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
('870616107', 'W11014607', 'W11014607', 'UT01', 'University Health Care', 'Douglas', 'G', 'Adler', 'MD', 'Gastroenterology', 'Internal Medicine', NULL, NULL, 'o', '1743 W Redstone Ctr Ste 115', 'Park City', 'Summit', 'UT', '84098', '4356589200', NULL, NULL, NULL, 'Summit', NULL, NULL, NULL, NULL, 'WISESTDU', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 6, '2006-07-17', '2006-07-17', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1891748687', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870564069', 'W11014608', 'W11014608', 'UT01', 'University Health Care', 'Sumati', 'V', 'Gupta', 'MD', 'Internal Medicine', 'Geriatric Medicine', '', NULL, 'o', '1138 Wilmington Ave', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8015812000', NULL, '1138 Wilmington Ave', 'Salt Lake City', 'Salt Lake', 'UT', '84106', '8015812000', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2006-08-01', '2012-08-20', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1003906603', 0, 'N', 0, '2012-08-21', NULL, NULL, 0, 0, NULL, NULL),
('320033433', 'W11014635', 'W11014635', 'UT01', 'PIMEO', 'Imad', 'S', 'Farrukh', 'MD', 'Sleep Medicine', NULL, NULL, NULL, 'O', '515 E 4500 S Ste G220', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8015625864', NULL, '515 E 4500 S Ste G220', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8015625864', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2008-10-03', '2011-09-29', 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1851498273', 0, 'N', 0, '2011-09-29', NULL, NULL, 0, 0, NULL, NULL),
('201428952', 'W11014637', 'W11014637', 'UT01', 'Western Anesthesia Associates ', 'Eric', NULL, 'Welling', 'MD', 'Anesthesiology', NULL, NULL, NULL, 'B', '1954 E Fort Union Blvd Ste 121', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8012992160', NULL, '1030 Woodmoor Dr', 'Bountiful', 'Salt Lake', 'UT', '84010', NULL, NULL, '', NULL, '1000', '48.50', '35.00', '0.00', 3, '2008-10-03', NULL, 1, 12, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1578665725', 0, 'Y', 0, '2008-10-08', NULL, NULL, 0, 0, NULL, NULL),
('201428952', 'W11014636', 'W11014636', 'UT01', 'Western Anesthesia Associates ', 'Tyler', 'M', 'Yeates', 'MD', 'Anesthesiology', NULL, NULL, NULL, 'B', '1954 E Fort Union Blvd Ste 121', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8012992160', NULL, '1030 Woodmoor Dr', 'Bountiful', 'Salt Lake', 'UT', '84010', NULL, NULL, '', NULL, '1000', '48.50', '35.00', '0.00', 3, '2008-10-03', NULL, 1, 12, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1427029974', 0, 'Y', 0, '2008-10-08', NULL, NULL, 0, 0, NULL, NULL),
('870616107', 'W11014603', 'W11014603', 'UT01', 'University Health Care', 'John', 'C', 'Fang', 'MD', 'Gastroenterology', 'Internal Medicine', NULL, NULL, 'o', '1525 W 2100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8012139900', '8012139910', NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, 'WISESTDU', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 6, '2007-08-01', '2007-08-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1134219736', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('743096310', 'W11014633', 'W11014633', 'UT01', 'St Marks Pain Center', 'David', 'D', 'Byrd', 'MD', 'Pain Management', '', '', NULL, 'O', '1200 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012687729', NULL, '1200 E 3900 S', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012687729', '', 'WISESTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2008-10-03', '2010-08-31', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1720173164', 0, 'N', 0, '2014-04-24', NULL, NULL, 0, 0, NULL, NULL),
('743096310', 'W11014632', 'W11014632', 'UT01', 'St Marks Pain Center', 'David', 'D', 'Byrd', 'MD', 'Pain Management', '', '', NULL, 'B', 'PO Box 271220', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '6153737629', NULL, 'PO Box 271220', 'Salt Lake City', 'Salt Lake', 'UT', '84127', '6153737629', '', 'WISESTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2008-10-03', '2010-08-31', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1720173164', 0, 'Y', 0, '2014-04-24', NULL, NULL, 0, 0, NULL, NULL),
('876000525', 'W11014605', 'W11014605', 'UT01', 'University Health Care', 'Daniel', 'A', 'Drennan', 'MD', 'Pain Management', NULL, NULL, NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015812121', NULL, NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, '', NULL, '1', '0.00', '0.00', '0.00', 6, '2008-07-01', NULL, 1, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|', '1932387966', 0, 'N', 0, '2008-10-07', NULL, NULL, 40.7685, -111.837, NULL, NULL),
('870564069', 'W11014609', 'W11014609', 'UT01', 'University Health Care', 'Sumati', 'V', 'Gupta', 'MD', 'Internal Medicine', 'Geriatric Medicine', '', NULL, 'B', 'PO Box 510004', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8015876303', NULL, 'PO Box 510004', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8015876303', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2006-08-01', '2012-08-20', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1003906603', 0, 'N', 0, '2012-08-21', NULL, NULL, 0, 0, NULL, NULL),
('876000525', 'W11014606', 'W11014606', 'UT01', 'University Health Care', 'Daniel', 'A', 'Drennan', 'MD', 'Pain Management', NULL, NULL, NULL, 'B', 'PO Box 510721 ', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8015812121', NULL, NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, NULL, NULL, '1', '0.00', NULL, NULL, 6, '2008-07-01', '2006-01-01', 1, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1932387966', 0, 'y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870616107', 'W11014604', 'W11014604', 'UT01', 'University Health Care', 'John', 'C', 'Fang', 'MD', 'Gastroenterology', 'Internal Medicine', NULL, NULL, 'B', 'PO Box 510708', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8015876303', NULL, NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, 'WISESTDU', 'WUSTDHCPC5', NULL, '0.00', '35.00', NULL, 6, '2007-08-01', '2007-08-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1134219736', 0, 'y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'W11014627', 'W11014627', 'UT01', '', 'Jay', 'M', 'Harrison', 'DC', 'Chiropractic', '', '', NULL, 'O', '428 E 2600 N Ste 4', 'North Ogden', 'Weber', 'UT', '84414', '8017820987', NULL, '428 E 2600 N Ste 4', 'North Ogden', 'Weber', 'UT', '84414', '8017820987', '          ', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2008-08-25', '2010-07-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1336301183', 0, 'N', 0, '2008-10-08', NULL, NULL, 0, 0, NULL, NULL),
('911490213', 'W11014618', 'W11014618', 'TX01', 'RS Medical', '', '', 'RS Medical (Muscle Stimulators', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'B', 'PO Box 872650', 'Vancouver', 'Clark', 'WA', '98687', '8006830353', '8009291930', 'PO Box 872650', 'Vancouver', 'Clark', 'WA', '98687', '8006830353', '8009291930', 'WCSTRSMED5', NULL, NULL, '0.00', '25.00', '0.00', 3, '2006-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000833766', 0, 'Y', 0, '2011-08-25', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W11014653', 'W11014653', 'WY01', 'Billings Clinic - Geriatrics', 'Lori', 'A', 'Hartford', 'NP', 'Geriatrics', NULL, NULL, NULL, 'O', '2825 8th Ave N', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062382806', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', NULL, NULL, '', NULL, NULL, '0.00', '17.00', '0.00', 3, '2008-09-23', '2009-04-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1194985572', 0, 'N', 0, '2010-01-15', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W11014686', 'W11014686', 'WY01', 'Billings Clinic - Geriatrics', 'Miranda', 'J', 'Meunier', 'NP', 'Geriatrics', NULL, NULL, NULL, 'O', '2825 8th Ave N', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062382771', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', NULL, NULL, '', NULL, NULL, '0.00', '17.00', '0.00', 3, '2008-09-23', '2009-04-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1588838213', 0, 'N', 0, '2010-01-15', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W11014654', 'W11014654', 'WY01', 'Billings Clinic', 'Lori', 'A', 'Hartford', 'NP', 'Geriatrics', NULL, NULL, NULL, 'B', 'PO Box 35100', 'Billings', 'Yellowstone', 'MT', '59101', '4062382617', '4062382806', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', NULL, NULL, '', NULL, NULL, '0.00', '17.00', '0.00', 3, '2008-09-23', '2008-09-23', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1194985572', 0, 'y', 0, '2010-01-15', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W11014652', 'W11014652', 'WY01', 'Billings Clinic - Pathology', 'Jeannie', '', 'Muir', 'MD', 'Pathology', '', '', NULL, 'O', '2800 10th Ave N', 'Billings', 'Yellowstone', 'MT', '59101', '4066574150', '4066574349', '2800 10th Ave N', 'Billings', 'Yellowstone', 'MT', '59101', '4066574150', '4066574349', '', NULL, NULL, '0.00', '17.00', '0.00', 3, '2008-12-01', '2009-04-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1093738395', 0, 'N', 0, '2014-02-04', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W11014685', 'W11014685', 'WY01', 'Billings Clinic - Miles City Clinic', 'Patricia', NULL, 'Grantham', 'MD', 'Family Practice', 'Obstetrics and Gynecology', NULL, NULL, 'O', '620 S Haynes', 'Miles City', 'Custer', 'MT', '59301', '4062337000', '4062337070', 'PO Box 37000', 'Billings', 'Custer', 'MT', '59107', NULL, NULL, '', NULL, NULL, '0.00', '17.00', '0.00', 3, '2008-10-01', '2009-04-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1003801275', 0, 'N', 0, '2009-05-04', NULL, NULL, 0, 0, NULL, NULL),
('743003947', 'W11014679', 'W11014679', 'TX01', 'The San Antonio Orthopaedic Group', 'Christina', 'M', 'Lamkin', 'PA-C', 'Orthopedic Surgery', '', '', NULL, 'O', '1200 Brooklyn Ste 320', 'San Antonio', 'Bexar', 'TX', '78212', '2103965260', NULL, '1200 Brooklyn Ste 320', 'San Antonio', 'Bexar', 'TX', '78212', '2103965260', '          ', 'TXORTHO', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2008-10-01', '2010-09-27', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1487810966', 0, 'Y', 0, '2010-07-13', NULL, NULL, 29.4403, -98.4903, NULL, NULL),
('562554975', 'W11014641', 'W11014641', 'TX01', 'Access Therapeutics Infusion', NULL, NULL, 'Access Therapeutics Infusion', 'GROUP', 'Infusion Agency', NULL, NULL, NULL, 'O', '1919 Oakwell Farms Pkwy Ste 160', 'San Antonio', 'Bexar', 'TX', '78218', '2109307200', NULL, '1919 Oakwell Farms Pkwy', 'San Antonio', 'Bexar', 'TX', '78218', NULL, NULL, '', NULL, '1001', '0.00', '100.00', '0.00', 3, '2007-08-01', NULL, 1, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000004897', 0, 'N', 0, '2008-10-08', NULL, NULL, 29.5093, -98.4338, NULL, NULL),
('743003947', 'W11014680', 'W11014680', 'TX01', 'The San Antonio Orthopaedic Group', 'Christina', 'M', 'Lamkin', 'PA-C', 'Orthopedic Surgery', '', '', NULL, 'O', '4243 E Southcross Blvd Ste 204', 'San Antonio', 'Bexar', 'TX', '78222', '2103965260', NULL, '4243 E Southcross Blvd Ste 204', 'San Antonio', 'Bexar', 'TX', '78222', '2103965260', '          ', 'TXORTHO', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2008-10-01', '2010-09-27', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1487810966', 0, 'Y', 0, '2010-07-13', NULL, NULL, 0, 0, NULL, NULL),
('743003947', 'W11014681', 'W11014681', 'TX01', 'The San Antonio Orthopaedic Group', 'Christina', 'M', 'Lamkin', 'PA-C', 'Orthopedic Surgery', '', '', NULL, 'B', 'PO Box 2516', 'San Antonio', 'Bexar', 'TX', '78299', '2103965260', NULL, 'PO Box 2516', 'San Antonio', 'Bexar', 'TX', '78299', '2103965260', '          ', 'TXORTHO', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2008-10-01', '2010-09-27', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1487810966', 0, 'Y', 0, '2010-07-13', NULL, NULL, 0, 0, NULL, NULL),
('383768885', 'W11014678', 'W11014678', 'ID02', 'Innovative Wellness', 'Tammy', 'L', 'Hadfield', 'NP', 'Gynecology', '', '', NULL, 'O', '323 E Riverside Dr Ste 220', 'Eagle', 'Ada', 'ID', '83616', '2083433883', NULL, '323 E Riverside Dr Ste 220', 'Eagle', 'Ada', 'ID', '83616', '2083433883', '', 'IDPPO', 'WUSTDHCPC5', NULL, '0.00', '30.00', '0.00', 3, '2008-10-15', '2009-02-01', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1457456022', 0, 'n', 0, '2013-10-01', NULL, NULL, 43.6892, -116.351, NULL, NULL),
('820497538', 'W11014687', 'W11014687', 'ID01', 'All Seasons Mental Health', 'Staci', 'M', 'Cooper', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '8040 W Rifleman Ste 100', 'Boise', 'Ada', 'ID', '83704', '2083210634', NULL, '8040 W Rifleman Ste 100', 'Boise', 'Ada', 'ID', '83704', '2083210634', '          ', 'IDMA', '', '', '0.00', '35.00', '0.00', 3, '2008-10-09', '2008-10-09', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1629228663', 0, 'N', 0, '2012-06-11', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11014684', 'W11014684', 'UTPEHP', '', 'L', 'Scott', 'Chidester', 'MD', 'Urology', '', '', NULL, 'O', '370 9th Ave Ste 208', 'Salt Lake City', 'Salt Lake', 'UT', '84103', '8014088998', NULL, '370 9th Ave Ste 208', 'Salt Lake City', 'Salt Lake', 'UT', '84103', '8014088998', '          ', 'PEHPPREF2', '', '', '0.00', '30.00', '0.00', 8, '2008-10-01', '2008-10-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000005670', 0, 'N', 0, '2012-03-21', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11014683', 'W11014683', 'UTPEHP', '', 'L', 'Scott', 'Chidester', 'MD', 'Urology', '', '', NULL, 'O', '5169 S Cottonwood St Ste 420', 'Murray', 'Salt Lake', 'UT', '84107', '8015073400', NULL, '5169 S Cottonwood St Ste 420', 'Murray', 'Salt Lake', 'UT', '84107', '8015073400', '          ', 'PEHPPREF2', '', '', '0.00', '30.00', '0.00', 8, '2008-10-01', '2008-10-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000005670', 0, 'N', 0, '2012-03-21', NULL, NULL, 0, 0, NULL, NULL),
('870542578', 'W11014651', 'W11014651', 'UT01', 'U Of U Dialysis Program', 'Marcellus', 'S', 'Assiago', 'MD', 'Internal Medicine', 'Nephrology', '', NULL, 'O', '85 N Medical Dr Ste E201', 'Salt Lake City', 'Salt Lake', 'UT', '84112', '8015818578', NULL, '85 N Medical Dr Ste E201', 'Salt Lake City', 'Salt Lake', 'UT', '84112', '8015818578', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2008-07-10', '2012-07-24', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1235348897', 0, 'N', 0, '2012-07-25', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11014669', 'W11014669', 'UTIHC03', NULL, 'Deirdre', 'A', 'Levstek Caplin', 'PHD', 'Mental Health', 'Psychology', 'Neuropsychology', NULL, 'O', '675 E 500 S Ste 300', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8015883938', NULL, NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, '', NULL, NULL, '0.00', '10.00', '0.00', 8, '2008-09-01', NULL, NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1649360231', 0, 'N', 0, '2010-03-09', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11014655', 'W11014655', 'UTIHC01', NULL, 'Deirdre', 'A', 'Levstek Caplin', 'PHD', 'Mental Health', 'Psychology', 'Neuropsychology', NULL, 'O', '675 E 500 S Ste 300', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8015883938', NULL, NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, '', NULL, NULL, '0.00', '10.00', '0.00', 8, '2008-09-01', NULL, NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1649360231', 0, 'N', 0, '2010-03-09', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11014659', 'W11014659', 'UTIHC01', NULL, 'Lisa', 'E', 'Giles', 'MD', 'Mental Health', 'Pediatric Psychiatry', NULL, NULL, 'O', '675 E 500 S Ste 300', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8015883938', NULL, NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '10.00', NULL, 8, '2000-01-01', '2000-01-01', 0, NULL, 0, 'Primary Childrens Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1841408309', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11014665', 'W11014665', 'UTIHC02', NULL, 'Deirdre', 'A', 'Levstek Caplin', 'PHD', 'Mental Health', 'Psychology', 'Neuropsychology', NULL, 'O', '675 E 500 S Ste 300', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8015883938', NULL, NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, '', NULL, NULL, '0.00', '10.00', '0.00', 8, '2008-09-01', NULL, NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1649360231', 0, 'N', 0, '2010-03-09', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11014666', 'W11014666', 'UTIHC02', NULL, 'Lisa', 'E', 'Giles', 'MD', 'Mental Health', 'Pediatric Psychiatry', NULL, NULL, 'O', '675 E 500 S Ste 300', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8015883938', NULL, NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, NULL, NULL, NULL, '0.00', '10.00', NULL, 8, '2000-01-01', '2000-01-01', 0, NULL, 0, 'Primary Childrens Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1841408309', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('743134253', 'W11014644', 'W11014644', 'UT01', 'University Health Care', 'Joshua', 'D', 'Schiffman', 'MD', 'Pediatric Hematology and Oncolocy', 'Pediatrics', '', NULL, 'o', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016624700', '8016624700', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016624700', '8016624700', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2008-09-18', '2012-07-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1639361314', 0, 'N', 0, '2012-07-31', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11014676', 'W11014676', 'UTIHC03', '', 'Richard', 'D', 'Martini', 'MD', 'Mental Health', 'Pediatric Psychiatry', '', NULL, 'O', '675 E 500 S Ste 300', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8015883938', NULL, '675 E 500 S Ste 300', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8015883938', '          ', '', '', '', '0.00', '10.00', '0.00', 8, '0200-09-16', '2013-07-01', 0, 0, 0, 'Primary Childrens Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1104995380', 0, 'N', 0, '2013-08-29', NULL, NULL, 0, 0, NULL, NULL),
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('870616107', 'W11014728', 'W11014728', 'UT01', 'University Health Care', 'Spencer', 'D', 'Johnson', 'OD', 'Optometry', '', '', NULL, 'O', '26 S Main St', 'Centerville', 'Davis', 'UT', '84014', '8016937900', NULL, '26 S Main St', 'Centerville', 'Davis', 'UT', '84014', '8016937900', '', 'WUNIVOP', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2008-10-07', '2008-10-08', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1487747408', 0, 'N', 0, '2011-09-23', NULL, NULL, 0, 0, NULL, NULL),
('870616107', 'W11014729', 'W11014729', 'UT01', 'University Health Care', 'Spencer', 'D', 'Johnson', 'OD', 'Optometry', '', '', NULL, 'O', '1492 W Antelope Ste 150', 'Layton', 'Davis', 'UT', '84041', '8017767804', NULL, '1492 W Antelope Ste 150', 'Layton', 'Davis', 'UT', '84041', '8017767804', '', 'WUNIVOP', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2008-10-07', '2008-10-08', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1487747408', 0, 'N', 0, '2011-09-23', NULL, NULL, 0, 0, NULL, NULL),
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('205529469', 'W11014720', 'W11014720', 'UT01', 'University Health Care', 'Derek', 'M', 'Krete', 'MD', 'Physical Medicine and Rehabilitation', NULL, NULL, NULL, 'O', '1493 Lowell Ave', 'Park City', 'Summit', 'UT', '84060', '4356557970', NULL, NULL, NULL, 'Summit', NULL, NULL, NULL, NULL, 'WUUUMG5', 'WUSTDHCPC5', NULL, '0.00', '25.00', '0.00', 3, '2008-07-01', '2009-07-31', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1467648410', 0, 'N', 0, '2008-10-13', NULL, NULL, 0, 0, NULL, NULL),
('870616107', 'W11014712', 'W11014712', 'UT01', 'University Health Care', 'Spencer', 'D', 'Johnson', 'OD', 'Optometry', '', '', NULL, 'O', '220 Millpond Rd Ste 100', 'Stansbury Park', 'Tooele', 'UT', '84074', '4358433000', NULL, '220 Millpond Rd Ste 100', 'Stansbury Park', 'Tooele', 'UT', '84074', '4358433000', '', 'WUNIVOP', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2008-10-07', '2008-10-08', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1487747408', 0, 'N', 0, '2011-09-23', NULL, NULL, 0, 0, NULL, NULL),
('201739412', 'W11014731', 'W11014731', 'UT01', 'Jordan Valley Medical Center', 'C', 'Rex', 'Scott', 'AUD', 'Audiology', '', '', NULL, 'O', '3580 W 9000 S', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015624250', NULL, '3580 W 9000 S', 'West Jordan', 'Salt Lake', 'UT', '84088', '8015624250', '', 'WISESTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2008-10-11', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1912044082', 0, 'n', 0, '2014-01-20', NULL, NULL, 40.5879, -111.975, NULL, NULL),
('261703236', 'W11014699', 'W11014699', 'UTMH2', 'Clinical Consultants ', NULL, NULL, 'Clinical Consultants LLC', 'GROUP', 'Mental Health Facility', NULL, NULL, NULL, 'O', '8541 S Redwood Rd Bld A', 'West Jordan', 'Salt Lake', 'UT', '84088', '8012338670', NULL, '8541 S Redwood Rd', 'West Jordan', 'Salt Lake', 'UT', '84088', NULL, NULL, '', NULL, '8', '0.00', '40.00', '0.00', 6, '2008-10-01', NULL, 1, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000005739', 0, 'n', 0, '2008-10-13', NULL, NULL, 40.596, -111.939, NULL, NULL),
('870616107', 'W11014715', 'W11014715', 'UT01', 'University Health Care', 'Spencer', 'D', 'Johnson', 'OD', 'Optometry', '', '', NULL, 'O', '1091 W S Jordan Pkwy', 'South Jordan', 'Salt Lake', 'UT', '84095', '8012139800', NULL, '1091 W S Jordan Pkwy', 'South Jordan', 'Salt Lake', 'UT', '84095', '8012139800', '', 'WUNIVOP', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2008-10-07', '2008-10-08', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1487747408', 0, 'N', 0, '2011-09-23', NULL, NULL, 0, 0, NULL, NULL),
