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
('870524176', 'W12019622', 'W12019622', 'UTMH1', 'Comprehensive Psychological Services', 'Ryan', 'F', 'Houston', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '1208 E 3300 S', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8014831600', NULL, '1208 E 3300 S', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8014831600', '          ', 'PHD', '', '', '0.00', '35.00', '0.00', 6, '2012-05-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1811137318', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('870524176', 'W12019623', 'W12019623', 'UTMH1', 'Comprehensive Psychological Services', 'Ryan', 'F', 'Houston', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '475 W 50 N', 'American Fork', 'Utah', 'UT', '84003', '8017563664', NULL, '475 W 50 N', 'American Fork', 'Utah', 'UT', '84003', '8017563664', '          ', 'PHD', '', '', '0.00', '35.00', '0.00', 6, '2012-05-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1811137318', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('870524176', 'W12019624', 'W12019624', 'UTMH1', 'Comprehensive Psychological Services', 'Clark', '', 'Johnson', 'MD', 'Mental Health', '', '', NULL, 'O', '1208 E 3300 S', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8014831600', '8014831610', '1208 E 3300 S', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8014831600', '8014831610', 'MD-5', '', '', '0.00', '35.00', '0.00', 3, '2012-05-23', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1487706099', 0, 'N', 0, '2014-04-24', NULL, NULL, 0, 0, NULL, NULL),
('870524176', 'W12019625', 'W12019625', 'UTMH1', 'Comprehensive Psychological Services', 'Molly', 'K', 'Prentice', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '1208 E 3300 S', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8014831600', NULL, '1208 E 3300 S', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8014831600', '          ', 'MA', '', '', '0.00', '35.00', '0.00', 6, '2012-05-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1396970786', 0, 'N', 0, '2013-03-12', NULL, NULL, 0, 0, NULL, NULL),
('870524176', 'W12019626', 'W12019626', 'UTMH1', 'Comprehensive Psychological Services', 'Molly', 'K', 'Prentice', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '3725 W 4100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8019653759', NULL, '3725 W 4100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8019653759', '          ', 'MA', '', '', '0.00', '35.00', '0.00', 6, '2012-05-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1396970786', 0, 'N', 0, '2013-03-12', NULL, NULL, 0, 0, NULL, NULL),
('870524176', 'W12019627', 'W12019627', 'UTMH1', 'Comprehensive Psychological Services', 'Natalie', '', 'Herndon', 'LPC', 'Mental Health', 'Counseling', 'Psychology', NULL, 'O', '1208 E 3300 S', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8014831600', '8014831610', '1208 E 3300 S', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8014831600', '8014831610', 'MA', '', '', '0.00', '35.00', '0.00', 6, '2012-05-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1356537542', 0, 'N', 0, '2013-03-12', NULL, NULL, 0, 0, NULL, NULL),
('870524176', 'W12019628', 'W12019628', 'UTMH1', 'Comprehensive Psychological Services', 'Natalie', '', 'Herndon', 'LPC', 'Mental Health', 'Counseling', 'Psychology', NULL, 'O', '3725 W 4100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8019653759', '8014831610', '3725 W 4100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8019653759', '8014831610', 'MA', '', '', '0.00', '35.00', '0.00', 6, '2012-05-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1356537542', 0, 'N', 0, '2013-03-12', NULL, NULL, 0, 0, NULL, NULL),
('850232628', 'W12019630', 'W12019630', 'NM01', 'Womens Specialists of NM', 'Seddah', 'B', 'Moya', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '201 Cedar Street SE Ste 5640', 'Albuquerque', 'Bernalillo', 'NM', '87106', '5058436168', '5052479743', '201 Cedar Street SE Ste 5640', 'Albuquerque', 'Bernalillo', 'NM', '87106', '5058436168', '5052479743', 'NMSWOMEN', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-05-23', '2013-06-30', 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1023269651', 0, 'N', 0, '2013-06-26', NULL, NULL, 0, 0, NULL, NULL),
('061506129', 'W12020924', 'W12020924', 'UT01', 'Wee Care Pediatrics', 'Roderick', 'D', 'Maxwell', 'PA', 'Pediatrics', '', '', NULL, 'O', '1792 W 1700 S Ste 102', 'Syracuse', 'Davis', 'UT', '84075', '8017738644', '8018254161', '1792 W 1700 S Ste 102', 'Syracuse', 'Davis', 'UT', '84075', '8017738644', '8018254161', 'WUSTDPEDE5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1902967219', 0, 'N', 0, '2014-07-21', NULL, NULL, 41.0891, -112.061, NULL, NULL),
('061506129', 'W12020921', 'W12020921', 'UT01', 'Wee Care Pediatrics', 'Roderick', 'D', 'Maxwell', 'PA', 'Pediatrics', '', '', NULL, 'O', '2084 N 1700 W Ste A', 'Layton', 'Davis', 'UT', '84041', '8017738644', '8019271591', '2084 N 1700 W Ste A', 'Layton', 'Davis', 'UT', '84041', '8017738644', '8019271591', 'WUSTDPEDE5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1902967219', 0, 'N', 0, '2014-07-21', NULL, NULL, 41.0897, -111.997, NULL, NULL),
('870524176', 'W12019631', 'W12019631', 'UTMH1', 'Comprehensive Psychological Services', 'Howard', 'G', 'Ingle', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '1208 E 3300 S', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8014831600', '8014831610', '1208 E 3300 S', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8014831600', '8014831610', 'MA', '', '', '0.00', '35.00', '0.00', 6, '2012-05-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1992854079', 0, 'N', 0, '2013-03-12', NULL, NULL, 0, 0, NULL, NULL),
('870524176', 'W12019632', 'W12019632', 'UTMH1', 'Comprehensive Psychological Services', 'John', 'W', 'Thatcher', 'MD', 'Mental Health', 'Psychiatry', '', NULL, 'O', '1208 E 3300 S', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8014831600', '8014831610', '1208 E 3300 S', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8014831600', '8014831610', 'MD-5', '', '', '0.00', '35.00', '0.00', 6, '2012-05-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1407933708', 0, 'N', 0, '2014-04-24', NULL, NULL, 0, 0, NULL, NULL),
('870524176', 'W12019634', 'W12019634', 'UTMH1', 'Comprehensive Psychological Services', 'Mark', 'D', 'Neuman', 'MD', 'Mental Health', 'Psychiatry', '', NULL, 'O', '1208 E 3300 S', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8014831600', '8014831610', '1208 E 3300 S', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8014831600', '8014831610', 'MD-5', '', '', '0.00', '35.00', '0.00', 6, '2012-05-01', '2013-02-14', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1194824961', 0, 'N', 0, '2013-03-12', NULL, NULL, 0, 0, NULL, NULL),
('870524176', 'W12019635', 'W12019635', 'UTMH1', 'Comprehensive Psychological Services', 'Steven', 'A', 'Szykula', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '1208 E 3300 S', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8014831600', '8014831610', '1208 E 3300 S', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8014831600', '8014831610', 'PHD', '', '', '0.00', '35.00', '0.00', 6, '2012-05-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1942224829', 0, 'N', 0, '2014-05-01', NULL, NULL, 0, 0, NULL, NULL),
('820529971', 'W12019637', 'W12019637', 'ID02', 'Childrens Therapy Place', 'Jeanne', '', 'Strozier-Wagner', 'PT', 'Physical Therapy', '', '', NULL, 'O', '6855 W Fairview Ave Ste 120', 'Boise', 'Ada', 'ID', '83704', '2083238888', NULL, '6855 W Fairview Ave Ste 120', 'Boise', 'Ada', 'ID', '83704', '2083238888', '          ', 'WestRehab', '', '', '0.00', '0.00', '65.00', 3, '2012-05-23', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1225396435', 0, 'N', 0, '2014-01-29', NULL, NULL, 0, 0, NULL, NULL),
('870550275', 'W12019638', 'W12019638', 'UT01', 'Wasatch Pediatrics', 'Destiny', '', 'Gmelch', 'MD', 'Pediatrics', '', '', NULL, 'O', '7138 S 2000 E Ste 106', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019421800', '8019441865', '7138 S 2000 E Ste 106', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8019421800', '8019441865', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-10-01', NULL, 0, 0, 0, 'Primary Childrens Medical Center', '', '', '', 'HCFA|UB|', '1013161413', 0, 'N', 0, '2012-10-23', NULL, NULL, 40.6215, -111.834, NULL, NULL),
('870550275', 'W12019639', 'W12019639', 'UT01', 'Wasatch Pediatrics', 'Destiny', '', 'Gmelch', 'MD', 'Pediatrics', '', '', NULL, 'B', 'PO Box 71550', 'Salt Lake City', 'Salt Lake', 'UT', '84171', '8019470830', '8019470864', 'PO Box 71550', 'Salt Lake City', 'Salt Lake', 'UT', '84171', '8019470830', '8019470864', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-10-01', NULL, 0, 0, 0, 'Primary Childrens Medical Center', '', '', '', 'HCFA|UB|', '1013161413', 0, 'N', 0, '2012-10-23', NULL, NULL, 0, 0, NULL, NULL),
('870550275', 'W12019641', 'W12019641', 'UT01', 'Wasatch Pediatrics', 'Clark ', '', 'Loftus', 'MD', 'Pediatrics', '', '', NULL, 'O', '620 Medical Dr Ste 100', 'Bountiful', 'Davis', 'UT', '84010', '8012952888', '8012950311', '620 Medical Dr Ste 100', 'Bountiful', 'Davis', 'UT', '84010', '8012952888', '8012950311', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-06-01', NULL, 0, 0, 0, 'Lakeview Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1285617928', 0, 'N', 0, '2012-06-12', NULL, NULL, 40.8869, -111.869, NULL, NULL),
('870550275', 'W12019642', 'W12019642', 'UT01', 'Wasatch Pediatrics', 'Clark ', '', 'Loftus', 'MD', 'Pediatrics', '', '', NULL, 'B', 'PO Box 71550', 'Salt Lake City', 'Salt Lake', 'UT', '84171', '8019470830', '8019470864', 'PO Box 71550', 'Salt Lake City', 'Davis', 'UT', '84171', '8019470830', '8019470864', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-07-01', NULL, 0, 0, 0, 'Lakeview Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1285617928', 0, 'N', 0, '2012-05-23', NULL, NULL, 0, 0, NULL, NULL),
('870550275', 'W12019644', 'W12019644', 'UT01', 'Wasatch Pediatrics Inc', 'Dale', 'L', 'Chapman', 'MD', 'Pediatrics', '', '', NULL, 'O', '5770 S 250 E Ste 100', 'Murray', 'Salt Lake', 'UT', '84107', '8017478700', '8017478701', '5770 S 250 E Ste 100', 'Murray', 'Salt Lake', 'UT', '84107', '8017478700', '8017478701', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-07-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1114959368', 0, 'N', 0, '2012-05-23', NULL, NULL, 40.6452, -111.884, NULL, NULL),
('870550275', 'W12019645', 'W12019645', 'UT01', 'Wasatch Pediatrics Inc', 'Dale', 'L', 'Chapman', 'MD', 'Pediatrics', '', '', NULL, 'B', 'PO Box 717550', 'Salt Lake City', 'Salt Lake', 'UT', '84171', '8019470830', '8019470864', 'PO Box 717550', 'Salt Lake City', 'Salt Lake', 'UT', '84171', '8019470830', '8019470864', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2011-07-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1114959368', 0, 'N', 0, '2012-05-23', NULL, NULL, 0, 0, NULL, NULL),
('900292646', 'W12019646', 'W12019646', 'UT01', 'Vision Source at Jordan Landing', 'William', 'C', 'Poulter', 'OD', 'Optometry', '', '', NULL, 'O', '7555 Ctr View Ct Ste 101', 'West Jordan', 'Salt Lake', 'UT', '84084', '8015665683', NULL, '7555 Ctr View Ct Ste 101', 'West Jordan', 'Salt Lake', 'UT', '84084', '8015665683', '          ', 'WUTALBERT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2008-10-17', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1932360690', 0, 'N', 0, '2014-01-17', NULL, NULL, 40.6147, -111.984, NULL, NULL),
('270350345', 'W12019648', 'W12019648', 'WYT1', 'Heart Mountain Chiropractic', 'Paul', 'W', 'Bergamini', 'DC', 'Chiropractic', '', '', NULL, 'O', '1543 Bleistein Ave', 'Cody', 'Park', 'WY', '82414', '3075874600', NULL, '1543 Bleistein Ave', 'Cody', 'Park', 'WY', '82414', '3075874600', '          ', '', '', '5004', '0.00', '100.00', '0.00', 3, '2009-10-01', NULL, 1, 0, 0, '', '', '', '', 'HCFA|UB|', '1053486480', 0, 'N', 0, '2012-06-25', NULL, NULL, 0, 0, NULL, NULL),
('270350345', 'W12019647', 'W12019647', 'WY01', 'Heart Mountain Chiropractic', 'Paul', 'W', 'Bergamini', 'DC', 'Chiropractic', '', '', NULL, 'O', '1543 Bleistein Ave', 'Cody', 'Park', 'WY', '82414', '3075874600', NULL, '1543 Bleistein Ave', 'Cody', 'Park', 'WY', '82414', '3075874600', '          ', '', '', '5004', '0.00', '100.00', '0.00', 3, '2009-10-01', NULL, 1, 0, 0, '', '', '', '', 'HCFA|UB|', '1053486480', 0, 'N', 0, '2012-06-25', NULL, NULL, 44.5283, -109.057, NULL, NULL),
('543560339', 'W12019654', 'W12019654', 'UTMH1', '', 'Lauralee', 'L', 'Gardner', 'LMFT', 'Mental Health', 'Counseling', '', NULL, 'O', '5711 S 1475 E', 'Ogden', 'Weber', 'UT', '84403', '8012982000', '8019511490', '5711 S 1475 E', 'Ogden', 'Weber', 'UT', '84403', '8012982000', '8019511490', 'MA', '', '', '0.00', '35.00', '0.00', 3, '2012-05-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1730246521', 0, 'N', 0, '2013-09-23', NULL, NULL, 0, 0, NULL, NULL),
('742927135', 'W12019657', 'W12019657', 'ID01', 'Mountain States Neonatology', 'Anthony', '', 'Dajnowicz', 'MD', 'Neonatology', '', '', NULL, 'B', 'PO Box 840532', 'Dallas', 'Dallas', 'TX', '75284', '2083677610', NULL, 'PO Box 840532', 'Dallas', 'Dallas', 'TX', '75284', '2083677610', '          ', 'IDNEONATE', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-05-23', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1710907209', 0, 'N', 0, '2013-10-22', NULL, NULL, 0, 0, NULL, NULL),
('742927135', 'W12019656', 'W12019656', 'ID01', 'Mountain States Neonatology', 'Anthony', '', 'Dajnowicz', 'MD', 'Neonatology', '', '', NULL, 'O', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083676063', NULL, '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083676063', '          ', 'IDNEONATE', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-05-23', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1710907209', 0, 'N', 0, '2013-10-22', NULL, NULL, 43.6145, -116.254, NULL, NULL),
('742927135', 'W12019658', 'W12019658', 'ID01', 'Mountain States Neonatology', 'Anthony', '', 'Dajnowicz', 'MD', 'Neonatology', '', '', NULL, 'M', '4722 N 24th St Ste 150', 'Phoenix', 'Maricopa', 'AZ', '85016', '2083676063', NULL, '4722 N 24th St Ste 150', 'Phoenix', 'Maricopa', 'AZ', '85016', '2083676063', '          ', 'IDNEONATE', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2012-05-23', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1710907209', 0, 'N', 0, '2013-10-22', NULL, NULL, 0, 0, NULL, NULL),
('455118509', 'W12019659', 'W12019659', 'ID01', 'Spaulding Counesling Services', 'Roy', 'C', 'Spaulding', 'LMFT', 'Mental Health', 'Marriage & Family Therapy', '', NULL, 'O', '1552 N Crestmont Dr Ste C', 'Meridian', 'Ada', 'ID', '83642', '2088871911', NULL, '1552 N Crestmont Dr Ste C', 'Meridian', 'Ada', 'ID', '83642', '2088871911', '          ', 'IDMA', '', '', '0.00', '35.00', '0.00', 3, '2012-05-03', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1366692790', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('352439145', 'W12019663', 'W12019663', 'UTMH1', 'Grace & Peace Christian Counseling', 'Robert', 'J', 'Reed', 'LPC', 'Counseling', '', '', NULL, 'O', '270 12 St', 'Ogden', 'Weber', 'UT', '84404', '8883323566', '8015619987', '270 12 St', 'Ogden', 'Weber', 'UT', '84404', '8883323566', '8015619987', 'MA', '', '', '0.00', '35.00', '0.00', 3, '2012-05-29', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1215056247', 0, 'N', 0, '2012-05-23', NULL, NULL, 41.2443, -111.974, NULL, NULL),
('352439145', 'W12019660', 'W12019660', 'UTMH1', 'Grace & Peace Christian Counseling', 'Robert', 'J', 'Reed', 'LPC', 'Counseling', '', '', NULL, 'O', '2909 Washington Blvd Ste 101', 'Ogden', 'Weber', 'UT', '84401', '8883323566', '8015619987', '2909 Washington Blvd Ste 101', 'Ogden', 'Weber', 'UT', '84401', '8883323566', '8015619987', 'MA', '', '', '0.00', '35.00', '0.00', 3, '2012-05-29', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1215056247', 0, 'N', 0, '2012-05-23', NULL, NULL, 41.2121, -111.971, NULL, NULL),
('352439145', 'W12019661', 'W12019661', 'UTMH1', 'Grace & Peace Christian Counseling', 'Robert', 'J', 'Reed', 'LPC', 'Counseling', '', '', NULL, 'O', '3665 S 8400 W Ste 110', 'Magna', 'Salt Lake', 'UT', '84044', '8883323566', '8015619987', '3665 S 8400 W Ste 110', 'Magna', 'Salt Lake', 'UT', '84044', '8883323566', '8015619987', 'MA', '', '', '0.00', '35.00', '0.00', 3, '2012-05-29', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1215056247', 0, 'N', 0, '2012-05-23', NULL, NULL, 40.6928, -112.092, NULL, NULL),
('352439145', 'W12019662', 'W12019662', 'UTMH1', 'Grace & Peace Christian Counseling', 'Robert', 'J', 'Reed', 'LPC', 'Counseling', '', '', NULL, 'O', '9055 E 1300 S Ste 20', 'Sandy', 'Salt Lake', 'UT', '84094', '8883323566', '8015619987', '9055 E 1300 S Ste 20', 'Sandy', 'Salt Lake', 'UT', '84094', '8883323566', '8015619987', 'MA', '', '', '0.00', '35.00', '0.00', 3, '2012-05-29', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1215056247', 0, 'N', 0, '2012-05-23', NULL, NULL, 0, 0, NULL, NULL),
('870286381', 'W12019665', 'W12019665', 'UT01', 'Ogden Clinic', 'Colby', 'J', 'Mitchell', 'PA-C', 'Ear, Nose and Throat', '', '', NULL, 'O', '425 E 5350 S Ste 130', 'Ogden', 'Weber', 'UT', '84405', '8014750361', '8014753071', '425 E 5350 S Ste 130', 'Ogden', 'Weber', 'UT', '84405', '8014750361', '8014753071', 'WUOGDCLIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2012-06-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1164546701', 0, 'N', 0, '2013-05-13', NULL, NULL, 41.166, -111.97, NULL, NULL),
('870286381', 'W12019664', 'W12019664', 'UT01', 'Ogden Clinic', 'Colby', 'J', 'Mitchell', 'PA-C', 'Ear, Nose and Throat', '', '', NULL, 'B', '4650 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014753000', '8014753414', '4650 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014753000', '8014753414', 'WUOGDCLIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2012-06-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1164546701', 0, 'N', 0, '2012-05-25', NULL, NULL, 0, 0, NULL, NULL),
('870286381', 'W12019667', 'W12019667', 'UT01', 'Ogden Clinic', 'Douglas', 'K', 'Anderson', 'MD', 'Ear, Nose and Throat', NULL, NULL, NULL, 'O', '425 E 5350 S Ste 130', 'Ogden', 'Weber', 'UT', '84405', '8014760342', '8014769088', '425 E 5350 S Ste 130', 'Ogden', 'Weber', 'UT', '84405', '8014760342', '8014769088', 'WUOGDCLIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2012-06-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1790898807', 0, 'Y', 0, '2013-07-25', NULL, NULL, 41.166, -111.97, NULL, NULL),
('870286381', 'W12019668', 'W12019668', 'UT01', 'Ogden Clinic', 'Douglas', 'K', 'Anderson', 'MD', 'Ear, Nose and Throat', NULL, NULL, NULL, 'B', '4650 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014753000', '8014753414', '4650 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014753000', '8014753414', 'WUOGDCLIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2012-06-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1790898807', 0, 'N', 0, '2013-07-25', NULL, NULL, 0, 0, NULL, NULL),
('841411398', 'W12019669', 'W12019669', 'UT01', 'Foothill Family Clinic', 'Alexander ', 'P', 'Clark', 'DO', 'Family Practice', '', '', NULL, 'O', '2295 Foothill Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84109', '8014863021', '8014856339', '2295 Foothill Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84109', '8014863021', '8014856339', 'WUFOOTHIL5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-08-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1578772109', 0, 'N', 0, '2012-08-28', NULL, NULL, 40.7206, -111.811, NULL, NULL),
('841411398', 'W12019670', 'W12019670', 'UT01', 'Foothill Family Clinic', 'Alexander ', 'P', 'Clark', 'DO', 'Family Practice', '', '', NULL, 'O', '6360 S 3000 E Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8013651032', '8013651036', '6360 S 3000 E Ste 100', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8013651032', '8013651036', 'WUFOOTHIL5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-08-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1578772109', 0, 'N', 0, '2012-08-28', NULL, NULL, 40.6339, -111.806, NULL, NULL),
('621801973', 'W12019672', 'W12019672', 'UT01', 'Davis Medical Group', 'Joseph', 'A', 'Francis', 'MD', 'Family Practice', '', '', NULL, 'O', '124 S Fairfield Rd', 'Layton', 'Davis', 'UT', '84041', '8019273080', '8019273088', '124 S Fairfield Rd', 'Layton', 'Davis', 'UT', '84041', '8019273080', '8019273088', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2012-06-01', '2014-04-30', 0, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1437268414', 0, 'N', 0, '2014-04-04', NULL, NULL, 41.0604, -111.945, NULL, NULL),
('621801973', 'W12019671', 'W12019671', 'UT01', 'Davis Medical Group', 'Joseph', 'A', 'Francis', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2012-06-01', '2014-04-30', 0, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1437268414', 0, 'N', 0, '2014-04-04', NULL, NULL, 0, 0, NULL, NULL),
('870286381', 'W12019673', 'W12019673', 'UT01', 'Ogden Clinic Professional Center North', 'Alexander', 'J', 'Larson', 'PA', 'Obstetrics and Gynecology', '', '', NULL, 'O', '4650 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014753100', '8014753101', '4650 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014753100', '8014753101', 'WUOGDCLIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2012-11-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1265695019', 0, 'N', 0, '2012-10-04', NULL, NULL, 41.1787, -111.949, NULL, NULL),
('161767581', 'W12019674', 'W12019674', 'UT01', 'Gynecology Specialist of Utah', 'Jody', 'L', 'Fowers', 'APRN', 'Family Practice', '', '', NULL, 'O', '5495 S 500 E Ste 320', 'Ogden', 'Weber', 'UT', '84405', '8014764200', '8014762070', '5495 S 500 E Ste 320', 'Ogden', 'Weber', 'UT', '84405', '8014764200', '8014762070', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-06-07', '2012-06-30', 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1992915052', 0, 'N', 0, '2013-10-24', NULL, NULL, 0, 0, NULL, NULL),
('161767581', 'W12019675', 'W12019675', 'UT01', 'Gynecology Specialist of Utah', 'Jody', 'L', 'Fowers', 'APRN', 'Family Practice', '', '', NULL, 'B', 'PO Box 741617', 'Atlanta', 'Fulton', 'GA', '30384', '8014764200', '8014762070', 'PO Box 741617', 'Atlanta', 'Fulton', 'GA', '30384', '8014764200', '8014762070', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-06-07', '2012-06-30', 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1992915052', 0, 'N', 0, '2013-10-24', NULL, NULL, 0, 0, NULL, NULL),
('870767026', 'W12019676', 'W12019676', 'ID01', 'West Valley Medical Group Nampa', 'Christy', '', 'Bayes', 'NP', 'Family Practice', '', '', NULL, 'O', '16459 M Midland Blvd', 'Nampa', 'Canyon', 'ID', '83687', '2087955075', '2084426520', '16459 M Midland Blvd', 'Nampa', 'Canyon', 'ID', '83687', '2087955075', '2084426520', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-07-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1760796296', 0, 'N', 0, '2013-11-12', NULL, NULL, 43.6116, -116.593, NULL, NULL),
('870767026', 'W12019677', 'W12019677', 'ID01', 'West Valley Medical Group Caldwell', 'Christy', '', 'Bayes', 'NP', 'Family Practice', '', '', NULL, 'O', '211 E Logan St Ste 303 Ste 203', 'Caldwell', 'Canyon', 'ID', '83605', '2084591667', '2084593372', '211 E Logan St Ste 303 Ste 203', 'Caldwell', 'Canyon', 'ID', '83605', '2084591667', '2084593372', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-07-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1760796296', 0, 'N', 0, '2013-11-12', NULL, NULL, 43.6554, -116.697, NULL, NULL),
('870767026', 'W12019678', 'W12019678', 'ID01', 'West Valley Medical Group', 'Christy', '', 'Bayes', 'NP', 'Family Practice', '', '', NULL, 'B', 'PO Box 277976', 'Atlanta', 'Fulton', 'GA', '30384', '2084594667', '2084593372', 'PO Box 277976', 'Atlanta', 'Fulton', 'GA', '30384', '2084594667', '2084593372', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-07-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1760796296', 0, 'N', 0, '2013-11-12', NULL, NULL, 0, 0, NULL, NULL),
('942938348', 'W12019679', 'W12019679', 'UTMH1', 'Valley Mental Health  Inc', 'Alicia', 'J', 'Bott', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', '5965 S 900 E Ste 430', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012637100', NULL, '5965 S 900 E Ste 430', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012637100', '          ', 'UTVMHPHD', '', '', '0.00', '35.00', '0.00', 6, '2012-05-24', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1467760116', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('263687593', 'W12019682', 'W12019682', 'UTMH1', 'New Directions Counseling Services', 'Kirt', 'D', 'Wise', 'LCSW', 'Mental Health', '', '', NULL, 'B', '590 E 1250 S', 'Kaysville', 'Davis', 'UT', '84037', '8016605557', '8017321671', '590 E 1250 S', 'Kaysville', 'Davis', 'UT', '84037', '8016605557', '8017321671', 'UTMA', '', '', '0.00', '35.00', '0.00', 3, '2012-06-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1215182795', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('528711825', 'W12019681', 'W12019681', 'UTMH1', 'New Directions Counseling', 'Matthew', 'T', 'Loveland', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', '590 E 1250 S', 'Kaysville', 'Davis', 'UT', '84037', '8016605557', NULL, '590 E 1250 S', 'Kaysville', 'Davis', 'UT', '84037', '8016605557', '', 'UTMA', '', '', '0.00', '35.00', '0.00', 3, '2012-06-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1326054222', 0, 'N', 0, '2014-05-16', NULL, NULL, 0, 0, NULL, NULL),
('455330549', 'W12019685', 'W12019685', 'UT01', 'Utah Valley Dermatology', 'David', 'J', 'Myers', 'MD', 'Dermatology', '', '', NULL, 'O', '680 E Main St Ste 201', 'Lehi', 'Utah', 'UT', '84043', '8017688800', NULL, '680 E Main St Ste 201', 'Lehi', 'Utah', 'UT', '84043', '8017688800', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-05-22', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1255425252', 0, 'N', 0, '2012-05-24', NULL, NULL, 40.3882, -111.838, NULL, NULL),
('455330549', 'W12019686', 'W12019686', 'UT01', 'Utah Valley Dermatology', 'David', 'J', 'Myers', 'MD', 'Dermatology', '', '', NULL, 'O', '385 E 600 N', 'Lindon', 'Utah', 'UT', '84042', '8017688800', NULL, '385 E 600 N', 'Lindon', 'Utah', 'UT', '84042', '8017688800', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-05-22', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1255425252', 0, 'N', 0, '2012-05-24', NULL, NULL, 0, 0, NULL, NULL),
('800124154', 'W12019688', 'W12019688', 'WY01', 'Best Home Health and Hospice', '', '', 'Best Home Health and Hopice', '', 'Home Health Agency', '', '', NULL, 'O', '1363 Dewar Dr Ste B-5', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073719032', '3073713171', '1363 Dewar Dr Ste B-5', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073719032', '3073713171', '', '', '5002', '0.00', '35.00', '0.00', 3, '2012-06-01', NULL, 1, 0, 0, '', '', '', '', 'HCFA|UB|', '1780615716', 0, 'N', 0, '2012-06-30', NULL, NULL, 0, 0, NULL, NULL),
('800124154', 'W12019687', 'W12019687', 'WY01', 'Best Home Health and Hospice', '', '', 'Best Home Health and Hopice', '', 'Home Health Agency', '', '', NULL, 'O', '637 Front St', 'Evanston', 'Uinta', 'WY', '82930', '3077892899', '3077893480', '637 Front St', 'Evanston', 'Uinta', 'WY', '82930', '3077892899', '3077893480', '', '', '5002', '0.00', '35.00', '0.00', 3, '2012-06-01', NULL, 1, 0, 0, '', '', '', '', 'HCFA|UB|', '1780615716', 0, 'N', 0, '2012-06-30', NULL, NULL, 41.2658, -110.962, NULL, NULL),
('800124154', 'W12019689', 'W12019689', 'WYT1', 'Best Home Health and Hospice', '', '', 'Best Home Health and Hopice', '', 'Home Health Agency', '', '', NULL, 'O', '1363 Dewar Dr Ste B-5', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073719032', '3073713171', '1363 Dewar Dr Ste B-5', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073719032', '3073713171', '', '', '5002', '0.00', '35.00', '0.00', 3, '2012-06-01', NULL, 1, 0, 0, '', '', '', '', 'HCFA|UB|', '1780615716', 0, 'N', 0, '2012-06-30', NULL, NULL, 0, 0, NULL, NULL),
('800124154', 'W12019690', 'W12019690', 'WYT1', 'Best Home Health and Hospice', '', '', 'Best Home Health and Hopice', '', 'Home Health Agency', '', '', NULL, 'O', '637 Front St', 'Evanston', 'Uinta', 'WY', '82930', '3077892899', '3077893480', '637 Front St', 'Evanston', 'Uinta', 'WY', '82930', '3077892899', '3077893480', '', '', '5002', '0.00', '35.00', '0.00', 3, '2012-06-01', NULL, 1, 0, 0, '', '', '', '', 'HCFA|UB|', '1780615716', 0, 'N', 0, '2012-06-30', NULL, NULL, 0, 0, NULL, NULL),
('330604557', 'W12019691', 'W12019691', 'NA01', 'Cardionet Inc', '', '', 'Cardionet, Inc', 'Group', 'Cardiac Monitoring', '', '', NULL, 'O', '227 Washington St Ste 210', 'Conshohocken', 'Montgomery', 'PA', '19428', '8664264402', '8664264403', '227 Washington St Ste 210', 'Conshohocken', 'Montgomery', 'PA', '19428', '8664264402', '8664264403', 'CARDIONET', '', '', '0.00', '100.00', '0.00', 3, '2012-06-01', '2014-01-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1790869402', 0, 'N', 0, '2014-01-27', NULL, NULL, 0, 0, NULL, NULL),
('330604557', 'W12019692', 'W12019692', 'NA01', 'Cardionet Inc', '', '', 'Cardionet, Inc', 'Group', 'Cardiac Monitoring', '', '', NULL, 'B', 'PO Box 501837', 'Philadelphia', 'Philadelphia', 'PA', '19175', '8664264402', '8664264403', 'PO Box 501837', 'Philadelphia', 'Philadelphia', 'PA', '19175', '8664264402', '8664264403', 'CARDIONET', '', '', '0.00', '100.00', '0.00', 3, '2012-06-01', '2014-01-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1790869402', 0, 'N', 0, '2014-01-27', NULL, NULL, 0, 0, NULL, NULL),
('820392395', 'W12019693', 'W12019693', 'ID01', '', 'Kristina', 'M', 'Huffaker', 'PA', 'Family Practice', '', '', NULL, 'O', '2036 N Cole Rd', 'Boise', 'Ada', 'ID', '83704', '2083750722', '2083750015', '2036 N Cole Rd', 'Boise', 'Ada', 'ID', '83704', '2083750722', '2083750015', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-07-01', '2012-08-19', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1508142613', 0, 'N', 0, '2014-03-27', NULL, NULL, 43.6238, -116.273, NULL, NULL),
('800331521', 'W12019694', 'W12019694', 'UT01', 'Wasatch Eye Specialists', 'Heather', 'M', 'Jetton', 'OD', 'Optometry', '', '', NULL, 'O', '120 W Cache Valley Blvd Ste 100', 'Logan', 'Cache', 'UT', '84341', '4357877200', '4357877203', '120 W Cache Valley Blvd Ste 100', 'Logan', 'Cache', 'UT', '84341', '4357877200', '4357877203', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'Logan Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1699742684', 0, 'N', 0, '2012-07-10', NULL, NULL, 41.7543, -111.831, NULL, NULL),
