bourbonnais', 'Kankakee', 'IL', '60914', '8159365167', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1063423655', 0, 'Y', 0, '2013-03-05', NULL, NULL, 41.1652, -87.8753, NULL, NULL),
('363330928', 'EDMPMG095', 'EDMPMG095', 'ILCHIGSTD', 'Hospitalist Group', 'Nadya', '', 'Modlin', 'PA-C', 'Physician Assistant', '', '', NULL, 'O', '5645 W Addison St Ste 202', 'Riverside', 'Cook', 'IL', '60546', '7084426006', NULL, '5645 W Addison St Ste 202', 'Riverside', 'Cook', 'IL', '60546', '7084426006', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1063721264', 0, 'Y', 0, '2013-04-17', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG184', 'EDMPMG184', 'ILCHIGSTD', 'Hospitalist Group', 'Nadya', '', 'Modlin', 'PA-C', 'Physician Assistant', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7084426006', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7084426006', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1063721264', 0, 'Y', 0, '2013-04-17', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG436', 'EDMPMG436', 'ILCHIGSTD', 'RMG Dunning Family Medicine', 'Lori', 'D', 'Winston', 'MD', 'Family Practice', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7735947871', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7735947871', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1083615082', 0, 'Y', 0, '2013-04-11', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG061', 'EDMPMG061', 'ILCHIGSTD', 'RMG Dunning Family Medicine', 'Lori', 'D', 'Winston', 'MD', 'Family Practice', '', '', NULL, 'O', '7435 W Talcott Ave', 'Chicago', 'Cook', 'IL', '60631', '7735947871', NULL, '7435 W Talcott Ave', 'Chicago', 'Cook', 'IL', '60631', '7735947871', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1083615082', 0, 'N', 0, '2013-04-11', NULL, NULL, 41.9901, -87.816, NULL, NULL),
('363330928', 'EDMPMG155', 'EDMPMG155', 'ILCHIGSTD', 'RMG North Shore Physicians Group', 'Colleen', NULL, 'Nugent', 'MD', 'Internal Medicine', '', '', NULL, 'O', '2614 Patriot Blvd Ste A', 'Glenview', 'Cook', 'IL', '60025', '8472511644', NULL, '2614 Patriot Blvd Ste A', 'Glenview', 'Cook', 'IL', '60025', '8472511644', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Francis Hospital', NULL, '', NULL, 'HCFA|UB|', '1083773535', 0, 'N', 0, '2013-03-05', NULL, NULL, 42.0981, -87.8246, NULL, NULL),
('363330928', 'EDMPMG502', 'EDMPMG502', 'ILCHIGSTD', 'RMG North Shore Physicians Group', 'Colleen', NULL, 'Nugent', 'MD', 'Internal Medicine', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '8472511644', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '8472511644', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Francis Hospital', NULL, '', NULL, 'HCFA|UB|', '1083773535', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('364314354', 'EDMPMG219', 'EDMPMG219', 'ILCHIGSTD', 'PMG Danville Plastic Surgery', 'Susan', '', 'Schneider', 'MD', 'Plastic Surgery', '', '', NULL, 'B', '25872 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '2174314038', NULL, '25872 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '2174314038', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Elgin', NULL, NULL, NULL, 'HCFA|UB|', '1083781587', 0, 'Y', 0, '2013-03-27', NULL, NULL, 0, 0, NULL, NULL),
('364314354', 'EDMPMG103', 'EDMPMG103', 'ILCHIGSTD', 'PMG Danville Plastic Surgery', 'Susan', '', 'Schneider', 'MD', 'Plastic Surgery', '', '', NULL, 'O', '800 N Logan Ave Ste 207', 'Danville', 'Vermilion', 'IL', '61832', '2174314038', NULL, '800 N Logan Ave Ste 207', 'Danville', 'Vermilion', 'IL', '61832', '2174314038', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Elgin', NULL, NULL, NULL, 'HCFA|UB|', '1083781587', 0, 'Y', 0, '2013-03-27', NULL, NULL, 40.1372, -87.6449, NULL, NULL),
('363330928', 'EDMPMG120', 'EDMPMG120', 'ILCHIGSTD', 'RMG Marine Dr Medical', 'James', NULL, 'McCreary', 'MD', 'Internal Medicine', '', '', NULL, 'O', '2800 N Sheridan Rd Ste 300', 'Chicago', 'Cook', 'IL', '60657', '7732488652', NULL, '2800 N Sheridan Rd Ste 300', 'Chicago', 'Cook', 'IL', '60657', '7732488652', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, NULL, NULL, 'HCFA|UB|', '1093708034', 0, 'N', 0, '2013-03-05', NULL, NULL, 41.9329, -87.6393, NULL, NULL),
('363330928', 'EDMPMG479', 'EDMPMG479', 'ILCHIGSTD', 'RMG Marine Dr Medical', 'James', NULL, 'McCreary', 'MD', 'Internal Medicine', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7732488652', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7732488652', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, NULL, NULL, 'HCFA|UB|', '1093708034', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('364314354', 'EDMPMG231', 'EDMPMG231', 'ILCHIGSTD', 'PMG Elgin ED', 'Christopher', NULL, 'Gruber', 'MD', 'Emergency Medicine', '', '', NULL, 'B', '25872 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '8476953200', NULL, '25872 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '8476953200', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1093753287', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('364314354', 'EDMPMG230', 'EDMPMG230', 'ILCHIGSTD', 'PMG Elgin ED', 'Christopher', NULL, 'Gruber', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '77 W Airlite', 'Elgin', 'Kane', 'IL', '60123', '8476953200', NULL, '77 W Airlite', 'Elgin', 'Kane', 'IL', '60123', '8476953200', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1093753287', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG167', 'EDMPMG167', 'ILCHIGSTD', 'Resurrection Medical Ctr', 'Vishal', NULL, 'Gupta', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '1555 W Montana St Ste Unit 2S', 'Chicago', 'Cook', 'IL', '60614', '3127702418', NULL, '1555 W Montana St Ste Unit 2S', 'Chicago', 'Cook', 'IL', '60614', '3127702418', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1093920191', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG401', 'EDMPMG401', 'ILCHIGSTD', 'Resurrection Medical Ctr', 'Vishal', NULL, 'Gupta', 'MD', 'Emergency Medicine', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '3127702418', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '3127702418', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1093920191', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG088', 'EDMPMG088', 'ILCHIGSTD', 'Presence Hospitalist Group', 'Tetiana', NULL, 'Zubrycky', 'MD', 'Hospitalist', '', '', NULL, 'O', '600 N Fairbanks Ct Ste 2005', 'Chicago', 'Cook', 'IL', '60611', '8479245685', NULL, '600 N Fairbanks Ct Ste 2005', 'Chicago', 'Cook', 'IL', '60611', '8479245685', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1093949240', 0, 'Y', 0, '2013-03-05', NULL, NULL, 41.8926, -87.6203, NULL, NULL),
('363330928', 'EDMPMG376', 'EDMPMG376', 'ILCHIGSTD', 'Presence Hospitalist Group', 'Tetiana', NULL, 'Zubrycky', 'MD', 'Hospitalist', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '8479245685', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '8479245685', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1093949240', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG014', 'EDMPMG014', 'ILCHIGSTD', 'Presence Emergency Medicine', 'Kelly', NULL, 'Clifford', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '3140 N Shefield Ste 602', 'Chicago', 'Cook', 'IL', '60657', '7736653086', NULL, '3140 N Shefield Ste 602', 'Chicago', 'Cook', 'IL', '60657', '7736653086', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', NULL, NULL, NULL, 'HCFA|UB|', '1104960400', 0, 'Y', 0, '2013-03-05', NULL, NULL, 41.9391, -87.6541, NULL, NULL),
('363330928', 'EDMPMG343', 'EDMPMG343', 'ILCHIGSTD', 'Presence Emergency Medicine', 'Kelly', NULL, 'Clifford', 'MD', 'Emergency Medicine', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7736653086', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7736653086', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', NULL, NULL, NULL, 'HCFA|UB|', '1104960400', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG457', 'EDMPMG457', 'ILCHIGSTD', 'RMG Hospitalist Group   Our Lady of Resurrection', 'David', NULL, 'Shen', 'MD', 'Hospitalist', '', '', NULL, 'O', '5645 W Addison St', 'Chicago', 'Cook', 'IL', '60634', '2245634994', NULL, '5645 W Addison St', 'Chicago', 'Cook', 'IL', '60634', '2245634994', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1114120771', 0, 'Y', 0, '2013-03-05', NULL, NULL, 41.9459, -87.7678, NULL, NULL),
('363330928', 'EDMPMG458', 'EDMPMG458', 'ILCHIGSTD', 'RMG Hospitalist Group   Our Lady of Resurrection', 'David', NULL, 'Shen', 'MD', 'Hospitalist', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '2245634994', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '2245634994', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1114120771', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12003840', 'W12003840', 'UTIHC04', 'Physical Therapy', 'Lindsay', 'A', 'Newlin', 'PT', 'Physical Therapy', '', '', NULL, 'O', '100 N Mario Capecchi Dr Ste 4400', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016624949', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '', '', '', '0.00', '10.00', '0.00', 8, '2010-07-22', NULL, NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1609193390', 0, 'N', 0, '2013-02-28', NULL, NULL, 40.7663, -111.837, NULL, NULL),
('363330928', 'EDMPMG340', 'EDMPMG340', 'ILCHIGSTD', 'Presence Ctr for Health', 'Voula', NULL, 'Asimacopoulos', 'MD', 'Internal Medicine', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '8002732614', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '8002732614', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1114920824', 0, 'Y', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG102', 'EDMPMG102', 'ILCHIGSTD', 'RMG Humbolt Prk Primary Care', 'Humberto', NULL, 'Vergara', 'MD', 'Family Practice', '', '', NULL, 'O', '1431 N Western Ave Ste 205', 'Chicago', 'Cook', 'IL', '60622', '7732784811', NULL, '1431 N Western Ave Ste 205', 'Chicago', 'Cook', 'IL', '60622', '7732784811', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', NULL, NULL, NULL, 'HCFA|UB|', '1124004262', 0, 'N', 0, '2013-03-05', NULL, NULL, 41.9073, -87.6871, NULL, NULL),
('363330928', 'EDMPMG463', 'EDMPMG463', 'ILCHIGSTD', 'RMG Humbolt Prk Primary Care', 'Humberto', NULL, 'Vergara', 'MD', 'Family Practice', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7732784811', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7732784811', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', NULL, NULL, NULL, 'HCFA|UB|', '1124004262', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG545', 'EDMPMG545', 'ILCHIGSTD', 'RMG Stony Island Internal Medicine', 'Gomez', NULL, 'Charleston', 'MD', 'Internal Medicine', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7737310670', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7737310670', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1124021795', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG544', 'EDMPMG544', 'ILCHIGSTD', 'RMG Stony Island Internal Medicine', 'Gomez', NULL, 'Charleston', 'MD', 'Internal Medicine', '', '', NULL, 'O', '9000 S Stony Island Ave', 'Chicago', 'Cook', 'IL', '60617', '7737310670', NULL, '9000 S Stony Island Ave', 'Chicago', 'Cook', 'IL', '60617', '7737310670', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1124021795', 0, 'N', 0, '2013-03-05', NULL, NULL, 41.7314, -87.5855, NULL, NULL),
('364314354', 'EDMPMG239', 'EDMPMG239', 'ILCHIGSTD', 'PMG Elgin ED', 'Pamela', '', 'Salzman', 'APN', 'Nurse Practitioner  ED', '', '', NULL, 'B', '25872 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '8476953200', NULL, '25872 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '8476953200', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1124074133', 0, 'Y', 0, '2013-04-17', NULL, NULL, 0, 0, NULL, NULL),
('364314354', 'EDMPMG238', 'EDMPMG238', 'ILCHIGSTD', 'PMG Elgin ED', 'Pamela', '', 'Salzman', 'APN', 'Nurse Practitioner  ED', '', '', NULL, 'O', '77 W Airlite', 'Elgin', 'Kane', 'IL', '60123', '8476953200', NULL, '77 W Airlite', 'Elgin', 'Kane', 'IL', '60123', '8476953200', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1124074133', 0, 'Y', 0, '2013-04-17', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG149', 'EDMPMG149', 'ILCHIGSTD', 'RMG Mount Prospect Family Medicine', 'Sabrina', '', 'Indyk', 'MD', 'Family Practice', '', '', NULL, 'O', '601 W Central Rd Ste 6', 'Mount Prospect', 'Cook', 'IL', '60056', '8473428956', NULL, '601 W Central Rd Ste 6', 'Mount Prospect', 'Cook', 'IL', '60056', '8473428956', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1124256136', 0, 'N', 0, '2013-03-07', NULL, NULL, 42.0663, -87.9452, NULL, NULL),
('363330928', 'EDMPMG488', 'EDMPMG488', 'ILCHIGSTD', 'RMG Mount Prospect Family Medicine', 'Sabrina', '', 'Indyk', 'MD', 'Family Practice', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '8473428956', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '8473428956', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1124256136', 0, 'Y', 0, '2013-03-07', NULL, NULL, 0, 0, NULL, NULL),
('364314354', 'EDMPMG276', 'EDMPMG276', 'ILCHIGSTD', 'PMG Joliet Pediatrics', 'Jonette', 'P', 'Belicena', 'MD', 'Pediatrics', '', '', NULL, 'B', '25872 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '8157257133', '8157254579', '25872 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '8157257133', '8157254579', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Elgin', NULL, NULL, NULL, 'HCFA|UB|', '1134117344', 0, 'Y', 0, '2013-10-04', NULL, NULL, 0, 0, NULL, NULL),
('364314354', 'EDMPMG131', 'EDMPMG131', 'ILCHIGSTD', 'PMG Joliet Pediatrics', 'Jonette', 'P', 'Belicena', 'MD', 'Pediatrics', '', '', NULL, 'O', '301 N Springfield Ave Ste 4', 'Joliet', 'Will', 'IL', '60435', '8157257133', '8157254579', '301 N Springfield Ave Ste 4', 'Joliet', 'Will', 'IL', '60435', '8157257133', '8157254579', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-04-03', 0, 0, 0, 'Presence Saint Joseph Hospital Elgin', NULL, NULL, NULL, 'HCFA|UB|', '1134117344', 0, 'N', 0, '2013-10-04', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG068', 'EDMPMG068', 'ILCHIGSTD', 'RMG Viking Medical Group Inc', 'Michael', NULL, 'Plunkett', 'MD', 'Internal Medicine', '', '', NULL, 'O', '5140 N California Ave  Ste 405', 'Chicago', 'Cook', 'IL', '60625', '7732755558', NULL, '5140 N California Ave  Ste 405', 'Chicago', 'Cook', 'IL', '60625', '7732755558', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', 'Presence Saint Francis Hospital', '', NULL, 'HCFA|UB|', '1144230756', 0, 'N', 0, '2013-03-05', NULL, NULL, 41.9752, -87.6989, NULL, NULL),
('363330928', 'EDMPMG553', 'EDMPMG553', 'ILCHIGSTD', 'RMG Viking Medical Group Inc', 'Michael', NULL, 'Plunkett', 'MD', 'Internal Medicine', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7732755558', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7732755558', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', 'Presence Saint Francis Hospital', '', NULL, 'HCFA|UB|', '1144230756', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG373', 'EDMPMG373', 'ILCHIGSTD', 'Presence Hospitalist Group', 'Dipeshkumar', NULL, 'Shah', 'MD', 'Hospitalist', '', '', NULL, 'O', '23306  Birchwood Ln', 'Deerfield', 'Lake', 'IL', '60015', '8479090177', NULL, '23306  Birchwood Ln', 'Deerfield', 'Lake', 'IL', '60015', '8479090177', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1144236233', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG374', 'EDMPMG374', 'ILCHIGSTD', 'Presence Hospitalist Group', 'Dipeshkumar', NULL, 'Shah', 'MD', 'Hospitalist', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '8479090177', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '8479090177', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1144236233', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG133', 'EDMPMG133', 'ILCHIGSTD', 'RMG Viking Medical Group Inc', 'Oleh', NULL, 'Terleckyj', 'MD', 'Internal Medicine', '', '', NULL, 'O', '5140 N California Ave  Ste 405 Galter Medical Pavilion', 'Chicago', 'Cook', 'IL', '60625', '7732755558', NULL, '5140 N California Ave  Ste 405 Galter Medical Pavilion', 'Chicago', 'Cook', 'IL', '60625', '7732755558', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', NULL, '', NULL, 'HCFA|UB|', '1144247958', 0, 'N', 0, '2013-03-05', NULL, NULL, 41.9752, -87.6989, NULL, NULL),
('363330928', 'EDMPMG554', 'EDMPMG554', 'ILCHIGSTD', 'RMG Viking Medical Group Inc', 'Oleh', NULL, 'Terleckyj', 'MD', 'Internal Medicine', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7732755558', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7732755558', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', NULL, '', NULL, 'HCFA|UB|', '1144247958', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG157', 'EDMPMG157', 'ILCHIGSTD', 'Presence Hospitalist Group', 'John', NULL, 'Marini', 'PA-C', 'Hospitalist', '', '', NULL, 'O', '5730 N Hermitage Ste 2', 'Chicago', 'Cook', 'IL', '60660', '6306998165', NULL, '5730 N Hermitage Ste 2', 'Chicago', 'Cook', 'IL', '60660', '6306998165', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1144325085', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG370', 'EDMPMG370', 'ILCHIGSTD', 'Presence Hospitalist Group', 'John', NULL, 'Marini', 'PA-C', 'Hospitalist', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '6306998165', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '6306998165', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1144325085', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('364314354', 'EDMPMG305', 'EDMPMG305', 'ILCHIGSTD', 'PMG PSJMC Hospitalist', 'Crystal', '', 'Hines Mays', 'MD', 'Family Practice', '', '', NULL, 'O', '333 N Madison St', 'Joliet', 'Will', 'IL', '60435', '8157257133', NULL, '333 N Madison St', 'Joliet', 'Will', 'IL', '60435', '8157257133', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-05-14', 0, 0, 0, 'Ingalls Memorial Hospital', NULL, '', '', 'HCFA|UB|', '1154348951', 0, 'N', 0, '2013-05-23', NULL, NULL, 41.5279, -88.1354, NULL, NULL),
('363330928', 'EDMPMG040', 'EDMPMG040', 'ILCHIGSTD', 'PMG SJH Emergency Medicine', 'Scott', NULL, 'Betzelos', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '4508 W Bryn Mawr', 'Chicago', 'Cook', 'IL', '60646', '7737285133', NULL, '4508 W Bryn Mawr', 'Chicago', 'Cook', 'IL', '60646', '7737285133', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, NULL, NULL, 'HCFA|UB|', '1154377711', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG338', 'EDMPMG338', 'ILCHIGSTD', 'PMG SJH Emergency Medicine', 'Scott', NULL, 'Betzelos', 'MD', 'Emergency Medicine', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7737285133', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7737285133', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, NULL, NULL, 'HCFA|UB|', '1154377711', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG573', 'EDMPMG573', 'ILCHIGSTD', '', 'Sara', NULL, 'Winstanley', 'DO', 'Emergency Medicine', '', '', NULL, 'O', '1525 Sumter Dr', 'Long Grove', 'Lake', 'IL', '60047', '7736615800', NULL, '1525 Sumter Dr', 'Long Grove', 'Lake', 'IL', '60047', '7736615800', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', NULL, NULL, 'HCFA|UB|', '1154412021', 0, 'Y', 0, '2013-03-05', NULL, NULL, 42.1668, -87.9915, NULL, NULL),
('363330928', 'EDMPMG574', 'EDMPMG574', 'ILCHIGSTD', '', 'Sara', NULL, 'Winstanley', 'DO', 'Emergency Medicine', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7736615800', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7736615800', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', NULL, NULL, 'HCFA|UB|', '1154412021', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('364286236', 'EDMPMG395', 'EDMPMG395', 'ILCHIGSTD', 'Resurrection Immediate Care Ctr', 'Tatiana', '', 'Magana', 'MD', 'Urgent Care', '', '', NULL, 'O', '4900 N Cumberland Ave', 'Norridge', 'Cook', 'IL', '60302', '7084561600', NULL, '4900 N Cumberland Ave', 'Norridge', 'Cook', 'IL', '60302', '7084561600', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1164661393', 0, 'N', 0, '2013-03-05', NULL, NULL, 41.9688, -87.8368, NULL, NULL),
('364286236', 'EDMPMG396', 'EDMPMG396', 'ILCHIGSTD', 'Resurrection Immediate Care Ctr', 'Tatiana', '', 'Magana', 'MD', 'Urgent Care', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7084561600', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7084561600', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1164661393', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG362', 'EDMPMG362', 'ILCHIGSTD', 'Presence Emergency Medicine', 'Mark', NULL, 'Supino', 'MD', 'Emergency Medicine', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7732827000', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7732827000', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1174741078', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG132', 'EDMPMG132', 'ILCHIGSTD', 'Presence Emergency Medicine', 'Mark', NULL, 'Supino', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '822 W Buckingham Pl Ste 401', 'Chicago', 'Cook', 'IL', '60657', '7732827000', NULL, '822 W Buckingham Pl Ste 401', 'Chicago', 'Cook', 'IL', '60657', '7732827000', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1174741078', 0, 'Y', 0, '2013-03-05', NULL, NULL, 41.9427, -87.6501, NULL, NULL),
('363330928', 'EDMPMG063', 'EDMPMG063', 'ILCHIGSTD', '', 'David', NULL, 'Bordo', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '5645 W Addison St', 'Chicago', 'Cook', 'IL', '60634', '7737947601', NULL, '5645 W Addison St', 'Chicago', 'Cook', 'IL', '60634', '7737947601', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Our Lady Of The Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1184624298', 0, 'Y', 0, '2013-03-05', NULL, NULL, 41.9459, -87.7678, NULL, NULL),
('363330928', 'EDMPMG564', 'EDMPMG564', 'ILCHIGSTD', '', 'David', NULL, 'Bordo', 'MD', 'Emergency Medicine', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7737947601', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7737947601', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Our Lady Of The Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1184624298', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG495', 'EDMPMG495', 'ILCHIGSTD', 'RMG North Shore Physicians Group', 'Adi', '', 'Gidron', 'MD', 'Internal Medicine', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '8474320300', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '8474320300', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwestern Lake Forest Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1184767444', 0, 'Y', 0, '2013-10-04', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG085', 'EDMPMG085', 'ILCHIGSTD', 'RMG North Shore Physicians Group', 'Adi', '', 'Gidron', 'MD', 'Internal Medicine', '', '', NULL, 'O', '767 Parks Ave  W Ste 120', 'Highland Park', 'Lake', 'IL', '60035', '8474320300', NULL, '767 Parks Ave  W Ste 120', 'Highland Park', 'Lake', 'IL', '60035', '8474320300', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwestern Lake Forest Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1184767444', 0, 'N', 0, '2013-10-04', NULL, NULL, 42.1888, -87.8077, NULL, NULL),
('363330928', 'EDMPMG496', 'EDMPMG496', 'ILCHIGSTD', 'RMG North Shore Physicians Group', 'Rajesh', '', 'Jindal', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1625 Sheridan Rd Ste F', 'Wilmette', 'Cook', 'IL', '60091', '8472511500', NULL, '1625 Sheridan Rd Ste F', 'Wilmette', 'Cook', 'IL', '60091', '8472511500', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Holy Family Medical Center', 'Presence Saint Francis Hospital', '', '', 'HCFA|UB|', '1184818791', 0, 'N', 0, '2014-01-10', NULL, NULL, 42.0878, -87.7012, NULL, NULL),
('363330928', 'EDMPMG497', 'EDMPMG497', 'ILCHIGSTD', 'RMG North Shore Physicians Group', 'Rajesh', '', 'Jindal', 'MD', 'Internal Medicine', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '8472511500', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '8472511500', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Holy Family Medical Center', 'Presence Saint Francis Hospital', '', '', 'HCFA|UB|', '1184818791', 0, 'Y', 0, '2014-01-10', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG071', 'EDMPMG071', 'ILCHIGSTD', 'Presence Hospitalist Group', 'Fe', NULL, 'Monterola', 'MD', 'Hospitalist', '', '', NULL, 'O', '5645 W Addison St', 'Chicago', 'Cook', 'IL', '60634', '7732827000', NULL, '5645 W Addison St', 'Chicago', 'Cook', 'IL', '60634', '7732827000', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1184847287', 0, 'Y', 0, '2013-03-05', NULL, NULL, 41.9459, -87.7678, NULL, NULL),
('363330928', 'EDMPMG371', 'EDMPMG371', 'ILCHIGSTD', 'Presence Hospitalist Group', 'Fe', NULL, 'Monterola', 'MD', 'Hospitalist', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7732827000', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7732827000', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1184847287', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('364314354', 'EDMPMG311', 'EDMPMG311', 'ILCHIGSTD', 'PMG PSMH Hospitalist ', 'Ashley', NULL, 'Chappell', 'APN', 'Nurse Practitioner', '', '', NULL, 'B', '25872 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '8159372400', NULL, '25872 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '8159372400', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1194070458', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('364314354', 'EDMPMG310', 'EDMPMG310', 'ILCHIGSTD', 'PMG PSMH Hospitalist ', 'Ashley', NULL, 'Chappell', 'APN', 'Nurse Practitioner', '', '', NULL, 'O', '500 W Court St', 'Kankakee', 'Kankakee', 'IL', '60901', '8159372400', NULL, '500 W Court St', 'Kankakee', 'Kankakee', 'IL', '60901', '8159372400', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1194070458', 0, 'Y', 0, '2013-03-05', NULL, NULL, 41.1211, -87.8718, 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
('363330928', 'EDMPMG196', 'EDMPMG196', 'ILCHIGSTD', 'Our Lady of the Resurrection Medical Ctr', 'Ronald', NULL, 'Reilly', 'MD', 'Emergency Medicine', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7735947871', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7735947871', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1194725465', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG033', 'EDMPMG033', 'ILCHIGSTD', 'Our Lady of the Resurrection Medical Ctr', 'Ronald', NULL, 'Reilly', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '7435 W Talcott Ave', 'Chicago', 'Cook', 'IL', '60631', '7735947871', NULL, '7435 W Talcott Ave', 'Chicago', 'Cook', 'IL', '60631', '7735947871', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1194725465', 0, 'Y', 0, '2013-03-05', NULL, NULL, 41.9884, -87.8124, NULL, NULL),
('363330928', 'EDMPMG043', 'EDMPMG043', 'ILCHIGSTD', 'Presence Emergency Medicine', 'Brian', NULL, 'Donahue', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '5645 W Addison St', 'Chicago', 'Cook', 'IL', '60634', '7737947601', NULL, '5645 W Addison St', 'Chicago', 'Cook', 'IL', '60634', '7737947601', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1194726562', 0, 'Y', 0, '2013-03-05', NULL, NULL, 41.9459, -87.7678, NULL, NULL),