('870616107', 'W11014714', 'W11014714', 'UT01', 'University Health Care', 'Spencer', 'D', 'Johnson', 'OD', 'Optometry', '', '', NULL, 'O', '1743 W Redstone Ctr Ste 115', 'Park City', 'Summit', 'UT', '84098', '4356589200', NULL, '1743 W Redstone Ctr Ste 115', 'Park City', 'Summit', 'UT', '84098', '4356589200', '', 'WUNIVOP', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2008-10-07', '2008-10-08', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1487747408', 0, 'N', 0, '2011-09-23', NULL, NULL, 0, 0, NULL, NULL),
('870640775', 'W11014693', 'W11014693', 'UT01', 'University Health Care', 'Richard', 'M', 'Craig', 'MD ', 'Gastroenterology', 'Internal Medicine', '', NULL, 'o', '1743 W Redstone Ctr Ste 115', 'Park City', 'Summit', 'UT', '84098', '4356589200', NULL, '1743 W Redstone Ctr Ste 115', 'Park City', 'Summit', 'UT', '84098', '4356589200', '          ', 'WISESTDU', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-08-01', '2012-09-18', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1174613764', 0, 'N', 0, '2012-09-19', NULL, NULL, 0, 0, NULL, NULL),
('201739412', 'W11014730', 'W11014730', 'UT01', 'Salt Lake Regional Medical Center', 'C', 'Rex', 'Scott', 'AUD', 'Audiology', '', '', NULL, 'O', '1050 E S Temple', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013504111', NULL, '1050 E S Temple', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013504111', '', 'WISESTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2008-10-11', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1912044082', 0, 'n', 0, '2014-01-20', NULL, NULL, 40.7694, -111.861, NULL, NULL),
('870401574', 'W11014698', 'W11014698', 'UTMH1', 'Highland Ridge Hospital', '', '', 'Highland Ridge Hospital', 'GROUP', 'Mental Health Facility', 'Substance Abuse Facility', '', NULL, 'O', '7309 S 180 W', 'Midvale', 'Salt Lake', 'UT', '84047', '8015692153', NULL, '7309 S 180 W', 'Midvale', 'Salt Lake', 'UT', '84047', '8015692153', '          ', '', '', '8', '0.00', '50.00', '0.00', 3, '2008-10-01', NULL, 1, 0, 0, '', '', '', '', 'HCFA|UB|', '1871504159', 0, 'N', 0, '2014-02-24', NULL, NULL, 40.6187, -111.897, NULL, NULL),
('710885968', 'W11014708', 'W11014708', 'UT01', 'University Health Care', 'Roberta', NULL, 'Lucas', 'APRN', 'Pain Management', '', '', NULL, 'o', '546 Chipeta Way', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015816393', NULL, '546 Chipeta Way', 'Salt Lake City', 'Salt Lake', 'UT', '84108', '8015816393', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2008-08-14', '2012-08-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1568538528', 0, 'N', 0, '2012-08-31', NULL, NULL, 0, 0, NULL, NULL),
('201739412', 'W11014732', 'W11014732', 'UT01', NULL, 'C', 'Rex', 'Scott', 'AUD', 'Audiology', '', '', NULL, 'B', 'PO Box 9397', 'Salt Lake City', 'Salt Lake', 'UT', '84109', '8015624250', NULL, 'PO Box 9397', 'Salt Lake City', 'Salt Lake', 'UT', '84109', '8015624250', '', 'WISESTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2008-10-11', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1912044082', 0, 'y', 0, '2014-01-20', NULL, NULL, 0, 0, NULL, NULL),
('870616107', 'W11014716', 'W11014716', 'UT01', 'University Health Care', 'Spencer', 'D', 'Johnson', 'OD', 'Optometry', '', '', NULL, 'O', '3730 W 4700 S', 'West Valley', 'Salt Lake', 'UT', '84118', '8012139200', NULL, '3730 W 4700 S', 'West Valley', 'Salt Lake', 'UT', '84118', '8012139200', '', 'WUNIVOP', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2008-10-07', '2008-10-08', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1487747408', 0, 'N', 0, '2011-09-23', NULL, NULL, 0, 0, NULL, NULL),
('870640775', 'W11014692', 'W11014692', 'UT01', 'University Health Care', 'Richard', 'M', 'Craig', 'MD ', 'Gastroenterology', 'Internal Medicine', '', NULL, 'o', '1525 W 2100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8012139900', NULL, '1525 W 2100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8012139900', '          ', 'WISESTDU', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-08-01', '2012-09-18', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1174613764', 0, 'N', 0, '2012-09-19', NULL, NULL, 0, 0, NULL, NULL),
('870616107', 'W11014726', 'W11014726', 'UT01', 'University Health Care', 'Matthew', 'A', 'Hughes', 'MD', 'Family Practice', 'Occupational Therapy', '', NULL, 'o', '1525 W 2100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8012139900', '8012139910', '1525 W 2100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8012139900', '8012139910', 'WISESTDU', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2008-09-24', '2012-09-16', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1326298563', 0, 'N', 0, '2012-09-18', NULL, NULL, 0, 0, NULL, NULL),
('870616107', 'W11014711', 'W11014711', 'UT01', 'University Health Care', 'Spencer', 'D', 'Johnson', 'OD', 'Optometry', '', '', NULL, 'O', '1525 W 2100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8012139900', NULL, '1525 W 2100 S', 'Salt Lake City', 'Salt Lake', 'UT', '84119', '8012139900', '', 'WUNIVOP', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2008-10-07', '2008-10-08', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1487747408', 0, 'N', 0, '2011-09-23', NULL, NULL, 0, 0, NULL, NULL),
('870480520', 'W11014722', 'W11014722', 'UT01', 'University Health Care', 'Jennifer', 'J', 'Majersik', 'MD', 'Neurology', '', '', NULL, 'o', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015856387', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015856387', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2008-10-02', '2012-08-09', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1114017134', 0, 'N', 0, '2012-08-10', NULL, NULL, 0, 0, NULL, NULL),
('870490866', 'W11014724', 'W11014724', 'UT01', 'University Health Care', 'Victoria', 'J', 'Serpico', 'APRN', 'General Surgery', '', '', NULL, 'o', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015814314', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015814314', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2008-09-29', '2012-09-16', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1104075092', 0, 'N', 0, '2012-09-17', NULL, NULL, 0, 0, NULL, NULL),
('562627035', 'W11014718', 'W11014718', 'UT01', 'University Health Care', 'William', 'R', 'Keye', 'MD', 'Obstetrics and Gynecology', 'Reproductive Endocrinology', '', NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015812719', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015812719', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2008-11-01', '2012-08-20', 0, 0, 0, 'University Health Care University Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1407815863', 0, 'N', 0, '2012-08-20', 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
('870616107', 'W11014727', 'W11014727', 'UT01', 'University Health Care', 'Matthew', 'A', 'Hughes', 'MD', 'Family Practice', 'Occupational Therapy', '', NULL, 'B', 'PO Box 510708', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8015876303', NULL, 'PO Box 510708', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8015876303', '          ', 'WISESTDU', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2008-09-24', '2012-09-16', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1326298563', 0, 'Y', 0, '2012-09-18', NULL, NULL, 0, 0, NULL, NULL),
('870616107', 'W11014710', 'W11014710', 'UT01', 'U of U Hospitals and Clinics', 'Spencer', 'D', 'Johnson', 'OD', 'Optometry', '', '', NULL, 'B', 'PO Box 510708', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8015876303', NULL, 'PO Box 510708', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8015876303', '', 'WUNIVOP', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2008-10-07', '2008-10-08', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1487747408', 0, 'y', 0, '2011-09-23', NULL, NULL, 0, 0, NULL, NULL),
('870640775', 'W11014694', 'W11014694', 'UT01', 'University Health Care', 'Richard', 'M', 'Craig', 'MD ', 'Gastroenterology', 'Internal Medicine', '', NULL, 'B', 'PO Box 510708', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8015876303', NULL, 'PO Box 510708', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8015876303', '          ', 'WISESTDU', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2006-08-01', '2012-09-18', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1174613764', 0, 'N', 0, '2012-09-19', NULL, NULL, 0, 0, NULL, NULL),
('870490866', 'W11014725', 'W11014725', 'UT01', 'University Health Care', 'Victoria', 'J', 'Serpico', 'APRN', 'General Surgery', '', '', NULL, 'B', 'PO Box 413035', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8015812121', NULL, 'PO Box 413035', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8015812121', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2008-09-29', '2012-09-16', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1104075092', 0, 'N', 0, '2012-09-17', NULL, NULL, 0, 0, NULL, NULL),
('205529469', 'W11014721', 'W11014721', 'UT01', 'University Health Care', 'Derek', 'M', 'Krete', 'MD', 'Physical Medicine and Rehabilitation', NULL, NULL, NULL, 'B', 'PO Box 58108', 'Salt Lake City', 'Salt Lake', 'UT', '84158', '8015883998', NULL, NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, 'WUUUMG5', 'WUSTDHCPC5', NULL, '0.00', '25.00', '0.00', 3, '2008-07-01', '2009-07-31', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1467648410', 0, 'y', 0, '2008-10-13', NULL, NULL, 0, 0, NULL, NULL),
('562627035', 'W11014719', 'W11014719', 'UT01', 'University Health Care', 'William', 'R', 'Keye', 'MD', 'Obstetrics and Gynecology', 'Reproductive Endocrinology', '', NULL, 'B', 'PO Box 413028', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, 'WUUUMG5', 'WUSTDHCPC5', NULL, '0.00', '25.00', '0.00', 3, '2008-11-01', NULL, NULL, 0, 0, 'University Health Care University Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1407815863', 0, 'y', 0, '2010-04-06', NULL, NULL, 0, 0, NULL, NULL),
('710885968', 'W11014709', 'W11014709', 'UT01', 'University Health Care', 'Roberta', NULL, 'Lucas', 'APRN', 'Pain Management', '', '', NULL, 'B', 'PO Box 413034', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012367778', NULL, 'PO Box 413034', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012367778', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2008-08-14', '2012-08-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1568538528', 0, 'N', 0, '2012-08-31', NULL, NULL, 0, 0, NULL, NULL),
('870480520', 'W11014723', 'W11014723', 'UT01', 'University Health Care', 'Jennifer', 'J', 'Majersik', 'MD', 'Neurology', '', '', NULL, 'B', 'PO Box 413027', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413027', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2008-10-02', '2012-08-09', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1114017134', 0, 'N', 0, '2012-08-10', NULL, NULL, 0, 0, NULL, NULL),
('204040088', 'W11014702', 'W11014702', 'UT01', 'Logan Regional Hospital', 'Wade', 'S', 'Harris', 'MD', 'Sleep Medicine', 'Neurology', NULL, NULL, 'O', '1400 N 500 E', 'Logan', 'Cache', 'UT', '84341', '4357165709', '2084540965', '211 E Logan', 'Caldwell', 'Cache', 'ID', '83605', NULL, NULL, 'WISESTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, 'West Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1134227945', 0, 'N', 0, '2009-04-27', NULL, NULL, 41.7569, -111.821, NULL, NULL),
('621801973', 'W11014734', 'W11014734', 'UT01', 'Surgical Weight Loss Center of Utah', 'Daniel', 'R', 'Cottam', 'MD', 'General Surgery', 'Bariatric Surgery', '', NULL, 'B', '406 W South Jordan Pkwy Ste 500', 'South Jordan', 'Salt Lake', 'UT', '84095', '8017462885', NULL, '406 W South Jordan Pkwy Ste 500', 'South Jordan', 'Salt Lake', 'UT', '84095', '8017462885', '          ', 'WUSTDSURG5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2008-09-01', '2011-04-01', 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1760574776', 0, 'N', 0, '2014-01-21', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W11014733', 'W11014733', 'UT01', 'Surgical Weight Loss Center of Utah', 'Daniel', 'R', 'Cottam', 'MD', 'General Surgery', 'Bariatric Surgery', '', NULL, 'O', '24 S 1100 E Ste 304', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8017462885', NULL, '24 S 1100 E Ste 304', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8017462885', '          ', 'WUSTDSURG5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2008-09-01', '2011-04-01', 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1760574776', 0, 'N', 0, '2014-01-21', NULL, NULL, 0, 0, NULL, NULL),
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('810231784', 'W11014751', 'W11014751', 'WY01', 'Billings Clinic - Red Lodge Clinic', 'Sarah', NULL, 'Stewart', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '10 S Oakes', 'Red Lodge', 'Carbon', 'MT', '59068', '4064462412', '4064461913', 'PO Box 37000', 'Billings', 'Carbon', 'MT', '59107', NULL, NULL, '', NULL, NULL, '0.00', '17.00', '0.00', 3, '2008-09-09', '2009-04-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1932372943', 0, 'N', 0, '2009-05-04', NULL, NULL, 0, 0, NULL, NULL),
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('820161600', 'W11014766', 'W11014766', 'ID02', 'Pacific Northwest Surgical Associates', 'Robert', 'L', 'Korn', 'MD', 'General Surgery', NULL, NULL, NULL, 'O', '222 N 2nd Ste 111', 'Boise', 'Ada', 'ID', '83702', '2083813915', '2083813918', NULL, NULL, 'Ada', NULL, NULL, NULL, NULL, 'IDACN', NULL, NULL, '0.00', '15.00', '0.00', 8, '2008-10-01', '2008-10-01', 1, 0, 1, 'Saint Alphonsus Medical Center Nampa', NULL, NULL, NULL, 'HCFA|UB|', '1700862786', 0, 'N', 0, '2008-10-15', NULL, NULL, 43.6131, -116.195, NULL, NULL),
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('820481676', 'W11014771', 'W11014771', 'ID02', 'Idaho Family Physicians Inc', 'Mont', 'B', 'Tolman', 'DO', 'Family Practice', '', '', NULL, 'O', '130 E Boise Ave', 'Boise', 'Ada', 'ID', '83706', '2083454066', NULL, '130 E Boise Ave', 'Boise', 'Ada', 'ID', '83706', '2083454066', '', 'IDACN', NULL, NULL, '0.00', '15.00', '0.00', 3, '2008-10-14', '2009-11-01', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1124069828', 0, 'n', 0, '2012-03-02', NULL, NULL, 0, 0, NULL, NULL),
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('870395551', 'W11014811', 'W11014811', 'UT01', '', 'Todd', '', 'Cramer', 'DC', 'Chiropractic', '', '', NULL, 'O', '440 E State St Ste 100', 'Eagle', 'Ada', 'ID', '83616', '2089393737', '8017749650', '440 E State St Ste 100', 'Eagle', 'Ada', 'ID', '83616', '2089393737', '8017749650', 'WLABRAD', 'WUSTDHCPC5', '', '0.00', '0.00', '55.46', 3, '2008-06-19', '2010-10-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1760551956', 0, 'N', 0, '2013-06-17', NULL, NULL, 0, 0, NULL, NULL),
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('870395551', 'W11014818', 'W11014818', 'UT01', NULL, 'Thomas', 'Cole', 'Snyder', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '134 W 1180 N', 'Tooele', 'Tooele', 'UT', '84074', '4358821621', '4358828267', '867 E 9400 S', 'Sandy', 'Tooele', 'UT', '84094', NULL, NULL, 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', '0.00', '55.46', 3, '2006-04-01', '2010-10-31', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000008798', 0, 'N', 0, '2008-10-21', NULL, NULL, 0, 0, NULL, NULL),
('800239738', 'W11014801', 'W11014801', 'UT01', 'Jordan Family Health LLC', 'Joni', 'W', 'Hougaard', 'MD', 'Family Practice', '', '', NULL, 'O', '8846 S Redwood Rd Ste E121', 'West Jordan', 'Salt Lake', 'UT', '84084', '8015691999', '', '8846 S Redwood Rd Ste E121', 'West Jordan', 'Salt Lake', 'UT', '84084', '8015691999', '', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2008-11-01', '2010-08-31', 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1508801606', 0, 'N', 0, '2014-07-25', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W11014803', 'W11014803', 'UT01', 'Salt Lake Senior Clinic', 'Alison', '', 'Schlisman', 'MD', 'Geriatrics', 'Internal Medicine', '', NULL, 'O', '82 S 1100 E Ste 204', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013504602', NULL, '82 S 1100 E Ste 204', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8013504602', '', 'WUSTDINT5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2008-10-15', '2014-04-30', 0, 0, 0, 'Salt Lake Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1265534887', 0, 'N', 0, '2011-04-21', NULL, NULL, 40.7676, -111.86, NULL, NULL),
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('743134291', 'W11014834', 'W11014834', 'ID01', 'University of Utah Dept of Pediatric Endocrinology', '', '', 'University of Utah Dept of Pediatric Endocrinology', 'GROUP', 'Pediatric Endocrinology', '', '', NULL, 'o', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8015882000', NULL, '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8015882000', '', 'WUUPEDS', 'WUSTDHCPC5', NULL, '0.00', '15.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009294', 0, 'N', 0, '2012-08-01', NULL, NULL, 40.7663, -111.837, NULL, NULL),
('743134251', 'W11014836', 'W11014836', 'ID01', 'University of Utah Dept of Pediatric Gastroenterology', '', '', 'University of Utah Dept of Pediatric Gastroenterology', 'GROUP', 'Pediatric Gastroenterology', '', '', NULL, 'o', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8015882000', NULL, '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8015882000', '', 'WUUPEDS', 'WUSTDHCPC5', NULL, '0.00', '15.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009295', 0, 'N', 0, '2012-07-31', NULL, NULL, 40.7663, -111.837, NULL, NULL),
('743134252', 'W11014838', 'W11014838', 'ID01', 'University of Utah Dept of Pediatric Genetics', '', '', 'University of Utah Dept of Pediatric Genetics', 'GROUP', 'Pediatric Genetics', '', '', NULL, 'O', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8015818943', NULL, '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8015818943', '', 'WUUPEDS', 'WUSTDHCPC5', NULL, '0.00', '15.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009296', 0, 'N', 0, '2012-07-17', NULL, NULL, 40.7663, -111.837, NULL, NULL),
('743134271', 'W11014828', 'W11014828', 'ID01', 'University of Utah Dept of Pediatric Cardiology', '', '', 'University of Utah Dept of Pediatric Cardiology', 'GROUP', 'Pediatric Cardiology', '', '', NULL, 'o', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8015882000', NULL, '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8015882000', '', 'WUUPEDS', 'WUSTDHCPC5', NULL, '0.00', '15.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009292', 0, 'N', 0, '2012-08-01', NULL, NULL, 40.7663, -111.837, 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
('743134273', 'W11014827', 'W11014827', 'ID01', 'Pediatric Bone Marrow Transplant-Department of University of', '', '', 'Pediatric Bone Marrow Transplant-Department of University of Utah', 'GROUP', 'Pediatric Hematology and Oncolocy', '', '', NULL, 'O', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8015882000', NULL, '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8015882000', '', 'WUUPEDS', 'WUSTDHCPC5', NULL, '0.00', '15.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000008108', 0, 'N', 0, '2012-08-01', NULL, NULL, 40.7663, -111.837, NULL, NULL),
('870476269', 'W11014820', 'W11014820', 'ID01', 'University of Utah Dept of Pediatrics', '', '', 'University of Utah Dept of Pediatrics', 'GROUP', 'Pediatrics', '', '', NULL, 'o', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8015882000', NULL, '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8015882000', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009306', 0, 'N', 0, '2012-10-16', NULL, NULL, 40.7663, -111.837, NULL, NULL),
('743134253', 'W11014840', 'W11014840', 'ID01', 'University of Utah Dept of Pediatric Hematology Oncology', '', '', 'University of Utah Dept of Pediatric Hematology Oncology', 'GROUP', 'Pediatric Hematology and Oncolocy', '', '', NULL, 'o', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8015882000', NULL, '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8015882000', '', 'WUUPEDS', 'WUSTDHCPC5', NULL, '0.00', '15.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009297', 0, 'N', 0, '2012-07-31', NULL, NULL, 40.7663, -111.837, NULL, NULL),
('743134266', 'W11014832', 'W11014832', 'ID01', 'University of Utah Dept of  Pediatric Emergency Medicine', '', '', 'University of Utah Dept of  Pediatric Emergency Medicine', 'GROUP', 'Pediatric Emergency Medicine', '', '', NULL, 'o', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8015882000', NULL, '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8015882000', '', 'WUUPEDS', 'WUSTDHCPC5', NULL, '0.00', '15.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009283', 0, 'N', 0, '2012-07-31', NULL, NULL, 40.7663, -111.837, NULL, NULL),
('364586972', 'W11014856', 'W11014856', 'ID01', 'University of Utah Pediatric Rapid Treatment Unit', '', '', 'University of Utah Pediatric Rapid Treatment Unit', 'GROUP', 'Pediatric Emergency Medicine', '', '', NULL, 'o', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8015882233', NULL, '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8015882233', '', 'WUUPEDS', 'WUSTDHCPC5', NULL, '0.00', '15.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009308', 0, 'N', 0, '2012-06-20', NULL, NULL, 40.7663, -111.837, NULL, NULL),
('870638577', 'W11014865', 'W11014865', 'ID01', 'University of Utah Pediatric Ophthalmology', '', '', 'University of Utah Pediatric Ophthalmology', 'GROUP', 'Pediatric Ophthalmology', '', '', NULL, 'o', '100 N Mario Capecchi Dr Ste 3650', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8015882000', NULL, '100 N Mario Capecchi Dr Ste 3650', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8015882000', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009316', 0, 'N', 0, '2012-08-10', NULL, NULL, 40.7663, -111.837, NULL, NULL),