('010885716', 'W12019695', 'W12019695', 'UTMH1', 'Riley Individual Family and Marriage Counseling', 'Sandra', 'G', 'Moody', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '873 Baxter Dr', 'South Jordan', 'Salt Lake', 'UT', '84095', '8016570163', '8015687856', '873 Baxter Dr', 'South Jordan', 'Salt Lake', 'UT', '84095', '8016570163', '8015687856', 'UTMA', '', '', '0.00', '35.00', '0.00', 3, '2012-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1346514726', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('010885716', 'W12019696', 'W12019696', 'UTMH1', 'Riley Individual Family and Marriage Counseling', 'Sandra', 'G', 'Moody', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', 'PO Box 708458', 'Sandy', 'Salt Lake', 'UT', '84070', '8016570163', '8015687856', 'PO Box 708458', 'Sandy', 'Salt Lake', 'UT', '84070', '8016570163', '8015687856', 'UTMA', '', '', '0.00', '35.00', '0.00', 3, '2012-07-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1346514726', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('870673273', 'W12019728', 'W12019728', 'UT01', '', 'Gregory', 'Floy', 'McGinn', 'DC', 'Chiropractic', '', '', NULL, 'O', '1116 E 3300 S', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8014852100', '8014852101', '1116 E 3300 S', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8014852100', '8014852101', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2012-06-01', '2012-07-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1104805993', 0, 'N', 0, '2012-07-09', NULL, NULL, 0, 0, NULL, NULL),
('841305502', 'W12019698', 'W12019698', 'WY01', 'Rock Springs Plastic Surgery', 'Scott', 'M', 'Sulentich', 'MD', 'Plastic Surgery', '', '', NULL, 'O', '1208 Hilltop Dr Ste 103', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073628211', '3073823451', '1208 Hilltop Dr Ste 103', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073628211', '3073823451', 'WUSTDPLAS5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'Memorial Hospital of Sweetwater County', '', '', '', 'HCFA|UB|', '1386738136', 0, 'N', 0, '2012-06-30', NULL, NULL, 41.5844, -109.231, NULL, NULL),
('870553965', 'W12019851', 'W12019851', 'UT01', 'Total Respiratory Care', '', '', 'Total Respiratory Care', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', '1664 S Dixie Commons Ste H-111', 'St George', 'Washington', 'UT', '84770', '4356882089', '4357739635', '1664 S Dixie Commons Ste H-111', 'St George', 'Washington', 'UT', '84770', '4356882089', '4357739635', 'DME8012', '', '', '0.00', '0.00', '0.00', 3, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1376508291', 0, 'N', 0, '2014-05-13', NULL, NULL, 37.0799, -113.604, NULL, NULL),
('841305502', 'W12019701', 'W12019701', 'WYT1', 'Rock Springs Plastic Surgery', 'Scott', 'M', 'Sulentich', 'MD', 'Plastic Surgery', '', '', NULL, 'O', '1208 Hilltop Dr Ste 103', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073628211', '3073823451', '1208 Hilltop Dr Ste 103', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073628211', '3073823451', 'WUSTDPLAS5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'Memorial Hospital of Sweetwater County', '', '', '', 'HCFA|UB|', '1386738136', 0, 'N', 0, '2012-06-30', NULL, NULL, 0, 0, NULL, NULL),
('870553965', 'W12019850', 'W12019850', 'UT01', 'Total Respiratory Care', '', '', 'Total Respiratory Care', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'B', '1395 S 400 E Ste A', 'Logan', 'Cache', 'UT', '84341', '8012988831', '8012982549', '1395 S 400 E Ste A', 'Logan', 'Cache', 'UT', '84341', '8012988831', '8012982549', 'DME8012', '', '', '0.00', '0.00', '0.00', 3, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1376508291', 0, 'Y', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('870553965', 'W12019852', 'W12019852', 'UT01', 'Total Respiratory Care', '', '', 'Total Respiratory Care', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', '1593 W 2350 S Ste C', 'Woods Cross', 'Davis', 'UT', '84087', '8012988831', '8012982549', '1593 W 2350 S Ste C', 'Woods Cross', 'Davis', 'UT', '84087', '8012988831', '8012982549', 'DME8012', '', '', '0.00', '0.00', '0.00', 3, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1376508291', 0, 'N', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
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INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
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('275238772', 'W12019734', 'W12019734', 'ID02', 'Direct Surgical Assist', 'Jeffrey', 'D', 'Smith', 'PA-C', 'Physician Assistant', '', '', NULL, 'B', '5066 Bernard Ln', 'Fruitland', 'Payette', 'ID', '83619', '2084526794', '2089147522', '5066 Bernard Ln', 'Fruitland', 'Payette', 'ID', '83619', '2084526794', '2089147522', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2012-05-01', '2013-06-11', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1013905793', 0, 'N', 0, '2013-06-24', NULL, NULL, 0, 0, NULL, NULL),
('275238772', 'W12019733', 'W12019733', 'ID02', 'Direct Surgical Assist', 'Jeffrey', 'D', 'Smith', 'PA-C', 'Physician Assistant', '', '', NULL, 'O', '7979 W Rifleman St', 'Boise', 'Ada', 'ID', '83706', '2089890598', '2089147522', '7979 W Rifleman St', 'Boise', 'Ada', 'ID', '83706', '2089890598', '2089147522', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2012-05-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1013905793', 0, 'N', 0, '2013-06-24', NULL, NULL, 0, 0, NULL, NULL),
('271740523', 'W12019735', 'W12019735', 'ID02', 'Rocky Mountain Foot and Ankle', 'Phillip', 'R', 'Burk', 'DPM', 'Podiatry', '', '', NULL, 'B', '1818 10th Ste 250', 'Caldwell', 'Canyon', 'ID', '83605', '2084590891', '2084598628', '1818 10th Ste 250', 'Caldwell', 'Canyon', 'ID', '83605', '2084590891', '2084598628', 'IDACN', '', '', '0.00', '15.00', '0.00', 8, '2011-11-10', '2013-07-23', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1306064258', 0, 'N', 0, '2014-03-26', NULL, NULL, 0, 0, NULL, NULL),
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('870487560', 'W12019737', 'W12019737', 'UT01', '', 'Douglass', 'W', 'Forsha', 'MD', 'Dermatology', NULL, NULL, NULL, 'O', '3570 W 9000 S Ste 220', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015691456', NULL, '3570 W 9000 S Ste 220', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015691456', '          ', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-06-01', NULL, 0, 0, 0, 'Evanston Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1285674671', 0, 'N', 0, '2013-10-23', NULL, NULL, 40.588, -111.975, NULL, NULL),
('870487560', 'W12019738', 'W12019738', 'WY01', '', 'Douglass', 'W', 'Forsha', 'MD', 'Dermatology', NULL, NULL, NULL, 'O', '940 E 3rd St Ste 207', 'Casper', 'Natrona', 'WY', '82601', '3072652936', NULL, '940 E 3rd St Ste 207', 'Casper', 'Natrona', 'WY', '82601', '3072652936', '          ', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-06-01', NULL, 0, 0, 0, 'Evanston Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1285674671', 0, 'N', 0, '2013-10-23', NULL, NULL, 42.8477, -106.313, NULL, NULL),
('870487560', 'W12019739', 'W12019739', 'WYT1', '', 'Douglass', 'W', 'Forsha', 'MD', 'Dermatology', NULL, NULL, NULL, 'O', '940 E 3rd St Ste 207', 'Casper', 'Natrona', 'WY', '82601', '3072652936', NULL, '940 E 3rd St Ste 207', 'Casper', 'Natrona', 'WY', '82601', '3072652936', '          ', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-06-01', NULL, 0, 0, 0, 'Evanston Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1285674671', 0, 'N', 0, '2013-10-23', NULL, NULL, 0, 0, NULL, NULL),
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('260553931', 'W12019741', 'W12019741', 'IDBOISTD', 'Saint Alphonsus Regional Medical Center Nampa', 'Gerard', 'P', 'Connor', 'MD', 'Gynecologic Oncology', '', '', NULL, 'O', '1524 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2083675227', '2083675225', '1524 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2083675227', '2083675225', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-05-10', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1669470274', 0, 'N', 0, '2014-06-13', NULL, NULL, 43.5537, -116.573, NULL, NULL),
('820200895', 'W12019743', 'W12019743', 'ID01', 'Saint Alphonsus Regional Medical Center', 'Karena', '', 'Drewien', 'LCSW', 'Mental Health', 'Counseling', '', NULL, 'O', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083676238', '2083670285', '1055 N Curtis Rd', 'Boise', 'Ada', 'ID', '83706', '2083676238', '2083670285', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-05-10', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1932466018', 0, 'Y', 0, '2014-06-20', NULL, NULL, 43.6145, -116.254, NULL, NULL),
('260553931', 'W12019744', 'W12019744', 'ID01', 'Saint Alphonsus Medical Group Orthopedic Spine Surgery', 'Charles', 'T', 'Floyd', 'MD; Spine', 'Orthopedic Surgery', '', '', NULL, 'O', '1075 N Curtis Rd Ste 101', 'Boise', 'Ada', 'ID', '83706', '2083677463', '2083677507', '1075 N Curtis Rd Ste 101', 'Boise', 'Ada', 'ID', '83706', '2083677463', '2083677507', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-06-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1124039714', 0, 'N', 0, '2014-07-09', NULL, NULL, 43.6143, -116.258, NULL, NULL),
('820200895', 'W12019745', 'W12019745', 'IDBOISTD', 'Saint Alphonsus Medical Group Orthopedic Spine Surgery', 'Erik', 'K', 'Hanson', 'PA-C', 'Orthopedic Surgery', '', '', NULL, 'O', '1075 N Curtis Rd Ste 101', 'Boise', 'Ada', 'ID', '83706', '2083677463', '2083677507', '1075 N Curtis Rd Ste 101', 'Boise', 'Ada', 'ID', '83706', '2083677463', '2083677507', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-06-01', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|', '1124307665', 0, 'N', 0, '2014-06-20', NULL, NULL, 43.6143, -116.258, NULL, NULL),
('820200895', 'W12019748', 'W12019748', 'IDBOISTD', 'Saint Alphonsus Medical Group Pulmonary and Sleep Lab Nampa', 'Cary', '', 'Jackson', 'MD', 'Pulmonary', 'Sleep Medicine', 'Sleep Disorders', NULL, 'B', '1512 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2084656952', '2084656449', '1512 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2084656952', '2084656449', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-05-10', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|', '1932169042', 0, 'Y', 0, '2014-06-20', NULL, NULL, 43.5537, -116.573, NULL, NULL),
('820200895', 'W12019749', 'W12019749', 'ID01', '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', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-05-10', '2013-01-09', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|', '1932169042', 0, 'N', 0, '2014-06-20', NULL, NULL, 43.5551, -116.569, NULL, NULL),
('820312175', 'W12019751', 'W12019751', 'ID01', 'Idaho Emergency Physicians PA', 'Brian', '', 'Reynolds', 'MD', 'Emergency Medicine', '', '', NULL, 'B', '2963 E Copper Point Dr', 'Meridian', 'Ada', 'ID', '83642', '2083221730', NULL, '2963 E Copper Point Dr', 'Meridian', 'Ada', 'ID', '83642', '2083221730', '          ', 'IDSAMG3', '', '', '0.00', '10.00', '0.00', 3, '2012-05-10', NULL, 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1477636900', 0, 'N', 0, '2012-05-29', NULL, NULL, 0, 0, NULL, NULL),
('260553931', 'W12019753', 'W12019753', 'ID01', 'St Alphonsus Medical Group General Sugery Nampa', 'George', '', 'Waterhouse', 'MD', 'General Surgery', '', '', NULL, 'O', '1603 12th Ave Rd Ste E', 'Nampa', 'Canyon', 'ID', '83686', '2084656940', '2084656961', '1603 12th Ave Rd Ste E', 'Nampa', 'Canyon', 'ID', '83686', '2084656940', '2084656961', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-05-10', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1811052020', 0, 'Y', 0, '2013-08-21', NULL, NULL, 0, 0, NULL, NULL),
('260553931', 'W12019754', 'W12019754', 'ID01', 'St Alphonsus Medical Group General Sugery Nampa', 'George', '', 'Waterhouse', 'MD', 'General Surgery', '', '', NULL, 'B', '3340 E Goldstone', 'Meridian', 'Ada', 'ID', '83642', '2083675180', '2084656961', '3340 E Goldstone', 'Meridian', 'Ada', 'ID', '83642', '2083675180', '2084656961', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2012-05-10', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1811052020', 0, 'Y', 0, '2013-08-21', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12019760', 'W12019760', 'UTIHCPHY', 'Utah Valley Pulmonary Clinic', 'David', 'A', 'Bradshaw', 'MD', 'Pulmonary', 'Critical Care', '', NULL, 'O', '1055 N 300 W Ste 500', 'Provo', 'Utah', 'UT', '84604', '8013577291', '8013577919', '1055 N 300 W Ste 500', 'Provo', 'Utah', 'UT', '84604', '8013577291', '8013577919', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2012-04-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1104897800', 0, 'N', 0, '2012-05-29', NULL, NULL, 40.2476, -111.664, NULL, NULL),
('942854057', 'W12019761', 'W12019761', 'UTIHCPHY', 'Cedar City Clinic', 'Mark', 'W', 'Corry', 'MD', 'Urgent Care', 'Family Practice', '', NULL, 'O', '1303 N Main St Ste 3C', 'Cedar City', 'Iron', 'UT', '84720', '4358685500', '4358685504', '1303 N Main St Ste 3C', 'Cedar City', 'Iron', 'UT', '84720', '4358685500', '4358685504', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2012-07-02', NULL, 0, 0, 0, 'Valley View Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1033347158', 0, 'Y', 0, '2012-05-29', NULL, NULL, 37.7003, -113.064, NULL, NULL),
('942854057', 'W12019762', 'W12019762', 'UTIHCPHY', 'Dixie Acute Rehab', 'Karen', 'M', 'Frieden', 'MD', '', 'Hospitalist', '', 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, '2012-04-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1043289820', 0, 'N', 0, '2012-05-29', NULL, NULL, 37.0989, -113.575, NULL, NULL),
('942854057', 'W12019763', 'W12019763', 'UTIHCPHY', 'Dixie Acute Rehab', 'Jerold', 'L', 'Hagen', 'MD', 'Internal Medicine', '', '', 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, '2012-04-01', '2013-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1639102635', 0, 'N', 0, '2013-07-12', NULL, NULL, 0, 0, NULL, NULL),
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('942854057', 'W12019765', 'W12019765', 'UTIHCPHY', 'Southwest Cardiology-Cedar City', 'Jaime', 'J', 'Molden', 'MD', 'Cardiovascular Disease', 'Internal Medicine', '', NULL, 'O', '110 W 1325 N Ste 100', 'Cedar City', 'Iron', 'UT', '84721', '4352512500', '4352512525', '110 W 1325 N Ste 100', 'Cedar City', 'Iron', 'UT', '84721', '4352512500', '4352512525', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2012-04-19', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1356540272', 0, 'N', 0, '2013-11-18', NULL, NULL, 37.7011, -113.064, NULL, NULL),
('942854057', 'W12019766', 'W12019766', 'UTIHCPHY', 'Cedar City Clinic', 'Scott', 'G', 'Newbold', 'DO', 'Pediatrics', '', '', NULL, 'O', '1303 N Main St Ste 3C', 'Cedar City', 'Iron', 'UT', '84720', '4358685500', '4358685504', '1303 N Main St Ste 3C', 'Cedar City', 'Iron', 'UT', '84720', '4358685500', '4358685504', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2012-06-25', '2012-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1033393806', 0, 'N', 0, '2013-05-30', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12019770', 'W12019770', 'UTIHCPHY', 'Southwest Regional Cancer Clinic', 'Richard', 'C', 'Tebbs', 'PA-C', 'Radiation 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, '2012-04-30', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1053677245', 0, 'N', 0, '2012-05-29', NULL, NULL, 37.0989, -113.575, NULL, NULL),
('870284475', 'W12018231', 'W12018231', 'UT01', 'Granger Medical Clinic', 'Jeffrey', 'G', 'Miles', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '3725 W 4100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019653479', '8019653717', '3725 W 4100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019653479', '8019653717', 'WUGRANGER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-04-01', NULL, 0, 0, 0, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1952399966', 0, 'N', 0, '2012-05-31', NULL, NULL, 40.682, -111.979, NULL, NULL),
('271534643', 'W12019797', 'W12019797', 'UT01', 'Horizon Home Health', '', '', 'Home Health Specialists', 'Group', 'Home Health Agency', '', '', NULL, 'O', '720 S River Rd Ste D2105', 'St George', 'Washington', 'UT', '84790', '8012251919', '8012244081', '720 S River Rd Ste D2105', 'St George', 'Washington', 'UT', '84790', '8012251919', '8012244081', '', '', '4', '0.00', '40.00', '0.00', 3, '2010-05-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1811226772', 0, 'N', 0, '2012-07-02', NULL, NULL, 37.0958, -113.557, NULL, NULL),
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('043827062', 'W12019803', 'W12019803', 'UTDT01', 'Zimbi Dental', 'Jared', '', 'Flitton', 'DMD', 'Dentist', '', '', NULL, 'O', '2779 W 4000 S Ste 101', 'Roy', 'Weber', 'UT', '84067', '8017315528', NULL, '2779 W 4000 S Ste 101', 'Roy', 'Weber', 'UT', '84067', '8017315528', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2012-03-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1770878241', 0, 'N', 0, '2013-09-06', NULL, NULL, 0, 0, NULL, NULL),
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('262072378', 'W12019872', 'W12019872', 'UT01', 'Southern Utah Womens Health Center', 'Pamela', 'J', 'Sorensen', 'PA', 'Obstetrics and Gynecology', '', '', NULL, 'O', '515 S 300 E Ste 206', 'St George', 'Washington', 'UT', '84770', '4356281662', '4356281722', '515 S 300 E Ste 206', 'St George', 'Washington', 'UT', '84770', '4356281662', '4356281722', 'Wise+', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', '2013-05-31', 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1992972616', 0, 'N', 0, '2013-06-03', NULL, NULL, 0, 0, NULL, NULL),
('262072378', 'W12019873', 'W12019873', 'UT01', 'Southern Utah Womens Health Center', 'Tracy', 'W', 'Winward', 'MD', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'O', '515 S 300 E Ste 206', 'St George', 'Washington', 'UT', '84770', '4356281662', '4356281722', '515 S 300 E Ste 206', 'St George', 'Washington', 'UT', '84770', '4356281662', '4356281722', 'Wise+', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', '2013-05-31', 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1922008846', 0, 'N', 0, '2013-12-19', NULL, NULL, 0, 0, NULL, NULL);
INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
('262072378', 'W12019874', 'W12019874', 'UT01', 'Southern Utah Womens Health Center', 'Jeffrey', 'G', 'Rogers', 'MD', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'O', '515 S 300 E Ste 206', 'St George', 'Washington', 'UT', '84770', '4356281662', '4356281722', '515 S 300 E Ste 206', 'St George', 'Washington', 'UT', '84770', '4356281662', '4356281722', 'Wise+', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', '2013-05-31', 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1588664312', 0, 'N', 0, '2013-06-03', NULL, NULL, 0, 0, NULL, NULL),
('061642941', 'W12019875', 'W12019875', 'NM01', 'Walgreens Home Care Inc', '', '', 'Corinthian Care Group LLC', 'GROUP', 'Infusion Agency', '', '', NULL, 'O', '4374 Alexander Blvd NE Ste AC', 'Albuquerque', 'Bernalillo', 'NM', '87107', '8006453099', NULL, '4374 Alexander Blvd NE Ste AC', 'Albuquerque', 'Bernalillo', 'NM', '87107', '8006453099', '          ', '', '', 'TX2', '0.00', '100.00', '0.00', 8, '2012-05-15', '2012-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1043380983', 0, 'N', 0, '2012-07-03', NULL, NULL, 0, 0, NULL, NULL),
('743200478', 'W12019882', 'W12019882', 'UT01', 'Draper Family Practice', 'Carlie', '', 'Hamilton', 'NP', 'Family Practice', '', '', NULL, 'B', 'PO Box 572528', 'Salt Lake City', 'Salt Lake', 'UT', '84157', '8017477237', '8017481601', 'PO Box 572528', 'Salt Lake City', 'Salt Lake', 'UT', '84157', '8017477237', '8017481601', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-03-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1104978873', 0, 'Y', 0, '2013-08-21', NULL, NULL, 0, 0, NULL, NULL),
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('870571510', 'W12019907', 'W12019907', 'UT01', 'Layton Ambulatory Anesthesia', 'Troy', 'N', 'Cummons', 'DO', 'Anesthesia', '', '', NULL, 'B', 'PO Box 160354', 'Clearfield', 'Davis', 'UT', '84016', '8017748992', '8015250347', 'PO Box 160354', 'Clearfield', 'Davis', 'UT', '84016', '8017748992', '8015250347', '', '', '', '49.50', '0.00', '0.00', 3, '2030-01-01', '2030-01-01', 0, 12, 0, '', '', '', '', 'HCFA|UB|', '1497835698', 0, 'N', 0, '2012-10-12', NULL, NULL, 0, 0, NULL, NULL),
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('870625250', 'W12019909', 'W12019909', 'UTMH1', 'Sundance Behavioral Resources', 'Loren', '', 'Mitchell', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '845 E 4800 S Ste 200', 'Murray', 'Salt Lake', 'UT', '84107', '8012649522', NULL, '845 E 4800 S Ste 200', 'Murray', 'Salt Lake', 'UT', '84107', '8012649522', '          ', 'MA', '', '', '0.00', '35.00', '0.00', 6, '2012-08-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1932342516', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('262518076', 'W12019910', 'W12019910', 'ID01', 'Journey Mental Health', 'JoAnne', '', 'Nearman', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '3288 E Pine Ave', 'Meridian', 'Ada', 'ID', '83642', '2088888886', '2086580153', '3288 E Pine Ave', 'Meridian', 'Ada', 'ID', '83642', '2088888886', '2086580153', 'IDMA', '', '', '0.00', '35.00', '0.00', 3, '2012-08-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1083907620', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('274294367', 'W12019912', 'W12019912', 'ID01', 'Remedy Counseling Center', 'Caitlin', 'A', 'Parker-Weiser', 'LCPC', 'Mental Health', 'Counseling', '', NULL, 'O', '201 N 21st Ave', 'Caldwell', 'Canyon', 'ID', '83605', '2084551222', '2083661602', '201 N 21st Ave', 'Caldwell', 'Canyon', 'ID', '83605', '2084551222', '2083661602', 'IDMA', '', '', '0.00', '35.00', '0.00', 3, '2012-08-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1114105194', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('274294367', 'W12019911', 'W12019911', 'ID01', 'Remedy Counseling Center', 'Caitlin', 'A', 'Parker-Weiser', 'LCPC', 'Mental Health', 'Counseling', '', NULL, 'O', '750 W Ustick Rd Ste 120', 'Meridian', 'Ada', 'ID', '83646', '2083661601', '2083661602', '750 W Ustick Rd Ste 120', 'Meridian', 'Ada', 'ID', '83646', '2083661601', '2083661602', 'IDMA', '', '', '0.00', '35.00', '0.00', 3, '2012-08-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1114105194', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('876000299', 'W12019913', 'W12019913', 'UTMH1', 'Heber Valley Counseling', 'Alicia', 'M', 'Power', 'LMFT', 'Mental Health', 'Counseling', '', NULL, 'O', '55 S 500 E', 'Heber City', 'Wasatch', 'UT', '84032', '4356543003', '4356540309', '55 S 500 E', 'Heber City', 'Wasatch', 'UT', '84032', '4356543003', '4356540309', 'UTMA', '', '', '0.00', '35.00', '0.00', 8, '2012-07-01', '2013-01-02', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1164716122', 0, 'N', 0, '2013-07-09', NULL, NULL, 0, 0, NULL, NULL),
('870446927', 'W12019914', 'W12019914', 'UTMH1', '', 'Gary', 'P', 'Sazama', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '545 W 465 N Ste 130', 'Providence', 'Cache', 'UT', '84332', '4357528010', '4357528076', '545 W 465 N Ste 130', 'Providence', 'Cache', 'UT', '84332', '4357528010', '4357528076', 'UTMA', '', '', '0.00', '35.00', '0.00', 3, '2012-06-01', '2012-12-28', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1336233097', 0, 'N', 0, '2013-01-02', NULL, NULL, 0, 0, NULL, NULL),
('453449729', 'W12019915', 'W12019915', 'ID02', '', 'Heather', 'S', 'Tustison', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '1020 W Franklin St', 'Boise', 'Ada', 'ID', '83702', '2088690199', '2084243382', '1020 W Franklin St', 'Boise', 'Ada', 'ID', '83702', '2088690199', '2084243382', 'IDMA', '', '', '0.00', '35.00', '0.00', 3, '2012-03-01', '2013-02-14', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1285767913', 0, 'N', 0, '2014-07-15', NULL, NULL, 0, 0, NULL, NULL),
('870218917', 'W12019916', 'W12019916', 'UT01', 'Tanner Memorial Clinic', 'Gregory', 'T', 'Austad', 'DO', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 337', 'Layton', 'Davis', 'UT', '84041', '8017734840', NULL, 'PO Box 337', 'Layton', 'Davis', 'UT', '84041', '8017734840', '          ', 'WUTANNER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-11-01', NULL, 0, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1558574087', 0, 'N', 0, '2012-11-12', NULL, NULL, 0, 0, NULL, NULL),
('262072378', 'W12019918', 'W12019918', 'UT01', 'Valley Obstetrics & Gynecology PC', 'Jennifer', 'A', 'Cook', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '585 N 500 W', 'Provo', 'Utah', 'UT', '84601', '8013741801', '8012168357', '585 N 500 W', 'Provo', 'Utah', 'UT', '84601', '8013741801', '8012168357', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-08-01', '2013-05-31', 0, 0, 0, 'Brigham City Community Hospital', 'Timpanogos Regional Hospital', NULL, NULL, 'HCFA|UB|', '1679667315', 0, 'N', 0, '2014-03-10', NULL, NULL, 0, 0, NULL, NULL),
('262072378', 'W12019919', 'W12019919', 'UT01', 'Valley Obstetrics & Gynecology PC', 'Jennifer', 'A', 'Cook', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '700 W 800 N Ste 200', 'Orem', 'Utah', 'UT', '84057', '8017569635', '8012168357', '700 W 800 N Ste 200', 'Orem', 'Utah', 'UT', '84057', '8017569635', '8012168357', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-08-01', '2013-05-31', 0, 0, 0, 'Brigham City Community Hospital', 'Timpanogos Regional Hospital', NULL, NULL, 'HCFA|UB|', '1679667315', 0, 'N', 0, '2013-06-03', NULL, NULL, 0, 0, NULL, NULL),
('223941333', 'W12019922', 'W12019922', 'ID01', 'Treasure Valley Eye Center', 'Brandon', 'B', 'Crawford', 'OD', 'Optometry', '', '', NULL, 'O', '3045 E St Lukes St Ste 100', 'Meridian', 'Ada', 'ID', '83642', '2082882020', '2082882015', '3045 E St Lukes St Ste 100', 'Meridian', 'Ada', 'ID', '83642', '2082882020', '2082882015', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1912159823', 0, 'N', 0, '2013-11-08', NULL, NULL, 43.6011, -116.356, NULL, NULL),
('270690153', 'W12019924', 'W12019924', 'UT01', 'Peak HealthCare Inc', 'Mark', 'A', 'Frazier', 'MD', 'Family Practice', '', '', NULL, 'B', '590 E 100 N Ste 5', 'Price', 'Carbon', 'UT', '84501', '4356372324', '', '590 E 100 N Ste 5', 'Price', 'Carbon', 'UT', '84501', '4356372324', '', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-05-01', NULL, 0, 0, 0, 'Castleview Hospital', 'Castleview Hospital', '', '', 'HCFA|UB|', '1801113147', 0, 'N', 0, '2014-07-25', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W12019925', 'W12019925', 'UT01', 'Endocrinology of Utah', 'Gordon', 'T', 'Goodman', 'MD', 'Endocrinology', '', '', NULL, 'O', '5980 S Fashion Place Blvd', 'Murray', 'Salt Lake', 'UT', '84107', '8019643697', '8019643698', '5980 S Fashion Place Blvd', 'Murray', 'Salt Lake', 'UT', '84107', '8019643697', '8019643698', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2012-04-03', '2014-04-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1750349205', 0, 'N', 0, '2012-06-08', NULL, NULL, 40.6647, -111.883, NULL, NULL),
('113676182', 'W12019927', 'W12019927', 'TX01', 'The Podiatry Group of South Texas', 'Jeff', 'S', 'Henke', 'DPM', 'Podiatry', '', '', NULL, 'O', '135 Burton Creed Rd Ste 300', 'Kyle', 'Hays', 'TX', '78640', '5122683668', NULL, '135 Burton Creed Rd Ste 300', 'Kyle', 'Hays', 'TX', '78640', '5122683668', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-06-08', '2012-08-19', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1871539007', 0, 'N', 0, '2014-03-20', NULL, NULL, 30.0058, -97.8588, NULL, NULL),
('870550275', 'W12019928', 'W12019928', 'UT01', 'Wasatch Pediatrics Inc', 'Renee', '', 'Kindler', 'FNP', 'Pediatrics', '', '', NULL, 'O', '1140 E 3900 S Ste 360', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012648686', '8012648962', '1140 E 3900 S Ste 360', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012648686', '8012648962', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-07-01', '2012-10-12', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1588653828', 0, 'N', 0, '2012-10-16', NULL, NULL, 0, 0, NULL, NULL),
('870550275', 'W12019930', 'W12019930', 'UT01', 'Wasatch Pediatrics Inc', 'Renee', '', 'Kindler', 'FNP', 'Pediatrics', '', '', NULL, 'M', '7138 S 2000 E Ste 103', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012648686', '8012648962', '7138 S 2000 E Ste 103', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012648686', '8012648962', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-07-01', '2012-10-12', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1588653828', 0, 'N', 0, '2012-10-16', NULL, NULL, 0, 0, NULL, NULL),
('870550275', 'W12019929', 'W12019929', 'UT01', 'Wasatch Pediatrics Inc', 'Renee', '', 'Kindler', 'FNP', 'Pediatrics', '', '', NULL, 'B', 'PO Box 71550', 'Salt Lake City', 'Salt Lake', 'UT', '84171', '8019470830', '8019470864', 'PO Box 71550', 'Salt Lake City', 'Salt Lake', 'UT', '84171', '8019470830', '8019470864', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2010-07-01', '2012-10-12', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1588653828', 0, 'N', 0, '2012-10-16', NULL, NULL, 0, 0, NULL, NULL),
('528748014', 'W12019931', 'W12019931', 'UTMH1', '', 'James ', 'G', 'Johnson', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '2040 Murray Holladay Rd Ste 120', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8015712691', '8015712691', '2040 Murray Holladay Rd Ste 120', 'Salt Lake City', 'Salt Lake', 'UT', '84117', '8015712691', '8015712691', 'UTMA', '', '', '0.00', '35.00', '0.00', 6, '2012-05-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1336317650', 0, 'N', 0, '2013-07-24', NULL, NULL, 0, 0, NULL, NULL),
('870284475', 'W12019933', 'W12019933', 'UT01', 'Granger Medical Clinic', 'Ryan', 'B', 'Empey', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '3181 W 9000 S', 'West Jordan', 'Salt Lake', 'UT', '84088', '8013525900', '8013525914', '3181 W 9000 S', 'West Jordan', 'Salt Lake', 'UT', '84088', '8013525900', '8013525914', 'WUGRANGER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-11-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', '', '', '', 'HCFA|UB|', '1154589505', 0, 'N', 0, '2012-11-12', NULL, NULL, 40.5877, -111.967, NULL, NULL),
('870284475', 'W12019934', 'W12019934', 'UT01', 'Granger Medical Clinic', 'Ryan', 'B', 'Empey', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '3725 W 4100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019653600', '8019653740', '3725 W 4100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019653600', '8019653740', 'WUGRANGER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-11-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', '', '', '', 'HCFA|UB|', '1154589505', 0, 'N', 0, '2012-11-12', NULL, NULL, 40.682, -111.979, NULL, NULL),
('870284475', 'W12019935', 'W12019935', 'UT01', 'Granger Medical Clinic', 'Ryan', 'B', 'Empey', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 70658', 'Salt Lake City', 'Salt Lake', 'UT', '84170', '8019653600', NULL, 'PO Box 70658', 'Salt Lake City', 'Salt Lake', 'UT', '84170', '8019653600', '          ', 'WUGRANGER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-11-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', '', '', '', 'HCFA|UB|', '1154589505', 0, 'N', 0, '2012-11-12', NULL, NULL, 0, 0, NULL, NULL),
('741967809', 'W12019936', 'W12019936', 'TX01', 'Gastroenterology Consultants of San Antonio', 'David', 'P', 'Jones', 'DO', 'Gastroenterology', '', '', NULL, 'O', '11485 Topperwein Ste 2', 'San Antonio', 'Bexar', 'TX', '78233', '2106141234', '2106147749', '11485 Topperwein Ste 2', 'San Antonio', 'Bexar', 'TX', '78233', '2106141234', '2106147749', 'TXSURGA', 'TXHCPCS', '', '0.00', '50.00', '0.00', 6, '2012-08-01', '2012-08-19', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1265410914', 0, 'N', 0, '2013-04-24', NULL, NULL, 29.5423, -98.3402, NULL, NULL),