('363330928', 'EDMPMG346', 'EDMPMG346', 'ILCHIGSTD', 'Presence Emergency Medicine', 'Brian', NULL, 'Donahue', 'MD', 'Emergency Medicine', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7737947601', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7737947601', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1194726562', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG056', 'EDMPMG056', 'ILCHIGSTD', 'Resurrection Medical Ctr', 'Sarah', NULL, 'Margulies', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '5645 W Addison St', 'Chicago', 'Cook', 'IL', '60634', '7737947601', NULL, '5645 W Addison St', 'Chicago', 'Cook', 'IL', '60634', '7737947601', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1194772145', 0, 'Y', 0, '2013-03-05', NULL, NULL, 41.9459, -87.7678, NULL, NULL),
('363330928', 'EDMPMG404', 'EDMPMG404', 'ILCHIGSTD', 'Resurrection Medical Ctr', 'Sarah', NULL, 'Margulies', 'MD', 'Emergency Medicine', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7737947601', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7737947601', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1194772145', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('364314354', 'EDMPMG080', 'EDMPMG080', 'ILCHIGSTD', 'PMG Behavioral Health', 'Shital', NULL, 'Mehta', 'MD', 'Psychiatry', '', '', NULL, 'O', '21 Heritage Dr Ste 102', 'Bourbonnais', 'Kankakee', 'IL', '60914', '8159378204', NULL, '21 Heritage Dr Ste 102', 'Bourbonnais', 'Kankakee', 'IL', '60914', '8159378204', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1205054608', 0, 'Y', 0, '2013-03-05', NULL, NULL, 41.1645, -87.8758, NULL, NULL),
('364314354', 'EDMPMG204', 'EDMPMG204', 'ILCHIGSTD', 'PMG Behavioral Health', 'Shital', NULL, 'Mehta', 'MD', 'Psychiatry', '', '', NULL, 'B', '25872 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '8159378204', NULL, '25872 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '8159378204', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1205054608', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG177', 'EDMPMG177', 'ILCHIGSTD', 'Diversified Emergency Services', 'Steven', NULL, 'Abdelmalak', 'MD', 'Hospitalist', '', '', NULL, 'O', '2233 W Division St', 'Chicago', 'Cook', 'IL', '60622', '3127702000', NULL, '2233 W Division St', 'Chicago', 'Cook', 'IL', '60622', '3127702000', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1205092806', 0, 'Y', 0, '2013-03-05', NULL, NULL, 41.9031, -87.6829, NULL, NULL),
('363330928', 'EDMPMG178', 'EDMPMG178', 'ILCHIGSTD', 'Diversified Emergency Services', 'Steven', NULL, 'Abdelmalak', 'MD', 'Hospitalist', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '3127702000', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '3127702000', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1205092806', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('364314354', 'EDMPMG118', 'EDMPMG118', 'ILCHIGSTD', 'PMG Elgin Internal Medicine', 'Desiree', 'F', 'Oliveros', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1975 Lin Lor Ln Ste 295', 'Elgin', 'Kane', 'IL', '60123', '8476222086', NULL, '1975 Lin Lor Ln Ste 295', 'Elgin', 'Kane', 'IL', '60123', '8476222086', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Elgin', NULL, NULL, NULL, 'HCFA|UB|', '1205846128', 0, 'N', 0, '2013-04-03', NULL, NULL, 42.0373, -88.3248, NULL, NULL),
('364314354', 'EDMPMG247', 'EDMPMG247', 'ILCHIGSTD', 'PMG Elgin Internal Medicine', 'Desiree', 'F', 'Oliveros', 'MD', 'Internal Medicine', '', '', NULL, 'B', '25872 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '8476222086', NULL, '25872 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '8476222086', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Elgin', NULL, NULL, NULL, 'HCFA|UB|', '1205846128', 0, 'Y', 0, '2013-04-03', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG555', 'EDMPMG555', 'ILCHIGSTD', 'RMG Women First Associated OB-GYN', 'Carrie', NULL, 'Giordano', 'DO', 'Obstetrics and Gynecology', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7737752180', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7737752180', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1205892072', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG134', 'EDMPMG134', 'ILCHIGSTD', 'RMG Women First Associated OB-GYN', 'Carrie', NULL, 'Giordano', 'DO', 'Obstetrics and Gynecology', '', '', NULL, 'O', '7447 W Talcott Ave Ste 418', 'Chicago', 'Cook', 'IL', '60631', '7737752180', NULL, '7447 W Talcott Ave Ste 418', 'Chicago', 'Cook', 'IL', '60631', '7737752180', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1205892072', 0, 'N', 0, '2013-03-05', NULL, NULL, 41.9887, -87.8131, NULL, NULL),
('364314354', 'EDMPMG227', 'EDMPMG227', 'ILCHIGSTD', 'PMG Elgin ED', 'Marie', NULL, 'Fleury', 'DO', 'Emergency Medicine', '', '', NULL, 'B', '25872 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '8476953200', NULL, '25872 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '8476953200', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1205921830', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('364314354', 'EDMPMG226', 'EDMPMG226', 'ILCHIGSTD', 'PMG Elgin ED', 'Marie', NULL, 'Fleury', 'DO', 'Emergency Medicine', '', '', NULL, 'O', '77 W Airlite', 'Elgin', 'Kane', 'IL', '60123', '8476953200', NULL, '77 W Airlite', 'Elgin', 'Kane', 'IL', '60123', '8476953200', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1205921830', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('364314354', 'EDMPMG099', 'EDMPMG099', 'ILCHIGSTD', 'PMG Via Bella', 'Nazneen', NULL, 'Ahmed', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1975 Lin Lor Ln Ste 205', 'Elgin', 'Kane', 'IL', '60123', '8477424111', NULL, '1975 Lin Lor Ln Ste 205', 'Elgin', 'Kane', 'IL', '60123', '8477424111', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Elgin', NULL, '', NULL, 'HCFA|UB|', '1215926621', 0, 'N', 0, '2013-03-05', NULL, NULL, 42.0373, -88.3248, NULL, NULL),
('364314354', 'EDMPMG316', 'EDMPMG316', 'ILCHIGSTD', 'PMG Via Bella', 'Nazneen', NULL, 'Ahmed', 'MD', 'Internal Medicine', '', '', NULL, 'B', '25872 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '8477424111', NULL, '25872 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '8477424111', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Elgin', NULL, '', NULL, 'HCFA|UB|', '1215926621', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('364314354', 'EDMPMG007', 'EDMPMG007', 'ILCHIGSTD', 'PMG Behavioral Health Urbana', 'Hayng Sang', '', 'Yang', 'MD', 'Psychiatry', '', '', NULL, 'O', '1400 W Park St  5th Fl', 'Urbana', 'Champaign', 'IL', '61801', '2173372130', NULL, '1400 W Park St  5th Fl', 'Urbana', 'Champaign', 'IL', '61801', '2173372130', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1215952684', 0, 'Y', 0, '2013-04-26', NULL, NULL, 40.1174, -88.2271, NULL, NULL),
('364314354', 'EDMPMG209', 'EDMPMG209', 'ILCHIGSTD', 'PMG Behavioral Health Urbana', 'Hayng Sang', '', 'Yang', 'MD', 'Psychiatry', '', '', NULL, 'B', '25872 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '2173372130', NULL, '25872 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '2173372130', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1215952684', 0, 'Y', 0, '2013-04-26', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG028', 'EDMPMG028', 'ILCHIGSTD', 'Our Lady of the Resurrection Medical Ctr', 'Viren', NULL, 'Gohil', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '2800 N Sheridan Rd', 'Chicago', 'Cook', 'IL', '60657', '7736653086', NULL, '2800 N Sheridan Rd', 'Chicago', 'Cook', 'IL', '60657', '7736653086', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1225081037', 0, 'Y', 0, '2013-03-05', NULL, NULL, 41.9329, -87.6393, NULL, NULL),
('363330928', 'EDMPMG192', 'EDMPMG192', 'ILCHIGSTD', 'Our Lady of the Resurrection Medical Ctr', 'Viren', NULL, 'Gohil', 'MD', 'Emergency Medicine', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7736653086', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7736653086', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1225081037', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('364314354', 'EDMPMG312', 'EDMPMG312', 'ILCHIGSTD', 'PMG St Joseph Family Practice', 'Alina', '', 'Paul', 'MD', 'Family Practice', '', '', NULL, 'O', '226 E Lincoln', 'St Joseph', 'Champaign', 'IL', '61873', '2174698270', NULL, '226 E Lincoln', 'St Joseph', 'Champaign', 'IL', '61873', '2174698270', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1225182702', 0, 'Y', 0, '2013-06-25', NULL, NULL, 40.1187, -88.0371, NULL, NULL),
('364314354', 'EDMPMG313', 'EDMPMG313', 'ILCHIGSTD', 'PMG St Joseph Family Practice', 'Alina', '', 'Paul', 'MD', 'Family Practice', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '2174698270', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '2174698270', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1225182702', 0, 'Y', 0, '2013-06-25', NULL, NULL, 0, 0, NULL, NULL),
('362709982', 'EDMPMG449', 'EDMPMG449', 'ILCHIGSTD', 'RMG Express Care Clinic', 'Lanay', '', 'Samuelson', 'APN', 'Nurse Practitioner', '', '', NULL, 'O', '2940 N Ashland Ave', 'Chicago', 'Cook', 'IL', '60657', '7735254440', NULL, '2940 N Ashland Ave', 'Chicago', 'Cook', 'IL', '60657', '7735254440', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1225390479', 0, 'Y', 0, '2013-04-17', NULL, NULL, 41.9358, -87.6686, NULL, NULL),
('362709982', 'EDMPMG450', 'EDMPMG450', 'ILCHIGSTD', 'RMG Express Care Clinic', 'Lanay', '', 'Samuelson', 'APN', 'Nurse Practitioner', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7735254440', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7735254440', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1225390479', 0, 'Y', 0, '2013-04-17', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG464', 'EDMPMG464', 'ILCHIGSTD', 'RMG Jefferson Prk Family Med', 'Rafal', NULL, 'Chojnacki', 'MD', 'Family Practice', '', '', NULL, 'O', '5251 N Milwaukee Ave', 'Chicago', 'Cook', 'IL', '60630', '7732839300', NULL, '5251 N Milwaukee Ave', 'Chicago', 'Cook', 'IL', '60630', '7732839300', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', NULL, NULL, NULL, 'HCFA|UB|', '1235142373', 0, 'N', 0, '2013-03-05', NULL, NULL, 41.9758, -87.7678, NULL, NULL),
('363330928', 'EDMPMG465', 'EDMPMG465', 'ILCHIGSTD', 'RMG Jefferson Prk Family Med', 'Rafal', NULL, 'Chojnacki', 'MD', 'Family Practice', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7732839300', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7732839300', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', NULL, NULL, NULL, 'HCFA|UB|', '1235142373', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG062', 'EDMPMG062', 'ILCHIGSTD', 'RMG ENT', 'Stacey', NULL, 'Chamberlain', 'AUD', 'Audiology', '', '', NULL, 'O', '2033 W Iowa St  Ste 3', 'Chicago', 'Cook', 'IL', '60622', '7735104180', NULL, '2033 W Iowa St  Ste 3', 'Chicago', 'Cook', 'IL', '60622', '7735104180', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1235331596', 0, 'Y', 0, '2013-03-05', NULL, NULL, 41.8977, -87.678, NULL, NULL),
('363330928', 'EDMPMG441', 'EDMPMG441', 'ILCHIGSTD', 'RMG ENT', 'Stacey', NULL, 'Chamberlain', 'AUD', 'Audiology', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7735104180', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7735104180', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1235331596', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG105', 'EDMPMG105', 'ILCHIGSTD', 'RMG North Shore Evanston', 'Keith', '', 'Sarpolis', 'MD', 'Internal Medicine', '', '', NULL, 'O', '2500 Ridge Ave Ste 210', 'Evanston', 'Cook', 'IL', '60201', '8474910888', NULL, '2500 Ridge Ave Ste 210', 'Evanston', 'Cook', 'IL', '60201', '8474910888', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Francis Hospital', NULL, '', '', 'HCFA|UB|', '1245283183', 0, 'N', 0, '2013-03-25', NULL, NULL, 42.0631, -87.684, NULL, NULL),
('363330928', 'EDMPMG425', 'EDMPMG425', 'ILCHIGSTD', 'RMG North Shore Evanston', 'Keith', '', 'Sarpolis', 'MD', 'Internal Medicine', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '8474910888', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '8474910888', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Francis Hospital', NULL, '', '', 'HCFA|UB|', '1245283183', 0, 'Y', 0, '2013-03-25', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG143', 'EDMPMG143', 'ILCHIGSTD', 'RMG Medical Cardiology', 'Vojislav', NULL, 'Lazarevic', 'MD', 'Internal Medicine', '', '', NULL, 'O', '2800 N Sheridian Ste 500', 'Chicago', 'Cook', 'IL', '60657', '7733480700', NULL, '2800 N Sheridian Ste 500', 'Chicago', 'Cook', 'IL', '60657', '7733480700', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, NULL, NULL, 'HCFA|UB|', '1245317940', 0, 'N', 0, '2013-03-05', NULL, NULL, 41.9329, -87.6393, NULL, NULL),
('363330928', 'EDMPMG482', 'EDMPMG482', 'ILCHIGSTD', 'RMG Medical Cardiology', 'Vojislav', NULL, 'Lazarevic', 'MD', 'Internal Medicine', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7733480700', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7733480700', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, NULL, NULL, 'HCFA|UB|', '1245317940', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG543', 'EDMPMG543', 'ILCHIGSTD', 'RMG SFH OB-GYN Group', 'Michele', 'A', 'Bucciero', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '8478690437', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '8478690437', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Francis Hospital', NULL, '', '', 'HCFA|UB|', '1255441275', 0, 'Y', 0, '2014-01-10', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG173', 'EDMPMG173', 'ILCHIGSTD', 'RMG SFH OB-GYN Group', 'Michele', 'A', 'Bucciero', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '800 Austin St West Tower Ste 505', 'Evanston', 'Cook', 'IL', '60202', '8478690437', NULL, '800 Austin St West Tower Ste 505', 'Evanston', 'Cook', 'IL', '60202', '8478690437', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Francis Hospital', NULL, '', '', 'HCFA|UB|', '1255441275', 0, 'N', 0, '2014-01-10', NULL, NULL, 42.0255, -87.6819, NULL, NULL),
('364314354', 'EDMPMG233', 'EDMPMG233', 'ILCHIGSTD', 'PMG Elgin ED', 'Brian', NULL, 'Kostuk', 'MD', 'Emergency Medicine', '', '', NULL, 'B', '25872 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '8476953200', NULL, '25872 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '8476953200', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1255560785', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('364314354', 'EDMPMG232', 'EDMPMG232', 'ILCHIGSTD', 'PMG Elgin ED', 'Brian', NULL, 'Kostuk', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '77 W Airlite', 'Elgin', 'Kane', 'IL', '60123', '8476953200', NULL, '77 W Airlite', 'Elgin', 'Kane', 'IL', '60123', '8476953200', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1255560785', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG537', 'EDMPMG537', 'ILCHIGSTD', 'RMG Riis Prk Medical Center', 'Nunilo', NULL, 'Rubio', 'MD', 'Internal Medicine', '', '', NULL, 'O', '5322 W Fullerton Ave', 'Chicago', 'Cook', 'IL', '60639', '7736220056', NULL, '5322 W Fullerton Ave', 'Chicago', 'Cook', 'IL', '60639', '7736220056', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', NULL, NULL, NULL, 'HCFA|UB|', '1265468557', 0, 'N', 0, '2013-03-05', NULL, NULL, 41.9241, -87.7596, NULL, NULL),
('363330928', 'EDMPMG540', 'EDMPMG540', 'ILCHIGSTD', 'RMG Riis Prk Medical Center', 'Nunilo', NULL, 'Rubio', 'MD', 'Internal Medicine', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7736220056', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7736220056', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', NULL, NULL, NULL, 'HCFA|UB|', '1265468557', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG148', 'EDMPMG148', 'ILCHIGSTD', 'RMG Edelson Practice', 'Sheldon', '', 'Edelson', 'MD', 'Internal Medicine', '', '', NULL, 'O', '2800 N Sheridan Rd Ste 506', 'Chicago', 'Cook', 'IL', '60657', '7734727680', NULL, '2800 N Sheridan Rd Ste 506', 'Chicago', 'Cook', 'IL', '60657', '7734727680', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, '', '', 'HCFA|UB|', '1265497069', 0, 'N', 0, '2013-07-02', NULL, NULL, 41.9329, -87.6393, NULL, NULL),
('363330928', 'EDMPMG438', 'EDMPMG438', 'ILCHIGSTD', 'RMG Edelson Practice', 'Sheldon', '', 'Edelson', 'MD', 'Internal Medicine', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7736615800', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7736615800', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, '', '', 'HCFA|UB|', '1265497069', 0, 'Y', 0, '2013-07-02', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG076', 'EDMPMG076', 'ILCHIGSTD', 'Resurrection Medical Ctr', 'Patricia', NULL, 'SweenyRywak', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '1341 W Fullerton Ave Ste 129', 'Chicago', 'Cook', 'IL', '60614', '7732827000', NULL, '1341 W Fullerton Ave Ste 129', 'Chicago', 'Cook', 'IL', '60614', '7732827000', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, NULL, NULL, 'HCFA|UB|', '1265513949', 0, 'Y', 0, '2013-03-05', NULL, NULL, 41.9252, -87.6619, NULL, NULL),
('363330928', 'EDMPMG410', 'EDMPMG410', 'ILCHIGSTD', 'Resurrection Medical Ctr', 'Patricia', NULL, 'SweenyRywak', 'MD', 'Emergency Medicine', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7732827000', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7732827000', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, NULL, NULL, 'HCFA|UB|', '1265513949', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('364314354', 'EDMPMG140', 'EDMPMG140', 'ILCHIGSTD', 'PMG Women First', 'Colleen', NULL, 'Jones', 'CNMW', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1300 N Highland Ste 5', 'Aurora', 'Kane', 'IL', '60506', '6308977700', NULL, '1300 N Highland Ste 5', 'Aurora', 'Kane', 'IL', '60506', '6308977700', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, '', NULL, 'HCFA|UB|', '1275506933', 0, 'N', 0, '2013-03-05', NULL, NULL, 41.7861, -88.3289, NULL, NULL),
('364314354', 'EDMPMG335', 'EDMPMG335', 'ILCHIGSTD', 'PMG Women First', 'Colleen', NULL, 'Jones', 'CNMW', 'Obstetrics and Gynecology', '', '', NULL, 'B', '25872 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '6308977700', NULL, '25872 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '6308977700', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, '', NULL, 'HCFA|UB|', '1275506933', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG348', 'EDMPMG348', 'ILCHIGSTD', 'Presence Emergency Medicine', 'Russell', NULL, 'Eisenberg', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '4015 Bordeaux Dr', 'Northbrook', 'Cook', 'IL', '60062', '7732827000', NULL, '4015 Bordeaux Dr', 'Northbrook', 'Cook', 'IL', '60062', '7732827000', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1285614347', 0, 'Y', 0, '2013-03-05', NULL, NULL, 42.1401, -87.8779, NULL, NULL),
('363330928', 'EDMPMG349', 'EDMPMG349', 'ILCHIGSTD', 'Presence Emergency Medicine', 'Russell', NULL, 'Eisenberg', 'MD', 'Emergency Medicine', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7732827000', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7732827000', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1285614347', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG176', 'EDMPMG176', 'ILCHIGSTD', 'Anna Sagan Blasius', 'Anna', '', 'Sagan Blasius', 'MD', 'Family Practice', '', '', NULL, 'O', '5645 W Addison St', 'Norridge', 'Cook', 'IL', '60706', '7736615800', NULL, '5645 W Addison St', 'Norridge', 'Cook', 'IL', '60706', '7736615800', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1285631838', 0, 'N', 0, '2013-03-07', NULL, NULL, 41.9459, -87.7678, NULL, NULL),
('363330928', 'EDMPMG005', 'EDMPMG005', 'ILCHIGSTD', 'RMG Presence Center for Health', 'Christine', NULL, 'Schwartz Peterson', 'MD', 'Family Practice', '', '', NULL, 'O', '205 S Northwest Hwy', 'Park Ridge', 'Cook', 'IL', '60068', '8476963370', NULL, '205 S Northwest Hwy', 'Park Ridge', 'Cook', 'IL', '60068', '8476963370', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, NULL, NULL, 'HCFA|UB|', '1285637801', 0, 'N', 0, '2013-03-05', NULL, NULL, 42.0091, -87.8262, NULL, NULL),
('363330928', 'EDMPMG557', 'EDMPMG557', 'ILCHIGSTD', 'RMG Women First Associated OB-GYN', 'Thythy', NULL, 'Pham', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '8557647687', '6309142469', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '8557647687', '6309142469', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1285880757', 0, 'Y', 0, '2013-08-15', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG136', 'EDMPMG136', 'ILCHIGSTD', 'RMG Women First Associated OB-GYN', 'Thythy', NULL, 'Pham', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '7447 W Talcott Ave Ste 418', 'Chicago', 'Cook', 'IL', '60631', '7737928671', '7737928672', '7447 W Talcott Ave Ste 418', 'Chicago', 'Cook', 'IL', '60631', '7737928671', '7737928672', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1285880757', 0, 'N', 0, '2013-08-15', NULL, NULL, 41.9887, -87.8131, NULL, NULL),
('364314354', 'EDMPMG225', 'EDMPMG225', 'ILCHIGSTD', 'PMG Elgin ED', 'Richard', NULL, 'Dahl', 'PA-C', 'Emergency Medicine', '', '', NULL, 'B', '25872 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '8476953200', NULL, '25872 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '8476953200', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1285964700', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('364314354', 'EDMPMG224', 'EDMPMG224', 'ILCHIGSTD', 'PMG Elgin ED', 'Richard', NULL, 'Dahl', 'PA-C', 'Emergency Medicine', '', '', NULL, 'O', '77 W Airlite', 'Elgin', 'Kane', 'IL', '60123', '8476953200', NULL, '77 W Airlite', 'Elgin', 'Kane', 'IL', '60123', '8476953200', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1285964700', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG344', 'EDMPMG344', 'ILCHIGSTD', 'Presence Emergency Medicine', 'Nicole', NULL, 'Colucci', 'DO', 'Emergency Medicine', '', '', NULL, 'O', '4701 Washington St', 'Downers Grove', 'Dupage', 'IL', '60515', '7736615800', NULL, '4701 Washington St', 'Downers Grove', 'Dupage', 'IL', '60515', '7736615800', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1295735017', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG345', 'EDMPMG345', 'ILCHIGSTD', 'Presence Emergency Medicine', 'Nicole', NULL, 'Colucci', 'DO', 'Emergency Medicine', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7736615800', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7736615800', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1295735017', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG021', 'EDMPMG021', 'ILCHIGSTD', 'RMG Dept of Phys Med and Rehab', 'Benjamin', NULL, 'Friedman', 'MD', 'Physical Medicine and Rehabilitation', '', '', NULL, 'O', '2900 N Lake Shore Dr Ste 1202', 'Chicago', 'Cook', 'IL', '60657', '7736653470', NULL, '2900 N Lake Shore Dr Ste 1202', 'Chicago', 'Cook', 'IL', '60657', '7736653470', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, NULL, NULL, 'HCFA|UB|', '1295772267', 0, 'Y', 0, '2013-03-05', NULL, NULL, 41.9349, -87.6367, NULL, NULL),
('363330928', 'EDMPMG416', 'EDMPMG416', 'ILCHIGSTD', '', 'Benjamin', NULL, 'Friedman', 'MD', 'Physical Medicine and Rehabilitation', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7736653470', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7736653470', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, NULL, NULL, 'HCFA|UB|', '1295772267', 0, 'Y', 0, '2014-01-24', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG527', 'EDMPMG527', 'ILCHIGSTD', 'RMG Oakton Maple Family Practice Center', 'Thaddeus', NULL, 'Zamirowski', 'MD', 'Family Practice', '', '', NULL, 'O', '1792 Oakton St', 'Des Plaines', 'Cook', 'IL', '60018', '8478274496', NULL, '1792 Oakton St', 'Des Plaines', 'Cook', 'IL', '60018', '8478274496', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1295779585', 0, 'N', 0, '2013-03-05', NULL, NULL, 42.0244, -87.8797, NULL, NULL),
('363330928', 'EDMPMG568', 'EDMPMG568', 'ILCHIGSTD', '', 'Steven', NULL, 'Bujewski', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7737752180', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7737752180', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1295791168', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG137', 'EDMPMG137', 'ILCHIGSTD', '', 'Steven', NULL, 'Bujewski', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '7447 W Talcott Ave Ste 418', 'Chicago', 'Cook', 'IL', '60631', '7737752180', NULL, '7447 W Talcott Ave Ste 418', 'Chicago', 'Cook', 'IL', '60631', '7737752180', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1295791168', 0, 'N', 0, '2013-03-05', NULL, NULL, 41.9887, -87.8131, NULL, NULL),
('363330928', 'EDMPMG412', 'EDMPMG412', 'ILCHIGSTD', '', 'Walter', '', 'Brodech', 'MD', 'Internal Medicine', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7737723121', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7737723121', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', NULL, NULL, NULL, 'HCFA|UB|', '1295827434', 0, 'Y', 0, '2014-01-23', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG411', 'EDMPMG411', 'ILCHIGSTD', '', 'Walter', '', 'Brodech', 'MD', 'Internal Medicine', '', '', NULL, 'O', '809 N Western Ave', 'Chicago', 'Cook', 'IL', '60622', '7737729121', NULL, '809 N Western Ave', 'Chicago', 'Cook', 'IL', '60622', '7737729121', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', NULL, NULL, NULL, 'HCFA|UB|', '1295827434', 0, 'N', 0, '2014-01-24', NULL, NULL, 41.896, -87.6868, NULL, NULL),
('364314354', 'EDMPMG221', 'EDMPMG221', 'ILCHIGSTD', 'PMG Elgin ED', 'Trisha', NULL, 'Atkins', 'APN', 'Physician Assistant', '', '', NULL, 'B', '25872 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '8476953200', NULL, '25872 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '8476953200', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1306000765', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('364314354', 'EDMPMG220', 'EDMPMG220', 'ILCHIGSTD', 'PMG Elgin ED', 'Trisha', NULL, 'Atkins', 'APN', 'Physician Assistant', '', '', NULL, 'O', '77 W Airlite', 'Elgin', 'Kane', 'IL', '60123', '8476953200', NULL, '77 W Airlite', 'Elgin', 'Kane', 'IL', '60123', '8476953200', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1306000765', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG372', 'EDMPMG372', 'ILCHIGSTD', 'Presence Hospitalist Group', 'Harjyot', NULL, 'Sandhu', 'MD', 'Hospitalist', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '8478739607', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '8478739607', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1306160247', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG015', 'EDMPMG015', 'ILCHIGSTD', 'Presence Hospitalist Group', 'Harjyot', NULL, 'Sandhu', 'MD', 'Hospitalist', '', '', NULL, 'O', '750 Pearson St Ste 806', 'Des Plaines', 'Cook', 'IL', '60016', '8478739607', NULL, '750 Pearson St Ste 806', 'Des Plaines', 'Cook', 'IL', '60016', '8478739607', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1306160247', 0, 'Y', 0, '2013-03-05', NULL, NULL, 42.0398, -87.8863, NULL, NULL),