('870645895', 'W11014863', 'W11014863', 'ID01', 'U of U pediatric Orthopedics', '', '', 'U of U pediatric Orthopedics', 'GROUP', 'Pediatric Orthopedic Surgery', '', '', NULL, 'O', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016625600', NULL, '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016625600', '', 'WUUPEDS', 'WUSTDHCPC5', NULL, '0.00', '15.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009248', 0, 'N', 0, '2012-08-02', NULL, NULL, 40.7663, -111.837, NULL, NULL),
('743134267', 'W11014846', 'W11014846', 'ID01', 'University of Utah Dept of Pediatric Inpatient Services', '', '', 'University of Utah Dept of Pediatric Inpatient Services', 'GROUP', 'Pediatric Emergency Medicine', '', '', NULL, 'o', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016623645', '8016623446', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016623645', '8016623446', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009300', 0, 'N', 0, '2013-01-22', NULL, NULL, 40.7663, -111.837, NULL, NULL),
('743134268', 'W11014858', 'W11014858', 'ID01', 'University of Utah Dept of Pediatric Sleep Medicine', '', '', 'University of Utah Dept of Pediatric Sleep Medicine', 'GROUP', 'Pediatric Pulmonology', 'Pediatric Sleep Medicine', 'Pediatrics', NULL, 'O', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8015882000', NULL, '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8015882000', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009305', 0, 'N', 0, '2012-08-01', NULL, NULL, 40.7663, -111.837, NULL, NULL),
('743134254', 'W11014842', 'W11014842', 'ID01', 'University of Utah Dept of Pediatric Immunology', '', '', 'University of Utah Dept of Pediatric Immunology', 'GROUP', 'Pediatric Immunology and Rheumatology', '', '', NULL, 'O', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8015882000', NULL, '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8015882000', '', 'WUUPEDS', 'WUSTDHCPC5', NULL, '0.00', '15.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009298', 0, 'N', 0, '2012-07-31', NULL, NULL, 40.7663, -111.837, NULL, NULL),
('743134264', 'W11014854', 'W11014854', 'ID01', 'University of Utah Dept of Pediatric Pulmonolgy', '', '', 'University of Utah Dept of Pediatric Pulmonolgy', 'GROUP', 'Pediatric Pulmonology', '', '', NULL, 'o', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8015882000', NULL, '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8015882000', '', 'WUUPEDS', 'WUSTDHCPC5', NULL, '0.00', '15.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009304', 0, 'N', 0, '2012-07-31', NULL, NULL, 40.7663, -111.837, NULL, NULL),
('743134260', 'W11014852', 'W11014852', 'ID01', 'University of Utah Dept of Pediatric Nephrology', '', '', 'University of Utah Dept of Pediatric Nephrology', 'GROUP', 'Pediatric Nephrology', '', '', NULL, 'o', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8015882000', NULL, '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8015882000', '', 'WUUPEDS', 'WUSTDHCPC5', NULL, '0.00', '15.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009302', 0, 'N', 0, '2012-07-31', NULL, NULL, 40.7663, -111.837, NULL, NULL),
('743134258', 'W11014850', 'W11014850', 'ID01', 'University of Utah Dept of Pediatric Neonatology', '', '', 'University of Utah Dept of Pediatric Neonatology', 'GROUP', 'Neonatology', '', '', NULL, 'o', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8015882000', NULL, '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8015882000', '', 'WUUPEDS', 'WUSTDHCPC5', NULL, '0.00', '15.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009301', 0, 'N', 0, '2012-07-31', NULL, NULL, 40.7663, -111.837, NULL, NULL),
('743134250', 'W11014830', 'W11014830', 'ID01', 'University of Utah Dept of Pediatric Critical Care', '', '', 'University of Utah Dept of Pediatric Critical Care', 'GROUP', 'Pediatric Critical Care', '', '', NULL, 'o', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8015882000', NULL, '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8015882000', '', 'WUUPEDS', 'WUSTDHCPC5', NULL, '0.00', '15.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009293', 0, 'N', 0, '2012-07-27', NULL, NULL, 40.7663, -111.837, NULL, NULL),
('743134262', 'W11014848', 'W11014848', 'ID01', 'University of Utah Dept of Pediatric Neurology', '', '', 'University of Utah Dept of Pediatric Neurology', 'GROUP', 'Pediatric Neurology', '', '', NULL, 'o', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8015882000', NULL, '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8015882000', '', 'WUUPEDS', 'WUSTDHCPC5', NULL, '0.00', '15.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009303', 0, 'N', 0, '2012-07-31', NULL, NULL, 40.7663, -111.837, NULL, NULL),
('743134257', 'W11014844', 'W11014844', 'ID01', 'University of Utah Dept of Pediatric Infectious Disease', '', '', 'University of Utah Dept of Pediatric Infectious Disease', 'GROUP', 'Pediatric Infectious Diseases', '', '', NULL, 'o', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8015882000', NULL, '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8015882000', '', 'WUUPEDS', 'WUSTDHCPC5', NULL, '0.00', '15.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009299', 0, 'N', 0, '2012-07-31', NULL, NULL, 40.7663, -111.837, NULL, NULL),
('870517255', 'W11014861', 'W11014861', 'ID01', 'Pediatric Orthopedic Associates/ Radiology Services', NULL, NULL, 'Pediatric Orthopedic Associates/ Radiology Services', 'GROUP', 'Pediatric Orthopedic Surgery', 'Pediatric Orthopedic Radiology', '', NULL, 'o', '100 N Mario Capecchi Dr Ste 4550', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8015883900', NULL, '100 N Mario Capecchi Dr Ste 4550', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8015883900', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2008-10-01', '2010-01-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000008120', 0, 'N', 0, '2008-10-22', NULL, NULL, 0, 0, NULL, NULL),
('870645559', 'W11014822', 'W11014822', 'ID01', 'University of Utah Dept of General Pediatrics', '', '', 'University of Utah Dept of General Pediatrics', 'GROUP', 'Pediatrics', '', '', NULL, 'o', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015812205', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015812205', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009284', 0, 'N', 0, '2012-11-30', NULL, NULL, 40.7685, -111.837, NULL, NULL),
('870638577', 'W11014866', 'W11014866', 'ID01', 'University of Utah Pediatric Ophthalmology', '', '', 'University of Utah Pediatric Ophthalmology', 'GROUP', 'Pediatric Ophthalmology', '', '', NULL, 'B', '65 Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015813195', NULL, '65 Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015813195', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2008-10-01', '2011-10-16', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009316', 0, 'N', 0, '2012-08-10', NULL, NULL, 0, 0, NULL, NULL),
('876151902', 'W11014867', 'W11014867', 'ID01', 'University of Utah Dept of Ophthalmology', '', '', 'University of Utah Dept of Ophthalmology', 'GROUP', 'Ophthalmology', '', '', NULL, 'B', '65 Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015813195', NULL, '65 Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015813195', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009291', 0, 'N', 0, '2012-12-07', NULL, NULL, 0, 0, NULL, NULL),
('383725436', 'W11014824', 'W11014824', 'ID01', 'University of Utah Dept of Pediatrics and Adolescent Medicin', '', '', 'University of Utah Dept of Pediatrics and Adolescent Medicine', 'GROUP', 'Pediatrics', 'Internal Medicine', '', NULL, 'o', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015813501', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015813501', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009307', 0, 'N', 0, '2012-10-16', NULL, NULL, 40.7685, -111.837, NULL, NULL),
('870564069', 'W11014871', 'W11014871', 'ID01', 'U Dept of Family & Preventative Medicine', '', '', 'U Dept of Family & Preventative Medicine', 'GROUP', 'Family Practice', 'Internal Medicine', 'Geriatrics', NULL, 'B', 'PO Box 510004', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8015876600', NULL, 'PO Box 510004', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8015876600', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009216', 0, 'N', 0, '2013-02-11', NULL, NULL, 0, 0, NULL, NULL),
('870476269', 'W11014821', 'W11014821', 'ID01', 'University of Utah Dept of Pediatrics', '', '', 'University of Utah Dept of Pediatrics', 'GROUP', 'Pediatrics', '', '', NULL, 'B', 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009306', 0, 'Y', 0, '2012-10-16', NULL, NULL, 0, 0, NULL, NULL),
('743134260', 'W11014853', 'W11014853', 'ID01', 'University of Utah Dept of Pediatric Nephrology', '', '', 'University of Utah Dept of Pediatric Nephrology', 'GROUP', 'Pediatric Nephrology', '', '', NULL, 'B', 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '', 'WUUPEDS', 'WUSTDHCPC5', NULL, '0.00', '15.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009302', 0, 'y', 0, '2012-07-31', NULL, NULL, 0, 0, NULL, NULL),
('870443046', 'W11014872', 'W11014872', 'ID01', 'U of U Medical Center - Psychiatry', '', '', 'U of U Medical Center - Psychiatry', 'GROUP', 'Mental Health', '', '', NULL, 'B', 'PO Box 413029', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413029', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '', 'WUUUMG5', 'WUSTDHCPC5', NULL, '0.00', '25.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009236', 0, 'y', 0, '2012-08-21', NULL, NULL, 0, 0, NULL, NULL),
('611463417', 'W11014870', 'W11014870', 'ID01', 'University of Utah OB Diagnostic Center', '', '', 'University of Utah OB Diagnostic Center', 'GROUP', 'Obstetrics and Gynecology', 'OB Diagnotic', '', NULL, 'B', 'PO Box 413028', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8015855172', NULL, 'PO Box 413028', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8015855172', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009314', 0, 'N', 0, '2012-10-16', NULL, NULL, 0, 0, NULL, NULL),
('870410144', 'W11014869', 'W11014869', 'ID01', 'University of Utah Dept of OB/GYN', '', '', 'University of Utah Dept of OB/GYN', 'GROUP', 'Maternal Fetal Medicine', 'Obstetrics and Gynecology', '', NULL, 'B', 'PO Box 413028', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413028', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '', 'WUUUMG5', 'WUSTDHCPC5', NULL, '0.00', '25.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009285', 0, 'y', 0, '2013-01-30', NULL, NULL, 0, 0, NULL, NULL),
('870480520', 'W11014868', 'W11014868', 'ID01', 'Dept of Neurology School of Medicine U of U', '', '', 'Dept of Neurology School of Medicine U of U', 'GROUP', 'Neurology', '', '', NULL, 'B', 'PO Box 413027', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413027', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000005954', 0, 'N', 0, '2012-10-16', NULL, NULL, 0, 0, NULL, NULL),
('870645895', 'W11014864', 'W11014864', 'ID01', 'U of U pediatric Orthopedics', '', '', 'U of U pediatric Orthopedics', 'GROUP', 'Pediatric Orthopedic Surgery', '', '', NULL, 'B', 'PO Box 413026', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413026', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '', 'WUUPEDS', 'WUSTDHCPC5', NULL, '0.00', '15.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009248', 0, 'y', 0, '2012-08-02', NULL, NULL, 0, 0, NULL, NULL),
('870517255', 'W11014862', 'W11014862', 'ID01', 'Pediatric Orthopedic Associates/ Radiology Services', NULL, NULL, 'Pediatric Orthopedic Associates/ Radiology Services', 'GROUP', 'Pediatric Orthopedic Surgery', 'Pediatric Orthopedic Radiology', '', NULL, 'B', 'PO Box 413026', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413026', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2008-10-01', '2010-01-01', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000008120', 0, 'N', 0, '2008-10-22', NULL, NULL, 0, 0, NULL, NULL),
('237268471', 'W11014860', 'W11014860', 'ID01', 'University Radiology Associates', '', '', 'University Radiology Associates', 'GROUP', 'Diagnostic Radiology', '', '', NULL, 'B', 'PO Box 413025', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413025', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '', 'WUUUMG5', 'WUSTDHCPC5', NULL, '0.00', '25.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009332', 0, 'Y', 0, '2012-08-02', NULL, NULL, 0, 0, NULL, NULL),
('743134268', 'W11014859', 'W11014859', 'ID01', 'University of Utah Dept of Pediatric Sleep Medicine', '', '', 'University of Utah Dept of Pediatric Sleep Medicine', 'GROUP', 'Pediatric Pulmonology', 'Pediatric Sleep Medicine', 'Pediatrics', NULL, 'B', 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009305', 0, 'N', 0, '2012-08-01', NULL, NULL, 0, 0, NULL, NULL),
('743134271', 'W11014829', 'W11014829', 'ID01', 'University of Utah Dept of Pediatric Cardiology', '', '', 'University of Utah Dept of Pediatric Cardiology', 'GROUP', 'Pediatric Cardiology', '', '', NULL, 'B', 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '', 'WUUPEDS', 'WUSTDHCPC5', NULL, '0.00', '15.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009292', 0, 'y', 0, '2012-08-01', NULL, NULL, 0, 0, NULL, NULL),
('743134264', 'W11014855', 'W11014855', 'ID01', 'University of Utah Dept of Pediatric Pulmonolgy', '', '', 'University of Utah Dept of Pediatric Pulmonolgy', 'GROUP', 'Pediatric Pulmonology', '', '', NULL, 'B', 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '', 'WUUPEDS', 'WUSTDHCPC5', NULL, '0.00', '15.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009304', 0, 'y', 0, '2012-07-31', NULL, NULL, 0, 0, NULL, NULL),
('870645559', 'W11014823', 'W11014823', 'ID01', 'University of Utah Dept of General Pediatrics', '', '', 'University of Utah Dept of General Pediatrics', 'GROUP', 'Pediatrics', '', '', NULL, 'B', 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8015812205', NULL, 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8015812205', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009284', 0, 'N', 0, '2012-11-30', NULL, NULL, 0, 0, NULL, NULL),
('743134258', 'W11014851', 'W11014851', 'ID01', 'University of Utah Dept of Pediatric Neonatology', '', '', 'University of Utah Dept of Pediatric Neonatology', 'GROUP', 'Neonatology', '', '', NULL, 'B', 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '', 'WUUPEDS', 'WUSTDHCPC5', NULL, '0.00', '15.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009301', 0, 'y', 0, '2012-07-31', NULL, NULL, 0, 0, NULL, NULL),
('743134262', 'W11014849', 'W11014849', 'ID01', 'University of Utah Dept of Pediatric Neurology', '', '', 'University of Utah Dept of Pediatric Neurology', 'GROUP', 'Pediatric Neurology', '', '', NULL, 'B', 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '', 'WUUPEDS', 'WUSTDHCPC5', NULL, '0.00', '15.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009303', 0, 'y', 0, '2012-07-31', NULL, NULL, 0, 0, NULL, NULL),
('743134257', 'W11014845', 'W11014845', 'ID01', 'University of Utah Dept of Pediatric Infectious Disease', '', '', 'University of Utah Dept of Pediatric Infectious Disease', 'GROUP', 'Pediatric Infectious Diseases', '', '', NULL, 'B', 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '', 'WUUPEDS', 'WUSTDHCPC5', NULL, '0.00', '15.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009299', 0, 'y', 0, '2012-07-31', NULL, NULL, 0, 0, NULL, NULL),
('743134254', 'W11014843', 'W11014843', 'ID01', 'University of Utah Dept of Pediatric Immunology', '', '', 'University of Utah Dept of Pediatric Immunology', 'GROUP', 'Pediatric Immunology and Rheumatology', '', '', NULL, 'B', 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '', 'WUUPEDS', 'WUSTDHCPC5', NULL, '0.00', '15.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009298', 0, 'y', 0, '2012-07-31', NULL, NULL, 0, 0, NULL, NULL),
('743134253', 'W11014841', 'W11014841', 'ID01', 'University of Utah Dept of Pediatric Hematology Oncology', '', '', 'University of Utah Dept of Pediatric Hematology Oncology', 'GROUP', 'Pediatric Hematology and Oncolocy', '', '', NULL, 'B', 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '', 'WUUPEDS', 'WUSTDHCPC5', NULL, '0.00', '15.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009297', 0, 'y', 0, '2012-07-31', NULL, NULL, 0, 0, NULL, NULL),
('743134252', 'W11014839', 'W11014839', 'ID01', 'University of Utah Dept of Pediatric Genetics', '', '', 'University of Utah Dept of Pediatric Genetics', 'GROUP', 'Pediatric Genetics', '', '', NULL, 'B', 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '', 'WUUPEDS', 'WUSTDHCPC5', NULL, '0.00', '15.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009296', 0, 'y', 0, '2012-07-17', NULL, NULL, 0, 0, NULL, NULL),
('743134251', 'W11014837', 'W11014837', 'ID01', 'University of Utah Dept of Pediatric Gastroenterology', '', '', 'University of Utah Dept of Pediatric Gastroenterology', 'GROUP', 'Pediatric Gastroenterology', '', '', NULL, 'B', 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '', 'WUUPEDS', 'WUSTDHCPC5', NULL, '0.00', '15.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009295', 0, 'y', 0, '2012-07-31', NULL, NULL, 0, 0, NULL, NULL),
('743134291', 'W11014835', 'W11014835', 'ID01', 'University of Utah Dept of Pediatric Endocrinology', '', '', 'University of Utah Dept of Pediatric Endocrinology', 'GROUP', 'Pediatric Endocrinology', '', '', NULL, 'B', 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '', 'WUUPEDS', 'WUSTDHCPC5', NULL, '0.00', '15.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009294', 0, 'y', 0, '2012-08-01', NULL, NULL, 0, 0, NULL, NULL),
('383725436', 'W11014825', 'W11014825', 'ID01', 'University of Utah Dept of Pediatrics and Adolescent Medicin', '', '', 'University of Utah Dept of Pediatrics and Adolescent Medicine', 'GROUP', 'Pediatrics', 'Internal Medicine', '', NULL, 'B', 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009307', 0, 'N', 0, '2012-10-16', NULL, NULL, 0, 0, NULL, NULL),
('743134267', 'W11014847', 'W11014847', 'ID01', 'University of Utah Dept of Pediatric Inpatient Services', '', '', 'University of Utah Dept of Pediatric Inpatient Services', 'GROUP', 'Pediatric Emergency Medicine', '', '', NULL, 'B', 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '8016623446', 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '8016623446', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009300', 0, 'N', 0, '2013-01-22', NULL, NULL, 0, 0, NULL, NULL),
('743134273', 'W11014826', 'W11014826', 'ID01', 'Pediatric Bone Marrow Transplant-Department of University of', '', '', 'Pediatric Bone Marrow Transplant-Department of University of Utah', 'GROUP', 'Pediatric Hematology and Oncolocy', '', '', NULL, 'B', 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '', 'WUUPEDS', 'WUSTDHCPC5', NULL, '0.00', '15.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000008108', 0, 'y', 0, '2012-08-01', NULL, NULL, 0, 0, NULL, NULL),
('364586972', 'W11014857', 'W11014857', 'ID01', 'University of Utah Pediatric Rapid Treatment Unit', '', '', 'University of Utah Pediatric Rapid Treatment Unit', 'GROUP', 'Pediatric Emergency Medicine', '', '', NULL, 'B', 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '', 'WUUPEDS', 'WUSTDHCPC5', NULL, '0.00', '15.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009308', 0, 'Y', 0, '2012-06-20', NULL, NULL, 0, 0, NULL, NULL),
('743134250', 'W11014831', 'W11014831', 'ID01', 'University of Utah Dept of Pediatric Critical Care', '', '', 'University of Utah Dept of Pediatric Critical Care', 'GROUP', 'Pediatric Critical Care', '', '', NULL, 'B', 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '', 'WUUPEDS', 'WUSTDHCPC5', NULL, '0.00', '15.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009293', 0, 'Y', 0, '2012-07-27', NULL, NULL, 0, 0, NULL, NULL),
('710920170', 'W11014873', 'W11014873', 'ID01', 'Medical Neuroscience', '', '', 'Medical Neuroscience', 'GROUP', 'Neurosurgery', '', '', NULL, 'B', 'PO Box 413030', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413030', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000007547', 0, 'N', 0, '2012-10-16', NULL, NULL, 0, 0, NULL, NULL),
('743134266', 'W11014833', 'W11014833', 'ID01', 'University of Utah Dept of  Pediatric Emergency Medicine', '', '', 'University of Utah Dept of  Pediatric Emergency Medicine', 'GROUP', 'Pediatric Emergency Medicine', '', '', NULL, 'B', 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '', 'WUUPEDS', 'WUSTDHCPC5', NULL, '0.00', '15.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009283', 0, 'y', 0, '2012-07-31', NULL, NULL, 0, 0, NULL, NULL),
('870395551', 'W11014812', 'W11014812', 'UT01', NULL, 'Dustin', NULL, 'Drussel', 'DC', 'Chiropractic', NULL, NULL, NULL, 'O', '777 N 500 W Ste 205', 'Provo', 'Utah', 'UT', '84601', '8013752420', '8013748588', '867 E 9400 S', 'Sandy', 'Utah', 'UT', '84094', NULL, NULL, 'WLABRAD', 'WUSTDHCPC5', NULL, '0.00', '0.00', '55.46', 3, '2006-04-01', '2010-10-31', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1922286194', 0, 'N', 0, '2008-10-20', NULL, NULL, 0, 0, NULL, NULL),
('880424585', 'W11014798', 'W11014798', 'UTPEHP', 'Mesquite Medical Associates', 'Donald', 'J', 'Dixon', 'MD', 'Family Practice', '', '', NULL, 'O', '1301 Bertha Howe Ave Ste 1', 'Mesquite', 'Clark', 'NV', '89027', '7023460800', NULL, '1301 Bertha Howe Ave Ste 1', 'Mesquite', 'Clark', 'NV', '89027', '7023460800', '          ', 'PEHPOOS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2008-10-15', '2011-08-31', 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1790787034', 0, 'N', 0, '2012-04-19', NULL, NULL, 0, 0, NULL, NULL),
