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
('453778194', 'W12025629', 'W12025629', 'WYT1', 'Premier Surgical Center', '', '', 'Premier Surgical Center', '', 'Ambulatory Surgery Center', '', '', NULL, 'O', '195 Overthrust Rd', 'Evanston', 'Uinta', 'WY', '82930', '3074443600', '3074443610', '195 Overthrust Rd', 'Evanston', 'Uinta', 'WY', '82930', '3074443600', '3074443610', '', '', '2', '0.00', '0.00', '0.00', 3, '2012-12-10', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1417228370', 0, 'N', 0, '2012-12-06', NULL, NULL, 0, 0, NULL, NULL),
('870327686', 'W12025631', 'W12025631', 'UT01', 'Professional Diagnostics', 'Neil', 'L', 'Jorgensen', 'MD', 'Pathology', '', '', NULL, 'O', '1050 E S Temple', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8012630810', '8012708170', '1050 E S Temple', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8012630810', '8012708170', 'WUSTDPATH5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-12-20', NULL, 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1467449454', 0, 'N', 0, '2012-12-18', NULL, NULL, 40.7694, -111.861, NULL, NULL),
('870327686', 'W12025633', 'W12025633', 'UT01', 'Professional Diagnostics', 'Neil', 'L', 'Jorgensen', 'MD', 'Pathology', '', '', NULL, 'O', '3460 S Pioneer Pkwy', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8012630810', '8012708170', '3460 S Pioneer Pkwy', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8012630810', '8012708170', 'WUSTDPATH5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-12-20', NULL, 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1467449454', 0, 'N', 0, '2012-12-18', NULL, NULL, 40.6972, -111.99, NULL, NULL),
('870327686', 'W12025632', 'W12025632', 'UT01', 'Professional Diagnostics', 'Neil', 'L', 'Jorgensen', 'MD', 'Pathology', '', '', NULL, 'O', '3580 W 9000 S', 'West Jordan', 'Salt Lake', 'UT', '84088', '8012630810', '8012708170', '3580 W 9000 S', 'West Jordan', 'Salt Lake', 'UT', '84088', '8012630810', '8012708170', 'WUSTDPATH5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-12-20', NULL, 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1467449454', 0, 'N', 0, '2012-12-18', NULL, NULL, 40.5879, -111.975, NULL, NULL),
('870327686', 'W12025634', 'W12025634', 'UT01', 'Professional Diagnostics', 'Neil', 'L', 'Jorgensen', 'MD', 'Pathology', '', '', NULL, 'B', 'PO Box 276', 'Midvale', 'Salt Lake', 'UT', '84047', '0000000000', '0000000000', 'PO Box 276', 'Midvale', 'Salt Lake', 'UT', '84047', '0000000000', '0000000000', 'WUSTDPATH5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-12-20', NULL, 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1467449454', 0, 'N', 0, '2012-12-18', NULL, NULL, 0, 0, NULL, NULL),
('760494600', 'W12025636', 'W12025636', 'TXHOUSTD', 'Southeast Dermatology', '', '', 'Southeast Dermatology', '', 'Dermatology', '', '', NULL, 'O', '11003 Resource Pkwy Ste 106', 'Houston', 'Harris', 'TX', '77089', '2814810033', '2814812465', '11003 Resource Pkwy Ste 106', 'Houston', 'Harris', 'TX', '77089', '2814810033', '2814812465', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1811932205', 0, 'Y', 0, '2013-05-10', NULL, NULL, 29.5862, -95.2086, NULL, NULL),
('760494600', 'W12025635', 'W12025635', 'TXHOUSTD', 'Southeast Dermatology', '', '', 'Southeast Dermatology', '', 'Dermatology', '', '', NULL, 'O', '4419 Crenshaw Rd', 'Pasadena', 'Harris', 'TX', '77504', '2819915944', '2819916849', '4419 Crenshaw Rd', 'Pasadena', 'Harris', 'TX', '77504', '2819915944', '2819916849', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1811932205', 0, 'Y', 0, '2013-05-10', NULL, NULL, 29.6405, -95.1757, NULL, NULL),
('760494600', 'W12025638', 'W12025638', 'TXHOUSTD', 'Southeast Dermatology', 'Manuel', '', 'Davila', 'MD', 'Dermatology', '', '', NULL, 'O', '11003 Resource Pkwy Ste 106', 'Houston', 'Harris', 'TX', '77089', '2814810033', '2814812465', '11003 Resource Pkwy Ste 106', 'Houston', 'Harris', 'TX', '77089', '2814810033', '2814812465', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Bayshore Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1194709626', 0, 'N', 0, '2012-12-11', NULL, NULL, 29.5862, -95.2086, NULL, NULL),
('760494600', 'W12025639', 'W12025639', 'TXHOUSTD', 'Southeast Dermatology', 'Manuel', '', 'Davila', 'MD', 'Dermatology', '', '', NULL, 'O', '4419 Crenshaw Rd', 'Pasadena', 'Harris', 'TX', '77504', '2819915944', '2819916849', '4419 Crenshaw Rd', 'Pasadena', 'Harris', 'TX', '77504', '2819915944', '2819916849', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Bayshore Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1194709626', 0, 'N', 0, '2012-12-11', NULL, NULL, 29.6405, -95.1757, NULL, NULL),
('760494600', 'W12025641', 'W12025641', 'TXHOUSTD', 'Southeast Dermatology', 'Mary', 'E', 'Garman', 'MD', 'Dermatology', '', '', NULL, 'O', '11003 Resource Pkwy Ste 106', 'Houston', 'Harris', 'TX', '77089', '2814810033', '2814812465', '11003 Resource Pkwy Ste 106', 'Houston', 'Harris', 'TX', '77089', '2814810033', '2814812465', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Bayshore Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1346277381', 0, 'N', 0, '2012-12-11', NULL, NULL, 29.5862, -95.2086, NULL, NULL),
('760494600', 'W12025642', 'W12025642', 'TXHOUSTD', 'Southeast Dermatology', 'Mary', 'E', 'Garman', 'MD', 'Dermatology', '', '', NULL, 'O', '4419 Crenshaw Rd', 'Pasadena', 'Harris', 'TX', '77504', '2819915944', '2819916849', '4419 Crenshaw Rd', 'Pasadena', 'Harris', 'TX', '77504', '2819915944', '2819916849', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Bayshore Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1346277381', 0, 'N', 0, '2012-12-11', NULL, NULL, 29.6405, -95.1757, NULL, NULL),
('760494600', 'W12025644', 'W12025644', 'TXHOUSTD', 'Southeast Dermatology', 'Ashkan', 'J', 'Ghorbani', 'MD', 'Dermatology', '', '', NULL, 'O', '4419 Crenshaw Rd', 'Pasadena', 'Harris', 'TX', '77504', '2819915944', '2819916849', '4419 Crenshaw Rd', 'Pasadena', 'Harris', 'TX', '77504', '2819915944', '2819916849', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Bayshore Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1851392039', 0, 'N', 0, '2012-12-11', NULL, NULL, 29.6405, -95.1757, NULL, NULL),
('760494600', 'W12025646', 'W12025646', 'TXHOUSTD', 'Southeast Dermatology', 'Christine', 'M', 'Hunt', 'MD', 'Dermatology', '', '', NULL, 'O', '11003 Resource Pkwy Ste 106', 'Houston', 'Harris', 'TX', '77089', '2814810033', '2814812465', '11003 Resource Pkwy Ste 106', 'Houston', 'Harris', 'TX', '77089', '2814810033', '2814812465', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Bayshore Medical Center', NULL, '', '', 'HCFA|UB|', '1366607194', 0, 'N', 0, '2012-12-11', NULL, NULL, 29.5862, -95.2086, NULL, NULL),
('760494600', 'W12025647', 'W12025647', 'TXHOUSTD', 'Southeast Dermatology', 'Christine', 'M', 'Hunt', 'MD', 'Dermatology', '', '', NULL, 'O', '4419 Crenshaw Rd', 'Pasadena', 'Harris', 'TX', '77504', '2819915944', '2819916849', '4419 Crenshaw Rd', 'Pasadena', 'Harris', 'TX', '77504', '2819915944', '2819916849', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Bayshore Medical Center', NULL, '', '', 'HCFA|UB|', '1366607194', 0, 'N', 0, '2012-12-11', NULL, NULL, 29.6405, -95.1757, NULL, NULL),
('760494600', 'W12025649', 'W12025649', 'TXHOUSTD', 'Southeast Dermatology', 'Lawrence', 'M', 'Joseph', 'MD', 'Dermatology', '', '', NULL, 'O', '4419 Crenshaw Rd', 'Pasadena', 'Harris', 'TX', '77504', '2819915944', '2819916849', '4419 Crenshaw Rd', 'Pasadena', 'Harris', 'TX', '77504', '2819915944', '2819916849', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Bayshore Medical Center', NULL, '', '', 'HCFA|UB|', '1649276692', 0, 'N', 0, '2012-12-11', NULL, NULL, 29.6405, -95.1757, NULL, NULL),
('760494600', 'W12025654', 'W12025654', 'TXHOUSTD', 'Southeast Dermatology', 'Wendy', 'C', 'Magee', 'MD', 'Dermatology', '', '', NULL, 'O', '11003 Resource Pkwy Ste 106', 'Houston', 'Harris', 'TX', '77089', '2814810033', '2814812465', '11003 Resource Pkwy Ste 106', 'Houston', 'Harris', 'TX', '77089', '2814810033', '2814812465', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Bayshore Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1760484349', 0, 'N', 0, '2012-12-11', NULL, NULL, 29.5862, -95.2086, NULL, NULL),
('760494600', 'W12025652', 'W12025652', 'TXHOUSTD', 'Southeast Dermatology', 'Paula', 'F', 'Leis', 'MD', 'Dermatology', '', '', NULL, 'O', '4419 Crenshaw Rd', 'Pasadena', 'Harris', 'TX', '77504', '2819915944', '2819916849', '4419 Crenshaw Rd', 'Pasadena', 'Harris', 'TX', '77504', '2819915944', '2819916849', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Bayshore Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1316905029', 0, 'N', 0, '2012-12-11', NULL, NULL, 29.6405, -95.1757, NULL, NULL),
('760494600', 'W12025655', 'W12025655', 'TXHOUSTD', 'Southeast Dermatology', 'Wendy', 'C', 'Magee', 'MD', 'Dermatology', '', '', NULL, 'O', '4419 Crenshaw Rd', 'Pasadena', 'Harris', 'TX', '77504', '2819915944', '2819916849', '4419 Crenshaw Rd', 'Pasadena', 'Harris', 'TX', '77504', '2819915944', '2819916849', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Bayshore Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1760484349', 0, 'N', 0, '2012-12-11', NULL, NULL, 29.6405, -95.1757, NULL, NULL),
('760494600', 'W12025657', 'W12025657', 'TXHOUSTD', 'Southeast Dermatology', 'Sheri', 'L', 'Ratoosh', 'PHD', 'Dermatology', '', '', NULL, 'O', '11003 Resource Pkwy Ste 106', 'Houston', 'Harris', 'TX', '77089', '2814810033', '2814812465', '11003 Resource Pkwy Ste 106', 'Houston', 'Harris', 'TX', '77089', '2814810033', '2814812465', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Bayshore Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1366425894', 0, 'N', 0, '2013-07-16', NULL, NULL, 29.5862, -95.2086, NULL, NULL),
('760494600', 'W12025658', 'W12025658', 'TXHOUSTD', 'Southeast Dermatology', 'Sheri', 'L', 'Ratoosh', 'PHD', 'Dermatology', '', '', NULL, 'O', '4419 Crenshaw Rd', 'Pasadena', 'Harris', 'TX', '77504', '2819915944', '2819916849', '4419 Crenshaw Rd', 'Pasadena', 'Harris', 'TX', '77504', '2819915944', '2819916849', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Bayshore Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1366425894', 0, 'N', 0, '2013-07-16', NULL, NULL, 29.6405, -95.1757, NULL, NULL),
('760494600', 'W12025660', 'W12025660', 'TXHOUSTD', 'Southeast Dermatology', 'Matthew', 'S', 'Petitt', 'DO', 'Dermatology', '', '', NULL, 'O', '4419 Crenshaw Rd', 'Pasadena', 'Harris', 'TX', '77504', '2819915944', '2819916849', '4419 Crenshaw Rd', 'Pasadena', 'Harris', 'TX', '77504', '2819915944', '2819916849', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Bayshore Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1912101593', 0, 'N', 0, '2012-12-11', NULL, NULL, 29.6405, -95.1757, NULL, NULL),
('522167869', 'W12025661', 'W12025661', 'UT01', 'WorkPoint Occ Medicine', 'Nolan', 'R', 'Brooksby', 'DO', 'Family Practice', 'Emergency Medicine', '', NULL, 'O', '175 N 100 W Ste N104', 'Vernal', 'Uintah', 'UT', '84078', '4357813053', '4357813055', '175 N 100 W Ste N104', 'Vernal', 'Uintah', 'UT', '84078', '4357813053', '4357813055', 'WURURAL5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Ashley Valley Regional Medical', '', '', '', 'HCFA|UB|', '1912949603', 0, 'N', 0, '2013-01-14', NULL, NULL, 40.4582, -109.53, NULL, NULL),
('741933469', 'W12025663', 'W12025663', 'TXHOUSTD', 'Padilla, Guillermo', 'Guillermo', '', 'Padilla', 'MD', 'Family Practice', '', '', NULL, 'O', '2502 Canal', 'Houston', 'Harris', 'TX', '77003', '7132240555', '8322429525', '2502 Canal', 'Houston', 'Harris', 'TX', '77003', '7132240555', '8322429525', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1548250996', 0, 'N', 0, '2013-04-17', NULL, NULL, 29.7571, -95.3452, NULL, NULL),
('201263344', 'W12025664', 'W12025664', 'TXDALSTD', 'Cody Mihills MD', 'Cody', 'L', 'Mihills', 'MD', 'Family Practice', '', '', NULL, 'O', '1001 W Southlake Blvd', 'Southlake', 'Tarrant', 'TX', '76092', '8173100421', '8173105870', '1001 W Southlake Blvd', 'Southlake', 'Tarrant', 'TX', '76092', '8173100421', '8173105870', 'DALLAS1', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Baylor Regional Medical Center at Grapevine', NULL, NULL, NULL, 'HCFA|UB|', '1548246671', 0, 'N', 0, '2013-05-24', NULL, NULL, 32.9412, -97.1652, NULL, NULL),
('741933469', 'W12025665', 'W12025665', 'TXHOUSTD', 'Santiago, Mary', 'Mary', 'A', 'Santiago', 'MD', 'Family Practice', '', '', NULL, 'O', '2502 Canal', 'Houston', 'Harris', 'TX', '77003', '7132240555', '8322429525', '2502 Canal', 'Houston', 'Harris', 'TX', '77003', '7132240555', '8322429525', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1528097268', 0, 'N', 0, '2013-06-28', NULL, NULL, 29.7571, -95.3452, NULL, NULL),
('760587668', 'W12025666', 'W12025666', 'TXHOUSTD', 'Nguyen, Vince', 'Vince', '', 'Nguyen', 'MD', 'Cardiology', '', '', NULL, 'O', '2020 NASA Rd 1 Ste 210', 'Houston', 'Harris', 'TX', '77058', '2813339200', '2813333570', '2020 NASA Rd 1 Ste 210', 'Houston', 'Harris', 'TX', '77058', '2813339200', '2813333570', 'HOUSTON2', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1952506511', 0, 'N', 0, '2013-04-17', NULL, NULL, 29.5513, -95.0892, NULL, NULL),
('760587668', 'W12025667', 'W12025667', 'TXHOUSTD', 'Nguyen, Vince', 'Vince', '', 'Nguyen', 'MD', 'Cardiology', '', '', NULL, 'O', '300 E Edgewood', 'Friendswood', 'Galveston', 'TX', '77546', '2816488600', '2813333570', '300 E Edgewood', 'Friendswood', 'Galveston', 'TX', '77546', '2816488600', '2813333570', 'HOUSTON2', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1952506511', 0, 'N', 0, '2013-04-17', NULL, NULL, 29.5368, -95.2025, NULL, NULL),
('751654999', 'W12025668', 'W12025668', 'TXDALSTD', '', 'Shanna', 'J', 'Brown', 'MD', 'Ophthalmology', '', '', NULL, 'O', '5000 Collinwood Ave', 'Fort Worth', 'Tarrant', 'TX', '76107', '8177325593', '8173420388', '5000 Collinwood Ave', 'Fort Worth', 'Tarrant', 'TX', '76107', '8177325593', '8173420388', 'DALLAS4', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-01-01', '2013-09-14', 0, 0, 0, 'Baylor All Saints Medical Center', '', '', '', 'HCFA|UB|', '1467613513', 0, 'N', 0, '2013-08-22', NULL, NULL, 32.7377, -97.395, NULL, NULL),
('751654999', 'W12025669', 'W12025669', 'TXDALSTD', '', 'Shanna', 'J', 'Brown', 'MD', 'Ophthalmology', '', '', NULL, 'O', '925 Santa Fe Trail', 'Weatherford', 'Parker', 'TX', '76086', '8173411600', '8173411603', '925 Santa Fe Trail', 'Weatherford', 'Parker', 'TX', '76086', '8173411600', '8173411603', 'DALLAS4', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-01-01', '2013-09-14', 0, 0, 0, 'Baylor All Saints Medical Center', '', '', '', 'HCFA|UB|', '1467613513', 0, 'N', 0, '2013-08-22', NULL, NULL, 0, 0, NULL, NULL),
('593836772', 'W12025672', 'W12025672', 'TXHOUSTD', 'East Texas Cardiology', 'Anwar', '', 'Ahmad', 'MD', 'Internal Medicine', 'Cardiovascular Disease', '', NULL, 'O', '15200 Southwest Fwy Ste 310', 'Sugar Land', 'Fort Bend', 'TX', '77478', '2813251005', '2813251008', '15200 Southwest Fwy Ste 310', 'Sugar Land', 'Fort Bend', 'TX', '77478', '2813251005', '2813251008', 'HOUSTON2', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Houston Methodist West Houston Hospital', 'West Houston Medical Center', '', '', 'HCFA|UB|', '1598704819', 0, 'N', 0, '2013-06-03', NULL, NULL, 29.6072, -95.6143, NULL, NULL),
('593836772', 'W12025671', 'W12025671', 'TXHOUSTD', 'East Texas Cardiology', 'Anwar', '', 'Ahmad', 'MD', 'Internal Medicine', 'Cardiovascular Disease', '', NULL, 'O', '2000 Crawford Ste 1403', 'Houston', 'Harris', 'TX', '77002', '7136511787', '7136511791', '2000 Crawford Ste 1403', 'Houston', 'Harris', 'TX', '77002', '7136511787', '7136511791', 'HOUSTON2', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Houston Methodist West Houston Hospital', 'West Houston Medical Center', '', '', 'HCFA|UB|', '1598704819', 0, 'N', 0, '2013-06-03', NULL, NULL, 29.7461, -95.3659, NULL, NULL),
('593836772', 'W12025673', 'W12025673', 'TXHOUSTD', 'East Texas Cardiology', 'Anwar', '', 'Ahmad', 'MD', 'Internal Medicine', 'Cardiovascular Disease', '', NULL, 'B', 'PO Box 36728', 'Houston', 'Harris', 'TX', '77236', '7136511787', '7136511791', 'PO Box 36728', 'Houston', 'Harris', 'TX', '77236', '7136511787', '7136511791', 'HOUSTON2', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Houston Methodist West Houston Hospital', 'West Houston Medical Center', '', '', 'HCFA|UB|', '1598704819', 0, 'N', 0, '2013-06-03', NULL, NULL, 0, 0, NULL, NULL),
('800552007', 'W12025674', 'W12025674', 'TXDALSTD', 'Family Care Clinic', 'Huy', 'Q', 'Nguyen', 'MD', 'Internal Medicine', 'Pediatrics', '', NULL, 'O', '3465 W Walnut St Ste 225', 'Garland', 'Dallas', 'TX', '75042', '9722727816', '9722768137', '3465 W Walnut St Ste 225', 'Garland', 'Dallas', 'TX', '75042', '9722727816', '9722768137', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1194986208', 0, 'N', 0, '2013-05-01', NULL, NULL, 32.9172, -96.6823, NULL, NULL),
('741933469', 'W12025675', 'W12025675', 'TXHOUSTD', '', 'Sam', '', 'Jahani', 'DO', 'Internal Medicine', '', '', NULL, 'O', '2502 Canal', 'Houston', 'Harris', 'TX', '77003', '7132240555', '8322429525', '2502 Canal', 'Houston', 'Harris', 'TX', '77003', '7132240555', '8322429525', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Conroe Regional Medical Center', '', '', '', 'HCFA|UB|', '1306894118', 0, 'N', 0, '2014-06-03', NULL, NULL, 29.7571, -95.3452, NULL, NULL),
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('870281028', 'W12025699', 'W12025699', 'UT01', 'Central Utah Clinic PC', 'Seongwook', '', 'Han', 'MD', 'Cardiology', '', '', NULL, 'B', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', '8014298180', 'PO Box 30079', 'Salt Lake City', 'Salt Lake', 'UT', '84130', '8013758858', '8014298180', 'WCUC', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2012-12-01', NULL, 0, 0, 0, 'Timpanogos Regional Hospital', '', '', '', 'HCFA|UB|', '1497078786', 0, 'N', 0, '2013-04-09', NULL, NULL, 0, 0, NULL, NULL),
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('860735726', 'W12025702', 'W12025702', 'Sinclair', 'Flagstaff Bone and Joint', 'Mark', '', 'Thiele', 'PA-C', 'Orthopedic Surgery', '', '', NULL, 'O', '77 W Forest Ave Ste 301', 'Flagstaff', 'Coconino', 'AZ', '86001', '9287732280', '9287732281', '77 W Forest Ave Ste 301', 'Flagstaff', 'Coconino', 'AZ', '86001', '9287732280', '9287732281', '', '', '', '0.00', '40.00', '0.00', 3, '2013-08-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1992708523', 0, 'N', 0, '2013-07-18', NULL, NULL, 0, 0, NULL, NULL),
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('870284475', 'W12025707', 'W12025707', 'UT01', 'Granger Medical Clinic', 'Richard', 'L', 'Jackson', 'MD', 'Pediatrics', '', '', NULL, 'O', '3181 W 9000 S', 'West Jordan', 'Salt Lake', 'UT', '84088', '8013525900', '0000000000', '3181 W 9000 S', 'West Jordan', 'Salt Lake', 'UT', '84088', '8013525900', '0000000000', 'WUGRANGER5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-09-01', '2013-09-01', 0, 0, 0, 'St Marks Hospital', 'Jordan Valley Medical Center', '', '', 'HCFA|UB|', '1295780559', 0, 'N', 0, '2013-09-19', NULL, NULL, 0, 0, NULL, NULL),
('870284475', 'W12025706', 'W12025706', 'UT01', 'Granger Medical Clinic', 'Richard', 'L', 'Jackson', 'MD', 'Pediatrics', '', '', 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, '2013-09-01', '2013-09-01', 0, 0, 0, 'St Marks Hospital', 'Jordan Valley Medical Center', '', '', 'HCFA|UB|', '1295780559', 0, 'N', 0, '2013-09-19', NULL, NULL, 0, 0, NULL, NULL),
('830326307', 'W12025708', 'W12025708', 'WY01', 'Quick Care', '', '', 'Community Health Center of Central Wyoming ', '', 'Urgent Care', NULL, '', NULL, 'O', '5000 Blackmore Rd', 'Casper', 'Natrona', 'WY', '82609', '3072336000', '0000000000', '5000 Blackmore Rd', 'Casper', 'Natrona', 'WY', '82609', '3072336000', '0000000000', 'WISEWYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-11-26', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1447480561', 0, 'N', 0, '2013-12-26', NULL, NULL, 42.8286, -106.293, NULL, NULL),
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('363395596', 'W12025713', 'W12025713', 'ILCHIGSTD', 'Northwest Oncology and Hematology Associates', '', '', 'Northwest Oncology and Hematology Associates', '', 'Oncology', '', '', NULL, 'O', '27750 W Hwy 22 Ste G70', 'Barrington', 'Lake', 'IL', '60010', '8478420180', '8478429877', '27750 W Hwy 22 Ste G70', 'Barrington', 'Lake', 'IL', '60010', '8478420180', '8478429877', 'CHIG12ONC', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', '', '', '', 'HCFA|UB|', '1225099427', 0, 'Y', 0, '2014-04-25', NULL, NULL, 42.193, -88.1736, NULL, NULL),
('363395596', 'W12025710', 'W12025710', 'ILCHIGSTD', 'Northwest Oncology and Hematology Associates', '', '', 'Northwest Oncology and Hematology Associates', '', 'Oncology', '', '', NULL, 'O', '3701 Algonquin Rd Ste 900', 'Rolling Meadows', 'Cook', 'IL', '60008', '8478704100', '8478700866', '3701 Algonquin Rd Ste 900', 'Rolling Meadows', 'Cook', 'IL', '60008', '8478704100', '8478700866', 'CHIG12ONC', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', '', '', '', 'HCFA|UB|', '1225099427', 0, 'Y', 0, '2014-04-25', NULL, NULL, 42.0619, -88.0252, NULL, NULL),
('363395596', 'W12025711', 'W12025711', 'ILCHIGSTD', 'Northwest Oncology and Hematology Associates', '', '', 'Northwest Oncology and Hematology Associates', '', 'Oncology', '', '', NULL, 'O', '800 Biesterfield Rd Wimmer Bldg Ste 210', 'Elk Grove Village', 'Cook', 'IL', '60007', '8474373312', '8479565107', '800 Biesterfield Rd Wimmer Bldg Ste 210', 'Elk Grove Village', 'Cook', 'IL', '60007', '8474373312', '8479565107', 'CHIG12ONC', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', '', '', '', 'HCFA|UB|', '1225099427', 0, 'Y', 0, '2014-04-25', NULL, NULL, 42.0034, -88.0174, NULL, NULL),
('760540476', 'W12025716', 'W12025716', 'TXHOUSTD', 'Oakbend Medical Group', '', '', 'Oakbend Medical Group', '', 'Clinics', '', '', NULL, 'O', '1601 Main St Ste 500', 'Richmond', 'Fort Bend', 'TX', '77469', '2813420222', '2812380009', '1601 Main St Ste 500', 'Richmond', 'Fort Bend', 'TX', '77469', '2813420222', '2812380009', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1366480725', 0, 'Y', 0, '2013-06-25', NULL, NULL, 29.5772, -95.7691, NULL, NULL),
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('760540476', 'W12025715', 'W12025715', 'TXHOUSTD', 'Oakbend Medical Group', '', '', 'Oakbend Medical Group', '', 'Clinics', '', '', NULL, 'M', '324 Dulles Dr', 'Lafayette', 'Lafayette', 'LA', '70506', '2812387870', '2816334985', '324 Dulles Dr', 'Lafayette', 'Lafayette', 'LA', '70506', '2812387870', '2816334985', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1366480725', 0, 'Y', 0, '2013-06-25', NULL, NULL, 0, 0, NULL, NULL),
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('760540476', 'W12025724', 'W12025724', 'TXHOUSTD', 'Oakbend Medical Group', 'Owen', 'C', 'Capocyan', 'MD', 'Family Practice', 'Geriatrics', '', NULL, 'O', '1601 Main St Ste 500', 'Richmond', 'Fort Bend', 'TX', '77469', '2816334930', '2816344933', '1601 Main St Ste 500', 'Richmond', 'Fort Bend', 'TX', '77469', '2816334930', '2816344933', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1063695328', 0, 'N', 0, '2014-02-24', NULL, NULL, 29.5772, -95.7691, NULL, NULL),
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('760540476', 'W12025739', 'W12025739', 'TXHOUSTD', 'Oakbend Medical Group', 'John', '', 'Butler', 'MD', 'Infectious Disease', '', '', NULL, 'O', '4911 Sand Hill Dr', 'Sugar Land', 'Fort Bend', 'TX', '77479', '2816334970', '2816334975', '4911 Sand Hill Dr', 'Sugar Land', 'Fort Bend', 'TX', '77479', '2816334970', '2816334975', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', '2014-01-26', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1427028430', 0, 'N', 0, '2014-02-19', NULL, NULL, 29.5992, -95.6808, NULL, NULL),
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('760540476', 'W12025747', 'W12025747', 'TXHOUSTD', 'Oakbend Medical Group', 'Yassir', '', 'Sonbol', 'MD', 'Cardiology', '', '', NULL, 'O', '4911 Sand Hill Dr', 'Sugar Land', 'Fort Bend', 'TX', '77479', '2816334900', '2816344993', '4911 Sand Hill Dr', 'Sugar Land', 'Fort Bend', 'TX', '77479', '2816334900', '2816344993', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', '2014-01-26', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1518039965', 0, 'N', 0, '2014-02-19', NULL, NULL, 29.5992, -95.6808, NULL, NULL),
('760540476', 'W12025749', 'W12025749', 'TXHOUSTD', 'Oakbend Medical Group', 'Barkat', '', 'Fazal', 'MD', 'Infectious Disease', '', '', NULL, 'O', '4911 Sand Hill Dr', 'Sugar Land', 'Fort Bend', 'TX', '77479', '2816334970', '2816334975', '4911 Sand Hill Dr', 'Sugar Land', 'Fort Bend', 'TX', '77479', '2816334970', '2816334975', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', '2014-01-26', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1619074721', 0, 'N', 0, '2014-02-19', NULL, NULL, 29.5992, -95.6808, NULL, NULL);
INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
('760540476', 'W12025751', 'W12025751', 'TXHOUSTD', 'Oakbend Medical Group', 'Khaja', '', 'Moinuddeen', 'MD', 'Cardiology', '', '', NULL, 'O', '4911 Sand Hill Dr', 'Sugar Land', 'Fort Bend', 'TX', '77479', '2812387870', '2816334985', '4911 Sand Hill Dr', 'Sugar Land', 'Fort Bend', 'TX', '77479', '2812387870', '2816334985', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Houston Methodist Sugar Land Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1154300903', 0, 'N', 0, '2013-03-29', NULL, NULL, 29.5995, -95.682, NULL, NULL),
('760540476', 'W12025753', 'W12025753', 'TXHOUSTD', 'Oakbend Medical Group', 'Joseph', 'A', 'Anzaldua', 'MD', 'Family Practice', '', '', NULL, 'O', '6350 Hwy 90A Ste 600', 'Sugar Land', 'Fort Bend', 'TX', '77498', '2812657000', '2812652101', '6350 Hwy 90A Ste 600', 'Sugar Land', 'Fort Bend', 'TX', '77498', '2812657000', '2812652101', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1659353001', 0, 'N', 0, '2013-04-04', NULL, NULL, 29.6069, -95.664, NULL, NULL),
('760540476', 'W12025755', 'W12025755', 'TXHOUSTD', 'Oakbend Medical Group', 'James', '', 'Pearce', 'MD', 'Family Practice', '', '', NULL, 'O', '6350 Hwy 90A Ste 600', 'Sugar Land', 'Fort Bend', 'TX', '77498', '2812657000', '2812652101', '6350 Hwy 90A Ste 600', 'Sugar Land', 'Fort Bend', 'TX', '77498', '2812657000', '2812652101', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1427062199', 0, 'N', 0, '2012-12-13', NULL, NULL, 29.6069, -95.664, NULL, NULL),
('760540476', 'W12025757', 'W12025757', 'TXHOUSTD', 'Oakbend Medical Group', 'Michael', 'C', 'Maier', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '7830 W Grand Pkwy Ste 280', 'Richmond', 'Fort Bend', 'TX', '77406', '2816334940', '2816334943', '7830 W Grand Pkwy Ste 280', 'Richmond', 'Fort Bend', 'TX', '77406', '2816334940', '2816334943', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1750317954', 0, 'N', 0, '2012-12-13', NULL, NULL, 29.6886, -95.7733, NULL, NULL),
('760540476', 'W12025759', 'W12025759', 'TXHOUSTD', 'Oakbend Medical Group', 'Karl', 'A', 'Simon', 'PA', 'Orthopedic Surgery', '', '', NULL, 'O', '7830 W Grand Pkwy Ste 280', 'Richmond', 'Fort Bend', 'TX', '77406', '2816334940', '2816334943', '7830 W Grand Pkwy Ste 280', 'Richmond', 'Fort Bend', 'TX', '77406', '2816334940', '2816334943', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', '2014-01-26', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1356671630', 0, 'N', 0, '2014-02-19', NULL, NULL, 29.6628, -95.7449, NULL, NULL),
('760540476', 'W12025761', 'W12025761', 'TXHOUSTD', 'Oakbend Medical Group', 'David', 'M', 'Wallace', 'MD', 'Family Practice', '', '', NULL, 'O', '7830 W Grand Pkwy Ste 280', 'Richmond', 'Fort Bend', 'TX', '77406', '2816334940', '2816334943', '7830 W Grand Pkwy Ste 280', 'Richmond', 'Fort Bend', 'TX', '77406', '2816334940', '2816334943', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1437349479', 0, 'N', 0, '2013-07-31', NULL, NULL, 29.6886, -95.7733, NULL, NULL),
('760450457', 'W12025762', 'W12025762', 'TXHOUSTD', 'Southwest OB-GYN Associates', '', '', 'Southwest OBGYN Associates', '', 'Obstetrics and Gynecology', '', '', NULL, 'O', '16651 Southwest Fwy Ste 200', 'Sugar Land', 'Fort Bend', 'TX', '77479', '7137745131', '7137744336', '16651 Southwest Fwy Ste 200', 'Sugar Land', 'Fort Bend', 'TX', '77479', '7137745131', '7137744336', 'HOUSTON3', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1336148378', 0, 'Y', 0, '2013-05-10', NULL, NULL, 29.5915, -95.6304, NULL, NULL),
('760450457', 'W12025763', 'W12025763', 'TXHOUSTD', 'Southwest OB-GYN Associates', '', '', 'Southwest OBGYN Associates', '', 'Obstetrics and Gynecology', '', '', NULL, 'M', '1 Sugar Creek Ctr Blvd Ste 360', 'Dallas', 'Dallas', 'TX', '75267', '7137745131', '7137744336', '1 Sugar Creek Ctr Blvd Ste 360', 'Dallas', 'Dallas', 'TX', '75267', '7137745131', '7137744336', 'HOUSTON3', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1336148378', 0, 'N', 0, '2013-05-10', NULL, NULL, 0, 0, NULL, NULL),
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('363689315', 'W12025806', 'W12025806', 'ILCHIGSTD', 'Midwest Digestive Disease Specialists', 'Shabana', '', 'Shahid', 'MD', 'Gastroenterology', '', '', NULL, 'O', '3825 Highland Ave Tower 2 Ste 307', 'Downers Grove', 'Dupage', 'IL', '60515', '6308330653', '6308339892', '3825 Highland Ave Tower 2, Ste 307', 'Downers Grove', 'Dupage', 'IL', '60515', '6308330653', '6308339892', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1871731836', 0, 'N', 0, '2012-11-30', NULL, NULL, 41.8181, -88.0102, NULL, NULL),
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('800109469', 'W12025670', 'W12025670', 'TXHOUSTD', 'Welcome Family Medicine', 'Yong Fang', '', 'Chen', 'MD', 'Family Practice', '', '', NULL, 'O', '9160 Bellaire Blvd Ste E', 'Houston', 'Harris', 'TX', '77036', '7139958886', '7132709358', '9160 Bellaire Blvd Ste E', 'Houston', 'Harris', 'TX', '77036', '7139958886', '7132709358', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2030-01-01', '2030-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1245238880', 0, 'N', 1, '2012-12-07', NULL, NULL, 0, 0, NULL, NULL),
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('363216902', 'W12025820', 'W12025820', 'ILCHIGSTD', 'Surgical Practice', 'W', 'Gregory', 'Ward', 'MD', 'General Surgery', '', '', NULL, 'O', '24600 W 127th Bldg B', 'Plainfield', 'Will', 'IL', '60585', '6305276300', '6305276307', '24600 W 127th Bldg B', 'Plainfield', 'Will', 'IL', '60585', '6305276300', '6305276307', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Edward Hospital', NULL, '', '', 'HCFA|UB|', '1174622971', 0, 'N', 0, '2013-04-26', NULL, NULL, 41.6514, -88.2182, NULL, NULL),