('363330928', 'EDMPMG047', 'EDMPMG047', 'ILCHIGSTD', 'Presence Emergency Medicine', 'Lawrence', NULL, 'Lim', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '1725 W Belmont Ave Ste A', 'Chicago', 'Cook', 'IL', '60654', '7736653086', NULL, '1725 W Belmont Ave Ste A', 'Chicago', 'Cook', 'IL', '60654', '7736653086', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, NULL, NULL, 'HCFA|UB|', '1316026420', 0, 'Y', 0, '2013-03-05', NULL, NULL, 41.9397, -87.672, NULL, NULL),
('363330928', 'EDMPMG354', 'EDMPMG354', 'ILCHIGSTD', 'Presence Emergency Medicine', 'Lawrence', NULL, 'Lim', 'MD', 'Emergency Medicine', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7736653086', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7736653086', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, NULL, NULL, 'HCFA|UB|', '1316026420', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG365', 'EDMPMG365', 'ILCHIGSTD', 'Presence Hospitalist Group', 'John', NULL, 'Affinito', 'MD', 'Hospitalist', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7737745172', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7737745172', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1316930191', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG364', 'EDMPMG364', 'ILCHIGSTD', 'Presence Hospitalist Group', 'John', NULL, 'Affinito', 'MD', 'Hospitalist', '', '', NULL, 'O', '7435 W Talcott Ave', 'Chicago', 'Cook', 'IL', '60631', '7737745172', NULL, '7435 W Talcott Ave', 'Chicago', 'Cook', 'IL', '60631', '7737745172', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1316930191', 0, 'Y', 0, '2013-03-05', NULL, NULL, 41.9884, -87.8124, NULL, NULL),
('363330928', 'EDMPMG188', 'EDMPMG188', 'ILCHIGSTD', 'North Shore Physicians Group', 'Mohammad', 'A', 'Gillan', 'MD', 'Internal Medicine', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '8475687400', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '8475687400', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Francis Hospital', NULL, '', '', 'HCFA|UB|', '1316984305', 0, 'Y', 0, '2013-04-03', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG187', 'EDMPMG187', 'ILCHIGSTD', 'North Shore Physicians Group', 'Mohammad', 'A', 'Gillan', 'MD', 'Internal Medicine', '', '', NULL, 'O', '7380 N Lincoln Ave', 'Lincolnwood', 'Cook', 'IL', '60712', '8475687400', NULL, '7380 N Lincoln Ave', 'Lincolnwood', 'Cook', 'IL', '60712', '8475687400', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Francis Hospital', NULL, '', '', 'HCFA|UB|', '1316984305', 0, 'N', 0, '2013-04-03', NULL, NULL, 42.0146, -87.7432, NULL, NULL),
('363330928', 'EDMPMG516', 'EDMPMG516', 'ILCHIGSTD', 'RMG North Shore Sheridan', 'Susan', NULL, 'Shapiro', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1625 Sheridan Rd Ste F', 'Wilmette', 'Cook', 'IL', '60091', '8472511500', NULL, '1625 Sheridan Rd Ste F', 'Wilmette', 'Cook', 'IL', '60091', '8472511500', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Francis Hospital', NULL, '', NULL, 'HCFA|UB|', '1326026139', 0, 'N', 0, '2013-03-05', NULL, NULL, 42.0878, -87.7012, NULL, NULL),
('363330928', 'EDMPMG517', 'EDMPMG517', 'ILCHIGSTD', 'RMG North Shore Sheridan', 'Susan', NULL, 'Shapiro', 'MD', 'Internal Medicine', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '8472511500', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '8472511500', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Francis Hospital', NULL, '', NULL, 'HCFA|UB|', '1326026139', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG431', 'EDMPMG431', 'ILCHIGSTD', 'RMG Belmont Cragin Family Medicine', 'Christophe', '', 'Walton', 'MD', 'Endocrinology', '', '', NULL, 'O', '1643 N Honore', 'Chicago', 'Cook', 'IL', '60622', '7733951715', NULL, '1643 N Honore', 'Chicago', 'Cook', 'IL', '60622', '7733951715', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', NULL, NULL, 'HCFA|UB|', '1326129008', 0, 'N', 0, '2013-04-03', NULL, NULL, 41.9113, -87.6738, NULL, NULL),
('363330928', 'EDMPMG432', 'EDMPMG432', 'ILCHIGSTD', 'RMG Belmont Cragin Family Medicine', 'Christophe', '', 'Walton', 'MD', 'Endocrinology', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7733951715', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7733951715', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', NULL, NULL, 'HCFA|UB|', '1326129008', 0, 'Y', 0, '2013-04-03', NULL, NULL, 0, 0, NULL, NULL),
('364314354', 'EDMPMG243', 'EDMPMG243', 'ILCHIGSTD', 'PMG Elgin ED', 'Ashley', NULL, 'Spindler', 'PA-C', 'Physician Assistant', '', '', NULL, 'B', '25872 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '8476953200', NULL, '25872 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '8476953200', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1326355850', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('364314354', 'EDMPMG242', 'EDMPMG242', 'ILCHIGSTD', 'PMG Elgin ED', 'Ashley', NULL, 'Spindler', 'PA-C', 'Physician Assistant', '', '', NULL, 'O', '77 W Airlite', 'Elgin', 'Kane', 'IL', '60123', '8476953200', NULL, '77 W Airlite', 'Elgin', 'Kane', 'IL', '60123', '8476953200', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1326355850', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG501', 'EDMPMG501', 'ILCHIGSTD', 'RMG North Shore Physicians Group', 'Karoon', NULL, 'Nititham', 'MD', 'Internal Medicine', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '8479051001', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '8479051001', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Francis Hospital', NULL, '', NULL, 'HCFA|UB|', '1336108901', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG172', 'EDMPMG172', 'ILCHIGSTD', 'RMG North Shore Physicians Group', 'Karoon', NULL, 'Nititham', 'MD', 'Internal Medicine', '', '', NULL, 'O', '800 Austin St West Tower Ste 501', 'Evanston', 'Cook', 'IL', '60202', '8479051001', NULL, '800 Austin St West Tower Ste 501', 'Evanston', 'Cook', 'IL', '60202', '8479051001', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Francis Hospital', NULL, '', NULL, 'HCFA|UB|', '1336108901', 0, 'N', 0, '2013-03-05', NULL, NULL, 42.0255, -87.6819, NULL, NULL),
('364314354', 'EDMPMG295', 'EDMPMG295', 'ILCHIGSTD', 'PMG New Lenox Pediatrics', 'Heather', NULL, 'Decker', 'MD', 'Pediatrics', '', '', NULL, 'B', '25872 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '8154852541', NULL, '25872 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '8154852541', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1336114529', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('364314354', 'EDMPMG294', 'EDMPMG294', 'ILCHIGSTD', 'PMG New Lenox Pediatrics', 'Heather', NULL, 'Decker', 'MD', 'Pediatrics', '', '', NULL, 'O', '410 E Lincoln Hwy', 'New Lenox', 'Will', 'IL', '60451', '8154852541', NULL, '410 E Lincoln Hwy', 'New Lenox', 'Will', 'IL', '60451', '8154852541', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1336114529', 0, 'N', 0, '2013-03-05', NULL, NULL, 41.5123, -87.957, NULL, NULL),
('363330928', 'EDMPMG128', 'EDMPMG128', 'ILCHIGSTD', 'RMG Lincoln Prk Internal Medicine', 'Faisal', '', 'Qureshi', 'MD', 'Endocrinology', '', '', NULL, 'O', '2800 N Sheridan Rd Ste 309', 'Chicago', 'Cook', 'IL', '60657', '7732486913', NULL, '2800 N Sheridan Rd Ste 309', 'Chicago', 'Cook', 'IL', '60657', '7732486913', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Our Lady Of The Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1336130483', 0, 'N', 0, '2014-03-24', NULL, NULL, 41.9329, -87.6393, NULL, NULL),
('363330928', 'EDMPMG476', 'EDMPMG476', 'ILCHIGSTD', 'RMG Lincoln Prk Internal Medicine', 'Faisal', '', 'Qureshi', 'MD', 'Endocrinology', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7732486913', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7732486913', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Our Lady Of The Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1336130483', 0, 'Y', 0, '2014-03-24', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG504', 'EDMPMG504', 'ILCHIGSTD', 'RMG North Shore Physicians Group', 'Ira', '', 'Oliff', 'MD', 'Internal Medicine', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '8475689930', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '8475689930', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwestern Lake Forest Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1336138726', 0, 'Y', 0, '2013-10-04', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG503', 'EDMPMG503', 'ILCHIGSTD', 'RMG North Shore Physicians Group', 'Ira', '', 'Oliff', 'MD', 'Internal Medicine', '', '', NULL, 'O', '9711 Skokie Blvd Ste A', 'Skokie', 'Cook', 'IL', '60077', '8475689930', NULL, '9711 Skokie Blvd Ste A', 'Skokie', 'Cook', 'IL', '60077', '8475689930', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-09-30', 0, 0, 0, 'Northwestern Lake Forest Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1336138726', 0, 'N', 0, '2013-10-04', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG541', 'EDMPMG541', 'ILCHIGSTD', 'RMG SFH OB-GYN Group', 'Lucy', NULL, 'Heo', 'DO', 'Obstetrics and Gynecology', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '8474916890', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '8474916890', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', 'Presence Saint Francis Hospital', NULL, NULL, 'HCFA|UB|', '1336163625', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG022', 'EDMPMG022', 'ILCHIGSTD', 'RMG SFH OB-GYN Group', 'Lucy', NULL, 'Heo', 'DO', 'Obstetrics and Gynecology', '', '', NULL, 'O', '800 Austin St East Tower Ste 354', 'Evanston', 'Cook', 'IL', '60202', '8474916890', NULL, '800 Austin St East Tower Ste 354', 'Evanston', 'Cook', 'IL', '60202', '8474916890', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', 'Presence Saint Francis Hospital', NULL, NULL, 'HCFA|UB|', '1336163625', 0, 'N', 0, '2013-03-05', NULL, NULL, 42.0255, -87.6819, NULL, NULL),
('363330928', 'EDMPMG002', 'EDMPMG002', 'ILCHIGSTD', 'RMG Rehabilitation Medical Group', 'David', NULL, 'Rosania', 'MD', 'Physical Medicine and Rehabilitation', '', '', NULL, 'O', '2900 N Lake Shore Dr 12th Fl', 'Chicago', 'Cook', 'IL', '60657', '7736654964', NULL, '2900 N Lake Shore Dr 12th Fl', 'Chicago', 'Cook', 'IL', '60657', '7736654964', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, NULL, NULL, 'HCFA|UB|', '1346281888', 0, 'Y', 0, '2013-03-05', NULL, NULL, 41.9349, -87.6367, NULL, NULL);
INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
('363330928', 'EDMPMG534', 'EDMPMG534', 'ILCHIGSTD', 'RMG Rehabilitation Medical Group', 'David', NULL, 'Rosania', 'MD', 'Physical Medicine and Rehabilitation', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7736654964', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7736654964', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, NULL, NULL, 'HCFA|UB|', '1346281888', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('364314354', 'EDMPMG092', 'EDMPMG092', 'ILCHIGSTD', 'PMG Cardiac and Vascular Specialist', 'Muhammad', '', 'Riaz', 'MD', 'Cardiology', '', '', NULL, 'O', '1435 N Randall Rd Ste 201', 'Elgin', 'Kane', 'IL', '60123', '8479314200', NULL, '1435 N Randall Rd Ste 201', 'Elgin', 'Kane', 'IL', '60123', '8479314200', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2014-02-19', 0, 0, 0, 'Presence Saint Joseph Hospital Elgin', NULL, NULL, NULL, 'HCFA|UB|', '1356433320', 0, 'N', 0, '2014-02-13', NULL, NULL, 42.0711, -88.3319, NULL, NULL),
('364314354', 'EDMPMG215', 'EDMPMG215', 'ILCHIGSTD', 'Presence Service Corporation', 'Muhammad', '', 'Riaz', 'MD', 'Cardiology', '', '', NULL, 'B', '25872 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '8479314200', NULL, '25872 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '8479314200', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Elgin', NULL, NULL, NULL, 'HCFA|UB|', '1356433320', 0, 'Y', 0, '2014-02-13', NULL, NULL, 0, 0, NULL, NULL),
('870299862', 'W40015836', 'W40015836', 'UTMH1', 'LDS Family Services', 'Mark', 'T', 'Hales', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', '125 N State St', 'Salt Lake City', 'Salt Lake', 'UT', '84150', '8013363040', '8013363041', '125 N State St  ', 'Salt Lake City', 'Salt Lake', 'UT', '84150', '8013363040', '8013363041', 'MA', '', '', '0.00', '40.00', '0.00', 8, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1588716039', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG422', 'EDMPMG422', 'ILCHIGSTD', '', 'Mary', NULL, 'Peterson', 'DO', 'Family Practice', NULL, NULL, NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '8002732614', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '8002732614', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1356508675', 0, 'Y', 0, '2014-01-23', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG126', 'EDMPMG126', 'ILCHIGSTD', 'RMG Lincoln Prk Internal Medicine', 'King', '', 'Leong', 'MD', 'Internal Medicine', '', '', NULL, 'O', '2800 N Sheridan Rd Ste 309', 'Chicago', 'Cook', 'IL', '60657', '7732486913', NULL, '2800 N Sheridan Rd Ste 309', 'Chicago', 'Cook', 'IL', '60657', '7732486913', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Our Lady Of The Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1356521314', 0, 'N', 0, '2014-01-31', NULL, NULL, 41.9329, -87.6393, NULL, NULL),
('363330928', 'EDMPMG474', 'EDMPMG474', 'ILCHIGSTD', 'RMG Lincoln Prk Internal Medicine', 'King', '', 'Leong', 'MD', 'Internal Medicine', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7738714183', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7738714183', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Our Lady Of The Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1356521314', 0, 'Y', 0, '2014-01-31', NULL, NULL, 0, 0, NULL, NULL),
('364314354', 'EDMPMG142', 'EDMPMG142', 'ILCHIGSTD', 'PMG Women First', 'Marcia', NULL, 'Snyder', 'CNMW', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1300 N Highland Ste 5', 'Aurora', 'Kane', 'IL', '60506', '6308977700', NULL, '1300 N Highland Ste 5', 'Aurora', 'Kane', 'IL', '60506', '6308977700', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, '', NULL, 'HCFA|UB|', '1366415747', 0, 'N', 0, '2013-03-05', NULL, NULL, 41.7861, -88.3289, NULL, NULL),
('364314354', 'EDMPMG337', 'EDMPMG337', 'ILCHIGSTD', 'PMG Women First', 'Marcia', NULL, 'Snyder', 'CNMW', 'Obstetrics and Gynecology', '', '', NULL, 'B', '25872 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '6308977700', NULL, '25872 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '6308977700', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, '', NULL, 'HCFA|UB|', '1366415747', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG189', 'EDMPMG189', 'ILCHIGSTD', 'Our Lady of the Resurrection Medical Ctr', 'Darien', NULL, 'Cohen', 'MD', 'Emergency Medicine', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7735947871', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7735947871', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1366437626', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG026', 'EDMPMG026', 'ILCHIGSTD', 'Our Lady of the Resurrection Medical Ctr', 'Darien', NULL, 'Cohen', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '7435 W Talcott Ave', 'Chicago', 'Cook', 'IL', '60631', '7735947871', NULL, '7435 W Talcott Ave', 'Chicago', 'Cook', 'IL', '60631', '7735947871', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1366437626', 0, 'Y', 0, '2013-03-05', NULL, NULL, 41.9884, -87.8124, NULL, NULL),
('363330928', 'EDMPMG493', 'EDMPMG493', 'ILCHIGSTD', 'RMG North Shore Physicians Group', 'Glynn', NULL, 'Elliott', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1625 Sheridan Rd Ste F', 'Wilmette', 'Cook', 'IL', '60091', '8472511500', NULL, '1625 Sheridan Rd Ste F', 'Wilmette', 'Cook', 'IL', '60091', '8472511500', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Francis Hospital', NULL, '', NULL, 'HCFA|UB|', '1366481426', 0, 'N', 0, '2013-03-05', NULL, NULL, 42.0878, -87.7012, NULL, NULL),
('363330928', 'EDMPMG494', 'EDMPMG494', 'ILCHIGSTD', 'RMG North Shore Physicians Group', 'Glynn', NULL, 'Elliott', 'MD', 'Internal Medicine', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '8472511500', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '8472511500', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Francis Hospital', NULL, '', NULL, 'HCFA|UB|', '1366481426', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG325', 'EDMPMG325', 'ILCHIGSTD', 'PMG Hospitalist', 'Sandhya', NULL, 'Seetharam', 'MD', 'Hospitalist', '', '', NULL, 'B', '25872 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '8159372400', NULL, '25872 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '8159372400', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1366638181', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG324', 'EDMPMG324', 'ILCHIGSTD', 'PMG Hospitalist', 'Sandhya', NULL, 'Seetharam', 'MD', 'Hospitalist', '', '', NULL, 'O', '500 W Court St', 'Kankakee', 'Kankakee', 'IL', '60901', '8159372400', NULL, '500 W Court St', 'Kankakee', 'Kankakee', 'IL', '60901', '8159372400', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1366638181', 0, 'Y', 0, '2013-03-05', NULL, NULL, 41.1211, -87.8718, NULL, NULL),
('363330928', 'EDMPMG048', 'EDMPMG048', 'ILCHIGSTD', 'Presence Emergency Medicine', 'Midori', NULL, 'Par', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '5645 W Addison St', 'Chicago', 'Cook', 'IL', '60634', '7737947601', NULL, '5645 W Addison St', 'Chicago', 'Cook', 'IL', '60634', '7737947601', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1376543199', 0, 'Y', 0, '2013-03-05', NULL, NULL, 41.9459, -87.7678, NULL, NULL),
('363330928', 'EDMPMG356', 'EDMPMG356', 'ILCHIGSTD', 'Presence Emergency Medicine', 'Midori', NULL, 'Par', 'MD', 'Emergency Medicine', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7737947601', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7737947601', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1376543199', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG321', 'EDMPMG321', 'ILCHIGSTD', 'PMG Emergency Medicine', 'Serena', NULL, 'Baqai', 'MD', 'Emergency Medicine', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7737748000', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7737748000', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1376543488', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG037', 'EDMPMG037', 'ILCHIGSTD', 'PMG Emergency Medicine', 'Serena', NULL, 'Baqai', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '7435 W Talcott Ave', 'Chicago', 'Cook', 'IL', '60631', '7737748000', NULL, '7435 W Talcott Ave', 'Chicago', 'Cook', 'IL', '60631', '7737748000', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1376543488', 0, 'Y', 0, '2013-03-05', NULL, NULL, 41.9884, -87.8124, NULL, NULL),
('363330928', 'EDMPMG571', 'EDMPMG571', 'ILCHIGSTD', '', 'Cynthia', NULL, 'Loy', 'APN', 'Nurse Practitioner', '', '', NULL, 'O', '5645 W Addison', 'Chicago', 'Cook', 'IL', '60634', '7737947601', NULL, '5645 W Addison', 'Chicago', 'Cook', 'IL', '60634', '7737947601', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1376895284', 0, 'Y', 0, '2013-03-05', NULL, NULL, 41.9459, -87.7678, NULL, NULL),
('363330928', 'EDMPMG572', 'EDMPMG572', 'ILCHIGSTD', '', 'Cynthia', NULL, 'Loy', 'APN', 'Nurse Practitioner', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7737947601', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7737947601', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1376895284', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG519', 'EDMPMG519', 'ILCHIGSTD', 'RMG Norwood Prk Pediatrics', 'Jonathan', NULL, 'Powell', 'MD', 'Pediatrics', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7737631126', '          ', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7737631126', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2014-06-01', 0, 0, 0, 'Presence Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1386622819', 0, 'Y', 0, '2014-05-05', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG138', 'EDMPMG138', 'ILCHIGSTD', 'RMG Norwood Prk Pediatrics', 'Jonathan', NULL, 'Powell', 'MD', 'Pediatrics', '', '', NULL, 'O', '7447 W Talcott Ave Ste 467', 'Chicago', 'Cook', 'IL', '60631', '7737631126', '          ', '7447 W Talcott Ave Ste 467', 'Chicago', 'Cook', 'IL', '60631', '7737631126', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2014-06-01', 0, 0, 0, 'Presence Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1386622819', 0, 'N', 0, '2014-05-05', NULL, NULL, 41.9887, -87.8131, NULL, NULL),
('363330928', 'EDMPMG525', 'EDMPMG525', 'ILCHIGSTD', 'RMG Oakton Maple Family Practice Center', 'Peter', NULL, 'Kiefer', 'MD', 'Family Practice', '', '', NULL, 'O', '1792 Oakton St', 'Des Plaines', 'Cook', 'IL', '60018', '8478274496', NULL, '1792 Oakton St', 'Des Plaines', 'Cook', 'IL', '60018', '8478274496', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1386688158', 0, 'N', 0, '2013-03-05', NULL, NULL, 42.0244, -87.8797, NULL, NULL),
('363330928', 'EDMPMG526', 'EDMPMG526', 'ILCHIGSTD', 'RMG Oakton Maple Family Practice Center', 'Peter', NULL, 'Kiefer', 'MD', 'Family Practice', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '8478274496', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '8478274496', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1386688158', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG200', 'EDMPMG200', 'ILCHIGSTD', 'Our Lady of the Resurrection Medical Ctr', 'Shruti', NULL, 'Shah', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '2335 N Lister  Unit C', 'Chicago', 'Cook', 'IL', '60614', '3129335074', NULL, '2335 N Lister  Unit C', 'Chicago', 'Cook', 'IL', '60614', '3129335074', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1386800688', 0, 'Y', 0, '2013-03-05', NULL, NULL, 41.9233, -87.6768, NULL, NULL),
('363330928', 'EDMPMG201', 'EDMPMG201', 'ILCHIGSTD', 'Our Lady of the Resurrection Medical Ctr', 'Shruti', NULL, 'Shah', 'MD', 'Emergency Medicine', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '3129335074', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '3129335074', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1386800688', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG507', 'EDMPMG507', 'ILCHIGSTD', 'RMG North Shore Physicians Group', 'James', '', 'Foydel', 'MD', 'Physical Medicine and Rehabilitation', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '8475687400', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '8475687400', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1407804768', 0, 'Y', 0, '2013-03-27', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG506', 'EDMPMG506', 'ILCHIGSTD', 'RMG North Shore Physicians Group', 'James', '', 'Foydel', 'MD', 'Physical Medicine and Rehabilitation', '', '', NULL, 'O', '7380 N Lincoln Ave', 'Lincolnwood', 'Cook', 'IL', '60712', '8475687400', NULL, '7380 N Lincoln Ave', 'Lincolnwood', 'Cook', 'IL', '60712', '8475687400', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1407804768', 0, 'Y', 0, '2013-03-27', NULL, NULL, 42.0146, -87.7432, NULL, NULL),
('363330928', 'EDMPMG064', 'EDMPMG064', 'ILCHIGSTD', '', 'Tracy', NULL, 'Boykin', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '5645 W Addison St', 'Chicago', 'Cook', 'IL', '60634', '7737947601', NULL, '5645 W Addison St', 'Chicago', 'Cook', 'IL', '60634', '7737947601', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1407888712', 0, 'Y', 0, '2013-03-05', NULL, NULL, 41.9459, -87.7678, NULL, NULL),
('363330928', 'EDMPMG565', 'EDMPMG565', 'ILCHIGSTD', '', 'Tracy', NULL, 'Boykin', 'MD', 'Emergency Medicine', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7737947601', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7737947601', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1407888712', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG174', 'EDMPMG174', 'ILCHIGSTD', 'RMG SFH OB-GYN Group', 'Thomas', '', 'Herriges', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '800 Austin St West Tower Ste 505', 'Evanston', 'Cook', 'IL', '60202', '8478690437', NULL, '800 Austin St West Tower Ste 505', 'Evanston', 'Cook', 'IL', '60202', '8478690437', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1407962079', 0, 'Y', 0, '2014-01-10', NULL, NULL, 42.0255, -87.6819, NULL, NULL),
('363330928', 'EDMPMG016', 'EDMPMG016', 'ILCHIGSTD', 'Our Lady of the Resurrection Medical Ctr', 'Mihail', NULL, 'Epure', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '5645 W Addison', 'Chicago', 'Cook', 'IL', '60634', '7732827000', NULL, '5645 W Addison', 'Chicago', 'Cook', 'IL', '60634', '7732827000', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1417106105', 0, 'Y', 0, '2013-03-05', NULL, NULL, 41.9459, -87.7678, NULL, NULL),
('363330928', 'EDMPMG191', 'EDMPMG191', 'ILCHIGSTD', 'Our Lady of the Resurrection Medical Ctr', 'Mihail', NULL, 'Epure', 'MD', 'Emergency Medicine', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7732827000', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7732827000', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1417106105', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG104', 'EDMPMG104', 'ILCHIGSTD', 'North Shore Physicians Group', 'Bruce', '', 'Doblin', 'MD', 'Internal Medicine', '', '', NULL, 'O', '2500 Ridge Ave Ste 210', 'Evanston', 'Cook', 'IL', '60201', '8474910888', NULL, '2500 Ridge Ave Ste 210', 'Evanston', 'Cook', 'IL', '60201', '8474910888', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Francis Hospital', NULL, '', '', 'HCFA|UB|', '1417903212', 0, 'N', 0, '2013-04-30', NULL, NULL, 42.0631, -87.684, NULL, NULL),
('363330928', 'EDMPMG186', 'EDMPMG186', 'ILCHIGSTD', 'North Shore Physicians Group', 'Bruce', '', 'Doblin', 'MD', 'Internal Medicine', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '8474910888', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '8474910888', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Francis Hospital', NULL, '', '', 'HCFA|UB|', '1417903212', 0, 'Y', 0, '2013-04-30', NULL, NULL, 0, 0, NULL, NULL),
('364314354', 'EDMPMG078', 'EDMPMG078', 'ILCHIGSTD', 'PMG Crest Hill', 'Bhavesh', 'R', 'Gandhi', 'MD', 'Family Practice', '', '', NULL, 'O', '16151 Weber Rd Ste 101', 'Crest Hill', 'Will', 'IL', '60403', '8157737827', NULL, '16151 Weber Rd Ste 101', 'Crest Hill', 'Will', 'IL', '60403', '8157737827', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Elgin', NULL, NULL, NULL, 'HCFA|UB|', '1417994013', 0, 'N', 0, '2013-04-03', NULL, NULL, 41.5905, -88.1225, NULL, NULL),