('880424585', 'W11014794', 'W11014794', 'UTPEHP', 'Mesquite Medical Associates', 'Paul', 'D', 'Havens', 'MD', 'Family Practice', '', '', NULL, 'O', '1301 Bertha Howe Ave Ste 1', 'Mesquite', 'Clark', 'NV', '89027', '7023460800', NULL, '1301 Bertha Howe Ave Ste 1', 'Mesquite', 'Clark', 'NV', '89027', '7023460800', '          ', 'PEHPOOS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2008-10-15', '2012-04-25', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1659353738', 0, 'N', 0, '2012-04-25', NULL, NULL, 0, 0, NULL, NULL),
('880424585', 'W11014795', 'W11014795', 'UTPEHP', 'Mesquite Medical Associates', 'Enrique', '', 'Alfaro', 'MD', 'Internal Medicine', '', '', NULL, 'O', '1301 Bertha Howe Ave Ste 1', 'Mesquite', 'Clark', 'NV', '89027', '7023460800', NULL, '1301 Bertha Howe Ave Ste 1', 'Mesquite', 'Clark', 'NV', '89027', '7023460800', '          ', 'PEHPOOS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2008-10-15', '2011-08-31', 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1184606279', 0, 'N', 0, '2013-08-14', NULL, NULL, 0, 0, NULL, NULL),
('880424585', 'W11014797', 'W11014797', 'UTPEHP', 'Mesquite Medical Associates', 'Smita', '', 'Mehta', 'MD', 'Pediatrics', '', '', NULL, 'O', '1301 Bertha Howe Ave Ste 1', 'Mesquite', 'Clark', 'NV', '89027', '7023460800', NULL, '1301 Bertha Howe Ave Ste 1', 'Mesquite', 'Clark', 'NV', '89027', '7023460800', '          ', 'PEHPOOS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2008-10-15', '2012-04-23', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1255313342', 0, 'N', 0, '2012-04-23', NULL, NULL, 0, 0, NULL, NULL),
('880236768', 'W11014799', 'W11014799', 'UTPEHP', 'Mesquite Medical Associates', 'Leo', 'F', 'Black', 'DC', 'Chiropractic', '', '', NULL, 'O', '1301 Bertha Howe Ave Ste 1', 'Mesquite', 'Clark', 'NV', '89027', '7023460800', NULL, '1301 Bertha Howe Ave Ste 1', 'Mesquite', 'Clark', 'NV', '89027', '7023460800', '', 'PEHPOOS', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2008-10-15', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1922080019', 0, 'n', 0, '2012-01-03', NULL, NULL, 0, 0, NULL, NULL),
('880424585', 'W11014796', 'W11014796', 'UTPEHP', 'Mesquite Medical Associates', 'Lonnie', 'R', 'Empey', 'DO', 'Internal Medicine', '', '', NULL, 'O', '1301 Bertha Howe Ave Ste 1', 'Mesquite', 'Clark', 'NV', '89027', '7023460800', NULL, '1301 Bertha Howe Ave Ste 1', 'Mesquite', 'Clark', 'NV', '89027', '7023460800', '          ', 'PEHPOOS', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2008-10-15', '2011-08-31', 0, 0, 0, NULL, '', '', '', 'HCFA|UB|', '1407838584', 0, 'N', 0, '2012-04-19', NULL, NULL, 0, 0, NULL, NULL),
('870541480', 'W11014875', 'W11014875', 'ID01', 'U of U Division of Pediatric Neurosurgery', '', '', 'U of U Division of Pediatric Neurosurgery', 'GROUP', 'Pediatric Neurosurgery', '', '', NULL, 'O', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8015883400', NULL, '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8015883400', '', 'WUUPEDS', 'WUSTDHCPC5', NULL, '0.00', '15.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009224', 0, 'N', 0, '2012-08-21', NULL, NULL, 40.7663, -111.837, NULL, NULL),
('942764098', 'W11014876', 'W11014876', 'ID01', 'University Neurosurgery Associates', '', '', 'University Neurosurgery Associates', 'GROUP', 'Neurosurgery', '', '', NULL, 'B', 'PO Box 413030', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413030', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '', 'WUUUMG5', 'WUSTDHCPC5', NULL, '0.00', '25.00', '0.00', 3, '2008-10-01', '2008-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009280', 0, 'y', 0, '2012-10-16', NULL, NULL, 0, 0, NULL, NULL),
('870541480', 'W11014874', 'W11014874', 'ID01', 'U of U Division of Pediatric Neurosurgery', '', '', 'U of U Division of Pediatric Neurosurgery', 'GROUP', 'Pediatric Neurosurgery', '', '', NULL, 'B', 'PO Box 413030', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413030', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '', 'WUUPEDS', 'WUSTDHCPC5', NULL, '0.00', '15.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009224', 0, 'y', 0, '2012-08-21', NULL, NULL, 0, 0, NULL, NULL),
('870648457', 'W11014878', 'W11014878', 'ID01', 'U of U OB Care Now', '', '', 'U of U OB Care Now', 'GROUP', 'Maternal Fetal Medicine', '', '', NULL, 'B', 'PO Box 1674', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8015876600', NULL, 'PO Box 1674', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8015876600', '', 'WUUUMG5', 'WUSTDHCPC5', NULL, '0.00', '25.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009239', 0, 'y', 0, '2012-08-22', NULL, NULL, 0, 0, NULL, NULL),
('743040723', 'W11014877', 'W11014877', 'ID01', 'University of Utah Hospital Professional Services', '', '', 'University of Utah Hospital Professional Services', 'GROUP', 'Clinics', '', '', NULL, 'B', 'PO Box 1674', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8015876600', NULL, 'PO Box 1674', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8015876600', '', 'WUUUMG5', 'WUSTDHCPC5', NULL, '0.00', '25.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009312', 0, 'y', 0, '2013-01-30', NULL, NULL, 0, 0, NULL, NULL),
('870442845', 'W11014890', 'W11014890', 'ID01', 'Huntsman Cancer Institute', NULL, NULL, 'Huntsman Cancer Institute', 'GROUP', 'Pediatric Hematology and Oncolocy', 'Hematology and Oncology', NULL, NULL, 'O', '1950 Circle of Hope', 'Salt Lake City', 'Salt Lake', 'UT', '84112', '8015850100', NULL, NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, 'WUUUMG5', 'WUSTDHCPC5', NULL, '0.00', '25.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000009379', 0, 'N', 0, '2008-10-22', NULL, NULL, 40.7732, -111.837, NULL, NULL),
('870442845', 'W11014889', 'W11014889', 'ID01', 'Huntsman Cancer Institute', '', '', 'Huntsman Cancer Institute', 'GROUP', 'Pediatric Hematology and Oncolocy', 'Hematology and Oncology', '', NULL, 'O', '2000 Circle of Hope', 'Salt Lake City', 'Salt Lake', 'UT', '84112', '8015850100', NULL, '2000 Circle of Hope', 'Salt Lake City', 'Salt Lake', 'UT', '84112', '8015850100', '', 'WUUUMG5', 'WUSTDHCPC5', NULL, '0.00', '25.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000006813', 0, 'N', 0, '2012-08-28', NULL, NULL, 40.7731, -111.837, NULL, NULL),
('870442845', 'W11014888', 'W11014888', 'ID01', 'Huntsman Cancer Institute', '', '', 'Huntsman Cancer Institute', 'GROUP', 'Pediatric Hematology and Oncolocy', 'Hematology and Oncology', '', NULL, 'B', 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '', 'WUUUMG5', 'WUSTDHCPC5', NULL, '0.00', '25.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000006813', 0, 'y', 0, '2012-08-28', NULL, NULL, 0, 0, NULL, NULL),
('870551044', 'W11014879', 'W11014879', 'ID01', 'University Radiation Oncologists', '', '', 'University Radiation Oncologists', 'GROUP', 'Radiation Oncology', '', '', NULL, 'B', 'PO Box 413031', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413031', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009331', 0, 'N', 0, '2012-10-16', NULL, NULL, 0, 0, NULL, NULL),
('870515631', 'W11014880', 'W11014880', 'ID01', 'U-U Rehabilitation Medicine', '', '', 'U-U Rehabilitation Medicine', 'GROUP', 'Physical Medicine and Rehabilitation', '', '', NULL, 'B', 'PO Box 413032', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8017158238', NULL, 'PO Box 413032', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8017158238', '', 'WUUUMG5', 'WUSTDHCPC5', NULL, '0.00', '25.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009386', 0, 'y', 0, '2012-08-23', NULL, NULL, 0, 0, NULL, NULL),
('870443687', 'W11014881', 'W11014881', 'ID01', 'U-U Cardiology Division', '', '', 'U-U Cardiology Division', 'MD', 'Cardiovascular Disease', 'Cardiology', '', NULL, 'B', 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000003104', 0, 'N', 0, '2013-02-11', NULL, NULL, 0, 0, NULL, NULL),
('870525237', 'W11014882', 'W11014882', 'ID01', 'U-U Clinical Immunology', NULL, NULL, 'U-U Clinical Immunology', 'GROUP', 'Infectious Disease', 'Clinical Pathology', NULL, NULL, 'B', 'PO Box 581700', 'Salt Lake City', 'Salt Lake', 'UT', '84158', '8012133800', NULL, NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, 'WUUUMG5', 'WUSTDHCPC5', NULL, '0.00', '25.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000009374', 0, 'y', 0, '2008-10-22', NULL, NULL, 0, 0, NULL, NULL),
('870542586', 'W11014883', 'W11014883', 'ID01', 'Division of Nephrology University of Utah', '', '', 'Division of Nephrology University of Utah', 'GROUP', 'Internal Medicine', 'Nephrology', '', NULL, 'B', 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '8015853655', 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '8015853655', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000005984', 0, 'N', 0, '2012-10-16', NULL, NULL, 0, 0, NULL, NULL),
('870443152', 'W11014884', 'W11014884', 'ID01', 'U-U Endocrinology Division', NULL, NULL, 'U-U Endocrinology Division', 'GROUP', 'Endocrinology', NULL, NULL, NULL, 'b', 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, 'WUUUMG5', 'WUSTDHCPC5', NULL, '0.00', '25.00', NULL, 3, '2000-01-01', '2000-01-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000009376', 0, 'y', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870443152', 'W11014885', 'W11014885', 'ID01', 'U-U Endocrinology Division', '', '', 'U-U Endocrinology Division', 'GROUP', 'Endocrinology', NULL, NULL, NULL, 'B', 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009376', 0, 'N', 0, '2012-10-16', NULL, NULL, 0, 0, NULL, NULL),
('870478993', 'W11014887', 'W11014887', 'ID01', 'U-U General Medicine Division', '', '', 'U-U General Medicine Division', 'GROUP', 'Internal Medicine', 'General Practice', '', NULL, 'B', 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84158', '8012133800', NULL, 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84158', '8012133800', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009378', 0, 'N', 0, '2013-02-11', NULL, NULL, 0, 0, NULL, NULL),
('710885968', 'W11014897', 'W11014897', 'ID01', 'U of U Pain Management Physicians Group', '', '', 'U of U Pain Management Physicians Group', 'GROUP', 'Pain Management', 'Anesthesiology', '', NULL, 'B', 'PO Box 413034', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413034', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2008-10-01', '2013-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009243', 0, 'N', 0, '2014-01-07', NULL, NULL, 0, 0, NULL, NULL),
('870473288', 'W11014891', 'W11014891', 'ID01', 'U-U Infectious Disease Division', '', '', 'U-U Infectious Disease Division', 'GROUP', 'Infectious Disease', '', '', NULL, 'B', 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009381', 0, 'N', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('870442755', 'W11014892', 'W11014892', 'ID01', 'U-U Pulmonary Division', '', '', 'U-U Pulmonary Division', 'GROUP', 'Pulmonary', '', '', NULL, 'B', 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '', 'WUUUMG5', 'WUSTDHCPC5', NULL, '0.00', '25.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009385', 0, 'y', 0, '2012-08-27', NULL, NULL, 0, 0, NULL, NULL),
('870453678', 'W11014893', 'W11014893', 'ID01', 'U-U Rheumatology Division', '', '', 'U-U Rheumatology Division', 'GROUP', 'Rheumatology', '', '', NULL, 'B', 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009387', 0, 'N', 0, '2012-10-16', NULL, NULL, 0, 0, NULL, NULL),
('870467746', 'W11014894', 'W11014894', 'ID01', 'U-U Human Development Division', '', '', 'U-U Human Development Division', 'GROUP', 'Geriatrics', '', '', NULL, 'B', 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '', 'WUUUMG5', 'WUSTDHCPC5', NULL, '0.00', '25.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009380', 0, 'y', 0, '2012-08-30', NULL, NULL, 0, 0, NULL, NULL),
('861168471', 'W11014895', 'W11014895', 'ID01', 'U of U Palliative Care', '', '', 'U of U Palliative Care', 'GROUP', 'Internal Medicine', '', '', NULL, 'B', 'Po Box 581700', 'Salt Lake City', 'Salt Lake', 'UT', '84158', '8012133800', NULL, 'Po Box 581700', 'Salt Lake City', 'Salt Lake', 'UT', '84158', '8012133800', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009244', 0, 'N', 0, '2012-10-16', NULL, NULL, 0, 0, NULL, NULL),
('870442129', 'W11014896', 'W11014896', 'ID01', '+240 = 10 mins unit U of U Dept of Anesthesiology', '', '', '+240 = 10 mins unit U of U Dept of Anesthesiology +240 = 10 mins unit', 'GROUP', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 581053', 'Salt Lake City', 'Salt Lake', 'UT', '84158', '8012133800', NULL, 'PO Box 581053', 'Salt Lake City', 'Salt Lake', 'UT', '84158', '8012133800', '          ', '', '', '1000', '47.52', '0.00', '0.00', 3, '2008-10-01', '2008-12-31', 1, 12, 0, '', '', '', '', 'HCFA|UB|', '1134158322', 0, 'N', 0, '2014-01-07', NULL, NULL, 0, 0, NULL, NULL),
('870446925', 'W11014886', 'W11014886', 'ID01', 'U-U Gastroenterology Division', '', '', 'U-U Gastroenterology Division', 'GROUP', 'Gastroenterology', 'Internal Medicine', '', NULL, 'B', 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009377', 0, 'N', 0, '2012-10-16', NULL, NULL, 0, 0, NULL, NULL),
('870659338', 'W11014899', 'W11014899', 'ID01', 'U-U Pediatric Dermatology', '', '', 'U-U Pediatric Dermatology', 'GROUP', 'Pediatric Dermatology', '', '', NULL, 'B', 'PO Box 3208', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8015876340', NULL, 'PO Box 3208', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8015876340', '', 'WUUPEDS', 'WUSTDHCPC5', NULL, '0.00', '15.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009384', 0, 'y', 0, '2013-12-12', NULL, NULL, 0, 0, NULL, NULL),
('870468377', 'W11014898', 'W11014898', 'ID01', 'U-U Dermatology Division', '', '', 'U-U Dermatology Division', 'GROUP', 'Dermatology', '', '', NULL, 'B', 'PO Box 3208', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8015876348', NULL, 'PO Box 3208', 'Salt Lake City', 'Salt Lake', 'UT', '84110', '8015876348', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009375', 0, 'N', 0, '2012-10-16', NULL, NULL, 0, 0, NULL, NULL),
('870450500', 'W11014907', 'W11014907', 'ID01', 'University Urology Associates', '', '', 'University Urology Associates', 'GROUP', 'Urology', '', '', NULL, 'O', '2000 Circle of Hope', 'Salt Lake City', 'Salt Lake', 'UT', '84112', '8015874888', NULL, '2000 Circle of Hope', 'Salt Lake City', 'Salt Lake', 'UT', '84112', '8015874888', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009334', 0, 'N', 0, '2013-12-12', NULL, NULL, 40.7731, -111.837, NULL, NULL),
('870551055', 'W11014912', 'W11014912', 'ID01', 'Pediatric Cardiothoracic Surgeons', '', '', 'Pediatric Cardiothoracic Surgeons', 'GROUP', 'Cardiovascular Disease', '', '', NULL, 'o', '100 N Mario Capecchi Dr Ste 2800', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016625566', NULL, '100 N Mario Capecchi Dr Ste 2800', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016625566', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000008111', 0, 'N', 0, '2013-12-12', NULL, NULL, 40.7663, -111.837, NULL, NULL),
('870659338', 'W11014900', 'W11014900', 'ID01', 'U-U Pediatric Dermatology', '', '', 'U-U Pediatric Dermatology', 'GROUP', 'Pediatric Dermatology', '', '', NULL, 'O', '100 N Mario Capecchi Dr Ste 1450', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8015882791', NULL, '100 N Mario Capecchi Dr Ste 1450', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8015882791', '', 'WUUPEDS', 'WUSTDHCPC5', NULL, '0.00', '15.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009384', 0, 'N', 0, '2013-12-12', NULL, NULL, 40.7663, -111.837, 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
('870642019', 'W11014904', 'W11014904', 'ID01', 'Pediatric Urology Associates', '', '', 'Pediatric Urology Associates', 'GROUP', 'Urology', 'Pediatric Urology', '', NULL, 'o', '100 N Mario Capecchi Dr Ste 2200', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8015883300', NULL, '100 N Mario Capecchi Dr Ste 2200', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8015883300', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000008124', 0, 'N', 0, '2013-12-12', NULL, NULL, 40.7663, -111.837, NULL, NULL),
('942854057', 'W11015130', 'W11015130', 'ID01', 'Primary Childrens Medical Center', '', '', 'Primary Childrens Medical Center', 'Group (Recognized PPO but not contracted pre-', 'Hospital', '', '', NULL, 'O', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621000', NULL, '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621000', '', '', '', '', '0.00', '0.00', '0.00', 8, '2008-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|DEN|', '1235148594', 0, 'N', 0, '2014-07-21', NULL, NULL, 40.7663, -111.837, NULL, NULL),
('870516127', 'W11014917', 'W11014917', 'ID01', 'University of Utah Pediatric Surgeons', '', '', 'University of Utah Pediatric Surgeons', 'GROUP', 'Pediatric Surgery', '', '', NULL, 'o', '100 N Mario Capecchi Dr Ste 2600', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8015883350', NULL, '100 N Mario Capecchi Dr Ste 2600', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8015883350', '', 'WUUPEDS', 'WUSTDHCPC5', NULL, '0.00', '15.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009318', 0, 'N', 0, '2013-02-01', NULL, NULL, 40.7663, -111.837, NULL, NULL),
('870659347', 'W11014919', 'W11014919', 'ID01', 'Pediatric Pathology Associates', '', '', 'Pediatric Pathology Associates', 'GROUP', 'Pathology', 'Pediatric Pathology', '', NULL, 'o', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8015812507', NULL, '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8015812507', '', 'WUUPEDS', 'WUSTDHCPC5', NULL, '0.00', '15.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000008125', 0, 'N', 0, '2013-12-12', NULL, NULL, 40.7663, -111.837, NULL, NULL),
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('876000525', 'W11014931', 'W11014931', 'ID01', 'University Health Care University Hospital', '', '', 'University Health Care University Hospital', 'GROUP', 'Hospital', '', '', NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015812121', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015812121', '', '', NULL, '1', '0.00', '0.00', '0.00', 6, '2008-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1588656870', 0, 'N', 0, '2014-07-11', NULL, NULL, 40.7685, -111.837, NULL, NULL),
('876000525', 'W11014930', 'W11014930', 'ID01', 'University Health Care Huntsman Cancer Hospital', '', '', 'University Health Care Huntsman Cancer Hospital', 'GROUP', 'Hospital', '', '', NULL, 'O', '1950 Circle of Hope Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015877000', NULL, '1950 Circle of Hope Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015877000', '          ', '', '', '1', '0.00', '0.00', '0.00', 6, '2008-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009276', 0, 'N', 0, '2012-10-16', NULL, NULL, 0, 0, NULL, NULL),
('870643697', 'W11014901', 'W11014901', 'ID01', 'U-U Otolaryngology - Pediatrics', '', '', 'U-U Otolaryngology - Pediatrics', 'GROUP', 'Ear, Nose and Throat', 'Pediatric Ear, Nose and Throat', '', NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8012133800', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8012133800', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009383', 0, 'N', 0, '2013-12-12', NULL, NULL, 40.7685, -111.837, NULL, NULL),
('810574312', 'W11014914', 'W11014914', 'ID01', 'University of Utah Pediatric Plastic Surgery', '', '', 'University of Utah Pediatric Plastic Surgery', 'GROUP', 'Plastic Surgery', '', '', NULL, 'o', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015817719', NULL, '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015817719', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009317', 0, 'N', 0, '2013-12-12', NULL, NULL, 40.7685, -111.837, NULL, NULL),
('870640775', 'W11014922', 'W11014922', 'ID01', 'U of U Hospitals and Clinics - FPO', '', '', 'U of U Hospitals and Clinics - FPO', 'GROUP', 'Cardiovascular Disease', 'Gastroenterology', 'Internal Medicine', NULL, 'B', 'PO Box 510708', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8015876600', NULL, 'PO Box 510708', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8015876600', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009234', 0, 'N', 0, '2013-12-12', NULL, NULL, 0, 0, NULL, NULL),
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('870567427', 'W11014928', 'W11014928', 'ID01', 'University of Utah Emergency Physicians', '', '', 'University of Utah Emergency Physicians', 'GROUP', 'Emergency Medicine', '', '', NULL, 'B', 'PO Box 510726', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8015876303', NULL, 'PO Box 510726', 'Salt Lake City', 'Salt Lake', 'UT', '84151', '8015876303', '', 'WUUUMG5', 'WUSTDHCPC5', NULL, '0.00', '25.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009310', 0, 'y', 0, '2012-10-09', NULL, NULL, 0, 0, NULL, NULL),
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('870642019', 'W11014905', 'W11014905', 'ID01', 'Pediatric Urology Associates', '', '', 'Pediatric Urology Associates', 'GROUP', 'Urology', 'Pediatric Urology', '', NULL, 'B', 'PO Box 413035', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413035', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000008124', 0, 'N', 0, '2013-12-12', NULL, NULL, 0, 0, NULL, NULL),
('870584427', 'W11014909', 'W11014909', 'ID01', 'University of Utah Vascular Surgeons', '', '', 'University of Utah Vascular Surgeons', 'GROUP', 'Vascular Surgery', '', '', NULL, 'B', 'PO Box 413035', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '8015853655', 'PO Box 413035', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '8015853655', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009325', 0, 'N', 0, '2012-10-16', NULL, NULL, 0, 0, NULL, NULL),
('870450500', 'W11014906', 'W11014906', 'ID01', 'University Urology Associates', '', '', 'University Urology Associates', 'GROUP', 'Urology', '', '', NULL, 'B', 'PO Box 413035', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413035', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009334', 0, 'N', 0, '2013-12-12', NULL, NULL, 0, 0, NULL, NULL),