('741967809', 'W12019937', 'W12019937', 'TX01', 'Gastroenterology Consultants of San Antonio', 'David', 'P', 'Jones', 'DO', 'Gastroenterology', '', '', NULL, 'O', '855 Proton Rd', 'San Antonio', 'Bexar', 'TX', '78258', '2106141234', '2106147749', '855 Proton Rd', 'San Antonio', 'Bexar', 'TX', '78258', '2106141234', '2106147749', 'TXSURGA', 'TXHCPCS', '', '0.00', '50.00', '0.00', 6, '2012-08-01', '2012-08-19', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1265410914', 0, 'N', 0, '2013-04-24', NULL, NULL, 29.6127, -98.4809, NULL, NULL),
('741967809', 'W12019938', 'W12019938', 'TX01', 'Gastroenterology Consultants of San Antonio', 'David', 'P', 'Jones', 'DO', 'Gastroenterology', '', '', NULL, 'B', '8415 Datapoint Dr Ste 1000', 'San Antonio', 'Bexar', 'TX', '78229', '2106141234', NULL, '8415 Datapoint Dr Ste 1000', 'San Antonio', 'Bexar', 'TX', '78229', '2106141234', '          ', 'TXSURGA', 'TXHCPCS', '', '0.00', '50.00', '0.00', 6, '2012-08-01', '2012-08-19', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1265410914', 0, 'N', 0, '2013-04-24', NULL, NULL, 0, 0, NULL, NULL),
('870281299', 'W12019940', 'W12019940', 'UT01', 'The Clinic PC', 'Shawn', 'P', 'McManus', 'DO', 'Family Practice', '', '', NULL, 'B', '226 N 1100 E Ste A', 'American Fork', 'Utah', 'UT', '84003', '8017668427', '8017665657', '226 N 1100 E Ste A', 'American Fork', 'Utah', 'UT', '84003', '8017668427', '8017665657', 'WUTANNER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-11-01', '2013-06-30', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1376707323', 0, 'N', 0, '2013-10-25', NULL, NULL, 0, 0, NULL, NULL),
('870281299', 'W12019941', 'W12019941', 'UT01', 'The Clinic PC', 'Shawn', 'P', 'McManus', 'DO', 'Family Practice', '', '', NULL, 'O', '76 E Commerce Dr Ste 204', 'Saratoga Springs', 'Utah', 'UT', '84045', '8017668427', '8017665657', '76 E Commerce Dr Ste 204', 'Saratoga Springs', 'Utah', 'UT', '84045', '8017668427', '8017665657', 'WUTANNER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-11-01', '2013-06-30', 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1376707323', 0, 'N', 0, '2013-10-25', NULL, NULL, 0, 0, NULL, NULL),
('201312583', 'W12019939', 'W12019939', 'ID01', 'Life Counseling Center', 'Kelly Javin', 'D', 'Mather', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '112 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2084655433', NULL, '112 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2084655433', '          ', 'IDMA', '', '', '0.00', '35.00', '0.00', 6, '2012-08-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1952668683', 0, 'N', 0, '2012-08-28', NULL, NULL, 0, 0, NULL, NULL),
('223941333', 'W12019945', 'W12019945', 'ID01', 'Treasure Valley Eye Center', 'Mark ', 'R', 'Miller', 'MD', 'Ophthalmology', '', '', NULL, 'O', '3045 E St Lukes St Ste 100', 'Meridian', 'Ada', 'ID', '83642', '2082882020', '2082882015', '3045 E St Lukes St Ste 100', 'Meridian', 'Ada', 'ID', '83642', '2082882020', '2082882015', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-06-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1881629327', 0, 'N', 0, '2012-11-08', NULL, NULL, 43.6006, -116.357, NULL, NULL),
('742592013', 'W12019950', 'W12019950', 'TX01', 'Dermatology Associates of San Antonio', 'Liliana', 'J', 'Saap', 'MD', 'Dermatology', '', '', NULL, 'O', '18540 Sigma Rd', 'San Antonio', 'Bexar', 'TX', '78258', '2104904661', NULL, '18540 Sigma Rd', 'San Antonio', 'Bexar', 'TX', '78258', '2104904661', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-01', '2012-08-19', 0, 0, 0, 'North Central Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1861460644', 0, 'N', 0, '2012-08-15', NULL, NULL, 29.6125, -98.4829, NULL, NULL),
('742592013', 'W12019951', 'W12019951', 'TX01', 'Dermatology Associates of San Antonio', 'Liliana', 'J', 'Saap', 'MD', 'Dermatology', '', '', NULL, 'B', '7832 Pat Booker Rd', 'San Antonio', 'Bexar', 'TX', '78233', '2106579338', NULL, '7832 Pat Booker Rd', 'San Antonio', 'Bexar', 'TX', '78233', '2106579338', '          ', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2012-08-01', '2012-08-19', 0, 0, 0, 'North Central Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1861460644', 0, 'N', 0, '2012-08-15', NULL, NULL, 29.5623, -98.3334, NULL, NULL),
('262072378', 'W12019953', 'W12019953', 'UT01', 'Valley Obstetrics & Gynecology PC', 'Sue', '', 'Schlegelmilch', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'B', '585 N 500 W', 'Provo', 'Utah', 'UT', '84601', '8013741801', '8012168357', '585 N 500 W  ', 'Provo', 'Utah', 'UT', '84601', '8013741801', '8012168357', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-08-01', '2013-05-31', 0, 0, 0, 'Timpanogos Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1366580714', 0, 'N', 0, '2014-03-10', NULL, NULL, 0, 0, NULL, NULL),
('262072378', 'W12019952', 'W12019952', 'UT01', 'Valley Obstetrics & Gynecology PC', 'Sue', '', 'Schlegelmilch', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '700 W 800 N Ste 200', 'Orem', 'Utah', 'UT', '84057', '8014344443', '8012168357', '700 W 800 N Ste 200', 'Orem', 'Utah', 'UT', '84057', '8014344443', '8012168357', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-08-01', '2013-05-31', 0, 0, 0, 'Timpanogos Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1366580714', 0, 'N', 0, '2013-06-03', NULL, NULL, 0, 0, NULL, NULL),
('870550275', 'W12019954', 'W12019954', 'UT01', 'Wasatach Pediatrics Inc', 'Andrea', '', 'Southerland', 'FNP', 'Pediatrics', '', '', NULL, 'O', '5770 S 250 E Ste 290', 'Murray', 'Salt Lake', 'UT', '84107', '8017478700', '8017478701', '5770 S 250 E Ste 290', 'Murray', 'Salt Lake', 'UT', '84107', '8017478700', '8017478701', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1932353380', 0, 'N', 0, '2013-09-23', NULL, NULL, 40.6452, -111.884, NULL, NULL),
('870550275', 'W12019955', 'W12019955', 'UT01', 'Wasatach Pediatrics Inc', 'Andrea', '', 'Southerland', 'FNP', 'Pediatrics', '', '', NULL, 'B', 'PO Box 71550', 'Salt Lake City', 'Salt Lake', 'UT', '84171', '8019470830', '8019470864', 'PO Box 71550', 'Salt Lake City', 'Salt Lake', 'UT', '84171', '8019470830', '8019470864', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1932353380', 0, 'N', 0, '2013-09-23', NULL, NULL, 0, 0, NULL, NULL),
('870550275', 'W12019956', 'W12019956', 'UT01', 'Wasatch Pediatrics Inc', 'Andrea', '', 'Southerland', 'FNP', 'Pediatrics', '', '', NULL, 'M', '7138 S 2000 E Ste 103', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8014539625', '8019447347', '7138 S 2000 E Ste 103', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8014539625', '8019447347', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1932353380', 0, 'N', 0, '2013-09-23', NULL, NULL, 0, 0, NULL, NULL),
('455225142', 'W12019957', 'W12019957', 'UT01', '+240 = 10 mins unit U-U Anesthesiology Department NCC-SICU School of Medicine', '', '', 'U-U Anesthesiology Department NCC-SICU School of Medicine', '', 'Anesthesiology', '', '', NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015816393', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015816393', '          ', 'WUUUMGANES', '', '', '57.68', '25.00', '0.00', 3, '2012-06-01', '2012-12-31', 1, 12, 0, '', '', '', '', 'HCFA|UB|', '1497014781', 0, 'N', 0, '2014-01-06', NULL, NULL, 0, 0, NULL, NULL),
('455225142', 'W12019967', 'W12019967', 'UT01', '+240 = 10 mins unit U-U Anesthesiology Department NCC-SICU School of Medicine', '', '', 'U-U Anesthesiology Department NCC-SICU School of Medicine', '', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', NULL, 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', '          ', 'WUUUMGANES', '', '', '57.68', '25.00', '0.00', 3, '2012-06-01', '2012-12-31', 1, 12, 0, '', '', '', '', 'HCFA|UB|', '1497014781', 0, 'N', 0, '2014-01-06', NULL, NULL, 0, 0, NULL, NULL),
('262072378', 'W12019968', 'W12019968', 'UT01', 'Valley Obstetrics & Gynecology PC', 'Dena', 'R', 'Walker', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '585 N 500 W', 'Provo', 'Utah', 'UT', '84601', '8013741801', '8013750369', '585 N 500 W', 'Provo', 'Utah', 'UT', '84601', '8013741801', '8013750369', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-08-01', '2013-05-31', 0, 0, 0, 'Timpanogos Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1750312831', 0, 'N', 0, '2014-03-10', NULL, NULL, 0, 0, NULL, NULL),
('454855728', 'W12019970', 'W12019970', 'UT01', 'Obstetrix Medical Group of Utah', 'Robert', 'H', 'Ball', 'MD', 'Perinatology', '', '', NULL, 'O', '1140 E 3900 S Ste 390', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8017434700', NULL, '1140 E 3900 S Ste 390', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8017434700', '          ', '', '', '', '0.00', '20.00', '0.00', 3, '2012-06-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1447215751', 0, 'N', 0, '2012-06-25', NULL, NULL, 40.6871, -111.859, NULL, NULL),
('454855728', 'W12019971', 'W12019971', 'UT01', 'Obstetrix Medical Group of Utah', 'Robert', 'H', 'Ball', 'MD', 'Perinatology', '', '', NULL, 'M', '4722 N 24th St Ste 150', 'Phoenix', 'Maricopa', 'AZ', '85016', '8017434713', NULL, '4722 N 24th St Ste 150', 'Phoenix', 'Maricopa', 'AZ', '85016', '8017434713', '          ', '', '', '', '0.00', '20.00', '0.00', 3, '2012-06-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1447215751', 0, 'N', 0, '2012-06-25', NULL, NULL, 0, 0, NULL, NULL),
('273995478', 'W12019932', 'W12019932', 'UT01', 'Southwest Spine and Pain Care', 'Brook', 'J', 'Mickelson', 'FNP', 'Pain Management', '', '', NULL, 'O', '652 S Medical Ctr Dr Ste 110', 'St George', 'Washington', 'UT', '84790', '4356562424', '4356562828', '652 S Medical Ctr Dr Ste 110', 'St George', 'Washington', 'UT', '84790', '4356562424', '4356562828', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-06-04', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1013916915', 0, 'N', 0, '2014-05-08', NULL, NULL, 37.0498, -113.574, NULL, NULL),
('870284475', 'W12019972', 'W12019972', 'UT01', 'Granger Medical Clinic', 'Kathryn', '', 'Casull', 'MD', 'Internal Medicine', NULL, NULL, NULL, 'O', '3725 W 4100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019653419', '8019653740', '3725 W 4100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019653419', '8019653740', 'WUGRANGER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'Pioneer Valley Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1831256635', 0, 'N', 0, '2013-08-28', NULL, NULL, 40.682, -111.979, NULL, NULL),
('452218152', 'ELHCA0189', 'ELHCA0189', 'TXHOUSTD', 'Cardiology Specialists of Houston', 'Juan', NULL, 'Rozo', 'MD', 'Cardiology', '', '', NULL, 'O', '1140 Westmont', 'Houston', 'Harris', 'TX', '77015', '7137971620', '7137971543', '1140 Westmont', 'Houston', 'Harris', 'TX', '77015', '7137971620', '7137971543', 'HCA', 'TXHCPC13', NULL, '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Bayshore Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1639164239', 0, 'N', 0, '2013-05-01', NULL, NULL, 29.773, -95.1947, NULL, NULL),
('454855728', 'W12019974', 'W12019974', 'UT01', 'Obstetrix Medical Group of Utah', 'Robert', 'H', 'Ball', 'MD', 'Perinatology', '', '', NULL, 'B', 'PO Box 840532', 'Dallas', 'Dallas', 'TX', '75284', '8014764280', NULL, 'PO Box 840532', 'Dallas', 'Dallas', 'TX', '75284', '8014764280', '          ', '', '', '', '0.00', '20.00', '0.00', 3, '2012-06-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1447215751', 0, 'N', 0, '2012-06-25', NULL, NULL, 0, 0, NULL, NULL),
('454855728', 'W12019975', 'W12019975', 'UT01', 'Mountain West Medical Center', 'Robert', 'H', 'Ball', 'MD', 'Perinatology', '', '', NULL, 'O', '2055 N Main St', 'Tooele', 'Tooele', 'UT', '84074', '8017434700', NULL, '2055 N Main St', 'Tooele', 'Tooele', 'UT', '84074', '8017434700', '          ', '', '', '', '0.00', '20.00', '0.00', 3, '2012-06-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1447215751', 0, 'Y', 0, '2012-06-25', NULL, NULL, 40.5716, -112.295, NULL, NULL),
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('454855728', 'W12019978', 'W12019978', 'UT01', 'St. Marks Hospital', 'Robert', 'H', 'Ball', 'MD', 'Perinatology', '', '', NULL, 'O', '1200 E 3900 S ', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8017434700', NULL, '1200 E 3900 S ', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8017434700', '          ', '', '', '', '0.00', '20.00', '0.00', 3, '2012-06-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1447215751', 0, 'Y', 0, '2012-06-25', NULL, NULL, 40.6871, -111.856, NULL, NULL),
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('202148889', 'W12019982', 'W12019982', 'TX01', 'Health Texas Medical Group of San Antonio', 'Eduardo', 'O', 'Caveda', 'MD', 'Family Practice', '', '', NULL, 'M', '6243 IH 10 W Ste 480', 'San Antonio', 'Bexar', 'TX', '78201', '2103714800', NULL, '6243 IH 10 W Ste 480', 'San Antonio', 'Bexar', 'TX', '78201', '2103714800', '          ', 'TXINT', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2030-01-01', '2012-08-19', 0, 0, 0, 'Baptist Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1811947880', 0, 'N', 0, '2012-11-12', NULL, NULL, 29.487, -98.5422, NULL, NULL),
('202148889', 'W12019983', 'W12019983', 'TX01', 'Health Texas Medical Group of San Antonio', 'Eduardo', 'O', 'Caveda', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 100026', 'San Antonio', 'Bexar', 'TX', '78201', '2108282531', NULL, 'PO Box 100026', 'San Antonio', 'Bexar', 'TX', '78201', '2108282531', '          ', 'TXINT', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2030-01-01', '2012-08-19', 0, 0, 0, 'Baptist Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1811947880', 0, 'N', 0, '2012-11-12', NULL, NULL, 0, 0, NULL, NULL),
('204043287', 'W12019987', 'W12019987', 'NM01', 'ABQ Health Partners', 'Ryan ', 'Patrick ', 'Tyner', 'MD', 'General Surgery', '', '', NULL, 'M', '5400 Gibson Blvd SE', 'Albuquerque', 'Bernalillo', 'NM', '87108', '5058726000', '5058726003', '5400 Gibson Blvd SE', 'Albuquerque', 'Bernalillo', 'NM', '87108', '5058726000', '5058726003', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2012-05-18', NULL, 0, 0, 0, 'Lovelace Westside Hospital', '', '', '', 'HCFA|UB|', '1003092701', 0, 'N', 0, '2014-07-14', NULL, NULL, 0, 0, NULL, NULL),
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('204043287', 'W12019986', 'W12019986', 'NM01', 'ABQ Health Partners', 'Ryan ', 'Patrick ', 'Tyner', 'MD', 'General Surgery', '', '', NULL, 'B', 'PO Box 27829           ', 'Albuquerque', 'Bernalillo', 'NM', '87125', '5052627600', '5058888503', 'PO Box 27829           ', 'Albuquerque', 'Bernalillo', 'NM', '87125', '5052627600', '5058888503', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2012-05-18', NULL, 0, 0, 0, 'Lovelace Westside Hospital', '', '', '', 'HCFA|UB|', '1003092701', 0, 'N', 0, '2014-07-14', NULL, NULL, 0, 0, NULL, NULL),
('870284475', 'W12019988', 'W12019988', 'UT01', 'Granger Medical Clinic', 'Bonnie', 'J', 'Shurtliff', 'PA', 'Family Practice', '', '', NULL, 'O', '12391 S 4000 W', 'Riverton', 'Salt Lake', 'UT', '84065', '8013021700', '8013021712', '12391 S 4000 W', 'Riverton', 'Salt Lake', 'UT', '84065', '8013021700', '8013021712', 'WUGRANGER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-08-01', NULL, 0, 0, 0, 'Riverton Childrens Unit Operated by Primary Childrens Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1487805743', 0, 'N', 0, '2012-10-09', NULL, NULL, 40.5226, -111.987, NULL, NULL),
('870284475', 'W12019989', 'W12019989', 'UT01', 'Granger Medical Clinic', 'Bonnie', 'J', 'Shurtliff', 'PA', 'Family Practice', '', '', NULL, 'O', '3725 W 4100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019653608', '8019683605', '3725 W 4100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019653608', '8019683605', 'WUGRANGER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-08-01', NULL, 0, 0, 0, 'Riverton Childrens Unit Operated by Primary Childrens Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1487805743', 0, 'N', 0, '2012-10-09', NULL, NULL, 40.682, -111.979, NULL, NULL),
('870284475', 'W12019990', 'W12019990', 'UT01', 'Granger Medical Clinic', 'Bonnie', 'J', 'Shurtliff', 'PA', 'Family Practice', '', '', NULL, 'B', 'PO Box 70658', 'Salt Lake City', 'Salt Lake', 'UT', '84170', '8019653720', '8019653740', 'PO Box 70658', 'Salt Lake City', 'Salt Lake', 'UT', '84170', '8019653720', '8019653740', 'WUGRANGER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-08-01', NULL, 0, 0, 0, 'Riverton Childrens Unit Operated by Primary Childrens Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1487805743', 0, 'N', 0, '2012-10-09', NULL, NULL, 0, 0, NULL, NULL),
('528801213', 'W12019991', 'W12019991', 'UTMH1', '', 'Patricia', '', 'McWhorter', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'B', 'PO Box 132', 'Sandy', 'Salt Lake', 'UT', '84091', '4358437060', NULL, 'PO Box 132', 'Sandy', 'Salt Lake', 'UT', '84091', '4358437060', '', 'ma', '', '', '0.00', '35.00', '0.00', 3, '2012-06-11', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1881750644', 0, 'N', 0, '2014-05-01', NULL, NULL, 0, 0, NULL, NULL),
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('453722062', 'W12019995', 'W12019995', 'UT01', 'Intermountain Lipid Center', 'Eliot', 'A', 'Brinton', 'MD', 'Endocrinology', 'Cardiovascular Disease', NULL, NULL, 'M', '596 W 750 S Ste 300', 'Bountiful', 'Davis', 'UT', '84010', '8015816862', NULL, '596 W 750 S Ste 300', 'Bountiful', 'Davis', 'UT', '84010', '8015816862', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1033209614', 0, 'N', 0, '2012-07-10', NULL, NULL, 0, 0, NULL, NULL),
('453722062', 'W12019994', 'W12019994', 'UT01', 'Intermountain Lipid Center', 'Eliot', 'A', 'Brinton', 'MD', 'Endocrinology', 'Cardiovascular Disease', NULL, NULL, 'O', '676 East Vine St Ste 6', 'Murray', 'Salt Lake', 'UT', '84107', '8015816862', NULL, '676 East Vine St Ste 6', 'Murray', 'Salt Lake', 'UT', '84107', '8015816862', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1033209614', 0, 'N', 0, '2012-07-10', NULL, NULL, 40.6548, -111.872, NULL, NULL),
('453722062', 'W12019996', 'W12019996', 'UT01', 'Intermountain Lipid Center', 'Eliot', 'A', 'Brinton', 'MD', 'Endocrinology', 'Cardiovascular Disease', NULL, NULL, 'B', 'PO Box 268', 'Bountiful', 'Davis', 'UT', '84010', '8015816862', NULL, 'PO Box 268', 'Bountiful', 'Davis', 'UT', '84010', '8015816862', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1033209614', 0, 'N', 0, '2012-07-10', NULL, NULL, 0, 0, NULL, NULL),
('223941333', 'W12019997', 'W12019997', 'ID01', 'Treasure Valley Eye Center', 'Bret', 'D', 'Williams', 'OD', 'Optometry', '', '', NULL, 'O', '3045 E St Lukes St Ste 100', 'Meridian', 'Ada', 'ID', '83642', '2082882020', '2082882015', '3045 E St Lukes St Ste 100', 'Meridian', 'Ada', 'ID', '83642', '2082882020', '2082882015', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1528003589', 0, 'N', 0, '2012-06-30', NULL, NULL, 43.6011, -116.356, NULL, NULL),
('830237313', 'W12024414', 'W12024414', 'WY01', 'Sheridan Pathology Associates', 'William', '', 'Doughty', '', 'Clinical Pathology', '', '', NULL, 'O', '1401 W Fifth St', 'Sheridan', 'Sheridan', 'WY', '82801', '3076721040', NULL, '1401 W Fifth St  ', 'Sheridan', 'Sheridan', 'WY', '82801', '3076721040', '          ', 'WYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-02-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1871677914', 0, 'N', 0, '2013-01-09', NULL, NULL, 44.8074, -106.976, NULL, NULL),
('454855728', 'W12019548', 'W12019548', 'UT01', 'Obstetrix Medical Group of Utah', 'Paul', 'W', 'Whitecar', 'MD', 'Maternal Fetal Medicine', '', '', NULL, 'O', '1140 E 3900 S Ste 390', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8017434713', NULL, '1140 E 3900 S Ste 390', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8017434713', '          ', '', '', '', '0.00', '20.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'St Marks Hospital', 'Ogden Regional Medical Center', '', '', 'HCFA|UB|', '1639144934', 0, 'N', 0, '2013-05-07', NULL, NULL, 40.6871, -111.859, NULL, NULL),
('454855728', 'W12019549', 'W12019549', 'UT01', 'Obstetrix Medical Group of Utah', 'Paul', 'W', 'Whitecar', 'MD', 'Maternal Fetal Medicine', '', '', NULL, 'O', '1200 S 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012687111', NULL, '1200 S 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012687111', '          ', '', '', '', '0.00', '20.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'St Marks Hospital', 'Ogden Regional Medical Center', '', '', 'HCFA|UB|', '1639144934', 0, 'N', 0, '2013-05-07', NULL, NULL, 0, 0, NULL, NULL),
('454855728', 'W12019550', 'W12019550', 'UT01', 'Obstetrix Medical Group of Utah', 'Paul', 'W', 'Whitecar', 'MD', 'Maternal Fetal Medicine', '', '', NULL, 'M', '4722 N 24th St Ste 150', 'Phoenix', 'Maricopa', 'AZ', '85016', '8014764280', NULL, '4722 N 24th St Ste 150', 'Phoenix', 'Maricopa', 'AZ', '85016', '8014764280', '          ', '', '', '', '0.00', '20.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'St Marks Hospital', 'Ogden Regional Medical Center', '', '', 'HCFA|UB|', '1639144934', 0, 'N', 0, '2013-05-07', NULL, NULL, 0, 0, NULL, NULL),
('454855728', 'W12019551', 'W12019551', 'UT01', 'Obstetrix Medical Group of Utah', 'Paul', 'W', 'Whitecar', 'MD', 'Maternal Fetal Medicine', '', '', NULL, 'B', 'PO Box 840532', 'Dallas', 'Dallas', 'TX', '75284', '8014764280', NULL, 'PO Box 840532', 'Dallas', 'Dallas', 'TX', '75284', '8014764280', '          ', '', '', '', '0.00', '20.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'St Marks Hospital', 'Ogden Regional Medical Center', '', '', 'HCFA|UB|', '1639144934', 0, 'N', 0, '2013-05-07', NULL, NULL, 0, 0, NULL, NULL),
('820492308', 'W12019999', 'W12019999', 'ID02', 'Idaho Gastroenterology Associates', 'Christopher', 'W', 'Hammerle', 'MD', 'Gastroenterology', '', '', NULL, 'O', '2235 E Gala St', 'Meridian', 'Ada', 'ID', '83642', '2088873724', '2088871682', '2235 E Gala St', 'Meridian', 'Ada', 'ID', '83642', '2088873724', '2088871682', 'IDPPONONFAC', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-10-01', '2014-06-30', 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1740336361', 0, 'N', 0, '2014-06-19', NULL, NULL, 0, 0, NULL, NULL),
('820492308', 'W12019998', 'W12019998', 'ID02', 'Idaho Gastroenterology Associates', 'Christopher', 'W', 'Hammerle', 'MD', 'Gastroenterology', '', '', NULL, 'O', '425 W Bannock St', 'Boise', 'Ada', 'ID', '83702', '2083436458', '2088435031', '425 W Bannock St', 'Boise', 'Ada', 'ID', '83702', '2083436458', '2088435031', 'IDPPONONFAC', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-10-01', '2014-06-30', 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1740336361', 0, 'N', 0, '2014-06-19', NULL, NULL, 0, 0, NULL, NULL),
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('870533611', 'W12020018', 'W12020018', 'UT01', 'North Davis Anesthesiology', 'Clay', '', 'Richardson', 'DO', 'Anesthesiology', '', '', NULL, 'B', '1652 Wildcat Ln', 'Ogden', 'Weber', 'UT', '84403', '8013932249', NULL, '1652 Wildcat Ln', 'Ogden', 'Weber', 'UT', '84403', '8013932249', '          ', '', '', '1000', '54.00', '0.00', '0.00', 6, '2013-06-15', NULL, 1, 12, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1295950731', 0, 'Y', 0, '2012-06-12', 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
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('870533611', 'W12020020', 'W12020020', 'UT01', 'North Davis Anesthesiology', 'Melvin', 'K', 'Richardson', 'MD', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 160354', 'Clearfield', 'Davis', 'UT', '84016', '8017748992', NULL, 'PO Box 160354', 'Clearfield', 'Davis', 'UT', '84016', '8017748992', '          ', '', '', '1000', '54.00', '0.00', '0.00', 6, '2013-06-15', NULL, 1, 12, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1467401737', 0, 'Y', 0, '2012-06-12', NULL, NULL, 0, 0, NULL, NULL),
('870533611', 'W12020021', 'W12020021', 'UT01', 'North Davis Anesthesiology', 'Mark', 'E', 'Rush', 'MD', 'Pain Management', 'Anesthesiology', '', NULL, 'B', 'PO Box 160354', 'Clearfield', 'Davis', 'UT', '84016', '8017748992', NULL, 'PO Box 160354', 'Clearfield', 'Davis', 'UT', '84016', '8017748992', '          ', '', '', '1000', '52.50', '0.00', '0.00', 6, '2012-06-15', '2013-06-14', 1, 12, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1801840806', 0, 'Y', 0, '2012-06-12', NULL, NULL, 0, 0, NULL, NULL),
('870533611', 'W12020022', 'W12020022', 'UT01', 'North Davis Anesthesiology', 'Mark', 'E', 'Rush', 'MD', 'Pain Management', 'Anesthesiology', '', NULL, 'B', 'PO Box 160354', 'Clearfield', 'Davis', 'UT', '84016', '8017748992', NULL, 'PO Box 160354', 'Clearfield', 'Davis', 'UT', '84016', '8017748992', '          ', '', '', '1000', '54.00', '0.00', '0.00', 6, '2013-06-15', NULL, 1, 12, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1801840806', 0, 'Y', 0, '2012-06-12', NULL, NULL, 0, 0, NULL, NULL),
('271387716', 'W12020028', 'W12020028', 'UT01', 'Kidney and Internal Medicine', 'Nazia', '', 'Junejo', 'MD', 'Internal Medicine', 'Nephrology', '', NULL, 'O', '1212 N Main St', 'West Jordan', 'Salt Lake', 'UT', '84084', '4352490554', '4352490744', '1212 N Main St', 'West Jordan', 'Salt Lake', 'UT', '84084', '4352490554', '4352490744', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-06-15', NULL, 0, 0, 0, 'Jordan Valley Medical Center', 'St Marks Hospital', 'Pioneer Valley Hospital', '', 'HCFA|UB|', '1346218047', 0, 'N', 0, '2013-04-26', NULL, NULL, 0, 0, NULL, NULL),
('830234097', 'W12020030', 'W12020030', 'WYT1', 'Powder River Orthopedics and Spine', 'Hans', 'C', 'Kioschos', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '508 Stocktrail Ste A', 'Gillette', 'Campbell', 'WY', '82716', '3076861413', '3076821113', '508 Stocktrail Ste A', 'Gillette', 'Campbell', 'WY', '82716', '3076861413', '3076821113', '', '', '', '0.00', '21.00', '0.00', 6, '2012-06-29', NULL, 0, 0, 0, 'Campbell County Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1740274265', 0, 'N', 0, '2013-09-17', NULL, NULL, 0, 0, NULL, NULL),
('830234097', 'W12020035', 'W12020035', 'WYT1', 'Powder River Orthopedics and Spine', 'John', 'P', 'Dunn', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '508 Stocktrail Ste A', 'Gillette', 'Campbell', 'WY', '82716', '3076861413', '3076821113', '508 Stocktrail Ste A', 'Gillette', 'Campbell', 'WY', '82716', '3076861413', '3076821113', '', '', '', '0.00', '21.00', '0.00', 6, '2012-06-29', NULL, 0, 0, 0, 'Campbell County Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1639163702', 0, 'N', 0, '2013-09-17', NULL, NULL, 0, 0, NULL, NULL),
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('942854057', 'W12020038', 'W12020038', 'UTPEHP', 'Utah Valley Heart & Lung Surgical Associates', 'John', 'H', 'Mitchell', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1134 N 500 W Ste 100', 'Provo', 'Utah', 'UT', '84604', '8013577081', '8013577351', '1134 N 500 W Ste 100', 'Provo', 'Utah', 'UT', '84604', '8013577081', '8013577351', 'IHCPEHP', '', '', '0.00', '30.00', '0.00', 8, '2008-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1699781674', 0, 'N', 0, '2014-07-09', NULL, NULL, 0, 0, NULL, NULL),
('161767581', 'W12020040', 'W12020040', 'UT01', 'Layton Family Practice LLC', 'Samuel', 'J', 'Otto', 'MD', 'Urology', '', '', NULL, 'O', '2950 N Church St Ste 200', 'Layton', 'Davis', 'UT', '84040', '8015469441', '8015462422', '2950 N Church St Ste 200', 'Layton', 'Davis', 'UT', '84040', '8015469441', '8015462422', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-06-15', '2012-06-30', 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1154565273', 0, 'N', 0, '2014-04-09', NULL, NULL, 0, 0, NULL, NULL),
('161767581', 'W12020041', 'W12020041', 'UT01', 'Layton Family Practice LLC', 'Samuel', 'J', 'Otto', 'MD', 'Urology', '', '', NULL, 'B', 'PO Box 281221', 'Atlanta', 'Fulton', 'GA', '30384', '8015469441', '8015462422', 'PO Box 281221', 'Atlanta', 'Fulton', 'GA', '30384', '8015469441', '8015462422', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-06-15', '2012-06-30', 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1154565273', 0, 'N', 0, '2014-04-09', NULL, NULL, 0, 0, NULL, NULL),
('204043287', 'W12020045', 'W12020045', 'NM01', 'ABQ Health Partners', 'David', '', 'Vity', 'PA-C', 'Urgent Care', '', '', NULL, 'B', 'PO Box 27829', 'Albuquerque', 'Bernalillo', 'NM', '87125', '5052627600', '5052627776', 'PO Box 27829', 'Albuquerque', 'Bernalillo', 'NM', '87125', '5052627600', '5052627776', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2012-05-21', NULL, 0, 0, 0, 'Lovelace Womens Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1174626071', 0, 'N', 0, '2012-06-13', NULL, NULL, 0, 0, NULL, NULL),
('161767581', 'W12020046', 'W12020046', 'UT01', 'Layton Family Practice LLC', 'Scott', '', 'Moulton', 'DO', 'Urology', '', '', NULL, 'O', '2950 N Church St Ste 200', 'Layton', 'Davis', 'UT', '84040', '8015469441', '8015462422', '2950 N Church St Ste 200', 'Layton', 'Davis', 'UT', '84040', '8015469441', '8015462422', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-06-15', '2012-06-30', 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1811141211', 0, 'N', 0, '2014-04-09', NULL, NULL, 0, 0, NULL, NULL),
('263091124', 'ELHCA0188', 'ELHCA0188', 'TXHOUSTD', 'Rowe, Guillermo', 'Guillermo', NULL, 'Rowe', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 405477     ', 'Atlanta', 'Fulton', 'GA', '30384', '          ', NULL, 'PO Box 405477     ', 'Atlanta', 'Fulton', 'GA', '30384', '          ', '          ', 'HCA', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'The Womans Hospital of Texas', NULL, NULL, NULL, 'HCFA|UB|', '1649372061', 0, 'Y', 0, '2013-05-01', NULL, NULL, 0, 0, NULL, NULL),
('942938348', 'W40006895', 'W40006895', 'UTMH1', 'Valley Mental Health  Inc', 'AURA', '', 'ROYO-SNARR', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'B', '5965 S 900 E Ste 430', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012637100', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, 'UTVMHMA', NULL, NULL, '0.00', '40.00', '0.00', 6, '2013-02-15', NULL, NULL, 0, NULL, '', '', '', '', 'HCFA|UB|', '1952460214', 0, 'Y', 0, '2013-02-28', NULL, NULL, 0, 0, NULL, NULL),
('830234097', 'W12020049', 'W12020049', 'WY01', 'Powder River Orthopedics and Spine', 'Nathan', 'S', 'Simpson', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '508 Stocktrail Ste A', 'Gillette', 'Campbell', 'WY', '82716', '3076851413', '3076821113', '508 Stocktrail Ste A', 'Gillette', 'Campbell', 'WY', '82716', '3076851413', '3076821113', '', '', '5001', '0.00', '0.00', '0.00', 6, '2012-06-29', NULL, 0, 0, 0, 'Campbell County Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1427042936', 0, 'N', 0, '2013-09-17', NULL, NULL, 44.2899, -105.515, NULL, NULL),
('942854057', 'W12020051', 'W12020051', 'UTIHC01', 'Safe and Healthy Families', 'Brian', 'J', 'Allen', 'PsyD', 'Mental Health', 'Psychology', '', NULL, 'O', '675 E 500 S Ste 300', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8016623600', NULL, '675 E 500 S Ste 300', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8016623600', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2012-05-21', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1437358223', 0, 'N', 0, '2012-06-18', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12020052', 'W12020052', 'UTIHC02', 'Safe and Healthy Families', 'Brian', 'J', 'Allen', 'PsyD', 'Mental Health', 'Psychology', '', NULL, 'O', '675 E 500 S Ste 300', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8016623600', NULL, '675 E 500 S Ste 300', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8016623600', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '2012-05-21', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1437358223', 0, 'N', 0, '2012-06-18', NULL, NULL, 0, 0, NULL, NULL),