('364314354', 'EDMPMG217', 'EDMPMG217', 'ILCHIGSTD', 'PMG Crest Hill', 'Bhavesh', 'R', 'Gandhi', 'MD', 'Family Practice', '', '', NULL, 'B', '25872 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '8157737827', '8158382656', '25872 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '8157737827', '8158382656', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Elgin', NULL, NULL, NULL, 'HCFA|UB|', '1417994013', 0, 'Y', 0, '2013-04-03', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG127', 'EDMPMG127', 'ILCHIGSTD', 'RMG Lincoln Prk Internal Medicine', 'Owais', '', 'Lodhi', 'MD', 'Internal Medicine', '', '', NULL, 'O', '2800 N Sheridan Rd Ste 309', 'Chicago', 'Cook', 'IL', '60657', '7732486913', NULL, '2800 N Sheridan Rd Ste 309', 'Chicago', 'Cook', 'IL', '60657', '7732486913', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, '', '', 'HCFA|UB|', '1427212638', 0, 'N', 0, '2013-09-19', NULL, NULL, 41.9329, -87.6393, NULL, NULL),
('363330928', 'EDMPMG475', 'EDMPMG475', 'ILCHIGSTD', 'RMG Lincoln Prk Internal Medicine', 'Owais', '', 'Lodhi', 'MD', 'Internal Medicine', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7732486913', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7732486913', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, '', '', 'HCFA|UB|', '1427212638', 0, 'Y', 0, '2013-09-19', NULL, NULL, 0, 0, NULL, NULL),
('364314354', 'EDMPMG262', 'EDMPMG262', 'ILCHIGSTD', 'PMG Internal Medicine Bourbonnais and Clifton', 'Wuraola', NULL, 'Omotosho', 'MD', 'Internal Medicine', '', '', NULL, 'B', '25872 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '8159365167', NULL, '25872 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '8159365167', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1427222884', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('364314354', 'EDMPMG160', 'EDMPMG160', 'ILCHIGSTD', 'PMG Internal Medicine Bourbonnais and Clifton', 'Wuraola', NULL, 'Omotosho', 'MD', 'Internal Medicine', '', '', NULL, 'O', '656 N Convent Ste B', 'Bourbonnais', 'Kankakee', 'IL', '60914', '8159365167', NULL, '656 N Convent Ste B', 'Bourbonnais', 'Kankakee', 'IL', '60914', '8159365167', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1427222884', 0, 'Y', 0, '2013-03-05', NULL, NULL, 41.1652, -87.8753, NULL, NULL),
('363330928', 'EDMPMG146', 'EDMPMG146', 'ILCHIGSTD', 'RMG Humboldt Prk Family Medicine', 'Carlos', '', 'Pedrera', 'MD', 'Family Practice', '', '', NULL, 'O', '1431 N Western Ave Ste 502', 'Chicago', 'Cook', 'IL', '60622', '7732782600', NULL, '1431 N Western Ave Ste 502', 'Chicago', 'Cook', 'IL', '60622', '7732782600', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2014-03-31', 0, 0, 0, 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', NULL, NULL, NULL, 'HCFA|UB|', '1437125648', 0, 'N', 0, '2014-02-24', NULL, NULL, 41.9073, -87.6871, NULL, NULL),
('363330928', 'EDMPMG461', 'EDMPMG461', 'ILCHIGSTD', 'RMG Humboldt Prk Family Medicine', 'Carlos', '', 'Pedrera', 'MD', 'Family Practice', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7732782600', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7732782600', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2014-03-31', 0, 0, 0, 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', NULL, NULL, NULL, 'HCFA|UB|', '1437125648', 0, 'Y', 0, '2014-02-24', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG455', 'EDMPMG455', 'ILCHIGSTD', 'RMG Hospitalist Group   Our Lady of Resurrection', 'Neil', '', 'Sharma', 'MD', 'Internal Medicine', '', '', NULL, 'O', '5645 W Addison St', 'Chicago', 'Cook', 'IL', '60634', '2245634994', NULL, '5645 W Addison St', 'Chicago', 'Cook', 'IL', '60634', '2245634994', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-04-23', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1437319290', 0, 'Y', 0, '2013-04-26', NULL, NULL, 41.9458, -87.7678, NULL, NULL),
('363330928', 'EDMPMG456', 'EDMPMG456', 'ILCHIGSTD', 'RMG Hospitalist Group   Our Lady of Resurrection', 'Neil', '', 'Sharma', 'MD', 'Internal Medicine', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '2245634994', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '2245634994', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-04-23', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1437319290', 0, 'Y', 0, '2013-04-26', NULL, NULL, 0, 0, NULL, NULL),
('364314354', 'EDMPMG289', 'EDMPMG289', 'ILCHIGSTD', 'PMG New Lenox Family Practice', 'Neil', '', 'Sharma', 'MD', 'Internal Medicine', '', '', NULL, 'B', '25872 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '8154852541', NULL, '25872 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '8154852541', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-04-23', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1437319290', 0, 'Y', 0, '2013-04-26', NULL, NULL, 0, 0, NULL, NULL),
('364314354', 'EDMPMG288', 'EDMPMG288', 'ILCHIGSTD', 'PMG New Lenox Family Practice', 'Neil', '', 'Sharma', 'MD', 'Internal Medicine', '', '', NULL, 'O', '410 E Lincoln Hwy', 'New Lenox', 'Will', 'IL', '60451', '8154852541', NULL, '410 E Lincoln Hwy', 'New Lenox', 'Will', 'IL', '60451', '8154852541', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-04-23', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1437319290', 0, 'N', 0, '2013-04-26', NULL, NULL, 41.5117, -87.9565, NULL, NULL),
('364314354', 'EDMPMG237', 'EDMPMG237', 'ILCHIGSTD', 'PMG Elgin ED', 'Joseph', NULL, 'Lo', 'MD', 'Emergency Medicine', '', '', NULL, 'B', '25872 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '8476953200', NULL, '25872 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '8476953200', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1437398476', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('364314354', 'EDMPMG236', 'EDMPMG236', 'ILCHIGSTD', 'PMG Elgin ED', 'Joseph', NULL, 'Lo', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '77 W Airlite', 'Elgin', 'Kane', 'IL', '60123', '8476953200', NULL, '77 W Airlite', 'Elgin', 'Kane', 'IL', '60123', '8476953200', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1437398476', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG009', 'EDMPMG009', 'ILCHIGSTD', 'RMG Hematology Oncology Lincoln Prk', 'Alan', NULL, 'Gilman', 'MD', 'Hematology and Oncology', '', '', NULL, 'O', '2900 N Lake Shore Dr 7th Fl', 'Chicago', 'Cook', 'IL', '60657', '7736615800', NULL, '2900 N Lake Shore Dr 7th Fl', 'Chicago', 'Cook', 'IL', '60657', '7736615800', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, NULL, NULL, 'HCFA|UB|', '1447249834', 0, 'N', 0, '2013-03-05', NULL, NULL, 41.9349, -87.6367, NULL, NULL),
('363330928', 'EDMPMG452', 'EDMPMG452', 'ILCHIGSTD', 'RMG Hematology Oncology Lincoln Prk', 'Alan', NULL, 'Gilman', 'MD', 'Hematology and Oncology', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7736615800', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7736615800', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, NULL, NULL, 'HCFA|UB|', '1447249834', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG060', 'EDMPMG060', 'ILCHIGSTD', '', 'E Bradshaw', NULL, 'Bunney', 'MD', 'Anesthesiology', '', '', NULL, 'O', '5645 W Addison St', 'Chicago', 'Cook', 'IL', '60634', '7737947601', NULL, '5645 W Addison St', 'Chicago', 'Cook', 'IL', '60634', '7737947601', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1447250543', 0, 'Y', 0, '2014-01-23', NULL, NULL, 41.9459, -87.7678, NULL, NULL),
('363330928', 'EDMPMG413', 'EDMPMG413', 'ILCHIGSTD', '', 'E Bradshaw', NULL, 'Bunney', 'MD', 'Anesthesiology', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7737947601', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7737947601', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1447250543', 0, 'Y', 0, '2014-01-23', NULL, NULL, 0, 0, NULL, NULL),
('364314354', 'EDMPMG162', 'EDMPMG162', 'ILCHIGSTD', 'PMG Lemont Internal Medicine', 'Iulia', NULL, 'Enacopol', 'MD', 'Internal Medicine', '', '', NULL, 'O', '15947 127th St Ste B', 'Lemont', 'Cook', 'IL', '60439', '6302436300', NULL, '15947 127th St Ste B', 'Lemont', 'Cook', 'IL', '60439', '6302436300', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, NULL, NULL, 'HCFA|UB|', '1447452917', 0, 'N', 0, '2013-03-05', NULL, NULL, 41.6565, -88.0052, NULL, NULL),
('364314354', 'EDMPMG282', 'EDMPMG282', 'ILCHIGSTD', 'PMG Lemont Internal Medicine', 'Iulia', NULL, 'Enacopol', 'MD', 'Internal Medicine', '', '', NULL, 'B', '25872 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '6302436300', NULL, '25872 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '6302436300', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, NULL, NULL, 'HCFA|UB|', '1447452917', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG523', 'EDMPMG523', 'ILCHIGSTD', 'RMG Oakton Maple Family Practice Center', 'Lenus', '', 'Damasaru', 'MD', 'Family Practice', '', '', NULL, 'O', '1792 Oakton St', 'Des Plaines', 'Cook', 'IL', '60018', '8478274496', NULL, '1792 Oakton St', 'Des Plaines', 'Cook', 'IL', '60018', '8478274496', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1467690040', 0, 'N', 0, '2013-08-29', NULL, NULL, 42.0244, -87.8797, NULL, NULL),
('363330928', 'EDMPMG524', 'EDMPMG524', 'ILCHIGSTD', 'RMG Oakton Maple Family Practice Center', 'Lenus', '', 'Damasaru', 'MD', 'Family Practice', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '8478274496', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '8478274496', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1467690040', 0, 'N', 0, '2013-12-03', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG169', 'EDMPMG169', 'ILCHIGSTD', 'Our Lady of the Resurrection Medical Ctr', 'Scott', NULL, 'Samlan', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '5645 W Addison St Unit 4104', 'Chicago', 'Cook', 'IL', '60654', '7732827000', NULL, '5645 W Addison St Unit 4104', 'Chicago', 'Cook', 'IL', '60654', '7732827000', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1477575306', 0, 'Y', 0, '2013-03-05', NULL, NULL, 41.9459, -87.7678, NULL, NULL),
('363330928', 'EDMPMG199', 'EDMPMG199', 'ILCHIGSTD', 'Our Lady of the Resurrection Medical Ctr', 'Scott', NULL, 'Samlan', 'MD', 'Emergency Medicine', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7732827000', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7732827000', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1477575306', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG113', 'EDMPMG113', 'ILCHIGSTD', '', 'Joseph', NULL, 'Sheehan', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '2222 W Division St Ste 235', 'Chicago', 'Cook', 'IL', '60622', '7734867200', NULL, '2222 W Division St Ste 235', 'Chicago', 'Cook', 'IL', '60622', '7734867200', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', NULL, NULL, NULL, 'HCFA|UB|', '1477580769', 0, 'N', 0, '2014-01-23', NULL, NULL, 41.9032, -87.6826, NULL, NULL),
('363330928', 'EDMPMG424', 'EDMPMG424', 'ILCHIGSTD', '', 'Joseph', NULL, 'Sheehan', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7734867200', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7734867200', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', NULL, NULL, NULL, 'HCFA|UB|', '1477580769', 0, 'Y', 0, '2014-01-23', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG296', 'EDMPMG296', 'ILCHIGSTD', 'PMG North Shore ', 'Thomas', 'A', 'Stern', 'MD', 'Internal Medicine', '', '', NULL, 'O', '525 Winnetka Ave', 'Winnetka', 'Cook', 'IL', '60093', '8475014060', NULL, '525 Winnetka Ave', 'Winnetka', 'Cook', 'IL', '60093', '8475014060', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1477592665', 0, 'N', 0, '2013-04-03', NULL, NULL, 42.0936, -87.7239, NULL, NULL),
('363330928', 'EDMPMG297', 'EDMPMG297', 'ILCHIGSTD', 'PMG North Shore ', 'Thomas', 'A', 'Stern', 'MD', 'Internal Medicine', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '8475014060', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '8475014060', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1477592665', 0, 'Y', 0, '2013-04-03', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG122', 'EDMPMG122', 'ILCHIGSTD', 'RMG Morton Grove Internal Medicine', 'Wolf', '', 'Peddinghaus', 'MD', 'Internal Medicine', '', '', NULL, 'O', '5747 W Dempster St Ste 300', 'Morton Grove', 'Cook', 'IL', '60053', '8473248700', NULL, '5747 W Dempster St Ste 300', 'Morton Grove', 'Cook', 'IL', '60053', '8473248700', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1487640660', 0, 'N', 0, '2013-09-10', NULL, NULL, 42.0409, -87.7702, NULL, NULL),
('363330928', 'EDMPMG486', 'EDMPMG486', 'ILCHIGSTD', 'RMG Morton Grove Internal Medicine', 'Wolf', '', 'Peddinghaus', 'MD', 'Internal Medicine', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '8473248700', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '8473248700', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1487640660', 0, 'Y', 0, '2013-09-10', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG426', 'EDMPMG426', 'ILCHIGSTD', 'RMG Belmont Cragin Family Medicine', 'Marzena', NULL, 'Lipinska', 'MD', 'Family Practice', '', '', NULL, 'O', '3204 N Oak Park Ave', 'Chicago', 'Cook', 'IL', '60634', '7737363131', NULL, '3204 N Oak Park Ave', 'Chicago', 'Cook', 'IL', '60634', '7737363131', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', NULL, '', NULL, 'HCFA|UB|', '1487657078', 0, 'N', 0, '2013-03-05', NULL, NULL, 41.9382, -87.7957, NULL, NULL),
('363330928', 'EDMPMG427', 'EDMPMG427', 'ILCHIGSTD', 'RMG Belmont Cragin Family Medicine', 'Marzena', NULL, 'Lipinska', 'MD', 'Family Practice', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7737363131', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7737363131', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', NULL, '', NULL, 'HCFA|UB|', '1487657078', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('364314354', 'EDMPMG090', 'EDMPMG090', 'ILCHIGSTD', 'PMG Cardiac and Vascular Specialist', 'Nighat', '', 'Nisar', 'MD', 'Radiologist', '', '', NULL, 'O', '1435 N Randall Rd Ste 201', 'Elgin', 'Kane', 'IL', '60123', '8479314200', NULL, '1435 N Randall Rd Ste 201', 'Elgin', 'Kane', 'IL', '60123', '8479314200', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2014-02-19', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1487774782', 0, 'Y', 0, '2014-02-12', NULL, NULL, 42.0711, -88.3319, NULL, NULL),
('364314354', 'EDMPMG213', 'EDMPMG213', 'ILCHIGSTD', 'PMG Cardiac and Vascular Specialist', 'Nighat', '', 'Nisar', 'MD', 'Radiologist', '', '', NULL, 'B', '25872 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '8479314200', NULL, '25872 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '8479314200', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1487774782', 0, 'Y', 0, '2014-02-07', NULL, NULL, 0, 0, NULL, NULL),
('364314354', 'EDMPMG098', 'EDMPMG098', 'ILCHIGSTD', '', 'Azra', '', 'Sadikovic', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1315 N Highland Ste 204', 'Aurora', 'Kane', 'IL', '60506', '6308015600', NULL, '1315 N Highland Ste 204', 'Aurora', 'Kane', 'IL', '60506', '6308015600', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1487821468', 0, 'N', 0, '2013-03-05', NULL, NULL, 41.7852, -88.3289, NULL, NULL),
('363330928', 'EDMPMG518', 'EDMPMG518', 'ILCHIGSTD', 'RMG Norwood Prk Family Medicine', 'Evangelos', NULL, 'Biscotakis', 'MD', 'Family Practice', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7737747474', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7737747474', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1487835138', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG114', 'EDMPMG114', 'ILCHIGSTD', 'RMG Norwood Prk Family Medicine', 'Evangelos', NULL, 'Biscotakis', 'MD', 'Family Practice', '', '', NULL, 'O', '7447 W Talcott Ave Ste 245', 'Chicago', 'Cook', 'IL', '60631', '7737747474', NULL, '7447 W Talcott Ave Ste 245', 'Chicago', 'Cook', 'IL', '60631', '7737747474', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1487835138', 0, 'N', 0, '2013-03-05', NULL, NULL, 41.9887, -87.8131, NULL, NULL),
('364314354', 'EDMPMG210', 'EDMPMG210', 'ILCHIGSTD', 'PMG Bourbonnais Endocrinology', 'Aruna', NULL, 'Ravanam', 'MD', 'Endocrinology', '', '', NULL, 'B', '25872 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '8159372155', NULL, '25872 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '8159372155', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1487875126', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('364314354', 'EDMPMG153', 'EDMPMG153', 'ILCHIGSTD', 'PMG Bourbonnais Endocrinology', 'Aruna', NULL, 'Ravanam', 'MD', 'Endocrinology', '', '', NULL, 'O', '656 N Convent Ste A', 'Bourbonnais', 'Kankakee', 'IL', '60914', '8159372155', NULL, '656 N Convent Ste A', 'Bourbonnais', 'Kankakee', 'IL', '60914', '8159372155', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1487875126', 0, 'Y', 0, '2013-03-05', NULL, NULL, 41.1652, -87.8753, NULL, NULL),
('363330928', 'EDMPMG513', 'EDMPMG513', 'ILCHIGSTD', 'RMG North Shore Physicians Group', 'Branka', NULL, 'O Sullivan', 'MD', 'Internal Medicine', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '8475687400', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '8475687400', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Francis Hospital', NULL, '', NULL, 'HCFA|UB|', '1497709968', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG512', 'EDMPMG512', 'ILCHIGSTD', 'RMG North Shore Physicians Group', 'Branka', NULL, 'O Sullivan', 'MD', 'Internal Medicine', '', '', NULL, 'O', '7380 N Lincoln Ave', 'Lincolnwood', 'Cook', 'IL', '60712', '8475687400', NULL, '7380 N Lincoln Ave', 'Lincolnwood', 'Cook', 'IL', '60712', '8475687400', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Francis Hospital', NULL, '', NULL, 'HCFA|UB|', '1497709968', 0, 'N', 0, '2013-03-05', NULL, NULL, 42.0146, -87.7432, NULL, NULL),
('363330928', 'EDMPMG532', 'EDMPMG532', 'ILCHIGSTD', 'RMG Prk Ridge Internal Medicine South', 'Lawrence', NULL, 'Pankau', 'MD', 'Internal Medicine', NULL, NULL, NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '8478256631', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '8478256631', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1497758114', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG531', 'EDMPMG531', 'ILCHIGSTD', 'RMG Prk Ridge Internal Medicine South', 'Lawrence', NULL, 'Pankau', 'MD', 'Internal Medicine', NULL, NULL, NULL, 'O', 'Presence Ctr for Health  205 S Northwest Hwy', 'Park Ridge', 'Cook', 'IL', '60068', '8478256631', NULL, 'Presence Ctr for Health  205 S Northwest Hwy', 'Park Ridge', 'Cook', 'IL', '60068', '8478256631', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1497758114', 0, 'N', 0, '2013-03-05', NULL, NULL, 42.0091, -87.8262, NULL, NULL),
('363330928', 'EDMPMG459', 'EDMPMG459', 'ILCHIGSTD', 'RMG Hospitalist Group   Our Lady of Resurrection', 'Irmina', NULL, 'Valinovic', 'MD', 'Hospitalist', '', '', NULL, 'O', '5645 W Addison St', 'Chicago', 'Cook', 'IL', '60634', '2245634994', NULL, '5645 W Addison St', 'Chicago', 'Cook', 'IL', '60634', '2245634994', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1508055047', 0, 'Y', 0, '2013-03-05', NULL, NULL, 41.9459, -87.7678, NULL, NULL),
('363330928', 'EDMPMG460', 'EDMPMG460', 'ILCHIGSTD', 'RMG Hospitalist Group   Our Lady of Resurrection', 'Irmina', NULL, 'Valinovic', 'MD', 'Hospitalist', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '2245634994', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '2245634994', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1508055047', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG057', 'EDMPMG057', 'ILCHIGSTD', 'Resurrection Medical Ctr', 'John', NULL, 'Martini', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '5645 W Addison St', 'Chicago', 'Cook', 'IL', '60634', '7737947601', NULL, '5645 W Addison St', 'Chicago', 'Cook', 'IL', '60634', '7737947601', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1508076522', 0, 'Y', 0, '2013-03-05', NULL, NULL, 41.9459, -87.7678, NULL, NULL),
('363330928', 'EDMPMG405', 'EDMPMG405', 'ILCHIGSTD', 'Resurrection Medical Ctr', 'John', NULL, 'Martini', 'MD', 'Emergency Medicine', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7737947601', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7737947601', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1508076522', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG055', 'EDMPMG055', 'ILCHIGSTD', 'Resurrection Medical Ctr', 'Leigh', NULL, 'Halpern', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '2136 W Thomas', 'Chicago', 'Cook', 'IL', '60622', '3127702418', NULL, '2136 W Thomas', 'Chicago', 'Cook', 'IL', '60622', '3127702418', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', NULL, NULL, NULL, 'HCFA|UB|', '1508810847', 0, 'Y', 0, '2013-03-05', NULL, NULL, 41.9013, -87.6805, NULL, NULL),
('363330928', 'EDMPMG402', 'EDMPMG402', 'ILCHIGSTD', 'Resurrection Medical Ctr', 'Leigh', NULL, 'Halpern', 'MD', 'Emergency Medicine', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '3127702418', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '3127702418', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', NULL, NULL, NULL, 'HCFA|UB|', '1508810847', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG378', 'EDMPMG378', 'ILCHIGSTD', 'Presence Neurology', 'Zahra', 'S', 'Afshari', 'MD', 'Neurology', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '8474916890', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '8474916890', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1508983628', 0, 'Y', 0, '2013-03-25', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG377', 'EDMPMG377', 'ILCHIGSTD', 'Presence Neurology', 'Zahra', 'S', 'Afshari', 'MD', 'Neurology', '', '', NULL, 'O', '800 Austin St West Tower', 'Evanston', 'Cook', 'IL', '60202', '8474916890', NULL, '800 Austin St West Tower', 'Evanston', 'Cook', 'IL', '60202', '8474916890', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1508983628', 0, 'N', 0, '2013-03-25', NULL, NULL, 42.0255, -87.6819, NULL, NULL),
('364314354', 'EDMPMG229', 'EDMPMG229', 'ILCHIGSTD', 'PMG Elgin ED', 'John', NULL, 'Gaskill', 'MD', 'Emergency Medicine', '', '', NULL, 'B', '25872 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '8476953200', NULL, '25872 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '8476953200', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Elgin', NULL, NULL, NULL, 'HCFA|UB|', '1516058043', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('364314354', 'EDMPMG228', 'EDMPMG228', 'ILCHIGSTD', 'PMG Elgin ED', 'John', NULL, 'Gaskill', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '77 W Airlite', 'Elgin', 'Kane', 'IL', '60123', '8476953200', NULL, '77 W Airlite', 'Elgin', 'Kane', 'IL', '60123', '8476953200', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Elgin', NULL, NULL, NULL, 'HCFA|UB|', '1516058043', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG046', 'EDMPMG046', 'ILCHIGSTD', 'Presence Emergency Medicine', 'Nadim', '', 'Hafez', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '2233 W Division St', 'Chicago', 'Cook', 'IL', '60622', '3127702000', NULL, '2233 W Division St', 'Chicago', 'Cook', 'IL', '60622', '3127702000', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1518164284', 0, 'Y', 0, '2013-07-02', NULL, NULL, 41.9031, -87.6829, 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
('363330928', 'EDMPMG352', 'EDMPMG352', 'ILCHIGSTD', 'Presence Emergency Medicine', 'Nadim', '', 'Hafez', 'MD', 'Emergency Medicine', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '3127702418', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '3127702418', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1518164284', 0, 'Y', 0, '2013-07-02', NULL, NULL, 0, 0, NULL, NULL),
('362709982', 'EDMPMG380', 'EDMPMG380', 'ILCHIGSTD', 'Resurrection Express Care Clinic', 'Marianne', '', 'Holmer', 'NP', 'Family Practice', '', '', NULL, 'O', '2940 N Ashland Ave', 'Chicago', 'Cook', 'IL', '60657', '7735254440', NULL, '2940 N Ashland Ave', 'Chicago', 'Cook', 'IL', '60657', '7735254440', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1518228915', 0, 'Y', 0, '2013-04-17', NULL, NULL, 41.9358, -87.6686, NULL, NULL),
('362709982', 'EDMPMG381', 'EDMPMG381', 'ILCHIGSTD', 'Resurrection Express Care Clinic', 'Marianne', '', 'Holmer', 'NP', 'Family Practice', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7735254440', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7735254440', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1518228915', 0, 'Y', 0, '2013-04-17', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG393', 'EDMPMG393', 'ILCHIGSTD', 'Resurrection Immediate Care Ctr', 'Marianne', '', 'Holmer', 'NP', 'Family Practice', '', '', NULL, 'O', '4900 N Cumberland Ave', 'Norridge', 'Cook', 'IL', '60706', '7084561600', NULL, '4900 N Cumberland Ave', 'Norridge', 'Cook', 'IL', '60706', '7084561600', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1518228915', 0, 'Y', 0, '2013-04-17', NULL, NULL, 41.9688, -87.8368, NULL, NULL),
('363330928', 'EDMPMG394', 'EDMPMG394', 'ILCHIGSTD', 'Resurrection Immediate Care Ctr', 'Marianne', '', 'Holmer', 'NP', 'Family Practice', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7084561600', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7084561600', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1518228915', 0, 'Y', 0, '2013-04-17', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG419', 'EDMPMG419', 'ILCHIGSTD', 'Presence Center for Health', 'Ejaz', NULL, 'Khan', 'MD', 'Family Practice', '', '', NULL, 'O', '205 S Northwest Hwy', 'Park Ridge', 'Cook', 'IL', '60068', '8476963370', NULL, '205 S Northwest Hwy', 'Park Ridge', 'Cook', 'IL', '60068', '8476963370', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1518902527', 0, 'N', 0, '2013-03-05', NULL, NULL, 42.0091, -87.8262, NULL, NULL),
('363330928', 'EDMPMG420', 'EDMPMG420', 'ILCHIGSTD', '', 'Ejaz', NULL, 'Khan', 'MD', 'Family Practice', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '8476963370', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '8476963370', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1518902527', 0, 'Y', 0, '2014-01-23', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG406', 'EDMPMG406', 'ILCHIGSTD', 'Resurrection Medical Ctr', 'Alicia', '', 'Salazar', 'MD', 'Emergency Medicine', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7735947871', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7735947871', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1518952027', 0, 'Y', 0, '2013-07-02', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG058', 'EDMPMG058', 'ILCHIGSTD', 'Resurrection Medical Ctr', 'Alicia', '', 'Salazar', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '7435 W Talcott Ave', 'Chicago', 'Cook', 'IL', '60631', '7737925255', NULL, '7435 W Talcott Ave', 'Chicago', 'Cook', 'IL', '60631', '7737925255', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1518952027', 0, 'Y', 0, '2013-07-02', NULL, NULL, 41.9884, -87.8124, NULL, NULL),