('364314354', 'ELPPA0272', 'ELPPA0272', 'ILCHIGSTD', 'Provena Medical Group - Coal City Family Health Ctr', 'Hung', '', 'Nguyen', 'DO', 'Family Practice', '', '', NULL, 'B', '25872 Network Place', 'Chicago', 'Cook', 'IL', '60673', '8156344545', '8156348136', '25872 Network Place', 'Chicago', 'Cook', 'IL', '60673', '8156344545', '8156348136', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Elgin', NULL, NULL, NULL, 'HCFA|UB|', '1588688832', 0, 'Y', 0, '2013-09-06', NULL, NULL, 0, 0, NULL, NULL),
('460740417', 'W12025851', 'W12025851', 'UTDT01', 'Genesis Dental Of Magna', 'Richard', '', 'Buck', 'DDS', 'Dentist', '', '', NULL, 'O', '3665 S 8400 W Ste 250', 'Magna', 'Salt Lake', 'UT', '84044', '8012500450', NULL, '3665 S 8400 W Ste 250', 'Magna', 'Salt Lake', 'UT', '84044', '8012500450', '', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2012-10-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1518167568', 0, 'N', 0, '2014-05-23', NULL, NULL, 0, 0, NULL, NULL),
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('264000182', 'W12025855', 'W12025855', 'UTDT01', '39th and 13th Street Dental', 'Glade', '', 'Crowther', 'DMD', 'Dentist', '', '', NULL, 'O', '1345 E 3900 S Ste 206', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012781333', NULL, '1345 E 3900 S Ste 206', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012781333', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2012-10-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000004111', 0, 'N', 0, '2012-11-28', NULL, NULL, 0, 0, NULL, NULL),
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('870570710', 'W12025884', 'W12025884', 'UTDT01', 'Hidden Valley Pediatric Dental', 'Brent', '', 'DeHart', 'DDS', 'Dentist', '', '', NULL, 'O', '114 E 12450 S Ste 200', 'Draper', 'Salt Lake', 'UT', '84020', '8014951610', NULL, '114 E 12450 S Ste 200', 'Draper', 'Salt Lake', 'UT', '84020', '8014951610', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2012-11-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000001153', 0, 'N', 0, '2012-11-28', NULL, NULL, 0, 0, NULL, NULL),
('452430565', 'W12025886', 'W12025886', 'UTDT01', 'Frandsen Orthodontics', 'Benjamin', '', 'Frandsen', 'DDS', 'Orthodontist', '', '', NULL, 'O', '1375 E 800 N Ste 101', 'Orem', 'Utah', 'UT', '84097', '8013753355', NULL, '1375 E 800 N Ste 101', 'Orem', 'Utah', 'UT', '84097', '8013753355', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2012-11-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000001154', 0, 'N', 0, '2012-12-04', NULL, NULL, 0, 0, NULL, NULL),
('800840767', 'W12025887', 'W12025887', 'UTDT01', 'Centerville Dental Group, LLP', 'Cordell', '', 'Nebeker', 'DDS', 'Pedodontist', '', '', NULL, 'O', '331 W Parrish Ln Ste 101', 'Centerville', 'Davis', 'UT', '84014', '8012983230', NULL, '331 W Parrish Ln Ste 101', 'Centerville', 'Davis', 'UT', '84014', '8012983230', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2012-11-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000009907', 0, 'N', 0, '2013-04-09', NULL, NULL, 0, 0, NULL, NULL),
('870627380', 'W12025889', 'W12025889', 'UTDT01', 'Koelliker Endodontics', 'Christopher', '', 'Sadler', 'DDS', 'Endodontist', '', '', NULL, 'O', '1953 E 5600 S', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012789505', NULL, '1953 E 5600 S', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012789505', '          ', 'UT0SPA', '', '', '0.00', '20.00', '0.00', 8, '2012-11-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1073777611', 0, 'N', 0, '2013-09-10', NULL, NULL, 0, 0, NULL, NULL),
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('870617336', 'W12025899', 'W12025899', 'UTDT01', 'Monarch Dental', 'James', '', 'Skousen', 'DDS', 'Dentist', '', '', NULL, 'O', '5419 S Redwood Rd Ste 2', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8012636400', NULL, '5419 S Redwood Rd Ste 2', 'Salt Lake City', 'Salt Lake', 'UT', '84123', '8012636400', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2012-11-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000001160', 0, 'N', 0, '2012-11-28', NULL, NULL, 0, 0, NULL, NULL),
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('870617336', 'W12025901', 'W12025901', 'UTDT01', 'Monarch Dental', 'James', '', 'Skousen', 'DDS', 'Dentist', '', '', NULL, 'O', '575 E University Pkwy Ste A-24', 'Orem', 'Utah', 'UT', '84097', '8012253300', NULL, '575 E University Pkwy Ste A-24', 'Orem', 'Utah', 'UT', '84097', '8012253300', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2012-11-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000001160', 0, 'N', 0, '2012-11-28', NULL, NULL, 0, 0, NULL, NULL),
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('870520179', 'W12025904', 'W12025904', 'UTDT01', 'Mountain View Dental', 'Kent O', '', 'Linsley', 'DDS', 'Dentist', '', '', NULL, 'O', '2717 N Hwy 89 Ste 100', 'Ogden', 'Weber', 'UT', '84414', '8017372410', NULL, '2717 N Hwy 89 Ste 100', 'Ogden', 'Weber', 'UT', '84414', '8017372410', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2012-11-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000007295', 0, 'N', 0, '2012-11-28', NULL, NULL, 0, 0, NULL, NULL),
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('870520179', 'W12025907', 'W12025907', 'UTDT01', 'Mountain View Dental', 'Paul', '', 'Mackley', 'DDS', 'Dentist', '', '', NULL, 'O', '2717 N Hwy 89 Ste 100', 'Ogden', 'Weber', 'UT', '84414', '8017372410', NULL, '2717 N Hwy 89 Ste 100', 'Ogden', 'Weber', 'UT', '84414', '8017372410', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2012-11-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000007383', 0, 'N', 0, '2013-06-11', NULL, NULL, 0, 0, NULL, NULL),
('261475323', 'W12025908', 'W12025908', 'UTDT01', 'Wisdom Teeth Only', 'Raymond K', '', 'Hendrickson', 'DDS', 'Dentist', '', '', NULL, 'O', '2148 N Hill Field Rd Ste 5', 'Layton', 'Davis', 'UT', '84041', '8013700050', NULL, '2148 N Hill Field Rd Ste 5', 'Layton', 'Davis', 'UT', '84041', '8013700050', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2012-11-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1013120245', 0, 'N', 0, '2013-09-06', NULL, NULL, 0, 0, NULL, NULL),
('272953516', 'W12025910', 'W12025910', 'UTDT01', 'Raechel Nelson, DDS', 'Raechel', '', 'Nelson', 'DDS', 'Dentist', '', '', NULL, 'O', '3409 W 12600 S Ste 220', 'Riverton', 'Salt Lake', 'UT', '84065', '8015420267', NULL, '3409 W 12600 S Ste 220', 'Riverton', 'Salt Lake', 'UT', '84065', '8015420267', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2012-11-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000001161', 0, 'N', 0, '2012-12-04', NULL, NULL, 0, 0, NULL, NULL),
('460898193', 'W12025911', 'W12025911', 'UTDT01', 'Creek Road Dental', 'Tyler', '', 'Carlson', 'DMD', 'Dentist', '', '', NULL, 'O', '7369 Creek Rd', 'Sandy', 'Salt Lake', 'UT', '84093', '8015665577', NULL, '7369 Creek Rd', 'Sandy', 'Salt Lake', 'UT', '84093', '8015665577', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2012-11-01', '2013-07-31', 0, 0, 0, '', '', '', '', 'DEN|', '1952558652', 0, 'N', 0, '2013-09-09', NULL, NULL, 0, 0, NULL, NULL),
('452765666', 'W12025912', 'W12025912', 'UTDT01', 'South West Dental', 'Victor', '', 'Pickett', 'DDS', 'Dentist', '', '', NULL, 'O', '5255 S 4015 W Ste 180', 'Taylorsville', 'Salt Lake', 'UT', '84118', '8019689003', NULL, '5255 S 4015 W Ste 180', 'Taylorsville', 'Salt Lake', 'UT', '84118', '8019689003', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2012-11-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000008200', 0, 'N', 0, '2013-03-27', NULL, NULL, 0, 0, NULL, NULL),
('262301367', 'W12025914', 'W12025914', 'UTDT01', 'Stone Creek Family Dental ', 'April', '', 'Hinton', 'DDS', 'Dentist', '', '', NULL, 'O', '2332 W 12600 S Ste A', 'Riverton', 'Salt Lake', 'UT', '84065', '8012534547', NULL, '2332 W 12600 S Ste A', 'Riverton', 'Salt Lake', 'UT', '84065', '8012534547', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2012-11-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000001162', 0, 'N', 0, '2013-06-10', NULL, NULL, 0, 0, NULL, NULL),
('300295299', 'W12025915', 'W12025915', 'UTDT01', 'All Around Dental Care', 'Andrew', '', 'Noble', 'DDS', 'Dentist', '', '', NULL, 'O', '1007 N Main St', 'Nephi', 'Juab', 'UT', '84648', '4356230866', NULL, '1007 N Main St', 'Nephi', 'Juab', 'UT', '84648', '4356230866', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2012-11-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000009892', 0, 'N', 0, '2012-11-28', NULL, NULL, 0, 0, NULL, NULL),
('300295299', 'W12025916', 'W12025916', 'UTDT01', 'All Around Dental Care', 'Andrew', '', 'Noble', 'DDS', 'Dentist', '', '', NULL, 'O', '110 S 100 W', 'Payson', 'Utah', 'UT', '84651', '8014654855', NULL, '110 S 100 W', 'Payson', 'Utah', 'UT', '84651', '8014654855', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2012-11-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000009892', 0, 'N', 0, '2013-04-01', NULL, NULL, 0, 0, NULL, NULL),
('460816040', 'W12025918', 'W12025918', 'UTDT01', 'Salem Smiles', 'Benjamin', '', 'Hulse', 'DDS', 'Dentist', '', '', NULL, 'O', '601 N State Rd 198', 'Salem', 'Utah', 'UT', '84653', '8014237969', NULL, '601 N State Rd 198', 'Salem', 'Utah', 'UT', '84653', '8014237969', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2012-11-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000001163', 0, 'N', 0, '2013-06-10', NULL, NULL, 0, 0, NULL, NULL),
('460898193', 'W12025919', 'W12025919', 'UTDT01', 'Creek Road Dental', 'Brian', '', 'Homer', 'DMD', 'Dentist', '', '', NULL, 'O', '7369 Creek Rd', 'Sandy', 'Salt Lake', 'UT', '84093', '8015665577', NULL, '7369 Creek Rd', 'Sandy', 'Salt Lake', 'UT', '84093', '8015665577', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2012-11-01', '2013-07-31', 0, 0, 0, '', '', '', '', 'DEN|', '1881696904', 0, 'N', 0, '2013-10-22', NULL, NULL, 0, 0, NULL, NULL),
('870515716', 'W12025920', 'W12025920', 'UTDT01', 'Mountainlands Community Health Center', 'Brian R', '', 'Jones', 'DMD', 'Dentist', '', '', NULL, 'O', '910 E 100 N Ste 155', 'Payson', 'Utah', 'UT', '84651', '8018550151', NULL, '910 E 100 N Ste 155', 'Payson', 'Utah', 'UT', '84651', '8018550151', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2012-11-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000006986', 0, 'N', 0, '2012-11-28', NULL, NULL, 0, 0, NULL, NULL),
('870520179', 'W12025921', 'W12025921', 'UTDT01', 'Mountain View Dental', 'Brent', '', 'Suisse', 'DDS', 'Dentist', '', '', NULL, 'O', '2717 N Hwy 89 Ste 100', 'Ogden', 'Weber', 'UT', '84414', '8017372410', NULL, '2717 N Hwy 89 Ste 100', 'Ogden', 'Weber', 'UT', '84414', '8017372410', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2012-11-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000008951', 0, 'N', 0, '2012-11-28', NULL, NULL, 0, 0, NULL, NULL),
('460740417', 'W12025923', 'W12025923', 'UTDT01', 'Genesis Dental Of Magna', 'David', '', 'Stubbs', 'DDS', 'Dentist', '', '', NULL, 'O', '3665 S 8400 W Ste 250', 'Magna', 'Salt Lake', 'UT', '84044', '8012500450', NULL, '3665 S 8400 W Ste 250', 'Magna', 'Salt Lake', 'UT', '84044', '8012500450', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2012-11-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '1588995377', 0, 'N', 0, '2014-03-20', NULL, NULL, 0, 0, NULL, NULL),
('870520179', 'W12025925', 'W12025925', 'UTDT01', 'North View Dental', 'Devin', '', 'Walker', 'DDS', 'Dentist', '', '', NULL, 'O', '2201 N 400 E', 'Ogden', 'Weber', 'UT', '84414', '8017826681', NULL, '2201 N 400 E', 'Ogden', 'Weber', 'UT', '84414', '8017826681', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2012-11-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000001165', 0, 'N', 0, '2012-11-28', NULL, NULL, 0, 0, NULL, NULL),
('870520179', 'W12025927', 'W12025927', 'UTDT01', 'Mountain View Dental', 'Heather', '', 'Walker', 'DDS', 'Dentist', '', '', NULL, 'O', '2717 N Hwy 89 Ste 100', 'Ogden', 'Weber', 'UT', '84414', '8017372410', NULL, '2717 N Hwy 89 Ste 100', 'Ogden', 'Weber', 'UT', '84414', '8017372410', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2012-11-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000001166', 0, 'N', 0, '2012-11-28', NULL, NULL, 0, 0, NULL, NULL),
('460544913', 'W12025928', 'W12025928', 'UTDT01', 'Academy Square Dental Care', 'Eric', '', 'Sorensen', 'DDS', 'Dentist', '', '', NULL, 'O', '488 N 100 E', 'Provo', 'Utah', 'UT', '84606', '8013740867', NULL, '488 N 100 E', 'Provo', 'Utah', 'UT', '84606', '8013740867', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2012-11-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000004005', 0, 'N', 0, '2012-11-28', NULL, NULL, 0, 0, NULL, NULL),
('870520179', 'W12025930', 'W12025930', 'UTDT01', 'Mountain View Dental', 'Heather', '', 'Hansen', 'DDS', 'Dentist', '', '', NULL, 'O', '2717 N Hwy 89 Ste 100', 'Ogden', 'Weber', 'UT', '84414', '8017372410', NULL, '2717 N Hwy 89 Ste 100', 'Ogden', 'Weber', 'UT', '84414', '8017372410', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2012-11-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000001167', 0, 'N', 0, '2012-11-28', NULL, NULL, 0, 0, NULL, NULL),
('261545953', 'W12025931', 'W12025931', 'UTDT01', 'Mountain High Dental', 'John M', '', 'Coats', 'DDS', 'Endodontist', '', '', NULL, 'O', '1680 Ute Blvd Ste C', 'Park City', 'Summit', 'UT', '84098', '4356473012', NULL, '1680 Ute Blvd Ste C', 'Park City', 'Summit', 'UT', '84098', '4356473012', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2012-11-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000005748', 0, 'N', 0, '2012-11-28', NULL, NULL, 0, 0, NULL, NULL),
('300295299', 'W12025933', 'W12025933', 'UTDT01', 'All Around Dental Care', 'James', '', 'Fairbanks', 'DMD', 'Dentist', '', '', NULL, 'O', '1007 N Main St', 'Nephi', 'Juab', 'UT', '84648', '4356230866', NULL, '1007 N Main St', 'Nephi', 'Juab', 'UT', '84648', '4356230866', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2012-11-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000001168', 0, 'N', 0, '2012-11-28', NULL, NULL, 0, 0, NULL, NULL),
('300295299', 'W12025934', 'W12025934', 'UTDT01', 'All Around Dental Care', 'James', '', 'Fairbanks', 'DMD', 'Dentist', '', '', NULL, 'O', '110 S 100 W', 'Payson', 'Utah', 'UT', '84651', '8014654855', NULL, '110 S 100 W', 'Payson', 'Utah', 'UT', '84651', '8014654855', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2012-11-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000001168', 0, 'N', 0, '2012-11-28', 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
('870520179', 'W12025935', 'W12025935', 'UTDT01', 'Northview Dental ', 'Jonathan', '', 'Greenhalgh', 'DDS', 'Dentist', '', '', NULL, 'O', '2717 N Hwy 89 Ste 100', 'Ogden', 'Weber', 'UT', '84414', '8017372410', NULL, '2717 N Hwy 89 Ste 100', 'Ogden', 'Weber', 'UT', '84414', '8017372410', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2012-11-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000006485', 0, 'N', 0, '2012-11-28', NULL, NULL, 0, 0, NULL, NULL),
('271161310', 'W12025937', 'W12025937', 'UTDT01', 'Kids Dental Barn', 'Joshua', '', 'Martin', 'DDS', 'Dentist', '', '', NULL, 'O', '3688 E Campus Dr Ste 220', 'Eagle Mountain', 'Utah', 'UT', '84005', '8013417999', NULL, '3688 E Campus Dr Ste 220', 'Eagle Mountain', 'Utah', 'UT', '84005', '8013417999', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2012-11-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000001169', 0, 'N', 0, '2012-11-28', NULL, NULL, 0, 0, NULL, NULL),
('271161310', 'W12025938', 'W12025938', 'UTDT01', 'Kids Dental Barn', 'Joshua', '', 'Martin', 'DDS', 'Dentist', '', '', NULL, 'O', '12391 S 4000 W Ste 204', 'Riverton', 'Salt Lake', 'UT', '84065', '8016768899', NULL, '12391 S 4000 W Ste 204', 'Riverton', 'Salt Lake', 'UT', '84065', '8016768899', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2012-11-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000001169', 0, 'N', 0, '2012-11-28', NULL, NULL, 0, 0, NULL, NULL),
('870520179', 'W12025939', 'W12025939', 'UTDT01', 'North View Dental', 'Jennifer', '', 'Phillips', 'DDS', 'Dentist', '', '', NULL, 'O', '2201 N 400 E', 'Ogden', 'Weber', 'UT', '84414', '8017826681', NULL, '2201 N 400 E', 'Ogden', 'Weber', 'UT', '84414', '8017826681', '          ', 'UT000A', '', '', '0.00', '20.00', '0.00', 8, '2012-11-01', NULL, 0, 0, 0, '', '', '', '', 'DEN|', '0000009945', 0, 'N', 0, '2012-11-28', NULL, NULL, 0, 0, NULL, NULL),
('371625746', 'W12025945', 'W12025945', 'UT01', 'MountainStar Cardiology St Marks', 'Thomas', 'S', 'Edwards', 'MD', 'Cardiovascular Disease', NULL, NULL, NULL, 'O', '2132 N 1700 W Ste 200', 'Layton', 'Davis', 'UT', '84041', '8017760171', '8014795642', '2132 N 1700 W Ste 200', 'Layton', 'Davis', 'UT', '84041', '8017760171', '8014795642', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-09-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1639163215', 0, 'N', 0, '2012-11-28', NULL, NULL, 41.0892, -111.997, NULL, NULL),
('371625746', 'W12025944', 'W12025944', 'UT01', 'MountainStar Cardiology St Marks', 'Ronald', 'E', 'Brown', 'MD', 'Cardiovascular Disease', NULL, NULL, NULL, 'O', '2132 N 1700 W Ste 200', 'Layton', 'Davis', 'UT', '84041', '8017760171', '8014795642', '2132 N 1700 W Ste 200', 'Layton', 'Davis', 'UT', '84041', '8017760171', '8014795642', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-09-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1447242060', 0, 'N', 0, '2012-11-28', NULL, NULL, 41.0892, -111.997, NULL, NULL),
('371625746', 'W12025942', 'W12025942', 'UT01', 'MountainStar Cardiology St Marks', 'Michael', '', 'Adjei-Poku', 'MD', 'Cardiovascular Disease', NULL, NULL, NULL, 'O', '2132 N 1700 W Ste 200', 'Layton', 'Davis', 'UT', '84041', '8017760171', '8014795642', '2132 N 1700 W Ste 200', 'Layton', 'Davis', 'UT', '84041', '8017760171', '8014795642', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-09-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1528050465', 0, 'N', 0, '2012-11-28', NULL, NULL, 41.0892, -111.997, NULL, NULL),
('371625746', 'W12025946', 'W12025946', 'UT01', 'MountainStar Cardiology St Marks', 'Edward', 'Wayne', 'Ganellen', 'MD', 'Cardiovascular Disease', NULL, NULL, NULL, 'O', '2132 N 1700 W Ste 200', 'Layton', 'Davis', 'UT', '84041', '8017760171', '8014795642', '2132 N 1700 W Ste 200', 'Layton', 'Davis', 'UT', '84041', '8017760171', '8014795642', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-09-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1164414017', 0, 'N', 0, '2013-07-25', NULL, NULL, 41.0892, -111.997, NULL, NULL),
('371625746', 'W12025947', 'W12025947', 'UT01', 'MountainStar Cardiology St Marks', 'Paul', 'S', 'Gilmore', 'MD', 'Cardiovascular Disease', NULL, NULL, NULL, 'O', '2132 N 1700 W Ste 200', 'Layton', 'Davis', 'UT', '84041', '8017760171', '8014795642', '2132 N 1700 W Ste 200', 'Layton', 'Davis', 'UT', '84041', '8017760171', '8014795642', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-09-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1487621389', 0, 'N', 0, '2012-11-28', NULL, NULL, 41.0892, -111.997, NULL, NULL),
('371625746', 'W12025948', 'W12025948', 'UT01', 'MountainStar Cardiology St Marks', 'Scott', 'B', 'Hacking', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '2132 N 1700 W Ste 200', 'Layton', 'Davis', 'UT', '84041', '8017760171', '8014795642', '2132 N 1700 W Ste 200', 'Layton', 'Davis', 'UT', '84041', '8017760171', '8014795642', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-09-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1992712285', 0, 'N', 0, '2013-07-15', NULL, NULL, 41.0892, -111.997, NULL, NULL),
('371625746', 'W12025949', 'W12025949', 'UT01', 'MountainStar Cardiology St Marks', 'Charles', 'W', 'Haws', 'MD', 'Cardiovascular Disease', NULL, NULL, NULL, 'O', '2132 N 1700 W Ste 200', 'Layton', 'Davis', 'UT', '84041', '8017760171', '8014795642', '2132 N 1700 W Ste 200', 'Layton', 'Davis', 'UT', '84041', '8017760171', '8014795642', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-09-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1396739983', 0, 'N', 0, '2012-11-28', NULL, NULL, 41.0892, -111.997, NULL, NULL),
('371625746', 'W12025950', 'W12025950', 'UT01', 'MountainStar Cardiology St Marks', 'Kira', 'D', 'Johnson', 'PA', 'Cardiovascular Disease', '', '', NULL, 'O', '2132 N 1700 W Ste 200', 'Layton', 'Davis', 'UT', '84041', '8017760171', '8014795642', '2132 N 1700 W Ste 200', 'Layton', 'Davis', 'UT', '84041', '8017760171', '8014795642', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-09-01', '2014-06-17', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1831138403', 0, 'N', 0, '2014-06-18', NULL, NULL, 41.0892, -111.997, NULL, NULL),
('371625746', 'W12025951', 'W12025951', 'UT01', 'MountainStar Cardiology St Marks', 'Julian ', '', 'Lain', 'PA', 'Cardiovascular Disease', '', '', NULL, 'O', '2132 N 1700 W Ste 200', 'Layton', 'Davis', 'UT', '84041', '8017760171', '8014795642', '2132 N 1700 W Ste 200', 'Layton', 'Davis', 'UT', '84041', '8017760171', '8014795642', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-09-01', '2014-04-04', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1134199094', 0, 'N', 0, '2014-06-17', NULL, NULL, 41.0892, -111.997, NULL, NULL),
('371625746', 'W12025952', 'W12025952', 'UT01', 'MountainStar Cardiology St Marks', 'Robert', 'W', 'Mackie', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '2132 N 1700 W Ste 200', 'Layton', 'Davis', 'UT', '84041', '8017760171', '8014795642', '2132 N 1700 W Ste 200', 'Layton', 'Davis', 'UT', '84041', '8017760171', '8014795642', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-09-01', '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', 'W12025953', 'W12025953', 'UT01', 'MountainStar Cardiology St Marks', 'Kenneth', 'G', 'Nielson', 'MD', 'Cardiovascular Disease', NULL, NULL, NULL, 'O', '2132 N 1700 W Ste 200', 'Layton', 'Davis', 'UT', '84041', '8017760171', '8014795642', '2132 N 1700 W Ste 200', 'Layton', 'Davis', 'UT', '84041', '8017760171', '8014795642', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-09-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1063404929', 0, 'N', 0, '2012-11-28', NULL, NULL, 41.0892, -111.997, NULL, NULL),
('371625746', 'W12025954', 'W12025954', 'UT01', 'MountainStar Cardiology St Marks', 'Steven', 'A', 'Rokeach', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '2132 N 1700 W Ste 200', 'Layton', 'Davis', 'UT', '84041', '8017760171', '8014795642', '2132 N 1700 W Ste 200', 'Layton', 'Davis', 'UT', '84041', '8017760171', '8014795642', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-09-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1740290212', 0, 'N', 0, '2012-11-28', NULL, NULL, 41.0892, -111.997, NULL, NULL),
('371625746', 'W12025955', 'W12025955', 'UT01', 'MountainStar Cardiology St Marks', 'Pawan', 'K', 'Sharma', 'MD', 'Cardiovascular Disease', NULL, NULL, NULL, 'O', '2132 N 1700 W Ste 200', 'Layton', 'Davis', 'UT', '84041', '8017760171', '8014795642', '2132 N 1700 W Ste 200', 'Layton', 'Davis', 'UT', '84041', '8017760171', '8014795642', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-09-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1114919073', 0, 'N', 0, '2012-11-28', NULL, NULL, 41.0892, -111.997, NULL, NULL),
('371625746', 'W12025956', 'W12025956', 'UT01', 'MountainStar Cardiology St Marks', 'Sally', 'D', 'Sharp', 'MD', 'Cardiovascular Disease', NULL, NULL, NULL, 'O', '2132 N 1700 W Ste 200', 'Layton', 'Davis', 'UT', '84041', '8017760171', '8014795642', '2132 N 1700 W Ste 200', 'Layton', 'Davis', 'UT', '84041', '8017760171', '8014795642', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-09-01', NULL, 0, 0, 0, 'St Marks Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1841282787', 0, 'N', 0, '2012-11-28', NULL, NULL, 41.0892, -111.997, NULL, NULL),
('371625746', 'W12025957', 'W12025957', 'UT01', 'MountainStar Cardiology St Marks', 'Charles', 'W', 'Tate', 'MD', 'Cardiovascular Disease', 'Electrophysiology', '', NULL, 'O', '2132 N 1700 W Ste 200', 'Layton', 'Davis', 'UT', '84041', '8017760171', '8014795642', '2132 N 1700 W Ste 200', 'Layton', 'Davis', 'UT', '84041', '8017760171', '8014795642', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-09-01', '2013-07-06', 0, 0, 0, 'St Marks Hospital', 'Valley View Medical Center', '', '', 'HCFA|UB|', '1376583526', 0, 'N', 0, '2014-05-27', NULL, NULL, 0, 0, NULL, NULL),
('371625746', 'W12025958', 'W12025958', 'UT01', 'MountainStar Cardiology St Marks', 'James', 'Scott', 'Zebrack', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '2132 N 1700 W Ste 200', 'Layton', 'Davis', 'UT', '84041', '8017760171', '8014795642', '2132 N 1700 W Ste 200', 'Layton', 'Davis', 'UT', '84041', '8017760171', '8014795642', 'UTHCAPS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-09-01', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1003808940', 0, 'N', 0, '2014-06-04', NULL, NULL, 41.0892, -111.997, NULL, NULL),
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('760672656', 'W12025981', 'W12025981', 'TXHOUSTD', 'Noble Primary Care Associates', 'Amir', '', 'Ali', 'MD', 'Internal Medicine', '', '', NULL, 'O', '2225 William Trace Blvd Ste 109', 'Sugar Land', 'Fort Bend', 'TX', '77478', '2813133900', '2813133901', '2225 William Trace Blvd Ste 109', 'Sugar Land', 'Fort Bend', 'TX', '77478', '2813133900', '2813133901', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Houston Methodist Sugar Land Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1750482691', 0, 'N', 0, '2012-12-14', NULL, NULL, 29.5948, -95.6038, NULL, NULL),
('412057748', 'W12025982', 'W12025982', 'UT01', 'Utah Pain and Rehab', 'Gigi', '', 'Whaley Pryor', 'NP', 'Pain Management', '', '', NULL, 'O', '1276 S Wall Ave', 'Ogden', 'Weber', 'UT', '84404', '8013374000', '8013374002', '1276 S Wall Ave', 'Ogden', 'Weber', 'UT', '84404', '8013374000', '8013374002', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1679820401', 0, 'N', 0, '2012-12-28', NULL, NULL, 41.2433, -111.978, NULL, NULL),
('202714504', 'W12025983', 'W12025983', 'TXHOUSTD', 'Dermatological Association of Texas', 'Lauren', 'S', 'Campbell', 'MD', 'Dermatology', '', '', NULL, 'O', '20320 NW Fwy Ste 700', 'Houston', 'Harris', 'TX', '77065', '7135544688', '8324785662', '20320 NW Fwy Ste 700', 'Houston', 'Harris', 'TX', '77065', '7135544688', '8324785662', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Houston Methodist Willowbrook Hospital', NULL, '', '', 'HCFA|UB|', '1447406400', 0, 'N', 0, '2012-12-18', NULL, NULL, 29.921, -95.6197, NULL, NULL),
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('061665963', 'W12025988', 'W12025988', 'ID01', 'Eye 2 Eye', 'Zackary', 'N', 'Hall', 'OD', 'Optometry', '', '', NULL, 'O', '440 E State St Ste 140', 'Eagle', 'Ada', 'ID', '83616', '2089397000', '2089395807', '440 E State St Ste 140', 'Eagle', 'Ada', 'ID', '83616', '2089397000', '2089395807', 'IDOPTOMETRY', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-01-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1588759229', 0, 'N', 0, '2013-09-12', NULL, NULL, 43.695, -116.349, NULL, NULL),
('364122551', 'W12025990', 'W12025990', 'ILCHIGSTD', 'West Suburban Eye Associates', '', '', 'West Suburban Eye Associates', '', 'Ophthalmology', '', '', NULL, 'O', '7411 W Lake St Ste 1140', 'River Forest', 'Cook', 'IL', '60305', '7084881900', '7084881974', '7411 W Lake St Ste 1140', 'River Forest', 'Cook', 'IL', '60305', '7084881900', '7084881974', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1255354601', 0, 'Y', 0, '2012-12-05', NULL, NULL, 41.8885, -87.8103, NULL, NULL),
('364122551', 'W12025992', 'W12025992', 'ILCHIGSTD', 'West Suburban Eye Associates', 'David', 'S', 'Springer', 'MD', 'Ophthalmology', '', '', NULL, 'O', '1 Erie Ct Ste 6140', 'Oak Park', 'Cook', 'IL', '60302', '7088482400', '7088482576', '1 Erie Ct Ste 6140', 'Oak Park', 'Cook', 'IL', '60302', '7088482400', '7088482576', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, '', '', 'HCFA|UB|', '1003811787', 0, 'N', 0, '2012-12-10', NULL, NULL, 41.8919, -87.775, NULL, NULL),
('364122551', 'W12025993', 'W12025993', 'ILCHIGSTD', 'West Suburban Eye Associates', 'David', 'S', 'Springer', 'MD', 'Ophthalmology', '', '', NULL, 'O', '7411 W Lake St Ste 1140', 'River Forest', 'Cook', 'IL', '60305', '7084881900', '7084881974', '7411 W Lake St Ste 1140', 'River Forest', 'Cook', 'IL', '60305', '7084881900', '7084881974', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, '', '', 'HCFA|UB|', '1003811787', 0, 'N', 0, '2012-12-10', NULL, NULL, 41.8885, -87.8103, NULL, NULL),
('364122551', 'W12025995', 'W12025995', 'ILCHIGSTD', 'West Suburban Eye Associates', 'Phillip', 'C', 'Wu', 'MD', 'Ophthalmology', '', '', NULL, 'O', '1 Erie Ct Ste 6140', 'Oak Park', 'Cook', 'IL', '60302', '7088482400', '7088482576', '1 Erie Ct Ste 6140', 'Oak Park', 'Cook', 'IL', '60302', '7088482400', '7088482576', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Francis Hospital', NULL, '', '', 'HCFA|UB|', '1962481598', 0, 'N', 0, '2012-12-10', NULL, NULL, 41.8919, -87.775, NULL, NULL),
('364122551', 'W12025996', 'W12025996', 'ILCHIGSTD', 'West Suburban Eye Associates', 'Phillip', 'C', 'Wu', 'MD', 'Ophthalmology', '', '', NULL, 'O', '7411 W Lake St Ste 1140', 'River Forest', 'Cook', 'IL', '60305', '7084881900', '7084881974', '7411 W Lake St Ste 1140', 'River Forest', 'Cook', 'IL', '60305', '7084881900', '7084881974', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Francis Hospital', NULL, '', '', 'HCFA|UB|', '1962481598', 0, 'N', 0, '2012-12-10', NULL, NULL, 41.8885, -87.8103, NULL, NULL),
('364122551', 'W12025998', 'W12025998', 'ILCHIGSTD', 'West Suburban Eye Associates', 'Marc', 'R', 'Levin', 'MD', 'Ophthalmology', '', '', NULL, 'O', '1 Erie Ct Ste 6140', 'Oak Park', 'Cook', 'IL', '60302', '7088482400', '7088482576', '1 Erie Ct Ste 6140', 'Oak Park', 'Cook', 'IL', '60302', '7088482400', '7088482576', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-04-03', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1417991621', 0, 'N', 0, '2013-04-03', NULL, NULL, 41.8918, -87.7775, NULL, NULL),
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('261737440', 'W12026008', 'W12026008', 'UT01', 'Desert Pain Specialists', 'Cortney', '', 'Bernardo', 'PA', 'Pain Management', '', '', NULL, 'O', '1490 E Foremaster Dr Ste 220', 'St George', 'Washington', 'UT', '84790', '4352167000', '4352167001', '1490 E Foremaster Dr Ste 220', 'St George', 'Washington', 'UT', '84790', '4352167000', '4352167001', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-11-15', NULL, 0, 0, 0, 'Dixie Regional Medical Center', '', '', '', 'HCFA|UB|', '1285735688', 0, 'N', 0, '2012-11-30', NULL, NULL, 37.0959, -113.551, NULL, NULL),