('876157946', 'W11014903', 'W11014903', 'ID01', 'University Ear, Nose, and Throat Associates', '', '', 'University Ear, Nose, and Throat Associates', 'CCCA', 'Ear, Nose and Throat', '', '', NULL, 'B', 'PO Box 413035', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413035', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000003005', 0, 'N', 0, '2012-10-16', NULL, NULL, 0, 0, NULL, NULL),
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('870490866', 'W11014910', 'W11014910', 'ID01', 'University of Utah Surgical Associates', '', '', 'University of Utah Surgical Associates', 'GROUP', 'General Surgery', '', '', NULL, 'B', 'PO Box 413035', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413035', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009322', 0, 'N', 0, '2012-10-16', NULL, NULL, 0, 0, NULL, NULL),
('870665299', 'W11014911', 'W11014911', 'ID01', 'University of Utah Cardiothoracic Surgeons', '', '', 'University of Utah Cardiothoracic Surgeons', 'GROUP', 'Cardiovascular Disease', '', '', NULL, 'B', 'PO Box 413035', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413035', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009282', 0, 'N', 0, '2012-10-16', NULL, NULL, 0, 0, NULL, NULL),
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('870526462', 'W11014916', 'W11014916', 'ID01', 'University of Utah Plastic Surgery Associates', '', '', 'University of Utah Plastic Surgery Associates', 'GROUP', 'Plastic Surgery', '', '', NULL, 'B', 'PO Box 58049', 'Salt Lake City', 'Salt Lake', 'UT', '84158', '8012133900', NULL, 'PO Box 58049', 'Salt Lake City', 'Salt Lake', 'UT', '84158', '8012133900', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009320', 0, 'N', 0, '2012-10-16', NULL, NULL, 0, 0, NULL, NULL),
('870659347', 'W11014918', 'W11014918', 'ID01', 'Pedicatric Pathology Associates', '', '', 'Pediatric Pathology Associates', 'GROUP', 'Pathology', 'Pediatric Pathology', '', NULL, 'B', 'PO Box 413037', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413037', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '', 'WUUPEDS', 'WUSTDHCPC5', NULL, '0.00', '15.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000008125', 0, 'y', 0, '2013-12-12', NULL, NULL, 0, 0, NULL, NULL),
('870619420', 'W11014923', 'W11014923', 'ID01', 'College of Nursing, University of Utah', '', '', 'College of Nursing, University of Utah', 'GROUP', 'Obstetrics and Gynecology', 'Certified Nurse Midwife', '', NULL, 'B', 'PO Box 413036', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413036', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000005767', 0, 'N', 0, '2012-10-16', NULL, NULL, 0, 0, NULL, NULL),
('870675415', 'W11014924', 'W11014924', 'ID01', 'U of U Rehabilitation & Wellness Program', '', '', 'U of U Rehabilitation & Wellness Program', 'GROUP', 'Physical Medicine and Rehabilitation', '', '', NULL, 'B', 'PO Box 581002', 'Salt Lake City', 'Salt Lake', 'UT', '84158', '8012367749', NULL, 'PO Box 581002', 'Salt Lake City', 'Salt Lake', 'UT', '84158', '8012367749', '', 'WUUUMG5', 'WUSTDHCPC5', NULL, '0.00', '25.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009256', 0, 'Y', 0, '2012-09-19', NULL, NULL, 0, 0, NULL, NULL),
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('870659348', 'W11014926', 'W11014926', 'ID01', 'University Pathology Associates', '', '', 'University Pathology Associates', 'GROUP', 'Pathology', 'Clinical Pathology', '', NULL, 'B', 'PO Box 413037', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413037', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2008-10-01', '2011-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009330', 0, 'N', 0, '2012-10-09', NULL, NULL, 0, 0, NULL, NULL),
('412144134', 'W11014927', 'W11014927', 'ID01', 'ARUP Pathology Associates', '', '', 'ARUP Pathology Associates', 'GROUP', 'Pathology', 'Clinical Pathology', '', NULL, 'B', 'PO Box 413037', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', NULL, 'PO Box 413037', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000005092', 0, 'Y', 0, '2014-03-06', NULL, NULL, 0, 0, NULL, NULL),
('364598541', 'W11014929', 'W11014929', 'ID01', 'University of Utah Surgical Intensive Care Unit', '', '', 'University of Utah Surgical Intensive Care Unit', 'GROUP', 'General Surgery', '', '', NULL, 'B', 'PO Box 413035', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '8015856336', 'PO Box 413035', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '8015856336', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009323', 0, 'Y', 0, '2012-10-16', NULL, NULL, 0, 0, NULL, NULL),
('810574312', 'W11014915', 'W11014915', 'ID01', 'University of Utah Pediatric Plastic Surgery', '', '', 'University of Utah Pediatric Plastic Surgery', 'GROUP', 'Plastic Surgery', '', '', NULL, 'B', 'PO Box 58049', 'Salt Lake City', 'Salt Lake', 'UT', '84158', '8012133900', NULL, 'PO Box 58049', 'Salt Lake City', 'Salt Lake', 'UT', '84158', '8012133900', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2008-10-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009317', 0, 'N', 0, '2013-12-12', NULL, NULL, 0, 0, NULL, NULL),
('621801973', 'W11015143', 'W11015143', 'UT01', 'Salt Lake Regional Hospital', 'Mary', 'Susan', 'Berkebile', 'MD', 'Internal Medicine', 'Hospitalist', NULL, NULL, 'B', '406 W South Jordan Pkwy Ste 500', 'South Jordan', 'Salt Lake', 'UT', '84095', '8019843418', '8019842418', 'PO Box 95970', 'South Jordan', 'Fulton', 'UT', '84095', NULL, NULL, 'WUSTDINT5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2008-08-01', '2009-08-01', NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1740296037', 0, 'Y', 0, '2008-10-23', NULL, NULL, 0, 0, NULL, NULL),
('752646025', 'W11015151', 'W11015151', 'TX01', 'Metro North Cardiovascular Associates PA', 'M', 'Gearald', 'Garoutte', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '8715 Village Dr Ste 519', 'San Antonio', 'Bexar', 'TX', '78217', '2106546000', NULL, '8715 Village Dr Ste 519', 'San Antonio', 'Bexar', 'TX', '78217', '2106546000', '', 'TXSTD', 'TXHCPCS', NULL, '0.00', '50.00', '0.00', 3, '2008-10-17', '2012-08-19', 0, 0, 0, 'North East Baptist Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1235135344', 0, 'n', 0, '2013-04-24', NULL, NULL, 29.5187, -98.4281, NULL, NULL),
('501847746', 'W11015148', 'W11015148', 'WY01', 'Clear Creek Counseling', 'Virginia', 'K', 'Oedekoven', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'O', '801 E 4th St Ste 14D', 'Gillette', 'Campbell', 'WY', '82716', '3076869422', NULL, '801 E 4th St Ste 14D', 'Gillette', 'Campbell', 'WY', '82716', '3076869422', '          ', 'WYMA', '', '', '0.00', '35.00', '0.00', 3, '2008-10-17', '2010-03-16', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1700988854', 0, 'N', 0, '2011-05-18', NULL, NULL, 0, 0, NULL, NULL),
('826000428', 'W11015134', 'W11015134', 'UT01', 'Oneida County Hospital', NULL, NULL, 'Oneida County Hospital', 'GROUP', 'Hospital', NULL, NULL, NULL, 'O', '150 N 200 W', 'Malad City', 'Oneida', 'ID', '83252', '2087662231', '2087664819', NULL, NULL, 'Oneida', NULL, NULL, NULL, NULL, '', NULL, NULL, '0.00', '20.00', '0.00', 6, '2008-10-23', NULL, NULL, 0, 0, NULL, NULL, NULL, NULL, 'UB|', '0000007974', 0, 'n', 0, '2008-11-12', NULL, NULL, 42.1897, -112.251, NULL, NULL),
('205506855', 'W11015137', 'W11015137', 'ID01', 'Northwest Radiation Oncology', 'Jennifer', 'L', 'Suida', 'NP', 'Radiation Oncology', 'Hematology and Oncology', '', NULL, 'O', '3123 Commercial Way', 'Caldwell', 'Canyon', 'ID', '83605', '2084532033', NULL, '3123 Commercial Way', 'Caldwell', 'Canyon', 'ID', '83605', '2084532033', '          ', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2008-08-18', '2012-09-19', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1316046972', 0, 'N', 0, '2013-01-04', NULL, NULL, 43.6591, -116.658, NULL, NULL),
('205506855', 'W11015138', 'W11015138', 'ID01', 'Northwest Radiation Oncology', 'Jennifer', 'L', 'Suida', 'NP', 'Radiation Oncology', 'Hematology and Oncology', '', NULL, 'O', '2855 E Magic View Dr', 'Meridian', 'Ada', 'ID', '83642', '2086394900', NULL, '2855 E Magic View Dr', 'Meridian', 'Ada', 'ID', '83642', '2086394900', '          ', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2008-08-18', '2012-09-19', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1316046972', 0, 'N', 0, '2013-01-04', NULL, NULL, 43.599, -116.36, NULL, NULL),
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('942938348', 'W11015152', 'W11015152', 'UTMH1', 'Valley Mental Health  Inc', 'Rene', 'J', 'Valles', 'MD', 'Mental Health', 'Psychiatry', '', NULL, 'B', '5965 S 900 E Ste 430', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012637100', NULL, '5965 S 900 E Ste 430', 'Salt Lake City', 'Salt Lake', 'UT', '84121', '8012637100', '', 'UTMD-2', NULL, NULL, '0.00', '35.00', '0.00', 6, '2008-10-23', '2013-02-14', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1013015189', 0, 'Y', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
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('521486235', 'W11015133', 'W11015133', 'UT01', 'Hanger Prosthetics & Orthotics Inc', '', '', 'Hanger Prosthetics & Orthotics Inc', 'GROUP', 'Durable Medical Equipment', '', '', NULL, 'O', '630 S 400 E Ste 102', 'St George', 'Washington', 'UT', '84770', '4356736449', '8012669570', '630 S 400 E Ste 102', 'St George', 'Washington', 'UT', '84770', '4356736449', '8012669570', 'WUDME5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2008-10-03', '2008-10-03', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000006560', 0, 'N', 0, '2014-05-13', NULL, NULL, 0, 0, NULL, NULL),
('826000428', 'W11015157', 'W11015157', 'UT01', 'Oneida County Clinic', 'Rick', 'C', 'Clark', 'PAC', 'Family Practice', '', '', NULL, 'O', '220 Bannock St', 'Malad City', 'Oneida', 'ID', '83252', '2087662600', NULL, '220 Bannock St', 'Malad City', 'Oneida', 'ID', '83252', '2087662600', '', 'WISESTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 6, '2008-10-24', NULL, 0, 0, 0, 'Oneida County Hospital', NULL, NULL, NULL, 'HCFA|', '1033190533', 0, 'n', 0, '2012-03-01', NULL, NULL, 42.1903, -112.253, NULL, NULL),
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('870520042', 'W11015154', 'W11015154', 'UT01', 'Nephrology Associates', 'Kevin', '', 'Jansen', 'MD', 'Nephrology', '', '', NULL, 'O', '650 E 4500 S Ste 210', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8012882634', NULL, '650 E 4500 S Ste 210', 'Salt Lake City', 'Salt Lake', 'UT', '84107', '8012882634', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2008-10-17', NULL, 0, 0, 0, 'St Marks Hospital', '', '', '', 'HCFA|UB|', '1013908995', 0, 'N', 0, '2011-12-16', NULL, NULL, 40.6743, -111.874, NULL, NULL),
('870682101', 'W11015155', 'W11015155', 'UT01', 'Salt Lake Orthopaedic Clinic', 'James', '', 'Harrison', 'PT', 'Physical Therapy', '', '', NULL, 'O', '1160 E 3900 S Ste 5000', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012628486', '8012629752', '1160 E 3900 S Ste 5000', 'Salt Lake City', 'Salt Lake', 'UT', '84124', '8012628486', '8012629752', 'WUSLORTH5', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2008-10-17', '2011-10-01', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1558459321', 0, 'N', 0, '2014-07-18', NULL, NULL, 0, 0, NULL, NULL),
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('518159642', 'W11015158', 'W11015158', 'UT01', '', 'Gustaf', 'I', 'Gibson', 'OD', 'Optometry', '', '', NULL, 'O', '145 W Cache Valley Blvd', 'Logan', 'Cache', 'UT', '84341', '4357879273', NULL, '145 W Cache Valley Blvd', 'Logan', 'Cache', 'UT', '84341', '4357879273', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2008-10-17', '2011-05-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1215917307', 0, 'N', 0, '2011-12-02', NULL, NULL, 0, 0, NULL, NULL),
('870516264', 'W11015160', 'W11015160', 'UT01', 'Utah County Surgical Associates', 'David', 'W', 'Brock', 'PAC', 'General Surgery', '', '', NULL, 'O', '3550 N University Ave Ste 250', 'Provo', 'Utah', 'UT', '84604', '8013749625', NULL, '3550 N University Ave Ste 250', 'Provo', 'Utah', 'UT', '84604', '8013749625', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 6, '2008-10-17', '2010-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1205024122', 0, 'N', 0, '2013-05-06', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W11015183', 'W11015183', 'WY01', 'Billings Clinic - Rheumatology', 'Melinda', 'K', 'Luce', 'PA-C', 'Physical Medicine and Rehabilitation', 'Rheumatology', NULL, NULL, 'O', '2825 8th Ave N', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062382978', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', NULL, NULL, '', NULL, NULL, '0.00', '17.00', '0.00', 3, '2008-10-27', '2009-04-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1245250703', 0, 'N', 0, '2010-01-15', NULL, NULL, 0, 0, NULL, NULL),
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('820487790', 'W11015163', 'W11015163', 'ID01', 'Selah Medical Center', 'Gloria', '', 'Beery', 'CNP', 'Family Practice', 'Obstetrics and Gynecology', '', NULL, 'O', '1618 S Millennium Way Ste 220', 'Meridian', 'Ada', 'ID', '83642', '2082881717', NULL, '1618 S Millennium Way Ste 220', 'Meridian', 'Ada', 'ID', '83642', '2082881717', '', 'IDPCPSELAH', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2008-10-09', '2011-12-15', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1043263064', 0, 'N', 0, '2014-05-20', NULL, NULL, 43.5903, -116.368, NULL, NULL),
('820505865', 'W11015180', 'W11015180', 'ID02', 'Cancer Center of Idaho', 'John', 'E', 'Gamboa', 'MD', 'Radiation Oncology', '', '', NULL, 'O', '9357 W Emerald St', 'Boise', 'Ada', 'ID', '83704', '2086721000', NULL, '9357 W Emerald St', 'Boise', 'Ada', 'ID', '83704', '2086721000', '', 'IDPPO', 'WUSTDHCPC5', NULL, '0.00', '30.00', '0.00', 3, '2008-11-01', NULL, 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1477597045', 0, 'n', 0, '2012-06-25', NULL, NULL, 0, 0, NULL, NULL),
('820505865', 'W11015179', 'W11015179', 'ID02', 'Cancer Center of Idaho', 'Dustin', 'K', 'Bowman', 'PA', 'Radiation Oncology', '', '', NULL, 'O', '9357 W Emerald St', 'Boise', 'Ada', 'ID', '83704', '2086721000', NULL, '9357 W Emerald St', 'Boise', 'Ada', 'ID', '83704', '2086721000', '          ', 'IDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2008-11-01', '2011-03-26', 0, 0, 1, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1386680239', 0, 'N', 0, '2008-10-27', NULL, NULL, 0, 0, NULL, NULL),
('820487790', 'W11015162', 'W11015162', 'ID01', 'Selah Medical Center', 'Gloria', '', 'Beery', 'CNP', 'Family Practice', 'Obstetrics and Gynecology', '', NULL, 'O', '6565 W Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083775055', NULL, '6565 W Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083775055', '', 'IDPCPSELAH', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2008-10-09', '2012-08-19', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1043263064', 0, 'n', 0, '2014-05-20', NULL, NULL, 43.6119, -116.268, NULL, NULL),
('820487790', 'W11015165', 'W11015165', 'ID01', 'Selah Medical Center', 'Beverly', NULL, 'Ludders', 'MD', 'Family Practice', 'Obstetrics and Gynecology', NULL, NULL, 'O', '6565 W Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083775055', NULL, '6565 W Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083775055', '          ', 'IDPCPSELAH', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2008-10-09', '2010-07-30', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1033158787', 0, 'N', 0, '2009-07-21', NULL, NULL, 43.6119, -116.268, NULL, NULL),
('820505865', 'W11015182', 'W11015182', 'ID02', 'Cancer Center of Idaho', 'John', 'E', 'Gamboa', 'MD', 'Radiation Oncology', '', '', NULL, 'B', 'PO Box 9589', 'Boise', 'Ada', 'ID', '83707', '2086721000', NULL, 'PO Box 9589', 'Boise', 'Ada', 'ID', '83707', '2086721000', '', 'IDPPO', 'WUSTDHCPC5', NULL, '0.00', '30.00', '0.00', 3, '2008-11-01', NULL, 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1477597045', 0, 'y', 0, '2012-06-25', NULL, NULL, 0, 0, NULL, NULL),
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('205128411', 'W11015170', 'W11015170', 'UT01', 'South Summit Pediatrics', 'Catherine', 'B', 'Johnson', 'APRN ', 'Dermatology', 'Pediatric Dermatology', 'Pediatrics', NULL, 'O', '267 E Traversepoint Dr', 'Draper', 'Salt Lake', 'UT', '84020', '8015538300', '          ', '267 E Traversepoint Dr', 'Draper', 'Salt Lake', 'UT', '84020', '8015538300', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2008-10-17', '2014-03-16', 0, 0, 0, 'Riverton Childrens Unit Operated by Primary Childrens Medical Center', '', '', '', 'HCFA|UB|', '1952424129', 0, 'N', 0, '2014-04-02', NULL, NULL, 40.4853, -111.883, NULL, NULL),
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('202630141', 'W11015189', 'W11015189', 'ID02', 'Primary Health Medical Group', '', '', 'Primary Health Medical Group', 'GROUP', 'Urgent Care', NULL, '', NULL, 'O', '6052 W State St', 'Boise', 'Ada', 'ID', '83703', '2089471947', '2089471945', '6052 W State St', 'Boise', 'Ada', 'ID', '83703', '2089471947', '2089471945', 'IDSTDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2009-05-26', '2013-02-28', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1568413920', 0, 'N', 0, '2014-04-24', NULL, NULL, 43.6597, -116.264, 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
('202630141', 'W11015186', 'W11015186', 'ID02', 'Primary Health Medical Group', '', '', 'Primary Health Medical Group', 'GROUP', 'Urgent Care', NULL, '', NULL, 'O', '1907 S Broadway Ave Ste 101', 'Boise', 'Ada', 'ID', '83706', '2083451222', '2083451261', '1907 S Broadway Ave Ste 101', 'Boise', 'Ada', 'ID', '83706', '2083451222', '2083451261', 'IDSTDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2008-10-01', '2013-02-28', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1568413920', 0, 'N', 0, '2014-04-24', NULL, NULL, 43.5896, -116.194, NULL, NULL),
('202630141', 'W11015190', 'W11015190', 'ID02', 'Primary Health Medical Group', '', '', 'Primary Health Medical Group', 'GROUP', 'Urgent Care', NULL, '', NULL, 'O', '8971 W Overland', 'Boise', 'Ada', 'ID', '83709', '2083784288', '2083784297', '8971 W Overland', 'Boise', 'Ada', 'ID', '83709', '2083784288', '2083784297', 'IDSTDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2008-10-01', '2013-02-28', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1568413920', 0, 'N', 0, '2014-04-24', NULL, NULL, 43.5898, -116.294, NULL, NULL),
('202630141', 'W11015191', 'W11015191', 'ID02', 'Primary Health Medical Group', '', '', 'Primary Health Medical Group', 'GROUP', 'Urgent Care', NULL, '', NULL, 'O', '10787 W Ustick', 'Boise', 'Ada', 'ID', '83713', '2084666567', '2084667922', '10787 W Ustick', 'Boise', 'Ada', 'ID', '83713', '2084666567', '2084667922', 'IDSTDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2008-10-01', '2013-01-31', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1568413920', 0, 'N', 0, '2014-04-24', NULL, NULL, 43.6338, -116.317, NULL, NULL),
('205529469', 'W11015196', 'W11015196', 'UT01', 'University Health Care', 'Rowan', 'V', 'Paul', 'MD', 'Sports Medicine', NULL, NULL, NULL, 'o', '1493 Lowell Ave', 'Park City', 'Summit', 'UT', '84060', '4356557970', NULL, NULL, NULL, 'Summit', NULL, NULL, NULL, NULL, 'WUUUMG5', 'WUSTDHCPC5', NULL, '0.00', '25.00', '0.00', 3, '2008-11-01', '2009-07-31', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1255507489', 0, 'N', 0, '2008-10-29', NULL, NULL, 0, 0, NULL, NULL),
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('711052367', 'W11015206', 'W11015206', 'UT01', 'University Health Care', 'Andrea', 'M', 'Noordewier', 'PA', 'Physician Assistant', '', '', NULL, 'O', '1950 Circle of Hope', 'Salt Lake City', 'Salt Lake', 'UT', '84112', '8015850100', NULL, NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, 'WUUUMG5', 'WUSTDHCPC5', NULL, '0.00', '25.00', '0.00', 3, '2008-10-09', '2008-12-31', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1982854543', 0, 'N', 0, '2009-11-30', NULL, NULL, 0, 0, NULL, NULL),
('870442845', 'W11015204', 'W11015204', 'UT01', 'University Health Care', 'Andrea', 'M', 'Noordewier', 'PA', 'Physician Assistant', '', '', NULL, 'O', '1950 Circle of Hope', 'Salt Lake City', 'Salt Lake', 'UT', '84112', '8015850100', NULL, '1950 Circle of Hope', 'Salt Lake City', 'Salt Lake', 'UT', '84112', '8015850100', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2008-10-09', '2012-08-27', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1982854543', 0, 'N', 0, '2012-08-28', NULL, NULL, 0, 0, NULL, NULL),
('870476269', 'W11015200', 'W11015200', 'UT01', 'University Health Care', 'Timothy', 'J', 'Gayowski', 'MD', 'General Surgery', '', '', NULL, 'o', '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621000', NULL, '100 N Mario Capecchi Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016621000', '          ', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2007-09-10', '2010-09-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1154515765', 0, 'N', 0, '2012-04-24', NULL, NULL, 0, 0, NULL, NULL),
('870515631', 'W11015202', 'W11015202', 'UT01', 'University Health Care', 'Cynthia', 'A', 'Newby', 'APRN', 'Nurse Practitioner', NULL, NULL, NULL, 'O', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015812268', NULL, NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, 'WUUUMG5', 'WUSTDHCPC5', NULL, '0.00', '25.00', NULL, 3, '2000-01-01', '2000-01-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1558484808', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('870442755', 'W11015198', 'W11015198', 'UT01', 'University Health Care', 'Sami', 'K', 'Weese', 'APRN', 'Family Practice', 'Nurse Practitioner', '', NULL, 'o', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8015817806', NULL, NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, 'WUUUMG5', 'WUSTDHCPC5', NULL, '0.00', '25.00', '0.00', 3, '2008-10-09', '2009-08-31', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1508017021', 0, 'N', 0, '2009-09-17', NULL, NULL, 0, 0, NULL, NULL),