('363330928', 'EDMPMG520', 'EDMPMG520', 'ILCHIGSTD', 'RMG Norwood Prk Pediatrics', 'Paul', NULL, 'Toussaint', 'MD', 'Pediatrics', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7737631126', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7737631126', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1518960145', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG139', 'EDMPMG139', 'ILCHIGSTD', 'RMG Norwood Prk Pediatrics', 'Paul', NULL, 'Toussaint', 'MD', 'Pediatrics', '', '', NULL, 'O', '7447 W Talcott Ave Ste 467', 'Chicago', 'Cook', 'IL', '60631', '7737631126', NULL, '7447 W Talcott Ave Ste 467', 'Chicago', 'Cook', 'IL', '60631', '7737631126', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1518960145', 0, 'N', 0, '2013-03-05', NULL, NULL, 41.9887, -87.8131, NULL, NULL),
('363330928', 'EDMPMG203', 'EDMPMG203', 'ILCHIGSTD', 'PMG Aurora Internal Medicine', 'Karl', NULL, 'Ambroz', 'MD', 'Internal Medicine', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7735947871', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7735947871', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', NULL, '', NULL, 'HCFA|UB|', '1528069465', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG036', 'EDMPMG036', 'ILCHIGSTD', 'PMG Aurora Internal Medicine', 'Karl', NULL, 'Ambroz', 'MD', 'Internal Medicine', '', '', NULL, 'O', '7435 W Talcott Ave', 'Chicago', 'Cook', 'IL', '60631', '7735947871', NULL, '7435 W Talcott Ave', 'Chicago', 'Cook', 'IL', '60631', '7735947871', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', NULL, '', NULL, 'HCFA|UB|', '1528069465', 0, 'N', 0, '2013-03-05', NULL, NULL, 41.9884, -87.8124, NULL, NULL),
('364286236', 'EDMPMG072', 'EDMPMG072', 'ILCHIGSTD', 'Resurrection Immediate Care Ctr', 'Anne', '', 'Burke', 'MD', 'Urgent Care', '', '', NULL, 'O', '205 S Northwest Hwy', 'Park Ridge', 'Cook', 'IL', '60068', '8472925200', NULL, '205 S Northwest Hwy', 'Park Ridge', 'Cook', 'IL', '60068', '8472925200', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1528099157', 0, 'Y', 0, '2013-03-05', NULL, NULL, 42.0091, -87.8262, NULL, NULL),
('364286236', 'EDMPMG392', 'EDMPMG392', 'ILCHIGSTD', 'Resurrection Immediate Care Ctr', 'Anne', '', 'Burke', 'MD', 'Urgent Care', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '8472925200', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '8472925200', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1528099157', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('364314354', 'EDMPMG245', 'EDMPMG245', 'ILCHIGSTD', 'PMG Elgin ED', 'Brigham', NULL, 'Temple', 'MD', 'Emergency Medicine', '', '', NULL, 'B', '25872 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '8476953200', NULL, '25872 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '8476953200', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1528134038', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('364314354', 'EDMPMG244', 'EDMPMG244', 'ILCHIGSTD', 'PMG Elgin ED', 'Brigham', NULL, 'Temple', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '77 W Airlite', 'Elgin', 'Kane', 'IL', '60123', '8476953200', NULL, '77 W Airlite', 'Elgin', 'Kane', 'IL', '60123', '8476953200', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1528134038', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG569', 'EDMPMG569', 'ILCHIGSTD', '', 'Julius', NULL, 'Kaplan', 'MD', 'Family Practice', '', '', NULL, 'O', '3546 N Nora Ave', 'Chicago', 'Cook', 'IL', '60634', '7734679977', NULL, '3546 N Nora Ave', 'Chicago', 'Cook', 'IL', '60634', '7734679977', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1538105440', 0, 'N', 0, '2013-03-05', NULL, NULL, 41.9444, -87.802, NULL, NULL),
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('363330928', 'EDMPMG470', 'EDMPMG470', 'ILCHIGSTD', 'RMG Lakeview Family Medicine', 'Bernard', '', 'Salvador', 'MD', 'Family Practice', '', '', NULL, 'O', 'Lakeview Plaza 3002 N Ashland Ave', 'Chicago', 'Cook', 'IL', '60657', '7732440441', NULL, 'Lakeview Plaza 3002 N Ashland Ave', 'Chicago', 'Cook', 'IL', '60657', '7732440441', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1548426174', 0, 'N', 0, '2013-09-03', NULL, NULL, 41.9366, -87.6686, NULL, NULL),
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('363330928', 'EDMPMG400', 'EDMPMG400', 'ILCHIGSTD', 'Resurrection Medical Ctr', 'Jeffrey', NULL, 'Gordon', 'MD', 'Emergency Medicine', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7735947871', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7735947871', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1558308676', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
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('870299862', 'W40006977', 'W40006977', 'UTMH1', 'LDS Family Services', 'Paul', 'J', 'Peterson', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'o', '930 W Hillfield Rd Ste A', 'Layton', 'Davis', 'UT', '84041', '8013363040', '8013363041', '930 W Hillfield Rd Ste A', 'Layton', 'Davis', 'UT', '84041', '8013363040', '8013363041', 'MA', NULL, NULL, '0.00', '40.00', '0.00', 8, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1528114667', 0, 'n', 0, '2013-09-23', NULL, NULL, 41.072, -111.981, NULL, NULL),
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('870476172', 'W40009286', 'W40009286', 'UTMH1', 'Shepherds Staff Christian Counseling Center', 'Vinessa', 'K', 'Trotter', 'PHD', 'Mental Health', '', '', NULL, 'O', '3665 S 8400 W', 'Magna', 'Salt Lake', 'UT', '84044', '8015619987', '8015619987', '3665 S 8400 W', 'Magna', 'Salt Lake', 'UT', '84044', '8015619987', '8015619987', 'PHD', '', '', '0.00', '40.00', '0.00', 6, '2013-02-15', '2013-02-27', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1952553794', 0, 'N', 0, '2013-02-28', NULL, NULL, 0, 0, NULL, NULL),
('364314354', 'EDMPMG115', 'EDMPMG115', 'ILCHIGSTD', 'Provena Service Corporation', 'Wendy', 'J', 'Marshall', 'MD', 'General Surgery', '', '', NULL, 'O', '410 E Lincoln Hwy Ste 251', 'New Lenox', 'Will', 'IL', '60451', '8154625566', '8154852667', '410 E Lincoln Hwy Ste 251', 'New Lenox', 'Will', 'IL', '60451', '8154625566', '8154852667', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, '', '', 'HCFA|UB|', '1578538492', 0, 'N', 0, '2013-04-04', NULL, NULL, 41.5123, -87.957, NULL, NULL),
('870299862', 'W40019535', 'W40019535', 'UTMH1', 'LDS Family Services', 'Mark', 'T', 'Hales', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '930 W Hillfield Rd Ste A', 'Layton', 'Davis', 'UT', '84041', '8013363040', '8013363041', '930 W Hillfield Rd Ste A', 'Layton', 'Davis', 'UT', '84041', '8013363040', '8013363041', 'MA', NULL, NULL, '0.00', '40.00', '0.00', 8, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1588716039', 0, 'N', 0, '2013-02-27', NULL, NULL, 41.072, -111.981, NULL, NULL),
('364314354', 'EDMPMG290', 'EDMPMG290', 'ILCHIGSTD', 'PMG New Lenox General Practice', 'Latha', '', 'Arla', 'MD', 'Internal Medicine', '', '', NULL, 'O', '410 E Lincoln Hwy', 'New Lenox', 'Will', 'IL', '60451', '8154852541', NULL, '410 E Lincoln Hwy', 'New Lenox', 'Will', 'IL', '60451', '8154852541', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-10-01', 0, 0, 0, 'Presence Saint Joseph Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1578548921', 0, 'N', 0, '2013-10-31', NULL, NULL, 41.5117, -87.9565, NULL, NULL),
('363330928', 'EDMPMG112', 'EDMPMG112', 'ILCHIGSTD', 'Resurrection Medical Ctr', 'Moses', NULL, 'Lee', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '195 N Harbor Dr Ste 2209', 'Chicago', 'Cook', 'IL', '60601', '3125404764', NULL, '195 N Harbor Dr Ste 2209', 'Chicago', 'Cook', 'IL', '60601', '3125404764', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, NULL, NULL, 'HCFA|UB|', '1578662185', 0, 'Y', 0, '2013-03-05', NULL, NULL, 41.8857, -87.6158, NULL, NULL),
('363330928', 'EDMPMG403', 'EDMPMG403', 'ILCHIGSTD', 'Resurrection Medical Ctr', 'Moses', NULL, 'Lee', 'MD', 'Emergency Medicine', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '3125404764', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '3125404764', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, NULL, NULL, 'HCFA|UB|', '1578662185', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG020', 'EDMPMG020', 'ILCHIGSTD', 'Resurrection Express Care Clinic', 'Jozef', NULL, 'Wilk', 'MD', 'Urgent Care', '', '', NULL, 'O', '2233 W Division St', 'Chicago', 'Cook', 'IL', '60622', '3127702418', NULL, '2233 W Division St', 'Chicago', 'Cook', 'IL', '60622', '3127702418', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1578679965', 0, 'Y', 0, '2013-03-05', NULL, NULL, 41.9031, -87.6829, NULL, NULL),
('363330928', 'EDMPMG386', 'EDMPMG386', 'ILCHIGSTD', 'Resurrection Express Care Clinic', 'Jozef', NULL, 'Wilk', 'MD', 'Urgent Care', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '3127702418', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '3127702418', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1578679965', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('364314354', 'EDMPMG279', 'EDMPMG279', 'ILCHIGSTD', 'PMG Kankakee Obstetrics', 'Leanne', '', 'Bishop', 'APN', 'Obstetrics and Gynecology', 'Nurse Practitioner', '', NULL, 'B', '25872 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '8159372400', NULL, '25872 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '8159372400', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1578811147', 0, 'Y', 0, '2013-04-17', NULL, NULL, 0, 0, NULL, NULL),
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('364314354', 'EDMPMG223', 'EDMPMG223', 'ILCHIGSTD', 'PMG Elgin ED', 'George', NULL, 'Borelli', 'MD', 'Emergency Medicine', '', '', NULL, 'B', '25872 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '8476953200', NULL, '25872 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '8476953200', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Elgin', NULL, NULL, NULL, 'HCFA|UB|', '1588663090', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('364314354', 'EDMPMG222', 'EDMPMG222', 'ILCHIGSTD', 'PMG Elgin ED', 'George', NULL, 'Borelli', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '77 W Airlite', 'Elgin', 'Kane', 'IL', '60123', '8476953200', NULL, '77 W Airlite', 'Elgin', 'Kane', 'IL', '60123', '8476953200', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Elgin', NULL, NULL, NULL, 'HCFA|UB|', '1588663090', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('263932640', 'W40022582', 'W40022582', 'UT01', NULL, 'Kristine', '', 'Plummer', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '535 E 500 S Ste 7', 'Bountiful', 'Davis', 'UT', '84010', '8013366363', NULL, '535 E 500 S Ste 7', 'Bountiful', 'Davis', 'UT', '84010', '8013366363', '', 'MA', NULL, '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1598821951', 0, 'n', 0, '2014-05-15', NULL, NULL, 40.8843, -111.869, NULL, NULL),
('870299862', 'W40015828', 'W40015828', 'UTMH1', 'LDS Family Services', 'Christopher', 'J', 'Bouwhuis', 'LMFT', 'Mental Health', 'Marriage and Family Therapy', '', NULL, 'B', '125 N State St', 'Salt Lake City', 'Salt Lake', 'UT', '84150', '8013363040', '8013363041', '125 N State St', 'Salt Lake City', 'Salt Lake', 'UT', '84150', '8013363040', '8013363041', 'MA', '', '', '0.00', '40.00', '0.00', 8, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1619053949', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG363', 'EDMPMG363', 'ILCHIGSTD', 'Presence Emergency Medicine', 'Connie', NULL, 'Swickhamer', 'DO', 'Emergency Medicine', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7735947871', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7735947871', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1588838676', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG051', 'EDMPMG051', 'ILCHIGSTD', 'Presence Emergency Medicine', 'Connie', NULL, 'Swickhamer', 'DO', 'Emergency Medicine', '', '', NULL, 'O', '7435 W Talcott Ave', 'Chicago', 'Cook', 'IL', '60631', '7735947871', NULL, '7435 W Talcott Ave', 'Chicago', 'Cook', 'IL', '60631', '7735947871', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1588838676', 0, 'Y', 0, '2013-03-05', NULL, NULL, 41.9884, -87.8124, NULL, NULL),
('363330928', 'EDMPMG360', 'EDMPMG360', 'ILCHIGSTD', 'Presence Emergency Medicine', 'Christen', NULL, 'Steinkuller', 'PA-C', 'Physician Assistant', '', '', NULL, 'O', '2718 W Berwyn Ave', 'Chicago', 'Cook', 'IL', '60625', '7732827000', NULL, '2718 W Berwyn Ave', 'Chicago', 'Cook', 'IL', '60625', '7732827000', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1598081812', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG361', 'EDMPMG361', 'ILCHIGSTD', 'Presence Emergency Medicine', 'Christen', NULL, 'Steinkuller', 'PA-C', 'Physician Assistant', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7732827000', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7732827000', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1598081812', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG444', 'EDMPMG444', 'ILCHIGSTD', 'RMG ENT', 'Matthew', NULL, 'Pogodzinski', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '5308 W Belmont Ave', 'Chicago', 'Cook', 'IL', '60641', '7734278114', NULL, '5308 W Belmont Ave', 'Chicago', 'Cook', 'IL', '60641', '7734278114', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Francis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1598755449', 0, 'N', 0, '2013-03-05', NULL, NULL, 41.9387, -87.7593, NULL, NULL),
('363330928', 'EDMPMG445', 'EDMPMG445', 'ILCHIGSTD', 'RMG ENT', 'Matthew', NULL, 'Pogodzinski', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7734278114', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7734278114', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Francis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1598755449', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('364314354', 'EDMPMG269', 'EDMPMG269', 'ILCHIGSTD', 'PMG Joliet Behavioral Health', 'Larisa', '', 'Kononova', 'MD', 'Psychiatry', '', '', NULL, 'B', '25872 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '8157257133', NULL, '25872 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '8157257133', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1598803033', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('364314354', 'EDMPMG268', 'EDMPMG268', 'ILCHIGSTD', 'PMG Joliet Behavioral Health', 'Larisa', '', 'Kononova', 'MD', 'Psychiatry', '', '', NULL, 'O', '333 N Madison', 'Joliet', 'Will', 'IL', '60435', '8157257133', NULL, '333 N Madison', 'Joliet', 'Will', 'IL', '60435', '8157257133', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1598803033', 0, 'Y', 0, '2013-03-05', NULL, NULL, 41.528, -88.1346, NULL, NULL),
('364314354', 'EDMPMG116', 'EDMPMG116', 'ILCHIGSTD', 'PMG New Lenox General Practice', 'Sylvia', '', 'Garcia Beach', 'MD', 'Family Practice', '', '', NULL, 'O', '410 E Lincoln Hwy Ste 251', 'New Lenox', 'Will', 'IL', '60451', '8154625566', '6309142499', '410 E Lincoln Hwy Ste 251', 'New Lenox', 'Will', 'IL', '60451', '8154625566', '6309142499', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1598876583', 0, 'N', 0, '2013-08-01', NULL, NULL, 41.5123, -87.957, NULL, NULL),
('363330928', 'EDMPMG315', 'EDMPMG315', 'ILCHIGSTD', 'PMG St Marys Hospitalist', 'Anuli', NULL, 'Ezimako', 'MD', 'Hospitalist', '', '', NULL, 'B', '25872 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '7736615800', NULL, '25872 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '7736615800', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1598949893', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG314', 'EDMPMG314', 'ILCHIGSTD', 'PMG St Marys Hospitalist', 'Anuli', NULL, 'Ezimako', 'MD', 'Hospitalist', '', '', NULL, 'O', '500 W Court St', 'Kankakee', 'Kankakee', 'IL', '60901', '7736615800', NULL, '500 W Court St', 'Kankakee', 'Kankakee', 'IL', '60901', '7736615800', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1598949893', 0, 'Y', 0, '2013-03-05', NULL, NULL, 41.1211, -87.8718, NULL, NULL),
('363330928', 'EDMPMG175', 'EDMPMG175', 'ILCHIGSTD', 'Presence Emergency Medicine', 'Stacy', NULL, 'Lambin', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '5308 W Belmont Ave', 'Chicago', 'Cook', 'IL', '60641', '7734278114', NULL, '5308 W Belmont Ave', 'Chicago', 'Cook', 'IL', '60641', '7734278114', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1598972127', 0, 'Y', 0, '2013-03-05', NULL, NULL, 41.9387, -87.7593, NULL, NULL),
('363330928', 'EDMPMG353', 'EDMPMG353', 'ILCHIGSTD', 'Presence Emergency Medicine', 'Stacy', NULL, 'Lambin', 'MD', 'Emergency Medicine', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7734278114', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7734278114', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1598972127', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG031', 'EDMPMG031', 'ILCHIGSTD', 'Our Lady of the Resurrection Medical Ctr', 'Lismaida', NULL, 'Jusino Maranto', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '5645 W Addison St', 'Chicago', 'Cook', 'IL', '60634', '7737947601', NULL, '5645 W Addison St', 'Chicago', 'Cook', 'IL', '60634', '7737947601', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1609898956', 0, 'Y', 0, '2013-03-05', NULL, NULL, 41.9459, -87.7678, NULL, NULL),
('363330928', 'EDMPMG193', 'EDMPMG193', 'ILCHIGSTD', 'Our Lady of the Resurrection Medical Ctr', 'Linda', '', 'Herman', 'MD', 'Emergency Medicine', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7735947871', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7735947871', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1619957776', 0, 'Y', 0, '2013-07-02', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG029', 'EDMPMG029', 'ILCHIGSTD', 'Our Lady of the Resurrection Medical Ctr', 'Linda', '', 'Herman', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '7435 W Talcott Ave', 'Chicago', 'Cook', 'IL', '60631', '7737925255', NULL, '7435 W Talcott Ave', 'Chicago', 'Cook', 'IL', '60631', '7737925255', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1619957776', 0, 'Y', 0, '2013-07-02', NULL, NULL, 41.9884, -87.8124, NULL, NULL),
('274184401', 'W40008041', 'W40008041', 'UTMH1', '', 'Mark', 'T', 'Hales', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '1828 S 2265 W', 'Syracuse', 'Davis', 'UT', '84075', '8013892112', NULL, '1828 S 2265 W', 'Syracuse', 'Davis', 'UT', '84075', '8013892112', '          ', 'MA', '', '', '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1588716039', 0, 'N', 0, '2013-02-27', NULL, NULL, 41.0871, -112.07, NULL, NULL),
('363330928', 'EDMPMG530', 'EDMPMG530', 'ILCHIGSTD', 'RMG Prk Ridge Internal Medicine South', 'Michael', NULL, 'Greising', 'MD', 'Internal Medicine', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '8002732614', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '8002732614', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1629071329', 0, 'Y', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('364314354', 'EDMPMG208', 'EDMPMG208', 'ILCHIGSTD', 'PMG Behavioral Health Joliet', 'Nashwa', '', 'Hasabou', 'MD', 'Psychiatry', '', '', NULL, 'B', '25872 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '8157257133', NULL, '25872 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '8157257133', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1639139058', 0, 'Y', 0, '2013-03-27', NULL, NULL, 0, 0, NULL, NULL),
('364314354', 'EDMPMG207', 'EDMPMG207', 'ILCHIGSTD', 'PMG Behavioral Health Joliet', 'Nashwa', '', 'Hasabou', 'MD', 'Psychiatry', '', '', NULL, 'O', '333 N Madison St', 'Joliet', 'Will', 'IL', '60435', '8157257133', NULL, '333 N Madison St', 'Joliet', 'Will', 'IL', '60435', '8157257133', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1639139058', 0, 'Y', 0, '2013-03-27', NULL, NULL, 41.528, -88.1346, NULL, NULL),
('363330928', 'EDMPMG326', 'EDMPMG326', 'ILCHIGSTD', 'PMG Hospitalist', 'Ashley', NULL, 'Wang', 'MD', 'Hospitalist', '', '', NULL, 'O', '355 Ridge Ave', 'Evanston', 'Cook', 'IL', '60202', '8473164000', NULL, '355 Ridge Ave', 'Evanston', 'Cook', 'IL', '60202', '8473164000', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Francis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1639391618', 0, 'Y', 0, '2013-03-05', NULL, NULL, 42.024, -87.6852, NULL, NULL),
('363330928', 'EDMPMG327', 'EDMPMG327', 'ILCHIGSTD', 'PMG Hospitalist', 'Ashley', NULL, 'Wang', 'MD', 'Hospitalist', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '8473164000', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '8473164000', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Francis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1639391618', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG375', 'EDMPMG375', 'ILCHIGSTD', 'Presence Hospitalist Group', 'Matthew', NULL, 'Troup', 'PA-C', 'Hospitalist', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '9896157596', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '9896157596', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1639404882', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG168', 'EDMPMG168', 'ILCHIGSTD', 'Presence Hospitalist Group', 'Matthew', NULL, 'Troup', 'PA-C', 'Hospitalist', '', '', NULL, 'O', '8 E Randolph St Unit 2007', 'Chicago', 'Cook', 'IL', '60601', '9896157596', NULL, '8 E Randolph St Unit 2007', 'Chicago', 'Cook', 'IL', '60601', '9896157596', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1639404882', 0, 'Y', 0, '2013-03-05', NULL, NULL, 41.8845, -87.6276, NULL, NULL),
('363330928', 'EDMPMG334', 'EDMPMG334', 'ILCHIGSTD', 'PMG St Marys Hospitalist', 'Rushdi', NULL, 'Alul', 'DO', 'Hospitalist', '', '', NULL, 'B', '25872 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '8159372400', NULL, '25872 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '8159372400', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1649365529', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG333', 'EDMPMG333', 'ILCHIGSTD', 'PMG St Marys Hospitalist', 'Rushdi', NULL, 'Alul', 'DO', 'Hospitalist', '', '', NULL, 'O', '500 W Court St', 'Kankakee', 'Kankakee', 'IL', '60901', '8159372400', NULL, '500 W Court St', 'Kankakee', 'Kankakee', 'IL', '60901', '8159372400', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1649365529', 0, 'Y', 0, '2013-03-05', NULL, NULL, 41.1211, -87.8718, NULL, NULL),
('364314354', 'EDMPMG284', 'EDMPMG284', 'ILCHIGSTD', 'PMG Lockport General Practice', 'Joseph', NULL, 'Karcavich', 'MD', 'Hospitalist', '', '', NULL, 'B', '25872 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '8158368656', NULL, '25872 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '8158368656', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1659377844', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('364314354', 'EDMPMG164', 'EDMPMG164', 'ILCHIGSTD', 'PMG Lockport General Practice', 'Joseph', NULL, 'Karcavich', 'MD', 'Hospitalist', '', '', NULL, 'O', '300 Read St Ste B', 'Lockport', 'Will', 'IL', '60441', '8158368656', NULL, '300 Read St Ste B', 'Lockport', 'Will', 'IL', '60441', '8158368656', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1659377844', 0, 'Y', 0, '2013-03-05', NULL, NULL, 41.5947, -88.0373, NULL, NULL),
('363330928', 'EDMPMG248', 'EDMPMG248', 'ILCHIGSTD', 'PMG Emergency Medicine', 'James', NULL, 'Chadd', 'MD', 'Emergency Medicine', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '3124205358', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '3124205358', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, NULL, NULL, 'HCFA|UB|', '1659393049', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG111', 'EDMPMG111', 'ILCHIGSTD', 'PMG Emergency Medicine', 'James', NULL, 'Chadd', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '701 S Wells Ste 2201', 'Chicago', 'Cook', 'IL', '60607', '3124205358', NULL, '701 S Wells Ste 2201', 'Chicago', 'Cook', 'IL', '60607', '3124205358', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, NULL, NULL, 'HCFA|UB|', '1659393049', 0, 'Y', 0, '2013-03-05', NULL, NULL, 41.8733, -87.6336, NULL, NULL),
('363330928', 'EDMPMG551', 'EDMPMG551', 'ILCHIGSTD', 'RMG Ukrainian Village Primary Care', 'Adriana', '', 'Velasquez', 'MD', 'Family Practice', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7335225200', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7335225200', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1659519361', 0, 'Y', 0, '2013-06-05', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG550', 'EDMPMG550', 'ILCHIGSTD', 'RMG Ukrainian Village Primary Care', 'Adriana', '', 'Velasquez', 'MD', 'Family Practice', '', '', NULL, 'O', '809 N Western Ave', 'Chicago', 'Cook', 'IL', '60622', '7335225200', NULL, '809 N Western Ave', 'Chicago', 'Cook', 'IL', '60622', '7335225200', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1659519361', 0, 'N', 0, '2013-06-05', NULL, NULL, 41.8961, -87.6868, NULL, NULL),
('363330928', 'EDMPMG369', 'EDMPMG369', 'ILCHIGSTD', 'Presence Hospitalist Group', 'Sana', NULL, 'Hasan', 'MD', 'Hospitalist', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7736615800', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7736615800', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1659652253', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG368', 'EDMPMG368', 'ILCHIGSTD', 'Presence Hospitalist Group', 'Sana', NULL, 'Hasan', 'MD', 'Hospitalist', '', '', NULL, 'O', '7311 W Montrose Ave', 'Norridge', 'Cook', 'IL', '60706', '7736615800', NULL, '7311 W Montrose Ave', 'Norridge', 'Cook', 'IL', '60706', '7736615800', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1659652253', 0, 'Y', 0, '2013-03-05', NULL, NULL, 41.96, -87.8099, NULL, NULL),
('363330928', 'EDMPMG509', 'EDMPMG509', 'ILCHIGSTD', 'RMG North Shore Physicians Group', 'Bruce', NULL, 'Massel', 'MD', 'Internal Medicine', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '8475687400', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '8475687400', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Francis Hospital', NULL, '', NULL, 'HCFA|UB|', '1669419412', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG508', 'EDMPMG508', 'ILCHIGSTD', 'RMG North Shore Physicians Group', 'Bruce', NULL, 'Massel', 'MD', 'Internal Medicine', '', '', NULL, 'O', '7380 N Lincoln Ave', 'Lincolnwood', 'Cook', 'IL', '60712', '8475687400', NULL, '7380 N Lincoln Ave', 'Lincolnwood', 'Cook', 'IL', '60712', '8475687400', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Francis Hospital', NULL, '', NULL, 'HCFA|UB|', '1669419412', 0, 'N', 0, '2013-03-05', NULL, NULL, 42.0146, -87.7432, NULL, NULL),
('363330928', 'EDMPMG010', 'EDMPMG010', 'ILCHIGSTD', 'RMG Hematology Oncology Lincoln Prk', 'Timothy', '', 'Hollister', 'MD', 'Radiation Oncology', '', '', NULL, 'O', '2900 N Lake Shore Dr 7th Fl', 'Chicago', 'Cook', 'IL', '60657', '7736615800', NULL, '2900 N Lake Shore Dr 7th Fl', 'Chicago', 'Cook', 'IL', '60657', '7736615800', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Francis Hospital', NULL, '', '', 'HCFA|UB|', '1669528428', 0, 'N', 0, '2013-07-02', NULL, NULL, 41.9349, -87.6367, NULL, NULL),