('261737440', 'W12026009', 'W12026009', 'UT01', 'Desert Pain Specialists', 'J', 'Court', 'Empey', 'MD', 'Pain Management', NULL, NULL, NULL, 'O', '1490 E Foremaster Dr Ste 220', 'St George', 'Washington', 'UT', '84790', '4352167000', '4352167001', '1490 E Foremaster Dr Ste 220', 'St George', 'Washington', 'UT', '84790', '4352167000', '4352167001', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-04-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', '', '', '', 'HCFA|UB|', '1205058294', 0, 'N', 0, '2012-11-30', NULL, NULL, 37.0959, -113.551, NULL, NULL),
('261737440', 'W12026010', 'W12026010', 'UT01', 'Desert Pain Specialists', 'Spencer', 'G', 'Wells', 'MD', 'Pain Management', '', '', NULL, 'O', '1490 E Foremaster Dr Ste 220', 'St George', 'Washington', 'UT', '84790', '4352167000', '4352167001', '1490 E Foremaster Dr Ste 220', 'St George', 'Washington', 'UT', '84790', '4352167000', '4352167001', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-11-15', NULL, 0, 0, 0, 'Dixie Regional Medical Center', '', '', '', 'HCFA|UB|', '1023151644', 0, 'N', 0, '2012-11-30', NULL, NULL, 37.0959, -113.551, NULL, NULL),
('870563433', 'W12026011', 'W12026011', 'UT01', 'Alpine Home Medical', '', '', 'Alpine Home Medical', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'M', '132 E 13065 S Ste 200', 'Draper', 'Salt Lake', 'UT', '84020', '0000000000', '0000000000', '132 E 13065 S Ste 200', 'Draper', 'Salt Lake', 'UT', '84020', '0000000000', '0000000000', 'DME80', '', '', '0.00', '25.00', '0.00', 3, '2012-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000000420', 0, 'N', 0, '2014-01-20', NULL, NULL, 0, 0, NULL, NULL),
('752646217', 'W12026012', 'W12026012', 'TXDALSTD', 'J W Eye Associates', '', '', 'J W Eye Associates', '', 'Ophthalmology', '', '', NULL, 'O', '3060 Communications Pkwy Ste 205', 'Plano', 'Collin', 'TX', '75093', '9727692020', '9727690204', '3060 Communications Pkwy Ste 205', 'Plano', 'Collin', 'TX', '75093', '9727692020', '9727690204', 'DALLAS4', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1285679803', 0, 'N', 0, '2012-12-05', NULL, NULL, 33.0424, -96.833, NULL, NULL),
('752646217', 'W12026013', 'W12026013', 'TXDALSTD', 'J W Eye Associates', '', '', 'J W Eye Associates', '', 'Ophthalmology', '', '', NULL, 'O', '910 N Davis Ste 400', 'Arlington', 'Tarrant', 'TX', '76012', '8174602272', '8172659684', '910 N Davis Ste 400', 'Arlington', 'Tarrant', 'TX', '76012', '8174602272', '8172659684', 'DALLAS4', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1285679803', 0, 'N', 0, '2012-12-05', NULL, NULL, 32.7467, -97.123, NULL, NULL),
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('752646217', 'W12026024', 'W12026024', 'TXDALSTD', 'J W Eye Associates', 'Jeffrey', '', 'Whitman', 'MD', 'Ophthalmology', '', '', NULL, 'O', '3060 Communications Pkwy Ste 205', 'Plano', 'Collin', 'TX', '75093', '9727692020', '9727690204', '3060 Communications Pkwy Ste 205', 'Plano', 'Collin', 'TX', '75093', '9727692020', '9727690204', 'DALLAS4', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1669401162', 0, 'N', 0, '2012-12-06', NULL, NULL, 33.0424, -96.833, NULL, NULL),
('752646217', 'W12026025', 'W12026025', 'TXDALSTD', 'J W Eye Associates', 'Jeffrey', '', 'Whitman', 'MD', 'Ophthalmology', '', '', NULL, 'O', '910 N Davis Ste 400', 'Arlington', 'Tarrant', 'TX', '76012', '8174602272', '8172659684', '910 N Davis Ste 400', 'Arlington', 'Tarrant', 'TX', '76012', '8174602272', '8172659684', 'DALLAS4', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1669401162', 0, 'N', 0, '2012-12-06', NULL, NULL, 32.7467, -97.123, NULL, NULL),
('363399794', 'IL0000103', 'IL0000103', 'ILCHIGSTD', 'WomanCare PC', 'Mark', 'A', 'Parra', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '355 W Northwest Hwy', 'Palatine', 'Cook', 'IL', '60067', '8472214700', '8472214796', '355 W Northwest Hwy', 'Palatine', 'Cook', 'IL', '60067', '8472214700', '8472214796', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1053387431', 0, 'N', 0, '2012-12-05', NULL, NULL, 42.123, -88.0508, NULL, NULL),
('363399794', 'IL0000105', 'IL0000105', 'ILCHIGSTD', 'WomanCare PC', 'Mark', 'A', 'Parra', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '363 W Northwest Hwy', 'Palentine', 'none', 'IL', '60667', '8472214601', '8472214651', '363 W Northwest Hwy', 'Palentine', 'none', 'IL', '60667', '8472214601', '8472214651', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1053387431', 0, 'Y', 0, '2012-12-05', NULL, NULL, 0, 0, NULL, NULL),
('760548150', 'W12027036', 'W12027036', 'TXHOUSTD', 'Bay Area Gastroenterology', 'Nikhil', 'V', 'Inamdar', 'MD', 'Gastroenterology', '', '', NULL, 'O', '1015 Medical Ctr Blvd Ste 1700', 'Webster', 'Harris', 'TX', '77598', '2814806264', '2814804046', '1015 Medical Center Blvd Ste 1700', 'Webster', 'Harris', 'TX', '77598', '2814806264', '2814804046', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB', '1093723132', 0, 'N', 0, '2013-01-08', NULL, NULL, 29.5362, -95.1332, NULL, NULL),
('760548150', 'W12027038', 'W12027038', 'TXHOUSTD', 'Bay Area Gastroenterology', 'Syed', 'Abbas', 'Jafri', 'MD', 'Gastroenterology', '', '', NULL, 'O', '1015 Medical Ctr Blvd Ste 1700', 'Webster', 'Harris', 'TX', '77598', '2814806264', '2814804046', '1015 Medical Ctr Blvd Ste 1700', 'Webster', 'Harris', 'TX', '77598', '2814806264', '2814804046', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB', '1124039839', 0, 'N', 0, '2013-04-04', NULL, NULL, 29.5362, -95.1332, NULL, NULL),
('363399794', 'IL0000114', 'IL0000114', 'ILCHIGSTD', 'WomanCare PC', 'Stacy', 'H', 'Weiss', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '363 W Northwest Hwy', 'Palentine', 'none', 'IL', '60667', '8472214601', '8472214651', '363 W Northwest Hwy', 'Palentine', 'none', 'IL', '60667', '8472214601', '8472214651', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1902806086', 0, 'Y', 0, '2012-12-05', NULL, NULL, 0, 0, NULL, NULL),
('363399794', 'W12026333', 'W12026333', 'ILCHIGSTD', 'WomanCare PC', 'Stacy', 'H', 'Weiss', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1450 Busch Pkwy Ste 110', 'Buffalo Grove', 'Lake', 'IL', '60089', '8472212200', '8472212196', '1450 Busch Pkwy Ste 110', 'Buffalo Grove', 'Lake', 'IL', '60089', '8472212200', '8472212196', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1902806086', 0, 'N', 0, '2012-12-05', NULL, NULL, 42.1717, -87.9275, NULL, NULL),
('390816848', 'IL0000407', 'IL0000407', 'ILCHIGSTD', 'Mercy Womens Health Center - Algonquin', 'Raja', '', 'Chatterji', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '2230 N Huntington Dr', 'Algonquin', 'McHenry', 'IL', '60102', '8478540688', NULL, '2230 N Huntington Dr', 'Algonquin', 'Mchenry', 'IL', '60102', '8478540688', '          ', 'CHIG9', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1245246065', 0, 'N', 0, '2012-12-06', NULL, NULL, 42.1703, -88.325, NULL, NULL),
('363399794', 'W12026331', 'W12026331', 'ILCHIGSTD', 'WomanCare PC', 'Amy', 'C', 'Shapiro', 'MD', 'Gynecology', '', '', NULL, 'O', '1450 Busch Pkwy Ste 110', 'Buffalo Grove', 'Lake', 'IL', '60089', '8472212200', '8472212196', '1450 Busch Pkwy Ste 110', 'Buffalo Grove', 'Lake', 'IL', '60089', '8472212200', '8472212196', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1932198041', 0, 'N', 0, '2012-12-05', NULL, NULL, 42.1717, -87.9275, NULL, NULL),
('363399794', 'W12026332', 'W12026332', 'ILCHIGSTD', 'WomanCare PC', 'Stacy', 'H', 'Weiss', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1051 W Rand Rd Ste 101', 'Arlington Heights', 'Cook', 'IL', '60004', '8472214900', '8472214996', '1051 W Rand Rd Ste 101', 'Arlington Heights', 'Cook', 'IL', '60004', '8472214900', '8472214996', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1902806086', 0, 'N', 0, '2012-12-05', NULL, NULL, 42.1228, -87.9956, NULL, NULL),
('363399794', 'IL0000111', 'IL0000111', 'ILCHIGSTD', 'WomanCare PC', 'Amy', 'C', 'Shapiro', 'MD', 'Gynecology', '', '', NULL, 'B', '363 W Northwest Hwy', 'Palentine', 'none', 'IL', '60667', '8472214601', '8472214651', '363 W Northwest Hwy', 'Palentine', 'none', 'IL', '60667', '8472214601', '8472214651', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1932198041', 0, 'Y', 0, '2012-12-05', NULL, NULL, 0, 0, NULL, NULL),
('363399794', 'W12026329', 'W12026329', 'ILCHIGSTD', 'WomanCare PC', 'Ann', 'M', 'Ressetar', 'MD', 'Gynecology', '', '', NULL, 'O', '455 S Roselle Rd Ste 120', 'Schaumburg', 'Cook', 'IL', '60193', '8472214300', '8472214396', '455 S Roselle Rd Ste 120', 'Schaumburg', 'Cook', 'IL', '60193', '8472214300', '8472214396', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1225026719', 0, 'N', 0, '2012-12-05', NULL, NULL, 42.0192, -88.0799, NULL, NULL),
('363399794', 'IL0000108', 'IL0000108', 'ILCHIGSTD', 'WomanCare PC', 'Ann', 'M', 'Ressetar', 'MD', 'Gynecology', '', '', NULL, 'B', '363 W Northwest Hwy', 'Palentine', 'none', 'IL', '60667', '8472214601', '8472214651', '363 W Northwest Hwy', 'Palentine', 'none', 'IL', '60667', '8472214601', '8472214651', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1225026719', 0, 'Y', 0, '2012-12-05', NULL, NULL, 0, 0, NULL, NULL),
('363399794', 'W12026330', 'W12026330', 'ILCHIGSTD', 'WomanCare PC', 'Amy', 'C', 'Shapiro', 'MD', 'Gynecology', '', '', NULL, 'O', '1051 W Rand Rd Ste 101', 'Arlington Heights', 'Cook', 'IL', '60004', '8472214900', '8472214996', '1051 W Rand Rd Ste 101', 'Arlington Heights', 'Cook', 'IL', '60004', '8472214900', '8472214996', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1932198041', 0, 'N', 0, '2012-12-05', NULL, NULL, 42.1228, -87.9956, NULL, NULL),
('363399794', 'W12026328', 'W12026328', 'ILCHIGSTD', 'WomanCare PC', 'Ann', 'M', 'Ressetar', 'MD', 'Gynecology', '', '', NULL, 'O', '1051 W Rand Rd Ste 101', 'Arlington Heights', 'Cook', 'IL', '60004', '8472214900', '8472214996', '1051 W Rand Rd Ste 101', 'Arlington Heights', 'Cook', 'IL', '60004', '8472214900', '8472214996', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1225026719', 0, 'N', 0, '2012-12-05', NULL, NULL, 42.1228, -87.9956, 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
('363399794', 'IL0000104', 'IL0000104', 'ILCHIGSTD', 'WomanCare PC', 'Mark', 'A', 'Parra', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '814 E Woodfield Rd', 'Schaumberg', 'Cook', 'IL', '60173', '8472214800', '8472214896', '814 E Woodfield Rd', 'Schaumberg', 'Cook', 'IL', '60173', '8472214800', '8472214896', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1053387431', 0, 'N', 0, '2012-12-05', NULL, NULL, 42.0429, -88.0596, NULL, NULL),
('363399794', 'IL0000102', 'IL0000102', 'ILCHIGSTD', 'WomanCare PC', 'Tammy', 'E', 'Novak', 'MD', 'Gynecology', '', '', NULL, 'B', '363 W Northwest Hwy', 'Palentine', 'none', 'IL', '60667', '8472214601', '8472214651', '363 W Northwest Hwy', 'Palentine', 'none', 'IL', '60667', '8472214601', '8472214651', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1376658682', 0, 'Y', 0, '2012-12-05', NULL, NULL, 0, 0, NULL, NULL),
('363399794', 'IL0000100', 'IL0000100', 'ILCHIGSTD', 'WomanCare PC', 'Michelle', 'M', 'Luthringshausen', 'MD', 'Gynecology', '', '', NULL, 'B', '363 W Northwest Hwy', 'Palentine', 'none', 'IL', '60667', '8472214601', '8472214651', '363 W Northwest Hwy', 'Palentine', 'none', 'IL', '60667', '8472214601', '8472214651', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1174552038', 0, 'Y', 0, '2012-12-05', NULL, NULL, 0, 0, NULL, NULL),
('363399794', 'IL0000099', 'IL0000099', 'ILCHIGSTD', 'WomanCare PC', 'Michelle', 'M', 'Luthringshausen', 'MD', 'Gynecology', '', '', NULL, 'O', '216 S Arlington Heights Rd', 'Arlington Heights', 'Cook', 'IL', '60005', '8472214400', '8472214465', '216 S Arlington Heights Rd', 'Arlington Heights', 'Cook', 'IL', '60005', '8472214400', '8472214465', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1174552038', 0, 'N', 0, '2012-12-05', NULL, NULL, 42.0794, -87.9805, NULL, NULL),
('363399794', 'IL0000098', 'IL0000098', 'ILCHIGSTD', 'WomanCare PC', 'Susan ', 'M', 'Lupo', 'MD', 'Gynecology', '', '', NULL, 'B', '363 W Northwest Hwy', 'Palentine', 'none', 'IL', '60667', '8472214601', '8472214651', '363 W Northwest Hwy', 'Palentine', 'none', 'IL', '60667', '8472214601', '8472214651', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1326037433', 0, 'Y', 0, '2012-12-05', NULL, NULL, 0, 0, NULL, NULL),
('363399794', 'W12026326', 'W12026326', 'ILCHIGSTD', 'WomanCare PC', 'Susan ', 'M', 'Lupo', 'MD', 'Gynecology', '', '', NULL, 'O', '455 S Roselle Rd Ste 120', 'Schaumburg', 'Cook', 'IL', '60193', '8472214300', '8472214396', '455 S Roselle Rd Ste 120', 'Schaumburg', 'Cook', 'IL', '60193', '8472214300', '8472214396', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1326037433', 0, 'N', 0, '2012-12-05', NULL, NULL, 42.0192, -88.0799, NULL, NULL),
('363399794', 'W12026327', 'W12026327', 'ILCHIGSTD', 'WomanCare PC', 'Tammy', 'E', 'Novak', 'MD', 'Gynecology', '', '', NULL, 'O', '1450 Busch Pkwy Ste 110', 'Buffalo Grove', 'Lake', 'IL', '60089', '8472212200', '8472212196', '1450 Busch Pkwy Ste 110', 'Buffalo Grove', 'Lake', 'IL', '60089', '8472212200', '8472212196', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1376658682', 0, 'N', 0, '2012-12-05', NULL, NULL, 42.1717, -87.9275, NULL, NULL),
('363399794', 'IL0000093', 'IL0000093', 'ILCHIGSTD', 'WomanCare PC', 'Rebecca', 'S', 'Keith', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '355 W Northwest Hwy', 'Palatine', 'Cook', 'IL', '60067', '8472214700', '8472214796', '355 W Northwest Hwy', 'Palatine', 'Cook', 'IL', '60067', '8472214700', '8472214796', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1104854785', 0, 'N', 0, '2013-03-11', NULL, NULL, 42.123, -88.0508, NULL, NULL),
('363399794', 'IL0000095', 'IL0000095', 'ILCHIGSTD', 'WomanCare PC', 'Rebecca', 'S', 'Keith', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '363 W Northwest Hwy', 'Palentine', 'none', 'IL', '60667', '8472214601', '8472214651', '363 W Northwest Hwy', 'Palentine', 'none', 'IL', '60667', '8472214601', '8472214651', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1104854785', 0, 'Y', 0, '2013-03-11', NULL, NULL, 0, 0, NULL, NULL),
('363399794', 'IL0000094', 'IL0000094', 'ILCHIGSTD', 'WomanCare PC', 'Rebecca', 'S', 'Keith', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '814 E Woodfield Rd', 'Schaumberg', 'Cook', 'IL', '60173', '8472214800', '8472214896', '814 E Woodfield Rd', 'Schaumberg', 'Cook', 'IL', '60173', '8472214800', '8472214896', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1104854785', 0, 'N', 0, '2013-03-11', NULL, NULL, 42.0429, -88.0596, NULL, NULL),
('363399794', 'IL0000090', 'IL0000090', 'ILCHIGSTD', 'WomanCare PC', 'Claudine', 'M', 'Kasinak', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '355 W Northwest Hwy', 'Palatine', 'Cook', 'IL', '60067', '8472214700', '8472214796', '355 W Northwest Hwy', 'Palatine', 'Cook', 'IL', '60067', '8472214700', '8472214796', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1124017330', 0, 'N', 0, '2012-12-05', NULL, NULL, 42.123, -88.0508, NULL, NULL),
('363399794', 'IL0000092', 'IL0000092', 'ILCHIGSTD', 'WomanCare PC', 'Claudine', 'M', 'Kasinak', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '363 W Northwest Hwy', 'Palentine', 'none', 'IL', '60667', '8472214601', '8472214651', '363 W Northwest Hwy', 'Palentine', 'none', 'IL', '60667', '8472214601', '8472214651', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1124017330', 0, 'Y', 0, '2012-12-05', NULL, NULL, 0, 0, NULL, NULL),
('363399794', 'IL0000091', 'IL0000091', 'ILCHIGSTD', 'WomanCare PC', 'Claudine', 'M', 'Kasinak', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '814 E Woodfield Rd', 'Schaumberg', 'Cook', 'IL', '60173', '8472214800', '8472214896', '814 E Woodfield Rd', 'Schaumberg', 'Cook', 'IL', '60173', '8472214800', '8472214896', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1124017330', 0, 'N', 0, '2012-12-05', NULL, NULL, 42.0429, -88.0596, NULL, NULL),
('363399794', 'IL0000089', 'IL0000089', 'ILCHIGSTD', 'WomanCare PC', 'Randall', 'Craig', 'Kahan', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '363 W Northwest Hwy', 'Palentine', 'none', 'IL', '60667', '8472214601', '8472214651', '363 W Northwest Hwy', 'Palentine', 'none', 'IL', '60667', '8472214601', '8472214651', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1275522377', 0, 'Y', 0, '2013-04-03', NULL, NULL, 0, 0, NULL, NULL),
('820513775', 'W12026335', 'W12026335', 'ID02', 'Bryan Anderson, M.D.', 'Bryan', 'J', 'Anderson', 'MD', 'General Surgery', '', '', NULL, 'O', '1072 N Liberty St Ste 201', 'Boise', 'Ada', 'ID', '83704', '2083772273', '2083673059', '1072 N Liberty St Ste 201', 'Boise', 'Ada', 'ID', '83704', '2083772273', '2083673059', 'IDACN', '', '', '0.00', '15.00', '0.00', 3, '2012-11-20', '2013-04-30', 0, 0, 1, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1811059264', 0, 'N', 0, '2014-06-11', NULL, NULL, 43.6139, -116.261, NULL, NULL),
('363399794', 'W12026325', 'W12026325', 'ILCHIGSTD', 'WomanCare PC', 'Susan ', 'M', 'Lupo', 'MD', 'Gynecology', '', '', NULL, 'O', '1051 W Rand Rd Ste 101', 'Arlington Heights', 'Cook', 'IL', '60004', '8472214900', '8472214996', '1051 W Rand Rd Ste 101', 'Arlington Heights', 'Cook', 'IL', '60004', '8472214900', '8472214996', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1326037433', 0, 'N', 0, '2012-12-05', NULL, NULL, 42.1228, -87.9956, NULL, NULL),
('363399794', 'W12026322', 'W12026322', 'ILCHIGSTD', 'WomanCare PC', 'Michelle', 'B', 'Goldin', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '455 S Roselle Rd Ste 120', 'Schaumburg', 'Cook', 'IL', '60193', '8472214300', '8472214396', '455 S Roselle Rd Ste 120', 'Schaumburg', 'Cook', 'IL', '60193', '8472214300', '8472214396', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1942299045', 0, 'N', 0, '2012-12-05', NULL, NULL, 42.0192, -88.0799, NULL, NULL),
('363399794', 'IL0000086', 'IL0000086', 'ILCHIGSTD', 'WomanCare PC', 'Michelle', 'B', 'Goldin', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '363 W Northwest Hwy', 'Palentine', 'none', 'IL', '60667', '8472214601', '8472214651', '363 W Northwest Hwy', 'Palentine', 'none', 'IL', '60667', '8472214601', '8472214651', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1942299045', 0, 'Y', 0, '2012-12-05', NULL, NULL, 0, 0, NULL, NULL),
('363399794', 'W12026323', 'W12026323', 'ILCHIGSTD', 'WomanCare PC', 'Randall', 'Craig', 'Kahan', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1051 W Rand Rd Ste 101', 'Arlington Heights', 'Cook', 'IL', '60004', '8472214900', '8472214996', '1051 W Rand Rd Ste 101', 'Arlington Heights', 'Cook', 'IL', '60004', '8472214900', '8472214996', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1275522377', 0, 'N', 0, '2013-04-03', NULL, NULL, 42.1228, -87.9956, NULL, NULL),
('363399794', 'W12026320', 'W12026320', 'ILCHIGSTD', 'WomanCare PC', 'Elyse', 'P', 'Erlich', 'MD', 'Gynecology', '', '', NULL, 'O', '1450 Busch Pkwy Ste 110', 'Buffalo Grove', 'Lake', 'IL', '60089', '8472212200', '8472212196', '1450 Busch Pkwy Ste 110', 'Buffalo Grove', 'Lake', 'IL', '60089', '8472212200', '8472212196', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1952371536', 0, 'N', 0, '2012-12-05', NULL, NULL, 42.1717, -87.9275, NULL, NULL),
('363399794', 'W12026321', 'W12026321', 'ILCHIGSTD', 'WomanCare PC', 'Michelle', 'B', 'Goldin', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '1051 W Rand Rd Ste 101', 'Arlington Heights', 'Cook', 'IL', '60004', '8472214900', '8472214996', '1051 W Rand Rd Ste 101', 'Arlington Heights', 'Cook', 'IL', '60004', '8472214900', '8472214996', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1942299045', 0, 'N', 0, '2012-12-05', NULL, NULL, 42.1228, -87.9956, NULL, NULL),
('363399794', 'IL0000083', 'IL0000083', 'ILCHIGSTD', 'WomanCare PC', 'Elyse', 'P', 'Erlich', 'MD', 'Gynecology', '', '', NULL, 'B', '363 W Northwest Hwy', 'Palentine', 'none', 'IL', '60667', '8472214601', '8472214651', '363 W Northwest Hwy', 'Palentine', 'none', 'IL', '60667', '8472214601', '8472214651', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1952371536', 0, 'Y', 0, '2012-12-05', NULL, NULL, 0, 0, NULL, NULL),
('363399794', 'W12026318', 'W12026318', 'ILCHIGSTD', 'WomanCare PC', 'Henry', 'A', 'Dominicis', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '455 S Roselle Rd Ste 120', 'Schaumburg', 'Cook', 'IL', '60193', '8472214300', '8472214396', '455 S Roselle Rd Ste 120', 'Schaumburg', 'Cook', 'IL', '60193', '8472214300', '8472214396', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1972592079', 0, 'N', 0, '2012-12-05', NULL, NULL, 42.0192, -88.0799, NULL, NULL),
('363399794', 'IL0000080', 'IL0000080', 'ILCHIGSTD', 'WomanCare PC', 'Henry', 'A', 'Dominicis', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '363 W Northwest Hwy', 'Palentine', 'none', 'IL', '60667', '8472214601', '8472214651', '363 W Northwest Hwy', 'Palentine', 'none', 'IL', '60667', '8472214601', '8472214651', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1972592079', 0, 'Y', 0, '2012-12-05', NULL, NULL, 0, 0, NULL, NULL),
('363399794', 'W12026319', 'W12026319', 'ILCHIGSTD', 'WomanCare PC', 'Elyse', 'P', 'Erlich', 'MD', 'Gynecology', '', '', NULL, 'O', '1051 W Rand Rd Ste 101', 'Arlington Heights', 'Cook', 'IL', '60004', '8472214900', '8472214996', '1051 W Rand Rd Ste 101', 'Arlington Heights', 'Cook', 'IL', '60004', '8472214900', '8472214996', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1952371536', 0, 'N', 0, '2012-12-05', NULL, NULL, 42.1228, -87.9956, NULL, NULL),
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('363399794', 'IL0000077', 'IL0000077', 'ILCHIGSTD', 'WomanCare PC', 'Carl', 'D', 'Cucco', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'B', '363 W Northwest Hwy', 'Palentine', 'none', 'IL', '60667', '8472214601', '8472214651', '363 W Northwest Hwy', 'Palentine', 'none', 'IL', '60667', '8472214601', '8472214651', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1912996109', 0, 'Y', 0, '2012-12-05', NULL, NULL, 0, 0, NULL, NULL),
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('363980044', 'W12026278', 'W12026278', 'ILCHIGSTD', 'Illinois Cancer Specialists ', 'David', '', 'Hakimian', 'MD', 'Hematology and Oncology', 'Hematology', 'Oncology', NULL, 'M', '110 E Woodfield Rd Ste 434', 'Schaumburg', 'Cook', 'IL', '60173', '          ', NULL, '110 E Woodfield Rd Ste 434', 'Schaumburg', 'Cook', 'IL', '60173', '          ', '', 'CHIG7', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', '', '', '', 'HCFA|UB|', '1972590347', 0, 'N', 0, '2014-04-25', NULL, NULL, 0, 0, NULL, NULL),
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('363980044', 'W12026281', 'W12026281', 'ILCHIGSTD', 'Illinois Cancer Specialists ', 'Prashant', '', 'Joshi', 'MD', 'Hematology and Oncology', 'Hematology', 'Oncology', NULL, 'M', '110 E Woodfield Rd Ste 434', 'Schaumburg', 'Cook', 'IL', '60173', '          ', NULL, '110 E Woodfield Rd Ste 434', 'Schaumburg', 'Cook', 'IL', '60173', '          ', '          ', 'CHIG7', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1316946890', 0, 'N', 0, '2013-09-18', NULL, NULL, 0, 0, NULL, NULL),
('363980044', 'W12026283', 'W12026283', 'ILCHIGSTD', 'Illinois Cancer Specialists ', 'Prashant', '', 'Joshi', 'MD', 'Hematology and Oncology', 'Hematology', 'Oncology', NULL, 'O', '8915 W Golf Rd', 'Niles', 'Cook', 'IL', '60714', '8478279060', '8478277196', '8915 W Golf Rd', 'Niles', 'Cook', 'IL', '60714', '8478279060', '8478277196', 'CHIG7', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1316946890', 0, 'N', 0, '2013-09-18', NULL, NULL, 42.0305, -87.815, NULL, NULL),
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('363980044', 'W12026284', 'W12026284', 'ILCHIGSTD', 'Illinois Cancer Specialists ', 'Bruce', 'R', 'Kaden', 'MD', 'Hematology and Oncology', 'Hematology', 'Oncology', NULL, 'M', '110 E Woodfield Rd Ste 434', 'Schaumburg', 'Cook', 'IL', '60173', '          ', NULL, '110 E Woodfield Rd Ste 434', 'Schaumburg', 'Cook', 'IL', '60173', '          ', '', 'CHIG7', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', '', '', '', 'HCFA|UB|', '1720075179', 0, 'N', 0, '2014-04-25', NULL, NULL, 0, 0, NULL, NULL),
('363980044', 'W12026286', 'W12026286', 'ILCHIGSTD', 'Illinois Cancer Specialists ', 'Bruce', 'R', 'Kaden', 'MD', 'Hematology and Oncology', 'Hematology', 'Oncology', NULL, 'O', '8915 W Golf Rd 3rd Floor', 'Niles', 'Cook', 'IL', '60714', '8478279060', '8478277196', '8915 W Golf Rd 3rd Floor', 'Niles', 'Cook', 'IL', '60714', '8478279060', '8478277196', 'CHIG7', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', '', '', '', 'HCFA|UB|', '1720075179', 0, 'N', 0, '2014-04-25', NULL, NULL, 42.0305, -87.815, NULL, NULL),
('363980044', 'W12026287', 'W12026287', 'ILCHIGSTD', 'Illinois Cancer Specialists ', 'Leonard', 'M', 'Klein', 'MD', 'Hematology and Oncology', 'Hematology', 'Oncology', NULL, 'M', '110 E Woodfield Rd Ste 434', 'Schaumburg', 'Cook', 'IL', '60173', '          ', NULL, '110 E Woodfield Rd Ste 434', 'Schaumburg', 'Cook', 'IL', '60173', '          ', '          ', 'CHIG7', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, '', '', 'HCFA|UB|', '1255328878', 0, 'N', 0, '2013-09-18', NULL, NULL, 0, 0, NULL, NULL),
('363980044', 'W12026289', 'W12026289', 'ILCHIGSTD', 'Illinois Cancer Specialists ', 'Leonard', 'M', 'Klein', 'MD', 'Hematology and Oncology', 'Hematology', 'Oncology', NULL, 'O', '8915 W Golf Rd 3rd Floor', 'Niles', 'Cook', 'IL', '60714', '8478279060', '8478277196', '8915 W Golf Rd 3rd Floor', 'Niles', 'Cook', 'IL', '60714', '8478279060', '8478277196', 'CHIG7', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, '', '', 'HCFA|UB|', '1255328878', 0, 'N', 0, '2013-09-18', NULL, NULL, 42.0305, -87.815, NULL, NULL),
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('363980044', 'W12026277', 'W12026277', 'ILCHIGSTD', 'Illinois Cancer Specialists ', 'Lisa', 'A', 'Flaum', 'MD', 'Hematology and Oncology', 'Hematology', 'Oncology', NULL, 'B', '25070 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '8475857000', NULL, '25070 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '8475857000', '          ', 'CHIG7', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', '2013-02-28', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1740261262', 0, 'N', 0, '2013-09-18', NULL, NULL, 0, 0, NULL, NULL),
('363980044', 'W12026279', 'W12026279', 'ILCHIGSTD', 'Illinois Cancer Specialists ', 'David', '', 'Hakimian', 'MD', 'Hematology and Oncology', 'Hematology', 'Oncology', NULL, 'B', '25070 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '8475857000', NULL, '25070 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '8475857000', '', 'CHIG7', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', '', '', '', 'HCFA|UB|', '1972590347', 0, 'N', 0, '2014-04-25', NULL, NULL, 0, 0, NULL, NULL),
('363980044', 'W12026282', 'W12026282', 'ILCHIGSTD', 'Illinois Cancer Specialists ', 'Prashant', '', 'Joshi', 'MD', 'Hematology and Oncology', 'Hematology', 'Oncology', NULL, 'B', '25070 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '8475857000', NULL, '25070 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '8475857000', '          ', 'CHIG7', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1316946890', 0, 'N', 0, '2013-09-18', NULL, NULL, 0, 0, NULL, NULL),
('363980044', 'W12026285', 'W12026285', 'ILCHIGSTD', 'Illinois Cancer Specialists ', 'Bruce', 'R', 'Kaden', 'MD', 'Hematology and Oncology', 'Hematology', 'Oncology', NULL, 'B', '25070 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '8475857000', NULL, '25070 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '8475857000', '', 'CHIG7', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', '', '', '', 'HCFA|UB|', '1720075179', 0, 'N', 0, '2014-04-25', NULL, NULL, 0, 0, NULL, NULL),
('363980044', 'W12026288', 'W12026288', 'ILCHIGSTD', 'Illinois Cancer Specialists ', 'Leonard', 'M', 'Klein', 'MD', 'Hematology and Oncology', 'Hematology', 'Oncology', NULL, 'B', '25070 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '8475857000', NULL, '25070 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '8475857000', '          ', 'CHIG7', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, '', '', 'HCFA|UB|', '1255328878', 0, 'N', 0, '2013-09-18', NULL, NULL, 0, 0, NULL, NULL),
('363980044', 'W12026291', 'W12026291', 'ILCHIGSTD', 'Illinois Cancer Specialists ', 'Patricia', 'J', 'Madej', 'MD', 'Hematology and Oncology', 'Hematology', 'Oncology', NULL, 'B', '25070 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '8475857000', NULL, '25070 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '8475857000', '          ', 'CHIG7', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, '', '', 'HCFA|UB|', '1124009642', 0, 'N', 0, '2013-09-18', NULL, NULL, 0, 0, NULL, NULL),
('363980044', 'W12026293', 'W12026293', 'ILCHIGSTD', 'Illinois Cancer Specialists ', 'Rajat', '', 'Malhotra', 'MD', 'Hematology and Oncology', 'Oncology', 'Hematology', NULL, 'B', '25070 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '8475857000', NULL, '25070 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '8475857000', '', 'CHIG7', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', '', '', '', 'HCFA|UB|', '1982693370', 0, 'N', 0, '2014-04-25', NULL, NULL, 0, 0, NULL, NULL),
('363980044', 'W12026295', 'W12026295', 'ILCHIGSTD', 'Illinois Cancer Specialists ', 'Randy', 'S', 'Rich', 'MD', 'Hematology and Oncology', 'Hematology', 'Oncology', NULL, 'M', '110 E Woodfield Rd Ste 434', 'Schaumburg', 'Cook', 'IL', '60173', '          ', NULL, '110 E Woodfield Rd Ste 434', 'Schaumburg', 'Cook', 'IL', '60173', '          ', '', 'CHIG7', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', '', '', '', 'HCFA|UB|', '1609863281', 0, 'N', 0, '2014-04-25', NULL, NULL, 0, 0, NULL, NULL),
('363980044', 'W12026296', 'W12026296', 'ILCHIGSTD', 'Illinois Cancer Specialists ', 'Randy', 'S', 'Rich', 'MD', 'Hematology and Oncology', 'Hematology', 'Oncology', NULL, 'B', '25070 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '8475857000', NULL, '25070 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '8475857000', '', 'CHIG7', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', '', '', '', 'HCFA|UB|', '1609863281', 0, 'N', 0, '2014-04-25', NULL, NULL, 0, 0, NULL, NULL),
('363980044', 'W12026298', 'W12026298', 'ILCHIGSTD', 'Illinois Cancer Specialists ', 'Christopher', '', 'Rose', 'MD', 'Hematology and Oncology', 'Hematology', 'Oncology', NULL, 'M', '110 E Woodfield Rd Ste 434', 'Schaumburg', 'Cook', 'IL', '60173', '          ', NULL, '110 E Woodfield Rd Ste 434', 'Schaumburg', 'Cook', 'IL', '60173', '          ', '          ', 'CHIG7', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1962401364', 0, 'N', 0, '2013-09-18', NULL, NULL, 0, 0, NULL, NULL),