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('753000957', 'W12020000', 'W12020000', 'ID02', 'The Lotus Tree Sensory Integration Center', 'Kathryn', 'S', 'Weinert', 'PT', 'Physical Therapy', '', '', NULL, 'O', '3169 S Bown Way', 'Boise', 'Ada', 'ID', '83706', '2084339152', '2083444752', '3169 S Bown Way', 'Boise', 'Ada', 'ID', '83706', '2084339152', '2083444752', 'WestRehab', '', '', '0.00', '0.00', '93.00', 3, '2012-05-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1447439385', 0, 'N', 0, '2012-06-14', NULL, NULL, 0, 0, NULL, NULL),
('830234097', 'W12020055', 'W12020055', 'WYT1', 'Powder River Orthopedics and Spine', 'Roxanne', 'L', 'Peters', 'PAC', 'Orthopedic Surgery', '', '', NULL, 'O', '508 Stocktrail Ste A', 'Gillette', 'Campbell', 'WY', '82716', '3076861413', '3076821113', '508 Stocktrail Ste A', 'Gillette', 'Campbell', 'WY', '82716', '3076861413', '3076821113', '', '', '', '0.00', '21.00', '0.00', 6, '2012-06-29', NULL, 0, 0, 0, 'Campbell County Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1558593731', 0, 'N', 0, '2013-09-17', NULL, NULL, 0, 0, NULL, NULL),
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('204043287', 'W12020100', 'W12020100', 'NM01', 'ABQ Health Partners', 'Vladislav', '', 'Zakharov', 'MD', 'Pathology', '', '', NULL, 'B', 'PO Box 27829', 'Albuquerque', 'Bernalillo', 'NM', '87125', '5052627600', '5057278391', 'PO Box 27829', 'Albuquerque', 'Bernalillo', 'NM', '87125', '5052627600', '5057278391', 'NMABQ', 'WUSTDHCPC5', '', '0.00', '40.00', '0.00', 3, '2012-06-08', NULL, 0, 0, 0, 'Lovelace Medical Center', 'Lovelace Rehab', 'Lovelace Womens Hospital', 'Lovelace Westside Hospital', 'HCFA|UB|', '1174664320', 0, 'N', 0, '2012-06-15', NULL, NULL, 0, 0, NULL, NULL),
('830258707', 'W12020111', 'W12020111', 'WY01', 'Wyoming Surgical Associates', 'Brock', 'A', 'Anderson', 'MD', 'General Surgery', '', '', NULL, 'O', '419 S Washington St Ste 102', 'Casper', 'Natrona', 'WY', '82601', '3075774220', '3072350931', '419 S Washington St Ste 102', 'Casper', 'Natrona', 'WY', '82601', '3075774220', '3072350931', '', '', '', '0.00', '12.00', '0.00', 3, '2012-06-15', NULL, 0, 0, 0, 'Wyoming Medical Center ', NULL, NULL, NULL, 'HCFA|UB|', '1962481655', 0, 'N', 0, '2012-07-13', NULL, NULL, 42.8464, -106.31, NULL, NULL),
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('454855728', 'W12020125', 'W12020125', 'UT01', 'Obstetrix Medical Group of Utah', 'Katherine', 'M', 'Gesteland', 'MD', 'Maternal Fetal Medicine', '', '', NULL, 'B', 'PO Box 840532', 'Dallas', 'Dallas', 'TX', '75284', '8014764280', NULL, 'PO Box 840532', 'Dallas', 'Dallas', 'TX', '75284', '8014764280', '          ', '', '', '', '0.00', '20.00', '0.00', 3, '2012-08-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1124155007', 0, 'N', 0, '2012-08-08', NULL, NULL, 0, 0, NULL, NULL),
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('870218917', 'W12020128', 'W12020128', 'UT01', 'Tanner Memorial Clinic', 'Ryan', 'D', 'Miller', 'DO', 'Obstetrics and Gynecology', '', '', NULL, 'O', '2038 W 1900 S', 'Syracuse', 'Davis', 'UT', '84075', '8017734840', '8017749219', '2038 W 1900 S', 'Syracuse', 'Davis', 'UT', '84075', '8017734840', '8017749219', 'WUTANNER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-11-01', NULL, 0, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1134383649', 0, 'N', 0, '2012-11-12', NULL, NULL, 41.0863, -112.065, NULL, NULL),
('870218917', 'W12020129', 'W12020129', 'UT01', 'Tanner Memorial Clinic', 'Ryan', 'D', 'Miller', 'DO', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 337', 'Layton', 'Davis', 'UT', '84041', '8017734840', NULL, 'PO Box 337', 'Layton', 'Davis', 'UT', '84041', '8017734840', '          ', 'WUTANNER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-11-01', NULL, 0, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1134383649', 0, 'N', 0, '2012-11-12', NULL, NULL, 0, 0, NULL, NULL),
('743096310', 'W12020130', 'W12020130', 'UT01', 'St Marks Senior Center', 'Rebecca', 'H', 'Moore', 'MD', 'Nephrology', '', '', NULL, 'O', '1160 E 3900 S Ste G200', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012687766', '8012703395', '1160 E 3900 S Ste G200', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012687766', '8012703395', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-06-15', '2012-06-30', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1477609089', 0, 'N', 0, '2014-04-16', NULL, NULL, 0, 0, NULL, NULL),
('743096310', 'W12020131', 'W12020131', 'UT01', 'St Marks Professional Services LLC', 'Rebecca', 'H', 'Moore', 'MD', 'Nephrology', '', '', NULL, 'B', 'PO Box 271220', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '8012687766', '8012703395', 'PO Box 271220', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '8012687766', '8012703395', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-06-15', '2012-06-30', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1477609089', 0, 'N', 0, '2014-04-16', NULL, NULL, 0, 0, NULL, NULL),
('742083988', 'W12020132', 'W12020132', 'TX01', 'Renal Associates', 'Michael', '', 'Wall', 'MD', 'Internal Medicine', '', '', NULL, 'O', '5131 Medical Dr Ste 120', 'San Antonio', 'Bexar', 'TX', '78229', '2106141515', '2106156904', '5131 Medical Dr Ste 120', 'San Antonio', 'Bexar', 'TX', '78229', '2106141515', '2106156904', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2030-01-01', '2012-08-19', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1639118730', 0, 'N', 0, '2012-09-12', NULL, NULL, 29.5107, -98.5885, NULL, NULL),
('742083988', 'W12020133', 'W12020133', 'TX01', 'Renal Associates', 'Michael', '', 'Wall', 'MD', 'Internal Medicine', '', '', NULL, 'O', '134 Menger Springs Ste 1100', 'Boerne', 'Kendall', 'TX', '78006', '2106141515', '2106156904', '134 Menger Springs Ste 1100', 'Boerne', 'Kendall', 'TX', '78006', '2106141515', '2106156904', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2030-01-01', '2012-08-19', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1639118730', 0, 'N', 0, '2012-09-12', NULL, NULL, 29.772, -98.7306, NULL, NULL),
('742083988', 'W12020134', 'W12020134', 'TX01', 'Renal Associates', 'Michael', '', 'Wall', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1050 Hwy 16 N', 'Bandera', 'Bandera', 'TX', '78003', '2106141515', '2106156904', '1050 Hwy 16 N', 'Bandera', 'Bandera', 'TX', '78003', '2106141515', '2106156904', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2030-01-01', '2012-08-19', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1639118730', 0, 'N', 0, '2012-09-12', NULL, NULL, 29.7305, -99.0578, NULL, NULL),
('742083988', 'W12020135', 'W12020135', 'TX01', 'Renal Associates', 'Michael', '', 'Wall', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1561 IH 35 N', 'New Braunfels', 'Comal', 'TX', '78130', '8303038770', '8304010412', '1561 IH-35 N', 'New Braunfels', 'Comal', 'TX', '78130', '8303038770', '8304010412', 'TXSTD', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2030-01-01', '2012-08-19', 0, 0, 0, 'Baptist Medical Center', '', '', '', 'HCFA|UB|', '1639118730', 0, 'N', 0, '2012-09-12', NULL, NULL, 29.7118, -98.0898, NULL, NULL),
('870283576', 'W12020136', 'W12020136', 'UT01', 'Excel Eye Center of Provo', 'Justin ', '', 'Wilkinson', 'MD', 'Ophthalmology', '', '', NULL, 'O', '1735 N State St', 'Provo', 'Utah', 'UT', '84604', '8013741818', '8013740163', '1735 N State St', 'Provo', 'Utah', 'UT', '84604', '8013741818', '8013740163', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-04-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1396937074', 0, 'N', 0, '2013-06-25', NULL, NULL, 40.2568, -111.673, NULL, NULL),
('870283576', 'W12020137', 'W12020137', 'UT01', 'Excel Eye Center of Orem', 'Justin ', '', 'Wilkinson', 'MD', 'Ophthalmology', '', '', NULL, 'O', '700 W 800 N Ste 160', 'Orem', 'Utah', 'UT', '84057', '8014269700', '8014269800', '700 W 800 N Ste 160', 'Orem', 'Utah', 'UT', '84057', '8014269700', '8014269800', 'WUUVPN11', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-04-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1396937074', 0, 'N', 0, '2013-06-25', NULL, NULL, 40.3121, -111.713, NULL, NULL),
('452656602', 'W12020138', 'W12020138', 'UTMH1', 'Desert Counseling', 'Nancy', 'L', 'Belliston', 'LCSW', 'Mental Health', 'Social Worker', 'Counseling', NULL, 'O', '1325 S 800 E Ste 115B', 'Orem', 'Utah', 'UT', '84097', '8013663166', '8018232254', '1325 S 800 E Ste 115B', 'Orem', 'Utah', 'UT', '84097', '8013663166', '8018232254', 'UTMA', '', '', '0.00', '35.00', '0.00', 3, '2012-08-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1841468147', 0, 'N', 0, '2014-05-16', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W12020142', 'W12020142', 'UT01', 'Central Utah Clinic PC', 'David', 'J', 'Frantz', 'MD', 'Internal Medicine', '', '', NULL, 'M', '1055 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013577350', NULL, '1055 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013577350', '          ', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2012-10-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1700092004', 0, 'N', 0, '2013-04-09', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W12020141', 'W12020141', 'UT01', 'Central Utah Clinic PC', 'David', 'J', 'Frantz', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1175 E 50 S Ste 231', 'American Fork', 'Utah', 'UT', '84003', '8017720775', '8013742615', '1175 E 50 S Ste 231', 'American Fork', 'Utah', 'UT', '84003', '8017720775', '8013742615', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2012-10-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1700092004', 0, 'N', 0, '2013-04-09', NULL, NULL, 40.3757, -111.77, NULL, NULL),
('870281028', 'W12020143', 'W12020143', 'UT01', 'Central Utah Clinic PC', 'David', 'J', 'Frantz', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', '8014290629', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', '8014290629', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2012-10-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1700092004', 0, 'N', 0, '2013-04-09', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W12020148', 'W12020148', 'UTMH1', 'Central Utah Clinic PC', 'Brett', 'R', 'Williams', 'LMFT', 'Mental Health', 'Counseling', '', NULL, 'M', '1055 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013577350', NULL, '1055 N 500 W', 'Provo', 'Utah', 'UT', '84604', '8013577350', '          ', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2012-07-01', NULL, 0, 0, 0, 'Mountain View Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1588796858', 0, 'N', 0, '2013-04-10', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W12020149', 'W12020149', 'UTMH1', 'Central Utah Clinic PC', 'Brett', 'R', 'Williams', 'LMFT', 'Mental Health', 'Counseling', '', NULL, 'B', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', '8014290629', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', '8014290629', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2012-07-01', NULL, 0, 0, 0, 'Mountain View Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1588796858', 0, 'N', 0, '2013-04-10', NULL, NULL, 0, 0, NULL, NULL),
('870281028', 'W12020147', 'W12020147', 'UTMH1', 'Central Utah Clinic PC', 'Brett', 'R', 'Williams', 'LMFT', 'Mental Health', 'Counseling', '', NULL, 'O', '97 Professional Way', 'Payson', 'Utah', 'UT', '84651', '8014654896', '8014654107', '97 Professional Way', 'Payson', 'Utah', 'UT', '84651', '8014654896', '8014654107', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2012-07-01', NULL, 0, 0, 0, 'Mountain View Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1588796858', 0, 'N', 0, '2013-04-10', NULL, NULL, 40.0429, -111.712, NULL, NULL),
('200552841', 'W12020152', 'W12020152', 'WY01', 'Central Wyoming Neurosurgery', 'Eric', 'B', 'Schubert', 'MD', 'Neurosurgery', '', '', NULL, 'O', '6600 E 2nd St', 'Casper', 'Natrona', 'WY', '82609', '3072664000', '3072664545', '6600 E 2nd St', 'Casper', 'Natrona', 'WY', '82609', '3072664000', '3072664545', '', '', '', '0.00', '10.00', '0.00', 3, '2012-08-01', NULL, 0, 0, 0, 'Mountain View Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1275594467', 0, 'N', 0, '2012-08-03', NULL, NULL, 42.8444, -106.244, NULL, NULL),
('200552841', 'W12020153', 'W12020153', 'WYT2', 'Central Wyoming Neurosurgery', 'Eric', 'B', 'Schubert', 'MD', 'Neurosurgery', '', '', NULL, 'O', '6600 E 2nd St', 'Casper', 'Natrona', 'WY', '82609', '3072664000', '3072664545', '6600 E 2nd St', 'Casper', 'Natrona', 'WY', '82609', '3072664000', '3072664545', '', '', '', '0.00', '10.00', '0.00', 3, '2012-08-01', NULL, 0, 0, 1, 'Mountain View Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1275594467', 0, 'N', 0, '2012-08-03', NULL, NULL, 0, 0, NULL, NULL),
('870284475', 'W12020844', 'W12020844', 'UT01', 'Granger Medical Clinic', 'Sheetal', 'R', 'Shah', 'MD', 'Nephrology', '', '', NULL, 'O', '3725 W 4100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019653600', '8019653740', '3725 W 4100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019653600', '8019653740', 'WUGRANGER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-09-01', '2012-09-01', 0, 0, 0, 'Jordan Valley Medical Center', 'St Marks Hospital', '', '', 'HCFA|UB|', '1841271491', 0, 'N', 0, '2014-07-25', NULL, NULL, 0, 0, NULL, NULL),
('203360654', 'W12020155', 'W12020155', 'WY01', 'Western Medical Associates', 'Robert', 'G', 'Day', 'MD', 'Family Practice', '', '', NULL, 'O', '3230 Cy Ave', 'Casper', 'Natrona', 'WY', '82604', '3072653600', '3072653640', '3230 Cy Ave', 'Casper', 'Natrona', 'WY', '82604', '3072653600', '3072653640', '', '', '', '0.00', '10.00', '0.00', 3, '2013-12-01', NULL, 0, 0, 0, 'Mountain View Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1235120437', 0, 'N', 0, '2013-11-26', NULL, NULL, 42.8261, -106.362, NULL, NULL),
('203360654', 'W12020150', 'W12020150', 'WY01', 'Western Medical Associates', 'Robert', 'G', 'Day', 'MD', 'Family Practice', '', '', NULL, 'O', '6500 E 2nd St Ste 200', 'Casper', 'Natrona', 'WY', '82609', '3075775100', '3072341201', '6500 E 2nd St Ste 200', 'Casper', 'Natrona', 'WY', '82609', '3075775100', '3072341201', '', '', '', '0.00', '10.00', '0.00', 3, '2013-12-01', NULL, 0, 0, 0, 'Mountain View Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1235120437', 0, 'N', 0, '2013-11-26', NULL, NULL, 42.8399, -106.228, NULL, NULL),
('203360654', 'W12020156', 'W12020156', 'WYT2', 'Western Medical Associates', 'Robert', 'G', 'Day', 'MD', 'Family Practice', '', '', NULL, 'O', '3230 Cy Ave', 'Casper', 'Natrona', 'WY', '82604', '3072653600', '3072653640', '3230 Cy Ave', 'Casper', 'Natrona', 'WY', '82604', '3072653600', '3072653640', '', '', '', '0.00', '10.00', '0.00', 3, '2013-12-01', NULL, 0, 0, 0, 'Mountain View Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1235120437', 0, 'N', 0, '2013-11-26', NULL, NULL, 0, 0, NULL, NULL),
('203360654', 'W12020151', 'W12020151', 'WYT2', 'Western Medical Associates', 'Robert', 'G', 'Day', 'MD', 'Family Practice', '', '', NULL, 'O', '6500 E 2nd St Ste 200', 'Casper', 'Natrona', 'WY', '82609', '3075775100', '3072341201', '6500 E 2nd St Ste 200', 'Casper', 'Natrona', 'WY', '82609', '3075775100', '3072341201', '', '', '', '0.00', '10.00', '0.00', 3, '2013-12-01', NULL, 0, 0, 0, 'Mountain View Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1235120437', 0, 'N', 0, '2013-11-26', NULL, NULL, 0, 0, NULL, NULL),
('453559574', 'W12020157', 'W12020157', 'UT01', 'Salt Lake Podiatry Center', 'Darren', 'F', 'Groberg', 'DPM', 'Podiatry', '', '', NULL, 'O', '144 S 700 E', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015321822', '8015237544', '144 S 700 E', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8015321822', '8015237544', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1396972469', 0, 'N', 0, '2012-12-28', NULL, NULL, 40.7659, -111.871, NULL, NULL),
('200552841', 'W12020158', 'W12020158', 'WY01', 'Central Wyoming Neurosurgery', 'Matthew', 'S', 'Hale', 'PA', 'Neurosurgery', '', '', NULL, 'O', '6600 E 2nd St', 'Casper', 'Natrona', 'WY', '82609', '3072664000', '3072664545', '6600 E 2nd St', 'Casper', 'Natrona', 'WY', '82609', '3072664000', '3072664545', '', '', '', '0.00', '10.00', '0.00', 3, '2012-08-01', NULL, 0, 0, 0, 'Mountain View Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1225200348', 0, 'N', 0, '2012-08-03', NULL, NULL, 42.8444, -106.244, NULL, NULL),
('200552841', 'W12020159', 'W12020159', 'WYT2', 'Central Wyoming Neurosurgery', 'Matthew', 'S', 'Hale', 'PA', 'Neurosurgery', '', '', NULL, 'O', '6600 E 2nd St', 'Casper', 'Natrona', 'WY', '82609', '3072664000', '3072664545', '6600 E 2nd St', 'Casper', 'Natrona', 'WY', '82609', '3072664000', '3072664545', '', '', '', '0.00', '10.00', '0.00', 3, '2012-08-01', NULL, 0, 0, 1, 'Mountain View Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1225200348', 0, 'N', 0, '2012-08-03', NULL, NULL, 0, 0, NULL, NULL),
('200552841', 'W12020160', 'W12020160', 'WY01', 'Central Wyoming Neurosurgery', 'Todd', '', 'Hammond', 'MD', 'Pain Management', '', '', NULL, 'O', '6600 E 2nd St', 'Casper', 'Natrona', 'WY', '82609', '3072664000', '3072664545', '6600 E 2nd St', 'Casper', 'Natrona', 'WY', '82609', '3072664000', '3072664545', '', '', '', '0.00', '10.00', '0.00', 3, '2012-08-01', NULL, 0, 0, 0, 'Mountain View Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1659359610', 0, 'N', 0, '2012-08-30', NULL, NULL, 42.8444, -106.244, NULL, NULL),
('200552841', 'W12020161', 'W12020161', 'WYT2', 'Central Wyoming Neurosurgery', 'Todd', '', 'Hammond', 'MD', 'Pain Management', '', '', NULL, 'O', '6600 E 2nd St', 'Casper', 'Natrona', 'WY', '82609', '3072664000', '3072664545', '6600 E 2nd St', 'Casper', 'Natrona', 'WY', '82609', '3072664000', '3072664545', '', '', '', '0.00', '10.00', '0.00', 3, '2012-08-01', NULL, 0, 0, 1, 'Mountain View Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1659359610', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('260545877', 'W12020162', 'W12020162', 'NM01', 'New Mexico Asian Family Center', 'Iris ', '', 'Jacinto', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '128 Quincy NE', 'Albuquerque', 'Bernalillo', 'NM', '87108', '5057172877', '5052551101', '128 Quincy NE', 'Albuquerque', 'Bernalillo', 'NM', '87108', '5057172877', '5052551101', 'NMMA', '', '', '0.00', '35.00', '0.00', 3, '2012-08-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1033424312', 0, 'N', 0, '2012-10-25', NULL, NULL, 0, 0, NULL, NULL),
('260545877', 'W12020163', 'W12020163', 'NM01', 'New Mexico Asian Family Center', 'Iris ', '', 'Jacinto', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '625 Silver SE', 'Albuquerque', 'Bernalillo', 'NM', '87102', '5057172877', '5052551101', '625 Silver SE', 'Albuquerque', 'Bernalillo', 'NM', '87102', '5057172877', '5052551101', 'NMMA', '', '', '0.00', '35.00', '0.00', 3, '2012-08-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1033424312', 0, 'N', 0, '2012-10-25', NULL, NULL, 35.0843, -106.65, NULL, NULL),
('260545877', 'W12020165', 'W12020165', 'NM01', 'New Mexico Asian Family Center', 'Iris ', '', 'Jacinto', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', 'PO Box 27344', 'Albuquerque', 'Bernalillo', 'NM', '87125', '5057172877', '5052551101', 'PO Box 27344', 'Albuquerque', 'Bernalillo', 'NM', '87125', '5057172877', '5052551101', 'NMMA', '', '', '0.00', '35.00', '0.00', 3, '2012-08-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1033424312', 0, 'N', 0, '2012-10-25', NULL, NULL, 0, 0, NULL, NULL),
('870635889', 'W12020166', 'W12020166', 'UT01', 'Tooele Clinic Corp', 'Mark ', 'S', 'Jorgensen', 'MD', 'Family Practice', '', '', NULL, 'O', '230 S Main St', 'Tooele', 'Tooele', 'UT', '84074', '4358822692', NULL, '230 S Main St', 'Tooele', 'Tooele', 'UT', '84074', '4358822692', '', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-08-01', '2013-09-30', 0, 0, 0, 'Mountain West Medical Center', '', '', '', 'HCFA|UB|', '1407083710', 0, 'N', 0, '2014-06-02', 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
('870635889', 'W12020167', 'W12020167', 'UT01', 'Oquirrh Family Practice', 'Mark ', 'S', 'Jorgensen', 'MD', 'Family Practice', '', '', NULL, 'M', 'PO Box 689022', 'Franklin', 'Williamson', 'TN', '37068', '8777303050', '6156286877', 'PO Box 689022', 'Franklin', 'Williamson', 'TN', '37068', '8777303050', '6156286877', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-08-01', '2014-05-02', 0, 0, 0, 'Mountain West Medical Center', '', '', '', 'HCFA|UB|', '1407083710', 0, 'N', 0, '2014-06-02', NULL, NULL, 0, 0, NULL, NULL),
('870635889', 'W12020168', 'W12020168', 'UT01', 'Oquirrh Family Practice', 'Mark ', 'S', 'Jorgensen', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 848416', 'Boston', 'Suffolk', 'MA', '02284', '8778481463', '6159254991', 'PO Box 848416', 'Boston', 'Suffolk', 'MA', '02284', '8778481463', '6159254991', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-08-01', '2014-05-02', 0, 0, 0, 'Mountain West Medical Center', '', '', '', 'HCFA|UB|', '1407083710', 0, 'N', 0, '2014-06-02', NULL, NULL, 0, 0, NULL, NULL),
('200552841', 'W12020169', 'W12020169', 'WY01', 'Central Wyoming Neurosurgery', 'Justin', 'L', 'Kidd', 'PA', 'Neurosurgery', '', '', NULL, 'O', '6600 E 2nd St', 'Casper', 'Natrona', 'WY', '82609', '3072664000', '3072664545', '6600 E 2nd St', 'Casper', 'Natrona', 'WY', '82609', '3072664000', '3072664545', '', '', '', '0.00', '10.00', '0.00', 3, '2012-08-01', NULL, 0, 0, 0, 'Mountain View Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1740279884', 0, 'N', 0, '2012-08-03', NULL, NULL, 42.8444, -106.244, NULL, NULL),
('200552841', 'W12020170', 'W12020170', 'WYT2', 'Central Wyoming Neurosurgery', 'Justin', 'L', 'Kidd', 'PA', 'Neurosurgery', '', '', NULL, 'O', '6600 E 2nd St', 'Casper', 'Natrona', 'WY', '82609', '3072664000', '3072664545', '6600 E 2nd St', 'Casper', 'Natrona', 'WY', '82609', '3072664000', '3072664545', '', '', '', '0.00', '10.00', '0.00', 3, '2012-08-01', NULL, 0, 0, 1, 'Mountain View Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1740279884', 0, 'N', 0, '2012-08-03', NULL, NULL, 0, 0, NULL, NULL),
('810608733', 'W12020171', 'W12020171', 'UT01', 'Nexus Pain Care', 'Jeremy', 'J', 'Kokkonen', 'DO', 'Physical Medicine and Rehabilitation', '', '', NULL, 'O', '3585 N University Ave Ste 150', 'Provo', 'Utah', 'UT', '84604', '8013566100', '8013562113', '3585 N University Ave Ste 150', 'Provo', 'Utah', 'UT', '84604', '8013566100', '8013562113', 'WUSTDPAIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-06-01', '2014-01-27', 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1750549424', 0, 'N', 0, '2014-01-31', NULL, NULL, 0, 0, NULL, NULL),
('810608733', 'W12020172', 'W12020172', 'UT01', 'Nexus Pain Care', 'Jeremy', 'J', 'Kokkonen', 'DO', 'Physical Medicine and Rehabilitation', '', '', NULL, 'B', 'PO Box 15109', 'Springfield', 'Hampden', 'MA', '01115', '8013566100', '8013562113', 'PO Box 15109', 'Springfield', 'Hampden', 'MA', '01115', '8013566100', '8013562113', 'WUSTDPAIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-06-01', '2014-01-27', 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1750549424', 0, 'N', 0, '2014-01-31', NULL, NULL, 0, 0, NULL, NULL),
('200552841', 'W12020173', 'W12020173', 'WY01', 'Central Wyoming Neurosurgery', 'Thomas', 'A', 'Kopitnik', 'MD', 'Neurosurgery', '', '', NULL, 'O', '6600 E 2nd St', 'Casper', 'Natrona', 'WY', '82609', '3072664000', '3072664545', '6600 E 2nd St', 'Casper', 'Natrona', 'WY', '82609', '3072664000', '3072664545', '', '', '', '0.00', '10.00', '0.00', 3, '2012-10-01', NULL, 0, 0, 0, 'Mountain View Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1669450656', 0, 'N', 0, '2012-10-09', NULL, NULL, 42.8444, -106.244, NULL, NULL),
('200552841', 'W12020174', 'W12020174', 'WYT2', 'Central Wyoming Neurosurgery', 'Thomas', 'A', 'Kopitnik', 'MD', 'Neurosurgery', '', '', NULL, 'O', '6600 E 2nd St', 'Casper', 'Natrona', 'WY', '82609', '3072664000', '3072664545', '6600 E 2nd St', 'Casper', 'Natrona', 'WY', '82609', '3072664000', '3072664545', '', '', '', '0.00', '10.00', '0.00', 3, '2012-10-01', NULL, 0, 0, 1, 'Mountain View Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1669450656', 0, 'N', 0, '2012-10-09', NULL, NULL, 0, 0, NULL, NULL),
('830182821', 'W12020175', 'W12020175', 'WY01', 'Gottsche Rehabilitation Center', 'Deborah', '', 'McMillan', 'OTR', 'Occupational Therapy', '', '', NULL, 'O', '720 Lindsay Ln', 'Cody', 'Park', 'WY', '82414', '3075781970', '3075781973', '720 Lindsay Ln', 'Cody', 'Park', 'WY', '82414', '3075781970', '3075781973', '', '', '', '0.00', '10.00', '0.00', 3, '2012-08-01', '2014-06-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1013103944', 0, 'N', 0, '2014-07-21', NULL, NULL, 44.5202, -109.074, NULL, NULL),
('830182821', 'W12020176', 'W12020176', 'WYT2', 'Gottsche Rehabilitation Center', 'Deborah', '', 'McMillan', 'OTR', 'Occupational Therapy', '', '', NULL, 'O', '720 Lindsay Ln', 'Cody', 'Park', 'WY', '82414', '3075781970', '3075781973', '720 Lindsay Ln', 'Cody', 'Park', 'WY', '82414', '3075781970', '3075781973', '', '', '', '0.00', '10.00', '0.00', 3, '2012-08-01', '2014-06-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1013103944', 0, 'N', 0, '2014-07-21', NULL, NULL, 0, 0, NULL, NULL),
('200552841', 'W12020177', 'W12020177', 'WY01', 'Central Wyoming Neurosurgery', 'Cody', '', 'McVay', 'NP', 'Neurosurgery', '', '', NULL, 'O', '6600 E 2nd St', 'Casper', 'Natrona', 'WY', '82609', '3072664000', '3072664545', '6600 E 2nd St', 'Casper', 'Natrona', 'WY', '82609', '3072664000', '3072664545', '', '', '', '0.00', '10.00', '0.00', 3, '2012-08-01', NULL, 0, 0, 0, 'Mountain View Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1790095636', 0, 'N', 0, '2012-08-28', NULL, NULL, 42.8444, -106.244, NULL, NULL),
('200552841', 'W12020178', 'W12020178', 'WYT2', 'Central Wyoming Neurosurgery', 'Cody', '', 'McVay', 'NP', 'Neurosurgery', '', '', NULL, 'O', '6600 E 2nd St', 'Casper', 'Natrona', 'WY', '82609', '3072664000', '3072664545', '6600 E 2nd St', 'Casper', 'Natrona', 'WY', '82609', '3072664000', '3072664545', '', '', '', '0.00', '10.00', '0.00', 3, '2012-08-01', NULL, 0, 0, 1, 'Mountain View Regional Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1790095636', 0, 'N', 0, '2012-08-28', NULL, NULL, 0, 0, NULL, NULL),
('200552841', 'W12020179', 'W12020179', 'WY01', 'Central Wyoming Neurosurgery', 'Yves', '', 'Meyer', 'MD', 'Neurosurgery', '', '', NULL, 'O', '6600 E 2nd St', 'Casper', 'Natrona', 'WY', '82609', '3072664000', '3072664545', '6600 E 2nd St', 'Casper', 'Natrona', 'WY', '82609', '3072664000', '3072664545', '', '', '', '0.00', '10.00', '0.00', 3, '2012-08-01', NULL, 0, 0, 0, 'Mountain View Regional Hospital', '', '', '', 'HCFA|UB|', '1104852847', 0, 'N', 0, '2012-08-03', NULL, NULL, 42.8444, -106.244, NULL, NULL),
('200552841', 'W12020180', 'W12020180', 'WYT2', 'Central Wyoming Neurosurgery', 'Yves', '', 'Meyer', 'MD', 'Neurosurgery', '', '', NULL, 'O', '6600 E 2nd St', 'Casper', 'Natrona', 'WY', '82609', '3072664000', '3072664545', '6600 E 2nd St', 'Casper', 'Natrona', 'WY', '82609', '3072664000', '3072664545', '', '', '', '0.00', '10.00', '0.00', 3, '2012-08-01', NULL, 0, 0, 1, 'Mountain View Regional Hospital', '', '', '', 'HCFA|UB|', '1104852847', 0, 'N', 0, '2012-08-03', NULL, NULL, 0, 0, NULL, NULL),
('529319115', 'W12020182', 'W12020182', 'UTMH1', 'Heather Nelson, LCSW', 'Heather', 'J', 'Nelson', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'M', '2861 W 560 S', 'Lehi', 'Utah', 'UT', '84043', '8015203160', '2087339463', '2861 W 560 S', 'Lehi', 'Utah', 'UT', '84043', '8015203160', '2087339463', 'ma', '', '', '0.00', '35.00', '0.00', 3, '2012-08-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1861414310', 0, 'N', 0, '2012-08-03', NULL, NULL, 0, 0, NULL, NULL),
('529319115', 'W12020181', 'W12020181', 'UTMH1', 'Heather Nelson, LCSW', 'Heather', 'J', 'Nelson', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '441 W Main Ste B', 'Lehi', 'Utah', 'UT', '84043', '8015203160', '2087339463', '441 W Main Ste B', 'Lehi', 'Utah', 'UT', '84043', '8015203160', '2087339463', 'ma', '', '', '0.00', '35.00', '0.00', 3, '2012-08-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1861414310', 0, 'N', 0, '2012-08-03', NULL, NULL, 0, 0, NULL, NULL),
('529319115', 'W12020183', 'W12020183', 'UTMH1', 'Heather Nelson, LCSW', 'Heather', 'J', 'Nelson', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', 'PO Box 1657', 'Twin Falls', 'Twin Falls', 'ID', '83303', '8015203160', '2087339463', 'PO Box 1657', 'Twin Falls', 'Twin Falls', 'ID', '83303', '8015203160', '2087339463', 'ma', '', '', '0.00', '35.00', '0.00', 3, '2012-08-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1861414310', 0, 'N', 0, '2012-08-03', NULL, NULL, 0, 0, NULL, NULL),
('260545877', 'W12020184', 'W12020184', 'NM01', 'New Mexico Asian Family Center', '', '', 'New Mexico Asian Family Center', '', 'Mental Health', '', '', NULL, 'O', '128 Quincy NE', 'Albuquerque', 'Bernalillo', 'NM', '87108', '5057172877', '5052551101', '128 Quincy NE', 'Albuquerque', 'Bernalillo', 'NM', '87108', '5057172877', '5052551101', 'NMMA', '', '', '0.00', '35.00', '0.00', 3, '2012-10-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1316249410', 0, 'Y', 0, '2012-10-01', NULL, NULL, 0, 0, NULL, NULL),
('260545877', 'W12020185', 'W12020185', 'NM01', 'New Mexico Asian Family Center', '', '', 'New Mexico Asian Family Center', '', 'Mental Health', '', '', NULL, 'O', '625 Silver SE', 'Albuquerque', 'Bernalillo', 'NM', '87102', '5057172877', '5052551101', '625 Silver SE', 'Albuquerque', 'Bernalillo', 'NM', '87102', '5057172877', '5052551101', 'NMMA', '', '', '0.00', '35.00', '0.00', 3, '2012-10-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1316249410', 0, 'Y', 0, '2012-10-01', NULL, NULL, 35.0843, -106.65, NULL, NULL),
('260545877', 'W12020186', 'W12020186', 'NM01', 'New Mexico Asian Family Center', '', '', 'New Mexico Asian Family Center', '', 'Mental Health', '', '', NULL, 'B', 'PO Box 27344', 'Albuquerque', 'Bernalillo', 'NM', '87125', '5057172877', '5052551101', 'PO Box 27344', 'Albuquerque', 'Bernalillo', 'NM', '87125', '5057172877', '5052551101', 'NMMA', '', '', '0.00', '35.00', '0.00', 3, '2012-10-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1316249410', 0, 'Y', 0, '2012-10-01', NULL, NULL, 0, 0, NULL, NULL),
('264551232', 'W12020187', 'W12020187', 'WY01', 'Platte River Family Practice', '', '', 'Platte River Family Practice', '', 'Family Practice', '', '', NULL, 'O', '1900 E 1st St', 'Casper', 'Natrona', 'WY', '82601', '3075777737', '3075770049', '1900 E 1st St', 'Casper', 'Natrona', 'WY', '82601', '3075777737', '3075770049', '', '', '', '0.00', '10.00', '0.00', 3, '2012-07-01', '2012-07-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1942443536', 0, 'N', 0, '2013-01-23', NULL, NULL, 0, 0, NULL, NULL),