('363330928', 'EDMPMG453', 'EDMPMG453', 'ILCHIGSTD', 'RMG Hematology Oncology Lincoln Prk', 'Timothy', '', 'Hollister', 'MD', 'Radiation Oncology', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7736654964', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7736654964', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Francis Hospital', NULL, '', '', 'HCFA|UB|', '1669528428', 0, 'Y', 0, '2013-07-02', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG150', 'EDMPMG150', 'ILCHIGSTD', 'RMG Lincoln Prk Family Medicine', 'Andrew', NULL, 'Pavlatos', 'MD', 'Family Practice', '', '', NULL, 'O', '2800 N Sheridan Rd Ste 606', 'Chicago', 'Cook', 'IL', '60657', '7735258846', NULL, '2800 N Sheridan Rd Ste 606', 'Chicago', 'Cook', 'IL', '60657', '7735258846', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, NULL, NULL, 'HCFA|UB|', '1679576201', 0, 'N', 0, '2013-03-05', NULL, NULL, 41.9329, -87.6393, NULL, NULL),
('363330928', 'EDMPMG472', 'EDMPMG472', 'ILCHIGSTD', 'RMG Lincoln Prk Family Medicine', 'Andrew', NULL, 'Pavlatos', 'MD', 'Family Practice', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7735258846', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7735258846', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, NULL, NULL, 'HCFA|UB|', '1679576201', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('362709982', 'EDMPMG390', 'EDMPMG390', 'ILCHIGSTD', 'Resurrection Behavioral Health', 'Slavomir', '', 'Puszcarski', 'MD', 'Psychiatry', '', '', NULL, 'O', '2233 W Division St', 'Chicago', 'Cook', 'IL', '60622', '3127702000', NULL, '2233 W Division St', 'Chicago', 'Cook', 'IL', '60622', '3127702000', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', NULL, NULL, NULL, 'HCFA|UB|', '1679606560', 0, 'Y', 0, '2013-06-04', NULL, NULL, 41.9031, -87.6829, NULL, NULL),
('362709982', 'EDMPMG391', 'EDMPMG391', 'ILCHIGSTD', 'Resurrection Behavioral Health', 'Slavomir', '', 'Puszcarski', 'MD', 'Psychiatry', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '3127702000', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '3127702000', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', NULL, NULL, NULL, 'HCFA|UB|', '1679606560', 0, 'Y', 0, '2013-06-04', 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
('362709982', 'EDMPMG382', 'EDMPMG382', 'ILCHIGSTD', 'Resurrection Express Care Clinic', 'Valerie', NULL, 'Morse', 'APN-CNP', 'Nurse Practitioner', '', '', NULL, 'O', '2940 N Ashland Ave', 'Chicago', 'Cook', 'IL', '60657', '7735254440', NULL, '2940 N Ashland Ave', 'Chicago', 'Cook', 'IL', '60657', '7735254440', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1679840904', 0, 'Y', 0, '2013-03-05', NULL, NULL, 41.9358, -87.6686, NULL, NULL),
('362709982', 'EDMPMG383', 'EDMPMG383', 'ILCHIGSTD', 'Resurrection Express Care Clinic', 'Valerie', NULL, 'Morse', 'APN-CNP', 'Nurse Practitioner', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7735254440', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7735254440', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1679840904', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG158', 'EDMPMG158', 'ILCHIGSTD', 'Presence Emergency Medicine', 'Lara', NULL, 'Mack', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '1355 N Dearborn St Ste 506', 'Chicago', 'Cook', 'IL', '60610', '7736653086', NULL, '1355 N Dearborn St Ste 506', 'Chicago', 'Cook', 'IL', '60610', '7736653086', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1679854459', 0, 'Y', 0, '2013-03-05', NULL, NULL, 41.9069, -87.6301, NULL, NULL),
('363330928', 'EDMPMG355', 'EDMPMG355', 'ILCHIGSTD', 'Presence Emergency Medicine', 'Lara', NULL, 'Mack', 'MD', 'Emergency Medicine', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7736653086', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7736653086', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1679854459', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG027', 'EDMPMG027', 'ILCHIGSTD', 'Our Lady of the Resurrection Medical Ctr', 'Marina', NULL, 'Del Rios', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '5645 W Addison St', 'Chicago', 'Cook', 'IL', '60634', '7732827000', NULL, '5645 W Addison St', 'Chicago', 'Cook', 'IL', '60634', '7732827000', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1689615585', 0, 'Y', 0, '2013-03-05', NULL, NULL, 41.9459, -87.7678, NULL, NULL),
('363330928', 'EDMPMG190', 'EDMPMG190', 'ILCHIGSTD', 'Our Lady of the Resurrection Medical Ctr', 'Marina', NULL, 'Del Rios', 'MD', 'Emergency Medicine', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7732827000', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7732827000', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1689615585', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG119', 'EDMPMG119', 'ILCHIGSTD', 'RMG Marine Dr Medical', 'Karen', '', 'Hawk', 'APN', 'Internal Medicine', '', '', NULL, 'O', '2800 N Sheridan Rd Ste 300', 'Chicago', 'Cook', 'IL', '60657', '7732488652', NULL, '2800 N Sheridan Rd Ste 300', 'Chicago', 'Cook', 'IL', '60657', '7732488652', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, NULL, NULL, 'HCFA|UB|', '1699056630', 0, 'Y', 0, '2013-04-17', NULL, NULL, 41.9329, -87.6393, NULL, NULL),
('363330928', 'EDMPMG478', 'EDMPMG478', 'ILCHIGSTD', 'RMG Marine Dr Medical', 'Karen', '', 'Hawk', 'APN', 'Internal Medicine', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7732488652', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7732488652', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, NULL, NULL, 'HCFA|UB|', '1699056630', 0, 'Y', 0, '2013-04-17', NULL, NULL, 0, 0, NULL, NULL),
('364314354', 'EDMPMG091', 'EDMPMG091', 'ILCHIGSTD', 'PMG Cardiac and Vascular Specialist', 'Asim', '', 'Nisar', 'MD', 'Cardiology', '', '', NULL, 'O', '1435 N Randall Rd Ste 201', 'Elgin', 'Kane', 'IL', '60123', '8479314200', NULL, '1435 N Randall Rd Ste 201', 'Elgin', 'Kane', 'IL', '60123', '8479314200', '', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2014-02-19', 0, 0, 0, 'Presence Saint Joseph Hospital Elgin', '', '', '', 'HCFA|UB|', '1699761973', 0, 'N', 0, '2014-05-20', NULL, NULL, 42.0711, -88.3319, NULL, NULL),
('364314354', 'EDMPMG214', 'EDMPMG214', 'ILCHIGSTD', 'PMG Cardiac and Vascular Specialist', 'Asim', '', 'Nisar', 'MD', 'Cardiology', '', '', NULL, 'B', '25872 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '8479314200', '          ', '25872 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '8479314200', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2014-05-20', 0, 0, 0, 'Presence Saint Joseph Hospital Elgin', '', '', '', 'HCFA|UB|', '1699761973', 0, 'Y', 0, '2014-05-20', NULL, NULL, 0, 0, NULL, NULL),
('364314354', 'EDMPMG261', 'EDMPMG261', 'ILCHIGSTD', 'PMG Internal Medicine Bourbonnais and Clifton', 'Venkata', NULL, 'Moparthi', 'MD', 'Internal Medicine', '', '', NULL, 'B', '25872 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '8159365167', NULL, '25872 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '8159365167', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1699797548', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('364314354', 'EDMPMG159', 'EDMPMG159', 'ILCHIGSTD', 'PMG Internal Medicine Bourbonnais and Clifton', 'Venkata', NULL, 'Moparthi', 'MD', 'Internal Medicine', '', '', NULL, 'O', '656 N Convent Ste B', 'Bourbonnais', 'Kankakee', 'IL', '60914', '8159365167', NULL, '656 N Convent Ste B', 'Bourbonnais', 'Kankakee', 'IL', '60914', '8159365167', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1699797548', 0, 'Y', 0, '2013-03-05', NULL, NULL, 41.1652, -87.8753, NULL, NULL),
('363330928', 'EDMPMG125', 'EDMPMG125', 'ILCHIGSTD', 'RMG Lincoln Prk Internal Medicine', 'Harold', '', 'Eulien', 'MD', 'Internal Medicine', '', '', NULL, 'O', '2800 N Sheridan Rd Ste 309', 'Chicago', 'Cook', 'IL', '60657', '7732486913', NULL, '2800 N Sheridan Rd Ste 309', 'Chicago', 'Cook', 'IL', '60657', '7732486913', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Our Lady Of The Resurrection Medical Center', 'Presence Resurrection Medical Center', NULL, NULL, 'HCFA|UB|', '1700877222', 0, 'N', 0, '2013-08-09', NULL, NULL, 41.9329, -87.6393, NULL, NULL),
('363330928', 'EDMPMG473', 'EDMPMG473', 'ILCHIGSTD', 'RMG Lincoln Prk Internal Medicine', 'Harold', '', 'Eulien', 'MD', 'Internal Medicine', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7738714183', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7738714183', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Our Lady Of The Resurrection Medical Center', 'Presence Resurrection Medical Center', NULL, NULL, 'HCFA|UB|', '1700877222', 0, 'Y', 0, '2013-08-09', NULL, NULL, 0, 0, NULL, NULL),
('364314354', 'EDMPMG285', 'EDMPMG285', 'ILCHIGSTD', 'PMG Lockport Pediatrics', 'Lee', 'V', 'Patterson', 'MD', 'Pediatrics', '', '', NULL, 'O', '703 E 9th St', 'Lockport', 'Will', 'IL', '60441', '8154630351', NULL, '703 E 9th St', 'Lockport', 'Will', 'IL', '60441', '8154630351', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1700905981', 0, 'N', 0, '2013-04-04', NULL, NULL, 41.5875, -88.0483, NULL, NULL),
('364314354', 'EDMPMG254', 'EDMPMG254', 'ILCHIGSTD', 'PMG Family Medicine Manteno', 'Rhodora', '', 'Rebadio', 'MD', 'Family Practice', '', '', NULL, 'B', '25872 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '8154686737', NULL, '25872 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '8154686737', '', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1710085535', 0, 'Y', 0, '2014-04-21', NULL, NULL, 0, 0, NULL, NULL),
('364314354', 'EDMPMG253', 'EDMPMG253', 'ILCHIGSTD', 'PMG Family Medicine Manteno', 'Rhodora', '', 'Rebadio', 'MD', 'Family Practice', '', '', NULL, 'O', '501 S Locust', 'Manteno', 'Kankakee', 'IL', '60950', '8154686737', NULL, '501 S Locust', 'Manteno', 'Kankakee', 'IL', '60950', '8154686737', '', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1710085535', 0, 'Y', 0, '2014-04-21', NULL, NULL, 41.2417, -87.8365, NULL, NULL),
('364314354', 'EDMPMG079', 'EDMPMG079', 'ILCHIGSTD', 'PMG Crest Hill', 'Mouhannad', NULL, 'Kantar', 'MD', 'Family Practice', '', '', NULL, 'O', '16151 Weber Rd Ste 101', 'Crest Hill', 'Will', 'IL', '60403', '8157737827', NULL, '16151 Weber Rd Ste 101', 'Crest Hill', 'Will', 'IL', '60403', '8157737827', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Elgin', NULL, NULL, NULL, 'HCFA|UB|', '1710127576', 0, 'N', 0, '2013-03-05', NULL, NULL, 41.5905, -88.1225, NULL, NULL),
('364314354', 'EDMPMG218', 'EDMPMG218', 'ILCHIGSTD', 'PMG Crest Hill', 'Mouhannad', NULL, 'Kantar', 'MD', 'Family Practice', '', '', NULL, 'B', '25872 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '8157737827', NULL, '25872 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '8157737827', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Elgin', NULL, NULL, NULL, 'HCFA|UB|', '1710127576', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG499', 'EDMPMG499', 'ILCHIGSTD', 'RMG North Shore Physicians Group', 'Jonathan', NULL, 'Maks', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1625 Sheridan Rd Ste F', 'Wilmette', 'Cook', 'IL', '60091', '8472511500', NULL, '1625 Sheridan Rd Ste F', 'Wilmette', 'Cook', 'IL', '60091', '8472511500', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Francis Hospital', NULL, '', NULL, 'HCFA|UB|', '1720033160', 0, 'N', 0, '2013-03-05', NULL, NULL, 42.0878, -87.7012, NULL, NULL),
('363330928', 'EDMPMG500', 'EDMPMG500', 'ILCHIGSTD', 'RMG North Shore Physicians Group', 'Jonathan', NULL, 'Maks', 'MD', 'Internal Medicine', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '8472511500', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '8472511500', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Francis Hospital', NULL, '', NULL, 'HCFA|UB|', '1720033160', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('364314354', 'EDMPMG257', 'EDMPMG257', 'ILCHIGSTD', 'PMG Family Practice Kankakee', 'Rajasekhar', NULL, 'Kolla', 'MD', 'Family Practice', '', '', NULL, 'B', '25872 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '8159378744', NULL, '25872 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '8159378744', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1720160179', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('364314354', 'EDMPMG083', 'EDMPMG083', 'ILCHIGSTD', 'PMG Family Practice Kankakee', 'Rajasekhar', NULL, 'Kolla', 'MD', 'Family Practice', '', '', NULL, 'O', '455 W Court St Ste 102', 'Kankakee', 'Kankakee', 'IL', '60901', '8159378744', NULL, '455 W Court St Ste 102', 'Kankakee', 'Kankakee', 'IL', '60901', '8159378744', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1720160179', 0, 'Y', 0, '2013-03-05', NULL, NULL, 41.1211, -87.871, NULL, NULL),
('363330928', 'EDMPMG440', 'EDMPMG440', 'ILCHIGSTD', 'RMG Emergency Medicine', 'Netanel', NULL, 'Herscovitch', 'MD', 'Emergency Medicine', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7736615800', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7736615800', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1720194293', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG439', 'EDMPMG439', 'ILCHIGSTD', 'RMG Emergency Medicine', 'Netanel', NULL, 'Herscovitch', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '6477 Sauganash Ave', 'Lincolnwood', 'Cook', 'IL', '60712', '7736615800', '          ', '6477 Sauganash Ave', 'Lincolnwood', 'Cook', 'IL', '60712', '7736615800', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1720194293', 0, 'Y', 0, '2014-06-13', NULL, NULL, 41.9988, -87.7515, NULL, NULL),
('363330928', 'EDMPMG004', 'EDMPMG004', 'ILCHIGSTD', 'Our Lady of the Resurrection Medical Ctr', 'Nataniel', NULL, 'Vasquez', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '3719 N Damen Ave 1st Fl', 'Chicago', 'Cook', 'IL', '60618', '7736973959', NULL, '3719 N Damen Ave 1st Fl', 'Chicago', 'Cook', 'IL', '60618', '7736973959', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1720379068', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG202', 'EDMPMG202', 'ILCHIGSTD', 'Our Lady of the Resurrection Medical Ctr', 'Nataniel', NULL, 'Vasquez', 'MD', 'Emergency Medicine', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7736973959', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7736973959', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1720379068', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG446', 'EDMPMG446', 'ILCHIGSTD', 'RMG Evanston Family Medicine', 'Tessa', NULL, 'Fischer', 'MD', 'Family Practice', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '8477331495', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '8477331495', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Francis Hospital', NULL, '', NULL, 'HCFA|UB|', '1730247859', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG170', 'EDMPMG170', 'ILCHIGSTD', 'RMG Evanston Family Medicine', 'Tessa', NULL, 'Fischer', 'MD', 'Family Practice', '', '', NULL, 'O', '800 Austin St West Tower Ste 409', 'Evanston', 'Cook', 'IL', '60202', '8477331495', NULL, '800 Austin St West Tower Ste 409', 'Evanston', 'Cook', 'IL', '60202', '8477331495', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Francis Hospital', NULL, '', NULL, 'HCFA|UB|', '1730247859', 0, 'N', 0, '2013-03-05', NULL, NULL, 42.0255, -87.6819, NULL, NULL),
('363330928', 'EDMPMG331', 'EDMPMG331', 'ILCHIGSTD', 'PMG Obstetrics and Gyncology', 'Allan', NULL, 'Adajar', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '2611 Commons Dr', 'Glenview', 'Cook', 'IL', '60026', '7736615800', NULL, '2611 Commons Dr', 'Glenview', 'Cook', 'IL', '60026', '7736615800', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Our Lady Of The Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1730318148', 0, 'N', 0, '2013-03-05', NULL, NULL, 42.0845, -87.8224, NULL, NULL),
('363330928', 'EDMPMG332', 'EDMPMG332', 'ILCHIGSTD', 'PMG Obstetrics and Gyncology', 'Allan', NULL, 'Adajar', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7736615800', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7736615800', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Our Lady Of The Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1730318148', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('364314354', 'EDMPMG097', 'EDMPMG097', 'ILCHIGSTD', 'PMG Womens Health Services', 'Elizabeth', NULL, 'Baron Kuhn', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1315 N Highland Ste 204', 'Aurora', 'Kane', 'IL', '60506', '6308015600', NULL, '1315 N Highland Ste 204', 'Aurora', 'Kane', 'IL', '60506', '6308015600', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1740288737', 0, 'N', 0, '2013-03-05', NULL, NULL, 41.7852, -88.3289, NULL, NULL),
('363330928', 'EDMPMG144', 'EDMPMG144', 'ILCHIGSTD', 'RMG Medical Cardiology', 'Dragic', NULL, 'Obradovic', 'MD', 'Internal Medicine', '', '', NULL, 'O', '2800 N Sheridian Ste 500', 'Chicago', 'Cook', 'IL', '60657', '7733480700', NULL, '2800 N Sheridian Ste 500', 'Chicago', 'Cook', 'IL', '60657', '7733480700', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, NULL, NULL, 'HCFA|UB|', '1740367424', 0, 'N', 0, '2013-03-05', NULL, NULL, 41.9329, -87.6393, NULL, NULL),
('363330928', 'EDMPMG483', 'EDMPMG483', 'ILCHIGSTD', 'RMG Medical Cardiology', 'Dragic', NULL, 'Obradovic', 'MD', 'Internal Medicine', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7733480700', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7733480700', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, NULL, NULL, 'HCFA|UB|', '1740367424', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG053', 'EDMPMG053', 'ILCHIGSTD', 'Resurrection Medical Ctr', 'Jennifer', NULL, 'Chan', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '5645 W Addison St', 'Chicago', 'Cook', 'IL', '60634', '7737947601', NULL, '5645 W Addison St', 'Chicago', 'Cook', 'IL', '60634', '7737947601', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1750372785', 0, 'Y', 0, '2013-03-05', NULL, NULL, 41.9459, -87.7678, NULL, NULL),
('363330928', 'EDMPMG399', 'EDMPMG399', 'ILCHIGSTD', 'Resurrection Medical Ctr', 'Jennifer', NULL, 'Chan', 'MD', 'Emergency Medicine', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7737947601', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7737947601', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1750372785', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG195', 'EDMPMG195', 'ILCHIGSTD', 'Our Lady of the Resurrection Medical Ctr', 'Jonathan', '', 'Matson', 'MD', 'Emergency Medicine', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7735947871', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7735947871', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1750491940', 0, 'Y', 0, '2013-07-02', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG032', 'EDMPMG032', 'ILCHIGSTD', 'Our Lady of the Resurrection Medical Ctr', 'Jonathan', '', 'Matson', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '7435 W Talcott Ave', 'Chicago', 'Cook', 'IL', '60631', '7737925255', NULL, '7435 W Talcott Ave', 'Chicago', 'Cook', 'IL', '60631', '7737925255', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1750491940', 0, 'Y', 0, '2013-07-02', NULL, NULL, 41.9884, -87.8124, NULL, NULL),
('364314354', 'EDMPMG274', 'EDMPMG274', 'ILCHIGSTD', 'PMG Joliet Hospitalist', 'James', NULL, 'Wright', 'MD', 'Internal Medicine', '', '', NULL, 'B', '25872 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '8157257133', '6309142499', '25872 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '8157257133', '6309142499', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1760406045', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('870299862', 'W40020070', 'W40020070', 'UTMH1', 'LDS Family Services', 'Kathryn', 'M', 'Hampton', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '94 E Pages Ln Ste A', 'Centerville', 'Davis', 'UT', '84014', '8012940578', NULL, '94 E Pages Ln Ste A', 'Centerville', 'Davis', 'UT', '84014', '8012940578', '', 'MA', NULL, NULL, '0.00', '40.00', '0.00', 8, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1588721260', 0, 'N', 0, '2013-06-19', NULL, NULL, 40.9066, -111.877, NULL, NULL),
('364314354', 'EDMPMG141', 'EDMPMG141', 'ILCHIGSTD', 'PMG Women First', 'Deborah', NULL, 'Riddell', 'CNMW', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1300 N Highland Ste 5', 'Aurora', 'Kane', 'IL', '60506', '6308977700', NULL, '1300 N Highland Ste 5', 'Aurora', 'Kane', 'IL', '60506', '6308977700', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, '', NULL, 'HCFA|UB|', '1760580708', 0, 'N', 0, '2013-03-05', NULL, NULL, 41.7861, -88.3289, NULL, NULL),
('364314354', 'EDMPMG336', 'EDMPMG336', 'ILCHIGSTD', 'PMG Women First', 'Deborah', NULL, 'Riddell', 'CNMW', 'Obstetrics and Gynecology', '', '', NULL, 'B', '25872 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '6308977700', NULL, '25872 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '6308977700', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, '', NULL, 'HCFA|UB|', '1760580708', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG017', 'EDMPMG017', 'ILCHIGSTD', '', 'Michael', NULL, 'Rock', 'MD', 'Anesthesiology', '', '', NULL, 'O', '5645 W Addison', 'Chicago', 'Cook', 'IL', '60634', '7732827000', NULL, '5645 W Addison', 'Chicago', 'Cook', 'IL', '60634', '7732827000', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1760596886', 0, 'Y', 0, '2014-01-23', NULL, NULL, 41.9459, -87.7678, NULL, NULL),
('363330928', 'EDMPMG423', 'EDMPMG423', 'ILCHIGSTD', '', 'Michael', NULL, 'Rock', 'MD', 'Anesthesiology', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7732827000', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7732827000', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1760596886', 0, 'Y', 0, '2014-01-23', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG121', 'EDMPMG121', 'ILCHIGSTD', 'RMG Morton Grove Internal Medicine', 'Jeffrey', NULL, 'Buckman', 'MD', 'Internal Medicine', '', '', NULL, 'O', '5747 W Dempster St Ste 300', 'Morton Grove', 'Cook', 'IL', '60053', '8473248700', NULL, '5747 W Dempster St Ste 300', 'Morton Grove', 'Cook', 'IL', '60053', '8473248700', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-11-22', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1760597710', 0, 'N', 0, '2013-12-19', NULL, NULL, 42.0409, -87.7706, NULL, NULL),
('363330928', 'EDMPMG485', 'EDMPMG485', 'ILCHIGSTD', 'RMG Morton Grove Internal Medicine', 'Jeffrey', NULL, 'Buckman', 'MD', 'Internal Medicine', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '8473248700', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '8473248700', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-11-22', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1760597710', 0, 'Y', 0, '2013-12-19', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG013', 'EDMPMG013', 'ILCHIGSTD', 'Presence Hospitalist Group', 'Cristina', NULL, 'Borraccini', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '233 E 13th St Ste 510', 'Chicago', 'Cook', 'IL', '60605', '7732827000', NULL, '233 E 13th St Ste 510', 'Chicago', 'Cook', 'IL', '60605', '7732827000', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1760638381', 0, 'Y', 0, '2013-03-05', NULL, NULL, 41.8659, -87.6219, NULL, NULL),
('363330928', 'EDMPMG366', 'EDMPMG366', 'ILCHIGSTD', 'Presence Hospitalist Group', 'Cristina', NULL, 'Borraccini', 'MD', 'Emergency Medicine', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7732827000', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7732827000', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1760638381', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG066', 'EDMPMG066', 'ILCHIGSTD', 'RMG Belmont Cragin Family Medicine', 'Monika', '', 'Olchawa', 'MD', 'Endocrinology', '', '', NULL, 'O', '3204 N Oak Park Ave', 'Chicago', 'Cook', 'IL', '60634', '7737363131', NULL, '3204 N Oak Park Ave', 'Chicago', 'Cook', 'IL', '60634', '7737363131', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1760646665', 0, 'N', 0, '2013-03-05', NULL, NULL, 41.9382, -87.7957, NULL, NULL),
('363330928', 'EDMPMG428', 'EDMPMG428', 'ILCHIGSTD', 'RMG Belmont Cragin Family Medicine', 'Monika', '', 'Olchawa', 'MD', 'Endocrinology', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7737363131', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7737363131', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1760646665', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('364286236', 'EDMPMG398', 'EDMPMG398', 'ILCHIGSTD', 'Resurrection Immediate Care Ctr', 'Shital', '', 'Shah', 'MD', 'Urgent Care', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7084533000', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7084533000', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1770517070', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('364286236', 'EDMPMG084', 'EDMPMG084', 'ILCHIGSTD', 'Resurrection Immediate Care Ctr', 'Shital', '', 'Shah', 'MD', 'Urgent Care', '', '', NULL, 'O', '7230 W North Ave Ste 106B', 'Elmwood Park', 'Cook', 'IL', '60707', '7084533000', NULL, '7230 W North Ave Ste 106B', 'Elmwood Park', 'Cook', 'IL', '60707', '7084533000', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1770517070', 0, 'N', 0, '2013-03-05', NULL, NULL, 41.9089, -87.8062, NULL, NULL),
('363330928', 'EDMPMG429', 'EDMPMG429', 'ILCHIGSTD', 'RMG Belmont Cragin Family Medicine', 'Ronald', NULL, 'Peplow', 'DO', 'Family Practice', '', '', NULL, 'O', '3204 N Oak Park Ave', 'Chicago', 'Cook', 'IL', '60634', '7737363131', NULL, '3204 N Oak Park Ave', 'Chicago', 'Cook', 'IL', '60634', '7737363131', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', NULL, '', NULL, 'HCFA|UB|', '1770545717', 0, 'N', 0, '2013-03-05', NULL, NULL, 41.9382, -87.7957, NULL, NULL),
('363330928', 'EDMPMG430', 'EDMPMG430', 'ILCHIGSTD', 'RMG Belmont Cragin Family Medicine', 'Ronald', NULL, 'Peplow', 'DO', 'Family Practice', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7737363131', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7737363131', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', NULL, '', NULL, 'HCFA|UB|', '1770545717', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG448', 'EDMPMG448', 'ILCHIGSTD', 'RMG Evanston Internal Medicine', 'Derek', '', 'Olson', 'DO', 'Internal Medicine', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7732712050', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7732712050', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Francis Hospital', 'Presence Saint Joseph Hospital Chicago', NULL, NULL, 'HCFA|UB|', '1770553901', 0, 'Y', 0, '2013-05-01', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG025', 'EDMPMG025', 'ILCHIGSTD', 'RMG Evanston Internal Medicine', 'Derek', '', 'Olson', 'DO', 'Internal Medicine', '', '', NULL, 'O', '800 Austin St East Tower Ste 451', 'Evanston', 'Cook', 'IL', '60202', '8473166600', NULL, '800 Austin St East Tower Ste 451', 'Evanston', 'Cook', 'IL', '60202', '8473166600', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Francis Hospital', 'Presence Saint Joseph Hospital Chicago', NULL, NULL, 'HCFA|UB|', '1770553901', 0, 'N', 0, '2013-05-01', NULL, NULL, 42.0255, -87.6819, NULL, NULL),