('363980044', 'W12026299', 'W12026299', 'ILCHIGSTD', 'Illinois Cancer Specialists ', 'Christopher', '', 'Rose', 'MD', 'Hematology and Oncology', 'Hematology', 'Oncology', NULL, 'B', '25070 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '8475857000', NULL, '25070 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '8475857000', '          ', 'CHIG7', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1962401364', 0, 'N', 0, '2013-09-18', NULL, NULL, 0, 0, NULL, NULL),
('363980044', 'W12026302', 'W12026302', 'ILCHIGSTD', 'Illinois Cancer Specialists ', 'Elyse', 'C', 'Schneiderman', 'MD', 'Hematology and Oncology', 'Hematology', 'Oncology', NULL, 'B', '25070 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '8475857000', NULL, '25070 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '8475857000', '          ', 'CHIG7', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, '', '', 'HCFA|UB|', '1407837925', 0, 'N', 0, '2013-09-18', NULL, NULL, 0, 0, NULL, NULL),
('363980044', 'W12026307', 'W12026307', 'ILCHIGSTD', 'Illinois Cancer Specialists ', 'Richard', 'S', 'Siegel', 'MD', 'Hematology and Oncology', 'Hematology', 'Oncology', NULL, 'B', '25070 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '8475857000', NULL, '25070 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '8475857000', '', 'CHIG7', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', '', '', '', 'HCFA|UB|', '1730176322', 0, 'N', 0, '2014-04-25', NULL, NULL, 0, 0, NULL, NULL),
('363980044', 'W12026309', 'W12026309', 'ILCHIGSTD', 'Illinois Cancer Specialists ', 'Donald', 'L', 'Sweet', 'MD', 'Hematology and Oncology', 'Hematology', 'Oncology', NULL, 'M', '110 E Woodfield Rd Ste 434', 'Schaumburg', 'Cook', 'IL', '60173', '          ', NULL, '110 E Woodfield Rd Ste 434', 'Schaumburg', 'Cook', 'IL', '60173', '          ', '          ', 'CHIG7', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, '', '', 'HCFA|UB|', '1811978133', 0, 'N', 0, '2013-09-18', NULL, NULL, 0, 0, NULL, NULL),
('363980044', 'W12026310', 'W12026310', 'ILCHIGSTD', 'Illinois Cancer Specialists ', 'Donald', 'L', 'Sweet', 'MD', 'Hematology and Oncology', 'Hematology', 'Oncology', NULL, 'B', '25070 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '8475857000', NULL, '25070 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '8475857000', '          ', 'CHIG7', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, '', '', 'HCFA|UB|', '1811978133', 0, 'N', 0, '2013-09-18', NULL, NULL, 0, 0, NULL, NULL),
('363980044', 'W12026312', 'W12026312', 'ILCHIGSTD', 'Illinois Cancer Specialists ', 'Christine', 'S', 'Winter', 'MD', 'Hematology', '', '', NULL, 'B', '25070 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '8475857000', NULL, '25070 Network Pl', 'Chicago', 'Cook', 'IL', '60673', '8475857000', '          ', 'CHIG7', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, NULL, '', '', 'HCFA|UB|', '1720069248', 0, 'N', 0, '2013-08-30', NULL, NULL, 0, 0, NULL, NULL),
('363395596', 'IL0000050', 'IL0000050', 'ILCHIGSTD', 'Northwest Oncology and Hematology Associates', 'Kevin', 'P', 'McKian', 'MD', 'Hematology and Oncology', '', '', NULL, 'O', '1555 Barrington Rd Ste 1200', 'Hoffman Estates', 'Cook', 'IL', '60169', '8478854100', '8478854199', '1555 Barrington Rd Ste 1200', 'Hoffman Estates', 'Cook', 'IL', '60169', '8478854100', '8478854199', 'CHIG12ONC', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', '', '', '', 'HCFA|UB|', '1972512853', 0, 'N', 0, '2014-04-25', NULL, NULL, 42.0542, -88.1444, NULL, NULL),
('363689315', 'W12025799', 'W12025799', 'ILCHIGSTD', 'Midwest Digestive Disease Specialists', 'Matthew', 'B', 'Smith', 'MD', 'Gastroenterology', '', '', NULL, 'O', '1220 Hobson Rd Ste 220', 'Naperville', 'Dupage', 'IL', '60540', '6308330653', '6308339892', '1220 Hobson Rd Ste 220', 'Naperville', 'Dupage', 'IL', '60540', '6308330653', '6308339892', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1508973926', 0, 'N', 0, '2013-07-02', NULL, NULL, 41.7528, -88.1191, NULL, NULL),
('363689315', 'W12025800', 'W12025800', 'ILCHIGSTD', 'Midwest Digestive Disease Specialists', 'Matthew', 'B', 'Smith', 'MD', 'Gastroenterology', '', '', NULL, 'O', '360 W Butterfield Rd Ste 280', 'Elmhurst', 'Dupage', 'IL', '60126', '6308330653', '6308339892', '360 W Butterfield Rd Ste 280', 'Elmhurst', 'Dupage', 'IL', '60126', '6308330653', '6308339892', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1508973926', 0, 'N', 0, '2013-07-02', NULL, NULL, 41.8648, -87.9509, NULL, NULL),
('363689315', 'W12025801', 'W12025801', 'ILCHIGSTD', 'Midwest Digestive Disease Specialists', 'Matthew', 'B', 'Smith', 'MD', 'Gastroenterology', '', '', NULL, 'O', '3825 Highland Ave Tower 2 Ste 307', 'Downers Grove', 'Dupage', 'IL', '60515', '6308521009', '6308339892', '3825 Highland Ave Tower 2 Ste 307', 'Downers Grove', 'Dupage', 'IL', '60515', '6308521009', '6308339892', 'CHIG2', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Elmhurst Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1508973926', 0, 'N', 0, '2013-07-02', NULL, NULL, 41.8181, -88.0102, NULL, NULL),
('363395596', 'IL0000027', 'IL0000027', 'ILCHIGSTD', 'Northwest Oncology and Hematology Associates', 'Bruce ', '', 'Bank', 'MD', 'Hematology and Oncology', '', '', NULL, 'O', '3701 Algonquin Rd Ste 900', 'Rolling Meadows', 'Cook', 'IL', '60008', '8478704100', '8478700866', '3701 Algonquin Rd Ste 900', 'Rolling Meadows', 'Cook', 'IL', '60008', '8478704100', '8478700866', 'CHIG12ONC', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', '', '', '', 'HCFA|UB|', '1225099823', 0, 'N', 0, '2014-04-25', NULL, NULL, 42.0619, -88.0252, NULL, NULL),
('363395596', 'IL0000028', 'IL0000028', 'ILCHIGSTD', 'Northwest Oncology and Hematology Associates', 'Bruce ', '', 'Bank', 'MD', 'Hematology and Oncology', '', '', NULL, 'O', '800 Biesterfield Rd Wimmer Bldg Ste 210', 'Elk Grove Villiage', 'Cook', 'IL', '60007', '8474373312', '8479565107', '800 Biesterfield Rd Wimmer Bldg Ste 210', 'Elk Grove Villiage', 'Cook', 'IL', '60007', '8474373312', '8479565107', 'CHIG12ONC', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', '', '', '', 'HCFA|UB|', '1225099823', 0, 'N', 0, '2014-04-25', NULL, NULL, 42.0034, -88.0174, NULL, NULL),
('363395596', 'IL0000030', 'IL0000030', 'ILCHIGSTD', 'Northwest Oncology and Hematology Associates', 'Gary', '', 'Gordon', 'MD', 'Hematology and Oncology', '', '', NULL, 'O', '3701 Algonquin Rd Ste 900', 'Rolling Meadows', 'Cook', 'IL', '60008', '8478704100', '8478700866', '3701 Algonquin Rd Ste 900', 'Rolling Meadows', 'Cook', 'IL', '60008', '8478704100', '8478700866', 'CHIG12ONC', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', '', '', '', 'HCFA|UB|', '1245291780', 0, 'N', 0, '2014-04-25', NULL, NULL, 42.0619, -88.0252, NULL, NULL),
('363395596', 'IL0000031', 'IL0000031', 'ILCHIGSTD', 'Northwest Oncology and Hematology Associates', 'Gary', '', 'Gordon', 'MD', 'Hematology and Oncology', '', '', NULL, 'O', '800 Biesterfield Rd Wimmer Bldg Ste 210', 'Elk Grove Villiage', 'Cook', 'IL', '60007', '8474373312', '8479565107', '800 Biesterfield Rd Wimmer Bldg Ste 210', 'Elk Grove Villiage', 'Cook', 'IL', '60007', '8474373312', '8479565107', 'CHIG12ONC', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', '', '', '', 'HCFA|UB|', '1245291780', 0, 'N', 0, '2014-04-25', NULL, NULL, 42.0034, -88.0174, NULL, NULL),
('363395596', 'IL0000033', 'IL0000033', 'ILCHIGSTD', 'Northwest Oncology and Hematology Associates', 'Gary', '', 'Grad', 'MD', 'Hematology and Oncology', '', '', NULL, 'O', '3701 Algonquin Rd Ste 900', 'Rolling Meadows', 'Cook', 'IL', '60008', '8478704100', '8478700866', '3701 Algonquin Rd Ste 900', 'Rolling Meadows', 'Cook', 'IL', '60008', '8478704100', '8478700866', 'CHIG12ONC', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', '', '', '', 'HCFA|UB|', '1629039227', 0, 'N', 0, '2014-04-25', NULL, NULL, 42.0619, -88.0252, NULL, NULL),
('363395596', 'IL0000034', 'IL0000034', 'ILCHIGSTD', 'Northwest Oncology and Hematology Associates', 'Gary', '', 'Grad', 'MD', 'Hematology and Oncology', '', '', NULL, 'O', '800 Biesterfield Rd Wimmer Bldg Ste 210', 'Elk Grove Villiage', 'Cook', 'IL', '60007', '8474373312', '8479565107', '800 Biesterfield Rd Wimmer Bldg Ste 210', 'Elk Grove Villiage', 'Cook', 'IL', '60007', '8474373312', '8479565107', 'CHIG12ONC', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', '', '', '', 'HCFA|UB|', '1629039227', 0, 'N', 0, '2014-04-25', NULL, NULL, 42.0034, -88.0174, NULL, NULL),
('363395596', 'IL0000036', 'IL0000036', 'ILCHIGSTD', 'Northwest Oncology and Hematology Associates', 'Steven', '', 'Kanter', 'MD', 'Hematology and Oncology', '', '', NULL, 'O', '3701 Algonquin Rd Ste 900', 'Rolling Meadows', 'Cook', 'IL', '60008', '8478704100', '8478700866', '3701 Algonquin Rd Ste 900', 'Rolling Meadows', 'Cook', 'IL', '60008', '8478704100', '8478700866', 'CHIG12ONC', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', '', '', '', 'HCFA|UB|', '1730140922', 0, 'N', 0, '2014-04-25', NULL, NULL, 42.0619, -88.0252, NULL, NULL),
('363395596', 'IL0000037', 'IL0000037', 'ILCHIGSTD', 'Northwest Oncology and Hematology Associates', 'Steven', '', 'Kanter', 'MD', 'Hematology and Oncology', '', '', NULL, 'O', '800 Biesterfield Rd Wimmer Bldg Ste 210', 'Elk Grove Villiage', 'Cook', 'IL', '60007', '8474373312', '8479565107', '800 Biesterfield Rd Wimmer Bldg Ste 210', 'Elk Grove Villiage', 'Cook', 'IL', '60007', '8474373312', '8479565107', 'CHIG12ONC', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', '', '', '', 'HCFA|UB|', '1730140922', 0, 'N', 0, '2014-04-25', NULL, NULL, 42.0034, -88.0174, NULL, NULL),
('363395596', 'IL0000039', 'IL0000039', 'ILCHIGSTD', 'Northwest Oncology and Hematology Associates', 'Gary', '', 'Kay', 'MD', 'Hematology and Oncology', '', '', NULL, 'O', '3701 Algonquin Rd Ste 900', 'Rolling Meadows', 'Cook', 'IL', '60008', '8478704100', '8478700866', '3701 Algonquin Rd Ste 900', 'Rolling Meadows', 'Cook', 'IL', '60008', '8478704100', '8478700866', 'CHIG12ONC', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', '', '', '', 'HCFA|UB|', '1205897923', 0, 'N', 0, '2014-04-25', NULL, NULL, 42.0619, -88.0252, NULL, NULL),
('363395596', 'IL0000040', 'IL0000040', 'ILCHIGSTD', 'Northwest Oncology and Hematology Associates', 'Gary', '', 'Kay', 'MD', 'Hematology and Oncology', '', '', NULL, 'O', '800 Biesterfield Rd Wimmer Bldg Ste 210', 'Elk Grove Villiage', 'Cook', 'IL', '60007', '8474373312', '8479565107', '800 Biesterfield Rd Wimmer Bldg Ste 210', 'Elk Grove Villiage', 'Cook', 'IL', '60007', '8474373312', '8479565107', 'CHIG12ONC', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', '', '', '', 'HCFA|UB|', '1205897923', 0, 'N', 0, '2014-04-25', NULL, NULL, 42.0034, -88.0174, NULL, NULL),
('363395596', 'IL0000042', 'IL0000042', 'ILCHIGSTD', 'Northwest Oncology and Hematology Associates', 'Suzanne', '', 'LaFollette', 'MD', 'Hematology and Oncology', '', '', NULL, 'O', '3701 Algonquin Rd Ste 900', 'Rolling Meadows', 'Cook', 'IL', '60008', '8478704100', '8478700866', '3701 Algonquin Rd Ste 900', 'Rolling Meadows', 'Cook', 'IL', '60008', '8478704100', '8478700866', 'CHIG12ONC', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', '', '', '', 'HCFA|UB|', '1417918681', 0, 'N', 0, '2014-04-25', NULL, NULL, 42.0619, -88.0252, NULL, NULL),
('363395596', 'IL0000043', 'IL0000043', 'ILCHIGSTD', 'Northwest Oncology and Hematology Associates', 'Suzanne', '', 'LaFollette', 'MD', 'Hematology and Oncology', '', '', NULL, 'O', '800 Biesterfield Rd Wimmer Bldg Ste 210', 'Elk Grove Villiage', 'Cook', 'IL', '60007', '8474373312', '8479565107', '800 Biesterfield Rd Wimmer Bldg Ste 210', 'Elk Grove Villiage', 'Cook', 'IL', '60007', '8474373312', '8479565107', 'CHIG12ONC', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', '', '', '', 'HCFA|UB|', '1417918681', 0, 'N', 0, '2014-04-25', NULL, NULL, 42.0034, -88.0174, NULL, NULL),
('363395596', 'IL0000045', 'IL0000045', 'ILCHIGSTD', 'Northwest Oncology and Hematology Associates', 'Steven', '', 'Leibach', 'MD', 'Hematology and Oncology', '', '', NULL, 'O', '3701 Algonquin Rd Ste 900', 'Rolling Meadows', 'Cook', 'IL', '60008', '8478704100', '8478700866', '3701 Algonquin Rd Ste 900', 'Rolling Meadows', 'Cook', 'IL', '60008', '8478704100', '8478700866', 'CHIG12ONC', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', '', '', '', 'HCFA|UB|', '1710948963', 0, 'N', 0, '2014-04-25', NULL, NULL, 42.0619, -88.0252, NULL, NULL),
('363395596', 'IL0000046', 'IL0000046', 'ILCHIGSTD', 'Northwest Oncology and Hematology Associates', 'Steven', '', 'Leibach', 'MD', 'Hematology and Oncology', '', '', NULL, 'O', '800 Biesterfield Rd Wimmer Bldg Ste 210', 'Elk Grove Villiage', 'Cook', 'IL', '60007', '8474373312', '8479565107', '800 Biesterfield Rd Wimmer Bldg Ste 210', 'Elk Grove Villiage', 'Cook', 'IL', '60007', '8474373312', '8479565107', 'CHIG12ONC', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', '', '', '', 'HCFA|UB|', '1710948963', 0, 'N', 0, '2014-04-25', NULL, NULL, 42.0034, -88.0174, NULL, NULL),
('363395596', 'IL0000048', 'IL0000048', 'ILCHIGSTD', 'Northwest Oncology and Hematology Associates', 'Kevin', 'P', 'McKian', 'MD', 'Hematology and Oncology', '', '', NULL, 'O', '3701 Algonquin Rd Ste 900', 'Rolling Meadows', 'Cook', 'IL', '60008', '8478704100', '8478700866', '3701 Algonquin Rd Ste 900', 'Rolling Meadows', 'Cook', 'IL', '60008', '8478704100', '8478700866', 'CHIG12ONC', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', '', '', '', 'HCFA|UB|', '1972512853', 0, 'N', 0, '2014-04-25', NULL, NULL, 42.0619, -88.0252, NULL, NULL),
('363395596', 'IL0000049', 'IL0000049', 'ILCHIGSTD', 'Northwest Oncology and Hematology Associates', 'Kevin', 'P', 'McKian', 'MD', 'Hematology and Oncology', '', '', NULL, 'O', '800 Biesterfield Rd Wimmer Bldg Ste 210', 'Elk Grove Villiage', 'Cook', 'IL', '60007', '8474373312', '8479565107', '800 Biesterfield Rd Wimmer Bldg Ste 210', 'Elk Grove Villiage', 'Cook', 'IL', '60007', '8474373312', '8479565107', 'CHIG12ONC', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', '', '', '', 'HCFA|UB|', '1972512853', 0, 'N', 0, '2014-04-25', NULL, NULL, 42.0034, -88.0174, NULL, NULL),
('363395596', 'IL0000052', 'IL0000052', 'ILCHIGSTD', 'Northwest Oncology and Hematology Associates', 'Robinson ', '', 'Ortiz', 'MD', 'Hematology and Oncology', '', '', NULL, 'O', '1555 Barrington Rd Ste 1200', 'Hoffman Estates', 'Cook', 'IL', '60169', '8478854100', '8478854199', '1555 Barrington Rd Ste 1200', 'Hoffman Estates', 'Cook', 'IL', '60169', '8478854100', '8478854199', 'CHIG12ONC', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', '', '', '', 'HCFA|UB|', '1265617203', 0, 'N', 0, '2014-04-25', NULL, NULL, 42.0542, -88.1444, NULL, NULL),
('363395596', 'IL0000053', 'IL0000053', 'ILCHIGSTD', 'Northwest Oncology and Hematology Associates', 'Robinson ', '', 'Ortiz', 'MD', 'Hematology and Oncology', '', '', NULL, 'O', '27750 W Hwy 22 Ste G70', 'Barrington', 'Lake', 'IL', '60010', '8478420180', '8478429877', '27750 W Hwy 22 Ste G70', 'Barrington', 'Lake', 'IL', '60010', '8478420180', '8478429877', 'CHIG12ONC', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', '', '', '', 'HCFA|UB|', '1265617203', 0, 'N', 0, '2014-04-25', NULL, NULL, 42.193, -88.1736, NULL, NULL),
('363395596', 'IL0000051', 'IL0000051', 'ILCHIGSTD', 'Northwest Oncology and Hematology Associates', 'Robinson ', '', 'Ortiz', 'MD', 'Hematology and Oncology', '', '', NULL, 'O', '3701 Algonquin Rd Ste 900', 'Rolling Meadows', 'Cook', 'IL', '60008', '8478704100', '8478700866', '3701 Algonquin Rd Ste 900', 'Rolling Meadows', 'Cook', 'IL', '60008', '8478704100', '8478700866', 'CHIG12ONC', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', '', '', '', 'HCFA|UB|', '1265617203', 0, 'N', 0, '2014-04-25', NULL, NULL, 42.0619, -88.0252, NULL, NULL),
('363395596', 'IL0000055', 'IL0000055', 'ILCHIGSTD', 'Northwest Oncology and Hematology Associates', 'Edwin', 'R', 'Priest', 'MD', 'Hematology and Oncology', '', '', NULL, 'O', '1555 Barrington Rd Ste 1200', 'Hoffman Estates', 'Cook', 'IL', '60169', '8478854100', '8478854199', '1555 Barrington Rd Ste 1200', 'Hoffman Estates', 'Cook', 'IL', '60169', '8478854100', '8478854199', 'CHIG12ONC', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', '', '', '', 'HCFA|UB|', '1588625875', 0, 'N', 0, '2014-04-25', NULL, NULL, 42.0542, -88.1444, NULL, NULL),
('363395596', 'IL0000054', 'IL0000054', 'ILCHIGSTD', 'Northwest Oncology and Hematology Associates', 'Edwin', 'R', 'Priest', 'MD', 'Hematology and Oncology', '', '', NULL, 'B', '3701 Algonquin Rd Ste 900', 'Rolling Meadows', 'Cook', 'IL', '60008', '8475770620', '8479561475', '3701 Algonquin Rd Ste 900', 'Rolling Meadows', 'Cook', 'IL', '60008', '8475770620', '8479561475', 'CHIG12ONC', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', '', '', '', 'HCFA|UB|', '1588625875', 0, 'N', 0, '2014-04-25', NULL, NULL, 42.0612, -88.0262, NULL, NULL),
('363395596', 'IL0000057', 'IL0000057', 'ILCHIGSTD', 'Northwest Oncology and Hematology Associates', 'Herbert', 'J', 'Reisel', 'MD', 'Hematology and Oncology', '', '', NULL, 'O', '27750 W Hwy 22 Ste G70', 'Barrington', 'Lake', 'IL', '60010', '8478420180', '8478429877', '27750 W Hwy 22 Ste G70', 'Barrington', 'Lake', 'IL', '60010', '8478420180', '8478429877', 'CHIG12ONC', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', '', '', '', 'HCFA|UB|', '1497716807', 0, 'N', 0, '2014-04-25', NULL, NULL, 42.193, -88.1736, NULL, NULL),
('363395596', 'IL0000056', 'IL0000056', 'ILCHIGSTD', 'Northwest Oncology and Hematology Associates', 'Herbert', 'J', 'Reisel', 'MD', 'Hematology and Oncology', '', '', NULL, 'B', '3701 Algonquin Rd Ste 900', 'Rolling Meadows', 'Cook', 'IL', '60008', '8475770620', '8479561475', '3701 Algonquin Rd Ste 900', 'Rolling Meadows', 'Cook', 'IL', '60008', '8475770620', '8479561475', 'CHIG12ONC', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', '', '', '', 'HCFA|UB|', '1497716807', 0, 'N', 0, '2014-04-25', NULL, NULL, 42.0612, -88.0262, NULL, NULL),
('363395596', 'IL0000058', 'IL0000058', 'ILCHIGSTD', 'Northwest Oncology and Hematology Associates', 'Ronald', 'J', 'Shade', 'MD', 'Hematology and Oncology', '', '', NULL, 'O', '3701 Algonquin Rd Ste 900', 'Rolling Meadows', 'Cook', 'IL', '60008', '8478704100', '8478700866', '3701 Algonquin Rd Ste 900', 'Rolling Meadows', 'Cook', 'IL', '60008', '8478704100', '8478700866', 'CHIG12ONC', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', '', '', '', 'HCFA|UB|', '1720049984', 0, 'N', 0, '2014-04-25', NULL, NULL, 42.0619, -88.0252, NULL, NULL),
('363395596', 'IL0000059', 'IL0000059', 'ILCHIGSTD', 'Northwest Oncology and Hematology Associates', 'Ronald', 'J', 'Shade', 'MD', 'Hematology and Oncology', '', '', NULL, 'O', '800 Biesterfield Rd Wimmer Bldg Ste 210', 'Elk Grove Villiage', 'Cook', 'IL', '60007', '8474373312', '8479565107', '800 Biesterfield Rd Wimmer Bldg Ste 210', 'Elk Grove Villiage', 'Cook', 'IL', '60007', '8474373312', '8479565107', 'CHIG12ONC', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', '', '', '', 'HCFA|UB|', '1720049984', 0, 'N', 0, '2014-04-25', NULL, NULL, 42.0034, -88.0174, NULL, NULL),
('363395596', 'IL0000062', 'IL0000062', 'ILCHIGSTD', 'Northwest Oncology and Hematology Associates', 'Al Karim', '', 'Tajuddin', 'MD', 'Hematology and Oncology', '', '', NULL, 'O', '1555 Barrington Rd Ste 1200', 'Hoffman Estates', 'Cook', 'IL', '60169', '8478854100', '8478854199', '1555 Barrington Rd Ste 1200', 'Hoffman Estates', 'Cook', 'IL', '60169', '8478854100', '8478854199', 'CHIG12ONC', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', '', '', '', 'HCFA|UB|', '1922069160', 0, 'N', 0, '2014-04-25', NULL, NULL, 42.0542, -88.1444, NULL, NULL),
('363395596', 'IL0000061', 'IL0000061', 'ILCHIGSTD', 'Northwest Oncology and Hematology Associates', 'Al Karim', '', 'Tajuddin', 'MD', 'Hematology and Oncology', '', '', NULL, 'O', '3701 Algonquin Rd Ste 900', 'Rolling Meadows', 'Cook', 'IL', '60008', '8478704100', '8478700866', '3701 Algonquin Rd Ste 900', 'Rolling Meadows', 'Cook', 'IL', '60008', '8478704100', '8478700866', 'CHIG12ONC', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', '', '', '', 'HCFA|UB|', '1922069160', 0, 'N', 0, '2014-04-25', NULL, NULL, 42.0619, -88.0252, NULL, NULL),
('363395596', 'IL0000063', 'IL0000063', 'ILCHIGSTD', 'Northwest Oncology and Hematology Associates', 'Al Karim', '', 'Tajuddin', 'MD', 'Hematology and Oncology', '', '', NULL, 'O', '800 Biesterfield Rd Wimmer Bldg Ste 210', 'Elk Grove Villiage', 'Cook', 'IL', '60007', '8474373312', '8479565107', '800 Biesterfield Rd Wimmer Bldg Ste 210', 'Elk Grove Villiage', 'Cook', 'IL', '60007', '8474373312', '8479565107', 'CHIG12ONC', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', '', '', '', 'HCFA|UB|', '1922069160', 0, 'N', 0, '2014-04-25', NULL, NULL, 42.0034, -88.0174, NULL, NULL),
('363395596', 'IL0000065', 'IL0000065', 'ILCHIGSTD', 'Northwest Oncology and Hematology Associates', 'Erol', '', 'Yorulmazoglu', 'MD', 'Hematology and Oncology', '', '', NULL, 'O', '1555 Barrington Rd Ste 1200', 'Hoffman Estates', 'Cook', 'IL', '60169', '8478854100', '8478854199', '1555 Barrington Rd Ste 1200', 'Hoffman Estates', 'Cook', 'IL', '60169', '8478854100', '8478854199', 'CHIG12ONC', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', '', '', '', 'HCFA|UB|', '1689635856', 0, 'N', 0, '2014-04-25', NULL, NULL, 42.0542, -88.1444, NULL, NULL),
('363395596', 'IL0000064', 'IL0000064', 'ILCHIGSTD', 'Northwest Oncology and Hematology Associates', 'Erol', '', 'Yorulmazoglu', 'MD', 'Hematology and Oncology', '', '', NULL, 'O', '3701 Algonquin Rd Ste 900', 'Rolling Meadows', 'Cook', 'IL', '60008', '8478704100', '8478700866', '3701 Algonquin Rd Ste 900', 'Rolling Meadows', 'Cook', 'IL', '60008', '8478704100', '8478700866', 'CHIG12ONC', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', '', '', '', 'HCFA|UB|', '1689635856', 0, 'N', 0, '2014-04-25', NULL, NULL, 42.0619, -88.0252, NULL, NULL),
('363395596', 'IL0000066', 'IL0000066', 'ILCHIGSTD', 'Northwest Oncology and Hematology Associates', 'Erol', '', 'Yorulmazoglu', 'MD', 'Hematology and Oncology', '', '', NULL, 'O', '800 Biesterfield Rd Wimmer Bldg Ste 210', 'Elk Grove Villiage', 'Cook', 'IL', '60007', '8474373312', '8479565107', '800 Biesterfield Rd Wimmer Bldg Ste 210', 'Elk Grove Villiage', 'Cook', 'IL', '60007', '8474373312', '8479565107', 'CHIG12ONC', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', '', '', '', 'HCFA|UB|', '1689635856', 0, 'N', 0, '2014-04-25', NULL, NULL, 42.0034, -88.0174, NULL, NULL),
('390816848', 'IL0000403', 'IL0000403', 'ILCHIGSTD', 'Mercy Woodstock Medical Center', 'Douglas', 'H', 'Bryan', 'MD', 'General Surgery', 'Vascular Surgery', '', NULL, 'O', '200 Lake Ave', 'Woodstock', 'McHenry', 'IL', '60098', '8153377100', NULL, '200 Lake Ave', 'Woodstock', 'McHenry', 'IL', '60098', '8153377100', '          ', 'CHIG9', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB', '1285743955', 0, 'N', 0, '2013-04-03', NULL, NULL, 0, 0, NULL, NULL),
('364130066', 'IL0000011', 'IL0000011', 'ILCHIGSTD', '', 'Dominic', 'A', 'Andriacchi', 'DPM', 'Podiatry', '', '', NULL, 'B', '30 S Michigan Ave  Ste 503', 'Chicago', 'Cook', 'IL', '60603', '3123721160', '3123723346', '30 S Michigan Ave  Ste 503', 'Chicago', 'Cook', 'IL', '60603', '3123721160', '3123723346', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1588620900', 0, 'N', 0, '2013-03-14', NULL, NULL, 41.8811, -87.625, NULL, NULL),
('364130066', 'IL0000010', 'IL0000010', 'ILCHIGSTD', 'Dominic Andriacchi  DPM', 'Dominic', 'A', 'Andriacchi', 'DPM', 'Podiatry', '', '', NULL, 'O', '9830 S Ridgeland Ave', 'Chicago Ridge', 'Cook', 'IL', '60415', '7084233377', '7084233999', '9830 S Ridgeland Ave', 'Chicago Ridge', 'Cook', 'IL', '60415', '7084233377', '7084233999', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1588620900', 0, 'N', 0, '2013-03-14', NULL, NULL, 41.7136, -87.7798, NULL, NULL),
('364130066', 'IL0000026', 'IL0000026', 'ILCHIGSTD', '', 'Gregory', 'M', 'Brown', 'DPM', 'Podiatry', '', '', NULL, 'B', '30 S Michigan Ave  Ste 503', 'Chicago', 'Cook', 'IL', '60603', '3123721160', '3123723346', '30 S Michigan Ave  Ste 503', 'Chicago', 'Cook', 'IL', '60603', '3123721160', '3123723346', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1548367535', 0, 'N', 0, '2012-12-05', NULL, NULL, 41.8811, -87.625, NULL, NULL),
('364130066', 'IL0000025', 'IL0000025', 'ILCHIGSTD', 'Foot and Ankle Pain Specialist ', 'Gregory', 'M', 'Brown', 'DPM', 'Podiatry', '', '', NULL, 'O', '3330 W 177th St Ste 2D1', 'Hazel Crest', 'Cook', 'IL', '60429', '7089573338', '7089574555', '3330 W 177th St Ste 2D1', 'Hazel Crest', 'Cook', 'IL', '60429', '7089573338', '7089574555', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1548367535', 0, 'N', 0, '2012-12-05', NULL, NULL, 41.5681, -87.698, NULL, NULL),
('364130066', 'IL0000014', 'IL0000014', 'ILCHIGSTD', '', 'Jennifer', 'A', 'Barra', 'DPM', 'Podiatry', '', '', NULL, 'B', '30 S Michigan Ave  Ste 503', 'Chicago', 'Cook', 'IL', '60603', '3123721160', '3123723346', '30 S Michigan Ave  Ste 503', 'Chicago', 'Cook', 'IL', '60603', '3123721160', '3123723346', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', '2013-03-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1407180532', 0, 'N', 0, '2013-03-12', NULL, NULL, 41.8811, -87.625, NULL, NULL),
('364130066', 'IL0000012', 'IL0000012', 'ILCHIGSTD', 'Tri County Foot and Ankle Centers', 'Jennifer', 'A', 'Barra', 'DPM', 'Podiatry', '', '', NULL, 'O', '36735 N Hwy 83 Ste D1', 'Lake Villa', 'Lake', 'IL', '60046', '8473563338', '8473563388', '36735 N Hwy 83 Ste D1', 'Lake Villa', 'Lake', 'IL', '60046', '8473563338', '8473563388', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', '2013-03-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1407180532', 0, 'N', 0, '2013-03-12', NULL, NULL, 0, 0, NULL, NULL),
('364130066', 'IL0000013', 'IL0000013', 'ILCHIGSTD', 'Tri County Foot and Ankle Centers', 'Jennifer', 'A', 'Barra', 'DPM', 'Podiatry', '', '', NULL, 'O', '4310 Crystal Lake Rd Ste F', 'McHenry', 'McHenry', 'IL', '60050', '8153633223', '8153633240', '4310 Crystal Lake Rd Ste F', 'McHenry', 'McHenry', 'IL', '60050', '8153633223', '8153633240', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', '2013-03-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1407180532', 0, 'N', 0, '2013-03-12', NULL, NULL, 0, 0, NULL, NULL),
('364130066', 'IL0000009', 'IL0000009', 'ILCHIGSTD', '', 'Joel', 'R', 'Anderson', 'DPM', 'Podiatry', '', '', NULL, 'B', '30 S Michigan Ave  Ste 503', 'Chicago', 'Cook', 'IL', '60603', '3123721160', '3123723346', '30 S Michigan Ave  Ste 503', 'Chicago', 'Cook', 'IL', '60603', '3123721160', '3123723346', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', '2013-02-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1952341505', 0, 'N', 0, '2013-02-06', NULL, NULL, 41.8811, -87.625, NULL, NULL),
('364130066', 'IL0000007', 'IL0000007', 'ILCHIGSTD', 'Advanced Foot and Ankle', 'Joel', 'R', 'Anderson', 'DPM', 'Podiatry', '', '', NULL, 'O', '4920 N Central Ave Ste 2D', 'Chicago', 'Cook', 'IL', '60630', '7737363338', '7737361289', '4920 N Central Ave Ste 2D', 'Chicago', 'Cook', 'IL', '60630', '7737363338', '7737361289', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', '2013-02-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1952341505', 0, 'N', 0, '2013-02-06', NULL, NULL, 41.9702, -87.7678, NULL, NULL),
('364130066', 'IL0000008', 'IL0000008', 'ILCHIGSTD', 'Advanced Foot and Ankle', 'Joel', 'R', 'Anderson', 'DPM', 'Podiatry', '', '', NULL, 'O', '711 W Dundee Rd', 'Palatine', 'Cook', 'IL', '60074', '8473587005', '8473587065', '711 W Dundee Rd', 'Palatine', 'Cook', 'IL', '60074', '8473587005', '8473587065', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', '2013-02-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1952341505', 0, 'N', 0, '2013-02-06', NULL, NULL, 0, 0, NULL, NULL),
('364130066', 'IL0000015', 'IL0000015', 'ILCHIGSTD', 'Mark Berman DPM', 'Mark', '', 'Berman', 'DPM', 'Podiatry', '', '', NULL, 'O', '10024 N Skokie Blvd Ste 303', 'Skokie', 'Cook', 'IL', '60077', '8476741660', '8476742688', '10024 N Skokie Blvd Ste 303', 'Skokie', 'Cook', 'IL', '60077', '8476741660', '8476742688', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1760428890', 0, 'N', 0, '2013-03-13', NULL, NULL, 42.0631, -87.7467, NULL, NULL),
('364130066', 'IL0000016', 'IL0000016', 'ILCHIGSTD', '', 'Mark', '', 'Berman', 'DPM', 'Podiatry', '', '', NULL, 'B', '30 S Michigan Ave  Ste 503', 'Chicago', 'Cook', 'IL', '60603', '3123721160', '3123723346', '30 S Michigan Ave  Ste 503', 'Chicago', 'Cook', 'IL', '60603', '3123721160', '3123723346', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1760428890', 0, 'N', 0, '2013-03-13', NULL, NULL, 41.8811, -87.625, NULL, NULL),
('364130066', 'IL0000024', 'IL0000024', 'ILCHIGSTD', '', 'Paul', 'F', 'Brezinski', 'DPM', 'Podiatry', '', '', NULL, 'B', '30 S Michigan Ave  Ste 503', 'Chicago', 'Cook', 'IL', '60603', '3123721160', '3123723346', '30 S Michigan Ave  Ste 503', 'Chicago', 'Cook', 'IL', '60603', '3123721160', '3123723346', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1962513804', 0, 'N', 0, '2013-03-15', NULL, NULL, 41.8811, -87.625, NULL, NULL),
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('352020416', 'W12026064', 'W12026064', 'ILCHIGSTD', 'Dolton Medical Group', 'Prabhakar', 'J', 'Parikh', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1328 W 127th St', 'Riverdale', 'Cook', 'IL', '60827', '7083893636', '0000000000', '1328 W 127th St', 'Riverdale', 'Cook', 'IL', '60827', '7083893636', '0000000000', 'CHIG11', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1417067778', 0, 'N', 0, '2013-04-26', NULL, NULL, 41.663, -87.6546, 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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('751453852', 'W12026066', 'W12026066', 'TXDALSTD', 'Retina Institute of Texas', 'Maurice', 'G', 'Syrquin', 'MD', 'Ophthalmology', '', '', NULL, 'O', '3414 Oak Grove Ave', 'Dallas', 'Dallas', 'TX', '75204', '2145211153', '2142193651', '3414 Oak Grove Ave    ', 'Dallas', 'Dallas', 'TX', '75204', '2145211153', '2142193651', 'DALLAS4', 'TXHCPC13', '', '0.00', '50.00', '0.00', 3, '2013-01-01', '2013-08-14', 0, 0, 0, 'Baylor Medical Center at Irving', 'Baylor Medical Center at Waxahachie', NULL, NULL, 'HCFA|UB|', '1376501635', 0, 'N', 0, '2013-11-11', NULL, NULL, 32.8042, -96.7971, NULL, NULL),
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('201709356', 'W12026068', 'W12026068', 'TXHOUSTD', 'Sharmim Ali MD', 'Shamim', '', 'Ali', 'MD', 'Family Practice', '', '', NULL, 'O', '707 S Fry Rd Ste 360', 'Katy', 'Harris', 'TX', '77450', '2815999979', '2815993540', '707 S Fry Rd Ste 360', 'Katy', 'Harris', 'TX', '77450', '2815999979', '2815993540', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1003816315', 0, 'N', 0, '2013-05-24', NULL, NULL, 29.7765, -95.7189, NULL, NULL),