('264551232', 'W12020188', 'W12020188', 'WYT2', 'Platte River Family Practice', '', '', 'Platte River Family Practice', '', 'Family Practice', '', '', NULL, 'O', '1900 E 1st St', 'Casper', 'Natrona', 'WY', '82601', '3075777737', '3075770049', '1900 E 1st St', 'Casper', 'Natrona', 'WY', '82601', '3075777737', '3075770049', '', '', '', '0.00', '10.00', '0.00', 3, '2012-07-01', '2012-07-01', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1942443536', 0, 'N', 0, '2013-01-23', NULL, NULL, 0, 0, NULL, NULL),
('621762573', 'W12020189', 'W12020189', 'UT01', 'Castleview Surgical Associates', 'Jon', 'S', 'Pressett', 'MD', 'General Surgery', '', '', NULL, 'O', '280 N Hospital Dr Ste 5', 'Price', 'Carbon', 'UT', '84501', '4356374590', '4356374598', '280 N Hospital Dr Ste 5', 'Price', 'Carbon', 'UT', '84501', '4356374590', '4356374598', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-08-01', NULL, 0, 0, 0, 'Castleview Hospital', 'Castleview Hospital', NULL, NULL, 'HCFA|UB|', '1942355821', 0, 'N', 0, '2013-07-25', NULL, NULL, 39.6047, -110.831, NULL, NULL),
('260545877', 'W12020190', 'W12020190', 'NM01', 'New Mexico Asian Family Center', 'Mutsumi', '', 'Shoji', 'LPAT, LPCnm', 'Mental Health', 'Counseling', '', NULL, 'O', '128 Quincy NE', 'Albuquerque', 'Bernalillo', 'NM', '87108', '5057172877', '5052551101', '128 Quincy NE', 'Albuquerque', 'Bernalillo', 'NM', '87108', '5057172877', '5052551101', 'NMMA', '', '', '0.00', '35.00', '0.00', 3, '2012-08-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1659504934', 0, 'N', 0, '2012-11-08', NULL, NULL, 0, 0, NULL, NULL),
('260545877', 'W12020191', 'W12020191', 'NM01', 'New Mexico Asian Family Center', 'Mutsumi', '', 'Shoji', 'LPAT, LPCnm', 'Mental Health', 'Counseling', '', NULL, 'O', '625 Silver SE', 'Albuquerque', 'Bernalillo', 'NM', '87102', '5057172877', '5052551101', '625 Silver SE', 'Albuquerque', 'Bernalillo', 'NM', '87102', '5057172877', '5052551101', 'NMMA', '', '', '0.00', '35.00', '0.00', 3, '2012-08-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1659504934', 0, 'N', 0, '2012-10-25', NULL, NULL, 35.0843, -106.65, NULL, NULL),
('260545877', 'W12020192', 'W12020192', 'NM01', 'New Mexico Asian Family Center', 'Mutsumi', '', 'Shoji', 'LPAT, LPCnm', 'Mental Health', 'Counseling', '', NULL, 'B', 'PO Box 27344', 'Albuquerque', 'Bernalillo', 'NM', '87125', '5057172877', '5052551101', 'PO Box 27344', 'Albuquerque', 'Bernalillo', 'NM', '87125', '5057172877', '5052551101', 'NMMA', '', '', '0.00', '35.00', '0.00', 3, '2012-08-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1659504934', 0, 'N', 0, '2012-11-08', NULL, NULL, 0, 0, NULL, NULL),
('270437667', 'W12020193', 'W12020193', 'UT01', 'New Horizon Medical Care', 'Barbara', '', 'Stuart', 'NP', 'Family Practice', '', '', NULL, 'O', '1273 W 12600 S Ste  420', 'Riverton', 'Salt Lake', 'UT', '84065', '8012544600', '8012549670', '1273 W 12600 S Ste  420', 'Riverton', 'Salt Lake', 'UT', '84065', '8012544600', '8012549670', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1518265750', 0, 'N', 0, '2012-08-03', NULL, NULL, 40.5223, -111.928, NULL, NULL),
('200552841', 'W12020194', 'W12020194', 'WY01', 'Central Wyoming Neurosurgery', 'Kamal', '', 'Thapar', 'MD', 'Neurosurgery', '', '', NULL, 'O', '6600 E 2nd St', 'Casper', 'Natrona', 'WY', '82609', '3072664000', '3072664545', '6600 E 2nd St', 'Casper', 'Natrona', 'WY', '82609', '3072664000', '3072664545', '', '', '', '0.00', '10.00', '0.00', 3, '2012-08-01', NULL, 0, 0, 0, 'Mountain View Regional Hospital', '', '', '', 'HCFA|UB|', '1174610174', 0, 'N', 0, '2012-08-03', NULL, NULL, 42.8444, -106.244, NULL, NULL),
('200552841', 'W12020195', 'W12020195', 'WYT2', 'Central Wyoming Neurosurgery', 'Kamal', '', 'Thapar', 'MD', 'Neurosurgery', '', '', NULL, 'O', '6600 E 2nd St', 'Casper', 'Natrona', 'WY', '82609', '3072664000', '3072664545', '6600 E 2nd St', 'Casper', 'Natrona', 'WY', '82609', '3072664000', '3072664545', '', '', '', '0.00', '10.00', '0.00', 3, '2012-08-01', NULL, 0, 0, 1, 'Mountain View Regional Hospital', '', '', '', 'HCFA|UB|', '1174610174', 0, 'N', 0, '2012-08-03', NULL, NULL, 0, 0, NULL, NULL),
('262518076', 'W12020196', 'W12020196', 'ID01', 'Journey Mental Health', 'Kendal', 'M', 'Tucker', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '3288 E Pine St', 'Meridian', 'Ada', 'ID', '83642', '2088888886', '2086580153', '3288 E Pine St', 'Meridian', 'Ada', 'ID', '83642', '2088888886', '2086580153', 'IDMA', '', '', '0.00', '35.00', '0.00', 3, '2012-08-01', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1285968859', 0, 'N', 0, '2013-07-11', NULL, NULL, 0, 0, NULL, NULL),
('260545877', 'W12020197', 'W12020197', 'NM01', 'New Mexico Asian Family Center', 'Ah', 'L', 'Wong', 'LMFT', 'Mental Health', 'Counseling', '', NULL, 'O', '128 Quincy NE', 'Albuquerque', 'Bernalillo', 'NM', '87108', '5057172877', '5052551101', '128 Quincy NE', 'Albuquerque', 'Bernalillo', 'NM', '87108', '5057172877', '5052551101', 'NMMA', '', '', '0.00', '35.00', '0.00', 3, '2012-08-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1487670295', 0, 'N', 0, '2012-11-08', NULL, NULL, 0, 0, NULL, NULL),
('260545877', 'W12020198', 'W12020198', 'NM01', 'New Mexico Asian Family Center', 'Ah', 'L', 'Wong', 'LMFT', 'Mental Health', 'Counseling', '', NULL, 'O', '625 Silver SE', 'Albuquerque', 'Bernalillo', 'NM', '87102', '5057172877', '5052551101', '625 Silver SE', 'Albuquerque', 'Bernalillo', 'NM', '87102', '5057172877', '5052551101', 'NMMA', '', '', '0.00', '35.00', '0.00', 3, '2012-08-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1487670295', 0, 'N', 0, '2012-10-25', NULL, NULL, 35.0843, -106.65, NULL, NULL),
('260545877', 'W12020199', 'W12020199', 'NM01', 'New Mexico Asian Family Center', 'Ah', 'L', 'Wong', 'LMFT', 'Mental Health', 'Counseling', '', NULL, 'B', 'PO Box 27344', 'Albuquerque', 'Bernalillo', 'NM', '87125', '5057172877', '5052551101', 'PO Box 27344', 'Albuquerque', 'Bernalillo', 'NM', '87125', '5057172877', '5052551101', 'NMMA', '', '', '0.00', '35.00', '0.00', 3, '2012-08-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1487670295', 0, 'N', 0, '2012-10-25', NULL, NULL, 0, 0, NULL, NULL),
('364586972', 'W12020202', 'W12020202', 'UT01', 'University of Utah Pediatric Rapid Treatment Unit', '', '', 'University of Utah Pediatric Rapid Treatment Unit', 'GROUP', 'Pediatric Emergency Medicine', '', '', NULL, 'O', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621234', NULL, '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621234', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2006-08-01', '2012-07-26', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009308', 0, 'N', 0, '2012-07-27', NULL, NULL, 0, 0, NULL, NULL),
('364586972', 'W12020203', 'W12020203', 'UT01', 'Pediatric Rapid Treatment Unit-Department of University of Utah', '', '', 'University of Utah Pediatric Rapid Treatment Unit', 'GROUP', 'Pediatric Emergency Medicine', '', '', NULL, 'B', 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', NULL, 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133900', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2006-08-01', '2012-07-26', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009308', 0, 'Y', 0, '2012-07-27', NULL, NULL, 0, 0, NULL, NULL),
('870571510', 'W12020204', 'W12020204', 'UT01', 'Layton Ambulatory Anesthesia', 'Blake', 'J', 'Brown', 'MD', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 160354', 'Clearfield', 'Davis', 'UT', '84016', '8017748992', '8015250347', 'PO Box 160354', 'Clearfield', 'Davis', 'UT', '84016', '8017748992', '8015250347', '', '', '1000', '52.50', '0.00', '0.00', 3, '2012-07-01', '2013-06-14', 1, 12, 0, '', '', '', '', 'HCFA|UB|', '1427060912', 0, 'Y', 0, '2012-11-26', NULL, NULL, 0, 0, NULL, NULL),
('870571510', 'W12020205', 'W12020205', 'UT01', 'Layton Ambulatory Anesthesia', 'Blake', 'J', 'Brown', 'MD', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 160354', 'Clearfield', 'Davis', 'UT', '84016', '8017748992', '8015250347', 'PO Box 160354  ', 'Clearfield', 'Davis', 'UT', '84016', '8017748992', '8015250347', '', '', '1000', '54.00', '0.00', '0.00', 3, '2013-06-15', NULL, 1, 12, 0, '', '', '', '', 'HCFA|UB|', '1427060912', 0, 'Y', 0, '2012-11-26', NULL, NULL, 0, 0, NULL, NULL),
('870571510', 'W12020206', 'W12020206', 'UT01', 'Layton Ambulatory Anesthesia', 'Troy', 'N', 'Cummons', 'DO', 'Anesthesia', '', '', NULL, 'B', 'PO Box 160354', 'Clearfield', 'Davis', 'UT', '84016', '8017748992', '8015250347', 'PO Box 160354', 'Clearfield', 'Davis', 'UT', '84016', '8017748992', '8015250347', '', '', '', '52.50', '0.00', '0.00', 3, '2012-07-01', '2013-06-14', 1, 12, 0, '', '', '', '', 'HCFA|UB|', '1497835698', 0, 'N', 0, '2012-11-26', NULL, NULL, 0, 0, NULL, NULL),
('870571510', 'W12020207', 'W12020207', 'UT01', 'Layton Ambulatory Anesthesia', 'Troy', 'N', 'Cummons', 'DO', 'Anesthesia', '', '', NULL, 'B', 'PO Box 160354', 'Clearfield', 'Davis', 'UT', '84016', '8017748992', '8015250347', 'PO Box 160354', 'Clearfield', 'Davis', 'UT', '84016', '8017748992', '8015250347', '', '', '', '54.00', '0.00', '0.00', 3, '2013-06-15', NULL, 1, 12, 0, '', '', '', '', 'HCFA|UB|', '1497835698', 0, 'N', 0, '2012-11-26', NULL, NULL, 0, 0, NULL, NULL),
('870571510', 'W12020208', 'W12020208', 'UT01', 'Layton Ambulatory Anesthesia', 'Bryan', 'G', 'Holbrook', 'MD', 'Pain Management', 'Anesthesiology', '', NULL, 'B', 'PO Box 160354', 'Clearfield', 'Davis', 'UT', '84016', '8017748992', '8015250347', 'PO Box 160354', 'Clearfield', 'Davis', 'UT', '84016', '8017748992', '8015250347', '', '', '1000', '52.50', '0.00', '0.00', 3, '2012-07-01', '2013-06-14', 1, 12, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1427034081', 0, 'Y', 0, '2012-11-26', NULL, NULL, 0, 0, NULL, NULL),
('870571510', 'W12020209', 'W12020209', 'UT01', 'Layton Ambulatory Anesthesia', 'Bryan', 'G', 'Holbrook', 'MD', 'Pain Management', 'Anesthesiology', '', NULL, 'B', 'PO Box 160354', 'Clearfield', 'Davis', 'UT', '84016', '8017748992', '8015250347', 'PO Box 160354', 'Clearfield', 'Davis', 'UT', '84016', '8017748992', '8015250347', '', '', '1000', '54.00', '0.00', '0.00', 3, '2013-06-15', NULL, 1, 12, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1427034081', 0, 'Y', 0, '2012-11-26', NULL, NULL, 0, 0, NULL, NULL),
('841625538', 'W12020212', 'W12020212', 'UT01', 'Beyond Limits Phyiscal Therapy', 'Brad', 'Robert', 'Pulsipher', 'DPT', 'Physical Therapy', '', '', NULL, 'O', '3726 E Campus Dr Ste H', 'Eagle Mountain', 'Utah', 'UT', '84005', '8017897333', '8017897444', '3726 E Campus Dr Ste H', 'Eagle Mountain', 'Utah', 'UT', '84005', '8017897333', '8017897444', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2012-07-01', '2013-08-21', 0, 0, 0, '', '', '', '', 'HCFA|', '1073872909', 0, 'N', 0, '2013-12-06', NULL, NULL, 0, 0, NULL, NULL),
('841625538', 'W12020213', 'W12020213', 'UT01', 'Beyond Limits Phyiscal Therapy', 'Brad', 'Robert', 'Pulsipher', 'DPT', 'Physical Therapy', '', '', NULL, 'O', '5734 W 13400 S Ste 300', 'Herriman', 'Salt Lake', 'UT', '84096', '8013027232', '8013027237', '5734 W 13400 S Ste 300', 'Herriman', 'Salt Lake', 'UT', '84096', '8013027232', '8013027237', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2012-07-01', '2013-08-21', 0, 0, 0, '', '', '', '', 'HCFA|', '1073872909', 0, 'N', 0, '2013-12-06', NULL, NULL, 0, 0, NULL, NULL),
('870543678', 'W12020214', 'W12020214', 'UT01', 'Spine, Orthopedic & Sports Physical Therapy', 'Ned', 'B', 'Bushnell', 'PT', 'Physical Therapy', '', '', NULL, 'O', '524 W 300 N Ste 201', 'Provo', 'Utah', 'UT', '84601', '8013709981', '8013709984', '524 W 300 N Ste 201', 'Provo', 'Utah', 'UT', '84601', '8013709981', '8013709984', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2012-06-13', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1528050861', 0, 'N', 0, '2012-06-21', NULL, NULL, 40.2378, -111.668, NULL, NULL),
('870543678', 'W12020215', 'W12020215', 'UT01', 'Spine Orthopedic & Sports Physical Therapy ', 'Daniel', 'R', 'Lillywhite', 'DPT', 'Physical Therapy', '', '', NULL, 'O', '524 W 300 N Ste 201', 'Provo', 'Utah', 'UT', '84601', '8013737438', '8013737486', '524 W 300 N Ste 201', 'Provo', 'Utah', 'UT', '84601', '8013737438', '8013737486', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2012-06-13', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1649437799', 0, 'N', 0, '2012-06-21', NULL, NULL, 40.2378, -111.668, NULL, NULL),
('870546388', 'W12020217', 'W12020217', 'UT01', 'Complete Fitness Innovations', 'John', 'Hiliary', 'Berryhill', 'MPT', 'Physical Therapy', '', '', NULL, 'O', '1177 S Main St', 'Smithfield', 'Cache', 'UT', '84335', '4355630750', '4355636347', '1177 S Main St', 'Smithfield', 'Cache', 'UT', '84335', '4355630750', '4355636347', 'WestRehab', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2012-07-01', '2013-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1396741989', 0, 'N', 0, '2013-01-25', NULL, NULL, 0, 0, NULL, NULL),
('870574059', 'W12020220', 'W12020220', 'UT01', 'Mountain Land Rehabilitation Inc', 'Jeremy', 'David', 'Stoker', 'DPT', 'Physical Therapy', '', '', NULL, 'O', '1188 Sportsplex Dr Ste 101', 'Kaysville', 'Davis', 'UT', '84037', '8015471155', '8015471173', '1188 Sportsplex Dr Ste 101', 'Kaysville', 'Davis', 'UT', '84037', '8015471155', '8015471173', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2012-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1598024184', 0, 'N', 0, '2012-06-21', NULL, NULL, 41.0432, -111.963, NULL, NULL),
('870574059', 'W12020219', 'W12020219', 'UT01', 'Mountain Land Rehabilitation Inc', 'Jeremy', 'David', 'Stoker', 'DPT', 'Physical Therapy', '', '', NULL, 'B', 'PO Box 711185', 'Salt Lake City', 'Salt Lake', 'UT', '84171', '8015471155', '8015471173', 'PO Box 711185', 'Salt Lake City', 'Salt Lake', 'UT', '84171', '8015471155', '8015471173', 'WESTREHAB', 'WUSTDHCPC5', '', '0.00', '0.00', '73.00', 3, '2012-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '1598024184', 0, 'N', 0, '2012-06-21', NULL, NULL, 0, 0, NULL, NULL),
('820200895', 'W12020221', 'W12020221', 'ID01', 'Saint Alphonsus Medical Group Family Medicine Dominican', 'Tricia', 'A', 'Beveridge', 'NPC', 'Pediatric Surgery', 'Family Practice', '', NULL, 'O', '1118 Nw 16th St Ste A', 'Fruitland', 'Payette', 'ID', '83619', '2083674000', '2083674052', '1118 Nw 16th St Ste A', 'Fruitland', 'Payette', 'ID', '83619', '2083674000', '2083674052', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 6, '2011-01-17', '2012-08-19', 0, 0, 0, '', '', '', '', 'HCFA|', '1295053189', 0, 'N', 0, '2014-06-20', NULL, NULL, 44.025, -116.928, NULL, NULL),
('870767026', 'W12020223', 'W12020223', 'ID01', 'West Valley Medical Group Caldwell', 'Daniel', 'J', 'Allen', 'DO', 'Family Practice', 'Sports Medicine', '', NULL, 'O', '16459 N Midland Blvd', 'Nampa', 'Canyon', 'ID', '83687', '2087955075', '2084593372', '16459 N Midland Blvd', 'Nampa', 'Canyon', 'ID', '83687', '2087955075', '2084593372', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-06-18', '2012-06-30', 0, 0, 0, 'West Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1720017247', 0, 'N', 0, '2013-10-14', NULL, NULL, 43.6116, -116.593, NULL, NULL),
('870767026', 'W12020222', 'W12020222', 'ID01', 'West Valley Medical Group Caldwell', 'Daniel', 'J', 'Allen', 'DO', 'Family Practice', 'Sports Medicine', '', NULL, 'O', '211 E Logan St Ste 203', 'Caldwell', 'Canyon', 'ID', '83605', '2084594667', '2084593372', '211 E Logan St Ste 203', 'Caldwell', 'Canyon', 'ID', '83605', '2084594667', '2084593372', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-06-18', '2012-06-30', 0, 0, 0, 'West Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1720017247', 0, 'N', 0, '2013-10-14', NULL, NULL, 43.6554, -116.697, NULL, NULL),
('870767026', 'W12020224', 'W12020224', 'ID01', 'West Valley Medical Group Caldwell', 'Daniel', 'J', 'Allen', 'DO', 'Family Practice', 'Sports Medicine', '', NULL, 'B', 'PO Box 277976', 'Atlanta', 'Fulton', 'GA', '30384', '8015470747', '2084593372', 'PO Box 277976', 'Atlanta', 'Fulton', 'GA', '30384', '8015470747', '2084593372', 'WISE+5', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-06-18', '2012-06-30', 0, 0, 0, 'West Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1720017247', 0, 'N', 0, '2013-10-14', NULL, NULL, 0, 0, NULL, NULL),
('870571510', 'W12020225', 'W12020225', 'UT01', 'Layton Ambulatory Anesthesia', '', '', 'Layton Ambulatory Anesthesia', 'Group', 'Anesthesiology', '', '', NULL, 'O', '1544 W Antelope Dr', 'Layton', 'Davis', 'UT', '84041', '8017748992', '8015250347', '1544 W Antelope Dr', 'Layton', 'Davis', 'UT', '84041', '8017748992', '8015250347', '', '', '1000', '52.50', '0.00', '0.00', 3, '2012-07-01', '2013-06-14', 1, 12, 0, '', '', '', '', 'HCFA|UB|', '1013950286', 0, 'Y', 0, '2012-11-02', NULL, NULL, 0, 0, NULL, NULL),
('870571510', 'W12020226', 'W12020226', 'UT01', 'Layton Ambulatory Anesthesia', '', '', 'Layton Ambulatory Anesthesia', 'Group', 'Anesthesiology', '', '', NULL, 'O', '1544 W Antelope Dr', 'Layton', 'Davis', 'UT', '84041', '8017748992', '8015250347', '1544 W Antelope Dr', 'Layton', 'Davis', 'UT', '84041', '8017748992', '8015250347', '', '', '1000', '54.00', '0.00', '0.00', 3, '2013-06-15', NULL, 1, 12, 0, '', '', '', '', 'HCFA|UB|', '1013950286', 0, 'Y', 0, '2012-11-02', NULL, NULL, 41.0893, -111.994, NULL, NULL),
('870571510', 'W12020227', 'W12020227', 'UT01', 'Layton Ambulatory Anesthesia', '', '', 'Layton Ambulatory Anesthesia', 'Group', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 160354', 'Clearfield', 'Davis', 'UT', '84016', '8017748992', '8015250347', 'PO Box 160354', 'Clearfield', 'Davis', 'UT', '84016', '8017748992', '8015250347', '', '', '1000', '52.50', '0.00', '0.00', 3, '2012-07-01', '2013-06-14', 0, 12, 0, '', '', '', '', 'HCFA|UB|', '1013950286', 0, 'Y', 0, '2012-11-02', NULL, NULL, 0, 0, NULL, NULL),
('870571510', 'W12020228', 'W12020228', 'UT01', 'Layton Ambulatory Anesthesia', '', '', 'Layton Ambulatory Anesthesia', 'Group', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 160354', 'Clearfield', 'Davis', 'UT', '84016', '8017748992', '8015250347', 'PO Box 160354', 'Clearfield', 'Davis', 'UT', '84016', '8017748992', '8015250347', '', '', '1000', '54.00', '0.00', '0.00', 3, '2013-06-15', NULL, 0, 12, 0, '', '', '', '', 'HCFA|UB|', '1013950286', 0, 'Y', 0, '2012-11-02', NULL, NULL, 0, 0, NULL, NULL),
('870571510', 'W12020229', 'W12020229', 'UT01', 'Layton Ambulatory Anesthesia', 'Earl', 'K', 'Leeman', 'MD', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 160354', 'Clearfield', 'Davis', 'UT', '84016', '8017748992', '8015250347', 'PO Box 160354', 'Clearfield', 'Davis', 'UT', '84016', '8017748992', '8015250347', '', '', '1000', '52.50', '0.00', '0.00', 3, '2012-07-01', '2013-06-14', 1, 12, 0, '', '', '', '', 'HCFA|UB|', '1831174333', 0, 'Y', 0, '2012-11-26', NULL, NULL, 0, 0, NULL, NULL),
('870571510', 'W12020230', 'W12020230', 'UT01', 'Layton Ambulatory Anesthesia', 'Earl', 'K', 'Leeman', 'MD', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 160354', 'Clearfield', 'Davis', 'UT', '84016', '8017748992', '8015250347', 'PO Box 160354', 'Clearfield', 'Davis', 'UT', '84016', '8017748992', '8015250347', '', '', '1000', '54.00', '0.00', '0.00', 3, '2013-06-15', NULL, 1, 12, 0, '', '', '', '', 'HCFA|UB|', '1831174333', 0, 'Y', 0, '2012-11-26', NULL, NULL, 0, 0, NULL, NULL),
('870571510', 'W12020231', 'W12020231', 'UT01', 'Layton Ambulatory Anesthesia', 'William', 'R', 'Lowe', 'MD', 'Anesthesia', '', '', NULL, 'B', 'PO Box 160354', 'Clearfield', 'Davis', 'UT', '84016', '8017748992', '8015250347', 'PO Box 160354', 'Clearfield', 'Davis', 'UT', '84016', '8017748992', '8015250347', '', '', '1000', '52.50', '0.00', '0.00', 3, '2012-07-01', '2013-06-14', 1, 12, 0, '', '', '', '', 'HCFA|UB|', '1114110608', 0, 'N', 0, '2012-11-26', NULL, NULL, 0, 0, NULL, NULL),
('870571510', 'W12020232', 'W12020232', 'UT01', 'Layton Ambulatory Anesthesia', 'William', 'R', 'Lowe', 'MD', 'Anesthesia', '', '', NULL, 'B', 'PO Box 160354', 'Clearfield', 'Davis', 'UT', '84016', '8017748992', '8015250347', 'PO Box 160354', 'Clearfield', 'Davis', 'UT', '84016', '8017748992', '8015250347', '', '', '1000', '54.00', '0.00', '0.00', 3, '2013-06-15', NULL, 1, 12, 0, '', '', '', '', 'HCFA|UB|', '1114110608', 0, 'N', 0, '2012-11-26', NULL, NULL, 0, 0, NULL, NULL),
('870571510', 'W12020233', 'W12020233', 'UT01', 'Layton Ambulatory Anesthesia', 'Clark', 'E', 'Petersen', 'MD', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 160354', 'Clearfield', 'Davis', 'UT', '84016', '8017748992', '8015250347', 'PO Box 160354', 'Clearfield', 'Davis', 'UT', '84016', '8017748992', '8015250347', '', '', '1000', '52.50', '0.00', '0.00', 3, '2012-07-01', '2013-06-14', 1, 12, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1275519894', 0, 'Y', 0, '2012-11-26', NULL, NULL, 0, 0, NULL, NULL),
('870571510', 'W12020234', 'W12020234', 'UT01', 'Layton Ambulatory Anesthesia', 'Clark', 'E', 'Petersen', 'MD', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 160354', 'Clearfield', 'Davis', 'UT', '84016', '8017748992', '8015250347', 'PO Box 160354', 'Clearfield', 'Davis', 'UT', '84016', '8017748992', '8015250347', '', '', '1000', '54.00', '0.00', '0.00', 3, '2013-06-15', NULL, 1, 12, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1275519894', 0, 'Y', 0, '2012-11-26', NULL, NULL, 0, 0, NULL, NULL),
('830258707', 'W12020235', 'W12020235', 'WY01', 'Wyoming Surgical Associates', 'James', '', 'Anderson', 'MD', 'Colon and Rectal Surgery', 'General Surgery', 'Vascular Surgery', NULL, 'O', '419 S Washington St Ste 102', 'Casper', 'Natrona', 'WY', '82601', '3075774220', '3072350931', '419 S Washington St Ste 102', 'Casper', 'Natrona', 'WY', '82601', '3075774220', '3072350931', '', '', '', '0.00', '12.00', '0.00', 3, '2012-06-15', NULL, 0, 0, 0, 'Wyoming Medical Center ', NULL, NULL, NULL, 'HCFA|UB|', '1205822442', 0, 'N', 0, '2012-06-27', NULL, NULL, 42.8464, -106.31, NULL, NULL),
('830258707', 'W12020236', 'W12020236', 'WYT2', 'Wyoming Surgical Associates', 'James', '', 'Anderson', 'MD', 'Colon and Rectal Surgery', 'General Surgery', 'Vascular Surgery', NULL, 'O', '419 S Washington St Ste 102', 'Casper', 'Natrona', 'WY', '82601', '3075774220', '3072350931', '419 S Washington St Ste 102', 'Casper', 'Natrona', 'WY', '82601', '3075774220', '3072350931', '', '', '', '0.00', '12.00', '0.00', 3, '2012-06-15', NULL, 0, 0, 1, 'Wyoming Medical Center ', NULL, NULL, NULL, 'HCFA|UB|', '1205822442', 0, 'Y', 0, '2012-06-27', NULL, NULL, 0, 0, NULL, NULL),
('870571510', 'W12020237', 'W12020237', 'UT01', 'Layton Ambulatory Anesthesia', 'Christopher', 'G', 'Reveley', 'MD', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 160354', 'Clearfield', 'Davis', 'UT', '84016', '8017748992', '8015250347', 'PO Box 160354', 'Clearfield', 'Davis', 'UT', '84016', '8017748992', '8015250347', '', '', '1000', '52.50', '0.00', '0.00', 3, '2012-07-01', '2013-06-14', 1, 12, 0, '', '', '', '', 'HCFA|UB|', '1144206723', 0, 'Y', 0, '2012-11-26', NULL, NULL, 0, 0, NULL, NULL),
('870571510', 'W12020238', 'W12020238', 'UT01', 'Layton Ambulatory Anesthesia', 'Christopher', 'G', 'Reveley', 'MD', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 160354', 'Clearfield', 'Davis', 'UT', '84016', '8017748992', '8015250347', 'PO Box 160354', 'Clearfield', 'Davis', 'UT', '84016', '8017748992', '8015250347', '', '', '1000', '54.00', '0.00', '0.00', 3, '2013-06-15', NULL, 1, 12, 0, '', '', '', '', 'HCFA|UB|', '1144206723', 0, 'Y', 0, '2012-11-26', NULL, NULL, 0, 0, NULL, NULL),
('870571510', 'W12020239', 'W12020239', 'UT01', 'Layton Ambulatory Anesthesia', 'Robert', 'M', 'Sorensen', 'MD', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 160354', 'Clearfield', 'Davis', 'UT', '84016', '8017748992', '8015250347', 'PO Box 160354', 'Clearfield', 'Davis', 'UT', '84016', '8017748992', '8015250347', '', '', '1000', '52.50', '0.00', '0.00', 3, '2012-07-01', '2013-06-14', 1, 12, 0, '', '', '', '', 'HCFA|UB|', '1609852243', 0, 'Y', 0, '2012-11-26', NULL, NULL, 0, 0, NULL, NULL),
('870571510', 'W12020240', 'W12020240', 'UT01', 'Layton Ambulatory Anesthesia', 'Robert', 'M', 'Sorensen', 'MD', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 160354', 'Clearfield', 'Davis', 'UT', '84016', '8017748992', '8015250347', 'PO Box 160354', 'Clearfield', 'Davis', 'UT', '84016', '8017748992', '8015250347', '', '', '1000', '54.00', '0.00', '0.00', 3, '2013-06-15', NULL, 1, 12, 0, '', '', '', '', 'HCFA|UB|', '1609852243', 0, 'Y', 0, '2012-11-26', NULL, NULL, 0, 0, NULL, NULL),
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('371625746', 'W12020244', 'W12020244', 'UT01', 'MountainStar Cardiology St Marks', 'Michael', '', 'Adjei-Poku', 'MD', 'Cardiovascular Disease', NULL, NULL, NULL, 'O', '3584 W 9000 S Ste 209', 'West Jordan', 'Salt Lake', 'UT', '84088', '8016763776', '8016760987', '3584 W 9000 S Ste 209', 'West Jordan', 'Salt Lake', 'UT', '84088', '8016763776', '8016760987', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1528050465', 0, 'N', 0, '2012-11-28', NULL, NULL, 40.5879, -111.976, NULL, NULL),
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('371625746', 'W12020246', 'W12020246', 'UT01', 'MountainStar Cardiology St Marks', 'Michael', '', 'Adjei-Poku', 'MD', 'Cardiovascular Disease', NULL, NULL, NULL, 'O', '74 E Kimballs Ln Ste 260', 'Draper', 'Salt Lake', 'UT', '84020', '8015716100', '8015720505', '74 E Kimballs Ln Ste 260', 'Draper', 'Salt Lake', 'UT', '84020', '8015716100', '8015720505', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1528050465', 0, 'N', 0, '2012-11-28', NULL, NULL, 40.537, -111.889, NULL, NULL),
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('371625746', 'W12020249', 'W12020249', 'UT01', 'MountainStar Cardiology St Marks', 'Michael', '', 'Adjei-Poku', 'MD', 'Cardiovascular Disease', NULL, NULL, NULL, 'B', 'PO Box 741729', 'Atlanta', 'Fulton', 'GA', '30384', '8012663418', '8012664174', 'PO Box 741729', 'Atlanta', 'Fulton', 'GA', '30384', '8012663418', '8012664174', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1528050465', 0, 'N', 0, '2012-11-28', NULL, NULL, 0, 0, NULL, NULL),
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('611572907', 'W12020258', 'W12020258', 'UT01', 'South Ogden Center for Family Medicine', 'Natalie ', '', 'Ahrenstorff', 'PA-C', 'Family Practice', '', '', NULL, 'B', 'PO Box 405714', 'Atlanta', 'Fulton', 'GA', '30384', '8014797771', NULL, 'PO Box 405714', 'Atlanta', 'Fulton', 'GA', '30384', '8014797771', '          ', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1659568293', 0, 'N', 0, '2012-06-22', NULL, NULL, 0, 0, NULL, NULL),
('820299231', 'W12020264', 'W12020264', 'ID02', 'Saltzer Medical Group', 'Scott', '', 'Coleman', 'PAC', 'Physician Assistant', '', '', NULL, 'B', '217 W Georgia Ave Ste 115', 'Nampa', 'Canyon', 'ID', '83686', '2084633280', '2082884987', '217 W Georgia Ave Ste 115', 'Nampa', 'Canyon', 'ID', '83686', '2084633280', '2082884987', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2012-06-18', '2012-12-31', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1649352139', 0, 'N', 0, '2013-02-21', NULL, NULL, 0, 0, NULL, NULL),
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('331177233', 'W12020271', 'W12020271', 'UT01', 'Ogden Adult and Senior Medicine', 'Leslie', 'A', 'Bean', 'APRN', 'Internal Medicine', '', '', NULL, 'O', '5405 S 500 E Ste 100B', 'Ogden', 'Weber', 'UT', '84405', '8014792911', '8014792914', '5405 S 500 E Ste 100B', 'Ogden', 'Weber', 'UT', '84405', '8014792911', '8014792914', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', '2012-05-02', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1336260447', 0, 'N', 0, '2012-08-03', NULL, NULL, 0, 0, NULL, NULL),
('331177233', 'W12020448', 'W12020448', 'UT01', 'Ogden Adult and Senior Medicine', 'Leslie', 'A', 'Bean', 'APRN', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 100925', 'Atlanta', 'Fulton', 'GA', '30384', '8014792911', '8014792914', 'PO Box 100925', 'Atlanta', 'Fulton', 'GA', '30384', '8014792911', '8014792914', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', '2012-05-02', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1336260447', 0, 'N', 0, '2012-08-03', NULL, NULL, 0, 0, NULL, NULL),
('770701557', 'W12020273', 'W12020273', 'UT01', 'Alta Internal Medicine', 'Richard', 'W', 'Bennett', 'MD', 'Internal Medicine', '', '', NULL, 'O', '74 Kimballs Ln Ste 300', 'Draper', 'Salt Lake', 'UT', '84020', '8015720311', '8015711363', '74 Kimballs Ln Ste 300', 'Draper', 'Salt Lake', 'UT', '84020', '8015720311', '8015711363', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1407871510', 0, 'N', 0, '2014-05-28', NULL, NULL, 40.537, -111.889, 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
('770701557', 'W12020274', 'W12020274', 'UT01', 'Alta Internal Medicine', 'Richard', 'W', 'Bennett', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 198560', 'Atlanta', 'Fulton', 'GA', '30384', '8006613365', '8015711369', 'PO Box 198560', 'Atlanta', 'Fulton', 'GA', '30384', '8006613365', '8015711369', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1407871510', 0, 'N', 0, '2014-05-28', NULL, NULL, 0, 0, NULL, NULL),
('331177233', 'W12020275', 'W12020275', 'UT01', 'Ogden Internal Medicine and Urology', 'Melissa', 'J', 'Bentley', 'MD', 'Internal Medicine', '', '', NULL, 'O', '5405 S 500 E Ste 203', 'Ogden', 'Weber', 'UT', '84405', '8014797500', '8014750960', '5405 S 500 E Ste 203', 'Ogden', 'Weber', 'UT', '84405', '8014797500', '8014750960', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1639354897', 0, 'N', 0, '2014-06-11', NULL, NULL, 41.1655, -111.969, NULL, NULL),
('331177233', 'W12020276', 'W12020276', 'UT01', 'Ogden Internal Medicine and Urology', 'Melissa', 'J', 'Bentley', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 100925', 'Atlanta', 'Fulton', 'GA', '30384', '6153737600', '8014750960', 'PO Box 100925', 'Atlanta', 'Fulton', 'GA', '30384', '6153737600', '8014750960', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1639354897', 0, 'N', 0, '2012-06-23', NULL, NULL, 0, 0, NULL, NULL),
('161767581', 'W12020277', 'W12020277', 'UT01', 'Layton Family Practice', 'Charles', 'J', 'Berwald', 'MD', 'Family Practice', '', '', NULL, 'O', '2950 N Church St Ste 200', 'Layton', 'Davis', 'UT', '84040', '8015469441', '          ', '2950 N Church St Ste 200', 'Layton', 'Davis', 'UT', '84040', '8015469441', '          ', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', '2014-04-04', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1194812925', 0, 'N', 0, '2014-04-14', NULL, NULL, 41.1009, -111.939, NULL, NULL),
('611572907', 'W12020278', 'W12020278', 'UT01', 'South Ogden Center for Family Medicine', 'James', 'A', 'Bledsoe', 'DO', 'Family Practice', '', '', NULL, 'O', '5740 Crestwood Dr', 'Ogden', 'Weber', 'UT', '84405', '8014797771', NULL, '5740 Crestwood Dr', 'Ogden', 'Weber', 'UT', '84405', '8014797771', '          ', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1669467544', 0, 'N', 0, '2012-06-23', NULL, NULL, 41.1583, -111.947, NULL, NULL),
('611572907', 'W12020279', 'W12020279', 'UT01', 'South Ogden Center for Family Medicine', 'James', 'A', 'Bledsoe', 'DO', 'Family Practice', '', '', NULL, 'B', 'PO Box 405714', 'Atlanta', 'Fulton', 'GA', '30384', '8014797771', NULL, 'PO Box 405714', 'Atlanta', 'Fulton', 'GA', '30384', '8014797771', '          ', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1669467544', 0, 'N', 0, '2012-06-23', NULL, NULL, 0, 0, NULL, NULL),