('364314354', 'EDMPMG089', 'EDMPMG089', 'ILCHIGSTD', 'PMG Cardiac and Vascular Specialist', 'Christopher', NULL, 'Berry', 'MD', 'Cardiology', '', '', NULL, 'O', '1435 N Randall Rd Ste 201', 'Elgin', 'Kane', 'IL', '60123', '8479314200', NULL, '1435 N Randall Rd Ste 201', 'Elgin', 'Kane', 'IL', '60123', '8479314200', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Elgin', NULL, NULL, NULL, 'HCFA|UB|', '1770668527', 0, 'N', 0, '2013-03-05', NULL, NULL, 42.0561, -88.3383, NULL, NULL),
('364314354', 'EDMPMG212', 'EDMPMG212', 'ILCHIGSTD', 'PMG Cardiac and Vascular Specialist', 'Christopher', NULL, 'Berry', 'MD', 'Cardiology', '', '', NULL, 'B', '25872 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '8479314200', NULL, '25872 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '8479314200', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Elgin', NULL, NULL, NULL, 'HCFA|UB|', '1770668527', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG418', 'EDMPMG418', 'ILCHIGSTD', '', 'Peter', NULL, 'Kerstan', 'MD', 'Family Practice', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '8002732614', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '8002732614', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1780687301', 0, 'Y', 0, '2014-01-23', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG096', 'EDMPMG096', 'ILCHIGSTD', 'RMG Dunning Family Medicine', 'Rokeya', NULL, 'Akhtar', 'MD', 'Family Practice', '', '', NULL, 'O', '5600 W Addison St Ste 202', 'Chicago', 'Cook', 'IL', '60634', '7732028444', NULL, '5600 W Addison St Ste 202', 'Chicago', 'Cook', 'IL', '60634', '7732028444', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Our Lady Of The Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1780687368', 0, 'N', 0, '2013-03-05', NULL, NULL, 41.9459, -87.7667, NULL, NULL),
('363330928', 'EDMPMG435', 'EDMPMG435', 'ILCHIGSTD', 'RMG Dunning Family Medicine', 'Rokeya', NULL, 'Akhtar', 'MD', 'Family Practice', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7732028444', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7732028444', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Our Lady Of The Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1780687368', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('364314354', 'EDMPMG100', 'EDMPMG100', 'ILCHIGSTD', 'PMG Via Bella', 'Anandita', '', 'Gephart', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1975 Lin Lor Ln Ste 205', 'Elgin', 'Kane', 'IL', '60123', '8477424111', NULL, '1975 Lin Lor Ln Ste 205', 'Elgin', 'Kane', 'IL', '60123', '8477424111', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1790709343', 0, 'N', 0, '2013-07-02', NULL, NULL, 42.0373, -88.3248, NULL, NULL),
('364314354', 'EDMPMG317', 'EDMPMG317', 'ILCHIGSTD', 'PMG Via Bella', 'Anandita', '', 'Gephart', 'MD', 'Internal Medicine', '', '', NULL, 'B', '25872 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '8479314200', NULL, '25872 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '8479314200', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1790709343', 0, 'Y', 0, '2013-07-02', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG491', 'EDMPMG491', 'ILCHIGSTD', 'RMG North Shore Physicians Group', 'John', '', 'Croghan', 'MD', 'Rheumatology', 'Geriatrics', '', NULL, 'O', '1625 Sheridan Rd Ste F', 'Wilmette', 'Cook', 'IL', '60091', '8472511500', NULL, '1625 Sheridan Rd Ste F', 'Wilmette', 'Cook', 'IL', '60091', '8472511500', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Francis Hospital', '', '', '', 'HCFA|UB|', '1790724060', 0, 'N', 0, '2013-03-25', NULL, NULL, 42.0878, -87.7012, NULL, NULL),
('363330928', 'EDMPMG492', 'EDMPMG492', 'ILCHIGSTD', 'RMG North Shore Physicians Group', 'John', '', 'Croghan', 'MD', 'Rheumatology', 'Geriatrics', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '8472511500', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '8472511500', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Francis Hospital', '', '', '', 'HCFA|UB|', '1790724060', 0, 'Y', 0, '2013-03-25', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG341', 'EDMPMG341', 'ILCHIGSTD', 'Presence Emergency Medicine', 'Shu', NULL, 'Chan', 'MD', 'Emergency Medicine', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7735947871', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7735947871', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1790770014', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG041', 'EDMPMG041', 'ILCHIGSTD', 'Presence Emergency Medicine', 'Shu', NULL, 'Chan', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '7435 W Talcott Ave', 'Chicago', 'Cook', 'IL', '60631', '7735947871', NULL, '7435 W Talcott Ave', 'Chicago', 'Cook', 'IL', '60631', '7735947871', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1790770014', 0, 'Y', 0, '2013-03-05', NULL, NULL, 41.9884, -87.8124, NULL, NULL),
('363330928', 'EDMPMG069', 'EDMPMG069', 'ILCHIGSTD', 'Presence Emergency Medicine', 'Nipa', NULL, 'Patel', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '225 Columbus Dr Ste 4114', 'Chicago', 'Cook', 'IL', '60601', '7736653086', NULL, '225 Columbus Dr Ste 4114', 'Chicago', 'Cook', 'IL', '60601', '7736653086', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1790988343', 0, 'Y', 0, '2013-03-05', NULL, NULL, 41.8864, -87.6206, NULL, NULL),
('363330928', 'EDMPMG357', 'EDMPMG357', 'ILCHIGSTD', 'Presence Emergency Medicine', 'Nipa', NULL, 'Patel', 'MD', 'Emergency Medicine', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7736653086', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7736653086', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1790988343', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('364314354', 'EDMPMG309', 'EDMPMG309', 'ILCHIGSTD', 'PMG PSJMC Hospitalist', 'Heidi', '', 'Whitaker', 'MD', 'Hospitalist', '', '', NULL, 'B', '25872 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '8157257133', NULL, '25872 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '8157257133', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-10-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1801024112', 0, 'Y', 0, '2013-10-31', NULL, NULL, 0, 0, NULL, NULL),
('364314354', 'EDMPMG308', 'EDMPMG308', 'ILCHIGSTD', 'PMG PSJMC Hospitalist', 'Heidi', '', 'Whitaker', 'MD', 'Hospitalist', '', '', NULL, 'O', '333 N Madison St', 'Joliet', 'Will', 'IL', '60435', '8157257133', NULL, '333 N Madison St', 'Joliet', 'Will', 'IL', '60435', '8157257133', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-10-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1801024112', 0, 'Y', 0, '2013-10-31', NULL, NULL, 41.5279, -88.1354, NULL, NULL),
('363330928', 'EDMPMG045', 'EDMPMG045', 'ILCHIGSTD', 'Presence Emergency Medicine', 'Jonathan', NULL, 'Garlovsky', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '5645 W Addison St', 'Chicago', 'Cook', 'IL', '60634', '7737947601', NULL, '5645 W Addison St', 'Chicago', 'Cook', 'IL', '60634', '7737947601', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1801058979', 0, 'Y', 0, '2013-03-05', NULL, NULL, 41.9459, -87.7678, NULL, NULL),
('363330928', 'EDMPMG351', 'EDMPMG351', 'ILCHIGSTD', 'Presence Emergency Medicine', 'Jonathan', NULL, 'Garlovsky', 'MD', 'Emergency Medicine', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7737947601', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7737947601', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1801058979', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG070', 'EDMPMG070', 'ILCHIGSTD', 'Presence Hospitalist Group', 'Patrick', NULL, 'Godwin', 'MD', 'Hospitalist', '', '', NULL, 'O', '5645 W Addison St', 'Chicago', 'Cook', 'IL', '60634', '2245634994', NULL, '5645 W Addison St', 'Chicago', 'Cook', 'IL', '60634', '2245634994', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1801986351', 0, 'Y', 0, '2013-03-05', NULL, NULL, 41.9459, -87.7678, NULL, NULL),
('363330928', 'EDMPMG367', 'EDMPMG367', 'ILCHIGSTD', 'Presence Hospitalist Group', 'Patrick', NULL, 'Godwin', 'MD', 'Hospitalist', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '2245634994', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '2245634994', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1801986351', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG145', 'EDMPMG145', 'ILCHIGSTD', 'RMG Medical Cardiology', 'Predrag', NULL, 'Simovic', 'MD', 'Internal Medicine', '', '', NULL, 'O', '2800 N Sheridian Ste 500', 'Chicago', 'Cook', 'IL', '60657', '7733480700', NULL, '2800 N Sheridian Ste 500', 'Chicago', 'Cook', 'IL', '60657', '7733480700', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, NULL, NULL, 'HCFA|UB|', '1811074503', 0, 'N', 0, '2013-03-05', NULL, NULL, 41.9329, -87.6393, NULL, NULL),
('363330928', 'EDMPMG484', 'EDMPMG484', 'ILCHIGSTD', 'RMG Medical Cardiology', 'Predrag', NULL, 'Simovic', 'MD', 'Internal Medicine', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7733480700', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7733480700', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, NULL, NULL, 'HCFA|UB|', '1811074503', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('364314354', 'EDMPMG093', 'EDMPMG093', 'ILCHIGSTD', 'PMG Cardiac and Vascular Specialist', 'Neda', '', 'Zamani', 'MD', 'Cardiology', '', '', NULL, 'O', '1435 N Randall Rd Ste 201', 'Elgin', 'Kane', 'IL', '60123', '8479314200', NULL, '1435 N Randall Rd Ste 201', 'Elgin', 'Kane', 'IL', '60123', '8479314200', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2014-02-19', 0, 0, 0, 'Presence Saint Joseph Hospital Elgin', NULL, NULL, NULL, 'HCFA|UB|', '1811935844', 0, 'N', 0, '2014-02-13', NULL, NULL, 42.0711, -88.3319, NULL, NULL),
('364314354', 'EDMPMG216', 'EDMPMG216', 'ILCHIGSTD', 'PMG Cardiac and Vascular Specialist', 'Neda', '', 'Zamani', 'MD', 'Cardiology', '', '', NULL, 'B', '25872 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '8479314200', NULL, '25872 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '8479314200', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Elgin', NULL, NULL, NULL, 'HCFA|UB|', '1811935844', 0, 'Y', 0, '2014-02-07', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG117', 'EDMPMG117', 'ILCHIGSTD', 'RMG Norwood Internal Medicine', 'Vesna', NULL, 'Zecevic Sternic', 'MD', 'Internal Medicine', '', '', NULL, 'O', '7447 W Talcott Ave Ste 267', 'Chicago', 'Cook', 'IL', '60631', '7737741818', NULL, '7447 W Talcott Ave Ste 267', 'Chicago', 'Cook', 'IL', '60631', '7737741818', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1811948185', 0, 'N', 0, '2013-03-05', NULL, NULL, 41.9887, -87.8131, NULL, NULL),
('362709982', 'EDMPMG389', 'EDMPMG389', 'ILCHIGSTD', 'Resurrection Behavioral Health', 'James', NULL, 'Patras', 'MD', 'Psychiatry', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7083666130', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7083666130', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1811948722', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('362709982', 'EDMPMG107', 'EDMPMG107', 'ILCHIGSTD', 'Resurrection Behavioral Health', 'James', NULL, 'Patras', 'MD', 'Psychiatry', '', '', NULL, 'O', '7627 W Lake St Ste 212', 'River Forest', 'Cook', 'IL', '60305', '7083666130', NULL, '7627 W Lake St Ste 212', 'River Forest', 'Cook', 'IL', '60305', '7083666130', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1811948722', 0, 'Y', 0, '2013-03-05', NULL, NULL, 41.8884, -87.8151, NULL, NULL),
('364314354', 'EDMPMG241', 'EDMPMG241', 'ILCHIGSTD', 'PMG Elgin ED', 'Darlie', NULL, 'Simerson', 'APN', 'Emergency Medicine', '', '', NULL, 'B', '25872 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '8476953200', NULL, '25872 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '8476953200', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1821043571', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('364314354', 'EDMPMG240', 'EDMPMG240', 'ILCHIGSTD', 'PMG Elgin ED', 'Darlie', NULL, 'Simerson', 'APN', 'Emergency Medicine', '', '', NULL, 'O', '77 W Airlite', 'Elgin', 'Kane', 'IL', '60123', '8476953200', NULL, '77 W Airlite', 'Elgin', 'Kane', 'IL', '60123', '8476953200', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1821043571', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG498', 'EDMPMG498', 'ILCHIGSTD', 'RMG North Shore Physicians Group', 'Alan', NULL, 'Kogan', 'MD', 'Internal Medicine', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '8473166600', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '8473166600', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Francis Hospital', NULL, '', NULL, 'HCFA|UB|', '1821057498', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG171', 'EDMPMG171', 'ILCHIGSTD', 'RMG North Shore Physicians Group', 'Alan', NULL, 'Kogan', 'MD', 'Internal Medicine', '', '', NULL, 'O', '800 Austin St West Tower Ste 501', 'Evanston', 'Cook', 'IL', '60202', '8473166600', NULL, '800 Austin St West Tower Ste 501', 'Evanston', 'Cook', 'IL', '60202', '8473166600', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Francis Hospital', NULL, '', NULL, 'HCFA|UB|', '1821057498', 0, 'N', 0, '2013-03-05', NULL, NULL, 42.0255, -87.6819, NULL, NULL),
('364314354', 'EDMPMG087', 'EDMPMG087', 'ILCHIGSTD', 'PMG Primary Cardiology', 'James', NULL, 'Burks', 'MD', 'Cardiology', '', '', NULL, 'O', '1975 Lin Lor Ln Ste 175', 'Elgin', 'Kane', 'IL', '60123', '8477170600', NULL, '1975 Lin Lor Ln Ste 175', 'Elgin', 'Kane', 'IL', '60123', '8477170600', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1821058819', 0, 'N', 0, '2013-03-05', NULL, NULL, 42.0373, -88.3248, NULL, NULL),
('364314354', 'EDMPMG300', 'EDMPMG300', 'ILCHIGSTD', 'PMG Primary Cardiology', 'James', NULL, 'Burks', 'MD', 'Cardiology', '', '', NULL, 'B', '25872 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '8477170600', NULL, '25872 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '8477170600', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1821058819', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG129', 'EDMPMG129', 'ILCHIGSTD', 'RMG Lincoln Prk Internal Medicine', 'Hemantha', '', 'Surath', 'MD', 'Internal Medicine', '', '', NULL, 'O', '2800 N Sheridan Rd Ste 309', 'Chicago', 'Cook', 'IL', '60657', '7732486913', NULL, '2800 N Sheridan Rd Ste 309', 'Chicago', 'Cook', 'IL', '60657', '7732486913', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Our Lady Of The Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1821166554', 0, 'N', 0, '2013-07-02', NULL, NULL, 41.9329, -87.6393, NULL, NULL),
('363330928', 'EDMPMG477', 'EDMPMG477', 'ILCHIGSTD', 'RMG Lincoln Prk Internal Medicine', 'Hemantha', '', 'Surath', 'MD', 'Internal Medicine', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7738714183', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7738714183', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Our Lady Of The Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1821166554', 0, 'Y', 0, '2013-07-02', 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
('363330928', 'EDMPMG067', 'EDMPMG067', 'ILCHIGSTD', 'RMG Viking Medical Group Inc', 'Krister', 'M', 'Johansson', 'MD', 'Family Practice', '', '', NULL, 'O', '5140 N California Ave  Ste 405', 'Chicago', 'Cook', 'IL', '60625', '7732755558', NULL, '5140 N California Ave  Ste 405', 'Chicago', 'Cook', 'IL', '60625', '7732755558', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', NULL, '', '', 'HCFA|UB|', '1831136027', 0, 'N', 0, '2013-04-03', NULL, NULL, 41.9752, -87.6989, NULL, NULL),
('363330928', 'EDMPMG552', 'EDMPMG552', 'ILCHIGSTD', 'RMG Viking Medical Group Inc', 'Krister', 'M', 'Johansson', 'MD', 'Family Practice', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7732755558', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7732755558', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', NULL, '', '', 'HCFA|UB|', '1831136027', 0, 'Y', 0, '2013-04-03', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG050', 'EDMPMG050', 'ILCHIGSTD', 'Presence Emergency Medicine', 'Criselda', '', 'Sayoc', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '5645 W Addison St', 'Chicago', 'Cook', 'IL', '60634', '7737947601', NULL, '5645 W Addison St', 'Chicago', 'Cook', 'IL', '60634', '7737947601', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1831179944', 0, 'Y', 0, '2013-07-02', NULL, NULL, 41.9459, -87.7678, NULL, NULL),
('363330928', 'EDMPMG359', 'EDMPMG359', 'ILCHIGSTD', 'Presence Emergency Medicine', 'Criselda', '', 'Sayoc', 'MD', 'Emergency Medicine', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '2245634994', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '2245634994', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1831179944', 0, 'Y', 0, '2013-07-02', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG549', 'EDMPMG549', 'ILCHIGSTD', 'RMG Ukrainian Village Primary Care', 'Eduardo', NULL, 'Cabrera', 'MD', 'Family Practice', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7737729121', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7737729121', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', NULL, NULL, NULL, 'HCFA|UB|', '1831337930', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG548', 'EDMPMG548', 'ILCHIGSTD', 'RMG Ukrainian Village Primary Care', 'Eduardo', NULL, 'Cabrera', 'MD', 'Family Practice', '', '', NULL, 'O', '809 N Western Ave', 'Chicago', 'Cook', 'IL', '60622', '7737729121', NULL, '809 N Western Ave', 'Chicago', 'Cook', 'IL', '60622', '7737729121', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', NULL, NULL, NULL, 'HCFA|UB|', '1831337930', 0, 'N', 0, '2013-03-05', NULL, NULL, 41.896, -87.6868, NULL, NULL),
('364314354', 'EDMPMG287', 'EDMPMG287', 'ILCHIGSTD', 'PMG New Lenox Family Practice', 'Adam', '', 'Cohen Lewe', 'MD', 'Family Practice', '', '', NULL, 'O', '410 E Lincoln Hwy', 'New Lenox', 'Will', 'IL', '60451', '8154852541', NULL, '410 E Lincoln Hwy', 'New Lenox', 'Will', 'IL', '60451', '8154852541', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1831362946', 0, 'N', 0, '2013-07-02', NULL, NULL, 41.5123, -87.957, NULL, NULL),
('363330928', 'EDMPMG521', 'EDMPMG521', 'ILCHIGSTD', 'RMG NSPG Winnetka', 'Roman', NULL, 'Mandzij', 'DO', 'Internal Medicine', '', '', NULL, 'O', '525 Winnetka Rd', 'Winnetka', 'Cook', 'IL', '60093', '8475014060', NULL, '525 Winnetka Rd', 'Winnetka', 'Cook', 'IL', '60093', '8475014060', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1841239902', 0, 'N', 0, '2013-03-05', NULL, NULL, 42.0936, -87.7239, NULL, NULL),
('363330928', 'EDMPMG522', 'EDMPMG522', 'ILCHIGSTD', 'RMG NSPG Winnetka', 'Roman', NULL, 'Mandzij', 'DO', 'Internal Medicine', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '8475014060', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '8475014060', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1841239902', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('364314354', 'EDMPMG086', 'EDMPMG086', 'ILCHIGSTD', 'PMG Primary Cardiology', 'David', NULL, 'Bromet', 'MD', 'Cardiology', '', '', NULL, 'O', '1975 Lin Lor Ln Ste 175', 'Elgin', 'Kane', 'IL', '60123', '8477170600', NULL, '1975 Lin Lor Ln Ste 175', 'Elgin', 'Kane', 'IL', '60123', '8477170600', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1841250958', 0, 'N', 0, '2013-03-05', NULL, NULL, 42.0373, -88.3248, NULL, NULL),
('364314354', 'EDMPMG299', 'EDMPMG299', 'ILCHIGSTD', 'PMG Primary Cardiology', 'David', NULL, 'Bromet', 'MD', 'Cardiology', '', '', NULL, 'B', '25872 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '8477170600', NULL, '25872 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '8477170600', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1841250958', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG547', 'EDMPMG547', 'ILCHIGSTD', 'RMG Stony Island Internal Medicine', 'Fred', '', 'Daniels', 'MD', 'Internal Medicine', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7737310670', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7737310670', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2014-03-01', 0, 0, 0, 'Presence Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1841293412', 0, 'Y', 0, '2014-03-24', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG546', 'EDMPMG546', 'ILCHIGSTD', 'RMG Stony Island Internal Medicine', 'Fred', '', 'Daniels', 'MD', 'Internal Medicine', '', '', NULL, 'O', '9000 S Stony Island Ave', 'Chicago', 'Cook', 'IL', '60617', '7737310670', NULL, '9000 S Stony Island Ave', 'Chicago', 'Cook', 'IL', '60617', '7737310670', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2014-03-01', 0, 0, 0, 'Presence Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1841293412', 0, 'N', 0, '2014-03-24', NULL, NULL, 41.7314, -87.5855, NULL, NULL),
('363330928', 'EDMPMG038', 'EDMPMG038', 'ILCHIGSTD', 'PMG Emergency Medicine', 'Adam', NULL, 'Black', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '3839 N Marshfield', 'Chicago', 'Cook', 'IL', '60613', '7737285133', NULL, '3839 N Marshfield', 'Chicago', 'Cook', 'IL', '60613', '7737285133', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', NULL, NULL, NULL, 'HCFA|UB|', '1851313241', 0, 'Y', 0, '2013-03-05', NULL, NULL, 41.9514, -87.6702, NULL, NULL),
('363330928', 'EDMPMG322', 'EDMPMG322', 'ILCHIGSTD', 'PMG Emergency Medicine', 'Adam', NULL, 'Black', 'MD', 'Emergency Medicine', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7737285133', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7737285133', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', NULL, NULL, NULL, 'HCFA|UB|', '1851313241', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG466', 'EDMPMG466', 'ILCHIGSTD', 'RMG Jefferson Prk Internal Medicine', 'Cory', NULL, 'Chen', 'MD', 'Internal Medicine', '', '', NULL, 'O', '4833 N Milwaukee Ave', 'Chicago', 'Cook', 'IL', '60630', '7732052857', NULL, '4833 N Milwaukee Ave', 'Chicago', 'Cook', 'IL', '60630', '7732052857', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1851394548', 0, 'N', 0, '2013-03-05', NULL, NULL, 41.9686, -87.7614, NULL, NULL),
('363330928', 'EDMPMG467', 'EDMPMG467', 'ILCHIGSTD', 'RMG Jefferson Prk Internal Medicine', 'Cory', NULL, 'Chen', 'MD', 'Internal Medicine', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7732052857', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7732052857', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1851394548', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('364314354', 'EDMPMG246', 'EDMPMG246', 'ILCHIGSTD', 'PMG Elgin ED', 'Susie', NULL, 'White', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '77 W Airlite', 'Elgin', 'Kane', 'IL', '60123', '8476953200', NULL, '77 W Airlite', 'Elgin', 'Kane', 'IL', '60123', '8476953200', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1851661862', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG147', 'EDMPMG147', 'ILCHIGSTD', 'RMG OB-GYN', 'M Matthew', NULL, 'Ahranjani', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '5600 W Addison St Ste 504', 'Chicago', 'Cook', 'IL', '60634', '7732825299', NULL, '5600 W Addison St Ste 504', 'Chicago', 'Cook', 'IL', '60634', '7732825299', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Our Lady Of The Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1861425050', 0, 'N', 0, '2013-03-05', NULL, NULL, 41.9459, -87.7667, NULL, NULL),
('363330928', 'EDMPMG528', 'EDMPMG528', 'ILCHIGSTD', 'RMG OB-GYN', 'M Matthew', NULL, 'Ahranjani', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7732825299', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7732825299', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Our Lady Of The Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1861425050', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG469', 'EDMPMG469', 'ILCHIGSTD', 'RMG Lakeview Family Medicine', 'Sara', NULL, 'Braunstein', 'DO', 'Family Practice', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7732440441', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7732440441', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1861551954', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG468', 'EDMPMG468', 'ILCHIGSTD', 'RMG Lakeview Family Medicine', 'Sara', NULL, 'Braunstein', 'DO', 'Family Practice', '', '', NULL, 'O', 'Lakeview Plaza 3002 N Ashland Ave', 'Chicago', 'Cook', 'IL', '60657', '7732440441', NULL, 'Lakeview Plaza 3002 N Ashland Ave', 'Chicago', 'Cook', 'IL', '60657', '7732440441', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1861551954', 0, 'N', 0, '2013-03-05', NULL, NULL, 41.9366, -87.6686, NULL, NULL),
('363330928', 'EDMPMG003', 'EDMPMG003', 'ILCHIGSTD', 'Metro Orthopaedics', 'Randon', '', 'Johnson', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '1431 N Western Ave 1st Fl', 'Chicago', 'Cook', 'IL', '60622', '3126335922', NULL, '1431 N Western Ave 1st Fl', 'Chicago', 'Cook', 'IL', '60622', '3126335922', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1861611816', 0, 'N', 0, '2013-05-01', NULL, NULL, 41.9073, -87.6871, NULL, NULL),
('363330928', 'EDMPMG185', 'EDMPMG185', 'ILCHIGSTD', 'Metro Orthopaedics', 'Randon', '', 'Johnson', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7732351900', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7732351900', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1861611816', 0, 'Y', 0, '2013-05-01', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG101', 'EDMPMG101', 'ILCHIGSTD', 'RMG Humbolt Prk Primary Care', 'Juan', NULL, 'Montoya', 'MD', 'Family Practice', '', '', NULL, 'O', '1431 N Western Ave Ste 205', 'Chicago', 'Cook', 'IL', '60622', '7732784811', NULL, '1431 N Western Ave Ste 205', 'Chicago', 'Cook', 'IL', '60622', '7732784811', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', NULL, NULL, NULL, 'HCFA|UB|', '1861625444', 0, 'N', 0, '2013-03-05', NULL, NULL, 41.9073, -87.6871, NULL, NULL),
('363330928', 'EDMPMG462', 'EDMPMG462', 'ILCHIGSTD', 'RMG Humbolt Prk Primary Care', 'Juan', NULL, 'Montoya', 'MD', 'Family Practice', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7732784811', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7732784811', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', NULL, NULL, NULL, 'HCFA|UB|', '1861625444', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('362709982', 'EDMPMG384', 'EDMPMG384', 'ILCHIGSTD', 'Resurrection Express Care Clinic', 'Joi', '', 'Sawyer', 'APN-CNP', 'Nurse Practitioner', '', '', NULL, 'O', '2940 N Ashland Ave', 'Chicago', 'Cook', 'IL', '60657', '7735254440', NULL, '2940 N Ashland Ave', 'Chicago', 'Cook', 'IL', '60657', '7735254440', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1861644619', 0, 'Y', 0, '2013-07-25', NULL, NULL, 41.9358, -87.6686, NULL, NULL),