('870286381', 'W12026070', 'W12026070', 'UT01', 'Ogden Clinic Professional Center North', 'Brett', 'E', 'Richards', 'MD', 'Hand Surgery', 'Orthopedic Surgery', '', NULL, 'O', '4650 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014753000', '8014753001', '4650 Harrison Blvd', 'Ogden', 'Weber', 'UT', '84403', '8014753000', '8014753001', 'WUOGDCLIN5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2013-02-01', NULL, 0, 0, 0, 'Ogden Regional Medical Center', '', '', '', 'HCFA|UB|', '1356470033', 0, 'N', 0, '2013-01-22', NULL, NULL, 41.1787, -111.949, NULL, NULL),
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('201350819', 'W12026071', 'W12026071', 'TXHOUSTD', 'Louetta Family Medicine', 'Dawn', '', 'Nguyen', 'MD', 'Internal Medicine', '', '', NULL, 'O', '5834 Louetta St Ste F', 'Spring', 'Harris', 'TX', '77379', '8326984291', '8326984297', '5834 Louetta St Ste F', 'Spring', 'Harris', 'TX', '77379', '8326984291', '8326984297', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', '2013-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1366537243', 0, 'N', 0, '2012-12-28', NULL, NULL, 0, 0, NULL, NULL),
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('810587644', 'W12026074', 'W12026074', 'UT01', 'Bear Lake Community Health Center', 'Jon', 'W', 'Ahlstrom', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '325 W Logan Hwy', 'Garden City', 'Rich', 'UT', '84028', '4359463660', '4359468215', '325 W Logan Hwy', 'Garden City', 'Rich', 'UT', '84028', '4359463660', '4359468215', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Logan Regional Hospital', '', '', '', 'HCFA|UB|', '1437146065', 0, 'N', 0, '2014-07-25', NULL, NULL, 41.9363, -111.394, NULL, NULL),
('202023766', 'W12026075', 'W12026075', 'TXSATSTD', 'LIttle Buddies Pediatric Clinic', 'Luis', 'A', 'Lopez', 'MD', 'Pediatrics', '', '', NULL, 'O', '13032 Nacogdoches Rd Ste 211', 'San Antonio', 'Bexar', 'TX', '78217', '2106500814', '2106500926', '13032 Nacogdoches Rd Ste 211', 'San Antonio', 'Bexar', 'TX', '78217', '2106500814', '2106500926', 'SANANTONIO1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'North East Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1083600035', 0, 'N', 0, '2013-05-24', NULL, NULL, 29.5592, -98.3962, NULL, NULL),
('364130066', 'IL0000512', 'IL0000512', 'ILCHIGSTD', '', 'Anna', 'C', 'Gurrera', 'DPM', 'Podiatry', '', '', NULL, 'B', '30 S Michigan Ave  Ste 503', 'Chicago', 'Cook', 'IL', '60603', '3123721160', '3123723346', '30 S Michigan Ave  Ste 503', 'Chicago', 'Cook', 'IL', '60603', '3123721160', '3123723346', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1588892277', 0, 'N', 0, '2013-10-30', NULL, NULL, 41.8811, -87.625, NULL, NULL),
('364130066', 'IL0000511', 'IL0000511', 'ILCHIGSTD', 'Alpine Foot and Ankle Specialists', 'Anna', 'C', 'Gurrera', 'DPM', 'Podiatry', '', '', NULL, 'O', '765 Ela Rd Ste 100', 'Lake Zurich', 'Lake', 'IL', '60047', '8475409949', '8475409971', '765 Ela Rd Ste 100', 'Lake Zurich', 'Lake', 'IL', '60047', '8475409949', '8475409971', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1588892277', 0, 'N', 0, '2013-10-30', NULL, NULL, 42.1847, -88.1017, NULL, NULL),
('364130066', 'IL0000485', 'IL0000485', 'ILCHIGSTD', '', 'Anthony', 'V', 'DeCeanne', 'DPM', 'Podiatry', '', '', NULL, 'B', '30 S Michigan Ave  Ste 503', 'Chicago', 'Cook', 'IL', '60603', '3123721160', '3123723346', '30 S Michigan Ave  Ste 503', 'Chicago', 'Cook', 'IL', '60603', '3123721160', '3123723346', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1083613293', 0, 'N', 0, '2013-04-15', NULL, NULL, 41.8811, -87.625, NULL, NULL),
('364130066', 'IL0000484', 'IL0000484', 'ILCHIGSTD', 'ACPM Podiatry Group', 'Anthony', 'V', 'DeCeanne', 'DPM', 'Podiatry', '', '', NULL, 'O', '111 S Main St', 'Canton', 'Fulton', 'IL', '61520', '3096473664', '3096479829', '111 S Main St', 'Canton', 'Fulton', 'IL', '61520', '3096473664', '3096479829', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1083613293', 0, 'Y', 0, '2013-04-15', NULL, NULL, 40.5545, -90.0352, NULL, NULL),
('364130066', 'IL0000483', 'IL0000483', 'ILCHIGSTD', 'ACPM Podiatry Group', 'Anthony', 'V', 'DeCeanne', 'DPM', 'Podiatry', '', '', NULL, 'O', '5017 N Glen Park Place', 'Peoria', 'Peoria', 'IL', '61614', '3096911589', '3096922032', '5017 N Glen Park Place', 'Peoria', 'Peoria', 'IL', '61614', '3096911589', '3096922032', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1083613293', 0, 'Y', 0, '2013-04-15', NULL, NULL, 40.7482, -89.6186, NULL, NULL),
('364130066', 'IL0000587', 'IL0000587', 'ILCHIGSTD', 'Bridgeport Footcare', 'Anthony', 'R', 'Perez', 'DPM', 'Podiatry', '', '', NULL, 'O', '16003 Executive Dr', 'Crest Hill', 'Will', 'IL', '60403', '8157442344', '8152547872', '16003 Executive Dr', 'Crest Hill', 'Will', 'IL', '60403', '8157442344', '8152547872', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1477587277', 0, 'N', 0, '2013-04-19', NULL, NULL, 41.5582, -88.1275, NULL, NULL),
('364130066', 'IL0000588', 'IL0000588', 'ILCHIGSTD', '', 'Anthony', 'R', 'Perez', 'DPM', 'Podiatry', '', '', NULL, 'B', '30 S Michigan Ave  Ste 503', 'Chicago', 'Cook', 'IL', '60603', '3123721160', '3123723346', '30 S Michigan Ave  Ste 503', 'Chicago', 'Cook', 'IL', '60603', '3123721160', '3123723346', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1477587277', 0, 'N', 0, '2013-04-19', NULL, NULL, 41.8811, -87.625, NULL, NULL),
('364130066', 'IL0000585', 'IL0000585', 'ILCHIGSTD', 'Bridgeport Footcare', 'Anthony', 'R', 'Perez', 'DPM', 'Podiatry', '', '', NULL, 'O', '436 W 31st St', 'Chicago', 'Cook', 'IL', '60616', '3128422230', '3128429737', '436 W 31st St', 'Chicago', 'Cook', 'IL', '60616', '3128422230', '3128429737', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1477587277', 0, 'N', 0, '2013-04-19', NULL, NULL, 41.8382, -87.6379, NULL, NULL),
('364130066', 'IL0000586', 'IL0000586', 'ILCHIGSTD', 'Bridgeport Footcare', 'Anthony', 'R', 'Perez', 'DPM', 'Podiatry', '', '', NULL, 'O', '5540 S Pulaski', 'Chicago', 'Cook', 'IL', '60629', '7737353338', '7737353373', '5540 S Pulaski', 'Chicago', 'Cook', 'IL', '60629', '7737353338', '7737353373', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1477587277', 0, 'N', 0, '2013-04-19', NULL, NULL, 41.7919, -87.7232, NULL, NULL),
('205463078', 'W12026076', 'W12026076', 'ID02', 'Speech Tree Inc', 'Nancy', '', 'Stockton', 'SLP', 'Speech Therapy', '', '', NULL, 'O', '935 E Winding Creek Dr Ste 120', 'Eagle', 'Ada', 'ID', '83616', '2089384748', '2089381710', '935 E Winding Creek Dr Ste 120', 'Eagle', 'Ada', 'ID', '83616', '2089384748', '2089381710', 'IDSPEECH', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2013-06-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1689954315', 0, 'N', 0, '2013-06-04', NULL, NULL, 0, 0, NULL, NULL),
('371533344', 'W12026122', 'W12026122', 'TXHOUSTD', 'Ukwade, Philomena', 'Philomena ', 'E', 'Ukwade', 'MD PA', 'Internal Medicine', '', '', NULL, 'O', '401 E Parkwood', 'Friendswood', 'Galveston', 'TX', '77546', '2814824949', '2814824950', '401 E Parkwood', 'Friendswood', 'Galveston', 'TX', '77546', '2814824949', '2814824950', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Clear Lake Regional Medical Center', NULL, '', '', 'HCFA|UB|', '1972593358', 0, 'N', 0, '2013-04-17', NULL, NULL, 29.5138, -95.1833, NULL, NULL),
('364130066', 'IL0000600', 'IL0000600', 'ILCHIGSTD', '', 'Bradley', 'S', 'Ross', 'DPM', 'Podiatry', '', '', NULL, 'B', '30 S Michigan Ave  Ste 503', 'Chicago', 'Cook', 'IL', '60603', '3123721160', '3123723346', '30 S Michigan Ave  Ste 503', 'Chicago', 'Cook', 'IL', '60603', '3123721160', '3123723346', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Francis Hospital', NULL, '', '', 'HCFA|UB|', '1588629455', 0, 'N', 0, '2013-03-15', NULL, NULL, 41.8811, -87.625, NULL, NULL),
('364130066', 'IL0000599', 'IL0000599', 'ILCHIGSTD', 'Bradley S Ross DPM PC', 'Bradley', 'S', 'Ross', 'DPM', 'Podiatry', '', '', NULL, 'O', '7126 N Lincoln Ave', 'Lincolnwood', 'Cook', 'IL', '60077', '8476731818', '8475839196', '7126 N Lincoln Ave', 'Lincolnwood', 'Cook', 'IL', '60077', '8476731818', '8475839196', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Francis Hospital', NULL, '', '', 'HCFA|UB|', '1588629455', 0, 'N', 0, '2013-03-15', NULL, NULL, 42.0109, -87.7383, NULL, NULL),
('364130066', 'IL0000617', 'IL0000617', 'ILCHIGSTD', '', 'Breck', 'M', 'Tiernan', 'DMP', 'Podiatry', '', '', NULL, 'B', '30 S Michigan Ave  Ste 503', 'Chicago', 'Cook', 'IL', '60603', '3123721160', '3123723346', '30 S Michigan Ave  Ste 503', 'Chicago', 'Cook', 'IL', '60603', '3123721160', '3123723346', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', '2014-04-29', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1861614380', 0, 'N', 0, '2014-05-02', NULL, NULL, 41.8811, -87.625, NULL, NULL),
('364130066', 'IL0000616', 'IL0000616', 'ILCHIGSTD', 'Advanced Foot and Ankle', 'Breck', 'M', 'Tiernan', 'DMP', 'Podiatry', '', '', NULL, 'O', '350 Houbolt Rd Ste 104', 'Joliet', 'Will', 'IL', '60431', '8155530990', '8155530991', '350 Houbolt Rd Ste 104', 'Joliet', 'Will', 'IL', '60431', '8155530990', '8155530991', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', '2014-04-29', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1861614380', 0, 'N', 0, '2014-05-02', NULL, NULL, 41.5145, -88.1693, NULL, NULL),
('363317058', 'W12026079', 'W12026079', 'ILCHIGSTD', 'Access Community Health Network', '', '', 'Access Community Health Network', '', 'Clinics', '', '', NULL, 'O', '222 N Canal', 'Chicago', 'Cook', 'IL', '60606', '3125262200', '3125262146', '222 N Canal', 'Chicago', 'Cook', 'IL', '60606', '3125262200', '3125262146', 'CHIG5', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1699701383', 0, 'Y', 0, '2014-01-10', NULL, NULL, 0, 0, NULL, NULL),
('364130066', 'IL0000565', 'IL0000565', 'ILCHIGSTD', 'Fox Valley Foot Specialists', 'Brendon', 'J', 'McCarthy', 'DPM', 'Podiatry', '', '', NULL, 'O', '1279 S Naper Blvd', 'Naperville', 'Dupage', 'IL', '60540', '6305483900', '6305483905', '1279 S Naper Blvd', 'Naperville', 'Dupage', 'IL', '60540', '6305483900', '6305483905', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1528125473', 0, 'N', 0, '2013-07-18', NULL, NULL, 41.7516, -88.1152, NULL, NULL),
('364130066', 'IL0000566', 'IL0000566', 'ILCHIGSTD', '', 'Brendon', 'J', 'McCarthy', 'DPM', 'Podiatry', '', '', NULL, 'B', '30 S Michigan Ave  Ste 503', 'Chicago', 'Cook', 'IL', '60603', '3123721160', '3123723346', '30 S Michigan Ave  Ste 503', 'Chicago', 'Cook', 'IL', '60603', '3123721160', '3123723346', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1528125473', 0, 'N', 0, '2013-07-18', NULL, NULL, 41.8811, -87.625, NULL, NULL),
('364130066', 'IL0000583', 'IL0000583', 'ILCHIGSTD', 'ACPM Podiatry Group', 'Brent', 'D', 'Parry', 'DPM', 'Podiatry', '', '', NULL, 'O', '111 S Main St', 'Canton', 'Fulton', 'IL', '61520', '3096473664', '3096479829', '111 S Main St', 'Canton', 'Fulton', 'IL', '61520', '3096473664', '3096479829', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1891794004', 0, 'Y', 0, '2013-07-15', NULL, NULL, 40.5545, -90.0352, NULL, NULL),
('364130066', 'IL0000584', 'IL0000584', 'ILCHIGSTD', '', 'Brent', 'D', 'Parry', 'DPM', 'Podiatry', '', '', NULL, 'B', '30 S Michigan Ave  Ste 503', 'Chicago', 'Cook', 'IL', '60603', '3123721160', '3123723346', '30 S Michigan Ave  Ste 503', 'Chicago', 'Cook', 'IL', '60603', '3123721160', '3123723346', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1891794004', 0, 'N', 0, '2013-07-15', NULL, NULL, 41.8811, -87.625, NULL, NULL),
('364130066', 'IL0000582', 'IL0000582', 'ILCHIGSTD', 'ACPM Podiatry Group', 'Brent', 'D', 'Parry', 'DPM', 'Podiatry', '', '', NULL, 'O', '5017 N Glen Park Place', 'Peoria', 'Peoria', 'IL', '61614', '3096911589', '3096922032', '5017 N Glen Park Place', 'Peoria', 'Peoria', 'IL', '61614', '3096911589', '3096922032', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1891794004', 0, 'Y', 0, '2013-07-15', NULL, NULL, 40.7482, -89.6186, NULL, NULL),
('364130066', 'IL0000539', 'IL0000539', 'ILCHIGSTD', 'Brian A King DPM', 'Brian', 'A', 'King', 'DPM', 'Podiatry', '', '', NULL, 'O', '1185 Dundee Ave Ste F', 'Elgin', 'Kane', 'IL', '60120', '8476952661', '7088480598', '1185 Dundee Ave Ste F', 'Elgin', 'Kane', 'IL', '60120', '8476952661', '7088480598', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Elgin', NULL, '', '', 'HCFA|UB|', '1962439091', 0, 'N', 0, '2012-12-05', NULL, NULL, 42.0592, -88.2665, NULL, NULL),
('364130066', 'IL0000541', 'IL0000541', 'ILCHIGSTD', '', 'Brian', 'A', 'King', 'DPM', 'Podiatry', '', '', NULL, 'B', '30 S Michigan Ave  Ste 503', 'Chicago', 'Cook', 'IL', '60603', '3123721160', '3123723346', '30 S Michigan Ave  Ste 503', 'Chicago', 'Cook', 'IL', '60603', '3123721160', '3123723346', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Elgin', NULL, '', '', 'HCFA|UB|', '1962439091', 0, 'N', 0, '2012-12-05', NULL, NULL, 41.8811, -87.625, NULL, NULL),
('364130066', 'IL0000540', 'IL0000540', 'ILCHIGSTD', 'Brian A King DPM', 'Brian', 'A', 'King', 'DPM', 'Podiatry', '', '', NULL, 'O', '611 E State St', 'Geneva', 'Kane', 'IL', '60134', '6302088900', '7088480598', '611 E State St', 'Geneva', 'Kane', 'IL', '60134', '6302088900', '7088480598', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Elgin', NULL, '', '', 'HCFA|UB|', '1962439091', 0, 'N', 0, '2012-12-05', NULL, NULL, 41.8865, -88.2934, NULL, NULL),
('364130066', 'IL0000538', 'IL0000538', 'ILCHIGSTD', 'Brian A King DPM', 'Brian', 'A', 'King', 'DPM', 'Podiatry', '', '', NULL, 'O', '6142 W Roosevelt Rd', 'Oak Park', 'Cook', 'IL', '60304', '7088480021', '7088480598', '6142 W Roosevelt Rd', 'Oak Park', 'Cook', 'IL', '60304', '7088480021', '7088480598', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Elgin', NULL, '', '', 'HCFA|UB|', '1962439091', 0, 'N', 0, '2012-12-05', NULL, NULL, 41.8654, -87.7781, NULL, NULL),
('364130066', 'IL0000612', 'IL0000612', 'ILCHIGSTD', 'Advanced Foot and Ankle', 'Carlos', 'F', 'Smith', 'DPM', 'Podiatry', '', '', NULL, 'O', '2930 S Michigan Ave Ste 102', 'Chicago', 'Cook', 'IL', '60616', '3128080018', '3128080037', '2930 S Michigan Ave Ste 102', 'Chicago', 'Cook', 'IL', '60616', '3128080018', '3128080037', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Little Company of Mary Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1033190079', 0, 'N', 0, '2013-04-16', NULL, NULL, 41.8414, -87.6235, NULL, NULL),
('364130066', 'IL0000613', 'IL0000613', 'ILCHIGSTD', '', 'Carlos', 'F', 'Smith', 'DPM', 'Podiatry', '', '', NULL, 'B', '30 S Michigan Ave  Ste 503', 'Chicago', 'Cook', 'IL', '60603', '3123721160', '3123723346', '30 S Michigan Ave  Ste 503', 'Chicago', 'Cook', 'IL', '60603', '3123721160', '3123723346', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Little Company of Mary Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1033190079', 0, 'N', 0, '2012-12-05', NULL, NULL, 41.8811, -87.625, NULL, NULL),
('364130066', 'IL0000611', 'IL0000611', 'ILCHIGSTD', 'Advanced Foot and Ankle', 'Carlos', 'F', 'Smith', 'DPM', 'Podiatry', '', '', NULL, 'O', '711 W North Ave Ste 210', 'Chicago', 'Cook', 'IL', '60610', '3126423440', '3126424319', '711 W North Ave Ste 210', 'Chicago', 'Cook', 'IL', '60610', '3126423440', '3126424319', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Little Company of Mary Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1033190079', 0, 'N', 0, '2013-04-16', NULL, NULL, 41.911, -87.6461, NULL, NULL),
('364130066', 'IL0000610', 'IL0000610', 'ILCHIGSTD', 'Advanced Foot and Ankle', 'Carlos', 'F', 'Smith', 'DPM', 'Podiatry', '', '', NULL, 'O', '9021 S Western Ave', 'Chicago', 'Cook', 'IL', '60620', '7734453964', '7734453971', '9021 S Western Ave', 'Chicago', 'Cook', 'IL', '60620', '7734453964', '7734453971', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Little Company of Mary Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1033190079', 0, 'N', 0, '2013-04-16', NULL, NULL, 41.7297, -87.6823, NULL, NULL),
('830250612', 'W12029112', 'W12029112', 'WY01', 'Central Wyoming Urological Asociates ', 'Henry', 'P', 'Gottsch', 'MD', 'Urology', '', '', NULL, 'O', '1416 E A St S-101', 'Casper', 'Natrona', 'WY', '82601', '3075778600', '3075778605', '1416 E A St S-101', 'Casper', 'Natrona', 'WY', '82601', '3075778600', '3075778605', '', '', '', '0.00', '10.00', '0.00', 3, '2013-02-01', NULL, 0, 0, 0, 'Wyoming Medical Center ', NULL, NULL, NULL, 'HCFA|UB', '1831209253', 0, 'N', 0, '2013-01-31', NULL, NULL, 42.8514, -106.307, NULL, NULL),
('364130066', 'IL0000515', 'IL0000515', 'ILCHIGSTD', 'Premier Foot and Ankle PC', 'Catherine', '', 'Halinski', 'DPM', 'Podiatry', '', '', NULL, 'O', '165 N Arlington Heights Rd Ste 170', 'Buffalo Grove', 'Lake', 'IL', '60089', '8474193939', '2246760448', '165 N Arlington Heights Rd Ste 170', 'Buffalo Grove', 'Lake', 'IL', '60089', '8474193939', '2246760448', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, '', '', 'HCFA|UB|', '1891788055', 0, 'N', 0, '2013-03-18', NULL, NULL, 42.1559, -87.9849, NULL, NULL),
('364130066', 'IL0000516', 'IL0000516', 'ILCHIGSTD', '', 'Catherine', '', 'Halinski', 'DPM', 'Podiatry', '', '', NULL, 'B', '30 S Michigan Ave  Ste 503', 'Chicago', 'Cook', 'IL', '60603', '3123721160', '3123723346', '30 S Michigan Ave  Ste 503', 'Chicago', 'Cook', 'IL', '60603', '3123721160', '3123723346', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, '', '', 'HCFA|UB|', '1891788055', 0, 'N', 0, '2013-03-18', NULL, NULL, 41.8811, -87.625, NULL, NULL),
('364130066', 'IL0000571', 'IL0000571', 'ILCHIGSTD', '', 'Catherine', 'J', 'Minnick', 'DPM', 'Podiatry', '', '', NULL, 'B', '30 S Michigan Ave  Ste 503', 'Chicago', 'Cook', 'IL', '60603', '3123721160', '3123723346', '30 S Michigan Ave  Ste 503', 'Chicago', 'Cook', 'IL', '60603', '3123721160', '3123723346', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1265581060', 0, 'N', 0, '2013-04-26', NULL, NULL, 41.8811, -87.625, NULL, NULL),
('364130066', 'IL0000569', 'IL0000569', 'ILCHIGSTD', 'Catherine J Minnick DPM', 'Catherine', 'J', 'Minnick', 'DPM', 'Podiatry', '', '', NULL, 'O', '561 W Diversey Parkway Ste 212', 'Chicago', 'Cook', 'IL', '60614', '7735490323', '7735497905', '561 W Diversey Parkway Ste 212', 'Chicago', 'Cook', 'IL', '60614', '7735490323', '7735497905', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1265581060', 0, 'N', 0, '2013-04-26', NULL, NULL, 41.9329, -87.6431, NULL, NULL),
('364130066', 'IL0000570', 'IL0000570', 'ILCHIGSTD', 'Catherine J Minnick DPM', 'Catherine', 'J', 'Minnick', 'DPM', 'Podiatry', '', '', NULL, 'O', '7100 W Higgins Ave Ste 1B', 'Chicago', 'Cook', 'IL', '60656', '7735490323', '7735497905', '7100 W Higgins Ave Ste 1B', 'Chicago', 'Cook', 'IL', '60656', '7735490323', '7735497905', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1265581060', 0, 'N', 0, '2013-04-26', NULL, NULL, 41.9806, -87.8047, NULL, NULL),
('364130066', 'IL0000481', 'IL0000481', 'ILCHIGSTD', 'Charlotte M Covello DPM', 'Charlotte', 'M', 'Covello', 'DPM', 'Podiatry', '', '', NULL, 'O', '30 N Michigan Ave Ste 720', 'Chicago', 'Cook', 'IL', '60602', '3127010770', '3127010705', '30 N Michigan Ave Ste 720', 'Chicago', 'Cook', 'IL', '60602', '3127010770', '3127010705', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', '2013-03-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1972681286', 0, 'N', 0, '2013-03-12', NULL, NULL, 41.883, -87.6248, NULL, NULL),
('364130066', 'IL0000482', 'IL0000482', 'ILCHIGSTD', '', 'Charlotte', 'M', 'Covello', 'DPM', 'Podiatry', '', '', NULL, 'B', '30 S Michigan Ave  Ste 503', 'Chicago', 'Cook', 'IL', '60603', '3123721160', '3123723346', '30 S Michigan Ave  Ste 503', 'Chicago', 'Cook', 'IL', '60603', '3123721160', '3123723346', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', '2013-03-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1972681286', 0, 'N', 0, '2013-03-12', NULL, NULL, 41.8811, -87.625, NULL, NULL),
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('200719874', 'W12027383', 'W12027383', 'TXHOUSTD', '', 'Xin', '', 'Wang', 'MD', 'Family Practice', '', '', NULL, 'O', '2505 Park Ave Ste B', 'Pearland', 'Brazoria', 'TX', '77581', '2814850334', '2814853358', '2505 Park Ave Ste B', 'Pearland', 'Brazoria', 'TX', '77581', '2814850334', '2814853358', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1124004783', 0, 'N', 0, '2012-12-20', NULL, NULL, 29.5617, -95.2827, NULL, NULL),
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('870635889', 'W12026087', 'W12026087', 'UT01', 'Tooele Clinic Corp', 'Amy', 'G', 'Williams', 'MD', 'Pediatrics', '', '', NULL, 'O', '576 E Hwy 138 Ste 400', 'Tooele', 'Tooele', 'UT', '84074', '4358433647', '4357759272', '576 E Hwy 138 Ste 400', 'Tooele', 'Tooele', 'UT', '84074', '4358433647', '4357759272', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-11-08', NULL, 0, 0, 0, 'Mountain West Medical Center', '', '', '', 'HCFA|UB|', '1649319674', 0, 'N', 0, '2012-12-04', NULL, NULL, 40.5621, -112.293, NULL, NULL),
('621801973', 'W12026089', 'W12026089', 'UT01', 'Copper Canyon Womens Center', 'Mindy', '', 'Ruhlman', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'O', '3336 S Pioneer Pkwy Ste 301', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019643865', '8019643894', '3336 S Pioneer Pkwy Ste 301', 'Salt Lake City', 'Salt Lake', 'UT', '84120', '8019643865', '8019643894', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2012-09-24', '2014-04-30', 0, 0, 0, 'Pioneer Valley Hospital', 'Jordan Valley Medical Center', '', '', 'HCFA|UB|', '1164453536', 0, 'N', 0, '2014-01-27', NULL, NULL, 40.6991, -111.99, NULL, NULL),
('621801973', 'W12026090', 'W12026090', 'UT01', 'Physician Group of Utah Inc', 'Mindy', '', 'Ruhlman', 'CNM', 'Obstetrics and Gynecology', '', '', NULL, 'B', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', 'PO Box 281415', 'Atlanta', 'Fulton', 'GA', '30384', '8019843418', '8019843479', 'WUSTDINT5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2012-09-24', '2014-04-30', 0, 0, 0, 'Pioneer Valley Hospital', 'Jordan Valley Medical Center', '', '', 'HCFA|UB|', '1164453536', 0, 'N', 0, '2014-01-27', NULL, NULL, 0, 0, NULL, NULL),
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('954893928', 'W12026094', 'W12026094', 'UT01', 'Exodus Healthcare Network', 'Randolph', 'K', 'Cribbs', 'MD', 'Wound Care', '', '', NULL, 'O', '3665 S 8400 W Ste 110', 'Magna', 'Salt Lake', 'UT', '84044', '8012509638', '8012503204', '3665 S 8400 W Ste 110', 'Magna', 'Salt Lake', 'UT', '84044', '8012509638', '8012503204', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2030-01-01', '2030-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1770675563', 0, 'N', 1, '2013-04-16', NULL, NULL, 0, 0, NULL, NULL),
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('850275777', 'W12026097', 'W12026097', 'NM01', 'Southwest Medical Associates', 'Patrick', '', 'Dawson', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '4420 Irving Blvd NW', 'Albuquerque', 'Bernalillo', 'NM', '87114', '5058231010', '5057974503', '4420 Irving Blvd NW', 'Albuquerque', 'Bernalillo', 'NM', '87114', '5058231010', '5057974503', 'NMSWMED', '', '', '0.00', '10.00', '0.00', 3, '2013-02-01', '2014-04-12', 0, 0, 0, 'Lovelace Medical Center', '', '', '', 'HCFA|UB|', '1356598726', 0, 'N', 0, '2014-03-14', NULL, NULL, 35.1902, -106.665, NULL, NULL),
('202422775', 'W12026099', 'W12026099', 'UT01', 'Wasatch Endocrinology and Diabetes Specialists', 'Joyce', 'C', 'Ferrone', 'NP', 'Endocrinology', 'Diabetes', '', NULL, 'B', 'PO Box 1009', 'Riverton', 'Salt Lake', 'UT', '84065', '8015618398', '8013020645', 'PO Box 1009', 'Riverton', 'Salt Lake', 'UT', '84065', '8015618398', '8013020645', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-11-20', NULL, 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1811107261', 0, 'Y', 0, '2013-11-14', NULL, NULL, 0, 0, NULL, NULL),
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('841416411', 'W12026101', 'W12026101', 'ID02', 'Advantage Psychological Services', 'Scott', 'H', 'Armentrout', 'PSYD', 'Mental Health', 'Psychology', NULL, NULL, 'O', '1903 Ridenbaugh', 'Boise', 'Garfield', 'OK', '73702', '2089062007', NULL, '1903 Ridenbaugh', 'Boise', 'Garfield', 'OK', '73702', '2089062007', '          ', 'IDPHD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2012-11-26', '2013-02-14', 0, 0, 1, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1619002987', 0, 'N', 0, '2012-12-04', NULL, NULL, 0, 0, NULL, NULL),
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('830182821', 'W12026104', 'W12026104', 'WYT2', 'Gottsche Rehab Center ', 'Sharon', '', 'Burns', 'OT', 'Occupational Therapy', '', '', NULL, 'O', '890 Hwy 20 S', 'Basin', 'Big Horn', 'WY', '82410', '3075689399', '3075689396', '890 Hwy 20 S', 'Basin', 'Big Horn', 'WY', '82410', '3075689399', '3075689396', '', '', '', '0.00', '10.00', '0.00', 3, '2030-01-01', '2030-01-01', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1770714032', 0, 'N', 1, '2013-04-16', NULL, NULL, 0, 0, NULL, NULL),
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('203276415', 'W12026121', 'W12026121', 'IDBOISTD', 'Ada West Dermatology', 'Juliann', 'C', 'Visser', 'PA', 'Dermatology', '', '', NULL, 'O', '1618 S Millennium Way Ste 100', 'Meridian', 'Ada', 'ID', '83642', '2088843376', '2088840858', '1618 S Millennium Way Ste 100', 'Meridian', 'Ada', 'ID', '83642', '2088843376', '2088840858', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2013-02-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1922309848', 0, 'N', 0, '2013-01-31', NULL, NULL, 43.59, -116.368, NULL, NULL),
('820200895', 'W12041680', 'W12041680', 'IDBOISTD', 'Saint Alphonsus Medical Group Oasis Medical Clinic', '', '', 'Saint Alphonsus Medical Group Urgent Care Clinics', '', 'Urgent Care', '', '', NULL, 'O', '3217 W Bavaria St', 'Eagle', 'Ada', 'ID', '83616', '2082866676', '0000000000', '3217 W Bavaria St', 'Eagle', 'Ada', 'ID', '83616', '2082866676', '0000000000', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2013-11-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|', '0000008549', 0, 'N', 0, '2014-06-13', NULL, NULL, 43.7, -116.35, NULL, NULL),
('205482970', 'W12026123', 'W12026123', 'TXHOUSTD', 'Tommy Vo MD', 'Tommy', 'Cong', 'Vo', 'MD', 'Family Practice', '', '', NULL, 'O', '9740 Barker Cypress Ste 116', 'Cypress', 'Harris', 'TX', '77433', '2815507600', '2815507609', '9740 Barker Cypress Ste 116', 'Cypress', 'Harris', 'TX', '77433', '2815507600', '2815507609', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Houston Methodist West Houston Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1932197498', 0, 'N', 0, '2013-05-24', NULL, NULL, 29.9186, -95.6862, NULL, NULL),
('043791254', 'W12026124', 'W12026124', 'TXHOUSTD', 'Bhagwat Patel MD', 'Bhagwat', 'P', 'Patel', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1250 Creekway Dr Ste 100', 'Sugar Land', 'Fort Bend', 'TX', '77478', '2814941420', '2814941471', '1250 Creekway Dr Ste 100', 'Sugar Land', 'Fort Bend', 'TX', '77478', '2814941420', '2814941471', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Houston Methodist Sugar Land Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1891729075', 0, 'N', 0, '2013-05-24', NULL, NULL, 29.6068, -95.6192, NULL, NULL),
('043791254', 'W12026125', 'W12026125', 'TXHOUSTD', '', 'Bhagwat', 'P', 'Patel', 'MD', 'Internal Medicine', '', '', NULL, 'B', 'PO Box 1000', 'El Campo', 'Wharton', 'TX', '77437', '2814941420', '2814941471', 'PO Box 1000', 'El Campo', 'Wharton', 'TX', '77437', '2814941420', '2814941471', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Houston Methodist Sugar Land Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1891729075', 0, 'N', 0, '2012-12-17', NULL, NULL, 0, 0, NULL, NULL),
('760654935', 'W12026128', 'W12026128', 'TXHOUSTD', 'Gastroenterology Diagnostic Center', 'Shabbir Husain', '', 'Jamali', 'MD', 'Gastroenterology', '', '', NULL, 'O', '421 School St Ste 110', 'Tomball', 'Harris', 'TX', '77375', '2813571977', '2813571057', '421 School St Ste 110', 'Tomball', 'Harris', 'TX', '77375', '2813571977', '2813571057', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Houston Methodist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1598735656', 0, 'N', 0, '2012-12-07', NULL, NULL, 30.0869, -95.619, NULL, NULL),
('742155737', 'W12026129', 'W12026129', 'TXHOUSTD', 'Jeremy W Szeto MD', 'Jeremy', 'W', 'Szeto', 'MD', 'Family Practice', '', '', NULL, 'O', '1429 Hwy 6 S Ste 301', 'Sugar Land', 'Fort Bend', 'TX', '77478', '2812426900', '2812426902', '1429 Hwy 6 S Ste 301', 'Sugar Land', 'Fort Bend', 'TX', '77478', '2812426900', '2812426902', 'HOUSTON1', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Houston Methodist Sugar Land Hospital', NULL, '', '', 'HCFA|UB|', '1386719946', 0, 'N', 0, '2013-06-03', NULL, NULL, 29.6021, -95.6325, NULL, NULL),
('742208066', 'W12026132', 'W12026132', 'TXHOUSTD', 'Foot Specialists of Memorial', 'Jeff', '', 'Hetman', 'DPM', 'Podiatry', '', '', NULL, 'O', '23920 Katy Fwy Ste 550', 'Katy', 'Fort Bend', 'TX', '77494', '2813713338', '2813713350', '23920 Katy Fwy Ste 550', 'Katy', 'Fort Bend', 'TX', '77494', '2813713338', '2813713350', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'West Houston Medical Center', NULL, '', '', 'HCFA|UB|', '1326092081', 0, 'N', 0, '2013-06-05', NULL, NULL, 29.7859, -95.7858, NULL, NULL),
('742208066', 'W12026130', 'W12026130', 'TXHOUSTD', '', 'Jeff', '', 'Hetman', 'DPM', 'Podiatry', '', '', NULL, 'O', '915 Gessner Ste 460', 'Houston', 'Harris', 'TX', '77024', '7134643775', '7134645325', '915 Gessner Ste 460', 'Houston', 'Harris', 'TX', '77024', '7134643775', '7134645325', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', '2013-03-20', 0, 0, 0, 'West Houston Medical Center', NULL, '', '', 'HCFA|UB|', '1326092081', 0, 'N', 0, '2013-03-21', NULL, NULL, 29.7799, -95.5456, NULL, NULL),
('742208066', 'W12026131', 'W12026131', 'TXHOUSTD', 'Foot Specialists of Memorial', 'Jeff', '', 'Hetman', 'DPM', 'Podiatry', '', '', NULL, 'B', 'PO Box 848947', 'Boston', 'Suffolk', 'MA', '02284', '7134643775', '7134645325', 'PO Box 848947', 'Boston', 'Suffolk', 'MA', '02284', '7134643775', '7134645325', 'HOUSTON4', 'TXHCPC13', '', '0.00', '45.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'West Houston Medical Center', NULL, '', '', 'HCFA|UB|', '1326092081', 0, 'Y', 0, '2012-12-07', NULL, NULL, 0, 0, NULL, NULL),