('900657284', 'W12020280', 'W12020280', 'UT01', 'Gynecology Specialists of Utah', 'Amber', 'D', 'Bradshaw', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'M', '3 Maryland Farms Ste 250', 'Brentwood', 'Williamson', 'TN', '37027', '8014764200', '8014762070', '3 Maryland Farms Ste 250', 'Brentwood', 'Williamson', 'TN', '37027', '8014764200', '8014762070', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1659589737', 0, 'N', 0, '2012-06-23', NULL, NULL, 0, 0, NULL, NULL),
('900657284', 'W12020281', 'W12020281', 'UT01', 'Gynecology Specialists of Utah', 'Amber', 'D', 'Bradshaw', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '5495 S 500 E Ste 320', 'Ogden', 'Weber', 'UT', '84405', '8014764200', '8014762070', '5495 S 500 E Ste 320', 'Ogden', 'Weber', 'UT', '84405', '8014764200', '8014762070', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1659589737', 0, 'N', 0, '2012-06-23', NULL, NULL, 41.1634, -111.969, NULL, NULL),
('900657284', 'W12020282', 'W12020282', 'UT01', 'Gynecology Specialists of Utah', 'Amber', 'D', 'Bradshaw', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 741617', 'Atlanta', 'Fulton', 'GA', '30374', '8014764200', '8014762070', 'PO Box 741617', 'Atlanta', 'Fulton', 'GA', '30374', '8014764200', '8014762070', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1659589737', 0, 'N', 0, '2012-06-23', NULL, NULL, 0, 0, NULL, NULL),
('371625746', 'W12020283', 'W12020283', 'UT01', 'MountainStar Cardiology St Marks', 'Ronald', 'E', 'Brown', 'MD', 'Cardiovascular Disease', NULL, NULL, NULL, 'O', '1160 E 3900 S Ste 2000', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012663418', '8012664174', '1160 E 3900 S Ste 2000', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012663418', '8012664174', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1447242060', 0, 'N', 0, '2012-06-23', NULL, NULL, 40.6871, -111.858, NULL, NULL),
('371625746', 'W12020284', 'W12020284', 'UT01', 'MountainStar Cardiology St Marks', 'Ronald', 'E', 'Brown', 'MD', 'Cardiovascular Disease', NULL, NULL, NULL, 'O', '3584 W 9000 S Ste 209', 'West Jordan', 'Salt Lake', 'UT', '84088', '8016763776', '8016760987', '3584 W 9000 S Ste 209', 'West Jordan', 'Salt Lake', 'UT', '84088', '8016763776', '8016760987', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1447242060', 0, 'N', 0, '2012-06-23', NULL, NULL, 40.5879, -111.976, NULL, NULL),
('371625746', 'W12020285', 'W12020285', 'UT01', 'MountainStar Cardiology St Marks', 'Ronald', 'E', 'Brown', 'MD', 'Cardiovascular Disease', NULL, NULL, NULL, 'O', '3725 W 4100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8016763776', '8016760987', '3725 W 4100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8016763776', '8016760987', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1447242060', 0, 'N', 0, '2012-06-23', NULL, NULL, 40.682, -111.979, NULL, NULL),
('371625746', 'W12020286', 'W12020286', 'UT01', 'MountainStar Cardiology St Marks', 'Ronald', 'E', 'Brown', 'MD', 'Cardiovascular Disease', NULL, NULL, NULL, 'O', '74 E Kimballs Ln Ste 260', 'Draper', 'Salt Lake', 'UT', '84020', '8015716100', '8015720505', '74 E Kimballs Ln Ste 260', 'Draper', 'Salt Lake', 'UT', '84020', '8015716100', '8015720505', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1447242060', 0, 'N', 0, '2012-06-23', NULL, NULL, 40.537, -111.889, NULL, NULL),
('371625746', 'W12020287', 'W12020287', 'UT01', 'MountainStar Cardiology St Marks', 'Ronald', 'E', 'Brown', 'MD', 'Cardiovascular Disease', NULL, NULL, NULL, 'O', '8846 S Redwood Rd Ste E-121', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015691999', '8015692001', '8846 S Redwood Rd Ste E-121', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015691999', '8015692001', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1447242060', 0, 'N', 0, '2012-06-23', NULL, NULL, 40.5911, -111.939, NULL, NULL),
('371625746', 'W12020288', 'W12020288', 'UT01', 'MountainStar Cardiology St Marks', 'Ronald', 'E', 'Brown', 'MD', 'Cardiovascular Disease', NULL, NULL, NULL, 'B', 'PO Box 741729', 'Atlanta', 'Fulton', 'GA', '30384', '8012663418', '8012664174', 'PO Box 741729', 'Atlanta', 'Fulton', 'GA', '30384', '8012663418', '8012664174', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1447242060', 0, 'N', 0, '2012-06-23', NULL, NULL, 0, 0, NULL, NULL),
('611572907', 'W12020289', 'W12020289', 'UT01', '', 'Stephen', 'J', 'Bruce', 'MD', 'Family Practice', '', '', NULL, 'O', '5740 Crestwood Dr', 'Ogden', 'Weber', 'UT', '84405', '8014757966', NULL, '5740 Crestwood Dr', 'Ogden', 'Weber', 'UT', '84405', '8014757966', '', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1841269321', 0, 'N', 0, '2014-04-04', NULL, NULL, 41.1583, -111.947, NULL, NULL),
('800481035', 'W12020290', 'W12020290', 'UT01', 'Mountainstar Canyon Surgical Clinic ', 'Lance', 'R', 'Bryce', 'MD', 'General Surgery', '', '', NULL, 'O', '2850 N 2000 W Ste 101', 'Ogden', 'Weber', 'UT', '84404', '8017311222', '8017311666', '2850 N 2000 W Ste 101', 'Ogden', 'Weber', 'UT', '84404', '8017311222', '8017311666', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1639372840', 0, 'N', 0, '2013-10-15', NULL, NULL, 41.3105, -112.028, NULL, NULL),
('800481035', 'W12020291', 'W12020291', 'UT01', 'Mountainstar Canyon Surgical Clinic ', 'Lance', 'R', 'Bryce', 'MD', 'General Surgery', '', '', NULL, 'M', '3 Marlyand Farms Ste 250', 'Brentwood', 'Williamson', 'TN', '37027', '8006613365', '8017311666', '3 Marlyand Farms Ste 250', 'Brentwood', 'Williamson', 'TN', '37027', '8006613365', '8017311666', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1639372840', 0, 'N', 0, '2013-10-15', NULL, NULL, 0, 0, NULL, NULL),
('800481035', 'W12020292', 'W12020292', 'UT01', 'Mountainstar Canyon Surgical Clinic ', 'Lance', 'R', 'Bryce', 'MD', 'General Surgery', '', '', NULL, 'O', '984 S Medical Dr Ste 2', 'Brigham City', 'Box Elder', 'UT', '84302', '4357230329', '4357230429', '984 S Medical Dr Ste 2', 'Brigham City', 'Box Elder', 'UT', '84302', '4357230329', '4357230429', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1639372840', 0, 'N', 0, '2013-10-15', NULL, NULL, 41.4888, -112.026, NULL, NULL),
('800481035', 'W12020293', 'W12020293', 'UT01', 'Mountainstar Canyon Surgical Clinic ', 'Lance', 'R', 'Bryce', 'MD', 'General Surgery', '', '', NULL, 'B', 'PO Box 402302', 'Atlanta', 'Fulton', 'GA', '30384', '8006613365', '8017311666', 'PO Box 402302', 'Atlanta', 'Fulton', 'GA', '30384', '8006613365', '8017311666', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1639372840', 0, 'N', 0, '2013-10-15', NULL, NULL, 0, 0, NULL, NULL),
('611572907', 'W12020294', 'W12020294', 'UT01', '', 'Alan', 'N', 'Bybee', 'PA', 'Family Practice', NULL, NULL, NULL, 'O', '166 N State St', 'Morgan', 'Morgan', 'UT', '84050', '8018293426', NULL, '166 N State St', 'Morgan', 'Morgan', 'UT', '84050', '8018293426', '          ', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1033184940', 0, 'N', 0, '2012-06-23', NULL, NULL, 41.039, -111.679, NULL, NULL),
('743096310', 'W12020295', 'W12020295', 'UT01', 'St Marks Pain Center', 'David', 'D', 'Byrd', 'MD', 'Pain Management', '', '', NULL, 'O', '1200 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012687729', NULL, '1200 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012687729', '', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1720173164', 0, 'N', 0, '2014-04-24', NULL, NULL, 40.6871, -111.856, NULL, NULL),
('743096310', 'W12020296', 'W12020296', 'UT01', 'St Marks Pain Center', 'David', 'D', 'Byrd', 'MD', 'Pain Management', '', '', NULL, 'B', 'PO Box 271220', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '6153737629', NULL, 'PO Box 271220', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '6153737629', '', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1720173164', 0, 'Y', 0, '2014-04-24', NULL, NULL, 0, 0, NULL, NULL),
('352329743', 'W12020297', 'W12020297', 'UT01', 'Mountain Star Pediatrics', 'David', 'F', 'Castro', 'PA-C', 'Pediatrics', '', '', NULL, 'O', '5495 S 500 E Ste 120', 'Ogden', 'Weber', 'UT', '84405', '8014790174', NULL, '5495 S 500 E Ste 120', 'Ogden', 'Weber', 'UT', '84405', '8014790174', '          ', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1427254135', 0, 'N', 0, '2012-06-23', NULL, NULL, 41.1634, -111.969, NULL, NULL),
('352329743', 'W12020298', 'W12020298', 'UT01', 'Mountain Star Pediatrics', 'Jan', 'M', 'Castro', 'PA-C', 'Pediatrics', '', '', NULL, 'O', '5495 S 500 E Ste 120', 'Ogden', 'Weber', 'UT', '84405', '8014790174', '          ', '5495 S 500 E Ste 120', 'Ogden', 'Weber', 'UT', '84405', '8014790174', '          ', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1235335944', 0, 'N', 0, '2014-04-04', NULL, NULL, 41.1634, -111.969, NULL, NULL),
('061787631', 'W12020299', 'W12020299', 'UT01', 'Lone Peak General Surgery', 'Ian', 'R', 'Cavin', 'DO', 'General Surgery', '', '', NULL, 'O', '4000 S 700 E Ste 9', 'Murray', 'Salt Lake', 'UT', '84107', '8012623564', '8012623613', '4000 S 700 E Ste 9', 'Murray', 'Salt Lake', 'UT', '84107', '8012623564', '8012623613', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', '2014-06-30', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1184647315', 0, 'N', 0, '2014-05-15', NULL, NULL, 40.6857, -111.871, NULL, NULL),
('061787631', 'W12020300', 'W12020300', 'UT01', 'Lone Peak General Surgery', 'Ian', 'R', 'Cavin', 'DO', 'General Surgery', '', '', NULL, 'O', '74 Kimballs Ln Ste 210', 'Draper', 'Salt Lake', 'UT', '84020', '8015663062', '8015018219', '74 Kimballs Ln Ste 210', 'Draper', 'Salt Lake', 'UT', '84020', '8015663062', '8015018219', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', '2014-06-30', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1184647315', 0, 'N', 0, '2014-05-15', NULL, NULL, 40.537, -111.889, NULL, NULL),
('061787631', 'W12020301', 'W12020301', 'UT01', 'Jordan Family Health', 'Ian', 'R', 'Cavin', 'DO', 'General Surgery', '', '', NULL, 'O', '8846 S Redwood Rd Ste E121', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015691999', '          ', '8846 S Redwood Rd Ste E121', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015691999', '          ', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', '2014-06-30', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1184647315', 0, 'N', 0, '2014-05-15', NULL, NULL, 40.5911, -111.939, NULL, NULL),
('061787631', 'W12020302', 'W12020302', 'UT01', 'Lone Peak General Surgery', 'Ian', 'R', 'Cavin', 'DO', 'General Surgery', '', '', NULL, 'B', 'PO Box 100253', 'Atlanta', 'Fulton', 'GA', '30384', '8006613365', '          ', 'PO Box 100253', 'Atlanta', 'Fulton', 'GA', '30384', '8006613365', '          ', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', '2014-06-30', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1184647315', 0, 'Y', 0, '2014-05-15', NULL, NULL, 0, 0, NULL, NULL),
('770701557', 'W12020303', 'W12020303', 'UT01', 'MountainStar Jordan Family Health', 'Erin', '', 'Coppin', 'PA', 'Family Practice', '', '', NULL, 'O', '8846 S Redwood Rd Ste E-121', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015691999', '8015692001', '8846 S Redwood Rd Ste E-121', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015691999', '8015692001', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1922066042', 0, 'N', 0, '2012-06-23', NULL, NULL, 40.5911, -111.939, NULL, NULL),
('770701557', 'W12020304', 'W12020304', 'UT01', 'MountainStar Jordan Family Health', 'Erin', '', 'Coppin', 'PA', 'Family Practice', '', '', NULL, 'B', 'PO Box 198560', 'Atlanta', 'Fulton', 'GA', '30384', '8015691999', '8015692001', 'PO Box 198560', 'Atlanta', 'Fulton', 'GA', '30384', '8015691999', '8015692001', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1922066042', 0, 'N', 0, '2012-06-23', NULL, NULL, 0, 0, NULL, NULL),
('770701557', 'W12020305', 'W12020305', 'UT01', 'St Marks Millcreek Primary Care', 'Robert', '', 'Corson', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 198560', 'Atlanta', 'Fulton', 'GA', '30384', '6153737600', '8012662362', 'PO Box 198560', 'Atlanta', 'Fulton', 'GA', '30384', '6153737600', '8012662362', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1902899545', 0, 'N', 0, '2014-04-16', NULL, NULL, 0, 0, NULL, NULL),
('770701557', 'W12020306', 'W12020306', 'UT01', 'St Marks Millcreek Primary Care', 'Robert', '', 'Corson', 'MD', 'Family Practice', '', '', NULL, 'O', '4465 S 900 E Ste 200', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012662777', '8012661377', '4465 S 900 E Ste 200', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012662777', '8012661377', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1902899545', 0, 'N', 0, '2014-04-16', NULL, NULL, 40.6753, -111.866, NULL, NULL),
('611572907', 'W12020307', 'W12020307', 'UT01', 'Mountain Star Medical Group', 'Adam', 'C', 'Craner', 'FNP-C', 'Internal Medicine', 'Family Practice', '', NULL, 'O', '5405 S 500 E Ste 100', 'Ogden', 'Weber', 'UT', '84405', '8014757966', NULL, '5405 S 500 E Ste 100', 'Ogden', 'Weber', 'UT', '84405', '8014757966', '          ', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1952326357', 0, 'N', 0, '2012-06-25', NULL, NULL, 41.1655, -111.969, NULL, NULL),
('611572907', 'W12020308', 'W12020308', 'UT01', 'Mountain Star Medical Group', 'Adam', 'C', 'Craner', 'FNP-C', 'Internal Medicine', 'Family Practice', '', NULL, 'B', 'PO Box 405714', 'Atlanta', 'Fulton', 'GA', '30384', '8014757966', NULL, 'PO Box 405714', 'Atlanta', 'Fulton', 'GA', '30384', '8014757966', '          ', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1952326357', 0, 'N', 0, '2012-06-25', NULL, NULL, 0, 0, NULL, NULL),
('134332141', 'W12020309', 'W12020309', 'UT01', 'MountainStar Cardiovascular Surgery', 'Analee', '', 'Creer', 'APRN', 'Cardiovascular Disease', '', '', NULL, 'O', '1160 E 3900 S Ste 3500', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8017434750', NULL, '1160 E 3900 S Ste 3500', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8017434750', '          ', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', 'St Marks Hospital', '', '', 'HCFA|UB|', '1689856320', 0, 'N', 0, '2012-06-25', NULL, NULL, 40.6871, -111.858, NULL, NULL),
('134332141', 'W12020310', 'W12020310', 'UT01', 'MountainStar Cardiovascular Surgery', 'Analee', '', 'Creer', 'APRN', 'Cardiovascular Disease', '', '', NULL, 'O', '698 W 800 N Ste 210', 'Orem', 'Utah', 'UT', '84057', '8017146412', NULL, '698 W 800 N Ste 210', 'Orem', 'Utah', 'UT', '84057', '8017146412', '          ', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', 'St Marks Hospital', '', '', 'HCFA|UB|', '1689856320', 0, 'N', 0, '2012-06-25', NULL, NULL, 40.3121, -111.713, NULL, NULL),
('770701557', 'W12006937', 'W12006937', 'UT01', 'Alta Internal Medicine', 'Scott', 'G', 'Anders', 'MD', 'Family Practice', '', '', NULL, 'O', '74 Kimballs Ln Ste 300', 'Draper', 'Salt Lake', 'UT', '84020', '8015720311', '8015711369', '74 Kimballs Ln Ste 300', 'Draper', 'Salt Lake', 'UT', '84020', '8015720311', '8015711369', 'wise+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-10-01', '2012-06-30', 0, 0, 0, 'Mountain West Medical Center', '', '', '', 'HCFA|UB|', '1194838128', 0, 'N', 0, '2012-06-25', NULL, NULL, 0, 0, NULL, NULL),
('770701557', 'W12020267', 'W12020267', 'UT01', 'Alta Internal Medicine', 'Scott', 'G', 'Anders', 'MD', 'Family Practice', '', '', NULL, 'O', '74 Kimballs Ln Ste 300', 'Draper', 'Salt Lake', 'UT', '84020', '8015720311', '8015711369', '74 Kimballs Ln Ste 300', 'Draper', 'Salt Lake', 'UT', '84020', '8015720311', '8015711369', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'Mountain West Medical Center', '', '', '', 'HCFA|UB|', '1194838128', 0, 'N', 0, '2013-07-25', NULL, NULL, 40.537, -111.889, NULL, NULL),
('770701557', 'W12006938', 'W12006938', 'UT01', 'Alta Internal Medicine', 'Scott', 'G', 'Anders', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 198560', 'Atlanta', 'Fulton', 'GA', '30384', '6153737600', '8015711369', 'PO Box 198560', 'Atlanta', 'Fulton', 'GA', '30384', '6153737600', '8015711369', 'wise+5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2010-10-01', '2012-06-30', 0, 0, 0, 'Mountain West Medical Center', '', '', '', 'HCFA|UB|', '1194838128', 0, 'N', 0, '2012-06-25', NULL, NULL, 0, 0, NULL, NULL),
('770701557', 'W12020268', 'W12020268', 'UT01', 'Alta Internal Medicine', 'Scott', 'G', 'Anders', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 198560', 'Atlanta', 'Fulton', 'GA', '30384', '6153737600', '8015711369', 'PO Box 198560', 'Atlanta', 'Fulton', 'GA', '30384', '6153737600', '8015711369', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'Mountain West Medical Center', '', '', '', 'HCFA|UB|', '1194838128', 0, 'N', 0, '2013-07-25', NULL, NULL, 0, 0, NULL, NULL),
('770701557', 'W12020312', 'W12020312', 'UT01', 'MountainStar Jordan Family Health', 'David', 'E', 'Curtis', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '8846 S Redwood Rd Ste E-121', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015691999', '8015692001', '8846 S Redwood Rd Ste E-121', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015691999', '8015692001', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1730222720', 0, 'N', 0, '2012-06-25', NULL, NULL, 40.5911, -111.939, NULL, NULL),
('770701557', 'W12020313', 'W12020313', 'UT01', 'MountainStar Jordan Family Health', 'David', 'E', 'Curtis', 'MD', 'Orthopedic Surgery', '', '', NULL, 'B', 'PO Box 198560', 'Atlanta', 'Fulton', 'GA', '30384', '8015691999', '8015692001', 'PO Box 198560', 'Atlanta', 'Fulton', 'GA', '30384', '8015691999', '8015692001', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1730222720', 0, 'N', 0, '2012-06-25', NULL, NULL, 0, 0, NULL, NULL),
('820454312', 'W12020311', 'W12020311', 'ID02', 'Progressive Nursing Services Inc', '', '', 'Progressive Nursing Services Inc', 'GROUP', 'Home Health Agency', '', '', NULL, 'O', '1514 Shoshone St', 'Boise', 'Ada', 'ID', '83705', '2083369898', '2083445980', '1514 Shoshone St', 'Boise', 'Ada', 'ID', '83705', '2083369898', '2083445980', 'IDHOMEHEALTH', 'DME80', '', '0.00', '35.00', '0.00', 3, '2012-01-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1104889526', 0, 'N', 0, '2013-02-26', NULL, NULL, 0, 0, NULL, NULL),
('061787631', 'W12020314', 'W12020314', 'UT01', 'Lone Peak General Surgery', 'Charles', 'R', 'Davis', 'MD', 'General Surgery', '', '', NULL, 'O', '4000 S 700 E Ste 9', 'Murray', 'Salt Lake', 'UT', '84107', '8012623564', '8012623613', '4000 S 700 E Ste 9', 'Murray', 'Salt Lake', 'UT', '84107', '8012623564', '8012623613', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', '2014-06-30', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1326136565', 0, 'N', 0, '2014-05-15', NULL, NULL, 40.6857, -111.871, NULL, NULL),
('061787631', 'W12020315', 'W12020315', 'UT01', 'Lone Peak General Surgery', 'Charles', 'R', 'Davis', 'MD', 'General Surgery', '', '', NULL, 'O', '74 Kimballs Ln', 'Draper', 'Salt Lake', 'UT', '84020', '8015663062', '8015018219', '74 Kimballs Ln', 'Draper', 'Salt Lake', 'UT', '84020', '8015663062', '8015018219', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', '2014-06-30', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1326136565', 0, 'N', 0, '2014-05-15', NULL, NULL, 40.537, -111.889, NULL, NULL),
('061787631', 'W12020316', 'W12020316', 'UT01', 'Jordan Family Health', 'Charles', 'R', 'Davis', 'MD', 'General Surgery', '', '', NULL, 'O', '8846 S Redwood Rd Ste E121', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015691999', '          ', '8846 S Redwood Rd Ste E121', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015691999', '          ', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', '2014-06-30', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1326136565', 0, 'N', 0, '2014-05-15', NULL, NULL, 40.5911, -111.939, NULL, NULL),
('061787631', 'W12020317', 'W12020317', 'UT01', 'Lone Peak General Surgery', 'Charles', 'R', 'Davis', 'MD', 'General Surgery', '', '', NULL, 'B', 'PO Box 100253', 'Atlanta', 'Fulton', 'GA', '30384', '8015663062', '          ', 'PO Box 100253', 'Atlanta', 'Fulton', 'GA', '30384', '8015663062', '          ', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', '2014-06-30', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1326136565', 0, 'Y', 0, '2014-05-15', NULL, NULL, 0, 0, NULL, NULL),
('743096310', 'W12020318', 'W12020318', 'UT01', 'St Marks Senior Center', 'Alexander', '', 'Del Castillo', 'MD', 'Geriatrics', 'Internal Medicine', '', NULL, 'O', '1160 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012687766', NULL, '1160 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012687766', '          ', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1881705168', 0, 'N', 0, '2014-02-06', NULL, NULL, 40.6871, -111.858, NULL, NULL),
('743096310', 'W12020319', 'W12020319', 'UT01', 'St Marks Senior Center', 'Alexander', '', 'Del Castillo', 'MD', 'Geriatrics', 'Internal Medicine', '', NULL, 'B', 'PO Box 271220', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '6153737629', NULL, 'PO Box 271220', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '6153737629', '          ', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1881705168', 0, 'Y', 0, '2014-02-06', NULL, NULL, 0, 0, NULL, NULL),
('770701557', 'W12020320', 'W12020320', 'UT01', 'Lone Peak Primary Care', 'Nichole', 'A', 'Delaplante', 'DO', 'Family Practice', '', '', NULL, 'O', '74 Kimballs Ln Ste 260', 'Draper', 'Salt Lake', 'UT', '84020', '8015458480', '8014548495', '74 Kimballs Ln Ste 260', 'Draper', 'Salt Lake', 'UT', '84020', '8015458480', '8014548495', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1831344910', 0, 'N', 0, '2012-06-25', NULL, NULL, 40.537, -111.889, NULL, NULL),
('770701557', 'W12020321', 'W12020321', 'UT01', 'Lone Peak Primary Care', 'Nichole', 'A', 'Delaplante', 'DO', 'Family Practice', '', '', NULL, 'B', 'PO Box 198560', 'Atlanta', 'Fulton', 'GA', '30384', '8015458480', '8014548495', 'PO Box 198560', 'Atlanta', 'Fulton', 'GA', '30384', '8015458480', '8014548495', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1831344910', 0, 'N', 0, '2012-06-25', NULL, NULL, 0, 0, NULL, NULL),
('331177233', 'W12020322', 'W12020322', 'UT01', 'Layton Specialty Clinic', 'Kathleen', 'R', 'DeRemer', 'MD', 'Internal Medicine', '', '', NULL, 'O', '2950 N Church St Ste 101-A', 'Layton', 'Davis', 'UT', '84040', '8017717202', '8017717242', '2950 N Church St Ste 101-A', 'Layton', 'Davis', 'UT', '84040', '8017717202', '8017717242', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1437267192', 0, 'N', 0, '2013-08-21', NULL, NULL, 41.1009, -111.939, NULL, NULL),
('331177233', 'W12020323', 'W12020323', 'UT01', 'Ogden Internal Medicine ', 'Kathleen', 'R', 'DeRemer', 'MD', 'Internal Medicine', '', '', NULL, 'O', '5405 S 500 E Ste 203', 'Ogden', 'Weber', 'UT', '84405', '8014754617', '8014758686', '5405 S 500 E Ste 203', 'Ogden', 'Weber', 'UT', '84405', '8014754617', '8014758686', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1437267192', 0, 'N', 0, '2013-08-21', NULL, NULL, 41.1655, -111.969, NULL, NULL),
('331177233', 'W12020324', 'W12020324', 'UT01', 'Ogden Internal Medicine ', 'Kathleen', 'R', 'DeRemer', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 100925', 'Atlanta', 'Fulton', 'GA', '30384', '8014758600', NULL, 'PO Box 100925', 'Atlanta', 'Fulton', 'GA', '30384', '8014758600', '          ', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1437267192', 0, 'N', 0, '2013-08-21', NULL, NULL, 0, 0, NULL, NULL),
('770701557', 'W12020325', 'W12020325', 'UT01', 'St Marks Millcreek Primary Care', 'An', 'T', 'Dinh', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '4465 S 900 E Ste 200', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012662777', '8012661377', '4465 S 900 E Ste 200', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012662777', '8012661377', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'Mountain West Medical Center', '', '', '', 'HCFA|UB|', '1144319997', 0, 'N', 0, '2013-07-25', NULL, NULL, 40.6753, -111.866, NULL, NULL),
('770701557', 'W12020326', 'W12020326', 'UT01', 'St Marks Millcreek Primary Care', 'An', 'T', 'Dinh', 'MD', 'Family Practice', NULL, NULL, NULL, 'B', 'PO Box 198560', 'Atlanta', 'Fulton', 'GA', '30384', '8006613365', '8012661377', 'PO Box 198560', 'Atlanta', 'Fulton', 'GA', '30384', '8006613365', '8012661377', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'Mountain West Medical Center', '', '', '', 'HCFA|UB|', '1144319997', 0, 'N', 0, '2013-07-25', NULL, NULL, 0, 0, NULL, NULL),
('134332141', 'W12020327', 'W12020327', 'UT01', 'MountainStar Cardiovascular Surgery', 'Wendy', 'S', 'Douglas', 'APRN', 'Cardiovascular Disease', '', '', NULL, 'O', '1160 E 3900 S Ste 3500', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8017434750', NULL, '1160 E 3900 S Ste 3500', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8017434750', '          ', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1427297084', 0, 'N', 0, '2012-06-25', NULL, NULL, 40.6871, -111.858, NULL, NULL),
('134332141', 'W12020328', 'W12020328', 'UT01', 'MountainStar Cardiovascular Surgery', 'Wendy', 'S', 'Douglas', 'APRN', 'Cardiovascular Disease', '', '', NULL, 'O', '5405 S 500 E Ste 200', 'Ogden', 'Weber', 'UT', '84405', '8014766900', NULL, '5405 S 500 E Ste 200', 'Ogden', 'Weber', 'UT', '84405', '8014766900', '          ', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1427297084', 0, 'N', 0, '2012-06-25', NULL, NULL, 41.1655, -111.969, NULL, NULL),
('134332141', 'W12020329', 'W12020329', 'UT01', 'MountainStar Cardiovascular Surgery', 'Wendy', 'S', 'Douglas', 'APRN', 'Cardiovascular Disease', '', '', NULL, 'B', 'PO Box 281490', 'Atlanta', 'Fulton', 'GA', '30384', '8017434750', NULL, 'PO Box 281490', 'Atlanta', 'Fulton', 'GA', '30384', '8017434750', '          ', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1427297084', 0, 'N', 0, '2012-06-25', NULL, NULL, 0, 0, NULL, NULL),
('770701557', 'W12020331', 'W12020331', 'UT01', 'Lone Peak Primary Care', 'Anne', 'M', 'Dubosky', 'DO', 'Family Practice', '', '', NULL, 'B', 'PO Box 198560', 'Atlanta', 'Fulton', 'GA', '30384', '8015458480', '8015458495', 'PO Box 198560', 'Atlanta', 'Fulton', 'GA', '30384', '8015458480', '8015458495', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', '2014-01-14', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1295769446', 0, 'N', 0, '2014-04-10', NULL, NULL, 0, 0, NULL, NULL),
('371625746', 'W12020332', 'W12020332', 'UT01', 'MountainStar Cardiology St Marks', 'Thomas', 'S', 'Edwards', 'MD', 'Cardiovascular Disease', NULL, NULL, NULL, 'O', '1160 E 3900 S Ste 2000', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012663418', '8012664174', '1160 E 3900 S Ste 2000', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012663418', '8012664174', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1639163215', 0, 'N', 0, '2012-06-25', NULL, NULL, 40.6871, -111.858, NULL, NULL),
('371625746', 'W12020333', 'W12020333', 'UT01', 'MountainStar Cardiology St Marks', 'Thomas', 'S', 'Edwards', 'MD', 'Cardiovascular Disease', NULL, NULL, NULL, 'O', '3584 W 9000 S Ste 209', 'West Jordan', 'Salt Lake', 'UT', '84088', '8016763776', '8016760987', '3584 W 9000 S Ste 209', 'West Jordan', 'Salt Lake', 'UT', '84088', '8016763776', '8016760987', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1639163215', 0, 'N', 0, '2012-06-25', NULL, NULL, 40.5879, -111.976, NULL, NULL),
('371625746', 'W12020334', 'W12020334', 'UT01', 'MountainStar Cardiology St Marks', 'Thomas', 'S', 'Edwards', 'MD', 'Cardiovascular Disease', NULL, NULL, NULL, 'O', '3725 W 4100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8016763776', '8016760987', '3725 W 4100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8016763776', '8016760987', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1639163215', 0, 'N', 0, '2012-06-25', NULL, NULL, 40.682, -111.979, NULL, NULL),
('371625746', 'W12020335', 'W12020335', 'UT01', 'MountainStar Cardiology St Marks', 'Thomas', 'S', 'Edwards', 'MD', 'Cardiovascular Disease', NULL, NULL, NULL, 'O', '74 E Kimballs Ln Ste 260', 'Draper', 'Salt Lake', 'UT', '84020', '8015716100', '8015720505', '74 E Kimballs Ln Ste 260', 'Draper', 'Salt Lake', 'UT', '84020', '8015716100', '8015720505', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1639163215', 0, 'N', 0, '2012-06-25', NULL, NULL, 40.537, -111.889, NULL, NULL),
('371625746', 'W12020336', 'W12020336', 'UT01', 'MountainStar Cardiology St Marks', 'Thomas', 'S', 'Edwards', 'MD', 'Cardiovascular Disease', NULL, NULL, NULL, 'O', '8846 S Redwood Rd Ste E-121', 'West Jordan', 'Salt Lake', 'UT', '84088', '8016763776', '8016760987', '8846 S Redwood Rd Ste E-121', 'West Jordan', 'Salt Lake', 'UT', '84088', '8016763776', '8016760987', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1639163215', 0, 'N', 0, '2012-06-25', NULL, NULL, 40.5911, -111.939, NULL, NULL),
('371625746', 'W12020337', 'W12020337', 'UT01', 'MountainStar Cardiology St Marks', 'Thomas', 'S', 'Edwards', 'MD', 'Cardiovascular Disease', NULL, NULL, NULL, 'B', 'PO Box 741729', 'Atlanta', 'Fulton', 'GA', '30384', '8012663418', '8012664174', 'PO Box 741729', 'Atlanta', 'Fulton', 'GA', '30384', '8012663418', '8012664174', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1639163215', 0, 'N', 0, '2012-06-25', NULL, NULL, 0, 0, NULL, NULL),
('800223062', 'W12020338', 'W12020338', 'UT01', 'Brigham Center for Womens Health', 'Daniel', 'R', 'Ferguson', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '984 S Medical Dr Ste 4', 'Brigham City', 'Box Elder', 'UT', '84302', '4356952273', NULL, '984 S Medical Dr Ste 4', 'Brigham City', 'Box Elder', 'UT', '84302', '4356952273', '          ', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'Brigham City Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1194802991', 0, 'N', 0, '2012-06-25', NULL, NULL, 41.4888, -112.026, NULL, NULL),
('800223062', 'W12020339', 'W12020339', 'UT01', 'Brigham Center for Womens Health', 'Daniel', 'R', 'Ferguson', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 405473', 'Atlanta', 'Fulton', 'GA', '30384', '4356952273', NULL, 'PO Box 405473', 'Atlanta', 'Fulton', 'GA', '30384', '4356952273', '          ', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'Brigham City Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1194802991', 0, 'N', 0, '2012-06-25', NULL, NULL, 0, 0, NULL, NULL),
('371643195', 'W12020340', 'W12020340', 'UT01', 'Timpanogos Professional Services', 'Omar', '', 'Mendez-Figueroa', 'MD', 'Internal Medicine', '', '', NULL, 'O', '750 W 800 N', 'Orem', 'Utah', 'UT', '84057', '8017146387', '8017146596', '750 W 800 N', 'Orem', 'Utah', 'UT', '84057', '8017146387', '8017146596', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1912034315', 0, 'N', 0, '2012-06-25', NULL, NULL, 40.3121, -111.714, NULL, NULL),
('800236802', 'W12020341', 'W12020341', 'UT01', 'Farr West Family Medicine', 'Jody', 'L', 'Fowers', 'APRN', 'Family Practice', '', '', NULL, 'O', '2850 N 2000 W Ste 101', 'Ogden', 'Weber', 'UT', '84404', '8017311222', '8017311666', '2850 N 2000 W Ste 101', 'Ogden', 'Weber', 'UT', '84404', '8017311222', '8017311666', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1992915052', 0, 'N', 0, '2013-10-24', NULL, NULL, 41.3105, -112.028, NULL, NULL),
('800236802', 'W12020342', 'W12020342', 'UT01', 'Farr West Family Medicine', 'Jody', 'L', 'Fowers', 'APRN', 'Family Practice', '', '', NULL, 'B', 'PO Box 405600', 'Atlanta', 'Fulton', 'GA', '30384', '8006613365', '8017311666', 'PO Box 405600', 'Atlanta', 'Fulton', 'GA', '30384', '8006613365', '8017311666', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1992915052', 0, 'N', 0, '2013-10-24', NULL, NULL, 0, 0, NULL, NULL),