('362709982', 'EDMPMG385', 'EDMPMG385', 'ILCHIGSTD', 'Resurrection Express Care Clinic', 'Joi', '', 'Sawyer', 'APN-CNP', 'Nurse Practitioner', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7735254440', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7735254440', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1861644619', 0, 'Y', 0, '2013-07-25', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG490', 'EDMPMG490', 'ILCHIGSTD', 'RMG Mount Prospect Family Medicine', 'Virendra', NULL, 'Patel', 'MD', 'Family Practice', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '8474541001', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '8474541001', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1871516302', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG489', 'EDMPMG489', 'ILCHIGSTD', 'RMG Mount Prospect Family Medicine', 'Virendra', NULL, 'Patel', 'MD', 'Family Practice', '', '', NULL, 'O', '770 ENorthwest Hwy', 'Mount Prospect', 'Cook', 'IL', '60056', '8474541001', NULL, '770 ENorthwest Hwy', 'Mount Prospect', 'Cook', 'IL', '60056', '8474541001', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1871516302', 0, 'N', 0, '2013-03-05', NULL, NULL, 42.059, -87.926, NULL, NULL),
('364314354', 'EDMPMG319', 'EDMPMG319', 'ILCHIGSTD', 'PMG Womens Heart Ctr', 'Agnieszka', '', 'Silbert', 'MD', 'Cardiology', '', '', NULL, 'B', '25872 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '8476541281', NULL, '25872 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '8476541281', '', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Elgin', NULL, '', '', 'HCFA|UB|', '1871543447', 0, 'Y', 0, '2014-04-02', NULL, NULL, 0, 0, NULL, NULL),
('364314354', 'EDMPMG318', 'EDMPMG318', 'ILCHIGSTD', 'PMG Womens Heart Ctr', 'Agnieszka', '', 'Silbert', 'MD', 'Cardiology', '', '', NULL, 'O', '77 N Airlite', 'Elgin', 'Kane', 'IL', '60123', '8476541281', NULL, '77 N Airlite', 'Elgin', 'Kane', 'IL', '60123', '8476541281', '', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Elgin', NULL, '', '', 'HCFA|UB|', '1871543447', 0, 'N', 0, '2014-04-02', NULL, NULL, 42.0362, -88.328, NULL, NULL),
('363330928', 'EDMPMG511', 'EDMPMG511', 'ILCHIGSTD', 'RMG North Shore Physicians Group', 'Julio', NULL, 'Mora', 'MD', 'Internal Medicine', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '8475687400', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '8475687400', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Francis Hospital', NULL, '', NULL, 'HCFA|UB|', '1871547349', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG510', 'EDMPMG510', 'ILCHIGSTD', 'RMG North Shore Physicians Group', 'Julio', NULL, 'Mora', 'MD', 'Internal Medicine', '', '', NULL, 'O', '7380 N Lincoln Ave', 'Lincolnwood', 'Cook', 'IL', '60712', '8475687400', NULL, '7380 N Lincoln Ave', 'Lincolnwood', 'Cook', 'IL', '60712', '8475687400', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Francis Hospital', NULL, '', NULL, 'HCFA|UB|', '1871547349', 0, 'N', 0, '2013-03-05', NULL, NULL, 42.0146, -87.7432, NULL, NULL),
('363330928', 'EDMPMG407', 'EDMPMG407', 'ILCHIGSTD', 'Resurrection Medical Ctr', 'Nicole', NULL, 'Schneiderman', 'MD', 'Emergency Medicine', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7735947871', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7735947871', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1871588111', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG059', 'EDMPMG059', 'ILCHIGSTD', 'Resurrection Medical Ctr', 'Nicole', NULL, 'Schneiderman', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '7435 W Talcott Ave', 'Chicago', 'Cook', 'IL', '60631', '7735947871', NULL, '7435 W Talcott Ave', 'Chicago', 'Cook', 'IL', '60631', '7735947871', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1871588111', 0, 'Y', 0, '2013-03-05', NULL, NULL, 41.9884, -87.8124, NULL, NULL),
('363330928', 'EDMPMG077', 'EDMPMG077', 'ILCHIGSTD', 'PMG Emergency Medicine', 'Christopher', NULL, 'Bannigan', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '450 E Waterside Ste 1004', 'Chicago', 'Cook', 'IL', '60601', '7736653086', NULL, '450 E Waterside Ste 1004', 'Chicago', 'Cook', 'IL', '60601', '7736653086', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', NULL, NULL, NULL, 'HCFA|UB|', '1871616722', 0, 'Y', 0, '2013-03-05', NULL, NULL, 41.8869, -87.6162, NULL, NULL),
('363330928', 'EDMPMG320', 'EDMPMG320', 'ILCHIGSTD', 'PMG Emergency Medicine', 'Christopher', NULL, 'Bannigan', 'MD', 'Emergency Medicine', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7736653086', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7736653086', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', NULL, NULL, NULL, 'HCFA|UB|', '1871616722', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('364286236', 'EDMPMG073', 'EDMPMG073', 'ILCHIGSTD', 'Resurrection Immediate Care Ctr', 'Helena', '', 'Podgorska', 'MD', 'Urgent Care', '', '', NULL, 'O', '4900 N Cumberland Ave', 'Norridge', 'Cook', 'IL', '60706', '7084561600', NULL, '4900 N Cumberland Ave', 'Norridge', 'Cook', 'IL', '60706', '7084561600', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1871674267', 0, 'Y', 0, '2013-03-05', NULL, NULL, 41.9688, -87.8368, NULL, NULL),
('364286236', 'EDMPMG397', 'EDMPMG397', 'ILCHIGSTD', 'Resurrection Immediate Care Ctr', 'Helena', '', 'Podgorska', 'MD', 'Urgent Care', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7084561600', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7084561600', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1871674267', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('364314354', 'EDMPMG280', 'EDMPMG280', 'ILCHIGSTD', 'PMG Kankakee Obstetrics', 'Degaulle', NULL, 'Haile', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '25872 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '8159372141', NULL, '25872 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '8159372141', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1881782506', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('364314354', 'EDMPMG109', 'EDMPMG109', 'ILCHIGSTD', 'PMG Kankakee Obstetrics', 'Degaulle', NULL, 'Haile', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '555 W Court St Ste 214', 'Kankakee', 'Kankakee', 'IL', '60901', '8159372141', NULL, '555 W Court St Ste 214', 'Kankakee', 'Kankakee', 'IL', '60901', '8159372141', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1881782506', 0, 'Y', 0, '2013-03-05', NULL, NULL, 41.1213, -87.8723, NULL, NULL),
('363330928', 'EDMPMG442', 'EDMPMG442', 'ILCHIGSTD', 'RMG ENT', 'Agnes', NULL, 'Hurtuk', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '5308 W Belmont Ave', 'Chicago', 'Cook', 'IL', '60641', '7734278114', NULL, '5308 W Belmont Ave', 'Chicago', 'Cook', 'IL', '60641', '7734278114', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Our Lady Of The Resurrection Medical Center', 'Presence Resurrection Medical Center', '', NULL, 'HCFA|UB|', '1881806511', 0, 'N', 0, '2013-03-05', NULL, NULL, 41.9387, -87.7593, NULL, NULL),
('363330928', 'EDMPMG443', 'EDMPMG443', 'ILCHIGSTD', 'RMG ENT', 'Agnes', NULL, 'Hurtuk', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7734278114', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7734278114', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Our Lady Of The Resurrection Medical Center', 'Presence Resurrection Medical Center', '', NULL, 'HCFA|UB|', '1881806511', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG012', 'EDMPMG012', 'ILCHIGSTD', 'Hospitalist Group', 'Chinelo', NULL, 'Animalu', 'MD', 'Hospitalist', '', '', NULL, 'O', '100 Forest Pl Ste 405', 'Oak Park', 'Cook', 'IL', '60301', '7732827000', NULL, '100 Forest Pl Ste 405', 'Oak Park', 'Cook', 'IL', '60301', '7732827000', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1881858165', 0, 'Y', 0, '2013-03-05', NULL, NULL, 41.8873, -87.8011, NULL, NULL),
('363330928', 'EDMPMG183', 'EDMPMG183', 'ILCHIGSTD', 'Hospitalist Group', 'Chinelo', NULL, 'Animalu', 'MD', 'Hospitalist', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7732827000', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7732827000', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1881858165', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG124', 'EDMPMG124', 'ILCHIGSTD', 'RMG Dunning Internal Medicine', 'Ziauddin', NULL, 'Ahmed', 'MD', 'Internal Medicine', '', '', NULL, 'O', '5600 W Addison St Ste 301', 'Chicago', 'Cook', 'IL', '60634', '7737364553', NULL, '5600 W Addison St Ste 301', 'Chicago', 'Cook', 'IL', '60634', '7737364553', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1891798476', 0, 'N', 0, '2013-03-05', NULL, NULL, 41.9459, -87.7667, NULL, NULL),
('363330928', 'EDMPMG437', 'EDMPMG437', 'ILCHIGSTD', 'RMG Dunning Internal Medicine', 'Ziauddin', NULL, 'Ahmed', 'MD', 'Internal Medicine', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7737364553', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7737364553', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1891798476', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('364314354', 'EDMPMG235', 'EDMPMG235', 'ILCHIGSTD', 'PMG Elgin ED', 'Jihun', NULL, 'Lee', 'MD', 'Emergency Medicine', '', '', NULL, 'B', '25872 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '8476953200', NULL, '25872 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '8476953200', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1902017254', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('364314354', 'EDMPMG234', 'EDMPMG234', 'ILCHIGSTD', 'PMG Elgin ED', 'Jihun', NULL, 'Lee', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '77 W Airlite', 'Elgin', 'Kane', 'IL', '60123', '8476953200', NULL, '77 W Airlite', 'Elgin', 'Kane', 'IL', '60123', '8476953200', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1902017254', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG567', 'EDMPMG567', 'ILCHIGSTD', '', 'Nathan', NULL, 'Brinker', 'MD', 'Family Practice', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7736653086', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7736653086', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', NULL, NULL, NULL, 'HCFA|UB|', '1902044613', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG156', 'EDMPMG156', 'ILCHIGSTD', '', 'Nathan', NULL, 'Brinker', 'MD', 'Family Practice', '', '', NULL, 'O', '811 W Aldine Ave Ste 1N', 'Chicago', 'Cook', 'IL', '60657', '7736653086', NULL, '811 W Aldine Ave Ste 1N', 'Chicago', 'Cook', 'IL', '60657', '7736653086', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', NULL, NULL, NULL, 'HCFA|UB|', '1902044613', 0, 'N', 0, '2013-03-05', NULL, NULL, 41.9418, -87.6498, NULL, NULL),
('363330928', 'EDMPMG342', 'EDMPMG342', 'ILCHIGSTD', 'Presence Emergency Medicine', 'Steve', NULL, 'Christos', 'MD', 'Emergency Medicine', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7735947871', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7735947871', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1902891237', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG042', 'EDMPMG042', 'ILCHIGSTD', 'Presence Emergency Medicine', 'Steve', NULL, 'Christos', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '7435 W Talcott Ave', 'Chicago', 'Cook', 'IL', '60631', '7735947871', NULL, '7435 W Talcott Ave', 'Chicago', 'Cook', 'IL', '60631', '7735947871', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1902891237', 0, 'Y', 0, '2013-03-05', NULL, NULL, 41.9884, -87.8124, NULL, NULL),
('363330928', 'EDMPMG556', 'EDMPMG556', 'ILCHIGSTD', 'RMG Women First Associated OB-GYN', 'Paul', NULL, 'Gleixner', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7737752180', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7737752180', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1912101254', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG135', 'EDMPMG135', 'ILCHIGSTD', 'RMG Women First Associated OB-GYN', 'Paul', NULL, 'Gleixner', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '7447 W Talcott Ave Ste 418', 'Chicago', 'Cook', 'IL', '60631', '7737752180', NULL, '7447 W Talcott Ave Ste 418', 'Chicago', 'Cook', 'IL', '60631', '7737752180', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1912101254', 0, 'N', 0, '2013-03-05', NULL, NULL, 41.9887, -87.8131, NULL, NULL),
('363330928', 'EDMPMG566', 'EDMPMG566', 'ILCHIGSTD', '', 'Emily', NULL, 'Brauer', 'MD', 'Family Practice', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '2178406656', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '2178406656', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1912103060', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG065', 'EDMPMG065', 'ILCHIGSTD', '', 'Emily', NULL, 'Brauer', 'MD', 'Family Practice', '', '', NULL, 'O', '711 W Gordon Terrace Ste 513', 'Chicago', 'Cook', 'IL', '60613', '2178406656', NULL, '711 W Gordon Terrace Ste 513', 'Chicago', 'Cook', 'IL', '60613', '2178406656', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1912103060', 0, 'N', 0, '2013-03-05', NULL, NULL, 41.9579, -87.6482, NULL, NULL),
('364314354', 'EDMPMG304', 'EDMPMG304', 'ILCHIGSTD', 'PMG PSJMC Hospitalist', 'Menka', NULL, 'Desai', 'MD', 'Hospitalist', '', '', NULL, 'B', '25872 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '8157257133', NULL, '25872 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '8157257133', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1912155169', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('364314354', 'EDMPMG303', 'EDMPMG303', 'ILCHIGSTD', 'PMG PSJMC Hospitalist', 'Menka', NULL, 'Desai', 'MD', 'Hospitalist', '', '', NULL, 'O', '333 N Madison St', 'Joliet', 'Will', 'IL', '60435', '8157257133', NULL, '333 N Madison St', 'Joliet', 'Will', 'IL', '60435', '8157257133', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1912155169', 0, 'Y', 0, '2013-03-05', NULL, NULL, 41.528, -88.1346, NULL, NULL),
('363330928', 'EDMPMG560', 'EDMPMG560', 'ILCHIGSTD', 'Rogers Prk Family Practice', 'Joseph', NULL, 'Sanchez', 'MD', 'Family Practice', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7737436300', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7737436300', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Francis Hospital', 'Presence Saint Joseph Hospital Chicago', '', NULL, 'HCFA|UB|', '1912907270', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG559', 'EDMPMG559', 'ILCHIGSTD', 'Rogers Prk Family Practice', 'Joseph', NULL, 'Sanchez', 'MD', 'Family Practice', '', '', NULL, 'O', '6974 N Clark', 'Chicago', 'Cook', 'IL', '60626', '7737436300', NULL, '6974 N Clark', 'Chicago', 'Cook', 'IL', '60626', '7737436300', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Francis Hospital', 'Presence Saint Joseph Hospital Chicago', '', NULL, 'HCFA|UB|', '1912907270', 0, 'N', 0, '2013-03-05', NULL, NULL, 42.0083, -87.6738, NULL, NULL),
('363330928', 'EDMPMG044', 'EDMPMG044', 'ILCHIGSTD', 'Presence Emergency Medicine', 'Marc', NULL, 'Dorfman', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '5645 W Addison St', 'Chicago', 'Cook', 'IL', '60634', '7737947601', NULL, '5645 W Addison St', 'Chicago', 'Cook', 'IL', '60634', '7737947601', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1912908583', 0, 'Y', 0, '2013-03-05', NULL, NULL, 41.9459, -87.7678, NULL, NULL),
('363330928', 'EDMPMG347', 'EDMPMG347', 'ILCHIGSTD', 'Presence Emergency Medicine', 'Marc', NULL, 'Dorfman', 'MD', 'Emergency Medicine', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7737947601', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7737947601', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1912908583', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('364286236', 'EDMPMG074', 'EDMPMG074', 'ILCHIGSTD', 'Resurrection Immediate Care Ctr', 'Claudia', '', 'Weddaburne Bossie', 'MD', 'Urgent Care', '', '', NULL, 'O', '7230 W North Ave', 'Elmwood Park', 'Cook', 'IL', '60707', '7084533000', NULL, '7230 W North Ave', 'Elmwood Park', 'Cook', 'IL', '60707', '7084533000', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1912920265', 0, 'N', 0, '2013-03-05', NULL, NULL, 41.9089, -87.8062, NULL, NULL),
('363330928', 'EDMPMG151', 'EDMPMG151', 'ILCHIGSTD', 'PMG North Shore Foster', 'Elizabeth', '', 'Anderson', 'MD', 'Internal Medicine', '', '', NULL, 'O', '4905 Old Orchard Ctr Ste 634', 'Skokie', 'Cook', 'IL', '60077', '8476795120', NULL, '4905 Old Orchard Ctr Ste 634', 'Skokie', 'Cook', 'IL', '60077', '8476795120', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Francis Hospital', NULL, '', '', 'HCFA|UB|', '1912940552', 0, 'N', 0, '2013-07-02', NULL, NULL, 42.0614, -87.7475, NULL, NULL),
('363330928', 'EDMPMG298', 'EDMPMG298', 'ILCHIGSTD', 'PMG North Shore Foster', 'Elizabeth', '', 'Anderson', 'MD', 'Internal Medicine', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '8476795120', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '8476795120', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Francis Hospital', NULL, '', '', 'HCFA|UB|', '1912940552', 0, 'Y', 0, '2013-07-02', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG019', 'EDMPMG019', 'ILCHIGSTD', 'Presence Emergency Medicine', 'Jennifer', NULL, 'Fleming', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '2900 N Lake Shore Dr', 'Chicago', 'Cook', 'IL', '60657', '7736653086', NULL, '2900 N Lake Shore Dr', 'Chicago', 'Cook', 'IL', '60657', '7736653086', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1912973975', 0, 'Y', 0, '2013-03-05', NULL, NULL, 41.9349, -87.6367, NULL, NULL),
('363330928', 'EDMPMG350', 'EDMPMG350', 'ILCHIGSTD', 'Presence Emergency Medicine', 'Jennifer', NULL, 'Fleming', 'MD', 'Emergency Medicine', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7736653086', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7736653086', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1912973975', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG408', 'EDMPMG408', 'ILCHIGSTD', 'Resurrection Medical Ctr', 'Louis', NULL, 'Sharp', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '2211 W Farragut Ave', 'Chicago', 'Cook', 'IL', '60625', '7732827000', NULL, '2211 W Farragut Ave', 'Chicago', 'Cook', 'IL', '60625', '7732827000', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1912987751', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG409', 'EDMPMG409', 'ILCHIGSTD', 'Resurrection Medical Ctr', 'Louis', NULL, 'Sharp', 'MD', 'Emergency Medicine', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7732827000', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7732827000', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1912987751', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG011', 'EDMPMG011', 'ILCHIGSTD', 'RMG Hematology Oncology Lincoln Prk', 'Vicky', '', 'Oros', 'APN-CNP', 'Nurse Practitioner', '', '', NULL, 'O', '2900 N Lake Shore Dr 7th Fl', 'Chicago', 'Cook', 'IL', '60657', '7736615800', NULL, '2900 N Lake Shore Dr 7th Fl', 'Chicago', 'Cook', 'IL', '60657', '7736615800', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, NULL, NULL, 'HCFA|UB|', '1912997719', 0, 'Y', 0, '2013-04-17', NULL, NULL, 41.9349, -87.6367, NULL, NULL),
('363330928', 'EDMPMG454', 'EDMPMG454', 'ILCHIGSTD', 'RMG Hematology Oncology Lincoln Prk', 'Vicky', '', 'Oros', 'APN-CNP', 'Nurse Practitioner', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7736615800', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7736615800', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, NULL, NULL, 'HCFA|UB|', '1912997719', 0, 'Y', 0, '2013-04-17', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG536', 'EDMPMG536', 'ILCHIGSTD', 'RMG Riis Prk Medical Center', 'Noel', NULL, 'Rubio', 'MD', 'Internal Medicine', '', '', NULL, 'O', '5322 W Fullerton Ave', 'Chicago', 'Cook', 'IL', '60639', '7736220056', NULL, '5322 W Fullerton Ave', 'Chicago', 'Cook', 'IL', '60639', '7736220056', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', NULL, NULL, NULL, 'HCFA|UB|', '1922036797', 0, 'N', 0, '2013-03-05', NULL, NULL, 41.9241, -87.7596, NULL, NULL),
('363330928', 'EDMPMG539', 'EDMPMG539', 'ILCHIGSTD', 'RMG Riis Prk Medical Center', 'Noel', NULL, 'Rubio', 'MD', 'Internal Medicine', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7736220056', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7736220056', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saints Mary and Elizabeth Medical Center Saint Mary Campus', NULL, NULL, NULL, 'HCFA|UB|', '1922036797', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG154', 'EDMPMG154', 'ILCHIGSTD', 'RMG North Shore Physicians Group', 'Jennifer', '', 'Centore Lober', 'PA-C', 'Physician Assistant', '', '', NULL, 'O', '9711 Skokie Blvd  Ste A', 'Skokie', 'Cook', 'IL', '60077', '8475689930', NULL, '9711 Skokie Blvd  Ste A', 'Skokie', 'Cook', 'IL', '60077', '8475689930', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-09-30', 0, 0, 0, 'Northwestern Lake Forest Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1932198322', 0, 'Y', 0, '2013-10-04', NULL, NULL, 0, 0, NULL, NULL),
('364314354', 'EDMPMG258', 'EDMPMG258', 'ILCHIGSTD', 'PMG Hampshire Family Practice', 'Muhammad', NULL, 'Ali', 'MD', 'Family Practice', '', '', NULL, 'B', '25872 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '8479314200', NULL, '25872 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '8479314200', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, '', NULL, 'HCFA|UB|', '1932201712', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('364314354', 'EDMPMG094', 'EDMPMG094', 'ILCHIGSTD', 'PMG Hampshire Family Practice', 'Muhammad', NULL, 'Ali', 'MD', 'Family Practice', '', '', NULL, 'O', '895 S State St Ste 201', 'Hampshire', 'Kane', 'IL', '60140', '8476837099', NULL, '895 S State St Ste 201', 'Hampshire', 'Kane', 'IL', '60140', '8476837099', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Mercy Medical Center', NULL, '', NULL, 'HCFA|UB|', '1932201712', 0, 'N', 0, '2013-04-04', NULL, NULL, 42.0897, -88.5301, NULL, NULL),
('363330928', 'EDMPMG329', 'EDMPMG329', 'ILCHIGSTD', 'PMG North Shore Physicians Group', 'Bhupinder', '', 'Singh', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1625 Sheridan Rd Ste F', 'Wilmette', 'Cook', 'IL', '60091', '8472511500', NULL, '1625 Sheridan Rd Ste F', 'Wilmette', 'Cook', 'IL', '60091', '8472511500', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Holy Family Medical Center', 'Presence Saint Francis Hospital', '', '', 'HCFA|UB|', '1932250446', 0, 'N', 0, '2014-01-10', NULL, NULL, 42.0878, -87.7012, NULL, NULL),
('363330928', 'EDMPMG330', 'EDMPMG330', 'ILCHIGSTD', 'PMG North Shore Physicians Group', 'Bhupinder', '', 'Singh', 'MD', 'Internal Medicine', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '8472511500', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '8472511500', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Holy Family Medical Center', 'Presence Saint Francis Hospital', '', '', 'HCFA|UB|', '1932250446', 0, 'Y', 0, '2014-01-10', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG039', 'EDMPMG039', 'ILCHIGSTD', 'PMG Emergency Medicine', 'Lukas', NULL, 'Ceha', 'MD', 'Emergency Medicine', '', '', NULL, 'O', '4350 N Broadway St Ste 1011', 'Chicago', 'Cook', 'IL', '60613', '7735288907', NULL, '4350 N Broadway St Ste 1011', 'Chicago', 'Cook', 'IL', '60613', '7735288907', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, NULL, NULL, 'HCFA|UB|', '1932285095', 0, 'Y', 0, '2013-03-05', NULL, NULL, 41.9612, -87.6548, NULL, NULL),
('363330928', 'EDMPMG323', 'EDMPMG323', 'ILCHIGSTD', 'PMG Emergency Medicine', 'Lukas', NULL, 'Ceha', 'MD', 'Emergency Medicine', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7735288907', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7735288907', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, NULL, NULL, 'HCFA|UB|', '1932285095', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('363330928', 'EDMPMG008', 'EDMPMG008', 'ILCHIGSTD', 'RMG Hematology Oncology Lincoln Prk', 'Nora', NULL, 'Bucher', 'MD', 'Hematology and Oncology', '', '', NULL, 'O', '2900 N Lake Shore Dr 7th Fl', 'Chicago', 'Cook', 'IL', '60657', '7736615800', NULL, '2900 N Lake Shore Dr 7th Fl', 'Chicago', 'Cook', 'IL', '60657', '7736615800', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, NULL, NULL, 'HCFA|UB|', '1942416524', 0, 'N', 0, '2013-03-05', NULL, NULL, 41.9349, -87.6367, NULL, NULL),
('363330928', 'EDMPMG451', 'EDMPMG451', 'ILCHIGSTD', 'RMG Hematology Oncology Lincoln Prk', 'Nora', NULL, 'Bucher', 'MD', 'Hematology and Oncology', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7736615800', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7736615800', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, NULL, NULL, 'HCFA|UB|', '1942416524', 0, 'Y', 0, '2013-03-05', NULL, NULL, 0, 0, NULL, NULL),
('363330929', 'EDMPMG001', 'EDMPMG001', 'ILCHIGSTD', 'RMG Rehabilitation Medical Group', 'Claribel', '', 'Manalo', 'APN', 'Physical Medicine and Rehabilitation', '', '', NULL, 'O', '2900 N Lake Shore Dr 12th Fl', 'Chicago', 'Cook', 'IL', '60657', '7736654964', NULL, '2900 N Lake Shore Dr 12th Fl', 'Chicago', 'Cook', 'IL', '60657', '7736654964', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, NULL, NULL, 'HCFA|UB|', '1942431630', 0, 'Y', 0, '2013-04-17', NULL, NULL, 41.9349, -87.6367, NULL, NULL),
('363330929', 'EDMPMG533', 'EDMPMG533', 'ILCHIGSTD', 'RMG Rehabilitation Medical Group', 'Claribel', '', 'Manalo', 'APN', 'Physical Medicine and Rehabilitation', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7736654964', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7736654964', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, NULL, NULL, 'HCFA|UB|', '1942431630', 0, 'Y', 0, '2013-04-17', NULL, NULL, 0, 0, NULL, NULL),
('153448606', 'W40020071', 'W40020071', 'UTMH1', NULL, 'Kathryn', 'M', 'Hampton', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '725 N 300 E', 'Bountiful', 'Davis', 'UT', '84010', '8016986079', NULL, '725 N 300 E', 'Bountiful', 'Davis', 'UT', '84010', '8016986079', '', 'MA', NULL, NULL, '0.00', '40.00', '0.00', 3, '2013-02-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1588721260', 0, 'N', 0, '2013-06-19', NULL, NULL, 40.8967, -111.874, NULL, NULL),
('364314354', 'EDMPMG251', 'EDMPMG251', 'ILCHIGSTD', 'PMG Family Medicine Channahon', 'Janandana', '', 'Jeganmohan', 'MD', 'Family Practice', '', '', NULL, 'O', '27025 W Eames', 'Channahon', 'Will', 'IL', '60410', '8154671988', NULL, '27025 W Eames', 'Channahon', 'Will', 'IL', '60410', '8154671988', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, '', '', 'HCFA|UB|', '1942468145', 0, 'N', 0, '2013-04-03', NULL, NULL, 41.4232, -88.2273, NULL, NULL),
('363330928', 'EDMPMG194', 'EDMPMG194', 'ILCHIGSTD', 'Our Lady of the Resurrection Medical Ctr', 'Matthew', '', 'Jordan', 'MD', 'Emergency Medicine', '', '', NULL, 'B', '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7735947871', NULL, '62311 Collection Ctr Dr', 'Chicago', 'Cook', 'IL', '60673', '7735947871', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1952302101', 0, 'Y', 0, '2013-07-02', NULL, NULL, 0, 0, NULL, NULL);