('201780406', 'IL0000298', 'IL0000298', 'ILCHIGSTD', 'UroPartners', 'Matthew', 'A', 'Meadows', 'MD', 'Urology', '', '', NULL, 'O', '5140 N California Ave Ste 775', 'Chicago', 'Cook', 'IL', '60625', '7738787555', '7738788545', '5140 N California Ave Ste 775', 'Chicago', 'Cook', 'IL', '60625', '7738787555', '7738788545', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-11-15', 0, 0, 0, 'Presence Saint Francis Hospital', 'Presence Saint Joseph Hospital Chicago', '', '', 'HCFA|UB|', '1275599219', 0, 'N', 0, '2014-04-25', NULL, NULL, 41.975, -87.7005, NULL, NULL),
('201780406', 'IL0000301', 'IL0000301', 'ILCHIGSTD', 'UroPartners', 'Daniel', 'S', 'Merrick', 'MD', 'Urology', '', '', NULL, 'O', '5140 N California Ave Ste 775', 'Chicago', 'Cook', 'IL', '60625', '7738787555', '7738788545', '5140 N California Ave Ste 775', 'Chicago', 'Cook', 'IL', '60625', '7738787555', '7738788545', 'CHIG10', 'UROHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-11-15', 0, 0, 0, 'Presence Saint Francis Hospital', 'Presence Saint Joseph Hospital Chicago', '', '', 'HCFA|UB|', '1184680654', 0, 'N', 0, '2014-04-25', NULL, NULL, 41.975, -87.7005, NULL, NULL),
('364130066', 'IL0000642', 'IL0000642', 'ILCHIGSTD', '', 'Dana', 'M', 'Wisby', 'DPM', 'Podiatry', '', '', NULL, 'B', '30 S Michigan Ave  Ste 503', 'Chicago', 'Cook', 'IL', '60603', '3123721160', '3123723346', '30 S Michigan Ave  Ste 503', 'Chicago', 'Cook', 'IL', '60603', '3123721160', '3123723346', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', '2014-04-29', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1598059354', 0, 'N', 0, '2014-05-02', NULL, NULL, 41.8811, -87.625, NULL, NULL),
('364130066', 'IL0000639', 'IL0000639', 'ILCHIGSTD', 'Advanced Foot and Ankle', 'Dana', 'M', 'Wisby', 'DPM', 'Podiatry', '', '', NULL, 'O', '455 S Roselle Rd Ste 100', 'Schaumburg', 'Cook', 'IL', '60193', '8479858380', '8479859475', '455 S Roselle Rd Ste 100', 'Schaumburg', 'Cook', 'IL', '60193', '8479858380', '8479859475', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', '2014-04-29', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1598059354', 0, 'N', 0, '2014-05-02', NULL, NULL, 42.0192, -88.0799, NULL, NULL),
('364130066', 'IL0000640', 'IL0000640', 'ILCHIGSTD', 'Advanced Foot and Ankle', 'Dana', 'M', 'Wisby', 'DPM', 'Podiatry', '', '', NULL, 'O', '4920 N Central Ave', 'Chicago', 'Cook', 'IL', '60630', '7737363338', '7737361289', '4920 N Central Ave', 'Chicago', 'Cook', 'IL', '60630', '7737363338', '7737361289', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', '2014-04-29', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1598059354', 0, 'N', 0, '2014-05-02', NULL, NULL, 41.9701, -87.7675, NULL, NULL),
('364130066', 'IL0000641', 'IL0000641', 'ILCHIGSTD', 'Advanced Foot and Ankle', 'Dana', 'M', 'Wisby', 'DPM', 'Podiatry', '', '', NULL, 'O', '501 N Hicks Rd', 'Palatine', 'Cook', 'IL', '60067', '8473587005', '7733587065', '501 N Hicks Rd', 'Palatine', 'Cook', 'IL', '60067', '8473587005', '7733587065', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', '2014-04-29', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1598059354', 0, 'N', 0, '2014-05-02', NULL, NULL, 42.1189, -88.0339, NULL, NULL),
('364130066', 'IL0000472', 'IL0000472', 'ILCHIGSTD', '', 'David', 'A', 'Charnota', 'DPM', 'Podiatry', '', '', NULL, 'B', '30 S Michigan Ave  Ste 503', 'Chicago', 'Cook', 'IL', '60603', '3123721160', '3123723346', '30 S Michigan Ave  Ste 503', 'Chicago', 'Cook', 'IL', '60603', '3123721160', '3123723346', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1205848975', 0, 'N', 0, '2013-04-16', NULL, NULL, 41.8811, -87.625, NULL, NULL),
('364130066', 'IL0000471', 'IL0000471', 'ILCHIGSTD', 'Alpine Foot Specialists PC', 'David', 'A', 'Charnota', 'DPM', 'Podiatry', '', '', NULL, 'O', '765 Ela Rd  Ste 100', 'Lake Zurich', 'Lake', 'IL', '60047', '8475409949', '8475409971', '765 Ela Rd  Ste 100', 'Lake Zurich', 'Lake', 'IL', '60047', '8475409949', '8475409971', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1205848975', 0, 'N', 0, '2013-04-16', NULL, NULL, 42.1847, -88.1017, NULL, NULL),
('364130066', 'IL0000521', 'IL0000521', 'ILCHIGSTD', '', 'David', 'F', 'Hettinger', 'DMP', 'Podiatry', '', '', NULL, 'B', '30 S Michigan Ave  Ste 503', 'Chicago', 'Cook', 'IL', '60603', '3123721160', '3123723346', '30 S Michigan Ave  Ste 503', 'Chicago', 'Cook', 'IL', '60603', '3123721160', '3123723346', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1821099276', 0, 'N', 0, '2013-03-07', NULL, NULL, 41.8811, -87.625, NULL, NULL),
('364130066', 'IL0000520', 'IL0000520', 'ILCHIGSTD', 'Hettinger Podiatry Center', 'David', 'F', 'Hettinger', 'DMP', 'Podiatry', '', '', NULL, 'O', '59 Danada Square East', 'Wheaton', 'Dupage', 'IL', '60189', '6306823338', '6306825836', '59 Danada Square East', 'Wheaton', 'Dupage', 'IL', '60189', '6306823338', '6306825836', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1821099276', 0, 'N', 0, '2013-03-07', NULL, NULL, 41.8306, -88.1037, 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
('364130066', 'IL0000513', 'IL0000513', 'ILCHIGSTD', 'Advanced Foot and Ankle', 'Dawn', 'R', 'Hackel', 'DPM', 'Podiatry', '', '', NULL, 'O', '153 N 19th Ave', 'Melrose Park', 'Cook', 'IL', '60160', '7083444300', '7083444358', '153 N 19th Ave', 'Melrose Park', 'Cook', 'IL', '60160', '7083444300', '7083444358', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Our Lady Of The Resurrection Medical Center', NULL, '', '', 'HCFA|UB|', '1124036546', 0, 'N', 0, '2013-04-16', NULL, NULL, 41.893, -87.8566, NULL, NULL),
('364130066', 'IL0000514', 'IL0000514', 'ILCHIGSTD', '', 'Dawn', 'R', 'Hackel', 'DPM', 'Podiatry', '', '', NULL, 'B', '30 S Michigan Ave  Ste 503', 'Chicago', 'Cook', 'IL', '60603', '3123721160', '3123723346', '30 S Michigan Ave  Ste 503', 'Chicago', 'Cook', 'IL', '60603', '3123721160', '3123723346', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Our Lady Of The Resurrection Medical Center', NULL, '', '', 'HCFA|UB|', '1124036546', 0, 'N', 0, '2013-03-18', NULL, NULL, 41.8811, -87.625, NULL, NULL),
('364130066', 'IL0000634', 'IL0000634', 'ILCHIGSTD', '', 'Eveleigh', 'E', 'Williams', 'DPM', 'Podiatry', '', '', NULL, 'B', '30 S Michigan Ave  Ste 503', 'Chicago', 'Cook', 'IL', '60603', '3123721160', '3123723346', '30 S Michigan Ave  Ste 503', 'Chicago', 'Cook', 'IL', '60603', '3123721160', '3123723346', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1629080742', 0, 'N', 0, '2013-04-26', NULL, NULL, 41.8811, -87.625, NULL, NULL),
('364130066', 'IL0000633', 'IL0000633', 'ILCHIGSTD', 'Foot and Ankle Pain Specialist', 'Eveleigh', 'E', 'Williams', 'DPM', 'Podiatry', '', '', NULL, 'O', '3330 W 177th St Ste 2D1', 'Hazel Crest', 'Cook', 'IL', '60429', '7089573338', '7089574555', '3330 W 177th St Ste 2D1', 'Hazel Crest', 'Cook', 'IL', '60429', '7089573338', '7089574555', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1629080742', 0, 'N', 0, '2013-04-26', NULL, NULL, 41.5681, -87.698, NULL, NULL),
('364130066', 'IL0000534', 'IL0000534', 'ILCHIGSTD', '', 'Francis', 'A', 'Kania', 'DPM', 'Podiatry', '', '', NULL, 'B', '30 S Michigan Ave  Ste 503', 'Chicago', 'Cook', 'IL', '60603', '3123721160', '3123723346', '30 S Michigan Ave  Ste 503', 'Chicago', 'Cook', 'IL', '60603', '3123721160', '3123723346', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1659368918', 0, 'N', 0, '2013-03-18', NULL, NULL, 41.8811, -87.625, NULL, NULL),
('364130066', 'IL0000533', 'IL0000533', 'ILCHIGSTD', 'Francis A Kania DPM', 'Francis', 'A', 'Kania', 'DPM', 'Podiatry', '', '', NULL, 'O', '539 N Lagrange Rd Ste 2', 'LaGrange Park', 'Cook', 'IL', '60526', '7083523338', '7083529933', '539 N Lagrange Rd Ste 2', 'LaGrange Park', 'Cook', 'IL', '60526', '7083523338', '7083529933', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1659368918', 0, 'N', 0, '2013-03-18', NULL, NULL, 41.824, -87.8715, NULL, NULL),
('364130066', 'IL0000635', 'IL0000635', 'ILCHIGSTD', 'Associated Foot and Ankle Center', 'Gary', 'L', 'Williams', 'DPM', 'Podiatry', '', '', NULL, 'O', '15614 S Harlem Ave Ste C', 'Orland Park', 'Cook', 'IL', '60462', '7084444114', '7084295950', '15614 S Harlem Ave Ste C', 'Orland Park', 'Cook', 'IL', '60462', '7084444114', '7084295950', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1396711073', 0, 'N', 0, '2013-03-06', NULL, NULL, 41.6071, -87.7944, NULL, NULL),
('364130066', 'IL0000638', 'IL0000638', 'ILCHIGSTD', '', 'Gary', 'L', 'Williams', 'DPM', 'Podiatry', '', '', NULL, 'B', '30 S Michigan Ave  Ste 503', 'Chicago', 'Cook', 'IL', '60603', '3123721160', '3123723346', '30 S Michigan Ave  Ste 503', 'Chicago', 'Cook', 'IL', '60603', '3123721160', '3123723346', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1396711073', 0, 'N', 0, '2013-03-06', NULL, NULL, 41.8811, -87.625, NULL, NULL),
('364130066', 'IL0000636', 'IL0000636', 'ILCHIGSTD', 'Gary L Williams DPM', 'Gary', 'L', 'Williams', 'DPM', 'Podiatry', '', '', NULL, 'O', '326 W 64th St', 'Chicago', 'Cook', 'IL', '60621', '7082892663', '7739620542', '326 W 64th St', 'Chicago', 'Cook', 'IL', '60621', '7082892663', '7739620542', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1396711073', 0, 'N', 0, '2013-03-06', NULL, NULL, 41.7781, -87.6334, NULL, NULL),
('364130066', 'IL0000637', 'IL0000637', 'ILCHIGSTD', 'Gary L Williams DPM', 'Gary', 'L', 'Williams', 'DPM', 'Podiatry', '', '', NULL, 'O', '7531 S Stony Island Ave', 'Chicago', 'Cook', 'IL', '60649', '7739477670', '7084295950', '7531 S Stony Island Ave', 'Chicago', 'Cook', 'IL', '60649', '7739477670', '7084295950', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1396711073', 0, 'N', 0, '2013-03-06', NULL, NULL, 41.7578, -87.5857, NULL, NULL),
('364130066', 'W12026264', 'W12026264', 'ILCHIGSTD', 'Advanced Foot and Ankle', 'Mark', 'A', 'Konieczny', 'DPM', 'Podiatry', '', '', NULL, 'O', '1000 E Ogden Ave', 'Naperville', 'Dupage', 'IL', '60563', '6303559811', '6303559179', '1000 E Ogden Ave', 'Naperville', 'Dupage', 'IL', '60563', '6303559811', '6303559179', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1003896978', 0, 'N', 0, '2013-04-16', NULL, NULL, 41.79, -88.1317, NULL, NULL),
('364130066', 'IL0000532', 'IL0000532', 'ILCHIGSTD', '', 'Gregory', '', 'Jansyn', 'DPM', 'Podiatry', '', '', NULL, 'B', '30 S Michigan Ave  Ste 503', 'Chicago', 'Cook', 'IL', '60603', '3123721160', '3123723346', '30 S Michigan Ave  Ste 503', 'Chicago', 'Cook', 'IL', '60603', '3123721160', '3123723346', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1639250632', 0, 'N', 0, '2013-03-18', NULL, NULL, 41.8811, -87.625, NULL, NULL),
('364130066', 'IL0000530', 'IL0000530', 'ILCHIGSTD', 'Suburban Podiatry', 'Gregory', '', 'Jansyn', 'DPM', 'Podiatry', '', '', NULL, 'O', '303 E Army Trail Rd Ste 101', 'Bloomingdale', 'Dupage', 'IL', '60108', '6308933668', '6308933670', '303 E Army Trail Rd Ste 101', 'Bloomingdale', 'Dupage', 'IL', '60108', '6308933668', '6308933670', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1639250632', 0, 'N', 0, '2013-03-18', NULL, NULL, 41.9391, -88.1019, NULL, NULL),
('364130066', 'IL0000537', 'IL0000537', 'ILCHIGSTD', '', 'Iqbal (Jay)', '', 'Khan', 'DPM', 'Podiatry', '', '', NULL, 'B', '30 S Michigan Ave  Ste 503', 'Chicago', 'Cook', 'IL', '60603', '3123721160', '3123723346', '30 S Michigan Ave  Ste 503', 'Chicago', 'Cook', 'IL', '60603', '3123721160', '3123723346', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1053341305', 0, 'N', 0, '2013-04-03', NULL, NULL, 41.8811, -87.625, NULL, NULL),
('364130066', 'IL0000536', 'IL0000536', 'ILCHIGSTD', 'Tri County Foot and Ankle', 'Iqbal (Jay)', '', 'Khan', 'DPM', 'Podiatry', '', '', NULL, 'O', '36735 N Highway 83 Ste D1', 'Lake Villa', 'Lake', 'IL', '60046', '8473563338', '8473563388', '36735 N Highway 83 Ste D1', 'Lake Villa', 'Lake', 'IL', '60046', '8473563338', '8473563388', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1053341305', 0, 'N', 0, '2013-04-03', NULL, NULL, 42.3967, -88.0653, NULL, NULL),
('390816848', 'IL0000401', 'IL0000401', 'ILCHIGSTD', 'Mercy Richmond Medical Center', 'Kim', '', 'Albright', 'MD', 'Family Practice', '', '', NULL, 'O', '9715 Prairie Ridge', 'Richmond', 'McHenry', 'IL', '60071', '8156784528', NULL, '9715 Prairie Ridge', 'Richmond', 'Mchenry', 'IL', '60071', '8156784528', '          ', 'CHIG9', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1982629390', 0, 'N', 0, '2012-12-06', NULL, NULL, 42.4653, -88.3048, NULL, NULL),
('364130066', 'IL0000621', 'IL0000621', 'ILCHIGSTD', 'Advanced Foot and Ankle', 'James', 'D', 'Velarde', 'DPM', 'Podiatry', '', '', NULL, 'O', '104 Tyler Creek Plaza', 'Elgin', 'Cook', 'IL', '60657', '6302381111', '6302380164', '104 Tyler Creek Plaza', 'Elgin', 'Cook', 'IL', '60657', '6302381111', '6302380164', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1972783413', 0, 'N', 0, '2013-04-16', NULL, NULL, 42.0594, -88.3143, NULL, NULL),
('364130066', 'IL0000564', 'IL0000564', 'ILCHIGSTD', '', 'James', 'C', 'Massaro', 'DPM', 'Podiatry', '', '', NULL, 'B', '30 S Michigan Ave  Ste 503', 'Chicago', 'Cook', 'IL', '60603', '3123721160', '3123723346', '30 S Michigan Ave  Ste 503', 'Chicago', 'Cook', 'IL', '60603', '3123721160', '3123723346', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', '2013-03-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1124072459', 0, 'N', 0, '2013-03-12', NULL, NULL, 41.8811, -87.625, NULL, NULL),
('363980044', 'W12026266', 'W12026266', 'ILCHIGSTD', 'Illinois Cancer Specialists ', 'Lisa', '', 'Baddi', 'DO', 'Hematology and Oncology', 'Hematology', 'Oncology', NULL, 'M', '110 E Woodfield Rd Ste 434', 'Schaumburg', 'Cook', 'IL', '60173', '          ', NULL, '110 E Woodfield Rd Ste 434', 'Schaumburg', 'Cook', 'IL', '60173', '          ', '          ', 'CHIG7', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1780683250', 0, 'N', 0, '2013-09-18', NULL, NULL, 0, 0, NULL, NULL),
('364130066', 'IL0000620', 'IL0000620', 'ILCHIGSTD', 'Advanced Foot and Ankle', 'James', 'D', 'Velarde', 'DPM', 'Podiatry', '', '', NULL, 'O', '1045 W Belmont', 'Chicago', 'Cook', 'IL', '60657', '7732488644', '6302380164', '1045 W Belmont', 'Chicago', 'Cook', 'IL', '60657', '7732488644', '6302380164', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1972783413', 0, 'N', 0, '2013-04-16', NULL, NULL, 41.9399, -87.6559, NULL, NULL),
('364130066', 'IL0000622', 'IL0000622', 'ILCHIGSTD', 'Advanced Foot and Ankle', 'James', 'D', 'Velarde', 'DPM', 'Podiatry', '', '', NULL, 'O', '1510 Larkin Ave Ste D', 'Elgin', 'Kane', 'IL', '60123', '6302381111', '6302380164', '1510 Larkin Ave Ste D', 'Elgin', 'Kane', 'IL', '60123', '6302381111', '6302380164', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1972783413', 0, 'N', 0, '2013-04-16', NULL, NULL, 42.0346, -88.315, NULL, NULL),
('364130066', 'IL0000618', 'IL0000618', 'ILCHIGSTD', 'Advanced Foot and Ankle', 'James', 'D', 'Velarde', 'DPM', 'Podiatry', '', '', NULL, 'O', '165 N Church Rd', 'Bensenville', 'Dupage', 'IL', '60106', '6302381111', '6302380164', '165 N Church Rd', 'Bensenville', 'Dupage', 'IL', '60106', '6302381111', '6302380164', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1972783413', 0, 'N', 0, '2013-04-16', NULL, NULL, 41.96, -87.9491, NULL, NULL),
('364130066', 'IL0000623', 'IL0000623', 'ILCHIGSTD', '', 'James', 'D', 'Velarde', 'DPM', 'Podiatry', '', '', NULL, 'B', '30 S Michigan Ave  Ste 503', 'Chicago', 'Cook', 'IL', '60603', '3123721160', '3123723346', '30 S Michigan Ave  Ste 503', 'Chicago', 'Cook', 'IL', '60603', '3123721160', '3123723346', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1972783413', 0, 'N', 0, '2013-02-27', NULL, NULL, 41.8811, -87.625, NULL, NULL),
('364130066', 'IL0000619', 'IL0000619', 'ILCHIGSTD', 'Advanced Foot and Ankle', 'James', 'D', 'Velarde', 'DPM', 'Podiatry', '', '', NULL, 'O', '4006 W 26th St', 'Chicago', 'Cook', 'IL', '60623', '6302381111', '6302380164', '4006 W 26th St', 'Chicago', 'Cook', 'IL', '60623', '6302381111', '6302380164', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1972783413', 0, 'N', 0, '2013-04-16', NULL, NULL, 41.8443, -87.725, NULL, NULL),
('364130066', 'IL0000631', 'IL0000631', 'ILCHIGSTD', 'The Foot Physicians', 'Jeannie', 'M', 'Waschow', 'DPM', 'Podiatry', '', '', NULL, 'O', '10350 Halgus Rd', 'Huntley', 'McHenry', 'IL', '60142', '8478548637', '8478546779', '10350 Halgus Rd', 'Huntley', 'McHenry', 'IL', '60142', '8478548637', '8478546779', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1497739700', 0, 'N', 0, '2013-03-06', NULL, NULL, 42.2143, -88.4224, NULL, NULL),
('364130066', 'IL0000632', 'IL0000632', 'ILCHIGSTD', '', 'Jeannie', 'M', 'Waschow', 'DPM', 'Podiatry', '', '', NULL, 'B', '30 S Michigan Ave  Ste 503', 'Chicago', 'Cook', 'IL', '60603', '3123721160', '3123723346', '30 S Michigan Ave  Ste 503', 'Chicago', 'Cook', 'IL', '60603', '3123721160', '3123723346', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1497739700', 0, 'N', 0, '2013-03-06', NULL, NULL, 41.8811, -87.625, NULL, NULL),
('364130066', 'IL0000629', 'IL0000629', 'ILCHIGSTD', 'The Foot Physicians', 'Jeannie', 'M', 'Waschow', 'DPM', 'Podiatry', '', '', NULL, 'O', '331 N Randall Rd', 'Lake In The Hills', 'McHenry', 'IL', '60156', '8478548637', '8478546779', '331 N Randall Rd', 'Lake In The Hills', 'McHenry', 'IL', '60156', '8478548637', '8478546779', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1497739700', 0, 'N', 0, '2013-03-06', NULL, NULL, 42.1855, -88.3355, NULL, NULL),
('364130066', 'IL0000630', 'IL0000630', 'ILCHIGSTD', 'The Foot Physicians', 'Jeannie', 'M', 'Waschow', 'DPM', 'Podiatry', '', '', NULL, 'O', '795 Main St', 'Antioch', 'Lake', 'IL', '60002', '8478383338', '8478546779', '795 Main St', 'Antioch', 'Lake', 'IL', '60002', '8478383338', '8478546779', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1497739700', 0, 'N', 0, '2013-03-06', NULL, NULL, 42.4812, -88.0963, NULL, NULL),
('364130066', 'IL0000559', 'IL0000559', 'ILCHIGSTD', '', 'Jeffrey', 'M', 'Mackler', 'DPM', 'Podiatry', '', '', NULL, 'B', '30 S Michigan Ave  Ste 503', 'Chicago', 'Cook', 'IL', '60603', '3123721160', '3123723346', '30 S Michigan Ave  Ste 503', 'Chicago', 'Cook', 'IL', '60603', '3123721160', '3123723346', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', '2013-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1215076617', 0, 'N', 0, '2013-03-19', NULL, NULL, 41.8811, -87.625, NULL, NULL),
('364130066', 'IL0000558', 'IL0000558', 'ILCHIGSTD', 'Bolingbrook Foot Specialist', 'Jeffrey', 'M', 'Mackler', 'DPM', 'Podiatry', '', '', NULL, 'O', '454 W Boughton Rd Ste A', 'Bolingbrook', 'Will', 'IL', '60440', '6307594411', '6307596063', '454 W Boughton Rd Ste A', 'Bolingbrook', 'Will', 'IL', '60440', '6307594411', '6307596063', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', '2013-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1215076617', 0, 'N', 0, '2013-03-19', NULL, NULL, 0, 0, NULL, NULL),
('364130066', 'IL0000597', 'IL0000597', 'ILCHIGSTD', 'Professional Foot and Ankle', 'Jerome', 'R', 'Randall', 'DPM', 'Podiatry', '', '', NULL, 'O', '20303 Crawford Ave Ste 210', 'Olympia Fields', 'Cook', 'IL', '60461', '7088982380', '7088982326', '20303 Crawford Ave Ste 210', 'Olympia Fields', 'Cook', 'IL', '60461', '7088982380', '7088982326', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, '', '', 'HCFA|UB|', '1467606152', 0, 'N', 0, '2013-04-26', NULL, NULL, 41.5207, -87.7132, NULL, NULL),
('364130066', 'IL0000598', 'IL0000598', 'ILCHIGSTD', '', 'Jerome', 'R', 'Randall', 'DPM', 'Podiatry', '', '', NULL, 'B', '30 S Michigan Ave  Ste 503', 'Chicago', 'Cook', 'IL', '60603', '3123721160', '3123723346', '30 S Michigan Ave  Ste 503', 'Chicago', 'Cook', 'IL', '60603', '3123721160', '3123723346', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, '', '', 'HCFA|UB|', '1467606152', 0, 'N', 0, '2013-04-26', NULL, NULL, 41.8811, -87.625, NULL, NULL),
('364130066', 'IL0000593', 'IL0000593', 'ILCHIGSTD', 'Professional Foot Care Specialists', 'Jesse', '', 'Plasencia', 'DPM', 'Podiatry', '', '', NULL, 'O', '19 N Grant St', 'Hinsdale', 'Dupage', 'IL', '60521', '6303232882', '6303232966', '19 N Grant St', 'Hinsdale', 'Dupage', 'IL', '60521', '6303232882', '6303232966', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1669562674', 0, 'N', 0, '2013-04-26', NULL, NULL, 41.8038, -87.9324, NULL, NULL),
('364130066', 'IL0000594', 'IL0000594', 'ILCHIGSTD', '', 'Jesse', '', 'Plasencia', 'DPM', 'Podiatry', '', '', NULL, 'B', '30 S Michigan Ave  Ste 503', 'Chicago', 'Cook', 'IL', '60603', '3123721160', '3123723346', '30 S Michigan Ave  Ste 503', 'Chicago', 'Cook', 'IL', '60603', '3123721160', '3123723346', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1669562674', 0, 'N', 0, '2013-04-26', NULL, NULL, 41.8811, -87.625, NULL, NULL),
('364130066', 'IL0000592', 'IL0000592', 'ILCHIGSTD', 'Professional Foot Care Specialists', 'Jesse', '', 'Plasencia', 'DPM', 'Podiatry', '', '', NULL, 'O', '5241 S Cicero Ave', 'Chicago', 'Cook', 'IL', '60632', '7732848811', '7732846431', '5241 S Cicero Ave', 'Chicago', 'Cook', 'IL', '60632', '7732848811', '7732846431', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1669562674', 0, 'N', 0, '2013-04-26', NULL, NULL, 41.7977, -87.7427, NULL, NULL),
('364130066', 'IL0000553', 'IL0000553', 'ILCHIGSTD', 'Advanced Foot and Ankle', 'John', 'M', 'Limanowski', 'DPM', 'Podiatry', '', '', NULL, 'O', '1036 Ogden Ave', 'Downers Grove', 'Dupage', 'IL', '60515', '6309684416', '6309684930', '1036 Ogden Ave', 'Downers Grove', 'Dupage', 'IL', '60515', '6309684416', '6309684930', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1356389332', 0, 'N', 0, '2013-04-16', NULL, NULL, 41.8088, -88.0116, NULL, NULL),
('364130066', 'IL0000554', 'IL0000554', 'ILCHIGSTD', '', 'John', 'M', 'Limanowski', 'DPM', 'Podiatry', '', '', NULL, 'B', '30 S Michigan Ave  Ste 503', 'Chicago', 'Cook', 'IL', '60603', '3123721160', '3123723346', '30 S Michigan Ave  Ste 503', 'Chicago', 'Cook', 'IL', '60603', '3123721160', '3123723346', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1356389332', 0, 'N', 0, '2013-03-18', NULL, NULL, 41.8811, -87.625, NULL, NULL),
('364130066', 'IL0000608', 'IL0000608', 'ILCHIGSTD', 'Foot and Ankle Center of Illinois', 'John', 'M', 'Sigle', 'DPM', 'Podiatry', '', '', NULL, 'O', '2921 Montvale Dr', 'Springfield', 'Sangamon', 'IL', '62704', '2177872700', '2177872715', '2921 Montvale Dr', 'Springfield', 'Sangamon', 'IL', '62704', '2177872700', '2177872715', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1174502868', 0, 'Y', 0, '2013-03-06', NULL, NULL, 39.7672, -89.6932, NULL, NULL),
('364130066', 'IL0000609', 'IL0000609', 'ILCHIGSTD', '', 'John', 'M', 'Sigle', 'DPM', 'Podiatry', '', '', NULL, 'B', '30 S Michigan Ave  Ste 503', 'Chicago', 'Cook', 'IL', '60603', '3123721160', '3123723346', '30 S Michigan Ave  Ste 503', 'Chicago', 'Cook', 'IL', '60603', '3123721160', '3123723346', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1174502868', 0, 'N', 0, '2013-03-06', NULL, NULL, 41.8811, -87.625, NULL, NULL),
('364130066', 'IL0000646', 'IL0000646', 'ILCHIGSTD', 'Podiatry Center SC', 'John', 'M', 'Wray', 'DPM', 'Podiatry', '', '', NULL, 'O', '30 N Michigan Ave Ste 1129', 'Chicago', 'Cook', 'IL', '60602', '3123720919', '3123721606', '30 N Michigan Ave Ste 1129', 'Chicago', 'Cook', 'IL', '60602', '3123720919', '3123721606', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, NULL, NULL, 'HCFA|UB|', '1366436131', 0, 'N', 0, '2012-12-05', NULL, NULL, 41.8824, -87.6245, NULL, NULL),
('364130066', 'IL0000648', 'IL0000648', 'ILCHIGSTD', '', 'John', 'M', 'Wray', 'DPM', 'Podiatry', '', '', NULL, 'B', '30 S Michigan Ave  Ste 503', 'Chicago', 'Cook', 'IL', '60603', '3123721160', '3123723346', '30 S Michigan Ave  Ste 503', 'Chicago', 'Cook', 'IL', '60603', '3123721160', '3123723346', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, NULL, NULL, 'HCFA|UB|', '1366436131', 0, 'N', 0, '2012-12-05', NULL, NULL, 41.8811, -87.625, NULL, NULL),
('364130066', 'IL0000647', 'IL0000647', 'ILCHIGSTD', 'John Wray DPM', 'John', 'M', 'Wray', 'DPM', 'Podiatry', '', '', NULL, 'O', '424 75th St', 'Downers Grove', 'Dupage', 'IL', '60516', '6305150705', '6305150783', '424 75th St', 'Downers Grove', 'Dupage', 'IL', '60516', '6305150705', '6305150783', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, NULL, NULL, 'HCFA|UB|', '1366436131', 0, 'N', 0, '2012-12-05', NULL, NULL, 41.7515, -87.9939, NULL, NULL),
('364130066', 'IL0000576', 'IL0000576', 'ILCHIGSTD', 'Park Ridge Podiatry', 'Jordan', 'J', 'Nichols', 'DPM', 'Podiatry', '', '', NULL, 'O', '135 N Northwest Hwy', 'Park Ridge', 'Cook', 'IL', '60068', '8478235077', '8478230371', '135 N Northwest Hwy', 'Park Ridge', 'Cook', 'IL', '60068', '8478235077', '8478230371', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1982684601', 0, 'N', 0, '2013-03-18', NULL, NULL, 42.0134, -87.8329, NULL, NULL),
('364130066', 'IL0000577', 'IL0000577', 'ILCHIGSTD', '', 'Jordan', 'J', 'Nichols', 'DPM', 'Podiatry', '', '', NULL, 'B', '30 S Michigan Ave  Ste 503', 'Chicago', 'Cook', 'IL', '60603', '3123721160', '3123723346', '30 S Michigan Ave  Ste 503', 'Chicago', 'Cook', 'IL', '60603', '3123721160', '3123723346', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1982684601', 0, 'N', 0, '2013-03-18', NULL, NULL, 41.8811, -87.625, NULL, NULL),
('363395596', 'W12041477', 'W12041477', 'ILCHIGSTD', 'Northwest Oncology and Hematology Associates', 'Bruce ', '', 'Bank', 'MD', 'Hematology and Oncology', '', '', NULL, 'O', '1555  Barrington Rd Ste 1200', 'Hoffman Estates', 'Cook', 'IL', '60169', '8478854100', '8478854199', '1555  Barrington Rd Ste 1200', 'Hoffman Estates', 'Cook', 'IL', '60169', '8478854100', '8478854199', 'CHIG12ONC', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Northwest Community Hospital', '', '', '', 'HCFA|UB|', '1225099823', 0, 'N', 0, '2014-04-25', NULL, NULL, 42.0542, -88.1444, NULL, NULL),
('364130066', 'W12026260', 'W12026260', 'ILCHIGSTD', 'Advanced Podiatry', 'Mark', 'J', 'Gagnon', 'DPM', 'Podiatry', '', '', NULL, 'O', '4749 W 138th St', 'Crestwood', 'Cook', 'IL', '60445', '7083854520', '7083854594', '4749 W 138th St', 'Crestwood', 'Cook', 'IL', '60445', '7083854520', '7083854594', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1043261282', 0, 'N', 0, '2013-04-04', NULL, NULL, 41.6422, -87.7366, NULL, NULL),
('364130066', 'IL0000480', 'IL0000480', 'ILCHIGSTD', '', 'Joseph', 'M', 'Coscino', 'DPM', 'Podiatry', '', '', NULL, 'B', '30 S Michigan Ave  Ste 503', 'Chicago', 'Cook', 'IL', '60603', '3123721160', '3123723346', '30 S Michigan Ave  Ste 503', 'Chicago', 'Cook', 'IL', '60603', '3123721160', '3123723346', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1093707796', 0, 'N', 0, '2013-03-13', NULL, NULL, 41.8811, -87.625, NULL, NULL),
('364130066', 'W12026145', 'W12026145', 'ILCHIGSTD', 'Premier Foot and Ankle Center', 'Joseph', 'M', 'Coscino', 'DPM', 'Podiatry', '', '', NULL, 'O', '1S067 Summit Ave', 'Villa Park', 'Dupage', 'IL', '60181', '6302619500', '6302619504', '1S067 Summit Ave', 'Villa Park', 'Dupage', 'IL', '60181', '6302619500', '6302619504', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', '2013-04-15', 0, 0, 0, 'Presence Saint Joseph Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1093707796', 0, 'N', 0, '2013-04-16', NULL, NULL, 0, 0, NULL, NULL),
('364130066', 'IL0000605', 'IL0000605', 'ILCHIGSTD', '', 'Kathleen', 'M', 'Schafer', 'DPM', 'Podiatry', '', '', NULL, 'B', '30 S Michigan Ave  Ste 503', 'Chicago', 'Cook', 'IL', '60603', '3123721160', '3123723346', '30 S Michigan Ave  Ste 503', 'Chicago', 'Cook', 'IL', '60603', '3123721160', '3123723346', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1346287505', 0, 'N', 0, '2012-12-05', NULL, NULL, 41.8811, -87.625, NULL, NULL),
('364130066', 'IL0000603', 'IL0000603', 'ILCHIGSTD', 'Southwest Foot and Ankle Specialist', 'Kathleen', 'M', 'Schafer', 'DPM', 'Podiatry', '', '', NULL, 'O', '9132 Ogden Ave', 'Brookfield', 'Cook', 'IL', '60513', '7084853668', '7084857866', '9132 Ogden Ave', 'Brookfield', 'Cook', 'IL', '60513', '7084853668', '7084857866', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1346287505', 0, 'N', 0, '2012-12-05', NULL, NULL, 41.8169, -87.8504, NULL, NULL),
('364130066', 'IL0000503', 'IL0000503', 'ILCHIGSTD', 'Algonquin Foot and Ankle Institute', 'Kevin', 'S', 'Gavin', 'DPM', 'Podiatry', '', '', NULL, 'O', '1219 S Main St', 'Algonquin', 'McHenry', 'IL', '60102', '8474581800', '8474588447', '1219 S Main St', 'Algonquin', 'McHenry', 'IL', '60102', '8474581800', '8474588447', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1861424624', 0, 'N', 0, '2013-04-01', NULL, NULL, 42.157, -88.2968, NULL, NULL),
('364130066', 'IL0000504', 'IL0000504', 'ILCHIGSTD', 'Woodstock Foot and Ankle Institute', 'Kevin', 'S', 'Gavin', 'DPM', 'Podiatry', '', '', NULL, 'O', '1666 S Eastwood Dr', 'Woodstock', 'McHenry', 'IL', '60098', '8153386800', '8153387105', '1666 S Eastwood Dr', 'Woodstock', 'McHenry', 'IL', '60098', '8153386800', '8153387105', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1861424624', 0, 'N', 0, '2013-04-01', NULL, NULL, 42.297, -88.4333, NULL, NULL),
('364130066', 'IL0000505', 'IL0000505', 'ILCHIGSTD', '', 'Kevin', 'S', 'Gavin', 'DPM', 'Podiatry', '', '', NULL, 'B', '30 S Michigan Ave  Ste 503', 'Chicago', 'Cook', 'IL', '60603', '3123721160', '3123723346', '30 S Michigan Ave  Ste 503', 'Chicago', 'Cook', 'IL', '60603', '3123721160', '3123723346', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1861424624', 0, 'N', 0, '2013-04-01', NULL, NULL, 41.8811, -87.625, NULL, NULL),
('364130066', 'IL0000560', 'IL0000560', 'ILCHIGSTD', 'Podiatry Consultants of Chicago', 'Lawrence', '', 'Marczak', 'DPM', 'Podiatry', '', '', NULL, 'O', '30 N Michigan Ave Ste 1229', 'Chicago', 'Cook', 'IL', '60602', '3123320041', '3123322324', '30 N Michigan Ave Ste 1229', 'Chicago', 'Cook', 'IL', '60602', '3123320041', '3123322324', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1831129170', 0, 'N', 0, '2013-03-18', NULL, NULL, 41.8824, -87.6245, NULL, NULL),
('364130066', 'IL0000625', 'IL0000625', 'ILCHIGSTD', '', 'Larry', 'J', 'Wapiennik II', 'DPM', 'Podiatry', '', '', NULL, 'B', '30 S Michigan Ave  Ste 503', 'Chicago', 'Cook', 'IL', '60603', '3123721160', '3123723346', '30 S Michigan Ave  Ste 503', 'Chicago', 'Cook', 'IL', '60603', '3123721160', '3123723346', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', '2013-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1740334150', 0, 'N', 0, '2013-02-21', NULL, NULL, 41.8811, -87.625, NULL, NULL),
('364130066', 'W12026146', 'W12026146', 'ILCHIGSTD', 'Larry J Wapiennik II  DPM', 'Larry', 'J', 'Wapiennik II', 'DPM', 'Podiatry', '', '', NULL, 'O', '11406 Broadway', 'Crown Point', 'Lake', 'IN', '46307', '2196637737', '2196637733', '11406 Broadway', 'Crown Point', 'Lake', 'IN', '46307', '2196637737', '2196637733', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1740334150', 0, 'Y', 0, '2013-02-21', NULL, NULL, 41.4111, -87.3354, NULL, NULL),