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INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
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('453617566', 'W12020421', 'W12020421', 'UT01', 'Davis Endocrinology and Diabeties ', 'Leslie', 'A', 'Bean', 'APRN', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 268', 'Bountiful', 'Davis', 'UT', '84011', '8012962113', '8012961715', 'PO Box 268', 'Bountiful', 'Davis', 'UT', '84011', '8012962113', '8012961715', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1336260447', 0, 'N', 0, '2014-04-04', NULL, NULL, 0, 0, NULL, NULL),
('260519219', 'W12020423', 'W12020423', 'UT01', 'Swenson Chiropractic', 'Joseph', 'Woodruff', 'Swenson', 'DC', 'Chiropractic', '', '', NULL, 'O', '3564 S 7200 W Ste D', 'Magna', 'Salt Lake', 'UT', '84044', '8015087246', '8015081902', '3564 S 7200 W Ste D', 'Magna', 'Salt Lake', 'UT', '84044', '8015087246', '8015081902', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2012-07-01', '2012-07-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1194843698', 0, 'N', 0, '2012-07-10', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12020424', 'W12020424', 'UTIHCPHY', 'Dixie Inpatient Psychiatry', 'Chauncey', 'S', 'Adams', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356884343', '4356885331', '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356884343', '4356885331', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2012-05-01', '2012-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1437251170', 0, 'N', 0, '2012-07-02', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12020425', 'W12020425', 'UTIHCPHY', 'Cedar City Clinic', 'Jaime', 'L', 'Bacon', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '1303 N Main St Ste 3C', 'Cedar City', 'Iron', 'UT', '84720', '4358685500', '4358685504', '1303 N Main St Ste 3C', 'Cedar City', 'Iron', 'UT', '84720', '4358685500', '4358685504', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2012-06-29', '2012-06-30', 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1376758342', 0, 'N', 0, '2014-01-08', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W12020426', 'W12020426', 'UTIHCPHY', 'Park City Sleep Disorders Clinic', 'Tom', 'V', 'Cloward', '', 'Pulmonary', '', '', NULL, 'O', '750 Round Valley Dr Ste 101A', 'Park City', 'Summit', 'UT', '84060', '4356586621', '8014123160', '750 Round Valley Dr Ste 101A', 'Park City', 'Summit', 'UT', '84060', '4356586621', '8014123160', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2012-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1053407726', 0, 'N', 0, '2012-06-26', NULL, NULL, 40.6855, -111.466, NULL, NULL),
('942854057', 'W12020427', 'W12020427', 'UTIHCPHY', 'Canyon View Orthopedics & Associates', 'Tyson', 'A', 'Cluff', 'PA', 'Family Practice', '', '', NULL, 'O', '1300 N 500 E Ste 130', 'Logan', 'Cache', 'UT', '84341', '4357162800', '4357162809', '1300 N 500 E Ste 130', 'Logan', 'Cache', 'UT', '84341', '4357162800', '4357162809', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2012-05-28', NULL, 0, 0, 0, 'Logan Regional Hospital', NULL, NULL, NULL, 'HCFA|', '1023253754', 0, 'N', 0, '2012-06-26', NULL, NULL, 41.7563, -111.821, NULL, NULL),
('820527771', 'W12023860', 'W12023860', 'IDBOISTD', 'Pediatric Cardiology', 'Michael', 'S', 'Womack', 'MD', 'Pediatric Cardiology', '', '', NULL, 'O', '100 E Idaho St Ste 200', 'Boise', 'Ada', 'ID', '83712', '2084539962', '2084539963', '100 E Idaho St Ste 200', 'Boise', 'Ada', 'ID', '83712', '2084539962', '2084539963', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-10-15', NULL, 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', 'West Valley Medical Center', '', 'Saint Alphonsus Medical Center Nampa', 'HCFA|UB|', '1912950338', 0, 'N', 0, '2014-06-20', NULL, NULL, 43.6122, -116.195, NULL, NULL),
('942854057', 'W12020430', 'W12020430', 'UTIHCPHY', 'Heber Valley Clinic', 'Jason', 'D', 'Eatough', 'PA', 'Occupational Medicine', '', '', NULL, 'O', '1473 S Hwy 40 Ste E', 'Heber City', 'Wasatch', 'UT', '84032', '4356574400', '4356574460', '1473 S Hwy 40 Ste E', 'Heber City', 'Wasatch', 'UT', '84032', '4356574400', '4356574460', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2012-06-01', NULL, 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1205874179', 0, 'N', 0, '2012-06-26', NULL, NULL, 40.4893, -111.409, NULL, NULL),
('743096310', 'W12020432', 'W12020432', 'UT01', 'St Marks Professional Services', 'Richard', 'L', 'Glines', 'MD', 'Pain Management', 'Anesthesiology', '', NULL, 'B', 'PO Box 271220', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '8012687729', '8012703320', 'PO Box 271220', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '8012687729', '8012703320', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'St Marks Hospital', 'Davis Hospital', '', '', 'HCFA|UB|', '1790794063', 0, 'Y', 0, '2013-10-08', NULL, NULL, 0, 0, NULL, NULL),
('743096310', 'W12020433', 'W12020433', 'UT01', 'St Marks Professional Services', 'Richard', 'L', 'Glines', 'MD', 'Pain Management', 'Anesthesiology', '', NULL, 'O', '1200 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012687729', '8012703320', '1200 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012687729', '8012703320', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'St Marks Hospital', 'Davis Hospital', '', '', 'HCFA|UB|', '1790794063', 0, 'N', 0, '2013-10-08', NULL, NULL, 40.6871, -111.856, NULL, NULL),
('770701557', 'W12020434', 'W12020434', 'UT01', 'South Jordan Family Medicine', 'Theresa', 'D', 'Gourde', 'MD', 'Family Practice', 'Internal Medicine', '', NULL, 'O', '10623 S Redwood Rd Ste 101', 'South Jordan', 'Salt Lake', 'UT', '84095', '8013020899', '8013020892', '10623 S Redwood Rd Ste 101', 'South Jordan', 'Salt Lake', 'UT', '84095', '8013020899', '8013020892', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', '2012-12-12', 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1487688685', 0, 'N', 0, '2013-09-19', NULL, NULL, 0, 0, NULL, NULL),
('770701557', 'W12020436', 'W12020436', 'UT01', 'South Jordan Family Medicine', 'Theresa', 'D', 'Gourde', 'MD', 'Family Practice', 'Internal Medicine', '', NULL, 'B', 'PO Box 198560', 'Atlanta', 'Fulton', 'GA', '30384', '8013020899', '8013020892', 'PO Box 198560', 'Atlanta', 'Fulton', 'GA', '30384', '8013020899', '8013020892', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', '2012-12-12', 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1487688685', 0, 'N', 0, '2013-09-19', NULL, NULL, 0, 0, NULL, NULL),
('134332141', 'W12020437', 'W12020437', 'UT01', 'MountainStar Cardiovascular Surgery', 'Joseph', 'E', 'Graham', 'MD', 'Cardiovascular Disease', 'Thoracic Surgery', 'Vascular Surgery', NULL, 'O', '1160 E 3900 S Ste 3500', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8017434750', NULL, '1160 E 3900 S Ste 3500', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8017434750', '          ', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1578638383', 0, 'N', 0, '2014-03-24', NULL, NULL, 40.6871, -111.858, NULL, NULL),
('134332141', 'W12020438', 'W12020438', 'UT01', 'MountainStar Cardiovascular Surgery', 'Joseph', 'E', 'Graham', 'MD', 'Cardiovascular Disease', 'Thoracic Surgery', 'Vascular Surgery', NULL, 'O', '5405 S 500 E Ste 200', 'Ogden', 'Weber', 'UT', '84405', '8014766900', NULL, '5405 S 500 E Ste 200', 'Ogden', 'Weber', 'UT', '84405', '8014766900', '          ', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1578638383', 0, 'N', 0, '2014-03-24', NULL, NULL, 41.1655, -111.969, NULL, NULL),
('134332141', 'W12020440', 'W12020440', 'UT01', 'MountainStar Cardiovascular Surgery', 'Joseph', 'E', 'Graham', 'MD', 'Cardiovascular Disease', 'Thoracic Surgery', 'Vascular Surgery', NULL, 'B', 'PO Box 281490', 'Atlanta', 'Fulton', 'GA', '30384', '8017434750', NULL, 'PO Box 281490', 'Atlanta', 'Fulton', 'GA', '30384', '8017434750', '          ', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1578638383', 0, 'Y', 0, '2014-03-24', NULL, NULL, 0, 0, NULL, NULL),
('770701557', 'W12020441', 'W12020441', 'UT01', 'MountainStar Jordan Family Health', 'Justin', 'D', 'Gull', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '8846 S Redwood Rd Ste E-121', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015691999', '8015692001', '8846 S Redwood Rd Ste E-121', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015691999', '8015692001', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1962600338', 0, 'N', 0, '2012-06-27', NULL, NULL, 40.5911, -111.939, NULL, NULL),
('770701557', 'W12020442', 'W12020442', 'UT01', 'MountainStar Jordan Family Health', 'Justin', 'D', 'Gull', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'B', 'PO Box 198560', 'Atlanta', 'Fulton', 'GA', '30384', '8015691999', '8015692001', 'PO Box 198560', 'Atlanta', 'Fulton', 'GA', '30384', '8015691999', '8015692001', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1962600338', 0, 'N', 0, '2012-06-27', NULL, NULL, 0, 0, NULL, NULL),
('371625746', 'W12020443', 'W12020443', 'UT01', 'MountainStar Cardiology St Marks', 'Scott', 'B', 'Hacking', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1160 E 3900 S Ste 2000', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012663418', '8012664174', '1160 E 3900 S Ste 2000', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012663418', '8012664174', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1992712285', 0, 'N', 0, '2013-07-15', NULL, NULL, 40.6871, -111.858, NULL, NULL),
('371625746', 'W12020444', 'W12020444', 'UT01', 'MountainStar Cardiology St Marks', 'Scott', 'B', 'Hacking', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '3584 W 9000 S Ste 209', 'West Jordan', 'Salt Lake', 'UT', '84088', '8016763776', '8016760987', '3584 W 9000 S Ste 209', 'West Jordan', 'Salt Lake', 'UT', '84088', '8016763776', '8016760987', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1992712285', 0, 'N', 0, '2013-07-15', NULL, NULL, 40.5879, -111.976, NULL, NULL),
('371625746', 'W12020445', 'W12020445', 'UT01', 'MountainStar Cardiology St Marks', 'Scott', 'B', 'Hacking', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '3725 W 4100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8016763776', '8016760987', '3725 W 4100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8016763776', '8016760987', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1992712285', 0, 'N', 0, '2013-07-15', NULL, NULL, 40.682, -111.979, NULL, NULL),
('371625746', 'W12020446', 'W12020446', 'UT01', 'MountainStar Cardiology St Marks', 'Scott', 'B', 'Hacking', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '74 E Kimballs Ln Ste 260', 'Draper', 'Salt Lake', 'UT', '84020', '8015716100', '8015720505', '74 E Kimballs Ln Ste 260', 'Draper', 'Salt Lake', 'UT', '84020', '8015716100', '8015720505', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1992712285', 0, 'N', 0, '2013-07-15', NULL, NULL, 40.537, -111.889, NULL, NULL),
('371625746', 'W12020447', 'W12020447', 'UT01', 'MountainStar Cardiology St Marks', 'Scott', 'B', 'Hacking', 'MD', 'Cardiovascular Disease', '', '', NULL, 'B', 'PO Box 741729', 'Atlanta', 'Fulton', 'GA', '30384', '8012663418', '8012664174', 'PO Box 741729', 'Atlanta', 'Fulton', 'GA', '30384', '8012663418', '8012664174', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1992712285', 0, 'N', 0, '2013-07-15', NULL, NULL, 0, 0, NULL, NULL),
('900512734', 'W12020449', 'W12020449', 'UT01', 'Lakeview Intermal Medicine & Surgery', 'Gregory', 'D', 'Hammond', 'MD', 'Pulmonary', 'Sleep Medicine', '', NULL, 'O', '520 E Medical Dr Ste 200', 'Bountiful', 'Davis', 'UT', '84010', '8012949338', '8012947558', '520 E Medical Dr Ste 200', 'Bountiful', 'Davis', 'UT', '84010', '8012949338', '8012947558', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'Lakeview Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1942374020', 0, 'N', 0, '2012-06-27', NULL, NULL, 40.8873, -111.87, NULL, NULL),
('371625746', 'W12020450', 'W12020450', 'UT01', 'MountainStar Cardiology St Marks', 'Charles', 'W', 'Haws', 'MD', 'Cardiovascular Disease', NULL, NULL, NULL, 'O', '1160 E 3900 S Ste 2000', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012663418', '8012664174', '1160 E 3900 S Ste 2000', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012663418', '8012664174', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1396739983', 0, 'N', 0, '2012-06-27', NULL, NULL, 40.6871, -111.858, NULL, NULL),
('371625746', 'W12020451', 'W12020451', 'UT01', 'MountainStar Cardiology St Marks', 'Charles', 'W', 'Haws', 'MD', 'Cardiovascular Disease', NULL, NULL, NULL, 'O', '3584 W 9000 S Ste 209', 'West Jordan', 'Salt Lake', 'UT', '84088', '8016763776', '8016760987', '3584 W 9000 S Ste 209', 'West Jordan', 'Salt Lake', 'UT', '84088', '8016763776', '8016760987', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1396739983', 0, 'N', 0, '2012-06-27', NULL, NULL, 40.5879, -111.976, NULL, NULL),
('371625746', 'W12020452', 'W12020452', 'UT01', 'MountainStar Cardiology St Marks', 'Charles', 'W', 'Haws', 'MD', 'Cardiovascular Disease', NULL, NULL, NULL, 'O', '3725 W 4100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8016763776', '8016760987', '3725 W 4100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8016763776', '8016760987', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1396739983', 0, 'N', 0, '2012-06-27', NULL, NULL, 40.682, -111.979, NULL, NULL),
('371625746', 'W12020453', 'W12020453', 'UT01', 'MountainStar Cardiology St Marks', 'Charles', 'W', 'Haws', 'MD', 'Cardiovascular Disease', NULL, NULL, NULL, 'O', '74 E Kimballs Ln Ste 260', 'Draper', 'Salt Lake', 'UT', '84020', '8015716100', '8015720505', '74 E Kimballs Ln Ste 260', 'Draper', 'Salt Lake', 'UT', '84020', '8015716100', '8015720505', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1396739983', 0, 'N', 0, '2012-06-27', NULL, NULL, 40.537, -111.889, NULL, NULL),
('371625746', 'W12020454', 'W12020454', 'UT01', 'MountainStar Cardiology St Marks', 'Charles', 'W', 'Haws', 'MD', 'Cardiovascular Disease', NULL, NULL, NULL, 'B', 'PO Box 741729', 'Atlanta', 'Fulton', 'GA', '30384', '8012663418', '8012664174', 'PO Box 741729', 'Atlanta', 'Fulton', 'GA', '30384', '8012663418', '8012664174', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1396739983', 0, 'N', 0, '2012-06-27', NULL, NULL, 0, 0, NULL, NULL),
('611572907', 'W12020455', 'W12020455', 'UT01', '', 'John', 'M', 'Hemmersmeier', 'MD', 'Family Practice', '', '', NULL, 'O', '5740 Crestwood Dr', 'Ogden', 'Weber', 'UT', '84405', '8014757966', NULL, '5740 Crestwood Dr', 'Ogden', 'Weber', 'UT', '84405', '8014757966', '', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1073582995', 0, 'N', 0, '2014-06-24', NULL, NULL, 41.1583, -111.947, NULL, NULL),
('900448097', 'W12020456', 'W12020456', 'UT01', 'Lakeview Urology & General Surgery ', 'David', 'J', 'Henderson', 'MD', 'Urology', '', '', NULL, 'O', '620 E Medical Dr Ste 300', 'Bountiful', 'Davis', 'UT', '84010', '8012983247', '8012989675', '620 E Medical Dr Ste 300', 'Bountiful', 'Davis', 'UT', '84010', '8012983247', '8012989675', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1417933284', 0, 'N', 0, '2013-04-11', NULL, NULL, 40.8869, -111.869, NULL, NULL),
('900448097', 'W12020457', 'W12020457', 'UT01', 'Lakeview Urology & General Surgery ', 'David', 'J', 'Henderson', 'MD', 'Urology', '', '', NULL, 'B', 'PO Box 405831', 'Atlanta', 'Fulton', 'GA', '30384', '8006613365', NULL, 'PO Box 405831', 'Atlanta', 'Fulton', 'GA', '30384', '8006613365', '          ', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'Davis Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1417933284', 0, 'N', 0, '2013-04-11', NULL, NULL, 0, 0, NULL, NULL),
('331177233', 'W12020458', 'W12020458', 'UT01', 'Layton Specialty Clinic', 'Richard', '', 'Herold', 'MD', 'Internal Medicine', '', '', NULL, 'O', '2950 N Church St Ste 101-A', 'Layton', 'Davis', 'UT', '84040', '8017717202', '8017717242', '2950 N Church St Ste 101-A', 'Layton', 'Davis', 'UT', '84040', '8017717202', '8017717242', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', '2014-06-01', 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1891799318', 0, 'N', 0, '2014-07-14', NULL, NULL, 41.1009, -111.939, NULL, NULL),
('331177233', 'W12020459', 'W12020459', 'UT01', '', 'Richard', '', 'Herold', 'MD', 'Internal Medicine', '', '', NULL, 'O', '5405 S 500 E', 'Ogden', 'Weber', 'UT', '84405', '8014792911', '8014792914', '5405 S 500 E', 'Ogden', 'Weber', 'UT', '84405', '8014792911', '8014792914', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', '2014-01-01', 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1891799318', 0, 'N', 0, '2014-07-14', NULL, NULL, 41.1655, -111.969, NULL, NULL),
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('770701557', 'W12020463', 'W12020463', 'UT01', 'Lone Peak Family Medicine', 'David', 'B', 'Jack', 'MD', 'Family Practice', NULL, NULL, NULL, 'B', 'PO Box 198560', 'Atlanta', 'Fulton', 'GA', '30384', '8006613365', '8015769800', 'PO Box 198560', 'Atlanta', 'Fulton', 'GA', '30384', '8006613365', '8015769800', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1255434296', 0, 'N', 0, '2013-10-21', NULL, NULL, 0, 0, NULL, NULL),
('611572907', 'W12020464', 'W12020464', 'UT01', 'MountainStar Primary Care', 'Hans', '', 'Jenkins', 'DO', 'Family Practice', '', '', NULL, 'O', '5405 S 500 E Ste 100', 'Ogden', 'Weber', 'UT', '84405', '8014757966', '8014797795', '5405 S 500 E Ste 100', 'Ogden', 'Weber', 'UT', '84405', '8014757966', '8014797795', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1316932866', 0, 'N', 0, '2012-06-27', NULL, NULL, 41.1655, -111.969, NULL, NULL),
('611572907', 'W12020465', 'W12020465', 'UT01', 'MountainStar Primary Care', 'Hans', '', 'Jenkins', 'DO', 'Family Practice', '', '', NULL, 'B', 'PO Box 405714', 'Atlanta', 'Fulton', 'GA', '30384', '8014757966', '8014797795', 'PO Box 405714', 'Atlanta', 'Fulton', 'GA', '30384', '8014757966', '8014797795', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1316932866', 0, 'N', 0, '2012-06-27', NULL, NULL, 0, 0, NULL, NULL);
INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
('371625746', 'W12020466', 'W12020466', 'UT01', 'MountainStar Cardiology St Marks', 'Kira', 'D', 'Johnson', 'PA', 'Cardiovascular Disease', '', '', NULL, 'O', '1160 E 3900 S Ste 2000', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012663418', '8012664174', '1160 E 3900 S Ste 2000', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012663418', '8012664174', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1831138403', 0, 'N', 0, '2014-06-18', NULL, NULL, 40.6871, -111.858, NULL, NULL),
('371625746', 'W12020467', 'W12020467', 'UT01', 'MountainStar Cardiology St Marks', 'Kira', 'D', 'Johnson', 'PA', 'Cardiovascular Disease', '', '', NULL, 'O', '3584 W 9000 S Ste 209', 'West Jordan', 'Salt Lake', 'UT', '84088', '8016763776', '8016760987', '3584 W 9000 S Ste 209', 'West Jordan', 'Salt Lake', 'UT', '84088', '8016763776', '8016760987', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', '2014-06-17', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1831138403', 0, 'N', 0, '2014-06-18', NULL, NULL, 40.5879, -111.976, NULL, NULL),
('371625746', 'W12020468', 'W12020468', 'UT01', 'MountainStar Cardiology St Marks', 'Kira', 'D', 'Johnson', 'PA', 'Cardiovascular Disease', '', '', NULL, 'O', '3725 W 4100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8016763776', '8016760987', '3725 W 4100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8016763776', '8016760987', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', '2014-06-17', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1831138403', 0, 'N', 0, '2014-06-18', NULL, NULL, 40.682, -111.979, NULL, NULL),
('371625746', 'W12020469', 'W12020469', 'UT01', 'MountainStar Cardiology St Marks', 'Kira', 'D', 'Johnson', 'PA', 'Cardiovascular Disease', '', '', NULL, 'O', '74 E Kimballs Ln Ste 260', 'Draper', 'Salt Lake', 'UT', '84020', '8015716100', '8015720505', '74 E Kimballs Ln Ste 260', 'Draper', 'Salt Lake', 'UT', '84020', '8015716100', '8015720505', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', '2014-06-17', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1831138403', 0, 'N', 0, '2014-06-18', NULL, NULL, 40.537, -111.889, NULL, NULL),
('371625746', 'W12020470', 'W12020470', 'UT01', 'MountainStar Cardiology St Marks', 'Kira', 'D', 'Johnson', 'PA', 'Cardiovascular Disease', '', '', NULL, 'O', '8846 S Redwood Rd Ste E-121', 'West Jordan', 'Salt Lake', 'UT', '84088', '8016763776', '8016760987', '8846 S Redwood Rd Ste E-121', 'West Jordan', 'Salt Lake', 'UT', '84088', '8016763776', '8016760987', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', '2014-06-17', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1831138403', 0, 'N', 0, '2014-06-18', NULL, NULL, 40.5911, -111.939, NULL, NULL),
('371625746', 'W12020471', 'W12020471', 'UT01', 'MountainStar Cardiology St Marks', 'Kira', 'D', 'Johnson', 'PA', 'Cardiovascular Disease', '', '', NULL, 'B', 'PO Box 741729', 'Atlanta', 'Fulton', 'GA', '30384', '8012663418', '8012664174', 'PO Box 741729', 'Atlanta', 'Fulton', 'GA', '30384', '8012663418', '8012664174', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1831138403', 0, 'N', 0, '2014-06-18', NULL, NULL, 0, 0, NULL, NULL),
('201710678', 'W12020472', 'W12020472', 'ID01', 'Orthopaedic Associates PA', 'Mark', 'C', 'Clawson', 'MD; Hand', 'Orthopedic Surgery', 'Hand Surgery', NULL, NULL, 'O', '901 N Curtis Ste 501', 'Boise', 'Ada', 'ID', '83706', '2083782868', '2083672877', '901 N Curtis Ste 501', 'Boise', 'Ada', 'ID', '83706', '2083782868', '2083672877', 'IDORTHO+', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-07-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1174572697', 0, 'N', 0, '2012-10-23', NULL, NULL, 43.6126, -116.255, NULL, NULL),
('201710678', 'W12020475', 'W12020475', 'ID01', 'Orthopaedic Associates PA', 'Timothy', 'E', 'Doerr', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '8854 W Emerald Ste 140', 'Boise', 'Ada', 'ID', '83704', '2083214790', '2083214836', '8854 W Emerald Ste 140', 'Boise', 'Ada', 'ID', '83704', '2083214790', '2083214836', 'IDORTHO+', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2030-01-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1083663868', 0, 'N', 0, '2013-03-07', NULL, NULL, 43.6123, -116.292, NULL, NULL),
('201710678', 'W12020474', 'W12020474', 'ID01', 'Orthopaedic Associates PA', 'Timothy', 'E', 'Doerr', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '901 N Curtis Ste 501', 'Boise', 'Ada', 'ID', '83706', '2083782868', '2083672877', '901 N Curtis Ste 501', 'Boise', 'Ada', 'ID', '83706', '2083782868', '2083672877', 'IDORTHO+', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2030-01-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1083663868', 0, 'N', 0, '2013-03-07', NULL, NULL, 43.6126, -116.255, NULL, NULL),
('201710678', 'W12020476', 'W12020476', 'ID01', 'Orthopaedic Associates PA', 'Mark', 'C', 'Clawson', 'MD; Hand', 'Orthopedic Surgery', 'Hand Surgery', NULL, NULL, 'O', '8854 W Emerald St Ste 140', 'Boise', 'Ada', 'ID', '83704', '2083214790', '2083214836', '8854 W Emerald St Ste 140', 'Boise', 'Ada', 'ID', '83704', '2083214790', '2083214836', 'IDORTHO+', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-07-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1174572697', 0, 'N', 0, '2012-10-23', NULL, NULL, 43.6123, -116.292, NULL, NULL),
('201710678', 'W12020477', 'W12020477', 'ID01', 'Orthopaedic Associates PA', 'Jeffrey', 'G', 'Hessing', 'MD; Shoulder', 'Orthopedic Surgery', '', '', NULL, 'O', '8854 W Emerald Ste 140', 'Boise', 'Ada', 'ID', '83704', '2083214790', '2083214836', '8854 W Emerald Ste 140', 'Boise', 'Ada', 'ID', '83704', '2083214790', '2083214836', 'IDORTHO+', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-07-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1023068194', 0, 'N', 0, '2012-10-23', NULL, NULL, 43.6123, -116.292, NULL, NULL),
('201710678', 'W12020478', 'W12020478', 'ID01', 'Orthopaedic Associates PA', 'Jeffrey', 'G', 'Hessing', 'MD; Shoulder', 'Orthopedic Surgery', '', '', NULL, 'O', '901 N Curtis Ste 501', 'Boise', 'Ada', 'ID', '83706', '2083782868', '2083672877', '901 N Curtis Ste 501', 'Boise', 'Ada', 'ID', '83706', '2083782868', '2083672877', 'IDORTHO+', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-07-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1023068194', 0, 'N', 0, '2012-10-23', NULL, NULL, 43.6126, -116.255, NULL, NULL),
('201710678', 'W12020482', 'W12020482', 'ID01', 'Orthopaedic Associates PA', 'Mark', 'C', 'Meier', 'MD: Joint', 'Orthopedic Surgery', '', '', NULL, 'O', '8854 W Emerald St Ste 140', 'Boise', 'Ada', 'ID', '83704', '2083214790', '2083214836', '8854 W Emerald St Ste 140', 'Boise', 'Ada', 'ID', '83704', '2083214790', '2083214836', 'IDORTHO+', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-07-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1528017209', 0, 'N', 0, '2013-10-07', NULL, NULL, 43.6123, -116.292, NULL, NULL),
('201710678', 'W12020481', 'W12020481', 'ID01', 'Orthopaedic Associates PA', 'Mark', 'C', 'Meier', 'MD: Joint', 'Orthopedic Surgery', '', '', NULL, 'O', '901 N Curtis Ste 501', 'Boise', 'Ada', 'ID', '83706', '2083782868', '2083672877', '901 N Curtis Ste 501', 'Boise', 'Ada', 'ID', '83706', '2083782868', '2083672877', 'IDORTHO+', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-07-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1528017209', 0, 'N', 0, '2013-10-07', NULL, NULL, 43.6126, -116.255, NULL, NULL),
('201710678', 'W12020483', 'W12020483', 'ID01', 'Orthopaedic Associates PA', 'Gregory', 'P', 'Schweiger', 'MD; General', 'Orthopedic Surgery', '', '', NULL, 'O', '8854 W Emerald St Ste 140', 'Boise', 'Ada', 'ID', '83704', '2083214790', '2083214836', '8854 W Emerald St Ste 140', 'Boise', 'Ada', 'ID', '83704', '2083214790', '2083214836', 'IDORTHO+', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-07-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|UB|', '1851340020', 0, 'N', 0, '2013-09-04', NULL, NULL, 43.6123, -116.292, NULL, NULL),
('201710678', 'W12020484', 'W12020484', 'ID01', 'Orthopaedic Associates PA', 'Gregory', 'P', 'Schweiger', 'MD; General', 'Orthopedic Surgery', '', '', NULL, 'O', '901 N Curtis Ste 501', 'Boise', 'Ada', 'ID', '83706', '2083782868', '2083672877', '901 N Curtis Ste 501', 'Boise', 'Ada', 'ID', '83706', '2083782868', '2083672877', 'IDORTHO+', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-07-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', NULL, '', '', 'HCFA|UB|', '1851340020', 0, 'N', 0, '2013-09-04', NULL, NULL, 43.6126, -116.255, NULL, NULL),
('201710678', 'W12020486', 'W12020486', 'ID01', 'Orthopaedic Associates PA', 'Jared', 'P', 'Tadje', 'MD; General, Joint, Shoulder', 'Orthopedic Surgery', '', '', NULL, 'O', '8854 W Emerald St Ste 140', 'Boise', 'Ada', 'ID', '83704', '2083214790', '2083214836', '8854 W Emerald St Ste 140', 'Boise', 'Ada', 'ID', '83704', '2083214790', '2083214836', 'IDORTHO+', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-07-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1821006289', 0, 'N', 0, '2012-10-23', NULL, NULL, 43.6123, -116.292, NULL, NULL),
('201710678', 'W12020487', 'W12020487', 'ID01', 'Orthopaedic Associates PA', 'Jared', 'P', 'Tadje', 'MD; General, Joint, Shoulder', 'Orthopedic Surgery', '', '', NULL, 'O', '901 N Curtis Ste 501', 'Boise', 'Ada', 'ID', '83706', '2083782868', '2083672877', '901 N Curtis Ste 501', 'Boise', 'Ada', 'ID', '83706', '2083782868', '2083672877', 'IDORTHO+', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2012-07-01', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1821006289', 0, 'N', 0, '2012-10-23', NULL, NULL, 43.6126, -116.255, NULL, NULL),
('830279242', 'W12020488', 'W12020488', 'WY01', 'Wyoming Medical Center ', '', '', 'Wyoming Medical Center', 'Group', 'Hospital', '', '', NULL, 'O', '1233 E 2nd St', 'Casper', 'Natrona', 'WY', '82601', '3075777201', NULL, '1233 E 2nd St', 'Casper', 'Natrona', 'WY', '82601', '3075777201', '          ', '', '', 'WMC5001', '0.00', '0.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1346332954', 0, 'N', 0, '2013-09-26', NULL, NULL, 42.8487, -106.309, NULL, NULL),
('830279242', 'W12020489', 'W12020489', 'WYT1', 'Wyoming Medical Center ', '', '', 'Wyoming Medical Center', 'Group', 'Hospital', '', '', NULL, 'O', '1233 E 2nd St', 'Casper', 'Natrona', 'WY', '82601', '3075777201', NULL, '1233 E 2nd St', 'Casper', 'Natrona', 'WY', '82601', '3075777201', '          ', '', '', 'WMC5001', '0.00', '0.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1346332954', 0, 'N', 0, '2013-09-26', NULL, NULL, 0, 0, NULL, NULL),
('770701557', 'W12020490', 'W12020490', 'UT01', 'MountainStar Jordan Family Health', 'LeeAnn', '', 'Johnson', 'FNP', 'Family Practice', '', '', NULL, 'O', '8846 S Redwood Rd Ste E-121', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015691999', '8015692001', '8846 S Redwood Rd Ste E-121', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015691999', '8015692001', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1942462825', 0, 'N', 0, '2012-06-27', NULL, NULL, 40.5911, -111.939, NULL, NULL),
('770701557', 'W12020491', 'W12020491', 'UT01', 'MountainStar Jordan Family Health', 'LeeAnn', '', 'Johnson', 'FNP', 'Family Practice', '', '', NULL, 'B', 'PO Box 198560', 'Atlanta', 'Fulton', 'GA', '30384', '8015691999', '8015692001', 'PO Box 198560', 'Atlanta', 'Fulton', 'GA', '30384', '8015691999', '8015692001', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1942462825', 0, 'N', 0, '2012-06-27', NULL, NULL, 0, 0, NULL, NULL),
('800701770', 'W12020492', 'W12020492', 'UT01', 'Mountainstar Medical Group Neurosurgery', 'Andrew', 'C', 'Johnson', 'PA', 'Neurosurgery', '', '', NULL, 'O', '1200 E 3900 S Ste 4E', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012618507', '8012618511', '1200 E 3900 S Ste 4E', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012618507', '8012618511', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', '2013-08-03', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1346550829', 0, 'N', 0, '2013-09-06', NULL, NULL, 0, 0, NULL, NULL),
('800701770', 'W12020493', 'W12020493', 'UT01', 'Mountainstar Medical Group Neurosurgery', 'Andrew', 'C', 'Johnson', 'PA', 'Neurosurgery', '', '', NULL, 'B', 'PO Box 741648', 'Atlanta', 'Fulton', 'GA', '30374', '6153737490', '8012618511', 'PO Box 741648', 'Atlanta', 'Fulton', 'GA', '30374', '6153737490', '8012618511', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', '2013-08-03', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1346550829', 0, 'N', 0, '2013-09-06', NULL, NULL, 0, 0, NULL, NULL),
('743096310', 'W12020495', 'W12020495', 'UT01', 'St Marks Senior Center', 'Laurene', '', 'Joseph', 'MD', 'Geriatrics', 'Internal Medicine', '', NULL, 'O', '1160 E 3900 S Ste G200', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012687766', NULL, '1160 E 3900 S Ste G200', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012687766', '          ', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1629145123', 0, 'N', 0, '2014-02-06', NULL, NULL, 40.6871, -111.858, NULL, NULL),