('800147425', 'W11015209', 'W11015209', 'ID01', 'Pediatric Behavioral Health', '', '', 'Pediatric Behavioral Health', 'GROUP', 'Mental Health', 'Pediatric Psychiatry', '', NULL, 'B', 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '8015853655', 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '8015853655', 'WUUPEDS', 'WUSTDHCPC5', NULL, '0.00', '15.00', '0.00', 3, '2008-02-28', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000008106', 0, 'y', 0, '2012-08-01', NULL, NULL, 0, 0, NULL, NULL),
('800147447', 'W11015208', 'W11015208', 'ID01', 'Pediatric Allergy', 'Marlene', '', 'Peng', 'MD', 'Pediatrics', 'Pediatric Allergy and Immunology', '', NULL, 'B', 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '8015853655', 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '8015853655', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2008-10-01', '2012-07-31', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1770697112', 0, 'N', 0, '2012-08-01', NULL, NULL, 0, 0, NULL, NULL),
('870442845', 'W11015205', 'W11015205', 'UT01', 'U-U Hematology / Oncology Division', 'Andrea', 'M', 'Noordewier', 'PA', 'Physician Assistant', '', '', NULL, 'B', 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '8015853655', 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '8015853655', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2008-10-09', '2012-08-27', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1982854543', 0, 'N', 0, '2012-08-28', NULL, NULL, 0, 0, NULL, NULL),
('870515631', 'W11015203', 'W11015203', 'UT01', 'U-U Rehabilitation Medicine', 'Cynthia', 'A', 'Newby', 'APRN', 'Nurse Practitioner', '', '', NULL, 'B', 'PO Box 58609', 'Salt Lake City', 'Salt Lake', 'UT', '84158', '8017158238', NULL, NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, 'WUUUMG5', 'WUSTDHCPC5', NULL, '0.00', '25.00', '0.00', 3, '2008-11-03', '2008-11-03', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1558484808', 0, 'y', 0, '2008-12-02', NULL, NULL, 0, 0, NULL, NULL),
('870476269', 'W11015201', 'W11015201', 'UT01', 'University Health Care', 'Timothy', 'J', 'Gayowski', 'MD', 'General Surgery', '', '', NULL, 'B', 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '8015853655', 'PO Box 413021', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '8015853655', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2007-09-10', '2010-09-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1154515765', 0, 'N', 0, '2012-04-24', NULL, NULL, 0, 0, NULL, NULL),
('870442755', 'W11015199', 'W11015199', 'UT01', 'U-U Pulmonary Division', 'Sami', 'K', 'Weese', 'APRN', 'Family Practice', 'Nurse Practitioner', '', NULL, 'B', 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '8015853655', NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, 'WUUUMG5', 'WUSTDHCPC5', NULL, '0.00', '25.00', '0.00', 3, '2008-10-09', '2009-08-31', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1508017021', 0, 'y', 0, '2009-09-17', NULL, NULL, 0, 0, NULL, NULL),
('205529469', 'W11015197', 'W11015197', 'UT01', 'University Health Care', 'Rowan', 'V', 'Paul', 'MD', 'Sports Medicine', NULL, NULL, NULL, 'B', 'PO Box 58108', 'Salt Lake City', 'Salt Lake', 'UT', '84158', '8015883998', NULL, NULL, NULL, 'Salt Lake', NULL, NULL, NULL, NULL, 'WUUUMG5', 'WUSTDHCPC5', NULL, '0.00', '25.00', '0.00', 3, '2008-11-01', '2009-07-31', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1255507489', 0, 'y', 0, '2008-10-29', NULL, NULL, 0, 0, NULL, NULL),
('412264277', 'W11015195', 'W11015195', 'ID01', '+240 = 10 mins unit University of Utah Anesthesiology Perioperative Echo ', '', '', '+240 = 10 mins unit University of Utah Anesthesiology Perioperative Echo +240 = 10 mins unit', 'Group', 'Anesthesiology', '', '', NULL, 'B', 'PO Box 581053', 'Salt Lake City', 'Salt Lake', 'UT', '84158', '8012133800', NULL, 'PO Box 581053', 'Salt Lake City', 'Salt Lake', 'UT', '84158', '8012133800', '          ', '', '', '1000', '47.52', '0.00', '0.00', 3, '2008-10-01', '2008-12-31', 1, 12, 0, '', '', '', '', 'HCFA|UB|', '1841477528', 0, 'N', 0, '2014-01-06', NULL, NULL, 0, 0, NULL, NULL),
('826000422', 'W11015211', 'W11015211', 'IDREC', 'Walter Knox Memorial Hospital (Recognized PPO but not contra', '', '', 'Walter Knox Memorial Hospital (Recognized PPO but not contracted)', 'GROUP', 'Hospital', '', '', NULL, 'O', '1202 E Locust St', 'Emmett', 'Gem', 'ID', '83617', '2083653561', NULL, '1202 E Locust St', 'Emmett', 'Gem', 'ID', '83617', '2083653561', '', '', NULL, NULL, '0.00', '0.00', '0.00', 3, '2008-11-01', '2009-02-01', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '0000009494', 0, 'n', 0, '2014-01-21', NULL, NULL, 43.8791, -116.485, NULL, NULL),
('820200896', 'W11015210', 'W11015210', 'IDREC', 'Mercy Medical Center (Recognized PPO but not contracted)', NULL, NULL, 'Mercy Medical Center (Recognized PPO but not contracted)', 'GROUP', 'Hospital', NULL, NULL, NULL, 'O', '1512 12th Ave Rd', 'Nampa', 'Canyon', 'ID', '83686', '2084635000', NULL, NULL, NULL, 'Canyon', NULL, NULL, NULL, NULL, '', NULL, NULL, '0.00', '0.00', '0.00', 3, '2008-11-01', '2009-02-01', 0, 0, 1, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000007573', 0, 'n', 0, '2008-10-30', NULL, NULL, 43.5537, -116.573, NULL, NULL),
('820161600', 'W11015223', 'W11015223', 'IDREC', 'Mountain States Tumor Institute (Recognized PPO but not cont', NULL, NULL, 'Mountain States Tumor Institute (Recognized PPO but not contracted pre-auth required)', '(Recognized PPO but not contracted pre-auth r', 'Pediatric Hematology and Oncolocy', 'Hematology and Oncology', NULL, NULL, 'O', '100 E Idaho St', 'Boise', 'Ada', 'ID', '83712', '2083812711', NULL, NULL, NULL, 'Ada', NULL, NULL, NULL, NULL, '', NULL, NULL, '0.00', '0.00', '0.00', 8, '2008-11-01', NULL, 1, 0, 1, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000007724', 0, 'n', 0, '2008-10-30', NULL, NULL, 43.6123, -116.194, NULL, NULL),
('820161600', 'W11015222', 'W11015222', 'IDREC', 'St Lukes Pediatric Surgery of Idaho', 'Randall', NULL, 'Jenkins', '(Recognized PPO but not contracted pre-auth r', 'Pediatric Nephrology', NULL, NULL, NULL, 'O', '100 E Idaho St Ste 201', 'Boise', 'Ada', 'ID', '83712', '2083817020', NULL, NULL, NULL, 'Ada', NULL, NULL, NULL, NULL, '', NULL, NULL, '0.00', '0.00', '0.00', 8, '2008-11-01', NULL, 1, 0, 1, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000006927', 0, 'n', 0, '2008-10-30', NULL, NULL, 43.6123, -116.194, NULL, NULL),
('820161600', 'W11015221', 'W11015221', 'IDREC', 'St Lukes Pediatric Surgery of Idaho (Recognized PPO but not contracted pre-auth required)', 'Ellen', '', 'Reynolds', '(Recognized PPO but not contracted pre-auth r', 'Pediatric Surgery', '', '', NULL, 'O', '100 E Idaho St Ste 300', 'Boise', 'Ada', 'ID', '83712', '2083817370', '          ', '100 E Idaho St Ste 300', 'Boise', 'Ada', 'ID', '83712', '2083817370', '          ', '', '', '', '0.00', '0.00', '0.00', 8, '2008-11-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '0000008370', 0, 'N', 0, '2014-05-19', NULL, NULL, 43.6123, -116.194, NULL, NULL),
('820161600', 'W11015220', 'W11015220', 'IDREC', 'St Lukes Pediatric Surgery of Idaho (Recognized PPO but not contracted pre-auth required)', 'Sarah', '', 'Hirsch', '(Recognized PPO but not contracted pre-auth r', 'Pediatric Surgery', '', '', NULL, 'O', '100 E Idaho St Ste 300', 'Boise', 'Ada', 'ID', '83712', '2083817370', '          ', '100 E Idaho St Ste 300', 'Boise', 'Ada', 'ID', '83712', '2083817370', '          ', '', '', '', '0.00', '0.00', '0.00', 8, '2008-11-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '0000006730', 0, 'N', 0, '2014-05-19', NULL, NULL, 43.6123, -116.194, NULL, NULL),
('820161600', 'W11015218', 'W11015218', 'IDREC', 'MSTI Medical Oncology Services', 'Eugina', NULL, 'Chang', '(Recognized PPO but not contracted pre-auth r', 'Pediatric Hematology and Oncolocy', '', '', NULL, 'O', '100 E Idaho St', 'Boise', 'Ada', 'ID', '83712', '2083812711', NULL, '100 E Idaho St', 'Boise', 'Ada', 'ID', '83712', '2083812711', '          ', '', '', '', '0.00', '0.00', '0.00', 8, '2008-11-01', NULL, 0, 0, 1, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000005642', 0, 'N', 0, '2008-10-30', NULL, NULL, 43.6123, -116.194, NULL, NULL),
('820161600', 'W11015217', 'W11015217', 'IDREC', 'MSTI Medical Oncology Services', 'Matthew', NULL, 'Hansen', '(Recognized PPO but not contracted pre-auth r', 'Pediatric Hematology and Oncolocy', NULL, NULL, NULL, 'O', '100 E Idaho St', 'Boise', 'Ada', 'ID', '83712', '2083812711', NULL, NULL, NULL, 'Ada', NULL, NULL, NULL, NULL, '', NULL, NULL, '0.00', '0.00', '0.00', 8, '2008-11-01', NULL, 1, 0, 1, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000006569', 0, 'n', 0, '2008-10-30', NULL, NULL, 43.6123, -116.194, NULL, NULL),
('820161600', 'W11015216', 'W11015216', 'IDREC', 'MSTI Medical Oncology Services', 'Nicolas', NULL, 'Camilo', '(Recognized PPO but not contracted pre-auth r', 'Pediatric Hematology and Oncolocy', '', '', NULL, 'O', '100 E Idaho St', 'Boise', 'Ada', 'ID', '83712', '2083812711', NULL, '100 E Idaho St', 'Boise', 'Ada', 'ID', '83712', '2083812711', '          ', '', '', '', '0.00', '0.00', '0.00', 8, '2008-11-01', NULL, 0, 0, 1, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000005546', 0, 'N', 0, '2008-10-30', NULL, NULL, 43.6123, -116.194, NULL, NULL),
('820161600', 'W11015219', 'W11015219', 'IDREC', 'St Lukes Pediatric Surgery of Idaho (Recognized PPO but not contracted pre-auth required)', 'Adrian', '', 'Curnow', '(Recognized PPO but not contracted pre-auth r', 'Pediatric Surgery', '', '', NULL, 'O', '100 E Idaho St Ste 300', 'Boise', 'Ada', 'ID', '83712', '2083817370', '          ', '100 E Idaho St Ste 300', 'Boise', 'Ada', 'ID', '83712', '2083817370', '          ', '', '', '', '0.00', '0.00', '0.00', 8, '2008-11-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '0000005858', 0, 'N', 0, '2014-05-19', NULL, NULL, 43.6123, -116.194, NULL, NULL),
('820161600', 'W11015214', 'W11015214', 'IDREC', 'St Lukes Pediatrics Endocrinology', 'Steven', NULL, 'LaFranchi', '(Recognized PPO but not contracted pre-auth r', 'Pediatric Endocrinology', NULL, NULL, NULL, 'O', '100 E Idaho St Ste 200', 'Boise', 'Ada', 'ID', '83712', '2083817340', NULL, NULL, NULL, 'Ada', NULL, NULL, NULL, NULL, '', NULL, NULL, '0.00', '0.00', '0.00', 8, '2008-11-01', NULL, 1, 0, 1, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000007176', 0, 'n', 0, '2008-10-30', NULL, NULL, 43.6123, -116.194, NULL, NULL),
('820161600', 'W11015215', 'W11015215', 'IDREC', 'St Lukes Pediatrics Surgery of Idaho', 'Thomas', NULL, 'Rand', '(Recognized PPO but not contracted pre-auth r', 'Pediatric Infectious Diseases', NULL, NULL, NULL, 'O', '100 E Idaho St Ste 315', 'Boise', 'Ada', 'ID', '83712', '2083817330', NULL, NULL, NULL, 'Ada', NULL, NULL, NULL, NULL, '', NULL, NULL, '0.00', '0.00', '0.00', 8, '2008-11-01', NULL, 1, 0, 1, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000008319', 0, 'n', 0, '2010-03-17', NULL, NULL, 43.6123, -116.194, NULL, NULL),
('820161600', 'W11015213', 'W11015213', 'IDREC', 'St Lukes Developmental Pediatrics', 'John', NULL, 'Leavell', '(Recognized PPO but not contracted pre-auth r', 'Pediatrics', NULL, NULL, NULL, 'O', '100 E Idaho St Ste 200', 'Boise', 'Ada', 'ID', '83712', '2083817312', NULL, NULL, NULL, 'Ada', NULL, NULL, NULL, NULL, '', NULL, NULL, '0.00', '0.00', '0.00', 8, '2008-11-01', NULL, 1, 0, 1, NULL, NULL, NULL, NULL, 'HCFA|UB|', '0000007235', 0, 'n', 0, '2008-10-30', NULL, NULL, 43.6123, -116.194, NULL, NULL),
('820161600', 'W11015212', 'W11015212', 'IDREC', 'St Lukes Developmental Pediatrics', 'Steven', '', 'Felix', '(Recognized PPO but not contracted pre-auth r', 'Pediatrics', '', '', NULL, 'O', '100 E Idaho St Ste 200', 'Boise', 'Ada', 'ID', '83712', '2083817312', NULL, '100 E Idaho St Ste 200', 'Boise', 'Ada', 'ID', '83712', '2083817312', '          ', '', '', '', '0.00', '0.00', '0.00', 8, '2008-11-01', '2011-07-01', 0, 0, 1, '', '', '', '', 'HCFA|UB|', '0000006215', 0, 'N', 0, '2012-07-25', NULL, NULL, 43.6123, -116.194, NULL, NULL),
('743003947', 'W11015251', 'W11015251', 'TX01', 'The San Antonio Orthopaedic Group', 'Eloy', '', 'Ochoa', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '11212 State Hwy 151 Ste 150', 'San Antonio', 'Bexar', 'TX', '78251', '2108045400', NULL, '11212 State Hwy 151 Ste 150', 'San Antonio', 'Bexar', 'TX', '78251', '2108045400', '', 'TXORTHO', 'TXHCPCS', NULL, '0.00', '50.00', '0.00', 3, '2007-01-01', '2012-08-19', 0, 0, 0, 'Baptist Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1144209990', 0, 'N', 0, '2013-07-09', NULL, NULL, 29.4666, -98.6958, NULL, NULL),
('743003947', 'W11015250', 'W11015250', 'TX01', 'The San Antonio Orthopaedic Group', '', '', 'The San Antonio Orthopedic Group LLP', 'GROUP', 'Orthopedic Surgery', 'Physical Therapy', '', NULL, 'O', '11212 State Hwy 151 Ste 150', 'San Antonio', 'Bexar', 'TX', '78251', '2108045400', NULL, '11212 State Hwy 151 Ste 150', 'San Antonio', 'Bexar', 'TX', '78251', '2108045400', '', 'TXORTHO', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2007-01-01', '2012-08-19', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000009051', 0, 'N', 0, '2014-07-18', NULL, NULL, 29.4666, -98.6958, NULL, NULL),
('743003947', 'W11015249', 'W11015249', 'TX01', 'The San Antonio Orthopaedic Group', 'Frank', 'K', 'Kuwamura', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '11212 State Hwy 151 Ste 150', 'San Antonio', 'Bexar', 'TX', '78251', '2108045400', NULL, '11212 State Hwy 151 Ste 150', 'San Antonio', 'Bexar', 'TX', '78251', '2108045400', '          ', 'TXORTHO', 'TXHCPCS', '', '0.00', '50.00', '0.00', 3, '2007-01-01', '2010-10-11', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1184671398', 0, 'N', 0, '2008-10-30', NULL, NULL, 29.4666, -98.6958, NULL, NULL),
('743003947', 'W11015252', 'W11015252', 'TX01', 'The San Antonio Orthopaedic Group', 'Casey', 'D', 'Taber', 'MD', 'Orthopedic Surgery', '', '', NULL, 'O', '11212 State Hwy 151 Ste 150', 'San Antonio', 'Bexar', 'TX', '78251', '2108045400', NULL, '11212 State Hwy 151 Ste 150', 'San Antonio', 'Bexar', 'TX', '78251', '2108045400', '', 'TXORTHO', 'TXHCPCS', NULL, '0.00', '50.00', '0.00', 3, '2007-01-01', '2012-08-19', 0, 0, 0, 'Baptist Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1972711463', 0, 'N', 0, '2011-09-22', NULL, NULL, 29.4666, -98.6958, NULL, NULL),
('820470163', 'W11015230', 'W11015230', 'ID01', 'FirstLine Medical', 'Karen', 'B', 'Barrett', 'PA', 'Family Practice', '', '', NULL, 'O', '6000 W Overland Rd', 'Boise', 'Ada', 'ID', '83709', '2083237588', NULL, '6000 W Overland Rd', 'Boise', 'Ada', 'ID', '83709', '2083237588', '          ', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2008-09-01', '2012-08-19', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1598921595', 0, 'N', 0, '2013-03-25', NULL, NULL, 0, 0, NULL, NULL),
('820470163', 'W11015231', 'W11015231', 'ID01', 'FirstLine Medical', 'Briant', 'E', 'Burke', 'MD', 'Family Practice', '', '', NULL, 'O', '6000 W Overland Rd', 'Boise', 'Ada', 'ID', '83709', '2083237588', '2085153468', '6000 W Overland Rd', 'Boise', 'Ada', 'ID', '83709', '2083237588', '2085153468', 'IDSTD', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2008-09-01', '2012-08-19', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1538322854', 0, 'N', 0, '2013-04-16', NULL, NULL, 0, 0, NULL, NULL),
('760762803', 'W11015232', 'W11015232', 'ID02', 'Center for Lifetime Health', 'John', 'J', 'Eck', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '300 E Bannock St', 'Boise', 'Ada', 'ID', '83712', '2083427400', '2083421879', '300 E Bannock St', 'Boise', 'Ada', 'ID', '83712', '2083427400', '2083421879', 'IDSTDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2008-11-01', NULL, 0, 0, 1, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1033148044', 0, 'N', 0, '2014-04-16', NULL, NULL, 0, 0, NULL, NULL),
('760762803', 'W11015233', 'W11015233', 'ID02', 'Center for Lifetime Health', 'David', 'L', 'Gee', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '300 E Bannock St', 'Boise', 'Ada', 'ID', '83712', '2083427400', NULL, '300 E Bannock St', 'Boise', 'Ada', 'ID', '83712', NULL, NULL, 'IDSTDPPO', 'WUSTDHCPC5', NULL, '0.00', '30.00', '0.00', 3, '2008-11-01', NULL, 0, 0, 1, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1073541983', 0, 'n', 0, '2008-10-30', NULL, NULL, 0, 0, NULL, NULL),
('204969546', 'W11015228', 'W11015228', 'ID01', 'Meridian Pediatrics', 'Barbara', '', 'Kissam', 'MD', 'Pediatrics', '', '', NULL, 'O', '3653 N Locust Grove Rd', 'Meridian', 'Ada', 'ID', '83646', '2083385437', NULL, '3653 N Locust Grove Rd', 'Meridian', 'Ada', 'ID', '83646', '2083385437', '', 'IDSTD10', 'WUSTDHCPC5', NULL, '0.00', '30.00', '0.00', 3, '2008-11-01', '2012-08-19', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1881689362', 0, 'n', 0, '2012-04-11', NULL, NULL, 43.6379, -116.376, NULL, NULL),
('870639098', 'W11015237', 'W11015237', 'UT01', 'After Hours Medical Company', 'Edward', 'R', 'Schultz', 'MD', 'Family Practice', '', '', NULL, 'O', '476 N 900 W Ste C', 'American Fork', 'Utah', 'UT', '84003', '8014921611', '8013529502', '476 N 900 W Ste C', 'American Fork', 'Utah', 'UT', '84003', '8014921611', '8013529502', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2008-10-03', NULL, 0, 0, 0, 'Primary Childrens Medical Center', '', '', '', 'HCFA|UB|', '1942287719', 0, 'Y', 0, '2014-04-22', NULL, NULL, 40.3961, -111.815, NULL, NULL),
('870639098', 'W11015248', 'W11015248', 'UT01', 'After Hours Urgent Care', 'David', 'J', 'Pombo', 'MD', 'Infectious Disease', 'Internal Medicine', '', NULL, 'O', '476 N 900 W Ste C', 'American Fork', 'Utah', 'UT', '84003', '8014921611', NULL, '476 N 900 W Ste C', 'American Fork', 'Utah', 'UT', '84003', '8014921611', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2008-10-03', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1558720783', 0, 'Y', 0, '2013-10-23', NULL, NULL, 40.3961, -111.815, NULL, NULL),
('870639098', 'W11015243', 'W11015243', 'UT01', 'After Hours Medical Company', 'William', 'D', 'Putnam', 'MD', 'Family Practice', '', '', NULL, 'O', '476 N 900 W Ste C', 'American Fork', 'Utah', 'UT', '84003', '8014921611', '8013529502', '476 N 900 W Ste C', 'American Fork', 'Utah', 'UT', '84003', '8014921611', '8013529502', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2008-10-03', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1932145968', 0, 'Y', 0, '2013-10-23', NULL, NULL, 40.3961, -111.815, NULL, NULL),
('870639098', 'W11015245', 'W11015245', 'UT01', 'After Hours Urgent Care', 'David', 'J', 'Pombo', 'MD', 'Infectious Disease', 'Internal Medicine', '', NULL, 'O', '1126 E 12300 S', 'Draper', 'Salt Lake', 'UT', '84020', '8015450600', NULL, '1126 E 12300 S', 'Draper', 'Salt Lake', 'UT', '84020', '8015450600', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2008-10-03', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1558720783', 0, 'Y', 0, '2013-10-23', NULL, NULL, 40.5284, -111.859, NULL, NULL),
('870639098', 'W11015242', 'W11015242', 'UT01', 'After Hours Medical Company', 'William', 'D', 'Putnam', 'MD', 'Family Practice', '', '', NULL, 'O', '1126 E 12300 S', 'Draper', 'Salt Lake', 'UT', '84020', '8015450600', '8013529502', '1126 E 12300 S', 'Draper', 'Salt Lake', 'UT', '84020', '8015450600', '8013529502', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2008-10-03', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1932145968', 0, 'Y', 0, '2013-10-23', NULL, NULL, 40.5284, -111.859, NULL, NULL),
('870639098', 'W11015236', 'W11015236', 'UT01', 'After Hours Medical Company', 'Edward', 'R', 'Schultz', 'MD', 'Family Practice', '', '', NULL, 'O', '1550 N Main St Ste E', 'Layton', 'Davis', 'UT', '84041', '8016149030', '8013529502', '1550 N Main St Ste E', 'Layton', 'Davis', 'UT', '84041', '8016149030', '8013529502', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2008-10-03', NULL, 0, 0, 0, 'Primary Childrens Medical Center', '', '', '', 'HCFA|UB|', '1942287719', 0, 'Y', 0, '2014-04-22', NULL, NULL, 41.0825, -111.993, NULL, NULL),
('870639098', 'W11015238', 'W11015238', 'UT01', 'After Hours Medical Company', 'William', 'D', 'Putnam', 'MD', 'Family Practice', '', '', NULL, 'O', '1550 N Main St Ste E', 'Layton', 'Davis', 'UT', '84041', '8016149030', '8013529502', '1550 N Main St Ste E', 'Layton', 'Davis', 'UT', '84041', '8016149030', '8013529502', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2008-10-03', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1932145968', 0, 'Y', 0, '2013-10-23', NULL, NULL, 41.0825, -111.993, NULL, NULL),
('870639098', 'W11015244', 'W11015244', 'UT01', 'After Hours Urgent Care', 'David', 'J', 'Pombo', 'MD', 'Infectious Disease', 'Internal Medicine', '', NULL, 'O', '1550 N Main St Ste E', 'Layton', 'Davis', 'UT', '84041', '8016149030', NULL, '1550 N Main St Ste E', 'Layton', 'Davis', 'UT', '84041', '8016149030', '          ', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2008-10-03', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1558720783', 0, 'Y', 0, '2013-10-23', NULL, NULL, 41.0825, -111.993, NULL, NULL),
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('330239910', 'W11015261', 'W11015261', 'WY01', 'Alliance Healthcare Services', '', '', 'Alliance Healthcare Services ', 'GROUP', 'Imaging Center', '', '', NULL, 'B', 'File 55828', 'Los Angeles', 'Los Angeles', 'CA', '90074', '8005300912', NULL, 'File 55828', 'Los Angeles', 'Los Angeles', 'CA', '90074', '8005300912', '          ', 'WYSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2008-11-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1134303845', 0, 'N', 0, '2013-06-18', NULL, NULL, 0, 0, NULL, NULL),