('364130066', 'IL0000562', 'IL0000562', 'ILCHIGSTD', '', 'Lawrence', '', 'Marczak', 'DPM', 'Podiatry', '', '', NULL, 'B', '30 S Michigan Ave  Ste 503', 'Chicago', 'Cook', 'IL', '60603', '3123721160', '3123723346', '30 S Michigan Ave  Ste 503', 'Chicago', 'Cook', 'IL', '60603', '3123721160', '3123723346', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1831129170', 0, 'N', 0, '2013-03-18', NULL, NULL, 41.8811, -87.625, NULL, NULL),
('364130066', 'IL0000561', 'IL0000561', 'ILCHIGSTD', 'Podiatry Consultants of Chicago', 'Lawrence', '', 'Marczak', 'DPM', 'Podiatry', '', '', NULL, 'O', '5511 1/2 West Monroe', 'Chicago', 'Cook', 'IL', '60641', '7732836200', '7732837578', '5511 1/2 West Monroe', 'Chicago', 'Cook', 'IL', '60641', '7732836200', '7732837578', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1831129170', 0, 'N', 0, '2013-03-18', NULL, NULL, 41.879, -87.7623, NULL, NULL),
('364130066', 'IL0000518', 'IL0000518', 'ILCHIGSTD', 'Professional Foot Care Specialists', 'Malcolm', 'D', 'Herzog', 'DPM', 'Podiatry', '', '', NULL, 'O', '19 N Grant St', 'Hinsdale', 'Dupage', 'IL', '60521', '6303232882', '6303232966', '19 N Grant St', 'Hinsdale', 'Dupage', 'IL', '60521', '6303232882', '6303232966', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', '2013-03-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1356450415', 0, 'N', 0, '2013-03-12', NULL, NULL, 41.8045, -87.932, NULL, NULL),
('364130066', 'IL0000519', 'IL0000519', 'ILCHIGSTD', '', 'Malcolm', 'D', 'Herzog', 'DPM', 'Podiatry', '', '', NULL, 'B', '30 S Michigan Ave  Ste 503', 'Chicago', 'Cook', 'IL', '60603', '3123721160', '3123723346', '30 S Michigan Ave  Ste 503', 'Chicago', 'Cook', 'IL', '60603', '3123721160', '3123723346', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', '2013-03-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1356450415', 0, 'N', 0, '2013-03-12', NULL, NULL, 41.8811, -87.625, NULL, NULL),
('364130066', 'IL0000517', 'IL0000517', 'ILCHIGSTD', 'Professional Foot Care Specialists', 'Malcolm', 'D', 'Herzog', 'DPM', 'Podiatry', '', '', NULL, 'O', '5241 S Cicero Ave', 'Chicago', 'Cook', 'IL', '60632', '7732848811', '7732846431', '5241 S Cicero Ave', 'Chicago', 'Cook', 'IL', '60632', '7732848811', '7732846431', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', '2013-03-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1356450415', 0, 'N', 0, '2013-03-12', NULL, NULL, 41.7975, -87.7425, NULL, NULL),
('364130066', 'IL0000650', 'IL0000650', 'ILCHIGSTD', 'Malik Zayed DPM', 'Malik', '', 'Zayed', 'DPM', 'Podiatry', '', '', NULL, 'B', '30 S Michigan Ave  Ste 503', 'Chicago', 'Cook', 'IL', '60603', '3123721160', '3123723346', '30 S Michigan Ave  Ste 503', 'Chicago', 'Cook', 'IL', '60603', '3123721160', '3123723346', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Our Lady Of The Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1881624872', 0, 'N', 0, '2013-02-28', NULL, NULL, 41.8811, -87.625, NULL, NULL),
('364130066', 'IL0000649', 'IL0000649', 'ILCHIGSTD', 'Malik Zayed DPM', 'Malik', '', 'Zayed', 'DPM', 'Podiatry', '', '', NULL, 'O', '3631 N Harlem Ave', 'Chicago', 'Cook', 'IL', '60634', '7732378226', '7732370902', '3631 N Harlem Ave', 'Chicago', 'Cook', 'IL', '60634', '7732378226', '7732370902', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Our Lady Of The Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1881624872', 0, 'N', 0, '2013-02-28', NULL, NULL, 41.9459, -87.807, NULL, NULL),
('364130066', 'IL0000499', 'IL0000499', 'ILCHIGSTD', '', 'Mark', 'J', 'Gagnon', 'DPM', 'Podiatry', '', '', NULL, 'B', '30 S Michigan Ave  Ste 503', 'Chicago', 'Cook', 'IL', '60603', '3123721160', '3123723346', '30 S Michigan Ave  Ste 503', 'Chicago', 'Cook', 'IL', '60603', '3123721160', '3123723346', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1043261282', 0, 'N', 0, '2013-03-14', NULL, NULL, 41.8811, -87.625, NULL, NULL),
('364130066', 'W12026261', 'W12026261', 'ILCHIGSTD', 'Advanced Podiatry', 'Mark', 'J', 'Gagnon', 'DPM', 'Podiatry', '', '', NULL, 'O', '8600 W 159th St', 'Orland Park', 'Cook', 'IL', '60463', '7084037250', '7084037259', '8600 W 159th St', 'Orland Park', 'Cook', 'IL', '60463', '7084037250', '7084037259', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1043261282', 0, 'N', 0, '2013-03-14', NULL, NULL, 41.6018, -87.8284, NULL, NULL),
('364130066', 'IL0000496', 'IL0000496', 'ILCHIGSTD', 'Advanced Podiatry', 'Mark', 'J', 'Gagnon', 'DPM', 'Podiatry', '', '', NULL, 'O', '7355 Archer Ave', 'Summit', 'Cook', 'IL', '60501', '7732298200', '7732299752', '7355 Archer Ave', 'Summit', 'Cook', 'IL', '60501', '7732298200', '7732299752', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1043261282', 0, 'N', 0, '2013-03-14', NULL, NULL, 41.7918, -87.8055, NULL, NULL),
('364130066', 'W12026262', 'W12026262', 'ILCHIGSTD', 'T L Foster DPM', 'Terri', 'L', 'Foster', 'DPM', 'Podiatry', '', '', NULL, 'O', '4440 W Lincoln Hwy Ste 102', 'Matteson', 'Cook', 'IL', '60443', '7084813338', '7084818643', '4440 W Lincoln Hwy Ste 102', 'Matteson', 'Cook', 'IL', '60443', '7084813338', '7084818643', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1720010481', 0, 'N', 0, '2013-03-15', NULL, NULL, 41.5062, -87.7235, NULL, NULL),
('364130066', 'W12026265', 'W12026265', 'ILCHIGSTD', 'Cary Grove Foot and Ankle Center', 'James', 'C', 'Massaro', 'DPM', 'Podiatry', '', '', NULL, 'O', '113 W Main St', 'Cary', 'McHenry', 'IL', '60013', '8476395800', '8476392980', '113 W Main St', 'Cary', 'McHenry', 'IL', '60013', '8476395800', '8476392980', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', '2013-03-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1124072459', 0, 'N', 0, '2013-03-12', NULL, NULL, 0, 0, NULL, NULL),
('364130066', 'IL0000547', 'IL0000547', 'ILCHIGSTD', '', 'Mark', 'A', 'Konieczny', 'DPM', 'Podiatry', '', '', NULL, 'B', '30 S Michigan Ave  Ste 503', 'Chicago', 'Cook', 'IL', '60603', '3123721160', '3123723346', '30 S Michigan Ave  Ste 503', 'Chicago', 'Cook', 'IL', '60603', '3123721160', '3123723346', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1003896978', 0, 'N', 0, '2013-03-18', NULL, NULL, 41.8811, -87.625, NULL, NULL),
('364130066', 'IL0000601', 'IL0000601', 'ILCHIGSTD', 'Central Podiatry', 'Mark', 'A', 'Ryerson', 'DPM', 'Podiatry', '', '', NULL, 'O', '125 E Central Rd', 'Arlington Heights', 'Cook', 'IL', '60005', '8472550330', '8472551785', '125 E Central Rd', 'Arlington Heights', 'Cook', 'IL', '60005', '8472550330', '8472551785', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1356395875', 0, 'N', 0, '2013-03-06', NULL, NULL, 42.0664, -87.9809, NULL, NULL),
('364130066', 'IL0000602', 'IL0000602', 'ILCHIGSTD', '', 'Mark', 'A', 'Ryerson', 'DPM', 'Podiatry', '', '', NULL, 'B', '30 S Michigan Ave  Ste 503', 'Chicago', 'Cook', 'IL', '60603', '3123721160', '3123723346', '30 S Michigan Ave  Ste 503', 'Chicago', 'Cook', 'IL', '60603', '3123721160', '3123723346', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1356395875', 0, 'N', 0, '2013-03-06', NULL, NULL, 41.8811, -87.625, NULL, NULL),
('364130066', 'IL0000501', 'IL0000501', 'ILCHIGSTD', 'Professional Foot Care Specialists', 'Matthew', 'G', 'Garoufalis', 'DPM', 'Podiatry', '', '', NULL, 'O', '19 N Grant St', 'Hinsdale', 'Dupage', 'IL', '60521', '6303232882', '6303232966', '19 N Grant St', 'Hinsdale', 'Dupage', 'IL', '60521', '6303232882', '6303232966', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1417066689', 0, 'N', 0, '2013-03-14', NULL, NULL, 41.8038, -87.9324, NULL, NULL),
('364130066', 'IL0000502', 'IL0000502', 'ILCHIGSTD', '', 'Matthew', 'G', 'Garoufalis', 'DPM', 'Podiatry', '', '', NULL, 'B', '30 S Michigan Ave  Ste 503', 'Chicago', 'Cook', 'IL', '60603', '3123721160', '3123723346', '30 S Michigan Ave  Ste 503', 'Chicago', 'Cook', 'IL', '60603', '3123721160', '3123723346', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1417066689', 0, 'N', 0, '2013-03-14', NULL, NULL, 41.8811, -87.625, NULL, NULL),
('364130066', 'IL0000500', 'IL0000500', 'ILCHIGSTD', 'Professional Foot Care Specialists', 'Matthew', 'G', 'Garoufalis', 'DPM', 'Podiatry', '', '', NULL, 'O', '5241 S Cicero Ave', 'Chicago', 'Cook', 'IL', '60632', '7732848811', '7732846431', '5241 S Cicero Ave', 'Chicago', 'Cook', 'IL', '60632', '7732848811', '7732846431', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1417066689', 0, 'N', 0, '2013-03-14', NULL, NULL, 41.7977, -87.7427, NULL, NULL),
('364130066', 'IL0000524', 'IL0000524', 'ILCHIGSTD', 'Advanced Foot and Ankle', 'Michael', 'R', 'Hollander', 'DPM', 'Podiatry', '', '', NULL, 'O', '10 W Phillip Rd Ste 114', 'Vernon Hills', 'Lake', 'IL', '60061', '8472470053', '8476321156', '10 W Phillip Rd Ste 114', 'Vernon Hills', 'Lake', 'IL', '60061', '8472470053', '8476321156', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1457353096', 0, 'N', 0, '2013-04-16', NULL, NULL, 42.2393, -87.9654, NULL, NULL),
('364130066', 'IL0000523', 'IL0000523', 'ILCHIGSTD', 'Advanced Foot and Ankle', 'Michael', 'R', 'Hollander', 'DPM', 'Podiatry', '', '', NULL, 'O', '30 S Michigan Ave Ste 302', 'Chicago', 'Cook', 'IL', '60603', '3122360680', '3123723871', '30 S Michigan Ave Ste 302', 'Chicago', 'Cook', 'IL', '60603', '3122360680', '3123723871', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1457353096', 0, 'N', 0, '2013-04-16', NULL, NULL, 41.8817, -87.6245, NULL, NULL),
('364130066', 'IL0000522', 'IL0000522', 'ILCHIGSTD', 'Advanced Foot and Ankle', 'Michael', 'R', 'Hollander', 'DPM', 'Podiatry', '', '', NULL, 'O', '350 W Kensington Rd Ste 114', 'Mt Prospect', 'Cook', 'IL', '60056', '8476321155', '8476321156', '350 W Kensington Rd Ste 114', 'Mt Prospect', 'Cook', 'IL', '60056', '8476321155', '8476321156', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1457353096', 0, 'N', 0, '2013-04-16', NULL, NULL, 42.0808, -87.9411, NULL, NULL),
('364130066', 'IL0000525', 'IL0000525', 'ILCHIGSTD', 'Advanced Foot and Ankle', 'Michael', 'R', 'Hollander', 'DPM', 'Podiatry', '', '', NULL, 'O', '9701 Knox Ave Ste 103', 'Skokie', 'Cook', 'IL', '60076', '8476321155', '8476321156', '9701 Knox Ave Ste 103', 'Skokie', 'Cook', 'IL', '60076', '8476321155', '8476321156', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1457353096', 0, 'N', 0, '2013-04-16', NULL, NULL, 42.0567, -87.7432, NULL, NULL),
('364130066', 'IL0000552', 'IL0000552', 'ILCHIGSTD', '', 'Michael', 'J', 'Leonetti', 'DPM', 'Podiatry', '', '', NULL, 'B', '30 S Michigan Ave  Ste 503', 'Chicago', 'Cook', 'IL', '60603', '3123721160', '3123723346', '30 S Michigan Ave  Ste 503', 'Chicago', 'Cook', 'IL', '60603', '3123721160', '3123723346', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1649246620', 0, 'N', 0, '2013-03-18', NULL, NULL, 41.8811, -87.625, NULL, NULL),
('364130066', 'IL0000551', 'IL0000551', 'ILCHIGSTD', 'Barrington Foot Care', 'Michael', 'J', 'Leonetti', 'DPM', 'Podiatry', '', '', NULL, 'O', '660 S Northwest Hwy', 'Barrington', 'Lake', 'IL', '60010', '8473815141', '8473825141', '660 S Northwest Hwy', 'Barrington', 'Lake', 'IL', '60010', '8473815141', '8473825141', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1649246620', 0, 'N', 0, '2013-03-18', NULL, NULL, 42.1499, -88.1259, NULL, NULL),
('364130066', 'IL0000550', 'IL0000550', 'ILCHIGSTD', 'Advanced Foot and Ankle', 'Michael', 'J', 'Leonetti', 'DPM', 'Podiatry', '', '', NULL, 'O', '9042 W 31st St', 'Brookfield', 'Cook', 'IL', '60513', '7084859300', '7083542822', '9042 W 31st St', 'Brookfield', 'Cook', 'IL', '60513', '7084859300', '7083542822', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1649246620', 0, 'N', 0, '2013-04-16', NULL, NULL, 41.835, -87.8485, NULL, NULL),
('364130066', 'IL0000580', 'IL0000580', 'ILCHIGSTD', 'Michal Palliser DPM', 'Michael', 'J', 'Palliser', 'DPM', 'Podiatry', '', '', NULL, 'O', '2 Talcott Rd Ste 23', 'Park Ridge', 'Cook', 'IL', '60068', '8476923700', '8476923838', '2 Talcott Rd Ste 23', 'Park Ridge', 'Cook', 'IL', '60068', '8476923700', '8476923838', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1427154319', 0, 'N', 0, '2013-04-17', NULL, NULL, 41.9934, -87.8221, NULL, NULL),
('364130066', 'IL0000581', 'IL0000581', 'ILCHIGSTD', '', 'Michael', 'J', 'Palliser', 'DPM', 'Podiatry', '', '', NULL, 'B', '30 S Michigan Ave  Ste 503', 'Chicago', 'Cook', 'IL', '60603', '3123721160', '3123723346', '30 S Michigan Ave  Ste 503', 'Chicago', 'Cook', 'IL', '60603', '3123721160', '3123723346', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1427154319', 0, 'N', 0, '2013-04-17', NULL, NULL, 41.8811, -87.625, NULL, NULL),
('364130066', 'IL0000606', 'IL0000606', 'ILCHIGSTD', 'Podiatric Management Systems', 'Michael', 'A', 'Schwartzman', 'DPM', 'Podiatry', '', '', NULL, 'O', '1213 Joliet Rd Ste C', 'West Chicago', 'Dupage', 'IL', '60185', '6302933668', '6302936673', '1213 Joliet Rd Ste C', 'West Chicago', 'Dupage', 'IL', '60185', '6302933668', '6302936673', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1477547131', 0, 'N', 0, '2013-03-27', NULL, NULL, 41.865, -88.2046, NULL, NULL),
('364130066', 'IL0000607', 'IL0000607', 'ILCHIGSTD', 'Podiatric Management Systems', 'Michael', 'A', 'Schwartzman', 'DPM', 'Podiatry', '', '', NULL, 'B', '30 S Michigan Ave  Ste 503', 'Chicago', 'Cook', 'IL', '60603', '3123721160', '3123723346', '30 S Michigan Ave  Ste 503', 'Chicago', 'Cook', 'IL', '60603', '3123721160', '3123723346', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1477547131', 0, 'N', 0, '2013-03-27', NULL, NULL, 41.8811, -87.625, NULL, NULL),
('364130066', 'IL0000545', 'IL0000545', 'ILCHIGSTD', '', 'Milton', '', 'Kondiles', 'DPM', 'Podiatry', '', '', NULL, 'B', '30 S Michigan Ave  Ste 503', 'Chicago', 'Cook', 'IL', '60603', '3123721160', '3123723346', '30 S Michigan Ave  Ste 503', 'Chicago', 'Cook', 'IL', '60603', '3123721160', '3123723346', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Our Lady Of The Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1548327711', 0, 'N', 0, '2013-03-18', NULL, NULL, 41.8811, -87.625, NULL, NULL),
('364130066', 'IL0000543', 'IL0000543', 'ILCHIGSTD', 'Kondiles Chicagoland Foot Care', 'Milton', '', 'Kondiles', 'DPM', 'Podiatry', '', '', NULL, 'O', '501 N Riverside Dr Ste 216', 'Gurnee', 'Lake', 'IL', '60031', '7735453338', '7735453788', '501 N Riverside Dr Ste 216', 'Gurnee', 'Lake', 'IL', '60031', '7735453338', '7735453788', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Our Lady Of The Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1548327711', 0, 'N', 0, '2013-03-18', NULL, NULL, 42.3675, -87.9256, NULL, NULL),
('364130066', 'IL0000542', 'IL0000542', 'ILCHIGSTD', 'Kondiles Chicagoland Foot Care', 'Milton', '', 'Kondiles', 'DPM', 'Podiatry', '', '', NULL, 'O', '5600 W Addison St Ste 2', 'Chicago', 'Cook', 'IL', '60634', '7735453338', '7735453788', '5600 W Addison St Ste 2', 'Chicago', 'Cook', 'IL', '60634', '7735453338', '7735453788', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Our Lady Of The Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1548327711', 0, 'N', 0, '2013-03-18', NULL, NULL, 41.9459, -87.7667, NULL, NULL),
('364130066', 'IL0000544', 'IL0000544', 'ILCHIGSTD', 'North Shore Medical Group', 'Milton', '', 'Kondiles', 'DPM', 'Podiatry', '', '', NULL, 'O', '7380 N Lincoln Ave', 'Lincolnwood', 'Cook', 'IL', '60712', '7735453338', '7735453788', '7380 N Lincoln Ave', 'Lincolnwood', 'Cook', 'IL', '60712', '7735453338', '7735453788', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Our Lady Of The Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1548327711', 0, 'N', 0, '2013-03-18', NULL, NULL, 42.0146, -87.7432, NULL, NULL),
('364130066', 'IL0000548', 'IL0000548', 'ILCHIGSTD', 'Nancy Lee DPM', 'Nancy', 'M', 'Lee', 'DPM', 'Podiatry', '', '', NULL, 'O', '231 Main St', 'Park Forest', 'Cook', 'IL', '60466', '7087483338', '7087484332', '231 Main St', 'Park Forest', 'Cook', 'IL', '60466', '7087483338', '7087484332', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1619062023', 0, 'N', 0, '2013-04-26', NULL, NULL, 41.4835, -87.6785, NULL, NULL),
('364130066', 'IL0000549', 'IL0000549', 'ILCHIGSTD', '', 'Nancy', 'M', 'Lee', 'DPM', 'Podiatry', '', '', NULL, 'B', '30 S Michigan Ave  Ste 503', 'Chicago', 'Cook', 'IL', '60603', '3123721160', '3123723346', '30 S Michigan Ave  Ste 503', 'Chicago', 'Cook', 'IL', '60603', '3123721160', '3123723346', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1619062023', 0, 'N', 0, '2013-04-26', NULL, NULL, 41.8811, -87.625, NULL, NULL),
('364130066', 'IL0000494', 'IL0000494', 'ILCHIGSTD', 'A Foot and Ankle Centre', 'Neal', 'R', 'Frankel', 'DPM', 'Podiatry', '', '', NULL, 'O', '2425 W 22nd St Ste 204 A', 'Oak Brook', 'Dupage', 'IL', '60523', '3123723117', '3123723871', '2425 W 22nd St Ste 204 A', 'Oak Brook', 'Dupage', 'IL', '60523', '3123723117', '3123723871', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, NULL, NULL, 'HCFA|UB|', '1386868966', 0, 'N', 0, '2013-03-13', NULL, NULL, 41.846, -87.9782, NULL, NULL),
('364130066', 'IL0000492', 'IL0000492', 'ILCHIGSTD', 'A Foot and Ankle Centre', 'Neal', 'R', 'Frankel', 'DPM', 'Podiatry', '', '', NULL, 'O', '30 S Michigan Ave Ste 302', 'Chicago', 'Cook', 'IL', '60603', '3123723117', '3123723871', '30 S Michigan Ave Ste 302', 'Chicago', 'Cook', 'IL', '60603', '3123723117', '3123723871', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, NULL, NULL, 'HCFA|UB|', '1386868966', 0, 'N', 0, '2013-03-13', NULL, NULL, 41.8817, -87.6245, 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
('364130066', 'IL0000493', 'IL0000493', 'ILCHIGSTD', 'Neal Frankel DPM', 'Neal', 'R', 'Frankel', 'DPM', 'Podiatry', '', '', NULL, 'O', '9669 N Lincoln Ave', 'Lincolnwood', 'Cook', 'IL', '60712', '3123723117', '3123723871', '9669 N Lincoln Ave', 'Lincolnwood', 'Cook', 'IL', '60712', '3123723117', '3123723871', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, NULL, NULL, 'HCFA|UB|', '1386868966', 0, 'N', 0, '2013-03-13', NULL, NULL, 42.0152, -87.7438, NULL, NULL),
('364130066', 'IL0000578', 'IL0000578', 'ILCHIGSTD', 'Naperville Foot Clinic', 'Patricia', 'M', 'ODonnell', 'DPM', 'Podiatry', '', '', NULL, 'O', '1279 S Naper Blvd', 'Naperville', 'Dupage', 'IL', '60540', '6309615300', '6305483905', '1279 S Naper Blvd', 'Naperville', 'Dupage', 'IL', '60540', '6309615300', '6305483905', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1013047190', 0, 'N', 0, '2013-03-18', NULL, NULL, 41.7516, -88.1152, NULL, NULL),
('364130066', 'IL0000579', 'IL0000579', 'ILCHIGSTD', '', 'Patricia', 'M', 'ODonnell', 'DPM', 'Podiatry', '', '', NULL, 'B', '30 S Michigan Ave  Ste 503', 'Chicago', 'Cook', 'IL', '60603', '3123721160', '3123723346', '30 S Michigan Ave  Ste 503', 'Chicago', 'Cook', 'IL', '60603', '3123721160', '3123723346', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1013047190', 0, 'N', 0, '2013-03-18', NULL, NULL, 41.8811, -87.625, NULL, NULL),
('364130066', 'IL0000567', 'IL0000567', 'ILCHIGSTD', 'Cary Grove Foot and Ankle Center', 'Patrick', 'A', 'McEneaney', '', 'Podiatry', '', '', NULL, 'O', '113 W Main St', 'Cary', 'McHenry', 'IL', '60013', '8476395800', '8476392980', '113 W Main St', 'Cary', 'McHenry', 'IL', '60013', '8476395800', '8476392980', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', '2013-03-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1174613319', 0, 'N', 0, '2013-03-12', NULL, NULL, 0, 0, NULL, NULL),
('364130066', 'IL0000568', 'IL0000568', 'ILCHIGSTD', '', 'Patrick', 'A', 'McEneaney', '', 'Podiatry', '', '', NULL, 'B', '30 S Michigan Ave  Ste 503', 'Chicago', 'Cook', 'IL', '60603', '3123721160', '3123723346', '30 S Michigan Ave  Ste 503', 'Chicago', 'Cook', 'IL', '60603', '3123721160', '3123723346', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', '2013-03-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1174613319', 0, 'N', 0, '2013-03-12', NULL, NULL, 41.8811, -87.625, NULL, NULL),
('364130066', 'IL0000489', 'IL0000489', 'ILCHIGSTD', '', 'Phillip', 'L', 'Forni', 'DPM', 'Podiatry', '', '', NULL, 'B', '30 S Michigan Ave  Ste 503', 'Chicago', 'Cook', 'IL', '60603', '3123721160', '3123723346', '30 S Michigan Ave  Ste 503', 'Chicago', 'Cook', 'IL', '60603', '3123721160', '3123723346', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', '2014-05-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1699897264', 0, 'N', 0, '2014-05-27', NULL, NULL, 41.8811, -87.625, NULL, NULL),
('364130066', 'IL0000488', 'IL0000488', 'ILCHIGSTD', '', 'Phillip', 'L', 'Forni', 'DPM', 'Podiatry', '', '', NULL, 'O', '430 S Main St', 'Lombard', 'Dupage', 'IL', '60148', '6306204848', '7088671964', '430 S Main St', 'Lombard', 'Dupage', 'IL', '60148', '6306204848', '7088671964', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', '2014-05-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1699897264', 0, 'N', 0, '2014-05-27', NULL, NULL, 41.8792, -88.0182, NULL, NULL),
('364130066', 'IL0000486', 'IL0000486', 'ILCHIGSTD', 'AFP Podiatry', 'Phillip', 'L', 'Forni', 'DPM', 'Podiatry', '', '', NULL, 'O', '4612 N Harlem Ave', 'Harwood Heights', 'Cook', 'IL', '60706', '7088673338', '7088671964', '4612 N Harlem Ave', 'Harwood Heights', 'Cook', 'IL', '60706', '7088673338', '7088671964', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', '2014-05-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1699897264', 0, 'N', 0, '2014-05-27', NULL, NULL, 41.9639, -87.8072, NULL, NULL),
('364130066', 'IL0000487', 'IL0000487', 'ILCHIGSTD', 'AFP Podiatry', 'Phillip', 'L', 'Forni', 'DPM', 'Podiatry', '', '', NULL, 'O', '825 N Roselle Rd', 'Roselle', 'Dupage', 'IL', '60172', '6305821100', '7088671964', '825 N Roselle Rd', 'Roselle', 'Dupage', 'IL', '60172', '6305821100', '7088671964', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', '2014-05-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1699897264', 0, 'N', 0, '2014-05-27', NULL, NULL, 42.0431, -88.0797, NULL, NULL),
('363330928', 'W12026658', 'W12026658', 'ILCHIGSTD', 'Presence Medical Group', '', '', 'Presence Medical Group', '', 'Clinics', '', '', NULL, 'B', '25872 Network Place', 'Chicago', 'Cook', 'IL', '60673', '          ', NULL, '25872 Network Place', 'Chicago', 'Cook', 'IL', '60673', '          ', '          ', 'CHIGP1', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000010017', 0, 'N', 0, '2013-10-28', NULL, NULL, 0, 0, NULL, NULL),
('364130066', 'IL0000644', 'IL0000644', 'ILCHIGSTD', 'Centers for Foot and Ankle Care', 'Qeena', 'C', 'Woodard', 'DPM', 'Podiatry', '', '', NULL, 'O', '2930 S Michigan Ave Ste 102', 'Chicago', 'Cook', 'IL', '60616', '3128080018', '3128080037', '2930 S Michigan Ave Ste 102', 'Chicago', 'Cook', 'IL', '60616', '3128080018', '3128080037', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Little Company of Mary Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1548210339', 0, 'N', 0, '2013-04-26', NULL, NULL, 41.8414, -87.6235, NULL, NULL),
('364130066', 'IL0000645', 'IL0000645', 'ILCHIGSTD', '', 'Qeena', 'C', 'Woodard', 'DPM', 'Podiatry', '', '', NULL, 'B', '30 S Michigan Ave  Ste 503', 'Chicago', 'Cook', 'IL', '60603', '3123721160', '3123723346', '30 S Michigan Ave  Ste 503', 'Chicago', 'Cook', 'IL', '60603', '3123721160', '3123723346', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Little Company of Mary Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1548210339', 0, 'N', 0, '2013-04-26', NULL, NULL, 41.8811, -87.625, NULL, NULL),
('364130066', 'IL0000643', 'IL0000643', 'ILCHIGSTD', 'Centers for Foot and Ankle Care', 'Qeena', 'C', 'Woodard', 'DPM', 'Podiatry', '', '', NULL, 'O', '9021 S Western Ave', 'Chicago', 'Cook', 'IL', '60643', '7734453964', '7734453971', '9021 S Western Ave', 'Chicago', 'Cook', 'IL', '60643', '7734453964', '7734453971', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Little Company of Mary Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1548210339', 0, 'N', 0, '2013-04-26', NULL, NULL, 41.7297, -87.6823, NULL, NULL),
('364130066', 'IL0000596', 'IL0000596', 'ILCHIGSTD', '', 'Richard', 'J', 'Powers', 'DPM', 'Podiatry', '', '', NULL, 'B', '30 S Michigan Ave  Ste 503', 'Chicago', 'Cook', 'IL', '60603', '3123721160', '3123723346', '30 S Michigan Ave  Ste 503', 'Chicago', 'Cook', 'IL', '60603', '3123721160', '3123723346', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1750310264', 0, 'N', 0, '2012-12-05', NULL, NULL, 41.8811, -87.625, NULL, NULL),
('364130066', 'IL0000595', 'IL0000595', 'ILCHIGSTD', 'Richard J Powers DPM', 'Richard', 'J', 'Powers', 'DPM', 'Podiatry', '', '', NULL, 'O', '7222 W Cermak Rd Ste 302', 'North Riverside', 'Cook', 'IL', '60546', '7084479700', '7084472969', '7222 W Cermak Rd Ste 302', 'North Riverside', 'Cook', 'IL', '60546', '7084479700', '7084472969', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1750310264', 0, 'N', 0, '2012-12-05', NULL, NULL, 41.8504, -87.8047, NULL, NULL),
('364130066', 'IL0000477', 'IL0000477', 'ILCHIGSTD', '', 'Robert', 'I', 'Cohen', 'DPM', 'Podiatry', '', '', NULL, 'B', '30 S Michigan Ave  Ste 503', 'Chicago', 'Cook', 'IL', '60603', '3123721160', '3123723346', '30 S Michigan Ave  Ste 503', 'Chicago', 'Cook', 'IL', '60603', '3123721160', '3123723346', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1649239740', 0, 'N', 0, '2013-03-14', NULL, NULL, 41.8811, -87.625, NULL, NULL),
('364130066', 'IL0000475', 'IL0000475', 'ILCHIGSTD', '', 'Robert', 'I', 'Cohen', 'DPM', 'Podiatry', '', '', NULL, 'O', '3048 W Peterson Ave', 'Chicago', 'Cook', 'IL', '60659', '7732710807', '7732716687', '3048 W Peterson Ave', 'Chicago', 'Cook', 'IL', '60659', '7732710807', '7732716687', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1649239740', 0, 'N', 0, '2013-03-14', NULL, NULL, 41.9904, -87.7062, NULL, NULL),
('364130066', 'IL0000473', 'IL0000473', 'ILCHIGSTD', 'Edgewater Beach Foot and Ankle Center', 'Robert', 'I', 'Cohen', 'DPM', 'Podiatry', '', '', NULL, 'O', '5555 N Sheridan Rd Ste O23', 'Chicago', 'Cook', 'IL', '60640', '7732710807', '7732716687', '5555 N Sheridan Rd Ste O23', 'Chicago', 'Cook', 'IL', '60640', '7732710807', '7732716687', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1649239740', 0, 'N', 0, '2013-03-14', NULL, NULL, 41.9829, -87.6552, NULL, NULL),
('364130066', 'IL0000476', 'IL0000476', 'ILCHIGSTD', 'Devon Lincoln Podiatry', 'Robert', 'I', 'Cohen', 'DPM', 'Podiatry', '', '', NULL, 'O', '6374 N Lincoln Ave Ste 101', 'Chicago', 'Cook', 'IL', '60659', '7732710807', '7732716687', '6374 N Lincoln Ave Ste 101', 'Chicago', 'Cook', 'IL', '60659', '7732710807', '7732716687', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Resurrection Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1649239740', 0, 'N', 0, '2013-03-14', NULL, NULL, 41.9969, -87.7182, NULL, NULL),
('390816848', 'W12041508', 'W12041508', 'ILCHIGSTD', 'Mercy Richmond Medical Center', 'Robert', '', 'MacDonald', 'DO', 'Family Practice', '', '', NULL, 'O', '9715 Prairie Ridge', 'Richmond', 'Mchenry', 'IL', '60071', '8156782121', NULL, '9715 Prairie Ridge', 'Richmond', 'Mchenry', 'IL', '60071', '8156782121', '          ', 'CHIG9', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1679640379', 0, 'N', 0, '2013-11-27', NULL, NULL, 42.4653, -88.3048, NULL, NULL),
('364130066', 'IL0000589', 'IL0000589', 'ILCHIGSTD', 'Dupage Foot and Ankle Associates', 'Rudolph', 'J', 'Petrich', 'DPM', 'Podiatry', '', '', NULL, 'O', '14 S Addison St', 'Bensenville', 'Dupage', 'IL', '60106', '6307668720', '6307669228', '14 S Addison St', 'Bensenville', 'Dupage', 'IL', '60106', '6307668720', '6307669228', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, '', '', 'HCFA|UB|', '1851313019', 0, 'N', 0, '2013-09-10', NULL, NULL, 41.9572, -87.9426, NULL, NULL),
('364130066', 'IL0000590', 'IL0000590', 'ILCHIGSTD', 'Dupage Foot and Ankle Associates', 'Rudolph', 'J', 'Petrich', 'DPM', 'Podiatry', '', '', NULL, 'O', '1515 W Lake St Ste 208', 'Hanover Park', 'Cook', 'IL', '60133', '6307668720', '6307669228', '1515 W Lake St Ste 208', 'Hanover Park', 'Cook', 'IL', '60133', '6307668720', '6307669228', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, '', '', 'HCFA|UB|', '1851313019', 0, 'N', 0, '2013-09-10', NULL, NULL, 41.986, -88.1476, NULL, NULL),
('364130066', 'IL0000591', 'IL0000591', 'ILCHIGSTD', '', 'Rudolph', 'J', 'Petrich', 'DPM', 'Podiatry', '', '', NULL, 'B', '30 S Michigan Ave  Ste 503', 'Chicago', 'Cook', 'IL', '60603', '3123721160', '3123723346', '30 S Michigan Ave  Ste 503', 'Chicago', 'Cook', 'IL', '60603', '3123721160', '3123723346', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, '', '', 'HCFA|UB|', '1851313019', 0, 'N', 0, '2013-09-10', NULL, NULL, 41.8811, -87.625, NULL, NULL),
('364130066', 'IL0000575', 'IL0000575', 'ILCHIGSTD', '', 'Scott', 'A', 'Newcomb', 'DMP', 'Podiatry', '', '', NULL, 'B', '30 S Michigan Ave  Ste 503', 'Chicago', 'Cook', 'IL', '60603', '3123721160', '3123723346', '30 S Michigan Ave  Ste 503', 'Chicago', 'Cook', 'IL', '60603', '3123721160', '3123723346', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1750308516', 0, 'N', 0, '2013-03-07', NULL, NULL, 41.8811, -87.625, NULL, NULL),
('364130066', 'IL0000574', 'IL0000574', 'ILCHIGSTD', 'Summit Green Podiatry Center', 'Scott', 'A', 'Newcomb', 'DMP', 'Podiatry', '', '', NULL, 'O', '431 Summit St Ste 102', 'Elgin', 'Kane', 'IL', '60120', '8476974500', '8476970446', '431 Summit St Ste 102', 'Elgin', 'Kane', 'IL', '60120', '8476974500', '8476970446', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1750308516', 0, 'N', 0, '2013-03-07', NULL, NULL, 42.0463, -88.2741, NULL, NULL),
('364130066', 'IL0000615', 'IL0000615', 'ILCHIGSTD', '', 'Stephanie', 'E', 'Spicer', 'DPM', 'Podiatry', '', '', NULL, 'B', '30 S Michigan Ave  Ste 503', 'Chicago', 'Cook', 'IL', '60603', '3123721160', '3123723346', '30 S Michigan Ave  Ste 503', 'Chicago', 'Cook', 'IL', '60603', '3123721160', '3123723346', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1578593398', 0, 'N', 0, '2013-03-06', NULL, NULL, 41.8811, -87.625, NULL, NULL),
('364130066', 'IL0000614', 'IL0000614', 'ILCHIGSTD', 'Foot and Ankle Pain Specialists', 'Stephanie', 'E', 'Spicer', 'DPM', 'Podiatry', '', '', NULL, 'O', '3330 W 177th St Ste 20-l', 'Hazel Crest', 'Cook', 'IL', '60429', '7089573338', '7089574555', '3330 W 177th St Ste 20-l', 'Hazel Crest', 'Cook', 'IL', '60429', '7089573338', '7089574555', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Ingalls Memorial Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1578593398', 0, 'N', 0, '2013-03-06', NULL, NULL, 41.5681, -87.698, NULL, NULL),
('364130066', 'IL0000509', 'IL0000509', 'ILCHIGSTD', 'Steven Gelsomino DPM', 'Steven', '', 'Gelsomino', 'DPM', 'Podiatry', '', '', NULL, 'O', '2266 N Lincoln Ave', 'Chicago', 'Cook', 'IL', '60614', '7084243334', '7084249543', '2266 N Lincoln Ave', 'Chicago', 'Cook', 'IL', '60614', '7084243334', '7084249543', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Little Company of Mary Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1376618900', 0, 'N', 0, '2013-04-03', NULL, NULL, 41.9231, -87.6454, NULL, NULL),