('743096310', 'W12020496', 'W12020496', 'UT01', 'St Marks Senior Center', 'Laurene', '', 'Joseph', 'MD', 'Geriatrics', 'Internal Medicine', '', NULL, 'B', 'PO Box 271220', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '6153737629', NULL, 'PO Box 271220', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '6153737629', '          ', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1629145123', 0, 'Y', 0, '2014-02-06', NULL, NULL, 0, 0, NULL, NULL),
('134332141', 'W12020497', 'W12020497', 'UT01', 'MountainStar Cardiovascular Surgery', 'Shreekanth', '', 'Karwande', 'MD', 'Cardiovascular Disease', 'Cardiothorac Vascular Surgery', '', NULL, 'O', '1160 E 3900 S Ste 3500', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8017434750', NULL, '1160 E 3900 S Ste 3500', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8017434750', '          ', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1972693570', 0, 'N', 0, '2012-06-27', NULL, NULL, 40.6871, -111.858, NULL, NULL),
('611572907', 'W12020498', 'W12020498', 'UT01', 'South Ogden Center for Family Medicine', 'Tim', '', 'Katsma', 'PA', 'Family Practice', '', '', NULL, 'O', '5740 Crestwood Dr', 'Ogden', 'Weber', 'UT', '84405', '8014797771', '          ', '5740 Crestwood Dr', 'Ogden', 'Weber', 'UT', '84405', '8014797771', '          ', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', '2014-04-04', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1205089489', 0, 'Y', 0, '2014-04-09', NULL, NULL, 41.1583, -111.947, NULL, NULL),
('371625746', 'W12020499', 'W12020499', 'UT01', 'MountainStar Cardiology St Marks', 'Julian ', '', 'Lain', 'PA', 'Cardiovascular Disease', '', '', NULL, 'O', '1160 E 3900 S Ste 2000', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012663418', '8012664174', '1160 E 3900 S Ste 2000', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012663418', '8012664174', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', '2014-04-04', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1134199094', 0, 'N', 0, '2014-06-17', NULL, NULL, 40.6871, -111.858, NULL, NULL),
('371625746', 'W12020500', 'W12020500', 'UT01', 'MountainStar Cardiology St Marks', 'Julian ', '', 'Lain', 'PA', 'Cardiovascular Disease', '', '', NULL, 'O', '3584 W 9000 S Ste 209', 'West Jordan', 'Salt Lake', 'UT', '84088', '8016763776', '8016760987', '3584 W 9000 S Ste 209', 'West Jordan', 'Salt Lake', 'UT', '84088', '8016763776', '8016760987', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', '2014-04-04', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1134199094', 0, 'N', 0, '2014-06-17', NULL, NULL, 40.5879, -111.976, NULL, NULL),
('371625746', 'W12020501', 'W12020501', 'UT01', 'MountainStar Cardiology St Marks', 'Julian ', '', 'Lain', 'PA', 'Cardiovascular Disease', '', '', NULL, 'O', '3725 W 4100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8016763776', '8016760987', '3725 W 4100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8016763776', '8016760987', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', '2014-04-04', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1134199094', 0, 'N', 0, '2014-06-17', NULL, NULL, 40.682, -111.979, NULL, NULL),
('371625746', 'W12020502', 'W12020502', 'UT01', 'MountainStar Cardiology St Marks', 'Julian ', '', 'Lain', 'PA', 'Cardiovascular Disease', '', '', NULL, 'O', '74 E Kimballs Ln Ste 260', 'Draper', 'Salt Lake', 'UT', '84020', '8015716100', '8015720505', '74 E Kimballs Ln Ste 260', 'Draper', 'Salt Lake', 'UT', '84020', '8015716100', '8015720505', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', '2014-04-04', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1134199094', 0, 'N', 0, '2014-06-17', NULL, NULL, 40.537, -111.889, NULL, NULL),
('371625746', 'W12020503', 'W12020503', 'UT01', 'MountainStar Cardiology St Marks', 'Julian ', '', 'Lain', 'PA', 'Cardiovascular Disease', '', '', NULL, 'O', '8846 S Redwood Rd Ste E-121', 'West Jordan', 'Salt Lake', 'UT', '84088', '8016763776', '8016760987', '8846 S Redwood Rd Ste E-121', 'West Jordan', 'Salt Lake', 'UT', '84088', '8016763776', '8016760987', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', '2014-04-04', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1134199094', 0, 'N', 0, '2014-06-17', NULL, NULL, 40.5911, -111.939, NULL, NULL),
('371625746', 'W12020504', 'W12020504', 'UT01', 'MountainStar Cardiology St Marks', 'Julian ', '', 'Lain', 'PA', 'Cardiovascular Disease', '', '', NULL, 'B', 'PO Box 741729', 'Atlanta', 'Fulton', 'GA', '30384', '8012663418', '8012664174', 'PO Box 741729', 'Atlanta', 'Fulton', 'GA', '30384', '8012663418', '8012664174', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', '2014-04-04', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1134199094', 0, 'N', 0, '2014-06-17', NULL, NULL, 0, 0, NULL, NULL),
('352329743', 'W12020505', 'W12020505', 'UT01', 'Mountain Star Pediatrics', 'Isabel', 'C', 'Lau', 'MD', 'Pediatrics', '', '', NULL, 'O', '5495 S 500 E Ste 120', 'Ogden', 'Weber', 'UT', '84405', '8014790174', NULL, '5495 S 500 E Ste 120', 'Ogden', 'Weber', 'UT', '84405', '8014790174', '          ', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1023288511', 0, 'N', 0, '2012-06-27', NULL, NULL, 41.1634, -111.969, NULL, NULL),
('770701557', 'W12020507', 'W12020507', 'UT01', 'MountainStar Jordan Family Health', 'Amelia', 'S', 'Maass', 'FNP', 'Family Practice', '', '', NULL, 'O', '8846 S Redwood Rd Ste E-121', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015691999', '8015692001', '8846 S Redwood Rd Ste E-121', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015691999', '8015692001', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1366488348', 0, 'N', 0, '2013-08-14', NULL, NULL, 40.5911, -111.939, NULL, NULL),
('770701557', 'W12020508', 'W12020508', 'UT01', 'MountainStar Jordan Family Health', 'Amelia', 'S', 'Maass', 'FNP', 'Family Practice', '', '', NULL, 'B', 'PO Box 198560', 'Atlanta', 'Fulton', 'GA', '30384', '8015691999', '8015692001', 'PO Box 198560', 'Atlanta', 'Fulton', 'GA', '30384', '8015691999', '8015692001', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1366488348', 0, 'N', 0, '2013-08-14', NULL, NULL, 0, 0, NULL, NULL),
('371625746', 'W12020511', 'W12020511', 'UT01', 'MountainStar Cardiology St Marks', 'Robert', 'W', 'Mackie', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '3584 W 9000 S Ste 209', 'West Jordan', 'Salt Lake', 'UT', '84088', '8016763776', '8016760987', '3584 W 9000 S Ste 209', 'West Jordan', 'Salt Lake', 'UT', '84088', '8016763776', '8016760987', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', '2014-01-01', 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1972595833', 0, 'N', 0, '2014-02-10', NULL, NULL, 0, 0, NULL, NULL),
('371625746', 'W12020512', 'W12020512', 'UT01', 'MountainStar Cardiology St Marks', 'Robert', 'W', 'Mackie', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '3725 W 4100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8016763776', '8016760987', '3725 W 4100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8016763776', '8016760987', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', '2014-01-01', 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1972595833', 0, 'N', 0, '2014-02-10', NULL, NULL, 0, 0, NULL, NULL),
('371625746', 'W12020513', 'W12020513', 'UT01', 'MountainStar Cardiology St Marks', 'Robert', 'W', 'Mackie', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '74 E Kimballs Ln Ste 260', 'Draper', 'Salt Lake', 'UT', '84020', '8015716100', '8015720505', '74 E Kimballs Ln Ste 260', 'Draper', 'Salt Lake', 'UT', '84020', '8015716100', '8015720505', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', '2014-01-01', 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1972595833', 0, 'N', 0, '2014-02-10', NULL, NULL, 0, 0, NULL, NULL),
('371625746', 'W12020514', 'W12020514', 'UT01', 'MountainStar Cardiology St Marks', 'Robert', 'W', 'Mackie', 'MD', 'Cardiovascular Disease', '', '', NULL, 'B', 'PO Box 741729', 'Atlanta', 'Fulton', 'GA', '30384', '8012663418', '8012664174', 'PO Box 741729', 'Atlanta', 'Fulton', 'GA', '30384', '8012663418', '8012664174', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', '2014-01-01', 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1972595833', 0, 'N', 0, '2014-02-10', NULL, NULL, 0, 0, NULL, NULL),
('611572907', 'W12020515', 'W12020515', 'UT01', 'Morgan Health Clinic', 'Bruce', 'C', 'McClellan', 'MD', 'Family Practice', '', '', NULL, 'O', '166 N State St', 'Morgan', 'Morgan', 'UT', '84050', '8018293426', '8018293135', '166 N State St', 'Morgan', 'Morgan', 'UT', '84050', '8018293426', '8018293135', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', '2014-04-04', 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1386731883', 0, 'N', 0, '2014-04-09', NULL, NULL, 41.039, -111.679, NULL, NULL),
('611572907', 'W12020516', 'W12020516', 'UT01', 'Morgan Health Clinic', 'Bruce', 'C', 'McClellan', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 405714', 'Atlanta', 'Fulton', 'GA', '30384', '8014797771', '8014797795', 'PO Box 405714', 'Atlanta', 'Fulton', 'GA', '30384', '8014797771', '8014797795', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', '2014-04-04', 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1386731883', 0, 'N', 0, '2014-04-09', NULL, NULL, 0, 0, NULL, NULL),
('611572907', 'W12020517', 'W12020517', 'UT01', 'Mountain Star Medical Group', 'Robert', 'R', 'Mohr', 'MD', 'Internal Medicine', '', '', NULL, 'O', '5405 S 500 E Ste 100', 'Ogden', 'Weber', 'UT', '84405', '8014757966', NULL, '5405 S 500 E Ste 100', 'Ogden', 'Weber', 'UT', '84405', '8014757966', '          ', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1750314480', 0, 'N', 0, '2012-06-27', NULL, NULL, 41.1655, -111.969, NULL, NULL),
('611572907', 'W12020518', 'W12020518', 'UT01', 'MountainStar Medical Group', 'Robert', 'R', 'Mohr', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 405714', 'Atlanta', 'Fulton', 'GA', '30384', '8014757966', NULL, 'PO Box 405714', 'Atlanta', 'Fulton', 'GA', '30384', '8014757966', '          ', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1750314480', 0, 'N', 0, '2012-06-27', NULL, NULL, 0, 0, NULL, NULL),
('743096310', 'W12020519', 'W12020519', 'UT01', 'St Marks Senior Center', 'Rebecca', 'H', 'Moore', 'MD', 'Nephrology', '', '', NULL, 'O', '1160 E 3900 S Ste G200', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012687766', '8012703395', '1160 E 3900 S Ste G200', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012687766', '8012703395', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1477609089', 0, 'N', 0, '2014-04-16', NULL, NULL, 40.6871, -111.858, NULL, NULL),
('743096310', 'W12020520', 'W12020520', 'UT01', 'St Marks Professional Services ', 'Rebecca', 'H', 'Moore', 'MD', 'Nephrology', '', '', NULL, 'B', 'PO Box 271220', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '8012687766', '8012703395', 'PO Box 271220', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '8012687766', '8012703395', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1477609089', 0, 'N', 0, '2014-04-16', NULL, NULL, 0, 0, NULL, NULL),
('161767581', 'W12020521', 'W12020521', 'UT01', 'Layton Family Practice ', 'Scott', '', 'Moulton', 'DO', 'Urology', '', '', NULL, 'O', '2950 N Church St Ste 200', 'Layton', 'Davis', 'UT', '84040', '8015469441', '8015462422', '2950 N Church St Ste 200', 'Layton', 'Davis', 'UT', '84040', '8015469441', '8015462422', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', '2014-04-04', 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1811141211', 0, 'N', 0, '2014-04-09', NULL, NULL, 41.1009, -111.939, NULL, NULL),
('161767581', 'W12020523', 'W12020523', 'UT01', 'Layton Family Practice ', 'Scott', '', 'Moulton', 'DO', 'Urology', '', '', NULL, 'B', 'PO Box 281221', 'Atlanta', 'Fulton', 'GA', '30384', '8015469441', '          ', 'PO Box 281221', 'Atlanta', 'Fulton', 'GA', '30384', '8015469441', '          ', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', '2014-04-04', 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1811141211', 0, 'N', 0, '2014-04-09', NULL, NULL, 0, 0, NULL, NULL),
('331177233', 'W12020524', 'W12020524', 'UT01', 'Layton Specialty Clinic', 'Scott', '', 'Moulton', 'DO', 'Urology', '', '', NULL, 'O', '2950 N Church St Ste 101-A', 'Layton', 'Davis', 'UT', '84040', '8017717202', '8017717242', '2950 N Church St Ste 101-A', 'Layton', 'Davis', 'UT', '84040', '8017717202', '8017717242', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1811141211', 0, 'N', 0, '2014-04-09', NULL, NULL, 41.1009, -111.939, NULL, NULL),
('331177233', 'W12020525', 'W12020525', 'UT01', 'Ogden Internal Medicine and Urology', 'Scott', '', 'Moulton', 'DO', 'Urology', '', '', NULL, 'O', '5405 S 500 E Ste 100A', 'Ogden', 'Weber', 'UT', '84405', '8014758600', NULL, '5405 S 500 E Ste 100A', 'Ogden', 'Weber', 'UT', '84405', '8014758600', '', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1811141211', 0, 'N', 0, '2014-04-09', NULL, NULL, 41.1655, -111.969, NULL, NULL),
('331177233', 'W12020526', 'W12020526', 'UT01', 'Ogden Internal Medicine and Urology', 'Scott', '', 'Moulton', 'DO', 'Urology', '', '', NULL, 'B', 'Po Box 100925', 'Atlanta', 'Fulton', 'GA', '30384', '8006613365', NULL, 'Po Box 100925', 'Atlanta', 'Fulton', 'GA', '30384', '8006613365', '', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1811141211', 0, 'N', 0, '2014-04-09', NULL, NULL, 0, 0, NULL, NULL),
('200133012', 'W12020527', 'W12020527', 'UT01', 'Lakeview OB/GYN Clinic', 'Gina', 'M', 'Muscolino', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '620 E Medical Dr Ste 340', 'Bountiful', 'Davis', 'UT', '84010', '8012992229', NULL, '620 E Medical Dr Ste 340', 'Bountiful', 'Davis', 'UT', '84010', '8012992229', '          ', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'Lakeview Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1194825117', 0, 'N', 0, '2013-06-19', NULL, NULL, 40.8869, -111.869, NULL, NULL),
('200133012', 'W12020529', 'W12020529', 'UT01', 'Lakeview OB/GYN Clinic', 'Gina', 'M', 'Muscolino', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 409836', 'Atlanta', 'Fulton', 'GA', '30384', '8012992229', NULL, 'PO Box 409836', 'Atlanta', 'Fulton', 'GA', '30384', '8012992229', '          ', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'Lakeview Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1194825117', 0, 'N', 0, '2013-06-19', NULL, NULL, 0, 0, NULL, NULL),
('450579013', 'W12020530', 'W12020530', 'UT01', 'St. Marks Gynecology Oncology Care', 'Bethany', 'A', 'Myers', 'PA', 'Gynecology', '', '', NULL, 'O', '1140 E 3900 S Ste 340', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8017434730', '8017434736', '1140 E 3900 S Ste 340', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8017434730', '8017434736', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', '2013-04-12', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1912215377', 0, 'N', 0, '2014-04-09', NULL, NULL, 0, 0, NULL, NULL),
('450579013', 'W12020531', 'W12020531', 'UT01', 'Monarch Womens Cancer Center', 'Bethany', 'A', 'Myers', 'PA', 'Gynecology', '', '', NULL, 'M', '3 Maryland Farms Ste 250', 'Brentwood', 'Williamson', 'TN', '37027', '8017434730', '8017434736', '3 Maryland Farms Ste 250', 'Brentwood', 'Williamson', 'TN', '37027', '8017434730', '8017434736', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', '2014-04-04', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1912215377', 0, 'N', 0, '2014-04-09', NULL, NULL, 0, 0, NULL, NULL),
('450579013', 'W12020532', 'W12020532', 'UT01', 'St. Marks Gynecology Oncology Care', 'Bethany', 'A', 'Myers', 'PA', 'Gynecology', '', '', NULL, 'B', 'PO Box 198546', 'Atlanta', 'Fulton', 'GA', '30384', '6153737600', NULL, 'PO Box 198546', 'Atlanta', 'Fulton', 'GA', '30384', '6153737600', '', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', '2013-04-12', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1912215377', 0, 'N', 0, '2014-04-09', NULL, NULL, 0, 0, NULL, NULL),
('371625746', 'W12020533', 'W12020533', 'UT01', 'MountainStar Cardiology St Marks', 'Kenneth', 'G', 'Nielson', 'MD', 'Cardiovascular Disease', NULL, NULL, NULL, 'O', '1160 E 3900 S Ste 2000', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012663418', '8012664174', '1160 E 3900 S Ste 2000', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012663418', '8012664174', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1063404929', 0, 'N', 0, '2012-06-27', NULL, NULL, 40.6871, -111.858, NULL, NULL),
('371625746', 'W12020534', 'W12020534', 'UT01', 'MountainStar Cardiology St Marks', 'Kenneth', 'G', 'Nielson', 'MD', 'Cardiovascular Disease', NULL, NULL, NULL, 'O', '3584 W 9000 S Ste 209', 'West Jordan', 'Salt Lake', 'UT', '84088', '8016763776', '8016760987', '3584 W 9000 S Ste 209', 'West Jordan', 'Salt Lake', 'UT', '84088', '8016763776', '8016760987', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1063404929', 0, 'N', 0, '2012-06-27', NULL, NULL, 40.5879, -111.976, NULL, NULL),
('371625746', 'W12020535', 'W12020535', 'UT01', 'MountainStar Cardiology St Marks', 'Kenneth', 'G', 'Nielson', 'MD', 'Cardiovascular Disease', NULL, NULL, NULL, 'O', '3725 W 4100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8016763776', '8016760987', '3725 W 4100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8016763776', '8016760987', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1063404929', 0, 'N', 0, '2012-06-27', NULL, NULL, 40.682, -111.979, NULL, NULL),
('371625746', 'W12020536', 'W12020536', 'UT01', 'MountainStar Cardiology St Marks', 'Kenneth', 'G', 'Nielson', 'MD', 'Cardiovascular Disease', NULL, NULL, NULL, 'O', '74 E Kimballs Ln Ste 260', 'Draper', 'Salt Lake', 'UT', '84020', '8015716100', '8015720505', '74 E Kimballs Ln Ste 260', 'Draper', 'Salt Lake', 'UT', '84020', '8015716100', '8015720505', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1063404929', 0, 'N', 0, '2012-06-27', NULL, NULL, 40.537, -111.889, NULL, NULL),
('371625746', 'W12020537', 'W12020537', 'UT01', 'MountainStar Cardiology St Marks', 'Kenneth', 'G', 'Nielson', 'MD', 'Cardiovascular Disease', NULL, NULL, NULL, 'B', 'PO Box 741729', 'Atlanta', 'Fulton', 'GA', '30384', '8012663418', '8012664174', 'PO Box 741729', 'Atlanta', 'Fulton', 'GA', '30384', '8012663418', '8012664174', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1063404929', 0, 'N', 0, '2012-06-27', NULL, NULL, 0, 0, NULL, NULL),
('161767581', 'W12020538', 'W12020538', 'UT01', 'Layton Family Practice ', 'Samuel', 'J', 'Otto', 'MD', 'Urology', '', '', NULL, 'O', '2950 N Church St Ste 200', 'Layton', 'Davis', 'UT', '84040', '8015469441', '8015462422', '2950 N Church St Ste 200', 'Layton', 'Davis', 'UT', '84040', '8015469441', '8015462422', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', '2014-04-04', 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1154565273', 0, 'N', 0, '2014-04-09', NULL, NULL, 41.1009, -111.939, NULL, NULL),
('161767581', 'W12020539', 'W12020539', 'UT01', 'Layton Family Practice ', 'Samuel', 'J', 'Otto', 'MD', 'Urology', '', '', NULL, 'B', 'PO Box 281221', 'Atlanta', 'Fulton', 'GA', '30384', '8015469441', '8015462422', 'PO Box 281221', 'Atlanta', 'Fulton', 'GA', '30384', '8015469441', '8015462422', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', '2014-04-04', 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1154565273', 0, 'N', 0, '2014-04-09', NULL, NULL, 0, 0, NULL, NULL),
('331177233', 'W12020540', 'W12020540', 'UT01', 'Layton Specialty Clinic', 'Samuel', 'J', 'Otto', 'MD', 'Urology', '', '', NULL, 'O', '2950 N Church St Ste 101-A', 'Layton', 'Davis', 'UT', '84040', '8017717202', '8017717242', '2950 N Church St Ste 101-A', 'Layton', 'Davis', 'UT', '84040', '8017717202', '8017717242', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1154565273', 0, 'N', 0, '2014-04-09', NULL, NULL, 41.1009, -111.939, NULL, NULL),
('331177233', 'W12020541', 'W12020541', 'UT01', 'Ogden Internal Medicine & Urology', 'Samuel', 'J', 'Otto', 'MD', 'Urology', '', '', NULL, 'O', '5405 S 500 E', 'Ogden', 'Weber', 'UT', '84405', '8014758600', NULL, '5405 S 500 E', 'Ogden', 'Weber', 'UT', '84405', '8014758600', '', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1154565273', 0, 'N', 0, '2014-04-09', NULL, NULL, 41.1655, -111.969, NULL, NULL),
('331177233', 'W12020543', 'W12020543', 'UT01', 'Ogden Internal Medicine and Urology ', 'Samuel', 'J', 'Otto', 'MD', 'Urology', '', '', NULL, 'O', '620 E Medical Dr Ste 300', 'Bountiful', 'Davis', 'UT', '84010', '8012983247', '8012989675', '620 E Medical Dr Ste 300', 'Bountiful', 'Davis', 'UT', '84010', '8012983247', '8012989675', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1154565273', 0, 'N', 0, '2014-04-09', NULL, NULL, 40.8869, -111.869, NULL, NULL),
('331177233', 'W12020544', 'W12020544', 'UT01', 'Ogden Internal Medicine & Urology', 'Samuel', 'J', 'Otto', 'MD', 'Urology', '', '', NULL, 'B', 'PO Box 100925', 'Atlanta', 'Fulton', 'GA', '30384', '8014758600', NULL, 'PO Box 100925', 'Atlanta', 'Fulton', 'GA', '30384', '8014758600', '', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1154565273', 0, 'N', 0, '2014-04-09', NULL, NULL, 0, 0, NULL, NULL),
('770701557', 'W12020545', 'W12020545', 'UT01', 'MountainStar Jordan Family Health', 'David', 'K', 'Palmer', 'MD', 'Ear, Nose and Throat', NULL, NULL, NULL, 'O', '8846 S Redwood Rd Ste E-121', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015691999', '8015692001', '8846 S Redwood Rd Ste E-121', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015691999', '8015692001', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'Mountain West Medical Center', 'St Marks Hospital', NULL, NULL, 'HCFA|UB|', '1427018191', 0, 'N', 0, '2012-06-27', NULL, NULL, 40.5911, -111.939, NULL, NULL),
('770701557', 'W12020546', 'W12020546', 'UT01', 'MountainStar Jordan Family Health', 'David', 'K', 'Palmer', 'MD', 'Ear, Nose and Throat', NULL, NULL, NULL, 'B', 'PO Box 198560', 'Atlanta', 'Fulton', 'GA', '30384', '8015691999', '8015692001', 'PO Box 198560', 'Atlanta', 'Fulton', 'GA', '30384', '8015691999', '8015692001', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'Mountain West Medical Center', 'St Marks Hospital', NULL, NULL, 'HCFA|UB|', '1427018191', 0, 'N', 0, '2012-06-27', NULL, NULL, 0, 0, NULL, NULL),
('770701557', 'W12020547', 'W12020547', 'UT01', 'MountainStar Jordan Family Health', 'Annliza', '', 'Piacitelli', 'MD', 'Family Practice', '', '', NULL, 'O', '8846 S Redwood Rd Ste E-121', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015691999', '8015692001', '8846 S Redwood Rd Ste E-121', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015691999', '8015692001', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1205034113', 0, 'N', 0, '2012-06-27', NULL, NULL, 40.5911, -111.939, NULL, NULL),
('770701557', 'W12020548', 'W12020548', 'UT01', 'MountainStar Jordan Family Health', 'Annliza', '', 'Piacitelli', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 198560', 'Atlanta', 'Fulton', 'GA', '30384', '8015691999', '8015692001', 'PO Box 198560', 'Atlanta', 'Fulton', 'GA', '30384', '8015691999', '8015692001', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1205034113', 0, 'N', 0, '2012-06-27', NULL, NULL, 0, 0, NULL, NULL),
('800701770', 'W12020549', 'W12020549', 'UT01', 'Mountainstar Medical Group Neurosurgery', 'James', 'C', 'Pingree', 'MD', 'Neurosurgery', 'Oncology', '', NULL, 'O', '1220 E 3900 S Ste 4-E', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012618507', '8012618511', '1220 E 3900 S Ste 4-E', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012618507', '8012618511', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1730249582', 0, 'N', 0, '2014-07-25', NULL, NULL, 40.6871, -111.856, NULL, NULL),
('800701770', 'W12020550', 'W12020550', 'UT01', 'Mountainstar Medical Group Neurosurgery', 'James', 'C', 'Pingree', 'MD', 'Neurosurgery', 'Oncology', '', NULL, 'B', 'PO Box 741648', 'Atlanta', 'Fulton', 'GA', '30374', '6153737490', '8012618511', 'PO Box 741648', 'Atlanta', 'Fulton', 'GA', '30374', '6153737490', '8012618511', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1730249582', 0, 'N', 0, '2014-07-25', NULL, NULL, 0, 0, NULL, NULL),
('770701557', 'W12020552', 'W12020552', 'UT01', 'MountainStar Jordan Family Health', 'Sean', 'A', 'Ponce', 'MD', 'Family Practice', '', '', NULL, 'O', '8846 S Redwood Rd Ste E-121', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015691999', '8015692001', '8846 S Redwood Rd Ste E-121', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015691999', '8015692001', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1376577049', 0, 'N', 0, '2013-11-25', NULL, NULL, 40.5911, -111.939, NULL, NULL),
('770701557', 'W12020553', 'W12020553', 'UT01', 'MountainStar Jordan Family Health', 'Sean', 'A', 'Ponce', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 198560', 'Atlanta', 'Fulton', 'GA', '30384', '8015691999', '8015692001', 'PO Box 198560', 'Atlanta', 'Fulton', 'GA', '30384', '8015691999', '8015692001', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1376577049', 0, 'N', 0, '2013-11-25', NULL, NULL, 0, 0, NULL, NULL),
('770701557', 'W12020554', 'W12020554', 'UT01', 'South Jordan Family Medicine', 'David', 'D', 'Poor', 'MD', 'Family Practice', '', '', NULL, 'O', '10623 S Redwood Rd Ste 101', 'South Jordan', 'Salt Lake', 'UT', '84095', '8013020899', '8013020892', '10623 S Redwood Rd Ste 101', 'South Jordan', 'Salt Lake', 'UT', '84095', '8013020899', '8013020892', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', '2014-04-04', 0, 0, 0, 'University Health Care University Hospital', '', '', '', 'HCFA|UB|', '1275589699', 0, 'N', 0, '2014-04-09', NULL, NULL, 40.5582, -111.939, NULL, NULL),
('770701557', 'W12020555', 'W12020555', 'UT01', 'South Jordan Family Medicine', 'David', 'D', 'Poor', 'MD', 'Family Practice', '', '', NULL, 'B', 'PO Box 198560', 'Atlanta', 'Fulton', 'GA', '30384', '8013020899', '8013020892', 'PO Box 198560', 'Atlanta', 'Fulton', 'GA', '30384', '8013020899', '8013020892', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', '2014-04-04', 0, 0, 0, 'University Health Care University Hospital', '', '', '', 'HCFA|UB|', '1275589699', 0, 'N', 0, '2014-04-09', NULL, NULL, 0, 0, NULL, NULL),
('743096310', 'W12020556', 'W12020556', 'UT01', 'St Marks Senior Center', 'Danesh', '', 'Rahimi', 'MD', 'Geriatrics', 'Internal Medicine', '', NULL, 'O', '1160 E 3900 S Ste G200', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012687766', NULL, '1160 E 3900 S Ste G200', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012687766', '          ', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1487744553', 0, 'N', 0, '2014-02-06', NULL, NULL, 40.6871, -111.858, NULL, NULL),
('743096310', 'W12020557', 'W12020557', 'UT01', 'St Marks Senior Center', 'Danesh', '', 'Rahimi', 'MD', 'Geriatrics', 'Internal Medicine', '', NULL, 'B', 'PO Box 271220', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '6153737629', NULL, 'PO Box 271220', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '6153737629', '          ', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1487744553', 0, 'Y', 0, '2014-02-06', NULL, NULL, 0, 0, NULL, NULL),
('450579013', 'W12020558', 'W12020558', 'UT01', 'St Marks Gynocology Oncology Care', 'Jennifer', 'M', 'Rhode', 'MD', 'Gynecologic Oncology', '', '', NULL, 'O', '1140 E 3900 S Ste 340', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8017434730', '8017434736', '1140 E 3900 S Ste 340', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8017434730', '8017434736', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'St Marks Hospital', 'Ogden Regional Medical Center', 'Timpanogos Regional Hospital', '', 'HCFA|UB|', '1992735534', 0, 'N', 0, '2014-03-28', NULL, NULL, 40.6871, -111.859, NULL, NULL),
('450579013', 'W12020559', 'W12020559', 'UT01', 'St Marks Gynocology Oncology Care', 'Jennifer', 'M', 'Rhode', 'MD', 'Gynecologic Oncology', '', '', NULL, 'O', '3100 Channing Way', 'Idaho Falls', 'Bonneville', 'ID', '83404', '2085296111', NULL, '3100 Channing Way', 'Idaho Falls', 'Bonneville', 'ID', '83404', '2085296111', '', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'St Marks Hospital', 'Ogden Regional Medical Center', 'Timpanogos Regional Hospital', '', 'HCFA|UB|', '1992735534', 0, 'Y', 0, '2014-03-28', NULL, NULL, 43.4696, -111.99, NULL, NULL),
('450579013', 'W12020560', 'W12020560', 'UT01', 'Monarch Womens Cancer Center', 'Jennifer', 'M', 'Rhode', 'MD', 'Gynecologic Oncology', '', '', NULL, 'B', 'PO Box 198546', 'Atlanta', 'Fulton', 'GA', '30384', '6153737600', NULL, 'PO Box 198546', 'Atlanta', 'Fulton', 'GA', '30384', '6153737600', '', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'St Marks Hospital', 'Ogden Regional Medical Center', 'Timpanogos Regional Hospital', '', 'HCFA|UB|', '1992735534', 0, 'N', 0, '2014-03-28', NULL, NULL, 0, 0, NULL, NULL),
('770701557', 'W12020562', 'W12020562', 'UT01', 'Alta Internal Medicine', 'Philip', 'L', 'Roberts', 'MD', 'Internal Medicine', NULL, NULL, NULL, 'O', '74 Kimballs Ln Ste 300', 'Draper', 'Salt Lake', 'UT', '84020', '8015720311', '8015711369', '74 Kimballs Ln Ste 300', 'Draper', 'Salt Lake', 'UT', '84020', '8015720311', '8015711369', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1013012418', 0, 'N', 0, '2013-07-25', NULL, NULL, 40.537, -111.889, NULL, NULL),
('770701557', 'W12020563', 'W12020563', 'UT01', 'Alta Internal Medicine', 'Philip', 'L', 'Roberts', 'MD', 'Internal Medicine', NULL, NULL, NULL, 'B', 'PO Box 198560', 'Atlanta', 'Fulton', 'GA', '30384', '8006613365', '8015711369', 'PO Box 198560', 'Atlanta', 'Fulton', 'GA', '30384', '8006613365', '8015711369', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1013012418', 0, 'N', 0, '2013-07-25', NULL, NULL, 0, 0, NULL, NULL),
('161767581', 'W12020564', 'W12020564', 'UT01', 'Layton Family Practice', 'Mont', 'C', 'Robins', 'PA', 'Family Practice', '', '', NULL, 'O', '2950 N Church St Ste 200', 'Layton', 'Davis', 'UT', '84040', '8015469441', '          ', '2950 N Church St Ste 200', 'Layton', 'Davis', 'UT', '84040', '8015469441', '          ', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', '2014-04-04', 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1467440701', 0, 'N', 0, '2014-04-09', NULL, NULL, 41.1009, -111.939, NULL, NULL),
('161767581', 'W12020565', 'W12020565', 'UT01', 'Layton Family Practice', 'Mont', 'C', 'Robins', 'PA', 'Family Practice', '', '', NULL, 'B', 'PO Box 281221', 'Atlanta', 'Fulton', 'GA', '30384', '8015469441', '          ', 'PO Box 281221', 'Atlanta', 'Fulton', 'GA', '30384', '8015469441', '          ', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', '2014-04-04', 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1467440701', 0, 'N', 0, '2014-04-09', NULL, NULL, 0, 0, NULL, NULL),
('371625746', 'W12020566', 'W12020566', 'UT01', 'MountainStar Cardiology St Marks', 'Steven', 'A', 'Rokeach', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1160 E 3900 S Ste 2000', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012663418', '8012664174', '1160 E 3900 S Ste 2000', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012663418', '8012664174', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-07-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1740290212', 0, 'N', 0, '2012-06-28', NULL, NULL, 40.6871, -111.858, NULL, NULL);