('810231784', 'W11015292', 'W11015292', 'WY01', 'Billings Clinic - ENT', 'Brooke', 'E', 'Hale', 'PA-C', 'Ear, Nose and Throat', '', '', NULL, 'O', '2825 8th Ave N', 'Billings', 'Yellowstone', 'MT', '59101', '4062382501', '4062385043', 'PO Box 37000', 'Billings', 'Yellowstone', 'MT', '59107', '4062382501', '4062385043', '', NULL, NULL, '0.00', '17.00', '0.00', 3, '2008-10-09', '2009-04-30', NULL, 0, 0, '', '', '', '', 'HCFA|UB|', '1215921838', 0, 'N', 0, '2010-05-26', NULL, NULL, 0, 0, NULL, NULL),
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INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
('870442845', 'W11015287', 'W11015287', 'UT01', 'University Health Care', 'Nicole', 'G', 'Orgain', 'PA', 'Physician Assistant', '', '', NULL, 'O', '1950 Circle of Hope', 'Salt Lake City', 'Salt Lake', 'UT', '84112', '8015850100', NULL, '1950 Circle of Hope', 'Salt Lake City', 'Salt Lake', 'UT', '84112', '8015850100', '          ', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2008-10-21', '2012-08-27', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1518975127', 0, 'N', 0, '2012-08-28', NULL, NULL, 0, 0, NULL, NULL),
('870516127', 'W11015289', 'W11015289', 'UT01', 'University Health Care', 'Douglas', 'C', 'Barnhart', 'MD', 'General Surgery', 'Pediatric Surgery', '', NULL, 'O', '100 N Mario Capecchi Dr Ste 2600', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016622950', '8016622980', '100 N Mario Capecchi Dr Ste 2600', 'Salt Lake City', 'Salt Lake', 'UT', '84113', '8016622950', '8016622980', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2008-11-01', '2012-09-16', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1750398517', 0, 'N', 0, '2013-12-12', NULL, NULL, 0, 0, NULL, NULL),
('870450500', 'W11015285', 'W11015285', 'UT01', 'University Health Care', 'Craig', 'A', 'Ensign', 'PA-C', 'Urology', 'Physician Assistant', '', NULL, 'o', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8012133800', '8015853655', '50 N Medical Dr', 'Salt Lake City', 'Salt Lake', 'UT', '84132', '8012133800', '8015853655', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2008-11-01', '2012-09-16', 0, 0, 0, 'University Health Care University Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1760412605', 0, 'N', 0, '2012-09-17', NULL, NULL, 0, 0, NULL, NULL),
('870450500', 'W11015286', 'W11015286', 'UT01', 'University Urology Associates', 'Craig', 'A', 'Ensign', 'PA-C', 'Urology', 'Physician Assistant', '', NULL, 'B', 'PO Box 413035', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8017158110', '8015853655', 'PO Box 413035', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8017158110', '8015853655', 'WUUPEDS', 'WUSTDHCPC5', '', '0.00', '15.00', '0.00', 3, '2008-11-01', '2012-09-16', 0, 0, 0, 'University Health Care University Hospital', NULL, NULL, NULL, 'HCFA|UB|', '1760412605', 0, 'N', 0, '2012-09-17', NULL, NULL, 0, 0, NULL, NULL),
('870442845', 'W11015288', 'W11015288', 'UT01', 'U-U Hematology / Oncology Division', 'Nicole', 'G', 'Orgain', 'PA', 'Physician Assistant', '', '', NULL, 'B', 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '8015853655', 'PO Box 413033', 'Salt Lake City', 'Salt Lake', 'UT', '84141', '8012133800', '8015853655', 'WUUUMG5', 'WUSTDHCPC5', '', '0.00', '25.00', '0.00', 3, '2008-10-21', '2012-08-27', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1518975127', 0, 'N', 0, '2012-08-28', NULL, NULL, 0, 0, NULL, NULL),
('870559169', 'W11015280', 'W11015280', 'UTMH1', 'Aspen Therapy Inc', 'Ruth', 'M', 'Killpack', 'PHD', 'Mental Health', 'Marriage & Family Therapy', '', NULL, 'O', '3707 N Canyon Rd Ste 2C', 'Provo', 'Utah', 'UT', '84604', '8012253111', NULL, '3707 N Canyon Rd Ste 2C', 'Provo', 'Utah', 'UT', '84604', '8012253111', '', 'UTPHD', NULL, NULL, '0.00', '35.00', '0.00', 6, '2008-10-17', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1932281227', 0, 'n', 0, '2013-11-18', NULL, NULL, 0, 0, NULL, NULL),
('870559169', 'W11015279', 'W11015279', 'UTMH1', 'Aspen Therapy', 'Rita', '', 'Edmonds', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '3707 N Canyon Rd Ste 2C', 'Provo', 'Utah', 'UT', '84604', '8012253111', NULL, '3707 N Canyon Rd Ste 2C', 'Provo', 'Utah', 'UT', '84604', '8012253111', '', 'UTMA', NULL, NULL, '0.00', '35.00', '0.00', 6, '2008-10-17', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1346322633', 0, 'n', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11015284', 'W11015284', 'UTIHCPHY', 'Intermountain Womens Health Specialists', 'Richard', 'W', 'Ott', 'MD', 'Obstetrics and Gynecology', NULL, NULL, NULL, 'o', '346 E 600 S', 'St George', 'Washington', 'UT', '84770', '4356884600', NULL, NULL, NULL, 'Washington', NULL, NULL, NULL, NULL, 'USTDMULT', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 8, '2008-11-01', NULL, NULL, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1003816927', 0, 'n', 0, '2008-11-03', NULL, NULL, 37.098, -113.576, NULL, NULL),
('742143569', 'W11015300', 'W11015300', 'TX01', 'Medical Center Ophthalmology Associates', 'Jason', 'D', 'Burns', 'MD', 'Ophthalmology', '', '', NULL, 'O', '11900 Crown Point Ste 140', 'San Antonio', 'Bexar', 'TX', '78233', '2106972020', NULL, '11900 Crown Point Ste 140', 'San Antonio', 'Bexar', 'TX', '78233', '2106972020', '', 'TXSTD', 'TXHCPCS', NULL, '0.00', '50.00', '0.00', 3, '2008-11-01', '2012-08-19', 0, 0, 0, 'Baptist Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1679579874', 0, 'N', 0, '2013-07-29', NULL, NULL, 29.5494, -98.3646, NULL, NULL),
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('742143569', 'W11015296', 'W11015296', 'TX01', 'Medical Center Ophthalmology Associates', '', '', 'Medical Center Ophthalmology Associates', 'MD', 'Ophthalmology', '', '', NULL, 'O', '11900 Crown Point Ste 140', 'San Antonio', 'Bexar', 'TX', '78233', '2106972020', NULL, '11900 Crown Point Ste 140', 'San Antonio', 'Bexar', 'TX', '78233', '2106972020', '', 'TXSTD', 'TXHCPCS', NULL, '0.00', '50.00', '0.00', 3, '2008-11-01', '2012-08-19', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000007546', 0, 'N', 0, '2013-05-06', NULL, NULL, 29.5494, -98.3646, NULL, NULL),
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('261738089', 'W11015369', 'W11015369', 'UT01', 'Advanced Foot & Ankle', 'Leon', 'K', 'Reber', 'DPM', 'Podiatry', '', '', NULL, 'O', '1811 W Royal Hunt Dr Ste 2', 'Cedar City', 'Iron', 'UT', '84720', '4355862225', NULL, '1811 W Royal Hunt Dr Ste 2', 'Cedar City', 'Iron', 'UT', '84720', '4355862225', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2009-01-14', NULL, 0, 0, 0, 'Dixie Regional Medical Center', 'Valley View Medical Center', NULL, NULL, 'HCFA|UB|', '1336179886', 1, 'N', 0, '2011-12-16', NULL, NULL, 37.658, -113.086, NULL, NULL),
('261738089', 'W11015366', 'W11015366', 'UT01', 'Advanced Foot & Ankle', 'Brad', 'S', 'Webb', 'DPM', 'Podiatry', '', '', NULL, 'O', '1811 W Royal Hunt Dr Ste 2', 'Cedar City', 'Iron', 'UT', '84720', '4355862225', NULL, '1811 W Royal Hunt Dr Ste 2', 'Cedar City', 'Iron', 'UT', '84720', '4355862225', '', 'WISESTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2008-11-07', NULL, 0, 0, 0, 'Dixie Regional Medical Center', 'Valley View Medical Center', NULL, NULL, 'HCFA|UB|', '1518900562', 0, 'n', 0, '2013-01-09', NULL, NULL, 37.658, -113.086, 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
('942854057', 'W11015357', 'W11015357', 'UTIHCPHY', 'Hurricane Valley Clinic', 'Kevin', 'Adams', 'Skinner', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '75 N 2260 W', 'Hurricane', 'Washington', 'UT', '84737', '4356356500', NULL, NULL, NULL, 'Washington', NULL, NULL, NULL, NULL, 'USTDMULT', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 8, '2008-05-01', '2009-04-30', NULL, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1013997881', 0, 'N', 0, '2008-11-17', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11015341', 'W11015341', 'UTIHCPHY', 'Hurricane Valley Clinic', 'Jed', 'R', 'Gardner', 'MD', 'Family Practice', '', '', NULL, 'O', '75 N 2260 W', 'Hurricane', 'Washington', 'UT', '84737', '4356356500', NULL, '75 N 2260 W', 'Hurricane', 'Washington', 'UT', '84737', '4356356500', '          ', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2008-07-01', '2011-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1861452542', 0, 'N', 0, '2012-02-29', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11015352', 'W11015352', 'UTIHCPHY', 'Cedar City WorkMed', 'Broc', 'B', 'Parson', 'DO', 'Family Practice', 'Occupational Medicine', '', NULL, 'O', '962 S Sage Dr', 'Cedar City', 'Iron', 'UT', '84720', '4358653440', NULL, '962 S Sage Dr', 'Cedar City', 'Iron', 'UT', '84720', '4358653440', '          ', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2008-07-14', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1285857268', 0, 'Y', 0, '2013-07-12', NULL, NULL, 37.6608, -113.081, NULL, NULL),
('208858441', 'W11015379', 'W11015379', 'UT01', 'Coral Desert Foot & Ankle', 'Jeffrey', 'L', 'Stewart', 'DPM', 'Podiatry', '', '', NULL, 'O', '1490 E Foremaster Dr Ste 250', 'St George', 'Washington', 'UT', '84770', '4356349225', '4358671909', '1490 E Foremaster Dr Ste 250', 'St George', 'Washington', 'UT', '84770', '4356349225', '4358671909', 'WiseSTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2008-07-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', '', '', '', 'HCFA|UB|', '1184623092', 0, 'N', 0, '2014-06-16', NULL, NULL, 37.0959, -113.551, NULL, NULL),
('942854057', 'W11015345', 'W11015345', 'UTIHCPHY', 'Southwest Regional Cancer Clinic', 'Robert', 'H', 'Lemon', 'MD', 'Oncology', 'Hematology and Oncology', '', NULL, 'O', '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356884900', NULL, '544 S 400 E', 'St George', 'Washington', 'UT', '84770', '4356884900', '', 'USTDMULT', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 8, '2008-03-03', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1992867147', 0, 'N', 0, '2013-04-25', NULL, NULL, 37.0989, -113.575, NULL, NULL),
('261738089', 'W11015367', 'W11015367', 'UT01', 'Foot and Ankle Institute', 'Brad', 'S', 'Webb', 'DPM', 'Podiatry', '', '', NULL, 'O', '754 S Main', 'St George', 'Washington', 'UT', '84770', '4356282671', NULL, '754 S Main', 'St George', 'Washington', 'UT', '84770', '4356282671', '', 'WISESTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2008-11-07', '2009-04-14', 0, 0, 0, 'Dixie Regional Medical Center', 'Valley View Medical Center', NULL, NULL, 'HCFA|UB|', '1518900562', 0, 'n', 0, '2013-01-09', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11015348', 'W11015348', 'UTIHCPHY', 'Sports Medicine-St George', 'Christian', 'S', 'Millward', 'MD', 'Sports Medicine', 'Family Practice', '', NULL, 'O', '652 S Medical Ctr Dr Ste 120', 'St George', 'Washington', 'UT', '84790', '4356284460', NULL, '652 S Medical Ctr Dr Ste 120', 'St George', 'Washington', 'UT', '84790', '4356284460', '          ', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2008-01-01', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1205942059', 0, 'N', 0, '2013-10-03', NULL, NULL, 37.0498, -113.574, NULL, NULL),
('261738089', 'W11015371', 'W11015371', 'UT01', 'Foot and Ankle Institute', 'Keith', 'R', 'Reber', 'DPM', 'Podiatry', '', '', NULL, 'O', '754 S Main Ste 3', 'St George', 'Washington', 'UT', '84770', '4356282671', NULL, '754 S Main Ste 3', 'St George', 'Washington', 'UT', '84770', '4356282671', '', 'WISESTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2008-11-07', '2009-04-14', 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1669479358', 0, 'n', 0, '2011-12-15', NULL, NULL, 0, 0, NULL, NULL),
('261738089', 'W11015368', 'W11015368', 'UT01', 'Foot and Ankle Institute', 'Leon', 'K', 'Reber', 'DPM', 'Podiatry', '', '', NULL, 'O', '754 S Main', 'St George', 'Washington', 'UT', '84770', '4356282671', NULL, '754 S Main', 'St George', 'Washington', 'UT', '84770', '4356282671', '', 'WISESTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2008-11-07', '2009-04-14', 0, 0, 0, 'Dixie Regional Medical Center', 'Valley View Medical Center', NULL, NULL, 'HCFA|UB|', '1336179886', 0, 'n', 0, '2011-12-16', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11015334', 'W11015334', 'UTIHCPHY', 'Southwest Cardiology - St George', 'Alberto', 'A', 'Brizolara', 'MD', 'Cardiovascular Disease', '', '', NULL, 'O', '1380 E Medical Ctr Dr Ste 1500', 'St George', 'Washington', 'UT', '84790', '4352512500', NULL, '1380 E Medical Ctr Dr Ste 1500', 'St George', 'Washington', 'UT', '84790', '4352512500', '          ', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2008-07-06', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1164488961', 0, 'N', 0, '2013-03-11', NULL, NULL, 37.0998, -113.554, NULL, NULL),
('942854057', 'W11015332', 'W11015332', 'UTIHCPHY', 'Dixie Hospitalists', 'William', 'W', 'Barney', 'MD', 'Internal Medicine', 'Cardiovascular Disease', 'Hospitalist', NULL, 'O', '577 S River Rd', 'St George', 'Washington', 'UT', '84790', '4356886200', NULL, '577 S River Rd', 'St George', 'Washington', 'UT', '84790', '4356886200', '', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2008-05-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', '', '', '', 'HCFA|UB|', '1194799890', 0, 'N', 0, '2014-07-16', NULL, NULL, 37.0986, -113.557, NULL, NULL),
('942854057', 'W11015349', 'W11015349', 'UTIHCPHY', 'Southern Utah Behavioral Health', 'Wade', 'O', 'Milne', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '1054 E Riverside Dr Ste 202', 'St George', 'Washington', 'UT', '84790', '4356346100', NULL, '1054 E Riverside Dr Ste 202', 'St George', 'Washington', 'UT', '84790', '4356346100', '          ', 'USTDMULT', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 8, '2008-07-15', '2012-06-30', 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1508843467', 0, 'N', 0, '2013-02-27', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11015347', 'W11015347', 'UTIHCPHY', 'Dixie Hospitalists', 'Kent', 'B', 'McDonald', 'MD', 'Hospitalist', '', '', NULL, 'O', '577 S River Rd', 'St George', 'Washington', 'UT', '84790', '4356886200', NULL, '577 S River Rd', 'St George', 'Washington', 'UT', '84790', '4356886200', '', 'USTDMULT', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 8, '2008-07-01', NULL, 0, 0, 0, 'Dixie Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1093794554', 0, 'N', 0, '2012-05-29', NULL, NULL, 37.0986, -113.557, NULL, NULL),
('205967125', 'W11015398', 'W11015398', 'ID02', 'Imaging Center of Idaho ', '', '', 'Imaging Center of Idaho LLC', 'GROUP', 'Imaging Center', 'Radiology', '', NULL, 'O', '4519 Enterprise Way', 'Caldwell', 'Canyon', 'ID', '83605', '2084557482', NULL, '4519 Enterprise Way', 'Caldwell', 'Canyon', 'ID', '83605', '2084557482', '', 'IDPPO', 'WUSTDHCPC5', NULL, '0.00', '30.00', '0.00', 3, '2008-11-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '0000006851', 0, 'n', 0, '2014-02-06', NULL, NULL, 0, 0, NULL, NULL),
('043698413', 'W11015405', 'W11015405', 'ID01', 'Scott P Hoopes MD & Associates', 'Joycelyn', 'J', 'Reiland', 'NP', 'Mental Health', '', '', NULL, 'O', '2273 E Gala St Ste 100', 'Meridian', 'Ada', 'ID', '83642', '2088988999', NULL, '2273 E Gala St Ste 100', 'Meridian', 'Ada', 'ID', '83642', '2088988999', '          ', 'IDMD', '', '', '0.00', '35.00', '0.00', 3, '2008-11-11', '2012-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1225101975', 0, 'N', 0, '2013-07-25', NULL, NULL, 0, 0, NULL, NULL),
('043698413', 'W11015404', 'W11015404', 'ID01', 'Scott P Hoopes MD & Associates', 'Gladys', 'J', 'Gonzales', 'PA', 'Mental Health', '', '', NULL, 'O', '2273 E Gala St Ste 100', 'Meridian', 'Ada', 'ID', '83642', '2088988999', NULL, '2273 E Gala St Ste 100', 'Meridian', 'Ada', 'ID', '83642', '2088988999', '          ', 'IDMD', '', '', '0.00', '35.00', '0.00', 3, '2008-11-11', '2012-12-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1588850812', 0, 'N', 0, '2013-07-25', NULL, NULL, 0, 0, NULL, NULL),
('205967125', 'W11015403', 'W11015403', 'ID02', 'Imaging Center of Idaho ', 'Paul', 'D', 'Traughber', 'MD', 'Radiology', NULL, NULL, NULL, 'B', '5777 W Century Blvd Ste 590', 'Los Angeles', 'Los Angeles', 'CA', '90045', '2084557482', NULL, 'PO Box 4813', 'Boise', 'Ada', 'ID', '83711', NULL, NULL, 'IDPPO', 'WUSTDHCPC5', NULL, '0.00', '30.00', '0.00', 3, '2008-11-01', NULL, 0, 0, 1, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1538107362', 0, 'y', 0, '2008-11-11', NULL, NULL, 0, 0, NULL, NULL),
('205967125', 'W11015402', 'W11015402', 'ID02', 'Imaging Center of Idaho ', 'Steven', 'F', 'Merandi', 'MD', 'Radiology', 'Imaging Center', '', NULL, 'B', '5777 W Century Blvd Ste 590', 'Los Angeles', 'Los Angeles', 'CA', '90045', '2084557482', NULL, '5777 W Century Blvd Ste 590', 'Los Angeles', 'Los Angeles', 'CA', '90045', '2084557482', '          ', 'IDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2008-11-01', NULL, 0, 0, 1, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1962458000', 0, 'Y', 0, '2013-04-26', NULL, NULL, 0, 0, NULL, NULL),
('205967125', 'W11015400', 'W11015400', 'ID02', 'Imaging Center of Idaho ', '', '', 'Imaging Center of Idaho LLC', 'GROUP', 'Imaging Center', 'Radiology', '', NULL, 'B', '5777 W Century Blvd Ste 590', 'Los Angeles', 'Los Angeles', 'CA', '90045', '2084557482', NULL, '5777 W Century Blvd Ste 590', 'Los Angeles', 'Los Angeles', 'CA', '90045', '2084557482', '', 'IDPPO', 'WUSTDHCPC5', NULL, '0.00', '30.00', '0.00', 3, '2008-11-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '0000006851', 0, 'y', 0, '2014-02-06', NULL, NULL, 0, 0, NULL, NULL),
('205967125', 'W11015401', 'W11015401', 'ID02', 'Imaging Center of Idaho ', 'Michael', 'B', 'Johnson', 'DO', 'Radiology', '', '', NULL, 'B', '5777 W Century Blvd Ste 590', 'Los Angeles', 'Los Angeles', 'CA', '90045', '2084557482', NULL, '5777 W Century Blvd Ste 590', 'Los Angeles', 'Los Angeles', 'CA', '90045', '2084557482', '', 'IDPPO', 'WUSTDHCPC5', NULL, '0.00', '30.00', '0.00', 3, '2008-11-01', NULL, 0, 0, 1, '', '', '', '', 'HCFA|UB|', '1205820842', 0, 'y', 0, '2014-02-06', NULL, NULL, 0, 0, NULL, NULL),
('205967125', 'W11015399', 'W11015399', 'ID02', 'Imaging Center of Idaho ', 'Diane', 'R', 'Newton', 'MD', 'Radiology', NULL, NULL, NULL, 'B', '5777 W Century Blvd Ste 590', 'Los Angeles', 'Los Angeles', 'CA', '90045', '2084557482', NULL, 'PO Box 4813', 'Boise', 'Ada', 'ID', '83711', NULL, NULL, 'IDPPO', 'WUSTDHCPC5', NULL, '0.00', '30.00', '0.00', 3, '2008-11-01', NULL, 0, 0, 1, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1689617797', 0, 'y', 0, '2008-11-11', NULL, NULL, 0, 0, NULL, NULL),
('260686204', 'W11015395', 'W11015395', 'UT01', 'Canyon Surgical Clinic', 'Lance', 'R', 'Bryce', 'MD', 'General Surgery', '', '', NULL, 'B', 'PO Box 268', 'Bountiful', 'Davis', 'UT', '84011', '4357230329', NULL, 'PO Box 268', 'Bountiful', 'Davis', 'UT', '84011', '4357230329', '', 'WISESTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2008-11-07', '2010-08-31', 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1639372840', 0, 'y', 0, '2013-10-15', NULL, NULL, 0, 0, NULL, NULL),
('519607188', 'W11015396', 'W11015396', 'UTMH1', NULL, 'Kary', 'R', 'Cotter', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '124 S 400 E Ste 300', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8015973617', NULL, '124 S 400 E Ste 300', 'Salt Lake City', 'Salt Lake', 'UT', '84111', '8015973617', '', 'MA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-11-07', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1689610677', 0, 'n', 0, '2011-11-22', NULL, NULL, 0, 0, NULL, NULL),
('260686204', 'W11015394', 'W11015394', 'UT01', 'Canyon Surgical Clinic', 'Lance', 'R', 'Bryce', 'MD', 'General Surgery', '', '', NULL, 'O', '984 S Medical Dr Ste 2', 'Brigham City', 'Box Elder', 'UT', '84302', '4357230329', NULL, '984 S Medical Dr Ste 2', 'Brigham City', 'Box Elder', 'UT', '84302', '4357230329', '', 'WISESTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2008-11-07', '2010-08-31', 0, 0, 0, 'Ogden Regional Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1639372840', 0, 'n', 0, '2013-10-15', NULL, NULL, 0, 0, NULL, NULL),
('203234597', 'W11015393', 'W11015393', 'UTMH1', NULL, 'Marque', NULL, 'Randall', 'PHD', 'Mental Health', 'Psychology', NULL, NULL, 'O', '1300 N 200 E Ste 114A', 'Logan', 'Cache', 'UT', '84341', '4357532687', NULL, '1300 N 200 E', 'Logan', 'Cache', 'UT', '84341', NULL, NULL, 'PHD', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-11-07', '2013-02-14', 0, 0, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1457371189', 0, 'n', 0, '2008-11-10', NULL, NULL, 0, 0, NULL, NULL),
('519607188', 'W11015397', 'W11015397', 'UTMH1', NULL, 'Kary', 'R', 'Cotter', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'B', '12 Redondo Ct', 'Alameda', 'Alameda', 'CA', '94501', '8015973617', NULL, '12 Redondo Ct', 'Alameda', 'Alameda', 'CA', '94501', '8015973617', '', 'MA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-11-07', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1689610677', 0, 'y', 0, '2011-11-22', NULL, NULL, 0, 0, NULL, NULL),
('900159459', 'W11015412', 'W11015412', 'TX01', 'Alpha Omega In-Home Family Counseling', 'Marian', '', 'Rubio', 'LPC', 'Mental Health', 'Counseling', '', NULL, 'B', '4203 Woodcock Ste 265', 'San Antonio', 'Bexar', 'TX', '78228', '2107372674', NULL, '4203 Woodcock Ste 265', 'San Antonio', 'Bexar', 'TX', '78228', '2107372674', '          ', 'TXMA', '', '', '0.00', '100.00', '0.00', 3, '2008-11-11', '2011-05-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1972673366', 0, 'Y', 0, '2011-02-24', NULL, NULL, 0, 0, NULL, NULL),