('364130066', 'IL0000508', 'IL0000508', 'ILCHIGSTD', 'Steven Gelsomino DPM', 'Steven', '', 'Gelsomino', 'DPM', 'Podiatry', '', '', NULL, 'O', '2810 W Fullerton Ave', 'Chicago', 'Cook', 'IL', '60647', '7084243334', '7084249543', '2810 W Fullerton Ave', 'Chicago', 'Cook', 'IL', '60647', '7084243334', '7084249543', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Little Company of Mary Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1376618900', 0, 'N', 0, '2013-04-03', NULL, NULL, 41.9249, -87.6981, NULL, NULL),
('364130066', 'IL0000510', 'IL0000510', 'ILCHIGSTD', '', 'Steven', '', 'Gelsomino', 'DPM', 'Podiatry', '', '', NULL, 'B', '30 S Michigan Ave  Ste 503', 'Chicago', 'Cook', 'IL', '60603', '3123721160', '3123723346', '30 S Michigan Ave  Ste 503', 'Chicago', 'Cook', 'IL', '60603', '3123721160', '3123723346', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Little Company of Mary Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1376618900', 0, 'N', 0, '2013-04-03', NULL, NULL, 41.8811, -87.625, NULL, NULL),
('364130066', 'IL0000507', 'IL0000507', 'ILCHIGSTD', 'Augusta Clinic', 'Steven', '', 'Gelsomino', 'DPM', 'Podiatry', '', '', NULL, 'O', '3454 N Lincoln Ave 3rd Fl', 'Chicago', 'Cook', 'IL', '60657', '7734721571', '7084249543', '3454 N Lincoln Ave 3rd Fl', 'Chicago', 'Cook', 'IL', '60657', '7734721571', '7084249543', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Little Company of Mary Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1376618900', 0, 'N', 0, '2013-04-03', NULL, NULL, 41.9447, -87.6721, NULL, NULL),
('364130066', 'IL0000506', 'IL0000506', 'ILCHIGSTD', 'Steven Gelsomino DPM', 'Steven', '', 'Gelsomino', 'DPM', 'Podiatry', '', '', NULL, 'O', '9760 S Kedzie Ave Ste 5', 'Evergreen Park', 'Cook', 'IL', '60805', '7084243334', '7084249543', '9760 S Kedzie Ave Ste 5', 'Evergreen Park', 'Cook', 'IL', '60805', '7084243334', '7084249543', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Little Company of Mary Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1376618900', 0, 'N', 0, '2013-04-03', NULL, NULL, 41.716, -87.7017, NULL, NULL),
('364130066', 'IL0000527', 'IL0000527', 'ILCHIGSTD', 'Evanston Podiatric Surgeons', 'Tayeb', 'S', 'Hussain', 'DPM', 'Podiatry', '', '', NULL, 'O', '2500 Ridge Ave Ste 110', 'Evanston', 'Cook', 'IL', '60201', '8474759030', '8474759031', '2500 Ridge Ave Ste 110', 'Evanston', 'Cook', 'IL', '60201', '8474759030', '8474759031', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, '', '', 'HCFA|UB|', '1487688925', 0, 'N', 0, '2012-12-05', NULL, NULL, 42.0631, -87.684, NULL, NULL),
('364130066', 'IL0000529', 'IL0000529', 'ILCHIGSTD', '', 'Tayeb', 'S', 'Hussain', 'DPM', 'Podiatry', '', '', NULL, 'B', '30 S Michigan Ave  Ste 503', 'Chicago', 'Cook', 'IL', '60603', '3123721160', '3123723346', '30 S Michigan Ave  Ste 503', 'Chicago', 'Cook', 'IL', '60603', '3123721160', '3123723346', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, '', '', 'HCFA|UB|', '1487688925', 0, 'N', 0, '2012-12-05', NULL, NULL, 41.8811, -87.625, NULL, NULL),
('364130066', 'IL0000528', 'IL0000528', 'ILCHIGSTD', 'Evanston Podiatric Surgeons', 'Tayeb', 'S', 'Hussain', 'DPM', 'Podiatry', '', '', NULL, 'O', '4905 Old Orchard Rd', 'Skokie', 'Cook', 'IL', '60077', '8474759030', '8474759031', '4905 Old Orchard Rd', 'Skokie', 'Cook', 'IL', '60077', '8474759030', '8474759031', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, 'Presence Saint Joseph Hospital Chicago', NULL, '', '', 'HCFA|UB|', '1487688925', 0, 'N', 0, '2012-12-05', NULL, NULL, 42.0614, -87.7475, NULL, NULL),
('364130066', 'IL0000491', 'IL0000491', 'ILCHIGSTD', '', 'Terri', 'L', 'Foster', 'DPM', 'Podiatry', '', '', NULL, 'B', '30 S Michigan Ave  Ste 503', 'Chicago', 'Cook', 'IL', '60603', '3123721160', '3123723346', '30 S Michigan Ave  Ste 503', 'Chicago', 'Cook', 'IL', '60603', '3123721160', '3123723346', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1720010481', 0, 'N', 0, '2013-03-15', NULL, NULL, 41.8811, -87.625, NULL, NULL),
('364130066', 'W12026263', 'W12026263', 'ILCHIGSTD', 'Warrenville Podiatry', 'Gregory', '', 'Jansyn', 'DPM', 'Podiatry', '', '', NULL, 'O', '28 W 530 Batavia Rd', 'Warrenville', 'Dupage', 'IL', '60555', '6303931970', '6303931971', '28 W 530 Batavia Rd', 'Warrenville', 'Dupage', 'IL', '60555', '6303931970', '6303931971', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1639250632', 0, 'N', 0, '2013-03-18', NULL, NULL, 41.8264, -88.1853, NULL, NULL),
('364130066', 'IL0000557', 'IL0000557', 'ILCHIGSTD', '', 'Thomas', 'J', 'Mack', 'DPM', 'Podiatry', '', '', NULL, 'B', '30 S Michigan Ave  Ste 503', 'Chicago', 'Cook', 'IL', '60603', '3123721160', '3123723346', '30 S Michigan Ave  Ste 503', 'Chicago', 'Cook', 'IL', '60603', '3123721160', '3123723346', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1548265689', 0, 'Y', 0, '2013-03-29', NULL, NULL, 41.8811, -87.625, NULL, NULL),
('364130066', 'IL0000555', 'IL0000555', 'ILCHIGSTD', 'Brookfield Podiatry Center', 'Thomas', 'J', 'Mack', 'DPM', 'Podiatry', '', '', NULL, 'O', '3704 Grand Blvd', 'Brookfield', 'Cook', 'IL', '60513', '7083870633', '7083870638', '3704 Grand Blvd', 'Brookfield', 'Cook', 'IL', '60513', '7083870633', '7083870638', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1548265689', 0, 'Y', 0, '2013-03-29', NULL, NULL, 41.824, -87.8464, NULL, NULL),
('364130066', 'IL0000556', 'IL0000556', 'ILCHIGSTD', 'Chicago Clinic', 'Thomas', 'J', 'Mack', 'DPM', 'Podiatry', '', '', NULL, 'O', '5650 Madison St', 'Chicago', 'Cook', 'IL', '60644', '7736262979', '7083870638', '5650 Madison St', 'Chicago', 'Cook', 'IL', '60644', '7736262979', '7083870638', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1548265689', 0, 'Y', 0, '2013-03-29', NULL, NULL, 41.8803, -87.7666, NULL, NULL),
('364130066', 'IL0000469', 'IL0000469', 'ILCHIGSTD', 'Bushnell Foot Clinic', 'William', 'F', 'Bushnell III', 'DPM', 'Podiatry', '', '', NULL, 'O', '183 W First St', 'Elmhurst', 'Dupage', 'IL', '60126', '6305303338', '6309410171', '183 W First St', 'Elmhurst', 'Dupage', 'IL', '60126', '6305303338', '6309410171', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1093749517', 0, 'N', 0, '2013-03-26', NULL, NULL, 41.9001, -87.9438, NULL, NULL),
('364130066', 'IL0000470', 'IL0000470', 'ILCHIGSTD', '', 'William', 'F', 'Bushnell III', 'DPM', 'Podiatry', '', '', NULL, 'B', '30 S Michigan Ave  Ste 503', 'Chicago', 'Cook', 'IL', '60603', '3123721160', '3123723346', '30 S Michigan Ave  Ste 503', 'Chicago', 'Cook', 'IL', '60603', '3123721160', '3123723346', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1093749517', 0, 'N', 0, '2013-03-26', NULL, NULL, 41.8811, -87.625, NULL, NULL),
('364130066', 'IL0000572', 'IL0000572', 'ILCHIGSTD', 'Forest View Foot and Ankle Center', 'William', 'A', 'Mohs', 'DPM', 'Podiatry', '', '', NULL, 'O', '1760 W Algonquin Rd', 'Hoffman Estates', 'Cook', 'IL', '60192', '8479913111', '8479911232', '1760 W Algonquin Rd', 'Hoffman Estates', 'Cook', 'IL', '60192', '8479913111', '8479911232', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1316089378', 0, 'N', 0, '2012-12-05', NULL, NULL, 42.0916, -88.1225, NULL, NULL),
('364130066', 'IL0000573', 'IL0000573', 'ILCHIGSTD', '', 'William', 'A', 'Mohs', 'DPM', 'Podiatry', '', '', NULL, 'B', '30 S Michigan Ave  Ste 503', 'Chicago', 'Cook', 'IL', '60603', '3123721160', '3123723346', '30 S Michigan Ave  Ste 503', 'Chicago', 'Cook', 'IL', '60603', '3123721160', '3123723346', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1316089378', 0, 'N', 0, '2012-12-05', NULL, NULL, 41.8811, -87.625, NULL, NULL),
('364130066', 'W12026147', 'W12026147', 'ILCHIGSTD', 'Tri County Foot and Ankle', 'Iqbal (Jay)', '', 'Khan', 'DPM', 'Podiatry', '', '', NULL, 'O', '4310 Crystal Lake Rd Ste F', 'Mchenry', 'McHenry', 'IL', '60050', '8153633223', '8153633240', '4310 Crystal Lake Rd Ste F', 'Mchenry', 'McHenry', 'IL', '60050', '8153633223', '8153633240', 'CHIG6', 'CHIHCPCS13', '', '0.00', '35.00', '0.00', 3, '2013-01-01', '2013-04-02', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1053341305', 0, 'N', 0, '2013-04-03', NULL, NULL, 0, 0, NULL, NULL),
('390816848', 'IL0000402', 'IL0000402', 'ILCHIGSTD', 'Mercy Woodstock Medical Center', 'Graziella', '', 'Bistriceanu', 'MD', 'Family Practice', '', '', NULL, 'O', '200 Lake Ave', 'Woodstock', 'McHenry', 'IL', '60098', '8153377100', NULL, '200 Lake Ave', 'Woodstock', 'McHenry', 'IL', '60098', '8153377100', '          ', 'CHIG9', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB', '1316911472', 0, 'N', 0, '2013-03-27', NULL, NULL, 0, 0, NULL, NULL),
('390816848', 'IL0000405', 'IL0000405', 'ILCHIGSTD', 'Mercy Algonquin Medical Center', 'Steven', '', 'Campau', 'MD', 'Internal Medicine', '', '', NULL, 'O', '2401 Harnish Dr Ste 101', 'Algonquin', 'McHenry', 'IL', '60102', '8474585440', NULL, '2401 Harnish Dr Ste 101', 'Algonquin', 'Mchenry', 'IL', '60102', '8474585440', '          ', 'CHIG9', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1255440954', 0, 'N', 0, '2012-12-06', NULL, NULL, 42.1638, -88.3302, NULL, NULL),
('390816848', 'IL0000406', 'IL0000406', 'ILCHIGSTD', 'Mercy Harvard Clinic South', 'Rodrigo', 'A', 'Castillo', 'MD', 'Pediatrics', '', '', NULL, 'O', '348 S Division St', 'Harvard', 'McHenry', 'IL', '60033', '8159431122', NULL, '348 S Division St', 'Harvard', 'McHenry', 'IL', '60033', '8159431122', '          ', 'CHIG9', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1396881850', 0, 'N', 0, '2013-04-03', NULL, NULL, 42.4121, -88.6134, NULL, NULL),
('390816848', 'IL0000408', 'IL0000408', 'ILCHIGSTD', 'Mercy Crystal Lake Med Center - West', 'Manju', '', 'Chatterji', 'MD', 'Pediatrics', '', '', NULL, 'O', '350 Congress Pkwy Ste E', 'Crystal Lake', 'McHenry', 'IL', '60014', '8154771555', NULL, '350 Congress Pkwy Ste E', 'Crystal Lake', 'Mchenry', 'IL', '60014', '8154771555', '          ', 'CHIG9', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1871694661', 0, 'N', 0, '2012-12-06', NULL, NULL, 42.2311, -88.3082, NULL, NULL),
('390816848', 'IL0000409', 'IL0000409', 'ILCHIGSTD', 'Mercy McHenry Medical Center', 'Rick', '', 'Chitwood', 'DO', 'Pediatrics', '', '', NULL, 'O', '3922 Mercy Dr', 'McHenry', 'McHenry', 'IL', '60050', '8153444499', NULL, '3922 Mercy Dr', 'McHenry', 'McHenry', 'IL', '60050', '8153444499', '          ', 'CHIG9', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-01-07', 0, 0, 0, '', '', '', '', 'HCFA|UB', '1609977305', 0, 'N', 0, '2013-07-26', NULL, NULL, 42.3167, -88.2746, NULL, NULL),
('390816848', 'IL0000410', 'IL0000410', 'ILCHIGSTD', 'Mercy Woodstock Medical Center', 'Saundra', '', 'Claiborne', 'MD', 'Urgent Care', '', '', NULL, 'O', '200 Lake Ave', 'Woodstock', 'McHenry', 'IL', '60098', '8153377100', NULL, '200 Lake Ave', 'Woodstock', 'McHenry', 'IL', '60098', '8153377100', '          ', 'CHIG9', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB', '1821199530', 0, 'N', 0, '2013-03-27', NULL, NULL, 0, 0, NULL, NULL),
('390816848', 'IL0000411', 'IL0000411', 'ILCHIGSTD', 'Mercy Woodstock Medical Center', 'Richard', '', 'Cook', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '200 Lake Ave', 'Woodstock', 'McHenry', 'IL', '60098', '8153377100', NULL, '200 Lake Ave', 'Woodstock', 'McHenry', 'IL', '60098', '8153377100', '          ', 'CHIG9', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB', '1508957705', 0, 'N', 0, '2013-03-27', NULL, NULL, 0, 0, NULL, NULL),
('390816848', 'IL0000412', 'IL0000412', 'ILCHIGSTD', 'Mercy Woodstock Medical Center', 'Terri', '', 'Crawley', 'MD', 'Pediatrics', '', '', NULL, 'O', '200 Lake Ave', 'Woodstock', 'McHenry', 'IL', '60098', '8153377100', NULL, '200 Lake Ave', 'Woodstock', 'McHenry', 'IL', '60098', '8153377100', '          ', 'CHIG9', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB', '1386735595', 0, 'N', 0, '2013-03-27', NULL, NULL, 0, 0, NULL, NULL),
('390816848', 'IL0000413', 'IL0000413', 'ILCHIGSTD', 'Mercy Crystal Lake Medical Center East', 'Jason', '', 'Cundiff', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '390 Congress Pkwy Ste M', 'Crystal Lake', 'McHenry', 'IL', '60014', '8154550850', NULL, '390 Congress Pkwy Ste M', 'Crystal Lake', 'McHenry', 'IL', '60014', '8154550850', '          ', 'CHIG9', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1053325233', 0, 'N', 0, '2013-07-26', NULL, NULL, 42.2312, -88.3073, NULL, NULL),
('390816848', 'IL0000414', 'IL0000414', 'ILCHIGSTD', 'Mercy Woodstock Medical Center', 'Amarish', '', 'Dave', 'DO', 'Neurology', '', '', NULL, 'O', '200 Lake Ave', 'Woodstock', 'McHenry', 'IL', '60098', '8153377100', NULL, '200 Lake Ave', 'Woodstock', 'McHenry', 'IL', '60098', '8153377100', '          ', 'CHIG9', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB', '1891877213', 0, 'N', 0, '2013-03-27', NULL, NULL, 0, 0, NULL, NULL),
('390816848', 'IL0000415', 'IL0000415', 'ILCHIGSTD', 'Mercy McHenry Medical Center', 'Paul', '', 'DeHaan', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '3922 Mercy Dr', 'McHenry', 'McHenry', 'IL', '60050', '8153444499', NULL, '3922 Mercy Dr', 'McHenry', 'Mchenry', 'IL', '60050', '8153444499', '          ', 'CHIG9', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1386727790', 0, 'N', 0, '2012-12-06', NULL, NULL, 42.3167, -88.2738, NULL, NULL),
('390816848', 'IL0000416', 'IL0000416', 'ILCHIGSTD', 'Mercy Woodstock Medical Center', 'Paul', '', 'Dillon', 'MD', 'Plastic Surgery', '', '', NULL, 'O', '200 Lake Ave', 'Woodstock', 'McHenry', 'IL', '60098', '8153377100', NULL, '200 Lake Ave', 'Woodstock', 'McHenry', 'IL', '60098', '8153377100', '          ', 'CHIG9', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB', '1285717561', 0, 'N', 0, '2013-08-01', NULL, NULL, 0, 0, NULL, NULL),
('390816848', 'IL0000417', 'IL0000417', 'ILCHIGSTD', 'Mercy Center for Corrective Eye Surgery - McHenry', 'Robert', '', 'Epstein', 'MD', 'Ophthalmology', '', '', NULL, 'O', '5400 W Elm St Ste 120', 'McHenry', 'McHenry', 'IL', '60050', '8153632020', NULL, '5400 W Elm St Ste 120', 'McHenry', 'Mchenry', 'IL', '60050', '8153632020', '          ', 'CHIG9', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1730100033', 0, 'N', 0, '2012-12-06', NULL, NULL, 42.351, -88.3028, NULL, NULL),
('390816848', 'IL0000418', 'IL0000418', 'ILCHIGSTD', 'Mercy Barrington Medical Center', 'Ahmed', '', 'Farrag', 'MD', 'Family Practice', '', '', NULL, 'O', '500 W Hwy 22', 'Barrington', 'Lake', 'IL', '60010', '8473813000', NULL, '500 W Hwy 22', 'Barrington', 'Lake', 'IL', '60010', '8473813000', '          ', 'CHIG9', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1255547220', 0, 'N', 0, '2013-08-01', NULL, NULL, 42.1849, -88.1804, NULL, NULL),
('390816848', 'IL0000419', 'IL0000419', 'ILCHIGSTD', 'Mercy Woodstock Medical Center', 'Julie', '', 'Favia', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '200 Lake Ave', 'Woodstock', 'McHenry', 'IL', '60098', '8153377100', NULL, '200 Lake Ave', 'Woodstock', 'McHenry', 'IL', '60098', '8153377100', '          ', 'CHIG9', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB', '1154418697', 0, 'N', 0, '2013-03-27', NULL, NULL, 0, 0, NULL, NULL),
('390816848', 'IL0000420', 'IL0000420', 'ILCHIGSTD', 'Mercy Crystal Lake Chiropractic and Rehab Center', 'Rodney', '', 'Gabbert', 'DC', 'Chiropractic', '', '', NULL, 'O', '330 W Terra Cotta Ave', 'Crystal Lake', 'McHenry', 'IL', '60014', '8154551751', NULL, '330 W Terra Cotta Ave', 'Crystal Lake', 'Mchenry', 'IL', '60014', '8154551751', '          ', 'CHIG9', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1447263561', 0, 'Y', 0, '2012-12-06', NULL, NULL, 42.2481, -88.3324, NULL, NULL),
('390816848', 'IL0000421', 'IL0000421', 'ILCHIGSTD', 'Mercy Woodstock Medical Center', 'Monica', '', 'Gavran', 'MD', 'Internal Medicine', '', '', NULL, 'O', '200 Lake Ave', 'Woodstock', 'McHenry', 'IL', '60098', '8153377100', NULL, '200 Lake Ave', 'Woodstock', 'McHenry', 'IL', '60098', '8153377100', '          ', 'CHIG9', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB', '1326123530', 0, 'N', 0, '2013-03-27', NULL, NULL, 0, 0, NULL, NULL),
('390816848', 'IL0000422', 'IL0000422', 'ILCHIGSTD', 'Mercy Crystal Lake Medical Center East', 'David', '', 'Goodman', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '390 Congress Pkwy Ste M', 'Crystal Lake', 'McHenry', 'IL', '60014', '8154550850', NULL, '390 Congress Pkwy Ste M', 'Crystal Lake', 'McHenry', 'IL', '60014', '8154550850', '          ', 'CHIG9', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1477610665', 0, 'N', 0, '2013-07-26', NULL, NULL, 42.2312, -88.3073, NULL, NULL),
('390816848', 'IL0000423', 'IL0000423', 'ILCHIGSTD', 'Mercy Woodstock Medical Center', 'Roshi', '', 'Gulati', 'MD', 'Family Practice', '', '', NULL, 'O', '200 Lake Ave', 'Woodstock', 'McHenry', 'IL', '60098', '8153377100', NULL, '200 Lake Ave', 'Woodstock', 'McHenry', 'IL', '60098', '8153377100', '          ', 'CHIG9', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB', '1922290816', 0, 'N', 0, '2013-03-27', NULL, NULL, 0, 0, NULL, NULL),
('390816848', 'IL0000424', 'IL0000424', 'ILCHIGSTD', 'Mercy Crystal Lake Medical Center - East', 'Douglas', '', 'Henning', 'MD', 'Pediatrics', '', '', NULL, 'O', '390 Congress Pkwy Ste M', 'Crystal Lake', 'McHenry', 'IL', '60014', '8154550850', NULL, '390 Congress Pkwy Ste M', 'Crystal Lake', 'Mchenry', 'IL', '60014', '8154550850', '          ', 'CHIG9', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1316017155', 0, 'N', 0, '2012-12-06', NULL, NULL, 42.2312, -88.3073, NULL, NULL),
('390816848', 'IL0000425', 'IL0000425', 'ILCHIGSTD', 'Mercy Northwest Womens Group', 'Susan', 'M', 'Howey', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '47 W Acorn Ln', 'Lake in the Hills', 'McHenry', 'IL', '60156', '8474584100', NULL, '47 W Acorn Ln', 'Lake in the Hills', 'McHenry', 'IL', '60156', '8474584100', '          ', 'CHIG9', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1639242035', 0, 'N', 0, '2013-04-03', NULL, NULL, 42.1817, -88.3334, NULL, NULL),
('390816848', 'IL0000426', 'IL0000426', 'ILCHIGSTD', 'Mercy Woodstock Medical Center', 'Yasmin', '', 'Hussain', 'MD', 'Gastroenterology', '', '', NULL, 'O', '200 Lake Ave', 'Woodstock', 'McHenry', 'IL', '60098', '8153377100', NULL, '200 Lake Ave', 'Woodstock', 'McHenry', 'IL', '60098', '8153377100', '          ', 'CHIG9', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB', '1649288457', 0, 'N', 0, '2013-03-27', NULL, NULL, 0, 0, NULL, NULL),
('390816848', 'IL0000427', 'IL0000427', 'ILCHIGSTD', 'Mercy McHenry Medical Center', 'Zehra', '', 'Hyderi', 'DPM', 'Podiatry', '', '', NULL, 'O', '3922 Mercy Dr', 'McHenry', 'McHenry', 'IL', '60050', '8153444499', NULL, '3922 Mercy Dr', 'McHenry', 'Mchenry', 'IL', '60050', '8153444499', '          ', 'CHIG9', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1033282280', 0, 'N', 0, '2012-12-06', NULL, NULL, 42.3167, -88.2738, NULL, NULL),
('390816848', 'IL0000428', 'IL0000428', 'ILCHIGSTD', 'Mercy Woodstock Medical Center', 'Nathan', '', 'Kakish', 'MD', 'Internal Medicine', '', '', NULL, 'O', '200 Lake Ave', 'Woodstock', 'McHenry', 'IL', '60098', '8153377100', NULL, '200 Lake Ave', 'Woodstock', 'McHenry', 'IL', '60098', '8153377100', '          ', 'CHIG9', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB', '1518975309', 0, 'N', 0, '2013-03-27', NULL, NULL, 0, 0, NULL, NULL),
('390816848', 'IL0000429', 'IL0000429', 'ILCHIGSTD', 'Mercy McHenry Medical Center', 'Hiejin', '', 'Kang', 'MD', 'Family Practice', '', '', NULL, 'O', '3922 Mercy Dr', 'McHenry', 'McHenry', 'IL', '60050', '8153444499', NULL, '3922 Mercy Dr', 'McHenry', 'Mchenry', 'IL', '60050', '8153444499', '          ', 'CHIG9', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1710052980', 0, 'N', 0, '2012-12-06', NULL, NULL, 42.3167, -88.2738, NULL, NULL),
('390816848', 'IL0000430', 'IL0000430', 'ILCHIGSTD', 'Mercy McHenry Medical Center', 'Sandhya', '', 'Karna', 'MD', 'Pediatrics', '', '', NULL, 'O', '3922 Mercy Dr', 'McHenry', 'McHenry', 'IL', '60050', '8153444499', NULL, '3922 Mercy Dr', 'McHenry', 'Mchenry', 'IL', '60050', '8153444499', '          ', 'CHIG9', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1700936390', 0, 'N', 0, '2012-12-06', NULL, NULL, 42.3167, -88.2738, NULL, NULL),
('390816848', 'IL0000431', 'IL0000431', 'ILCHIGSTD', 'Mercy Woodstock Medical Center', 'M Yvonne', '', 'Karney', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '200 Lake Ave', 'Woodstock', 'McHenry', 'IL', '60098', '8153377100', NULL, '200 Lake Ave', 'Woodstock', 'McHenry', 'IL', '60098', '8153377100', '          ', 'CHIG9', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB', '1760557987', 0, 'N', 0, '2013-03-27', NULL, NULL, 0, 0, NULL, NULL),
('390816848', 'IL0000432', 'IL0000432', 'ILCHIGSTD', 'Mercy Woodstock Medical Center', 'Jeffrey', '', 'Kershaw', 'MD', 'Ophthalmology', '', '', NULL, 'O', '200 Lake Ave', 'Woodstock', 'McHenry', 'IL', '60098', '8153377100', NULL, '200 Lake Ave', 'Woodstock', 'McHenry', 'IL', '60098', '8153377100', '          ', 'CHIG9', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB', '1770641110', 0, 'N', 0, '2013-03-27', NULL, NULL, 0, 0, NULL, NULL),
('390816848', 'IL0000433', 'IL0000433', 'ILCHIGSTD', 'Mercy Harvard Clinic South', 'Viquar', '', 'Khan-Mundozie', 'MD', 'Family Practice', '', '', NULL, 'O', '348 S Division St', 'Harvard', 'McHenry', 'IL', '60033', '8159431122', NULL, '348 S Division St', 'Harvard', 'Mchenry', 'IL', '60033', '8159431122', '          ', 'CHIG9', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1972671923', 0, 'N', 0, '2012-12-06', NULL, NULL, 42.4121, -88.6134, NULL, NULL),
('390816848', 'IL0000434', 'IL0000434', 'ILCHIGSTD', 'Mercy Woodstock Medical Center', 'Ruby', '', 'Khanna', 'DC', 'Chiropractic', '', '', NULL, 'O', '200 Lake Ave', 'Woodstock', 'McHenry', 'IL', '60098', '8153377100', NULL, '200 Lake Ave', 'Woodstock', 'McHenry', 'IL', '60098', '8153377100', '          ', 'CHIG9', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB', '1629087226', 0, 'Y', 0, '2013-03-27', NULL, NULL, 0, 0, NULL, NULL),
('390816848', 'IL0000435', 'IL0000435', 'ILCHIGSTD', 'Mercy Woodstock Medical Center', 'Vikram', '', 'Khanna', 'MD', 'Dermatology', '', '', NULL, 'O', '200 Lake Ave', 'Woodstock', 'McHenry', 'IL', '60098', '8153377100', NULL, '200 Lake Ave', 'Woodstock', 'McHenry', 'IL', '60098', '8153377100', '          ', 'CHIG9', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB', '1598824732', 0, 'N', 0, '2013-04-11', NULL, NULL, 0, 0, NULL, NULL),
('390816848', 'IL0000436', 'IL0000436', 'ILCHIGSTD', 'Mercy Woodstock Medical Center', 'Anil', 'K', 'Khemani', 'MD', 'Cardiology', '', '', NULL, 'O', '200 Lake Ave', 'Woodstock', 'McHenry', 'IL', '60098', '8153377100', NULL, '200 Lake Ave', 'Woodstock', 'McHenry', 'IL', '60098', '8153377100', '          ', 'CHIG9', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB', '1750389953', 0, 'N', 0, '2013-04-03', NULL, NULL, 0, 0, NULL, NULL),
('390816848', 'IL0000438', 'IL0000438', 'ILCHIGSTD', 'Mercy Womens Health Center - Algonquin', 'Humberto', '', 'Lamoutte', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '2230 N Huntington Dr', 'Algonquin', 'McHenry', 'IL', '60102', '8478540688', NULL, '2230 N Huntington Dr', 'Algonquin', 'Mchenry', 'IL', '60102', '8478540688', '          ', 'CHIG9', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1588671812', 0, 'N', 0, '2012-12-06', NULL, NULL, 42.1703, -88.325, NULL, NULL),
('390816848', 'W12026148', 'W12026148', 'ILCHIGSTD', 'Mercy Crystal Lake Medical Center - South', 'Marko', '', 'Krpan', 'DO', 'Orthopedic Surgery', '', '', NULL, 'O', '415 Congress Pkwy', 'Crystal Lake', 'McHenry', 'IL', '60014', '8153567494', NULL, '415 Congress Pkwy', 'Crystal Lake', 'Mchenry', 'IL', '60014', '8153567494', '          ', 'CHIG9', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1992871347', 0, 'N', 0, '2012-12-06', NULL, NULL, 42.2322, -88.3052, NULL, NULL),
('390816848', 'IL0000439', 'IL0000439', 'ILCHIGSTD', 'Mercy Harvard Hospital Clinic', 'Mykola', '', 'Lisowsky', 'DPM', 'Podiatry', '', '', NULL, 'O', '1001 Grant St', 'Harvard', 'McHenry', 'IL', '60033', '8159438090', NULL, '1001 Grant St', 'Harvard', 'Mchenry', 'IL', '60033', '8159438090', '          ', 'CHIG9', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1053329839', 0, 'N', 0, '2012-12-06', NULL, NULL, 42.4268, -88.6077, NULL, NULL),
('390816848', 'IL0000440', 'IL0000440', 'ILCHIGSTD', 'Mercy Crystal Lake Medical Center East', 'Gary', '', 'Livingston', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '390 Congress Pkwy Ste M', 'Crystal Lake', 'McHenry', 'IL', '60014', '8154550850', NULL, '390 Congress Pkwy Ste M', 'Crystal Lake', 'McHenry', 'IL', '60014', '8154550850', '          ', 'CHIG9', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1184775744', 0, 'N', 0, '2013-07-26', NULL, NULL, 42.2312, -88.3073, NULL, NULL),
('390816848', 'IL0000441', 'IL0000441', 'ILCHIGSTD', 'Mercy Crystal Lake Medical Center - East', 'Mabria', '', 'Loqman', 'MD', 'Family Practice', '', '', NULL, 'O', '390 Congress Pkwy Ste M', 'Crystal Lake', 'McHenry', 'IL', '60014', '8154550850', NULL, '390 Congress Pkwy Ste M', 'Crystal Lake', 'Mchenry', 'IL', '60014', '8154550850', '          ', 'CHIG9', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1891862678', 0, 'N', 0, '2012-12-06', NULL, NULL, 42.2312, -88.3073, NULL, NULL),
('830337204', 'W12041510', 'W12041510', 'WY01', 'Robert A Vigneri', 'Robert', 'A', 'Vigneri', 'MD', 'Pediatrics', '', '', NULL, 'O', '940 E 3rd St Ste 203', 'Casper', 'Natrona', 'WY', '82601', '3075770465', '3075770469', '940 E 3rd St Ste 203', 'Casper', 'Natrona', 'WY', '82601', '3075770465', '3075770469', 'CasperPed1', '', '', '0.00', '0.00', '0.00', 3, '2013-12-05', NULL, 0, 0, 0, 'Wyoming Medical Center ', NULL, NULL, NULL, 'HCFA|', '1083704803', 0, 'N', 0, '2014-01-28', NULL, NULL, 42.8477, -106.313, NULL, NULL),
('390816848', 'IL0000443', 'IL0000443', 'ILCHIGSTD', 'Mercy Algonquin Medical Center', 'Camelia', '', 'Marian', 'MD', 'Internal Medicine', '', '', NULL, 'O', '2401 Harnish Dr Ste 101', 'Algonquin', 'McHenry', 'IL', '60102', '8474585440', NULL, '2401 Harnish Dr Ste 101', 'Algonquin', 'Mchenry', 'IL', '60102', '8474585440', '          ', 'CHIG9', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1851451132', 0, 'N', 0, '2012-12-06', NULL, NULL, 42.1638, -88.3302, NULL, NULL),
('390816848', 'IL0000444', 'IL0000444', 'ILCHIGSTD', 'Mercy Health Systems Corp', 'Leslie', 'C', 'McClellan', 'MD', 'General Surgery', '', '', NULL, 'O', '1001 Grant St', 'Harvard', 'McHenry', 'IL', '60033', '8159432193', NULL, '1001 Grant St', 'Harvard', 'McHenry', 'IL', '60033', '8159432193', '          ', 'CHIG9', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB', '1255408878', 0, 'N', 0, '2013-07-26', NULL, NULL, 42.4268, -88.6073, NULL, NULL),
('390816848', 'IL0000445', 'IL0000445', 'ILCHIGSTD', 'Mercy Woodstock Medical Center', 'Aisha', '', 'Mirza', 'MD', 'Pediatrics', '', '', NULL, 'O', '200 Lake Ave', 'Woodstock', 'McHenry', 'IL', '60098', '8153377100', NULL, '200 Lake Ave', 'Woodstock', 'McHenry', 'IL', '60098', '8153377100', '          ', 'CHIG9', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB', '1689742637', 0, 'N', 0, '2013-03-27', NULL, NULL, 0, 0, NULL, NULL),
('390816848', 'IL0000446', 'IL0000446', 'ILCHIGSTD', 'Mercy McHenry Internal Medicine Center', 'Deepak', '', 'Mitra', 'MD', 'Internal Medicine', '', '', NULL, 'O', '633 Ridgeway Dr', 'McHenry', 'McHenry', 'IL', '60050', '8153442760', NULL, '633 Ridgeway Dr', 'McHenry', 'McHenry', 'IL', '60050', '8153442760', '          ', 'CHIG9', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-04-03', 0, 0, 0, '', '', '', '', 'HCFA|UB', '1114068467', 0, 'N', 0, '2013-04-04', NULL, NULL, 0, 0, NULL, NULL),
('390816848', 'IL0000447', 'IL0000447', 'ILCHIGSTD', 'Mercy Crystal Lake Medical Center - West', 'Ranjana', '', 'Nath', 'MD', 'Pediatrics', '', '', NULL, 'O', '350 Congress Pkwy Ste E', 'Crystal Lake', 'McHenry', 'IL', '60014', '8154771555', NULL, '350 Congress Pkwy Ste E', 'Crystal Lake', 'Mchenry', 'IL', '60014', '8154771555', '          ', 'CHIG9', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1982762456', 0, 'N', 0, '2012-12-06', NULL, NULL, 42.2311, -88.3082, NULL, NULL),
('390816848', 'IL0000448', 'IL0000448', 'ILCHIGSTD', 'Mercy Harvard Clinic South', 'Sangita', '', 'Patel', 'MD', 'Internal Medicine', '', '', NULL, 'O', '348 S Division St', 'Harvard', 'McHenry', 'IL', '60033', '8159431122', NULL, '348 S Division St', 'Harvard', 'Mchenry', 'IL', '60033', '8159431122', '          ', 'CHIG9', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1922168442', 0, 'N', 0, '2012-12-06', NULL, NULL, 42.4121, -88.6134, NULL, NULL),
('390816848', 'IL0000449', 'IL0000449', 'ILCHIGSTD', 'Mercy Crystal Lake OB/GYN', 'Richard', '', 'Persino', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '750 E Terra Cotta Ste B', 'Crystal Lake', 'McHenry', 'IL', '60014', '8154591212', NULL, '750 E Terra Cotta Ste B', 'Crystal Lake', 'Mchenry', 'IL', '60014', '8154591212', '          ', 'CHIG9', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1396806303', 0, 'N', 0, '2012-12-06', NULL, NULL, 42.2486, -88.2921, NULL, NULL),
('390816848', 'IL0000450', 'IL0000450', 'ILCHIGSTD', 'Mercy McHenry Medical Center', 'Michael', '', 'Petersen', 'DPM', 'Podiatry', '', '', NULL, 'O', '3922 Mercy Dr', 'McHenry', 'McHenry', 'IL', '60050', '8153444499', NULL, '3922 Mercy Dr', 'McHenry', 'Mchenry', 'IL', '60050', '8153444499', '          ', 'CHIG9', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1518974153', 0, 'N', 0, '2012-12-06', NULL, NULL, 42.3167, -88.2738, NULL, NULL),
('390816848', 'IL0000451', 'IL0000451', 'ILCHIGSTD', 'Mercy Woodstock Medical Center', 'Patrick', 'E', 'Phelan', 'MD', 'Pediatrics', '', '', NULL, 'O', '200 Lake Ave', 'Woodstock', 'McHenry', 'IL', '60098', '8153377100', NULL, '200 Lake Ave', 'Woodstock', 'McHenry', 'IL', '60098', '8153377100', '          ', 'CHIG9', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', '2013-01-01', 0, 0, 0, '', '', '', '', 'HCFA|UB', '1083771398', 0, 'N', 0, '2013-04-03', NULL, NULL, 0, 0, NULL, NULL),
('390816848', 'IL0000452', 'IL0000452', 'ILCHIGSTD', 'Mercy Center for Corrective Eye Surgery - McHenry', 'Jung', '', 'Rhee', 'MD', 'Ophthalmology', '', '', NULL, 'O', '5400 W Elm St Ste 120', 'McHenry', 'McHenry', 'IL', '60050', '8153632020', '8153638040', '5400 W Elm St Ste 120', 'McHenry', 'McHenry', 'IL', '60050', '8153632020', '8153638040', 'CHIG9', 'CHIHCPCS13', '', '0.00', '40.00', '0.00', 3, '2013-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB', '1023031770', 0, 'N', 0, '2013-07-26', NULL, NULL, 42.351, -88.3028, NULL, NULL);