('204511600', 'W11015418', 'W11015418', 'WY01', 'Wind River Clinic', 'James', 'R', 'White', 'DO', 'General Surgery', '', '', NULL, 'O', '1005 College View Dr', 'Riverton', 'Fremont', 'WY', '82501', '3078573488', NULL, '1005 College View Dr', 'Riverton', 'Fremont', 'WY', '82501', '3078573488', '', '', NULL, NULL, '0.00', '20.00', '0.00', 3, '2008-11-12', NULL, 0, 0, 0, 'SageWest Health Care', NULL, NULL, NULL, 'HCFA|UB|', '1528045614', 0, 'n', 0, '2012-01-04', NULL, NULL, 43.0349, -108.42, NULL, NULL),
('826000428', 'W11015419', 'W11015419', 'ID03', 'Oneida County Hospital', NULL, NULL, 'Oneida County Hospital', 'GROUP', 'Hospital', NULL, NULL, NULL, 'O', '150 N 200 W', 'Malad City', 'Oneida', 'ID', '83252', '2087662231', '2087664819', NULL, NULL, 'Oneida', NULL, NULL, NULL, NULL, '', NULL, NULL, '0.00', '20.00', '0.00', 6, '2008-10-23', NULL, NULL, 0, 1, NULL, NULL, NULL, NULL, 'UB|', '0000007974', 0, 'n', 0, '2008-11-12', NULL, NULL, 0, 0, NULL, NULL),
('942854057', 'W11015415', 'W11015415', 'UTPEHP', 'IHC Bountiful Health Center', 'David', 'A', 'VandeMerwe', 'MD', 'Family Practice', NULL, NULL, NULL, 'O', '390 N Main St', 'Bountiful', 'Davis', 'UT', '84010', '8012941000', NULL, '390 N Main', 'Bountiful', 'Davis', 'UT', '84010', NULL, NULL, 'IHCPEHP', NULL, NULL, '0.00', '30.00', NULL, 8, '2000-01-01', '2000-01-01', 0, NULL, 0, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1003859547', 0, 'N', 0, NULL, NULL, NULL, 0, 0, NULL, NULL),
('262478287', 'W11015416', 'W11015416', 'UT01', 'South Hills Family Eye Care', 'Sherman', 'H', 'Peirce', 'OD', 'Optometry', '', '', NULL, 'O', '12357 S 450 E Ste 2', 'Draper', 'Salt Lake', 'UT', '84020', '8015729804', NULL, '12357 S 450 E Ste 2', 'Draper', 'Salt Lake', 'UT', '84020', '8015729804', '', 'WISESTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2008-11-07', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1164455317', 0, 'n', 0, '2011-10-17', NULL, NULL, 40.5261, -111.878, NULL, NULL),
('870284475', 'W11015421', 'W11015421', 'UT01', 'Granger Medical Clinic', 'Tricia', '', 'Twelves', 'MD', 'Obstetrics and Gynecology', '', '', NULL, 'O', '3968 W Crossing Dr Ste 100', 'Riverton', 'Salt Lake', 'UT', '84065', '8013021700', '8019653740', '3968 W Crossing Dr Ste 100', 'Riverton', 'Salt Lake', 'UT', '84065', '8013021700', '8019653740', 'WUGRANGER5', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2008-10-17', NULL, 0, 0, 0, 'Pioneer Valley Hospital', 'Riverton Childrens Unit Operated by Primary Childrens Medical Center', NULL, NULL, 'HCFA|UB|', '1730389297', 0, 'N', 0, '2012-04-30', NULL, NULL, 40.5257, -111.986, NULL, NULL),
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('562326691', 'W11015407', 'W11015407', 'UT01', 'Jordan Valley Family Health', 'Dennis', 'R', 'Hamp', 'DO', 'Family Practice', '', '', NULL, 'B', 'PO Box 572528', 'Salt Lake City', 'Salt Lake', 'UT', '84157', '8012807774', NULL, 'PO Box 572528', 'Salt Lake City', 'Salt Lake', 'UT', '84157', '8012807774', '', 'WiseSTD', 'WUSTDHCPC5', NULL, '0.00', '35.00', '0.00', 3, '2008-07-01', NULL, 0, 0, 0, 'Jordan Valley Medical Center', NULL, NULL, NULL, 'HCFA|UB|', '1568405397', 0, 'y', 0, '2011-09-28', NULL, NULL, 0, 0, NULL, NULL),
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('870621744', 'W11015410', 'W11015410', 'UTMH1', 'Mt Logan Clinic', 'Bruce', '', 'Johns', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'B', 'PO Box 6244', 'Logan', 'Cache', 'UT', '84341', '4357506300', NULL, 'PO Box 6244', 'Logan', 'Cache', 'UT', '84341', '4357506300', '', 'PHD', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-11-07', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1831102052', 0, 'y', 0, '2012-01-03', NULL, NULL, 0, 0, NULL, NULL),
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('753107416', 'W11015413', 'W11015413', 'UTMH1', NULL, 'Nancy', 'B', 'Webb', 'LMFT', 'Mental Health', 'Marriage & Family Therapy', '', NULL, 'O', '550 E 1400 N Ste H', 'Logan', 'Cache', 'UT', '84341', '4357538863', NULL, '550 E 1400 N Ste H', 'Logan', 'Cache', 'UT', '84341', '4357538863', '', 'MA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-11-07', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1487720181', 0, 'n', 0, '2011-10-14', NULL, NULL, 0, 0, NULL, NULL),
('870299862', 'W11015408', 'W11015408', 'UTMH1', 'LDS Family Services', 'Laura', 'L', 'Hall', 'LCSW', 'Mental Health', 'Social Worker', '', NULL, 'O', '630 W Price River Dr', 'Price', 'Carbon', 'UT', '84501', '4356372991', NULL, '630 W Price River Dr', 'Price', 'Carbon', 'UT', '84501', '4356372991', '', 'MA', NULL, NULL, '0.00', '35.00', '0.00', 8, '2008-11-07', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1104035856', 0, 'N', 0, '2013-06-17', NULL, NULL, 0, 0, NULL, NULL),
('260598096', 'W11015411', 'W11015411', 'UT01', 'Red Hills Wellness Center', 'Shelly', 'F', 'Kirk', 'FNP', 'Obstetrics and Gynecology', 'Gynecology', 'Family Practice', NULL, 'O', '301 N 200 E Ste 2C', 'St George', 'Washington', 'UT', '84770', '4356741700', NULL, '301 N 200 E Ste 2C', 'St George', 'Washington', 'UT', '84770', '4356741700', '          ', 'WISESTD', 'WUSTDHCPC5', '', '0.00', '35.00', '0.00', 3, '2008-11-07', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1932229259', 0, 'N', 0, '2013-07-15', NULL, NULL, 37.1081, -113.566, NULL, NULL),
('830333324', 'W11015434', 'W11015434', 'WY01', 'Sweetwater Surgery Center', '', '', 'Sweetwater Surgery Center', 'GROUP', 'Ambulatory Surgery Center', '', '', NULL, 'O', '2761 Commercial Way', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073826873', NULL, '2761 Commercial Way', 'Rock Springs', 'Sweetwater', 'WY', '82901', '3073826873', '', '', NULL, NULL, '0.00', '25.00', '0.00', 3, '2008-10-31', NULL, 0, 0, 0, '', '', '', '', 'HCFA|UB|', '0000008972', 0, 'n', 0, '2011-06-10', NULL, NULL, 41.5825, -109.254, NULL, NULL),
('820301586', 'W11015432', 'W11015432', 'ID01', 'CVA Vascular Lab', 'Philippe', 'A', 'Masser', 'MD This Provider will terminate on July 1st', 'Cardiovascular Disease', '', '', NULL, 'O', '977 S Progress Way', 'Meridian', 'Ada', 'ID', '83642', '2088989381', NULL, '977 S Progress Way', 'Meridian', 'Ada', 'ID', '83642', '2088989381', '          ', '', '', '', '0.00', '15.00', '0.00', 3, '2008-09-01', '2010-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1104878446', 0, 'N', 0, '2012-05-31', NULL, NULL, 0, 0, NULL, NULL),
('820301586', 'W11015431', 'W11015431', 'ID01', 'CVA Vascular Lab', 'Jeffrey', 'J', 'Gilbertson', 'MD This Provider will terminate on July 1st', 'Cardiovascular Disease', '', '', NULL, 'O', '977 S Progress Way', 'Meridian', 'Ada', 'ID', '83642', '2088989381', NULL, '977 S Progress Way', 'Meridian', 'Ada', 'ID', '83642', '2088989381', '          ', '', '', '', '0.00', '15.00', '0.00', 3, '2008-09-01', '2010-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1790738516', 0, 'N', 0, '2012-05-31', NULL, NULL, 0, 0, NULL, NULL),
('820301586', 'W11015430', 'W11015430', 'ID01', 'CVA Vascular Lab', 'Brian', 'D', 'Matteson', 'MD This Provider will terminate on July 1st', 'Cardiovascular Disease', '', '', NULL, 'O', '977 S Progress Way', 'Meridian', 'Ada', 'ID', '83642', '2088989381', NULL, '977 S Progress Way', 'Meridian', 'Ada', 'ID', '83642', '2088989381', '          ', '', '', '', '0.00', '15.00', '0.00', 3, '2008-09-01', '2010-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1609828003', 0, 'N', 0, '2012-05-31', NULL, NULL, 0, 0, NULL, NULL),
('820301586', 'W11015429', 'W11015429', 'ID01', 'CVA Vascular Lab', 'Michael', 'J', 'Tullis', 'MD This Provider will terminate on July 1st', 'Cardiovascular Disease', '', '', NULL, 'O', '977 S Progress Way', 'Meridian', 'Ada', 'ID', '83642', '2088989381', NULL, '977 S Progress Way', 'Meridian', 'Ada', 'ID', '83642', '2088989381', '          ', '', '', '', '0.00', '15.00', '0.00', 3, '2008-09-01', '2010-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1598717985', 0, 'N', 0, '2012-10-09', NULL, NULL, 0, 0, NULL, NULL),
('820342377', 'W11015433', 'W11015433', 'ID02', NULL, 'Darrell', 'A', 'Kammer', 'MD', 'Ear, Nose and Throat', '', '', NULL, 'O', '1615 12th Ave Rd Ste C', 'Nampa', 'Canyon', 'ID', '83686', '2084672129', NULL, '1615 12th Ave Rd Ste C', 'Nampa', 'Canyon', 'ID', '83686', '2084672129', '', 'IDPPO', 'WUSTDHCPC5', '', '0.00', '30.00', '0.00', 3, '2008-11-01', NULL, 0, 0, 1, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1326038571', 0, 'n', 0, '2014-07-09', NULL, NULL, 43.5533, -116.573, NULL, NULL),
('820301586', 'W11015428', 'W11015428', 'ID01', 'Cardiovascular & Chest Surgical Associates', 'Michael', 'J', 'Tullis', 'MD This Provider will terminate on July 1st', 'Cardiovascular Disease', '', '', NULL, 'O', '333 N 1st St Ste 280', 'Boise', 'Ada', 'ID', '83702', '2083456545', NULL, '333 N 1st St Ste 280', 'Boise', 'Ada', 'ID', '83702', '2083456545', '          ', '', '', '', '0.00', '15.00', '0.00', 3, '2008-09-01', '2010-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1598717985', 0, 'N', 0, '2012-10-09', NULL, NULL, 43.6135, -116.194, NULL, NULL),
('820301586', 'W11015427', 'W11015427', 'ID01', 'Cardiovascular & Chest Surgical Associates', 'Andrew', 'D', 'Forbes', 'MD This Provider will terminate on July 1st', 'Cardiovascular Disease', '', '', NULL, 'O', '333 N 1st St Ste 280', 'Boise', 'Ada', 'ID', '83702', '2083456545', NULL, '333 N 1st St Ste 280', 'Boise', 'Ada', 'ID', '83702', '2083456545', '          ', '', '', '', '0.00', '15.00', '0.00', 3, '2008-09-01', '2010-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1346292679', 0, 'N', 0, '2012-05-31', NULL, NULL, 43.6135, -116.194, NULL, NULL),
('820301586', 'W11015426', 'W11015426', 'ID01', 'Cardiovascular & Chest Surgical Associates', 'David', 'C', 'Stuesse', 'MD This Provider will terminate on July 1st', 'Cardiovascular Disease', '', '', NULL, 'O', '333 N 1st St Ste 280', 'Boise', 'Ada', 'ID', '83702', '2083456545', NULL, '333 N 1st St Ste 280', 'Boise', 'Ada', 'ID', '83702', '2083456545', '          ', '', '', '', '0.00', '15.00', '0.00', 3, '2008-09-01', '2010-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1427155290', 0, 'N', 0, '2012-05-31', NULL, NULL, 43.6135, -116.194, NULL, NULL),
('820301586', 'W11015425', 'W11015425', 'ID01', 'Cardiovascular & Chest Surgical Associates', 'Jeffrey', 'J', 'Gilbertson', 'MD This Provider will terminate on July 1st', 'Cardiovascular Disease', '', '', NULL, 'O', '333 N 1st St Ste 280', 'Boise', 'Ada', 'ID', '83702', '2083456545', NULL, '333 N 1st St Ste 280', 'Boise', 'Ada', 'ID', '83702', '2083456545', '          ', '', '', '', '0.00', '15.00', '0.00', 3, '2008-09-01', '2010-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1790738516', 0, 'N', 0, '2012-05-31', NULL, NULL, 43.6135, -116.194, NULL, NULL),
('820301586', 'W11015424', 'W11015424', 'ID01', 'Cardiovascular & Chest Surgical Associates', 'Philippe', 'A', 'Masser', 'MD This Provider will terminate on July 1st', 'Cardiovascular Disease', '', '', NULL, 'O', '333 N 1st St Ste 280', 'Boise', 'Ada', 'ID', '83702', '2083456545', NULL, '333 N 1st St Ste 280', 'Boise', 'Ada', 'ID', '83702', '2083456545', '          ', '', '', '', '0.00', '15.00', '0.00', 3, '2008-09-01', '2010-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1104878446', 0, 'N', 0, '2012-05-31', NULL, NULL, 43.6135, -116.194, NULL, NULL),
('820301586', 'W11015423', 'W11015423', 'ID01', 'Cardiovascular & Chest Surgical Associates', 'Steven', 'S', 'Huerd', 'MD This Provider will terminate on July 1st', 'Cardiovascular Disease', '', '', NULL, 'O', '333 N 1st St Ste 280', 'Boise', 'Ada', 'ID', '83702', '2083456545', NULL, '333 N 1st St Ste 280', 'Boise', 'Ada', 'ID', '83702', '2083456545', '          ', '', '', '', '0.00', '15.00', '0.00', 3, '2008-09-01', '2010-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1891747275', 0, 'N', 0, '2012-05-31', NULL, NULL, 43.6135, -116.194, NULL, NULL),
('820301586', 'W11015422', 'W11015422', 'ID01', 'Cardiovascular & Chest Surgical Associates', 'Brian', 'D', 'Matteson', 'MD This Provider will terminate on July 1st', 'Cardiovascular Disease', '', '', NULL, 'O', '333 N 1st St Ste 280', 'Boise', 'Ada', 'ID', '83702', '2083456545', NULL, '333 N 1st St Ste 280', 'Boise', 'Ada', 'ID', '83702', '2083456545', '          ', '', '', '', '0.00', '15.00', '0.00', 3, '2008-09-01', '2010-06-30', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1609828003', 0, 'N', 0, '2012-05-31', NULL, NULL, 43.6135, -116.194, NULL, NULL),
('331078261', 'W11015445', 'W11015445', 'ID01', 'Saint Alphonsus Physicians PA', 'Teresa', 'A', 'Weeks', 'NP-C', 'Neurosurgery', 'Nurse Practitioner', '', NULL, 'O', '1118 NW 16th St', 'Fruitland', 'Payette', 'ID', '83619', '2083674000', NULL, '1118 NW 16th St', 'Fruitland', 'Payette', 'ID', '83619', '2083674000', '          ', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 3, '2008-10-23', '2012-12-13', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1346259454', 0, 'N', 0, '2013-04-30', NULL, NULL, 44.025, -116.928, NULL, NULL),
('331078261', 'W11015442', 'W11015442', 'ID01', 'Saint Alphonsus Physicians PA', 'Stephanie', '', 'Hilpert', 'NP-C', 'Neurosurgery', 'Nurse Practitioner', '', NULL, 'O', '1118 NW 16th St', 'Fruitland', 'Payette', 'ID', '83619', '2083674000', NULL, '1118 NW 16th St', 'Fruitland', 'Payette', 'ID', '83619', '2083674000', '', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 3, '2008-10-23', '2012-12-13', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1760584346', 0, 'N', 0, '2014-07-09', NULL, NULL, 44.025, -116.928, NULL, NULL),
('820477852', 'W11015448', 'W11015448', 'ID01', 'Saint Alphonsus Medical Group Iowa', 'Laura', 'M', 'Thompson', 'NP-C', 'Family Practice', 'Nurse Practitioner', '', NULL, 'o', '211 W Iowa Ave', 'Nampa', 'Canyon', 'ID', '83686', '2084657377', '2084657397', '211 W Iowa Ave', 'Nampa', 'Canyon', 'ID', '83686', '2084657377', '2084657397', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2008-10-23', '2012-04-03', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1548205966', 0, 'N', 0, '2012-04-03', NULL, NULL, 43.5539, -116.575, NULL, NULL),
('820477852', 'W11015447', 'W11015447', 'ID01', 'Saint Alphonsus Medical Group Shoreline', 'Vanessa', 'C', 'Holstine', 'NP-C', 'Family Practice', 'Nurse Practitioner', '', NULL, 'O', '1673 W Shoreline Dr Ste 120', 'Boise', 'Ada', 'ID', '83702', '2084298311', '2084298310', '1673 W Shoreline Dr Ste 120', 'Boise', 'Ada', 'ID', '83702', '2084298311', '2084298310', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2008-10-23', '2012-03-29', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1043346901', 0, 'Y', 0, '2012-03-29', NULL, NULL, 43.6171, -116.222, NULL, NULL),
('820477852', 'W11015449', 'W11015449', 'ID01', 'Saint Alphonsus Medical Group Emerald', 'Mary Ann', '', 'Tuthill', 'PA-C', 'Family Practice', 'Physician Assistant', 'Obstetrics and Gynecology', NULL, 'o', '6533 Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083674170', '2083775039', '6533 Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083674170', '2083775039', 'IDSAMG2', NULL, '', '0.00', '10.00', '0.00', 6, '2008-10-23', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Regional Medical Center', '', '', '', 'HCFA|UB|', '1720020217', 0, 'n', 0, '2014-06-20', NULL, NULL, 43.6119, -116.268, NULL, NULL),
('331078261', 'W11015446', 'W11015446', 'ID01', 'Saint Alphonsus Physicians PA', 'Teresa', 'A', 'Weeks', 'NP-C', 'Neurosurgery', 'Nurse Practitioner', '', NULL, 'O', '1075 N Curtis Ste 102', 'Boise', 'Ada', 'ID', '83706', '2083674000', NULL, '1075 N Curtis Ste 102', 'Boise', 'Ada', 'ID', '83706', '2083674000', '          ', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 3, '2008-10-23', '2012-12-13', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1346259454', 0, 'N', 0, '2013-04-30', NULL, NULL, 43.6143, -116.258, NULL, NULL),
('331078261', 'W11015443', 'W11015443', 'ID01', 'Saint Alphonsus Physicians PA', 'Stephanie', '', 'Hilpert', 'NP-C', 'Neurosurgery', 'Nurse Practitioner', '', NULL, 'O', '1055 N Curtis', 'Boise', 'Ada', 'ID', '83706', '2083674000', NULL, '1055 N Curtis', 'Boise', 'Ada', 'ID', '83706', '2083674000', '', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 3, '2008-10-23', '2012-12-13', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1760584346', 0, 'N', 0, '2014-07-09', NULL, NULL, 43.6127, -116.254, NULL, NULL),
('331078261', 'W11015444', 'W11015444', 'ID01', 'Saint Alphonsus Physicians PA', 'Teresa', 'A', 'Weeks', 'NP-C', 'Neurosurgery', 'Nurse Practitioner', '', NULL, 'O', '1055 N Curtis', 'Boise', 'Ada', 'ID', '83706', '2083674000', NULL, '1055 N Curtis', 'Boise', 'Ada', 'ID', '83706', '2083674000', '          ', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 3, '2008-10-23', '2012-12-13', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1346259454', 0, 'N', 0, '2013-04-30', NULL, NULL, 43.6127, -116.254, NULL, NULL),
('331078261', 'W11015441', 'W11015441', 'ID01', 'Saint Alphonsus Physicians PA', 'Stephanie', '', 'Hilpert', 'NP-C', 'Neurosurgery', 'Nurse Practitioner', '', NULL, 'O', '1075 N Curtis Rd Ste 102', 'Boise', 'Ada', 'ID', '83706', '2083674000', NULL, '1075 N Curtis Rd Ste 102', 'Boise', 'Ada', 'ID', '83706', '2083674000', '', 'IDSAMG1', '', '', '0.00', '10.00', '0.00', 3, '2008-10-23', '2012-12-13', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1760584346', 0, 'N', 0, '2014-07-09', NULL, NULL, 43.6143, -116.258, NULL, NULL),
('205917784', 'W11015439', 'W11015439', 'UTMH1', '', 'Brian', 'J', 'Taracena', 'PSYD', 'Mental Health', 'Psychology', '', NULL, 'O', '175 N Main St', 'Heber City', 'Wasatch', 'UT', '84032', '4356544037', NULL, '175 N Main St', 'Heber City', 'Wasatch', 'UT', '84032', '4356544037', '          ', 'PHD', '', '', '0.00', '35.00', '0.00', 3, '2008-11-07', '2012-03-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1730129883', 0, 'N', 0, '2013-07-09', NULL, NULL, 0, 0, NULL, NULL),
('528377718', 'W11015438', 'W11015438', 'UTMH1', 'UIPT', 'Brad', 'W', 'Lundahl', 'PHD', 'Mental Health', 'Psychology', '', NULL, 'O', '505 E 200 S Ste 303', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8016354141', NULL, '505 E 200 S Ste 303', 'Salt Lake City', 'Salt Lake', 'UT', '84102', '8016354141', '          ', 'PHD', '', '', '0.00', '35.00', '0.00', 3, '2008-11-07', '2011-01-31', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1033239827', 0, 'N', 0, '2012-01-16', NULL, NULL, 0, 0, NULL, NULL),
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INSERT INTO `providers_new` (`Provider_Tax_ID`, `Provider_Suffix`, `Provider_Network_ID`, `Provider_Region`, `Provider_Name`, `Provider_Doctor_First_Name`, `Provider_Doctor_Middle_Name`, `Provider_Doctor_Last_Name`, `Provider_Doctor_Degree`, `Provider_Specialty_1`, `Provider_Specialty_2`, `Provider_Specialty_3`, `Provider_Specialty_4`, `Provider_Address_Type`, `Provider_Address`, `Provider_City`, `Provider_County`, `Provider_State`, `Provider_Zip`, `Provider_Phone`, `Provider_Fax`, `Provider_Mailing_Address`, `Provider_Mailing_City`, `Provider_Mailing_County`, `Provider_Mailing_State`, `Provider_Mailing_Zip`, `Provider_Mailing_Phone`, `Provider_Mailing_Fax`, `Provider_Primary_Schedule`, `Provider_Secondary_Schedule`, `Provider_Rate_Sheet`, `Provider_Anes_Rate`, `Provider_Default_Rate`, `Provider_Max_DOS`, `Provider_Min_Match_Value`, `Provider_Effective_Date`, `Provider_Term_Date`, `Provider_Pend`, `Provider_Anes_Minutes`, `Provider_PPO`, `Provider_Hospital_1`, `Provider_Hospital_2`, `Provider_Hospital_3`, `Provider_Hospital_4`, `Provider_Type`, `Provider_NPI`, `Provider_Check_Override`, `Exclude_Dir`, `Audit_Status`, `Last_Change_Date`, `Medicare_ID`, `Provider_Lang`, `Provider_Latitude`, `Provider_Longitude`, `Provider_school`, `Provider_cert`) VALUES
('820506078', 'W11015526', 'W11015526', 'ID02', 'Boise Endoscopy Center ', NULL, NULL, 'Boise Endoscopy Center LLC', 'GROUP', 'Endoscopy Center', NULL, NULL, NULL, 'O', '425 W Bannock', 'Boise', 'Ada', 'ID', '83702', '2083427169', NULL, '425 W Bannock', 'Boise', 'Ada', 'ID', '83702', NULL, NULL, 'IDENDO2', NULL, NULL, '0.00', '40.00', '0.00', 3, '2008-11-01', NULL, 0, 0, 1, NULL, NULL, NULL, NULL, 'HCFA|UB|', '1114912102', 0, 'n', 0, '2008-11-18', NULL, NULL, 0, 0, NULL, NULL),
('820486458', 'W11015528', 'W11015528', 'ID01', 'Adult Adolescent & Children Counseling Center', 'Christine', '', 'Wilson', 'LCPC LMFT', 'Mental Health', 'Counseling', 'Marriage & Family Therapy', NULL, 'O', '3318 N Cole Rd', 'Boise', 'Ada', 'ID', '83704', '2083752730', NULL, '3318 N Cole Rd', 'Boise', 'Ada', 'ID', '83704', '2083752730', '', 'IDMA', NULL, NULL, '0.00', '35.00', '0.00', 3, '2008-11-13', '2013-02-14', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1710002746', 0, 'y', 0, '2011-12-13', NULL, NULL, 0, 0, NULL, NULL),
('331078261', 'W11015482', 'W11015482', 'ID01', 'Saint Alphonsus Physicians PA', 'Laura', 'A', 'Morton', 'NP-C', 'Cardiology', 'Nurse Practitioner', '', NULL, 'B', '6140 W Curtisian Ste 200', 'Boise', 'Ada', 'ID', '83704', '2083674278', '2083675200', '6140 W Curtisian Ste 200', 'Boise', 'Ada', 'ID', '83704', '2083674278', '2083675200', 'IDSAMG1', NULL, '', '0.00', '10.00', '0.00', 3, '2008-11-17', '2012-08-19', 0, 0, 0, 'Saint Alphonsus Medical Center Nampa', '', '', '', 'HCFA|UB|', '1477597573', 0, 'Y', 0, '2014-07-09', NULL, NULL, 43.6151, -116.256, NULL, NULL),
('820477852', 'W11015478', 'W11015478', 'ID01', 'Saint Alphonsus Medical Group Emerald Family Medicine', 'Ignacio', '', 'Campa-Garcia', 'PA-C', 'Physician Assistant', '', '', NULL, 'O', '6533 Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083674170', '2083678135', '6533 Emerald St', 'Boise', 'Ada', 'ID', '83704', '2083674170', '2083678135', 'IDSAMG2', '', '', '0.00', '10.00', '0.00', 6, '2008-11-17', '2012-03-29', 0, 0, 0, '', '', '', '', 'HCFA|UB|', '1265478648', 0, 'N', 0, '2014-01-23', NULL, NULL, 43.6119, -116.268, NULL, NULL),
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